560 NE 102 St (4)PERMIT APPLICATION FOR MUNICIPALITIES OF DADE COUNTY
(OWNER TO RETAIN COPY) f
Job Address 6 J`- / /6 2 5 Tax Folio f ✓o / / 17 / ,r/
Legal Description, ,% nivi) Pf- ' Master Permit #
(rtes La-pipte / T-etreet vOv,, \z \AA°
Owner's Address 5 6 lv 13 Z.. 5 --
Contracting Co. j Lv/1 (`/
WORK DESCRIPTION / s a�t �
Signature of Owner and /or Condo President
Date:
Address lj ( 0 w E ! 6 7. 5 A'
Qualifier °phone
State# Competency# Ins.Co.
Architect /Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL PAVING FENCE SIGN
Square Ft. Estimated Cost g& 0o
WARNING TO OWNER: YOU MUST RECORD A NOTICE OF COMMENCEMENT AND YOUR FAILURE TO
DO SO MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY (IF YOU
INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE
RECORDING YOUR NOTICE OF COMMENCEMENT).
Application is hereby made to obtain a permit to do work and installation as indicated. I certify
that all work will be performed to meet the standards of all laws regulating construction in this
jurisdiction. I understand that separate permits are required for ELECTRICAL, PLUMBING, SIGNS,
POOLS, ROOFING, and MECHANICAL work.
OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work
will be done in compliance with all applicable laws regulating construction and zoning.
Furthermore, I authorize the above -named contractor to do the work stated.
1
S'gnature of Con�tor or Owner - Builder
Date:
„re/a/4,k
Notary as to Owner and /or Condo President N nary as to Contractor or Owner - Builder.
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Expires: My Commission xpiresy Commission xpires:,S/ r i�G
* * * * * * * * * * *� * * *
PERMIT FEE: APPROVED: Fire Other
z ga Zoning Building # WV 19( Electrical
hitre 0.1,41
C Q r .9 Mechanical Plumbing Engineering
4
phone
756 - G 3 6 .s
PLANNING BOARD AGENDA OF .4 /D 4 ITEM NO.
Name of Owner /Appl i c a n t 'J O # / 1 / Phone No. 7 c 3 ?;
Address of Property, and /or Legal Description c60 /y aT /O Sf
Nature of Request „ael�/9( O� Q�ydlr' 4,2- Ite/.0/1
r
Present Zoning 2+"/1."
Area of Present Building
Area with Proposed Addition
Parking Spaces Provided
aiami chores91llage
F L OR ID A
Parking Spaces Required with Addition
Setbacks as per Code
Setbacks Provided
Vari ances/Exceptions/Zoni ng Change
Council Action Required No
Date of Applicant Notification
Planning Board Action 'CP M-fl )0019) APP'S( 16 ) 22
Council Action
ki.tkamk
Director of Building and Zoning
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Owner of
Building
Architect
Contractor
or Builder
Legal
Description
Address of
Building
Lot
CONTRACTOR OR BUILDER
MIAMI SHORES VILLAGE. FLORIDA
BUILDING D
ELECTRICAL ❑ PERMIT N? PLUMBING El N . 8 5 21
ROOFING ❑
❑ Work to be performed under this Permit
Bl.
Subdi-
vision
Sq. Ft
Value of
Project $
DATE 4 -4 -
Contractor's
License No `.
Amt. of
Permit $
195 7.
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 tilt statements or specifications and that he assumes responsibility for work
done by his agents, servants or employees.
•
Signed:
INSPECTOR
In consideration of the issuance to me of this permit I agree to perform the work covered hereunder in compliance with all ordinances and regulations
pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village.
In accepting this permit I assume responsibility for all work done by either, myself, my agent, servant oc employee. -
BY AUTHORITY
ss.
Owner's Name and Address. _. /.I..r_ 4 J-_A_)
MIAMI SHORES VILLAGE
BUILDING INSPECTION DEPARTMENT
APPLICATION FOR 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.
Registered Architect and /or Engineer
Name and address of licensed contractor- .i.t2�dLl
Date r "! . ,
No Street
Coo, 2. 7 f g- / o A v-e (4A( p4'-
Location and legal description of lot to be built on:
Lot Block / Subdivision
Street and Number where work is to be done r 6 . �-P_,� �� fi//h/
State work to be done and purpose of building (by floors)_--- . ACV h'ldl,0 : H:p .IFS et
and for no other purpose.
New Building Remodeling Addition Repairs No. of Stories
To be constructed of Kind of foundat' 0 Roof Covering
Estimated Total cost of improvements $ 9 9 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 a site of the work such public notice
or notices as are required by the Act. The undersigned agrees to employ only such subcontractors, vvtprk to be performed under this
permit, as are licensed by Miami Shores Village.
Remarks (Signed)_ f / _ - Cl L�� —a
STATE OF FLORIDA,
COUNTY OF DADE.
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally ap-
peared
----------------------- to 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 stated are true. ``
Permit No.- _... �t Date `f= Read, Sworn to and Subscribed before me.
Disapproved Dated
(Signed)
Building Inspe �r
Notary Public, State of Florida
My 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.