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76 NE 102 St (4)PERMIT APPLICATION FOR MIAMI SHORES VILLAGE Date 0 ') Job Address 7b Ng 70 a ST Tax Folio No Legal Description Historically Designated: Yes Owner/Les see / Tenant ' TOO /t l M% e rc! (1(2 G[ y FEES: PERMIT APPROVED: Zoning Mechanical Building / Signature of owner and/or Condo President D.te Notary as to Owner and/or Condo President Date My Commission Expires: RADON ! C.C.F. j •4 NOTARY ') Master Permit # zid'( 7 g Phone 1 7 5 ' 3 39 Owner's Address 345 Ai E /no Sr. Contracting Co. •-1 t4 C R Address Qualifier SS# Phone State # Municipal # Competency # Ins. Co. Architect/Engineer Address Bonding Company Address Mortgagor Address Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN WORK DESCRIPTION VellloJ,sh Lt i , room- DilviN5 roo,u. pia and 1irfjhen (�d ?Oar down ow // d Cel / /N ,n) 644 rooru. s Q( zp)a cr� 14.91%-h nett %'� (3 qu are Ft. q 00 9. Ffi • Estimated Cost (value) cal20 a 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 above, and on the attached addendum (if applicable). 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. ignature of Contractor or Owner- Builder Date Notary as to Contractor or Owner- Builder My Commission Expires: 4 . Electrical Date BOND b a TOTAL DUE 3 rp Plumbing Engineering a STATE OF FLORIDA DEPARTMENT OF STATE D■Ision of Archives, History and Records Managerrenl DS-!'SP -34A4 Rev. 3.79 Location' Miami Shores Ser. 1 Auld_ subdivision name County' Dade Owner of Site: Name: Gurshman, Charles Address' 76 NE 102 St, Miami Shores, Condition of Site: Integrity of Site: Check One ❑ Excellent 863 = = ❑ Good 863= = I] Fair 863= = ❑ Deteriorated 863= = ❑ Restored( ) (Date: )( (858 = = ❑ Moved( )(Date: )( )858= = NR Classification Category: Building Threats to Site: Check One or More ❑ Zoning ( )( ❑ Development( )( ❑ Deterioration( )( ❑ Borrowing ( )( ❑ Other (See Remarks Below): Areas of Significance: FLORIDA MASTER SITE FILE Site Inventory Form FDAHRM Check One or More Altered . ❑ Unaltered ki Original Site )( ) 878 = = )( )878= = )( ) 878 = = )( )878 =.= Architecture 858 = = 858= = 858= = 11 . block no. F1. 33138 878 = = Site No. 830 = = Survey Date Site Name Address of Site: 76 NE 102 St, Miami Shores, FT,. 11111 Instruction for locating on S side of NE 102 St. between N. Miami NE 1 Avenue Type of Ownership privat - 848 = = Recording Date . Recorder: Name & Title' Newton, Margo (Chairman) # Stofik, Marty Address' MSHPB ❑ Transportation( ❑ Fill( )( ❑ Dredge( )( W20'2 & 3 lot no. 802 = = 1009 = = 8506 820= = 905= = Avenue and 813= = 868= = 808= = 902= = 832 = = 818= = Original Use private residence838= = Present UsePrivate residence 850= = Dates: Beginning +1926 844 = = Culture /Phase American 840 = = Period 20th Century 845= = 916= = )( )878. = )( ) 878 = = )( ) 878 = = 910 = = Significance: Structure is a good example of Mediterranean Revival architecture which was the predominant theme of the original Miami Shores development by the Shoreland Company. Noteworthy features include a 4 -bay arched entry porch. The structure is in scale and character with the surrounding neighborhood. 9 = = ARCHITECT -- BUILDER STYLE AND /OR PERIOD Mediterreanean Revival PLAN TYPE rectangular; irregular EXTERIOR FABRIC(S) stucco: rough STRUCTURAL SYSTEMS) masonry: concrete block PORCHES N/ entry 4 arched bays, access from N and W FOUNDATION: concrete block 942 = 'ROOF TYPE: flat 942 = = SECONDARY ROOF STRUCTURE(S): hip 942 = = CHIMNEY LOCATION: W: end, exterior 942 = WINDOW TYPE: awning, metal # fixed 942 = = CHIMNEY: concrete block, stuccoed with tile cap Tre flcote 882= = ROOF SURFACING: tar and gravel with barrel tile coping 882 ='= ORNAMENT EXTERIOR:. masonry # stone 882= = NO. OF CHIMNEYS ' 1 952 = = NO. OF STORIES 1 950 = = NO. OF DORMERS 954 =. = Map Reference (incl. scale & date)Miami Shore,s Village Pl at 1280 Latitude and Longitude: LOCATION SKETCH OR MAP Contact Print FEN /G .