PAINTIssue Date: 6/1/2006
Owner's Name: L CHRISTOPHER PENICK
Permit Type: Paint
Work Classification: New
Job Address: 94 102 Street NE
Comments:
EXTERIOR PAINTING
Additional Information
Miami Shores Village, FL 33138-
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
Expires: 11/27/2006
Contractor(s) Phone Primary Contractor
HOME OWNER
Yes
Type of Work: Exterior Color: 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.
Parcel #:
Block:
Section:
Permit Status: APPROVED
Permit Number: PT -5 -06 -1476
Phone: (305)726 -6400
1132060131450
Lot:
PB:
Total Square Feet: 0
Total Valuation: $ 200.00
Required Inspections
Final
Fees Due
CCF
Education Surcharge
Notary Fee
Permit Fee
Technology Fee
Total:
Amount
$0.60
$0.20
$5.00
$60.00
$1.50
$67.30
Invoice Number
PT - 5 - 06 - 25031
Total:
ri O2
Amt Due
$67.30
Amt Paid
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.
EXTERIOR PAINTING
:c y 4/ ?
JUN 1 2 2'
6,
Passed
Inspector Comments
Failed
Correction
Needed
Re- Inspection
Fee
($75)
No Additional Inspections can be scheduled
re- inspection fee is paid .
until
•
nec
Inspection Date: 06/12/2007
Inspector: Grande, Claudio
Owner: PENICK, L CHRISTOPHER
Job Address: 94 102 Street NE
Miami Shores Village, FL 33138-
Project: <NONE>
Contractor: HOME OWNER
Building Department Comments
Monday, June 11, 2007
Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Block:
Permit Type: Paint
Inspection Type: Final
Work Classification: New
Phone Number (305)726 -6400
Parcel Number 1132060131450
Lot:
Page 2 of 2
Y
BUILDING
PERMIT APPLIC • ON
FBC 2004
Permit Type (circle) Building
Owner's Name (Fee Simple i e older)
Owner's Address iU E /0 21)1 s7
City /Y) U't#?l / S/ -late dfi- g
Tenant/Lessee Name
r 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) got 'e
City Miami Shores Village County Miami -Dade Zip 3 3) 3 8
FOLIO / PARCEL #
Is Building Historically Designated YES NO
Contractor's Company Name 5 tj dcon e —f 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 $
d
Type of Work: ❑Addition ['Alteration ew El Repair/Replace ❑ Demolition
Describe Work: fa It T (7 u- Se-
Miami Shores Village
MIZMEWMI
Permit No.
Master Permit No.
BY: .NIb
lectrical Plumbing Mechanical Roofing
/ C` Phone # 3 S 7
HIS P
Zip `?313Z
Phone #
Square / Linear Footage Of Work:
e r1 [. /2 a-q / i t s .
Submittal Fee $ Permit Fee $ GO . \C�O CCF $ 0 . (DO CO /CC
CC Notary $ 6 ' Training/Education Fee $ 0. �J Technology Fee $ i .
Scanning $ Radon $ DPBR $ Zoning $
Bond $ Code Enforcement $ Double Fee $
Structural Review. $ Total Fee Now Due $ ( (�7 30
PTCro 14
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 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
Sign:
Print:
NOTARY PUBLIC:
My Cwmm ssion Expires:
(Revised 02/08/06)
APPLICATION APPROVED BY:
Lyuc
ti ded'
(e7 /
Signature " Signature
Owner or Agent Contractor
The for ofing instrument was ackn be me th 3 i The foregoing instrument was acknowledged before me this
day of 1( ( t 1, 20a, , by ; acknowledged
I : _ ) f'L. -- 1 ) k k , day of , 20 , by
who is personally known to me or who has produced who is personally known to me or who has produced
[CI
c_-
As identification and who did take an oath. as identification and who did take an oath.
vtolON
i `a.1r.S- • 1 1 , V.
