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ROOFINGDate 1 Job Address Legal Description Owner / Lessee / Tenant Owner's Address Contracting Co. &1I P-T(a5 RV(- Qualifier 1'4'a- m4( T (4, Lgi-Fe / Phone State # RC °O1 ° Municipal # 1` Competency # (03. Ins.Co. Architect /Engineer Address Bonding Company Address Mortgagor Address Permit Type(circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING PENCE SIGN WORK DESCRIPTION k{Qea 0.2 ' - 7 - ;le T - 7 - 77.c 3.0 -y(5- l'orr,,p �b ` k w l 'TJ / ti C 4q -1/ ab\jort. �� TTT y / Square Ft. 2 Z a 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 he above -named contractor to do the work stated. Signature of owner and /or Condo President Date: Notary as to Owner and /or Condo resident My Commi s s p ICHELLE GIBSON • i ` 1SSION # CC 488152 IM EXPIRES AUG 13, 1999 * o �* � BONDED U ATLANIft &ONDING"CO., MIC. ** * FEES: PERMIT V' RADON APPROVED: A J u2 V1PJC �r PERMIT APPLICATION FOR MIAMI SHORES VILLAGE 119 (Q.6. q9 sT pig t-1-6. qy sT * Zoning Mechanical C.C.F. Signature of Contractor or Owner- Builder Date: Mic( &/ / 4 /act-1 e.. Pa.eS lb eA,Yr Notary asAq,.Contt 9 [ g 9 9 uilder My Comm4F SON ••0162 DES AUG 13, TZ BONDED rw311 i C fiONLIINO CYO., :itD. * ** _�.. 3©vr NOTARY `-' 0 TOTAL DUE37 /• T Tax Folio Master Permit # ; ' , f 2/f Phone C/. Address 1(3 t..,iNco 4.J ST / 4 (3 c ) 9c(5-.2y(,7 Fire Other .qtr �J Gj BuildinR`L ' ''� A r y Electrical Plumbing Engineering NOTICE OF COMMENCEMENT PERMIT NO. TAX FOLIO NO. STATE OF FLORIDA: COUNTY OF DADE: THE UNDERSIGNED hereby gives notice that improvements 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. I`( N.e. 99 s7- 1. Legal description of property and street address: M I ST *(1.c) ( 2. Description of improvement: P( F a2 D Ao 3. Owner(s) name and address: 2 yr c e Jr 141 N e- 7? s r INVA,vt. Fl Interest in property: Name and address of fee simple titleholder: 4. Contractor's name and address: 1T 11 4 T1-5 R(-'G X2 t ( 3 1,i i J c alb S // w0 0 /G/ 5. Surety:(Payment bond q ired by 'owner from contr / irt ti -- C,�CCI Name and address: (�' G?,,Y Amount of bond $ 6. Lender's name and address: Signature of Owner Print Owners Name A J r Jrt., ! A , Notary Public �, _._�,..�._. •da Print Notary's Name .,;' • My Commission Expir es: 1.10 i r;;; ATLANTIC SONBINQ r;rL HELLE GIB SON 1 t.!G t? lgg9 1 Sworn to and subscribed before me this 12 day of r4. , 19 5'7 . 99R077176 1999 FEB 12 10:37 a 2 V ;MATE OF FLORIDA, COUNTY OF DADE HEREBY CERTifY ghat this is a gnu < co of fho original •' . d i i gh ;s offico on u . of MINESS ny h,nd and •Picks' soal. HARVEYRUJIIA ER of Circuitard county Courts 7. Persons within the State of Florida designated by Owner upon whom notices or other documeT may be served as provided by Section 713.13(1)(a)7., FI 2�a S atutes, Name and address: 1 8. In addition to himself, Owner deli nates the following person(s) to receive a copy of the Lienor's Notice as provided in Section 713.13(1)(b), Florida Stage Name and address: ,Nl 9. Expiration date of this Notice of Commencement: (the expiration date is 1 year from the date of recording unless a different date is specified) Prepared by: M ;C(44 T ( o - ILC(/. Address: .I G +tJ(°l 5 T. /40 (1 . 