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691 NE 94 St (6)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. Owner's Name and Address . .: Registered Architect and /or Engineer �'J /J .......... -.,. Name and address of licensed contrpctor.,�' CZ" ° z i / ' _ 42 2 Location and legal description of lot to be built on: Lot Block Subdivision Street and Number where, work is to be done &) 9_,/ IV 5- State work to be done and purpose of building (by floors) 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 $ c= ° Amount of Permit S.. � � ©p 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 pennit 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 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 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.. _ /S Z S Date Read, Sworn to and Subscribed before me. Disapproved (Signed) MIAMI SHORES VILLAGE BUILDING INSPECTION DEPARTMENT APPLICATION FOR BUILDING PERMIT No. 9 sued .�r' w Date.. Notary Public, State of Florida Buil•' g Inspector My Commission Expires • to me well known, PLAN NC 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 hoard. 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. STATE OF FLORIDA, COUNTY OF DADE. ss. Permit No Disapproved (Signed) Chairman Member Member Building Inspecto MIAMI SHORES VILLAGE BUILDING INSPECTION DEPARTMENT. APPLICATION FOR BUILDING PERMIT Application is hereby wade 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. 1 Stre 9.1W f2 Name and address of licensed contactor... Location an // d lc al description of lot to be built on: ,Le„ „ " 8�llL.�L Lot 1.7 Block ‘7 / Subdivision s Street and Number where work is to be done ,69/ �� � JJ l 7 __.f State work to be done and purpose of building (by floors) , dr .�: LD1!a 2. ... /7.cte/ r�i _.. and for no other purpose. New Building Remodeling dditio ! r .. Repairs To be constructed ofc S Kind of f�o ndation in 1— t aYIC/Z°.T_eRoof Covering v`T Estimated Total cost of improvements $ ! - •. � Amount of Permit S,. ( ' r (,\); 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 Libor 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 o the h public notice or notices as are required by the Act. The undersigned agrees to employ only such subcontractors, on wor o r rme4 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 — •- ____ 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 t4- ( -"L Date q' 27— 7 Z— Daye Council Approved Date NOTE: A charge of $1.00 will be made for making corrections the Planning Board. A re fee of $1.00 will be charged materials anu /or workmanship. Read, Sworn to and Subscribed before me. Notary Public, State of Florida My Commission Expires NNING BOARD DATE Member Member Member -- --_ -- • -_ -.- Disapproved Date or changes to this application after approval has been obtained from when such re- inspection is made necessary by improper notice for inspection or faulty MIAMI SHORES VILLAGE BUILDING INSPECTION DEPARTMENT APPLICATION FOR BUILDING PERMIT Application is hereby uinde 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. — —/./ _ _. .._ __. .... jj% Owner's Name and Address 7 ,r/ /' ..... Ni y7 i .Street2f .. i ..: ia.;f'�: 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) New Building Remodeling Addition Permit No.. Disapproved R .._ x ( Signed) ANNING BOARD Chairman \lcrnber Member ...... Council Approved NOTE: A charge of $1.00 will be made for making the Planning Board. A re- inspection fce of $1.00 will be charged materials and /or workmanship. Member Member Member Date Disapproved and for no other purpose. Repairs No. of Stories To be constructed of Kind of foundation Roof Covering Estimated Total cost of improvements $ si,1. t-t Amount of Permit $. . 9 D Zone cubage required plan Cubage Distance to next nearest building Size of Building Lot Maximum live load to be borne by each floor Ikereby submit all the plans and specifications for said building. All notices with reference to the building and its construction may be 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 such public notice or notices as are required by the Act. The undersigned agrees to employ only such subcontractors, on w to be per ormed under this pennit, as are licensed by Miami Shores Village. Remarks..._ (Signed) .:44/ ,/ 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 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. /s( Cr Date ( Z -? 3 Read, Sworn to and Subscribed before me. Date Notary Public, State of Florida Building Inspcc r My Commission Expires DATE corrections or changes to this application after approval to me well known, Date has been obtained from when such re- inspection is made necessary by improper notice for inspection oc faulty 1 1 Name and address of licensed contactor APPLICATION FOR BUILDING PERMIT Application is hereby made for the appro\•al of the detailed statement ur ere 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 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. June 6, _ _ 86 A. Roger Infante Date..._..._... x;11 N .E • ' L.th St Owner's Name and Address .....__ _ No...._.._ _ . Street_... Registered Architect and /or Engineer sins rsr V.J.Knezevich General Contractor, _Inc. Location a legal description of lot to be a b ilt on: Ufa l Lot ).. Block i � Subdivision. j�'A l.. �l. rA /.l1 !1 .11;2-. /r/ / 9SD Street and Number where: work is to be done 691 N.E. 94th Street State work to be done and purpose of building (by floors) and walkway. and for no other purpose. New Building Remodcling....X......... Addition Repairs No. of Stories To be constructed of Kind of foundation Roof Covering Estimate Total cost of improvements $. .••. :`.'.6. C • �� Amount of Permit 3�.. Of Zone cubage required _.._....Plan Cubage Distance • to next nearest building.. Size of Building Lot \faxirnum 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 V.J.Knezevich Pres. V.J.Knezevich General Contractor, Inc. • be sent to.. }�..... •t•• r 6.1 rIrckena Drive Miami Springs, Fl, 3I66 The undersigned applicant for this building permit does hereby certify that d ie un crstan s and accepts his obligations as an employer of labor under the Honda \ \'orkinen•s Compensation Act, being Section 5966, Compiled Cen 1 Laws of Florida, Permanent Sup slenrent, and has complied ss ith the provisions thereof, and will require similar compliance from all r actors or sub - contractors employe cl by him in the work to be performed under this permit; and will post or cause to be posted for in jf on on the she of the work such public notice or notices as arc required by the Act. The undersigned agrees to employ only such sue •• dots, 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 Bcfore 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 tru . Permit No......2t Date Disapproved _ Q _ Date. (Signed) Building Inspector Chairman Member Member .. .. _ .._...._._..._.r..... Council Approved MIAMI SHORES VILLAGE BUILDING INSPECTION DEPARTMENT N 1,/ oti,6 A PLANNING BOARD DATE NOTE: A charge of $1.00 will be made for making corrections the Plannir.:; Board. A re- inspection ice of 31.00 will be charged materials and /or workmanship. Install brick ,pavers_on_outside patio Member Member Member Date Disapproved Read, Sworn to and Subscribed before me. Notary Public, State of Florida My Commission Expires or changes to this application after approval C'€ 00 ;177 0 Date has been obtained from when such re- inspection is made necessary by improper notice for inspection or faulty Contracting Co. 4'i o Qualifier ] t c -L=, -O �✓ y'^'� SS# -1% - Si a Date: ** * * * * * * * * Notary as to Owner and /or Condo President My Commission Expires: APPROVED: • PERMIT AP'PLICATION FOR MUNICIPALITIES OF DADE COUNTY (OWNER TO RETAIN COPY) Date -' /— Job Address / / 772I/ Gf Tax Folio// 42274 It' /A , � Legal Description,, / _____ Owner / Lessee / Tenant ����'- . ! N" .-' Owner's Address '9/ C,J' . 9 T Square Ft. Estimated Cost(value) Master Permit #�o Phone Address ."7 c2.5' Jam✓ y - ? ( 2 —Phone (7 �/ L. 7 State # Municipal # Competency #/L5 W Ins.Co. Architect /Engineer Address Bonding Company Address Mortgagor Address Permit Type(circle one): BUILDING ELECTRICAL PLUMBING MECH / ANICAL ROOFING PAVING PENCE SIGI WORK DESCRIPTION -t -- l� G°d� • �� a „.. le er/or WARNING TO OWNER: YOU MUST RECORD A NOTICE OF COMMENCEMENT AND YOUR FAILURE TO DC SO MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY (IF YOU INTENI TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUF NOTICE OF COMMENCEMENT). Application is hereby made to obtain a permit to do work and installation as indicated above, an on the attached addendum (if applicable). I certify that all work will be performed to meet th standards of all laws regulating construction in this jurisdiction. I understand that separat( 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 wil. be done in compliance w applicable laws regulating construction and zoning. Furthermore, authorize the above -n ontractor to do the work stated. or Condo President Signature of Contr or or Owner- Builder Date.: Notary as to Contractor or Owner- Builder Fri TWIPT F 0IPMP ry Gblic tary Public State of Florida Perron iIv known DOR Produced I.D. y Ty?c and numo r of I.D. produced: handed Commission Expires 9/18/92 Thru Stembter & Sweei * Other * AJ * * * cake an oacl or * ** ❑D FEES: PERMIT / fl RADON C.C.F. lll wh`t an A a TOTAL DUE k$4 Fire Zoning Building J I95✓ Electrical Mechanical Plumbing Engineering 'r • ADDITIONAL DtFINITIONS The following definitions apply only to coverage afforded under Section I I of this policy: 1.. "bodily injury": means bodily injury, sickness or disease, including care, loss of services and death resulting therefrom. 2. "medical expenses ": means expenses for necessary medical, surgical, x -ray, dental services, including prosthetic devices, ambulance, hospital, professional nursing and funeral services. 3. "motor vehicle ": means a land motor vehicle, trailer or semi- trailer designed for travel on public roads (including any machinery or apparatus attached thereto) but does not include, except while being towed by or carried on a motor vehicle, any of the following: utility, boat, camp or home trailer, recreational motor vehicle, crawler or frame type tractor, farm implement or, if not subject to motor vehicle registration, any equipment which is designed for use principally off public roads. 4. "Property damage ": means injury to or destruction of tangible property, including loss of use thereof. 5. "occurrence ": means an accident, including injurious exposure to conditions, which results, during the policy term, in bodily injury or property damage. 6. "recreational motor vehicle ": means (1) a golf cart or snowmobile or (2) if not subject to motor vehicle registration, any other land motor vehicle designed for recreational use off public roads. j✓7. "residence employee ": means an employee of any Insured whose duties are in connection with the maintenance or use of the insured premises, including the performance of household or domestic services, or who performs elsewhere duties of a similar nature not in connection with any Insured's business. COVERAGE ,AND LIMIT OF LIABILITY Payments To Ot A. Dwelling B. Appurtenant . Structures C. Unscheduled Personal Property • .D. Additional Living Expense S.. , E 11 . Personal. Liability (Bodily Injury and Property Damage) ,. , F. Medical $ 500.00 $ 25,006 Each person Each ace 33 000 $ 3 s 16,500 $ s 0_,60 $ $ 25 Each occurrence $ PREMIUM PAYABLE: At each an Basic Premium Additional Premiums Total Premium $ 444 At $ 148 Inception (and $ 444 $ $ 148 Premium forScheduledProperty $ $ $ '_ Total Premium $ $ $ 858.938 Pt9LICY NUMUOJ HQMROWNERB RQLICY ( dint 1 46 Ma ataMl� i ✓ii/ufflitAft ea a roil 1041, cxgci,vriya, oFFregfi - WAfi•TMAM,MIAd9Y, DECLARATIONS Named Insured and P.O. Address (No., Street, Town, County, State, Zip Code) f ICHAEL F. HUTTER AND JULIE A. HU'1'TER, His a 691 N. E. 94th Street Miami Shores, Dade, Florida 33138 __J 5/3/71 INCEPTION 5/3/74 EXPIRATION The described residence premises covered hereunder is located at the above address, unless otherwise stated herein. Insurance is provided only with respect to the following coverages for which a limit of liability is specified, subject to all conditions of this Form and Endorsements made part of this policy at ime of issue: Hil:_3__ 11.70. • .29116_- _.