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918 NE 92 St (2)APPLICANT: AGENT: STATE OF FLORIDA DEPARTMENT OF HEALTH ONSITE SEWAGE TREATMENT AND DIPOBAL SYSTEM[ CONSTRUCTION INSPECTION AND FINAL APPROVAL PROPERTY ADDRESS: � // LOT: saa�sa :uas : s oss�� TANK [01] [02] [03] [04] [05] [06] [07] [08] [09] FILL [ [23] [ [25] [26] WATERTIGHT .' LEVEL DEPTH TO LID / EXCAVATION MATERIAL FILL AMOUNT ` FILL TEXTURE EXCAVATION DEPTH AREA REPLACED REPLACEMENT MATERIAL BLOCK: i SUBDIVISION: INSTALLATION TANK SIZE [1] ; [2] TANK MATERIAL : 4 J OUTLET DEVICE ' MULTI- CHAMBERED [ C.Y./ N ] OUTLET 7ILTER_ -; ' LEGEND .- • C/ ._� DRAINFIELD INSTALLATION r ' [10] AREA [1]y' °," G [2] -b SQFT [11] DISTRIBUTION BOX _ HEADER [12] NUMBER OF DRAINLINES [13] DRAINLINE SEPARATION [14] DRAINLINE SLOPE ,. [15] DEPTH OF COVER H [16] ELEVATION [ABOV* /BELOW)BM [17] SYSTEM LOCATION [18] DOSING PUMPS [19] AGGREGATE SIZE�% [20] AGGREGATE EXCESSIVE FINES [21] AGGREGATE DEPTH EXPLANATION OF VIOLATIONS / REMARKS: CONSTRUCTION [APPROVED /BISAPPROVED]: PROPERTY ID #: l l SETBACKS [ [ [29] [30] [31] [32] [33] [34] [35] (36] [37] [38] [39] [40] (41] (42] [43] [44] [45] (46] [ [48] n 4016, 10/97 (Previous Editions May Be Used) PERMIT NO. DATE PAID: FEE PAID: RECEIPT #: FILLED / MOUND SYSTEM DRAINFIELD COVER SHOULDERS SLOPES STABILIZATION ADDITIONAL INFORMATION ssssssss:sa: =mms =a= CHECKED [X] ITEMS ARE NOT IN COMPLIANCE WITH STATUTE OR RULE AND MUST BE CORRECTED. SURFACE WATER DITCHES PRIVATE WELLS PUBLIC WELLS /'" . r IRRIGATION WELLS POTABLE WATER LINES BUILDING FOUNDATION PROPERTY LINES OTHER ABANDONMENT [49] TANK PUMPED _ / / [50] TANK CRUSHED & FILLED _ / CHD DATE t FT FT FT FT FT FT FT FT FT UNOBSTRUCTED AREA STORMWATER RUNOFF ALARMS MAINTENANCE AGREEMENT BUILDING AREA LOCATION CONFORMS WITH SITE PLAN FINAL SITE GRADING CONTRACTOR / FINAL SYSTEM [APPROVED /DISAPPROVED]: '' CND DATEt, Page 2 of 3 APPLICANT: Property owner's full name. AGENT: Property owner's legally authorized representative. MAILING ADDRESS: P.O. box or street mailing address for applicant or agent. LOT, BLOCK, SUBDIVISION Lot, Block and Subdivision for lot or PROPERTY ID#: 27 character number for property. (property appraiser ID # or GIS location) COUNTY HEALTH DEPARTMENT CHECKS [X] ITEMS NOT IN COMPLIANCE WITH CONSTRUCTION PERMIT AND STATUTE OR RULE. INFORMATION IS COMPLETED BY CHD ON FOLLOWING ITEMS: TANK SIZE (gallons) TANK MATERIAL (concrete, fiberglass, etc) OUTLET FILTER (manufacturer, make, model) LEGEND (manufacturer code) DRAINFIELD AREA (square feet) DISTRIBUTION BOX / HEADER (check box) NUMBER OF DRAINLINES (number installed) SYSTEM ELEVATION (in relation to BM) DOSING PUMPS (number installed) SETBACKS (record actual setbacks in ft) SETBACKS OTHER (as required) STABILIZATION (date stabilized) CONTRACTOR (contractor installing system) ADDITIONAL INFORMATION (as required) ABANDONMENT TANK PUMPED (date) TANK CRUSHED AND FILLED (date) EXPLANATION OF VIOLATIONS: Record item number, explanation of violation, and required CONSTRUCTION APPROVAL: Circle approved or disapproved, CHD signature and date. J. AS BUILT INSTALLATION SKETCH FINAL APPROVAL: Circle approved or disapproved. CHD signature and date of approval. Final approval shall not be granted unit the CHD.has confirmed that building construction and lot grading are in substantial compliance with plans and specifications submitted with the permit application. ELEVATION WORKSHEET ELEVATION OF BENCHMARK OR REFERENCE POINT: EXISTING GROUND TOP OF AGGREGATE [ +] SHOT H.I. H.I. H.I. H.I 1-1 SHOT [ -] SHOT [ -] SHOT ELEVATION SPIIC IF ICAT IOW FOR A ! M VENOM Fat Ws. F. C. MAC CREADT TO B3 LOCATED OM Lcir 10 GOLDEN GATE PARK AMR MM D 7 -54 MIAi^I SHORES FLA. EDT'? IN G. COBELI,I DLfiIGN • GENERAL C OIZ L. IOI$ 1- 110i 0P Worms The Intention of thane :;peeifieations and tlt• moos. pinging plans is is describe all material and labor *emissary tee eo*ple tie ly 'root and finish the above named building. 