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ROOFINGDater r � y-riil-k/ Legal Description / Lessee / Tenant /� X ( / 11452,401,/ /TG Address 142 S J/' 2 fY�'e ° 42- Qualifie ��/G: . SS# // Phone State leR GWA Municipal # Competency # Ins.Co. Architect /Engineer Address Bonding Company Address Mortgagor Address Permit Type(circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN WORK DESCRIPTIONA ' ' �� / %7 4:00r S 7 7 E - Owner's Address Contrac `/ /.<Zgie Estimated Cost(value) Square Ft. WARNING TO OWNER: YOU MUST RECORD A NOTICE OF COMMENCEMENT AND YOUR FAILURE TO DO SO MAY RESULT IN YOUR PAY,I IMPROVEMENTS TO YOUR PROPERTY (IF YOU INTEND TO OBTAIN FINANCING; CONSULT.FTH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT) .`...'; .:3 Application is hereby made to obtain a permit to do work and installation as indicated above, and on the attached addendum (if applicable). I 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, SIGNS, POOLS, ROOFING and MECHANICAL WORK. 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 const uction and zo�:n Furthermore, I authorize the above -named contractor to do the work state Pt L' Signatur f 'own r do and/or Con President Date: ,,/7/ Notary as to Own My Commission Ex oets ** ** * APPROVED: Zoning PERMIT APPLICATION FOR MIAMI SHORES VILLAGE Job Address.5 , E• 9' 52 7e/%IAdTax Folio /( g' t' 1.9 /J4 2- 71/ 51./S teAzo Z■jident MY COMMISSION 9 1303,1 EXPIRES: Fabruto amaira Tni rotary Nu 4r6on+'' Mechanical * * FEES: PERMIT-I"' RADON Plumbing_ Master Permit # 3 62 71t- Phone 7 ? --,337‘ gnatuTv o tractor or Owner- Builder Date: // //y i ota / as to C y Commission ' " r',HURCH `tor or OwnecqI , :ion Exp. pr 996 No.CC197545 �'•.��orr�� * * NOTARY 57-ae TOTAL DUE I iI f 5-61 ** Other Electrical Engineering PERMIT NO. TAX FOLIO NO. // 3a L ? /Pi 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. y� q 1. Legal descriptio of property and str et ddyess J�.3 �Y� /�S /. /C 4 61,40 q t r ; 2. Description of improvement: i "" 3. Owner(s) name and address: /WI'7 ��� � t1,,) , ( 7 / g l/ S J e6, Interest in property: Name and address of fee simple titleholder: NOTICE OF COMMENCEMENT 4. dress: 7-24 /¢ /02 �.�i //a �i . Contractor's name and ,4� a �3. , Name and address: Amount of bond $ 6. Lender's name and address: Notary Public Print Notary's Name My Commission ExpiresY 5. Surety:(Payment bond required by owner from contractor, if any) STATE OF FLORIDA, couNr' OF DADE 1 HEREBY CERTIFY 4::®' S( ra is c 4. n�� 7. Persons within the State of Florida designated by Owner upon whom notices by Section 713.13(1)(a)7., Florida Statutes, 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)(D), Florida Statutes. Name and address: 9. Expiration date of this Notice of Commencement: (the expiration date is 1 year from the date of recording unless a ditforent date is specified) r Signature of a et Print 0) rs Name 4i'� %7 Sworn to and subscribed before me this 1 7 / iay of G ottliDA,19 ) . Addr ss: • A{ N B' , "` /AI MI SSION # CC 25813+ �. of EXPIRES: February 9, 1997 9 R5 7 3504 1993 NOV 19 ivz?c ents may be served as provided Prepared by:4' F/eA/- Z 5V, /'"-' t /� � , 3 qz - -METRO-DADE TO WHOM IT MAY CONCERN Santafe' Tile Corporation has filed with this office an application with appropriate test data to support the approval of both their Santafe' "S" Clay Roof Tile , for Nail & Mortar -Set systems, measuring 11" wide by 18" long and their Santafe' Mission Barrel Clay Tile, a Mortar -Set system measuring 7" to 9" by 18" long and both identified with the imprint "Ladrillera Santafe' made in Columbia ". The tiles shall be installed on a solid nailable deck of 5/8" thick plywood for new construction or to 1/2" plywood on re- roofing as follows. PAGE] AS FOLLOWS: A: Santafe' "S" Clay Tile min. slope 2 1/2:12 1: Nail -Set System METROPOLITAN DADE COUNTY, FLORIDA METRO -DADE FLAGLER BUILDING BUILDING CODE COMPLIANCE DEPARTMENT SUITE 1603 METRO -DADE FLAGLER BUILDING 140 