PT-06-153Issue Date: Not Issued
Owner's Name: MARY ANN WILSON
Permit Type: Paint
Work Classification: New
Job Address: 28 104 Street NW
Contractor(s) Phone Primary Contractor
HOME OWNER
Yes
Comments:
PAINT
Additional Information
Miami Shores Village, FL 33138-
Type of Work:
Additional Info:
Color:
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
CCF $1.20
Education Surcharge $0.40
Permit Fee $60.00
Technology Fee $1.50
Total: $63.10
Invoice Number
PT - 1 - 06 - 23514
Total:
Amt Due
$63.10
Amt Paid
$63.10
$63.10
Building Department File Copy
Applicant Signature
Miami Shores Village
10050 N.E. 2nd Avenue
Miami Shores, FL 33138 -0000
Phone: (305)795 -2204 Fax: (305)756 -8972
Permit
Expires: 01/19/2007
Parcel #:
Block:
Section:
Permit Status: APPLIED
Permit Number: PT -1 -06 -153
Phone:
1121360131030
Lot:
PB:
Total Square Feet: 0
Total Valuation: $ 1,250.00
Required Inspections
Final
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.
'Return to:
Miami Shores Village
10050 N.E. 2nd Avenue
Miami Shores, FL 33138 -0000
(Bill To 1
KARLA ARTEAGA
28 NW 104 Street
MIAMI SHORES, FL 33150 -1238
Date
Fee Name
04/20/2010 Expired Permit Renewal Fee
Tuesday, April 20, 2010
Invoice
Miami Shores Village
10050 N.E. 2nd Avenue
Miami Shores, FL 33138 -0000
Phone: (305)795 -2204 Fax: (305)756 -8972
For Inspections please call: (305)762 -4949
Invoice Number: PT -4 -10 -37628
Invoice Date: April 20, 2010
Permit Number: PT -1 -06 -153
Bond Number:
'Comments:
Fee Type
Calculated
Total Fees Due:
Fee Amount
$60.00
$60.00
Payments
Date Pay Type
04/20/2010 Check
Check Number Amount Paid
2036 $60.00
Change
$0.00
Total Paid:
$60.00
Total Due: $0.00 I
1/8/2008
To: Current Owner
28 NW 104 Street
Miami Shores Village, FL 33138-
Permit: PT- 1- 06-153
Address:28 NW 104 Street
Miami Shores Village FL33138-
Date Expired: January 19, 2007
Type: Paint
Dear Sir or Madam
In order for us to serve you better, we need to keep our files up to date. Our records
indicate that the above reference Permit has expired.
The Building Department has determined that the work applied for has been completed
with out the required inspections and it has been more than 180 days since your last
approved inspection and thus your permit has expired as per Sec. 104.5.of the Florida
Building Code. You are required to renew your permit and schedule all required
inspections.
In the event you do not comply with the requirements herein, the Building Department
will file a complaint with Miami -Dade County Building Code Compliance Office for
possible disciplinary action against your licensed contractor And/or if permit was
obtained by the home owner the requirements of the Unsafe Structure Code of Miami
Dade County Sec. 8 -5. (3) will apply. "The building shall be presumed and deemed
unsafe and a permit shall be obtained to demolish the structure or bring the building in to
compliance with applicable codes as provided herein."
Please contact the Building Department, immediately upon receipt of this letter.
Sincerer,
C$udio Grande C.B.O
Building Official/ Director
Miami Shores Village
Building Department
10050 NE 2 Ave, Miami Shores, Fl 33138
Tel: (305)795 -2204 • Fax; (305)756 -8972
BUILDING
PERMIT APPLICATION
FBC 2001
Permit Type (circle):
Owner's Name (Fee Simple Title
Owner's Address 750 I 6
City I } i n
Tenant/Lessee Name
Submittal Fee $ Permit Fee $
Notary $
Scanning $
Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
Electrical Plumbing Mechanical Roofing
FQr Ann ,A .1 \JOI hone#
,nh�1�
Q
State TX Zip —781 4 52.