•❑ .;v � �. Ate• • •
NOTARY PUBLIC:
Sign:
Print:
My Commission Expires:
*******************,***************************,******************************* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
Plans Examiner
Engineer
Zoning
Date
P Phone # 2d 26 4Uv
Owner's Name /
Owner's Address 6 9` / 7 () /v 2 ��
City alto S h(r7 -e-g state Zip r 3 8
Job Address (where the work is being done). J C% V/A ' te
City Miami Shores Village
Is Building Historically Designated YES NO
• Paint Color Approval and Agreement
Contractor's Company Name (if applicable) (,/"1 111 k) Vrn Phone #
***************************************************************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
All elements on the site must be listed and indicate the color to be painted
C--- ) tr—
Walls
Fascia
Signature
Drip Cap /drip Edge
Soffit
Roof
rd
APPLICATION APPROVED BY:
Miami Shores Village
Flower bins
Shutters
Awnings \
Chimnney /' L) ,I +e Doors and door jams l
Garage doors
Railings
Fences
County Miami -Dade
Decorative met
All brick (simulated or regul
Stucco banding
Any other stucco features
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 an�oning.
Zip
Attach Color Samples
With Numbers
Date c/3 D /Dt
Date 1 \ W
clic 6/18/03
PROPERTY OWNER
Name G pe►f-1lGv..
Address
olH tJ E 1 O2rli si
p✓A,Lew.A:■ s airy -es' k r 1 3313
Home Telephone 70 1 S 4 G, 333
Business Telephone 3U 5 i ZGo 6 qoi
Fax
TYPE OF MANAGEMENT (✓ )
New Construction
Enclosure
Alteration Exterior
Repair
Alteration Interior
Demolish
Relocation of Structure
Shell Only
Foundation Only
Add'I Attachment
Other
Add'I Detachment
Other
Address
PERMIT TYPE (✓ )
Building
Electrical
Mechanical
Plumbing
LPGX
Roofing
Fence
Other
•
• •
• ••
• •
• • • • • •
• • • • • • • • •
••• •
•
••• ••• • • •
• •••
INSTRUCTIONS - Thp following steps must be taken to obtain a permit from the Miami Shores Village:
• •••
Step I. Complex tI a a[ tahep �n
p� 4iplicdlson which must be signed by the property owner and qualifier. Both signatures must be notarized. Please
print of type to a1f0v0 f : aunke accurate processing of your application. If roofing work will be done, a roofing application must be submit
ted along with this permit appli>~Stioti•
Step 2. Submit the completed application with all necessary documents to the Building, Planning and Zoning Department for processing. During the
processing of your application, you may be asked to submit additional information.
APPLICATION
X ob Address: 9 Ni & 1 0 Zr' f S+ )1,1,-- ,y
Apt. City
PERMIT CHANGE (✓ )
Chg. Contractor
Renewal
Revision
Extension
Supplement
Reinspection
ARCHITECT
Name
License No.
Address
Telephone
Fax
Master Permit No.
Subsidiary Permit No.
PERMIT APPLICATION
e ale)
SVu.o'S 1 Fc - s3 i 3 �S
State Zip
Folio Number description of Work t ►/lt lDt - W ■ -fro iz h t 13L_
Lot Block
Subdivision PB PG Zoning Linear Feet
Current Use of Property Square Feet Units Floors
Proposed Use of Property Value of Work Bldg Value
Tenant Information Tax Assessed/Appraised Value
Flood Zone Base Floor Elev.
ENGINEER
Name
License No.
Address
Telephone
Fax
CONTRACTOR
Name
License No.
Address
Telephone Fax
Qualifier Name
Page 2
IMPORTANT NOTICES
DO NOT BEGIN ANY WORK WITHOUT HAVING RECEIVED YOUR VALIDATED PERMIT.APiD PERMIT CARD. Applying for a permit does not grant
the right to begin construction. HOURS OF CONSTRUCTION are limited to: Monday through Friday from 7:30 a.m. to 6:00 p.m., and Saturday from 8:00 a.m.
to 5:00 p.m. No inspections will be conducted on weekends or holidays. • • • • ' •
2. All construction of demolition areas MUST BE MAINTAINED IN A CLEAN, NEAT AND SANITARYWNLIITI(7�1 tre fr edhttruution debris.
3. STREETS AND NEIGHBORING PROPERTIES SHALL 13E KEPT FREE FROM DIRT AND DEBRI�! • • • • •• * ; • • , ' • •
4. SWALES MUST BE PROTECTED FROM BEING DAMAGED BY EQUIPMENT OR VEHICLES, qQ NO'I•BE USED FOR STORAGE. A bond is
required for work in or near the street/sidewalk.
