930 NE 96 StSTATE OF FLORIDA, 1 .
COUNTY OF DADE. j SS'
MIAMI SHORES VILLAGE
Building Inspector
BUILDING INSPECTION DEPARTMENT
APPLICATION FOR BUILDING PERMIT
Application is hereby made for the approval of the detailed statement art the plans and specifications herewith submitted for the build •
ing 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.
Date..._ .._.r L_ L_..._.__..._.. ,19..2 0
Owner's Namc and Address .,....C. t� „... rr ..... No� . . ..41 -,: Street-2.0 1� ...J.4. in t
4.... ��'
Registered Architect hitcct and /or >yngincer l.A�` ..:,. .., ,,.• : .... ........... „ :..
Name and address of licensed contractor..... __. ... _._. ..
Location and legal description of lot to be built on:
Lot Block Subdivision
Street and Number where work is to be done ...9.. -0. f✓ 1_ .. �_ '^-
0 State work to be done and purpose of building (by floors)..... .. ."^ .. .._)..
__...�.__ and for no other purpose.
New Building / ~ O Remodeling Addition Repairs No. of Stories
To be constructed of Kind of foundation Roof Covering
Estimate Total cost of improvements S•...D D (), 0 0 Amount of Permit $.
Zone cubage required .Plan Cubage
Distance .to next newest building.. Size of Building Lot
Maximum live load to be borne by each floor
I hereby submit all the 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 dots hereby certify that he understands and accepts his obligations as an employer
of labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida, Pertnxnent Supplement.
and has complied ss ith 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
pertnit, as are licensed by Miami Shores Village.
R emarks (Signed) _ .._......__.._:........_._...
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally ap-
peared
My Commiuion Expires
_ Y c
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.
Permit No.. _.... '15 O C 6 Date 5t a 9 /7 0 Read, Sworn to and Subscribed before me.
Disapproved ; . P ` Date
Notary Public, State of Florida
(Signed)
PLANNING BOARD DATE
C'rtairtnan Member
Nicrr,bcr Member
Member.. ... _.....__....._..._. ....._..... Member ....-
Council Approved Date Disapproved Date
NOTE: A charge of $1.00 will be made for making corrections or changes to this application after approval has been obtained from
the Planning Board.
A re- inspection Ice of $1.00 will be charged when such re- inspection is made necessary by improper notice for inspection at faulty
materials and /or workmanship.
Leg
Owne
Dat ya� b Address)( x IVI 5 Tax Folio / ".3.z0/6 /� - ;?44 1 , (
B a ride, L,Dr — 4-b - s
enant
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PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
4)#: 9
Contracting Co./ 0 60/Ueg.
Qualifier SS# -
v2.5 Master Permit # -
Phone - , 5 e 8
Address
Phone
State # Municipal # Competency # Ins. Co.yJI9'T) r 01
Architect /Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type(circle one': BUILDIN2ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIPTION At - </((. d /f2oy ' IJ *LL
Square Pt. Estimated Cost(value/ e-A
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 cons uction and zon g. Furthermore, I
authorize the above -named contractor to do the work stated.
Signature of owner and /or Condo President
Date:
Notary as to Owner and /or Condo President
My Commission Expires:
ignature o
Date:
n ractor . Owner- Builder
Not ty /as to Contractor or Owner- Builder
My Oommission Expires*
TARY PUBLIC STATE OF PI.O A
MY COMMISSION EXP. P4AY 13,1906
BONDED THRU GENERAL INS. U1M.
** * * * * * * * * t * * * * * * * .y/ **
1
FEES: PERMIT /� RADON C.C.F. f NOTARY TOTAL DUE 60
APPROVED: Fire Other
Zoning Buildi • L' Electrical
Mechanical Plumbing. Engineering
MIAMI SHORES VILLAGE
BUILDING DEPARTMENT
305- 795 -2204
Building Inspection Request
Date '1 A 4)`(
Type Insp' n Y1..OLP
Permit No. P 04- a b
Name
Address
Company
Phone #
E o yoi' amd tkacr f fitr i rD�
Qk sr
Inspection Date
Approved
Correction
Re- Insp'n Fee
&35 .- - 7 5 ^ 1 — g IS 7 7
4
Miami Shores Village
10050 NE 2nd Avenue
Phone: 305 - 795 -2204
Printed: 1/15/2004
Building Permit
Permit Number: BP2004 -26
Applicant: SARAH & KARI TRITON
Owner: TRITON SARAH & KARI
JOB ADDRESS: 930 NE 96 ST
Contractor
Local Phone:
Parcel # 1132060143010
Contractor's Address:
Legal Description: MIAMI SHORES SEC 3 PB 10 - 37 LOT 8 & E1/2 OF LOT 9 BLK 76 LOT SIZE
Fees: Description Amount
FEE2004 -424 Building Painting Fee $60.00
FEE2004 -425 CCF $0.60
FEE2004 -426 Notary Fee $5.00
FEE2004 -427 Training and Education Fee $0.20
FEE2004 -428 Technology Fee $1.50
FEE2004 -429 Scanning Fee $3.00
Total Fees: $70.30
Total Fees: $70.30
Total Receipts: $70.30
Permit Status: APPROVED Permit Expiration: 7/10/2004 Construction Value: $800.00
Work: PANT EXTERIOR OF HOUSE AS AGREED
Signed: (INSPECTOR)
Page 1 of 1
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:
Miami Shores Village
10050 NE 2nd Avenue
Phone: 305 - 795 -2204 Permit Number: BP2004 -26
Printed: 1/15/2004
Applicant: SARAH & KARI
Owner: TRITON
JOB ADDRESS: 930 NE 96
Contractor
Local Phone:
Parcel # 1132060143010
Signed: (INSPECTOR)
Building Permit
TRITON
SARAH & KARI
ST
Contractor's Address:
Page 1 of 1
Legal Description: MIAMI SHORES SEC 3 PB 10 -37 LOT 8 & E1/2 OF LOT 9 BLK 76 LOT SIZE
Fees: Description Amount
FEE2004 -424 Building Painting Fee $60.00
FEE2004 -425 CCF $0.60
FEE2004 -426 Notary Fee $5.00
FEE2004 -427 Training and Education Fee $0.20
FEE2004 -428 Technology Fee $1.50
FEE2004 -429 Scanning Fee $3.00
Total Fees: $70.30
Total Fees: $70.30
Total Receipts: $70.30
Permit Status: APPROVED Permit Expiration: 7/10/2004 Construction Value: $800.00
Work: PANT EXTERIOR OF HOUSE AS AGREED
JAN 16 pA�
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:
BUILDING
PERMIT APPLICATION
FBC 2001
Type of Work: ]Adddiit ❑Alterati
Describe Work: - ` k oQ, �� \ V &
Scanning $ 3-00
Radon $
Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
Master Permit No.
