BP-05-1091BUILDING
PERMIT APPLICATION
FBC 2001
Permit Type (circle):
Owner's Name (Fee Simple Titleho s er) // /LL/ remi .Dr /E- Phone #
Owner's Address /1 g'3 J' &. 9
cit
Tenant/Lessee Name
Job Address (where the work is being done) / / 2 - NE /1/ 57
City Miami Shores Village County Miami -Dade Zip Z / 6/
Is Building Historically Designated YES NO X
Contractor's Company Namer/C( Phone #
Contractor's Address
City State Zip
Qualifier
State Certificate or Registration No. Certificate of Competency No.
Architect/Engineer's Name (if applicable)
$ Value of Work For this Permit
Type of Work: ❑Addition
Describe Work:
Submittal Fee $
Notary $
Scanning $ 4r49-
Code Enforcement $
Total Fee Now Due $
(Continued on opposite side)
Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
State FL—
Electrical Plumbing Mechanical Roofing
DAlteration ❑New
Structural Plan Review. $
Master Permit No.
Zip
Phone #
Square Footage Of Work:
Permit No. 1 PoS /o /
Phone #
-32y7
❑ Repair/Replace
6
r
❑ Demolition
* * * * * * * * * * * * * ** * * * * * * * * ** ** F ees * * *** * * * *:r * * ** * * * * * * * * * * * * * * **
Permit Fee $ CC $ .,4Q 0 CO /CC
Training/Education Fee $ • 2.0 Technology Fee $ ( • 5
Radon $ — Zoning Bond $
Bonding Company's Name (if applicable)
f ,
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 reinspection fee will be charged.
NOTARY
Sign:
Print:
My Co
* * * * * * * **
APPLICATION APPROVED BY:
Chc 05/13/03
Owner or Agent
The foregoing instrument was acknowledged before me
day o(P., 20� � by x-10 .- CL)1� Il
who i personally known to me or who has produced_
Expires:
* * * * * * * * * * * * * * * * **
As identification and who did take an oath.
C r ay of ,20_,by
who is personally known to me or who has produced
as identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
My Commission Expires:
************* * * * * * * * * * * * * * * * * * * * * * * * **:* * * ** c *4= *.:{.. 44***+k*** � k******k*+ k******ek********** * *zk************** **
Ati
7 / ) , 7
77
Signature
Contrac
The foregoing instrument was acknowledged before me this
Plans Examiner
Engineer
Zoning
Miami Shores Village
• • • h Paint Color Approval and Agreement
Date b /
Owner's Name PO L L-f»9 1 Phone # 3 q -'' Z-q7
Owner's Address l /s` 3 /J 9
City d f / *f S 7e state �L
Job Address (where the work is being done)
City Miami Shores Village
Is Building Historically Designated YES
Contractor's Company Name (if applicable)
***************************************************************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
All elements on the site must be listed and indicate the color to be 'minted
t /ir/E/iX - 7 - t - 4 ' oD�".S� FLEY
Walls , gl6-P
Fascia PW /r
Drip Cap /drip Edge
Soffit
Roof
Flower bins
Shutters
rc
Awnings FLEX
Chimney co .o '-4,2A 13
� Doors and door jams S -`�- Y F
Garage doors
o�
/ r P/
Railings
Fences
Decorative metal
All brick (simulated or regular) !U/'f f TE
Stucco banding
Any other stucco features
Accessory Buildings
Zip 3 3 /. g
County Miami -Dade Zip 3 3) 6 (
NO.NX
Phone #
15
'pies
s
ill i) A01
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.
Signature
Owner or Agent
APPLICATION APPROVE /�
Date
D BY:
al
Date
4oVac/®s
.7A 7
chc 6/18/03
Contractor:
Inspection Date: 02/16/2006
Inspector: Grande, Claudio
Owner: MCINTIRE, CAROLEE
Job Address: 867 91 Terrace NE
Miami Shores Village, FL 33138-
Project: <NONE>
Building Department Comments
Wednesday, February 15, 2006
Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Block:
Permit Type: Imported Permit
Inspection Type: Final
Work Classification: <NONE>
Phone Number
Parcel Number 1132060050280
Lot:
Page 2 of 2
Passed
Inspector Comments
Failed
Correction
Needed
Re- Inspection
Fee
($75)
No Additional Inspections can be scheduled
re- inspection fee is paid.
until
Contractor:
Inspection Date: 02/16/2006
Inspector: Grande, Claudio
Owner: MCINTIRE, CAROLEE
Job Address: 867 91 Terrace NE
Miami Shores Village, FL 33138-
Project: <NONE>
Building Department Comments
Wednesday, February 15, 2006
Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Block:
Permit Type: Imported Permit
Inspection Type: Final
Work Classification: <NONE>
Phone Number
Parcel Number 1132060050280
Lot:
Page 2 of 2