Loading...
1099 NE 91 Terr (5)Date Legal Description .4 or /3, 84/G 1 / /�qz'�� 'F Historically Designated: Yes No Owner/Lessee / Tenant C- 04V ' S Master Permit # 3 2 b 39 Owner's Address / / 11/ Pipi - 011 tj Phone (Jo) 7S S' 6'9f» Contracting Co. i PERMIT APPLIICATION FOR MIAMI SHORES VILLAGE Job Address �0 7 7A 9/ '�,�� � TF�2 Tax Folio Qualifier State# 7 c o37 Square Ft. / 20. Municipal # Architect/Engineer Bonding Company Mortgagor Address Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICA ROOFIN PAVING FENCE SIGN WORK DESCRIPTION � —��4� � fl C 1'/7 AIV Z[ r /ii; S /tiG •/0 WARNING TO OWNER: YOU MUST RECORD A NOTICE OF COMMENCEMENT AND YOUR FAILURE TO DO SO 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.) Application is hereby made to obtain a permit to do work and installation as indicated above, and on the attached addendum (if applicable). I certify that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that separate permits are required for ELECTRICAL, PLUMBING, SIGNS, POOLS, ROOFING and MECHANICAL WORK. 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. Furthermore, I authorize the above -named contractor to do the work stated. Signature of owner and/or Condo President Date CZ's- z{� tom! r Nov lan as to Owner and/or Condo Preside t Date M Cq isW MOM. NOTARY SEAL O ei SANDRA M MONTIEL 2 Ili ; 0 C NUMBER ' .'.I� < CC40126 -7,. �~ QU MY COMMISSION •FX✓'. OF FLO AUO. 17, 1990 a o � FEES: PERM 66. RADON C.C.F. Address '..gi3O/ d'/k) ? 7f e :; ,rye .�. ✓ ,c 4C. SS# 4pholer)C (-90 ( Competency # Ins. Co. Address Address o �. Estimated Cost (value) 5 Signature o Contractor or weer- Builder Date 9f F . 5 NOTARY ST c otary as to Contractor or Owner- Builder • . "wit. i; i rvr. • 1• ure$O T ARY SEAL .. e ii SANDRA M MONTIEL s 7 ' * COMMISSION NUMBER v - X 1 1 ' r r CC401261 MY COMMISSION EXP. n F\ AUG. 17 1998 Date APPROVED: Zoning Building Electrical Mechanical Plumbing Engineering TOTAL DUE Job Address: /O /re r Contractor £,eitAP ,< Process No. APPENDIX 'E' Base Sheet: Fasteners: METRO -DADE UNIFORM BUILDING PERMIT SECTION II BUILT -UP APPLICATIONS AND MODIFIED BITUMEN SYSTEMS GENERAL: Type of Roof System Assembly to be Applied: AID Manufacturer of Roof System Assembly: N 3T' 1 -tO Mir( < Product Control Approval Number: 9V System Number from Product Control Approval: COPIES (Attach irof the Roof System Assembly Product Control Approval and the Manufacturer's System Guide Specification. ) ( Note: If a minimum roof system is to be applied, describe all components within the system and list the manufacturer of each component. DO NOT complete this section if system is Product Control Approved. ) Ply Sheet(s): Cap Sheet: Asphalt: ( Note: No insulation system is acceptable under the minimum roof category. ) Complete the following for all Roof System Assemblies: Built -Up Applications and Modified Bitumen Systems • Page -1 Job Address: /077 7/ S '% Contractor Process No. ( Check one of the following) Recover Re-roof: New Construction If a recover, is the existing Roof System Assembly to be used as a bonding substrate ?: Y fN If YES, has an ASTM E907 test been carried out to confirm adhesion of the existing membrane to the substrate ?: (If 'yes', attach ASTM E907 test report. ) Proposed Fastener: (Attach withdrawal resistance test report. ) Has the deck been examined for moisture ?: (Provide data confirming compliance with Section 3401.9(c) . ) THE SYSTEM; All Roof System Assemblies in the Product Approval have a variety of options. Briefly describe the Roofing Components to be used in the Roof System Assembly and attach a copy of the manufacturer's published specification: Deck: ( Briefly describe ) Insulation: (Type, size and method of attachment, if applicable ) (,v ,,i.