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EL-16-2504Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Q -N15--2-1°1-7 Inspection Number: INSP-267025 Permit Number: EL -9-16-2504 Scheduled Inspection Date: September 30, 2016 Inspector: Devaney, Michael Owner: Job Address: 175 NW 109 Street Miami Shores, FL 33168-4316 Project: <NONE> Contractor: ALL PHASE ELECTRIC CORP Permit Type: Electrical - Residential Inspection Type: Final Work Classification: Temp for Test Phone Number (786)444-2945 Parcel Number 1121360030170 Phone: 305-345-6480 Building Department Comments TEMPORARY FOR TEST > NEED FOR WOOD FLOOR 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 ,Ro September 29, 2016 For Inspections please call: (305)762-4949 Page 14 of 32 Project Address Miami Shores Village 10050 N.E. 2nd Avenue NW Miami Shores, FL 33138-0000 Phone: (305)795-2204 Permit Permit NO. EL -9-16-2504 Permit Type: Electrical - Residential Work Classification: Temp for Test Permit Status: APPROVED Issue Date: 9/12/2016 Expiration: 03/11/2017 Parcel Number Applicant 175 NW 109 Street Miami Shores, FL 33168-4316 1121360030170 Block: Lot: JCAS FUND CORP Owner Information Address Phone CeII JCAS FUND CORP 5600 SW 135 Street FL (786)444-2945 Contractor(s) ALL PHASE ELECTRIC CORP Phone 305-345-6480 Cell Phone Valuation: Total Sq Feet: $ 250.00 0 Type of Work: TEMPORARY FOR TEST > NEED FOR WOOD Additional Info: TEMPORARY FOR TEST > NEED FOR WOOD Classification: Residential Scanning: 1 Fees Due CCF DBPR Fee DCA Fee Education Surcharge Permit Fee - Additions/Alterations 1 1 Scanning -Fee Technology Fee Total: Amount $0.60 $2.00 $2.00 $0.20 $100.00 $3.00 $0.80 $108.60 r :a Pay Date Pay Type Amt Paid Amt Due Invoice # EL -9-16-61286 09/09/2016 Check #: 1159 $ 50.00 $ 58.60 09/12/2016 Check* 1299 $ 58.60 $ 0.00 Available Inspections: Inspection Type: Final Review Electrical 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, PLUMBIN NICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work. OWNERS,AFFIDAVIT: construction an. .ning. Futh or auth• e the above-named contractor to do the work stated. t all e fore• g information is accurate and that all work will be done in compliance with all applicable laws regulating Author Buil Owner / Applicant / Contractor / Agent ng Department Copy September 12, 2016 Date September 12, 2016 1 (ln BUILDING PERMIT APPLICATION ❑BUILDING VELECTRIC Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795-2204 Fax: (305) 756-8972 INSPECTION LINE PHONE NUMBER: (305) 762-4949 ❑ ROOFING FBC 2014 Master Permit No. lC. LS - `q4 Sub Permit No. GL -9-16--2504 StAN ❑ REVISION ❑ EXTENSION 111 PLUMBING ❑ MECHANICAL El PUBLIC WORKS ❑ CHANGE OF CONTRACTOR JOB ADDRESS: City: 1)-c- /3 i,., 1047 ani Miami Shores County: ❑ RENEWAL ❑ CANCELLATION ❑ SHOP DRAWINGS Miami Dade Zip: Folio/Parcel#: Is the Building Historically Designated: Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: Phone#: 39T-3(12-'83-) OWNER: Name (Fee Simple Titleholder):'C nC f p. Address: City: /i\ C,a 1 State: Tenant/Lessee Name: la? Email: Tc/IS • C k -r c-- , Cc• CONTRACTOR: Company Name: Ail 4-5 E- ile. Address: 1 l e q4 1(-e) q 4V Phone#: Zip: 1 F Phone#: -7-1Y6 City: • b 2, b !L N/ State: r Qualifier Name: L gar e z State Certification or Registration #: � L -3 0 03 / .5Z DESIGNER: Architect/Engineer: Phone#: Zip:7 3 i 27 Certificate of Competency #: Phone#: State: Zip: Address: City: Value of Work for this Permit: $ 2.5149 Square/Linear Footage of Work: Type of Work: ❑ Addition n Alteration ❑ New ❑ Repair/Replace Description of Work: 1 /tti /9tt R -a (Ly t7 IL, i 7' / 7 oe,d fir (Dvog Floor' 0 n Demolition Specify color of color thru tile: j Submittal Fee $ �6 ; Permit Fee $ / ©0,Od CCF $ CO/CC $ Scanning Fee $ • CAM Radon Fee $ 2 `03 / DBPR $ G • ( ' 6 .t Technology Fee $ 0 " e0 Training/Education Fee $ . 