PAINT PERMITDESCRIPTION OF
and how they will,be
shall be accompanied
THE PROPOSED PROJECT (Explain what changes will be made
accomplished - use continuation sheet if necessary - all applications
by at least one 3" x 5" photograph of the property):
3EST OF MY (O
TS ATTAC
?LICANT(S):
NER(S):
FOR BOARD USE ONLY
E (date application received by Secretary of the Board):
CERTIFICATION
KNO EDGE AND BELIEF THAT ALL INFORMATION IN
S IS AND CORRECT:
4
DATE:
DATE:
MIAMI SHORES VILLAGE HISTORIC PRESERVATION BOARD
APPLICATION FOR A
CERTIFICATE OF APPROPRIATENESS
NAME OF PROPERTY (if applicable) :
ADDRESS OF PROPERTY:
NAME(S) OF APPLICANT(S):
(NOTE: IF THE APPLICANT IS A PERSON
OTHER THAN THE OWNER(S) . EVIDENCE
OF THAT PERSON'S AUTHORITY AS AGENT
MUST BE ATTACHED TO THE APPLICATION.)
TELEPHONE OF APPLICANT(S): (305) '� ; (305)
ADDRESS OF APPLICANT(S):
(if different than address of property)
PRESENT USE OF PROPERTY:
please typeor print clearly
q/ £/ ted
Urite Prizr
so/14.4
c
a.
J> ee.
CLASSIFICATION OF WORK FOR WHICH CERTIFICATE IS DESIRED:
(circle the letter next to the appropriate classification)
A. MAINTENANCE OR REPAIR: The act or process of applying measures to sustain the existing form. integrity and
material of a building or structure and the existing form or vegetative cover of a site. It may include initial stabilization work.
where necessary, as well as on -going maintenance and repair. Samples of material must be submitted with the Application.
B. RESTORATION: The process of accurately recovering the form and details of a property and its setting as it appeared at
a particular period of time by means of the removal of later work or by the replacement of missing earlier work. All
applications for restoration shall include site plans (if required by the Building Permit), a statement with bibliography
historically justifying the work, and any additional photos or information to support the proposed work.
C. REHABILITATION: The process of returning a property to a state of utility through repair or alteration which makes
possible an efficient contemporary use while preserving those portions or features of the property which are significant to its
historical. architectural and cultural values. All applications for rehabilitation shall include: site plans (if required by Building
Permit), and any other supplementary information, such as drawings. that will support the proposed project.
D. DEMOLITION: The process of destroying or tearing down a building or structure or a part thereof, or the process of
removing or destroying an archeological site or a part thereof. The applicant shall include a report explaining why the proposed
action should occur. If this action is to occur for reasons of financial hardship, all pertinent financial data should be included
pertaining to the cost of preservation. demolition and new construction. Any other material pertinent to the application is also
encouraged as supplementary information.
E. NEW CONSTRUCTION: The process of constructing a building or structure that has never existed at that location.
Applications shall include : a site plan, elevations, floor plan and/or landscape plan.
FORM : MSHPB.COA (adopted 4/95)
NOTICE TO APPLICANT(S)
HEARING: The Board will act upon the Application within ten (10) working days after receipt of the
Application by the Secretary of the Board. You will be notified by the Chairman of the date of the
hearing. An Application will not be considered until the required supplementary material has been
provided and the Applicant and the owner sign the Application attesting to the truthfulness of the
information provided.
APPEALS: Any person desiring to appeal a decision of the Board shall within fourteen (14) days from
the date of such decision, file a written notice of appeal with the Village Clerk.
HELPFUL TIP: Historic photographs, photographs showing existing conditions, proposed plans and
drawings, and samples of proposed materials are all very important in assisting the Board in making an
informed decision.
{
TO:
FAX NO.:
FROM:
RE:
[ ] READ
[ ] HANDLE
[ ] APPROVE
[ ] CALL ME
[ ] FYI
10050 N.E. SECOND AVENUE
MIAMI SHORES. FLORIDA 33138-2382
TELEPHONE (305) 758 -8000
FAX (305) 756-8972
TRANSMITTAL DATE:
NUMBER OF PAGES:
1)edolf-1-
57q_ � q
hota t
FAX NO.: (305) 756 -8972
/7 - zr
LI
(including cover sheet)
MIAMI SHORES VILLAGE
PERSONNEL DEPARTMENT
NOTE:
A
MIAMI SHORES VILLAGE HISTORIC PRESERVATION BOARD
APPLICATION FOR A
CERTIFICATE OF APPROPRIATENESS
please type or print clearly
NAME OF PROPERTY (if applicable) :
ADDRESS OF PROPERTY: v2 V 42 q /5/ Jh
NAME(S) OF APPLICANT(S): �tl Pn6 i# i
(NOTE: IF THE APPLICANT IS A PERSON
+
l ig,ft OTHER TH AN THE OWNER(S) . EVIDENCE /}�v,�� OF THAT PERSON'S AUTHORITY AS AGENT S � s
MUST BE ATTACHED TO THE APPLICATION.)
