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CONTRACTOR 3313 Name ( / t pp I • � - r illsri- ft1 274Z- License No. qjr` 65.00 / S Business Telephone 5 4 ‘ , 5 Address ,/ V apt/1p avjeo, �aSE r ?? N, S(VRES ... , 33(3 Repair Telephone 51.1C-77_ 7,6 1 ( Fax 7s ,- 63 69 Qualifier Name`4 , i ‘56004_, . Demolish Address /36 At E /D sr AK , A / // gEs 3313 Home Telephone 3x403 274Z- Business Telephone 5 4 ‘ , 5 Repair Fax 1 Alteration Interior P TYPE OF MANAGEMENT (✓ ) New Construction Enclosure Alteration Exterior Repair Alteration Interior . Demolish Relocation of Structure Shell Only Foundation Only Add', Attachment Other Add'1 Detachment Other Name Company Phone # MIAMI SHORES VILLAGE BUILDING DEPARTMENT 305- 795 -2204 Building Inspection Request Date Type Insp'n Permit No. P v r 0 - — L 24? (a Address 1 Co e /0 / 6 7 • -5ps 7 /6 V Inspection Date Approved Correction Re- Insp'n Fee 1 t AAA ps 61 PERMIT APPLICATION Master Permit No. S P7.cO Subsidiary Permit No. Lain a permit from the Miami Shores Village: l ed by the property owner and qualifier. Both signatures must be notarized. Please application. If roofing work will be done, a roofing application must be submit- nts to the Building, Planning and Zoning Department for processing. During the additional information. I re 33i3�' City State Zip ption of Work ?h te eel t Linear Feet Feet Units Floors f Work 2Y60. 06 Bldg Value sessed/Appraised Value one Base Floor Elev. ENGINEER Name License No. Telephone F Page 2 IMPORTANT NOTICES DO NOT BEGIN ANY WORK WITHOUT HAVING RECEIVED YOUR VALIDATED PERMIT AND PERMIT CARD. Applying for a permit does not grant the right to begin construction. HOURS OF CONSTRUCTION are limited to: Monday through Friday from 7:30 a.m. to 6:00 p.m., and Saturday from 8:00 a.m. to 5:00 p.m. No inspections will be conducted on weekends or holidays. 2. All construction of demolition areas MUST BE MAINTAINED IN A CLEAN, NEAT AND SANITARY CONDITION free from construction debris. 3. STREETS AND NEIGHBORING PROPERTIES SHALL BE KEPT FREE FROM DIRT AND DEBRIS. 4. SWALES MUST BE PROTECTED FROM BEING DAMAGED BY EQUIPMENT OR VEHICLES, AND MAY NOT BE USED FOR STORAGE. A bond is required for work in or near the street/sidewalk. 5. CONSTRUCTION TRAILERS ARE PROHIBITED ON SINGLE FAMILY RESIDENTIAL CONSTRUCTION SITES. Other construction may have a trailer which requires a separate permit. 6. PORTABLE TOILETS for a construction site require a separate permit. 7. DO NOT DISCHARGE WATER INTO THE RIGHT OF WAY OR STORM DRAINS without approval from the Building, Planning and Zoning Department. 8. EQUIPMENT AND MATERIALS SHALL BE STORED at least 10 feet from the edge of pavement. 9. Department of Health and Rehabilitative Services (HRS) approval is required for applications involving septic tanks. Department of Environmental Resources Management (DERM) and/or Miami -Dade Water and Sewer Department (MDWASD) approval is required for applications involving sewers. 1. AFFIDAVIT - Please read carefully'. Application is hereby made to obtain a permit to do work and installation as indicated. I, the OWNER of the property, 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, POOL, EXTERIOR DOOR, MECHANICAL, WINDOW, FENCE, DRIVEWAY, ROOFING and SIGNS and there may be additional permits required from other governmental agencies. I, the OWNER of the property, have disclosed all information related to any work at the property performed in the prior twelve months to the Building Official. Further, I am fully aware that if the cumulative cost of work to my home or business under this and any other permit equals or exceeds fifty percent (50 %) of the fair market value of the structure, the entire structure must meet the present federal flood criteria for finished floor elevation. I am also fully aware that if the total cost of work to my home or business under this and any other permit exceeds fifty percent (50 %) of the replacement cost of the structure, then the entire structure must conform to the current code requirements of the Building Code. WARNING TO OWNER: Your failure to record a NOTICE OF COMMENCEMENT may result in you paying twice for improvements to your property. If you are spending more than $2,500 or intend to obtain financing, you may wish to consult with your attorney or lender before recording your Notice of Commencement. The Notice of Commencement must be recorded at: 22 N.W. 1st Street, 1" Floor, (305) 679 -1078. Once recorded, the Notice of Commencement must be POSTED AT THE JOB SITE in accordance with Section 713 -35 of Florida Statutes. Review the brochure at Village Hall on Construction Lien Law and Choosing a Contractor. STATE OF FLORIDA, COUNTY OF MIAMI -DADE Signatur f Owner f � c-r) "�" ► narnpl6 Prin Nanhe • j�� p e Sworn to and subscribed before me this ?.. day of '" \Rt�C'IA 700 Signat SEAL: Personally known of Notary t blic - State of Florida 41 te , Wanda P. Harris � u a .Commissitm # D0078077 gBptres Jan. 20 2006 y� Bonded Twit '0 �, ,�`� Atlantic Bonding Co.. Inc. V OR, Produced Identification gnat e of Contractor / uali er oEa Sct Print Name Sw ..� to subscribed before me thi2 eT day . Type of Identification Produced: Type of Identification Produced: PERMIT APPLICATION Personally known OR, Produced Identification Type Insp'n MIAMI SHORES VILLAGE BUILDING DEPARTMENT 305- 795 -2204 Building Inspection Request Date St ir O'- Name rt--er' Address 1 (0 �� "" E 10 / ? Company Vt 5 C_:0 » 1 Pa. n- 4-1.45 Phone # �S / 7/ y Inspection Date 3- 7-2-6 — /t ) / Permit No. P 04 - L04? Approved Correction Re- Insp'n Fee -f -i Y LiQ Pat_` i t- Correction Re- Insp'n Fee • MIAMI SHORE . V,AGE BUILDING DE 1MENT 305 -795 -2204 Building Inspection Request Date Sf ary l 0 4 r-. �� Type Insp'n 'nod Pe-6 Y 1 Permit No.- P 0 4 a Name e) r \v©--Y-' cQ5 Address 3 t0 /U e /0/ S ' Company 111 S C1 1.7 * YG t' n Phone # X S --7.S-17/6 U Inspection Date /a y Approved CONTRACTOR New Construction Name r \l <n t> I T 'PI; K'1"ItSt* Enclosure License No. gy_ 6 I 33 Address/ a . , ( D ,44, ",ns� ANA A; S,(ver5 _' , 33(3P Repair Telephone 7 (i_ 7 ( 6 T Fax 3 g. 63 83 Qualifier Name O6 1 s co ii r ,p . Demolish PROPERTY OWNER New Construction Name /1A geyDl✓ /i.jo/_ Enclosure Address /36 / ET /0/ dui #E$ 7' , A i 5�k 33 Home Telephone 3aS 2732 Repair Business Telephone V/, ,E `^ Alteration Interior • Fax . Demolish TYPE OF MANAGEMENT (✓ ) New Construction Enclosure Alteration Exterior Repair Alteration Interior . Demolish Relocation of Structure Shell Only Foundation Only Add'l Attachment Other Add'I Detachment Other INSTRUCTIONS - The following steps must be taken to obtain a permit from the Miami Shores Village: Step 1. Complete the attached permit application which must be signed by the property owner and qualifier. Both signatures must be notarized. Please print or type to allow for a more accurate processing of your application. If roofing work will be done, a roofing application must be submit- ted along with this permit application. Step 2. Submit the completed application with all necessary documents to the Building, Planning and Zoning Department for processing. During the processing of your application, you may be asked to submit additional information. APPLICATION Job Address: / 36 // E. / (9( Address Folio Number Lot Block Subdivision PB PG Current Use of Property Proposed Use of Property Tenant Information PERMIT TYPE (✓ ) Building Electrical Mechanical Plumbing LPGX Roofing Fence Other Apt. Zoning PERMIT CHANGE (✓ ) Chg. Contractor Renewal Revision Extension Supplement Reinspection ARCHITECT Name License No. Telephone F .A/1 .41./ 0 PERMIT APPLICATION Master Permit No. 2 P7-O0q- 4 2.e Subsidiary Permit No. �l � hsL? ( Sgori City State Description of Work ?J exert t c 33i 3e' Zip Linear Feet Square Feet Units Floors Value of Work 2`7 00 Bldg Value Tax Assessed/Appraised Value Flood Zone Base Floor Elev. ENGINEER Name License No. Telephone F Page 2 IMPORTANT NOTICES 1. DO NOT BEGIN ANY WORK WITHOUT HAVING RECEIVED YOUR VALIDATED PERMIT AND PERMIT CARD. Applying for a permit does not grant the right to begin construction. HOURS OF CONSTRUCTION are limited to: Monday through Friday from 7:30 a.m. to 6:00 p.m., and Saturday from 8:00 a.m. to 5:00 p.m. No inspections will be conducted on weekends or holidays. 2. All construction of demolition areas MUST BE MAINTAINED IN A CLEAN, NEAT AND SANITARY CONDITION free from construction debris. 3. STREETS AND NEIGHBORING PROPERTIES SHALL BE KEPT FREE FROM DIRT AND DEBRIS. 4. SWALES MUST BE PROTECTED FROM BEING DAMAGED BY EQUIPMENT OR VEHICLES, AND MAY NOT BE USED FOR STORAGE. A bond is required for work in or near the street/sidewalk. 5. CONSTRUCTION TRAILERS ARE PROHIBITED ON SINGLE FAMILY RESIDENTIAL CONSTRUCTION SITES. Other construction may have a trailer which requires a separate permit. 6. PORTABLE TOILETS for a construction site require a separate permit. 7. DO NOT DISCHARGE WATER INTO THE RIGHT OF WAY OR STORM DRAINS without approval from the Building, Planning and Zoning Department. 8. EQUIPMENT AND MATERIALS SHALL BE STORED at least 10 feet from the edge of pavement. 9. Department of Health and Rehabilitative Services (HRS) approval is required for applications involving septic tanks. Department of Environmental Resources Management (DERM) and/or Miami -Dade Water and Sewer Department (MDWASD) approval is required for applications involving sewers. AFFIDAVIT - Please read carefully. Application is hereby made to obtain a permit to do work and installation as indicated. I, the OWNER of the property, 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, POOL, EXTERIOR DOOR, MECHANICAL, WINDOW, FENCE, DRIVEWAY, ROOFING and SIGNS and there may be additional permits required from other governmental agencies. I, the OWNER of the property, have disclosed all information related to any work at the property performed in the prior twelve months to the Building Official. Further, I am fully aware that if the cumulative cost of work to my home or business under this and any other permit equals or exceeds fifty percent (50 %) of the fair market value of the structure, the entire structure must meet the present federal flood criteria for finished floor elevation. I am also fully aware that if the total cost of work to my home or business under this and any other permit exceeds fifty percent (50 %) of the replacement cost of the structure, then the entire structure must conform to the current code requirements of the Building Code. WARNING TO OWNER: Your failure to record a NOTICE OF COMMENCEMENT may result in you paying twice for improvements to your property. If you are spending more than $2,500 or intend to obtain financing, you may wish to consult with your attorney or lender before recording your Notice of Commencement. The Notice of Commencement must be recorded at: 22 N.W. 1st Street, 1" Floor, (305) 6791078. Once recorded, the Notice of Commencement must be POSTED AT THE JOB SITE in accordance with Section 713 -35 of Florida Statutes. Review the brochure at Village Hall on Construction Lien Law and Choosing a Contractor. STATE OF FLORIDA, COUNTY OF MIAMI -DADE Signatur R ry r� arnpls Priii Na e pp p Sworn to and subscribed before me this r )% 1 4 3 day of 1�1\RRCH , 700 Signat of Notary : blic - State of Florida + Olisoo�, Wanda P. Harris SEAL: :commission* DD078077 g gapire$ Ian 20 2006 ° Bonded Thru -at" Atlantic Bonding Co„ Inc. Personally known V OR, Produced Identification ST F MIAMI -DADE Sw „ to d subscribed before me thi2 SEAL: Personally known Nag 1} c ',r UrVIWRAgi Expires November 15, 2006 PERMIT APPLICATION OR, Produced Identification Type of Identification Produced: Type of Identification Produced: Date V /• Owner's Name xli ge . / i �r10UI Phone # J qb3 27 / Owner's Address / 3(o 4 • /0/ 5 T City /, &I(, 5;44E5 State Zip /36 i✓ /o/ Job Address (where the work is being done) City Miami Shores Village Is Building Historically Designated YES ` NO Contractor's Company Name (if applicable) VI 6Cochil - a i tAg Phone # * * * * * * * * * * * * * * ** * * * * * * * * * * * * * * ** Signature Walls Fascia Drip Cap /drip Edge rsi/& - Co Pea, - we Pact( oJE ni,� --- Roof NI Flower bins Shutters NI Awnings . ty Chimney Doors and door jams r . (7- - /b Garage doors Railings Fences o 7� i Decorative etal K 1. All brick (simulated r regular) Stucco banding 14 Accessory Buildings Other APPLICATION APPROVED BY: • Miami Shores Village Paint Color Approval and Agreement All elements on the si must -be listed and indicate the color to be painted rz/ GB-rr- -.q&4 1= 81,4a Any other stucco features _A G - T 1/.orfrA— B-AAT){ ) • Owner or Agent f County Miami -Dade • P& Z O cial 33t e � tc5e. evt ?/ I 6c cie 04 r Zip 33130 Yar -7161( 21 s t- r10 A` ** ** ** ** ** ******* ** ** ** ** ** ** ** *** * *** ** ** ** ** ** *** * *** ** ** ** ** ** *** * *** ** ** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * 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. Date 't - - (1 Date G// chc6 /1803 rkeL 135 3'; -b 1 7 6 - \x5 ADDRESS OF PROPERTY: CERTIFICATE OF APPROPRIATENESS NAME(S) OF APPLICANT(S): Bryon & Alejanra Thomas APPLICATION DATE: (Date Application Received by Village Clerk) March 1, 2004 CERTIFICATE OF APPROPRIATENESS REQUEST FOR: DATE: A. Request to Paint Exterior Benjamin Moore — Moorelife Paint Formula : Deep Base 10 3B OY — 6x RX — 7.50 OG -6 GY — 1 x 5 WH -3X12 BOARD DECISION: APPROVED WITH CONDITIONS DENIED 136 N.E. 101 Street ,. 3/9/ov SIGNATURE & TITLE 6 miciAGt (,/ . �� , G9.d pe MIAMI SHORES VILLAGE APPLICATION FOR CERTIFICATE OF APPROPRIATENESS Georg rr +4o U 52 NAME OF PROPERTY (If applicable): 'Br j r\ Ft� Iril'�I� t'bt — Morn 5 ADDRESS OF PROPERTY: 13I0 1Q -6 101 NAME(S) OF APPLICANT(S): / (Note: If the applicant is a person other than the owner(s), evidence of that person's authority as agent other than the owner(s), evidence of that person's authority as agent must be attached to the application.) CONTACT TELEPHONE NUMBERS: 305- -2737 APPLICANT ADDRESS.: 5 burn_ (If different than property address) PRESENT USE OF PROPERTY: 1? m Ze,5■4n INDICATE CLASSIFICATION OF PROPOSED WORK: MAINTENANCE OR REPAIRS RESTORATION X REHABILITATION DEMOLITION NEW CONSTRUCTION OTHER (PLEASE EXPLAIN) 1 DESCRIPTION OF THE PROPOSED PROJECT: ttin l orti ^} ni,\ I c,llor PLEASE PROVIDE THE FOLLOWING SUPPLEMENTARY INFORMATION: SITE PLAN (W/ DIMENSIONS) FLOOR PLANS (W/ DIMENSIONS) ELEVATION (W /DIMENSIONS) LABELED PHOTOS MATERIAL SAMPLE / SURVEY (WITHIN 5 YEARS) k COLOR SAMPLE OTHER CERTIFICATION UNDER PENALTY OF PERJURY, I (WE) CERTIFY THAT ALL INFORMATION IN THIS APPLICATION AND THE ATTACHMENTS HERETO IS TRUE AND CORRECT TO THE BEST OF MY (OUR) KNOWLEDGE AND BELIEF, THAT THE WORK FOR WHICH APPROVAL IS SOUGHT HEREIN IS BEING PROPOSED IN GOOD FAITH AND WILL BE PROMPTLY PERFORMED IN THE EVENT OF THE APPROVAL OF THIS APPLICATION AND THE GRANTING OF A BUILDING PERMIT, AND THAT I (WE) DESIRE THAT THIS APPLICATION BE GRANTED AND SUPPORT THE GRANTING OF THIS APPLICATION. SIGNATURE OF APPLICANT(S): DATE: 2 /27 /0+ DATE: SIGNATURE OF OWNER(S): > DATE: 2/ 2.21/ 04- DATE: cou,-eA V•ev r� v\ 06_ \ alai born aE cvw,Ne.to Miami Shores Village 10050 NE 2nd Avenue Building Permit Phone: 305 - 795 -2204 Permit Number: BP2004 -428 Printed: 4/7/2004 Applicant: BRYON THOMAS Owner: THOMAS BRYON JOB ADDRESS: 136 NE 101 ST Page 1 of 1 Contractor VISCOUNT PAINTING & DECORATING Contractor's Address: 640 GRAND CONCOURSE Local Phone: 305 - 751 -7164 Parcel # 1132060132000 Legal Description: MIAMI SHORES SEC 1 AMD PB 10 - 70 LOT 10 BLK 15 LOT SIZE 50.000 X Fees: Description Amount FEE2004 -3662 Building Painting Fee $60.00 FEE2004 -3663 CCF $1.80 FEE2004 -3664 Notary Fee $5.00 FEE2004 -3666 Technology Fee $1.50 FEE2004 -3668 Training and Education Fee $0.60 Total Fees: $68.90 Total Fees: $68.90 Total Receipts: $68.90 Permit Status: APPROVED Permit Expiration: 9/25/2004 Construction Value: $2,460.00 Work: PAINT EXTERIOR OF HOUSE AS AGREED Signed: (INSPECTOR) In consideration of the issuance to me of this permit, 1 agree to perform the work covered hereunder in compliance with all ordinances and regulations pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I assume responisibility for all work done by either myself, my agent, servants or employes. Signed: (Contractor or Builder) BY: EL TYPE: Minimum Fee Q'I'1'. 'I'1'1'E Dryer QTY. Ti IT Outlet, Appliance (1'1'1'. Tl I'I: Service Repair Q'I Y. A/C Central 1 -3 Ton Heating Strips, each Fan Outlet, Wall Service, Temporary Paint Booth A/C Central 4 -7 Ton Fire Pump Outlet, Switch Piping, Flammable Liquid Signs A/C Central 8 -15 Ton Fixture - Fluorescent Process/Pressure Piping Oven Space Heater (kw) A/C Central 16 -20 Ton Pressure Vessel Fixture Light Parking Lot Lights Spas/Hot Tubs A/C Central 20+ Ton Flood Lights Plugmold/Strip Subfeeds, No. of Amps A/C Window FPL - Load Central Posts Swim Pool, Commercial Air Conditioners Garbage Disposal Range/Range Top Swim Pool, Residential Chiller Generators, etc. Receptacles Switchboards Clear Violations Heat Recovery Refrigerator, Comm. (p/PH) Temp Serv., Construction Compactor Low -volt, Burglar Refrigerator, Domestic Temp for Test - 30 days Deep Freezer Low -volt, Fire Renew - Temp Service Water Closet Demolition Low -volt, Intercom/Teleph. Repair Circuits Water Heater Dishwasher Low -volt, Television Service, Number of Amps Water Heater New MECHANICAL TYPE Minimum Fee QT1'. I'YPE Condensate Drain QTY. 