PT-10-357 40/
Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number: INSP- 137349 Permit Number: PT -3 -10 -357
Scheduled Inspection Date: March 24, 2010 Permit Type: Paint
Inspector: Bruhn, Norman
Inspection Type: Final
Owner: SOUTHARD, ROBERT Work Classification: Addition /Alteration
Job Address: 351 NE 103 Street
Miami Shores, FL Phone Number (305)756 -5067
Parcel Number 112136013026
Project: <NONE>
Contractor: COMPLETE HOME PAINTING BY MIC HAEL Phone: 305 -895 -1368
Building Department Comments
Inspector Comments
Passed
Failed
Correction ❑
Needed
Re- Inspection ❑
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
March 23, 2010 For Inspections please call: (305)7624949 Page 11 of 20
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Miami Shores Village o TCME 9 W 3
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Building Departmen
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1.0050 N.!_i.2tid Avenue. Miami Shores. Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972 �: ... ......•
BUILDING Permit No.
PERMIT APPLICATION Master Permit 1N o .21�1 0
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Permit Type: PAINT PERMIT
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Owner's Name (Fee Simple Titleholder) R o%rz 8roec Smv ' A .9e a CV -7U Phone # 10s- 7j j 7
Owner's Address ,?51 N a /D3 s?:
Cit / s, vge State F1_04 /P-4 Zip 3313J Z Y.3Z.
`Fenant /Lesseee Name Phone #
E- MAIL: - -brvc Il_Q+/'4 —_C Cao j
Job Address (where the work is being done) /vE ID3 42C
' City Miami Shores County Miami -Dade - zip 333& _
4* FOLIO /PARCEL# ! /- 2 /,�`- o13•y26o
Is Building; Historically Designated YES NO k
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Contractor s Company Name i�k °�_�T"
Contractor's Address / /(/-. 13D f
City__ W /o Stat Zip 3 3 -�z
Qualifier Name / 2- 1 /c4p , g = / Phone # .30,x , 0 0 146
State Certificate or Registration No. Certificate of Competency No. /W 3
OWNER BUILDER:
Value of Work For this Permit $ Z� Sd't� Type of Work: ❑ A dition / Alteration / QNew / ❑ Repair /Replace
Describe Work: //
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Application is hereby made to obtain a permit to do the work and installat' s 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 ol'all laws regulating construction in this jurisdiction. I understand that a separate pennit must be secured for
ELI C TRICAI. WORK. PLUMBING, SIGNS WEIJ,S. POOLS. PURNACFS, BOILERS. HEATERS, TANKS and AIR CONDITIONERS, ETC.....
"WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAVING TWICE FOIR
IMPROVEMENTS TO YOUR PROPERTI'. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH VOUR LENDER OR AN AT fORNEV BEFORE
RECORDING YOUR NOTICE OF COMMENCEMENT."
Notice to. I ppliarnt: :9s it condition to the issuance off building permit with an estimated value exceeding $2500. the applicanl rntrst lrronrik in goo lijilh that a c•apy ol'!he otice
notice ail'cormuencement and construction lien law• brochure will be delivered to the person whose property is subject to attachment. dlso, a cerir copy a�f 1he recorded +r e
of cornmencenienl must be posted at 1he job site_ %r the first inspection which occurs seven (7) dWs after the building permit is issued. In the absence clf such lros7ed notice. the
inspection will not be approved and a reinspection jee will be charged.
Permit Fee $ CCF $ Technology Fee:
Training /Education Fee $ Notary $ Code Enforcement $
Double Fee $ Zoning $ Total Fee Now Due $ l0 I
See Reverse side -a
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.
watts: 4 Attach color samples with name and
Fascia: 1 S w 2 3 4 number.
Drip Cap/Drip Edge: 1 2 W 4 — -
So ff it -. -- — I 3 4
Roof: 1 2 /U A l" 3 4
Flower Bins: 1 2 3 4
rn rM
Shutters 1 2 / 3 4
Awnings 1 2 A 1+ 3 4 2
�A I J cJ 2 V J.
Chimney: 1 2 3 4
Doors and Door Jams: 1 2 3 4
Garage Doors: I 2 3 4
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Railings: 1 2 , 4 3 -
Fences: I 2 3 4
All brick (simulated or regular : 1 3 4 3ronze 62
Stucco Banding: 1 4
Any other Stucco Features: 1 2 4
Accessory Buildings 4
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 R __ 9 Signature M
Owner or Agent Contractor
The loregoing instrument was acknowledged before me this t0 The foregoing instrument was acknowledged before me this,
day of 20 [d . by _ day of W O ZAAL _. 20 L by
who is personally known to me or who has produced _ who is personally known to me or who has produced C—E-1
As identification and who did take an oath. as identification and who did take an oath.
NOTARY PUBLIC: NOTARY PU IC
Sign:
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/ Sign: ��`� 40 3,(b,
Print: _- a tY /L Print: �'� 9L�Q �` / ���
'QTARY PUBLIC STATE OF FLORI A : -a o o�sslW� o �
My Commission Expire, : My Commission Expires:
Michael Iwaskewycz
Commissio n # DD 2�5 35
'
'xpli es:
onded Thtu Atlantic Bonding Co., Inc. i . • 8 J , ,•''�� `v im
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;APPLICATION APPROVED BY: Plans Examin&f i)lliiw%\\\
Preservation Board
—
Vic Code Gnlincement
(Revised 04 /24/0;