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MECHANICALPERMIT APPLICATION FOR MIAMI SHORES VILLAGE Job Address 30h, E Q9Tax Folio (/ ✓ ao ©( 340 /fd Date Legal Description / Historically Designated: Yes No / / Tenant / ` l/ L () clil Tr Owner's Address A) I/ Phone Contracting Co. �J� % / s; /L�% . ! � Id Qualifier / G J / - (C/J a Y State # re unicipal # Competency # Address Address Architect/Engineer Bonding Company Mortgagor Permit Type (circle one): BUILDING ELECTRICAL PLUMBIN ECHANICAL OOFING PAVING FENCE SIGN WORK DESCRIPTION e i Ce �'E1,.1 x441./4- food-v-7 (/,t// `7 / 7 ( J 3iut C L 1e— pew / c 1 �sudz / d 6 To"' Square Ft. Estimatedost (value) "cit. J '0.7 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 AFFID VIT I certify that all the foregoing information is accurate and that'all work will be done in compliance with all applicable laws regulating co .trucon and zo y( Furthermore, I authorize the above -named contractor to do the work stated. Signature of o er and /6t'4 q'{ ule { }dent Date r+C1 Notary as to Owner.and'(.or My Commission Expire '. ora,,, X77 uo �`Gy FEES: PERMIT /� RADON ate C.C.F. Address g/i4d Signature of Contractor wp,e� er 4N' °� Nit a � o B(/ / " / iii � C'' \ ci 5 \ ST 1, Notary as to Contracto = or Liw$e&Bui My Commission ExpirkA #CC 3843 1 , 0 � 90 nGed e' itin!11111 re' Master Permit # L,/2" 3 NOTARY Ins. C BOND ,✓i? End{ Address doaso he/6 -e/e/ Date Date TOTAL DUE / 04. APPROVED: Zoning �/ Building Electrical (i' �/ Mechanical < � i ' Plumbing Engineering ITEM( BATH 11.13 UNIT FEE ITEM SWITCH OUTLETS UNIT FEE ITEM SPACE HEATERS UNIT FEE BIDET LIGHT OUTLETS CENTRAL % -- a.5 - Tr7loc $ DISHWASHER RECEPTACLES A/C (WI lqs,. 02 DISPOSAL SERVICE TEMPORARY A/C (CE '. 01/E DRINKING FOUNTAIN SERVICE SIZE IN MPS DUCT WORK /0- 522e;; FLOOR DRAIN SERVICE REPAIR/LETER CHANGE REFRIGERATION Q/i GREASE TRAP APPLIANCE OUTLETS PROCESS AND PRESS PIPING IHTERCEPTCA RANGE TOP UIDERGROIRU TANKS LAVATORY OVEN ABOVE GROUND TANKS • LAUNDRY TRAY HATER HEATER U.F. PRESSURE VESSELS CLOTHES WASHER MDTORS 0- 1 FP STEAM BOILERS SHOWER MOTORS OVER 1- 3 HP HOL HATER BOILERS SINK. POT /3 CLAP. MUTCRS OVER 3- 5 HP MECHANICAL VENTILATION A SINK. RESIDENCE MOTORS OVER 5- 8 FP TRANSPORTING ASSEMBLIES SINK. SLOP MGTCRS OVER 8- 10 FP ELEVATCRS/ESCALATORS TEMPORARY WATER CLOSET MOTCRS OVER 10- 25 HP FIRE SPRINKLER SYSTEMS URINAL MOTORS OVER 25-100 FP COOLING TOWERS WATER CLOSET MICAS OVER 100 FP VIOLATION INDIRECT WASTES A/C WINDOW REINZSPECTION WATER SUPPLY TO: AIR CONDITIONERS A/C UNIT STRIP HEATER edVielt, sid4 02 /Def— FIRE SPRINKLER GENERATORS TRANSFORMERS HEATER -NEW INST. GENERATORS TRANSFORMERS HEATER - REPLACE GENERATORS TRANSFER ERS LAWN SPRINKLER -WELL SPECIAL P RPOSE SAWING P001. CUTLETS COMMERCIAL WATER SERVICE SIGN 1113ES SEWER CONNECTIONS SIGN TRANSFORMERS UTILITY -SERER SIGN TIME CLOCK t' JTILITY -HATER FIXTURES SEPTIC TANG( ANTENNA A TELAY TELEVISION OUTLETS BAINFIELD, 