ROOFINGPROPERTY OWNER
New Construction
' A' (
\
Name
72 1 , --ilia
��
Address
Repair
(Q
/il
Home Telephon
_
Business Telephon 5)
'7
( 1-t ^ 9 Y
Fax
TYPE OF MANAGEMENT (✓ )
New Construction
Enclosure
Alteration Exterior
Repair
Alteration Interior
Demolish
Relocation of Structure
Shell Only
Foundation Only
Add'l Attachment
Other
Add'I Detachment
Other
5-s r , . . two �'!.' 'i• `;.rs� -�-� F ".� . .- L , ._ fir. ,..i
INSTRUCTIONS - The following ; stejim
s ust be taken R to obtain a permtf'from the Niiaimi'Sl ores Village:
Step 1.
Step 2. Submit the completed application with all necessary documents to the Building, Planning and Zoning Department for processing. During the
processing of your application, you may be asked to submit additional information.
APPLICATIOO N
I)( Job Address: /' o 0 tktE v
�� 1 City State / Zip �j,
Folio Number/ /3 9-O iQ ' 01 4 1 ) �°�` O d escription of Work - r t A a_i_ � u ,e `�°
Lot
Block ,P.
Subdivision PB PG Zoning Linear Feet
Current Use of Property Square Feet Units Floors
Proposed Use of Property ,k Value of Work St) D ' 00 Bldg Value
Tenant Information Tax Assessed/Appraised Value
Flood Zone Base Floor Elev.
ARCHITECT
Name
License No.
Address
Telephone
Fax
Complete the attached permit application which {rust be signed by the property owner and qualifier. Both signatures must be notarized. Please
print or type to allow for a more accurate processing of your application. If roofing work will be done, a roofing application must be submitted
along with this permit application.
Address
PERMIT TYPE (✓ )
Building
Electrical
Mechanical
Plumbing
LPGX
Roofing
Fence
Other
( ✓)
PERMIT CHANGE
Ch ' . Contractor
Renewal
Revision
Extension
Su ' lement
Reins • ection
-::' II it IIL_I
Master Permit No.
Subsidiary Permit No. , 5p' 6 OOc ' /°z C2
PERMIT APPLICATION
ENGINEER
Name
License No.
Address
Telephone
Fax
CONTRACTOR
Name
License No.
Address
Telephone
Fax
Qualifier Name
Page 2
PERMIT APPLICATION
InIPOR'1'ANT NOTICES
1. DO NOT BEGIN ANY WORK WITHOUT HAVING RECEIVED YOUR VALIDATED PERMIT AND PERMIT CARD. Applying for a permit does not grant
the right to begin construction. HOURS OF CONSTRUCTION are limited to: Monday through Friday from 7:30 a.m. to 6:00 p.m., and Saturday from 8:00 a.m.
to 5:00 p.m. No inspections will be conducted on weekends or holidays.
2. All construction of demolition areas MUST BE MAINTAINED IN A CLEAN, NEAT AND SANITARY CONDITION free from construction debris.
3. STREETS AND NEIGHBORING PROPERTIES SHALL BE KEPT FREE FROM DIRT AND DEBRIS.
4. SWALES MUST BE PROTECTED FROM BEING DAMAGED BY EQUIPMENT OR VEHICLES, AND MAY NOT BE USED FOR STORAGE. A bond is
required for work in or near the street/sidewalk.
5. CONSTRUCTION TRAILERS ARE PROHIBITED ON SINGLE FAMILY RESIDENTIAL CONSTRUCTION SITES. Other construction may have a trailer
which requires a separate permit.
6. PORTABLE TOILETS for a construction site require a separate permit.
7. DO NOT DISCHARGE WATER INTO THE RIGHT OF WAY OR STORM DRAINS without approval from the Building, Planning and Zoning Department.
8. EQUIPMENT AND MATERIALS SHALL BE STORED at least 10 feet from the edge of pavement.
9. Department of Health and Rehabilitative Services (HRS) approval is required for applications involving septic tanks. Department of Environmental Resources
Management (DERM) and/or Miami -Dade Water and Sewer Department (MDWASD) approval is required for applications involving sewers.
