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BUILDINGSECTION BY DA Zonin: / %.�LIPA F0 Electrical Mechanical Mir P a i Plumbin: 11_ �_�1__ `1511 Fire Public Works Structural IMP/W it IIIM■71WR W7mm Building Official Page 4 OFFICE USE ONLY CHECKLIST ❑ OWNER - BUILDER FORM (Attach) ❑ FIRE DEPARTMENT APPROVAL (Commercial / multi - family) ❑ CONCURRENCY (New Construction) ❑ OTHER (Specify & Attach) ❑ PROOF OF OWNERSHIP (Attach) ❑ HRS / DERM APPROVAL (Septic / Sewer) ❑ IMPACT FEE (New Construction) ❑ OTHER (Specify & Attach) PERMIT FEES $3.00 per page (Scanning Fee) $ ` Miami Shores Village $ t O Bond $ 3D 0 ^ Metropolitan Dade County (C.C.F.) $ t 0 0 ( sq.ft. = x/1000 x0.60) Inspector State Educational Fund $ (0.005 /sq.ft.) State DCA (Radon) $ (0.01 / sq.ft.) Code Enforcement Fine $ Zoning Review Notary $ gyp 00 $ " .--e.Q/W lHe /3 REVIEWED AND PREPARED BY: DATE: PERMIT APPLICATION ❑ CONDO ASSOCIATION APPROVAL (Attach) ❑ BPR APPROVAL (Restaurants) ❑ CONTRACTOR REGISTRATION (On File) OTAL $ I O Revised July 2001 10050 N.E. 2ND AVE., MIAMI SHORES, FL o (305) 795 -2207 0 FAX (305) 756 -8972 0 http:/ /www.miamishoresvillage.com ELECTRICAL n Minimum Fee QTY. .I.v.I,I.: Dryer ()TV . I . vI , I: Outlet, Appliance ()Ty. 'I Service Repair VI Y A/C Central 1 -3 Ton Dryer Vents, Number of Fan Ventilation, Cost Outlet, Wall Ductwork, Cost of Service, Temporary Periodic Inspections A/C Central 4 -7 Ton Fire Sprinkler System Fire Pump Outlet, Switch Fireplaces, Number of Signs A/C Central 8 -15 Ton Fixture - Fluorescent Oven Space Heater (kw) A/C Central 16-20 Ton Fixture Light Parking Lot Lights Spas/Hot Tubs A/C Central 20+ Ton Flood Lights Plugmold/Strip Subfeeds, No. of Amps A/C Window FPL - Load Central Posts Swim Pool, Commercial Air Conditioners Garbage Disposal Range/Range Top Swim Pool, Residential Chiller Generators, etc. Receptacles Switchboards Clear Violations Heat Recovery Refrigerator, Comm. (p/PH) Temp Serv., Construction Compactor Low -volt, Burglar Refrigerator, Domestic Temp for Test - 30 days Deep Freezer Low -volt, Fire Renew - Temp Service Water Closet Demolition Low -volt, Intercom/Teleph. Repair Circuits Water Heater Dishwasher Low -volt, Television Service, Number of Amps Water Heater New I\1LCHANICAL nil.: QTY. Minimum Fee "I VPP. Condensate Drain ()Ty. I'VI'E Generator (1T1'. Tvi'i Q I'V. Refrigeration, Tons A/C Central, Tons Cooling Tower Heating Strips, each Vent Hood, Cost A/C Wall/Win. Tons Dryer Vents, Number of Paint Booth Ventilation, Cost Air Handler, Tons Ductwork, Cost of Piping, Flammable Liquid Periodic Inspections Barbecue Fire Sprinkler System Process/Pressure Piping Bath Fan - Vented, # Fireplaces, Number of Pressure Vessel PLUMBING TYPI? A/C Condensate ()Ty. 'FVI'I Drains, Roof ()Ty. TYPE Miscellaneous Fixture QTY. TYPE PI? Soakage Pit (1'I'Y. Bath Tub Drinking Fountain Miscellaneous Repairs Solar Water Heater Bidet Filter Replace Pool Piping Sprinkler Repair Cap - Fixture Fountain Pump and Abandon Sprinkler System Cap - Water Gas - Appliance Pump, Domestic Supply, AC Well Cap - Sewer Gas - Natural Pump, Fire Stand Temporary Toilet Catch Basin Gas - Propane Pump, Re- circulate Temporary Water Closet Clothes Washer Gas Piping Pump, Replace - Pool Urinal Dental Chair Grease Trap Pump, Sprinkler Utility - Sewer Discharge Well Ice Maker Pump, Sump Utility - Water Dishwasher Indirect Wastes Relay Repair Vacuum Pump Disposal Interceptor Roof Inlet Water Closet Domestic Well Laundry Tray Septic Connection Water Heater Drainfield, 4" Tile/Res. Lavatory Septic Tank Water Heater New Drains, Area Meter Set (Gas) Sewer Connection Water Re -pipe Drains, Floor Minimum Fee Shower Water Service Drains, French Miscellaneous Equipment Sink Well, Supply Page 3 PERMIT APPLICATION INSTRUCTIONS: Please indicate the type of work being performed and quantity(ies) in the space provided below. RECEIVED AND REVIEWED BY: DATE: Page 2 INIPORTANT NOTICES DO NOT BEGIN ANY WORK WITHOUT HAVING RECEIVED YOUR VALIDATED PERMIT AND PERMIT CARD. Applying for a permit does not grant the right to begin construction. HOURS OF CONSTRUCTION are limited to: Monday through Friday from 7:30 a.m. to 6:00 p.m., and Saturday from 8:00 a.m. to 5:00 p.m. No inspections will be conducted on weekends or holidays. 2. All construction of demolition areas MUST BE MAINTAINED IN A CLEAN, NEAT AND SANITARY CONDITION free from constriction debris. 3. STREETS AND NEIGHBORING PROPERTIES SHALL BE KEPT FREE FROM DIRT AND DEBRIS. 4. SWALES MUST BE PROTEeIbD FROM BEING DAMAGED BY EQUIPMENT OR VEHICLES, AND MAY NOT BE USED FOR STORAGE. A bond is required for work in or near the street/sidewalk. 5. CONSTRUCTION TRAILERS ARE PROHIBITED ON SINGLE FAMILY RESIDENTIAL CONSTRUCTION SITES. Other construction may have a trailer which requires a separate permit. 6. PORTABLE TOILETS for a construction site require a separate permit. 7. DO NOT DISCHARGE WATER INTO THE RIGHT OF WAY OR STORM DRAINS without approval from the Building, Planning and Zoning Department. 8. EQUIPMENT AND MATERIALS SHALL BE STORED at least 10 feet from the edge of pavement. 9. Department of Health and Rehabilitative Services (HRS) approval is required for applications involving septic tanks. Department of Environmental Resources Management (DERM) and/or Miami -Dade Water and Sewer Department (MDWASD) approval is required for applications involving sewers. AFFIDAVIT - Please read carefully. Application is hereby made to obtain a permit to do work and installation as indicated. I, the OWNER of the property, 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, POOL, EXTERIOR DOOR, MECHANICAL, WINDOW, FENCE, DRIVEWAY, ROOFING and SIGNS and there may be additional permits required from other governmental agencies. I, the OWNER of the property, have disclosed all information related to any work at the property performed in the prior twelve months to the Building Official. Further, I am fully aware that if the cumulative cost of work to my home or business under this and any other permit equals or exceeds fifty percent (50 %) of the fair market value of the structure, the entire structure must meet the present federal flood criteria for finished floor elevation. I am also fully aware that if the total cost of work to my home or business under this and any other permit exceeds fifty percent (50 %) of the replacement cost of the structure, then the entire structure must conform to the current code requirements of the Building Code. WARNING TO OWNER: Your failure to record a NOTICE OF CO,....MME_NS_EMENT may result in you paying twice for improvements to your property. If you are spending more than $2,500 or intend to obtain financing, you may wish to consult with your attorney or lender before recording your Notice of Commencement. The Notice of Commencement must be recorded at: 22 N.W. 1st Street, 1° Floor, (305) 679 -1078. Once recorded, the Notice of Commencement must be POSTED AT THE JOB SITE in accordance with Section 713 -35 of Florida Statutes. Review the brochure at Village Hall on Construction Lien Law and Choosing a Contractor. OF FLO', ' , COUNTY OF MIAMI -DADE Signature of O Print Name worn to and subscribed before me this Si '• . Lure o o -1 blic . to of + rids OFFICIAL S.J>L hPaV P0 B e ANGELA kil BECKER V4,-.)',17''(' COA1.nss1oN NUMBER jz " y_ ,t CC786697 y tx2A ^.IS^�'o EXPIRSS Personally known a ,. Or, r�}tcedl kleiSti#`t'cati n Type of Identification Produced: SEAL: STATE OF FLORID COUNTY OF MIAMI -DADE f O r Signature of Contractor / Qualifier Print Name Sworn to and subscribed before me this day of SEAL: PERMIT APPLICATION Flo da OFFICIAL k1F3tl' ' • ANGELA F1 tSLi:,• c � 6s4 uueca. 65 iG669 Ii 1, i c 63 Personally known — 017; Produce roduced Identification Type of Identification Produced: CONTRACTOR Name © v. i\L < /� License No. b OS � y , c j Address •q c --t-s; `X -s.my r -76\ 4 L c.i . \,&, o,,n, : C\ -$ l • 3 `3 13 ? Teleph e �04� ° 0 Fax �o ] "`ri SS" at) cls Qualifier Name . PROPERTY OWNER Name ��N�2 Address V.C‘r\ S.Q‘r esFt .. -313? Home Telephone 31 5 _ - (a , s, � � Busin Cel n s _ ^ o s _ � 1 + 4 �w�,e c7L �9 1 < Fax � -S — ISB - �� C)a, TYPE OF MANAGEMENT (✓ ) New Construction Enclosure Alteration Exterior Repair / Alteration Interior Demolish Relocation of Structure Shell Only Foundation Only Add'I Attachment Other Add'l Detachment Other INS'T'RUCTIONS - The following steps must be taken to obtain a permit from the Miami Shores Village: Step 1. Complete the attached permit application which must be signed by the proper y owner and qualifier. Both .signature mu st be notarized. Please print or type to allow for a more accurate processing of your application. If roofing work will be done, a roofing application must be submit- ( ted along with this permit application. Step 2. \ Submit the completed application with all necessary documents to the Building, Planning and Zoning Department for processing. During the processing of your application, you may be asked to submit additional information. as kQ N .E U.ko,m 1 S\(,ore.:s V 10r c b 3313 Address ' Apt./ City State Zip Folio Number Lot Block Subdivision Current Use of Property Proposed Use of Property Tenant Information PERMIT TYPE ( ✓) Building Electrical Mechanical Plumbing LPGX Roofing Fence Other PERMIT CHANGE (✓ ) Chg. Contractor Renewal Revision Extension Supplement Reinspection ARCHITECT Name License No. Address Telephone Fax Master Permit No. Subsidiary Permit No. PERMIT APPLICATION Description of Work CO'() ' V") fio V17,Vj VA k^( v Or \ 1 • �:Qiln PB PG Zoning Linear Feet t/Sq Feet �lg 0 Units Floors �/alue of Work t `) l V ti �1 e j4idg Value Tax Assessed/Appraised Value Flood Zone Base Floor Elev. d i ENGINEER Name License No. Address Telephone Fax Miami Shores Village 10050 NE 2nd Avenue (1 Phone: 305-795-2204 Printed: 8/5/2002 Applicant: DONATO MASUCCI ( Owner: MASUCCI DONATO JOB ADDRESS: 1256 NE 92 ST 0 Contractor Orso, Inc. N � Local Phone: 