118 NE 102 St (6)7
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
t./
Date ,S' =29 Ah Address //g NE /02 ST Tax Folio
Historically Designated: Yes No
Legal Description
Owner/Lessee / Tenant abtl -D 44A/y) $4d tS Ig LW/ D Master Permit # ( q )-17
Owner's . We' /e, - T' s f I U57 GD733
Phone
3s- e lq — r / 353 Ce
Contracting Co. ow J' a r• Address
Qualifier SS# Phone
State # Municipal # Competency # Ins. Co.
Architect/Engineer Address
Bonding Company
Mortgagor Address
Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING
WORK DESCRIPTION ) C (QC ,/, CDiI/(_'ie ' �/!JF CG)/9 6e9(7
Address
Square Ft. Estimated Cost (value) „ • .
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. Furthermore, I authorize the above -named contractor to do the work stated.
Signature of owner and/or Condo President Date
Notary as to Owner and/or Condo President Date
My Commission Expires:
FEES: PERMIT
APPROVED` \ -- P \°\ ‘.k , (
Zoning L � Building
Mechanical
as to C ntractor . r Owner- Builder
My Commission Expire
RADON C.C.F. - ,C 0 NOTARY c 1 0 Q BOND 30 n p. c
Electrical
. PU e, OFFICIAL NOTARY I
BECKER
0
2 co lesan nuMaett
41(94 '455; CC786697
� e Y COMMISSION EXPIRES
F OF F'.O NOV. 1S,2002
TOTAL DUE
FENCE SIGN
L ' —tar'
Date
S / Zg 1 Da e 1
Plumbing Structural Engineer
PERMIT NO. •
ADDRESS:
MIAMI SHORES VILLAGE
BUILDING / ZONING DEPARTMENT'
SECTION
BY
DATE
ZONING
ELECTRICAL
MECHANICAL
PLUMBING
FIRE
PUBLIC WORKS
STRUCTURAL
BUILDING OFFICIAL
I. Subject to compliance with alt Federal. State.
County.Wlage totes and tegutatlans. Wage essua
no responslbp(ty tor accutdcy aflot resutts from
these plans.
2. This copy of plans must b. available ea
building site at ao Inspection wtii be conducted.
JOB ADDRESS ` l " / 7O - T
APPLICANT , t'Z 4 e &WO
APPUCATION
0
CRITIQUE SHEET
PHONE #
«& w/9- f
SHEET OF
MISCELLANEOUS
DATE MlelV • y \o"\ COMMENTS
INITIALS
5 / 34 /o / No A tires o w 4eo,672 77 - L €
IeEZa? F3 Two t cx At2oP 'ry
tio7 0,0 t o-7 - off'- w •
114 e_ t^_to bh vt!} PO'tt i la 5 /V A 1, P Qe_t2.
7// harni ShoreJ
10050 N.E. SECOND AVE.
MIAMI SHORES. FLORIDA 33138 - 2382
Telephone: (305) 795 -2207
Fax: (305) -756 -8972
COVENANT OF CONSTRUCTION WITHIN RIGHT OF WAY
WHEREASE2O .QN TCA.),cl i .444/10 , hereinafter referred to as the Owner of the
(owner)
following described property:
Legal description /folio #:
Lot 1 � .� �- � a 13 Block
Tax Folio #: I I 3O b 0/3 ID
requests permission to install:
OR[uiiuify
APPeo tf
I) Subdivision rn S SQ C 1 (B -4'B TO 7b
Asphalt, concrete, brick pavers
()Landscaping
[) Other //
within the public road right of way of //g ire ./o L sr /)70 �i (vres 24 33/38
(address)
IN CONSIDERATION of the approval of this permit by the Village, the Owner agrees as follows:
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.
?. 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 this
SIGNED. SEALED AND DELIVERED in the presen
STATE OF FLORIDA)
COUNTY OF DADE)
The undersigned Affiant, t, ReiC0 4tZT/ii — /►4fV /v, does hereby attest that the
(property owner)
d/aASI.A1.-61 0- 4.0--erk
(name of surveyor's company)
attached survey, performed by
AFFIDAVIT
performed on 9- 5- 9 « , 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 o day of
Witness(sign and print) Witness(sign and print)
1 n 16
Affiant is personally known to me, oduced �'/, b).., O °.� ') 6° / o was i entificatioh.
41110
•
OFFICIAL NOTARY SEAL
nY P06 ANGELA QA BECKER
Q St' CI COpIySSION NUYBe.
- a' CC786697
9 j 'III ; • to Ov 1SS1 5N2 0 Es
' OFF�0 _ - --
STATE OF FLORIDA
) SS.
COUNTY OF MIAMI DADE )
The foregoing instrument was acknowledged before me on
Q A h
A
F k ]) L A Sac'- L 7‘ ° '7a - /6 ], as ident''won and who did (i ' a . ot) take an oath.
STATE OF FLORIDA )
) SS.
COUNTY OF MIAMI DADE )
(ACKNOWLEDGEMENT-INDIVIDUAL)
Signature of Acknowledger.
, who is personally known to me or who has produced
Name of Acknow edger:
(Typed, Printed, or Stamped)
Title or Rank:
Serial No .(if any):
(ACKNOWLEDGEMENT - CORPORATION)
tu 21
The foregoing instrument was acknowledged before me on by
, of
a corporation, on behalf of the corporation. He/She is
is personally known to me or has produced as
identification and did (did not) take an oath.
Signature of Acknowledger:
Name of Acknowledger:
(Typed, Printed, or Stamped)
by
Title or Rank
Serial No.(if any):
BUILDING
ELECTRICAL
PLUMBING
Owner of -
Building '
1
4
PERMIT N? 7817
Work to be performed under this Permit
Architect
Contractor
or Builder °' - -/
Legal Lot
Description
MIAMI SHORES VILLAGE, FLORIDA
DATE - 4
194
Contractor's
License No.
CONTRACTOR BUILDER
Bl.
4 a 'v t- ..+�
Subdi-
vision
AUTHORITY
Address of / � �7 a' , c' Value 011 Amt.
Building ., Project ' ,,' Permit ? i /' t .1.'.
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 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
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. '. _,
Signed•` ` d - — r X a e, u_.1. By J
INSPECTOR
In consideration of the issuance to me of this permit I agree to perforn( jfie work covered hereunder in compliance with aordirkinces and latjon D
pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper autho'rr'ii'ttji`es of Miami SholeS``�Vi1lfAge.
In acceptipg this permit I assume responsibility for all work done by either myself, my agent, servant or employee.
STATE OF FLORIDA,
COUNTY OF DADE. ss.
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.
Date Mar. 5 19 49
Owner's Name and Address________LLr_ _,___2j? _4___D iclVa No 118 Street W• `02nd St
Registered Architect and /or Engineer
Name and address of licensed contractor LittleJObbers 9201 N. oa. 4th Ave.
Location and legal description of lot to be built on:
Lot _ Block Subdivision_
Street and Number where work is to be done _ 118 � J . 10 and. St .
State work to be done and purpose of building (by floors )_ Concrete driveway-
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 $ 100.00 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 rovisions 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.
I'i'PLL JOBBERS Remarks_____________________ (Signed)
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 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. G
Permit No._ Date
Disapproved ____________________________ _____ Date
(Signed) 3 Z - 1)f 00 1 t 1 1_ e_-.e i
Building Inspector f t
Read, Sworn to and Subscribed before me.
Notary Public, State of Florida
My Commission Expires
PLANNING BARD 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.