PT-17-1084 I
T.
Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795-2204 Fax: (305)756-8972
Inspection Number: INSP-281102 Permit Number: PT-4-17-1084
Scheduled Inspection Date: October 03, 2017 Permit Type: Paint
Inspector: Naranjo, Ismael
Inspection Type: Final
Owner: DEL RIO,JUAN R. Work Classification: Addition/Alteration
Job Address: 123 NE 97 Street
Miami Shores, FL 33138-2332 Phone Number
Parcel Number 1132060132440
Project: <NONE>
Contractor: HOME OWNER
Building Department Comments
OUTSIDE PAINT Infractio Passed Comments
INSPECTOR COMMENTS False
[:::,,.,,-1Inspector Comments
Passed
Failed
Correction ❑
Needed
Re-Inspection ❑
Fee
No Additional Inspections can be scheduled until
re-inspection fee is paid.
October 03, 2017 For Inspections please call: (305)762-4949 page 1 of 16
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Miami Shores Village D
P 8 2017
Building Department
10050 N.E.2nd Avenue,Miami Shores,Florida 33138 GSM,
Tel: (305)795.2204 Fax: (305)756.8972
INSPECTION'S PHONE NUMBER:(305)762.4949
BUILDING Permit No. Z� lei
PERMIT APPLICATION Master Permit No.
FBC 20
Permit Type:PAINT � nna
OWNER:Name(Fee Simple Titleholder): �. V Phone#: 30S. � ` k- 01 Q q
Address:
City: 2 J State: Y• Zip: 4 100,
Tenant/Lessee Name: N Pho #: �4 elf
Email: + d ` Cdn,
JOB ADDRESS: Y ?7 000O
City: Miami Shores 2^ County: Miami Dade Zip:
Folio/Parcel#: � 0 �ely,A
Is the Building Historically Designated: Yes NO Flood Zone:
CONTRACTOR:Company Name: Phone#:
Address:
City: State: Zip:
Qualifier Name: Phone#:
State Certification or Registration#: Certificate of Competency#:
Contact Phone#: Email Address:
Value of Work for this Permit:.$ � • Square//Linear Foo ge of Work:
Description of Work:
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.....
"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$2500,the applicant must promise in good faith that a copy of
the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also,a certified copy of the
recorded notice of commencement must be posted at the job site for the first inspection which occurs seven(7)days after the building permit is issued. In the absence of
such posted notice,the inspection will not be approved and an inspection fee will be charged.
:xx**:x*********��*:x:x***�*****x***:x:x**:�*:xFees***:x********:�:x*:x:x:x�x�:x:x:x**:xx*****•z:�:�:xx:�x::��*�
Permit Fee$ Vd CCF$ O. 6O- Notary$A Training/Education Fee$
Technology Fee$ Double Fee$ TOTAL FEE NOW DUE$ (b
PAINT COLOR APPROVAL AND AGREEMENT
All elements on the site must be listed and indicate the color to be painted
DIRECTIONS:Please circle corresponding number to appropriate color sample.
/ ��
Walls: 1 1 1 2 3 4
Attach color sample with name and number
Fascia: 1 2 3 4
Drip edge: 1 2 3 4 SW 7014 256-05
Soffit: 1 2 3 4
1 Eider White
Roof: 1 2 3 4
Flower Bins: 1 2 3 4
Shutters: 1 2 3 4
Awnings: 1 2 3 4 2
ecan SW 3124-P
P
Chimney: 1 2 3 4 _ �y—
Doors&Jambs:l 2 3 4 4� �fJIS
Garage Doors: 1 2 3 4
3.
Railings: /1 2 3 4
Fences: ( lI 2 3 4
All Brick: 1 2 3 4
Stucco Bands: 1 2 3 4
Other Stucco 4.
Feature: 1 2 3 4
Accessory Bldg: 1 2 3 4
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: Signature: AL-11
Owner or Agent Contractor
The forKnt was acknowledged bbefore e this The foregoing instrument was acknowledged before me this
day of byreltf-�. , day of 20_,bywho is n to me or who has produced who is personally known to me or who has produced
ks identification and who did take an oath. as identification and who did take an oath.
NOTARY PUBLIC: NOTARY PUBLIC:
Sign: Sign:
Print: Print:
-' MY COMMISSION#GG 075921
My Commission Ex cq EXPIRES FeDruary22,2021 My Commission Expires:
B�(�Thru Notary n.p,PublicNI .-v` Urklerwftvs 17
*�*�*�**%k**%k%k i}.** %k.•{'. � �ir.*• *•`.r.�'.{'.{'.i�'.i�'. �* *�%k*��%k%K%k*%k* %k%k%k� �%k**�**•********%k**ift*%k
APPROVED BY: Code Official
Preservation Board