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205 NE 101 StDate 1- 1 -94 PERMIT APPLICATION FOR MIAMI SHORES VILLAGE Job Address 205 NF 101 STRFFT Tax Folio 11-3206-4880-306 Legal Description %%�� Master Permit 4� 35✓ /I �� 0 205 NF 101 STREET Phone 759 -3078 Address 6600 NW 72 AVENUE Owner / Lessee / Tenant Owner's Address Contracting Co. rLOBAL ROOFING, I NC • Qualifier PFDRO RODRIGIIFZ SS# Phone 889 -2990 State # Municipal # Competency # Ins.Co. iAIAUSAU INS Co. Architect /Engineer Address Bonding Company Address Mortgagor Address Permit Type(circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN WORK DESCRIPTION #iQ AM . ,FELT, TIN TAGGED 12" 0.0. BOTH DIRECTIONS, 3X3 EAVE METAL, 90 A,II M FELT, HOT MOPPED AND FLAT BROOMSWEPT METRO TILES. `FEES: PERMIT AFPROVEL: Zoning SERCIO LEON Square Ft. 345 SQ FEET Estimated Cost(value) $900.00 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 • all 1 : re lating construction in this jurisdiction. I understand that separate permits a ECTRICAL, PLUMBING, SIGNS, POOLS, ROOFING and MECHANICAL WORK. OWNER'S cer ify that all the foregoing information is accurate and that all work will be done co .p ian-e with all applicable laws regulating construct n and zoning. Furthermore, I autho t :bo e-named ractor tondo the work stated. - Signa o' "` and /or Cond President 'Date: Notary to Owner:Id /or C ndo President My Commission Expires: NOJA(RY PUBLIC STATE OF urn COMMON 'EMS JttNf 14, t?"'! ONDED TH J4ls .' UNOEN;1TM RADON * * Signature of D..te: 1 Notar as to Contractor or er- Builder My Commission Expires: NOTARY PtURU TATE Of FtO i •4 MY COMM •N EXPIRES JUNE i;: ^�' * BONDED TOUGH GEl. UNDEfRN i ci5 * * ** C.C.F. i % 6 NOTARY TOTAL DUE Fire Buildin Mechanical Plumbing Engineering Other Electrical :HUSE 7FET s -47 SIGNATURE/TITLE /LOCATION /PHONE /DATE DATE: TO: FROM: SUBJECT: d os UMEHU HEMQ DEPARTMENT: DEPARTMENT: 996 07, • MEMO -DADE FLAOLEFI BUILDING j • • Metro Roof Tile Corporation Iias filed with this office the additional and required acceptable test data to support the request for renewal and continued use of their Cement Mal Itoof'1'ile' for a mortar -set system which will expire on November 19, 1993.e /Z2 ,,_ �� .! � � :';;�.,� '.';r' l 6 ' The tile sitali be installed on a solid nailable roof deck of 5/8" thick p ywood for all new construction or to 1/2" plywood deck on re-roofing; i . The prepared deck shall consist of an underlayment (anchor sheet) conforming to No. 30 Type 11 (ASTM D -226) and tin capped 6" o.c. on all laps, 12" o.c. In the held and 4" on drip edge over this, a hot - mopped 9011 ASTM D -249 granular surface cap sheet by Tamko, or equal applied. The tile 811011 be applied with a 2" head lap to the roof with the mortar consisting of pinker Roof Tile Cenent mixed with sand conforming to ASTM C -144 for a 3:1 mix, • , The tiles shall be presoaked and set using approximately one MI trowel; of mortar. •' Due to Hurricane Andrew, this office has been inundated with requests for both new • products and renewals of those to expire which has caused a large back log in responding with an official Notice of Acceptance, . In the Interim period, please accept letter in allowing these products to be installed by a licensed roofing contractor In accordance with the nhanufhcturer's anther specifications and Chapter 34 of the South Florida Building Code until an official Notice of Acceptance is issued. OD:co BUILDING CODE COMPLIANCE DEPA1htMENT SUITE 1003 MEtfO•DADE FLAO1Efl BUILDING 140 WEST FLA0LEN STREET MIAMI, FLOITIDA 33130.1603 (305) 378.2901 FAX (305) 378.2908 June 15, 1993 ;,r ::. TO W'YIIO111 IT MAY CO14Ct1 ?4 ir Dlaulmid, .13.. Product Control Division Supervisor METROPOLITAN DADE COUNTY, FLORIDA • . 