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171 NE 100 St (11)Date Square Ft. PERMIT APPLICATION FOR MIAMI SHORES VILLAGE Job Address /7f %/" Owner's Address / Afa? es MO O 11 Contractingg Co. Oti Dv CO . Qualifier �/al l 1 � , oc ezS Notary as to Owner and/or Condo President My Commissio Expires: r P` U . OFFICIAL OY�RY i AL o • AM, * COMMISSION NUMBER v \ p CC4Q 12 @: MY COMMISSION •EXP. SS# Tax Folio Legal Description Historically Designated: Yes No X Owner/Lessee / Tenant C,Afee Master Permit # 'Y 7 .71-2 ijo6V&r Phone r3al 4 D C— 3� H6e Signature of owner and/or Condo President Date Signature of Contractor o Address 24 (4 eJ, /" i�,c'ol60 - 13Q0q State # Municipal # Competency # gotg5 Ins. Co. Address Address Architect/Engineer Bonding Company Mortgagor Address Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN WORK DESCRIPTION ((.tad l,14LG 6/14.e ))0 Estimated Cost (value) X6700- 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. F ermore, I authorize the above -named contractor to do the ork stated. (4,0 Not % as to Contractor o My Commission Expires: Electrical Phone STATE OF FLORID SION NO. CC 401332 , „� r tIG.17,1g AP A9r 171090 FEES: PERMIT � ON C.C.F. s (00 NOTARY " BOND TOTAL DUE 4 -4 -98 Date ate APPROVED: Zoning Building Mechanical Plumbing Engineering METRO -DADS PRODUCT CONTROL NOTICE OF ACCEPTANCE Overhead Door Corporation 1900 Crown Drive Farmers Branch, TX 75234 Acceptance No.:97- 0821.03 Expires:12 /01 /00 Approved:12 /01/97 Internet mail address: postmaster (o?buildingcodeonline.com W METROPOLITAN DADE COUNTY, FLORIDA METRO -DADE FLAGLER BUILDING BUILDING CODE COMPLIANCE OFFICE METRO -DADE FLAGLER BUILDING 140 WEST FLAGLER STREET, SUITE 1603 MIAMI, FLORIDA 33130 -1563 (305) 375 -2901 FAX (305) 375 -2908 PRODUCT CONTROL DIVISION (305) 375 -2902 FAX (305) 372 -6339 Your application for Product Approval of: Sectional Steel Door 9' Wide under Chapter 8 of the Metropolitan Dade County Code governing the use of Alternate Materials and Types of Construction, and completely described in the plans, specifications and calculations as submitted by: Applicant along with Overhead Door drawing # D408775 with latest revision on 10/29/97 and signed and sealed by L.R. Krupke P.E. on 10/29/97. (For listing see Section 7 of this Notice of Acceptance) has been recommended for acceptance by the Building Code Compliance office to be used in Dade County, Florida under the specific conditions set forth on pages 2 ct. seq. and the Standard Conditions on page 3. This approval shall not be valid after the expiration date stated below. The Office of Code Compliance reserves the right to secure this product or material at anytime from a jobsite or manufacturer's plant for quality control testing. If this product or material fails to perform in the approved manner, the Code Compliance Office may revoke, modify, or suspend the use of such product or material immediately. The applicant shall re- evaluate this product or material should any ammendments to the South Florida Building Code be enacted affecting this product or material. The Building Code Compliance Office reserves the the right to revoke, this approval, if it is determined by the Building Code Compliance Office that this product or material fails to meet the requirements of the South Florida Building Code. The expense of such