�.10_ -62 D EDUCTIBLE — SECTION I: A ny Toss by pares Insured against under Section I of this:policy is subject to a deductible: Exceptions if any: Special Loss Deductible Clause $ _ ( SECT(N1i i Additional residence premises, if any, located: Mortgageels) (Name and Address) : ROBERT FLEACANE, Box 218, Cadiz, Ohio Countersignature Date and Place 5/5/71 dc r I'iami, Florida In Consideration of the Provisions and Stipulations Herein or Added Hereto and of the Premium Above Sper ified(or specified in endorsements) made a part hereof), this Company, for ,the term shown above from Inception date shown above at noon (Standard Time; ti' expiration date shown above at noon (Stanc'ard lime) :at ta,catteri'et property Imo) tved;'to'an'^amouht tOrOxce din t11li1ipljt o tiphi) tits :btve V;.ieciaia:i y loot t iirouI t)te ''" Insures) flamed in the Declaration above arid legal representatives, to the extent of the aCtual ca. ^7fi vatuc o; the ptt:4:ity ,'t itie time .3 4Q.s,S., Nit 7r4t exceedolg the amount which 'it would cost to repair or replace the Property with indtorial of Ilk :kind and tiuullty wtt'ttii+ U tienOtinlrttt ..i, °a Alt Min, icss, without Allowance for any Increased cost of repair or rocanntruction by .rootUii 0 Ony entlndtllttr Or IllW ttl +p 1A'tmg dohttrttet;t" ter ti +ItArt':t d • without compensation' for loss resulting from Interruption of business or munufec Linn, nor in any ovtlut fr7t nirrit xtit+n the intftrt'At fit the Win lid against all DIRECT LOSS BY FIRE LIGHTNING AND OTHER PERILS INSURED AGAINST IN THIS P INLI,UIa1NG (ic.�,ttlVrif F PREMISES ENDANGERED BY THE PERILS INSURED AGAINST IN THIS FDL,I:,Y, E)'CP'T AS HEREINAPTCR.PROVIDED, to the property de- . scribed eeerein while located or contained as described in this policy, or pro rata for five days at each proper place to which any of the property, ` :; shall necessarily be removed for preservation from the perils insured against in this policy, but not elsewhere. Assignment of this policy shall not be valid except with the written consent of this Company. . This policy is made and accepted subject to the foregoing provisions and stipulations end those hereinafter' stated, which are hereby made . a part of this policy, together with such other provisions, stipulations and agreements as may be added Hereto, as provided in this Policy, ' 1 Rating Information Only 07 I a Amount � = E e r • � .N F r M L ff! 7 Actual' Oi pinaf gj IA. 1 � ' ti, As Er A f ' N C a 4: iu F , y n �. t2 rr 0 '1 , 7, H In su rance Premrum ' Premlurn y a 0 ▪ d r `' o c' , � 't I _ ._ It,' :.c.? _ (El Ma Yr. ` i � ' 16 1 09 33. 148. 148 0 02 3 1 1 3 7 4 3 1 5 1 ,1 191 001 HA 68 • FACTURERS MUTUAL INSURANCE CQ Ag (a) The described dwelling is not seasonal (b) no business pursuits are conducted on the desc ihed premises: (c) the described premises is the, p only premises where the Named Insured or spouse maintains a residence other than business of farm properties: (d) the Insured has no full time res- r idence employee(s): (e) the Insured has no outboard motor(s) or watercraft otherwise excluded under this policy for which coverage is desired. Ex- vention, if any, to (a), (b), (c), (d) pr (e)* ,. ..., I Cestraewt,4a„ t, 1h t teller) tt,•hcv shell h$ v,it.t tf, vrfrathi.i lid Cresol. bett,nr' CI} alts" 4 a,r.t the bee !dot hex eitl It' "• 3 frilly r One ralral nt n,l'rr•trirl 04,1 ,btv soh Herr 4 tt!ti ?1 foo or CirC•rrrt5tenr :r C' <7rtr r^ !t tn•i,r,trt( f! ri Ih !i ,° '.t 1- i' e t tit ✓ 0, the' : nt Ci l Cf tt,: , enure) th' virt, or in Cabe (> nt •!.i fr,■i or fens ,•nt'r.end r,y tie_■ , nswecl relihr,•g thereto. 7 3lni.t v,rable this vcbcy shall not rover ae.crsunts, hilts, 3 ant currency, deeds, evidences of debt, money or 9 excepted property. securities; nor, unless specifically named 10 hereon in writing, bullion or eganplpripbs.ree 1 l perils not This Company shall not be ita1 tfr ` br 'tli y 12 included. fire or other perils Insured against in this 13 policy caused, directly or indirectly, by: (a) 14 enemy attack by armed forces, including action taken by mili- 15 tary, naval or air forces in resisting an actual or art immediately 16 impending enemy attack; (b) invasion; (c) insurrection; (d) 17 rebellion; (e) revolution; (f) civil war; (g) usurped power; (h) 18 order of any civil authority except acts of destruction at the time 19 of and for the purpose of preventing the spread of fire, provided 20 that such fire did not originate' from any of the perils excluded 21 by this policy; (it neglect of the insured to use all reasonable 22 means to save and preserve the property at and after a toss, or 23 wren the property is endangered by fire in neighboring prom• 24 uses; '(t) nor shall . this Company be liable for loss by theft. 25 Other Insurance, • Other insurance may be prohibited or the 26 amount of insurance may be limited by en- 27 dnrenmerit attached hereto. n28 Conditions suspending or rest/414 ty ineeranee. Unless 5111Are 29 wine provided in writing added' "Hewett. •tbla''Compiify 'shftll t' not 30 be liable far tort '4raurri g r yr , n t . .be 31 (a) •chile the hazard Is increased by any ams?witlein the con- 32 trot cr knewledge'of the insured; or 33 (h) trhi': a described bu ldtr , whether intended for occupancy 34 by u,enet or tenant, is vet :ant or unoccupied beyond a period of • 35 sieve consecutive days; or ' 36 tc) as a result of explosion pr riot, unless fire rs e, and in 37 that e'(a r1�' (for loss by fire 0ri19' C .1� {1x. 38 Other perils' Any other peril, 4o be insured against or sub- . 39 or cuhjects, tect of insurance to be covered in this policy 40 shall be by endorsement in writing hereon or 41 added hereto. • 42 ,tAled provisions. The extent of the application of insurance 43 under thie policy and of the contribution to 44 be made by this Company in case of loss, and any other pro - 45 vision or agreement not inconsistent with the provisions of this 46 gal!ry, may be provided for in writing added hereto, but no pro- 47 vision m;iy be waived except such as by the terms of this policy 48 is subject to change. 49 Waiver No ermi l fec ` ins. t.$ 50 provisions. exist, or w of gi p o be valid, 51 unless granted herein or expressed in writing 52 added hereto. No provision, stipulation or forfeiture shall be 53 held to be waived by any requirement or proceeding on the part 54 of this Company relating to appraisal or to any examination .55 provided 4or herein. ' Sd . Conciliation. This policy shall ,'le .cancelled at any time '37 , of police. • at the, request .of i,thit insu i red, , jatiich case a 58 Company' shall; upon demand and sur- ;•s render of this policy, refund the excess of .paid premium above tsG the customary short rates fr,r the expired time. This pol- 61' ; icy may be. cancelled: at „amyl :.their. :'by• this' Cor,panviebv giving 5'2 to the insured a five day; written notice of r,,ncell,!r;or! with 63 or without tender of the excess of paid premium above the pro !ii .,eta prer!iurn for the emitted thrr'C, which excess, if not ten '65 dared, shall be refunded or demand.• Notice of cancellation •;hail 6r s•ete tl-,at +,aid extr'ss premium (if not tendered) will ye re- ` t:nrrrand. • ,t orfgance 1f lois hereunder , it •made p.i,rabie in wfcile, interests and 'Or ;n' part, to a designated mortgagee not 70 obligations. named' herein Ss the inured, such interest in • 71 this policy may be cancelled by giving to such 72 mortgagee a ter(days' w•iften notice of can - 73 tenation. 88 89 90 91 92 156 award as herein provided. 157 Suit. No suit or action on this policy.fcr the .decoy... 158 ery of any claim shell be yustainitte, in any 159 :otrrt of law or eglfitt' unless all the ra,ytriremtnl r tote pollee' l eis shell hu,P been c',rr',,plie.f teeth, oriel uM:s• r1tt7UA,,!ICm41 'aiitlltl twelrr M9hibe nom. affflr ins „stlti ;t, c4¢ ?f bra. t;c,t'tnaedVltYF?. rlii' Cla • t dt tel : tlt. 1+.'0 ^4;1 • dC .0(.41 10t :if ttif .'Mil e f tcr,;Jkim f'.0141 oriv sow,. fnt ltisv - (4,. , 1 .0 , 0)0 � it, tt f; +y ,41)i :ft's It) mien: '•.vm.1 ::' Wfi''f :E`.)=, this, Coe •o_,'y hat r, ;(!;.1tr'1 .nrf :artc q'nrl these prr:si•nrs, but thr :, policy shall no! he valid unless countersigned by the HO» .' thorized Agent of this Company at the'agency hereinbefore mentioned. 74 1$ the insured fart, to renc'er raroof of loss s;ch mortgagee, upon ' shall ruder ' •i9,N.,r•z, Proof of L >ss In t f orte Feerein spi:.•ifieu .')6 within >iety (60 rays therr,efier aid shall !re sui.i••r•t trr tho pro- 7.e ve';^7ri re•cof r,. hit ter) it, -epr :regal „std 'Imo , r1 payrnryrt a n•;I of 7t t' relee” ;i !.;it. If this r;o ,'.ln• Lt4ll (line' tf , t hr. I „oddity 0v- f” r1 C1 1'• !' a :1 .' ;'ar,"[r, a ' AO C. a) tf e't"t,tent r7) flay: 1 f il l tt•;l e .,' <i ' r ,• ', f t,':;i rpvitfrioirpv, '))N'.4r't_l.afrd r. rill the rre.,it. 1f,'t h i r til l :'^. ,4.ts it ereeeie1'y, bet wift•,ot ,'r,i),vtniit► r,.'it1l llit,,,`y I ../ j ' r ,!' I'r , tr: ',t t I Stt'/ 'rf to r ;et aw l u'e rite I '•r' 1 33 ,;it. a',srrtnrN,.i!r,t i,� .r,f. Of..t.: 9t;'rT,er9f;ejrct ' 1'ltfr.'!r '. f',r'7vi :i(triS (f3.'i tclhln!rj F:r tt.. irvin,: sla ,arl.l i,lrlll)dsi ,r)y r,t ,e h rrlttfuh.t1.1 r'•pr le: e l toI tiro .rir• li nitriiniiihi to terilItit) het t410 iik7 }itlty (1 1 'torn; 4 nt till rittl tit 1341.1, ,n y I'iJgere s. !p, ►irul,eU-3uen of on/ )u.: 11.041 rrn hereby m5 shell brat to the weejte e•!su ranee reverie() fhb property against the per.; involved, whether t ;ollechblrr or not Requirerreeesbs in The insured shall give ;mime-charm written case loss occurs, notice to this Company of any loss, protect the property from further damage, forthwith *Lin' t 'ste t( irl ra 'S l qn s prscriet pt 1'qn ti ' !•ib i tes" ,e Y` (344:1';' {'Ut ' ,, r 4) ,pietc_tiris r 46 _.af 95 the destroyed, damaged at3eae •'•} operty; st 96 Elt t rYeanti a yG sr ere tual�,a .slue nl t Ipas 97 clamed; and wr 7iiw irti' dada ijf6i - tile l s, t� aide 'freer 98 is extended in wrieine by this Co¢npany, ehc insured shall render 99 to this Company a proof of ions pgred and sworn to by the 00 insured, stating edc v ' g the lenc.v' ���n�1 li�f of the ins�i�� � P� 01 the following: the time and ong, - of the loss, the interest o the 02 insured and of all others in the proper.,, the actual call', value of 03 each item t hereof and the amount of toss tteeretc, all encum- 04 brances thereon, all other contracts of insurance, ',cherher valid 05 or not, covering any of sa prorerry, ane changes in th-! title, 06 use, occupation, location, possession or eepcsures of said prop - 07 etty since the issuing of this policy, by es i and for what 08 purpose any building hereon described and the several parts 09 thereof were occupied of the t me of Tess and whether dr not it 10 then stood on leased grou and shall furr'-h a ' ^f'v ..f all the 11 ii te.SFrrpt)ort • f nrJ scF 1i des it ,ill polie.,"t end, if 0qu,10�l verified 11 ' plalrifi ^a • &lent 4'40c*tt ' df ail), be afdind;. lfixrr :ree ©t tee e ifre!'r: 1 ?)ic strq' ed 'or dqt d.. 3te Insured,CO.0to as rr.ay iteeas 14' Itbfy' quired, 'Shaer exhibit to any per &o1, designated• byci"iii 15 Company all that remains of 'any priperty herein described, and 16 submit to examinations under oath by ane person earned by this 17 Company, and subscribe the same, and, as often as may be 18 reasonably required, shalt produce for eearninetic -' all books .of 19 account, bills, invoices and other vouchers, or cer°ified cdp`e r 20 thereof if originals be lost, at such reasonable time and pfate' as 21 may be designated by lh,s Company c' its referesentatise, and 22 shall permit, extracts and copies thereof to be made.