EL-16-647 Inspection Worksheet
Miami Shores Village
10050 N.E.2nd Avenue Miami Shores, FL
Phone: (305)795-2204 Fax: (305)756-8972
nspection Number: INSP-255015 Permit Number: EL-3-16-647
Inspection Date: March 18,2016 Permit Type: Electrical- Residential
Inspector: Devaney, Michael Inspection Type: Final
Owner: , Work Classification: Low Voltage
Job Address:1151 NE 99 Street
Miami Shores, FL 33138- Phone Number (786)253-2869
Parcel Number 1132050180070
Project: <NONE>
Contractor: SOUTH DOM ELECTRIC INC Phone: (305)626-5904
Building Department Comments
LOW VOLTAGE Infractio Passed Comments
INSPECTOR COMMENTS False
FT1 Inspector Comments
Passed
Failed
Correction
Needed
Re-Inspection
Fee
No Additional Inspections can be scheduled until
re-inspection fee is paid
For Inspections please call: (305)762-4949
March 18,2016 Page 1 of 1
a 7 { 3
Miami Shores Village
10050 N.E.2nd Avenue NE
Miami Shores,FL 33138-0000 y yY
Phone: (305)795-2204 ,
Expiration: 0911 201
Project Address Parcel Number Applicant
1151 NE 99 Street 1132050180070
Miami Shores, FL 33138- Block: Lot: Shima VII LLC
Owner Information Address Phone Cell
Shima VII LLC 1235 NE 100 Street (786)253-2869 (305)796-4922
Miami Shores FL
1235 NE 100 Street
Miami Shores FL
Contractor(s) Phone Cell Phone Valuation: $ 150.00
SOUTH DOM ELECTRIC INC (305)626-5904
Total Sq Feet: 00
Type of Work: Available Inspections:
Additional Info: Inspection Type:
Classification:Residential
Review Electrical
Scanning:1
Fees Due Amount Pay Date Pay Type Amt Paid Amt Due
CCF $0.60 Invoice# EL-3-16-58985
DBPR Fee $2.00 03/11/2016 Credit Card $50.00 $63.60
DCA Fee $2.00
Education Surcharge $0.20 03/18/2016 Credit Card $63.60 $0.00
Notary Fee $5.00
Permit Fee-Additions/Alterations $100.00
Scanning Fee $3.00
Technology Fee $0.80
Total: $113.60
In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations
pertaining thereto and in strict conformity with the plans,drawings,statements or specifications submitted to the proper authorities of Miami Shores Village. In
accepting this permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are
required for ELECTRICAL,PLUMBING,MECHANICAL,WINDOWS,DOORS,ROOFING and SWIMMING POOL work.
OWNERS AFFIDAVIT..I that al a foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating
construction and zonin e re,I orize the above-named contractor to do the work stated.
March 18,2016
Authorized Signature:Owner / Applicant / Contractor / Agent Date
Building Department Copy
March 18,2016 1
Miami Shores Village i1: :
Building Department aaA� 10t�
10050 N.E.2nd Avenue,Miami Shores,Florida 33138
Tel:(305)795-2204 Fax:(305)756-8972
INSPECTION LINE PHONE NUMBER:(305)762-4949
FBC 20 ��, jj
BUILDING Master Permit NoY C j�-- 2 )Lb
PERMIT APPLICATION Sub Permit No _ ".
❑BUILDING WELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
❑PLUMBING ❑ MECHANICAL F-1 PUBLIC WORKS ❑ CHANGE OF [:]CANCELLATION ❑ SHOP
j CONTRACTOR DRAWINGS
JOB ADDRESS: / 157/
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#: Is the Building Historically Designated:Yes -NO ��
Occupancy Type: Load: cc Construction Type:_Flood Zone: BFE: FFE:
OWNER:Name(Fee Simple Titleholder): Poe#:
Address: �A�-Y�.,P A-A®� »
City: State: Zip:
Tenant/Lessee Name: // Phone#:
L.3 SCS S Gam_ 7A Onz
CONTRACTOR:Company Name: SO UM b0/`'H i IIJC Phone#: 912 * yVS % ?>C
Address q Z 5
City: State: Ez Zip:
Qualifier Name: Phone#: '�f �e S �/
State Certification or Registration M [ter,/.3Certificate of Competency#:
DESIGNER:Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for this Permit:$ ®r7 Square/linear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace ❑ Demolition
Description of Work:
CV ® G G
� pill 2/7) Z—:7X r S 7%`4 SLG d
Specify color of color thru tile: �� 0-.-w--";7
Submittal Fee$ ��` Permit Fee$ CCF$ 6 CO/CC$ d�
Scanning Fee$ Radon Fee$ DBPR$ CIO Notary$,ro •fes)
Technology Fee$ Training/Education Fee$ Double Fee$
Structural Reviews$ Bond$ nn
TOTAL FEE NOW DUE$ •�l
(Revised02/24/2014)
Bonding Company's Namp(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
YE30R-NMC- -QU0MMENCEMENT."
Nptiette 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 approv spection fee will be charged.
rwe&Signature Signature dd
OWN or AGEN U CONTRACTOR
The foregoing instrument was ac nowledged before/m'a this The foregoing instrument was acknowledged before me this
_day of 20 �f� ,by day of J to 20 16 .by
UJ SS whois rsonally know to ,C /�/il`� ,who is personally known to
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:
Si n:
Print: Print•
Seal: Notary Public State of Florida Seal:
X4`0 ; Joanna M Fef►ciano
Commission FF 082753 ;o.%Oy 1%, Notary Public State of Florida
��o� F-Pireso"'1120t8 Joanna M Feliciano
My Commission FF 082753
APPROVED BY /2 Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)