AFF11)A\'l'I' - Please read carefully.
Application is hereby made to obtain a permit to do work and installation as indicated. I, the OWNER of the property, 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, POOL, EXTERIOR DOOR, MECHANICAL, WINDOW, FENCE, DRIVEWAY,
ROOFING and SIGNS and there may be additional permits required from other governmental agencies.
I, the OWNER of the property, have disclosed all information related to any work at the property performed in the prior twelve
months to the Building Official. Further, I am fully aware that if the cumulative cost of work to my home or business under this and
any other permit equals or exceeds fifty percent (50 %) of the fair market value of the structure, the entire structure must meet the
present federal flood criteria for finished floor elevation. I am also fully aware that if the total cost of work to my home or business
under this and any other permit exceeds fifty percent (50 %) of the replacement cost of the structure, then the entire structure must
conform to the current code requirements of the Building Code.
WARNING TO OWNER: Your failure to record a NOTICE OF COMMENCEMENT may result in you paying twice for
improvements to your property. If you are spending more than $2,500 or intend to obtain financing, you may wish to consult with
your attorney or lender before recording your Notice of Commencement. The Notice of Commencement must be recorded at:
22 N.W. 1st Street, 1°' Floor, (305) 679 -1078. Once recorded, the Notice of Commencement must be POSTED AT THE JOB SITE in
accordance with Section 713 -35 of Florida Statutes. Review the brochure at Village Hall on Construction Lien Law and
Choosing a Contractor.
STATE OF FLORIDA COUNTY OF MVIIAMI -DADE STATE OF FLORIDA, COUNTY OF MIAMI -DADE
p( £I /Z4J7d/ R. ''r L"
Signa a of Owner Signature of Contractor / Qualifier
j t L�
Si
SEAL:
Print Name / d1
Sworn to and subscribed before me this / 6 day of
q r
I
IA .
.. - S •�of '. i i .y . M BEC ER
( 1� / n COMMISSION NUMBER
� # ¢ CC786697
MY COMMISSION EXPIRES
O pt NOV. 15,2002
ature of
Print Name
Sworn to and subscribed before me this day of
Signature of Notary Public - State of Florida
SEAL:
Personally known OR, Produced Identification Personally known OR, Produced Identification
Type of Identification Produced' 0 C 63 0- DType of Identification Produced:
ELECTRIC
T1'1'E I
Minimum Fee
QTY.
TYPE
Dryer
QTY.
TYPE
Outlet, Appliance
Q'I'Y.
TYPE
Service Repair
'
QTY.
A/C Central 1 -3 Ton
■
Fan
Dryer Vents, Number of
Outlet, Wall
Ventilation, Cost
Service, Temporary
Air Handler, Tons
A/C Central 4 -7 Ton
Piping, Flammable Liquid
Fire Pump
Outlet, Switch
Fire Sprinkler System
Signs
A/C Central 8 -15 Ton
Bath Fan - Vented, #
Fixture - Fluorescent
Pressure Vessel
Oven
Space Heater (kw)
A/C Central 16-20 Ton
Fixture Light
Parking Lot Lights
Spas/Hot Tubs
A/C Central 20+ Ton
Flood Lights
Plugmold/Strip
Subfeeds, No. of Amps
A/C Window
FPL - Load Central
Posts
Swim Pool, Commercial
Air Conditioners
Garbage Disposal
Range/Range Top
Swim Pool, Residential
Chiller
Generators, etc.
Receptacles
Switchboards
Clear Violations
Heat Recovery
Refrigerator, Comm. (p/PH)
Temp Serv., Construction
Compactor
Low -volt, Burglar
Refrigerator, Domestic
Temp for Test - 30 days
Deep Freezer
Low -volt, Fire
Renew - Temp Service
Water 1leater
Demolition
Low -volt, Interc:om/Teleph.
