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405 NE 99 St (15)N° Owner, Agent Lot 12 & Street Address CERTIFICATE OF OCCUPANCY MIAMI SHORES VILLAGE, FLORIDA BUILDING DIVISION 1278 Miami Shores Village, Florida, 11 -15-61 or Tenant of Building M. 70RfVTTf;H W �ock 29 MIAMI SH ORES # 4 2 Subdivision 405 N.E. 99th St. BEDROOM AND BATH ADDITION Approved use by occupancy Remarks - 1959 4 This Certificate of Occupancy is issued to the above named OWNER for building at above named location only upon the express provision that the applicant will abide by and comply with all conditions of Ordinances Nos. 92, 93, 94 and 97, known as the Zoning, Electrical, Plumbing and Building Ordinances of Miami Shores Village pertaining to the erection, construction, alteration or remodeling of buildings or structures. PLAN CUBE 3651.84 TAX VALUE 1825.92 BUILDING DIVISION �/ / OWNER'S NAME M • Ze . V 0 c 1c PRESENT 4mss° 14 .'e • LOT 11 -Ig) 4o4 ADD ESS 11. ( M°. 5 I @4.• LICENSE NO. SUBDIVISION S ,. ''''4=, PHONE NO. JOB LOCATION ($„:T. OR AVE.) 4®V N •C • Si.. GENERAL CONTRACTOR IA C- � A.�.rc..,dc, ADDRESS 61 ®1 0•�• 7-1 - fi PHONE NO. LICENSE NO. BUILDING PERMIT NO. VICSI DATE aawz -61 PERMIT FEE $ IC) BUILDER'S BOND NO. Irv® DATE 8 V? ' kgg rr 0 ® lei - ZONE REQUIREMENTS CU. FT. PLAN CUBE S • a CU. FT. °° EST. COST $ -- V72, a® DRAWINGS. SPECIFICATIONS. RESTRICTIONS AND CUBE CHECKED •BY:4• IF.• 7, R04O r•••@)02. 0 L4' DATE 0' 1 ° L' NEW CONSTRUCTION TYPE IC.,% STORIES IMI , ROOF CONSTRUCTION a.�T 0 e INTERIOR CONSTRUCTION ". 4 tts-eu 4,ig/j°I .REPAIRS q� �4t( ey DESCRIPTION �q'f Cal ( .(%3(, Inld7t S 1,..6 a ern ` n..b 4R ta c at r 4 ,. Oa Cal W - � . ALTERATION ,' _"qq Q nn � ES � R IPTION `VyflC.O PC6 N- - `^JCL �f l. cs• . ADDITION SUBMITTED TO PLANNING BOARD APPROVED REJECTED REFERRED TO COUNCIL REASONS RE- SUBMITTED TO PLANNING.BOARD jAA/ /ySj�r.�rO.r /}�I�dG / /1- /f` /•'-'I am ,4 './. 4- m SUBMITTED TO VILLAGE COUNCIL REMARKS Z- CERTIFICATE OF OCCUPANCY NO. ,^ l 5 II 1 S=C , / ISSUED BY TO M . z.,..t -„, l,, CtC 11 BUILDING PERMIT AND INSPECTION RECORD —MIAMI SHORES VILLAGE INSPECTIONS DATE BY 1 INSPECTIONS DATE BY FOUNDATION $ SEPTIC TANK ROOF TEMPORARY SERVICE $ BEAMS & LINTELS $ POOL • SOLAR HEATER FRAMING RANGE CONN. $ AIR COND. SEWER MOTORS FINAL $ CLEAN UP c SEPTIC TANK SLAB t SLAB SPECIALS PERMITS PERMIT NO. DATE FEE TEMPORARY SERVICE RE - INSPECT BY $ SEPTIC TANK FEE TEMPORARY SERVICE $ SEWER $ TUB & TOP OUT $ SOLAR HEATER $ RANGE CONN. $ GAS SEWER MOTORS $ $ FIXTURES c INSPECTIONS DATE BY RE - INSPECT BY RE - INSPECT BY ROUGHING DATE FEE TEMPORARY SERVICE $ TUB & TOP OUT H. W. HEATER CONN $ RANGE CONN. I SEWER MOTORS $ FIXTURES • SEPTIC TANK 5 t SOLAR HEATER FIXTURES GAS CONTRACTOR C . E 71 L°, . PHONE • PERMIT NO. /1 ( I DATE Es-- 2 4 6� FEE 55 S� NEW BLDG. I ALTERATION 1 ADDITION REPAIRS SPECIAL PERMITS PERMIT NO. DATE FEE TEMPORARY SERVICE $ H. W. HEATER CONN. H. W. HEATER CONN $ RANGE CONN. I $ MOTORS $ FIXTURES • 5 t INSPECTIONS DATE BY RE- INSPECTI BY RE- INSPECT' BY TFMP. SERVICE 1 ROUGHING 1 H. W. HEATER CONN I RANGE CONN. • FIXTURES & FINAL 4.6€ 43° e • BUILDING INSPECTIONS � � PLUMBING PERMITS & INSPECTIONS CONTRACTOR �VV(.ev C)GJA3 / //CJ c-p I PHONE PERMIT NO. OK DATE re�2-7 --(o/ NEW BLDG. 1 ALTERATION 1 ADDITION K REPAIRS FEE $ ELECTRICAL PERMITS & INSPECTIONS APPROVAL TO POWER CO. FOR SERVICE DATE BY Owner's Name and Address._/f. A.