PAINTPERMIT APPLICATION FOR MIAMI SHORES VILLA(
Date ( • / t ( ( Job Address ell 15- 57 Tax Folio ,
Legal Description Historically Designated: Yes — No
Owner/Lessee / Tenant 4 c; a �NDbe 1/ d Fide / L2 /tL 4 Master Permit #
Owner's A d d r e s s 1 1/ / U � ' g? 5 7 / , M , 1 S'o /e 5 33 1315 Phone 7 51 - .2 4)1
Contracting Co. 0441 e ✓ Address
Qualifier SS#
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 P a ;, OA'/ 3 d < ,, `L
Phone
Square Ft. z 2, 2 OO St T - f Estimated Cost (value) DO d
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 contractor to do the work stated.
Signature of owner and/or Condo President Date
5-° FEES: PERMIT 3 ' RADON
C.C.F. `C NOTARY
Si�natfu`e of Contractor or Owner- B ilder
. 2e V-7
Notary as to Owner and/or Condo President Date rotary as to Contractor or Owner - Builder Date
My Commission Expires: My Co
ICIAL NOTARY SEAL
0 <. SANDRA M MONTIEL
2
ti \� . * COMMISSION NUMBER
�:�1':. Q CC401281
-1 �" Q ? . MY COMMISSION .EXP.
�OF F. AUG. 17 1998
TOTAL DUE -
Date
6v
APPROVED:
Zoning Building G 1 t
l Electrical
Mechanical Plumbing
Engineering
Issue Date: 6/30/2006
Owner's Name: RYAN AND ELAINE COOPER
Permit Type: Paint
Work Classification: New
Job Address: 41 95 Street NE
Comments:
EXTERIOR PAINTING
Additional Information
Miami Shores Village, FL 33138-
Building Department File Copy
Miami Shores Village
10050 N.E. 2nd Avenue
Miami Shores, FL 33138 -0000
Phone: (305)795 -2204 Fax: (305)756 -8972
Permit
Expires: 12/27/2006
Contractor(s) Phone Primary Contractor
HOME OWNER
Yes
Type of Work: Exterior Color: FAVORITE TAN, SUPERIOR BRONZE
Additional Info: WHITE 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.
Parcel #:
Block:
Section:
Permit Status: APPROVED
Permit Number: PT -6 -06 -1708
Phone: (305)751 -4932
1132060130700
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 Amt Due
PT - 6 - 06 - 25337 $67.30
Total:
C�IUS
JUL 0 5 ph0p
Amt Paid
NOTICE: In addition to the requirements of this permit, there may be additional
restrictions 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 .
,Miami Shores Village 1° 1 ° C °
City F1(18 1 t 6,4012-0_5 State ff.—
Value of Work For this Permit $ 007 '
Building Department
10050 N E 2nd Avenue Miami res Florida 33138
Tel (3 ( : ' isg 756.8972
BUILDING
PERMIT APPLICATION B Y
FBC 2004
Permit Type (circle
Electrical
Is Building Historically Designated YES NO
_Master Permit No.
Plumbing Mechanical
(' Owner's Name (Fee Simple Tit e older) g JIL e---g:: PM. ' Phone # e
Owner's Address 41 o 232)s1-1 fr,
zip 33135
Tenant/Lessee Name Phone #
Job Address (where the work is being done) 4- 1 �� 8 25 S r.
City Miami Shores Village County Miami -Dade Zip -3 13>
n FOLIO / PARCEL #
Contractor's Company Name 0' Phone #
Contractor's Address
City State Zip
Qualifier Name Phone #
State Certificate or Registration No. Certificate of Competency No.
Architect/Engineer's Name (if applicable) Phone #
Square / Linear Footage Of Work:
Permit No. PrO r as
See Reverse side —>
******** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** F * * * * * * * * * * * * * * * * * * * * * * * * * * * * * *
Roofing
7s (2 3
Type of Work: ['Addition IgAlteration ['New ❑ Repair/Replace ❑ Demolition
Describe Work: eac L) f a-s6j fp - \ t r
Submittal Fee $ Permit Fee $ (GC) CCF $ 0 • CO /CC
Notary $ S CO Training/Education Fee $ 0.2C 2C Technology Fee $ 1 'CEI:
Scanning $ Radon $ DPBR $ Zoning $
Bond $ Code Enforcement $ Double Fee $ / �7 \ I�
Structural Review. $ Total Fee Now Due $ 'b / 4 t �1 i, � V 5 MD
Bonding Company's Name (if applicable) e n 4
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 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 appr. • i n • • nspection fee will be charged.
ignature
Sign:
Print:
My Com
Owner • Agent Contractor
The fore oing instrument was acknowledged before me this 2-2- The foregoing instrument was acknowledged before me this
day o , 2(4 qty GW-1 day of , 20 , by
who is personally knownpto- me.or.w,tio has produced who is personally known to me or who has produced
f �� ST� F Fr.