testing will be incurred by the manufacturer. Raul Rodfiguez Product Control Supervisor THIS IS THE COVERSHEET, SEE ADDITIONAL PAGES FOR SPECIFIC AND GENERAL CONDITIONS BUILDING CODE COMMITTEE This application for Product Approval has been reviewed by the Metropolitan Dade County Building Code Compliance Department and approved by the Building Code Committee to be used in Dade County, Florida under the conditions set forth above. Director Building Code Compliance Dept. Metropolitan Dade County Homepage: http : / /www.buildingcodeonline.com Track Skin End Stile Center Stile End Hinge Center Hinge Horizontal Reinforcement Shape Frequency 0.090. 24 GA .057" .057" 0.070" 0.070" .055 Strut ' / x 3'/2" One /Section. Overhead Door Corporation ACCEPTANCE No. : 97- 0821.03 APPROVED DEC 0 1 1997 EXPIRES DEC 0 1 1000 NOTICE OF ACCEPTANCE SPECIFIC CONDITIONS 1.0 DESCRIPTION: This approves sectional door 9' -0" wide x 7' -0" through 8' -0" high, made out of steel, lock forming Quality with a minimum yield of 40,000 PSI, galvanized coating of G90 (ASTM A525) and finished with baked on enamel. The door shall be constructed and reinforced as detailed in the approved Drawing No. D- 408775, Sheets 1 and 2 of 2. 2.0 USE: This door is approved for a maximum design pressure of +46.7 PSF and —46.7 PSF and its use is restricted to this pressure. The door passed the impact and cyclic test; therefore, it does not require hurricane protection devices. The door shall meet the burglary security requirement of Section 3603.2(c)2(aa) of the South Florida Building. Code. The door operating mechanism is not included in this approval and shall be certified by Underwriters Laboratories or other recognized agency. andido Font, P.E., Sr. Product Control E xaminer Product Control Division -2- Overhead Door Corporation ACCEPTANCE No. : 97- 0821.03 3.0 INSTALLATION: APPROVED DEC 0 1 1997 EXPIRES [1FC Q 1 2000 NOTICE OF ACCEPTANCE SPECIFIC CONDITIONS The door shall be installed as shown in the approved Drawing No. D- 408775, Sheets 1 and 2 of 2. Wood in contact with concrete or cement shall be treated with an approved preservative as set forth in paragraph 2913.2(a)1 or shall be of a durable specie as defined in subparagraph 2913.2(a)5 of the South Florida Building Code. Installation of 2" x 6" wood jamb requires a' / x 3" Rawl Lok/Bolt and 1" 0 x 1/16" thick washer @ 16" o/c with a minimum embedment of 1 -1/2" into 2000 PSI (minimum) concrete or into grout - filled concrete block. Installation of track requires a 5 /16" x 1'/4" long lag screws @ 16" o/c one per bracket as shown on Drawing #D408775, with a minimum embedment of 1'V2 into PT 2 x 6 Southern Pine wood jambs 4.0 CONDITIONS OF USE: Application for building permit shall be accompanied by duplicate prints of the approved Drawing No. D-408775, Sheets 1 and 2 of 2, bearing the approval stamp, Notice of Acceptance number, and date by the Dade County Product Control Section, along with computations prepared by a qualified Florida Professional Engineer or Architect verifying the adequacy of the door at each site. The shop drawing shall bear the signature of the Architect or Engineer with the following statement: "The supporting structure has been designed for the forces shown on the approved manufacturer's drawing." Application for building permit for replacement doors shall be