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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