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912 NE 95 St (7)CERTIFICATE OF OCCUPANCY, MIAMI SHORES VILLAGE, FLORIDA BUILDING DIVISION N° _ 62 Miami Shores Village, Florida Owner, Agent or Tenant of Building Approved us by Remarks. } lqc `rte \fe? Lot Block^ Subdivision_„__ Street Address D r oA, 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 OWNER'S NAME C. Richardson PRESENT ADDRESS LICENSE NO. PHONE NO. JOB LOCATION (ST. OR AVE.) 912 N.E. 95th Street LOT BLOCK SUBDIVISION t,f GENERAL CONTRACTOR Maurer Const. Co. ADDRESS PHONE NO. LICENSE NO. r/ BUILDING PERMIT NU. d DATE 10- 18 -5G. PERMIT FEE 5 10.00 BUILDER'S BOND NO.J719 DATE ZONE REQUIREMENTS CU. FT. PLAN CUBE 4,495 CU. FT. EST. COST 6,000 DRAW NGS, SPECIFICATIONS, RESTRICTIONS AND CUBE CHECKED BY: DATE NEW CONSTRUCTION TYPE STORIES ROOF CONSTRUCTION INTERIOR CONSTRUCTION DESCR IPTION bedr and bath addn. and car ports also DESCRIPTION ALTERATION ADDITION SUBMITTED TO PLANNING BOARD APPROVED REJECTED REFERRED TO COUNCIL REASONS RE- SUBMITTED TO PLANNING BOARD SUBMITTED TO VILLAGE COUNCIL REMARKS CERTIFICATE OF OCCUPANCY NO. 6' ISSUED�1 /4 / BY Ar(/i.1 TO �� BUILDING PERMIT AND INSPECTION RECORD -MIAMI SHORES VILLAGE INSPECTIONS PHONE DATE FEE $ � V) BY RE- INSPECT BY RE-INSPECT BY FOUNDATION / , � � EA SEPTIC TANK H. W. HEATER CONN. $ BEAMS & LINTELS RANGE CONN. / SOLAR HEATER MOTORS $ GAS FRAMING / /` ( /� $ a\( $ INSPECTIONS DATE BY RE- INSPECT BY RE- INSPECT BY ROUGHING TEMP. SERVICE FINAL )x.' 1.1 °s'1 GAS W4 /H / yc' ✓["` CLEAN -UP SEWER %k • ` SEPTIC TANK CONTRACTOR /�4}�4 PHONE PERMIT NO. /� d DATE e,°t� 7 FEE $ � V) NEW BLDG. IY ALTERATION ADDITION REPAIRS , SPECIAL PERMITS PERMIT NO. DATE FEE TEMPORARY SERVICE TEMPORARY SERVICE $ SEPTIC TANK H. W. HEATER CONN. $ SEWER RANGE CONN. $ SOLAR HEATER MOTORS $ GAS FIXTURES $ $ $ INSPECTIONS DATE BY RE- INSPECT BY RE- INSPECT BY ROUGHING TEMP. SERVICE GAS ROUGHING /H / yc' ✓["` SEWER H. W. DATER CONN SEPTIC TANK RANGE CONN. SOLAR HEATER i ' FIXTURES 11,, D.'l1° �� IJf �1\ r y1 CONTRACTOR 1 - <h PP CLJ .. -"`" • PHONE PERMIT NO. 1 c(1 I DATE fA /5 FEE $ NEW BLDG. ALTERATION I I ADDITION REPAIRS SPECIAL PERMITS PERMIT NO. DATE FEE TEMPORARY SERVICE $t $ H. W. HEATER CONN. (--J " $ / / ? RANGE CONN. $ MOTORS $ FIXTURES $ $ INSPECTIONS DATE BY RE- INSPECT BY RE- INSPECT BY TEMP. SERVICE ROUGHING /H / yc' ✓["` H. W. DATER CONN RANGE CONN. i ' FIXTURES & FINAL 1 6 BUILDING INSPECTIONS 2 o3 PLUMBING PERMITS & INSPECTIONS ELECTRICAL PERMITS &„INSPECTIONS APPROVAL. TO POWER CO. FOR SERVICE D E / �i�1 n /9 BY Application is hereby made for the approval of the detc iled statemen of the plans and specifications herewith submitted for the build- ing or o h. - , 11.icture her i . described. This :pilicatic is made in compliance and con•o w.th the Building Ordinance of Mia Shores Villac ;or and all pro isions of the Law if the State of Fkrid all o d nances f Mi in Shores Village and all rules and reguion. of the Building Div.. i of ..iam Sho1 iilage 1 1 ,e -o. ipl.ed with, whether herein specified or not. A copy of approved plans and specificati any must be key at bunding durin,. progress of tl.e wcrk. Date November 8 1954 , 19 Owner',. Name and Address....lialireT____C_Orlat_r_gc. GOA. No 46 N E st 6th St . Registered Architect and/or Engineer