785 NE 96 St (3)M OAM II SHORES VO LLA E
BUILDING INSPECTION DEPARTMENT
AfPfP0_OQ_;A11ON FOR BUOLDONG PER(MIQT
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. D It
•
r
Date.. j> /e/ /
8S
Regl6lered Architect and /or Engineer.., ., :. ....:......: .::.....: ....... .... :: ... ,..,.. ....: , ..,,:.,:.:,,- ' ..
:.. :,...
Name and address of licensed contractor.. /"t e_/Pc-fi (� (l [ _ - -- -. - t o- 6 „ 7Q2 1l E /y,.. /7' '
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
Estimated Total cost of improvements $
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 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 contr ct&s or sub - contractors employed by him
in the work to be performed under this permit; and will post or cause to be posted for inspect•r on the site . e work : , ch public notice
or notices as are required by the Act. The undersigned agrees to employ only suc .....n. 'ctors, on work � . be p ed 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
Permit No 3” r r /
Disapproved
(Signed)
Building Inspector
Date
Amount of Permit $,
Read, Sworn to and Subscribed before me.
to me well known,
Notary Public, State of Florida
My Commission Expires
PLANS G BOARD DATE
Chairman Member
Member Member
Membe: 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
tLe Pl:umirg Board.
A rc inspection fee of S1.00 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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UNITED STATES FIDEL Y AND UARANTY COMPANY
-1 , 4:
FIDELITY AND GUARANTY INSURA UNDERWRITERS,• INC.
BALTIMORE, MARYLAND
OF
INSURANCE
Name and Address To Whom Issued
Village of Miami Shores
g
10050 N. E. 2nd Avenue
Miami Shores, Florida
This b certify that the policies
• CERTIFICATE
listed below, subject to their terms,
conditions and exclusions, have
been issued by the Company dl
ignated below to the Insured named
below.
Named Insured and Address J. M. Toppa 6: Sons, Inc.
8895 N. E. 4th Avenue
Miami, Florida 33138
Type of Insurance
Policy
Number
Policy
Term
Limits of Liability
Bodily Injury Property Damage
Workmen's Compensation
J_261469
3/3/71 -72
Statutory
Employers' Liability
$ ,000
Each Person
$ ,000
Each Accident
$
Medical- Each Person
Comprehensive Automobile
Liability
$ ,000
Each Person
$ ,000
Each Occurrence
$ 3
Comprehensive General
Liability
Including
❑ Includin Blanket
Contractual Liability
$ ,000
Each Person
$ ,000
Each Occurrence
$ 3
Aggregate Operations
$ ,000
Aggregate Protective
$ 0
$ ,000
Aggregate Completed
$ 3
Operations - Products
Manufacturers and
Contractors' Liability
2C(',_ 25380
10/1/68-71 1 / 6$— 71
$ 100 ,000
Each Person
$ 300 ,000
Each Occurrence
$ 10 3
❑ Owners' , Landlords' and
Tenants' Liability
Aggregate
$ 25 )
Completed Operations and
Products Liability
$ 000
Each Person
$ ,000
Each Occurrence
$ 3
$ ,000
Aggregate
$ )
Contractual Liability
$ ,000
Each Person
$ ,000
Each Occurrence
$ )
Aggregate
$ )
Comprehensive Excess
Indemnity
$ ,000
Each Occurrence
Combined Personal
Injury and
Property Damage
$ ,000
Aggregate
Description and location of operations and automobiles covered:
Contractor -
Miami, Dade County and elsewhere in the State of Florida
-10 days prior written
The Company designated below will m xnotify the holder of this Certificate of any material
in these kuk=x
change
PI
❑
or cancellation of policies,
UNITED STATES FIDELITY AND GUARANTY COMPANY
FIDELITY AND GUARANTY INSURANCE UNDERWRITERS, INC.
G A� R IN AGENCY, INC.
Date 3 By / l•2/1_
or `G ..
4. t 1• •45i ,
Gen. 348 (1 -68) O
oµl N ic
U. S.P
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i t es ,s1
( �(�9 ter •
- SHORES VILLAGE
1„ 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 alll lesand
plans and specifications u Building kept of Miami Shores Village of the progress with, whether herein specified or not. A copy approve
Date - - a/`" l / .,192.Q
--- I ii . --
Owner's Name and Addres � -_� /j No
Registered Architect and/or b^' gineer
Name and address of licensed contractor__ . ___ — 6
Location and legal description of lot to be built on: 7 2' Y rr t
Lot C Block VI Subdivision
Street and Number where work is to be done
State work to be done and purpose of building (by floors) +1e.ti12 _ .
and for no other purpose.
New Building �%' Remodeling n Addition Repairs No. of Stories
- - - Kind of foundation_ - - 7r Roof Covering_
To be constructed of____ _ � 1 - - a -- --
®Oo Amount of Permit $-- �'- 7.-a - - -�
Estimated Total cost of improvements $__ f _did ,�
Zone cubage requrred_.___. __. _
b b • C'-6 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, Pennanent 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 inspectio - ,in the site of the work such public notice
or notices as are required by the Act. The undersigned agrees to employ only such su contrac ' , on work to be performed under this
permit, as are licensed by Miami Shores Village.
