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271 NE 101 St (10)MIAMI SHORES VILLAGE BUILDING DEPARTMENT • 305- 795 -2204 Building Inspection Request Date 31 7 1-- Y' Type Insp'n +"Cr v` Permit No. BP ,2C06 NameO9J2Q Address 71 Nt 101 S Company CDC.L.(\ Phone # Inspection Date Correction Re- Insp'n Fee ❑ 1 I -- 1 ••41111 KJ' N./ L) BUILDING- Permit 'Type ( Owner's Name Owner's Address CHI VII Qd ynt 'fenanl /I..,cssee Name Contractor's Company Name Contractor's Address State Certificate or Registration No. Value of Work For this Permit 'I'ype of Work: ❑Addition Describe Work.: Total Fee Now Due $ (Continued on opposite side) V 111 • CJ Bulld�lzg epartment 10050 N.E.2nd Avenue, 4iiani Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 Fee Si le Titlel PERIVVl.1.T APPLICATION EEC 2001 Architect /Engineer's Name (if applicable) n 4 !ethical Plumbing ond✓a c l2 le IN strinefatate t' f (-Pc c. 7 o.. ' of Job Address (where the work is being done) Slate 2-11 10\ City Miami Shores Village Country Miami-Dade Is Building Historically Designated YES NO Zip Phone /I Certificate of Competency No. Square Footage Of Work: CO /CC 50 ['Alteration 0 �. �~ * * * * * * * * * * * * * * *" * * ees ** ** * Submittal Fee $ r J Permit Fee $ Notary $ lining /Education Fee $ Scanning $ 3 Radon $ (ode Enforcement $ ^ , ❑ ew /00 e),ct-p ZoTing Structural Plan Review. $ Phone # Zip Permit No. .8i .05 Oat? I\'iaster Permit: No. Mechanical Rooting Phone # 3 DS ?D0 - y g9 D I L // Phone # Zip Repair /Replace Technology Fee $ io Bond $ ❑ Demolition 1,74LILA Bonding Company's Name (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. 1 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 constriction and zoning. "WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR 'IMPROVEMENTS TO YOUR PROPERTY. W 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 e.stimated value exceeding $2500, the applicant must promise in good faith that a copy of the notice of commencement and conslruclion 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 afier the building permit is issued In the absence of such posted notice, the inspection will not be approved and inspection_ fee will be charged. Signatur 'Ja Owner or Agent The foregoing inst►7iment was ack► wledged before me this / r The foregoing instrument was acknowledged before me this____ day of 4 , 20©� , by ay of , 20 _, by who is personally known to me l 6 �c9(D o/8 ' (9.5 A�identifi NOTARY P My Commission Expires: Signature Contractor / who is personally known to me or who has produced W323870 OM: fq , 2008 Bond antic BoR91 , hw My Commission Expires: as identification and who did take an oath, ***************************************'************************************** * * * * * * * * * * * * * * * * * * * * * * * * * * ** * ** *********************************************:* ** * *: * * * * *** * *** * * * * ** * * ****** • ***4 * * * **** +:r *** + +��•.h.i.a � �:: APPLICATION APPROVED BY: Chc 05/13/03 Ito Plans Examiner Engineer Zoning Proof of ownership provided ( ) Q Owner Owner VILLAGE OF MI MI SHORES BUILDING DEPARTMENT OWNER BUILDER DISCLOSURE STATEMENT a t !�Gt - C.K .-- being the legal property owner, for the property Located at: a KJ 6 DI s • Legally described as ' Do hereby petition the Village of Miami Shores to act as my own contractor pursuant to the laws of the State of Florida, F.S. 489.103(7),And I have read and understand the following disclosure Statement, which entitles me to *ork as my own con actor, I further understand that I as the owner rnust appear in person to complete all applications. DISCLOSURE STATEMENT State law requires construction to be done by licensed contractors. You have applied for a permit under an exemption to that law. The exemption allows you, as the owner of your property, to act as your own contractor even though you do not have a license. You must supervise the construction yourself. You may build or improve a one - family or two-family residence or a farrr out - building. ` You may also build or improve a commercial building at a cost of 525,000.00 or less. The building must be for your own use and occupancy. It may not be built for sale or lease. If you sell or lease a building you have built yourself within one year after the construction is completed, the law will presume that you built it for sale or lease, which is a violation of this exemption. You may not hire an unlicensed person as your contractor. It is your responsibility to make sure that people employed by you have licenses required by state law and by county or municipal licensing ordinances. Any person working on your building who�is not Licensed must work under your supervision and must be employed by you, which means that you must deduct F.I.C.A. and with- holding tax and provide workers' compensation for that employee, all as prescribed by law. Your construction must comply with all applicable laws, ordinances, building codes and zoning regulations. Was • . • wledged before me this day of initial of reviewing clerk. The foregoing instrument as identification and who personally known to me or who has id take an oath. 5582 N.W. 7th STREET, SUITE 202 MIAMI, FLORII:)4 33126 TELEPFIONc;.(305) 264-2660 FAX: (305) 264 -0229 . • Nona ururtnrii $nt. LAND SURVEYORS SURVEY NO _.. �_ X05/ J SHEET NO ' OF -� in 15 Sc IG .. 17 1 8 ' - . A p • 21 at S o 23- 5: 5582 N.W. 7th STREET, SUITE 202 MIAMI, FLORIDA 33126 TELEPHONE: j'.305) 264,2660 FAX' (305) 264-0229 DRAWN BY: SURVEY OF LOT 19 AND THE WEST 1/2 OF LOT 20 IN Subdivision: AN AMENDED PLAT OF MIAMI SHORES SECTION NO. 1 According to the Plat thereof as recorded in the Plat Book No. 10 at Page No. 70 of the public records of MIAMI -DADE County, Florida. Property Address: 271 NE 101 ST, MIAMI For: ALEXANDAR SELZER 6 � A = ARC. A/C = AIR CONDITIONER PAD. A.E. = ANCHOR EASEMENT. A/R = ALUMINUM ROOF. A/S = ALUMINUM SHED. ASPH. = ASPHALT. B.C. = BLOCK CORNER. BLDG. = BUILDING. B.M. = BENCH MARK. B.O.B. = BASIS OF BEARINGS. C. = CALCULATED. C.B. = CATCH BASIN. . C.B.S. = CONCRETE BLOCK STRUCTURE. CBW = CONCRETE BLOCK WALL. CH. = CHORD DISTANCE. CH. B. = CHORD BEARING. CL. = CLEAR. • C.L.F. = CHAIN UNK FENCE. C.M.E. =CANAL MAINTENANCE EASEMENT. CONC. = CONCRETE. C.P. = CONC. PORCH. C.S. = CONCRETE SLAB. D.E. = DRAINAGE EASEMENT D.M.E. = DRAINAGE MAINTENANCE EASEMENT. DRIVE. = DRIVEWAY. 0 = DEGREES. E. =EAST. E.T.P. = ELECTRIC TRANSFORMER PAD. ELEV. = ELEVATION. ENCR. = ENCROACHMENT. F.H. = FIRE HYDRANT. F.I.P. = FOUND IRON PIPE. F.I.R. = FOUND IRON ROD. F.F.E. = FINISHED FLOOR ELEVATION. Nnua frur equrs e llur. v,/-/ LAND SURVEYORS LOCATION SKETCH Scale 1" =,</• 7: Sa o' 1 - IO ' 0 11 2 L•. ABBREVIATIONS AND MEANING F.N.D. = FOUND NAIL 8 DISK FR. = FRAME. FT. = FEET. FNIP. = FEDERAL NATIONAL INSURANCE PROGRAM. F.N. = FOUND NAIL. H. = HIGH (HEIGHT) IN & EG. = INGRESS AND EGRESS EASEMENT. L.P. = LIGHT POLE. L.F.E. = LOWEST FLOOR ELEVATION. L M E. = LAKE MAINTENANCE EASEMENT. = MINUTES. M. = MEASURED DISTANCE. MON. = MONUMENT. MM. = MANHOLE M/L. = MONUMENT LINE. N.A P. = NOT A PART OF. NGVD= NATIONAL GEODETIC VERTICAL DATUM. N. = NORTH. N. T.S. = NOT TO SCALE. M - NO. =NUMBER. 