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ROOFINGPERMIT APPLICATION FOR MIAMI SHORES VILLAGE Date 1(►Li 12(.c o Job Address fay + r 9 Li 14- Tax Folio Legal Description Historically Designated: Yes No Owner/Lessee / Tenant + UDR A 12T H S . SS Master Permit # 1 7 1 23 -- 9 0 Owner's Address t ;)"S t Sb . V 7I c wU S Contracting Co. Wtkk kctciek .R©oil 9 Address 5 1✓�Ec �1 ir1,C�• l'" M Sh 3 °� 1 �r % 4 R c Qualifier P60-.6 4G�,1tiICt t �.I 1� SS# Phone 3o5 r iS q - o /c7 V State # Municipal # Competency # ( t P2,6 f 6Ins. Co. 1—eCLA c r K Architect/Engineer Address Bonding Company Address Mortgagor Address Permit Type (circle one): � BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN l WORK DESCRIPTION e.A.r e4 ∎-. +1 �1.C1 + 1 e rot> - F c p 14 , (iik A- f`1 c IA.: Spc i4-S L - f k y co [pr roi 'L-4 re- wi-f -h 2 &M Square Ft. 31: 00 Estimated Cost (value) t 1 / i200.00 WARNING TO OWNER: YOU MUST RECORD A NOTICE OF COMMENCEMENT AND YOUR FA]IURE 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. OWNERS Al.HDAVTI': 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. Fnyhermore, I authorize the above -named contractor to do the work stated. i¢natur of My Commission Expires: FEES: PERMIT Signature of o ,z =.., / Da 5 S Laba o as t O and/or Condo President Date No : f as to Contractor My Commission Exp Davita Mandrel) Commission # CC 799618 3f3 Expires FEB. 20, 2003 fl, BONDED THRU nnN�` ATLANTIC BONDING CO., INC. APPROVED: Zoning Building Mechanical RADON C.C.Fhh'' k NOTARY lifetfro S 't4 Phone (30g) ?'S _ L /iy C3 Sy Electrical ontractor or r n er- wilder r Own r- J AI: MAR? PUT?IC STATE O^ J LC" % COMMISSION N3. CC71 Yr/ CCyMNSIC19I Plumbing Structural Engineer 1 /g ,e9 Date ed Date BOND 30o TOTAL DU 'm3' Contr*ctor i Name: P4-1. ek. ROOF CATEGORY ❑ (Low Slope Application) ❑ (Nail On Tile) g(Mortar- Adhesive Set Tile) ❑ (Asphalt/Fiberglass Shingles) ❑ ( Metal RoofssWood Shingles & Shakes) ❑ (Other) - gRe ROOF TYPE ❑ New Roof ❑ Recovering ❑ Repair ❑ Maintenance Flat Roof Area (ft') 0 Sloped Roof Area (ft) 3ZD Total (ft ) 3 -1 Master Permit No. Exposure category (per ASCE 7 -88): Building Classification category (per ASCE 7 -88 table 1): F Ft. +23.01.78 9/96 Deck type: Fastener Type: Field: DETAIL 1 & 2 ATTACHMENT SPACING Job Addresr- i _ 517 ROOF HEIGHT AND SYSTEM DETAILS (Draw details as needed) Perimeter: Corner: Page -1 ROOF PLAN ( Ridge Il`t�! q1 I MEAN HEIGHT I Deck type: z Underlaymestt: Insulation: D E T A I L 3 ROO ?!LOPE (PmaxI: 95 °4 X (Aerodynamic Multiplier): (Pmax2: 1)6 X X (Aerodynamic Multiplier): (Pmax3: I X (Aerodynamic Multiplier): "PPtuuu Li UNIFORM ROOFING PERMIT APPLICATION PROCESS No. SLOPED SYSTEM DESCRIPTION Fastener type & sparing: Cap Sheet: Roof Covering: Drip edge: TILE CALCULATIONS °'t or, lAp )2" o /d Page -2. cb dot- JAl eN ATTACHMENTS REQUIRED 1) Fire Directory Listing Page 2) Dade County Product Control Notice of Acceptance -Cover Sheet a) Specific System Description b) Specific System Limitation c) General Limitations d) Applicable Detail Drawings 3) Municipal Permit Application 4) Other Component Approvals a 'po ly ! t' _ _ PCA: bb1C t°' C i ) - M Q : b io = M 3 PCA: 66,5* i��) - m g : bto :7g6 A: 76k a APPENDIX "F" REQUIRED OWNERS \OTIFICATION FOR ROOFING CONSIDERATIONS As it pert; ins to this Appendix "F ", it i3 !Ile responsibility of the roc fin_ contractor to provide the owner with the required roofing permit, to provide the owner with this appendix and to explain to the owner the content of this forth. The provisions of Chapter 34 of the South Florida Building Code (SFEC) govern all the minimum requirements and standards of the industry for roofing system installations. Additionally, the following items should be addressed as part of the agre.cment between the owner and the contractor. The owner's initial in the adjacent box indicates that the item has been explained. 