517 NE 102 St (12)Application is hereby urndc for the approval of the detailed statement in the plans and specifications herewith submitted for the build •
inc or other structure herein described. This application Is made in compliance and conformity with the Building Ordinance of Miami
Shores Village, I"lorid.t, and all provisions of the Laws of the State of Florida, all ordinances of Miami Shores Village and all rules and
regulations of the iuilding 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 MAY 1 1979 , 19.._._
Owner's Name and Address .... JACK CUMMINS _ Noo 5 r street _NE ST
Registered Architect and /or Engineer NONE. , .,.
Name and address of licensed contractor DFAN...R...GLADISSEN
Location and legal description of lot to be built on:
Lot Block Subdivision
51.7 Street and Number where work is to be done .L�TE.._ Z Q2...$rj,'.
State work to be done and purpose of building (by floors) CHANGE GARAGE TO LIVING QUARTERS
New Building Remodeling X. Addition Repairs No. of Stories
To be constructed of Kind of foundation Roof Covering
Estimate Total cost of improvements $ 2000. 00 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 umlersigncd 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 st ith the provisions thereof, and will require similar compliance from all contractors or sub - contractors employed by hini
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 arc required by the Act. The undersigned agrees to employ only suc - subcontractors, on work be performed under this
permit, as are licensed by Miami Shores Village.
Remarks (Sig
STATE OF FLORIDA,
COUNTY OF DADE. ss.
Before me, the undersigned authority. a notary public, duly authorizcd 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, snd that all facts
therein by him stated are true.
Vi . L/ Date.. )Xi)
Permit No
Disapproved ._
(Signed)
MIAMI SHORES VILLAGE
BUILDING INSPECTION DEPARTMENT
APPLICATION FOR BUILDING PERMIT
ate
and for no other purpose.
Read, Sworn to and Subscribed before me.
to me well known,
Notary Public, State of Florida
Building Inspector My Commission Expires
PLANNINC BOARD DATE
Chairman Member
Member Member
Member .. .. Member
Council Approved Date Disapproved
NOTE: A ch.rrge of $1.00 will be made for making corrections or chnnges to this application after approval
the 1'I,urnir Board.
A re impcction fee of $1.00 will be charged when such re inspection is made necessary by Improper notice for inspection ow faulty
materials anu /or workmanship.
Date
has been obtained from