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230 NE 100 St (10)p nspection Number: INSP -5421 Inspection Date: 01106/2006 Inspector: Inspector, Default Owner: BENTON, THOMAS Job Address: 230 100 Street NE Project: <NONE> Contractor: Building Department Comments Friday, March 31, 2006 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Pte: (305)795 -2204 Fax: (305)756 -8972 CL Miami Shores Village, FL 33138- Block: Permit Number: PT- 1 -06 -52 Permit Type: Paint Inspection Type: Final Work Classification: New Phone Number Parcel Number 1132060134480 Lot: Passed y i Failed Correction Needed Re- Inspection Fee I I ($75) No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments Page 2 of 2 BUILDING PERMIT APPLICATION FBC 2001 Permit Type (circle): Owner's Name (Fee Simple Tit Owner's Address City ` i 4P''1 Tenant/Lessee Name SUen Contractor's Company Name Contractor's Address Total Fee Now Due $ (Continued on opposite side) 23 0 Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 Job Address (where the work is being done) 230 fV Ls / o p s State ( Zip 3 ';/• City Miami Shores Village County Miami -Dade Is Building Historically Designated YES NO X Electrical Plumbing Mechanical Roofing ov-k bt" 0 Phone # tvK /005 r /A OW i tg Phone # City State Zip Qualifier State Certificate or Registration No. Certificate of Competency No. Architect/Engineer's Name (if applicable) Phone # $ Value of Work For this Permit X 2 5O o� Type of Work: ❑Addition ❑Alteration Describe Work: /o4 1A) ❑New (02., .(JClet 33Yc1 Permit No. PP 1 -0(0 ' 5 Master Permit No. Phone # 3or.- ? 9f" Z zc? Zip 33/5? Square Footage Of Work: * * * * * * * * * * * * * * * * * * * * * * * * * * ** Fees * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** ❑ Repair/Replace ❑ Demolition Submittal Fee $ Permit Fee $ 40.00 CCF $ I 6 0 C /CC Notary $ Training/Education Fee $ ' 2,0 Technology Fee $ 1 ` -SCE Scanning $ Radon $ Zoning Bond $ Code Enforcement $ Structural Plan Review. $ Bonding Company's Name (if applicable) Bonding Company's Address City State Zip Mortgage Lender's Name (if applicable) Mortgage Lender's Address City State Zip Application is hereby made to obtain a permit to do the work and installations as indicated. 1 certify that no work or installation has commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRICAL WORK, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and AIR CONDITIONERS, ETC 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. "WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT 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." Notice to Applicant: As a condition to the issuance of a building permit with an estimated value exceeding $2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. Signature Owner or Agent The foregoing instrument was acknowledged before me this day o who is personall 2006 , by IOM 1 own to me or who has produced As identification and who did take an oath. as identification and who did take an oath. NOTARY PUBLIC: ��yy���� /' NOT PUBLIC: Sign: X (,6aQ [ (..t . Sign: Print: r 4, Com p Print: MY • My Comm ion DD178470 My Commission Expires: 1 - Expires March 29, 2006 Signature Contractor The foregoing instrument was acknowledged before me this day of , 20 , by who is personally known to me or who has produced My Commission Expires: APPLICATION APPROVED BY: f le Plans Examiner Engineer Zoning Chc 05/13/03 Date Miami Shores Village Paint Color Approval and Agreement Ori le Owner's Name f T Owner's Address Z 3 ° �(f JOD City ri r qr+' S trig.f J State fl Job Address (where the work is being done) 5/0V City Miami Shores Village County Miami-Dade is Building Historically Designated YES NO Name if applicable) �TA Phone # Contractor's Company (� PP � � ***************************************************************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** All elements on the site must be listed and indicate the color to be painted Walls V f ilo fr.) Fascia {tiji" Drip Cap /drip Edge 4.;r4 r fv Soffit h' /A Roof Flower bins Shutters Awnings Chimney Doors and door jamsr Garage doors Railings Fences Decorative metal All brick (simulated or regular) Stucco banding Any other stucco features Accessory Buildings Other ***************************************************************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** 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. Signature APPLICATION APPROVED BY: rfi Owner or Agent P& Z Official Phone # Zip P/' Zip 7r- 2207 Attach Color Samples Date /".