Repair Circuits
Water Heater New
Dishwasher
Low -volt, Television
Service, Number of Amps
Water Re -pipe
MECHANICAL
TYPE
Minimum Fee
Q'I'Y. TYPE
Condensate Drain
QTY. Tl'1'E
Generator
QTY. TYPE
Refrigeration, Tons
QTY.
A/C Central, Tons
Cooling Tower
Heating Strips, each
■ Vent Hood, Cost
■
A/C Wall/Win. Tons
Dryer Vents, Number of
Paint Booth
Ventilation, Cost
Solar Water Heater
Air Handler, Tons
Ductwork, Cost of
Piping, Flammable Liquid
Periodic Inspections
Barbecue
Fire Sprinkler System
- Process/Pressure Piping
Cap - Fixture
Bath Fan - Vented, #
Fireplaces, Number of
Pressure Vessel
Pump and Abandon
PLUMBING
TYPE
A/C Condensate
QTY.
'fl'PE
Drains, Roof
Q'I'Y.
'1'1'1'1.
Miscellaneous Fixture
Q'I'Y.
TYPE
Soakage Pit
TY.
Bath Tub
Drinking Fountain
Miscellaneous Repairs
Solar Water Heater
Bidet
Filter Replace
Pool Piping
Sprinkler Repair
Cap - Fixture
Fountain
Pump and Abandon
Sprinkler System
Cap - Water
Gas - Appliance
Pump, Domestic
Supply, AC Well
Cap - Sewer
Gas - Natural,
Pump, Fire Stand
Temporary Toilet
Catch Basin
Gas - Propane
Pump, Re- circulate
Temporary Water Closet
Clothes Washer
Gas Piping
Pump, Replace - Pool
Urinal
Dental Chair
Grease Trap_
Ice Maker
Pump, Sprinkler
Pump, Sump
Utility - Sewer
Utility - Water
Discharge Well
Dishwasher
Indirect Wastes
Relay Repair
Vacuum Pump
Water Closet
Disposal
Interceptor
Roof Inlet
Domestic Well
Laundry Tray
Septic Connection
Water 1leater
Drainfield, 4" Tile/Res.
Lavatory
Septic Tank
Water Heater New
Drains, Area
Meter Set (Gas)
Sewer Connection
Water Re -pipe
Drains, Floor
Minimum Fee
Shower
Water Service
Drains, French
Miscellaneous Equipment
Sink
Well, Supply
Page 3
II I
i '1 :∎1 1 1 1_
PERMIT APPLICATION
INSTRUCTIONS: Please indicate the type of work being performed and quantity(ies) in the space provided below.
RECEIVED AND REVIEWED BY: DATE:
SECTION
BY
DATE
p��/g /0,-
Zoning
a, .;
Electrical
Mechanical
Plumbing
Fire
Public Works
Structural
f/
Building Official
„-
Page 4
OFFICE USE ONLY
CHECKLIST
O OWNER - BUILDER FORM
(Attach)
❑ FIRE DEPARTMENT
APPROVAL (Commercial /
multi - family)
O CONCURRENCY
(New Construction)
O OTHER
(Specify & Attach)
$3.00 per page (Scanning Fee)
Miami Shores Village
Bond
Metropolitan Dade County (C.C.F.) $
Inspector State Educational Fund $
State DCA (Radon) $
Code Enforcement Fine
Zoning Review
❑ PROOF OF OWNERSHIP
(Attach)
❑ HRS / DERM APPROVAL
(Septic / Sewer)
❑ IMPACT FEE
(New Construction)
O OTHER
(Specify & Attach)
(sq.ft. = x/1000
x 0.60)
(¢.005 / sq.ft.)
(¢.01 /sq.ft.)
