PAINT PERMITSMiami Shores Village
BUILDING
PERMIT APPLICATION
FBC 2001
Permit Type (circle): Builds ° Electrical Plumbing Mechanical Roofing
Owner's Name (Fee Simple Titleholder) JO D /1; cJ- a.21 kA/P. er Phone # 3 0 5 " te r' 9 6- 9155
Owner's Address 991 N E °13 S t,
City /1 l'a.ti., 5 LareS State FL — Zip 33 i3 R
Tenant/Lessee Name Phone #
Job Address (where the work is being done)
City Miami Shores Village County Miami -Dade
Is Building Historically Designated YES NO
Contractor's Company Name
Contractor's Address
City State Zip
Qualifier
State Certificate or Registration No. Certificate of Competency No.
Architect/Engineer's Name (if applicable) Phone #
$ Value of Work For this Permit
Type of Work:
Describe Work:
Total Fee Now Due $
['Addition
h ,-
(Continued on opposite side)
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
GW r Phone #
' 40o - / 5oo
Alteration
NOin
991 N E . 6 13 ,c4 S1 ,
❑New
* * * * * * * * * * * * * * * * * * * * * * * * * * ** F ees * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
Permit No. ?P ooh -1Oyg '
Master Permit No.
Square Footage Of Work:
Zip
❑ Repair/Replace ❑ Demolition
Submittal Fee $ Permit Fee $ LC' LC CCF $ i � a: CO /CC
Notary $ - - CA) Training/Education Fee $ „)-C Technology Fee $ l ''C
Scanning $ Radon $ Zoning Bond $
Code Enforcement. $ Structural Plan Review. $
�; 'CO* 15g1
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 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 he 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
Owner or Agent Contractor
The foregoing instrument was acknowledged before me this c / The foregoing instrument was acknowledged before me this
day of C , 20 0 ( I , by ` )JJVl Ikk. , day of , 20 _, by
who is personal known to me or who has produced 1/ l l0 0 91 3 who is personally known to me or who has produced
CD 3 ' (D As identification and who did take an oath. as identification and who did take an oath.
NOTARY
Sign:
Print:
•.S
4 D 1)231984
200
My Conunission Expires:
* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** ******************************************* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
******** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** *: * * * * * ** *. * * ** *************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
APPLICATION APPROVED BY:
Chc 05/13/03
(,?/.4
•'
Signature
NOTARY PUBLIC:
Sign:
Print:
7
My Commission Expires:
Plans Examiner
Engineer
Zoning
Miami Shores Village
Paint Color Approval and Agreement
Date 7/2 810 Y
Owner's Name To lt n 11 c e. 1
Owner's Address 9 q 3 r s t
City /1;0,►" 3i,or State F.L
Walls P i`1 3 /
Fascia P AA - ff
Drip Cap /drip Edge /v 0
Soffit P I 1
Roof `"3 I rA
Flower bins • j■i 1 IA
Shutters Clock
CIA
N I ►�
Doors and door jams P- 2 2
Garage doors l P - 2 2
Railings Ai / A
Fences /\J �A
Awnings
Chimney
Decorative metal /v het
All brick (simulated or regular) Ai /A
Stucco banding /v /A
Any other stucco features /J /A
Accessory Buildings n/ el
Other geC E'SSe J Wa1 5 P-22
Signature
APPLICATION APPROVED BY:
Owner or Agent
We r Phone # S03- /?,- 78`5S
Job Address (where the work is being done) 991 Al E 93 ✓ _S-r,
City Miami Shores Village County Miami -Dade Zip
Is Building Historically Designated YES NO . X
Contractor's Company Name (if applicable) Ow h P r' Phone #
***************************************************************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
All elements on the site must be listed and indicate the color to be painted
Zip 33138'
A
: :: P-¶43 Sys
with Numbers
2 -22W -
cr :: :7ff 7 .. T4 17
5 /Milk 17L14 r
Date
***************************************************************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
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.
7Z7/9r
Date
P& Z Official chc /18/03
Permit No.