- (yik„ NA /c Pope_ Ply Sheet(s): (Type and method of attachment) Built -Up Applications and Modified Bitumen Systems Page -2 N / x g Base Sheet or Ply: azigS eine 'TN ( Type and method of attachment ) ��,��� JLy c...IbEtr -0.01 L Job Address: /6 f 9/ Sr Contractor if' /Z Process No. Top Ply: ( Type and method of attachment ) Surfacing: ( Type, if applicable ) Flashing Materials: ( Type and method of attachment ) • Page -3 Ce JS F u,,/.- 2.4 : l aT pit Built -Up Applications and Modified Bitumen Systems Job Address: /099 1/F 9/ jr Contractor 8- !I\ I _ inches T I _ inches T inches FILL IN APPLICABLE ROOFING COMPONENTS WHICH MAKE UP ROOF SYSTEM ASSEMBLY AND THICKNESS OF DECK AND INSULATION LAYER(S). (Where Roofing Component not used in Roof System Assembly, fill in with "N /A ".) / Surfacing: /V /� Surfacing: describe, K / applicable op Ply: krN"q SL. Bonding Material: VA Ply Sheet(s): /"/ Bonding Material: F/A" Fastener: 2 7 N�fL — - / (/bate sheet mrc at ac t. IVAN ION Process No. Base Sheet: Ft gt/CCLAf S Primer. (I� aPPlic .57 _44,ft Bonding Material: /11/ (ifbant eeebonded) Bonding Material: (1 /top i,uu ation layer bonded) Fastener: Of insulation mech. attached) Insulation: Bonding Material: ((/laudation bonded) Vapor Retarder: " 0/applicable) DECK: Type: Gage or Thickness: Built -Up Applications and Modified Bitumen Systems • Page -4 Fastener. /" ! A (! /fop !nndation layer mech. snacked ) it/1/1 Insulation layer. (/applicable) /4 /WA 41/ /4-- /J-lft Density, if concrete deck: Job Address: )9 91 '9j -c f Contractor 8 4 Coping Cap Gage: Fastener Spacing: _ o.c. Clip Type: Clip Gage: PERIMETER DETAIL #1: Parapet Wall Detail Deck Type: PERIMETER DETAIL #2: Flashing Detail Built -Up Applications and Modified Bitumen Systems Page -5 Process No. Sketch Roofing Components which make up Roof System Assembly at Perimeter Parapet Walls. Insert leaders indicating Roofing Component names, dimensions, thicknesses, etc. Include fastener type and spacing used for wood - blocking attachment. Sketch Roofing Components which make up Roof System Assembly at Perimeter Areas to be Flashed. Insert leaders indicating Roofing Component names, dimensions, thicknesses, etc. Include fastener type and spacing used for wood - blocking attachment. Job Address: Sketch Roofing Components which mute up Roof System Assembly at Perimeter Edge with Gutters. Insert leaders indicating Roofing Component names, dimensions, thicknesses, etc. Include fastener, type and spacing used for wood - blocking attachment Gutter Type: &A Gutter Gage: Fastener Spacing: Contractor PERIMETER DETAIL #3: Gravel Stop or Drip Edge Sketch Roofing Components which make up Roof System Assembly at Perimeter Edge with Gravel Stop or Drip Edge. Insert leaders indicating Roofing Components names, dimensions, thicknesses, etc. Include fastener type and spacing used for wood - blocking attachment Gravel Stop/Drip Edge Gage: Fastener y� Spacing: o.c. Clip Type: Clip Gage: Y .. Deck Type: _fi Deck Type: PERIMETER DETAIL #4: Gutter Detail Built -Up Applications and Modified Bitumen Systems Page -6 Process No. Job Address: / Af / Sr Contractor f� Na . Process No. Sketch Roofing Components which make up Roof System Assembly at any 'other' Perimeter Condition which may eitisit Insert leaders indicating Roofing Component names, dimensions, thickesscs, etc. Include fastener type and spacing used for wood - blocking attachment. PERIMETER DETAIL #5: 'Other' Detail NA) Sketch Roofing Components which make up Roof System Assembly at any 'other' Perimeter Condition which may exisit Insert leaders indicating Roofing Component names, dimensions, thickesses, etc. Include fastener type and spacing used for wood - blocking attachment