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362 NE 95 St (2), PERMIT APPLICATION FOR MIAMI SHORES VILLAGE Date 3// c if q'� Job Address v2 't g ! S' S f Tax Folio Legal Description R.esiS ,QNc Historically Designated: Yes ©° Owner/Lessee / Tenant Hr./ R GoiSSir,41.(48 Master Permit # 4/5/3/3 3 Owner's Address '36 , '(5 S Phone TO S -25- 7` Q r Contracting " Co. � BRAD/ yjil r - / Or\ rk, Z`tc_ Address / $ 7o $, IA, /07 Qualifier V../� �S � (: R�'n L L y / SS# Phone 3096- ',S State # Q_,ACp 3 '3SL 1 Municipal # Competency # Ins. Co. Architect/Engineer Address Bonding Company Address Mortgagor Address Permit Type (circle one): BUILDING ELECTRICAL PLUMBIN ROOFING PAVING FENCE SIGN WORK DESCRIPTION Ey—, 4-C, `� C' /�� h . q t D L (OF - 3 -rot. 5 f j1 fu,,mp Square Ft. Estimated Cost (value) C) 6, CC WARNING TO OWNER: YOU MUST RECORD A NOTICE OF COMMENCEMENT AND YOUR FAILURE TO DO SO MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY (IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT.) Application is hereby made to obtain a permit to do work and installation as indicated above, and on the attached addendum (if applicable). I certify that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that separate permits are required for ELECTRICAL, PLUMBING, SIGNS, POOLS, ROOFING and MECHANICAL WORK. OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. Furthermore, I authorize the above -named contractor to do the w•_ .ted. II ?c / / I . .( - ' ' ' ' \ • Signature of owner and/or CondaP..res r ient Date i wner- Builde Date , UIfOn ':� MY COMMISSION # CC776840 EXPIRES °y I. C. Quinonez _.• �r- • - 31, 20 u 0 � 0 a �� .pN �, , � _ NCE. INC c ;. � � *_ MY -CO MMISSION # CC776840 EXPIRES \ sr i 6., 1 I q9 Notary as to Owner and/or Condo President Date o tary as to Cont f t r O 9'� f� : a �" Date My Commission Expires: My Commission Expires: APPROVED: 7 nning ical . ure • •ntractor o 1 NS: PERMIT RADON C.C.F. /•• 25 0 NOTARY TOTAL DUE f. Building Electrical Plumbing Engineering ITEM BATH TUB UNIT FEE ITEM SWITCH OUTLETS UNIT FEE ITEM SPACE F ATERS UNIT FEE 81 CE i� LIGHT OUTLETS CENTRAL HEATING kAext. fJ A/C (WIlC) DISHWASHER RECEPTACLES DISPOSAL SERVICE TEMPORARY A/C (CENTRAL) /VA DRINKING FOUNTAIN SERVICE SIZE IN AMPS CLOT POK FLOOR (',RAIN SERVICE REPAIR/METER 1 WrGE REFRIGERATION GREASE TRAP APPLIANCE OUTLETS PROCESS AND PRESS PIPING INTuiCEPTOR RANGE TOP UIDER1 WO TANKS LAVATORY OVEN ABOVE MHO TANKS LAUNDRY TRAY WATER HEATER U.F. PRESSURE VESSELS CLOTHES WASHER MOTORS 0- 1 HP STEAM BOILERS SHOWER MOTORS OVER 1- 3 HP HOT WATER BD I LERS SINK, POT /3 COMP. MOTORS OVER 3- 5 HP MECHANICAL VENTILATION SINK, RESIOENCE MOTORS OVER 5- 8 HP TRANSPORTING ASSc3ELIES SINK. SLOP MOTORS OVER 8- 10 HP ELEVATCRS/ESGUTU'RS TEIPCRARY WATER CLOSET MOTORS OVER 10- 25 HP FIRE SPRINKLER SYSTO S URINAL MOTORS OVER 25-100 If COOLING TOWERS WATER CLOSET MOTORS OVER 100 HP [ VIOLATION INDIRECT WASTES A/C WINDOW RED PE,'TION WATER SUPPLY TO: AIR CONDITIONERS • A/C UNIT STRIP HEATER FIRE SPRINKLER GENERATORS TRANSFORMERS • HEATER -NEW INST. GENERATORS TRANSFORMERS H EATER - REPLACE GENERATORS TRANSFORMERS LAWN SPRINKLER -WELL SPECIAL PURPOSE _' SWIMMING P00I. • OUTLETS COMERCIAL WATER SERVICE • SIGN TUBES SEWER CONNECTIONS SIGN TRANSFORMERS UTILITY-SEWER SIGN TIME CLOCK UTILITY -WATER FIXTURES SEPTIC TANK ANN RELAY TELEVISION CUTLETS GRAINFIELD, 4' TILE/RES. VIOLATION PUMP & ABANDON SEPTIC TANK REINSPECTION SOAKAGE PIT CU. FT. '^ CATCH BASIN DISC4APZE WELL —� DOMESTIC WELL AREA CRAIN ROOF INLET SOLAR PLATER HEATER FIRE STANDPIPE POOL PIPING LAWN SPRINKLER SYSTEM GAS RA.Na —' METER SET (GAS) GAS GAS PIPING (AN APPLICATION FOR BUILDING PERMIT