RE-OCCUPANCYSTATE OF FLORIDA) SS
COUNTY OF DATE )
AFFIDAVIT
- (t "of the Village of "Miami Shores
County 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 MIiami Shores Village, he desires to build a
on Lot Block of Subdivision,
that he is the owner of said property, and will be the owner of said
, that he will do the work personally, and that
he will, at such times 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.
3. Pay the required fees.
4. Execute the work 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 t United States of
America.
8. Assume the responsibility of not employing other than properly
licensed contractors by Miami Shores Village for any part or
portion of the work.
9. Not set himself up as a "contractor ".
10, Sign an affidavit before comencing 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, Zlectrical,
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 subterfuge the right of such
owner - builder as herein provided, limited to but one
owner - builder permit each 2 years, and where an owner - builder
has once exercized the privilege herein conferred no second
application for owner - builder permit shall be granted in less
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:
OWNER
SUBSCRIBED AND SWORN To BEFORE ME this taijj day of
19 S r
,L
NOTARY PUBLIC,
Notcry Thhlie S?.atn at
/14.y C omtnissi'ri Expirro .4 O:j'o
• A.. D•,
-�- JOB DATA
BUILDING ELECTRICAL
PERMIT NO. PERMIT NO.
TYPE
NUMBER
FEE
OUTLETS, ROUGH WIRING
NAME
DATE
CONTRACTING FIRM 0gc) -rc4e/24 k LEC G IZ c,. - Z-n/ c
SERVICE CAPACITY
�^�
1 33 9 ADDRESS "I 0 .s / p _ 4 &s� -6,s 6. 2.
CONTRACTOR'S RESS L A- As PHONE
RANGE
SLAB
RANGE TOP
OWNER'S NAME Z (% _`C, IZ, PHONE
RECESSED OVEN
ROUGH
JOB ADDRESS E ( � /
770 ® ,474.- ?R .� �
DRYER
AIR CONDITIONER (ROOM)
LOT BLOCK
AIR CONDITIONER (CENTRAL -
A / �
A v
A
�
SUBDIVISION
MOTORS LIST BELOW
WATER HEATERS
CLOTHES WASHER
Application is hereby made to obtain a permit to do the work and installations as
PP Y P
hereon indicated. I certify that no such work or installation hos been effected
prior to the issuance of said permit and that all work will be performed to meet
the standards of all lows regulating construction in Dade County, I further certify
that I have checked and am responsible for the adequacy of any existing wiring
systems to which the work described in this permit adds extension or makes
changes.
DISHWASHER
PERMANENT FANS
SPACE HEATER
DISPOSAL
NUM3ER NUM3ER OF LAMPS
ELECTRICIA OWNER
INSURANCE DATE ISSUED BY:
DATE OF ISSUANCE:
This permit does not become valid until signed by an authorized representotive
of the Director, Metropolitan Dade County Building and Zoning Department and
all fees ore paid and receipt acknowledged in the space provided.
TEMPORARY SERVICE
REFRIGERATOR
TOTAL FEE -'
3 ®�
LIST OF MOTORS
/
PROPOSED USE OF BUILDING /1 �--
No.
Same Floor
Fee
No.
A.C.
Fee
NO. OF STORES FAMILIES / METERS
OFFICES BEDROOMS 2
BUILDING INFORMATION: OLD NEW
TYPE OF WORK ADD ffr NEW ALTER. REPAIR
FIELD CHECK REQUIRED
APPLICATION APPROVED BY
FINAL INSPECTION MADE
DATE
ELECTRICAL INSPECTOR
O.K. TO CONNECT YES NO D
REMARKS:
NOTE:
mr€r�I:
BUILDING and ZONING
MIAMI, FLORIDA 33125
ELECTRICAL PERMIT APPLICATION
cAri
INSPECTOR'S REPORT
Electrical Inspections
INSPECTOR" COPY
S
FOR OFFICE USE ONLY
List under "REMARKS" above the date and type of all notices left, all verbal instructions to the contractor, and any
other information pertinent to the inspection of this job.
123 -03 -8 (Rev.)
APPROVED
DISAPPROVED
NAME
DATE
NAME
DATE
REASON
TEMPORARY
SLAB
ROUGH
OTHER
REMARKS:
NOTE:
mr€r�I:
BUILDING and ZONING
MIAMI, FLORIDA 33125
ELECTRICAL PERMIT APPLICATION
cAri
INSPECTOR'S REPORT
Electrical Inspections
INSPECTOR" COPY
S
FOR OFFICE USE ONLY
List under "REMARKS" above the date and type of all notices left, all verbal instructions to the contractor, and any
other information pertinent to the inspection of this job.
123 -03 -8 (Rev.)
BALDWIN INSURANCE AGENCY, INC.
GENERAL AGENT
220 SEYBOLD BUILDING, MIAMI, FLORIDA
•
MARYLAND CASUALTY COMPANY
Mr, C. Lawton McCall, Manger,
Miami Shores village,
10050 1y. E. 2nd Ave.,
Miami Shores, Florida.
Dear Sill
BTEWART McDONALO, CHAIRMAN or THE BOARD
WILLIAM T. HARPER, PRESIDENT
RE; Maryland Policies
01- 537486 & 53- 112495
JOHN J. ROTE
April 23rd, 1951
We enclose certificate showing issuance of the captioned
policies which renew similar coverage expiring May 4th, 1951.
We trust the enclosure will be found in order.
HIT: CFR
encl.
Your very truly,
xt-e
H. E. PARKER,
Vice- .Presi.dent.
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THIS IS TO
MARYLAND CASUALTY
Insured .1
Address o f Insured 915...N...
Locations Covered
Description of Work All types
of tree
Certificate of 3 urance
April 23 19 51..
is at this date insured with
schedule.
o ther business operations
Date
CERTIFY that the Insured named below
COMPANY as described in the following
DESCRIPTIVE SCHEDULE
....J......B0TH
+..... 91at...T e. rrace,.... Miami...�Sho.re.s.,....Flor-ida
Anywhere in...the State of...Plorida
of construction work.; and all
insur.....in....the Stda....of...Florida
TYPE OF INSURANCE
Policy No.
Expiration Date
Limits of Liability
Workmen's Compensation
01- 537486
O e W •
5-4-51 (Sel
5-4.51 5 a
M
?< \+•-... . f -.
Statutory
Each Person $ • 10,000.00
Each Accident $ 20
Each Accident $ 1, 000 .00
Aggregate $ i n n nn
Each Person $ + �
Each Accident $
Manufacturer's or Contractor's
Public Liability Bodily Injury
53-112495
11
Manufacturer's or Contractor's
Property Damage
Owner's or Contractor's Protective
Liability Bodily Injury
Owner's or Contractor's Protective
Property Damage
Each Accident $
Aggregate $
Automobile Bodily Injury
Each Person $
Each Accident $
Automobile Property Damage
Each Accident $
This certificate is issued at the
whose address is 10050...N.
In the event of Cancellation of
Village of...kliami...
fi ve days before the date of Cancellation,
request of Village of Miami Shores
zi..... 2od ..Avenue.,....Miami....Shores, Florida
the insurance Maryland Casualty Company agrees i, lo give notice to the said
Shores., by....registered..mail
,.,,....,, ;.., ,.:....,'. ,. ,.: '.,......,,...,..,.,.....:1 ;
...,...: ,, ,:....,, .s...
MARYL ' ND CASUALTY COMPANY
13: � , �. - I
B A CY, nc s<porated
B '
Authorized Representative
. /'' .l./✓./✓l l lllll l l ./- .4..c - Illll lllllll ✓✓✓' //.///// /' ll ✓✓/:
Lla. 3019. Ed. 5 -45. Rep. 12-48. 40 -M.
s
k I r
•
MIAMI SHORES VILLAGE
BUILDING DEPARTMENT
305- 795 -2204 � `\
Buildin: Inspection Request
Nam C ^
Address / 9� Gd'
Company
Phone # �� 5/ o �7
Inspection Date
Correction
Re- Insp'n Fee ❑
Date
Type Insp'n
Permit No.
Name
Address
Company
Phone #
Inspection Date
Correction
MIAMI 6HGRES VILLAGE
BUILDING DEPARTMENT
305- 795 -2204
Building Inspection Request
� cf °rte
Re- Insp'n Fee ❑
/'f5'., G G c
boos-
(Rev. 04 /24/03)
• Miami Shores Village
The following residence is issued a Certificate of Re- Occupancy
Address q9'40 a q;__
City Miami Shores State Florida. Zip ,3 /3S
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 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.
