210 NE 102 St (2)MIAMI SHORES VILLAGE
BUILDING INSPECTION DEPARTMENT
APPLICATION FOR BUILDING PERMIT
Application is hereby made for the approval of the detailed statement or we 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.
. I Date 17- 2: 3___. ,19. o .4
v
Owner's Name and Address ........ al ha* I)< -4 947. - No..........S..._... Street-B.. Clue ....e.to/P •
Registered Architect and /or Engineer.... f.. 41gik... V fkl. to et ?:C- 'i. ........ P . e . - . n.1Q . .,',. ,
Name and address of licensed contractor 5 6 2..S_Y.1r L4... • - SgMi1Y.1. f t
Location and legal description of lot to be built on:
Lot I. Block 3 S Subdivision Y _ . . . . . . . .
Street and Number where work is to be done a..10 'Y1- .. 4',_ 19.. 2'' •
State work to be done and purpose of building (by floors) 4. • 9 • � ? A pt 1.r k- •
Disapproved
(Signed)
and for no other purpose.
Ncw Building v Remodeling Addition Repairs No. of Stories
To be constructed of C.- (2) • 5 • Kind of foundation .a,..,..6.... , a- • Roof vering
Estimated Total cost of improvements S f2i0OG" Amount of Permit S.D n1
Zone cubage required .Plan Cubage
Distance to next nearest building Size of Building Lot
\iaxiunum live load to be borne by each floor
The undersigned applicant for this building permit does hereby certify that he understands an
of Ltbur under the 'Florida Workmen's Compensation Act, being Section 5966, Compiled General
and has complied s.ith the provisions thereof, and will require similar compliance from all contra
in the work to be performed under this permit; and will post or cause to be posted for inspectio
or notices as arc required by the Act. The undersigned agrees to employ only such subcontra
permit, as are licensed by Miami Shores Village.
Remarks (Signed ).. .
I hereby submit all the plans and specifications for said building. All notices with reference to the building and its
be sent to..
a erma
c oe
w
c woe
be
ccepts his obli
s of Florida
or sub -co
the site of
on work
construction may
an employer
t rp clement,
plo •ed by him
ch public notice
ormed under this
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 /ZZ �k ' Date .._. J 5 1 Read, Sworn to and Subscribed before me.
Notary Public, State of Florida
Building Inspector My Commission Expires
PLANNING BOARD DATE
Chairman Member
Micrr,ber 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 I'I. Board.
A re- inspection fee of $1.00 will be charged when such re- inspection is made necessary by Improper notice for inspe tinn or faulty
materials and /or workmanship.
40'
40'
ELEVATIONS SHOWN THUSLY +
ARE RELATIVE TO THE NATIONAL
GEODETIC VERTICAL DATUM OF 1929
REF '• •t -Ccoo
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NOTE: ALL RIGHTS OF WAY, EASEMENTS,
SET BACK AND ZONING 1Nf OtiMAT1ON MUST
BE CONFIRMED BY ARCHITECT ANDJOR
OWNER BASED UPON DESIGN USAGE.
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130
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DONALD W. McINTOSH ASSAM
581N.E91STST.
MIAMI SHORES, FL*. 31138
JUNE 1(0 , 1g Bo
w
1 02 N ° • ST.
905,1 :(o;5 4
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1 PM SKORES, DRbE. C�u*1ZY , FLORIDA.
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�Ine Puc1 c. Rewords h•acie_C-o., (rlo -■da
SURVEYOR'S CERTIFICATION: We hereby
certify that the attached "Sketch of Sur-
vey" of the above described property is
true and correct to the best of our knowl-
edge and belief as,reepntly surveyed un er
our direction. ..." r
DONALD W. W. McINTOSH ASSOCIATES, INC.
Reg. Surveyor " State of Florida
g NOT VALID UNLESS SEALED
GS. . 222