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1050 NE 91 TerrPOLICY NUMBER MIND OP INOURANCG EXPIRATION DATE LIMIYO OP LIABILITY Workmen's Compensation Employer's Liability Statutory 2 ®064 ®S4 Contractors Bodily Injury Liability 6/23/59 $ S0, 000. 00 Each Person $ 100, 000.00 Each Accident 2®061 - 54 Contractors Property Damage Liability 6/23/59 $ 5, 000. Each Accident $ 25,00000 Aggregate Limit Comprehensive General Bodily Injury Liability $ Each Person $ Each Accident Comprehensive General Property Damage Liability $ Each Accident $ Aggregate Limit Automobile Bodily Injury Liability $ Each Person $ Each Accident Automobile Property Damage Liability $ Each Acc dent HMC3 HMC Address 350 ..L.l:.m....54th Stroot Description Ce.rp.entvg Issued to Address Dated at 23 *Tyne Form No. UD -11 -0-953 BU Trip CERTIFICATE OF INSURANCE 9OWA HOME MUTUAL CASUALTY COMPANY DES MOINES, IOWA This is to certify that the following Insurance Policies are in force in this company as of the date of this certificate. Insured IRA $$Q T Locations Covered 1 050 N.E. 91st AWenue Miami Shores Florida In the event of any material chap a in or cancellation of the above insurance, the Company wi:1 fur- nish the holder of this certificate.12 days prior written notice of such change or cancellatio_r lausas rci - eshaehb:abifis - by- reeseca•af.•faiLWe.sa{le.se• written notice, registered man. CYU k MIAMI SHORES, FLORIDA Miami Beach, Florida 19 58 IOWA HOME C SUA rYJCOMPAGr', ByTOBIN a., ROSE II SURANCE AGZNCy, Authorized Representative t � AGENT -Copy MUST be mailed to Company on date of issue % • KIND OF POLICY POLICY NO. POLICY PERIOD LIMITS OF LIABILITY Bodily Injury Pro,erty Damage A— Workmen's Compensation Eff. Exp. Provided by Workmen's Compensation Law State of Nil B— Manufacturers' or Contractors' Liability MCL 8528 Eff6 /13/58 Exj / Each person $ 50,000. Each accident $100, 000. Each accident $ 5, 000 s Aggregate $225,000. C— Owners', Landlords' and Tenants' Liability Eff. Exp. Each person $ Each accident $ Each accident $ D— Owners' or Contractors' Protective Liability Eff. Exp. Each person $ Each accident $ Each accident $ Aggregate $ E— Scheduled General Liability Eff. Exp. Each person $ Each accident $ Each accident $ Aggregate $ F— Automobile Liability (1) Owned Vehicles (2) Hired Vehicles (3) Other Non -owned Vehicles Eff. Exp. Each person $ Each accident $ Each accident $ G— Comprehensive Liability (1) Automobile Eff. Exp. Each person $ Each accident $ Each accidert $ (2) General Eff. Exp. Each person $ Each accident $ Aggregate $ Each accident $ Aggregate $ (3) General- Automobile Eff. Exp. Each person $ Each accident $ Aggregate $ Each accidenl $ Aggregate $ CERTIFICATE OF INSURANCE This is to Certify, that policies in the name of IRA E ASON at 3500 N.W. 54th Street Miami (Street and Number) are in force at the date hereof, as follows: and