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577 NE 96 St (3)a 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 Camp House 830= = Survey Date 8504 820 = = Address of Site: 577 NE 96 Street, Miami Shores, FL 905= = ' Instruction for locating on N side of NE 96 Street between NE 5th Ave. and NE 6th Ave. 813= = Location: Miami Shores Ser. _ 4 Arid 99 19, 20, 21 868= subdivision name block no. lot no. County: Dade 808 = = Owner of Site: Name: Fabian, Dr. Carl Address 577 NE 96 St. Miami Shores , FL 902= = Type of Ownership private - 848= = Recording Date 832= = Recorder: Name & Title: Stofik, Marty Address: MSHPB Condition of Site: Integrity of Site: Original Useprivate residence838= = Check One Check One or More Present Useprivate residence 850 = = ❑ Excellent 863= _ ❑ Altered 858= = Dates: Beginning +1925 844 = = (} Good 863= = l� Unaltered 858= = CulturelPhase American 840 = ❑ Fair 863= = O riginal Site 858= = Period 20th Century 845 = = ❑ Deteriorated 863 = = ❑ R estored( ) (Date: )( ) 858 = = ❑ Moved ( ) (Date: )( ) 858 = _ NR Classification Category Building 916= = Threats to Site: None Check One or More ❑ Zoning ( )( )( ) 878 = = ❑ Transportation ( )( )( ) 878 = = .)( ) 878 = )( ) 878 = = ❑ Development( )( )( )878= = ❑ Fill( )( ❑ Deterioration ( )( )( ) 878 = = ❑ Dredge ( )( ❑ Borrowing (. )( )( ) 878 = _. ❑ Other (See Remarks Below): . 878 = = Areas of Significance Architecture, History Significance: Residence is one of outstanding homes in Miami Shores. It was designed by Walter DeGarmo, the first registered arhictect in the state of Florida and designer of the Coral Gables Bank and Post Office, the McAllister Hotel and the J.C. Penney residence on Miami Beach. Two of his other Miami Shores designs are located in the immediate area. Structure is an outstanding example of the adaptation of the Italian Villa;,to the Mediterranean Revival style. Noteworthy features include a 21/2 story entry tower at the intersection of the T with the entrance on the W facade off the street and an arcade extending the length of the front wing. The first owner of the home, Mrs. Willa Jean Camp, was a granddaughter of Gen. the only Florida general in the Civil War and for whom Sumter Co. FL was named. The residence is a designated. Miami Shores landmark. 911 = = 818 = = 910 = = ARCHITECT DeGarmo, Walter (Miami, PL) BUILDER Godard & Sydow (Miami, FL) STYLE AND /OR PERIOD Mediterranean Revival PLAN TYPE — T- shape; irregular EXTERIOR FABRIC(S) rough stucco STRUCTURAL SYSTEM(S) concrete block PORCHES S $ E: arcade fronting masses, access S E E FOUNDATION: concrete block ROOF TYPE: gable /hip SECONDARY ROOF STRUCTURE(S): shed CHIMNEY LOCATION: W, end, ext. bellcote WINDOW TYPE: wood casement and awning CHIMNEY: CBS ROOF SURFACING: barrel tile ORNAMENT EXTERIOR: cast masonry NO. OF CHIMNEYS one 952= = NO. OF STORIES two NO.:OF DORMERS .►one Map Reference (incl. scale & date)Miami Shores VIllage Plat 1980 Latitude and Longitude:. Site Size (Approx..Acreage of Property): LT 1 LOCATION SKETCH OR MAP N s Contact Print m . 4 NE 96 , ?4 NE g7 "9 ttt CHAPEL. 5771 (o5i Township Photographic Records Numbers ___85N101HG08A /85N101HG09A Range 53S 42E UTM Coordinates: fne — Tasting - 11orlring Section 872 = = 874 = = 964 = = 966 = = 854 = = 856 = = 942 = = 942= = 942 = = 942 = = 942 = = 942 = = 882 = = 882 = = 882 = = 950 = = 954 = = 809 = = 800 = = 833 = = 812 = = 890 = = 860 = = STA1E OF FLORIDA DEPARTMENT OF STATE Division of Archives, History and Records M4iiageme'ht DS•N,SP•3E 9.74 CONTINUATION SHEET Silo No. Site Name Camp House 577 NE 96 St. Miami Shores, FL Physical Description: Structure is a two -story Mediterranean Revival residence in a T- shape. A 21/2 story entry tower forms the intersection of the T on the W; entrance door is on W off the street. The S and E sides of the front projecting wing and S side of E wing are fronted by arched arcade with round and elliptical arches separated by octagonal pillars with diamond pattern. .A11 arches have wrought iron grillwork. French doors lead from front projecting wing to arcade, doors have fanlights as does secondary entrance door on street side. 2nd floor windows on E wing have fanlike brackets, elliptical arch shape. W entry door has oolitic limestone surround. 2nd floor facade has French doors to masonry balcony with cast stone motif's; doors have cast stone surround. A low masonry wall on S and E forms a courtyard with the arcade. �Ar •J /b 15 /J a: 0. VIM . I , a 0 111111 9 2 11011 20 1. 1.1 Emma 9 ) DUI MN amm'! am®® am= MEM N N s a dmae g4mmn 111111 �mmmmma N w O. 111ao ST 1maa 4 ia mmEsp it N.W 99 plasma X00 tTJ�mm�� w,l I NW MN /2 I®E J =N.w. rv.w. 96TH 12 t 2J 5 9 - gam . J 21 1-© 3 10 1 9 7 IIO0i4 I dormmm Nw 9 4' tint mum J.w 93 mo1v4111amm in ammd OEM 04 r�• RD. 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E S mor N E �mmm va Homo MN 1' ill'oA 1 mug �IIOIDm �11L� WEI Env a liddh NMI *!o 611 0 074 • 1t P••r 1 , • do C'. 0 5 mmv4a: oa Mb Rh 10 4' lit lilt Mg IMt 1 0 Z dov�aoom� 101 ga 1:01111. wm�amm9 10 0 9 1 y, • 9 9 5 ". 9 7 9 5 9 1 • T. figrirm Will mareedm 1mm1mmm. ® G989a 0a °a MOM 98' ". Immo phampg OPINE mmmaE 96 '.. �O��OrQ� lb t 'I amp r.rip ®i® �mQalv41111� 5 imimpolt itamm9` 5-T, � moa- v400mm� RWAMA= 5T. "maolo�11lm ;r, a�iaamse��� mimmaint R mom tmeemmmui magma 2 5 - fl MUM 1111: WOW 5 T. Fr lo a " cir ttok * AZ T. O _ "-'s a 93 5 111 :Ng TRACT- Sr ROM OF 1114/1 SC.N001 !CHURCH Agir re mu gime liniment MU All aiiiiiimil +, AIR MANN NE 1 IONE 11111111 II ziorlag-rwrion tommimmo mtmplum IMP OLIO 1 !Pr' MI mill Alltr 0 L d LAKE MIAMI SHORE'S I SCHOOL BUILDING ELECTRICAL PLUMBING ROOFING Architect Contractor or Builder Legal Description Lot CONTRACTOR OR BUILDER MIAMI SHORES VILLAGE, FLORIDA PERMIT Owner of Building Bl DATE. 19 N 9 4066 Contractor's License No. Work to be performed under this Permit Subdi- vision Address of Value of 1 Amount of Building Project $ 1 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 applica- tion 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 respon- sibility for work done by his agents, servants or employees. Signed. 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 as cepting this permit I assume responsibility for all work done by either, myself, my agent, servant or employee. BY AUTHORITY 4Yl0T LOCATION 577 N. L. 96th ., treat GARBAGE TAX RECORD f � PAID BY • { � 4— f YE ANNUAL TAX PERIOD USED AMOUNT PAID . DATE PAID RECEIPT NUMBER 1940 /o f J .-/ # 4 4 /6° /• ��t�.i' . _ _. . ' ..,- » '� �! Af, , . 1941 / 6 - O• 4 K . 4 11.1 �/ 1 %/ 1 :. �.� / III 5/4 J � , 1 2 . /6 = /— - -Y 3,3 943 NW 70 0d I/ � /9 ‘ V A /_,0. i 4,k,iJ / � 1944 /0 • e 3 -C -4/ r �� C /7 7 (�C�ri( s'oq./ Cf��9 aS I � C% f ( 1945 1946 / 1 /r / ° /- A-vz, 1947 F? C!5 ,, ? ., °1 a a 1948 i /2- \V f � " Y) /J� /� it i, 1949 P•" ./•.1 /..2- R/-5 i gZ' N)' 1950 LOCATION 577 N. L. 96th ., treat GARBAGE TAX RECORD 577 Na E. 96th St. by year annual tax period used amount paid date paid _ receipt i _ Mrs. Vaughn Camp / /.? °° V �_ o Application is hereby wade 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-<2e • e/Chaeker .PS �e�l....._. _ No.... ..._... Street..L F Registered Architect and /or Engineer ,,.... .............. ....... -•. Name and address of licensed contactor..,2.0 at��.,t .. /.a... •'.1.1•..../.. &. - Location and legal description of lot to be built on: - Lot / 20 -a (Block ' / Subdivision..... ..- . .5... Street and Number where work is to be done ,.J. A/ .... 7" • _..._.._� State work to be done and purpose of building (by floors)....,Leax�,�.