FORM : MSHPB.COA (adopted 4/95)
TELEPHONE OF APPLICANT(S): (305) 7Y/ (305) g 4.--eoz/
ADDRESS OF APPLICANT(S):
(if different than address of property) /�
PRESENT USE OF PROPERTY: !" 5/GCQ
CLASSIFICATION OF WORK FOR WHICH CERTIFICATE IS DESIRED:
(circle the letter next to the appropriate classification)
A. MAINTENANCE OR REPAIR: The act or process of applying measures to sustain the existing form integrity and
material of a building or structure and the existing form or vegetative cover of a site. It may include initial stabilization work,
where necessary, as well as on -going maintenance and repair. Samples of material must be submitted with the Application.
B. RESTORATION: The process of accurately recovering the form and details of a property and its setting as it appeared at
a particular period of time by means of the removal of later work or by the replacement of missing earlier work. All
applications for restoration shall include site plans (if required by the Building Permit), a statement with bibliography
historically justifying the work. and any additional photos or information to support the proposed work.
G REHABILITATION: The process of returning a property to a state of utility through repair or alteration which makes
possible an efficient contemporary use while preserving those portions or features of the property which are significant to its
historical architectural and cultural values. All applications for rehabilitation shall include: site plans (if required by Building
Permit), and any other supplementary information. such as drawings, that will support the proposed project.
D. DEMOLITION: The process of destroying or tearing down a building or structure or a part thereof. or the process of
removing or destroying an archeological site or a part thereof. The applicant shall include a report explaining why the proposed
action should occur. If this action is to occur for reasons of financial hardship. all pertinent financial data should be included
pertaining to the cost of preservation. demolition and new construction. Any other material pertinent to the application is also
encouraged as supplementary information.
E. NEW CONSTRUCTION: The process of constructing a building or structure that has never existed at that location.
Applications shall include : a site plan. elevations. floor plan and/or landscape plan.
DESCRIPTION OF THE PROPOSED PROJECT (Explain what changes will be made
and how they will,be accomplished - use continuation sheet if necessary - all applications
shall be accompanied by at least one 3" x 5" photograph of the property):
SIGNATURE OF OWNER(S):
3. DENIED
I (WE) CERTIFY TO THE BEST OF MY (0
THIS APPLICATION AND ITS ATTAC
SIGNATURE OF APPLICANT(S):
CERTIFICATION
4
FOR BOARD USE ONLY
APPLICATION DATE (date application received by Secretary of the Board):
EDGE AND BELIEF THAT ALL INFORMATION IN
AND CORRECT:
DECISION OF THE BOARD (circle the appropriate number):
1. APPROVED
2. APPROVED WITH CONDITIONS (set forth conditions below):
DATE: `.
DATE:
DATE:
SIGNATURE OF CHAIRMAN: DATE:
NOTICE TO APPLICANT(S)
HEARING: The Board will act upon the Application within ten (10) working days after receipt of the
Application by the Secretary of the Board. You will be notified by the Chairman of the date of the
hearing. An Application will not be considered until the required supplementary material has been
provided and the Applicant and the owner sign the Application attesting to the truthfulness of the
information provided.
APPEALS: Any person desiring to appeal a decision of the Board shall within fourteen (14) days from
the date of such decision, file a written notice of appeal with the Village Clerk.
HELPFUL TIP: Historic photographs, photographs showing existing conditions. proposed plans and
drawings, and samples of proposed materials are all very important in assisting the Board in making an
informed decision.
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Date .6 Job Address a ci iv «dl t S € 2 ax Folio
Legal Description Historically Designated: Yes ' No
Owner/Lessee / Tenant fi P 4a4 f T ! i1 J yY1 O ff "" Master Permit # j 9 a J
Owner's Address Phone K6 ' a,of ( aka (IC
1 � CY
Contracting Co. fr % ii ' V'7 / tril /;Address
Qualifier �� SS#
State # Municipal # Competency # Ins. Co.
Architect/Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIPTION 1 Lak i;�� ,
Square Ft. Estimated Cost (value)5I 600 °
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.
0 'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable
la ' re : ating construction an g. Furthermore, I authorize the above -named contractor to do the work stated.
