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386 NE 92 St (11)PERMIT APPLICATION FOR MIAMI SHORES VILLAGE a - pzt2, -0/ Date 1 31 A 1 Job Address 386 N . E . 92 Street Tax Folio 11 3a 0 C2 —0/3 _ (n ! a 0 Legal Description Historically Designated: Yes No Owner/Lessee / Tenant Gary S. Ku t c he r Master Permit # o wner i s Add ress 386 N.E. 92 Street Miami Shores Phone 756 -6858 ContactingCo,Quality Roofing Contractor, Inc. Address 13800 N.W. 1st Avenue Que Carlos Arocho State # RC 0 0 5 8 6 2 7 Municipal # Competency # 17889 Ins. Co. Architect/Engineer Address Bonding Company Address Mortgagor Address Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN WORK DESCRIPTION Tear off old roof to wood deck, tin cap 301b. ASTM felt,install galvanized eave drip and valley metals where required, mop on with type III asphal one layer of 901b. ASTM felt., Install Spanish S Clay Terracotta colorthru tile with polyfoam adhesive setting. Square Ft. 30 s a. Estimated Cost (value) $ 11;500 . 0 0 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 (Ile 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. Signature of owner and/or Notary as to a er and/or Condo President / My Commission Expires: ,;;:it MARYLOU HERNANDEZ �` � MY COMMISSION # CC 680474 EXPIRES: October 10, 2001 ' °:' Bonded Thu Notary Public Undemrtfters 15 I Date 0 c� FEES: PERMIT e2,) RADON C.C.F. APPROVED: SS# 0 46/ Signature of Contractor or Owner- Builder Date di Notary as to Contrac Kr or Own My Conunission Expires: NOTARY --- ® BOND--- � , TOTAL DUE, _D yZ °--� Electrical Phone 751-0382 LOU HERNANDEZ My COMMISSION # CC 680474 EXPIRES: Garber 10. 2001 Burr i rhtu Notari Puallc Undanvriters Mechanical Plumbing Structural Engineer NOTICE OF COMMENCEMENT ' A RECORDED COPY MUST BE POSTED ON THE JOB SITE AT TIME OF FIRST INSPECTION PERMIT NO. TAX FOLIO NO. STATE OF FLORIDA: COUNTY OF DADE: 1R096476 2001 MAR 01 09:59 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: 3 8 6 N.E. 9 2 Street 2. Description of improvement: Reroof to a new Tile roof . 3. Owner(s) name and address: Gary S . Kutcher Interest in property: Owner Name and address of fee simple titleholder: N/A Amount of bond $ 0 0 6. Lender's name and address: Ignature of Owner Print Owner's Name -3' A S, KJs Sworn to and subscribed befW me this 3 I day of 61.,y,-. Notary Public Print Notary's Name My Commission Expires r�rd Miami Shores, Florida 1111R 386 N.E. 92 Street Miami Shores, Florida 33138 4. Contractor's name and address: Quality Roofinq Contractor, Inc. 13800 N.W. 1st Avenue Miami, Florida 33168 5. Surety:(Payment bond required by owner from contractor, itato !)E OF FLORIDA, COUNTY OF DADE Name and address: N /A I HEREBY CERTIFY that this is a The a oy of the final to in this ofhcL On' 1�, day of C ) , A0 20 G ( Pi i iVESS my hand and G ial Seal. 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: N /A 8. In addition to- t1imgelf, 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: N/A YLOU HERNANDEZ MY GOMMissiuN k UX,1380474 EXPIRES: October 10, 2001 , 4.: • ru ' , •. ry bHc Underw ite's , 9. Expiration date of this Notice of Commencement: (the expiration date is 1 year from the date of recording unless a different date is specified) Prepared by Carlos Arocho Quality Roofing Contracto: Address:1 3 8 0 0 N.W. 1st Ave. Miami., Florida 33168 Contractor's Name: ROOF CATEGORY ❑ (Nail -On Tile) 2 (<ortar Adhesive Set Tile ❑ (Asphalt/Fiberglass Shingles) ❑ ( Metal Roofs \Wood Shingles & Shakes) ❑ (Other) ROOF TYPE ❑ New Roof LU'Re- roofin g Recovering P ❑ Recoverin ❑ Repair ❑ Maintenance ❑ (Low Slope Application) Flat Roof Area (ft Sloped Roof Area (ft 3o 57 . Total (ft 3 0 • Master Permit No. Exposure category (per ASCE 7 -88): C Building