- ( -DG Date chc 6/18/03 • BUILDING pa P uMe i�� ` ° o PERMIT ROOFING ❑ 0 Owner of Building k Architect Contractor or Builder dy f Legal Lot Description Address of Building CONTRACTOR or BUILDER MIAMI SHORES VILLAGE, FLORIDA Date Contractor's License No. Work to be performed under this Permit Subdi- visionr. ��, � Sq. Ft.: Value of Project $ Permit: CCF: Notary: Bond: Radon: Amount of r " Permit: ° ='y 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 applica- tion 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 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 specifications and that he assumes respon- sibility for work done by his agents, servants or employees. Signed • (INSPECTOR) BY In consideration of the issuance to me of this permit I agree to perform the work covered hereunder in compliance with all ordinances and regulation: 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 responsibility for all work done by either, myself, my agent, servant or employee. BY AUTHORITY PERMIT APPLICATION FOR MIAMI SHORES VILLA4 Date 7 /17 /iXt Job Address o�3O t&E (OOH'^ 54- Tax Folio ( l 3a0 kO O l7 Legal Description Historically Designated: Yes / Tenant TOM l ei1,6YN Master Permit # I f 7/53 Owner's Address 3.30 14,E 1.00 Skrej Phone (3 (M) 75 t - 108q Contracting Co. 1) (Pt 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 Po tr - HnCse & Y1(Sl Square Ft. Estimated Cost (value) g 3 v 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. A or Co '+; GLA � -, VILLAR • • ate s' NOTARY Pl3B LIC STATE OF FLORIDA COMMISSION NO. CC714103 MY COMMISSION EXP. MAR. 1 002 er an Signature of Notary as to My Commission Expir er and/or Condo President FEES: PERMIT (0 RADON APPROVED: 7 // 8/ Building Zo Mechanical Paull oo) A4:,7 e. 7 ez Plumbing '7- / Date Signature of Contractor or Owner- Builder Date C.C.F. ov 1/B Notary as to Contractor or Owner - Builder Date My Commission Expires: NOTARY 3 BOND TOTAL DUE Structural Engineer L 304 BUILDING ,® MIAMI SHORES VILLAGE FLORIDA Date j 19! PLUMBING ` 0 PERMIT 4 4 4 4 Contractor's License No. ROOFING ❑ ❑ Work to be performed under this Permit Owner of Building :s/ ro `. Architect Contractor or Builder I l Description Address of Building Lot W s �4Ai A.� CONTRACTOR or BUILDER B1. Subdi- vision Sq. Ft.: Value of Project $ 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 applica- tion 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 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 specifications and that he assumes respon- sibility for work done by his agents, servants or employees. ;;' Signed• '• (INSPECTOR) BY 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 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 1 assume responsibility for all work done by either, myself, my agent, servant or employee. BY AUTHORITY Permit: CCF: Notary: Bond: •�^ Radon: Amount of Permit: ' i - PERMIT APPLICATION FOR MIAMI SHORES VILLAGE 3 - 2 ' �Y9 230 /00 sf Date Job A ddress Tax Folio Legal Description Historically Designated: Yes No ' Owner/Lessee / Tenant O r i 0 S 3 e r\ t O c1 Master Permit # 4 7 1/ N Owner's Address a 3 0 1-1E-- / 00 STf"e eT Phone Contracting Co. 0 \Al n e r 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 lock I n - r ro &r- \A-? t e.. Po( e-e to r i o r 0F V1 f U S e. Square Ft. Estimated Cost (value) S OO, 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 APPROVED: Zoning Building f Date gna ctor or Owner - Builder fo v‘l�n 17�P �'eS care �l eayt Si e of Contra -p7 Notary as to Owner and/or Condo President Date Notary as to Con My Commission Expires: My Commissieu n y,s OFFICIAL NOTARY SEAL 0 0 u 0 S MARGARITA MORtIEL 1 r .v: U' pr 74, t MY COMMVBSION EXPIRES QF p DE0 2002 FEES: PERMIT 4 RADON C.C.F. • 4' NOTARY .S * OOMMS ON NUMBER CC797277 Electrical or or Owner - Builder Date "5 z y7y Date BOND TOTAL DUE 4 3 7 6 d Mechanical Plumbing Structural Engineer • BUILDING MIAMI SHORES VILLAGE, FLORIDA , Date PLUMBING ❑ PERMIT N2 3232 Contractor's ROOFING ❑ License No. A . ❑ Work to be performed under this Permit i / . ' Owner of Building / ./. Architect Contractor or Builder Legal Description Address of Building r a h Lot , " - (1 A /// mil 131 "'/ 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 applica- tion herefor in strict compliance with all ordinances pertaining thereto and with