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40 NE 95 StMIAMI SHDRES 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. Owner's Name and Address . /60.43 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 New Building _ ___...._` .. Statn work t be done and purpose of building (by floors) _._ d. / .j)Y / e'er Bate... :. .1�f 2d , 19 4' / No ' Ai .Street C . h I / — f G! and for no other purpose. Remodeling Addition Repairs _.__ No. of ( Stories . ... ...... To be constructed of Kin of foundation__.. Roof Covering. e . Estimated Total cost of improvements $._ ... / __ex'e'c____________________ __Amount of Pennit $ 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 bnrit 9th p ans and : scificat s for said building. All notices witi reference to the-building and its c nstrgction may 9th a /cf,: ,`."� /� �/yJy /_� �J'�f `col )' �+ � r� i. , J /j b e s eas .e " ___ __ r ` c- (T C! ? !.__ - ✓-A--� -` ••(�� G.+� s� J uT•f t* ' �l d a 1 ant f buildin permit does hereby that h understands . The undersigned pp �g p y y he de r stands and accepts his obligations as an employer of labor under the Florida Workmen's Compensation Act, being Section 5966, Comgiled 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 he performed under this permit, as are licensed by Miami Shores Village. Rem Irks . (Signed) 4) . 1! i` ;1 - L.� t. 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/5ays 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 f � , .___ Date.._. Re Swora to and Subscribed before me. Disapproved / Date Notary Public, State of Florida (Signed) Building 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. R. 15C 4 MIAMI SHORES VILLAGE BUILDING INSPECTION DEPARTMENT APPLiCATIDN 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 cr ether structure herein described. This application is made in compliance and conformity with the Building Ordinance of Miami Shares 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 bei T ., ' l A e r e } © ti Registered Architect and /or Engineer r��+ wt<+- ` ► Name and address of licensed contractor F G t- ' — V < <a e Location and legal description of lot to be built on: Lot_ 11 ct E in Block T Subdivision_/ r /' al ' ``A ° ' '© Street and Number where work is to be done A l (?-- C_6 t- fr r State work to be done and p u u rpose of building (by floors) '41 c N' and for no other purpose. New Building Remodeling . Addition Repairs No. of Stories To be constructed of C Kind of foundation _ e, 0 C N e- i Roof Covering r;./ P i Estimated Total cost of improvements $ j 6 D 0 Amount of Permit $ (/{. 1, ' .. Zone cubage required 1 A, ` - c.r' c_ .' ct plan Cubage "'. II, / ': '14.'st I1A a_ . t.. ' 4 c -_ 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 Data `� -- • i r 19 e No P 9 Street A) E' S 6 Sfi / A- 6A e � cl 0 4 , q 0 l r ✓, n� R o o = 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 Workman'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 ublic notice or notices as are required by the Act. The undersigned agrees to employ only such styl ontractors, on Or to be performed under this permit, as are licensed by Miami Shores Village. Remarks ( Signed) - -- ! a 4 4 , A,, v STATE OF FLORIDA, COUNTY OF DADE. I 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. boffin by me first duly sworn, upon oath deposes and says that he is the. of the above &scribed construction, that he has carefully read the foregoing application, and that he did sign the same, and that all facts therein by him stated true. Permit No d 5 ti, Date 3/ '— / Read, Sworn to and Subscribed before me. Disapproved Date. ( Signed) L✓q� ` e/ c -- r ` Notary Public, State of Florida V Building Inspet or My Commission Expires PZANNING 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 tais application after approval has been obtained from the Planning Board. A re- inspection fee of $1.00 will be charged when such re- inspection is made necessary by improper notice for inspection or faulty materials and /or workmanship. {l- 0. e f,, 'o Tp 2 it 135', 9 4. pp 55.1 t = g'& t''- \ 92. •1S Hs J '(t. -, is 1S. o I rs95*. Sz T 4 M�V L E E C' a I % 1. gr- t CIA 0 4 - C L Q cn G h(te� tL 7 04 vb Q•g23 -Jra FT, n ee p e � 1 1 ,8I 2, cTe 21, L- `a MSV /1958 UPON ^(R(,'IFTZON Cr ADATT fl THIS LICENSE EXPIRES 19 In consideration of the sum of Date Issued 3- 31.61 THIS LICENSE MUST BE DISPLAYED IN C eSP OUS PLACE A PENALTY IS IMPOSED FOR FAILURE TO KEEP THIS LICENSE EXHIBITED . T Y ABLISHMENT OR PLACE OF BUSINESS �AOR�c, l icense Tuinty Fin end " ($ Paid to Miami Shores Village, Dade County, State of Florida, ROBZRT N° 4936 is hereby ry licensed to engage in or operate the business of •JN 1Int I LT i MIAMI ,SHORES' VILLAGE; FI PRIDA By G ` THIS LICENSE' NO1 TRANSFERItlig VKITROUT THI;":AabPRO'�1.k OF THE VILLAGE MANAGER. APC 6 ��'�r� OWNER'S NAME 'mac z °. '4l,d -r 0t= `�,C'a PRESENT ADDRESS -7,, f. 1 .e ..ate, ',°. LICENSE NO. PHONE NO. .L_° JOB LOCATION OR AVE.) LOT 1 I3LOCK SUBDIVISION S- GENERAL CONTRACTOR ADDRESS 's S„, PHONE NO. LICENSE NO. A C� BUILDING PERMIT NO. IA t. DATE '''. "'' .' t r PERMIT FEE $ �`"' BUILDER'S BOND NO. .2 5 C' "-: DATE h - M LP i gg ZONE 1C ., 1-., REQUIREMENTS e %'"-> CU. FT. -r.o. r, 1gl, {.,fib PLAN CUBE P Will CU. FT. .•e.c EST. COST $ 1 oS DRAWINGS, SPECIFICATIONS, RESTRICTIONS AND CUBE CHECKED BY: ' AC Y 1E a a`, '(" DAT: Ft- `J. a— tr I NEW CONSTRUCTION TYPE STORIES ROOF CONSTRUCTION INTERIOR CONSTRUCTION REPAIRS DESCRIPTION + bl1,3AA,.'9 47SSOIb APR i%r "i #.v4 ., 4tvd u.'L' r., �C. .i>w 9 f {,M.,4 ( -try. ..,Alt a,.,.it ALTERATION i DESCRIPTION ADDITION —a mt..7 . .r.a4, sp4.,1 t :;,^.-( `r■rm• • . la )!4- SUBMITTED TO PLANNING BOARD APPROVED REJECTED REFERRED TO COUNCIL REASONS RE- SUBMITTED TO PLANNING BOARD S UB MITTF0 TO VILLAGE COUNCIL 4 LOMA. REMARKS k •b t• 2r• ui .e ��.���. I+.5C... x '11 C.'i' Toy. Ja - ., E //i C.s Ir' fZr CERTIFICATE OF OCCUPANCY NO. - ''I(l I ISSUED • BY TO 1� -' � j > <- ( F` c BUILDING PERMIT AND INSPECTION RECORD —MIAMI SHORES VILLAGE INSPECTIONS DATE BY INSPECTIONS DATE BY FOUNDATION I $ SOLAR HEATER ROOF $ GAS BEAMS & LINTELS 5 TUB & TOP OUT POOL I $ FRAMING RANGE CONN. AIR COND OND.. MOTORS FINAL $ FIXTURES CLEAN UP SEPTIC TANK $ SLAB S SOLAR HEATER SLAB SPECIALS PERMITS PERMIT NO. DATE FEE I L TEMPORARY SERVICE 14. ; � YOI. E S I mil..., . -. 24.4. SEPTIC TANK I $ SEWER BY I $ SOLAR HEATER FEE $ GAS 5 TUB & TOP OUT H. W. HEATER CONN I INSPECTIONS DATE BY RE- INSPECT BY RE- INSPECT BY ROUGHING DATE FEE TEMPORARY SERVICE $ TUB & TOP OUT H. W. HEATER CONN $ RANGE CONN. RANGE CONN. SEWER MOTORS $ FIXTURES SEPTIC TANK $ S SOLAR HEATER FIXTURES GAS CONTRACTOR /apeaf74,-7E E C-e PHONE PERMIT NO. 7,t7 1 DATE 9_ - 6.i FEE 953o.ao NEW BLDG. I ALTERATION 1 ADDITION REPAIRS SPECIAL PERMITS PERMIT NO. DATE FEE TEMPORARY SERVICE $ H. W. HEATER CONN. H. W. HEATER CONN $ RANGE CONN. RANGE CONN. $ MOTORS $ FIXTURES $ S INSPECTIONS DATE BY RE- INSPECT BY RE- INSPECT' BY TFMP.SERVICE ROUGHING H. W. HEATER CONN RANGE CONN. FIXTURFS & FINAL PLUMBING PERMITS & INSPECTIONS CONTRACTORJo� / u e PERMIT NO. Zo 2.0 NEW BLDG. APPROVAL TO POWER CO. FOR SERVICE DATE uv• y Ex* 64N /A., BUILDING INSPECTIONS Zo S s q- �LJm /3 e.1 G I DATE 1 ALTERATION � ADDITION PHONE ELECTRICAL PERMITS & INSPECTIONS FEE $ /o b. — REPAIRS BY Street Address CERTIFICATE OF OCCUPANCY MIAMI SHORES VILLAGE, FLORIDA BUILDING DIVISION N° 1294 Approved use by occupancy Remarks. 