2*. C0)T] RA4T *S & PERMITS: The several sum- contractors shall be entirely respons- ible for the furnishing of ,all labor as materials required by their soxtraat• and the satisfactory pertormanes of their Welt. They s)iall obtain and pay far all permits and licenses, ee ply with all laws and or4ina ees and shall hold the Owner hama3sss from loss. 3- LIVES & LEVELS: The Contractor shall stake out the building in the proper loeation, set batter boards and establish benek marks for determing floor levels. 4- RISKJI & INSURANCE: The Coxtrastor shall errry Xesir'lian's Liability . Tasuraxee in the entire project, and the Owner will earn► fire ant windstorm insuranes as their interests may appear it the wont. 5- DOCUMENTARY STAID TAX AOS: Each sontraetesr snail compute in his estimate and properly pay and discharge any obligation due the state of Florida under the previsions of ehapter 15797, laws of Florida, Acts of 1931, known as the Documentary Stamp Alt. Tax is 1/10 of one percent on all written obligations to pay money. 6- PERM : • Omer will pr•eure and pay for general building per. mite. Special permits shall be taken out and paid for by the Oen- traetor for suck work. 7- Flaa S0C I LL S �CT� fY ACr : as diva" iras t err s'�"* 1 eonput• in kis a st irate and properly pay and diseharBe any obligations due the United States of America or the State of Florida wader the provisions of the ??sderal Social Security Aet (Mr 7260) enaeted by the 74th Con. gross. Tax Id 1% on week for 20 weeks during the year. 8. OLigAVII0 UP: After completion ad before final asesptanse of the work, all work shall be left broom clean and r.yady for final F.H.A. inspsetioz, should inspestion be required. ►VAT lop 9- CLEARING OF imp: Tke Coneraetor shall Blear tam lot of all underbrusk, trees, stumps, ate., within tke building arra, 10* EXCAVATION: Shall be carried to firm, kart soil and footing trenohas shall be out to sire on plans. All sated poekets shall be eo *plotely dug out and filled with eoaerate. 11• HAM ILL: ---- Mad van all footings after same have been properly cured and inspected. All filling to be water tamped. 1St* D: Concrete proportions shall bo soiposed of 2 parts sand 1 past **meat and 4 parts aggrega bs. Crystex waterproofing Meal/ added to all eoxsrete according to ianufaeturor s direetioas. 13- NOW A: """"'"""griek and biosk mortar a all be sompose4 of 2 parte Olean sharp sand and ',part Portland sement to whisk shall be added Crystak waterproofing asoording to manufasturer's iirestions No lime shall be used ix this mortar. All brisk and biosk shall bo wet w itk hose before laying in wall, 14.01,1111111450eit Ventilators where shown on plans shall be 6 "x 19" La area aai sereex wire ak all be nailed direct to masonry walls No wood frames will be allowed. 15- ANCHORS: -- " -- "For joists aril rafters as required by building Bode, shall be installed in masonry walls. 