816 NE 91 Terr (6)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 he 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 �/
CF1'ntl 3 NAM@ and Addrt . , C N , O' `== tll.im._R...:_ '' / 7E'" (-
Registered Architect and /or Engineer • C , e ; — t. .7c-> .. i` L /`i ;. ';
Name and address of licensed contractor
Location and legal description of lot to be built on:
Lot /O-f e 1 " ' ,'p Block 3 Subdivision 6 ,D t )E. e-1 6 <i e - A, i I , A, P/ lAjP
Street and Number where work is to be done
State work to be done and purpose of building (by floors)
Permit No
Disapproved
(Signed)
Date
Date
Building Inspect
MIIAM0 SHORES VOLLA E
J7,.. e L M r,l rl
Chairman
Member
Member
Council Approved Date
NOTE: A charge of $1.00 will be made for
the Planning Board.
A re- inspection fee of 51.00 will be charged
materials and /or workmanship.
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New Building Remodeling \O� Addition Repairs No. of Stories
To be constructed of Kind of foundation Roof Covering
Estimated Total cost of improvements $ !1
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 subcpntractors, on work to be performed under this
permit, as are licensed by Miami Shores Village.
Remarks (Signed)
1
ANNING BOARD DATE
Read, Sworn to and Subscribed before me.
and for no other purpose.
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 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
Notary Public, State of Florida
My Commission Expires
Member
Member
Member
Disapproved Date
making corrections or changes to this application after approval has been obtained from
when such re- inspection is made necessary by improper notice for inspection or faulty
ADDRESS OF FILE REQUESTED:
Miami Shores Village
Building Department
10050 NE 2 Ave, Miami Shores, Fl 33138
Tel: (305)795 -2204 - Fax; (305)756 -8972
PLEASE PRINT
DATE: � /0C TIME: • ?�� 1
NAME OF PERSON REQUESTING FILE: — Tail e Cry 11 t S
PI -IONE #:30 • S `q"3 OUR ADDRESS: e t(c C st (t° r r
INFORMATION REQUESTED: 4-1
Acknowledged by:
FILE RETURNED TO: INITIAL
N6 -
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 (8x 1 1) 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.
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__
�sL by
Owner's Name and Address 'i(•_
Registered Architect and /or Engineer
Name and address of licensed contractor
Location and legal description of lot to be built on:
Lot Block Subdivisions
-------- - - - - -- - --
Street and Number where work is to be done ___1_ �G' 0 c°'
State work to be d r?/and purpose of- .building (by o rs )
Lq_en_lri:e_r -- - rGt12L ,E' - cZ.?4) / pie (me: _'le
and for no other purpose.
New Building Remodeling Addition Repairs No. of Stories
To be constructed of__ __Ck Kind of found ign Roof ?n�*
Estimated Total cost of improvements $ Amount of Permit $ =�
.Plan Cubage
Size of Building Lot
Zone cubage required_
Distance to next nearest building
Maximum live load to be borne by each floor
STATE OF FLORIDA,
COUNTY OF DADE. ss.
t
MIAMI SHORES, VI LLAG E
BUILDING INSPECTION DEPARTMENT
e 3
APPLICATION FOR BUILDING PERMIT
I hereby submit all the plans and specifications for said buu ding. All notices with reference to the building and its construction may
� ^
be sent to s✓ � �__ ___ _ _�2 AA/ r
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 9 / rfthe site of 'Ile work such public notice
or notices as are required by the Act. The undersigned agrees to employ only such subcontracto on work performed under this
permit, as are licensed by Miami Shores Village.
Remarks____
Permit No._ — Date
Disapproved Date
(Signed)
Council Approved
Building Inspector
(Signed)
No
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 klefioses 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.
and Subscribed before_- e
Not. ublic, St
My eon,
My Com sion Expires______
y �
Street
to me well known,
IP ,
taro. T i �rg
eapi -s Jon /ry I. 1960
- inerirnr- Surety. -mss-- of - ,- A
PLANNING BOARD__
Chairman / Member
Member ___ Member
Member Member
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.
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