187 NE 100 St (5)DATE: 3 3 Gi'1 `?
Miami Shores Village
Building Department
NAME OF PERSON REQUESTING FILE:
10050 NE 2 Ave, Miami Shores, Fl 33138
Tel: (305)795 -2204 • Fax; (305)756 -8972
PLEASE PRINT
TIME: 3 2-
PHONE #: 3da� — 833 CYOUR ADDRESS: I g 14 ( (9 O S
ADDRESS OF FILE REQUESTED: / 2 ( tO 0 S7'
INFORMATION REQUESTED: )c.—
I understand that all documents in this file are property of Miami Shores Village and
that NO documents may be removed from this file. You may get 4 complementary
copies (8x11) size, additional copies will be furnished at 0.15 cents per page, not
including any blue prints. If blue prints are order please be aware that we are not
responsible for the quality of the printed documents.
Acknowledged by: (/v
FILE RETURNED TO: INITIAL
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Date itclaroilq Job Address 8 i46: 1 o O ST Tax Folio
Legal Description Historically Designated: Yes No
Ownedizes9° nt- tE LLe4
Owner's A d d r e s s 1 87 N E 1 0 0 S T
1.1 I LLi5
Master Permit #
Phone /3 0S) 15t— g '3'3 s
Contracting Co. -/`)AR� Coo . Address
Qualifier SS# Phone
State # Municipal # Competency # Ins. Co.
Architect/Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIPTION /1-01-4( N C - tt i-E 1 ,J S t b tS
Square Ft. Estimated Cost (value) / 600-
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
Notary as to Owner and/or Condo President
My Commission Expires:
FEES: PERMIT .50 . RADON
Date
Date
C.C.F. • C NOTARY
Signature of Contractor or Owner- Builder Date
Notary as to Contractor or Owner - Builder Date
My Commission Expires.
CATHERINE ESTES
Notary Public -State of Florida
My Commission Expires Aug 3, 2001
Commission .,` CC668812
BOND
APPROVED: i TOTAL DUE ( - 5 - 0 ,4
Zoning Building 1d
g dmg [ � Electrical
Mechanical Plumbing Structural Engineer
Location dlegal t flot tob built
New Building
To be constructed of
Disapproved k
(Signed)
MIAMI SHORES VILLAGE
BUILDING INSPECTION DEPARTMENT
APPLICATION FOR BUILDING PERMIT
Application is hereby wade 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 her in specified or not. A copy of approved
plans and specifications must be kept at building during progress of the work.
Date..—. L.2____, _____.... ,19.?7
Owner's Name and Address ... ... No./ Streetll ..��
Registered Architect and /or ngint: r
Name artd address of licensed contractor ..,. QM J� j R'i 4� Leo ST
oca ion an ega description o c ui on: 3950 S.W 6 Street
Lot Block Subdivision Ft. �.au erflalf3,.E1 �1 r
Street and A'umber where work is to be done . � , • ,! �` � G .---»
State work to be done and purpose of building (by floors)
and for no other purpose.
Remodeling Addition Repairs No. of Stories
Kind of foundation . Roof Covering —
o
Estimated Total cost of improvements $ Amount of Permit $. 1
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 pennit 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 inspectoo, on the site of the work such public notice
or notices as arc required by the Act. The undersigned agrees to employ only suc ors, on work to be performed under this
permit, as are licensed by Miami Shores Village.
Remarks ( S
STATE OF FLORIDA,
COUNTY OF DADE. ss
Before me, the undersigned authority, a notary public, duly authorize • 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 true.
Permit No. _ »_. X.) _� *I Date 9 1 4
Read, Sworn to and Subscribed before me.
Date
Building Inspector
PLANNING BOARD
Notary Public, State of Florida
My Commission Expires
DATE
to me well known,
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 $1.00 will be charged when such re- inspection is made necessary by improper notice for inspection or faulty
materials and /or workmanship.
