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Fublie Rew ofd Dade' County, Florida. # 4 s
wEe...- v ♦ v�
rry 0. 8ohwebke
Registered Land Surveyor 602
State or floc /da
I WRBBY C 1ri; That the attached " '4H OF 3 of the above described propert
e trite and correct: to, the beetf' of m owledge and belief, at recently' Surveyed, and
-
'.p tea under '=d! c1t -
F
Permit No
Disapproved
(Signed)
MIAMI SHEORES VILLAGE
BUILDING INSPECTION DEPARTMENT
APPLICATION FOR BUILDING PERMIT
4:::!
Application is hereby made for the approy4 of the detailed statement of the plans and specifications
ing or other structure herein described. Thifipplieation is made in compliance and conformity with t L. ng rdinaje
Shores Village, Florida, and all provisions of the Law I of the State of Florida, all ordinances of Miam resjViUa e and all
regulations of the Building Division of Miami Shores Village shall be complied with, whet er herein s. A copy of appr
plans and specifications must be kept at building during progress of the work.
t
Owner's Name and Address 1114 Pal I, Date 1
No, I 11 N treet
,
Registered Architect and/or N
Name and address of licensed contractor
Location and legal descripofklp)1 built c
Lot • tith ;8 K_;Broc Subdivision 5 6 efs1,.
Street and Number where r
work is to be done (11.'741 nAszksn
State work to be done and purpose of building (by floors)_____
Building Inspector
•
New Building anIdeling
To be constructed of_ Ces of fo ndation
Estimated Total cost of improvements s_ !JO
Zone cubage required
Distance to next nearest minding A kf_N—e
Maximum live load to be borne by each floor__ ________
44.
Re lairs No. of Stories ___ Jpoj Covering__
Read, Sworn to and Subscribed before me.
Notary Public, State of Florida
My Commission Expires
PLANNING BOARD _DATE
Amount of Permit $_
__Plan Cubage_________ ________
guilding Lot
I hereby submit all the plans and specifications for said building. l itkes with reference to the building and its
be sent to
and for no oth r purpose.
Chairman Member
Member Member
Member Member
Council Approved __________ Date Disapproved
construction may
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 5960, 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 f spe .tion on the site of the yor such public notice
or notices as are required by the Act. The undersigned agrees to employ only such ubco etors, on wor to be formed 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, upoh 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.
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.
STATE 02 OF FLORIDA)
COUNTY OF DADS )
2. Apply for and secure a Permit.
And Further this Deponent says nets
A F F I D A V I T
of the Village of Miami Shores,
County of Dade and State of Florida, being duly sworn, doth depose and sdy,
that under the provisions of Ordinance No. 185, dated June 15, 190, a epd-
lug paragraph (d) of Section B -368 of Ordinance No. 97 of the Building Code
of Miami Shores Village, he desires to build a
on Lot .Block of _ Subdivision,
that he is the owner of said property, and will be'the owner of said
, that he will do the work personally, and that
he will, at such times as are required by the Zoning and Building Directors-
1, File plans and specifications and obtain approval of the
Planning Board and the Building Inspector.
3. Pay the required fees.
4. Execute the work in accordance with the provisions of this
Code.
5• Apply for inspections.
6. , File with the Building 'Inspector certificates that provision
has been made to carry the necessary !ioricien's Compensation,
Public Liability and Property Damage Insurance.
7. File with the Building Inspector as the job progresses certi-
ficates showing the payment required by the Federal Social
Security At to the State•of Florida or the United States of
America.
8. Assume the responsibility of not employing other than properly
licensed contractors by Miami Shores Villao for any part or
portion of the work.
9. kit set himself up as a *contractor".
10. Sign an affidavit before com encing work to the effect thAt
he has read this Article and will do the work personally and
observe all of the requirements of the Building, 3lectrienl,
Plumbing and Zoning Codes of Miami Shores Village. Such
affidavit to be properly notarized upon blanks to be supplied
by the Building Inspector.
11. In order to prevent abuses and subterfuge the right of such
owner- builder as herein provided, is limited to but one
owner- builder perr4t each 2 years, and where an owner - builder
has once exercised the privilege herein conferred no second
application for owner- builder permit shall be granted in less
than 2 years. unless the applicant is qualified as a licensed``
General Contractor under the applicable Ordinances of said
Village.
SUBSC) D AID a�rOIUI TO B "vOlt: Zu this yY- -_ day of
19 .SO FEE
Am fi r e
A, P.,
NOTARY VUBLIQ
NOTARY PUBLIC, STATE OF FLORID, T LARGE.
MY COMMISSION EXPIRES AUGUST 15, 1952.
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