EL-16-2899 . . s
Inspection Worksheet
Miami Shores Village j _
10050 N.E.2nd Avenue Miami Shores, FL
Phone: (305)795-2204 Fax: (305)756-8972
Inspection Number: INSP-272159 Permit Number: EL-10-16-2899
Scheduled Inspection Date: December 01,2016 Permit Type: Electrical - Residntial
Inspector: Devaney, Michael Inspection Type: Rgh
Owner: SWAN, ROBERTA Work Classification: Alteration
Job Address: 1700 NE 105 Street 111
Miami Shores, FL Phone Number (305)893-4535
Parcel Number 1122300500110
Project: <NONE>
Contractor: MOODY ELECTRIC INC Phone: (305)758-2000
Building Department Comments
FINISH AND INSTALL NEW LIGHT POLE IN PLACE OF Infractio Passed comments
ONE KNOCKED DOWN ONE. SAME CONDUCT AND INSPECTOR COMMENTS False
WIRING 1 FIXTURE 250
Inspector Co
Passed [E�
Failed
Correction a
Needed
Re-Inspection
Fee
No Additional Inspections can be scheduled until
re-inspection fee is paid.
November 30,2016 For Inspections please call: (305)762-4949 Page 30 of 33
Perrli N�.,� 10-16- P899
Miami Shores Village Plormif 7� e El trldal-Residential
10050 N.E.2nd Avenue NE
p� e' r it
Work Cls fllc. l rl�Alto
ration
Miami Shores,FL 33138-0000 P P ►mf° taPus:APPROVED
Phone: (305)795 2204
�'CORiDP'
Issue bate:111119120% .F Expiration: 05/08/2017
Project Address Parcel Number Applicant
1700 NE 105 Street Number: 111 1122300500110
Miami Shores, FL Block: Lot: ROBERTA SWAN
Owner Information Address Phone Cell
ROBERTA SWAN 1700 NE 105 CT#111 (305)893-4535
MIAMI SHORES FL 33138
Contractor(s) Phone Cell Phone Valuation: $3,200.00
MOODY ELECTRIC INC (305)758-2000
Total Sq Feet: 0
Type of Work:FINISH AND INSTALL NEW LIGHT POLE I Available Inspections:
Additional Info: Inspection Type:
Classification:Residential Review Electrical
Scanning:3
Fees Due Amount Pay Date Pay Type Amt Paid Amt Due
CCF $2.40
DBPR Fee Invoice# EL-10-16-61777
$2.25 11/09/2016 Credit Card $ 119.90 $50.00
DCA Fee $2.25
Education Surcharge $0.80 10/25/2016 Credit Card $50.00 $0.00
Permit Fee-Additions/Alterations $150.00
Scanning Fee $9.00
Technology Fee $3.20
Total: $169.90
In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations
pertaining thereto and in strict conformity with the plans,drawings,statements or specifications submitted to the proper authorities of Miami Shores Village. In
accepting this permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are
required for ELECTRICAL,PLUMBING,MECHANICAL,WINDOWS,DOORS,ROOFING and SWIMMING POOL work.
OWNERS AFFIDAVIT: I ce at all a foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating
construction and zonin he re,I thorize the pKovsmamed contractor to do the work stated.
November 09, 2016
Authorized Signature:Owner / Appli it
/ Contractor / Agent Date
Building Department Copy
November 09,2016 1
R�QEIVL®
Miami Shores village OPT 2
Building Department
�V p �
10050 N.E.2nd Avenue,Miami Shores,Florida 33138
Tel: (305)795.2204 Fax: (305)756.8972
INSPECTION'S PHONE NUMBER:(305)762.4949
BUILDING Permit No.
