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700 NE 96 St (6)BUILDING PERMIT APP FBC 2001 Permit Type (circle): Owner's Name (Fee Simple Titleholder) Owner's Address ' o o N e City I�rP`i�l S f� tf Tenant/Lessee Name i■.l gt- Job Address (where the work is being done) mi l' o d l/J 5 e s T City Miami Shores Village County Miami -Dade Zip 3 3 i 3 8 Is Building Historically Designated YES NO t� Contractor's Company Name , IC 'ION Contractor's Address City Qualifier Architect/Engineer's Name (if applicable) Phone # ®0 $ Value of Work For this Permit P 7 0 o c) Type of Work: ❑Addition ['Alteration Describe Work: • Total Fee Now Due $ Notary $ -s . d Training/Education Fee $ (Continued on opposite side) State K Miami Shores Village Building Department .10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 Electrical Plumbing Mechanical f3 'L Phone # G Sta ❑New -)) perl ) 2 � (23 * * * * * * * * * * * * * * * * * * * * * * * * * * * *F s * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** Submittal Fee $5 4 0 Permit Fee $ / CCF $ `Zl 0 Technology Fee $ 3/ Scanning $ "' Radon $ Bond $ iO Phone # ❑ Repair Code Enforcement $ ---- Structural Plan Review. $ Permit No. ) 7 D? Master Permit No. Roofing "Nog -7S -5 6e (7 Zip 3 Phone # Zip Square Footage Of-Work: Cu5fl. DEC 1 1 PAID ❑ Demolition --0 Bonding Company's Name (if a ;"+licable) Bonding Company's Address City State Zip Mortgage Lender's Name (if applicable) 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 conunenced 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 not be approved and a reinspection fee will be charged Owner or Agent 3 c.~ " 7 0 s. " ' Contractor The foregoing instrument was acknowledged before me this 4 The foregoing instrument was acknowledged before me this day ofDe_Q__ _, 2021, by u C & . Y v Q day of , 20 , by who is ersonall e f .L t who is personally known to me or who has produced p y kno o , or who has pro � Z ta, 0' L1 4-3 identification and who did take an oath. as identification and who did take an oath. Signature Ex;.res Nri '5 rifle NO PUBLI ry Print: ; -, My Commission Exp State Certificate or Registration No. ******************************************************* ***************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** APPLICATION APPROVED BY: Chc 10/14/03 Signature NOTARY PUBLIC: Sign: Print: (Certificate of Competency Holder) My Commission Expires: Certificate of Competency No. DEC 1 0 PAID Plans Examiner Engineer Zoning By Owner VILLAGE OF MIAMI SHORES BUILDING DEPARTMENT OWNER BUILDER DISCLOSURE STATEMENT I L O I S LE--a- being the legal property owner, for the property Located at: J ®p 1'J. e• "j G. ST M i tm 1 3 H-d qz-e L. `, , %3 8' Legally described as 1,0^k a L < �i'I, A uw 1 -5 00 R F S t.T1 ° I .9 - Do hereby petition the Village of Miami Shores to act as my own contractor pursuant to the laws of the State of Florida, F.S. 489.103(7),sgnd I have read and understand the following disclosure Statement, which entitles me to 3l ork as my own contractor, I further understand that I as the owner must appear in person to complete all applications. DISCLOSURE STATEMENT State law requires construction to be done by licensed contractors. You have applied for a permit under an exemption to that law. The exemption allows you, as the owner of your property, to act as your own contactor even though you do not have a license. You must supervise the construction yourself. You may build or improve a one - family or two-family residence or a farm out - building. You may also build or improve a commercial building at a cost of $25,000.00 or less. The building must be for your own use and occupancy. It may not be built for sale or lease. If you sell or lease a building you have built yourself within one year after the construction is completed, the law will presume that you built it for sale or lease, which is a violation of this exemption. You may not hire an unlicensed person as your contractor. It is your responsibility to make sure that people employed by you have licenses required by state law and by county or municipal licensing ordinances. Any person working on your building who Is not licensed must work under your supervision and must be employed by you, which means that you must deduct F.I.C.A. and with- holding tax and provide workers' compensation for that employee, all as prescribed by law. Your construction must comply with all applicable laws, ordinances, building codes and zoning regulations. Proof of ownership provided ( ) initial of reviewing clerk. Tlie foregoing instrument Was acknowledged before me this (Al day of , 20.0 a ' who is personally known to me or who has Produced as identification and who did take an oath. Vivienne Avis Commission #DD225265 Expires: Jul 12,2007 X74; Bonded Tiro 1, ) u ' Atlantic Bonding Co., Inc. t Miami -Dade County Clerk - County Recorder's Record Search CFN Details Clerk of Courts r i c h Judicial Circuit of Florida MiamDade County Horne Online Services Meet the Clerk " Contact Us mi3midade.gov' County Recorder's Record Search CFN Details CFN #1996 R 396235, Group ID #1 Page 1 of 1 First Party (Code): BUTLER, ROBERT S JR & LOIS H (D) Second Party: BUTLER, LOIS H Subdivision Name: MIAMI SHR SEC 03 Legal Description: LOT 9 Clerk's File No: 1996 R 396235 Pages in Document: 2 Rec. Date: 9/3/1996 Group ID: 1 Doc. Date: 8/26/1996 Doc. Type: QCD - QUIT CLAIM DEED Entry Date: 1/1/1901 Rec. Book/Page: 17336 / 4031 Block No: 68 Orig. CFN No: Section: Orig. Book/Page: Township: Plat Book/Page: 10 / 371 Range: Misc. Reference: Folio No: 1132060142110 BEGIN A NEW SEARCH RETURN TO SAME SEAR( First Party (Code): BUTLER, LOIS H (R) Second Party: BUTLER, ROBERT S JR & LOIS H Subdivision Name: MIAMI SHR SEC 03 Legal Description: LOT 9 Clerk's File No: 1996 R 396235 Pages in Document: 2 Rec. Date: 9/3/1996 Group ID: 1 Doc. Date: 8/26/1996 Doc. Type: QCD - QUIT CLAIM DEED Entry Date: 1/1/1901 Rec. Book/Page: 17336 /4031 Block No: 68 Orig. CFN No: Section: Orig. Book/Page: Township: Plat Book/Page: 10 / 371 Range: Misc. Reference: Folio No: 1132060142110 BEGIN A NEW SEARCH RETURN TO SAME SEAR( Home 1 Online Services 1 Meet the Clerk 1 Contact -Us 1 Miami -Dade County 1 Privacy Policy 1 Disclaimer Hints I Email 1 Public- Records Home 1 Login http: / /www.miami- dadeclerk. com/public- records /cfndetai ls. asp ?pcfn _year = 1996 &pcfn_seq... 12/8/2003 Application is hereby made for the approval 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. 3° oaj � t j� Owner's Name and Address � a Date No �' �' , _._ (Str �0, Registered Architect and /or Engineer _ ' _: �- Name and address of licensed contractor - - -- Location and le description of lot to be built on::, �� A LR__b Subdivision -3 Lot Block 9 S e vork to begone and purpose of building (by floors) Street and Number where work is to be done New Building APPLICATION FOR BUILDING PERMIT • MIAMI SHORES VILLAGE BUILDING INSPECTION DEPARTMENT Remodeling Additio To be constructed of Kind of foundation Estimated Total cost of improvements $ �s 2. Zone cubage required_______ )___�_ Plan Cubage 0 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 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 tors, on work to be performed under this permit, as are licensed by Miami Shores Village. Disapproved (Signed) and for no pairs No. of Stories Roof Covering,,, _ Amount of Permit $ 1 7 -- 1 Ej Remarks (Signed). other purpose. STATE OF FLORIDA, COUNTY OF DADE. ss. Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally ap- peared and who, being by me first duly sworn, upon oath . eposes and says that he is the of the above described construction, that he has ca •fully reed the foregoing application, and that he did sign the same, and that all facts therein by him stated are true. Permit No C! Date __ Read, Sworn to and Subscribed before me. to me well known, Notary Public, State of Florida Build g Inspector My Commission Expires Chairman Member Member PLANNING BOARD DATE 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. Building Inspector MIAMI SHORES BUILDING INSPECTION D New Building Remodeling Addition To be constructed of ___AL afrn Kind of foundation___(A/vGE r - S ,E5( LAG E TMENT APPLICATION FOR BUIL .'`NG PERMIT ���� Date. - -_../ / � '/ 7 Owner's Name and Address �� //✓e •!le/!_ 4E:va`! f No. ING BOARD DATE 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. /g/ , 197 Street 9'6 rN A/ E, Registered Architect and /or Engineer ■/.O 4 fl__Z / Q_(JE_a PE. /�0f / Name and address of licensed contractor 14 T `Z /e l NblisT /e5 SOS O . //T1/Av , /.Ade-di/„ Location and legal description of lot to be built on: on: �J Lot j Block Subdivision .__./__!1_ /j4m/ s 1 S , 3 , Street and Number where work is to be done :7'.. /t' y. 721 S 7 State work to be done and purpose of building (by floors) --- /E� / .—�c Ga 5 u.e4 / re Pc, The L The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations as an of labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida, Permanent S and has complied with the provisions thereof, and will require similar compliance from all contractors or sub -con :.tors emplo in the work to be performed under this permit; and will post or cause to be posted • ' , s ection on the site of th or notices as are required by the Act. The undersigned agrees to employ only c subco , actors, on work permit, as are licensed by Miami Shores Village. Remarks (Signed)._ and for no other purpose. Repairs No. of Stories SC2G ����rJlo Roof c9vering Estimated Total cost of improvements $ I 2--1 0 • Amount of Permit $ Zone cubage required .Plan Cubage____ -. Y J ' 7 Distance to next nearest building. __ /4T7t 4 L - 1 6 ____ 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 /_�' 4 be sent to__ — 1__7C /4J,,PIi$2 e _, ._ S S C./- -; r // //8'i_4,, 33c7/3 , employer lenient, by him notice n•er this STATE OF FLORIDA, COUNTY OF DADE. 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 foregoing application, and that he did sign the same, and that all facts therein by him stated are Permit No / Date. -- Read, Sworn to and Subscribed before me. Disapproved .___ . _ .._ Date. (Signed) / Notary Public, State of Florida My Commission Expires 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. Owner's Name and Address Registered Architect and /or Engineer Name and address of licensed contractor Location and legal description of lot to be bolt on: Lot_ Block ((77 t1 Street and Number where work is to be done State work to be done and urpose of building -- - - - T.4 3 J �¢1 a- a ' to Disapproved _ ( Signed) Chairman Member Member . Council Approved 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 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. II� , Date J - 6-- , 156. 2 Lal�L_ WIL L-p9o0G- Subdivision 7 &O AJ ' 9G oors) __ (- -- Date Building Inspector PLANN{NC BOARD.. 1 (Signed) o Street and for no other purpose. New Building Re yodeling ____. ___ Addition Repairs No. of Stories To be constructed of_ /A/ i iNikt dtf f8u nlc ation Roof Covering Estimated Total cost of improvements $ 3.S Amount of Permit $ Zone cubage required plan Cubage____ _. Size of Building Lot Distance to next nearest building 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 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, f t wq k such public notice or notices as are required by the Act. The undersigned agrees to employ only such subcontractors, on vf9J4cptof rformed under this permit, as are licensed by Miami Shores Village. Remarks e. 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 foregoing application, and that he did sign the same, and that all facts therein by him stated are true. Permit No it 3 45 y._ - -_._ . Date____.. ' 3-c-7 �._. Read, Sworn to and Subscribed before me. Notary Public, State of Florida My Commission Expires__ _- DATE Member Member Member 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. Date V Miami Shores Village Building and Zoning Department Attention: Building Official SWIMMING POOL OWNER'S CERTIFICATION 1 certify that I am the legal owner of the property described as tOT q cau< 68 sig. S. 3 '760-o /J. —. 96 located at In accordance with Section 33- 12(f), Code of Metropolitan Dade County, I certify that 1 understand and agree that the swimming pool to be constructed at the above address cannot be used or filled with water until a separate permit has been obtained for an approved safety bar- rier, and such barrier erected, inspected and approved. I further understand that this certification, however, does not eliminate the need for ob- taining a permit and erecting an approved barrier prior to final inspection and use of the pool. Note: This certification is to be submitted with a swimming pool permit application in duplicate. 123.03-92 Leg al Owner o 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 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 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. Owner's Name and Address /? C 343 E 2 . 1 t] f f— F J 2 Registered Architect and/or Engineer 5 e Name and address of licensed contractor ' Location and legal description of lot to be uil on: Lot Block Subdivision MS 147-C/ / Street and Number where work is to be done J Yt'1 G /9 S .4 , OV / State work to be done and purpose of building by floors). state exterior colors (submit samples) 3' &7 IA/ a C7 GFn/ C 6 F 12001 n/. t,v. COIZA-16 i9 r2 /3& o tvec i L/M 1- ft :A/c6 . %O TJ/ v) p 1 OP ,ht S FGA / an/ p F 7?