620 NE 101 St (7)Permit Type(circle
WORK DESCRIPTION
Signature
Date: /
Jam
oiary as
My Commission Expires:
FEES: PERMIT )W11
APPROVED:
Zonin
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Date fob / /7 /9J Job �'ress 6)2° Nig (0 /SCE
. .ri; .e/y // 41
Legal Description i
Owner / Lessee / Tenant Idl ,PS - c A- ( u (e 1 c Master Permit # 3�� 9/
Owner's Address 6:::), H /6/5 l Phone 7S 2 c?? ?`,
Contrac 4 / %17/ 1I i2 r Address /9 d1 9c:,
Qualifier ./ ) f r vai c. SS4# - Phone L ; g_.? 2d 2/
State #0'tr 0,36 ? l lcipal # Competency # 7 / /(n Ins.Co.
Architect /Engineer Address
Bonding Company Address
Mortgagor Address
Mechanical
one): BUILDING ELECTRICAJ., ,LUUMBING MECHANICAL ROOFING PAVING FENCE
27;/‘ f . (.....%/V - A
Square Ft. Estimated Cost(value) /991)6
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 don in compliance with all applicable laws regulating construction and zoning. Furthermore, I
author ze the above-n•med contractor to do the work sta
L.%:.
� •�
nd /or Condo :President
td Owner and /or Condo President
cc : , : . s :1I:'' d
�.! �:X� r.; -�a„
1 , , ��
y � QED I al dy ��•'. : li lS. INS. W�0,c yy
RADON
Plumbing
Date:
0
My
Tax Folio / , � / 19t' O
Signare of Contractor or Owner- Builder
ary as to Contractor or Owner -nu �
Commission Expi t , � ';i =5't� : E\( 1. ?2. £ = i
s3Gi'10cu Yh:J Ca 7 , 1 E.73.
C.C.F. ( l , ° NOTARY TOTAL DUE tl I�✓
Fire Other
Building Electrical
Engineering
SIGN
R R R
10./0 /tS 2
MIAMI SHORES VILLAGE
STATE OF FLORIDA,
COUNTY OF DADE.
} ss.
BUILDING INSPECTION DEPARTMENT
APPLICATION FOR BUILDING PERMIT
New Building Remodeling Addition
To be constructed of Kind of foundation
Estimated Total cost of improvements $ 1
and has complied w ith the provisions thereof, and will require similar compliance from all contrac
in the work to be performed under this permit; and will post or cause to be poste o rosye,e tion
or notices as arc required by the Act. The undersigned agrees to employ only su th sybco &Era
pcnnit, as are licensed by Miami Shores Village.
Remarks.
(Sign
r
Application is hereby sonde for the approval of the detailed statement ur ore 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 progreu of the work.
Owner's Name and Address . 4" E ill d
Registered Architect and /or Engineer
Name and address of licensed contractor _._...—.:
Location and legal description of lot to be built on:
Lot Block Subdivision . .._. ...__ . ....._....._ ._... ._...._.
i
Street and Number where work is to be done k A, 0 A7/ jell _ ...k! ... �:_._...,. el 1`' Y
Stat work to be done and purpose of building (by floora)..� J F L�.�..�1_t.ra..LL. _. �,
cr.. a
and for no other purpose.
Repairs No. of Stories
Roof Covering
Amount of Permit S.
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 fur this building permit does hereby certify that he understands and accepts his obligations as an employer
of Lebur under the Florida Workmen's Compensation Act, being Section 5066, Compiled General'.aws of Florida, Permanent Sup Clement,
rs or sub - contractors employe • .by him
of the ork such . lie notice
under this
Bcfore me, the undersigned authority, a notary public, duly authoefcd to administer oaths and take acknowledgments, personally ap-
peared
Disapproved
(Signed)
Member
Date
Notary Public, State of Florida
Building Inspector My Commiuion Expires _._.
