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136 NE 96 St (6)STATE OF FLORIDA DEPARTMENT OF STATE Division of Archives, History and Records Management DS.HSP-3AAA Rev. 3.79 FLORIDA MASTER SITE FILE Site Inventory Form FDAHRM 802= = 1009= = Site No. Site Name 830= = Survey Date 8506 Address of Site: _1_3L NF 96 St._, Miami Shores, FT Instruction for locating on S side of NE 96 t . w Location Miami Shores Sec. 1 Amd. 20 subdivision name Count Dade Owner of Site: Name: Santos, Carolyn P. Address: 902 = = Miami Shores, ii • Type of Ownership private - 848 = = Recording Date 832 = = Recorder: Name & Title Rodriguez, Vivian f; Newton, Margo (Chair) Address MSHPB 136 NE 96 St. block no. Architecture- Condition of Site: Integrity of Site: Original Use private residenre538= = Check One Check One or More Present Use private residence850 = = ❑ Excellent 863= = IXAltered 858= = Dates: Beginning +1925 844 = = Good 863= = Unaltered 858= = Culture/Phase Ameri can 840 = = ❑ Fair 863= = Original Site 85e= = P eriod 20th Centur y 845= = ❑ Deteriorated 863 = = ❑ Restored ( ) (Date: )( ) 858 = = ❑ Moved ( ) (Date: )( )858= = NR Classification Category: Building Threats to Site: None Check One or More ❑ Zoning ( )( )( )878= = ❑ Transportation( )( ❑ Development( )( )( )878= = ❑ Fill ( )( ❑ Deterioration( )( )( )878= ❑ Dredge ( )( ❑ Borrowing( )( )( )878= = ❑ Other (See Remarks Below): Areas of Significance 878 = = ,9,10,11 lot no. 820= = 905= = 813= = 868= = 808= = 818= = 916= = )( ) 878 = = )( ) 878 = = )( )878= = 910= = Significance: Structure is a fine example of Mediterranean Revival architecture and is one of the homes built as part of the original Miami Shores development by the Shoreland Company. The architects, Kiehnel $ Elliott, were one of the firms that helped establish the Mediterranean Revival theme for the community. Noteworthy features include the use of arched windows on the ground floor. Structure is in scale and character with the surrounding neighborhood. 911 == ARCHITECT Kiehnel Elliott "Miami, FL1 BUILDER STYLE AND /OR PERIOD Mediterranean Revival. PLAN TYPE rectangular /irregular EXTERIOR FABRIC(S) textured stucco STRUCTURAL SYSTEM(S) concrete block PORCHES none FOUNDATION: concrete block ROOF TYPE: multiple hip SECONDARY ROOF STRUCTURE(S): shed, gable CHIMNEY LOCATION: W, end, ext. WINDOW TYPE: aluminum awning CHIMNEY: CBS, barrel tile shed cap ROOF SURFACING: barrel tile ORNAMENT EXTERIOR: stucco NO. OF CHIMNEYS one 952 = = NO. OF STORIES two NO. OF DORMERS none Map Reference (incl. scale & date)Miami Shores Village Plat 1980 Latitude and Longitude: 0 Site Size (Approx. Acreage of Property): LT 1 LOCATION SKETCH OR MAP N Contact Print 1 36 N.E. g6rm Sr. Township Range Section 1 53S 41E UTM Coordinates: Photographic Records Numbers _ 85N107HG43/85N107HG44 one — Ea sTing flfiing 872 = = 874 = = 964 = = 966 = = • 854 = = 856 = = 942 = = 942 = = 942 = = 942 = = 942 = = 942 = = 882 = = 882 = = 882 = = 950 = = 954 = = 809 = = 800 = = 833 = = 812= = 890 = 860 = = STAVE OF FLORIDA DEPARTMENT OF STATE Division of Archives, History and Records Management DS-HSP -3E 9-74 CONTINUATION SHEET Sito No. Sith Name 136 NE 96 St. Miami Shores, FL Physical Description: Home is a two -story residence of Mediterranean Revival design. Arched full length windows on E of front facade; wrought iron balcony. Entrance is from one -story section on E of front facade, enclosed porch with windows set in bays flanking entry door bay'. Entry porch has shed roof. 