ACMIAMI SHORES VILLAGE
BUILDING INSPECTION DEPARTMENT
APPLICATION FOR BUILDING PERMIT
Application is hereby Linde for the approval of the detailed statement ur the plans and specifications herewith submitted for the build
inc 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.
U
Date.. �� ' _ 1 _ lgq ° _
O nA
Owner's Name and Address t IR t C k ' CR � No 2 2r Street . °� 6 �� • ST
C - v a y C ° � . c . 6 966 . . : 4 ' '
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 IV?, E' 0k �...._ _ „
State work to be done and purpose of building (by floors) . r�a��.l� ..............._cQ�?. „TN__
pQ( Wtr2k
1 ° 4 TOP.) p ■13 f 1'01- . 10 IC J - ik�'o - Y2-
l 11 z • 5 TO K) \A) 4$}• 5 ISi d fo aAFi purpose•
New Building Remodeling Addition Repairs No. of Stories
To be constructed of Kind of foundation... Roo verin
Estimated Total cost of improvements $
9 Z Amount of Permit 5�..:/.. .'. .
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
. STATE OF FLORIDA,
COUNTY OF DADE. } ss.
Date... I!
uilding Inspector
Date
Chairman
\fcff bcr
Member .. ..
Council Approved Date
Read, Sworn to
The undersigned applicant for this building perinit 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 •, the site of the work such public notice
or notices as arc required by the Act. The undersigned agrees to employ only such -su • actors, on work to pe ormed under this
permit, as are licensed by Miami Shores Village. , ■
Remarks (Signed �.. N) 41
ill
Before me, the undersigned authority, a notary public, duly authorizcd to administer oaths and take acknowledgments, personally ap-
peared
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.._
Disapproved
(Signed)
Notary Public, State of Florida
My Commission Expires
PLANNING BOARD DATE
and Subscribed before me.
to me well known,
Member
Member
Member
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 I'lannia 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.
MIAMI S H O R E S VILLAGE
BIItt..DING INSPECTION DEPARTMENT
APPLIC: =•TIDN FOR BUILDING PERMIT
Application is hereby made for the approyal 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.
6004
Owner's Name and Address No..._� Street__/• /Q/ ,.tA
Registered Architect and /or Engineer
Name and address of licensed contractor___a—Q..W .R (_. Gtuct -_ __ ..... n
Location and legal description of lot to be built on:
Lot Block r� Subdivision Street and Number where work is to be done /di_V__.__.___:. /Q _ l
State work to be done and purpose of building (by floors)
- - - -- 1 v w141_1 0 _tes.1._t . n2• 1Q_ d 00c1 At ca
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 $ 1 QQ_._D___U Amount of Permit' $ , Q 0
Zone cubage required _Plan Cubage__
Distance to next nearest building Size of Building Lot
Maximum live load to be borne by each floor___
STATE OF FLORIDA, I
COUNTY OF DADE. ss
Council Approved
Disapproved ___ _
( Signed) li
Building Inspector
Date - f , 19'0
/ 5' ,2
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 11 contractors or sub - contractors - - ployed by him
in the work to be performed under this permit; and will post or cause to be posted f in ection on the site a wor h public notice
or notices as are required by the Act. The undersigned agrees to employ only such ul3,co tractors, on wor ed under this
permit, as are licensed by Miami Shores Village.
Remarks (Signed) -
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. ,Q 1,
Permit No.__. , Date __.!J ✓__r__ V Read, Sworn to and Subscribed before me.
Notary Public, State of Florida
My Commission Expires
PLANNING BOARD __.. DATE
Chairman ..... _. ___ . ___ _.__ .__._ Member
Member Member
Member Member _..
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 ins, 'inn or faulty
materials and /or workmanship.
BUILDING
ELECTRICAL
PLUMBING
ROOFING
y ore
MIAMI SHORES VILLAGE, FLORIDA
PERMIT
Owner of
Building `= -
Architect
Contractor
or Builder
Legal Lot
Description II BI
N9 5829
Work to be performed under this Permit
DATE ," -
- / -°"19
Contractor's cs
License No.
Subdi-
vision
Address of s Value of - ll Amount of
Building Project $ -- ---" II Permit $
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 applica-
tion 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 respon-
sibility for work done by his agents, servants or employees.
Signed-,._ . . -. INSPECTOR
In consideration of the issuance to me of this permit I agree to perform the work covered hereunder in compliance with all o
ordin a o ei 4ngd regulations
pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In ae
cepting this permit I assume responsibility for all work done by either, myself, my agent, servant or employee.
a
CONTRACTOR OR BUILDER BY
AUTHORITY
AOEOT
Disapproved ` _ Date
( Signed) p ` ` �—
MIAMI SHORES VILLAGE /72
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 , Date aa
Owner's Name and Address._ ...
Registered Architect and /or Engineer
Name and address of licensed contractor
Notary Public, State of Florida
Street._ /0 1-45
P-6 ,1
Location and legal description of lot to be built on
Lot Block Subdivision /
Street and Number where work is to be done ..... L�,2u__�__ -C /d / / cd eY -t-G74
State work to be done and purpose of bu ding (by floors)
r e 6 - 9 ✓ - Y -n -2 s .L — z
and for no other purpose.
New Building Remodeling Addition Repairs No. of Stories
To be constructed of Kind J foundation ioof Covering
Estimated Total cost of improvements $ 4& -'- Q� 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 inspection on t ite of the work such public notice
or notices as are required by the Act. The undersigned agrees to employ only sucht ubcontractors, o ork 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 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. g _ Date 1.0 Read, Sworn to and Subscribed before me.
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 81.00 will be charged when such re- inspection is made necessary by improper notice for inspection or faulty
materials and /or workmanship.