1179 NE 98 St (13)k
MIAMI SHORES VILLAGE
BUILDING DEPARTMENT
305- 795 -2204
Buildi g Ins ction Request
Date /
Type Insp'n
--.
Name
Address
Company �j u
Phone # ✓ 0 / qqq 7'
Inspection Date 111
t5
Permit No.
Approved
„
Re- Insp'n Fee ❑
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F ( ( 0 U
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Company
Phone #
MIAMI SHORES GE
BUILDING DEPARTMENT
305- 795 -2204
Building Inspection Request
Date
Type Insp'n ( Fe__ GC C. car Ca-v■ C
Permit No. 0
Name '" t ; , at? ve ct
Address
Inspection Date
pproved� _
Correction
Re- Insp'n Fee ❑
(Rev. 04/24/03)
Miami Shores Village
Building Department
Date
Certificate of Re- Occupancy
The following residence is issued a Certificate of Re- Occupancy
Address , f r7 9 i 6 • qg -
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795 -2204
Fax: (305) 756 -8972
Permit No. WO 05 -S/
City Miami Shores State Florida Zip
This certificate verifies that the referenced property has been inspected by Miami Shores Village
and has been determined to presently comply with the schedule of regulations of the Miami Shores
Land and Development Code pertaining solely to the requirement that each one - family dwelling is
used and intended to used for a one - family dwelling purpose only; however, this certificate does not
constitute any representation or warranty as to the condition of the dwelling or other structures on
the premises described herein, or any aspect of such condition, and interested persons are advised
and encouraged to make their own inspection of the premises in order to determine the condition
thereof.
Building Officials Approval:
Rev. 10/02/03)
RE- OCCUPANCY
APPLICATION
Contact Name E rni o V
Buyer c
Property Address \\ - tO 5+
Date
Applicant N
nature
Sign:
Print:
My Comrnissio
Miami Shores Village
Building Department
10\
Seller Realtor j
City Miami Shores State Fl
et31
The foregoing instrument was acknowledged before me this
OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate.
Building Officials Approval:
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795 -2204
Fax: (305) 756-8972
Permit No. S/
LocID
Phone # 1S4-°tttq - 1 X301
Company Name
zip 3 eD
I hereby certify that I understand that the zoning of the property is for single - family residential use and
that it is unlawful for more than one family to reside therein. I also understand that any Certificate of Re-
Occupancy that may be issued by Miami Shores Village certifies only that the referenced property is
being used for single - family purposes and that such Certificate does not constitute any representation,
warranty or certification as to the condition of the dwelling or other structures on the property.
day of rl/ 1 , 20 05 ,
by CiMi ('15 �0 �G.. , who is personally known_to me or who has
produced � as identification and who did take an oath.
NOTARY PUBLIC:
Re -Occ. $60.00
Notary $5.00
CCF $0.60
Total
r
L
t4- occupy the single family residence known as : (address)
// 7 55 7,
Legal Description:
Lot:
tA,ae to-kleza :e46
APPLICATION FOR CERTIFICATE OF RE- OCCUPANCY
•
L6:/e4'4 4A,
, Miami Shores, Florida.
, hereby apply for a certificate
Block PB & PG:
I hereby certify that I understand that the zoning of the property is for single - family residential use
and that it is unlawful for more than one family to reside therein. I also understand that any
Certificate of Re- Occupancy that may be issued by Miami Shores Village, certifies only that the
referenced property is being used for single -family purposes and that such Certificate does not
constitute any representation, warranty or certification as to the condition of the dwelling or other
structures on sychroperty.
Applicant L Date j --
Print Name \ cQ O Y \ !
*********************************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
Comments:
For purposes of conducting the inspection required by Section 902 of the Miami Shores Land
Development and,.oning Code, please contact: Q�
Contact N
4— '-.i Telephone: 7 ^0 r�
Realtor
Buyer Seller
PAGE 1 0F 2
C ompany Name
Application Fee ($50) paid: Cash )Check No.
Inspected by: F. LUB I EN Approved X Denied Date 3/22/99
2
CER'ilICATE OF RE- OCCUPANCY
On behalf of Miami Shores Village, Florida, the undersigned certifies that the property
described in the above application has been inspected for purposes of re- occupancy pursuant to
Sections 901 and 902 of the Miami Shores Land Development and Zoning Code and that such
property may be re- occupied by the above applicant for single - family residential purposes.
THIS CERifICATE VERIFIES THAT THE REFERENCED
PROPERTY HAS BEEN INSPECTED BY MIAMI SHORES
VILLAGE AND HAS BEEN DETERMINED TO PRESENTLY
COMPLY WITH THE SCHEDULE OF REGULATIONS OF THE
MIAMI SHORES LAND AND DEVELOPMENT CODE
PERTAINING SOT.FT.Y TO THE REQUIREMENT THAT EACH
ONE - FAMILY DWELLING IS USED AND INTENDED TO BE
USED FOR A ONE - FAMILY DWELLING PURPOSE ONLY;
HOWEVER, THIS CERI. t ICATE DOES NOT CONSTITUTE ANY
REPRESENTATION OR WARRANTY AS TO THE CONDITION
OF THE DWELLING OR OTHER STRUCTURES ON THE
PREMISES DESCRIBED HEREIN, OR ANY ASPECT OF SUCH
CONDITION, AND INTERESTED PERSONS ARE ADVISED AND
ENCOURAGED TO MAKE THEIR OWN INSPECTION OF THE
PREMISES IN ORDER TO DETERMINE THE CONDITION,
THEREOF.
PAGE 2 OF 2
MIAMI SHORES VILLAGE, FLORIDA
n%
By:
3/22/99
Date of Certification:
DATE: 5/23* TIME: // S Z
NAME OF PERSON REQUESTING FILE:
PHONE #:,5n5 75-1/3 V Or YOUR ADDRESS: //79 ,ft),- 9 T.l sr
ADDRESS OF FILE REQUESTED: //79 » 9 ' 7 S7
INFORMATION REQUESTED:
I understand that all documents in this file are property of Miami Shores Village and
that NO documents may be removed from this file. You may get 4 complementary
copies (8x11) size, additional copies will be furnished at 0.15 cents per page, not
including any blue prints. If blue prints are order please be aware that we are not
responsible for the quality of the printed documents.
Acknowledged by:
FILE RETURNED TO: INITIAL
Miami Shores Village
Building Department
10050 NE 2 Ave, Miami Shores, Fl 33138
Tel: (305)795 -2204 • Fax; (305)756 -8972
PLEASE PRINT
1/ oAJ/ d H 4H
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 CL r A S c/7 6 n# L y No 1 r �r A/ C Street q g
Registered Architect andior Engineer /
7 - / joy
Name and address of licensed contractor
Location and legal description of lot to be built on:
Lot 2-O Block
Street and Number where work is to be done
State work to be done and purpose of building (by floors state exterior colors (submit samples)
A're / /i7e /,Slfi
and for no other purpose.
New Building Remodeling
To be constructed of Kind of foundation 7. Covering
Estimated Total cost of improvements $ e f ®�� P, Amount of Permit S B / • 0
Zone cubage required Plan Cubage
Distance to next nearest building Size of Building Lot
Maximum live load to be borne by each floor
1 hereby submit all 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 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 be performed
under this permit. as are licensed by Miami Shores Village.
Remarks (Signed)
STATE OF FLORIDA
COUNTY OF DADE.
Permit No.
}SS.
Before me, the undersigned authority. a notary public. duly authorized to administer oaths and take acknowledgments. personally appeared.
APPLICATION FOR BUILDING PERMIT
171.
MIAMI SHORES VILLAGE
BUILDING INSPECTION DEPARTMENT
Addition
and who. being by me first duly sworn, upon oath deposg5 and says that he is the Nw t%�
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.
HAROLD ALwfin
KVji Pt blip, Stata c Floes@
+ . Ore?.) U', �. fly, L n
J 6 T ' 71cral no. lthul.
Date
Disapproved Mate
(Signed) kikW
Building Inspector
7 .
Subdivision iel4// e '14 r 9/ M a 1/ (70 /1 A
07 Ct
Repairs No. of Stories
Read. Sworn to bscribed b
PLANNING BOARD DATE
Date ' j e- 19 7/
y Public, tate of, Florida
My Commission Expires 1� / ! V-
to me well known.
Chairman Member
Member Member
Member Member
Council Approved Tate Disapproved Date
NOTE: A charge of $25.00 will be trade for making corrections or changes to this application after approval has been obtained from the Planning Board.
A re-inspection fee of $25.00 will be charged when such re- inspection is made necessary by improper notice for inspection or faulty materials andior workmanship.
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1
AFF IDAVIT
STATE OF FLORIDA) SS
COUNTY OF DADE )
Z- .//�1/] ., of the Village of Miami Shores, County of Dade and
Stat f Florida, being duly sworn, doth depose and says that under the provisions
of Section B -368, Sub - section (d), of the :uildin_ Code of Miami Shores Village
he desires to buil ,...�.•;� , / a on Lot c=
Block ./7r of 4eLs u•. s on; that he is the owner of said
property, and Will do the work personally, and that he will, at such timed as are
requited by the Zoning and Building Director$
1. File plans and specifications and obtain approtal of Village Tanning Board
and of the Building Inspector.
2. Apply for and secure a permit.
3: Pay the required fees for license and for permit.
4 Execute the work in accordance with the provisions of the Zoning, Building,
and Electrical Codes of Miami Shores Village.
5; Apply for inspections•
6. File with the Building Inspector der!tificates that provision has been made
to carry the necessary Workman Compensation, Public Liability and t'roperty
Damage Insurance.
7. File with the Building Inspector as the job pregrosses certificates showing
the payment required by the Foder . Social Security Act to the State of
Florida or the Unitei.States of America,
8. Assume the responsibility of not employing, contractors or sub - contractors
other than those properly licensed by Miami Shores Village oT any part or
portion of the work including, but hot limited to, general contracting,
plumbing, heating, electrical, septic tank, solo* system, lathing, tile,
torrazo, painting, roofing and shoot metal work or installation.
9��,/ Not sot himself up as a "Contractile,
1®4 Execute $diidoris Bondi
And further this Deponent soya not.
1. Signature of Applicai$t.
2. Signature of Officer administering oaths
SUBSCRIBED AND SWORN TO BEFORE ME THIS of ______ D., 19