PT-06-1833r ,(r_c , ti, rik
Miami Shores Village
Building Department JuL 1 o 2006
BUILDING
PERMIT APPLICATION
FBC 2004
Permit Type (circle): Building Electrical Plumbing Mechanical Roofing
Owner's Name (Fee Simple Titlehol er 'Al
\t ►'lt'✓ l`Dbey'T� 1 Phone # 35 — 77g— / 2' S
(` ,per's Address g.s ti C1 1 &f
L
Tcnant/Lessee Name
( itv
FOLIO / PARCEL #
Contractor's Company Name
tractor's Address
City . ■
t_r `ier Name
Certificate or Registration No.
Submittal Fee $
Scanning $
Bond $
' 4 T nr•tnral Review. $
State
Address (where the work is being done)
Miami Shores Village County Miami -Dade Zip 3 '3 32,
i; :,ding Historically Designated YES
.`, ri .i iicctiEngineer's Name (if applicable)
of Work For this Permit $ 2 / 0 C9 Square / Linear Footage Of Work:
'1' ,,c of Work: Addition ❑Alteration ew ❑ Repair /Replace ['Demolition
Describe Work: f J
State
******** * * * * * * * * * ** * * * * * * *** * * * * * * * * * ** F ***** * * ** * ** * * * * * * * ** ** * * * * * * **
Permit Fee $
Training /Education Fee $
Radon $
Code Enforcement $
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
a` NE 9( S4-.
L
DPBR $
Master Permit No.
'L ip . 13
Phone #
Permit No. I J 06 - (`1 1 3
Lip
Phone # 7 (c -- _ ___`__
Certificate of Competency No. d/ B S 001 7
Phone #
CCF$
Technology Fee $
Zoning $
CO /CC
Double Fee $
Total Fee Now Due $ � .10
0 051
See Reverse sidEAIL i ! PALO
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 10 Applicant: As a condition to the issuance of a building permit with an estimated value exceeding $2500. the applicant must
promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person
whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site
for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the
inspection will not be approved and a reinspection fee will be charged.
Signature
Sign:
Print:
My Commission Expires:
APPLICATION APPROVED BY:
(Revised 02/08/06)
' o Signature
Contractor /�
The foregoing instrument was acknowledged before me this w
day of "V t ( , 20 @ ( a , f7l F f rr1 U PodeS4 day of 201 , by Airtt, N,i 0 66 4614 TC /S
who is personally known to me or who has produced F/, /$ Ltc. . who is personally known to me or who has produced R. ' ri(( / Li;
" identification and who did take an oath. as identification and who did take an oath.
NOTARY PUBLIC: NOTARY PUBLIC:
Owner agent
The foregoing instrument was acknowledged before me this 10
Sian:
Print:
My Commission Expir
o�
Plans Examiner
Engineer
Zoning
•
•
Date /0
Owner's Name
Miami Shores Village
Paint Color Approval and Agreement
6
ir1p2Y\ _ r • �� '°- ►. Phone# 3 OS - 77' X95
Owner's Address vD-55 A) V 9 1
City (Vi i c rrut9. Sktn.-Q5) State T _
Job Address (where the work is being done) �$S A-) E 9 ( f
City Miami Shores Village County Miami -Dade Zip 33 1 3 Fr
Is Building Historically Designated YES NO
Contractor's Company Name (if applicable) 4( r- Pr L∎rt, 4 e. Phone # 7 g (- .7 7 ` g-i? < l
***************************************************************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
All elements on the site must be listed and indicate the color to be painted
Ai — Th 2 - (5
Walls
Fascia t,l� FfCi (404,(i) [ '
Drip Cap /drip Edge (COdrePtitooCT
k
Soffit (AM% (0(!14
Roof \ I COIM
Flower bins
Decorative metal
,41
Shutters
Awnings
Chimney /V II
doors � � Doors and door jams e V(11 ( 1 v ((tiiT)
s /) 4 Y ( r-Ugeo l
NIA
Railings / /f
Fences
/ A .
/-( /) (Oyfm /
All brick (simulated or regular)
Stucco banding V/4 4 ,
Any other stucco features /1
�f
Accessory Buildings /
Zip 33(3$'
Attach Color Samples
With Numbers
Other .
***************************************************************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
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.
Signatur
Owner or Agent
• (
APPLICATION APPROVED BY: 1 � } d - II
P& Official
Date - 'Ab /O__
Date
kA
chc 6/18/03
OUHUuII J LIGIJOILNIIIne. vv..............
Inspector Comments
Passed
Failed
Correction
Needed
Re- Inspection
Fee
($75)
No Additional Inspections can be scheduled
re- inspection fee is paid.
until
Inspection Number: INSP -21882
cL
Permit Number: PT -7 -06 -1833
Inspection Date: 07/25/2006
Inspector: Grande, Claudio
Owner: DOMLESKY, ROBERT
Job Address: 285 91 Street NE
Miami Shores Village, FL 33138-
Project: <NONE>
Contractor: HOME OWNER
Monday, July 24, 2006
Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
9l�
Block:
Permit Type: Paint
Inspection Type: Final
Work Classification: New
Phone Number
Parcel Number 1132060133460
Lot:
Page 1 of 2
Receipt
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL 33138 -0000
Phone: (305)795 -2204 Fax: (305)756 -8972
Permit Number: PT -7 -06 -1833
Invoice Number: PT -7 -06 -25498
Applicant: ROBERT DOMLESKY
Company Name:
Owner Address:
285 NE 91 ST
MIAMI SHORES, FL 33138
Job Address:
285 91 Street NE
Miami Shores Village, FL 33138-
Date
Friday, July 14, 2006
07/14/2006 Check
Payment Type Check Number
457
Amount
$68.10
Change
$0.00
Total Payment: $68.10
Page 1 of 1
Issue Date: 7/13/2006
Owner's Name: ROBERT DOMLESKY
Permit Type: Paint
Work Classification: New
Job Address: 285 91 Street NE
Additional Information
Miami Shores Village, FL 33138-
Miami Shores Village
10050 N.E. 2nd Avenue
Miami Shores, FL 33138 -0000
Phone: (305)795 -2204 Fax: (305)756 -8972
Comments:
exterior paint
BENJAMIN MOORE A/1 32B LIGHT YELLOW
Permit
Expires: 01/09/2007
Contractor(s) Phone Primary Contractor
HOME OWNER
Yes
Type of Work: Exterior Color: YELLOW
Additional Info: Classification: Residential
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,
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.
Parcel #:
Block:
Section:
Permit Status: APPROVED
Permit Number: PT - - - 1833
Phone:
1132060133460
Lot:
PB:
Total Square Feet: 0
Total Valuation: $ 2,000.00
Re • uired Ins ' ections
Final
Fees Due Amount
CCF $1.20
Education Surcharge $0.40
Notary Fee $5.00
Permit Fee $60.00
Technology Fee $1.50
Total: $68.10
Invoice Number
PT - 7 - 06 - 25498
Total:
Amt Due
$68.10
..
Amt Paid
Building Department File Copy
Applicant Signature
NOTICE: In addition to the requirements of this permit, there may be
additional restrictions applicable to this property that may be found in the
public records of this county.
AND THERE MAY BE ADDITIONAL PERMITS REQUIRED FROM OTHER
GOVERNMENTAL ENTITIES SUCH AS WATER MANAGEMENT
DISTRICTS, STATE AGENCIES, OR FEDERAL AGENCIES.