PAINTApplication is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the building or other structure herein
described. This application is made in compliance and conformity with the Building Ordinance of Miami Shores Village, Florida, and all provisions of the Laws of the
State of Florida, 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 �d 7 7l "/ p'
MIAMI SHORES VILLAGE
BUILDING INSPECTION DEPARTMENT
APPLICATION FOR BUILDING PERMIT
Registered Architect and/or Engineer
Name and address of licensed contractor ' r (;f Sill o! i i /A ^ //! 5 So, ‹ 3/65
Location and legal description of lot to be built on: 0. 717/7g / / Q �/ k � j
Lot / Block Subdivision �w� �ai J 3,,i / �/ V /
Street and Number where work is to be done ii 6,96 (j i '
State work to be done and purpose of building (by floors), state exterior colors (submit samples) X I'f' d i U d' G i vz 47.: -1 h t 4 /e::2,---,-
61 ? / .'3"- 0-0 r.., h, l Y4,4 I/d _ 0 ,,,_ .1 re - 1/2 . 6 a 4G! / dl ti..-4 d 7t� t� / ,,- i Q /;Y
/ and for no other purpose.
New Building Remodeling Addition Repairs (/ No. of Stories 2
To be constructed of Kind of foundation , Roof Covering
O?/L F4�
Estimated Total cost of improvements S Y.500 Amount of Permit $
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 undersigned agrees to employ only such subcontractors, on work to be performed
under this permit, as are licensed by Miami Shores Village.
Remarks ' (Signed)
STATE OF FLORIDA
COUNTY OF DADE. } ss.
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeared
to me well known.
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 application, and that he did sign the same, and that all facts therein by him stated are true.
Date
Permit No.
Disapproved Date
(Signed)
Building Inspector
Date
No. /
Read, Sworn to and Subscribed before me.
`- /
7 ' Street !/! f 1
Notary Public, State of Florida
My Commission Expires
PLANNING BOARD DATE
Chairman Member
Member Member
Member Member
Council Approved Date Disapproved Date
NOTE: A charge of S25.00 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 S25.00 will be charged when such re- inspection is made necessary by improper notice for inspection or faulty materials and /or workmanship.
I-
Permit Type (circle one):
WORK DESCRIPTION:
PERMIT APPLICATION:FORMIleM1 SHOVES VILLAGE
• .. • • • • • • •
10050 N.E. 2nd Avenue • Miami Shores, Flarida3198 'Mope: 3Q5 -795 -2204 • Fax: 305- 756 -8972
LSD to / 1 - c 'C rob Address ( N E.. °3 J v
Legal Description N4tofic3113:Deandte4
Owner /Lessee/Tenet �'QiC2
Owner's Address \C �ti �. \ �5\
Square Ft.
L >) L
Netary as t caner and/ Condo Presi nt LI ifde
My Commission Expires flit flit Becku;
. euc Angela
r " t ,,q y Commissic» DD t 5G 4t
' rnue :rvembet 15 COOP
FEES: PERMIT 0 RADON
APPROVED:
Zoning ..a'I 144 ¢' a � • Building
Mechanical
• ... • • • • •••
Tax Folio
• • • • •••
• • • • • • •
• • • • • • • • • • •
•
A F � e•PAiit #
•• • • • •• ••• ••
• • • . • itope
C.C.F � 0
•
•• • • • • • ••• • .
Contracting Co. Address
Qualifier SS#
State # Municipal # Competency #
•
ELECTRICAL PLUMBING
No
Phone
Ins. Co.
IF THERE IS NO PERMIT PACKAGE ACCESSIBLE ON THE JOB SITE FOR INSPECTORS TO VERIFY,
THERE WILL BE NO INSPECTION. RE- INSPECTION FEE IS $50.00 AND MUST BE PAID IN ADVANCE
BEFORE CALLING FOR ANOTHER INSPECTION.
MECHANICAL
ROOFING
C -CV‘ C;c\�_ C VC \i l ' 1 C>VuC'
Estimated Cost (value) (7 \3 V
--•
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 ANY 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 all disciplines.
