PT-10-1033Inspection Number: INSP - 145402 Permit Number: PT -6 -10 -1033
Scheduled Inspection Date: June 10, 2010
Inspector: Rodriguez, Jorge
Owner: LANE, CULLEN
Job Address: 103 NW 103 Street
Project: <NONE>
Contractor: HOME OWNER
Building Department Comments
paint
Passed
Failed
Correction
Needed
Re- Inspection
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
Inspector Comments
June 09, 2010
Miami Shores, FL 33150-
Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
For Inspections please call: (305)762 -4949
Permit Type: Paint
Inspection Type: Final
Work Classification: Addition /Alteration
Phone Number 305 - 539 -2495
Parcel Number 1121360131580
Page 12 of 17
Protect Address
103 NW 103 Street
Miami Shores, FL 33150-
1121360131580
Block: Lot:
CULLEN LANE
1
Owner Information
Miami Shores Village
10050 N.E. 2nd Avenue
Miami Shores, FL 33138 -0000
Phone: (305)795 -2204
,
CULLEN LANE
1200 NE 91 Terrace
MIAMI SHORES FL 33138 -3406
305 - 539 -2495
Contractor(s)
HOME OWNER
Phone
Cell Phone
Type of Work: Exterior
Color: BM - linen white 70
Additional Info:
Classification: Residential
Color: BM - linen white 70_Approved
Color. BM - linen white 70_Approved_
Code Comments:
Color: BM - linen white 70_Denied
Fees Due
CCF
Education Surcharge
Notary Fee
Permit Fee
Technology Fee
Total:
Amount
$0.60
$0.20
$5.00
$60.00
$0.80
$66.60
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.
Authorized Signature: Owner / Applicant / Contractor / Agent
Building Department Copy
Address
Parcel Number
Phone
,
Pay Date Pay Type Amt Paid Amt Due
Invoice # PT -6 -10 -38129
06/07/2010 Check #: 112 $ 66.60 $ 0.00
June 07, 2010
Date
Expiration: 12/04/2010
Applicant
CeII
Valuation:
Total Sq Feet:
$ 500.00
0
1
Available Inspections:
Inspection Type:
Final
June 07, 2010 1
BUILDING
PERMIT APPLICATION
FBC 2004
Permit Type: PAINT PERMIT
Owner Address 5 oe
Cit Vv State F L-- Zip 3
Owner's Name (Fee Si}nple Titleholder)
Tenant/Lessee Name
E -MAIL:
Job Address (where the work is being done)
City Miami Shores Village
FOLIO / PARCEL #
Is Building Historically Designated YES
Contractor's Company Name �`
Contractor's Address
OWNER BUILDER:
Value of Work For this Permit $ 50 `C�J
Describe Work:
Training/Education Fee $
Miami Shores Village
Building Department
10050 N.E.2nd Avenue. Miami Shores. Florida 33138
T4 305) 795.2204 * 305) 756.0972
Permit No.
Coun
NO
Master Permit No.
NVOCV Phone # S " L C((
Phone #
Miami -Dade Zip
Phone #
Notary $ Code Enforcement S
Double Fee S Zoning $ Total Fee Now Due $
City State Zip
Qualifier Name Phone #
State Certificate or Registration No. Certificate of Competency No.
Type of Work: ❑ Addition / ❑ Alteration / ❑New / ❑ Repair/Replace
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 td 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
"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: .4s a condition to the issuance ofa building permit with an estimated value exceeding S2500. the applicant nncst promise in good fcdth that a copy of the
notice of commencement and construction lien law brochure will he delivered to the person whose property is subject to attachment..Ilso. a certyied 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
a******** ** ******* ********* ***********a F ees ******** *********ea******** **,x*seerr>psr*********
Permit Fee $ CCF $ Technology Fee:
See Rev erse side -
Signature
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
Fascia: 1
Drip Cap/Drip Edge:
Soffit: 1
Roof: 1
Flower Bins: 1
Shutters: 1
Awnings: 1
Chimney: 1
Doors and Door Jams:
Garage Doors: 1
Railings: 1
Fences: 1
APPLICATION APPROVED BY:
2 3
2 3
3
2 3
2 3
3
2 3
2 . 3
2 3
2 3
2 3
2 3
2 3
All brick (simulated or regular): 1 2
J, �
Owner • r Agent
The foregoing instilment was acknowledged before me this . _ -- 1 _
who is personally laiown to me or who has piftillinyl ,... D__
NOTARY PUBLIC:
Sign:
Print: _ - 'o c° a -- : C3
/ •�� 6�! 1 ...� per. r
My Commission Expires: ▪ G o s .. r A 2`
c
� .
4
4
4
4
4
4
4
4
4
4
4
4
4
Stucco Banding: 1 2 3 4
Any other Stucco Features: 1 2 3 4
Accessory Buildings Other:
OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in
co ce wit all applicable laws regulating construction and zoning.
ature
My Commission Expires:
Attach color samples with name and
number.
Linen White 70
Contractor
The foregoing instrument was acknowledged before me this_
day 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:
aaaia a , e eo** sr** se* Re uutk/i�f trygait11 ***its.***s **It*** rrs **** ** * ***** * ** let.* a. ae+ e* u,writ* ***it,a,�,aa
Plans Examiner
Preservation Board
Code Enforcement
(Revised 0-12407)