• 23 iespraisal. In rase the insured avid this Company shall 24 , fail to agree as to the actual cash value or '• 25 the amount, of loss, then, on, the written demand o either, eac;'s 26 shall select a corpetlr t'and dt i ,r'ereste.d'ap ra;;:,er 'end not;f 27 the other of i(hVeosfeA s @e fi3 tiVr(ly.evstx,tre>e ca+'s0 28 demand. The appraisere shall first select a crtmdeteet acrd c ^s 29 interested umpire and failing • for fifteen days to area •:;c'' 30 such umpire, then, on reovest of the insured cr ^::it Cceeez :.'t,r, 3'' such � tim� ire ^ ;hall be r s � e � lected by a ,ur see of a coon :s r s • :- }4r @ec it#, ' wFE ,,,cperry c ^'vrre1 7_ I sf rat' t &p , 33 praisers shall then appraise the less, :tari s le atele 2ct.s. 34 cash ' +alue and loss to each item; and, as tins to egreee., steal; 35 submit their differences, only, to the umpe.e. ' e n award , tn wrie- 36 ing, so itemized, of any two when filed with this Company shall 37 determine the amount of actual cash , value and loss. , Eau" 38 appraiser shall be paid by the party.. selecting laird •and. the ex 39 penses of appraisal and umpire shall .be paidr t,ffseF 40 equally • 41 Company's It shall be options. :V7I x'.tatts Cofr:p53t(i_'$�,+ , ', 42 options. • take all or any part, of the preeerty at the 43 ;'agreed or appraised value, ant's atsa to re , 144' hair, 'rebbilcf off, replace' the CerO0eety destroyed or riaivra.Ded with - 145 other of like kind and quality within a rcascna5le time, on err• 146 ing notice of it's intention so to do 'within thirty days alter the 147 teCeint of the proof of loss herein rettuirtd 1 43 Abanrotvmene. There can be re et an icreir'reeee . T if-le Cre 149 . 'early of any groporty, • 150 WHien leiis . The amount cei foss for Weette 3i >s CCic"eteew 151 payable: may 'may be liabtrr shat; be pevable ; txte. 152 d after ,pro of foes, as herein pro'etcreej, 153 r bye this'Ceespany end ae 01 the 3 03' is 'mxde 154 either by agreement ieetween the insured and this Company ex- 155 pressed• in writingior by the filing. with this Camoeny. of £ri nee rz; ri WINbSTORM EXTERIOR PAINT AND N .o -2 WATERPROOFING EXCLUSION CLAUSE (Ed.io 62) It is hereby stipulated that coverage under this policy does not include damage caused in any manner by windstorm to paint or waterproofing material applied to the exterior of the building(s) or structure(s) covered hereunder. The value of paint or waterproofing material, being excluded from the coverage as above stated, shall not be considered in the determination of actual cash value when applying the Co- Insurance Clause applicable to loss from windstorm. ADDITIONAL CONDITIONS 1. Replacement Cost — Coverages A and B: This condition shall be applicable only to a building structure covered hereunder excluding outdoor radio and television antennas and aerials, carpeting, awnings, including their supports, domestic appliances and outdoor equipment, all whether attached to the building structure or not. a. If at the time of loss the whole amount of insurance applicable to said building structure for the peril causing the loss is 80% or more of the full replacement cost of such building structure, the coverage of this policy applicable to such building structure is extended to include the full cost of repair or replacement (without deduction for depreciation). b. If at the time of loss the whole amount of insurance applicable to said building structure for the peril causing the Toss is less than 80% of the full replacement cost of such building structure, this Company's liability for loss under this policy shall not exceed the larger of the following amounts (1) or (2): (11 the actual cash value of that part of the building structure damaged or destroyed; or (2) that proportion of the full cost of repair or replacement without deduction for depreciation of that part of the building structure damaged or destroyed, which the whole amount of insurance applicable to said building structure for the peril causing the loss bears to 80% of the full replacement cost of such building structure. c. The Company's liability for loss under this policy shall not exceed the smallest of the following amounts (1), (2), or (3): (1) the limit of liability of this policy applicable to the damaged or destroyed building structure; (21 the replacement cost of the building structure or any part thereof identical with such building structure on the same premises and intended for the same occupancy and use; or (3) the amount actually and necessarily expended in repairing or replacing said building structure or any part thereof intended for the same occupancy and use. d. When the full cost of repair or replacement is more than $1,000 or more than 5% of the whole amount of insurance applicable to said building structure for the peril causing the loss, this Company shall not be liable for any loss under paragraph a. or sub- paragraph (2) of paragraph b. of this condition unless and until actual repair or replacement is completed. e. In determining if the whole amount of insurance applicable to said building structure is 80% or more of the full replacement cost of such building structure, the cost of excavations, underground flues and pipes, underground wiring and drains, and brick, stone and concrete foundations, piers and other supports which are below the under surface of the lowest basement floor, or where there is no basement, which are below the surface of the ground inside the foundation walls, shall be disregarded. f. The Named Insured may elect to disregard this -8- condition in making claim hereunder, but such election shall not prejudice the Named Insured's right to make further claim within 180 days after loss for any additional liability brought about by this policy condition. 2. Special Limits of Liability on Certain Property: a. This Company shall be liable for loss to trees, shrubs, plants and lawns (except those grown for business purpbses) only when the loss is caused by fire, lightning, explosion, riot, civil commotion, vandalism, malicious mischief, theft, aircraft, or vehicles not owned or operated by an occupant of the premises. This Company's liability for loss in any one occurrence under this provision shall not exceed in the aggregate for all such property 5% of the limit of liability of Coverage A, nor more than $250 on any one tree, shrub or plant, including expense incurred for removing debris thereof. b. Under Coverage C, this Company shall not be liable for loss in any one occurrence with respect to the following property for more than: (1) $100 in the aggregate on money, bullion, numismatic property and bank notes; (2) $500 in the aggregate on securities, accounts, bills, deeds, evidences of debt, letters of credit, notes other than bank notes, passports, railroad and other tickets or stamps, including philatelic property; (3) $1,000 on manuscripts; (4) $500 in the aggregate for Toss by theft of jewelry, watches, necklaces, bracelets, gems, precious and semi-precious stones, gold, platinum and furs including articles containing fur which represents its principal value; (5) $500 in the aggregate on watercraft, including their trailers (whether licensed or not), furnishings, equipment and outboard motors; or (6) $500 on trailers, not otherwise provided for, whether licensed or not. 3. Loss Clause: Loss hereunder shall not reduce the applicable limit' of liability under this policy. 4. Mortgage Clause — Coverages A and B only: (This entire clause is void unless name of mortgagee tor trustee) is inserted in the Declarations): Loss, if any, under this policy, shall be payable to the mortgagee (or trustee), named on the first page of this policy, as interest may appear, under all present or future mortgages upon the property herein described in which the aforesaid may have an interest as mortgagee (or trustee), in order of precedence of said mortgages, and this insurance as to the interest of the mortgagee (or trustee) only therein, shalt not . be invalidated by any act or neglect of the mortgagor or owner of the within described property, nor by any foreclosure or other proceedings or notice of sale relating to the property, nor by any change in the title or ownership of the property, nor by the occupation of the premises for purposes more hazardous than are permitted by this policy; provided, that in case the mortgagor or owner shall neglect to pay any premium due under this policy, the mortgagee (or trustee) shall, on demand, pay the same. Provided also, that the mortgagee (or trustee) shall notify this Company of any change of ownership or occupancy or increase of hazard which shall come to the knowledge of said mortgagee (or trustee) and, unless permitted by this policy, it shall be noted thereon and the mortgagee (or trustee) shall, on demand, pay the premium for such increased hazard for the term of the use thereof, otherwise this policy shall be null and void. This Company reserves the right to cancel this policy at any —9-- time'as provided by its terms but in such case this policy shall continue in force for the benefit only bf the mortgagee (or trustee) for ton days after notice to the mortgagee (or trustee) of such cancellation and shall then cease, and this Company shall have the right, on like notice to cancel this agreement. Whenever this Company shall pay the mortgagee (or trustee) any sum for loss under this policy, and shall claim that, as to the mortgagor or owner, no liability therefor existed, this Company shall, to the extent of such payment, be thereupon legally subrogated to all the rights of the party to whom such payment shall be made, under all securities held as collateral to the mortgage debt; or may at its option pay to the mortgagee (or trustee) the whole principal due or to grow due on the mortgage, with interest accrued and shall thereupon receive a full assignment and transfer of the mortgage and of all such other securities; but no subrogation shall impair the right of the mortgagee (or trustee) to recover the full amount of said mortgagee's (or trustee's) claim. 5. Occupancy Clause - It is a condition of this policy that if the described dwelling is associated with and in proximity to farming operations (1) the agricultural products produced on the land are incidental to the occupancy of the dwelling and are principally for home consumption, or (2) that the occu- pants of the dwelling and buildings appurtenant thereto are not engaged in the operation of the farm and said buildings are in addition to a complete set of farm buildings on the farm and are not exposed within 200 feet by any farm building. 