280 NE 95 St (9)• AIAMI SHORES VILLAGE
BUILDING DEPARTMENT
305- 795 -2204
Building Inspection Request
Date %{O /a I /0:5
Type Insp'n Qe occo po rcj
Permit No. RDc)00 — 143
Name i20 r
Address ato k (45-11' ST
Company
r Lk> it1i0r- ,
Phone # C ) a 8 i - 83wc,
Inspection Date CXO /ad i 05
Approved
Correction ❑
Re- Insp'n Fee ❑
�r
Village of Miami Shores
10050 NE 2nd Avenue
Miami Shores, FL 33138
Phone: 305 - 795 -2204
Printed: 1/18/2002 Page 1 of 1
Applicant: DANIEL
Owner: DOWER
Contractor JAM WELDING SERVICE Address: 5791 COMMERCE LANE
Local Phone: Cellular:
Parcel # 1132060133710 Legal Description: MIAMI SHORES SEC 1 AMD PB 10 -70 LOT 7 & E1/2 LOT 8 & W1/2 LOT 6 BLK 28 LOT
Job Address: 280 NE 95 ST
Fees: Description Amount
FEE2002 -349 Building Fee $125.00
FEE2002 -350 CCF $1.80
FEE2002 -351 Notary Fee $5.00
Total Fees: $131.80
Permit Status: Approved Permit Expiration: 7/9/2002 Construction Value:
Work: INSTALL STRUCTUPA' TIC RFAMS
If there is no permit packag
fee is $50.00, which must be F
ll
This Permit is granted to the contrac'
ordinances pertaining thereto and with
and approved by the proper municipal : KI PAY
authorization. A further condition upon TO THE
ordinances and regulations pertaining t!i ORDE F
by his agents, servants or employees.
Signed:
In consideration of the issuance to r
with the plans, drawings, statements c
myself, my agent, servants or employ
Consumer Technologies
5524 N E. 7th Ave.
Miami, TC 33137
Building Permit
Permit Number: BP2002 -71
First Union National Bank
® firstunion.com
R/T 067006432
Signed: �. ,......._. -
DOWER
DANIEL
$2,500.00
FOR
f 11'00189 i• 7006113 -_ -- — —
.
0 6 2 ' :209000 2 2734 741.
63- 643/670
DATE •") / � / A BRANCH 1309:
Total Fees: $131.80
Total Receipts: $0.00
DOLLARS El
1895
Carlos F. Sant, P.E
Structural Engineer
185 NW 108th Street
Miami, Florida 33168
REMOVE SLAB AS
REQD. TO INSTALL
COLUMN & BASE PL.
LINE OF TIE BM.
ABOVE
DINING ROOM
/
1
S
EXIST. CMU COL.
TO REMAIN
EXIS .
TO :E
K -2
EXIS .
BELeW
:MU COL.
DEMOLISHED
EXIS :,MU COL.
TO : E DEMOLISHED
OOTING
NEW TS 4x4x 1 /4
(T
-- `
PARTIAL FOUNDATION /S -O -G PLAN
DOWER - MONTERO RESIDE!
Scale: I Date:
3/8" = 1'-0" 11 -10 -01
FAMILY ROOM
L_
Daniel Dower
280 NE 95th St.
Miami Shores, FL 33138
Sheet No:
SK -1
1
rg
pgp
co
co
o
N "
S
m
0
0
r
USE 2 goCr
ai
(TVA )
EXIST. TIE BM.
8" W x 12 "D
NEW TS 4x4x 1/4
(TYP.)
EXIST. SLOB -OrI -GRADE
EXIST. FOOTING —
20" Wx10 "D
EXIST. CMU COL.
TO BE DEMOLISHED
EXIST. ROOF RAFTERS
1 1
NEEW C x 20 CHANN.
(N & S)
f
J
PARTIAL SECTION / ELEVATION
EXIST. CMU COL.
TO REMAIN
EXIST. FOOTING
TS COLUMN
3/4 "" x 6" x 10" BASE PLATE
W/ 4-1/2" DIA. ADHESIVE ANCHORS
HILT' HVA OR SIMILAR (6" EMBED.)
Daniel Dower
280 NE 95th St.
Miami Shores, FL 33138 RESIDENCE
RENOVATION
EXIST. FOOTING
Carlos F. Sand, PE
Structural Engineer
185 NW 108th Street
Miami, Florida 33168
3/4" MIN. GROUT
TO ENSURE BEARING
Scale: Date:
Y = 1 11 -10-01
IZ - 1 -, -3
I Sheet No:
SK -3
Carlos F. Sant, P.E.
Structural Engineer
185 NW 108th Street
Miami, Florida 33168
EXIST. TIE BEAM
2 5DLTS
& EaD
EXIST. TIE BEAM
TS COLUMN
1/4"
Scale:
EXIST. ROOF
RAFTERS
EXIST. ROOF
RAFTERS
L
Daniel Dower
280 NE 95th St.
Miami Shores, FL 33138
P : 1' - 0"
C 9x20 STEEL CHANNELS
W/ 5/8" DIA. THRU —BOLTS
STAGGERED ® 18" O.C.
C 9x20 STEEL CHANNELS
GROUT AS REQUIRED
TO ENSURE BEARING
Date:
11 -10 -01
1/2" x 6" x 10" CAP PLATE
W/ 4-1/2" DIA. ADHESIVE ANCHORS
HILTI HVA OR SIMILAR (4" EMBED.)
RESIDENCE RENOVATION
I Sheet No:
SK-4
r
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. . .
0 7/0 2
ri_iji‘tifiltTi
,...... — i
onf.vrtr.
....—........ __
BI.D r_11:17;c;Al
'''''),
SUBJECT TO COMPLiA.KcE lifffi MI. F.',JE.P.AL, STWE AO CelkiTY
1) .. ),Ltit;LAT:ONS.
.LAM SHORi..3 VIIIVE ASSi:V.S : RES0NSZ!!..MZS FOR Ace,uncy
OF OR i',Zi.:3t11:1S, I.ii'jP.:1'ilfiS;.-: PLAYS.
' litlICE Mill TP,F. SOUTH FLORIDA BIJILDg CO!jr.: !S ArlOritD CA'
SHORE.S VELLA...SE
V!1 AGC. THE TYILDER & SUB
PE CHAF verei ThF. EOWLEHE OF AL',_
Mfill ;ER 0:: NOT ,l'ECIFICALLY :MID
CONTRACTOR
Name L (� �/ /� / )
. f 4 q t 4 /�_ E� W/C; c
(
License No. J / 6' `�
74er,
Address
C! t L
J fli { 3 3
Telephone �05 x ?off 6 4 ;-Pah
Qualifier Name /yr ; /1 4 0 .'f,iVO�'7 ..
