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ROOFINGIssue Date: 9/14/2006 Expires: 03/13/2007 Owner's Name: IVAN AND MARCELA ASTRALAGA Permit Type: Roof Work Classification: Roof - Repair Job Address: 254 101 Street NE Miami Shores Village, FL Contractor(s) DALEY ROOFING INC Phone (305)754 -9892 Primary Contractor Yes Comments: SEAL CHIMENEY FLASHING REMOVE APPROX 20 TILES REPAIR LEAK & INSTALL TILE WHERE REMOVED Additional Information Type of Work: Repairs Additional Info: Classification: Residential 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 accepting this permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are required for ELECTRICAL, PLUMBING, MECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work. OWNERS 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. Futhermore, I authorize the above -named contractor to do the work stated. Fees Due CCF Education Surcharge Notary Fee Permit Fee - Repairs Scanning Fee Technology Fee Total: Amount $1.20 $0.40 $5.00 $100.00 $3.00 $2.50 $112.10 Building Department File Copy Applicant Signature Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL 33138 -0000 Phone: (305)795 -2204 Fax: (305)756 -8972 Permit Re Parcel #: Block: Section: Roof in Progress Final Roof Permit Status: APPROVED Permit Number: RF -9 -06 -2308 Phone: (305)773 -0577 1132060134620 Lot: PB: Total Square Feet: 30 Total Valuation: $ 1,500.00 uired Ins ' ections Invoice Number RF - 9 - 06 - 26150 Total: CAS Y. GU Gg Amt Due $112.10 Amt Paid SEP 2 9 MOO NOTICE: In addition to the requirements of this permit, there may be additional restrictions applicable to this property that may be found in the public records of this county. AND THERE MAY BE ADDITIONAL PERMITS REQUIRED FROM OTHER GOVERNMENTAL ENTITIES SUCH AS WATER MANAGEMENT DISTRICTS, STATE AGENCIES, OR FEDERAL AGENCIES. Miami Shores Village Owner's Address Z5f NE- 101 Si City ii i/g 7// State Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 BUILDING FBC 2004 litg©MEWM . Permit No. \\T" 06' 2.79)(6 PERMIT APPLICATION aster Permit No. ` B Y: WANNic■ . Permit Type (circle): Building Electrical Plumbing Mechanical Owner's Name (Fee Simple Titleholder) /! 4s7-496196 /9 Phone # City 1( -1'VYl 1 e,ec State t—t, Zip aJ3 S Tenant/Lessee Name Phone # Job Address (where the work is being done) 2 6 ti E /0/ City Miami Shores Village County Miami -Dade FOLIO / PARCEL # Is Building Historically Designated YES NO Contractor's Company Name DALE2j WorfAJ 7 /1dc... Contractor's Address 73i /U /01 _sr" mo v CAD • Phone # Zip Qualifier Name 1• J /Q.■ 6 - atCti Phone # 006 75Y 9er 9c; State Certificate or Registration No. e- NiC 6 0 Certificate of Competency No. Architect/Engineer's Name (if applicable) Phone # Value of Work For this Permit $ Square / Linear Footage Of Work: p j� Type of Work: ❑Addition // LL ❑Alteration ❑New �epair/Replace ❑ Demolition Describe Work: SF (i � 7ivi 1..y -S H-i C1 () - - o 2- Pt-PP x 20 - n 1 , e_ '('A-i d I An Zip 33/3&'" C� /755 98 _ _ , ******** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** F * * * ** ar;t * *,� * * * * *,� *•1 * * ** Submittal Fee $ Permit Fee $ :::..GGF`$sr4v CO /CC.' Notary $ Training/Education Fee $ 0. 40 Technology Fee $ 2• Scanning $ 3•0D Radon $ Bond $ Code Enforcement $ Double Fee $ DPBR $ Zoning $ Structural Review. $ Total Fee Now Due $ 112 See Reverse side -* Bonding Company's'N'ame (if applicable) Bonding Company's, Address, City State Zip Mortgage Lender's Name (if applicable) Mortgage Lender's Address City State Zip Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRICAL WORK, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and AIR CONDITIONERS, ETC 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. "WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT 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." Notice to Applicant: As a condition to the issuance of a building permit with an estimated value exceeding $2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. 