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1255 NE 95 St (2)1f Inspection Number: INSP -10434 Inspection Date: 04/05/2006 Inspector: Grande, Claudio Permit Type: Paint Inspection Type: Final Owner: WILLENBORG, BLAINE AND LORI Work Classification: Miscellaneous Job Address: 1255 95 Street NE Miami Shores Village, FL 33138 -2304 Project: <NONE> Contractor: HOME OWNER Building Department Comments Tuesday, April 4, 2006 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: j305)795 -2204 Fax: (305)756 -8972 Block: 6. 4 - Permit Number: PT -2-06 -460 Phone Number (305)754 -2604 Parcel Number 1132060144000 Lot: Page 1 of 2 Passed 4 71 : , ;( Inspector Comments Failed Correction Needed Re- Inspection Fee ($75) No Additional Inspections can be scheduled re- inspection fee is paid. until 1f Inspection Number: INSP -10434 Inspection Date: 04/05/2006 Inspector: Grande, Claudio Permit Type: Paint Inspection Type: Final Owner: WILLENBORG, BLAINE AND LORI Work Classification: Miscellaneous Job Address: 1255 95 Street NE Miami Shores Village, FL 33138 -2304 Project: <NONE> Contractor: HOME OWNER Building Department Comments Tuesday, April 4, 2006 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: j305)795 -2204 Fax: (305)756 -8972 Block: 6. 4 - Permit Number: PT -2-06 -460 Phone Number (305)754 -2604 Parcel Number 1132060144000 Lot: Page 1 of 2 FBC 2001 Miami Shores Village City fit( UM; £kbre.S Tenant/Lessee Name Owner's Address /ass AJE Building Department State BUILDING PERMIT APPLICATION i ' ` 2 Permit Type (circle): Building Electrical Plumbing Owner's Name (Fee Simple Tit e o der) LOV1 ; l'lu✓1 . I,CJi i!C'IY1 Job Address (where the work is being done) /G55 n/6 • City Miami Shores Village County Miami -Dade Is Building Historically Designated YES NO y Contractor's Company Name; (L3YL ? ✓ Phone # 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 10001 CtJ Square Footage Of Work: Type of Work: ['Addition ['Alteration [New ❑ Repair/Replace r] Demolition Describe Work: 2-(Prt e e,i o F hor -,-e_ * * * * * * * * * * * * * * * * * * * * * * * * * * ** Fees * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** Submittal Fee $ Permit Fee $ '0 . e, CCF $ } ()C) CO /CC Notary $ 5 Training/Education Fee $ i7L) Technology Fee $ 1- 0 Scanning $ Radon $ Zoning Bond $ Code Enforcement $ Structural Plan Review. $ Total Fee Now Due $ 7 .) . (.,/l CL I0-6 (Continued on opposite side) 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: X25 795 2204 Fax (305) 756.8972 Permit No. PT - aster Permit No. Zip .33/35 Phone # Mechanical Roofing Phone # i 75 "Z6O t Zip 33/3J 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: 1 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 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 day of chc 05/13/03 NOT • ' Y ' UB IC: Sign: Print: My Co mission Expires: Owner or Agent Contractor The foregoing instrument was acknowledged before me th -V) The foregoing instrument was acknowledged before me this LV 2 by , Uv i I `. ir" day of APPLICATION APPROVED BY: Signature ,20 _,by who is personal! - known to me or who has produced who is personally known to me or who has produced As identification and who did take an oath. as identification and who did take an oath. NOTARY PUBLIC: Sign: Print: My Commission Expires: * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** ********************************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** **** 1& / * * * * * * * * r * * * * * * * * * * * * * * * * * * * ** v1 vta 1 4 \ (up Plans Examiner Engineer Zoning Date �o�- O �1 ([ ` � 1' 1 6la -)r1 - L- (J�d1 e+'� � Phone ) /_ '� Owner's Name �' Owner's Address ( /d. 5 �� G 1 j `-' [ S#' City /7/.4..