1 1: Aesthetics- WVorkntanship:. The workmanship provisions of Chapter 34 are for tile. purpose of providing that the roofing system meets tltc wind resistance and water intrusion performance standards. Aesthetics (appearance) issues are not a consideration with respect to workmanship provisions. Aesthetic issues such as color or a r.:kitect :: .I appearance, ills', tot o 1 r or code should ; ..��: at are n part o � innin , � be addressed ;rs hart o the agreement between the owner and the contractor. • 2. Renailing'Wood Decks: When replacing roofing, the existing wood roof'deck niay hive to be renailed in accordance withithc current provisions of Chapter 29 of the SFBC. (The roof dee.; is usually concealed prior to removing the existing roof system) 3. Common Roofs: Common roofs are those which have no visible del.neation between neiv.hboring units (i.c. townhouses, condominiums, etc.). In buildings with common roofs, the roofing contractor and /or owner should notify the occupants of adjacent units of roofing work to bc performed. 1. Exposed ceilings: Exposed, open beam ceilings are where the underside of the roof decking can be viewed from below. The owner may wish to maintain the architectural appearance, therefore, roofing nail penetrations of the underside of the decking may not be acceptable. The SFBC provides the option of.n:aintaining this appearance. Ponding \Vnter: The current roof systcn and /or deck of the building may not drain well and may cause water to pond (accumulate) in low-lying areas of the roof. Ponding can be an indication of structural distress and may require the review of a profess'ional structural engineer. Pondinr may shorten the life expectancy and performance of the new room`, system. Ponding conditions may no: bc evident until the original roofing system is removed. Ponding conditions should bc corrected. L. Overflow Scuppers. (wall outlets): It is required that rainwater now oft so that the roof is no: overloaded from a build up of water. Pcrimcter;ed`c walls or other roof extensions may block this discharge if overflow scuppers (wall outlets) are not provided. It may be necessary to install overftoj scuppers in accordance with Chapter 23 of the SFBC. 7. Ventilation: Most roof structures should have some ability to vent natural airflow through the interior of the structural assembly (the building itself). The existing amount of attic ventilation shall not be reduced. 1: may be beneficial to consider additional venting which can result in extending the service life of the roof. The owner may contact the Miami -Dade County Constuttcr Scr. ices Department for f•.::thcr information regarding the above. 0wwncr's /Agcn ' Signature Date Cont :tor's Sig:laturc M 1 AM I MIAMI -DADE COUNTY, FLORIDA METRO -DADE FLAGLER BUILDING BUILDING CODE COMPLIANCE OFFICE METRO -DADE FLAGLER BUILDING 1.40 WEST FLAGLER STREET, SUITE 1603 MIAMI, FLORIDA 33130 -1563 (30,,) 375 -2901 FAX (305) 375-2903 Almar (USA), Inc. CONTRACTOR LICENSING SECTION 6645 NW 77 Ave. (305) 375.2527 FAX (305) 375 -2553 Miami FL 33166 CONTRACTOR ENFORCEMENT SECTION (305) 375-2966 FAX (305) 375 -2908 application for Product Approval PRODUCT CONTROL DIVISION Your a PP pproval of: (305) 375 -2902 FAX (305) 372-6339 Altusa "S" Tile- under Chapter 8 of the Code of Miami -Dade County governing the use of Alternate Materials and Types of Construction, and completely described herein, has been recommended for acceptance by the Miami -Dade County Building Code Compliance Office (BCCO) under the conditions specified