EL-16-1549 Inspection Worksheet
Miami Shores Village
10050 N.E.2nd Avenue Miami Shores, FL
Phone: (305)795-2204 Fax: (305)756-8972 esuis"rof�I AL a
C
Inspection Number: INSP-266204 Permit Number: EL-6-16-1549
Scheduled Inspection Date:August 29,2016 Permit Type: Electrical- Residential
Inspector: Devaney, Michael Inspection Type: Final
Owner: STANDAERT, NATACHA Work Classification: Service Change
Job Address:576 NE 97 Street
Miami Shores, FL 33138- Phone Number (646)460-6061
Parcel Number 1132060171510
Project: <NONE>
Contractor: SUNSHINE ELECTRICAL CONTRACTORS CO Phone: (305)268-4958
Building Department Comments
REVISION TO RISER DIAGRAM Infractio Passed Comments
INSPECTOR COMMENTS False
NEW UNDERGROUND SERVICE
Inspector Comments
Passed
Failed
Correction
Needed
Re-Inspection ❑
Fee
No Additional Inspections can be scheduled until
re-inspection fee is paid.
August 26,2016 For Inspections please call: (305)762-4949 Page 35 of 38
Miami Shores Village
N
Building Department JUN 03 2016
10050 N.E.2nd Avenue,Miami Shores,Florida 33138
Tel:(305)795-2204 Fax:(305)756-8972 BY:
INSPECTION LINE PHONE NUMBER:(30S)762-4949 S
FBC 20I`{
BUILDING Master Permit No.-F':>PF1 4(0(D
PERMIT APPLICATION Sub Permit No.- E-1- 1 -- I H
❑BUILDING M ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION [-]RENEWAL
❑PLUMBING ❑MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: 576 NE 97 Street
City: Miami Shores County: Miami Dade rp:
Folio/Parcel#: Is the Building Historically Designated:Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER:Name(Fee Simple Titleholder):Natacha Standaert Phone#:646 460-6061
Address:576 NE 97 Street
City: Miami Shores State: FI Zip: 33138
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR:Company Name:
�r�rJ �i`J� P Phone#: 7dv's�3�' �a
Address: 7� U� ���c 9 �� G/
City: Stat Zip: 3 3 J
Qualifier Name: 3 Phone#:
State Certification or Registration#: < 7--Certificate of Competency#:
DESIGNER:Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for this Permit-$ oo• Li-,> Square/Unear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace ❑ Demolition
Description of Work:
Specify color of color thru tile:
Submittal Fee$ Permit Fee$ lg;; , VO CCF$ 0. CO/CC$
Scanning Fee$ o® � ' Radon Fee$ '!�— DBPR$ —7° Notary$
Technology Fee$ a Training/Education Fee$ Q - ?,0 Double Fee$
Structural Reviews$ Bond$
TOTAL FEE NOW DUE$
(Revised02/24/2014)
v
s
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 d copy of the recorded notice of commencement must be posted at the job site
for the first inspection which oc seven s after the building permit is issued. In the absence of such posted notice, the
Inspection will not be approve d a rei p on fee will be charged.
Signature Signature
WNER or AGENT CONTRACTOR
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
A� day ofJ y' �' 20 ,by day of oc 20 h ,by
EW,2 o is personally known to !.4-e/.4 A1,0 ��� ,' i� oally 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:
Sign: �� c" '� Sign: 4 06
Print: "�� �; 'Y' P''•• '�� Print:
iNotary ruinic-bane OT morm
;IPRv pVb
Seal: `?: •z My Comm.Expires Jun 27,2016 Seal: :'r°. .`��: Notary PubliC-State of Florida
Commisslon#EE 212106 :•_My Comm.Expires Jun 27,2016
°� °P, Bonded Through Il�loael Notary Assn. '.;�, p= Commission#r EE 212108
�'' �°.�°`' Bonded Through Natlonal Notary Assn.
APPROVED BY� ��?COit1/�� Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)