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429 NE 101 ST 3MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT Permit No.-� - -- Date---- ._...J_ —� Application is hereby made for the approval of the detailed statement of the plans and specifications herewith{ bmitted for the building or other, structure herein described. This application is made in compliance and conformity with the Building Ordinance of Mia>ni 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. Owner's Name and Address_____>; _ J_±­( _ Registered Architect and /or Employing Plumber's Name Location and Legal Descrir. Street and Number where N Street------------------------- -- ----- ----- -- -- - - - --- State 'work to be performed and purpose of building (By Floors) New Building ------------ Lec-1 ------ --- --- ---- Remodeling----------------- ------ -- - - -- Addition------ .- .- -. - -.. Repairs .......................... No. of Stories ---------- --------------- Size Septic Tank - - - -Type of 1— � —�-- -- pi.. y Gals ------- _ -__.- .------------- --- -- -___.. � Feet of Drain Tile --------- _- ----------- --- — ------ Dist. Feet of Tank or Drain Field from Well __•------.__-__• _— .___...�_.__.______.____ —__._ Nature of Water Supply: City — Well ---- -_--__---•-------- •.-_- _---- ---- _------ - -_ -- ---- Size of Soakage Amount of Permit (Signed) jt { Plumbing Inspector. The undersigned applicant for this building permit does hereby certify that he u0eystands and accepts his obligs as an employer of labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled Gen Laws of Florida Permane upplement, 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 work to be performed under this permit, as are licensed by Miami Shores Village. (Signed) STATE OF FLORIDA, ss. COUNTY OF DADE. 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. My Commission Expires Notary Public, State of 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. BATH LAVA- SLOP LAUNDRY CATCH FLOOR DRINKING TOTAL CLOSETS TUBS SHOWERS TORIES SINKS SINKS TUBS URINALS BASIN DRAIN FOUNT'NS FIXTURES CONTR. LIST CHECK SEPTIC SEWER DRAIN SOAKAGE GREASE SQLAR DEEP SPRKLR. SWIM'G i TANK CONN. FIELD PIT TRAP HEATER WELL SYSTEM POOL CONTR. LIST CHECK Size Septic Tank - - - -Type of 1— � —�-- -- pi.. y Gals ------- _ -__.- .------------- --- -- -___.. � Feet of Drain Tile --------- _- ----------- --- — ------ Dist. Feet of Tank or Drain Field from Well __•------.__-__• _— .___...�_.__.______.____ —__._ Nature of Water Supply: City — Well ---- -_--__---•-------- •.-_- _---- ---- _------ - -_ -- ---- Size of Soakage Amount of Permit (Signed) jt { Plumbing Inspector. The undersigned applicant for this building permit does hereby certify that he u0eystands and accepts his obligs as an employer of labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled Gen Laws of Florida Permane upplement, 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 work to be performed under this permit, as are licensed by Miami Shores Village. (Signed) STATE OF FLORIDA, ss. COUNTY OF DADE. 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. My Commission Expires Notary Public, State of 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. MIAMI SHORES VILLAGE. FLORIDA 3UILDING ❑ ELECTRICAL ❑ DATF 4t:, 19` )LUMBING PERMIT "r 8 91 Contractor's License No. 1i = d 100FMG ❑ ❑ Work to be performed under this Permit _ )weer of ;uilding? _ " `?�` r # architect ; ontractor ,r Builder :x, , r - f.: .egad Lot II n Bl. Subdi- )escriptio vision SQ. Ft. Wdress of Value of Amt. of iuilding ¥` % gY Project $ Permit $ 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 applicatior erefor in strict compliance with all ordinances pertaining thereto and with the understanding that the work will be performed in compliance with any plans rawings, statements or specifications that may have been submitted to and approved by the proper municipal authorities. This Permit may be revoked at an} ime 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 ranted is the understanding that the contractor or builder named above assumes the responsibility for a thorough knowledge ofithe ordinances and regulation ertaining to the work covered hereby whether shown on the plans or drawings or in thetements or specifications and that he assumes responsibility for wort one 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`Fhereunder in compliance with all ordin n"-W and regulation; ,ertaining thereto and in strict conformity with the plans, drawings, statements or specificatiios submitted to the proper authorities of 1vliami Shores Village n accepting this permit I assume responsibility for all work done by either, myself, my 9gent, serwt or employee. G ....� - 1 CONTRACTOR OBe' BUILDER BY AUTHORITY BUILDING ELECTRICAL PLUMBING Owner of Building Architect contractor or Builder_ MIAMI SHORES VILLAGE, FLORIDA F7 DATF 195, ❑ PERMIT N° 9477 Contractor's El, License No Work to be performed under this Permit Subdi. Legal Lot Bl. vision Description. Address of �` Value of II Amt. of $ Building Project $ Permits, 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 applic herefor in strict compliance with all ordinances pertaining thereto and with the understanding that the work will be performed in compliance with any 1 drawing's, statements or specifications that may have been submitted to and approved by the proper municipal authorities. This Permit may be revoked at 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 pert granted is the understanding that the contractor or builder named above assumes the responsibility for a thorough knowledge of the ordinances and regula pertaining to the work covered hereby whether shown on the plans or drawings or,in the statements of specifications and that he assumes responsibility for done by his agents, servants or employees. Signed: BY INSPECTOR In consideration of the issuance to me of this permit I agree to perform the work covered hereunder in compliance wit,4 -4 /ordinances and regula pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper autl 6ritie_ of Miami Shores Vi: In accepting this, permit I assume responsibility for al. work done by either, myself, my agent, servant or employee. CONTRACTOR OR BUILDER BY AUTHORITY'