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MIAMI SHORES VILLAGE
BUILDING INSPECTION DEPARTMENT
APPLICATION FOR BUILDING PERMIT
Application is hereby made for the approyal of the detailed statement or ore 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, 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 iiuikling 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 �� ,.r........;.»»... »»».m»
Registered Architect and /or Engineer 40;el
Date... r....». _» _»» ............. �....... •.... ...19i�
No....JZ2°- ....... Street«_...
Name and address of licensed contractor
Location and legal description of lot to be built on:
Lot .../12 J . e Block e.° :0/ .... »._ Subdivision el /9
Street and Number where work is to be done.... 72 _ .. «.« .
State work to be done and purpose of building (by floors). .«
New Building Remodeling ✓ Addition Repairs No. of Stories
To be constructed of Kind of foundation:... «..... «... .. Roof Covering _...
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Estimated Total cost of improvements $ ...3OO ' Amount of Permit 4,..... «...F ..._ . «. «.........dr _ ....«
nits? • own • •*if reen*mretm.:•ftmasss :me
and for no other purpose.
Zone cubage required . «. «« «....Plan Cubage
Distance • to next nearest building ..._. «._ ....Size of Building Lot
Maximum live load to be borne by each floor
I herebyyss mit all the pjan and specifi ations� for said building. All notices withh referenee to the building and its construction may
be sent to.: %r �.� �'r�✓ o.-7-0/7 j (17'44_5- d.'a'
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
pennit, as are licensed by Miami Shores Village.
Remarks
STATE OF FLORIDA,
COUNTY OF DADE. j ss'
Before me, the undersigned asthority, a notary public, duly authorized to administer oaths and take acknowledgments, personally ap-
peared `1 Downey
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
therein by him staged are e.
Permit No.. .« A Ds 6 I l «.«... Read, ,. t •, and Su
DisapprovedDate..__.. «__«. .... —..... ..«« / ._. _.___..._.�.._......r.
« Notary Public, State of Florida
(Signed) r-N
��uiaaY poofILlC STATE + FLO IDA-AI LARGE
Building Inspector
My Commission ExpfreuY� EltRi� APR. 9 1983,
.to me well known,
he did sign the same, and that ell facts
PLANNING BOARD.
Chairman _ Member
Member * Member - .._.
Member
Council Approved .... -Date Disapproved Date
NOTE: A charge of 41.00 will be made for making corrections or changes to this application after approval has hero obtained from
the Planning Board.
A rv.in.pcc•tion fee of $1.00 will be charged when such re- inspection is made necessary by improper notice for inspection or faulty
materials anti /or workmanship.
»DA I'm , UNDIRWMTERS
Member. _.._........ ....««.� .......•....«... •_«.•_.••........_.•_.._•.._...
;SINCE 1954
.U. T. "JACK" DOWNEY
R. & S. WINDOW CO., INC.
General Contractors
HOME IMPROVEMENTS
ADDITIONS - KITCHENS -- BATHROOMS
WINDOWS - DOORS - SECURITY GRILLS
261 -2573 625 -6196
6461 S. W. 8TH ST. ) 5440 N. W. 161ST.
MIAMI. FLA. HIALEAH. FLA.
Certificate of Insurance
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER
THIS CERTIFICATE DOES NOT AMEND. EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES LISTED BELOW.
NAME AND ADDRESS OF AGENCY
HEAD- BECKHAM INSURANCE AGENCY, INC.
Flagship Tower - Suite 1012
777 Brickell Avenue
Miami, FL 33131
COMPANIES AFFORDING COVERAGES
COMPANY
LETTER ANTED STATES FIDELITY & GUARANTY CO.
COMPANY B
LETTER
NAME AND ADDRESS OF INSURED
R & S WINDOW COMPANY INC.
76 , 61 SW. 8th Street
Miami, FL 33144
COMPANY ■ _"
LETTER V
s
Y'
COMPANY D
LETTER
COMPANY
LETTER E
,s
This is to certify that policies of insurance listed below have been issued to the insured named above and are in force at this time. Notwithstanding any requirement, term or condition
of any contract or other document with respect to which this certificate may be issued o may pertain, the insurance afforded by the policies described herein is subject to all the
terms, exclusions and conditions of such policies.
COMPANY
LETTER
TYPE OF INSURANCE
POLICY NUMBER
POLICY
EXPIRATION DATE
Limits Of Liabil
ty in Thousands
(000)
OCCURRENCE
AGGREGATE
A
GENERAL LIABILITY.
A
SMP 427295
•
7/15/82
BODILY INJURY
PROPERTY DAMAGE
$
300
$
50
$
300
$
50
iii COMPREHENSIVE FORM
ri PREMISES — OPERATIONS
❑ EXPLOSION AND COLLAPSE
HAZARD
❑ UNDERGROUND HAZARD
PRODUCTS /COMPLETED
OPERATIONS HAZARD
❑ CONTRACTUAL INSURANCE
❑ BROAD FORM PROPERTY
DAMAGE
E1 INDEPENDENT CONTRACTORS
❑ PERSONAL INJURY
BODILY INJURY AND
PROPERTY DAMAGE
COMBINED
$
$
PERSONAL INJURY
$
{
AUTOMOBILE LIABILITY
❑ COMPREHENSIVE FORM
OWNED
❑ HIRED
❑ NON -OWNED
BODILY INJURY
(EACHPERSON)
BODILY INJURY
(EACH OCCURRENCE)
$
$
PROPERTY DAMAGE
E
k�
BODILY INJURY AND
PROPERTY DAMAGE
COMBINED
$°
e'I
EXCESS LIABILITY
❑ UMBRELLA FORM
❑ OTHER THAN UMBRELLA
FORM
BODILY INJURY AND
PROPERTY DAMAGE
COMBINED
$
$
fY,
A
WORKERS' COMPENSATION
and _,� _
EMPLOYERS' LIABILITY
4501088818
7/15/82
STATUTORY{.
g _.. ],Q(
(EACH ACCIDENT)''
OTHER
DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES
Window Mfg., Service &Repair - tame & Elsewhere in the State of Florida
Cancellation: Should any of the above described policies be cancelled before the expiration date thereof, the issuing com-
pany will endeavor to mail - days written notice to the below named certificate holder, but failure to
mail such notice shall impose no obligation or liability of any kind upon the company.
NAME AND ADDRESS OF CERTIFICATE HOLDER:
MIAMI SHORES VILLAGE
10050 NE 2nd Avenue
Miami Shores, FL 33138
DATE ISSUED'
7/20/81.
HEAD- BECKHAM INSURANCE AGENCY, INC.
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