Loading...
1225 NE 95 StPROPERTY OWNER /'�(� Name ar Gll e/n OBrr y) Address 1 ii5 NE 95. S-F MAavttir Shores, 1 33 f 38' Home Telephone 3 oS 15 G 6> c a q Business Telephone 305 5 B 3 17 59 / l / Fax 3o5 75 d I O 9 �J TYPE OF MANAGEMENT (✓ ) New Construction Enclosure Alteration Exterior Repair Alteration Interior Demolish Relocation of Structure Shell Only Foundation Only Add'I Attachment Other Add'l Detachment Other INSTRUCTIONS - The following steps must be taken to obtain a permit from the Miami Shores Village: Step 1. Complete the attached permit application which must be signed by the property owner and qualifier. Both signatures must be notarized. Please print or type to allow for a more accurate processing of your application. If roofing work will be done, a roofing application must be submit- ted along with this permit application. Step 2. Submit the completed application with all necessary documents to the Building, Planning and Zoning Department for processing. During the processing of your application, you may be asked to submit additional information. APPLICATION -Job Address: I a a S i V E q c ` Mitaryil Shores h_ 3 8J3 O Folio Number A% r Lot Block Subdivision PB PG Current Use of Property Proposed Use of Property Tenant Information PERMIT TYPE (✓ ) Building Electrical Mechanical Plumbing LPGX Roofing Fence Other PERMIT CHANGE (✓ ) Chg. Contractor Renewal Revision Extension Supplement Reinspection ARCHITECT Name License No. Address Telephone Fax City State Zip EE ci filed_ leon eS o -o area of spc► /deck. 14' Ii cue, removed escription of Work Master Permit No. Subsidiary Permit No. PERMIT APPLICATION Zoning Linear Feet Square Feet Units S� Floors I Value of Work ' 2, 000 s- dl l I C "Bldg Value Tax Assessed/Appraised Value Flood Zone Base Floor Elev. ENGINEER Name License No. Address Telephone Fax CONTRACTOR , `4 Name License No. Address Telephone Fax Qualifier Name Page 2 IMPORTANT NOTICES DO NOT BEGIN ANY WORK WITHOUT HAVING RECEIVED YOUR VALIDATED PERMIT AND PERMIT CARD. Applying for a permit does not grant the right to begin construction. HOURS OF CONSTRUCTION are limited to: Monday through Friday from 7:30 a.m. to 6:00 p.m., and Saturday from 8:00 a.m. to 5:00 p.m. No inspections will be conducted on weekends or holidays. 2. All construction of demolition areas MUST BE MAINTAINED IN A CLEAN, NEAT AND SANITARY CONDITION free from construction debris. 3. STREETS AND NEIGHBORING PROPERTIES SHALL BE KEPT FREE FROM DIRT AND DEBRIS. 4. SWALES MUST BE PROTECTED FROM BEING DAMAGED BY EQUIPMENT OR VEHICLES, AND MAY NOT BE USED FOR STORAGE. A bond is required for work in or near the street/sidewalk. 5. CONSTRUCTION TRAILERS ARE PROHIBITED ON SINGLE FAMILY RESIDENTIAL CONSTRUCTION SITES. Other construction may have a trailer which requires a separate permit. 6. PORTABLE TOILETS for a construction site require a separate permit. 7. DO NOT DISCHARGE WATER INTO THE RIGHT OF WAY OR STORM DRAINS without approval from the Building, Planning and Zoning Department. 8. EQUIPMENT AND MATERIALS SHALL BE STORED at least 10 feet from the edge of pavement. 