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PAINTMiami Shores Village Building Department 10050 NE 2 Ave, Miami Shores, Fl 33138 Tel: (305)795 -2204 - Fax; (305)756 -8972 PLEASE PRINT DATE: 3�.'( -0 - TIME: ) NAME OF PERSON REQUESTING FILE: 1 ma (r PHONE #: — 7S6 -363y YOUR ADDRESS: 4 Ake /00 Sr ADDRESS OF FILE REQUESTED: /40/ /V /Du S% INFORMATION REQUESTED: (of (W n/ s /''cr> ' s . I understand that all documents in this file are property of Miami Shores Village and that NO documents may be removed from this file. You may get 4 complementary copies (8x11) size, additional copies will be furnished at 0.15 cents per page, not including any blue prints. If blue prints are order please be aware that we are not responsible for the quality of the printed documents. Acknowledged by: FILE RETURNED TO: INITIAL Correction MIAMI SHORES VILLAGE BUILDING DEPARTMENT 305- 795 -2204 Building Inspection Request Date' 5 Type Insp'n NQ -10(10` 1 Permit No. P) Q Z -YS 1 011 1 Name ;or C Address t_ µ k3 Company Phone # Inspection Date A ( 1P Re- Insp'n Fee ❑ f Miami Shores Village AU Building Department G 1 9 2003 BUILDING PERMIT APPLICATION FBC 2001 Building Electrical Plumbing Mechanical Roofing p�q Owner's Name (Fee Simple Titleholder) C Co, 41t d Phone # 31) 5 - Owner's Address 1/ / fi •�� t� City V' JAt &t Wl 1 ✓fh State Zip 13 Tenant/Lessee Name Phone # Permit Type (circle): Job Address (where the work is being done) 0' NE, Ie City Miami Shores Village County Miami -Dade Zip Is Building Historically Designated YES NO Contractor's Company Name Contractor's Address City Qualifier Architect/Engineer's Name (if applicable) Architect/Engineer's Address City State Permit No Master Permit No. Phone # 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 Zip Phone # State Zip el) $ Value of Work For this Permit v �,'.` . Square Footage Of Work: Number of: Bays Stories Families Bedrooms Type of Work: ['Addition L I ['Alteration q New ❑ Repair/Replace Describe Work: 1- ya,I Al Y1�101�R/ 41�✓S 1 Baths ❑ Demolition County Escrow Fee $ / 1 ) 0 Permit Fee $ ‘ 0 -, Notary . 0 0 - Education/Training Fee $ Tech $ Scanning $ Radon $ Code Enforcement $ Bond $ Struct. $ Minus Plans Check Fee $ Total Fee Now Due $ C -5 6 d (Continued on opposite side) 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 su. ' ct to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first insp c hi % o cu s seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will ap r and rei pec 'on fee will be charged. 1 Q Contractor The fo oing instrument was acknowled ed me this C I The foregoing instrument was acknowledged before me this day o 2, byy,Q, (../ day of • , 20 _, by who is personall known to me or who has produced who is personally lmown to me or who has produced As identification and who did take an oath. as identification and who did take an oath. NOT ran NOTARY PUBLIC: Sign: •�- n ..__ Sign: Print: . • .. Print: My Commission Expires: (Certificate of Competency Holder) State Certificate or Registration No. Certificate of Competency No. ,.„ AUG 2 0 2003 Plans Examiner Chc7/7/03 IC: My Commission Expires: Owner or Agent V E, APPLICATION APPROVED BY: Engineer Signature Zoning MIAMI SHORES VILLAGE Paint Color Approval and Agreement DATE: /DUI OUP 5 11 1 0L OWNER'S NAME: ADDRESS: IavJ A In ***** ** * ******************.******* t * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** ADDRESS OF SITE: i 2D I N e I Op '/ CONTRACTOR & LICENSE (if applicable) N A ` COMPANY NAME: N A PHONE: JV 4 ********************************* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** All Elements o the site must be listed and indicate the color to be painted. Walls Fascia v Inl t ; Drip Cap/Drip dge Soffit v1V, Roof -- Wild �o,dvc, Flower Bins N A Shutters g Lh Am n AA �u� e, ni NPc All brick (simulated or regular) N A Stucco Banding 1,A6 Any other stucco features nj P Accessory Buildings Pt Other k i Ipo V1 v -I t CO" 411-444 Awnings Chimney Doors and door jams tt+vh Garage Doors ti J\ Railings Fences e/ Decorative Metal 4f 014 ( sAfeAniv PHONE: 10y -3-59 - //31 0 z 00 E OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that . 