the understanding that the work will be g g performed in compliance with any W 1 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 assumes the responsibility for a thorough knowledge of the ordinances and regulations pertaining to the work covered hereby whethe[ shown on the plans or drawings or in the statements or specifications and that he assumes respon- sibility for work done by his agents, servants or employees: , _ Subdi- vision Sq. Ft. Value of Project .rya / /Q/ , da (J Amount of r 1 %� 7 , (1 Permit $ Signed • (INSPECTOR) BY 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 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 assume responsibility for all work done by either, myself, my agent, servant or employee. CONTRACTOR or BUILDER BY AUTHORITY GFN1_`Kr\L ACKNOWLEDGEMENT - 1NDIVIDUAL(S) FL -161 State of Florida County of b NOTARY PUBLIC SEAL OF OFFICE: OPTIONAL INFORMATION: T∎ pc of Document: Number of Pages: Number of Signatures Notarized: On this the day of ti ALL -(-} the undersignecNotary PHblic th State of Florida, personally appeared IName(s) of individual(s) who appeared before notaryl and whose name(s) is /are subscribed to the within instrument, and he /she/ they acknowledge that he /she /they executed it. WITNESS my hand and official seal. 199 before me,. NOTARY PUBLIC, STATE OF FLORIDA Rotary Public, State of Florida T ���Jp l ommissios Exx pires Sept. 12, 1991 d 7b• T•�y F ain - Inruronco Inc. Name of Nolary Public: Print, Stamp, or Tylx as Comtnisstoned. _ Personally known to me, or U Produced identification - (Type of Identification Produced) 1.7 DID take an oath, or 1'1 DID NOT take an oath. Legal Description g4 .PERMIT APPLICATION FOR MUNICIPALITIES OF DADE COUNTY Signature of owner and /or Condo President APPROVED: Fire (OWNER TO RETAIN COPY) �/ 2 3 0 Ale" /do f // I.4% /3 /74/1709 Date �" - % 2 Job Address T ax F olio heee/i4/0) / Lessee / Tenant - e Master Permit #'c2' Owner's Address 'Igo ivil /1/ Phone Contracting Co. OWwT Address Qualifier SS# - - Phone State 00 Municipal 0 Competency 0 Ins.Co. Architect /Engineer Address Bonding Company Address Mortgagor Address Permit Type(circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING PENCE SIGN WORK DESCRIPTION ( /tgA eye -- tx ;1, Jr Square Ft. Estimated Cost(value) kn ± 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. Date: Date: Zoning Building Mechanical Plumbing_ Signature of 'Owner - Builder Notary as to Owner and /or Condo President Notary as to Eentrectet=or Owner- Budder My Commission Expires: My Commission Expires: Notary Pub9Ec, State of Florida ** * * * * * * * * * * CV Com lissiow Enp rc4 Sept. I2, 1993 � Bonded T *u Troy Fain *nsuronce Inc* FEES: PERMIT 4 h RADON C.C.F. �` 'NOTA114 TOTAL DUE yA) Other Electrical Y� Engineering Issue Date: 1/6/2006 Owner's Name: THOMAS BENTON Permit Type: Paint Work Classification: New Job Address: 230 100 Street NE Comments: PAINT Additional Information Miami Shores Village, FL 33138- Building Department File Copy Applicant Signature Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL 33138 -0000 Phone: (305)795 -2204 Fax: (305)756 -8972 Permit Expires: 01/06/2007 Contractor(s) Phone Primary Contractor Type of Work: Exterior Color: YELLOW Additional Info: 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 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 responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are required for ELECTRICAL, PLUMBING, MECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work. OWNERS 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. Futhermore, I authorize the above -named contractor to do the work stated. Parcel #: 1132060134480 Block: Lot: Section: PB: Total Square Feet: Total Valuation: Re • uired Ins • ections Final Permit Status: APPROVED Permit Number: PT- 1 -06 -52 Phone: 0 $ 250.00 Fees Due Amount CCF $0.60 Education Surcharge $0.20 Permit Fee $60.00 Technology Fee $1.50 Total: $62.30 Invoice Number PT -1 -06 -23360 Total: Amt Due $62.30 Amt Paid $62.30 $62.30 NOTICE: In addition to the requirements of this permit, there may be additional restrictions applicable to this property that may be found in the public records of this county. AND THERE MAY BE ADDITIONAL PERMITS REQUIRED FROM OTHER GOVERNMENTAL ENTITIES SUCH AS WATER MANAGEMENT DISTRICTS, STATE AGENCIES, OR FEDERAL AGENCIES. Friday, January 6, 2006 Date 01/06/2006 Permit Receipt Permit Number: PT- 1 -06 -52 Invoice Number: PT -1 -06 -23360 Applicant: THOMAS BENTON Company Name: Payment Type CheckNum Amount Check 3389 $62.30 Total Payment: $62.30 Page 1 of 1 BUILDING ELECTRICAL PLUMBING Owner of Building Architect Contractor ., or Builder • Legal Lot 1 Work to be performed under this Permit/ MIAMI SHORES VILLAGE, FLORI DATE 194 PERMIT N9 3007 *IA - .. .. w it Bl. Subdi- vision that he assumes responsibility for work done by his agents, servants or employees. Contractor's License No. Amt. of Permit Description Address of . - a' + 44, '' Value of . eI !f'� Projectfl'i „r Building r- s ' 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 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 assumes tite 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 specifications and 0 , .,....rte+ Signed• ...- By INSPECTOR In consideration of the issuance to me of this permit I agree to perform the work covered hereunder in compliance with all ordinances and regula- tions 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 1 assume responsibility for all work done by either myself, my agent, servant or employee. . -'' f CONTRACTOR OR BUILDER BY AUTHORITY 0 J Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the building 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 ' Shores Village and all rules and regula- tions of the Building Division of Miami Shores Village shall be complied with, whether rein s• cified or not. A copy of approved plans and specifications must be kept at building during progress of the work. a4 1 Stree Owner's Name and Address Registered Architect and /or Engineer Name and address of licensed contractor Distance to next nearest building Disapproved (Signed) MIAMI SHORES VILLAGE APPLICATION FOR BUILDING PERMIT Location and legal description of lot to be built on: Lot Block_____ _,.___ Subdivision Street and Number where work is to be done State work to be do ajtd purpose of building (by 11 and for no other purpose. New Building __________________________ Remodeling_____________ Addition_____ Repairs No. of Stories____________ To be constructed of_W__— ________ Kind of foundation___________________ Roof Covering_ Estimated Total cost of improvements $ __Amount of Permit $ Zone cubage required Plan Cubage 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. 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 sub s outrac 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 notary public, duly authorized to administer oaths and take acknowledgments, personally appeared and who, being by me first duly sworn, upon oath deposes and says that he is the of the above described construction, that h carefully read the foregoing application, and that he did sign the same, and that all facts therein by him tateed are true. - Permit No SL Date end, Sworn to and Subscribed before me. Building Inspector f PLANNI ' BOARD BUILDING INSPECTION DEPARTMENT Chairman Member Member Council Approved Notary Public, State of Florida My Commission Expires_ DATE Member Member Member Date Disapproved 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. to me well known, _Date 4 1 .. 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 building 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 regula- tions 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 �� �% ' ___..t' No �•�-� ��� Street y Registered Architect and /or Engineer Name and address of licensed contractor Location and legal description of lot to be built on: Lot_ Block Subdivision Street and Number where work is to be done State work to be doh and purpose of building (by floors) and for no other purpose. New Building Remodeling______________ Addition_____ _ - -_ Repairs No. of Stories___________ To be constructed of_—_ — Kind of foundation Roof Covering_ — Estimated Total cost of improvements $ __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 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 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. Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeared 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 Disapproved Date (Signed) t Building Inspector 'Read, Sworn to and Subscribed before me. Notary Public, State of Florida My Commission Expires PLANNING BOARD DATE Chairman Member _ Member Member _ Member Member Council Approved Date Disapproved 10 1 \ to me well known, 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.