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1250 NE 102 St (6)Owners Name and Address N.. It l� 3a o5 cz.5003' MIAMI SHORES VILLAGE (3 7 BUILDING INSPECTION DEPARTMENT APPLICATION FOR BUILDING PERMIT Application is hereby wade for the approval of the detailed statement us toe 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. Registered Architect and /or Engtncer e 0 vj t N N I !- 011, MI ?? ?" "'.,,,,,3,,,. •t*ie „, :., ,f ff ] / Name and address of licensed contractor 0 g..u..1. /.ta.. :.r...i. .. �... .. .z_.v C.. ».... » . f ... :.... ... ...i% .a.�t A1 R Location and legal description of lot to be built on: 3s Lot Block Subdivision A r ._ Street and Number where work is to be done e - C _ J v i l 0°'2 � //,�,, P. t _ °i' State yea to l! b � e . done and purpose of building (by floors) .C �- fes) c.o. . ..4Q .to g.. �'1 c. .. _ e os;: �1.. ..._... c ecPocA• to °t 1.I _._... ».__.... ».. ,19.3 Qt (� 1 _No./ !� SO... street. ..& C and for no other purpose. Ncw Building Remodeling 2,-- ------ - Addition Repairs No. of Stories To be constructed of Gv!PI CON:L Kind of f� a �f Estimated Total cost of improvements $ Amount of Perm $...Z.ij ` 0 Zone cubage required Plan Cubage Distance .to next nearest building Size of Building Lot Maxirnum lire load to be borne by each floor I hereby submit all the -ins and specs stations for said building. All notices with reference to the buildin q be sent to.. D.. r.of.... .1.. . c. 4 . l �-�. �. ... E 3. S F .x h a.. tt.. ., STATE OF FLORIDA, t . COUNTY OF DADE. i ss' Building Inspector My Commission Expires Notary Public, State of Florida t nd its construction may I a . _? o 6, 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 Sup plernent, anti has complied .t ith 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 ork such public notice or notices as arc required by the Act. The undersigned agrees to employ only such ntractors, k to ,t parfo yned u der this pcnnit, 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- 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 Permit No..-.1 9 therein by him stated are true .r� Date 1 tt � ). 1 Read, Sworn to and Subscribed before me. c Disapproved .... !�l % }. Date.. (Signed) PLANNING BOARD DATE Chaironan Member \fcrnbcr 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 31.00 will be charged when such re- inspection is made necessary by improper notice for inspection or faulty materials anti /or workmanship. Owner's Name and Address Registered Architect and /or Engineer Name and address of licensed contrpctor Location and legal description of lot to be built on: Lot Block Street and Number where work is to be done 4 State work to be done and purpose of building ( Disapproved - D te. (Signed) .... 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 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. Chairman \fcrnber Member Council Approved Date NOTE: A charge of $1.00 will be made for making the Planning Board. A re fee of $1.00 will be charged materials anti /or workmanship. "XAIC Date. 7 7 Nohlr A StreetL° 2" ....... . 4. /.Ja . ubdivision /' 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 $ 7 6 "� — Amount of Permit $1 cc 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 pennit 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 inspecti t e tte • i c work such public notice or notices as arc required by the Act. The undersigned agrees to employ only such ctor /. w be pew d under this pennit, as are licensed by Miami Shores Village. ` Remarks (Signed). STATE OF FLORIDA, ss. COUNTY OF DADE. Bcfore 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.._. � Date.. -. , r -7 Read, Sworn to and Subscribed before me. Notary Public, State of Florida PLANNING BOARD DATE to me well known, uilding nspcctor My Commission Expires Member Member Member ._.._ Disapproved Date corrections or changes to this application after approval has been obtained from when such re- inspection is made necessary by improper notice for inspection or faulty ` t45 -er.' 1 Legal: Lot No. Subdivision or Metes & Bounds NOTE: 1. Show existing 2. Show distance additions. 3. Locate septic PLOT PLAN ST., TERR., AVE., CT., PL. NO SCALE Block No. SEC. T4P. RGE. Plat book and Page No. buildings and from property tank or sewer G NORTH ARROW additions. lines to buildings and /or new and electrical service.