0 /5.= OFFSET. OH. = OVERHEAD. O.H.L = OVERHEAD UTILITY LINES OVH. = OVERHANG. O.R.B. = OFFICIAL RECORD BOOK. PVMT. = PAVEMENT. PL. = PLANTER. P /L. = PROPERTY LINE. P.C.C. = POINT OF COMPOUND CURVE. P.0 = POINT OF CURVE. PT. = POINT OF TANGENCY. POC. = POINT OF COMMENCEMENT P08. = POINT OF BEGINNING. P.R.0 = POINT 0 REVERSE CURVE. PROP. COR. = PROPERTY CORNER P.B = PLAT BOOK PG = PAGE PWY = PARKWAY PRM = PERMANENT REFERENCE MONUMEN'. P L.S = PROFESS NAL. LAND SURVEYOR, = RECORDED DISTANCE. RR. = RAILROAD. RES. = RESIDENCE. R/W. = RIGHT -OF -WAY RAD. = RADIUS OR RADIAL. H.P. = RADIUS PONT. RGE. = RANGE. SEC. = SECTION. STY. = STORY SWK = SIDEWAL SIP = SET IRON PIPE L.8 66044 S. = SOUTH. 5 N D = SET NAIL & DISK L.B.#604 SP. = SCREENED " =SECONDS. P T. = TANGENT. ORCH TWP. = TOWNSHIP. U.E. = UTILITY EA UTIL. = UTILITY. U.P. = UTILITY PO E. W.M. = WATER M TER. W.F. = WOOD FEI CE. WS. = WOOD SHED. = CENTRAL ANGLE W = WEST. = CENTER LIN ANGLE. LEGAL NOTES TO ACCOMPANY SKETCH OF SURVEY (SURVEY): EXAMINATION OF THE ABSTRACT OF TITLE WILL HAVE TO BE MADE TO DETERMINE RECORDED INSTRUMENTS, IF ANY. AFFECTING THE PROPERTY. THIS SURVEY IS SUBJECT TO DEDICATIONS. LIMITATIONS, RESTRICTIONS, RESERVATIONS OR EASEMENTS OF RECORD. LEGAL DESCRIPTIONS PROVIDED BY CLIENT OR ATTESTING TITLE COMPANY. BOUNDARY SURVEY MEANS A DRAWING AND/OR A GRAPHIC HEPRESENTA TION OF THE SURVEY W •RK PERFORMED IN THE FIELD, COULD BE DRAWN AT A SHOWN SCALE AND/OR NOT TO SCALE. EASEMENTS AS SHOWN ARE PER PLAT BOOK, UNLESS OTHERWISE SHOWN. THE'TERM 'ENCROACHMENT' MEANS VISIBLE AND ABOVE GROUND ENCROACHMENTS ARCHITECTS SHALL VERIFY ZONING REGULATIONS, RESTRICTIONS AND SETBACKS AND THEY M. BE RESPONSIBLE OF SUBMITTING PLOT PLANS WITH THE CORRECT INFORMATION FOR THEIR APPROVAL FOR AUTHORIZATION TO AUTHORITIES IN A NEW CONSTRUCTION, UNLESS OTHERWISE NOTED, THIS FIRM HAS NOT ATTEMPTED TO LOCATE FOOTINGS AND/OR FOUNDATIONS FENCE OWNERSHIP NOT DETERMINED. THIS PLAN OF SURVEY. HAS BEEN PREPARED FOR THE EXCLUSIVE USE OF THE ENTITIES NAMED HEREON, THE CERTIFICATE DOES NOT EXTEND TO ANY UNNAMED PARTY: THE FNIP FLOOD MAPS HAVE DESIGNATED THE HEREIN DESCRIBED LAND TO BE BLOCK 35 SHORES, FL 33138 So h9 8 7 b 5 4 3 50 57 '1\ in 0.00 X x0.00 SURVEY No 50 t (t LEGEND TYPICAL 2) IF SHOWN, ELEVATIONS ARE REFERRED TO 3) THIS IS A SPECIFIC PURPOSE SURVEY BY. REVISEDON Situated in Zone: X Community /Panel /Suffix: 120652- 0093 -J Date of Firm: 07/1 -7/1995 Base Flood Elevation: Certified to: ALEXANDAR SELZER SOUTH PO.INTE TITLE COMPANY - ATTORNEYS TITLE INSURANCE FUND, INC. AAMES HOME LOAN , I.TS S HUES SORS. ANI) /OR ASS.i.( SHEET NO. OF 2 Date: 09/28/2001 1- 0010513 11 (O 13i 14 lb IL 501 57 WOOD FENCE CHAIN LINK FENCE. C.B.S. WALL (C.B.W.) EXISTING ELEVATIONS. PROPOSED ELEVATIONS SURVEYORS'S NOTES: I) IF SHOWN. BEARINGS ARE REFERRED TO AN ASSUMED MERIDIAN. BY SAID PLAT IN THE DESCRIPTION OF THE PROPERTY IF NOT, THEN BEARINGS ARE REFERRED TO COUNTY TOWNSHIP MAPS B M ELEV ..__ - OF N,G V.D OF 1929 4. 