MUST ACCOMPANY THIS ADDENDUM. IT A MASTER PERMIT HAS B. OBTAINED, THE OWNER'S NOTARIZED SIGNATURE NEED NOT BE PRESENT ON SUBSEQUENT APPLICATIONS.) PLUMBING ADDENDUM TO BUILDING PERMIT APPLICATION ELECTRICAL MECHANICAL ;UILDING LECTRICAL 'LUMBING zOOFING A C Awner of wilding C— / `/ C ❑ DATE /c + 195 _ o _ Z PER � 1'© 4464 Contractors License No. i i 9 e/ 0 © Work to be performed under this Permit architect = ontractor 4. Builder At ,egal Lot )escription Iddress of �, luilding S CONTRACTOR OR BUILDER MIAMI SHORES VILLAGE, FLORIDA Bl. /'. L t ; f BY / A) `4, ,fit 1 / t? i_t Subdi- vision Value of Project $ Amount of - , Permit $ This permit is granted to the contractor or builder named above to construct the building or to install the equipment or device described in the application terefor in strict compliance with all ordinances pertaining thereto and with the understanding that the work will be performed in compliance with any plans, Irawings, statements or specifications that may have been submitted to and approved by the proper municipal authorities. This Permit may be revoked at any Ime 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 !ranted 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 siiejfiRl�tions and that he assumes responsibility for work lone by his agents, servants or employees. J ! J �• r � Signed. (' . INSPECTOR In consideration of the issuance to me of this permit I agree to perform the work covered reunder in compliance with all ordinances and regulations )ertaining thereto and in strict conformity with the plans, drawings, statements or specifications sub tted to the proper authorities of Miami Shores Village. In ac- ^.epting this permit I assume responsibility for all work done by either, myself, my agent, servant or employee. AUTHORITY e PAUL R. KAWALEK ROOFING & PAINTING 485 N.E. 92ND STREET P11. 305-75441191 MIAMI SHORES, FL 33138-25t-A \CUVI 5kC re e _ - ) V e- 1 ; S /Ar t4uod ed_ POu_ 8 7) DalsAfs BankofAmerica. Ac.H1.3.0,77 PerrAii— 10,3 6,2 iva 5t 46u) 4063100 2??1: 00366060 L91411 2262 11310- 2262 63-213I fl 810 Page 4 OFFICE USE ONLY CHECKLIST ❑ OWNER - BUILDER FORM (Attach) ❑ FIRE DEPARTMENT APPROVAL (Commercial / multi- family) ❑ CONCURRENCY (New Construction) ❑ OTHER (Specify & Attach) $3.00 per page (Scanning Fee) Miami Shores Village Bond Metropolitan Dade County (C.C.F.) Inspector State Educational Fund State DCA (Radon) Code Enforcement Fine Zoning Review ❑ PROOF OF OWNERSHIP (Attach) ❑ HRS / DERM APPROVAL (Septic / Sewer) ❑ IMPACT FEE (New Construction) ❑ OTHER (Specify & Attach) PERMIT FEES $ 1 $3o0, D t7 $ ie(7 0 (sq.ft. = x/1000 x ¢.60) $ (¢.005 /sq.ft.) $ (0.01/sq.ft.) REVIEWED AND PREPARED BY: SECTION Zoning Electrical Mechanical Plumbing Fire Public Works Structural Building Official BY DATE 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 ELECTRICAL TYPE. Minimum Fee QTY. TYPO Dryer QTY. TYPE, Outlet, Appliance QTY. TYPE, Service Repair QTY. A/C Central 1 -3 Ton Dryer Vents, Number of Fan Ventilation, Cost Outlet, Wall Ductwork, Cost of Service, Temporary Periodic Inspections A/C Central 4 -7 Ton Fire Sprinkler System Fire Pump Outlet, Switch Fireplaces, Number of 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 Ty QTY Minimum Fee TYPE Condensate Drain ()Ty. TYPE Generator QT y. 'I-Y- QTY. Refrigeration, Tons 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 Bath Fan - Vented, # Fireplaces, Number of Pressure Vessel PLUNIBIN(: "ATE A/C Condensate QTY. .1.}.1,1, Drains, Roof QTY. nil Miscellaneous Fixture ()Ty. . LVI , I , ; Soakage Pit Q . I . Y . 