5. CONSTRUCTION TRAILERS ARE PROHIBITED ON SINGLE FAMILY RESIDENTIAL CONSTRUCTION SITES. Other construction may have a trailer
which requires a separate permit.
6. PORTABLE TOILETS for a construction site require a separate permit.
7. DO NOT DISCHARGE WATER INTO THE RIGHT OF WAY OR STORM DRAINS without approval from the Building, Planning and Zoning Department.
8. EQUIPMENT AND MATERIALS SHALL BE STORED at least 10 feet from the edge of pavement.
9. Department of Health and Rehabilitative Services (HRS) approval is required for applications involving septic tanks. Department of Environmental Resources
Management (DERM) and/or Miami -Dade Water and Sewer Department (MDWASD) approval is required for applications involving sewers.
AFFIDAVIT - Please read carefully.
Application is hereby made to obtain a permit to do work and installation as indicated. I, the OWNER of the property, certify that all
work will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that separate permits
are required for ELECTRICAL, PLUMBING, POOL, EXTERIOR DOOR, MECHANICAL, WINDOW, FENCE, DRIVEWAY,
ROOFING and SIGNS and there may be additional permits required from other governmental agencies.
I, the OWNER of the property, have disclosed all information related to any work at the property performed in the prior twelve
months to the Building Official. Further, I am fully aware that if the cumulative cost of work to my home or business under this and
any other permit equals or exceeds fifty percent (50 %) of the fair market value of the structure, the entire structure must meet the
present federal flood criteria for finished floor elevation. I am also fully aware that if the total cost of work to my home or business
under this and any other permit exceeds fifty percent (50 %) of the replacement cost of the structure, then the entire structure must
conform to the current code requirements of the Building Code.
WARNING TO OWNER: Your failure to record a NOTICE OF COMMENCEMENT may result in you paying twice for
improvements to your property. If you are spending more than $2,500 or intend to obtain financing, you may wish to consult with
your attorney or lender before recording your Notice of Commencement. The Notice of Commencement must be recorded at:
22 N.W. 1st Street, 1°' Floor, (305) 679 -1078. Once recorded, the Notice of Commencement must be POSTED AT THE JOB SITE in
accordance with Section 713 -35 of Florida Statutes. Review the brochure at Village Hall on Construction Lien Law and
Choosing a Contractor.
STATE OF FL�,O1A, COUNTY OF MIAMI -DADE
X S ignature of Owner
( ' t„ r1 1'e v' c (-
Print Name
Swotp and subscribed before me this
S nature of Kvtary Public State of Florida
.•• •
• - • - •
• • • • • ••' •
• • • PERMIT APPLICATION
• •• • ..
• • • •• • • • •
STATE OF FLORIDA, COUNTY OF MIAMI -DADE
Signature of Contractor / Qualifier
Print Name
• . ••• ••
.• • • . • •
Sworn to and subscribed before me this day of
Signature of Notary Public - State of Florida
SEAL: SEAL:
Angela M Becker
My Commission D0160048
Personallykit®w*' 'P Expires Nov uced8dentification Personally known OR, Produced Identification
"
Type of Identification Produced: � � j\ k L
,'I'Ype of Identification Produced:
SECTION
BY
DA E
Zoning
/ /jQ
(/
/2/ 3
0:
Electrical
Mechanical
Plumbing
Fire
Public Works
Structural
Building Official
+7, 1 7 1 -- - 2
Page 4
OFFICE USE ONLY
CHECKLIST
❑ OWNER - BUILDER FORM
(Attach)
❑ FIRE DEPARTMENT
APPROVAL (Commercial /
multi - family)
❑ CONCURRENCY
(New Construction)
❑ OTHER
(Specify & Attach)
PERMIT FEES
$3.00 per page (Scanning Fee)
Miami Shores Village
Bond
Metropolitan Dade County (C.C.F.)
Inspector State Educational Fund $
State DCA (Radon) $
Code Enforcement Fine
Zoning Review
Notary
❑ PROOF OF OWNERSHIP
(Attach)
❑ HRS / DERM APPROVAL
(Septic / Sewer)
❑ IMPACT FEE
(New Construction)
❑ OTHER
(Specify & Attach)
$ .4
$ ` ( sq.ft. = x/1000
x ¢.60)
$ on
ISSUING OFFICIAL
REVIEWED AND PREPARED BY:
(¢.005 /sq.ft.)
(¢.01 /sq.ft.)
•••
. •
• •
••• •
•
••• •
• •
• • PERMIT APPLICATION
• • ••• ••
• ••• •
• • .. • • • ••• • •
•••
❑ CONDO ASSOCIATION APPROVAL
•.(Ats2Q )..: •• • • ' • ••
.• •; • .: •• • ••
ti $PR AP
❑ CONTRACTOR REGISTRATION
(On File)
TOTAL $ j S .b (')
DATE:
CONDITION OF APPROVA L
Revised July 2001
10050 N.E. 2ND AVE., MIAMI SHORES, FL • (305) 795 -2207 • FAX (305) 756 -8972 • http : / /www.miamishoresvillage.com
1'.LEC'1'R1( :AL
'fl'PE
Minimum Fee
QTY.
TYo :
Dry.? • •
QTY.
Tv'PE
Outlet, Appliance
QT1'.
'I'1'PE
Service Repair
QT)
A/C Central 1 -3 Ton
Fan
Dryer Vents, Number of
Outlet, Wall
Ventilation, Cost
Service, Temporary
Air Handler, Tons
A/C Central 4 -7 Ton
Piping, Flammable Liquid
Fire Pump
Outlet, Switch
Fire Sprinkler System
Signs
A/C Central 8-15 Ton
Bath Fan - Vented, #
Fixture - Fluorescent
Pressure Vessel
Oven
Space Heater (kw)
A/C Central 16 -20 Ton
Fixture Light
Parking Lot Lights
Spas/Hot Tubs
A/C Central 20+ Ton
Flood Lights
Plugmold/Strip
Subfeeds, No. of Amps
A/C Window
FPL - Load Central
Posts
Swim Pool, Commercial
Air Conditioners
Garbage Disposal
Range/Range Top
Swim Pool, Residential
Chiller
Generators, etc.
Receptacles
Switchboards
Clear Violations
Heat Recovery
Refrigerator, Comm. (p/PH)
Temp Serv., Construction
Compactor
Low -volt, Burglar
Refrigerator, Domestic
Temp for Test - 30 days
Deep Freezer
Low -volt, Fire
Renew - Temp Service
Water Closet
Demolition
Low -volt, Intercom/Teleph.
Repair Circuits
Water Heater
Dishwasher
Low -volt, Television
Service, Number of Amps
Water Heater New
NILCHANICAL
'I'1'PI?
Minimum Fee
QTY. TYPE
Condensate Drain
Q"1'Y. TYPE.
Generator
Q'I'Y. 'I'1'i'E
Refrigeration, Tons
Q'I'Y.
A/C Central, Tons
Cooling Tower
Heating Strips, each
Vent Hood, Cost
A/C Wall/Win. Tons
Dryer Vents, Number of
Paint Booth
Ventilation, Cost
Solar Water Heater
Air Handler, Tons
Ductwork, Cost of
Piping, Flammable Liquid
Periodic Inspections
Barbecue
Fire Sprinkler System
Process/Pressure Piping .
Cap - Fixture
Bath Fan - Vented, #
Fireplaces, Number of
Pressure Vessel
Pump and Abandon
PLUN1131NG
TYPE
A/C Condensate
QTY
TYPE
Drains, Roof
()Ty.
'I'1'
Miscellaneous Fixture
QTY.
'I'YI'E
Soakage Pit
QTY.