PROPERTY OWNER
/,
Name }�mi1- if, )a"�
!
Address N`
,ez
yio cfYK 33l$
Home Telephone 3 Q 1f e i -, —
Business Telephone ?: �V .rjrTe 0 W2---
v
f t)
Fax r
� �P f�
ENGINEER
�p'!2 Q�
Name 0/M -L o F (PI e f' �'
License No. 576-400
Address t F MW ` /
Telephone Z O r �` e
/ J `/ J
Fax
TYPE OF MANAGEMENT (✓ )
New Construction
Enclosure
Alteration Exterior
Repair
Alteration Interior
Demolish
Relocation of Structure
Shell Only
Foundation Only
Add'I Attachment
Other
Add'I Detachment
Other
Step 1.
INSTRUCTIONS - The following steps must be taken to obtain a permit from the Miami Shores Village:
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 submitted
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: ,vr 9‘th
Address Apt.
L DC. 013-3110
Folio Number
Lot
Subdivision PB PG
Current Use of Property
Proposed Use of Property
Tenant Information
Block
PERMIT TYPE (✓ ) /
Building
Electrical
Mechanical
Plumbing
LPGX
Roofing
Fence
Other
•
1
PERMIT CHANGE (✓ )
Chg. Contractor
Renewal
Revision
Extension
Supplement
Reinspection
ARCHITECT
Name
License No.
Address
Telephone
Fax
e cription of Work
Master Permit No.
Subsidiary Permit No. 8P aOO a • 8- /
1 4-47fC FL— 3 ?/3
City State Zip
/ C. .l1 -Qurf fv ∎a. )
Zoning
Square Feet Floors
>cValue of Work
Tax Assessed/Appraise
Flood Zone Base Floor Elev.
PERMIT APPLICATION
•
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.
1.
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 Commencemen must be POSTED AT THE JOB SITE in
accordance with Section 713 -35 of Florida Statutes. Review the brochure at Hall on Construction Lien Law and
Choosing a Contractor.
Si
1 •
.!
a e of Owper
day of
STAT
RIDA, COUNTY OF MIAMI -DADE
Print Name
wo : to id subscribed before me this
•. RAVI.
Ai
gnature of N,fnry Public - ' ,te of Flo
Prink' Name
wom and subscribed before me this
ST gaterbco
'tier
Signat
Signature
SEAL:
of Contractor /
Notary Pub Sta t of o
PERMIT APPLICATION
MIAMI -DADE
day of i=" c'G ,
Personally known OR, Produced Identification Personally known OR, Produced Identification
Type of Identification Produced4 .P ODD ' ( 95 4 .34 Y Type of Identification Produced"+ fA S " 0)D 0 ° /1)V°
SECTION
BY
77 ,, 2-
Zoning
,,
Electrical
Mechanical
Plumbing
Fire
Public Works
Structural
e
v/ 742 -
1/ I y 21/4--
Building Official
i
6/
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.) $ J t F 0
Inspector State Educational Fund $
State DCA (Radon)
Code Enforcement Fine
Zoning Review
ISSUING OFFICIAL
$
❑ PROOF OF OWNERSHIP
(Attach)
❑ HRS / DERM APPROVAL
(Septic / Sewer)
❑ IMPACT FEE
(New Construction)
❑ OTHER
(Specify & Attach)
$/
REVIEWED AND PREPARED BY:
(sq.ft. = x/1000
x ¢.60)
(¢.005 / sq.ft.)
(¢.01 /sq.ft.)
S G . Sa_ oo P c4 TOTAL
S
PERMIT APPLICATION
❑ CONDO ASSOCIATION APPROVAL
(Attach)
❑ BPR APPROVAL (Restaurants)
❑ CONTRACTOR REGISTRATION
(On File)
PERMIT FEES
/ 31 a E0
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
ELECTRICAL
TYPE
Minimum Fee
QTY.
TYPE
Dryer
QTV.
TYPE
Outlet, Appliance
QTV.
TYPE
Service Repair
QTY.
A/C Central 1 -3 Ton
Fan
Outlet, Wall
Service, Temporary
A/C Central 4 -7 Ton
Fire Pump
Outlet, Switch
Signs
A/C Central 8 -15 Ton
Fixture - Fluorescent
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
TYPE
Minimum Fee
QTY.
TYPE
Condensate Drain
QTY.
TYPE
Generator
QTY.
TYPE
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
Air Handler, Tons
Ductwork, Cost of
Piping, Flammable Liquid
Periodic Inspections
Barbecue
Fire Sprinkler System
Process/Pressure Piping
Supply, AC Well
Bath Fan - Vented, #
Fireplaces, Number of
Pressure Vessel
Temporary Toilet
PLUIIBING
TYPE.
A/C Condensate
QTY.
TYPE
Drains, Roof
QTY.
TYPE
Miscellaneous Fixture
QTV.
TYPE
Soakage Pit
QTY.
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:
Owner's Name and Address - -G. -�
Registered Architect and /or Engineer
Maximum live load to be borne by each floor
STATE OF FLORIDA,
COUNTY OF DADE. ss.
Building Inspecar
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, whe rer herein specified or not. A copy of approved
plans and specifications must be kept at building during progress of the work.
PLANNING BOARD
Permit No
Disapproved _ ___ Date
(Signed) * ,at
Chairman
Member
Member
Council Approved
y
Name and address of licensed contractor__cx_��____ –__` t r
Dat
Location and legal description of lot to be built on:
s� I : % � — Block Subdivision 11 r !
Street and Number where work is to be done ? `__C_
,-,
State work to be done and purpose of building (by floors __- "_ � _____p:__ = __ .____ ,, ..
and for no other purpose.
No. f of Stomas
..----
New Building "
` Remodeling Addif
foyndAtion – ,•.._ A_,...._ _ Roof Covering , ,t__;________
Estimated Total cost of improveme r —
+ � t Amount of Permit $
a required ��
Zone cuba
g q _ /-__ _ _Plan Cubage
Distance to next nearest building ,.___Size_gf Building Lot
_ Repairs
I hereby submit all the plans and specifications for said building. All botices 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 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 site of the work such public notice
or notices as are required by the Act. The undersigned agrees to employ only such) subcontractors, onvork to l be performed° under this
permit, as are licensed by Miami Shores Village. - ` m f•
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally ap-
peared
and who, being b me first duly sworn, upon oath deposes nd says that he is e
of the above des ibed construction, that he has carefully r a d the foregoin pplication, and that he did sign the same, and that all facts
therein by him Ated e tru
:__w_____ ( Read, Sworn to and Subscribed before me.