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 1. PERMIT APPLICATION INSTRUCTIONS: Please indicate the type of work being performed and quantity(ies) in the space provided below. RECEIVED AND REVIEWED BY: DATE: CONTRACTOR , Name P� l • e,wqteX License No. q s 00 `7 J2 6 Address Lig S I�EF C O h ( s-j--; Telephone � nCr 7 T`LJ, / Fax Qualifier Name V) G te<(a. leK 2 ,72 R RY wN W GOAS774944-46 6 z /v E. ?, 01-7e-- Address/31/;160,4; S/S FL_ 506,) 73 igo .bsr.9' 6 �� Home elephone , ` ,MAI`gKer F Pli7a0 (P0�4 ) Business Telephone C3os) 55 — 4 072. Fax (305 'f5 - 8a /3 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 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. A PPLICATION Job Address: r Da 1" l q s 1 Address Apt. Folio Number 1 / , �oSO 6 Q / �O & 7Q Lot L+ �� Block Subdivisiio PB( 0 PG Current Use of Property Proposed Use of Property Tenant Information PERMIT TYPE (✓ ) Building Electrical Mechanical Plumbing LPGX Roofing Fence Other vz PERMIT CHANGE (✓ ) Chg. Contractor Renewal Revision Extension Supplement Reinspection ARCHITECT Name License No. Address Telephone Fax Poe) Copy A 777,c PERMIT APPLICATION Master Permit No. Subsidiary Permit No. M.5 hotespF_. - 315 City State Zip escnption of Work 1 ckr -4-F e,x s4-1 ng +i [ e' roaP rcpl&Ce wIha neLa,141 le--4e same co lot- Aro Zoning Linear Feet nn o�nn Square Feet o U Units Floors L.—Value of Work 6 1 1 9 100 Bldg Value Tax Assessed/Appraised Value Flood Zone Base Floor Elev. ENGINEER License No. Name Address Telephone Fax Page 2 IMPORTANT NOTICES 1. DO NOT BEGIN ANY WORK WITHOUT HAVING RECEIVED YOUR VALIDATED PERMIT AND PERMIT CARD. Applying for a permit does not grant the right to begin construction. HOURS OF CONSTRUCTION are limited to: Monday through Friday from 7:30 a.m. to 6:00 p.m., and Saturday from 8:00 a.m. to 5:00 p.m. No inspections will be conducted on weekends or holidays. 2. All construction of demolition areas MUST BE MAINTAINED IN A CLEAN, NEAT AND SANITARY CONDITION free from construction debris. 3. STREETS AND NEIGHBORING PROPERTIES SHALL BE KEPT FREE FROM DIRT AND DEBRIS. 4. SWALES MUST BE PROTECTED FROM BEING DAMAGED BY EQUIPMENT OR VEHICLES, AND MAY NOT BE USED FOR STORAGE. A bond is required for work in or near the street/sidewalk. 5. CONSTRUCTION TRAILERS ARE PROHIBITED ON SINGLE FAMILY RESIDENTIAL CONSTRUCTION SITES. Other construction may have a trailer which requires a separate permit. 6. PORTABLE TOILETS for a construction site require a separate permit. ' 7. DO NOT DISCHARGE WATER INTO THE RIGHT OF WAY OR STORM DRAINS without approval from the Building, Planning and Zoning Department. 8. EQUIPMENT AND MATERIALS SHALL BE STORED at least 10 feet from the edge of pavement. 9. Department of Health and Rehabilitative Services (HRS) approval is required for applications involving septic tanks. Department of Environmental Resources Management (DERM) and/or Miami -Dade Water and Sewer Department (MDWASD) approval is required for applications involving sewers. AFFIDAVIT - Please read carefully. Application is hereby made to obtain a permit to do work and installation as indicated. I, the OWNER of the property, certify that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that separate permits are required for ELECTRICAL, PLUMBING, POOL, EXTERIOR DOOR, MECHANICAL, WINDOW, FENCE, DRIVEWAY, ROOFING and SIGNS and there may be additional permits required from other governmental agencies. I, the OWNER of the property, have disclosed all information related to any work at the property performed in the prior twelve months to the Building Official. Further, I am fully aware that if the cumulative cost of work to my home or business under this and any other permit equals or exceeds fifty percent (50 %) of the fair market value of