-/6 ` D .' ® A 6-A24)44-And for no other purpose. New Building Remodeling Addition X Repairs No. of Stories To be constructed of /�i2 ✓2r i /2 fr7GOWKind of foundation Estimated Total cost of improvements $ 7 5 Amount of Permit S e' Go 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 plans and specifications for said building. All notices with reference to the building and its construction may he sent to J SS. 5 /95 !I6ovE Permit No. 201 70 / Disapproved h ' \� ' Date (Signed) Date Date / /�G. � 19 F7 No. 7QC Streeter 910 1/ P7/ o S`' Co cRE f9 T,2 57 Roof Covering The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligatons 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 subcontractors, on work to he performed under this permit. as are licensed by Miami Shores Village. Remarks (Signed) Read. Sworn to and Subscribed before me. Notary Public. State of Florida STATE OF FLORIDA COUNTY OF DADE. Before me, the undersigned authority. a notary public. duly authorized to administer oaths and take acknowledgments. personally appeared 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 foregoing application, and that he did sign the same. and that all facts therein by him stated are true. Building Inspector My Commission Expires PLANNING BOARD DATE Chairman Member Member Member Member Member Council Approved Date Disapproved Date NOTE: A charge of $25.00 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 $25.00 will be charged when such re- inspection is made necessary by improper notice for inspection or faulty materials and-or workmanship. M i _ _4.44 cog e4 rA _4/ flit. 1 40 , 1 4.. SPAN) 3t - ()cs � GA TG IS 3a L IDE F GM 6 t?cvcv i R 01 WI t= 1 - /niGE . F6NGr✓ W► A'rc6-( 6-No 5i /0 e FEJvcE Btri 1 arm2��2. • • �.r Tv -, ', i / ` ' r tvoaD FE�JG 0 Kind of Insurance Policy No. Expiration Date Limits of Liability Bodily Injury Property Damage (a) Automobile Liability $ each person $ each accident $ each accident Manufacturers' & (b) Public ctors' Liability C30533 3/23/56 $ 10p000. each person $ 20 . each accident $ 1 • each accident $10 000 ® aggregate Contractors' Protective (c) Public Liability $ each person $ each accident $ each accident $ aggregate (d) Workmen's campen_ sation U 9925 3/23/56 States for which coverage is afforded: Statuatory (e) (f) (9) Description of Operations Location Building No0®C.. Miami Shores, Florida Carpentry N.O.C. AZ_ la Lia tat C01013124441 o/ �� P CERTIFICATE OF I NSURANCE This is to certify that the below described policies of insurance issued by this Company are in force as of date hereof. In the event of cancellation, the Company will give to the principal named below d written notice prior to cancellation. If the number of days is not stated above, then the maximum period of notice sF be five (5) days. 1. Certificate issued to Village of Miami Shores, Florida (Principal) 2. Address of Principal Miami Shores, Dade County, Florida 3. Policy issued to Ho R. Roberts (Insured) 4. Address of Insured 3314 NW la.t Avenue, Miami, Florida 5. Policies in Force: Form G -13-XK AMERICAN CASUALTY CO By R4 Date March 23, 1955 READING, PENNSYLVANIA ENCY, I➢" (Authorized Representati STATE OF FLORIDA) SS COUNTY OF DADE ) A F F I D A V I T H. R. ROBERTS of the Village of Miami Shores, County of Dade and State of Florida, being duly sworn, doth depose and say, that under the provisions of Ordinance No. 185, dated June 15, 1948, amending paragraph (d) of Section B -368 of Ordinance No. 97 of the Building Code of Miami Shores Village, he desires to build a one -story dwelling on Lot 9 Block bpi of MIAMI SHORES SECTION 3 Subdivision, that he is the owner of said property, and will be the owner of said dwelling , that he 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 of the Planning Board and the Building Inspector. 2. Apply for and secure a Permit. 3. Pay the required fees. 4. Execute the work in accordance with the provisions of this Code. 5. Apply for inspections. 6. File with the Building Inspector certificates that provision has been made to carry the necessary Workmen's Compensation, Public Liability and Property Damage Insurance. 7. File with the Building Inspector as the job progresses certificates showing 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 other than properly licensed contractors by Miami Shores Village for any part or portion of the work. 9. Not set himself up as a "contractor ". 10. Sign an affidavit before commencing work to the effect that he has read this Article and will do the work personally and observe all of the requirements of the Building, Electrical, Plumbing and Zoning Codes of Miami Shores Village. Such affidavit to be properly notarized upon blanks to be supplied by the Building Inspector. 11. In order to prevent abuses and subterfuge the right of such owner- builder as herein provided, is limited to but one owner- builder permit each 2 years, and where an owner - builder has once exercized the privilege herein conferred no second application for owner - builder permit shall be granted in less than 2 years, unless the applicant is qualified as a licensed General Contractor under the applicable Ordinances of said Village. And Further this Deponent says not: SUBSCRIBED AND SWORN TO BEFORE ME this ,4 day of 195,5' >97 NOTARY PUBLIC Notary Public, State of Florida qt tgitfAi My commission expires April 9, 19 I`, Bonded by American Surety Co, 0f Ids y, A.D. APPLICATION FOR BUILDING PERMIT Application is hereby made for the approval 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. L & I Date Owner's Name and Address U Disapproved e _ (Signed) LO Y` MIAMI SHORES VILL GE BUILDING INSPECTION DEPARTMENT Registered Architect and /or Engineer and address of licensed contractor_. ......... 0 ill I /„ J.F Name Location and legal description of lot to be built on: Lot__ '7 Block .$ Subdivision Pre- Street and Number where work is to be done 1 0 0 State work to be done and purpose of building (by floors) Estimated Total cost of improvements $ / ,7- © d Zone cubage required Distance to next nearest building__. Maximum live load to be borne by each floor.__ and for no other purpose. New Building , Remodeling Addition �__ / Repairs No. of Stories To be constructed of C' /1, 5 Kind of foundation. _arri- '` ",' ! d XtG Roof Covering 7_. /f 1. Amount of Permit $ .Plan Cubage____ Size of Building Lot I hereby submit all the plans and specifications for said building. All notices with reference to be sent to__.- _ the build' 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 subcJ, actors, on work to be performed under this permit, as are licensed by Miami Shores Village. - Remarks - (Signe 0 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 foregoing application, and that he did sign the same, and that all facts therein by him stated are true. � Permit No 1__l_. a Z Date__._.. 6- `S _. _ Read, Sworn to and Subscribed before me. Notary Public, State of Florida Building Inspector My Commission Expires__ __ ( 7 _ di 19 Street.