herein. This approval shall not be valid after the expiration date stated below. BCCO reserves the right to secure this product or material at anytime from a jobsite or manufacturer's plant for quality control testing. If this product or material fails to perform in the approved manner, BCCO may revoke, modify, or suspend the use of such product or material immediately. BCCO reserves the right to revoke this approval, if it is determined BCCO that this product or material fails to meet the requirements of the South Florida Building Code. PRODUCT CONTROL NOTICE OF ACCEPTANCE The expense of such testing will be incurred by the manufacturer. Acceptance No.:99- 1102.04 (Revises No.: 97- 0918.02) Expires:12 /16/2002 Raul Rodriguez Chief Product Control Division THIS IS THE COVERSHEET, SEE ADDITIONAL PAGES FOR SPECIFIC AND GENERAL CONDITIONS BUILDING CODE & PRODUCT REVIEW COMMITTEE This application for Product Approval has been reviewed by the BCCO and approved by the Building Code and Product Review Committee to be used in Dade County, Florida under the conditions set forth above. r_ Approved: 12 /16/1999 rancisco Quintana, R.A. Director 1 of 8 Miami -Dade County Building Code Compliance Offi' Table 3: Attachment Resistance Expressed as a Moment - M, (ft-Ibf) for Nail -On Systems Tile Profile Fastener Type Direct Deck (min 15/32" plywood) Direct Deck (min. 19/32" plywood) Battens One Piece 'S' Tile 2 -10d Ring Shank Nails 28.6 41.2 19.4 1 -10d Smooth or Screw Shank Nail 5.1 6.8 2.8 2 -10d Smooth or Screw Shank Nails 6.9 9.2 7.3 1 . #8 Screw 28.7 28.7 N/A 2 . #8 Screws 58.2 58.2 26.8 1 -10d Smooth or Screw Shank Nail (Field Clip) 23.1 23.1 19.0 1 -10d Smooth or Screw Shank Nail (Eave Clip) 29.3 29.3 24.0 2 -10d Smooth or Screw Shank Nails (Field Clip) 27.6 27.6 38.6 2 -10d Smooth or Screw Shank Nails (Eave Clip) 38.1 ii 38.1 41.8 2 -10d Ring Shank Nails' 33.1 48.1 45.2 I Installation with a 4" tile headlap and fasterners are located a min. of 2W from head of tile. Table 2: Restoring Moments due to Gravity - M (ft-Ibf . Tile Profile 3 ":12" or Tess 4 ":12" 5 ":12" 6 ":12" 7 ":12" or greater One Piece 'S' Tile Battens Direct Deck Battens Direct Deck Battens Direct Deck Battens Direct Deck Battens Direct , Deck 4.47 5.35 4.40 I 5.27 4.31 5.16 4.20 5.03 4.08 4.89 'ALMAR (USA), INC. ACCEPTANCE No.: 99- 1102.04 APPROVED :December 16, 1999 EXPIRES :December 16, 2002 NOTICE OF ACCEPTANCE: STANDARD CONDITIONS 4.2 Data For Attachment Calculations Frank Zuloaca. RRC Table 1: Aerodynamic Multipliers - X (ft') Tile X (ft') a. (ft') Profile Batten Application Direct Deck Application One Piece 'S' Tile 0.253 0.274 'ALMAR (USA), INC. ACCEPTANCE No.: 99- 1102.04 APPROVED :December 16, 1999 EXPIRES :December 16, 2002 NOTICE OF ACCEPTANCE: STANDARD CONDITIONS 4.2 Data For Attachment Calculations Frank Zuloaca. RRC Table 4: Attachment Resistance Expressed as a Moment M1 (ft -lbf) for Two Patty Adhesive Set Systems Tile Profile Tile Application Minimum Attachment Resistance One Piece 'S' Tile Adhesive 29.3 2 See manufactures component approval for installation requirements. 3 Flexible Products Company TileBond Average weight per patty 10.7 grams. Polyfoam Product, Inc. Average weight per patty 8 grams. Table 4A: Attachment Resistance Expressed as a Moment - M, (ft -Ibf) for Single Patty Adhesive Set Systems Tile Profile Tile Application Minimum Attachment Resistance One Piece 'S' Tile Polyfoam PolyPro 66.5 Polyfoam PolyPro 38.7 4 Large paddy placement of 63grams of PolyPro TM . 