815 NE 91 Terr (6)I ' I
MIAMI SH El RES VILLAGE
f- °
APPLICATION FOR BUILDING PERMIT / mot - �
S �Q
Application is hereby made for the approval of the detailed statement of the plans and specifications herewith su bmitte o the build —
, r other structure herein described. This application is made in compliance and conformity with the Building Ord' nce of Miami
Shores Village, Florida, and all provisions of the Laws of the State of Florida, all ordinances of Miami Shores Village and all s and
regulations of the Building Division of Miami Shores Village shall be complied with, whether herein specified or not. A copy o
plans and specifications must be kept at building during progress of the work. ��
BUILDING INSPECTION DEPARTMENT
Date _______ -' C ( , 19_5 ~
Owner's Name and Address_ Q.Sa - -- ilaxikQ3._S9j ti4ai2.4.1S No.24r1S Street__rk• ti*• MalS.
Registered Architect and /or Engineer Qi n t.iaS
Name and address of licensed contractor sJ!) R." Wert—
Location and legal description of lot to be built on: ^ (�
Lote _ � __1(? ti Block 2 Subdivision � C ,�QL,_.Clek
Street and Number where work is to be done_______ C _� _ _Ii..E_.__5_1_LY`_____ _Te$a. l.:.
State work to be done and purpose of building (by floors) Eg ec...r
New Building
To be constructed of_ Clet% •
Estimated Total cost of improvements $
Maximum live load to be borne by each floor
Remodeling Addition Repairs No. of Stories
Kind of foundationletk1• COAL• o4riP.c s_____ Roof Covering_ .t'e 4..
Zone cubage required (@_S
Distance to next nearest building
Disapprove • 1 Date
(Si_�ed)=
Building Inspector
1'
Amount of Permit $ f
"15- - - * - -- 1 6'51
_Plan Cubage
Size of Building Lot
I hereby submit all the plans and s ecifications for said building. All notices with reference to the building and its construction may
be sent toSL4.e 7 ‘1c ft.0k0041) Da. NVl4l1. i -- - askGis
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 subcontra rs7.on rk to be perfo dur} er this
permit, as are licensed by Miami Shores Village.
Remarks (Signe aairetiLfr
and for no
other purpose.
pa w
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
to me well known,
and who, being •y me first duly sworn, upon oath deposes and says that he is the
of the above escrib • construction, that he has carefully read the foregoing application, and that he did sign the same, and that all facts
therein by h' : " ed . e true.
Permit No Date
`( 1 f �� Read, Sworn to and Subscribed before me.
_ _ ___ - 1 � ___ _
Notary Public, State of Florida
My Commission Expires
PLANNING BOARD G DATE
Chairm..- -- 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.
STATE OF FLORIDA) SS
COUNTY OF DADE )
�• � AtLP I�AR.Rr►S 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, amend-
ing paragraph (d) of Section B -368 of Ordinance No. 97 of the Building Code
of Miami Shorts Vi.lage, he desires to b id a Os Q
on Lot Ei1.1.904pe 11 Block L. of (OLIN Arks nd( Subdivision:,
that he is the owner of said property, and will be the owner of said
_kES kQ evG6t that he will do the work personally, and that
he will, at such times as are required by the Zoning and Building Director: -
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 cork in accordance with the provisions of this
Code.
A F F I D A V I T
5. Apply for inspections.
6. File with the Building Inspector certificates that provision
has been made to carry the necessary Workmen's Compensation,
Public Liability and Property Damage Insurance.
7. File with the Building Inspector as the job progresses certi-
ficates showing the payment required by the Federal Social
Security tot 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. 10t 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 per,ait each 2 years, and where an owner- builder
has once exercised the privilege herein conferred no second
application for owner- builder permit shall be granted in lest
than 2 years, unless the applicant is qualified as a licenser.
General Contractor under the applicable Ordinances of said
Village.
And Further this Deponent says not:
C
r'
A
OWNER
SUBSCRIBED AND SWORN TO B52,70Ril ME this day of
19.5.
A. D•,
NtTAilY PUBLIC
NOTARY PUOLIC, STAY. UV vLORID
MY COMMISSION EXPIRES'AIueUS ,
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