3390a
MIAMI SHORES VILLA1E
BUILDING INSPECTION DEPARTMENT
APPLICATION FOR BUILDING PERMIT
Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the building
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 pf the State of Florida, all ordinances of Miami! Shores Village and all rules and regula-
tions of the Building Division of Miami Shores Village shall be complied with, whether herein specified or not. A copy of'4pproved plans
and specifications must be kept at building during progress of the work.
� a
Owner's Name and A .. / . e'�f * . -
Registered Architect and /or Enginee
Name and address of licensed contractor
Location and legal description of lot to be built on:
- Lot Block. Subdivision -°e ,, r `
Street and Number where work is to be dono. f r '-- F - s f
State work to be done and purpose of building (by floors)
P
I � and for no other purpose.
New Building Remodeling Addition !/ Repairs No. of Stories
To be constructed of Kind of foundation Roof Coeering
Estimated Total cost of improvements $ 6 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 Computation 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 perforn►ed under this
permit. as are licensed by Miami Shores Village.
Remarks (Signed)
STATE OF FLORIDA. I
COUNTY OF DADE. f m '
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally
appeared
to nee well known,
and who, being by me first duly sworn, upon oath deposes and says that he is rho
of the above described construction, that be 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 - I" rof Data ' �° Read, Sworn to and Subscribed before me.
Disapproved Drip
Notary Public, blic, State of Florida
B ding Inspector My Commission Exp ros
PLANNING BOARD DATE
Chairman Member
Member Member
Member Member
Council Approved nate Disapproved nate
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.
MIAMI SHORES VILLAGE
BUILDING INSPECTION DEPARTMENT
APPLICATION FOR BUILDING PERMIT
Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted fpr the building
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 regula-
tions 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
Owner's Name and Ad . I/ , ' _ v= ,1.4,4; t N
Registered Architect and /or Engin
Name and address of licensed contractor
Location and legal description of lot to be built on
Lor
Subdivision ` .�`7'4
---- --
Street and Number where work is to be done ^��� � , t°�.F "� �^' (4.0' - d.
State work to be done and purpose of building (by floors)
19
and for no other purpose.
New Building Remodeling Addition / Repairs No of Stories
To be constructed of Kind of foundation Roof Covering
r "
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 tbis 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 compliances 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 su:h 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 Shorn Village.
Remarks (Signed)
STATE OF FLORIDA, -
COUNTY OF DADE.'
Before me, the undersigned authority. a notary public. duly authorized to administer oaths and take acknowledgments, personally
appeared
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
therein by him stated are true.
Permit No Date Read, Sworn to and Subscribed before me.
Disapproved Da
(Signed)
Building Inspector My Commission Exppi
PLANNING BOARD DATE
Chairman Member
Member Member
Member Member
Council Approved ate Disapproves
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 an d/or workmanship.
Notary Public, State of Florida
to me well known,
same, and that all facts
BUILDING
ELECTRICAL
PLUMBING
Owner of /
Building ,/ /r A'"'*
CONTRACTOR OR BUILDER
MIAMI SHORES VILLAGE
Work to be performed under this Permit
N° 3390
DATE
Contractor'
License No
WARNING: This Construction may be In violation of
War Production Board General Limitations Older 141
You are caution'd to consult your War Production
Board office before starting the work authorized in
this permit
Subdi-
vision
Architect
Contractor
or Builder
Legal
Description
Address of
Building
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 ;s drawin or in the statements or specificatipas and
that he assumes responsibility for work done by his agents, servants or employees.
Signed.
Value of
Project
BY
g ei/e.6"
AUTHORITY
IN PECTOR
In consideration of the issuance to me of this permit I agree to perform the work covered hereunder in compliance with all ordinances and regula-
tions 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.
BUILDING
ELECTRICAL
PLUMBING
Owner of /
Building ,/ /r A'"'*
CONTRACTOR OR BUILDER
MIAMI SHORES VILLAGE
Work to be performed under this Permit
N° 3390
DATE
Contractor'
License No
WARNING: This Construction may be In violation of
War Production Board General Limitations Older 141
You are caution'd to consult your War Production
Board office before starting the work authorized in
this permit
Subdi-
vision
Architect
Contractor
or Builder
Legal
Description
Address of
Building
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 ;s drawin or in the statements or specificatipas and
that he assumes responsibility for work done by his agents, servants or employees.
Signed.
Value of
Project
BY
g ei/e.6"
AUTHORITY
IN PECTOR
In consideration of the issuance to me of this permit I agree to perform the work covered hereunder in compliance with all ordinances and regula-
tions 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.