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BUILDING PERMITCOMMUNITY AFFAIRS ANO COCE ENFORCZMENT DIVISIONS 10030 N.E. $°.3'rO AVENUE wIAM1 SHORES. F:.".210.% 33138•Z38Z TELE? »ONE (3051 793•t204 FAX (305) 756 - 3972 PLEASE PRIM' � 5 DATE: f ' \`) � TIDE: NARE OF PERSON REQUESTINC FILE , YOLR ADDRESS : ADDRESS OF FILE RECXJESTED : INFCRMATIQY REQUESTED: X C I UNDERSTAND THAT ALL =wan IN THIS FILE. ARE PROPERTY OF ; MIAMI SHORES VILLKE AND THAT ND DOCI.MEN S MAY ISE REMOVED FROM THIS FILE. YCU MAY �T LIP 10 FCLR (4)OOMRLIMENTARY COPIES.. ADDITIC AL COPIES WILL BE FURNISHED AT IS cars PER PA NOT INNLUDING BLUEPRINTS. j • 11 =. BY (Signature) : /fi' FILE RETURNED - DATE: TIME: RETLRNED TO: , APPLICATION FOR BUILDING PERMIT 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 Or ' iami Shores Village, Florida, and all provisions of the Laws of the State of Florida, all ordinances of Miami Shores Vi ag €and all rule and regulations of the Building Division of Miami Shores Village shall be complied with, whether herein spe ified.. ot: A copy of app owed plans'and specifications must be kept at building during progress of the work. / �� x / / , li Owner's Name and Address L 1 (! • % G� 2 Registered Architect and /or Engineer Name and address of licensed contractor L Location and legal description of lot to be built on: Lot_ Block Subdivision Street and Number where work is to be done 11 L Site work to be d ne d pure of building (by floors )_______��_:_ t <f,t_ S _g_:- (?, S-'2_- 4' = C j %� �— ° j and for no other purpose. New Building Rem ling 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 a work such public notice or notices as are required by the Act. The undersigned agrees to employ only such subcontractors, on wo o be performed under this permit, as are licensed by Miami Shores Village. �' Remarks (Signed) _� � C� C � / / ?�� Disapproved Date (Signed) MIAMI SHORES VILLAGE BUILDING INSPECTION DEPARTMENT No 191 Street __ /W , STATE OF FLORIDA, COUNTY OF DADE. ss. Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take ac \nowledgments, personally ap- peared 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 Read, Sworn to and Subscribed before me. Notary Public, State of Florida 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. BUILDING ELECTRICAL PLUMBING MIAMI SHORES VILLAGE, FLORIDA PERMIT N? 6034 Work to be per €ormed under this Permit Signed. DATE 1 2? -eeeeZ Contractor' License No. Architect l f Cont or Builder Legal Description ti Address of Building This pe • t is granted to the •n: actor or :uilder named above to on ct the building or to install the equipment or device described in the appli- cation herefor ' strict compliance with all ordinances pertaining thereto and with the understanding that the work will 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 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 assumes the responsibility for a thorough knowledge of the ordinances and regulations pertaining to the work covered hereby whether shown on the plans or draws or in the sta1 p is or sp cifica tions a tha yl►iii�id mes respon- sibility for work done by his agents, servants or employees. By AUTHORITY 1941 INSPL+`CTO In consideration of the issuance to me of this permit I agree to perform the work covered hereunder i/f comp nce with all ordinances and re gul tions -ping thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authoriti'1's 6f Miami ShoregV 1agb. .:rig this permit I assume responsibility for all work done by either myself, my agent, servant or employee. • c� o A CTOR OR / BU E R 91 BY Dig ,.� gz L 3 3 /® ' ,ett- 01)it ./Y,/ //4i)k- • GIRDERS JOISTS BRIDGING . Material Size ' Material .4" 1,..... 4 Size Spacing ■ Material Akt.se Size .uhtiff.,44/tP• First11001 Second floor Third floor rt - * ,- OA/ • ,- . N. // X " X " X t ft et ft V 0 0 i ° X " X et " X // FHA Form No. 2005 • Property adt4ess FEDERAL HOUSING ADMINISTRATION DESCRIPTION OF MATERIALS No. (To be inserted by FHA) 4It * r4t b (v ". 1,4; State _-- Ciuy "ittwor ter . A Mortgagor or Sponsor This exhibit will be accepted in lieu of specifications with Title I, Class 3 "Application for Property Approval," or with "Mortgagee's Application for Insurance" or "Application for Conditional Commitment" under Title II, Section 203. The use of this exhibit, executed in a clear and complete manner enables the insuring office to give full credit for the material used, and facilitates processing of the application. Suggestions.