400 NE 102 St (2)INFORMATION REQUESTED:
Acknowledged by:
Miami Shores Village
Building Department
10050 NE 2 Ave, Miami Shores, Fl 33138
Tel: (305)795 -2204 - Fax; (305)756 -8972
PLEASE PRINT
DATE: 6/ a d TIME: / / • 1
NAME OF PERSON REQUESTING FILE: /1647 F4 Ogcc,
PHONE #: 30r' '(S /e CYOUR ADDRESS: L/0O Je /CZ �"g
ADDRESS OF FILE REQUESTED: 1/0 /■_) & /o Z S
I understand that all documents in this file are property of Miami Shores Village and
that NO documents may be removed from this file. You may get 4 complementary
copies (8x11) size, additional copies will be furnished at 0.15 cents per page, not
including any blue prints. If blue prints are order please be aware that we are not
responsible for the quality of the printed documents.
1,0„ -
FILE RETURNED TO: :
O. INITIAL
APPLICATION FOR CER' OF RE- OCCUPANCY
L c Zee"
hereby apply for a certificate to re- occupy the single family residence known as: (address)
, Miami Shores, Florida.
Legal description:
Lot: ,Block: ,PB&PG:
I hereby certify that I understand that the zoning of the property is for single - family residential use
and that it is unlawful for more than one family to reside therein. I also understand that any
Certificate of Re- Occupancy that may be issued by Mani Shores Village, Florida, certifies only
that the referenced property is being used for single - family purposes and that such Certificate does
not constitute any representation, warranty or certification as to the condition of the dwelling or
other structures on such property.
Applicant: 4 P ziJ3E LL1 Date:
Print Name:
Comments:
For the purposes of conducting the inspection required by Section 902 of the Miami Shores
Development and Zoning Code, contact:
C Contact Name: 7 1 0 1( C ,- (�i n �`--j Telephone: 7 S ci Oa 7
7 —Co 7-D-
** ::** * *.*** *** ****** i ** * ***** *** ** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * *
Buyer. Seller. ✓Realtor. Company Name:
Application Fee ($50) Paid: Cash: Check_ Number.
Inspection: By: Approved: ✓Denied:Date:
CERI IHCATE OF RE- OCCUPANCY
On behalf of Miami Shores Village, Florida, the undersigned certifies that the property described
in the application has been inspected for the purposes of re- occupancy pursuant to Sections 901
and 902 of the Miami Shores Land Development and Zoning Code and that such property may be
re- occupied by the applicant for single - family residential purposes.
MIAMI SH S VILLAGE, FLORIDA
By:
Date of Certification:, 17
THIS CERTIFICATE VERIFIES THAT THE REFERENCED PROPERTY
HAS BEEN INSPECTED BY MIAMI SHORES VILLAGE AND HAS BEEN
DETERMINED TO PRESENTLY COMPLY WITH THE SCHEDULE OF
REGULATIONS OF THE MIA1MI SHORES LAND AND DEVELOPMENT
CODE PERTALNING SOLELY TO THE REQUIREMENT THAT EACH
ONE-FAMILY DWELLING IS USED AlND INTENDED TO BE USED FOR
A ONE - FAMILY DWELLING PURPOSE ONLY; HOWEVER, THIS
CERTIFICATE DOES NOT CONSTITUTE ANY REPRESENTATION OR
WARRANTY AS TO THE CONDITION OF THE DWELLING OR OTHER
STRUCTURES ON THE PREMISES DESCRIBED HEREIN, OR ANY
ASPECT OF SUCH CONDITION, AND INTERESTED PARTIES ARE
ADVISED AND ENCOURAGED TO MAKE THEIR OWN INSPECTION
OF THE PREMISES IN ORDER TO DETERMINE THE CONDITION
THEREOF.
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.
APPLICATION FOR BUILDING PERMIT
bovi< Date..._..._ . CO 22' _ /. U — _.... ,9 ,�
_ No 14 ° ... ._... Street._...N _. L 2 �!
Owner's Name and Address
Registered Architect and /or Engineer
Name and address of licensed contractor
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 pu se of building (by floors)
STATE OF FLORIDA,
COUNTY OF DADE. j ss
MIAMI SHORES VILLAGE
BUILDING INSPECTION DEPARTMENT
14,T o ... ...........Su s „ 6 /0.3
050 .15114^1 tiv
(C7 4fito i owes "=
s-" 2a oovies and for no other purpose.
New Building Remodeling Addition Repairs
we
No. of Stories
To be constructed of Kind of foundation Roof Covering
Estimated Total cost of improvements $ 40 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 u
of labor under the "Florida Workmen's Compensation Act, being Section 5966, C
and has complied with the provisions thereof, and will require similar coi
in the work to be performed under this permit; and will post or cause to be p
or notices as are required by the Act. The undersigned agrees to employ only
pennit, as are licensed by Miami Shores Village.
Remarks._._ (Sign
and acre is obligations as an employer
ral Laws . , ida, Permanent Supplement,
trac ors or . , ntractors employed by him
h site . the work such public notice
be performed under this
'Before 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. __ 0 ? Date
Disapproved w V _ Dat
(Signed)
Building Inspcc ,r
Read, Sworn to and Subscribed before me.
Notary Public, State of Florida
My Commission Expires
ANNINC BOARD DATE
to me well known,
Chairman Member
\fernber Member
Member ...... r 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 hoard.
A re-inspection fce of S1.00 will be charged when such re- inspection is made necessary by improper notice for inspection or faulty
materials anti /or workmanship.