61 NE 96 StPERMIT APPLICATION FOR MIAMI SHORES VILLAGE
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Date 9: C: Job Address 6 t t `'6 Tax Folio 3 � tO 19 .0626o
Legal Description 5 "k— Mot I G iele Historically Designated: Yes No
Ownessee / Tenant A" l.f /7 ° / Master Permit #
G�/ � • 3o.� -- 7r - r9�o
Owners Address l� l / ` v Phone'• TS4' - f6 P — 22-00
Contracting Co. GT Address
Qualifier SS# Phone
State # Municipal # Competency # Ins. Co.
Architect/Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIPTION / —/ / s € 0 /Z 'cIN/¢"C W 2 / /
We-1/6 76 £ Oo#,e/,- Gam' £/Valf AA"✓!i✓6S'
Square Ft. Estimated Cost (value) CAiw4 f — 77 Z t)
WARNING TO OWNER: YOU MUST RECORD A NOTICE OF COMMENCEMENT AND YOUR FAILURE TO DO SO 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.)
Application is hereby made to obtain a permit to do work and installation as indicated above, and on the attached addendum (if applicable). I certify that all work
will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that separate permits are required for ELECTRICAL
PLUMBING, SIGNS, POOLS, ROOFING and MECHANICAL WORK.
OWNER'S
constru
Signature of owner and/or Condo President
Notary as to Owner and/or Condo President Date Notary as to Contractor or Owner- Builder Date
My Commission Expires: My Commission Expires:
FEES: PERMIT
: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating
g. Furthermore, I authorize the above -named contractor to do the work stated.
o
Date Signature of Contractor or Owner- Builder Date
RADON C.C.F. NOTARY BOND
APPROVED: TOTAL DUE
O vreielY di , \ \G \ ��
Zoning r c -OVA Building Electrical
Mechanical Plumbing Structural Engineer
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MIAMI SHORES VILLAGE HISTORIC PRESERVATION BOARD
APPLICATION FOR A
CERTIFICATE OF APPROPRIATENESS
A/
NAME OF PROPERTY (if applicable) :
Vim—
ADDRESS OF PROPERTY: / �
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.) G
TELEPHONE OF APPLICANT(S): (305) 7� / �7 / � 9(1 (395j a a.-°7420o
ADDRESS OF APPLICANT(S):
(if different than address of property)
PRESENT USE OF PROPERTY:
please type or print clearly
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CLASSIFICATION OF WORK FOR WHICH CERTIFICATE IS DESIRED:
(circle the letter ngxt to the appropriate classification)
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 fors 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 work. 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. REFIAB!LITATION: The process of 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 rehahilitatiun 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 process of
removing or destroying an archeological site or a part thereof. The applicant shall include a report explaining why the proposed
action should ocwr. if this action is to occur for reasons of financial hardship. all pertinent financial data should be included
pertaining to the out of preservation. demolition and new construction. Any other material pertinent to the application is also
encouraged as supplementary information.
E. NEW CONSTRUCTION: me process or 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.
FORM : MSHPB.COA (adopted 4/95)
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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):
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CERTIFICATION
I (WE) CERTIFY TO TEE BEST OF MY (OUR) ICNOWL
THIS APPLICATION AND ITS ATTACHMENTS IS
SIGNATURE OF APPLICANT(S):
SIGNATURE OF OWNER(S):
FOR BOARD USE ONLY
APPLICATION DATE (date application received by Secretary of the Board):
DECISION OF THE BOARD (circle the appropriate number):
(
2. APPROVED WITH CONDITIONS (set forth conditions below):
3. DENIED
SIGNATURE OF CHAIRMAN:
IEF THAT ALL INFORMATION IN
CT:
DATE: 'Z ZO- 0/
DATE:
DATE:
DATE:
7
s • •
NOTICE TO APPLICANT(S)
HEARING: The Board will act upon the Application within ten (10) working days after receipt of the
Application by the Secretary of the Board. You will be notified by the Chairman of the date of the
hearing. An Application will not be considered until the required supplementary material has been
provided and the Applicant and the owner sign the Application attesting to the truthfulness of the
information provided.
APPEALS: Any person desiring to appeal a decision of the Board shall within fourteen (14) days from
the date of such decision. file a written notice of appeal with the Village Clerk.
HELPFUL TIP: Historic photographs, photographs showing existing conditions, proposed plans and
drawings, and samples of proposed materials are all very important in assisting the Board in making an
informed decision.
/&Ni,J 6602.