BP-04-1628MIAMI SHORES VILLAGE
BUILDING DEPARTMENT
305 - 795 -2204
Building Inspection Request
Date — 1 ® 5 --
Type Insp'n Per t f 't 4..
Permit No. I P o 7 f 6*2 5
Name �[
r4 L'
Address
Company
Phone #
Inspection Date - 7 ` S
re) C c °
A
Correction
Re- Insp'n Fee
Permit Type (circ
BUILDING
PERMIT APP TIO
FBC 2001
Owner's Name (Fee Simp
Owner's Address / F' 0
City 'l' a e. vti 5(.1,0 State
Tenant/Lessee Name
Job Address (where the work is being done)
City Miami Shores Village
Is Building Historically Designated YES
Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
e Building
ECE lleylI D
DEC 1
Electrical
� P`I $ u5 %`('"-) Phone #
l ®0 zrr
County Miami -Dade
NO
Contractor's Company Name 6(A) 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 576 0 a s
Type of Work: ['Addition ❑Alteration [New sue' Repair/Replace ❑ Demolition
Describe Work: r Gt a 14) ( o rc (D d S tea-' c " 4 5 °t ate' 'i G .5pf
12 O O'- v ' ' k 5-t„ 9 F i o lo . 4 j �'e �t . ° .a e e ) 0 0 0 r-554x
G Br et g— 0Div°
** * ** * * * ** *** * ***********Fees****************************** Submittal Fee $$ ^�- Permi Fee $ ! (.1 Q, CCF $ ' 0 6v CO /CC
Notary 8 U Training/Education Fee $ p- Technology Fee $ / ' a-1
Scanning $ �`— Radon $ --"' Zoning Bond $
Code Enforcement $ - Structural Plan Review. $
Fee Now Due $
(Continued on opposite side)
6,
1 °
Permit No.
Master Permit No.
ing Mechanical Roofing
-7095
Zip
Phone #
Zip
Square Footage Of Work:
Bonding Company's Name (if applicable)
Bonding Company's Address
City
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 CONDMONERS, ETC
OWNER'S A}HDAVIT: 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 approved and a reinspection fee will be charged.
Signature
Signature
Contractor
The foregRing instrument was acknowledged before me this /3 The foregoing instrument was acknowledged before me this
Owner
day of , 20 CT by
who is personally known to me
14- 49a06 -3ci1 iden
NOTARY P
Si '
Print. ..00 r . 0
Gonelf
Commission #DD
J May 26, 2008
My Commission Expires: 6—/ Bonded Tina My Commission Expires:
Atlantic Bonding Co., hie.
APPLICATION APPROVED BY:
Chc 05/13/03
State
MIA voluk
2 / -11
day of , 20 , by
who is personally known to me or who has produced
as identification and who did take an oath.
NOTARY PUBLIC:
*** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * *
** *** ** * ak* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * *
PlanR Examiner
Engineer
Zoning
Miami Shores Village
Paint Color Approval and Agreement
Date r
Owner's Name ° J -6 6., 4 � 5u S Phone # 305—c ^ c 3 r® y
Owner's Address 1 `t O IL) • LA- 1 ar °-
City 14n r' ✓h r' e S in 0 et .S . State Zip
Job Address (where the work is being done) S .
City Miami Shores Village County Miami -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
Fascia b
Drip Cap /drip Edge
Soffit
� A 1- / off k l 6
Flower bins Q (.
Shutters
Awnings ��pp �!
Chimney W �'1'�` - tom
Doors and door jams tA1 i -- f,
Garage doors t1-k - C
Railings
Fences
Decorative metal
All brick (simulated or regular)
Stucco banding
Any other stucco features
Accessory Buildings coesY 7 t,diro
"
Other -� Dcd � c c r kcct i.s j/tacsc�L' CYJ vvic
**************************************************************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
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.
Signature
Owner or Agent
APPLICATION APPROVED BY: t
P& Z Offic
OA
Attach Color Samples
With Numbers
Date 1 Zr 1 3 -C)
-(
?3a
Miami Shores Village
10050 NE 2nd Avenue
Phone: 305 - 795 -2204 Permit Number: BP2004 -1628
Printed: 1 /3 /2005
Applicant: JEAN
Owner: AUGUSTIN
JOB ADDRESS: 190
Contractor
Local Phone:
Parcel # 1131010230250
NW 100
Building Permit
AUGUSTIN
JEAN
TERR
Contractor's Address:
Permit Status: APPROVED Permit Expiration: 6/25/2005 Construction Value: $500.00
Work: PAINT HOUSE EXTERIOR AND GARAGE ROOF
Page 1 of 1
Legal Description: BONMAR PK ADD A RE -SUB PB 24 -71 W75FT OF LOTS 1 2 3 & 4
Fees:
FEE2004 -12447
FEE2004 -12448
FEE2004 -12449
FEE2004 -12450
FEE2004 -12451
Description
Building Painting Fee
CCF
Notary Fee
Training and Education Fee
Technology Fee
Total Fees:
Amount
$60.00
$0.60
$5.00
$0.20
$1.50
$67.30
Total Fees: $67.30
Total Receipts: $67.30
0
Signed: (INSPECTOR)
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 4