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171 NE 102 St (10)Test Location 1 2 Uplift Test (P A ' Pull or F S'iA Test Location 26 27 Uplift Pull Test (P or F) 7' Zif,. .y . Test Location 52 Uplift Pull Test 'P or F) �� At3 3 28 53 4 29 54 5 30 55 6 31 56 7 32 57 8 33 58 9 34 59 10 35 60 11 36 61 12 37 62 13 38 63 14 39 64 15 40 65 16 41 66 17 42 67 18 43 68 19 44 69 20 45 70 21 46 71 22 47 72 23 73 24 49 74 25 50 _ 75 Owner's Name: Job Address Du Quesne & Associates, Inc. Consulting Engineers Testing Laboratory Roofing Contractor: I< u) lac ' s OIDV Type of Tile: ST ■liv C+-'t 'ET Date Installed: 4 .1, O0 Approximate Roof Height: (2 feet Roof Pitch : Type of Access to Roof: Scaffolds Ladder Other Approximate Square Footage of Roof: 3 1 00 ft I Required TestinForce: t 5 s. Testing Equipment: Chatillion DFIS 100 Date Tested ' Op IN ACCORDANCE WITH THE CRITERIA OF PROTOCOL PA 106, THIS ROOF ASSEMBLY HAS PASSED THE STATIC UPLIFT QUALITY CONTROL TEST. REPORT S ITTED BY or Du Quesne, P. vil Engineer . #24513 D Quesne & A - .ciates, Inc. E.B. License #0005245 Lab Certification #94- 0318.01 ON -SITE CONCENTRATED UPUFT LOAD TESTING OF ROOF TILE IN ACCORDANCE WITH METRO -DADE BUILDING CODE COMPLIANCE PROTOCOL PA 106 Net e._. r SITE SPECIFIC INFORMATION TEST RESULTS P = PASS, F = FAIL SKETCH OF ROOF IN BACK UTR 16994 Environmental • Civil • Structural Building Inspection Services Permit #. o 4 THIS PA '106 TEST HAS BEEN PERFORMED IN FULL ACCORDANCE TO THE REQUIREMENTS OF DADE COUNTY, WITH NO DEVIATIONS. Please Note: This form is not valid unless Company logo appears in color (burgundy) 7815 S.W. 24th Street • Suite 109 • Miami, Florida 33155 • Telephone (305) 264 -1425 • Fax (305) 264 -1426 KETCH OF ROOF 10B SHEET NO. OF CALCULATED BY CHECKED BY DATE SCALE DATE NOTES' KETCH OF ROOF JOB III NA 1 o2 Sr, hits I-to cs 29 OF SHEET NO. CALCULATED BY DATE CHECKED BY SCALE DATE 94 .4 Al 111115111■' 11 ■1112`1/ ■► 111=11 II rF1111•uir 5Wu/R IPM31u1 7`JUIIIMINAMPM1 It1 AILi ■ ■tti ►g111■ ■■ J151111111110 imatoornimown. ma'am .11 41104111 62‘ramillammwramell z S NOTES: f )OOJthA PERMIT APPLICATION ATION FOR MIAMI SHORES VILLAGE Date 1 1 d dress 1 11 1 V . F t 10: st1 Tax Folio Historically Designated: Yes No V ._} - Master Permit # 1 4 6) 1.t y 1l ! N - E. 10)- .51 t M I U.r%4l � p 1-=?A 1 VL-Phone )D 5 956 9 ',IOC Contracting Co. 14a. U..) CC! R0rf 1 h Address I / IV • 4 -I „St, 1"G1.0 Jl.\ a uv -, (ek - 70 $q'5 Phone T 05 151' I `"1 I `r ' Competency # £ 3ES 0 Ins. Co. A-�er1 Ca\ EtC4 (y Architect/Engineer Address Bonding Company Address Mortgagor Address Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN 1 . WORK DESCRIPTION - fear o �X S`J" l h *- 4 k 4- S I e r UD C rep l c e . OA �:� h e w s pave i h S G I&y +-1 I e (51 �� I e ''(.o L ord - ot h' Square Ft. 3 / 0 0 Estimated Cost (value) L_ 0 0 0 I Legal Description - tally Owner/Lessee / Tenant Fria �kr 1 ei J {- Owner's Address Qualifier State # Municipal # 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 o er and/or Condo President / � ■ 3v ©Do 27•3o30 L� % e ft . • • er and/or C • iresOFFI GLADYS) .AR NARY PUBLIC STATE F FLO COMMISSION NO. MY COMMISSION EXP. MAR. 1 002 e Notary as t My Commission FEES: PERMIT I Y RADON APPROVED: Zoning Mechanical 0/— If e0 °2oa..f— �09v ss# OSb 4 a,LA.P4 . moo Signature of Contractor or Owner- Builder Date Notary as to Contract My Commission Expires: C.C.F. �, c 7 0 NOTARY 5 gl= O wner - Builder /o at OD BOND 3 Cj/> TOTAL DUE 7 Building 0 Electrical Plumbing Structural Engineer is - NOTICE OF COMMENCEMENT A RECORDED COPY MUST BE POSTED ON THE JOB SITE AT TIME OF FIRST INSPECTION PERMIT NO. TAX FOLIO NO. 1/ 3ab (c=' 66 / 6°V-7" STATE OF FLORIDA: COUNTY OF DADE: THE UNDERSIGNED hereby gives notice that improvements will be made to certain real property, and in accordance with Chapter 713, Florida Statutes, the following information is provided *n this Notice of Commencement. Leal description of property and street address: S F t 19 I f " E . 