1411 NE 101 St (3)Date
Type Insp'n
Permit No.
Name
MIAMI SHORES VILLAGE
BUILDING DEPARTMENT
305- 795 -2204
Building Inspection Request
Address 1 f L / n/\-•
Compa x
Phone # 3 0 S- 9 )° 6
/ O
For Inspect(;r) / Name & Date
Correction
Re- Insp'n Fee
c,
f,
CONTRACTOR
Name
0...A41....
- Name
CA Awl ll"ri✓ee e.O•r/7ndoCt-,
Home Telephone 3 j 7 S 4 /— I g? t
License No.
Alteration Exterior
Address
32.26) vv .4 S s 7 , `e:,-,
'
Telephone/ /'V /i Fay 0 S ) " 9 .1 3 IN
b
Qualifier Name . r i 4, (��► a ft ?D
PROPERTY OWNER
Name
0...A41....
t
Address s
ILi 11 ) o I 5 r.
Home Telephone 3 j 7 S 4 /— I g? t
Business Telephone
Alteration Exterior
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 he 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 submitted
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.
A PPLICATION
Job Address:
Folio Number
PERMIT TYPE (✓ )
Building
Electrical
Mechanical
Plumbing
LPGX
Roofing
Fence
Other
HI/ vg Misr
Address
Apt.
Lot Block
Subdivision PB PG
Current Use of Property
Proposed Use of Property
Tenant Information
PERMIT CHANGE (✓ )
Chg. Contractor
Renewal
Revision
Extension
Supplement
Reinspection
ARCHITECT
Name
License No.
Address
Telephone
Fax
Master Permit No.
City State
15) • O /'
PERMIT APPLICATION
Subsidiary Permit No.
3yi
Zip
,Description of Work 1/) 2 ,e,„vce 5 'ea,
Linear Feet
Zoning
Square Feet
)(Value of Work
Tax Assessed/Appraised Value
Flood Zone Base Floor Elev.
1 g5o a tno Floors
Bldg Value
ENGINEER
Name
License No.
Address
Telephone
Fax
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.
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.
STAT,)dF FLORID
AT� Y OF MIAM -DADS STATE OF FLORIDA, COUNTY OF MIAMI -DADE
l �� V
Signature of Owner
o LAI)
0 -
,..li Ai .!i
Signatur of Now1'+ blic - ` .te of .rida
SEAL: c ':. AUp, A; :: - . . et
Personally known - GF F OR, Prodneed°Id"entification
T y p e of Identification Produced —49k ( 0 f ' DE , 3S . 3S/ . 0
Personally known
PERMIT APPLICATION
Signature of Contractor / Qu tfier
6 7A C 11 4 - t
Print Name � //
Sworn ,��,
,``to and subscribed before me this Co* day of
oc ) I
/Ii.�/
d .. i./! ./ /:: � /r' fit
Signature of Notary Public - �`` F �1 A fl'iAr V ZEAL
\\! ,p p /6 r BARBARA Al N FUGAZI
SEAL: � 3 cC1.u.YISSlON NUMBER a CC723�
: G e V CZ3i�A�, ^,f 90,JEXPif ES
4c
Type of Identification Produced: 0I (/V �41 KVF 1l
ELECTRICAL
TYPE
Minimum Fee
QTY.
TYPE
Dryer
QTY.
TVl'i;
Outlet, Appliance
QT1'.
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
PLUMBING
TYPE
A/C Condensate
QTY.
TYPE.
Drains, Roof
QTY.
"1'1'1'E
Miscellaneous Fixture
QTV.
"1'1'1'1:
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
RECEIVED AND REVIEWED BY:
PERMIT APPLICATION
INSTRUCTIONS: Please indicate the type of work being performed and quantity(ies) in the space provided below.