REVIEWED AND PREPARED BY:
PERMIT APPLICATION
❑ CONDO ASSOCIATION APPROVAL
(Attach)
O BPR APPROVAL (Restaurants)
0 CONTRACTOR REGISTRATION
(On File)
PI.RIII'I' FEES
TOTAL $
ISSUING OFFICIAL
DATE:
CONDITION OF APPROVAL
Revised July 2001
10050 N.E. 2"° AVE., MIAMI SHORES, FL • (305) 795 -2207 • FAX (305) 756 -8972 • http : / /www.miamishoresvillage.com
Date 91.-<Thob Address
Owner's Address nn ''
Contracting Co. 1..�-lh'I!9 - co/9-r
Qualifier Flvl S
State # �►�
Legal Description
Owner / Lessee / Tenant Master Permit # 3 9, 5 0,2
ign
Date:
N. ary as
y Commis ion Expire
** * *
FEES: PERMIT
APPROVED:
Zoning
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
//lt /'V 9),;'1'.1457 Tax Folio
/000 i 9(0 3
SS#
Municipal #
Architect /Engineer L.D 1 A"'
Bonding Company
Mortgagor
Permit Type(circle one): BUILDING ELECTRICAL PLUMBING' MECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIPTION 1- ll1) T,,i. ROOF 104/TE 7) W/1 TE
Lp2 /SC.
Square Ft. ''1i Estimated Cost(value) 1 50. c
WARNING TO OWNER: YOU MUST RECORD A NOTICE OF COMMENCEMENT AND YOUR FAILURE TO DO
SO MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY (IF YOU INTEND
TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR
NOTICE OF COMMENCEMENT).
Application is hereby made to obtain a permit to do work and installation as indicated above, and
on the attached addendum (if applicable). I certify that all work will be performed to meet the
standards of all laws regulating construction in this jurisdiction. I understand that separate
permits are required for ELECTRICAL, PLUMBING, SIGNS, POOLS, ROOFING and MECHANICAL WORK.
OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurst :nd that all work will
be done in compliance with all applicable :laws regulating constructio • zoning. hermore, I
authorize the above -named contractor to dote work stated.
3
Jre of owner and /or Condo President
KIMB
o ` PIRES AY 11, 1898
BONDED THRU
OFW ATLANTIC ONDING CO., INC.
75 RADON C.C.F.
- - Phone )91 (D
Competency WO Ins.Co. 1 4- a e-F
Fire
Building
Mechanical .Plumbing
Address NIA) li
Address
Address
Address
S ! ure of Co act
Date:
tary as
y Commission Ex
NOTARY TOTAL DUE (5-■5
to?‘v
Phone - I g4
Other
Owner- Builder
MOURNS
OURNS
.t EXPIRES MAY 11, 1999
BONDED DM
OF FV ATLANTIC BONDING CO., INC.
Electrical
Engineering
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 herein specified or not. A copy of approved
plans and specifications must be kept at building during progress of the work.
(� 1 �^ � Date 1_.Q 7/5 / , 19
Owner's Name and Address 1\J r -___ \__ _!-14 O . a @_ k i No..7 p 2 6 A) V Street S a o e r Rci
Registered Architect and /or Engineer ? �
Name and address of licensed contractor - 1 __ J }o ft n(( zL CO - �._ 75_f_1V • 1. '7 _ __
Location and legal description of lot to be built on:
Lot Block Subdivision
Street and Number where work is to be done__ Q b Q___ ,Ai L_ __9.‘
State work to be done and purpose of ping (by floor )
O 0 d_ -- I mo_.____
and for no other purpose.
New Building Remodeling Addition Repairs No. of Stori9s /
To be constructed of Kind of foundation Roof Covering re 7 -9
015 17(15
Estimated Total cost of improvements $__1_ b _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. 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 nie 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 A a ` G 7 7 `�
Date ®v � Read, Sworn to and Subscribed before me.
Disapproved Date
(Signed) 1 Notary Public, ____
Building Inspector 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 $1.00 will be charged when such re- inspection is made necessary by improper notice for inspection or faulty
materials and /or workmanship.
BUILDING
ELECTRICAL
PLUMBING
ROOFING
Owner o::
Building
Architect
Contractor
or Builder.
