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ROOFINGPERMIT APPLICATION FOR MIAMI SHORES VILLAGE Date , / l Job Address �( ' 0 N 2 ? / S fTax Folio Legal Description / Historically Designated: Yes No Owner/Lessee / Tenant Owner's Address Contracting CO( /I. S 7 Qualifie rfi e 0 L . SS# - Phone 7 State # tf C © 6 4/ 7 1 Municipal # Competency # Ins. Co. Architect/Engineer Address Bonding Company Address Mortgagor Address Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICA ROOFING ' AVING FENCE SIGN WORK DESCRIPTIO t ' ��✓ /X Cs'� 2 Evf ( ,A7ti 75, r Square Ft. Z p 9 e ./e 7 Estimated Cost (value) \, Z5 . d C) 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. OWNERS AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. Furthermore, I authorize the above -named contractor to do the work stated. of owner and/or Condo 3 esident o : s to O%AMr : . or, Co p,Pr My Co 'Moir Expires: .• 553 FEES: PERMIT RADON APPROVED: Zoning Buil Mechanical Date Master Permit # T R53 9 /44'e( .S,o/", Phone Address /" 2 -7.-/ sw Notary as to Contractor o}:,Ow ie My Commission Expires ' uilder Date oriel: Date ORLANDO NUNEZ yammis:,ion 1 {x (.; {a 7:`x791 •orrtrn C:vPire_; Mn" 11. 200e /65 - /4/744i( ?5 /6f 5104 APPENDIX "F" APPENDIX "F "REQUIRED OWNERS NOTIFICATION FOR ROOFING CONSIDERATIONS As it pertains to this Appendix "F ", it is the responsibility of the roofing contractor to provide the owner with the required roofing permit, to provide the owner with this appendix and to explain to the owner the content of this form. The provisions of Chapter 34 of the South Florida Building Code (SFBC) govern the minimum requirements and standards of the industry for roofing system installations. Additionally, the following items should be addressed as part of the agreement between the owner and the contractor. The owner's initial in the adjacent box indicates that the item has been explained. A 1 1. Aesthetics - Workmanship: The workmanship provisions of Chapter 34 are for the purpose of J oviding that the roofing system meets the wind resistance and water intrusion performance standards. Aesthetics (appearance) issues are not a consideration with respect to workmanship provisions. Aesthetic issues such as color or architectural appearance, that are not part of a zoning code, should be addressed as part of the agreement between the owner and the contractor. 2. Renailing Wood Decks: When replacing roofing, the existing wood roof deck may have to be r nailed in accordance with the current provisions of Chapter 29 of the SFBC. (The roof deck is usually concealed prior to removing the existing roof system) _ 3. Common Roofs: Common roofs are those which have no visible delineation between n eighboring units (i.e. townhouses, condominiums, etc.). In buildings with common roofs, the roofing contractor and/or owner should notify the occupants of adjacent units of roofing work to be performed. xi 4. Exposed ceilings: Exposed, open beam ceilings are where the underside of the roof decking /an be viewed from below. The owner may wish to maintain the architectural appearance, therefore, roofing nail penetrations of the underside of the decking may not be acceptable. The SFBC provides the c option of maintaining this appearance. 5. Ponding Water: The current roof system and/or deck of the building may not drain well and L ay cause water to pond (accumulate) in low -lying areas of the roof. Ponding can be an indication of structural distress and may require the review of a professional structural engineer. Ponding may shorten the life expectancy and performance of the new roofing system. Ponding conditions may not be evident until the original roofing system is removed. Ponding conditions should be corrected. 