1
MIAMI SHORES VILLAGE
BUILDING DEPARTMENT
305- 795 -2204
Building Inspection Request
Date -
Type Insp'n
Name -,
'7
Address
Company s
Phone #
Inspection Date
Correction
Re- Insp'n Fee
Name
j ,
MIAMI SHORES VILLAGE
BUILDING DEPARTMENT
305- 795 -2204
Buil'in: Inspection Request
Date
Type Insp'n Po
Permit No. - — 10G
aje
Address F 1 v t cr.5
�
Company nu ./" u"
Phone #
Inspection Date
Approved
Correction
Re- Insp'n Fee ❑
ii7
Date
tar
APPROVED:
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Job Address 99� //2", /c 5
Leg= Description g l i In W /4C,,,,,,xr:4 q
Lessee / Tenant V 0111MAJ Master Permit # J .M1
Owner's Address / /0' c9 5F Phone 7f7 ' 7/ f7
Contracting Co. Address /
Qualifier / 1 i , , ,/j'16 SS# - - Phone
State 1fr Municipal # Competency # Ins.Co.
Architect /Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type(circle one)(BUILDIN)LECTRICAL PLUMBING MECHANICAL ROOFING PAVING PENCE SIGN
WORK DESCRIPTION L - / / •% ` 1 - & L E - : 0 1 T -
1 9 0077 t 7 - / a l 7 ! O R - £K7 l ok C u�jf I TE)
Square Ft. Estimated Cost(value) 6 6
WARNING TO OWNER: YOU MUST RECORD A NOTICE OF COMMENCEMENT AND YOUR FAILURE TO DO
SO 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).
Application is hereby made to obtain a permit to do work and installation as indicated above, and
on the attached addendum (if applicable). I certify that all work will be performed to meet the
standards of all laws regulating construction in this jurisdiction. I understand that separate
permits are required for ELECTRICAL, PLUMBING, SIGNS, POOLS, ROOFING and MECHANICAL WORK.
OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will
be done in mpliance w'th all applicable laws regulating construction and zoning. Furthermore, I
authoriz stated.
Signat e o o er
Date' ei /1
a aAl4e
as to Owner and /or T Cadd "F'f4g IA p oduc
My Commission Expires:
o " "` ° "'''' JOSEPHINE CHURCH
:Notar Public, State of Florida
4fti?R ZP• AM 30.1996
No. CC197545
e /Print type or stamp name of Notary Pubic,
rsonally known ❑OR Produced
r
Cosa �
Tax Folio //
Signature of Contractor or Owner- Builder
Date:
Notary as to Contractor or Owner- Builder
My Commission Expires:
i., DID rake an oath, or
DID NOT take an oath.
** * * * *. * * * * * * * * * * * // // **
FEES: PERMIT J 71.9 RADON C.C.F. iO NOTARY ,Q/' TOTAL DUE ? e 9 P
Fire Other
Zoning � uildin t _ ?'t Electrical
Mechanical Plumbing Engineering
_ Pf wev73_1‹
- -141c) 4X/TrOis/ CF/L//4
t: 4- M N iAe
89e ,-,- 5 > or
o'_7x
M 4) I IN 4 '7"7: IP of
3, RgPk4ce LAM i774 NEK/
7JJA L
4, fiE PLAGE: irectv: :L. (3 rfi A A1 z, E_ P
-atr.A rE 10 i\rei Pk C.; F-1, TarA T
EX (5T.
FOIINOAT'l rd WALL
L - ev&rtoN CLE____,Lbe_i_UCLArrxi-21T____,IErA
VICTOR GLORM JOHNSQN
99/ N 93 577-LEET
- RE P L ACEMENT Or
DAM A r•, r1 JV
8/ /3 ic.2
NY V - 7 ---- /a cwiN5
>
"--,L.
e_xisr. 3 Gol-unnAis ro IRFAIA iN
F xi 5 r. at.V vViLLL.
_ Pf wev73_1‹
- -141c) 4X/TrOis/ CF/L//4
t: 4- M N iAe
89e ,-,- 5 > or
o'_7x
M 4) I IN 4 '7"7: IP of
3, RgPk4ce LAM i774 NEK/
7JJA L
4, fiE PLAGE: irectv: :L. (3 rfi A A1 z, E_ P
-atr.A rE 10 i\rei Pk C.; F-1, TarA T
EX (5T.