305 - 695 -4244 'Parcel # 1132050270500 ir Fees: Description Amount FEE2002 -4291 Building Fee $160.00 FEE2002 -4292 Buildier's Bond $300.00 FEE2002 -4293 CCF $6.00 FEE2002 -4294 Miscellaneous $20.00 FEE2002 -4296 Notary Fee $5.00 Total Fees: $491.00 Total Fees: $491.00 Total Receipts: $0.00 Permit Status: APPROVED Permit Expiration: 2/1 /2003 Construction Value: $10,000.00 If there is no permit package accessible on the job -site for inspectors to verify, there will be no inspections. Re- inspection fee is $50.00, which must be paid in advance before calling for another inspection. fi t + .,. ows e equ or device described in the application herefor in strict compliance with all 110 7 with any plans, drawings, statements or specifications that may have been submitted to c not done in compliance with such ordinances,or if the plans are changed without :tor orbuilder named above assumes the responsibility for a thorough knowledge of the igs or in the statements or specifications and that he assumes responsibility for work done DONATO R MASUCCI RENEE J MASUCCI 1256 NE 92ND ST MIAMI SHORES, FL 33138 Order oAIVl∎t •,V'� `1 Dat For Micro Print signature line, grey border and backgrou First Union National Bank ' / R/T 063000021 T> 04 ' ( It 1 D Dollars a ZI::.....;. with CAP type, first Union logo on back. If nar present, do not cash. -1:06 30000 2 L1: 998 248 3 L 280' - L L Building Permit Permit Number: BP2002 -1355 Legal Description: BAY LURE MIAMI SHORES VILLAGE NOTICE Owner is Responsible for Maintenance of Contractor's Address: 8990 Biscayne Blvthll Village Sidewalks as per Village of Miami Shores Code of Ordinances, Including D:ivewys, fi cAaused By Current Construction Acti ti i PB 44 -63 LOT 1 BLK 3 LOT SIZE 75.000 X 125 OR 63 -2/630 BRANCH 00789 PIP BY: Page 1 of 2 BY: compliance with all ordinances and regulations pertaining thereto and in strict conformity ;s Village. In accepting this permit I assume responisibility for all work done by either Work: CONVERTING EXISTING CARPORT TO UTILITY ROOM /DEN If there is no permit package accessible on the job -site for inspectors to verify, there will be no inspections. Re- inspection fee is $50.00, which must be paid in advance before calling for another inspection. This Permit is granted to the contractor or builder named above to construct the building or to install the equipment or device described in the application herefor in strict compliance with all ordinances pertaining thereto and with the understanding that the work will be performed in compliance with any plans, drawings, statements or specifications that may have been submitted to and approved by the proper municipal authorities. This Permit may be revoked at any time if the work is not done in compliance with such ordinances or if the plans are changed without authorization. A further condition upon which this permit is granted is the understanding that the contractor or builder named above assumes the responsibility for a thorough knowledge of the ordinances and regulations pertaining to the work covered hereby whether shown on the plans or drawings or in the statements or specifications and that he assumes responsibility for work done by his agents, servants or employees. Signed: (INSPECTOR) BY: . In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I assume responisibility for all work done by either myself, my agent, servants or employes. Signed: \�1u 4 (Contractor or Builder) BY: Donato 2n Masucci St. Miami i L 33138 Miami Shores, � to the \ • rder of • 4, First Union National Bank firstunlon.com Org. 003 R/7 067006 :p6700 43 2i. L09000 2000 60 6►►' 461+ • 0 HARVND Vd '-Hate 4640 63- 643/6 BRANCH 00666 \ro Olaf 6 PRES1IGE 4211 py cf S["E CF )ND DADE COUNTY CC ' FLORIDA A - CATION (DPER) := sal REGISISATDON f / EP'__L�:KY LI' `� Copv of currant COCUPATICaL LICENSE = dti2 .mess is located. -rS cr L:.. i or 111:.:'_ al �. where C ..._ti.__Icate of Insurance for LT_ Aaiia'r (addressed to Miami Shores °s Village). Notice of Commencement ur__,r• *__ 177-s7 EU:LD =`(G Al "C;: Jam'_; (3C�� C0 N. _ . ltomffJE _. 2 (_35) . = -:c- BUILDING _PF fI i /CONr_e AC ORS R-%7SrP.AT_ION CHECKLIST ST 1 / 1 6:rtificate of Insurance for WORKER'S QP (addressed tc ShoresVillage) or if exempt PLEASE SUBt r Evrey.riEG CFF C Trent survey of the property. .1%:Ce.*tificate of Elevation sinned and sealed by Surveyor. 0/4) ntial Improvements checklist (contractor e= owner).' Struc.LILO. Review fee SDO O vu/ ae r ‘o\E ( Stat° of Florida LeM Form BCH -204, Construction - -.^ , .:s` Notice of Election to be Exempt. P°..nnit Application (signed by person performing the work, licensed contractor and the property owner, both signatures notarized). 1 3 v sets of plats /dryings s _ signed and sealed by registered architect or engineer. Occupancies by GrouT Classification must be on plans and permit anplicatlon. All plans must include folio number and o address.. Amended plans, �Y / p _m t number. • i,� addition to the above, must also include the / v Structural Calculations signed and sewed by a-cito or engineer when policable. Four sets of energy calculations, signed and sealed po sets of signed a sealed Truss Ply (Engineer). DADE County or State of Florida Prowcts 1 for - r S a t sheds, ?��'. � fo_ roof materials, i windows, exterior/garage for /garage doors, aluminum carports, screen enclosures, shutters awning,-, s47.71ts, = -ems doors and etc. 4 fiA_provais from IRS, DADE County Impact Fee Section, Fire Department a Health Department (when applicable). DEM Warranty Deed or Other Proof of Cwoership if nec_ss 1%.c yr WMMENCEMENT A RECORDED COPY MUST BE POSTED QbJ THE JOB SITE AT TIME OF FIRST INSPECTION PERMIT NO. STATE OF FLORIDA: COUNTY OF DADE: TAX FOLIO NO. -c3sto 02R450377 2002 JUL 19 11 :41 THE UNDERSIGNED hereby gives notice that improvements will be made to certain real property, and in accordance with Chapter 713, Florida Statutes, the following information is provided in this Notice of Commencement. 1. Legal description of property and street address: 2. Description of improvement: as< . 3. Owner(s) name and address: G4 -(98 3 owl Interest in property: r.'\ A e Name and address of fee simple titleholder: V • 4. Contractor's name and address: �) C SO S Z nL 5. Surety:(Payment bond required by owner from contractor, if any) Name and address: Amount of bond $ 5. Lenders name and address: .gna ure 01 Owner 'rint Owners N'F e worn to and subscr L • V. IL, Ike Skr,oC STATE OF FLORIDA, COUNTY OF DADE I HEREBY CERTIFY that this is a tru cn r t h angina/ filed in this office on i.^ 7 rrf'rf:T.q of , A 2J C) WITNESS my hand - IARVEY RUVIN, LERI; I Circuit`nd County Courts D.C. 'Q3.41 7 . Persons within the State of Florida designated by Owner upon whom notices or other docu )y Section 7 13.13(1)(a)7., Florida Statutes, Verne and address: is may be served as provided 3. In addition to himself, Owner designates the following person(s) to receive a copy of the Lienor's Notice as provided in Section 713.13(1)(b), Florida Statutes. Jame and address: 1 . Expiration date of this Notice of Commencement: (the expiration date is 1 year from the date of recording unless a lifferent date is specified) lotary Public rint Notary's Name I'Y'a.i, (\E LI (Ev ly Commission Expires: V 1 \(,o t4D , Prepared by' Alec ()\-"N\ \<. 12101-52 299 Address: \r-s 1O IV E �� •�(,\ �� B4. MAP AND PANEL B5. SUFFIX B6. FIRM INDEX B7. FIRM PANEL B8. FLOOD 89. BASE FLOOD ELEVATION(S) NUMBER DATE EFFECTIVE/REVISED DATE ZONE(S) (Zone AO, use depth of flooding) 12025C0093 J 7/17/95 3/2/94 AE 8.00' For Insurance Company User Policy Number Company NAIC Number BUILDING OWNER'S NAME DONATO MASUCCI FEDERAL EMERGENCY MANAGEMENT AGENCY NATIONAL FLOOD INSURANCE PROGRAM ELEVATION CERTIFICATE Important: Read the instructions on pages 1 - 7. SECTION A - PROPERTY OWNER INFORMATION 07- 1337 BUILDING STREET ADDRESS (Including Apt., Unit, Suite, and /or Bldg. No.) OR P.O. ROUTE AND BOX NO. 1256 N.E. 92ND ST. CITY STATE MIAMI SHORES FT.ORTDA PROPERTY DESCRIPTION (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.) BUILDING USE (e.g., Residential, Non - residential, Addition, Accessory, etc. Use Comments section if necessary.) RESIDENTIAL LATITUDE /LONGITUDE (OPTIONAL) ( ##° - ##' - ##.##" or ##.#t#q## ° ) SECTION B - FLOOD INSURANCE RATE MAP (FIRM) INFORMATION 311 '18 O.M.B. No. 3067 -0077 Expires July 31, 2002 ZIP CODE HORIZONTAL DATUM: SOURCE: II GPS (Type): I NAD 1927 I NAD 1983 II USGS Quad Map II Other: B1. NFIP COMMUNITY NAME & COMMUNITY NUMBER 120652 B2. COUNTY NAME MIAMI — DADE B3. STATE FLORIDA B10. Indicate the source of the Base Flood Elevation (BFE) data or base flood depth entered in B9. I FIS Profile I XI FIRM I Community Determined I I Other (Describe): B11. Indicate the elevation datum used for the BFE in B9: IX I NGVD 1929 I I NAVD 1988 I I Other (Describe): B12. Is the building located in a Coastal_ Barrier Resources System (CBRS) area or Otherwise Protected Area (OPA)? 1_I Yes Designation Date: SECTION C - BUILDING ELEVATION INFORMATION (SURVEY REQUIRED) C1. Building elevations are based on: I_IConstruction Drawings* (_(Building Under Construction* I X (Finished Construction *A new Elevation Certificate will be required when construction of the building is complete. C2. Building Diagram Number 1 (Select the building diagram most similar to the building for which this certificate is being completed - see pages 6 and 7. If no diagram accurately represents the building, provide a sketch or photograph.) C3. Elevations – Zones A1-A30, AE, AH, A (with BFE), VE, V1 -V30, V (with BFE), AR, AR/A, AR /AE, AR /A1 -A30, AR /AH, AR/A0 Complete Items C3a -i below according to the building diagram specified in Item C2. State the datum used. If the datum is different from the datum used for the BFE in Section B, convert the datum to that used for the BFE. Show field measurements and datum conversion calculation. Use the space provided or the Comments area of Section D or Section G, as appropriate, to document the datum conversion. Datum NGVT) Conversion /Comments Elevation reference mark used RF.NCH MARK Does the elevation reference mark used appear on the FIRM? ❑ a) Top of bottom floor (including basement or enclosure) 8 01 ft.