151 NE 101 St (7)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
and specifications the Building Division
kept a
D t ivi iont Miami Shores shall be c o work.
with, whether herein specified or not. A copy of approved
Owner's Name and Address Mr & Mrs Jack Norma n
ss.
MIAMI SHORES VILLAGE
Date Oetober__hth ,19 6 9
Street_ N. E. _103 Wit_.
No 1 5 1
Registered Architect and /or Engineer
Name and address of licensed contractor Lang Roofing& Tile CQ 573 N. W. 71st St, Miami 11150
Location and legal description of lot to be built on:
Lot Block Subdivision
Street and Number where work is to be done 151 N.E. 101st Street
'" . .
State work to be done and purpose of building (by floors) _____Mop___1., L1.__ fe l-t.-- t.O=- ShP3tkt.:t�.;--- ... mop 1 - 9 0 #
' ;
slate with hot asphalt and cover with a layer of' standard white c e meet shingle tile.
and for no other purpose.
New Building Yes Remodeling Addition Repairs No. of Stories 1
N CoveringCement tile
To be constructed of Kind of foundation �*-
Estimated Total cost of improvements $ 1475,00 Amount of Permit $_ -_c!
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 required ir by by the A ct. The undersigned agrees to employ only such ubcontractors, •.n work to be perfo ed under this
permit, as are licensed
29.5q_S_m
( Signed) _ =-
STATE OF FLORIDA,
COUNTY OF DADE. j
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 111.10 I D' `3
Date Read, Sworn to and Subscribed before me.
Disapproved PP \\ Date__ _ _ - = Notary Public, State of Florida
(Signed) W - ` L _ '�
Building Inspector My Commission Expires
PL ' ING 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.