4' TILE/RES. VIOLATION 'UP & ABANDON SEPTIC TAN( RE I N1,SPECT ION MO SE PIT CO. FT. LATCH BASIN 1ISCHARGE WELL XBEST IC WELL PEA GRAIN IOOF INLET MAR WATER HEATER IRE STANJP IPE COL PIPING . AWN SPRINKLER SYSTEM AS RANGE ETER SET (GAS) AS PIPING 1 r ADDENDUM TO BUILDING PERMIT APPLICATION (AN APPLICATION FOR BUILDING PERMIT RUST ACCOMPANY THIS ADDENDUM. IF A RASTER PERMIT HAS BEEN OBTAINED, THE OWNER'S NOTARIZED SIGNATURE NEED NOT BE PRESENT ON SUBSEQUENT APPLICATIONS.) PLUMBING ELECTRICAL MECHANICAL a Sec. 5-1.1. Air conditioning regulations. - (a) All individual air conditioning units installed in walls or windows shall be securely anchored to the walls by approved methods. Units installed over public property, paths of egress or more than ten (10) feet above grade shall be secured to the struc- ture by bolts or screws to resist horizontal wind loads. Such units cantilevering more than eight (8) inches on the exterior of a building shall be supported by steel angle brackets secured by bolting. Bolts to masonry shall be set in lead shields or similarly rot - resistant fastenings. (b) The following special requirements shall apply to the con- trol and regulation of noise nuisance from air conditioning machinery: (1) All equipment. existing or hereafter installed, regardless of location, shall be maintained in good working order. Equipment so located that normal operating noises create a nuisance to adjacent owners or occupants shall be pro- vided with soundproofing, or sound - absorbing baffels, or enclosures. as approved to insure maintenance of a rea- sonable noise level. (2) All equipment on outer walls, on roofs, or in other exposed locations, which are unduly noisy, and which causes valid complaints from adjoining property owners or occupants, may be required to be relocated. redesigned and/or en- closed in noise - retarding materials when, in the opinion of the building official, such enclosure is necessary or would be effective. ,(3) Special consideration shall be given to the planning of all future installations to minimize the noise nuisance to ad- joining property owners or occupants, and the building official shall have authority to reject or require the rede- sign of any system which, in his opinion, would cause such a .noise nuisance. (c) Violation of this section shall be punished as is now or may hereafter be provided by law. (Ord. No. 299, I§ 1 -3, 2- 21 -61) I have read the above ordinance and will cormly with the regulations thereof. atiami eJ botts I i11age r L O al t D • ( Contractor Siqnature 2 &Tau- SeeviLED r 4 & rr214.111a a Ata. g% 100 Carrier Air Conditioning 1) f) f Ca•r'r• Cornorntor Carrier Parkway Syracuse, New York 13221 Commercial Air Conditioning • CkonciensoR 38 Bre o3 o A 14FtsJD. Fk4 CN8005 — 7.rkt) seklk q 4- Sens gvroo Prepared for t Ack\< M C D GNI Tr Address 358 NE ki S1-40R '754- o_o5 40 .43 I L Best 0.2 0.2 0.2 0.2 • Average 0.5 0.5 0.4 0.4 Poor 0.8 0.7 0.6 0.5 °F. TemperatUre Diff. 30 40 50 60 70 80 suBJEcT , Adjustment Factor 3 4 5 6 7 8 58 AJ 7 2 1 i I' HEATING , COMMON DATA SECTION 1 001.1517 ram; TEMP pirE COOLING 0 TUH 1088 , , T. f ....