Name :nd address of licemed contractor. The Cornell Co. 2 4100 N. V.. 26th St . Location and legal description of lot to be built on: Lot. Block. Subdivision Street and Number where work is to be done 912i 9thtTt State work to be done and purpose of building (by floors) and for no other purpose. Addition X No. of Stories. New Building_ Remodeling__ Repairs. . To be constructed of ___ _ Kind of foundation . Roof Cov BU Estimated ". - ,tal cost of improvements $_20. Q 0 Amount of Permit $ 5_ 00 Zone ubage required_ __. Plan Cubage Distance to next nearest building__ _ _ Size of Building Lot Maximum live load to be borne by each floor hereby submit all the plans and specineations for said building. All notices with reference to the building and its construction may be sent to The unde signed appli .ant for th's building permit does hereby certify that he understands and accepts his ...bligations as an employer of 1- bor under he Florida Workmen's Compensation Act bung S. -tion 5966 Coi p led Gen al Laws of Florida J2r anen Sopple nent, and h !s complied w;th he prov'ilons thereof, and will require similar complance from all contrac s or sub-co ors emplo •ed by h / in the work to be p.'rf under this perwit and ill post or cause to bc posted or ins ectio the site e work su :11 public no '.e, /: or i.otit es as are requir d by the Act. The u.,d; r :ignr.d agrees to employ only bco tr. ct on worx permit as are licensed by M amt Shores Nil:: ge. eetafprp t_ th i ls/7 / Remarks._ (Signed) _ Chairinan Member __ PPLICATION FOR BUILDING PERMIT IAMI SHORES VILLAGE BUILDIN INSPECTION DEPARTMEN STATE OF FLORIDA, COUNTY OF DADE. ss. Before me, the undersigned authority, a notary public, duly authorized to adm:nister oaths ,.rid take acknowledgments, personally op- peared PLANNING BOARD DATE Member Member Member Member Council Approt _Date Disapproved .to me well known, and who, being by me first di ly sworn, upon oath deposes and says that he is the of th abov. described instruction t'.. it h has carefully read the foregoing application, and that he did sign the same, and that all facts therein by him stated are tr le. Permit No c 2 d 3 Date.. j/- 9''' ..c271 Read, Sworn to and Subscribed before me. Disapproved Date (Signed) Notary Public State of Florida Buildi nspector My Com:nission Expires. Date NOT NOTE: charge of $1.00 will be made for making corrections or changes to this application after approval his hecn obtained from the P1aui'u Board. A re-inspection fee of $1.00 will be charged when such re-inspection is ma de necessary by improper notice for inspet.tw or fa ity materials and/or workmanship. THIS CERTIFICATE MUST BE PRESENTED TO THE ELECTRIC COMPANY WHEN APPLYING FOR SERVICE. TOWN OF MIAMI SHORES Office of Electrical Inspector N9 141 CERTIFICATE OF INSPECTION THIS CERTIFIES that the wiring and apparatus installed at by Address for owner, and occupied as has been inspected and current is authorized to be turned on, until otherwise notified, for: Lights: Number of lamps Watts Heating: Stove watts. Water Heater watts Power: Connected load H. P. volts phase cycle Other Apparatus Electrical Inspector. Nip. STREET ^ PART of LOT LOT B LOCK SUBDIVISION BUILDING TO BE USED / ROOF Cosr OF BUILDING PERMIT FEE - Z/ 7,,/,, FRONT DEPTH HEIGHT STORIES TYPE OF