16^ QROUT I)O da CAULKING: Thee "backs or all wooden frame* in exterior openings shall be f illo4 with Bement mortar, wkere sane are ix masonry walls. Also .glean out around all door wad window frames and fill solid with elastic+ pointing compound, applied under pressure w*tk caulk* iag tool. The above applies only to masonry construction. CARP$ RT 17- FRAMING: 41---a members shall be *artfully *Ai ateurately framed,I' dates shall be halved together at all sorners and splisss. Ratter and *oiling joists to be caretully out out, accurately set and so! eu. ►sly; spike d. All boor joists under partitions to bo doubled. Every fourth joist to be secured to masonry by LA, smokers as siown. All joists resting ou masonry to be placed and painted with Gel-Ours-Sol or Creosote. All partitions running asross joists to have es4" Aker and partitions to rest s,* f1ooa. A►31 bearing pars titjoie to Asro' 1'011 1 "k4 b i ash *ll skeins of Cleo joists to ,ono rely 1"x4" ero$s bride* asmurateiy " o e a: i securely nailed with two nails each end, the above, ur�3ess otherwise 4poa� /Pied, shall be #2 yellow piss properly sised. All framing lubber shall be long lead` yeoow pine #2 or better. 18- ma: • All form lumber Shall be 1 d ant shall be new and, tigkt fitting, properly: nailed and braced. Forms shall be cleaned 401 amid- wet before sonsrets is placed. ST Hier W nomq 19. 0B RAL RBQII 1RE UE NT : All windows throughout shall be a tee l windows as maw. featured by the Detroit Steel Pr.oiuets Co., types Fenestra Pone wrought or equal art noted on plans. All vsntilatotts shall be eav►i- ppe& with #18 mesh broaso wive spreans set in steel lranes. 111r41* wareshall bo solid browse with die east adjuster kousi*g typo "D" opera=.img and. locking handle. Adjuster housing Shall bo mou0041 on steel plate securely welled to window frame. - All windows sot in wood busks furnished by others. See details of lamb conditions. 20- MUTT! �appr�: ' Ail sowtinous metal termite shield must be used placed at the tops of all foundation walls and piece and arouni shimmy and fireplaces. The top of foundation shall bo damp- proofed witk emulsified asphalt or coal tar pitch before applying 01141141: Shield to sztend into the wall at least 3" and project out+ t'rom the inside of the foundation wall 3" pn a* angle of 45 degrees. 21.; 7QQ $1 : glop. be reinforced as shown on plans with deformed bars of proper sits, 22- GO11:CR i BLOCK: YA8OtT were shown on pans shall be 8z8zi6" bearing hader- writer! s apprOvat label. 23- CRty & FIR3PLACH: Chimse shall be so*Mtruetod of ee:sent blocks and slay brisks and fires and flue lining of sine shown on drawing*. 24 �^L00RS & SHBAT H ING : F ever a '1 r1 oor joists and roof rafters with 1" #A common Sheathing laid diagonally on floors and at right Anglos to supp<brti for roofs. 1iILLWORK & FINISH 25- D00 FRA : rift frames Shall. be 1-3/4" cypress backed by#15 fslti• Interior frames shall be 7/8" with planted storks. 26• DOORS: Exterior *oors shall be 1 -3/4" thiok sypress with re- movable wood colds where glass occurs. Typical interior doors shall be i 1-3/8" stook two panel doors. screen doors shall be 1 -1/8" thick with 18 mesh bronze wire, am detailed. Front and rear doors toitave aluminum threshelds. 27- IY2ER IOR TRIM DOor aaa window trig shall be stook molt as approved and applied before plastoring. Base skill be 4" high flush wift piaster exespt were tile is specified, li4 28- KITCHENT CABINETS:, Shall be built over and around sink in kitehen as per details and near fining room door, 29- CLOSET S : have 1 "z 12" wood shelf supported on 1 "z4" hoot: drip. A 1" pipe elothes rot shall be installed in each closet. Two sh amber closets to be seder lined as per plans. 