DATE .
Member
Member
Member
Date Disapproved
1/4?
No -
Street
fi
` r
NOTE: A charge of $1.00 will be made for making correction
the Planning Board.
A re- inspection fee of $1.00 will be charged when such re- inspection is made necessary by improper notice
materials and /or workmanship.
s or changes to this application after approval
to me well known,
Notary Public, State of Florida
My Commission Expires
Date
has been obtained from
for inspection or faulty
BUILDING
ELECTRICAL
PLUMBING
Owner of
Building
Lot
ork to be
CO ( NhACTOR 1 (
MIAMI SHORES VILLAGE, FLORIDA
Architect
Contractor
or Builder
Legal
Description
Address of
Building _
This permit is granted to the contractor or
cation herefor in strict compliance with all ordina
plans, drawings, statements or specifications that
at any time if the work is not done in complianc
permit is granted is the understanding that the
Value of
Project
Contracto
icense
Amt. of
Permit
PERMIT N° 6813
med under this Perini
Subdi-
vision
BY
D E
d med above . construct the building or to install the equipment or device describe. . .e appli-
es pertaining there, and w th the understanding that the work will be performed in compliance any
ay have been sub tted to and approved by the proper .iunicipal authorities. This Permit may be revoked
with such ordinances or if the plans are chan d witho uthorization. A further condition upon which this
ontractor or builder named above assumes the •sponsi. f• a th ..ugh knowled of the ordinances and
regulations pertaining to the work covered heresy whether shown on the plans or drawings or the s . r: • : • ion, that he assumes respon-
sibility for work done by his agents, servants or employees. �_.. --
— "'"- fined•
PECTOR
In consideration of the issuance to me of this permit I agree to perform the • . overed hereunder in comp ' ce wi all ordinances and scggyyl�aations
- rtaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the p oper au orities of Miami Shores•V'111i fie.
acceptin permit I assume respo ibility for all work done by either myself, my agent, servant or employee.
AUTHORITY
•
OWNER'S NAME
w • ''t . VA*.Zi Ems.
NEW CONSTRUCTION
PRESENT ADDRESS
z &e k). e . 9 s SI
STORIES
LICENSE NO.
PHONE NO.
JOB LOCATION (ST. OR AVE.)
z o O. • 9g si .
REPAIRS
LOT
Ii % cm- 1- V% s
BLOCK
- z 8
ALTERATION DESCRIPTION
SUBDIVISION
MIA.,." 01IP$ SFc..
GENERAL CONTRACTOR
( •(MAT(ZOL. (o2{D
SUBMITTED TO PLANNING BOARD
ADDRESS
REJECTED
PHONE NO.
LICENSE NO.
t'2.a4-
BUILDING PERMIT NO. Z 2. II
DATE
1 O - 3 1 - • I
PERMIT FEE $ /lb
o °
�
BUILDER'S BOND
NO. DATE
keg! Tlb-y --
ZONE REQUIREMENTS
CU. FT.
TA% 00LVt c 1 i2 ecr
-.41.
PLAN CUBE /75 —
Cast •
CU. FT.
• ,.. O O
EST. COST $ 35 a
DRAW NGS. SPECIFICATIONS. RESTRICTIONS AND CUBE CHECKED BY: Lai• Q• IJ2.QOFo2
BUILDING PERMIT AND INSPECTION RECORD —MIAMI SHORES VILLAGE
1? ..i't.FJ
/0-
DATL
3/- (.
NEW CONSTRUCTION
TYPE
STORIES
ROOF CONSTRUCTION '
INTERIOR CONSTRUCTION
REPAIRS
DESCRIPTION
6 dz. E'i -A ) f 9770 !000/7/ 0 A)
ALTERATION DESCRIPTION
ADDITION
SUBMITTED TO PLANNING BOARD
APPROVED
REJECTED
REFERRED TO COUNCIL
REASONS
RE- SUBMITTED TO PLANNING BOARD
SUBMITTFD TO VILLAGE COUNCIL
REMARKS
CERTIFICATE OF OCCUPANCY NO. J " 1
IS SUED ( 247 4 t
BY 1 .'" I ' Y/
TO 1.+a. V! .:-1 A..: C C
DRAW NGS. SPECIFICATIONS. RESTRICTIONS AND CUBE CHECKED BY: Lai• Q• IJ2.QOFo2
BUILDING PERMIT AND INSPECTION RECORD —MIAMI SHORES VILLAGE
1? ..i't.FJ
/0-
DATL
3/- (.
INSPECTIONS
DATE
BY
INSPECTIONS
DATE
BY
FOUNDATION
ROUGHING
$
ROOF
$
BEAMS & LINTELS
I
$
POOL
c
FRAMING
AIR COND.
MOTORS
FINAL
$
FIXTURES
CLEAN UP
SEPTIC TANK
$
SLAB
S
SOLAR HEATER
SLAB
TEMPORARY SERVICE
I
$
SEPTIC TANK
I
$
SEWER
ROUGHING
$
SOLAR HEATER
$
GAS
I
$
c
INSPECTIONS
DATE
BY
RE- INSPECT
BY
RE- INSPECT
BY
ROUGHING
DATE
FEE
TEMPORARY SERVICE
ROUGHING
$
TUB & TOP OUT
$
RANGE CONN.
SEWER
MOTORS
RANGE CONN.
$
FIXTURES
SEPTIC TANK
$
S
SOLAR HEATER
FIXTURES & FINAL
FIXTURES
GAS
CONTRACTOR
PHONE
PERMIT NO. 1 DATE
FEE $
NEW BLDG. I ALTERATION 1 ADDITION
REPAIRS
SPECIAL PERMITS
PERMIT NO.
DATE
FEE
TEMPORARY SERVICE
ROUGHING
$
H. W. HEATER CONN.
$
RANGE CONN.
$
MOTORS
RANGE CONN.
$
FIXTURES
$
S
INSPECTIONS
DATE
BY
RE- INSPECT
BY
RE- INSPECT BY
TFMP. SERVICE
ROUGHING
H. W. HEATER CONN
RANGE CONN.