6. INFLATION PROTECTION CLAUSE Coverages A, B, C, and D - Section I only The limits of liability specified in the Declarations of this policy for Coverages A, B, C, and D, shall be automatically increased (but not cumulatively) by: 1% on the date the policy has been in effect 3 months; 2% on the date the policy has been in effect 6 months; 3% on the date the policy has been in effect 9 months; 4% on the date the policy has been in effect 12 months; 5% on the date the policy has been in effect 15 months; 6% on the date the policy has been in effect 18 months; 7% on the date the policy has been in effect 21 months; 8% on the date the policy has been in effect 24 months; 9% on the date the policy has been in effect 27 months; 10% on the date the policy has been in effect 30 months; 12% on the date the policy has been in effect 33 months; -10- HOMEOWNERS POLICY — SECTION II — COMPREHENSIVE PERSONAL LIABILITY — CONDITIONS APPLICABLE TO SECTION 11 COVERAGE E — PERSONAL R LIABILITY This Company agrees to pay on behalf of the Insured all sums which the Insured shell become legally obligated to pay as damages because of bodily injury or property damage, to which this insurance applies, caused by an occurrence. This Company shall have the right and duty, at its own expense, to defend any suit against the Insured seeking damages on account of such bodily injury or property damage, even if any of the allegations of the suit are groundless, false or fraudulent, but may make such investigation and settlement of any claim or suit as it deems expedient. This Company shall not be obligated to pay any claim or judgment or to defend any suit after the applicable limit of this Company's liability has been exhausted by payment of judgments or settlements. COVERAGE F — MEDICAL PAYMENTS TO OTHERS This Company agrees to pay all reasonable medical expenses, incurred within one year from the date of the accident, to or for each person who sustains bodily injury to which this insurance applies caused by an accident, while such person is: 1. on an insured premises with the permission of any Insured; or 2. elsewhere, if such bodily, injury a. arises out of a condition in the insured premises or the ways immediately adjoining, b. is caused by the activities of any Insured, or by a residence employee in the course of his employment by any Insured, c. is caused by an animal owned by or in the care of any Insured, or d. is sustained by any residence employee and arises out of and in the course of his employment by any Insured. EXCLUSIONS This policy does not apply: 1. Under Coverage E — Personal Liability and Coverage F _ Medical Payments to Others: a. to bodily injury or property damage arising out of the ownership, maintenance, operation, use, loading or unloading ;3» of: _ (1) any aircraft; or (2) any motor vehicle owned or operated by, or rented or loaned to any Insured; but this subdivision (2) does not apply to bodily injury or property damage occurring on the residence premises if the motor vehicle is not subject to motor vehicle registration because it is used exclusively on the residence premises or kept in dead storage on the residence premises; or (3) any recreational motor vehicle owned by any Insured, if the bodily injury or property damage occurs away from the residence premises; but this subdivision (3) does not apply to golf carts while used for golfing purposes. This exclusion does not apply to bodily injury to any residence employee arising out of and in the course of his employment by any Insured except while such employee is engaged in the operation or maintenance of aircraft; b. to bodily injury or property damage arising out of the ownership, maintenance, operation, use, loading or unloading of any watercraft. (1) owned by or rented to any Insured if the watercraft has inboard or inboard- outboard motor power of more than 50 horsepower or is a sailing vessel (with or without — 11 — auxiliary power) 26 feet or more in overall length; or (2) powered by any outboard motor(s), singly or in combination of more than 25 total horsepower, if such outboard motor(s) is owned by any Insured at the inception of this policy and not endorsed hereon, unless the Insured reports in writing to this Company within 45 days after acquisition his intention to insure the outboard motor or combination of outboard motors, ownership of which was acquired prior to the policy term. This exclusion does not apply to (a) bodily injury or property damage occurring on the residence premises or (b) bodily injury to any residence employee arising out of and in the course of his employment by any Insured; c." to bodily injury or property damage arising out of the rendering of or failing to render professional services; d. to bodily injury or property damage arising out of business pursuits of any Insured except activities therein which are ordinarily incident to non - business pursuits; e. to bodily injury or property damage arising out of any premises, other than an insured premises,• owned, rented or controlled by any Insured; but this exclusion does not apply to bodily injury to any residence employee arising out of and in the course of his employment by any Insured; f. to bodily injury or property damage which is either expected or intended from the standpoint of the Insured. 2. Under Coverage E — Personal Liability a. to liability assumed by the Insured under any contract or agreement not in writing or under any contract or agreement in connection with the Insured's business; b. to bodily injury to any person, including a residence employee, if the Insured has a policy providing workmen's compenstion or occupational disease benefits for such bodily injury or if benefits for such bodily injury are in whole or in part either payable or required to be provided by the Insured under any workmen's compensation or occupational disease law; c. to property damage to property owned by the Insured; d. to property damage to property occupied or used by the Insured or rented to or in the care, custody or control of the Insured or as to which the Insured is for any purpose exercising physical control; e. to sickness, disease or death resulting therefrom of any residence employee unless written claim is made or suit is brought therefor against the Insured within 36 months after the end of the policy term. 3. Under Coverage F — Medical Payments to Others a. to bodily injury to any person, including a residence employee, if any person or organization has a policy providing workmen's compensation or occupational disease benefits for such bodily injury or if benefits for such bodily injury are in whole or in part either payable or required to be provided under any workmen's compensation or occupational disease law; b. to bodily injury to (1) any Insured under parts (1) and (2) of the definition of "Insured ", (2) any person, other than a residence employee, regularly residing on any part of the insured premises, or (3) any person while on the insured premises because a business is conducted or professional services are rendered thereon. SUPPLEMENTARY COVERAGES 1. Damage to Property of Others: This Company will, at its option, either pay for the actual cash value of property damaged or destroyed during the policy period by any Insured, or repair or replace such property with other property of like quality and kind, but in no event shall this —12— • Company's limit of liability exceed $250 in any one occurrence. This coverage does not apply to damage to or destruction of property: a. caused intentionally by any Insured who has attained the age of 13; b. owned by or rented to any Insured, any tenant of any Insured or any resident of Named Insured's household; c. arising out of (1) any act or omission in connection with premises (other than the insured premises) owned, rented or controlled by any Insured, (2) business pursuits or professional services or (3) the ownership, maintenance, operation, use, loading or unloading of any land motor vehicle, trailer or semi- trailer, farm machinery or equipment, aircraft or watercraft; d. if insurance therefor is provided under Section I of this policy. 2. Personal Liability Claim Expenses: This Company will pay: a. all expenses incurred by this Company .and all costs taxed against the Insured in any suit defended by this Company; b. all premiums on appeal bonds required in any such suit, premiums on bonds to release attachments in any such suit for an amount not in excess of the applicable limit of liability of this policy, and the cost of bail bonds required of the Insured because of accident or traffic law violation arising out of the use of any vehicle to which this policy applies, not to exceed $250 per bail bond, but this Company shall have no obligation to apply for or furnish any such bonds; c. all interest on the entire amount of any judgment which accrues after entry of the judgment and before this Company has paid or tendered or deposited in court that part of the judgment which does not exceed the limit of this Company's liability thereon; d. reasonable expenses incurred by the Insured at this Company's request, including actual loss of earnings (but not loss of other income) not to exceed $25 per day because of his attendance at hearings or trials at such request. Any expenses incurred by this Company under this provision shall not reduce the applicable limit of liability. 3. First Aid Expenses: In addition to this Company's limit of liability, this Company will pay expenses incurred by the Insured for first aid to others at the time of an accident, for bodily injury to which this insurance applies. 4 Property in Control of the Insured: Such insurance as is afforded under Coverage E — Personal Liability, applies to property damage to any insured premises and to house furnishings therein if such property damage arises Out of fire, explosion, or smoke or smudge caused by sudden, unusual and faulty operation of any heating or cooking unit. Exclusion 2.d. does not apply to this Supplementary Coverage. 5. Construction of New Residence. Such insurance as is afforded under Coverage E — Personal Liability, applies to bodily injury and property damage arising out of any vacant land owned by or rented to any Insured on which a one or two family dwelling is being constructed for use by any Insured as a residence. Such insurance as is afforded under Coverage F — Medical Payments to Others, applies to bodily injury sustained by any person while on such vacant land with he permission of any Insured. This coverage does not apply to bodily injury to any employee, other than a residence employee, of any Insured arising out of and in the course of this employment by any Insured. Exclusion 1.e. does not apply to this Supplementary Coverage. — 1 Owner's Name and Address l t Name .•nd address of licemed contractor ( + • ` Registered Architect and /or Engineer Location and legal description of lot to be built on: Lot. Block.._ ___ Street and Number where work is to be done_ State work to be done and purpose of building (by floors) New Building_ To be constructed of Estimated " ,tal cost Remodeling_ .