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910 NE 91 Terr// MIAMI SHORES VILLAGE BUILDING INSPECTION DEPARTMENT APPLICATION FOR BUILDING PERMIT Application is hereby wade 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 budding during progress of the work. Date..._ 1L%.._. _,2, 7 _..._._ _... .11:. Owners Name and Address ......A / / t a. y _ No.... / 0 _. Street-Y-4 2.L : Registered Architect and /or Engineer , ,... f. .y .. ........... ..I.,_+,-- . ..... Name and address of licensed contractor V14.21.- 6,--1/...-:-.4.-- di' 4 /,' �lr_{ -ci . 1 S 32 0 w Q'- r y Location and legal description of lot to be built on: Lot Block Subdivision . .... �.._.._ Street and Number where work is to be done State work to be done and pu ose of building (by floor and for no other purpose. New Building Remodeling Addition Repairs No. of Stories To be constructed of Kind of foundation Roof Covering 4P° 0 rr 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 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 work I to be performed under this pennit, as are licensed by Miami Shores Village. Remarks (Signed) therein by him stated are true. Permit No.. S / Disapproved _ Date (Signed) ... Building Inspector Date / c, PJ . d✓ �. r'`�'� Z._ /0 /r li' .S7;- / Read, Sworn to and Subscribed before me. 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 Notary Public, State of Florida My Commission Expires 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 PLAN NC 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 hecn obtained from the Planning Board. A rc in>pcc•tion 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. C. LAWTON McCALL VILLAGE MANAGER �'aos y3 August 27, 1948 for PA 41iami Alores llage F L O R ID A AFFIDAVIT I, the undersigned, do hereby swear that the BUILDERS BOND NO. 563, issued to me on No. 922 and No. 910 North East 91st Terrace has been lost. SIGNED AND SWORN to before me this 27th day of August, 1948. D. HANSELL BUILDING INSPECTOR BALDWIN INSURANCE AGENCY, INC. GENERAL AGENT 220 SEYBOLD BUILDING, MIAMI, FLORIDA MARYLAND CASUALTY COMPANY Building Division, Village of Miami Shores, 9545 N. E. 2nd Ave., Miami 38, Pla. Gentlemen: STEWART McDONALD, CHAIRMAN OF THE BOARD AND PRESIDENT March 5th, 1947 RE: Maryland Policies 01- 362283 & 57 -023583 John J. Both. In accordance with instructions of the Assured,we eftelose certificate of insurance showing issuance of the above policies covering Workmen's Compensation, Public Liability and Property Damage insurance, effective as of March 5th, 1947. Trusting the enclosures will be found in order, we are Yours very truly, encl. JOHN: " KILLS, Manager, R CASUALTY DEPARTMENT. regist • Certificate of Insurance • Date March 5th„ 19 47 This is to Certify that the Assured set forth below is at this date insured with the MARYLAND CASUALTY COMPANY as described in the following schedule. Deaeriptive Schedule Assured _ JOHN J. ROTH, 915 N. E. 91st Terrace, Miami 38, Florida Address of Assured Locations Covered Description of Work Miami, Fla. and elsewhere in the State of Florida. OamstruOttcln work and all other business operations of the Assured in the State of Florida. HIND OF INSURANCE This certificate is issued at the request of the Building Division, Village of whose address is 9.545 N.__.L..__ 2nd __A4a. Miami, Fla. We agree,iicinxitac to notify the said. Building Division, Vi11a a of Shores, • 1 14 bays before date of Cancellation, if policy should be cancelle zakkedircbisdrrowiDupstiAlturazcgeMSAMMO RYLAND CASUALTY COMPANY At ENOY, Incorporated, � 3 • itle thorized Representative or Official b Policy No. ■ Expiration Date Limits of Liability Workmen's Compensation 01- 362283 March 5, 1947 legal One Person $ 10,000.00 One Accident $ 20,000.00 Manufacturer's or Contrac- tor's Public Liability Bodily Injuries 57- 023583 March 5, 1947 Manufacturer's or Contras- tor's Property Damage 57-023583 March 5, 1947 One Accident $ 1,000.00 Aggregate $ 10,000.00 Owner's or Contractor's Contingent Liability Bodily Injuries One Person $ One Accident $ Owner's or Contractor's Contingent Property Damage One Accident $ Aggregate $ Automobile Bodily Injuries One Person $ One Accident $ Automobile Property Damage One Accident $ regist • Certificate of Insurance • Date March 5th„ 19 47 This is to Certify that the Assured set forth below is at this date insured with the MARYLAND CASUALTY COMPANY as described in the following schedule. Deaeriptive Schedule Assured _ JOHN J. ROTH, 915 N. E. 91st Terrace, Miami 38, Florida Address of Assured Locations Covered Description of Work Miami, Fla. and elsewhere in the State of Florida. OamstruOttcln work and all other business operations of the Assured in the State of Florida. HIND OF INSURANCE This certificate is issued at the request of the Building Division, Village of whose address is 9.545 N.__.L..__ 2nd __A4a. Miami, Fla. We agree,iicinxitac to notify the said. Building Division, Vi11a a of Shores, • 1 14 bays before date of Cancellation, if policy should be cancelle zakkedircbisdrrowiDupstiAlturazcgeMSAMMO RYLAND CASUALTY COMPANY At ENOY, Incorporated, � 3 • itle thorized Representative or Official b