1165 NE 100 St (8)PAID BY
ctf.occ. 1-6 -50
YEAR
ANNUAL TAX
PERIOD USED
AMOUNT PAID
', DATE PAID
RECEIPT
NUMBER
/ 9s a
/ .2i 0
/a -3/• So
/a\ 6
A
d R � .._. �..
I,
le? ��
i,
�2. 3/• a/
'�
/- ag-a 1
/ 77a
ADDRESS 1165 N. E. 100th St.
LEGALLOt 141,B1k.177, MSS ##8
RECORD GARBAGE TAX
New Building ` Remodeling Ad
To be constructed of C ,? e „ Kind of foundation
Estimated Total cost of improvements $______/3 49 CC
Zone cubage required G _____ 0 Q
Permit No Date
Disapproved Date
(Signed)
IAM I SHORES V I L L A G
/VP
BUILDING INSPECTION DEPARTMENT eft
1
APPLICATION FOR BUILDING PER
4 , #2 S
Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for
ing or other structure herein described. This application is made in compliance and conformity with the Building Ordinance o Miami
Shores Village, Florida, and all provisions of the Laws of the State of Florida, all ordinances of Miami Shores Village and all les 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. 1 V Name and address of licensed contracto e r � A , \ A ' r Date O�-c I ._ , 19 ' R �I.SJI-/ r4i.G ,b 1\lE. Nos lfl Street R� Owner's Name and Address__ _ __ ((�� r _ � Registered Architect and /or Engineer �!srS111 f�' c� � " z-Z
r ( '
Location and d scription of lot to be b il t on:
Lot - i'z Block / v 7 Subdivisign,_
Street and Number where work is to be done___, ,
State work to be done and ose of build ,1 f }0
P rP ' g Y ors)_______ _LA) � �- /���� -�
1
Building Inspector
Amount of Permit $__
__Plan Cubage 2 /
E
L6
Distance to next nearest building _ Size of Building Lot
Maximum live load to be borne by each floor 40 4' /
Read, Sworn to and Subscribed before me.
and for no other purpose.
'tion irs No. of ____
off SSttories____1
/ L .49.0 �C_ Roof Covering ! �h
1 -r
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 inspection on the site of the work such u lic notice
or notices as are required by the Act. The undersigned agrees to employ only suc.. . a � o s, on work to be performe nder this
permit, as are licensed by Miami Shores Village. /
arY
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.
Notary Public, State of Florida
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 Plannipg 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.
J
STATE OF FLORIDA) SS
COUNTY OF DADE
•� F!&
f)1)4( 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 15, 1948, amend-
ing paragraph (d) of Section B -368 of Ordinance No. ,97 of the Building. Code
of Miami Sho es Village, he desires to build a £ S •
on Lot 1 I Block __ / 27 of Subdivision,
that he is the owner of said _ property, and will be the owner of scid
p../2, - 'w , that he will do the ork personally,
and tha T 12„
e will, at etch imes as are required by the Zoning and Building
Director:-
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.
A F F I D A V I T
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 the 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 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 exercised the privilege herein conferred no second
application for owner - builder permit shall be granted in less
than 2 years, unless the applicant is qualified as a licensed
General Contractor under the applicable Ordinances of said
Village.
And Further this Deponent says not:
OWNER
SUB803, BED AND SWORN TO B 'ORE ME this l Z d of djej A. D.,
a
. 19_
N afiaf PUB