DRIVEWAYMIAMI 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 Law of the State of Flor da, all ordinances of Miami Shores Village ^nd all rules and
regulations of the Building Division of Miami Shores Village sh. -11 be co•:iplied with whether hr. in specifie ; . not. A cop of approved
plans and specifications must be kept at building during progress of the work.
Date_
Owner's Name and Address._ .. \\ �-� No. . _ ___ Street_ri._ei
Registered Architect and /or Engineer
and address of licensed contractor 0_>_\ ° Ca_0-__ k_A_91__5 -_
Location and legal description of lot to be built on:
Lot Block Subddi
Street and Number where work is to be done C I (D
State work to be done and purpose of building (by floors) __,__._.__.___
J 4 - ..\- - \ < G
and for no other purpose.
New Building _________________ -.__._ _ _ Remodeling Addition Repairs No. of Stories __
To be constructed of Kind of foundation Roof Covering
to 0
Estimated Total cost of improvements II
1? $--- 4 - -Q - -� Ol---- ��. - -- Amount of Permit $._.__ - - ° `J c
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, 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, 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, perso:ially 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 4 Date — Read, Sworn to and Subscribed before me.
Disapproved
C . A __„- - -._._ Date__
( Signed) ?
Notary
Public, State of Florida
Building Inspector . My Commission Expires __
PL NING BOARD_ -_ __ .__ DATE
Chairman __ __ _ __ _ _ _ Member __
Member _ Member ___
- - - - - - - - -- - Member Member
Council Approved Date Disapproved
_ _ __ to me well known,
. ____ Date
NOTE: A charge of $1.00 will be made for making corrections or changes to this application after appr::.1 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.
H ® r-t o va
�� e.
BUILDING
ELECTRICAL
PLUMBING
ROOFING
CONTRACTOR OR BUILDER
MIAMI SHORES VILLAGE, FLORIDA
PERMIT
Owner of e
Building #
Architect
Contractor
or Builder
Legal Lot
Description II Bi
Address of - Value of ( I Amount of
Building a ,: ' ` Project $_i li 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 applica-
tion herefor in strict compliance with all ordinances pertaining thereto and with the understanding that the work will be performed in compliance with any
plans, drawings, statements or specifications that may have been submitted to and approved by the proper municipal authorities. This Permit may be revoked
at any time if the work is not done in compliance with such ordinances or if the plans are changed without authorization. A further condition upon which this
permit is granted is the understanding that the contractor or builder named above assumes the responsibility for a thorough knowledge of the ordinances and
regulations pertaining to the work covered hereby whether shown on the plans or drawings or in the statements or specifications and that he assumes respon-
sibility for work done by his agents, servants or employees.
Signed ' ° ! "� INSPECTOR
In consideration of the issuance to me of this permit I agree to perform the work covered hereunder in compliance ,rith all ordinances aid regulations
pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In ao
cepting this permit I assume responsibility for all work done by either, myself, my agent, servant or employee.
N° 5705
Contractor's
License No.
DATE J t ' 19
Work to be performed under this Permit
Subdi-
vision
BY AUTHORITY
APIOT
• . PERMIT.4PPLICATION FOR MIAMI SHORES VILLAGE
Date Job Address y 5O h 75 Tax Folio
Legal Description Historically Designated: Yes No
Owner/Lessee / Tenant / I,I_5r ;,. cS•f J Master Permit # '[]O3 2
Owner's Address 7 O ,'CJ8 75 -f Phone
f' Contracting Co. „4„,;,, - N Address 7 153 X) • a /C� J / ./ 6
/
Qualifier / / (e A -)Z i P SS# G / d - 6 7 O/OQ'hone J6/ 7?5 ) ..5 —
State # Municipal # Competency # i c5WIns. Co.
Architect/Engineer Address
Bonding Company A Address
Mortgagor Address
Permit Type (circle one): BUILDINA ELECTRICAL PLUMBING MECHANICAL ROOFIN AVING NCE SIGN
WORK DESCRIPTION 4ce -x�S7 ' `� /9 w 0 ` 4 /
no/ , y44/ .