Permit Type (circle): Buildi Electrical Plumbing Mechanical Roofing
Owner's Name (Fee Simple Titleholder) a(R6 SQ \ a4A1A Phone #
Owner's Address 0 N. )E (>�
City1 M k(\ &k.C3a.e . State
Zip 3 ` '
Tenant/Lessee Name Phone #
•
Job Address (where the work is being done) 2 ) �Q \
City Miami Shores Village County Miami -Dade Zip
Is Building Historically Designated YES NO
ncurle.�' - ,
Contractor's Company Name
Contractor's Address
City State Zip
Phone #
Qualifier
Architect/Engineer's Name (if applicable) Phone #
$ Value of Work For this Permit kb S ® O
Code Enforcement $ Structural Plan Review. $
Total Fee Now Due $ w . L C.
(Continued on opposite side)
Square Footage Of Work:
IFFr
k
Permit No. 6000 i
['New ❑ Repair/Replace ❑ Demolition
Cad Yk \1.)
b o 2 Ga -AG U
* * * * * * * * * * * * * * * * * * * * * * * * * * ** F ees * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
Submittal Fee $ Permit Fee $ (C0.00 CCF $ K CO /CC
Notary $ ). 00 Training/Education Fee $ 0 Technology Fee $ 1 -SO
Zoning Bond $
Bonding Company's Name (if applicable)
Bonding Company's Address `+
City State Zip
Mortgage Lender's Naine (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 pasted notice, the
inspection will not be approved and a reinspection fee will be charged.
Owner or Agent Contractor
The foregoing instrument was acknowledged before me this fa foregoing instrument was acknowledged before me this
day of� J , 20(.13, b 5 �i � day of , 20 , by
who is personally known to me or who has produced who is personally known to me or who has produced
i\ ilifici(1 'and' take an oath. as identification and who did take an oath.
4... - mission #DD231984
NOTARY P BL IC: :,* Expi ' Jul 13, 2007 NOTARY PUBLIC:
Q. on. - r .
Sign: ,., ■' . °..' .ir�R�
. B .:rl!R!!li'.!�� Sign:
Print: arI C, Print:
chc 12/15/03
My Commission Expires:
Signature
My Commission Expires:
(Certificate of Competency Holder)
State Certificate or Registration No. Certificate of Competency No.
************************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ******* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
APPLICATION APPROVED BY:
JAN 1 3 2004
Plans Examiner
Engineer
Zoning
IF •
I
Datd3(\ t2 O ee ¢¢ CC
Owner's Name - S A laCZ 1 `� P��O\ Phone # -4 5 -
^ U O
Owner's Address _ \ a 0 ) G c (o p�
City IINVa3Pkk SEQC 2 State .1. Zip n k 3 F�
Job Address (where the work is being done) 9 0 L ` `' \ cS'
City Miami Shores Village County Miaui -Dade 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
Walls V•PA T
Fascia G\1 k.-(i'T •
Drip Cap /drip Edge •11-k111—
Soffit (N 'k(
Roof VJ l- TE
Flower bins �1 ( � •
Shutters - r 6t2.43V4
Miami Shores Village
Paint Color Approval and Agreement
Awnings W tTc
Chimney kJ ( P'
Doors — 1/4 7 .. T 91Q0W 1•> Cel<iS'Z1 Cc&o ✓)
Garage doors WckcCe
Railings AN k
Fences h14-k
Decorative metal ■1■'Xt
All brick (simulated or regular) J 4
Stucco banding %% P r
Any other stucco features I I •
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 an zoning.
Signatur
�L1 AW 1 » r
Owner or Agent
APPLICATION APPROVED BY:
P& Z cial
A tt i 1
Date 0% t \ \0 _
Date
W0`
chc 6/1$/03