761 NE 95 St/„r- /
,, , /
Block Subdivision No. Street
4(j/ t
,Owner''s " Name L c.I
,Lj / i J �, t,. /d,'
General Contractor Lic.No.
Zone Req.Cu.Ft. Qd
Plat Restriction Checked by
To Planning Board j' �' Approved k Rejected
Re- Submitted to P.B. Approved Rejected
Plans & Spec. Checked by
To Council
Approved Rejected
Bldg. Permit No. 7 / Date i Fee
___/ y ,Cost
Type ' ti' Stories / Roof
New Construction
Plumbing Permit No.
Septic Tank
Sewer
Misc' 1
New Const.
- Electrical Permit No.
Fixtures
Heater
Motors
Misc'1
New Construction
Alterations
Cu. Cont . I r' r' /
Date
11
11
11
Alteration
Date
11
11
n
11
Add. or Phone
Add. or Phone
Repairs
Fee
11
11
11
Re •airs
Fee
11
n
11
I1
Repairs
Cf
Building Inspection , By Re-insp By Re.Insp By
Foundation /}/
Beams & Lintels [,� ... 0/
Final
Final Clean -Up
Plumbing Inspection Date. - By
Roughing
Fixtures
Sower
septic Tank
Solar Heater
Final Certificate
Electrical Inspection
Rcug.L ing
Fixtures
Final
Tempo O•K.
ervice O.K. to Power Co. Cert.Occup.Issued
Alteration
P/4 1/4 .e -c
Re
insp By Re-Insp By
Re -insp By Re -Insp By
Location and le al description of lot to built on:
t Lot/- o.c / Block — a _ —_ Subdivision
Street and Number where work is to be done x--
State work to be done and purpose of building (by floors)
To be constructed of __-1 Kind of foundation_
MIAMI SHORES VILLAGE
APPLICATION FOR BUILDING PERMIT
BUILDING INSPECTION DEPARTMENT
Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the building
or other structure herein described. This application is made in compliance and conformity with the Building Ordinance 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 regula-
tions 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_-- - /cT
Owner's Name and Address No._ —__ — Street__
Registered Architect and /or Engineer `..-' ' 944 F-5 L fi / " c isc,C Ft S
Name and address of licensed contractor
New Building________ Remodeling __ Addition Repairs No. of Stories
`�— — Roof Covering_
Estimated Total cost of improvements $ _— ____Amount of Permit $_ ____________t__'�______
Zone cubage required____ / _Plan Cubage / / _,
Distance to next nearest building Size of Building Lot k
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 co . castors or sub - contractors employed by him
in the work to be performed under this permit: and will post or cause to be posted for ins e ton on the site of the work such ublic notice
or notices as are required by the Act. The undersigned agrees to employ only such subco t . ctors, . • • rk to � ` , • rm : nder this
permit, as are licensed by Miami Shores Village.
Remarks (Signed)
STATE OF FLORIDA,
COUNTY OF DADE. se.
3
PLANNING BOARD DATE
Chairman Member
Member Member
Member Member
Council Approved__ Date Disapproved
195
and for no other purpose.
/
Before me, the undersigned authon a notary ubl duly authorized to administer oaths and take acknowledgments, personally
appeared . �r � Q
to me well known.
and who, being by me first duly sworn, upon oath deposes and says that he is the .d.a.,,
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 5'1613 Date /� Re , Sworn to and Subscribed before me.
Disapproved ___________________— __ Date S
// Notary Public!State of Florida
(Signed) n �
Building Inspector My Commission Expires
—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.
4 1 1 i
Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the building or other structure herein
described. This application is made in compliance and conformity with the Building Ordinance 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
MIAMI SHORES VILLAGE /7,a _ e ft
BUILDING INSPECTION DEPARTMENT
APPLICATION FOR BUILDING PERMIT
�9
Date /2 3 o
No 7 / / Street z11.. fr�„/-
Registered Architect and /or Engineer
Name and address of licensed contractor
and �al legal description of lot to be built on: Q 4
Lot /�� W ,�( /6 Block d 1' Subdivision r —7 '/
n / ' `
21/ 71•x'
Street and Number where work is to be done
State work to be done and purpose of building (by floors), state exterior colors (submit samples)
and for no other purpose.
New Building Remodeling Addition Repairs No of Stories
To be constructed of Kind of foundation Roof Covering
✓Estimated Total cost of improvements $ j 0 OO Amount of Permit S `I/' n
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 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 obligatons 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 work to be performed
under this permit. as are licensed by Miami Shores Village.
Remarks (Signed)
STATE OF FLORIDA
COUNTY OF DADE.
Permit No.
Disapproved
(Signed)
}SS.
Building Inspector
Date
3d0Z IA/ -
Before me. the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments. personally appeared
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.
Date \- 1/40/17 Read. Sworn to and Subscribed before me.
Notary Public. State of Florida
My Commission Expires
PLANNING BOARD DATE
Chairman Member
Member Member
Member Member
Council Approved Date Disapproved Date
NOTE: A charge of $25.00 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 $25.00 will be charged when such re- inspection is made necessary by improper notice for inspection or faulty materials and /or workmanship.
Notary Public, State of Florida at Large
"HOLD HARMLESS" LETTER
MIAMI SHORES VILLAGE
BUILDING AND ZONING DEPARTMENT
DATE:
Gentlemen:
Re: Property located at (address and legal description) \ t 47
'off
As legal Jywner o subject property, I request the cancellation of permit
number ._�5 73 issued to
•
on ` ■ • ,,,. $ `. , for the followin reason:
\ Ip (.( )C \ \ ))S.
I hereby appl s ow builder, or authorize
to apply for such permits as are necessary to construct or complete the
construction on subject property.
I agree to hold ■Q...mi tirc'� \JA harmless and relieve it from any responsibility
or liability for any legal action r damage resulting from the cancellation
of the existing permit or the issuance of a new permit. I furthermore assume
responsibility for the correction, if required, of work performed under the
permit for which I am requesting cancellation.
Very truly yours,
r — DS)(\ \5 \ \k _ `ctnS (print)
STATE OF FLORIDA) SS:
COUNTY OF DADE )
The undersigned, being first duly sworn, deposes
and says that he /she is the legal owner of the
above property.
Sworn to and subscribed before me this day of ") 1J / 917
NOTARY PUBLIC. STATE OF FLORIDA
MY COMMISSION EXPIRES APRIL 16. 1992
BONDED THRD STEMBEER.ADAMS & SWEET