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ROOFINGPERMIT APPLICATION FOR MUNICIPALITIES OF DADE COUNTY /0A7 Sraeer Legal Description Owner / Lessee / Tenant M qTn� a MAR G A R.T12 DOZ AL Job Address Owner's Address /d ql Ms. q$ StRtc4- Contracting Co. i p ,btey Aeet.NC c.. Address SS# Competency# cc ,.3437 M/ Architect /Engineer Address Bonding Company Address Mortgagor Address Qualifier Re Ater BeAbtey State# Re- two y33 g4 Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL PAVING FENCE SIGN WORK DESCRIPTION A e Re s. Square Ft. 9,1.0 Estimated Cost` 6 $sa re 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 PROPFnTY (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, 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. 1,4/ gf. Signat7of Owner and /or Condo President Signature of.Contractor or Owner - Builder Date: Notary as to Owner and or -Condo President My Commission Expires, :. * * PERMIT FEE: Ud i°ttKr 3 cc1 3 t1 * APPROVED: (OWNER TO RETAIN COPY) 5 Poit/,SA S 71,Lt Mechanical Plumbing Date: Tax Folio // gJ J0Z 005, O Master Permit # phone phone ij . / 2 c cs Ins. Co. L;NcoLN tary /as to Contractor 9r Owner- Builder y Commission Expires: /5 4 * * * * * * * Other Zoning Building 4' 4 1 t Vi* Electrical Engineering b. Amount of bond% STATE OF FLORIDA COUNTY OF DADE I HEREBY CERTIFY that this is • origin led in thi office o A.D. 1 WITNESS my hand and Official Seal. Olerk Circuit Court Dv PERMIT # J � / Tax Folio No. / 1 ..3CC) MFi1Mi RLAI 32 2. S. Surety: a. Name and Address NOTICE OF COMMENCEMENT D.C. State of Florida County of Dade 91R4:35663 19i DEC 1310:1 THE UNDERSIGNED hereby gives notice that improvement will be made to certain real property, and in accordance with Chapter 713, Florida Statutes, the following information is provided in this Notice of Commencement. 1. Description of property: (legal description of the property, and street address if available) 40y/ A467. 914 state* /ft 2. General description of improvement: ReRooF PROM FLAt ro S • L 3. Owner information: a. Name and Address: MRRrAN .f M,RCAR,TA OOZAL /04_2 A,,E. q$1 RtCt b. Interest in property: c. Name and address of fee simple titleholder(if other than owner): r 4. Contractor: (name and address) BRAUI.t,' aenPrn/G• CO. Ice') Abvti, 5 St, 6. Lender: (name and address) 7. Persons with the State of Florida designated by Owner upon whom notices or other documents may be served as provided by Section 713.13(1)(a)7., Florida Statutes:(name and address) 8. In addition to himself, Owner designates of to receive a copy of the Lienor's Notice as provided in Section 713.13(1)(b), Florida Statutes. 9. Expiration date of notice of commencement (the expiration date is 1 year from the date of recording unless a different date is specified) Pkef ii? e 13/ Robert 13/ '9oLey 5 ' 8 70 /v, kv , O A U S i ..,;13' u r e of Owner Sworn to and subscribed before me this // day of ,7 e' 2. , 1991. Notary Public • - '� My Commission Expires: be sent to. STATE OF FLORIDA, COUNTY OF DADE. MIAMI SHORES VILLAGE BUILDING INSPECTION DEPARTMENT APPLICATION FOR BUILDING PERMIT Application is hereby made for the approval of the detailed statc•Hent ot me plans and specifications herewith submitted for the build in 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 thc 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 progreu of the work. Owner's Name and Address . 4 / 4 "77//1,0 Registered Architect and/or Engineer H." III ot ,, . , ,ITITT•tref• Nam c and address of licensed contractor C.-....:z-ibLQ,....i L oc a t ion and•legal description of lot to be built on: Lot Block Subdivision Street and Number where work is t be done State work to be don anpfirpps4 building (by floors) 3 Building Inspector No.10 1 43.3 Sere ,2) and for no other purpose. New Building Remodeling Addition Repairs No. of Stories _ To be constructed of likd of foundation Roof Covering ..... - - ...... •------- Estimated Total cost of improvements $ d 0 Amount of Permit $ 611 i 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 The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations as an e mplo yer of labor under the Florida Workmen's Compensation Act, b Section 5966, Compiled General Laws of Florida, Pernument Supplement, anti has complied with the provisions thereof, and will require similar compliance from all contractors or sub-contractors emplo .ed by him in the work to be performed