95 NE 96 St (8)6L9
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 8 -- z__ , 19
Owner's Name and Address._... , _ ° i- - C. �o ` a- =_- --- No Street
Registered Architect and /or Engineer (% ' ^
Name and address of licensed contractor 7 L "CC E c' S " t
Location and legal description of lot to be built on: '€ t." Y �
Lot • S � L 1 =t A P.y_ _Z� Block Ao Subdivision
Street and Number whe rk is to be done
State work to be done and pu of building (by floors) � G4z <= cJ
STATE OF FLORIDA,
COUNTY OF DADE. j ss.
Permit No
Disapproved _
( Signed)
APPLICATION FOR BUILDING PERMIT
MIAMI SHORES VILLAGE
6
and who, being by me first duly sworn, upon oath deposes and says that he
of the above described construction, that he has carefully read the foregoing
therein by him stated are true.
Building spector
BUILDING INSPECTION DEPARTMENT
'
I■3D t V .` C---"3
Amount of Permit $
_Plan Cubage
Size of Building Lot
and for no other purpose.
New Building Remodeling Addition y Repairs No. of Stories
To be constructed of Kind of foundation rs, RoaCovering
to
Estimated Total cost of improvements $
Zone cubage required
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 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)
OAA5L
NOTE: A charge of $1.00 will be made for making corrections or changes to this application after
the Planning Board.
A re- inspection fee of $1.00 will be charged when such re- inspection is made necessary by impro
materials and /or workmanship.
r
Date 3 .1 p
` / Read, Sworn to and Subscribed before me.
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally ap-
peared
to me well known,
is the
application, and that he did sign the same, and that all facts
Notary Public, State of Florida
My Commission Expires
PLANNING BOARD DATE
Chainnan Member
Member Member
Member .. _._ _ Member
Council Approved Date Disapproved . _ I\- Date
val has been obtained from
er notice for inspection or faulty
I
MIAMI SHI ERES 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.
Owner's Name and Address.... -_.� _ !!.a L'� /_ Ql �J ' �/ No S
- - -• -- - - -�` -- -- -- -- - -�� Street- -� < - -�.. 9 Fri
State work to be done and purpose of building (by floors)
..rt... T. J..
STATE OF FLORIDA,
COUNTY OF DADE.
ss.
Registered Architect and /or Engineer..._ -_ - ,.6.cf ,/3 /L_
�IeG1
Name and address of licensed contractor a2�x_(
Location and legal description of lot to be built on:
Lotj&s 4 - . G f ! 4 ''f` _ ? Block <p Subdivision �.' C. / ¢ f�a y-
Street and Number where work is to be done y .) --- L ''.
Chairman
Member
f
Member ..._ _.
Council Approved Date
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 $ 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 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.
Remarks ( Signed) J 7 1t._d41li_/ i . / e)
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.____Sa 2_( Date
Disapproved . e
(Signed). _ ..,'� —
B uil.`1rg
PLANNING BOARD DATE
Member
Member
Member
Disapproved Date
NOTE: A charge of 11.00 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 S1.Q10 will be charged when such re- inspection is made necessary by improper notice for inspection or faulty
materials and /or workmanship.
Date
S
�1 <(:� C�t,.4A.e
to me well known,
Read, Sworn to and Subscribed before me.
,19
Notary Public, State of Florida
My Commission Expires
OWNER'S NAME
R. beef V 3e //
PRESENT ADDRESS
95 N. E• 96. S r.
LICENSE NO.
PHONE NO.
JOB LOCATION (ST. OR AVE.)
9t; N . C . W. - 1%,, Sr.
LOT
25 4 E % Z2
BLOCK
!o
SUBDIVISION
Ali OV.41 .�`i�ees .Secf. /
GENERAL CONTRACTOR
De•.) nee
ADDRESS
PHONE NO.
LICENSE NO.
BUILDING PERMIT NO. 101 0 2
4.- 10•(08
DATE
O e
PERMIT FEE $ S
BUILDER'S BOND
NO. r' DATE r
ZONE REQUIREMENTS CU. FT.
PLAN CUBE Z` 1 1' 5o CU. FT.
