30 NE 93 St (8)MIAMI SHORES VILLAGE
BUILDING INSPECTION DEPARTMENT
APPLICATION FOR BUILDING PERMIT
Application is hereby made for the approval of the detailed statement of tie plans and specifications herewith submittal for the build-
ing or other structure herein described. This application is made in compliance and conformity w`.th the Building Ordinance of Miami
Shores Village, Florida, and all provisions of the Laws of the State of Florida, all ordinances of Miami Shores Village and all rules and
regulations of the Building Division of Miami Shores Village shall be complied with, whether herein specified or not. A copy of approved
plans and specifications must be kept at building during progress of the work.
Owner's Name and Address .
Registered Architect and /or Engineer..
Name and address of licensed contractor
and legal description of lot to be built on:
Lot - - - -• - - -� -- - Block - - --
Street and Number where work is to be done
Subdivision_
State work to be done and purpose of building (by floors)— __.,:_,
Date_
— ----- _ —__ -- and for no other pu- rpose.
New Building __- _:_ _ Remodeling Addition Repairs No. of Stores
To be constructed of. Kind of foundation �- ___� " Roof Covering___
Es'ama :cel Total cost of improvements $
Amount of Permit $
Zone cubage required _Plan Cubage
Distance to next nearest building_______ __ ________ __ __________ _________ -___—_____Size of Building Lot
Ma•cimum 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
'De sent to - - — The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations as an employer
of lab: under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida, Permanent Supp :,
and his 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 ub'ie notice
or notices as are required by the Act. The undersigned agrees to employ only such subcontractors, on work to be performed under t tis
permit, as are licensed by Miami Shores Village.
Remarks - (Signed) - _. _
P: nnit Na. .
DRupp_'ov xd
(Signe i)
Clmafe uan
Member
Me nbcr ___ _
Council Approvet
building Inspector
PLANNING BOARD_____ 71
7
DATE
2- Member
° Member _
Member
Date Disapproved
Street
Date _ __ _ Read, Sworn to and Subscribed before me.
Date
Notary Public, S441.9,f Florida " ".
1, •;
My Commission Expires -.;. w f ,__
,19
STATE OF FLORIDA,
COUNTY OF DADE. -
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally ap-
peared
to me well known,
and v.'_.r. Ix.a,g uy :.r. ti. t duly sworn, upon oath deposes and says that he is the
t •e 'hove uescribed crnv„ruction, that I.c has carefully read the foregoing application, and that he did sign the same, and that all facts
tiirrc :. i him stated are true. -
Date
NOTE: A change of $1.00 will be made for snaking corrections or changes to this application after approval has been ob;aincd fi-orn
Board.
A re- inspection fcc of $1.00 will be charged when such re-inspection is made necessary by improper notice Er inspection or fe..:liy
met: ials and /or workmanship.
•
•
b
Lot Block
Cwnerfs
General
Zone Req.Cu.Ft.
Plat Restriction Checked by
To ?lanning Board
Re-Subnitted to P.B.
Plans & Soec. Checked by
To Council
Bldg. Permit No.
Type
New Construction
Contractor
Date
Plumbing Permit No.
Septic Tank
Sewer
:J_seT1
New Const.
electrical Permit No.
Fixtures
Heater
loters
nscfl
Now Construction Alteration
Namo
Building Inspection Date
Foundation
Beans & Lintels
Final
Final Clean-Up
une:,.) inspection
Roughing
Fixtures
Sower
SePtic Tank
Solar Heater
Final Certificate
I Inspection Date
7_ourtning
Fixtures
Final
17=o. O.K.
service O.K. to Power Co.
Subeivisfi.on No. Street
Stories Roof
Alterations Repairs
Date Fee
Alteration Repairs
Diato Fee
By
Lic.No.
Lic•No.
Cu. Cont
I'
Approved
Approved
Approved
Fee
Re By
Date By " -ins p
Add. or Phone
Add. or Phone
Cost
11
Repairs
By
Cert.Occup.Issued
By
Rejected
Rejected
Rejected
Re-Insp By
Re-insp By
By Re-insp By ho-Insp By