253 NE 101 St (15)Disapproved
(Signed)
Member
MIAMI SHORES VILLAGE
BUILDING INSPECTION DEPARTMENT
APPLICATION FOR BUILDING PERMIT
Application is hereby wade for the approval of the detailed statement ut 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 o L t . To E_ `3'c"') y ° ' T I.,
Registered Architect and /or Engineer _
Name and address of licensed contractor B ' 3 C c�'1C r.--111:, 4, n t O.,
t . , � P 1 ...• .4i t }
, n i. ri . p Tack 3c_ I I
Location and legal description of lot to be built on: 2�-SS N. 4/ )),2 sr
yy►�
Lots' f 7.. j 1 g Block . Subdivision..)4;ctwi 1 5 1 '`ow e
*. ... cll..i.c..._fl }z ._..riti: 'L
Street and Number where work is to be done ,25 .N.,. E,....!_ Q.1 1 r. ?Li ¢Dk•t 0 / ol,•e- ?N
C . v,act°ci-0- VC � rzcre4'Cr'�nr, - u 1
State work to be done and purpose of building (by floors) ( � es,.j�, r ..Y c... .�4sey
" !/ " III 1.0 /`7` I l S - 6T T a - & - - O t
b ` 1,,r1 }u cw - e .. S .jr Is o -. c - k, :_ 4 . "ire P c.,_ l l e , and for no other purpose.
New Building Remodeling Addition Repairs No. of Stories ,
To be constructed of G o vler'.2 Te..,.. Kind of foundation Roof Covering
Estimate Total cost of improvements $ 3 s . , 6) 'O Amount of Permit S.
Zone cubage required plan Cubage
Distance to next nearest building � r
g. f f (e Size of Building Lot l c' o Y l i 5
\faxiunum 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.. �� 3 /. /b/ 9 7; "-)//: li-1,,,' S d areas
The undersigned applicant for this building permit does hereby certify that he understands a accepts his obligations as an employer
of labor under the 'r lorida \Vorkmen•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 employefd by him
in the work to be performed u nder this permit; and will post or cause to be posted for inspection on the site of the work such public notice
or notices as arc required by the Act. The undersigned agrees to employ only such subcontra ors, on work to be performed under this
permit, as are licensed by Miami Shores Village. e
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 roe 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 e. Permit No e'.). .�f Date I) )7? Read, Sworn to and Subscribed before me.
Date
No S 3 Street 1 ' 1 ' • I . ... S..'...
Member ...._ .
Notary Public, State of Florida
My Commission Expires
PLANNING BOARD DATE
Chairman .. , .. 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 I'Lrnnir.;; 13o.trd.
A re Ice of $1.00 will be charged when such re- inspection is made necessary by improper notice for inspection or faulty
materials and /or workmanship.
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 Stale 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 ptggress of the work.
O .C.�(.l... • 1 Dat ..�.. _...__._.._..__. - �� s ��
/• I No ._._...._.. Owner's Name and Address .. .. S � ...... Street t‘) �...
R egistered Architect and /or Engineer. . ,, ,,,,,,,,,,,,,,,,/# ,a'I ,.,, / ,4,44 G m „el ,..felt ST , „-,
i
Name and address of licensed contractor ,l l , - la... / --
Location and legal description of lot to be built on
Lot /.7 I if Block. ._.lb' Subdivision 7G,012 / — �.__
Street and Number where work is to be done. ...- p/62 __.... ii - I' / _. _
R�
State work to be done and purpose of building (by floors)..._.._......_... L.t. r l G2 /e sG
4 fG7E"C fU E. 2 o/-- .d /k'v p j't and for no other purpose.
New Budding Remodeling Addition 7` Repairs No. of Stories
To be constructed of Kind of foundation Roof-Covering
Estimated Total cost of improvements $ 3 7 -d°
STATE OF FLORIDA,
COUNTY OF DADE. J ss
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 a specifications for said building. All notices with reference to the building and its construction may
be sent to 1.- .11.
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 e site o e wao k such public notice
or notices as are required by the Act. The undersigned agrees to employ only such u. .. , actors, .n om �t b perfo ed u
pennit, as are licensed by Miami Shores Village.
Remarks..._ _....__ _. _ _ (Signed)
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally ap-
peared
..to me well known,
Permit No.
Disapproved ___
( Signed) r/
Building Inspector
MIAMI SHORES VILLAGE
PLANNI$ BOARD DATE
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 pre e.. /
Date s Read, Sworn to and Subscribed before me.
Notary Public, State of Florida
My Commission Expires
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 31.00 will be charged when such re- inspection is made necessary by improper notice for inspection or faulty
materials and /or workmanship. .
lr
Y .._ L `J -