CONSTRUCTION BUILDING TO BE USED FOR ROOF Cosr OF BUILDING PERMIT FEE - Z/ 1:>,' Brame, o Residence. l ✓ �` ;f BUILDING PERMIT • Owner of Building Architect Contractor or Builder Dated , 19. -PA:( PROPOSED LOCATION MIAMI SHORES VILLAGE OFFICE OF BUILDING INSPECTO Miami Shor$' Village, Florida, / , I93/ DESCRIPTION OF BUILDING In consideration of the issuance to me of this, building permit I hereby agree to application and plans and specifications thereof heretofore by me submitted, and in' State of Florida, all the building ordinances and zoning laws of Miami Shores Village of Miami Shores Village. N. 181 This permit is hereby issued to �� ? //) ' , ( To S,6 1 ��� the building above described, as per applicatHans and Specifications heretofore filed in this office. This permit is granted upon the ex- press condition that all facts stated in the application are true and that the construction complies strictly with the plans and specifications submitted; and in accordance and compliance with the building laws of the State of Florida and with the building ordinances and zoning laws Miami Shores Village, and rules and regulations of the building department of Miami Shores Vill�lge. This permit may be revoked at any f y e upon the violation of any provisions of said laws, ordinances or rules and regulations or uV'on% any change in the plans and specifications authorized by the building inspector. BUILDNO INSPECTOR do the proposed construction in strict conformity with the compliance with all provisions of all building laws of the and all riles and regulations of the building department / ' / I , • (SEAL) Registered Architect and /or Engineer. nd address of licensed contractor. STATE OF FLORIDA, COUNTY OF DADE. Ss. Disapproved ate_ ( Signed) - - - - -- := urlding Inspector Chairman Member ___ Member _ Council Approved MIAMI SHORES VILLAGE BUILDIN INSPECTION DEPARTMEN APr - ' LIGATION FOR - UILDING PERMIT Application is hereby made for the approval of the detL iled statemem of the plans and specifications herewith submitted for the build- ing or o h. r `ructure her 1 , described This •-t•Iicatic is made in compliance and con o'm•ty w,th the Building Ordinance of Mia ii Shores Villatre, i ,or:da, and all pro. isions of the Laws cf the State of hl,.rid. all o d nances ,f Mi ni Shores Village and all rules and regulation.; of the Building Div.. i of .ram Shoff illage 1- 'I a -ot ipl.ed with, whether herein specified or not. A copy of approved plans and specificati •m• must be key at building durin progress of tl.e wcrk. Owner': Name and Address No Date Location and legal description of lot to be built on: Lot_ __. ___.. Block_._ ..__ bdivision Street and Number where work is to be done_ Stat��w to be done and rpose of din ! (by floors) e°'¢ and for no other urpose. New Building_ Remodeling._ ___. Addition__._ _.__ ___ _____ _. _ Repairs. _ No. of Stories. 1 .. � 9 . To be constructed of ___ _ _ Ki of foundatio� Roof Covering_ Estimated ^. ,tal cost of improvements 7 0 Amount c f Permit $_ Zone -ubage required. __. -Plan Cubage Distance to next nearest building.. _ _ __Size of Building Lot Maximum live load to be borne by each floor_ _ . _____ ___ __ hereby submit all the plans and specifications for said building. All notices with reference to the building and its construction may be sent to 'sIING BOA D PAA ___ . lca DA '�E Member _ Member Member .. Date Disapproved _. treet Notary Public State of Florida i/ My Commission Expires. 