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Palm Beach, Florida 33406 (305) 547-2828 (305) 484-1450 1305) 968-8700 ,_.!1. �,. r /-t....I ( `. -) l .... -L - .: 623 1a � - , '1 , . ,-)h -- I I — i) i 1 u ‘ `1...? \,,..)c...) 2.,..-, _ ' _H (...) --' ‘--:_) (-6i-3 T, :._-.., . -3 L1 . ) ,; ) ( c,....), 003 4 ._)I i 3 --- a �i•.)(.c) (, . �v. a . - � 2 �(�— v' Lt.). <.,..._ L.. «/ (1J c, ( IA f LOU I Ls ..())0 -a ;,,,.......,. _L , f, . l ) 1, , , I (J is :.,t_ i. J C . �`. --' 1 i a 1 r l� f 9 0� - 0 '' 1 ? . 1 (,-! .�. 1 ; e / C./3 f • , 2) i • �' ? \ C -� k..A `i'. 1 J s i --' j ---- , t i C. \ Ci ( 1 • • c_ l A .3 ( ''. ' 1." '' 1, \ ). J) ,.■ '• I .. f k4 ‘-)22. 2C)./ LL.' f 1( /L- - . Imo+ w ISAC Form 004 Rev. 7/76 I NSURANCE )ERVICING & ADJUSTING COMPANY CLAIM NO. POLICY NO. INSURED DATE OF LOSS ADDRESS 1 DATE PAGE PROPERTY SCOPE OF DAMAGES Accepted By Date Time Please reply to: ❑ P.O. BOX 3861 0 P.O. BOX 5144 02934 Forest Hill Boulevard Miami, Florida 33101 Ft. Lauderdale. Florida 33310 W. Palm Beach, Florida 33406 (305) 547-2828 (305) 484-1450 1305) 968-8700 ISAC Form 004 Rev. 7/76 CLAIM NO POLICY NO INSURED 1 INSURANCE )ERVICING & ADJUSTING (OMPANY DATE DATE OF LOSS (?).- ADDRESS L S 7:13 PAGE • PROPERTY SCOPE OF DAMAGES Accepted By Date Time Please reply to: D P.o8ox 3861 0 P.O. BOX 5144 02934 Forest Hill Boulevard Miami, Florida 33101 Ft. Lauderdale, Florida 33310 W. Palm Beach, Florida 33406 13051 547-2828 13051 484-1450 13051 988-8700 1] .Ls ii;...01()30") <-1-c:).:1 - .S a -0 fti (") ( C (d 1 1 .5 .4 inn -r c-- ,.. ( . .. ,)(....„ (..,) .-., (3 ot C. Lo (. • ---).- -- c . ) ..) i---- i\s t— V-h I .,_ .._ c LiL3f.') I ( L,,, )( .•,) (.. ( c 3 1.:1 („iji) ( k) c C (:_)_ ' I ). IDS • 7 L(... A,...) , , ±. .-7- (-,,,) • 1 3 CO _. ( S.-ti.,)S uc._) -- L 4 ,-,--r-- 1 f Li I v-! ;.. ISAC Form 004 Rev. 7/76 CLAIM NO POLICY NO INSURED 1 INSURANCE )ERVICING & ADJUSTING (OMPANY DATE DATE OF LOSS (?).- ADDRESS L S 7:13 PAGE • PROPERTY SCOPE OF DAMAGES Accepted By Date Time Please reply to: D P.o8ox 3861 0 P.O. BOX 5144 02934 Forest Hill Boulevard Miami, Florida 33101 Ft. Lauderdale, Florida 33310 W. Palm Beach, Florida 33406 13051 547-2828 13051 484-1450 13051 988-8700 ISAC Form 004 Rev. 7/76 S ERVICING A A INSURANCE & ADJUSTING OMPANY CLAIM NO POLICY NO. t 1 '�' I 1 INSURED -✓ "._•L l_ -�,al t cr DATE OF LOSS ' �� ADDRESS PAGE DATE PROPERTY SCOPE OF DAMAGES Accepted By Date Time Please reply to: 0 P.O. BOX 3861 0 P.O. BOX 5144 ❑ 2934 Forest Hill Boulevard Miami, Florida 33101 Ft. Lauderdale. Florida 33310 W. Palm Beach, Florida 33406 (305) 647.2828 (305) 484.1460 13051 968 -8700 M L (2y 7 '.) 1R- 1 4 ` I(1..)3 • /7 7 `IrV /1 ^ -LJ I . 1 / C_. i iJ 1. ) (� , Ili i l J 1 �� f 1„,LA ii L, - o -� . . - 1 f (. L 1. , , LA-j fJ l .. -,L.) � 1 ''')...?-1-4 � / 1 : 1 t � . ' '° Lk 4 C I 0 C.- I— 1 \-1 I 1 � ( ) -. I / `i • t '- -.Q.� Co6 (C & C (a) i '> L (In t='- -- 1 ---, L---_ - a .. S - .: L) .' . tC 1\ t' �J J l U i Y� l..7 J '`,` C � . . j d J ( r \ C 6 . d ru tom) r (U Cam , LA.) a C_.. , Q.. � .1 .� r' \ (Ur 1 V !.J '. _ j. i Ji e V D. (A a y r! C I. • 2 J s • S i c ;(- ),...i I --: ,.......j. `D j ? rj ,- , , 2 1 ):-- (2 t 1 ..1 I i_, ('2`"" - ISAC Form 004 Rev. 7/76 S ERVICING A A INSURANCE & ADJUSTING OMPANY CLAIM NO POLICY NO. t 1 '�' I 1 INSURED -✓ "._•L l_ -�,al t cr DATE OF LOSS ' �� ADDRESS PAGE DATE PROPERTY SCOPE OF DAMAGES Accepted By Date Time Please reply to: 0 P.O. BOX 3861 0 P.O. BOX 5144 ❑ 2934 Forest Hill Boulevard Miami, Florida 33101 Ft. Lauderdale. Florida 33310 W. Palm Beach, Florida 33406 (305) 647.2828 (305) 484.1460 13051 968 -8700 ISAC Form 004 Rev. 7/76 I NSURANCE JERVICING del ADJUSTING \O PANY CLAIM NO. POLICY NO. INSURED i `l A-) t 2 -114 t, 1 DATE OF LOSS ADDRESS DATE PAGE PROPERTY SCOPE OF DAMAGES Accepted By Date Time Please reply to: ❑ P.O. BOX 3861 0 P.O. BOX 5144 02934 Forest Hill Boulevard Miami, Florida 33101 Ft. Lauderdale, Florida 33310 W. Palm Beach, Florida 33406 (305) 547.2828 13051 484 -1450 (3051 968 -8700 A I c • - .... �� - '.).)._ - >, , 1\._>L c_.?( ;_t 1 1_. • i ( t J ! f i 1 1 "� ) / f` r- .) r . J , r3 ✓t 1 ( . - `--.‘ I ` fi I, • \ C .� - . 1 , ' b� . • 1 ` 1 (( )(J (r)t -?( 1 1(_ i A) = = I Id - , r; gy , . m la � h.Q. 1 � C U // 1 S ( /!. ISAC Form 004 Rev. 7/76 I NSURANCE JERVICING del ADJUSTING \O PANY CLAIM NO. POLICY NO. INSURED i `l A-) t 2 -114 t, 1 DATE OF LOSS ADDRESS DATE PAGE PROPERTY SCOPE OF DAMAGES Accepted By Date Time Please reply to: ❑ P.O. BOX 3861 0 P.O. BOX 5144 02934 Forest Hill Boulevard Miami, Florida 33101 Ft. Lauderdale, Florida 33310 W. Palm Beach, Florida 33406 (305) 547.2828 13051 484 -1450 (3051 968 -8700 A ISAC Form 004 Rev, 7/76 CLAIM NO. POLICY NO INSURED DATE OF LOSS ADDRESS INSURANCE ERVICING & =STING OMPANY DATE PROPERTY SCOPE OF DAMAGES PAGE M1 5 Accepted By Date Time Please reply to: O P.O. 80X 3881 O P.O. 80X 5144 02934 Forest Hill Boulevard Miami, Florida 33101 Ft. Lauderdale. Florida 33310 W. Palm Beach. Florida 33406 (305) 547-2828 13051 484 -1450 13051 988.8700 _l_> _ . ll !.Jt`-� J 1 - . i i /l J ---) -- IT? ( i'• I . L / 9 J ( . ; { f N..)(.., , : /vf t .,,� r � jr;? c . t i .-t'( v}•(a� r2 ` �� . , / 1 • / r ! ,' " , ) — t - f 1 .. I . J (. - j (i . 1 4 -x..' . (� I L p 3 I 1 i 2 _-.- -) r• 1 1 o3 ISAC Form 004 Rev, 7/76 CLAIM NO. POLICY NO INSURED DATE OF LOSS ADDRESS INSURANCE ERVICING & =STING OMPANY DATE PROPERTY SCOPE OF DAMAGES PAGE M1 5 Accepted By Date Time Please reply to: O P.O. 80X 3881 O P.O. 80X 5144 02934 Forest Hill Boulevard Miami, Florida 33101 Ft. Lauderdale. Florida 33310 W. Palm Beach. Florida 33406 (305) 547-2828 13051 484 -1450 13051 988.8700 SAC Form 004 Rev. 7/78 CLAIM NO. POLICY NO. INSURED NSURANCE _�. r�,1E1.' I( 7 , DATE OF LOSS f� ADDRESS ERVICING & ADJUSTING OMPANY DATE PAGE PROPERTY SCOPE OF DAMAGES trk Accepted By Date Time Please reply to: 0 P.O. BOX 388.1 0 P.O. BOX 5144 0 2934 Forest Hill Boulevard Miami, Florida 33101 Ft. Lauderdale, Florida 33310 W. Palm Beach, Florida 33408 (305) 547.2828 13051 484 -1450 13051 988 -8700 L.- • • i 1 ( ..`,A) 01 e (... C' l ‘, NOT .) (i (6 • ,--__ - 1 ` V _ f 1 V ' t� / )^,�� ( ( ` I • . - i i l ci c -A SO, ".'-I (.) X `�..,> - c.) 1 . r /�� .)1, ,�� , � 1 � �J�JO �} Vi�Y.- t_ -.� { i S (pc.) , -) ) I ___._. ..,!34 ` ;J L/3!' -,,-/ ', ` "� t ✓f_s c ,_ J (. r ( ( Cr) �i � 1 ` �. / j 1 / 3 4:p _,22 0 L j 1 1 � .1 ! I .- - .. 1 G.3. l(, (2L ',Nt • i- '•'). .: ) f' f ) u 1 • , • , ( ti 4 \_,;(., I i,..J /_• { � ' • ( 61) . �.� e.., O l� i .-e6 1 ((I L . _i "J �' . 1 \ U _� , c - 1 , n 1 f � _ - - ( Z .---( ..___.,,,,) ,.-t, ( ,- ( - 3 rq ''.. . /7)) 2 5` -- 1 v 5 ----- ' / L r � SAC Form 004 Rev. 7/78 CLAIM NO. POLICY NO. INSURED NSURANCE _�. r�,1E1.' I( 7 , DATE OF LOSS f� ADDRESS ERVICING & ADJUSTING OMPANY DATE PAGE PROPERTY SCOPE OF DAMAGES trk Accepted By Date Time Please reply to: 0 P.O. BOX 388.1 0 P.O. BOX 5144 0 2934 Forest Hill Boulevard Miami, Florida 33101 Ft. Lauderdale, Florida 33310 W. Palm Beach, Florida 33408 (305) 547.2828 13051 484 -1450 13051 988 -8700 ISAC Form 004 Rev. 7/76 CLAIM NO INSURANCE SERVICING & ADJUSTING \OMPANY POLICY NO. C � INSURED (:i `,0 ,! i J 1 \..) DATE OF LOSS !' — - ADDRESS '1(G` N .S1 • ( 4 _ S_ I� DATE PAGE PROPERTY SCOPE OF DAMAGES -3 Accepted By Date Time Please reply to: 0 P.O. 80X 3861 0 P.O. BOX 5144 02934 Forest Hill Boulevard Miami, Florida 33101 Ft. Lauderdale. Florida 33310 W. Palm Beach, Florida 33406 (305)647.2828 13051 484.1450 13051 968-8700 • � - 11 - 1'3 .s1() I I " �aa07 (i 2.1• `PCe.) I .7) i•'F C. r N7 d x /c.� y i �.� t (pie, - J 15 1 . ; ,e 1 ' ( _' 0 ( = , L-2 ' _.)! i 1,fl (� ( / )olv`∎ / 1... 1�1i,(J�,,, 1 CO. ► - ( _ i 'a • G--)1 t ow,D IU J • 2SV . , , ,: 1 r III �. ' (.4,3//q co t's3 oc, ...o.war■ TO , ' 1 a --- . / if . 4, r 4-.. ) 1 - e - [. a pc) i.2* P f / t,� 67 • ,:--(- , ., } � ' . . td u r r te... -.. / (lam .: ,s:. - it -- r -i ► i i) ( i E- ( ,10G �..(, u -' - n , ;J . C I(b2C5 1 ISAC Form 004 Rev. 7/76 CLAIM NO INSURANCE SERVICING & ADJUSTING \OMPANY POLICY NO. C � INSURED (:i `,0 ,! i J 1 \..) DATE OF LOSS !' — - ADDRESS '1(G` N .S1 • ( 4 _ S_ I� DATE PAGE PROPERTY SCOPE OF DAMAGES -3 Accepted By Date Time Please reply to: 0 P.O. 80X 3861 0 P.O. BOX 5144 02934 Forest Hill Boulevard Miami, Florida 33101 Ft. Lauderdale. Florida 33310 W. Palm Beach, Florida 33406 (305)647.2828 13051 484.1450 13051 968-8700 Accepted By ISAC Form 004 Rev. 7/76 CLAIM NO • POLICY NO INSURED I NSURANCE SERVICING & ADJUSTING COMPANY 4 (fic,c. 1 u �i p DATE OF LOSS J ADDRESS ±(`.) Y 1 tA rv'"t• jc_ Please reply to: DATE PAGE N PROPERTY SCOPE OF DAMAGES Date Time a 0 P.O. BOX 3861 D P.O. BOX 5144 ❑ 2934 Forest Hill Boulevard. Miami, Florida 33101 Ft. Lauderdale, Florida 33310 W. Palm Beach, Florida 33406 (305) 547.2828 1305) 484.1450 (305) 968 -8700 I• ex 2. (z1,.)' c' 1 ,, y ' " ( ` • k : • ( 1 . 7 , . . ; e 0 ( X,_,,<.... , ) 11 ( / ( 2L) /10(n i fla..Jry‘ " 4 Lt 1 ( \. ; -;- "� ± -{-- 2.4 -f X (L) ( '2. ) 0 - 2-S - 9 0 s . 0.) ((,0 /.?() 2W o.orJ C CLAIM NO - POLICY NO INSURED 4 Accepted By Date ISAC Form 004 Rev. 7/76 ADJUSTING M INSURANCE SERVICING & COMPANY i 1 t, 1 DATE OF LOSS --' `` - -- ADDRESS 1 7:.-_,(.4 ru • 1 !y Please reply to: DATE PAGE PROPERTY SCOPE OF DAMAGES ❑ P.O. BOX 3861 Miami, Florida 33101 (305) 547 -2828 Time 0P.O. BOX 5144 02934 Forest Hill Boulevard Ft. Lauderdale. Florida 33310 W. Palm Beach, Florida 33406 13051 484-1450 (305) 968 -8700 t -7- '�1- h—L .C.- A,C..t)(a \ :) (0 i v ' -Yee. . 1 'vu ( J i 6 '.p Ak., ,....: ` - 1 Q 1( �...S( /..; ; U i-i . C: ,) St'. 2c.)0 -= r 0 — 4 i• (C. ,)%.. 1 ' L:) TU . C.--1-4 LILa( `. 6 L 1 .'Z 1 LM 0 , // y J? • . V / e Y Z, �3• •J- 1 WA )E L ' L 1U 1 10i • . - , _(1 30e . ,-.. - (;)(-/..0-{ o . 11\1 c,4 C=OJ� .- / ' 1 'd- , -.) - 1 t ry a% 6D ) ,.) !- _ ). .,,..> � ^ -- docd ;)3 ()U i / . ; ncc? r --•-r- 900C.) ' ? . 3. 'f I x . .. 1 7 " _, vca • r CLAIM NO - POLICY NO INSURED 4 Accepted By Date ISAC Form 004 Rev. 7/76 ADJUSTING M INSURANCE SERVICING & COMPANY i 1 t, 1 DATE OF LOSS --' `` - -- ADDRESS 1 7:.