9. Department of Health and Rehabilitative Services (HRS) approval is required for applications involving septic tanks. Department of Environmental Resources Management (DERM) and/or Miami -Dade Water and Sewer Department (MDWASD) approval is required for applications involving sewers. AFFIDAVIT - Please read carefully. Application is hereby made to obtain a permit to do work and installation as indicated. I, the OWNER of the property, 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, POOL, EXTERIOR DOOR, MECHANICAL, WINDOW, FENCE, DRIVEWAY, ROOFING and SIGNS and there may be additional permits required from other governmental agencies. I, the OWNER of the property, have disclosed all information related to any work at the property performed in the prior twelve months to the Building Official. Further, I am fully aware that if the cumulative cost of work to my home or business under this and any other permit equals or exceeds fifty percent (50 %) of the fair market value of the structure, the entire structure must meet the present federal flood criteria for finished floor elevation. I am also fully aware that if the total cost of work to my home or business under this and any other permit exceeds fifty percent (50 %) of the replacement cost of the structure, then the entire structure must conform to the current code requirements of the Building Code. WARNING TO OWNER: Your failure to record a NOTICE OF COMMENCEMENT may result in you paying twice for improvements to your property. If you are spending more than $2,500 or intend to obtain financing, you may wish to consult with your attorney or lender before recording your Notice of Commencement. The Notice of Commencement must be recorded at: 22 N.W. 1st Street, 1" Floor, (305) 679 -1078. Once recorded, the Notice of Commencement must be POSTED AT THE JOB SITE in accordance with Section 713 -35 of Florida Statutes. Review the brochure at Village Hall on Construction Lien Law and Choosing a Contractor. STATE OF FLORIDA, COUNTY OF MIAMI -DADE Print Name la r E/ f eiv' O B V'r `e-0 X S om to and subscribed before me th Signature of Owne SEAL: STATE OF FLORIDA, COUNTY OF MIAMI -DADE Signature of Contractor / Qualifier Print Name Sworn to and subscribed before me this day of Signature of Notary Public - State of Florida PERMIT APPLICATION `p ttV PU S a` � t . SEAL: II • • •$z%' 4�,•' C;1 ;. : Personally known :24 OR, . Produc Identification Personally known OR, Produced Identification Type of Identification Produced: J) Q / —Si'1 S S ` . O ,y ( pe of Identification Produced: ELECTRICAL Tl'PP: Minimum Fee ()Ty. — mg.: Dryer ()T1 Tvrt: Outlet, Appliance ()Ty. TYPE: Service Repair Q A/C Central 1 -3 Ton Fan Dryer Vents, Number of Outlet, Wall Ventilation, Cost Service, Temporary Air Handler, Tons A/C Central 4 -7 Ton Piping, Flammable Liquid Fire Pump Outlet, Switch Fire Sprinkler System Signs A/C Central 8 -15 Ton Bath Fan - Vented, # Fixture - Fluorescent Pressure Vessel Oven Space Heater (kw) A/C Central 16-20 Ton Fixture Light Parking Lot Lights Spas/Hot Tubs A/C Central 20+ Ton Flood Lights Plugmold/Strip Subfeeds, No. of Amps A/C Window FPL - Load Central Posts Swim Pool, Commercial Air Conditioners Garbage Disposal Range/Range Top Swim Pool, Residential Chiller Generators, etc. Receptacles Switchboards Clear Violations Heat Recovery Refrigerator, Comm. (p/PH) Temp Serv., Construction Compactor Low -volt, Burglar Refrigerator, Domestic Temp for Test - 30 days Deep Freezer Low -volt, Fire Renew - Temp Service Water Closet Demolition Low -volt, Intercom/Teleph. Repair Circuits Water Heater Dishwasher Low -volt, Television Service, Number of Amps Water Heater New MECHANICAL TVI.l.