19 The unde signed appli .ant for th :s building permit does hereby certify ,'mat he understands and accepts his .bligations as an employer of 1: bor under he Florida Workmen's Compensation Act being S' 'tion 5966 Col p led Gen al Laws of Florida P r anon. S.ipplc Went, and his complied with the prov•aons thereof, and will require similar compiance from all contractors or sub - contractors cmplo •ed by him in the work to be pi under this permit and - ill post or cause to be posted for in spec�� , n the site of the work su:h public note e or i•otices as are required by the Act. The u. d�, r ign.•d agrees to employ only such- - perform permit as are licensed by M.ami Shores 'ih: ge. Remarks__ (Signed) _ Before me, the undersigned authority, a notary public, duly authorized to adm.nister oaths and take acknowledgments, personally i p- peared to me well known, and who, being by me first d; ly sworn, upon oath deposes and says that he is the of th abov. de .c ibed istruction. t; . , Ir has carefully read the foregoing application, and that he did sign the same, and that all facts therein by him stated are tr ie. Permit No � . _ � _ . _ _ Date._ - � o 0�_i_.a Read, Sworn to and Subscribed before me. ■ - Date NOTE: A charge of $1.00 will be made for making corrections or changes to this application ift'-r approval his been obtained from the Plans ng Board. A re-- inspection fee of $1.00 will be charged when such re- inspection is ma_ :e necessary by improper notice for inspe:•t'or or fa. Ity materials and /or workmanship. Miami Shores Village Building and Zoning Department Miami Shores, Fl 33138 RE: Property located at (address and legal description) 1e • t1 Gentlemen: As to 2_ /2 VIHrl_ HOLD HARMLESS Date0/0 1 owner of subject .roperty, I request the cancellation of permit numli+;r�1 k 0 IPJ Date of last inspection: I hereby apply as owner- to apply for such permits as necessary to construct or complete the construction on subject property. I agree to hold Miami Shores Village, its agents and authorized personnel harmless and relieve them from any responsibility or liability for any legal action or damage, cost or expense (including attorney's fee) resulting from the cancellation of the existing permit or the issuance of a new permit. I furthermore assume responsibility for the correction, if required, of work performed under the permit for which I am requesting cancellation. Very truly yours, 4‘ . % /f Dsoet/ (print name) STATE OF FLORIDA , COUNTY OF DADE: , for the following reason: 13, uilder,or authorize (newcont actor) The undersigned, being the first duly sworn, deposes and says that he /she is the legal owner of the above property. Sworn to and subscribed before me this _ day of Notary Public, State of Florida at Large rI . (print name) (1 N-6- ' SvP11 • ■ .1 !nKL_ 1' T 1 PAID BY YEA ANNUAL TAX PERIOD USED AMOUNT PAID DATE PAID RECEIPT NUMBER I' a ' . . , 1940 � o / .2 f /i'"© /FT d / / I S p 119 411 19 42 / / /�° ®® l/ -� - 'cam s -g Kr /1 I Cf r , iA �/ m t._ t ' . _ 1943 —y /0 ' 0 O /D.. o d • 2 �.,? 3 e ‘1 � ter %..,.. ✓ /` f /, v ± 4.- , . - " , 1 . 