PAINTMIAMI SHORES VILLAGE
BUILDING DEPARTMENT
305- 795 -2204
Building Inspection Request
Date ' \0'1\
Type Insp'n }; V\0,1 ?Q;„t'
Permit No. a P 0 3" l.8y Co
Name (e d(Q Cdf(Q2f}s
Address 1 D tT 5 T
Company
Phone # 30S — 15i 5P S
Inspection Date
Approved
Correction
Re- Insp'n Fee
Io°i\o9-
FiEciovEn iami Shores Village
'NOV 2 k 26 Building Department
P C— 10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
Permit No. £IZ20 3- $4o
Master Permit No.
BUILDING
PERMIT APPLICATION
FBC 2001
Permit Type (circle): Building (,(2 Electri
Owner's Name (Fee Simple Titleholder) U
Owner's Address // / O � �°- (0 U .
Cit 2) )7)) yr) 614()) (1
Job Address (where the work is being done) /1/0 � -' E_ u)U S
City Miami Shores Village
Contractor's Company Name
Is Building Historically Designated YES
nwyN
City State
cal Plum ing
NO
Phone #
Mechanical Roofing
ail de _ l(.� d fh (3a) 6,M
one # 26 2 �
Zip i Q
Tenant/Lessee Name Phone #
County Miami -Dade Zip / U
(ac 7s ) 51
Contractor's Address
Zip
Qualifier
Architect/Engineer's Name (if applicable) Phone #
$ Value of Work Fqr this Permit
Type of Work:
Describe Work:
Addition
ctvof
/ U
Total Fee Now Due $ 1p S ' (n C fa` d hi T-L <
(Continued on opposite side)
DAlteration
(11kD1
❑New
Square Footage Of Work:
Repair/Replace ❑ Demolition
* * * * * * * * * * * * * * * * * * * * * * * * * * ** F ees * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
80 c7 • Submittal Fee $ Permit Fee $ Go' CCF $
Notary $ 5 Training/Education Fee $ Technology Fee $
Scanning $ Radon $ Bond $
Code Enforcement $ Structural Plan Review. $
Bonding Company's Name (if applicable)
Bonding Company's Address e j
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 seve (7) s ' r the building permit is issued. In the absence of such posted notice, the
inspection w ` . t be approved ' nd a re pec fe l be ch lged.
Signa
6
NOT
Sign:
Prin
Chc 10/14/03
Owner or Agent
The foregoing instrument was acknowledged before me this Z�
day of tA00• , 20 (5, by 4e30.01G de �G7r( ,
who is personally known to me or who has produced Mai 00 ()
My Commission Expires:
As identificati
************************ * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
APPLICATION APPROVED BY:
who did take an oath.
Commission DD150018
M wennner 1F5, 2006
(01-Alo,3
Signature
Contractor
The foregoing instrument was acknowledged before me this
day of , 20 , by
who is personally known to me or who has produced
as identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
My Commission Expires:
***************************************************************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
(Certificate of Competency Holder)
State Certificate or Registration No. Certificate of Competency No.
*************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
Plans Examiner
Engineer
Zoning
Miami Shores Village 1 1-z. - 03
P aint o lor A proval and Agreemen
Date I )O c49 —03
' Name f e �� n a e l Phone # ( �� J �� 7 (7;,
Owner's l
Owner's Address (' 1 0 k- 1 A) O r
Cit .m 10 f/Vl 1 State 1r ( Zip 3 /
Job Address (where the work is being done) (b—L-0.---
City Miami Shores Village County Miami -Dade Zip _
Is Building Historically Designated YES NO
Contractor's Company Name (if applicable)
******* **************************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * *
All elements on a the site must be listed and indicate the co
C�-�1
Walls Pcuv1 "l 0 w ICI I' 3 n i d l
Fascia
Drip Cap /drip Edge
Soffit `�
Roof l�W
Flower bins
Shutters
Awnings
Chimney
Doors and door jams
Garage doors
Railings
Fences
Decorative metal
All brick (simulated or r gular) 0
Stucco banding
Any other stucco fea r res
Accessory Buildin
Other
**************************************************************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
OWNER'S that
applicable 1. G gulating co ction d
Signa
foreg
g.
I ce
all
dorset gold
P-Itit
g information is accurate and that all work will be done in compliance with all
Date , ) °DA
Owner or gent
APPLICATION APPROVED BY: Date /
P& Z chc /18/03
Miami Shores Village
10050 NE 2nd Avenue
Printed: 12 /2/2003
Applicant: ALEXANDRA COLLAZOS
Owner: COLLAZOS ALEXANDRA
JOB ADDRESS: 1110 NE 100 ST
Contractor
Local Phone:
Parcel # 1132050190460
Signed: (INSPECTOR)
Building Permit
Phone: 305 - 795 -2204 Permit Number: BP2003 -1846
Contractor's Address:
Permit Status: APPROVED Permit Expiration: 5/22/2004 Construction Value:
Work: PAINT EXTERIOR HOUSE
Page 1 of 1
Legal Description: MIAMI SHORES SEC 8 REV PB 43 -67 LOT 10 BLK 178 LOT SIZE 98.050 X
Fees: Description Amount
FEE2003 -7632 Building Fee $60.00
FEE2003 -7633 Notary Fee $5.00
FEE2003 -7634 CCF $0.60
Total Fees: $65.60
Total Fees: $65.60
Total Receipts: $65.60
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: