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9600 NE 2 Ave (5)Permit Type: Plumbing - Commercial Work Classification: Addition /Alteration Job Address: 165 96 Street NE Additional Information Miami Shores Village, FL 33138- Comments: INSTALLATION OF WATER HEATER & LAUNDRY SINK Fees Due CCF Education Surcharge Miscellaneous Fee Pool - Private Scanning Fee Technology Fee Total: Amount $0.60 $0.20 $20.00 $150.00 $3.00 $4.25 $178.05 Building Department File Copy Applicant Signature Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL 33138 -0000 Phone: (305)795 -2204 Fax: (305)756 -8972 Permit Issue Date: 8/18/2006 Expires: 02/14/2007 Owner's Name: CAMP BISCAYNE AT THE GROVE LLC Contractor(s) MARBAR PLUMBING CO INC Phone 305 - 681 -0009 Primary Contractor Yes Type of Work: PLUMBING Type of Piping: Additional Info: Classification: Commercial In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder 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 accepting this permit assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are required for ELECTRICAL, PLUMBING, MECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work. OWNERS 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. Futhermore, I authorize the above -named contractor to do the work stated. Invoice Number PLC - 8 - 06 - 25958 Total: Parcel #: Block: Section: dittoc‘) Permit Status: APPROVED Permit Number: PLC -8 -06 -2143 Phone: (786)290 -8815 1131010250130 Amt Due $178.05 Lot: PB: Total Square Feet: 0 Total Valuation: $ 1,000.00 Re • uired Ins • ections Underground Rough Water Main Top Out Main Drain Lavatory Water Service Re Pipe Heater Final SEP 12 PAID Amt Paid NOTICE: In addition to the requirements of this permit, there may be additional restrictions applicable to this property that may be found in the public records of this county. AND THERE MAY BE ADDITIONAL PERMITS REQUIRED FROM OTHER GOVERNMENTAL ENTITIES SUCH AS WATER MANAGEMENT DISTRICTS, STATE AGENCIES, OR FEDERAL AGENCIES. y/ o 4( / 0 Passed • c omments Failed Correction Needed Re- Inspection Fee ($75) No Additional Inspections can be scheduled re- inspection fee is paid. until Inspection Number: INSP -28 Inspection Date: 10/04/2006 Inspector: Levrack, James Owner: Job Address: Project: <NONE> Contractor: MARBAR PLUMBING CO INC Building Department Comments Tuesday, October 3, 2006 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 082 LLC, CAMP BISCAYNE AT THE GROVE 165 96 Street NE Miami Shores Village, FL 33138- urr PLC -8 -06 -2143 Permit Type: Plumbing - Commercial Inspection Type: Final Work Classification: Addition /Alteration Block: Phone Number (786)290 -8815 Parcel Number 1131010250130 Lot: Phone: 305 -681 -0009 Page 2 of 2 (\ 0 0 \.\ 0 (,. Q� v � Inspector omments Passed Failed ‘A Correction Needed Re- Inspection Fee ($75) No Additional Inspections can be scheduled until re- inspection fee is paid . lseet�sar ;> ter:: d • • Inspection Date: 09/27/2006 Inspector: Levrack, James Owner: LLC, CAMP BISCAYNE AT THOVE Job Address: 165 96 Street NE Miami Shores Village, FL 33138- Project: <NONE> Contractor: MARBAR PLUMBING CO INC Building Department Comments Tuesday, September 26, 2006 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 • $,EP282000 • Permit Type: Plumbing - Commercial Inspection Type: Final Work Classification: Addition /Alteration Block: Phone Number (786)290 -8815 Parcel Number 1131010250130 Lot: Phone: 305 - 681 -0009 Page 1 of 2 1 .............. ............... .............. I�si�ee Inspection Date: 09/27/2006 Inspector: Levrack, James Owner: LLC, CAMP BISCAYNE AT THE GROVE Job Address: 165 96 Street NE Miami Shores Village, FL 33138- Project: <NONE> Contractor: MARBAR PLUMBING CO INC Building Department Comments Tuesday, September 26, 2006 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 1. 