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. Furthermore, I authorize the above named contractor to do the work stated.
&keg Y /k
Signature of owner and/or Condo President ate Signature of Contractor or Owner Builder Date
3s�— If
Notary as to Contractor or Owner Builder Date
My Commission Expires
NOTARY - 0 0 BOND
TOTAL DUE S r✓ 6
Electrical
Plumbing Structural Engineer
1111L X.A. V �_11. -IL v ■L 1..1 V 1L L - 11. J 1-J
Building Offic
DATE: l - 03
OWNER'S NAME: P ONE:. - 1Sbf13 k
ADDRESS: O' ►� ..: �' �� a:� vt/\S
************ * * * * * * * * * * * * * * * * * * * **:* **•, **;; * * *r* *r* * * * * * * * * * * * * * * **
ADDRESS OF SITE:
CONTRACTOR & LICENSE (if applleabll) : : • • • • •
COMPANY NAME: : PHONE:
.' 1 ********************************* * * * * * * * * * * * * * * * * *** * * ** * * * * * * **
All Elements n the site must be listed and indicate the color to be painted.:.
Walls ( _ .:.
Fascia
Paint Color Approval and Agreement • •
•
Drip Cap/D . Edge
Soffit a
Roof w? •
Flower Bins
Shutters CZ)
Awnings (A)
Chimney W l off - ,r, IL
Doors and door 'ams (2�
Garage Doors - 4- a)
Railings (
Fences �2
Decorative Metal
All brick (simulated or regular) VI-
Stucco Banding k c A k " b ea k r 9 a, 61,
Any other stucco features
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 applicable laws regulating
construction and zoning. I authorize the above -named contractor, if applicable, to
do the work stated. Furthermore , the paint colors will be as per the attached
p
Signature of Owner ' e Signature of Contractor Date
*********************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
APPROVED: WHEN PAINTING IS FINISHED,
// CALL FOR FINAL INSPECTION
Date
•• •• • • • •• •• •
• • • • • • • • • •
• • • ••• • • •
• • • • • • • • • • • •
•
• • • ••••
4/23/01
Miami Shores Village
10050 NE 2nd Avenue
Phone: 305 - 795 -2204
Printed: 4/8/2003
Applicant: NELSON
Owner: ADAMS
JOB ADDRESS: 1098
Contractor
Local Phone:
Parcel # 1132050120010
Permit Status: Approved Permit Expiration: 10/5/2003
Work: EXTERIOR PAINTING AS PER AGREEMENT
If there is no permit package accessible on the job -site for inv.
fee is $50.00, which must be paid in advance before calling for
This Permit is granted to the contractor or builder named above to construct the bL
ordinances pertaining thereto and with the understanding that the work will be perforr
and approved by the proper municipal authorities. This Permit may be revoked at an
authorization. A further condition upon which this permit is granted is the understand
ordinances and regulations pertaining to the work covered hereby whether shown on
by his agents, servants or employees.
Signed:
ADAMS
NELSON
NE 95 ST
(INSPECTOR)
In consideration of the issuance to me of this permit, I agree to perform the work o
with the plans, drawings, statements or specifications submitted to the proper author.,.
myself, my agent, servants or employes.
Signed: (Contractor or Builder)
Building Permit
Permit Number: BP2003 -549
Contractor's Address:
Legal Description: KIRBYS ADD TO MIAMI SHORES
Fees:
FEE2003 -2051
FEE2003 -2052
FEE2003 -2053
Description
Building Permit Application Fee
CCF
Notary Fee
Total Fees:
Amount
$60.00
$0.60
$5.00
$65.60
Total Fees: $65.60
Total Receipts: $0.00
NELSON L ADAMS, M.D.
EFFIE R. ADAMS
1098 N.E. 95TH STREET
MIAMI SHORES, FL 33138
Pay to the
order of
BankofAm rica.
ACH R/r 063100277
For
BY:
Page 1 of 1
PB 41-44 LOT 1 LOT SIZE 34880 SQ
1516
Date 1 1 -
63- 27/631 FL
966
Bank of America Advantage
_-\./---tea' --• -• .. _1