795 NE 95 St (14)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 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.
Owner's Name and Address - 14 • 2) R Q 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
Street and Number where work is to be done
State work to be done and purpose of building (by floors)
Date_ /I , 19 ✓
No.? S treet —i✓ Cs
_ ---- _�_- -- _ - -_ -- _ -- __ -- __and for no other purpose.
New Building______ .... —_ ____ Remodeling- ____—___ —__ Addition__ ___ —_ _____ Repairs No. of Stories_
To be constructed of_____—____________ Kind f foundation ___________— Roof Covering
Estimated Total cost of improvements $ ( O. 0 ______Amount of Permit $-- 0
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 inspection on the site of the work suc ublic notice
or notices as are required by the Act. The undersigned agrees to employ only such subco actors, on work to be perfor +under this
permit, as are licensed by Miami Shores Village.
Remarks
•
Disapp .'ved 7a--rjt — Date
(Signed) % 7
Chairman
Member
Member
Council Approved_
Building Inspecto
STATE OF FLORIDA,
COUNTY OF DADE.
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments,
appeared
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._ __ Date - // Read, Sworn to and Subscribed before me.
Notary Public, State of Florida
My Commission Expires
personally
to me well known,
PLA NG BOARD DATE
Member
Member
Member
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.
APPLICATION FOR BUILDING PERMIT
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_A_ _— -Z• '(� __ ____ L ____, 19
Owner's Name and Address �•'� • A • DR 0a, a No.? S J'— Street —i✓ 4
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
State work to be done and purpose of building (by floors)
MIAMI SHORES VILLAGE
BUILDING INSPECTION DEPARTMENT
New Building Remodeling_____________ Addition_______— ________ Repairs No. of Stories_
To be constructed of Kind/of foundation_________ Roof Covering_
Estimated Total cost of improvements $_ CP 0 0 ' _— ,_Amount of Permit $._ 0___
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 inspection on the site of the work suc ublic notice
or notices as are required by the Act. The undersigned agrees to employ only such subcorractors, on work to be erfor under this
. permit, as are licensed by Miami Shores Village.
Remarks (Signed) 444 CoW
STATE OF FLORIDA, t
COUNTY OF DADE. SS.
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.
Permit No._ ®.•t`I_ V,__ Dated / / Id Read, Sworn to and Subscribed before me.
Disapp ved "_ __ _ Date
(Signed) �' •� L �
wilding Inspecto ri
Council Approved_
PLA ING BOARD DATE
Chairman Member
Member _ Member
Member Member —
Date Disapproved
Notary Public, State of Florida
My Commission Expires
and for no other purpose.
___Date
NOTE: A charge of $1.00 will be made for making corrections or changes to this application after approval has been optained 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 ❑ MIAMI SHORES VILLAGE, FLORIDA
ELECTRICAL ❑
PLUMBING ❑ PERMIT N° 9721
ROOFING ❑
FC.i: ❑
Owner of
Building
Architect
Contractor
or Builder
Legal
Description
Address of
Building
� ,ai ■
N
d • +ti! � / 7 N 1�"
Lat
"
M BI 6
I
?I 1
Date Z Z 19 :
Contractor's
License No.
Work to be performed under this Permit
Subdi-
vision ff 3
Sq Ft
Value of of
Project $ Q 11 Permit $
r
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 applica-
tion 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 gr drawings or in the statements or specifications and that he assumes respon-
sibility for work done by his agents, servants employe06.
r i /
Signed t.----,4
CTOR) BY
In consideration of the issuance to me of this permit I agree,,to perform the wor vered hereunder in compliance with all ordinances and regulations
pertaining thereto and in strict conformity with the plans, drawing "s tements or specifications submitted to the proper authorities of Miami Shores Village.
In accepting this permit I assume responsibility for all work don by either, myself, my agent, servant or employee.
COIITRACTOR o/ BUILDER
BY
1 .
AUTHORITY