28 Permit Type: Plumbing - Commercial Inspection Type: Underground Rough Work Classification: Addition /Alteration Block: Phone Number (786)290 -8815 Parcel Number 1131010250130 Lot: Phone: 305- 681 -0009 Page 1 of 2 Passed Inspec or C • ments Failed Correction Needed Re- Inspection Fee ($75) No Additional Inspections can be scheduled re- inspection fee is paid . until 1 .............. ............... .............. I�si�ee Inspection Date: 09/27/2006 Inspector: Levrack, James Owner: LLC, CAMP BISCAYNE AT THE GROVE Job Address: 165 96 Street NE Miami Shores Village, FL 33138- Project: <NONE> Contractor: MARBAR PLUMBING CO INC Building Department Comments Tuesday, September 26, 2006 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 1. 28 Permit Type: Plumbing - Commercial Inspection Type: Underground Rough Work Classification: Addition /Alteration Block: Phone Number (786)290 -8815 Parcel Number 1131010250130 Lot: Phone: 305- 681 -0009 Page 1 of 2 `Q).∎(\ .4\ v.M Miami Shores Village i mo �E7 B hth Building Department g �� 6 BUILDING PERMIT APPLICATION FBC 2004 City 0- State F L Tenant/Lessee Name 5 Structural Review. $ Is Building Historically Designated YES NO 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 BY: / C .5 Zip Permit No. 9 10( - 2-14 Master Permit No. Permit Type (circle): Building Electrical ( Plumbing) Mechanical Roofing Owner's Name (Fee Simple Titleholder)Get-YK� Phone # Owner's Address // 33'3-7- 2 Phone # `3 d 5 4 q 8 - `y T v ce- Job Address (where the work is being done) l6 At e 6 ,Sh- City Miami Shores Village County Miami -Dade Zip 33 / 3 / FOLIO / PARCEL # it 3 2_0(9 - o/ 3 Contractor's Company Name I `1 a vl a v / I C. Phone # 3o 5 {O / - 000? Contractor's Address q 3 O- (,() 1�/ LA) (L7 t J Sfr e et City on I CVYR4 State F L Zip 3 31(-4 Qualifier Name 7iivy\ PS - 'frI () k \ Phone # 30 "5 fv p r Q /(Q 0 C State Certificate or Registration No. Certificate of Competency No. �i C F 03 6 (// , k J Architect/Engineer's Name (if applicable) Phone # Value of Work For this Permit $ 1 000 0 0 Square / Linear Footage Of Work: Type of Work: ❑Addition Iteration ['New i El Repair/Replace El Demolition Describe Work: - 1fr t al) 10 oft ��� 1 1 cS S k)a V 1 cq f t . u- / ' J ********** * * * * * * * * * * * * * * * * * * * * * * * * * * * * *F * * * * * * * * * * * * * * * * * * * * * * * * * * * * *** U Submittal Fee $ Permit Fee $ / f & CCF $ 0-60 '1 CO /CC Notary $ Training/Education Fee $ Q 2O Technology Fee $ 4 Scanning $ V)0 Radon $ DPBR $ Zoning $ Bond $ Code Enforcement $ Double Fee $ Total Fee Now Due $ In -05 See Reverse side -4 Bonding Company's Name (if applicable) Bonding Company's Address City State Zip Mortgage Lender's Name (if applicable) Mortgage Lender's Address City State Zip Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRICAL WORK, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and AIR CONDITIONERS, ETC 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. "WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT 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." Notice to Applicant: As a condition to the issuance of a building permit with an estimated value exceeding $2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will of be approved and a reinspection fee will be charged. Signature 0 •r Agent The fore oing instrume acknowledged before me this ic` The fore day of , 2000 , by ��(j(i'1(��j /30.-1/ Z— day of who is persdtfall me or who has produced who is pers As identification and who did take an oath. NOTARY PUBLIC: ROBIN LUECKE Print: NQTARY P11,g I IC - STATF F Ft (]Rtnq CO !1 COMMISSION # DD211637 My Commission Expires: EXPIRES 06 /25/2007 BONDED TMRU 1. 888- NOTARYI ************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** APPLICATION APPROVED BY: (Revised 02/08/06) Signature Contractor i ing instrument was acknowledged before me this 1 , 20 D_0 by leS k -. /11- lly known to me or who has produced as identification and who did take an oath. NOTARY PUBLIC: ROBIN LUECKE NOTARY ' umh - sT My Commission Expires: COMMISSION # DD211637 EXPIRES 06/25/2007 J1— Pl ans Examiner Engineer Zoning ITEM 3ATH TUB UNIT FEE ITEM SWITCH OUTLETS UNIT FEE ITEM SPACE HEATERS UNIT FEE 3IDET LIGHT CUTLETS CENTRAL HEATING )ISHWASHER RECEPTACLES A/C (WIN)) )ISPOSAL SERVICE TEMPORARY A/C (CENTRAL) 3RINKIN3 FOUNTAIN SERVICE SIZE IN AMPS DUCT WORK FLOOR DRAIN SERVICE REPAIRA€TER CHANGE REFRIGERATION GREASE TRAP APPLIANCE OUTLETS PROCESS AND PRESS PIPING INTERCEPTOR RANGE TOP UNDERGROUND TANKS LAVATORY OVEN ABOVE GROUND TANKS LAUNDRY TRAY 1 WATER HEATER 1 U.F. PRESSURE VESSELS CLOTHES WASHER MOTCRS 0- 1 FP STEAD BOILERS SHOWER MOTCRS OVER 1- 3 FP HOT WATER BOILERS SINK, POT /3 COMT'. MOTORS OVER 3- 5 hP MECHANICAL VENTILATION SINK, RESIDENCE MOTORS OVER 5- 8 FP TRANSPORTING ASSEM$LIES SINK, SLOP MOTCRS OVER 8- 10 FP ELEVATORS/ESCALATDRS TEMPORARY WATER CLOSET MOTCRS OVER 10- 25 P FIRE SPRINKLER SYSTEMS URINAL MOTORS OVER 25-100 HP COOLING TOWERS WATER CLOSET ' MOTCRS OVER 100 FP VIOLATION INDIRECT WASTES A/C WINGI0W REILNSFECTJON WATER SUPPLY T0: AIR CONDITIONERS A/C UNIT STRIP HEATER FIRE SP R I NKLER GENERATORS TRANSFORMERS . HEATER -NEW INST. 1 1 GENERATORS' TRANSFORMERS HEATER - REPLACE 1 GENERATORS TRANSFORMERS LAWN SPRINKLER -WELL SPECIAL PURPOSE 1 SWIMMING POOL OUTLETS COM4 ERCIAL WATER SERVICE SIGN TUBES SEWER CONNECTIONS ,*.SIGN TRANSFORMERS UTILITY -SEWER SIGN TIME CLOCK UTILITY -WATER FIXTURES SEPTIC TANK ANTENNA BELAY 1 TELEVISION OUTLETS )RAINFIELD, 4' TILE/RES. 'UMP 1 VIOLATION S ABANDON SEPTIC TANK REINSPECTION OAKAGE PIT CU. FT. :AT CH BASIN • ) I SDFIARGE WELL • )OM!ESTIC WELL REA DRAIN DOF INLET OLAR WATER HEATER IRE STANDPIPE I 1 I OOL PIPING AWN SPRINKLER SYSTEM; AS RANGE :TER SET (GAS) AF PIPING f {� I I I 1 PLUMBING 1 I• u L. I r v L/ 1 r.1 1 U U U J. L L./ l I V 1 L.. l l i ?I J. 1 !'l 1 1 c_ r. V I 1 .. :AN APPLICATION FOR BUILDING PERMIT MUST ACCOMPANY THIS ADDENDUM. IF A MASTER PERMIT HAS B. OBTAINED, THE OWNER'S NOTARIZED SIGNATURE NEED NOT BE PRESENT ON SUBSEQUENT APPLICATIONS.) ELECTRICAL MECHANICAL BUILDING - ELECWCAL PLUMBING ROOFING Owner of Building Architect Contractor or Builder Legal Description Lot i‘.� CONTRACT R OR BUILDER MIAMI SHORES VILLAGE. FLORIDA ❑ PERMIT IN ?. 12023 ❑ Work to be performed under this Permi Bl. Signed: Subdi- vision DATE =' "' ! / S' i 195 Contractor's License No Address of r 1 r Value of Amt. of Building 1 , �i . tC As _ ! '� �"" f 'j 4 ) it r , Project $ Permit $ /9 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. 4 BY koL, !CIA In consideration of the issuance to me of this permit I agree to perform the work covered hereunder 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 accepting-this permit I assume responsibility for all irk done by either, myself ag ent, se r tint or employee. BY AUTHORITY Permit No ( ° a' 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. Owner's Name and Address Amount of Permit $ / f (Signed) s s. MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT o. _ - -_� (Signed) M fr Date Street Registered Architect and /or Engineer W 4 /140.444.