—Fill out completely all spaces in the outline description below. Draw a 'hie through all state- ments which do not apply. Place an "X" in the square opposite the description of the material to be used. If the space provided is insufficient, write "See Misc." therein and insert complete description under 27. MISCELLANEOUS: If existing leave all spaces blank and describe repairs or alterations under 27. MISCELLANEOUS. Proposed construction. CI Under construction. El Alterations or repairs. General.—All construction shall equal or exceed the FHA Minimum Construction Requirements, local building codes, zoning orclinances, and restrictive covenants. The materials described herein shall be new and the best of the grade or quality stated. Erection, application, or installation shall be in accordance with the manufacturer's direc- tions or the best standard practice and shall be done in a workmanlike manner For final approval, all buildings must be complete and ready for occupancy, connections with utilities completed, and with all equipment installed in operating condition. 1. EXCAVATION: Minimum depth below finished grade, Type of bearing soil, :42 r'tir 2. FOUNDATIONS: .- - Concrete: Mix-1 part cement, '•»» parts sand, parts gravel or stone. ID Transit mixed. D Machine mixed. D Hand mixedp, t " 1. .. • Wall footings: Width, "; thickness, "; reinforcing, Pier or column footings:. " X "; thickness, 0 Foundation walls: ; thickness, Piers or columns: ; size, Waterproofing: Drainage: Basement floor slab: ; thickness, A reaway ws.1 . 4., ' . ..7...- .I*.......4 ...t '''' .a. ' ; thickness, Vents: 4,,,,,. , 1 'X. 4.*.s. ; size, " X ; veneer, " X 11 3. CHIMNEYS: Flues: No., ; size, " X ff X " ; lining, 4. FIREPLACE: 0 Wood burning 4, ^E] Gas burnin 0:, =1 .1 Circulating heater: , mitation. , Size opening, • - et x ,..„, -.- .., .,t , 0 Size damper, " X " Size flues, " X Fireplace lining: ; thickness, Mantel: . • Facing: Hearth: Other: 5. EXTERIOR WALLS: ( - - *4 El Solid masonry: Facing, ; backing, Waterproofing: Furring: 0 Wood frame construction: Studs: ; size, " X "; c. to c., Sheathing: ; thickness, " (If wood): 0 Hon; 0 Diag. Building paper: ; weight, #. Ell Veneer: ; bond, ; paint, ID Wood siding: ; thickness, "; width, "; weather, v D Shingle siding: ; size, " X "; weather, 111 Stucco: ; lath, ; weight, #. 0 Other: Finish: 0 Paint; LI stain. Coats, Mfr. or formula, 6. FLOOR FRAMING: (1) 16-14578 7. SUBFLOORING: Material: 8. FINISH FLOORING; Valley rafters -*- Sheathing: 4 Special: 13. SHEET METAL WORK: Gutters: ; weight, Drain: 0 Splash blocks; 1:11 sump; E] sewer. Roof flashing: • Valley flashing: ; size, " " [1;1-Diagonal 111 Straight. 9. PARTITION FRAMING: Studs: - ; size, 10. CEILING FRAMING: J oists: 11.44.44 _4_ IA ; size, ' - " X ......./.; _____ "; c. to c., _Y-s ____ ". ,,--, to -0 Bridging: ; size, " X "; spacing, n. 11. ROOF FRAMING: Rafters: - 1 -;71 ; size "; c. to c., " ; size, " X olid; fl strip. Size, ' x 12. ROOFING: Roofing felt: ; weight, O Wood shingles: • Asphalt shingles: ; type, ; weight, Asbestos shingles: ; type, ; laid, O Slate: ; length, "; weather, Other: # Downspouts: ; weight, #. 14. LATH AND PLASTER: Lath: ; size grounds, Plaster: ; coats, ; finish, Other: 15. DECORATING: ' Walls: Ceilings• Kitchen: Bath: Other finish: 16. INTERIOR DOORS AND TRIM: Type door: Trim: Casings, Finish: Special: 7, -1 , • `' 17. WINDOWS: Sash material: ; type, 4 P Balances: 18. ENTRANCE AND EXTERIOR DETAIL: Basement windows: Special: • , Main entrance door and trim: • t '' • f '''t .. - ; thickness • " Service door: / J .,., . ... - Nif , thickness, 44 Other exterior doors: k ..., ‘,... c 4:.. ; thickness, Hoods or canopies: Shutters: Cornice: Ornamental iron: Special: (2) ; material, ; thickness, ;, base, ; other, r?' 4 ; thickness, "; glass, Screens: ' " X "; c. to c., " X • 4' ;-weight,- #. ; weight, _ 16-14578 ff #. Paper Flooring Grade Size FINISH First floor . Second floor ' " X ""*" " ,-- 4 Third floor " X f, ..,. .. _t_-_, . i■.,. 7. SUBFLOORING: Material: 8. FINISH FLOORING; Valley rafters -*- Sheathing: 4 Special: 13. SHEET METAL WORK: Gutters: ; weight, Drain: 0 Splash blocks; 1:11 sump; E] sewer. Roof flashing: • Valley flashing: ; size, " " [1;1-Diagonal 111 Straight. 9. PARTITION FRAMING: Studs: - ; size, 10. CEILING FRAMING: J oists: 11.44.44 _4_ IA ; size, ' - " X ......./.; _____ "; c. to c., _Y-s ____ ". ,,--, to -0 Bridging: ; size, " X "; spacing, n. 11. ROOF FRAMING: Rafters: - 1 -;71 ; size "; c. to c., " ; size, " X olid; fl strip. Size, ' x 12. ROOFING: Roofing felt: ; weight, O Wood shingles: • Asphalt shingles: ; type, ; weight, Asbestos shingles: ; type, ; laid, O Slate: ; length, "; weather, Other: # Downspouts: ; weight, #. 