�tld �T v4e. ,4.e.cesS.e'7.d..e ..2/s"9 ...��1..ed e . <,2R ` e of ,/42.7t. . k, 0, and for no other purpose. New Building Remodeling Addition Repairs No. of Stories To be constructed of Kind of foundation Roof Covering b 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 pennit, as are licensed by Miami Shores Village. Remarks..._ (Signed) A Mai MIAMI SHORES VILLAGE BUILDING INSPECTION DEPARTMENT. PLICATION FOR BUILDING PERMIT 1,5 Date ✓ 4 Permit No. Disapproved (Signed) Buil mg pector ate PLANNIN Chairman Member Member ...... Council Approved NOTE: A charge of $1.00 will be made for making corrections the Planning Board. A re- inspection fee of $1.00 will be charged materials and /or workmanship. OARD Member Member Member Date Disapproved Read, Sworn to and Subscribed before me. Notary Public, State of Florida My Com' -.ion Expires DATE or changes to this application after approval STATE OF FLORIDA, COUNTY OF DADE. ss. Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally ap- peared to me well known, and who, being by me first duly sworn, upon oath deposes and says that he is the. of the above described construction, that he has carefully read the foregoing application, and that he did sign the same, and that all facts therein by him stated are true. Date has been obtained from when such re- inspection is made necessary by improper notice for inspection or faulty Registered Architect Name and address o Location and legal description of Lot. /.. U a. STATE OF FLORIDA, COUNTY OF DADE. j ss and /or Engineer.. f licensed contr :r Disapproved `,._� r ,l._. __.. Date.. (Signed) MIAMI SCI ORES V LL 9 BUILDING INSPECTION DEPARTME APPLICATION FO t= -CL98LD Application is hereby wade for the approval of the detailed statement o e plans and specifications herewith submitted for the build- ing or other structure herein described. This application is made in co r lance and conformity with the Building Ordinance of Miami Shores Village, Florida, and all provisions of the Laws of the State o '' lorida, all ordinances of Miami Shores Village and all rules and regulations of the Building Division of Miami Shores Village shal :e complied with, whether herein specified or not. A copy of approved plans and specifications must be kept at building during pros 's of the work. 1972 Ow-ner's Name and Address .. r . M 1 . ' ' 'awe./ _ No. ,9 Street ..9" 31 Subdivision.$tanxi.._. r, Street and Number where work i be State work to be done an purpose of bu Note : 1"4/ s ausitd v T reA • .e6,p Arca New Building • Remodeling To be constructed of. .......... Kind of foundation n Estimated Total cost of improvements $.._.1.0. . 0 /.. A1..242.71e; 44.s► 7 Addition,k— Repairs No. of Stto O1 / 1 '...;._ Roof Covering.... £' �. _. Amount of Pe it a. / � . Zone cubage required .Plan Cubage t 0 t ` J' a y X _t'E�I�ticnee.eif" J e 6et re + 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 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 arc 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).. MIT Notary Public, State of Florida £lr..Ye. : 7+avi�ed l o-�' °r� e rL'"�O`+ for no other purpesst.''". _ 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 e true. Permit No.._.? _ _ _ Date 77 _._ Read, Sworn to and Subscribed before me. Bui • g Inspector My Commission Expires to me well known, PLA .. INC 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 in >pec•tion fee of $1.00 will be charged when such re- inspection is made necessary by improper notice for inspection ce faulty materials and/or workmanship. BUILDING ELECTRICAL PLUMBING Owner of Building Architect Contractor or Builder Legal Description Address of Building Lot CONTRACTOR OR BUILDER MIAMI SHORES VILLAGE, FLORIDA Fl ! ! PERMIT N° 9647 Work to be performed under this Permit Bl. Subdi- vision Value of Project $ DATE Contractor's License No / Amt. of Permit $ /.3 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. 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 T. MIAMI SHORES VILLAGE Owner's Name and Address BUILDING INSPECTION DEPARTMENT APPLICATION FOR U8I_OBNG RE MIT 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 worts. Permit No.__.___ � Date Disapproved D (Signed) 64))/L But ing Inspec Chairman Member Member ...... __...._......_..._._ - - --• Council Approved... NOTE: A charge of $1.00 will be made for making corrections the Planning Board. A re inspection fee of $1.00 will be charged materials and /or workmanship. INN Member Member Member Date Disapproved Date kith June 1!1/73 �x e1 -• -57.7•° •sE-:. - •• &t and_ Ithei eso ......_... Street...._. Registered Architect and /or Engineer Orkin- ba,O0,1113.,... 960 1\, 4d 6:2 , AVer taitt -, ,,..,_..... 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 577 N.E. 96 St. Miami Shores. State work to be done and purpose of building (by floors) .. L1.Qf..Tefte Fumigation lLi.kan.e .8z2,�1 $51111:,5 59#._ $260 ;00 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 a 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 subeoontr ors, on work to be performed under this pennit, as are licensed by Miami Shores Village. Remarks..._ (Signed) 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 - -- 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 state a true. Read, Sworn to and Subscribed before me. NNINC BOARD DATE Notary Public, State of Florida My Commission Expires or changes to this application after approval h to me well known, Date ns hecn obtained from when such re- inspection is mode necessary by improper notice for inspection ce faulty Registered Architect and /or Engineer Name and address of licensed contractor Location and legal description of lot to be built on: M I A BSI 0 S H O BUILDING INSPECTION DEPARTMENT AP;" LICATION 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 bc kept at building during progress of the work. 00 .__._ 6 1 O wner's Name and Address ... ... No...a�1.> ! ..._... StreetT ......� ate. Lot Block Subdivision .,p, .� Street and Number where work is to be done 51 7 �..� 6 -a tom. State work to be done and purpose of budding (b floors) 111/`a w ES VILLAGE and for no other purpose. New Building Remodeling Addition Repairs 14 No. of Stories To be constructed of Kind gj foundation Roof Covering Estimated Total cost of improvements $ / u 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 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 all contractors or sub - contractors employed by him in the work to be performed under this pennit; and will post or cause to be posted for inspection on the site of the work such public notice or notices as arc required by the Act. The undersigned agrees to employ only such subcontractors, on work to be performed under this pennit, as are licensed by Miami Shores Village. Remarks._._ (Signed) Notary Public, State of Florida 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 a� — true. 7 Permit No.-__.- ._ ......... `� S Date 2- 9-- 3 , r -�ead, Sworn to and Subscribed before me. Disapproved _ -` /�' (Signed) Building Inspector /J My Commission Expires PLANNING BOARD DATE Chairman Member Member Member Member ...... __.._._..._._..._._....._ Member Council Approved Date Disapproved NOTE: A charge of $1.010 will be made for making corrections or changes to this application after approval the Planning Board. A re 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. Date has been obtained From Permit No Disapproved (Signed) w Y L. MIAMI SH s RES VILLAGE BUILDING INSPECTION DEPARTMENT. AP LICATION FOR i=.UILDING 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 pragress of the work. ,19 �'� / / / Dat ®..._.l._... :... ._..._ .. _....