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271 NE 101 St (6)MIAMI SHORES VILLAGE BUILDING DEPARTMENT 305- 795 -2204 Building Inspection Request Date t L J Time /� Type lnsp'n T 1 (1 / 1` Thin-I- Permit No. 3P v J J i315. Approved Correction Re- Insp'n Fee Name A \-e Address ! I 1.1F. 101 S I- Company vC NF 1 _ Phone # For Inspector: 9 6 303 Name & Date lA CEIVEU BUILDING PERMIT APPLICATION FBC 2001 Tenant/Lessee Name $ Value of Work For this Permit 'i 0 Miami Shores Village Building Department Permit Type (circle): uildin ` Electrical Plumbing Mechanical Roofing Owner's Name (Fee Simple Titleholder) ALEX AN D�2. F SELZE Phone # .3 • 75 q • ( Owner's Address 21) N E 1 I ST e E E r City Nlz P fr)I 5.}- }0E-ES State FL- . Zip 331 3$ Phone # o Job Address (where the work is being done) 21 ( NE 1 01 ST C E ET City Miami Shores Village County Miami -Dade Zip Is Building Historically Designated YES NO Contractor's Company Name Phone # Contractor's Address City State Zip Qualifier Architect/Engineer's Name (if applicable) - Phone # Architect/Engineer's Address City State Zip 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 Permit No. 'J r 2 - 13) S Master Permit No. _ - Square Footage Of Work: 2 D " Number of: Bays Stories Families Bedrooms Baths Type of Work: ['Addition ['Alteration [New ❑ Repair/Replace ❑ Demolition ® Describe Work: C I1 PL p144 rx it) EXTEZ.I OF -NDUSE * * * * * * * * * * * * * * * * * * * * * * * * * * ** F ees * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** County Escrow Fee $ ' `"F - Permit Fee $ CO 0 Notary $ S •e() . Education/Training Fee $ Tech $ Scanning $ Radon $ Code Enforcement $ Bond $ Struct. $ Minus Plans Check Fee $ Total Fee Now Due $ � � 0 . (Continued on opposite side) ?act Nan - 0 at ao 6(c) . 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 a ,a Owner or Agent NOT Sign: ,, pp � Print:l Q Q1 Va Yea.\ Chc7/7 /03 Signature Contractor The foregoing trument was acknowledged be or me this 12— The foregoing instrument was acknowledged before me this day f ll.,�.,,�1_ • Y .,.. ,20 —,by who is personally known to me or who has produced who is personally known to me or who has produced ' As identificati n,apd w 20 a by gezr rU olrlevic of sion #DD2319 4` Tres: Jul 13, 2007 NOTARY PUBLIC: Thru tag Cn „Inc as identification and who did take an oath. Sign: Print: My Commission Expires: My Commission Expires: (Certificate of Competency Holder) State Certificate or Registration No. Certificate of Competency No. ************** 4***************** * * * * * * * * * * * * * * * *s * * * * * * * * * * * * ** � ********* s* * * * * * * *s *s * * * * * * * * * * *s * * *s * * * *s APPLICATION APPROVED BY: -AUG 1 3 2003 Plans Examiner Engineer Zoning MIAMI SHORES VILLAGE Paint Color Approval and Agreement 13 DATE: 8• 11- 0 3 OWNER'S NAME: A LEX P - De A 'SEL2 Ei - PHONE: 305. 75 We ADDRESS: 2.7 l N E lb 1 Srt• 4M Glees ****************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** ADDRESS OF SITE: CONTRACTOR & LICENSE (if applicable) COMPANY NAME: PHONE: ********************************* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** All Elements on the site must be listed and indicate the color to be painted. Walls E.Ta Fascia W {-1STE Drip Cap/Drip Edge N/14 Soffit N Roof NlI Flower Bins A/ /c} Shutters W t-1 T E Awnings A/ Chimney Al 1g Doors and door jams MOT) Garage Doors U-D•1 -1 TE Railings N A Fences Decorative Metal /V All brick (simulated or regul r) 41i Stucco Banding AJ ) Any other stucco features 1 Accessory Buildings /g Other samp Signa re of Owner * * * * * * * * * * * * * * * * ** APPROVED: Building Official 00. 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. I authorize the above -named contractor, if applicable, to do the work state ' . ' urthermore , the paint colors will be as per the attached ate Signature of Contractor Date ************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** WHEN PAINTING IS FINISHED, CALL FOR FINAL INSPECTION 4 Date 4/23/01 MIAMI SHORES VILLAGE APPLICATION FOR BUILDING PERMIT Application is hereby mode for the approval of the detailed statement of Inc plans and specifications herewith submitted for the build • ing or other structure herein described. This application.Is made in compliance and conformity with the Building Ordinance of Miami Shores Village, Florida. and all provisions of the Laws of the State of Florida, all ordinances of Miami Shores Village and all rules and regulations of the Building Division of Miami Shores Village shall be complied with, whether herein specified or not. A copy of approved plans and specifications must be kept at building during progress of the work. Date..._ F Owner's Namc and Address ........ 4 L 5e 1 20g No Registered Architect and /or Engineer ,._. „-„ Name and address of licensed contractor 0 k.IS _.. Location and legal description of lot to be built on: Lot Block Subdivision ._ Street and Number where work is to be done `` _........_..._...... -_ _ State work to be done and purpose of building (by floors). 1 E_PI LIZ / ---1. F1 - I—. 12 T 15Z I 5.17 _.._. and for no other purpose. New Building Remodeling Addition Repairs' No. of Stories To be constructed of Kind of foundation Roof hovering Estimate Total cost of improvements $ 1 %0 Amount of Permit Zone cubage required plan Cubage Distance to next nearest building Size of Building Lot Maxiunum live load to be borne by each floor I hereby submit all the plans and specifications for said building. All notices with reference to the building and its construction may be sent to. The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations as an employer of Lebor under the Honda Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida, Permanent Supplement, and has complied s ith the provisions thereof, and will require similar compliance from all ,. tractors or sub - contractors employed by him in the work to be performed under this permit; and will post or cause to be posted for 1 ' do • the site of the way such public notice or notices as arc required by the Act. The undersigned agrees to employ only such s 1 s, onig t to rformed under this pcnnit, as are licensed by Alfami Shores Village. Remarks (Signed)..''._ G Building Inspector BUILDING INSPECTION DEPARTMENT �4 .r(�....__.. Street STATE OF FLORIDA, COUNTY OF DADE. ss. Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally ap- peared to me well known, and who, being by me first duly sworn, upon oath deposes and says that he is the. of the above described construction, that he has carefully read the foregoing application, and that he did sign the same, and that all facts therein by him stated are true. Permit No f r Date .� Read, Sworn to and Subscribed before me. Disapproved Date Notary Public, State of Florida (Signed) My Commission Expires PLANNING BOARD DATE Chairman Member Mcmbcr Mcmbcr Mcmbcr .. .. Member Council Approved Date Disapproved Date NOTE: A charge of $1.00 will be made for making corrections or changes to this application after approval has been obtained frrnn the Plennir.g Bo.ird. A re - pection ice of $1.00 will be charged when such re inspection is made necessary by Improper notice for inspection or faulty materials and /or workmanship.