45 NE 94 St (15)APPLICATION FOR CER i'fCATE OF RE- OCCUPANCY
hereby apply for a certificate to re- occupy the single family residence kaown as: (address)
L S — ,Miami Shores, Florida_
Legal description:
Lot: / 7 a)/, , ). u r i ,Bloch: 1L ,PB&PG: I 0 — 7 0
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, Florida, 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: Jf9
Application Fee (S50) Paid: Cash:
Date: l`"
Number: c
Inspection: By: / Approved: D enied:_Date: 9
Comments:
ar--A
******************_*** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
For the purposes of conducting the inspection required by Section 902 of the Miami Shores
Development and Zoning Code, contact:
Contact Name:
Telephone: �' 3 " & / ' (
c 1,�-�v � Gs�-L ,��� �
Buyer. Seller. Company Name: e .
CERTIFICATE OF RE- OCCUPANCY
On behalf of Miami Shores Village, Florida, the undersigned certifies that the property described
in the application has been inspected for the 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 applicant for single - family residential purposes.
MIAMI Mg • S VILLA FLORIDA
By:
Date of Certification:
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- FAMJLY DWELLING IS USED AND INTENDED TO BE USED FOR
A ONE - FAMILY DWELLING PURPOSE ONLY; HOWEVER, THIS
CER'I UI ICATE DOES NOT CONSTITUTE ANY REPRESENTATION OR
WARRANTY AS TO THE CONDITION OF THE DWELLING OR 0'i HER
STRUCTURES ON 'THHE PREMISES DESCRIBED HEREIN, OR ANY
ASPECT OF SUCH CONDITION, AND INTERESTED PARTIES ARE
ADVISED AND ENCOURAGED TO MAKE THEIR OWN INSPECTION
OF THE PREMISES IN ORDER TO DETERMINE THE CONDITION
THEREOF.
Architect
Contractor
or Builder
Legal
Description.
Address of
Building
Lot
n
PERMIT 'N? 13028
BUILDING
ELECTRICAL
PLUMBING
ROOFING
Owner of
Building
I
II
n Work to be performed under this Permit
CONTRACTOR OR BUILDER
MIAMI SHORES VILLAGE, FLORIDA
Bl.
Subdi-
vision
Value of
Project $
DATF 'i 7 , y 195
Contractor's
License No
1
Amt. 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
herefor in strict compliance with all ordinances pertaining thereto and with the understanding that the work will be performed in compliance with any plans,
drawings, statements or specifications that may have been submitted to and approved by the proper municipal authorities. This Permit may be revoked at any
time if the work is not done in compliance with such ordinances or if the plans are changed without authorization. A further condition upon which this permit is
granted is the understanding that the contractor or builder named above assumes the responsibility for a thorough knowledge of the ordinances and regulations
pertaining to the work covered hereby whether shown on the plans or drawings or in the statements or specifications and that he assumes responsibility for work
done by his agents, servants or employees.
Signed' 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
pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village.
In accepting this permit I assume responsibility for all work done by either, myself, my agent, servant or employee.
BY AUTHORITY
John PAID BY
d Olaii Nelson PAID - 2
YEAR
ANN
ANNUAL TAX
PERIOD USED
AMOUNT PAID
DATE PAID
RECEIPT
NUMBER
ADDRESS 45 N.- • 94th St.
LEGAL 17 -t 18, M Sec.' RECORD GARBAGE TAX
BUILDING
ELECTRICAL
PLUMBING
ROOFING
Owner of
Building
Architect
Contractor
or Builder
Legal
Description
Address of
Building
Lot
MIAMI SHORES VILLAGE, FLORIDA
PERMIT 'N° 12990
[1 Work to be performed under this Permit
Bl.