30- OAK FLOORS: Shall be se le oteit, 1" x 2 " T & G laid straight and blind nailed through the tongue where specified in plans. Storm shutters to be made of cypress stock and hying by sontrastor. HARDWARE 31- HARDWARE: ' sum of $30,00 for all finish hardware. ROOFING & SR] L'T METAL 52- WHET OF WORK: This part, of the eontrast insluie n materials, labor and equipment for all roofs, sheet metal work and f1askings of sl1 dessriptie*i► for entire building. All work shall be water blot at eonplstioz. 33- ?LASHINGS: A11 intersections of roofs with vertical surfaees of every nature shall be ' flashed and counter- flashed. Flashing shall be full length pisses, locked and solder joints. All pipes passing thru roof shall be caulked is the Dubs or embedded in elastic cement and hO14 with brass 'lamps. Rosin shall be used for soldering limit. Provide flashing around desk, and gal,, iron gripe at eaves;' TILE warm 34- TILE 3RLBC I01 & $PZCWIO I0 : o z red sinamo* quarry tile; -4- 1 T IIlg WORK Steps leading from orsk to have 6z6 quarry tile treats and plain 6x6 quarry tile risers. Tile for kitshex Sisk ant bask splash to be 4x4 light green and blask with neat roll edge all set in cement. Bath room floor and wainscoting 4 kigh amd around tub 6 high, color and pattern ee is ete 4 by Owner.- -5 - 1 HEARTH: To UM 4x4 quarry tile. §JIINJ All window sills through the house, with the eZ- .s ox of sills in the bath *xi kiteken, to have 6x6 quarry ti )a1 LATHIMG•PLASTER Iwo & STUCCO 35- LATH: Wool lath shall be #1 eypress, La±led at eve' bearing and metal lath shall be #24 guava expanded steel, tied at all laps and stapled at every bearing, staples sot more than 6" apart, Metal lath shall lap 3" each way at all sorr+ers. 36- PPAST$R t Small be two coat work. Seratek soat shall be ono part sand and oue part fibre& gypsum plaster. Texture plater shali be a f ixish •oat of gypsum piaster, hydrated lute and ssrsens4 brown piaster properly applied. All ceilings shall be p].t ' tered. Texture of above shall be selected by Owner. 37- .STUCCO: On fowidatior, walls a-rd shinney shall be eoxposed of two parts of *lean, sharp sand to 1 part of Portland semen'', to whisk shall be added Crystex waterproofing assor*iag to naxu- fasturer's spesifisations. PAIN' s IMl 38- WENT OF rW ORK : This part of the contrast ixsludes all materials, labor, equipment and ssaffoliing for the painting of all exterior axi interior; Bxterior stussoed walls to have one Boat in water- proofing paint, color to be selected by Owner. 39- MAT IAL�} : A11 paints, var *iskes, lacquers *rd oils shall be Sherwin-Williams, DuPont Benjamin jamin 'Voore & Co., or Pittsburg Platte 41ase Co., or equal. All special brand's herein + called for shall be brought to the building in the original packages; they shall be ilsed in strict ascOrdaaae with the maxufaeturer's direetioes and must not be thinned unless directed by Owner. All colors to be selected by Owner. 4O- y4OREMAl $H17: Al dust, dirt, etc., shall be removed before applying paint. Puttying Shall be Iona after the priming Boat 1 1 has been applied. All finished surf ass s shall be smooth, even and free from detests, Sand papering shall be done where assessary, Closets shall be says as epeeified for the adjoining room. See that woodwork is ppopsr1 prepared and in per .eat :eo*ditio* before any painting .is started. Failing to do ee the painting soia<tnaetor s shall be responsible for any defective work or paint, 41• PRIMING & BAOK PR IN ING: Ail woodwork to be painted shall be prised with lead and oil paint;; Bxteri•r door fraAes wed window busks shall be bask painted with keavy coat of creosote before erection. All shall be gives a heavy *oat shellac after fitting. All Moors shall have t+sp and bottQ* edges painted, 42E IOR ITO,JDWO : All *stoma woodwork shall receive, tH addition to priming, two emits of lead tad sins paint. 