'I'YPI Generator QTY. 'rvi'I.: Refrigeration, Tons Q'I'1'. A/C Central, Tons QTY Cooling Tower Heating Strips, each Vent Hood, Cost A/C Wall/Win. Tons Dryer Vents, Number of Paint Booth Ventilation, Cost Air Handler, Tons Ductwork, Cost of Piping, Flammable Liquid Periodic Inspections Barbecue Fire Sprinkler System Process/Pressure Piping Pump and Abandon Bath Fan - Vented, # Fireplaces, Number of Pressure Vessel Gas - Appliance PLUMBING TYPE A/C Condensate QTY '1'11T Drains, Roof QTY. TYPE Miscellaneous Fixture QTY. TYPE Soakage Pit QTY Bath Tub Drinking Fountain Miscellaneous Repairs Solar Water Heater Bidet Filter Replace Pool Piping Sprinkler Repair Cap - Fixture Fountain Pump and Abandon Sprinkler System Cap - Water Gas - Appliance Pump, Domestic Supply, AC Well Cap - Sewer Gas - Natural Pump, Fire Stand Temporary Toilet Catch Basin Gas - Propane Pump, Re- circulate Temporary Water Closet Clothes Washer Gas Piping Pump, Replace - Pool Urinal Dental Chair Grease Trap Pump, Sprinkler Utility - Sewer Discharge Well Ice Maker Pump, Sump Utility - Water Dishwasher Indirect Wastes Relay Repair Vacuum Pump Disposal Interceptor Roof Inlet Water Closet Domestic Well Laundry Tray Septic Connection Water Heater Drainfield, 4" Tile/Res. Lavatory Septic Tank Water Heater New Drains, Area Meter Set (Gas) Sewer Connection Water Re -pipe Drains, Floor Minimum Fee Shower Water Service Drains, French Miscellaneous Equipment Sink Well, Supply Page 3 PERMIT APPLICATION INSTRUCTIONS: Please indicate the type of work being performed and quantity(ies) in the space provided below. RECEIVED AND REVIEWED BY: DATE: SECTION BY D ATE b/ by Zoning (,L . yr' Electrical Mechanical Plumbing Fire Public Works Structural Building Official ,, /i Page 4 OFFICE USE ONLY C C 11 I CKL1ST ❑ OWNER - BUILDER FORM (Attach) LI FIRE DEPARTMENT APPROVAL (Commercial / multi - family) ❑ CONCURRENCY (New Construction) ❑ OTHER (Specify & Attach) $3.00 per page (Scanning Fee) Miami Shores Village Bond Inspector State Educational Fund $ State DCA (Radon) Code Enforcement Fine Zoning Review Notary $ ❑ PROOF OF OWNERSHIP (Attach) ❑ HRS / DERM APPROVAL (Septic / Sewer) ❑ IMPACT FEE (New Construction) ❑ OTHER (Specify & Attach) $ ‘o $ . Metropolitan Dade County (C.C.F.) $ f1 y0 (sq.ft. = x/1000 x 0.60) $ (¢.005 /sq.ft.) (¢.01 /sq.ft.) PERMIT APPLICATION ❑ CONDO ASSOCIATION APPROVAL (Attach) ❑ BPR APPROVAL (Restaurants) ❑ CONTRACTOR REGISTRATION (On File) PERMIT FEES so TOTAL ISSUING OFFICIAL 0 REVIEWED AND PREPARED BY: DATE: CONDITION OF APPROVAL Revised July 2001 10050 N.E. 2ND AVE., MIAMI SHORES, FL • (305) 795 -2207 • FAX (305) 756 -8972 • http : / /www.miamishoresvillage.com PROPERTY OWNER Name t 1.5 r y o^c\" - aomillS Address / BID tot 10051 3} Home Telephone 305-151 Business Telephone S on- gZ13- 2.7.3 Fax TYPE OF MANAGEMENT (✓ ) New Construction Enclosure Alteration Exterior Repair Alteration Interior Demolish Relocation of Structure Shell Only Foundation Only Add'I Attachment Other Add'I Detachment Other INSTRUCTIONS - The following steps must be taken to obtain a permit from the Miami Shores Village: Step 1. Step 2. Submit the completed application with all necessary documents to the Building, Planning and Zoning Department for processing. During the processing of your application, you may be asked to submit additional information. APPLICATION Job Address: Address Apt. Folio Number 1 ` 3 0 L ' 0 /3 . a- mm h� � C;1 escription of Work pA‘,,i' )e.-;-,P_, 1 C'a Lot Subdivision PB PG Zoning Linear Feet Current Use of Property Square Feet Units Floors )c Proposed Use of Property Value of Work Tenant Information Complete the attached permit application which must be signed by the property owner and qualifier. Both signatures must be notarized. Please print or type to allow for a more accurate processing of your application. If roofing work will be done, a roofing application must be submitted along with this permit application. PERMIT TYPE (✓ ) Building Electrical Mechanical Plumbing LPGX Roofing Fence Other ‘310 Na lo)* 3 Block PERMIT CHANGE (✓ ) Chg. Contractor Renewal Revision Extension Supplement Reinspection ARCHITECT Name License No. Address Telephone Fax Master Permit No. Subsidiary Permit No. Er "c>00 01,1/5 M i 1 StorP S +1-■ City State 4800 Tax Assessed/Appraised Value PERMIT APPLICATION 33138 Zip Bldg Value Flood Zone Base Floor Elev. ENGINEER Name License No. Address Telephone Fax CONTRACTOR Name License No. Address Telephone Fax Qualifier Name Page 2 U'IPORTANT NOTICES DO NOT BEGIN ANY WORK WITHOUT HAVING RECEIVED YOUR VALIDATED PERMIT AND PERMIT CARD. Applying for a permit does not grant the right to begin construction. HOURS OF CONSTRUCTION are limited to: Monday through Friday from 7:30 a.m. to 6:00 p.m., and Saturday from 8:00 a.m. to 5:00 p.m. No inspections will be conducted on weekends or holidays. 2. All construction of demolition areas MUST BE MAINTAINED IN A CLEAN, NEAT AND SANITARY CONDITION free from construction debris. 3. STREETS AND NEIGHBORING PROPERTIES SHALL BE KEPT FREE FROM DIRT AND DEBRIS. 4. SWALES MUST BE PROTECTED FROM BEING DAMAGED BY EQUIPMENT OR VEHICLES, AND MAY NOT BE USED FOR STORAGE. A bond is required for work in or near the street/sidewalk. 5. CONSTRUCTION TRAILERS ARE PROHIBITED ON SINGLE FAMILY RESIDENTIAL CONSTRUCTION SITES. Other construction may have a trailer which requires a separate permit. 6. PORTABLE TOILETS for a construction site require a separate permit. 7. DO NOT DISCHARGE WATER INTO THE RIGHT OF WAY OR STORM DRAINS without approval from the Building, Planning and Zoning Department. 