DEMO-10-158Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
\ -(hav
Inspection Number: INSP- 163871 Permit Number: DEMO -2 -10 -158
Scheduled Inspection Date: August 30, 2011
Inspector: Devaney, Michael
Owner: KOTALIK, KENNY
Job Address: 950 NE 100 Street
Miami Shores, FL 33138-
Project: <NONE>
Contractor: FIVE STAR ELECTRIC SERVICE
Permit Type: Demolition
Inspection Type: Final
Work Classification: Electric
Phone Number
Parcel Number 1132060340200
Phone: (786)356 -0162
Building Department Comments
AS PER CONVERSATION WITH PL CONTRACTOR, OK
TO EXTEND THEM 60 DAYS. NB
Passed
Failed
Correction
Needed
Re- Inspection
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
Inspector Comments
c
69
August 29, 2011
For Inspections please call: (305)762 -4949
Page 21 of 22
Miami Shores Village
Building Department
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 APPLICATION
FBC 20
Permit Type: Electrical
OWNER: Name (Fee Simple Titleholder): Venn
Address. F LOQ
City: M karn'1
State:
MAR 2 4 2011
Permit No9fI O I 0 1%
Master Permit N
vo40 Phone :305 7c51 244-6
goo Nw (44 5+
PI zip: 331G78
Tenant/Lessee Name: Phone #:
Email:
JOB ADDRESS: q 50 NE 100 54-
City: Miami Shores County:
Folio/Parcel #: (1— 320G- O34 -020°
Is the Building Historically Designated: Yes
Miami Dade
Zip: 333 8
NO
Flood Zone:
CONTRACTOR: Com any Name: friOe `J y?. r d€L4T1'._ Set UtZe - T�Phone #C 3- Sg.-ag2_
Address: ♦ 9pL,. octo(I' ' Glen Ce {. e-
City: = �. State: Zip: .51-/-7 3
/���
Qualifier Name: 2tv2 n '1 von Actre t ex-% Phone #:
State Certification
r���Registration #: E 1300 a��3 Certificate of Com. -tency #:
Contact Phone #: '?ilOa. st -0147Z Email Address: 4 12'122 �' P i . earn
DESIGNER: Architect/Engineer: Phone #:
Value of Work for this Permit: $ t S 00 c" Square/Linear Footage of Work:
Type of Work: Address ❑Alteration ❑New ❑Repair/Replace
Description of Work: Q fled. eC. tY 1 C 0.1 Demo ll a n
£2rn,o -2- 10- 158
U emolition
Pere►t+
s kxk*ak*aks 4sk: ksk%ksk*:ksF-Ba:>::kka::i::d:4 $r.. *>k>dsazkkeR*pis :k***Fees *=R.k8asF8s$s *sk****. *r..::kxok>aokskek****K * : >;:ekxa;:aasksF*A'sak***
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 DUE $
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 lo the issuance of a building permit with an estimated value exceeding $2500, the applicant must
promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person
whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site
for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the
inspection will not be approved and a reinspection fee will be charged.
Signature w Signature
Owner or Agent
Contractor
The for 14UC1'22� oing itrument was ac wledged before me this / The for going i strument was acknowledged before this /
day of V I , by to Yl 14D 'i {� • , day of , 20 ! f , by �Iej
1( who is personally knot to me or who has prod ced 4 -C`! i -
As identification and who did take an oath. —* 412as identification and who did take an oath.
NOT Y1 UBLIC:
v�ho is personally known. to me or who has produced •
Si // / / %il
Print: ,e Y� % et I II4 .. V A. WERA
My Commissi a `� MY COMMISSION # DD753565
, 9 EXPIRES March 16, 2012
• Fh-1r.'_ ,1otaryS ^rm o.com
(407)398-01'3
NOT Y !' UBLIC:
Sign:
Print:
My Comi
Rriio
(407) 339.0955 F.1 ^.1_7 :1;AeryScr ice.com
MY COMMISSI
° )res:I=XPIRE . March 16, 2012
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1M %9$ . ***ill*ill*litfitf t****
APPROVED BY Plans Examiner Zoning
Structural Review Clerk
(Revised 07 /10 /07)(Revised 06 /I0/2009)(Revised 3/15/09)
Project Address
Miami Shores Village
10050 N.E. 2nd Avenue
Miami Shores, FL 33138 -0000
Phone: (305)795 -2204
Parcel Number
Expiration: 08/09/2010
Applicant
950 100 Street
Miami Shores, FL 33138-
Owner Information
Address
1132060340200
Block: Lot:
KENNY KOTALIK
Phone
Cell
KENNY KOTALIK
950 100 Street
MIAMI SHORES FL 33138 -2513
Contractor(s)
Phone Cell Phone
FIVE STAR ELECTRIC SERVICE (786)356 -0162 (786)356 -0162
Type of Demo: Electric
Additional Info: DEMOLITION
Classification: Residential
Fees Due
CCF
CCF
Education Surcharge
Education Surcharge
Permit Fee
Scanning Fee
Submittal Fee
Submittal Fee
Submittal Reversal Fee
Technology Fee
Technology Fee
Total:
Amount
$0.00
$1.20
$0.40
$0.00
$150.00
$3.00
$0.00
$50.00
($50.00)
$0.00
$1.60
$156.20
Invoice # Total Amt Paid Amt Due
EL -2 -10 -36942 $ 156.20 $ 10820 Et 0 01)
EL -2 -10 -36942 $ 156.20 $ 156.20 $ 0.00
Check #: 4917
For Inspections please call:
(305)762 -4949
Available Inspections:
Inspection Type:
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 contractor to do the work stated.