'METAODAOE • 1 PRODUCT CONTROL NOTICE Og AC'f E . METRO -DADE CENTER BUILDING & ZONING DEPARTMENT METRO•DADE CENTER 111 N.W. FIRST STREET SUITE 1010 MIAMI, FLORIDA 33128.1874 (305) 375 -2612 Metro Roof Tile, Inc. 11350 N.W. South River Drive. Medley, FL. 33178. Your application for Product Approval of Cement Flat Roof Tile under Sections 203 and 204 of the South Florida Building Code governinc the use of Alternate Materials and Types of Construction, and complete) described in the plane, specifications and calculations as submitted by • . l . has been accepted by Product Control to be used in the Unincorporated areas of Dade County under the Specific Conditions set forth on pages 2 -2a and the Standard Conditions on Page 3 ACCEPTANCE No.t 90- 1005.3 EXPIRES APPROVED $ Nov. 19. 1990 Nov. 19. 1993 coauixinas i amon•, P.E. roduct Control Supervisor Metropolitan Dade County Building & Zoning Department -•.;I •• This application for Product Approval has been accepted by the Metropolitan Dade County Board of Rules and Appeals to be used in the Incorporated and Unincorporated areas of Dade County under the conditic set forth above. • 1 5 APPROVED: November 19.1990 -1- ¶ onlbe M. Blac Deputy Secretary Metropolitan Dade County Board of Rules and Appeals • • .6100..••••••■•••• 0 metro Roof Tile, Inc. . . • 4 4. Each tile shall be identified by the markings METRO ROOF TILE ' .5. • , The permittee ahall retain the services of a an independent testi') laboratory to maintain quality control. Testing shall be performe on a minimum of five (5) tiles. Tile shall be selected by ASTM D-3665. Selection shall be made periodically from domestic tile. The tile shall be tested for strength according to Section 3404 of the South Florida Building Code and for moisture absorption according to ASTM C-4. The test reports shall identify the tile b a description of the tile as well as the Notice of Acceptance number. Test reports shall be transmitted to the Dade County Product Control. Section every ninety (90) days. If no test report are received within a one hundred twenty (120) day period, the • 'Notice of Acceptance will•be considered as being abandoned and the • approval will be cancelled without, noticEcto the permittee. Reinstatement will require a new application and full fee. 6. This renewal supersedes Notice of Acceptance 187-0901.1 dated October 19, 1987. • gligaira-Cantrol • • . ACCEPTANCE No. 9Q-1005, 3 APPROVED * Noy. 19, 1290 EXPIRES Nov. 19. 199, 1 .! ; /...14,.! . Gil Diamond, P.E. Product Control Supervisor Metropolitan Dade County Building & Zoning Department 1. �- .This approves flat cement tile as conforming to Section 3404.1 the South Florida Building Code 2. The tile shall be installed in conformance with Sections 34CR the South Florida Building Code.' 3. The tile shall conform to the followings $11601 4.I i Diam nd,P.E Product Controlpervisor .Metropolitan Dade County • -2- Building & Zoning Departwent Cill:co BUILDING CODE COMPLIANCE DEPA111MENT SUITE 1003 MET 1O -DADE FIAGLEIT BUILDING 140 WEST FLAGLE11 MEET /- MIAMI. FLOIIIDA 33130.1003 306 375 -2901 FAX (305) 078.2909 June 15, 1993 MYEDELMIAMIttagt Metro ltoof Tile Corporation has tiled with this office the additional and required acceptable test data to support the request for renewal and continued use of their Cement Flat Roof Tile' for a mortar -set system which will expire on November, 19, 1993.e - % �2 ;,; Z '..t T. c o - r .. •.i.