375 NE 99 St (4)MIAMIHORES VILLAGE, FLA.
JOB 7,0-0
ADDRESS 47 .4" //• C.` ! f �_,_�_
N? 6076
INSPECTION } �.✓
TIME READY ?r/7. • f" , J7
REMARKS:
INSPECTOR W
DATE 7 - /
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MIAMI 1P1ORES VILLAGE, FLA. N? 6081
JOB 24" L - _
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ADDRESS X7.5 /
INSPECTION �T 4 c
TIME READY r - . - d - 12
REMARKS:
INSPECTOR �' � � DATE 4 r"
MIAMI `SHORES VILLAGE, FLA.
JOB PA-v C S G A Ns
ADDRESS 37 i Af 6. ! ,y. 2.?
INSPECTION Tr h Ta,o 6.07 -
TIME READY
REMARKS:
INSPECTOR
N? 6063
DATE
MIAMI SHORES VILLAGE, FLA. N° 6074
JOB P.a v s Z. Ai c=
ADDRESS . 2 Ai. c= S A
INSPECTION f' .4,,". f
TIME READY
REMARKS •
INSPECTOR DAT'
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MIAMOSHORES VILLAGE, FLA.
JOB
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ADDRESS .37s .37s �'- � g � / ,9 <S
INSPECTION T/ /ti‘ -
TIME READY kin - S
REMARKS:
INSPECTOR
N? 5892
PL .
DATE
MIAMI SHORES VILLAGE, FLA.
N? 5955
JOB 1 UC
ADDRESS
INSFECTION �7 �:� _�: / `E
TIME READY
REMARKS:
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INSPECTOR DATE
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M11 SHORES VILLAGE, FLA.
JOB 4 •-.ft
ADDRESS
7c Al m . yizs�
INSPECTION
TIME READY ? - - " J 1
REMARKS:
INSPECTOR
N? 6069
DATE
- MIAMI SHORES VILLAGE, FLA.
JOB AN - •
ADDRESS
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N? 6271
INSPECTION _F' c-.
TIME READY I 9 /1/1 G - 3-2
REMARKS
INSPECTOR DATE
MIAMI SHORES VILLAGE
BUILDING INSPECTION DEPARTMENT
APPLICATION FOR BUILDING PERMIT
Application is hereby wade 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 bfiami
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 iuilding 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 budding during pregress of the work.
Date
April 18, 79
R.K. Hitke 375 Str N.E. 99 Street
Owner's Name and Address No ee
Registered Architect and /or Engineer •.,•,.,•....,,,,
Name and address of licensed contractor 0 'F'7� 'rQY!X1J n &fi na',...�iD.a..._....�.a.6�... a a... 27... �venuQ._.... 125
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)
Nit .Qn- -.TQnt FUMiggtjQf
,000 CLl.f'I'i. and for no other purpose.
New Building Remodeling Addition Repairs No. of Stories
To be constructed of Kind of foundation Roof Covering
Estimated Total cost of improvements $
Vikane 18 -2 hrs. 3
1 00
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 59GG, Compiled General Laws of Florida, Permanent 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 arc required by the Act. The undersigned agrees to employ only such subcgn tract yrs, on work to be performed under this
pennit, as are licensed by Miami Shores Village.
Remarks (Signed).
Disapproved
( Signed)
Date
Building Inspector
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 / Date / I )19
Read, Sworn to and Subscribed before me.
Notary Public, State of Florida
My Commission Expires
PLANNING BOARD DATE
Chairman Member
\fcrr,bcr 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 fmnr
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.
--- ORKIN EX71:7;717.L.TING wrPANY, INC.
C 1960 NU 27 Avenue
land Fl. 33125
TJiaGJIoy 14UTITIOATI0r
LOCATION CF ST.RUCTURE 37. N.L staw4
a -I'M'S NAIT ArD ADDRESS • Jut. mike .
TIE CF STRUCTURE
rt:1•3R. OF CUBIC FET,T (AFF:710X11 )
'74111171.11N61,4".1”111111.11.174&W,',. 41 1''! f • —
One Story 0111
NAPIE Ai) iP0X T] 1 .7TA.:7 1 '17/: 7.71.:1(3, CUL'..
4.4.8.n9
DATE An APTOxnAT Tflp CF RELI Cr FT:1Cr.ZT
LENGHT OF FUnaLTICIT F'ERIOD PROMTE) 182h. Hours
DISTi.NCE TO NEAREST STRUCTURE 10 OVER 10 FT. UNDER 10 FT.
IIIMVIOR■• ••■■■MINI ammaraelwer..rtmem.
CERTIFIED FUrIGATION. OPERLTOR 1 CR SPEC= FUEIGiLTION
IDENTITIOATION.
CARD HOLDER fl; Che.RGE.
JY IC
TELEPHONE: DLY: 6 33-3421
1,T: 62.6865
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iRLIOL PZ,RFCIE .11^ IN STRICT 1,D1,aRaTCE TO THE
YCTr R::::GIST= ILBIL 2:LNJ) STATE BC;ARD OF REGTTIATIONS •
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FORM OF INSURANCE
LIMITS OF LIABILITY
Policy Number
Policy Term
Bodily Injury
Property Damage
Workmen's
Compensation
Provided by Workmen's
Compensation Law
State of F 0 ri, da
Nil
CEY-269668
4/1/57•4/1/58
Manufacturers' or
Contractors'
Liability
$ Each Person
S Each Accident
$ Each Accident
S Aggregate
Owners' or Contractors'
Protective Liability
$ Each Person
$ Each Accident
$ Each Accident
$ Aggregate
Owners', Landlords
and Tenants'
Liability
$ Each Person
$ Each Accident
$ Each Accident
Automobile Liability
(1) Owned Auto-
mobiles
(2) Hired Auto-
mobiles
(3) Other Non-Owned
Automobiles
$ Each Person
$ Each Accident
$ Each Accident
$ Each Person
$ Each Accident
$ Each Accident
$ Each Person
S Each Accident
$ Each Accident
Comprehensive
Liability
(1) Comprehensive
Automobile
(2) Comprehensive
General
(3) Comprehensive
(Combined General
and Automobile)
$ Each Person
$ Each Accident
$ Each Accident
$ 25, 000Each Person
$ 50, 000Each Accident
$ Aggregate
$ 5,000 Each Accident
$ 25, 000 Aggregate
C.ND-23687
4/1/57-4/1/58
$ Each Person
$ Each Accident
$ Aggregate
S Each Accident
$ Aggregate
Locations
Covered
State of Florida
Certificate of Insurance
This is to CertiFy that the COLUMBIA CASUALTY COMPANY
has issued to
Name of Insured
Address
Policies of insurance described as follows:
This Certificate is
Name
Address
whom we will
Countersigned by
pJ
Form 80810B-25M-12-56-
PAUL S. LANE
9303 N. Miami Avenue, Miami. Shores, Florida
issued at the request .uf;
Citty of Miami Shores, Florida-I3uilding Dept.
Miami Shores, Florida
advise of notice of cancellation or any changes affecting this Certificate.
COLUMBIA CASUALTY COMPANY
N-BUCHANAN, INC.
r
A uthorized A gent
(Name of Company)
(Official Title)
April .1
Dated._ ................. ...... ....... 19 *
President
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3» 99
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