434 NE 102 St (14)BUILDING INSPECTION DEPARTMENT
APPLICATION FOR BUILDING PERMIT
Application is hereby wade 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.
D te..._...__. March 8, 1 9 ?._._ _..._.... , 19..
Mr. Williams - 431 NE 102 S�t. Shores . S treet_
Owner's Name and Address ....._.. _ o..... . _... _
Registered Architect and /or Engineer QI'1C?I...E3E Oo, ale 196E}� i;z� .
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
MIAMI SHORES VILLAGE
1434 02 - `3t: Mtan i:
State work to be done and purpose of building (by floors) ZIj.1on. --Te t -.F' -t tk3:gatle*- •Vi-kene- 3:8--•c' Yietire 3-2# $)95.00
and for no other purpose.
New Building Remodeling Addition Repairs No. of Stories
To be constructed of Kind of foundation Roof Covering
Estimated Total cost of improvements $ 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 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 subcontractors, on work to be performed under this
pennit, as are licensed by Miami Shores Village.
Remarks..._ (Signed)...._. ..... _ _l �j _42
STATE OF FLORIDA,
COUNTY OF DADE.
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally ap-
ss.
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—..1.10.3.1
o.._...1 .3.1' Date
Date
Disapproved
(Signed)
Building Insp for
3 f
I ---"
PLAN NC BOARD
Chairman
Mlcrnbcr
Member .......
Council Approved Date
NOTE: A charge of $1.00 will be made for
the Planning Board.
A re inspection fee of $1.00 will be charged
materials and/or workmanship.
Read, Sworn to and Subscribed before me.
Notary Public, State of Florida
My Commission Expires
DATE
to me well known,
Member
Member
Member ...._ _ _._.._
Disapproved Date
making corrections or changes to this application after approval has hero obtained from
when such re- inspection is made necessary by improper notice for inspection or faulty
ITEMS
SUB CONTRACTORS & SUPPLIERS
& ADDRESS
AMOUNT
1. Architectural Fee laps
2. Asphalt walks, drives . etc,
/ , i
3. Cabinets o Bath Vanity
4, Cabinets m Kitchen
It •
5, Cabinets - Medicine
4 ae, ; JeL lJ t+�x
6, Cabinets ® Unit Closet
7. Cleanin
(C & L&)
,,
8. Clearin Site
9. Concrete m Foundation,Slabs�Beams
10. Concrete - Walks drives etc.
%d
11. Contractors Fee
A I1�'7,_ _ __
12. Electric Fixtures
13, Electric Wiring__________
14. E ui ment Rental
1 .
15. Excavation
16. Fill for Slab
2 v- tiJ
I/
17. Floors - Finish wood & kit
18. Floors - Terrazzo
:/ , . ::C CL Z- _
19. Garagf Doors
Mr 41-41t.,‘ AIVI
/' X We- ('_
tr ! _
20. Glass Sliding Doors
21. Hardware m Finish
22. Hardware Rough
23. Hea +, .inky.-
_. • -,_ P /f NIK!L 4
24. Insurance m Liabilit ,com.. -bond
.
W�,T., . /,- / . , - ,
UMW / /
25. Labor - Payroll
26. Labor m Contract
r - ,J
27. Labor m Contract
28. Landscaping Fill• Grading
I.
we - � , __f ..,
29. Lath Plaster. Stucco
30. Lumber All
i„ Alm__ I. FFIr
31. Hasonr Labor
L A1IIPNilllP'"
0)..••. "" �,_ _ �� :
32, Masonr Materials Block
33. Millwork
r-_� L. ...
BM T
;
34. Il laneeus /,.
ssol- : _
35. Ornamental Iron Work
,p _ • .. ,A A AA. 1'/6-1-•-
MEI
36. Oven & Plate -• Built-in
37. Overhead
38. Paintir
I
•
39. Permits Temporary Power
40. Piling oundation
_
41. Plumbing Complete
/ , 4/1 �Q,gy- i+
42, Pool - Swimming
„
43. Roofing & Sheet Metal Work
A ...: __ _r
44. Roof Trusses m Prefab.
I W (� 0.!Mi
45. Screen Enclosures
I i APOJI ,_ 1
46. Septic Tank or Sewera e
�Ler1r�/�,su:�1
sm.' ,,,'- •
47. Shower or Tub Enclosures
48. Steel - Reinf orcin & strl,
_A!' c�J /!!!/
49. Supervision
11111111111111W AIIIWArt
` J 4 1 !%IIfcn
500 Surveys
51. Tile & Marble
52. Water - Public
53. Water - Well & Pump
54, Windows m Glazin & Screens
55. Window Frames - Concrete
< <L - .
Prior to a final inspection this application must be filled out if sub contractors have
failed to take out permits the general contractor shall be responsible for the permit and
fee. A final. :; must be made prior to the release to Florida Power and Light Co,
and the issueance of a c rtificate of occupancy,
•
0TOE'ER ASS </� /�/, �` , 0 /
�.� JOB ADDRESS h�'
SUB, /�c-a a Lc, L - c -a •
BUILDER &,'- 4.9 �e54, LC+ .DAY LABOR CONTRACT/ DATE 2
t • 19 6 3
to• (c•
LOT Qe44 BLOCK q/
W . W - C a o N s 4 c i. ) CA •
SIGNED �
CONTRACTOR 0 + ,,J i e,/
Miami Shores Village
APPLICATION FOR FINAL INSPECTION
TOTAL