863 NE 92 St (3)r3UILUING INSPECTION DEPARTMENT
ApPLI0A1'ItJmi Fo mill riEru
Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the build-
ing or other stricture 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 Dixisicn of Miami Shores Village shall be complied with, whether herein specified or not. A copy of approved
pins and specifications moist be kept at building during progress of the work.
Owner's Name and Add t t
Streit and Number where work is to be done %!
State work to be done and purpose of building (by floors)
Building Inspector
MIAMI OHIO ` \ /ILLAUE
i'.F- gistered Architect and /or Engineer.
Name and address of licensed ccntractor
Location and legal description oftot b� ba iit on • 3
Lot S - q - -f-r-> tom
'"' j 13Tock -- / "at-, �,� Subdivision
Disapproved _.. Date
(Signed)
Date
No.
and for no other purpose.
New Building / Remodeling Addition Repairs No. of Stories
l
To be constructed of.. "it' -. ri -.' Kind of foundation.. Roof Covering
Estimated Total cost of improvements $ `.r,? 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 and its construction may
be sent to._. __ ,� ' C � � S et l v.
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 5068, Compiled General Laws of Florida, Permanent Supplement,
and has complied with the provisions thereof, and will require similar compliance from all contractors or subcontractors 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 noticesubcontract s as are required by the Act. The undersigned agrees to employ only such su rs, on work to be Performed under this
permit, as are licensed by Miami Shores Village.
/ /
Remarks (Signed) f " , - / '( ..
Street
, 19'
STATE OF FLORIDA, I
COUNTY OF DADE. j ss
Before nee, 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 rvo n, 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 sarne, and that all facts
therein by him stated are t
rr (t
Permit No rr? / . (� C
Date ! 2
Read, Sworn to and Subscribed before roe.
Notary Public, State of Florida
My Commission Expires
PL BOARD _ , €`d4", DATE
f hairrnan - \ .. , fY1C C� "� r Member
Member
MMeo_ber _ r , a .. d G' Alernber
Council Approved. Date Disapproved Date
NOTE: A charge of $1.00 will be nrde 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.
I I
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MIAMI 31 IclEZ :`j ':/ILLAt ::
131JILDIN INSPECTION O R\,2TMEN
APPLICATION FOR 3 UILOINC9 P r Mrr
Application is hereby made for the approval of the det� sled statenienr o
ii ° or o h rui h e her 2 described This fah; s may P , f the plans and specific atans herewith submitte
e build-
t t j_ n compliance and con o'm ty w •th the Building Ordinance of fia
`' i
'rtes Village, or d3, and all pro isions of the Law, o f the State c f k J id. all o d nances :f Mi m Shores Village e and all rules and
regu a on of the Building Div 2 of .tam She), tillage h '1 e o pl ed with, whether herein specified or not. A copy of approved
plans and :pecificati ms' must be ket at bui'ding durin, progress of tl.e work.
Disapproved __ .
ll e_
( Sigr_ed) k:-...,-, KS- ,.• `' - Notary Pub State of 1 or'da
tar Public ate o F
B ildin'Inspector My Com_nission Expires.
PLANNING BOARD
! / Date
.._e and Address ___ ._
4 . 1_ � No. �lv . !�. � /�� Street.. 1 /�� $1': //
Name :ad address of licensed contractor. 0 '4,21e..)^ 3 wi'll 1.*- 5_ - - - - - --- - --
Locitio;ld lot to be built on:
U 'Z)--1,1 -57 .
New Building 1------- Remodeling.. . and for no other purpose.
Addition_ . Repairs . No. of Stories.