43- INTERIOR WOODWORK: To have two soate paint in /Very finish, door panels stained walnut with ivory stiles. WINI NOTE Platiered walls and seilingi not included. unless directed by Owner later on as sk: extra. 44- PLUMBING, G SCOP&: The work under thin seatie' shall inaslude the sow• plate installation of the plumbing system,. insluding sounestioae with sewer water supply lines and pluebijg fixtures, This 00*. tractor must pay t11 somnestios fees required for plumbing work.; The plumbinag system must sowpl7 with all ordiaa*ses and regulations governing same. 45- EXCAVATION: The sod tractor shall do all excavation work required by this 'ontrast, ineluiixg all necessary bask•tilliag after kit work has been tested, inspestei and approved, Ito pipe &all bit exposed above the grou,ai 46• SEWER g0JCT ;OwS: $?nail be ascordii to sole requirements and sontiawue uncle the building` and sosneet to all fixiwes.,wlth proper eiits pe . t►equi uil S by the „bd its , sods, All. 1oiiits < ,ice s o j 1 wag V' �nt i ii sag Y � si;ll tie paishsmd w�.hh,;; �a run. 11" *Max Tsai l stulhei. 4�• 114 fiYS ' E let: S ri niard xs ter , 'will `be f. tiered ant- installed by rater Compiler, prom the meter run 3 /4" ipe to baths and kitehsi and xesesury etas pipe distributing cold water to all tiffs.. Install !3/4 -x 12" air skubere ox all risers. Hot water Supply liaesiixes shall be 1/2" 41u . ket water pipes t• all fixtures seeps water elosef aid till seeks,,` gill seeks shall be 1/$" as -6- 1 shaves on plans. All water pipe and fillings from from seers tkroughOut of sizes epesified, shall be Gaily. iron. All soil pips shall be oast irons, standard weight. 48• SOLAR WATER SYSTEM: Is to be installed by this sontras':.or; said system to be 66 gallon tank. 49- FUTUREfis To be standards fixtures ix white unless otlw wise advised. 50- BATH: 51- KIT Gild: 1 - P 2315 -,b' Pembroke tub f itte i with K 47 R H tub & shower f :xture K 438 Pop up drain 1- F 2175 Water sloset "Cadet" 0 214 Chureh white seat Lavatory 3867 B.Z. Hexagon 20" x 18" 1- P 7020 - 20" s 24" F. R. Sink BLitCTR IC 1.Y IR VG 52- MA T R IALS : All materials shell be approved by the National Board of Fire Uniorwriters amid the wiring system shall sOmply with all losal regulations and ordinansis governing sans, 53- LOGATIOV OF OUTLETS; 'Sall be ar shown on plane. 54 F IX'1' URE ALLOWA) C$: T O be *sleeted and paid for by Owner and hurl by Contrasts unless otherWiss specified or directed. 55- GUARANTsgi Thin entire work shall be guaranteed against amy defeats for a period of ` one year from date of aseeptarse, 56- HEDIOINE CABINETS: Provide ui set n bathroom. Allowanse $7.50 BottoA line of nedisine cabinet to be 48" from floor. 57 Those epeeifiaatioxs do not i elude venetian blinds, curtain; shades, awnings, driveways, walks *or fill. -7� PII\____:_. CERTIFICATE OF RE- OCCUPANCY On behalf of Miami Shores Village, Florida, the undersigned certifies that the property described in the above application has been inspected for purposes of re- occupancy pursuant to Sections 901 and 902 of the Miami Shores Land Development and Zoning Code and that such property may be re- occupied by the above applicant for single - family residential purposes. By: PAGE 2 OF 2 MIAMI S RES VILLAGE, FLORIDA Date of Certi cation: 5/4/00 THIS CERTIFICATE VERIFIES THAT THE REFERENCED PROPERTY HAS BEEN INSPECTED BY MIAMI SHORES VILLAGE AND HAS BEEN DETERMINED TO PRESENTLY COMPLY WITH THE SCHEDULE OF REGULATIONS OF THE MIAMI SHORES LAND AND DEVELOPMENT CODE PERTAINING