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1234 NE 96 St (10)Miami Shores Village Building Department BUILDING C2L - C,4 -- Permit No. PERMIT APPLICATION MA. ;` 1904 \Master Permit No. FBC 2001 Permit Type (circle): Building Electrical Plumbing Roofing Cpl /9J / #3 0 S s M7 /// Owner's Address /. 2 1 2 y Js/E State PL Owner's Name (Fee Simple Titleholder) Tenant/Lessee Name Job Address (where the work is being done) /23 I 6 9,6 City Miami Shores Village County Miami -Dade Is Building Historically Designated YES NO Contractor's Company Name rL / C- — v`� _t C - Phone # 2 OS 8 2 2 z/ 86 7 ©I LLJ !S CT City /// /A L 6-74Z State PL-- Qualifier T�/L y / L Ro J S' . Contractor's Address Architect/Engineer's Name (if applicable) $ Value of Work For this Permit [J 8 Q Type of Work: ['Addition ['Alteration ❑New 1st' Repair/Replace 1:1 Demolition Describe Work: Z " , /4& I, & &h /T" CS A c5" � S 7a) - P L E7Z 'L L&2 /-r7 '/ c /7 T E - Submittal Fee $ Notary $ Scanning $ C)L Radon $ Code Enforcement $ Total Fee Now Due $ (Continued on opposite side) * * * * * * * * * * * * * * * * * * * * * * * * * * ** F ees * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** Permit Fee $ / / S Z— 70 v Training/Education Fee $ 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 Structural Plan Review. $ MAY 2 5 PAID Zip 33 l _3S Phone # 722 C2-rl Zip Zip 2-d/ Phone # Square Footage Of Work: CCF $ 3 . 'b ,U �7 CO /CC /- Technology Fee $ - r) Zoning Bond $ Bonding Company's Name (if applicable) Bonding Company's Address City Mortgage Lender's Name (if applicable) Mortgage Lender's Address City State Zip Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has commenced prior to the issuance of a pennit and that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRICAL WC WT r- UMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and AIR CONDITI OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate an( pliance with all applicable laws regulating construction and zoning. ) // •\ "WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF C � ` \T IN YOUR PAYING TWICE FOR EVIPROVEMENTS TO YOUR PROPERTY. IF ANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFOI ICE OF COMMENCEMENT." Chc 12/15/03 APPLICATION APPROVED BY: As identifi . 'on and who did take an oath. Print: s o ^off Bruce B Oilman { t '? �/ 1t MY Commission cC 14480 My Commission E ' Expires February 28, 2004 1 \I My Commission Expires: Zip _ Notice to Applicant: As a condition to the issuance of a building permit with an estimate — � .. b — ,ozo00, the must promise in good faith that a copy of the notice of commencement and construction lien ldw will be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first, inspection which occurs seven (7) days after the building permit is •issued. In the absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. Signature ,e al6,4_____ Signatur� Owner or Agent Contractor The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this day of, j`—LC , 20 0L/ by , day of 6%4o , 20 0 L/ by who is personally known to me or who has produced who is personally known to me or who has produced as identification ani ho did take an oath. i 114489 ssa+ NOTARY Sign: V Print: y +J Expires February 28, 2004 ***************************************************************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** (Certificate of Competency Holder) State Certificate or Registration No. a /9 e ozi 30 6 Certificate of Competency No. ***************************************************************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** (; <2 5 L o' O Plans Examiner Engineer Zoning ITEM BATH TUB UNIT FEE ITEM SWITCH OUTLETS UNIT FEE ITEM SPACE HEATERS UNIT FEE BIDET LIGHT OUTLETS CENTRAL HEATING 7,(2 fr..J 1 DISHWASHER RECEPTACLES A/C (WIND) DISPOSAL SERVICE TEMPORARY A/C (CENTRAL) .i b ,J 1 DRINKING FOUNTAIN SERVICE SIZE IN AMPS DUCT WORK FLOOR DRAIN SERVICE REPAIR/METER CHANGE REFRIGERATION GREASE TRAP APPLIANCE OUTLETS PROCESS AND PRESS PIPING INTERCEPTOR RANGE TOP UNDERGROUND TANKS LAVATORY OVEN ABOVE GROUND TANKS LAUNDRY TRAY WATER HEATER U.F. PRESSURE VESSELS CLOTHES WASHER MOTORS 0- 1 If STEAM BOILERS SHOWER MOTORS OVER 1- 3 HP HOT WATER BOILERS SINK, POT /3 COMP. MOTORS OVER 3- 5 HP MECHANICAL VENTILATION SINK, RESIDENCE MOTORS OVER 5- 8 HP TRANSPORTING ASSEMBLIES SINK, SLOP MOTORS OVER 8- 10 HP ELEVATORS/ESCALATORS TEMPORARY WATER CLOSET MOTORS OVER 10- 25 HP FIRE SPRINKLER SYSTEMS URINAL MOTORS OVER 25-100 HP COOLING TOWERS WATER CLOSET MOTORS OVER 100 HP VIOLATION INDIRECT WASTES- A/C WINDOW REINSPECTION WATER SUPPLY TO: AIR CONDITIONERS A/C UNIT STRIP HEATER FIRE SPRINKLER GENERATORS TRANSFORMERS HEATER -NEW INST. GENERATORS TRANSFORMERS HEATER - REPLACE GENERATORS TRANSFORMERS LAWN SPRINKLER -WELL SPECIAL PURPOSE SWIMMING POOL OUTLETS COMMERCIAL WATER SERVICE SIGN TUBES SEWER CONNECTIONS SIGN TRANSFORMERS UTILITY -SEWER SIGN TIME CLOCK UTILITY -WATER FIXTURES SEPTIC TANK ANTENNA RELAY TELEVISION OUTLETS DRAINFIELO, 4' TILE/RES. VIOLATION PLM' & ABANDON SEPTIC TANK REINSPECTION SOAKAGE PIT CU. FT. pe Insp'n tN °• ��� CATCH BASIN DISCHARGE WELL I `�I >� r � 'J./Lb I)C ��45, V DEp D � BUl�dtn his 79S_2 p �� to i Peer/on 4 ' y - � `? l _ — � DOMESTIC WELL _ -- I LL 1 � ?EN E 1 DRAIN R EA 0o INLET 7, Pe rm, 1 Na me SO ATER ST I PE POOL PIPING LAWN SPRINKLER SYSTEM GAS RANGE METER SET (GAS) GAS PIPING (AN APPLICATION+FOR BUILDING PERMIT MUST ACCOMPANY THIS ADDENDUM. IF A MASTER PERMIT HAS B. OBTAINED, THE OWNER'S NOTARIZED SIGNATURE NEED NOT BE PRESENT ON SUBSEQUENT APPLICATIONS.) PLUMBING ADDENDUM TO BUILDING PERMIT APPLICATION y ELECTRICAL MECHANICAL � AIR CONDITIONING EQUIPMENT fr EXACT CHANGE OUT AFFIDAVIT FORM ALL INFORMATION MUST BE FILLED IN ACCURATELY. THE FOLLOWING INFORMATION REPRESENTS THE EXISTING CONDITIONS: ADDRESS: • Ckwit Breaker AMP Size CB Circuit Breaker 2 AMP 5o Sae Circuit Breaker Panel Branch Circuit IlVlre� Branch Circuit Nit F re THE FOLLOWING REPRESENTS THE NEW EQUIPMENT: NAME PLATE INFORMATION: — NEW AM HANDLER UNIT -_— _ �= =____: ____ —.NEW CONDENSER UNIT -- = __ MINIMUM CIRCUIT AMPACITY? U . MINIMUM CIRCUIT AMPACITY? 3 7 . Isifi MUM OVER CURRENT SIB?? U . _ _ ... _ _ _ • MAJOIvIUM OVER CURRENT Std? g 0 ELECTRIC HEATER KW SIZE? J i as qualifying agent for the air conditioning equipment installation at the above address location hereby attest: The above information provided for the existing electrical conditions and the nameplate information provided for the new equipment is accurate and truthful. Company Name Qualifier Name Q a(ifier S' fume - /9/7/, /,vC T12 / 2 -y L PoJS Miami Shores Village AMP Size Air Handler Disconnect AMP Size Condenser Unit Disconnect Disconnect Mounting Location information: Mounted on AHU unit? Yes >4 No Above Base Flood Level? Yes > No Clear workspace 30" wide & 36" front? Yes,X No Mounted on GU unit? Yes No Above Base Flood Level? Yes X No Clear workspace 30" wide & 36" front? YesX No Low voltage thermostat wiring is installed in a separate raceway from the power wiring? YesX No �., Bnicc G((man l iti* My Commission CC9 ti 445 3N4R, Expires February 28, 2004 Miami Shores Village 10050 NE 2nd Avenue Phone: 305 - 795 -2204 Printed: 5/21/2004 Applicant: CHARLES Owner: ALLEN JOB ADDRESS: 1234 NE 96 Contractor CLASSIC AIR INC Local Phone: 305 - 825 -2486 Parcel # 1132060143930 Mechanical Permit Permit Number: MC2004 -78 ALLEN CHARLES ST Contractor's Address: 7801 W. 25 CT. Page 1 of 1 Legal Description: MIAMI SHORES SEC 3 PB 10 -37 LOTS 12 & 13 & E2OFT OF LOT 14 Fees: FEE2004 -5187 FEE2004 -5188 FEE2004 -5189 FEE2004 -5190 Description Building Fee CCF