Phone #
Job Address (where the work is being done) 20 NW 1044
City Miami Shores Village County Miami -Dade
Is Building Historically Designated YES NO X
Contractor's Company Name OUJ rtie. 15Elf
Contractor's Address
City State Zip
Qualifier
State Certificate or Registration No. Certificate of Competency No.
Architect/Engineer's Name (if applicable) Phone #
$ Value of Work For this Permit 1 2_50 Square Footage Of Work:
Type of Work: ['Addition ['Alteration [New ❑ Repair/Replace
❑Demolition
Describe Work: 20_,p elZt f 1n e, coloi 5
****************************F
Training/Education Fee $
fr
s`
Radon $ Zoning
Code Enforcement $ Structural Plan Review. $
Total Fee Now Due $ Cp & I o Gk is j
(Continued on opposite side)
Phone #
Permit No. PV® I SS
Master Permit No.
Zip
CCF $ .l • CO /CC.
Technology Fee $ 1-50
Bond $
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 certffied 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_,by , 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: Sign:
Print: Print:
My Commission Expires: My Commission Expires:
***************************************************************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
APPLICATION APPROVED BY:
Chc 05/13/03
klksk4
PIans Examiner
Engineer
Zoning
TEXAS ORDINARY CERTIFICATE OF ACKNOWLEDGMENT
02000 National Notary Association .9350 De Soto Ave., P.O. Box 2402 • Chatsworth, CA 91313-2402 • wvAymationainotary.org
CIVIL PRACTICE & REMEDIES CODE § 121.007
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Before me, 1,t X1:`2► -��5� , on this
e and C r of Notarizing Officer, e.g., "John Smit , Notary Public'
day personally appeared
Name of Signer
❑ known to me
❑ proved to me on the oath of
Name of Credible Witness
y proved to me through ` 1( -�-
Description of Identity Card or Document
to be the person whose name is subscribed to the foregoing
instrument and acknowledged to me that he /she executed the
same for the purposes and consideration therein expressed.
Given under my hand and seal of office this
I ? day of d
Day Month
ill 1A�
Signature of Notarizing Office
OPTIONAL
Though the information in this section is not required by law, it may prove valuable to persons relying on the
document and could prevent fraudulent removal and reattachment of this form to another document.
Description of Attached Document
Title or Type of Document:
Document Date: ` Number of Pages:
Signer(s) Other Than Named Above:
•
,
Year
RIGHT THUMBPRINT
OF SIGNER
Top of thumb here
Prod. No. 5243
Reorder. Call Toll-Free 1-800-876-6827
BUILDING
PERMIT APPLICATION
FBC 2001
Owner's Name (Fee Simple Titleholder) Permit Type (circle): Building Elect cal PI�m — bung Mechanical Rooting
Owner's Address l 5 O ( C 2M.
City 1S -\ State \ X
Tenant/Lessee Name - -A.e vt a Phone #
Job Address (where the work is being done) 2.2
City Miami Shores Village County Miami -Dade Zip . 50
Is Building Historically Designated YES NO \✓
Contractor's Company Name 0 V . - , l Se. t� Phone #
Contractor's Address
City State
Qualifier
Architect/Engineer's Name (if applicable) +V - 4. Phone #
°--
$ Value of Work For this Permit
Type of Work: ['Addition ['Alteration ❑New
Describe Work: vie_ e•1- , vist _ e.' t es Y"
Submittal Fee $
Notary $
Scanning $
Code Enforcement $
Total Fee Now Due $
(Continued on opposite side)
Miami Shores Village
Building Department
>0050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
Permit No.
Master Permit No.
