245 NE 96 St (7)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 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.
Owner's Name and Address 1C N +•CW1
Registered Architect and /or Engineer
Name and address of licensed contractor 95icti kbeN'i
Location and legal description of lot to be built on:
30
Lot 1
Street and Number where work is to be done
To be constructed of
Permit No. 91009
Disapproved
(Signed)
Jvaa - b bE .
"V Block Subdivision
State work to be done and purpose of building (by floors), state exterior colors (submit samples) C ADAISTQ4ICr Tb-CbL.Ot 09 IV S
A. Owe.
and for no other purpose.
New Building ✓ Remodeling Addition Repairs No. of Stories
C. 1,4 Kind of foundation C.-04 C.e xE._
Estimated Total cost of improvements $ Sell 0 Amount of Permit S (kl
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 ' +
4(rw►J O1 C s.+v'C * Zl1 N. t�itr \11..L. `Ft.. 331
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) IN • 4.* cLt.
,
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
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.
Date ` n "9 Read, Sworn to and Subscribed before me.
Date
M1 w•1 SLOee 6 EC.TI O l■-1
X16 s +'
I 444
Date )l 4 - 4- — `' 19 1
No. +4o Street IC ' -- si r Qk1`f
tean1ep -r 211
75x 11•'
CFe /
Roof Covering
Notary Public, State of Florida
144 f VO
N
s.,31 k DON
to me well known.
Building Inspector My Commission Expires
PLANNING BOARD DATE
Chairman Member
Member Member
Member Member
Council Approved Date Disapproved Date
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.
Building Permit
Miami Shores Village
10050 NE 2nd Avenue
Phone: 305 - 795 -2204 Permit Number: BP2004 -1274
Printed: 10 /6/2004
Applicant:
Owner:
Y JOB ADDRESS: 173 NW 106 ST
Contractor
Local Phone:
Parcel # 1121360080260
Signed:
Contractor's Address:
Legal Description: DUNNINGS MIAMI SHORES EXT 4
Permit Status: APPROVED Permit Expiration: 3/20/2005 Construction Value: $200.00
Work: SHUTTERS FOR BAY WINDOW
(INSPECTOR)
Page 1 of 1
PB 48 -20 LOT 10 BLK 205
Fees: Description Amount
FEE2004 -9868 Building Fee $100.00
FEE2004 -9869 CCF $0.60
FEE2004 -9870 Training and Education Fee $0.20
FEE2004 -9871 Technology Fee $2.50
FEE2004 -9872 Scanning Fee $15.00
Total Fees: $118.30
Total Fees: $118.30
Total Receipts: $0.00
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: