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BUILDING PERMITOwner's Name and Address Registered Architect and /or Engineer Name and address of licensed contractor Location and legal description of lot to be built on: MIAMI SHORES VILLAGE 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. BUILDING INSPECTION DEPARTMENT Date. Lot Block Subdivision Street and Number where work is to be done State work to be done and purpose of building (by floors) No Street /A � 19 J and for no other purpose. New Building Remodeling Addition Repairs No. of Stories To be constructed of Kind o foundation Roof Covering Estimated Total cost of improvements $ Q 0 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, 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 ork to be p rformed under this permit, as are licensed by Miami Shores Village. Remarks (Signed) STATE OF FLORIDA, COUNTY OF DADE. j 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. F ea Date / i o `_� Permit No �' 1 �_.:_ �" Read, Sworn to and Subscribed before me. Disapproved Date Notary Public, State of Florida (Signed) 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. Name and address of licensed contractor Member *� 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 C � Owner's Name and Address._..... - � � � � � - � �.. No / ` 1 r`� 4 - ` Street____ .1r ^ Registered Architect and /or Engineer___._ Location and legal description of lot to be built on: f � ,9 ; - it Lot ../. <> _ ' Block Subdivision Street and Number where work is to be done � a� % �� �, State work to be done and purpose of building (by floors) and for no other purpose. New Building Remodeling Addition Repairs No. of Stories To be constructed of Kind of f undation Roof Covering Estimated Total cost of improvements $ ty.0"__ Amount of Permit $ Zone cubage required _Plan Cubage 1�- 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, 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. y Remarks (Signed).-;Z„... 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. <; r - Permit No. " -; Date ' � Read, Sworn to and Subscribed before me. Disapproved Date ,c Notary Public, State of Florida (Signed) � ... - - -c Building Inspector My Commission Expires PLANNING BOARD 1_ b 1 a " _ -- -- DATE Chairman _....- ` Member - - Member Member Member 19 Council proved Date Disapproved Date p A charge of $1.00 will be made for making corrections or changes to this application after approval has been obtained from the PI min Board. mater is a d /or workmanship. 4 re -i spection fee of $1.00 will be charged when such re- inspection is made necessary by improper notice for inspection or faulty KIND OF POLICY POLICY NO. POLICY PERIOD LIMITS OF LIABILITY Bodily Injury Property Damage Workmen's Compensation Eff. Exp. Statutory Nil Manufacturers' and Contractors' Liability r - Eff. __ r . � o Exp. s.---_,; _ i _, ;, Each person $ a ` Each accident $ c _„ , ,, „ ,; , ,, „_, Each accident $ Aggregate $ , 3 . , Owners', Landlords' and Tenants' Liability Eff. Exp. Each person $ Each accident $ Each accident $ Owners' or Contractors' Protective Liability Eff. Exp. Each person $ Each accident $ Each accident $ Aggregate $ Automobile Liability Eff. Exp. Each person $ Each accident $ Each accident $ Comprehensive General Liability Eff. Exp. Each person $ Each accident $ Aggregate $ Each accident $ Aggregate $ Comprehensive Automobile Liability Eff. Exp. Each person $ Each accident $ Each accident $ BITUMINOUS CASUALTY CORPORATION BITUMINOUS FIRE AND MARINE INSURANCE COMPANY HOME OFFICE • ROCK ISLAND, ILLINOIS CERTIFICATE OF INSURANCE THIS IS TO CERTIFY that the described policies, covering in accordance with the terms thereof, are in force as of the date hereof: Insured .. , . Address I Location covered c ! A This certificate is issued to Address In the event of any material change in said policies, the insuring company will notify the party to whom this cer- tificate is issued and in the event of cancellation thereof, ten (10) days prior notice of such cancellation will be given. Insuring company designated by " Dated ' Form P334a -7 -53 ■ IA BITUMINOUS CASUALTY CORPORATION ❑ BITUMINOUS FIRE AND MARINE INSURANCE COMPANY AUT IZF,D REPliebENT'ATIVE 4 LOCATION STATE OF FLORIDA) SS COUNTY OF DADE ) A F F I D A V I 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, amending paragraph (d) of Section B .'368 of Ordinance No. 97 of the Building Code of Miami 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 Director: m 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 certificates showing the payment required by the Federal Social Security Act to the State of Florida or the 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 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, Electrical, Plumbing and Zoning Codes of Miami Shores Village. Such affidavit to be properly notarized upon blanks to be supplied by the Building Inspector. 