ROOFPERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Date Job Address /9,a3 N . F , g411? ST Tax Folio
Legal Description Historically Designated: Yes No X
Owner/Lessee / Tenant M r, DECK. Ed- Master Permit #
Owner's Address
/2a3 N.E. 94
Contracting Co. Tf Ho LOi E It -- Roo c) >v.3_ Address s 4 / A) . t) . / "1 9
Qualifier So M k3 1A)6:E. g SS# ' Phone 6 'f- /77n
State # Municipal # Competency # 1/ 977 Ins. Co. 1.,..t 0 / brti
Architect/Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICALCROOFINNPAVING FENCE SIGN
WORK DESCRIPTION Eip a► I r LE-14 (.2._) �i L � / ry C. 2 o A r
Square Ft 3 /J 7 Estimated Cost (value)
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.
Si g nature of owner and/or Con • // nt Date
/1)
Notary as to Owner and/or Condo President
My
0,0 PU FFI N DR NOTARY NOT L
IEL
2. 1 0 , f 0 COMMISSION NUMBER
►' ;`.: w C CC40126 1
"' . j MY COMMISSION .EXP.
OF FAO AUG. 17,1998
FEES: PERMIT
APPROVED:
Zoning
Mechanical
RADON
Building
Date
/— c( —cif
Phone 7 Sit - 4 D Lo.9
NOTARY.
Electrical
4 61/ :
C W.AQi` aka] ? 1 7
Signat e of Contractor or Owner- Builder Date
Notary as to Contractor or Owner- Builder Dgte
My Commission Expires: ///41/77
O P QV P OFFICIAL NOTARY SEAL
e■ SANDRA M MONTIEL
it Aw • * COMMISSION NUMBER
. 41 —9 Q C C 4 012 61
l'A F ta. MY COMMISSION .EXP.
OF FA AUG , 17,1096
BOND
Plumbing Engineering
❑ DATE
❑ PERMIT N? 15821
• Work to be performed under this Permit
BUILDING
ELECTRICAL
PLUMBING
ROOFING
Owner of
Building 4.:..,
t ..
Architect
Contractor
or Builder
Legal Lot II Bi.
Description
Address of
Building
CONTRACTOR OR BUILDER
MIAMI SHORES VILLAGE, FLORIDA
Subdi-
vision
Value of
Project $
Amt. of
Permit $
BY AUTHORITY
195
Contractor's
License No.
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 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 responsibility for work
done by his agents, servants or employees.
Signed: BY
INSPECTOR .�
In consideration of the issuance to me of this permit I agree to perform 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.
APPLICATION FOR BUILDING PERMIT
Application is hereby made for the approval of the det.. iled statemen of the plans and specifications herewith submitted for the build-
ing or o h. •• , ..:ructure her 1., described. This imlicatic is made in compliance and con•orm.ty wAli the Building Ordinance of Mia ii
Shores Villarte, 1 '.or.da, and all pro • isions of the Laws cf the Statc of Fh, rid. all o dmances uf Mi au Shores Village and all rules and
regu:a. ion, of the Building Div.. i of .iam Shoi illage h '1 ,e -ch ipl.ed with, whether herein specified or not. A copy of approved
plans and specificati m must be ke, -. at building durin„ progress of tl.e wcrk.
Date 2/24/54
745 Street 91t St ,19
.NE s
Owner': Name and Address_______Pala_XiiMeY No.
Registered Architect and/or Engineer.
Name .nd address of licensed contractor. Lang Roofing and Tile 0 .(1,4 430 N. W. 79th $t.
Location and legal description of lot to be built on:
Lot_ Block. Subdivision
Street and Number where work is to be done_ 1223 E— E—_99th
State work to be done and purpose of building (by floors)
and for no other purpose.
New Building. X Rernodeling Addition__ Repairs_ No. of Stories
To be constructed of _ _ Kind of foundation Roof Cov zing__ Tile
Estimated 7 -,tal cost of improvements $__ _925.00 Amount oF Permit $.
Zone -..ubage required Ylan Cubage
Distance to next nearest building__ _ _Size of Building Lot
Maximum live load to be borne by each floor_ _ _____
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 unde signed appli -ant for th's bulding permit does hereby certify t'iat he understands and accepts his ,..bligations as an employer
of 1 bor under he Florida Workmen's Compensation Act being S- -tion 5966. Coi p led Gen al Laws of Florida P r anen. Sipple nent,
and h •s compl ed w;th the prov• ;ions thereof, and will require smilar comp lance from all contractors or sub-contractors emplo 'ed by him
in the wol k to be p.11,-med under th;s pern it and "ill post or cause to be posted for inspection on the site of the work su :h public noti•e
or •otices as are requir d by the Act. The u. r ign •d agrees to employ only such abcontr. ctors, on work to be perform d . der this
permit as are licensed by Mrarn, Shores \ ge. Lang Roofing and Tile Co., Inc
Remarks (Signed)._
_ C/C/A64-reoPc. - -
STATE OF FLORIDA,
COUNTY OF DADE. ss.
Before me, the undersigned authority, a notary public, duly authorized to adm:nister oaths take acknowledgments, personally op-
peared
and who, being by me first d. ly vworn, upon oath depoc.es and says that he is the
of th abov. de ,c.ibed •.istruction t h has careially read the foregoing application, and that he did sign the same, and that all facts
therein by him stated are tr ie.
Permit No
Disapproved
(Signed)
Chairman
Member
Member
Council Approved.
/ssgal
MIAMI SHORES VILLAGE
BUILDIN INSPECTION DEPARTMEN
Date a ° - S4
mg Inspector My Com:nission Expires_
PLANNING BOARD _DATE
Member ,
Member
Member
Date Disapproved Date
NOTE: A charge of $1.00 will be made for making corrections or changes to this application Ifter approval his been obtained from
the Planr ng Board
A re-inspecti ee of $1.00 will be charged when such re-inspection is nude necessary by improper notice for inspel.tw or fa. Ity
materials and/o orkmanship.
Read, Sworn to and Subscribed before me.
Notary Public State of Florida
to me well known,