___/ 1 . q,6 i�S'cgnstruction may PLAN G 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. p BUILDING ELECTRICAL ❑ PERMIT PLUMBING ROOFING ❑ Owner of Building Architect Contractor or Builder Legal Description Lot CONTRACTOR OR BUILDER Address of � Building Bl. MIAMI SHORES VILLAGE. FLORIDA DATF is ,Contractor's License No ' 195 ," Work to be performed under this Permit vision _ Sq. Ft V I ie of Project $ 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 plans or drawings or in the statements or "specifications and that he assumes responsibility for work done by his agents, servants or employees. _ ,7 Signed• ,' , s' f C K BY INSPECTOR 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 responsibility for all work done by either, myself, my agent, servant or employee. BY f' fl t e Amt. of Permit $ AUTHORITY = i 7 1.TILDING -LECTRICAL 'LUMBING LOOFING MIAMI SHORES VILLAGE. FLORIDA ❑ DATF 195 ❑ PERMIT N° 4430 Contractor's License No. ❑ Work to be performed under this Permit Owner of , wilding g, ; t . Architect Contractor or Builder Legal Lot Description 131. Address of Building o O Subdi- vision -' Value of Project $ Amount of Permit $ This permit is granted to the contractor or builder named above to construc 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 plans or drawings or in the statements or specifications and that he assumes responsibility for work done by his agents, servants or employees. Signed' _ / BY INSPECTOR 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 ac- cepting this permit I assume responsibility for all work done by either, myself, my agent, servant or employee. CONTRACTOR OR BUILDER BY AUTHORITY ep UILDING LECTRICAL LUMBING 'weer of uilding rchitect ontractor Builder egal Lot BL escription ddress of Aiding 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 appli- tion herefor in strict compliance with all ordinances pertaining thereto and w th the understanding that the work will be performed in compliance with any ans, drawings, statements or specifications that may have been submitted to and approved by the proper municipal authorities. This Permit may be revoked 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 :rmit is granted is the understanding that the contractor or builder named above assumes the responsibility for a thorough knowledge of the ordinances and " gulations pertaining to the work covered hereby whether shown on the plans or drawings or in the statements or specifications and that he assumes respon- ,ility for work done by his agents, servants or employees. CONTRACTOR' OR BUILDER MIAMI SHORES VILLAGE, FLORIDA DATE PERMIT N° 8603 Work to be performed under this Permit Subdi- vision Value of Project BY AUTHORITY Amt. of Permit 194.__ Contractor's License No. Signed: By INSPECTOR 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 rtaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. accepting this permit I assume responsibility for all work done by either myself, my agent, servant or employee. Owner's Name and AddressT!d Lo Disapproved CP- (Signed) Chainnan Member Member _ Council Approved Building Inspector MIAMI SIADRES VILLASE BI ' DING INSPECTION DEPARTMENT APPUrr TO N FOR 8 UllDNt PERMOT 0 Application is hereby made for the pproyal 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. Registered Architect and/or Engineer Name and address of licensed contractor_ At Location and legal description of lot to be built on: Lot Block Subdivision Street and Number where work is to be done 1 c "' • E- 4 rp c_.e, - State work to be done and purpose of building (by floors) --- 4- " and for no other purpose. New Building Remodeling Addition Repairs_ No. of Stories To be constructed of Kind of foundation Roof Covering Estimated Total cost of improvements $ C2 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 foi said building. All notiqes yjth reference to the building and its construction may be sent to._ The undersigned applicant for this building permit dois 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 subcontract , on work to be performed under this permit, as are licensed by Miami Shores Village. Remarks._ ....... (Signed) STATE OF FLORIDA, COUNTY OF DADE. ss. Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally ap- peared Date Date , 19 1 - Le. No 1 Street 14.E. "feaD 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 - _____ Date — L. -7 Read, Sworn to and Subscribed before me. to me well known, Notary Public, State of Florida My Commission Expires. PLA NING BOARD DATE Member Member Member Date Disapproved .......... Date NOTE: A charge of $1.00 will be made for making corrections or changes to this application after approval has b. obtained from the Planning Board. A re-inspection fee of 51.00 will be charged when such re-inspection is made necessary by improper no for ins; ion or faulty materials and/or workmanship. Owner's Name and Address._ Registered Architect and /or Engineer Name and address of licensed contractor -s 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 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 S No ,/d Street ° tL. • Location and legal description of lot to be built on: Lot Block Subdivision Street and Number where work is to be done State work to be done and purpose of building (by floors) and for no other purpose. New Building Remodeling. Addition Repairs No. of Stories To be constructed of Kind of foundation Roof Covering 6� ' Estimated Total cost of improvements $ ,,/G - !" .; • Amount of Permit $ Zone cubage required plan Cubage Distance to next nearest building Size of Building Lot Maximuin 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 pennit does hereby certify that he understands and accepts his obligations as an employer of labor under the Florida Workmen's Compensation Act, being Section 5968, 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 performed under this permit, as are licensed by Miami Shores Village. Remarks (Signed) STATE OF FLORIDA, COUNTY OF DADE. 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 foregoing application, and that he did sign the same, and that all facts therein by him stated are e. Permit No YJ Date ,°a.°‘, Read, Sworn to and Subscribed before me. Date Disapproved Notary Public, State of Florida (Signed) Building Inspector My Commission Expires 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. 1 ate re- inspection fee of $1,00 will be charged when such re- inspection is made necessary by improper notice for inspection or faulty rials and /or workmanship. INSPECTIONS DATE BY INSPECTIONS DATE BY FOUNDATION I BY ROOF SEPTIC TANK RANGE CONN. BEAMS & LINTELS I POOL SEWER MOTORS FRAMING I $ AIR COND. FIXTURES FINAL GAS SEWER CLEAN UP $ ?6,9 AI is. s - Dui SLAB , t SEPTIC TANK SLAB FIXTURES & FINAL SOLAR HEATER SPECIALS PERMITS PERMIT NO. DATE FEE TEMPORARY SERVICE RE - INSPECT BY $ SEPTIC TANK RANGE CONN. ROUGHING $ SEWER MOTORS TUB & TOP OUT $ SOLAR HEATER FIXTURES $ GAS SEWER $ ?6,9 AI is. s - Dui 1 a 11 , t INSPECTIONS DATE BY RE- INSPECT BY RE - INSPECT BY ROUGHING I $ RANGE CONN. ROUGHING $ MOTORS TUB & TOP OUT H. W. HEATER CONN S FIXTURES S SEWER S SEPTIC TANK FIXTURES & FINAL SOLAR HEATER FIXTURES GAS SPECIAL PERMITS PERMIT NO. DATE I FEE TEMPORARY SERVICE RE- INSPECT BY I $ H. W. HEATER CONN. I $ RANGE CONN. ROUGHING $ MOTORS H. W. HEATER CONN S FIXTURES S S INSPECTIONS DATE BY RE- INSPECT BY RE- INSPECT BY TEMP. SERVICE ROUGHING H. W. HEATER CONN RANGE CONN. FIXTURES & FINAL r PLUMBING CONTRACTOR L ". r e f I`��'1 PERMIT NO. NEW BLDG. PERMIT NO. NEW BLDG. BUILDING INSPECTIONS ALTERATION CONTRACTOR I- ,b. -- EC,i c- 7 �L .. _ t 1 Z Ge..- I DATE C 0.-13 - / S 1 ALTERATION I ADDITION APPROVAL TO POWER CO. FOR SERVICE DATE PERMITS & INSPECTIONS I PHONE DATE 3— 4 FEE $ I ADDITION REPAIRS ELECTRICAL PERMITS & INSPECTIONS PHONE - FEE $ ( 0- REPAIRS BY OWNER'S NAME H Z4 G h1E (a> e .( _ PRESENT ADDRESS ?c o rJ - El . /Co ` Jr- I LICENSE NO. PHONE NO. JOB LOCATION (ST. OR AVE.) ' 7 4 =' (=> 14 - ._ 1C� fY, q LOT 1 BLOCK CS' SUBDIVISION 1 /y7•.irrn d / r -S # GENERAL CONTRACTOR c—'n i3.a. (lei ADDRESS PHONE NO. LICENSE NO. BUILDING PERMIT NO. 2 _1 DAT �_ a ("4:3. O° P ERMIT FEE $ 1 f — BUILDER•S BOND NO. ` DATE AOtieTrvw ZONE REQUIREMENTS CU. FT. PLAN CUBE " a"? ( CU. FT. J EST. COST $ f 2 c , - // ^^j� DRAWINGS. SPECIFICATIONS, RESTRICTIONS AND CUBE CHECKED BY: y _ _ - r`�� DAT= / (p�� �°� NEW CONSTRUCTION TYPE I STORIES I /J ROOF CONSTRUCTION INTERIOR CONSTRUCTION REPAIRS DESCRIPTION ALTERATION • (�J DESCRIPTION ( e "J Ft a_ : -t om - � E,bL S. 1 (3 O 17 3190 �om ( 1 71- 3-='. ..- ADDITION SUBMITTED TO PLANNING BOARD APPROVED REJECTED REFERRED TO COUNCIL REASONS RE- SUBMITTED TO PLANNING BOARD $UBMITTFD TO VILLAGE COUNCIL Se-a_ �0J r\ 13,E-MARKS 'C/Z' d_11 sit ���S --- Es'►'- L..)..,-,(2_ 1 >- CERTIFICATE OF OCCUPANCY NO. I ISSUED BY TO BUILDING PERMIT AND INSPECTION RECORD —MIAMI SHORES VILLAGE OWNER'S NAME /dim. 4-,uo me acs.✓ Ic2(f � en,e PRESENT ADDRESS (' 7o0 /4- c,s LICENSE NO. PONE NO. JOB LOCATION (ST. OR AVE.) 7o m Al. L � e ,ft LOT 5' BLOCK 6 K SUBDIVISION i, ,9,...„ ,' 377 GENERAL CONTRACTOR ALTERATION ADDRESS PHONE NO. LICENSE NO. SUBMITTED TO PLANNING BOARD f/�i/ BUILDING PERMIT NO. O '+ Q7 ` � / / . DATE � "� 3 / ��/p �- PERMIT FEE $ BUILDER'S BOND NO. DATE ZONE REQUIREMENTS CU. FT. 7.-/- L'a— ' -._ - - / /G o PLAN CUBE z3 z J CU. FT. / EST. COST $ ( ©a s o CJ DRAWINGS. SPECIFICATIONS. RESTRICTIONS AND CUBE CHECKED BY: BUILDING PERMIT AND INSPECTION RECORD -MIAMI SHORES VILLAGE `7 -2_ DAT= ' NEW CONSTRUCTION TYPE S STORIES c,r-16 ROOF CONSTRUCTION : < ` 7 '%' INTERIOR CONSTRUCTION 497 t75 � i .. REPAIRS DESCRIPTION ALTERATION DESCRIPTION ADDITION SUBMITTED TO PLANNING BOARD APPROVED REJECTED REFERRED TO COUNCIL REASONS RE- SUBMITTED TO PLANNING BOARD - • SUBMITTED TO VILLAGF COUNCIL REMARKS y6 CERTIFICATE OF OCCUPANCY NO. , 2 S °( ISSUED / , ,� / 6a S e BY s cep e-‘-' /Se G TO DRAWINGS. SPECIFICATIONS. RESTRICTIONS AND CUBE CHECKED BY: BUILDING PERMIT AND INSPECTION RECORD -MIAMI SHORES VILLAGE `7 -2_ DAT= ' INSPECTIONS DATE BY INSPECTIONS DATE BY FOUNDATION S SEPTIC TANK ROOF TEMPORARY SERVICE S BEAMS & LINTELS S H. W. HEATER CONN. POOL SOLAR HEATER S FRAMING S GAS AIR COND. MOTORS S FINAL S FIXTURES CLEAN UP INSPECTIONS DATE SLAB RE- INSPECT BY RE- INSPECT BY ROUGHING SLAB SPECIALS PERMITS PERMIT NO. DATE FEE TEMPORARY SERVICE REPAIRS SPECIAL PERMITS S SEPTIC TANK FEE TEMPORARY SERVICE S SEWER S H. W. HEATER CONN. S SOLAR HEATER S RANGE CONN. S GAS S MOTORS S S FIXTURES S INSPECTIONS DATE BY RE- INSPECT BY RE- INSPECT BY ROUGHING TUB & TOP OUT SEWER SEPTIC TANK SOLAR HEATER FIXTURES GAS CONTRACTOR PHONE PERMIT NO. 1 DATE FEE S NEW BLDG. 1 ALTERATION I ADDITION REPAIRS SPECIAL PERMITS PERMIT NO. DATE FEE TEMPORARY SERVICE S H. W. HEATER CONN. H. W. HEATER CONN S RANGE CONN. S MOTORS S FIXTURES S S INSPECTIONS DATE BY RE- INSPECT BY RE- INSPECT BY TEMP. SERVICE ROUGHING H. W. HEATER CONN RANGE CONN. FIXTURES & FINAL 1/4 -t 5 CONTRACTOR PERMIT NO. NEW BLDG. BUILDING INSPECTIONS 4 ' PLUMBING PERMITS & INSPECTIONS DATE ALTERATION ELECTRICAL PERMITS & INSPECTIONS APPROVAL TO POWER CO. FOR SERVICE DATE ADDITION PHONE FEE S REPAI RS BY CERTIFICATE OF OCCUPANCY MIAMI SHORES VILLAGE, FLORIDA BUILDING DIVISION ■9 961 Miami Shores Village, Florida, 7 - - Owner, Agent or Tenant of Building BLANE WILLENBORG Lot 9 Block 6 9, Subdivision Miami Shores Street Address 700 N.E. 96th St. Approved use by occupancy ITti 1 ity Room Addition Remarks• 8886 This Certificate of Occupancy is issued to the above named OWNER for building at above named location only upon the express provision that the applicant will abide by and comply with all conditions of Ordinances Nos. 92, 93, 94 and 97, known as the Zoning, Electrical, Plumbing and Building Ordinances of Miami Shores Village pertaining to the erection, construction, alteration or remodeling of buildings or structures. Plan Cube 2320 Tax Value 1160 BUILDING DIVISION OWNER'S NAME P PRESENT ADDRESS L LICENSE NO. P PHONE NO. JOB LOCATION (ST. OR AVE.) L LOT B BLOCK S SUBDIVISION GENERAL CONTRACTOR A ADDRESS P PHONE NO. L LICENSE NO. 1� DATE 2 ..29 -55 P PERMIT FEE $ 19.00 N BUILDER•S BOND ZONE REQUIREMENTS CU. FT. P PLAN CUBE 20,077 plus C59 irAA FOR Ga. 15,0( C 11 0 BUILDING f#ERMIT AND INSPEC {ION REGORD -MIAMI SHORES VILLAGE 0 INSPECTIONS DATE BY RE- INSPECT BY RE- INSPECT BY FOUNDATION PERMIT NO. DATE FEE TEMPORARY SERVICE ` $ BEAMS & LINTELS • ,./ " E- f'•,ii '`Z+ "• i a ,s'' $ SEWER FRAMING - tea• f. • $ $ GAS / A _/ �r N Y` �/7�// /' /� /'y^J' 0I $ INSPECTIONS FINAL A y �� ; RE- INSPECT BY RE- INSPECT BY CLEAN -UP .. a ROUGHING l" CONTRACTOR if ] PHONE PERMIT NO. -) DATE / ` „ ` ", FEE $ / - C' � . NEW BLDG. I ALTERATION ADDITION REPAIRS SPECIAL PERMITS PERMIT NO. DATE FEE TEMPORARY SERVICE ` $ $ SEPTIC TANK $ $ SEWER $ $ SOLAR HEATER • $ $ GAS $ $ $ INSPECTIONS INSPECTIONS DATE ,/BY . RE- INSPECT BY RE- INSPECT BY ROUGHING 1 I I p )0 ROUGHING l" GAS P 4 } L' 1 G 4' ' r 1 rt P a -• t, H. W. HEATER CONN SEWER RANGE CONN. SEPTIC TANK SOLAR HEATER FI - L'RFg & FINAL FIXTURES j ' . CONTRACTOR Sx (i ,/.. PHONE PERMIT NO. / 72� DATE "/0 w�_ FEE$ j...57('''' NEW BLDG. I ALTERATION ADDITION REPAIRS SPECIAL PERMITS PERMIT NO. DATE FEE TEMPORARYSERVICE - - - -� ` $ H. W. HEATER CONN. $ RANGE CONN. $ MOTORS • $ FIXTURES $ $ INSPECTIONS DATE BY RE- INSPECT BY RE- INSPECT BY TEMP. SERVICE ROUGHING l" Cv ‘.6): H. W. HEATER CONN RANGE CONN. FI - L'RFg & FINAL 6,///,, j ' . ,BUILDING INSPECTIONS - , PLUMBING PERMITS & INSPECTIONS ELECTRICAL PERMITS & INSPECTIONS APPROVAL TO POWER CO. FOR SERVICE DATE CERTIFICATE OF OCCUPANCY MIAMI SHORES VILLAGE, FLORIDA BUILDING DIVISION N? 179 Owner, Agent or Tenant of Building Miami Shores Village, Florida, Lot 9 Block— _ Subdivision � = < _. • 3 Street Address ' TA ° q( suA_49f4,!