20 Structural Reviews $ (Revised02/24/2014) Notary $ Double Fee $ Bond $ TOTAL FEE NOW DUE $ 5 .66 6 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 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 approvedand a reinspection fee will be charged. Signa ei/9/./ OWNER or AGENT The foregoing instrument was acknowledged before me this , 20 , by J\kr\ AiruloctelieGii 4,6 who is personally known to me or who has producedil birekt jaihV-Y?` Li atlas identification and who did take an oath. NOTARY PUBLIC: day of _.4e.:31-7/ Sign: Print: Seal: *********** „ Y Dt4 • �`""r "`4'% EMMELLiNE ROOgItiUEI �i►!.� Notary Public • State of Florida _ = ComnHssion I FF *405 Signature CONTRACTOR The foregoing instrume t was acknowl dged before me this fi5 day of U LAS , 20 (I , by r-fir-A(x) V /-09 , who is personally known to me or who has produced as identification and who did take an oath. NOTARY PUBLIC: Sign: Print: Seal: YYVk APPROVED BY 74 2 557./.4 Plans Examiner (Revised02/24/2014) Structural Review i a Notary Public •State of Florida i.• :�a ,d:�•�, MyCommielion d► 11111141es Feb 2017 Zoning Clerk Miami Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 AFFIDAVIT FOR 30 DAY TEMPORARY -ELECTRIC SERVICE NOTE: ELECTRIC SERVICE WILL BE DISCONNECTED "WITHOUT NOTICE" UPON 30 DAY TERMINATION UNLESS APPLICATION IS RENEWED. It is understood that the temporary -electrical approval by the Miami Shores Village, Building Department given in connection with the building being constructed under: Building Permit N: PNC-- l5 -2 99.1 Electrical Permit N: -451 -16 —2.504 At Address: 11S hP W I Cl % Si -re. 4 Miami Shores, FL For Owners: , and is being given only for construction purpose or for testing the following equipment in said structure: The owner does herby 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 purpose of use and occupancy, and no occupancy shall be granted or permitted until further 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 disconcerted of ie building concerned is occupied before final inspections are approved 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. , 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 of be occupied until the building contractor has obtained approval of final inspections an . • stained ertifica of Occupancy of Completion. Note: Failure to comply with the provisio r s of thi . affid vit will re ult in your 0 obtai uture Te YANADY PRIETO MY COMMISSION # FF 214031 6iLt ' Signature of Owner;.���sa, EXPIRES: March 25, 2019 I, e2LLrc the bo e -described property aprI that the PIPirtrirAl inctaitat►nn5.as n if tori rary`gervi is c• nected iii**4., KAREN D TRIVINO *,'- MY COMMISSION # EE834075 EXPIRES September 11, 2016 (a01?39&0153 Floridalloterpervice.ogm , being first duly sworn, depose of the above described property and that I will not permit occupancy of this building until final inspections have been called for by the contractors and sub -contractors concerned and final approval by the inspection division obtained and that I have the authority insofar as the owner of said property is concerned to prohibit occupancy until such final inspections are obtained and/or a Certificate of Occupancy or Completion is issued. „RA „ 4.0 Bonded Thru Notary Public Unde,writers , being duly sworn, depose and say that I nature of Electrical m tb'e Electrical C 'ntractor for o - ' ti • ill n. -ate . safety hazard madmen.; calk a11111!1111y ; e Buildi!ractor gnature of Building Contractor Signature of Inspector Signature of Notary Signature of Notary