9944 `, ,,, 1945 L' 194 9, s��`o ' to , 2.3/4{6 w / v / 1-14 / y /4 7zAs /6 9 / fel i � 0 1947 ' / V 0 1 l ( 9949 /� or/ / / - S�� �' /`.���-S� 7 //3, ,, / % 1949 '' /o( 3/ V '' g- /,- Y s -.1- g- `J Q // /If97 /( /r 1950 /r /2- ? /- -Z LOCATION 912 N. E. 95th Street /— 72) GARBAGE TAX RECORD 912 Na E® 95th St. .year annual tax period used _amoun_t_paid datepai,d xei1 0 6 0. J. Deeki3e1 04) icg —L11.1.71 4/2 -- 7 - 77 _./40 7k7.67 _ BUILDING ❑ ELECTRICAL PLUMBING ❑ ROOFING Owner of Building CONTRACTOR OR BUILDER Architect Contractor or Builder Legal Lot II BI. Description Address of Building MIAMI SHORES VILLAGE, FLORIDA ❑ PERMIT N? 15189 ❑ Work to be performed under this Permit Subdi- vision Value of Project $ DATE: 195 Contractor's License No Amt. of Permit $ This permit is granted to the contractor or builder named above to construct the building or to install the equipment or device described in the application herefor in strict compliance with all ordinances pertaining thereto and with the understanding that the work will in performed in compliance with any plans, drawings, statements or specifications that may have been submitted to and approved by the proper municipal authorities. This Permit may be revoked at any time if the work is not done in compliance with such ordinances or if the plans are changed without authorization. A further condition upon which this permit is granted is the understanding that the contractor or builder named above assumes the responsibility for a thorough knowledge of the ordinances and regulations pertaining to the work covered hereby whether shown on the plans or drawings or in the statements or specifications and that he assumes responsibility for work done by his agents, servants or employees. Signed • BY INSPECTOR In consideration of the issuance to me of this permit I agree to perform the work covered hereunder in compliance with all ordinances and regulations pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I assume responsibility for all work done by either, myself, my agent, servant or employee. BY AUTHORITY - ' 41 11111111i APPLICATION Application is hereby made for the approval of the plans and specifications herewith submitted for the building or other sturcture herein described. This application is made in com- pliance and conformation with the Building Ordinance of the 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 Department of Miami Shores Village, shall be complied with whether specified or not. ARCHITECT h CONTRACTOR LOT -- ELK S OWNER NEW k AD DITIONREPAIRSNUMBER OF STORIESROOF;x-p.r A 4' COST (excludin Archtit I g ect s fee, landscaping & / Building to be used for ,?(;('/,/ and STATE OF FLORIDA) COUNTY OF DADE ) My Commission expires M er Member Secretary ./7 Vt.95 Building Inspector BUILDING - PERIVIIT RECORD MIAMI SHORES VILLAGE FLORIDA Permit No. Issued to ,-- Electrical Permit No, Tr I hereby submit all the plans and specifications Signed Notary Public(Signed) DATE 4 J PLANNING. BOARD Cubic Feet feet required in this Block Plumbing Permit No. STR'EET# 9 ;1 garage )$ no other use, for said building. , I Before me, tho_Undersigned authority, a notary public,-duly authorized to administer oaths and take acknowledgment, personally appeared to me well known; and who, being by me first sworn, upon oath deposes