Training and Education Fee Technology Fee Total Fees: Amount $300.00 $3.60 $1.20 $7.50 $312.30 Total Fees: $312.19 Total Receipts .00 aba.3 Vi AY 2 5 PAID Permit Status: APPROVED Permit Expiration: 11/16/2004 Construction Value: $6,000.00 Work: EXACT CHANGE OUT OF 5 TON SPLIT SYSTEM WITH ELECTRICAL HEAT Signed: (INSPECTOR) In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I assume responisibility for all work done by either myself, my agent, servants or employes. Signed: (Contractor or Builder) BY: NOTICE OF COMMENCEMENT A RECORDED COPY MUST BE POSTED ON THE JOB SITE AT TIME OF FIRST INSPECTION PERMIT NO. TAX FOLIO NO. 113 20 6, b ` 3 % 30 STATE OF FLORIDA: COUNTY OF DADE: THE UNDERSIGNED hereby gives notice that improvements will be made to certain real property, and in accordance with Chapter 713, Florida Statutes, the following information is provided in this Notice of Commencement. 1. Legal description of property and street address: / 2 3 (4 N e ' (o ST M t Arc I S 1-1-o2 . r FLA. 2. Description of improvement: % / C. VI.) t t P F p t GE rt € fi 3. Owner(s) name and address: c.wptaL G5 4- S u S'°i ti A le ti 3 Interest in property: Name and address of fee simple titleholder: 4. Contractor's name and address: C L$ 551c_ A 12 /go, w as C T Fh A l eco4 c L A. 3 3o 1� 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 date is specified) 01)6A4 Signature of Owner Print Owner's Name Sworn to and subscribed before me this 2S day of M t4 u Notary Public Print Notary's Name My Commission Expire Sus s - A I le V7if.J_':SS r. ,20 0'} . ROSA M AVS1.UAN Notary Public - State of Florida O - Prr:r'rart • Y /L! `` L ..4, Prepared by 1 � ) SI U� Address: Vol s CT eo, ►-1 - LF1 4J1 '4 nZ \� 0 t *+w MIAMI SHORES VILLAGE, FLORIDA BUILDING ❑ Date t _t - � 19 ELECTRICAL ❑ n PLUMBING ❑ PERMIT N ? 10697 Contractor's ~• j. 4 ROOFING ❑ - 1 License No. ❑ Work to be performed under this Permit Owner of Building Architect Contractor - 2. or Builder L t`• '•r : i . 7 ; + . Legal Lot Description Bl Address of 0 'j { / Building " (' . ,t 4, ( 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 ?employee, r Signed• r t — t INSPECTOR) BY CONTRACTOR or BUILDER In consideration of the issuance to me of this permit I agree perform the work covered hereunder in compliance with all ordinances and regulations pertaining thereto and in strict conformity with the plans, drawings tements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I assume responsibility for all work done either, myself, rgy agent, servant or employee. r G 1 q'( 1.a .. e i Subdi- vision Sq Ft Value of --7 �"` 4 Amount of Project $ • vJ ` II Permit $ ' 6 BY 1 • !,. . . 1.L t 4 ; 4 1 �=.. AUTHORITY MIAMI SHORES VILLAGE BUILDING INSPECTION DEPARTMENT APPLICATION FOR BUILDING PERMIT Application is hereby made for the approyal 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_ Lam' • ,19 Owner's Name and Address_14-'t /1l (h l?SS W ___ '/ "_ No Street_ Registered Architect and /or Engineer Name and address of licensed contractor - !% /= — ./�L_i:�/9 / We L_! Location and legal description of lot to be built on: . Lot Block , Subdivision ''dle"irreet and Number where work is to be done or to be done and purpo se of buildin& (by floors) __ - ._ . 7'er"- __ - -._. Y _z -447 STATE OF FLORIDA, COUNTY OF DADE. ss. Notary Public, State of Florida f and for no other purpose. New Building Remodeling Addition Repairs No. of Stories To be constructed of Kind of foundation_ Roof Covering p Estimated Total cost of improvements $ a _ Amount of Permit $ 1 3 ''- Zone cubage required Plan Cubage._ Size of Building Lot Distance to next nearest building 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 sylaFgptractors, on work to rformed under this permit, 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 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. t a '..,.9� _q Permit No._________ _ Date __ Read, Sworn to and Subscribed before me. Disapproved pate__ ( Signed) 1 ' 17 Building,spector My Commission Expires PLANNING BOARD DATE Chainnan _ 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. Date hi-/y - .:� Job Address /)-.3 y -4/E 76 tim..e-,:rfrax Folio Legal Description Historically Designated: Yes No Owner/Lessee / Tenant ( ,.f-/ 1 ' Master Permit # 3 W7 Owner's Address ( .)