accompanied by duplicate prints of the approved Drawing No. D- 408775, Sheets 1 and 2 of 2, bearing the approval stamp, Notice of Acceptance number, and date by the Dade County Product Control Section. Additionally, the Building Official must be satisfied that the proposed installation meets the use of Section 2 above. andido Font, P.E., Sr. Product Control Examiner Product Control Division -2a- Overhead Door Corporation ACCEPTANCE No. • 97- 0821.03 5.0 LIMITATIONS: This approval requires the manufacturer to do testing of all coils used to fabricate door panels under this Notice of Acceptance. A minimum of 2 specimens shall be cut from each coil and tensile tested (according to ASTM E -8) by a Dade County approved laboratory selected and paid by the manufacturer. Every 3 months, four times a year, the manufacturer shall mail to this office: a copy of the test reports with confirmation that the specimens were selected from coils at the manufacturer's production facilities and a notarized statement from the manufacturer that only coils with a yield strength of 40,000 PSI or more shall be used to make door panels for Dade County under this Notice of Acceptance. 6.0 IDENTIFICATION: All approved products shall be permanently labeled with the manufacturer's name, city, state and the following statement: "Dade County Product Control Approved ". 7.0 EVIDENCE SUBMITTED: Test Report Tests CRL 6066A PA 201, 202 & 203 Calculations Overhead Door Corp. NOTICE OF ACCEPTANCE SPECIFIC CONDITIONS Drawing Number Overhead Door Corp. D- 408775 APPROVED EXPIRES Date 09/06/94 Last Revision Signature DECO 1 1997 Bic 0 2000 Date Signature 04/18 -21/94 Vipin Tolat, P.E. Signature Scott Boucher, P.E. 10/29/97 LeRoy Krupke, P.E. Candido Font, P.E., Sr. Product Control Examiner ' ControrDivision -2b- Overhead Door Corporation ACCEPTANCE No:: 97- 0821.03 APPROVED : OEC 0 1 1997 EXPIRES : OEC 0 1 2000 NOTICE OF ACCEPTANCE STANDARD CONDITIONS 1. Renewal of this Acceptance (approval) shall be considered after a renewal application has been filed and the original submitted documentation, including test supporting data, engineering documents, are no older than eight (8) years. 2. Any and all approved products shall be permanently labeled with the manufacturer's name, city, state, and the following statement: "Dade County Product Control Approved ", or as specifically stated in the specific conditions of this Acceptance. 3. Renewals of Acceptance will not be considered if a) There has been a change in the South Florida Building Code affecting the evaluation of this product and the product is not in compliance with the code changes; b) The product is no longer the same product (identical) as the one originally approved; c) If the Acceptance holder has not complied with all the requirements of this acceptance, including the correct installation of the product; d) The engineer who originally prepared, signed and scaled the required documentation initially submitted, is no longer practicing the engineering profession. 4. Any revision or change in the materials, use, and/or manufacture of the product or process shall automatically be cause for termination of this Acceptance, unless prior written approval has been requested (through the filing of a revision application with appropriate fee) and granted by this office. 