BD-05-1044Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel gi 204 Fax: 305) 756.8972
BUILDING
PERMIT APPLICATION
FBC 2001
Permit Type (circle):
Owner's Name (Fee Simple Titleholder)
Owner's Address `7("% MG ICJc7
Permit No. 5 -1044
Master Permit No.
El. tr' al Plumbing Mechanical
5feplu.� aUcSinS
st
F�
City Atli* i tc
1 State
Roofing
Phone # .5os -7102-73 GS"
zip 3313 3
Tenant/Lessee Name Phone # S
N Job Address (where the work is being done) Solar
City Miami Shores Village County Miami -Dade Zip
Is Building Historically Designated YES
O Contractor's Company Name
Contractor's Address
NO
Phone #
City
Qualifier
State Certificate or Registration No.
State
Zip
Certificate of Competency No.
Architect/Engineer's Name (if applicable) Phone #
$ Value of Work For this Permit
Type of Work:
Describe Work:
EAddition
❑Alteration
Square Footage Of Work:
['New ❑ Repair/Replace
❑ Demolition
****************************Fees******************************
Submittal Fee $ Permit Fee $ CQO CCF $ r) ' G C7 CO/CC
Notary $ 5 Vowx
Scanning $
Code Enforcement $
Training/Education Fee $ 0. Zp Technology Fee $ '
Radon $
Zoning Bond $
Structural Plan Review. $
Total Fee Now Due $
/.3V
(Continued on opposite 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
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.
y Signature
Owner or Agent
Signature
Contractor
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
day of 7/ 1 4 , 20 5, by5t-C ,day of , 20 , by
who is personally known to me or who has produced who is personally known to me or who has produced
As identification and who did take an oath. as identification and who did take an oath.
NOTARY PUBLIC: yr
�.2319R-1
‘:)Ju 3,2'07
had :'In u
onding Co L.,,
Sign:
Print:
My Commisshm Expires:
NOTARY PUBLIC:
Sign:
Print:
My Commission Expires:
************************************************************************************************************
APPLICATION APPROVED BY:
chc 05/13/03
ii-(ar-
OR 47 7//vkr
Plans Examiner
Engineer
Zoning
Miami Shores Village
Paint Color Approval and Agreement
Date 7/j 4Jo
Owner's Name
Owner's Address J, LI
M -_
City (4IY►ISIWie1 State rt.. Zip
Job Address (where the work is being done) SLUM -
City Miami Shores Village County Miami -Dade Zip 3513 v
Is Building Historically Designated YES NO
Contractor's Company Name (if applicable)
14 Phone #
************************************************************************************************************
All elements on the site must be listed and indicate the color to be painted
Walls C_APJ'O0 VIEW ECC-ZO—I? ((5610
Fascia IZA1 et ECC-Zu `?2h(rp)„,
Drip Cap/drip Edge Ri\PCk AE -S r✓ CC” 70-7' `ref')
Soffit akNU 3 ECL. -10-2.°
heA COLLsi6s
3 Irreksr
Phone# 74f27305
352
Roof N4 64tia *&�
Flower bins N�&
Shutters 14 IA
`)
Awnings 111A
Chimney N IA
Doors and door jams ik\Gtj-Dal t(zoECC.-to -3n(f Qhr)
Garage doors ti 14 f
Railings N14
Fences IIIA
Decorative metal
RANcu Qs 1✓CC-zo-Z' (17eiv)
All brick (simulated or regular) KIA
Stucco banding t'1 IA _ _
Any other stucco features ca 1c SktlA - COMM Vieto E�.-� �LeC3e10I rI
NIA
6E1g.
2
1 1 Body Canyon View ECC -20-1°
2 Trim: Ranch Acres ECC -20-2°
3 Accent: Hickory Grove ECC -20-3°
Accessory Buildings
Other NIA
************************************************************************************************************
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.
Signature
APPLICATION APPROVED BY:
Owner or Agent
Date 2/VAS
Date 7/7 r
chc 6/18/03
Miami Shores Village
10050 NE 2nd Avenue
Phone: 305-795-2204
Printed: 7/18/2005
Building Permit
Permit Number: BP2005-1044
Page 1 of 1
Applicant: STEPHEN & MARY COUSINS
Owner: COUSINS STEPHEN & MARY
JOB ADDRESS: 443 NE 100 ST
Contractor
Local Phone:
Parcel # 1132060170510
Contractor's Address:
Legal Description: 6 53 42 PB 15-14 AMD PL OF MIAMI SHORES SEC 4 LOTS 18 & 19 BLK
Fees: Description Amount
FEE2005-9765 Building Fee $60.00
FEE2005-9766 CCF $0.60
FEE2005-9767 Notary Fee $5.00
FEE2005-9768 Training and Education Fee $0.20
FEE2005-9769 Technology Fee $1.50
Total Fees: $67.30
Total Fees: $67.30
Total Receipts: $0.00
Permit Status: APPROVED Permit Expiration: 1/10/2006 Construction Value: $300.00
Work: HOUSE PAINT
Signed: (INSPECTOR)
ck0QCe.
JUL 18 PAID
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 responisibility for all work
done by either myself, my agent, servants or employes.
Signed: (Contractor or Builder) BY: