PLUMBING PERMITPermit No
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 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 work. \,�' , - T
Owner's Name and Address \‘.A..4% 4�-�' _._Yr r.CJtNA- No. ._ _ _--.. Street__- -_. -1 q .e• - _i - .. - ...
Registered Architect and /or Eng' �; ----------- _-- - -_ - _. _ .__
V..4%__ f..__ No. BP
•
STATE OF FLORIDA,
COUNTY OF DADE. J
Size Septic Tank -Type of Tank
Feet of Drain Tile__ - ' List. Fe of Tank
Nature of Water Suppl
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMEM
APPLICATION FOR PLUMBING
Employing Plumber's Name
Location and Legal Description Lot_ �l��L! SD I °Y ' lock__ —__ Subdivision....
.1_ Street a�.c_.L.._._q... S
Street and Number where work is to be performed —No
State work to be performed and purpose of building (By Floors)...
New Building r� __._._ Remodeling_..__ __. —_ Addition_
(Signed) .._ e .. - -
Date
treat_
Repairs No. of Stories.
. C /' Capadty Gals.
. Drain F •. Well
Amount of Permit $ /C - (Signed)_
d_ _.-
The undersigned applicant for this building permit does hereby certify that he understands and accepts his ob gatfons as an employer of labor
under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Pennanent Supplement, and has com-
plied 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 tlie Act. The undersigned agrees to employ only such sub- contractors, on work to be p ed under this permit, as are
licensed by Miami Shores Village.
My Commission Expires Notary Public, State of Florida
Master Plumber.
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeared
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.
s ,
NOTE: A re- inspection fee of $1.00 will be made when such re- inspection is made•necessary by improper notice for inspection, or faulty
materials and /or workmanship.
CLOSETS
BATH
TUBE
SHOWERS
LAVA.
TORIES
SINKS
SLOP
SINKS
LAUNDRY
rues
U RINAL/
CATCH
BASIN
FLOOR
DRAIN
DRINKING
FOUNT'NB
TOTAL
FIXTURES
CONTR.
6T
/
'/ RI
--1_
/
I y
/ ,
CHECK
SEPTIC
TANK
SEWER
CONN.
DRAIN
FIELD
SOAKAGE
PIT
GREASE
TRAP
SOLAR
HEATER
DEEP
WELL
SPRKLR.
SYSTEM
SWING
POOL
CONTR.
LINT
/
/ OM
- --
_
CHECK
Permit No
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 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 work. \,�' , - T
Owner's Name and Address \‘.A..4% 4�-�' _._Yr r.CJtNA- No. ._ _ _--.. Street__- -_. -1 q .e• - _i - .. - ...
Registered Architect and /or Eng' �; ----------- _-- - -_ - _. _ .__
V..4%__ f..__ No. BP
•
STATE OF FLORIDA,
COUNTY OF DADE. J
Size Septic Tank -Type of Tank
Feet of Drain Tile__ - ' List. Fe of Tank
Nature of Water Suppl
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMEM
APPLICATION FOR PLUMBING
Employing Plumber's Name
Location and Legal Description Lot_ �l��L! SD I °Y ' lock__ —__ Subdivision....
.1_ Street a�.c_.L.._._q... S
Street and Number where work is to be performed —No
State work to be performed and purpose of building (By Floors)...
New Building r� __._._ Remodeling_..__ __. —_ Addition_
(Signed) .._ e .. - -
Date
treat_
Repairs No. of Stories.
. C /' Capadty Gals.
. Drain F •. Well
Amount of Permit $ /C - (Signed)_
d_ _.-
The undersigned applicant for this building permit does hereby certify that he understands and accepts his ob gatfons as an employer of labor
under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Pennanent Supplement, and has com-
plied 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 tlie Act. The undersigned agrees to employ only such sub- contractors, on work to be p ed under this permit, as are
licensed by Miami Shores Village.
My Commission Expires Notary Public, State of Florida
Master Plumber.
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeared
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.
s ,
NOTE: A re- inspection fee of $1.00 will be made when such re- inspection is made•necessary by improper notice for inspection, or faulty
materials and /or workmanship.
- .Pent No.
OWner's Name and Address
Registered Architect and/or Engineer_
Dade) Gas Company
Employing Plumber's Name
__-
Amount of Permit $
My Commission Expires
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
No.
( Signed )_
( Signed )_
67,3- /te/
1
Date 10-26-67
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 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 work.
A. R. Roy Jr. 1207 No. Street N.E. 92 St.
, .
955 East 25 St.
Street
Location and Legal Description Lot_._ Subdivision
Street and Number where work is to be performed—No. —1207 11.AE..__92 _St. Street
State work to be performed and purpose of building (By Floors) ROUGH & SET I3BQ GRILL — 2 100# Gas
New Building Remodeling Addition Repairs No. of Stories ......
Size Septic Tank_ _Type of Tank_ Capacity Gals
Feet of Drain Tile _Dist. Feet of Tank or Drain Field from Well
Nature of Water Supply: City—Well _Size of Soakage Pit
Plumbing Inspector.
The undersigned applicant for this building permit does hereby certify that he understands and accepts is 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 com-
plied 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 sub-contractors, on rk to be performed under this permit, as are
licensed by Miami Shores Village.
STATE OF FLORIDA,
ss.
COUNTY OF DADE.
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeared
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.
Notary Public, State of Florida
NOTE: A re-inspection fee of $L00 will be made when such re-inspection is made necessary by improper notice for inspection, or faulty
materials and/or workmanship.
CLOSETS
BATH
TUBS
SHOWERS
LAVA-
TORIES
SINKS
SLOP
SINKS
LAUNDRY
TUBS
URINALS
CATCH
BASIN
FLOOR
DRAIN
DRINKING
FOUNT• NS
TOTAL
FIXTURES
CONTR.
LIST
-.-
CHECK
SEPTIC
TANK
SEWER
CONN.
DRAIN
FIELD
SOAKAGE
PIT
GREASE
TRAP
SOLAR
HEATER
DEEP
WELL
SPRKLR.
SYSTEM
SW IM'G
POOL
---
CONTR.
LIST
CHECK
- .Pent No.
OWner's Name and Address
Registered Architect and/or Engineer_
Dade) Gas Company
Employing Plumber's Name
__-
Amount of Permit $
My Commission Expires
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
No.
( Signed )_
( Signed )_
67,3- /te/
1
Date 10-26-67
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 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 work.
A. R. Roy Jr. 1207 No. Street N.E. 92 St.
, .
955 East 25 St.
Street
Location and Legal Description Lot_._ Subdivision
Street and Number where work is to be performed—No. —1207 11.AE..__92 _St. Street
State work to be performed and purpose of building (By Floors) ROUGH & SET I3BQ GRILL — 2 100# Gas
New Building Remodeling Addition Repairs No. of Stories ......
Size Septic Tank_ _Type of Tank_ Capacity Gals
Feet of Drain Tile _Dist. Feet of Tank or Drain Field from Well
Nature of Water Supply: City—Well _Size of Soakage Pit
Plumbing Inspector.
The undersigned applicant for this building permit does hereby certify that he understands and accepts is 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 com-
plied 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 sub-contractors, on rk to be performed under this permit, as are
licensed by Miami Shores Village.
STATE OF FLORIDA,
ss.
COUNTY OF DADE.
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeared
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.
Notary Public, State of Florida
NOTE: A re-inspection fee of $L00 will be made when such re-inspection is made necessary by improper notice for inspection, or faulty
materials and/or workmanship.
- -^
CLOSETS
BATH
TUB.
SHOWERS
LAVA.
TORIES
61NKa
SLOP
SINKS
LAUNDRY
Tu..
URINAL[
CATCH
BASIN
FLOOR
DRAIN
DRINKING
FOUNT'N.
TOTAL
FIXTURES
CONTR.
LIST
CHECK
.
SEPTIC
TANK
SEWER
CONK.
DRAIN
FIELD
SOAKAGE
PIT
GREASE
TRAP
SOLAR
M
DEEP
WttL
SPRKLR.
S
SWIMG
POOL
CONTR.
-
LIST
CHECK
Permit No
1
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
Date... 1 6 - 75 ....-- - ....
. _- - -
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 regulations of the Building Division
off Miami Shores Village shall be complied with, whether herein specified or not. A copy of approved plans and specifications must be kept at
bZeting.tktn g progress of work.
Owni 's.. aamefand Address Mr. & Mrs. R Oberman N N.B. S .9 ?ad Street
Registered =mg and /or Engineer Janes Rodgers and Amociates
Employing Plumber's Name EdwarL.W. Garcia $ treet....16 .;.1.6 - Avenue
Location and Legal Description Lot. 19 148.1_„.E_• 50' and All Block 2 Subdivision. Bay Ltnte_ Seet3an
Or LOt ZO 1 207 N.B.
Street and Number where work is to be performed -No Street ..92nd..Strtaet - - -
State work to be performed and purpose of building (By Floors)_p l Piping fot Sw ing_,Po01 Fap ,Uy..Re idence
New Building _ Remodeling Addition..__..._ 8 Repairs No. of Stories ................
Size Septic Tank -------- - - -_ -- - - - -- Type of Tank_
Feet of Drain Tile.-.- — -_- _.Dist. Feet of Tank or Drain Field from Well ..._.._..___ _ _...--- • - -__ --
Nature of Water Supply: City-Well. __.___--...Size of Soakage Pit
Amount of Permit $5-.0Q
STATE OF FLORIDA, t se.
COUNTY OF DADE.
My Commission Expires
(Signed)_
Capacity Gals
Edward W. Garcia
tor.
The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligation! as an employer of labor
under the Florida Workmen's Compensation Act, being Section 5968, Compiled General Laws of Florida Permanent Supplement, and has com-
plied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors employ, "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 otice or notices as are
required by [hie Act. The undersigned agrees to employ only such sub - contractors, v k to be • orm . unk this permit, as are
licensed by Miami Shores Village. III
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeared
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.
Notary Public, State of Florida
Master Plumber.
NOTE: A re- inspection fee of $1.00 will be made when such re-inspection L made.neoessary by improper notice for inspection, or faulty
materials and /or workmanship.
CONTRACTOR
New Construction
Name N 1' ii P u11 /�y Qi INC
Name
License No. /809,
Alteration Exterior
Address 60113 t oj MST s° ire The
A -Sress f��
1061
Telephone 305 r1:3 _t3
J it Fax 3 s,)3
—0 , 52 s)
Qualifier Name p g ° EN'fsTe,/'
l� o fa ephone
PROPERTY OWNER
New Construction
1(
Name
Alteration Exterior
A -Sress f��
1061
.f
9N_
A
l� o fa ephone
��
Business Telephone
Foundation Only
Fax
Other
TYPE OF MANAGEMENT (✓ )
New Construction
1(
Enclosure
Alteration Exterior
Repair
Alteration Interior
Demolish
Relocation of Structure
Shell Only
Foundation Only
Add'1 Attachment
Other
Add'l Detachment
,
Other
!!:.
INSTRUCTIONS - The following steps must be taken to obtain a permit from the Miami Shores Village:
Step 1.
0 1 '101
Complete the attached permit application which must be signed by the property owner and qualifier. Both signatures must be notarized. Please
print or type to allow for a more accurate processin of your application. If roofing work will be done, a roofing application must be submitted
along with this permit application.
Step 2. Submit the completed application with all necessary documents to the Building, Planning and Zoning Department for processing. During the
processing of your application, y ou ma be asked to submit additional information.
APPLICATION
Job Address: n t c / )si
Address
Apt.
Folio Number
Lot Block
Subdivision PB PG
Current Use of Property
Proposed Use of Property
Tenant Information
PERMIT TYPE (✓ )
Building
Electrical
Mechanical
Plumbing
LPGX
Roofing
Fence
Other
PERMIT CHANGE (✓ )
Chg. Contractor
Renewal
Revision
Extension
Supplement
Reinspection
ARCHITECT
Name
License No.
Address
Telephone
Fax
Master Permit No
Subsidiary Permit
City
State
Ni Description of Work Pf un2B/ 49 RPmoit'L
ODD 1 Raih Rim
PERMIT APPLICATION
Zip
Linear Feet
Zoning
Square Feet Units Floors
Value of Work 36°O c5 Bldg Value
Tax Assessed/Appraised Value
Flood Zone Base Floor Elev.
ENGINEER
Name
License No.
Address
Telephone
Fax
Page 2
SEAL:
Personally known
OUNTY OF MIAMI - DADE
gnature of 0 per
g/4
Print Name
Sw� to and subscribed before me this I 1 day of 1 C
S A w
L&
o rtt
h - 6§tatgtp[r on da;
Q CC765E97
iV PAY Ct7 Ni.1:..
CF � % t ,. ,?
OR, Produced Identification
Type of Identification Produced:
Signature of Contractor / Qualifier
x P8eRT EDe!s Tefg
Print Name
Signature o
SEAL:
o and subscribed before
PERMIT APPLICATION
IMPORTANT NOTICES
1. DO NOT BEGIN ANY WORK WITHOUT HAVING RECEIVED YOUR VALIDATED PERMIT AND PERMIT CARD. Applying for a permit does not grant
the right to begin construction. HOURS OF CONSTRUCTION are limited to: Monday through Friday from 7:30 a.m. to 6:00 p.m., and Saturday from 8:00 a.m.
to 5:00 p.m. No inspections will be conducted on weekends or holidays.
2. All construction of demolition areas MUST BE MAINTAINED IN A CLEAN, NEAT AND SANITARY CONDITION free from construction debris.
3. STREETS AND NEIGHBORING PROPERTIES SHALL BE KEPT FREE FROM DIRT AND DEBRIS.
4. SWALES MUST BE PROTECTED FROM BEING DAMAGED BY EQUIPMENT OR VEHICLES, AND MAY NOT BE USED FOR STORAGE. A bond is
required for work in or near the street/sidewalk.
5. CONSTRUCTION TRAILERS ARE PROHIBITED ON SINGLE FAMILY RESIDENTIAL CONSTRUCTION SITES. Other construction may have a trailer
which requires a separate permit.
6. PORTABLE TOILETS for a construction site require a separate permit.
7. DO NOT DISCHARGE WATER INTO THE RIGHT OF WAY OR STORM DRAINS without approval from the Building, Planning and Zoning Department.
8. EQUIPMENT AND MATERIALS SHALL BE STORED at least 10 feet from the edge of pavement.
9. Department of Health and Rehabilitative Services (HRS) approval is required for applications involving septic tanks. Department of Environmental Resources
Management (DERM) and/or Miami -Dade Water and Sewer Department (MDWASD) approval is required for applications involving sewers.
AFFIDAVIT - Please read carefully.
Application is hereby made to obtain a permit to do work and installation as indicated. I, the OWNER of the property, 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, POOL, EXTERIOR DOOR, MECHANICAL, WINDOW, FENCE, DRIVEWAY,
ROOFING and SIGNS and there may be additional permits required from other governmental agencies.
I, the OWNER of the property, have disclosed all information related to any work at the property performed in the prior twelve
months to the Building Official. Further, I am fully aware that if the cumulative cost of work to my home or business under this and
any other permit equals or exceeds fifty percent (50 %) of the fair market value of the structure, the entire structure must meet the
present federal flood criteria for finished floor elevation. I am also fully aware that if the total cost of work to my home or business
under this and any other permit exceeds fifty percent (50 %) of the replacement cost of the structure, then the entire structure must
conform to the current code requirements of the Building Code.
WARNING TO OWNER: Your failure to record a NOTICE OF COMMENCEMENT may result in you paying twice for
improvements to your property. If you are spending more than $2,500 or intend to obtain financing, you may wish to consult with
your attorney or lender before recording your Notice of Commencement. The Notice of Commencement must be recorded at:
22 N.W. 1st Street, 1 °` Floor, (305) 679 -1078. Once recorded, the Notice of Commencement must be POSTED AT THE JOB SITE in
accordance with Section 713 -35 of Florida Statutes. Review the brochure at Village Hall on Construction Lien Law and
Choosing a Contractor.