7 1 6. Overflow Scuppers (wall outlets): It is required that rainwater flow off so that the roof is not ;overloaded from a build up of water. Perimeter /edge walls or other roof extensions may block this discharge if overflow scuppers (wall outlets) are not provided. It may be necessary to install overflow scuppers in accordance with Chapter 23 of the SFBC. 7. Ventilation: Most roof structures should have some ability to vent natural airflow through the interior of the structural assembly (the building itself). The existing amount of attic ventilation shall not be reduced. It may be beneficial to consider additional venting which can result in extending the service life of the roof. j do d7i'(? ,.? ner's /Ag is Signature Signature 3//retort Date Contractor' Signature Contractor's Name: _ 6 0 / . 4:72 41 Job Address: lo fie e 9l s" ROOF CATEGORY ❑ (Low Slope Application) ❑ (Nail -On Tile) (Mortal/ esive Set Tile). ❑ (Asphalt/Fiberglass Shingles) ❑ ( Metal Roofs \Wood Shingles & Shakes) ❑ t er) ROOF TYPE ❑ New Roof ❑ Re roofing ❑ Recovering ,Repair ❑ Maintenance Flat Roof Area (f1 - Sloped Roof Area (ft2) 6 6 Total (ft2) l v Master Permit No. Exposure category (per ASCE 7 -88): Building Classification category (per ASCE 7 -88 table 1): Ft. A V Ft. A V Fie Deck type: 12 ROOT 7L PE ATTACHMENT Fastene, Type: SPACING Perimeter: Corner: DETAIL 1 & 2 ROOF HEIGHT AND SYSTEM DETAILS (Draw details as needed) r r r r ROOF PLAN 123.01 -78 5/00 Appendix "E" UNIFORM ROOFING PERMIT APPLICATION PROCESS No. Page -1 Appendix "E" UNIFORM ROOFING PERMIT APPLICATION PROCESS No. Ridge Ventilation? MEAN HEIGHT Deck type: y „, .§f8" Underlayn►ent: Insulation: 12" ROOF SLOPE D E T A I L 3 SLOPED SYSTEM DESCRIPTION _ GV ( A Fastener type & spacing: 2 -- C � / T (, Cap Sheet: 11' df ,,C r - `C 9d Roof Covering: 0 f/4 -' Maje-7_ Drip edge: ATTACHMENTS REQUIRED 1) Fire Directory Listing Page 2) Miami -Dade County Product Control Notice of Acceptance -Cover Sheet a) Specific System Description b) Specific System Limitation c) General Limitations d) Applicable Detail Drawings 3) Municipal Permit Application 4) Other Component Approvals TILE CALCULATIONS Qj (Pmaxl: `a � X X (Aerodynamic Multiplier): 4 1 ) - M t r = M '. Q k PCA: ✓ - v (Pmax2: 9 1 X X (Aerodynamic Multiplier): t ) - M 6 ° = M r2 : l I °/6 PCA: 3 7-C) (Pmax3: Kr x X (Aerodynamic Multiplier): ' ) - M 6-6 = M /7i PCA: 37-4 d r y Page -2 UU /16/UU alUiV 1U:U.: rAA JOl JJO JJyl DlU1V1Lll L1rL11LL MIAMI -OADE PRODUCT CONTROL NOTICE OF ACCEPTANCE Monier Lifetilc LLC 135NW20St. Boca Raton Your application for Product Approval of: Atlantis Shake and Slate Flat Profile Tile under Chapter 3 of the Code of Miami -Dade County governing the use Construction, and completely described herein, has been recommended County Building Code Compliance Office (BCCO) under the conditior This approval shall not be valid after the expiration date stated below. B product or material at anytime from a jobsite or manufacturer's plant for If this product or material fails to perform in the approved manner, BCC the use of such product or material immediately. BCCO reserves the riE determined BCCO that this product or material fails to meet the require: Code The expense of such testing will be incurred by the manufacturer. Acceptance No. :99- 1012.07 (Revises No.: 98- 0604.01) Expires: I2/16/2002 THIS IS TIIE COVERSHEET, SEE ADDITIONAL PAGES FC CONDITIONS BUILDING CODE Si PRODUCT REVIE}V C This application for Product Approval has been reviewed by the BI:CC and Product Review Committee to be used in Dade County, Floric :a ur Approved: 12/30/1999 FL 33431 le UUl MI]AMME -DADE COUNTY, FLORIDA .IET RO•I)ADE FLAGLER BUILDING RI ILD' NG CODE COMPLIANCE OFFICE ;4IET:O•DADF. FLAGLER BUILDING : .0 WEST FLAGLER STREET. SUITE 1603 MIAMI. FLORIDA 33l30.1563 (3i:) 375 -2901 FAX (305) 375 -29u8 CO'TR„CTOR LICENSING SECTION (3i: ) 375•2527 FAX (305) 375 -2535 CO ITR..CT: R ENFORCEMENT SECTION (3(.) 