5. Any of the following shall also be grounds for removal of this Acceptance: a) Unsatisfactory performance of this product or process; b) Misuse of this Acceptance as an endorsement of any product, for sales, advertising or any other purpose. 6. The Notice of Acceptance number preceded by the words Dade County, Florida, and followed by the expiration date may be displayed in advertising literature. If any portion of the Notice of Acceptance is displayed, then it shall be done in its entirety. 7. A copy of this Acceptance as well as approved drawings and other documents, where it applies, shall be provided to the user by the manufacturer or its distributors and shall be available for inspection at the job site at all times. The engineer need not re- sealed the copies. 8. Failure to comply with any section of this Acceptance shall be cause for termination and removal of Acceptance. 9. This Acceptance contains pages I, 2, 2(a), 2(b) and this last page 3. Items 10, 11 & 12 listed below only apply to dazed products and doors 10. Unless specifically indicated in the Acceptance ( approyal), this unit is approved as a single unit installation. For multiple installation of this unit, a separate Acceptance for mullions is required from the Product Control Section. 11. The spacing of fasteners at windowsills shall be as indicated in Section 4 of this Notice of Acceptance. The spacing of fasteners in all other parts of the frame, shall be as indicated in Section 4 of this Notice of Acceptance, but in no case shall exceed 24 "' on center. The first fastener shall be located at a maximum of 6" from each corner and mullion or stile. Fastener shall fully penetrate the buck, which shall be the same size as the one tested with the unit. No wood or plastic shields or pins shall be used for anchoring. 12. Hardware for all windows and doors shall conform to Security and Forced Entry Pr.n Chapter 36 of the South Florida Building Code. • ido Font, P. E., Sr. Product Control Examiner Product Control Division END OF THIS ACCEPTANCE 3 NOTES 1 REMOVED. 2. FOR SECTION HIGH CCCR 6 g' MIQI OOCR5 PAYE FIVE SEc1lc s. • 3. SECTION HEIp47 OF 20 5 19 CC a 15 75 ARE 6.14(74.21( AN0 MAT EE USED IN cC.elNA TO ADMEN( VARICLS HE104T DOORS. E3e0S9.ENT PA1tEZ4 OF 1..50 4 20.375 51C*39. ALTERNATE PATTERNS CF 12.50 x .3.375 'AO 12 50 x 20.375 MAT 5E LSE0. 0008 '*114031 EAeC59.EN15 ALSO AVAILAaLE. 5. TORSION SPRINGS S OwN. Ex1EN51EyN SPRINGS AVAILA21E. (7D HINGE 6. RATED DESIGN LOAD .•6 7 P.S.F. 7. LSE THIS BRACKET. REF. F/N •0596• -0002. 09 9' x 8' HIGH COORS. /• 1 -1/2' RE'- 6. FS -3 SIRJTS TO 5E A1TAGiD •/- 6' FROd CENTER LINE 0'F SECTIONS. • - - 9. TESTED I N ACC ✓lM4E WITH DA DE C31/T Y PRCIOCO1S ?A 201 -9•. P 202 -9'. R PA 203 - 94. 10. RE.0,ED. 11. A51M A - 527 .0.000 PS1 MIN. YIELD PER 605755. ROLLER 5/HAFT 12. 744.E LOAD CAt0.lATIC9S: c 7. 0001 (1/2 CCCR 'NID14,1(1 FCO1 OF 4-E1G9T1(CESIGN LOAD) 40557. ? - . (..5 F71(1 F11(.6.7 PSF).210 (5 /FT OF HEIGHT. 13 JAI FASTENER RECUIRELENT: F, .(1/2 DOOR WIOTH3(1 1/2 F'7T((CES)G.1 LOAD) .(4,5 FT1(1.5 FT((.6.7 ?44)•315 lb. 1.. COCK SKIN MATERIAL STALL SE GALVANIZED ACCORDING TO AS:M A -525 TO G90 CR AN ECUIV/LENT SURFACE COATING APPROVED EY OADE CCLNTY.?,JILDING CODE CCNPLIANCE CFFICE 15. CENTER LOUVER SETWEEN CENTER STILES LNCER ((1-€/0 SECOND a.ecSs.ENT CF 50T1CM 5E' =TIC*. 15. FCR 4.