PT-06-1292V %
Inspection Worksheet
Miami Shores Village
� 10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
V
Inspection Date: 0713112006 AUG 0 1
Inspector. Grande, Claudio Fn
Owner. EKLUND, GLENWOOD AND JEANNE
Job Address: 1460102 Street NE
Miami Shores Village, FL 33138-
Project: <NONE>
Contractor. HOME OWNER
Ri lrfinn nanartmant [:nmmanta
Permit Type: Paint
Inspection Type: Final
Work Classification: Repair
Phone Number (305)758 -9095
Parcel Number 1132050240250
Block: Lot:
I L
I I
—
.
Inspector Comments
Passed
Failed El
Correction
Needed
Re- Inspection
Fee
($751
No Additional Inspections can be scheduled until
re- inspection fee is paid.
Friday, July 28, 2006 Page 1 of 3
Miami Shore's Village
Building Department
o w 10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
BUILDING
PERMIT AP
FBC 2004
i I
r - Permit No. °` ! _`1 Z
ICATIU ;MAY, $' "'' Master Permit No.
f1 n �
Permit Type (circle):
Owner's Name (Fee Simple Tit
Owner's ddress Z
City Wee
Tenant/Lessee Name
Job Address (where the
City Miami S'.
FOLIO / PARCEL # _
Is Building :Historically
Contractor's Company
Contractor's Address
City
Qualifier Name
State Certificate or Regi
e ric Plumbing
a State __ Zip
is being done)
6140 A16 I
#
mated YES NO_*"�__
Phone #
State Zip
Phone #
No. Certificate of Competency No.
Architect Engineer's Nam (if applicable) Phone #
Value of Work For this Permit $�`��6 0 • Square l Linear Footage Of Work:
Type of Work: � ]Altai w Repair Describe Work: j
h",0q&
Submittal Fee $
Notary $ S—CE
Scanning $
Bond $
Structural Review. $
it
x
Permit Fee $ °,,I. '� CCF $ O� J CO /CC
iining/Education Fee $ � � �J Technology Fee $
Radon $ 13PBR $ Zoning $
Code Enforcement $ Double Fee $
Total Fee Now Due $
See Reverse side —�
Bonding Company's Name (if applicable)
Bonding Company's Address
City
State
Zip
.V
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) dRs after the building permit is issued. In the absence of such posted notice, the
inspection will 9Q be approved and a reinspectio will be charged
Owner or Agent
The foregoing instrument was actowwledged before me this
day of 20yj_JC- -t n y_1<
who is personally-1mown to me or who has produced
C'L ' As identification and who did take an oath.
NOTARY PUBLIC:
APPLICATION APPROVED BY:
(Revised 02/08/06)
Signature
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:
My Commission Expires:
Plans Examiner
Engineer
zoning
- -, Miami Shores Village
.`� Paint Color Approval and Agreement
Date
�% -P�0�1 �U Phone #
Owner's Name „ A.
® � % ' <!' Owner's Address State C
Zip cit- _i� '
Job Address (where the work is being done). /% o /�� /0
V,17�-4
City Nliami Shores Village County - Miami -Dade Zip
Is Building Historically Designated YES NO-
Contractor's Company Name (if applicable) ��"z" 'ci'�'^�`'�` Phone #
All elements on the site must be listed and indicate the color to be painted
Walls
Fascia
Drip Cap /drip Edge
Soffi
Roof
Flower
Shutters
Awnings
Chimney
Doors and door jams
Garage doors
Railings
Fences
Decorative metal
All brick (simulated or regular)
Stucco banding
Any other stucco features
Accessory Buildings
Other .
Attach Color Samples
With Numbers
OWNER'S AFFID T: I certify that all the foregoing information is accurate and that all work will be done in compliance with all
applicable laws reg a�4ng construction and zoning.
Date
Signature
Owner or Agent
APPLICATION APPROVED BY: Date chc 5/18103
M Z Official
Miami Shores Village
10050 N.E. 2nd Avenue
Miami Shores, FL 33138 -0000
Phone: (305)795 -2204 Fax: (305)756 -8972
Permit
Permit Status: APPROVED
Issue Date: 5/19/2006 Expires: 11/1412006 Permit Number: PT -5-06 -1292
Owner's Name: GLENWOOD AND JEANNE EKLUND one: 305)758 -9095
Permit Type: Paint
Work Classification: Repair
Job Address: 1460 102 Street NE
Miami Shores Village, FL 33138-
Contractor(s) Phone Primary Contractor
HOME OWNER Yes
Comments:
REPAINT ROOF WITH HIGH QUALITY SEALER
Additional Information
Type of Work: Exterior Color. WHITE
Additional Info: ROOF Classification: Residential
In consideration of the issuance to me of this permit, I agree to perform the work
covered nereunoer 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.
Fees Due
Amount
CCF
$0.60
Education Surcharge
$0.20
Notary Fee
$5.00
Permit Fee
$60.00
Technology Fee
$1.50
Total:
$67.30
Building Department File Copy
Applicant Signature
Parcel 41 1132050240250
Block: Lot
Section: PB:
Total Square Feet 0
Total Valuation: $ 1,000.00
Final
Invoice Number Amt Due I Amt-P
PT -5-06 -24853 $67.30
Total:
uw 19 PAID
C- C
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.