4 � Signature � r J i y a Signature. Agent Contractor c. The foregoing ins>rument was acknowledged before me this /7 The foregoing instrument was acknowledged before me this A day of .e? , 20 GIG, by _71/4:0 �3 p l i•G /4 4 , day of , 20 06, by V &nnt7( Et /ty who 1 : - •nail known e or who has produced who i ersonally kno o me or who has produced as identification and who did take an oath. Sign: NOTARY PUBLIC: APPLICATION (Revised 02/08/06) As identification and who did take an oath. ieszIIu,.c1NICALISSETHD �uNl 3 _M MY COMMISSION # DD 4 39`. My Commission Expires: d� 00 • ° , ' ? EXPIRES: October 20, 200E a• ��--: ************************************** �t�t****** **** *** *�F�k*** * *ic*** * *�k***�t . vFS�QJ is *9c �t *vY 4e is Print: ly /C•/,.i /yl_cszNOS LISETTE MONTESINOS Notary Public - State of Florida commis ion Of DD 441626 Bonded By National NoWypsn. I Ai id NOTARY PUBLIC: Sign: Print: My Commis Plans Examiner Engineer Zoning Property Address MCIEET SEP 0 8 M0.1 SEP 0 8 2006 SECTION 1524 B Y: _C ' " j C& HIGH VELOCITY HURRICANE ZONES REQUIRED OWNERS NOTIFICATION CONSIDERATIONS 1524.1 As it pertains to this section, it is the responsibility of the roofing contractor to provide the owner with the required roofing permit, and to explain to the owner the content of this section.. The provisions of Chapter 15 of the Florida Building Code, Building govern the minimum requirements and standards of the industry for roofing system installations. Additionally, the following items should be addressed as part of the agreement between the owner and the contractor. The owner's initial in the adjacent box indicates that the item has been explained. _1. Aesthetics - Workmanship: The workmanship provisions of Chapter 15 (High Velocity Hurricane Zone) are for the purpose of providing that the roofing system meets the wind resistance and water intrusion performance standards. Aesthetics (appearance) issues are not a consideration with respect to workmanship provisions. Aesthetic issues such as color or architectural appearance, that are not part of a zoning code, should b as part of the agreement between the owner and the contractor. 1 ' r+ 1 2 Renailing Wood Decks: When replacing roofing, the existing wood roof deck may have to be renailed in accordance with the current provisions of Chapter 16 (High Velocity Hurricane Zones) of the Florida Building Code. (The roof deck is usually concealed prior to removing the existing roof system). .�_3. Common Roofs: Common roofs are those which have no visible delineation between neighboring `units (i.e. townhouses, condominiums, etc.). In buildings with common roofs, the roofing contractor and /or owner should notify the occupants of adjacent units of roofing work to be performed. . Exposed Ceilings: Exposed, open beam ceilings are where the underside of the roof decking can be viewed from below. The owner may wish to maintain the architectural appearance, therefore, roofing nail penetrations of the underside of the decking may not be acceptable. The Florida Building Code provides the option of maintaining this appearance. Y Ponding Water: The current roof system and /or deck of the building may not drain well and may cause water to pond (accumulate) in low -lying areas of the roof. Ponding can be an indication of structural distress and may require the review of a professional structural engineer. Ponding may shorten the life expectancy and performance of the new roofing system. Ponding conditions may not be evident until the original roofing system is removed. Ponding conditions should be corrected. , 6. Overflow scuppers (wall outlets): It is required that rainwater flow off so that the roof is not overloaded from a build up of water. Perimeter /edge walls or other roof extensions may block this discharge if overflow scuppers (wall outlets) are not provided. It may be necessary to install overflow scuppers in accordance with the Florida Building Code, Plumbing. F - 7. Ventilation: Most roof structures should have some ability to vent natural airflow through the interior of the structural assembly (the building itself). The existing amount of attic ventilation shall not b beneficial to consider additional venting which can result in extending the service life of the r / "6 Owner's /Agent's Signature Date (! Contractor's Signature •• ••• • • • • • •• Permit Nun oer�: • • • • • • •• ••• •• • • • •• Rev:1 /20 /2005,Computer