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501 NE 101 St (6)10050 NE 2 Ave, Miami Shores, Fl 33138 Tel: (305)795 -2204 • Fax; (305)756 -8972 PLEASE PRINT TIME: / ° 7 1° 44-1 NAME OF PERSON REQUESTING FILE: 4 /(-)/ 0 (/ , o�c�� DATE: 1//0‘ Miami Shores Village Building Department PHONE #: C30S. 77 - f9J YOUR ADDRESS: / Ale /0( 64 ADDRESS OF FILE REQUESTED: & 4/L/6 INFORMATION REQUESTED: 056 r/Ce I understand that all documents in this file are property of Miami Shores Village and that NO documents may be removed from this file. You may get 4 complementary copies (8x11) size, additional copies will be furnished at 0.15 cents per page, not including any blue prints. If blue prints are order please be aware that we are not responsible for the quality of the printed documents. Acknowledged by: FILE RETURNED TO: INITIAL DATE: 1 7 1 / 2 1 — lot Acknowledged by: FILE RETURNED TO: INITIAL Miami Shores Village Building Department 10050 NE 2 Ave, Miami Shores, Fl 33138 Tel: (305)795 -2204 • Fax; (305)756 -8972 PLEASE PRINT NAME OF PERSON REQUESTING FILE: / lL3 PHONE #: -31C-776 -fmro YOUR ADDRESS: 3/ Nr / s/ -- ADDRESS OF FILE REQUESTED: c�'4 iC INFORMATION REQUESTED: Se-fr17 I understand that all documents in this file are property of Miami Shores Village and that NO documents may be removed from this file. You may get 4 complementary copies (8x11) size, additional copies will be furnished at 0.15 cents per page, not including any blue prints. If blue prints are order please be aware that we are not responsible for the quality of the printed documents. TIME: a % 7 f '"� City (Rev. 04124103) Address Miami Shores Building Officials Approval ,/ Miami Shores Village Building Department Certificate of Re- Occupancy The following residence is issued a Certificate of Re- Occupancy State Florida 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795 -2204 Fax: (305) 756 -8972 Permit No. 2 J 2 Date 6N,/ NO 3 Zip This certificate verifies that the referenced property has been inspected by Miami Shores Village and has been determined 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 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 interested persons are advised and encouraged to make their own inspection of the premises in order to determine the condition thereof. 4. (Rev. 5/5/03) RE- OCCUPANCY APPLICATI I N /. Q3 Date c� Contact Name EDJAe_ LC :So ►^---) Phone # 6 / /-'.c: Buyer Seller Realtor v Company Name Property Address 5 0 ( /-,EL (0 / L N- City Miami Shores State Fl Zip $ 3/ 3,P 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 the property. OWNER'S AFFIDAVIT: I certify that all the foregoing inform tion is accurate. Applicant Name Signature The foregoing instrument was acknowledged before me this 0 1 day of '._k no , 200 ?j , by SLD s vs , , who is personally known to me or who has produced bi-\ _ k c NOTARY PUBLIC: Miami Shores Village Building Department A. Sign: 033._tA% Print: N2--ti-\00. S p a 1Ck My Commission Expires: Building Officials Approval: 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795 -2204 Fax: (305) 756 -8972 Permit No. 0232) Loc ID as identification and who did take an oath. Re -Occ. $5.0.00 Notary $5.00 CCF $0.60 Total THIS .LICENSE MOST . PI$PLAYED IN A CONtP'.CU.flPUS _ PLACE A 7-ehatty is imposed for fore to ems license exhibited at. y estab&bot aee of business' ii 't'� mu. c a t v . Z t tr t •• t ° t tF� V ' a � a ,.'• ... c 'cp 4� 'cp 4�xi a si ucvlag it i 4 p fc $f •�' c `�i;�cp ' di! co" sLde alrio *vet ale P aid to Miami Shores . Village, . Dade County, State of. 104 :14 e period beginnin t to, the ' z . t � xnesS` .o F.., YV1' `HCYUT AMR-OVAL OF THE VILLAGE . M AGER STATE OF FLORIDA ) SS COUNTY OF DADE ) / y ' 7`r '� of the Village of Miami Shores, County of Dade and State of Florida, being duly swam, doth depose and say. lhal under the provisions of Ordinance No. 185, dated June 15, 1948. as snit ins paragraph.(d) of Section B.C48 of Ordinance No. 97 p the Building Code of Miami Shores' T lags, he des r to bu ld a �° , d. a d oa Lot 5 Meek ( 05P / ► f iQ` r,z, r 0r Subdivision, that he is the owner of said property, and will be the owner of said , that he 1111 th the work perm nally, and that he wilr1, at such tines as are required by the Zoning and Building Directors- 1. File plans and specifications and obtain approval of the Planning Board and the Building Inspector. 2. Apply for and secure a Perait. 3. Pay the required fees. 4. Execute the work is accordance with the provisions of this Code. 5. Apply for inspeet ion. 6, File with the Buildiag Inspector certificates that provision has bean made to carry the aecessary Workmen's Compensation, Public Liability and Property Damage Insuresoee #FFIDAVIT File with the Building Inspector as the jot progresses oerti- fioates showing the payment required by the Federal Social Security Act to the State of Florida or the United States of America. 6. Assume the responsibility of not employing other than properly licensed contractors by Miami Shores Village for an part or portion of the work. 9. Not set himself up as a "oontractor ". 10. Sig* an affidavit before commencing work to the effect that he has read this Article and. will do t he work personally std observe all of tha Eleotrioal, Plumbing and Zoning, Cedess of Miami Shores village, Such affidavit to be prcperAy notarized upon blanks to be supplied by the Building Inspector. 11. SA order to prevent abuses and aibterfuge tin right of such owner.'builder as herein profided, is limited to but one owner- builder permit each 21 years. aad where as ownerbuilder has ono, exercised the privilege herein conferred so second application for owner- builder permit shall be gram ed in less than 2 years, unless the applicant is qualified se a licensed Cameral Contractor under the applicable Ordinances of said Village. And Further this Deponent Bays note --- .0 4 - 1 4 vi 0 SUBSCR FV AN SWORN TO BEFORE ME THIS v � (� day of 19 v — / ' NOTARY PUBLIC A. D., NOTARY PUBLIC, STATE_ OF FLORIDA AT LARC.i, MY COMMISSION EXRIR'LS AUGUST 15, 1f:5r:•