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59 NE 92 St (7)Inspection Date: 06/13/2006 Inspector: Grande, Claudio Owner: KISILUK, PETER Job Address: 59 92 Street NE Project: <NONE> Contractor: Miami Shores Village, FL 33138- Building Department Comments Monday, June 12, 2006 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Block: Permit Type: Imported Permit Inspection Type: Final Work Classification: Roof - Repair Phone Number Parcel Number 1132060130250 Lot: Page 1 of 2 /j Inspector Comments / ��, � ,,+` / 4, , � ' , /��, I . �, f /, , , -, or io c , / �' , Passed / j ��r'� Failed % ;� Correction Needed Re- Inspection Fee ($75) No Additional Inspections can be scheduled re- inspection fee is paid . until Inspection Date: 06/13/2006 Inspector: Grande, Claudio Owner: KISILUK, PETER Job Address: 59 92 Street NE Project: <NONE> Contractor: Miami Shores Village, FL 33138- Building Department Comments Monday, June 12, 2006 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Block: Permit Type: Imported Permit Inspection Type: Final Work Classification: Roof - Repair Phone Number Parcel Number 1132060130250 Lot: Page 1 of 2 Tenant/Lessee Name /WA $ Value of Work For this Permit (Continued on opposite side) Woe Total Fee Now Due $ Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 BUILDING PERMIT APPLICATION e9/2 2 2 :35MaLter Permit No. FBC 2001 d o _ a ,vt //-3,7,o-e7/3 - 0R6 Permit No. f Fb5 Permit Type (circle): Building Electrical Plumbing Mechanical Roofing) Owner's Name (Fee Simple Titleholder) P7,_ y //9/U///S /L , L Phone # 3 • 33 ' - }�(,C Owner's Address £/ /(/E. 7Zf/O City M/A/h/ JNae State Pt • Job Address (where the work is being done) 59 /(/,L 92 Azo_ Jr City Miami Shores Village County ami -Dade Historically J� Is Building Histo y gn ated YES NO Z ip .33 Phone # /(/J/� Architect/Engineer's Name (if applicable) NA Phone # /v/ Zip 33/3 - z g.// Contractor's Company Name V ©r44/ / /� iec Phone # 30 .57 279 . ff 97 Contractor's Address 30o , 9/ J% City /� /XXA1/ State AZ, Zip 33/3 g Qualifier 7 ?/5///iCFJL .r—j a4S /A Square Footage Of Work: 60 SA Type of Work: ❑Additio� ❑Alteration p ❑New . $ Repair/Replace ❑ Demolition Describe Work: ' 44/€ aim e1x/. ��y Submittal Fee $ 5 Permit Fee $ CCF $ CO /CC Notary $ Training/Education Fee $ a Technology Fee $ o 0 Scanning $ 6— Radon $ � Zoning Bond $ Code Enforcement $ Structural Plan Review. $ * * * * * * * * * * * * * * * * * * * * * * * * * * ** Fees * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** Bonding Company's Name (if applicable) �A Bonding Company's Address City State Zip Mortgage Lender's Name (if applicable) , //. Mortgage Lender's Address City State Zip Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRICAL WORK, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and AIR CONDITIONERS, ETC 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. "WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT 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." Notice to Applicant: As a condition to the issuance of a building permit with an estimated value exceeding $2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will of be'approved and a reinspection fee will be charged. NOTARY Sign: Print: Owner or Agent The foregoing instrument was acknowledged before me thus /07;V day of f 4,E CA/ , 20 55', by who is ersonally known me or who has produced As identification and who did take an oath. P LIC: Signature Contractor The foregoing instrument was acknowledged before me this /&, day of MA ,e & /> , 2005 by who is p