Classification category (per ASCE 7 -88 table 1): = Ft. Ft. 123.01-78 4/88 eck type: ATT CEMENT Fastener Type: Field: Perimeter: DETAIL 1 & 2 Appendix "E" UNIFORM ROOFING PERMIT APPLICATION PROCESS No. Job Address: ROOF HEIGHT AND SYSTEM DETAILS (Draw details as needed) Corner: Page -1 3R 14. A). F_ 92 (S ice ROOF PLAN Deck type: SLOPED SYSTEM DESCRIPTION wood 1 x( Underlaylnent: Insulation: 3016,A-STM IV 'Is Ridge Ventilation? � MEAN HEIGHT 1 t a � 12" ROOF slop¢ D E T A I L 3 Fastener type & spacing: Cap Sheet: Roof Covering: Drip edge: ea-t) d—r ii / to .c . cd '1 ors k. C D /Dr R apt r 7,_ ATTACHMENTS REQUIRED 1) Fire Directory Listing Page 2) Miami -Dadc County Product Control Notice of Acceptance -Cover Sheet a) Specific System Description b) Specific System Limitation . c) General Limitations d) Applicable Detail Drawings 3) Municipal Permit Application 4) Other Component Approvals (Pmaxl: x X (Aerodynamic Multiplier):a,D .9 - (Pmax2: Ill:>.) X X (Aerodynamic Multiplier) :3 0 9 M = M 15,09 PCA: (o 1.9 D ' ) - M = M .I PCA: i0 /SO (Pmax3: ID 3J7 x A (Aerodynamic Multiplier): 3 D .O 1 - • Appendix "E" UNIFORM ROOFING PERMIT APPLICATION PROCESS No. TILE CALCULATIONS M W = M 1`I 4I') PCA: (,LO Ac ih l e5i)e- APPENDIX "F" REQUIRED OWNERS NOTIFICATION FOR ROOFING CONSIDERATIONS As it pertains to this Appendix "F" it is the responsibility of the rooting contractor t ' I r o provide the owner w itlt th required roofing permit, to provide the owner with this appendix and to explain to the owner the cont.nt or this form. The provisions of Chapter 34 of the South Florida Building Code SFBC ' (SFBC) govern all the niinint::ri requirements and standards of the industry for roofing system installations. Additionally, the following items should be addressed as part or the agreement between the owner and the contr;t;,tor. The owner's initial in•tlt adjacent box indicates that the item has been explained. Aestlictics- Work►nnnship: The workmanship provisions of Chapter 34 are for the purpose o f providing that the roofing system meets the wind resistance and water intrusion performance standards. Aesthetics (appearance) issues are not a consideration with respect to workmanship provisions. Aesthetic issues such as color or architectural appearance, that are not part of a zoning code, sltottld be addressed as part of the agreement between the owner and the contractor. 2. Renailing Wood Decks: When replacing roofing, the existing wood roof deck may have to be renai!ed iit'z cordance with the current provisions of Chapter 29 of the SFBC. (The roof deck is usually concealed prior to removing the existing roof system) 3. Common Roofs.: Common roofs units (i.e. townhouses, condominiums, ctc.). owner should notify the occupants of adjacent V o are those which have no visible delineation between nei�shbori :to In buildings with common roofs, the roofing contractor and /or units of roofing work to be performed. 4. Exposed ceilings: Exposed, open beans ceilings are where the underside of the roof decking can be viewed from below. The owner may wish to maintain the architectural p r a penetrations of the underside of the decking may not be acceptable. The SFBC provides the option of moii this appearance. L.3. Ponding Water: The current roof system and /or deck of the building cause water l0 pond (accumulate) in low-lying � may not drain well and ma y g'areas of the roof. Ponding can be an indication of structural distress and may require the review of a professional structural engineer. Ponding may shorten the life expectancy and performance of the new roofing system. Ponding conditions may not be evident until the original roofing system is removed. Ponding conditions should be corrected. 