\''',!'f' HEATING FACTOR filf 1 suBJEcT , 1( A..* g.: a. 8 . FT. 5 COOLING r FACTOR , ; fr.tr •••'• :T ,„.1.E.,,./.,,,,„. 5.8 BTUH GAIN • A . - , - Or , GROSS WALL DOORS Er WINDOWS (Table A or B) 58 AJ 7 2 1 i I' 831_ NET WALL -/g 28. 4. 1.25 CEILING 19 14 31 44 39 te 1 41 18 - 35 48 43 11 FLOORS. 13 28 40 35 Ilt - 4 V Xr_y • rt 1 ' aifl 41 a;y 514. NE &NW 37 07 45 Infiltratiou 1 le,thug -, 8 to / 4. = • e D Volume X X ' 1 6o X 10 / u. Ft. Volume u. Ft) - • x 0 .-,- Cooling i Coo 1 2 X A T X Table = t Infatratort Btu/ hr Ulf ,MI •-•-• x 0.18333 x , iirili_gf 01833 x IS x v 2 & , , . .r. .. . , : '-' ' i ,,,' ' _, -. ,,,,, • , .....,,...1-: ,i, ... .. -,„4 - ,,,,--- - : '^4 .ii,.... . i.. K . ,, , o r. • .,„„r , • '4,...,--i. . ..- 1. „,,,, SUB-TOTAL BTUH LOSS (per 10°F) 21 -, ,.. - - --- ,..v .4..t. . 4: , ..`,14,t1 4. '• *40'1! ,,,.•:=,,, , . , ,,, , , ,. 1.i. ;iieo . 7. 7' V.,1` . .....;,.....,-......4....., • ; - - -i4....a.- ADJUSTMENT FACTOR (Table C) 443 TOTAL BTU H LOSS PEOPLE x 300 BTUH GAIN (Assume 2 peraons bedroom) 43.4 - ) 0 0 \ APPLIANCES BTUH 86 3.5 1200 F4 11111111".71111 x I. 1. 1 5 li l x 1.3 Ir#1141:Vil SUB TOTAL BTUH GAIN (room sensible only) 4) 41 108 DUCT LOSS/GAIN FACTOR (Table F) 88 10.0 SUB-TOTAL BTUI-1 (Sensible Gain) Wood w/storm ro,po 7 MOISTURE REMOVAL (sub total x 1.3) 4.5 5 4 TOTAL BTUH LOSS/GAIN 4 5 5.4 ndow Et D or Types S141511 G1055 1 001.1517 ram; TEMP pirE TRINE CUM TIM TEMP Mt 31:6114 0177. 1( A..* - PTUII DAIN Direction 47 ro- 72 .14 55 49 7,- 78 45 ei) 53 4)- 2tr 75 15 7r, 28. 6.09 1.25 N 19 14 31 44 39 te 1 41 18 - 35 48 43 11 _ 27 r 34 13 28 40 35 Ilt - 4 V Xr_y • rt 1 ' aifl 41 a;y 514. NE &NW 37 07 45 E 6 W SE 6 Sw S 78 37 le 73 25 27 19 70 21 St,ylights 15; 1m i 72 141 443 145 132 43.4 140 wood 4 86 3.5 40 0 .1 5 432 5 4 4) 41 108 13 7 88 10.0 13.2 Wood w/storm ro,po 7 1 5 4.5 5 4 3 5 4 5 5.4 - 11 For wood doors nricl TOTALS , • •••• t..q n_q■ ndow Et D or Types Frames - x Area --- Rtuh Loss Wood TIM Metal Single Pane Clear 9.90 10.45 11 .55 3cm 4562- With Storm 4.75 5.25 6.50 - Double Pane Clear ' 5.51 6.09 1.25 With Storm 3.41 3.85 4.90 Triple Pane Clear 3.80 4.39 5.48 Jalousie Single - - 11.0 Single wistorm Skylights Single "11.07 11.69 12.9 Double 6.65 7.35 8.75 Door Wood Only 4.60- - • ‘3 2 Wood w/storm 3.20 - - Urethane Core (R-5) - - 1.90, Urethane Core (R-51 w/storm - - 1.70 • ' ., TOTALS 45s 4 (A = -_, 1 • AIN* • Manual J Cakulation w,..peetree C„str2rner'g .Namrk M M C De V Add City 5t1 RES State Zip WINTER: Inside Design Temp 10 °F- Outside Design Temp _40° F = Heating Temp Difference 30 °F SUMMER: Outside Design Temp q 1 °F- Inside Design Temp 07 4, ^F , Cooling Temp Difference _ °F TA LE A-HEATING -Doon* a WOOD FRAME WINDOWS (PER 10°F) For sliding glass doors - use