PT-09-2049 S
Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number: I NSP- 131473 Permit Number: PT -12 -09 -2049
Scheduled Inspection Date: May 17, 2010 Permit Type: Paint
Inspector: Bruhn, Norman
Inspection Type: Final
Owner: DUCASSI JESUS Work Classification: New
Job Address: 1254 NE 100 Street
. Miami Shores, FL Phone Number
Parcel Number 113205009004
Project: <NONE>
Contractor: HOME OWNER
Building Department Comments
Inspector Comments
Passed
�� v4, ��-
Failed
Correction ❑
Needed
Re- Inspection ❑
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
May 14, 2010 For Inspections please call: (305)762 -4949 Page 6 of 32
1 ! Miami Shores Village���
10050 N.E. 2nd Avenue
Miami Shores, FL 33138 -0000
V
Phone: (305)795 -2204
Expiration: 061131201
Project Address Parcel Number Applicant
1254 100 Street 1132050090040
Miami Shores, FL Block: Lot JESUS DUCASSI
Owner information Address Phone Cell
JESUS DUCASSI 1254 NE 100 ST
MIAMI SHORES FL 33138 -2604
Contractor(s) Phone Cell Phone Valuation: $ 0.
H OME OWNER
.. ... ....._. Total Sq Feet: 0
Type of Work: Exterior For Inspections please call:
Color: (305)762 -4949
Additional Info: Available Inspections:
Classification: Residential Inspection Type:
Color. Approved Code Comments: BEN MOORE - WALLS, GARAGE Final
Color Approved_ Color. _Denied
Fees Due Amount Invoice # Total Amt Paid Amt Due
Notary Fee $5.00 PT -12- 09-36636 $ 65.00 $ 65.00 $ 0.00
Permit Fee $60.00
Scanning Fee $0.00 Check #: 2344
Total: $65.00
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 responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are
required for ELECTRICAL,- PLUMBING, MECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work.
OWNERS 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. Futhermore, I authorize the above -named contractor to do the work stated.
December 21, 2009
Authorized Signature: Owner / Applicant ! Contractor i Agent Date
Building Department Copy
December 21, 2009 1
EIVE Miami Shores Village
DEC 2009 Building Department
1.00-50 N.E.2nd Avenue, Miami Shores, Florida 331;8
Tel: (305) '795.2209 Fax: (305) 756..8972.
BUILDING Permit No. r l
PERMIT APPLICATION Master Permit No.
FBCfWO
Permit Type: PAINT PERMIT
Owner's Name (Fee Simple Titleholder) j C 5 U--S
�Ut" S / Phone # 30 t ( Q �T
Owner's Address —/- L3 gq /v E l00 -�;'r
City MP Zip 7 3"3 /31�
Tenant /Lessee Name ---Q( Phone # _
E-MAIL: D V G sgSS ( 6e SAC) q, �w
Job Address (where the work is being done) 1 IV S
go r
City Miami Shores Village County Miami -Dade
FOLIO / PARCEL #
Is Building Historically Designated YES NO --
Contractor's Company Name ;6Cz11vz� Phone # —5 , 4014§7
Contractor's Address
Cit - -- State Zip
Qualifier Name Phone #
State Certificate or Registration No. Certificate of Competency No.
OWNER BUILDER: 1 e- �vC4 CS /
Value of Work For this Permit Type of Work: (] Addition / ❑ Alteration 1 ❑New / ❑ Repair /Replace
De ibe Work: pl� k 0 &0 .S L
n
Application is hereby made to obtain a pennit 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 k t all wo4 will be perlbrmed to meet the standards of all laws regulating construction in this jurisdiclim. I understand that a separate pennit must he scarred fin
El.l - RI(_'AI. WORK. PLUMBING. SIGNS. W'EL.I,S, POOLS, f•I.JRNACI?S, BOILERS, HEATERS, TANKS and AIR CONDITIONERS, ETC.....
"M+,j3NING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR
IMWVEMENTS - 1'0 YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE-
REGARDING YOUR NOTICE OF COMMENCEMENT."
Noti & . I ppl icanl: A,r a condition to the issuance gl'a building pertnil with an eslintaled value exceeding $ 25M. the applicant musl promise in good faith that a copy ol'the
notice of commencement and construction lien law brochure will be delivered to the person whose properly is subject to atlachm.cm. Also. a certified copy of /he recorded notice
gf cZtencenrenl Hurst he polled al the job site far the frost inspection which occurs seven (7) days after the building permit is issued. In (he absence of such posted notice. the
insjxMon mill not he approved and a reinspection,ffee will be charged.
- P y e t F e e s __ -00- CID CCF S Technology Fee:
Training /Education Fee $ Notary S � —0 0 Code Enforcement $
Double Fee $ Zoning $ Total Fee Now Due $
See Reverse side
/ A /J/ PAINT COLOR APPROVAL AND AGREEMENT
All elements on the site must be listed and indicate the color to be pain ;.Odd,
r
Directions: Please circle corresponding number to appropriate color sample.
11Jalfs: 1' Attach cot - - w.,�oa_v,�_.�,�o °old
Fascia I 2 4
Drip Cap /Drip Edge: 1 ? 4
Sorel _ - - 4 Z
Room. I 2 4 dried parsley 522
Flower Bins: 1 2 3 4
Shutters l 2 3 4
Awnings: l 3 4 2
Chimney: t 2 4
Doors and Door .lams 1 2 3 4
Garage Doors: I 2 3 4
Railings: I 2 3 4 3
Fences: I 3 4 O
All brick (simulated or regular I 2 3 4 w ancient ivory
Stucco Banding: I 2 3 4 -_
Any other Stucco Features: I 2 3 4
Accessory Buildings Other: lcr�
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_, Signature
Owner or Agenl Contractor
The foregoii instrument was acknowledged before me this The foregoing instrument was acknowledged before me this .
o ` l IIIIfIF
day of�. 200 t \, by <SJ�� -- day of . 20 _ , by
�N G
who is personally known to me or w`� has pitiq cji' _ who is personally known to the or who has produced
As identifica_`ion itd � ,�it z <aty�jl + as identification and who did take an oath.
cc
NOTARY PUBLIC: _ O /O '0 0 • ¢ - NOTARY PUBLIC:
Sign: :7. N X90/ b60 COD \ Sign:
% s' Print:
Print: — _ - - - -- — - ,
My Commission 13xpires:
My Commission Expires:
Plans Cxamintr
APPLICATION APPROVED BY:
IZ
Preservation Board
...: �� Code Enlbrcement
(Revised 04/24/0 .,
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