5 Medium paddy placement of 24grams of PoIyProTM. Table 4B: Attachment Resistance Expressed as a Moment - M (ft -Ibf) for Mortar Set Systems Tile Profile Tile Application Attachment Resistance One Piece 'S' Tile Mortar Set' 24.50 ALMAR (USA), INC. ACCEPTANCE No.: 99- 1102.04 APPROVED :December 16, 1999 EXPIRES :December 16, 2002 NOTICE OF ACCEPTANCE: STANDARD CONDITIONS 5. LABELING All tiles shall bear the imprint or identifiable marking of the manufacturer's name or logo, or following statement: "Miami -Dade County Product Control Approjed ". 6. BUILDING PERMIT REQUIREMENTS 6.1 Application for building permit shall be accompanied by copies of the following: 6.1.1 This Notice of Acceptance. 6.1.2 Any other documents required by the Building Official or the South Florida Building Code (SFBC) in order to properly evaluate the installation of this system. .ALMAR (USA), INC. ACCEPTANCE No.: 99- 1102.04 APPROVED :December 16, 1999 EXPIRES :December 16, 2002 NOTICE OF ACCEPTANCE: STANDARD CONDITIONS PROFILE DRAWINGS 10-1/ 2" ONE PIECE `S' CLAY ROOF TILE I 1 Frank Zuloasa. RRC. ,ALMAR (USA), INC. 1. SCOPE This revises a roofing system using Almar `One Piece S' Clay Roof Tile, as manufactured Almar (USA), Inc. described in Section 2 of this Notice of Acceptance, designed to comply with the. South Florida Building Code, 1994 Edition for Miami -Dade County. For the locations where the pressure requirements, as determined by SFBC Chapter 23, do not exceed the design pressure values obtain by calculations in compliance with RAS 127 using the values listed in section 4 herein. The attachment calculations shall be done asa moment based system. 2. PRODUCT DESCRIPTION Manufactured by Applicant One Piece `S' Tile Trim Pieces 430 Felt APPROVED :December 16, 1999 EXPIRES :December 16, 2002 NOTICE OF ACCEPTANCE: STANDARD CONDITIONS Category: Prepared Roofing Sub Category: High Profile Tile Dimensions 1= 18 '' /--" w= 10" '' /--" thick nominal 1= varies w = varies varying thickness 2.1 Components or products manufactured by others Product 443 Coated Base Sheet Dimensions N/A N/A Test Specifications ACCEPTANCE No.: 99 1102.04 PA 112 High profile clay roof tile. For direct deck or batten nail -on, mortar set or adhesive set applications. PA 112 Test Specifications Accessory trim, clay roof pieces for use at hips, rakes, ridges and valley terminations. Manufactured for each tile profile. Product Description Product Description ASTM D 226 Saturated organic felt to type II be used as a nailed anchor sheet. ASTM D 2626 Saturated and coated generic organic base sheet for single or double ply underlaysr_ one- J Manufacturer generic ALM AR (USA), INC. ACCEPTANCE No. : 994102,04 APPROVED :December 16, 1999 EXPIRES :December 16, 2002 NOTICE OF ACCEPTANCE: STANDARD CONDITIONS 1. Renewal of this Acceptance (approval) shall be considered after a renewal application has been filed and the original submitted documents, including test - supporting data, engineering documents, are no older than eight (8) years. 2. Any and all approved products shall be permanently labeled with the manufacturer's name, city, state, and the following statement: "Miami -Dade County Product Control Approval ", or as specifically stated in the specific conditions of this Acceptance. 3. Renewals of Acceptance will not be considered if: a. There has been a change in the South Florida Building Code affecting the evaluation of this product and the product is not in compliance with the code changes. b. The product is no longer the same product (identical) as the one originally approved. c. If the Acceptance holder has not complied with all the requirements of this acceptance, including the correct installation of the product. d. The engineer who originally prepared, signed and sealed the required documentation initially submitted, is no longer practicing the engineering profession. 