� ' l : . ... y y s -- / mil r.., The tile shall be installed on a solid nailable roof deck of 5/8" thick p ywood for all new "` construction or to 1/2" plywood deck on te- rooling: The prepared deck shalt consist of an underlayment (anchor sheet) contbrming to No. 30 Type 11 (ASTM D -226) and tin capped 6" o.c. on all laps, 12" o.c. in the held and 4" on drip edge over this, a hot - cropped 90 /E ASTM P-249 granular surface cap sheet by Tamko, or quays applied. . 'flee : tile shall be applied with a 2" head lap to the roof with the mortar consisting of linker Roof Tile Cvnent mixed with sand conforming to ASTM C -144 for a 3 :1 mix. ME1HO - DADE ELAGLEFI BUILDING The tiles elrall be presoaked and set using approximately one 1tllt trowel; of urortar. •' Due to Hurricane Andrew, this office has been Inundated with requests for both new products and renewals of those to expire which has caused a large back log in responding with an official Notice of Acceptance, In lite interim period, please accept letter In allowing these products to be Installed by a licensed rooting contractor in accordance with the ntanufhcturer's ftrtther specifications and Chapter 34 of the South Florida Building Code until an official Notice of Acceptance is issued, anl ond, Product Control Division __11 Supervisor . • METROPOLITAN DADE COUNTY, FLORIDA 'METRO•DADE Metro Roof Tile, Inc. 11350 H.N. South River Drive• Medley, FL. 33178. Your application for Product Approval of Cement Flat Roof Tile under Sections 203 and 204 of the South Florida Building Code governinc the use of Alternate Materials and Types of Construction, and completel described in the plane, specifications and calculations as submitted by • • l • has been accepted by Product Control to be used in the Unincorporated areas of Dade County under the Specific Conditions set forth on pages 2 - 2a and the Standard Conditions on Page 3 ACCEPTANCE Noes 90- 1005.3 APPROVED $ Nov. 19. 1990 EXPIRES PRODUCT CONTROL• NOTICE OF CCPTAN Nov. 19. 1993 CONDITIONS METRO -DADE CENTER BUILDING & ZONING DEPARTMENT METRO -DADE CENTER 111 N.W. FIRST STREET SUITE 1010 MIAMI, FLORIDA 33128.12'74 (305) 375 -2612 r i amon• , P.E. roduct Control Supervisor Metropolitan Dade County Building & Zoning Department BdARD_OF RULES AND HEALS NOTICE OF ACCEPTANCA This application for Product Approval has been accepted by the Metropolitan Dade County Board of Rules and Appeals to be used in the Incorporated and Unincorporated areas of Dade County under the conditic set forth above. APPROVED: November 19.1990 -1- fg M. Blac P. E,. Deputy Secretary Metropolitan Dade County Board of Rules and Appeals 5. Quality Control . The permittee ahall retain the services of a an independent testis) laboratory to maintain quality control. Testing shall be perform on a minimum of five (5) tiles. Tile shall be selected by ASTM D-3665. Selection shall be made periodically from domestic tile. The tile shall be tested for strength according to Section 3404 of the South Florida Building Code and for moisture absorption according to ASTM C-4. The test reports shall identify the tile b a description of the tile as well as the Notice of Acceptance number. Test reports shall be transmitted to the Dade County Product Control. Section every ninety (90) days. If no test report are received within a one hundred twenty (120) day period, the • *Notice of Acceptance will.be considered as being abandoned and the approval will be cancelled without notice :to the permittee. Reinstatement will require a new application and full fee. 6. This renewal supersedes Notice of Acceptance #67-0901.1 dated October 19, 1987. • • k • • :. • .