}. kl-Orel State Ki • Zip 33/A Job Address (where the work is being done) J b J5 N • City Miami Shores Village County Miami -Dade Is Building Historically Designated YES NO X Contractor's Company Name (if applicable) Phone # ***************************************************************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** All elements on the site must bt listed and indicate the color to be painted Walls -d - 3 Fascia Drip Cap /drip 1_ ) Soffit W 6 ' J Roof Flower bins Shutters Awnings Chimney Railings Signature •T Miami Shores Village Paint Color Approval and Agreement °700 -1 5 - ---) Doors and door jams` (,c ) Garage doors /1 0 Zip 33/3,' 350C -3 Applesauce W -B -200 " Popped Corn Fences Decorative metal All brick (simulated or regular) Stucco banding 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. /a, ) APPLICATION APPROVED BY: P& Z Official Date Date \- chc 6/18/03 Located at: Owner Owner VILLAGE OF MIAMI SHORES BUILDING DEPARTMENT OWNER BUILDER DISCLOSURE .STATEMENT 0 _,L1Ledtbuy \ being the legal property owner, for the property Legally described as Do hereby petition the Village of Miami Shores to act as my own contractor pursuant to the laws of the State of Florida, F.S. 489.103(7),s'}nd I have read and understand the following disclosure Statement, which entitles me to cork as my own contractor, I further understand that I as the owner must appear in person to complete all applications. DISCLOSURE STATEMENT State law requires construction to be done by licensed contractors. You have applied for a permit under an exemption to that law. The - exemption allows you, as the owner of your property, to act as your own contractor even though you do not have a license. You must supervise the construction yourself. You may build or improve a one - family or two - family residence or a farm out - building. You may also build or improve a commercial building at a cost of $25,000.00 or less. The building must be for your own use and occupancy. It may not be built for sale or lease. If you sell or lease a building you have built yourself within one year after the construction is completed, the law will presume that you built it for sale or lease, which is a violation of this exemption. You may not hire an unlicensed person as your contractor. It is your responsibility to make sure that people employed by you have licenses required by state law and by county or municipal licensing ordinances. Any person working on your building who is not Icensed must work under your supervision and must be employed by you, which means that you must deduct F.I.C.A. and with- holding tax and provide workers' compensation for that employee, all as prescribed by law. Your construction must comply with all applicable laws, ordinances, building codes and zoning regulations. Proof of ownership provided ( ) initial of reviewing clerk. The foregoing instrument Was acknowledged before me this day of , 20 B who is personally known to me or who has Produced as identification and who did take an oath. Notary Issue Date: 2/27/2006 Owner's Name: LORI WILLENBORG Permit Type: Paint Work Classification: Miscellaneous Job Address: 1255 95 Street NE Comments: EXTERIOR PAINTING Additional Information Miami Shores Village, FL 33138 -2304 Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL 33138 -0000 Phone: (305)795 -2204 Fax: (305)756 -8972 Permit Expires: 02/23/2007 Contractor(s) Phone Primary Contractor HOME OWNER Yes Type of Work: Exterior Color: APPLESAUCE, POPPED CORN, EVERG 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. Building Department File Copy Applicant Signature Parcel #: Block: Section: Permit Status: APPROVED Permit Number: PT- 2- 06-460 Phone: (305)754 -2604 1132060144000 Lot: PB: Total Square Feet: 0 Total Valuation: $ 1,000.00 Required Inspections Final Fees Due CCF Education Surcharge Notary Fee Permit Fee Technology Fee Total: Amount $0.60 $0.20 $5.00 $60.00 $1.50 $67.30 Invoice Number PT - 2 - 06 - 23921 Total: Amt Due $67.30 Amt Paid $67.30 $67.30 NOTICE: In addition to the requirements of this permit, there may be additional restriotions 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.