EST. COST 5
DRAWINGS. SPECIFICATIONS. RESTRICTIONS AND CUBE CHECKED BY W • R • 13 r4 cii - Vor ci
DATE
L.- I C. Co 8
NEW CONSTRUCTION
TYPE
Gg
STORIES
a ^c
ROOF CONSTRUCTION
eK, S :n
INTERIOR CONSTRUCTION
eon ✓de 1- ex,,lt' „T 7 A raj e
REPAIRS
li DESCRIPTION
1 Te vv. e rd O M _
70-
ALTERATION DESCRIPTION
ADDITION
SUBMITTED TO PLANNING BOARD
APPROVED
REJECTED
REFERRED TO COUNCIL
REASONS
RE- SUBMITTED TO PLANNING BOARD
SURMITTFr) TO VILLAGF COUNCIL
REMARKS
CERTIFICATE OF OCCUPANCY NO,
ISSUED
BY
TO
BUILDING PERMIT AND INSPECTION RECORD -MIAMI SHORES VILLAGE
INSPECTIONS
DATE BY
INSPECTIONS DATE
BY
FOUNDATION
RE- INSPECT
BY
ROOF
SEPTIC TANK
FEE
BEAMS & LINTELS
$
SEWER
POOL
TUB & TOP OUT
$
FRAMING
RANGE CONN.
AIR COND.
GAS
SEWER
FINAL
$
CLEAN UP
$
SLAB
1$
FIXTURES & FINAL
SLAB
SOLAR HEATER
SPECIALS PERMITS
PERMIT NO.
DATE
FEE
TEMPORARY SERVICE
RE- INSPECT
BY
$
SEPTIC TANK
FEE
TEMPORARY SERVICE
$
SEWER
$
TUB & TOP OUT
$
SOLAR HEATER
RANGE CONN.
$
GAS
SEWER
I $
$
$
INSPECTIONS
DATE
BY
RE- INSPECT
BY
RE- INSPECT
BY
ROUGHING
DATE
FEE
TEMPORARY SERVICE
$
TUB & TOP OUT
H. W. HEATER CONN
$
RANGE CONN.
$
MOTORS
SEWER
I $
FIXTURES
$
SEPTIC TANK
1$
FIXTURES & FINAL
SOLAR HEATER
FIXTURES
GAS
CONTRACTOR
PHONE
PERMIT NO. 1 DATE
FEE $
NEW BLDG. I ALTERATION I ADDITION
REPAIRS
SPECIAL PERMITS
PERMIT NO.
DATE
FEE
TEMPORARY SERVICE
$
H. W. HEATER CONN.
H. W. HEATER CONN
$
RANGE CONN.
$
MOTORS
I $
FIXTURES
$
1$
INSPECTIONS
DATE
BY
RE - INSPECT BY
RE- INSPECT BY
TEMP. SERVICE
ROUGHING
H. W. HEATER CONN
RANGE CONN.
FIXTURES & FINAL
CONTRACTOR
PERMIT NO.
NEW BLDG.
BUILDING INSPECTIONS
PLUMBING PERMITS & INSPECTIONS
PHONE
FEE $
REPAIRS
DATE
ALTERATION
ADDITION
ELECTRICAL PERMITS & INSPECTIONS
APPROVAL TO POWER CO. FOR SERVICE DATE
BY
BUILDING f]
ELECTRICAL ❑
PLUMBING ❑
ROOFING ❑
Owner of Cif— T
Architect
Contractor
or Builder
Legal
Description
Address of
Building
04#.3 or, IL
Lot Z3
94
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 applica-
tion herefor in strict compliance with all ordinances pertaining thereto and with the understanding that the work will be performed in compliance with am,
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 respon-
sibility for work done by his agents, servants or employees.
Signed to
In consideration of the issuance to me of this permit I agree to orm the work cove • hereunder in compliance with all ordinances and regulations
pertaining thereto and in strict conformity with the plans, drawings, st nts or specifications submitted to the proper authorities of Miami Shores Village.
In acceptin I assume responsibiligyfor all work done by er, myself, my agent, servant or employee.
ON RACTOR or BUI ER
MIAMI SHORES VILLAGE, FLORIDA
Date s► a �Q__ 191ir1
PERMIT N? 10102
Work
B1
Subdi-
vision M 14 4_
Sq Ft
Value of t 1 mss'
Project $ ^ d
BY
Contractor's
License No.
II Amount of
II Permit $
to be performed under this Permit oal a r GN „c
t...�....1 �S ♦ h * /a. 0.11—
-tn 7
AI �.�...
Sie�t!
OR) BY
AUTHORITY
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 n
Owner's Name and Address.. .. /Z Una 3 1 �4 L un��� 2N No
9 �3
Permit No
Disapproved
(Signed) _ -A.
MIAMI SHORES VILLAGE
Date
Building In ' ector
Chairman
Member
Member
BUILDING INSPECTION DEPARTMENT
Member
Member
Member
PLANNING BOARD DATE
,4 u� oee c I -7°)) ? 7ivr / 3 S g r
Registered Architect and /or Engineer
Name and address of licensed contractor
Location and legal description of lot to be built on:
Lot �r �Y ?' Block (p Subdivision )fl ./ 4 / S /�d /e(F ) /
Street and Number where work is to be done 7 C
,r �1
State work to be done and purpose of building (by floors) ®� �'�" tJ �� /� i� ,S f
and for no other purpose.
New Building . _..._.. _ .... Remodeling Addition Repairs No. of Stories /
To be constricted of Kind of foundation Z. 4/C,, Roof Covering2d/ t 7 a 7 7 "f 6
Estimated Total cost of improvements $._ ..... � Amount of Permit $
Zone cubage required .Plan Cubage
Distance to next nearest buildi _._ Size of Building Lot
Maximum live load to be borne lv ea •h floor
1 hereby submit all the plans pecifications for said building. All notices with reference to the building and its construction may
be sent to
c'-``
Street
The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations as an employer
of labor under ;he 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.
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 true.
Read, Sworn to and Subscribed before me.
Notary Public, State of Florida
My Commission Expires
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 rc- inspection fee of 51.00 will be charged when such re- inspection is made necessary by improper notice for inspection or faulty
materials and /or workmanship.
goo
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.
Owner's Name and Address._..V.._.._G'_.'�
Registered Architect and /or Engineer
MIAMI SHORE
Name and address of licensed contractor_. 1 ; '/ 22 �'
Location and legal description of lot to be built on:
Lot._: `?, _ Block i Gsi?n.7.E.
Subdivis+on._._, �
Street and Number where work is to be done
State work to be done and purpose of building (by floors)
STATE OF FLORIDA,
COUNTY OF DADE. ss
W. 6°, .74,
/ j
Date___ f'
Date 7' c)
Chairman
Member
Member .. __..
Council Approved Date
NOTE: A charge of $1.00 will be made for making corrections
the Planning Board.
A re- inspection fee of 51.00 will be charged
materials and /or workmanship.
I LLAG E
Date Y
No
J
Cam, ey4 �� . , �,
and for no other purpose.
New Building Remodeling Addition . Repairs No. of Stories r
To be constructed of C4. :___. Kind of foundation - l% Roof Co eying ' _ - , 1 _ ‘ . . . _ d'
Z.
( = Amount of Permit $ /fit
Estimated Total cost of improvements $ c
Zone cubage required .Plan Cubage 7. '‘'• 4'. cam -
Distance to next nearest building Size of Building Lot2./ /__ /r_Z a
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 perinit 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 rovisions 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 ubcontraptors, on wqrk to be performed under this
permit, as are licensed by Miami Shores Village.
Remarks (Signed) tN
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 ..r
Disapproved
Bu ildin g �rispector •
Read, Sworn to and Subscribed before me.
19
Street .E.f?; ..._.G I
Notary Public, State of Florida
My Commission Expires
PLANNING BOARD DATE
Member
Member
Member
Disapproved Date
or changes to this application after approval has been obtained from
when such re- inspection is made necessary by improper notice for inspection or faulty
STATE OF FLORIDA,
COUNTY OF DADE. Ss.
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 � •
Owner's Name and Address -- Street__ •
Registered Architect and /or Engineer
Name and address of licensed contractor � a's 1 ...,: +_`__'_ ± ___— – ti r
Location and legal description of lot to be built on: S
Lot Block Subdivision
/�
• . '
Street and Number where work is to be done r _— 4_ • r —
State work to be done and puoseof building (by floors)_
r" rp 1� ® 2 r.�
The undersigned applic for this building pettnit 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.
t
Remarks (Signed ). t� : t.� fi F- -4.-_,.:11.1__ _- � !, � ,. i y
,19
and for no other purpose.
New Building ---" Remodeling Addition Repairs No. of Stories
To be constructed of Kind of foundation Roof Covering / 1 / '
Estimated Total cost of improvements $ I, of Permit $ ' . 2...,'
., ' '
Zone cubage required —___ _Plan Cubage
Distance to next nearest building Size of Building Lot
Maximum live load to be borne by each floor
iestiew& -for ,said—building. All notices with reference to the building and its construction may
be sent to - -- -f`' `' -- - `---- , - -`-. '— A — r _.,.. y
_t' • , ,
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 Date Read, Sworn to and Subscribed before me.
Disapproved Date
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.
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.
N9 1470
Miami Shores Village, Fla , rr
Owner, Agent or Tenant of Building) �--
Lot 23 - F? Block Subdivision
Street Address
Approved use by occupancy
CERTIFICATE OF OCCUPANCY
MIAMI SHORES VILLAGE, FLORIDA
BUILDING DIVISION
Remarks.
This Certificate of Occupancy is issued to the above named L.