110 In order to prevent abuses and subterfuge the right of such owner - builder as herein provided, is 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: SUBSCRIBED AND SWORN TO BEFORE NE this 195 1 OWNER ( day of A.D., NOTARY PUBLIC KIND OF POLICY POLICY NO. POLICY PERIOD LIMITS OF LIABILITY Bodily Injury Property Damage Workmen's Compensation Eff. Exp. Statutory Nil Manufacturer' and Contractor' Liability ;,`, Eff. , : , i„,/ )1 Exp. t =/ , f" / Each p erson $ ; ;`,; Each accident $ c ,; s ' , . n ,,', • Each accident $ ` , Aggregate $ „ , Owners', Landlords' and Tenants' Liability Eff. Exp. Each person $ Each accident $ Each accident $ Owners' or Contractors' Protective Liability Eff. Exp. Each person $ Each accident $ • Each accident $ Aggregate $ Automobile Liability Eff. Exp. Each person $ Each accident $ Each accident $ Comprehensive General Liability Eff. Exp. Each person $ Each accident $ Aggregate $ Each accident $ Aggregate $ Comprehensive Automobile Liability Eff. Exp. Each person $ Each accident $ Each accident $ SECURITY SERVICE BITUMINOUS CASUALTY CORPORATION BITUMINOUS FIRE AND MARINE INSURANCE COMPANY THIS IS TO CERTIFY that the described policies, covering in accordance with the terms thereof, are in force as of the date hereof: Insured , �: Address Location covered This certificate is issued to Address In the event of any material change in said policies, the insuring company will notify the party to whom this cer- tificate is issued and in the event of cancellation thereof, ten (10) days prior notice of such cancellation will be given. Dated "" • - - Form P334a -7 -53 Insuring company designated by " CERTIFICATE OF INSURANCE If HOME OFFICE • ROCK ISLAND, ILLINOIS [ BITUMINOUS CASUALTY CORPORATION ❑ BITUMINOUS FIRE AND MARINE INSURANCE COMPANY By` fr..s� y� e! AIITHOIII REPRLSE�;TA7 A LOCATION I s zMil H J BUR- !NG BNSSPfECTIOM DEPARTMENT r.: ■ ES VILLAGE PPLICATION FOR L ILD!NG PERM6l Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted foe 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 oe riot. A copy of approv plans and specifications must be kept at building during gtmgress of the work. pp .� Owner's Name and Address e•• e> c. � � � ... No ... ........ . . Stares...._ Registered Architect and /or Engineer 1,1•••,, ..1,,1-1, ..7,...,.,,,.,- <..... Name and address of licensed contractor .., Location and legal description of lot to be built on: Lot Block Subdivision.. �...._�...._ Street and Number where work is to be done 2 State work to be done and purpose of building (by flooss) (8) and for no other purpose. New Building Remodeling Addition Repairs No. of Stories To be constructed of Kind of foundation . Roof Covering a c, Estimated Total cost of improvements $ ...��1 >.c Amount of Permits i 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 uith 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 ublic notice or notices as arc required by the Act. The undersigned agrees to employ only su'h subcontractors, on work to be performed under this pennit as are licensed by Miami Shores Village. er Si ned L s J � Remarks ( \ g )... -.. _ .. STATE OF FLORIDA, 4 COUNTY OF DADE. Ss. Bcfore me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally ap- peared — 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 therein by him stated are true. Permit No i & Date 1 2--- 7 `? Read, Sworn to and Subscribed before me. Disapproved / Qa e_. ..._ °` C. (Signed) �f�� Ae —7,/ Building In Pcctor / PLANNING BOAR D DATE Chairman Member Member Member Member sass. - - . - - --_ Member Council Approved Date Disepprov:-i Date Notary Public, State of Florida My Commission Expires to me well known, sign the same, and that all facts NOTE: A charge of $1.00 will be made foe making corrections oe changes to this application nfter approval has been obtained from the Planning Board. A re fee of 51.00 will be charged when ouch we- inspection is rrac& necessary by improper notice fog inspection sr faulty materials and /or workmanship. BUILDING ELECTRICAL PLUMBING ROOFING Owner of Building PERMIT N9 2770 Architect Contractor or Builder Legal Lot Description Address of Building CONTRACTOR OR BUILDER MIAMI SHORES VILLAGE. FLORIDA DATE 195 Contractor's License No. Work to be performed under this Permit Bl. Subdi- vision Value of Project $ Amount of Permit $ This permit is granted to the contractor or builder named above to construct the building or to install the equipment or device described in the application herefor in strict compliance with all ordinances pertaining thereto and with the understanding that the work will be performed in compliance with any plans, drawings, statements or specifications that may have been submitted to and approved by the proper municipal authorities. This Permit may be revoked at any time if the work is not done in compliance with such ordinances or if the plans are changed without authorization. A further condition upon which this permit is granted is the understanding that the contractor or builder named above assumes the responsibility for a thorough knowledge of the ordinances and regulations pertaining to the work covered hereby whether shown on the plans or drawings or in the statements or specifications and that he assumes responsibility for work done by his agents, servants or employees. Signed. BY INSPECTOR 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 ac- cepting this permit I assume responsibility for all work done by either, myself, my agent, servant or employee. BY AUTHORITY MIAMI SHORES VILLfr E UILDING 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. �� 'p - D ate 19 1( Owner's Name and Address -. "vA� 0 D a / NOS& .A /Y Registered Architect and /or Engineer ��``` Name and address of licensed contractor_..._ ._.. _. -. �J_t? F Location and legal de ription off to be, built on: q Lot /r 1c, 3 o- Block Subdivision ` F '; Street and Number where work is to be done . J 6 9 2. v47 S PLANNING BOARD __ . DATE Chairman __ Member Member Member Member Member _........ Council Approved __Date Disapproved State work to be done and purpose of building (by floors) a/ _,' and for no other purpose. New Building Remodeling Addition Repairs No. of Sto ' s To be constructed of Kind of foundation -_ P__X 1 L Roof Covering , Estimated Total cost of improvements $ .-CD 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, 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 th ork such public notice or notices as are required by the Act. The undersigned agrees to employ only suc bcpntractors, s work to4,. - performed under this permit, as are licensed by Miami Shores Village. Remarks - - (Signed - -a12 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. /e %/ 6, � Permit No ___ Date ______ Read, Sworn to and Subscribed before me. Disapproved 2 bate Notary Public, State of Florida (Signed) Building I n spector / My Commission Expires.. 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. 2 A e ' k40( L Lt■ , • ■'k===._ r MIAMI SHORES VILLAGE Owner's Name and Address i (� W (IV LP 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. Registered Architect and /or Engineer Name and address of licensed contractor .a.. Location and legal description of lot to,bepuilt on: Lot Block " Subdivision. Street and Number where work is to be done 9 9 () State work to be done and purpose of building (by floors) Remarks Disapproved Q. Dat (Signed) u ' -- -_, Building Inspec E Date. .._.... No . f and for no other purpose. New Building Remodeling. Addition Repairs No. of Stories 0 To be constructed of C• e 5 e Kind of foundation Q_J r JR 4- Roof Covering d u �'• Estimated Total cost of improvements $ a, C) Amount of Permit $ 1 Zone cubage required _Plan Cubage Distance to next nearest building Size of Building Lot / 5 Q 3 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, 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 w to be performed under this permit, as are licensed by Miami Shores Village. P° (Signed) STATE OF FLORIDA, COUNTY OF DADE. J 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 � _ n Date ' - 3! / - �,.�,_ Read, Sworn to and Subscribed before me. Notary Public, State of Florida y Commission Expires ANNING 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 51.00 will be charged when such re- inspection is made necessary by improper notice for inspection or faulty materials and /or workmanship. 1-2.(\c, ivO__ if .°/ i)! t 5 7? if& sc? — ,7 111 1 1— A 9 • • t % ( 7 , 4L i o " n • , • \ A e - 0 ; e ) G 7 - • t e ,;) r • , ) BUILDING'! owner of 3uilding Irchitect 3ontractor r . Builder_ =gam Lot ascription dress of iding MIAMI SHORES VILLAGE. FLORIDA ELECTRICAL 111 DATE 195 LEUMBrNG ❑ PERMIT N9 7597 1OOFTNG ❑ ❑ Work to be performed under this Permit__ _ Bl. Subdi- vision Contractor's License No. J- Sq. Ft Value of Project $ ,p Amt. of Permit $ This permit is granted to the contractor or builder named above to construct the building or to install the equipment or device described in the application r in strict compliance with all ordinances pertaining thereto and with the understanding that the work will be performed in compliance with any plans, qs, statements or specifications that may have been submitted to and approved by the proper municipal authorities. This Permit may be revoked at any he work is not done in compliance with such ordinances or if the plans are changed without authorization. A further condition upon which this permit is is the understanding that the contractor or builder named above assumes the responsibility for a thorough knowledge of the ordinances and regulations to the work covered hereby whether shown on the plans or drawings or in the statements or specifications and that he assumes responsibility for work i s agents, servants or employees. Signed: BY INSPECTOR - ideration of the issuance to me of this permit I agree to perform the work covered hereunder in compliance with all ordinances and regulation: to and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. permit I assume responsibility for all work done by either, myself, my agent, servant or employee. 'TRACTOR OR BUILDER BY AUTHORITY 17 BUILDING ELECTRICAL PLUMBING ROOFING MIAMI SHORES VILLAGE. FLORIDA D DATF 195 2556 teM ❑ PERMIT T Q cntrac t $ s Liens. lit. ❑ Work to be performed under this Permit__ Owner of Building Architect Contractor or Builder Legal Lot Description I Bl. Address of Building This permit is granted to the contractor or builder named above to construct the building or to install the equipment or device described in the application herefor in strict compliance with all ordinances pertaining thereto and with the understanding that the work will be performed in compliance with any plans, drawings, statements or specifications that may have been submitted to and approved by the proper municipal authorities. This Permit may be revoked at any time if the work is not done in compliance with such ordinances or if the plans are changed without authorization. A further condition upon which this permit is granted is the understanding that the contractor or builder named above assumes the responsibility for a thorough knowledge of the ordinances and regulations pertaining to the work covered hereby whether shown on the plans or drawings or in the statements or specifications and that he assumes responsibility for work done by his agents, servants or employees. Subdi- vision Value of Amount of Project $ ji Permit $ Signed: — BY INSPECTOR 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 ac- cepting this permit I assume responsibility for all work done by either, myself, my agent, servant or employee. CONTRACTOR OR BUILDER BY AUTHORITY