10 _$ . ► c A ► ,e1\ o r s BPS sae_ I /OD a.. I- - 3 b I oc K i3 2. Description of improvement: 3. Owner(s) name and address: Mi Amt )bore P, ra off" Interest in property: Name and address of fee simple titleholder: 4. Contractor's name and address: Palid �l A RAJ c& / r 8q / l'' . E l I i Miami ,cho re3 1 3' 5. Surety:(Payment bond required by owner from contractor, if any) Name and address: Amount of bond $ i 'A . c OF FLO' NRF.87 ' ;MP ;naI f OCaYa m: ' 0 � '" 6. Lender's name and address: . ,. - - - ■ s � ®i • friMEM 0 )' Ion" 7. Persons within the State of Florida designated by bwfiei~ t�` = m� ;( • ■ :!�:' i � rit a1. as provided by Section 713.13(1)(a)7., Florida Statutes, "" Name and address: 8. In addition to himself, Owner designates the following person(s) to receive a copy of the Lienor's Notice as provided in Section 713.13(1)(b), Florida Statutes. Name and address: 9. Expiration date of this Notice of Commencement: (the expiration date is 1 year from the date of recording unless a different date is specified) Signature of Owner • Sworn to and subscribed before me this roc- 6 3-0 oY P V OFRCIAL NOTARY d RITA � ON Print Owners Name r Notary Public Print Notary's Name My Commission Expi M rc * CC7972 day of DA, CO.w►r U of this is ofico n� ,19 00R034652 2000 JAN 24 14:17 ev Prepared by: Ida t� Ki( I.LxLIc Address: 4 13 1 717, 'v L , ! CO M1014.1 _Shore ' - F 12a01 -52 2, Ft. n V Ft n Deck type: 123.01.71 966 DETAIL 1 & 2 Appendix "E" UNIFORM ROOFING PERMIT APPLICATION PROCESS No. Contractors Name: yCA S \ G1,Va1 d Job Address: jtOOF CATEGORY ❑ (Law Slope Application) ❑ (Nail -On Tile) W (Monar•Adhesive Set Tile) ❑ (Asphalt/Fiberglass Shingles) ❑ ( Metal Roofs Wood Shingles & Shakes) ❑ (Other) jtOOP TYPE ❑ New Roof 0/Re roofing ❑ Recovering ❑ Repair ❑ Maintenance Flu Roof Ara (R') 0 Sloped Roof Area (R') 3 100 Total (R') 3100 Master Permit No. Exposure category (per ASCE 748): Building Classifiation category (per ASCE 748 table 1): A TTACEMENT Fastener Type: $PACING Field: Perimeter Corner. ROOF HEIGHT AND SYSTEM DETAILS (Draw details u Deeded) Page - I �1( N.E , l 0.. s ROOF PLAN AMAX ITT �? Appendix "E" UNIFORM ROOFING PERMIT A PPLIC. "- TION PR( NESS No. 41100• SILOPS D E T A I L 3 ,ELOPED SYSTEM DESCRIPTIQN DKk trpt:fl \A 19 Nu z Urailertayment 3D pair Ittodstlidc 1usartype **Pedlar Cep Sheet 1 o PeLP -er Roof Covering. 1 G II r TILE CALCULATIONS (hoax': 2.1 X (Aerodynamic Multiplier): 11A1 ) • M - M PCA: (Thn 2: 101: 7l rAe oayr►.mt. Mutlipl;c,: oal) • M - M,,: PCA: (Pntar3: 1D 1 4x 7l cAeoay+vm+c !ilulupli : a "-` 1) • M ' M, PCA: Page -2 ATTL CHMENT� REQUIRED 1) Fire r irectory Li; . 1g Page 2) Dads. :,ounty Pro, ct Camrtrol Notic • of Ac eptr .. e.Cover Sheet a) Sy ::ci5c Syne.: .Description b) S45 :ifc Syste Limitation c) Gr Limit; • ions d) A.5 Acable De a1 Drawings 3) Muss *al Pei ppliation 4) Othex Wrongs L-cLy" 4 wL 'scOe-tbek APPENDIX "F" REQUIRED OWNERS NOTIFICATION FOR ROOFING CONSIDERATIONS As it pertains to this Appendix "F ", it is t!:e responsibility of the roofing contractor to provide the owner with the required roofing permit, to provide the owner with this appendix and to explain to the owner the content of this form. The provisions of Chapter 34 of the South Florida Building Code (SFBC) govern all the minimum requirements and standards of the industry for roofing system installations. Additionally, the following items should be addressed as part of the agreement between the owner and the contractor. The owner's initial in the adjacent box indicates that the item has been explained. d i 1. Aesthetics - Workmanship:. The workmanship provisions of Chapter 34 are for the purpose of providing that the roofing system meets the %vin! resistance and water intrusion performance standards. Aesthetics (appearance) issues are not a consideration with respect to workmanship provisions. Aesthetic issues such as color or architect: :: a ! appearance, that are not part of a inning code, should be addressed as part of the agreement between the owner and the contractor. 