cover, in accordance with the policy terms, location at 1050 N.E. 91st Avenue Miami Shores Florida Certificate issued to BUILDING DEPARTMENT MIAMI SHORES, FLORIDA In the event of any material change in or cancelation of said policies the undersigned company will notify the party to whom this certificate is issued of such change or cancelation. five Clays prior to such change or cancellation. T0BIN. ROSP ...1NSURANCE...AGENCY,....INC . 13 - --June .1958 Dated GU6469a BEd. 5 -541 UNIFORM PRINTING 8 SUPPLY DIV. (Name of Insured) (City or Town) FI cac' ida (State) EAGLE STAR INSURANCE CCM?ANY, L'I'D. 111 John Street New York, N.Y. OWNER'S NAME fli k 1R EA ®mss PRESENT ADDRESS -yz„, ' ai 1. A — � LICENSE NO. 0 7 r PHONE NO. JOB LOCATION (ST. OR AVE.) LOT BLOCK SUBDIVISION GENERAL CONTRACTOR ADDRESS PHONE NO. LICENSE NO. BUILDING PERMIT NO. g DATE qq l"7° � ®� PERM FEE $ � � BUILDER'S BOND � j Go to -..S NO. & C ' ice) D ATE A) ' ZONE k4° REQUIREMENTS C� ®p © CU. FT. p lOO� rd. cp O U 5..e. e's,p¢.'/7� 6" PLAN CUBE r - ® c .,41-(1- CU. FT. Moo a— fit 6, .; won c7 EST. COST $ 17 e OC') n / (/ NEW CONSTRUCTION TYPE STORIES ROOF CONSTRUCTION INTERIOR CONSTRUCTION MARVEL. REPAIRS ' 7F?CL, 1 Oh�' tl ' a,/e Ocz Cv ARVEL. 'sL�CZ F ,,lfC_ � .�5 c% ),C,'° ALTERATION , /� DESCRIPTION �� ��, �� ADDITION V%l(Q, =h �F ==.C $C. C "0 a- ! E. 4 ES.0; �.f�) c t 1 iL , APPROVED REJECTED d REFERRED TO COUNCIL REASONS SUBMITTED TO PLANNING BOARD RE- SUBMITTED TO PLANNING BOARD REMARKS SUBMITTED TO VILLAGE COUNCIL 11 CERTIFICATE OF OCCUPANCY NO. .s...'•11.0., ISSUED BY TO (� E - 5 ` ," ✓. Doge. DVS" DRAW NGS. SPECIFICATIONS. RESTRICTIONS AND CUBE CH ECKED BUILDING PERMIT AND INSPECTION RECORD — MIAMI SHORES VILLAGE DAT= ✓. Doge. DVS" DRAW NGS. SPECIFICATIONS. RESTRICTIONS AND CUBE CH ECKED BUILDING PERMIT AND INSPECTION RECORD — MIAMI SHORES VILLAGE DAT= INSPECTIONS DATE BY INSPECTIONS DATE RE- INSPECT BY FOUNDATION F .- gzw3lac„. T ,4,. ROOF $c7.4?' ° of SEWER rUB & TOP OUT BEAMS & LINTELS 7-A "S1' ...RA, POOL SOLAR HEATER SEWER MOTORS FRAMING $ AIR COND. GAS SEPTIC TANK $ 1 FINAL &II, 60A . - bl ' S CLEAN UP SOLAR HEATER ,,.,/ SLAB e P TMot.Pf�( 7-i=7S t FIXTURES /� ,/ 0V- �fLj,. , 1 - - - 1 SLAB ,Se. ,,�J ,.7----. I id4C- .1'0- / -c(; TEMPORARY SERVICE DATE 1 RE- INSPECT $ RE- INSPECT SEPTIC TANK ( o=..e. ;OA, F .- gzw3lac„. T ,4,. Z $c7.4?' ° of SEWER rUB & TOP OUT H. W. HEATER CONN $ $ SOLAR HEATER SEWER MOTORS $ FIXTURES GAS SEPTIC TANK $ 1 5 FIXTURES & FINAL S SOLAR HEATER INSPECTION,$ -' DATE BY // RE- INSPECT BY RE- INSPECT BY ROUGHING y /-i/° "d %i/�`�7 -gg F4- °.5, t..A/1,5 1 $ 1 rUB & TOP OUT H. W. HEATER CONN $ RANGE CONN. RANGE CONN SEWER MOTORS $ I FIXTURES SEPTIC TANK $ 1 FIXTURES & FINAL S SOLAR HEATER FIXTURES /� ,/ 0V- �fLj,. , 1 - - - 1 t GAS 1 CONTRACTOR • 4 4c,H & 4C 6r �,. PHONE .t fi PERMIT NO. 7 1 DATE 2 5 ° g FEE $ . NEW BLDG. W. 1 ALTERATION 1 ADDITION REPAIRS SPECIAL PERMITS PERMIT NO. DATE FEE 1 TEMPORARY SERVICE - 1 $ 1 H. W. HEATER CONN. H. W. HEATER CONN $ RANGE CONN. RANGE CONN $ MOTORS $ I FIXTURES $ 1 FIXTURES & FINAL S INSPECTIONS DATE BY RE- INSPECT BY RE- INSPECT BY TEMP. SERVICE ROUGHING H. W. HEATER CONN RANGE CONN FIXTURES & FINAL p Ok .411e4 / 0i /$ � V J ( 0 d 0 CONTRACTOR 4a .. 