8. EQUIPMENT AND MATERIALS SHALL BE STORED at least 10 feet from the edge of pavement. 9. Department of Health and Rehabilitative Services (HRS) approval is required for applications involving septic tanks. Department of Environmental Resources Management (DERM) and/or Miami -Dade Water and Sewer Department (MDWASD) approval is required for applications involving sewers. 1. AFFIDAVIT - Please read carefully. Application is hereby made to obtain a permit to do work and installation as indicated. I, the OWNER of the property, 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, POOL, EXTERIOR DOOR, MECHANICAL, WINDOW, FENCE, DRIVEWAY, ROOFING and SIGNS and there may be additional permits required from other governmental agencies. I, the OWNER of the property, have disclosed all information related to any work at the property performed in the prior twelve months to the Building Official. Further, I am fully aware that if the cumulative cost of work to my home or business under this and any other permit equals or exceeds fifty percent (50 %) of the fair market value of the structure, the entire structure must meet the present federal flood criteria for finished floor elevation. I am also fully aware that if the total cost of work to my home or business under this and any other permit exceeds fifty percent (50 %) of the replacement cost of the structure, then the entire structure must conform to the current code requirements of the Building Code. WARNING TO OWNER: Your failure to record a NOTICE OF COMMENCEMENT may result in you paying twice for improvements to your property. If you are spending more than $2,500 or intend to obtain financing, you may wish to consult with your attorney or lender before recording your Notice of Commencement. The Notice of Commencement must be recorded at: 22 N.W. 1st Street, 1' Floor, (305) 679 -1078. Once recorded, the Notice of Commencement must be POSTED AT THE JOB SITE in accordance with Section 713 -35 of Florida Statutes. Review the brochure at Village Hall on Construction Lien Law and Choosing a Contractor. STATE OF FLORIDA, COUNTY OF MIAMI -DADE STATE OF FLORIDA, COUNTY OF MIAMI -DADE atur Owner 'V r V ' "' 4 Aj b--v\- Nam ' .5 to and subscribed before me this J _ • day o State of Florida CIAO B Y sic tiP� Pu r e A :0 97 N D ER * CC �g669 7 gR N.A ' wr N 2002 • t - : . - � entificcaation (� Type of identification Produced 5 V'Q b� V ' 0 RO . c/ Si ignature o Notary Publ SEAL: Personally known Signature of Contractor / Qualifier Print Name Sworn to and subscribed before me this day of Signature of Notary Public - State of Florida SEAL: PERMIT APPLICATION Personally known OR, Produced Identification Type of Identification Produced: MIAMI SHORES VILLAGE HISTORIC PRESERVATION BOARD NAME(S) OF APPLICANT(S): (NOTE: IF THE APPLICANT IS A PERSON OTHER THAN THE OWNER(S) . EVIDENCE OF THAT PERSON'S AUTHORITY AS AGENT MUST BE ATTACHED TO THE APPLICATION.) ADDRESS OF APPLICANT(S): (if different than address of property) APPLICATION FOR A CERTIFICATE OF APPROPRIATENESS FORM : MSHPB.COA (adopted 4/95) please type or print clearly NAME OF PROPERTY (if applicable) : A 1-1 0115 to- ADDRESS OF PROPERTY: 136 mE. 5r y er, -- T TELEPHONE OF APPLICANT(S): (305) 754-103$1 ; (305) PRESENT USE OF PROPERTY: ? r'i mart' RC.Si ?af\�.R� CLASSIFICATION OF WORK FOR WHICH CERTIFICATE IS DESIRED: (circle the letter next to the appropriate classification) MAINTENANCE OR REPAIR: The act or process of applying measures to sustain the existing tbrm. integrity and material of a building or structure and the existing form or vegetative cover of a site. It may include initial stabilization work. where necessary, as well as on -going maintenance and repair. Samples of material must be submitted with the Application. B. RESTORATION: The process ot'accurately recovering the form and details of a property and its setting as 11 appeared at a particular period of time by means of the removal of later work or by the replacement of missing earlier work. All applications for restoration shall include site plans (if required by the Building Permit). a statement with bibliography historically justi the work. and any additional photos or information to support the proposed work. C. REHABILITATION: The process ofretuming a property to a state of utility through repair or alteration which makes possil'le an efficient contemporary use while preserving those portions or features of the property which are significant to its historical. architectural and cultural values. All applications for rehabilitation shall include: site plans (if required by Building Permit). and any other supplementary information, such as drawings. that will support the proposed project. D. DEMOLITION: The process of destroying or tearing down a building or structure or a part thereof, or the process of removing or destroying an archeological site or a part thereof: The applicant shall include a report explaining why the proposed action should occur. If this action is to occur for reasons of financial hardship. all pertinent financial data should be included pertaining to the oast of preservation. demolition and new construction. Any other material pertinent to the application is also encouraged as supplementary information. E. NEW CONSTRUCTION: The process of constructing a building or structure that has never existed at that location. Applications shall include : a site plan elevations, floor plan and/or landscape plan. DESCRIPTION OF THE PROPOSED PROJECT (Explain what changes will be made and how they will be accomplished - use continuation sheet if necessary - all applications shall be accompanied by at least one 3" x 5" photograph of the property): 'Pa � 5-x or I (WE) CERTIFY TO THE BEST OF MY (OUR) KNOWLEDGE AND BELIEF THAT ALL INFORMATION IN THIS APPLICATION AND ITS ATTACHMENTS IS TRUE AND CORRECT: SIGNATURE OF APPLICANT(S): SIGNATURE OF OWNER(S): FOR BOARD USE ONLY APPLICATION DATE (date application received by Secretary of the Board): DECISION OF THE BOARD (circle the appropriate number): 1. APPROVED 2. APPROVED WITH CONDITIONS (set forth conditions below): 3. DENIED SIGNATURE OF CHAIRMAN: CERTIFICATION DATE: ) - Z3 DATE: DATE: DATE: - —�Z Bryon - r\- n- a s ':es; de/n 13 NE- 1o1s+ J m ► 51 -)ore.5 , 'l- 33138 ir 2157 -70 $eni)A min Moore- floor `a10 Nov— Golor : 5o/ 2i57 -40 50% 207-50 Ben,GfrnIh Moore. MoorLift, 5o/5 0 3 me E x or 23 - Tan 42. 