`C - CR'NG INTO 'NCCO. :SE ONE 5/16' LAG SCR_* PER PACK 'EP.AC<E1 WITH 1 1/2' 4'.eEc. ENT INTO S.Y. P :NE CR 37 17 (1 ..NC ■P.ED DIRECTLY 70 CONCRETE SR GROUT FILLE0 CCNCRE "E 21C3<5 CR Ti{?,J A 276 'ACGO JADNES. LSE ONE 5/16' R.A'WL LCKi301T PER (RAG< BRACKET 'NITRO 1 1/2' ENEECNENt (WC CCNCRE E CR BLOCK. SAF T i I•:PIE51 0 9G 7 S IQI I IYAR 059.9C IElp.l I N/( w5 11• 3 T / - I • x 6 • x660 2' x 4' WCCO CR EOLIIVALENT `CPiICNAL SPLICE IN i- CPIZ'NIAL TRACK AT TCP OF ROILS •0596 -0002 0 I� .0596. -0002 a 0.6450 -0003 20 1/2 36 `405964 -0001 STANDARD TRACK DETAIL FOR 9• SCALE: 1/16' • 1• 5 1/2 ,CR :Z:!NTAL :RACK / & CC.NTERSALANCE 405771 -0001 061166-0002 DETAIL - F SCALE 1/4 (9' NICE: !1 II _IV CENTER STILE 570(1 57%.'75 .. _. .... -_ ... (9' NID( 55I •••"" ROLLER CPL •- rS'.RIN ANC-0R i / *'AFT / (RACKET / .01199 -0001 I 061 1665 ^0.02 UP I YP -' I u i.l 1111 )III/ /HI 061 P 2 -LOS i F . / -0003 ii I 1!P 2 ?ICS ii 1 1 1 1 1 i I III ! I I I 11 N 061 ROY? STRUTS. z PLCS I 1 i l 1 � .A. 1 pS .. OC650-OCC3 ALL SECTICNSr 1, I I � II (� 'NI 1 (�i I i i .0605 -2002 I' , I 1,6.."........-001601-0000 TrP7z?LC5 I d� ' p N 061165 -OCOt TYP 2 PLCS /1 II IN- I�i( II h Ili 9'-0' MAX DOOR WIDTH INTERIOR ELEVATICi4 50.417: 1/16••1• DOOR WIDTH SERIES 180 - 46.7 PSF WI7OLOAD CENTER 51(14(7.0 STILEI I STRUTS /SECT. ROLLER IVER1IU TRAC%I # 1040 l 1,aFf�VARE GE 9' 3 ISM 4/EW CAP1 YES PS3 12' X 7/16'1 .090' 1 210 1 STD. \CS11wl1 < f-4,.. _W P/N 635679 -000 . RED. PER ENO 5711E SECTION B-3 1 L-:=E=.;:;11EEILIJ '8" •08405 -0001 - SEE 0E18(1 '0 - CENT STIL • R SCREW P V 605879 -0002 2 RED. PER CENTER 5111E STEEL HS STRUT. P/N .00650 -0003 ENO STILES 516MN IN 5067:0.5 •9 -2• ARE ECUIVALENT CCNS7 LC11CN .07603 - 0001 (9 'LCSI (1' -0• SLUM*) 6' 3 MAX. i71y11 4 05771 -0OC2 06 -00O2 0,04 4074* OM .0 om, CT,/IIv. o. T . cam - � • o- v o .c,o�em: Iwn ... amiss 41)17 W 11 CLOSED E`D C AP 1 1 SEE NOTE 3 /G 9 - ?' f-CENIZR l l_ I, / SCREW P/N 605879 -2(2 4 RED. PER ENO STILE ----1 1/5' T-K. S=ALE. 1/4 rs 0,,•••a 1166 Cm ft I i 1 51(71 67''1S • (9' :COPS) END HINGE - 4- N/A -•. . EACH NONE scREN P N 605879 -0002 2 RED. PER CENTER STILE SECT ■CN - - ` STEEL 1-S STRUT. P/N .00650 -0003 .966 T� VIEW 'D - D' 1 y 2• TRACK 2.593 .090 1H( (VERTICAL) SECTICN 'A. - .C68 /PK (3<4SIZC4'TAL( OVERHEAD DOOR CCP :PATION 190C ORDMN DRIVE FARMERS 6RM-c -1. TEXAS 75234 LeROY G. ((PUPAE. P.E. #36580 JW r Jw CCA,PTON 4/8/9. �.1 AL- (_E/. 2!24/24. JL CRISHAAA 4 /8 /9. REVISIONS 1 rl1 1.T. 3 1 :7v 733 . 15131191 1 59 C I .1 P'E: 5_3 1 - (311194 1 Se 0 1 4 7 .E4 _ 17746 ( - - 4 ' i ' , WE• .5EAL SECT 1C "C-C" SCA_7 1/ 5341_. 1/5 ,/ ,--ANL_ SECTiCN - .901 .7 0V BAR - APPROVED AS COMPLYING wTa THE SOUTH FLCRIDA BUILDING CODE DAT ) C P • 19gy BY_ RODU� L DIVISION BUILDING CODE COMPLIANCE OFFICE ACCEPTANCE NO. l - /V2I 3 SERIES 100 RESIDENTIAL STEEL DCCR. 46.7 PSF.• DACE COUNTY D - 408775 v.1 3/6. >cu 1 > 2 NOTES n nt © © 2 I/26 2 13/32 0! 0 t- P/N 4 0119.9.-0001. TCP FIXTURE 1 I I ITT51 3 3/16 tr. .pCLICi I 006:1 P/N A07602-0001. CENTER HINGE STEEL DCCRS .25 R. TYP SECOND EMBOSS:A:NT FREM END 1 I i /1 ! \ I 1 ■••-- r , ., ; .:J.-.../ ... .070 MIN -,- 1'7-.010 MIN L-.156 CIA PCP RIVET TYP. 15.00 DETAIL 'G' SCALE. 1/4 CUT OJT 15 60 SO. INS. LCUvEREO AREA INE LONER IS AN CPT1CNAL FEATURE A00 64351 BE SPECIFIED BY DiSTRIBUTOR • .091 MIN-1.