37$.2966 FAX (30$) 375 -2908 Piz ()DUCT CONTROL DIVISION (3(G) 375-2902 FAX (305) 372.6339 f Ater- ate Materials and Types of 'pr acceptance by the Miami -Dade sp:cified herein. ::C() re erves the right to secure this quality • :ontrol testing. :) may : :voke, modify, or suspend t t;► r_ this approval, if it is !en's oI' South Florida Building L' Rri)l Rodriguez C1. of Product Control Division R SPECIFIC AND GENERAL :'M \WI'I TEE gale ap :roved by the Building Code :.er the :onditions set forth above. I ;tnci$co . Quintana. R.A. DI •ector 1 of 3 N: •ami -Bade County B. ilding Code Compliance Offcc U`J /l0%UU atio lU.Ui CAA 4U1 JO') JJ01 HOMER LTFETILE LLC ACC:EP" .Alti CE No.: 99- 1012.07 1. SCOPE This revises a roofing system using Monier Lifetile Atlan:is S Tile, as manufactured Monier Lifetile LLC described in S Acceptance, designed to comply with the South Florida l3uilc Miami -Dade County. For the locations where the pressure: req SFBC Chapter 23, do not exceed the design pressure valut compliance with RAS 127 using the values listed in sectior calculations shall be done as a moment based system. NOTICE OF ACCEPTANCE: STANDARD C aN1)ITJ ONS Category: Prepared Roofing Sub Category: Flat Profile Tile PRODUCT DESCRIPTION Manufactured by Test ?ro l uct Applicant Dimensions Specifications b :scriptinn Monier Lifetile I = 15" Atlantis Shake and w = 10 3/8" Slate Tile 1 �Y thick Trim Pieces Product Rainproof II Ice and water Shield 1= varies w = varies varying thickness 2.1 Components or products manufactured by other! Test Dimensions Specifications 30" x 75' roll 36 "x 75'roll or 60 "x 75' roll PA (12 PA 112 PA 104 36" x 75' roll PA 103 UULVLL1\ LLrL11LL APPROVI D :December 30, 1999 EXPIRES : Iecember 16, 2002 Flat, inte(-loci concrete shah with rwc nail or adhesive s Accessory tri at hips, rakes terminations. profile. Single ply, ail -on underlaymc •.t v.ith :r' self -ac herii. i; to edge. Self- adheri g undeelayr1 Prot act Desert ; tiro n ake do :date Concrete Roof :ction of this Notice of ing Co: e, 1994 Edition for cire:ner. s, as determined by 0')tai7 by calculations in 4 sere n. The attachment ing, hig . pressure extruded : an i sla e roof tile equipped poles. I' )r direct deck, mortar 1. applic ations. n, cmcnae roof pieces for use ridges aid valley M.anufi ctured for each the Manufacturer Protect -O -\V rap, Inc. (with current NOA) W.R. Grace Co. NOA) Frank Z low a, RICO Roofing Proc.uct ::ontrol Examiner IV4JUUG � LI�ETXLF• LDC prof `goo B Tile Nails Zile Screws CCFp TANcE: NOTICE pF A Roof Tile Mortar ( "TileTite` Roo Tile Mortar ("Quikrete'iD Roof Tile Mortar r 1140 , ) Roof Tile Mortar SAL Roof Roo Tile Mortar Roo Roof Tile Ad h es ive ( o ?o lyprori A K160 ") ' V 1' ., jvlin• � � fo Horizontal r use Ott. ens with v ertical ba or Ntin. 1 ' 2 " f use alone Ntin. 10d .3„ t/ long Mc ' ►.ad ia' d Q 335 h.. dia• 0.131„ hank 0 1? 5 ' sc {ew thread dia• Tt1 A : f. ►ece 16,7.0 r�pPT`Ov {'D :December E�I D AR , C l)NDj I� ST AND P ,ct M gener Test S , Salt pressure treated Woo p or Decay ces ,tart [nstitutc 1-P — ` lumber batti. Is NIA PA 114 Appendix E. PA 114 Appen 6 PA 1 ' 3 ?i\ 123 PA 123 See ?CA 3 generi Corros :on rt :,ist�tnt screw or sm loth shank nai t tnt, Corrosion r alts . ��ive. coated, sou galvanized, :ostse thread ,.voo. scr :ws Prepared m star m► , designe fc mortar Set roof the application • Prepa cr. ►rta+ n1i; designed fc • m`'.rtat S et roof the ap plicatio n