4. Any revision or change in the materials, use, and /or manufacture of the product or process shall automatically be cause for termination of this Acceptance, unless prior written approval has been requested (through the filing of a revision application with appropriate fee) and granted by this office. 5. Any of the following shall also be grounds for removal of this Acceptance: a. Unsatisfactory performance of this product or process. b. Misuse of this Acceptance as an endorsement of any product, for sales, advertising or any other purposes. 6. The Notice of Acceptance number preceded by the words Miami -Dade County, Florida, and followed by the expiration date may be displayed in advertising literature. If any portion of the Notice of Acceptance is displayed, then it shall be done in its entirety. 7. A copy of this Acceptance as well as approved drawings and other documents, where it applies, shall be provided to the user by the manufacturer or its distributors and shall be available for inspection at the job site at all time. The engineer need not reseal the copies. 8. Failure to comply with any section of this Acceptance shall be cause for termination and removal of Acceptance. 9. This Notice of Acceptance consists of pages 1 through 7 and this last page 8. END OF TI-EIS ACCEPTANC 1,11.. 7.. 0 n r. r ALMAR (USA), INC. Product Mineral Surface Cap Sheet Rainproof II Ice and Water Shield Wood Battens Tile Nails Tile Screws Roof Tile Mortar ( "TileTiteT" ") NOTICE OF ACCEPTANCE: Test Dimensions Specifications N/A 30" x 75' roll 36" x 75' roll or 60" x 75' roll 36" x 75' roll vertical min. 1 " x4" horizontal min. l" x 4" for use with vertical battens or min. 1" x 2" for use alone Min. l0d x 3" x 2 '/:" long 0.335" head dia. 0.131" shank dia. 0.175" sctrew thread diameter N/A APPROVED :December 16, 1999 EXPIRES :December 16, 2002 STANDARD CONDITIONS Product Description ASTM D 249 Mineral surfaced asphalt roll roofing for use as a top ply in a double ply underlayment system. PA 104 PA 114 Appendix E PA 114 Appendix E PA 123 ACCEPTANCE No.: 99 1102.04 Single ply, nail -on underlayment with 2" self - adhering tob edge. PA 103 Self - adhering underlayment for use as a top ply in a two ply underlayment system with Approved x`•30 or K43 as the base layer. Wood Preservers Salt pressure treated or Institute LP - 2 decay resistant lumber battens Corrosion resistan:, smooth, screw or annular ring shank nail. Corrosion resistand coated square drive, galvanized, Yf coarse thread wood screw Prepared mortar mix designed for mortar set roof tile applications. Manufacturer generic Protect -O -Wrap, Inc. with current NOA, W.R. Grace Co. with current NOA generic generic generic Bermuda Roof Company, Inc. (with current NOA) ' ALMAR (USA), INC. Product Quickcrete Roof N/A PA 123 Tile Mortar Roof Tile Adhesive ( "Polypro® AH 160 ") Tile -Bond 3. LIMITATIONS NOTICE OF ACCEPTANCE: Test Dimensions Specifications N/A See PCA Factory premixed canisters See PCA ACCEPTANCE No.: 99- 1102.04 APPROVED :December 16, 1999 EXPIRES :December 16, 2002 STANDARD CONDITIONS Product Description Prepared mortar mix designed for mortar set roof tile applicaitions. Two component polyurethane adhesive designed for adhesive set roof tile applications. Single component polyurethane foam roof tile adhesive Manufacturer Quickrete Mortar (with current NOA) Polyfoam Products, Inc. (with current NOA) Flexible Products (with current NOA) 3.1 Fire classification is not part of this acceptance. 3.2 For mortar or adhesive set tile applications, a static field uplift test shall be performed in accordance with RAS 106. 3.3 Applicant shall retain the services of a Miami -Dade County Certified La'Doratory to perform quarterly test in accordance with PA 112, appendix 'A'. Such testing shall be submitted to the Building Code Compliance Office for review. 