330 NE 96 St (8)p o
APPLICATION FOR BUILDING PERMIT
Application is hereby mode for the approval of the detailed statem=ent of the plans and specifications herewith submitted for the build •
ine 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 pregreu of the work.
Owner's Name and Address Mgrna 6� Q _ __._ No.., ? ®........ Street_
Registered Architect and /or Engineer ..:,.•••••. •- •...•_,., „,._....•_- .__.
Name and address of licensed controctor. -q. A t.•. a.�..Q .w. tzQn .(f ._� icon L /c2. — AGE- °
Location and legal description of lot to be built on:
Lot Block Subdivisioon ,,.,,
Street and Number where work is to be done 3O .. �_.._.� 12 ....-- .• – (yr re. - --
State work to be done and purpose of building (by floors).. �..Ainc ... -- Ari . -.. --
New Bui!ding Remodeling V Addition Repairs; No. of Stories
To be constructed of Kind of foundation Roof Covering
t l
Estimated Total cost of improvements $ 3 OQ . ” Amount of Permit $. QC) +
MIAMI SHORES VILLAGE
Building Inspector
Disapproved j► Vii. Date
(Signed)
BUILDING INSPECTION DEPARTMENT
and for no other purpose.
Zone cubage required _.._...Plan Cubage
Distance .to next nearest building. Size of Building Lot _ .............
s live load to be borne by each floor
I hereby submit all the plans and specifications for said building. All notices with reference to the building and its construction may
be sent to
The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations as an employer
of labor under the Florida \\'ork►nen's Compensation Act, being Section 5966. Compiled General Laws of Florida, Permanent Supplement,
and has complied %% WI the provisions thereof, and will require similar compliance from all contractors or sub - contractors employed by him
in the work to be performed under this permit; and will post or cause to be posted for inspection on the site of the work such public notice
or notices as are required by the Act. The undersigned agrees to employ only such ,, ubcontractors, on work to be performed under this
permit, as are licensed by Miami Shores Village. li
Remarks (Signed) D
STATE OF FLORIDA,
COUNTY OF DADE. ss'
Before me the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally ap-
peared SIAilfri a. S V)) i7C)$
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 fads
therein by him stated are true..
Permit No.._a... ..5 Date Read, S�vorn to and Subscribed before me.
Notog ,Px+►bligaStatie AFlpri4111)a
My Commiui •, "• 1f" SgtO i £LI U 2 B9BZ
to me well known,
PLANNING BOARD DATE
Chairman Member _ ...._ ................. ...._._
\Icrr,ber 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.
WINDSTORM PROTECTIVE DEVICES - (HURRICANE /ORDINARY)
- PROOF OF COMPLIANCE RESIDENTIAL FORM
The Intent.of this form is solely for the application of shutter discounts. This form is not for use in conjunction with any other
mitigation features or discounts.
APPLICANT OR INSURED'S NAME: I4M C fl Sat- 3 p l -..rr APPLICATION/POLICY NO. 1 r 3 I y
DATE DEVICE(S) INSTALLED:
AGENT /APPLICANT: The property address shown in D.2 must match the property address on the Application for Coverage to
which this document pertains.
Shutter Requirements:
A. All exterior wall and roof openings, such as doors
(exterior and garage), windows, sky- lights and vents,
of the insured building or unit, if a condominium unit,
as described in the Declarations, is fully protected with
STORM SHUTTERS of any style and material, or
alternative as noted in Section B, designed and properly
installed to meet one or more of the criteria requirements
listed below.
All shutters and/or altemative to shutters at the location
shown in D.2 of this form are designed to meet one of
more of the following:
1. withstand wind pressure that at a minimum meets the
American Society of Civil Engineers, July 1988 standards
(ASCE 7/88) and impact from wind -borne debris, adopted
by Dade County, Florida in September 1994 or any local
code that meets, at a minimum, September 1994 Dade
County requirements for wind pressure and impact from
wind borne debris or complies with SSTD -12 standards for
wind pressure and impact from wind borne debris.
2. withstand wind pressure that at a minimum meets the
standards set forth in the South Florida Building Code,
adopted in Dade County, Florida in August. 1988.
NOTE: Roof ridge vents, soffit vents, and breakaway walls
as defined and required by the National Flood Insurance
Program (NFIP), and other non shutter openings as
required by the Dade County building code, do not have
to be protected by shutters.
B. As an alternative to Storm Shutter(s):
1. The garage door(s) meets or is RETROFITTED to meet
the wind pressure and debris impact requirements
noted in Al.
2. The exterior door meets both the wind pressure and
debris impact requirements described in Al.
