PAINT PERMITMiami Shores Village
10050 NE 2nd Avenue
Phone: 305 - 795 -2204
Printed: 4/22/2005
Applicant: KENNETH JACOBS
Owner: JACOBS KENNETH
JOB ADDRESS: 1163 NE 92 ST
Contractor
Local Phone:
Parcel # 1132050270350
Signed:
(INSPECTOR)
Building Permit
Permit Number: BP2005 -539
Contractor's Address:
Legal Description: BAY LURE PB 44 -63 LOT 23
Page 1 of 1
Permit Status: APPROVED Permit Expiration: 10/12/2005 Construction Value: $500.00
Work: PAINT
BLK 2 LOT SIZE 75.000 X 125 OR
Fees: Description Amount
FEE2005 -4889 Building Painting Fee $60.00
FEE2005 -4890 CCF $0.60
FEE2005 -4891 Notary Fee $5.00
FEE2005 -4892 Training and Education Fee $0.20
FEE2005 -5148 Technology Fee $1.50
Total Fees: $67.30
Total Fees: $67.30
Total Receipts: $67.30
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:
4 VV.. @C W 2005
AMI :SHES VILLA
BUILDING DEPARTMENT ®c5,.
305- 795 -2204
Building Inspection Request
Date tO _
Type Insp'n F�u1 'P�1k0
Permit No. ' 1203 SYt
Name ‘D®'S r,
Address ® Nt RZ
Company (Wt(0
Phone # SI° — 4 5
Inspection Date
Approved
Correction
Re- Insp'n Fee
BUILDING
PERMIT APPLICATION
FBC 2001
Permit Type (circle)( Building
Owner's Name (Fee Simple'1'itiefror
Owner's Address 1/63 A) E.
City Hkoit :, lJ2: State
Tenant/Lessee Name Sam
Job Address (where the work is being done)
City Miami Shores Villa :e
Is Building Historically Designated YES
Contractor's Company Name
Contractor's Address
City
Qualifier
State Certificate or Registration No.
Architect /Engineer's Name (if applicable)
Type of Work: ❑Addition
Describe Work: .d/
Total Fee Now Due $
(Continued on opposite side)
J »/k m11
$ Value of Work For this Permit x an • CO
Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
Electrical Plumbing
ab a 4 Al '-6
9o/ Ad sf •
FL
['Alteration
rl c)Z.
//‘.3 s¢ Ad
County Miami -Dade
NO Y
State Zip
['New
k7.o 12D2 .
Zip 33/_3(?
Phone #
1,(.4._)— Phone #
Certificate of Competency No.
Phone #
Square Footage Of Work:
Permit No.' P 6
Master Permit No.
Mechanical
Roofing
Phone # ; 3 OS - 7S - 73 9 6
❑ Repair /Replace ❑ Demolition
* * * * * * * * * * * * * * * * * * * * * * * * * * *** F ees * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
Submittal Fee $ Permit Fee $ w ' co CCF $ t (, 0 CO /CC
Notary $ 5 •00 Training /Education Fee $ t 60 Technology Fee $ 1 -50
Scanning $ Radon $ Zoning Bond $
Code Enforcement $ Structural Plan Review. $
Bonding Company's Name (if applicable) f� /f-
Bonding Company's Address /
City State Zip
Mortgage Lender's Name (if applicable) f7 ,4
Mortgage bender'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. 1 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 ivhich 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
Chc 05/13/03
NOTARY PU
Sign:
Print:
My Commi.sion Expires:
* * * * * * * * * * * * * * * * * * **
APPLICATION APPROVED BY:
Owner or Age! Contractor
The foregoing instrument was ac wl d before me this �1 The foregoing instrument was acknowledged before me this
day of J9r1 L, 20 U..�, by 0 �[U I deal'" , day of , 20 , by
.
who is personally known to me or who has produced
who is personally k own to me or who has produced
* * * * * * *
;xon J
As identification and who did take an oath. as identification and who did take an oath.
or. R..0
•
t ry I
Signature
NOTARY PUBLIC:
I eaS Sign:
;''■1
,r , Print:
!tie' t
My Commission Expires:
********************************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * Ir ************ * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
APR 202t
Plans Examiner
Engineer
Zoning
Date LI 13 0 S —
Owner's Name )11 f ( I a (1:1 -G56f
Owner's Address / lI le,3 N E 9�
City f - f IdM cken..PA� �^
State r
Job Address (where the work is being done) Yd4A-R_ a1-S
City Miami Shores Village County Miami -Dade Zip 3 3 13 cP
Is Building Historically Designated YES NO .
Contractor's Company Name (if applicable)
d Phone #
***************************************************************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
All elements on site must be listed and indicate the color to be painted
Walls �cl F ( a 1002\
C I-1-t [Is
Fascia
Drip Cap /drip Edge
Soffit
Roof
Flower bins
Shutters
Awnings
Chimney h a
Doors and door jams S4
d 1
MY hs 194( -8
Garage doors
Railings
Fences
Miami Shores Village
Decorative metal
ha
na
ha
All brick (simulated or regular)
na
Stucco banding h Pr
Any other stucco features V1 A
Accessory Buildings d
Signature
APPLICATION .APPROVED BY:
Paint Color Approval and Agreement
Owner or Agent
P� Z Officia; c�
Phone #
Zip 33 /38
Attach Color Samples
With Numbers
I 5,ur
— e
Litt d j- I-41
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 re ating constructio and zoning.
Date
Date