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 2 the
Zoning, Electrical, Plumbing and Building Ordinances of Miami Shores Village pertaining to
the erection, construction, alteration or remodeling of buildings or structures.
• .. -- • '% BUILDING DIVISION
OWNFR NAME
D ean Clausen
PRESENT ADDRESS
LICENSE NO.
PHONE NO.
JOB LOCATION (ST. OR AVE.)
95 N.E. 96th St.
LOT
23-4 22
BLOCK
6
SUBDIVISION
Miami Shores
GENERAL CONTRACTOR
Dean Claussen
ADDRESS
PHONE NO. LICENSE NO.
BUILDING PERMIT NO. 12 r]�7 45
DATE 2_7 59
PERMIT FEE $16.00
BUILDER'S BOND
ta � - ° - (0 s,
NO. 1 39$ DATE
ZONE REQUIREMENTS 20,000 CU. FT.
PLAN CUBE 20,021 CU. FT.
EST. COST S 12,000
DRAWINGS, SPECIFICATIONS, RESTRICTIONS AND CUBE CHECKED BY:
DATE
X
NEW CONSTRUCTION
/r TYPE
C BS
STORIES
1
ROOF CONSTRUCTION
tile
INTERIOR CONSTRUCTION
terrazzo floors,plaster walls
REPAIRS
DESCRIPTION ceilings
2 hdrm_ -2 hAt - living porch- living rnom- kitchen - garage
ALTERATION
DESC PTION
ADDITION
SUBMITTED TO PLANNING BOARD
APPROVED
REJECTED
REFERRED TO COUNCIL
REASONS
RE- SUBMITTED TO PLANNING BOARD
SUBMITTED TO VILLAGE COUNCIL
REMARKS
1/�
CERTIFICATE OF OCCUPANCY NO. I • 7
I ISSUED .( i'J
j1
BY �` 1.)./
TO i ---
BUILDING PERMIT AND INSPECTION RECORD —MIAMI SHORES VILLAGE
I NSIcTIONS
DATE
BY
RE- INSPECT
BY
RE- INSPECT
BY
FOUNDATION
' ' . .
'
FEE
TEMPORARY SERVICE
$
BEAMS & LINTELS
SEPTIC TANK
y" -y , �, ,
$
$
SEWER
FRAMING
$
SOLAR HEATER
$
$
GAS
$
$
$
$
FINAL
. 1-t.
BY
RE- INSPECT
BY
RE- INSPECT
BY
CLEAN -UP
4'
ROUGHING
CONTRACTOR
PHONE
PERMIT NO. 1 N "�-+ DATE
FEE $
NEW BLDG. I ALTERATION
ADDITION
REPAIRS
SPECIAL PERMITS
PERMIT NO.
DATE
FEE
TEMPORARY SERVICE
$
$
SEPTIC TANK
y" -y , �, ,
$
$
SEWER
$
$
SOLAR HEATER
$
$
GAS
$
$
$
$
INSPECTIONS
DATE
BY
RE- INSPECT
BY
RE- INSPECT
BY
ROUGHING
ROUGHING
GAS
H. W. HEATER CONN
SEWER
RANGE CONN.
SEPTIC TANK
7 I
G ./1'.
SOLAR HEATER
FIXTURES & FINAL
FIXTURES
/
l/0 /9')
i0
•
CONTRACTOR +
PHONE
_
PERMIT NO. . _ PATE
FEE $
NEW BLDG. I ALTERATION I ADDITION
REPAIRS
SPECIAL PERMITS
PERMIT NO.
DATE
FEE
TEMPORARY SERVICE
$
H. W. HEATER CONN.
$
RANGE CONN.
$
MOTORS
$
FIXTURES
$
$
INSPECTIONS
DATE
BY
RE- INSPECT
BY
RE- INSPECT
BY
TEMP. SERVICE
ROUGHING
H. W. HEATER CONN
RANGE CONN.
FIXTURES & FINAL
4--, 1.:
•
BUILDING INSPECTIONS 6 K
PLUMBING PERMITS & INSPECTIONS
ELECTRICAL PERMITS & INSPECTIONS
APPROVAL TO POWER CO. FOR SERVICE DATE
v (r
OWNER'S NAME
./ ;:,,,e �.�r
PRESENT ADDRESS
9r ,46.-. y r
LICENSE NO.
PHONE NO,
JOB LOCATION (ST. OR AVE.)
7t
9r A 9 e - S a �+ t.
LOT
Z3 4 e5 z t
BLOCK
G
SUBDIVISION
HA a...a. .s ' � /
GENERAL CONTRACTOR
�
1'rr ;s • D.+. / / .7. 6,-,e.
ADDRESS
`7o/ /%,J• 2-7
`
PHONE NO.