FOIINOAT'l rd WALL
L - ev&rtoN CLE____,Lbe_i_UCLArrxi-21T____,IErA
VICTOR GLORM JOHNSQN
99/ N 93 577-LEET
- RE P L ACEMENT Or
DAM A r•, r1 JV
8/ /3 ic.2
NY V - 7 ---- /a cwiN5
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Date i r Job Address 95/ 4/ t, v 7" Tax Folio
Legal Descri • 'on Historically Designated: Yes No
Own see / Tenant — O ( SO e--1 Master Permit # YO 47// 7
Owner's Address Phone 75C - � . / 9 7
Contracting Co. D tv/ti Address
Qualifier SS# Phone
State # Municipal # Competency # Ins. Co.
Architect/Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIPTION / A.) r / !i/ ,S H / Tr/ G')/ / TE-
Square Ft. Estimated Cost (value) X00
WARNING TO OWNER: YOU MUST RECORD A NOTICE OF COMMENCEMENT AND YOUR FAILURE TO DO SO 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.)
Application is hereby made to obtain a permit to do work and installation as indicated above, and on the attached addendum (if applicable). I
certify that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that separate
permits are required for ELECTRICAL, PLUMBING, SIGNS, POOLS, ROOFING and MECHANICAL WORK.
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. Furthermore, I authorize the above -named tor to d work stated.
Signature of owner and/or Condo President Date
Notary as to Owner and/or Condo President Date Notary as to Contractor or Owner- Builder Date
My Commission Expires: My Commission Expires:
,o
APPROVED:
Zoning Building
Mechanical Plumbing
actor or Owner -Bui der
9/(r77,6
S
FEES: PERMIT 470 RADON C.C.F. s° NOTARY 5 BOND 4"
TOTAL DUE
Electrical
Engineering
Test Location
Uplift Pull
Test (P or F)
Test Location
Uplift Pull
Test (P or F))
Test Location
Uplift Pull
Test (P or F)
1
26
r
51
2
/��?�
27
e"4'
52
3
28
53
4
29
54
5
30
55
6
31
56
7
32
57
8
33
58
9
34
59
10
35
60
11
36
61
12
37
62
13
38
63
14
39
64
15
40
65
16
41
66
17
42
67
18
43
68
19
44
69
20
45
70
21
46
71
22
47
72
23
48
73
24
49
74
25
V
50
S
75
r Du Quesne & Associates, Inc.
Consulting Engineers
Testing Laboratory
Owner's Name:
ON -SITE CONCENTRATED UPUFT LOAD TESTING OF ROOF TILE
IN ACCORDANCE WITH METRO-DADE BUILDING CODE COMPUANCE
PROTOCOL PA 106
ge Du Quesne, P.E.
I Engineer
P #24513
Du •uesne & Associates, Inc.
E.B. License #0005245
Lab Certification #94- 0318.01
SITE SPECIFIC INFORMATION
Job Address q5/ /= 9 3 S
Roofing Contractor 4 A /U
Type of Tile: _ 4� _ ./..." Date Installed -r z 2 - '45
Approximate Roof Height __LE feet �/ Roof Pitch` 3 / 2,-
Type of Access to Roof: Scaffolds I[ Ladder Qth r
e
Approximate Square Footage of Root 5100 ft 2
Required Testing Force: 35 lbs. Testin Chatillion DFIS 100
Date Tested• b l e
TEST RESULTS
Ps PASS, F =FAIL
SKETCH OF ROOF IN BACK
IN ACCORDANCE WITH THE CRITERIA OF PROTOCOL PA 106, THIS ROOF ASSEMB
QUALITY CONTROL TEST.
UTR 13993 ei
Environmental • Civil • Structural
Building Inspection Services
Permit #•
HAS PASSE
l
TiiESTATIC UPLIFT
Please Note: This form is not valid unless
Company logo appears in
color (burgundy)
7821 S.W. 24th Street • Suite 104 • Miami, Florida 33155 • Telephone (305) 264 -1425 • Fax (305) 264 -1426
' • . , 1,
JOB 7/
N1 7 3J7: /4/444/
2
$KETCH OF ROOF
SHEET NO 2- OF
CALCULATED BY 7‘b
CHECKED BY DATE
SCALE
DATE
NOTES
,
1
/
/)
5
Q