(m) ❑ b) Top of next higher floor N/A ft.(m) N/A ft.(m) 6 . 63 ft.(m) ❑ c) Bottom of lowest horizontal structural member (V zones only) ❑ d) Attached garage (top of slab) ❑ e) Lowest elevation of machinery and /or equipment servicing the building ❑ f) Lowest adjacent grade (LAG) ❑ g) Highest adjacent grade (HAG) 6 . 77 ft.(m) 6 . 62 ft.(m) 6 . 74 ft.(m) ❑ h) No. of permanent openings (flood vents) within 1 ft. above adjacent grade N/A sq. in. (sq. cm) ❑ i) Total area of all permanent openings (flood vents) in C3h N/A SECTION D - SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION IX I Yes IXINo I —I No This certification is to be signed and sealed by a land surveyor, engineer, or architect authorized by law to certify elevation information. I certify that the information in Sections A, 8, and C on this certificate represents my best efforts to interpret the data available. I understand that any false statement may be punishable by fine or imprisonment under 18 U.S. Code, Section 1001. CERTIFIER'S NAME LICENSE NUMBER ADIS N. NUNEZ TITLE REGISTERED LAND SURVEYOR ADDRESS 555 N. S RE DR. nt • SIGNATURE / FEMA Form 81 -31 JUL 00 SEE REVERSE SIDE FOR CONTINUATION 5924 COMPANY NAME BLANCO SURVEYORS, INC. CITY STATE ZIP CODE MIAMI BEACH FLORIDA 33119 DATE 6/27/02 ( 305 ) 865-1200 REPLACES ALL PREVIOUS EDITIONS IMPORTANT: In these spaces, copy the corresponding information from Section A. , BUILDING STREET ADDRESS (Including Apt., Unit, Suite, and /or Bldg. No.) OR P.O. ROUTE AND BOX NO. 1256 N.E. 92ND ST. CITY STATE ZIP CODE MIAMI SHORES FLORIDA 33138 SECTION D - SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION (CONTINUED) Copy both sides of this Elevation Certificate for (1) community official, (2) insurance agent/company, and (3) building owner. COMMENTS 1_1 Check here if attachments SECTION E - BUILDING ELEVATION INFORMATION (SURVEY NOT REQUIRED) FOR ZONE AO AND ZONE A (WITHOUT BFE) For Zone AO and Zone A (without BFE), complete Items El through E4. If the Elevation Certificate is intended for use as supporting information for a LOMA or LOMR -F, Section C must be completed. El. Building Diagram Number (Select the building diagram most similar to the building for which this certificate is being completed – see pages 6 and 7. If no diagram accurately represents the building, provide a sketch or photograph.) E2. The top of the bottom floor (including basement or enclosure) of the building is I -1_I ft•(m) I_I— Iin.(cm) 1_1 above or 1_1 below (check one) the highest adjacent grade. E3. For Building Diagrams 6 -8 with openings (see page 7), the next higher floor or elevated floor (elevation b) of the building is 1_1_1 ft.(m) I— I— Iin.(cm) above the highest adjacent grade. E4. For Zone AO only: If no flood depth number is available, is the top of the bottom floor elevated in accordance with the community's floodplain management ordinance? II Yes I No I Unknown. The local official must certify this information in Section G. SECTION F - PROPERTY OWNER (OR OWNER'S REPRESENTATIVE) CERTIFICATION The property owner or owner's authorized representative who completes Sections A, B, and E for Zone A (without a FEMA- issued or community- issued BFE) or Zone AO must sign here. PROPERTY OWNER'S OR OWNER'S AUTHORIZED REPRESENTATIVE'S NAME ADDRESS CITY STATE ZIP CODE SIGNATURE COMMENTS CROWN OF ROAD ELEVATION: 4.43' ON CENTERLINE ON CENTER OF ROAD BM# B -50 G4. PERMIT NUMBER COMMENTS SECTION G - COMMUNITY INFORMATION (OPTIONAL) The local official who is authorized by law or ordinance to administer the community's floodplain management ordinance can complete Sections A, B, C (or E), and G of this Elevation Certificate. Complete the applicable item(s) and sign below. G1. I_I The information in Section C was taken from other documentation that has been signed and embossed by a licensed surveyor, engineer, or architect who is authorized by state or local law to certify elevation information. (Indicate the source and date of the elevation data in the Comments area below.) G2. II A community official completed Section E for a building located in Zone A (without a FEMA- issued or community- issued BFE) or Zone AO. G3.1 I The following information (Items G4 -G9) is provided for community floodplain management purposes. G5. DATE PERMIT ISSUED LOCAL OFFICIAL'S NAME TITLE COMMUNITY NAME TELEPHONE SIGNATURE DATE LOCATOR# 3250 S ELEV. 10.02' DATE TELEPHONE For Insurance Company Use: Policy Number Company NAIC Number I —I Check here if attachments G6. DATE CERTIFICATE OF COMPLIANCE /OCCUPANCY ISSUED G7. This permit has been issued for New New Construction I I Substantia Improvement G8. Elevation of as -built lowest floor (including basement) of the building is: . ft.(m) Datum: G9. BFE or (in Zone AO) depth of flooding at the building site is: . ft.(m) Datum: I Check here if attachments FEMA Form 81 - 31, JUL 00 REPLACES ALL PREVIOUS EDITIONS • 1/2' IP 0 8LK CDR 1 COMMONIT Y NUMBER 120652 OEL NOTES.- 2 PANEL IAJMBER 93 235.0' 3: sUFFiv J LOT 14 BLK 3 FND 1 /2' IP NO ID N, FN0 1/2' IP NO ID 4 :DATE OF FIRM INDEX 7/17/95 U) 5 FIRM ZONE AE BOUNDARY SURVEY 1) BASIS OF SEARING' AS PER PLATIIENTEALINE NE 92 ST. - N 09 22' 45• W) 2) ELEVATIONS SHOWN NEEAEON ARE RELATIVE TO NATIONAL d 0E00ETIC VERTICAL DATUMIN.O.Y.D.I 3) LOCATION AND IDENTIFICATION OF UTILITIES ON AND/OR ADJACENT TO THE PROPERTY WERE NOT SECURE AS SUCH INFORMATION VAS NOT REOESTED. 41 NOT VALID WITHOUT THE SIGNATURE AND THE ORIGINAL RAISED SEAL OF A FLORIDA LICENSED SURVEYOR AND NIPPER. 5) DCRDACHMENTS AND VIOLATIONS ON SURVEYCIF ANY). 10.0' x 6 BASE FLOOD ELEVATION 75.0' 4' C.L.F 8.00 BRICK TERRACE , 26.2 651605EDOE 19 - 141) 19. LEGAL DESCRIPTION LnT 13 IN BLOCK 3 OF BAY LURE. ACCORDING TO THE PLAT THEREOF AS RECORDED IN PLAT BOOK 44 AT PAGE 83 OF THE PUBLIC RECORDS OF MIAMI -DADE COUNTY. FLORIDA. 34.8 x ASPHALT DRIVEWAY V ' v N 89 22' 45" W 14.5 • �+1p STORY RES ��• ppQ�1� CBS LOT 13 BLK 3 34.0' 7.0' o • / A N 75.0 N 89 22' 45' W SKETCH OF SURVEY SCALE. 1' - 20' -U- - OVERHEAD LINE 0 - /WILE ® co - CATCH BASIN o - TREE 21.9' 20.3' •CARPORT •\ CBS GARAGE 22.4 LEGEND FND - FOUND CM - CONCRETE MONUMENT IR - IRON ROD IP - IRON PIPE Rl11 - RIGHT OF WAY POO - POINT OF BEOINNINO POC - POINT OF COIIEwCEMENT PC - POINT OF CURVE POC - POINT ON A CURVE - + -- CHAIN LINK FENCE - 1 -- WOOD FENCE PO - PLAT SOCK P - PAGE M - MEASURED 0-D® R - RADIUS A - ARC A - CENTRAL AMBLE C - CHORD X.XX _ ELEVATION - I I` NON-VEHICULAR ACCESS LINE 11.0 — - C NE 92 STREET (20.0' PAVEMENT) — - — 50.0' TOTAL R/W - CONCRETE 4' CBS WALL ui N FND 1/2' IP / NO ID FND 1/2' IP NO ID LOT 12 BLK 3 CERTIFICATION OF BOUNDRY SURVEY. I HEREBY CERTIFY THAT THIS SURVEY WAS MADE UNDER MY RFSPONSIRI F EHAROF ANO TO THE RFST OF MY KNOW) Fflr,F AND BELIEF; THIS SURVEY MEETS THE 14J0IHUM TECHNICAL STANDARDS •S SET FORTH BY THE_BDA):HD iPRD E6SIONAL LAND UR d SRS IN CHAPTER 61617 FL0f 1161%AOM,INISTRATIVE CO T TO SECTION 472- FLORIDA - STATUTES. � T.Y = r 0 S. PITA. P:L.S.' PROFESSIONAL LAND SURVEY - LICENSE N0. PSM 5789 - ` r� STATE OF FLORIDA • s.. r ' • ' JULIO S- PITA, r LAND SURVEYORS 7805 CORAL WAY. SUITE 100 MIAMI. FLORIDA 33155 PH(INF . 1 1 ) 76 ? - 74014 SECTION: 6 -53 -42 I COUNTY: DADS CERTIFIED TO DONATO MASUCCI RENEE J. MASUCCI. HIS WIFE STANDARD FEDERAL BANK. A FEDERAL SAVINGS BANK, ITS SUCCESSORS AND /OR ASSIGNS. ATIMA ATTORNEYS TITLE INSURANCE FUND. INC. SILVER & SILVER 1256 NE 92 STREET. MIAMI. FLA 33138 DATE: 1 / 1 5/99 ' REF: 99 - 01 DWG: GL 1 357 ` .' � _ \ JOB ADDRESS APPLICANT APPUCATION DATE 7/m 101.56 /lie' c7,1 G� cc ,OR riaA) ZONINy CRITIQUE SHEET PHONE tt SHEET OF MISCELLANEOUS i l,"52, COMMENTS PERMIT NO ADDRESS: SECTION ZONING ELECTRICAL MECHANICAL PLUMBING FIRE PUBLIC WORKS STRUCTURAL BUILDING OFFICIAL` L,, /» 7" /5 , 'f"/$✓/ 'J ® E MIAMI SHORES VILLAGE BUILDING / ZONING DEPARTMENT" BY DATE 1. Subject to compliancy with eft Federal. State, County,YUlage rules and mutations. Wage assumes no responsibility for accuracy oUor results fro these plans. 2. This copy of plans must be available oe building site or no Inspection will ba conducted INITIALS A 6 ll 5- 4W64F5 1P 7/(V6 ? o 07/13/2002 10:11 3059451226 MIAM iDADE DOORSOURCE PRODUCT CONTROL NOTICE OF ACCEPTANCE DAYT3AR INDt1STRIES LIMITED 1235 AEROWOOD DRIVE Canada , L4W 1139 PAGE 01 MIAMI -DAVE COUNTY. FLORIDA METRO-DUE FLAGLER BUILDING 13UWLDlNe CODE COMPLIANCE OFFICE MF'1'ItC DADS FLAGL Eft t31111.1)1NC ;40 �V1aS�' (1.AOLEIt STREET, Slim: 16 03 M1.foM:, FLJRtriA 331 .30 -1551 003).37_5.29c1 FAX (3!)5) 3'7 CONTRACTOR LACIiiNS:N'C S:iCTION ( 3OS) 373x327 PAN (343) 37._53$ CONTRACTOR ENFbttC!•:A1 oivts:CN (305) 375_zDa: FAN (303) 373 is PRot)ucr CONTROL Inv :sioN (305) 373.2932 FAS. (303) ;11.63'3 Your application for Notice of Aeeepttincc {�10A) of Series LS18 Flush Outswing Commercial Steel Dovrp Impact Resistant ✓ under Chapter 8 of the Code ofMiarni -Dade County dove: ring the use of Alternate Mite:ials and Types of Construction, and completely described herein, has been recommended for acceptance by the Miami -Di:de County Building Code Compliance Office (ECCO) under the conditions specified herein, .This NOA shall not be valid after thc expiration date stated below. BCCO reserves thc right to secure this product or material at any time from a jobsite or manufacturer's plant for quality control testing. If this product or material fails to perform in the approved manner, 3i C O may revoke, modify, or suspend the use of such product or material immediately. BCCO reserves the right to revoke this approval, if it is determined by BCCO that this product or material fails to meet the requirements of the South Florida Building Code. The expense of such testing will be incurred by the rnanufacturer. ACCEPTANCE NO.: 01-0730.01 EXPIRES: 09!24; 2006 .