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FW-10-19134/ Inspection Number: INSP - 152737 Permit Number: FW -10 -10 -1913 Scheduled Inspection Date: November 17, 2010 Inspector: Rodriguez, Jorge Owner: DOWSON, NANCY Job Address: 252 NE 104 Street Miami Shores, FL 33138 -2016 Project: <NONE> Contractor: GRAHAM BUILDING INSPECTION INC Building Department Comments REPAIR CRACKS IN BBQ WALL Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments November 16, 2010 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 For Inspections please call: (305)762 -4949 Permit Type: Fence/Wall Inspection Type: Final Work Classification: Masonry Phone Number Parcel Number 1121360130330 Phone: (305)776 -3106 Page 8 of 14 BUILDING PERMIT APPLICATION FBC 20 Address: JOB ADDRESS: Contact Phone #: P f7��1!V /cam Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 INSPECTION'S PHONE NUMBER: (305) 762.4949 Permit Type: BUILDING (Fee Simple Titleholder): /� 2, $fJ23D n / C C o OWNER: Name : / 4 !(J O U' i e% n/ ` g 6 Phone #: I"J �J 3 �/ 6 T o i' P Titleholder 3o 4/15_ s 74.- City: �� P State: G -- Permit No. Master Permit No. Zip: OCT 2` 010 cu..) t 0 H if 3 Tenant/Lessee Name: e '«'5 _ Phone#: Email: Zip: 3,? f J r City: Miami Shores County: Miami Dade Folio/Parcel #: Is the Building Historically Designated: Yes NO Flood Zone: CONTRACTOR: Company Name: /OM /M / I /l / Ih'`s ) � hC Address: 4/ /S. V/ City: �I�.yvtdl State: M Qualifier Name: , C k G..Q 1 9YA h a tM State Certification or Registration #: 3D S" 71 31 Email Address: 365 ,5ta' 7 (' Zip: J /.?� Phone #: 30S 6 Si D to Phone #: Certificate of Competency #: "D�►tte C0O© r�beQi'o �a � ralnA w� — b�t1dt+te . ca►., DESIGNER: Architect/Engineer: Phone #: Value of Work for this Permit: $ `. Square/Linear Footage of Work: Type of Work: Address ❑Alteration ❑New ❑Repair/Replace Q Description of Work: 0 /74 4' j n, , /� &'� J\. L/ ❑Demolition COLOR THROUGH ROOF TILE IS REQUIRED acknowledged by: ******** * * * * * * *** * * * * * * * * * * * * * * * * * + * * ** F *, * * * * * * **** * * * * * * ** * * * * * * * * * ** Submittal Fee $ Permit Fee $ Aocet) CCF $ CO /CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ TOTAL FEE NOW DUE $ 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 b/ . ved a ' ection fee will be charged. Signature day of , 20 � by D who is personally known to me or who has produced 1 As identification and who did take an oath. iuet11, NOTARY PUBLIC: g rE The foregoi instrument was acknowledged before me this Sign: Print: My Commission Expires: APPROVED BY A/ Ow r -r.'r Agent �® t,` cJ p ",,, /j TM `\\ (Revised 07 /10 /07)(Revised 06 /10 /2009)(Revised 3/15/09)(rev6/4/10) Plans Examiner Contractor The foregoing instrument was acknowledged before me this I day of tt , 20 0, b - — who is personally known to me or who has produced FL,{O as identification and who did take an oath. NOTARY PUBLIC: Sign: Print: 11 1 111/ , ' lvere My Commission i r°\ ��'®��� ' c • Cod ®�6 %� • loft Zoning Structural Review Clerk acTia IJ W4LES ER3 D3 1M SURVEYOR'S SEAL rI9 • • • • • • t,fEE SJDRY s G8.S RES H 252 Ia�1 2Z0 tar & BLaL1 5� ca x ►6¢t a' tiOr REYLr,EO 17.30' � rouau Qaar »; iP) 9Tw kf' FLr,9N0 J!E(J7Y pJJo 0, •• ••• • • • • • • • seit -E-E •• •• • ra;rr� waer Pft 3 /s t • e(pL• T? : ••• • • • ••• • • , n ri t•lnrd 01 1V11103U,UNV S �i tor�elvarra z 1V ilVt`.> 1VU3a2d 11V IH11M 3ONVS1dWO3 011J.1('f I(I:; 1dj® 1dja O d r BECT TOOPWONOF1ITIE. 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I 4d' ADS t& I Z REQL9iti LAI. ®SLIR1'I�OR LOCATlCN SKETCH SCALE: NTS e:9 (3OGj BU -4200 2 3 I 7 iGtA0 �nxr NFt J/V 0_ C11TIIFI1D SO. I+X i . DO'w8fN AND ALF3ED 3)AVL'D DOr1S0V, 251 $.E. 1W� MIAMI SUORFS, FLORIDA 33138., L RIS0P11 P. RALLEY, P.A., Lt1 DRN YS INSURAICE FUND, lilC., 0110 SALVDUS U!1K, 11S SUCCESSORS 1ID(03 ASS1C LEGA1 DESCRIPftON: TII6 WESY 1/2 OE Lot S AND AIL 0! LOT & BLOCK AN »WIRED PLAT OH SECf0M 110. S OF MIAMI SH091S SU6DN� ACCORDIAGTO1HE PLAT THEREO� O DEDINP1.AT8OOK LO AT PAGE. 01= T E PLIHL C RECORDS COUNTY. FLORiOA SDK 5987 BL2Nco SURVEYOR: Engtrr e,s•LasdEwveyors•Pbai r• 696 NOF 1 II SNORE CW1fl MI*V BFACI{ FL 39541 0 12( Mc