PAINTPERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Date oz-o6frt $ ' Job Address ICS gZ577, 0N+ $ &Q1 Tax Folio
Legal Description Historically Designated: Yes N
Owner/Lessee / Tenant 7 S A n 3 E 00/A Master Permit # - 2 y ;
Owner's Address "t ''20 o dJ� i of (3. E .6t1 a i vti l3 C O (� �ccau �' ��•33r�2 Phone �Z S ' ¢ l r
Contracting Co. CO W W Z Address
Qualifier SS# Phone
State # Municipal # Competency # Ins. Co.
Architect/Engineer Address
Bonding Company Address / ,
Mortgagor StEe (►A16 1B. is l K. Address 11 ZY [J y no/c o. ,of £ / b7 'hz I/. 3 3 46, 2.
Permit Type (circle one)- ILD LECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIPTION / 1J7) L) 6 o 'e
Signature of
FEES: PERMIT
RADON
Square Ft Estimated Cost (value)
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 authorize the above-named contractor to do the work stated.
resident Date
Notary as to Owner and/or Condo President Date
My Commission Expires:
C.C.F.
/ /'/ v iii
Si
ature
Contractor or
Notary as to Contractor or Owner - Builder
My Commission Expires:
NOTARY BOND
n),
er- Builder Date
Date
APPROVED: ► y
Zoning Building � 2/1 iqg Electrical
Mechanical Plumbing Engineering
Registered Architect and /or Engineer
Name and address of licensed contractor
STATE OF FLORIDA,
COUNTY OF DADE. ss.
Permit No. Date
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 building
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 regula-
tions 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_!!___
Location and legal description of lot to be built on:
Lot 0� - -°�_ °� _ Subdivision
Street and Number where work is to be done______
State work to be done and purpose of building (by floors)
PLANNING BOARD DATE
Chairman Member
Member Member
Member — ______- — __— .______________ —__ ____________ Member
Council Approved Date Disapproved
NOTE: A charge of $1.00 will be made for making corrections or changes to this applicatio,
the Planning Board.
A re- inspection fee of $1.00 will be charged when such re- inspection is made necessary by
materials and /or workmanship.
(ov er)
_ Date - - - - -- - 19 �%
0c - -
_ —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
Distance to next nearest building__ _
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 z
Plan Cubage
_Size of Building Lot _
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 subc ntrac rs, on work . be performed under this
permit, as are licensed by Miami Shores Village. ld 1
Remarks (Signed) .� � (.1
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments,
appeared
and who, being by me first duly sworn, upon oath deposes and says that he is the
of the above described construction, that be has carefully read the foregoing application, and that he did sign the same,
therein by him stated are true.
Read, Sworn to and Subscribed before me.
Notary Public, State of Flo.
Building Inspector My Commission Expires____— __ —____
to mv'
23
LIST OF CONTRACTORS, 'SUB- CONTRACTORS; ETC.
REQUIRING. OCCUPATIONAL LICENSES
MIAMI SHORES VILLAGE
,1. General Building Contractor.
2. Plumbing, Heating, Ventilating, Air Conditioning and Gas
3. , Electrical.
Architects, Engineer, Surveyors, Landscape Architects and Interior Decorators..
5. Excavating, grading, filling and Landscaping.
6. Moving or wrecking.
'7. Septic Tank and Drain Field.
8. Brick, Stone, Tile, Cement Block, Concrete and Gypsum. .
9. Carpentry, Millwork, Awning and Shutters.
10. Cement, Lime, Plastering, Stucco, Lathing Cast Stone.
11. Decorating (interior and exterior) , Painting; Waterproofing, Damp= Proofing and Paper- hanging.
12. Flooring, sanding or finishing; wood, rubber, composition, linoleum and other flooring not otherwise
specified.
13. Ornamental Iron, Bronze and Steel, Steel Sash, Over -head Doors. •
14. Roofing, Sheetmetal and 'Skylights.
15 Solar Water Systems.
16. Well drillers. ;
17. Sprinkler Systems of all kinds, including those for Buildings, Lawns, etc.
18. Structural and Reinforcing Iron and Steel. .
19. Tile, Terrazzo, Marble, Granite Cut Stone.
20. Electric Fixtures. . .
'1. Illuminated Signs.
Bridge, Bulk- heading, Drainage Sewer, Water and Gas excavation and Construction, Dredging, Irriga-
tion System, Pile Driving, Sea Wall, Paving, Sidewalks, Curb and Gutter or similar work.
Every person, firm, .co-partnership, Corporation, Association or other organization engaged in the bus
iness of supplying, furnishing or delivering building materials fo any construction project within' the
Village Limits and not having a regularly .established and license's place of business in the Village.
Owner's Name and Address________ _ � 6
Registered Architect and /or Engineer
Name and address of licensed contractor
Location and legal description of lot to be built on:
Lot____ e Block___— ___________ Subdivision
Street and Number where work is to be done (e))
State work to be done and purpose of building (by floors)
Zone cubage required
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 building
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 Slate of Florida, all ordinances of Miami Shores Village and all rules and regula-
tions 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.
D a t e _
0 No 10 5 St Eeei
_Plan Cubage
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 $
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 be 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 subc }ntractors, on work Ito 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
appeared
Disapproved Date
(Signed)
Building Inspector My Commission Expires
PLANNING BOARD DATE
Chairman Member
Member Member
Member _ Member
Council Approved— _ _Date Disapproved
(over)
Notary Public, State of Florida
to me well known,
and who, being by me first duly sworn, upon oath deposes and says that be 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.
_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.
LIST OF CONTRACTORS, SUB = CONTRACTORS, ETC.
REQUIRING OCCUPATIONAL LICENSES
MIAMI SHORES VILLAGE
:1. General Building Contractor.
2. Plumbing, Heating, Ventilating, Air Conditioning and Gas Fitting.
3. Electrical. .
4. Architects, Engineer, Surveyors, Landscape Architects and Interior Decorators.
5... Excavating, grading, filling and Landscaping.
Moving or wrecking.
7. Septic Tank and Drain Field.
8. Brick, Stone, Tile, Cement Block, Concrete and Gypsum.
9. Carpentry, Millwork, Awning and Shutters.
10. Cement, Lime, Plastering, Stucco,, Lathing and Cast Stone.
11. Decorating (interior and exterior) , Painting, Waterproofing, Damp - Proofing and Paper-hanging.
12. Flooring, sanding or finishing; wood, rubber, composition, linoleum and other flooring not otherwise
specified.
13. Ornamental Iron, Bronze and Steel, Steel Sash, Over -head Doors.
14. Roofing, Sheetmetal and 'Skylights.
15. 'Solar Water Systems.
16. Well drillers.
17. Sprinkler Systems of all kinds, including those for Buildings, Lawns, etc.
18. Structural and Reinforcing Iron and Steel.
19. Tile, Terrazzo, Marble, Granite And Cut Stone,
20. Electric Fixtures. ,
21. Illuminated Signs.
22. Bridge, Bulk- heading, Drainage, Sewer, Water and Gas excavation and. Construction, Dredging; Irriga-
tion System, Pile Driving, Sea Wall, Paving, Sidewalks, Curb and Gutter or similar work.
23. Every person, firm, co-partnership, Corporation, Association or other organization engaged in the bus
iness of supplying, furnishing or delivering: building materials for any construction project within the
Village Limits and not having a regularly established and licensed place of business in„the Village.
1