PT-10-307 F�
Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number: INSP - 136546 Permit Number: PT- 3- 10-307
Scheduled Inspection Date: April 28, 2010 Permit Type: Paint
Inspector: Bruhn, Norman
Inspection Type: Final
Owner: PROCTOR, PATRICIA Work Classification: Addition /Alteration
Job Address: 350 NE 101 Street
Miami Shores, FL 33138 -2425
Phone Number (305)756 -0309
Parcel Number 113206013529
Project: <NONE>
Contractor: HOME OWNER
Building Department Comments
Inspector Comments
Passed
Failed
Correction ❑
Needed
Re- Inspection ❑
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
April 27, 2010 For Inspections please call: (305)762 -4949 Page 8 of 22
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Miami Shores Village
10050 N.E. 2nd Avenue
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Miami Shores, FL 33138-0000 a
Phone: (305)795 -2204 Un ;w >
3' 4 w w, 3 Expiration: 08129/2
Project Address Parcel Number Applicant
350 101 Street 1132060135290
Miami Shores, FL 33138 -2425 Block: Lot: PATRICIA PROCTOR
Owner Information Address Phone Ceti
PATRICIA PROCTOR 350 101 Street (305)756 -0309
MIAMI SHORES FL 33138 -2425
Contractor(s) Phone Cell Phone Valuation: $ 3 00.00
HOME OWNER
Total Sq Feet: 0
Type of Work: Exterior For Inspections please call:
Color: (305)762 -4949
Additional Info: PAINT Available Inspections:
Classification: Residential Inspection Type:
Color: _Approved Code Comments: BEN MOORE- WALLS - DOLPHIN: Final
Color: Approved_ Color: Denied
Fees Due Amount Invoice # invoice Total Amt Paid Amt Due
CCF $0.60 3-10-37146
Education Education Surcharge $0.20
$66.60 $66.60 $0.00
Notary Fee $5.00
Permit Fee $60.00
Technology Fee $0.80
Total: $66.60
Building Department Copy
March 02, 2010 2
Miami Shores Village $ T(RIFM 1
B uilding Department
VAR. 0 1 2010
10050N.1_'.2nd Avenue. Miami Shores. Florida 33133 BY; ..
Tel: (305) 795.2204 Fax: (305) 756.8972
BUILDING Permit No. VT t(D '
PERMIT APPLICATION Master Permit No.
FBC 2004
Permit Tyne PAINT PERMIT
Owner's Name (Fee Simple Titleholder) Phone # 't>�
Owner's Address
V.
City CL ate C Zip
Tenant /Le see Nam( Phone #
E -MAIL:
Job Address (where the work is being done) 1 C)
City Miami Shores Villa <ge 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.
OWNER BUILDER:
� o — v
Value of Work For this Permit $ �_ Type of Work: ❑ Addition / ❑ Alteration / [New / ❑ Repair /Replace
Describe Work:
Application is hereby made to obtain a permit to do the work and installations w 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 ofall laws regula(ingconstruction in this jurisdiction. I understand that a separate permit must be secured R)r
EL C'TRK.'AI. WORK. PLUMBING. SIGNS, WELLS. POOLS, FURNACE -:S, BOILERS, FIEATERS, TANKS and AIR CONDITIONERS, ETC.....
"WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE. FOR
IMPROVEMENTS TO YOUR PROPERTY. IF YOU IN'T'END TO owrAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE
RECORDING YOUR NO "1'1C'i OF COMMENCEMENT."
Notice to . I pplic•ani: :1s a condition to the issuance ofo building permit with cm estimated value exceeding $ 2500. the applicant must proniise in g(xxl faith that a copy of the•
notice cif cornntencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also. a cerdlied cop), cf the rec.urded notice
of commencement roust he posted at the job sire far the inspection which occurs seven (7) days after the building permit is issued. In the absence cif such fxrsted notice. the
inspection iril/ not he approved and a reinspection fee will be charged:
((��( �� *mar * ��� a �� r,x � * � *
Permit Fee $ �V'0 CCF $ O (JQ0 Technology Fee: 0' <�
Training /Education Fee $_� Notary $ J Code Enforcement $
Double Fee $ Zoning Total Fee Now Due $
See Reverse side —>
PANT )LOR APPROVAL AND AGREEMENT
All element he site must be listed and indicate the color to be painted
Directions: Please circle corru ng number to appropriate color sample.
Walls: 4 Attach color samples with name and
Fascia: I 2 3 4
Drip Cap/Drip Edge: 1 2 3 4
Soffit: 1 3 4 1
Roos: 1 2 3 4
Flo%,ver Bins: 1 ` 2 3 4
Shutters: 1 2 3 4
Awnings I 2 3 4 2
Chimney: 1 2 3 4 F`T"
Doors and Door .lams: 1 2 3 4
Garage Doors: 1 2 3 4
Railings: 1 2 3 4 3
Fences: 1 2 3 4
All brick (sinutlated or regular ): 1 2 3 4
Stucco Banding: 1 ' 3 4
Any other Stucco Features: 1 2 3 4 4
Accessory Buildings Other:
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.
Signatu Signature
Owner or Agent — Contractor
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this_ .
day of _W u ' fA 20 1V . by A. riL b- ?9-UG.1 day of 20 _. by
who IS personally known to me or who has produced _ who is personally known to me or who has produced
As identification and who did take an oath. as identification and who did take an oath.
NOTARY PUBLIC: NOTARY PUBLIC:
Sign: C2 Sign:
Print: —_- __ -- ``��tNItIt1Nl/ Print:
M Commission Exp ires: a� " "�i M Commission Expires:
Y Y
o ►;`'��,
APPLICATION APPROVED BY: Plans Examiner
' x`` _ Preservation Board
Code En(orcement
(Revised 04/24/0 i