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PT-10-894 d r Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP - 143894 P e r mit Num PT -5 -10 -894 Scheduled Inspection Date: May 20, 2010 Permit Type' Paint Inspector: Bruhn, Norman Inspection Type: Final Owner: ROJAS, FERNANDO Work Classification: Addition /Alteration Job Address: 803 NE 91 Terrace Miami Shores, FL 33138- Phone Number (305)751 -0714 Project: <NONE> Parcel Number 1132060050230 Contractor: HOME OWNER Building Department Comments Inspector Comments Passed Failed Correction Needed Re- Inspection ❑ Fee No Additional Inspections can be scheduled until re- inspection fee is paid. May 19, 2010 For Inspections please call: (305)762 -4949 Page 19 of 23 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP - 143894 Permit Number: PT -5 -10 -894 Scheduled Inspection Date: May 20, 2010 Permit Type: Paint Inspector: Bruhn, Norman Inspection Type: Final Owner: ROJAS, FERNANDO Work Classification: Addition /Alteration Job Address: 803 NE 91 Terrace Miami Shores, FL 33138 - Phone Number (305)751 -0714 Parcel Number 1132060050230 Project: <NONE> Contractor: HOME OWNER Building Department Comments Inspector Comments Passed El Failed Correction ❑ Needed Re- Inspection ❑ Fee No Additional Inspections can be scheduled until re- inspection fee is paid. May 19, 2010 For Inspections please call: (305)762 -4949 Page 19 of 23 PT4, j 94l p eli Miami Shores Village . 10050 N.E. 2nd Avenue r ��rfc IOAbU17 At(t�t3 ©n Pk l ' Miami Shores, FL 33138 -0000 ` k F 18 Phone: (305)795- 2204� toad* Expiration: 010112999 Project Address Parcel Number Applicant 803 NE 91 Terrace 1132060050230 FERNANDO ROJAS Miami Shores, FL 33138- Block: Lot: Owner Information Address Phone Cell FERNANDO ROJAS 803 NE 91 Terrace (305)751 -0714 MIAMI SHORES FL 33138 -3217 Contractor(s) Phone Cell Phone Valuation: $ 500.00 HOME OWNER �._.. �_. _. ._ _ __ .... .. ................._..........._� .............. Total Sq Feet: 0 Type of Work: Exterior Available Inspections: Color. Inspection Type: Additional Info: PAINT Final Classification: Residential Color: Approved Code Comments: MARTHA STEWART LIVING -WAL Color. Approved_ Color. Denied Fees Due Amount Pay Date Pay Type Amt Paid Amt Due CCF $0.60 Invoice # PT -5 -10 -37942 Education Surcharge $0.20 05/19/2010 Credit Card $ 61.60 $ 0.00 Permit Fee $60.00 Technology Fee $0.80 Total: $61.60 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. 1 understand that separate permits are required for ELECTRICAL, PLUMBING, MECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work. OWNERS 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. Futhermore, I authorize the above -named contractor to do the work stated May 19, 2010 Authorized Signature: Owner / Applicant / Contractor / Agent Date Building Department Copy May 19, 2010 1 ' f r -� 0 9 i/ 9 j Miami Shores Village MAY 1 9 2010 Buildin g Department artment BY: ........ (0050 N.E.2nd Avenue, Miami Shores, Florida 33138 Sh (305) 795A2" 1mw 305) 756.897a RT) BU ILDING Permit No. 0— 1 PERMIT APPLICATION Master Permit No. FBC 2004 Permit Type: PAINT PERMIT p Owner's Name (Fee Simple Titleholder) ��yy C�t1 (tone # 30 ` x ' 91 ®® S , Owner's Address S03 (� . st 1 (' Vi CI c c ) City (i l I am ti State 'EL Zip 3 I Tenant/Lessee Name Phone # E- MAIL: Job Address (where the work is being done) S d 3 N6 6v q I ji fmce p &Lm l City Miami Shores Village County Miami -Dade Zip FOLIO / PARCEL # J 1 3,2 ®& 00,9() 2 3C) Is Building Historically Designated YES NO Contractor's Company Name Se lf Phone # Contractor's Address City State Zip Qualifier Name Phone # State Certificate or Registration No. Certificate of Competency No. OWNER BUILDER: Value of Work For this Permit $ Type of Work: ❑ Addition / ❑ Alteration / ❑New / ❑ Repair/Replace Describe 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 EMPROVEMENTS 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 Permit Fee $ CCF $ Technology Fee: Training/Education Fee $ Notary $ Code Enforcement $ q Double Fee $ Zoning $ Total Fee Now Due $ 1 • (� See Reverse side —� 4" F ' A 1 � y i PAINT COLOR APPROVAL AND AGREEMENT All elements on the site must be listed and indicate the color to be uainted Directions: Please circle corresponding number to appropriate color sample. Walls: 1 2 3 4 Attach color samples with name and Fascia 1 2 3 4 number. Drip Cap/Drip Edge: 1 2 4 Soffit: 1 2 3 4 " Roof: 1 2 3 4 Flower Bins: 1 2 3 4 Shutters: 1 2 3 4 Awnings 1 2 3 4 2 'w H Chimney: 1 2 3 4 Doors and Door Jams: 1 2 3 4 Garage Doors: 1 2 3 4 Railings: 1 2 3 4 3 Fences: 1 2 3 4 All brick (simulated or regular): 1 2 3 4 Stucco Banding: 1 2 3 4 Any other Stucco Features: 1 2 3 4 4 Accessory Buildings Other: OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all ap icable laws regulating construction and zoning. Signature gi - e L Signature Owner or Agent Contractor The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this day of 20 /P. by , 7 1 fne- C2 °e .Zday of 20 by who is personally known t o 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 P C• ',� NOTARY PUBLIC: Sign: ,/ Sign: Pmt D® ODBRIDQE JR. Print: ON 9 DD M31 My Commission Expires: MOMM: April 01.2014 My Commission Expires: 1 Y FL NaiyDWOMMAso QL frink4r dt�rQr�nk 4drinY Pe Ar fk�r�n4 4 etr4r4t8r4r4r$4rdr9e s4 de ie �tdr9r Je 4r8i�i sY aY 4e tYs�r4t tY t44t tYtY9t tYtY s4 Ys4xaYs4 &da t4 tft 7U 4t 4e it 4t dt it 4r#t t4inY4tdn@'yy{r$4t{t$4r 4r 4t iritink de dtdetYt&tY4ttY4r4r4t4rJtirsY APPLICATION APPROVED BY: Plans Examiner Preservation Board Code Enforcement (Revised 04/24/07) ti