PT-06-1767Issue Date: 6/29/2006 Expires: 12/26/2006
Owner's Name: WILLIAM/MARLENE ROACH
Permit Type: Paint
Work Classification: New
Job Address: 2 109 Street NW
Contractor(s) Phone Primary Contractor
HOME OWNER
Yes
Comments:
EXTERIOR PAINTING
Additional Information
Miami Shores Village, FL 33138-
Type of Work: Exterior Color: HC -102 AND ANTIQUE WHITE
Additional Info:
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 $0.60
Education Surcharge $0.20
Notary Fee $5.00
Permit Fee $60.00
Technology Fee $1.50
Total: $67.30
Invoice Number
PT - 6 - 06 - 25390
Total:
Amt Due
$67.30
Amt Paid
jut 0 6 PAID
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
Parcel #:
Block:
Section:
Permit Status: APPROVED
Permit Number: PT -6-06 -1767
Phone:
1121360110170
Lot:
PB:
Total Square Feet: 0
Total Valuation: $ 1,000.00
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 .
BUILDING
PERMIT APPLICATION
FBC 2004
Permit Type (circle):
Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
Job Address (where the work is being done) ( p' A' / ' 9 57
1,1
lig JUN 2 8 2006 y _I
BY: ------ - - - - --
Permit No. ? JOG ° ri&
Master Permit No.
Electrical Plumbing Mechanical Roofing
Owner's Name (Fee Simple Title o er) AV4// Phone # 776 8 gry
Owner's Address / "-/E `DV 67
City /14 f'4 /mil State _ ' Zip 39 (. f
®C
Tenant/Lessee Name /A Phone #
City Miami Shores Village County Miami -Dade Zip 3.3 / 3 f
FOLIO / PARCEL #
Is Building Historically Designated YES NO
Contractor's Company Name P A OC.JA Phone #
Contractor's Address
City State Zip
Qualifier Name Phone #
State Certificate or Registration No. Certificate of Competency No.
Architect/Engineer's Name (if applicable) Phone #
Value of Work For this Permit $ (v £2
Square / Linear Footage Of Work:
Type of Work: ['Addition ['Alteration ❑New 7 Repair/Replaae ❑ Demolition
Describe Work: �% �/�/� z3 ��9 — �'�'o PL/4G, S ,, c$'
******** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** F ees * * ***�** * * * * ** * * ** * * * ** * *** * *** * * * ** *** *** * **
Submittal Fee $, , Permit Fee $ C . CO CCF $ 0. CO /CC
Notary $ S w y , Training/Education Fee $ 0 . Z-O____ Technology Fee $ ( -'■—
Scanning $ Radon $ DPBR $ Zoning $
Bond $ Code Enforcement $ Double Fee $
Structural Review. $ Total Fee Now Due $ — 7° (3(0
See Reverse side -+
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 Al4FIDAVIT: 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 occur en (7) days after the building permit is issued In the absence of such posted notice, the
inspection will not . app/ % nd a rei pection fee will be charged
i _ 1 I I I is /
Signature . Signature
% , r or Agent Contractor
The foregoin trument was acknowledged before me this 2B The foregoing instrument was acknowledged before me this
day of 200 (, 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:
Sign:
Print
My Co ission Expires:
* * * * * * * * * * * * * * * * * * * * * * * * * ** ****************************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
APPLICATION APPROVED BY: Plans Examiner
(Revised 02/08/06)
Sign:
Print:
My Commission Expires:
Engineer
Zoning
Date
Owner's Name ( 4lt x'/5 V4 S & Phone # (59,5 77 - SSD
`J
Owner's Address , / A/ / 3 ( , Sr
City �l4/tf ( 4) 3 State i Zt Zip .3 /Ser
Job Address (where the work is being done). e (i /0 9 S
City Miami Shores Village County Miami -Dade Zip 33 /5e
Is Building Historically Designated YES NO .7
Contractor's Company Name (if applicable) Phone #
***************************************************************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
All elements on the site must be listed and indicate the color to be painted
was
f3 T.�Nl/N 41D O, i4c402
Fascia
Drip Cap /drip Edge E.).-A ' 1C
Soffit i'V — r( Q ( - /f 7 , , ZOGYLorrn 01�1
Roof A-14
Flower bins
Shutters
Awnings
Chimney
Doors and door jams (v� G-v 7 a �4Z /&
Garage doors
Railings
Fences
Decorative metal
All brick (simulated or regular)
Stucco banding
Any other stucco features
Accessory Buildings
Other .
***************************************************************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
OWNER'S AFFIDAVI I ce at all the foregoing information is accurate and that all work will be done in compliance with all
d zoning.
applicable laws re
Signature
Miami Shores Village
Paint Color Approval and Agreement
APPLICATION APPROVED BY:
Owner or
P& Z Official
ttach Color Samples
With Numbers
Date
Date
(CPC ( C
the 6 /18/03