MECHANICALSTATE OF FLORIDA,
COUNTY OF DADE.
Disapproved Date_ C 6)( ( Signed)
1 ss .
MIAMI SHORES
Chairman
Member
BUILDING INSPECTION DE I ARTMENT
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 Spt 18 ,1967
Owner's Name and Address Kay C r e ve 1 on No 291 NE StrILO th___Street
Registered Architect and /or Engineer Char _ 1es_ __Markel
Name and address of licensed contractor Aince Inc 19944 NW 2n.cl_Ave
Location and legal description of lot to be built on:
Lot_ _ 25 &26 __ Block 46 Subdivision
Street and Number where work is to be done 365 11-E..____93_rd_ Stree t State work to be done and purpose of building (by floors)__ Heat_Lng___A Alr___ nditi8�Cl i.Rb
Y.,.. !oiJ Ql`G �Z cf4 c> 1 J Eo2_. . LE Nrx
and for no other purpose.
LAGE
New Building X Remodeling Addition Repairs No. of Stories
To be constructed of Kind of foundation Roof Covering
Estimated Total cost of improvements $ $14_DD___QO__ of Permit $ l • va
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
The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations as an employer
of labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida, Permanent Supplement,
and has complied with the provisions thereof, and will require similar compliance from all contractors or sub- contractors employed by him
in the work to be performed under this permit; and will post or cause to be posted for inspection on the site of the work such public notice
or notices as are required by the Act. The undersigned agrees to employ only such subcontractyyS, gp work to p ormed under is
permit, as are licensed by Miami Shores Village.
Remarks (Signed)
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally ap-
peared _
to me well known,
and who, being by me first duly sworn, upon oath deposes and says that he is the_
of the above described construction, that he has carefully read the foregoing application, and that he did sign the same, and that all facts
therein by him stated are true.
Permit No mo d ' 1 Date ( Read, Sworn to and Subscribed before me.
Notary Public, State of Florida
Building Inspector/ My Commission Expires
PL / / NING BOARD DATE
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 i:)tice for inspection or faulty
materials and /or workmanship.
•
Date Job Address 36 5-44 g` 93 S Tax Folio /K 3v2(� e2,9'1..? 0
' Legal Description � / `� //
Lessee / Tenant Meer ' J d i `!�v Master Permit #-..
Owner's Address 365 At / 5pJ°Z.Qi
Contracting Co. Scw 4-eiticeek (0,
Qualifier Oe' SS#
Phone v 7
Signature on
Date: lJ
Notary as to
My Commissi
* * *
C.C.F. NOTARY
Fire
Building
Plumbing
Ins.Co.
accura a d that all work will
on an
r. ,
�i'•1
Adj,
Ul
: IST'A
z e s
1 COMMISSION # CC 2,44
MKS: ES: Dacemtxr 6, Vt06
Braided TT.JU Nor Pubic U: `
. Furthermore, I
* **
TOTAL DUE 63-
Other
Electrical
Engineering
T TE OF FLORIDA, COUNTY OF DADE
FIE'it9Y CERfIr•Y t' a this is a f-.r cnpy oS to
Inas Mod in fhi, o `..^ on 0/ 'aY of
J 9 /
Sr 1
fly {1,lt.Ll \:c, C ...JY :... Cr U :u ..
W YNF.
PERMIT NO. TAX FOLIO NO. 30) 0 6 - 013 — 000
STATE OF FLORIDA:
COUNTY OF DADE:
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.
3_ ,,F 13 sit
1. Legal description of property and street address:
2. Description of improvement:
3. Owner(s) name and address:
Interest in property:
Name and address of fee simple titleholder:
4. Contractor's name and address:
NOTICE OF COMMENCEMENT
va_clallet4
n /44i)7 55 .02_ 33/38
5. Surety:(Payment bond required by owner from contractor, if any)
Name and address:
Amount of bond $
6. Lender's name and address:
7. Persons within the State of Florida designated by Owner upon whom notices or other documents may be served as provided
by Section 713.13(1)(a)7., Florida Statutes,
Name and address:
8. 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.
Name and address:
9. Expiration date of this Notice of Commencement: (the expiration date
different date is specified)
sl
ature of Owner
Print Owners Name
Notary Public
Print Notary's Name
My Commission Expires:
A�ee� ■. aLl.Q`r.,
Sworn to and subscribed before me this It& day of 1 a ` , 19 C OS .