2. Renailing Wood Decks: When replacing roofing, the existing wood roof deck may have to be renailed in , ccordance withithe current provisions of Chapter 29 of the SFBC. (The roof deck is usually concealed prior to removing the existing roof system) r ■ . 3. Common Roofs: Common roofs are those which have no visible delineation between neighboring units (i.e. townhouses, condominiums, etc.). In buildings with common roofs, the roofing contractor and /or owner should notify the occupants of adjacent units of roofing work to be performed. 4. Exposed ceilings: Exposed, open beam ceilings are where the underside of the roof decking, can be viewed from below. The owner may wish to maintain the architectural appearance, therefore, roofing nail penetrations of the underside of the decking may not be acceptable. The SFBC provides the option of.mainta ining this appearance. '5. Ponding Water: The current roof system and /or deck of the building may not drain well and may c water to pond (accumulate) in low -lying areas of the roof. Ponding can be an indication of structural distress and may require the review of a profcsional structural engineer. Ponding may shorten the life expectancy and performance of the new roofing system. Ponding conditions may not be evident until the original roofing, system is removed. Ponding, conditions should be corrected. G. Overflow Scuppers. (wall outlets): It is required that rainwater flow off so that the roof is not overloaded from a build up of water. Perimeter /edge walls or other roof extensions may block this discharge if oVerflow scuppers (wall outlets) are not provided. It may be necessary to install overflow scuppers in accordance with Chapter 23 of the SFBC. 7. Ventilation: Most roof structures should have some ability to vent natural airfio•.v through the interior o t to structural assembly (the building, itself). The existing, amount of attic ventilation shall not be reduced. 1: may be beneficial to consider additional venting which can result in extending the service life of the roof. S. The owner may contact the Miami-Dade County Consumer Ser i:es Department for f..:ether information regarding the above. 0wwner's /Agent's Signature U i.4l 00 Date Contractor's Signature - JAN -20 -00 THU 7:34 AM ABC. SUliLY. , E11/20/2888 08:28 385898085 • MIAM Approved: 09/16/1999 PRODUCT CONTR I NOTICE OF ACCEPTANCE FAX NO. 954 491 4489 SANTAFE TILE CORP P. 1 PAr6E 81 MIAMI -DADE COUNTY. FLORIDA METRO -DADE FLAGLER BUILDING BUILDING CODE COMPLIANCE OFFICE METRO.OADE FLAGLER BUILDING 140 WEST FLAGLER STREET. SUITE 1603 MIAMI. PLORIDA 33130.1563 (305) 375 -290) PAX (301) 373.2901 Santa Fe Tile Corporatl. CONTRACTOR LICENSING SECTION 10302 N.W.South River ve, Bay M16 (30$) 375 -2127 FAx (303) 37$.25sa Medley 33118 CONTRACTOR ENFORCEMENT SECTION (305) 375 -2966 FAX (305) 375 -2905 PRODUCT CONTROL DIVISION Your application.for Produ Approval of: (305) 375 -2903 FAX (303) 372 -6339 Spanish S Clay Tile under Chapter 8 of the Cod4of Miami -Dade County governing the use of Alternate Materials and Types of Construction, and completely described herein, has been recommended for acceptance by the Miami -Dade County Building Code Compliance Office (BCCO) under the conditions specified herein. This approval shall not be valid after the expiration date stated below. BCCO reserves the right to secure this product or material at anytime from a jobsite or manufacturer's plant for quality control testing if this product or material fails to perform in the approved manner, BCCO may revoke, modify, or