3.4 Minimum underlayments shall be in compliance with the applicable Roofing Applications Standards listed section 4.1 herein. 3.5 30/90 hot mopped underlayment applications may installed perpendicular to the roof slope unless stated otherwise by the underlayment material manufacturers published literature. 3.6 This acceptance is for wood deck applications. Minimum deck requirements shall be in compliance with chapter 29 of the SFBC. 1 3.7 May be installed on slopes 7:12 and greater. 4. INSTALLATION 4.1 Almar 'One Piece S' Clay Roof Tile and its components shall be installed in strict compliance with Miami Dade County Roofing Application Standard RAS 118, RAS 119, and RAS 120. Frank Zuloa_a. RRC MIAMI SHORES VILLAGE BUILDING INSPECTION DEPARTMENT APPLICATION FOR BUILDING PIERMIT 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. , 19 -- i 3E No. . __ Street___,: Owner's Name and Address C� l 1 IE i `A. _ Registered Architect and /or Engineer r Name and address of licensed contractor ?_'C'_ Y__1_: _`_ i I � 1 �� � !�� , f\_ r 7. Location and legal description of lot to be built on: Lot Block Subdivision Street and Number where work is to be done____, I. i_ 1 ' ` State work to be done and pu pose of building (by floors) — r STATE OF FLORIDA, COUNTY OF DADE. ss. Disapproved Date (Signed) and for no other purpose. New Building 1" Remodeling Addition Repairs No. of Stories To be constructed of Kind of foundation Roof Covering ________L 1 l r Estimated Total cost of improvements $ ) 1 ' C Amount of Permit $ 1_ 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 b sent to n „ ; { The undersigned applicant for this buildingt 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 en 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 pennit, as are licensed by Miami Shores Village. Remarks . (Signed) _ I `r) Before 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 : did sign the same, and that all facts therein by him stated are true. Permit No 1 ( Date J . f " / Read, Sworn to and Subscribed before me. PLANNING BOARD DATE Chairman Memb Member - Memb Member Member Council Approved Date __ '_ ___� Notary Public, S tate of Florida to me well known, Building Inspector , ! - t ,s My Commission Expires 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. MIAMI SHORES VILLAGE, FLORIDA BUILDING ❑ ELECTRICAL p ERM IT IN? 12713 PLUNThIIGG •ROOFI G ❑ Work to be performed under this Permit Owner of Building Architect Contractor or Builder Leggy Description, Address of Building Lot No CONTRACTOR OR BUILDER /;i7 This permit is granted to the contractor or builder named above to construct the bwlding or to install the equipment or device r , herefor in strict compliance with all ordinances pertaining thereto and : with the understanding that the wort will be performed in drawings, statements or specifications that may have been submitted to rod approved by the proper munitifpg authorities. This Perak time if the work is not done in compliance with such ordinances or if the plans are hanged without authQrti es atfon. A further eond granted is the understanding that the contractor or builder named above' assumes the responsibility for a thosoouA knowledge of the pertaining to the work covered hereby whether shown on the plans or &awings or the eta or sse ieatioas and that he done by his agents, servants or employees. Value of Project $ BY r DA s License No. 4 W 4/- , BY ) INWECTOR In consideration of the issuance to me of this permit I agree to the work covered hereunder in s anpf imce with all or�rtanoes mill thereto and in strict conformity with the plane, drawings, statements or specifications submitted to the ;proper aut of Mons In accering this hermit I assume responsibility for all work done by either, myself, my agent, servant or eniployite. I Amt. of Permit 0 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 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. i 19 Owner's Name and Address V%�� `t .s 1 `1 'I th No Street Registered Architect and/or Engineer � Name and address of licensed contractor 1 ', l C /� A&'M /1 'l N 3 11 _ \� 'l• .- it ?i) 11 -kA, ": \ .- 1 Location and leg 1 description of lot to be built on: u. \ ""�" , _ � \ % .; -'$u Y 'i Lot Block Subdivision . g a eic /I ✓o � �C ©L7�e 1 _ Street and Number where work is to be done Ov`C / !kE ,. ( °r £ State work to be done and purpose of building (by floors), state exterior colors (submit samples) tt 1 ' •• ��at. i.R I 1 and for no other purpose. New Building Remodeling Addition Repairs )C No. of Stories i To be constructed of Kind of foundation Roof Covering u 'P- - Estimated Total cost of improvements S 4 • 66 Amount of Permit $ 2)0, 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 plans and specifications for said building. All notices with reference to the building and its cor struction may be sent to . N.0.;- -� The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligatons 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 appeared 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 si Permit No. Disapproved (Signed) Building Inspector MIAMI SHORES VILLAGE BUILDING INSPECTION DEPARTMENT APPLICATION FOR BUILDING PERMIT Date Date PLANNING BOARD DATE Chairman Member Member Member Member Member Council Approved Date Disapproved Date NOTE: A charge of $25.00 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 525.00 will be charged when such re- inspection is made necessary by improper notice for inspection or faulty materials and or workmanship. Read, Sworn to and Su Date My Commission Expires to me well known. at all facts therein by him stLted are true. ore me. Notary ' i c• S� tale of Florida ?fli?ftY i'UD►_1e "J7Art: O 4 -- n'1 COfiVISSIO? aP JU:iE 28,IP!11; CEDED M U GE; RAL 1L . U'.J. BUILDING ❑ ELECTRICAL ❑ PERMIT 'N °: 12971 PLUMBING ❑ ROOFING [ r3 Work to be performed under this Permit Owner of Building is •��.a Architect Contractor or Builder l Legal Lot ` II BL ~ °. Description Address of Building i j 7 4, '1 * r CONTRACTOR OR BUILDER MIAMI SHORES VILLAGE. FLORIDA Signed. Subdi- vision DATE � - 1 '? Value of y , Amt. of Project $ ( 7 d Permit • Contractor's Lea No .. 4 -. ) rL 1 ...• This permit is granted to the contractor or builder named above to construct the building or to install the e or device herefor in strict compliance with all ordinances pertaining thereto and with the understanding that the work will be performed in drawings, statements or epeafications that may have been submitted to and approved by the proper mutddpal authorities. This Permit time if the work is not done in compliance with such ordinances or if the plans are changed without authorisation. A further condition granted is the understanding that the contractor or builder named above assumes the responsibility for a thou knowledge of the pertaining to the work covered hereby whether shown on the plane or drawings or in the statements or spedficatiass and that he aesrsates done by his agents, servants or employees. ner ' Ec t.w BY L ' -� BY AUTHORITY In consideration of the issuance to me of this permit I agree to peAsesw "the work covered hereunder in compliance with all odium= god pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authoekles of Mimi Rim In accepting this permit I assume responsibility for all work done by either, myself, mx agent, servant or employee.