PAINTDate
Type Insp'n
Permit No.
Name
Address
Company
Phone #
Inspection Date
Approved
Correction
Re- Insp'n Fee
MIAMI SHORES VILLAGE
BUILDING DEPARTMENT
305- 795 -2204
Building Inspection Request
.. _ _- — Miami Shores Village
RECEIVE
FR 2 2004 ; Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
• Tel: (305) 795.2204 Fax: (305) 756.8972
BUILDING
PERMIT APPLICATION
FBC 2001
Permit No.
Master Permit No.
Permit Type (circle): Building Electrical Plumbing Mechanic ai Roofing
as �
Owner's Name (Fee Simple Tit e older) je,e4 ft (- - Phone #
Owner's Address 1.11 fJE 11 t-{'(&
City !n S lizlie S State Zip 33 (j
Tenant/Lessee Name Phone #
Job Address (where the work is being done) (l (s" WE ? t4tL
City Miami Shores Village County Miami - Dade Zip
Is Building Historically Designated YES NO
Contractor's Company Name Phone #
Contractor's Address
City State Zip
Qualifier
Architect/Engineer's Name (if applicable) Phone #
$ Value of Work For this Permit
Type of Work: ❑Addition DAlteration ❑New
Describe Work: P4:4 (,vT�. / `
t
Total Fee Now Due $d t 3 n (J
(Continued on opposite side)
yam.
*********** F * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
Submittal Fee $ Permit Fee $ 0
3t5' �-5 13 s{
Square Footage Wo rk:
1
❑ Repair/Replace ❑ Demolition
CCF $ b CO /CC
Notary $ 5 -0 Trainiog/Education Fee $ R 0 Technology Fee $ l , - o
Scanning $ Radon $ Zoning Bond $
Code Enforcement $ Structural Plan Review. $
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: 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 no be approved and a reinspection fee will be charged.
Signature Signature
NOTARY
Sign:
Print:
Contractor
The forego t - instrument was The foregoing instrument was acknowledged before me this
day of , 2001, by day of , 20 by
who is personally known to me or who has produced F L who is personally known to me or who has produced
D ;! - Is identification and who did take an oath. as identification and who did take an oath.
NOTARY PUBLIC:
Sign:
„ Print:
f..,r'rar i ;, ;%U06
My Commission Expires:
State Certificate or Registration No. Certificate of Competency No.
******************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** * * ** * F i ll * * ** * * * * * * * * * * * * * * * * * * * * **
APPLICATION APPROVED BY:
Chc 12/15/03
(Certificate of Competency Holder)
(:e?? do?
My Commission Expires:
Plans Examiner
Engineer
Zoning
. Miami Shores Village
Paint Color Approval and Agreement
Date f g
Owner's Name
Owner's Address
City pltfet -01 e5
Job Address (where the work is being done) ve / 5
City Miami Shores Village County Miami -Dade Zip 3 1
Ls Building Historically Designated YES NO X
Contractor's Company Name (if applicable) Phone #
***************************************************************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
All elements on the site must be listed and indicate the color to be painted
✓ Walls
Fascia
Drip Cap /drip Edge
t/ Soffit (.
Roof
Flower bins
Shutters
Awnings
Chimney
;Doors and door jams
/ Garage doors
Railings
Fences
Decorative metal
( Pe-re
e c I L •
State T Zip 35 1
fAl
V
All brick (simulated or regular)
Stucco banding
Any other stucco features
Accessory Buildings
Other
V■(
Signature
APPLICATION APPROVED BY:
Phone # 365
•
•
***************************************************************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
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 �/� 7
Date 36 64r
P& Z Offi t'1 chc 6/18/03
Miami Shores Village
10050 NE 2nd Avenue
Phone: 305 - 795 -2204 Permit Number: BP2004 -259
Printed: 2/27/2004
Applicant: JOEL PEREZ
Owner: PEREZ JOEL
JOB ADDRESS: 1167 NE 99 ST
Contractor
Local Phone:
Parcel # 1132050180080
Signed: (INSPECTOR)
Building Permit
Contractor's Address:
Legal Description: REV PL MIAMI SHORES SEC 8
Fees: Description Amount
FEE2004 -2168 Building Painting Fee $60.00
FEE2004 -2169 CCF $0.60
FEE2004 -2170 Notary Fee $5.00
FEE2004 -2171 Training and Education Fee $0.20
FEE2004 -2172 Technology Fee $1.50
Total Fees: $67.30
Total Fees: $67.30
Total Receipts: $67.30
Permit Status: APPROVED Permit Expiration: 8/24/2004 Construction Value:
Work: EXTERIOR PAINTING
Page 1 of 1
PB 43 -69 LOT 19
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:
BLK 178 LOT
Miami Shores Village
10050 NE 2nd Avenue
Phone: 305 - 795 -2204 Permit Number: BP2004 -259
Printed: 2/27/2004
Applicant: JOEL PEREZ
Owner: PEREZ JOEL
JOB ADDRESS: 1167 NE 99 ST
Contractor
Local Phone:
Parcel # 1132050180080
Signed:
(INSPECTOR)
Building Permit
Contractor's Address:
Legal Description: REV PL MIAMI SHORES SEC 8
Page 1 of 1
PB 43 -69 LOT 19
Permit Status: APPROVED Permit Expiration: 8/24/2004 Construction Value:
Work: EXTERIOR PAINTING
Fees: Description Amount
FEE2004 -2168 Building Painting Fee $60.00
FEE2004 -2169 CCF $0.60
FEE2004 -2170 Notary Fee $5.00
FEE2004 -2171 Training and Education Fee $0.20
FEE2004 -2172 Technology Fee $1.50
Total Fees: $67.30
Total Fees: $67.30
Total Receipts: $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 responisibility for all work
done by either myself, my agent, servants or employes.