PERIMETER DETAIL #6: 'Other' Detail Built -Up Applications and Modified Bitumen Systems Page -7 Job Address: AO 97 ")/ S' Contractor Process No. Insert Building and Parapet Heights. (/f no Parapet exists, insert "N/A") Also insert applicable information pertaining to the building below. (See AStrE 7.88 Fact Shin Attached) Exposure Category' Classification Catagorw At Hunicssno Otcanfrtte ?: _ Y _ N Basic Wind Speed at Building Localiont 110 mph Building Condition based on % of Openings: GROUND LEVEL feet fact BUILDING INFORMATION #1 Built -Up Applications and Modified Bitumen Systems Page -8 Job Address: /O N 9/ -S Contractor ��t Process No. Sketch Roof Plan indicating all dimensions, any slopes, roof drains, crickets, or roof top equipment. Also insert variable labeled "a" which indicates perimeter and corner dimensions per Chapter 23 of the South Florida Building Code. (See ASCE 7 -88 Fact Sheet Attached ) 1 z ) ysc'G 4/' 27 Built -Up Applications and Modified Bitumen Systems Page -9 BUILDING INFORMATION #2: Roof Plan with Perimeter and Corner Dimensions Job Address: / ri Ng 7 Sr" Contractor ��- � Process No. Roof System Assembly Product Control Approved: Y N If NO, note any deficiencies: Design Presstjte Requirements: Field: Perimeter Areas: Corner Areas: Note any limitations: Reviewed Iaet i, ls?: Notes: • -- FOR PLAN EXAMINER USE ONLY -- psf psf psf Page -10 Built -Up Applications and Modified Bitumen Systems Y N Job Address: /0/9 ' 2/ S% Contractor 8C 0 X-- Process No. Reviewed Field Test Data ?: Notes: Additional Notes: Y N Built -Up Applications And Modified Bitumen Systems Page -11 Plan Examiner SURFACE ROOF SYSTEM, S p GTA ME N MINERAL. ELKS � DIAMO MODIFIED BITUMEN OVE NAILAB PAG 5) TA or WHITE Type BLACK asphal S PECIFI CATION ICAT GTA GT A- 2- 3C O N CR TE OVER IFLINTLASTIC 3 „ in 12" use Y Above SP EC s: Up to NO. SHEET " i 1 2" s e e Page 8 & 9)• (FOR LI Y �F GIASBA GLASBASE 2° to 6 ONE PLY UP tO 6" �n Incline SECTION 07510 PART 1 - GENERAL 1.01 DESCRIPTION A. Related work specified elsewhere. Accessories as required by project details. 1.02 PRODUCT HANDLING, STORAGE AND DELIVERY A. Products. Materials shall be GS brands delivered in original packages bearing manufacturer's labels. B. Storage of Materials. Store all roofing materials, coatings and accessories off the ground completely pro- tected against weather. 1.03 WARRANTY A. Roof Membrane Warranty. GS will issue the applicable Roof Membrane Warranty upon receipt of the war- ranty fee, when all published conditions are met. To be eligible requires installation by a GS Authorized Roofing Contractor or a member of the GS Golden Star Applicator Program. Prior to commencing work, the Roofing Contractor shall submit the nec- essary application form to GS for approval. The Roofing Contractor shall notify GS three working days prior to commencing work to arrange for required inspections. PART2- PRODUCTS 2.01 ROOFING SYSTEM A. Modified Bitumen Roof System on Nailable Decks. On areas indicated on drawings to receive modified bitumen roofing, apply GTA -2 -3 Roof System, with the appropriate GS Approved Base Flashing and Metal Counterflashing or Wall Covering, as specified in the current GS Specification Manual. Roof shall be installed by a Roofing Contractor authorized by GS to install the specified Roof Membrane Warranty System. B. Insulation. (See 07240 or pages 23 - 24 of this catalog.) C. Summary of Materials per 100 Square Feet * GLASBASE Base Sheet (1 ply) 23 lbs. FLINTLASTIC GTA (1 ply) (White or Black Diamond GTA = 95 lbs.) 105 lbs. APPROXIMATE TOTAL WEIGHT WITHOUT OPTIONAL SURFACING 128 lbs. "Alternate approved GS Base Sheets include: Ultra, Premium, Flex- i -glas, and All Weather /Empire Base Sheet. D. Cants. In