suspend the use of such product or material immediately. BCCO reserves the right to revoke this approval, if it is determined BCCO that this product or material fails to meet the requirements of the South Florida Building Code. The expense of such testing will be incurred by the manufacturer. Acceptance No.:99 0716.03 (Revises No.: 97 0515.05) Expires:01/22 /2001 Raul Rodriguez Chief Product Control Division THIS IS THE COVERSHEET, SEE ADDITIONAL PAGES FOR SPECIFIC AND GENERAL CONDITIONS BUILDING CODE & PRODUCT REVIEW COMMITTEE This application for Product Approval has been reviewed by the BCCO and approved by the Building Code and Product Review Committee to be used in Dade County, Florida under the conditions set forth above. ranctsco ti ul to ana, .A. Director Miami -Dade County Building Code Compliance Office Internet ea pl1 •ddret9: postQt •lttr @bui141necedeonline.com 135 Homepdgr: 6tlp :/ /NvM.buildingrodrantInu.eo9t JAN -20 - 00 THU 7:35 AM ABC. S LY. ' elf 28/2800 88:20 3858888 S_A T C 1. SCOPE This - revises a roof described in Seen Florida Building pressure requirem pressure values 0 in section 4 herein. Category: Sub Category: 2. PRODUCT DESCRIPTION ')('cat IN u ct re t Test icont Dime na Sp jlf Sentafe 'S' Clay Roof Tile Trim Pieces Elpelikst Tile Screws 2.1 Components or products manufactured by others Product N[anuf ct er. Dcsc 1 n ll .r. Stainless Steel generic -pingnsions Ni x 2 -'/,' long 0.130" shank dia. 0.178 flute die. PTA Prepared Roofing High Profile Tile 1= 18" w =11.5" 1/," thick I F varies w - varies varying thickness Test Ce tea ions PA 114 Appendix E FAX NO. 954 491 4489 SANTAFE TILE CCRP ACCEPTANCE No. : APPROVED :September 16, 1999 EXPIRES ua 2 Zoo1 ST :N A' i O DiT INS Sa.ntafe , as manufactured Santafc Tile Corporation system using designed to comply with the South 2 of this Notice of A g F or the locations where the 1994 Edition for Miami -Dade County. do not exceed the design s , as 4etermined by SRC Chapter 23, n by calculations in compliance with 127 using moment the values lis e [ fie attac hment calculations shall be don s PA 112 High profile, one piece, clay roof tile equipped with two nail holes. For nail -on, mortar set and adhesive set applications. PA 112 Accessory trim, clay roof pieces for use at hips, rakes, ridges and valley terminations. Manufactured for each tile profile. Product Dsseri0911 Frank Zu olof 8a, RRC + ~� Roofing Product Ccntrol Examiner P. 2 PAGE 02 SAN - 20 - 00 THU 7:35 AM ABC. SU ' P1 '20/2000 08:20 TA 30598800 NOTICE 3. LIMITATIONS 3.1 Fire class 3.2 For moth performe 3.3 Applicant to perfor Santafe 'S' Santafe 'S' Tile Profile Santafe S Tile Profile Battens Direct Deck S.93 [ 5.90 Tile Applicatiofl Direct Deck Battens LY. a tion i or ad acco all re uarter 4.2 Data For Attachment Calculations Battens Direct Deck 5.85 5.12 Two Nails 21.8 Battens 5.73 L Approved scre as nottd'P manufactured by others' FAX N0. 954 491 4489 SANTAFE TILE CORP ON ACCEPTANCE No.: 99- 0716.03 not part of this acceptance. e sive set tile applications, a static field uplift test shall be l ance with RAS 106. in the services of a Miami -Dade County Certified Laboratory test in accordance with PA 112, appendix `A'. Such testing shall be submitted to the Building Code Compliance Office for review. 3.4 Minimum underlayments shall be in compliance with the applicable Roofing Applications Standards listed section 4.1 herein. 3.5 30/90 hot mopped underlayment applications may be installed perpendicular to the roof slope unless stated otherwise by the underlayment material manufacturers published literature. 3.6 This acceptance is for wood deck applications. Minimum deck requirements shall be in compliance with chapter 29 of the SFBC. 4_ INSTALLATION 4.1.1 Santafe 'S' and its components shall be installed in strict compliance with Miami Dade County Roofing Application Standard RAS 118, RAS 119, and RAS 120. Table 1: Aerodynamic Multlplyers- 1.