14. LATH AND PLASTER: Lath: ; size grounds, Plaster: ; coats, ; finish, Other: 15. DECORATING: ' Walls: Ceilings• Kitchen: Bath: Other finish: 16. INTERIOR DOORS AND TRIM: Type door: Trim: Casings, Finish: Special: 7, -1 , • `' 17. WINDOWS: Sash material: ; type, 4 P Balances: 18. ENTRANCE AND EXTERIOR DETAIL: Basement windows: Special: • , Main entrance door and trim: • t '' • f '''t .. - ; thickness • " Service door: / J .,., . ... - Nif , thickness, 44 Other exterior doors: k ..., ‘,... c 4:.. ; thickness, Hoods or canopies: Shutters: Cornice: Ornamental iron: Special: (2) ; material, ; thickness, ;, base, ; other, r?' 4 ; thickness, "; glass, Screens: ' " X "; c. to c., " X • 4' ;-weight,- #. ; weight, _ 16-14578 ff #. FIXTURES MANUFACTURER PLATE NUMBER NAME Kitchen sink Bath tub ` — , '1: Shower: Stall; nr tub_ Lavatory...1‘;‘' Water closet Laundry trays - . r • k r ty. 19. CABINETS AND INTERIOR DETAIL: Kitchen cabinets: China cabinets: Bookcases: Medicine cabinet: (3) ; closet equipment, Other: .7„- " st Special: 20. STAIRS: Basement: 0 Open; 0 closed; treads, ; rail, 1st to 2d: 0 Open; 0 closed; treads, ; trim, ; rail, 2d to 3d: 0 Open; 0 Closed; treads, ; trim, ; rail, Special: 21. SPECIAL FLOORS AND WAINSCOT: ,-* ; wainscot, ...- tt t :', - , height, 414_ fi Bathroom: Floor, , --,ik N - TAWrir Kitchen: Floor, '• - -Lei. ; wainscot, , height, f, ,....-■,-, ,t , 4, ,10 22. PLUMBING: Sewage disposal: 0 Sewer; 0ptic tank; n cesspool. (Indicate private well, sewage disposal system on plot plan.) Water supply: 0 Public main; 0 private water system, Supply piping: El Brass or copper pipe; 0 copper tubing; steel; 0 wrought iron. i t* Waste piping: Soil pipe, , ; waste pipe, /‘ A.. vents, 4 A 4 Domestic hot water: Storage, 4 t;_ gals.; fuel, ; 4' j automatic; 1=1 manual. Special: 23. HEATING: El Steam. ID Vapor. El Hot water: 0 1 pipe; 0 2 pipe; gravity; 0 forced. Boiler; make, model: ; capacity, Radiation: sq. ft. D Hot air: 0 Floor furnace; 11 Wall furnace; 0 pipeless; 0 gravity; El forced. Furnace; make and model: ; capacity, Fuel: El Gas (burner, ); Ej coal: 0 manual, 0 stoker ( ); fl wood; oil (burner, Control: 0 Manual; n automatic, _ Fuel storage: El Bin; 0 tank (capacity, Built-in gas or electric heaters: Special: 24. ELECTRIC WIRING: Okonduit. 0_ B. X. 0 -Nonmetallic cable. El Knob and tube. Switches: Outlets: Power outlets: 0 burner; lange; 0 water heater; 0 25. LIGHTING FIXTURES: Allowance, $ Special: 26. INSULATION: Walls: ; thickness, ". Roof or ceiling: ; thickness '' N Weather stripping: Doors, ; windows, t. r ' 0 Storm doors, ; 0 Storm windows, - ; 0 Caulking, Special: 16-14573 27. MISCELLANEOUS (Describe any materials or features of construction not adequately covered in the drawings or elsewhere in this exhibit): 4 .. , , , , . t ■ ' A . . 4, ( "4. — •• e, ' •• e , ; ' \ " 28. -POWIES. ii,NI Porch: Foundation, , c " ' t,ii)' ; flooring, 44n070 ; ,,,,,,,,, roof, __---,-..tat ; railing, ; steps, v±..., Terrace: Foundation, ; surface, Other: 29. GARAGE: Foundation: Walls: Doors: 30. WALKS AND DRIVES: Walks: - = Floor: 11 ADDENDA Roof: Date, _ (Contractor or Builder) .1 ; thickness, T /I Finished rooms: - • Drainage: Plumbing: Heating: Electricity: ; thickness, _ ff. Drives: .4-.4 thickness, 4 31. LANDSCAPING: Lawn: [1] Sodded; seeded; 11 sprigged. Planting: Allowance, (If extensive, include planting plan.) Walls: Fences: Date, (Mortgagor orrSponsor) U. S. GOVERNMENT PRIN VG OFFICE 16-14578 (4) BUILDING ELECTRICAL PLUMBING ADD: / d t/` . G OR K_ DONE BY: • 1.; �U STED The following is ready for inspection: - Inspector's Report :- • WILL BE READY 34f/sty 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. Owner's Name and Address:_?_! r_ �_��- r * Registered Architect and /or Engineer �' • ' x *� Name and address of licensed contractoi Lo and legal description of lot to be built on: Loca -' Block___ — r" Subdivision ' ` J. t Street a- nd Number where work is to be done —_ State work to be done and purpose of building (by floors) _and for no other purpose. New Building f —___ Remodeling __ Addition_______________________ Repairs No. of Stories____- - To be constructed of _ ! �_W______ Kind of foundation ` ` °° ` ''� ` � Covering Coven G ' a -t=- -, Estimated Total cost of improvements $____.L' o_ _ __________ Amount of Permit $ / Q � + __ Zone cubage required— Plan Cubage 9 4._ e.a�% �? �—" Distance to next nearest building____ ________ –__ —_— _____________Size of Building Lot ,Y 0 1 i r 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 r, o �' P ii ....4„,,,,.'