WEST FLAGLER STREET MIAMI, FLORIDA 33130-1563 (305) 375 -2901 FAX (305) 375 -2908 August 2, 1993 The deck shall be covered with Northern Elastomeric, Inc's RTU -100 base sheet as an underlayment. Each sheet shall be installed with a nominal 3" overlap and tin -cap 12" o.c. in the field and 6" o.c. at side. At the overlap, the top of the bottom sheet shall be nailed 1 -2" o.c. along with the bottom of the top sheet with nails off set 6 ". A 36" wide strip of RTU -100 shall be installed at all valleys and nailed 12" o.c. in a line 3" from each edge. A nominal 16" wide galvanized steel flashing strip shall be provided over the RTU -100 and nailed 6" o.c. along each edge, with . the RTU -100 applied in the field of roof to overlap valley flashing 3 " and continuously be imbedded in a nominal 3" wide bead of roofing cement to the deck at the eave. A nominal 2 "x 2 " galvanized steel drip nailed 4" o.c. shall be provided over the RTU -100 at the perimeter of the deck and continuously bedded in roofing cement. All nailing referred above shall be 0.150 diameter, 0.375 diameter head, I" long galvanized steel roofing nails. Santafe' Tile Corporation August 2, 1993 The field tiles maintaining a 2" head lap shall be applied with two 6d galvanized common nails and a nominal 3/4" wide by 3" long bead of Ohio Sealant Inc's RTU -600 adhesive at the barrel portion head lap. The rake tiles shall be applied with 2 -10d galvanized common nails per tile installed in 3/16" diameter drilled holes. The eave tiles shall be closed off with molded closed cell foam eave ship nailed 12" o.c. incorporating drain holes at the base and at the center of each barrel portion. The application of this system is acceptable up to 75 feet above grade. * 2: Mortar -Set System The deck shall be covered with a 30 Type II (ASTMD -226) anchor sheet tin -caped 12" o.c. in the field and 6" o.c. at the laps. Over this, a hot - mopped 9011 Type II (ASTM D -249) granular surface roll roofing cap sheet using hot steep asphalt Type IV conforming to ASTM D- 319 -89, shall be applied The tiles shall be applied with a 2" head lap to the prepared roof deck with mortar consisting of volumetric proportions of 2.5 to 1 of sand conforming to ASTM C -144: One bag of Rinker Roof Tile Cement with approximately.75 gallons of water mixed to a workable consistency for 2 to 5 minutes. B: Santafe' Mission Barrel Clay Tile 1: Mortar -Set System The deck preparation and the mortar used shall be as called out in Section A (2) with the tile applied maintaining a two inch head lap Due to Hurricane Andrew, this office has been inundated with requests for both new products and renewals, which has caused a large back log in responding with an official Notice of Acceptance. In the interim period, please accept these products to be installed by a licensed roofing contractor in accordance with further instructions and specifications by the manufacturer and Chapter 34 of the South Florida Building Code and until an official Notice of Acceptance is issued. GD: co PAGE2 Gil I iamon Product Con Supervisor 4 rKIKUNiLH 1-HX M �� GD:co .i{05b33y`J'14 TO WHOM IT�Y CO C ' HUU 1W, ly`j.i 1: SdHM METROPOLITAN DADE COUNTY, FLORIDA METRO.DADE FLAGLER BUILDING BUILDING CODE COMPLIANCE DE ENT RE 1603 METRO.OADE FLAGLER BUILDING 140 WEST FLAGLER STREET MIAMI, FLORIDA 33130-1583 (305) X15.2401 FAX (306) 376.2808 February 22, 1993 Revised August 06, 1993 MFM Building Products, f heir Wind and Water seal as an alternate application o an anchor sh esubstantial as defined data to support the use o in Section 3403.4 of the South Florida Building Code (S.F.B.C.). Tho product consists of fiberglass acrylic 30 core coated a in modified vv>I'de rolls. t adhsive having a total thickness of 45 nail. and weighing per square This membrane is self adhesive and may be used for nail on roof covering systems such as but not limited to composition & metal shingles and nail on clay or cement roof tiles for slopes as low as 2:12. Due to an avalanche of requests for new approvals brought about by Hurricane Andrew, the issuance of Notice of Acceptance are being delayed. In the interim period, please accept this letter in allowing this products to be used under a temporary approval until final approval is granted. Sincerely your Gil Diamond, P Product Control ivision Supervisor N. kid to re- occupy the single family residence known as : (address) Legal Description: Lot: Print Name Buyer APPLICATION FOR CERTIFICATE OF RE- OCCUPANCY 1,241 c_ saA I hereby certify that I understand that the zoning of the property is for single - family residential use and that it is unlawful for more than one family to reside therein. I also understand that any Certificate of Re- Occupancy that may be issued by Miami Shores Village, certifies only that the referenced property is being used for single - family purposes and that such Certificate does not constitute any re • resentation, warranty or certification as to the condition of the dwelling or other structures on sus property. Applicant Date ,14) *********************************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** For purposes of conducting the inspection required by Section 902 of the Miami Shores Land Development and Zoning Code, please contact: reardse. � �e Contact Name: ac,10 goozi.ct Application Fee ($50) paid: Cash Inspected by: F • LUB I EN Comments: Block Seller Realtor Approved PAGE 1 OF 2 , hereby apply for a certificate Miami Shores, Florida. Check No. /5 IL( X PB & PG: Denied sl?‘ Telephone: OS ( 4 (o9 -- 7 8 Company Name `Q eoat Date 8 /30 /00 CERTIFICATE OF RE- OCCUPANCY On behalf of Miami Shores Village, Florida, the undersigned certifies that the property described in the above application has been inspected for purposes of re- occupancy pursuant to Sections 901 and 902 of the Miami Shores Land Development and Zoning Code and that such property may be re- occupied by the above applicant for single - family residential purposes. MIAMI SHORES VILLAGE, FLORIDA By: THIS CERTIFICATE VERIFIES THAT THE REFERENCED PROPERTY HAS BEEN INSPECTED BY MIAMI SHORES' VILLAGE AND HAS BEEN DETERMINED TO PRESENTLY COMPLY WITH THE SCHEDULE OF REGULATIONS OF THE MIAMI SHORES LAND AND DEVELOPMENT CODE PERTAINING SOLELY TO THE REQUIREMENT THAT EACH ONE-FAMILY DWELLING IS USED AND INTENDED TO BE USED FOR A ONE - FAMILY DWELLING PURPOSE ONLY; HOWEVER, THIS CERTIFICATE DOES NOT CONSTITUTE ANY REPRESENTATION OR WARRANTY AS TO THE CONDITION OF THE DWELLING OR OTHER STRUCTURES ON THE PREMISES DESCRIBED HEREIN, OR ANY ASPECT OF SUCH CONDITION, AND INTERESTED PERSONS ARE ADVISED AND ENCOURAGED TO MAKE THEIR OWN INSPECTION OF THE PREMISES IN ORDER TO DETERMINE THE CONDITION, THEREOF. PAGE 2 OF 2 Date of Certification: 8/30/00 BUILDING ELECTRICAL PLUMBING ROOFING Owner of Building A' + 12 Architect Contractor or Builder Legal Lot C._ MIAMI SHORES VILLAGE. FLORIDA DATP. 1 j 195 F c 9 In consideration of the issuance to me pertaining thereto and in strict conformity with cepting this plipati I assue responsibility for CONTRACtOR OR BUIL DER PERMI Description Address of Building = it T N? 3995 Work to be performed under this Permit 120 .I t rsJ i I B1 BY Value of Project $ Signed. S _ Contractor's License No. Amount of Permit $ Subdi- vision s 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 stat- ents or specif1ti•ns at he assumes responsibility for work done by his agents, servants or employees. INSPECTOR of this permit I agree to perform the work covered he eunder in compliance with all ordinances and regulations the plans, drawings, ergs, or specifications bmitted to the proper authorities of Miami Shores Village. In ac- all work done by let myself, my agent, se ant or employee. AUTHORITY s. BUILDING ELECTRICAL PLUMBING ROOFING Owner of Building Architect Contractor or Builder J 4 Legal Lot Description — Address of wilding ` - 0 0 0 0 4. MIAMI SHORES VILLAGE. FLORIDA PERMIT TQ 