Legal
Description
Address of
Building
Lot
PERMIT IST? 1
CONTRACTOR OR BUILDER
MIAMI SHORES VILLAGE, FLORIDA
Work to be performed under this Permit
}� m
Bl.
Subdi-
vision
Value of
Project $
DATE • Vt 195
Contractor's
License No
Amt. of
i
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 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 t:ae 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. e ". r
i
Signed: v ; , § .' , BY .� k 4
INPECTOR
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 r
BUILDING p MIAMI SHORES VILLAGE, FLORIDA
Date /
ELECTRICAL ❑
PLUMBING ❑ PERMIT N °• 8879
ROOFING ;V ,
D Work to be performed under this Permit
4.
Owner of
Building
Architect
Contractor r.
or Builder r
Legal 1 Lat
Description I B1
Address of r
Building /
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- s% � "�; ,J ( INSPECTOR) BY
In consideration of the issuance to me of this permit) 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.
Contractor's
License No.
Asti
Subdi-
vision
Sq. Ft.
Value of �}`� f ` '" II Amount of
Project $ II Permit $
CONTRACTOR or BUILDER BY AUTHORITY
APPLICATION FOR BUILDING PERMIT
Application is hereby sonde for the approval of the detailed statement or me plans and specifications herewith submitted for the build
inc 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 progreu of the work.
�/ -. Date..._..._... GK .A---- G
�y "
Owner's Name and Address % "<l'' r �' c � :••.._ _ No./0 d Q street F 2. __..7....:r .. Pc
Registered Architect and /or Engineer
Name and address of licensed contpctor Ra d:
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 pu ose of buildi g (by floors). /:-5
Subdivision
0 ' � 7 ..._. 5 __ S .._.
447 Jl =�� ..�-° � -�- . off �� . / _1c,/
pealed
Remarks.
� .
Permit ' 4 1 6 Date 1 4 1 ) 4
Disapproved
(Signed)
MIAMI SHORES VILLAGE
Date
Building Inspector
BUILDING INSPECTION DEPARTMENT
PLANNING BOARD
NOTE: A charge of 31.00 will be made for
the J'Lrnnir. )BOAR'. A re- inspection fce of 31.00 will be charged
materials and /or workmanship.
Citairnrn
Nferr,bcr
Member .. ..
Council Approved Date
er . nr nr .nrsrr.�yrrr.
(Signed
Rea
My
STATE OF FLORIDA, e_ -16657
COUNTY OF DADE. ss.
DATE
and for no other purpose.
c X3
Before me undcrsig ed authority, a notary public, duly authorized to administer oaths and take acknow edgments, personally ap-
-7 '/? PAi /A
to me well known,
and who, being by me first duly sworn, upon oath deposes and says that he is the. o d n 4=�Ir J�` eior-
of the above described construction, that he has carefully read the foregoing application, and tha he did sign the same, and that all facts
therein
b y him stated are e.
Member
Member
Member _.._.....
Disapproved Date
making corrections 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
x, / VZ
New Bui!ding Remodeling Addition Repairs. -e No. of Stories f
To be constructed of Kind of foundation Roof Covering
Estimated Total cost of improvements $..9/ 9 07) - c-4./ Amount of Permit 3,... 47 Q' (2
Zone cubage required .Plan Cubage
Distance .to next nearest building Size of Building Lot
Maximum live load to be borne by each floor
I herebv submit all the plans and specifications for said building. All notices with reference to the building and its construction may
A R dd..,.. .-/ 0 / Gt " 3 :, `-` C /' 4 6------1 �1 �,.. 331
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 Sup iletnent,
and has complied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors employed by hint
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 n•!ice
or notices as are required by the Act. The undersigned agrees to employ only such subcon • actors, on wo performed and i• this
pennit, as are licensed by Miami Shores Village.
- LS- -
d, ,S to and Subscribed before me.
F es-` - dd , � t
Notary Public, Sta lY O ARY o � i76LIC STATE OF FLORIDA AT LARGE
Commission Expires ...t ALCQ MMI.SSJ.RI1I.EXPIRES.LIAJL.4 1 985
BONDED THRU GENERAL INS. UNDERWRITERS
Registered Architect and /or Engineer `�l(
Name and address of licensed contractor ........