6. Overflow Scuppers (wall outlets): It is required that q • t rauiwater flow off so that the roof is overloaded from a build up of water. I'erintcter /edt:c walls or other roof extensions may block this d;s;l•,ar2.: if overflow scuppers (wall outlets) are not provided. It may bc necessary to install overflow scuppers in accordance with Chapter 23 of the SFBC. (/7. Ventilation: t`'lost roof structures should have some ability to vent natural airflow through tit•: i :•, ;:rig: of the structural assembly (the building itself). The existing amount of attic ventilation shall not bc reduced. 1: may bc beneficial to consider additional venting which can result in cxtendin,:. the service life of the rot;. ( /(�-- The owner may contact the Miami-Dade t Cot my Consumer Services De.p r tment foe frees;:: r information regarding the above. U'tc Contractor's Sicn ;►turc FEB 21 '01 14:12 FR BRADCO • • MIAM40A PRODUCT CON�'ROL NOTICE OF ACCEPT Santa Fe Tile Corporation 103021't.W. South River Drive, Bay #16 Medley ,FL 33178 Your application for Notice of Acceptance (NOA) of: Spanish "S" Clay Tile under Chapter 8 of the Code of Miami -Dade County governin Construction, and completely described herein, has been recd County Building Code Compliance Office (BCCO) under the This NOA shall not be valid after the expiration date stated b- ow. BCCO reserves the right to secure this product or material at arty time from a jobsite or manufactu is plant for quality control testing. If this product or material fails to perform in the approved manner, IBCCO may revoke, modify, or suspend the use of such product or material immediately. BCCO reserv' s the right to revoke this approval, if it it 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 manufacturer. ACCEPTANCE NO.: 40.1212. 6 EXPIRES: 02/0/20(h5 HIS APPROVEVI ovoingill 115045000 IIye2000utempheestnotite aeeeptaue■ cover pal/641ot Internet mail address: postmasterebulldtngeod eontine.com FEB 13 '31 17 305 597 9484 COND1T1ONS pUILDING CODE & PRODUCTIK This application for Product Approval has been reviewed Code and Product Review Committee to be used in Miami- forth above. CL TO 3059533333 P.01/05 MIAMI -DADE COUNTY. FLORIDA METRO•DADE FLAMER BUILDING BUILDING CODE COMPLIANCE OFFICE METRO -DARE FLAGLCR BUILDING 140 WEST %LACL R STRUT, SUITE 1603 MIAM I'LORU)A 13 130-1563 (30S) 375.2001 FAX (303) 37s•24o$ the use of Alternate Materials and Types of ended for acceptance by the Miami -Dade nditions specified herein. W COMUITTEE CONTRACrOR LICENSING 5ECt'10 . (305) 375.2527 VAX (305) 375 - 2SSS conto.croR ENFORCENI :ri' Dlvisto• (305) 375.3966 PAX (305)373 -2908 rttouurr CON1 aOL Drv1StON (305) 375 -2902 FAX (303) 372.6339 Raul Rodriguez Chief Product Control Division IF :. ► .AL the BCCO and approved by the Building de County. Florida under the conditions set Francisco J. Quintann, R.A. Director Miami -Dade County _ Building Code Compliance Office I tmcpage: http :h..Ww.Duildingcodeonline.com 3058880050 PAGE.01 FEB 21 '01 14 :13 FP BRADCO 1V/ LVVi 4V•..••• ROOFING ASSEMBLY APPROVAL CntecgrY: hoofing Sub - Category: 07320 Roofing Tiles Materials Deck Tyne: Manufactured by 6. iiCant S a tyT FE TILE CORPORATI4_ Santafd 'S' Clay 1= 18" Roof Tile w = 1 1 . i" %" thick Trim Pi eces 1 = varies w = varies varying thickness FEB 13 ' ®1 17;45 Clay Roof Tiles Wood 1. SCOPE This renews a roofing system using Santa Fe " Santafe Santafe Tile Corporation described in Section 2 of this comply with the South Florida Building Code, 1994 E locations where the design pressure requirements, as d does not exceed the design pressure values obtain by c using the values listed in herein. The attachment calcu system. 