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504 NE 101 St (13)PERMIT APPLICATION FOR MIAMI SHORES VILLAGE Date 2 2 Job Address .5 ' /t 44-- /0/ II Tax Folio Legal Description Historically Designated: Owner/Lessee / Tenant c / i t P y � GU'9 IG 2S 57 V ' / / S7` Contracting Co. &VP',/ lr /%/ // Uy / /� � Acd dress Owner's Address Qualifi State # Architect/Engineer Bonding Company Mortgagor Permit Type (circle one): WORK DESCRIPTION otary as to - My Commission FEES: PERMIT APPROVED: Zoning Mechanical BUILDING A RADON Munici�al # Competency # 0/WV Ins. Co. / ELECTRICAL PLUMBING Square Ft. Estimated Cost (value) 7,5 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. OWNERS AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construct and zoning. Furthermore, I authorize the above -named contractor to do the work stated. of owner and/or Condo President Date ASKEWYCZ - • • . COMP.ISSS t CC 721000 t:XAIkt:S: April 10, 2002 Banded Tin Notary Public Undernrttm C.C.F. No Building 4T f 71Rq SS# Address Address Address MECHANICAL ctor or Owner -Buil 4 / , t 1: ' or. � l. I. `" •RYSEAL tress OFF DYS l VILLAR NRIDA C7t4103 MY COMMON EXP. M� 2 Si gna My Commission E NOTARY Master Permit # Phone /4 77 / 11--- / 3 Electrical Yes ROOFINGVING F NCE SIGN C / BOND TOTAL DUE No V Date Plumbing Structural Engineer BUILDING ELECTRICAL PLUMBING Architect Contractdr� or Builder Legal Description Lot PERMIT N? 6853 f MIAMI SHORES VILLAGE, FLORIDA DATE Work to be performed under L � Buildingf v- 016 Bl. . 1; 1 this Permit Subdi- vision (k1 r, Value of Project Address of /.._ c. Building J This permit • , „.. ° • ea reetor.'oi4uilder+'iiaff etF above to construct the building or to install the equipment or devic • described in the appli- cation here .r . a a ict compliance with all ordinances pertaining thereto and with the understanding that the work wil 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 revoke 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 0 permit is granted is the understanding that the contractor or builder named above assume the res onsibility for a thorough knowledge o the ordinances regulations pertaining to the work covered hereby whether shown on the plan draw' gs or i th statements or specifications and elassumes rer sibility for work done by his agents, servants or employees. S' oak BY Contractor's Lkense No. 7 Amt. of Permit rs "� By 194,. AUTHORIT In consideration of the issuance to me of this permit I agree to per foral the work covered hereunder in compliance with all ordinances and iv pertaining ereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Sho In acceptin this permit 1 jassur responsibility for all work done by either myself, my agent, servant or employee. CONTRACTOR OR BUILDER Ownei's Name and Address_' IA_B . _ � R N o _ O Registered Architect and /or Engineer Name and address of licensed contractor Location and legal description of lot to be built on: Lot_ STATE OF FLORIDA, COUNTY OF DADE. Permit No. Disapproved ______________________ Date (Signed) 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 building 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 regula- tions 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. Subdivision Street and Number where work is to be done_ State work to be done and purpose of building (by floors) To be constructed of __ Kind of foundation__ Building Inspector and for no other purpose. New Building ___ Remodeling __ Addition_____ Repairs No. of Stories Roof Covering_ Estimated Total cost of improvements $ J G�� �, . ____Amount of Permit $ © y Zone cubage required___ _Plan Cubage Distance to next nearest 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) ms t Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeared 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, therein by him stated are true. Date Read, Sworn to and Subscribed before me. 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 materials and /or workmanship. be charged when such re- inspection is made necessary by improper notice for inspection or faul✓ Date_ uLy i_ _ , 19_T_ No. . Street__ fi 1L //V TI N My Commission Expires Notary Public, State of Florida to me well known. and that he did sign the same, and that all facts