�PC2�fl f 4/ Registered Architect and /or Engineer . .eP ,S Name and address of licensed contractor_. ✓_ft�. e Location and legal description of lot to be built on: Lot /_!Z ...ZA4__ , _..o2(...4... Block 9 B Street and Number where work is to be done 4-0.f' STATE OF FLORIDA, COUNTY OF DADE. j ss MIAMI SHORES VILLAGE BUILDING INSPECTION DEPARTMENT `) ' ` (Se F 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. The undersigned applicant for this building pennit does hereby certify that he of labor under the Florida Workmen's Compensation Act, being Section 5966, Co and has complied with the provisions thereof, and will require similar compliance,f in the work to be performed under this permit; and will post or cause to be sted or notices as are required by the Act. The undersigned agrees to employ on uc} permit, as are licensed by Miami Shores Village. Remarks (Sig Date_.d "7u5 �l �Y /,„s' - 2 / ._ Subdivision Xer, _____f��'1'atil��_ ,19 No._. 4as - Street___- ? 1 z!l°r State work to be done and purpose of building (by floors) - L'r. -S• .42)/22&,4/ � ' .4X/.r,7° /- .ril - :.,c i274 e.e and for no other purpose. New Building Remodeling. Addition ' Repairs No. of Stories .l To be constructed of.___l..il• 4'. Kind of foundation , r Roof Covering 12i'YGPZ Estimated Total cost of improvements $ e ,4) ' o Amount of Permit $ 465. Zone cubage required .Plan Cubage a71 — Distance to next nearest building._._ Size of Building Lot ___f./.,l /2 _,� 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 derstands and accepts his obligations as an employer fled General Laws of Florida, Pennanent Supplement, n all contractors or sub- contractors employed by him jp inspection ,on the site o the work such ublic notice bcontract S, on work o be perform under this Notary Public, State of Florida Built)ing Insp for My Commission Expires Before me, the undersigned authority, a notary public, duly authorized to ac; , ster oaths and take acknowledgments, personally ap- .� geared 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 Read, Sworn to and Subscribed before me. Disapproved r __ t 1} ,' Dat _ ( Signed) P ANNING BOARD DATE Chairman 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. r F3 A 09/T! et'' i R1 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. Date_.! /�� ���� ✓ , 19 Owner's Name and Address_.."1, No 4f6 .4' Street r>'i" Registered Architect and /or Engineer._;. 2 'i? '"S Name and address of licensed contractor..,.�6r "e".'7 Location and legal description of lot to be built on: ... Block ``a :l Subdivision Street and Number where work is to be done. 4/14: p1' State work to be done and purpose of building (by floors) /.27 t� -f e/7'e • e ..e.v.A/ : 1- ' o. • and for no other purpose New Building Remodeling - Addition Repairs No. of Stories To be constructed of J?. Kind of foundation , f_- / . Roof Covering 7 Estimated Total cost of improvements $ ` �' re�e •- ` ;- Amount of Permit $ Zone cubage required Plan Cubage Distance to next nearest building Size of Building Lot_ ___�!i! 