� Kimol of foundation of improvements $__ Zone ^ubage required __. C Distance to next nearest building_- - _ Maximum live load to be borne by each floor _____ Remarks. Permit No.. Disapproved (Signed) -__ _. Chairman Member and who, being by me firs of th abov. de c ibe ! i therein by him p e tr Member Council Approved MIAMI SHORES VILLAGE 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 o her structure her:•ir described. This application is made in compliance and con•orm'ty with the Building Ordinance of Miai ii Shores Village, Ftorda, and all provisions of the Laws cf the State, of Florida all o of Miami Shores Village and all rules and regulations of the Building Diviti -,n of illage h 'I lie ^ompl,ed with, whether herein specified or not. A copy of approved plans and specifications must be kelp at building durint progress of the work. BU•1LDIN: INSPECTION DEPARTMEN .. Date late — -; uilding Inspector PLANNING BOA Su ivision Cl I No Addition Date Member Member - _ - Member Date Disapproved Repairs. 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 unde signed appli-•ant for this budding permit does hereby certify That he understands and accepts his obligations as an employer of 1: bor under he Florida Workmen's Compensation Act, bang St•-•tion 5966. Col - pled Gen • al Laws of Florida. P' •r• anon: &ipplt 'lent . ntractors or sub - contractors cinplo .ed by him coon on the site of the work suelj public notif e , ctors, on work to be perforn; d .:. h r this and h s compl ed with he provisions thereof, and will require similar comn Lance from all in the wo k to be p rf . under this permit: and will post or cause to be posted for insp or es as are requir• d by the Act. The u. dtrigncd agrees to employ only such :ubcont permit as are licensed by M am Shores ‘ ill:;ge. (Signed) " 6 Amount c f Permit plan Cubage ___Siz y s of Building Lot .&_/. STATE OF FLORIDA, COUNTY OF DADE. ss. Before me, the undersigned authority, a notary public, duly authorized to administer oaths ,-nd take acknowledgments, personally t'p- peared orn, upon oath depofes and says that he is the ___ _ ______ ______ _ .. structionl t; t h. ha carefully read the foregoing application, and that he did sign the same, and that all facts 4 ; 5 ) / Read, Sworn to and Subscribed before me. Notary Public State of Florida My Com:nission Expires DATE ,19 and for no other purpose. No. of Stories / .. _ Roof Covering_ - , _ - to me well known, Date NOTE: A charge of $1.00 will be made for making corrections or changes to this application after approval 1, is be n obtained from the Planr'ng Board. A re- inspection fee of $1.00 will be charged when such re- inspection is m.• le necessary by improper notice for inspr•hon or lay Ity materials and /or workmanship. FORM OF INSURANCE LIMITS OF LIABILITY Policy Number Policy Term Bodily Injury Property Damage Workmen's Compensation Provided by Workmen's Compensation Law State of Nil Manufacturers' or Contractors' Liability $ 25, 000 Each Person $ 5) ! GO® Each Accident S 7 9 0001 Each Accident $10 9 000 Aggregate $ Each Accident $ Aggregate GNA 14GGC0 (0 9/54 - /19, Owners' or Contractors' Protective Liability $ Each Person $ Each Accident Owners', Landlords' and Tenants' Liability $ Each Person $ Each Accident $ Each Accident Automobile Liability (1) Owned Auto- mobiles (2) Hired Auto- mobiles (3) Other Non -Owned Automobiles $ Each Person $ Each Accident $ Each Accident $ Each Person $ Each Accident $ Each Accident $ Each Person $ Each Accident $ Each Accident Comprehensive Liability (1) Comprehensive Automobile (2) Comprehensive General (3) Comprehensive (Combined General and Automobile) $ Each Person S Each Accident $ Each Accident $ Each Person $ Each Accident $ Aggregate $ Each Accident S Aggregate S Each Person $ Each Accident $ Aggregate S Each Accident S Aggregate Locations Covered C .7`�', 17. E. 94 S ectp Zcve, Shor u V 11C..g9 9 r, .,,a P1 o bt d a, '�.s �'G Cots �� s Certificate of Insurance This is to CertiFy that the 2a:: C z1 C uan;a has issued to Name of Insured atari .`J..... licIrt-t21 Address � s __a € gL�L__. i,. i �._..�� ' ' �r s Flo td Policies of insurance described as follows: This Certificate is issued at the request of: Name. Village . . . . o _ f . _ I 1 i c m f , . . . S 3 a_ .5 1d2 g fexa at t Address 10..0.50 . -Aus2rae . Riant - ''1a 14c� whom we will wife of cancellation or any changes affecting this Certificate. /give a 5-jay tr£tten .qot ce till raga terdd -raat1 PR TOR 1u? b:la.. -c : x2a1 tv Caf cr;.Y (Name of Company) Form 80810B- 50M -1 -52- Authorized Agent Dated Ei ?a t 1 19 �— (Official Title) Owner's Name and Address 114i Registered Architect and /or Engineer Name and address of licensed contractor Location and legal description of lot to be pn: Lot Street and Number where work is to be STATE OF FLORIDA, COUNTY OF DADE. f ss Chainnan .... Member Member Counc' Approved 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 hores Village and all rules and regulations of the Building Division of Miami Shores Village shall be complied with, whether herein s ified or not. A copy of approved plans and specifications must be kept at building during progress of the work Block State work to . - don a and purpose of ilding (by floors)._ u vision_ and for no other purpose. New Building .L,l Remodeling Addition Repairs No. of Stories To be constructed of Kind of foundation - ._ - - - - -- - Roo Covering „c �,t� Estimated Total cost of improvements $__ _ - _ - v� _________Amount of Permit $ Zone cubage required_ Distance to next nearest building__..._.- ............................. of Building Lot Maximum live load to be borne by each floor ____ .................. __.__._ ...... __.______._ I hereby submit the • ns and spec' ' ation for said building. All notices wit ` o t r b 'ldin: and its co struct `� lay be sent to -- - - j - ' _. - _--- ..0. � ' _ � / t i f 7 - The undersigned applicant for this buildi /p- /it does hereby certify that he t�(derstands and accepts h' 'obligations as an employer of labor under the Florida Workmen's Compensation Act, being Section 5968, 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 subcontractors, work to be performed under this permit, as are licensed by Miami Shores Village. Remarks ._ ________- - -_ - -- Date �► '' i ,19 °/ _ -- No Street__ plan Cubage 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 true. Permit No._ ________ _ __________ Date Read, Sworn to and Subscribed before me. Disapproved _______ Date. (Signed) Buildin: Inspector My Commission Expires Notary Public, State of Florida to me well known, PLANNING BOARD DATE Member Member Member _ Date Disapproved Date OTE: A charge of $1.00 will be made for making corrections or changes to this application after approval has been obtained from 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. Exclusions —This insurance does not cover on motor vehicles, boats and aircraft, nor upon any completed building or building occupied in whole or in part. Termination of Contract —It is a condition of this insurance that this policy covers the property described herein only while the building is in process of erection and completion and that the building herein insured is unoccupied and not completed and that when occupied in whole or in part, this Company shall be notified and rate adjusted, except that if the building is to be a manufacturing plant, machinery may be set up and tested. Work and Materials Clause— Permission granted to do such work and keep and use such materials as are usual in the erection and completion of such buildings. Method of Computing Premium —In consideration of this policy being issued for "this Company's percentage" of the "Estimated Completed Cost" and of the liability under this policy being limited to "this Company's percentage" of the actual completed values as to each building or structure insured hereunder and in no event to exceed "this Company's percentage" of the "Estimated Completed Cost" of each as hereinbefore shown, the premium under this policy shall be calculated by multiplying one -half of "this Company's percentage" of the specified "Estimated Completed Cost" of each building or structure by the rate applicable thereto. Automatic Reinstatement Clause —In event of loss, the amoun o sso�h 11 automatically reinstated and in consideration of such reinstate- ment the Insured shall pay this Company an additional premium co e rate at which this policy is written for the unexpired term of this policy on the amount of loss paid. Electrical Apparatus Clause (Not applicable to Windstorm and Hail Insurance) —If electrical appliances or devices (including wiring) are covered under this policy, this Company shall not be liable for any electrical injury or disturbance to the said electrical appliances or devices (including wiring) caused by electrical currents artificially generated unless fire ensues, and if fire does ensue this Company shall be liable only for its proportion of loss caused by such ensuing fire. Mortgagee Clause (This entire clause is void unless name of mortgagee or trustee is inserted on reverse side in space provided) —Loss, if any on building items under this policy, shall be payable to the mortgagee (or trustee) as provided herein, as interest may appear, and this insurance, as to the interest of the mortgagee (or trustee) only therein, shall not be invalidated by any act or neglect of the mortgagor or owner of the within described prop- erty, nor by any foreclosure or other proceedings or notice of sale relating to the property, nor by any change in the title or ownership of the property, nor by the occupation of the premises for purposes more hazardous than are permitted by this policy: Provided, That in case the mortgagor or owner shall neglect to pay any premium due under this policy, the mortgagee (or trustee) shall, on demand, pay the same. Provided also, That the mortgagee (or trustee) shall notify this Company of any change of ownership or occupancy or increase of hazard, which shall come to the knowledge of said mortgagee (or trustee) and unless permitted by this policy, it shall be noted thereon, and the mortgagee (or trustee) shall, on demand, pay the premium for such increased hazard for the term of the use thereof ; otherwise, this policy shall be null and void. This Company reserves the right to cancel this policy at any time as provided by its terms, but, in such case this policy shall continue in force for the benefit only of the mortgagee (or trustee) for ten days after notice to the mortgagee (or trustee) of such cancellation, and shall then cease, and this Company shall have the right, on like notice, to cancel this agreement. Whenever this Company shall pay the mortgagee (or trustee) any sum for loss under this policy and shall claim that. as to the mortgagor or owners, no liability therefor existed, this Company shall, to the extent of such payment, be thereupon legally subrogated to aH the rights of the party to whom such payments shall be made, under all securities held as collateral to the mortgage debt, or may at its option pay to the mortgagee (or trustee) the whole principal due or to grow due on the mortgage with interest, and shall thereupon receive a full assignment and transfer of the mortgage and of all such other securities ; but no subrogation shall impair the right of the mortgagee (or trustee) to recover the full amount of his, her or their claim. The above Mortgagee Clause DOES NOT apply to personal property. EXTENDED COVERAGE (Applies only in consideration of Additional Premium shown on the reverse side in space provided) - 1 In consideration of the premium for this coverage shown on reverse side hereof, and subject to provisions and stipulations (hereinafter referred 2 to as "provisions ") herein and in the policy to which this Extended Coverage is attached, including riders and endorsements thereon, the coverage of 8 this policy is extended to include direct loss by WINDSTORM, HAIL, EXPLOSION, RIOT, RIOT ATTENDING A STRIKE, CIVIL COMMOTION, 4 AIRCRAFT, VEHICLES AND SMOKE. 