-_,(.4 ru • 1 !y Please reply to: DATE PAGE PROPERTY SCOPE OF DAMAGES ❑ P.O. BOX 3861 Miami, Florida 33101 (305) 547 -2828 Time 0P.O. BOX 5144 02934 Forest Hill Boulevard Ft. Lauderdale. Florida 33310 W. Palm Beach, Florida 33406 13051 484-1450 (305) 968 -8700 r■ J. I! AC Fern) 004 Rev. 1/78 CLAIM NO. POLICY NO. INSURED DATE OF LOSS ADDRESS INSURANCE SERVICING & ADJUSTING COMPANY 1j 111(: lL e a J ...le: J 3 1� lU t 1• DATE PROPERTY SCOPE OF DAMAGES PAGE Accepted By Date Time 'Please reply to: 0 P.O. BOX 3881 0 P.O. 80X 5144 02934 Forest Hill Boulevard Miami, Florida 33101 Ft. Lauderdale, Florida 33310 W. Palm Beach, Florida 33406 (305) 547-2828 (305) 484 -1450 1305) 968-8700 C.: % . �I� Q 1 Off) i v 4,141 + X� c �5 e i i(„6 i , / i 4 2 . ( - ) 0 �r ;�. - 3 , rO (J .- k i ce` 7) 1-1 3 •v 3L.) A.) ► t) C> (1 G (....G& (1. -). - 3 "lvi fl 4_ • 4 17 435 22. fi�.,b( ->e. c. 1 - - t H2,t) • Y . ., 4 A) l 1.,cL1 (C.© u f_,iGJ- 1 . 12- •2Z , • •r • • i " .. 2. . i § q 33 .4 1 q ,. o iii ! 6 9 3. 3 LI oleo c.:1 1 c k ,,.,a a ( r) Oft) - .1 r■ J. I! AC Fern) 004 Rev. 1/78 CLAIM NO. POLICY NO. INSURED DATE OF LOSS ADDRESS INSURANCE SERVICING & ADJUSTING COMPANY 1j 111(: lL e a J ...le: J 3 1� lU t 1• DATE PROPERTY SCOPE OF DAMAGES PAGE Accepted By Date Time 'Please reply to: 0 P.O. BOX 3881 0 P.O. 80X 5144 02934 Forest Hill Boulevard Miami, Florida 33101 Ft. Lauderdale, Florida 33310 W. Palm Beach, Florida 33406 (305) 547-2828 (305) 484 -1450 1305) 968-8700 ''r OSAC Form 004 Rev. 7/76 CLAIM NO. POLICY NO INSURED DATE OF LOSS ADDRESS I NSURANCE SERVICING a ADJUSTING COMPANY •^ /V tX yiu • t St yw1 �, !Yl f mil✓ rJ • DATE PAGE PROPERTY SCOPE OF DAMAGES Accepted By Date Time Please reply to: ❑ P.O. sox A861 D P.O. BOX 6144 02934 Forest Hill Boulevard Miami, Florida 33101 Ft. Lauderdale, Florida 33310 W. Palm Beach. Florida 33408 (305) 547.2828 13051 484 -1450 (305) 968-8700 (_r.rr, )X1 f ' ".. ..� , co C I . ( 17 E , ,.k6 `, it - r ; Vial) L- 40 -ij -01( A.),),)/ I) i L N 1 � ,-) `r' X . 7 2 c) -- ' ,s . ` G - IS ..., - .4 I<-- U vu I. L 'fir Le a ,- 4X) f'')), \_ 0 •t-' )I� 1 4- � l • rim ' --- ou ( '.• 1 I,...- C� 2, 1 `' ' _ • ) v . i t j 'tic. -1 1 e 1 .� - �i.. 0 <c�(" -T i N.) “ :::...“- ( \ . --(-- c.D3 V' ( 8 rc - 2 • S . Z.() -- ) '•f (/ ,..1 (7 A )IlGIO 4C D c ,:) knn , r C) (r.,L'T I-1 muc m. i 1 "r- O 2' J 0 3`2•. ..c0 l C' '', I , ,(''• ( d. J 0 ) ' i t MC \) , -A...) ._.. ''r OSAC Form 004 Rev. 7/76 CLAIM NO. POLICY NO INSURED DATE OF LOSS ADDRESS I NSURANCE SERVICING a ADJUSTING COMPANY •^ /V tX yiu • t St yw1 �, !Yl f mil✓ rJ • DATE PAGE PROPERTY SCOPE OF DAMAGES Accepted By Date Time Please reply to: ❑ P.O. sox A861 D P.O. BOX 6144 02934 Forest Hill Boulevard Miami, Florida 33101 Ft. Lauderdale, Florida 33310 W. Palm Beach. Florida 33408 (305) 547.2828 13051 484 -1450 (305) 968-8700 • r ISAC Form 004 Rev. 7/76 INSURANCE SERVICING & ADJUSTING COMPANY CLAIM NO. POLICY NO. `{1 INSURED _ rC a L i iCL! DATE OF LOSS ADDRESS ) I.CJ 1 -1/4); E:7 - � � ( - 0 � Please reply to: DATE PROPERTY SCOPE OF DAMAGES PAGE Accepted By Date Time 0 P.O. 80X.3861 0 P.O. BOX 5144 02934 Forest Hill Boulevard Miami, Florida 33101 Ft. Lauderdale, Florida 33310 W. Palm Beach, Florida 33406 (305) 547.2828 (305) 484-1450 (3051 968 -8700 I, ,1c) - \■ Ai 01 C • . -- i (....�. +_ 6 7 )-cam` l i G ‘ t, i1 1 i ) ,, (~ -_) , t., 00,-� G ,. i 4 4 , ... 6 601 ()L ( ) 1)� ` r . ,r).a A .,L )0 1:.. / i L 2 ' , �•YM+ J C.) •..) L 6 N..) r 6 / (' ' / . 