800 NE 95 St (5)Date
Legal Description JoKA ey T 16-23 lot ( FtOCk 1 lof 5(ze / 9 • (�
Owner / Lessee / Tenant SCOJTt.E. &14(/L,1 f >i T. 4(CCj' /(Ql? Master Permit # .0-1 / 1
Owner's Address !OO NE P>m P>/ StYea
Contracting Co. ; -�-- .-- ,- ,.;;.,..����.,��. Address
Qualifier ,s —
y Commission Expire
** *
APPROVED:
as to Owner a
FEES: PERMIT 3
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Job Address 6 IV E /51.42;hreet
-
`�' -61. U
Municipal # Competency #
State #
Architect /Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type(circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE -* >IGN
e`laih/iik t feet h'h)
WORK DESCRIPTION MOUIVLQ avid IlairPt9 acaa/,5, i /o 'fe4iCe_ b 7 .op-of
Square Ft. Estimated Cost(value) D
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 construction and zoning. Furthermore, I
authorize the above -named contractor to do the work stated.
Signatur/ of owner and /or Condo President
Date: / /// f
■'ota e
* * * *
*
RADON C.C.F. , .5°
Fire
Mechanical
Plumbing_
Tax Folio 1 0-320e-0W-00/6 7
Phone 7S7-10B Z
/V7)'.✓it /7,P,_
Signature of Contractor or Owner- Builder
Date:
Notary as to Contractor or Owner- Builder
My Commission Expires:
* * * * * * **
NOTARY D D TOTAL DUE .3.7 ;S
Other
Electrical
Engineering
OFFICE
4201 LF: JcurJr. SD
ORAL GADLES FLA 23146
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LOCATION SKETCH
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ThOMAS J. KELLY INC.
LAND SURVEYOR
MIAMI, FLORIDA
SURVEY NUMBER- 76
SCALE I" = '‘". •
c 51,040,,
112 0 VVE
SURVEY OF
BLOCK
SUBDIVISION _____3,.. • — • / •`• r i ... c..; / /
ACCORDING TO THE PLAT THEREOF •S ErccRnEri IN PLAT BOOK No. .L.1 (i-: AT PAGE No. ........*".
PUBLIC RECORDS OF7)44......,:. C.OUNT v, r L ORIDA.
DATE: •"1 /...T /V76, F OR.
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1 HEREBY CERTIFY THAT THE ATTACHED
SKETCH REPRESENTS A RECENT SURVEY MADE
UNDER MY DIRECTION AND IS TRUE AND COR-
RECT TO THE HST OF MY KNOWLEDGE AND
BELIEF.
THERE ARE NO ENCROACHMENTS.
• REGISTE,REOLAPSO SURVEYOR 81%1
STATE OF sf1.0704.
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LOT DilTAILi • "CALI 1"
TELEPHONE.
444-7692
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Per 489.103(7) F.S.S.
State law requires constriction 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 outbuilding. You may also build or improve a commercial
building at a cost of $25,000 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 more than one building you have
built yourself within one (1) year after the construction is
complete, 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. Your construction must
be done according to building codes and zoning regulations. It
is your responsibility to make sure that people employed by you
have license required by state law and by county or municipal
licensing ordinances.
�L�1
ate
Village Use Only
Owner's name(print)
Permit No.
DISCLOSURE STATEMENT
Owner's s gnature
MIAMI SHORES VILLAGE
BUILDING INSPECTION Z EPARTMENT
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 budding during progress of, the work.
Date / ,
n ... .._..... C .��=� –• •.. —.........,19..2V
/� /y� may
Owner's Name and Address &c._ (/ !%_ — No. 'A? __. Street_&✓ t ..
Registered Architect and /or Engineer
Name and address of licensed contractor
Location and legal description of lot to be built on: ,i
Lot 1 Block 1 Subdivision....
Street and Number where work is to be done : &.CJ .. P L y 4- _ ..._.. ___ -
State work to be done and purpose of building (by fl s)
,�_ � 1 Ai ' ,llt _. /-- .-e ,
Disapproved
(Signed)
L
Date.
peared
2 ,., : „►:,,- 111.1,,. <., ::,1211- :1......
ZaT
Notary Public, State of Florida
Building Inspcc My Commission Expires
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 $.._._.05 1 j. 4 ,/..'tael . Amount of Permit $,. 6r.a.
•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 tinder this permit; and will post or cause to be posted for inspection on the s' .of the work such public notice
or notices as are required by the Act. The undersigned agrees to employ only such subcon ctors on or to be performed under this
pennit, 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-
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 s ted are / truce
s
Permit No..__ Date Read, Sworn to and Subscribed before me.
ANNINC 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.
MIAMI SHORES VILLAGE BUILDING AND ZONING DEPARTMENT
INSTRUCTIONS TO OWNER- BUILDER
YQu have, this date, made application for a building permit as an owner -
builder. You should be advised of the following provisions and reauirements
that apply to owner - builder.
Proof of Ownership - Prior to a building permit being issued to you,
you must submit proof of ownership of the land concerned in the
application in the form of a recorded deed, showing you own the Property,
or a copy of mortgage or warranty deed of the land, or a Dade County tax
receipt, statement to contain legal description of property and indicate
property is in your name. Legal description and name on document of proof
must correspond to the name and legal description on the application.
Responsibility - You will be responsible for all work done by your day
labor employees, and you must either employ licensed contractors or
persons to be paid on an hotly or per diem basis. Any one contracting
(including labor) with you, verbally or in writing, on a fixed fee basis
for any work, who is not properly licensed, will be subject to a fine of
$500.00 and/or imprisonment for six months.
Insurance - You should be advised that if your day labor employees cause
any damage to persons or property, or if any of your day labor employees
are injured on the job, you are liable. Your regular home insurance
policy ordinarily does not cover this type of liability.
Withholding Taxes, etc. - You should be advised to investigate your
responsibility for withholding Social Security, Federal and State
Unemployment Insurance Taxes and Federal Income Taxes from the wages
of employees working for you on the proposed construction, and for
making returns thereof to the proper agencies.
Work Permitted Owner - Builder - An owner- builder subject to the foregoing
provisions and requirements, is limited to constructing one single family
residence each year for his own use and occupancy; or maintaining, altering
or repairing his own single family residence.
If you do not intend to do the work involved yourself, or with day labor, please
list below, the name of the individual or firm with whom you ha entered (or
will enter) into a contract for the work.
NOTICE: SEPARATE PERMITS REQUIRED FOR ELECTRICAL, PLUIIRING,
ROOFING AND MECHANICAL WORK
` %(s6akd t GO/ E
Name of Individual or Firm
1 C t 7l I E / 7 Fi4 S6'ee , Atat 5
Address
I, the owner of property described as 800 #1E '?s , SA/re-D ,C44ar4w' S4oves,
a ,3313Y
do hereby certified
that 1 have read the foregoing instructions, and am aware of my responsibilities
and liabilities under my application for a building permit for construction work
on the above described property.
Witn Owner
Date
CaIrsammil
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