� a : /I /qr/r gum maw E o ^ /Z/,. lC / 5 . mon mom 4 0 0 Site Size (Approx. Acreage of Property): LT 1 Range Section Township 53S 41E UTM Coordinates: Photographic Records Numbers 85N114MS17/85N114MS18 872 = = 874 = = 964 = = 966 = = 854 = = 856 = = 942 = = 809 = = 800 = = 833 = = 812 = = 890 = _ 860 = = ;IAAIE OF FLORIDA DEPARTMENT OF STATE Division of Archives. History and Records Management DS•HSP•3E 9 -74 ' Physical Description: Structure is a one -story Mediterranean Revival residence. Entry porch (N) -has four arched bays. Imitation stone watertable at entry. Masonry walls extend E and W from structure, barrel tile coping. MSHPB USE ONLY Reroof 1952 CONTINUATION SHEET Site Name J V NE 102 b... ' Miami Shores, FL jig e2 ll: 1 1 1 4. a 0 2 0011 1111, PIPIIMMIREMPIN j��floQD1 2 1111mmmmm®d ®1mm114 4 l t ammo are po ®o 1 : rte•• N . G 5 4 — IL FaS la If 2 NJ. 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L A K E 11 11 tt ,e moon alo mmecmvOmat aL NE t ,II I e , L f, 1 1 11111111111; mown 1o611md11m1t SP= mast 1111 1 UM 31111 i1111 aillibilill NEM: mown hill IMO MI JUN 11 MP iIIIkgi • II • • 0C 1 18'14M1 SHORE5 BUILDING ELECTRICAL PLUMBING Owner of Building - Contractor or Builder i t. regal Lot egal Lot B1 Description CONTRACTOR OR BUILDER MIAMI SHORES VILLAGE, FLORIDA DATE /— .Po. Contractor's License No. PERMIT N9 3543 Work to be performed under this Permit • Architect Subdi- vision ` -f l'c ;sti'!! t may LP! f L' S ' . / F •i' ` /1' x •1" 1 t1 t f 7f:`' R ,!iSi'i't yk 31d1.,1!4 Ltd 'tiOJL: tthiti ,, ddress o f Value of Amt. of Building ^ i ! , Z J �." "�' ,,� l Project . ( 0 , 0 / V Permit / _• r.. 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 he assumes responsibility for work done by his agents, servants or employees. Signed i' B ,4 'J...< i,r" N PECTOR In consideration of the issuance to me of this permit I agree to perform the work coverer he in compliance with all juplinances and rjegp tions pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper au ies of Miami 81 Village. In accepting this permit I assume responsibility for all work done by either myself, my agent, servant or employee. ,4) AUTHORITY 194,E 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 building 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 regula- tions 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. Owner's Name and Address Registered Architect and /or Engineer Name and address of licensed contractortUdlman Corporation Location and legal description of lot to be built on: Lot Block__ Subdivision Street and Number where work is to be done Z6 1Qu S tom_ State work to be done and purpose of building (by floors) L.iai. t p,a._nCe New Building _________ Remodeling_________________ Addition__— ___ —_— Repairs____ „X 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 permit, as are licensed by Miami Shores Village. litcarazdo .N MEP-ORATION By (Signed) STATE OF FLORIDA. 1 COUNTY OF DADE. Before me, e uigne a th rity, a notary public, duly authorized to administer oaths and take acknowledgments, personally, appeared LLLL and who, being by me first duly sworn, upon oath deposes and says that be is the i z- ic-!il c--/ 5 of the above described construction, that he has carefully read the foregoing application, and that he did sign the name, and that all facts therein by him stated are true. Permit No._ Date_ Disapproved ________________ Date (Signed) Read ...Sworn to and Subscrtbed b o. me. Building Inspector My Commission Expires Date_ -29-t ---� ury------- -- - - - - -, 19 4 5 _ No Z_ —_ strea_R,E, 102n St. Notary Public, State of Florida __and for no other purpose. to me well known, 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.