LICENSE NO.
BUILDING PERMIT NO. -37.7 S
DATE 8% 7'7.. `7i
PERMIT FEE $ " 0...-
BUILDER'S BOND
NO. DATE
ZONE 441,4. REQUIREMENTS CU. FT.
T. i). = /12j. 9t
PLAN CUBE ZZ 43.g(.. CU. FT.
ato
EST. COST $ /1 —
DRAWINGS, SPECIFICATIONS, RESTRICTIONS AND CUBE CHECKED BY: •41• M0 ° C-•
DATL
Z .7 -
BUILDING PERMIT AND INSPECTION RECORD —MIAMI SHORES VILLAGE
NEW CONSTRUCTION
TYPE
C.115
STORIES
I o., .
ROOF CONSTRUCTION
Z., /1 d/.
INTERIOR CONSTRUCTION
"4,, d',... 2 . 4 -, 4 del ,1 - ,0%-y -
REPAIRS
DESCRIPTION
Coos .ati� s •fe -4 p /a. Acre I G.)at`S , CepJ /n • .1
ALTERATION
DESCRIPTION
l
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C I'IC.. ,, ' ; ,
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8- 3. s
ADDITION
1APPR Off' � ED
SUBMITTED TO PLANNING BOARD v1 y =' §
REJECTED
• C i 4.."
REFERRED TO COUNC REASONS
�, • , / , ( V. =
RE- SUBMITTED TO PLANNING BOARD
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7
t,ate` L 0... €-. �j`'7
_ L %W0''t(Zty IN C
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SUBMITTFD TO VILLAGE COUNCIL
3 3 °3
..,•40 i. REMARKS,
e -
Ec1 C,.....,;,-v 6 �,v.- 2b o
• yy q
CERTIFICATE OF OCCUPANCY NO. 1 7 ( y
1l— IY_(.v
ISSUED
. A
1 BY
12-01 Yo
TO y i. ( . L, l `7 { G ( J
DRAWINGS, SPECIFICATIONS, RESTRICTIONS AND CUBE CHECKED BY: •41• M0 ° C-•
DATL
Z .7 -
BUILDING PERMIT AND INSPECTION RECORD —MIAMI SHORES VILLAGE
INSPECTIONS
DATE BY
INSPECTIONS
DATE
BY
FOUNDATION
SPECIAL PERMITS
ROOF
SEPTIC TANK
FEE
BEAMS & LINTELS
$
SEWER
POOL
H. W. HEATER CONN.
$
F.I3AMING
$
RANGE CONN.
AIR COND.
GAS
$
FINAL
$
Ja .".■ t.. S
CLEAN UP
FIXTURES
- (#
SLAB
INSPECTIONS
DATE
BY
RE- INSPECT
BY
SLAB
BY
ROUGHING
SPECIALS PERMITS
PERMIT NO.
DATE
FEE
TEMPORARY SERVICE
REPAIRS
SPECIAL PERMITS
$
SEPTIC TANK
FEE
TEMPORARY SERVICE
$
SEWER
$
H. W. HEATER CONN.
$
SOLAR HEATER
$
RANGE CONN.
$
GAS
$
MOTORS
$
Ja .".■ t.. S
$
FIXTURES
- (#
b •■
INSPECTIONS
DATE
BY
RE- INSPECT
BY
RE - INSPECT
BY
ROUGHING
TUB & TOP OUT
SEWER
SEPTIC TANK
SOLAR HEATER
FIXTURES
GAS
CONTRACTOR kQ`.. at, EL. �G TeC... L.
PHONE
A
PERMIT NO. 43 M.( C,... I DATE 7- la G �
FEE 4 'Z',
NEW BLDG. I ALTERATION 1 ADDITION
REPAIRS
SPECIAL PERMITS
PERMIT NO.
DATE
FEE
TEMPORARY SERVICE
$
H. W. HEATER CONN.
H. W. HEATER CONN
$
RANGE CONN.
$
MOTORS
$
FIXTURES
$
S
INSPECTIONS
DATE
BY
RE- INSPECT BY
RE- INSPECT BY
TEMP. SERVICE
ROUGHING
H. W. HEATER CONN
RANGE CONN.
FIXTURES & FINAL
/LG'+Qne col =+n-
CONTRACTOR
PERMIT NO.
NEW BLDG.
BUILDING INSPECTIONS 33 a
PLUMBING PERMITS & INSPECTIONS
PHONE
FEE $
I DATE
I ALTERATION
APPROVAL TO POWER CO. FOR SERVICE DATE
ADDITION
ELECTRICAL PERMITS & INSPECTIONS
REPAIRS
BY
CERTIFICATE OF OCCUPANCY
MIAMI SHORES VILLAGE, FLORIDA
BUILDING DIVISION
N° 1392
Miami Shores Village, Florida,
Owner, Agent or Tenant of Building
Lot " - - Block Subdivision _
Street Address
Approved use by occupancy `
Remarks 5= '7P _'7a :'
This Certificate of Occupancy is issued to the above named
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.
-
r . 1. 1 C 'nF n 11
BUILDING DIVISION
N9 1470
CERTIFICATE OF OCCUPANCY
MIAMI SHORES VILLAGE, FLORIDA
BUILDING DIVISION
Miami Shores Village, Fla ,
Owner, Agent or Tenant of Building
Lot Block Subdivision
Street Address
Approved use by occupancy
Remarks.
This Certificate of Occupancy is issued to the above named
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.
N.
BUILDING DIVISION
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 Vov. l6th, 1 60 ,19
Owner's Name and Address _.. S.] 1 T1j_� _ 411,11.1P0 '. r No 95 Street [ = • o uh au.,
Registered Architect and /or Engineer
Name and address of licensed contractor Lank' Roofirp & Tile Company,. Inc. ,x,30 i 7Sth. St,s " i- r i_ i'1f2 .
Location and legal description of lot to be built on:
Lot Block Subdivision
Street and Number where work is to be done 95° U. E. 96th St., !''iiaml Sho_res F13.
State work to be done and purpose of building (by floors) 3° sq. 4 —ply gravel addition to residence
Tie into _gravel and under tile
and for no other purpose.
New Building Remodeling Addition X Repairs No. of Stories
To be constructed of Kind of foundation Roof Covering 4 7 0ly _. 2ravol
r 7
Estimated Total cost of improvements $ 100.00 Amount of Permit $ '� ,� V
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 site of the work such public notice
or notices as are required by the Act. The undersigned agrees to employ only such subcontra .' s, on work to be performed under this
pernut, as are licensed by Miami Shores Village. [;C RC . . (: � "' I (;(i 11:(;,
Remarks (Signed)
5
.1
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 true.
Permit No e q ` Date �^y Read, Sworn to and Subscribed before me.
Disapproved Dale
( Signed) t, � _ t :La. V
Building Inspe or
Notary Public, State of Florida
My Commission Expires
NNING 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 51.00 will be charged when such re- inspection is made necessary by improper notice for inspection or faulty
materials and /or workmanship.
P AID BY
Dean Claussen 2 -7 52
YEAR
TAX
ANNUAL TA
PERIOD USED
AMOUNT PAID
DATE PAID
RECEIPT
NUMBER
ADDRESS 95 N.E. 96th St.
LEGAL 20 -E`21 bl. 6 MS
RECORD GARBAGE TAX
BUILDING d
ELECTRICAL ❑
PLUMBING El
ROOFING ❑
Owner of
Building _
Architect - .1 - \
Contractor
or Builder
Legal Lot
Description . 1 #i
Address of
Building
CONTRACTOR OR BUILDER
MIAMI SHORES VILLAGE, FLORIDA
PERMIT IT? 12745
DATF
Contractor's
License No
Work to be performed under this Permit
Subdi- 4°\
vision
Value of Amt. of
Project j I Permit $
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 plane,
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.
BY ` ,•
BY AUTHORITY
Signed.. '"" a .
IN
cTOR
In consideration of the issuance to me of this permit I agree tb petform 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.
IERMIT APPLICATION FOR MUNICIPALITIES OF DADE COUNTY
(OWNER TO RETAIN COPY) c/
Job Address 9-f 9e SST . r,- P / Tax Folio /J ,�,2�j t / If' *
Legal Description �7 G' 4oe �, '7 // 7 ) t4 � ster Permit i 3 Qz 9?
Owner / 42essea• 4-Tenant.
phone
Contracting Co. cA4, q pup c c/S T' /, lc Address � O /Il 9‘ .5;
Owner's .Address
Qualifier " ,v,&_ �97•e�}�� SS # # /J6 - -8/ '/? phone 71 - 99e'
State# CQ C QQ 2.6 80 ' k ' petency# 19 v Ins. Co.
Architect /Engineer
Bonding Company
Mortgagor
Permit Type (circle one): BUILDING ELECTRICAL PLUMING MECHANICAL PAVING FENCE SIGN
WORK DESCRIPTION APiAs,e F19C//9. .SG✓z,E =�:,c,/
yo ,9 c:., )9 v . o, - .r.� i►�.d�- C4 1�.�.a� �:� d� /Q ' 4_I C
A../2" .Ps= •T l,= .t/iG E.r.r.exey,
Sq Ft . 70 `,cj / 7 fir- VD" r'9G'''9 19' Estimated Cost ,0 f °° r�
s /pe o d .4.X -a
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. 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, PLUMING, SIGNS,
POOLS, ROOFING, and MECHANICAL work.