3 0 0 2157 -70 0 . w 2157 -50 26 © 2157 -40 BENJAMIN COLORPREV EW Ee 2157 Village of Miami Shores 10050 NE 2nd Avenue Miami Shores, FL 33138 Phone: 305 - 795 -2204 Printed: 2/6 /2002 Applicant: BRYON Owner: THOMAS Contractor Local Phone: Parcel # 1132060132000 Job Address: 136 NE 101 ST Fees: FEE2002 -720 FEE2002 -721 FEE2002 -722 Permit Status: Building Permit Permit Number: BP2002 -245 Address: Cellular: THOMAS BRYON Legal Description: MIAMI SHORES SEC 1 AMD PB 10 - 70 LOT 10 Description Amount Building Permit Application Fe$60.00 CCF $0.60 Notary Fee $5.00 Total Fees: $65.60 Approved Permit Expiration: 8/5/2002 Construction Value: $800.00 Work: EXTERIOR PAINTING AS PER AGREEMENT (OWNER BUILDER PERMIT) Page 1 of 1 Total Fees: $65.60 Total Receipts: $0.00 BLK 15 LOT SIZE 50.000 X If there is no permit package accessible on the job -site for inspectors to verify, there will be inspections... Re- incnActinn»._-- ...--- .---------- fee is $50.00, which must be paid in advance before calling fc This Permit is granted to the contractor or builder named above to construct the ordinances pertaining thereto and with the understanding that the work will be pert and approved by the proper municipal authorities. This Permit may be revoked at authorization. A further condition upon which this permit is granted is the understE ordinances and regulations pertaining to the work covered hereby whether shown by his agents, servants or employees. Signed: (INSPECTOR) In consideration of the issuance to me of this permit, I agree to perform the work with the plans, drawings, statements or specifications submitted to the proper auth myself, my agent, servants or employes. Signed: (Contractor or BRYON JOHN THOMAS PHONE: 305- 754 -6381 136 NE 101ST ST. MIAMI SHORES, FL 33138 SchwabOne DATE Z - ? -OZ PAYTOTHE a ORDER OF 213 3 -5/310 150 Charl>� Schwab PNC BANII, N.A. Philadelphia, PA �.,�_ FOR FA ∎14 P1A'fiT ✓► � ! ' ? __ — _"� 1:0 3 L00005 31: 70 2 68 7096 211' 20 2 L 3 ,o6 The Sunshine State UCENSE NUMBER T520-070-68-190-0 BRYON JOHN THOMAS " 138 NE 101 ST • MIAMI SHORES, FL 33138-0000 80111411kTE SEX HOT. REST. MORSE. 05-3048 M 6-04 ISSUED 04-1946 EXPIRES DUPLICATE 06-3042 1047-97 SAFE DRIVER V10070134 Operation of a motor vehicle constitutes consent to any sobriety test required by law. ELECTRICAL TYPE Minimum Fee QTY. TYPE Dryer QTY. TYPE Outlet, Appliance QTY. TYPE Service Repair QTY. A/C Central 1 -3 Ton Fan Outlet, Wall Service, Temporary A/C Central 4 -7 Ton Fire Pump Outlet, Switch Signs A/C Central 8 -15 Ton Fixture - Fluorescent Oven Space Heater (kw) A/C Central 16 -20 Ton Fixture Light Parking Lot Lights Spas/Hot Tubs A/C Central 20+ Ton Flood Lights Plugmold/Strip Subfeeds, No. of Amps A/C Window FPL - Load Central Posts Swim Pool, Commercial Air Conditioners Garbage Disposal Range/Range Top Swim Pool, Residential Chiller Generators, etc. Receptacles Switchboards Clear Violations Heat Recovery Refrigerator, Comm. (p/PH) Temp Serv., Construction Compactor Low -volt, Burglar Refrigerator, Domestic Temp for Test - 30 days Deep Freezer Low -volt, Fire Renew - Temp Service Water Closet Demolition Low -volt, Intercom/Teleph. Repair Circuits Water Heater Dishwasher Low -volt, Television Service, Number of Amps Water Heater New MECHANICAL TYPE Minimum Fee QTY. TYPE Condensate Drain QTY. 'TYPE Generator QTY. TYPE Refrigeration, Tons QTY. A/C Central, Tons Cooling Tower Heating Strips, each Vent Hood, Cost A/C Wall/Win. Tons Dryer Vents, Number of Paint Booth Ventilation, Cost Air Handler, Tons Ductwork, Cost of Piping, Flammable Liquid Periodic Inspections Barbecue Fire Sprinkler System Process/Pressure Piping Supply, AC Well Bath Fan - Vented, # Fireplaces, Number of Pressure Vessel Temporary Toilet PLUMBING TYPE • A/C Condensate QTY. TYPE Drains, Roof QTY. TYPE Miscellaneous Fixture QTY. TYPE Soakage Pit QTY. Bath Tub Drinking Fountain Miscellaneous Repairs Solar Water Heater Bidet Filter Replace Pool Piping Sprinkler Repair Cap - Fixture Fountain Pump and Abandon Sprinkler System Cap - Water Gas - Appliance Pump, Domestic Supply, AC Well Cap - Sewer Gas - Natural Pump, Fire Stand Temporary Toilet Catch Basin Gas - Propane Pump, Re- circulate Temporary Water Closet Clothes Washer Gas Piping Pump, Replace - Pool Urinal Dental Chair Grease Trap Pump, Sprinkler Utility - Sewer Discharge Well Ice Maker Pump, Sump Utility - Water Dishwasher Indirect Wastes Relay Repair Vacuum Pump Disposal Interceptor Roof Inlet Water Closet Domestic Well Laundry Tray Septic Connection Water Heater Drainfield, 4" Tile/Res. Lavatory Septic Tank Water Heater New Drains, Area Meter Set (Gas) Sewer Connection Water Re -pipe Drains, Floor Minimum Fee Shower Water Service Drains, French Miscellaneous Equipment Sink Well, Supply Page 3 PERMIT APPLICATION INSTRUCTIONS: Please indicate the type of work being performed and quantity(ies) in the space provided below. RECEIVED AND REVIEWED BY: DATE: SECTION BY ;37y . Zoning ar t Electrical Mechanical . Plumbing Fire Public Works Structural 4/ Building Official