2. PRODUCT DESCRIPTION Test Dimensions Snecifcations 305 597 5484 TO 3 059533333 PA 112 0 m PA I I2 A hi 2.1 COMPONENTS OR PRODUCTS MANUFAC Test Product Di tootteleiss Soccifientinns Tile Screws #8 x 2 -Y" long PA 114 0.130" shank dia. Appendix E 0.178 flute dia. 3. LIMITATIONS 3,1 Fire classification is not part of this aeceptanc 3.2 For mortar or adhesive set tilt applications. a alit field uplift test shall be performed in accordance with RAS 106. 3.3 Applicant shall retain the services of a Mia perform quarterly test in accordance with PA submitted to the Building Code Compliance 0 ACCEPTANCE No.: 00- 1212.06 Approval Date: February 1, 2001 Expiration Date: Lebrunry 1, 2006 S" clay rooting tile. manufactured by otice of Acceptance, designed to tion for Miami -Dade County. For ermined by applicable building code, Iculations in compliance with RAS 127 lions shall be done as a moment based Product poscrintlon e piece high profile clay roof tile ipped with two nail holes. For nail -on, rtar sct and adhesive set applications. cessory trim. clay roof pieces for use at s. rakes, ridges and valley terminations. nufacturcd for each tile profile. URED BY OTHERS Product pescrintion tainless Steel Mnnu faeiuror generic i -Dade County Certified Laboratory to 112 a hall be oap, RRC Roofing Product Control Examiner 3058880850 PAGE.82 Tile Profile 2 " :12" 3 ":12" 4 ":12" ! 1 5 ":12" 1 6 ":12" 7 " :12" greater Battens or ' Direct' Deck Battens Direct Deck = attens Direct 1 Battens Deck Direct Deck 6 ens! Direct ; Deck Battens Direct Deck Santafe '5' 3.93 5.90 5.85 5,82 5,73 5.69 ,S6 5.53 5,32 5.29 5.03 N/A j For Nall -On Syst Tile Profile Tile Application Two Nails One Screw w'o Screws 1 Onc Screw I Two Scrcws w/ Clip I w/ Cli Santafe S Direct Deck 21.8 29.18' 38,28' 57,31 1 57.60 Battens 51.771 1. Approved screws as noted 'Product manufactured b others' II i =ED 21 '01 14:13 FR BRADCO SANTAFK TILE CORPORATION 3.5 30/90 hot mopped underlayment applicauons slope unless stated otherwise by the undcrl literature. 3.6 This acceptance is for wood deck application: compliance with applicable building code. 4. INSTALLATION 4.1.1 Santafe 'S' and its components shall be instal le County Roofing Application Standard RAS 11 4.1,2 Data For Attachment Calculations Sanlafe 'S' P'cB 13 '01 17:46 Tile Profile Table 1: Aerodynamic Multi 305 597 9484 10 3059533333 = .03/05 ACCEPTANCE No.: 00- 1212.06 (ft Batten A . • tic 0.274 • Restoring Moments duet 3 ay be installed perpendicular to the roof ymcnt material manufacturers published Minimum deck requirements shall be in in strict compliance with Miami Dade , RAS 119, and RAS 120, lyers- tion Gravity - M (ft -lb a. M Direct Deck 0,297 Table 3: Attachment Resistance Express 4d as a Moment Mf (ft -Ibf) rank Zuloaga, RAC Roofing Product Control Examiner 3058180058 PAGE.03 Table 4: Attachment Resistance Expres d as a Moment - Mr (ft -Ibf) for Mortar or Adhesive S t Systems Tile Profile Tile Application Attachment Resistance_ Santafe 'S' Mortar Set 23.6 Adhesive Set 81.9 =ED 21 '01 14:13 FR BRADCO SANTAFK TILE CORPORATION 3.5 30/90 hot mopped underlayment applicauons slope unless stated otherwise by the undcrl literature. 3.6 This acceptance is for wood deck application: compliance with applicable building code. 4. INSTALLATION 4.1.1 Santafe 'S' and its components shall be instal le County Roofing Application Standard RAS 11 4.1,2 Data For Attachment Calculations Sanlafe 'S' P'cB 13 '01 17:46 Tile Profile Table 1: Aerodynamic Multi 305 597 9484 10 3059533333 = .03/05 ACCEPTANCE No.: 00- 1212.06 (ft Batten A . • tic 0.274 • Restoring Moments duet 3 ay be installed perpendicular to the roof ymcnt material manufacturers published Minimum deck requirements shall be in in strict compliance with Miami Dade , RAS 119, and RAS 120, lyers- tion Gravity - M (ft -lb a. M Direct Deck 0,297 Table 3: Attachment Resistance Express 4d as a Moment Mf (ft -Ibf) rank Zuloaga, RAC Roofing Product Control Examiner 3058180058 PAGE.03 FE S 21 '01 14!13 FP BRADCO SANTATE CORPORATION 5. LABELING 5.1 All tiles shall bear the imprint or identifiable miarking of the ma.nufacturer's name or logo, or following statement: "Miarni-Dade County Iioduct Control Approved". 