Not as to Owner and/or Condo President Date
My Commissior(Expires:
APPROVED:
Zoning
Mechanical
FEES: PERMIT 4 7 RADON
Building
C.C.F. '1 NOTARY �S TOTAL DUE
r
ignature of Contra c tor
Owner-Builder
Electrical
Phone 6x; —
D
e > f_,__,_d,--z.a., e5
Ndtary as to Contractor or Owner- Builder Date
My Commission Expires:
. - <,
Plumbing Engineering
MIAMI SHORES VILLAGE HISTORIC PRESERVATION BOARD
APPLICATION FOR A
CERTIFICATE OF APPROPRIATENESS
NAME OF PROPERTY (ita9pliable) :
ADDRESS OF PROPERTY:
NAME(S) OF APPLICANT(S):
(NOTE'. Q' THE APPLICANT 1S A PERSON
Oaf ttEI THAN Txz cramt!t(3) . EvIDEINCE
OP THAT PERSON'S A fORIT'Y As AQ&NT
M XT SE ArrACHELTO THE APELIC.ATICN
TELEPHONE OF APPLICANT(S): (305) 7g-5x, ; 005)
ADDRESS OF APPLICANT(S):
hr ddte.Ina than Adaeaarp<epeen,)
PRESENT USE OF PROPERTY:
A.
FOLM NSNt&COA (aneesid 495)
r€451,h4ce...
a9 yls/ .S�r�t
cJa,�
SeArrAwl
CLASSIFICATION OF WORK FOR WHICH CERTIFICATE 1S DESIRED:
(cilele the letter to= to the appropriate elaStificativn)
XefiVTENANCF OR REPAIR: The as t* pew goidyipg mve.= to s the airing Rim 7 se
ateriat of a building or dreamt mad edam; keen as veEeaaiue cover Oa suer E mph iretude it e) aabiIiession see.
when m ecermy. as veil a aeleomS iimeseranee and remit. Simla of swrsrial mart be mash q4 wide the Agplicsaioo.
RLSTORAl1OM TAe sere of agwraoel)' Towering time lam sad de uele of a peepraer net in m a it litP"tmd
a polar period of time by mane of the reuervel of laser *urn or by the repiessmwa of *win t Sea wort All
mcpdicadoee for rogenoou shall iichabt: slue piers (if required by the Staid* Fading). a able_ bebl ctSral 'y
ry jet tumors led say additionsl pima or m6oeeeiaro be magma doe peened meek
REXABILfT 4 ?7ON: The lreccas of tesureat6 a papery to a smo of agility dam* mair or alaua;.en maim
pool* is effidat rude iperary wham ROeMeg dew panics or fuser of the prepay to as
b;sredoaL aeavinrval and cultural values all epy(iaadtsnt for y d biro i shall iodide dee W (if required by 3i3
Patel made, ether suppirsairry m[a>msiati sucti es drswosgr. *et 44 wpm The a aped palms
D. DEjpLIPTOF The ream oC dtaeryevg •re wring deem a 1amilern6 a< 9nec0aee or a i nt • or the Pg.". eF
leavening or nmenvying m *drooiogial site N a pet tiered: Me appiican shell iaoiude a repot cepieloce we! tic Pe4cong
action should ooes: if ibis aatm is to o¢ar far memo of Gaesaeasl handaltip. all Feruni it anemia loam should be included
parsairiam re du cat a peeee.u:cs. & aliden and mew sorgraesion. •lay Wier medial webs= aD the elifii aiaa it also
e.aa na i s capplaracaor
E
tvEcoPes urnar The process of masavaa>E a buitda g or snueure that here ea,.r =led ae dud maim&
Apptioper sell clews : a sea pled aleawet*. Roar plan altar taoacpe td
Benjamin Moore Paints
4 /F't
301
Benjamin Moore Paints
Benjamin Moore Paints
:z 1
,., . 3. • D
•
S ( GNATLJRE OF C4AIRMAN;
SIGNATURE OF OWNER(S):
DESCRIPTION OF 'THE PROPOSED PROJECT (Explain what changes will be made
and how they will,be accomplished - use continuation sheet if necessary - all applications
shall be accompanied by at !east one 3" x 5" photograph of the properry):
CERTIFICATION
I (WE) CERTIFY TO TIM BEST OF MY (• - • .2• E AND BELIEF THAT ALT. INFORMATION IN
mw APPLICATION AND ITS ATTACHMENTS IS - AND CORAEc n
SIGNATURE OF APPLICANT(S):
FOR BOARD USE ONLY
APPLICATION DATE (due tpplicstion =mind b Sinewy athe 3
DECISION OF THE BOARD (circle the appropriate number):
1. APPROVED
2. APPROVED WITH CONDITIONS (set forth conditions below):
Ck G Ex d` tro
Chocc
• r j
DATE:
DATE: /
o! kft'i Ck