EL-15-2942 Inspection Worksheet
Miami Shores Village
10050 N.E.2nd Avenue Miami Shores,FL
Phone: (305)795-2204 Fax: (305)756-8972
Inspection Number: INSP-256826 PermitNumber: EL-11-15-2942
Scheduled Inspection Date: April 14,2016 Permit Type: Electrical- Residential
Inspector: Devaney, Michael
Inspection Type: Final
Owner: GUILLEN,KRISTINA Work Classification: Alteration
Job Address:1298 NE 104 Street
Miami Shores, FL 33138- Phone Number
Parcel Number 1122320300100
Project: <NONE>
Contractor: AAA ON TIME ELECTRIC INC Phone: (786)295-1748
Building Department Comments
WIRING FOR KITCHEN AND BATHROOMS Infractio Passed Comments
INSPECTOR COMMENTS False
Inspector Comments
Passed FCT
Failed
Correction ❑
Needed
Re-Inspection
Fee
No Additional Inspections can be scheduled until
re-inspection fee is paid
Apra 13,2016 For Inspections please call: (305)762-4949 Page 21 of 29
Miami Shores Village
10050 N.E.2nd Avenue NE
Miami Shores,FL 33138-0000 rtW
Phone: (305)795-2204 j
11 ., .<..
3 Expiration: 0513112016
Project Address Parcel Number Applicant
1298 NE 104 Street 1122320300100
Miami Shores, FL 33138- Block: Lot: KRISTINA GUILLEN
Owner Information Address Phone Cell
KRISTINA GUILLEN 1298 NE 104 Street
MIAMI SHORES FL 33138-
1298 NE 104 Street
MIAMI SHORES FL 33138-
Contractor(s) Phone Cell Phone $ 2,000.00
AAA ON TIME ELECTRIC INC (786)295-1748 Valuation:
Total Sq Feet: 00
Type of Work:WIRING FOR KITCHEN AND BATHROOMS Available Inspections:
Additional Info: Inspection Type:
Classification:Residential
Scanning:3 Review Electrical
Fees Due Amount Pay Date Pay Type Amt Paid Amt Due
CCF $1.20
DBPR Fee $3.38 InvoiC@# EL-1415-57845
DCA Fee $3.38 11/23/2015 Credit Card $50.00 $193.96
Education Surcharge $0.40 12/03/2015 Check*5047 $193.96 $0.00
Permit Fee-Additions/Alterations $225.00
Scanning Fee $9.00
Technology Fee $1.80
Total: $243.96
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 Khe2rmore,
that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating
construction and zonin I authorize the above-named contractor to do the work stated.
December 03,2015
Authoriz ture:Owner / Applicant / Contractor / Agent Date
Building De artment Copy
December 03,2015 1
Miami Shores Village
NOV $3 2015
Building Department
10050 N.E.2nd Avenue,Miami Shores,Florida 33138 BY.
Tel:(305)795-2204 Fax:(305)756-8972
INSPECTION LINE PHONE NUMBER:(305)762-4949
FBC 20 /�/ Jdk
BUILDING Master Permit No. KC-9 -/S-2-q-7
PERMIT APPLICATION Sub Permit No. a
❑BUILDING 5Z/ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
❑PLUMBING ❑ MECHANICAL [:]PUBLICWORKS ❑ CHANGE OF ❑CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: 1298 NE 104 STREET
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#:11-2232-030-0100 is the Building Historically Designated:Yes NO X
Occupancy Type: Load: Construction Type: Flood Zone: NO BFE: FFE:
OWNER:Name(Fee Simple Titleholder):KRISTINA GUILLEN Phone#:305-975-1070
Address:1298 NE 104 STREET
city. MIAMI SHORES State: FL Zip: 33138
Tenant/Lessee Name: NOT APPLICABLE Phone#:N/A
Email: KRISTIGUILLEN@GMAIL.COM art
CONTRA7;company Name: TVNOP i ��eC I �� Phone#:� "{D-�9 1��Address: l 7'ifa�c City: ' State: Zip: 3 J
Qualifier Name: 1 F-ft'/ ZdN+A Phone#:
State Certification or Registration#: C (/s Certificate of Competency#:
DESIGNER:Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for this Permit:$ ,�--,, Q66-
66• o 6 Square/Linear Footage of Work:
Type of Work: ❑ Addition EU/�Alteration ❑ New ❑ Repair/Replace ❑ Demolition
Description of Work: 14.1 /.fit./✓ ICI T-e P'--PJ )0 A69
Spec#f color'jDf.c�otor thru t1k
Subm6aTM6'$'" Permit Fee$ �S 40® CCF$ CO/CC$
Scanning Fee$ Radon Fee$ DBPR$ Notary$
Technology Fee$ Training/Education Fee$ Double Fee$
Structural Reviews$ Bond$
TOTAL FEE NOW DUE$
(Revised02/24/2014)
Bonding Company's Name(if applicable) NOT APPLICABLE
Bonding Company's Address
City State Zip
Mortgage Lender's Name(if applicable) SPACE COAST CREDIT UNION
Mortgage Lender's Address 15900 MIRAMAR PARKWAY
city MIRAMAR State FL Zip 33027
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 d a reinspection fee will be charged.
Signature Signature ./�
INNER or AGENT CONTRACTOR
The foregoin ' str emit was acknowledged before me this The foregoing instrument was ajckk wledged before me this
Zg` day of &2Rk:- ,20 l� by day of i� 20 by
Kri St(b 0'.,a L&I vho is personally known to s personally known to
mer who has produced as me or who has produced ✓ as
identification and who did take an oath. identificati n and who did take an oath.
NOTARY PUBLIC: NOTARY P BLIC:
G
JJ�
Sign Sign:
Print: Hae i 0- G'�[oaJ�,e�r-a,-,, Print: OS t c�
Seal: Seal: °f° �� FMridr
�vg"ups Notary Public Stele of Fbrida
Maria Carballelm My Ca mlasim PR 814315
My Commeaion EE131472 Egka 08/31/Z018
�} o ExpNes 12/14/2015
******rrrr****► '�*r r �► r r rrrrrrrrrrrrrrrrrrrr**rrr*****rr**oar**r**rrrrrrrrrrr**rrrrrr*+�
APPROVED BY �/4 �'3� !�Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)