14.�
STATE OF FLORIDA, i
COUNTY OF DADE. ss.
(Signed)
Building Inspector
Chairman
ferr,bcr
Member _..__._......_..._.�.._..
Council Approved
NOTE: A charge of $1.00 will be
the PL,nnir.g Hoard.
A rc•in.pection fee of S1
materials and /or workmanship.
MIAMI SHORES VIILLAGE
BUILDING INSPECTION DEPARTMENT
APPLICATION FOR BUILDING PERMIT
Application is hereby made for the approval of the detailed statement u► toe plans and specifications herewith submitted for the build
ine or other structure herein described. This application is made in compliance and conformity with the Building Ordinance of Miami
Shores Village, Florida. and all provisions of the Laws of the State of Florida, all ordinances of Miami Shores Village and all rules and
regulations of the Building Division of Miami Shores Village shall be complied with, whether herein specified or not. A copy of approved
plans and specifications must be kept at building during progress of the work.
� ` _.. A ..19� 0
Owner's Name and Address ........F ... �.L. . ._... _ _. No.JJ .�'�N Street_. ` • _ � ... � . / _
n: .... m, • • •:.,,nn. rw.•. •rarer,. r. e.
Location nd legal depeription of lot to be b on: �,�
Lot A id 1 L.... Block Z� Subdivision.! /_f, -9 ' ' .ggee /L251.0
Street and Number where work is to be done / a o O V _
JRooF /,$)
PLANNING BOARD DATE
Member
Member
Member
Date Disapproved
State work to be done and purpose of building (by floors)
and for no other purpose.
Repairs v No. of Stories _
Ncw Building Remodeling Addition
To be constructed of Kind of foundation // Roof vering
Estimated Total cost of improvements $....,.y - 00 Amount of Permit i..e , o .o
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 \1'orkrnen's Compensation Act. being Section 5966, Compiled General Laws of Florida, Permanent Supplement,
a 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 insp ion on the site of the work such public notice
or notices as arc required by the Act. The undersigned agrees to employ only such subcoctgtts, on rk to be performed 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 _..
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..— ...N 'l Date \ Read, Sworn to and Subscribed before me.
n I
Disapproved ,� .!•% Date..
Notary Public, State of Florida
My Commission Expires
made for making corrections or changes to this application after approval
to me well known,
Date
has hecn obtained from
.00 will be charged when such re- inspection is made necessary by improper notice for inspection or faulty
I. BARRY BLAXBERG
RONALD L. BOOK
CHARLES A. CITRIN
EDWARD HEILBRONNER
URSULA MANCUSI-UNGARO
HOWARD E. ROSKIN
ROBERT L. RUBIN
RONALD A. SHAPO
ARNOLD D. SHEVIN
JEROME H. SHEVIN
ROBERT L. SHEVIN
STEVEN SONBERG
BYRON L. SPARBER
STEPHEN A. STIEGLITZ
SETH STOPEK
ARTHUR E. TEELE, JR.
JEFFREY M. WEISSMAN
Dear Andrew:
SPARBER, SHEVIN, SHAPO, HEILBRONNER & BOOK
PROFESSIONAL ASSOCIATION
JAMES H. BARRETT
RICHARD I. BLINDERMAN
JOSE A. BOLANOS
FRANCISCA COPELAND-LOPEZ
MICHAEL J. CONIGLIO
BRIAN S. DERVISHI
MARTIN E. DOYLE
GREGG FIERMAN
ALAN J. FRIEDMAN
PAUL A. GOLDBERG
MOISES T. GRAYSON
SANDRA P. GREENBLATT
DAVID B. HABER
MICHAEL E. HILL
MICHAEL KOSNITZKY
ELIO F. MARTINEZ, JR.
JAMES A. MINIX
Andrew D. Kaplan, Esq.
Hyman & Kaplan, P.A.
