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1239 NE 100 St (10)PROPERTY '' - . OwjEIjt v11 6 , c h Name >v l �1� Address / ?,. /vi ) 00 L r rl) ' 54 3 3I 3d Home Telephone (, ) — 759 J )1-114 ►�j J 7 7 I y Business Telephon ` C x 5GC J � _ 60'4 Cs lJ Fax TYPE OF MANAGEMENT (✓ ) New Construction Enclosure Alteration Exterior Repair Alteration Interior Demolish Relocation of Structure Shell Only Foundation Only Add'l Attachment Other Add'l Detachment Other Step 1. • • • • • • • • • ••• • • • • • • • • • • • ... • • •.••. • • PERMIT APPLICATION • • . Master Permit No. •• •• •••• • •• • • • • •• . $uossdtar�cPermit No. • • • • ••• ••• .•• ••• • • INSTRUCTIONS - The following steps must be taken to obtain a permit from the Miami Shores Village: Complete the attached permit application whi‘tr lust be signed toy tile rropert' owner and qualifier. Both signatures must be notarized. Please print or type to allow for a more accurate proc!ssing'bt yaur�pplicatien. If roofing work will be done, a roofing application must be submit- • ted along with this permit application. • • • • • • • • •• • • • • • ••• •• Step 2. Submit the completed application with all necessary documents to the Building, Planning and Zoning Department for processing. During the processing of your application, you may be asked to submit additional information. APPLICATION Job Address: 1 f J) j )0() S /')- 1) -ID b t/e) F[ 3(5/ (..) O Address Apt. City State Zip Folio Number Lot Block PERMIT TYPE (✓) Building Electrical Mechanical Plumbing LPGX Roofing Fence Other PERMIT CHANGE (✓ ) Chg. Contractor Renewal Revision Extension Supplement Reinspection ARCHITECT Name License No. Address Telephone Fax escription of Work Tax Assessed/Appraised Value ( A 1 � . o f- F xi1 94,5(-W Subdivision PB PG Zoning Linear Feet Current Use of Property Square Feet Units Floors alu Proposed Use of Property e of Wor 1. k ,30 6 . () 6 Bldg Value Tenant Information Flood Zone Base Floor Elev. ENGINEER Name License No. Address Telephone Fax CONTRACTOR Name License No. Address Telephone Fax Qualifier Name Page 2 S I/A TE OF FLORIDA , COUNTY OF MIAMI -DADE ture of Owner 1U� ignature of ••. Print Name n/ p Print Name Sworn to and subscribed before me this Q day olt —. 1 Sworn to and subscribed before me this day of StatE� of Flori `� • • .. • • • • . • ... • • • • • • • • • • • •.. • . • . • •.• • • Signature of Contractor / Qualifier Signature of Notary Public - State of Florida PERMIT APPLICATION IMPORTANT NOTICES • DO NOT BEGIN ANY WORK WITHOUT HAVING RL+C•BIVED YOUR WXLU'ED W 4Fgvil,r PERMIT CARD. Applying for a permit does not grant the right to begin construction. HOURS OF CONSTRUCTION are limited to: Monday through Friday from 7:30 a.m. to 6:00 p.m., and Saturday from 8:00 a.m. to 5:00 p.m. No inspections will be conducted on weekends or holidays. 2. All construction of demolition areas MUST BE MAINTAINEDJN•At•(L M NATAfND SANITARY CONDITION free from construction debris. 3. STREETS AND NEIGHBORING PROPERTIES SHALL BrICEPTIPRBE • PROivI bll�` INDj BRIS. 4. SWALES MUST BE PROTECTED FROM BEING DAMAIG • B pEDICLES, AND MAY NOT BE USED FOR STORAGE. A bond is •• • • • • • •• required for work in or near the street/sidewalk. 5. CONSTRUCTION TRAILERS ARE PROHIBITED ON SINGLE FAMILY RESIDENTIAL CONSTRUCTION SITES. Other construction may have a trailer which requires a separate permit. 6. PORTABLE TOILETS for a construction site require a separate permit. 7. DO NOT DISCHARGE WATER INTO THE RIGHT OF WAY OR STORM DRAINS without approval from the Building, Planning and Zoning Department. 8. EQUIPMENT AND MATERIALS SHALL BE STORED at least 10 feet from the edge of pavement. 