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PAINTMIAMI SHORES VILLAGE BUILDING INSPECTION DEPARTMENT APPLICATION FOR BUILDING PERMIT on is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the building or other structure herein 080 GRAYSTONE / us application is made in compliance and conformity with the Building Ordinance of Miami Shores Village, Florida, and all provisions of the Laws of the L -A8C )90) / d a , all ordinances of Miami Shores Village and all rules and regulations of the Building Division of Miami Shores Village shall be complied with. whether herein specified or not. A copy of approved plans and specifications must be kept at building during progress of the work. Owner's Name and Address % 0 & Q 13 r/9-tk Registered Architect and /or Engineer (� Name and address of licensed contractor Location and legal description of lot to be built on: Lot /9 Block Street and Number where work is to be done STATE OF FLORIDA COUNTY OF DADE. SS. Subdivision 47 /1 free 0.P/OGQ- 6 6 v2 ,e 6 c WiPee and for no other purpose. State work to be done and purpose of building I�orsl state exterior colors (submit samples) New Building Remodeling Addition Repairs To be constructed of Y �j Kind of foundation Roo��overing Estimated Total cost of improvements 5 / 0O Amount of Permit $ 9YY�� Zone cubage required Plan Cubage Distance to next nearest building Size of Building Lot Maximum live load to be borne by each floor I hereby submit all plans and specifications for said building. All notices with reference to the building and its construction may be sent to The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligatons as an employer of Labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida. Permanent Supplement. and has complied with the provisions thereof. and will require similar compliance from all contractors or sub-contractors employed by him in the work to be performed under this permit; and will post or cause to be posted for inspection on the site of the work such public notice or notices as are required by the Act. The undersign. = - • 7i mploy only such su j ontra s. . on work be erformed under this permit, as are licensed by Miami Shores Village. Remarks (Signed) Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments. personally appeared and who, being by me first duly sworn, upon oath deposes and says that he is the of the above described construction. that he has carefully read the foregoing a application, and that he did sign the same. and that all facts therein by him stated are true. Date d✓/ 24°0 Read. Sworn to and Subscribed before me. Permit No. Disapproved 1 ' Date (Signed) Building Inspector My Commission Expires PLANNING BOARD DATE Chairman Member Member Member Member Member Council Approved Date Disapproved Date NOTE: A charge of $25.00 will be made for making corrections or changes to this application after approval has been obtained from the Planning Board. A re- inspection fee of $25.00 will be charged when such re- inspection is made necessary by improper notice for inspection or faulty materials and/or workmanship. Date / No.g Street 4 ?91 d I , , /1 ,LW ,o ea 9 No. of Stories Notary Public, State of Florida to me well known, 3(I3 Ok MIAMI SHORES VILLAGE ftti BUILDING DEPARTMENT 305- 795 -2204 Building Inspection Request Date 7 Type Insp'n R r Q 0 ROOD PA Permit No. ZPO5 ° q Name p c4che � Address S q9 H5 l a s4 Company CW NE _ Phone # Inspection Date Approved Correction Re- Insp'n Fee 0 __ fir , 19n) nMssL) G eAA)J2O S.e 61-5 h PA) c� LJ BUILDING PERMIT APPLICATION FBC 2001 Owner's Name (Fee Sirylpl Title o dam) Owner's Address Aka ti, f t( 4 j r 7 ty 1 ,1 i Ci fio / ICt i State ,� � Tenant/Lessee Name Contractor's Company Nam,.. Contractor's Address City Qualifier Architect /Engineer's Name (if applicable $ Value of Work For this Permit Type of Work: ❑Addition EAlteration Describe Work: Total Fee Now Due $ (Continued on opposite side) Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 ea Permit Type (circle): Building, Electrical Plumbing Mechanical Job Address (where the work is being done) ..,) �, e fi h 1 9. City Miami Shores Village County Miami -Dade Is Building Historically Designated ,YES NO _ 1 D State ( i State Certificate or Registration No. Certificate of Competency No. ❑New Code Enforcement $ Structural Plan Review. $ Zip Permit No. ,,')� ;l '� i L& Master Permit No. Phone # qc q; �p C Phone # "Phone# Zip Phone # Square Footage Of Work: Zip Roofing : c :23 CC c;.6 1 ❑ Repair/Replace ❑ Demolition / * * * * * * * * * * * * * * * * * * * * * * * * * * ** Fees * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** Submittal Fee $ :fr Permit Fee $ (O " - CCF $ CO /CC Notary $ / Training/Education Fee $ Technology Fee $ Scanning $ Radon $ Zoning Bond $ • Bonding Company's Name (if applicable) Bonding Company's Address .\i 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. 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 e recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after t uilding permit is issued In the absence of such posted notice, the inspection w not be approve a reinspec,; fee wi .e charged r. di. al I_ .f Signature The foregoing instrument was acknowledged before me this day of who i' fsonally known to me or who produced NOTARY PU Sign: Print: My Commiss .n Expires: APPLICATION APPROVED BY: Chc 05/13/03 Owner or Agent Contracttor by As identification and who did take an oath. Signature 6'1) )0c The foregoing instrument was acknowledged before me this day of ,20,by who is personally known to me or who has produced as identification and who did take an oath. M V' N1©TIR PUBLIC: a o ` •P' • o.• �o': Con—lission 2 Sign: 3 2 007 Y Expires: u , e , Ronded print: ' ;y1lntic Bon. mg Co.. In My Commission Expires: * * * * * * * * * * * * * * * * * * * * * * * * * * ** ****************************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** ****************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** * * * * * * * * * * * * * *4 * * 0 ** *** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** 0? 0.1 Plans Examiner Engineer Zoning Date Owner's Name Owner's Address MA L/U City """ Walls Fascia Drip Cap /drip Edge Soffit Roof Si gnature Miami Shores Village Paint Color Approval and Agreement APPLICATION APPROVED BY: elk W State Job Address (where the work is being done) City Miami Shores Village \R;t7b County Miami -Dade Flower bins Shutters Awnings Chimney Doors and door jams Garage doors Railings Fences Decorative metal All brick (simulated or regular) Stucco banding Any other stucco features Accessory Buildings Owner or Agent a/4 P &ZOfficial ' Phone # Zip Zip Is Building Historically Designated YES NO Contractor's Company Name (if applicable) Phone # ***************************************************************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** All elements on the site must be listed and indicate the color to be painted Attach Color Samples With Numbers r Other ***************************************************************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** OWNER'S AFFIDAVIT: I certify that all the foregoing informatio ' is accurate and that all work will be done m compliance with all applicable laws r ating construction : d zoning. Date Date chc 6/18/03 ■ Miami Shores Village 10050 NE 2nd Avenue Phone: 305 - 795 -2204 Printed: 7/5/2005 Applicant: MARSHA BRADLEY Owner: BRADLEY MARSHA JOB ADDRESS: 899 NE 92 ST Contractor Local Phone: Parcel # 1132060050020 Building Permit Permit Number: BP2005 -984 Contractor's Address: Page 1 of 1 Legal Description: 6 53 42 GOLDEN GATE PARK ADD PB 6 -130 LOT 1 & E1/2 LOT 2 BLK 1 LOT SIZE Fees: Description Amount FEE2005 -9100 Building Painting Fee $60.00 FEE2005 -9101 CCF $0.60 FEE2005 -9102 Training and Education Fee $0.20 FEE2005 -9103 Technology Fee $1.50 FEE2005 -9104 Notary Fee $5.00 Total Fees: $67.30 Total Fees: $67.30 Total Receipts: $67.30 Permit Status: APPROVED Permit Expiration: 12/27/2005 Construction Value: $500.00 Work: CLEAN AND PAINT ROOF Signed: (INSPECTOR) 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: