FUMIGATIONPERMIT APPLICATION FOR MUNICIPALITIES OF DADE COUNTY
(OWNER TO RETAIN COPY)
Job Address 1237 NE 99 St. Tax Folio // , 3 „us- o1 4 /
Legal Description �O / 6 Master Permit # 1
Owner / Lessee / Tenant Christopher Kelly
Owner's Address
Contracting Co.Guarantee Floridian P. C. Address 658 NW 99 St.
Qualifier SS# - - phone 758 -1811
State# Competency# 0 a/e/ Ins. Co.
Architect /Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL PAVING FENCE SIGN
WORK DESCRIPTION Pays will ha frAnfed 'Friday 2/7/A7
Square Ft. Estimated Cost �pOii
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, 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.
Signature of Owner and /or Condo President
Date:
Notary as to Owner and /or Condo President Notar i as to C tractor-or. 0 ne Builde 6
My Commission Expires: My Commission Expires T,
* *
25.00
757 -7325 Home
1237 NE 99 St. phone 754 -1617 Work
Fire Ofher
PERMIT FEE: APPROVED:
Zoning
Mechanical Plumbing Engineering
Building 2_ 46_7 2
Electrical
BUILDING ❑ MIAMI SHORES VILLAGE, FLORIDA
ELECTRICAL ❑
PLUMBING ❑ PERMIT N°
ROQFING ❑
Owner of
Building
Lat yu
Architect
Contract
or Builder c. t;wr �9f . I t- . 4
Legal
Description
Address of P. . e� J
Building 4 ' '}
Date
9054
Work to be performed under this Permit
. Contractor's
License No.
19
Subdi-
vision
Sq Ft
Value of II Amount of
$ 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 applica-
tion 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 respon-
sibility for work done by his agents, servants or employees.
Signed (INSPECTOR) BY
In consideration of the issuance to me this permit I a ee to perform the work covered hereunder in compliance with all ordinances and regulations
pertaining thereto and in strict conformity with the plans, drayydngs, statements or specifications submitted to the proper authorities of Miami Shores Village.
In accepting this permit I assume responsibility for all work drone by either, myself, my agent, servant or employee.
CONTRACTOR or BUILDER BY , AUTHORITY
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.
Owner's Name and Address._ •
Registered Architect and /or Engineer
Name and address of licensed contractor_._ _
Location and legal description of lot to be built on:
Lot Block Subdivision
Street and Number where work is to be done
State work to be done and purpose of building (by floors)
Date. qq ��fjj
No.___ a !___. Street 1 2
ate
Notary Public, State of Florida
9 s�
and for no other purpose.
New Building Remodeling Addition Repairs No. of Stories
To be constructed of Kind of fotridation 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 perrnit 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, Pennanent 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 subcontractors, on work to be performed under this
permit, as are licensed by Miami Shores Village. -
Remarks (Signed). 4/
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 J ____ ..... Date /J �� — !v _ Read, Sworn to and Subscribed before me.
Disapproved /''
(Signed) _LEI/ f // GG
Buil.. g Inspector My Commission Expires
PLANNING BOARD DATE
Chainnan 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.
p
APPLICATION NO.
APPLICATION
VIKANE X
FOR PERMIT TO FUMIGATE WITH CYANIDE METHYL BROMIDE ACRITET
DATE 19
1. Location of building to be fumigated 1237'N. E. 99 Street', Miami Shotes
2. Name and address of owner of premised. Alvarez
3. Type, size and construction of buildingCBS Res
4. Is entire building to be fumigaieu:' Yes
5. If not, state what portion
6. Approximate number of cubic feet of space in building or in portion to be fumigated.
34.000
7. Kind and quantity of fumigant to be used and manner of application and length of fumigation period
Vikane Approx 20 hours
8. Distance of nearest building and direction from building to be fumigated
over 1.0 ft
9. In what manner will vents to exterior of building be sealed?
Nylon tent
10. Date whem fumigation will be begun August 10, 1967
11. It is hereby agreed to station a guard on the premises to be fumigated during the fumigation period and to post
suitable placards at each entrance into the building bearing the following words in letters at least two inches
by one inch in size: "DANGER" — THIS BUILDING UNDER FUMIGATION WITH A DEADLY GAS."
12. It is hereby agreed to make such provisions that all openings into the building may be opened from the outside
after the period of fumigation is over and to take such other precautions as may be necessary to insure that all
of the fumigant is removed from the building before anyone is permitted to enter.
13. It is hereby agreed to notify the County Health Department when the building has been prepared for fumigation.
FIRM NAME: TRULY NOLEN, INC.
600 N. W. 7th Avenue
Miami 36, Florida
control o
(Signature of ertified pes
of this fum .ation job.)
Time
2:30 P.M.
ato in char