9. Department of Health and Rehabilitative Services (HRS) approval is required for applications involving septic tanks. Department of Environmental Resources Management (DERM) and/or Miami -Dade Water and Sewer Department (MDWASD) approval is required for applications involving sewers. AFFIDAVIT - Please read carefully. Application is hereby made to obtain a permit to do work and installation as indicated. I, the OWNER of the property, 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, POOL, EXTERIOR DOOR, MECHANICAL, WINDOW, FENCE, DRIVEWAY, ROOFING and SIGNS and there may be additional permits required from other governmental agencies. I, the OWNER of the property, have disclosed all information related to any work at the property performed in the prior twelve months to the Building Official. Further, I am fully aware that if the cumulative cost of work to my home or business under this and any other permit equals or exceeds fifty percent (50 %) of the fair market value of the structure, the entire structure must meet the present federal flood criteria for finished floor elevation. I am also fully aware that if the total cost of work to my home or business under this and any other permit exceeds fifty percent (50 %) of the replacement cost of the structure, then the entire structure must conform to the current code requirements of the Building Code. WARNING TO OWNER: Your failure to record a NOTICE OF COMMENCEMENT may result in you paying twice for improvements to your property. If you are spending more than $2,500 or intend to obtain financing, you rnay wish to consult with your attorney or lender before recording your Notice of Commencement. The Notice of Commencement must be recorded at: 22 N.W. 1st Street, 1°' Floor, (305) 679 -1078. Once recorded, the Notice of Commencement must be POSTED AT THE JOB SITE in accordance with Section 713 -35 of Florida Statutes. Review the brochure at Village Hall on Construction Lien Law and Choosing a Contractor. STATE OF FLORIDA, COUNTY OF MIAMI -DADE SEAL: SEAL: Angela M Bec ket • My Commission DD150048 a 8 Expires November 15, 2008 '� Personally known OR, Produced Identification Personally known OR, Produced Identification Type of Identification Produced: �D � . � jC () Type of Identification Produced: Miami Shores Village 10050 NE 2nd Avenue Phone: 305 - 795 -2204 Permit Number: BP2002 -2219 Printed: 12 /24/2002 Applicant: BEATRIZ Owner: ROBINSON JOB ADDRESS: 1239 NE 100 Contractor Local Phone: Parcel # 1132050080050 1:067006432136539004053430 0 Building Permit ROBINSON BEATRIZ ST Contractor's Address: Legal Description: GORDON SHORES Fees: Description Amount FEE2002 -7408 Building Permit Application Fee $60.00 FEE2002 -7410 CCF $0.60 FEE2002 -7411 Notary Fee $5.00 $65.60 Total Fees: Total Fees: $65.60 Total Receipts: $0.00 Permit Status: APPROVED Permit Expiration: 6/22/2003 Construction Value: $300.00 Work: REPAIR FRONT DOOR FASCIA If there is no permit package accessible on the job -site for inspectors to verify, there will be no inspections. Re- inspection fee is $50.00, which must be paid in advance before calling for another inspection. JOHN T ROBINSON 1239 NE 100TH STREET Miami Shores, Fl 33138 119 63- 643/670 BRANCH 00539 DATE / 0`0 O ) TO THE k45-1•{,.6 $ s _6i;60 ORDER OF v 1 t Union National Bank R /T0 7Florida DOLLARS a FOR api PREMIUM MONEY MARKET ie equipment or device described in the application herefor in strict compliance with all iith any plans, drawings, statements or specifications that may have been submitted to not done in compliance with such ordinances or if the plans are changed without :or or builder named above assumes the responsibility for a thorough knowledge of the fs or in the statements or specifications and that he assumes responsibility for work done BY: BY: PB 45 -8 W75FT LOT 5 BLK 1 LOT SIZE 75.000 X compliance with all ordinances and regulations