Loading...
54 NE 101 St (11)Inspection Number lNSPI2642 Inspection Date: 04/05/2006 Inspector: Grande, Claudio Owner: PATTON, KAREN Job Address: 54 101 Street NE Project: <NONE> Miami Shores Village, FL Contractor: DECORATIVE MASONRY INC Building Department Comments Tuesday, April 4, 2006 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phon ` 05)795 -2204 Fax: (305)756 -8972 Permit Type: Driveways /Sidewalks /Slabs Inspection Type: Foundation Work Classification: New Block: ermit Number: DS -3-06 -707 Phone Number (305)807 -2220 Parcel Number 1132060131350 Lot: Phone: (305)757 -7765 Page 2 of 2 Passed P --' 109(4 Inspector Comments Failed Correction Needed Re- Inspection Fee ($75) No Additional Inspections can be scheduled re- inspection fee is paid. until Inspection Number lNSPI2642 Inspection Date: 04/05/2006 Inspector: Grande, Claudio Owner: PATTON, KAREN Job Address: 54 101 Street NE Project: <NONE> Miami Shores Village, FL Contractor: DECORATIVE MASONRY INC Building Department Comments Tuesday, April 4, 2006 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phon ` 05)795 -2204 Fax: (305)756 -8972 Permit Type: Driveways /Sidewalks /Slabs Inspection Type: Foundation Work Classification: New Block: ermit Number: DS -3-06 -707 Phone Number (305)807 -2220 Parcel Number 1132060131350 Lot: Phone: (305)757 -7765 Page 2 of 2 BUILDING PERMIT APPLICATION FBC 2004 Permit Type (circle): Building Electrical Plumbing Mechanical Roofing Owner's Name (Fee Simple Titleholder) r J /j4Tr Phone # . ,.. &07 ?22.0 Owner's Address : 5 - 40) --- / City /. f /�Xi>y°S State AZ Tenant/Lessee Name /Y/f¢ Job Address (where the work is being done) City Miami Shores Village FOLIO / PARCEL # Is Building Historically Designated YES Contractor's Address State Certificate or Registration No. Value of Work For this Permit $ %eta Miami Shores Village Building D epartment 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 ‘3, Y County Miami -Dade Zip NO Phone # Architect/Engineer's Name (if applicable) Phone # Permit No. It 1 0 Master Permit No. Zip /�Ic& Contractor's Company Name .. ecap,rf' oe. hone #3Qa 75 7 7 <&< 3 4 99,-- _ City /��� = ��� - L�" tate� Zip �� , Qualifier Name '� Phone # 7e 7Z9.SQ .5 Certificate of Competency No. , >,,eS'� �a Square / Linear Footage Of Work: - C OVED MAR 1 0 2005 SZO tO-f Type of Work: ❑Addition Alteration ' , '' ' "'' f' . „ " yp ❑ ❑New � ' " �Repair/Replace ': ❑Demolition Describe Work: . Z,42 54t,, 4 eJ, I, -1r ` '' ri�l�6� r/U'2 Gc1/5 1 7 . P C ********* * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** F * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** Submittal Fee $ P Permit Fee $ G ar� CCF $ CO /CC Notary $ Training/Education Fee $ Technology Fee $ Scanning $ Radon $ DPBR $ Zoning $ Bond $ Code Enforcement $ Double Fee $ Structural Review. $ Total Fee Now Due $ See Reverse side —3 Bonding Company', ar>ee (abf<appl cable) Bonding Company's Address City Mortgage Lender' , `?a ne 1 if applicable) Mortgage Lender's Address City State Zip Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRICAL WORK, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS an¢�► C(ND�IVIE NER , ETC OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. "WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT 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." Notice to Applicant: As a condition to the issuance of a building permit with an estimated value exceeding $2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. Signature (Revised 02/08/06) Owner or Agent The foregoing instrument was acknowledged before ' m e this / day of 6/t 200!0 , by -4- t Vl TC 1 '-,-, who is perso own to me or who has produced NOTARY PUBLIC: iRrtnratt / '�j }!rf I r,., i Lrr,..� ! rnt .,'w a, Le . , o °" i 'State Zip APPLICATION APPROVED BY: Signa As identification and who did take an oath. Atb 16h 51 2-1i 0 as identification and who did t an oath. Contractor The fore oing instrument w acknowledged before me this /4 day of I , 20 Ub , by {ale( FGiCI S .400 , who is personally known to me or who has produced 17, £'t ✓UtS LiL NOTARY PUBLIC: Sign: Print: " MONICA USSETH DIAZ MY COMMISSION # DD 483995 J � BoMetl Ttw Notary PO* UrldOIVIrit0f3 Sign: Print: My Commission Expires: _ " ' • _ MY Comm. Expires Jun 18, 2009 My Commission Expires: .' Commission q DD 399013 E. *,t * * * * * * * * * * * * * * * * * ** * ' e»f * rydeN kl lF,A#i!►x, *************, r*********, t * * * *,r * * *,t * * * * *,r * * * * * * * * * * * ** 7111111111111111111111111111111111111111118 111811118111111111111111111111111111111111119. Plans Examiner a,„, ngineer requests permission to install: within the public road right of way of /j PPS 0r+crF Y?