441 NE 101 St (15)I, P u )k
APPLICATION FOR CERTIFICATE OF RE- OCCUPANCY
to re- occupy the single family residence known as : (address)
4 )V JO1' 37,
. Legal Description:
Lot: 1 i/o() , ' BIock C/ f
I hereby certify that I understand that the zoning of the property is for single- family residential use
and that it is unlawful for more than one family to reside therein. I also understand that any
Certificate of Re- Occupancy that may be issued by Miami Shores Village, certifies only that the
referenced property is being used for single - family purposes and that such Certificate does not
constitute any representation, warranty or certification as to the condition of the dwelling or other
structures on such property.
Applicant CI V) Po r e, Date A / C41 -- , 9 20 0 O
Print Name
******** * * * * * * * * * * * * * * * * * * * * * * * * * * * * **. ******* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
For purposes of conducting the inspection required by Section 902 of the Miami Shores Land
Development and Zoning Code, please contact:
Contact Name: A n Yl �G i Jc
Buyer Seller Realtor Company Name Y' V f C9 0i1
Application Fee ($50) paid: Cash Check No.
Comments:
PAGE I OF 2
, Miami Shores, Florida.
•
, hereby apply for a certificate
PB &PG: I6
Telephone: 3
Inspected by: Frank LuBien Approved x Denied Date 11 /13/00
CER'I II ICATE OF RE- OCCUZ'ANCY
On behalf of Miami Shores Village, Florida, the undersigned certifies that the property
described in the above application has been inspected for purposes of re- occupancy pursuant to
Sections 901 and 902 of the Miami Shores Land Development and Zoning Code and that such
property may be re- occupied by the above applicant for single- family residential purposes.
THIS CER 1 U ICATE VERIFIES THAT THE REFERENCED
PROPERTY HAS BEEN INSPECTED BY MIAMI SHORES
VILLAGE AND HAS BEEN DETER LED TO PRESENTLY
COMPLY WITH THE SCHEDULE OF REGULATIONS OF THE
MIAMI SHORES LAND AND DEVELOPMENT CODE
PERTAINING SOLELY TO THE REQUIREMENT THAT EACH
ONE - FAMILY DWELLING IS USED AND INTENDED TO BE
USED FOR A ONE- FAMILY DWELLING PURPOSE ONLY;
HOWEVER, THIS CERTIFICATE DOES NOT CONSTITUTE ANY
REPRESENTATION OR WARRANTY AS TO THE CONDITION
OF THE DWELLING OR OTHER STRUCTURES ON THE
PREMISES DESCRIBED HEREIN, OR ANY ASPECT OF SUCH
CONDITION, AND INTERES lhll PERSONS ARE ADVISED AND
ENCOURAGED TO MAKE THEIR OWN INSPECTION OF THE
PREMISES IN ORDER TO DETERMINE THE CONDITION,
THEREOF.
PAGE 2 OF 2
MIAMI S ORES VIT.T,AGE, , ORIDA
Date of Certification: 1 1/ 1 3/ 0 0
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, whetl r herein specified or not. A copy of approved
plans and specifications must be kept at building ( during progress of the work.
Date ""�► I/ �, `°
Owner's Name and Address
No... Street
Registered Architect and/or Engineer .
Name and address of licensed contracte-A-a. e.„ ‘411.7),\L„
Location and legal description of lot to be built on:
Lot
Subdivision
Street and Number where work is to be done. , •
State work to be and purpose of wilding (by floors) t1..
Block
Building Ins ctor
- 5
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 $ c� Q _._ / 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 p s and specifications for said building. All notices with reference to the building and its construction may
b
be sent to 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 .n the site of the work such Zmblic notice
or notices as are required by the Act. The undersigned agrees to employ only such bcontracto `l work to be performed under this
permit, as are licensed by Miami Shores Village.
Remarks ( Signeefl�✓''""� �•
STATE OF FLORIDA,
COUNTY OF DADE. 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.
Permit No _� - -, Date _._lt'-
Disapproved t3
(Signed) ..-
Read, Sworn to and Subscribed before me.
Notary Public, State of Florida
My Commission Expires
LANNING 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 S 'I.00 will be charged when such re- inspection is made necessary by improper notice for inspection or faulty
materials and /or workmanship.