(ft') X. (ft) Batten Application 0.274 Table 2: Restoring Moments due to Gravity - M (ft-Ibf) Tile 2":12" 3 ":12" 4 ":12" 5 6 ":12" Profile Table 3: Attachment Resistance Expressed as a Moment- Mf (ft-lbf) For Nall -On S stem One Screw 29.16' Direct Deck 5.69 APPROVED :September 16, 1999 EXPIRES :January 22, 200 N I ARD C ' . DITIONS Battens 5.56 Direct Deck 5.53 Two Screws 38.20' Battens 5.32 t Direct Deck 0.297 One Screw Two Screws " w/ CU? 57.31 Direct Deck 5 -29 p 3 • J PAGE 83 7 ":12" or greater Battens l Direct Deck 5.03 N/A rank 2uloaga, R0C Roofin8 Product Control Examiner wt Clip 57.60' 61 77' JAN - 20 - 00 THU 7:36 AM ABC. SU 'LY. 01/20/2000 08:20 30588800 MTAFE Santate 'S' ON FAX NO. 954 491 4489 SAI`(TAFE TILE CORP PROFILE DRAWING SANTAFE "SANTAFE S" CLAY PAGE 04 ACCEPTANCE No. :92.4)7 [4.03 APPROVED :September 16, 1999 EXPIRES :January 22 2001 NOTICE ACCEPTANCE: STANDAR CON ON .- .Table 4: A hme Resistance Expressed as a Moment - M, (ft -tbf) for ortar or Adhesive Set Systems Tile Tile Attachment Profile Application Resistance Mortar Set 23.0 Adhesive Set 61.9 5. LABELING All tiles shall bear the imprint or identifiable marking of the manufacturer's name or logo, or following statement: "Miami -Dade County Product Control Approved ". 6. BUILDING PERMIT REQUIREMENTS 6.1 Application for building permit shall be accompanied by copies of the following: 6.1.1 This Notice of Acceptance. 6.11 Any other documents required by the Building Official or the South Florida Building Code (SFBC) in order to properly evaluate the installation of this system. fil a. RRC �� Roofing Product Control Examiner anec • mitt JAN - 20 - 00 THU 7:37 AM ABC. SU 'LY. @L 20/ 2800 08:20 30588800 SAN . AFE TI . E CO NOTI E 1. Renewal of this A filed and the origin are no older than ei (g ye SANTAFE TILE CORP 11 N ACCEPTANCE No_ : 99- 0716.03 APPROVED : September 16, 1999 EXPIRES :January 22.2QQI pproval) shall be considered after a renewal application has been documents, including test- Supporting data, engineering documents, 2. Any and all approv produc$S shall be permanently labeled with the manufacturers name, city, state, and the foil. ng sta4meet: "Miami -Dade County Product Control Approval ", or as specifically stated in a specs is conditions of this Acceptance. 3. Renewals of Acceptance will not be considered if: a. There has been a change in the South Florida Building Code affecting the evaluation of this product and the product is not in compliance with the code changes b. The product is no longer the same product (identical) as the one originally approved. c. If the Acceptance holder has not complied with all the requirements of this acceptance, including the correct installation of the product. d. The engineer who originally prepared, signed and scaled the required documentation initially submitted, is no longer practicing the engineering profession. 4. Any revision or change in the materials, use, and /or manufacture of the product or process shall automatically be cause for termination of this Acceptance, unless prior written approval has been requested (through the filing of a revision application with appropriate fee) and granted by this office. 5 Any of the following shall also be grounds for removal of this Acceptance: a. Unsatisfactory performance of this product or process. b. Misuse of this Acceptance as an endorsement of any product, for sales, advertising or any other purposes. 6. The Notice of Acceptance number preceded by the words Miami -Dade County, Florida. and followed by the expiration date may be displayed in advertising literature. If any portion of the Notice of Acceptance is displayed, then it shall be done in its entirety. 