S3
Phone# 5 12 1 4a' B335
Zip ``lit
Zip
Square Footage Of Work: gii.,.t?!P \p A--
l RePair/Replace ❑ Demolition
a• &ej V-0 \ VCs
* * * * * * *** * * * * * * * * ** * ** * * * * ** Fee1* * * * * *4 * * * * * * * * * * * * * ** * *** * * **
•
Permit Fee $ CCF $
Training/Education Fee $ Technology Fee $
Radon $ Bond S
Structural Plan Review. $
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 reinspec 'on fee will be charged
er or Agent �{ Contractor
The foregoing instrument was acknowledged before me this 1 { k The foregoing instrument was acknowledged before me this
d a y o _, 20dQby Rhh w ay of , 20 , by
who is personally kn too a or who has produced who is personally known tome or who has produced
\f �S � and who did take an oath. as identification and who did take an oath.
NOT
Si
Signature
NOTARY PUBLIC:
Sign:
Print:aei∎ i A .16 C SC Print:
My Commission Expires:
My Commission Expires: 1 �. , w► . A e'
* * * * * * * * * * * * * * * * * * * * * * ** *** *** **** ******* ******************************************* * * *** * * * * * * * * * * * * * * * * * * * * * * ****
(Certificate of Competency Holder)
State Certificate or Registration No. Certificate of Competency No.
APPLICATION APPROVED BY: Plans Examiner
Engineer
Zoning
Chc 10/14/03
J
Miami Shores Village
10050 Northeast Second Avenue
Miami Shores, Florida 33138-2382
Telephone: (305) 795 -2207
Fax: (305) 756 -8972
www.miamishoresvillage.com
Paint Color Approval and Agreement
DATE: `�
OWNER'S NAME: v� I��.� W ‘...S<5"sr∎ , PHONE: 5\?.,• 1 \b • $ 335
ADDRESS: 15h ( �1 e,��+�.� lka . 'k\ : A. t i511.5 �.
ADDRESS OF SITE: 28 N■ V(`04. �'t, • A�c1nn�C \skOpca S
CONTRACTOR & LICENSE (if applicable) N
COMPANY NAME:
All Elements on the site must be listed and indicate the color to be painted.
Walls: \ava
Fascia: WAt,iF-e.
Drip Cap /Drip Edge: w\n.;'t.�
Soffit: t ,\ A ..;'
Roof: �1 Q
Flower Bins: \%
Shutters: 1
Awnings: w\Likre-
Chimney: \s ?..
Doors and door jams: W\L,�e..
Garage Doors:
Railings: \.) ,1 .\4?
Fences: N
Decorative Metal: kz\,,.;".
All brick (simulated or regular):„Ea
Stucco Banding: ‘N){,
Any other stucco features: Kam, t o \ 3 v t
Accessory/Buildings:
Other: KN A.
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 stated. Furthermore, the paint colors will be as per the attached samples.
\\Q4 Signatur�(cOwner D ate Signature of Contractor Date
APPROVED:
Building Official
Date
PHONE:
331x0
WHEN PAINTING IS FINISHED, CALL FOR FINAL
INSPECTION
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cameo white
'N IN) W \10 -
linen white
Thursday, January 19, 2006
Date
01/19/2006
Permit Receipt
Permit Number: PT -1 -06 -153
Invoice Number: PT -1 -06 -23514
Applicant: MARY ANN WILSON
Company Name:
1
Payment Type CheckNum
Check 1339
Amount
$63.10
Total Payment: $63.10
Page 1 of 1
Inspection Number: INSP -6586 Permit Number: PT -1 -06 -153
Scheduled Inspection Date: April 22, 2010
Inspector: Bruhn, Norman
Owner: ARTEAGA, KARLA
Job Address: 28 NW 104 Street
Miami Shores, FL 33138-
Project: <NONE>
Contractor: HOME OWNER
Building Department Comments
EXTERIOR PAINT
Passed
Failed
Correction
Needed
Re- Inspection
Fee
April 21, 2010
No Additional Inspections can be scheduled until
re- inspection fee is paid.
Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspector Comments
For Inspections please call: (305)762 -4949
Permit Type: Paint
Inspection Type: Final
Work Classification: New
Phone Number
Parcel Number 1121360131030
Page 25 of 25