304 NE 99 St (11)Date I 1 ime
Type Insp'n
Permit No.
Name
Address
Company pa
3 as---
Phone #
For Inspector:, 0 /i Name & Date
Approved
Correction
Re- Insp'n Fee
MIAMI SHORES VILLAGE
BUILDING DEPARTMENT
305- 795 -2204
Building Inspection Request
ccW / ell
bS
Date
Type Insp
4 Permit No.
Name VD-
Address c ) 'f r •
Company er+"—+
Phone #
MIAMI SHORES VILLAGE
BUILDING DEPARTMENT
305- 795 -2204
Building Inspection Request
Time
For Inspector: 04 1 D Name & ate
Approved [ ®/7 ��
Correction ❑
Re- Insp'n Fee ❑
Date
Type Insp'n
Permit No.
Name
Address
Company
Approved
Correction
Re- Insp'n Fee
MIAMI SHORES VILLAGE
BUILDING DEPARTMENT
305- 795 -2204
Building Inspection Request
0 ime
0 1
.
Phone #3 ds 3
For Inspector /3o /ti �_j
Date
d ad 0
\;
� Miami Shores g
Mii Sh Village
` n 10050 NE 2nd Avenue
Phone: 305 -795 -2204
1Y Printed: 9/18/2002
0
0 - Applicant: JOHN
(� Owner: FORBES
JOB ADDRESS: 304 NE 99
Contractor PADRON BRICK SALES INC
Local Phone: 305 - 378 -1000
0
1
Fees:
r FEE2002 -5221
FEE2002 -5223
FEE2002 -5239
Permit Status: Approved
FOR
Parcel # 1132060135600 Legal Description:
work• RRICK DRIVEWAY
Bank of America.
.
ACH R/T 063100277
Description
Buildier's Bond
CCF
Building Fee
Total Fees:
Permit Expiration:
PADRON BRICK SALES INC.
954 -434 -6800
4474 WESTON RD., NO. 228
DAVIE, FL 33331 -3195
11 '00 L 5 3411' 1:06 30000 71: 00 38'7
Building Permit
Permit Number: BP2002 -1610
3/17/2003
FORBES
JOHN
ST
Contractor's Address: 16155 SW 117 AVE
MIAMI SHORES SEC 1 AMD PB 10 - 70 LOT 11 & 12 BLK 41 LOT SIZE 100.000
Construction Value:
.r—i�mmimrf C3 fi r— iamile r-t3m®mrirr xn r=r2w:�u�r.r
_ __ ..— .nItti.
'emqrZ:�� ^�ffia rsv �mtler- _r�.�....- - �iitmn'snncr�vsizm�-r.
5 1911'
Amount
$300.00
$4.20
$100.00
$404.20
$6,500.00
DATE
PAY TO THE
ORDER OF Ai A h1 S p Vi
1$ Yoy. zo
DOLLARS 8
1534
63 -4/630 FL
893
Page 1 of 1
16
Total Fees: $404.20
Total Receipts: $0.00
. Re- inspection
)plication herefor in strict compliance with all
ecifications that may have been submitted to
ices or if the plans are changed without
•esponsibility for a thorough knowledge of the
nd that he assumes responsibility for work done
lations pertaining thereto and in strict conformity
me responisibility for all work done by either
OFF. REC.8A.
20537PG0507
NOTICE OF COMMENCEMENT
A RECORDED COPY MUST BE POSTED ON THE JOB SITE AT TIME OF FIRST INSPECTION
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:
1. Legal description of property and street address: `Z Z / s L`' `/ 6
H >i A iL-•�
2. Description of improvement: Gz..774C .ti;V �'-`' A
6a/Ar-D - r
Z2 SL--' /64 s - f-r r>A .-. t , -,,.o
3. Owner (s) name and address:
Interest in property:
Name and address of fee simple titleholder:
4. Contractor's name and address:
y7 '/ Ltd 4 3 7
5. Surety: (Payment bond required by owner from contractor, if any)
Name and address:
Amount of bond: $
6. Lender's name and address:
Name and address:
8. In addition to himself, Owner designates the following person (s) to receive a copy of the Lienor's Notice as
provided in Section 713. 13 (1) (b ) 7., Florida Statutes.
