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375 NE 102 StApplication 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. Owner's Name and Address..._.. A.[ __ . %4411/Sfiar0 Registered Architect and /or Engineer Name and address of licensed contractor /1/ Disapproved __ _. D ( Signed) i Building Inspector MIAMI SHORES VILLAGE BUIL -DING INSPECTION DEPARTMENT APPLICATION FOR BUILDING PERMIT Date..._ ,19 7l No 3 15- Street /0 Y sr- 0 0E /N6- ..LNG J4) 4Z/ /Ilk/ 7c 4R, L Location and legal description of lot to be built on: Lot Block Subdivision Street and Number where work is to be done 75 /1/ t State work to be done and purpose of building (by floors) 4-29D/77 and for no other purpose. New Building Remodeling Addition Gi Repairs No. of o 'es To be constructed of Kind of foundation Roof Covering Estimated Total cost of improvements $ 2420 Amount of Permit $ .5 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 inspection on the site of the work such public notice or notices as are required by the Act. The undersigned agrees to employ only such contractors, work to be perfpnned under this permit, as are licensed by Miami Shores Village. Remarks_--_ —._ -- -- (Signed) - ._��_ - STATE OF FLORIDA, COUNTY OF DADE. j 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.�___�_.9Q__ _ Date -9 - Read, Sworn to and Subscribed before me. Notary Public, State of Florida My Commission Expires PLANNING BOARD_________ _________ ._ DATE v Chainnan Member Member Member Member _. Member G 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 $1.00 will be charged when such re- inspection is made necessary by improper notice for ins an or faulty materials and /or workmanship. ctu-c„ v3 7 I a,6e12 -- )av f z/k) /rj„, A/.270 aie-ei A- /tezee MlA I SHORES VILLAGE ILLAGE t 1ILDING 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 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... T� ..... .19..71 Owner's Name and Address -./ '2 ... ,e,r4reP- -r and Now 75 Street.LL_de ./ & 7``�• Registered Architect and /or Engineer . _ ` 100e a 4 E New Building Remodeling Addition To be constructed of - &i .I Kind of foundation.. ? _ Estimated Total cost of improvements $..! � 0 Zone cubage required. Distance to next nearest building ...I Q Maximum live load to be borne by each floor STATE OF FLORIDA, I COUNTY OF DADE. ss • Disapproved _..4) , � Date. (Signed) Build' g Inspector Name and address of licensed contractor 0 of/Az ..." . - Location and legal description of lot to be built on: Lot eZ_!� GV.$.S o1"Alock 3 7 Subdivision._ / 1 o qt• I, u - - Street and Number where work is to be done 7 T'' State work to be done and purpose of building (by floors) - -L Pe. ._ t.l. - -7 ee- _ ___4'e 'Oec"d and for no other purpose., Repairs No. of Stories . + es f _ _ of Roof Covering.. l i. tt. Amount of Permit $ .Plan Cubage 4'2 _Size of Building Lot L ) 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, Pennanent 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 employ only such subcontractors, on work to be performed under this permit, as are licensed by Miami Shores Village. Remarks-- •- _----- -•-- .._ —._ (Signed) / Ct Notary Public, State of Florida My Commission Expires Lama PLAN 1`G BOARD _. Chainnan f Member Member ...__--------- •---------- • -__ -- Member Member _..M_ Member Council Approved 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. Z _. Date. I �/ . _ Read, Sworn to and Subscribed before me. _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 and /or workmanship. P L- PrtJ 20 „ 1 4-0'_ g ? L , per-b- G t V 1 .4• .: x. rkk •i A ?i, rLS.,:JA xxlr z...xx dd�k , ..i y,�r,k.. . hLSy M1ss:;x ° !'��'Ar��t. ..x:f1'o' ; { kt �1'dR�tt irr rM1 r' :5' ?x +1'dh'S i'f ? %s , -.. A,l O'.kf'•t: xxxrr,..,,. :...., f'r•'Si....?`J ° • "Stt:• xrrfy"•5•t:Y 5GV t t:x ;54tt::'•°�G'rir 't::i. .. ., 7, ;:' 5 x,� 5 r d :.r.:a'sf A• �t'�',i ;.,..+'r h kL: >: a?s .•t •:::a } :s. ^. ?: ... ssn•: .: ,la . ':•°'.' s ' e ... 1 •.o� ,.. .:nt' 0 . , . ... ,'.f e.. .., r,.r .., "{t ; fa 7 ,...... ..„, [., ... ,.., r*; ,,. :f... ..-,_ 0 r 0 rl Oti 4 14 .3Lid ..0,, F =.....„ -, v t :... t1 r,. ...., :-.,... FA F ., <1 .:-.' §.: : ,--, 0 ro gl r, 44'0=' ,_ UNITED STATES FIDELITY AND GUARANTY COMPANY FIDELITY AND GUARANTY INSURANCE UNDERWRITERS, INC. BALTIMORE, MARYLAND CERTIFICATE OF INSURANCE Name and Address To Whom Issued Village of Miami. Shores 10050 N.E. 2nd Avenue Miami Shores, Florida This is to certify that the policies listed below, subject to their terms, conditions and exclusions, have been issued by the Company designated below to the Insured named below. Ta ig -7 3ZRZ r Named Insured and Address Mr. A.C. Mansfield 14865 N.E. 10th Court • Miami, Florida Type of Insurance Policy Number Policy Term Limits of Liability Bodily Injury Property Damage Workmen's Compensation Statutory Employers' Liability $ ,000 Each Person $ ,000 Each Accident $ Medical - Each Person 77 Comprehensive Automobile Liability $ ,000 Each Person W14 •• i2L,26.11:1 $ ,000 Each Occurrence $ 10 Comprehensive General Liability ❑ Including Blanket Contractual Liability $ 000 Each Person FMWANISF, $ ,000 Each Occurrence $ 10 Aggregate Operations $ • O Aggregate Protective $ l0 $ ,000 Aggregate Completed $ l0 Operations - Products Manufacturers' and Contractors' Liability Owners', Landlords' and ❑ Tenants' Liability 2 CC 475569 1/7/71 -72 $ ,000 50 Each Person $ 10 0 ,000 Each Occurrence $ 0 Aggregate 0 $ rfiTm:57,77 .. . Completed Operations and Products Liability Contractual Liability $ ,000 Each Person $ 5 000 Each Occurrence $ 0 $ 25 ,000 $ ,000 Aggregate Each Person $ 0 $ ,000 Each Occurrence $ 0 Aggregate $ 0 , Comprehensive Excess Indemnity $ ,000 Each Occurrence Combined Persona Injury and Prcperty Damage $ ,000 Aggregate ;••,,, �- Description and location of operations and automobiles covered: CARPENTRY AND MASONRY The Company designated below will make every effort to notify the holder of this Certificate of any material change in or cancellation of these policies, but assumes no responsibility for failure to do so. UNITED STATES FIDELITY AND GUARANTY COMPANY ❑ FIDELITY AND GUARANTY INSURANCE UNDERWRITERS, INC. � Date -. 1/7/71 By MORTON INSURANCE A Y, INC. . . .c � :.. .; r .r ...; ._ ..r : :: . :: ^ : . :;^•rvr :::, a t :::. : .,,, .a......... r. .v. ......trn v �. V i 1' .�. r W-.L � w�u r t ..1. :5r .•L F •rYr •.t s�4d 1, .. . .. .,M1 Or .... rr ..:44 "O is :SOY V,:; 'r 5 Gen. 348 (1 -68)