577 NE 96 St (7)MIAMI SHORES VILLAGE HISTORIC PRESERVATION BOARD
NAME OF PROPERTY (ifapplicable) :
ADDRESS OF PROPERTY: S 7 7 E' 4 st . 11.5.
NAME(S) OF APPLICANT(S):
(NOTE: IF THE APPLICANT IS A PERSON
OTHER THAN THE OWNER(S), EVIDENCE
OF THAT PERSON'S AUTHORITY AS AGENT
MUST BE ATTACHED TO THE APPLICATION.)
TELEPHONE OF APPLICANT(S): (305) 1.' V-9443; (305)
ADDRESS OF APPLICANT(S):
(if different than address of property)
PRESENT USE OF PROPERTY: Sci 1 1 % \ R S
CLASSIFICATION OF WORK FOR WHICH CERTIFICATE IS DESIRED:
(circle the letter next to the appropriate classification)
APPLICATION FOR A
CERTIFICATE OF APPROPRIATENESS
FORM : MSHPB.COA (adopted 4/95)
please tvpe or print clearly
c. Fbf
MAINTENANCE OR REPAIR: The act or process of applying measures to sustain the existing form. integrity and
material of a building or structure and the existing form or vegetative cover of a site. 11 may include initial stabilization work.
where necessary, as well as on -going maintenance and repair. Samples of material must be submitted with the Application.
B. RESTORATION: The process of accurately recovering the form and details of a property and its setting as it appeared at
a particular period of time by means of the removal of later work or by the replacement of missing earlier worm All
applications for restoration shall include site plans (if required by the Building Permit). a statement with bibliography
historically justifying the work. and any additional photos or information to support the proposed work.
C. REHABILITATION: The process ol'returning a property to a state of utility through repair or alteration which makes
possil•le an efficient contemporary use while preserving those portions or features of the property which are significant to its
historical. architectural and cultural values. All applications for rehabilitation shall include: site plans (if required by Building
Permit). and any other supplementary information, such as drawings. that will support the proposed project.
D. DEMOLITION: The process of destroying or tearing down a building or structure or a part thereof, or the prods of
removing or destroying an archeological site or a part thereof: The applicant shall include a report explaining why the proposed
action should occur. If this action is to occur for reasons of financial hardship. all pertinent financial data should be included
pertaining to the asst of preservation. demolition and new construction. Any other material pertinent to the application is also
encouraged as supplementary information.
E. NEW CONSTRUCTION: The process of constructing a building or structure that has never existed at that location.
Applications shall include : a site plan. elevations, floor plan and/or landscape plan.
J
DESCRIPTION OF THE PROPOSED PROJECT (Explain what changes will be made
and how they will be accomplished - use continuation sheet if necessary - all applications
shall be accompanied by at least one 3" x 5" photograph of the property):
Rep ite*c iv%4 (R.x IST ) Y.0 ®pct.` S
% 50 ( , U.. w1 r, %A) — 1 7 6 i - t c,�
e-- ` / /nifiac7
CERTIFICATION
I (WE) CERTIFY TO THE BEST OF MY (OUR) KNOWLEDGE AND BELIEF THAT ALL INFORMATION IN
THIS APPLICATION AND ITS ATTACHMENTS IS TRUE AND CORRECT:
�
SIGNATURE OF APPLICANT(S): �G -- DATE:
SIGNATURE OF OWNER(S):
FOR BOARD USE ONLY
APPLICATION DATE (date application received by Secretary dale Board):
SIGNATURE OF CHAIRMAN: 2
DATE:
DATE:
DECISION OF THE BOARD (circle the appropriate number):
1. APPROVED
2. APPROVED WITH CONDITIONS (set forth conditions below):
DATE: