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813 NE 97 St (3)• MIAMI 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. Date 19 Owner's Name and Address.- Y. 4N' f7.5 Registered Architect and /or Engineer �y Name and address of licensed contractor CR Y5 L- W.H I T& RO `LA f . [ 4 �`� � n iN Location and legal description of lot to be built on: Lot Block p Subdivision Street and Number where work is to be done �' d 3 A/ E 17 . B State work to be done and purpose of building (by floors) r c. (4- - COO % O0G • • Street and for no other purpose. New Building Remodeling Addition -- Repairs No. of Stories To be constructed of Kind of foundation_ R o Covering 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 buiding. 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 subcontra - , s, on work to performed under this permit, 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 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 fo ;egoing application, and that he did sign the same, and that all facts therein by him stated are true. ,, J Permit No � �- Date ti ` �• Disapproved i/ ./,/ i Dat • Public, State of Florida (Signed) a �- -� Notary .„ % Y Building Inspector Mission Expires Read, Sworn to and Subscribed before me. PLANNING 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- 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. Tenant/Lessee Name Miami Shores Village i Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 BUILDING PERMIT APPLICATION FBC 2001 Permit Type (circle : Building L Electrical C Plumbing Mechanical Roofing N Owner's Name (Fee Simple Titleholder) 2 d%' 1.50xr 1 , i Al 1 n 0 Phone #(341) 7/.1 / q 4744- - Owner's Address / 3 A(/Z- / • City /�'f i4 /41 ;r/ :oLA- S state F1 4 21,4 'A Zip 13/36 Job Address (where the work is being done) /4/A 8/3 Ali 17 X`r., City Miami Shores Village County Miami -Dade Is Building Historically Designated YES NO Contractor's Company Name LOS %'M 44voL. `; Contractor's Address l 3 )" rid / • City , /i44/ State 1: • Zip 33/ $ , Qualifier aCr t-) f 1-/t L-© State Certificate or Registration No. Certificate of Competency No. Architect/Engineer's Name (if applicable) A,/ $ Value of Work For this Permit` 1 `Jl .0() Type of Work: ❑Addition ['Alteration ❑New Describe Work: )490)nn lAck Submittal Fee S Notary S Scanning $ / �- Code Enforcement S - Total Fee Now Due S (Continued on opposite side) * * * * **,* * * * ** ***** * ** ** * * * * ** F e es ** * * * * ** * * * * * * * ** ** ** * * * * * ** ** Permit Fee $ Training/Education Fee $ Radon $ C- i4 • Structural Plan Review. $ f� Permit No. CS - .l Master Permit No. Phone # 3D6-5 Mi/1 J'itiva4f , Zip 3 3 / 3ee Phone # (344 aPrg/L• Phone # Ygii) Square Footage Of Work: ❑ Repair/Replace ❑ De olition CCF S / CO /CC Technology Fee $ / Zoning Bond $ G.3 Bonding Company's Name (if applicable) SIN ' • f Bonding Company's Address City State Zip Mortgage Lender's Name (if applicable) 0 LA Mortgage Lender's Address City State Zip Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRICAL WORK, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and AIR CONDITIONERS, ETC 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. "WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT 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." Notice to Applicant: As a condition to the issuance of a building permit with an estimated value exceeding $2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection. which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will no/�tt be approved and a fee will be charged. Signature Signature , 11 9 711* Contractor The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this day of V� d / , 20 c94 by day of () c Db2- t , 20 04, by who is personally known to me or who has produced who is personally known to me or who has produced as identification and who did take an oath. Cho 05/13/03 Owner or Agent NOT LI = /' Si p r.i eel 040 �� hy.' 1.900.3-NOTARY C, r,-Aan. De +n�,m AIM R Not_ !kc . rtl4ttrt i My Commission Expires: My Commission Expir ' NOT'wr re ***************************************************************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** APPLICATION APPROVED BY: As identification and who did take an oath. ETF foc)u_p ?o EY ^iF.' .anunry 1. _'.?G.. ******************************* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** 4******** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** NOTARY P Si P COY (� , ,/(7 MY COMMc?.;:Io ' 1)0 278276 - 7 2004 Plans Examiner Engineer Zoning Miami Shores Village 10050 NE 2nd Avenue Phone: 305 - 795 -2204 Printed: 12/14/2004 Applicant: ROBERT Owner: HANNAU JOB ADDRESS: 813 Contractor CUSTOMS POOLS Local Phone: Parcel # 1132060142590 NE 97 Building Permit Permit Number: BP2004 -1487 HANNAU ROBERT ST Contractor's Address: 13250 SW 131 ST #100 Legal Description: MIAMI SHORES SEC 3 PB 10 -37 LOT 14 & W1/2 OF LOT 15 Fees: FEE2004 -12552 FEE2004 -12562 FEE2004 -12563 FEE2004 -12564 FEE2004 -12565 FEE2004 -12566 FEE2004 -12567 FEE2004 -12568 FEE2004 -12569 Description Building Fee CCF Training and Education Fee Technology Fee Scanning Fee Radon Structural Fee Builders Bond Submittal Fee Total Fees: Amount $408.00 $8.40 $2.80 $10.20 $15.00 $9.51 $50.00 $300.00 ($250.00) $553.91 Total Fees: $553.91 Total Receipts: $0.00 N7 0 Permit Status: APPROVED Permit Expiration: 5/11/2005 Construction Value: $13,600.00 Work: SWIMMIMG POOL Signed: (INSPECTOR) Signed: (Contractor or Builder) BY: Page 1 of 1 NV 1 Rin 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 responisibility for all work done by either myself, my agent, servants or employes. BLK 73