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'4/ L t ot t„■. , .0 IC,. fr ir:: : (1 0C 1 • 1 C • . ;' `, L 9 4.4 • Kind of Insurance Policy No. Expiration Date Limits of Liability Workmen's Compensation Employer's Liability WC- 205845 1/1/52 Statutory Manufacturer's or Con- tractors Public Liability Bodily Injuries MPL -819 1�1�52 $ 50,000 one person $ 100,000 one accident Manufacturer's or Con- tractors Property Damage MPD- 1 +81 1 +9 1/1/52 $ 1000 one accident , $ 10, 000 aggregate Owner's or Contractor's Contingent Liability Bodily Injuries $ one person $ one accident Owner's or Contractor's Contingent Property Damage $ one accident $ aggregate P - 120d -9 -50 Certificate of Insurance Date June. - 27 • This is to Certify that the following described Policies, subject to their terms, conditions and exclusions, have been issued to the Assured named herein by either the BITUMINOUS CASUALTY COR- PORATION or Me BITUMINOUS FIRE FIND MARINE INSURANCE COMPANY, of Rock Island, Illinois, and are now in full force and effect. Descriptive Schedule Assured Address of Assured Locations Covered BOBERT C _ BARSER 197 N. R. 89th Street Miami Florida S.E. Corner 101st Street, and 4th Avenue, Miami Shores, Florida Same and e lsexhere in the State o Florida Description of Work A11 operations of the Asarred This Certificate is issued to Bni 1 rl i ng DPpFn'tment - Att I n, Mr - Joree Village of Miami Shores whose address is In the event of cancellation of any of the above Policies the insuring company will notify Me party to whom this certificate is issued by giving ten (zo) days prior notice of such cancellation, butJlieitzsuring_r. r. urn4c.aao t+bray. 47Llialu Y49a 4 iluse e.gsoe- 646644ae46e. by registered mail to the Building Department, Village of Miami. Sh CASUALTY CORPORATION Miami Shores, Fla. or BITUMINOUS FIRE _AND MARINE ,,,INSURANCE COMPANY Miami ShoreR F1nridR By Authorized Representative 1735 Ponce de Leon Blvd., Coral Gables, Fla. Location Certificate of Insurance BITUMINOUS CASUALTY CORPORATION OR BITUMINOUS FIRE AND MARINE INSURANCE COMPANY ROCK ISLAND, ILLINOIS H. H. CLEAVELAND, .Jr., President ISSUED TO SPECIALIZING IN WORKMEN'S COMPENSATION AND ALL LINES OF LIABILITY COVERAGE "sec with se' ice" • Notary Public, State of Florida at Large, My Commission Exri•n, f,taY 2D, iS3S5_ And Further this Deponent says not: A F F I D A V I T 2. Apply for and secure a Permit. 3. Pay the required fees. 4. Execute the work in accordance with the provisions of this Code. 5. Apply for inspections. 6. File with the Building Inspector certificates that provision has been made to carry the necessary Workmen's Compensation, Public Liability and Property Damage Insurance. 7. File with the Building Inspector as the job progresses certi, ficates showing the payment required by the Federal Social Security Act to the State of Florida or the United States of America. 8. Assume the responsibility of not employing other than properly licensed contractors by Miami Shores Village for any part or portion of the work. 9. Not set himself up as a "contractor ". 10. Sign an affidavit before commencing work to the effect that he has read this Article and will do the work personally and observe all of the requirements of the Building, Electrical, Plumbing and Zoning Codes of Miami Shores Village. Such affidavit to be properly notarized upon blanks to be supplied by the Building Inspector. 11. In order to prevent abuses and subterfuge tba right of such owner - builder as herein provided,'is limited to but one owner •builder permit each 2 years, and where an owner - builder has once exercized the privilege herein conferred no second application for owner - builder permit shall be granted_.in less than 2 years, unless the applicant is qualified as a licensed General Contractor under the applicable Ordinances of said Village. OWNER SUBSCRIBED AND-SWORN TO BEFORE ME this o`' R �' day of � 19 5/ • STATE OF FLORIDA) SS COUNTY OF DATE ) b -U of the Village of ' Miamj,,$hores, County of Dade and State of Florida, being duly sworn, doth depose and say, that under the provisions of Ordinance No. 185,, dated June 15, 1948, amend' ing paragraph (,d) of Section B - 368 of Ordinance No. 97 of the :.uilding Code of Miami Shores Village, he desires to bu'ld a 42,. on Lot 114%1 Block 9p of 4 Subdivision, that he is the owner of said property, and will be the owner of said , that he will do the work personally, and that . he will, at such times as are required by the Zoning and Building Director:- 1. File plans and specifications and obtain approval of the Planning Board and the Building Inspector, A. D., /fir) a /Z 5 .. i/ .. /0 - . - 9 . 8 .. 7 .r 6 .5 .. 4 .. 3 fro 2 ,'04// v H a cn 'o °l 6 "fi/ / /4 /5 /c /7 - /8 w /9 Zo Zl 77 - Z3 N N N NE: / 5 A / / e /0 /sT /00 Ty /00 Sc / =3 o' 57 E't T 5712E Scale: 1:4/6o' SKETCH OF SURVEY Lki vt Lots 11 and 12, Block 90, MIAMI SHORES SECTION 14.4 Amd., according to the Plat thereof, recorded in Plat Book 15, at page 14, of the Public Records of Dade County, Florida. Order #4897 F.B. #93_16 June 30,1951 Scales shown I HEREBY CERTIFY: That the attached "SKETCH OF SURVEY" of _ Oa 1 ove deso*tb ed property is trust t to the best of my know1ed - ref, as re- cently surveyed �ted r my direction. Ha ke Registe ed ti- Surveyor #602 State off' " o'er.,