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PT-06-1023 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 I nspection Number: INSP -15410 Permit Number: PT -4 -06 -1023 Inspection Date: May 19, 2010 Permit Type: Paint Inspector: Bruhn, Norman Inspection Type: Final Owner: CHURCH, MIAMI SHORES CHRISTIAN Work Classification: Repair Job Address: 144 NE 101 Street Miami Shores, FL 33138- Phone Number Parcel Number 113206013199 Project: <NONE> Contractor: OWNER Building Department Comments EXTERIOR PAINT Inspector Comments Passed Failed E:1 Correction ❑ Needed Re- Inspection ❑ Fee No Additional Inspections can be scheduled until re- inspection fee is paid. For Inspections please call: (305)762 -4949 May 25, 2010 Page 1 of 1 Miami Shores Village APR z o zoos -� Building Department BY• ,� 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 r, (� Tel: (305) 795.2204 Fax: (305) 756.8972 BUILDING Permit No 6 PERMIT APPLICATION aster Permit No, FBC 2004 Permit Type (circle): Building Electrical Plumbing Mechanical Roofing Owner's Name (Fee Simple Titleholder) ��'!" Phone # �� 7 Owner's Address ,� / V� e pl w` City State Zip Tenant/Lessee Name /�`�� Phone # Job Address (where the work is being done) Q ok e— _ City Miami Shores Village County . Miami -Dade Zip __ FOLIO / PARCEL # Is Building Historically Designated YES NO Contractor's Company Name Phone # Contractor's Address City State Zip Qualifier Name Phone # State Certificate or Registration No. Certificate of Competency No. Architect/Engineer's Name (if applicable) Phone # Value of Work For this Permit $ 2.--00 Square/ Linear Footage Of Work: Type of Work: E]Addition DAlteration ew �i`Repair/Replace El Denik Iition Describe Work: J0 -1 Submittal Fee $ Permit Fee $ CCF $ 0 CO /CC Notary $ �5 - CIO Training/Education Fee $ _ eDC • Technology Fee $ Scanning $ Radon $ DPBR $ Zoning Bond $ Code Enforcement $ Double Fee $ Structural Review. $ Total Fee Now Due $ See Reverse 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 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 Owner or Agent Contractor The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this day of ( 20 QC_, by INWA 1 ffa day of , 20 ___, by who is personally known to me or who has produced ��/, who is personally known to me or who has produced 55 - 57 56 fl8t} As identification and who did take an oath. as identification and who did take an oath. NOTARY 'PUBLIC; NOTARY PUBLIC: Sign: Print: MOMCA L ssm DIAZ COMMISSIO # DD 48399 My Commission Expires: _ EXPIRES: October 20, y ommission Expires: Bwdad Thru Notary Publc U �c *9e et ie:F * * *ie 4e icie9c ie *nY9: �Y * *:k �F 9c * * *�� * * * * * ** *** *�c�Y4r9eR�t9e *�c *ok * * *ic:Q:t9e �Y9c 9e �Ydc *9c4c icii9cic �raY 9nF9c 9c ieie APPLICATION APPROVED BY: ��/ Plans Examiner Engineer Zoning (Revised 02/08/06) Miami Shores village Paint Color Approval and Agreement Date " �1 9N'eS CAt'tSfl ' K CA u l-e Phone # 3 �S ' ©� -0 � 1p Owners Name '� t OLwt t _ Owner's Address 4-+ A) ri ICJ � , 1, 0 P * E !a 1 �A J State Ct--- Zip 3 city ^ /' +"�t�.vKb Job Address (where the work is being done) J 4 /� � O t `� City Miami Shores Village I County Miami -Dade Zip Is Building Historically Designated YES NO Contractor's Company Natne (if applicable) f Phone # All elements on the site must be listed and indicate the color to - aimed Walls Fascia Drip Cap /drip Edge Soffit Roof; j Flower bins es Shutters Awnings Chimney Doors and door jams Garage doors 0/egJ S 9PAG?LK;AL -� f Railings �? Fences Decorative metal All brick (simulated or regular) Stucco banding Any other stucco features Accessory Buildings Otherk 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 AjF- Signature Owner or Agent ./ - Date APPLICATION APPROVED BY: she 6/18/03 P& Z' Official Miami Shores Village 10050 N.E. 2nd Avenue "'" Miami Shores, FL 33138 -0000 Phone: (305)795 -2204 Fax: (305)756 -8972 �lo>Riv�` Permit Permit Status: APPROVED Issue Date: 4/25/2006 Expires: 1011712006 Permit Number: PT -4 -06 - 1023 Owner's Name: MIAMI SHORES CHRISTIAN CHURCH one: Permit Type: Paint Parcel #: 1132060131990 Work Classification: Repair Block: Lot: Job Address: 144 101 Street NE Section: PB: Miami Shores Village, FL 33138 - Contractor(s) Phone Primary Contractor Total Square Feet: 0 OWNER Yes Total Valuation: $ 200.00 C omments: Re uired Insl2ections EXTERIOR PAINT Final Additional Information Type of Work: Exterior Color: ORIGINAL COLOR OF 5 YEARS AGO Additional Info: Classification: Residential 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. Fees Due Amount Invoice Number Amt Due Amt Paid CCF $0.60 PT -4 -06 -24562 $68.30 $68.30 Education Surcharge $0.20 Total: $68.30 Notary Fee $5.00 Permit Fee $60.00 MAY 0 2 PAID Technology Fee $2.50 Total: $68.30 Building Department File Copy NOTICE: In addition to the requirements of this permit, there may be additional restrictions applicable to this property that may be found in the public records of this county. AND THERE MAY BE ADDITIONAL PERMITS REQUIRED FROM OTHER GOVERNMENTAL ENTITIES SUCH AS WATER MANAGEMENT DISTRICTS, STATE AGENCIES, OR FEDERAL AGENCIES. Applicant Signature