1210 NE 100 StN9 1820
CERTIFICATE OF OCCUPANCY
MIAMI SHORES VILLAGE, FLORIDA
BUILDING DIVISION
Miami Shores Village, Fla , c.„
Block Subdivision ^k ",
Owner, Agent or Tenant of Building
Lot
Street Address t)
(h)
•
Remarks j , " e
V M
This Certificate of Occupancy is issued to the above named
for building at above named location only upon the express provision that the applicant will
abide by and comply with all conditions of Ordinances Nos. 92, 93, 94 and 97, known as the
Zoning, Electrical, Plumbing and Building Ordinances of Miami Shores Village pertaining to
the erection, construction, alteration or remodeling of buildings or structures.
1 6 t. " -„!, ,:fi Y,,..,
�. BUILDING DIVISION
Approved use by occupancy
BUILDING
ELECTRICAL. o PERMIT N°
PLUMBING ❑
ROOFING
Owner of
Building
Architect
Contractor «_
or Builder
Legal Lot II BL
Description
Address of
Building
MIAMI SHORES VILLAGE, FLORIDA
❑ Work to be performed under this Permit
CONTRACTOR OR BUILDER
15279
Subdi-
vision
Value of
Project $
DATE 195
Contractor's
License No
Amt. of
Permit
BY AUTHORITY
$
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 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 or in the statements or specifications and that he assumes responsibility for work
done by his agents, servants or employees.
Signed: BY
INSPECTOR
In consideration of the issuance to me of this permit I agree to perform the work covered hereunder in compliance with all ordinances and regulations
pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village.
In accepting this permit I assume responsibility for all work done by either, myself, my agent, servant or employee.
STATE OF FLORIDA,
COUNTY OF DADE. j ss.
MIAMI SHORES VILLAGE
BUILDIN INSPECTION DEPARTMEN
APPLICATION FOR BUILDING PERMIT
Application is hereby made for the approval of the det, iled statemen+ of the plans and specifications herewith submitted for the build-
ing or o h, : `ructure her 1 described. This i-tdicatic is made in compliance and con•o•m ty w,th the Building Ordinance of Mia, ri
Shores Village, 1 .or da, and all pro, isions of the Laws cf the State of I krid. all o d•nances ,,f Mi .ni Shores Village and all rules and
regu'a +ion. of the Building Div.. 1 of , lam Shoi illage 1 1 1 e 'o, ipLed with, whether herein specified or not. A copy of approved
plans and specificati •n'- must be kei at building durin progress of the wcrk.
Owner' Name and Address_ 1 A /�
Registered Architect and /or Engineer.__. L
( o
Name .nd address of licensed contractor. A\ co; ,4 ,' _ `' rt _ �=
Date 19
No Street
Location and legal description of lot to be built on •
Lot_ Block.._ ____. Subdivision £ . t-
Street and Number where work is to be done_ 2 1/4 •
State work to be done an purpose of building (by floors)
-
\ - - - -- and for no other purpose.
New Building_ _ Remodeling_ ____ _ __. Addition____ ____ ___ _____ __ _Repairs_ _ No. of Stories.
To be constructed of Kind of foundation ,�00 ®o firing_
`,
Estimated ': -ital cost of improvements $__. i i s= = Amount of Permit $
Zone ^ubage required_ ._. __Plan Cubage _______________ ___
Distance to next nearest building__ _ _ _ Size of Building Lot
Maximum live load to be borne by each floor
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 uncle signed appli 'ant for this building permit does hereby certify that he understands and accepts his obligations as an employer
of 1" bor under he Florida Workmen's Compensation Act being S• rtion 5966 Coi pled Gen al Laws of Florida P r anon. Supple rent,
and h •s cornpl ed w;th 'he prov'aons thereof, and will require similar comp lance from all contractors or sub-contractors cniplo 'ed by him
in the wo to be p rf "med under th;s pern it and - ill post or cause to be posted for,rrnispection on the site of the work su.:h public noti •e
or - •otit es as are required by the Act. The u: d:"rign.'d agrees to employ only such /dbcont ; .,tors, on work to be perforn, d . der this
permit as are licensed by M!ami Shores N.11:: ge.
(Signed) -�� ' �__�
Remarks._ - , 7
Before me, the undersigned authority, a notary public, duly authorized to adm.nister oaths .nd take acknowledgments, personally rp-
peared _. -_ - - - - - -
and who, being by me first dh•ly sworn, upon oath deposes and says that he is the -
of th abov. de.t ibed :•istruction t : :± h has carefully read the foregoing application, and that he did sign the same, and that all facts
therein by him stated are tr ie.
• � 'I P G
Permit No _-/._Fi 9 Date__ ___\ 0._ ° __ -- _____ Read, Sworn to and Subscribed before me.
.to me well known,
Disapproved `,. _ Date.
�z 0 - Notary Public State of Florida
( Signed) - --
Building Inspector My Com:nission 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 ift,•r approval h is been obtained from
the Plant' ng Board . -
A re- inspection fee of $1.00 will be charged when such re- inspection is made necessary by improper notice for inspe :•t or fa ity
materials and /or workmanship.