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1050 NE 91 Terr (9)Disapproved _c Date (Signed) 4�1r'd Chairman /'7 Member Member MIAMI 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 build- ing 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 regulations 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 Owner's Name and Address No /Stud 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 7 State work to be done and purpose of building (by floors) and for no other purpose. New Building Remodeling Addition Repairs No. of Stories To be constructed of 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 perinit 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 Suppler nt, and has complied with the provisions thereof, and will require similar compliance from all contractor or sub - contractors employed b 'him in the work to be performed under this permit; and will post or cause to be posted for i pection on the site of the work such ubli notice or notices as are required by the Act. The undersigned agrees to employ only tuch s ntractor , n rk to be performer der this permit, as are licensed by Miami Shores Village. Remarks (Sign l . -- -1. I, Li ( STATE OF FLORIDA, COUNTY OF DADE. ss Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally ap- 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. / r Permit No ` ' Date ( ' / ` Read, Sworn to and Subscribed before me. } Building Insppeto ANNING BOARD DATE to me well known, Notary Public, State of Florida My My Commission Expires 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 51.00 will be charged when such re- inspection is made necessary by improper notice for inspection or faulty materials and /or workmanship. MIAMI SIiORES 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 build- ing 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 regulations 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. Owner's Name and Address._ Registered Architect and /or Engineer..... Name and address of licensed contractor Location and legal description of lot to be built on: Lot 9 �� / Block ' Subdivision. -... ` 4i Date Street and Number where work is to be done State work to be done and purpose of building (by floors)- ..L�.�� �ca��- �A.... ,19 ` s � No 3 /3 S eet W and for no other purpose. New Building Remodeling Addition Repairs No. of Stories To be constructed of L g - S Kind of fou ation Roof Covering 4 4 -:_" Y (. . ''''' , '_::ir -t° Estimated Total cost of improvements $ 1 ori Amount of Permit $ / ' 2. ,4 Zone cubage required p . lan Cubage ' ':_ "Y �`� Distance to next nearest building Size of Building Lot Maximum live load to be borne by each floor I hereby submit all the plans d specifications for said building. All notices with reference to the building and its construction may be sent to -I��- i 3 /.S 2/1 61/ /0 9/ e' // 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 prk to be performed under this permit, as are licensed by Miami Shores Village. Remarks (Signed) Notary Public, State of Florida `l'/ - `i'C STATE OF FLORIDA, COUNTY OF DADE. j ss Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally ap- peared to me well known, 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. Permit No Date Read, Sworn to and Subscribed before me. Disapproved Date (Signed) Building Inspector My Commission Expires 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. AREAS 4 n a to to ;� 41 ,y 4 5/ raw - NEt4 ( � q, 0 4 . Ly Lot No.8i Al: ,9 Block No. - Subdivision - - - - According to Plc! thereof a; recorded in Plat Book _ ^ 9 - __Page , Public Records of Dade County, Florida. For: 4.7" • _ INITIAL CERTIFICATE I HEREBY CERTIFY that the attached plat represents a recent survey made hy tne or under my direction and is true and correct ' to the best of my knowledge and belief: a/sa that the building ■ and foundation lines are wholly within the title lines a.; shown and constructed. Miarnk Florida ,10 V /3 _ _ . 1954 THOMAS E, FREDERICK C.E. Engr. Cert. # 222 Surveyor's Cert. #83 NE tk; 77 . g -; r 5 q0 THOMAS E. FREDERICK CIVIL ENGINEER AND LAND SURVEYOR MIAMI. FLORIDA PH. 65-3448 4 L(;"C Survey of • Ir /1/4 rek?,4 FINAL CERTIFIC.17 I HEREBY CERTIFY that the building has bcpn erected a.; shown hereon. Miami, Florida- 19.54 sem,r /'"/670 • , (b..1e 4ve) ., ,, .4_ • , fa' t 11 , , ,, •, •••..,.' • \,'‘, 0 4 - '■ A -'1 .,. /0 J'.( • Nst s '(,5 0:72,t7: 0 ?- THOMAS E. FREDERICK En7r. Cert. -"=.- 22:2 Suf-nijor Crrt. (:.F STATE OF FLORIDA) SS COUNTY OF DADE ) t A F F I D A V I T of the Village of Miami Shores, County of Dade and State of Florida, being duly sworn, doth depose and say, that under the provisions of Ordinance No. 185, dated June 15, 1948, amending paragraph (d) of Section 3-368 of Ordinance No. 97 of the Building Code of Miami Shores Village, he desires to build a on Lot L±A± Block y of / �.� h_ Subdivision, that he is the owner of said property, and will be the own of said , that he wi11 do the work personally, and that he gill, at such times as are required by the Zoning and Building Director: m 1. File plans and specifications and obtain approval of the Planning Board and the Building Inspector. 2. Apply for and secure a Permit. 3. Pay the required fees. 4. Execute the work in accordance with the provisions of this Code. 5. Apply for inspections. 6. File with the Building Inspector certificates that provision has been made to carry the necessary Uorkmen's Compensation, Public Liability and Property Damage Insurance. 7. File with the Building Inspector as the job progresses certificates showing the payment required by the Federal Social Security Act to the State of Florida or the United States of America. 8. Assume the responsibility of not employing other than properly Licensed contractors by Miami Shores Village for any part or portion of the work. 9. Not set himself up as a "contractor ". 10. Sign an affidavit before commencing work to the effect that he has read this Article and will do the work personally and observe all of the requirements of the Building, Electrical, Plumbing and Zoning Codes of Miami Shores Village. Such affidavit to be properly notarized upon blanks to be supplied by the Building Inspector. 11. In order to prevent abuses and subterfuge the right of such owner-builder as herein provided, is limited to but one owner - builder permit each 2 years, and where an owner - builder his once exercized the privilege herein conferred no second application for owner-builder permit shall be granted in less than 2 years, unless the applicant is qualified as a licensed General Contractor under the applicable Ordinances of said Village. And Further this Deponent says not: SUBSCRIBED AND SUORN TO BEFORE NE this 195 . OMB. day of A.D., NOTARY PUBLIC