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574 NE 96 St• JUL 1, '0L( 10:39 FROM CORAL GABLES NURSING PA :iE . 0a 1 FAX TRANSMIT'T'AL COVER SHEET 1 I� DATE: 7-1 3 -0° TIME: � 1 4" " TOTAL #: OF PAGES: 2 --` (i.ncludi.ng cover page) PLEASE DELIVER THE FOLLOWING ?AGE(S) TO: NAME: /'4. ( Cif COMPANY: FAX NUMBER: ��rr ?1, g L FROM: ,70 r 1 N ,fre''r t'n c , g- c CORAL SPECIAL INSTRUCTIONS: CONFIDENTIAL: FOR YOUR INFORMATION: MEMO: LES CONVALES 'T CENTER 706 STREET Kt 0` 33144 E #: (305) 26 363 FAX *: 0305) 267-075 URGENX: • • C x"" 41c, IJ 4/. 1) vi l( 1 y. COPY TO: G�!I f r Ar' f ? i/ iv. 6-, PLEASE REPLY BY: HARD COPY TO FOLLOW: ,'A o L.4 7 l< ti . . ✓r C ,J vie,,J /41 J / 4 20y — 2-L/ �< J 3/ .3r e Cr -aJ IP YOU DO NOT RECEIVE THii TOTAL TRANSMISSION, PLEASE CONTAT: 4 f c rr i�C w C'3 • B UILDING ELECTRICAL N PLUMBING ROOFING Ardutect Contractor (n or Builder k/ D Legal Lot 7 L C f j Description `' —F- B1. J ti N I' m � m Fa Owner of Bwlding PERMIT 0 Sf,Q/ 61 mt.g y e v" Addre� d / i '° ButTdin 37 .� CONTRACTOR or BU MIAMI SHORE Y��� �� �� c��a� ✓ 2 Dade M_ . 46775 Work to be performed under this Permit ttb Contractor's License No. N w Permit; 5 ? ‘5.4%, Gee. / - O/1.7 : vision r !� Qr Bond: Sq. Ft.: Radon: Value of Amount o ja/ j G( Project , 4# i' Amount o This permit is granted to the contractor or builder named above to construct the building or to install the equipment or device described in the applica- tion berefor in strict compliance with all ordinances pertaining thereto and with the understanding that the cork will be performed k. compliance with any plans, drawings, statements or specifications that may have been submitted to sad approved by the proper municipal authorities. This Permit may be revoked st any time if the work is not done its compliance with snub ordinances or if the plans are changed without authorisation. A further condition upon which this permit is granted is the understanding that the contractor or builder named above assumes the responsibility for a thorough knowledge of the ordinances and regulations pertaining to the work covered hereby whether shown on the plans or drawings or in the statement. or specifications and that he assumes respon- sibility for work done by his agents, servants or employees. " ~ Signed '"" (INSPECTOR} BY in consideration of the issuance to me of this permi 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 responsibility for all work done by either, myself, my agent, servant or employee. BY AUTHORITY PERMIT APPLICATION FOR MUNICIPALITIES OF DADE COUNTY (OWNER TO RETAIN COPY) Date g'/I l ( Job Address _ r y e ] Ai( G rr Legal Description 14' J '/ 7r) Master Permit # / Lessee / Tenant �y'04- (-/‘ J'r6,". iiic y 6 ' — Owner's Address .1r 7 - 6 ( �U Contracting -Co-. eta /ZA (e t Qualifier State ° Architect /Engineer Bonding Company Mortgagor Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL PAVING FENCE SIGN WORK DESCRIPTION v, G2) CCdif Square Ft. /7," � r/ r .1`/IA '2 M, 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 AN 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 ELECTRICAL, PLUMBING, SIGNS, POOLS, ROOFING, and MECHANICAL work. 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. Furthermore, I authorize the above -named contractor to do the work stated. Competency # u / �l� 3ignature,_a_ Owil.e and /or Condo President Jotary`" t, � O� n e • and/or o do President iy Commission Expires: �y� * - . * . * ?ERMIT FEE: APPROVED: Zoning Mechanical n ate: eriXe ii0114 -!k CC Fire Other Building Plumbing Address Address Address Address rL 9 0+ p !h;14.4ei Tax Folio 1/ Jae( /y 017r/ Phone 7 rf- Ins. Co. Electrical Engineering SSA / Phone 7 f d 6 Estimated Cost , Signatu of Contractor or Owner- Builder Date: eL .14;iV &WI/ N ary as to Contractor or Ow r- Builder M Commission Expires: //` „{ * * * * <-3 38 , Z )G tT . zve 6 /J 7 2)( f?r, `/IA M /6 " 6 7 / 7 4 EASE p/.4 Cawc %c / /6 ' dN co/tic PizE F� � 13 S E THESE PLANS ARE APPROVED FOR ISSUANCE OF A BUILDING PERMIT YARIA'!CE(S) LISTED IN "REMARKS" ?''.".' S'!: BUILDING AND ZONING !.I: ' r SP. CIi L ?.Y LISTED BELOW. '::D ..UU.:,Y LAWS MUST BE COMPLIED ,,,,, : n ;-, ^'gri Date • WITH NO VARIANCES • WITH NO OTHER DEVIATIO "S FR' M T:!'.: ORDINANCES WILL BE PEW. :111 ALL OTHER APPLICABLE STATE WITH BY ALL PARTIES. FIRE DEPARTMENT PUBLIC WORKS _! POLICE DEPARTMEi6 BUILDING DIRECTOR M PLANNING & ZOr'lii G ;:;. VILLAGE COUNCIL APPROVAL PRELIMINARY: FINAL: REMARKS: COMPLIANCE WITH THE SOUTH FLORIDA BUI•..D; ':; CODE AS ADOPTED BY MIAMI SHORES VILLAGE IS REQUIRED. . E ARCHITECT, BUILDER SUB CONTRACTORS i•RE C!''`:' ' .'. '' 0 •'? F: 4. E OF LNG REGULATIONS WHETHER OR NOT SPECIFICALLY INDICATED & ALL. !MILD- HEREIN. 4 MIAMI SHORES VILLAGE BUILDING INSPECTION DEPARTMENT APPLICATION FOR BUILDING PERMIT Application is hereby upndc for the approval of the detailed statement ur roe 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 prggreu of the work. Owner's Name and Address .... � .�: "�ti c.�i ,_.... Registered Architect and /or Engineer..........: Pad. . �1 �� yfc Name and address of licensed contractor_ i,j - !_L- �:�c y • :•—a • Location and legal description of lot to be built o Lot Block Subdivision ..»_ .._. ....._....•. Estimated Total cost of improvements $ �� Built' ng Inspector 1 1 Date..._...__..__ .. _ ...._�_.._.__....__...19 %=. ._ No. 2 __ ...... Str ? � 11.1! Street and Number where work is to be done N 4 State work to be done and purpose of building (by floors �i✓lrsd._. r �::.A.__ .:~ __... _........and for no other purpose. New Building Remodeling Addition � Repairs No. of Stories To be constructed of }al of foundation Roof Covering Amount of Permit S. 1 0 y . Zone cubage required plan Cubage 114 gq ! rT' 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 workstrt$n Wilk: notice or notices as arc required by the Act. The undersigned agrees to employ only such, subcontrasjo9, on work to be performs under this pcnnit, as are licensed by Miami Shores Village. - Rernuks..._..... _ (Signed) [.3 STATE OF FLORIDA, COUNTY OF DADE. j 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 tru Permit No.._. Date Pill/ .1 - Read, Sworn to and Subscribed before me. Disapproved fi E ... _ ` Date .._........_........._ Notary Public, State of Florida (Signed) My Commission Expires .. _...._....„._.__.: PLANNING BOARD DATE C ainnan Member — ....... _.. .... ..._..._ \Icrr.ber Member — Mcmber .. .. Member ...._ _ __......._ _.._..... Council Approved Date Disapproved Date NOTE: A charge of $1.00 will be made for making corrections or changes to this application after appmval has been obtained frrnn the PLannir.g Board. A re- inspection fce of $1.00 will be charged when such re- inspection is made necessary by improper notice for inspection or faulty materials and/or workmanship. PAID BY YEAR ANNUAL TAX PERIOD USED AMOUNT PAID DATE PAID RECEIPT NUMBER • . W. S1can 1951 $12.00 5 -- $12.50 12 -19 -50 151119 0 ADDRESS 574 N. 2. 96th Street 2 LEGAL 3 & Ei 4 B1.54 M/S See.;JRECD GARBAGE TAX or STATE OF FLORIDA) SS COUNTY OF DADS A F F I D A V I T S. W. Sloan of the Village of Miami Shores, County of Dade and State of Florida, being duly sworn, doth depose and say, that under tiie provisions of Ordinance No. 185, dated June 15, 1948, amend- ing paragraph (d) of Section B -368 of Ordinance No. 97 of the Building Code of Miami Shores Village, he desires to build a Single family residence on Lot Ei 4 Block 54 of Miiani Shores Sect. #2 Subdivisior, that he is the owner of said property, and will be the owner of said residence , that he will do the work personally, and that he will, at such times as are required by the Zoning and Building Director: - 1. File plans and specifications and obtain approval of the Planning Board and the Building; Inspector. 2. Apply for and secure a Permit. 3. Pay the required fees. 4. Execute the work in accordance with the provisions of this Code. 5. Apply for inspections. 6. File with the Building Inspector certificates that provision has been made to carry the necessary Workmen's Compensation, Public Liability and Property Damage Insurance. 7. File with the Building Inspector as the job progresses certi- ficates showing the payment required by the Federal Social Security Act to the State of Florida or the United States of America. 8. Assume the responsibility of not employing other than properly licensed contractors by I.iiarai Shores Village for any part or portion of the work. 9. riot set himself up as a "contractor ". 10. Sign an affidavit before commencing work to the effect that he has read this Article and will do the Mork personally and observe all of the requirements of the Building, Electrical, Plumbing and Zoning Codes of Miami Shores Village. Such affidavit to be properly notarized upon blanks to be supplied by the Building Inspector. 11. In order to prevent abuses and subterfuge the right of such owner- builder as herein provided, is limited to but one otmer- builder periiit each 2 years, and where an owner- builder has once exercised the privilege herein conferred no second application for other- builder permit shall be granted in lest than 2 years, unless the applicant is qualified as a licensee. General Contractor under the applicable Ordinances of said Village. And Further this Deponent says not: UUNER SUBSCRIBED AND 2.+011ii TO B3Y ltli: I,iE this day of 196 NOT, 3Y PUBLIC A. D•, rc (SEAL) Date Issqed - 1 7. ' , -'_.,u By _ — VILLAGE MANAGER THIS LICENSE MUST BE DISPLAYED IN A CONSPICUOUS PLACE , A Penalty is imposed for failure to keep this license exhibited at your establishment or place of business r ••11.���yy� �11,���yy� %?; �tJ.• fy cr • 1e4rc�W�',f s.d � 1f.•_��yy� �t!• iJ.•_�tPc �iicIIyrJ�`,iCQT4�;e?i-�•�1 J,•� ��yy__�1! ,� 1!iC.• �y ni3 tf.• � t!.• �y 1iGaTm;iGII-7 -� !.• � 1)C � AN:z3iC�T� UCpW�i �f.• {y 1!.•'"b'••1 /.•••�y "••1 L ICViV�'; fco•1A�iicDiv .';? �T�'; Till PLIC.1T E VILLAGE LICENSE This License Expires _ _ _ I ni)ntha frcm citA° I n consideration of the sum of' Paid to Miami Shores Village, Dade County, State of Florida, c Address 38 is hereby licensed to engage in or operate the business of _v •- �,,_,;. For the period beginning vim' subject to the Provisions of all ordinances. — and ending MIAMI SHORES VILLAGE, FLORIDA THIS LICENSE NOT TRANSFERABLE WITHOUT APPROVAL OF THE VILLAGE MANAGER No. • Dollars $ ° `"`' F :s• SLOAN, S, 574 N. . 