Page 4 OFFICE USE ONLY CI- IECKLIST ❑ OWNER - BUILDER FORM (Attach) ❑ FIRE DEPARTMENT APPROVAL (Commercial / multi- family) ❑ CONCURRENCY (New Construction) ❑ OTHER (Specify & Attach) ❑ PROOF OF OWNERSHIP (Attach) ❑ HRS / DERM APPROVAL (Septic / Sewer) ❑ IMPACT FEE (New Construction) ❑ OTHER (Specify & Attach) PERMIT FEES $3.00 per page (Scanning Fee) $ Miami Shores Village Bond Metropolitan Dade County (C.C.F.) Inspector State Educational Fund $ State DCA (Radon) $ Code Enforcement Fine Zoning Review $ 60 $ ,66 $ $ (sq.ft. = x/I000 x ¢.60) (¢.005 / sq.ft.) (¢.01 /sq.ft.) REVIEWED AND PREPARED BY: PERMIT APPLICATION ❑ CONDO ASSOCIATION APPROVAL (Attach) ❑ BPR APPROVAL (Restaurants) ❑ CONTRACTOR REGISTRATION (On File) DATE: CONDITION OF APPROVAL Revised July 2001 10050 N.E. 2" AVE., MIAMI SHORES, FL • (305) 795 -2207 • FAX (305) 756 -8972 • http : / /www.miamishoresvillage.com Date d s PERMIT APPLICATION FOR MIAMI SHORES VILLAGE (3 NC (O( St. Job Address Legal Description Historically Designated: Yes No K Owner/Lessee / Tenant 7 D r"I a S (Art (50 v► Master Permit # 37S7S Owner's Address Sa Phone e 5 7,1 6 8 Contracting Co. Address Qualifier SS# Phone Notary as to Owner and/or Condo President Date My Commission Expires: Tax Folio State # ` icii '\' 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 P a ' i f house 1 c Lt.4 d, n 5 Coo c !_c k ) Ct r4 c, e house- - o' r4 I€ sa 'fS co Gvv ; - c.)441-e, ; wr,,;c w tv r'w► - mo ss � re Square Ft. 2 Z U 0 ("cal Y C) d F Estimated Cost (value) 700 " G 1 /,, � r f a �S 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 Signature of Contractor or Owner- Builder Date Notary as to Contractor or Owner- Builder My Commission Expires: ,0P(ZY P(j OFFICIAL NOTARY SEAL 2 . SCOTT W DAVIS Sc " !t * COMMISSION NUMBER ,A.= III` %A c CC255237 � F MY COMMISSION EXP. •Of p O AN. 26 1997 FEES: PERMIT 7 RADON C.C.F. NOT � i� "" • I • I f‘,...„),err Building Electrical • S/z6 �SJ' Date APPROVED: Zoning Mechanical Plumbing Engineering BUILDING _LECTRICAL 'LUMBING tiOOFING Dwner of iuilding Irchi tect contractor )r Builder El .T- MIAMI SHORES VILLAGE. FLORIDA 0 � �..� DATF 195 ❑ PERMIT N° 6506 Contractor'$ License No. 4 ,egal Lot )escription Bl 'address of wilding 1 Work to be performed under this Permit 4 Subdi- vision Value of Project $ Ag Amount of Permit $ This permit is granted to the contractor or builder named above to construct the building or to install the equipment or device described in the application ierefor in strict compliance with all ordinances pertaining thereto and with the understanding that the work will be 'performed in compliance with any plans lrawings, statements or specifications that may have been submitted to and approved by the proper municipal authorities. This Permit may be revoked at any ime if the work is not done in compliance with such ordinances or if the plans are changed without authorization. A further condition upon which this permit is ;ranted is the understanding that the contractor or builder named above assumes the responsibility for a thorough knowledge of the ordinances and regulations Pertaining to the work covered hereby whether shown on the plans or drawings"'' or in the statements or specificat)ofts and that Ise assumes responsibility for work lone by his agents, servants or employees. ti Signed. BY;_G" INSPECTOR In consideration of the issuance to me of this permit I agree to perform the work covered b reunder in compliance with all ordinances and regulations 'ertaining thereto and in strict conformity with the plans, drawings, statements or specifications sugitted to the proper authorities of Miami Shores Village. In ac- -epting this permit I assume responsibility for all work done by either, myself, my agent, servant or employee. CONTRACTOR OR BUILDER BY AUTHORITY 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- 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. Street and Number where work is to be done Permit No Disapproved (Signed) Building nspector PLANNI Owner's Name and Address Registered Architect and /or Engineer Name and address of licensed contractor Location and legal description of lot to be built on: Lot Block Subdivision- -- �G J - State work to be done and purpose of building (by floors) 1_.e ' ) r+") New Building Remodeling Addition Repairs No. of Stories To be constructed of Kind of foundation Roof Covering Estimated Total cost of improvements $ ®a Amount of Permit $ 2. ' 0 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, Pennanent 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 ) - T wyt STATE OF FLORIDA, i COUNTY OF DADE. 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. ate Chairman Member Member Council Approved Date NOTE: A charge of $1.00 will be made for making the Planning Board. A re- inspection fee of $1.00 will be materials and /or workmanship. MIAMI SHORES VILLAGE BUILDING INSPECTION DEPARTMENT ?A4Q- (:)-7- No . Street it), foi-L 44 - 14 - 4.6.g BOARD DATE and for no other purpose. Date ft- — / 4 �) ead, Sworn o . d Subscribed before me. blic, State of Florida y Commission Expires Member Member Member Disapproved Date corrections or changes to this application after approval has been obtained from charged when such re- inspection is made necessary by improper notice for inspection or faulty MIAMI 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 build- ing or oilier 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 Law, cf the Statc. of Florida, all ordinances of Miami Shores Village and all rules and regulations of the Building Division of 'Miami Shore; E illage sh -1.1 be complied with, whether herein specified or not. A copy of approved plans and specifications must. be kepi at building during progress of the work. Date 5`� J , 19 Owner's Name and Address. No Street_..