-3 � t= 6 ` ` y /( , l ;Y - Phone C3i 5� ?5 -5.5:55 Contracting Co. ( `j i 4-vt_ Qualifier > V rib `; . '1> n L) State # 7 Municipal # Architect/Engineer Bonding Company Mortgagor Address WORK DESCRIPTION «¢C:`- ,4C y Z.1-e4- f / ,C , a2•r✓ PERMIT APPLICATION FOR MIAMI SHORES VILLAGE Signature of owner and/or Condo President Date Notary as to Owner and/or Condo p :i:f• N..s,h )1) C ,(7n A) e_2.,f_ C icj �'I��' =A IILJ� e 140iARY SEAL COMMISSION NO CC.317755 FEES: PERMIT APPROVED: Zoning Mechanical RADON 33c Address 1,t C CC -1T 144, }Ct 4�f SS# ' ' r �� "� ;)f/el"'6 Competency # Address Address Square Ft. Estimated Cost (value) Signature,of Notary as to Contractor My Commission Expir C.C.F. NOTARY Building Electrical Ins. Co. Permit Type (circle one): BUILDING ELECTRICAL PLUMBING ECHANIC ROOFING PAVING FENCE SIGN 7 .4 K-: r -C 2 Li c s (/', .56- '.) 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 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. ontractor or Owner- , ilder . i: GMP/QAL NO TAR Y S. R OSAi.4AVEL1A.N COOMLSSION NO W'a7MM N FXP a Date TOTAL DUE 7 Date Plumbing Engineering PERMIT NO TAXFOUONO 11 3206 014 3930 STATE OF FLORIDA: . COUNTY OF - • 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: MIAMI SHORES SEC 3 PB 10 -37 T.n'PS 1.2 ANT) 13 & F..20ft of LOT 14 BLR 84 1234 NE 96 STREET 2. Description of improvement: EXACT REPLACEMENT OF 4 TON AIR HANDLER AND CONDENSING UNIT 3. Owner(s) name and address: CHARLES AND SUSAN ALLEN Interest in property: OWNER Name and address of fee simple titleholder: SAME 4. Contractor's name and address: CLASSIC AIR INC. 7801 WEST 25 COURT 5. Surety:(Payment bond required by owner from contractor, if any) Name and address: n/a Amount of bond $ n/a 6. Lender's name and address: n/a 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: CHARLES AND SUSAN ALLEN 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 date is specified) NLZO.S Signature of Owner Print Owners Name •• "'' . o 0r l�,e. 1/ Sworn to and subscribed before. = �• day of NO t) • ,19 __ . t Notary Public -*.:111 ... • Print Notary's Name - % : ~ '•slt y __ • '7 �` My Commission Expirbs: whir 4: 9 1 .190. NOTICE OF COMMENCEMENT 1234 NE 96 STREET HIALEAH, FLORIDA 33016 1234 NE 96 STREET CHARLES AND SUSAN ALLEN 1234 NE 96 STREET ONE YEAR FROM DATE OF RECORDING 95R468589 1995 NOV 15 11:39 Prepared by: DAVID S . DESO JR . CLASSIC AIR INC Address: 701 WEST 2S COURT 4H1ALEM! ,— rLA . 4 ,W t „— Application is hereby made 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 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 /e) — — 19 le) Owner's Name and Address :57/5.4 i-Yee l/ //,:-2 / 5' . 5k7; No. _ Street Registered Architect andror Engineer / 7 Name and address of licensed contractor 7)i/?' �� Q C% _ :f6/6 Location and legal descriptip� pi lot to be built on: Lot /w fV igi° i' e Pit s' ! A -'�i' !