the structure, the entire structure must meet the present federal flood criteria for finished floor elevation. I am also fully aware that if the total cost of work to my home or business under this and any other permit exceeds fifty percent (50 %) of the replacement cost of the structure, then the entire structure must conform to the current code requirements of the Building Code. WARNING TO OWNER: Your failure to record a NOTICE OF COMMENCEMENT may result in you paying twice for improvements to your property. • If you are spending more than $2,500 or intend to obtain financing, you may wish to consult with your attorney or lender before recording your Notice of Commencement. The Notice of Commencement must be recorded at: 22 N.W. 1st Street, 1" Floor, (305) 679 -1078. Once recorded, the Notice of Commencement must be POSTED AT THE JOB SITE in accordance with Section 713 -35 of Florida Statutes. Review the brochure at Village Hall on Construction Lien Law and Choosing a Contractor. STATE OI�ID Signature oft/owner ' Helen R, Goldstaub Print Name COUNTY OF MIWADE STATi OF (Margaret F, Pitkin, POA) day of tal.) Sworn to and subscribed before me this ©` Signature of Nota Public ° ^' : ► WEARY S • S RAMIREZ X0111.'tY ► LIC STATE OF FLORIDA ^__)MMISSiON NO. CC831389 iU COMM ETON FJ(? APt /9,n3 SEAL: •• Pine /1 ;i / Personally known ✓ OR, Produced Identification Type of Identification Produced: Signature of Con l . t il) afore Notary Pu SEAL: OII )A, COUNTY � �/MrV 6 1,( ctor Print Name worn tq and subscribed before me G • PERMIT APPLICATION to of Florida MIAMI -DADE day of (�--e L- , Personally known • OR, Produced Identification Type of Identification Produced: r a BUILDING ZONING LINE & GRADE SURVEY FIRE PREVENTION PLUMBING Estimated cost of improvements: $ This space represents the lot; make outline of ground plan showing distance of building from all lot lines. MIAMI SHORES CITY OF teENEWancyckw FLORIDA or ma Or BUILDING IN.PiCTOa APPLICATION FOR BUILDING PERMIT Application is hereby made for the approval of the detailed statement of the plans and, specifications herewith submitted for the building or other structure herein described. This application is made in compliance and conformity with the Building Ordinance and Zoning of the City of North Miami, Florida, and all provisions of the Laws of the State of Florida, all ordinances of the City of North Miami, and all rules and regulations of the Building and Zoning Department of the City of North Miami, 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..._.._ JU 1� 1Zi. _. _..._......_.._.._.._......� 19 owner Mr. & Mrs. William Goldstau. tAdareee Idiami .Shores Registered /or in r• e� A � onclition3ng »' Address Miami a _ 8.VJ. 38th. Ct., Miam Fla. Contractor .&. Sheet Meta 3. Inc. � Location of Proposed Work: Lot Block._. Subdivision._.......... p Street and number where work is to be done: 362 N.Ee St. Miami Shores Install 3 A.P. A/C s stem Description of proposed work: — . _ . and for no other purpose. New building. Remodeling......._.._......__. Addition....._...._......_... Repairs..._ __ No. of stories.__...__._....__ To be constructed of_... .._...__..__ _..— .._.._.._._.._.. Kind of foundation 1500.00 Plumbing _.. _ .__ _._...._..» Electric. I hereby submit all the plans and specifications for said building. I hereby make application for a Certificate of Occupancy. All notices with references to the building and its construction may be Bent to: Signed: Address The undersigned applicant for this building permit does hereby certify that._........