angles of roof deck and vertical surfaces, the Roofing Contractor shall furnish and install a solid wood, wood fiber or insulation type Cant Strip with a minimum 3" face. PART 3- EXECUTIQN 3.01 INSPECTION OF SURFACES A. Roof Deck. Roof deck shall be smooth, dry, clean and securely nailed. Cover large cracks with metal. Properly grade surfaces to outlets. Roof accessories shall be available before Roofing Contractor begins work. B. Outlets. Drainage outlets shall be installed below roof deck surface to permit free flow of water and to prevent forming water dams at rims. 3.02 PREPARATION A. Sheet Metal Work. All metal fleshings shall be factory primed or lightly primed with asphalt primer and allowed to dry before roofing mate- rials are applied. B. Cants. Nail cants on top and bottom 16" o.c. Cants shall fit flush at ends and to vertical surfaces. Where scuppers occur, apply cant 2" back from flange and bevel cant 8" from ends. 3.03 APPLICATION A. Outlets. Install base ply, trimmed even with drain flange. Follow with a torch applied, approximately 40" x 40" collar of FLINTLASTIC STA extending into, and fully adhered to, drain flange and interior surface. Install FLINTLASTIC GTA, fully adhered to base ply, flashing collar and extending into drain. Install clamp ring and tighten while membrane is still hot. GS recommends the use of a minimum 30" square, 4 Ib. lead or 16 oz. soft copper flashing installed between the flashing collar and field membrane. FLINTLASTIC STA flashing collar shall extend 4" beyond lead or copper flashing. B. Valleys. Torch apply one ply of FLINTLASTIC GTA over the base ply, centered in the valley, lapping 6" on ends. Field membrane courses shall overlap the valley sheet a minimum of 6 ". Valleys shall have positive drainage. C. Pipe Flashing. Where projections extend through the roof surface, install a collar of FLINTLASTIC STA over the base ply to extend a mini- mum of 4" beyond flanges. Install metal flashing with a minimum 4" wide continuous flange on top of the FLINTLASTIC STA collar. (For nail - able surfaces, flange must be nailed 3" o.c. 3/4" from perimeter.) Field membrane shall be fully adhered to the FLINTLASTIC STA collar and metal flange. Seal flashing by trowelling a bead of melted modified bitumen at membrane termination to the metal flashing. (Not suitable for hot pipe projections.) D. Roofing Membrane. Apply one ply of GLASBASE Base Sheet lapping 2" on sides and 4" on ends. Attach base ply 9" o.c. at side laps and 18° o.c. staggered in two rows 12" in from each edge with Approved Fasteners. Install base ply to provide and maintain a 6" minimum offset between side and end laps of the base ply and FLINTLASTIC GTA. Torch apply one ply of FLINTLASTIC GTA over the base ply, lapping 3" on sides and 6" on ends. All end laps shall be diagonally staggered and not less than 3' apart. Roofing System shall be applied in a continu- ous application. E. Base Flashing and Curbs. Over completed membrane at vertical surfaces, install Base Flashing consisting of one ply of FLINTLASTIC GTA/fl, torch adhered to primed concrete or masonry surfaces: Base flashing shall extend a minimum of 8" up vertical surfaces and 4" out onto field membrane. Wood surfaces shall receive one ply of base sheet extending from top of cant strip to top edge of Base Flashing prior to torch application of FLINTLASTIC GTA/fl. Nail top edge of Base Flashing 9" o.e. through tin - discs. F. Final Surfacing. Refer to General Requirements Section for information on reflective coatings and optional surfacings. Refer to General Requirements Section for definitions. These shall be considered part of and used in conjunction with Roof System Specs. • 1E�DADE METROPOLITAN DADE COUNTY, FLORIDA