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 pennit 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 contractors or sub - contractors employed by him in the work to be performed under this.permit; and will post or cause to be posted r 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 s bcontractor I on wor to be performed under this permit, as are licensed by Miami Shores Village. Remarks (Signed) � 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 Date Read, Sworn to and Subscribed before me. Disapproved Date Notary Public, State of Florida (Signed) Building Inspector My Commission Expires PLANNING BOARD DATE Chairman 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. 4 AL: 1. — • .m.■■••••■••••• r 1 r4 ft r N izt c. 1 ; 2-; - " • e -4Pormi— _ - r kore N9 1789 Street Address CERTIFICATE OF OCCUPANCY MIAMI SHORES VILLAGE, FLORIDA BUILDING DIVISION Miami Shores Village, Fla , Owner, Agent or Tenant of Building Y'\ - • ) p rl Lot t)- V -� � Block Subdi ision ' 4 L}01 •C, .e•A d. Approved use by occupancy \ ' r -J -a \1� 1:-- F� Remarks- f1,.�- t� ah �- � ,'t —C s This Certificate of ,Occupancy is issued to the above named 0 44_ ,,; — for building at above named location only upon the express provision that the applicant will abide by and comply with all conditions of Ordinances Nos. 92, 93, 94 and 97, known ss the Zoning, Electrical, Plumbing and Building Ordinances of Miami Shores Village pertaining to the erection, construction, alteration or remodeling of buildings or structures. 19 .6 1 1 BUILDING D\IVISION - - OWNER'S NAME M.J. Zorovich PRESENT ADDRESS LICENSE NO. PHONE NO. JOB LOCATION (ST. OR AVE.) 405 N.E. 99th St. LOT 12 -13 -414 BLOCK 89 SUBDIVISION Sec. 4 GENERAL CONTRACTOR owner ADDRESS PHONE NO. • LICENSE NO. /'� BUILDING PERMIT NO. 1 454 1 DATE 4 -22-53 PERMIT FEE S 5.00 BUILDER'S BOND NO. DATE ZONE PEQUIREMENTS CU. FT. PLAN CUBE CU. FT. EST. COST 5 DRAWINGS. SPECIFICATIONS, RESTRICTIONS AND CUBE CHECKED BY: DATE NEW CONSTRUCTION TYPE STORIES ROOF CONSTRUCTION INTERIOR CONSTRUCTION REPAIRS DESCRIPTION 'ds room addn. ALTERATION DESCRIPTION ADDITION SUBMITTED TO PLANNING BOARD APPROVED REJECTED REFERRED TO COUNCIL REASONS RF- SUBMITTED TO PLANNING BOARD 3 ' SUBMITTED TO VILLAGE COUNCIL REMARKS y I CERTIFICATE OF OCCUPANCY NO. k i�J q /� 0 I ISSUE G ry`��G'4,"d ) BY A.4 j rya).- TO - -70 G4 BUILDING PERMIT AND INSPECTION RECORD —MIAMI SHORES VILLAGE INS' ECTIONS DATE IIM RE- INSPECT BY RE- INSi.ECT BY FOUNDATION - _ FF PERMIT NO. DATE FEE BEAMS & LINTl =LS �' �r' , / 1, $ SEPTIC TANK a .....,,4„.„, a .....,,4„.„, „,, �� / 4/G,7 0 � ”. $ FRAMING dill $ SOLAR HEATER $ GAS DATE BY $ BY RE- INSPECT FINAL BR moils DATE BY RE- INSPECT BY CLEAN -UP BY OSI 1 , 3 ) ° i 3 � I 1 CONTRACTOR ,. ._,' PHONE PERMIT NO. P t 4 -� - � , " � . DATE o /19' -6 Cr FEE$ NEW BLDG. I ALTERATION ( ADDITION REPAIRS SPECIAL PERMITS PERMIT NO. DATE FEE TEMPORARY SERVICE $ SEPTIC TANK a .....,,4„.„, a .....,,4„.