_..._.._.... — ...understands and accepts_.. — _ ._.. —.. _ _..obligations as an employer of labor under the Florida Workmen's Com- pensation Act, being Section 5966, Compiled General Laws of Florida, Permanent Supplement, and has com- plied with the provisions thereof, and will require similar conpliance from all contractors or subcon- tractors employed by_. —.. —.. .._...in the work to be performed under this permit; and will poet or cause to be sted for inspec ' to on the site of the work such ; t1.lic n e or nl <cee u are required by this act. / ! "- i (Owner and /or Contractor) Do Not Write In T is Space Board of Adjustments Approval: Planning and Zoning Board Approval: Council Approval: Sq. Footage: ______ Estimated Bldg. Coat: Bldg. Permit Fee. ....—..—.---- ..— ..__.�__.._..— .._..�- -.._.. Certificate of Occupancy Fee: Total Fee: Approved by Building 'Inspector: Permit No.• A 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 a/r:" - I ,19 C+— Owner's Name and Address '1-13' It IN °A m C... Z ST Au a , , .. No 41632 Street /..- a;, • c t.S . SF Registered Architect and /or Engineer Name and address of licensed contractorC- o C_ iTt ta, ay, s Location and legal description of lot to be built on: Lot Block Subdivision Street and Number where work is to be done_S,Co71 N - G - 1,. $ State work to be done and purpose of building (by floors) (n, L 3____VkFt. ' k Cit., 4 and for no other purpose. New Building Remodeling Addition Repairs No. of Stories To be constructed of Kind of foundation Roof Covering Estimated Total cost of improvements $ $Ss0 0 Amount of Permit $ Zone cubage required Plan Cubage Distance to next nearest building. Size of Building Lot Maximum live load to be borne by each floor I hereby submit all the plans and specifications for said building. All notices with reference to the building and its construction may be sent to The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations as an employer of labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida, Pennanent Supplement, and has complied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors employed by him in the work to be performed under this permit; and will post or cause to be posted for inspection on the site of the work such public notice or notices as are required by the Act. The undersigned agrees to employ only such subcontractors, on work to be performed under this permit, as are licensed by Miami Shores Village. Remarks (Signed) f ato— n Sr� n t,., k STATE OF FLORIDA, COUNTY OF DADE. j ss. Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally ap- peared to me well known, and who, being by me first duly sworn, upon oath deposes and says that he is the. of the above described construction, that he has carefully read the foregoing application, and that he did sign the same, and that all facts therein by him stated are true. - Permit No 7, 2 ( :_ Date 3 Read, Sworn to and Subscribed before me. Disapproved ___ __ i Date • ( Signed) Notary Public, State of Florida ding Inspector My Commission Expires PLANNING BOARD DATE Chairman Member Member Member Member Member Council Approved Date Disapproved Date NOTE: A charge of $1.00 will be made for making corrections or changes to this application after approval has been obtained from the Planning Board. A re- inspection fee of $1.00 will be charged when such re- inspection is made necessary by improper notice for inspection or faulty materials and /or workmanship. BUILDING ZONING LINE & GRADE SURVEY FIRE PREVENTION PLUMBING This space represents the lot; make outline of ground plan showing distance of building from all lot lines. MIAMI SHORES CITY OF NEfflacjikoMMITA FLORIDA OFFICE OF BUILDING INSPECTOR APPLICATION FOR BUILDING PERMIT Application is hereby made for the approval of the detailed statement of the plena and specifications herewith submitted for the building or other structure herein described. This application is made in compliance and conformity with the Building Ordinance and Zoning of the City of North Miami, Florida, and all provisions of the Laws of the State of Florida, all ordinances of the City of North Miami, and all rules and regulations of the Building and Zoning Department of the City of North Miami, 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. Z1.11 r.._...,......