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1249 NE 100 StMIAMI 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. 4-0.0/..--: �, - / y i 7 / V J Date ,�', — )'` � 19 7 J Owner's Name and Address � r/ - / , 4 7"1 4 C/ / fIf J. ��R No.'' / ov p Street 6. /O C' ,S Re Architect andior Engineer -" 44 --- 2 11' • 8 4 0-12 fx (C. K Name and address of licensed contractor D s--, Ai 4 Location and legal description of lot to be built on: {02S. a44-) o l o - ! o O � O O CG Q- Block / Subdivision Oaf � � S�OiI � l 3 � � U Street and Number where work is to be done `r,2 et, Ar 4_ / 0 0 S77 I State work to be done and purpose of building (by floors). state exterior colors (submit samples) / Y TO 4'y /4 D t 7i 1/ d,4/ P A-/ 444 - 7 - c) ) F U S6P /9" (? 1, - -L-? &? 4.00`t i 65,4 c. // A''X /S il .rierAe �ly /f 61 �S `, O 0 / % , I ,4�% / -4 ' /o - 0 / 19 oC / T ,-/- i \$ 5 y and for no other purpose. New Building Remodeling Addition ` Repairs No. of Stories To be constructed of t.' 2-5 Kind of foundation C"=" " C. 4' '7:7' e Roof Covering -7 7.-- L Estimated Total cost of improvements S ._j )re) O Amount of Permit $ C 66 � Zone cubage required Plan Cubage o?c. y y ec T .sg .r � 7 `X /a / Distance to next nearest building pG © Size of Building Lot Maximum live load to be borne by each floor 1 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 accepts his obligatons 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. 1 ss. Before me. the undersigned authority. a notary public duly authorized to administer oaths and take acknowledgments, personally appeared 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. to o ! 1 b Date Read. Sworn to and Subscribed before me. Disapproved Date Notary Public. State of Florida (Signed) But ding Inspector My Commission Expires PLANNING BOARD DATE 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 andior workmanship. APPLICATION FOR BUILDING PERMIT Application is herr-by mode for the approval of the detailed statement ur cede 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 ill rules and regulations of the iluikling 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 budding during progress of the work. / Date / Y/3 Owner's Name and Address ... ./.E .. /`?!�g ' . _. � Registered Architect and /or Engineer Name and address of licensed contractor 2 3 Location and d le al description of lot to be built on: "2 Lot 4- G+l .. Block. ».......1._.._.._..._. «._ SubdivisionLe4! l il /1 J 2- es es" Me 6 e 1" Street and Number where work is to be done . / ° o .S St a work to be done and purpose of building (by floors)._ _ and for no other purpose. New Bui: ding....._.._... »..._......_.. Remodeling Addition Repairs . No. of Stories Roo Covering To be constructed of ...t'i'c Kind of foundation ./ Estimated Total cost of improvements $.• = ...__.____.._ of Permit $.. .1r.... 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.. . /.v `i 7 /' ( Co o S7 The undersigned applicant for this building per:nit 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 Snp ilenient, and has complied %%ith the provisions thereof, and will require 'lar 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 arc required by the Act. The undersigned agrees to employ only such su rs, on woe to be perfo ed under this pcnnit, as are licensed by Miami Shores Village. (Signed) 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- 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 l e.. Permit No.. . " t Chairman \lcrr.ber Member .. .. Council Approved Date Disapproved Date. »____. (Signed) Building Inspector \U T E: A charge of $1.00 will be made for the Plannir.;; Itu.ird. A re- m.pection fee of 51.00 will be charged materials anu /or workmanship. MIAMI SHORES VILLAGE BUILDING INSPECTION DEPARTMENT ...._...... «._ _..__ «.. ».. «........... . ••.^..Httf.•• -111 NOI4J0 t,•1TTA11.!•t••••,Ttf A`! TT to me well known. Read, Sworn to and Subscribed before me. Notary Public, State of Florida My Commiuion Expires PLANNINC BOARD .. _._ — DATE ._ _ Member ... __........._...._• «_4 ----- -_-. Member_....._......_---._..._.... -__ .___ .. Member ._ ._�. _... __._....r.. ._..._ Disapproved making corrections or changes to this application after approval has when such re- inspection is made necessary by Improper notice for 7s 5/- 4//f Date been obtained fmtn inspection or faulty Location and legal descriptio of lot to be built on: Lot f A C - t 14/ 5/ Block / MIAMI SHORES VILLAGE BUILDING INSPECTION DEPARTMENT APPLICATION FOR BUILDING PER$IIT 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 Gf approved plans and specifications must be kept at building during progress of the work. Owner's Name and Address ,6t'JL //. /`7 4I Zl '1 c l -- s/ ib)771 M • A to //d No. /)- I 9 Street Al /DO S7 Registered Architect and /or Engineer IA 111A A R f GK Name and address of licensed contractor Street and Number where work is to be done /14 q /l)E /OO <,77, State work to be done and purpose of building by floors), state exterior colors (submit samples) I ,'air 7-to RC (15 ED A-s 3,ea 1)2 r s- ri it) G lc .B /o2 ,?Q /5Kc� 4 tor ZolDr and for no other purpose. New Building Remodeling Addition Repairs No. of Stories To be constructed of C S Kind of foundation / n a) C2-ErE Roof Covering 'T/ t- E 1t5.O Estimated Total cost of improvements S 1 .4 O 0 Amount of Permit 5 Zone cubage required Plan Cubage C9c.) r Distance to next nearest building .=2O Size of Building Lot 7,( )( /06' 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 accepts his obligatons 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 appeared 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. 7J L Date Date Subdivision 7- // 3.2o) 6 D D 7 9 f Date Read, Sworn to and Subscribed before me. Notary Public, State of Florida /0 /)- O 19 C 7 Permit No. Disapproved (Signed) Building Inspector My Commission Expires PLANNING BOARD DATE Chairman Member Member Member Member Member Council Approved Date Disapproved Date NOTE: A charge of 525.00 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 525.00 will be charged when such re- inspection is made necessary by improper notice for inspection or faulty materials and/or workmanship.