EL-16-2391 Inspection Worksheet
Miami Shores Village WS W 16 -13
6
10050 N.E.2nd Avenue Miami Shores,FL
Phone: (305)795-2204 Fax: (305)756-8972
Inspection Number: INSP-267196 PermitNumber: EL-8-16-2391
Scheduled Inspection Date: September 14,2016 Permit Type: Electrical- Residential
Inspector: Devaney, Michael
Inspection Type: Final
Owner: CIGNO,NANCY Work Classification: Alteration
Job Address:1301 NE 100 Street
Miami Shores,FL 33138- Phone Number
Parcel Number 1132050140020
Project <NONE>
Contractor. LEWDI ELECTRIC Phone: 9541782-0006
Building Department Comments
INSTALL PEDESTAL WITH 30 AMP/20 AMP SHORE Infractio Passed Comments
POWER AND CONVENIENCE OUTLET. INSPECTOR COMMENTS False
Inspector Comments
Passed
Failed
Correction
Needed
Re-Inspection ❑
Fee
No Additional Inspections can be scheduled until
re-inspection fee is paid
September 13,2016 For Inspections please call: (305)762-4949 Page 37 of 44
Miami Shores Village
10050 N.E.2nd Avenue NE ,
w" Miami Shores,FL 33138-0000 ` � �
Phone: (305)795-2204
Expiration: 03/12!2017
Project Address Parcel Number Applicant
1'301 NE 100 Street 1132050140020
NANCY CIGNO
Miami Shores, FL 33138- Block: Lot:
Owner Information Address Phone Cell
NANCY CIGNO P.O.BOX 530188
MIAMI FL 33153-
Contractor(s) Phone Cell Phone Valuation: $ 900.00
LEWDI ELECTRIC 954/782-0006
_,m.:.. Total Sq Feet: 0
Type of Work:BOB'S PLUMBING CO,INC 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-8-16.61120
DBPR Fee $2.25 08/26/2016 Check#:23758 $50.00 $109.10
DCA Fee $2.25
Education Surcharge $0.20 09/13/2016 Check#:23774 $109.10 $0.00
Permit Fee-Additions/Aiterations $150.00
Scanning Fee $3.00
Technology Fee $0.80
Total: $159.10
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 a rate and that all work will be done in compliance with all applicable laws regulating
construction and zoning. Futhermore,I authorize the above-na n or to do the work stated.
September 13,2016
Authorized Signature:Owner / Applicant ntract r ! Agent Date
Building Department Copy
September 13,2016 1
Miami Shores Village c' A'�n
&G a2l ois,
Building Department Y
B
10050 N.E.2nd Avenue,Miami Shores,Florida 33138 7
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Tel:(305)795-2204 Fax:(305)756-8972 - 14
INSPECTION LINE PHONE NUMBER:(305)762-4949
FBC 20
BUILDING Master Permit N.)
PERMIT APPLICATION Sub Permit No. �
❑BUILDING IXELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
PLUMBING ❑ MECHANICAL PUBLIC WORKS [:] CHANGE OF F-1 CANCELLATION [:] SHOP
�� )) CONTRACTOR DRAWINGS
JOB ADDRESS: /3 o A/�! ! Oc) 5�'
City: Miami Shores County: Miami Dade Zip: *"3j l3 b
Folio/Parcel#: Is the Building Historically Designated:Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER:Name(Fee Simple Titleholder): ®`� 0�''�� Phone#:
Address: L `tlb-y,
City: State: Zip: X315
Tenant/Lesse.,e(�Name: ( Phone#:
Email: C iz)
CONTRACTOR:Company Name: 4 �-✓'�� �- Z4 e-'T-� �C Phone#:
Address: -A rrr YL C
City: n 2e Jw/ 9-e State: Al. Zip: 5_?O Lam_
Qualifier Name: Phone#:
State Certification or Registration#: 6C-/3 3 Certificate of Competency#:
DESIGNER:Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for this Permit:$ C4 i Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration [gNew ❑ Repair/Replace ❑ Demolition
Description of Work:':X:_-%-�
A,
Specify color of color thru tile:
Submittal Fee$ �p V Permit Fee$ /.�®��4 CCF$ 0 GG CO/CC$ 1(3'
Scanning Fee$ Radon Fee$ •`� DBPR$ 2 Notary$
Technology Fee$ ( Training/Education Fee$ 0' 2-C) Double Fee$
Structural Reviews$ Bond$
TOTAL FEE NOW DUE$ 1 • (0
(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 . not be approved and a reinspection fee will be charged.
Signature Signature_ o
O NER or AGENT CONTRACTOR
The foregoing instrument was acknowledged beforemethis The foregoing instrument was acknowledged before me this
O`r day of 46Y 20 �f� ,by L day of / 20 r .by
NA N @!! C�`(A o ft who is personally known to � SooA-A �- who is personally known to
me or who has produced f�Y °" f 1� �'� 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:
Sign Sign: G
Print: Print: f4 5'�
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APPROV Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)
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RICK SCOTT GOVERNOR KEN LAWSON,SECRETARY
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