MY COMMISSION # CC 323048
(PIIICC. et,t,rb. 12, 1
',`;P 'dy '' Bonded Tfmr Notary Public Undennnitera
m
r.a
95R .18877 1995 MAY 01 10.11
CENTRAL INSTALLATION OFFICE
Sears, Roebuck and Co. (5596)
3tiz5 Forsyth Rd.
Winter Park, FL 32792
1 year from the date of recording unless a
Prepared by:J
Address:
CENTRAL ITISTAILATION OFFICE
Sears, o buck and Co. (5596)
3825 Forsyth Rd.
Winter Park, FL 32792 \
n.
ITEM
BATH TUB
UNIT
FEE
ITEM
SWITCH OUTLETS
UNIT
FEE
ITEM
SPACE HEATERS
UNIT
FEE
BIDET
LIGHT OUTLETS
CENTRAL HEATING 4P104
/
DISHWASHER
RECEPTACLES
A/C (WIND)
DISPOSAL
SERVICE TEMPORARY
A/C (CENTRAL) SV777
/
DRINKING FOUNTAIN
SERVICE SIZE IN AMPS
DUCT WORK
FLOOR DRAIN
SERVICE REPAIR/METER CHANGE
REFRIGERATION
GREASE TRAP
APPLIANCE OUTLETS -
PROCESS AND PRESS PIPING
INTERCEPTOR
RANGE TOP
UNDERGROUND TANKS
LAVATORY
OVEN
•
ABOVE GROUND TANKS
LAUNDRY TRAY
WATER HEATER
U.F. PRESSURE VESSELS
CLOTHES WASHER
MOTORS 0- 1 HP
STEAM BOILERS
SHOWER
MOTORS OVER 1- 3 HP
HOT WATER BOILERS
SINK. POT /3 COMP.
MOTORS OVER 3- 5 HP
MECHANICAL VENTILATION
SINK, RESIDENCE
MOTORS OVER 5- 8 HP
_
TRANSPORTING ASSEMBLIES
SINK, SLOP
MOTORS OVER 8- 10 HP -
ELEVATORS /ESCALATORS
TEMPORARY WATER CLOSET
MIDTORS OVER 10- 25 HP
FIRE SPRINKLER SYSTEMS
URINAL
MOTORS OVER 25-100 If
COOLING TOWERS
WATER CLOSET
•
MOTORS OVER 100 HP
_
VIOLATION
INDIRECT _WASTES
A/C WINDOW
REINSPECTION.
WATER SUPPLY TO:
AIR CONDITIONERS
A/C UNIT
STRIP HEATER
FIRE SPRINKLER
GENERATORS TRANSFORMERS
HEATER -NEW INST.
GENERATORS TRANSFORMERS
HEATER - REPLACE
GENERATORS TRANSFORMERS
LAWN SPRINKLER -WELL
SPECIAL PURPOSE
•
J
-
SWIMMING POOL
OUTLETS COMMERCIAL
WATER SERVICE
SIGN TUBES
-
SEWER CONNECTIONS
SIGN TRANSFORMERS
UTILITY -SEWER -
SIGN TIME CLOCK
UTILITY -WATER
FIXTURES
SEPTIC TANK
ANTENNA
3ELAY
TELEVISION OUTLETS
JRAINFIELD, 4' TILE/RES.
VIOLATION
PUMP & ABANDON SEPTIC TANK
REINSPECTION
$OAKAGE PIT - CU. FT.
;ATM BASIN
)ISCHARGE WELL
XIMESTIC WELL
_
TEA DRAIN
100F INLET
;TAR WATER HEATER
-
'IRE STANDPIPE
'OOL PIPING -
-
1
.AWN SPRINKLER SYSTEM
;AS RANGE
IETER SET (GAS) -
-
1
;AS PIPING -
-
ADDENDUM TO BUILDING PERMIT APPLICATION
(AN APPLICATION FOR BUILDING PERMIT MUST ACCOMPANY THIS ADDENDUM. IF A MASTER PERMIT HAS BEEN
OBTAINED, THE OWNER'S NOTARIZED SIGNATURE NEED NOT BE PRESENT ON SUBSEQUENT APPLICATIONS.)
PLUMBING
ELECTRICAL
MECHANICAL