290 NE 100 St (11)Date
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
ob Address Tax Folio
Legal Description / Historically Designated: Yes / No ✓_
Owner/Lessee / Tenant e'A f Q / .y 1 \ e ¢-)O Master Permit # 17144 6!
Owners Address 20t O ) Phone 5 1ao 022 Z
Contractin Co. Q W.. Address
Qualifier SS# - Phone
State # Mynicipal # Competency # Ins. Co.
Architect/Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVIN
WORK DESCRIPTION ' E v I G � 7 TO e e ) 6 \ N � Y C , i P V 2 P ' \ S ' P E A r k- ?
Square Ft '2Z 1' 2 4 E 2 Estimated Cost (value) 1 -1-GOO
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 perfonned 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 re
7
ating
d, z( 0-%
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construction and zoning. Furthermore, I authorize the above -named contractor to do the wor stated.
Signature of owner and/or Condo President Date
Notary as to Owner and/or Condo President Date No
My Commission Expires:
FEES: PERMIT p RADON C.C. O NOTARY S
APPROVED:
ntractor o
Si
to Contractor o 'Owner - Builder
My ommission Expires:
Electrical
Owner- Builder
Date
Date
SIGN
Mechanical Plumbing Structural Engineer
O
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BOUNDARY SURVEY
Legal Description:
Lets 1 and 2, Block 33, Plat of AN
AMiENDED PLAT OF MIAMI
SHORES SECTION NO. 1, according .
to the Plat thereof, as recorded in Plat
Book 30, Page 70, of the Public Records
of Miami Dade County. Florida.
Certified to:
Gary Hicks; Richard Gonmlez, P.A.;
Attorney's Title Insurance Fund, lac.;
Chase Manhattan Mortgage Corporation,
its successors and/or assigns as their
interest may appear.
Panel: 0093
Flood zone: X
Date of fieldwork: 09/17/99
Completion date: 09/17/99
Survey number: G -21384
Property Address:
290 N.E. 100 Street
Miami Shores, Florida 33138
age
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First.
Financial
Surveyors,
Inc.
xg
STATE OF FLORIDA, 1
COUNTY OF DADE. J ss
rue
MIAMI SHORES VILLAGE
Registered Architect and /or Eri J7
Name and address of licensed contractor C ,, " .- �✓ e K .
Locatio and legal description of lot to be ' t on: y� �/ /
Lot l Block...__..._. Subdivision. a.� �L' �'1i / 61 4 ci ! is /13 - ..
Street and Number where work is to be done_. .9 fl,l & • / 0 • / f 1 '
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. /
�j
Date.. G / � ,J) , 19 /
Owner's Name and Address.... L /��� No.. � 90 Street 1 - £ / 0 D •s�'y
Date.
St1 work to be done and purpose of building (by floors)
/ J-/ / ,//G , G
and for no other purpose
New Building Remodeling Addition Repairs No. of Stories
To be constructed of Kind j of foundation Roof Covering
Estimated Total cost of improvements $._._ ,(.Ll. .. 7s .. Q -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
I hereby submit all the plans and specifications for said building. All notices with reference to the building and its construction may
be sent to
The undersigned applicant for this building pennit does hereby certify that he understands and accepts his obligations as an employer
of labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida, Permanent Supplement,
and has complied with the provisions thereof, and will require similar compliance from all contractors or sub- contractors employed by him
in the work to be performed under this permit; and will post or cause to be posted for ' spection on the site of the work such public notice
or notices as are required by the Act. The undersigned agrees to employ only such, ontr ctors on rk to berp7formed under this
permit, as are licensed by Miami Shores Village. if
Remarks (Signed)..
--- a
t /Q 0 '
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknpwledgments, 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 state 7 >
Permit No._. /.. ...... .
Read, Sworn to and Subscribed before me.
Disapproved Date
(Signed)
uifd Inspe tor My Commission Expires
PLANNING BOARD DATE
Chainnan 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.
Notary Public, State of Florida
A
v
1.