7. Persons within 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:
P 4c(Lc,#_) g0
rz 2 2 -iP' j, c - /-0 3 3 33
9. Expiration date of this Notice of Commencement (the expiration date
unless a different date in specified)
,/&.2-) .t�.e.---
Signatureaf_ v
Print Owner's Name / 1 y� A M O k e g P A
Sworn to and subscri - • befor me t�s / day o ✓4, 20 V
Notary Public 4111 .,/..,/
/
Print Notary's N. re /t1 % zD
My Commission Expires: /--r / -_ 4 ) , ...;:.r.",„ M. C. PADRON
* MY COMMISSION # DD 055049
.6 EXPIRES: September 30, 2005
c og- Bonded Thru Budget Notary Services
02R446558 2002 JUL 18 10:14
RECORDED IN OFFICIAL RECORDS BOOK
OF DADE COcnrY Ramat
RECORD VERIFIED -
HARVEY RUVIN
CLERK CIRCUIT CouRT
is 1 year from the date of recording
Prepared by: A 6 t---
Address: �� -it Pb 11ti- t `'4'
`...Dp,-cr, FlA f333/
•
m arni Shore6 '9p
10050 N.E. SECOND AVE.
MIAMI SHORES. FLORIDA 33138 - 2382
Telephone: (305) 795 -2207
Fax: 1305) -756 -8972
COVENANT OF CONSTRUCTION WITHIN RIGHT OF WAY
WHEREAS, y U N 4 , hereinafter referred to as the Owner of the
(owner)
following described property:
Legal description/folio #:
Lot 1 1 / 1 Z - Block V 1 Subdivision CecA ru ...
Tax Folio #:
requests permission to install:
[eKsphalt, concrete, brick pavers
[ ] Landscaping
[ ] Other
within the public road right of way of 19)1 A./ G 9 q 2
-1,-.e e.
(address)
IN CONSIDERATION of the approval of this permit by the Village, the Owner agrees as follows:
1. To maintain and repair, when necessary, the above- mentioned item(s) installed within the dedicated right
of way. If it becomes necessary for Miami Shores Village or Dade County to make repairs or maintain said
items within public right of way including restoration of street by reason of the Owner's failure to do so,
such expense shall be paid by the Owner or shall constitute a lien against the above described property
until paid.
2. The owner does hereby agree to indemnify and hold Miami Shores Village or dade County harmless from
any and all liability, which may rise by virtue of permitting the installation of these items within the public
right of way.
3. The Owner does hereby agree to remove or relocate their facilities at their own expense, within 60 days
notice by the Village to do so. Failure to comply with this notice will result in the Village causing the
item(s) to be removed and a lien being placed on the property and/or assessed against the Owner for all
costs incurred in the removal and disposal of the item(s).
4. The undersigned further agrees that these conditions shall be deemed a covenant running with the land and
shall remain in full force and effect and be binding on the undersigned, their heirs and assigns, until such
time as this obligation has been canceled by an affidavit filed in the Public records of Dade County, Florida
by the Village Manager of Miami Shores Village (or his fully authorized representative).
SIGNED, SEALED, EXECUTED AND ACKNOWLEDGE on this /3 day of
SIGNED. SEALED AND DELIVERED in the presence of:
14 0F Ft
M. C. PADRON
* MY COMMISSION # DD 055049
• EXPIRES: September30, 2005
Bonded Thru Budget Notary Services
pt`tvCwir
f� PPRo,' ctf
.Q. �C'.
sir
e
• .
lI \' , �
wee ti
01 /,.ay5' ' 7
• - •
,y
c L d'
0 0
A
j ,
e
)
i
1s �6
•1 _
Zor i�g
Approved 1 1
3•.
. c�c,
rr-
�
soy 47,
•
This property described as:
Lots 11 and 12, Block 41
AN AMENDED PLAT.OF
MIAMI. :SHORES :SECTIQN..NO:.
.•. according . to 'the'Plat
thereof,' as 'recorded in
Plat Book 10, Page 70
of the Public Records of
Dade County, Florida.
FLOOD ZONE: X
FLOOD INFORMATION:
Community No. 120652
Panel No.: 93 Suffix: J
Date of F. I . R. M.: 3-2-94
Base Not Available
PROPERTY OF:
Forbes, John L. and
— ' Not valid unless embossed 'A BOUNDARY SUM f
with Surveyor's Seal. I hereby crusts that the survey repro•
rented hereon meets the minimum
technical standards set forth by the Board
01 Lan rcyevors in chapter 61617.6
florga Ad • 'notarise Code pursuant to
chon, ...017. f Ia. Steno tire are no
imr rn menu, ow• s. easemenh
ap . aunt{ urt the .t. other than a.
rwn hereto.