1994 PI ANN Mail l 21, 2.x,9 TAX 10,625 Miami Shores Village, Florida, Owner, Agent or Tenant of Building ' ' ' " 1 -0Z , Lot 7 8, '`�' Block Su " '�� " -T '' 0 ' 1 '" 3 i 1• 3o6roonm, n Th ` nd n icc.itio:n This Certificate of Occupancy is issued to the above named_ �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. BUILDING DIVISION Owner, Agent or Tenant of Building Lot Street Address CERTIFICATE OF OCCUPA.NCY MIAMI SHORES VILLAGE, FLORIDA BUILDING DIVISION 790 Miami Shore f Village, Block Subdivjeion o �` Approved use by occupancy Mark's This Certificate of Occupancy is issued to the ab for building at above named location only upon th abide by and comply with all conditions of Ordinan Zoning, Electrical, Plumbing and Building Ordinan the erection, construction, alteration or remodeling o f ve named express provision that the applicant will s Nos. 92 ' . 94 and 97, known as the s of W i s QQres Village pertaining to build' • es or stkuctuzres. BUILDING D MR. ROSEIIT MOA7o iON 269 NOR_TH` 9,6114 . STA t.ET ;1 M1, FLO, to* t ` SNEL$Y MuTuAt. IN$UR CO. Policy 011021.u.972 & MC519 -055 DEA,i Soo: HERE ARE' TNt W04#10ri i 'COMPiN$ATIO$ AND JA01 L 1'?Y' ;YOu o Rini TOSIETNEI .. v,l I `1tE IK14.01ct l. • AS NAVE MAILED A CEATLIrleATE 0r• TNIE 1wl vRAMOE TO Tow MtAMI 46,0*Es. LcING - ZOI tN0 . DDPARtMENT A$ 'fit[ RfQULfUP• Sync °BO APP*ECI ATE 'OUP SU$ I II* *$, AN * KUOM 1 F YOM MAME.' Arr QUI T Io+N$ You W! I.L eta' U$ *NOrr, 1 Ci.. CCs MIAMI *NO/tef. B1Utk0`u I & Z MI Ia ( l►R'�IIEl11 MIAMI SMOME, ;'Vt .'1'Mt Mi AM`I SN011iO AUTO BUSINESS HOME TYPE OF INSURANCE POLICY NUMBER POLICY PERIOD LIMITS OF LIABILITY AS PROVIDED BY THE WORKMEN'S COMPENSATION LAW OR LAWS OF: EMPLOYERS LIABILITY COVERAGE B $25,000 UNLESS SPECIFIED BELOW: A - Workmens' Compensation V/C211 -072 EFF.9/5/61 EXP. 9/ 5/62 FLORID A B - Manufacturers' or Contractors Liability Me51 -055 EFF. 9/5/61 EXP. 9/5/62 Bodily Injury each person• $ 25,000 each accident $ 50 1 000 ,, Property Damage each accident $ 'I) $ 000. aggregate $ G5 1 000. C - Owners', Landlords' and Tenants Liab. EFF. EXP. each person $ each accident S each accident $ D. Products Liability EFF. EXP. each person $ each accident $ aggregate each occident $ aggegate $ E - Owners' or Contractors Protective Liability EFF. EXP. each person b each accident $ each accident $ aggregate $ F - Comprehensive Personal or Storekeepers' Liab. EFF. EXP. each occurrence $ medical $ included G G. Comprehensive Liability (1) Automobile EFF. EXP. each person $ each accident $ each accident $ (2) General EFF. EXP. each person $ each accident $ aggregate $ each accident $ aggregate $ (3) General - Automobile EFF. EXP. each person $ each accident $ aggregate $ each accident $ aggregate $ THE SHELBY MUTUAL INSURANCE COMPANY OF SHELBY, OHIO hereby certifies coverage as follows: ROBERT riORTONSON (NAME OF INSURED) 269 NORTH EAST 56TH STREET i l AM I . DP.UE L OUNTY, FLOF ILA (C ITY OR TOWN) (STATE) (STREET AND NUMBER) CERTIFICATE ISSUED TO: JOB LOCATION: Dote •JEP.I.E.[41B..E.R 121.)x., 19E'1 FORM No. GL -44 a (Certificate of Insurance) CERTIFICATE OF INSURANCE £:I1 AM I SHORES BU ILDING ez ZONING DEPARTMENT (NAME AND ADDRESS) NORTH EAST 2ND ,0VENUE MIAMI SHORES, FLORI[ :A In the event of any material change in or cancelation of said policies THE SIIELBY MUTUAL. INSURANCF COMPANY will notify the holder of this certificate. THE SHELBY MUTUAL INSURANCE COMPANY OF SHELBY, OHIO ; W ANCE r\GLNCY. INC. AUTHOR 1ZED REPRESENTATIVE tas MIAMI 57!