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120 NE 100 St (7)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 building 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 S le_ • ern- r�-ie Registered Architect and /or Engineer / / / �� Name and address of licensed contractor '; '4 t � ii ?- 4 0-- 7S 3 / c?- C9 Location and legaal ascription of lot to be built on: on: Lot /� �j 4 0 // Block f !/ Subdivision OA , ._ / "/AP / / 3z4 43 ,z/'v Street and Number where work is to be done / -_O N &"-- /0 0 S7 State work to be done and purpose of building (by floors), state exterior colors (submit samples) R e �1f, to ( 1-c T - ;b2_. /x New Building /rte , Z -e ( �I Le. s Remodeling Addition Repairs No of Stories To be constructed of Kind of foundation Roof Covering Estimated Total cost of improvements S 2 - e 9C1 Amount of Permit $ / 4 06 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 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 cepts his obligatons as an empl . er of Labor under the Florida Wo men's Compensation Act, being Section 5966, Compiled General Laws of Florida. Permanent Supplem t nd has complied with the J ovision thereof, and will require s , filar compliance from all contractors or sub - contractors employed by him in the work to be perform der this permit; nd wil .ost or use to be posted for inspe ion on the site of the work such public notice or notices as are required by the Act. The undersign a ees to employ on s subcont actors. on work to be perfor ed 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 ac nowledgments. personally appeared Myron Lieberman 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 Permit No. 7 937 (Signed) Building Inspector Date 3/ 16/ 88 Disapproved \ Date Re Date 3- 19 V S No. /02 Street7 /ae2 Notar -1110' and for no other purpose. Sworn to id sign the same, and at a ibed b f• m facts therein by him stated are true. My Commission Expires Y OMISSION EXr ,IOY 14, PLANNING BOARD DATE :Ys .Chairman Member Member Member Member Member Council Approved Date Disapproved Date NOTE: A charge of $25.00 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 $25.00 will be charged when such re- inspection is made necessary by improper notice for inspection or faulty materials and /or workmanship. BUILDING ELECTRICAL PLUMBING ROOFING Owner of Building Architect Contractor or Builder = x ,.ti IC.. Legal Lot Description MIAMI SHORES VILLAGE, FLORIDA / ❑ DATE 1 -A--7-6 19 ❑ PERMIT N 6304 Contractor's frt E. ,,,�'" License No. ' `f" ❑ � Work to be performed under this Permit s II B1 CONTRACTOR OR BUILDER BY C t A-x.- s- a '.s4 i.% Subdi- vision Address of g d -, „ f Value of :yam, Amount of A i �° Building r . [ i i 1 _ Project $ f PA . I Permit $ a, '•••• 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. In consideration of the issuance to me of this permit I agree to perform the work covered hereunder in compliance with all # ordinances aad 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 ell work done by either, myself, my agent, servant or employee. i ' F P' 4 ' { ' INSPECTOR AUTHORITY •oeor ' Disapproved Date (Signed) MIAMI SHORES VILLAGE BUILDING INSPECTION DEPARTMENT APPLICATION FOR BUILDING PERMIT Building Inspector Date Notary Public, State of Florida 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 Registered Architect and /or Engineer Name and address of licensed contractor_ i _ _2 • �?� - e __ Location and legal description of lot to be built on: Lot Block Subdivision Street and Number where work is to be done State work to be done and purpose of building (b floors)__-- -- __ __ ___ —e mi tl 4e4c - -- r and for no other purpose. New Building Remodeling Addition _ Repairs .S- No. of Stories To be constructed of KWof foundation Roof Covering Estimated Total cost of improvements $ ___ _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 subcontractors, on work 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° auth orized 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 b3 V '` Date S Read, Sworn to and Subscribed before me. 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.