96th Street Owner - Builder Sr- ILO:NS PERMIT NO OWNER'S NAME . %CB LOCATION ;ST. OR AVE.) CENERAL CCNTRACTOR ZONE DRAWINGS X NEW CONSTRUCTION REPAIRS ALTERATION ADDITION 97,58 OUI REM ENTS_17.500 SUBMITTED TO PLANNING BOARD 1 2 car garage R E.SURMITTED TO PLANNING BOARD OBS DATE 7/27/50 APPROVED CU. FT. 1 PRESENT ADDRESS 38 N. `,Y. 105th Street LOT BLOCK 3 & Ej 4 REJECTED PLAN CUBE ADDRESS 54 38 N. W. 105th Street PERMIT FEE $ 21.00 2 SPECIFICATIONS. RESTRICTIONS AND CUBE CHECKED BY: JLLJ. TYPE STORIES ROOF CONSTRUCTION Miami Shores Sect. #2 CU. FT. LICENSE NO. PHONE NO. LICENSE NO. NO. 1067 EST. COST $ SUBDIVISION BUILDER'S BOND INTERIOR CONSTRUCTION PHONE NO. 3 0 -B DATE 7/27/5 174000.00 DATE 7/27/50 Tile Terrazzo Floors - Plaster DESCR IPTION Liv Rai - Study - Kit - 3 Bed Rms - 3 Baths - Ser. Porch - Breezeway - DESCRIPTION REFERRED TO COUNCIL REMARKS REASONS SUBMITTED TO VILLAGE COUNCIL CERTIFICATE OF OCCUPANCY NO/ �. ISSUED„2 ! ' BY a- TO � E9 i'` +` BUILDING P RMIT AND INSPECTI R ORD —MIAMI SHORES VILLAGE INSPECTIONS DATE BY RE I 1 ECT BY RE- INSPECT BY FOUNDATION 8�/4/�',g0 pG 8217/5C PG TEMPORARY SERVICE $ 1.00 BEAMS & LINTELS �7 y7/53`I 50 9/20 Pr. JDH ��y $ FRAMING $ SEWER $ MOTORS $ SOLAR HEATER $ FINAL /� /� ;-_, ; -= $ CLEAN -UP INSPECTIONS $ INSPECTIONS DATE BY RE- INSPECT CONTRACTOR J. B. Rose PHONE PERMIT NO. 97 DATE 8/2/50 FEE S14-075 NEW BLDG. $ ALTERATION ADDITION REPAIRS SPECIAL PERMITS PERMIT NO. DATE FEE TEMPORARY SERVICE $ 1.00 H. W. HEATER CONN. $ SEPTIC TANK $ RANGE CONN. $ SEWER $ MOTORS $ SOLAR HEATER $ FIXTURES $ GAS $ $ INSPECTIONS $ INSPECTIONS DATE BY RE- INSPECT BY RE- INSPECT BY ROUGHING 8 / 1 5/5 0 PG ROUGHING 9/27/50 GAS H. W. HEATER CONN SEWER RANGE CONN. SEPTIC TANK 8/7/50 JDH JDH SOLAR HEATER FIXTURES & FINAL FIXTURES p y ,y / /fr, Dry ..el]. (2) 10/11/;0 JDH CONTRACTOR E. C .. Cornelius PHONE PERMIT NO. ioo 6 DATE 9/26/50 FEE $ 11 .9 0 NEW BLDG. X I ALTERATION 1 ADDITION REPAIRS SPECIAL PERMIT NO. DATE FEE TEMPOR7� E P 9797 8/2/50 $ 1.00 H. W. HEATER CONN. $ RANGE CONN. $ MOTORS $ FIXTURES $ INSPECTIONS DATE BY RE- INSPECT BY RE- INSPECT BY TEMP. SERVICE 7/3/S0 JDH ROUGHING 9/27/50 JDH H. W. HEATER CONN RANGE CONN. FIXTURES & FINAL g / /' /F it it BUILDING INSPECTIONS PLUMBING PERMITS & INSPECTIONS ELECTRICAL PERMITS & INSPECTIONS APPROVAL TO POWER CO. FOR SE • VICE DATE BY N° 1081 CERTIFICATE OF OCCUPANCY Miami Shores Village, Fla , Owner, Agent or Tenant of Building ; , A •�` Lot �.- 'Block ;' Subdivision Street Address MIAMI SHORES VILLAGE, FLORIDA BUILDING DIVISION Approved use by occupancy Remarks: This Certificate of Occupancy is issued to the above named for building at above named location only upon the express provision that the applicant will abide ley and comply with all conditions of Ordinances Nos. 92, 93, 94 and 97, known as the Zoning, Electrical, Plumbing and Building Ordinances of Miami Shores Village pertaining to the erection, construction, alteration or remodeling of buildings or structures. '7 lt2aq r BUILDING DIVISION C 'f %� BUILDING ELECTRICAL PLUMBING Owner of Building Architect Contractor or Builder Legal Lot Description Address of Building PERMIT N° 9758 CONTRACTOR OR BUILDER MIAMI SHORES VILLAGE, FLORIDA Work to be performed under this Permit Bl. Subdi- vision Value of Project $ DATE 95 Contractor's License No Amt. of Permit $ This permit is granted to the contractor or builder named above to construct the building or to install the equipment or device described in the application herefor in strict compliance with all ordinances pertaining thereto and with the understanding that the work will be performed in compliance with any plans, drawings, statements