141 NE 102 St (2)5- 3- 3 -
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BUILDING
ELECTRICAL
PLUMBING
PERMIT N° 3316
Work to be performed under this Permit
Owner of
Building f r ` ,�
Architect
Contractor
or Builder
Legal Lot Bl.
Description
MIAMI SHORES VILLAGE, FLORIDA
DATE 194 --�
Subdi-
vision
Address of i' Value of
Building �r >' Project .......
This permit is granted to the contractor or builder named above to construct the building or to install the equipment or device descried in the
application 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 responsibility for work done by his agents, servants or employees.
Signed•
INSPECTOR
In r on of rth issuance to me off( is permit I agree to perform the work covered hereunder in compliance with all ordinances and regula-
tions pe ing t ` in strict confor , with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores
Village. n a .:��' t i ermit I assume .onsibility for all work done by either myself, my agent, servant or employee,'
y `1' /:44tom 14..-4'
BY AUTHORITY
e ,
Contractor's
License No.
Amt. of
Permit
By s..r..w•�°
T
STATE OF FLORIDA,
COUNTY OF DADE.
Permit No
Disapproved
(Signed) _
Chairman
Member
Building Inspector
MIAMI SHORES VILLAGE
Date
Date
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
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 �1 __ 1� / �
Registered Architect and /or Engineer
Name and address of licensed contractor
Location and legal description of lot to be built on:
Date - -- _-
Lot Block____ Subdivision y1 46-1 __
Street and Number where work is to be done _I 4 1 L •__1 o__1 S
State work to be done and purpose of building (by floors)
__and for no other purpose.
New Building ________________________ Remodeling__Y ________ Addition_____________________ Repairs No. of Stories_
To be constructed of Kind of foundation Roof Covering
Estimated Total cost of improvements $ G—e _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 inspecti n on the site of the / ork such pu is notice
or notices as are required by the Act. The undersigned agrees to employ only such subcont ors, pp por performed rider 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 be 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.
Read, and Subsc bed before me.
Notary Piic, State of Florida
My Commission Expires
PLANNING BOARD DATE
Member
Member
Member Member
Council Approved_ Date Disapproved
Kr? . -V
No.! /L_—_ Street_ /
Q/L eC 7 -G �iya �� /t,✓✓ i"-
to me well known,
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.
_Date