As'dent "itssio A r, d # j ,iX847645 �o dtg� � an oath. as identification and who did take an oath.
� ancJ
NOTARY PUBLIC: NOTARY PUBLIC:
: '
IL- '', ., �E 27 ,o
A`
Expires: N My Commission Expires:
issio
APPLICATION APPROVED BY:
(Revised 02/08/06)
Signature
Le
Sign:
Print:
oto
Plans Examiner
Engineer
Zoning
Date e ia
Owner's Name R G/Vt. (0001.10.0
Owner's Address
� L/ f v e 476 s 4
City : (AAA.; Shorv2 5 State F
Walls
Fascia
Drip Cap /drip Edge
Soffit 01.1V
Roof
Flower bins /
Shutters te✓'k
Railings
Fences
Signature
Decorative metal
All brick (simulated or regular) ""-
APPLICATION APPROVED BY:
Miami Shores Village
Paint Color Approval and Agreement
Owner or Agent
DrtNvv
Awnings
r
Chimney
Doors and door jams
Garage doors c)LAr
Z Pr— cial
Phone # 3o& 3 - 0 6 k
Zip 33(39
Job Address (where the work is being done). q 1 OE' q5
City Miami Shores Village County Miami -Dade
Is Building Historically Designated YES NO
Zip 3 5/7?
Phone #.
Contractor's Company Name (if applicable)
***************************************************************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
All elements on the site must be listed and indicate the color to be painted SGM"t. a00
f'A✓d 5ta AC � � a
3D t t NIZ gig
Stucco banding
Any other stucco features
Accessory Buildings
Other , eteXti (,✓ f ((dogs.
********************************************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
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.
Date
Date
* * * * * * * * * * * * * * * * * **
exA 7/
c,l
clic 6/18/03
Inspection Number: INSP -20894 Permit Number: PT -6 -06 -1708
Inspection Date: 07/24/2006
Inspector: Grande, Claudio
Owner: COOPER, RYAN AND ELAINE
Job Address: 41 95 Street NE
Project: <NONE>
Miami Shores Village, FL 33138-
Contractor: HOME OWNER
Iding Department Comments
Friday, July 21, 2006
Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
JUL 2 5 REC'D
CL.
Block:
Permit Type: Paint
Inspection Type: Final
Work Classification: New
Phone Number (305)751 -4932
Parcel Number 1132060130700
Lot:
Page 2 of 2
1 t
Inspector Comments
Passed 4
Failed
Correction
Needed
Re- Inspection
Fee
($75)
No Additional Inspections can be scheduled
re- inspection fee is paid.
until
Inspection Number: INSP -20894 Permit Number: PT -6 -06 -1708
Inspection Date: 07/24/2006
Inspector: Grande, Claudio
Owner: COOPER, RYAN AND ELAINE
Job Address: 41 95 Street NE
Project: <NONE>
Miami Shores Village, FL 33138-
Contractor: HOME OWNER
Iding Department Comments
Friday, July 21, 2006
Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
JUL 2 5 REC'D
CL.
Block:
Permit Type: Paint
Inspection Type: Final
Work Classification: New
Phone Number (305)751 -4932
Parcel Number 1132060130700
Lot:
Page 2 of 2
Receipt
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL 33138 -0000
Phone: (305)795 -2204 Fax: (305)756 -8972
Permit Number: PT -6 -06 -1708
Invoice Number: PT -6 -06 -25337
Applicant: RYAN AND ELAINE COOPER
Company Name:
Owner Address:
41 NE 95 ST
MIAMI, FL 33138 -2706
Job Address:
41 95 Street NE
Miami Shores Village, FL 33138-
Date
Wednesday, July 5, 2006
07/05/2006 Credit Card
Payment Type Check Number
Amount
$67.30
Change
$0.00
Total Payment: $67.30
Page 1 of 1