-' Approved use by occupancy 1 Zi? -,,,t- -4141 A' n V \ Remarks • This Certificate of Occupancy is issued to the above named building at above named location only upon the express provision that the applicant will abide by and comply with all conditions of Ordinances Nos. 92, 93, 94 and 97, known as the Zoning, Electrical, Plumbing and Building Ordinances of Miami Shores Village pertaining to the erection, construction, alteration, or remodel'ng of buildings or structures. BUILDING DIVISION Application is hereby made for the approval 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 a' building during progress of the work. Owner's Name and Address..... • %6 Registered Architect and /or Engineer.._ - -0 % e2 _ t1 7 Name and address of licensed contractor (— '2t1- " Location and legal description of lot to be built on: Lot Block _.i Subdivision_._f�l I -it Street and Number where work is to be done e ,_e- State work to be done and purpose of building (by floors) C Z•: (Signed) .. +� Building Inspector MIAMI SHORES VILLAGE BUILDING INSPECTION DEPARTMENT APPLICATION FOR BUILDING PERMIT Remarks (Signed) Disapproved Date Date /, y/ ,19—� No._ f,Y Street L( r _,g- / cD and for no other purpose. New Building Remodeling Addition Repairs No. of Stories To be constructed of Kind of foundation Roo Covering Estimated Total cost of improvements $ Amount of Permit $ 9 r Zone cubage required Plan Cubage •O 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 oflabor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida, Permanent Supl)lement, 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 performed under this permit, as are licensed by Miami Shores Village. Permit No H Date r S Read, Sworn to and Subscribed before me. Notary Public, State of Florida / % 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 Ile has carefully read the foregoing application, and that he did sign the same, and that all facts therein by him stated a true. My Commission Expires PLANNING BOARD DATE Chainnan 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 beet' obtained from the Planning Board. A re- inspection fee of $1.00 will be charged when such re- inspection is made necessary by improper notice for inspection or faulty materials and /or workmanship. 7 / ^ THIS LICENSE MUST BE DISPLAYED IN A CONSPICUOUS PLACE A PENALTY IS IMPOSED FOR FAILURE TO KEEP THIS LICENSE EXHIBITED AT YOUR ESTABLISHMENT OR PLACE OF BUSINESS Village THIS LICENSE EXPIRES 19 In consideration of the sum of PajtUe -Miami Shores Village, Dade County, State of Florida, is hereby licensed to engage in or operate the business of Date Issued a " MSV 1954 License B N° 593 Dollars ($ �y MIAMI SHORES VILLAGE, FLORIDA THIS LICENSE NOT TRANSFERABLE WITHOUT THE APPROVAL OF THE VILLAGE MANAGER. 64080 Application is hereby made for the approval 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. Owner's Name and Address . .(%/ /- L IN , i O (' 6 Registered Architect and /or Engineer Name and address of licensed contractor Location and legal description of lot to be built on: Lot 7 Block ;r?. _ Street and Number where work is to be done Q 1.Y & 71C _57 State work to be done and purpose of building (by floors) Permit No Disapproved (Signed) _.. MIAMI SHORES VILLAGE BUILDING INSPECTION DEPARTMENT APPLICATION FOR BUILDING PERMIT c /-/017/!/$ Subdivision..._. - . - ` 3 Date D4 /t /D t'( (),z_ ` , 19._.5`7 No 1. 7 0 Street 4 .3 .-6 W J /7A t' and for no other purpose. New Building Remodeling Addition '- Repairs No. of Stories To be constructed of Kind of foundjIion Roof t:gvering U y r _' /- �j` Estimated Total cost of improvements $ / 0 Amount of Permit $ Zone cubage 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 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 subcontractors, on work to be performed under this permit, as are licensed by Miami Shores Village. rC Remarks ( Signed ) A) STATE OF FLORIDA, COUNTY OF DADE. 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 foregoing application, and that he did sign the same, and that all facts therein by him stated� t�u� Date Read, Sworn to and Subscribed before me. Date Building Inspectors My Commission Expires Notary Public, State of Florida 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. PROPERTY OWNER Name 4 - - d j 1 S 4.( T L E &) C/- e//5 7 Address G 0 o _ 1 • E 02 cc, 51-- 3c.)s 75" CD— Co Co 1 Home Telephone 3v5 - 7 5 - 6 _5 6 6 Business Telephone Fax -b s'` 7 s 9/ 77 TYPE OF MANAGEMENT (✓ ) New Construction Enclosure Alteration Exterior Repair Alteration Interior Demolish Relocation of Structure Shell Only Foundation Only Add'I Attachment Other Add'I Detachment Other INSTRUCTIONS - The following steps must be taken to obtain a permit from the Miami Shores Village: Step 1. Complete the attached permit application which must be signed by the property owner and qualifier. Both signatures must be notarized. Please print or type to allow for a more accurate processing of your application. If roofing work will be done, a roofing application must be submit- ted along with this permit application. Step 2. Submit the completed application with all necessary documents to the Building, Planning and Zoning Department for processing. During the processing of your application, you may be asked to submit additional information. APPLICATION >( Address: to 0 N . <: • co Address Apt Folio Number Lot Block _ e ctT/ Subdivision PB PG Zoning Current Use of Property Square Feet Units Floors Proposed Use of Property Value of Work O 0 Bldg Value Tenant Information Tax Assessed/Appraised Value Flood Zone Base Floor Elev. PERMIT TYPE (✓ ) Building Electrical Mechanical Plumbing LPGX Roofing Fence Other PERMIT CHANGE (✓ ) Chg. Contractor Renewal Revision Extension Supplement Reinspection ARCHITECT Name License No. Address Telephone Fax ( ( Pi l S r,I-a r- S I F= C City State escription of Work Master Permit No. Subsidiary Permit No. PERMIT APPLICATION 3 3 Zip Y Q EP 9-f (z a.) 5 L ) Linear Feet ENGINEER Name License No. Address Telephone Fax CONTRACTOR Name License No. Address Telephone Fax Qualifier Name Page 2 111POR'I'N'I' NoTI('I:S DO NOT BEGIN ANY WORK WITHOUT HAVING RECEIVED YOUR VALIDATED PERMIT AND PERMIT CARD. Applying for a permit does not grant the right to begin construction. HOURS OF CONSTRUCTION are limited to: Monday through Friday from 7:30 a.m. to 6:00 p.m., and Saturday from 8:00 a.m. to 5:00 p.m. No inspections will be conducted on weekends or holidays. 2. All construction of demolition areas MUST BE MAINTAINED IN A CLEAN, NEAT AND SANITARY CONDITION free from construction debris. 3. STREETS AND NEIGHBORING PROPERTIES SHALL BE KEPT FREE FROM DIRT AND DEBRIS. 4. SWALES MUST BE PROTECTED FROM BEING DAMAGED BY EQUIPMENT OR VEHICLES AND MAY NOT BE USED FOR STORAGE. A bond is required for work in or near the street/sidewalk. 