pertaining thereto and in strict conformity s Village. In accepting this permit I assume responisibility for all work done by either ELECTRICAL TYPE Minimum Fee QTY. TYPE Dryer . • • : : Q'I 1'. ' . • 1 i'H. :ad • t,Apphance Q"1'V. "I'VI'1•: Service Repair Q•I'V'. A/C Central 1 -3 Ton Dryer Vents, Number of Fan Ventilation, Cost Outlet, Wall Ductwork, Cost of Service, Temporary Periodic Inspections A/C Central 4 -7 Ton Fire Sprinkler System Fire Pump Outlet, Switch Fireplaces, Number of Signs A/C Central 8 -15 Ton Fixture - Fluorescent • Oven Space Heater (kw) A/C Central 16 -20 Ton Fixture Light Parking Lot Lights Spas/Hot Tubs A/C Central 20+ Ton Flood Lights Plugmold/Strip Subfeeds, No. of Amps A/C Window FPL - Load Central Posts Swim Pool, Commercial Air Conditioners Garbage Disposal Range/Range Top Swim Pool, Residential Chiller Generators, etc. Receptacles Switchboards Clear Violations Heat Recovery Refrigerator, Comm. (p/PH) Temp Serv., Construction Compactor Low -volt, Burglar Refrigerator, Domestic Temp for Test - 30 days Deep Freezer Low -volt, Fire Renew - Temp Service Water Closet Demolition Low -volt, Intercom/Teleph. Repair Circuits Water Heater Dishwasher Low -volt, Television Service, Number of Amps Water Heater New MECHANICAL 'I'1'PE Minimum Fee QTY. TYPE Condensate Drain QTY. 'TYPE Generator QTV. T\'PE Q'I'Y. Refrigeration, Tons A/C Central, Tons Cooling Tower Heating Strips, each Vent Hood, Cost A/C Wall/Win. Tons Dryer Vents, Number of Paint Booth Ventilation, Cost Air Handler, Tons Ductwork, Cost of Piping, Flammable Liquid Periodic Inspections Barbecue Fire Sprinkler System Process/Pressure Piping Bath Fan - Vented, # Fireplaces, Number of Pressure Vessel PLUMBING TYPE A/C Condensate QTY. TYPE Drains, Roof QTY. TYPE Miscellaneous Fixture QTY. 'I'YI'E Soakage Pit QTY. Bath Tub Drinking Fountain Miscellaneous Repairs Solar Water Heater Bidet Filter Replace Pool Piping Sprinkler Repair Cap - Fixture Fountain • Pump and Abandon Sprinkler System Cap - Water Gas - Appliance Pump, Domestic Supply, AC Well Cap - Sewer Gas - Natural Pump, Fire Stand Temporary Toilet Catch Basin Gas - Propane Pump, Re- circulate Temporary Water Closet Clothes Washer Gas Piping Pump, Replace - Pool Urinal Dental Chair Grease Trap Pump, Sprinkler Utility - Sewer Discharge Well Ice Maker Pump, Sump Utility - Water Dishwasher Indirect Wastes Relay Repair Vacuum Pump Disposal Interceptor Roof Inlet Water Closet Domestic Well Laundry Tray Septic Connection Water Heater Drainfield, 4" Tile/Res. Lavatory Septic Tank Water Heater New Drains, Area Meter Set (Gas) Sewer Connection Water Re - pipe Drains, Floor Minimum Fee Shower Water Service Drains, French Miscellaneous Equipment Sink Well, Supply Page 3 • •.• • • • • • • • - - • • • ••• • r . . . . • . • • • .. .• •••• • ••• • • • • • ••• • . . • • PERMIT APPLICATION INSTRUCTIONS: Please indicate the tyv. of.k being perforth ! or quantity(ies) in the space provided below. RECEIVED AND REVIEWED BY: DATE: Page 4 OFFICE USE ONLY CHECKLIST LI OWNER - BUILDER FORM (Attach) LI FIRE DEPARTMENT APPROVAL (Commercial / multi - family) ❑ CONCURRENCY (New Construction) LI OTHER (Specify & Attach) • • .•.• ❑ PROOF OF OWNERSHIP • • • • I n (Attach) •• ••• • • • • • • • • • . • • • ❑ FIRS: DER1! A1 •' ❑ (SepfC / St vet) • • • • ❑ IMPACT FEE (New Construction) ❑ OTHER (Specify & Attach) PERMIT FEES $3.00 per page (Scanning Fee) $ Miami Shores Village Bond Metropolitan Dade County (C.C.F.) Inspector State Educational Fund $ State DCA (Radon) $ Code Enforcement Fine $ Zoning Review Notary $ �Q $ / 0 ( sq.ft. = x/1000 x ¢.60) (¢.005 /sq.ft.) (¢.01 /sq.ft.) $ 9 C 7 • • • • ••• • SECTION Zoning Electrical Mechanical Plumbing Fire Public Works Structural Building Official BY DATE • • • • • •.