sonally known ' me or who has produced as identification and who did take an oath. `& • • 4 vdo eir∎ . - .r t_• h • 'icrr r • � � s Notary Public Comm IasioP 1-D 1 • coded By National N My Commission Expires: \pun � I th -e 1C—e-- C lac. xpires: 44plikel t (, c C.0- ***************************************************************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** (Certificate of Competency Holder) State Certificate or Registration No. Certificate of Competency No. ****************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** j , ********** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** APPLICATION APPROVED BY: 616) l a 2 5 2t5 Plans Examiner Engineer Zoning Chc 12/15/03 Miami Shores Village 10050 NE 2nd Avenue Phone: 305 - 795 -2204 Permit Number: BP2005 -404 Printed: 3/29/2005 Applicant: LANI Owner: KISILUK JOB ADDRESS: 59 Contractor JOHN BUSTA Local Phone: 305 - 219 -9699 Parcel # 1132060130250 NE 92 Signed: (INSPECTOR) Building Permit KISILUK LANI ST Contractor's Address: 300 NE 91 ST Page 1 of 1 Legal Description: MIAMI SHORES SEC 1 AMD PB 10 -70 LOTS 17 & 18 Fees: Description Amount FEE2005 -3944 Building Fee $100.00 FEE2005 -3945 CCF $0.60 FEE2005 -3946 Training and Education Fee $0.20 FEE2005 -3947 Technology Fee $2.50 FEE2005 -3948 Scanning Fee $3.00 FEE2005 -3949 Submittal Fee ($50.00) Total Fees: $56.30 Total Fees: $56.30 Total Receipts: $0.00 Permit Status: APPROVED Permit Expiration: 9/18/2005 Construction Value: $800.00 Work: REPAIR FRONT DOOR ROOF AREA TILE OFF TILE 0 BLK 21* SIZE 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: (Contractor or Builder) BY: 100.000 lt'OoEfild: Mang Cod ®Eagan n 2 Hurons tone Uniform PormIt ° ,•<. liostion Form. Section A (general information) Nagobar r smolt No. Process ' ®. Contractor's Nams . ON/V zTA ,e6rl" //G4 Job Address ® Low Slope ❑ Asphaltic Shingles ROOF CATEGORY 5 WE 92 tia . in Mortar /Adhesive Set Tile ❑ Wood Shingles/Shakes Are there ❑ Prescriptive BUR -RAS 150 Gas Vent Stacks? Yes ❑ No E ROOF TYPE Type: Natural 0 LPGX ❑ ❑ Mechanically Fastened Tile ❑ Metal PaneUShingles ❑ New Roof ❑ Re- Roofing ❑ Recovering ® Repair ❑ Maintenance ROOF SYSTEM INFORMATION Low lope Roof Area (SF) Steep Sloped Roof Area (SF) Total (SF) 6'0 s/' 6° �/F Section B (Roof Plan), Sketch Roof Plan: Illustrate all levels and sections, roof drains, scuppers, overflow scuppers and overflow drains. Include dimensions of sections and levels, clearly identify dimensions of elevated pressure zones and location of parapets. . 1.4111 � ■ dill ° ■:.iEE ■ :.: i ■ i n - "' I" : ■:E1- ' ;:EE' n 1 1/ 4 ..E WI ' EE :. ■ .E'E E .E ': ° Q. ■ C :pp.. CC .p.. C C C CEE::: E C E Q.0 C.:. ■ �' ■■ ■ C'. ■ ••■ ° :' ::C:CC'CCCC' :C: ' '���CC' "'CC�U :: I I Q ::EEE 111 :: CC ' E E Q ' QE Epp E'E: CG� : :C . ■ :C:C Avg EQ ■ Q ■.E ri`ii C ■E : C:a■ ■ C ■ C. ...■.■ . ■....... .Q: ■ . ° �.. :. ■C . �..■ uCQ . Q ■ .Q ■ :: ..C■ : . Q■ .::■ .I �..: �.. •I .r\ ,, EC E CEEE C :. ..:C■...C: QEIpC:. . E CE.. ■ ` ■O:. u ■EEi'. Cu.ii ■.� tau• i ' ' ■ E:E ■ :.:QE ' u.u... : " :. C' E • ':" :' ' •• 'C : .::G°"m! Ir;CC !I ■ ■■ Q. .: E Q Q . :QC Q- c:.r' - - i i i ur ■ III: : ■ .■:QE■ CE / ■ C E ■I E .` s.C►i I MM\.r. • .�■ ;11:1111:11111111iiiiiiiiii:::1115114iiiiili : CEa'm �• CQ ■. :� e� :�r ■ . ■� ► ,,E ., ► 'U' : :. E . C m ■' °:.■ : '. a :,� �• MN INW N:C�. ■ i• E :. :E QE . :C .Q Q ..6i :_ � I Ui i i l ' :i Q ■ ' E E.G E :E'�Q ' E� + :�EEE : : Q : I I I . ' Q. � . ■ :� � Qii:E 1111111 : C: C . C: 'C 1: 1CCQ • . E EE :Q ' : ' :� : : :�E��...: E .: �:■ . . C C E I ii il E . Q . 