553 NE 101 St (14)BUILDING INSPECTION DEPARTMENT
APPLICATION FOR BUILDING PERMIT
Application is hereby made for the approval of the detailed statement us we 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, l lorid.c, 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 progress of the work.
Owner's Name and Addresswl� � ...1
Registered Architect and /or Engineer
i
Name and address of licensed eontractor.� . ,..�:.�1Y1.�t.l
Location and leg I t cr tion of lot to a built on:
Lot 2 I.� 410.1..I. Block % i t Subdivision. llla
Street and Number where work is to be done .5 .z ...
STATE OF FLORIDA, 1 .
COUNTY OF DADE. j ss.
geared
D isapproved ... n ...c�..:.�.,� Date .__........_
(Signed)
NOTE: A charge of $1.00 will be made for
the Planni,.. Board.
A rc•in.pectiun fee of $1.00 will be charged
materials and /or workmanship.
MIAMI SHORES VILLAGE
Building Inspector
Chairman
\fcrrsber
Member ... _.....__....._..._._...._....._
Council Approved Date
_ �3
V L3 Date. _ .No. - 5 , .._ t . .._ �•5 5'\..
i 0 I I 3 1 . i k . r I.,
4T. 30C _..�14�
x . 11_ _.._ _._ ._._..
State work to be dyne an purpo of building (by floors).. ..._.. ' .._
..._... ' enC 9, 1 JJ.
_..._. :......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 $ ! 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, 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 stybFontractors, n wor to be performed under this
permit, as are licensed by Miami Shores Village.
Remarks..._ (Signed)..
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally ap-
PLANNING BOARD DATE
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 1 )
RI Sworn an Subscribed before me.
uC Florida g a tary liar F1 act. Sta DB5 �pndsd itsru Jedcp Insurancncy My Comm iuion xpir , ...._ ,.._
Member
Member
Member
Disapproved Date
making corrections or changes to this application after approval has hero obtained lama
when such re- inspection is made necessary by improper notice for inspection or faulty
•
l'icOPOSAL SIAM
. EET
NE /olsr Se.
r■EY, STATE A D ZIP CET
ARCHITECT
We hereby submit specifications and estimates for:
c•
Date of Acceptance: —..• _
co TO
1 DATE OF i'l ANS .
___
.27
Vr111.1001.' tc, furnish miitrlioi
. . •
44.41}-t2
Payment to be made a:,
Art) A44141.A.444,
^. • • _ • . _
Arreptattre nt frviptigni—Th„b,v,
and conditions are satistai are hereby acceptel. ,
to do the work as spec:l-d. i•.1,•.• • : 0•111e matte f int t•h• '
Fc7IINC.* COMPANY --
i;
7.th Avenue - • . .
VI.OPIDA 33168' • . _ • <a:. .
Dade; 74.Ui Broward; 922 • •, •
atartai is guaranteed to 1.« tpee•r•ed. All work to be q. ,•••,•••• •■ ••:
1,11111110f accord•ng to stand.tfci Al 4,Ierdt•on Of • n!..• • • •
bons Involving extra costs t,« •.ec,ted only upon written )Id *. „,•::
II 'Ara charge over and •bow All sigiven•ents cont•nuttr.1,,,,, sr:o.
!! or delays beyond our cmtrol (:)••■• er to ,airy 6re, totnado and °the, i.eces
I ( Our workers are luny covered by Wr••■•nen'a Compensation Insurance
PHONE
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7.5 - S.2 7
•10ft NAME
Jon LOCATION
30'
•• complete in accordance with above specifications, for the sum of:
0 0
0- ete4-4-4.J .&t 644W
--L ollars ($
6 °C. 1" . " 4-e— /
&AY!
Authorized
Signature
Signature
e: This proposal may be
withdrawn by us if not accepted within
Page No. of Riges
DATE
-e3
•t. •
P O414., Act 1
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)11‘2-t2-
days.
REF
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LOCATION SKETCH
A PORTION OF SEC. G TWP. 53 RGE. 4ze
SCALE: / "= 200'
SKETCH OF SURVEY
EA5T 1 /2 OF LOT /8 ,9NO ALL OF /9
BLocK 94 — AMENDED PLAT Of
MM Ml 5H ORES - SECT/ON No. 4
V/L LA G E OF MIA M 1 5HORE5 DADE COUNrl,
A ccoRDING ro PLAT 6001< /5, PAGE /4 OF THE PUBL /C
RECORDS OF PADc CoUNTy, FLORIOA.
NOTE ALL RIGHTS OF WAY. EASEMENTS, SET BACK AND ZONING
INFORMATION MUST BE CONFIRMED BY ARCHITECT AND /OR OWNER
BASED UPON DESIGN USAGE.
CERTIFICATION
wE HEREBY CERTIFY THAT THE ATTACHED SKETCH OF SURVEY OF
THE ABOVE DESCRIBED PROPERTY IS TRUE AND CORRECT TO THE
BEST OF OUR KNOWLEDGE AND B EF AS RECENTLY SURVEYED
UNDER OUR DIRECTION.
DON D VG. Mc. INTOSA5,SOC., INC.
DANIEL C. FORTIN , VICE PRESIDENT
PROF LANG SURVEYOR No.2853
STATE OF FLORIDA
"NOT VALID UNLESS SEALED"
Prepared by.
DONALD W. McINTOSH ASSOCIATES, INC.
581 NE 9IetSTREET MIAMI SHORES, FLORIDA. 33138
SK.No.: CS 81 -080