BP05-1225Inspection Date
Approved
Correction
Re- Insp'n Fee
4zio
MIAMI SHORES VPL 05
BUILDING DEPARTMENT
305- 795 -2204
Building Inspection Request
Date1Olb Jc
Type Insp'n PataA 44
Permit No. . PC — 12,7 =S
Name )
Address c::: E
Company "` "' ►� OC.L) -��
Phone # 1 � — 352:1
BUILDING
PERMIT APPLICATION
FBC 2001
Permit Type (circle): Building Electrical
Owner's Name (Fee Simple Titleholder) 1758(1
Owner's Address C k
City -k\RM\ Sr tS State -FL
Tenant/Lessee Name
City Miami Shores Village
Is Building Historically Designated YES
Contractor's Company Name
Contractor's Address
City State
Qualifier
Architect/Engineer's Name (if applicable)
Type of Work: ❑Addition ❑Alteration
Describe Work: QCti kc>V .
Submittal Fee $
Notary $
Scanning $
Code Enforcement $
Training/Education Fee $
Total Fee Now Due $ I • _ 30;
(Continued on opposite side)
Miami Shores Village
Permit Fee $
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: 0.5. J • 5 _ 204 Fax: 305 756.8972
NE (OWED
0. 2005
Job Address (where the work is being done) 9 ■ I�� Ll
County Miami -Dade
$ Value of Work For this Permit'7C _ .
NO X
❑New
(p /O
0, 2,o
Structural Plan Review. $
Permit Na1 1-0 23
aster Permit No.
Plumbing Mechanical
Phone #
State Certificate or Registration No. Certificate of Competency No.
Zip 331 3S
Phone # 30S - 6a 35
Zip 331 3
Phone #
****************************. ees * * * * * * * * * * * * * * * * * * * * * * * * * * * * *
/94►n4-
Roofing
Zip
Phone #
Square Footage Of Work:
/Repair/Replace ❑ Demolition
CCF $ 0 • C2') CO /CC
Technology Fee $ 1 •6
Radon $ Zoning Bond $
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
Agent Contractor
The foregoing instrument was acknowledged before me this 1 The foregoing instrument was acknowledged before me this
day of ,20Q3by on , day of ,20,by
who is persona ly known to me or who has produced .I f) 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
Sign:
Print:
My Commission Expi
***************************************************************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
chc 05/13/03
APPLICATION APPROVED BY:
Illw V : J w3, 200
thntic Rnn iinn („ Iii
*** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * *** I/ * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
Signature
NOTARY PUBLIC:
Sign:
Print:
My Commission Expires:
Plans Examiner
Engineer
Zoning
•
,. .
Date
Owner's Name 5 x-r) 6ir`cre
Owner's Address
City J\ '\ 91ORec State
Job Address (where the work is being done) ' l �% Sr
City Miami Shores Village
County Miami -Dade Zip 3 31 3
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 painted
Q o.b\e 6cee t
Walls
Fascia
Drip Cap /drip Edge L kUct 61 e Ere iA)
Soffit Live. v1-e 6 's
Roof tJ /A
Flower bins v-(� I
Shutters
Awnings
Chimney
L uc 6re2
Miami Shores Village
Paint Color Approval and Agreement
Railings
Signature
c h 'N6
Doors and door jams i A 3 ht
Gara doors iz',h1 I se
Fences ‘t)i ht
Decorative metal ro ('.S i g r e p n - SA fYPP a S
All brick (simulated or regular) u AU
u
Stucco banding 1/4
Any other stucco features (V ( /4
Accessory Buildings
APPLICATION APPROVED BY:
SR me aS
I �
6 eCTQA-
wner or Agent
P& Z Official ✓
Phone # 35
Zip 331 3Y
GOG 35
Sh
(Co lOr c tART
cf
1
Attach Color Samples
With Numbers
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.
81l (Dio
Date
Date Er
chc 6/18/03
Miami Shores Village
10050 NE 2nd Avenue
Phone: 305 - 795 -2204
Printed: 8/22/2005
Applicant: SUSAN
Owner: GARRETT
JOB ADDRESS: 91
Contractor
Local Phone:
Parcel # 1132060130140
NE 91
Signed: (INSPECTOR)
Signed: (Contractor or Builder)
Building Permit
Permit Number: BP2005 -1225
GARRETT
SUSAN
ST
Contractor's Address:
Page 1 of 1
Legal Description: MIAMI SHORES SEC 1 AMD PB 10 -70 LOT 23 & E1/2 OF LOT 22 BLK 1 LOT SIZE
Fees:
FEE2005 -11477
FEE2005 -11478
FEE2005 -11479
FEE2005 -11480
FEE2005 -11481
Description
Building Painting Fee
CCF
Notary Fee
Training and Education Fee
Technology Fee
Total Fees:
Amount
$60.00
$0.60
$5.00
$0.20
$1.50
$67.30
Total Fees: $67.30
Total Receipts: $0.00
Permit Status: APPROVED Permit Expiration: 2/14/2006 Construction Value: $500.00
Work: PAINT EXTERIOR
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 responisibility for all work
done by either myself, my agent, servants or employes.
BY:
AUG 2 PAID