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EL-15-2739 Inspection Worksheet Miami Shores Village 10050 N.E.2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-253878 Permit Number: EL-10-15-2739 Scheduled Inspection Date: March 03,2016 Permit Type: Electrical - Residential Inspector: Devaney, Michael Inspection Type: Final Owner: MUSTAD, KRISTEN Work Classification: Low Voltage Job Address: 1260 NE 94 Street Miami Shores, FL 33138- Phone Number (305)661-6633 Parcel Number 1132050100180 Project: <NONE> Contractor: 50 STATE SECURITY SERVICE INC Phone: 305-893-7766 Building Department Comments SECURITY SYSTEM (ALARMS) Infractio Passed Comments INSPECTOR COMMENTS False Inspec ents Passed Failed Correction Needed Re-Inspection ❑ Fee No Additional Inspections can be scheduled until re-inspection fee is paid March 02,2016 For Inspections please call: (305)762-4949 Page 41 of 44 �1� 'tf� �s+N y Miami Shores Village ParM # T� El r1 1-Re dental 10050 N.E.2nd Avenue NEP Work esWatiow Low Voltage �.. Miami Shores,FL 33138-0000 PBttta 1§fa>410 :APpIStEl3 Phone: (305)795-2204r issueDate 'i1fq*0 : Expiration: 05/02/2016 Project Address Parcel Number Applicant 1260 NE 94 Street 1132050100180 Miami Shores, FL 33138- Block: Lot: KRISTEN MUSTAD Owner Information Address Phone Cell KRISTEN MUSTAD 1260 NE 94 Street (305)661-6633 MIAMI SHORES FL 33138- 1260 NE 94 Street MIAMI SHORES FL 33138- Contractor(s) Phone Cell Phone Valuation: $ 2,700.00 50 STATE SECURITY SERVICE INC 305-893-7766 _ Total Sq Feet: 0 Type of Work:SECURITY SYSTEM(ALARMS) Available Inspections: Additional Info: Inspection Type: Classification:Residential Review Electrical Scanning: 1 Fees Due Amount Pay Date Pay Type Amt Paid Amt Due CCF $1.80 Invoice# EL-10-15-57574 DBPR Fee $2.25 11/04/2015 Credit Card $ 112.30 $50.00 DCA Fee $2.25 Education Surcharge $0.80 10/27/2015 Credit Card $50.00 $0.00 Permit Fee-Additions/Alterations $150.00 Scanning Fee $3.00 Technology Fee $2.40 Total: $162.30 In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations pertaining thereto and in strict conformity with the plans,drawings,statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are required for ELECTRICAL,PLUMBING,MECHANICAL,WINDOWS,DOORS,ROOFING and SWIMMING POOL work. OWNERS AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. Futhermore,I authorize the above-named tract r to do the work stated. November 04, 2015 Authorized Signature:Owner / Applicant / ntractor / Agent ate Building Department Copy November 04,2015 1 w Miami Shores e Villa g Building Department 0CT/ 2095 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 Tel:(305)795-2204 Fax:(305)756-8972 INSPECTION LINE PHONE NUMBER:(305)762-4949 S� FBC 201 14 BUILDING Master Permit No. 9C. - la - I q J PERMIT APPLICATION Sub Permit No. Eu s - 2. 39 ❑BUILDING 'z ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP f� }� a/�z/ CONTRACTOR DRAWINGS JOB ADDRESS: �(/ /V• City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: Is the Building Historically Designated:Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER:Name(FeeSimple Titleholder): /_ l�T6_1\1 M UST^ Phone#: 43i - 16 ivy Address: 06o � �C • [Z �Y/L�� ? -t City: mi 4-4.", State: u�(b4 Zip: c� J f 179 Tenant/Lessee Name: Phone#: Email: �-- CONTRACTOR: 9Company Name: �/i9�T� � Cu�n� Phone#: /- Address: //J Al L 42S_':"` City: /V• ltil14zC U' State: /'C Zips Qualifier Name: � 1V ;C��UT61Ll� Phone#: r State Certification or Registration#: i—zomn Certificate of Competency#: DESIGNER:Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit:$ �j TWA` Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration ❑ New Repair/Replace ❑ Demolition Description of Work: �f L g l -r Specify color of color thru tile: Submittal Fee$rpo 1(k� Permit Fee$ CCF$ CO/CC$ Scanning Fee$ Radon Fee$ DBPR$ Notary$ Technology Fee$ Training/Education Fee$ Double Fee$ Structural Reviews$ Bond$ 11 TOTAL FEE NOW DUE$ 1�' ",Z) (Revised02/24/2014) ' t Bonding Company's Name(if applicable) Bonding Company's Address City State Zip Mortgage Lender's Name(if applicable) Mortgage Lender's Address City State Zip Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRIC, PLUMBING, SIGNS, POOLS, FURNACES, BOILERS,HEATERS,TANKS,AIR CONDITIONERS,ETC..... OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. "WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT." Notice to Applicant: As a condition to the issuance of a building permit with an estimated value exceeding$2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also,a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. Signature Signature OW ER or AGEN CONTRACTOR The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this day of cT 04L ,20 r �P , by 3Q``t'�day of �� Ot&k ,20 l� ,by 4R ki J �_ who is ersonally kno to � [�E�U 14AA-X -t A— ,who i ersonally kno o me or'who has produced as me or who has produced as identification and who did take an oath. identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: —rrtl .L� Sign: AQeSign: Print: It PFA G Print: G Seal: =r; « Notary Public-State of Florida Seal: • • MY Comm.Expires Jurr 13,2017 q. °or Commission.#FF 013940 r''" _. KEVIN MICHAEL LOWE Banded Through National Notary Assn. '': •'c MY COMMISSION*FF239123 nru"a ************ ********* ** * * ************ ****gt( 4wwNP290** ** ******* �4a/ aY8.0'09 FbndeN rotoa.ean APPROVED BY /,�i Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014)