3 T Q ,mss le...._ 4 i 14c, 'T c r ti r I 6 :,.) . • t 1'( 1 -1 1.. �tiy ;,, ; L.- /._QlJ ciotrJ , 'l) L r\ - �"i:+?�� ..- j �'- t , Iv i „,r-t” I ;'',.., � • 3- S"L r3 , 63 C. Lra A.1 ?. e.,, J . 1 ,) ''/O /Z C 4 0 ic , .. 0 »U//'- Y jc C.7- :)6 /`7) ..--'..■ / f • r ISAC Form 004 Rev. 7/76 INSURANCE SERVICING & ADJUSTING COMPANY CLAIM NO. POLICY NO. `{1 INSURED _ rC a L i iCL! DATE OF LOSS ADDRESS ) I.CJ 1 -1/4); E:7 - � � ( - 0 � Please reply to: DATE PROPERTY SCOPE OF DAMAGES PAGE Accepted By Date Time 0 P.O. 80X.3861 0 P.O. BOX 5144 02934 Forest Hill Boulevard Miami, Florida 33101 Ft. Lauderdale, Florida 33310 W. Palm Beach, Florida 33406 (305) 547.2828 (305) 484-1450 (3051 968 -8700 CLAIM NO POLICY NO INSURED DATE OF LOSS ADDRESS I NSURANCE SERVICING & ADJUSTING (OMPANY -J DATE PAGE - PROPERTY SCOPE OF DAMAGES Accepted By Date Time Please reply to: O P.O. BOX 3861 0 P.O. BOX 5144 Q 2934 Forest Hill Boulevard Miami, Florida 33101 Ft. Lauderdale. Florida 33310 W. Palm Beach, Florida 33406 13051 547-2828 (3061484.1450 13051968 -8700 ISAC Form 004 Rev. 7/76 • 4 4 I �-- -- ' I a .. . V4 r . 3 - ! . .. - r� Lf r a 1 ! ',' } } ; a 1 t i..... �; ` ,,,,, r , • ` ( 1 i � ' +,� L1.! .) 1 i j ' . t i l is r . �� < i _ ) ! i'.' • '' ._ r 11__(). . , '. 1 ) 1 . , ,t . . 4 ... , ..; i,r ' i -• ` l .13 1 r ; _ / - ... J . , ' ,t c t.s i. -) .. CLAIM NO POLICY NO INSURED DATE OF LOSS ADDRESS I NSURANCE SERVICING & ADJUSTING (OMPANY -J DATE PAGE - PROPERTY SCOPE OF DAMAGES Accepted By Date Time Please reply to: O P.O. BOX 3861 0 P.O. BOX 5144 Q 2934 Forest Hill Boulevard Miami, Florida 33101 Ft. Lauderdale. Florida 33310 W. Palm Beach, Florida 33406 13051 547-2828 (3061484.1450 13051968 -8700 ISAC Form 004 Rev. 7/76 2 1 ji, ,,e_.- ' pl: ..: „. A ,- ......5 - ..7 ,- ,,,,. 1 • C'; ; A” : , : i ,./' .,5 ';..,;-' ',- ...: ,,,,- - ',,'" 7 - - - -:,,! • -.5 .4 . :5 7 > ie: g- ->,,,' 7,- - _ ' . / ./ - _ t7c>c,x_y; -00 2.7 2 7,C," 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 o,f 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 budding during progress of the work. 19?-1 Owner's Name and Address eh. <5 — No Z- .... Street-.-/v"-' .7 e Registered Architect and/or Engineer C1:2 .1,1,12,22,t, f.,1•11,7111.2,1 Name and address of licensed contractor Awe 69,457et/e TY 0 A.! Ave • Location and legal description of lot to be built on: Lot Block Subdivision Street and Number where work is to be done t L C e State work to be done and purpose of building (by floors) 0 / e e / /....< I - . c et - le.5, L T01.57:5,,..ivc , , /3y. a . /# ?n'/, 4 - e:;e2:i i- 4-,i ov ri A/6 and for no other purpose. New Building Remodeling Addition Repairs 1/ No. of Stories To be constructed of ' fi Kind o foundation /2// Roof Covering 6 79 Estimated Total cost of improvements $./ Vej 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 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 al contractors or.sub-contractors employed by him in the work to be performe d under this permit; and will post or cause to be posted for .., ection o n t site of = yorehAtilblic notice or notices as arc required by the Act. The undersigned agrees to employ only such actors, ----- ,./..../ ,•:-:-. permit, as are licensed by Miami Shores Village. / ' Remarks (Signed) ,/Y.‘ ..'. STATE OF FLORIDA, COUNTY OF DADE. ss. Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally ap- peared `e.L• 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 Permit No. . e-> i 7 Date X2-4/ t j2 , 77 Aead, Sw Disapproved (Signed) MIAMI SHORES VILLAGE BUILDING INSPECTION DEPARTMENT. APPLICATION FOR BUILDING PERMIT Date.. Building Inspector ANNINC BOARD inc. Notary Public, 11111UCSIMi WILCOX:IA AT LARGE My Commission Exinerfaraw.comviasioNIMITIENna-r9B0— ,,.., L 911111 GOMM NI. INDBNIUTBIS 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-inNpection fee of $1.00 will be charged when such re-inspection is made necessary by improper notice for inspection oc faulty materials annior workmanship. NO. STREET HEIGHT PART of LOT LOT BLOCK ROOF COST OF BUILDINo SUBDIVISION PERMIT FEE > q4 - I/ / lam J • l Y. ...c L. ! ♦ Ji .. : 4 lei t .01 .t. ' eLf , FRONT DEPTH HEIGHT STORIED TYPE OF CONSTRUCTION BUILDING TO DE USED FOR ROOF COST OF BUILDINo PERMIT FEE l Rcnte, Stucco tt' d I t Hate) Oi f I` y "� �'""""" .. -"" BUILDING PERMIT Owner of Building Architect Contractor or Builder Miami Shores, Village, Florida, :y 19 PROPOSED LOCATION DESCRIPTION OF BUILDING This permit is issued to / `. / PA 1 / 1 - '` if„," To .;4 t/ �•s� {: ', �+ {: - ' x the building above described, as per application, Plans and Specif heretofore filed in this office. This permit is t ranted u p on t l� rms condition that all facts stated in the application are true and that the construction complies strictly with the plans and specifications sub$aitted, and in accordance and compliance with the building laws of the State of Florida and with the building ordinances and zoning laws of Miami Shores Village, and rules and regulations of the building department of Miami Shores Village. This permit may be revoked at any time upon the violation of any provisions of said laws, ordinances or rules and regulations, or upon any change in the plans and specifications unauthorized by,tllte building inspegtor. In consideration of the issuance to me of this building permit 1 hereby agree to do the proposed construction in strict confo#inity with the application and plml and specifications thereof heretofore by me submitted, and in compliance with all provisions of all building laws of the State of Florida, all the build ordinances and Boning laws of Miami Shores Village and all rules and regulations of the building department of Miapti -Shores Village. � � UILDING INSPECTOR MIAMI SHORES VILLAGE OFFJCEE ` OF BUILDING INSPECTOR f- , N° 251 The on will b Permit No. a y for f �P, .; inspection at f �. = �' -.. > > Memo to Building Dept: - Request for Inspection Company advises that * ?'r job at /c? f= ` 1 r . No. STREET PART OF LOT LOT BLOCK SUBDIVISION ROOF COST OF BUILDING PERMIT G FRONT DEPTH HEIGHT STORIES TYPE OF CO. 8TRUCTION BUILDING TO BE USED FOR ROOF COST OF BUILDING PERMIT ra e, s oncrete, Stucco I Apf, Stores, Hotel �� 0 2 � FE / E BUILDING PERMIT Dated ,19 Miami Shores Village, Florida, / r Owner of Building Architect Contractor or Builder PROPOSED LOCATION DESCRIPTION OF BUILDING MIAMI SHORES VILLAGE OFF CE OF BUILDING INSPECTOR UILDING INSPECTOR N9 251' � q / V f '� ' This permit is issued to o • e l , T y cif To '' `� �' ,fl� � ' the building above described, as per application, Plans and Specifications heretofore filed in this office. This permit is grante upon thf express condition that all facts stated in the application are true and that the construction complies strictly with the plans and specifications submitted, and in accordance and compliance