and says that he is the builder of the above described construction, that he has read the foregoing application, and that'he did sign the same, and that facts stated by him are true. Read, Sworn and Subscribed before me, t-h , 44 2 ] , Date AL— e r r STATE OF FLORIDA DEPARTMENT OF STATE D.viston of Archives, History and Records Management DS.HSP -3AAA _ Rev.3.79 Site No. Site Name • 830= = Survey Date 8506 820= = Address of Site: 912 NE 95 Street. Miami Shores. FL 905= = Instruction for locating can SE corner of NE 95 St F NF. 9 Ave Location Marilyn Heights subdivision name County Dade Owner of Site: Name: Richardson, Paula J. Address: 917 NF. 95 St Miami Shn FL Type of Ownership private = = .Recorder: Name & Title Rodriguez, Vivian F Stofik, Marty Address MSHPB • Condition of Site: Integrity of Site: Check One ❑ Excellent 863= = aq Good 863= = ❑ Fair 863= = ❑ Deteriorated 863= = NR Classification Category Threats to Site None Check One or More ❑ Zoning ( )( Check One or More ❑ Altered DC) Unaltered I Original Site ❑ Restored( ) (Date: )( ) 858 = = ❑ Moved( )(Date: )( )858 Building ❑ Development ❑ Deterioration( ❑ Borrowing ( )( ❑ Other (See Remarks Below): Areas of Significance Architecture ►l FLORIDA MASTER SITE FILE Site Inventory Form 858 = = 858 = _ 858 = = )( )878 =.= )( ) 878 = = )( )878 = = )( )878= = ❑ Transportation( El Fill( )( ❑ Dredge ( )( 878 = = FDAHRM 802= = 1009= = • 911 == 813= = 1 868= = block no. lot no. 808 = = 902 = = Recording Date 832= = 818= = Original Use private residenco838 = = Present Use private residence850 = = Dates: Beginning +1935 844= = CulturelPhase American 840 = = Period s . . . 645 = ._ 916= = )( ) 878 = = )( ) 878 = = )( ) 878 = = 910= = Significance: Structure is a single - family frame vernacular home of classical design. Noteworthy features include a classical doorway with Ionic entablature on fluted pilasters. Its frame construction cannot be duplicated under present Miami Shores building codes. The home was built by George Burkel who had a number of Miami Shores homebuilt on speculation for investment purposes. The structure is located in an area of Miami Shores Are there are a number of frame homes and is in scale and character with the neighborhood. The building site is unusually high above the street and surrounding properties. ARCHITECT Knight, Howard B. (Miami, FL) 872 = = BUILDER (day labor) 874 = _ STYLE AND /OR PERIOD Frame vernacular 964 = _ PLAN TYPE irregular /irregular 966= = EXTERIOR FABRIC(S) wood; horizontal weatherboard 854 = = STRUCTURAL SYSTEM(S) frame 856 = = PORCHES N: entry portico, wood columns, access N 942 = = FOUNDATION: concrete block f slab 942 = = ROOF TYPE: multiple gables 942 = = SECONDARY ROOF STRUCTURE(S): gable; rear wing, flat 942 _ = CHIMNEY LOCATION: Offset, E .slope 9 _ = WINDOW TYPE: wood DHS 942 = = CHIMNEY: brick 882= _ ROOF SURFACING: asphalt shingles 882 = = ORNAMENT EXTERIOR: wood 882 _ NO. OF CHIMNEYS one 952 = = NO. OF STORIES 12 950 = = NO. OF DORMERS four 954 = = Map Reference (incl. scale & date) Miami Shores Village Plat 1980 Latitude and Longitude: Site Size (Approx. Acreage of Property): LT 1 • Contact Print e zvr i rye. "*s R. 1 171 1 i t Yt2 N.E. 95 ST O If Township Range Section 6 53S 42E UTM Coordinates: Tone Ting - NaiThing Photographic Records Numbers 