• • • • • • • • • • • • ••• • "• • • ..•. • • • REVIEWED AND PREPARED BY: PERMIT APPLICATION CONDO ASSOCIATIC)N APPROVAL (Attach) BPR APPROVAL (Restaurants) LI CONTRACTOR REGISTRATION (On File) TOTAL $ (� _ 6 ISSUING OFFICIAL DATE: CONDITION OF APPROVAL Revised July 2001 10050 N.E. 2ND AVE., MIAMI SHORES, FL • (305) 795 -2207 • FAX (305) 756 -8972 • http : / /www.miamishoresvillage.com PERMIT APPLICATION FOR MIAMI SHORES VILLAGE Date . • /s - ' Job Address /073 9 rig / 61J S Tax Folio Legal Description Historically Designated: Yes —7 No Owner/Lessee / Tenant !* J 9 e �t1O Q C/ a /YO Master Permit # 378 8 / 7 fr Owne>'s Address /, 3 t / / Phone $ / • O Contracting Co. JMM e s aka D R4'a ! C � E .. Address / / bD-0 /`1 e!e 7Z Qualifier .,l uipt?e g 7 / /C® SS# !..hone G", State #12 6 . OD 3 D Cg' Municipal # I So 9 Competency # fns. Co. Architect/Engineer Address Bonding Company Address Mortgagor Address Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN WORK DESCRIP'T'ION €? !Z_D es /'rte -Ct Square Ft. 4 f G P e20 Estimated Cost (value) 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 o ran or C ondo President Date Notary as to Owner and/or Condo President Date My Commission Expires: Date /6/9,c ot. : s to Contractor or Owner - Builder Date My Commission Expires: ; lli 111111111111Nll lllNlllllNllllllNlllllNlll, • .. "r IV* (- Bridgette O. Hibbert • -c' Notary Public, State of Florida '' F ° Conunission No. CC 292736 ear My Commission Expires 6/7/97 . j . •. MI TAroudh Fla. Notary Service le goading Co. i)\)l)s)')WA ))))))) )))))1))))1)))))))))))))))))))) FEES: PERMIT RADON C.C.F. * 5 NOTARY TOTAL DUE JQ r APPROVED: 11 • Zonin g Building `� Buildin ttigt5 Electrical Mechanical Plumbing Engineering Disapproved Date. (Signed) Led. � • /, c . Building Insflector 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. in 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 1/0 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 / State work to be done and purpose of buildin yy _....__... 19Z ... No./.1,3 f .._... street2 J . /4.,*' • l> 0.. . :... ..... ................ef,...,,.,,t.,= :,_sass. 4 /— 30 Gee/ /— fD /7-w9 New Building Remodeling Addition Repairs. To be constructed of Kind of foundation Roof Covering Estimated Total cost of improvements $ 7�.. "c � ( 9--c Amount of Permit &. 7 0 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 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 jinder this permit, as axe 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 . 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.._..� l Date ' 2 8'/T Read, Sworn to and Subscribed before me. Notary Public, State of Florida My Commission Expires X2 5. and for no other purpose. No. of Stories / to me well known, • PLANNING BOARD DATE Chairman Member Mfcrnber Member Member sass.. 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 of faulty materials and /or workmanship. BUILDING ELECTRICAL PLUMBING ROOFING Owner of Building Address of Building MIAMI SHORES VILLAGE. FLORIDA '❑ ❑ PERMIT N° 5091 Architect Contractor or Builder ^' Legal Lot Description 11 Bl O/ s �, r" �' • r • j- -ft_ (1 ' L Work to be performed under this Permit Value of Project DATE Contractor's License No. 195____ Subdi- vision Amount of 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 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 i ` BY /i �1 . a. • INSPECTOR oe 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 ac- cepting this permit I assume responsibility for all work done by either, mytelf, my agent, servant or employee. CONTRACTOR OR BUILDER �, BY j AUTHORITY 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: Date 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. Date ' ..P'" ® , if i " 1 " No... /rx2i 7 Street. .. 