3362.6 Contractor's Name: Aar Arks 2 o- S Fk 2':k Job Address: 7 7 1 ' - ` e ' / 9 s ' — ROOF CATEGORY ��/ ❑ (Low Slope Application) ❑ (Nail -On Tile) R(Mortar- Adhesive Set Tile) ❑ (Asphalt/Fiberglass Shingles) ❑ ( Metal Roofs \Wood Shingles & Shakes) ❑ (Other) ROOF TYPE ❑ New Roof Re roofing ❑ Recovering ❑ Repair ❑ Maintenance Flat Roof Area (ft Sloped Roof Area (ft )) D Total (ft AO 43 Master Permit No. Exposure category (per ASCE 7 -88): Building Classification category (per ASCE 7 -88 table 1): __ Ft. Ft. A V A V Deck type: ATTACHMENT Fastener Type: Field: SPACING Perimeter: Corner: DETAIL 1 & 2 ROOF HEIGHT AND SYSTEM DETAILS (Draw details as needed) 1J r ROOF PLAN 123.01 -78 9/96 Appendix "E" UNIFORM ROOFING PERMIT APPLICATION PROCESS No. Page -1 Ridge Ventilation? MEAN HEIGHT L2 Deck type: 1X. Underiaynlent: Appendix "E" UNIFORM ROOFING PERMIT APPLICATION PROCESS No. Insulation: 12" ROOF SLOPL D E T A I L 3 (Pmaxi: 2- c ? (Aerodynamic Multiplier): (Pmax2: < <1' 3 x X (Aerodynamic Multiplier): (Pmax3: 117.1 X (Aerodynamic Multiplier): SLOPED SYSTEM DESCRIPTION fisr eA 3D4 Fastener type & spacing: Cap Sheet: Roof overing: i Drip edge: TILE CALCULATIONS ) - M ` 43 = Mr1:' / • ° PCA: Y(' �c '° ) - M = Mr2: -2 7'22 PCA: C . 4 ( , a 9 ). M ➢ = M k( y r4/) 4N SK P4 6 41,•-t-^" L c ATTACHMENTS REQUIRED 1) Fire Directory Listing Page 2) Dade County Product Control Notice of Acceptance -Cover Sheet a) Specific System Description b) Specific System Limitation c) General Limitations d) Applicable Detail Drawings 3) Municipal Permit Application 4) Other Component Approvals OCD - L4'10 ,vt !U•'.0 +n M. ,):'r :. . 1 rJ . k r'. q . Le gip METROPOLITAN DADE COUNTY, FLORIDA METRO -DADE FLAGLER BUILDING • 9VILDING COOE COMPLIANCE OFFICE ME7R0•CADEE FLAMER SU'LDIMO :e0 NEST FLAMER STREET. SUITE 1603 MIAMI. FLOR:OA 33133.1563 PRODUCT CONTROL NOTICE OF ACCEPTANCE ;305) 3'5. 2901 FAX (305) 375.2901 Alninr (USA), Inc. 6645 Northwest 77th Avenue Miarni, FL 33166 Your application for product Approval of: AItusa Tile Nail - On, Mortar Set or Adhesive Set One Piece "S" Tile Roofing Tile under Chapter 8 of the Metropolitans Dade County Code governing the use of Alternate Materials and Types of Construction, and completely described in the plans, specifications and calculations as submitted by: Redland Technologies, The Center for Applied Engineering, Inc. has been recommended for acceptance by the Building Code Compliance Office to be used in Dade County, Florida under the specific conditions set forth on pages 2.16 and the standard conditions on page I7. This approval shall not be valid after the expiration date stated below. The Building Code Compliance Office reserves the right to secure this product or material at any time from a jobsite or manufacturer's plant for quality control testing, If this product or material faits to perform in the approved manner, the Building Code Compliance Office may revoke, modify, or suspend the use of such product or material immediately, The Building Code Compliance Office reserves the right to revolve this approval, if it is determined by the Building Code Compliance Office that this product or material falls to meet the requirements of the South Florida Building Code. The expense of such testing will be incurred by the manufacturer. ACCEPTANCE NO.: 97-0918.02 Renews 26.1030.03 EXPIRES: 02/13/00 ' Raul Rodriguez Product Control Division Supervisor THIS IS THE COtIRSHUT ApDITIONAL PAGES FOR SP ECIF(C AND GENERAL CONDITIONS BUILDING CODE COMMITTEE This application for Product Approval has been reNiewed by the Metropolitan Dade County a ding Code Compliance Of` ee and approved by the Building Code Committee to be use in rade County. Fv ri a under the conditions set forth above. APPROVED: 02113/97 rn;. t +l'. JJY 17; 11Q2 1. I PRODUCT CONTROL 0:VISION (33S) 375.2902 FAX (305) 372.6339 Charles Danger, P.E Director Building Code Compliance Dept Atetropotitan Dade Coolly Z./ reo �u +�: +�•�� xl A rc. App :leant: Altusa Tile Alfareria del Turbie, S.A. Barquisimeto, Venezuela PRODUCT CONTROL, NOTICE OF ACCEPTANCE ROOFING SYSTEM APPROVAL Cateaorv: Prepared Roofing Sub - Category: Tile Tvpe: Nail- on/Mortar Set/Adhesive Set Sub -Tvpe: Clay Alfareria del