1285 NE 101 St (15)PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
D 2- V Job Ad -..M4 1 3 Folio 1 l O a& OC) l l J
. 1' ! rni r Lar .
1 • % Qualifier SS#
Address
_..r: IP r 1 Master Permit #
Owner/Lessee / Tenant x Ownees Address / '7 1 W I 0 sr Phone 30c - 1 7'2' 0 Fla.
Contracting CoAt 9 e J P ____, c/ CA. I, f f2._ Address
Architect/Engineer
Bonding Company
Mortgagor Address
Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIPTION Sc f"G- p r
Square Ft. Estimated Cost (value) / Y
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 Date
My Commission Expires:
FEES: PERMIT
APPROVED:
RADON
Mechanical Plumbing
Zoning Building
orically Designated: Yes No
Address
IYCr ( )-- G)–
),,1T- Ca 1 �-
Contra for
My Commission Expire
Electrical
4,0C.4�v P 9 (c NGELA
Q CC 766597
��O GiY C%?15SION EXPIRES
OF Flo NOV. 1 ".2002
Structural Engineer
Phone
Ins. Co.
Cc `- pcircL
6 1 12 --C4 1.4i06 k
C.C.F. 1 0 NOTARY 5, 0 a BOND
TOTAL DUE 6.S 60
U
e
APPROVED:
MIAMI SHORES VILLAGE
Paint Color Approval and Agreement
DATE: �� 9- 0
OWNER'S NAME: /4 A v (.. a d PHONE: ,0 ',5 r6.5
ADDRESS: - / .8'15 _
* * * * * * * * * * * * * * * * * * * * * * * * * * * ** ** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
ADDRESS OF SITE:
CONTRACTOR & LICENSE (if applicable)
COMPANY NAME: r PHONE.
Shutters y�
Awnings rJ 1 F
Chimney {'J / h
Doors and door jams IV / A
Garage Doors pJ / $
Railings & /
Fences !J /
Decorative Metal
All brick (simulated or re_ular)
Stucco Banding /
Any other stucco features 6/ / )9.
Accessory Buildings n) / f3
Other
Building Official Date
_ ! ., •,c-_Air•
•
**************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
All Elements on the site must be listed and indicate the color to be painted.
Walls
Fascia L J ;)--Q
Soffit l' f /9
Roof 1J ( 14
Flower Bins NI'
G`et/ANOV3
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. I authorize the above -named contractor, if applicable, to
do the work stated. Furthermore , the paint colors will be as per the attached
samp es.
1
I
! - � or
Signature of Own37
* * * * * * * * * * * * * ** ******************* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
ate / Signature of Contractor Date
WHEN PAINTING IS FINISHED,
CALL FOR FINAL INSPECTION
MIAMI SHORES VILLAGE
Building Inspector
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.
BUILDING INSPECTION DEPARTMENT
Q. Date... sQ..s .._._._...___......__........ .. 19..e
' /� n ,.�
Osxi cr's Name and Address ....... c ac) :.:sass._ ._. No..J e:�4). L. Street._.. /O( •
Registered Architect and /or Engineer ,,,,, .,.• . .,,,•,,.,TII,.,t..t•,•.,,.,.t,e-
■
Name and address of licensed contactor R -Q t.. ,_vg(au / s _A-1.2 v At i a ut( /we Fc
Location and legal description of lot to be b Ito // .7 '' 0 S _ 7. - O B /e / <r, / nnqq
Lottrl'' — 17"- 1 -.' Block i 9 ° Subdivision / Au D f_'.L.. ivif1 9 ?'
Street and Number where work is to be done .._sass _ _ .. » .._._•. . _ »�....._._.._...._
State work to be done and purpose of building (by floors)... 2 .C.
> ..�/S • . z t.._ . ......_.._..__
and for no other purpose.
New Building Remodeling Addition Repairs No. of Stories _
To be constructed of Kind of foundation � , Roof Covering
Estimate Total cost of improvements $ / Amount of Permit 3.. �� /
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,
anti 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 arc required by the Act. The undersigned agrees to employ only such subcunjactors on work to be performed under this
permit, as are licensed by Miami Shores Village.
Remarks.
STATE OF FLORIDA, 1 /9.296
COUNTY OF DADE. j 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.
Disapproved
(Signed)
Notary Public, State of Florida
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 I'l,,nnir.;t Board.
A rc•in.pection fee of 31.00 will be charged when such re- inspection is made necessary by improper notice for inspection or faulty
materials and /or workmanship.