- Minimum Fee QTY. TYPE Condensate Drain ()Ty. TYPl, Generator ()Ty. Tv � is Refrigeration, Tons QTY. A/C Central, Tons Cooling Tower Heating Strips, each Vent Hood, Cost A/C Wall/Win. Tons Dryer Vents, Number of Paint Booth Ventilation, Cost Solar Water Heater Air Handler, Tons Ductwork, Cost of Piping, Flammable Liquid Periodic Inspections Barbecue Fire Sprinkler System Process/Pressure Piping Cap - Fixture Bath Fan - Vented, # Fireplaces, Number of Pressure Vessel Pump and Abandon PLUMBING i'VPE A/C Condensate QTY. TY'PP. Drains, Roof QTY TAPE Miscellaneous Fixture Q'I'1'. "I'1 PE Soakage Pit Q'fl'. Bath Tub Drinking Fountain Miscellaneous Repairs Solar Water Heater Bidet Filter Replace Pool Piping Sprinkler Repair Cap - Fixture Fountain Pump and Abandon Sprinkler System Cap - Water Gas - Appliance Pump, Domestic Supply, AC Well Cap - Sewer Gas - Natural Pump, Fire Stand Temporary Toilet Catch Basin Gas - Propane Pump, Re- circulate Temporary Water Closet Clothes Washer Gas Piping Pump, Replace - Pool Urinal Dental Chair Grease Trap Pump, Sprinkler Utility - Sewer Discharge Well Ice Maker Pump, Sump Utility - Water Dishwasher Indirect Wastes Relay Repair Vacuum Pump Disposal Interceptor Roof Inlet Water Closet Domestic Well Laundry Tray Septic Connection Water Heater Drainfield, 4" Tile/Res. Lavatory Septic Tank Water Heater New Drains, Area Meter Set (Gas) Sewer Connection Water Re -pipe Drains, Floor Minimum Fee Shower Water Service Drains, French Miscellaneous Equipment Sink Well, Supply Page 3 PERMIT APPLICATION INSTRUCTIONS: Please indicate the type of work being performed and quantity(ies) in the space provided below. RECEIVED AND REVIEWED BY: DATE: SECTION BY DATE Zoning l �d�/f )) Electrical Mechanical Plumbing Fire Public Works Structural 7t2— 2-- Building Official Page 4 OFFICE USE ONLY CHECKLIST ❑ OWNER - BUILDER FORM (Attach) ❑ FIRE DEPARTMENT APPROVAL (Commercial / multi - family) ❑ CONCURRENCY (New Construction) ❑ OTHER (Specify & Attach) $3.00 per page (Scanning Fee) Miami Shores Village Bond Metropolitan Dade County (C.C.F.) Inspector State Educational Fund State DCA (Radon) Code Enforcement Fine Zoning Review Notary $ $ ❑ PROOF OF OWNERSHIP (Attach) ❑ HRS / DERM APPROVAL (Septic / Sewer) ❑ IMPACT FEE (New Construction) ❑ OTHER (Specify & Attach) $ $ O ( x ¢ 60 x/1000 ) (¢.005 /sq.ft.) (¢.01 /sq.ft.) PERMIT APPLICATION ❑ CONDO ASSOCIATION APPROVAL (Attach) ❑ BPR APPROVAL (Restaurants) 0 CONTRACTOR REGISTRATION (On File) PERMIT FEES TOTAL $3 0 ISSUING OFFICIAL REVIEWED AND PREPARED BY: DATE: CONDITION OF APPROVAL Revised July 2001 10050 N.E. 2ND AVE., MIAMI SHORES, FL • (305) 795 -2207 • FAX (305) 756 -8972 • http : / /www.miamishoresvillage.com Miami Shores Village 10050 NE 2nd Avenue Phone: 305 - 795 -2204 ' Virinted:5/16/2 tQ p „ _ Applicant: Owner: - TRtPe0O C:7 1 'e■, JOB ADDRESS: 1225 NE 95 Contractor Local Phone: Building Permit Permit Number: BP2002 -935 © Contractor's Address: Page 1 of 1 1). +Ica Parcel # 1132060143990 Legal Description: MIAMI SHORES SEC 3 PB 10 -37 LOTS 25 & 26 BLK 84 LOT SIZE 100 X 131 OR Fees: Description Amount FEE2002 -2794 Building Permit Application Fee $60.00 FEE2002 -2795 CCF $1.20 FEE2002 -2796 Buildier's Bond $300.00 FEE2002 -2797 Notary Fee $5.00 Total Fees: $366.20 Permit Status: Approved Permit Expiration: 11/12/2002 Construction Value: $2,000.00 Total Fees: $366.20 Total Receipts: $0.00 Work: EXTEND TILED PATIO TO AREA OF SPA/DECK WHICH IS REMOVED If there is no permit package accessible on the job -site for inspectors to verify, there will be no inspections. Re- inspection fee is $50.00, which must be paid in advance before calling for another inspection. 