Services, Building Department • • • • • • • • • • • • • • • • • • • • • • • • • •• • • •• • • • • • • • • • • • • • • • •• • • • • • ••• • • • • ••• • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • , • • • • • • ••• • • • ••• • • 6 Z • 1 High Velocity Hurricane Zone Uniform Roofing Permit Application Form MIAMI -DADE COUNTY BUILDING DEPARTMENT ELECTRONIC APPLICATION 1 Master Permit No. (9(a- 240$ I Low Slope E Asphaltic Shingles ✓ Pa:sal - Om BUR -RAS 150 Section A (General Information) Process No. Otherl Contractor's dame: Job Address: 1 P KAi fj la (— 1 2.6y Ai6 /0/ st- Roof Category E Mechanically Fastened Tile I Metal Panel/Shingles Roof Type r New Roof r Re- Roobrg r Recovering Are there Gas Vat Marks located on the roar! r Yes r No Low slope rod area (1t Section B (Roof Plan) Roof System Information E Mortar /Adhesive Set Tile r Wood Shingles /Shakes r Maintenance ff lIes. what type? r Klemm! r LPGC Steep Sbped area (IL2) I Total R Page 1 of 1 Sketdn Roof Marc Mustrate al levels and sections. rod drains. sappers, overflow sappers and overflow drains_ Include dimensions of sedions and levels. dearly identify dimensions of elevated pressure zones and oration of parapets. Perin,eter,l r(e I Corner Size (a' _ ar I ..r • .4 • • • • .. • . • • . . . • • ..• • • • • • • • .1, • • •• • r • • •• • • • • • • • • • • • • • • • • • • • • • • • •• • • • • • • • • • • • • • • • 11 Page ..•• • • • • • • • • • • • • • • •• • • • • • • • • file: / /C:\Ivy %20Documents\a endix %20e.h • • • • • • • • • • • Y PP �... . ... . • 9/8/2006 SEAL CHIMENEY FLASHING REMOVE APPROX 20 TILES REPAIR LEAK TILE WHERE REMOVED & INSTALL Passed 7 7 Inspector Comments 0/ Z ° 7 0 V Failed Correction Needed Re- Inspection Fee ($75) No Additional Inspections can be scheduled re- inspection fee is paid. until Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Date: 01/25/2007 Inspector: Rodriguez, Jorge Owner: ASTRALAGA, IVAN AND MARCELA Job Address: 254 101 Street NE Miami Shores Village, FL Project: <NONE> Contractor: DALEY ROOFING INC Building Department Comments Wednesday, January 24, 2007 Block: Permit Type: Roof Inspection Type: Final Roof Work Classification: Roof - Repair Phone Number (305)773 -0577 Parcel Number 1132060134620 Lot: Phone: (305)754 -9892 Page 1 of 1 Owner's Address • frdRMIT APPLICATION FOR MIAMI SHORES VILLAGE 10050 N.E. WE Avenue • / Miami Shores, Florida 33138.330579 - - /,, Date c v I b Address �5 Iv 10 1 r Tax Folio 1 f 3 a / /n (eC / 2 11/) Legal Description Historically Designated: Yes No No Owner /Lessee/Tenet .�. LJAJ � 1� l-1= s " z' Master Permit # I / P c2-00a) • . Z !p 2s' / /Of l (0 1 3'r- (� Phone 3 3-3 .7} 1 J Contracting Co. W a- ll/' ftC' v \ l / Address Qualifier ot,L i Kik v/V a-1 &i ss# 305 T5' l 4 i State # Municipal # Competency # J B.Soo ! `Ins. Co. Leedei IF THERE IS NO PERMIT PACKAGE ACCESSIBLE ON THE JOB SITE FOR INSPECTORS TO VERIFY, THERE WILL BE NO INSPECTION. RE- INSPECTION FEE IS $50.00 AND MUST BE PAID IN ADVANCE BEFORE CALLING FOR ANOTHER INSPECTION. Permit Type (circle one): l BUILDING ELE CTRICAL PLUMBING MECHANNICAL R o WORK DESCRIPTION: ` Repdi r L Fro n+ lower v&I1(y ) Square Ft. Estimated Cost (value) j'L1o0 0 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 ANY 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 all disciplines. OWNERS 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. natu • t f owner s d/or Condo President V a1,6664 , FEES: PERMIT P * APPROVED: Zoning Building Mechanical RADON Notary as ro Owner and/or Condo President Date 41r. ry as to C My Commission Expires Haydee Valdes My Commissi * *My Commission CC748188 st, Expires May 28, 2002 46w10)6/tat-eek Date Signa ure of s tj tractor or Owner Builder ate C.C.F 6 LISA CARSON MY COMMISSION # CC 866680 EXPIRES: August 26, 2003 Bonded Thru Notary Public Underwriters NOTARY TOTAL DUE BOND Dat Electrical Plumbing Structural Engineer C .1:.c-acc,:' Name I ? OO F CA T: r'>R 0 (Low Slccc A. 7,E.,i ccic ) 0 (Y2.5-0r, ' Mt-) L �* +�'� =C Tat) I 1 iS = =�:/; :CC?_.� Si'.:��!