•
11 Beg. land Yur eyor M.
/ ,/6 es
Note: Underground encroachments
and utilities, if any., not located. :
Fence ownership by visual means only,
legal ownership not.determined.
Certified To -. Rapid Title Services Company,
Attorneys' Title Insurance Fund, Inc.,
Forbes, John L. and Claveria, Lillian and
Suncoast Savings and Loan Association, FSA,
A Federally Chartered Savings Association,
its successors and /or assigns.
e� :4-7—vCte
Z ?....5 Vii' ,..
cl.• c c' .=•∎— ' L./ .; e—
C/ /; ate /rJ h' ('I �xJ..,
ti /
. J . `
�'� i 4P.:?..- ::....
1 e): / 67.e ? , (,
1 /
A.34: Li.' .,
'✓ CH C. - O!a Z / ..A.,..77'
Ga - Go•7 <•.i
4 2 ! .i. ✓�^ 6ry #...� - 1 4 .. -.�
T 41
Claveria, Lillian, 304 N.E. 99th Street, Miami Shores,
Florida 33138.
CANNES and GARCIA, INC.
ENGINEERS - LAND SURVEYORS - LAND PLANNERS
Mailing address: P.O. Box 561131• Miami. Florida 33156
(305) 666 -7909 (305)523 -8663 •
•
z
0
W
DATE , DRAWN BY DRWG: NO
cs /V15 I /x - 20' I O/ 35589
i
• .
0
0
W
z
0
z
0
2
W
Office address: 359 Alcazar Ave'riue, Coral Gables, Florida 33114
CONTRACTOR
Name TO l N
Name (4 0 az, *-, i !t-‘ g---
License No. c S' C
A / j 36/
Address (/y7 y
D A.--t' e
C‘/CS tiC # 2 2 'F
, F fA 33331
Telephone 3 . ,
/ 006 Fax 9f Y— y jv_ v79/
Qualifier Name
41 /I s % ' ...1.,04 .
PROPERTY OWNER
Name TO l N
t/NA *0el
Address 3 0 q ,.
)..11ri.
4 q s )
s'1,- oel -,v3, cc( A
Home Telephone 3 Q J
. 7 __ 7 7 f - c7
Business Telephone
Alteration Interior
Fax
Demolish
TYPE OF MANAGEMENT (✓ )
New Construction
Enclosure
Alteration Exterior
Repair
Alteration Interior
Demolish
Relocation of Structure
Shell Only
Foundation Only
Add'I Attachment
Other
Add'I Detachment
Other
INSTRUCTIONS - The following steps must be taken to obtain a permit from the Miami Shores Village:
Step I.
Step 2. Submit the completed application with all necessary documents to the Building, Planning and Zoning Department for processing. During the
processing of your application, you may be asked to submit additional information.
APPLICATION
Job Address:
Complete the attached permit application which must be signed by the property owner and qualifier. Both signatures must be notarized. Please
print or type to allow for a more accurate processing of your application. If roofing work will be done, a roofing application must be submit-
ted along with this permit application.
30y ue 9c1 ST
Address
Folio Number
Lot 1■ �Li Block
Subdivision JtcTrw- 1 PB 10 PG 7 0
Current Use of Property I�.c
/ .B a ��
Proposed Use of Property
Tenant Information
PERMIT TYPE (✓ )
Building
Electrical
Mechanical
Plumbing
LPGX
Roofing
Fence
Other
y
Apt.
PERMIT CHANGE (✓ )
Chg. Contractor
Revision
Extension
Supplement
Reinspection
ARCHITECT
Name
License No.
Address
Telephone
Fax
MIAMI S JIhe
City
Description of Work
Master Permit No.
Subsidiary Permit No.
FL.
State
PERMIT APPLICATION
s t sS
Zip
2A-c - RANI u,J 11
Zoning Linear Feet
Square Feet t° S C Units Floors
Value of Work Ce .f 0 D ' o v Bldg Value
Tax Assessed/Appraised Value
Flood Zone Base Floor Elev.
ENGINEER
Name
License No.