February 11, 2010
Authorized Signature: Owner / Applicant / Contractor / Agent
Building Department Copy
Date
February 11, 2010 1
Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
BUILDING
PERMIT APPLICATION
FBC 2004
Permit No.
@mamg7311
FEB 0 2 2010 gli
BY:..`
Master Permit No.DEiM0 `O -/0
Permit Type: Electrical {
Owner's Name (Fee Simple Titleholder) V-er1iN' VCr3'Cc i \ 1
Owner's Address 6) 00 N tll) 144- 54
Phone # P Si `l -1 C
City M OM l State
Zip 3316
Tenant/Lessee Name Phone #
E -MAIL: I
Job Address (where the work is being done) GI 50 NE 100 S T •
City Miami Shores Village County Miami -Dade Zip
FOLIO / PARCEL # AI- 320G-o 4- °ZOO
Is Building Historically Designated YES NO
Contractor's Company Name Y tj'2.- e612_
I L �e J'cc 3-r7C_ Phone #
Contractor's Address b !fl 1`1t3e.L J
City I ct agY\ Read-, State
Qualifier Name` an )h' n ALA c-e_(i'`
State Certificate,or Registration No. - �� �iQ Certificate of Competency No.
E -MAIL: C2 12 31n o(. r
Architect/Engineer's Name (if applicable) Phone #
7P-4J 35'6 1 1 t2
zip 33 q-7A
Phone # 7 76:)'3 -- z 1
Value of Work For this Permit $ 15 Cy(/
Square / Linear Footage Of Work:
Type of Work: ❑Addition ❑Alte`ratiion 1_ ['New ❑ Repair /Replace Demolition
escribe Work: Demo. (-Lc:tS-fe r pe (r+- if 01-10 - fo 0
ee.d -�t1
* * * * * ** * * * * * * * * *xxxxx x xx x xxxxxx *x * * * * ** Fees * * * * *x *x *xxxxxxxxxxxxxxxxxx xxxrxxxxxxxx * ** **
Submittal Fee $ ""(:)4 " Permit Fee $ j -re, 4°,%;') CCF $ - (20 CO CC
Notary $ Training/Education Fee $ '40 Technology Fee $ 1-
Scanning $V' o Radon $ DPBR $
Bond $
Code Enforcement $
Structural Review. $
Double Fee $
Zoning $
Total Fee Now Due $
See Reverse side -*
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
PAVING 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 S2500, 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 he posted at the job site
for the first inspection Which occurs seven I7) 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
wner or Agent
The foregoing instrument was acknowledged before me this
day of , 20 ��', by k—itNef 1A
who is personally known to me or who has produced FL. L 1?
As identification and who did take an oath.
NOTARY PUBLIC:
sign: . :;, .... . S -;
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Print: cam:• y0, �,i~' m
My Commission Expires; p °• 4��1 : sou °
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iVASA: •••. ....... `.
APPLICATION APPROVED BY' �.,.`/`.�' 9 Plans Examiner
Engineer
Zoning
Contract
The foregoing instrument was acknowledged before me this 1
i 11PT
day of 're , 20 0 , by J ceer)
who is perso
I kr own to me or who has produced
NOTARY P
an WINN itd BERNAAn
`= MY COMMISSION # DD753565
EXPIR - "` arch 16,2012
(407)388 -0153 ;;: <_ rvice.com
Sign:4(o'
Print: C r r+9,2fl
My Commission Expires:
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(Revised 02/08/06)