Council Approved Date Disapproved
NOTE: A charge of $1.00 will be made for making corrections or changes to this application after approval has
the P1. nnir.g Board.
A re- inspection fee of 51.00 will be charged when such re- inspection is made necessary by improper notice for
materials anti /or workmanship.
— .....to me well known,
and who, being by me first duly sworn, upon oath deposes and says that he is the.
of the above described construction, that he has carefully read the foregoing application, and that he did sign the same, and that all facts
therein by him stated are true. , /
Permit No..__Q.. .5 ../1 DDate el .�.C�. /A p v Read, Sworn to and Subscribed before me.
PLANNING BOARD DATE
Chairman Member
Member Member
Member __. ...._ _..__...
Date
been obtained from
inspection or faulty
BUILDING El Date SHORES VILLAGE, FLORIDA 30– 23
Date 19
ELECTRICAL ❑
PLUMBING ❑ PERMIT N? 10558 Contractor's 9
� ` � � 7
ROOFING ❑ License No.
❑ Work to be performed under this Permit
? trIn.. t //4_ 14/ e
Owner of +'
Building l ei k$ /i/ ii # L t- f J r./ i/ a. c it ! S —t, _ 2- 1 1 t 11 a 1 V.- -.
Architect
Contractor
or Builder r ` (-).-2.)
Legal Lot j Subd
Description Bl jj iCnii-
n
Address of Sq Ft
' "� �-� ` �G7� % Value of �� Amount of
Building I Project $ ��'" 11 Permit $ /
This permit is granted to the contractor or builder named above to construct the building or to install the equipment or device described in the applica-
tion herefor in strict compliance with all ordinances pertaining thereto and with the understanding that the work will be performed in compliance with an
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 are changed without authorization. A further condition upon which this
permit is granted is the understanding that the contractor or builder named above as mes the responsibility for a thorough knowledge of the ordinances and
regulations pertaining to the work covered hereby whether shown on the plans or dra or in the statements or specifications and that he assumes respon-
sibility for work done by his agents, servagts or employees.
Signed • : -' INSPECTOR) BY
In consideration of the issuance to me of this permit I agree to pert rm the work covered hereunder in compliance with all ordinances and regulations
pertaining thereto and in strict conformity with the plans, drawings, state nts or specifications submitted to the proper authorities of Miami Shores Village.
In accepting this permit I assume responsibility for all work done by eit r, myself, my agent, servant or employee.
CONTRACTOR or BUILDER
r) I _
BY AUTHORITY
E3UILDING 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 baild-
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 progress of the work.
Owner's Name and Addres
Registered Architect and /or Engineer. -.
Name and address of licensed contractor ■
Location and legal description of lot to be built on:
Lot Block Subdivision
Street and Number where work is to be done b 2_.Q N / 0 / s �VU
State work to a don and p se of building (by floors)__ bO ztt
117- r
Ik -- &Ca. Ct iA __ - - - -- and for no other purpose.
New Building Remodelir,.g t ''' ''. Addition Repairs No. of Stories
To be constructed of Kind of f undation Roof Covering
/
Estimated Total cost of improvements $ .. J �0 .W._ 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
STATE OF FLORIDA,
COUNTY OF DADE. j ss.
Disapprove
( Signed)
Date
Buildin _Inspector
MIAMI SHORES VILLAGE
I�
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 f inspection on the site of the work such public notice
or notices as are required by the Act. The undersigned agrees to employ only su contractors, on work to be performed under this
permit, as are licensed by Miami Shores Village.
Remarks- – – (Signed) "41seei .7 -. J / ////n/ 1117
Before me, the undersigned authority, a notary 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 stated are true.
Permit No 1 1 O Date ..__ A_P ... _ Read, Sworn to and Subscribed before me.
Date
to me well known,
Notary Public, State of Florida
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 51.00 will be charged when such re- inspection is made necessary by improper notice for inspection or faulty
materials and /or workmanship.