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de, 4/ S
,290
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/lc /
BUILDING
ELECTRICAL
PLUMBING
ROOFING
Owner of
Building 1^^
Architect
Contractor
or Builder
Legal
Description
Address of
Building
Lot
CONTRACTOR OR BUILDER
MIAMI SHORES VILLAGE, FLORIDA
DATE._... ! f1Al l;...- .01:6 195j
Contractor's
License No
❑ PERMIT
V ork to b
' I
N° 14866
erformed under this Permit
Project
Subdi-
vision
' I Value of
(!,✓ � /C $ /
Signed•
BY
let t
,6 ✓ 7; Amt. of ' <C
' - Permit $ ,,,, ` `
This permit is gra ed 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 compli ce with all ordinances 'pertaining thereto and with the understanding that the work will be performed in compliance with any plans,
drawings, statements o 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 p . ns are chap
granted is the understanding that the contractor or builder named above a sumes the r
pertaining to the work covered hereby whether shown on the plans or dr ings
done by his agents, servants or employees.
6.
without authorization. A further condition upon which this permit is
ponsibility for a thorough knowledge of the ordinances and regulations
e statements or specifications and that he assumes responsibility for work
SPECTOR
Q
In consideration of the issuance to me of this pet$nit I agree perform the work covered hereunder in compliance with all ordinances and regulations
pertaining thereto and in strict conformity with the plans drawings tatements or specifications submitted to the proper authoritie of Miami Shores Village.
In accepting this permit I assume responsibility for all w. k do . .y either, myself, my agent, servant or employee.
AUTHORITY
APPLICATION FOR BUILDING PERMIT
Application is hereby made for the approval of the deviled statenem of the plans and specifica herewith submitted for the build-
ing or o Ir, -ructure her i described This rplicatic is made in compliance and con o'm.ty w.th the Building Ordinance of Mia ii
Shores Village or da, and all pro isions of the Laws t f the State of ff krid. all o d nances ,f Mi ni Shores Village and all rules and
regu a i . of the Building Div.. i of .tam Shop illage 1- '1 e o ipl.ed with, whether herein specified or not. A copy of approved
plans a ti .ns• mu. .1 key at building durin, progress of tl.e wcrk.
Owner' Name and Address
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 done and purpose of building (by floors
New Building_
To be constructed of
Remarks_
STATE OF FLORIDA,
COUNTY OF DADE. ss.
Permit No
Disapproved
(Signed)
Chairman
Member ___ __ _ _
Member _
Council Approved
MIAMI SHORES VILLAGE
Remodeling__
Kind of foundation
Date_
mg Inspect r
BUILDIN INSPECTION DEPARTMEN'
Z. 5'
Registered Architect and /or Engineer._
Name nd address of licem,ed contractor.
PLANNING BOARD __DATE
Member
Member
Member
.Date Disapproved
Date �- 19
Street_.
Roof Cov
of Permit $... 2. cml
_..
Read, Sworn to and Subscribed before me.
Notary Public State of Florida
My Com :nission Expires_
and for no other purpose.
Addition____ ____ ___ _____ __ _ Repairs.. No. of S t o r i e s
/ v - --
Estimated ^. ;tal cost of improvements $__
Zone ^ubage 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 specifications for said building. All notices with reference to the budding and its construction may
be sent to
The unde signed appli ant for di 's budding permit does hereby certify :?fat he understands and accepts his obligations as an employer
of 1 bor under he Florida Workmen's Compensation Act being S. -tion 5966 Col p led Gen al Laws of Florida P r anon. S•Ipplt Went.
and h s compl ed w :th he prov' cons thereof, and will require sanilar coma lance from all contractors or sub - contractors cmplo .ed by him
in the wo k to be p rf med under th s pern it and ill post or cause to be posted for inspection on the site of the work su :h zmblic not. c
or •otites as are requir d by the Act. The u. d. r ign d agrees to employ only such abcontr. ctors, pn work to be perform d . der this
permit as are licensed by M am, Shores ‘1,1!: ge.
(Signed'
4
Before me, the undersigned authority, a notary public, duly authorized to administer oaths ..nd take acknowledgments, personally ap-
peared _ .
to me well known,
and who, being by me first d. ly sworn, upo th deposes and says that he is the
of th abov de ibed • I sttruction t. h 1 as careially read the foregoing application, and that he did sign the sane, and that all facts
therein by him sta
Date
NOTE: A charge of $1.00 will be made for making corrections or changes to this application after approval h is been obtained from
the Plans ng Board
A re- inspection fee of $1.00 will be charged when such re- inspection is mr_'te necessary by improper notice for inspe :•t'or or fa. Ity
materials and /or workmanship.
.*/
kith Ki L
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