PT-10-236 Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number: INSP - 135681 Permit Number: PT -2 -10 -
Scheduled Inspection Date: February 23, 2010 Permit Type: Paint
Inspector: Bruhn, Norman Inspection Type: Final
Owner: INTOYAN, HMAYAK Work Classification: Addition /Alteration
Job Address: 85 NW 102 Street
Miami Shores, FL
Phone Number
Parcel Number 113101018008
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.
February 22, 2010 For Inspections please call: (305)762 -4949 Page 12 of 25
Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number: INSP- 135681 Permit Number: PT -2 -10 -236
Scheduled Inspection Date: February 23, 2010 Permit Type: Paint
Inspector: Bruhn, Norman
Inspection Type: Final
Owner: INTOYAN, HMAYAK Work Classification: Addition /Alteration
Job Address: 85 NW 102 Street
Miami Shores, FL Phone Number
Parcel Number 113101018008
Project: <NONE>
Contractor: HOME OWNER
Building Department Comments
Inspector Comments
Passed El
Failed
Correction ❑
Needed
Re- Inspection ❑
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
February 22, 2010 For Inspections please call: (305)762 -4949 Page 12 of 25
Miami Shores Village 1 lax 9 713 HE
Building Department FEB 1 0 10
10050 N.l2nd AVenUe, Miami Shores.. Florida 33138
Tel: (305) 79`;.2209 Fax: (305) 756.8972 :...... ..... ...
BUILDING Permit No. T — �O►p
PERMIT APPLICATION Master Permit N o.
FBC 2004
Permit Tyre PAINT PERMIT
Owner's Name (Fee Simple Titleholder) � i �^/ Phone #
Owner's Address 1,2
City State _ /.moo Zip 3,3323
Tenant /Lessee Name Phone #
GIViA1L:
Job Address (where the work is being done) $ _ Aj ze 2 S:
City ___. Miami Shores County Miami -Dade Zip 331 5 a
FOLIO / PARCEL #
Is Building Historically Designated YES NO
Contractor's Company Name _ t_/i yI< C; / /)� Phone # � n2v ,4 X6ot
Contractor's Address
City__ _ _ State Zip
Qualifier Name Phone #
State Certificate or Registration No. Certificate of Competency No.
OWNER BUILDER:
Value of Wort. For this Permit $ �0. W 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 of a pennit
and that all work will be performed to meet the standards of all laws regulating construction in this iurisdiction. I understand that a separate pennit must be secured lit
FLIVTRICAI. WORE. 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 VOUR LENDER OR AN ATTORNEY BEFORL
RECORDING YOUR NOTICE OF COMMENCEMENT."
Notice to.1 pp1 ic•anl: :T.s a condition to the issuance gl'u building hertnil with an estimated value exceeding x2500. the applicant nrlrst promise in gocxlfcrith that a cnpv of the
notice of corumencemenl and construction lien law brochure will be deliverer! to the person whose property is subject to attachment. Als2 a certified copygf the recorded notice
of conunencement nurse he posted at the job site for the inspection which occurs seven (7) days after the building permit is issued.d in the absence of such posted notice. the
inspection ivill not he approved and a reinspeclion fee will be charged.
Permit Fee $ CCF $ Technology Fee: .
Training /Education Fee $ Notary $ Code Enforcement $
Double Fee $ Zoning $ Total Fee Now Due 1; '10�
`� 111110 Q�� 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 2 3 4 Attach color samples with name and
Fascia: I 2 3 4 number.
Drip Cap /Drip Edge: 1 3 4 �G.�/�i1✓�.P� / ®5
Soffit I 3 4
Roof: 1 2 3 4 E
Flower Bins 1 2 3 4
Shutters: I 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
Railin I 2 3 4 3
Fences: 1 2 3 4
All brick (simulated or rqyular ): 1 2 3 4
Stucco Banding: l 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 a applicable laws regulating construction and zoning.
Signatui Signature
Owner or Agent ��tuulu ►U1111i Contractor
The foregoing instrument was ac know\pt1' e�eq�trl'�te.tne thi The foregoing instrument was acknowledged before me this
day of _ Ff_L �17 .20 by day of 20 _. by
who is personally known to me or 141491i4*1cs who is personally known to me or who has produced
As iclentific, u.dQ I �Ex tt as identification and who did take an oath:
NOTARY PUBLIC: NOTARY PUBLIC:
Sign: ( %?'�c —'- ��� Sign: _
►�rn
Princ Print:
My Commission I:ixpires: My Commission Expires:
APPLIC'A'TION APPROVED BY: Plans Examiner
Preservation Board
Code Enlorcement
(Revised 04 /24/0.