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1240 NE 100 St (2)MIAMI SHORES VILLAGE Z ITUILDING DEPARTMENT 4, 305- 795 -2204 Buil g Inspection Request Date Type Insp'n Permit No. Name Address Company Phone # Inspection Date Correction Re -Insp' n Fee s' G L (Rev. 04/24/03) Miami Shores Village Building Officials Approval: _ Building Department Certificate of Re- Occupancy The following residence is issued a Certificate of Re- Occupancy Address 7,1z/i0 / V & boo )114 City Miami Shores State Florida Zip 33 J 6' 10050 N.E.2nd Avenue — Miami - Shares- Florida 3 Tel: (305) 795 -2204 Fax: (305) 756 -8972 Permit No. 05 Date 5 — ' o5 This certificate verifies that the referenced property has been inspected by Miami Shores Village and has been determined to presently comply with the schedule of regulations of the Miami Shores Land and Development Code pertaining solely to the requirement that each one - family dwelling is used and intended to used for a one - family dwelling purpose only; however, this certificate does not constitute any representation or warranty as to the condition of the dwelling or other structures on the premises described herein, or any aspect of such condition, and interested persons are advised and encouraged to make their own inspection of the premises in order to determine the condition thereof. (Rev. 1 0/02/03) Miami Shores Village Building D - • artment 10050 N.E.2nd Avenue • __ .o nom. �` �' Miami Shores, Florida 33138 Tel: (305) 795 -2204 Fax: (305) 756 -8972 APPLICA -T4ON _ -- - - -- - - - P-ermit,No._ __ _ 0t) 1 n'��Os� n W _ Loc ID Date p( c Contact Name De Y G WN C `C: V Phone # (9 5) Buyer Seller Realtor c Company Name Property Address J /O /NIC 1 eo & T"T City Miami Shores State Fl Zip ,33/3, RE- OCCUPANCY I hereby certify that I understand that the zoning of the property is for single - family residential use and that it is unlawful for more than one family to reside therein. I also understand that any Certificate of Re- Occupancy that may be issued by Miami Shores Village certifies only that the referenced property is being used for single- family purposes and that such Certificate does not constitute any representation, warranty or certification as to the condition of the dwelling or other structures on the property. OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate. r COrCE I C AO color 2e(v l'Lg CONCC-1'CGAlO Signature e. -�-V : (.C! CAc Applicant N The foregoing instrument was acknowledged before me this 21 day of by produced 5cd -1 (PO -' l 9 / NOTARY PUBLIC: ign: �' _ Re -Occ. $60.00 Print: L�f My Commission Expires: `3 Building Officials Approval: , who is personally known to me or who has Gonell ' r _ Co nion # DD323870 9' � Expires: May 26, 2008 °bd iCe ,s Bonded Thru Atlantic Bonding Co., Inc. as identification and who did take an oath. 200J Notary $5.00 4l CCF • $0.60 / Total CP 6 a r BUILDING INSPECTION DEPARTMENT APPLICATION FOR BUILDING PERMIT Application is hereby uinde 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. _ M Grizzle . No Street 1240 N.E. 100 St. Owner's Name and Address Orkin Exterminating Co., Inc. Registered Architect and /or Engineer _... , 749N. _ 7 . � st . Name and addre of licensed contrpctor 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 (by floors)...— ...talon T- eut.. Fumi.gti.on 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 $ 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 s of Florida, Permanent Supplement, of labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled Gen or sub employed by him and has complied with the provisions thereof, and will require similar compliance from all co e site of the work such public notice in the work to be performed under this permit; and will post or cause to be posted for inspecti ntract work to be performed under this or notices as arc required by the Act. The undersigned agrees to employ only suc permit, as are licensed by Miami Shores Village. (] �f Remarks (Signed)... .. J.... ..� peared MIAMI SHORES VILLAGE Date , ll Y - -. __...._._ . -..._. _....... 19.. ....... STATE OF FLORIDA, COUNTY OF DADE. j ss. Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally ap- 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. J ar Permit No. .__.! T ! Date Read, Sworn to and Subscribed before me. Disapproved Date Notary Public, State of Florida (Signed) uil ► Inspecto My Commission Expires PL NING 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 51.00 will be charged when such re- inspection is made necessary by improper notice for inspection or faulty materials and/or workmanship.