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1125 NE 91 Terr (3)PERMIT APPLICATION FOR MUNICIPALITIES OF DADE COUNTY (OWNER TO RETAIN COPY) Date 07/9/ Job Address g- S-0./ Legal Description/i7'/ 7 Owner / Lessee / Tenant Owner's Address /OS Contracting Co. Qualifier 71z . 2 ¢O ri), itdci C 6 c,6 `�i State ¢ G Competency # Architect /Engineer Bonding Company Mortgagor WORK DESCRIPTION 'ERMIT FEE: Fignature- /of Owner end /or C -.•• President nate: 'rot y alto ommission A - Owner and /or Condo President Expires: , ///6/9.,A * * * * APPROVED: Fire Zoning Building /Mechanical Plumbing Tax Folio,/ ✓ �Q/ iW 1 Master Permit # J Phone ) Address gGr 2 2,4 /%/p j�� .7.3/6f SS# - - Phone 751-- ; Z' Address Address Address Ins. Co. Permit Type (circle one): BUILDING ELECTRI PLUMBING CHANICAL PAVING FENCE SIG1; Square Ft. Estimated Cost /MO WARNING TO OWNER: YOU MUST RECORD A NOTICE OF COMMENCEMENT AND YOUR FAILURE TO DO SO MAX 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). Application is hereby made to obtain a permit to do work and installation as indicated above, and on the attached addendum (if applicable). I 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, SIGNS, POOLS, ROOFING, and MECHANICAL work. 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. Furthcrmors, I authorize the above -named contractor state ate: u e o ,tar as to Contractor or Owner- Builder y Commission Expires:// / * * * � 9 * * Other Electrical tor or Owner - Builder * `�' 1 Engineering CERTIFICATE OF OCCUPANCY MIAMI SHORES VILLAGE, FLORIDA BUILDING DIVISION N° 982 Owner, Agent or Tenant of Building Street Address 1125 N.: 91st Terr. Miami Shores Village, Florida, 9/25/59 H.D. Gaggstatter, Jr. Lot 16 -17 Block 1 Subdivision Waters "Ldge Approved use by occupancy 3 Bedroom — 2 Bath Res.. Remarks. S . S' L E , This Certificate of Occupancy is issued to the above named Owner for building at above named location only upon the express provision that the applicant will abide by and comply with all conditions of Ordinances Nos. 92, 93, 94 and 97, known as the Zoning, Electrical, Plumbing and Building Ordinances of Miami Shores Village pertaining to the erection, construction, alteration or remodeling of buildings or structures. .21an Gube - 26,584 Tax Value - 13, 292 Wit BUILDING DIVISION Application is hereby made for the approval of the detailed statement of tyro plans and specifications herewith submitted for the building or other structure herein described. This application is made in compliance and with the E;uilding Ordinance of Miami Shores Village, Florida, and all provisions of the Laws of the State of Florida, all ordinances of Miami Snores Viiian:; aid all rules and regulations of the Building Division of Miami Shores Village shall be complied with, whether herein specifier' nr4. A cop;' If approved plans and specifications must be kept at building during progress of work. Permit No 472/ Owner's Name and Address_.._ Q •O a11.24t att er, J r . . Registered Architect and /or Engineer- ________ _______.____ — — — — Employing PlinlibT,r% Name SoUthern Dri11-inra & Equ No._ _ 1�51 _. E. — Street.. — 52 St., His lea h,Fla. _.�-- -- -- --.- - -_— Location and Legal Description Lot_ — _ - _ - - -_ -_ -- Block_ Subdivision - .-------.._.----------_--_-- Street and Number where work is to be performed —No Same as above Street State work to be performed and purpose of building (By Floors) 2!!._au ?_ .._ ie1 & 3pr New Building ______ Remodeling____ __ —._ Addition Size Septic Tank______ A..moa,:nt of Permit $ STATE OF FLORIDA, } (:MINTY 0: DADE. My Crmmission Expires MIAMI SHORES VI p - .0 Ge PLUMBING INSPECTION DEPARTM €I << - APPLICATION FOR PLUMBING • . u■°s No._ 1125 IT .E. Date _._._.. - - -- 2.1__516. 4__ Street 91 Ter. , r.. Sh o r e s , syst em Repairs No. of Stories . . ........ ........ 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 (Signed) - r Plumbing Inspecto -: The undersigned applicant for this building permit does hereby certify that he understands and accepts his obl ations as an employer of labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Per 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 performed under this permit, as are licensed by Miami Shores Village. (Signed). Notary Public, State of Florida Master, I;efue 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 materials and /or worlmranship. CLOSETS BATH TUBS OW SHOWERS LAVA- TORIES S INKS SLOP SINKS LAUNDRY TUeB U RINALS 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 SWIM'G POOL CONTR. LIST - -- CHECK Application is hereby made for the approval of the detailed statement of tyro plans and specifications herewith submitted for the building or other structure herein described. This application is made in compliance and with the E;uilding Ordinance of Miami Shores Village, Florida, and all provisions of the Laws of the State of Florida, all ordinances of Miami Snores Viiian:; aid all rules and regulations of the Building Division of Miami Shores Village shall be complied with, whether herein specifier' nr4. A cop;' If approved plans and specifications must be kept at building during progress of work. Permit No 472/ Owner's Name and Address_.._ Q •O a11.24t att er, J r . . Registered Architect and /or Engineer- ________ _______.____ — — — — Employing PlinlibT,r% Name SoUthern Dri11-inra & Equ No._ _ 1�51 _. E. — Street.. — 52 St., His lea h,Fla. _.�-- -- -- --.- - -_— Location and Legal Description Lot_ — _ - _ - - -_ -_ -- Block_ Subdivision - .-------.._.----------_--_-- Street and Number where work is to be performed —No Same as above Street State work to be performed and purpose of building (By Floors) 2!!._au ?_ .._ ie1 & 3pr New Building ______ Remodeling____ __ —._ Addition Size Septic Tank______ A..moa,:nt of Permit $ STATE OF FLORIDA, } (:MINTY 0: DADE. My Crmmission Expires MIAMI SHORES VI p - .0 Ge PLUMBING INSPECTION DEPARTM €I << - APPLICATION FOR PLUMBING • . u■°s No._ 1125 IT .E. Date _._._.. - - -- 2.1__516. 4__ Street 91 Ter. , r.. Sh o r e s , syst em Repairs No. of Stories . . ........ ........ 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 (Signed) - r Plumbing Inspecto -: The undersigned applicant for this building permit does hereby certify that he understands and accepts his obl ations as an employer of labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Per 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 performed under this permit, as are licensed by Miami Shores Village. (Signed). Notary Public, State of Florida Master, I;efue 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 materials and /or worlmranship. Permit No Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for tlfe 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 ' Size Septic Tank Feet of Drain Tile_ Nature of Water Supply: City —W Amount of Permit $- MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING Registered Architect and /or En inee _ _! Employing Plumber's Name_ tit 4iVa"l Zf4-- No.-- -- _-- . - -_._ Street__ Location and Legal Description Lok ______________ — ____I Z/—g--9Z Subdivision Street and Number where work is to be performed —No State work to be performed and purpose of building (By Floors)_____ • T ype of Tank_ New Building —._ Remodeling —__ _____.__ Addition.___ Repairs No. of Stories. _ .. ._Dist. Feet of Tank or Drain Field from Well . A e S j iLef % I age Pit .... Street__ _ Street-_________- (Signed)- ( Signed). Date Capacity Gals Plumbing Inspector. The undersigned applicant for this building permit does hereby certify that he understands and accepts his o • gations as an employer of labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida P anent 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 performed under this permit, as are 1 by Miami Shores Village. Master Plumber. My Cnnumission Expires Notary Public, State of Florida STATE OF FLORIDA, 1 " OUNTY OF DADE. 1 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__- cf the above described construction, that he has carefully read the foregoing application, and that he did sign the same, and that all facts tbcr -in by him . stated are true. NOTE: A re- inspection fee of 1$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 TUBS SHOWERS LAVA. TORIES SINKS SLOP SINKS LAUNDRY Tuff URINALS I NAf CATCH BASIN FLOOR DRAIN DRINKING FOUNT' N5 TOTAL FIXTURES CONTR. LIST y CHECK __- SEPTIC TANK SEWER CONN. DRAIN FIELD SOAKAGE PIT GREASE TRAP SOLAR HEATER DEEP WELL SPRKLR. SYSTEM SW IM'G POOL CONTR. LIST CHECK l Permit No Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for tlfe 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 ' Size Septic Tank Feet of Drain Tile_ Nature of Water Supply: City —W Amount of Permit $- MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING Registered Architect and /or En inee _ _! Employing Plumber's Name_ tit 4iVa"l Zf4-- No.-- -- _-- . - -_._ Street__ Location and Legal Description Lok ______________ — ____I Z/—g--9Z Subdivision Street and Number where work is to be performed —No State work to be performed and purpose of building (By Floors)_____ • T ype of Tank_ New Building —._ Remodeling —__ _____.__ Addition.___ Repairs No. of Stories. _ .. ._Dist. Feet of Tank or Drain Field from Well . A e S j iLef % I age Pit .... Street__ _ Street-_________- (Signed)- ( Signed). Date Capacity Gals Plumbing Inspector. The undersigned applicant for this building permit does hereby certify that he understands and accepts his o • gations as an employer of labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida P anent 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 performed under this permit, as are 1 by Miami Shores Village. Master Plumber. My Cnnumission Expires Notary Public, State of Florida STATE OF FLORIDA, 1 " OUNTY OF DADE. 1 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__- cf the above described construction, that he has carefully read the foregoing application, and that he did sign the same, and that all facts tbcr -in by him . stated are true. NOTE: A re- inspection fee of 1$1.00 will be made when such re-inspection is made necessary by improper notice for inspection, or faulty materials and /or workmanship. Permit No Amount of Permit $ -- My Commission Expires 5 T)317 4 No._ c� °'� CJ t o L' — MIAMI SHORES VILLAGE' PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING 7 ;,.MIT Date Owner's Name and Address Registered Architect and /or Engineer ..... __________ ...... ____.._w__ — __ Employing Plumber's Name__ Me - lexl'Atel®e .4C _ 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. Street Location and Legal Description Lot___. _______ _ _.________ _ Block Subdivision __ ______._____._.______ Street and Number where work is to be performed—No. ___/ Street 71' Aok.ted - _ State work to be performed and purpose of building (By Floors)_ New Building _.__._ V Remodeling__-__ __.__ Addition____ Repairs No. of Stories . . ..... Size Septic Tank-___------ _- __-- _--- --- _--- -- --- -___ -_ Type of Tank Feet of Drain ................. Feet of Tank or Drain Field from Well Nature of Water Supply: City — Well..____ _ _ - ___Size of Soakage Pit Capacity Gals Plumbing Inspector. - The undersigned applicant for this building permit does hereby certify that he understands and accepts his obli .t, Lions as an employer of labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Perin • t Supplement, and has com- plied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors em . r yed 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 perfo...ed under this p :nit, as are licensed by Miami Shores Village. STATE CF FLORIDA, } :OUNTY OF DADE. T Mare 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 ihezein 1•q _;:.. stated are true. Notary Public, State of Florida 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. CLOSET! BATH TUBE SHOWER! LAVA- TORIES GINK! SLOP KINK! LAUNDRY TUBS VW Vr U �Eµy. - 7 - CATCH BASIN FLOOR DRAIN DRINKING FOUNT'NB 6 l i t wo $ IR R W tv, c1 to rat TOTAL FIXTURES CONTR. LIST 1 1 r CHECK SEPTIC TANK SEWER CONN. DRAIN FI ELD SOAKAGE PIT GREASE TRAP SOLAR HEATER DEEP WELL SPRKLR. SYSTEM SWIM'O POOL CONTR. LIST I - �— CHICK Permit No Amount of Permit $ -- My Commission Expires 5 T)317 4 No._ c� °'� CJ t o L' — MIAMI SHORES VILLAGE' PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING 7 ;,.MIT Date Owner's Name and Address Registered Architect and /or Engineer ..... __________ ...... ____.._w__ — __ Employing Plumber's Name__ Me - lexl'Atel®e .4C _ 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. Street Location and Legal Description Lot___. _______ _ _.