Address
Telephone
Fax
Signature of Notary Pu :lie
6 r19t'a1.4gf Florida M. C. PADRON
* , * MY COMMISSION # DD 055049
SEAL:
,Til A : EXPIRES: September 30, 2005
0, 44.0F �c Bonded Thru Budget Notary Services
Page 2
INIPORi'ANT NOTICES
DO NOT BEGIN ANY WORK WITHOUT HAVING RECEIVED YOUR VALIDATED PERMIT AND PERMIT CARD. Applying for a permit does not grant
the right to begin construction. HOURS OF CONSTRUCTION are limited to: Monday through Friday from 7:30 a.m. to 6:00 p.m., and Saturday from 8:00 a.m.
to 5:00 p.m. No inspections will be conducted on weekends or holidays.
2. All construction of demolition areas MUST BE MAINTAINED IN A CLEAN, NEAT AND SANITARY CONDITION free from construction debris.
3. STREETS AND NEIGHBORING PROPERTIES SHALL BE KEPT FREE FROM DIRT AND DEBRIS.
4. SWALES MUST BE PROTECTED FROM BEING DAMAGED BY EQUIPMENT OR VEHICLES, AND MAY NOT BE USED FOR STORAGE. A bond is
required for work in or near the street/sidewalk.
5., CONSTRUCTION TRAILERS ARE PROHIBITED ON SINGLE FAMILY RESIDENTIAL CONSTRUCTION SITES. Other construction may have a trailer
which requires a separate permit.
6. PORTABLE TOILETS for a construction site require a separate permit.
7. DO NOT DISCHARGE WATER INTO THE RIGHT OF WAY OR STORM DRAINS without approval from the Building, Planning and Zoning Department.
8. EQUIPMENT AND MATERIALS SHALL BE STORED at least 10 feet from the edge of pavement.
9. Department of Health and Rehabilitative Services (HRS) approval is required for applications involving septic tanks. Department of Environmental Resources
Management (DERM) and/or Miami -Dade Water and Sewer Department (MDWASD) approval is required for applications involving sewers.
AFFIDAVIT - Please read carefully.
Application is hereby made to obtain a permit to do work and installation as indicated. I, the OWNER of the property, 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, POOL, EXTERIOR DOOR, MECHANICAL, WINDOW, FENCE, DRIVEWAY,
ROOFING and SIGNS and there may be additional permits required from other governmental agencies.
I, the OWNER of the property, have disclosed all information related to any work at the property performed in the prior twelve
months to the Building Official. Further, I am fully aware that if the cumulative cost of work to my home or business under this and
any other permit equals or exceeds fifty percent (50 %) of the fair market value of the structure, the entire structure must meet the
present federal flood criteria for finished floor elevation. I am also fully aware that if the total cost of work to my home or business
under this and any other permit exceeds fifty percent (50 %) of the replacement cost of the structure, then the entire structure must
conform to the current code requirements of the Building Code.
WARNING TO OWNER: Your failure to record a NOTICE OF COMMENCEMENT may result in you paying twice for
improvements to your property. If you are spending more than $2,500 or intend to obtain financing, you may wish to consult with
your attorney or lender before recording your Notice of Commencement. The Notice of Commencement must be recorded at:
22 N.W. 1st Street, 1" Floor, (305) 679 -1078. Once recorded, the Notice of Commencement must be POSTED AT THE JOB SITE in
accordance with Section 713 -35 of Florida Statutes. Review the brochure at Village Hall on Construction Lien Law and
Choosing a Contractor.
STATE O0 FLORIDA, COUNTY OF MIAMI -DADE
itdature of Owner
J�
11.71 j ?ggs
Print Name
Sworn to and subscribed before me this / 3 day ofJ
Personally known % OR, Produced Identification
Type of Identification Produced:
STATE OF FLORIDA, COUNTY OF MIAMI - DADE
Signature of Contractor / Qualifier
i 4 -A , / — 1,- S -✓J
Print Name
Sworn to and subscribed before me this
Signatur
SEAL:
PERMIT APPLICATION
M. C. PADRON
MY COMMISSION # DD 055049
EXPIRES: September 30, 2005
onded Thru Budget Notary Services
Personally known
S day of S - � �'�✓ !�
OR, Produced Identification
Type of Identification Produced:
EL
'I VPE
Minimum Fee
(1T1'.
T1'PI'.
Dryer
QTY.
"I'VPE
Outlet, Appliance
OTT.
'r i i;
Service Repair
v1'1'.