under this permit; and will post or cause to b • . ection • he o work such u notice or noticcs as arc required by the Act. The undersigned agrees to employ onl • • • • act. rk to performea under this pcnnit, as are licensed by Miami Shores Village. ft nem.ks (Si /Fe j5 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.._. - 1 1 Date 4 )v5 Read, Sworn to and Subscribed before me. 4'5 1 •1' Disapproved Date Notary Public, State of Florida (Signed) My Commission Expires a 2J to me well known, PLANNING BOARD DATE Chainnan Member Member Member Member Member Council Approved Date Disapproved Date NOTE: A ch.irge of $1.00 will be made for making corrections or changes to this application niter approval has been obtained from the PlanniNg Hoard. A rc fee of S1.00 will be charged when such re-inspection is made necessary by Improper notice for inspection or faulty materials anti/or workmanship. MIAMI SHORES VILLAGE BUILDING INSPECTION DEPARTMENT APPLICATION FOR BUILDING PERMIT Application is hereby made for the approval of the detailed statcrrn•nr or we plans and specifications herewith submitted for the build in 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 L _ Owner's Name and Address ... ... ' - ,lQ 3._... Street .G._.. Registered Architect and /or Engine ,., Name and address of licensed contractor t 1 Location and legal description of lot to be built on: Lot Block Su - .... p� C ! Street and Number where work is to be done.. / �1. / vi , A .. ?1 0 / g (by floors)... divis work to be donee nd pu ose of . /' . �' - � - and for no other u i P Rik• New Buildi 1 .. Remodeling Addition..... Repairs No. of tprii To be constructed of Kind o oundatio�t Roof Covering _.........._..__ Estimated Total cost of improvements $ C �' 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 Disapproved Date (Signed) • �" Building Inspector 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 Su1pleinent and has complied with the provisions thereof, and will require similar compliance from 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 ection on the site of the work such public notice or notices as arc required by the Act. The undersigned agrees to employ only such su .ntractors, on ; ork to be performed under this pennit, as are licensed by Miami Shores Village. Remarks (Signe Notary Public, State of Florida My Commission Expires STATE OF FLORIDA, COUNTY OF DADE. i 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. tt ) Permit No.__.. .t CLJIJ Date... .l " 3 D Read, Sworn to and Subscribed before me. PLANNING BOARD DATE Chairman Member Member Member Mcmbcr . _..... .... 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 hern obtained from the Planning; Board. A re- m.pection fce of $1.00 will be charged when such re- inspection is made necessary by improper notice for inspection or faulty materials and /or workmanship. 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 Owner's Name and AddresPe an Claussen No.982 N. E •Street 4th Ave. Rd. Registered Architect and /or Engineer and address of licensed contractor Brady Roofing .. Mfg.. CQA_-a95. N, W 73rd St Location and legal description of lot to be built on: Lot Block Subdivision Street and Number where work is to be done 1O'43 N • 1?. • gSth St. State work to be done and purpose of building (by floors) and for no other purpose. New Building X Remodeling Addition Repairs No. of Stories To be constructed of Kind of foundation Roof Covering Tile Estimated Total cost of improvements $.$QQ. Amount of Permit $.5..0 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 aws of Florida, Permanent Su lenient, and has complied with the provisions thereof, and will require similar compliance from all contrac ors or sub - contractors employ by him in the work to be performed under this permit; and will post or cause to be posted for inspectio o the .•te of the work sue is notice or notices as are required by the Act. The undersigned agrees to employ only such su.contract'js, on ork to be erfor nder this permit, as are licensed by Miami Shores Village. Remarks (Signe STATE OF FLORIDA, COUNTY OF DADE. j ss. Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take a nowledgments, 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 Date Disapproved (Signed) to me well known, Read, Sworn to and Subscribed before me. Notary Public, State of Florida 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.