Subdi-
vision
Value of
Project $
DATE
License No 9. :z '40
Contractor's
Amt. 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
herefor in strict compliance with all ordinances pertaining thereto and with the understanding that the work will be performed in compliance with any plans,
drawings, statements or specifications that may have been submitted to and approved by the proper municipal authorities. This Permit may be revoked at any
time if the work is not done in compliance with such ordinances or if the plans are changed without authorization. A further condition upon which this permit is
granted is the understanding that the contractor or builder named above assumes the responsibility for a thorough knowledge of the ordinances and regulations
pertaining to the work covered hereby whether shown on the plans or drawings or in the statements or specifications and that he assumes responsibility for work
done by his agents, servants or employees.
Signed • 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
pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village.
In accepting this permit assume responsibility for all work done by either, myself, my agent, servant or employee. il
i ::(010
CONTRACTOR I c BUILDER ,f BY AUTHORITY
.f°
N? 1492
CERTIFICATE OF OCCUPANCY
MIAMI SHORES VILLAGE, FLORIDA
BUILDING DIVISION
Miami Shores Village, Fla.,
Owner, Agent or Tenant of Building
Lot Block Subdivision
Street Address
Approved use by occupancy
Remarks:
This Certificate of Occupancy is issued to the above named
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 : s 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
b)'
Owner's Name and Address
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.
Registered Architect and /or Engineer
MIAMI SHORES VILLAGE
BUILDING INSPECTION DEPARTMENT
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 Y4 Al ' f% • g
State work to be done and purpose of building (by floors) / ci f 4407e, Rri#' .0 < ' c» o z2 e v Gz
itJ CL g / -xler
Permit No
Disapproved
(Signed)
5‘
Date
Dat
L Date C , 19 1
L . D °gr _ No Street
TL r �(a's Ri1
and for no other purpose.
New Building Remodeling. Addition Repairs No. of Stories
To be constructed of Kind of f undation Roof Covering
Estimated Total cost of improvements $ 00 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 Su element,
and has complied with the provisions thereof, and will require similar compliance from all contractors or su• -co tractors employed by him
in the work to be performed under this permit; and will post or cause to be posted for ins ion o the sit of he work such public notice
or notices as are required by the Act. The undersigned agrees to employ only such sub tor; on �`. o bepermed under this
permit, as are Licensed by Miami Shores Village. e
/
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 are true.
Read, Sworn to and Subscribed before me.
Notary Public, State of Florida
Building Inspectef My Commission Expires
B ANNING 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.
OWNER•S NAME
John V. Nelson
PRESENT ADDRESS
370 N.E. 107th St.
LICENSE NO.
PHONE NO.
JOB LOCATION (ST. OR AVE.)
45 W.E. 94th St.
LOT
17-w.118
BLOCK
4
SUBDIVISION
i:aS Sec .1
GENERAL CONTRACTOR
Joe Cherney
ADDRESS
PHONE NO.
LICENSE NO.
9 Q
BUILDING PERMIT NO. 12990
DATE .32..5.". [ J
PERMIT FEES 1 7. 00
7.'}y-Ji ) UILDEV & �j-..ii _ 2
Na l•4 DATE
ZONE REQUIREMENTS 20,000 CU. FT.
PLAN CUBE 20,518 CU. FT.
EST. COST 5 13,000
DRAW
NGS, SPECIFICATIONS. RESTRICTIONS AND CUBE CHECKED BY
DATE
$
NEW CONSTRUCTION
T YPE
CBS
STORIES
1
ROOF CONSTRUCTION
tile
INTERIOR CONSTRUCTION
oak and terrazzo floors,plast
REPAIRS
DESCRIPTION walls and ceilings
2 bdrm. -2 baths - living room - porch - kitchen- garage
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.
e , ,
ISSUED
., t
BY ✓✓ - //
TO - —
BUILDING PERMIT AND INSPECTION RECORD -MIAMI SHORES VILLAGE
er
INSPECTIONS '1/4
HATE
BY
RE- INSPECT
BY
RE- INSPECT
BY
FOUNDATION
Z}/ J .
FEE
TEMPORARY SERVICE
$
BEAMS & LINTELS
4• It '
(11 T
/
$ / �b
SEWER
/
FRAMING
- / 3- -
" '
$
GAS
$
$
INSPECTIONS
FINAL
r i - a3 --5a
sE34.