Prep ared R de5 i tt r:ed Et mortal set roof tilt a pplic 3 u or Two comp 'ner polyuretha to . I �r adhesive d adhes si 1' rC� ) f t11= adhesi s app lic:atiot a enertc Bermud Roof nc with Company, current P Ci\ i • idol ;a• It RC of Ecarn irer t .ank . ?reduc► -ortt R�a�tn Qu ikretc C Products with Current PC■ VJ • R Bonsai Co. with current 1'CP. Poky foam Products. Inc. uui 1t$ /UU nuo IU:UJ r[l.l JOl JJO 0J01 Product Roof Tile Adhesive Tile6ond Hurricane: Clip & Fasteners 3. LIMITATIONS LUUL' LL1[ L1rL11LL MONIER LIFETILE LLC ACCEF I'ANC:: No.: 99- 1012.07 APPRO' IUD EXPIRE: NOTICE OF ACCEPTANCE: STANDARD tt 'Di DI ION'S Test Prod ict Dimensions lecilications a:seri itio'i Factory premixed canisters Clips PA 114 Min. ''A" width Appendix E Min. 0.060" thick Clip Fasteners Min. 8d x 1 'h" See PCA Single corr :,or.ent polyuretha .e foam roof tile ad 1.esive Table 1: Aerodyn Tile Profile Mcnier Lifetile Atlantis Shake & Slate Tile Corrosion r i�tznt clips with c irro.;ion resistant na IS. :December 30, 1999 :')ecembcr 16, 2002 ii\tanufacturcr Flexible Products (with current NOA) Generic 3.1 Fire classification is not part of this acceptance. 3.2 For mortar or adhesive set tile applications, a s performed in accordance with RAS 106. 3.3 Applicant shall retain the services of s Ivlia.mi•.Dad to perform quarterly test in accordance with PA 1 shall be submitted to the Building Code Complianc 14 Minimum underlayments shall be in compliance Applications Standards listed section 4.1 herein. 3.5 30/90 hot mopped underlayment applications ma: the roof slope unless stated otherwise by the under] published literature. 3.6 This acceptance is for wood deck applications. Mi be in compliance with chapter 29 of the SFBC.. 3.7 May be installed on slopes 7:12 and greater with a 4. INSTALLATION 4.1 Monier Lifetile Atlantis Shake & Slate Concrete Roc'f Z -le and its components shall be installed in strict compliance with 1' liarii :jade County Roofing Application Standard RAS 118, RAS 119, and RA ; 120. 4.2 DP to For Attachment Calculations :.tic field uplift test shall be Ccun1:' Certified Laboratory 2, i:ppeiidix 'A'. Such testing Office for review, wi h t:e applicable Roofing be installed perpendicular to cyn material manufacturers im tm :eck requirements shall :tin mu-1 of two screws. amic Multipliers - (ft') (ft') Direcl 17e':k Application I7a7 rT i.ulc.aga, izooti P: xdu • Control Examiner UU y Table 2: Restoring Moments due to Gravity Tile Profile 3":12" 4 ":12" I 5 ":12" Monier Lifetile Atlantis Shake & Slate Tile Direct Deck Direct Deck I Direct De :k 6.0 5.9 I 5.8 Table 4: Attachment Resistance Expressed its a for Two Patty Adhesive Set Systei Tile Profile Tile Applicatior Monier Lifetile Atlantis Shake & Slate Tile Adhesive 2 See m:.nufactures component approval for installation requirements. 3 Flexible Products Company TileBond Average weight per patty 13.9 gram Polyfoam Product. Inc. Average weight per patty 8 grams. VV• iV• vv ALL va. iv. vv ♦ibill. v vvv vvv MONIER L1EETILE LLC NOTICE OF ACCEPTANCE: STANDLI : :OND•'rIONS Tile Profile Monier Lifetile Atlantis Shake & Slate Tile Table 3: Attachment Resistan for Na Fastener Type 2 -10d Ring Shank Nails 1 -10d Smooth or Screw Shank Nail 2 -10d Smooth or Screw Shank Nails 1 #8 Screw 2 #8 Screw 1 -10d Smooth or Screw Shank Nail (Field Clip) 1 -10d Smooth or Screw Shank Nail (Eave Clip) 2 -10d Smooth or Screw Shank Nails (Field Clip) 2 -10d Smooth or Screw Shank Nails (Eave Clip) 2 -10d Ring Shank Nails' l Installation with a 4" tile headtap and fasterners ce Expressed as a N :gym ant • M (ft-Ibf) it -On Systems Direct Deck 7 Direc:. Deck Battens (min 15/32" (min. 19/32" plywood) ply‘k ood) 30.9 7.3 14.0 30.8 51.7 