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EL-12-583Permit Number: EL -4 -12 -583 J Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 -e7( inspection Number: INSP - 172123 Inspection Date: April 09, 2012 Inspector: Devaney, Michael Owner: POLANCO, DEYSI Job Address: 1183 NE 91 Terrace Miami Shores, FL 33138- Project: <NONE> Contractor: F JIMENEZ ELECTRICAL CONTRACTOR, INC Permit Type: Electrical - Residential Inspection Type: W. W. Work Classification: Temp for Test Phone Number Parcel Number 1132050010200 Phone: 305/556-5759 Building Department Comments temp for test riP/7-1Y--- Passed Inspector Comments /2; �7 C-/-(72-- Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled re- inspection fee is paid. until April 09, 2012 For Inspections please call: (305)762 -4949 Page 1 of 1 Miami Shores Village Building Department NI APR 042012 Lili o �o 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 INSPECTION'S PHONE NUMBER: (305) 762.4949 lj 1- 75 05rt-- BUILDING Permit Nu. .1 PERMIT APPLICATION Master Permit No. R c ° 0 c °, $ FBC20 Permit Type: Electrical OWNER: Name (Fee Simple Titleholder): " 'l a Y `s Q ®� (A° i'� ® Phone #: Address: 82,17 5 r p City: i V (pi 1' 8 3 State: Zip: 3 312. Tenant/Lessee Name: Phone #: Email: JOB ADDRESS: 1! 3 g L� City: Miami Shores Folio/Parcel #: Is the Building Historically Designated: Yes CONTRACTOR: Company Name: County: Miami Dade Zip: NO Flood Zone: J /04 e/v� L c +i' . c lob- Phone#: Address: ,/2,t(OI it) oleo- ec!/,J,48 g c. City: He ;,I;'J. State: PL— Qualifier Name: rf L4l'1CeS C,0 °fine Zip: / g Phone #: State Certification or Registration #: € t / 3 00 J. 4 ] Certificate of Competency #: Contact Phone#: Email Address: DESIGNER: Architect/Engineer: Phone#: Value of Work for this Permit: $ Square/Linear Footage of Work: Type of Work: °Address °Alteration New °Repair/Replace °Demolition Description of Work: rem P 0 RA Re ,OK._ r Submittal Fee $ Permit Fee $ / "‘") ''f "E' CCF $ CO /CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ TOTAL FEE NOW DUE $ )$bnding 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, BO1T.F,RS, 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 o`►' tee) Signature Owner or Agent iL The foregoing instrument was acknowledged foe me this The forego' g instrum /ent was acknowledged before m this��4 day of o` , 20 � Z b y V S l t * O o day of %'' ! , 20 i by ri°�d�nae.Lcca Jie rol. , who is personally known to me or who has produced who is ersonally known to me or who has produced Contractor As identification and who did take an oath. as identification and who did take an oath. NOTARY PUBLIC: Sign: c -- Print: F � R 9 S le% He' 7 My Commission Exp ***************** APPROVED BY NOTARY PUBLIC: 4/ 4' 2 r' (.2-- Plans Examiner Zoning Structural Review (Revised 07 /10 /07)(Revised 06 /10/2009)(Revised 3/15/09) 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 -Dad Building Department is given in connection with the building being constructed under the Building Permit # W(�. ' ®9- i33/ and Electrical Permit # —1/ - ®°t l 9 0 B at address /183 'Y ?' 7-Er !9 for owner: Sys/ /aria,,,w and is being given only for construction purposes or for testing the olio ing equipment in said structure: 4-! W' -g �-� 9 alb ®N6 .T The owner does hereby agree to assume the responsibility of 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, L y £ / /o. Arco , 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 Temporary for Test permits. S'gn of Owner Signatur °'.f Notary My Commission Expi I, C?44 A/Cf.SCO //L9 ?R/z' ?being duly sworn, depose and say that I a the above - described property and that the electrical installations as now existing will temporary s ;rvice is connected. Signature of El p fIical C of the bee 0 ©,S a cribed y the t I ha called for ained and t ch final insp ontractor Signature of Notary C/�** My Commission Expir ON/ 2, , being first duly sworn, depose and say that I property and that I will not permit occupancy of this building co. . . ; .nd sub - contractors concerned and final approval the authori insofar as the owner of said property is concerned to e obtained and/or a Certificate of Occupancy or Completion is is /4 i� : wilding Signature of Electrical Inspector 123_01- 124 6/06 inspection division prohibit occupancy until sued. Signature of Notary My Commission Expire Date: Date released to FPL: