Loading...
4062MIAMI SHORES VILLAGE BUILDING INSPECTION DEPARTMENT APPLICATION FOR BUILDING PERMIT Application is hereby made for the approyal 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. Else_ 1 Owner's Name and Address. „PH/ _ aff,ki./.4 4 No. 4/2, Registered Architect and/or Engineer Name and address of licensed contractor .__,4 1 2,Z./.40? .4 -4 7 / o' Location and legal description of lot to be built on: Lot_ & + Block •-cf Subdivision Street and Number where work is to be done State work to be done and purpose of building (by floors)_7e New Building. Remodeling Addition To be constructed of Kind of foundation_ Roof Covering Estimated Total cost of isaistrovernents $ Amount of Permit $ Zone cubage required Plan Cubage_ Distance to next nearest building__-_- .... ..... 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 be sent The undersigned applicant for this building permit does hereby certify that he uride of labor under the Florida Workmen's Compensation Act, being Section 5966, Compil and has complied with the provisions thereof, and will require similar compliance from in the work to be performed under this permit; and will post or cause to be posted for • or notices as are required by the Act. The undersigned agrees to employ only such permit, as are licensed by Miami Shores Village. Remarks_ (Signed)... STATE OF FLORIDA, COUNTY OF DADE. ss • peared No 7 1 4. e ) Date ,E,0 Di sapproved ___ Date (Signed) -- g Inspector PLANNING BOARD .. - Chairman Member ..... Member Council Approved_ _Date ,rg and for no other purpose. Repafrs No. of Stories 11..)16 ands and accepts his obligations as an employet General Laws of Florida, Permanent Supplement) contractors or sub-contractors employed by him on on the site of the work such public. notice 'tractors, on • to be performed under this law Before me, the undersigned authority, a notary public, duly autho ed to administer oaths and take acknowledgments, personally a% to me well know, and who, being by me first duly sworn, upon oath deposes and says that he is the_ a . - of the above described constxuction, that he has carefully read the foregoing application, and that he did sign the same, and that ail facts therein by him stated ag true. Permit N 41 Read, Sworn to and Subscribed before me. Notary Public, State of Florida My Commission Expires DATE Member Member Member Disapproved and its construction \ 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. ■.■ ' s / 1011111111111111111011111 1111111111111111111111111 10111101111111111111MI1�1f 11111111111111111111111111111 11001111111111111111111111 1111111111111111111111111 11101111110111111111111111 1111111111111111111E11111 .1111101111110111EE111E MERIPMENNEREMIN INUMINTIE111111111111 INMENIMMINEMEHOMI4 IMPRINIMEIM ii u 11111111111111ME INESEINEMELZIONI i llJIVlhlhllLIl IWHII iliVRIMININ Effiummumany IF EMI 1111111 IIIMMENEMINIMS 1111111111111111111111191111111E 1.0=11.1.1111.11MEN 11111111111110111 BUILDING ELECTRICAL PLUMBING ROOFING Owner of Building Architect Contractor or Builder Legal Description Lot CONTRACTOR OR BUILDER MIAMI SHORES VILLAGE, FLORIDA PERMIT N? 4062 Address of # = " Value of II Amount of Building . . '- °. Project $ 11 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. DATE 19 Contractor's License No. Work to be performed under this Permit Subdi- Bl. vision Signed INSPECTOR In consideration of the issuance to me of this permit I agree to perform the work covered hereunder in compliance with ail 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 ABBOT 'e"o.