1. A copy of this Acceptance as well as approved drawings and other documents, where it applies, shall be provided to the user by the manufacturer or its distributors and shall be available for inspection at the job site at all time. The engineer need not reseal the copies. 8. Failure to comply with any section of this Acceptance shall be cause for termination and removal of Acceptance. 9. This Notice of Acceptance consists of pages I through 4 and this last page 5. END OF THIS ACCEPTANCE FAX NO. 954 491 4489 STANDARD a ND ION Frank Zuloaga, RRC Roofing Product Control Examiner PAGE 85 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 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 Cl in � w42„, S Registered Architect and /or Engineer II__ �. / Name and address of licensed contractor ob e r is / c ' /i - 0117 0 Of J cka 61v) Location and legal description of lot to be built on: ) R Lei Q�/� Lot a a J Block [3 Subdivision // / /✓ , / / A f / / I Ate/ � 3 I / (/ O 5 Street and Number where work is to be done 17 1 lt/ / 03 c State work to be done and purpose of building (by floors), state exterior colors (submit am 11-' EIIl i/e e, A) goo'[- Alec, : VA are Fo ,(/,IstA a STATE OF FLORIDA COUNTY OF DADE. } SS. aq New Building Remodeling Addition Repairs No o Stories To be constructed of Kind of foundation Roof Covering rI 4 f Estimated Total cost of improvements S w9 J 0 • 00 Amount of Permit $ - i• ri5.4 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 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 obligatons 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 em o 4 such subcontracto . on work to be performed under this permit. as are licensed by Miami Shores Village. 1 Remarks (Signed) Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments. personally appeared 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. Disapproved (Signed) a 7 (2.1 MIAMI SHORES VILLAGE BUILDING INSPECTION DEPARTMENT APPLICATION FOR BUILDING PERMIT Date / /ot /'r Date Date O 19 No / 7/ A/ Street dad Read. Sworn to and Subscribed before me. Notary Public, State of Florida and for no other purpose. Building Inspector My Commission Expires PLANNING BOARD DATE Chairman Member Member Member Member Member Council Approved Date Disapproved Date NOTE: A charge of $25.00 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 $25.00 will be charged when such re- inspection is made necessary by improper notice for inspection or faulty materials and /or workmanship. 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 1/6455 , 19 Owner's Name and Address ,J....S_.._.Carr_011 No 59 Street NE 101 St. Registered Architect and /or Engineer Name and address of licensed contractor i<ang__Rot? ing_. and.._ Tile 430 N. W. 79th St, 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) - - -- and for no other purpose. New Building X Remodeling Addition Repairs No. of Stories To be constructed of Kind of foundation Roof Covering Tile Estimated Total cost of improvements $ 833_.00 Amount of Permit $_ ...5_.00 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 inspection on the site of the work such ublic notice or notices as are required by the Act. The undersigned agrees to employ only such subcontractors, on work to be p forme4. under this permit, as are licensed by Miami Shores Village. Lang Roofing and 1 le Go., r nc. Remarks ( Signed) STATE OF FLORIDA, COUNTY OF DADE. j 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 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._ ID (2 0 Date l' Read, Sworn to and Subscribed before me. Disapproved (Signed) 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 51.00 will be charged when such re- inspection is made necessary by improper notice for inspection or faulty materials . /or workmanship. MIAMI SHORES VILLAGE Building Jnspector BUILDING INSPECTION DEPARTMENT ate ___'• 171 N, E, 102nd St, Miami Shores, Notary Public, State of Florida My Commission Expires