MECHANICAL
TYPE
Minimum Fee
A/C Central, Tons
A/C Wall/Win. Tons
Air Handler, Tons
Barbecue
Bath Fan - Vented, #
QTY. TYPE
ME
Condensate Drain
Cooling Tower
Dryer Vents, Number of
Ductwork, Cost of
Fire Sprinkler System
Fireplaces, Number of
QTY. TVI'E
INI
Generator
Heating Strips, each
Paint Booth
Piping, Flammable Liquid
Process/Pressure Piping
Pressure Vessel
QTY. TYPE
Refrigeration, Tons
Vent Hood, Cost
Ventilation, Cost
Periodic Inspections
QTY.
DATE:
SECTION
BY
DATE
/c2//// d f
Zoning
�P 41 y
Electrical
Mechanical
Plumbing
Fire
Public Works
Structural
/ �,
1 `"I e,-2.
Building Official
'
Page 4
OFFICE USE ONLY
rCIIEC I<1I ST
• OWNER - BUILDER FORM
(Attach)
U FIRE DEPARTMENT
APPROVAL (Commercial /
multi- family)
® CONCURRENCY
(New Construction)
LI OTHER
(Specify & Attach)
PERMIT FEES
$3.00 per page (Scanning Fee)
Miami Shores Village
Bond
Metropolitan Dade County (C.C.F.) $ (sq.ft. = x/1000
x ¢.60)
Inspector State Educational Fund
State DCA (Radon)
Code Enforcement Fine
Zoning Review
U PROOF OF OWNERSHIP
(Attach)
® HRS / DERM APPROVAL
(Septic / Sewer)
El IMPACT FEE
(New Construction)
LI OTHER
(Specify & Attach)
$ (¢.005 /sq.ft.)
$ (¢.01 /sq.ft.)
REVIEWED AND PREPARED BY:
PERMIT APPLICATION
la CONDO ASSOCIATION APPROVAL
(Attach)
BPR APPROVAL (Restaurants)
LI CONTRACTOR REGISTRATION
(On File)
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
DATE:
Look for: blue background oil the front of This check, rind the hnagoSnfu logo on I)O(k. 11 not present, do n cat..sh.
MiZIE:FlarDS:7■271111111STIMI
PAY
TO THE L //
ORDER OF b i c I 04 s
NaiionsBank
Nntiotisllnnk, N.A.
ACH FUT 063F547
re/2 /`.'L J (` 'o A A.,42 •
FOR
GATOR FENCE CONTRACTOR CORP.
305- 691 -1600
01 -99
DATE
2_0
P,/ 1 3/2- 00 / 6
r Da
n'00 L 3 9 9ii' I:0 6 30000 4 7i: 00306055819 Lo
I $ 6"e( Zo
DOLLARS
1399
63-4/630 FL
1229
Ircluelood
L),;\fl:
1)R1`. I., NO
pi ° v
I
4 Ca
e �
v
0
• P.ROPERTY OF: Per iberq,
'IN;(-! yalill embossed
•. •O ••• • • • •.
• • • .. ..
• .• • •
• • •
• ••• • • •
t / ' O7 / -" r • -r
•
•
• d XII • .■•• ?., . 1 t Ni •ti .,,
•
.. •. • i 1 wA• \ v °" L _ o ,• . )• i /mod
•
1 `` , . 1 I ry
,\ )././' *A\ • . 0.7-.; -7
. �1 i
•
_� _ _ .r3iit... '•r•••
•
•• • •
••
Int HEREIN DESCRIBED
SITUATED IN ION
•
ti
1
• , !.I `...! 0 v � �'L ► •
J.7 r
3 k �i 1
V.
t� ii . , 6� Ike,
-- 4.. TO,• kr' , u
• -.. t, .L ., s \C-‘ „: t•1 - \
•/ , „ 1' ,..✓
i
y ,
e
; (1,3 2 4 4,f?
G �a� • 5. ;•
L
ul
/r_
/
NOTE : Underground encroachments,
.if any, not located.
Arnold N. & '1'rur
A 13OUNDARY SURVEY
I hereby centfy that the survey repre-
sented hereon meets the minimum
technical standard% set forth by the
Huard of land Surveyors pursuant to
Section 472.0? la. Statuujt. There are
nuencro , ents.overl s, easements
appear on the PI . other than as
sho% hereto. ,
77/
•
I! kt'K . tanJ'Sune;ut Noo.