Distance to next nearest building__ .. 1 /
Maximum live load to be borne by each floor
hereby submit all the plans and specnications for said building. All noti with reference to the building and its construction may
The uncle signed appli ant for th bu'lding permit does hereby certify elat he understands arid accepts h:s , .bltgations as an employer
of I bor under ne Florida Workmen's Compensation Act be'ng S. - Con 596(3 Col p led Gen al Laws of Florida P r anen S nent,
and h s comp! ed wth 'he proy' thereof, and will require s rnilar comp lance from all contractors or sub contractors emplo 'ed by him
in the wo k to be p rt • under th s pern a and ill post or cause to be posted for inspection on the site of the work su ill public not! e
pein as are licensed by NI am. Shores ‘11 ge.
or •otices as are requir d by the Act. The u. cf. r ign -xl agrees to employ only such abcontr. (tors, on work to be perform d . der this
Remarks
(S'g red) - 'AJrt9
STATE OF FLORIDA.,
COUNTY OF DADE. J Ss.
Before me, the undersigned authority, a notary public, duly authorized to adm.nister oaths c.nd take acknowledgments, personally op-
peared
and ssho, being by me first d ly sworn, upon oath deposes and says that he is the _ to me well known,
t h re abo sta e a struction t h has care,_,l]y read the forey - -
n , stated ar tr :e. g application, and that he did sign the same, and that all facts
Per m-.t No 'VP .. Date__ ' �
Read, Sworn to and Subscribed before me.
Chairman
Member
_ feinber
Member _ Member
Council Approved
Member _
.Date Disapproved - -
i
NOTE: A charge of 1.G0 will be made for making Date
materials a
t,ie Ylarr ng Board g corrections or changes to this application �_ft, r r- :
A is a nspecti o foe of $1.00 will be charged when such re- inspection is mi :_e necessary by improper notice f or insp tl,t,,i� fa ��t i
nd /or workmanship.
S r C B LD AND SW VaN
A F F I D A V I T 3.. •
STATE OF FLORIDA) SS
COUNTY OF DATE )
C / L' ,l��IJ,Sk/ of the Village of'Miaml,,
County of Dade and State of Florida, being duly sworn, doth depose 4.0 say,
that under the provisions of Ordinance No, 135, dated June 15, 1948, amens,.
in; paragraph (d) of aedtion B - 368 of Ordinance No, 97 of the Building Code
of map $hg s i Nape I.e desires to build a 5 ✓� iN✓ C,,L
on Lot .� /. 1 $ r? 4.`j, ock / of ricii) N ri,m 1-;)_): , 0 ubdivis
that he is the owner of said property, and will be the owner of said
, that ha will do the work per:o na' ly, and that
he will, at such tines as are required by the Zoning and Building Directors -
1. File plans and specifications and obtain approval of the
Planning Board and the Building Inspector.
2. Apply for and secure a Permit.
30 Pay the required fees.
4. Execute the work in accordance with the provisions of this
Code,
5, Apply for inspect ions.
6, File with the Building Inspector certificates that provision
has been made to berry the necessary Vtorkmenls Compensation,
Public Liability and. Property Dares() Insurance.
7, File with the Building Inspector as the job progresses certi.,
f ieates showing the payrlent required by the Federal Social
Security Act to the State of Florida or the Unitod States of
America.
8. Assume the responsibility of apt e-rploying other than properly
licensed contractors by Muni Shores Village for any part or
portion of the work.
9. Not set himself up as a "contractor ".
10, Sign an affidavit before commencing work to the effect that
he has read this Article and will do the work personally and
observe all of the requirements of the Building, Slectrical,
Plumbing and Zoning Codes of Miami Shores Village. Such
affidavit to be properly notarized upon blanks to be supplied
by the Building Inspector.
11, In order to prevent abuses and subterf use tte right of such
owner ®builder as herein provided, is limited to but one
owner-builder Hermit each 2 years, and where an °I-mar
has once exercized the privilege herein conferred no second
application for owner- builder permit shall be granted_ in less
than .2 years, unless the a;plicant is qualified as a licensed
General Contractor under ti]e applicable Ordinances of said
Village,
And Further this Deponent says not
r3 FORT IviE this_ / da
NO iY PUBLIC.
L/16/4
trw'�r Pub "'a'� cf F'w, ?e�iat `sryt
PJ,y orrrcf »'ai ?xp es Jan. 15, 1954.
Forded by Arncr :cs :n Surety Coy. .1f N. Y.
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