FIXTURES & FINAL
CONTRACTOR
PLUMBING PERMITS & INSPECTIONS
PERMIT NO. 1 DATE
BUILDING INSPECTIONS
NEW BLDG. 1 ALTERATION 1 ADDITION
SPECIALS PERMITS I PERMIT NO. DATE
ELECTRICAL PERMITS & INSPECTIONS
APPROVAL TO POWER CO. FOR SERVICE DATE
PHONE
FEE $
REPAIRS
BY
FEE
CERTIFICATE OF OCCUPANCY
MIAMI SHORES VILLAGE, FLORIDA
BUILDING DIVISION
N? 1274
Owner, Agent or Tenant of Building 'I -H _ T,
T.V. 175.00
Miami Shores Village, Florida, 20-20 -61
Lot 2 6,7 8 Block 28 Subdivisio
Street Address 280 Id.E. 95th Street
Approved use by occupancy Screen Porch Adrdi ti on
Remarks 2219 TAX ULT.;2 EST COST
This Certificate of Occupancy is issued to the above named O i'
for building at above named location only upon the express provision that the applicant will
abide by and comply with all conditions of Ordinances Nos. 92, 93, 94 and 97, known as the
Zoning, Electrical, Plumbing and Building Ordinances of Miami Shores Village pertaining to
the erection, construction, alteration or remodeling of buildings or structures.
•
„
T.'
BUILDING DIVISION
MIAMI SHORES VILLAGE, FLORIDA
BUILDING
ELECTRICAL
PLUMBING 1
Owner of
Building J ♦' t a J
Architect
Contractor
or Builder
C' ♦ ~.I� ear /•- ..'(c_ &R.4.*
Legal Lot ' Bl.
Description
Address of _ �i
Building „ ? / ` y
sibility for work done by his agents, servants or employees.
CONTRACTOR O$ BUILDER
PERMIT N? 7820
Work to be performed under this Permit ✓'� - --
Subdi-
vision
Value o -
Project ?i
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 appli-
cation 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 respon-
Signed. 4271 fl,••�_ , . B y 0
INSPECTOR
In consideration of the issuance to me of this permit I agree to perform tie work covered hereunder in compliance with ordinances and {eagons
fTti
pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper autho es of Miami ShoferfinfigeN
In accepti• g this permit I assume responsibility for all work done by either myself, my agent, servant or employee.
DATE .2J 194
Contractor's
License No
Amt. of
Permit ' 1-
AUTHORITY
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.
STATE OF FLORIDA,
COUNTY OF DADE.
Before me, the
peared
Permit No
Disap . r
Chairman
Member
Member
Council Approved
BUILDING INSPECTION DEPARTMENT
APPLICATION FOR BUILDING PERMIT
NOTE: A charge of $1.00 will be
the Planning Board.
A re- inspection fee of $1.00 will be
materials and /or workmanship.
MIAMI S,H O RES VILLAGE
tie
Building Inspecto
PLANNING BOA
made for making
k ..
Date
Owner's Name and Addres
Registered Architect and /or Engineer
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
State work to be done and purpose of building (by floors),
(Signed)
, 19` 7 .
,– Street
' 1
�= — – – -- – -- and for no other purpose.
New Building
g _� Remodeling Addition Repairs No. of Stories
To be constructed of Kind of foundation___ Roof overing
dam
Estimated Total cost of improvements $ 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, 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
ss.
dersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally ap-
-� -- to me well known,
and who, being b me st duly sworn, upon oath oses says that h the
of the above desc bed onstruc • on, that he has car il�v re the fo pg.' g application, and that he did sign the same, and that all facts
therein by him sta
Read, Sworn to and Subscribed before me.
Notary Public, State of Florida
My Commission Expires
D DATE
Member
Member
Member
Date Disapproved Date
corrections or changes to this application after approval has been obtained from
charged when such re- inspection is made necessary by improper notice for inspection or faulty
1
A
BUILDING
ELECTRICAL
PLUMBINq
Owner of
Building
\rchitect
Contractor
,. - or Builder
MIAMI SHORES VILLAGE, FLORIDA
CONTRACTOR OR BUILDER
PERMIT N? 6607
Work be performed under this Permi
'ie l -g.. --mot/
DATE
Legal iv--1-017-t28. B l. Subdi- / Description :� vision ��(t"
Address of '' � Value �� Amt. of 0
Building Q i Proj - �► � Permi .,.r1
This permit is granted to the con actor or build name above tD construct th . ' cling or to install the equipment or device escriVe in the appli-
cation 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 respon-
sibility for work done by his agents, servants or employees.
i
Signed. ' . �_ By ,
IN PE OR
In consideration of the issuance to me of this permit I agree to perform the work covered hereunder in compliance wit ordinancesjanyk rwti ons
pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities, of Miamlf ShHSSres - V age.
In accepting this permit I assume responsibility for all work done by either myself, my agent, servant or employee.
BY
AUTHORITY
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PHO `E: (HOME( f7 7 ? (OFFICE)
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`` / /
DELIVERY DATE:
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Date' 30 - 9? Job Address ,g0 ry C 9'S 5 Tax Folio
Legal Description L.... Historically Designated: Yes No /
Owner/Lessee / Tenant �J ( et_ ✓l / c .e ,) ( U (15 - F Master Permit # q 4 ¶/ / 2
Owner's Address D / 0 G 9 c Phone 3 0 Sr ` 7 c 7 l `7. X
Contracting Co. Q L/
Qualifier
State #
Architect/Engineer
Bonding Company
Mortgagor
Permit Type (circle one).
WORK DESCRIPTION
Square Ft. Estimated Cost (value) /c; 0 0 d
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.
OWNERS 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.
ture of o : er an
FEES: PERMIT
Notary : to Owner and/or
My Commission Exp es: C'.'FICIAL NOTARYS
GLADYS J VILI A!3
7III'ARY PUBIC STATE OF FLORIDA
COMMISSION NO. CC714103
MY COMMISSION EXP. MAR 1 002
d/ � President Date Signature of Contractor or Owner- Builder Date
3 7 - L8- D i5143-1-0
Date / Notary as to Contractor or Owner- Builder Date
RADON
Municipal #
ELECTRICAL �/ PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
✓vI R) 4 N 1 r /�-- i I c 1 YI e r�
C.C.F.
SS#
Competency #
Address
Address
Address
Address
My Commission Expires:
Phone
NOTARY BOND
Ins. Co.
APPROVED: TOTAL DUE
Zoning Buil' 1 ,J i Electrical
Mechanical Plumbing Structural Engineer
Monday, March 29, 1999
1611111.
Computer rendering may not be 100% accurate
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.
State work to be done and purpose of building (by floors) •
Date
Owner's Name and Address _
,•y
Registered Architect and /or Engineer ... .
Name and address of licensed contractor
Location and legal description of lot to be built on:
Lot 4 - // Block Subdivision
Street and Number where work is to be done `�_F`'� � c�
No :;'
/
PLA$N);NG BOARD DATE
and for no other purpose.
New Building Remodeling Addition / % r Repairs No. of ,Stories.
