1165 NE 97 St/1/1 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 app.oved
plans and specifications must be kept at building during progress of the work.
STATE OF FLORIDA,
COUNTY OF DADE. j
ss.
Date
October..30,_J,957
Owner's Name and Address . J • S • Carroll No 20 Street N • E • I ,
Registered Architect and /or Engineer 4
Name and address of licensed contractor Lang Roofing & Tile Co„, Inc. ,430N, _.. W. __. 79 h . St, , Miami F .
Location and legal description of lot to be built on:
Lot Block Subdivision
Street and Number where work is to be done 1165 E E 97th St.., M .ami ...►ShQPt9.8. } _.Fla.
State work to be done and purpose of building (by floors)
New Building residence Remodeling Addition
To be constructed of Kind of foundation
Estimated Total cost of improvements $ 858,00 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 rimay
be sent to
Repairs No. of Stones
f covering._ shingle tile pointed,
aq. 4 -ply gravel l
•
The undersigned applicant for this building pennit 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. LANG ROOFINy'r .E COMPANY INU• ,
Remarks ( Signed) %__(T' ._ i"
19
and for no other purpose.
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 !!� _ ,/ Date L — - ( Read, Sworn to and Subscribed before me.
Disapproved Date
tit /� Notary Public, State of Florida
(Signed)
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.
• 9
Remarks
peared
Disapproved
(Signed)
MIAMI SHORES VILLAGE
Street and Number where work is to be done
Estimated Total cost of improvements $
Zone cubage required
be sent to
STATE OF FLORIDA,
COUNTY OF DADE. ss •
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.
Owner's Name and Address. + � « K,..: C __ No / N. � Street
Registered Architect and /or Engineer... - -_ f " !1 ' U
Name and address of licensed contractor ! '
Location and legal description of lot to be built on:
Lot Block / Subdivision. .7 ry ( r d
Building Inspector -
�l�
d dd�Ck
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 of -_ t%
Kind of foundation ' 6 C+ Roof Covering O a Z.,4_1
/ %; ,',
Amount of Permit $ 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 fe laid building. All notices with reference to the building and its construction may
The undersigned applicant for this building permit does hereby certify that h e understands an
of labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General
and has complied with the provisions thereof, and will require similar compliance from all cont?a
in the work to be performed under this permit; and will post or cause to be posted for inspecti
or notices as are required by the Act. The undersigned agrees to employ only- such subcontr
permit, as are licensed by Miami Shores Village.
(Sighed)
d
accepts his obligations as an employer
avyi of Florida, Permanent Supplement,
orss'llor sub - contractors employed by him
n the site of the work "such public notice
wor '$02 performed under this
Before me, the undersigned authority, a notary public, dult/autho lied to administer oaths and take acknowledgments, personally ap-
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.__ "� Date___ ( "� � �� Read, Sworn to and Subscribed before me.
Notary Public, State of Florida
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 51.00 will be charged when such re- inspection is made necessary by improper notice for inspection or faulty
materials and /or workmanship.
)
~ Wr , ~' _ ____
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