EL-13-408Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number: INSP - 186798
Permit Number: EL- 2- 13-408
Scheduled Inspection Date: March 06, 2013
Inspector: Devaney, Michael
Owner: GLINN, MacDAM & DENISE
Job Address: 1201 NE 102 Street
Miami Shores, FL 33138-
Project: <NONE>
Contractor: ENERGIZER ELECTRIC LLC
Permit Type: Electrical - Residential
Inspection Type:
Work Classification: Temp for Test
%(
Phone Number
Parcel Number 1132050250160
Phone: (305)308 -5061
Building Department Comments
TEMP FOR TEST
Infractio
Passed Comments
INSPECTOR COMMENTS
False
Passed
Failed
Correction
Needed
Re- Inspection
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
Inspector Comments
TEMP FOR TEST
HI 2 /2..
March 05, 2013
For Inspections please call: (305)762 -4949
Page 37 of 43
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
Permit Type: Electrical
JOB ADDRESS: I a a)
13.
FBC20L
Permit No. / Z - 2 Z Z a
aster Permit NoiL1(3 -. V O
City: Miami Shores County: Miami Dade
Zip: 3
Folio/Parcel #:
Is the Building Historically Designated: Yes NO '- Flood Zone:
OWNER: Name (Fee Simple Titleholder): M a c,On, GA' n,vl
Address: 0 i iJ (0 d. SA-.
City: V` d 0. vim .• S r e< State:
Tenant/Lessee Name: 1 % A
Email:
e , cam. V 1 1-v
Phone #: 3-v f.?, j. 1 1 a rk
Zip: 33 t ?Al
Phone #: `�°-1
CONTRACTOR: Company Name: c5 % I e ' \� t' Jr- ` C Phone #: .3'a.5- 3® e' S® 6'
Address: 7J , vd, a 6%
City: ,372:4, Of r State: 74 Zip: ,x..3®07,5'
Qualifier Name: _a/7 4c - i- Ze �3®e Phone #:
State Certification or Registration #: Certificate of Competency #: 0 ?C 0®06 6/
Contact Phone #:4 30S-308 -5O'6 ,' Email Address: ./err ,gere, 4 &7rr✓# / ems.
DESIGNER: Architect/Engineer: Phone #:
Value of Work for this Permit: $ Square/Linear Footage of Work:
Type of-Wo ddress OAlteration UNew ORepair/Replace Demolition
Description o Work: / a-, e F�.+r� , 4 c .
m****** ***x: ********************* ** x**** Fees****** ************ ***: x***x :****+x+xx:**** ** *****
Submittal Fee $ ' C)-j1® Permit Fee $ 74,e, 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
tu/A
Mortgage Lender's Name (if applicable) CL o< Co a , a V i� u ° e
Mortgage Lender's Address
`l
City ovv- S� . '-C St State Zip 3 1�
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 chi e,d.
Signature
Owner or Agent c.4kC 0 c0 (° o
The foregoing instrument was ac owledged before me this�'�
day of , 20 (3, by ' S 2 QJ N N3,
who is personally known to me or who has produced
As identificflionms »vho did take an oath.
NOTARY PUBLIC: .`` .. %/co�'''�,,�
Sign: _ -��
'sue ; eP a,
Print: %o `��r °9
My Commission Expires: '�i`QR'• ••>••
* * * * * * * * * * * * * * * * * **
APPROVED BY
Signature 046240
0 Contractor �7 ,�
The foregoing instrument was acknowledged before me this !/6
day of
who is personally known to me or who has produc
,20th,by OCf" Pt4∎13AVOiiL
as identification and w,aiid take �P¢ i'i,,�
NOTARY PUBLIC:
Sign:
Print:
My Commission Expires:
i
I DA •�s.� `\` ®``\tea
'���urrn u i �N ►���
********************** ********:x ********** * * * ***** :* ***** **********u:***** *** * *** * **
Plans Examiner
Structural Review
(Revised 302)fj2ist/ /10 /07)(Revised 06 /10 /2009)(Revised 3/15/09)
Zoning
Clerk
MIAMI•DADE
COUNTY
Building
11805 SW 26th Street
Miami, Florida 33175 -2474
786 - 315 -2100
AFFIDAVIT FOR 30 DAY TEMPORARY ELECTRIC SERVICE
ELECTRICAL CATEGORY 26
miamidade.gov
ELECTRIC SERVICE WILL BE DISCONNECTED "WITHOUT NOTICE" UPON 30 DAY TERMINATION
UNLESS APPLICATION IS RENEWED OR CERTIFICATE OF OCCUPANCY OBTAINED.
It is understood that the temporary electrical approval by the Miami -Dade Building Department is given in connection
with the building being constructed under the Building Permit # and Electrical
Permit# at address I a 0 X11= f (,) St _ ii,A.. —.', Saves .zi3g'
for owner: 11/1 a. c.. ILk otit w. C- V....,..-- and is being given only for construction purposes or for
testing the following equipment in said structure: c ∎ AA r kt % i%.1 ("a w.. (2.
The owner does hereby agree to assume the responsibility df maintaining the installation in such manner that there
is no hazard to life or property. Such approval is in no event to be considered a RELEASE of said structure for the
purposes of use and occupancy, and no occupancy shall be granted or permitted until final inspections have been
called for and approved by the inspection divisions concerned, and/or a Certificate of Occupancy or Completion
is obtained.
The undersigned also understands that the temporary electric approval is subject to rescission and cancellation
and electric power can be cut off at the discretion of the Building Official and will be disconnected if the building
concerned is occupied before final inspections are approved and /or a Certificate of Occupancy or Completion
is obtained. �/
I, MA, e �t IA. , being first duly sworn, depose and say that I am the owner of the above
described property, and that I agree that the structure covered in this agreement shall not be occupied until the
building contractor has obtained approval of final inspections and /or obtained a Certificate of Occupancy or
Completion. Note: Failure to comply with the provisions of this affidavit will result in your being unable to obtain
future Te • • rary for Test permits.
Signat e of Owner
I, . eiv - 4 — �.6se
the above - described property and
temporary service is conne ed.
Signature of Electrical Contractor
1, / r C- .Ca irbDFav L-., ,, being first duly sworn, depose and say that r% e•�Builiiin ,�`ontractor
of the above described property and that I will not permit occupancy of this building of J, ���►4aI s'ctions have
been called for by the contractors and sub - contractors concerned and final approval by the inspection division
obtained h have the authority insofar as the owner of said property is concerned to prohibit occupancy until
such fi / ctions are obtained and /or a Certificate of Occupane� or Completion is issued.
,e k .
Signat re of N
My Comm issio
, being duly sworn, depose and say th
that the electrical installations as now existi
Signature of Notary o? �'ss. G - ' J
My Commission Expr;'•. s� • l� _
a
Signat ►re of Building Contractor
Signature of Electrical Inspector
123_01-124 6/06
Signature of Notary
My Co
Date:
Date rel
`o4PA o,n
`A` MY COMMISSION # DD995435
407 3 =8-0153
. - .
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