„, „,, �� / 4/G,7 0 � ”. $ SEWER $ SOLAR HEATER $ GAS DATE BY $ BY RE- INSPECT BY $ INSPECTIONS DATE BY RE- INSPECT BY RE- INSPECT BY ROUGHING 1 , 3 ) ° i 3 � I 1 H. W. HEATER CONN GAS SEWER S RANGE CONN. SEPTIC TANK SOLAR HEATER FIXTURES & FINAL 1"):).'S1) FIXTURES n d i '�V 3 ` SPECIAL PERMITS PERMIT NO. DATE FEE TEMPORARY SERVICE $ H. W. HEATER CONN. $ RANGE CONN. $ MOTORS $ FIXTURES $ $ INSPECTIONS DATE BY RE- INSPECT BY RE- INSPECT BY TEMP. SERVICE ROUGHING H. W. HEATER CONN S RANGE CONN. FIXTURES & FINAL 1"):).'S1) c'. - A\ BUILDING INSPECTIONS PLUMBING PERMITS & INSPECTIONS CONTRACTOR PERMIT NO. NEW BLDG. [ELECTRICAL ['PERMITS & INSP! CTIOG 1S 1 DATE ALTERATION PHONE FEE $ REPAIRS APPROVAL TO POWER CO. FOR SERVICE DATE ADDITION BY 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 erein specified or not. A copy of approved plans and specifications must be kept at building during progress of the work. / 0 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 o Lot_1_. ®--- I _�_7 � - - - Block Street and Number where work is to be done State work to be done and purpose of buildi �. (by flo New Building Remodeling To be constructed of Kind of foundation STATE OF FLORIDA, COUNTY OF DADE. ss. Permit No Disapprov (Signed) • • MIAMI SHORES VILLAGE BUILDING INSPECTION DEPARTMENT 1\ ,c z Ro ui 1'+ ing Inspector Subdivision Date e _it of Bu g Lot R f_Cpvering Estimated Total cost of improvements $ _'� Q Amo t of Permit $ Zone cubage required � _Plan Cubage Distance to next nearest building 10 Street • ,19 and for no other purpose. Add'. 'on pairs _ No. _ 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 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 bcontractors, on work to be formed under this permit, as are licensed by Miami Shores Village. Remarks (Signe 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 e first . 1ly sworn, upon '' deposes and says that he is the of the above describ; d cons ction, that ie h. !, ar efully ead the foregoing application, and that he did sign the same, and that all facts therein by him stat e dre . d- 0 ) to Read Sworn to and Subscribed before me. l 71 Notary Public, State of Florida My Commission Expires PLANNING BOARD_ DATE Chairman 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. AVA. _5 - 0L�57_ Bui N9 1339 Miami Shores Village, Fla , Owner, Agent or Tenant of Building Lot Block Street Address CERTIFICATE OF OCCUPANCY MIAMI SHORES VILLAGE, FLORIDA BUILDING DIVISION Subdivision Approved use by occupancy Remarks. This Certificate of Occupancy is issued to the above named for building at above named location only upon the express provision that the applicant will abide by and comply with all conditions of Ordinances Nos. 92, 93, 94 and 97, known is the Zoning, Electrical, Plumbing and Building Ordinances of Miami Shores Village pertaining to the erection, construction, alteration or remodeling of buildings or structures. BUILDING DIVISION INSPECTIONS DATE BY RE- INSPECT BY RE- INSPECT BY FOUNDATION SPECIAL PERMITS PERMIT NO. - FEE BEAMS &LINTELS _ S yt ` - H. W. HEATER CONN. FRAMING S la $ MOTORS S FIXTURES FINAL S ag ar. ti CLEAN -UP S A r .lt,1"., : ' PLUMBING PERMITS : lr PECTIONS RE- IN CONTRACTOR PHONE PERMIT NO. DATE M FEE $ NEW BLDG. I ALTERATION ET ION REPAIRS SPECIAL PERMITS PERMIT N0- DATE FEE TEMPORARY SERVICE $ SEPTIC TANK $ SEWER $ SOLAR HEATER RANGE CONN. $ GAS S $ INSPECTIONS DATE BY RE- INSPECT BY RE- INSPECT BY ROUGHING GAS SEWER SEPTIC TANK SOLAR HEATER FIXTURES CONTRACTOR PHONE PERMIT NO. I DATE