PT-13-303 Miami Shores Village
Building Department FEB 13 2013
10050 N.E.2nd Avenue,Miami Shores,Florida 33138
Tel: (305)795.2204 Fax:(305)756.8972 LCIL
INSPECTION'S PHONE NUMBER:(305)762.4949
BUILDING
Permit No.
PERMIT APPLICATION Master Permit No. Pc l
FBC 20 c..o
Permit Type:PAINT
OWNER:Name(Fee Simple Titleholder): MAG.04 IYA9 6� Phone#:_ _3pST.�q-!2 6q
Address: 10 l0l<s 7 41e I/Ave
City: &_Lh�f iekes- State: Zip:
Tenant/Lessee Name: Phone#:
Email:
JOB ADDRESS: 11212,12 7 Alt° IIA-e
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#:
Is the Building Historically Designated: Yes NO Flood Zone:
CONTRACTOR:Company Name: Phone#:
Address:
City: State: Zip:
Qualifier Name: Phone#:
State Certification or Registration#: Certificate of Competency#:
Contact Phone#: Email Address:
Value of Work for this Permit:$ 75-�) �-� Square/Linear Footage of Work:
Description of 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 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: As a condition to the issuance of a building permit with an estimated value exceeding$2510,the applicant must promise in good faith that a copy of
the notice of commencement and construction lien law,brochure will be delivered to the person whose property is subject to attachment. Also,a certified copy of the
recorded notice of commencement must be posted at the job site for the first inspection which occurs seven(7)days after the building permit is issued. In the absence of
such posted notice,the inspection will not be approved and an inspection fee will be charged.
** *** *******Fees*************
Permit Fee$ CCF$ Notary$ Training/Education Fee$
Technology Fee$ Double Fee$ TOTAL FEE NOW DUE$
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
Attach color sample with name and number
Fascia: 1 2 3 4
Drip edge: 1 2 3 4 I f
Soffit: 1 2 3 4
Roof: 1 2 3 4
Flower Bins: 1 2 3 4
Shutters: 1 2 3 4 2 ra U4 r(0 G/�
Awnings: 1 2 3 4
Chimney: 1 2 3 4
Doors&Jambs:l 2 3 4
Garage Doors: 1 2 3 4
3.
Railings: 1 2 3 4
Fences: 1 2 3 4
All Brick: 1 2 3 4
Stucco Bands: 1 3 4 _
4.
Other Stucco
Feature: 1 2 3 4
Accessory Bldg: 1 2 3 4
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:t:�� — Signature:
Owner or Agent Contractor
The forg�gotng ' strument,jas ackngledged b fore me t4 The foregoing instrument was acknowledged before me this
day of y _, ,20_I�(byl 1 ( !# �, 4day of 20_,by
hosierson 11 knownpe
fation and who did take an oath. as identification and who did take an oath.
NOTARY V� I Z ' NOTARY PUBLIC:
'-
Sign: Sign:
Print: Print::> p�s�
My Commission Expires: `' �'`'� � My Commission Expires:
•,ut
APPROVED BY: 24 t`{ 1 Code Official
Preservation Board
Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795-2204 Fax: (305)756-8972
Inspection Number: INSP-185901 Permit Number: PT-2-13-303
Scheduled Inspection Date: March 07, 2013 Permit Type: Paint
Inspector: Bruhn, Norman
Inspection Type: Final
Owner: MENDOZA, MARIEDY Work Classification: Addition/Alteration
Job Address: 10667 NE 11 Avenue
Miami Shores, FL 33138-2120 Phone Number
Parcel Number 1122320280310
Project: <NONE>
Contractor: HOME OWNER
Building Department Comments
PAINT Infractio Passed Comments
INSPECTOR COMMENTS False
Inspector Comments
Pass
Failed
Correction ❑
Needed
Re-Inspection ❑
Fee
No Additional Inspections can be scheduled until
re-inspection fee is paid.
March 07, 2013 For Inspections please call: (305)762-4949 Page 17 of 46