Signed: (Contractor or Builder) BY:
BLK 178 LOT
Date Job Addres p6 7 N E• Q L 7T Tax Folio
Legal Description / r/4 E L% ieiP\ —
Owner/Lessee / Tenant " X Master Permit # l ( 9 7
Qs Tt�✓f L keKy $Jyngii
Contracting Co. \Il g(� �— KO.
Qualifier / 2 r \fl s& o
Owner's Address
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
SS# Phonex(305")'7, ' . 7 1 (o
State # Municipal # _' Competency # giiF350002 / Ins. Co. 1 1 S /Q4wp,
Architect/Engineer
Bonding Company
Mortgagor
otary as to
y
/ //
FEES: PE RMTI G r V . RADON
Permit Type (circle one): UILDIN a ELECTRICAL PLUMBING MECHANICAL ROOT SIGN
WORK DESCRIPTION 9A n1 0
APPROVED:
Zoning
Mechanical
r
Square Ft. Estimated Cost (value) y (/ZQ r
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
on and zoning. Furthermore, I authorize , above -named c. tractor to d. • work stated.
f owner and/or Condo Pres
TARY SEAL
TA MONTIEL
•
v ' CC797277
137. ,21T02
n y
r
S'r')FFiT, be( op-At ;ue. ,sPto rr
Date
/—O
Building 9�� YI11 /9 a /
• Historically Designated: Yes No
Address
f T
/ I
gnature of Contractor or Owner -But
iotary as to Con
My Co
Phon'C ) 7,C7— /073
• •A.fly -: • ti
OFRCIAL NOTARY
SO��t EROS'S MARGARITA MONTI EL
0 COMMISSION NUMBER
a q < CC797277
.414 MY �MISt� 2 02 RES
to
C.C.F. / ' NOTARY
Electrical
Date
Date
%G 2- c> ,-
BOND
TOTAL DUE 7 3.5
Plumbing Structural Engineer
BUILDING ❑
ELECTRICAL ❑
PLUMBING ❑
RQ FING ❑
4 N,r ❑
Owner of --
Building /7 / _�: a C c7
Legal Lot II
Description
Address of r eNe;
Building f/ 7
MIAMI SHORES VILLAGE, FLORIDA
DAVE ; 195 i
Architect
Contractor
or Builder``- "
PERMIT N? 7254
Work to be performed under this Permit
Value of
Project
OAP
/190
Contractor's
License No
Subdi-
vision
Amount of
Permit $
This permit is granted to the contractor or builder named above to construct the building or to install the equipment or device described in the application
herefor in strict compliance with all ordinances pertaining thereto and with the understanding that the work will be performed in compliance with any plans
drawings, statements or specifications that may have been submitted to and approved by the proper municipal authorities. This Permit may be revoked at any
time if the work is not done in compliance with such ordinances or if the plans are changed without authorization. A f e- condition upon which this permit is
granted is the understanding that the contractor or builder named above assumes the responsibility for a thorough kn ledge of t; ordinances and regulations
pertaining to the work covered hereby whether shown on the plans or drawings or in the tements or specification: an at he ass es responsibility for work
done by his agents, servants or employees.
CONTRACTOR OR BUILDE
Signed.
INSPECTOR f'
In consideration of the issuance to me of this permit I agree to perform the work cove ereunder in compliance with all ordinan and regulations
pertaining thereto and in str with the plans, drawings, statements or specifications milted to the proper authorities of Miami Shores Village. In ac-
cepting thi permit I as •..e •onsibil for all work done by either, myself, my agent, s an or employee.
BY
i
AUTHORITY
s
APPLICATION FOR BUILDING PERMIT
Application is hereby made for the approval of the detailed statement of 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.
glii-
Date
Owner's Name and Address � � , � (r N
Registered Architect and /or Engineer
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 _.f/ a 7
State work to be done and purpose of building (by floors)
Disapproved
(Signed) t
MIAMI SHORES VILLAGE
BUILDING INSPECTION DEPARTMENT
ti
Member
Council Approved
Date
"* ^. L- If., -' • " `a- '�~ and for no other purpose.
New Building Remodeling Addition pairs No. of Stories
To be constructed of Kind g undation Roof Covering
Estimated Total cost of improvements $ J i? 0 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 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 does 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, Permanent Supplement,
and has complied with the provisions thereof, and will require similar compliance from all contractors or sub - tractors employed by him
in the work to be performed under this permit; and will post or cause to be posted for inspection on the s o t e ork such public notice
or notices as are required by the Act. The undersigned agrees to employ only such sub ontractors, on 'or o be .erformed under this
permit, as are licensed by Miami Shores Village.
Remarks (Signed) Ct - --
STATE OF FLORIDA,
COUNTY OF DADE. j ss•
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally ap-
peared
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 ar true.
Permit No._ ) s Date S ! Read, Sworn to and Subscribed before me.
Notary Public, State of Florida
Building , !pector My Commission Expires
PLANNING BOARD DATE
Chairman Member
Member Member
7 Stree
to me well known,
Member
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 fee of $1.00 will be charged when such re- inspection is made necessary by improper notice for inspection or faulty
materials and /or workmanship.