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 4r specifications and that he assumes responsibility for work done by his agents, servants or employees. Signed: (INSPECTOR) BY: 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 accepting this permit I assume responisibility for all work done by either myself, my agent, servants or employes. Signed: (Contractor or Builder) BY: The Sunshine State — IJCSISENLOASER 0165- 585 -51 -503-0 MARY ELLEN O BRIEN 1225NE96ST MU1MI SNORES, FL 851880000 BIRTH DATE SOX HOT. REST. EPDORSE. 01-03-61 F 6-:9 ISSUED EXPIRES 11-0648 0108.06 OIPUCATE 02-25-00 SAFE ISMER 70002250006 Operation ct a motor vehicle constitutes consent to any sobriety test required by law. Affiant is personally known to me, produced AFFIDAVIT STATE OF FLORIDA) COUNTY OF DADE) The undersigned Affiant, ll or j Ell e" 0 Brien does hereby attest that the Q( (property owner) attached survey, performed by �J r Oi t C O b Oi n in 1 4 5 D C . (name of surveyor's company) performed on 5-S-01 9 , is an accurate representation of the existing conditions and (date of survey) locations of all structures on the property as of this date. The purpose of this Affidavit is to induce Miami Shores Village to issue a building permit for the property without first providing a survey less than six (6) months old. The Affiant, as property owner, further agrees to remove or obtain permits for any structures which now may exist on the property which are not permitted or which may violate zoning or building code regulations. The Affiant further understands that the existence of any such structures may affect final inspections as applicable to this or other permits.. Further, Affiant sayeth naught. SWORN TO AND SUBSCRIBED before me this day of Affiant/Property owner Witness(sign and print) Witness(sign and print) Notary as identification. • NOT REVISED: VALID UN.ESS EM.BOSSED'WITH SURVEYOR'S SEAL N 0 o_. rn • BOUNDARY SURVEY a _ /E,s. 2& yTXe) ! 4 .690' X &) Eteva:iOnS based c& Catit Elev. � NGV D Locator Index cE? LEGEND • FIP= Found Iron Pipe a S.P.0 =SET1 /2 "PIN & CAPLB4789 F 2:,D -roan_ tail .5 Disc S.PCP= SET PERMANENT CONTROL POINT LB4789 q= CENTERLINE. P /L= PROPERTY LINE. 0 /L= ON LINE M.H.= MANHOLE. WM= WATER METER, PP= POWER POLE F.C.= FENCE CORNER. R= RECORD. M= MEASURED CHAIN LINK OR WIRE FENCE= • . v WOOD FENCE= MASONRY WALL - CONCRETE= S:• •',:• ; • •• • - ; • • • . Y_AINI DANCE & DRENAGE EASE T = maD.E. NOTES: UNLESS OTHERWISE SHOWN, THE FOLLOWING NOTES APPLY. INSURAN7CE ONLY ON TEE VALUE. OF THE SI:RPEY 1) Record and measured calls are in substantial agreement. 2) Bearings, if shown are based on Plat data. 3) The lands shown hereon were not abstracted for Easements or other recorded emcumbrances not shown on the plat and :he same, if any may not be shown on this sketch. 4) Underground portions of Footings, Foundations or other improverner.ts were not located. 5) Elevations are based on National Geodetic Datum. 6) Fence Ties are to the Centerline of the feat, :e. 7) Wall _ Ties to the face of the Wall. $ _ `r t'.._:i Sii��' i =E = ;..N �: _l S -, r s .. (- • ma • • .•.• • • • .•• •• •. • • • .. •• • • • •.•.• • • • • ... . • • • • • • •. . . • • • .....•• • ••• • ••• • •• • • • • •. • • . • • • • .. • •• • • . . . . 1 —:F•7 .i.TY■- • :.r .:3!'. .•i...