PT-07-27805 Receipt
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL 33138-0000
Phone: (305)795-2204 Fax: (305)756-8972
Permit Number: PT-3-07-486 Owner Address:
Invoice Number: PT-3-07-27805 50 109 Street NW
Applicant: MARCEL NESTOR MIAMI SHORES, FL 33168
Company Name:
Job Address:
50 109 Street NW
Miami Shores, FL 33168-4315
Date Payment Type Check Number Amount Change
Monday, March 19, 2007
03/19/2007 Cash $67.30 $0.00
Total Payment: $67.30
Page 1 of 1
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F'e11: .. PT
Miami Shores Village F3atl f y e Patn
? ) 10050 N.E.2nd Avenue
Miami Shores, FL 33138-0000 0 � � �e
Phone: (305)795-2204
1- ? St6hm P.P'R V.EU
Isue:[#aie: 9� 5/2007
Project Address Parcel Number Applicant
......... _............. .._ ......... ._ _._............. ......... ..... _..... .._........_......... ................._._...._..
50 NW 109 Street 1121360110210
Miami Shores, FL 33168-4315 Block: Lot: MARCEL NESTOR
Owner Information Address Phone Cell
MARCEL NESTOR 50 NW 109 Street
MIAMI SHORES FL 33168-4315
.......................................................... .................
Contractor(s) Phone Cell Phone : Valuation: $ 1,000.00
HOME OWNER
Total Sq Feet: 0
Type of Work: Exterior Available Inspections:
Color:CAMEO WHITE 77 BENJAMIN MOORE Inspection Type:
Additional Info:
Final
Classification: Residential
Color:CAMEO WHITE 77 BENJAMIN MOORE_Approved Code Comments: BM Paint Walls-hug&kisses 097/
Color:CAMEO WHITE 77 BENJAMIN MOORE_Approved Color:CAMEO WHITE 77 BENJAMIN
Fees Due Amount Total I Amt Paid I Amt Due
CCF $0.60 .............................
Education Surcharge $0.20 $ 0.00 $ 0.00 $ 0.00
Notary Fee $5.00 :.
Permit Fee $60.00 Payment Type
Technology Fee $1.50 1
Total: $67.30 1 9 PAID
In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations pertaining
thereto and in strict conformity with the plans,drawings,statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this
permit I assume responsibility for all work done by either myself,my agent,servants,or employes. I understand that separate permits are required for ELECTRICAL,
PLUMBING,MECHANICAL,WINDOWS, DOORS, ROOFING and SWIMMING POOL work.
OWNERS AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating
construction and zoning . Futhermore authorize the above -named contractor to do the work stated
71 �Ll e!r_4 k March 19, 2007
Authorized Signature I
ne / Applicant / Contractor / Agent Date
BuildingDepat; nt Copy
Monday, March 19,2007 1
�Atl� 3I1310'� 1�'.Ib AH
w/ kr• Awed . Miami Shores Village
"A92
Building Department
10050 N.E.2nd Avenue,.Miami Shores,Florida 33138
Tel: (305)795.2204 Fax:(305)756.8972 6Y_AZ�0
BUILDING Permit No. Pr �_ "
PERMIT APPLICATION Master Permit No.
FBC 2004
Permit Type(circle): uilding Electrical Plumbing Mechanical Roofing
Owner's Name(Fee Simple i e older) f�,2 C 2 Z Phone# �Q.s, 7 g®f
Owner's Address 677 �, /�� e- 24
City W Za1W4 State rel Zip-- -� Z/ 4 '
Tenant/Lessee Name /f Phone#
Job Address(where the work is being done)
City 4�44CZ lij Miami Shores Village County Miami-Dade Zip
FOLIO/PARCEL#
Is Building Historically Designate YES . NO
Contractor's Company Name 4 Ze Phone#
Contractor's Address
City State Zip
Qualifier Name Phone#
State Certificate or Registration No. Certificate of Competency No.
Architect/Engineer's Name(if applicable) Phone#
Value of Work For this Permit$ Square/Linear Footage Of Work:
Type of Work: ❑Addition ❑Alteration ❑New [�Repair/Replace ❑Demolition
Describe Work:
Submittal Fee$ Permit Fee$ (L CC.11� ' CCF S 160 CO/CC
Notary Training/Education Fee$ Q ozo Technology Fee$ ou
Scanning$ Radon$ DPBR$ Zoning$
Bond S 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) 4i�
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 �����1`�lz Signature
Owner or Agent Contractor
The foregoing instrument was ackXr',
edged before me this �Z The foregoing instrument was acknowledged before me this
day of XICA ,20 O,by �eST V, day of .20 by ,
who is personally known tome or who has produced 9- 91141who is personally known to me or who has produced
�J 91A11) As identification and who did take an oath. as identification and who did take an oath.
NOTARY PUBLIC: NOTARY PUBLIC:
Sign: 1pN#DD Sign:
Print: AlArto Ski :'� Ey,P1HEs` pu�gc�nee+w"` Print:
My Commission Expires: My Commission Expires:
APPLICATION APPROVED BY: / Plans Examiner
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#:
All elements on the site must be listed and indicate the color to be a:.inted
Fascia: Attach color Samples
Drip Cap/Drip Edge: Com,,-,e-, k--.3 �e Zl -�.- ""+h n,imhers
Soffit: C
Roof--
Flower Bins:
oof:FlowerBins:
Shutters: (A
Awnings. _.
Chimney: rJ � />
Doors and Door Jams:
h
Garage Doors: Lj �
Railings: �-j l n
Fences: t J 1,:,�
Decorative Metal: r,j
All brick(simulated or regular):
Stucco Banding:
Any other Stucco Features:
Accessory Buildings: Cameo White 77
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:' f��Ci� -�� �2 Date:
Owner or Agent
APPLICATION APPROVED BY: t Date: — t3
P&Z OFFICIAL
**MUST BE ATTACHED WITH PURPLE BUILDING APPLICATION**