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.
Furthermore, I authorize the above -named contractor to do the work stated '1 2` - d-r- ea/
X t��r A�� �,_ •
�
Signatur of Owner a.d.har- C °r e'4ent..
Date: Dat
k!V
tar as to Owner and /or Condo President Notary as '
o o Contractor or Owner - Guilder
My Commission Expires: h.ATARYRQl�CSTF� My Commis ion Expire
0191RY Fitf6LTC STATE OF F'�QRIDIF
* * * �k Fid �f? 'ii IvJ L.:[a + 1$3I 1 END JL 28,t9�2
' £ �. 1.2�, 9
TE'. r � , � • �ii , .l VS. �Z @ �I,fERA1. %iP;►. AD.
PERMIT FEE: APPROVED: moi Other
9e sT
4/r
A A'
1
Zoning Building
Mechanical
Plumbing
Address
Address
Address
Signature of Contractor or Owner- Builder
/Ozi
Electrical
Engineering
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
. -
Date 7-7- F2 Job Address 44f 96 57 / Tax Folio lr /_/ 4051
Legal Description 4F444 / 7/4k'/ 441;
Owner / Lessee / Tenant gee( Master Permit 4 91
Owner's Address 9$ /V'f / O/N Phone
Contracting Co. /t2v /004E" Address
301E /977)9e/tE z> 6k.5--?//
Qualifier SS# - - Phone 7
State # Municipal # Competency # J5
Architect /Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type(circle one): BUILDING ELECTRICL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIPTION A �.Llib
Square Ft. Estimated Cost(value) :04
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 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. Furthermore, I
authorize the above -named contractor to do the work stated.
9 -0 0 1./ 6��' b 'C ;/��' G
Signature of owner and /or Condo President Signature of Contractor or Owner- Builder
Date: Date:
Notary as to Owner and /or Condo President
My Commission Expires: My Commission Expires:
** * * * * * * * * * * * * * * * **
FEES: PERMIT �� ' 019 RADON C.C.F. NOTARY TOTAL DUE 0 pt0
APPROVED: Fire Other
1 1 ' , / Q
Zoning Buildin 1 { Electrical
Mechanical Plumbing Engineering
Notary as to Contractor or Owner- Builder
note
II SI COMIIOI
IIIMIIIS
[
In' lal
Initial
FACTS OF FUMIGATION
Release of Company Liability for Contingent Damage
THANK YOU FOR GIVING TRULY NOLEN, INC., THIS OPPORTUNITY TO BE OF SERVICE. IN TERMS OF INTEGRITY, QUALITY
PERFORMANCE AND SENSE OF RESPONSIBILITY, YOU HAVE CHOSEN THE BEST VALUE. INTEGRITY ITSELF REQUIRES
THAT WE EXPLAIN CERTAIN PHYSICAL FACTS REGARDING ANY FUMIGATION PROCESS, AS FOLLOWS:
1. INTENT: It is the TRULY NOLEN, INC., objective to exterminate specific wood - destroying organisms that infest the struc-
ture and, otherwise, to leave the premises in the condition they were found. .
2. DEFINITION: Contingent damage is damage that may occur during the fumigation operation but which Is not caused by our
application of fumigant to the structure.and the subsequent process of ventilation. The fumigation operation Includes all
details from the time we arriJe on the Job until . we declare the structure safe for re- occupancy and have removed our person-
nel and equipment from the premises.
3. LIMITATIONS (one or more of the following may apply to your structure accordingly as advised by our Inspector):
a) Tile or Wood -Shake Shingling; Rock or Gravel Roofing. Roofing must be walked upon by msn carrying heavy tarpaulins.
The tarpaulins must be drawn across the roofing when covering and uncovering the structure. Although our men are
trained, experienced and cautious In this procedure, cracking andlor loosening of some shingles may be unavoidable;
rock.and gravel may be disturbed, some falling to the ground. We are not able to Inspect the roof prior to and again after
our work to determine whether we caused damage or if it existed previously. Therefore we are not liable for the con-
tingency of minor 'roof damage.
h) Plant Life Too Neal, Overhanging or Inside the Structure. Direct exposure to fumigants may destroy plant life. Where tar-
paulins are used, they must be drawn over the structure and sealed fo the ground along the exterior perimeter. Turf or
plantings that are nearer than 12" to a structure, or that overhang it or that are planted under a wide eave, may Interfere
with the tenting procedure. If such plantings have not been trimmed or removed (by the owner), we cannot be liable for
contingent damage.
c) Appended Exterior Lighting andlor Electrical Signs. Uncontrollable winds may cause tenting to flap agains such exterior
appendages as may need to be covered, possibly causing breakage of signs, fixtures, neon tubing, lamps andlor bulbs.