Bath Tub
Drinking Fountain
Miscellaneous Repairs
Solar Water Heater
Bidet
Filter Replace
Pool Piping
Sprinkler Repair
Cap - Fixture
Fountain
Pump and Abandon
Sprinkler System
Cap - Water
Gas - Appliance
Pump, Domestic
Supply, AC Well
Cap - Sewer
Gas - Natural
Pump, Fire Stand
Temporary Toilet
Catch Basin
Gas - Propane
Pump, Re- circulate
Temporary Water Closet
Clothes Washer
Gas Piping
Pump, Replace - Pool
Urinal
Dental Chair
Grease Trap
Pump, Sprinkler
Utility - Sewer
Discharge Well
Ice Maker
Pump, Sump
Utility - Water
Dishwasher
Indirect Wastes
Relay Repair
Vacuum Pump
Disposal
Interceptor
Roof Inlet
Water Closet
Domestic Well
Laundry Tray
Septic Connection
Water Heater
Drainfield, 4" Tile/Res.
Lavatory
Septic Tank
Water Heater New
Drains, Area
Meter Set (Gas)
Sewer Connection
Water Re -pipe
Drains, Floor
Minimum Fee
Shower
Water Service
Drains, French
Miscellaneous Equipment
Sink
Well, Supply
Page 3
• • • • • •••.. •
• • ••• • •
•
.• •• • •
•
• • • •; ... • • •
• • • • • • = , • •
• ii. •
INSTRUCTIONS Please indicate the t 'p of work being performed and quantity(ies) in the space provided below.
•• • •
• _ •
•
•
•
. •••
PERMIT APPLICATION
RECEIVED AND REVIEWED BY: DATE:
Miami Shores Village
10050 NE 2nd Avenue
Phone: 305 - 795 -2204 Permit Number: BP2002 -2180
Printed: 12 /16/2002
Applicant: L CHRISTOPHER
Owner: PENICK
JOB ADDRESS: 94
Contractor
Local Phone:
Parcel # 1132060131450
NE 102
Fees: Description Amount
FEE2002 -7228 Building Permit Application Fee $60.00
FEE2002 -7229 CCF $0.60
FEE2002 -7230 Notary Fee $5.00
Total Fees: $65.60
Total Fees: $65.60
Total Receipts: $0.00
Permit Status: APPROVED Permit Expiration: 6/14/2003
Work: EXTERIOR PAINTING OF ROOF WHITE TO WHITE
If there is no permit package accessible on the job -site for inspectors to verify, there will be no inspections. Re- inspection
fee is $50.00, which must be paid in advance before calling for another inspection.
/\ This Permit is granted to the contractor or builder named above to construct the building or to install the equipment or device described in the application herefor in strict compliance with all
• ordinances pertaining thereto and with the understanding that the work will be performed in compliance with any plans, drawings, statements or specifications that may have been submitted to
▪ and approved by the proper municipal authorities. This Permit may be revoked at any time if the work is not done in compliance with such ordinances or if the plans are changed without
authorization. A further condition upon which this permit is granted is the understanding that the contractor or builder named above assumes the responsibility for a thorough knowledge of the
ordinances and regulations pertaining to the work covered hereby whether shown on the plans or drawings or in the statements or specifications and that he assumes responsibility for work done
by his agents, servants or employees.
Signed: (INSPECTOR) BY:
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 •r specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I assume responisibility for all work done by either
myself, my agent, servants or em•loy s.
Signed:
Building Permit
PENICK
L CHRISTOPHER
ST
Contractor's Address:
Page 1 of 1
Legal Description: MIAMI SHORES SEC 1 AMD PB 10 -70 LOT 1 & E3OFT OF LOT 2 BLK 11 LOT SIZE
Construction Value:
$500.00
REG C01 121802 0955 NC01 003480 CHARGE $65.60
(Contractor or Builder) BY:
Sta te
the Su `:‘,100.‘
hie"
?St 3
vf* e cP°
ai
orsP
• •
•
•
• • •
..
• ••••
•• • •
• • • •• •
OOOOOO •
•••. •
• • • • • .
. ••..
• •••• ..•••• •
•
...... .....
• • •• .
•• • • • ••••••
• ••
.••••• ......
• •
• • •
•
• ••••..
• •
••• • ••••..
• • • • •
• •
•• •
�.. ...
Chimney cr
Doors and door jams 41G
Garage Doors )V�
Railings N
Fences M ,a
Decorative Metal Nom/
All brick (simulated or regular) i q
Stucco Banding
Any other stucco features 11/0
Accessory'Buildings ii/•
Other Nc
DATE: 1 2 i 1 2 - 1 3 ? — OWNER' NAME: Ch rL3tb01 chic IC PHONE: 3 DS - 7sz/ 40 3 3 "S
ADDRESS: ci4 /v& IOZ -ryr) s nfl « v-, i Shores, F4_ 3 I3 �'
********************************* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
ADDRESS OF SITE: S2 -i-n-e
CONTRACTOR & LICENSE (if applicable)pc ( r\ - re S f F
COMPANY NAME: PHO J - - , -
*********** ********************** * * * * * * * * * * * * * * * *4* * * * * * * * * * * * **
/ All Elements on the site t be listed and indicate the color to be painted..
Walls s k (1 'y - Cu i-- 1 Thir . f �! �, cc. - • .
Fascia / .r a l �v •
Drip Cap/Drip Edge /J G
0
L-.. .:.
Soffit N `� t
-.
APPROVED:
1 I'l l f �.l'V11 O JO t J itj V_ L LA ILTE
Paint Color Approval and Agreement
..g/(4 /_2/<}ZP
Building icial Date
Roof vo
Flower Bins lJ qi
Shutters
Awnings
En
. v
ro
•
r
'.3
z.
• •c
3
w
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. I authorize the above -named contractor, if applicable, to
do the work stated. Furthermore , the paint colors will be as per the attached
0 samples. ... • •
CG. (2/ IZ • ... • . • . ..
i\Signature of Owner Date Signature of Contractor" **Date: i .; •
********************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
• •
WHEN PAINTI It FINTSEIEII : •: •
CALL FOR FIIC AE INgP .
... ; -
• : ':4
. •
. •• • :.
• • •• • ..
•
STATE OF FLORIDA,
COUNTY OF DADE. ss
NOTE: A charge of $1.00 will be made for
the Planning Board.
A re- inspection fee of $1.00 will be charged
materials and /or workmanship.
MIAMI SHORES VILLAGE
BUILDING INSPECTION DEPARTMENT
APPLICATION FOR BUILDING PERMIT
Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the build-
ing or other structure herein described. This application is made in compliance and conformity with the Building Ordinance of Miami
Shores Village, Florida, and all provisions of the Laws of the State of Florida, all ordinances of Miami Shores Village and all rules and
regulations of the Building Division of Miami Shores Village shall be complied with, whether herein specified or not. A copy of approved
plans and specifications must be kept at building during progress of the work.
Date / d `8e S , 19 • Owner's Name and Address _. No Street
Registered Architect and /or Engineer
Name and address of licensed contractor
Location and legal description of lot to be built on:
Lot Block Subdivision
Street and Number where work is to be done
State work to be done and purpose of building (by floors)
Building Iryector
Date
New Building Remodeling Addition
To be constructed of Kind of foundation
Estimated Total cost of improvements $
and for no other purpose.
Repa rs No. of Stories
Amount of Permit $
Zone cubage required _Plan Cubage
Distance to next nearest building Size of Building Lot
Maximum live load to be borne by each floor
I hereby submit all the plans and specifications for said building. All notices with reference to the building and its construction may
be sent to
The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations as an employer
of labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida, Permanent Supplement,
and has complied with the rovisions thereof, and will require similar compliance from all contractors or sub- contractors employed by him
in the work to be performed under this permit; and will post or cause to be posted for inspection on the site of the work such public notice
or notices as are required by the Act. The undersigned agrees to employ only such subcontractors, on work to be performed under this
permit, as are licensed by Miami Shores Village.
Remarks (Signed) -....?
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally ap-
peared
— -- - - - - -- to me well known,
and who, being by me first duly sworn, upon oath deposes and says that he is the_
of the above described construction, that he has carefully read the foregoing application, and that he did sign the same, and that all facts
therein by him stated are true.
Permit No '2 (?
Disapproved
( Signed)
Chairman
Member
Member
Council Approved Date
Read, Sworn to and Subscribed before me.
Notary Public, State of Florida
Roof Covering
My Commission Expires
PLANNING BOARD DATE
Member
Member
Member
Disapproved Date
making corrections or changes to this application after approval has been obtained from
when such re- inspection is made necessary by improper notice for inspection or faulty
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