factors for the same type window cotlistrtjctlon. TABLE C - ADJUSTMENT FACTORS - (HEATING) 6) American Standard Inc. 1991 Whole House Worksheet r ess I 5,1 IJi 9(1 sr 'te)ephone Number 00 - c3 8 TABLE 0 - COOLING - DOORS Et WINDOWS Factors assume windows have inside shading by draperies or venetian blinds and sliding glass doors are treated as windows. " • (5) r metheue COW metal r1nrtre Floor Area Best Average 1 1.2 1 0 Poor 1 22 For each fireplace add: Floor Area 900 or less 900-1500 15002100 0.4 0.4 1.6 TABLE 0 - INFILTRATION MULTIPLIERS Winter Ai Changes Per Hour Best 0.1 0.3 0.8 1.2 Summer Air Changes Per Hour 900 or less 900 1500 1500-2100 • over 2100 0.3 0.7 1.0 Average Poor 0.2 0.6 over 2100 Pub. No. 22-8019-1 P.I. (L) Qualifier / Tenant PE Date .� d frJob Address (� �- q(7,f Zio a / 3c) 0 /3 6/.1 Historically Designated: Yes No C eat 77 Master Penn it # Z /2 & 0 2-- Owner's Address • J /\4f -- ,6 /413 V Phone r7 2 ^ da)'6 Contracting Co. k-e,1 ��! c �i � �J Address .?-02--J 1 / L / ro - SS # ' 400/F5: Ins. C geti -' Leval Description State #F V °6 93 le 7 Municipal # Notary as to Owner aiieg, My Commission Expiresp,...>,, ij6s FEES: PERMIT Pte' e RADON APPROVED: Zoning Mechanical MIT APPLICATION FOR MIAMI SHORES VILLAGE Date C.C.F. C Architect/Engineer Bonding Compan Mortgagor Permit Type (circle one): BUILDING ELECTRICAL, PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN WORK DESCRIPTION par r e6r,1- I m i 77E7) Square Ft. Estimated Cost (value) s / 9 0 -- 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 n and zo ' - g. Furth ore, I authorize the above -named contra jor t do th , stat 4/4 Sign Notary as to Contractort,,Qw q My Commission Expires;;?;•"' l'6F;� i` ' firn 1111 NOTARY BOND TOTAL DUE Date Building Electrical Plumbing Engineering ITEM BATH TU8 UNIT FEE ITEM SWITCH OUTLETS UNIT FEE ITEM SPACE HEATERS UNIT FEE BIOET LIGHT OUTLETS CENTRAL HEATING DISHWASHER RECEPTACLES A./t (WIPO) DISPOSAL SERVICE TEMPORARY A/C (CENTRAL) DRINKING FOUNTAIN SERVICE SIZE IN MPS ,a O 0 0 ;4 CJCT WORK FLOOR GRAIN SERVICE REPAIR/1ETER CHANGE REFRIGERATION GREASE TRAP APPLIANCE CUTLETS PROCESS AND PRESS PIPING INTERCEPTOR RANGE TOP UHDERGRCUD TANKS LAVATORY OVEN ABOVE GROUND TANKS LAUH[IAY TRAY WATER HEATER U.F. PRESSURE VESSELS CLOTHES WASHER MOTORS 0- 1 HP STEAM BOILERS SHOWER MJTCGS OVER 1- 3 HP HOL WATER BOILERS SINK. POT /3 COMP. MOTORS OVER 3- 5 HP MECHANICAL VENTILATION SINK. RESIDENCE MOTORS OVER 5- 8 11' TRANSPORTING ASSEMBLIES SINK. SLCP MOTORS OVER 8- 10 HP ELEVATORS/ESCALATCRS TEMPORARY WATER CLOSET MJTCRS OVER 10- 25 HP FIRE SPRINKLER SYSTEMS URINAL MJTCRS OVER 25-100 HP COOLING TOWERS WATER CLOSET MOTORS OVER 100 HP VIOLATION INDIRECT WASTES A/C WINDOW a,,,4 REINZSPECTION WATER SUPPLY TO: AIR CONDITIONERS i WC ()Iv 2. 4/4 • A/C UNIT STRIP HEATER 'Skd ( 2 !