5. CONSTRUCTION TRAILERS ARE PROHIBITED ON SINGLE FAMILY RESIDENTIAL CONSTRUCTION SITES. Other construction may have a trailer which requires a separate permit. 6. PORTABLE TOILETS for a construction site require a separate permit. 7. DO NOT DISCHARGE WATER INTO THE RIGHT OF WAY OR STORM DRAINS without approval from the Building, Planning and Zoning Department. 8. EQUIPMENT AND MATERIALS SHALL BE STORED at least 10 feet from the edge of pavement. 9. Department of Health and Rehabilitative Services (HRS) approval is required for applications involving septic tanks. Department of Environmental Resources Management (DERM) and/or Miami -Dade Water and Sewer Department (MDWASD) approval is required for applications involving sewers. AFFI DAVIT - Please read carefully. Application is hereby made to obtain a permit to do work and installation as indicated. I, the OWNER of the property, 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, POOL, EXTERIOR DOOR, MECHANICAL, WINDOW, FENCE, DRIVEWAY, ROOFING and SIGNS and there may be additional permits required from other governmental agencies. I, the OWNER of the property, have disclosed all information related to any work at the property performed in the prior twelve months to the Building Official. Further, I am fully aware that if the cumulative cost of work to my home or business under this and any other permit equals or exceeds fifty percent (50 %) of the fair market value of the structure, the entire structure must meet the present federal flood criteria for finished floor elevation. I am also fully aware that if the total cost of work to my home or business under this and any other permit exceeds fifty percent (50 %) of the replacement cost of the structure, then the entire structure must conform to the current code requirements of the Building Code. WARNING TO OWNER: Your failure to record a NOTICE OF COMMENCEMENT may result in you paying twice for improvements to your property. If you are spending more than $2,500 or intend to obtain financing, you may wish to consult with your attorney or lender before recording your Notice of Commencement. The Notice of Commencement must be recorded at: 22 N.W. 1st Street, 1" Floor, (305) 679 -1078. Once recorded, the Notice of Commencement must be POSTED AT THE JOB SITE in accordance with Section 713 -35 of Florida Statutes. Review the brochure at Village Hall on Construction Lien Law and Choosing a Contractor. ST ORIDA, CO Y O_ MIAMI -DADE e of 'i wner 7 1.2 iv> _ Print Name �w band subscribed before me day of �e7C. ` ),l Sworn to and subscribed before me this day of Signat e of Notary Public - State of SEAL: Personally known Type of Identification Produced: Type of Identification Produced: OFFICIAL NOTARY SEAL YANET ESTEVEZ NOTARY PUBLIC STATE OF FLORIDA COMMISSION NO. CC850828 MY COMMISSION EXP. JUNE 30,2003 OFFICIAL NOTARY SEAL YANET ESTEVEZ NOTARY PUBLIC STATE OF FLORIDA COMMISSION NO. COE0828 MY COmmica'n» rvr. OR, Produced Identification STATE OF FLORIDA, COUNTY OF MIAMI - DADE Signature of Contractor / Qualifier Signature of Notary Public - State of Florida SEAL: PERMIT APPLICATION Personally known OR, Produced Identification ELECTRICAL TYPE Minimum Fee QTY. T\PL. Dryer QTY. TYPL. Outlet, Appliance QTY. TYPI', Service Repair Q'FY. A/C Central 1 -3 Ton Fan Outlet, Wall Service, Temporary A/C Central 4 -7 Ton Fire Pump Outlet, Switch Signs A/C Central 8 -15 Ton Fixture - Fluorescent Oven Space Heater (kw) A/C Central 16-20 Ton Fixture Light Parking Lot Lights Spas/Hot Tubs A/C Central 20+ Ton Flood Lights Plugmold/Strip Subfeeds, No. of Amps A/C Window FPL - Load Central Posts Swim Pool, Commercial Air Conditioners Garbage Disposal Range/Range Top Swim Pool, Residential Chiller Generators, etc. Receptacles Switchboards Clear Violations Heat Recovery Refrigerator, Comm. (p/PH) Temp Serv., Construction Compactor Low -volt, Burglar Refrigerator, Domestic Temp for Test - 30 days Deep Freezer Low -volt, Fire Renew - Temp Service Water Closet Demolition Low -volt, Intercom/Teleph. Repair Circuits Water Heater Dishwasher Low -volt, Television Service, Number of Amps Water Heater New MECHANICAL T1'Pt: Minimum Fee QTY. 'rvI'I Condensate Drain QTY. TYPE Generator QTY. 'rYi'I: Refrigeration, Tons Q'rY. A/C Central, Tons Cooling Tower Heating Strips, each Vent Hood, Cost A/C Wall/Win. Tons Dryer Vents, Number of Paint Booth Ventilation, Cost Air Handler, Tons Ductwork, Cost of Piping, Flammable Liquid Periodic Inspections Barbecue Fire Sprinkler System Process/Pressure Piping Supply, AC Well Bath Fan - Vented, # Fireplaces, Number of Pressure Vessel Temporary Toilet PLUMBING 'i' A/C Condensate ()Ty. .ry i 'i Drains, Roof QTY '11 Miscellaneous Fixture Q. I.Q. .Levi.: Soakage Pit QTY. Bath Tub Drinking Fountain Miscellaneous Repairs Solar Water Heater Bidet Filter Replace Pool Piping Sprinkler Repair Cap - Fixture Fountain Pump and Abandon Sprinkler System Cap - Water Gas - Appliance Pump, Domestic Supply, AC Well Cap - Sewer Gas - Natural Pump, Fire Stand Temporary Toilet Catch Basin Gas - Propane Pump, Re- circulate Temporary Water Closet Clothes Washer Gas Piping Pump, Replace - Pool Urinal Dental Chair Grease Trap Pump, Sprinkler Utility - Sewer Discharge Well Ice Maker Pump, Sump Utility - Water Dishwasher Indirect Wastes Relay Repair Vacuum Pump Disposal Interceptor Roof Inlet Water Closet Domestic Well Laundry Tray Septic Connection Water Heater Drainfield, 4" Tile/Res. Lavatory Septic Tank Water Heater New Drains, Area Meter Set (Gas) Sewer Connection Water Re -pipe Drains, Floor Minimum Fee Shower Water Service Drains, French Miscellaneous Equipment Sink Well, Supply Page 3 PERMIT APPLICATION INSTRUCTIONS: Please indicate the type of work being performed and quantity(ies) in the space provided below. RECEIVED AND REVIEWED BY: DATE: SECTION BY D TE Zoning a, ! die —A7 ?O< Electrical Mechanical Plumbing Fire Public Works Structural Building Official Ca g Z� z Page 4 OFFICE USE ONLY CIIECKL1 ❑ OWNER - BUILDER FORM (Attach) ❑ FIRE DEPARTMENT APPROVAL (Commercial / multi - family) ❑ CONCURRENCY (New Construction) ❑ OTHER (Specify & Attach) $3.00 per page (Scanning Fee) Miami Shores Village Bond Inspector State Educational Fund $ State DCA (Radon) $ Code Enforcement Fine Zoning Review Notary ❑ PROOF OF OWNERSHIP (Attach) ❑ HRS / DERM APPROVAL (Septic / Sewer) ❑ IMPACT FEE (New Construction) ❑ OTHER (Specify & Attach) l'ER\II'I' FEES Metropolitan Dade County (C.C.F.) $ C ( sq.ft. = x/1000 x0.60) tr (¢.005 /sq.ft.) (0.01 / sq.ft.) PERMIT APPLICATION ❑ CONDO ASSOCIATION APPROVAL (Attach) ❑ BPR APPROVAL (Restaurants) ❑ CONTRACTOR REGISTRATION (On File) TOTAL $ ‘°, b 0 ISSUING OFFICIAL REVIEWED AND PREPARED BY: DATE: CONDITION OFAPPROVAL Revised July 2001 10050 N.E. 2ND AVE., MIAMI SHORES, FL • (305) 795 -2207 • FAX (305) 756 -8972 • http : / /www.miamishoresvillage.com NOTES Miami Shores Village 10050 NE 2nd Avenue Phone: 305- 795 -2204 