STATE OF FLORIDA, COUNTY OF MIAMI -DADE
GALVA
day 0V(21° C.J ,
ature of
R\s � fI figq{trat. ,..C. l4r E
l" A� t:.t� A 6EC�:EH
n WhiNt:sSIUN NUMER
+ 4 < CC786697
` F1. � ' . 1?
� t
Personally known OR, P roduced Identification 1
Type of Identification Produced'tg I '
ELECTRICAL
TYPE
Minimum Fee
QTY.
TYPE
Dryer
QTY.
TYPE
Outlet, Appliance
QTY.
TYPE.
Service Repair
QTY.
A/C Central 1 -3 Ton
Fan
Dryer Vents, Number of
Outlet, Wall
Ventilation, Cost
Service, Temporary
Air Handler, Tons
A/C Central 4 -7 Ton
Piping, Flammable Liquid
Fire Pump
Outlet, Switch
Fire Sprinkler System
Signs
A/C Central 8 -15 Ton
Bath Fan - Vented, #
Fixture - Fluorescent
- Pressure Vessel
Oven
Space Heater (kw)
A/C Central 16-20 Ton
Fixture Light
Parking Lot Lights
Spas/Hot Tubs
A/C Central 20+ Ton
Flood Lights
Plugmold/Strip
Subfeeds, No. of Amps
A/C Window
FPL - Load Central
Posts
Swim Pool, Commercial
Air Conditioners
Garbage Disposal
Range/Range Top
Swim Pool, Residential
Chiller
Generators, etc.
Receptacles
Switchboards
Clear Violations
Heat Recovery
Refrigerator, Comm. (p/PH)
Temp Serv., Construction
Compactor
Low -volt, Burglar
Refrigerator, Domestic
Temp for Test - 30 days
Deep Freezer
Low -volt, Fire
Renew - Temp Service
Water Closet
I
Demolition
Low -volt, Intercom/Teleph.
Repair Circuits
Water Heater
j
Dishwasher
Low -volt, Television
,
Service, Number of Amps
Water Heater New
MECHANICAL
TYPE
Minimum Fee
QTY. TYPE
Condensate Drain
QTY. TYPE
Generator
QTY. TYPE
Refrigeration, Tons
QTY.
A/C Central, Tons
Cooling Tower
Heating Strips, each
Vent Hood, Cost
A/C Wall/Win. Tons
Dryer Vents, Number of
Paint Booth
Ventilation, Cost
Solar Water Heater
Air Handler, Tons
Ductwork, Cost of
Piping, Flammable Liquid
Periodic Inspections
Barbecue
Fire Sprinkler System
- Process/Pressure Piping
Cap - Fixture
Bath Fan - Vented, #
Fireplaces, Number of
- Pressure Vessel
Pump and Abandon
PLUMBING
T1'1'P.
A/C Condensate
QTY.
TYPE
Drains, Roof
QTY.
TYPE
Miscellaneous Fixture
QTY.
TYPE
Soakage Pit
QTY.
Bath Tub
/
Drinking Fountain
Miscellaneous Repairs
Solar Water Heater
Bidet
Filter Replace
Pool Piping
Sprinkler Repair
Cap - Fixture
3
Fountain
Pump and Abandon
Sprinkler System
Cap - Water
Gas - Appliance
Pump, Domestic
Supply, AC Well
Cap - Sewer
Gas - Natural
Pump, Fire Stand
Temporary Toilet
Catch Basin
Gas - Propane
Pump, Re- circulate
Temporary Water Closet
Clothes Washer
Gas Piping
Pump, Replace - Pool
Urinal
Dental Chair
Grease Trap
Pump, Sprinkler
Utility - Sewer
Discharge Well
Ice 'Maker
Pump, Sump
Utility - Water
Dishwasher
Indirect Wastes
Relay Repair
Vacuum Pump
Disposal
Interceptor
Roof Inlet
Water Closet
I
Domestic Well
Laundry Tray
Septic Connection
Water Heater
j
Drainfield, 4" Tile/Res.
Lavatory
,
Septic Tank
Water Heater New
Drains, Area
Meter Set (Gas)
Sewer Connection
Water Re -pipe
Drains, Floor
Minimum Fee
Shower
Water Service
Drains, French
Miscellaneous Equipment
Sink
Well, Supply
Page 3
PERMIT APPLICATION
INSTRUCTIONS: Please indicate the type of work being performed and quantity(ies) in the space provided below.
RECEIVED AND REVIEWED BY: DATE:
SECTION
BY
DATE
Zoning
Electrical
Mechanical
Plumbing
/9
-4
Fire
Public Works
Structural
Building Official
Page 4
OFFICE USE ONLY
CHECKLIST
❑ OWNER - BUILDER FORM
(Attach)
❑ FIRE DEPARTMENT
APPROVAL (Commercial /
multi- family)
❑ CONCURRENCY
(New Construction)
❑ OTHER
(Specify & Attach)
PERMIT FEES
$3.00 per page (Scanning Fee)
Miami Shores Village
Bond
Metropolitan Dade County (C.C.F.)
Inspector State Educational Fund
State DCA (Radon)
Code Enforcement Fine
Zoning Review
❑ PROOF OF OWNERSHIP
(Attach)
❑ HRS / DERM APPROVAL
(Septic / Sewer)
❑ IMPACT FEE
(New Construction)
❑ OTHER
(Specify & Attach)
(sq.ft. = x/1000
x ¢.60)
(¢.005 /sq.ft.)
(¢.01 /sq.ft.)
REVIEWED AND PREPARED BY:
PERMIT APPLICATION
❑ CONDO ASSOCIATION APPROVAL
(Attach)
❑ BPR APPROVAL (Restaurants)
❑ CONTRACTOR REGISTRATION
(On File)
TOTAL $ lJ v
ISSUING OFFICIAL
DATE:
CONDITION OF APPROVAL
Revised July 2001
10050 N.E. 2ND AVE., MIAMI SHORES, FL • (305) 795 -2207 • FAX (305) 756 -8972 • http : / /www.miamishoresvillage.com
Permit No
Size Septic Tank ---4�
Feet of Drain Tile - -- "
Nature of Water Supply: City — Well.
STATE OF FLORIDA, 1
COUNTY OF DADE.
me
My Commission Expires
G^vUTAMI SHORES VI", i1
PLUMBING INSPECTION DEPARTMEi -
APPLICATION FOR PLUMBINS ' f,;`,
No...
------ --- ---- -- -- -- ----- ---- - - - - - -- —
Amount of Permit $ ------------ - - - - -- — - -- (Signed)_ -_- `
r
Capacity Gals
Notary Public, State of Florida
Application is hereby made for the approval of the detailed statement of t'r,; Jiens and specifications herewith submitted for the building or other
structure herein described. This application is made in compliance and coaf3). :. with the Sdiiding Ordinance of Miami Shores Village, Florida,
and all provisions of the Laws of the State of Florida, all ordinances of Miami .;,,Ores Viiiane a.ici all rules and regulations of the Building Division
of MiaLli Shores Village shell be complied with, whether herein specified '+r''. A cop : of approved plans and specifications must be kept at
building during progress of work.
Owners Name and Address � ! j , _ Na..__ ___ -__ -_ Street
Registered Archr; e t and /or
Employing Plumber's Nam
Street-- ______..._
Location and Legal Description Lot____ B1 _ _ Subdivision
OQ:lC�
Street and Number where work is to be performed —No.__ R 6 _... �� _- 9 k i+'tt treet.
State work to be performed and purpose of building (By Floors) _ ____
N6w Building -___ -- _-------- --- ---- -- - - --_ -- Remodeling_. - -- __.____ -- Addition.---- _ -_ -._ Repairs No. of Stories - - .-- .....__-----
e of Tank___ - 0-
- F t of Tank or Drain Field from Well
----------- _- _ - - - -• - Size of Soakage Pit
lumbing Inspector.
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 com-
plied 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 ublic notice or notices as are
required by the Act. The undersigned agrees to employ only such sub - contractors, on,work to be perfoc red , idy+t this pc it as
r- i
. +ceased by Miami Shores Village. J
(Signed)._ p
Q - - c -" �; (
Master Plumber
Befaae me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeared
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.
NOTE: A re- inspection fee of $1.00 will be made when such re- inspection is made necessary by improper notice for inspection, or faulty
mat/seals and /ar worlananship.
CLOSETS
BATH
TUBS
OW
SHHRS
LAVA-
TORIES
SIS
SINKS
SLOP
SINKS
LAUNDRY
TUBS
U RINALS
CATCH
BASIN
FLOOR
DRAIN
DRINKING DRINK
FOUNT' NS
TOTAL
FI %TORES
CONTU.
LIST
CHECK
SEPTIC
TANK
SEWER
CONN.
DRAIN
FIELD
SOAKAGE
PIT
GREASE
TRAP
SOLAR
H EATER
DEEP
WELL
SPRKLR.
SYSTEM
SW IM•O
POOL
CONTR.
LIST
` — —
CHECK
Permit No
Size Septic Tank ---4�
Feet of Drain Tile - -- "
Nature of Water Supply: City — Well.
STATE OF FLORIDA, 1
COUNTY OF DADE.
me
My Commission Expires
G^vUTAMI SHORES VI", i1
PLUMBING INSPECTION DEPARTMEi -
APPLICATION FOR PLUMBINS ' f,;`,
No...
------ --- ---- -- -- -- ----- ---- - - - - - -- —
Amount of Permit $ ------------ - - - - -- — - -- (Signed)_ -_- `
r
Capacity Gals
Notary Public, State of Florida
Application is hereby made for the approval of the detailed statement of t'r,; Jiens and specifications herewith submitted for the building or other
structure herein described. This application is made in compliance and coaf3). :. with the Sdiiding Ordinance of Miami Shores Village, Florida,
and all provisions of the Laws of the State of Florida, all ordinances of Miami .;,,Ores Viiiane a.ici all rules and regulations of the Building Division
of MiaLli Shores Village shell be complied with, whether herein specified '+r''. A cop : of approved plans and specifications must be kept at
building during progress of work.
Owners Name and Address � ! j , _ Na..__ ___ -__ -_ Street
Registered Archr; e t and /or
Employing Plumber's Nam
Street-- ______..._
Location and Legal Description Lot____ B1 _ _ Subdivision
OQ:lC�
Street and Number where work is to be performed —No.__ R 6 _... �� _- 9 k i+'tt treet.
State work to be performed and purpose of building (By Floors) _ ____
N6w Building -___ -- _-------- --- ---- -- - - --_ -- Remodeling_. - -- __.____ -- Addition.---- _ -_ -._ Repairs No. of Stories - - .-- .....__-----
e of Tank___ - 0-
- F t of Tank or Drain Field from Well
----------- _- _ - - - -• - Size of Soakage Pit
lumbing Inspector.
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 com-
plied 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 ublic notice or notices as are
required by the Act. The undersigned agrees to employ only such sub - contractors, on,work to be perfoc red , idy+t this pc it as
r- i
. +ceased by Miami Shores Village. J
(Signed)._ p
Q - - c -" �; (
Master Plumber
Befaae me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeared
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.
NOTE: A re- inspection fee of $1.00 will be made when such re- inspection is made necessary by improper notice for inspection, or faulty
mat/seals and /ar worlananship.
BUILDING
ELECTRICAL
PLUMBING
ROOFING
• Owner of
Building
Architect
Contractor
or Builder
Legal
Description
Address of
Building
Lot
a� f
MIAMI SHORES VILLAGE. FLORIDA
o PERMIT
e
" •
Signed.
N? - 3746
Work to be performed under this Permit
Bl.
CONTRACTOR OR BUMPER BY
Subdi-
vision
Value of
Project $
4
DATF
Contractor's / t ,y
License No.
Amount of . .r
Permit $
This permit is granted to the contractor or builder named above to construc 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.
INSPECTOR
In consideration of the issuance to me of this permit I agree to perform the work covered hirr'sunder 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 ac-
cepting this permit I ass responsibility r all work done by either, myself, my agent, se;vftrit ortbmployee.
