910 NE 91 Terr (5)Name and address of licensed contractor
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 . • \y,�` No Street
Registered Architect and /or Engineer
Location and legal description of lot to be built on:
Lot_ Block Subdivisi
Street and Number where work is to be done i 0
a
State work to be done and purpose of building (by floors)
- - - - - -- - - - -- - --
_(- — -.. % . & 2,. .rtes�7 to L.
- -- ) roer purpose.
New Building Remodeling Addi ion 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 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 to be performed under this
permit, as are licensed by Miami Shores Village.
Remarks — ( Signed)
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.
Permit No.___ --- _____ —XL Date `' Read, Sworn to and Subscribed before me.
Disapproved Date
(Signed)
Notary Public, State of Florida
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.
442 "'e - 't. 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.
New Building___ —_ ° __________ Remodeling
To be constructed of C s,. Kind of foundation
Estimated Total cost of improvements $____
Zone cubage required_ ________e
Distance to next nearest building .
Maximum live load to be borne by each floor
I hereby submit all the plans and specifications for said building.
be sent to ;% j j ' ' /
■
permit, as are licensed by Miami Shores Village.
Remarks _
STATE OF FLORIDA,
COUNTY OF DADE. ss.
Before me, the undersigned authori
peared
Building Inspector
MIAMI SHORES VILLAGE
BUILDING INSPECTION DEPARTMENT
Date " ` / , 19
No `t Street
Owner's Name and Address
Registered Architect and /or Engineer
Name and address of licensed contractor % ' ' c- "� y �/`!"
Location and legal description of lot to be built on: G 9 t. -4 / • ` ." ° t c t ,� ,- . , ' Y _ w, C
Lot________ Block Subdivision ., - 44604 sf� /t r., r
C.
Street and Number where work is to be done__ . /1 1.
State work to be done and purpose of building (by floors)_ 'a�= ' ..'r':r� %is_''
Addition
Repairs
t" °'� "' Roof Covering
Amount of Permit $
t' 4,
_Plan Cubage__
_Size of Building Lot 4 #7,... ,
All notices with reference
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 subcor actors, on work to be performed under this
1IL
(Sign
c, duly au dminister o5tis and take acknowledgments, personally ap-
and who, being by me first duly . n, upon oath depose !nd says that he is the
of the above described constructi. , that he has carefully read the foregoing application, and that he did sign the same, and thai facts
therein by him stated are true.
Permit No ' / 1 Date
Disapproved Date
(Signed)
Rea., Sworn t. /" Subscribed before in
Notar6 • VOr§f t f i to
My Comm
y commission c�
and for no other purpose.
No. of Stories
to the building and its construction may
to me well known,
1950
of 14. Y.
PLANNING BOARD fi�`�, 1 �_- D"ATE
Chairman _ Member :_ !
_ _
Member __ _ __ Member
ter' i'
Member ____, 2- ;�'� /_ __ 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)
COUNTY OF DADE )SS
e /s e .c. 77/
P. F V
County of Dade and State of Florida, being duly sworn, doth depose
and say, that under the provisions of Section B -368, Sub - section (d),
of the Building Code of Miami Shores Village he desires to build a
t� v GI/At .ly"aF w.�9 '�F.f�9o'
..2 4izE /�/yl /Lr' Z J /DENSE on Lo t Of ..a, ' ow/WO ow SE,i
Block of 0.Sr Tu; wso.Ps3.N5Aariw that he
is the owner of said property, and will be the owner of said
�.E1S //YC -" , 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
Village Planning Board and of the Building Inspector.
2. Apply for and secure a permit.
3. Pay the requires' fees, for license and for permit.
4. Execute the work in accordance with the provisions of
the Zoning, Building, Plumbing and Electrical Codes of
Miami Shores Village.
5. Apply for inspections.
6. File with the Building Inspector certificates that pro-
vision has been made to carry the necessary Workman'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. Execute Builder's Bond.
And further this Deponent says not. / '
SUBSCRIBED AND SWORN TO BEFORE ME this day of
A.D., 19
2.
1. Signature of Applicant
2. Signature of Officer administering oath.
of the Village of Miami Shores,