� 1Z APPROVED: 013r /OO1 /leg?* Raul ttoarixzjcz. Chief Product Control Division THIS IS TUE COVERSHEE7 C1t7 "TONAL PArF S FOR SPECIFIC AND GENERAL CONDITIONS �3UILOJtiG COD . PRODIVCT REV'1LtW COMMITTEE This application for Product Approval has been reviewed by the BCCO and approved by the Building Code and Product Review Committee to be used in Miami -Deck County, Florida under the conditions set forth above, Francisco J, Quiat na, F..A. 1]trcetor Miami -Daac County 8:r'slein.g Code Compliance Office 6804 5000l'pt200C11tempbto\moti. 7o acct p•Anee [ >"l2; par.d,c Internet moil aduress: p otcn ;Zebui : odconlirac.com Honi'page: httii: / /www.buildin:cpdenraintcum 9 07/19/2002 10:11 3059451226 DOORSOUJRCE FACE 02 Daybar Industries Limited ACCEPTANCE No.: 01-0 APPROVED : August 2.1 2(101 EXPIRES Sept. 24, 2006 NO'S' CE v F d SYECIE'XC CONDITIONS 1. SCOPE I.1 This renews NOA # 98- 0528.02, which approves a steel door, as described in Section. 2 of this Notice of Acceptance, designed to comply with the South Florida Building Code (SFBC), 1994 Edition, for Miami -Dade County, for the locations wncre the pressure requirements, rs det^rmined by SFBC Chapter 23. do not exceed the Design Pressure Rating values, indicated ir. tile approved drawings. 2. Mt ODUCT DES C12.11, 71oN 2.1 The Series LSIS, Flush Outswing Commercial Steel Door- Impact Resistant and its components shall be constructed in strict compliance with the following docutncets: Drawing No }1P1D 0901, titled "Series LS18", Sheets i. through 5 of 5, prepared by manufacturer dated 05 -22 -98 and revised on 08- 21 -98, signed and sealed by Kelvyn Wh tfield, P.E., bearing the Miami -Dade County product Control ret?Gwa! st»rrip with tiie Notice of Acceptance number and expiration date by the Miasr.i- Dade County Product Control Division. These documents shall hereinafter be referred to as the appro ted drawings. 3. LIMITATIONS 3.1 This approval applies ro single unit applications of pair of doors and single door only, as shown in approver: drawings. Single door units shall include all components described is the active leaf of this approval, 3.2 Unit shall be installed only get locations protected by n canopy or overhang sa ch that the angle between ['.s- edge of canopy or r to sit( is Jess than 45 degrees. Unless unit is installed in non habiteb e arc :s where the uani.t and the area a.re designed !o n7-ccpt wz.tcr ina�ltration, 4. INSTALLATION 4.1 The commercial steel doors and its components shall be installed in strict compliance with the approved drawings. 4.2 Hurricane protection system (shutters): the installation of this unit oriel riot require a hurricane protection system. 5. LAl'iELING 5.1 Each unit shall bear a permanent label with the rnanvf:acturcr's riar;tc or logo, city, state and following statement: "Miami -Dade County Product Control Approved ". 6. BVILDISG ,FERMIT REQUIREMENTS 6.1 Application for building permit shall be accompanied by copies of the foilowing; 6.1.1 This Notice ofAcaeptarce 6.1.2 Duplicate copies of the approved drawings, as identified h Section 2 of this Notice of Acceptance, clearly marked to show the components sc;ccted rot the proposed instal ation_ 6.1..3 A.ny other do rcgaired by the Building 0111ciai yr the South Florida building Codc (SFI3C) in order to properlY evainate the installation of this system. •--"( I ,AK Raul Rodriguez, Chief Product Control Division. 7 e7/19/2002 10:11 3059451226 ACCEPTANCE: STANDARD CO,NYtl'1"t 1. Renewal of this Acceptance (approval) shall be considered a[er a renewal upplicct,an h:.s bee:, filed and the original submitted documentation, including' test supporting data, engineering &curnorms., are no older than eight (8) years. 2. Any and all approved products shall be permanently labeled with the manufachirer's dame, city, state, and the following statement: "Miar7i -Dade County Product Control Approved ", or as spccifi cei y stated in the specific conditions of this Acceptance, 3. Renewals of Acceptkutoc %%iil not be considered if: a) There has been a change in the South Flor;da Building Code affecting the evaluation of this product t.ttd the product is not in compliance with the code changes' b) The product is no longer thc same product (identical) as the one originally approved; c) If the Acccptar!ce holder has not complied with All the requirements of this acce.,tancc, including the. correct installation ale product: d) The engineer who originally prepared, signed and scaled the required docurnentatian initially submitted is no longer practicing the engineering profession. 4. Any revision or change in thc materials. use, und'or manufacture. of the product or process shrill automatically be cause for termination of this Acceptance, unless prior written, approval has been requested (through the filing, of a revision application with 'appropriate fec) and granted by this of iC :'. 5. Any of the following shall also be ;mounds for removal of this Acceptance; a) Unsatisfactory performance o f this product or process, b) .Misuse of this Acceptance as ell endorsement of any product, for sales, advcrtisirg or any other purpose. Davbar industries Limited ACCEPTANCE No_: 01- 0230.01 APPROVE L) . Aug1st 23200! EXPIRES S� tit. 24, 2f,tif DOORSOUFCE 6. The Notice of Acceptance cumber preceded by the words Miami -Dade County, i ioridn. and foliowcd by the e:cpiration date may be displayed in advertising literature. If any portion of the Notice of Acceptance is displayed, thr;t it shall be done irk its entirety. 7. A copy of this A.cccptance as well as approved drawings and other documents. .s hcv it appIi.,s, be provided to the user by the manufacturer or i;s distributors and ::hail be availah,e for inspection at the job site at 'all time, The engineer aced not reseal the copies. 8. Failure to comply with any section of this Acceptance shall be cause Fcr termination and removal of Acceptance. 9. This Notice of Acceptance consists of pages 1.2 and this last page 3. LEND OF THIS ACC>h l'TANCE /7 ,,-/" ' Rodriguez, Chief Product Control Division - 3 - PAGE 0 07/19/2002 10:11 MOM :059451226 DOORSOURCE MEMORANDUM Agenda Item No. 4(N) (Public Hearing 7 -11 _971 110110 . > Chairpca'4tin and Members Dart: May 20, 1992 stnty I v P.C. bulgy Manager svarntct: Yropomi tTNiflance Amending the South Florida building Code, 9 7.1 14 chapter 33 gr&agialaitati ' It b recommended that tb licard approve ties stitched Otdinance unending Subsection 3508.E (b) ( of Stec 35 (Cladding aid Olturuaaj) of the South Florida 8uild.og Codr (SPBC) to arcato qn exeepdon At she requlremeots of s wafer Infiltration test for all door arsrembliea Installed in ion - habitable mar, Thia item has been reviewed and tecouiroended by the Building Code and Prodtict Acvlow COrnmittae and tin Dutlaing Cock Compliancc wirawauaw The proposed ordiaxnce amends Subsection 3304.3 (b) (I) of Chapter 33 creating nn exception for the reluinmente of water indloration testigg fcr dcrrr asumblie, hutalled in non•habitable anal. The PrePcksed w(ception will bctp arpedite Use my few of such doors by providing for a rcalucUon in the assembly facing rcgvir inuats: it will also provide a cast savings 10 the indt$ tr1 by tlittioating the aced for this additional test ptocoklur lot door atsu®1nblia dcsigaod fur instillation of nott•habitable aces. This amendment will also provide the coneduetion insitutry with m appropriote exception for the many eases that require verttiltsleu of meter roocu, and Mao of the door pourer trtuuformer room by aeyetu4iiat. i s door wectr4bties, because aC fiat txistenoe of the vontiletion op g, will not pass the roquiremanls of the water Infdtretfon test Newevsr, bereuso tbe.zuas ire non- hebfta►bia, tifap iimittxi infiltration of water does not post any throat of to themes ammo or cue. By Wining this limited esception for ltt+sttilatiausl iio non.laabitable teas, we will not be undandating dos County's eoeuaitmesst of providing qualify eorutruction products which ant coat effective and tciieblo, FCGE 04 07/19/2002 10:11 3059451226 DOORSOURCE , 't(rt r i rt 1114.,MinUUJEi (REVISLO 19,4,1 GUES'it': (a) Itt connection with multiple - family Occupancies means a person hiring a room for living and/or Sleeping purposes. (b) do connection with single- fatnily and two-family Occupancies means e person sharing single - family accommodations without profit on those accommodations. GUEST HOUSE: (n) Ai a part of multiple- family Occupancies means a detached single - family dwelling occupied or intetadcd to be occupied for hire. (b) Asa part of a single- family and two- family Occupancies means a detached portion which provides rooms and necessary appurtenances for the sleeping . acconurtodation and/or entertainment of non- paying guests and Their servants,; but not 'provided with means for the general and regular serving ormoals. GUEST ROOM; (a) in connection with multiple family Occupancies means s roam in a building, occupied or intended to be occupied for hire (h) in connection with singie- facitily and two - family Ot;t.upancies means a room in the main or en accessory building occupied or intended to be occupied by non- paying guests. BITABLE ROOM' A room in residential ,zit used for hying, 6ieeping, Bating or co ta ng, but cxcluding baths, toilets, storage spaces or corridors. J�EIGIlI7, 1gULUM0: Ir► general, this term defines the vertical distance front grade to the highest finished roof surface of a flat roof or to the average levet of a gable, or nip roof, accept that with regard to the application of requirements for high rise Cif: protcctioo, the tent shall be defined as set forth in Chapter 37 of this Code. IIEICUT, STORY: The vertical distance from top to top of 2 successive floors or floor or root. HEIGHT, STRUC The height of a structure erected on the ground shall be the vertical distance from grade to the highest point thereof, and for roof structures shall he the vertical distance from the mean level of ►he roof to the highest point of such stnnctuse. In general, the height of a structure shall be the overall height. HIGH HAZARD; High Haratrd contents shall be classified as those which are liable to buret with extreme rapidity or rrom which poisonous fumes or exptasions are to be tested FAGE 05 07/19/2002 10:11 205945122E. D00RS0UFCE sTAYE or rimiluA VAUf t Y ) Ss, 1, 44AAYBY AMIN, Clerk et tilt Cireett C in and for bode County. �1oCddr*, sod ;t.d(ticlo Clerk of the board of County Co'm,i& Loneta of gmtcl Cewthr, m0 mu:sr C!