To be constructed of /i —/ '' /7 Kind of foundation Roof Covering % 47 'r`
Estimated Total cost of improvements $ i i Amount of Permit $
Zone cubage required Plan Cubage
Distance to next nearest building Size of Building Lot
Maximum live load to be home by each floor
I hereby submit all the p ns and specifications for said building. All notices with refEr nce to the building and its constru may
be sent to / (, -, , /--.,-; ,,16J l' % >' . % r 9 \ d.: ✓ 1 � : > l
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 subcontractor , on work to a performed under this
permit, as are licensed by Miami Shores Village.
� ?; i
Remarks (Signed) o = , 9
%
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.
Permit No.__ '�� i „/Date 4. e 3 Read, Sworn to and Subscribed before me.
Disapproved__ Date 2 Notary Public, State of Florida
(Signed) - i - :,� .
Building Inspector My Commission Expires
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.
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
(r 1 Owner's Name and Addre • '• '. J J' Z' = -` .
No Street
Registered Architect and /or Engineer I
Name and address of licensed contractor. ._eio - ..,.s, z-o,
Location and legal description of lot to be buil
� r> 1
Lot_ -.7A I ' �"7 . ` Block s 6 Subdivision 'V
Street and
(Signed)
ber where work is to be done A s'/ fr S
State work to be done and purpose of building (by floors)
New Building...._ Remodeling Addition
.. l� .
e
Building Inspector
NOTE: A charge of $1.00 will be made for
the Planning Board.
A re- inspection fee of $1.00 will be charged
materials and /or workmanship.
Disapproved Date. -_..-__ ..... _.___. ..............
Chairman
Member
Member
'
Council Approved Date
Amount of Permit $
plan Cubage
Size of Building Lot
c,,T
Repairs •-
PLANNING BOARD DATE
Read, Sworn to and Subscribed before me.
No. of Stories
19 �
Notary Public, State of Florida
My Commission Expires
making corrections or changes to this application after approval has been obtained from
when such re- inspection is made necessary by improper notice for inspection or fault,
and for no other purpose.
To be constructed of Kind of foundation Roof Covering
® •
Estimated Total cost of improvements $
Zone cubage required
Distance to next nearest building 42-d • �� x 1:4,A
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 work to be erformed under this
permit, as are licensed by Miami Shores Village. ,
Remarks (Signed) � \ \ . ;
STATE OF FLORIDA,
COUNTY OF DADE. j
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 hire stated are true.
Permit Date E r — ? 2 _:_a
Member
Member
Member
Disapproved Date
• UILDING
LECTRICAL
- LUMBING
)wner of
•uilding
rchitect
' ontractor
r Builder
legal
)escription
- ddress of
• uilding
Lot
MIAMI SHORES VILLAGE, FLORIDA (A -
PERMIT N? 6607
CONTRACTOR OR BUILDER
Work to be performed under this Permit
%
F
4_ 1 I BI.
.1 ilk. . ..--
Subdi-
vision
Value of Amt. of [� r
Project r` �... I Permit ,D►
This permit is granted to the contractor or builder i amed above to bonstruct the uilding or to install the equipment or device described IA the appli-
ation herefor in strict compliance with all ordinances pertaining thereto and with the understanding that the work will be performed in compliance with any
laps, drawings, statements or specifications that may have been submitted to and approved by the proper municipal authorities. This Permit may be revoke
t smy time if the work is not done in compliance with such ordinances or if the plans are changed without authorization. A further condition upon •'ch th
ermit is granted is the understanding that the contractor or builder named above assumes the responsibility for a thorough knowled e of the o
-gulations pertaining to the work covered hereby whether shown on the plans or drawings or in the statements or specifications an t he
:bility for work done by his agents, servants or employees.
Signed. ! i t , • ' Is` �'t t=
INSPECT
In consideration of the issuance to me of this permit I agree to perform the work covered n
ertaining thereto and in strict conformity with the plans, drawings, statements or specifications
• accepting this permit I assume responsibility for all work done by either myself, my agent, serve r
BY
f
DATE
Contractor's License No /)/;
�- 194
wi rdin.nces and regulations
au ' es of Miami Shores Village.
AUTHORITY
BUILDING
ELECTRICAL
PLUMBING
Owner of
Building
MIAMI SHORES VILLAGE, FLORIDA
PERMIT N? 6813
rk to be p ++ ed under this Perim
DATE
Contractor
License N
Architect
Contractor
or Builder
Legal Lot
Description
Address of
Building
This permit is granted to the contractor or b d ed above construct the building or to install the equipment or device descri. - appli-
cation herefor in strict compliance with all ordinan s pertaining there and w th the understanding that the work will be performed in compliance any
plans, drawings, statements or specifications that + y have been sub ted to and approved by the proper + unicipal authorities. This Permit may be revoked
at any time if the work is not done in compliant: ith such ordinances or if the plans are chang witho thorization. A further condition upon which this
permit is granted is the understanding that the .. ntractor or builder named above assumes the . onsi . j fo a th .. • u� know of the ordinances and
regulations pertaining to the work covered hereby whether shown on the plans or drawings or +e s, r +nthat he assumes respon-
sibility for work done by his agents, servants or employees.
Subdi-
vision
ECTOR
In consideration of the issuance to me of this permit I agree to perform the . .vered hereunder in compli • witl(all ordinances and regulations
pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the pr per authorities of Miami Shores Village,
In accepting permit I assume responsibility or all work done by either myself, my agent, servant or employee.
AUTHORITY 0)j/
BY
MIAMI SHORES VILLAGE
BUILDING INSPECTION DEPARTMENT 757— 7 ?4/
APPLICATION FOR BUILDING PERMIT
Application is hereby made for the approval of the detailed statement or 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 ...... .t,.k..11.i4 V ..Jhf. LA LL ._ No.. .. a . street...tie /1
Registered Architect and /or Engineer ' 74r.141.0 Al- ..l „ M. 14..4.., ,..,, „,,,.,„.,.,,t.,,.,_«1.1,
Name and address of licensed contractor 01e?
Location and legal description of lot to be built on:
Lot . .7.* .ea4 ka t.ta..4'Sf.`✓.Z1 Block. Subdivision... g.S.... .. .» .tis� _L, t�e,n.l._ ^Ar�s ...., • t . ( /')_ . ?"=.)
Street and Number where work is to be done 2 ,r ffr' 5 1 - , _.. __ —
State work to be done and purpose of building (by floors) . CS?t^ ±Y...v.S`f' tOc 5.htr. _. C-3.5-.....EIAr...etts ...lea ,._._
_........... for no other purpose.