Remarks_ (Signed)
__
STATE OF FLORIDA, ss.
COUNTY OF DADE.
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.
Permit No.__
C.° rz— Date Read, Sworn to and Subscribed before me.
Disapproved Date Notary Public, State of Florida
(Signed) ' - • ` - guildin Inspector
My Commission Expires
PLANNING BOARD DATE
Chairman Member -
Member Member
Member Member Date
Council Approved Date Disapproved -
NOTE: A charge of $1.00 will be made for making corrections or changes to this application after approval has been obtained from
A re- inspection fee of 51.00 will be charged when such re- inspection is made necessary by improper notice for inspection or faulty
the Planning Board.
materials and /or workmanship.
to me well known,
ft-
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Aso
OFFICE:
5139 5. W. 8$11
LOCATION SKETCH
LOTS - " ' mid/ /� V BLOCK ' '
SUBDIVISION - 4'a1�''a7f� - ��' / ! ✓ .r � if
ACCORDING TO THE PLAT THEREOF AS RECORDED 114 PLAT BOOK No. " AT PAGE No.
PUBLIC RECORDS OF' COUNTY, FLORIDA.
DATE: — e,,. �,,,,- Z..9 --- - -FORr____f _ _
/OO•0
•
THOMAS J. KELLY
LAND SURVEYOR
MIAMI, FLORIDA
SURVEY NUMBER= - -< -=
SCALE 1,0 cG'00
SURVEY OF
k‘i
LOT UETAGLS
1 HEREBY CERTIFY THAT THE ATTACHED
SKETCH REPRESENTS A RECENT SURVEY MACE
UNDER MY DIRECTION AND IS TRUE AND COR-
RECT TO THE BEST OF MY KNOWLEDGE AND
BELI EF.
THERE ARE NO ENCROACHMENTS.
REGISTERe AND ;SURVEYOR 41961
STATE OF F RI,UA.
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TELEPHONE:
H1 8.0504
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-_- UNITED STATES
° ' "" FIDELITY AND
FIDELITY AND GUARANTY
GUARANTY INSURANCE UNDERWRITERS,
BALTIMORE, MARYLAND
Name and Address To Whom Issued
village of Miami Shores
10050 N. E. 2nd Avenue
Miami Shores Florida
..
COMPANY
INC.
CERTIFICATE
OF r
INSURANCE
This is to certify that the policies
listed below, subject to their terms,
conditions and exclusions, have
been issued by the Company des-
ignated below to the Insured named
below.
s•
Named Insured and Address J. M. Toppa & Sons, Inc.
8895 N. E. 4th Avenue
Miami, Florida 33138
1 3).(grAlii
Type of Insurance
Policy
Number
Policy
Term
Limits of Liability
Bodily Injury Property Damoge
Workmen's Compensation
J- 261430
3/3/70 -71
Statutory
Employers' Liability
$ ,000
Each Person
$ ,000
Each Accident
$
Medical -Each Person
Comprehensive Automobile
Liability
$ ,000
Each Person
$ ,000
Each Occurrence
$ D
µ
Comprehensive General
Liability
❑ Including Blanket
Contractual Liability
$ ,000
Each Person
$ ,000
Each Occurrence
$ )
Aggregate Operations
$ )
Virg4M\
Aggregate Protective
$ 3
$ ,000
Aggregate Completed
$ )
Operations - Products
. ='
~`-
...•
"
w:'
S,.
= _
...
2CC- 253807
10/1/68 -71
$ 000
100'
Each Person
Wittt/Anli
Manufacturers' and
Con tractors' Liability
❑ Owners' , Landlords' and
Tenants' Liability
$ 300,000
Each Occurrence
$ 10 ,000
Aggregate
$ 25 ,000
Completed Operations and
Products Liability
$ 000
Each Person
$ ,000
Each Occurrence
$ )
PTFA, W.Elp7,
$ ,000
Aggregate
$ )
Contractual Liability
$ ,000
Each Person
$ ,000
Each Occurrence
$ ,000
Aggregate
$ )
Comprehensive Excess
Indemnity
$ 000
Each Occurrence
Combined Personal
Com Injury and
Property Damage
se 'e' .11WI"NITHWErgrekiiniMirN.7q7:$7."'.7
$ ,000
Aggregate
Contractor = Miami,
The Company designated
change in or cancellation
Description and location of operations and automobiles covered:
Dade County and elsewhere in the State of Florida
=10 days prior written
below will itlescfuriudk notify the holder of this Certificate of any material
of these policies, litc6=Miudarpacat111.1tvax.txkluradixtlxxxx
AND GUARANTY COMPANY
INSURANCE UNDERWRITERS, INC.
G SUR AGEN INC,
By C. f �� /�U �GL
X UNITED STATES FIDELITY
❑ FIDELITY AND GUARANTY
Date 11/2/70
mor
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Gen. 348 (1 -68) O
1 CO
5, A-