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375 NE 94 St (7)Oily r 1(, l' I I s) State f 'Tenant /Lessee Name .lob Address (where the work is being clone) .., .a 1%.{..Y 111 Iv 11 \I1 •L) V 1 A 11415 tJ Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 • U I _ ...- — Permit No. , )IC(�v. 2. _ PERMIT APPLICATION j ° 11 aster Permit No. r remit : Type (circle): Building Electiic ---_ , -l1utitbiitg Mechanical Roofing Ohs'ner's Name (Fee Simple Titleholder) 2e )1 . � 1 tee 4rze� Phone # (hvncr's Addressg 3 O' c Zip 33( Phone # '3.2,S• ►--659 City Miarni Shores Village County Mimi-Dade Zip) 3� Is Building Historically Designated YES NO )( Contractor's Company Name WclL 1 LG (2-- Phone # ('onl t actor's Address ('ity Slate Zip Onalitier Slate Certificate or Registration No. Certificate of Competency No. Architect /Engineer's Name (if applicable) J - . e 4'P LAIC 'Phone II 1 • oc3 Value of Work For this Permit ��eU Type of Work: ❑Addition ❑Alteration [New 1K Repair/ eplace ❑ Demolition Describe Work: (Mt (A) PgP( N 'r" IN , 601S .j. Z. 0/ (1--- Submittal Fee $ Notary $ y Scanning $ (ode Enforcement $ (Continued on opposite side) * * * * * * * * * * * * * * * * * * * * * * * * * * ** F ees * * * * * **, * * * *** * ** * * ** * * * * * * **** Permit Fee $ Training /Education Fee $ Radon $ Zoning Structural Plan Review. $ Tol;tl Fee Now Due $ �tY�• /R_�� Square Footage Of Work: Bond $ CCF $ `'i 6 � coicc J Technology Fee $ , 6 1 Bonding Company's Name (if applicable) Bonding Company's Address City State Zip Mortgage Lender's Name (if applicable) Mortgage Lender's Address City State • Zip Application is hereby made to obtain a permit to do the work and installations as indicated. T certify that no work or installation has commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. i understand that a separate permit must be secured for ELECTRICAL WORK, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and AIR CONDITIONERS, ETC OWNER'S AFFIDAVIT: 1 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. "WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR 'IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN AT'T'ORNEY BEFORE RECORDING YOUR NOTICE 01? COMMENCEMENT." Notice to Applicant: As a condition to the issuance of building permit with an estimated value exceeding $2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also, a certi /ied copy of the recorded notice of commencement must be po.s•led al the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection w l not b approved and a rein.spection fee will be charged. Signature Owner or Agent The foregoing instrument was acknowledged before me this 7 day of 2c05, byacota who is personally known to me or who has produced As identification and who did take an oath. NOTAR Sign: Print: ,�iR. A4 . ° • " ' . H H 1n+ Print: W Expires: Jul 13, EGO My Commission Expires: o, i i ondedThru My Commission Expires: -o 9 ... OF *** * ***' *k� n� n rn LO. II it: *** ******* * **** ** l *** /War c Xq j *'X Act *** * *** * ***** * ***ic:l:k**** *** * *** *i:oti:*ic*** * *** * *kkkkt: ************ * * ** * ** * * * * * ** *** * **** ** * *** *** * ** ** * * * ******** * *% 'i' ij 4+ ** *** ** * *** * * ** •h F hd..F Fb4;8::; APPLICATION APPROVED BY: Cho 05 /13/03 czo� �9�os FEB 23 ;5 Signature Contractor The foregoing instrument was acknowledged before we this day of , 20 , by who is personally known to me or who has produced as identification and who did lake an oath. NOTARY PUBLIC: Sign: Plans Examiner Engineer Zoning t, VILLAGE OF MIAMI SHORES ' BUILDING DEPARTMENT OWNER BUILDER DISCLOSURE .STATEMENT I -f (' arwt•,..) being the legal property owner, for the property Located at: 3 �' gOe `7 s Legally described as Lc:57 V ) 'S - ' 1 ' ?f7 t cs I ' Do hereby petition the Village of Miami Shores to act as my own 'contractor pursuant to the laws of the State of Florida, F.S. 489.103(7),And I have read and understand the following disclosure. Statement, which entitles me to Arork as my own contractor, I further understand that I as the owner must appear in person to complete all applications. State law requires construction to be done by licensed contractors. You have applied for a permit under an exemption to that law. The exemption allows you, as the owner of your property, to act as your own contractor even though you do not have a