- 2 1l/32 0 7" )1.188 1 P/N 400 4.00 J. 2 7/16' _ _ _ _ • r P/N 0 C5771-XXXX SOT. FIXTURE FOR 160/200/290/390 SERIES 1, v. r _ . ; 2/22 1• (0,-A: .090 mIN--- -1 2 1/4 P/N 405742-0001. BRACKEI. RCIIER 0HA77 0 0 • 0 0 PART. NLKBER I - L - 1 405964-0001 13-114 0 F IEND:NI • coca WIDTH - 1 11 17/8 i 1 I 44 F ! 6/8_.....01.5 P/N 400650-0002. RCILE0 NS-3 STRUT , 1 13/16 CIA REF ROLLER R STEM ASSY. DE TA I LS 2 1/2 1 .108 MIN ---- > P/N 40536 & 0 BRACKET. 51 A3 rt _, 3/4 SCAB BRACKET DE TA I LS MONK% .0.0.0..3 .4 0 ro..• W 0 .4400. 0.03.010 • • 03 WI LS.. •3 3.03 01.030. 303 • • 1.. •. NO to, 30 30 Cr .33 10 3 . 0 40 , 30.30 .12.0 0•10.0339 0 001. w WOO Or CONCI3 • • M.... fr 0•17•40 IN. 33.0 .3 s-cr 7/16 CIA t ___4 3/8' --- 2 3/8' 0.0.03 ant 10.371.1. • r la• 7/16 D)A. REF. 7/15-4 P/N 061166-:.:0 ROLLER =S3Y. IR-3 9 /N061165 - 0002. 601.109 4554• 16-2 .108 MIN -.- P/N 4 05964-0002. BRACKET. SCAB JOINT r ---- 1 --- 1 3''• cat N/A 13/ DIA ...CD I...2w 0• 3.0.03 0.0 I EACH C I 01,003..0. P/N 061931-0000. SLICE LOCK ASSY Mr OvERHEAD DOOR CCRPORATICN 1900 CROwN DRIVE FARt.c_Rs BRANCH TEXAS 75234 LeROY C. KRUI.XE. P.E. 136580 f'ZI, P/N =07605-XXXX. E\D. HINGE 9E510. STEEI DCCRS C.J. ',OCRS 464. t0 5 80.0-09 9001 REVISIONS 3FP .00 020 "13 I 61669' 0 1 E '09 EN .0066 1 :e/ '01605-0002 I 85 I =c1605-5005 1 1 10 •01655-2004 1 1.15 '01605-.7,005 i 1.60 APPROVED AS COMPLYING WITH THE SOUTH FLORIDA BUILDING CODE DAT - 7 IR C r' BY PRODUAONTROL DIV!S.ON BUILDING CODE COMPLIANCE OFFICE ACCEPTANCE NO. C177-0 ' ' • 7/25/9 8/8/94 8/8/94 og, IES 180 RESICENIIN. STEEL CCCR. 46.7 951, : 04CE CONIT • D-408775 v.., 3/8 2 2 6 -• • 1 • 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. Owner's Name and Address Miss DeNeice Bustin N 171 Street N. E. 100th St. Registered Architect and /or Engineer • --- Name and address of licensed contractor___. -a--•-- Location and legal des ription of lot to be built on: / / t )1"-4-;'--"""-- l a✓� -. a� . Lot_.2t�___L.t._y_. _? _�. Block . t✓..� Su bdivision Street and Number where work is to be done 171 N. E. 100th Street State work to be done and purpose of building (by floors) and for no other purpose. New Building 1.-' Addition Repairs No. of Stories 1 To be constructed of_ -�,._ I lemodeling Kind of foundation ' Roof Covering " Estimated Total cost of improvements $.,..3 . 2.. ' ts? O Amount of Permit $ Zone cubage required plan Cubage — MIAMI SHORES VILLAGE BUILDING INSPECTION DEPARTMENT. 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 Owner 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 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 n ary public, duly authorized to administer oaths and take acknowledgments, personally ap- � _' geared G'uP�%. s -- - - , to me-well known, _ ;" L and who, being by me first duly sworn, upon oath deposes and says that9he is the L = ° of the above described construction, that he has carefully read the foregoing application, and that he did sign the st nie, and the all facts _ therein by him stated are true. _ .: - ` ,. - Permit No L Date 7' Y R e d om to and Subscribed l fore me. :, -' ' Disapproved Dat (Signed) APPLICATION FOR BUILDING PERMIT Building Inspe NNING BOARD Date July 7 ,196 9 DATE Chairman Member Member Member Member __ Member Council Approved _Date Disapproved \. Notary Public, State of Florida My Commission Expires 4- 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.