_.._.._.._......., 14Z Owner Mr. & Mrs . ] atal badarese 3h2. L.E. 9..th..... .&t_ , Dffi A rai .Shapres Registered c lute ct and/ Engineer: c entral Air c onditioning Contractor Address 3 Q 4 .](J - 38 th . C t • e m Fl a . Location of Proposed Work: Lot___ _ Block_.. Subdivision. Street and number where work is to be done • . 36.2 TT ..E... ttl . S t _ , M a m i Sh r r.e.a Description of proposed work • x...P . A /C.._s_y.s. t cam and for no other purpose. New building. Remodeling Addition Repairs... No. of stories..._..___._...._._ To be constructed of_..._..._..._...._ _.. _ .._.._.._._.._.. Kind of foundation Estimated cost of improvements: 5..15.QQ..Q.Q.__ Plumbing I hereby submit all the plans and specifications for said building. I hereby make application for a Certificate of Occupancy. All notices with references to the building and its construction may be sent to: Address: The undersigned applicant for this building permit does hereby certify that_..__.._.._.._.... ._...understands and accepts_.. _ _ .._.... .._.._.._ ._ .obligations as an employer of labor under the Florida Workmen's Com- pensation Act, being Section 5966, Compiled General Laws of Florida, Permanent Supplement, and has cony plied with the provisions thereof, and will require similar conpliance from all contractors or subcon- tractors employed by_._ . .. .in the work to be performed under this pe . 't; and will post or r inspe n on the site of the ce or ticefras are required by Do Not Write In T i is p Board of Adjustments Approval: Planning and Zoning Board Approval: Council Approval: Sq. Footage: _ Estimated Bldg. Cost: Bldg. Permit Fee :...._.._.__. Certificate of Occupancy Fee. Total Fee: Approved by Building Inspector: Permit No.: A 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 hereinjpecified or not. A copy of approved plans and specifications must be kept at building during progress of the work. Owner's Name and Address Registered Architect and /or Engineer Name and address of licensed contractor.__ L Location and legal description of lot to be built on: MIAMI SHORES VILLAGE A/I c Zi/e4c DA y ' $ate /a eS g No Street. IV 6 of SEfI/ /c f ®3:1 °S 177®4 8 Lot Block Subdivision Street and Number where work is to be done State work to be e se of building (1 floors / o and for no other purpose. New Building Remodeling. Addition Repairs No. of Stories To be constructed of Kind of foundation Roof Covering Estimated Total cost of improvements $ Amount of Permit $ Zone cubage required _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 ubco ctors, on work to be performed 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 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 Disapproved ( Signed) Date_ _ \ Building Inspe r Date to me well known, Read, Sworn to and Subscribed before me. Notary Public, State of Florida My Commission Expires PLANNING BOARD DATE Chairman Member Member Member Member .. Member Council Approved Date Disapproved Date NOTE: A charge of $1.00 will be made for making corrections or changes to this application after approval has been obtained from the 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.