1111111111111.111 E p : :. :1. E . E � aE :EE :e :, E6:� ■E � Q E _.SEE : EE�.� ■ 11 Q - 11 E .C. ■ E 11111111111110111111 _ C ;.:E U .Q G .■ E . _ : Q . ; *il - - - • III . :: Mil: .■ :: I 6C 123_01 -48 5/03 PAGE 2 R.Fi A'1 &or 1)gyvE rgw-/ SECTION 1524 HIGH VELOCITY HURRICANE ZONES REQUIRED OWNERS NOTIFICATION FOR ROOFING CONSIDERATIONS 1524.1 As it pertains to this section, it is the responsibility of the roofing contractor to provide the owner with the required roofing permit, and to explain to the owner the content of this section.. The provisions of Chapter 15 of the Florida Building Code, Building govern the minimum requirements and standards of the industry for roofing system installations. Additionally, the following items should be addressed as part of the agreement between the owner and the contractor. The owner's initial in the adjacent box indicates that the item has been explained. 1. Aesthetics - Workmanship: The workmanship provisions of Chapter 15 (High Velocity Hurricane Zone) are for the purpose of 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, should be ddressed as part of the agreement between the owner and the contractor. g 2. Renailing Wood Decks: When replacing roofing, the existing wood roof deck may have to be renailed in accordance with the current provisions of Chapter 16 (High Velocity Hurricane Zones) of the Florida Bujlliing Code. (The roof deck is usually concealed prior to removing the existing roof system). 3. Common Roofs: Common roofs are those which have no visible delineation between neighboring units (i.e. townhouses, condominiums, etc.). In buildings with common roofs, the roofing contractor and/or ow er should notify the occupants of adjacent units of roofing work to be performed. 4. Exposed Ceilings: Exposed, open beam ceilings are where the underside of the roof decking can be iewed from below. The owner may wish to maintain the architectural appearance, therefore, roofing nail penetrations of the underside of the decking may not be acceptable. The Florida Building Code provides the option of maintaining this appearance. 5. Ponding Water: The current roof system and/or deck of the building may not drain well and may u se water to pond (accumulate) in low -lying 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 rainwater flow off so that the roof is not overloaded from a build up of water. Perimeter /edge walls or other roof extensions may block this discharge if overflow scuppers (wall outlets) are not provided. It may be necessary to install overflow scuppers in a rdance with the Florida Building Code, Plumbing. 7. Ventilation: Most roof structures should have some ability to vent natural airflow through the interior of the structural assembly (the building itself). The existing amount of attic ventilation shall not be reduced. It may be beneficial to consider additional venting which can result in extending the service life of the roof. 4 i * "l : lor er's /Agent's Signa re CADneumenb and Settingtk6emmn \Loth Settingt\Temp \l'emponry Internet Flkt \ConteoLIESOKLBAFTT .SECTION 1524111.dot 03 l /0 / OS C , ate Contractor's Signature PERMIT APPLICATION FOR MIAMI SHORES VILLAGE l 27 Job Address S9 6^ ?,2)1- ` Tax 94fl 9 900k Mot ,8eti Date Legal Description 45141) ' If ° I - 3 — 6 2 S U Lessee / Tenant /'W y -t - 4/ & 9 / Owner's Address - 9 •6 47 7 4 :t4= 1 " . Phone 7 ^b 7 Contracting Co. 00,1/1 bi/ g -J bC4 i � Address Y' ?