BY
RE- INSPECT
BY
ROUGHING
CLEAN-UP
\^
�/ x`
t1
GAS
CONTRACTOR ' T'Ydstik , ,Q`� 1/ ■
PHONE
PERMIT NO. VIO ? -( i I DATE , -7 ' J Z
FEE $ J/ °7J
NEW BLDG. ALTERATION ADDITION
L
REPAIRS
SPECIAL PERMITS
PERMIT NO.
DATE
FEE
TEMPORARY SERVICE
$
SEPTIC TANK
1,1
oS /s?
/
$ / �b
SEWER
/
$ ///
SOLAR HEATER
$
GAS
$
$
INSPECTIONS
DATE
BY
RE- INSPECT
BY
RE- INSPECT
BY
ROUGHING
. 2_ Q- .51_
\^
�/ x`
1
^,.Cq,,,,r..•� L1
GAS
54., "'''' .
SEWER
SEPTIC TANK
5c - Q --St
Eta
SOLAR HEATER
FIXTURES
'7- -S
.
M •
CONTRACTOR L,1�
PHONE
PERMIT NO. I . 31 1 4 Q DATE , ' -
FEE $
NEW BLDG. I ALTERATION I ADDITION
REPAIRS
SPECIAL PERMITS
PERMIT NO.
DATE
FEE
TEMPORARY SERVICE
$
H. W. HEATER CONN.
$
RANGE CONN.
$
MOTORS
$
FIXTURES
$
$
INSPECTIONS
DATE
B
RE- INSPECT
BY
RE- INSPECT
BY
TEMP. SERVICE
r
6 K1, `�
\^
�/ x`
1
^,.Cq,,,,r..•� L1
ROUGHING
54., "'''' .
H. W. HEATER CONN
RANGE CONN.
FIXTURES & FINAL
-/- a 1 -- ) -
1 ,
1
10'
13 UIL4I14G CSPECTIONS
PLUMBING PERMITS & INSPECTIONS
ELECTRICAL PERMITS & INSPECTIONS
APPROVAL TO POWER CO. FOR SERVICE DATE 1 l ', y BY
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 atiilding 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 butffon:
Lot Block Subdivision
Street and Number where work is to be done
Permit No
Disapproved
(Signed)
a�-
Date ,'g-
T Dat
Building In tor
MIAMI SHORES VILLAGE
419,a32
Date �+
No , 3 Street. d I K
Q
State work to be done and purpose of building (by floors)
Chairman
Member
Member ...._ .
Member
Member
Member
and for no other purpose.
New Building Remodeling Addition Repairs /'k/ -a, No. of Stories
To be constructed of Kind of foundation Roof/ overing
Estimated Total cost of improvements $ _ .60 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 inspectio . on the site of the work such public notice
or notices as are required by the Act. The undersigned agrees to employ only such subcontr, o ., on work to b . performed under this
permit, as are licensed by Miami Shores Village.
Remarks (Signed) �.�.t�__a __,
STATE OF FLORIDA, 4
COUNTY OF DADE. Ss.
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally ap-
peared
to me well known,
and who, being by me first duly sworn, upon oath deposes and says that he is the .
of the above described construction. that he has carefully read the foregoing application, and that he did sign the same, and that all facts
therein by him stated are true.
Read, Sworn to and Subscribed before me.
PLANNING BOARD DATE
Notary Public, State of Florida
My Commission Expires
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.
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.
t" Date- -- SE P T 2 "7 / 9 6 8
j � �/ .,19
Owner's Name and Address ii -- _r_ ___________ No 45 Street_ _47� 9I- .7"
Registered Architect and /or Engineer 11 0
Name and address of licensed contractor A Ma s g/li .,Q_6 ae kl2 ___feyc
Location and legal description of lot to be built on:
Lot Block Subdivision
Street and Number where work is to be done �__
State work to be done and purpose of building (by floors) quil.c.ltaa' <r" Ae_ /Pei_g_____
and for no other purpose.
