1140 NE 100 St (2)FILE No .808 02/15 '02 11:49 I D :MIAMI _SHORES_V I LLAGE____ FAX :3057568972
APPLICATION FOR CERTIFICATE OF RE- OCCUPANCY
ri S - i dg
to re-occupy the single family residence known as : (address)
Legal Description:
Lot:
Block
IVliami Shores, Florida.
PB & PG:
hereby apply for a certificate
I hereby certify that I understand that the zoning. of the ro e
and that it is unlawful for more than one family to reside therein. is
I also u derstand t at a y ial use
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 dwelling or other
structures on such property.
Applicant Date —`0;/
Print Name
* ** ** * * * * * * ** ♦ * * * * *** ** *fie * *ii * * * * ** * *i ., * * ** * * ** ** *SIC * ** ** * * * *** ** ** * * * ** * * * **
For purposes of conducting the inspection required by Section 902 of the Main Shores Land
Development and Zoning Code, please contact:
Contact Name:
Buyer
fits.
R Company Realtor Com
P y Nara e
Application Fee ($50) paid: Cash
Check No.
ri2 Telephone; Q5f 3 — 9(01 7
PAGE 1 OF 2
Inspecte ! • ' f
Approved Denied
Dat
Comore
PAGE 1/ 2
FILE No.808 02/15 '02 11:49 ID:MIAMI_SHORES_VILLAGE____ FAX:3057568972
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.
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 TH E ACH
ONE DWELLING IS USED AND UNTENDED 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
SHORES VII== GE, FLORIDA
Date of Certification:
PAGE 2/ 2
Date 5-)= Job Address l l 4 0 J E 100 sr Tax Folio
APPROVED:
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Legal Description - T''" "rT"4)
Owner / Lessee / Tenant -.5 T -L._ 4. 2E60 Master Permit # 3 4 7 77
Owner's Address 1110 NE 100 51 Phone 7 7S O 25S
Contracting Co. 5E L r Address
Qualifier SS# - - Phone
State # Municipal # Competency 4>~ Ins.Co.
Architect /Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type(circle one BUILDIN ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIPTION CABTNE 1 Q.E 1 1 L
tk) CA8 r-#.1ET 4 LLB SOni
�
Square Ft. Estimated Cost(value) .b��tt /I/ I
� � ) vv
WARNING TO OWNER: YOU MUST RECORD A NOTICE OF COMMENCEMENT AND YOUR FAILURE TO DO
SO MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY (IF YOU INTEND
TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR
NOTICE OF COMMENCEMENT).
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 . '1 applicable laws regulating construction and zoning. Furthermore, I
Bove- e. 'ontract.r to do the work stated_
aut •i ze th � i
Sign of owner an•/or Condo 'resident
Dat
Notary as to Owner and /or Condo President
My Commission Expires:
Sigrfature of Contractor or Owner- Builder
Date: sla - q 4 '
Notary a d F ' tg ar--
ar�Oh11tt- Builder
Pa , OFFicIAL NOTARY SEAL
My Commi abn Ex &res scoTT W DAVIS
. 1 1 * COMMISSION NUMBER
` c CC 55237
** * * * * * * * * * * i►fF i * .:
� c k7'? P2a�+iS:i N EXP.
'�. **
OF F -y;: :5,
NOTARY TOTAL DUE
FEES: PERMIT 57* RADON C.C.F.
Zoning Buildin
Fire Other
oiL
w
Electrical
Mechanical Plumbing Engineering
CABINET STYLE
CABINET HARDWARE
MISC.
APPLIANCES
SPECIAL INSTRUCTION:
1 �--
554 "/ -., ,
IRO � Sd
4 !a L) 12 X42
1
. pket Vele O
2
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1
1
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QF ;Th. )i )P
1
Sold To Delivered To Customer Approval
Address Sold By
Delivery Date
BUILDING
ELECTRICAL
PLUMBING
ROOFING
Owner of
Building
Architect
Contractor
or Builder
Legal
Description
Address of
Building
Lot
In consideration of the issuance to me
pertaining thereto and,:in strict conformity with
cepting this permit I a ssume responsibility for
0
0
MIAMI SHORES VILLAGE. FLORIDA
PERMIT N? 2683
B1
Work to be performed under this Permit
CONTRACTOR OR BUILDER BY
Subdi-
vision
Value of
Project $
DATE
Contractor's
License No.
Amount of
Permit $ f
AUTHORITY
195
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 cr in the statements or specifications and that he assumes responsibility for work
done by his agents, servants or employees.
Signed. BY
INSPECTOR
of this permit I agree to perform the work covered hereunder in compliance with all ordinances and regulations
the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In ac-
all work dory! by either, myself, my agent, servant or employee.
f i rr : A