415 NE 102 St (11)MIAMI SHORES VILLAGE
BUILDING INSPECTION DEPARTMENT
APPLICATION FOR BUILDING PERMIT
Application is hereby mode for the approval of the detailed statement or the plans and specifications herewith submitted for the build
ins 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.
Osvncr's Name and Address /
SO.-A? ._ No... ms ` . Street! ./
a_
Registered Architect and /or Engineer
Name and address of licensed contactor
Locates and legal description of lot to be jlt on: /
ll //��,,,, hh s
Lot. . ../ � . ...5 Block Subdivision.niti.1.� ...(...1� ,1 _. / � .. / 7 U 7
Street and Number where work is to be done
floors) _ _..`... _...�......_.
'7 — d �
3 ( .140 C</'‘Al b . an purpose
no other urpose
New Building Remodeling � Addition Repairs No. of Stories _
• To be constructed of Kind of foundation Roof vering
Estimated Total cost of improvements S ' sue— Amount of Permit S.....) 47
Zone cubage required .Plan Cubage
Distance .to next nearest building 2 2 Size of Building Lot
Mtaxunum 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..
State work to be done and purpose of building (by
TXrs7`/.e f c, Sys f'if
STATE OF FLORIDA,
COUNTY OF DADE. ss.
Disapproved
(Signed)
Date.
Building Inspector
Chairman
Member
Member .. _....._......_..._._...._....._
Council Approved Date
NOTE: A charge of $1.00 will be made for
the I'Iannir.g llo.rrd.
• A re- inspection fee of 51.00 will be charged
materials and /or workmanship.
The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations as an employes
of labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida, Permanent Sup clement,
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 uhlic notice
or notices as are required by the Act. The undersigned agrees to employ only such subcontractors, work t. be perfo e4 under this
pcnnit, as are licensed by Miami Shores Village.
Remarks..._ (Signed)
19 137Z
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.._. b. ‘ .1 Date A,LA14, Read, Sworn to and Subscribed before me.
Notary Public, State of Florida
My Commission Expires
PLANNING BOARD DATE
to me well known,
Member
Member
Member ...._ . _.._ ._
Disapproved Date
making corrections or changes to this application after approval has been obtained from
when such re- inspection is made necessary by improper notice for inspection or faulty
ROOFING ,. , ❑
Owner of
Building
Architect
Contractor
or Builder
Legal Lot
Description
Address of
Building tr ' Y L
C
MIAMI SHORES VILLAGE. FLORIDA
BUILDING ❑
ELECTRICAL ❑ PERMIT N? PLUMBING ❑ N. 8388
Bl.
Work to be performed under this Permit a dam'
Subdi-
vision
CONTRACTOR OR BUILDER BY
Sq. Ft
Value of
Project $ l r
DATE .: 195
Contractor's
License No
Amt. of
Permit $ 1;
This permit is granted to the contractor or builder named above to construct the building or to install the equipment or device described 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 h assumes responsibility for work
done by his agents, servants or employees. �¢'` , . '
Signed: ��'� F.... .. • BY. #
INSPECTOR
In consideration of the issuance to me of this permit I agree to perform the work covered hereunder in compliance with all ordinances regulations
pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Sho Village.
In accepting this permit I assume responsibility for all work done by either, myself, my agent, servant or employee.
AUTHORITY
i7
Disapproved
(Signed)
Bui ing Inspecto
MIAMI SH
&FPLICATION F
S VILLAGE
BUILDING INSP ON DEPARTMENT
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 '" , 19 S q
Owner's Name and Address n►1tf `4 Th t S Fka N"ti tnt k•.tn • No 4' 1 S Street 14 ‘),E- - i o "L 5.4...
Registered Architect and /or Engineer
Name and address of licensed contractor_._. .5)4411L_ Akx C ►IE:_VIA . 4 � `1 +1_191 'C.e1_te - - i 40 - Nrea 41vk G ,C7 •
Location and legal description of lot to be built on:
Lot Block Subdivision
Street and Number where work is to be done r' 1 S t . 1 G Z t L
State work to be done and purpose of building (b floors) h.,.
New Building Remodeling. Addition Repairs No. of Stories
To be constructed of Kind of foundation Roof Covering
Estimated Total cost of improvements $ l q I C . y.__. Amount of Permit $ o `�
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
sent - to bO C- LYat e. kvt C_a_i!s� - - - - - -- s�.10 ( •
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 hint
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 ) _.t,.- - -1
Date
and for no other purpose.
STATE OF FLORIDA,
COUNTY OF DADE. 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 gated are truce. ` e
Permit No � /! Date 3 — 4� _ Read, Sworn to and Subscribed before me.
Notary Public, State of Florida
Commission Expires
ANNING 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 $1.00 will be charged when such re- inspection is made necessary by improper notice for inspection or faulty
materials and /or workmanship.
(NcbiAj c41'‘
a,„.4