Revised 3/14/00 1:35 PM
3. Window or other wall, and roof opening(s) are covered
by permanently installed glazing material that, along with
respective window or other wall and roof opening structural
components, meet both the wind pressure and debris impact
requirements noted in Al.
As the Insured, I certify the following:
3 3 \ ,Q)
C. 1. 1 will close and secure my shutters in event of a tropical
storm or hurricane affecting my premise(s); and
2. 1 have made arrangements to close and secure all
shutters in my building or unit (if in a multi -unit building)
when 1 am away from the premise.
3. The devices certified below are properly installed in
compliance with the manufacturer's installation
recommendation and aforementioned building codes.
4. "While your failure to comply with the above conditions
will not result in denial of a claim for Toss caused
by the peril of Hurricane, Other Windstorm or Hail, we
reserve the right to discontinue the benefits of this
endorsement, including any related premium credit, in
the event of such failure ", and as stated in the policy
conditions, " we may cancel immediately if there
has been a material misstatement or misrepresentation or
failure to comply with underwriting requirements .
established by us."
Signature of Applicant Date
D. A signature of tither a Registered Architect, Regulations
and Code "Qualifier" for a Manufacturing Company,
Engineer, or Building Code Compliance Official is
required to verify section A and/or B. Notary
Public to affirm. (Continued on Page 2)
WPD-1 R (7/00)
Page 1 or2
This eel titication is intended ONLY for the benefit of the Named Insured's receipt of a property insurance premium discount and for
no other purpose. Unless otherwise specifically agreed in writing, other persons or entities, including assigns and successors di'-the
building or unit owners, shall not be entitled to rely on this certification.
I. I hereby certify that I am a State of Florida registered Architect, or an Engineer, proficient in structural design, or a duly
designated Regulations and Code "Qualifier" for a Manufacturing Company, or a Building Code Official (who is duly authorized by
the State of Florida or it's county's municipalities, to verify building code compliance); and
2. In my professional opinion, based
shutters, on the building or unit at the
and where applicable section B:
(check le only)
A.I (Hurricane)
A.2 (Ordinary)
Signature of Registered Date
ArchitccVEngineer /Qualifier (Notarize below)
Print Name Below
Property Address:
State of
County'of
Wi
The
b
Revised 11/3/99 11:05 AM
on my knowledge, information and belief, 1 hereby certify that shutters, or alternatives to
address indicated below, comply with one or more of the stipulations set forth in section A,
Cliff b'*. 9 1 H' 4 .t A-CC. (PA/A 4V s ? wa vO
(chec�k pne only) (chec that apply)
A.l (Hurricane) " "(Hurricane)
A.2 (Ordinary) X8.2 (Hurricane)
B.3 (Hurricane)
at apply)
(Hurricane) .
B.2 (Hurricane)
B.3 (Hurricane)
/ /0 I z - i.- =t
Signature of Building Date
Code Compliance Official (Notarize below)
Print Naa 1 B Io�G�4 _g t'� 1764
Address Title l ;,D.- v Gc t1
City/Statc/Zip Department - ,- - (..-1;
4( 9 _ -
Registration Number Dept. Address / V-2 X-43 '� ,, a
City/State/Zip 1/z4"'i-i-44 4luW S _e{ - 3 -13
Phone Number ' 7 791 .-- ' ti
orida
\ L&. - t )Q L.
respect to the above, --- )..'e 01
bovenamed signatory+ has sworn to and subscribed before me this r 1 day of ( , , A.D., 2@@8;
me of person making the statement) the information contained within this document is accurate
and true. The above signatory is personally known to me f or produced , (type of
identification) for identification.
Signa
,
Print, Tyre o ,$.ta - *tame :of T
t o rA j
�' '; n [ti:
E. hardship Acceptance when signature in Section D. above cannot be procured:
I have attached documentation proving that shutters, other devices, and doors without shutters meet the wind pressure and debris
impact requirements stated in the rule and the devices are properly installed in compliance with the manufacturer's installation
recommendation and aforementioned building codes. Such documentation must come from a Building Code and Compliance
Official, the Regulation and Code "Qualifier" for the Manufacturing Company, a Florida Registered Architect, or Engineer
proficient in structural design. Such documentation may be waived if said individuals complete Section 'D of this document.
Signature of Applicant
Date
FWUA reserves the right to confirm all information contained in this form via a survey of the risk.
"Any person who knowingly and with intent to injure, defraud, or deceive any insurer files a statement of claim or an
application containing any false, incomplete, or misleading information is guilty of a felony of the third degree."
