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PT-09-1795 Miami Shores Village �. 10050 N.E. 2nd Avenue, Miami Shores, FL 33138 -0000 Phone: (305)795 -2204 3 1 ' Expiration: 091291 Project Address Parcel Number Applicant 425 95 Street 1132060140610 Miami Shores, FL Block: Lot MIAMI SHORES BAPTIST CH Owner Information Address Phone Cell MIAMI SHORES BAPTIST CH 370 GRAND CONCOURSE AVE (305)758 -0559 MIAMI FL 33138 -2753 Contractor(s) Phone Cell Phone Valuation: $ 1,000.00 HOME OWNER _.._.. Total Sq Feet: 0 Type of Work: Exterior For Inspections please call: Color. (305)7624949 Additional Info: Available inspections: Classification: Residential Inspection Type: Color: Approved Code Comments. BEHR - WALL S - APRIL MIST 450 Final Color: Approved_ Color. _Denied Fees Due Amount Invoice # Total Amt Paid Amt Due CCF $0.60 PT- 10-09 -36271 $ 67.30 $ 67.30 $ 0.00 Education Surcharge $0.20 Miscellaneous Fee $1.50 Check #: 39809 Notary Fee $5.00 Permit Fee $60.00 Scanning Fee $0.00 Total: $67.30 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 November 03, 2009 Authorized Signature: Owner / Applicant / Contractor / Agent Date Building Department Copy November 03, 2009 1 Miami Shores Village Building Department OCT 3 0 20 10050 N.1-;.2nd Avenue, Miami Shores, Florida 33138 ...... Tel: (305) 795.2209 Fax: (305) 756.$972 BUILDING Permit No. PERMIT APPLICATION Master Permit No. P BC 2004 eermit Tyne: PAINT PERMIT Owner's Name (Fee Simple Titleholder) IN stte ,f-f A&47c.r- � C ne � # -��' - 1 S' J f Owner's Address r tV s� City rl\ t t t 1' wAl, -/ State FL Zip Dr Tenant/L.essee Name nn �/(!� Phone # E- MAIL:- - atr�A W 2vF/ il 1j�G+O� GOr. Job Address (where the work is being done) (-ity Miami Shores Village County Miami -Dade Zip 71/ -7 FOLIO / PARCEL # Is Building Historically Designated YES NO Contractor's Company Name _ ow Phone # Contractor's Address City_ State Zip Qualifier Name Phone # State Certificate or Registration No. Certificate of Competency No. OWNER BUILDER: /"\(A �t f /111 In-Ca CHViL c Value of Work For this Permit $ Z.0 O Type of Work: ❑ Addition / ❑ Alteration / ❑New epair /Replace scribe Work: C, r- yv1 - k AS w4t e- Aj r l-i� �•tit/►'� r A llication is hcrebv made to obtain a permit to do the work and installations as indicated. 1 certify thatno work or installation has commenced prior to the issuance of a pennit a that all work will be perlormed to meet the standards ofall laws regulating construction in this jurisdiction. 1 understand that a separate'p3ermit must besearrgd tier C "I'RICAI. WORK. MAJIVIBING, SIGNS WELLS, POOLS. I'URNACES, BOILERS, HEATERS. TANKS and AIR CONDITIONERS. ETC..... =ARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR 1WROVEMENTS TO YOUR PROPERTY. IF YOU INTEND - 1'0 OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORt. Rh,'ORDING YOUR NO'T'ICE OF COMMENCEMENT." ce lo. I pplicant: As a condition to the issuance cola building permit u2ith an estimated value exceeding $2500, the applicant roust promise in good laith Iliac u copy of the notice of cornrnencement and construction lien Icnr• brochure will he delivered to the person whose property is subject to attachment. Also. a certified cop)' of the recorded notice 4 wrmrnencenrent nnal he posted at the job site,for the first inspection which occurs seven (7) days after the building permit is issued. In the ahsence of such listed notice. the r'lre ciion will not be approved and a reinspection, fee will he charged. G rmit Fee $. L1dv • CCF $ y Technology Fee: wining /Education Fee Notary $ Code Enforcement $ uble Fee $ Zoning $ Total Fee Now Due $ (e2 0 OCT 3 0 F'.. See Reverse side -> C�4�°� PAINT COLOR APPROVAL AND AGREEMENT All elements on the site must be listed and indicate the color to be2{iiated Directions: Please circle corresponding number to appropriate color sample— Walls: 1 2 3 4 Atta eoior samoks with Fascia: 1 2 3 4 Drip Cap /Drip Edge: I 2 3 4 C, Soffit _ _ 2 3 4 1 ;i Roof: 1 2 3 4 Flower Bins: 1 2 3 4 Shutters: 1 2 3 4 450E -2 4 Awnings 1 2 3 4 2 April Mist Chimney: 1 2 3 4 Doors and Door Janis: 1 2 3 4 Garage Doors: 1 2 3 4 0 Railings: f 2 3 4 3 Fences: 1 2 3 4 All brick (simulated or regular): I 3 4 Stucco Bandin «: I 2 3 4 l Any other Stucco Features: 1 2 3 4 �. 4 i Accessory Buildings Other: OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all :wiN W40ne i compliance with all applicable laws regulating construction and zoning. Signature Signature Owner or Agent Contrnetor The fo o ins eiu was a no ` � edged e me thi l The foregoing instrument wasacknowhxlged before me ttriS , day of _ . 20 . by 1 day of • 20 _. by who is c %onally known t�o me ^ or who has produced who is personally known to me or who has pruducmd ' ttl.siEl ntiiticat an wh did take �u► oath. as idtntifteaiit»t eaten did • NOTAft U L �39 ARY PUBLIC; i- ��d Sign: c St �,i►1�3c. . Print: tnt: My Commission Expires: � `� ��ti �� My Commission Expires: va APPLICATION APPROVED BY: P °ncsr Pr ei Code corium (Revisbd`04/24ffi, Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP - 128233 Permit Number: PT Scheduled Inspection Date: December 29, 2009 Permit Type: Paint Inspector: Bruhn, Norman Inspection Type: Final Owner: CHURCH, MIAMI SHORES BAPTIST Work Classification: New Job Address: 425 NE 95 Street Miami Shores, FL Phone Number (305)758 -0559 Parcel Number 1132060140610 Project: <NONE> Contractor: HOME OWNER Building Department Comments PAINT EXTERIOR OF THE HOUSE Inspector Comments Passed�� Failed Correction ❑ Needed Re- Inspection ❑ Fee No Additional Inspections can be scheduled until re- inspection fee is paid. December 28, 2009 For Inspections please call: (305)762 -4949 Page 8 of 18