__...... Owner's Name and Address 2.20../../ L.Q. 9....iV4/ — 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..,S7 State work to be d9ne and urpose of building (by floors)._,f�j. <.�.1l' New Building To be constructed of Kind of foundation Remodeling' Addition Building 4hspector .1yee . . k f ' iec4;/ - ' ... 7_44/2.r :;n_:7:1. �.�_.... ..G.!.and for no other pu Repairs No. of Stories..... Read, Sworn to and Subscribed before me. Roof Covering Estimated Total cost of improvements .....CQ Amount of Permit $. Zone cubage required _Plan Cubage Distance to next nearest building Size of Building Lot Jfaxitnum 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 pennit, as are licensed by Miami Shores Village. Remarks (Signed) . e 2 /J C, • �� STATE OF FLORIDA, 1 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 true. /C° -1'7 Notary Public, State of Florida My Commission Expires PLANNING BOARD DATE Chairman Member Niel-giber Member Member ...... .. Member Council Approved Date Disapproved Date NOTE: A charge of $1.00 will be madc.,for making corrections or changes to this application after approval has hecn obtained from the Planning Board. A rc 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. CITY OF MIAMI FLORIDA OFFICE OF BUILDING INSPECTOR (A copy of this Application together with one copy of plans and specifications, must be kept at building during Type of Construction is Y" Roof covering t • Size of building lot " street) Heating system, if any (kind) Maximum live Load to be borne by each floor My commission expires Permit No, issued upon above Application Classification Disapproved , 192_ Reasons: In this space give lot dimensions; make sketch of ground plan, and distance of building from all lot lines. APPLICATION FOR BUILDING PERMIT progress of the work) Application is hereby made for the approval of the detailed statement of the plans and specifications herewith sub- mitted for the building or other structure herein described. This application is made in compliance and conformity with the Building Ordinance of the City of Miami, Florida, which said Ordinance was approved July 7th, 1919. All provisions of the Laws of the State of Florida, all ordinances of the City of Miami, and all rules and regulations of the Building Department of the City of Miami, shall be complied with, w her r in specified or not. ,f � ate % `l / Name , 192 Owner's me an Address r _O_ 5� A „ _ / /` -_ Architect Estimated cost of Improvements (not including furnishings) Number of persons to be accommodated (maximum) per floor �r Name and address of contractor or builder Location and legal description of lot to be built on: �� Lot Block Street and Number where work is to be clone Subdivision °1•4? n "7 A g Purpose of. building (by floors) , ,f and fo, no other purpose. New Building Addition Repair ( '‘-f/1- 1 C F a ?- : ? ' ` Remodeling Number of. Stories /' I hereby submit all the plans and specifications for said building. and its construction may be sent to Foundation (Signed) THIS TO BE FILLED IN BY BUILDING INSPECTOR (Signed) Distance from next nearest adjoining building (from all sides except Plumbing Elec Elevators: passenger freight Manufacturer tices with reference to th building r STATE OF FLORIDA, COUNTY OF DADE. , } SS. Before me, the undersigned authority, a notary public, duly authorized to `a. minister oaths and take acknowl- edgments, personally appeared 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 building, that he has carefully read the foregoing application, and that he did sign the same, and that all cts therein by him stated are true. C e 192 Building Inspector. ` /A�6