� FIRE SPRINKLER GENERATORS TRANSFORMERS HEATER -NEW INST. GENERATORS TRANSFORMERS �-------- HEATER- REPLACE GENERATORS TRANSFORMERS LAWN SPRINO(LER -HELL SPECIAL PUIPOSE SWIMMING POOL OUTLETS COWERCRCIAL -' S'J WATER SERVICE SIGN T &S SEWER CONNECTIONS SIGN TRANSFORMERS UTILITY - SETTER SIGN TIME CLOCK JTILITT -WATER FIXTLPES SEPTIC TANK ANTENNA RELAY TELEVISION CUTLETS 7RAINEIELD. 4 TILE/RES. VIOLATION 'MP & ABANDON SEPTIC TANK REINLSPECTION WAGE PIT CU. FT. :ATOM BASIN ) I SCHiARGE WELL WOMESTIC WELL IREA DRAIN 0OF IILET DLAR WATER HEATER IRE STANDPIPE COL PIPING . AWN SPRINKLER SYSTEM ' AS RANGE ETER SET (GAS) AS PIPING ADDENDUM TO BUILDING PERMIT APPLICATION (AN APPLICATION FOR BUILDING PERMIT RUST ACCOMPANY THIS ADDENDUM. IF A RASTER PERMIT HAS BEEN OBTAINED, THE OWNER'S NOTARIZED SIGNATURE NEED NOT BE PRESENT ON SUBSEQUENT APPLICATIONS.) PLUMBING ELECTRICAL MECHANICAL c ._ ci< 6on, Y /7/7 iiarz 9 0. 8/lf<sO ./1(37 fsif SibE- L/16-c,) P1 , Tk.w S.00F tJNO • 'k p_A1s ( , 1) 0 1 ga V' ,; Coie F PL's i2,E 1 z NE r, 00 S F-RwcE !di 4 a a00.4 MR; 8/ze.a,�.A. PA itlE L 1l 82es fad c6•vin,4c. A / FV ivA. Pool -rc- oar, , .r 1ro�,��, ✓1!& /,5'4' ./1g,/.!' .%'eir ' . JPf79 (ms/ 6:37. 6040 RANGE WATER HEATER �„D ►�13 - A/C ��a-- t o n )cw HEATER *LARGER OF 2* CC000018527 / 85CME981X SQ. FEET C� 3 -WATTS 2 SMALL, APP. CIRCUITS C' 1500 -W EACH I- R$;FF CIRCUIT ( 1500 -W LAUNDRY CIRCUIT 1500 -W TOTAL GENERAL LIGHTING AND SMALL APPLC 1st 3,000 -W n 100 % = Remainder C 35 %_ d' S NET GENERAL LIGHTING AND SMALL APPLC 240V = i -40s a2g2 TOTAL I %4 Amp Stf-eW Signature of Qualifier Notary Public (fo. ) 761- 0401'.; 3,000W 1,500W 1,500W 3 0 O 3 ?X5 w W w 8,000W 5,000W 5,000W ;0 SAO ,3t5 D)ATP i ATIrVTION: UILDINO OFFICIAL 1 jnma » proporty ciescribeI ADDRESS: OWNER'S AFFIDAVIT beAji certify that I am the owner of the an, 350 )'E, q//2 ( ,j /3 /r 7 �'� l � SUDDIVISIOU: LOT: BL/OCCK:G �� I nuthorize J l `C�av' C v/ / C �' " 6/" [ P to obta n a tSuilZing permiETor tho fo o ing work: �+ /c e(Vn,i1Ci.atilfa)') offa&e, e(e6-62,1c-z-e unrIC . PTATn OF FLORIDA COUNTY Or DADE On this / b. fore me, to •ida %, OWNER. ,e/ day of • ereigned Votary Public of t i1Thtate of ly appeared: an no n -(a) n nre euEITCT16 to inntr ant, and he /she /they acknowledge that executed it. �,ii01911E1l11 / / ose4,AP L. B(/Nc witnonn my han f' ��11vf i a seal °°->' l J,` ' i ‹,,,„ o NOTARY PUBLI 9 T IN a :°: atle •(iTme or / ////1)I)))M 0 Pernonally known to me, or Produced ID: Din t.tke no oath: or ' DID NOT take nn oath. nn my agent 39 thy WItFIn he /she /they or Type_an Comminsionei► (Type of ID Pr6Auc ❑) NOTICE OF COMMENCEMENT MUST BE FILED IF JOB VALUATION EXCEEDS $ 2,500.00 IN LABOR AND MATERIAL NOTICE OF COMMENCEMENT MUST BE POSTED PRIOR TO JOB COMMENCING NOTICE OF COMMENCEMENT CAN BE FILED AT: 44 WEST FLAGLER STREET, OTM FLOOR, MIAMI, FLORIDA O2r4.• Kim 6:52 - owe Coa 01-11Vre. A u. FUSE gox,r, S INTO 6N Jt- CIQCarr BQ KfR A4NA.4 202,5"0 ./VW 1,Sti .Ao;- t�./f��ii�n.i r erce .9Xcrux ,Pf /79 S 'Q mErert- O. Y 761- O1d'.9 A.16.t 1 ).O0A4a lh,�T ANO o' AA; c 1Qcv/r /�kF.4KE.