//iamL Shorei 10050 N.E. SECOND AVE. MIAMI SHORES. FLORIDA 33138 - 2382 Telephone: (305) 795 -2207 Fax: (3051756 78972 COVENANT OF CONSTRUCTION WITHIN RIGHT OF WAY WHEREAS, 4fW , hereinafter referred to as the Owner of the (owner) following described property: Asphalt, concrete, brick pavers (] Landscaping (] Other SIGNED, SEALED AND DELIVERED in the presence of: Guns u uuuuu uu mavulummom uumnnuauuuuunl ''!N. MICHELE E. SOLOMON v. . ?o Notary Inc State of Florida _ � i 7 a ', M C o m m. Expires Jun 18, 200A 1 " pop; Commission N DD 399013 F. g 4 4 fY ` Bonded by National Notary Assn. g nniIIIIIIIIIIIIII►IIIIIIIII IIIII II IIIIIIIIIIIIIIIIIImIII11111II II II II IIII IIItIIIIIIIIIIlit (owner) Legal description /folio #: Lot 6 fe Block /e Subdivision jp, caP o;CI,." Tax Folio R: address) IN CONSIDERATION of the approval of this permit by the Village, the Owner agrees as follows: 1. To maintain and repair, when necessary, the above- mentioned item(s) installed within the dedicated right of way. If it becomes necessary for Miami Shores Village or Dade County to make repairs or maintain said items within public right of way including restoration of street by reason of the Owner's failure to do so, such expense shall be paid by the Owner or shall constitute a lien against the above described property until paid. 2. The owner does hereby agree to indemnify and hold Miami Shores Village or dade County harmless from any and all liability, which may rise by virtue of permitting the installation of these items within the public right of way. 3. The Owner does hereby agree to remove or relocate their facilities at their own expense, within 60 days notice by the Village to do so. Failure to comply with this notice will result in the Village causing the item(s) to be removed and a lien being placed on the property and/or assessed against the Owner for all costs incurred in the removal and disposal of the item(s). 4. The undersigned further agrees that these conditions shall be deemed a covenant running with the land and shall remain in full force and effect and be binding on the undersigned, their heirs and assigns, until such time as this obligation has been canceled by an affidavit filed in :the. Public records of.Dade County, Florida by the Village Manager of Miami Shores Village (or his fully authorized representative). SIGNED, SEALED, EXECUTED AND ACKNOWLEDGE on is III day of /V744.44 ► x00 'STATE OF FLORIDA) COUNTY OF DADE) The undersigned Affiant, 4(1160 Pfr (property owner attached survey, performed by Th4 j 14 J !,1 _ Zee. (name of surveyor's company) performed on 0/ *.Q,y -2, is an accurate representation of the existing conditions and (date of survey) locations of all structures on the property as of this date. The purpose of this Affidavit is to induce Miami Shores Village to issue a building permit for the property without first providing a survey less than six (6) months old. The Affiant, as property owner, further agrees to remove or obtain permits for any structures which now may exist on the property which are not permitted-or which may violate zoning or building code regulations. The Affiant further understands that the existence of any such structures may affect final inspections as applicable to this or other permits.. Further, Affiant sayeth naught. SWORN TO AND SUBSCRIBED before me this / ' day of Affiant is ersonally known to me, produced , does hereby attest that the as identification. M 11II IIIIl 111111011111111111111111 titi1111111111111u111111111IiIIIIIIIIIitllumwg ` �,� o � � � MICHELE E. SOLOMON Public - State of Florida ''� • ° My Comm. Expires Jun 18, 200P ; � �P�' Commission # DD 399013 Bonded by National Notary Assn. 1111 unin 11111 111111111111111unnuIIIIIIIIinin IIIIIIIIIIIIIIIIIIIIIinninnili in STATE OF FLORIDA: COUNTY OF MIAMI -DADE: differ fit date is 'pe 'fied) Notary Public Print Notary's 123.01 -52 PAGE 4 8/02 Name My commission expires: STATE 0 1 H: RE 0 WI NOTICE OF COMMENCEMENT A RECORDED COPY MUST BE POSTED ON THE JOB SITE AT TIME OF FIRST INSPECTION PERMIT NO. TAX FOLIO NO. THE UNDERSIGNED hereby gives notice that improvements will be made to certain real property, and in accordance with Chapter 713, Florida Statutes, the following information is provided in this Notice of Commencement. 1. Legal description of property and street/address: %GS d - �� i ,re / • 2. Description of improvement: .�u' , 5,,d / �d�fGeL.C �/?'�e :$ A ice/ V 3. Owner(s) nanfe and address: .'9' I e,ii PA-7-7-00, 5Y rue 101 .