953 NE 91 Terr (10)X
MIAMI SHOREILLAGE
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 confonnity 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.
Y
r y
Date
Owner's Name and Address
Registered Architect and /or Engineer
Name and address of licensed contractor
Location and legal description of lot to be bu9t on:
L l
t,.�2 _fl ' Block Subdivision_
Street and Number p
where work is to be done ilk A 'i E ci
r'
State worlb to be done And purpose of building (by floors)
Disapproved Date
(Signed)
Street__,/f 1,_
No. _�---
Y r
and for no other purpose.
New Building ,/..,-.'"- d f
� Remodeling Addition Repairs No. of Stories 7- To be constructed of 4 i / L__ Kind of foundation � ___�f _; _!__C � 7 � R000f ®
X Covering �
G ,___ n
Estimated Total cost of improvements $_ 7 // - Amount of Permit $
_
Zone cubage require � g 9— � � r L _ _ � r C _Pla Cuba ge 2 " . ��
Distance to next near st building Size of Building Lot
Notary Public, State of Florida
Maximum live load to be borne by each floor___
I hereby submit the plans and specifications for said building. All notices with reference to the building and its construction may
be sent to r YER,, _
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 ha. carefully read the foregoing application, and that he did sign the same, and that all facts
therein by him stated are true.
Permit No S D ate 1 / — �� 7 Read, Sworn to and Subscribed before me.
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- inspectic., is made necessary by improper notice for inspection or faulty
materials and /or workmanship.
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STATE OF FLORIDA) SS
COUNTY OF DADE )
And further this Deponent says not.
AFFIDAVIT
VI; A/755},,S of the Village of Miami Shores, County of Dade and
State of Florida, being duly sworn, doth depose and says that under the provisions
of Section B -368, Sub-section (d), of the Building Code of Miami Shores Village
he desires to build /4 7 .. f/.6 CS/W/CE' on Lot4 r , 40 , .: F
Block/ of AfeMOYEAtit
property, and 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 required fees for license and for permit.
4. Execute the work in accordance with the provisions of the Zoning, Building,
and Electrical Codes of Miami Shores Village.
5. Apply for inspections.
6. File with the Building Inspector certificates that provision has been made
to carry the necessary Workmanis Compensation, Public Liability and Rroperty
Damage Insurance..
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 contractors or sub - contractors
other than those properly licensed by Miami Shores Village or any part or
portion of the work including, but not limited to, general contracting,
plumbing, heating, electrical, septic tank, solar system, lathing, tile,
torrazo, painting, roofing and sheet motel work or installation.
9: Not sot himself up as a "Contractor ".
10: Exocuto Builder's Bond.
SUBSCRIBED AND SWORN TO BEFORE ME THIS DAY of ,__
2.
1. Signature of Applicant.
2. Signature of Officer administering oath.
subdivision; that he is the owner of said
A. D., 19