METRO-DADE FLAGLER BUILDING GS Roofing Products 5525 Mac Arthur Blvd. Suite 900 Irving Texas Your application for Product Approval of (S Roofing Products. Modified Bitumen Membrane Roof System under Chapter 8 of the Metropolitan Dade County Code Governing the use of Alternate Materials and types of Construction, and completely described in the plans, specifications and calculations as submittedd by Applied Research Laboratories, Factory Mutual Research Corporation, Underwriters Laboratories, Inc. and United States Testing Laboratories has been recommended for acceptance by the Building Code Compliance Department to be used in Dade County; Florida under the specific and standard set forth herein. The approval shall be valid for a period of three years. The Building Code Compliance Department reserves the right to secure a product or material at any time for a jobsite or manufacturer plant for quality control testing. If prodcut or material fail to perform in the approved manner, the Code Compliance Department may revoke, modify or suspend the use of such product or material immediately. The Building Code Compliance Diparment reserves the right to require testing of this product or material should any amendments to the South Florida Buliding Code be enacted affecting this product or material. BUILDING CODE COMPLIANCE DEPARTMENT SUITE 1603 METRO-DADE FLAGLER BUILDING 140 WEST FLAGLER STREET MIAMI, FLORIDA 33130 -1563 (305) 375 -2901 PRODUCT CONTROL NOTICE OF ACCEPTANCE FAX (305) 375-2908 THE EXPENSE OF SUCH TESTING WILL BE INCURRED BY THE MANUFACTURER. PRODUCT NO.: ACCEPTANCE NO.: 94- 0531.04 EXPIRES: SEP 1 21997 Gil Diamond, P.E. Product Control Division Supervisor - PLEASE NOTE - THIS IS THE COVERSHEET. SEE ADDTIONAL PAGES FOR SPECIFIC AND GENERAL CONDITIONS. BUILDING CODE COMMITTEE This application for Product Approval has been reviewed by the Metropolitan Dade County Building Code Compliance Department and approved by the Building Code Committee to be used in Dade county, florida under the conditions set forth above. /y APPROVED: SEP 1 2 1994 Charles Danger, P.E., D' ctor Building Code Compliance Department Metro -Dade County 1 •. rroTh 44: ' • Membrane Type: Deck Type 1: Deck Description: System Type E: All General and System Limitations apply. Base Sheet: Fastening: Ply Sheet: Membrane: Surfacing: Maximum Design Pressure: Maximum Fire Classification: Maximum Slope: Specification No.: APP Wood, Non - insulated 19 / 72 " or greater plywood or wood plank decks Base sheet mechanically fastened. One or more plies of GS FlintGlas ply IV or Ply VI, GS Glas Base, GS Flex -1 Glas Base, Flex -I Glas FR Base or GS Poly SMS base mechanically attached to the deck as retailed below. Base sheet shall be lapped 4" and fastened with approved roofing nails and tin caps 9" o.c. in the lap and two rows staggered in the center of the sheet 12" o.c.. (Optional) See products listed under 'Base Sheet' above. Flintlastic-STA or Flintlastic GTA Torch adhered to base sheet. Install one of the following: 1. 400 lb./sq. gravel or 300 lb./sq. slag in a asphalt at an application rate of 60 Ibfsq.. 2. 'Karnak 97, APOC 212 Fibrated Aluminum, AL MB at an application rate of 1 ''A gal./sq.. -45 psf. Class 'A'; see General Limitation #2. 