534 NE 102 St (4)BUILDING
ELECTRICAL
PLUMBING
MIAMI SHORES VILLAGE, FLORIDA
PERMIT N° 9010
Work to be perforn{td under this Perniit
Owner of
Building la, �� Q
Architect
Contractor
or Builder
Legal Lot
Description
Address of i M S
Building '""' 1'� Gr r ��• � «
Bl.
Subdi-
vision
Value of
Project $
BY
DATE
Contractor's
License No
Amt. t
Permit
This permit is granted to the contractor or builder named above o construct the building or to install the equipment or device described in the application
herefor in strict compliance with all ordinances pertaining thereto an 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 he plans e c . nged without authorization. A further condition upon which this permit is
granted is the understanding that the contractor or builder named ave assu es th> responsibility for a thorough knowledge of the ordinances and regulations
pertaining to the work covered hereby whether shown on the plans r drawi ;s or ' the statements or specifications and that h assumes responsibility for work
done by his agents, servants or employees.,
INSPECTOR
In consideration of the issuance to me of this permit l'sgz
pertaining thereto and in strict conformity with the plans, drawing
In accepting this permit I assume responsibility for all work done 'by
'CONTRACTOR OR BUILDER
perform the work covered hereunder inmpliance with 11 ordinances and regulations
ements or specifications submitted to the proper authori ,'es of Miami Shores Village.
either, myself, my agent, servant or employee.
AUTHORITY
REQUEST FOR INSPECTION
Company > "a� _
PHONE
h Job
Address
Inspection
-' s " ,,�
Time Ready
Date Ready
•
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 thb work.
Name and Address____.- 4_ TV/ -_ /_.?.___ I
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
e work to be done and purpose of bu ilding (by floors)__C
New Building
To be constructed of
and who, bei
of the above
therein by hi
Permit No.
Disapproved
Signed
STATE OF FLORIDA,
COUNTY OF DADE. SS.
MIAMI SHORES VILLAGE
BUILDING INSPECTION DEPARTMENT
APPLICATION FOR BUILDING PERMIT
c, ,1) -
and for no other purpose.
modeling dditio Re irs
ov
Kind of foundation_ � Roerir�g
Estimated Total cost of improvements
P $ - -- � ,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
permit, as are licensed by Miami Shores Village.
•
Remarks (Signed) l �' `-
2,2N1
n
/____ Date _\
Date
Building Inspector
u _r (jA. —
Date
LS Read, Sworn to and Subscribed before me.
o. of Stories
19 `= '
Street_ - tQ
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally ap-
peared
to me well known,
'g by me first duly sworn, upon oath deposes and says that he is the
escribed construction, that he ha carefully read the foregoing application, and that he did sign the same, ,and that all facts
stated are true.
Notary Public, State of Florida
My Commission Expires
PLANNING 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.
Job
Company
Address
Time Ready
Date Ready
REQUEST FOR SPECTION
PHONE
P.M.
Inspection
7-
• •
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__
1`--51.br
15 51
5 6
Agj IfEA I
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111_
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