•t /m iami Shots, R 33i38 Interest in property: -3/ /c 401 Name and address of fee simple titleholder: 4. Contractor's name and address: 5. Surety: (Payment bond required by Name and address: Amount of bond $ 6. Lender's name and address: .3.3/e owner from contractor, if any) 7. Persons within •the state of Florida designated by Owner upon whom notices or other documents may be served as provided by Section 713.13(1)(a)7., Florida Statutes, Name and address: 8. In addition to himseli Owners designates the following person(s) to receive a copy of the•Lienor's Notice as provided in Section 713.13(1)(b), Florida Statutes. Name and address: 9. Expiration date of this Notice of Commencement: (the expiration date is 1 year from the date of recording unless a S lyiiauaic vi vvv.,ici ,, __ `` Print Owner's Name 4/1 Z.€- Pk --sv 1.-/ Sworn to and subscribed before me this /'& day of eGG� tiGce /e /lo'� 'Mt C.�1 I e t/ �. ,20 J 4..P $- gl9e9t7 .....IIII WItlI11111 111 11111IIlIIl lllIIIlmmmmmmlm1',IttttttHWHufluI't_` • mici ICL E.SOLOMON °— — a � __ ° � ;; Nofary=Publia Stets ottElorfda R. . _ _. A B . My Comm. Expires Jun 18, 2000. '! - Commission # DD 399Q13 %. " Bon b y Nati ona l Notary Assn. 1tI IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIt lI111111IIIIllllltR. ORIDA, COUNTY OF DADE RTIFY that this is a true of the day Courts DEC. 111111111111111111111111111111111 111111111111 CFN 20nt6R02932 OR Bk 24338 F'9 2648; (1P9) RECORDED 03/17/2006 15:25:39 HARVEY RUVIN, CLERK OF COURT MIAMI -DADE COUNTY' FLORIDA LAST F'AGE Prepared by 0i74y /.' /AAV Address: Permit No.: DS 30 G - 70 7 Miami Shores Village Building Department Planning & Zoning C-fitiq let �C nK rTr O.� O cAp?,,, I 4 / Applicant: /(are Job Address: Sy /0/ 5-! Date U . ga y € (e,ch an le J ( � in -for th tel 1,4/4 , o f 10050 NE 2 Avenue Miami Shores, Florida 33138 Comments re 1tr,Q t 2 (le] 441 5 4 Swale /pnr CIA/ G,r aA(1 / d ry ve►r . PIe0.SP b r -oulol P D y at (e-4 I n ' /7 ( i . .P - i-,eets P a iP 1 / 4wo Bees prep Derh h✓ Initials Tel: (305) 795 -2204 Fax: (305)756 -8972 40 ' Res i vice o._ M rerVr 4/ Ala M ems 5 /l/ /0/ i /vAir Shore .s, /2 IYe& ,;-ec - 467 A/e6Ir/ j�'�eT . /Feea / rep /ee ospi ,.t. iya‘ a," 44/ % / / / 9 , 9 ° � ®4 / AAA; / v C "",//)0err0 ,l4$ e &./i// co4'cr E of y,y r see de 4i /,6e /�uv 23' PARKWAY s/c7. : 75.00'00R) AVEMENT CHIMNEY BLOCK CORNER 295.10'(Mf 295.00'(0 LOT 7 BLOCK 10 FINISH GRADE i► 1a11 111 55.00' ONE STORY RES. 54 CONCEALED EDGE RESTRAINT W/y #5 --- ST SLOPE 1-111- 11 - 1I- DETAIL (1 BRICK PAVERS • • JOINT FILLING SAND , /� J` - SAND DED 1• • • 3%161 • • • o ••• • f • • •• • •••• • • • • •••• • • • •• • 5 ••••;• • • •••••• • • • ••••• • ••.•• •••••• .: •••••• • • 6" LIMEROCK COMPACTED TO A MIN. OF 98% OF MAX. DENSITY AS DETERMINE 5Y AASHTO T -180 (MIN. 4" THICKNESS REQUIRED) LEgEND OF SURVEY ABBREVIATIONS ' A ARC DISTANCE A/C .... AIR CONDMONINo C CALCULATTO C.B CATCH BASIN CL .... CLEAR CIL ....CENTER UNE ENC ... ENCROACHMENT p,C POINT OF CURVATURE FIP .... FOUND IRON PIPE P.O.B.. , POINT Of BEGINNING O.M.... OVER NANO W.M WATER METER P.B.... PLAT BOOK M MEASURED PAL ...PROPERTY LINE CONC .. CONCRETE UP ... UTILRY'POLE F.D FOUND CERTIFY TO: Karen Patton & Paul Kaess Columbia Title Of Florida, Inc. Ticor Title Insurance Company First Guaranty Mortgage Corp. Its Successors And /Or Assigns LEGAL DESCRIPTION: Lot: 6&LW 1/2 OFLOT5 Block: 10 Subdivision: An Amended Plat Of Miami Shores Sec 1 According to the Plat thereof as recorded in Plat Book: 10 Page: 70 Public Records of MIAMI -DADE County, Florida. ADDRESS: 54 NE 101 STREET MIAMI, FL 33138 Encroachments Noted: LOCATION SKETCH SCALE: 16 7 17 SE'A. ER A, P.S. d M. #4858 STATE O FLORIDA NOT VALID UNLESS IMPRINTS) WITH AN EMBOSSED SURVEYORS•S SEAL N.E. 101st STREET 18 NOTES■ . A) AS Clwsrmn ewUer aaa1lm ss$, show hens w of sparest wire. Fence crash* by marl soar. Lapel ewmashp of fames at detonable/. II) This wrrsy is Weeded fr Inane p or refineries purposes ariy amtwvely for Hub w by the to Me m H is certified. This surety is et to be used for orrinMtien, permit/Ws. &Om or wry ether we wIthout written cen- e* of Thaw J. Kelly, Iwo. C) Cede restriction •,d NTIe arch ere me reflected en this money. 0). The flied 5.fanmstNn shown hareem des me Imply . fret the referenced property will or WE wet be fres from flsdiq or dump •d doss eat assts liability e the pert of the fine. ••y •fncer r employee thereof, for ery damps the results from Whom on sold 0 The lends depicted hereon were arrayed per the Iq•I descriptive ad no claws es to ownership er natters of Me ere soda sr Implied. 