858 NE 97 StDisapproved
(Signed)
Distance to next nearest building_
STATE OF FLORIDA, }
COUNTY OF DADE.
MIAMI SHOR JILLAGE
BUILDING INSPECTION D PARTMENT
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 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.
Owner's Name and Address 61-' c . f e
Registered Architect and /or Engineef A- ' 1L�2 . m
Name and address of licensed contractor - ' - "' / • - • -. t -'_./ "
Location and legal description of lot to be built on:
Lot_ b7n ' 2- 1 Block __ Subdivision /
Street and Number where work is to be done 1 1'2 . 2 -? //, .1 Z 9:_:/-; / o
State work to be done and purpose of building (by floors) 1 - • ' k �
_and for no other purpose.
New Building___ —__ Remodeling________________ Addition______________ Repairs No of Stories__,____
To be constructed of- ' 1' ?P '- _Kind of foundation C." fie_ Roof Covering__ )o °I' .
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Estimated Total cost of improvements $__ C '� �_ _ %_.-______Amount of Permit $____ _ <
Plan Cubage J /T, '
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
/7 A ^
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 r 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 stork to be performed under this
permit, as are licensed by Miami Shores Village. \
Remarks (Signed) f ✓�
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 same, and that all facts
therein by him stated are true.
Permit No. SS? ��__ Date v Read, Sworn to and Subscribed before me.
Date
Building Inspector My Commission Expires
•
Date_=? —` — � - - 19—
NO -- Streets /' !
Notary Public, State of Florida
el '
to me well known,
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.
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STATE OF FLORIDA) SS
COUNTY OF DADE )
_ &2C °61/2/j � of the Village of Miami Shores, County of Dade and
State of Florida, being duly sworn, doth depose and saya that under the provisions
of Section B •368, Sub - section (d), of the Building Code of Miami Shores Village
he desires to build ✓ , A ' 4 ( . 4 E - / ; , 4 / / 4 . . . C . Z e . , i A - / _ _ on Lot dim Z. si; ft'2 f
Block 71 of /40 ✓;Z'ir J subdivision; that he is the owner of said
property, and will do the work personally, and that he will, at such times as are
required by the Zoning and Building Director: -
1. File plans and specifications and obtain approval ttf Village Planning Board .
and of the Building Inspector.
2. Apply for and secure a permit.
3. Pay the required fees for license and for permit.
4. Execute the work in accordance with the provisions of the Zoning, Building,
and Electrical Codes of Miai Shores Village.
5. Apply for inspections.
6. File with the Building Inspector certificates that provision has been made
to carry the necessary Workman's Compensation, Public Liability and Rroperty
Damage Insurance.
7. File with the Building Inspector as the job progresses certificates shoring
the payment required by the Federal Social Security Act to the State of
Florida or the United States of America.
8. Assume the responsibility of not employing contractors or sub - contractors
other than those properly licensed by Miami Shores Village or any part or
portion of the work including, but not limited to, general contracting,
plumbing, heating, electrical, septic tank, solar system, lathing, tile,
torrazo, painting, roofing and sheet metal work or installation.
9. Not sot himself up as a "Contractor ".
10. Execute Builder's Bond.
And further this Deponent says not.
9 •
AFF I'1) .7 I T
1. Signature of Applicant.
2. Signature of Officer administering oath.
SUBSCRIBED AND SWORN TO BEFORE ME THIS DA ' of A. D., 19 ,
2.
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