•• •
• A••
,t
•. . •
• .• •,:
• •::i••
::,••
• •4 • •t• •
TO UE
„ ti\
1
Are-' 6(4 Z" \fi . '---
,�. , - is •
�± --'
9,�', ( � 44. • ' . �
- I 5
1X11.1. N:E. I01st: Si : r.et_!i- ;•iiruwi SIldr:e
�
L A N N•E S and CARCIA, 1' IIt N,'C. 1cla .
ENGINEERS - LAND SURVEYORS - LAND PL»\NNERS
Office address :: 4080 S.W. 84th Avenue, Miami, Florida 33155
Mailing address: P.O. Hox.561131, Miami. Florida 33156
;
property . descried as
Lot 13, Block 3,
RL:PLAT OF TRACT A OF MIAMI
SHORES BAY PARK ES'i
according to thu Plat
thereof, as recorded in
Plat Hook 56, Pago 86
of the Public Records. of
Dade County, Florida.
1
1
5'-0' MAX
21-0"
• • •• • •
•• • •• •••
••
• • • • • • • • • • • • •
WOOD • rrNVES : • :•
'i •• • • • ••• ••• • •
• • • • • • • • • • •
• •
•
• •
• • • • • • • • •
••• ••• ••• ••• • • • • •••
Owner's Side
Concrete
Iri / 4° °II
L =II
1_II 4 ° ° 111-
-1= a _I =11
1 =111 ° ° ° 11=
.I =1 11 =11
_ _� —III a a _III_
_11111 a
HIE 11 1 =1I1= ° 4
1=I 1= • - II =III III - I.I
1 -1 I I -I I - I I - I I - I -
- III III - III - I I - III - I
▪ • •
'4" X 4" WoOCI•POSi :
•••• • •
•• • •
/ 211 X 4" Ward dad
1 "X6 "or 1 "X8"
Wood P Ickets
Concurred
•• •••.
•....
••• ••
•
••• •
• •
• •
•••
•
• • • • • • •
Wood Posts
2915 Fences
4' -0" High or Less = 6' -0" O.C.
5' -0" High or Less = 5' -0" O.C.
2915.1 Wood fences, so located on a property
that by zoning regulations they cannot be used
as a wall of a building, shall be constructed to
meet the following minirnum specifications.
(a) Fences not exceeding 5 feet in
height shell be constructed to meet
the following minimum
requirements: from nominal 4 inch
by 4 inch by 8 feet -0 inch long
posts spaced 5 fee inches on
centers, leaving a fiber stress of
1200 p.s.i. in bendinc., and shall be
embedded 2 feet -0 inches into a
concrete footing 1 fcot -0 inches in
diameter and 3 feet -0 inches deep.
Other components shall be
designed to comply with the
provisions of this Chapter and
Chapter 23.
(b) Fences not exceeding 5 feet and 4
feet in height respectively shall be
constructed as provided in
paragrap!i 2915.1 (a) herein,
except that the spacing of posts
may be increased to 5 feet -0
inches and 6 feet -0 inches on
centers for these heights.
performed on
76
(date of survey)
?7haini SIzorp ? i ' /&tr
C`\
C7 pL o,-FictAL ,o) MAY VIAL
,I' '9e ANGELA M BECit�R
Z r,-,-;:r1 i 0 OOkee SiG:t AUR?EE
C !'.11 'fig. .z G 4... o t: 7 c
GFr-
STATE OF FLORIDA)
COUNTY OF DARE) nn
The undersigned Affiant, l�2rJ�L �' , does hereby attest that the
(property owner)
attached survey, performed by �"' Nc� A i L
(name of surveyor's company)
, is an accurate representation of the existing conditions and
locations of all structures on the property as of this date.
The purpose of this Affidavit is to induce Miami Shores Village to issue a building permit for the
property without first providing a survey less than six (6) months old. The Affiant, as property owner, further
agrees to remove or obtain permits for any structures which now may exist on the property which are not
permitted or which may violate zoning or building code regulations. The Affiant further understands that the
existence of any such structures may affect final inspections as applicable to this or other permits..