Turbio, S.A. (Altusa), located in Barquisirneto, Venezuela, manufacturers clay roof the for nail -on, mortar set or adhesive set applications. All tile is manufactured from natural Venezuelan clays. This Product Co)(gj Appf9val relates to Altusa's "Altusa S° We prof le. Refer to_appropriate Product Control Aooryvals for othertile_profites. The "Altusa S" tile profile is available in a variety of natural clay colors and has matching trim pieces used for rake hip, ridge hip, and valley terminations. These accessories are manufactured for all profiles and form a part of this Product Control Approval. Optional rubber or clay cave closures are also available. Altusa roof tiles have been tested in compliance with the South Florida Building Code requirements for clay, nail-on, mortar set or adhesive set tile applications. The minimum roof slope for the "Altusa S" nail -on Wes shall be 2":l2". See the "Profile Drawing" section in this approval for the "Altusa S" profile drawing, The "Altusa S" profile has been tested for both wind characteristics and static uplift performance, therefore, any consideration for installation shall be done as a 'Moment Based System'. Data for attachment calculations is noted in Tables 1 through 4 of this Approval. A'rrar (USA), Inc., located in Miami, Florida, is the sole approved importer under contract for selling and distributing Altusa prod.icts in the South Florida jurisdiction. • System Description Contact; Carlos J. Fernandez General Manager Altusa Tile, Almar (USA), Inc 6545 Northwest 77th Avenue Miami, FL 33166 (305) 471-5830 1 ri1 nv 7'.Y 't :1 7'VJ Frank Zuloaga Product Control No Approval Date: Expiration Date: Product Control No.. 97- 0918.02 .: 97- 0918.02 February 13, 1997 February 13, 2000 6 , 5 , V 1 4W gg WO WV OM Trim Pieces end* fl 417 T41 11VJ t. - TRADE NAMES OF PRODUCTS MANUFACTURED OR LABELED BY APPLICANT Test Product Prod uct Dimension{ Specifications, pcscriptIon Altusa One Picce "S" 1.. 13 W PA 112 Nigh profile clay roof the for direct Tile w - 10 W deck or battened nail•on, mortar or ''A" thick adhesive set applications. I ead•lap min. 2�h " Exposure max. 16 I = varies w - varies PA 112 Frank Zuloaga Product Control No.: 97. 0918.42 Accessory trim, clay roof pieces for use at hips, rakes, ridges and valley terminations. f 10 4. 4, •V - - t/ ,• n 4 Produc g30 Felt 043 Coated Base Sheet Mineral Surface Cap Sheet Rainproof 11 Ice and Water Shield Mopping Asphalt Flashing Cement 64 •• W. ... • r • • Lenzingtex -ZB 140 59" x 164' roll Underlayment 22 Ibs/roll TRADE NAMES OF PRODUCTS MANUFACTURED OTHERS Dimensions N/A NIA N/A 30" x 75' roll 36" x 7S' roll or 60 "x 75' roll 36" x 75' roll NIA N/A Test §teciticajlons ' ASTM D 226 type 11 ASTM D 2626 ASTM D 249 PA 104 PA 104 PA 103 ASTM D 312 type III or IV ASTM D 4586 4 • 4444 ,\ :, 447 / 1 1 1 S Product Description Saturated organic felt to be used as a nailed anchor sheet, Saturated and coated organic base sheet for single or double ply underiayment: Mineral surfaced asphalt roll roofing for use as a top ply in a double ply underlayment system. Single ply, nail -on underlayment. Single ply, rail -on underlayment with 2" • self-adhering top edge. Self - adhering underlayment for use as a top ply in a two ply underlayment system with Approved b30 or N43 as the base layer. Asphalt for bonding a mineral surface cap to a meth. attached base sheet in a double ply underlayment system. Cut back, asphalt based, asbestos free, fiber reinforced, trovcl grade cement for repair and flashing applications T Product Control No.: 97- 0918.02 Manufacturer generic' generic generic Lenzing Performance, Inc. with current PCA Protect•O -Wrap, Inc. • with current PCA W.R. Grace Co. with current PCA generic generic FE6 dd 1 Aid A6'., ;,;Jt!' :L Test Product ' Product pimersions Specifications Description Manufacturer Asphalt Primer NSA ASTM 0 4l Cut back, asphalt generic based coating used to facilitate bonding of dissimilar materials. Rooi'tng Nails Tin Caps Wood Battens Hurricane Clip & Fasteners Roof Tile Mortar ( "TileTiteT"") min. 12 ga. with 'I head PA 114 Appendix E eV: NO. 954 49! 