/1) 4)'fr) /9 5' Qualifier lT y N Zit Pre,2Lc WORK DESCRIPTION 2- Q• 4 - 6 6F - Ijk AOF Dv Risieat/-71, Signatur Date: Notary as to Owner and /or Condo President My Commission Expires: APPROVED: Zoning er and /or Condo President Master Permit # SS# / Phone y 3 3cP State it `C (IG /S7Municipal # Competency # Ins.Co. Architect /Engineer Address Bonding Company Address Mortgagor Address Permit Type(circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL OOFIN PAVING FENCE SIGN ,�G Square Ft. 3 � Estimated Cost(value) 1 /, 'f00 i - 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 aut e the ,.ove -nam:• contractor to do the work state Signatur pf Cbrftractor or Date: / 7 Owner- Builder ��`` • ' ° i PHINE CHURCH 4110_1/ , 7 _ i� , ` % r .:,�h ' wary v.M[r, Sete Of Rasta 'ftary as to Co , ` ti _i 'l � mr roPCENetmefau[p1 11991 My Commission p .• �" o; No. CC197545 FEES: PERMITt. - 400 RADON C . C . F . (2 Q ° NOTARY , j pD TOTAL DUE Ht D( Electrical Mechanical Plumbing Engineering -1-)/L) o Let v b el( te- WV tILe9- Pea 114-e-( C.o(or AD/ 1\e4,_ -Q %b. I nterest In property: c. Name and 4 . ntractor : 5. Surety: a. Name and Address Lender:(Name and address) a a A t_ ' 9. 7 N. . w i t h the State of F l o r i d a designated by Owner upon whom m ! ,�, �7 or other documents may be served as provided by Section 713.13(17 1 � 9 a Florida Statutes:(Name and address) .4 ^ �� 3 ,f--- N., )v $ \ In addition to himself, Owner designates of PERMIT* State of Florida County of Dade 3 Owner Information: a. Name and Address: Mft / ,r/1) qr/9 - i v b. Amount of bond $ ary Public address of fee simple titleholder (name and address) TAX FOL NO. 1 1 - 3c2a6 a 13 -©„2-s6) 9 3 I~i 0 5 4345 1993 FEB n2 15:54 NOTICE OF COMMENCEMENT THE UNDERSIGNED hereby gives notice that Improvement 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. Description of property:(Iegal description � o 1 f the property, and street address If available) 5 ,4 .E l .2A)te _ia.Fcv, f'yt1,o Qh FL.33 /3c' m % &m; smh6 s , Z671 /7 V . /? / 2. General description of improvement: /G-2wQ -be) /J c, 4aL �O i (If other than owner ad s to V cbd= SeR-u ; 6 Xiiu C . / 0 .1%)•/0 � to receive a copy of the Lienor's Notice as \ provided In Section 7.13.13(1)(b), Florida Statutes. N Explratlon date of notice of commencement (the expiration date Is 1 year from the date of recording unle a different date Is specified) •,‘ // ): Signa e of Own_G Stern to and subscribed before me t h i s 3 W 'i • - y of `,1, 1993 , Q NO TARr DLiI. br. , r rb. O O.r.J�,1 ✓/ 41-elej- ---)014"" ` 0IV---)014"" Ple ftlY r ; ' ..... r rL A bONDLD TIIRU f1UiA(•Y.+UEALII.: uNGt. :I /,Zlr = ; 3 er May Commisslon_ MIAMI SHORES VILLAGE BUILDING INSPECTION DEPARTMENT APPLICATION FOR BUILDING PERMIT Application is hereby mode for the approyal of thc detailed state lent 01 the plans and specifications herewith submitted for the build • ins 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 thc 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 MT Aa.. D.a`ri 1a .. No59..V. :.Er._ . Street ...Sti Registered Architect and /or Ensincer ,.,. .,.•..,,,. ,.,.,,-.,........ „..... r....... Name and address of licensed contractor James Glico Roofing Co, Tl�. 114e3..N...F...2DC1.. e.rr... Location and legal description of lot to be built on: (� Lot ... d: -I.d Biock p Subdivision..r.. . . ,�,? ' „Le/ .1..._ y i /_ __ i.1 s .we l P` a 3D Street and Number where work is to be done.. 92 .St.. ......._..._._. State work to be done and purpose of building (by floors) Repair all leaks._ und..caerhang.,._ And replace all rotterf...wQOd.. f1 and for no other purpose. New Building Remodeling Addition Repairs ## No. of Stories To be constructed of Kind of foundation Roof Covering.. Tile Estimated Total cost of improvements $ 1000 -00, 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 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. Pennanent Supplement, anti 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 •rk to be performed under this pcnnit, as are licensed by Miami Shores Village. ` - • Remarks (Signed) Date..._...._ 6 _. 