379 NE 100 St (9)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 Re?
Registered Architect and /or Engineer
Name and address of licensed contractor
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 • purpose of b il.ing by floors)
a
Date__._7_
f No
and for no other purpose.
New Building Remodeling. L Addition Repairs No. of Stories
To be constructed of Kind of founda Roof Covering
®�
Estimated Total cost of improvements $�_sr�. 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 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 as are required by the Act. The undersigned agrees to employ only such subcontractor on ork o be perform d under this
permit, as are licensed by Miami Shores Village.
Remarks (Signed)._
Street
/ ,Z'./%- cc?J... J� � ... ►...
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 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 Date Read, Sworn to and Subscribed before me.
Disapproved Date
Notary Public, State of Florida
(Signed)
Building Inspector My Commission Expires
PLANNING 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.
ll
1
fri
$UILDING
ELECTRICAL
PLUMBING
HOOFING
Owner of
Hui'ding f 3
MIAMI SHORES VILLAGE. FLORIDA
El
❑ DATE f 1 CP 1954
❑ PERMIT N? 4069 Contractor's
License No. ` f
21 Work to be performed under this Permit
'\ rchitect I I
L'ontractor
Builder
.egal Lot
)escription —
n ddress of
wilding
4,.
_ �r
/ r
II Subdi-
B1 vision
Value of
Project $
f„ PAmount e of $ 2
This permit is granted to the contractor or builder named above to construct the building or to install the equipment or device described in the application
lerefor in strict compliance with all ordinances pertaining thereto and with the understanding that the work will be performed in compliance with any plans,
irawings, statements or specifications that may have been submitted to and approved by the proper municipal authorities. This Permit may be revoked at any
ime if the work is not done in compliance with such ordinances or if the plans are changed without authorization. A further condition upon which this permit is
granted is the understanding that the contractor or builder named above assumes the responsibility for a thorough knowledge of the ordinances and regulations
pertaining to the work covered hereby whether shown on the plans or drawings cr in the statements or specifi . tionn and that he assumes responsibility for work
one by his agents, servants or employees. /
i
Signed .. , ,,
INSPECTOR
In consideration of the issuance to me of this permit I agree to perform the work covered • under in compliance with a ordinances and regulations
_'ertaining thereto and in strict conformity with the plans, drawings, statements or specifications sub .. tted to the proper authorities of Miami Shores Village. In ac-
-epting this permit I assume responsibility for all work done by either, myself, my agent, servant or employee.
CONTRACTOR OR BUILDER BY AUTHORITY 6 ..
Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the build-
ing or oilier structure herera described. This .irplicatiou is made in compliance and con•ormity with the Building Ordinance of Miami
Shores Village, Florida, and all provisions of the Laws c:f the State. of Florida all o of Miami Shores Village and all rules and
regula` ions of the Building Divi:L of a.iianu Slion" illage •h .'1 )e complied with, whether herein specified or not. A copy of approved
plans and specifications must be kept at building durin progress of the work.
Owner's Name and Address__
Registered Architect and /or Engineer._ _ ___ _ -._ .___.._ ._... .
Name and address of licensed contractor ._ -. ' _A-.r ___..___
Location and legal description of lot to be built on:
Lot. __. Block.._ ___ Subdivision..
MIAMI SHORES VILLAGE
APPLICATION FOR BUILDING PERMIT
Remodeling
Date__ .__.
..5 /o S
BUILDIN' INSPECTION DEPARTMEN
Addition...
flan Cubage_
Date
Disapproved - -- ________ - - Dat
(Signed) ___ _ •_...
BuildirJnspector
PLANNING BOARD
Chairman Member
Member ____ _ _ ______ __ __ . Member
Member _ _ .__ Member _.. . .
Council Approved Date Disapproved .
Repairs. _
No Street.
F jj C U
Street and Number where work is to be done. 1 . 7 _ - _____ A _ 2 6
State work to b purpose of building (by floors)
New Building_
To be constructed of Kind of foundatin
Estimated " .ta1 cost of improvements S. a_ °6 4_- Amount of Permit $._ ...
Zone rubage required __.
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 building and its construction may
be sent to
The unde signed appli -ant for this building permit does hereby certify 'that he understands and accepts his obligations as an employer
of 1• bor under he Florida Workmen's Compensation Act. being S ction 5966, Compiled Gen. -al Laws of Florida. P r,,umcnl Supple cent,
and h s cornpl:ed with he prov' :ions thereof, and will require similar comnliance from all contractors or sub - contractors cmplo'.•ed by hint
in the wo k to be p rf - med under this peen it and •:ill post or cause to be posted for inspection on the site of the work simli public note, e
or •otices as are requir d l:y the Act. The u. do nign.•d agrees to employ only such subcontr, ctors, on work to be perform. d a der this
permit as are licensed by M ami Shores
Remarks_. (Signed) - _x
My Commission Expires_
and for no other purpose.
No. of Stories
Roof Covering__
STATE OF FLORIDA,
COUNTY OF DADE. ss.
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally i'p-
peared
and who, being by me first d: ly sworn, upon oath depoees and says that he is the
of th abov. de ibed istruction t ..t h. has carefully read the foregoing application, and that he did sign the same, and that all facts
therem by him stated are tr,ie.
Permit No._ ....
Read, Sworn to and Subscribed before me.
Notary Public State of Florida
DATE
------- - -- --- - 19
to me well known,
l y; -c
Date
NOTE: A charge of $1.00 will be made for snaking corrections or changes to this application .after approval h s het n obtained from
the Plan' ng Board.
A re- inspection fee of $1.00 will be charged when such re- inspection is mr ie necessary by improper notice fir inspc• too or fa. aty
materials and /or workmanship.
j
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