4). THE CLOSURE IN THE BOUNDARY SURVEY IS ABOVE 1:7500 FT I HEREBY CERTIFY. THAT THIS 'BOUNDARY SURVEY' OF THE PROPERTY DESCRIBED HEREON, AS RECENTLY SURVEYED AND DRAWN UNDER MY SUPERVISION, COMPLIES WITH THE MINIMUM TECHNICAL STANDARDS AS SET FORTH BY THE FLORIDA BOARD OF PROFESSIONAL LAND SURVEYORS IN CHAPTER 61017 -6, FLORIDA ADMINISTRATIVE CODE PURSUANT TO 472.027. FLORIDA STATUTES r IBARRA (DATE OF FIELL] W PROFESSIO AL LANG SURVEYOR NO. 5 `Oy STATE OF FLORIDA (VALID COPIES OF THIS S RVEY WILL BEAR T116 EMBOSSED SEAL OF THE ATTESTING LAND SURVEYOR) 9 SEAL Miami Shores Village 10050 NE 2nd Avenue Phone: 305 - 795 -2204 Permit Number: BP2005 -222 Printed: 2/28/2005 Applicant: CARL PAULSEN Owner: PAULSEN CARL JOB ADDRESS: 271 NE 101 ST Contractor Local Phone: Parcel # 1132060134810 Signed: (INSPECTOR) Building Permit Contractor's Address: Page 1 of 1 Legal Description: MIAMI SHORES SEC 1 AMD PB 10 -70 LOT 19 & W1/2 OF LOT 20 BLK 35 LOT SIZE Fees: Description Amount FEE2005 -2574 CCF $1.20 Total Fees: $62.10 FEE2005 -2575 Notary Fee $5.00 — FEE2005 2576 T- raining -and E- ducation -Fee $0.40 Total Receipts: $0.00 FEE2005 -2577 Technology Fee $2.50 FEE2005 -2578 Scanning Fee $3.00 FEE2005 -2579 Building Fee $100.00 FEE2005 -2580 Submittal Fee ($50.00) Total Fees: $62.10 Permit Status: APPROVED Permit Expiration: 8/15/2005 Construction Value: $1,130.00 Work: REPLACE PORTION OF WOOD FENCE AS PER SURVEY ATTACHED. r r�`'• G 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 responisibility for all work done by either myself, my agent, servants or employes. Signed: (Contractor or Builder) BY: Owner's Name and Addres Remarks 7.9`, t-V1 MIAMI SHORES VILLAGE BUILDING INSPECTION DEPARTMENT APPLICATION FOR Application is hereby made for the approval of the detailed statement of the described. This application is made in compliance and conformity with the Buildi State of Florida. all ordinances of Miami Shores Village and all rules and regulati herein specified or not. A copy of approved plans and specifications must be kep Registered Architect and/or Engineer Name and address of licensed contractor /24/0- Location and lleega description of lot to be b!ujIt on: Lot / 7 / t gall) /6? Block '� Street and Number where work is to be done or 7J Permit No. Disapproved Date (Signed) Subdivision 77//g State work to be done and purpose of building by floors), state exterior colors Isubmit samples) /2 . LNG ) 746 4 !1.--. j7aa (ye /2 G L -y 12 / /1 e_ O Ari 5. f.s WOOD yWC +c/ 150X New Building Remodeling Addition To be constructed of Kind of foundation oo Estimated Total cost of improvements $ Zone cubage required Distance to next nearest building Maximum live load to be borne by each floor 1 hereby submit all plans and specifications for said building. All notices wi The undersigned applicant for this building permit does hereby certify that he undo Compensation Act, being Section 5966, Compiled General Laws of Florida. Perman compliance from all contractors or sub - contractors employed by him in the work t on the site of the work such public notice or notices as are required by the Act. T under this permit, as are licensed by Miami Shores Village. STATE OF FLORIDA COUNTY OF DADE. } ss. Before me. the undersigned authority. a notary public, duly authorized to administer oaths and take acknowledgments, personally appeared 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. Date Building Inspector PLANNING BOARD BUILDING PERMIT ns and specifications herewith submitted for the building or other structure herein g Ordinance of Miami Shores Village, Florida, and