1) Uhdsryre end Enc eadmmm. If my, ass located. I hereby certify that the trawl represented hemm mats th• nl:aaMwn technical stso- derds set forth by tits ilea d of Lad 5sr ywy In chap 617 - Merida AdminItnMvo Cad. elm 472.0 _ Statutes. NOTES: 1. IF SHOWN, BEARING ARE TO AN ASSUMED MERIDIAN (BY PLAT). 2. IF SHOWN, ELEVATIONS ARE REFERRED N.6.V.0 1929. 3. THIS I5 A BOUNDARY SURVEY. 19 CBS... CONCRETE BLOCK STRUCTURE O.U.L OVERHEAD UTILITY LOIS P.C.C POINT OF COMPOUND CURVE P.O.C POINT OF COMMENCEMENT BLDG B MLOINO C.M CHORD DISTANCE D.E DRAINAGE EASEMENT F.H FIRE HYDRANT R RADIUS 4 4LLEY 20 3 21 LOCATION SKETCH 22 N.E. 100th STREET 1 NOVO NATIONAL GEODETIC VERTICAL DATUM PRC ... POSIT OF REVERSE CURVATURE RAD... RADIAL RW . ..RIGHT OF WAY SEC ... SECTION SCR... SCREENED S.I.P SET IRON PIPE MK ...SIDEWALK U.S UTILITY EASEMENT CHLF CHAIN LINK FENCE 1 As Their Interest May Appear 23 30' W Q w Sheet 1 of FLOOD ZONE: X _ THIS I5 A FLOOD / AUK) ZONE HIS I5 NOT A FLOOD HAZARD ZONE PANEL NO.:. 93/J COMMUNITY #: 120652 DATE OF FIRM: 07/17/1995 BASE FLOOD: N/A FINISH FLOOR: N/A LOWEST N/A ADJ GRADE • • • • • • •• • • • • - •• •• w aw a•• • ••• ••• • ••• • • • • ••• •••••• •• •• •• •••••• • • • • •••• • . • •• •••• wa • • •• • -•• • i • • -••• • • • • 000 •• • •• • • • • • wawa •• • • •• • THOMAS J. KELLY, INC. L.B. #6486 SURVEYORS- MAPPERS -LAND PLANNERS 8125 SW 120 STREET PINECREST, FLORIDA 33156 (786) 242 -7692 DADE (954) 779 -3288 BRWD (786) 242 -6494 DADE FAX (954) 779 -3260 BRWD FAX ••• • ••• ••• -• • • • • w awa•• •••• • • •••• DATE FIELD WORK 01/05/2004 SCALE 1" - I • ( SURVEY NO. 03 -7345 • • •••••• • • 40' BLOCK CORNER 295.10'01) 295.00'(C) LOT 7 BLOCK 10 23' PARKWAY F.I.P. ;7 0 ID 0.30' CLEAll 0.20' CLEAR 0 5.0' Lei 4' C. L F. (TYP) -\ 0.20' CLEAR 0.40'" CLEAR FND 1/2' RE- BAR • N.E.i 101st STREET 20.0' ASPHALT PAVEMENT/ 5' CONC. S/W.; : 75.00 ' (M)(R).• , 11.6' 1 �CONC. SLAB. 3 H e da or 18.0' 4.0' s r 2 /1.00 NI 12.6 h 0 39.0 so ASPHALT Q CV 29.8' CHIMNEY 21.0' 55.00' ONE STORY RES. M 54 30.30' o 'TILE • ,CONC.. 2 . .. 8.3' 9.1' 8.3 �0 er POOL 7.0 L AIC. 3104' o : 4 c 6' W.F. c v c) (TYP) 7.5.0 (M,(R' o 15' ALLEY \ 10.0' RE " 1 .0 •••• • •••• ••••.• N • • • • • •• ••i •••••• •• • • • . • •••• • • • ` g gyp: .• • • . �•. ••• �� CLEAA• • ••••• . •• •• • • •••• • • .. • • • ••4 320' •••• •••••• • • Q BLEAR '..••• :••••o • • • • • t '" : 13.60' 9.70' REM. OF LOT 5 p BLOCK 10 0 0.10' CLEAR oa to F.I.P. NO ID 0 ai SHEET 2 OF 2 THOMAS J. KELLY, INC. L.B. #6486 SURVEYORS- MAPPERS -LAND PLANNERS 8125 SW 120 STREET PINECREST, FLORIDA 33156 (786) 242 -7692 DADE (954) 779 -3288 BRWD (786) 242 -6494 DADE FAX (954) 779 -3260 BRWD FAX DATE FIELD WORK SCALE SURVEY NO, 1 = ZO o - 3</5 Issue Date: 3/27/2006 Owner's Name: KAREN PATTON Permit Type: Driveways /Sidewalks /Slabs Work Classification: New Job Address: 54 101 Street NE Miami Shores Village, FL Contractor(s) Phone DECORATIVE MASONRY INC (305)757 -7765 Primary Contractor Yes Comments: INSTALL CIRCULAR BRICK DRIVEWAY Additional Information - Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL 33138 -0000 Phone: (305)795 -2204 Fax: (305)756 -8972 Permit Expires: 03/17/2007 Type of Work: DRIVEWAY Additional Info: BRICK Bond Return : Classification: Residential In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are required for ELECTRICAL, PLUMBING, MECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL 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 construction and zoning. Futhermore, I authorize the above -named contractor to do the work stated. Fees Due Bond Type - Contractors Bond CCF Education Surcharge Notary Fee Permit Fee Scanning Fee Technology Fee Total: Amount $300.00 $2.40 $0.80 $5.00 $125.00 $6.00 $3.20 $442.40 Building Department File Copy Applicant Signature Parcel #: Block: Section: Permit Status: APPROVED Permit Number: DS -3 -06 -707 Phone: (305)807 -2220 1132060131350 Lot: PB: Total Square Feet: 1000 Total Valuation: $ 4,000.00 Required Inspections Foundation Sidewalk Landscaping Final Invoice Number DS -3 -06 -24244 Total: MAR 2 7 PM Amt Due $442.40 Amt Paid $442.40 $442.40 NOTICE: In addition to the requirements of this permit, there may be additional restrictions applicable to this property that may be found in the public records of this county. AND THERE MAY BE ADDITIONAL PERMITS REQUIRED FROM OTHER GOVERNMENTAL ENTITIES SUCH AS WATER MANAGEMENT DISTRICTS, STATE AGENCIES, OR FEDERAL AGENCIES. PERMIT APPLICATION FOR MIAMI SHORES VILLAGE Da 01 Job Address 5 NE 101 STREET Tax Folio — 013 - 1350 Legal Description n t S LOT IA w' 12. t t o T K v P e,K , PS to—Historically Designated: Yes No t- ∎ApA5tkoizes SECT P. PAO LOT V AwOw•12 0e LON 5 et-IC 10. Owner/Lessee / Tenant L p g {21 ' ot• A Master Permit # (4 a t'- 2) ' 3 30 Owner's Address 54 NE 101 ST(Z EE-r Phone 3p5 - 8G 41 bs7EJ2. 