1 . _._.._..._�_..._._ �....... ,19.85_ Notary Public, State of Florida Building Inspector My Commission Expires STATE OF FLORIDA, COUNTY OF DADE. Ss. Before me, the undersigned authority, a notary public, duly authorizcd 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. . r Permit No.._ ”' 5 ' Date �J� Read, Sworn to and Subscribed before me. Disapproved t Date (Signed) PLANNING BOARD DATE Chairman Member Micrriber Member \fcmbcr .. 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 f'lannir 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. 1 State work to be done and purpose of building (by floors) <c 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 ,2 19 Owner's Name and Address. 41A L T .,1 ,2 -," ,� NoJ > Street ,[ /. C 5' Z Registered Architect and /or Engineer Name and address of licensed contractor O 14 i 7 T. o Y r Location and legal description of lot to be built on: Lot Block Subdivision Street and Number where work is to be done 7 rti! ti;, 9 Z -� )7 and for no other purpose. New Building Remodeling Addition Repairs X No. of Stories To be constructed of Kind of foundation Roof Covering Estimated Total cost of improvements $ / e i a 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 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 5968, 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 eniployed 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) $TATE OF FLORIDA, N� - �( /4' COUNTY OF DADE. Ss' Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally ap- peared it V/ 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 constr tion, that he has carefully read the foregoing application, and that he did sign the same, and that all facts therein by him e � Permit No Date / [! Read, Sworn to and Subscribed before me. Disapproved ji2 Date Notary Public, State of Florida (Signed) .... ing Inspector My Commission Expires PLANNING BOARD DATE Chairman Member Member Member Member Member Council Approved Date Disapproved Date NOTE: charge of $1.00 will be made for making corrections or changes to this application after approval has been obtained from the Planning ard. A re -insp ction 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. Registered Architect and /or Engineer and address of licensed contractor Location and legal description of lot to be built on: Lot Block Street and Number where work is to be done State work to be done and purpose of building (by f ‘1 CLeAtviiy STATE OF FLORIDA, COUNTY OF DADE. ss Disapproved Date (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. � - Owner's Name and Address .. ...__.... Subdivision t 0cPP l 7s c . I J (11, Date 1 t / 9 , 19 ' o Sb? Street v 2 s and for no other purpose. New Building Remodeling Addition Repairs No. of Stories To be constructed of Kind of foundation Roof Covering Estimated Total cost of improvements $ 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) Notary Public, State of Florida 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 Date Read, Sworn to and Subscribed before me. Building Inspector 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.