% 7" 1I.4''L'� i' / / �/ & / / Block Subdivision Street and Number where work is to be done (a' ./1/i- Y‘ • State work to be done and purpose of building (by floors), state exterior colors (submit samples) '< 7 XI'✓ � - 1,lr:Y /.4 / 177e '.e- 7e) CLe) S Jam' 576Y ( -4— 4:11t__ - - c'.G) 4 7 2 .4 ' �K._ /4) C ___ C New Building Remodeling To be constructed of Estimated Total cost of improvements S j . isc APPLICATION FOR BUILDING 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 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 obligatons 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) Qi}+.t,.A, C-/e e C1986,p cI..tif IL<L -. STATE OF FLORIDA COUNTY OF DADE. } ss. Before me, the undersigned authority. a notary public, duly authorized to administer oaths and take acknowledgments. personally appeared 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 1 � Read. Sworn to and Subscribed before me. Disapproved (Signed) v ^� MIAMI SHORES VILLAGE BUILDING INSPECTION DEPARTMENT Kind of foundation Date Addition Amount of Permit Repairs and for no other purpose No. of Stories Roof Covering ff o'' ' Notary Public, State of Florida Building Inspector My Commission Expires PLANNING BOARD DATE Chairman Member Member Member Member Member Council Approved Date Disapproved Datr NOTE: A charge of $25.00 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 $25.00 will be charged when such re- inspection is made necessary by improper notice for inspection or faulty materials and or workmanship. 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 stru ture he=ein described. This application is made in compliance and conformity with the Building Ordinance of Miami Shores Villag', F'onda, and all provisions of the Law of the State of Flo* da 311 ordinances of Miami Shores Village nd all rules and regulations of the Building Division of Miam Shores Village sh 11 be co _.plied with whether h r in specifie'' not. A cop of apt rov. d plans and specifLations must be kept at build ng during progress of the work. Dat- _ 1 ____ • Owner s Name and Address __R.,. F.4 No. 1 72. 34 ___ Street__ f•I. Registered Architect and/i Engineer. le Name and address of licensed contractor _ • VI • E gt-v is+ 4 Cr.V:rt r4. C. 4 L3E .7-1A,,A Ti NI S ""• Location and legal description of lot to be built on: Lot Block _ Subdivision_ Street and Number where work is to be done___1 4 kJ • E • 9 State work to be done and purpose of building ( by floors)4n _ Ci, 51; f. . _ _ c.j. - and for no other purpose. New Building Remodeling Addition__ _ _ _ Repairs___ . No. of Stories _ _ To be constructed of . _ Kind of foundation _ Roof Covering Estimated Total cost of improvements $ Amount of Permit $ Z 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 employ:r 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 vompliance from all contractors or sub-contractors emplo)ed 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 ) g R•V I c1j - STATE OF FLORIDA, - COUNTY OF DADE. j Ss ' Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, peno laity 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 - ___ C _ _ Date L ° ` Read, Sworn to and Subscribed before me. Disapproved Date ( Signed) Notary Public, State of Florida Building Inspe r My Commission Expires . PLANNING BOARD __ _ ___ _. . _ DATE Chairman _ __ Member Member Member _ Member _ _ _ _ Member Council Approved Date D'sapproved _ _ Date NOTE: A charge of $1.00 will be made for making corrections or change to this application after appr , ' 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 imp notice for inspection or faulty materials and/or workmanship BUILDING ELECTRICAL PLUMBING ROOFING Owner of Building MIAMI SHORES VILLAGE, FLORIDA PERMIT Architect Contractor or Builder ` J t Legal Lot Description II Bl N9 5760 Work to be performed under this Permit 1 r f DATE • 19 Contractor's License No. Subdi- vision Address of Value of 1 1 Amount of Building -* Li °; , i ( ` Project $ I- - 11 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 't INSPECTOR In consideration of the issuance io 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 as cepting this permit I assume responsibility for all work done by either, myself, my agent, servant or employee. CONTRACTOR OR BUILDER BY AUTHORITY ,,..,.