Paint permit.PROPERTY OWNER
+NaSt--000_,Ilke_ 1me € -+- lei—
Address 6 n �y ,,� , f�
Home Telephone 1 .72) . 0 #)_ — 0 0
Business Telephone . o �_ ) - 7s-7-7/
Fax
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 1.
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 submitted
along with this permit application.
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:
PERMIT TYPE (✓ )
Building
Electrical
Mechanical
Plumbing
LPGX
Roofing
Fence
Other
s /or -e
Address
Folio Number
Lot Block
Subdivision PB
Current Use of Property
Proposed Use of Property
Tenant Information
PERMIT CHANGE (✓ )
Chg. Contractor
Renewal
Revision
Extension
Supplement
Reinspection
ARCHITECT
Name
License No.
Address
Telephone
Fax
Cit
Apt.
`description of Work
PG Zoning
Master Permit No.
Subsidiary Permit No. 15p '02062-4- 9.
Square Feet
Ka"lue of Work
PERMIT APPLICATION
,c-R0 )3
St Zip
Linear Feet
Units Floors
57)0 Bldg Value
Tax Assessed/Appraised Value
Flood Zone Base Floor Elev.
ENGINEER
Name
License No.
Address
Telephone
Fax
CONTRACTOR
Name
License No.
Address
Telephone Fax
Qualifier Name
Page 2
INIPORTANT NOTICES
1. 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.
Print ame
Sw% s to : nd subscribed before me this
STA' • FLq uDA, C • IAMI -DADE
f Owner
.. _
IVA; ././i I, ....,......_-___..., .„......._.........
lure of No;ryPubl�_"" >,.::,
$°
1A Y PO B( @,i!C cLA ;•.1 is .0 . 1..
0 . i(-) co =i : -..,:, py M U °:ia... \
1 OF :: ice
SEAL:
Type of Identification Produced:/ i
STATE OF FLORIDA, COUNTY OF MIAMI - DADE
Signature of Contractor / Qualifier
Print Name
Sworn to and subscribed before me this day of
Signature of Notary Public - State of Florida
SEAL:
PE liT APPLICATION
Personally known OR, Produced Identification Personally known OR, Produced Identification
Type of Identification Produced:
ELECTRICAL
TAPE
Minimum Fee
QTY.
TYPE
Dryer
QTY.
TYI'E
Outlet, Appliance
QTY.
TVI'i:
Service Repair
QTY.
A/C Central 1 -3 Ton
Fan
Outlet, Wall
Service, Temporary
A/C Central 4 -7 Ton
Fire Pump
Outlet, Switch
Signs
A/C Central 8 -15 Ton
Fixture - Fluorescent
Oven
Space Heater (kw)
A/C Central 16-20 Ton
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
1(ECI1ANICAL
TYPE:
Minimum Fee
QTY.
TVPE
Condensate Drain
QTY.
TYI'E:
Generator
QTY.
TYPE:
Refrigeration, Tons
Q'EV.
A/C Central, Tons
Cooling Tower
Heating Strips, each
Vent Hood, Cost
A/C WaWWin. 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
Supply, AC Well
Bath Fan - Vented, #
Fireplaces, Number of
Pressure Vessel
Temporary Toilet
PLU11131NG
TYPE:
A/C Condensate
QTY.
TYPE:
Drains, Roof
QTY.
Tvi'E:
Miscellaneous Fixture
QTY.
TYPE:
Soakage Pit
QTV.
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 Re -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
D E
Zoning
,de 4
r .t.. d�
Electrical
Mechanical
Plumbing
Fire
Public Works
Structural
Building Official
7� 1/
Page 4
OFFICE USE ONLY
CHECKLIST
LI OWNER - BUILDER FORM
(Attach)
❑ FIRE DEPARTMENT
APPROVAL (Commercial /
multi- family)
❑ CONCURRENCY
(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
LI PROOF OF OWNERSHIP
(Attach)
❑ HRS / DERM APPROVAL
(Septic / Sewer)
❑ IMPACT FEE
(New Construction)
❑ OTHER
(Specify & Attach)
PERMIT FEES
$
(sq.ft. = x/1000
x ¢.60)
(¢.005 /sq.ft.)
(¢.01 /sq.ft.)
PERMIT APPLICATION
❑ CONDO ASSOCIATION APPROVAL
(Attach)
❑ BPR APPROVAL (Restaurants)
❑ CONTRACTOR REGISTRATION
(On File)
TOTAL $
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
Phone: 305 - 795 -2204
Contractor
Local Phone:
Parcel # 1132060131130
Permit Status:
Miami Shores Village
10050 NE 2nd Avenue
Printed:4 /22 /2002 Page 1 of 1
Applicant: JACQUELINE PORTAL
Owner: PORTAL JACQUELINE
JOB ADDRESS: 45 NE 98 ST
Approved Permit Expiration: 10/15/2002
Building Permit
Permit Number: BP2002 -777
Contractor's Address:
Legal Description: 1 53 41 6 53 42 MIAMI SHORES SEC 1 AMD PB 10 -70 E1/2 OF LOT 16 & ALL LOT 17
�X2t V 1 bD • 00
Fees: Description Amount O
FEE2002 -2235 Building Permit Application Fee $60.00
FEE2002 -2236 CCF $0.60
FEE2002 -2237 Notary Fee $5.00
Total Fees: $65.60
Construction Value: $500.00
Work: EXTERIOR PAINTING AS PER AGREEMENT (OWNER BUILDER PERMIT)
Total Fees: $65.60
Total Receipts: $0.00
If there is no permit package accessible on the job -site for inspectors to verify, there will be no inspections. Re- inspection
fee is $50.00, which must be paid in advance before calling for another inspection.
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 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
bo, by his agents, servants or employees.
Signed: (INSPECTOR) BY:
In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations 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 responisibility for all work done by either
myself, my agent, servants or employes.
Signed: (Contractor or Builder) BY:
Miami Shores Village
10050 NE 2nd Avenue
Phone: 305 - 795 -2204 Permit Number: BP2002 -777
Printed: 4/22/2002 ,Page 1 of 1
Applicant: JACQUELINE
Owner: PORTAL
JOB ADDRESS: 45
Contractor
Local Phone:
Permit Status:
NE 98
Total Fees:
Building Permit
PORTAL
JACQUELINE
ST
Contractor's Address:
Parcel # 1132060131130 Legal Description: 1 53 41 6 53 42 MIAMI SHORES SEC 1 AMD PB 10 - 7,D E1/2 OF LOT 16 & ALL LOT 17
Fees: Tescrip ion 00• op
-
FEE2002 -2235 Building Permit Application Fee $60.00.4- Le 0 Total Fees: $65.60
FEE2002 -2236 CCF $0.60 Total Receipts: $0.00
FEE2002 -2237 Notary Fee $5.00
$65.60
Approved Permit Expiration: 10/15/2002 Construction Value: $500.00
Work: EXTERIOR PAINTING AS PER AGREEMENT (OWNER BUILDER PERMIT)
Signed: (Contractor or Builder) 847 0 AM 0 04/24/021
225 .60
cd_s. 0
If there is no permit package accessible on the job -site for inspectors to verify, there will be no inspections. Re- inspection
fee is $50.00, which must be paid in advance before calling for another inspection.
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 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 emplo es.
Signed: l/ (INSPECTOR) BY:
.
In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations 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 responisibllity for all work done by either
myself, my agent, servants or employes.
MIAMI SHORES VILLAGE
TPaint Color Approval and Agreement
DATE: r I
OWNER'S NAME: J� - � �ri PHONE: '�5� -- �
ADDRESS: E �J!` D�11 r)
********************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
ADDRESS OF SITE: 649YY1\e --
CONTRACTOR & LICENSE (if applicable)
COMPANY NAME: PHONE:
smpl es.
i 0
APPROVED:
2e,r Y 4 /.2
Building Official Date
********************************* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
All Elements on th s it must be listed and indicate the
Walls (Le_.
Fascia , (t`e Nt:4~ e-)4
Drip Cap/Drip Edge
Soffit n A
Roof
Flower Bins
Shutters
Awnings
Chimney '�/ L \ \c C
Doors and door jams /
Garage Doors ■/ •
Railings 1
Fences
Decorative Metal
All brick (simulated or regular) 1
Stucco Banding
W� 1 a-Rene_
r\t
Any other stucco features 1 1
Accessory Buildings
Other /2 J J P-
Date
R7)-44
Signature of Contractor
OWNER'S AFFIDAVIT: I certify that all the foregoing information is accuraLe
and that all work will be done in compliance with all applicable laws regulating
construction and zoning. I authorize the above -named contractor, if applicable, to
do the work siated Furthe o -e , the paint colors will be as per the attached
Date
g ature of Owner
*********************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
WHEN PAINTING IS FINISHED,
CALL FOR FINAL INSPECTION
4/23/01
Aoi jct
\,0 \N . PtXl -P (-)
\9"1--T-T)
MIAMI SHORES VILLAGE
°Paint Color Approval and Agreement
1
DATE: 3' (
D'OWNER'S NAME:
L- 4DDRESS:
********************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
kbDRESS OF SITE: (`
CONTRACTOR & LICENSE (if applicable)
COMPANY NAME:
******* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
All Elements on the site must be listed and indicate the color to be painted:
Walls ' e / /��r
Fascia V 2 -Piti
Ca /Dri Edge � �
Drip Cap /Drip g ��
Soffit ,l /�
Roof
Flower Bins
Shutters
Awnings
Chimney
/07,09-
/-//fi 111-1,Lr
Doors and door jams
Garage Doors
Railings A
Fences r
Stucco Banding Decorative Metal �� ��1�
All brick (simulated or regular) G,I��g
g // `11 °a-
� i �
Any other stucco features .4 1/`
Accessory Buildings /17/
Other"
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. I authorize the above -named contractor, if applicable, to
do the w. .. • ate . . Furthermore , the paint colors will be as per the attached
s 1
3
i:nature of Owner Date Signature of Contractor Date
*********************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
APPROVED: WHEN PAINTING IS FINISHED,
CALL FOR FINAL INSPECTION
Building Official Date 4/23/01
i
aif4L
oNE: 3l6- ?Re-J:09
ONE:
Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the building 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 1 air r'I + 4tet4eil Sri ND,1eS
Registered Architect and /or Engineer
Name and address of licensed contractor Q)
Location and // legal descripti n of lot to be built on:
i
Lot JI // ( J I Clock
Street and Number where work is to be done
State work to be done and purpose of building (by floors), state exterior colors (submit samples)
PA t NT xTT e) naZ H USE F-e vi c_e z}Vrt - p -c
c L o e — ) tT
MIAMI SHORES VILLAGE
BUILDING INSPECTION DEPARTMENT
APPLICATION FOR BUILDING PERMIT
New Building Remodeling Addition Repairs No of Stories
To be constructed of Kind of foundation
Estimated Total cost of improvements S 5 0 Amount of Permit S
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 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 obligatons 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 work to be 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 appeared
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. 7� V Il
Disapproved
(Signed)
Building Inspector
Subdivision rn .4 £Pr." l gAttsb ,P-06 15 //.9 N cN ST
Date / 0//," 7
Date
Read, Sworn to and Subscribed before me.
PLANNING BOARD DATE
My Commission Expires
Chairman Member
Member Member
Member Member
Council Approved Date Disapproved Date
NOTE: A charge of S25.00 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 S25.00 will be charged when such re- inspection is made necessary by improper notice for inspection or faulty materials and/or workmanship.
Date bC, 19
No (-1-5 Street q - J 1
and for no other purpose.
Roof Covering
3 ?. Su
Notary Public. State of Florida
BUILDING ❑
ELECTRICAL ❑
PLUMBING ❑
ROOFING ❑
_ T . _./ ❑
Owner of _
Building —' t - r-
Architect
Contractor
or Builder
Legal Lot
Description
Address of
Building
CONTRACTOR OR BTIILDEV
MIAMI SHORES VILLAGE. FLORIDA
PERMIT N9 2 913
DATE ! 3
Contractor's
License No.
1
195
Work to be performed under this Permit
B1
Signed. L ' ) ' `
BY
c'1
Subdi-
vision
Value of I Amount of
Project $ z �D I Permit $
This permit is granted to the contractor or builder named above to construc the building or to install 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 specif- ations and that he assumes responsibility for work
done by his agents, servants or employees.
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 regulations
pertaining thereto and n strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In ac-
cepting this permit ssume responsibility for all work done by either, m +self, my agent, servant or employee.
AUTHORITY eta
BUILDING
ELECTRICAL
PLUMBING
Owner of
Building
Architect o
Contractor r
or Builder
Legal L
Description
Address of ,
Building
NTRACTOR OR BU$DER
PERMIT N° 4936
be perform under this Permit
4 _ 4
,/"
Subdi-
vision
MIAMI SHORES VILLAGE, FLORIDA
1
DATE
•
Value of Amt. of
Project Permit
Signed • By
/ x-
194`�
Contractor's ,
License No.
This permit is granted to the contr ctor or buildenamed above to construct the building or to install the equipment or vice described in the appli-
cation herefor in strict compliance with all ordinances pertaining thereto and with the understanding that the work will be per�t66rmed 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. ' 1
INSPECTOR
In consideration of the issuance to me of this permit I agree to perform the work covered hereunder in compliance witIP011kordinances an rauQtiong
pertaining and in strict co ormit th the plans, drawings, statement .ecifications submitted . the proper authorities of Miami Shores Village.
In acceptiperg}it I assumr spopy fo work done by ejer statement y ent, ervant or � ; � �, ee
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.
i
Date / 19.. 4
Owner's Name and Address T l4 V IJ .- 2)1V I (c No 4-4' Street N. l . c7
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 A / / 4 5' . 8 °577efs:e'v
State work to be done and purpose of building (by floors )
�kTF 2 t O e - 73. A l Ni T 1 n/
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 $ Z..O._l3 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 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 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 subcontract, on work to be 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 first duly sworn, upon oath deposes and says that he is the
of the above described construction, that upon 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 51.00 will be charged when such re- inspection is made necessary by improper notice for inspection or faulty
materials and /or workmanship.