278 NE 101 St (8)PERMIT A P78'x! / PLICATIO F
o / N OR MIAMI SHORES VILLAGE
6 S T
Date 2 - *76 6 Job Address 3go F a fie4 Bev • Tax Folio
4
Legal Description 413 �d W Y2 1 et 2 Oleic t3 Historically Designated: Yes
Owner/Lessee / Tenant A/67 So N C /j PO Si d L 10 . Master Permit #
Owner's Address 27 6? A ( /0/ 4t2ce■T M - S . Phone 757- STO 1 Wo4C : '7 • /000
Contracting Co. (7 v(/ /1 /F' /2_ Address
Qualifier SS# Phone
State # Municipal # Competency # Ins. Co.
Address
Architect/Engineer
Bonding Company Address
Mortgagor JT /d ??ck Cc) Address
Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING
G✓GUd24 -,
{ /wait j bvid / 66-eed W44K
Cht&I
WORK DESCRIPTION
Square Ft. 75 `ea-L. lee,t Estimated Cost (value) / foO CU
FEES: PERMIT
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 t9 do the work stated.
Si
of owner and/or Condo President Date
Notary as to Owner and/or Condo President Date
My Commission Expires:
RADON
APPROVED:
Zoning Buildin
Mechanical
2• i6'
C.C.F.
No I/
3faa-6
FENCE SIGN
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Si gna e o ntractor or Owner- Builder Date
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NOTARY _ / — TOTAL DUE i
Notary as to Contractor or Owner- Builder
My Commission Expires:
Electrical
Date
dO - 7-6
Plumbing Engineering
4. " * iAMBRA CIRCLE — SUITE 404
_ GABLES, FLA. 33134 THOMAS J KELLY, INC.
t ( 300)444 -7692 LAND SURVEYOR
0 (300) 779 - 3288
,X : (3001 441- 6494
SKETCH OF SURVEY
SCALE: In= WI
SURVEY N0.____ __
SHEET OF
MIAMI SHORES VILLAGE, FLORIDA
BUILDING - � 4,r7
ELECTRICAL Date "' - '' 19St -/
PLUMBING ❑ PERMIT Np 9196 Contractor's
ROOFING ❑ License No 41 d
❑ Work to be performed under this Permit
Owner of E'
Building - 4...
Architect
Contractor
or Builder
Legal Lox 11
Description 11 B1
Address of
Building
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.
CONTRACTOR or BUILDER
Subdi-
vision
Sq. Ft.
Value of � 't .• I I Amount of /
Project $ 11 Permit $ €o
Signed: L..- ." ., ' (INSPECTOR) BY
In consideration of the issuance to me /of this permit I ree to perform the work covered hereunder in compliance with all ordinances and regulations
pertaining thereto and in strict conformity with the plans, dra ngs, 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, servant or employee.
dr
fi.. L •
BY AUTHORITY
Permit No
Disapproved
(Signed)
91
l
Building
MIAMI SHORES VILLAGE
Date
Dat
BUILDING INBIP[CTION 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.
Date � r SUPT. Z 1 , 19 67
iw No 2
Owner's Name and Address . 4.. M_ ®_ rzst $ Street__ _�F 5r
.._.�5�1 �T..._
Registered Architect and /or Engineer_
Name and address of licensed contractor Ehiera.At...___ceNC.0 CC 1 NI , ? 8 S._.__N. W.._2r6*t'
Location and legal description of lot to be built on:
Lot &.__ . 0r____Ze _._ Block 34 Subdivision_AMENc—U__RAT b_F _ iAt✓_u. -a_1 Ca
Street and Number where work is to be done
State work to be done and
purpose of building (by floors). etn31.1._].__ -Pe ►1 ce z(-is " y C t
(draw aw tnci -. -Q � b� o-�- pl c ats
and for no other purpose.
New Building Remodeling Addition Repairs No. of Stories
To be constructed of Kind of foundation Roof Covering 9 Estimated Total cost of improvements $ ) 7 S
Amount of Permit $.6
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.Gel_g C G., — 7 a5 N . W. 2 6 s% Av c .
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, Pennanent 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 suc : . tr ctors, on work to be performed under this
permit, as are licensed by Miami Shores Village.
Remarks (Si
ctor
o6
STATE OF FLORIDA,
COUNTY OF DADE. j 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.
Read, Sworn to and Subscribed before me.
Notary Public, State of Florida
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.
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