__ Registered Architect and /or Engineer.__ Name and address of licensed contractor. __. OThetri Location and legal description of lot to be built on: Lot_. __. Block._ ___ . Subdivision_ Street and Number where work is to be done _. 1 t State worly o be done and purpose of building (by floor Disapproved (Signed) Chairman Member . M e m b e r Council Approved lad 0 a Jl T 4,4,14/1 and for no over purpose. New Building Remodeling__ Addition _ ___ _.._.. __.. Repairs_. _ .. . _ No. of Stories To be constructed of Kind foundation Roof Cove ing_..... Estimated ; :tal cost of improvements $__.'4 a - Amount c` Permit $._._ ... _..� ---- PLANNING BOARD DATE Member ...__ _. Member Member _ -- _Date Disapproved _.. 6 Zone cubage required. __ .Plan Cubage__.__.. Distance to next nearest building__ ____ Size of Building Lot Maximum live load to be borne by each floor hereby submit all the plans and speciiications for said building. All notices with reference to the building and its construction may be sent to _ • The uncle e signed applicant for this building permit does hereby certify ilia he understands and accepts his obligations as an employer of labor under he Florida Workmen's Compensation Act, being S; rtion 5966, Compiled Ceneral Laws of Florida, Permanent Supplement. and h s complied w;th the provisions thereof, and will require similar comnliarice from all contractors or sub- contraetors emplo..-ed by hint in the wo k to be p rf :mimed under this permit: and will post or cause to he posted for in- ection on the site of the work such public noti• e or i,otiees as are required by the Act. The uadtrsigned agrees to employ only such sub t ..etors, on work to perforn,'.d/trgder this permit as are licensed. by M - am. Shores \ illage. i f ,� Remarks-- (Signed ). / I W , STATE OF FLORIDA, COUNTY OF DADE. 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 th abov. described destruction. t:,.t h, has careially read the for Ding application, and that he did sign the same, and that all facts therein by him stated are tr re. Permit No _ .._. __ Date._ __.. _ t i t � Read, Sworn to and Subscribed before me. Notary Public State of Florida My Com:nission Expires_ Date NOTE: A charge of $1.00 will be made for making corrections or changes to this application aft.-r approval L is been obtained from the Planning Board. A re- inspection fee of $1.00 will be charged when such re- inspection is m.: le necessary by improper notice fc•r inspeyton or linity materials and /or workmanship. Remarks STATE OF FLORIDA, COUNTY OF DADE. ss. Disapproved Date (Signed) MIAMI 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 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 Registered Architect and /or Engineer Name and address of licensed contractor Location and legal description of lot to be built on: Lot Block Subdivision_ C 9z c' Date_l-_ &V / G / , 19 V C( No._ ' Street_AtE / Ol a4T Street and Number where work is to be done__ State work to be done and purpose of building (by floors) !e��' -k�- n l � and for no other purpose. New Building Remodeling Addition Repairs No. of Stories To be constructed of Kind of foundatioh____., Roof Covering Estimated Total cost of improvements $_ - _e '.- 4� i / 0 Amount of Permit $ Zone cubage required .Plan Cubage Distance to next nearest building Size of Building Lot Maximum live load to be borne by each floor ( Signed ) 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, 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 w rk such public notice or notices as are required by the Act. The undersigned agrees to employ only such sub ntra s, o wor to p'erfo ed under this permit, as are licensed by Miami Shores Village. 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 catOully 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. Notary Public, State of Florida Building Inspector 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 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. BUILDING ELECTRICAL PLUMBING Owner of Building PERMIT N° 7264 to�'lie per Architect /4) Contractor (' ? Legal Lot Description Address of � s r Building MIAMI SHORES VILLAGE, FLORIDA / DATE 194 f med under this Permit Bl. Subdi- vision Contractor's c:3- ^ C) ( 5) License No • 7 AxSo awn. Value of, Amt. of; f Project + Permit (..]/. This permit is granted to the contractor or builder named above to construct the building or to install the equipment or'device described in the appli- cation herefor in strict compliance with all ordinances pertaining thereto and with the understanding that the work will be performed in compliance with any plans, drawings, statements or specifications that may have been submitted to and approved by the proper municipal authorities. This Permit may be revoked at any time if the work is not done in compliance with such ordinances or if the plans are changed without authorization. A further condition upon which this permit is granted is the understanding that the contractor or builder named above assumetlre responsibility for a thorou knowledge of the ordinances and regulations pertaining to the work covered hereby whether shown on the plans orllrawings or in s tements or sp ' mations and that h6 assumes respon- • sibility for work done by his agents, servants or employees. �� / + 1 / ., i � , y � t . Sig / / INSPECTOR a By ✓� ' d In consideration of the issuance to me of this permit I agree to perform the work covered hereunder in compliance with all ordinances and regulations pertaining ereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In ac g pe t I 40,ime r all work done by either myself, my agent, servant or employee. Cor TRACTOR OR BUILDER BY AUTHORITY