EL-16-199 Inspection Worksheet
Miami Shores Village
10050 N.E.2nd Avenue Miami Shores,FL
Phone: (305)795-2204 Fax: (305)756-8972
Inspection Number: INSP-253668 Permit Number: EL-1-16-199
Scheduled Inspection Date: March 09,2016 Permit Type: Electrical- Residential
Inspector. Devaney,Michael
Inspection Type: Final
Owner. CATHERINE HABERMANN,GLENN Work Classification: Pool - Private
CADIZ
Job Address:164 NE 105 Street
Miami Shores,FL 33138-2033 Phone Number
Parcel Number 1121360130660
Project: <NONE>
Contractor. HAMILTON ELECTRIC Phone: (561)210-5263
Building Department Comments
RENEWAL OF EXPIRED PERMIT EL14-2665 Infraactio Passed Comments
INSPECTOR COMMENTS False
Inspector Comments
Passed CREATED AS REINSPECTION FOR INSP-253482 CREATED AS
REINSPECTION FOR INSP-251566. PERMIT IS LOCATED BY THE POOL
EQUIPMENT.Gates locked no access to pool equipement
26 feb 16
Failed ❑ Gates locked at 4:20 p. m..No access to pool equipement
Correction
Needed
Re-Inspection ❑
Fee
No Additional Inspections can be scheduled until
re-inspection fee is paid.
March 08,2016 For Inspections please call: (305)7624949 Page 27 of 43
41
h Miami Shores Village
10050 N.E.2nd Avenue NE
Miami Shores,FL 33138-0000OAK }
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Phone: (305)795-2204 .
Z
Expiration: 08/17/2016
Project Address Parcel Number Applicant
164 NE 105 Street 1121360130660
Miami Shores, FL 33138-2033 Block: Lot: GLENN FORD CATHERINE HABI
Owner information Address Phone Cell
GLENN FORD CATHERINE 164 NE 105 Street
•------- • MIAMI SHORES FL 33138-
164 NE 105 Street
MIAMI SHORES FL 33138-
Contractor(s) Phone Cell Phone Valuation: $ 900.00
HAMILTON ELECTRIC (561)210-5263
m- Total Sq Feet: 416
Type of Work:RENEWAL OF EXPIRED PERMIT EL14-2665 Available Inspections:
Additional Info: Inspection Type:
Classification:Residential Final
Scanning:1
Light Niche
Bonding
Review Electrical
Alarms
Fees Due Amount Pay Date Pay Type Amt Paid Amt Due
CCF $0.60
DBPR Fee $4.50 Invoice# EL-1-16.58442
DCA Fee $4.50 01/26/2016 Check*25406 $50.00 $263.60
Education Surcharge $0.20 02/19/2016 Check#:26101 $263.60 $0.00
Permit Fee-Additions/A iterations $300.00
Scanning Fee $3.00
Technology Fee $0.80
Total: $313.50
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 zo ' g. Futhermore,I authorize the above-named contractor to do the work stated.
February 19, 2016
Autho Signature:Owner / Applicant / Contractor / Agent Date
Building Department Copy
February 19,2016 1
Miami Shores Village ;SAN $,6 2016
Building Der artment BY: c7,Z
10050 N.E.2nd Avenue,Miami ;hores,Florida 33138
Tel:(305)795-2204 Fax:(305)756-8972
INSPECTION UNE PHONE NUR ISER:(305)7�, 2-4949
FBG 20,16)
BUILDING _
Master Permit No
PERMIT APPLICATION SOb Permit No. --
❑BUILDING ®ELECTRIC ❑ ROOFING ❑ REVISION ❑EXTENSION ®RENEWAL
❑PLUMBING ❑MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑CANCELLATION I❑SHOP
CCNTRACTOR DRAWINGS
JOB ADDRESS: 164 NE 105 Street
—Miami Shores county:
Folio/Parcel#:11-2136-013-0660 Is the B sliding Historically Designated:Yes_jNO X
Occupancy Type: Res load: Construction Type: New Flood Tone: BFE:_ ; FFE:
OWNER:Name(Fee Simple Titleholder):GLEN FORD&CATHERINE HABERMAN Phone#:305-$05-7104
Address:164 NE 105 STREET
City, MIAMI SHORES state: FL Zip: 3138
Tenant/Lessee Name: NSA Phone#:
Email: GLEN.FORD@BTINTERNET.COM
CONTRACTOR:Company Name: HAMILTON ELECTRIC phone#. 561- 10-5263 _
Address:2701 NE 27 CIRCLE
city: BOCA RATON State: FL Zip: 3 33
Qualifier Name: MARK HAMILTON Phone#: 561- 10-5263
State Certification or Registration#: EC 13006694 rtificate of competency#:
DESIGNER:Architect/Engineer: DAVID FAE MAN Phone#: 561-445-1787
Address:22171 WATERSIDE DRIVE city: BOCA RATON State: FL Zip: 33428
Value of Work for this Permit:$ 100.00 Squar Unear Foot
AS BU LT
,ge w work:
Type of Work: M Addition ❑ Alteration ❑ New ❑ ROpair/Replace Demolition
Description of work.. CLOSE PERMIT W orK C ,
Specify color of color thru tile:
.Submittal Fee S �� 6�) Permit Fee$- 1®e,op CF co/cc$
Scanning Fee$ 2 oz�' Radon Fee$ —Notary$ I�
Technology Fee$ Training/Education Fee$ 20 Double Fee$ j
Structural Reviews$ Bond$
TOTAL FEE NOW DUE$
(Revised02/24/2014)
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 reinspection fee will be charged.
F!
Signature Signature
OWN R or AGENT C NTRACTOR
The foregoing instrument was acknowledged before me this The foregoing instrumen was acknowledged before me this
22 day of JANUARY 20 16 by 22 day of JANUARY 2016 ,by
GLENN FORD ,who is personally known to MARK HAMILTON ,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 UBLIC: NOTARY PUB C:
Sign: Sign:
Print: E A MASKER Print: ALE A MASKER
Seal: DALE A.MASKER
. c �" i FF 236797 Seal: DALE A MASKER
``
Commission# r Commission#FF 236797
Expires June 6,2019 June 6,2019
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APPROVED BY Z�J`�-���Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)