ROOFINGAPPROVED:
PERMIT APPLICATION FOR MUNICIPALITIES OF DADE COUNTY
(OWNER TO RETAIN COPY)
.d
Date �� A ' Job Address 5 V /✓ /fe & - X . Tax Folio /I .70,E 7-' H.67
Legal Description / eL39 / c /1 T om'. Pi/ /9-AiP
Owner / Lessee / Tenant 74-• gi ,?,,/ ,Master Permit #I
Owner's Address a Y A76 /0 7 i
Contracting Co. Address r 3 f� r�
Qualifier - - �� 'Phone f1 i i
State # Municipal # Competency # Ins.Co.
Architect /Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type(circle one) : Ui IIIING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGi
WORK DESCRIPTION
Square Ft. ti, , Estimated Cost (value)
WARNING TO OWNER: YOU MUST RECORD A NOTICE OF COMMENCEMENT AND YOUR FAILURE TO DC
SO MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY (IF YOU INTENI
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, an
on the attached addendum (if applicable). I certify that all work will be performed to meet th
standards of all laws regulating construction in this jurisdiction. I understand that separat
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 wil .
be done in compliance with all applicable laws regulating construction and zoning. Furthermore,
auth ze the above -named contractor to do the work stated.
Signature of owner and /or Cond• President
Date: (y -' 2
Notary to Ownc,r and /or
Condo President
My Cou3mi.ssi.on Er.pitNe g y PUBLIC STATE OF FLORIDA
. MY COMMISSION EXP. KAY 12, ION
* BONDED THRU GENERA. INS..
**
* *
FEES: PERMIT RADON C.C.F.
Fire
-^r„r„ a t / 4 4 4 :17 . :. ,,
•
Zoning L Building
Mechanical Plumbing
Phone
i
•
Signature of Contrac
Date: d- /
r or
r- Builder
Notary as to Contractor or Oivner- hmil.Jer
My Commission ExE1 :PIN STATE OF FLORIDA
NY COMMISSION EXP. FAY 12,149$
BONDED THRU GENERAL INS. UNO.
NOTARY TOTAL DUE
4v/
Other
Electrical
Engineering
MIAMI SHORES VILLAGE
BUILDING INSPECTION DEPARTMENT
APPLICATION FOR BUILDING PERMIT
Application is hereby erode 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 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.
Owner's Name and Address GEORGE T. BERGEN.,, WI. No Street: Street_... _
Registered Architect and /or E ngincer , „... ,reve,:et ^.:vne•:•n• �•,
Name and address of licensed contactor G.••••&-. I,.....ROOEINrz...'i . .N...E... .. .i: ih ...G.o.1, :t Miami. la.
Location and legal description of lot to be built on:
Lot Block Subdivision _
Street and Number where work is to be done 94 ...N......E......102nd_Street. _
State work to be done and purpose of building (by floors )....Remove ta.1.SY.rQQf pv y
...tire. _.irap.. -30z ... felt, mop on 1 -30# . felt and 1 -90# slate
New Building Remodeling Addition Repairs No. of Stories
To be constructed of Kind of foundation Roof Covering
20 Sqrs.
Estimated Total cost of improvements $ 5..,.h.QO._00
Amount of Permit &.. 12..51
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 uhlic notice
or notices as are required by the Act. The undersigned agrees to employ only such subcontractors, on work to b� �erfor�� e' Ju Y0l this
permit, as are licensed by Miami Shores Village. & L. ,.0 +�IiVhi Du Y
Remarks
STATE OF FLORIDA,
COUNTY OF DADE. j ss.
Disapproved a� \...�. Date
(Signed)
Building Inspector
(Signed) r� �� -1
March 22, 1979
Before me, the undersigned authority, a notary public, duly authorized 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, and that all facts
therein by him state are tru
Perm B
Permit No..__.__ L Date ,) 1y
j7__._....___._ Read, Sworn to and Subscribed before me.
Notary Public, State of Florida
My Commission Expires
entire house and garage,
and white barrel cement
and for no other purpose.
PRES.
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 31.00 will be charged when such re- inspection is made necessary by improper notice for inspection oe faulty
materials and /or workmanship.