Building Officials Approval: _
Building Department
Certificate of Re- Occupancy
10050 N.E.2nd Avenue
Miami - S - bores, Florida - 33138
Tel: (305) 795 -2204
Fax: (305) 756 -8972
Permit No.
Date
oo-
(Rev. 10/02/03)
Building Department
RE- OCCUPANCY
APPLICATION
Date S/. /a/
Contact Name
L c-lisE-
My Commission Expires:
Miami Shores Village
6,41^/LY
Applicant Name /, u p s L 67,A 1 n7 e y
The for :, • ing instrui ent was acknowledgge befo
Permit No.
Loc ID
OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate.
Ginny H. Gonell • ,.• Y P • Commission #DD323870 •
° = Expires: May 26, 2008
:. - ::s Thru
Atlantic Bonding Co., Inc.
Building Officials Approval:
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795 -2204
Fax: (305) 756 -8972
005-(17
Phone # (36))
Buyer Seller I/ Realtor 5erq 44$Ch Company Name ../1f � /r / s /c /ES 40e 4 77
Property Address � 7 Ai L q 2 s'7"R L r 7
City Miami Shores State Fl Zip X33/3/
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 the property.
oo is personally known to me or who has
produced as identification and who did take an oath.
NOTARY PUBLIC:
20 CJ
Re -Occ. $60.00
Notary $5.00
CCF $0.60 "
Total
MIAMI SHORES VILLAGE
BUILDING DEPARTMENT
.105- 795 -2204
Building Inspection Request
Date Z0
Type Insp'n Re- ()CC"
Permit No. goon—
Name ( Q 111c
Address _` ° NE qa J 1
Company ® d
Phone # 7 S S 1CFS
Inspection Date `5S.
Re- Insp'n Fee
P
(e_e.
Address
thereof.
Building Officials Approval: _
(Rev. 04'24/03)
Miami Shores Village
Building Department
Certificate of Re- Occupancy
Date SP - NCL
The following residence is issued a Certificate of Re-Occupancy
q
NE. G o-S--
10050 N.E.2nd Avenue
Miami es,
Tel: (305) 795 -2204
Fax: (305) 756 -8972
Permit No. 3--L \Ec
City Miami Shores State Florida Zip
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 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
(Rev. 10/02/03)
RE- OCCUPANCY
APPLICAT -1-ON
Date 2 � 6. 5—
/ /
Contact Name o ; fl i N � Phone # .5
Buyer .Seller 2 Realtor
Property Address
City Miami Shores
Building Department
970 / 92- �f
State Fl Zip es 5 / r
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 the property.
OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate.
Applicant Name
produced
/
/ NOTARY PUBLIC:
Sign: (._______.
Print: Qi
My Commission Expires:
Building Officials Approval:
Signature
ir
The foregoing instrument was acknowledged before me this cLU day of
(.)1), who is personally known to me or who has
hxp� r e , : Ju , 4
,ndctil hrt 3
n
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795 -2204
Fax: (305) 756 -8972
_Permit. No.
Loc ID
Company Name f ��9,(��7 ,�, p.
, 20
as identification and who did take an oath.
Re -Occ. 560.00
Notary $5.00
CCF $0.60
Total (4)5 • COO
(Rev. 10/02/03)
1
RE- OCCUPANCY
APPLICATION
Date
Miami Sho
Buildin ' I e • ment
Contact Name 0' ; - A i try -o Phone #
Buyer Seller $ Realtor
Property Address 9 70 6) c ? -
City Miami Shores
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 the property.
OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate.
Applicant Name L, ° /Se C h i N� y
Signature
The foregoing instrument was acknowledged before me this 1 day of
C.S h who is personally known to me or who has
produced
Sign:
Print:
My Commission Expires:
NO ARY PUBLIC:
Building Officials Approval:
State Fl Zip
as identification and who did take an oath.
a sion 1 ♦ :231984
'�OFFLOQ 21/07
'nded . 'hru
nnd C 1
Permit No.
Loc ID
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795 -2204
Fax: (305) 756 -8972
Total
j /
Company Name ,' N A E , Q.
, 20
Re -Occ. $60.00
Notary $5.00
CCF $0.60