1223 NE 102 St (2)Address
4105
C o f M,JAMI SHORES-VILLAGE
BUILDING DEPARTMENT
305- 795 -2204 SEP 3 0 2005
Building Inspection Request
Date 1 7
Type Insp'n — Ot t )P ''H'F� .
Permit No. 2 C° 5 2.12
Name ` `I -M.1. 1 -4- * - n1-OeI.L
122.3 N- toz
Company Q ^-)Z
Phone # C305)2(6- 9.308
Inspection Date al ?'° 5
Approved lld
Correction ❑
Re- Insp'n Fee ❑
Qs) 15(1 - 4301
RE- OCCUPANCY
APPLICATION
Date 7/ 2,. b
by
produced
Sign:
Print:
(Rev. 10/02/03)
My Commission Expires:
OTARY PUBLIC:
Miami Shores Village
Building Department
IL.
Signature 1
Loc ID
�os � z /g- 9308
Contact Name X E 1 J N e i i / 7 U RA) Phone # 9 oS— 7 r — 3
Buyer Seller ✓ Realtor Company Name
Property Address J 2, 2 3 N L / 0 - sit
City Miami Shores State Fl Zip 3313 8
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795 -2204
Fax: (305) 756 -8972
Permit_No CO zocs z1
I hereby certify that I understand that the zoning of the property is for single- family residential use and
that it is unlawful for more than one family to reside therein. I also understand that any Certificate of Re-
Occupancy that may be issued by Miami Shores Village certifies only that the referenced property is
being used for single- family purposes and that such Certificate does not constitute any representation,
warranty or certification as to the condition of the dwelling or other structures on the property.
OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate.
Applicant Name 4. Ft/ 6 c4-7-7--ii 0A
The foregoing instrument was acknowledged before me this 2 -7 day of , 20 05 ,
ho is personally known to me or who has
as identification and who did take an oath.
,,y � el Vargas
./ 1 10Kek_ .. \.�� o p te s : Ju l 3 •
0
"
i ��d .Ex i�'es' Jull_ 3 ,2� 1 `
- nr
Atlantic knndinpCn Inc
Building Officials Approval:
Re -Occ. $60.00
Notary $5.00
CCF $0.60
Total zt6 - L .
STATE OF FLORIDA) SS
COUNTY OF DADE )
of the Village of I ienii Shores,
County of Dade and State of Florida, being duly sworn, doth depose and say,
that under the provisions of Ordinance No. 185, dated June 15, 1948, amend-
ing paragraph (d) of Section B -368 of Ordinance No, 97 of the Building Code
of Miami Shores Village, he desires to bu �, � e� .
on Lot Block / r‘ of Subdivision,
that ,e is the owner of said property, and 11 be the er of said
that he will do the work personally, and that
he will, at =uch times as are required by the Zoning and Building Director:-
1. File plans and specifications and obtain approval of the
Planning Board and the Building Inspector.
2. Apply for and secure a Permit.
3. Pay the required fees.
4. Execute the 14ork in accordance with the provisions of this
Code.
5. Apply for inspections.
6. File with the Building Inspector certificates that provision
has been made to carry the necessary Workmen's Compensation,
Public Liability and Property Damage Insurance.
7. File with the Building Inspector as the job progresses certi-
ficates showing the payment required by the Federal Social
Security Act to the State of Florida or the United States of
America.
8. Assume the responsibility of not employing other than properly
licensed contractors by Iuiarni Shores Village for any part or
portion of the work.
9. Mot set himself up as a "contractor".
10. Sign an affidavit before commencing work to the effect that
he has read this Article and will do the work personally and
observe all of the requirements of the Building, Electrical,
Plumbing and Zoning Codes of Miami Shores Village. Such
affidavit to be properly notarized upon blanks to be supplied
by the Building Inspector.
11. In order to prevent abuses and subterfuge the right of such
owner- builder as herein provided, is limited to but one
owner- builder permit each 2 years, and where an owner- builder
has once exercised the privilege herein conferred no second
application for owner- builder permit shall be granted in less
than 2 years, unless the applicant is qualified as a licenser.
General Contractor under the applicable Ordinances of said
Village.
And Further this Deponent says not:
A F F I D A V I T
OWNER
SUBSCRIBED AND SWORN TO BEFORE ME this 6717 day of `7�' A. D.,
19 3V .
NOTARY PUBLIC
NOTARY Pli -c 1!l, S 11 v.':; c.•
my f1.1-7 1.....
. R; r NUI:U l \