1:12; see General Limitation #3. STA 2 -3, GTA 2 -3 28 Gil Diamond, P.E. Product Control No.:94- 0531 -04 flood coat of approved mopping Henry 520 Aluminum or Grundy BUILDING ELECTRICAL PLUMBING ROOFING Owner of Building t , `f ti , , MIAMI SHORES VILLAGE. FLORIDA ❑ DATE — t 1951_ ❑ PERMIT N? 6164 Contractor's © License No. ❑ Work to be performed under this Permit Architect Contractor or Builder 1 '' I.egal Lot Description Bl. CONTRACTOR OR BUILDER Signed INSPECTOR Y i 2-1 i FL BY AUTHORITY 7 .a Subdi- vision Address of - —° Value of — 11 Amount of 'wilding r ' t t ` '' • { Project $ ,,.7t-, 1 Permit $ This permit is granted to the contractor or builder named above to construct the building or to install the equipment or device described in the application herefor in strict compliance with all ordinances pertaining thereto and with the understanding that the work will be performed in compliance with any plans awings, statements or specifications that may have been submitted to and approved by the proper municipal authorities. This Permit may be revoked at any time if the work is not done in compliance with such ordinances or if the plans are changed without authorization. A further condition upon which this permit is 7ranted is the understanding that the contractor or builder named above assumes the responsibility for a thorough knowledge of the ordinances and regulations - •ertaining to the work covered hereby whether shown on the plans or drawings or in the statements or specifications and that he assumes responsibility for work gone by his agents, servants or employees. "` BY. 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 :ertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In ac• -epting this permit I assume responsibility for all work done by either, myself, my agent, servant or employee. 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. Owner's Name and Address. Mrs. D' Andrea No 1099 Registered Architect and /or Engineer..._ Name and address of licensed contractor Adams & Beagles Roofing Co. Inc Location and legal description of lot to be built on: Lot Block Subdivision...... Street and Number where work is to be done 1099 N.E. 91st Terrace Rear State work to be done and purpose of building (by floors) Re -roof 2 story garage apt'. Back half to be removed, 1/30, 2/I5 & gravel applied. Front half, tincapped & 1T90 applied. New Building Remodeling. To be constructed of Kind of foundation Estimated Total cost of improvements $ 234,00 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 pennit 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 der this permit, as are licensed by Miami Shores Village. Remarks (Signed) e� :1 �, ��� C� , 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 hi n> ated are t Disapproved (Signed) Permit No -' ' • Date ( O - 2 2. spe Date June 21 Street s 62 N.E. 91 Urrac e 4021 WW 28th St. Miami and for no other purpose. No. of Stories 2 Roof Coverin9O# slate. . & Built up Amount of Permit $ �_�_QQ - - -� 2 sgrs s Addition Repairs 'Z —Read, Sworn to and Subscribed before me. to me well known, Notary Public, State of Florida My Commission Expires PL ING 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 51.00 will be charged when such re- inspection is made necessary by improper notice for inspection or faulty materials and /or workmanship. Owner's Name and Address. - �!.� 4 //A4 13 C Registered Architect and /or Engineer - ... Name and address of licensed contractor. Location and legal description of lot to be built on: Lot Block Subdivision MIAMI SHORES VILLAGE 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. BUILDING INSPECTION DEPARTMENT Date. Street and Number where work is to be done State work to be doe and purpose of uildin ( floo )4-9-140Va- No / q.7 Street 9/ ... 4d X f 4 7ce), -6-- and for no other purpose. New Building Remodeling Addition Repairs No. of Stories To be constructed of Kind of foundation Roof Covering a 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 pennit 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. s 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 Notary Public, State of Florida (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.