PAINT PERMIT•
•
New Building Remodeling
Zone cubage required
Distance to next nearest buildi: A'
to
Maximum live load to be
1 hereby submit all plans ar
Permit No. • / q
Disapproved
(Signed)
APPLICATION FOR BUILDING PERMIT
Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the building 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.
, Owner's Name and Address
Fran D. A 1 s
Registered Architect and/or Engineer (� + 1n , ( j
"'Name and address of licensed contractor I t r- i Ci V' a °1 �� r ` o t► ' '(1- � � ' ') t (G v' 4- ( \
Location and legal description of lot to be built on:
/ * NVs� 9 � '
Lot ((� Block � -J Subdivision
,'Street and Number where work is to be done 57
)(State work to be done and purpose of building (by floors). state exterior colors (submit samples) „4.1 44 -' 0 -t -' ` 14'4' 1Q y--
kt(Z) it,o(dled lat ; J` 412. Jb and for no other purpose.
MIAMI SHORES VILLAGE
BUILDING INSPECTION DEPARTMENT
N. e .
Date
Addition
7ri1 ' £ J / gM .,
To be constructed of Kind of foundation �J Roof Covering
Estimated Total cost of improvements S / Amount of Permit S 32 C
W
m
w
D
to
m
w n
Da t Read. Sworn to and Subscribed before me.
Date C% . 4 19_
No R57 Street A E 9/ v
Repairs No. of Stories
to
- 7 1
w �
The undersigned applicant for th U _ .,r Labor under the Florida Workmen's
Compensation Act. being Section _ _ .. ovpp,ement, and has complied with the provisions thereof. and will require similar
compliance from all contractors of 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 acs to employ only such subcontractors. on work to be performed
under this permit. as are licensed by Miami Shores Village. u
Remarks (Signedi `
STATE OF FLORIDA
COUNTY OF DADE. } ss.
Before me. the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments. personally appeared
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
Building Inspector My Commission Expires
PLANNING BOARD DATE
Chairman Member
Member Member
Member Member
Council Approved Date Disapproved Date
NOTE: A charge of S25.00 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 $25.00 will be charged when such re- inspection is made necessary by improper notice for inspection or faulty materials and/or workmanship.
1.
MIAMI SHORES HISTORIC PRESERVATION BOARD
APPLICATION FOR A CERTIFICATE OF APPROPRIATENESS
DATE: a d�
NAME OF PROPERTY: L �
• 2. ADDRESS g )V F. 9 5.31 p hnt.c, 757 3°
LEGAL DESC. t4,-45 /7 — /1 C . 6f k d S /)) shoves 5'
3. NAME OF OWNER & ADDRESS: 7 H ee6 � S: An. c
c 5 7 ))/ • 9/
4. NAME OF APPLICANT & RELATIONSHIP TO OWNER: 244.x.9
!oa '2 /3; Q-44 � ?�7 - / 47:5
•
5. PRESENT USE AND CONDITION: /P - .4_ / .41-0 /1
6. TYPE OF PROJECT: (circle one or add unlisted project- (J. OTHER)
MAINTENANCE OR REPAIR
B. RESTORATION
C. REHABILITATION
D. ALTERATION
E. ADDITION
F. EXCAVATION
G. DEMOLITION
H. NEW CONSTRUCTION
•
I. RELOCATION
J. OTHER (EXPLAIN)
7. IS A ZONING VARIANCE REQUIRED FOR THIS PROJECT?
8. DESCRIPTION OF PROPOSED PROJECT, INCLUDING WHAT CHANGES WILL BE MADE
AND HOW THEY WILL BE ACCOMPLISHED.
�i�- - p�2•�e_ ' — .tcA e�.r ! 6744:444 O 44 --14-‘4A-c. 6-1-Ca„,
4.; '.1 & z ck ( 711 5 T - �� /av- a s lua
c a, v (; O/) 54 DYl Acoke>
fr kJ 44, /)4 444 Yh5 cv /44-- &4t q
&dw k - e)r t p Cv/ - - iL 7`e �e �
9. IF USE OF THE PROPERTY WILL CHANCE A A RESULT OF THE PROPOSED WORK,
EXPLAIN THE IMPACT OF THE CHANGE.
The Board shall be supplied with copies of the Original Designation Report
filed when the property was designated as a Historic Landmark and copies of
any Certificates of Appropriateness granted previously for this site
a/ol gig()
v /y/
al"
4
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Date 3 -077 Job Address o? S 7 AAC ? f S" Tax Folio
Legal Description JJ
Own / Tenant �2�4�c <2e`S S T-T a.e�cJSI<o E
Owner's Address ? S — 7 Ale 9/ S r
Contracting Co. 6A r o f CO3- `�� 1i\ {�
Qualifier A Y4
State #
-Architect/Engineer
Bonding Company Address
Mortgagor Address
Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIPTION P4.i ,¢JT L /cv 1tv 00 O\ J(J j ak C'az, a72 , 7 / S
,RuJ % W/4-/
Square Ft.
WARNING TO OWNER: YOU MUST RECORD A NOTICE OF COMMENCEMENT AND YOUR FAILURE TO DO SO MAY
RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY (IF YOU INTEND TO OBTAIN FINANCING,
CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT.)
Application is hereby made to obtain a permit to do work and installation as indicated above, and on the attached addendum (if applicable). I
certify that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that separate
permits are required for ELECTRICAL, PLUMBING, SIGNS, POOLS, ROOFING and MECHANICAL WORK.
OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable
1aulating construction and zoning. Furthermore, I authorize the above -named contractor to do the work stated.
gnature of o and/or C fdo President
Notary as to 0
My Commission
Historically Designated: Yes
Vl v 1r 0.1/' Q S-4:44
FEES: PERMIT YD RADON
APPROVED:
Zoning
Municipal #
3
r�
xpiEDI M NOVAK MIL`:., ;`.
NOTARY PUBLIC STATE OF FLO.�'
COMMISSION NO. CC29185;
MY COMMISSION EXP. ULY 9 W'
Date
C O
C.C.F.
� � ( S •w , 1 t S I.
,5
Oo
Estimated Cost (value) GGC).
Signature of Contractor or Owner - Builder
IGotary as to Contractor or Owner- Builder
My Commission Expires:
/-:" l •
Buildin ' V/?3 )9b
Address
Address
Master Permit #
Phone 75
Competency # ( t 0 (, c Ins. Co.
NOTARY
Electrical
No
39s
Date
/ l Date
TOTAL DUE
Mechanical Plumbing Engineering