370 NE 97 StBUILDING
PERMIT APPLICATION
FBC 2001
Permit Type (circle): Building Electrical Plumbing Mechanical Roofing
Owner's Name (Fee Simple Titleholder) /7'4 /, `. 7," -7 ( C.te T 'jV Phone #j": 3L-
Owner's Address 7(�
City/ r'Syk - State ' Zip
Phone #
Tenant/Lessee Name
Job Address (where the work is being done) 7 /1/,, e7
City Miami Shores Village County Miami -Dade Zip
Is Building Historically Designated YES NO (t
97
Contractor's Company Name ! C'G/ ,. l %. )' ( / fhone # 73-2 ' f – 7
Contractor's Address
City /� /': —7 " ;7/ ? State -S ,�-� Zip
Qualifier j� �r� � !" , /` Vir
/
$ Value of Work For this Permit
Minus Plans Check Fee $
Number of: Bays Stories Families
‘21, 03 -pot c4
Miami Shores Village
Building Department
Permit No.
Master Permit No.
.Phone #
« * * * * * * * * * * * * * * * * * * * * * * * * ** F ees * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
Bedrooms
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
•
Architect/Engineer's Name (if applicable)
Architect/Engineer's Address
City State
Zip
Square Footage Of Work:
Baths
Type of Work: ❑Addion Alteration [New ❑ Repair/Replace ❑ Demolition
Describe Work:
Asizite-0,e/Aff -00191
County Escrow Fee $ Permit Fee $ Notary $
Education/Training Fee $ Tech $ Scanning $ Radon $
Code Enforcement $ Bond $ ,3 Struct. $
Total Fee Now Due $'! 30 (Continued on opposite side)
Bonding Company's Name (if applicable)
Bonding Company's Address
City State Zip
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 permit 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 WORK, PLUMBING, SIGNS,
WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and AIR CONDITIONERS, ETC
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.
"WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT 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."
Notice to Applicant: As a condition to the issuance of a building permit with an estimated value exceeding $2500, the applicant must
promise in good faith that a copy of the notice of commencement and construction lien law brochure 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 Signature
Owner or Agent Contractor
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
day of ,20 , day of - ,20
who is personally known to me or who has produced who is personally known to me or who has produced
As identification and who did take an oath. as identification and who did take an oath.
NOTARY PUBLIC: NOTARY PUBLIC:
Sign: Sign:
Print: Print:
My Commission Expires: My Commission Expires:
***************************************************************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
(Certificate of Competency Holder)
State Certificate or Registration No. Certificate of Competency No.
APPLICATION APPROVED BY:
chc7nios
047_ I )-1 A)
JUL 2 9 2003
Plans Examiner
Engineer
Zoning
•
ZOCAFIOS 9CK
fiTCli SCALb: 20
.r te Wsx �.
/,wKw►x,Ife
Eg e 10 4,4044 P 5,eL 4
Ie 9 .0 :' { e,
} 1, E '7 1. 17?
AO 1 45 i
a
i
31 Ale q7 St
r
x wan = : t : „ r,.tut;,`.
4 hereon ,represents a S er v e* eAde ender iy
direction end le tree mod correct to the '
best of ny laic' splodge and belief. .
J. B. FORD CO.
C * - - e:c .A
C. K. Ladd = 1230 'I
Registered Land Sarver*:
State of Florida
•
a*e cf gsejboth IPALWAALrAll
Sfv'r5/ - • aiewice
•
10.3t
•
A-5r . "
r•
I
Date( 4'Y Job Address 4 A/2 L .Viies, Tax Folio
g Description ` 4 ' ` - Y g
Legal Descri /k01 _� �� � Historicall Designated: Yes
Owner /Lessee/Tenet . / ( 05 9' /WV. /'E2. Master Permit #
Owner's Address -:9M' Phone
Contracting Co. brk,k/AV/1/e,iA Address 'ir7 /!.S'_ /p/�G /�S .S/
?p se s 9
SS# ") Phone 3 S 757' 776 .S
Qualifier 4/4//i/r._�1,/ /i�
State # .. rX91Q:1 Municipal # 1—aV ? 9 9 Competency #( / -- In� Ins. Co. �jgA(.4rS
IF THERE IS NO PERMIT PACKAGE ACCESSIBLE ON THE JOB SITE FOR INSPECTORS TO VERIFY,
THERE WILL BE NO INSPECTION. RE- INSPECTION FEE IS $50.00 AND MUST BE PAID IN ADVANCE
BEFORE CALLING FOR ANOTHER INSPECTION.
