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PT-10-407 A � \ g g r Miami Shores Villages LK 10050 N.E. 2nd Avenue Miami Shores, FL 33138 -0000 Phone: (305)795 -2204 Expiration: 09/1112010 Project Address Parcel Number Applicant 297 105 Street 1122310130400 ELLYN OLSON Miami Shores, FL Block: Lot: Owner Information Address Phone Cell ELLYN OLSON 297 NE 105 ST (305)756 -5176 MIAMI SHORES FL 33138 -2024 Contractor(s) Phone Cell Phone Valuation: $ 1,0 00.00 HOME OWNER Total Sq Feet: 0 Type of Work: Exterior Available Inspections. Color. Inspection Type. Additional Info: Final Classification: Residential Color. Approved Code Comments: Color: Approved_ Color. Denied Fees Due Amount Pay Date Pay Type Amt Paid Amt Due CCF $0.60 Invoice # PT -3 -10 -37278 Education Surcharge $0.20 03/12/2010 Check #: 2700 $ 66.60 $ 0.00 Notary Fee $5.00 Permit Fee $60.00 Technology Fee $0.80 Total: $66.60 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 March 12, 2010 Authorized Signature: Owner / Applicant / Contractor / Agent Date Building Department Copy March 12, 2010 1 Miami Shores Village Building Department V Mp , R l ° 10050 N.l;.2rid Avenue. Miami Shores. Florida 33135 , Tel: ( "_'105) 795.2204 Fax: (305) 756.8972 ,, •••" BUILDING Permit No. — rr ~. PERMIT APPLICATION Master Permit No. FBC 2004 Permit Type: PAINT PERMIT t _ Owner's Name (Fee Simple Titleholder Owner's Addres - -- Cit)* -' sc» S'�c c State l _ Zip Tenant /Lessee Name Phone # E -MAIL: Job Address (where the work is being done) City _ _ Miami Shores Village County Miami -Dade _ Zip 's���� FOLIO / PARCEL # Is Building Historically Designated YES NO Contractor's Company Name Phone # -I(D` Contractor's Address City_ State Zip Qualifier Name Phone # State Certificate or Registration No. Certificate of Competency No. OWNER BUILDER: 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 as indicated. I certify that no work or installation has commenced prior to the issuance ora permit and that all w(wk will he perromied to meet the standards of all laws regulatingconstruction in this jurisdiction. I understand that a separate permit must be secured for ELECTRICAL WORK- PLUMBING, SIGNS. WEL.I,S. POOLS, r'URNACES, BOILERS. HEATERS. TANKS and AIR CONDITIONERS. ETC.....' "WARNING TO OWNER: YOUR FAUAIRF. 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 REI RECORDING YOUR NOTICE OF COMMENCEMCsNT." Notice to. I ppl icani: : is if condition to the issuance g(a building permit with an estimated value exceeding $2500. the applicant boos! premnise in g(xrd faith Iht# a cop! of the notice of cornme ncement and construction lien lair brochure will be delivered to the person whose property is subject to attachment. Also. a certified copy of the recorded notice gl'cornmencentenl must he posted at the job site for 1he firs! inspection which occurs seven (7) days after the building perniit is issued. In the absence of such posted notice. the inspection gill trot he approved and a reinspeGion fee will be charged. • VV Technology V Permit Fee $ CCF $ gy Fee• Training /Education Fee.$ — Notary $ Code Enforcemen Double Fee $ Zoning $ Total Fee Now Due $ l (L(D See Reverse side —> PAINT COLOR APPROVAL AND AGREEMENT All elements on the site must be listed and indicate the color to be painted Directions: Please circle corresponding number to appropriate color sample. Walls: I 4 Attach color samples with name and Fascia: I 2 3 4 number. Drip Cap /Drip Edge: 1 2 3 4 Softie. 1 2 ; 4 Roof: I 3 4 Flower Bins: 1 2 3 4 Shutters: 1 2 3 4 Awnings: 1 2 3 4 2 Chimney: 1 2 3 4 Doors and Door .lams: 1 2 3 4 Garage Doors: 1 2 3 - 4 Railings: I 2 3 4 3 Fences: 1 2 3 4 All brick,(sinutlated or regular 1 2 3 4 Stucco Banding: I ? 3 4 Any other Stucco Features: 1 2 3 4 Any 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. Signahu•e Signature Owner or Agent Contractor The fi •ee ,2g instrument Nvas acknc ledged be re a is The foregoing instrument was acknowledged before me this . day of 20 0 by day ol• .20 _. by who is onallV kn wi o r or Who I is piuduced I y p )C _ - ho is personally known to me or who has produced • s °1 fication al i who did take t as identification and who did take an oath. NOT ! I " � ��„�' NOTARY PUBLIC: " ti Sign: , `J• UI Sign: Print: $ Print: ..,,,, My Commission t:xpires: Z , 4G `�. My Commission Expires: APPLICATION APPROW-D BY: Plans Examiner Preservation Hoard Code [-.nR,rcement (Revised 04/24/01 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP 137817 Permit Number: PT -3 -10 -407 Scheduled Inspection Date: March 22, 2010 Permit Type: Paint Inspector: Bruhn, Norman Inspection Type: Final Owner: OLSON, ELLYN Work Classification: New Job Address: 297 NE 105 Street Miami Shores, FL Phone Number (305)756 -5176 Parcel Number 1122310130400 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. March 19, 2010 For Inspections please call: (305)762 -4949 Page 9 of 26 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Insp Number: I I 137817 Permit Numb PT- 3- 10-407 Scheduled Inspection Date: March 22, 2010 Permit Type: Paint Inspector: Bruhn, Norman Inspection Type: Final Owner: OLSON, ELLYN Work Classification: New Job Address: 297 NE 105 Street Miami Shores, FL Phone Number (305)756 -5176 Parcel Number 112231013040 Project: <NONE> Contractor: HOME OWNER Building Department Comments Inspector Comments Passed E Failed Correction ❑ Needed Re- Inspection ❑ Fee No Additional Inspections can be scheduled until re- inspection fee is paid. March 19, 2010 For Inspections please call: (305)762 -4949 Page 9 of 26