373 NE 92 St (12)PERMIT NO.
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STATE OF FLORIDA )
COUNTY OF DADE )
THE UNDERSIGNED hereby
1
in acco .ante with Chap
Legal description of property: Lot(s)
General description of improvements
Surety's name
and address
Bond Number
PBZ 1/2/91
PLANNING, BUILDING i ZONING DEPARTMENT
IOTICE OF
gives notice that improv nts will be made to the real property located at
in the City of Miami, Florida, and
er 713 of Florida Statutes, the following information is provided:
Expiration date
Owner /Title Holder's name
different from job address
Contractor's name 0
and address • 3
Lender's name
and - ,address -
Person within the State of Florida, designated by Owner to receive service of notices or other
documents as provided by Sec ion 713.13(1)(a)7 of Florida Statutes:
Name
address
Person, in addition to owner,
designated to receive a copy of Lienor's Notice as provided in Section
713.13(1)(b) of Florida St•t tes:
Mane
address
nt shall
Unless a different date is specified, the expiration date of this
(1) year from date of recording.
(Print Owner's name)
Sworn to and subscribed before me on this S day of
My commission expires:
' `r P Air °':'+';F A. DUFFiN
a.�' ''� �' CC,03698
EXPIRES .,-3 23, 2001
D(ES
- -., dP Atw+nc
ATE OF FLORIDA, COUNTY OF LADE
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HWEARATIM
Block
98R300357 1993 JUN 22 14 :15
FOLIO NO. ' ( "
of
Signature of
•
ry Public •
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� 3 22s' 497aL 7,L
, �Q �.
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and address, if
one
STATE 02 FLORIDA) SS
COUNTY OF DADE )
A F F I D A V I T
of the Village of i.2iami Shores,
Co y of Dade and State of Florida, being duly sworn, doth depose and say,
that under the provisions of Ordinance No. 185, dated June 15, 1948, amend-
ing paragraph (d) of Section B -368 of Ordinance No. 97 of the Building Code
of Nliami Shores Village, he desires to build a
on Lot / `' 7- Block 4' i of - z��..; � 5 �ia't +ubdivision.,
that he is the owner of said property, and will be the owner of said
s-- G- ��,�,• , that he will do the work personally, and that
he will, at such times as are required by the Zoning and Building Director:-
1. File plans and specifications and obtain ap: ?roval of the
Planning Loard and the Building; Inspector.
2. Apply for and secure a Permit.
3. Pay the required fees.
4. Execute the c+or:c in accordance with the provisions of this
Code.
5. Apply for inspections.
6. File with the Building Inspector certificates that provision
has been made to carry the necessary Workmen's Compensation,
Public Liability and Property Damage Insurance.
7. File with the Building Inspector as the job progresses certi-
ficates showing the payment required by the Federal Social
Security Act to the State of Florida or the United States of
America.
8. Assume the responsibility of not employing other than properly
licensed contractors by Liiami Shores Village for any part or
portion of the work.
9. Slot set himself up as a "contractor ".
10. Sign an affidavit before commencing work to the effect that
he teas read this Article and will do the work personally aad
observe all of the requirements of the Building;, Electrical,
Plumbing and Zoning Codes of Uiami Shores Village. Such
affidavit to be properly notarized upon blanks to be supplied
by the Building Inspector.
11. In order to prevent abuses and subterfuge the right of such
owner- builder as herein provided, is limited to but one
owner- builder periait each 2 years, and where an owner- builder
has once exercised the privilege herein conferred no second
application for owner-builder permit shall be granted in lest
than 2 years. unless the applicant is qualified as a licensed
General Contractor under the applicable Ordinances of said
Village.
And Further this Deponent says not:
QVINER
SUBSCRIBED Aap $.4ORN TO B::.F0RZ 11E this day of
19
NOTARY PUBLIC
A. D•,
Kind of Insurance
Policy No.
Expiration Date
Limits of Liability
Workmen's Compensation
Employer's Liability
WC 1729
9/22/51
Statutory
Manufacturer's or Con-
tractor's Public Liability
Bodily Injury
GL 2633
GL 2633
9/22/51
9/22/51
$ 10000.00 one person
one accident
$ 20,000.00
$ 1,000.00 one accident
$ 10 000.00 aggregate
,
$ one person
$ one accident
Manufacturer's or Con-
tractor's Property Damage
Owner's or Contractor's
Contingent Liability
Bodily Injury
Owner's or Contractor's
Contingent Property
Damage
$ one accident
$ aggregate
Automobile Bodily Injury
Owned ❑ Hired ❑
Non - Ownership ❑
$ one person
$ one accident
Automobile Property Damage
Owned ❑ Hired ❑
Non - Ownership ❑
$ one accident
.
1
•
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• This is to Certify that the following described Policies, subject to their terms, conditions and exclu-
sions, have been issued to the Assured named herein by the PUBLIC NATIONAL INSURANCE
COMPANY of Miami Beach, Florida, and are now in full force and effect.
Assured Wilbur F. Thorne •
•
Address of Assured 1120b L :. 9th Court, Miami, Dade County, Florida
•
.} Locations Covered 11204 N.E. 9th Ct., and elsewhere in the State of Florida
•
• Description of Work Builder
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w•JV. V_AP M XI FAIJM! VIi,MMixPJ_.lMMtill.N ,l,•lr •rilU� ucl!JdUJ ANA • A•AtiRl f tilll nR1
dr
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t1 in event of cancellation of this
policy 5 days written notice by
1 registered mail will be given.
,
This Certificate is issued to Village of Miami Shores (Attin License Di v, )
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It _is agreed by the Company that
whose address is
Certificate of Insurance
DESCRIPTIVE SCHEDULE
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Date Zeptember__26 I•
By
PUBLIC NATIONAL INSURANCE COMPANY
Insuran s Agency, In
1397 N- . 3ht.t
AUTHORIZED REPRESENTATI
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LOCATION
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FORM H.O 5 3M -12-49
Certificate of
Insurance
PUBLIC NATIONAL
INSURANCE
COMPANY
"ISSUED TO