5 . ao•c aeS/ PERMIT NO. 7,1 rl� NEW BLDG. A. I SPECIALS PERMITS ALTERATION "sic- ✓G UILDING INSPEC DATE PERMIT NO. DINS PLUMBING PERMITS & INSPECTIONS -/ 6 -S I ADDITION I DATE ' Zi PHONE FEE $ c3 J REPAI RS FEE ELECTRICAL PERMITS & INSPECTIONS APPROVAL TO POWER CO. FOR SERVICE DATE in 4 r #' .q &"" Ts ice• 4 • / ®. ,, a Pµi BY SI THIS LICENSE MUST BE bISPLAYED IN A CONSPICUOUS PLACE A PENALTY IS IMPOSED FOR FAILURE TO KEEP THIS LICENSE EXHIBITED AT YOUR ESTABLISHMENT OR P ..ACE OF BUSINESS Village iN9 2675 Dollars ($ Paef irii Shores 'Village, Dade County, State of Florida, THIS LICENSE EXPIRES In consideration of the sum of ) .0. is hereby licensed to engage in or operate the business of Date Issued MSV/1958 License MIAMI SHORES VILLAGE, FLORIDA By THIS LICENSE NOT TRANSFERABLE WITHOUT THE APPROVAL OF THE VILLAGE MANAGER. _ _ s�I APPLICATION FOR CERTIFICATE OF RE- OCCUPANCY 1, fU.Sa n L 4 &s» r.0 , hereby apofy for a csrtmca to re-c :cy tie sincie- famity residence known as /05 ME 91 Th, r• , Miami Shores. Florida. aikla Lot , Block , Plat , as a single -family residence. hereby certify that I understand that the zoning of the property is for single - family residential use and that it is unlawful fcr more than one family to reside therein_ ' I also understand that any Certificate of Re- Occupancy that may be issued by Wang Shores Village, Florida, certifies only that the referenced property is being used for single - family purposes and that such Certificate does not constitute arty representation, warranty or certification as to the condition of the dwelling or other • on such 1 0 /49P Page 1 of 2 s Print Name: S (.“ an La w•f O 1J For purposes of conducting the inspection required by Section 902 of the Miami Shores Land Development and Zoning Cade, please contact the A foil i person(s): I ie' -1 Name: J U,S 1 ! C.Q wSV I► Relationship: Phone No.: 7S7 -/? 00 Address: BY: Application Received: Application Fee ($50) Paid: Inspection Made: fei1 Inspection: Passed (0) on 1 ofP ' J54 Failed ( ) because: Check No. CERTIFICATE OF RE -OCCUPANCY On behalf of Miami Shores Village, Florida. the undersigned certifies that the property described in the above application has been inspected for purposes of re- occupancy pursuantto Sections 901 and 902 of the Miami Shores Land Development and Zoning Code and that such property may be re-occupied by the above applicant for single - family residential purposes. Page 2 of 2 MIAMI SHORES VILLAGE, FLORIDA By Date: cfCzt ification: THIS CERTIFICATE