4122 Bl C- 14,, 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 iime 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 ?ertaining 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 jone 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 regulations pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In ac- epting this permit I assume responsibility for all work done by either, myself, my agent, servant or employee. CONTRACTOR OR BUILDEIL t , g / � BY Value of - ` Project $ / ? Amount of Permit $ AUTHORITY DATE 1' C v / 3 195__ Contractors 0 License No. Work to be performed under this Permit Subdi- vision BUILDING INSPcCTION DEPARTMENT APPLICATION i 0R B ..3 L PERM rr AI+plieation is hereby made for the approval of the detailed statement of Inc piar.s and specifications herewith submitted for the build• fog or other structure herein described. This application is made in compliance and conformity with the Building Ordinance of Miami I;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,.whcthcr herein specified or not. A copy of approved ::plans s and specifications must be kept at building during progress of the work. Nov. 23, 1982 Owner's Name and Address (hr • Shaw Foster .53 NE 98 Street — No ....... Street_.. Registered Architect and /or Engineer.. Date ' Name and address of licensed contractor....lil.R..E3ub bins_ &..,Sans,....Zn.c.:....1. 431... A141 •..20,..st....Riant.1- 3314•g Location and legal description of lot to be built on. Lot Block Subdivision ........._: ;...., .._........_ ................... Street and Number where work is to be done ,_ ' 53 ly.E...s. _.StS.e @.t.,...P1iarai aboLES •■■•■•• State work to be done and purpose of building (by floors) • Tear off; apply one 30it_fel t .. tin cajd, nailed., _ 29 sfuares . . . , Ncw Building., Remodeling Addition Repairs No. of Stories. To be constructed • of Kind f foou�pdation Roof Covering ..._,.� Estimated Total, cost of improvements $ ) Amount of Permit $,.....,.2�„ ... • Zone cubage required .Plan Cubage �. • Distance to next nearest building Size of Building Lot ... .Maximum live load to be borne by cash 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.. ..W..R.Etobbins... &..Sons...1. 40.1... 1uW- •- 2II.•- 5.- •.•-- Kliami•..33142 pealed Disapproved . (Signed) Conned Approved Cnair;r,an Nfcmber Building Inspector NOTE; A charge of $1.00 will be made for the I'i,rnr ir, L'u.1ru. A re -rn' ;motion fee of S1.00 will be charged materials anu /or workmanship. 11.11 H,• •,,,.1„1,,,.1,„,•.• „• 111 e "1 RC 0020296 The undersigned applicant for this building perinit does hereby certify that he understands and accepts his obligations as an employer or Libor under the ' Florda %Vorkmen's Compensation Act, being S; ction &9G6, Compiled General Laws of Florida, Permanent Supplement, and has complied kith the provisions thereof, and will require similar compliance from all contractors or subcontractors employed by hint 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. (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- 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 ire true,', 1 Permit No V59 • Date 1 I / 9 x . Read, Sworn to and Subscribed before me; Date ,•......._....— Notary Public, State of Florida My Commission Expires, PLANNING BOARD DATE MOM and for no other purpose. to me well known. Member ... of c-„ bcr ... » ......... .... ».... Member ...._ ....... ..__.._._... ». .... .»...........� Dole D•sapproved Date makin, cvncctions. or cllanzes to this application after approval has been obtained from when such re- inapcatfon in :a:.da necessary by improper notice for .insp rrtion or faulty 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. Owner's Name and Address STATE OF FLORIDA, COUNTY OF DADE. Permit No /.