with the building laws of the State of Florida and with the building ordinances and zoning laws of Miami Shores Village, and rules and iiip ulations of the building department of Miami Shores Village. This permit may be revoked at any time upo • the violation of any provisions of said s, ordinances or rules and regulations, or upon any change in the plans and specifications unauthor ,y. e building inspector. In consideration of the issuance to me of this building permit I hereby agree to do the proposed construction in strict conformity with the application and plans and specifications thereof heretofore by me submitted, and in compliance with all provisions of all building laws of the State of Florida, all the building ordinances and zoning laws of Miami Village and all rules and regulations of the building department of Miami Shores Village. (SEAL) �J 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 .X `I 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 j_..'> N1 • G' State work to be done and purpose of building (by floors) ,-) ill: �� i�',;, .�. New Building MIAMI SHORES VILLAGE BUILDING INSPECTION DEPARTMENT Date .2 tf No./ 6r Building Inspector Street 19` .-c+ d t _fay _V 7 ?Al,' 2/ V _.� < and for no other purpose. Remodeling Addition Repairs i 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 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, Permanent Supplement, and has complied with the rovisions 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 s� tractors, on work to be performed under this permit, as are licensed by Miami Shores Village. y ; t Remarks (Signed h_; , ` ` STATE OF FLORIDA, COUNTY OF DADE. 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. Permit No ? Date ' " F Read, Sworn to and Subscribed before me. Disapproved Date Th (Signed) Notary Public, State of Florida My mission Expires ING 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. LOCATION 136 1.. 96 L�' S GARBAGE TAX RECORD PAID BY YEAR ANNUAL TAX PERIOD USED AMOUNT PAID DATE PAID RECEIPT NUMBER . . ' _ j ©� 1940 .d �-° �o . 1941 C, ,. ,• - / /� 1942 O 0 42-30-1/4 / - N - 43 3 f/.2.. ( 7 1 ,3 ger /a /Q B e • ./• ' 1943 e . .- (4/ , ! 1944 M 4-42 //2--9,/,3-y13 C ' Lutu iu- 19 45 /a. f o i _ s_ Li 6Skt i - i a • h (D 1946 /17. D /' 46'''440 P /t N 1947 / l )'. f° J i -. 6 - 1 /, , G c (( 1948 /, . ) c) �} /g -S /lVt ,/ /-- 6 /7Y7' h fl 1949 f, - 3!- 1 ii ,' /' qg S � I I // // ,, 1950 /..3-.3 / - tp /- 9 Sa /y /a a LOCATION 136 1.. 96 L�' S GARBAGE TAX RECORD 136 N. E. 96th st. by R. N. Turner year annual tax period used 1Q5 1a. date paid amount paid recut,# /-- to -57 42, . /6 So S" 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 approved plans and specifications must be kept at building during progress of the work. Date , 19 Owner's Name and Address t 5 No Street 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 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 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 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, 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. _____ —___ -- ( Signed) _ STATE OF FLORIDA, COUNTY OF DADE. 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. Permit No. Date Read, Sworn to and Subscribed before me. Disapproved Date 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 n')ti 'e for inspection or faulty materials and /or workmanship. W"4