New Building 5 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 7 ___ . 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 s contractors, on wor, 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
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 tree.
Permit Date — Read, Sworn to and Subscribed before me.
Disapproved // Date_
( Signed)
Building Inspector
to me well known,
Notary Public, State of Florida
My Commission Expires
PL INC 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.
fir
grav E- gle sr
AsP11 L ,&v €
MIAMI SHORES VILLAGE
BUILDING INSPECTION DEPARTMENT
APPLICATION FOR BUILDING PERMIT
Application is hereby wade for the approval of the detailed statement in ine 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 pregreu of the work. �
Date......_.. j . 7� ° 2 8 .��....._ .19"t-
Registered Architect and /or Engineer.•.. • •et.IL . :.:.. ,..•••,,. •:...�,..,,..•.•
Name and address of licensed contractor....t5O ,AY4L.
Location and legal description of lot to be built on:
Lot Block Subdivision .....�..
Street and Number where work is to be done / ..._.
State work to be done and purpose of building (by floors)...._ 1 Vii /.Q /A')
Owner's Name and Address .Da` 1 e
STATE OF FLORIDA, t .
COUNTY OF DADE. l ss.
Building Inspector
Date .1 '" 1
I.
PLANNING BOARD DATE
Citair:nan
Member
Member
Council Approved Date Disapproved
NOTE: A charge of $1.00 will be made for making corrections or changes to
the Planning Board.
A re- inspection fce of 51.00 will be charged when such re inspection is made
materials anei /or workmanship.
__........... for no other purpose.
New Building Remodeling Addition Repair, No. of Stories
To be constructed of Kind of foundation Roof Covering
Estimated Total cost of improvements $••• 00 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
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, Penn:ene•nt Supplement,
and has complied .eith the provisions thereof, and will require similar compliance from all contractors or sub - contractors employed by hint
in the work to be performed under this permit; and will post or cause to be posted for inspection orr the site of the work such public notice
or noticcs as are required by the Act. The undersigned agrees to employ only such s ntractors oq ha to be performed under this
pcnnit, as are licensed by Miami Shores Village.
Remarks (Signed)
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally ap-
peared
Notary Public, State of Florida
My Commission Expires _._.
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
Permit No ..
Disapproved
(Signed)
Read, Sworn to and Subscribed before me.
Member
Member
_......_..._.�...._....._ Member
Date
this application after approval has been obtained from
necessary by improper notice for inspection or faulty
Application is hereby made for the approval of the detailed sintc,,,enr ur 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 nII 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... ?" 7 ' _ _ , 19 . 2C .
Owner's Name and Address Alf .s..,...._ ._ Noy - r • Street -y .'�'
Registered Architect and/or Engineer Q .,... .......... ....�,,,,,,..,...<.,..,�..,.,,.
Name and address of licensed contractor. 15 ._ a- �... ° .. a ,f Gym ssa€._.... / _... . . ........ ci7 - O`v ?
Location and lcgal ion of lot to be built on:
Lot./ V t / Block
.
Street and Number wham work is to be done �....5 _ /%14 ... _. � . � _.. G/r
_ _ — .._ __ _ ...._.__ _
Ste work to be done and purposc of building (by floors). eDt'/ ....o7. .£ 3; esG .__. x Y
Estimate Total cost of improvements $ ....��'v
STATE OF FLORIDA,
COUNTY OF DADE.
Disapproved
(Signed)
ss.
APPLICATION FOR BUILDING PERMIT
Date /
Date.. _......
Building Inspector
MIAMI SHORES VILLAGE
BUILDING INSPECTION DEPARTMENT
/, ,r/.S ..f..._..
and for no other purpose.
New Building Remodeling Addition Repairs ✓ No. of Stories
To be constructed of Kind of foundation
Roof Covering
Amount of Permit $..
