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