PT-17-1524 • r
1
Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795-2204,Fax: (305)756-8972
Inspection Number: INSP-284010 Permit Number: PT-6-17-1524
Scheduled Inspection Date: November 02, 2017 Permit Type: Paint
Inspector: Naranjo, Ismael
Inspection Type: Final
Owner: MASS, GREGORY M Work Classification: Addition/Alteration
Job Address: 101 NE 104 Street
Miami Shores, FL 33138- Phone Number
" Parcel Number 1121360130700
Project: <NONE>
Contractor: BLUE DOLPHINE CONSTRUCTION LLC Phone: (954)605-1418
Building Department Comments
PAINT Infractio Passed Comments
INSPECTOR COMMENTS False
F
Inspector Comments
Passed
Failed
Correction
Needed
Re-Inspection ❑
Fee
No Additional Inspections can be scheduled until
re-inspection fee is paid.
November 01,2017 For Inspections please call: (305)762-4949 Page 8`of 40
�.�._ X
' Miami Shores Village
RECEIVED
�
� Building Department
N� 017
10050 N.E.2nd Avenue,Miami Shores,Florida 33138 MAY 16 ,.
Tel: (305)795.2204 Fax: (305)756.8972
INSPECTION'S PHONE NUMBER: (305)762.4949 r
BUILDING Permit No. �C��' I"qg `�
PERMIT APPLICATION Master Permit Na-PT I q ► S I-A
FBC 20
Permit Type:PAINT �n
OWNER:Name,`(Fe Sim(le Titleholder): �'"1 l�s� 6T.Ur'A S ' � Phone#: 3o `
Address: 4M,W I�-o { ,
City: QPc-\ Sr'% S State:
*—� Zip:Tenan
Email:/Lessee Name: Phone#: 'W- ?Vy—
Email: 2c M (ft t�r f7 Cc�V"1
JOB-ADDRESS: 1 a� r�l Oq
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#:
Is the Building Historically Designated:Yes NO Flood Zone:
•
$
CONTRACTOR:Company Name: p�� (1r,.�l�t Phone#: lI _�L/
Address: Sw� 3'� qJ.0 Srci--E-
�
City: CON
State: Zip:
Qualifier Name: Ce Cir IZ t3 M.&kua, Phone#:
State Certification or Registration#: � j, G; 1 Certificate of Competency#:
Contact Phone#: Email Address:
Value of-Work for this Pit:,$ �
e .- _ erm._ Square/Linear Footage 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$2500,the applicant must promise in good faith that a copy of
the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also,a certified copy of the
recorded notice of commencement must be posted at the job site for the first inspection which occurs seven(7)days after the building permit is issued. In the absence of
such ported notice,the inspection will not be approved and an inspection fee will be charged.
Permit Fee$ CCF$ Notary$ Training/Education Fee$
Technology Fee$ Double Fee$ TOTAL FEE NOW DUE$
i
PAINT COLOR APPROVAL AND AGREEMENT
All elements on the site must be listed and indicate the color to be painted
cf
DIRECTIONS: Please circle corresponding number to appropriate color sample.
Walls: 1 2 3 4
Fascia:
Attach color sample with name and number
1 2 3 4 �
Drip edge: 1 2 3 4
Soffit: 1 2 3 4 1'
Roof: 1 2 3 4
Flower Bins: 1 2 3 4
Shutters: 1 2 3 4
Awnings: 1 2 3 4 2 f
Chimney: 1 2 3 4 i
Doors&Jambs:1 2 3 4
Garage Doors: 1 2 3 4
Railings: l 2 3 4 3'
Fences: 1 2 3 4
All Brick: 1 2 3 4 i
I
Stucco Bands: 1 2 3 4 ,
Other Stucco 4•
I
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.
1
Signature:
Signature: f
Owner or Agent Contractor
The foregoing instrument was acknowledged before me this � l
g The foregoing instrument was acknowledged before me this
day of a-v► 20[L,by �D2��s 4q SS day of20 n
who is personally known to me or who has produce ff D�/7V. _ '
P who is personal] known to me or who has produced
As identification and who did take an oath.
as identification and who did take an oath.
NOTA UBLIC: NOTARY PUBLIC:
I ,
I ti1�,RYPVe�� JOY TRAILI_E
Sign: :_. _ j
// t Florida SigAl
Print: /� 11G.
's? ,'My Comm.Expkss Aq 19,2017 Print: a ' 0 o 'da
k ) / omm as on N FF 46720 ' , UV�s
My Commission Expires: ?/�/ My Commissio E MY Comm. ExPlres Feb Ig, 2020
Bonded through National Nora.,
APPROVED BY:
Code Official
Preservation Board
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