24.3 ACCE 'Tel.NC E No. : 99- 1012.07 APPRO 'ET) :December 30, 1999 EXX'IR.k : December 16, 2002 19.0 • 1.0 35.5 31.9 :11.9 50.3 65.5 are located a min. of 214'1 :gym Ileac of tile. iiorner. M (ft -Ibf) ri inimum Attachment Resistance 31.3' • rrartl: .ula:lga, FRC F.aot�r , Product Control Examiner M (ft. I bf) Ii ":1 : ?' Dii ect beck 5.15 4.9 7.4 18.2 24.4 24.2 22.1 34 8 32.2 48.3 :3.8 1U.8 :1).8 L7 ;i5.5 7 ":12" or greater DirectDeck 5.5 17.2 Table 4A: Attachment Resistance Expressed as a M for Single Patty Adhesive Set Sy:;terr Tile Profile Tile Application Monier Liietile Atlantis Shake & Slate Tile PolyPro' PolyPro' 4 Large paddy placement of 45 grams of PolyPro'". 5 Medium paddy placement of 24 grams of PolyProT ". vur yyr vv tav�• yv. vu ♦ aaaa vvi ....• ., ., ... MONIER LIFETILE LLC tuv,•aua. a.0 ... a....r NOTICE OF ACCEPTANCE: STANDARD C :)NOI1`1ONS Tile Profile ACCEP :'Af 1C1: No. : 99- 1012.07 APPROV ;D : :'ecember 30, 1999 EXPIRE; :December 16, 2002 • 'me nt . M, (ft-Ibf) Minimum Attachment Resistance 118.9° 40.4' Table 46: Attachment Resistance Expressed as a M Mme nt M, (ft -Ibf) for Mortar or Adhesive Set System; Tile Attachment Application Resistance Monier Lifetile Atlantis Shake & Slate Tile Mortar Set" 39.0 5. LABELING All tiles shall bear the imprint or identifiable marking of the nar.ufa:turer's name or logo, or following statement: "Miami -Dade County Product Contro rip xro• ed ". 6. BUILDING PERMIT REQUIREMENTS 6.1 Application for building permit shall be accompanied b) :oF ies (if the following: 6.1.1 This Notice of Acceptance. 6.1.2 Any other documents required by the Building :)ff cia or the South Florida Building Code (SFBC) in order to properly evaluate: the zsiilla . on of this system. Funk 2 iloa a, FAC Rc,otin: ?rotluct Control Examiner 09/18/UU NUN LU:U4 tA3. 001 JJ4 OJUI MUNItX LirtliLt • • MONIER LIFETILE LI,C ACCEP No. : 99-1012.07 ••• NOTICE OF ACCEPTANCE: STANDARD ( ONDrf IONS PROFILE DRAWINGS YVATERLOCX 16 .s. 9 " . •---1. I" L APPRO\ :December 30, 1999 EXPIRE: :December 16, 2002 _1112" S life" MONIER LIFETILE ATLANTIS SHAKE & SLATE CONC 1.ET ROOF TILE Frank Z toa.a, RC Rcofins Product Control Examincr LEJ U 1.1 US /1VUU MUN 1u: u4 rAA 0O1 J40 JJal mvrutz Llraiiiz 4ONIER LIFETILE LLC ACCEP "ANCI: No.: 99- 1012.01 APPROV ;D :December 30, 1999 EXPIRE5. :December 16, 2002 NOTICE OF ACCEPTANCE: STANDARD C :)NDITIONS Renewal of this Acceptance (approval) shall be considered atter rer ewwi application has been filed and the original submitted documents, including test- supportir data, c igineering documents, are no older than eight (8) years. 2. Any and all approved products shall be permanently labeled with the martifacturer's name, city, state, and the following statement: "Miami -Dade County Product Cocitro( Approval ", or as specifically stated in the specific conditions of this Acceptance. 3. Renewals of Acceptance will not be considered if: a. There has been a change in the South Florida Building Code lffectirl; the evaluation of this product and the product is not in compliance with the code ct The product is no longer the same product (identical) as the c •e originally approved. If the Acceptance holder has not complied with all the n :luiremerrts or this acceptance, including the correct installation of the product. The engineer who originally prepared, signed and sealed the equired iocumentation initially submitted, is no longer practicing the engineering profession 4. Any revision or change in the materials, use, and/or manufacture Df the product or process shall automatically be cause for termination of this Acceptance, u ltess pricer w • tten approval has been requested (through the filing of a revision application with appr ori: to to e) and granted by this office. b. c. d. 5. Any of the following shall also be grounds for removal of this Acc pta:tee:: a. Unsatisfactory performance of this product or process. b. Misuse of this Acceptance as an endorsement of any prod ct, or Iles, advertising or any other purposes. 