- • •• L . �Irii�V : LEGAL DESCRIPTION: LOTS 7S & 26 BLOCK R4 OF MIAMI SHORES SECTION NO. 3 SUBDIVISION ACCORDING TO THE PLAT THEREOF AS RECORDED IN PLAT BOOK 10 AT PAGE 37 OF THE PUBLIC - RECORDS OF DADE COUNTY, FLORIDA. I HEREBY CERTIFY That the survey represented hereon meets the minimum technical requirements adopted by the STATE OF FLORIDA Board of Land Surveyors pursuant to Section 472.027 Florida Statutes. There are no encroachments. overlaps. easements appearing on the plat or visible easements other than as shown hereon ADIS N. NUNEZ R_g s:ereCLand Surveyor No 5924 L O C A T I O N S K E T C H SCALE: N T S FLOOD ZONE: CERTIFIED TO: ANTHONY J. TRIPODO AND MARY ELLEN O'BRIEN, HUSBAND AND WIFE, 1225 N.E. 95TH ST., MIAMI SHORES,-FLORIDA 33138., CHRISTOPHER P. KELLEY, P.A. ATTORNEYS' TITLE INSURANCE FUND INC., dHASE MANHATTAN MORTGAGE CORPORATION, ITS SUCCESSORS AND /OR ASSIGNS, ATIMA. SINCE 1987 BLANCO, DANIAL & ASSOC. INC. Engineers • Land Surveyors • Planners LB . # .4789 555 NORTH SHORE DRIVE MIAMI BEACH FL. 33141 (305) 865 -1200 N-E : 0093 DATE: SCALE: - G -99 _ 11= 20 Fax" (305 865 -7810 SUFFIX::) DATE: 3 BASE: 4 . ( I , tT ,*V rrr.f2r 1? • 1 (') DWN. BY: F. Lt4co JOB No. .99- !7 MIAMI SHORES VILLAGE BUILDING INSPECTION DEPARTMENT APPLICATION FOR BUILDING PERMIT Application is hereby made for the approval of the detailed statement or me 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, Horid.t. 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 Divisinn 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. — No.. LI"? Street--- . 4-- Owner's Name and Address .6. STATE OF FLORIDA, COUNTY OF DADE. ss. Registered Architect and /or Engineer ,,:,. .,.••.,, ,•:,,,,,n,,,...:•.,T,,,,,z,,,:� , y� p�� �i 1� , Fame and address of licensed contractor � 1�'.°.Y'c�_SL:.Y. �.. ..yc.a",) 1 Location and legal description of lot to be built on: Lot Block Subdivision o r• Street and Number where work is to be don State work to be done and purpose of building (by floors) woo and for no other purpose. New Building Remodeling Addition Repairs No, of Stories i To be constructed of Kind of foundatio 4 Roof Covering. ...!..e.:-/-* :.. sL ...._..__ Estimated Total cost of improvements S t4' - Amount of Permit S. F � 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 Lthor under the Honda Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida, Permanent Supplement, anti 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 arc required by the Act. The undersigned agrees to employ only such subcontractors, on work to be performed under this pcnnit, as are licensed by Miami Shores Village. Remarks (Signed)_.. ...-.. j '.- !_(,<"4,l- - ,),: - Disapproved Date.. (Signed) tu.. Building Inspector ru- 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.._ Date 1 Read, Sworn to and Subscribed before me. Notary Public, State of Florida 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 PLrnnir.g Board. A rc•in.peution fee of $1.00 will be charged when such re- inspection is made necessary by Improper notice for inspection or faulty materials anti /or workmanship. Date Type Insp'n Permit No. Name Address Approved Correction Re- Insp'n Fee MIAMI SHORES VILLAGE BUILDING DEPARTMENT 305- 795 -2204 Buildi g Inspection Request oI E cs c 4 . tO 5- .3g-s ot5 3+ Company U«-J')n e Phone # Inspection Date a MIAMI SHORES VILLAGE BUILDING DEPARTMENT 305-795-2204 Building Inspection Request Date - - , c - - ,- Type Insp'n r -,=- - .. --, A '----..