VERIFIES THAT THE REFERENCED PROPERTY HAS BEEN INSPECTED BY MIAMI SHORES VILLAGE AND HAS BEEN DETERMINED TO PRESENTLY COMPLY WITH THE SCHEDULE OF REGULATIONS OF THE MMAM1 SHORES LAND AND DEVELOPMENT CODE PERTAINING SOLELY TO THE R ECUIRFMEN TTHAT EACH ONE- FAMILY DWELLING IS USED AND INTENDED TO BE USED FOR A ONE - FAMILY DWELLING PURPOSE ONLY; HOWEVER, THIS CERTIFICATE DOES NOT CONSTITUTE ANY lRESENTATION OR WARRANTY AS TO THE CONDITION OF THE DWELLING OR OTHER STRUCTURES ON THE PREMISES DESCRIBED HEREIN, OR ANY ASPECT OF SUCH CONDITION, AND INVESTED PERSONS ARE ADVISED AND ENCOURAGED TO MAKE THEIR OWN INSPECTION OF THE PREMISES IN ORDER TO DETERMINE THE CONDITION THEREOF. TOTAL P.O3 Description \ __Locat(on Of Risers- / 70B ORDER SHEET Type Of Service Residence lab. Of Apt. Units Commercial r1. /o /q6.3 Thx Districted• Date Zssn INSPECTORQS REPORT: Status Of iildings Estimated Installation Date: Remarks: .spector Municipal Permit: Date Reinspected Remarks: Estimated Actual Quantity Qtantity PGS -EC Size MATERIAL LIST Pipe Olndicate Type) Cocks, Lobe Fittings Description nate Approved By: Supt. Dhte Job Completed Retirement Disposition J� .0 MIAMI SHORES VILLAGE, FLA. N° 8290 JOB Uv ADDRESS Gam' 6 INSPECTION TIME READY c INSPECTOR 1 REMARKS: cr�• - OS • / U 1 ATE I ' ' 'MIAMI SHORES VILLAGE, FLA. Ivy 8303 • JOB ADDRESS INSPECTION TIME READY REMARKS: ���� �� A INSPECTOR DATE DATE: I `K, [avU") NAME OF PERSON REQUESTING FIL PHONE #:75( °� P - 2/Y -kOUR ADDRESS: pso 0-E 1 t r- • ADDRESS OF FILE REQUESTL; . Miami Shores Village Building Department 10050 NE 2 Ave, Miami Shores, Fl 33138 Tel: (305)795 -2204 • Fax; (305)756 -8972 PLEASE PRINT INFORMATION REQUESTED: blU rl tjk TIME: 10 I understand that all documents in this file are property of Miami Shores Village and that NO documents may be removed from this file. You may get 4 complementary copies (8x11) size, additional copies will be furnished at 0.15 cents per page, not including any blue prints. If blue prints are order please be aware that we are not responsible for the quality of the printed documents. Acknowledged by: FILE RETURNED TO: INITIAL DATE: ( /J p ADDRESS OF FILE REQUESTED: INFORMATION REQUESTED: 6:41 Acknowledged by, FILE RETURNED TO: INITIAL Miami Shores Village Building Department 10050 NE 2 Ave, Miami Shores, Fl 33138 Tel: (305)795 -2204 • Fax; (305)756 -8972 b(i) PLEASE PRINT TIME: r f _ NAME OF PERSON REQUESTING FILES 4 i \e _.?. PHONE #: 7(O5 /o o ` J / . 1 1 (9 On 7:-/c/ cie42--(r_ I understand that all documents in this file are property of Miami Shores Village and that NO documents may be removed from this file. You may get 4 complementary copies (8x11) size, additional copies will be furnished at 0.15 cents per page, not including any blue prints. If blue prints are order please be aware that we are not responsible for the quality of the printed documents.