license. You must supervise the construction yourself. You may build or improve a one - family or two-family residence or a farm out - building. You may also build or improve a commercial building at a cost of $25,000.00 or less. The building must be for your own use and occupancy. It may not be built for sale or lease. If you sell or lease a building you have built yourself within one year after the construction is completed, the law will presume that you built it for sale or lease, which is a violation of this exemption. You may not hire an unlicensed person as your contractor. It is your responsibility to make sure that people employed by you have Licenses required by state law and by county or municipal licensing ordinances. Any person working on your building who is not Icensed must work under your supervision and must be employed by you, which means that you must deduct F.I.C.A. and with- holding tax and provide workers' compensation for that employee, all as prescribed by law. Your construction must comply with all applicable laws, ordinances, building codes and zoning regulations. Proof of ownership provided ( ) initial of reviewing clerk. Tlie foregoing instrument 1�1.nn Was acknowledged before me this 7day of !L-Q—' !20 6 B 7 (S /k who is personally known to me or who has Produced as identific . io and who did take an oath. Owner Owner DISCLOSURE STATEMENT �, i gas Co missions D231984 Na,'Q Ex 13, 2007 y O: t o u e d "I'hru ' 11, 11 . " Atlantic Bonding Co., Inc. I, } v \ �_ l - to re- occupy the single family residence known as : (address) Legal Description: Lot: I h , l- r? Block 10 Jr' PB & PG: ,tom TO - 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 such property. Applicant Print Name M0C14AG I Ci 4N.t' *********************************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** For purposes of conducting the inspection required by Section 902 of the Miami Shores Land Development and Zoning Code, please contact: Contact Name: j ' \ c • R Q Buyer Seller Realtor V Company Name /U OA- - ' h QPf - Application Fee ($50) paid: Cash Inspected by: F. LUBIEN I EN /Approved X Denied Date 1/27/00 Comments: APPLICATION FOR CERTIFICATE OF RE- OCCUPANCY z4-( 'h.e S4 Si- c:, Z c: 4 k J PAGE 1 OF 2 , Miami Shores, Florida. Date ©6 Check No. .7/ 5 , hereby apply for a certificate !3 -i0 dS - Telephone: CERTIFICATE OF RE- OCCUPANCY On behalf of Miami Shores Village, Florida, the undersigned certifies that the property described in the above application has been inspected for purposes of re- occupancy pursuant to Sections 901 and 902 of the Miami Shores Land Development and Zoning Code and that such property may be re- occupied by the above applicant for single- family residential purposes. MIAMI SHORES VILLAGE, FLORIDA By: THIS CERTIFICATE VERIFIES THAT THE REFERENCED PROPERTY HAS BEEN INSPECTED BY MIAMI SHORES VILLAGE AND HAS BEEN DETERMINED TO PRESENTLY COMPLY WITH THE SCHEDULE OF REGULATIONS OF THE MIAMI SHORES LAND AND DEVELOPMENT CODE PERTAINING SOLELY TO THE REQUIREMENT THAT EACH ONE - FAMILY DWELLING IS USED AND INTENDED TO BE USED FOR A ONE - FAMILY DWELLING PURPOSE ONLY; HOWEVER, THIS CERTIFICATE DOES NOT CONSTITUTE ANY REPRESENTATION OR WARRANTY AS TO THE CONDITION OF THE DWELLING OR OTHER STRUCTURES ON THE PREMISES DESCRIBED HEREIN, OR ANY ASPECT OF SUCH CONDITION, AND INTERESTED PERSONS ARE ADVISED AND ENCOURAGED TO MAKE THEIR OWN INSPECTION OF THE PREMISES IN ORDER TO DETERMINE THE CONDITION, THEREOF. PAGE 2 OF 2 Date of Certification: 1 / 27 / 00 MIAMI SHORES VILLAGE. FLORIDA TILDING •ECTRICAL ❑ PERMIT N9 UMBING ❑ N. 8455 3 OFING ❑ mer of lding_ -hitect itracto luilde ;criptic _tress (ding CONTRACTOR OR BUILDER Work to be performed under this Permit 1 r' DATE 7 4 Contractor's License No 195 —.L_` 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 for in strict compliance with all ordinances pertaining thereto and with the understanding that the work will be performed in compliance with any plans, rings, statements or specifications that may have been submitted to and approved by the proper municipal authorities. This Permit may be revoked at any iif 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 ted is the understanding that the contractor or builder named above assumes the responsibility for a thorough knowledge of the ordinances and regulations