PT-14-1603 Miami Shores Village RECyYVED
I o,S 1 Building Department artment
10050 N.E.2nd Avenue,Miami,Shores, Florida 33138 BY'
Tel:(305)795-2204 Fax:(305)756-8972
INSPECTION LINE PHONE NUMBER:(305)762-4949
FBC 20 L O
PAINT Master Permit No--?T- 4— I G®:3
PERMIT APPLICATION Sub Permit No.
JOB ADDRESS: J� ^
City: Miami Shores County: Miami Dade zip:
Folio/Parcel#: Is the Building Historically Designated:Yes NO
OWNER: Name(Fee Simple Titleholder): 10' � Phone#: b �b
Address: ���� )it q(
City: _ i '�hutyn Stater Zip: Y_�3 i
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR:Company Name: Phone#:
Address:
City: State: Zip:
Qualifier Name: Phone#:
State Certification or Registration M Certificate of Competency M
Value of Work for this Permit:$ Q�� Square/Linear Footage of Work:
Description of Work:00141 T Int) home- b f jof
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,PLUMBING,SIGNS,WELLS,POOLS,FURNACES,BOILERS,
HEATERS,TANKS,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$2500,the applicant must promise in good faith that a
copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment Also,a certified
copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven(7)days after the building permit is issued.
In the absence of such posted notice,the inspection will not be approved and an inspection fee will be charged.
Permit Fee$ CCF Fee$ Notary$
Technology Fee$ Training/Education 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 1 / 2 3 4
Attach color sample with name and number
Fascia: 1 2 3 4
Drip edge: 1 2 3 4
Soffit: 1 2 3 4
Flower Bins: 1 2 3 4
Shutters: 1 % 23 4
Awnings: 1 2 3 4 1l"
2. r2� >
Chimney: 1 2 3 4
Doors&Jambs: 1 2 4
Garage Doors: 1 2 3 4
Railings: 1 2 3 4 3.
Fences: 1 2 3 4
All Brick: 1 2 3 4
Stucco Bands: 1 2 3 4
Other Stucco
Feature: 1 2 3 4 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 Signature
OWNER or AGENT CONTRACTOR
The regoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
� day of -'� .20 by day of ,20 , by
f) + ho is personally known to ,who is personally known to
me or who has produced r`- 0 2r as me or who has produced as
identification and who did take an oath. identification and who did take an oath.
\\\\\\111111111////ejA
NOTARY PUBL •, ! ° G��`;��®,� NOTARY PUBLIC:
Sign: - = Sign:
Print: Commission i� Print:
I f :®@
Seal: '6 0 . FI�D�o�`�•,`` Seal:
APPROVED BY: T 1 7/"�J-1 t 4 Code Official
Historic 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-250031 Permit Number: PT-7-14-1603
Scheduled Inspection Date: December 30,2015 Permit Type: Paint
Inspector: Rodriguez,Jorge
Inspection Type: Final
Owner: PUENTES,ANDRES Work Classification: Addition/Alteration
Job Address:354 NE 91 Street
Miami Shores, FL 33138-3130 Phone Number (786)606-9930
Parcel Number 1132060190220
Project: <NONE>
Contractor: HOMEOWNER
Building Department Comments
PAINT HOUSE EXTERIOR Infractio Passed Comments
INSPECTOR COMMENTS False
Inspector Comments
Passed CREATED AS REINSPECTION FOR INSP-216545. Cancelled
E!111� No paint sample supplied
Failed o
Correction ❑
Needed
Re-Inspection a
Fee
No Additional Inspections can be scheduled until
re-inspection fee is paid.
December 29,2015 For Inspections please call: (305)762-4949 Page 23 of 34