�) i �f2 RCQf7iocd cZ __f-S (C±.."j G i.New Roai GRe- =_oofing GRecc erng VRaair Pat L .' C 514.t c: Ro•f rra (T..) coc ASCU 7-84: ?SC 7-32 F L Fe. , /i■ Dc_'c tyqc , ,1 • r Frtc'.d: dea Morn sad Adhere Se: Tile t1 coo click Job ? dc- Q ;y Ea ROOF HXtG i INT S Y S = DEL.TS (Dr r dam. ) a TT1_CFilf Y Fritterer Tppc DETAIL 1 & MOM ROOF P'i E 6 t.: vcott 3 .1.' IJ. . - - • - SLOPED SYSTEV DESCRIP770w Dc6:. ry7= Uc2e..-:o.y=czi d 4 Fs-1==r typo & zoo r DETAIL 3- Roar C4yerir.g1 Dr c± ?ago ASTI. 0:11 REQUP.RE) 1) Ea-c par. 2) Ddc Cry P:n.at= Catt • Nod= ofAc-- ace Sfc Sy = Dc=--trai b) LImbriac c) d) 3) Mcnict Atm = 4) Odaa. Ccc , _.A43Fovzis : • at SRI 11 • th x ) - x ) - Zif =11,4 PCA: x ) - M.A: APPENDIX "F "REQU 1 ED OWNERS NOTIFICATION FOR ROOFING CONSIDERATIONS As it pertains to this Appendix "F ", it is the responsibility of the roofing contractor to provide the owner with the required roofing permit, to provide the owner with this appendix and to explain to the owner the content of this form. The provisions of Chapter 34 of the South Florida Building Code (SFBC) govern the minimum requirements and standards of the industry for roofing system installations. Additionally, the following items should be addressed as part of the agreement between the owner and the contractor. The owner's initial in the adjacent box indicates that the item has been explained. •K, 1. Aesthetics - Workmanship: The workmanship provisions of Chapter 34 are for the purpose of Providing that the roofing system meets the wind resistance and water intrusion performance standards. Aesthetics (appearance) issues are not a consideration with respect to workmanship provisions. Aesthetic issues such as color or architectural appearance, that are not part of a zoning code, should be addressed as part of the agreement between the owner and the contractor. - 2. Renailing Wood Decks: When replacing roofing, the existing wood roof deck may have to be renailed in accordance with the current provisions of Chapter 29 of the SFBC. (The'roof deck is usually conceded prior to removing the existing roof system) I , : 3. Common Roofs: Common roofs are those which have no visible delineation between neighboring units (i.e. townhouses, condominiums, etc.). In buildings with common roofs, the roofing con for and/or owner should notify the occupants of adjacent units of roofing work to be performed. trA 4. Exposed ceilings: Exposed, open beam ceilings are where the underside of the roof decking can be viewed from below. The owner may wish to maintain the architectural appearance, therefore, roofing nail penetrations of the underside of the decking may not be acceptable. The SFBC provides the option of maintaining this appearance. 5. Ponding Water. The current roof system and/or deck of the building may not drain well and may cause water to pond (accumulate) in low -lying areas of the roof. Ponding can be an indication of structural distress and may require the review of a professional structural engineer. Ponding may shorten the life expectancy and performance of the new roofing system. Ponding conditions may not be evident until the original roofing system is removed. Ponding conditions should be corrected. ricA 6. Overflow Scuppers (wall outlets): It is required that rainwater flow off so that the roof is not overloaded from a build up of water. Perimeter/edge walls or other roof extensions may block this discharge if overflow scuppers (wall outlets) are not provided. It may be necessary to install overflow scuppers in accordance with Chapter 23 of the SFBC. 9 ' 7. Ventilation: Most roof structures should have some ability to vent natural airflow through the interior of the structural assembly (the building itself). The existing amount of attic ventilation shall not be reduced. - • y be beneficial to consider additional venting which can result in extending the service life of 5104 APPENDIX "F" fwner�?l�ent's Signature Date ontracpuc's Signa • re Signaturt Auld 0 i ( I l i t iPg I Miami Shores Village 10050 NE 2nd Avenue Building Permit Phone: 305- 795 -2204 Permit Number: BP2002 -516 Printed: 3/12/2002 Q Applicant: Owner: _ \ rx_ Contractor KAWALEK PAUL Address: 485 NE 92 ST Local Phone: 305 - 218 -3552 Cellular: Parcel # 1132060134620 Job Address: 254 NE 101 ST Fees: Description Amount FEE2002 -1483 Building Permit Application Fe$60.00 FEE2002 -1484 CCF $0.60 Total Fees: $60.60 Permit Status: Approved Permit Expiration: 9/8/2002 Construction Value: $400.00 Work: ROOF REPAIR (FRONT LOWER VALLEY) If there is no permit package accessible on the job -site for inspectors to verify, there will be no inspections. Re- inspection ee is $50.00, which must be paid in advance before calling for r This Permit is granted to the contractor or builder named above to construct the bL ordinances pertaining thereto and with the understanding that the work will be perforr and approved by the proper municipal authorities. This Permit may be revoked at an uthorization. A further condition upon which this permit is granted is the understand es and regulations pertaining to the work covered hereby whether shown on s agents, servants or employees. Signed: Legal Description: MIAMI SHORES SEC 1 AMD PB 10 -70 W1/2 OF LOT 5 & LOT 6 BLK 34 LOT SIZE (INSPECTOR) In consideration of the issuance to me of this permit, I agree to perform the work co ith the plans, drawings, statements or specifications submitted to the proper authom yselt, my agent, servants or employes. Signed: (Contractor or BL PAUL R. KAWALEK ROOFING & PAINTING 485 N.E. 92ND STREET PH. 305- 754 -0191 MIAMI SHORES, FL 33138 -2566 Total Fees: $60.60 Total Receipts: $0.00 o. , . sll43lo2 Porag or he 1�/ �& `� der 1 / / Ba o erc � 5 N t -ai r A CH 63100277 t,��� n (1 For 12/.0. I� V t f e rr •l t •P 1:063 L002771: 00366060 L91410 2508 Dollars 2508 63- 27/631 FL 810 8 MIAMI SHORES VILLAGE a35_, j,Pi BUILDING INSPECTION DEPARTMENT APPLICATION FOR BUILDING PERMIT Application is hereby wade for the approval of the detailed statement ur me plans and specifications herewith submitted for the build • in 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 ,. . , .•••,•,•,,., „n „ „,•.• Name and address of licensed contractor �.CY6 - ti /T fi' c-C[ l Q / to (2.3 4 y � ^"'c- ' /.1a_ , Location and legal . .1 des ription of lot to be built �” /V .. . ? f Block , u vson -7/ T n: Sbdiii s..a�,/.p..__._. // .__ 3°Zdl° /'3 `f4ze Lot. '� �P _ 1 A -� Street and Number where work is to be done r ti? 5i .••.._ /6)/ s .0 '<:1 .._._ To be constructed of STATE OF FLORIDA, COUNTY OF DADE. ss. Permit No Disapproved (Signed) Date.•._ _ / S_..._.__..._...� }9.d Cli 1/4.4,1 � � No ...r_t� ? Street._ ' Cs /0/ . Yz. Estimated Total cost of improvements $....57.e. •.�Sa. b e sent to.. . Building Inspector State work to be done and urpose of building (by floors) Stn' j O? New Building Remodeling Addition Amount of Permit 3,. Zone cubage required .Plan Cubage Distance .to next nearest building Size of Building Lot Maximum live load to be borne by each floor I hereb ubmit all the plans and specific ions for said building. All notic9 wi h reference to the building and its construction may .. ... .. - 2/Of w - 2, - f loc The undersigned applicant for this`Kuilding 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-t a work such public; notice or noticcs as are required by the Act. The undersigned agrees to employ only such su tractors, on t• be .performed und.. this permit, as are licensed by Miami Shores Village. Remarks....l� T..Lt,{ -� __ _ __ ( Signed Before me, the undersigned authority, a n000 ury 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. /7.! �...LGr`CI of the above described construction, that he has carefully read the foregoing application, and that 9fe did sign the same, and that all facts therein by him stated are true. Date 15 11 /1 . Chairman sk'rr,ber Mfembet .. _ - ...._..._._...._....... Council Approved Date V ....:...... for no other purpose. Repairs. No. of Stories 1 Kind of foundation Roof j- rY Read, S rn to and Subscribed befo me, Notary Public, State of Florida NVIMM1Y PUBLIC SIATE OF FLORIDA AT LARGE My Commission Expires m o t - C434M4ZiCAL.EXP•IBES NOV 4 1985 5UI`IUEU IHRU GENERAL INS.. UNDERWRITE PLANNING BOARD DATE' Member Member Member Disapproved Date NOTE: A charge of $1.00 will be made for making corrections or changes to this application after approval has been obtained fmm the I'Lrnnir.g ltu.vd. A re fee of 51.00 will be charged when such re inspection is made necessary by improper notice for inspection or faulty materials and /or workmanship.