6. The Notice of Acceptance number preceded by the words M cm ; County, Florida, and followed by the expiration date may be displayed in advertising itcratute. If any portion of the Notice of Acceptance is displayed, then it shall be done in its cntir :ty. 7. A copy of this Acceptance as well as approved drawings and ot. er'loct. tents, where it applies. shall be provided to the user by the manufacturer or its distril .rtors an shall be available for inspection at the job site at all time. The engineer need not reseal le c:opi :s. 8. Failure to comply with any section of this Acceptance shall be c ise for termination and removal of Acceptance. 9. This Notice of Acceptance consists of pages l through 7 and this :cst page 8. END OF THIS ACCEPTAN'X F •ank : ulo: ga, 112C Roofin ; Prcduc.Control Examiner tyJ UU4 M SHORES VILLAGE BUILDING INSPECTION DEPARTMENT APPLICATI ®N 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.. January 31st 0.9 72 O e o Nam() and Adder §3. Mr. ::John_, krraY -- No 420 Ravi E. 91st. St. Registered Architect and /or Engineer Name and address of licensed contractor Lang_ Roofing & Tile Co., 'DC . 573 NW 71st St., Miami 33150 Location and legal description of lot to be built on: Lot Block Subdivision Street and Number where work is to be done 420 N. E, Street State work to be done and purpose of buildin (by floors)Tear off existing roof and replace with 1 -30# tin capped to sheathing, mop 1 - 90# slate with hot asphalt and cover with a layer of standard white cement shingle type tile. STATE OF FLORIDA, COUNTY OF DADE. ss. and for no other purpose. New Building Remodeling Addition Repairs Re..roof N of Stories 1 To be constructed of Kind of foundation Roof Covering _ Estimated Total cost of improvements $.. 155.00 Amount of Permit $,. 7.00 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 pennit 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, Pennanent Sup {dement, and has complied with the provisions thereof, and will require similar compliance from all contractors or sub -con ors employed by him in the work to be per under this permit; and will post or cause to be posted for inspect on the site o e ork such ublic notice or notices as are required by the Act. The undersigned agrees to employ only such ubcon on wor to . performee nder this permit, as are licensed by Miami Shores Village. Remarks__._ 2 3sgs• (Signe Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally ap- peared 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. r-� Permit No 1=` � _f Date J- Read, Sworn to and Subscribed before me. Disapproved (Signed) _ T.& ( Date. Notary Public, State of Florida to me well known, uilding 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 obt: ined 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. Owner's Name and Address Street and Number where work is to be done STATE OF FLORIDA COUNTY OF DADE. 1 ss 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 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. f Registered Architect and,or Engineer i f U Name and address of licensed contractor Location and legal description of lot to be built on: g/ � Lot �a. �� pF lock / Subdivision ijiP State work to ge done and purpose of building (by floors) sate e colors (submit samples) S New Building Remodeling Ad Vtion To be constructed of _ Kind of foundation Roof Covering •J1 Estimated Total cost of improvements S / 5 .... 