Permit Type (circle one): BUILDING ELECTRICAL
WORK DESCRIPTION:
i/e % / % � i �if���_J.��i��i�� %1!� ✓��sl� /�LAZ - fit �Li
Square Ft. �''� Estimated Cost (vale R t
J
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 ANY 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 all disciplines.
OWN RS AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws
regula g construction aening. Furthermore, I authorize the above named contractor to do the work stated.
No as to Ow r an l roisige
My Commission Exp3r =mission DD15004f3
o` Expires November 15, 2006
FEES: PERMIT
APPROVE !
,
Mechanical
71
PERMIT APPLICATION FOR MIAMI SHORES VVLI - v , - �
10050 N.E. 2nd Avenue • Miami Shores, Florida 33138 • Phone: 305 - 795 -2204 • Fax: 30 - 56=8 2
Zoning 6v
r'c3/Y-5'1 ext.; / ,e2i rzeJ -49 ,4v /rte
RADON
G 'Buildin
Plumbing
Date Signature of Contractor or Owner Builder
3-2,3;- aL�
—C/ 21 / 0.9
Date
C.C.F
)) Q
yR2o6 5 ?-
PLUMBING MECHANICAL ROOFING
6-?5 zz-03
Date
y 07 - 1,,A L.NOTARY SE/
. (2 AU C:;:OYSJ VII /
Notary as to Contractor ` O y ) wi lder' 'APti ICN NUM7r Date
My Commission Expires ���; u) rmis >.oN ::r. , :s
e 0F Fk.� MAC 1 20:,,
NOTARY _ , . 0 BOND 3 q) O . D 0
TOTAL DUF,,__S 6 4, e� v
Electrical
Structural Engineer
t '- 4 sAirv - . .e„
------,-.---- . I RtREBT .CERTIlrf tha,t 041" inforand:ion aitpain7
hereon represento a Surifeir made under my '.
H , ,, ., r -. .... direction and is true and correct to the: "..-:.
l 6 . i 0 ° 1 6
NN—r-t -.: best of :kr knowledge and belief. ,.....
//indo ! eit ;.. I 4, -
. I . ■ . kN,
• ' .1
J. B. FORD CO. • .. ,• _ ■
•
..- -
1 ' ! k A* •
c. w. Ladd
-- 120
i4 vs i/z /7 /, g.:.. If/ I ?f , 1 2
I ! I , I Et- Regiatered Land Surveyer:
A ,
'
,s
! • .3
Agoryw
0
/rx
I A. ••■••••• •••••
s •
: FLOCATION SCKETCli SCALE: 1 is 200
1-
J. B. FOrila CO.
C. VOi LAIVI PARS.
393 N. W. 4,1ad Avt,
33126
Pbtrat: 4446574
•
AMY
4P11 41"
• A e•
Re -ecP4s1 - x/7;3#43 ~ere* -
r40,414
otliv /"'avie-fre. ..ef.ie .4t.WW
7 Z fiA..ez iya4sde
&nit FAvv",6001-7:1,614 f
, /< 40.. eirrivoce. fa r-exiw $
State of Florida
/ (7 0.0 (7
'ee/7ce
--7
•27( «,rf PAwer artalk
carer ek
/AIX 6 .-- Al .014390
rsive4/
/O. /
• .
,
For : OLAUSSTI .