>ATip'Y that the above torepoinw La a trvo i nd rorro _........� ..r _,.�,.... ad'hsArs o[ r eeoril, IN k17IMS WIMP, 1 Alva heroonto vet my land and otliclel seal on tbla lettt day off JOLT A.D. 199,, pP � . e moard of County Commltetotleto Dodo County, rlooLda BLMV'E7 AUVIN, Clark An and or County Commissioners wade county rlotlU4 FAGE 06 07/19/2002 10:11 3059451226 LOORSOLFCE &idiot 3., It is tlta intention of the Pound of County Cetnmislloner1, and it is hereby ogdained that the provisions of this ordinance shall become and berm& part of the South Florida >t�uilding Code, The section; of this ordinsnce rosy be rtoumbettd or relcnerrd to accomplish such Intrntton, and the word "ordinance" may be changed to "aectdosh, 4 articic~ or other opproyrsl0'te *oral. assiktd, `ht ordin*pae shah become effective tort (10) days after the data env; atadmcnt ;ales' vetoed by the Mryor, aged if mood, bvcorrc eflicrive ®ulv upon ac cvertid this board. kulioat This ordlnancc'doet nog ontain a sunset provision. PASSED AND ADOPTED: JUL 0 8 1497 Approved by Cow) Attorney u t0 form and te$si turiciancy: Prepared by; PAGE tit? Agenda Item No. 1 I N rage No, 2 07/19/2002 10:11 3059451226 DOORSOIJPGE ORDINANCE AMENDING TTIC SOUTH FLORIDA BUILDING CODE; CREATING, AN EXCEPTION FOR THE REQUIREMENT OF A WATER IMILLTRATION TEST FOR DOQRS INSTALLED IN NON ARBAS; AMRNDINO SECTION )308; PROVIDING SEVVRA$1LITY, INCLUSION IN THE SOUTH PLOR1DA BUILD/NO CODE AND AN EI° FECTrvE DATE ry �{,� p DE IT ORDAINED EY THE � 3OAJ 1) OF COUNTY COMMI3SIUN1 kS OF DADE COVN . FLQIUDA: fissnxi, The South Florida a uildini Coda, adopted by otditla,tcr urreradocl, da hereby Anther amended s3 follows :' 3308.3 DOOR>Ptc-e ANO OPRIRA,TIY,E WINDOWS IN EXTgR1011 WALLA (b) TESTS (I) Qperatlhe window p l door akesenabileo eha J be te,tad in accu�denc with Ow m uaat3 or Shia Paragraph, ANSIMAMA 101, and the forces! entrY'pterc;cl1ocu Iuirestra r of the Architectural Alugtailati 1 AsWCimuJn (AMA) Standards 1302,5 end 1303.3 . battik If any Malian, guingoign, senIcnr, Clause or prDvision of the vrdina,icc Ie hctd Invalid the >nnitaInder of lhla ordlnw►ce tall rat be attl ote i by sub ln raJIdlt , < rnttttit¢ t ur Nimble biltitaattn gall be dented. UbdsA word, I'uider >Y1krJbit oad lod. qba pa tone art no^�r in eKat Ltd atgf! nmtin PAGE 1'''- M I A M'DADE PRODUCT CONTROL NOTICE OF ACCEPTANCE PCT Industries 1070 Technology Drive Nokomis ,FL 34275 Your application for Notice of Acceptance (NOA) of: Series 710 Aluminum Horizontal Sliding Window - Non - Impact & Impact Resistant ✓ under Chapter 8 ofthe Code of Miami -Dade County governing the use of Alternate Materials and Types or Construction, and completely described herein, has been recommended I'or acceptance by the Miami -Dade: County Building Code Compliance Office (BCCO) under the conditions specified herein. This NOA shall not be valid after the expiration date stated below. BCCO reserves the right to secure this product or material at any time from a jobsitc or manufacturer's plant for quality control testing. If this product or material fails to perform in the approved manner, BCCO may revoke, modify, or suspend the use of such product or material immediately. BCCO reserves the right to revoke this approval, if it is determined by BCCO that this product or material fails to meet the requirements of the South Florida Building Codc. The expense of such testing will be incurred by the manufacturer. ACCEPTANCE NO.: 01- 0518.05 EXPIRES: 07/30/2006 / TIIIS IS T1IE COVERSIIEET, SEE ADDITIONAL PAGES FOR SPECIFIC AND GENERAL CONDITIONS BUILDING CODE & PRODUCT REVIEW COMMITTEE This application for Product Approval has been reviewed by the BCCO and approved by the Building Code and Product Review Committee to be used in Miami -Dade County. Florida under the conditions set forth above. APPROVED: 09 /13/2001 \ 1s04500011pc20001kemplateslnotice acceptance cover page.dot Internet mail address: postmaster @buildingcodconlinc.conl MIAMI -DADE COUNTY. FLORIDA METRO -DADE FLAGLER BUILDING (BUILDING CODE: COMPLIANCE: OFFICE: MI :'JRO -DADE FLAGLER BUILDING 1.10 WEST FLAGLER STRH r. sum 1603 MIAMI. FLORIDA 33130 -1563 (305) 375 -2901 FAX (305) 375 -2908 (:ONTItAC1'OR l.1cF:NSIN(: SECTION (305) 375 -2527 FAX (305) 375.2558 ( :ON'rRACI'OR ENFORCE: %tEN'r DIVISION (305) 375 - FAX (305) 375.2905 PRODUCT (.CONTROL. DIVISION (305) 375.2902 FAX (305) 372-6339 Raul Rodriguez Chief Product Control Division Francisco J. Quintana, R.A. Director fM lialni -Dade County Building Code Compliance Office 1Iomcpagc: http : / /www.buildingcodconlinc.com PGT Industries ACCEPTANCE No.: 01- 0518.05 APPROVED : SEP 1 3 2001 EXPIRES July 30, 2006 NOTICE OF ACCEPTANCE: SPECIFIC CONI)li'IONS 1. SCOPE 1.1 This renews the Notice of Acceptance No. 97- 1124.11, which was issued on July 30, 1998. It approves an aluminum horizontal sliding window, as described in Section 2 of this Notice of Acceptance, designed to comply with the South Florida Building Code (SFBC), 1994 Edition for Miami -Dade County, for the locations where the pressure requirements, as determined by SFBC Chapter 23, do not exceed the Design Pressure Rating values indicated in the approved drawings. 2. PRODUCT DESCRIPTION 2.1 The Series 710 Aluminum horizontal Sliding Window — Non - Impact and Large <<lissilc Impact Resistant and its components shall be constructed in strict compliance with the following documents: Drawing No 4111, Sheets 1 through 5 of 5, titled "HS -710 Aluminum horizontal Sliding Window," prepared by manufacturer, dated 11/13/97, revised on 5/8/01, signed and sealed by Robert L. Clark, P.E., bearing the Miami -Dade County Product Control approval stamp with the Notice of Acceptance number and approval date by the Miami -Dade County Product Control Division. These documents shall hereinafter be referred to as the approved drawings. 3. LIMITATIONS 3.1 This approval applies to single unit applications only, as shown in approved drawings. 4. INSTALLATION 4.1 The aluminum horizontal rolling window and its components shall be installed in strict compliance with the approved drawings. 4.2 Hurricane protection system (shutters): The installation of this unit up to 30 feet above grade, will require a hurricane protection system, but for installations above 30 feet above grade will not require a hurricane protection system. 5. LABELING 5.1 Each unit shall bear a permanent label with the manufacturer's name or logo, city, state and following statement: "Miami -Dade County Product Control Approved ". 6. BUILDING PERMIT REQUIREMENTS 6.1 Application for building permit shall be accompanied by copies of the following: 6.1.1 This Notice of Acceptance 6.1.2 Duplicate copies of the approved drawings, as identified in Section 2 of this Notice of Acceptance, clearly marked to show the components selected for the proposed installation. 6.1.3 Any other documents required by the Building Official or the South Florida Building Code (SFBC) in order to properly evaluate the installation of this system Mai net Perez, P.G. Prod ontrol Examiner Pro Control Division PCT Industries ACCEPTANCE No.: 01- 11518.05 APPROVI ?U NOTICE OF ACCEPTANCE: STANDARD CONDITIONS :—SFP 1 3 2001 EXPIRES .luIv 30 2006 I. Renewal of this Acccptancc (approval) shall be considered after a renewal application has been tiled and the original submitted documentation, including test supporting data, engineering documents, are no older than eight (8) years. 2. Any and all approved products shall be permanently labeled with the manufacturer's name. city, state, and the following statement: "Miami -Dade County Product Control Approved ", or as specifically stated in the specific conditions oI'this Acceptance. 3. Renewals of Acccptancc will not be considered if: a) There has been a change in the South Florida Building Code affecting the evaluation of this product and the product is not in compliance with the code changes; b) The product is no longer the same product (identical) as the one originally approved; c) If the Acccptancc holder has not complied with all the requirements of this acceptance, including the correct installation of the product; d) The engineer who originally prepared, signed and scaled the required documentation initially submitted is no longer practicing the engineering profession. 4. Any revision or change in the materials, use, and /or manufacture of the product or process shall automatically be cause for termination oI'this Acceptance, unless prior %vritten approval has been requested (through the filing of a revision application with appropriate fee) and granted by this oft ice. 5. Any of the following shall also be grounds for removal of this Acceptance: a) Unsatisfactory performance of this product or process. b) Misuse of this Acceptance as an endorsement of any product, for sales, advertising or any other purpose. 6. The Notice of Acceptance number preceded by the words Miami -Dade County, Florida, and followed by the expiration date may be displayed in advertising literature. 11 any portion of the Notice of Acccptancc is displayed, then it shall be done in its entirety. 7. A copy of this Acceptance as well as approved drawings and other documents, where it applies, shall be provided to the user by the manufacturer or its distributors and shall be available for inspection at the job site at all time. The engineer need not reseal the copies. 8. Failure to comply with any section of this Acceptance shall be cause for termination and removal of Acceptance. 9. This Notice of Acceptance consists oI'pages I, 2 and thirst page 3. Mama Perez, P. H., Product Control, Examiner Prodt ontrol Division END OF '1,11IS ACCEPTANCE 3 - 63.000 MAX r 74.125 MAX NON — IMPACT WINDOWS 1.) GLAZING: 3/16 ANNEALED 2.) CONFIGURATIONS: XO or OX 3.) DESIGN PRESSURE RATING: SEE COMPARATIVE ANALYSIS TABLES ON SHEET 3 4.) ANCHORS: SEE COMPARATIVE ANALYSIS TABLES ON SHEET 3 5.) SHUTTER REQUIREMENT: SHUTTERS ARE REQUIRED AT ALL INSTALLATIONS 6.) REF. TEST REPORT FTL -1820 ELEVATION U1RCE MISSLE IMPACT WINDOWS 1.) GLAZING: 3/16" SENTRY CLASS 2.) CONFIGURATIONS: XO or OX 3.) DESIGN PRESSURE RATING: +55.5 P.S.F.. - 55.5 P.S.F. 4.) ANCHORS: MAX. 6" FROM EACH CORNER 2 ANCHORS 4" APART. 4" FROM EACH MEETING RAIL MAX. SPACING AT HEAD & SILL: 12.000 MAX. SPACING AT JAMBS: 12.000 5.) SHUI7CR REQUIREMENT: NO SHUTTERS REQUIRED 6.) REF. TEST REPORT FTL -1821 1 N0. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 NON — IMPACT WINDOWS 1.) GLAZING: I /4" TEMPERED 2.) CONFIGURATIONS: X0 or OX J.) DESIGN PRESSURE RATING: +55.5 P.S.F., - 55.5 P.S.F. 4.) ANCHORS: MAX. 6" FROM EACH CORNER 2 ANCHORS 4" APART. 4" FROM EACH MEETING RAIL MAX. SPACING AT HEAD & SILL; 12.000 MAX. SPACING AT JAMBS: 12.000 5.) SHUTTER REQUIREMENT: SHUTTERS ARE REQUIRED AT ALL INSTALLATIONS 6.) REF. TEST REPORT FTL -1819 DESCRIPTION FLANGE FRAME JAMB FIXED MEETING RAIL SASH TOP RAIL SASH BOTTOM RAIL GLAZING BEAD - 1/4" WINDLOAD ADAPTER FLANGE FRAME HEAD FLANGE FRAME SILL FRAME SILL .ADAPTER SASH TOP & 80T. RAIL SCREEN RETAINER 3/16" Annealed Gloss 3 /16" Ann. Gloss ./Dupont 457 1,e4" Tempered Gloss 1 x /2 "x 3" OPEN CELL PAD 16 x 1.000 PH. PAN SMS 18 x .375 PHIL. P.H. TEK 18 x .500 PHIL. Fl SMS ¢ x 1.000 PHIL. P.H. SMS SWEEP LATCH WEEP HOUSING WEEP FLAP ROLLER HOUSING BRASS WHEELS Wstp. - PfLE FINSEAL SILICON WEATHERSTRIP, BULB VINYL Wstp., THIN WALL BULB VINYL ANT! -LIFT CHANNEL 1x3 /4 "x 1/4" OPEN CELL PAD 31 Wstp. THICK WALL BULB VINYL Ro i 7 ' °r L. C ark. P.E. PE 139712 l'�nirl��ral V.T. # 612225 612228 612229 612230 612234 612236 612237 612238 612239 612240 6532377 76X1PPA 78X38PPT 7856A 781POA 71096 70250 70251 71092 7BRWHL2 61062W 62899 6TP249 6TP247 612244 FAT INDUSTRIES 1070 TECHNOLOGY ORNE P.O. BOX 1529 NOKOMIS. 71 34275 NOKOMIS. FL 34274 VENDOR ALUMAX ALUMAX ALUMAX ALUMAX ALUMAX ALUMAX ALUMAX ALUMAX ALUMAX ALUMAX ALUMAX PPG. LOF lam. by Romoq. Vericom PPG. LOF MERCHANTS FASTENER MERCHANTS FASTENER MERCHANTS FASTENER MERCHANTS FASTENER MIN. DIE CASTING MASTER TOOL MASTER TOOL MASTER TOOL TEAM PLASTICS 6TP248 TEAM PLASTICS Rene By Ir : F.K. 7/1 1/01 Onion B. D.B. Cnee OAK 11/13/97 Sn tsNaaet HS -710 OTY. /LOCATION 2 1 1 1 1 1 1 2 1 3 ( each weephole) A 1 Anti-lift Channel 4 Windfood Adopter 4 Sweep Latches) 2 (meet.rail 11 1/2 from ends 3 ( , 5 72.25" from ends, 1 0 cen. 3 2.25" from ends, 1 0 cen. 2 10 ea. end of vent bottom VINYL- TECH /P.G.T. 2 per Roller Housing. SCHLECEL CORP. Vent top /bot. & meet. roil DOW CORNING TEAM PLASTICS Vent iamb Glozinq Beod (Sentry, 1/4") 1 (frame head 0 vent midspon) 2 (10 eo. end of meet. roil) Oozing Beod (3/16 ") REVS 0.B. 6/9/98 REVSO: F.K. 5/8/01 scar: NTS Sneer 1 s1 5 BY VENDOR# AF -12225 AF -12228 AF -12229 AF -12230 AF -12234 AF -12236 AF -12237 AF -12238 AF -12239 AF -12240 532377 PGT 214. XX 7 -M10 -250 7 -M10 -251 70312 FS7826 -187 899 TP -249 TP -247 . ALUMAX AF -12244 TP -248 APPROVEO AS COurt.mtd PAM IN[ a TM EP 1 L t oDE ROL DIVISION COMPLIANCE OFFICE ACCEPTANCE 140.0 1 - O 1 C • OS 04 se HoGon: ELEVATION VIEW — IMPACT (XO) Nile: ALUMINUM HORIZONTAL SLIDING WINDOW Oro.i05 No. 4111 Re". 63.000 MAX 58.250 MAX DAYLIGHT OPENING 2.710 ROUGH OPENING ROUGH OPENING VERTICAL SECTION .500 2.710 2.094 .500 57.000 MAX DAYLIGHT OPENING REFERENCE: FTL -1819, FTL -1820 & FTC 1821 ROUGH OPENING 2.784 CORNER DETAIL BUTT JOINT .705 GLAZING OPTION: 3/16 ANN. 33.625 MAX DAYLIGHT OPENING j y y 6/ Robert . Clark. P.E. PE 939712 Structural 2.643 74.125 MAX HORIZONTAL SECTION INDUSTRIES rut: 33.625 MAX DAYLIGHT -.- OPENING GLAZING OPTION; 3/16 ANN. w /DUPONT DttcnPNpn: 1070 TECHNOLOGY DRIVE P.O. BOX 1329 NOKOMIS. FL 31273 NOKOMIS, FL 34274 GLAZING OPTION: 1/4" TEMP. 2.784 SECTION VIEWS - IMPACT (XO) .500 ROUGH OPENING APPROVED AS COMPLYING WITH TIf BY PROD CT C IJTROI GMSKXI BIPIDRIG CODE COMPUANCE OFFICE ACCEPTANCE NO U I' VS 15S • US ALUMINUM HORIZONTAL SLIDING WINDOW Smits /Mpda: Scow SM.I: Oro.inp N. rS -7TO NTS 2 pr 5 4 1 1 1 R COMPARATIVE ANALYSIS FOR GLASS: 3/16 ANNEALED FTL- 1820 MAX- SIZE NOTES: 1.1 Numbers in (1 parentheses are quantity of anchors per side 74.125 x 63.000 2.) Negative Design Loads based on Comparative Analysis and Glass Table ASTM 61300. 3.) Positive Design Loads based on Comparative Analysis and Water Test Pr re . 4.) Numbers are for 612 screws or 114' Tapcans. S.) (1) anchor 4' from each side of meeting rail is required. (Total of (2) anchors at each meeting rail.) Anchors 6' from each comer and as follows: Max. apse ng at head & 5111 a 15.250' Max. spacing at Jambs • 12.500' Window Width 24.000 (4) 26.500 (4) 37.000 ( 48.000 (4) 53.125 (6) 60.000 (6) 66.000 (6) 72.000 (6) 74.000 (6) Window Height 26.000 (2) neg - 120.00 . 120.00 - 120.00 - 120.00 - 107.70 45.90 -73.10 43.50 -60.90 pas 66.67 66.67 66.67 68.67 66.67 66.67 66.67 63.50 60.90 38.375 (3) neg - 120.00 - 120.00 - 120.00 -89.30 -60.30 -72.30 -67.30 -58.60 -55.50 pa s 66.67 66.67 66.67 66.67 66.67 66.67 66.67 58.60 55.50 50.625 (4) neg - 120.00 - 120.00 - 107.10 -67.60 -58.40 -53.20 -49.60 -47.30 46.50 poi 66.67 66.67 66.67 66.67 58.40 53.20 49.60 47.30 46.50 63.000 (5) neg - 120.00 .120.00 -91.90 -57.20 -48.00 -41.10 -38.10 -36.70 .36.50 po i 66.67 66.67 66.67 57.20 48.00 41.10 36.10 36.70 36.50 REFERENCE TEST REPORTS: FTL-1819 & FTL-1820 Ruben L Clark. P.E. PE 039712 Structural COMPARATIVE ANALYSIS FORT GLASS: 1/4 TEMPERED FTL- 1819 MAX. SIZE NOTES: 1.) Numbers Intl hazes are quantity of anchors per side 74.125 x 63.000 2.) Negative Design Loads based on Comparative Analysis and Glass Table ASTM 61300. 3.) Positive Design Loads based on Comparalive Analysis and Water Tint Pressure. 4.) Numbers are for 612 screws or 114' Tapcons. 5.) (1) anchor 4' from each side of meeting rail Is required. (Total of (2) anchors at each meeting rail.) Anchors 6' from each comer and as follows: Max. spat ng at head It 3111 a 15.250' Max. spac ng at Jambs • 12 500' Window Width 24.000 (4) 26.500 (4) 37.000 (4) 48.000 (4) 53.125 (6) 60.000 (6) 66.000 (6) 72.000 (6) 74.000 (6) Window Haight 26.000 (2) nag - 190.00 - 190.00 - 190.00 - 190.00 . 155.30 - 123.90 - 105.30 -91.60 -87.80 pa s 66.70 66.70 66.70 66.70 66.70 66.70 66.70 68.70 66.70 38.375 (3) nog - 190.00 - 190.00 - 190.00 - 190.00 - 155.20 - 121.70 - 100.60 -84.50 40.00 pas 66.70 66.70 66.70 66.70 66.70 66.70 66.70 66.70 66.70 50.625 (4) nag - 190.00 - 190.00 - 172.10 - 142.10 - 132.80 - 121.70 - 100.60 -84.80 -80.00 pas 66.70 66.70 66.70 66.70 66.70 66.70 66.70 66.70 66.70 63.000 (5) nog - 190.00 - 190.00 .132.50 - 107.60 -99.70 -91.50 -65.80 •61.30 -80.00 pa s 66.70 66.70 66.70 66.70 66.70 66.70 66.70 66.70 66.70 INDUSTRIES Rend 8r: te: F.K. 7/11/0 Oro.. B O. B. 1070 TECHNOLOGY MIME P.O. BOX 1329 NOKOUIS. FL 34275 NOKOMIS, F2 34274 CIWa By: r14: 0. ( /13/97 S.lic /u•e.r HS -710 14. REVSO: D.B. 6/9/98 REVSO: F.K. 5/8/01 544.: NTS Sh..I: 3a5 APPROVED AS COYPLYINC Mt5*11k 500TH FLORIDA BUILDING CODE OA BY PR .+ . . TROIOVISON BUILDING CODE CA4PUANCE OFFICE ACCEPTANCE N0('(' ( (. -O S Orrcnploo COMPARATIVE ANALYSIS - 3/16A & 1 /4T fue: ALUMINUM HORIZONTAL SLIDING WINDOW 044.4nq No. 4111 1 ° . . • • 11 . .li 1.250 s v • • TYP HEAQ TYP l 1.250 1 x WOOD BUCK .250 MAX. 1 /4 • TAPCON SEE SPACING ON SHEET 1 I/4' TAPCON SEE SPACING ON SHEET 1 .250 MAX. REFERENCE: FTL -1819, FTL - 1820 & FTL - 1821 TYP. 5111 r .250 M AX. /12 PANHEAO SEE SPACING ON SHEET 1 /12 PANHEAD SEE SPACING ON SHEET 1 .250 MAX. r � 1.250 2 x WOOD BUCK ,, // Robe L. Clark, P.E. PE 039712 Structural INDUSTRIES TYP. .14118 R..sa B,. F.K. Drown e • TYP. JAMB D.B. 1070 TECHNOLOGY DRIVE P.0. BOX 1329 NOKOMIS, P1 34275 NOKOMIS. 11 34274 e• FI S EE /12 PANHEAO SPACING ON SHEET 2 x W000 BUCK ANCHORAGE •- 1.2501 • • • 1 x WOOD BUCK 0.1.. CM4 B,: 7/11/01 1.250- Dot.: 1 7/13/97 1 /4 • TAPCON SEE SPACING ON SHEET 1 R.. en.: REVSO: F.K. 5/8/01 REVSD: D.B. 6/9/98 APPRCNEU AS COUPLnNG VAN THE SATE �I.6 R9A 3u�CODE Br 7/9 , — P90 T •NI ROLOIVI$ION CUIL . 1 0 CODE COMPLIANCE ACCEPTANCE NO01 •nS T. r.: ALUMINUM HORIZONTAL SLIDING WINDOW 5.6o/uoe.e Sca.: Sf..c Ma..nq Ne. 41 1 1 HS -770 NTS 4 a 5 ---1 .705 .062 2.784 L --1 �-- . 737 0 FLANGE FRAME 6063 - T5 ALUM. .678 . 1.057 Q 1/4" GLAZING BEAD .062 1.187 --I E-- 4 2.074 1.349 .062 J 9Q FRAME SILL ADAPTER 6063 - 73 ALUM REFERENCE: FTL- 1819, FTL -1820 & FTL -1821 .062 II I - .723 .688 -- ^i .062 © WIND LOAD ADAPTER 6063 - T5 ALUM. 1.403 20 FIXED MEETING RAIL 6063 - T5 ALUM. ® SASH TOP & BOTTOM RAIL 6063 -T5 ALUM. 1 .062 1.187 1.081 ---I �---� SASH TOP RAIL 6063 -T5 ALUM. L i .062 1.373 1.273 �F - 2.710 -I 0 FLANGE FRAME HEAD 6063 -T5 ALUM. it,/1 r INDUSTRIES I Ro en 4 nark, P.E. PE 139712 Structural 1070 1rc.NOLOGY OWE NOKOMIS. rt 34275 R..ae 8y: t.: CAW Br: F.X. 7 /ii /01 1.970 ® SASH BOTTOM RAIL 6063 -T5 ALUM. Dote: Oro. n F.K. mt.. 5/8/01 DeKnipnon: EXTRUSION PROFILES 1.291 1 .062 - III- -- 1.349 l 2.094 1.122 ` 1I 1 1 k 2.710 �1 ® FLANGE FRAME SILL 6063 -T5 ALUM. R..:arona: REVSD: F.K. 5/8/01 REVSO: 0.8. 6/9/98 APPROVED AS COMPLYING YMI11 THE SOUTH EP LU�OL I EY fR TCO ROLOMSIOR MI CODE COUPUANCE OF ACCEPTANCE NO.01 - rstQ• US rtw: ALUMINUM HORIZONTAL SLIDING WINDOW Sen.a/Maeee Seale: Snuc Wo..p No. P.O. 805 1529 NOKOMIS. FL 34 27. HS - 710 NTS 5 °r 5 41 1 1 s STATE OF FLORIDA) COUNTY OF DADE) The undersigned Affiant, tviYve e. , does hereby attest that the (property owner) attached survey, performed by i Q S . 