• ••• i• ; •I • • s. L • r•■■•■■■•11, • metro Roof Tile, Inc. t. • ACCEPTANCE No.* F APPROVED s Nov. 19, 1990 EXPIRES A, 4. Each tile shall be identified by the marking' METRO ROOF TILE • : ,• . • . t2 8 Nov..19. 1993 f' /fl Gil Diamond, P.E. Product Control Supervisor Metropolitan Dade County Building & Zoning Department 1I I 1.=-- ..This approves flat cement tile as conforming to Section 3404.1 the South Florida Building Code.; 2. The tile shall be installed in conformance with Sections 340 the South Florida Building Code.' • ;. 3. The tile shall conform to the following$ NOTICE pF ACCEPTANCE' SPECIFIC . CONDITION$ s it Diamon , "P .E Product Control upervisor .Metropolitan Dade County -2- Building & Zoning Department Square Ft . :24)/D 5,1-r PERMIT APPLICATION FOR MIAMI SHORES VILLAGE Date /0 ? 3 Job Address AoS7 A) 4E / 0 1 S Tax Folio l) 3 6 7r 0.� i Legal Description % / - - v gifrJ � 1.4j y 3 Owner / Lessee / Tenant SL i G/D /a, Lo N Master Perm �� o� �( 7 4 Owner's Address a05 ,iUE /0/ ST. is4 t #4-01A t DALI F C' CL 3g /3Y Phone 7r -7- /7 ' Contracting Co. AJOIJE. - 0 /C 1- ' 45 A- 17- Address <A 1-,14 C. Qualifier SS# - - Phone State # Municipal # Competency # Ins.Co. Architect /Engineer Address Bonding Company Address Mortgagor Address Permit Type(circle one):iUILDING) ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN /evo WORK DESCRIPTION / QGr,+ovE 4 o S`errnt- v F 4)uE21I -A �6.-aAIL f 64LT, i32 j - - SS15r -RIkr 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. 0_143 2 ALA5w7 — , t i LZG -,e /Go 3 Signature of owner and /or Condo President Date: Notary as to Owner and /or Condo President My Commission Expires: Estimated Cost(value) S"oo. o (Ai ,u6e. b ar g-/L. 7W 2' Signal �� Contractor or Owner- Builder Date' ary as to Co Commission E ** * * .? * * * * * * * * * * * * ** � V 0 TOTAL DUE 944 FEES: PERMIT � ��'1�ir %/ RADON C.C.F. C . C . F . � NOTARY � APPROVED: Fire - I Other Zoning Buildin: �!` Electrical Mechanical Plumbing Engineering jP H!NE CHURCH � � , � ! I l+ Jt0tc V, 1 I II& App $ C tlflil# JV: l99 , p :' No. CCI97545 amosajagoseaswawawaarastimatammatwow Inspection Number: INSP -31336 Permit Number: RF -11 -06 -2707 Inspection Date: 12/27/2006 Inspector: Grande, Claudio Owner: CHIONG, NENA Job Address: 205 101 Street NE Project: <NONE> Miami Shores Village, FL Contractor: KAWALEK ROOFING & PAINTING, INC Building Department Comments Tuesday, December 26, 2006 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Block: Permit Type: Roof Inspection Type: Tile In Progress , • Work Classification: Roof - New Phone Number Parcel Number 1132060480030 Lot: Phone: 786- 277 -9540 Page 1 of 2 DEC 2 8 MOD Passed Inspector Comments Failed Correction Needed Re- Inspection Fee ($75) No Additional Inspections can be scheduled re- inspection fee is paid. until Inspection Number: INSP -31336 Permit Number: RF -11 -06 -2707 Inspection Date: 12/27/2006 Inspector: Grande, Claudio Owner: CHIONG, NENA Job Address: 205 101 Street NE Project: <NONE> Miami Shores Village, FL Contractor: KAWALEK ROOFING & PAINTING, INC Building Department Comments Tuesday, December 26, 2006 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Block: Permit Type: Roof Inspection Type: Tile In Progress , • Work Classification: Roof - New Phone Number Parcel Number 1132060480030 Lot: Phone: 786- 277 -9540 Page 1 of 2 !Inspection Number: I'NSP- 3'13'344, Permit Number: RF -11 -06 -2707 Inspection Date: 11/21/2006 Inspector: Grande, Claudio Owner: CHIONG, NENA Job Address: 205 101 Street NE Project: <NONE> Miami Shores Village, FL Contractor: KAWALEK ROOFING & PAINTING, INC Building Department Comments Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 p 2 2 200i Block: Permit Type: Roof Inspection Type: Tin Cap Work Classification: Roof - New Phone Number Parcel Number 1132060480030 Lot: Phone: 786 - 277 -9540 Monday, November 20, 2006 Page 1 of 2 Infractio Passed Comments TIN CAP SPACEING True t Passed ) 0 / nspector Comments Failed Correction Needed Re- Inspection Fee ($75) No Additional Inspections can be scheduled re- inspection fee is paid. until !Inspection Number: I'NSP- 3'13'344, Permit Number: RF -11 -06 -2707 Inspection Date: 11/21/2006 Inspector: Grande, Claudio Owner: CHIONG, NENA Job Address: 205 101 Street NE Project: <NONE> Miami Shores Village, FL Contractor: KAWALEK ROOFING & PAINTING, INC Building Department Comments Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 p 2 2 200i Block: Permit Type: Roof Inspection Type: Tin Cap Work Classification: Roof - New Phone Number Parcel Number 1132060480030 Lot: Phone: 786 - 277 -9540 Monday, November 20, 2006 Page 1 of 2 Inspection Date: 11/21/2006 Inspector: Grande, Claudio Owner: CHIONG, NENA Job Address: 205 101 Street NE Project: <NONE> Miami Shores Village, FL Contractor: KAWALEK ROOFING & PAINTING, INC Monday, November 20, 2006 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 ICON 2 2 21 Block: Permit Type: Roof Inspection Type: Hot Mop Work Classification: Roof - New Phone Number Parcel Number 1132060480030 Lot: Phone: 786- 277 -9540 Page 1 of 2 ( 1 l Passed v / Inspector Comments . I/ Failed Correction Needed Re- Inspection Fee ($75) No Additional Inspections can be scheduled re- inspection fee is paid. until Inspection Date: 11/21/2006 Inspector: Grande, Claudio Owner: CHIONG, NENA Job Address: 205 101 Street NE Project: <NONE> Miami Shores Village, FL Contractor: KAWALEK ROOFING & PAINTING, INC Monday, November 20, 2006 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 ICON 2 2 21 Block: Permit Type: Roof Inspection Type: Hot Mop Work Classification: Roof - New Phone Number Parcel Number 1132060480030 Lot: Phone: 786- 277 -9540 Page 1 of 2 TEAR OFF EXISTING TILE CONCRETE COLOR THRU ROOF TILE ROOF SYSTEM ROOF, MULTI COLOR REPLACE MONIER COLER TWO TONE IS ARIZONA CLAY FEB 0 1 2 E Passed b ,. Inspector Comments Failed Correction Needed Re- Inspection Fee ($75) No Additional Inspections can be scheduled until re- inspection fee is paid. i nspection Number: INSP -31338 Inspection Date: 02/01/2007 Inspector: Grande, Claudio Owner: CHIONG, NENA Job Address: 205 101 Street NE Project: <NONE> Miami Shores Village, FL Contractor: KAWALEK ROOFING & PAINTING, INC Building Department Comments Wednesday, January 31, 2007 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 C(- Block: Permit Type: Roof Inspection Type: Final Roof Work Classification: Roof - New Phone Number Parcel Number 1132060480030 Lot: Phone: 786 - 277 -9540 Page 1 of 1 Test Location Uplift Pull Test(P or F) Test Location Uplift Pull Test(P or F) Test Location Uplift Pull Test(P or F) Test Location Uplift Pull Test(P or F) 1 - ] 71A - ", // 'p 26 D 51 76 2 l 27 �� 52 77 3 28 53 78 4 29 54 79 5 30 55 80 6 31 56 81 7 32 57 82 8 33 58 83 9 34 59 84 10 35 60 85 11 36 61 86 12 37 62 87 13 38 63 88 14 39 64 89 15 40 65 90 16 41 66 91 17 42 67 92 18 43 68 93 19 44 69 94 20 45 70 95 21 46 / 71 96 22 47 72 97 23 48 73 98 24 49 74 99 25 /. 