Further, Affiant sayeth naught.
a—Q-4e
Affiant/Property owner
Witness(sign and print) Witness(sign and print)
SWORN TO AND SUBSCRIBED before me this day of (! 0
Affiant is personally known to me, produced- RDId'1.41 ' 0)4 , 35 3g/ • (as identification.
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 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
Permit No.
Disapproved
(Signed)
/3
Block
MIAMI SHORES VILLAGE 97
BUILDING INSPECTION DEPARTMENT
APPLICATION FOR BUILDING PERMIT
Street and Number where work is to be done / y / r
1/State work to be done and purpose of building (by floors). state exterior colors (submit samples)
New Building Remodeling
J ` Date
Building Inspector
Date VA
No. T Street
19
`7'I /D / S�
Subdivision " � ✓N L-L,/ / � 3 �O 02 pyDO
m e io' Sfi
C►M000 WOUVJal hd f2�,ly C u UtaiK- C-FJJ (6 hub NCk-`p(. 1�4 S c ..- 1,11k and for no other purpose.
Addition Repairs No. of Stories
To be constructed of Kind of foundation Roof Covering
'/ Total cost of improvements S SO- 00
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 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 obligatons 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 ages to employ only sycl subcontractors. on work to be performed
under this permit. as are licensed by Miami Shores Village.
Remarks (Signed) (_)_4,4,0 /2.1U9-4-1:1
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
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.
Date
Amount of Permit S
iC/ 1
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 Date
NOTE: A charge of $25.00 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 $25.00 will be charged when such re- inspection is made necessary by improper notice for inspection or faulty materials and /or workmanship.
4a , _71-7 b
View
-Croft\
E
3'
rTj
-->.
Viet)) --Troo
•
! -
• i
IV; i
!
_
=
BUILDING
ELECTRICAL
PLUMBING
ROOFING
Owner of
Building
o
MIAMI SHORES VILLAGE, FLORIDA
PERMIT
Architect
Contractor
or Builder .f f;.4.1
Legal Lot
Description
B1
N° 4063
CONTRACTOR OR BUILDER ;BY
DATE '
Contractor's
License No.
Work to be performed under this Permit
19
Subdi-
vision
P•%
Address of '' r Value of , - ` (J .Amount of
Building c Project $ 11 Permit $
This permit is granted to the contractor or builder nam 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 knowledgeof the ordinances and
regulations pertaining to the work covered hereby whether shown on the plans or drawings or in the statements or sR ifications and that he sumes respon-
sibility for work done by his agents, servants or employees. „F # e-741
Signed 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 regulations
pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In ao
cepting this permit I assume responsibility for all work done by either, myself, my agent, servant or employee.
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. i1
Owner's Name and Address.
Location and legal description of lot to be built on: ``rr
Lot ✓33 Block N-3 Subdivision.. ��
Street and Number where work is to be done. _1_ // . - -_._ f__Q_l
State work to be done and purpose of building (by floors)
� 7 / ,q,
STATE OF FLORIDA,
COUNTY OF DADE. j ss.
afrett■ 16/46'
Disapproved D
(Signed) _.__
ilding nspector
Date
3.0
/l Street..
19..11
C. iohdA
Registered Architect and /or Engineer �! j�
Name and address of licensed contractor . Cts l�.e4 .e_.C�O _ - - 90/ /22,..)
and for no other pu
New Building I/ Remodeling Addition Repairs No. of Stories
To be constructed of Kind 4f found Roof Covering
Estimated Total cost of improvements $.. 7.pt...— Ut/
_ 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 spection on the site of the work sucl ublic notice
or notices as are required by the Act. The undersigned agrees to employ only such ``'contractors,.-on wr to be pprfor under this
permit, as are licensed by Miami Shores Village. /
Remarks (Signed) __ ' /.sf/
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and 'ake 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 '6 — 1 a 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 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.
/6 '
,,
/