6 This Extended Coverage does not increase the amount or amounts of insurance provided in the policy to which it is attached. 6 If this policy covers on two or more items, the provisions of this Extended Coverage shall apply to each item separately. 7 Substitution of Terms: In the application of the provisions of this policy, including riders and endorsements (but not this Extended Coverage), 8 to the perils covered by this Extended Coverage, wherever the word "fire" appears there shall be substituted therefor the peril involved or the loss 9 caused thereby, as the case requires. 10 Apportionment Clause: This Company shall not be liable for a greater proportion of any loss from any peril or perils included in this Extended 11 Coverage than (1) the amount of insurance under this policy bears to the whole amount of fire insurance covering the property, whether collectible 12 or not, and whether or not such other fire insurance covers against the additional peril or perils insured hereunder; (2) nor for a greater proportion 18 than the amount hereby insured bears to all insurance, whether collectible or not, covering in any manner such loss; except if any type of insurance 14 other than fire with extended coverage or windstorm insurance applies to any loss to which this insurance also applies, the limit of liability of each 16 type of insurance for such loss, hereby designated as "joint loss," shall first be determined as if it were the only insurance, and each type of insurance 16 shall be liable for no greater proportion of joint loss than the limit of its liability for such loss bears to the sum of all such limits. The liability of 17 this Company (under this Extended Coverage) for such joint loss shall be limited to its proportionate part of the aggregate limit of this and all other 18 insurance of the same type. The words "joint loss," as used in the foregoing, mean that portion of the loss in excess of the highest deductible, if 19 any, to which this Extended Coverage and other types of insurance above referred to both apply. 20 War Risk Exclusion Clause: This Company shall not be liable for loss caused directly or indirectly by (a) hostile or warlike action in time 21 of peace or war, including action in hindering, combating or defending against an actual, impending or expected attack, (1) by any government or 22 sovereign power (de jure or de facto), or by any authority maintaining or using military, naval or air forces; or (2) by military, naval or air forces; 23 or (3) by an agent of any such government, power, authority or forces, it being understood that any discharge, explosion or use of any weapon of war 24 employing atomic fission or radioactive force shall be conclusively presumed to be such a hostile or warlike action by such a government, power, 25 authority or forces; (b) insurrection, rebellion, revolution, civil war, usurped power, or action taken by governmental authority in hindering, combating 26 or defending against such an occurrence. 27 Waiver of Policy Provisions: A claim for loss from perils included in this Extended Coverage shall not be barred because of change of occupancy 28 nor because of vacancy or unoccupancy. 29 Provisions Applicable Only to Windstorm and Hail — subject to the provisions of the Deductible Clause appearing on the reverse side hereof: This 80 Company shall not be liable for loss caused directly or indirectly by (a) frost or cold weather or (b) ice (other than hail), snowstorm, tidal wave, high 31 water or overflow, whether driven by wind or not. 82 This Company shall not be liable for loss to the interior of the building or the property covered therein caused, (a) by rain, snow, sand or 83 dust, whether driven by wind or not, unless the building covered or containing the property covered shall first sustain an actual damage to roof or 34 walls by the direct force of wind or hail and then shall be liable for loss to the interior of the building or the property covered therein as may be 36 caused by rain, snow, sand or dust entering the building through openings in the roof or walls made by direct action of wind or hail or (b) by water 86 from sprinkler equipment or other piping, unless such equipment or piping be damaged as a direct result of wind or hail. 37 Unless liability therefor is assumed in the form attached to this policy by separate and specific item(s), or by endorsement hereon, this Com- 38 pang shall not be liable for damage to the following property: (a) grain, hay, straw or other crops outside of buildings, or (b) windmills, windpumps 39 or their towers, or (c) crop silos (or their contents), or (d) cloth awnings, signs, metal smokestacks. 40 Provisions Applicable Only to Explosion: Loss by explosion shall include direct loss resulting from the explosion of accumulated gases or un- 41 consumed fuel within the firebox (or the combustion chamber) of any fired vessel or within the flues or passages which conduct the gases of combustion 42 therefrom but this Company shall not be liable for loss by explosion, rup': or bursting of steam boilers, steam pipes, steam turbines, steam engines 48 or fly - wheels, owned, operated or controlled by the Insured or located in the building(s) described in this policy. 44 Any other explosion clause made a part of this policy is superseded by this Extended Coverage. 46 Provisions Applicable Only to Riot, Riot Attending a Strike and Civil Commotion: Loss by riot, riot attending a strike or civil commotion shall 46 include direct loss by acts of striking employees of the owner or tenant(s) of the described building(s) while occupied by said striking employees and 47 shall also include direct loss from pillage and looting occurring during and at the immediate place of a riot, riot attending a strike or civil commotion. 48 This Company shall not be liable, however, for loss resulting from damage to or destruction of the described property owing to change in temperature 49 or interruption of operations resulting from riot or strike or occupancy by striking employees or civil commotion, whether or not such loss, due to 50 change in temperature or interruption of operations, is covered by this policy as to other perils. 51 Provisions Applicable Only to Loss by Aircraft and Vehicles: The term "vehicles," as used in this Extended Coverage, means vehicles running 62 on land or tracks but not aircraft. Loss by aircraft or by vehicles shall include only direct loss resulting from actual physical contact of an aircraft 68 or a vehicle with the property covered hereunder or with the building containing the property covered hereunder, except that loss by aircraft includes 64 direct loss by objects falling therefrom, This Company shall not be liable, however, for loss (a) by any vehicle owned or operated by the Insured 55 or by any tenant of the described premises ; (b) by any vehicle to fences, driveways, walks or lawns ; (c) to any aircraft or vehicle including con- 56 tents thereof other than stocks of aircraft or vehicles in process of manufacture or for sale. 67 Provisions Applicable Only to Smoke: The term "smoke" as used in this Extended Coverage means only smoke due to a sudden, unusual and 58 faulty operation of any heating or cooking unit, only when such unit is connected to a chimney by a smoke pipe, and while in or on the premises described 59 in this policy, excluding, however, smoke from fireplaces or industrial apparatus. CAUTION —WHEN THIS EXTENDED COVERAGE IS PURCHASED WITH ONE FIRE POLICY, THE INSURED SHOULD SECURE LIKE COVERAGE ON ALL FIRE POLICIES COVERING THE SAME PROPERTY. (80-F) rIng 1„ BUILDER'S RISK—ACTUAL COMPLETED VALUE FORM Attached to and formin part of Policy No 335123 MUTUAL I'VE INAMANCE CONIPANT NAME OF INSURANCE COMPANY" Masi ..._, issued at itS CITY OR TOWN Fla., Agency. Building Location and Description- 691 X: 14 , ilith SUVA Lot Ui, Stook 67 of IIWIZ SWABS SECTION MIEN VE TTTTT OR liar TION not otherwise. Said building, when completed, to be occupied as a of the Jamul it m IMMINENCE, INC. No. 80-F Florida Agent. , FLORIDA. City or Town of On the CN A A MMO HERE GIVE NUIWYVOCKS, C STR ON A ROOF COVERING- roof building and all permanent fixtures belonging to and constituting a part thereof, all while in course of construction and unoccupied and ca u 0 P•2 0 0i • This policy as to each or any building or structure above described shall be and constitute insurance on each or any of the said buildings or structures while in the course of construction in an amount not exceeding "this Company's percentage" of the u2 • actual values which may have been placed into or made a part of each or any of such buildings or structures. The amount of insurance applicable to each or any of the buildings or structures insured in course of construction shall change from time to time • a in accordance with "this Company's percentage" of the actual values which have been put into each or any of the buildings or - "B structures (in so far as they may have been completed at the time of loss), and in no event shall the amount of insurance with 1 "4.4 respect to these buildings, or structures exceed "this Company's percentage" of the "Estimated Completed Cost" of each as shown 0 in this policy. fa, Valuation Clause—The insurable value of the building described herein, when completed, is fixed at 4' Full Completed Value Co-Insurance Clause—It is a part of the consideration of this policy, and the basis upon which the pre- 8 mium is fixed, that the Insured shall at all times maintain insurance on each item of property insured by this policy of not less than the full completed value thereof, and that, failing so to do, the Insured shall be an insurer, to the extent of such deficit, and in that event shall bear his, her or their proportion of any loss. Mortga ee Clause—Loss, if any on building items, shall be payable to: (1) RUCS ISUIRALMVINALANikkIN This policy also covers items of labor, materials, equipment, supplies, forms and temporary structures of all kinds to be used in the construction of above described building, and (when not otherwise covered) builder's machinery, tools and equipment; all while forming a part of or contained in said building or temporary structure or while in cars on switches or side tracks on premises described or within 100 feet of building described in this policy, or while in the open on premises described, or when adjacent thereto while on sidewalks, streets or lleys. Estimated Completed Cost It is the intent of this contract to cover—_i._ per cent (....3a0_%), hereinafter referred to as "this Company's per- centage," of the value of the property covered hereby, but the maximum limit of liability of this Company under this policy shall not exceed this Company's percentage of the Estimated Completed Cost shown above and this Company's liability in case of loss to the property covered hereby shall not exceed this Company's percentage of such loss. (If this policy be divided into two or more items, the above shall apply to each item separately). (2) as interest may appear, subject to provisions of the Mortgagee Clause appearing on the reverse side of this form. Extended Coverage (Perils of Windstorm, Hail, Explosion, Riot, Riot Attending a Strike, Civil Commotion, Aircraft, Smoke, Vehicles, Except as Hereinafter Provided): Coverage against the perils indicated in the above caption in accordance with and subject to all the terms and conditions of the Extended Coverage appearing on the reverse side