930 NE 96 St (9)STATE OF FLORIDA,
COUNTY OF DADE. j ss
MIAMI SHORES VILLAGE
BUILDING INSPECTION DEPARTMENT.
APPLICATION FOR BUILDING PERMIT
Application is hereby wade 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 i3uilding 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.
3sqs.
Date..._..._...._ 28th ._........._.�.._.... ,19.76_
Owner's Name and Address ....John... a.pa.tri.ck N . Street N.: E, .96th
Registered Architect and /or Engineer - :,::.. , ....
Name and address of licensed contractor Lang Roofin.g_& Tile Co., Inc, X73 N. W. 71st St., Miami 33150
Location and legal description of lot to be built on:
Lot Block Subdivision
Street and Number where work is to be done 930 N. E. 96th Street
State work to be done and purpose of building (by
and haul away debris. Tin cap 1 -30# feltmop 2 -15# felts with hot asphalt' and cover with
pea.. gravel... embedded .. in.. to- hat•..a.spha1t..and..rep .lace.- .ane..roiz..of...t3.le, and for no other purpose.
New Building Remodeling Addition Repairs Reroof No. of Stories 1
To be constructed of Kind of foundation Roof Covering Gravel •..-- .•• - -• ..._ -.�
Estimated Total cost of improvements $465...00 Amount of Permit & ., r 5a.Q.Q
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 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 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 sit : e ork such public notice
or notices as are required by the Act. The undersigned agrees to employ only such subcon• ctors, on ork to • performed u der this
pertnit, as are licensed by Miami Shores Village.
Remarks..._ (Signed)
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.._ .__ d A� Date ? t O Read, Sworn to and Subscribed before me.
Disapproved p / Date — Notary Public, State of Florida
( Signed) ` / J4/
Building Inspcc r My Commission Expires
floors) Remove one row of tile,, tear off exidtirtg gravel roof
to me well known,
PLANNING BOARD _.._......DATE
Chairman Membcr
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 hoard.
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.