� ss. Registered Architect and /or Engineer Name and address of licensed contractor.... L_.. Disapproved _ (Signed) Date NOTE: A charge of $1.00 will be made for the Planning Board. A re- inspection fee of $1.00 will be charged materials and /or workmanship. MIAMI SHORES VILLAGE ,Wee :e f' ?f _ 1Q6 Building Inspe 'r PLANNING BOARD Chairman Member Member Council Approved Date Date... Cam. S t - /94_0 ,19 Street Location and legal description of lot to be built on: Lot Block Subdivision Street and Number where work is to be done' '3 77 5 State work to be done and purpose of buildir%(by fl and for no other purpose. New Building Remodeling Addition Repairs No. of Stories To be constructed of Kind of foundation Roof Covering e � Estimated Total cost of improvements $ / 7 8 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, Pennanent 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 subcontractor, on work to be performed under this permit, as are licensed by Miami Shores Village. Remarks (Signed) (fi (Yitv-tieeJ 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. W z Read, Sworn to and Subscribed before me. Notary Public, State of Florida My Commission Expires DATE Member Member Member Disapproved Date making corrections or changes to this application after approval has been obtained from when such re- inspection is made necessary by improper notice for inspection or faulty 4 /U6 I09� Z To Whom It May Concern: Due to customer's cancellation of the installation of equipment, please cancel permit(s) for Nationwide Power Corporation. If refundable, please refund permit fee(s) to Nationwide at the address above. PERKIT NO s 2-3 NAME : it/b EL / jJ ADDRESS: S /ti FK sT CITY: //4 S lad�?eS V/ /0/2 2 / 8 s NA'T': :c)NW.I :t :li::: POWER CORP-ND 1994 0 NE 15 CT N. MIAMI BEACH F'L. 33179 STATE AND ZIP CODE: P 33/ 3 g' LOT: /g LL4J1 of: / q' BLOCK : SUB: e s SEC. Very truly yours, 2 ,1 / 1 / A0e Robert Hartleb State Certification Ne. CFC019063 iinrl +•.1% • 1 it 0\ VI 1%1111 • :'l I6.1I'/ \13' • 111 /'.1'11 1 I tilt ." As. PI • 11 I 1 I '11 Location and legal description of lot to be built on: Lot Block Subdivision 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. ,�,,r ���p / Owner's Name and Address._ /.i - Date No .3 Street._ , 19 Registered Architect and /or Engineer ,; A / Name and address of licensed contractor G� .�1�'G !� C! ��" 7 U ._' p/I/ e Street and Number where work is to be done ._3 ' State work to be done and purpose of building (by floors) and for no other purpose. New Building Remodeling Addition Repairs No. of Stories To be constructed of Kind of fou datiion Roof Covering Estimated Total cost of improvements $ __L/ Amount of Permit $ / ` ed 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 sub ontra tors, work to be performed under this permit, as are licensed by Miami Shores Village. Remarks ( Signed)... J 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. Owner's Name and Address._..._ v-1J--I-.._.F' FIE LP Registered Architect and /or Engineer Name and address of licensed contractor Disapproved t /J Date (Signed) -. W C 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. Location and legal description of lot to be built on: Lot Block Subdivision Street and Number where work is to be done 3 A/ 9 State work to be done and purpose of building (by floors) and for no other purpose. New Building Remodeling. Addition Repairs No. of Stories To be constructed of Kind of foundation Roof Covering 7/ LC Estimated Total cost of improvements $ y,51 • 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 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 ins - ion on the site of the work such public notice or notices as are required by the Act. The undersigned agrees to employ only such b•.ntractorshon work to performed under this permit, as are licensed by Miami Shores Village. Remarks (Signed) — E Date___-! - " 3 q , 19 IO No P Street Af _ / 8" g /576 OM / STATE OF FLORIDA, I 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 3 9 9 S — Date ?- Read, Sworn to and Subscribed before me. Notary Public, State of Florida 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.