'9
( mER , No, 27599 4569 '
31 PO 97 5f
Date: AUGUST 21,1962
REVISED: June 17 19
F . 1 3 _ 3 8 0 4 . 6 e 7 S•45695
•
• / 0 4
fm
SURVEY OF LOTS 3 and 43 BLOCK 433 LOT DETAILS SCAM 1 "= 20'
Amended P
I IAT1I SORES SECTION PTO, 1
'According to the Plat thereof as recorded in Plat Book 10 , at Page 70
Public Records of Dade County, Florida.
m iarni SIiorei VIGLGI!,yE
10050 N.E. SECOND AVE.
MIAMI SHORES. FLORIDA 33138 -2382
Telephone: (305) 795 -2207
Fax: (3051756 -8972
COVENANT OF CONSTRUCTION WITHIN RIGHT OF WAY
WHEREAS, , hereinafter referred to as the Owner of the
(owner)
following described property:
pRtu /y
f�
P f'e o&Ai
Legal description /folio #: F`(. s - 7 4!-Ce5 5
LoK „� d V Block 4/3 Subdivision o ��j�,d�l � l
Tax Folio #: //3 S2'c9
requests permission to install:
Asphalt, concrete, brick pavers
[ ] Landscaping
[ ] Other
within the public road right of way of 37® , 6-- 97..,
(address)
IN CONSIDERATION of the approval of this permit by the Village, the Owner agrees as follows:
1. To maintain and repair, when necessary, the above - mentioned item(s) installed within the dedicated right
of way. If it becomes necessary for Miami Shores Village or Dade County to make repairs or maintain said
items within public right of way including restoration of street by reason of the Owner's failure to do so,
such expense shall be paid by the Owner or shall constitute alien against the above described property
until paid.
2. The owner does hereby agree to indemnify and hold Miami Shores Village or dade County harmless from
any and all liability, which may rise by virtue of permitting the installation of these items within the public
right of way.
3. The Owner does hereby agree to remove or relocate their facilities at their own expense, within 60 days
notice by the Village to do so. Failure to comply with this notice will result in the Village causing the
item(s) to be removed and a lien being placed on the property and/or assessed against the Owner for all
costs incurred in the removal and disposal of the item(s).
4. The undersigned further agrees that these conditions shall be deemed a covenant running with the land and
shall remain in full force and effect and be binding on the undersigned, their heirs and assigns, until such
time as this obligation has been canceled by an affidavit filed in the Public records of Dade County, Florida
by the Village Manager of Miami Shores Villag- (or4 is fully authorized representative).
SIGNED, SEALED, EXECUTED AND ACKNOWLED o 1 day of �,/‘,C Do 3
SIGNED. SEALED AND DELIVERED in the presence o
a
FLORIDA 3CEHSE
- The Sunshine State
KENNETH FRANKLIN CLAUSSEN
370 NE 97 ST
MIAMI SHORES, FL 33138 -2406
08 -03 -43 M 6 -00 A
C425-506-43-283-a"" 08-03-97 -
CLASS: E
DWI COE
V SAy ty 0,0
10 -03 -91
5029201
4-
JOB ADDRESS
APPLICANT
PHONE#
APPLICATION
DATE
CRITIQUE SHEET 1N 03
4,
3 7 N. C. `” 5 77
CL ( $5
Wet (te.)4ry
SHEET OF
MISCELLANEOUS
ZINI.Nt
PERMIT NO.
ADDRESS:
ZONING
ELECTRICAL •
MECHANICAL
PLUMBING
FIRE
PUBLIC WORKS
STRUCTURAL
BUILDING OFFICIAL
MIAMI SHORES VILLAGE
BUILDING / ZONING DEPARTMENT'
SECTION BY DATE
1. Subject to compliance with aft Federal, Stag
CocmtySillage Me: and regulations. Wage assure(
no responsibility for accuracy allot results fro
these plans.
2. This copy of plans must be available c
building site or no Inspection *tit be conducte
INITIALS
COMMENTS
� (" 0 3 A L/ s /oNs oiv ,L 41t orCc '
C5 0 0 L V6r 10
�� s o - se 7'/34rs F40 041 ,4e P, t i
(A-la