A/C Central 1 -3 Ton
- Heating Strips, each
Fan
Outlet, Wall
Service, Temporary
Paint Booth
A/C Central 4 -7 Ton
Fire Pump
Outlet, Switch
- Piping, Flammable Liquid
Signs
A/C Central 8 -15 Ton
Fixture - Fluorescent
Process/Pressure Piping
Oven
Space Heater (kw)
A/C Central 16-20 Ton
Pressure Vessel
Fixture Light
Parking Lot Lights
Spas/Hot Tubs
A/C Central 20+ Ton
Flood Lights
Plugmold/Strip
Subfeeds, No. of Amps
A/C Window
FPL - Load Central
Posts
Swim Pool, Commercial
Air Conditioners
Garbage Disposal
Range/Range Top
Swim Pool, Residential
Chiller
Generators, etc.
Receptacles
Switchboards
Clear Violations
Heat Recovery
Refrigerator, Comm. (p/PH)
Temp Serv., Construction
Compactor
Low -volt, Burglar
Refrigerator, Domestic
Temp for Test - 30 days
Deep Freezer
Low -volt, Fire
Renew - Temp Service
Water Closet
Demolition
Low -volt, Intercom/Teleph.
Repair Circuits
Water Heater
Dishwasher
Low -volt, Television
Service, Number of Amps
Water Heater New
's1ECHANICA1
TYPE
Minimum Fee
()1'1'.
TyPP,
Condensate Drain
()Ty. TYPE P1'.
Generator
QT1'. T1'PE
Refrigeration, Tons
QYI'Y.
A/C Central, Tons
Q . 1 . 1 •
Cooling Tower
- Heating Strips, each
Vent Hood, Cost
A/C Wall/Win. Tons
Dryer Vents, Number of
Paint Booth
Ventilation, Cost
Air Handler, Tons
Ductwork, Cost of
- Piping, Flammable Liquid
Periodic Inspections
Barbecue
Fire Sprinkler System
Process/Pressure Piping
Pump and Abandon
Bath Fan - Vented, #
Fireplaces, Number of
Pressure Vessel
Gas - Appliance
PLUMBING
.1.1,1,1,,
A/C Condensate
QTY.
TYPE
Drains, Roof
( . 1 . 1 .
.1.1.pE
Miscellaneous Fixture
QTY
. 1 . 1 . 11;
Soakage Pit
Q . 1 . 1 •
Bath Tub
Drinking Fountain
Miscellaneous Repairs
Solar Water Heater
Bidet
Filter Replace
Pool Piping
Sprinkler Repair
Cap - Fixture
Fountain
Pump and Abandon
Sprinkler System
Cap - Water
Gas - Appliance
Pump, Domestic
Supply, AC Well
Cap - Sewer
Gas - Natural
Pump, Fire Stand
Temporary Toilet
Catch Basin
Gas - Propane
Pump, Re- circulate
Temporary Water Closet
Clothes Washer
Gas Piping
Pump, Replace - Pool
Urinal
Dental Chair
Grease Trap
Pump, Sprinkler
Utility - Sewer
Discharge Well
Ice Maker
Pump, Sump
Utility - Water
Dishwasher
Indirect Wastes
Relay Repair
Vacuum Pump
Disposal
Interceptor
Roof Inlet
Water Closet
Domestic Well
Laundry Tray
Septic Connection
Water Heater
Drainfield, 4" Tile/Res.
Lavatory
Septic Tank
Water Heater New
Drains, Area
Meter Set (Gas)
Sewer Connection
Water ate -pipe
Drains, Floor
Minimum Fee
Shower
Water Service
Drains, French
Miscellaneous Equipment
Sink
Well, Supply
Page 3
•
PERMIT APPLICATION
INSTRUCTIONS: Please indicate the type of work being performed and quantity(ies) in the space provided below.
RECEIVED AND REVIEWED BY: DATE:
SECTION
BY ,,n.,
DATE
?,b
Zoning&
74
Electrical
Mechanical
Plumbing
Fire
Public Works
Structural
Wi5i ` -
Building Official
Page 4
OFFICE USE ONLY
CHECKLIST
❑ OWNER - BUILDER FORM
(Attach)
❑ FIRE DEPARTMENT
APPROVAL (Commercial /
multi - family)
❑ CONCURRENCY
(New Construction)
❑ OTHER
(Specify & Attach)
Notary
❑ PROOF OF OWNERSHIP
(Attach)
❑ HRS / DERM APPROVAL
(Septic / Sewer)
O IMPACT FEE
(New Construction)
❑ OTHER
(Specify & Attach)
$3.00 per page (Scanning Fee) $
Miami Shores Village
Bond
Metropolitan Dade County (C.C.F.)