or specifications that may have been submitted to and approved by the proper municipal authorities. This Permit may be revoked at any time if the work is not done in compliance with such ordinances or if the plans are changed without authorization. A further condition upon which this permit is granted is the understanding that the contractor or builder named above assumes the responsibility for a thorough knowledge of the ordinances and regulations pertaining to the work covered hereby whether shown on the plans or drawings or in the statements or specifications and that he assumes responsibility for work done by his agents, servants or employees. f Signed • BY INSPECTOR 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 responsibility for all work done by either, myself, my agent, servant or employee. BY AUTHORITY • 1st nirOtrir OOrs PERCOLATION TEST & SUBSURFACE INVESTIGATION ORDER NO.8 504„ 1 CLIENT: PROJECT: PROJECT LOCATION: LEGAL DESCRIPTION: DATE OF TEST: LOCATION OF TEST: REPORTED TO: Below Ground Surface Trial Depth of Depth of Water Level No,_ Test Hole Start Finish 1 36" 15" 21" 2 36" 15" 21" Depth below Ground Surface O. 0' -0.25' 0.25' -0.33' 0.33' -l.0' 1.0' -3.0' 3.o' -6.o' Field Tech: JRS Engineer: Stan Weeks & Assocs.,Inc. 3061 NW 7th St.,, Miami, Fla, 33125 WING(ERTER LABORATORIES, INC. Engineer's Laboratory and Inspection Service 1829 N.E. 144th Street P.O. Box 155, North Miami, Florida 33161 0 -0741 1/8/71f, Lab. # B 8971 C.V.D. Building Corp. Addition to Residence and Pool 57 NE 96th St., Miami Shores, Fla. Lot 3, E2 Lot 4 Blk 54, Miami Shores Section . 2 (10 -37) Dade County, Fla. January 7, 1971 Approximately 86' West of East P/L 55' North of South P/L (As designated in field by client's representative) C.V.D. Building Corp. 8786 Sri 129th St., Miami, Fla. 33156 ATT: Mr. Mike Crochetti Total Time Average Time for 6" fall per inch of fall 0 min. 5l sec.. 0 min.. sec. 1 min. 06 sec. 0 min. ll sec. 3 36" 15" 21" 1 min, 30 sec. 0 min. 15 sec. Average rate per inch of fall 0 min. 12 sec. Soaking Period 5 min. No Ground Water 72" below ()round Surface. SUBSURFACE INVESTIGATION Soil Desc Top soil Limerock with some lime sand Gray silica sand with traces of organic material Light gray silica sand and limerock fragments Light gray silica sand and limerock fragments REMARKS: The above test results were obtained in accordance with Dade County Health Department Procedures, Respectfully submitted, WING RTER LABORAT ES , INC . W.G. HICKS, P.E. AS A MUTUAL PROTECTION TO CLIENTS, THE PUBLIC AND OURSELVES, ALL REPORTS ARE SUBMITTED ('_ Ai THE CONFIDENTIAL PROPERTY OF CLIENTS, AND AUTHORIZATION FOR PUBLICATION OF STATEMENTS, CONCLUSIONS OR EXTRACTS FROM OR REGARDING OUR REPORTS IS RESERVED PENDINO OUR WRITTRN APPROVAL. MIAMI SHORES VILLAGE BUILDING; INSPECTION DEPARTMENT APPLICATION FOR BUILDING PERMIT T -, 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 thi; Building Ordinance of Miamm 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 /I}1.( � , 19_�r Owner's Name and Address__ ° c_ _C No Street i '-_ __ T'_„ Registered Architect and /or Engineer \ \a�__.___�__ ��� Name and address of licensed contractor Location and legal description of lot to be built on: g , _ - -- Block Subdivision- - Lot R- Estimated Total cost of improvements $_ Zone cubage required Maximum live load to be borne by each floor__ STATE OF FLORIDA, COUNTY OF DADE. ss. Disapproved '. (Signed) Date_ Remarks ___ ( Signed) Street and Number where work is to be done rr State work to be done and purpose of building (by floors ) New Building Remodeling ________ Addition Repairs To be constructed of Kind of foundation 1 and for no other purpose. No. of Stories is° Roof Covering Amount of Permit $ �' ' y _Plan Cubage y>�. ° Distance to next nearest building " ' = % z Size of Building Lot 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. Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally ap- peared 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. to me well known, Notary Public, State of Florida Building Inspector ' My Commission Expires PLANNING BOARD DATE Chairinan J 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. 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..--4-.':-/-8 Owncr's Name and Aciciress. ( -4/' 0 ._"-67. "2„e-2._. No..... Ad Weit___T_a___ .. ... I stilgiA kehlilla iiiidief Eligilitlef a: i u, Zaiignallii. it suletlittitititit4,1ttuttittitt ttttt fa aufttenttuntetutttattt ttttt tiommes Name and address of licensed contractor ..... ..e.." .-....0-4.-...—..a.e.Z..i..4. Location and Isgal desrjp of lot to be b ' _ on: Er 78' 4p,) • / 'D..- Lot..4......./ — 13lock... `" Subdivision / /i t ,S Street and Number where work is to be done 65 74/ dii • e• , e 1 - . Remarks MAM SHDRES ViLLASE BUILDING INSPECTION DEPARTMENT State work to be done an purpose of building (by floors) da..27.C2 • • __......._._ Remodeling . Addition. New Building - To be constructed of 6 Kind of foundation---../A Rod-Covering ' Estimated Total cost of improvements $ ..37e9evr- 6 0 ...Amount of Permit $ ■■•••• •■ ■ Zone cubage required —.Plan Cubage.. Distance to net nearest building.. ..Size of Building Lot Maxi:num live load to be borne by each floor... I hereby submit all the plans andsRecifications for said building. All notices with reference to the building and its construction may be sent to.... . C. ..7 7 C 6 e 7 cr6 s , (.4-9 , ./a9zrsx ,.. The undersigned applicant for this building permit dots hereby certify that he understands and accepts his obligations as an employer of labor under the Florida Worknien's CoMpensation Act, being Section 5966, Compiled General Laws of Florida. Pennanent 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 ublic notice or notices as are required by the Act. The undersigned agrees to employ only such subcontractors, ort,, r to be perf under this- permit, as are licensed by Miami Shores Village. ‘"" '' ' 7 th (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 Repairs...... _ No. of St Read, Sworn to and Subscribed before me. ••••••••■••••••■••■■•.• Aeszaz t>72-71&-, — ; and PurPosg", • .i•••••••••••• / to me well lalown, and who, being by me first duly sworn, upon oath deposes and says that he • above described construction, that he has carefully read the foregoing application, and that he did sign th;same, and that a11 facts min by him statedazoTue. Yri Permit No Date__ Disapproved ___ Date._.... .1 .._, , / .- Notary Public, State of Florida (Signed) ./.. 7 .h. Building Inspector My Commission Expires / PLANI$ING BOARD.. -- ----DATE Member Member Member - - -- ..............Date Disapproved .--.__________.— ...._— --, ,. --___Date Chairman Member Member Council Approved. the Planning Board. NOTE: A en.ir of $1.00 will be made for making corrections or changes to this application after approval has hecn obtained from • akaterials and/or workmanship. A re-inspection fee of SLOO will be charged when such re-inspection is made necessary by improper notice for inspection oe faulty • ; • 7.