4050A/ ,e ,LE LAL coal; Address M/ k l ,, 2 Contracting Co. 3 �' � 33/ 2 5 • Qualifier JO/ZG6 L • rOS-7€/Z state #E/Z 00/5146 Municipal # Competency #79E0+0 Co. Architect/Engineer Address Bonding Company Mortgagor Address Permit Type (circle one): BUILDING LECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN WORK DESCRIPTION DERV IC C N N( ,A. N 0 N'cvs1 OVTLE - TS . Square Ft. 2 4 0 st • OWNER'S A••U)AVIT: I cert that all th construction and zoning. ermore, • owner ; _ /ARV tary as to • - and/or'• My Commissi• Expires: do President FEES: PERMIT 1/• cm RADON Date ©2 / Pr+esjdent R r . , ' DC LOREeF 5i l'<O . M Y :OMMiSSION # CC 802175 i t,. • ` cli EXPIRES: 01/13,2003 1 RV ,' ";ot er•..cc. Y_. Ro..d`,tt: Co ;f ss# Phone Oar) 633 - 075t, Address 00 Estimated Cost (value) 2 t SOO. 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. egoing information is accurate and that all work 11 be done in compliance with all applicable laws regulating orize the above -named contractor to do the wor ':. ted. v) 81 604/— �. D2 Si Notary My C o Contracto .r •� -, L ssion E DCLOBES CAS1RO Ml'CrM IISSION #CC802175 EOf SL A XPIRES: 01 /13,2003 C.C.F. / • g d NOTARY BOND TOTAL DUE O/ Date • :Date ' , rrySer.:ccs &.I3c. »: Cr / APPROVED: Zoning Building Electri Mechanical Plumbing Structural Engineer ITEM BATH 1L8 UNIT FEE ITEM SWITCH OUTLETS UNIT a FEE ITEM SPACE HEATERS UNIT FEE BIOET LIGHT OUTLETS 3 CENTRAL HEATING DISHWASHER RECEPTACLES ; A/C (WIND) DISPOSAL SERVICE TEMPORARY A/C (CENTRAL) DRINKING FOUNTAIN SERVICE SIZE IN ASPS AGO DUCT WORK FLOOR GRAIN SERVICE REPAIRAM€TEER CHANGE 1 REFRIGERATION GREASE TRAP APPLIANCE OUTLETS A PROCESS AND PRESS PIPING INTERCEPTOR RANGE TOP UNDERGROUND TANKS LAVATORY OVEN ABOVE GROUND TANKS LAUNDRY TRAY WATER HEATER 1 U.F. PRESSURE VESSELS CLOTHES WASHER MOTORS 0- 1 HP STEAM BOILERS SHOWER MOTORS OVER 1- 3 HP HOT WATER BOILERS SINK, POT /3 COMP. MOTORS OVER 3- 5 HP MECHANICAL VENTILATION SINK. RESIOENCE MOTCRS OVER 5- 8 PP TRANSPORTING ASSEALIES SINK, SLOP _ MOTORS OVER 8- 10 HP ELEVAT0RS/ESCALATC!t S TEMPORARY WATER CLOSET MOTCRS OVER 10- 25 HP _ FIRE SPRINKLER SYSTEMS URINAL MOTORS OVER 25-100 HP COOLING TOWERS WATER CLOSET MOTORS OVER 100 HP VIOLATION _ INDIRECT WASTES A/C WINDOW REINSPECTION WATER SUPPLY TO: AIR CONDITIONERS A/C UNIT STRIP HEATER _ FIRE SPRINKLER GENERATORS TRANSFORMERS 'HEATER -NEW INST. GENERATORS TRANSFORMERS HEATER - REPLACE GENERATORS TRANSFORMERS LAWN SPRINKLER -WELL SPECIAL PURPOSE SW I Mf1 I NG POOL OUTLETS COMERC I AL WATER SERVICE • SIGN TUBES SEWER CONNECTIONS SIGN TRANSFORMERS UTILITY-SEWER - SIGN TIME CLCCX UTILITY -WATER FIXTLRES SEPTIC TANK ANTENNA RELAY TELEVISION OUTLETS DRAINFIELO, 4' TILE/RES. VIOLATION PUMP & ABANDON SEPTIC TANK REINSPECTION SOAKAGE PIT CU. FT. CATCH BASIN DISCHARGE WELL DOMESTIC WELL AREA DRAIN ROOF INLET SOLAR WATER HEATER FIRE STANDPIPE POOL PIPING LAWN SPRINKLER SYSTEM GAS RANGE METER SET (GAS) GAS PIPING ■ (AN APPLICATION FOR BUILDING PERMIT MUST ACCOMPANY THIS ADDENDUM. IF A MASTER PERMIT HAS B. OBTAINED, THE OWNER'S NOTARIZED SIGNATURE NEED NOT BE PRESENT ON SUBSEQUENT APPLICATIONS.) PLUMBING ADDENDUM TO BUILDING PERMIT APPLICATION ELECTRICAL 62 MECHANICAL 2 PERMIT APPLICATION FOR MIAMI SHORES VILLAGE Date 4 r 1(O '0 Job Address S4 Ark. / b / ST Tax Folio Legal Description Historically Designated: Yes Owner/Lessee / Tenant / AR-`al R-- ) A. • Master Perm 4-gif 87o Owner's Address Phone 30C 75 O ` t 7 Contractin Co. mE / /2O E .E0 /gI SK-12_0 1 C Address /50 SO NE pie 40c. Qualifier SARR01.0 ss# // 76Phone, 3OS 94 0 State # oc000gs Municipal # Competency # Ins. Co. Architect/Engineer Address Bonding Company Address Mortgagor Address Permit Type (circle one): BUILDING ELECTRICAL LUMBING MECHANICAL ROOFING PAVING FENCE SIGN WORK DESCRIPTION .gf K€- � �iC —,C 7U�2 i f66, Cur( // - a►Shj,U4 /ZeF0 /41 &L ` / gaff Pik,/ / 3 7 OU �s / 1 6 OU i Lt1 • Square Ft. Estimated Cost (value) - /9GO 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. OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. Furthenmje, I authorize the above -named contractor to do the work stated. d/or Condo President c4 inis Bonded o Pratletltan y ShapiroDate Notary Public, State of Florida Commission No. CC 985240 My Conunission Exp. 1/20/2005 Through Fla. Notary Service & Bonding Co. Signature of own Notary as to Own My Commission FEES: PERMIT 149 eOO RADON APPROVED: Zoning Mechanical Date C.C.F. Building