New Building Remodeling Addition 1- Repairs No of Stories
To be constructed of ...L'/.5 Kind of foundation. ...legl.t 5 C.AwIcre& Roo Coverin
Estimate Total cost of improvements $ ” /13 b Amount of Permit L ..._ L7'' / Q''`
Zone cubage required P �
_Plan Cubage '
Distance .to next nearest building Size of Building Lot ,(00 , � /ate � —
Maxitnum live load to be borne by each floor / A
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 Su >lement,
and has complied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors employe 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 noticcs as arc 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.
Rem.uks (Signed) / f i
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 F1'lt.Va. V / t.tse.S.
and who, being by me first duly sworn, upon oath deposes and says that he is the...OLAJ.vt..r — 6.ei.J.aer
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 stat ad e true.
.
D
P N 1►(1 1 i �`� V� d
pt _....... f ate Read, 1 worn to and Sub
u n ore ,)
errrut o - ... Date.•- - (- ' .c--C..i ( _ �ct q' �
Disa roved
s ... ._ Notary Public, State of Florida
(Signed) .. � I t i Y Pi
I..LIC STATE OF FttYW7A AT LAR(
Building Inspector My Commission Expirer
PLANNING BOARD DATE
Citairnan 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 bern 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 anti /or workmanship.
to me well known,
Otf. Oco 8/9/48
PAID BY
YEAR
ANNUAL TAX
PERIOD USED
AMOUNT PAID
DATE PAID
NUMBER
Let
- - D. -Bey '
G- ,,,
1948
12.00
�a/9i/f
'T `f
?7, 7/1 Y
/777
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1
42- .1 1-Yf
/42. o o
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ADDRESS 280 N. E. 95th St.
LEGAL W2 6 , 7, E-- 8, Bik 28
RECORD GARBAGE TAX
OWNER'S NAME
Louis D. Benn
BUILDING PERMIT NO.
JOu LOCATION (ST. OR AVE.)
280 N E 95th Street
GENERAL CONTRACTOR
Benn Bros. Construction Company
X NEW CONSTRUCTION
REPAIRS__
ALTERATION
ADDITION
g1IBMITTED TO VILLAGE COUNCIL
CBS
Bldg Insp / / ///
5UBMITTED TO 17VANN /N SGaR
RE- SUBMITTED TO PLANNING BOARD
DATE
ZONE R - 6 PEOUIREMENTS 18,500 CU. FT. PLAN CUBE 20,16/ CU. FT. EST. COST S
D7AWINGS. SPECIFICATIONS. RESTRICTIONS AND CUBE CHECKED BY: JDH
TYPE STORI ROOF CONSTRUCTION
APPROVED
6/2/48
1
'1 -car attached -ara e
3925 NW 10th Avenue
REJECTED
LOT
; A ll 7;
28
ADDRESS
1011 Olympia Bldg
PERMIT FEE S
Tile
PRESENT ADDRESS LICENSE NO.
.+w
BLOCK SUBDIVISION
M S Section #1
DESCR IPTION
v_Rmr Liv Porch- Kit - B.1Rms - 2Baths
DESCR PTION
REFERRED TO COUNCIL
Frame: INTERIOR CONSTRUCTIO
Oak Floors
REMARKS
II rransf. .
NO. 612
CERTIFICATE OF OCCUPANCY NO. 557 ISSUED J /9/48 BY JDIT TO Louis D .onn
BUILDING PERMIT AND INSPECTION RECORD -MIAMI SHORES VILLAGE
PHONE NO.
BUILDER'S BOND
REASONS
PHONE NO.
LICENSE NO.
3-0911 1988
DATE 9/9/L7
00
DATE
INSPECTIONS
DATE
PERMIT NO. 6674
RE- INSPECT
BY
RE- INSPECT
BY
FOUNDATION
SPECIAL PERMITS
all
ULP
DATE
FEE
TEMPORARY SERVICE
BEAMS & LINTELS
AJ5/
6 4
JDH
$
$
SEWER
FRAMING
7/1 48
T7
JDII
SOLAR HEATER
$
$
GAS
$
$
$
FINAL
INSPECTIONS
DATE
BY
RE- INSPECT
BY
RE- INSPECT
CLEAN -UP
ROUGHIN4
6/15/48
JDH
CONTRACTOR 1•iam Plumbing Co (Santoro)
PHONE
PERMIT NO. 6674
.DATE 6/11/48
FEE $ 10.00
NEW BLDG.
I ALTERATION 1 ADDITION
REPAIRS
SPECIAL PERMITS
PERMIT NO.
DATE
FEE
TEMPORARY SERVICE
$
$
IfEPTIC TANK
$
$
SEWER
$
$
SOLAR HEATER
$
$
GAS
$
$
$
$
INSPECTIONS
DATE
BY
RE- INSPECT
BY
RE- INSPECT
BY
ROUGHIN4
6/15/48
JDH
ROUGHING
GAS
,mH
H. W. HEATER CONN
SEWER
RANGE CONN.
SEPTIC TAW
7/16/48
JDH
SOLAR HEATER.
FIXTURES & FINAL
F IXTURESFinal
/ A
/ /4 t1
J r
CONTRACTOR C Grimm Elec Co
PHONE
PERMIT NO. 6691, DATE
FEE $ 10.55
NEW BLDG. X I
6 /16/48
ALTERATION j l ADDITION
REPAIRS
SPECIAL PERMITS
PERMIT NO.
DATE
FEE
TEMPORARY SERVICE
Same
$
¢-I. W. HEATER CONN.
-
$
RANGE CONN.
$
MOTORS
$
r IXTURES
$
$
INSPECTIONS
DATE
BY
RE- INSPECT
BY
RE- INSPECT
BY
TEMP. SERVICE
6/16/48
JDH
ROUGHING
7/1/4"
,mH
H. W. HEATER CONN
RANGE CONN.
FIXTURES & FINAL
8/6/48
BUILDING INSPECTIONS
PLUMBING PERMITS & INSPECTIO
ELECTRICAL PERMITS & INSPECTIONS
APPROVAL TO POWER CO. FOR SERVICE DATE
8/ 9/48 BY JDIT
Miami Shores Village
, 10050 NE 2nd Avenue
Phone: 305 - 795 -2204
Printed: 12 /4/2002
Applicant: DANIEL
wner: DOWER
JOB ADDRESS: 280 NE 95
Contractor
Local Phone:
Parcel # 1132060133710
Fees:
FEE2002 -6920
FEE2002 -6921
FEE2002 -6922
Description
Building Permit Application Fee
CCF
Notary Fee
Total Fees:
Amount
$60.00
$0.60
$5.00
$65.60
Total Fees: $65.60
Total Receipts: $0.00
Permit Status: APPROVED Permit Expiration:
Work: TILE PORCH & WALKWAY
If there is no permit package
fee is $50.00, which must be pai'
This Permit is granted to the contractor .
ordinances pertaining thereto and with the
and approved by the proper municipal autt
authorization. A further condition upon wt'
ordinances and regulations pertaining to ti
by his agents, servants or employees.