6. BUILDING PERMIT REQUEREMENTS 6, 1 Application for building permit shall be accompanied by copies of the following: 6.1.1 This Notice of Acceptance. 6.1.2 Any other documents required by the Builcgng Official or applicable Building Code in order to properly evaluate the installation othis system, PROFILE DRAWIN1C SANTAFE "SANTAFE S" CLAY1ROOF T1LE FEB 13 '01 17:46 305 597 3484 TO 3059533333 ACCEPTANCE No. : 00-1212,0 4 MEP Frank Zuloagn, R.RC Roofing Product Control Examiner 3058880050 PRGE.C4 SANT TILE (ORPOR6TION ACCEPTANCE No.: 00- 1212.06 F A CE :I AN E ND it r ONDTTIONS 1 Renewal of this Atxeptanee (approval) shall be considered aft original submitted documentation, including it supposing da eight (hi) years. 2 Any and all approved products shall be permanently labeled wi the following statement: "Miami -Dade County Product Contro specific conditions of this Acceptance. 3 Renewals of Acceptance will not be coosidcrcd if: a) The has been a change in the South Florida Building C and the product is not in compliance with the code change b) The product is no longer the same produce (Identical) as c) If the Acceptance holder has not complied with all the req correct installation of the product; a) The engineer who originally prepared, aigncd and sealed submitted, is no longer practicing the eagincering preterit 4 Any revision or change in the materials, use, and/or nuinufactu automatically be cause for termination of this Acceptance, unies (through the filing of a revision application with appropriate fee 5 Any of the following shall also be grounds for removal of this A a) Unsatisfactory performance of this product or process; b) Misuse of this Acceptance as an endorsement of any pr purposes. 9 This Acceptance contains pages 1 through 5 END OF THIS ACCEPTA FEB 13 '01 17:46 5 a renewal application has been filed and the engineering documents, arc no older than the manufacturer's name, city, stale, and pproved ", or at epecifically stated in Ow affecting the evaluation of this product one originally approved; remenls of this acceptance, including the required documentuUon initially of the product or process shall prior written approval has bccu requested and granted by this office. ptance: ct, for salts, advcndsing or any other 6 The Notice of Acceptance number preceded by the words Miami lade County, Fonda, and followed by the expiration date may be displayed in advertising literature. If any pion of the Notice of Acceptance is displayed, then it shall be done in its entirety. 7 &copy of this Acceptance as wall as approved drawings and oth documents, where it applies, shall be provided to the user by the manufacturer or its distributors and to 11 be available for inspection at the job site at all times. The copies need not be resealed by the engineer 8 Failure to comply with any section of this Acceptance shall bo ca > se for termination and removal of Acceptance. 1 I rank Zuloaga, RRC ofing Product Control Examinar 3058880050 PA5E.05 ** TOTAL PAOE.05 ** Test Location Uplift Pull Test (P or F) Test Location Uplift Pull Test (P or F) Test Location Uplift Pull Test (P or F) Test Location Uplift Pull Test (P or F) 1 �1?� 1? 