Plumbing Notary as to Contractor or Owner- Builder My Commission E Gale Nancy Shapiro Notary Public, State of Florida ° ComnMSion No. CC 985240 s�► My Commission Exp. 1/20/2005 Bonded Through Fla. Notary Service & Bonding Co. NOTARY 0 BOND TOTAL DUE Electrical Structural Engineer Date ITEM 3ATH TUB UNIT FEE ITEM SWITCH OUTLETS UNIT /Z FEE ITEM SPACE HEATERS UNIT FEE 3I0ET LIGHT OUTLETS Ja CENTRAL HEATING DISHWASHER RECEPTACLES ail A/C (WIND) DISPOSAL SERVICE TEMPORARY A/C (CENTRAL) DRINKING FOUNTAIN SERVICE SIZE IN AMPS DUCT WORK FLOOR DRAIN SERVICE REPAIR/METER CHANGE REFRIGERATION GREASE TRAP APPLIANCE OUTLETS .5 PROCESS AND PRESS PIPING INTERCEPTOR RANGE TOP UNDERGROUND TANKS LAVATORY _ OVEN / ABOVE GROUND TANKS LAUNDRY TRAY WATER HEATER U.F. PRESSURE VESSELS CLOTHES WASHER MOTORS 0- 1 HP STEAM BOILERS SHOWER MOTORS OVER 1- 3 HP HOT WATER BOILERS SINK, POT /3 COMP. MOTORS OVER 3- 5 HP MECHANICAL VENTILATION SINK, RESIDENCE MOTORS OVER 5- 8 HP TRANSPORTING ASSEMBLIES SINK, SLOP MOTORS OVER 8- 10 HP ELEVATORS/ESCALATORS TEMPORARY WATER CLOSET MOTORS OVER 10- 25 HP FIRE SPRINKLER SYSTEMS URINAL MOTCRS OVER 25-100 HP COOLING TOWERS WATER CLOSET MOTORS OVER 100 HP VIOLATION INDIRECT WASTES A/C WINDOW REINSPECTION WATER SUPPLY TO: AIR CONDITIONERS A/C UNIT STRIP HEATER FIRE SPRINKLER GENERATORS TRANSFORMERS • 'HEATER -NEW INST. GENERATORS TRANSFORMERS HEATER - REPLACE GENERATORS TRANSFORMERS LAWN SPRINKLER -WELL SPECIAL PURPOSE SWIMMING POOL OUTLETS COMMERCIAL WATER SERVICE SIGN TUBES SEWER CONNECTIONS SIGN TRANSFORMERS UTILITY -SEWER SIGN TIME CLOCK UTILITY -WATER F I XTLRES /A SEPTIC TANK ANTENNA : RELAY TELEVISION OUTLETS GRAINFIELD, 4' TILE/RES. VIOLATION PUMP 8 ABANDON SEPTIC TANK REINSPECTION SOAKAGE PIT CU. FT. Sfiol.G Q�TCGTof S S CATCH BASIN DISCHARGE WELL DOMESTIC WELL AREA DRAIN ROOF INLET SOLAR WATER HEATER FIRE STANDPIPE POOL PIPING LAWN SPRINKLER SYSTEM GAS RANGE METER SET (GAS) GAS PIPING (AN APPLICATION FOR BUILDING PERMIT MUST ACCOMPANY THIS ADDENDUM. IF A MASTER PERMIT HAS B. OBTAINED, THE OWNER'S NOTARIZED SIGNATURE NEED NOT BE PRESENT ON SUBSEQUENT APPLICATIONS.) PLUMBING ADDENDUM TO BUILDING PERMIT APPLICATION ELECTRICAL MECHANICAL Inspection, Number INSP- 12645 ` N ( g Y „ p e emit Number:` DS4-06 -707 Inspection Date: 06/12/2006 Inspector: Grande, Claudio Owner: PATTON, KAREN Job Address: 54 101 Street NE Project: <NONE> Miami Shores Village, FL Contractor: DECORATIVE MASONRY INC Building Department Comments Friday, June 9, 2006 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Permit Type: Driveways /Sidewalks /Slabs Inspection Type: Final Work Classification: New Block: Phone Number (305)807 -2220 Parcel Number 1132060131350 Lot: Phone: (305)757 -7765 Page 1 of 2 �I ( Passed Inspector Comments Failed Correction Needed Re- Inspection Fee ($75) No Additional Inspections can be scheduled re- inspection fee is paid. until Inspection, Number INSP- 12645 ` N ( g Y „ p e emit Number:` DS4-06 -707 Inspection Date: 06/12/2006 Inspector: Grande, Claudio Owner: PATTON, KAREN Job Address: 54 101 Street NE Project: <NONE> Miami Shores Village, FL Contractor: DECORATIVE MASONRY INC Building Department Comments Friday, June 9, 2006 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Permit Type: Driveways /Sidewalks /Slabs Inspection Type: Final Work Classification: New Block: Phone Number (305)807 -2220 Parcel Number 1132060131350 Lot: Phone: (305)757 -7765 Page 1 of 2 BUILDING ELECTRICAL PLUMBING Architect Contractor or Builder MIAMI SHORES VILLAGE, FLORIDA DATE 7 1 194 PERMIT N° 5511 Contracto'r's License No. Legal Lot (/ Bl. : Description Address of Building s This permit is granted to the contractor or builder named above to construct the building or to install the equipment or device described the appli- cation herefor in strict compliance with all ordinances pertaining thereto and w th the understanding that the work will be performed in complia ce with any plans, drawings, statements or specifications that may have been submitted to and approved by the proper municipal authorities. This Permit may be revoked at any time if the work is not done in compliance with such ordinances or if the plans ar han: -d itho auth• ation. A further condition upon which this permit is granted is the understanding that the contractor or builder named above .as - es .th s, onsi y fo thorough knowledge of the ordinances and regulations pertaining to the work covered hereby whether shown on the plans of / � .ecifications and that he assumes'respon- sibility for work done by his agents, servants or employees. : •�` a O • B y t F.. , a, . In consideration of the issuance to me of this permit I agree to perform the .work .vere.r ereunder in compliance with . all.ordinances and reg kations pertaining thereto and in strict conformity -with the plans, drawings, statements or specificati• s submitted to the proper authorities of Miami' Shores Village. In acceptirig this permit L assum pons' •ility for a}1"CCb;k done by either myself, my agent, .ervant or employee. Signed. � : BY .. AUTHORITY UILDING LECTRICAL LUMBING )wner of uilding . ontractor Builder egal Lot 'escription 4:0• 7 0 , 1 ,!;;-, kir T MIAMI SHORES VILLAGE, FLORIDA PERMIT N° 5511 Work to be performed under this Permit rchitect Bl. ddress of t � $ Value of Amt. of uilding h � // `' 6 .1 (.1 ' G .r . Project Permit h This permit is granted to the contractor or builder named above to construct the building or to install the equipment or device described ie appli- ition herefor in strict compliance with all ordinances pertaining thereto and w th the understanding that the work will be performed in complianVe with any ans, drawings, statements or specifications that may have been submitted to and approved by the proper 1!unicipal authorities. This Permit may be revoked author* tion. A further condition upon which this for borough knowledge of the ordinances and ifications and that he assumes respon- any time if the work is not done in compliance with such ordinances or if the plans are rmit is granted is the understanding that the contractor or builder named above ass :gulations pertaining to the work covered hereby whether shown on the plans•or bility for work done by his agents, servants or employees. In consideration of the issuance to me of this permit I agree to perform the work c ered ereunder in compliance with all ordinances and regulations -rtaining thereto and in strict conformity with the plans, drawings, statements or specificatio submitted to the proper authorities of Miami Shores Village. accepting this permit I assume onsihllity for all WO'rk, done by either myself, my agent, s. rvant or employee. § "7 Subdi- vision BY DATE nsibi Signed .I! 'a rtrld By INS'_ ' ©R 2. / Contractor's License No AUTHORITY 1942 BUILDING RL PERMIT A N° PL' .,.. S ner of Building Architect and /or Engineer_ Contractor or Builder_ Proposed Location $ AMOUNT Dated k ti F LOT ,/1 NAME NAME 19 BUILDING INSPECTION DEPARTMENT BLOGK�. This permit is issued to RECD. PAYM CCT. DEPT. 201 P SUB -DIVIS N f r ADDRESS ADDRESS MIAMI SHORES VILLAGE 7Y b'7_ d Jl �yf� -tom - - -y/ ADDRESS 4A; >1' e the building above described, as Pe applic ion, Plans and Specifications heretofore filed in this office. This permit is granted upon the express condition that all facts stated in the application are true and that the const8ction complies strictly with the plans and specifications submitted, and in accordance and compliance with the building laws of the State_of 3loiid5 regulations of the building department of�Miam S1 ores�/V„'l e. This permit may,_- .be- ..4mked at ny tin}etupon the violation of any provisions of said laws, ordinances o r rules and regulati6s .on e., ange in the plans and specifications I t onze -by the building inspector. .- .-,_'-n r and with the building ordinances and zoning laws of Miami Shores Village, and rules and I n consideration of the issuance to me of this permit I hereby agree to the proposed c onstruction in strict with the a n s and specifications thereof heretofore by me submitted, and in compliance with all provisions o , alli building awss' the State of building ordinances and zoning laws of Miami Shores Village and all rules and regulations of the building depmen of ` '. i S i .res r ;, (SEAL) NOTE: A charge of $1.00 will be made for making correc ions or changes to this application after approval has ben obtained from the Pla Wing Board. A re- inspection fee of $1.00 will be made when such re- inspection is made necessary by improper notice for inspection fa lty materials and /or workmanship. 411( LICENSE NO. LICENSE NO. NO STREET To_ � d'r g. � 244 INSPECTOR application and lorida, all the Village. 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 wor Owner's Name and Address_ Registered Architect and /or Engineer Name and address of licensed contractor Location and legal descrptti_on of lot to be built on: e Lot – o old – Subdiyision ,+ � Street and Number where work is to be done !_._. ___Ze rr State work to be done and purpose of building (by floors) STATE OF FLORIDA, COUNTY OF DADE. ss. appeared Disapproved (Signed) 11 MIAMI SHORES VILLAGE. • BUILDING INSPECTION DEPARTMENT APPLICATION FOR BUILDING PERMIT Member Member • _ -- ��- -- _ 1' Member Council Approved __ _ Date Disapproved Date___ L _// _ a - - - -, 194! No.