- RES VILLAGE BULLS NG :a..sPECTION DEPARTMENT APPLII7ATION Ffl BUILDING PERMIT Application is hereby made for the approval cf 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 E 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 1 3 lM_S®►°` Registered Architect and /or Engineer _......... ce__. .S ' € i _.._ _3_ Q ,L-' .. $ f ..... Name and address of licensed contractor _...___t id.F'2_Q, - C!ZJr ieW viia Location and legal desc iption of lot to be built on 'LS 4z hl k'' 36' c4-- Lot_7__ /1„,. 5 Block Subdivision Ai/".32/ Street and Number where work is to be done . . Qs __._.5.7 State work to be dene and urpose q building (by floors) and for no other purpose. New 3uildir.g Remodeling . 'Addition..._.__ -.... __...... Repairs No. of Stories ... To be constructed ofJ-i1 ( v) Kind of foundation__..__ __._ Roof Covering Estimated Total cost of improvements $ .... S(1, _Amount of Permit $ r- Zone cubage required Plan Cubage Distance to next nearest building Size of Building Lot .___... ->'c ..�. Maximum live load to be borne by each floor I hereby submit all the plans and specifications for sal building. All notices with reference to the building and its construction may be sent to_ _ 42.- ' " a-S 0 /y Ct .3 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 Laves 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 cr notices as are required by the Act. The undersigned agrees to employ only such subcontractors, on worly to }ier performed under this permit, as are licensed by Miami Shores Village. Remarks (Signed) >_. STATE OF FLORIDA, COUNTY OF BADE. SS. Before roe, the undersigned authority, a notary ppubl•c, duly authorized to administer oaths and take acknowledgments, personally ap- peared ,AL' e /-o!0 lrL t -i, -5 /1/ 1 -4-- /1��- . .rn_.1 t ��T 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. !!// PL Permit No ,.2��_'_!__ .c 7' Date JO 7 / Read, Sworn to and Subscribed before me. Disapproved Date_ (Signed) Notary Public, State of Florida (� _, _. Buil ng nspector - 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. Date No Street , 19._.4 PERMIT APPLICATION FOR MUNICIPALITIES OF DADE COUNTY. (OWNER TO RETAIN COPY) Date /' — / / Job Address Legal Description,/"" % 12.:L Sc 1 Master Permit. # Owner / Lessee / Tenant Owner's Address I/® /1/, 1. 9 Contracting Co./#55-v Address Qualifier State¢ / Vc 9S Competency .39 S v v Architect /Engineer Address Bonding Company Address Mortgagor Address Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL PAVING FENCE SIC WORK DESCRIPTION SSA-a1 /' 8 ' ®,A) Square Ft. / 13 WARNING TO OWNER: YOU MUST RECORD A NOTICE OF COMMENCEMENT AND YOUR FAILURE Z DO SO MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY (IF YC 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, ar on the attached addendum (if applicable). I certify that all work will be performed to meet ti standards of all laws regulating construction in this jurisdiction. I understand that separat 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 vox 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. Sig .: t 're of owner and (or • o Pres dent Date Notary as to Owner and /o ondo My Commission Expires: * * * * PERMIT FEE: APPROVED: Zoning Mechanical ro n I /Lee./ -74L -/- / ��z�4 r�( � s1 * sident Fire SS# ) Plumbing Phone 25 • ;7 d 7 q& /v. 0° Estimated Cost Tax Folio / 5i'< /d 6401.,2 Ins. Co. Signature of Contractor or Owner - Builder Date: Notary as o Contracto My Coms Expires: :k * * * Other Engineering 3S * lder *� * Building �-� 1 �`� Electrical