Suite 416, Biscayne Building
19 West Flagler Street
Miami, Florida 33130
LAW OFFICES
D. JUSTIN NILES
GARY S. PHILLIPS
LAWRENCE M. PLOUCHA
MARK T. REEVES
MARSHA C. ROSEN
GARY R. RUTLEDGE
NANCY SCHLEIFER
ELIZABETH SCHWABEDISSEN
SEYMOUR N. SINGER
GREGG S. TRUXTON
GLENN J. WALDMAN
ROBERT T. YOUNGS
GERALD D. KISNER •
OF COUNSEL
BSD /lgp
cc: Mr. Leo A. Price
Mr. Frank J. LuBin -
Director of Building and Zoning
Miami Shores Village
L. A."SKIP' BAFALIS
GOVERNMENTAL AFFAIRS CONSULTANT
• ADMITTED IN OHIO S
WASHINGTON, D. C.
Re: L.A. Price v. Roberts Roofing
1 ?)o o cif 5
May 6, 1986
AMERIFIRST BUILDING
ONE SOUTHEAST THIRD AVENUE
MIAMI, FLORIDA 33131-1766
TELEPHONE (305) 347-4700
TELECOPIER 347 -4889
FORT LAUDERDALE 524 -0209
NORTH BROWARD 781.9521
TELECOMMUNICATIONS 347-4899
TELEX I 51- 06002181
TELEX EASYLINK 62899002
TALLAHASSEE OFFICE
315 SOUTH CALHOUN STREET
BARNETT BANK BUILDING • SUITE 348
TALLAHASSEE, FLORIDA 32301
TELEPHONE (904) 681.7051
TELECOPIER 224 -2784
REPLY TO MIAMI OFFICE
WRITER'S DIRECT#
My client has informed me that the tile on the house
has finally been laid as of May 5, 1986. According to
the terms of our agreement, Mr. Price will wait until 38
days has passed from today's date prior to anyone going
up on the roof for inspection. I calculate that date to
be June 13, 1986.
After June 13, 1986, we will have a final inspection
of the roof, in accordance with the Settlement Agreement,
by Mr. Price's representatives and by a representative
of the Village of Miami Shores.
Thank you for your cooperation. Please do not hesitate
to contact me if you have any questions or comments.
Very truly yours,
j S'
BRIAN S. DERVISHI
For the Firm
PERMIT APPLICATION FOR
(OWNER
Job Address
Legal Description /4 ®/
Owner / .i,.4e / - en'a'n't
Owner's Address /! QQU
Contracting C
Qualifier
State / (>7° �d�l
Architect /Engineer
Bonding Company
Mortgagor
Permit Type (circle one): •BUILDING ELECTRICAL
c I D
WORK DESCRIPTION /// At4.j
Square Ft. 6
MUNICIPALITIES, OF DADE COUNTY
TO RETAIN COPY 6i
600V "T Folio �I J6 a ,&/r
SS
94
Competency# /r/,J
Address
Address
Address
phone
address G) 74Vic
: � l U - 3 _h-o)-phone
PLUMBING MECHANICAL PAVING FENCE SIGN
Estimated Cost
Master Permit # .? / f -r
Ins. Co.
60
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. I certify
that all work will be performed to meet the standards of all laws regulating construction in this
jurisdiction. I understand that separate permits are required for ELECTRICAL, PLUMBING, SIGNS,
POOLS, ROOFING, and MECHANICAL work.
OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work
will be done in compliance with all applicable laws regulating construction and zoning.
Furthermore, I authorize the above -named contractor to do the work stated.
Signature of Owner and /or Condo President
Date:
Notary as to Owner and /or Condo President
My Commission Expires:
PERMIT FEE: APPROVED:
, 00 !u&r4( 5% b b
3S;b�
Zoning
Mechanical
Notary as to Contractor or Oy Builder
My Commission Expires: df / i, p
* * * * * * * *
Fire
Building
Plumbing
e
Signature of Contractor or Owner - Builder
Date:
∎ 82,149
Other
Electrical
Engineering