4C19 F. 5 Annular rang shank, hot dipped, electro or mechanically galv. rooting nails for use in underlayment attachment. min. 32 ga. PA 114 Corrosion resistant mist. 1 o.d. Appendix E circular disc for use in max. 2" o.d, underlayment attachment vertical Wood Preservers Salt pressure treated min. 1 x 4" institute LP • 2 or decay resistant lumber battens horizontal min. I" x 4'' for use with vertical battens or min. I " x 2" for use alone PA 114 Corrosion resistant min. A" width Appendix E bronze, aluminum, rain. 0.062" thick stainless steel, galvanized steel or Clip Fasteners plastic attachment min. 8d x I' /." clips for supplemental tile attachment. Clips are installed with corrosion resistant roofng nails compatible with the clip. A hurricane clip • is required on all nail-on eave tiles. ?�' PA !23 Prepared mortar mix designed for mortar set roof tile eppl.cations. Product Control No.: 97.0918.02 generic generic generic generic Bermuda Roof Company, Inc. with eaten! PCA • b, • Prod Roof The Mortar (' Quikrete.T Roe Tile Mortar x 1 140') Roof Tile Adhesive ( "PolyproSG AH160 ") Valley Flashing Drip Edge flSY. V 4 1 4 I N pimensions, N/A N/A min. 26 ga. min. 16" width min. 26 ga. min. 2" face flange min. 2" deck flange Test Specifications PA 123 See PCA ASTM A 525 rnn 'W. .7.T 1 7VJ Funk Zulosgs Product DeIcription Prepared mortar mix designed for mortar set roof tile applications. Product Ccntrol No.: ,97.0918.02 Two component polyurethane adhesive designed for adhesive set roof tile applications. _ Galvanized steel valley flashing PA 111 Galvanized steel drip edge Manufacturer Quikrete Construction. Products with current PCA Pclyfoam Products, Inc. with current PCA generic generic rcc ct » avc £U•1.10 Test . A¢eccv Test IdentlRer Test,ame'Repert Date TesN.e Craig Laboratories Lab. #AAP -2 ASTM 1 :67 Oct. 1994 8; Consultants, Inc. Redland Technologies 7161.03 Static Uplift Testing Dec. 1991 Appendix 111 PA 102 R.edlane Technologies 7161.03 Wind Tunnel Testing Dec. 1991 Appendix 11 PA 108 (Nail -On) Redland Technologies Letter Dated Aug. I, 1994 Wind Tunnel Testing Aug. 1994 PA 108 (Jai : -On) Redland Technologies P0631.01 Wind Tunnel Testing July 1994 • PA 108 (M.ottar Set) Redland Technologies PO402 Withdrawal Resistance Testing Sept. 1993 Redland Technologies 7161.03 Appendix 111 The Center for Applied 94.83 Engineering, Inc. The Center for Applied 94-084 Engineering, Inc, The Center for Applied 25.7200.1 Engineering, Inc. TEST REPORTS rrla 11 1 „ 524 44r t, 1 Frank Zuloaga of screw vs. smooth shank nails Static Uplift Testing PA 101 (Adhesive Set) Static Uplift Testing PA 101 (Mortar Set) Static Uplift Testing PA 102 (Quick -Drive Screws, Battens) The Center for Applied Project No. 307025 . Engineering. Inc. Test i;MDC -78 PA 100 Product Control No.: 97.0915.02 Static Uplift Testing Dec. 1991 PA 102(A) Wind Driven Rain Oct. 1994 April 1994 May 1994 Feb. 1995 r :r ti ,3 c c:: 1U•t;t~ x7 ncu. JV:c1.1. Deck Type: Wood, Non - insulated Deck Description.: New Constriction I''/ or greater plywood or wood plank. SYSTEM A: Counter - Batten Application Slope Range: SYSTEMS rAA Product Control No.: 97-09)8.02 2 ": I2" to 7 ":12" Note: Counter - Battens, as noted below, are required for slope range : " :12" to less than 4 ":12" and are optional for slopes of4 " :12" to 7 ":12 ". For slopes exceeding 