... �t..n.,.o 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) ^ ,R STATE OF FLORIDA, 1 ss' COUNTY OF DADE. f Before .. t appeared MIAMI SHORES VILLAGE — BUILDING INSPECTION DEPARTMENT uthority, a notary public, duly authorized to administer oaths and take acknowledgments, personally 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 carefylly read the foregoing application, and that be did sign the same, and that all facts therein by him state re true. Permit No.__ Date_I! t 7A2 Read Swor, _ o nd Subsc Disapproved Date (Signed) Building Inspector PLANNING BOARD DATE Member 1 ,,,y tUll Io zi,. U oAp aS ..la.. 1, iBYJ. Bonded by Mass. Bonding 6- los. Co. • w. G Q r� -,d ,f Date_ ____ -- < ' - -_ __'rte_______ ---_ -, 19_ No.____ --_ - -_ Street_ __ —_ - - - d before me. Notary Pub 'c, State of Florida My Commission Expires Notary Public, Sta e of Flores of (a;ce, Chairman 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. 6°7Y 2/, hyr /a -° - /4 4 /5 oc7 7f OWaEe AmE KAPP, E. C. PRESENT ADDRESS 78 N. E. 101st Street LICENSE NO. �. ' PHONE NO. JOB LOCATION (ST. OR AVE.) 78 N. E. 101st Street LOT BLOCK SUBDIVISION GENERAL CONTRACTOR Dean Claussen ADDRESS 4 N. W. 95th Street PHONE NO. LICENSE NO. 2234 BUILDING PERMIT NO. 8 359 DATE 1 PERMIT FEE $ 5000 BUILDER'S BOND NO. DATE ZONE PEQUIREMENTS CU. FT. PLAN CUBE CU. FT. EST. COST $ 185.00 TTY DRAWINGS, SPECIFICATIONS, RESTRICTIONS AND CUBE CHECKED BY: J DATE 10/17/49 NEW CONSTRUCTION TYPE STORIES I ROOF CONSTRUCTION INTERIOR CONSTRUCTION REPAIRS DESCR IPTION ALTERATION DESCRIPTION Extension to front of garage X ADDITION SUBMITTED TO PLANNING BOARD APPROVED REJECTED REFERRED TO COUNCIL REASONS RE- SUBMITTED TO PLANNING BOARD SUBMITTED TO VILLAGE COUNCIL REMARKS CERTIFICATE OF OCCUPANCY NO. ISSUED BY I TO BUILDING PERMIT AND INSPECTION RECORD -MIAMI SHORES VILLAGE INSPECTIONS PHONE BY RE- INSPECT BY RE- INSPECT BY FOUNDATION /// //0 W NPG'.r FEE TEMPORARY SERVICE $ BEAMS & LINTELS / G r ' s ' $ SEWER FRAMING $ !tiii �:.i:i $ $ GAS $ $ $ FINAL DATE BY RE- INSPECT BY RE- INSPECT BY CLEAN -UP ROUGHING CONTRACTOR PHONE PERMIT NO. DATE FEE $ NEW BLDG. I ALTERATION ADDITION REPAIRS SPECIAL PERMITS PERMIT NO. DATE FEE TEMPORARY SERVICE $ $ SEPTIC TANK $ $ SEWER $ $ SOLAR HEATER $ $ GAS $ $ $ INSPECTIONS DATE BY RE- INSPECT BY RE- INSPECT BY ROUGHING ROUGHING GAS H. W. HEATER CONN SEWER RANGE CONN. SEPTIC TANK SOLAR HEATER. FIXTURES & FINAL FIXTURES CONTRACTOR PHONE PERMIT NO. DATE FEE $ NEW BLDG. I ALTERATION 1 ADDITION REPAIRS SPECIAL PERMITS PERMIT NO. DATE FEE TEMPORARY SERVICE $ H. W. HEATER CONN. $ RANGE CONN. $ MOTORS $ FIXTURES $ INSPECTIONS DATE BY RE- INSPECT BY RE- INSPECT BY TEMP. SERVICE ROUGHING H. W. HEATER CONN RANGE CONN. FIXTURES & FINAL BUILDING INSPECTIONS PLUMBING PERMITS & INSPECTIONS ELECTRICAL PERMITS & INSPECTIONS APPROVAL TO POWER CO. FOR SERVICE DATE BY BUILDING ELECTRICAL PLUMBING ROOFING Owner of Building I MIAMI SHORES VILLAGE, FLORIDA PERMIT Architect Contractor or Builder : 'r A_ ° • Legal Lot Description II Bl Address of Building CONTRACTOR OR BUILDER y N9 7158 Work to be performed under this Permit / DATE r 19 J Contractor's S: r • License No. - �- Subdi- vision Value of # t � Project $ • Amount of 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 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 are changed without authorization. A further condition upon which this permit is granted is the understanding that the contractor or builder named above assumes the responsibility for a thorough knowledge of the ordinances and regulations pertaining to the work covered hereby whether shown on the plans or drawings or in the statements or specifications and that he assumes respon- sibility for work done by his agents, servants or employees. a IA Signed o '��' ' f .. . ,,. N, , �- r . .. . -. IIVSPECFOR In consideration of the issuance to me of this permit I agree to perform the work covered hereunder in compliance wi hlall 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 ao cepting this permit I assume responsibility for all work done by either, myself, my agent, servant or employee. "� BY AUTHORITY .0T ' • J` 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 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 progress of the work. Owner's Name and Address__ Registered Architect and /or Engineer Name and address of licensed contractor DiC 01 Location and legal description of lot to be built on: Lot Block Subdivision_ Street and Number where work is to be done State work to be done and purpose of building (by floors )_ PLANNING BOARD Date No Addition - t__ s No. of Stories New Building To be constructed of__ �__ Kind of fo dation _ 0-e.* Estimate d Total cost o f $ 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 su . ' s ntractors, on work( e performed under this permit, as are licensed by Miami Shores Village. / I Remarks (Signed) __ oof Covering /7 Street Notary Public, State of Florida DATE 19 and for no other purpose. STATE OF FLORIDA, COUNTY OF DADE. ss. Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally ap- peared to me well known, and who, being b_ _ e first duly sworn, upon oa • . eposes and says that he is the of the above de ribed construction, that he h. care ully read the foregoing application, and that he did sign the same, and that all facts therein by him s ated are true. Permit No Date ° _-ii29 Read, Sworn to and Subscribed before me. Disapproved Date (Sig Building Inspector ' l r' I My Commission Expires 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. 1/4 • 1-1. A V /tr P1 r1 LINE L-• •■1 c 4 % ' I • Disapproved (Signed) Building Inspector 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 build- ing of other stru ture herein described. This application is made in compliance and conformity with the Building Ordinance of Miami Shores F orida, 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 Miam Shores Village sh 11 be complied with whether her in specified cr not. A cope of approv d plans and specifications must be kept at budding during progress of the work. Date --s Zone Cubage required Distance to next nearest b u i l d i n g Maximum live Load to be borne by each floor..__. __ ___ ____ ____ Owner s Name and Address ___ __ _ Registered Architect and /or Engineer Name and address of licensed contractor ._ __ -c1 "d w ,c_ff __._ Po !e___ S_ t'. Location and legal description of lot to be built on: Lot __ __ Block _ _ Sybdivisio Street and Number where work is to be done__ ___ ___� / - _ State work t e done and purpose of building (by floors) f.!� _.__�V e H _)P_d_LY Date __.. No._ _____ -- 7 a_ Street__ _ and for no other purpose. New Building Remodeling . ___ Addition_ Repairs No. of Stories To be constructed of Kind of foundation Roof Covering Estimated Total - . of improvements $ 7 l f i Amount of Permit $ plan Cubage _Size of Building Lot 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 u: der 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 ubcontrac • s, on wo to be pg.foi ned upder this permit, as are licensed by Miar. i Shores Village. t'4lf� s ie �! K S d ��S c_- Remarks__ _. _____ - -- _ _ _ -_ -- .. _ __ ( Signed) _- x ,19 _ I - /O /. STATE OF FLORIDA, COUNTY OF DADE. ss • Before me, the undersigned authority, a notary publi::, duly r.uthorized to administer oaths and take aclmowledgments, personally ap- peared to me well known, and who, being by me first duly swo.u, 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. J q Peririt No ___ . _____ Date_ __ Read, Sworn to and Subscribed before me. Notary Public, State of Florida My Commission Expires PLAN G BOARD \-___ DATE Chainnan . __ __ _ Member __ Member - Member Member _ Member Council Approved _ - _ 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 - in_ ect'oa fee of $1.00 will be charged when such re inspection is made necessary by improper notice for inspection or faulty materials and /or workmanship. OWNER'S NAME :. C. KAPP PRESENT ADDRESS 78 NE st St LICENSE NO. PHONE NO. JOB LOCATION (ST. OR AVE.) '$.NE lO1st.St c LOT 3 & W30 2 BLOCK 10 SUBDIVISION MS Sect #1 GENERAL CONTRACTOR lwner- Builder ADDRESS Same PHONE NO. LICENSE NO. BUILDING PERMIT NO. 5742 DATE 10/9/47 PERMIT FEE $ 5.00 BUILDER'S BOND NO. 628 DATE 10/9/47 EST. COST $ 1000.00 ZONE REQUIREMENTS CU. FT. PLAN CUBE CU. FT. DRAWINGS, SPECIFICATIONS, RESTRICTIONS AND CUBE CHECKED BY PIS DATE 10 /9/47 NEW CONSTRUCTION / TYPE CBS STORIES 1 ROOF CONSTRUCTION Gravel INTERIOR CONSTRUCTION REPAIRS DESCRIPTION ALTERATION DESCRIPTION Screened Porch to residence X X ADDITION SUBMITTED TO PLANNING BOARD APPROVED E'IS REJECTED REFERRED TO COUNCIL REASONS RE- SUBMITTED TO PLANNING BOARD SUBMITTED TO VILLAGE COUNCIL REMARKS CERTIFICATE OF OCCUPANCY NO. ISSUED BY TO BUILDING PERMIT AND INSPECTION RECORD -MIAMI SHORES VILLAGE INSPECTIONS DATE BY � v RE- INSPECT BY RE- INSPECT BY FOUNDATION • 12/3/47 PERMIT NO. DATE FEE TEMPORARY SERVICE BEAMS I ? �/ 7/ B �q +MB EWS 5825 11/4/47 $ 1.00 SEWER FRAMING. 2 8 EWS SOLAR HEATER $ GAS $ FINAL 5/ VLn BY RE- INSPECT BY RE- INSPECT CLEAN -UP ROUGHING CONTRACTOR HONE PERMIT NO. DATE EE $ NEW BLDG. ALTERATION ADDITION REPAIRS SPECIAL PERMITS PERMIT NO. DATE FEE TEMPORARY SERVICE $ SEPTIC TANK O'Neil 5825 11/4/47 $ 1.00 SEWER $ SOLAR HEATER $ GAS $ $ INSPECTIONS f •• DATE BY RE- INSPECT BY RE- INSPECT BY ROUGHING w GAS SEWER S+.PTIC TANK 11 / 6 /4 r SOLAR HEATER FIXTURES ELECTRICAL PERMITS & INSPECTIONS CONTRACTOR PHONE PERMIT NO. DATE. FEE $ NEW BLDG. I ALTERATION ADDITION REPAIRS 1 SPECIAL PERMITS PERMIT NO. DATE FEE TEMPORARY SERVICE $ H. W. HEATER CONN. $ RANGE CONN. $ MOTORS $ FIXTURES $ $ INSPECTIONS DATE BY RE- INSPECT BY RE- INSPECT BY TEMP. SERVICE • ROUGHING H. W. HEATER CONN. RANGE CONN. FIXTURES & FINAL BUILDING INSPECTIONS PLUMBING PERMITS & INSPECTIONS APPROVAL TO POWER CO. FOR SERVICE DATE BY ' % BUILDING ELECTRICAL PLUMBING Owner of Balding Architect MIAMI SHORES VILLAGE, FLORIDA ro e -- i DAT PERMIT N? 57 2 nse C ce ontractor's L i 7. Work to be performed under this Permi f�1 Contractor 7 V. or Builder ' Legal Lot 3 h'30 / / Bl. / D. Description.' y / , Address of- , " 4( 1 /0/AA- A 4- Value of Amt. of Building' Project Permit In consideration of the issuance to me of this permit I. agree to perform the pertaining thereto and in strict conformity with the plans, drawin .. atements In accepting this permit I assume responsibility for all work CONTRACTOR OR BUILDER Subdi- vision plans, drawings, statements or specifications that may have been submitted to and approve at any time if the work is not done in compliance with such ordinances or if the plans permit is granted is the understanding that the contractor or builder named . .. regulations pertaining to the work covered hereby whether shown on the plans or sibility for work done by his agents, servants or employees. work covere speci • 1947 This permit is granted to the contractor or builder named above to construct the building or to install the equipment or device'lc escribed in the appli- cation herefor in strict compliance with all ordinances pertaining thereto and with the understanding that the work will be performed in compliance with any by the proper m nicipal authorities. This Permit may be revoked change ithout thori " • for on. A further condition upon which this rough knowle. of the ordinances and ecifications t sumes xespon- Y itAr ,4 and l "' By RECTOR hereunder compliance with all ordinan d regulat tins submitted to the proper agt}ztprities of Miami Shlip,yillaie. • t, servant or employee. AUTHORITY Distance to next nearest building STATE OF FLORIDA, COUNTY OF DADE. 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 VillaIge, 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. Date — — — ✓ �/ — – 197 Owners Name and Address C ' ' No. a tree ® Registered Architect and /or Engineer —_— t !P.l /l "' – – 1'J i M Name and address of licensed contractor L2x����• Location and legal de cription of lot to be built on: Z ' Block.. Subdivis �4 ''� '� �� � __ � 1 E, ©r�_ �� �_ �� ! / _ � __ -��� Street and Number where work is to be done g -! zo /_ —lip - State work to be done and urposerof- building (by floors) – _ • ^ ---•9- • 8 / and for no other purpose. New Building Remodeling Addition__ � Repairs No. of Stories____L_ ___ To be constructed ofeDNs�'.t___ Kind of foundation Roof Covering__44/_ Estimated Total cost of improvements $ _DA_... Amount of Permit $ _ Zone cubage required_______ Plan Cubage i ° 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 • C- . // 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) 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, and that he did sign the same, and that all facts therein by him stated are rue. . ' Permit No.___ —_ Date Read, Sworn to and Subscribed before me. Disapproved — _______ Date (Signed) -- — – – — – Building Inspector My Commission Expires_ PLANNING BOARD DATE Chairman Member Member Member — Member ._ Member Council Approved__ ._— _____� _ Date Disapproved Notary Public, State of Florida to me well 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. STATE OF FLORIDA) SS COUNTY OF DADE ) / 4 7 • /19i of the Village of Miami Shores, County of Dade and State of Florida, being duly sworn, doth depose and says that under the provisions of Section B -368, Sub - section (d), of the Building Code of Miami Shores Village he desires to build e-/�#CEF.