Square Ft. V� /7
My Commission Exp
FEES: PERMIT jid . o o RADON
Estimated Cost (value)
WARNING TO OWNER: YOU MUST RECORD A NOTICE OF COMMENCEMENT AND YOUR FAILURE TO DO SO MAY
RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY (IF YOU INTEND TO OBTAIN FINANCING,
CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT.)
Application is hereby made to obtain a permit to do work and installation as indicated above, and on the attached addendum (if applicable). I
certify that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that separate
permits are required for ELECTRICAL, PLUMBING, SIGNS, POOLS, ROOFING and MECHANICAL WORK.
- 7 OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable
laws regulating construction and zoning. Furthermore, I authorize the above -named contractor to do the work stated.
X
er� d/or Co do Presiden Date l ' Signature of Con .act. / _ r der Date
Sign.
CKERSON P �. : I
N,i� as to z� �}.��� _ _ '� �A,ni
or r►wner-
Notary as to a 0 uilder Date
My Commission Expires: INGRID LOPEZ
Notary Public. State of Florida
My Comm. expires Feb 22, 1609
No.CC440959
L t'cP X..ro o o
C.C.F. /. t1 NOTARY TOTAL DUE 1: r
APPROVED:
Zoning Building ) J I(�
}° Electrical
Mechanical Plumbing Engineering
VY ATE OF FLORIDA, COUNTY OF DADE
cEnrir'Y that this is a fruo copy of the
crlg;nc! ¢;lcd Ches ifi 3 day of
y co on � ` '
11) / / A.J. 19 (� ..
, a
(nty Croe.o
NOTICE OF COMMENCEMENT
A RECORDED COPY MUST BE POSTED ON THE JOB SITE AT TIME OF FIRST INSPECTION
PERMIT NO. TAX FOLIO NO.
STATE OF FLORIDA:
COUNTY OF DADE:
96R292896 1996 JUL 03 14:02
THE UNDERSIGNED hereby gives notice that improvements will be made to certain real property, and in accordance with
Chapter 713, Florida Statutes, the following information is provided in this Notice of Commencement.
1. Legal description of property and street address: c 5 ]UE q6
1 S+
2. Description of improvement: AL l Z1t e (, Ile e.,024.1
3. Owner(s) name and address: <r/, )/, Y,l
ciO /OF 9
Interest in property:
Name and address of fee simple titleholder:
4. Contractor's name and address: t IV ) 1k.
5. Surety:(Payment bond required by owner from contractor, if any)
Name and address:
Amount of bond $
6. Lender's name and address:
7. Persons within the State of Florida designated by Owner upon whom notices or other documents may be served as provided
by Section 713.13(1)(a)7., Florida Statutes,
Name and address:
8. In addition to himself, Owner designates the following person(s) to receive a copy of the Lienor's Notice as provided in
Section 713.13(1)(b), Florida Statutes.
Name and address:
9. Expiration date of this Notice of Commencement: (the expiration date is 1 year from the date of recording unless a
different d e is cified)
Signature of Owner
Print Owners Na
Sworn to and subscri , 19 q&.
Notary Publ • A ir
r
Print Nola '
1C1A N Y
JAMES H DICKERSON
- COMMISSION Nd. CC242095
OV. 16,1996
Prepared by: 1
1LLR
Address: }(GUL1 ( ,
C� G --'
S313
ieeinn 91n1.59 910'1
•
Z Si
2
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 herein specified or not. A copy of approved
plans and specifications must be kept at building during progress of the work.
Date ! , 19 (-
Owner's Name and Address._... �6�. �___ _ ® t : . r p ! No Street__ 1_ '
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 r B 1. ..
State work to be done and purpose of building (by floors) ., :Y. 4 ‘R Mt n ti
D
Building In . = tor
MIAMI S .ORES VILLAGE
and for no other purpose.
New Building Remodeling Addition Repairs No. of Stories
To be constructed of Kind of foundation Roof Co ring
Estimated Total cost of improvements $ 14-p 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 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
to me well known,
and who, being by me first duly sworn, upon oath deposes and says that he is the
of the above described construction, that he has carefully read the foregoing application, and that he did sign the same, and that all facts
therein by him stated are true.
Permit No+ `�4-7/ Date Read, Sworn to and Subscribed before me.
Disapproved
(Signed)
Notary Public, State of Florida
My Commission Expires
ANNING 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.
-i-
Pes1