We are not liable for this contingent damage.
d) Screened Enclosures. Most patio andlor pool screened enclosures will support neither the weight of a man drawing tar-
paulin over the structure nor the weight of the tarpaulin itself. We may seal off such enclosures rather than cover Ahem.
Construction may be such that a few top or side screen. panels need to be removed In order to seal off the enclosure.
There is no problem in removing them. The problem is putting back old, dried out, brittle or torn screening and rubber
molding. If this cannot be done, we are not liable for the owner's cost of replacement.
e) Fabric, Wood or Metal Awnings. Such awnings may not support the weight of overhanging tarpaulins or they may in-
terfere with our securing a tight cover of the structure_ Many awnings have not been lowered In a long time and the hard-
ware is corroded. Owners are asked to have all awnings.lowered and put back. 0 thi8 has not been done, we cannot be •
liable for.contingent damage. _ : .4•. -' -- ;
f) Antennas. ' irhers are asked to lower, and set out of the way of workers, aiI,TV, FM, Ham Op and such antennas. If this Is
not done and we must lower the antenna(s), we will not put up again because we are not knowledgeable with regard to
"direction ", and we cannot be liable for contingent darn
g) Other (specify: sealing tape on painted surface, horti l ill sheds, abutting fences, etc )
4. THIRD PARTY ACTS: TRULY NOLEN, INC., does not have care and custody of the premises during that " "' "
tion operation when our personnel are not on the premises, specifically, from the time that tho 4w - 4° c U ' ted until the
crew returns to take if'down, and again from the time the tent is down until the premises are re- occupled. A guard posted
during that time may deter third party acts such 4 � as va burglary andlor Intrusion. The owner the np tlon to provide
— ° '�°�r N ^' " 'r --• ---- "°rang a or Toss that Is
egasen t Mi party acts. ` --
' '
5. ACTS OF GOD: Certain circumstances beyond our control can affect our ability to complete or even to commence the
• fumigation operation on the•date specified. Heavy rains, high velocity winds, temperature below 60' F., civil disturbances or
acts of war may cause us to delay or postpone a specific Job. Inasmuch as these circumstances cannot be anticipated by us
and are beyond our control, TRULY NOLEN, INC., Is not liable for any costs that the owner may incur as a result of our
necessary delay or postponement of work.
inspector branch no.
+i WE CARE, FOR OR POP.EI AT YOU CARE FOR ,.
Ask Your Inspector About TRULY NOLEN' Pest Control And LaOrS
• TN 211 REV. 5 -82
.veer / tesee / Tenant
Master Permit #
sner's Address 96 i6 90 fi s
- /Ifi/ , - 02n 5 Phone 7,55/ �'
, �C 7
7
ontracting Co. r / ev_Y boo Address 1'�'%' ,4 - (Y577 a',/, ,f
ualifier SS #! - - Phone
tate # Municipal 0 Competency I# Ins.Co.
rchitect /Engineer Address
.ceding Company Address
iortgagor Address
'ermit Type(circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
'ORK DESCRIPTION pij%l /f'f'rl ) ei9F - ST�Lfz /w/_;
;quare Ft. Estimated Cost(value)
;ARNING TO OWNER: YOU MUST RECORD A NOTICE OF COMMENCEMENT AND YOUR FAILURE TO DO
;0 MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY (IF YOU INTEND
PO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR
NOTICE OF COMMENCEMENT).
-.pplication is hereby made to obtain a permit to do work and installation as indicated above, and
'n 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
iermits are required for ELECTRICAL, PLUMBING, SIGNS, POOLS, '! ;' NG and ECHANICAL WORK.
JWNER'S AFFIDAVIT: I certify that all the foregoing infor
Je done in compliance with all applicable laws regulatin
authorize the above - named contractor to do the work st
Signature of owner and /or Condo President
Date:
ate and that all work will
zoning. Furthermore, I
at re of Contractor or Owner - Builder
Date: -7
Notary as to Contractor or Owner- Builder
Notary as to Owner and /or Condo President
My Commission Expires: My Commission es:
• AIOA FEBLES
** * * * * * * * * �jp ..aMy Commission Wcptres **
'�` / March 31, 1996
Comm. No. CC 190192
trAK.4,17/427 '0 AL DUE
FEES: PERMIT RADON C.C.F.
OFFICIAL SEAL
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