1086 NE 96 St (7)Chairman
Member
Member
Permit No
Date._
Disapproved
( Signed) /A-k L- -
Bui. din;; Inspect
Date >
J
MIAMI SHORES VILLAGE
BUILDING INSPECTION DEPARTMENT
APIPLICATION 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 - � J:� , 19
Owner's Name and Address.... No / Street t_ �_..:
Registered Architect and /or Engineer
Name and address of licensed contractor 4 .. __.i %
Location and legal description of lot to be built on:
Lot__ - - Block ° Subdivision / i _4,',4..': e
\ (- n . ' .E ) .> •
Street and Number where work is :o be done , �= .._,�', ` y.....
State work to be done and purpose: of building (by floors)
r , ( e ,< 2 0 ' {
and for no other purpose.
New Rriilding___ Remodeling Addition Repairs No. of Stories
To be constructed of Kind of foundation Roof Covering
Estimated Total cost of improvements $ - -�� 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 : nd 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 Apt. The undersigned agrees to employ only such subcontractors, on work to be performed under this
permit, as are licensed by Miami Shores Village.
( Signed) /.l& 1" ' 2,/)A,-) . �
Remarks
z
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.
56) �-
Read, Sworn to and Subscribed before me.
INNING BOARD DATE
Notary Public, State of Florida
My. Commission Expires
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.
APPLICATION FOR BUILDING PERMIT
Application is hereby wade for the approval of the detailed statement or toe 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
plans and specifications must be kept at building during progreu of the work.
Owner's Name and Address ...t1.14 .2.. n/
Registered Architect and /or E;ngineer...........
Name and address of licensed contactor t9 &Lir Or e ...
Location and legal description of lot to be built on:
Lot Block Subdivision
Street and Number where work is to be done /.0 e S.7' °
State work to be done and purpose of building (by floors)
�.eg..,r it/ i
and for no other purpose.
New Building Re,nodcling Addition Repairs No. of Stories
To be constructed of Kind. $.. of foundation � ,( RoofCovering
Estimate Total cost of improvements $ g % 0 0 Amount of Permit 1 1.PDV j
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 undcrsigrcd applicant for this building permit does hereby certify that he understands and accepts his obligations as an employer
of Lrhur under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida, Permanent Sip p leirent,
anti 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 noticcs as are required by the Ac:. The undersigned agrees to employ only such subcontractors, on work to be performed under this
pennit, as are licensed by Miami Shores Village.
Remarks (Signed
STATE OF FLORIDA,
COUNTY OF DADE.
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 true.
Permit No.
Disapproved
(Signed)
t Y "f e
Date \114-3
It
Date.
Notary Public, State of Florida
Building Inspector My Commission Expires
Chairman
\Icrr,bcr
Member _.....__..._._..._. .....__......
Council Approved Date
MIAMI SHORES VILLAGE
BUILDING INSPECTION DEPARTMENT
Read, Sworn to and Subscribed before me.
PLANNING BOARD DATE
Member
Member
Member _.. - - -...
Disapproved Dale
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 w ll be charged when such re inspection is made necessary by improper notice for inspectinn or faulty
materials and /or workmanship.
BUILDING ❑
ELECTRICAL ❑ DATE = 195
PLUMBING ❑ PERMIT N? 9672 Contractor s
License No —
ROOFING
❑ Work to be performed under this Permit
Owner of
Building
Architect
Contractor f i
or Builder
Legal Lot
Description
Address of
Building 1
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 E,ave 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 responsibility for work
done by his agents, servants or employees.
j s A J � Z .t,
Y ,.
Signed: BY
INSPECTOR - ...
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 :or all work done by either, myself, my agent, servant or employee.
CONTRACTOR OR BUILDER
MIAMI SHORES VILLAGE, FLORIDA
Bl.
Subdi-
vision
f_
Sq. Ft
Value of
Project $ r''
Amt. of
Permit $
BY AUTHORITY