✓YEJI .BCe//YD .P /j /" on Lot Block of ;7.4.(S subdivision; that he is the owner of said property, and will do the work personally, and that he will, at such times as are required by the Zoning and Building Director: - 1. File plans and specifications and obtain approval of Village Planning Board and of the Building Inspector. 2. Apply for and secure a permit. 3. Pay the required fees for license and for permit. 4, Execute the work in accordance with the provisions of the Zoning, Building, and Electrical Codes of Miami Shores Village. 5. Apply for inspections. 6, File with the Building Inspector certificates that provision has been made to carry the necessary Workman's Compensation, Public Liability and eroperty Damage Insurance,. File with the Building Inspector as the job progresses certificates showing the payment required by the Federal Social Security Act to the State of Florida or the United States of America. Assume the responsibility of not employing contractors or sub - contractors other than those properly licensed by Miami Shores Village or any part or portion of the work including, but not limited to, general contracting, plumbing, heating, electrical, septic tank, solar system, lathing, tile, torrazo, painting, roofing and shoot metal work or installation. ,'9. Not sot himself up as a "Contractor ". 10. Execute Builder's Bond. And further this Deponent says not. AFF I J)A V I T SUBSCRIBED AND SWORN TO BEFORE ME THIS DAY of A. Di, 19 Signature of Applicant. 2. Signature of Officer administering oath. 2. r • • . . , • • ' • • 1 MIAMI SHORES VILLAGE BUILDING INSPECTION DEPARTMENT APPLICATION FOR BUILDING PERMIT Application is hereby made for the approval of the detailed statement su me plans and specifications herewith submitted for the build inc or other structure h d escri b e d. This application Is made In compliance and conformity with the Building Ordinance of Miami Shores Florida, and ail provisions of the Laws rsf 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 piogreu of the work. APRIL 7th. 1987 Owner's N31710 and AddressJACKQUELINE HOLME S — m 78 N .E . &Ted 101 M SH'ORE7. Registered Architect and/or Engineer... . s . ret5R .Trf.y....wTN15.e.ws 5100 N.W. 72 FLORIDA 33166 Name and address of licensed controctor.S.EY.Uedja....C.CLIZJELE' Location and legal desert lion of lot to be built on subdivision,d JS/x/ /PM I/ Jai' a /gm 0 Lot 3 Q.04 Block Street and Number where work is to be done State work to be done and purpose of building (by floors) REPLACING 2 0 WDWS WITH 2 ATW IN EXISTING OPENING S . NO STRUCTURAL CHANGES. 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 $ 2 7 0 Q Amount of Permit S. 22.50 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 \S'orkinen's Compensation Act, being Section 5960, Compiled General Laws of Florida, Permanent Sopplement, and has complied said) 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 sit of the work such public notice or notices as are required by the Act. The undersigned agrees to employ only such su tractors under this pennit, permit, as are licensed by Miami Shores Village. ......ddmialiel:L Rein.uks (Signed) STATE OF FLORIDA. COUNTY OF DADE. si* 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 care ully read the foregoing application, and that he did sign the same, and that all facts therein by him stated are tru Permit No. Date Read, to and Subscribed bef. e e. -477 Bedding Inspector ••• 78 N.E. 101 STREET SHORES. FLA. "C Disapproved Date otary Public. State of orida (Signed) My Commission E.„,.....m-Ny0_,TAmRgaiNc.. ANP me well known, JULY 25 1987 PLANNING BOARD DATE BONDED THRU GENERAL INSURANCE UNQ Chairman Member ' Member Member • ...... .... ............... ..... ............. Member Member Council Approved Date Disapproval Date NOTE: A charge of $1.00 will be made for making corrections Of changes to this application after approval has been obtained fmns die Pl. ,i ni r, Board. A re.m.pection 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. Application is hereby made for the approval of the detailed statement or roe plans and specifications herewith submitted for the build ing or other structure herein described. This application is madc'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. At-LA?. S�`�t— f t; ►—r 4�2 19..16 Owner's Name and Address ...3�-(L(C C mil. ._. No.. Ne ». street2.2 l S Ei Registered Architect and /or ,,,,, , ,,,,,,,,,,,,, ,, ,,, , ,,,,,, ,,,,,,,,t>,,.,. - Name and address of licensed contractor ...SC ..Et.