Zone cubage required ........... 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 dots hereby certify that he understands and accepts his obligations as an employer
of labur under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida, Permanent Smp rieurent,
and has complied ssith the provisions thereof, and will require similar compliance from all contractors or sub - contractors employe by him
in the work to be performed under this permit; and will post or cause to be posted for inspection on the site of the work such public notice
or notices as are required by the Act. The undersigned agrees to employ only such subcontractors, on work to be performed under this
pcnnit, as are licensed by Miami Shores Village.
Remarks (Signed) 2 —
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 F ar r a true..
Perrnit No .._.._._'���
Read, Sworn to and Subscribed before me.
Notary Public, State of Florida
My Commission Expires _...._..._.._.____
PLANNING BOARD DATE
Chairman Member
\Ierr,ber 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 1'I.rnnir,g ]lu.trd.
A re inspection fce of $1.00 will be charged when such re-inspection is made necessary by improper notice for inspection or faulty
materials anti /or workmanship.
Date /o Job Address
Legal Description ! v v ig 1 7 1 � i/� 4--/4p
/ Lessee / Tenant
Owner's Address
Contracting Co.
Qualifier
State # Municipal #
Architect /Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type(circle one "�
WORK DESCRIPTION � e CiG e C
Square Ft. 7 Z
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
be done in compliance
authorize the
APPROVED:
PERMIT APPLICATION FOR MUNICIPALITIES OF DADE COUNTY
(OWNER TO RETAIN COPY)
Signature ` c fowner and /or
Date: /9 g
I/5 NE 9' S7
&f/ l.- .Vde
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ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
certify that all the foregoing information is accurate and that all work will
with all applicable laws regulating construction and zoning. Furthermore, I
d .,_eantractor to do the work stated.
"P . JOSEPHINE CHURCH
N. a Publi . State of Ftonda
Oftkppegifflon Exp. April 30, 19%
e. No. CC197545
Zoning uilding�`
Mechanical Plumbing
Address
Phone
Competency #
Estimated Cost(value)
Tax Folio /1 JQ'6 1 / j MS'S d 7
Master Permit # 3' 7/7
Ins.Co.
Phone - 966,1r
1
t
Signature of Contractor or Owner - Builder
Date:
a Priur rype or stamp s, ' 1 % / i4,h�ii/ PPrsnp ll name of Nnr, .
1�„ }Public
y'rp
Not : y ai to Owner and /oioA i
g � tduced I.D. Notary as to Contractor or Owner - Builder
My Comnission Expires:
❑ Dtv rake an L Produced: My Commission Expires:
oarh,
1:4 DID NOT Sam °
Ni ** * * * * * * '* * * * * * * * * **
FEES: PERMIT RADON C.C.F. r NOTARY TOTAL DUE 7.7i
Fire Other
Electrical
Engineering
MIAMI SHORES VILLAGE. FLORIDA
BUILDING ❑
ELECTRICAL ❑ PERMIT o
PLUMBING ❑ . 9 613
ROOFING ❑
❑ Work to be performed under this Permit
Owner of
Building
Architect
Contractor
or Builder
Legal
Description
Address of
Building
Lot
CONTRACTOR OR BUILDER
Bl.
Subdi-
vision
Sq. Ft
Value of
Project $
DATE 195_____
Contractor's
License No
Amt. 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
herefor in strict compliance with all ordinances pertaining thereto and with the understanding that the work will be performed in compliance with any plans,
drawings, statements or specifications that may have been submitted to and approved by the proper municipal authorities. This Permit may be revoked at any
time if the work is not done in compliance with such ordinances or if the plans are changed without authorization. A further condition upon which this permit is
granted is the understanding that the contractor or builder named above assumes the responsibility for a thorough knowledge of the ordinances and regulations
pertaining to the work covered hereby whether shown on the plans or drawings or in the statements or specifications and that he assumes responsibility for work
done by his agents, servants or employees.
Signed: 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
pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village.
In accepting this permit I assume responsibility for all work done by either, myself, my agent, servant or employee.
BY AUTHORITY