SOLELY TO THE REQUIREMENT THAT EACH ONE - FAMILY DWELLING IS USED AND INTENDED TO BE USED FOR A ONE - FAMILY DWELLING PURPOSE ONLY; HOWEVER, THIS CERTIFICATE DOES NOT CONSTITUTE ANY REPRESENTATION OR WARRANTY AS TO THE CONDITION OF THE DWELLING OR OTHER STRUCTURES ON THE PREMISES DESCRIBED HEREIN, OR ANY ASPECT OF SUCH CONDITION, AND INTERESTED PERSONS ARE ADVISED AND ENCOURAGED TO MAKE THEIR OWN INSPECTION OF THE PREMISES IN ORDER TO DETERMINE THE CONDITION, THEREOF. Legal Description: Applicant APPLICATION FOR CERTIFICATE OF RE- OCCUPANCY I, k) ( -' }? y .., to re- occupy the single family residence known as : (address) , Miami Shores, Florida. Lot: Block PB & PG: , hereby apply for a certificate I hereby certify that I understand that the zoning of the property is for single- family residential use and that it is unlawful for more than one family to reside therein. I also understand that any Certificate of Re- Occupancy that may be issued by Miami Shores Village, certifies only that the referenced property is being used for single - family purposes and that such Certificate does not constitute any representation, warranty or certification as to the condition of the dwelling or other structures on such property. 1/6' tf" Date 6 / //t b Print Name 6T //t/G —r,E //E-L, *********************************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** For purposes of conducting the inspection required by Section 902 of the Miami Shores Land Development and Zoning Code, please contact: Contact Name: C44 / L A ki 5 9 /v Telephone: OS 7Y7-/7 0 U Buyer Seller Realtor Y Company Name Eit Application Fee ($50) paid: Cash Comments: Check No. ? 4 / 1--- Inspected by: F . LUB I EN Uy Approved X Denied Date 5/4/00 PAGE 1 OF 2 MIAMI SHORES VILLAGE BUILDINg_,AN�� ZONING DEPARTMENT DATE: �" Gentlemen: "HOLD HARMLESS" LETTER Re: Property located at (address and legal description): i0 Gol.A€03 6ATe- ktiv`A VI> 7- ie E As legal owner of subject property, I request the cancellation of permit number 1=M45 issued to (1._-:11,.1:03(L. on I , for the following reason: I hereby apply as owner - builder, or authorize to apply for such permits as are necessary to construct or complete the construction on subject property. r I agree to hold �f tc(A_q e ©F 1A.i mk,t, harmless and relieve it from any responsibility or liability for any legal action or damage resulting from the cancellation of the existing permit or the issuance of a new permit. I furthermore assume responsibility for the correction, if required, of work performed under the permit for which I an requesting cancellation. Very truly yours, (sign) (print) STATE OF FLORIDA) SS: COUNTY OF DADE) The undersigned, being the first duly sworn, deposes and says that he /she is the legal owner of the above property. Sworn to and subscribed before me this 0 16 day of, Notary Public, State of Florida at Larg SB "04% CHURCH � 1 ' tNotery Public, S2ata es Ronda 1 :My Commissma Exp. Poll 30. 1 ��. CC197545 September 20, 1993 Mr. Frank LuBien Building Official Village of Miami Shores 10050 Northeast Second Avenue Miami Shores, Florida 33138 Roofing Permit 1$ 33457 Job Location: 918 Northeast 92nd Street Miami Shores, Florida Dear Mr. LuBien: CHARLES W. SMITH 918 NORTHEAST 92ND STREET MIAMI SHORES, FLORIDA 33138 TELEPHONE (305) 758 -9451 Please be advised that PCSI, Inc. has performed no work on the above job site since February of this year. Accordingly, this letter will serve as notice to the Village of Miami Shores that the contractor has abandoned the job and that I wish to employ a tile setter to complete the work. As