7 ":12 ", refer to System C. t:nderlayment: Install underlayment system in compliance with Dade County Application Standard PA 118. Vertical Battens: Install vertical battens in compliance with Dade County Application Standard PA 118 Horizontal Battens: Install 'horizontal battens in compliance with Dade County Application Standard PA 118. Rooting Tile: Install tile in compliance with Dade County Application Standard PA 118. (See "Data for Attachment Calculations" included in this Approval.) Comments: 1. For re -roof applications, "/7 plywood is an acceptable substrate. Fran Zuloaga IS I rcc ct Qv :vc :V. JO AA ADV. �v:: :1. SYSTEMS (CONTINUED) rRA [iv. 771 171 1107 C. 0 Deck Type: Wood. Non - insulated Deck Description: New construction 19 6" or greater plywood or wood plank. SYSTEM 13: Direct Deck Application Product Control No.: 97- 0918.02 Slope Range: 4 ":12" to 7 ":12" Note: System B is only acceptable in this slope range. For slopes less than 4 ":12 ", refer to System A. For slopes in excess of 7 ":12 ", refer to System C. Underlayment: Roofing Tile: Comments: Install underlayrtent system in compliance with Dade County Application Standard PA 118. Install tile in compliance with Dade County Application Standard PA 1 I8. (See "Data for Attachment Calculations" included In this Approval.) 1. For re -roof applications, " /, :" plywood is an acceptable substrate. SYSTEMS (CONTINUED) VA,: V. 7J7 74I T1•:4 I. IV Deck Typc: wood, N on• insulated Deck Description: New construction " / or greater plywood or wood plank. SYSTEM C: Horizontal Batten Application Product Control No.: 97.091$.02 Slope Range: 4 ": ! 2" or greater Note: Horizontal battens, as noted below, are required for slopes in excess of 7 " :12" and are optional for slopes 01'4 to 7 ";12 ". For slopes less than 4 ":12 ", refer to System A. Underlayment: install ur.derlayment system in compliance with Dade County Application Standard PA 119. Horizontal Battens: Install horizontal battens in compliance with Dade County Application Standard PA 119. Roofing Tile: Install tile in compliance with Dade County Application Standard PA 119. (See "Data for Attachment Calculations" included in this Approval.) Comments: I. For re -roof applications, Isl » " plywood is an acceptable substrate, Frank Zuloage r"-L7 ,J'J 1'414 £. t n4 V, W.&4r1 SYSTEMS (CONTINUED) Deck Type: Wood. Non-insulated Deck Description: New construction 1 ° /," or greater plywood cr wood plank. SYSTEM D: Mortar or Adhesive Set Application Slope Range: 2 " :12" to 7 ":12" Note: System D is only acceptable in this slope range. For slopes in excess of 7 ":1I2 ", refer to System C. Undcrlayment: Install underlayment system in compliance with Dade County Application Standard PA 123. (See System Limitation NS.) Rooting Tile: Install tile in compliance with Dade County Application Standard PA 120. (See "Data for Attachment Calculations" included in this Approval.) Comments: 1. For re•roof applica :ions,'$ /»" plywood is an acceptable substrate. CAA AV. J74 YJl IIQJ r. 11 Frank Zuloaga Product Con:rol No.: 9 7•4918.02 Table 2: Restoring Moments duo to Gravity • M (ft•Ibf) from PA 102 Testing Tile Profile 3 ":12" or less 4 ":12" S " :12" 6 " :12" 7 ":12" or g reater Battens Direct Deck Battens Direct Deck Battens Direct Deck Battens Direct Deck Battens 1 Direct ' Deck Altuse 'S' Tile f 4.47 5.35 4.40 5.27 1 4.31 5.16 4.20 5.03 4.08 N/A Table 3: Attachment Resistance Expressed as a Moment - M! (tt -Ibf) from PA 102 and PA 102(A) Testing Tile Profile TILE APPLICATION • APPROVED NAILS I APPROVED' SCREWS I APPROVED FIELD CLIP WITH: APPROVED EAVES CLIP WITH: 1 nail 1 2 nails • 1 screw 2 screws 1 naJ 2 nails 1 nal! [ 2 nails Altusa'S' Tile L. Battens N/A N/A NIA 28.80 WA NIA NIA • N/A Direct Deck 13,20 1 8.40 28.70 58.20 21.20 25.30 28.90 t 34.90 L rez cti 77 :.c AA • r c.. .