Signed: ! I
In consideration of the issuance to me
with the plans, drawl s, statements or s
myself, my agent, s4nts or employes.
N,/ Signed:
PAY
TO THE
ORDERr
FOR
Building Permit
Permit Number: BP2002 -2091
Legal Description: MIAMI SHORES SEC 1 AMD PB 10 -70 LOT 7 & E1/2 LOT 8 & W1/2 LOT 6 BLK 28 LOT
6/2/2003
Consumer Technologies
5524 x E. 7th Ave.
Miami, 51 33137
DOWER
DANIEL
ST
Contractor's Address:
Construction Value: $750.00
Page 1 of 1
- -- o..- :nenacfion
t Unlon Nato = Bank
F I 0 6 70 0 6 4 3
/T 06700643? 2
4.4
,/
00019990 ' : f2 2090002 ,..
DATE /2
DOLLARS
1999
63-643/670
BRANCH 13093
v v�
6
sir b.i.,.
D... on Oa,
[f i
1�1
ki
'ur VAUD wri :tour rU( SIGNATURE
AND T11( URI(:INA I. RAISED SEAL OF
1, 1.URIDA I. (LIS(D SURVEYOR
ARO \IA/PR
This property described as:
The west 1/2 of Lot 6, all of
Lot 7, and the East 1/2 of Lot 8,
Block 28,
AN AMENDED PLAT OF
MIAMI SHORES SECTION NO. 1,
according to the Plat
thereof, as recorded in
Plat Book 10, Page 70
of the Public Records of
Dade County, Florida.
A BOUNDARY
N. , 94/- �l
W A Tiot, MA/
PROPERTY OF: Dower, Daniel P., 280 N.E. 95th Street, Miami Shores, Florida
SUAVEY
I hereby certify that the survey repre-
sented hereon meets the minimum
technical standards yet forth by the Board
land Surveyors chapter Fein m pursuant ppursuant to o
Section Cl 0a Fla Starnes There are no
tames. overlaps, easements
appearing on the Rat. other than as
shown hereto.
ti f001.701rrpR ARO /*Arena Od
V7'7
LANNES AND (.ARCIA. INC.
LII.# -
SI lMAPPERS -LAND PLANNERS
BEALE SMITH #5238
33138
Office address_ 359 lcazar Avenue. Coral tables. Florida 33134
(305) 066 -7909 l95-1) 523 -8663
FIELD D TE SCALE
06 1" - 2o'
DRAWN BY DRWS ' NO
129414
Page 1 of 2
/
•
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AND T11( URI(:INA I. RAISED SEAL OF
1, 1.URIDA I. (LIS(D SURVEYOR
ARO \IA/PR
This property described as:
The west 1/2 of Lot 6, all of
Lot 7, and the East 1/2 of Lot 8,
Block 28,
AN AMENDED PLAT OF
MIAMI SHORES SECTION NO. 1,
according to the Plat
thereof, as recorded in
Plat Book 10, Page 70
of the Public Records of
Dade County, Florida.
A BOUNDARY
N. , 94/- �l
W A Tiot, MA/
PROPERTY OF: Dower, Daniel P., 280 N.E. 95th Street, Miami Shores, Florida
SUAVEY
I hereby certify that the survey repre-
sented hereon meets the minimum
technical standards yet forth by the Board
land Surveyors chapter Fein m pursuant ppursuant to o
Section Cl 0a Fla Starnes There are no
tames. overlaps, easements
appearing on the Rat. other than as
shown hereto.
ti f001.701rrpR ARO /*Arena Od
V7'7
LANNES AND (.ARCIA. INC.
LII.# -
SI lMAPPERS -LAND PLANNERS
BEALE SMITH #5238
33138
Office address_ 359 lcazar Avenue. Coral tables. Florida 33134
(305) 066 -7909 l95-1) 523 -8663
FIELD D TE SCALE
06 1" - 2o'
DRAWN BY DRWS ' NO
129414
Page 1 of 2
/
•
1 -I
-
G = l
v
22
-T
23
ki
'ur VAUD wri :tour rU( SIGNATURE
AND T11( URI(:INA I. RAISED SEAL OF
1, 1.URIDA I. (LIS(D SURVEYOR
ARO \IA/PR
This property described as:
The west 1/2 of Lot 6, all of
Lot 7, and the East 1/2 of Lot 8,
Block 28,
AN AMENDED PLAT OF
MIAMI SHORES SECTION NO. 1,
according to the Plat
thereof, as recorded in
Plat Book 10, Page 70
of the Public Records of
Dade County, Florida.
A BOUNDARY
N. , 94/- �l
W A Tiot, MA/
PROPERTY OF: Dower, Daniel P., 280 N.E. 95th Street, Miami Shores, Florida
SUAVEY
I hereby certify that the survey repre-
sented hereon meets the minimum
technical standards yet forth by the Board
land Surveyors chapter Fein m pursuant ppursuant to o
Section Cl 0a Fla Starnes There are no
tames. overlaps, easements
appearing on the Rat. other than as
shown hereto.
ti f001.701rrpR ARO /*Arena Od
V7'7
LANNES AND (.ARCIA. INC.
LII.# -
SI lMAPPERS -LAND PLANNERS
BEALE SMITH #5238
33138
Office address_ 359 lcazar Avenue. Coral tables. Florida 33134
(305) 066 -7909 l95-1) 523 -8663
FIELD D TE SCALE
06 1" - 2o'
DRAWN BY DRWS ' NO
129414
Page 1 of 2
t h o ;V i/1
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.
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(`�... r 1 • /LGLj7ZL XI
STATE OF FLORIDA)
COWTY OF DADE)
Pft The undersigned Afiiant, D. 6 ��i 2 _
(property owner)
Witness(sign and print)
SWORN TO AND SUBSCRIBED before me this
. .. AFFIDAVIT
Ck=
� MY Co. •
a ad. Raft N a�a�;w
day of
oes hereby attest that the
attached survey, performed by ! IAN 6
(name of surveyor's company)
performed on , is an accurate representation of the existing conditions and
date of vbr ey)
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.
Affiant/Property owner
Witness(sign and print)
Affiant is personally known to me, produced
as identification.