Inspector State Educational Fund $
State DCA (Radon) $
Code Enforcement Fine $
Zoning Review
(% �ftt. x/1000
(¢.005 /sq.ft.)
(¢.01 /sq.ft.)
z •
PERMIT APPLICATION
❑ CONDO ASSOCIATION APPROVAL
(Attach)
❑ BPR APPROVAL (Restaurants)
❑ CONTRACTOR REGISTRATION
(On File)
PERMIT FEES
TOTAL $ 0 yl 0
ISSUING OFFICIAL
REVIEWED AND PREPARED BY: DATE:
CONDITION OF APPROVAL
Revised July 2001
10050 N.E. 2ND AVE., MIAMI SHORES, FL • (305) 795 -2207 • FAX (305) 756 -8972 • http : / /www.miamishoresvillage.com
BUILDING
ELECTRICAL
PLUMBING
MIAMI SHORES VILLAGE, FLORIDA
DATE 44-4—" 1 V 1941_
CU ractor's
License No
PERMIT N° 7970
Work to be performed under this Permit
Owner of s
Building
Architect
Contractor
or Builder
Legal Lot
Description
Address of r - ' p ^ Value of < , ',. Amt. of
Building ' s F Project �' : • tr.::: � s,,.. Permit .At "0
This permit is granted to the contractor it builder named above to construct the building or to install the equipment or device described in the appli-
cation herefor in strict compliance with all ordinances pertaining thereto and w th 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.
Bl.
INSPECTOR
In consideration of the issuance to me of this permit I agree to perform the ork covered hereunder in compliance with a cis and ,
pertaining thereto and in strict conformity with the plans, drawings, statements o, specifications submitted to the proper authoriti o Miami Shorts till
In accep. • this rmit I assume responsibility for all work done by either myself, my agent, servant or employee.
Signed.
ubdi-
vision
BY
AUTHORITY
4S
STATE OF FLORIDA,
COUNTY OF DADE. j ss.
Disapproved
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.
S 4 d Date itY ° y Y ° , 19
Owner's Name and Address 4 =_ t`_ __-: No Street
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)
i L - ` �!
Before me, the undersigned authority, a notary public, duly authorized to admi
peared
(Si,gnCe� �'�
Building Inspect
and for zo other purpose.
New Building Remodeling Addition Repairs No. of Stories
To be constructed of Kind of foundation Roof
Estimated Total cost of improvements $___ 06, w 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 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 Supplement,
and has complied with the provisions thereof, and will require similar compliance from all c tractors or sub - contractors employed by him
in the work to be performed under this permit; and will post or cause to be posted for, insp 'ctiin on the site of the work such public notice
or notices as are required by the Act. The undersigned agrees to employ only suc1ysubcon4ract}ors, on work to be performed under this
permit, as are licensed by Miami Shores Village.
Remarks____ (Signed)
- - - -- - \1Y // to me well known,
and who, being by e first duly sworn, uppo oath deposes and says that he is the
of the above descr ed construction, tha the as carefully read the foregoing application, and that he did sign the same, and that all facts
therein by him sta d are )rue.
Permit No _l_�__� D
c
„ :, __ ) ° � Mead, Sworn to and Subscribed before me.
e J
Ii A ,
ake acknowledgments, personally ap-
Notary Public, State of Florida
My Commission Expires
PLANNING BOARD DATE
Chairman Member
Chairman
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.
•
t "`
BUILDING
ELECTRICAL
PLUMBING
Contractor 1 i
or Builder
1
Legal Lot
Description
Address of
Building -
V
MIAMI SHORES VILLAGE, FLORIDA
PERMIT N9 3655
Architect
1 Bl.
Subdi-
vision
DATE
Contractor's
License No.
Work to be performed under this Permit
Owner of p
Building
V
„
Board o;ficeifose 3'1,014 t =d IN • ice' } °fl
ilia perrRt
Value J Amt. of +'
Project �� y(/ Permit
This permit is granted to the contractor or builder named above to construct the building or to itlstal?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 regula-
tions 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.
CONTRACTOR OR BUILDER BY AUTHORITY
194