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441 NE 101 St (5)MIAMI SHOR S 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 pt gress of the work. 4r - 7 Z • Owner's Name and Address /4Q. terms � No .... ��( .._.. StreeL..,GOL R egii;tgted 4 hitQ t crn .fr,.r1,... , :., -.:- .. ::......:.r , ....... , . , ,....,,...,.u.a :u: , , trl SS ft Itt.,21 Name and address of licensed contractor Otv N !ti - Location and legal desc iption of lot to be built on: Loti // ( .r ._ �l � 4 '44' .. ...l..l Block �� Subdivision e4'e'� t"`r����� � r� -s.�c ..�?� Street and Number where work is to be done '�'( 1 t.._�e/ _ _� State work to be done and purpose of building (by floors)_..— .....S r.N .... rg.0 -- ._._ .: � . - o-v —_ /C_ (Signed) Disapproved ___. — __._ _ .. .. D. to and for no other purpose. New Building Remodeling " Addition L"'" Repairs No. of Stories To be constructed of -Ce" -- e Kind of foundation /Q Roof vering Estimated Total cost of improvements $ S _ 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 onl subcontracto on ork o • " performed under this permit, as are licensed by Miami Shores Village. ' Remarks .---- _..- --- --_ --�. STATE OF FLORIDA, COUNTY OF DADE. J ss Before me, the undersigned authority, a notaxy public, duly authorized to administer oaths and take acknowledgments, personally ap- peared . 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 state are true Permit No. S-3 Date ? __ Read, Sworn to and Subscribed before me. Notary Public, State of Florida Building Inspector My Commission Expires to me well known, PLANNIN • , BOARD DATE Chairman Member Member .. - -- Member ..._.._...__.._....._.. __....__._......_..._ Member .. Member _.._............ _ ._�._ ... _....._......_....w. 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. • OFFICE: 4201 Le JEUNE RD. CORAL GABLES, FLA. 33146 LOCATION SKETCH LAND SURVEYOR MIAMI, RLORroA SURVEY NUMBER 72 WOO Of LOT /8 AA/O TIME 4UEi5r 440' OA LOT /9 SUBDIVISION AmENOED . GAT , QF M /%•# M /. SHG1/ -DES S4` eT/04/ A4. ¢ ACCORDING TO THE PLAT THEREOF AS RECORDED IN PLAT BOOK No. /S AT PAGE No. /4 PUBLIC RECORDS OF, OA ©E COUNTY, FLORIDA. DATE: /I.4!?C�'/ - 15 /9 , 72 FOR: DOS/ /A/ /OAI ,�A/0 4/V J 77 TLe Ea So :2 [1 14 b 1. Io l 9 IS IS It 8 t t 7 2o It 4 El 3 22 So 2 62. s I� ,0 23 24 szJ PIPE N.E. IO2 " sr NE '' 0 U! 1 0.2 d. Is 01 101 2.0 SCALE 1" = 200' 20.(. 3T 42. f3 90.00 I - S RY c. Ij. S A/0. 441, 24.1 24.1 20.9 'ST¢C's. J 3 N 1L :fit IS' ALLEY 8' PLIVEME NT Po 'rein 4 WATEIQ LINES 4... 4.4 ; J So. 00 5' S I DEW ALK. Q,E, I0t ST 7 s' R/ W - 2 o' PAVEMEAIrr. 25.4 2Co. BLOCK I HEREBY CERTIFY THAT THE ATTACHED SKETCH REPRESENTS A RECENT SURVEY MADE UNDER MY DIRECTION AND IS TRUE AND COR- RECT TO THE BEST OF MY KNOWLEDGE AND BELIEF. THERE ARE NO ENCROACHMENTS. REGISTERED STATE OF FL LOc4TE0 I N M■d &l 1.i0 a, FLA 11.7 0 0 PIPE TELEPHONE: 444-7692 1961 LOT MAILS SCALE 1" or 2,0'