DRIVEWAYs
`PERMIT APPLICATION FOR MUNICIPALITIES OF DADE COUNTY
(OWNER TO RETAIN COPY)
Date r Job Address /a5o N cE 10 ( S -4-- Tax Folio // .�._,Wf OF 1 9LQ2 7
Legal Description 4e07 %'` I;O.P3? '1 S11' t S Master Permit #
/ Lessee / Tenant L+ E3 li— P c-7- n-C (4-
's Address
Contracting Co. Cic jj ka." /A4,6 L Address
Qualifier SS# - Phone
State # Competency# Ins.Co.
Architect /Engineer Address
Bonding Company Address
\ortgagor Address
Permit Type (circle one):(Iiii4LDIN6 ELECTRICAL PLUMBING MECHANICAL PAVING FENCE SIGN
WORK DESCRIPTION ''�,A J P ,i,_,) Ao4.9l A2/4e4 / 7 ,9aW cL
Square Ft.
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 all applicable laws regulating construction and zoning.
Furthermore, I authorize the above -named contractor to do the work stated.
Signature of Owner and /or Condo President
Date:
Notary as to Owner and /or Condo President
My Commission Expires:
* . * * * * * *
PERMIT FEE: APPROVED:
Zoning
I tchanical
Fire
Building
Plumbing
Phone > 740
Estimated Cost 9
Signature of Contractor or Owner - Builder
ry as to Contractor or Owp Builder
My Commission Expires: 1 0/ 6 /4K
lectrical
Engineering
MIAMI SHORES'VILLAGE BUILDING AND ZONING DEPARTMENT
Yqu have, this date, made application for a building permit as an owner -
builder. You should be advised of the following provisions and requirements
that apply to owner - builder.
Proof of Ownership - Prior to a building permit being issued to you,
you must submit proof of ownership of the land concerned in the
application in the form of a recorded deed, showing you own the property,
or a copy of mortgage or warranty deed of the land, or a Dade County tax
receipt, statement to contain legal description of property and indicate
property is in your name. Legal description and name on document of proof
must correspond to the name and legal description on the application.
Responsibility - You will be responsible for all work done by your day
labor employees, and you must either employ licensed contractors or
persons to be paid on an hourly or per diem basis. Any one contracting
(including labor) with you, verbally or in writing, on a fixed fee basis
for any work, who is not properly licensed, will be subject to a fine of
$500.00 and /or imprisonment for six months.
Insurance - You should be advised that if your day labor employees cause
any damage to persons or property, or if any of your day labor employees
are injured on the job, you are liable. Your regular home insurance
policy ordinarily does not cover this type of liability.
Withholding Taxes, etc. - You should be advised to investigate your
responsibility for withholding Social Security, Federal and State
Unemployment Insurance Taxes and Federal Income Taxes from the wages
of employees working for you on the proposed construction, and for
making returns thereof to the proper agencies.
Work Permitted Owner - Builder - An owner - builder subject to the foregoing
provisions and requirements, is limited to constructing one single family
residence each year for his own use and occupancy;,or maintaining, altering
or repairing his own single family residence.
If you do not intend to do the work involved yourself, or with day labor, please
list below, the name of the individual or firm with whom you have entered (or
will enter) into a contract for the work.
NOTICE: SEPARATE PERMITS REQUIRED FOR ELECTRICAL, PLUMBING,
ROOFING AND MECHANICAL WORK
Name of Individual or Firm Address
I, the owner of property described as /a..'CL AJ6 (Of S - 4-
v l f e-t_ (ro -7
that I have read the foregoing instructions, and am aware of my responsibilities
and liabilities under my application for a building permit for construction work
on the above described property.
. / .11 i ./ i /�.I Lt.L
Witness
INSTRUCTIONS TO OWNER- BUILDER
ti
Date
do hereby certified
Owner
• 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 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
Location and legal description of lot to be built on:
State work to be done and purpose of building (by floors)
and who, bein
of the above
therein by hi
Permit No.____
Disapproved
(Signed)
Bu ding Insp
e
Chairman
Member
Member
Council Approved
Date
No /Yr°
/A/
PLANNING BOARD DATE
Z -) y
Lot Block Subdivision
Street and Number where work is to be done / Y ■re, f O / -
Street
ate Read, Sworn to and Subscribed before me.
19 it
and for no other purpose.
New Building Remodeling Addition Repairs__. 7 0 No. of Stories
To be constructed of Kind of foundation Revering
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 pennit 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 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 authorized to administer oaths and take acknowledgments, personally ap-
peared
to me well known,
by me first duly sworn, upon oath deposes and says that he is the
o struction, that he has carefully read the foregoing application, and that he did sign the same, and that all facts
e.
Notary Public, State of Florida
My Commission Expires
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 $1.00 will be charged when such re inspection is made necessary by improper notice for inspection or faulty
materials and /or workmanship.
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