1 ork will be done in compliance with all applicable laws regulating co :: . a • zo ing. I authorize the above -named contractor, if applicable, to / d • o s . . urthermore , the paint colors will be as per the attached 'L i . /L I . t: igna re o '� wner II 11 7013 to 1 Signature of Contractor Date *********************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** APPROVED: WHEN PAINTING IS FINISHED, CALL FOR FINAL INSPECTION ae i 6/-7, Building Official Date 4/23/01 Wa By owledged before me this Owner VILLAGE OF MIAMI SHORES BUILDING DEPARTMENT OWNER BUILDER DISCLOSURE STATEMENT being the legal property owner, for the property Located at: N Siam'( -s w ?�v 131, Legally described as Do hereby petition the Village of Miami Shores to act as my own contractor pursuant to the laws of the State of Florida, F.S. 489.103(7),,And I have read and understand the following disclosure Statement, which entitles me to airork as my own contractor, I further understand that I as the owner must appear in person to complete all applications. DISCLOSURE STATEMENT State law requires construction to be done by licensed contractors. You have applied for a permit under an exemption to that law. The exemption allows you, as the owner of your property, to act as your own contractor even though you do not have a license. You must supervise the construction yourself. You may build or improve a one - family or two- family residence or a farm out - building. You may also build or improve a commercial building at a cost of $25,000.00 or less. The building must be for your own use and occupancy. It may not be built for sale or lease. If you sell or lease a building you have built yourself within one year after the construction is completed, the law will presume that you built it for sale or lease, which is a violation of this exemption. You may not hire an unlicensed person as your contractor. It is your responsibility to make sure that people employed by you have licenses required by state law and by county or municipal licensing ordinances. Any person working on your building who is not licensed must work under your supervision and must be employed by you, which means that you must deduct F.I.C.A. and with - holding tax and provide workers' compensation for that employee, all as prescribed by law. Your construction must comply with all applicable laws, ordinances, building codes and zoning regulations. Proof of ownership provided ( ) initial of reviewing clerk. Tlid foregoing instrument 20 who is personally known to me or who has as identification and who did take an oath. Prod Owner otary Contracting Co. ()WI.) IZ Qualifier er SS# _ - - % phone State # Mnnicinal # Competency # PERMIT APPLICATION FOR MIAMI SHORES VILLAGE Date OI /0 Li f e ( Job Address 1201 NE 100 StRadc. Tax Folio �� Legal Description Historically Designated: Yes �(3) -Qo � iv,,,(.,e, Owner/Lessee / Tenant .\ A" <Tfttli r1 S Master Permit # q z i D 4. Owner's Address 1 2. n1 N 6 iO 0 Sfi Phone '" QS — 2 4 3 9 2 Architect/Engineer Bonding Company Mortgagor Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN WORK DESCRIPTION-Pale k p.o L'touse - Square Ft. .2 • O O O 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 construction and zoning. Furthermore, I authorize the above -named contractor to do the work stated. i S 04 /ot Ic4 owner and/or Condo President Date Signature of Contractor or Owner- Builder Date 3S3 OOZ —“, otary as to My Commis ion FEES: PERMIT 4 D RADON 07 2- do President Date FFI NOTARY SEAL CLADYS j VILLAR NOTARY PUBUC STATE OF FLORIDA °OMMISSION NO. CC7I4103 MCOMM/WON EXP. MAR. 1 r Address Ins. Co. Estimated Cost (value) .2 ©© Q OD Notary as to Contractor or Owner- Builder Date My Commission Expires: C.C.F. (' ; NOTARY S BOND TOTAL DUE 7 t0 APPROVED: g I Zoning Building L 1' 1 7 ? Electrical Mechanical Plumbing Engineering