required, I will execute a Hold Harmless Agreement with the Village and will have the new contractor seek application for a new permit. The tin cap inspection was performed by you on this roof and the 90i slate has been hot - mopped in accordance with the South Florida Building Code. The only remaining task is to set the approved tile. Please contact me if you have any questions. er truly your V ` Charles W. Sm %th DATE APPLICATION Application is hereby made for the approval of the plans and specifications herewith-submitted for the building or other structure herein described. This application is made in com- pliance and conformation with the 3uilding Ordinance of the 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 Department of Miami Shores Village, fall be complied with, whether specified or not. OWNER LOT / My Commission expires Chairman Member Secretary Building Inspector Permit No. P '._ Issuers "t6,' BUILDING PERP.IIT RECORD LIAMl SHORES VILLAGE FLORIDA CONTRI.CTOR E BLIC SUBDIVISION siti‘n jlffhi 0:4 NEW \ ADDITION REPAIRS NUMBER OF STORIT5c'f`'r ROOF, ; COST (excluding Architect's fee, landscaping & garage), Building to be used for and no other use. I hereby submit all the plans and specifications for said building. STATE OF FLORIDA) COUNTY OF DADE ) Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgment, personally appeared to me well known, and who, being .)r me first duly sv :orn, upon oath deposes and says that he is the builder of the above described construction, that he has read the foregoing; application, and that he did sign the same, and that facts stated by him are true. Read, Sworn and Subscribed before me, Notary Public (Signed) Cubic Feet Cubic feet required in this Block T "G ,QRD Electrical Permit No. Plumbing Permit No. rr, Signed ( J. Date / Painting Plastering Electrical Mason &Condret'O' .• , 'Plumbing Roofing • Glazing Tile Miscellaneous . ' • " . • LIST OF SUB-CONTRACTORS . . . . • • ,••■••■•■••■■•••■•••• ' 'At 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. ��7 ,' Date , 19 Owner's Name and Address > "__' ➢_�� No. Street Registered Architect and /or Engineer Name and address of licensed contractor Location and legal description of lot to be built on: Lot Block Subdivisio Street and Number where work is to be done f 7 - -� -------------- - --- - - - -�- =-------------- - -- State work to be done and purpose of building (by floors) MIAMI SHORES VILLAGE BUILDING INSPECTION DEPARTMENT APPLICATION FOR BUILDING PERMIT and for no other purpose. New Building Remodeling Addition Repairs No. of Stories To be constructed of Kind of f urldation Ro 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 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 subcontractors, on work to be performed under this permit, as are licensed by Miami Shores Village. Remarks (Signed) STATE OF FLORIDA, COUNTY OF DADE. 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 stated are true. Permit No I _�_ <r Date__ J 7 4, Read, Sworn to and Subscribed before me. Disapproved Date (Signed) Notary Public, State of Florida 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 $1.00 will be charged when such re- inspection is made necessary by improper notice for inspection or faulty materials and /or workmanship. . :AISViti :... ...: . ... :i: :*itizitiN :ti :..ktt :ti :i **. {Nisi=:: i .aizis{:i :s -• ..- 'ti :ice: : :i.. c%:.. . :s =:7 :::: _- 4 f:L :=-.:411z.::: si •c!.:: - :fie:: :4 =i % : :: C t:tifitilit Bali: tit, itit :::- iii : ::s ^nti * i. . • is itis.kki : c$ N 6:? :1si: *-5. :ti:i : z: 4:-- .s: : :ti:isi,:ti {-G