lining to the work covered hereby whether shown on the plans or drawings or in the statements or specifications and that he assumes responsibility for work - by his agents, servants or employees. Signed • " .R BY INSPECTOR In consideration of the issuance to me of this permit I agree to perform the work covered hereunder in compliance with all ordinances and regulations : ining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. ccepting this permit I assume responsibility for all work done by either, myself, my agent. servant or employee. BY AUTHORITY 17 ( F' a ,lk i4+ v f �y R r • r n Lot Bl. S vision / �` i� f y " sq. Ft Amt. of Permit $ '' ° — Value of Project $ 4 i ^ : : , 5 - - MIAMI SHORES VILLAGE. FLORIDA TILDING •ECTRICAL ❑ PERMIT N9 UMBING ❑ N. 8455 3 OFING ❑ mer of lding_ -hitect itracto luilde ;criptic _tress (ding CONTRACTOR OR BUILDER Work to be performed under this Permit 1 r' DATE 7 4 Contractor's License No 195 —.L_` 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 for in strict compliance with all ordinances pertaining thereto and with the understanding that the work will be performed in compliance with any plans, rings, statements or specifications that may have been submitted to and approved by the proper municipal authorities. This Permit may be revoked at any iif 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 ted is the understanding that the contractor or builder named above assumes the responsibility for a thorough knowledge of the ordinances and regulations lining to the work covered hereby whether shown on the plans or drawings or in the statements or specifications and that he assumes responsibility for work - by his agents, servants or employees. Signed • " .R BY INSPECTOR In consideration of the issuance to me of this permit I agree to perform the work covered hereunder in compliance with all ordinances and regulations : ining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. ccepting this permit I assume responsibility for all work done by either, myself, my agent. servant or employee. BY AUTHORITY 17 PAID BY YEAR ANNUAL TAX PERIOD USED AMOUNT PAID DATE PAID RECEIPT NUMBER Iftinifteet 9 -24 -51 ADDRESS 375 N.?. 94th St. LEGAL E50 of 13 -all 14 El. 4 5 RECORD GARBAGE TAX OWNER'S NAME P.I. Jimmer PRESENT ADDRESS f LICENSE NO. PHONE NO. JOB LOCATION (ST. OR AVE.) 375 N. 94th St. LOT 250' of 13 all BLOCK 14 45 SUBDIVISION , � c.a , . GENERAL CONTRACTOR R.Wi aner ADDRESS PHONE NO. LICE NO. 1 20 BUILDING PERMIT NO. 9 9 2t! — 1 DATE 4 J 22.00 PERMIT FEE $ ro YNo-c-BUILDER'S BOND S- 1--- —'-9-25-51 NQ. CC T DATE ZONE P EQUIREMENTS � 0,000 CU. FT. PLAN CUBE 25,596 CU. FT. EST. COST $ 17,320 DRAWINGS, SPECIFICATIONS. RESTRICTIONS AND CUBE CHECKED BY DATE x NEW CONSTRUCTION TYPE C.B.S. STORIES 1 ROOF CONSTRUCTION tile INTERIOR CONSTRUCTION oak floors, plaster v. 'all and REPAIRS DESCR IPTIor' eil.»gs 9 bdrm., 2 baths, kitchen., diningroom, living rooi.1 car g ;. r..se ALTERATION DESCRIPTION ADDITION SUBMITTED TO PLANNING BOARD APPROVED REJECTED REFERRED TO COUNCIL REASONS RE- SUBMITTED TO PLANNING BOARD SUBMITTED TO VILLAGE COUNCIL REMARKS CERTIFICATE OF OCCUPANCY NO. J L O g ISSUED 0' 2 " BY i� TO t) 1 4 I - - z Ft: BUILDING PERMIT AND INSPECTION RECORD -MIAMI SHORES VILLAGE INSPECTIOIU DATE BY RE- INSPECT BY RE- INSPECT BY FOUNDATION FEE TEMPORARY SERVICE FEE TEMPORARY SERVICE SEPTIC TANK BEAMS & LINTELS ,� v` w�^'S� ` $ /®' G- d ",.%` SEWER $ RANGE CONN. , $ FRAMING A ' QA/' $ GAS $ FIXTURES $ $ $ INSPECTIONS DATE FINAL LI' a-, ,L ;V k. RE- INSPECT BY ROUGHING / S ? CLEAN -UP 11 1 / ou ' CONTRACTOR ,�w _. ��._, PHONE' q y PERMIT NO. /,.)._)(41-1 I DATE / a '' " py 7 FEE $ C' ��> REPAIRS NEW BLDG. I ALTERATION I ADDITION SPECIAL PERMITS PERMIT NO. DATE FEE TEMPORARY SERVICE FEE TEMPORARY SERVICE SEPTIC TANK / � G (,-) ,� v` w�^'S� ` $ /®' G- d ",.