1064 NE 97 StApplication is hereby trade for the approval of the detailed statement of the plans and specifications herewith submitted for the building
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 regula-
tions 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.
1i
Owner's Name and Address ..
�51�1'1— Date — �� = —� -- Street— — — 19k1 b .
W�LLA�� No. _______�.— ,:___
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 __ \ 2 ) G/'
� / e,
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 — _______ Kind of
Estimated Total cost of improvements $ _`: -° _ ._ - — Amount of Permit $
Zone cubage requited__ s 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 WV •
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.
1
Remarks (Signed) ` / /'.o / ;, ,. „ ., -.
STATE OF FLORIDA,
COUNTY OF DADE.
Before me, the und,rsinncd authority. a notary public, duly authorized to administer oaths and take acknowledgments, personally
appeared . / — ' G; %- . / / _/ %L .
and who, bein by me first duly sworn, upon oath deposes and says that he is the
of the above d cribed construction, that be has carefully read the foregoing application, and that be did sign the same, and tha: all facts
therein by him ted p are •true. W*,s- -- ,. �i, i� /
Permit No ' t Date °ti - � "a Read, Sworn to and Subscribed befoite
Disapproved — ..._...--------- - --- -- Date • S , . (j o - f i wt. l
Notary K 9ti of Flsri0 eras.
My csmmissise .3ires Pv!,rc' 9, 1931.
My Commission Eupire fl� � $c �1y�..
(Signed)
Chairman
Member
Member
Council Approved_
MIAMI SHORES VILLAGE
BUILDING INSPECTION DEPARTMENT
APP .ICATIIIN FOR BUILDING PERMIT
Building Insge :tor
to cue well known,
PLANNING BOARD DATE
Member
Member
Member
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.
r� /T
4
1
STATE OF FLORIDA) SS
COUITTY OF DAD
`' F I D A V I T
ce
[ :" the Village of Taami Shores
County of Dade and State of Florida, h^'_i1g duly sworn, doth
that under the j :rovie7.on of ( r.1:i_ 1a:7. ".c 1'.c_ �.. C. , ed June 155,
ing p` :rag7_ aph '(5) of Ee tion -36,:; of 1O Li:.i !7 Je 7o. 97 H of t t'
of iii ^,iai Sh U_: as Village, he desires to build .
on o ; $ Diock 4KW of
that j.5 the owner of said property, and t ill be the owner of
that he will do the tror
ad that he gill, at such times as are re:uired by the Zoning a -. :.
Director:-
1. File plans and specifications and obtain approval of
Plcn:.7ing Board and the Building Inspector.
2. Apply for and secure a Permit.
3. Pay the required fees.
4. Execute the work in accordance with the provisions of
Code.
5. Apply for inspections.
S. File with the Building Inspector certificate
has been made to carry the necessary
Public Liability and Property Damage Insue .,.
7. File with the Building Inspector as the job zo r; :3c F : c ^vi --
fi sates showing the payment required by the L. sdo . cc_
Security Act to the State of Florida or the United S c__ . s c:L
America.
8. Assume the responsibility of not employing other than proper :_y
licensed contrcctors 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 commencing 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 Euilding Inspector.
11. In order to prevent abuses and subterfuge the 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 exercised 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.?IBD AHD SWORN TO BL TORE 1\M this
19 •
-- OWNER -
day of
A. D.,
ET
r ..
IdOTARY PUBLI
zeleiiee
STATE OF FLO3IDA) SS
COUNTY OF DADE )
F I D A V I T
44._ ' ! , cf the Village of Miami Shoree,
County of Dade and State of Florida, "re ing duly sworn, doth depose ^,rya say,
t dated June 15 , _,..8, 7.:ae .:c --
that under the provisions of Oz °c?ina�:,�c � ?c. . =EIS dam.. J�'L`
iiig paragraph (d) of Section D--36E of Ordinance i? . 97 of the ';L:L .::.:.-, C: : : ..�
of iiiani Shores Village, he desires to build
on Lot _..,<� <__ _. Llocic _.er/!1 _. of
e e
that he is the owner of said property, and wi11 be the ouner of e , ..
that he will do the wox.
.d that he vi11, at such times as are re. :uired by the Zoning LIZ
Director:-
•
1. File plans and specifications and obtain approval al-
P1aniing 53oarC end the Building Inspector.
2. Apply for and secure a Permit.
3. Pay the required fees.
4. Execute the work in accordance with the provisions of this
Code.
5. Apply for inspections.
S. File with the Building Inspector certif` eat( .r. prnvi_si.cn
has been made to carry the necessary Wor I1E;::.' a
Public Liability and Property Damage Ina-r.a,:tcr.
7. File with the Building Inspector as the Job pro ree:, cart .
ficates showing the payment required by the :C eder el Social
Security Act to the State of Florida or tie tinited. S 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 commencing i•rork 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 the right of such
otmer- builder as herein provided, is limited to but one
owner-builder permit each 2 years, and where an owner - builder
has once exercised 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:
.... - .
OWNER
SUBArf AND SWORN TO &TORE hE this x fa day of , _G' f- A. D.,
19
i1OTAR PUB