all provisions of the Laws of the ns of the Building Division of Miami Shores Village shall be complied with. whether at building during progress of the work. I 9M > // 1.24 M • /1 / __Amount of Permit $ Plan Cubage Size of Building Lot and for no other purpose. Repairs No. of Stories Roof Covering h reference to the building and its construction may be sent to rstands and accepts his obligatons as an employer of Labor under the Florida Workmen's nt Supplement. and has complied with the provisions thereof. and will require similar be performed under this permit: and will post or cause to be posted for inspection he undersigned grees to e only h subco actors, on w. to be performed (Signed) Read. Sworn to and Subscribed before me. Date J /oz, 199 No. A V/ Street /494e Notary Public. State of Florida to me well known. My Commission Expires DATE Chairman Member Member Member Member Member Council Approved Da Disapproved Date NOTE: A charge of $25.00 will be made for making corrections or changes to his application after approval has been obtained from the Planning Board. A re- inspection fee of $25.00 will be charged when such re- inspection is made ecessary by improper notice for inspection or faulty materials and/or workmanship. _El L. 2 LEZU14/.. Z 41 New Building APPLICATION FO 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 shal 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. To be constructed o Estimated Total cost of improvements $ Zone cubage required Distance to next nearest building Maximum live load to be borne by each floor MIAMI SHO Owner's Name and Address Registered Architect and /or Engineer Name and address of licensed contractor___ Location and legal description of lot to be built on: Lotna a3 Block I1!/ Subdivision -'4 Street and Number where work is to be done szt State work to be done and purpose of building (by floors) deling of oundation 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 here y 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 si ilar compliance from all contractors or sub - contractors employed by him in the work to be performed under this permit; and will post or ause 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 subcontractors, on work to b performed s under this permit, as are licensed by Miami Shores Village. Remarks (Signed) _ STATE OF FLORIDA, COUNTY OF DADE. Before me, the undersigned authority, a notary public, duly peared to me well known, and who, being by me first duly sworn, upon oath deposes and ays 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 4 i 7 Date Disapproved ( Signed) SS. Building Insp; ctor PLANNING BOARD Chairman Member Member Council Approved NOTE: A charge of $1.00 will be made for making correc the Planning Board. A re- insection fee Of $1.00 will be charged when such re materials and /or workmanship. BUILDING INSPECTION DEPARTMENT RES VILLAGE Addition BUILDING PERMIT Date o.__= Street_ le G g,.e,i .Gd oq e and for no other purpose. Repairs No. of Stories Roof Covering Amount of Permit $ _Plan Cubage Size of Building Lot 00. 4-5 uthorized to administer oaths and take acknowledgments, personally ap- Read, Sworn to and Subscribed before me. Date 4,/ Notary Public, State of Florida My Commission Expires DATE Member Member Member Disapproved Date ions or changes to this application after approval has been obtained from inspection is made necessary by improper notice for inspection or faulty a2Li jz../ 5/ � 7 _ ac_ NIA Sliefl,a3 BUILDING ELECTRICAL PLUMBING ROOFING tl �. r Owner of Building =< MIAMI SHORES 1;ILLAGE, FLORIDA D DATE i 19 o PERMIT N? 