85N106HG41 /85N106HG43/85N106HG44 809 = = 800 = = 833 = = 812 = = 890 = = 860 = = SLATE OF FLORIDA DEPARTMENT OF STATE ' Division of Archives, History and Records Management DS F'7SP.3E 9 -74 CONTINUATION SHEET Site No. Site Name 912 NE 95 St. Miami Shores, FL Physical Description Structure is a 11/2-story single family home of frame construction with classically- inspired design. The building site is several feet above street level and higher than surrounding properties. The'entry portico (N) is classical with Ioniclentablature on fluted pilasters. Entry is French doors. Windows have wood shutters. Dentil brackets on gable ends simulate pediment. Dormers windows on the 1 story are located on the E (2) and W (2) . MSHPB USE ONLY Orig. cypress roof shingles replaced 1953 Addition 1954 • 9' • 1 1 r g vionee S t 1 111 1A rr . 3MO12C3 co•r s CO + "T Q./ Cwo O5zc PO 44,9 Nf �� . Oa it 10; NE 98 Sr 37'• sr A NW ary 0 ,1 0 • r N, • G• W • D N Raw Vitt ',GI' 040 /PArr /t,, •401N0 iwave.s. 3r +1 m •./.0 / 93 !Aminkett* a mag AMIN mimmg Airati rim 9 4 5 T. AMP I mmamm�m� 5Ta • • So N. N E. y. _ . 91 3 • TIL A.. t- 2 9:01 211111 vovaam 4m®m111dmv10 VIEllhigAM Tt OO ACc ( z 97 T". S . 91 U 9L" 2 ♦' 1. Tr2 CT- I Na e N. yi• wvaaaar . 10 .0 • I i MOW ggie m $4 S T. PAIS ACM N. 411,1 9 5 0 " U r : to- 0. ®lf32 MI �Z� neM c1UIE RR MI En EIE ®v; t FE • 9 5 A IW noon NM g WE W E volemDm N CO -al agtiOn`7©na 6 6 5 55 (eveN (44.5-.1) S T. A le nc loz••• Sr.a 31i i IC71• 5 T - - f tt+41" 5 T Awari NC F P 96 3 • 14 I 4.49 9r1 AWN 'ICJ It JO NW /3 -73 me ©D DOq�pp 0� ODD v �. �4 NIV p1 1OW ST MI Q© W a 9 Winn OgrdElde J 1 Mel 1Qalaaoadnmman1 Q:110�11 vta fig mgounem n d Q • NC 99r ST let" 1L IMi 97 iI IN NOM 1i , : 'I` i . "UM ,MININIM 000a®Er m0 ©A ABE r ®00 ®� ®0® ®®®® sge � �©01100MIN0911©1®2OX1Dm A N.E 10100. 1 mm v� ©� oao ®m1®m�0 � ¢�o ®ma:o4 z sr 5 ST. T. r �� - u uoa /3111511111, . inswilffil as 4 fl7J Ao 3. c ni A is •r • . 'I N Q A I N A G K.0 10 • j T, H I ►t H JULIA 5 r, N E. 92 c„ 44 .9 " ACT - A SIIOgE.S C(MTCq TRACT ri ft§ ! rt �i 0 .c r. w:_4 f5C.;r SUC. ( - 14/ • N. c 0 "- TRCCT 1111 J ' a ��1®�U® / G N E • miArtA sHo2E , MIAMI SnORCO VILLAGE ' 4 NIP i " ilia! • • f I o reirr[E ( 8 . 4 ) \ . _ _ S . 1 A NA L Time & Date Called Name PAN AMERICAN EXTERMINATING COMPANY, INC. 275 S. W. 6th Street m Miami, Florida 33130 Dade: 854 -5110 Broward: 584-4337 FUMIGATION NOTIFICATION / ' d } Date and approximate time of release y /d � 7 Location of structure 6 /42 ,�` E 95 J Owner's name and addressC_ / /;/ r/,( ?.-5Q/d Type of structure Approximate number Cubic Feet Name and quantity of Fumigant Length of fumigation period Distance of nearest building Certified (or special I.D.) Fumigator in charge: Name Telephones 41/A c 2 /1 2v, (iJ/z W 51 /U Day Night Fumigation shall be performed in strict adherence to the Fumigant's registered label and Florida State Board of Health Rules 1701 -2. Notification to be received not later than the day prior to release of the Fumigant by 0 County Health Department 0 Fire Department 0 Other d'J Af,!..e Type Insp'n Permit N Name Address Company Correction MIAMI SHORES VILLAGE BUILDING DEPARTMENT 305- 795 -2204 B ilding Inspection Request Date _ • Time Pho ne 1C- � l For Inspector: 9/ O j Name & D Re- Insp'n Fee I �i Q C I Ou -3 7/.40