FENCEMIAMI SHORES VILLAGE
BUILDING INSPECTION DEPARTMENT
APPLICATION FOR BUILDING PERMIT
Application is hereby mode 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 iuilding 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. 4'
Date..._......�11.Z 9 .._._......__..._._._...._... 19 ?4
Owrper's Name and Address � ` . 0 ..__.......... _ .. No. ...-Lin _. Street__ C22 7.
Registered Architect and /or 1?,nOncer
Name and address of licensed contractor v! Q (2 . t o Q k J M (tS J4
Location and legal description of lot to be built on:
Lot LOT' lPI Block k Subdivision
Street and Number where. work is to be done
State work to be done and purpose of building (by floors)
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The undersigned applicant for this building permit does hereby certify that he understands and
of labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General L
anti has complied ssith the provisions thereof, and will require similar compliance from all cont Offs or
in the work to be performed under this permit; and will post or cause to be posted for inspe• o• on the
or notices as arc required by the Act. The undersigned agrees to employ only such subco • • a • ors, o
pcnnit, as are licensed by Miami Shores Village.
Remarks (Signed)
and for no other purpose.
Ncw Bui!ding Remodeling Addition Repairs No. of Stories _
To be constructed of 1 400O a Kind of foundation , Roof Covering . ........... ..._..__
Estimate Total cost of improvements $ 4 S. O • D a Amount of Permit S.
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.
accepts his obliga on as an employer
ws of F•rida, rmanent Supplement,
ctors employed by him
work such public notice
be performed under this
• con
to of
rk
STATE OF FLORIDA,
COUNTY OF DADE. i 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 " .. e
Permit No ..__ fr j ' Date ‘ l aJ' Read, Sworn to and Subscribed before me.
Disapproved
(Signed)
Building Inspector
Notary Public, State of Florida
My Commission Expires
PLANNING BOARD DATE
Chairman Member
Member Afember
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.-ui pection fee of $1.00 will be charged when such re inspection is made necessary by improper notice for inspection oe faulty
materials and /or workmanship.
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Registered Architect and /or Engineer .........
MIAMI SHORES VILLAGE `f/
BUILDING INSPECTION DEPARTMENT
APPLICATION FOR BUILDING PERMIT
Application is hereby made for the approyaI 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
phis: and specifications must be kept at building during progress of the work.
._ �..._._._..._.... ,19
Owner's Name and Address 't 2 A 15 Off ._
4 sass ...__ No ��........._. Street._.....
tip s<s••. rtr •r -esr n'i •lrZ `',•�;
Name and address of licensed contractor.... _
Location and legal description of lot to be built on:
o
Lot..........t.• Block d Subdivision
Gi ,6 e
—
State work to be done and purpose of building (by floors) a." ° 6
Street and Number where work is to be done
_..__..._..__ and for no other purpose.
New Building Remodeling Addition Repairs No. of Stories _
To be constructed of ,/x/ Kind of fou dation �� Roof Covering
Estimate Total cost of improvements $ Amount of Permit S.. �.
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 o� i - =°' GT
The undersigned applicant for this building pennit does hereby certify that he understands and accepts his bligations as an employer
of labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Fl Ida, Permanent Supplement,
anti has complied with the provisions thereof, and will require similar compliance from all contractors or s contractors employed by him
in the work to be performed under this permit; and will post or cause to be posted for ins 1 tion on e e of the work such public notice
or notices as arc required by the Act. The undersigned agrees to employ only such sue tractors on ork to be performed under this
pennit, as are licensed by Miami Shores Village.
Remarks
ne
Disapproved �`:,.... .� l Date
(Signed)
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STATE OF FLORIDA,
COUNTY OF DADE. i ss.
Before me, the undersigned authority, a notary public, duly authorizcd 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.. .'L!. Date (1 ` 1J .. !4 '
Read, Sworn to and Subscribe?pbefore me.
Notary Public, State of Florida
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 niter approval has been obtained from
the Plannir.g 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 anti /or workmanship.
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THESE PLANS ARE APPROVED FOR ISSUANCE OF A BUILDING PERMIT
p WITH NO VARIANCES Q WITH "ARIA';CErS) t_'STED IN "REMARKS"
NO OTHER DEVIATION'S FROM TIE :1".'. S " " ^E' BUV.DFVG AND ZO\:IP''l
ORDINANCES WILL BE PERMITTED, WV E SPE') I ;.'.L' Y LISTED BEI 0'.:.
ALL OTHER APPLICABLE STATE AND COU,;IY LAWS MUST BE COMPLIED
WITH BY ALL PARTIES.
FIRE DEPARTMENT
PUBLIC WORKS
POLICE DEPARTMENT
BUILDING DIRECTOR
VILLAGE COUNCIL
PLANNING & ZONING BO.—
PRELIMINARY:
REMARKS:
•1 - "+ S'qn ^cure
APPROVAL
FINAL:
COMPLIANCE WITH THE SOUTH FLORIDA BUILDFHG C 0 r 'E AS ADOPTED
BY MIAMI SHORES VILLAGE IS REQUIRED. T; ;E ARCI;I I E "T, BU!! DER &
SUB CONTRACTORS ARE C4 +'' '':' Is 0 ..„ r' ;•F 'F q „ !. D.
ING REGULATIONS WHETHER OR NOT SPECIFICALLY INDICATED HEREIN.
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MIAMI SHORES VILLAGE
BUILDING DEPARTMENT
305- 795 -2204
Building Inspection Request
Date O_2 Time
Type Insp'n BOO 1 AC& F I f i
Permit No. BP 2001.° 1 q
Name Au €`ta.
Address a.)- NE °F S
Company
Phone #
qy Gq3 . q 90S
For Inspector:6 P '7
Approved
Correction
Re- Insp'n Fee ❑
23 Name & Date
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Type Insp'n WOO 0 C& F I J P
Permit No. BP 20 ° t q
Name PLO € ?Q .
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MIAMI SHORES VILLAGE
BUILDING DEPARTMENT
305- 795 -2204
Building Inspection Request
Date X-= Time
Address 1 : U "F. en- s
Company , I� g
Phone # q3(-1 `I 4613- "I t 0 US •
For Inspector: 5 P T7
Approved ❑
Correction
Re- Insp'n Fee ❑
23 Name & Date
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• MIAMI SHORES VILLAGE
BUILDING DEPARTMENT
305-795-2204
Building Inspection Request
Date ' Time
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eV\ "
Type Insp'n
Permit No. ,
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Name
Address
Company
Phone #
„ ,
Approved
Correction
Re-Insp'n Fee
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For Inspector:5 ? "'S Name & Date
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