%` SEWER $ RANGE CONN. , $ SOLAR HEATER $ MOTORS $ GAS $ FIXTURES $ $ $ INSPECTIONS DATE BY RE- INSPECT BY RE- INSPECT BY ROUGHING / S ? W/ I ou GAS ROUGHING I I — 1 . , ((1 A..) g ' SEWER . SEPTIC TANK ^ ,// j - d :s 6 Y�1 _ SOLAR HEATER 1 FIXTURES q ` a-' S IA 4 // ,/,`." o A CONTRACTOR �- `%, :)L .A PHONE PERMIT NO. ! L 1 0 I DATE ,/ (�- FEE $ 13 "7 NEW BLDG. ALTERATION I ADDITION REPAIRS SPECIAL PERMITS PERMIT NO. DATE FEE TEMPORARY SERVICE $ H. W. HEATER CONN. $ RANGE CONN. $ MOTORS $ FIXTURES $ $ INSPECTIONS DATE BY RE- INSPECT BY RE- INSPECT BY TEMP. SERVICE ou ROUGHING I I — 1 . , ((1 A..) g ' H. W. HEATER CONN. RANGE CONN. FIXTURES & FINAL // ,/,`." o BUILDING INSPECTIO S PLUMBING PERMITS & INSPECTIONS ELECTRICAL PERMITS & INSPECTIONS APPROVAL TO POWER CO. FOR SERVICE DATE /°' ILL, // MIAMI SHORES VILLAGE / BUILDING INSPECTION DEPARTMENT 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 approve plans and specifications must be kept at building during progress of the work. Owner's Name and Address -1 APPLICATION FOR BUILDING PERMIT Date 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 7s State work to be.done and purpose of building (by floors) 4 J2. /, / y # , . - ' - be sent New Buildin6 To be constructed of Remodeling Addition Kind of foundation Estimated Total cost of improvements $ —5 570 0 ~ R000f�overing STATE OF FLORIDA, COUNTY OF DADE ss. ., Disapproved (Signed) Building '!pector Chairman Member Member Council Approved Date Amount of /7 19 (' No 24 StreetJv' 1 4 944 a - A (5 • and for no other purpose. Permit • Repairs PLANNING BOARD DATE No. of Stories 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 plitns and specifications foj's b ding. All 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, Compile• n. . Laws of Florida, Permanent Supplement, and has complied with the provisions thereof, and will require similar compliance fr•. ' all contra ors or sub -co in the work to be performed under this permit; and will post or cause to be posted • or inspection • the si or notices as are required by the Act. The undersigned agrees to employ only suc su • co on permit, as are licensed by Miami Shores Village. Remarks (Sign ces with reference to the building and its construction may t t e work rk to be pe ed by him notice tlis 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 he foregoing application, and that he did sign the same, and that all facts therein by him ated are true. Permit No °� Date 2— (� Read, Sworn to and Subscribed before me. Notary Public, State of Florida My Commission Expires 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 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 ELECTRICAL PLUMBING ROOFING Owner of Building Architect Contractor or Builder Legal Description Address of Building Lot ted MIAMI SHORES VILLAGE. FLORIDA PERMIT N? 12099 n ❑ Work to be performed under this Permit ger / / In consideration of the issuance to me of this permit I pertaining ereto and in strict conformity with the plans, dra In acceptintl�is permit I assume responsibility for all wor • CONTRACTOR OR2 UI L DEtt Sign Subdi- vision Value of Project This permi t is g r to the contractor or bur er named above to nstruct the herefor in strict compliance with all ordinances pert ning thereto and w h the and drawings, statements or specifications that may have been submitted to a d approv time if the work is not done in compliance with such ordinances or if the Tans ar granted is the understanding that the contractor or builder named abov pertaining to the work covered hereby whether shown on the plans or 'd done by his agents, servants or employees. INSPE BY DAT R Contractor License No. Amt. of Permit $ AUTHORITY 'Wing or to insta equipment or device described in the application tapding that the work will be performed in compliance with any plans, ". the proper municipal authorities. This Permit may be revoked at any aiiged without auth.rization. A further condition upon which this permit is e responsibility or thorough knowledge of the ordinances and regulations or in pl1e Stateme',..; :.ecifications and that hg/assu s responsibility for work a: ee to perform the work covered hereun n complianc,�6vith all ordinances and regulations ngs, statements or specifications submitt i to the proper authorities of Miami Shores Village. one by either, myself, my agent, servant or employee. 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 /4GrC 17 19 c5:9 Owner's Name and Address... /Yt !q ._.. e.ile5 B_(t. C.iL y No yam` , - � ,! Street_._ .eV a Registered Architect and /or Engineer Name and address of licensed contractor Location and legal description of lot to be built on: Lot Block Subdivision..._.. ��y Stream an Number where work is to he done %.77 /vE State wor t, be done and purpose of buildin cte, (by fl ors) - Repairs New Bulilding Remodeling Addition To be constructed of �_4, Kind o foundation %- 77.4.4, 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 rovisions 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 subco tractors, on work to be per under this permit, as are licensed by Miami Shores Village. Remarks ( Signed) -- -- - --- - -- --- ' STATE OF FLORIDA, COUNTY OF DADE. ss. Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally 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 e true. Permit No Date e� -��" Read, Sworn to and Subscribed before me. Disapproved (Signed) Buildlii`g�Irfspector % M Commission Expires an or no other purpose. No. of Stories Roof Covering Notary Public, State of Florida PLAN 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. ' /SJ/iL) Cam )• 1 4 r. Tl � 6: 7; t: 1 /1 MIAMI SHORES VILLAGE BUILDING INSPECTION DEPARTMENT APPLICATION FOR BUILDING PERMIT Application is hereby made for the approyal 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:_. 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 work to be done and purpose of building (by floors) Date ,/5 New Building Remodeling Addition Repairs No. of Stories ,19.67.0 . and for no other rP u ose. P To be constructed of Kind of oundation 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 5968, Compiled General Laws of Florida, Permanent Supplement, and has complied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors employed by him in the work to be performed under this permit; and will post or cause to be posted for inspection on the site of the work such public notice or notices as are required by the Act. The undersigned agrees to employ only such subcontractors, on work to be performed under this permit, as are licensed by Miami Shores Village. Remarks (Signed) STATE OF FLORIDA, COUNTY OF DADE. 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.. .3/9 d Date 2 t - 5 Read, Sworn to and Subscribed before me. Disapproved / - , Date (Signed) - ' „ Notary Public, State of Florida Building Inspecto 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 51.00 will be charged when such re- inspection is made necessary by improper notice for inspection or faulty materials and /or workmanship. be sent to _ _____ _ Disapproved _ ( Signed) MIAMI SHORES VILLAGE APPLICATION FOR BUILDING PERMIT Applicat -on is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the build- ing o: other stru ture herein described. This application is made in compliance and conformity with the Building Ordinance of Miami Shores Vi11ag ^, F orida, and all provisions of the Laws of the State of Florida, all orcUnances of Miami Shores Village and all rules and regulations of the Building Division of Miam Shores Village sh 11 be complied with whether her in specified cr not. A copy of approv d plans and specifications must be kept at building during progress of the work. Date- - - - -- , Owner s Name and Address W'P `f • i3ei key -� - -- __. N o.- �- -� - --- Street__ it/G . _ 9- _y Registered Architect and /or Engineer._- _ F5'_.._ W!_. L- ___.. _. 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_ . 7 -f___N ter'_ ___. S, _ ST. State work to be done and purpose of building (by floors)____Z// ;?1 /9.7-1__.0"- _.___ 67 o - !"Tv ----- - -1 el-f) - - c . ' ? .44. �Tf- Sys vfi/ TA( /.l -- . �.4,c . / L T,74/ !'_ 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 $ �O 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 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 wo to be • -rformed under this permit, as are licensed by Miai_ i Shores Village. Remarks -- -- - -- -- -- (Signed) STATE OF FLORIDA, COUNTY OF DADE. ss Before me, the undersigned authority, a notary public duly authorized to administer oaths and take acknowledgments, personally ap- peared and who, being by me first duly swoiu, 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. ___ ___. _. Date c. ___._ Read, Sworn to and Subscribed before me. Date BUILDING INSPECTION DEPARTMENT Notary Public, State of Florida _ and for no other purpose. to me well known, Building Inspecto , ` My Commission Expires P ANNING BOARD_.____. DATE Chairman .. __ __ Member __ Member - - - - - -- - Member Member .. _ _ . _ _ _ Member Council Approved _ 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- impect'on 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. 2