- ' Employing Plumber's Name C • li I A se No. Att i Street___ / Wig eide Location and Legal Description Lot 4 4 M� lo Subdivision Street and Number where work is to be performed—No �� f�� S treet J I 1 State work to be perfo med 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 Dist. Feet of Tank or Drain Field from Well Nature of Water Supp ell 4 -- _ Size of Soakage Pit 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 public notice or notices as are required by the Act. The undersigned agrees to employ only such sub - contractors, on work to be p•r iri d un this permit, as are licensed by Miami Shores Village. / My Commission Expires Notary Public, State of Florida Plumbing Inspector. Master Plumber. STATE OF FLORIDA, 1 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. NOTE: A re- inspection fee of $1.00 will be made when such re- inspection is made necessary by improper fro > i ce or inspection, or faulty materials and /or workmanship. CLOSETS BATH TUBS SHOWERS LAVA- TORIES S NKS SLOP SINKS LAUNDRY TUBS URINALS CATCH BASIN FLOOR DRAIN DRINKING FOUNT NS TOTAL FIXTURES CONTR. LIST � _ e CHECK .3.1&— ,` 16L/ 3 1 SEPTIC TANK SEWER CONN. DRAIN FIELD SOAKAGE PIT GREASE TRAP SOLAR H EATER DEEP WELL SPRKLR. SYSTEM SW IM'G POOL 1 CL LIST •, � I CHECK }}�� /, OD Permit No ( ° a' 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. Owner's Name and Address Amount of Permit $ / f (Signed) s s. MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT o. _ - -_� (Signed) M fr Date Street Registered Architect and /or Engineer W 4 /140.444.- ' Employing Plumber's Name C • li I A se No. Att i Street___ / Wig eide Location and Legal Description Lot 4 4 M� lo Subdivision Street and Number where work is to be performed—No �� f�� S treet J I 1 State work to be perfo med 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 Dist. Feet of Tank or Drain Field from Well Nature of Water Supp ell 4 -- _ Size of Soakage Pit 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 public notice or notices as are required by the Act. The undersigned agrees to employ only such sub - contractors, on work to be p•r iri d un this permit, as are licensed by Miami Shores Village. / My Commission Expires Notary Public, State of Florida Plumbing Inspector. Master Plumber. STATE OF FLORIDA, 1 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. NOTE: A re- inspection fee of $1.00 will be made when such re- inspection is made necessary by improper fro > i ce or inspection, or faulty materials and /or workmanship. BUILDING ELECTRICAL PLUMBING MIAMI ERMI to be loerfu Owner of r,'; t: ,.• -, `, Building f dron 6R - BUILL ER SHORES VILLAGE, FLORIDA DATE N? 7045 med under this Permit t f Architect Contractor k ` .. or Builder Legal Lot f 1 BI. Subdi Description vision Address of Value of I Amt. of � y,� Building f , „ ---'" , " Project Permit f - This permit is granted to the contractor or build`er named above to - construct the building or to install the equipment or device described in the appli- cation here,for 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 ar buflder named above assumes the responsibility for a thorough knowledge of the ordinances and regulations pertaining to the work covered hereby whbther shown on the plans or drawings fir in the statements or s cifications and t he assumes respon- sibility for work done by his agents; servants or employees. Signed INSPECTOR In consideration of the.issnance to me of this permit I agree to perform the work covered hereunder in compliance with all ordinances and regulations pertaining thereto and in stricteonformity with the r lans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In aocepting this permit l asguaah`responsibility for all work done by either myself, my agent, servant or employee. BY Contractor's License No. By AUTHORITY 5 tie WA/ 1 / 'IL >-"-- • LC 174; — ."" e "fr. "IA .4/ ry V i ' My Commission Expires MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT 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 berefn specified or not. A copy of approved plans and specifications must be kept at building during progress of work. Owner's Name and Address 1 t `A U 0J.G. S __L__,104,1025 No. ` e ) S " Street._ g__(0 54 . 1 Registered Architect and /or Engineer r Employing Flumber's Name 'Q t _ , Na..� e...�.._....._....... Itrsgt.._._...,.. .,.........._ Location and Legal Description Lot 5 ( A_ Bleek , . Subdivision G Street and Number where work is to be performed -No (Q& S 4 Street. l ._ , 1 State work to be performed and purpose of building (By Floo[s�__._._ _.. S.� -.__- ...No, ,S New Building. .- ..._.— _.._.. .... ...._.. Remodeling__-_._ Addition.. _____ Repairs Size Septic Tank-.4.-1--(grip- 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 $ 1N 6 e7P (Signed)_ (Signed) Plumbing 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 5968, Compiled General Laws of Florida Permanent Supplement, and her com- plied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors employed by him in the wore to he performed under this permit; and will post or cause to be posted' for inspection on to of the work such public notice or notices as are required by the Act. The undersigned agrees to employ only such sub -contra s' work to be ormed under this permit, as are licensed by Miami Shores Village. No. of Stories STATE OF FLORIDA, 1 µ COUNTY OF DADE. I 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 be has carefully read the foregoing application, and that be did sign the same, and that all facts therein by him stated are true. Notary Public, State of Florida iils>itttpr. NOTE: A re- inspection fee of $1.00 will be made whoa snob se.ispeotlon is sasde•sioaisy by improper notice for Inspection, or faulty materials and /ce workmanship. CI-oasis BATH a LAVA TORIES 11"4" SLO/ SINK[ LAUNDR Tuns U RINAL[ CA BASIN FLOOR DRAIN DRINKING FOUNT' NE TOTAL FIITyREE CONTR. LItT ' 3 . CHICK _ SEPTIC TANK SEWER CONN. DRAIN FIELD SOAKAGE PIT G TRAP SOLAR HEATER DEEP WELL SPRKLR. SYSTEM SW IM'O FOOL CoNTR. LIST �- CHICK V i ' My Commission Expires MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT 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 berefn specified or not. A copy of approved plans and specifications must be kept at building during progress of work. Owner's Name and Address 1 t `A U 0J.G. S __L__,104,1025 No. ` e ) S " Street._ g__(0 54 . 1 Registered Architect and /or Engineer r Employing Flumber's Name 'Q t _ , Na..� e...�.._....._....... Itrsgt.._._...,.. .,.........._ Location and Legal Description Lot 5 ( A_ Bleek , . Subdivision G Street and Number where work is to be performed -No (Q& S 4 Street. l ._ , 1 State work to be performed and purpose of building (By Floo[s�__._._ _.. S.� -.__- ...No, ,S New Building. .- ..._.— _.._.. .... ...._.. Remodeling__-_._ Addition.. _____ Repairs Size Septic Tank-.4.-1--(grip- 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 $ 1N 6 e7P (Signed)_ (Signed) Plumbing 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 5968, Compiled General Laws of Florida Permanent Supplement, and her com- plied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors employed by him in the wore to he performed under this permit; and will post or cause to be posted' for inspection on to of the work such public notice or notices as are required by the Act. The undersigned agrees to employ only such sub -contra s' work to be ormed under this permit, as are licensed by Miami Shores Village. No. of Stories STATE OF FLORIDA, 1 µ COUNTY OF DADE. I 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 be has carefully read the foregoing application, and that be did sign the same, and that all facts therein by him stated are true. Notary Public, State of Florida iils>itttpr. NOTE: A re- inspection fee of $1.00 will be made whoa snob se.ispeotlon is sasde•sioaisy by improper notice for Inspection, or faulty materials and /ce workmanship.