PT-09-1307 t zl
Miami Shores Village; '
10050 N.E. 2nd Avenue
.... NOW
Miami Shores, FL 33138 -0000
Phone: (305)795 -2204 ,.. .
/s. Expiration: 02/02/201
P roject Addre Parcel Number Applicant
g ... �.. ...,.w.
16 111 Street 1121360030340
FERDO SARSON
Miami Shores, FL Block: Lot:
Owner Inf ormation Addre Phone Cell
F DRE O SARSON 16 NW 111 ST
MIAMI SHORES FL 33168 -4322
Contractor(s) Phone Cell Phone Valuation: $ 1,000.0 0 � wrt
HOME OWNER
Total Sci Feet: 0
Type of Work: Exterior For inspections please call:
Color: (305)762 -4949
Additional Info: Available Inspections:
Classification: Residential Inspection Type:
Color: _Approved Code Comments: Final
Color: _Approved_ Color: _Denied MM 1
Fees Due Amount Invoice # Total Amt Paid Amt Due
CCF $0.60 PT -8.09 -35559 $ 67.30 $ 67.30 $ 0.00
Education Surcharge $0.20
Notary Fee $5.00 Check #: 2060
Permit Fee $60.00
Technology Fee $1.50
Total: $67.30
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.
August 06, 2009
Authorized Signature: Owner / Applicant / Contractor / Agent Date
Building Department Copy
Auqust 06, 2009 1
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: 1 2 3 4 AttAi%h eni-p-
with name and
Fascia: 1
Drip Cap /Drip Edge: 1 2 3 4
Soffit: 1 2 3 4
Roof: 1 2 3 4
Flower Bins: 1 2 3 4
Shutters: 1 2 3 4
Awnings 1 2 3 4 2
Chimney �1,J 2 3 4
Doors and Door Jams: 1 Z 2 3 4
Garage Doors: 1 2 3 4
Railings: 1 2 3 4 3
Fences: 1 2 3 4
All brick (simulated or regular): 1 2 3 4
Stucco Banding: 1 2 3 4
Any other Stucco Features: 1 2 3 4
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.
Signature \ ��5— eq--1 �"� Signature
Owner or Agent Contractor
The for going nsttument was wl dged e ore me this The foregoing instrument was acknowledged before me this
day of 20M, by day of 1 20 _, by
who is p rs nay jCnown t me or who
Yl� has produced who is personally known tome or who has produced
entificati and o did t a as identification and who did take an oath.
NOTA P Ll j a V) kt, E ,�" NOTARY PUBLIC:
Sign: Sign: —
Print:? , Print:
My Commission Expires: My Commission Expires:
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APPLICATION APPROVED BY: Plans Examiner
Preservation Board
Code Enforcement
(Revised 04/24/07)
Miami Shores Village =?.oqvmZVX
. (� BUG 0 6 209
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
BUILD Tel: (305) 795.22.04 Fax: (305) 756.8972 BYE - �t.J\J �•••••
B
U Permit No.
PERMIT APPLICATION Master Permit No.
FBC 2004
Permit Type PAINT PERMIT
s Name Fee Simple Titleholder t� n 4 l
' ( p ) / ' f4 ��� Phone # :5P
Owner's
Address
City State C/' Zip 3 �/
Tenant/Lessee Name Phone #
E -MAIL:
Job Address (where the work is being done)
City 04_Miami Shores Villa e County Miami -Dade Zip 3 3
FOLIO / PARCEL #
Is Building Historically Designated YES NO
Contractor's Company Name Phone #
Contractor's Address
City at I I Zip
Qualifier Name V Phone #
State Certificate or Registration No. Certificate of Competency No.
OWNER BUILDER: 1 / Cam` o 944.5,077
Value of Work For this Permit $ ® Type of Work: El Addition/ ❑ Alteration / []New 1( �Repair/Replace
Describe Work: v
Application is hereby made to obtain a permit to do the work and installations as indicated. 1 certify that no work or installation has commenced prior to the issuance of it
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.....
"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 f rst inspection which occurs seven (7) days after the building permit is issued. In the absence ofsuch posted notice, the
inspection will not be approved and a reinspection fee will be charged.
Permit Fee $ CCF $ Technology Fee:
Training /Education Fee $ Notary $ Code Enforcement $
Double Fee $ Zoning $ Total Fee Now Due $
See Reverse side -
` Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
i
Inspection Number: INSP- 121245 Permit Number: PT -8 -09 -1307
Scheduled Inspection Date: August 12, 2009 Permit Type: Paint
Inspector: Bruhn, Norman
Inspection Type: Final
Owner: SARSON, FERDO Work Classification: New
Job Address: 16 NW 111 Street
Miami Shores, FL
Phone Number
Parcel Number 112136003034
Project: <NONE>
Contractor: HOME OWNER
Building Department Comments
PAINT EXTERIOR OF THE HOUSE
I
Inspector Comments
Passed G K 6 97
Failed ou
Correction ❑
Needed
Re- Inspection ❑
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
„ „ „
44 ,,,,,, For Inspections please call: (305)762 -4949