50 75 100 THIS R • o °T ' BMITTED BY: Lab Certification # 98 0608.04 State of FL Certificate Authorization # 4100 U.S. SOUTH Engineering & Testing Lab., Inc. 6065 N.W. 167th Street, Suite B -23 • Miami Lakes, Florida 33015 Telephone: (305) 558 -2588 • Fax: (305) 362 -4669 ON -SITE CONCENTRATED UPLIFT LOAD TESTING OF ROOF TILE IN FULL ACCORDANCE WITH METRO -DADE BUILDING CODE COMPILANCE PROTOCOL TAS 106 SITE SPECIFIC INFORMATION Owner's Name Job Address `Z�� o l S T. t 1,k19,( Roofing Contr. c or Type of Tile: ' 1t1. t ' - 'A Date Installed• Approximate Roof Height: 11 feet Roof Pitch: 4'-i Z Type of Access to Roof: Sca olds i Ladder Other Approximate Square Footage of Roof 5 ft Required Testing Force: 35 lbs. Testing Equipment: Chatillion 100 Date Tested 1- 10 - P ' TEST RESULTS P = PASS, F = FAIL IN ACCORDANCE WITH THE CRITERIA OF PROTOCOL TAS 106, THIS ROOF ASSEMBLY HAS PASSED THE STATIC UPLIFT QUALITY CONTROL ST. Project piQ 8638 r rit # 06- 2 - -- Job Zt7 S t4 e- v td ;11+51-L&-5 Sheet Number Contractor V-441.1 Checked By Sketch of Roof Scale • mulmJmmealit Ail 1 IIIIMMEMMMEMMOCAMMMEMENEMNIMMUMEM IIMMEMMUMIIMMEMEMMENNEMONMMEgUMM EMINIMMMEMMEMEMMNIMMINMUMMMEMEMM MIIMMEMEMMIMMOOMMUMWOMMMOMMMUMMII MOMMOMMINIMENMERMAIMEMMONAMMUMMI MMEINIMMEMMOMOMMO MMININEWMEMBEMM 1111111111111111111 11111 111111111 11111111111111111 imminummommomuummiammummi... 111111111111111111141111k11111111 MMEMMIIMEMMIMOMMEMEMEMESIMMUMME MMEMMIIMMERMEMMEMMORNMEMOMMMEMMII MEMMEMMEMMMEMEMMRAMMUMMININAMMO 111111111111/1111111111111111111 MMOMENEMESEMEMPIMMEMMEMMEMUMME 11 11111d1111141121 r. • F-Orp-cl 04 Disapproved 4 . (Signed) 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..... .•....a.Y.R.Q...Y ltttl. @Z►....... ._. No 2Q...N..E Street...l41 Straet..Miami Shore: Registered Architect and /or Engint'er . Name and address of licensed contrpctor .ACQf3t &.RQ.tfing..OQ• 2.4a4.. N..11.. . 78th..Strest � 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 Bui!ding.X Remodeling Addition Repairs NetmanNiE brown The undersigned applicant for this building permit does hereby certify that he understands and ac of labor under the 'Florida Workmen's Compensation Act, being Section 5966, Compiled Genera and has complied with the provisions thereof, and will require similar compliance from all coat in the work to be performed under this permit; and will post or cause to be posted for inspect or notices as are required by the Act. The undersigned agrees to employ only such subcontr pennit, as are licensed by Miami Shores Village. Remarks (Signed Budding Inspector Date 205 N.E. 101 Str4ot ahmm. _.._ and for no other purpose. No. of Stories To be constructed of Kind of foundation Roof Covering Estimated Total cost of improvements $ 5, 972 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 1 - 30 felt nailed on the wood mop 1 - 90 slate install 2x2" eave drip. install tile Florida, Pennant. sub -cones tors emp) e site of ,' work such on work rfo STATE OF FLORIDA, COUNTY OF DADE. j ss Before me, the undersigned authority, a notary public, duly authorizefl 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.._ .1 Date 4)i Read, Sworn to and Subscribed before me. Notary Public, State of Florida My Commission Expires s as an employer Supplement, 'ed by hint blic notice under this PLANNING BOARD DATE Chairman Member Member Member Member Member W_._..... Council Approved Date Disapproved Date NOTE: A charge of $1.00 will be made for making corrections or changes to this application nfter 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.