26 Er i=, 51 rAS 76 2 1 27 7 52 77 3 28 53 78 4 29 54 74 5 30 55 80 6 31 56 81 7 32 57 82 8 33 58 R3 9 34 59 84 10 35 60 85 11 36 61 86 12 37 62 R7 13 38 63 88 14 39 64 89 15 40 65 90 16 41 66 91 17 42 67 92 18 43 68 93 19 44 69 94 20 45 70 95 21 46 71 96 22 47 72 97 23 48 73 98 24 49 74 99 25 50 75 100 Owner's Name' V t'GLk G Z Job Address' 6 !v 8•4. q 2- 9i M 1 /4A l Roofing Contractor t %T.. o 'Ft N1 &V Type of Tile: '* \ Fob Approximate Roof Height j eet Type of Access to Roof' Scaffolds' Approximate Square Footage of Roof: 3 0 'Q 0 Required Testing F Date Tested' THIS REPORT SU B rce: 35 lbs. Z3 /o( IN ACCORDANCE WITH THE CRITERIA OF PROTOCOL PA 106, THIS ROOF ASSEMBLY HAS PASSED THE STATIC UPLIFT QUALITY CONTROL TEST. P.E. Civil Engineer: /6 144 qS) Lab Certification ff 98- 0608.04 ED BY: State of FL Certificate Authorization ff 4100 U.S. SOUTH Engineering & Testing Lab., Inc. H2 001121 6065 N.W. 167th Street, Suite B -23 • Miami, Florida 33015 Telephone: (305) 558 -2588 • Fax: (305) 362 -4669 ON -SITE CONCENTRATED UPLIFT LOAD TESTING OF ROOF TILE IN FULL ACCORDANCE WITH METRO -DADE BUILDING CODE COMPLIANCE PROTOCOL PA 106 ft' SITE SPECIFIC INFORMATION Date Installed 5111 'o 1 Roof Pitch' 3 : ( Z Ladder Other Testing Equipment: Chatillion 100 TEST RESULTS P = PASS, F = FAIL 5 24 4/ Permit #: 4 A-0 sS ®4oc Project SKETCH OF ROOF , - 396, 612.S i i m I Amt ‘# aP&--;,o. SHEET NO CONTRACTOR G lA l 1, 1 ®F L aJ t1 CHECKED BY DATE SCALE iE!!!1UIIII timiiiuuiiii oa 1.x I �I� .■...w p 4P gr' NOTES: Application is hereby uindc for the approval of the detailed statement or toe plans and specifications herewith submitted for the build ine 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.. _°_�..._._ , 19.'� Owner's Name and Address ` Y,F' F _ No.. ` . Street-27 0 pe Registered Architect and /or Enginee . . ............ r . Name and address of licensed cont t' t d L Location and legal description of lot to be b ilt on: . Lot .......ketg Block ' Street and Number where work is to be done.. State work to be done and purpose of building (by floors). Vr PA - r_ New Building To be constructed of Estimate Total cost of Zone cubage required' Distance .to next nearest building.. Permit No Disapproved (Signed) APPLICATION FOR BUILDING PERMIT improvements Dale Date Remodeling Addition Repairs No. of Stories / - Kind of foundation.... Mat . © 0 MIAMI SHORES VILLAGE 23 07(1f-3 Building Inspector BUILDING INSPECTION DEPARTMENT cr7 CE-G, />,4 A vision ..... _.... r 2 Amount of Permit S. .Plan Cubage Size of Building Lot Maximum live load to be borne by each floor I hereby submit all the plans and specifications for said building. All notices with reference to the building and its construction may be sent to.. The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations as an employer of labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida, Permanent Supplement, and has complied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors employed by him in the work to be performed under this permit; and will post or cause to be posted for in ection on the site of the work such public notice or notices as are required by the Act. The undersigned agrees to employ only such su tractors, o k to be under this pcnnit, as are licensed by Miami Shores Village. Remarks (Signe STATE OF FLORIDA, 1 COUNTY OF DADE. i 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 scat are true.. Read, Sworn to and Subscribed before me. Notary Public, State of Florida My Commission Expires /1 vow J .. and for no other purpose. PLANNING BOARD DATE Chairman Member \ternber Member Mfembcr .. .. _ ....._......_..._.— ...._....... 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 1'I.i Board. A re inspection fee of SI.00 will be charged when such re- inspection is made necessary by Improper notice for inspection or faulty materials and /or workmanship.