PERMIT APPLICATION Master Permit No. ( !o-28�C1
FBC 20
Permit Type: Electrical
OWNER:Name(Fee Simple Tit eholder): Phone#: c 877 1
Address:
City: State: Zip:
Tenant/LesseerName:. Phone#:
Email:
JOB ADDRESS: /Z®r Aloe 'le)S ��N I��I�I `
City: Miami Shores County: Miami Dade Zip: 331 1
Folio/Parcel#:
Is the Building Historically Designated:Yes NO�� Flood Zone: ^�
CONTRACTOR: Company Name: P A)e Phone#: 575�F? �
Address:
�c
City: L'��� State: Zip:
p--
Qualifier Name: Phone#:
State Certification or Registration#:® Certe of Competency#:
Contact Phone#: �� 7�Q ° Email Address: jQA
DESIGNER: Architect/Engineer: Phone#:
Value of Work for this Permit:$ ®' ®� Square/Linear Footage of Work:
Type of Work: ❑Address DAlteration ❑New ❑Repair/Replace ODemolition
Description of Work:
YAJ - 410-44 1J-X- Cq7xV-
xxxx�x�x:xxxxx����xx����x����x�������xxxFeesxxx�xxxx���x:x�� xxx�xx��xax�xx�xxxxxxxxxxx�
Submittal Fee$ 00 Permit Fee$ 4f-el-e 1--' CCF$ L• /d CO/Ccs
dr® Radon Fee$ Z . 2 S DBPR$ 2• Z.�J ,Bond$
Scanning Fee$ C?.
Notary$ Y-e Training/Education Fee$ o 18 C1561 Technology Fee$ 3 a 2 f
Double Fee$ St uctural Review$ +
TOTAL FEE NOW DUE$ I I 01 00,
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 $2500, the applicant must
promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person
whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site
for the first inspection which occurs seven (7) days after the building pennit is issued. In the absence of such posted notice, the
inspection will not be approved and a reinspection fee will be charged.
Signature Signature
Owner or Age ,p Contractor h
The foregoing instrument was ac owledged before me this 9 L0 The foregoing instrument was acknowledged before me this
day of�40&,by ®✓6/ ,CC Cl day of 0�'t(J ,20 Lam,by�7ohn J , mood( ,
who is personally known to me who is personally known to me or who has produced
as identification and who did take an oath.
NOTARY PUBLIC: NOTARY PUBLIq:
- 2 i
Sign: Ck- Sign:
Print:
ATP 1 L(A 8+0 ID 65 Print:
My Commission Expir My Commissio I S.
4yiv vy0o, a Notary Public State of RofWa PATRICIA A. STUBBS �' % Rebeca Munoz
S�11
MY COMMISSION#EE 385191 4o�'e EJypires09108/2019Commission FF 918344
k� x ,xxxx,x,xxxx,xxx
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Flo W0J,Jt..,yBcrvice.com
APPROVED BY L T$d��I� Plans Examiner Zoning
Structural Review Clerk
(Revised 07/10/07)(Revised 06/10/2009)(Revised 3/15/09)
STANDARD 1 POLE • ' •
O BOX 24
2 3/8" TENON MCGAHEYSVILLE VA 22840
/0 - 770
PURCHASE ORDER#JOB NAME�S
POLE
SPECIFICATIONS
FILAMENT WOUND SECTIONAL
• ROVING
SHAFT
CONSISTING OF
WOUND IN •
COMBINED WITH • . . .
4444.. .
DEFLECTION AND SHEAR. POLE FINISH-1441 0 TO 1.5
MIL THICK POLYESTER FINISHING RESI
DIRECT BURIAL POLE ASTM 4923 CM93-f
ABOVEDEFLECTION SHALL NOT EXCEED
HEIGHT @MAX WIND LOADING . , PA18' WEIGHT) DESIGN CRITERIA X , . ,
90
MOUNTING HEIGHT ANSI Cl 36.20-1990 WITH A MIN SAFETI FACTUR',
OF 1
SHAFT LENGTH
REC - ED
OCT 2 5 2016
. ABOVE GROUND LINE
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