's 4 9 2'7 Contractor's License No. 4 El gi Work to be performed under this Permit Architect Contractor ""-- or Builder Legal Lot ‘4:- - D • escription it C CONTRACTOR OR BUILDER Subdi- vision . Address of 4 Value of _' l l Amount of Building ; 4 ? Project $ ll Permit $ 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 applica- tion herefor in strict compliance with all ordinances pertaining thereto and with the understanding that the work will be performed in compliance with any plans, drawings, statements or specifications that may have been submitted to and approved by the proper municipal authorities. This Permit may be revoked at any time 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 or in the statements or specifications and that he assumes respon- sibility for work done by his agents, servants or employees. (' Signed. ' INSPECTOR In consideration of the issuance to me of this permit I agree to perform he 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 as cepting this permit I assume responsibility •fdi~ all work done by either, myself, ny agent, servant or employee. 1' . - F' BY AUTHORITY ABBOT ek" MIAMI SHORES VILLAGE BUILDING INSPECTION DEPARTMENT APPLICATION FOFt 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 l of Florida, all ordinances of Miami Shores Village and all rules and regulations of the Building Division of Miami Shores Village shall e complied with, whether herein specified or not. A copy of approved plans and specifications must be kept at building during progress of the work. / D Date- - - - -( te �C. 5 ,.. , Owner's Name and Address._. e/ / / ct o :L . / ,Street /C/ %St( Registered Architect and /or Engineer `� 4 - -_ . 4, /� Name and address of licensed contractor t 1 t 1 i ' Location and legal descrip ion of lot to be built on: //. // Lot.. .t= e /2=.__ �.�Block ' Subdivision._. / , g __ /70_,CP-S Street and Number where work is to be done._,. _7/ ,.ei / g /_4/172Z State work to be done and purpose of building (by floors) ,eF'c ) .._ /-",--'4,). 6 — To be constructed of Kind of foundation Estimated Total cost of improvements $ o.� ( � Zone cubage required Distance to next nearest building. Maximum live load to be borne by each floor F GL - 7.C and for no other purpose. New Building Remodeling Addition Repairs No. of Stories Roof Covering Amount of Permit $ .Plan Cubage Size of Building Lot 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 ca ise 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 subcontra rs, on work to be performed ;der this permit, as are licensed by.Miami Shores Village. Remarks (Signed) A Permit No Disapproved (Signed) 1 Date _ C� Building 'pector PLANNING BOARD Chairman Member Member Council Approved Date M. a./ /S Read, Sworn to and Subscribed before me. vas STATE OF FLORIDA, COUNTY OF DADE. ss. Before me, the undersigned a \thou , 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, upo 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. Notary Public, State of Florida My Commission Expires 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 from the Planning Board. A re- inspection fee of $1.00 will be charged when such re-in pection is made necessary by improper notice for inspection or faulty materials and /or workmanship.