21.. 1, 1 ®0 .m 54. Lot Block Subdivision Street and Number where work is to be done State work to be done and purpose of building by floors) �.r 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 $... L . s% Q A 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 s conjactors, on wor o be perfo ':d under this permit, as are licensed by Miami Shores Village. Remarks (Signed) STATE OF FLORIDA, COUNTY OF DADE. f 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 constr tion, that he has carefully read the f egoing application, and that he did sign the same, and that all facts therein by him sta �� Permit No ti __ Date.. � _ Read, Sworn to and Subscribed before me. Disapproved (Signed) Notary Public, State of Florida Building Inspector My Commission Expires PLANNING BOARD DATE Chainnan 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. BU ELECTRICAL PLUMBING Work to be performed under this Permit Building Owner :•f _ . di 40 9. - 1 11 1640smar l.. 1 7 . , . Architect - - .;"j i *ir ..t' - .."1 • Contractor or Builder 11 Legal Lot Description. 11 Value of Amt. of Address 'of os Building / 1 r( j y e . E di .* 0 x, Project $ 11 Permit $ iopZ VI. 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 a drawings, statements or specifications that may have been submitted to and approved by the proper municipal authorities. This Permit may be revoked at any all ordinances pertaining thereto and with the understanding that the work will be performed in compliance with any plans, 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 tp 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 hit agents, servants or employees. MIAMI SHORES VILLAGE, FLORIDA DATE da PERMIT N° 10999 Subdi- vision Signed: INSPECTOR - - - BY 2A. Contractor's License No. In consideration of the issuance to me of this permit I perform the work covered hereunder in compliance with all ordinances and regulations limning thereto and in strict conformity with the plans, drawings, tements or specifications submitted to the proper authorities of Mianii Shores Village. accepting this ermit I assume responsibility for all work done by either, myself, my agent, servant or employee. 1954__ Disapproved (Signed) MIAMI SHORES VILLAGE 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. //++ / Dater $J2 A�`I 444 , Owner's Name and Address___S?_S_D__l['__ V _i? _1i__f _J_1 No 355 Street_ _N_ _K_>___S' %St - Registered Architect and /or Engineer /� Name and address of licensed contractor_�[1__Y!__1�Si_ __Q 1 _ _ _/s[___ _______/__/__1 S _ f _S_& Co . - _ S I AMA). Location and legal description of lot to be built on: Lot Block Subdivision_ Street and Number where work is to be done____j__ 3 3______ _C__,___1___ b State work to be done and purpose of building (by floors) Date BUILDING INSPECTION DEPARTMENT __ _ 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 $ 9 S.°-- Amount of Permit $ .. s� 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 specification In _] for said building. All notices with reference to the building and its construction may be sent to_ 11 _____ _e_b___F- 1___1+ -_ _ / _ QS____k_ f _ ._P___ C b 7 S) 11.14 • 1 _V % _ The undersigned tcpplicant 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 the site of the work s public notice or notices as are required by the Act. The undersigned agrees to employ only such sMbcontr a ors on work to be p f•s 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 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._ / _ / Date ?� Read, Sworn to and Subscribed before me. Notary Public, State of Florida 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 $1.00 will be charged when such re- inspection is made necessary by improper notice for inspection or faulty materials and /or workmanship.