*
L ` / " -' k ff - . tlt4i..fi..9i�'- ,V 4::_
AUTHORITY Bm
Permit No. f 6.7
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for tiie 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 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 work. 7
Owner's M a Name and Address - -- Rol J� • No. 1203 __ At 4
µ Street 7.2 Si
Registered Architect and /or Engineer — _— _______________. __.__- -_ - _ --_ .__ ._ Employing-Plumber's Name i4 U STO L _ Sawn e C a __ ��_ - No. L I 1 -- - � / y Street--- - � --- -----•-- •-----•--------•-----
Location and Legal Description Lot Bloele I g Subdivision _.___.______._________._______
Street and Number where work is to be performed -No / P-07 t' E • Street ---(__ A. sr '
State work to be performed and purpose of building (By Floors)
New Building _---- .----------- __ -_ -- Remodeling ___.. Addition._ -_ Repairs No. of Stories .................. ....
Size Septic Tank Type of Tank_ Capacity Gals..
Feet of Drain Tile_
Nature of Water Supply: City - Well.______ ________ ___________________________Size of Soakage Pit
Amount of Permit $
STATE OF FLORIDA, }
COUNTY OF DADE.
—Dist. Feet of Tank or Drain Field from Well
(Signed) _
(Signed)
Date - - 1`P ti_ • /
�� i •
P um. : Inspector.
The undersigned applicant for this building permit does hereby certify that he understands and accepts his o • ions as an employer of labor
under the Florida Workmen's Compensation Act, being Section 5988, Compiled General Laws of Florida Perl ent Supplement, and bus coin -
plied 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 sub- contractors, on work to be performed under this perinit, as are
licensed by Miami Shores Village.
My Commission Expires Notary Public, State of Florida
M>Plmnber.
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeared
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.
NOTE: A re- inspection fee of $1.00 will be made when such re- inspection is made•necesssry by improper notice for insp- • , 'n, or faulty
materials and /or worlananship.
CLOSETS
BATH
TUBS
SHOWERS
R
LAVA-
TORIES
SINKS
SLOP
SINKS
LAUNDRY
TUBE
INALS
URINALS
CATCH
BASIN
FLOOR
DRAIN
DRINKING
FOUNT•NS
TOTAL
FIXTURES
CONTR.
LIST
CHECK
-
SEPTIC
TANK
SEWER
CONN.
DRAIN SOAKAGE
FIELD PIT
GREASE
TRAP
SOLAR
HEATER
DEEP
WELL
SPRKLR.
SYSTEM
SWIM'G
POOL
CONTR. .
3 H yp 'LC p ct IQ
- --
CHECK
Permit No. f 6.7
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for tiie 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 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 work. 7
Owner's M a Name and Address - -- Rol J� • No. 1203 __ At 4
µ Street 7.2 Si
Registered Architect and /or Engineer — _— _______________. __.__- -_ - _ --_ .__ ._ Employing-Plumber's Name i4 U STO L _ Sawn e C a __ ��_ - No. L I 1 -- - � / y Street--- - � --- -----•-- •-----•--------•-----
Location and Legal Description Lot Bloele I g Subdivision _.___.______._________._______
Street and Number where work is to be performed -No / P-07 t' E • Street ---(__ A. sr '
State work to be performed and purpose of building (By Floors)
New Building _---- .----------- __ -_ -- Remodeling ___.. Addition._ -_ Repairs No. of Stories .................. ....
Size Septic Tank Type of Tank_ Capacity Gals..
Feet of Drain Tile_
Nature of Water Supply: City - Well.______ ________ ___________________________Size of Soakage Pit
Amount of Permit $
STATE OF FLORIDA, }
COUNTY OF DADE.
—Dist. Feet of Tank or Drain Field from Well
(Signed) _
(Signed)
Date - - 1`P ti_ • /
�� i •
P um. : Inspector.
The undersigned applicant for this building permit does hereby certify that he understands and accepts his o • ions as an employer of labor
under the Florida Workmen's Compensation Act, being Section 5988, Compiled General Laws of Florida Perl ent Supplement, and bus coin -
plied 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 sub- contractors, on work to be performed under this perinit, as are
licensed by Miami Shores Village.
My Commission Expires Notary Public, State of Florida
M>Plmnber.
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeared
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.
NOTE: A re- inspection fee of $1.00 will be made when such re- inspection is made•necesssry by improper notice for insp- • , 'n, or faulty
materials and /or worlananship.