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EL-16-2199 (2) Inspection Worksheet Miami Shores Village 10050 N.E.2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-264800 Permit Number: EL-8-16-2199 Scheduled Inspection Date: August 15,2016 Permit Type: Electrical - Residential Inspector: Devaney, Michael Inspection Type: Final Owner: ANNA MUELLER GIESBERS, HELMUT Work Classification: Repair ""N 1 Co Job Address:1131 NE 104 Street Miami Shores, FL 33138-2657 Phone Number (305)600-9070 Parcel Number 1122320290030 Project: <NONE> Contractor: LONGMAN ELECTRIC INC Phone: (305)758-1211 Building Department Comments SERVICE REPAIR Infractio Passed Comments INSPECTOR COMMENTS False Inspector Comments Passed Failed Correction Needed 41 /," /,07 Re-Inspection ❑ Fee No Additional Inspections can be scheduled until re-inspection fee is paid. August 12,2016 For Inspections please call: (305)762-4949 Page 18 of 36 £k 3 Miami Shores Village {` 1� � E �Isidrttial 10050 N.E.2nd Avenue NE � c F � � ca Miami Shores,FL 33138-0000 h— � Phone: (305)795-2204 k Expiration: 02/08/2017 p� Project Address Parcel Number Applicant 1131 NE 104 Street 1122320290030 HELMUT MUELLER ANNA MUEL Miami Shores, FL 33138-2657 Block: Lot: Owner Information Address Phone Cell HELMUT MUELLER ANNA MUELLER 1131 NE 104 Street (305)600-9070 -•------ MIAMI SHORES FL 33138-2657 1131 NE 104 Street MIAMI SHORES FL 33138-2657 Contractor(s) Phone Cell Phone Valuation: $ 1,000.00 i LONGMAN ELECTRIC INC (305)758-1211 Total Sq Feet: 0 Type of Work:SERVICE REPAIR Available Inspections: Additional Info: Inspection Type: Classification:Residential Final Scanning:3 Review Electrical Fees Due Amount Pay Date Pay Type Amt Paid Amt Due CCF $0.60 Invoice# EL-8-16-60872 DBPR Fee $2.25 DCA Fee $2.25 08/04/2016 Credit Card $50.00 $115.10 Education Surcharge $0.20 08/12/2016 Credit Card $ 115.10 $0.00 Permit Fee-Additions/Alterations $150.00 Scanning Fee $9.00 Technology Fee $0.80 Total: $165.10 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 accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. Futhermore,I authorize the above-named contrpctor to do the work stated. / Aug'st 12, 2016 Authorized Signature:Owner / Applicant / C " tractor / Agent ate Building Department Copy August 12,2016 1 Miami Shores Village rv,F-T ° Building Department _ Q G 0 4 2016 ^z �' 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 BY: Y Tel: (305)795.2204 Fax: (305)756.8972 _ ---- INSPECTION'S PHONE NUMBER: (305)762.4949 FBC 201 BUILDING Permit No. PERMIT APPLICATION Master Permit No.F1 ( G- `2 ( C19 Permit Type:Electrical JOB ADDRESS: I I AO1L � �Ll City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: Is the Building Historically Designated:Yes NO Flood Zone: OWNER:Name(Fee Simple Titleholder): Helmut Mueller Phone#:7735178357 Address: 1131 NE 104th street City: miami shores State: Florida Zip: 33138 Tenant/Lessee Name: Phone#: Email: 1 CONTRACTOR:Company Name: L©n om 04 1� �1 �G Phone#:_#3 e 5, Address: � � "!05/— city: a State: - Zip:._�l 1 Qualifier Name: L`r g P r -*31 Sy Phone#1: State Certification or Registration#: FF C. 1 �[�B 3 '2` 3 Certificate of Competency#:I Contact Phone#: Email Address: DESIGNER: Architect/Engineer: Phone#: Value of Work for this Permit:$1000.00 Square/Linear Footage of Work: Type of Work: ❑Address ❑99Alteration ❑New �Mepair/Replace ODemolition Description of Work: �,�✓�iY�� G/� V��- x�xxx:xxx:x��.xx��x�=xxux��x:x:xxm�:mx:xxFees�x��:xmxxxx�xxx��:��xx�x��x��xx�x��xxxxx�� Submittal Fee$ ��° Permit Fee$ CCF$ CO/CC$ Scanning Fee$ Radon Fee$ DBPR$ Bond$ Notary$ Training/Education Fee$ Technology Fee$ Double Fee$ Structural Review$ TOTAL FEE NOW D E$ 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 ELECTRICAL WORK, PLUMBING, SIGNS, WELLS,POOLS,FURNACES,BOILERS,HEATERS,TANKS and 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-,�-14� Signature Owner or Agent Contractor The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this, day of -0 X,by ht rj l- day of J A-,20��p,,by ALre „�• who is personally known to me or who has produced D. L who is personally known to me or who has produced jql�.//�6-*3 3&4 (p[OAs identification and who did take an oath. as identification and who did take an oath. I NOTARY PUBLIC: NOTARY PUBLIC: Sign: Sign: Print: 11 a I Print: $ ° Notary i P Stzate of Flo C 41 My commission FF UUUJZI My Commis s:�y�arrtrn{s My � apgt4/08/201 Y xxx��xxxuss�xa�xxx��m�xmx�xxm�m�xxxs<x��as<�xs<mmxxxx��x�xu��x��muxxa�x�umxmxxxxxxss�xx��m��uxs¢��xm�>kx��>kx APPROVED BYPlans Examiner Zoning Structural Review Clerk (Revised 3/12/2012)(Revised 07/10/07)(Revised 06/10/2009)(Revised 3/15/09)