�l�: �' [.. r g / Ai' 7P . icto Loca n and legal dyscc of lot to be built on: Q �J Lot °, /Cre a1 Block l ° Subdivision2 S. .1 `� /� .»1 �_ 62Y /. c,,C Street and Number where work is to be done State work to be done and purpose of building (by floors) ` ' �'�? c 1 -- ! 1 / Z o > ? ' S . . 2 /9 T'v' / AJ -- 2 )( 75 7) "/ 6 cr/cJ j DS — rvo ....5p&-z742 s Y t � r C i New Building Remodeling Addition To be constructed of Kind of foundation Estimate Total cost of improvements S o ' Amount of Permit S Zone cubage required plan Cubage Distance .to next ne.uest 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 be sent to.. STATE OF FLORIDA, COUNTY OF DADE. ss. peared ....� Fz�✓nU....��o..t .l{{ Permit No.._ Disapproved (Signed) MIAMI SHORES VILLAGE Building Inspector BUILDING INSPECTION DEPARTMENT APPLICATION FOR BUILDING PERMIT PLANNING BOARD Repairs and for no other purpose. No of Stories o Covering its construction may The undersigned applicant for this building permit does hereby certify that he understands and accepts of Lrhur under the Florida %%'orkmen's Compensation Act, being Section 5966, Compiled General Laws of F and has complied with the provisions thereof, and will require similar compliance from all contractors or in the work to be performed under this permit; and will post or cause to be posted for inspection on or notices as arc required by the Act. The undersigned agrees to employ only such s permit, as are licensed by Miami Shores Village. 'I Remarks igned Read, S , to and Subscribed before me. otary My Commission obligations as an employer orida, Permanent Supplement, contractors employed by him he work such uhlic notice nder this 3 Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments. 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. . / <9—I46 CO Date 9 1 I �J1 Date.._........_ Public, State of Florida _ Expires... NOTARY PUBLIC STATE OF.FLORIDA 7VIT C071743ST017'E771K>:;'JUt' -29 iytsi DATE 1ONDED T}IRU GENERAL INSURANCE UNO Chairman Member a _ Member Member Member .. .. _ ....._......_..._._...._......_ Member Council Approved Date Disapproved Date NOTE: A charge of S1.00 will be made for making corrections or changes to this application niter approval has been obtained from the PL,nnit, hoard. A rc- inspec•tiort fee of 51.00 will be charged when such re- inspection is made necessary by improper notice for inspection of faulty materials anti /or workmanship. Location and legal description of lot to be built on: Lot .,3 v iele P... a . Block ,/ P Street and Number where work is to be done ss. MIAMI SHORES VILLAGE BUILDING INSPECTION DEPARTMENT. APPLICATION FOR BUILDING PERMIT Application is hereby wade 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 ‘'illage, 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 pgress of the work. � /� Date ._..., (Tuner's Name and Address • 47 'ti 40"✓c 4 - 1 C-i „:a, ,• ,,, No, ! Street .Il�,�,, „„ ... -. Registered Architect and /or Engineer r..0.1....MM.... SITIMI Name and address of licensed contrgctor.... l i - . fC'�! -3 /ls .Z.. , 1• Subdivision ✓Z � .� � d?.7' ‘`‘' / '/ O - 70 78 )2e 1x1.1 State work to be done and purpose of building (by floors).. -- -- -- `\ and for no other purpose. New Building Remodeling Addition Repairs No. of Stories To be constructed of Kind of foundation ' r oof Covering . Estimated Total cost of improvements $....P2 Q P 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 su it all the plans and s ecifications for said building. All notices with reference to the building and its construction may t,r�s be sent to �� - ��f -�� � 1P �.-f ' 0 6 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 hint in the work to be performed under this permit; and will post or cause to be poste 'r inspection on the site of the work such public notice or notices as are required by the Act. The undersigned agrees to employ only suc ' t . ntractors, on wor be pe fc�ymed under this permit, as are licensed by Miami Shores Village. Remarks (Signed) STATE OF FLORIDA, 1 COUNTY OF DADE. Notary Public, State of Florida My Commission Expires Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally ap- peared - - -- 3 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.. / 4- fra 3 -C - Date - _. 2-.a....__ Read, Sworn to and Subscribed before me. Disapproved Date..__. (Signed) k (.4-a Building Insp otor PLANNING BOARD ....... -DATE Chairman Member bfcrnber Member Member Member — Council Approved - Date Disapproved - w 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.