__ S2 " Street l''''....----- -- — – – – – – – – – -- -- -and for no other purpose. New Building Remodeling Addition Repairs LL_ —___ No. o /_________ To be constructed of____11 Kind of foundation Roof Covering___ e _ Estimated Total cost of improvements $__ _ .2.tO 1 0 ® Amount of Permit $ Zone cubage required__ _Plan flan Cubage Distance to next nearest building _j4 _F/ • 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, Permanent Supplement, and has complied with the provisions thereof, and will require similar compliance from all contracto 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 site of the work such public notice or notices as are required by the Act. The undersigned agrees to employ only such subcontractors, o - work to be performed ynder this permit, as are licensed by Miami Shores Village. Remarks (Signed) C N . 1 Before me, the undersigned authority, a notary public, duly authorized tc administer oaths and take acknowledgments, personally f to me well 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 1 2' p-z Read, Sworn to and Subscribed before me. • My C' mmission Expires_ Notary Public, State of Florida known, __,_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. (over) • LIST OF CONTRACTORS, SUB - CONTRACTORS, ETC. REQUIRING OCCUPATIONAL LICENSES MIAMI SHORES VILLAGE 1. , General Building Contractor. 2. Plumbing, Heating, Ventilating, Air Conditioning and Gas Fitting. 3. Electrical. 4. Architects, Engineer, Surveyors, Landscape Architects and Interior Decorators. 5. Excavating, grading, filling and Landscaping. 6. Moving or wrecking. 7. Septic Tank and Drain Field. 8. Brick, Stone, Tile, Cement Block, Concrete and Gypsum. 9. Carpentry, Millwork, Awning and Shutters. 10. Cement, Lime, Plastering, Stucco, Lathing and Cast Stone. 11. Decorating (interior and exterior) , Painting, Waterproofing, Damp- Proofing and Paper- hanging. 12. Flooring, sanding or finishing; wood, rubber, composition, linoleum and other flooring not otherwise specified. 13. Ornamental Iron, Bronze and Steel, Steel Sash, Over -head Doors. 14. Roofing, Sheetmetal and Skylights. 15. Solar *Water Systems. 16. Well drillers. 17. Sprinkler Systems of all kinds, including those for Buildings, Lawns, etc. 18. Structural and Reinforcing Iron and Steel. 19. Tile, Terrazzo, Marble, Granite and Cut Stone. 20. Electric Fixtures. , 21. Illuminated Signs. 22. Bridge, Bulk- heading, Drainage ,Sewer, Water and Gas excavation and Construction, Dredging, Irriga- tion System, Pile Driving, Sea Wall, Paving, Sidewalks, and Gutter or similar work. 23. Every person, firm, co- partnership, Corporation, Association or other organization engaged in the bus- iness of supplying, furnishing or delivering building materials for any construction project within the Village Limits and not having a regularly established and licensed place of business in the Village. 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.progr; s of the work. Owner's Name and Address New Building Remodeling Disapproved Date (Signed) MIAMI SHORES VILLAGE BUILDING INSPECTION DEPARTMENT -" APPLICATION FOR BUILDING PERMIT Registered Architect and /or Engineer 4 Name and address of licensed contractor Location and legal description of lot to be built on: Lot Block Sub dt isio Street and Number where work is to be done_ Remarks (Signed) __ peared Date 19 No ,l Street State work to be done and purpose of building (by floors) _ and for n other purpose. No. of Stories Addition Repairs Notary Public, State of Florida To be constructed of Kind of foundation _ Roof Covering Estimated Total cost of improvements $ Amount of Permit $ Zone cubage required flan 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, Permanent Supplement, and has complied w ith 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 i ection on the site of-the work such public notice or notices as are required by the Act. The undersigned agrees to employ only such sub tractors; on work to be performed under this permit, as are licensed by Miami Shores Village. !i /) STATE OF FLORIDA, COUNTY OF DADE. ss. Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take aclfno ledgments, personally ap 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 " 7 ,Read, Sworn to and Subscribed before me. Building Inspector My Commission Expires 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 be charged when such re- inspection is made necessary by improper notice for inspection or faulty materials and /or workmanship.