RE-OCCUPANCYI,
APPLICATION FOR CERTIFICATE OF RE- OCCUPANCY
to re- occupy the single family residence known as : (address)
Legal Description:
Lot: /f Block PB & PG: /0 --
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 representation, warranty or certification as to the condition of the dwellins or other
structures on such property.
Applicant Date %� 7
1
Print Name
Contact Name:
Inspecte
Comments:
fiffi /7 —�,t_
* t * * ** * ** * ** * ** * ** * ******* * ** * ** * ** I t * * ** * ** * * * * * *s * *** * * * * * *s * * * * * * * * * * * *
For purposes of conducting the inspection required by Section 902 of the Miami Shores Land
Development and Zoning Code, please contact:
Buyer Seller Realtor ,/ Company Name
Application Fee (S50) paid: Cash Check No.
Denied
,11/fiami Shores, Florida.
PAGE 1 OF 2
hereby apply for a certificate
3
Telephone: - RD -(� 7.(' , -c Z1).
Date )/?,)) t2_3
CERTIFICATE OF RE- OCCUPANC
ed certifies that the property d
e, Florida, the undersign an pursuant to Sections described be
i
On behalf is 1tion has Shores spec purposes of re-occupancy P roe ma be 901
in the application has been inspected for the pure Code and that such pro rtY y
and 902 of the Mani Shores Land D l residential purposes.
re- occupied by the applicant for single-family
r, •� • i ORES VILL . FLORIDA
a
Date of Certification:
THIS CERTIFICATE
VERIFIES THAT THE REFERENCED PROPERTY BEN
DETERM ITH
HAS BEEN INSPECTED BY MIAMI SHORES �,LAGE AND EE
INED TO PRESENTLY COMPLY W THE DEVELOPMENT DULE OF
GULATIONS OF THE MIAMI SHORES LAND AND T THAT EACH
RE SOLELY TO THE REQUIRE
CODE PERTAL� G S
ONE - FAMILY DWELL ING IS USED AND INTENDED TO BE USED FOR
IS
A ONE-FAMILY DWELLING PURPOSE ONLY; HOWEVER, TON OR
CERTI ICATE DOES NOT CONSTITUTE ANY D REPRESENT.
WELLING OR OTHER
WAgRA1NTY AS TO THE CONDITION OF HEREIN OR ANY
STRUCTURES ON THE PREMISES DESCR REFS ED PARTIES ARE
,... ASPECT OF SUCH CONDITION, AND � THEIR OWN INSPECTION TO
OF THE PREMISES 1N ORDE
ADVISED AND ENCOURAGER TO DETERMINE THE CONDITION
THEREOF.
COMPENSATION
AND /OR
PUBLIC LIABILITY
4071B
.J.,. ..X
(Street and Number)
are in force and expire as indicated herein:
Workmen's Compensation
No. of Policy
C..359646
Expiration Date December ..1,,1,9.52.
Employers' Liability
No. of Policy
Limits of Liability
One Person $
One Accident $
Expiration Date
Comments or Additional Coverages
and cover the following operations or work
Dated at
H. 4071B•15M Sets 12 -51
Miceli, Florida
This is to certify that the following described policies
CERTIFICATE OF INSURANCE
(Name of Assured)
b30 Grand Concourse, Miami, Florida
(City or Town)
15/1 )' `r 1' f
issued in the name of
(State)
Public Liability
No. of Policy LC..120019
Limits of Liability
One Person $
One Accident $
Expiration Date
Contingent Liability
No. of Policy
Limits of Liability
One Person $
One Accident $
Expiratibn Date
Property Damage Liability
No. of Policy 1+C .2Q019
Limit of Liability
One Accident $ 1,000,04
Aggregate Liability for Loss $...10 .,004..00
Expiration Date December 1,1,
All-operations. performed
in the State or States of /Florida
, as described in said policies.
ve five da s written notice to
In the event of cancelation of the said policies the Company will arl not/te - t�—
M,j,ap ,. ,cage - Bu Inspector
at Village Hall, Miami Shores 38 Florida
(Street and Number) (City or Town) (Sate)
at whose request this certificate is issued.
P
Okra ) mrriran llnbrmnitg eiamgnng,
this 1st day of
10„000,00
20,000.00
Deeember••1
0ctober 52
E OFFICE, NEW YORK, N Th
EYNOLDS INC
Authorized Agent.
EGAN MOTOR COMPANY, Inc.
De. Soto • PeginfititA
301 Madison Street
MAYWOOD.-WA
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• f. /e
4. a
DESOTO LETS YOU DRIVE WITHOUT SHIFTING
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STATE OF FLORIDA) Sr
COUNTY OF DATE )
And Further this Deponent says not:
AFFIDAVIT
'of the Village of'Miami Shores,
County of Dade and State of Florida,, being duly sworn, doth depose and say,
that under the provisions of Ordinance No. 185, dated June 13, 1918, amen&
ing paragraph (d) of Section H -368 of Ordinance No. 97 of the Building Code
of Miami Shores Village, he desires to build a
on Lot Block of Subdivision,
that he is the owner of said property, and will be the owner of said
, that he will do the work personally, and that
he will, at such times as are required by the Zoning and Building Directors -
1. File plans and specifications and obtain approval of the
Planning Board and the Building Inspector.
2. Apply for and secure a Permit.
3. Pay the required fees.
4. Execute the work in accordance with the provisions of this
Code.
5. Apply for inspections.
6. File with the Building Inspector certificates that provision
has been made to carry the necessary Workmen's Compensation,
Public Liability and Property Damage Insurance.
7. File with the Building Inspector as the job progresses certi-
ficates showing the payment required by the Federal Social
Security Act to the State of Florida or t United States of
America.
8. Assume the responsibility of not employing other than properly
licensed contractors by Miami Shores Village for any part or
portion of the work.
9. Not set himself up as a "contractor ".
10. Sign an affidavit before commencing ing work to the effect that
he has read this Article and will do the work personally and
observe all of the requirements of the Building, Electrical,
Plumbing and Zoning Codes of Miami Shores Village. Such
affidavit to be properly notarized upon blanks to be supplied
by the Building Inspector.
11. In order to prevent abuses and subterfuge the right of such
owner builder as herein provided, ' is limited to but one
owner - builder permit each 2 years, and where an owner•.builder
has once exercized the privilege herein conferred no second
app ication for owner builder permit shall be granted in leas
than 2 years, unless the applicant is qualified as a licensed
General Contractor under the applicable Orblinanoes of said
Village.
SUBSCRIBD AND SWORN TO BEFORE ME this
19 •
0
day of A« D•,
NOTARY PUBLIC.