1 jt-D•• . L .S , L(Nr S \A-v- v e ors (name of surveyor's company) 1 C; V : \ is an accurate representation of the existing conditions and date o survey) performed on locations of all structures on the property as of this date. The purpose of this Affidavit is to induce Miami Shores Village to issue a building permit for the property without first providing a survey less than six (6) months old. The Affiant, as property owner, further agrees to remove or obtain permits for any structures which now may exist on the property which are not permitted or which may violate zoning or building code regulations. The Affiant further understands that the existence of any such structures may affect final inspections as applicable to this or other permits.. Further, Affiant sayeth naught. Witness(sign and print) • 7/ SI2ori AFFIDAVIT SWORN TO AND SUBSCRIBED before me this day of G .o AffiantfPr• %owner Witness(sign and print) Affiant is personally known to me, produced as identification. Notary WARRANTY DEED STATUTORY F. S. 689.02 'tnesset y That the sai parties of the first part, for and in consideration of the sum of Ten dollars and other good and valuable consideration Dollars, to them in hand paid by the said parties of the second part, the receipt whereof is hereby acknowl- edged, have granted, bargained, and sold to the said parties of the second part, their heirs and assigns forever, the following described land, situate, and being in the County of Dade State of Florida , to -wit: Lot 13, Block 3, of BAY LURE, according to the plat thereof, recorded in Plat Book 44, Page 63, of the Public Records of Dade County, Florida. L9 .8ED 85R393987 .••• - RAMCO 'POR'M 5 (PHOTO) OFFC. . 2T34Pc 1 631 This 1iidtiitiu kE Made this /t M1 day of December • A. D. 19 85, Between Michael Namour and Danuta Namour, his wife of the County of Dade , in the State of Florida , part ies of the first part, and Donato Masucci and Renee J. Masucci, his wife of the County of Dade , in the State of Florida 1256 N.E. 92nd Street, Miami Shores, Florida 33138 part ies of the second part, Subject to: 1. Taxes for the year 1986, and all subsequent years; 2. Restrictions, reservations and limitations of record, if any; 3. Easements of record, if any; 4. Mortgage in favor of Atlantic Federal Savings and Loan Association of Ft. Lauderdale, recorded under Clerk's File No. 76R- 81240, on April 16, 1976, having an approximate balance of $ 48,080.26 , which the grantees herein assume and agree to pay. Signed, se STATE OF FLORIDA, COUNTY OF DADE 8 6 &D Documsntsry stamps Collective Dodo CoOTtty +tIchard P. Brinker ( ; (011 4Cliculti0Coun - Cowrie And the said part i of the first part do hereby fully warrant the title to said land, and will defend the same against the lawful claims of all persons whomsoever. �n witness whereof, The said part ies of the first part ha ve hereunto set their hand s and seals the day and year first above written. ^ d deliu red in presence of: } CHAEL NAMOUR ® DANUTA NAMOUR , whose post office address is alcORDlo IN OFFICIRE 080104 DOM Of OW C0UNTr, NOW A. RECORD VEI8F1ED RICHARD R. BRISICEIC CLERK CIRCUIT GOUT ; '41 I HEREBY CERTIFY that on this day, before me, an officer duly authorized in the State aforesaid and in the County aforesaid to take acknowledgments, personally appeared MICHAEL NAMOUR and DANUTA NAMOUR, his wife to me known to be the persons described in and who executed the foregoing instrument and before me that they executed the same. WITNESS my hand and official seal in the County and State last aforesaid this December, A. D. 1985 r n ?! , n , ti,,.t.r! t7'1 ., 11, r l nn T')R Qt't t;001, L ?. ULC 24,1'221 i Pv"'dx' 1N n t;: A:: L 1MS. L'"D. This Insirumeni prepared by: Address Miami, FL 33131 (305) 577 -0500 they acknowledged day of NOTARY PUBLIC „ 'Stf3te o , gF Q � - T_ SCOTT WEISBURD, ESQ. � y UG L'C LAW OFFICES OF SCOTT WEISBURD, Suite 900 Peninsula Office Building 200 SE First Street at Large Legal Description 1 OS 6 . Lute L t J - istorically Designated: Yes No Master Permit # 1 4 1 5 - ` 7 Owner's Address ) a`c (s) Phone 15S, s tY7 Owner/Lessee / Tenant -1 R e t,e, .r, "bel`ryi • �, t�.c�..l Contracting Co. DvLi A l C Address Qualifier SS# Phone State # Municipal # Competency # Ins. Co. Architect/Engineer Address Bonding Company Address Mortgagor Bc44ZA -VMA Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN PERMIT APPLICATION FOR MIAMI SHORES VILLAGE Job Address JS(n N ,E .cia . Tax Folio I I -3bS -6a7-0s( Square Ft. affore,k 1 0 b , . Estimated Cost (value) ik : 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. G7B.eC..... FEES: PERMIT 11 0 - RADON Signature of owner and/or Condo President Date Address Signature of Contractor or Owner - Builder Date Notary as to Owner and/or Condo President Date Notary as to Contractor or Owner - Builder Date My Commission Expires: —(9 -9' 7 My Commission Expires: /r. v C.C.F. I • NOTARY S BOND TOTAL DUE V kO • APPROVED: Zoning Buildin:/ `" ` Electrical Mechanical Plumbing Engineering • - PERMIT APPLICATION FOR MIAMI SHORES VILLAGE Date 2 AZ 93 Job Address 42 /0E /oC a,( T Tax Folio 1/ So, O .co?7 OS 00 3 Legal Description /, 0 Rey Are Owner / Lessee / Tenant 6Ona 11 ter Permit 4� So BCC %o /Jnee Master 9 Owner's Address ,� � Scz °f Phone 7c X8"3 7 Contracting Co. / 4 �M 2 vc 7o- C. Address '5/9/ 4/6 /Job ~ ' S, T Qualifier .�uis /r'v i U SS# / Phone State # <. l roZ Municipal # Competency # /R'3%.' Ins .Co. Architect /Engineer ' 6s//neir A-r,,L> �1 Ve/ 6,/ /Gd'p C' 6 ) Bonding Company V Address Mortgagor Permit Type(circle one WORK DESCRIPTION 1 .7041r /or \io/47 (See f ore(/' Parwe,`1 fe't\i S?c9 1A/tr 5 0Mk Estimated Cost(value) /.e • -o C) Square Ft. A /s 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 laws regulating construction and zoning. Furthermore, I authorize the above-named contractor to do the work stated. 4404-7a4 Signature of owner and /or Condo President Date: Notary as to Owner and /or Condo President My Commission Expires: APPROVED: Fire Zoning Building Address yd c Address ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN Date: re o ' Co t . 7/0 k e .0 ear, /✓J2 oc.G/ 6 /es. or Owner- Builder Notary as to Contractor or Owner- Builder My Commission Expires: * * * * * * * * * * * * * * ** FEES: PERMIT 1 )0;5 '1 5 RADON C.C.F. NOTARY TOTAL DUE' 15 Other 111/ (7 Electrical Mechanical Plumbing Engineering - PERMIT: APPLICATION FOR MUNICIPALITIES OF DADE COUNTY (OWNER TO RETAIN COPY) Date 4/ Job Address /t7 %-2 ' ° Tax Folio // .3sZ D - off 0 6 J Qa,1 Legal Description i3 1 Owner / Lessee / Tenant 10nafo /1e #ee, , / 4 ' a s u c c l Owner Addre /v2 6 /V• Cy. 9,72 8 " ( ,C c t Contracting Co. On G fq g Luc a--,,,. Qualifier 0 J State Ite/ /H. Municipal 12 .. o vert -c4) 6s 1, Mc i q (4rc4) y / tV via CoAd�o P• E. 07) Architect /Engineer Bonding Company of wne and /or Date: 6 0202 ar as to Owner and /ppAR • ' 41oA 4 iced Commission Expires: Type and number of jr DID take an oath, or ** * * * * ri, DID bfOT tak* an oadi,* Zonin SS# Phone P7, 8`7'8? Competency Mortgagor Permit Type(circle one):( BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGP WORK DESCRIPTION efoa,J• �.or ( / Disf Square Pt. 4,p, /BOO 14 Estimated Cost(value) /.2 06" O a W !! WARNING TO IER: YOU MUST RECORD A NOTICE OF COMMENCEMENT AND YOUR FAILURE TO DC SO MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY (IF YOU INTENL 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, anc 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 acc be done in compliance with all applicable laws regulating onstruc 'on • t r pHild re, authorize the above -named contra or to do the work - ed �� 1 ;� t4 • ry Public, State of Honda a � i,? Commission Exp. April 30, 1996: o. CC197545 �'.� .. .31Ct • r -- I OM, it. A —.16 Date: ractor or Owner -Bui •er FEES' PERMIT ‘41) '5'6 RADON C.C.P. /' SO NOTARY TOTAL DUE 1 V1 (6 ! 5 APPROVED: r Address Master Permit Phone 7- M37 Address - A' g. /',3„3 Va ns . Co . g900 S. ade /� 6/J Address rol0 S.CAL 37 -r C7` Address tary as to Conti'metcitrionvegfertPaiiicl �.� My Commission Expff & numb, of !_.9. produced ❑ DID rake an oath, or * 74. DID NOT talsi an oath Other Electrical ** Mechanical Plumbing Engineering Legal Description Architect /Engineer Bonding Company WORK DESCRIPTION Signature o Date: PERMIT APPLICATION FOR MUNICIPALITIES OF DADE COUNTY (OWNER TO RETAIN COPY) Date (00/ 94 Job Address I3 1 Owner / Lessee. / Tenant loilAcCto Owner's Address /o20 Al l>. 9,2 " `� Contracting Co . Da G qir . g rue �o•w� �N c• Qualifier A//..S nevi/ //0 J Zonin ddc 4 Pv fi v ems/ L Mortgagor Permit Type(circle one ):B BUILDING 3,tt r oor be done in compliance with all applicable laws regulating onstruc authorize the above -named contra or to do the work 01 tiw EM " ar i as to Owner and /PNrsocf.Rf}' Rotbi .4e need f.D. Commission Expires: Type and number of I 1� Qdr�ced: DID rake an oath, or ** * * * *M. DID 114tale* OT tale* au oath.* FEES: PERMIT \11-1)1 5'6 RADON APPROVED: * C.C.P. Fire Mechanical Plumbing Tax Folio // ,,. ,Z� aZ 7 ,06 .j • AotSucc7 Master Permit # 1 \ Address �o//4 E. (� 1 I'So NOTARY Phone ;ST' 8T-87 Address 4'47 A' K "J,� A l S ss# Phone P�15 8 Y State 4�1� /'/ �� Municipal # , A s / r h e r ✓' 4 (Arco) 84 S . Avl a de / / � e� Competenc # /e' ?F f Vlns . Co . �� o ? 8'ao S. W. 37' Cy: (/ Address Address ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING PENCE SIGN Square Pt. PTp,A / . /S O )J Estimated Cost(value) X2 5� � WARNING TO OWNER: YOU M UST 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, ROOPING and MECHANICAL WORK. OWNER'S AFFIDAVIT: I certify that all the foregoing information is acc-- ,. * OA, rs� b r pHIRb more, ' N . ry Public, State of Florida Commission Exp. April 30, 1996 o. CC197545 mid 14 ales$ 'allgnd AJeloN . f i 830183 3NINd3SOr ° ;P ed i_ at Date: tary as to Conti'acwc v terW0 ifettBiiii 8r.ai My Commission Exp >F SS': number of I.1�• produced: ❑ DID rake an oath, or * * * *)'''. DIDIOT tali an oath ** Other and that all wnrk wi l ractor or Owner -Bui •er TOTAL DUE 1 V1 46 ! 