Permit Number: BP2002 -1505 Printed: 8/27/2002 Applicant: LOIS BUTLER Owner: BUTLER LOIS JOB ADDRESS: 700 NE 96 ST Contractor Local Phone: Parcel # 1132060142110 vem-14_(J 4 6°' (� l� 6o , ) Total Fees: $@-6A- Total Receipts: $0.00 Permit Status: Approved Permit Expiration: 2/23 /2003 Construction Value: Work: EMERGENGY REPAIR (2) 5 1/2 X 5 ' EXISITNG GATES & 4 X 5 WALL (WOOD) If there is no permit package accessible on the job -site for inspectors to verify, there will be no inspections. Re- inspection fee is $50.00, which must be paid in advance before calling for another inspection. DUDLEY R. WELLS LOIS HOPKIN WELLS 700 NE 96TH ST. MIAMI, EL 33138 -2520 PAY TO THE i _ _ _ w •`' _ �' '-`. —' ORDER OF DOLLARS et ed W! Was Ington Mutual P L A T I N U M C U S T O M E R 1 4 Waslungu n Mutual Bank, FA • Miami Shores Financial Center 1722 9640 NE. 2n4 Avenue Miami Shores, FL 33138 1 -8O0- 768.7000 34 nau Custmner e44414e -1:267084 1 3 1':3q3 131 1 S60371 DATE g 0 63- 8413/2670 3931560375 Building Permit Contractor's Address: 154 Page 1 of 1 Legal Description: MIAMI SHORES SEC 3 PB 10 -37 LOT 9 BLK 68 LOT SIZE SITE VALUE $300.00 ie equipment or device described in the application herefor in strict compliance with all Arith any plans, drawings, statements or specifications that may have been submitted to not done in compliance with such ordinances or if the plans are changed without :tor or builder named above assumes the responsibility for a thorough knowledge of the lgs or in the statements or specifications and that he assumes responsibility for work done compliance with all ordinances and regulations pertaining thereto and in strict conformity es Village. In accepting this permit I assume responisibility for all work done by either BY: BY: This property described as Lot 9 . Block 68 . MIAMI SHORES SECTION NO. 3, according to the Plat thereof, as recorded in Plat Book 10 . Page 37 of the Pubttc Records of Dade County, Florida. FLOOD ZONE: X NOT EIeva4 on $hoyrrt fe4sres3 4o N,,•.i,o,i !Aeon Sea leJel• Butler. kohprt Pk; 111 kIl • c)1 • Loi H., N V/' .LID_ UPI Et∎Vi ) ^ .7' 1 E2ORS'♦ SEAb. Alin. tech. standard :ret ``firth by t11E 13u. Cry - Survo pursuant to �'• ‘4 po s r-_6 a4 -0cZ(2 (6 codvc I r n ri ec( I 1 d i 4 7 1{ I _ / / / qt fib' ( '` ' � L HE wEh CAP ft ', thaI 1 VP. epresented hereon 'pets ihP mini m,.m requlreTents adopted nv the FSPl S and the rl T * and th•■• are sr' PrICroaChmen l4 over �dUS Pas.mPnis apoPannq „n the US A! easPnnPnls pthPr than as otoo,W, hereon sir L keg or No 2243 v R �- {�f-► �Cr S q-i ,\ r-.0 G Certified To: Enterprise Title, Ltd., Attorneys' Title Insurance Fund, Inc., Butler, Robert S. Jr. a• Lois H. a Barnett $ank Of South Florida, N.A., its successors and /or assigns. 5 ' e5 r ud 1 -23 -91 "Recertified ", Certified o I -1 H p4 dd E IEVArIo ar1d Name 2evi .and- Floo Zone a • • rP• I cf, 1 - 25 - 91 "Names' revised. .1 .. • Vii. IG1/• •S M Kam? .ps:.., c F104,FL.EIEV• • • �+ 41 A I,., R `t Sec. 472 .027, F Rog E ngnvvr Nn DATE I SCALE r • . (, • 4i .9' gwev( ( cs Anse 4 cats- 0 'L2.3c: yi 700 N.E. 96th Street, Miami Shores, Ardamorrimmormar Florida. LANNES and GARCIA, INC. E.N(,INI 1 RS LAND SURVEYORS LAND Pl. ANNE RS P C.) B t Sr, I ; 31 Miami, FIntIda 33156 DRAWN BY �`,�� �1 • 1 DRW 182 -3498 191 -638 STATE OF FLORIDA) COUNTY OF DADE) The undersigned Affiant, attached survey, performed by performed on 1 g, (date of survey) 1 1' /wont, - Jhoreo UL-tt 5 or"k-�i2 —, d oes h e reby attest that the (property owner) /�— (name of surveyor's company) , is an accurate representation of the existing conditions an locations of all structures on the property as of this date. The purpose of this Affidavit is to induce Miami Shores Village to issue a building permit for the property without first providing a survey less than six (6) months old. The Affiant, as property owner, further • agrees to remove or obtain permits for any structures which now may exist on the property which •are not . permitted or which may violate zoning or building code regulations. The Affiant further understands that the existence of any such structures may affect final inspections as applicable to this or other permits.. Further, Affiant sayeth naught. SWORN TO AND SUBSCRIBED before me this 22- d b a y of 7 , 2002_, . AFFIDAVIT LS • a ' tf?rope ovine Witness(sign and pr t) Affiant is personally known to me, y produced as identification. YANET ESTEVEZ NOTARY PUBLIC STATE OF FLORIDA COMMISSION NO. CC850828 MY COMMISSION EXP. NE 30 Application is hereby mode for the approval of the detailed statement or Isle 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, Florid.r. 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 wish, whether herein specified or not. A copy of approved plans and specifications must be kept at building during progress of the work. Ow-ncr's Name and Address . / 3( .• 17-1-- E ' = . ! Registered Architect and /or Engineer .......... 4 Name and address of licensed contractor 546 F Location and legal description of lot to be built on: Lot Block 6 .. Subdivision Street and Number where work is to be done 4H9 E 4 l�f ` State work to be done and purpose of building (by floors) _...rte' V. .T../ C ./ ... kt' ° . 1�. �'l G E T2 ............ ./.. . c : ...... Vda..12 ,f# O _..__ and for no other purpose. Ncw Building Remodeling Addition ......X Repairs; No. of Stories /?,- /'i'uL= ���L LTG To be constructed of ovr/4"as Kind of foundation %10.(1?-)0 Rooff Covering Estimated Total cost of improvements $ `7 o Amount of Permit 5.... 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 budding. All notices with reference to the building and its construction may be sent to 4111 g A:S /96 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 Snpplcurent, and has complied s•ith 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 arc 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 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 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.. l Permit No.. 115-6 Date L z Read, Sworn to and Subscribed before me. Disapproved .._��....(� f Notary Public, State ' Date.._.. -- My Commission Expires Building Inspector Chairman Member Member MIAMI SHORES VILLAGE ( BUILDING INSPECTION DEPARTMENT APPLICATION FOR BUILDING PERMIT _ No. 7 � _. Street.A / `269 S-t " e. PLANNING BOARD DATE Member Member Member to me well known, Council Approved Date Disapproved Date NOTE: A charge of $1.00 will be made for making corrections or changes to this application niter approval has been obtained from the I'I.rnnir.g 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. 4 ;" Type Insp'n MIAMI SHORES VILLAGE BUILDING DEPARTMENT 305- 795 -2204 Building Inspection Request Dat Time Permit Name �u� W 6Q/`°& Address l.i 0 , e , ¶ ( Company " "`-&_ Phone # 0S- 0 S" For Inspector (3 Do\ Name & DpteA Correction Re- Insp'n Fee