PROPERTY OWNER
New Construction
\am
e (// 9 / � r / AO' , 00)
/
Alteration Exterior
Address / /IS-
ot if
,* C P/_
'
69S
Home Telephone
Demolish
Business Telephone 303'313— 13—
/J`
Relocation of Structure
Fax
Foundation Only
TYPE OF MANAGEMENT (✓ )
New Construction
Enclosure
Alteration Exterior
Repair
Alteration Interior
Demolish
Relocation of Structure
Shell Only
Foundation Only
Add'l 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.
Folio Number /description of Work
Lot Block
Subdivision PB
Current Use of Property Square Feet � 7 Units Floors
Proposed Use of Property 2lue of Work °-'7 0 Bldg Value
Tenant Information
PERMIT TYPE (✓ )
Building
Electrical
Mechanical
Plumbing
LPGX
Roofing
Fence
Other
PG
PERMIT CHANGE (✓ )
Chg. Contractor
Renewal
Revision
Extension
Supplement
Reinspection
ARCHITECT
Name
License No.
Address
Telephone
Fax
Master Permit No.
Subsidiary Permit No.
Tax Assessed/Appraised Value
PERMIT APPLICATION
Zoning Linear Feet
Flood Zone Base Floor Elev.
ENGINEER
Name
License No.
Address
Telephone
Fax
CONTRACTOR
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.
ATE A ' • ' ID , COUNTY OF MIAMI -DADE
/Mil
Sign. e e of t. caner
Print Nam/ ll Peft
Sworn to and subscribed before me this
Lam' r
P
♦d/
Signature o,otary
SEAL:
of Florida
Angela M Becker
comm D0160048 d' Expires November 15, 2006
a�
Personally known OR, Produced Identification
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
SEAL:
PERMIT APPLICATION
Personally known OR, Produced Identification
Type of Identification Produced: Type of Identification Produced:
ELECTRICAL
TYPE
Minimum Fee
QTV'.
TYPE
Dryer
QTV'.
TYPE
Outlet, Appliance
QTV'.
TYPE.
Service Repair
QTY.
A/C Central 1 -3 Ton
Fan
Outlet, Wall
Service, Temporary
A/C Central 4 -7 Ton
Fire Pump
Outlet, Switch
Signs
A/C Central 8 -15 Ton
Fixture - Fluorescent
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
TYPE
Minimum Fee
QTY.
TYPE
Condensate Drain
QTY.
TYPE
Generator
QTY.
TYPE
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
Air Handler, Tons
Ductwork, Cost of
Piping, Flammable Liquid
Periodic Inspections
Barbecue
Fire Sprinkler System
Process/Pressure Piping
Supply, AC Well
Bath Fan - Vented, #
Fireplaces, Number of
Pressure Vessel
Temporary Toilet
PLUMBING
TYPE
A/C Condensate
QTY.
TYPE
Drains, Roof
QTY.
TYPE
Miscellaneous Fixture
QTY.
TYPE
Soakage Pit
QTY.
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:
Page 4
OFFICE USE ONLY
CHECKLIST
❑ OWNER - BUILDER FORM
(Attach)
❑ FIRE DEPARTMENT
APPROVAL (Commercial /
multi - family)
❑ CONCURRENCY
(New Construction)
❑ OTHER
(Specify & Attach)
❑ PROOF OF OWNERSHIP
(Attach)
❑ HRS / DERM APPROVAL
(Septic / Sewer)
❑ IMPACT FEE
(New Construction)
❑ OTHER
(Specify & Attach)
PERMIT FEES
$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
0
$
SECTION
Zonin:
Electrical
Mechanical
Plumbing
Fire
Public Works
Structural
Building Official
BY
DATE
x ¢ 60) x/1000
(¢.005 /sq.ft.)
(¢.01 /sq.ft.)
REVIEWED AND PREPARED BY:
PERMIT APPLICATION
❑ CONDO ASSOCIATION APPROVAL
(Attach)
❑ BPR APPROVAL (Restaurants)
❑ CONTRACTOR REGISTRATION
(On File)
TOTAL $
ISSUING OFFICIAL
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
Address ZSL KLE 9S ST
Company P d RCS m2 W
Phone # Z 8'1a `� �j - I U .
�
For Inspector: PDP iU l i S t (3 Name & Date
MIAMI SHORES VILLAGE
BUILDING DEPARTMENT
305- 795 -2204
Building Inspection Request
1 ° 140 3
Date Time
Type Insp'n PX)52 •
Permit No. fSP c) I `f (a S
Name
Approved
Correction
Re- Insp'n Fee
Date
Type Insp'n t' C `(-'
Permit No. 1 S O �' `� (-0
Name .IN‘.�
Address ? •
MIAMI SHORES VILLAGE
BUILDING DEPARTMENT
305- 795 -2204
Building nspection Request
l°1140 3
Time
Company \" 1 V J'\ C v ) i O- .
Phone # ` cf - I0
For Inspector: 1=6P IU I 1 i' 63 Name & Date
Approved
Correction ❑
Re- Insp'n Fee ❑
RE- OCCUPANCY
APPLICATION
Date
Rev. 10/02/03)
Applicant Nam
Signature
Miami Shores Village
Building Department
My Co mission Expires:
Sign:
or • 14I0
Print:
Permit No.
Loc ID
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795 -2204
Fax: (305) 756 -8972
tzO 5 - 143
Contact Name k�7 �3ov� Phone #�
Buyer Seller Realtor Company Name
Property Address / C(s �J`�
City Miami Shores State Fl Zip 33\37)
I hereby certify that I understand that the zoning of the property is for single - family residential use and
that it is unlawful for more than one family to reside therein. I also understand that any Certificate of Re-
Occupancy that may be issued by Miami Shores Village certifies only that the referenced property is
being used for single- family purposes and that such Certificate does not constitute any representation,
warranty or certification as to the condition of the dwelling or other structures on the property.
OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate.
The foregoing instru ent was acknowledged before me this day of , 20
by , who is personally known to me or who has
produced as identification and who did take an oath.
ARY PUBLIC:
Building Officials Approval:
Re -Occ. $60.00
Notary $5.00
CCF $0.60
Total 2 (O
oe_ 41=1445
MIAMI SHORES VILLAGE
BUILDING DEPARTMENT
305- 795 -2204
Building Inspection Request u
Date 9 Time
Type Insp'n s�. • r
Permit No. ,B P ®6 z
Name D/1»
Address 1. 90 /y: 9$
J si
Company J Q�ii I I/ _
Phone# 30 7S 9_
S 7S 3
For Inspector: p 0i Name & Date
Approved 4? `j2. G
Correction ❑
Re- Insp'n Fee ❑