WPD-IR (7/00)
Pagc 2 of 2
f
FLORIDA WINDSTORM UNDERWRITING ASSOCIATION
MITIGATION VERIFICATION AFFIDAVIT
Page 2
Gable Bracing
7. If this is a gable roof, is the gable braced? (Trusses [or the wall portion that extends above
the gable end wall] are strengthened by properly securing (via 16d nails or 3 ", 14 guage wood
screws) the bottom chord of the truss to the top of the end wall and bracing the bottom chord to the
adjacent trusses to prevent the wind from pushing or pulling the gable end where the gable
truss is connected along the gable wall.)
YES NO NOT VERIFIED
Garage Doors
8. if there is an attached garage does the door(s), meet or is retrofitted to meet ASCE 7/88 wind and debris
impact standards adopted by Dade County in September 1994, or any local code that meets at a minimum
these standards; or is the dgof(s) compliant with SSTD -12 wind pressure and debris impact standards?
YES
I hereby certify that I am either a resident Licensed Building Contractor, Registered Architect or an Engineer
in the State of Florida or a Building Code Official (who is duly authorized by the State of Florida or it's
county's municipalities, to verify building code compliance). In my professional opinion, based on my
knowledge, information and belief, I certify that the above statements are true and correct. This certification is
intended only for the benefit of the named insured's receipt of a property insurance premium discount and for
no other purpose. By completion of this Affidavit, the undersigned does not make a health or safety
certification.
Signatur (Notarize below)
License No 1'2
NO NOT VERIFIED
State of Florida
County offin
With respect to the above,
The above named signatory has sworn to and u r'bed before me this
--- >J day of (Oa ,A.D., 20(11 , dime of
person making the statement) the information within this document is
accurate and true. The above signatory is personally known to me
or produced AM ( re of identification)
for identification.
411,
iena r of No
<9 ANC
Print lipsompfamehoful o
CC
Date 1 /
FWUA reserves the right to confirm all information contained in this form via a survey of the risk.
"Any person who knowingly and with intent to injure, defraud, or deceive any insurer files a statement of
claim or an application containing any false, incomplete, or misleading information is guilty of a felony of
the third degree."
2
MIT -1 7/00
Policy Number: 9
Named Insured
Location Address
Asexcira
c - f) !� I Ry d7 , r rizA eY /?
Sheathing/Attachment
1. Does this roof have, at a mi imum, 1/2" roof sheathing?
'Description
YES
Roof Construction
YES
Wall Construction
YES
YES
YES
FLORIDA WINDSTORM UNDERWRITING ASSOCIATION
MITIGATION VERIFICATION AFFIDAVIT
Item No:
NO
NOT VERIFIED
2. Is the sheathing attached to the roof trusses by 8D nails or greater , e.g. (10D nails or #8 screws) which
are spread 6" on edge and 12" or better in the field or a AFG -01 structural adhesive that is continuously
applied, using the manufacturer's instructions, on both sides of the truss/rafter with a' /." or greater bead
between the sheathing and each truss/rafter over the entire length of the truss/rafter and its connection with
the sheathing to within a foot o the roof overhang? A foamed polyurethane sheathing adhesive described
under "secondary water r ance" meets this requirement.
NO NOT VERIFIED
Secondary Water Resistance
3. Does this roof have a self adhering polymer modified bitumen roofing underlayment (thin rubber
or asphalt sheets with peel and stick underside located beneath the roof covering) or a foamed
polyurethane adhesive that is applied to seal all joints in the sheathing to protect from interior
water intrusion? All secondary water resistance products must be installed per the
manufacturer's instructions. Roofing felt or similar paper based products are not acceptable for
secondary water resistance.
NO NOT VERIFIED
Roof Straps
4. Are there roof straps/clips ins alled on each truss/rafter per the manufacturer's installation requirements?
NO NOT VERIFIED
5. Is this a reinforced concrete roof? (A roof deck designed in accordance with the provisions
of ACI (American Concrete Institute) 318. The roof deck shall be monolithic and constructed
integrally with the wall system and meet the wind d l oad requirements of the local building code.)
/
YES NO V NOT VERIFIED
6. Is this a reinforced masonry structure? (Exterior walls are constructed of masonry materials
that are reinforced with both vertical and horizontal steel reinforcement and are relied upon
for structural stability. Vertical reinforcement shall be fully grouted in the cells of hollow
masonry units, and horizontal reinforcement shall be fully grouted in specially formed
[Bond Beam] units designed for that purpose or poured concrete tie beams. Tilt -up or poured
concrete wall units shall be reinforced both vertically and horizontally with reinforcing steel.)
NO NOT VERIFIED
Continued on Page 2 MIT -1 7/00