of this form will become effective only in consideration of an additional premium next specifically inserted herein. Additional Premium, Unearned Premium Clause—In consideration of $.. _ additional premium this policy covers $ on premiums charged for this policy (but not this Clause) which, by virtue of a loss under this policy, becomes earned for the unexpired term. The limit of liability under this Pose *hall be computed on a pro rata basis, being such proportion of the premiums charged under this policy as the numt4r df days from date of loss to expiration bears to the number of days in the policy term, and the amount recoverable hereunder shall not exceed the limit of liability nor a pro rata proportion thereof for partial loss. If this policy be divided into two or more items (not including this Clause), the foregoing provisions of this Clause shall apply to each item separately. Deductible Clause (Applicable to Windstorm or Hail property damage coverage only)—In consideration of the rate of pre- mium at which this policy is written, it is a condition of this contract that loss by any one windstorm and/or hailstorm to the extent of One Hundred Dollars to each of the separate items of property covered hereunder, is not recoverable, and this pol- icy is liable only for loss in excess thereof (or if there be other insurance, for its pro rata share in excess thereof). This condition shall apply (1) separately to each building, if two or more buildings be covered hereunder, and (2) separately to building and sepa- rately to contents, if a building and its contents be covered hereunder, and (3) separately to the contents of each building, if the contents of two or more buildings be covered hereunder; whether such insurance be written under specific schedule or under blanket form. THE PROVISIONS PRINTED ON THE BACK OF THIS FORM ARE HEREBY REFERRED TO AND MADE A PART HEREOF UNLESS INDICATED TO THE CONTRARY. NOTE TO AGENTS—(1) In the blanks provided on the face of the policy for showing AMOUNTS OF INSURANCE, insert the words—"See Form Attached." (2) In addition to Fire or Fire with Extended Coverage, this form may be used in writing Windstorm coverage by attaching the Windstorm and Hail Conditions Endorsement No. 2500. Correct premium for the hazard(s) insured against must be shown in the blanks provided on the face of the policy. x No Additions or Erasures in the Wording of this Form are Permitted. No. 305 Ala.-Fla. Ga.-S. C. (Edition 1 -54) VANDALISM AND MALICIOUS MISCHIEF ENDORSEMENT (For Use Only With Extended Coverage Endorsement Nos. 300, 300 -F, 300 -S, 302, 302 -F and 302 -S) 1. In consideration of Vandalism and Malicious Mischief premium shown on the first page of this policy or in the blank space below, and subject to the provisions of this policy of fire insurance and the Extended Cover- age Endorsement attached thereto and of this endorsement, the coverage under said Extended Coverage Endorse- ment is hereby extended to include direct loss to the described property from Vandalism and Malicious Mischief. 2. The term "Vandalism and Malicious Mischief" as used herein is restricted to and includes only wilful or malicious physical injury to or destruction of the described property. 3. When this endorsement is attached to a policy covering direct loss to the described property, this Com- pany shall not be liable under this endorsement for any loss (a) to glass (other than glass building blocks) constituting a part of the building; (b) by pilferage, theft, burglary or larceny, except loss by wilful or malicious physical injury to or de- struction of a building described and covered hereunder; (c) by explosion, rupture or bursting of steam boilers, steam pipes, steam turbines, steam engines, or rotating parts of machines or machinery, owned, operated or controlled by the Insured or located in the building(s) described in this policy; (d) from depreciation, delay, deterioration or loss of market; nor unless specifically endorsed hereon in writing for any loss resulting from change in temperature or humidity. 4. When this endorsement is attached to a policy covering Business Interruption (Use and Occupancy), Extra Expense, Additional Living Expense, Rents, Leasehold Interest, Profits and Commissions, or Consequential Loss, this Company shall not be liable under this endorsement for any loss due to damage to the described prop- erty when such damage results from any of the causes listed in subdivisions (b), (c) or (d) of paragraph No. 3 above. 5. The permitted period of vacancy as provided by said fire policy shall apply to liability under this en- dorsement except when such permitted period is in excess of thirty days, in which case this Company shall not be liable for loss under this endorsement occurring while the described building is vacant beyond a period of thirty days, whether or not such period commenced prior to the inception date of this endorsement; but a building in process of construction shall not be deemed vacant. Miami Beach Federal Savings and Loan Association INSURANCE MORTGAGE CLAUSE Provided that in case the Mortgagor or Owner shall neglect to pay any premium due under this Policy, the Mortgagee "or Trustee" shall on demand pay the same. Loss or damage, if any under this policy, shall be payable to MIAMI BEACH FEDERAL SAVINGS & LOAN ASSOCIATION, first mortgagee (or trustee), as interest may appear, and this insurance, as to the interest of the mortgagee (or trustee) only therein, shall not be invalidated by any act or neglect of the mortgagor or owner of the within-described property, nor by the foreclosure of the premises the 1 arzardous by permit are hangs to d by this policy. Provided, also, that the mortgagee (or trustee) shall notify this Company of any change of ownership or occupancy or increase of hazard which shall come to the knowledge of said mortgagee (or trustee) and, unless permitted by this policy, shall be noted thereon and the mortgagee (or trustee) shall, on demand, pay the premium for such increased hazard for the term of the use thereof; otherwise this policy shall he null and void. This Company reserves the right to cancel this policy at any time as provided by its terms, but in such case this policy shall continue in force for the benefit only of the mortgagee (or trustee) for ten days after notice to the mortgagee (or trustee) of such cancellation and shall then cease, and this Company shall have the right, on like notice, to cancel this agreement. Whenever this Company shall pay the mortgagee (or trustee) any suns for loss or damage under this policy, and shall claim that, as to the mortgagor or owner, no liability therefore existed, this Company shall, to the extent of such payment, be there- upon legally subrogated to all rights of the party to whom such payment shall be made, under all securities held as collateral to the mortgage debt, or may at its option, pay to mortgagee (or trustee) the whole principal due or to grow due on the mortgage, with interest accrued thereon to the date of such payment, and shall thereupon receive a full assignment and transfer without recourse of the mortgage and of all such other securities; but no subrogation shall impair the right of the mortgagee (or trustee) to recover the full amount of its claim. 4 40 earned premium on the amount of such loss payment. If a loss is paid under this policy, this insurance shall indemnify the Insured for loss of the pro rata un - This Company', however, may elect by written notice within sixty days after date of loss to reinstate this policy in the amount of such loss and, in consideration of such rein- statement, make no payment to the Insured as provided by this clause. M I p � 1 �, llC ^ �VG', r , r It Is here�y si windstorm or hail to paint or waterproof1 m t covered her ) i i I I I I N i I N I' I 1 1 I i �I 1 l� + �-� :7 Do in an , ie 'd . 11e 0 pa or waterproofing material, the exterior th e b Y manner by g(s) or structure stated, shall not be considered in the determination of actual cash value when applying g ed from the coverage as above applicable to windstorm or hail perils. the Co- Insurance Clause UNEARNED PREMIUM CLAUSE N No. 850 (Edition 8 -58) �i ill PI msINE1 1 Item No. 2 Amount Fire or Fire and Extended Cov. erase, or Other Peril 3 Amount Windstorm and Hail (If Insured) 4 Co•Insuranee % Applicable 5 Deductible Applicable Windstorm and Hail 6 DESCRIPTION AND LOCATION OF PROPERTY COVERED Show construction, type of roof and occupancy of building(s) covered or containing the property covered. If occupied as a dwelling state No. of families. Fire and Lightning Ext. Cov. or Specific Wind & Han No. 335113 Middlesex Mutual Fire Insurance Company RENEWAL OF NUMBER VOW DUMP te alas VW `1i INSURANCE IS PROVIDED AGAINST ONLY THOSE PERILS AND FOR ONLY THOSE COVERAGES INDICATED BELOW BY CHARGE AND AGAINST OTHER PERILS AND FOR OTHER COVERAGES ONLY WHEN ENDORSED THEREON OR ADDED THERETO. PERIL(S) Insured Against and Cover- AMOUNT age(s) Provided (Insert Name of Each) FIRE AND LIGHTNING EXTENDED COVERAGE (including Windstorm and Hail) WINDSTORM AND HAIL $ YOB kalicious insane at d- legal reprc-nntatives,-te- the would cost to repair or replace the p for any increased cost of repair or rec sation for loss resul ' g from interruption o DIRECT LOSS BY FIRE, LIGHTNING AND BY RE THEREINAFTER PROVIDED, to the property described the proper place to which any of the property shall necessarily Total Insurance — Valuation Clause — Subject to Bureau Form No(s). Policy Issued ON31 -O -A Asi%Mt 25, 1,954 MEMORANDUM OF INSURANCE Concord, Massachusetts ESTABLISHED 1826 $ X X X X $ $ $ Dividend $ RATE PREMIUM . • s� 6 2 MUTUAL COMPANY NONASSESSABLE POLICY THIS CERTIFIES, that policy numbered as above has been issued. TOTAL PREMIUM $ 641031 In Consideration of the Provisions and Stipulations Therein or Added Thereto AND OF the premium above specified this Company, for, the tegn of 41144 from August 25 , At Noon (Standard Time) to 25. At Noon (Standard Time) at location of property involved, to an amount not exceeding the amount(s) above specified, has insured 4+4 O. '. 41. w s the actual cash value of the "property at the time of- lomig,:J not- exceeding the amount which it material of like kind and quality within a reasonable time after such loss, with:Out allowance Aiy reason of any ordinance or law regulating construction or repair, `and without ,compen- manufacture, nor in any event for more than the interest of the in t " all jEMISES ENDANGERED BY THE PERILS INSURED AGAINST IN THE POLICY %' ,S while located or contained as described ih the policy, or prd rata for five'daylt ved for preservation from the perils insured against in the policy, but not else Item 1, $ ; Item 2, $ Item $ Item , $ # $ SO! ; Item 3, $ ; Item 4, $ ; Item , $ ; Item , $ The Safe Flue Warranty in form does Mortgage Clause: Subject to the provisions of the mortgage clause attached to policy, loss, if any, on building items, shall be payable to: A PREMIUM apply. This is furnished simply as a memorandum of said Policy as it stands at the date of issue hereof, and is given as a matter of information only and confers no rights on the holder and imposes no liability upon this Company. Ctia *It 441144siocitv *44 Agent. MEMORANDUM OF INSURANCE See Inside for Amount(s) of Insurance and Peril(s) Insured Against No. 335123 Expires August 25, 1955 Basic Amount $ 16,300 Premium $ 64.31 Property Dwelling Under Construction Insured's name and mailing address Starr W. Horton & Charlotte C. Horton 1412 N. W. 100th Street Miami, Florida 17. It is important that the written portions of all policies covering the same property read exactly alike. If they do not, they should be made uniform at once. MIDDLESEX MUTUAL Fire Insurance Company Concord, Massachusetts ESTABLISHED 1826 A Mutual Company THIS POLICY IS NONASSESSABLE THIS LICENSE MUST BE DISPLAYED IN A CONSPICUOUS PLACE A PENALTY IS IMPOSED FOR FAILURE TO KEEP THIS LICENSE EXHIBITED AT YOUR ESTABLISHMENT OR PLACE OF BUSINESS Village THIS LICENSE EXPIRES In consideration of the sum zp7 )242 iNaivo License 19 Paid to Miami Shorq/ ViI!ige, D de County, Florida, is h eby licensed to engage in or operate the business of i 12 - • - " c io / Date Issued 414 /9' 180 Dollars ($" ow, • SOw �1 VIL THIS LICENSE NOT TRANSFERABLE WITHOUT THE PPRO OF THE VILLAGE MANAGER. MSV 1934 6.411EPP KENNEDY & ELY INSURANCE C O M P R E H E N S I V E • A L L R I S K P O L I C I E S • F L O A T E R S • C A S U A L T Y • M A R I N E Village of Miami Shores Miami Shores, Florida 1 N C. Re: Starr W. Horton & Charlotte C. Horton Gentlemen: CONGRESS BUILDING M1A111.FIORIDA August 31, 1954 Enclosed is memorandum of Middlesex Mutual Fire Insurance Company Policy No. 335123 which provides $16,300 Builder's Risk coverage on the dwelling under construction at 691 N. E. 94th Street. We trust you will find this enclosure entirely satisfactory and await the pleasure of serving you again. Yours very truly KENNEDY & ELY INSURANCE, INC. C. r =Ze T. C. Hollett TCH:db Enc. \N C E S 9 TELEPHONE 3 -0641 MIAMI SHORES VILLAGE BUILDING INSPECTION DEPARTMENT. APPLICATION FOR BUILDING PERMIT Application is hereby made for the approya1 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 contactor — 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) Permit No Disapproved (Signed) ._ No‘9l . Street �1 ._ �• and for no other purpose. New Building Remodeling Addition P Repairs No. of Stories To be constructed of Kind of foundation Roo ring Estimated Total cost of improvements $ :Q. :. 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 inspection on the site of the work such public notice or notices as arc required by the Act. The undersigned agrees to employ only such subcontractor , on work to be performed 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 - -- 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 ss tee ark true. , 3 f Date Read, Sworn to and Subscribed before me. Notary Public, State of Florida to me well known, Building Inspector y Commission Expires PLANK G 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 and Address 0 Registered Architect and /or Engineer � Name and address of licensed contractor i �" 14 arc' Location and legal description of lot to be built on: Lot Block Subdivision State work to l?s.,done and purpo,,se, of building (by floors) VA 1 etv-A Build' '' nspector • 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 herei i specified or not. A copy of approved plans and specifications must be kept at building during progress of the work. No. b Q ..j JL! Street and Number where work is to be done 1 ( A '5 q t4 $ Date (Signed) 1 cQ L O-3 5 u ( 7 `1 c� ,19 Street_ Cr r 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 $_l 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 inspection on th - of the work such public notice or notices as are required by the Act. The undersigned agrees to employ only such subcontractors, o- wor' to performed under this permit, as are licensed by Miami Shores Village. Remarks 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 ead the foregoing application, and that he did sign the same, and that all facts therein by him stated are true. / Permit No ZA C� Date /tD Read, Sworn to and Subscribed before me. Disapprove --- K (Signed) 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 $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. APPLICATION FOR BUILDING PERMIT Application is hereby wade 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. Owner's Name and Address . Registered Architect and /or Engineer Name and address of licensed contractor Location an legal description of lot to be built on: Lot Block Subdivision 4i 4->n,, C s ___.. Street and Number where work is to be done y . l.._2 . 9X State work to be done and purpose of building (by floors) MIAMI SHOR[S /VILLAGE BUILDING INSPECTIO EPARTMENT Disapproved {{,' Date (Signed) (�Y� �� P But ding lnspecto Date..._..4.1 /Zs _ _ _ ..... ,.1 7-3 _ No.. 4691. StreetZ5 .ia .f. .. .................. !.11..11.1 and for no other purpose. New Building Remodeling Addition Repairs No. of tories To be constructed of . Kind of foundation... Roof Covering _ Estimated Total cost of improvements $ 1 �C 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, Pennxnc•nt 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 pennit, as are licensed by Miami Shores Village. Remarks._._ (Signed)_. s�!�._. 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. / q� Permit No.. / Z Date.../ a - 7 3 Read, Sworn to and Subscribed before me. Notary Public, State of Florida My Commission Expires PLC NNING BOARD DATE Chairman Member Mfcrnber 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 hoard. 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 PRESENT ADDRESS t LICENSE NO. PHONE NO. A JOB LOCATION (ST. OR AVE.) 691. 77 C J -L 71 ,_ . ;77 t, LOT . BLOCK n7 SUBDIVISION n _:c.:(: " C , 3 GENERAL CONTRACTOR i1 ,, -+ ., . � , - , 'T . : ADDRESS n ,f I PHONE NO. e � n .� V . C / T.I 7•, ^�. IC - -'�'1 4 � C^f i 4- LICENSE NO. 7 !l / % BUILDING PERMIT NO. �7 , / -- ) � DATE 0 �.9 ,�± , • PERMIT FEE $ r- "- _ rot t l/lJ /� ^/� BUILDER'S BOND NO ,,. T �. DATE .J H', .t /7 . �� f 1 5J -r C !� ZONE J. I, 500 CU. FT. 7.%4 PLAN CUBE CU. FT. EST. COST S 1 (I� 1 )0 - DRAWINGS. SPECIFICATIONS, RESTRICTIONS AND CUBE CHECKED BY: � t � i •tt DATE L%, �` b ~ ') �/ 4✓ X CONSTRUCTION TYPE ^•b•,,t STORIES ROOF CONSTRUCTION 04, t..P INTEOR CONSTRUCTION r7 "5,i�•F'Y' /.71 I q p £'.f-?l 7 4 "or REPAIRS DESCR IPTION ' ALTERATION ADDITION SUBMITTED TO PLANNING BOARD RE- SUBMITTED TO PLANNING BOARD SUBMITTED TO VILLAGE COUNCIL APPROVED REJECTED DESCR.PTION REFERRED TO COUNCIL REMARKS S CERTIFICATE OF OCCUPANCY NO. • t•"- ISSUED 1` .,� ` �� x BY �" / TO BUILDING PERMIT AND INSPECTION RECORD —MIAMI SHORES VILtiA4g REASONS INSPECTIONS DATE BY RE- INSPECT BY RE- INSPECT BY FOUNDATION SPECIAL PERMITS PERMIT NO. DATE FEE TEMPORARY SERVICE BEAMS & LINTELS "a ' a i y X': 3 - - i� 1 SEWER FRAMING /24 )/ .. SOLAR HEATER • +1 $ GAS I $ f /', / S �� .; / / / / f FINAL INSPECTIONS DATE BY RE- INSPECT IY RE- INSPECT CLEAN -UP ROUGHING i //, ' ., CONTRACTOR 1 -- �,� ' PHONE PERMIT NO. DATE FEE $ NEW BLDG. I ALTERATION ADDITION REPAIRS SPECIAL PERMITS PERMIT NO. DATE FEE TEMPORARY SERVICE $ $ SEPTIC TANK A f.} ; .; X': 3 - - i� 1 SEWER . a x, +. } $ • SOLAR HEATER • +1 $ GAS ® - $ f /', / S �� .; / / / / f $ INSPECTIONS DATE BY RE- INSPECT IY RE- INSPECT BY ROUGHING i //, ' ., ROUGHING / GAS • SEWER RANGE CONN. SEPTIC TANK SOLAR HEATER FIXTURES & FINAL FIXTURES . • CONTRACTOR �' �-� ^ ^ f� PHONE FEE $ PERMIT NO. �.! DATE NEW BLDG. 1 ALTERATION ADDITION REPAIRS SPECIAL PERMITS PERMIT NO. DATE FEE TEMPORARY SERVICE $ H. W. HEATER CONN. $ RANGE CONN. $ MOTORS FIXTURES �� -' " ® - $ f /', / INSPECTIONS DATE BY RE- INSPECT BY RE- INSPECT BY TEMP. SERVICE i r/—.V,6 ROUGHING H. W. HEATER CONN RANGE CONN. FIXTURES & FINAL " ,` � � . . • BUILDING INSPECTIONS PLUMBING PERMITS & INSPECTIONS ELECTRICAL PERMITS & INSPECTIONS APPROVAL TO POWER CO. FOR SERVICE DATE Lot ) CERTIFICATE OF OCCUPANCY MIAMI SHORES VILLAGE, FLORIDA BUILDING DIVISION N? 32 Owner, Agent or Tenant of Building Z • Miami Shores Village, Florida, Block Subdivision Street Address i i 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 as 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 MIAMI SHORES VILLAGE BU :;.DING INSPECTION DEPARTMENT APPLIr( TION 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 2/8/ _._.�.._....,19......_ Owner's Name and Address Mr. Flagame - 691 N. E .j St . M. Sh %. Registered Architect and /or Engineer Orkin Ext.Co. Inc. 1960 N.W. 27 Ave.Miami- 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 691 N.E. 94 St. M. Shores. State work to be done and purpose of building (by floors Nylon Tent Fumigation - Vikane 18 -24 hours Pure g ( Y )• - ... _........_... — _ - -- — 2 - 8# $260.00 .. -- ._•- ___ - -_ 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 $ Amount of Permit $ Zone cubage required plan Cubage. Distance to next nearest building._- -__ _ _ ___._ -Size of Building Lot. 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 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) - -- Z4 �sa� 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 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. 2 3 �' f (... Read, Sworn to and Subscribed before me. Permit No. _ -__ Date-•--••--- -___-- -- ___ - -- Disapproved (Signed) t to me well known, Notary Public, State of Florida Building Inspec My Commission Expires P NNING BOARD DATE 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 hecn obtained from the Planning 13oard. 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. Chairman Member STATE OF FLORIDA) SS COUNTY OF DATE ) /® �► ??" " of the Village of ' Miam#•Ohores, County of Dade and Utate of Florida, being duly sworn, doth depose and say, that under the provisions of Ordinance No. 185, dated June 15, 1948, amend. ing paragraph (d) of Section B -368 of Ordinance No. 9 o the Building Code of Miami Shores Village, he desires to build a on Lot / Block 4,-) o f ..S(pc..3 J V 4 ) M , Aj r - diel Subdi ision, that he is the owner of said property, and will be the owner of said , that he will do the work personally, and that . he will, at such times as are required by the Zoning and Building Director:- 1. File plans and specifications and obtain approval of the Planning Board and the Building Inspector. 2. Apply for and secure a Permit. 3. Pay the required fees. AFFIDAVIT 4. Execute the work in accordance with the provisions of this Code. 5. Apply for inspections. 6. File with the Building Inspector certificates that provision has been made to carry the necessary Workmen's Compensation, Public Liability and Property Damage Insurance. 7. File with the Building Inspector as the job progresses certiR ficates showing the payment required by the Federal Social Security Act to the State of Florida or the United States of America. 8. Assume the responsibility of not employing other than properly licensed contractors by Miami Shores Village for any part or portion of the work. 9. Not set himself up as a "contractor ". 10. Sign an affidavit before con menc ing work to the effect that he has read this Article and will do the work personally and observe all of the requirements of the Building, Electrical, Plumbing and Zoning Codes of Miami Shores Village. Such affidavit to be properly notarized upon blanks to be supplied by the Building Inspector. 11. In order to prevent abuses and subterfuge tin right of such owner- builder as herein provided, is limited to but one owner- builder permit each 2 years, and where an owner- builder has once exercized the privilege herein conferred no second application for owner- builder permit shall be granted_.in less than ,2 years, unless the applicant is qualified as a licensed General Contractor under the applicable Ordinances of said Village. And Further this Deponent says not: SUBSC ED AND - SW9 N - 0 $EEORE ME this / / day of 19 �' --- NOTARY PUBLIC i'.G`' '' „'.0 s of ; l..fi; ,•