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Roof repair 1973MIAMI SHORES VILLAGE BUILDING INSPECTION DEPARTMENT APPLICATION FOR BUILDING PERMIT Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the building or other structure herein described. This application is made in compliance and conformity with the Building Ordinance of Miami Shores Village, Florida, and all provisions of the Laws of the State of Florida, all ordinances of Miami Shores Village and all rules and regula- tions of the Building Division of Miami Shores Village shall be complied with, whether herein specified or not. A copy of approved plans and specifications must be kept at building during progress of the work. Date_ , 19__w. Owner's Name and Address No.__________ —_ Registered Architect and /or Engineer Name and address of licensed contractor Location and legal description of lot to be built on: Lot Block Subdivision Street and Number where work is to be done___ !z___— _ State work to be done and purpose of building (by floors) ----------- - - - - -- �_ and for no ether purpose. New Building_______________________ Remodeling___________ Addition__________________ Repairs No. of Stories To be constructed of___— Kind of oundnion Roof Covering___��_._ ' _ _�_�� l Estimated Total cost of improvements $ - Amount of Permit $ Zone cubage required_____ __Plan Cubage Distance to next nearest building Size of Building Lot Maximum live load to be borne by each floor I hereby submit all the plans and specifications for said building. All notices with reference to the building and its construction may be sent to The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations as an employer of labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida, Permanent Supplement. and has complied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors employed by him in the work to be performed under this permit; and will post or cause to be posted for inspection on the .site of the work such public notice or notices as are required by the Act. The undersigned agrees to employ only such subcontractors, on work to be performed under this permit, as are licensed by Miami Shores Village. Remarks (Signed) STATE OF FLORIDA, COUNTY OF DADE. ss. Before me, the undersigncd authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeared to me well known, and who, being by me first duly sworn, upon oath deposes and says that be is the of the above described construction, that he has carefully read the foregoing application, and that he did sign the same, and that all facts therein by him stated are true. Permit No. Date Read, Sworn to and Subscribed before me. Disapproved Date (Signed) Building Inspector My Commission Expires Notary Public, State of Florida PLANNING BOARD____ DATE Chairman Member Member Member Member Member Council Approved____ Date Disapproved Date NOTE: A charge of $1.00 will be made for making corrections or changes to this application after approval has been obtained from the Planning Board. A re- inspection fee of $1.00 will be charged when such re- inspection is made necessary by improper notice for inspection or faulty materials and/or workmanship. MIAMI SHIRES VILLAGE UILDING ONSPECTION DEPARTMENT APPLICATION FOR BUILDING PERMIT Application is hereby wade for the approval of the detailed statement of the plans and specifications herewith submitted for ing or other structure herein described. This application is made in compliance and conformity with the Building Ordinance Shores Village, Florida, and all provisions of the Laws of the State of Florida, all ordinances of Miami Shores Village and all regulations of the Building Division of Miami Shores Village shall be complied with, whether herein specified or not. A copy of plans and specifications must be kept at building during progress of the work. Owner's Name and Address �' ` 7,Zeji Registered Architect and /or Engineer Name and address of licensed contractor 4l./...! .... t1i..4 4. 4 i the build - of Miami rules and approved Da _.� .. . Strut.._ _._o....... ,19,`%y Location and legal description of lot to be built on: Lot Bock Subdivision Street and Number where work is to be done. /Z// ' 4 .„g V'7i -`9 /� 1d,?.(;---g7 State work to be done and purpose of building (by floors) �%f�u ���'� -- - •�'1-.--!-: sod for no other purpose. Remodeling Addition Repairs...�� No. of Stories Kind of foundation Roof Covering Estimated Total cost of improvements $ � � Amount of Permit $.. Zone cubage required _.._._. _Plan Cubage Distance to next nearest building Size of Building Lot Maximum live load to be borne by each floor I hereby submit all the plans and specifications for said building. All notices with reference to the building and its construction may be sent to.. . • •• --- The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations as an employer of labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida, Permanent Supplement, and has complied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors employed by him in the work to be performed under this permit; and will post or cause to be posted for inspection on the site of the work such public notice or notices as arc required by the Act. The undersigned agrees to employ only such subcontractors on work to be performed v�der permit, as are licensed by Miami Shores Village. Remarks (Signed) New Building To be constructed of STATE OF FLORIDA, COUNTY OF DADE. SS. Bcfore me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, peared and who, being by me first duly sworn, upon oath deposes and says that he is the. of the above described construction, that he has carefully read the foregoing application, and that he did sign the same, and that all facts therein by him stated are true. /-s 21 - Date / ( 7- Read, Sworn to and Subscribed before are. Permit No.. Disapproved (Signed) 7 ( ..� / \. Date Notary Public, State of Florida PL a '.NING BOAR;a DATE to me well known, Building Inspector \. My Commission Expires personally ap- � /, Chairman Member Member Member Member ... — - - - - - Member Council Approved Date Disapproved Date NOTE: A charge of $1.00 will be made for making corrections or changes to this application after approval has been obtained from the Planning Board. A re inspection fee of $1.00 will be charged when such re- inspection is made necessary by tmproper rta3fco for inspdtion or faulty materials and /or workmanship.