FEE S NEW BLDG. 1 ALTERATION 1 ADDITION REPAIRS SPECIAL PERMITS PERMIT NO. DATE FEE TEMPORARY SERVICE $ H. W. HEATER CONN. S RANGE CONN. $ MOTORS S FIXTURES S S INSPECTIONS DATE BY RE- IN BY RE- INSPECT BY TEMP. SERVICE ROUGHING H. W. HEATER CONN. RANGE CONN. FIXTURES & FINAL BUILDING INSPECTIONS ELECTRICAL PERMITS & INSPECTIONS APPROVAL TO POWER CO. FOR SERVICE DATE BY q OWNER'S NAME D.R. Laugher PRESENT ADDRESS LICENSE NO. PHONE NO. JOB LOCATION (ST. OR AVE.) 405 N.E. 99th St. LOT BLOCK SUBDIVISION GENERAL CONTRACTOR owner -builder ADDRESS PHONE NO. LICENSE NO. BUILDING PERMIT NO. 12462 � DATE 12 ®5 ®511 M I, - , BUILDER'S BOND TO / o PERMIT FEE $ 5.00 NO. � 13 � DAT , � ' ZONE REQUIREMENTS CU. FT. r' =675 'r O ' =- ... .3— 8 aw-� " i ' T4 Wrig. PL LA � N CUU / t r / CU. T. EST. COST $ 44 i - 14U DRAWINGS, SPECIFICATIONS. RESTRICTIONS AND CUBECHECKED BY DATE NEW CONSTRUCTION TYPE STORIES ROOF CONSTRUCTION INTERIOR CONSTRUCTION REPAIRS DESCR IPTION ALTERATION DESCRIPTION tool room addition to garage $ ADDITION SUBMITTED TO PLANNING BOARD APPROVED REJECTED REFERRED TO COUNCIL REASONS RE- SUBMITTED TO PLANNING BOARD SUBMITTED TO VILLAGE COUNCIL REMARKS r CERTIFICATE OF OCCUPANCY NO. 4 ISSUED , e.• S, BY AI , � TO (- -' r,- --)"..—, BUILDING PBRMIT AND INSPECTION RECORD —MIAMI SHORES VILLAGE J�- 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, ________L Registered Architect a Z F nor Name and address of licensed contractor Location and legal description of lot to be built on: Lot Block Subdivision Distance to next nearest building Maximum live load to be Borne by each floor MIAMI SHORES VILLAGE BUILDING INSPECTION DEPARTMENT APPLICATION FOR BUILDING PERMIT- d g No a f-74-44. ate 4 o iS Date Street and Number where work is to be done 1Q.2 C • r State work to be done and purpose of building (by floors), 717 Q _,t�_ , F 4 - 4/ I 4/ t 4 c'e Q ,v COW C. S 44 _ New Building C emodeling Add' • n To be constructed of___ _:__ 9 Kind of foundation Estimated Total cost of improvements $ Zone cubage required C O/VD - "" ee , 19 _/ � __l iv3 741 Street - - r and for no other purpose. 1 "W:=9-7" C9 0 R.4S_Viil Repairs No. of Stories 1 G of Permit ount $ __ __Plan Cubage __Size of Building Lot Notary Public, State of Florida • I hereby su it ll th plans and specifications for said building. All notices with reference to the building and its construction may be sent to • // , ` ELV/Q ?Y '- 03__.__ /s _c 'C /p 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 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 w.rk to b performed under this permit, as are licensed by Miami Shores Village. Remarks (Signed) 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 .'irst duly ”pqp oath deposes and says that he is the of the above describe con uctio�n That he a carefully re,id the foregoing application, and that he did sign the same, and that all facts therein by him stated : e tr e. Permit No i !gt; _ �_ Read, Sworn to and Subscribed before me. Disapproved _ / Date ( Signed Building Inspector , '1 My Commission Expires PLANNING BOARD DATE v C " Member Mem 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 materials and /or workmanship. necessary by improper notice for inspection or faulty ‚3