1401 NE 101 St (10)Date
Sig
Dat
ure
Notary a 4o
My Commission Expires:
**
FEES: PERMI
APPROVED:
Zoning
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Job Address /140( NE 1 o 1\S7-
Legal Description S l , n31t {"Ot,'rh I c_S
Lessee / Tenant 8610 V t Cl∎ e
Owner's Address 1 ' ( Mt-:7101.7
Contracting Co. LrtR c rCDrci
Qualifier R oet � l_in ('IS T
State #CAGOI.0 (/ (Municipal #
Architect /Engineer
Bonding Company
Mortgagor
Permit Type(circle one): BUILDING ELECTRICAL PLUMBING ROOFING PAVING FENCE SIGN
WORK DESCRIPTION / = L . „`, f •r
p
Square Ft. Estimated Cost(value) �
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 regulatin onst ctio -nd ironing. Furthermore, I
authorize the above -named contractor to do the work sta
l' C'y
... a.,_ and/ S d es
MY CO SION #�CC7a1112 E gent
,.,
- o
14 k
er and /or Condo President
Mechanical
May 24, 2002
BONDED THRU TROY FAIN INSURANCE, INC
RADON C.C.F. �
Plumbing
D
Tax Folio
Master Permit it 4 g g
Phone 3 - 5 -2 - - f 0
(0. Address (2.0 . L c &.1330 calm
p �
ssrr Phone .`30 S -6 0 66 s-. C 3 r �f
Competency # Ins .Co . Kcit l etel 1 .
Address
Address
Address
lr
ti tt
•I 1.4'.
Signatur
4 for or Owner- Builder
Nota Contrac •r or Owner Builder
My �' on Expie � nz
.: MY COMMISSION # CC
• Febmary 14, 2003
* * * * * * as k; ){i F;2+k BONBCV4RUITROY Filitl INSURANCE.ANC
*
**
NOTARY TOTAL DUE
Fire Other
Building Electrical
Engineering
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 / 7-64 il, / LJD/ NJ -,1/1 s v- No Street
Registered Architect and /or Engineer
and address of licensed contractor v — tea L..9 &)9S Sys 'r�.!_f?___ - 4 / &' / ?5 "" -3.7—
Location and legal description of lot to be built on:
Lot Block Subdivision
Street and Number where work is to be done /q 4) & !01 S P-
State work to be done and purpose of building (by floors) ' ...- / 1) 5 ?/QL L ,S 70 AI (A 1T/P/99
&A f!e,E_ ,/5 C- ➢ /mod, O ov 491-1) /z /e/z/ 9'
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
Size of Building Lot
PL ING BOARD
_Date
Date________ 2 L 19 9 0
Distance to next nearest building
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 inspectio the site of the work s public notice
or notices as are required by the Act. The undersigned agrees to employ only such subcontr - ors on work to be pe rmed 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 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.
Permit No / / '( Date Read, Sworn to and Subscribed before me.
Disapproved _._ / Date
(Signed) L:!7/ !:�
Buil. mg Inspector My Commission Expires
Notary Public, State of Florida
DATE
Chairman Member
Member Member
Member Member
Council Approved Disapproved Date
NOTE: A charge of $1.00 will be made for making corrections or Chang s 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.
April 13,1970
TO WHOM IT MAY CONCERN:
I hereby give permission for Peoples Gas System Inc
to install an Air Conditioning unit outside the Premises
of 1401 N.E. 101 Street. Miami Shores, Fla.,
10151 N.E. 14th Ave
Miami Shores, Fla.,