350 NE 101 St (8)1-�
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Date ? -9 ,Job Address , '. V \OVA _ Tax Folio
Legal Description Historically Designated: Yes
Owner/Lessee / Tenant \ \\V-N Master Permit #
Owner's Address . \Q`
Contracting Co. 0 cAl A-( 5
Qualifier
State # Municipal #
Architect/Engineer
Bonding Company
Mortgagor Address
WORK DESCRIPTION
SS#
Competency #
Address
Address
Address
Phone
Phone
Square Ft. Estimated Cost (value) S1',c
Ins. Co.
No
Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECH, )FING PAVING FENCE SIGN
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.
laws regulat ng co
VIT: I certi
truction and
AFF
Signature of owner and/or Condo President
FEES: PERMIT i tt l RADON
APPROVED:
Zoning
Mechanical
that all the foregoing information is accura
ning. Furthermore, I authorize the ab
Date
Notary as to Owner and/or Condo President Date
My Commission Expires:
C.C.F.
Building � t3 / 4 J[ 6 k
that all wor
ctor to
Signature of Contractor or Owner- Builder Date
Electrical
in compliance with all applicable
ted.
Notary as to Contractor or Owner- Builder
My Commission- Expires; - -
i
Date
NOTARY I TOTAL DUE
Engineering
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.
STATE OF FLORIDA,
COUNTY OF DADE. ss
MIAMI SHORES VILLAGE
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:
Lot Block
Street and Number where work is to be done
BUILDING INSPECTION DEPARTMENT
eV ) /_. No.... Street.
Subdivision..._..... _.
Stet wor to be done d par osse of building (bv floors )
and for no other purpose.
New Building Remodeling Addition Repairs � No. of Stories
To be constructed of Kind of foundation Roof Covering
Estimated Total cost of improvements $ . . " 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 subcontractors, 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 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 aret t i e. . Permit No Date / e °' � =,e' � Read, Sworn to and Subscribed before me.
Disapproved Date
(Signed) j ,�` < "�
Building Inspector My Commission Expires
Chairman
Member
Member
Notary Public, State of Florida
PLANNING BOARD DATE
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.
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.... -. '. /14. h J 6No...3 Street.
Registered Architect and /or Engineer
Name and address of licensed contractor r-
Location and legal description of lot to be built on
Lot Block 3 Su � f i vision "
Street and Number where work is to be done
S ta wto be 7yu of building ()y floors
STATE OF FLORIDA,
COUNTY OF DADE. j ss •
,,z_.. ,yam y /
/a/
old i4 4/P iF Y' iP/._a,rQ
and for no other purpose.
New Building Remodeling Addition Repairs No. of Stories
To be constructed of Kind of foundation Roof Covering
Estimated Total cost of improvements $4. lid " ' ' 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, 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 such subcontractors, on work to be performed under this
permit, as are licensed by Miami Shores Village.
Remarks (Signed)
7
!te fo %�
•
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.
BUILDING
ELECTRICAL
PLUMBING
ROOFING
VCa , 11,
Owner of
Building "'"ii " i/
Architect
Contractor
or Builder
Legal
Description
Address of
Building
Lot
p PERMIT
`r ❑
MIAMI SHORES VILLAGE. FLORIDA
/ s
• 4r7
tee
r-
BI
/
N° _ 4846
CONTRAC'OR OR BUILDER BY
Work to be performed under this Permit
Value of
Project $
DATE J - f 1952 —
Contractor s
License No / (
1
u
Amount of
Permit $
v
t
Subdi-
vision
y
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 kowitdge of the ordinances and regulations
pertaining to the work covered hereby whether shown on the plans or drawingyb in the statens€nts or specificatig?t p
Aaid that he assumes responsibility for work
done by his agents, servants or employees. ` ff .{
Signed. I • ' „ BY
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 ac-
cepting this permit I assume responsibility for all work done by either, myself, my agent, servant or employee.
AUTHORITY B