�r; r.t: :v . DATA FOR ATTACHMENT CALCULATIONS it,7 r. I Prod'4c: Control No : 97.0918.02 Table 1: Aerodynamic Multipliers • k (ft') Tile 1, (ft') a. (it') Profile —I Application Direct Deek Application r Altusa'S' Tile 1 C.29 0.31 ' 1. Quik•Drive screws installed n two manufactured holes located 134 and 1'!," from the had of the tila. Table 4: Attachment Resistance Expressed as a Moment • M (ft•Ibf) from PA 101 Testing Tits Profile Tile Application Altusa 'S' Too Mortar Set Adhesive Set Attachment Resistance 24.50 66.50 12 Fr >tn Zulco; �"""' • r o GT IV. l • PA .G . .4.., L CxJE 14, 10-i/ Z' 13 CAA ak). 771 17I 11• PROFILE DRAw'INC ALTUSA "S" CLAY ROOF TILE ACCESSORIES Frank Zuloiga Product Control No.: 97 - 0918.02 •■• • NAIL HOLE BIRD STOP 14 ran. Z.uloaja Prod; t Control No.: S1'±plag,2. GABLE-RAKE BUILDING ELECTRICAL PLUMBING ROOFING Owner of Building Architect Contractor or Builder Legal Description Address of Building 11 Bl Lat /9 CONTRACTOR or BUILDER MIAMI SHORES VILLAGE, FLORIDA PERMIT N9 8870 Work to be performed under this 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 his assumes respon- sibility for work done by his agents, servants or employees. Signed• 4„,,,,:// 6i L 'ate (INSPECTOR) BY In consideration of the issuance to me of this perm I agree to perform the work covered hereunder in compliance with all ordinances and regulations pertaining thereto and in strict conformity with the plans, rawings, 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. • 4 e Date (- Contractor's License No. Subdi- vision Sq Ft Value of L 11 Amount of - Project $ f 44? _Co II Permit $ BY AUTHORITY l 19 _/ APPLICATION FOR BUILDING PERMIT Application is hereby made for the approyal 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... _A74.0 u fi v Registered Architect and /or Engineer._ _.. r _ __ Name and address of licensed contractor-( 2 f ✓ .. / / - a x i r . / � P. /._ S O.EZ4 4 ///o3.3 A(LO / d r _ Location and legal description of lot to be built on: Lot-_ Block .. Subdivision Street and Number where work is to be done./ _ T -7 11 (1 57; y e State work to be done and purpose of building (by floors) _ ____ ' ._ GOF 1 3 1 G / / 0 i j 17 7f l A- r 714 P_ Zone cubage required Distance to next nearest building_ Maximum live load to be borne by each floor Chairman Member Member Council Approved MIAMI SHORES VILLAGE BUILDING INSPECTION DEPARTMENT PLANNING BOARD__ __ . DATE Member Member _ – Member . Date Disapproved Date rV WE / V ,19_.5 No.L. J._. __. Street._.t1 F 77 5 7- � and for no other purpose. New Building Remodeling Addition Repairs No. of Stories To be constructed of Kind of found�tjon_.__ Roof Covering.__ 7X 4 ' Estimated Total cost of improvements $___J Oc k570 Amount of Permit $ _Plan Cubage__ _. Size of Building Lot I hereby submit all the plans and specifications foi said building. All notices with reference to the building and its construction may be sent to.. – -- The undersigned applicant for this building permit dot hereby certify that he understands and accepts his obligations as an employer of labor under the Florida Workmen s Compensation Act, being Section 5968, Compiled General Laws of Florida, Pennanent 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 ) - r; STATE OF FLORIDA, COUNTY OF DADE. j 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 £D a Date.__L� / — ,0 ___ 4 7 Read, Sworn to and Subscribed before me. Disapproved ____ _ _ _ . D / , Notary Public, State of Florida (Signed) - -LPL.! -� -- -- -- -- - - - -� - •- -- - - Building pector My Commission Expires__ 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.