PT-06-2537 Miami Shores Village
Building Department
10050 N.E.2nd Avenue,Miami Shores,Florida 33138
Tel:(305)795.2204 Fax: (305)756.8972 OCT 1 20 06 U
BUILDING Permit No. `S ` "6�r---=�S-
PERMIT APPLICATION Master Permit No.
FBC 2004
Permit Type(circle):Ooder)
Electrical Plumbing Mechanical Roofing
Owner's Name(Fee Simple �(�— J\\ Phone#
Owner's Address
City State l Zip
Tenant/Lessee Name Phone#
Job Address(where the work is being done) C�to k-A r.[ Sa f Q.�,
City Miami Shores Village County Miami-Dade Zip
FOLIO/PARCEL#
Is Building Historically Designated YES NO
Contractor's Company Name �C_Ukr-_4 _ Phone#
Contractor's Address
City State Zip
Qualifier Name Phone#
State Certificate or Registration No. Certificate of Competency No.
Architect/Engineer's Name(if applicable) Phone#
I ��ll civ
Value of Work For this Permit$ `I Square/Linear Footage Of Work:
Type of Work: ❑Addition ❑Alteration ❑New ❑ Repair/Replace ❑Demolition
Describe Work: ��F"� �Q�J�- ��.-c: •..C..
ed********** *** *****************************
Submittal Fee$ Permit Fee$ ��� CCF$ CO/CC
Notary$ Training/Education Fee$ Technology Fee$
Scanning$ Radon$ DPBR$ Zoning$
Bond$ Code Enforcement$ Double Fee$
Structural Review.$ Total Fee Now Due$
See Reverse side-�
Bonding Company's Name(if applicable)
Bonding Company's Address
City State Zip
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) 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.
Signature ::�� :�" Signature
Owner or Agent Contractor
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
day of ,20_,by day of ,20_,by
who is personally known to me or who has produced who is personally known to me or who has produced
As identification and who did take an oath. as identification.and who did take an oath.
NOTARY PUBLIC: NOTARY PUBLIC:
Sign: Sign:
Print: Print:
My Commission Expires: My Commission Expires:
O
APPLICATION APPROVED BY: le � Plans Examiner
411 Engineer
Zoning
(Revised 02/08/06)
Miami Shores Village
Paint Color Approval and Agreement
Date:
Owner's Name: Phone#:
Job Address(where the work is being done):
City: Miami Shores Village County: Miami-Dade Zip:
Is Building Historically Designated?: YES NO
Contractor's Company Name(if applicable): Phone#:
■0 0 0 0 0 0 0 0 0 0 0 a 0 a 0 a 0 0 a a a a a a a 0 a 0 0 a 0 0 0 0 a 0 0 0 0 0 0 a 0 0 0 a a 0 a 0 0 a 0 a a a a 0 a 0 0 0 t a 9
All elements on the site must be listed and indicate the color to be pwinted
Walls:—
Fascia:—
alls:Fascia: �-.. 'cC Attach color Samples
Drip Cap/Drip Edge:
with numbers
Soffit:
Roof-
Flower Bins:
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:
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: Date:
Owner or Agent
APPLICATION APPROVED BY: Date: (L
`P&Z dFFICIAL
**MUST BE ATTACHED WITH PURPLE BUILDING APPLICATION**
" Res Miami Shores Village
10050 N.E. 2nd Avenue
'`,'°° Miami Shores, FL 33138-0000
- Phone: (305)795-2204 Fax: (305)756-8972
�ioRiv�`
Permit
Permit Status: APPROVED
Issue Date: 10/10/2006 Expires: 04/08/2007 Permit Number: PT-10-06-2537
Owner's Name: HERTA HOLLY one: (305)757-4679
Permit Type: Paint
Parcel#: 1132060170170
Work Classification: New
Block: Lot:
Job Address: 9660 5 AVE Street NE
Section: PB:
Miami Shores Village, FL 33138-
Contractor(s) Phone Primary Contractor
Total Square Feet: 0
Total Valuation: $ 1,000.00
Re uired Inspections
Additional Information Final
Type of Work: Exterior Color:PINK
Additional Info: Classification:Residential
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.
Fees Due Amount Invoice Number Amt Due Amt Paid
CCF $0.60 PT-10-06-26370 $67.30
Education Surcharge $0.20 Total:
Notary Fee $5.00
Permit Fee $60.00
Technology Fee $1.50
Total: $67.30
Building Department File Copy 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.
Applicant Signature