456 NE 100 St (10)Street and Number where work is to be done
STATE OF FLORIDA
COUNTY OF DADE.
} SS.
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 building 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 ✓ P -) P l9�U
Owner's Name and Address P.644/WL- No. Street
Registered Architect and/or Engineer J
Name and address of licensed contractorr...A P /t/d /'5if # J> irti 444.01e &t)
Location legal description of lot to be built on: '7 94 )
S r 4 4 ; , ► �L / 352/ �.�s'A .�
Lot�,s �Z� Block f Subdivision � L_
State work to be done and purpose of building (by floors). state exterior colors (submit samples)
/ and for no other purpose.
Repairs
No. of Stories
New Building V Remodeling Addition
To be constructed of ) Kiyd�f foundation Roof Covering
Estimated Total cost of improvements $ 7 �J 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 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 obligatons 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 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 ploy on/s subc tracto . on work to be performed
under this permit, 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 appeared
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. 1(S V Date 1 � � 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 $25.00 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 $25.00 will be charged when such re- inspection is made necessary by improper notice for inspection or faulty materials and/or workmanship.
BUILDING ❑
ELECTRICAL ❑
PLUMBING ❑ PERMIT N9 8726
ROOFING ❑
Owner of
Building_
Architect
Contracto
or Builder
Legal
Descriptic
Address
Building
a
CONTRACTOR OR BUILDER
MIAMI SHORES VILLAGE. FLORIDA
Work to be performed under this Permit
DATE
Contractor's
License No I t -.
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
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 responsibility for work
done by his agents, servants or employees.
Signed: 4 .,� Y.p �� BYE
INSPECTOR
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, r ant or employee.
BY AUTHORITY
195''
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Sq. Ft
Amt. of
Permit
$
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Value of
Project
$ �
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BUILDING ❑
ELECTRICAL ❑
PLUMBING ❑ PERMIT N9 8726
ROOFING ❑
Owner of
Building_
Architect
Contracto
or Builder
Legal
Descriptic
Address
Building
a
CONTRACTOR OR BUILDER
MIAMI SHORES VILLAGE. FLORIDA
Work to be performed under this Permit
DATE
Contractor's
License No I t -.
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
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 responsibility for work
done by his agents, servants or employees.
Signed: 4 .,� Y.p �� BYE
INSPECTOR
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, r ant or employee.
BY AUTHORITY
195''
a
's
.: Balance due Builder
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IGT�W�t; IIC.CW�1 . ..Vi'O..iCW' ..... �3'�t/GVZ'�S ;GQZQJS .1i;GAT'�i; :.. Fri(GVT'�:I i;CpT'V�ff i ;�DZtT�..
Issued 19"
Amount
No. Houses
KNOW ALL MEN BY T
Address
in consideration of the issuance
WITNESS MY HAND and
WHEN CLEARED AND REPAIRED BY THE VILLAGE
Amount of Bond $ 60-90
Cost of clearing and repairs done by Village . $ HOHC
cJd lami £oreslllage
F L O A ID A
BUILDER'S BOND
ESE PRESENTS, that I,
,,..
to me by Miami Shores Village, Florida, of a permit or permits to construct or repair a building
or build' gs at the following a d ;esses: 141 7
/ � G
®
4- ,- 4< /
do hereby deposit with Miami Shores Village, Florida, the sum of 0 , and I agree with said Village that, when such construction shall
have been completed by me within the meaning of the ordinances of said Village, I will clear all premises and repair any Village property damaged by me,
used for the deposit of material or equipment in the construction or repair and that, if I do not so clear and repair such premises immediately upon the
completion of such constructipa wi»ttathe meaning of such ordinances, the Village may dear and repair the same and pay the costs of such clearance and
repairs t of the aforesaid �nd return the remainder to me; and that, if 1 shall clear and repair said property immediately, as aforesaid, then
said shall be returned to me.
Seal at Miami Shores Village, Florida, this
INSTRUCTIONS TO BUILDER -- -When above mentioned construction is completed and the premises are cleared and repaired take this bond to the
Village Building Inspector and obtain his approval, after which Miami Shores Village will refund your money in accordance with the above agreement.
VILLAGE BUILDING INSPECTOR'S APPROVAL
I hereby certify that the construction contemplated under this Bond, has been completed and that the builder thereof has
caused the surrounding premises to be cleared and repaired in as good condition as they weye befo co ing said construction.
r
day of
506
age )3 il. • _ .e• or, Miami Shores Village.
50.
Cancelled 19 By �P