6 Amount of Permit S --,,'197, 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 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 obligatons 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 unde this permit: and will post or cause to be posted :or inspection on the site of the work such public notice or notices as are required by the Act. The undersigned a es to employ only such subcontractors. on work to be performed under this permit, as are licensed by Miami Shores Village. Remarks (Signed) C Date t �. / t:. 19 No. Rtr et_ L �!. i/J -off if as7a Repairs No of Stories Before me. the undersigned authority. a notary public. duly authorized to administer oaths and take acknowledgments. personally appeared Notary Public. State of Florida and for no other purpose 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 A © Date 2 ' hot / 9'j Read. Sworn to and Subscribed before me. Disapproved Q/ Date (Signed) ,, , / V Building Inspector My Commission Expires PLANNING BOARD DATE Chairman Member - Member Member Member Member Council Approved Date Disapproved Date NOTE: A charge of $25.00 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 525.00 will be charged when such re- inspection is made necessary by improper notice for inspection or faulty materials and workmanship. MIAMI SHORES VILLAGE, FLORIDA BUILDING ❑ A ❑ PERMIT IN? 11231 PL n ROOFING V Work be pesforawd under this Permit Owner of ,.- ,� Building, ✓ ,�;' Y „ Architect `r CONTRACTOR OR BUILD DATE II oinem Contractor's License No Contractor or Builder Legal . Description 4,- Address o f Value of 4 Amt. of to cp Building i . � �► k, ) , Project $ A. Permit $ .{..++ +'„ „ i ,. Y ... This permit is granted to the contractor or buildEr / named above to construct the building or install the equipment or device described is the herefor in strict compliance with all ordinances pertaining thereto and with the understanding that the work will be performed in compliance wlllt drawings, statements or specifications that may have been submitted to and approved by the proper municipal authorities. This Permit may be time if the work is not done in compliance with such ordinances or if the pie are changed without authorisation. A further condition upon which granted is the understanding that the contractor or budder named above assumes the responsibility for a thorough knowledge of the or "".: pertaining to the work covered hereby whether shown on the plas s or dtawilpEs or in the statements or specifications and that he assumes r ugloosib�igr iii done by his agents, servants or employees. In consideration of the issuance to me of this permit 1 agree^ + erform the work covered hereunder compliance with all ordinances and reibilations pertaining thereto and in strict conformity with the plank drawit0, tements or specifications submitted to the proper authorities of Miami Spews Village. In accepting this permit I assume responsibility for all work do either, myself, my agent, servant or employee. / Subdi- vision State work to be done and purpose of building (by floors)._ 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. r Date , 19 Owner's Name and Address No. Street. Registered Architect and /or Engineer Name and address of licensed contractor Location and legal description of lot to be built on: Lot _ Block Subdivision_ Street and Number where work is to be done '__._____ and for no other purpose. New Building Remodeling._.___ Addition Repairs No. of Stories 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 Date Read, Sworn to and Subscribed before me. Disapproved Date Notary Public, State of Florida (Signed) 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.