--- - -------- - .e-- ::.,t -- ±,_'-'). Permit No. Name ' A C . / Company Address Phone # Inspection Date Approved Correction 7 7 Re-Insp'n Fee r nmt I MrrL . ,arra a iwall vet — (OWNER TO RETAIN COPY) Date 4/10/91 Job Address Legal Description?; 5'o2 Owner's Address 1225 N.E. 95th St. Qualifier James D. Obenntir State# CC0014306 WORK DESCRIPTION Sign Date: Zoning Mechanical 1225 N.E. 95th Street Owner / Lessee / Tenant John Knezevich er and /or Condo President Miami Shores No ary as to Owner and /or C ./. do President My Commission Expi es` etary Publie State of Fiort * * * ?t' Ceirission Ex *es Fab. 11 ` * PERMIT FEE: APPROVED: Fire Tax Folio 11 _ 5:7i9 // D: Master Permit. # 30 C ? alai /q/ 20 Phone Obenour Roofing, Sheet MetaL & Supi 7357 N.W. Miami Ct Contracting Co. ,vi 1 am �, F u s i T5 0 SS# 265 — 44 — 3517 Phone 757 - 2612 Competency # 006454 Ins.Co.F.C.C.I. Fund Architect /Engineer Address Bonding Company Address Mortgagor Address Permit Type (circle one): UILDING ELECTRICAL PLUMBING MECHANICAL PAVING FENCE Install new Gory cement barrel tile to matrh PViC1-141g Square Ft. 9 sqs Estimated Cost 4,300.00 WARNING TO OWNER: YOU MUST RECORD A NOTICE OF OF COMMENCEMENT AND YOUR FAILURE DO SO MTY TEND TO OBTAIN FFIINANCING PAYING YOUR LENDER OR AN ATTORNEY BEFORE INTEND RECORDING YOUR NOTICE OF COMMENCEMENT). Application is hereby made to obtain a permit to do work and installation as indicated above, on the attached addendum (if applicable). I certify that all work will be performed to meet standards of all laws regulating construction in this jurisdiction. I understand that sepa 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 will be done in compliance with all applicable laws regulating construction and zon Furtherm• , authorize the above -named contractor to do work stated. Ali!:4( /e "12.4' �� atur of Contrac or Owner- Builder T tra • 4 i Notary as to Contractor Commi*op or Ettpi a s�, '• . eb. 1 1988 - Builder 14y Commission F.xp aiv:Public State of Florida y� * * . 14.]' i1 Building Electrical Plumbing Engineering Application is hereby made for the approyal 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. Owner's Name and Address...! Reifistered Architect and /or Engineer... _ // . Name and address of licensed contractor.. 1.- _ e o ? - (N4 / 4' - . Location and legal description of lot to be built on: Lot__ Block.__._.... __. __._.__._ ... Subdivision Street and Number where work is to be done work to be done and purpose of building (by floors)_ New Building Remodeling 6" Addition Repairs No. of Stories To be constructed of Kind of foundation Roof Covering___ Q 777 $ s� © 0 Estimated Total cost of improvements $ 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 foi said building. All notices with reference to the building and its construction may be sent The undersigned undersigned applicant for this building permit doc 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 s bcontractor , 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 a.knowledgments, 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 be has carefully read the foregoing application, and that he did sign the same, and that all facts therein by him stat d are true. t o Permit No._ ..... __� Date_.__. if— 7 Read, Sworn to and Subscribed before me. Disapproved ____ _ (Signed) Ld /Z Chairman _. Member ______________ Member _ Council Approved MIAMI SHORES VILLAGE BUILDING INSPECTION DEPARTMENT APPLICATION FOR BUILDING PERMIT f �o Date Building Inspect.. My Commission Expires NING BOARD_ NOTE: A charge of $1.00 will be made for making corrections the Planning Board. A re- inspection fee of 51.00 will be charged materials and /or workmanship. Date Amount of Permit Date ,19 NoL2 . Street. _J,� and for no other purpose. to me well known, Notary Public, State of Florida DATE Member Member Member ..._ Disapproved _._..._ .Date or changes to this application after approval has been obtained from when such re- inspection is made necessary by improper notice for inspection or faulty