Date
Bill to
Address
Job Address
Lot 47
Signed by
Purdy Soil Compaction Service
1
Remarks +
P. O: BOX `357
MIAMI, FLORIDA 33166
TELEPHONE 947-6677
WORK COMPLETION RECEIPT
r) re'
/ 7 , / 0,0
777 . 2
Block /5 Subdivision
Job No. Purchase Order No
Heavy Compactor Medium Compactor Light Compactor
Time Arrive Job Time Leave Job
Amount $
Hour: Worked
Operator of Machine /0
(no initials accepted)
SERVICE IS OUR BUSINESS
ITEMS
SUB CONTRACTORS & SUPPLIERS
NAME & ADDRESS
1. Architectural Fee lans
2, Asphalt walks drives. etc.
3, Cabinets - Bath Vanity
,I _/_" k v�•, 41 . e
4 Cabinets - Kitchen
.;/ r ,
5. Cabinets- Medicine
6. Cabinets - Unit Closet
7. Cleanin
C a s/ 74-.n e. to PEI
8. Clearin: Site
9. Concrete - Foundation. Slabs Beams
o,/.,, c/o si, ., g. 1.-e
10, Concrete - Walks drives: etc.
11, Contractors Fee
12. Electric Fixtures
13.• Electric Wirin:
S'• ./ 4,..A... r A e e, , /2.-e
14. E quip ment Rental
,D G, / • 1e - >
15. Excavation
.11, air,/ n- (s c•- f\ e !q vm iv it)
16. Fill for S1
(a 1 rc n L t) rt.
17. Floors - Finish wood & kitchen
18. Floors - Terrazzo
. - •
19. Gara:e Doors
' e/, ai •- 'Doo 2
20. Glass. Slidin• Doors
21. Hardware - Finish
Co't /X,,c /o `c, -, . /.- /4101
22. Hardware - Rou_h
e, - ciev /., i e„,..... .
23. Heatin:
24. Insurance - Liability,comp. -bond
,
25. Labor - Payroll •
•
26. Labor - Contract
_ c7 /.e -' c d4N
27. Labor - Contract
28. Landsca.in.. Fill. Gradin:
.e0 sr.- iz 41 C /o W.
,.
29. Lath Plaster, Stucco
1/a re r.) 5 Cale 19. 1
30. Lumber (A11)
31. Masonry• Labor
C o Ai 1 n r► e I v vt
32. Masonry Materials, B1oek
,
33. Millwork
34. Miscellaneous
35. Ornamental Iron Work
--
••
36. Oven & Plate - Built -in
•
37. Overhead
38. Painting --
e o ,- • , s71 C /o .z.
• r
39, Permits. Tem.orar Power
40. Pilin: Foundation
ACINIMIMMIMMIIIMMEIMI
41. Plumbin: Com.lete
42. Pool - Swimming .
43. Roofing & Sheet Metal Work
•.
44. Roof Trusses Pre -fab..
• F , rz.c 0.0 . T/f a xi
1�
.
-•
45. Screen Enclosures
-
46. Se.tic Tank or Sewera:e
S� , o 1'•.p r 5 7■9r? -14 .
47. Shower or Tub Enclosures
48.• Steel - Reinforcin: & str1.
'as - 1".q,, /o av .a a z •
49. Supervision •
.
re • .I !% t WAa
50. Surve s
51. Tile & Marble
C 7>e' S .. ,.,d 77/ e
52. Water - Public
53. Water - Well & Pump
54. Windows - Glazing & Screens `
r - . -e r.. a • rA- ,:,. s -
V /
55. Window Frames - Concrete
Ca sz.vi rra e /' /z,
Prior to a final inspectin this application must be filled out; if sub contractors have
failed to take out permits the general contractor shall be responsible for the permit and
fee. A final inspection, must be made prior to the release to Florida .Power and Light Co,
and the issueance of a certificate of occupancy.
OWNER T, JOB ADDRESS /� �g /D& 2/
LOT ; BLOCK
MIAMI SHORES VILLAGE
APPLICATION FOR FINAL INSPECTION
SUB, //i9/l /. SI,, . r J e. .
- - -7D
DAY LABOR `' CONTRACT ` DATE
56 . Builders Bond Must Accompany This Application for Final Inspection
•1
;'77
// Y19 72
TOTAL