Loading...
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.