�_ PAN 10 1 A AA I'rl&WAL R460axFL Ew � '0 , Lot Location and legal ,r desc {.p�s be 4u on: Disapproved _��.. t _.L.. Date (Signed) Chairman Member Member .. .. Council Approved Date MIAMI SHORES VILLAGE BUILDING INSPECTION DEPARTMENT APPLICATION FOR BUILDING PERMIT Application is hereby mode for the approval of the detailed statement in me plans and specifications herewith submitted for the build ins 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 n( the State of Florida, all ordinances of Miami Shores Village and all rules and regulations of the auditing 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 Martyria 358 N,E 96_ST Registered Architect and /or Engineer nut m•••t,.•n,tm. <rw. -•• -. .. . Name and address of licensed contrpctor 20701 S Allapattah RD II.ltc v-1 t F • Subdivision. Street and Number where work is to be done..._...... . I1I�.E_ 9.4..ST r...._.._._. _ ._ __ — State work to be done and purpose of building (by floors)..W1i1dOW . ,, 3, Unit 000 BTU I hereby submit all the plans and specifications for said building. All notice be sent to.. 1• Date ,19..— ._— No........ _ ....._..__. Street d:ecvzr s &'i &91,11 jj.. .�� r (Signed) Addition Repairs No. of Stories _ _ New Building Remodeling To be constructed of Kind of foundation Roof Covering Estimate Total cost of improvements $ J7 /nd Amount of Permit S... Zone cubage required ....___....Plan Cubage Distance . to next nearest building Size of Building Lot Maximum live load to be borne by each floor The umlcr>icnctl applicant for this building permit does hereby certify that he understands and accepts his obligations as an employer of Libor under the Florida Workmen's Compensation Act. being Section 5966, Compiled General Laws of and has complied with the provisions thereof, and will require similar compliance from all coxtractgrs or in tl:c work to be performed under this permit; and will post or cause to be posted for inspection od the or notices as arc required by the Act. The undersigned agrees to employ only such subcontx permit. as are licensed by Miami Shores Village. Remarks s with reference to the building and its construction may STATE OF .FLORIDA, COUNTY OF DADE. s$ ' 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 carefu ly read the foregoing application, and that he did sign the same, and that all facts therein by him stated are true. Permit No.._.. _... pate 9 ).2 `_......._._._ Read, Sworn to and Subscribed before me. Notary Public. State of Florida Building Inspector My Commission Expires PLANNING BOARD DATE and for no other purpose. ride. Perin:tnent Supplement. contractors employed by him of the worjt such public notice 0 be performed under this Member Member Member 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 PLtnnit,. lluerd. A re-inspection ice of $1.00 will be charged when such re- inspection is made necessary by Improper notice for inspection or faulty materials ants /or workmanship.