5 a Electrical Engineering Application is hereby made for the approval of the detailed statement in 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. ./f/_,-. /7 19.21 Owner's Name and Address .. 4e.% t / f ' .... /(d' S _ No.../2.1 . Str - n Registered Architect and /or Engineer \‘ &A' //0.. . / 77 -1)4 ,LI��,.., " .. . DV. .-C� Name and address of licensed contractor ... 4/i/ ... / /2 ....._. // _ � U/e _5(-.5-z-- /envt_. Location and / d Ic al description of lot to be built on: �� p a , ,p Lot . Block 3 Subdivision... /& Y LJglc ..._l.Il4 -7 Vi o!Z 4" / !!4- 6 C _ Street and Number where work is to be done f.2. • 5.,�.: �, ._.. - - . State work to be done nd purpose of buildin (by floors) !C.4c-. .' 2- ,Q. - zir.6..<._ Maximum live load to be borne by each floor MIAMI SHORES VILLAGE APPLICATION FOR BUILDING PERMIT BUILDING INSPECTION DEPARTMENT Disapproved Date (Signed) Date and for no other purpose. New Bui!ding Remodeling A�d /lion �� R � e ,, pai ir rs , No. of Stories......._ / }�K To be constructed of 40 s i n d of foundation C._d &C'' T 0...L�IiI.G_1e��... Roof Covering 4/.e/. G ..._• -_ Estimated Total cost of 1 Zone cubage required /�— . ��77 Distance to next nearest building/. t/2 7 �n.GZ.�. /.7NL �A 6141,ilding Lot d ` ?c,_./ Z pro $ ,,,J�..C/.4,.i ®o Amount of Permit $. 2 / 5. 1.O0 �oc� l =.cx t2g:,Q /es: I hereby submit all the plans and specifications for said ui ding. All notices with reference to the building and its construction be sent to.. /�.. a� , 45 /2..5.6.._ .. ..t ... (.�/ Z'...hr.a..r.- fe The undersigned applicant for this huild'ng permit does hereby certify that he understands and accepts hi : • '• tions as an employer of labor under the 'Florida Workmen s Conit cation Act, being Section 5966, Compiled General Laws of o Yrr• .rrp ilrrnent, and has complied slits, the provisions thereof, . d will require similar compliance from all contractors .- contra•''% ployed by Trim in the or to th Act will post or cause es to employ such su o : oa work.— %• r�rmed public nothis permit, as are licensed by Miami Shores Village. Remarks _._. (Signed). may 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 � LX are , �true. Permit No..._ Date / / ..............___ Read, Sworn to and Subscribed before me. Notary Public, State of Florida Building Inspector My Commission Expires PLANNING BOARD DATE Cirair:nan Member \Icrr,ber Member \tembcr .. .. 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 hecn obtained fmm the 1'I,rnnir.;; Board. A re inspection Ice of 51.00 will be charged when such re- inspection is made necessary by improper notice for inspectitm or faulty materials and /or workmanship. Apt lication is hereby made for the approval of the detailed statement of the plans and specifications hcrrwith submitted for the build in¢ 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 � 9 G� Date (fit s _ , 19/ J OuTCr's Name and Address . J� �,.r �..g � Street/1i' a..- Registered Architect and /or Epslncer ,,.,. -""Tai 1 , "' - �p - 'r' ^ � `'• Name and address of licensed contractor Location and legal description of lot to be built on: F::. -- -, e "~'' ----- ` Lot Block Subdivision. Strut and Number where work is to be done State work to be done and purpose of building (by floors) APPLICATION FOR BUILDING PE • 3,/ 0 0 and for no other purpose. New Buiiding v Remodeling Addition... .... .. .._ .. Repairs No. of Stories To be constructed of Kind of foundation Roof Covering I Estimated Total cost of improvements $...._ . Amount of Permit g,. Zone cubage required flan Cuhage .... 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. be dent to_ . ._. .. . The umlersiened applicant for this building permit does hereby certify that he understands and accepts his obligations .is an employer of ;.ihur under the Florida Workmen's Compensation Act, being Section 5!)()6, Compiled General Laws of Florida, Permanent Supplement, clement, and has complied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors employed by him in t!:c work to be performed under this permit; and will post or cause to be for 145, ion on the site of the work such public notice or notices as arc required by the Act. The undersigned agrees to employ o u actors, on work tt be performed under this penal , as are licensed by 'Miami Shores Village Remarks (Signed STATE OF FLORIDA, COUNTY OF DADE. j ss. 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 Permit No 6 l Date ki /A) Li 9 Read, Sworn to and Subscribed before me. Disapproved ..p �.... Date Notary Public, State of Florida (Signed) Building Inspector Chairman Muml,er Member Council Approved . Date MIIAM0 SHORES VOLLAGE BUILDING INSPECTION DEPARTMENT PLANNING BOARD DATE MIT All notices with reference to the building and its construction may to me well known, My Commission Expires Member Member Member Disapproved ..................... .. Date NOTE: A ch.i of $1.00 will be made for making corrections or changes to this application after approval has lxrn obtained from the Pi.uu,u,� l;u.ucl A ri h-e of 51.00 will be charged when such re- inspection is made necessary by improper notice for inspection oz faulty materials and /or workmanship. UILDING :LECTRICAL LUMBING OOFING )caner of uilding rchitect ontractor Builder _:gal escription ddress of gilding Lot MIAMI • SHORES VILLAGE. FLORIDA ❑ DATE 195 ❑ PERMIT N? 2654 Contractor's License No. ❑ Work to be performed under this Permit Bl Subdi- vision Value of Project $ Amount of Permit $ This permit is granted to the contractor or builder named above to construc the building or to install the equipment or device described in the application :refor in strict compliance with all ordinances pertaining thereto and with the understanding that the work will be performed in compliance with any plans, awings, statements or specifications that may have been submitted to and approved by the proper municipal authorities. This Permit may be revoked at any fie if the work is not done in compliance with such ordinances or if the plans are changed without authorization. A further condition upon which this permit is anted is the understanding that the contractor or builder named above assumes the responsibility for a thorough knowledge of the ordinances and regulations -rtaining to the work covered hereby whether shown on the plans or drawings cr in the statements or specifications and that he assumes responsibility for work .ne by his agents, servants or employees. Signed. BY INSPECTOR In consideration of the issuance to me of this permit I agree to perform the work covered hereunder in compliance with all ordinances and regulations , rtaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In ac- piing this permit I assume responsibility for all work done by either, myself, my agent, servant or employee. CONTRACTOR OR BUILDER BY AUTHORITY a t` _ Owner's Name and Address Street and Number where work is to be done Disapproved ( Signed) 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 Date Registered Architect and /or Engineer Name and address of licensed contractor Location and legal description of lot to be built on: Lot Block Subdivision State work to be done and purpose of building (by floors) / 1A 1 6— " - Q 0-1 A- S A2 c) c and for no other purpose. New Building Rernodeling.. Addition Repairs No. of Stories To be constructed of Kind of foundation e- CAA^ `t" , --U 'Roof Covering o� Estimated Total cost of improvements $ 01 O n 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 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 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) ( x , 19,s • X S Co Street STATE OF FLORIDA, I COUNTY OF DADE. j 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. Q� Permit No ..20 D Date ..__P Read, Sworn to and Subscribed before me. Notary Public, State of Florida uilding Inspec Commission Expires LANNING 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 51.00 will be charged when such re- inspection is made necessary by improper notice for inspection or faulty materials and /or workmanship. 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, whet herein specified or not. A copy of approved plans and specifications must be kept at building during progress of the work. New Building STATE OF FLORIDA, COUNTY OF DADE. j ss Owner's Name and Address.... . Registered Architect and /or Engineer and address of licensed contractorrL 7 La�!�Ls Location and legal description of lot to be built on: Lot / 3 Block � /1S b�� Street and Number where work is to be done State work to be done and purpose of byjlding (by Remodeling Addition To be constructed of Kind of foundation . ./e Estimated Total cost of improvements $. 4;00. 6t Amoun of Permit Zone cubage required ..... .._ Distance to next nearest building._......_._ Size of Building Lot 7_ye /2. Maximum live load to be borne by each floor ,4:7e I hereby subrr�i sp if' '•ns id b ing. �ll notices h reference to the building and its construction may be sent to b _. . 1 .._. 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 rk s - public notice or notices as are required by the Act. The undersigned agrees to employ only such subcontra�c s, onWork to 'pe reed under this permit, as are licensed by Miami Shores Village. Disapproved Date., (Signed) Building Inspector Remarks (Signed) Date. - No / f Street and for no other purpose. Repairs No. of Stories Roof Covering.__ _Plan Cubage 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. /I Permit No a co 4' Date l (3 ° Read, Sworn to and Subscribed before me. Notary Public, State of Florida 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.