________ _ Block Subdivision __ ______._____._.______ Street and Number where work is to be performed—No. ___/ Street 71' Aok.ted - _ State work to be performed and purpose of building (By Floors)_ New Building _.__._ V Remodeling__-__ __.__ Addition____ Repairs No. of Stories . . ..... Size Septic Tank-___------ _- __-- _--- --- _--- -- --- -___ -_ Type of Tank Feet of Drain ................. Feet of Tank or Drain Field from Well Nature of Water Supply: City — Well..____ _ _ - ___Size of Soakage Pit Capacity Gals Plumbing Inspector. - The undersigned applicant for this building permit does hereby certify that he understands and accepts his obli .t, Lions as an employer of labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Perin • t Supplement, and has com- plied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors em . r yed 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 perfo...ed under this p :nit, as are licensed by Miami Shores Village. STATE CF FLORIDA, } :OUNTY OF DADE. T Mare 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 ihezein 1•q _;:.. stated are true. Notary Public, State of Florida 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. ti Lr •.• BUILDING ELECTRICAL PLUMBING ROOFING Owner of Building 4 i 1 MIAMI SHORES VILLAGE, FLORIDA ❑ DATE "s 19 6' ❑ PERMIT N9 4971 971 Contractors ..- ® License No. ` r4 ❑ Work to be performed under this Permit— CONT1 **TOR OR BUILDER { Architect Contractor !' or Builder .t !^ , Legal Lot Description Bi er . t Subdi- vision Address of r . Value of , _r , II Amount of Building / 1 ? 4 t ; 1. f Project $ 1 II Permit $ x 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 applica- tion 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 th2t he assumes respon- sibility for work done by his agents, servants or employees. t C 3 .. -- { r...r' Signed INSPECTOR , In consideration of the issuance to me of this permit I agree to perform the work covered hereunder in complian 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 as cepting this permit I assume responsibility for all work done by either, myself, my agent, servant or employee. s BY AUTHORITY ABBOT t Permit No""W 67 My Commission Expires MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT Location and Legal Description Lot. Bkxlr Street and Number where work L to be performed —No /`d` 5 State work to be performed and purpose of building (By Floors )_—_21 New Building - - -_ -- --- ._.........._._ Remodeling__ ___ Addition. Amount of Permit $ —.i..t ` " " (Signed) 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. No. i/2 Owner's Name and Address Registered Architect and /or En ' eer J £zxtployin; Plumber's Name 01"---2-4 d . , Na O «..�........ ItrN! _ (y : _• • - Subdivision....._ Street_.._ — Repairs No. of Stories Size Septic Tank_ -. -Type of Tank__ Feet of Drain Tile Dist Feet of Tank or Drain Field from WeU ..._. __. -- __._------ •- -... -- - - -•— Nature of Water Supply: City —Well. Size of Soakage Pit Notary Public, State of Florida /P'5 Plumbing I... , tor. 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 hay 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 the site of the work such public notice or notices as arr required by the Act. The undersigned agrees to employ only such sub - contractors, on wor to be performed under this perini as are licensed by Miami Shored Village. STATE OF FLORIDA, l 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 swan, upon oath deposes and says that he is the .__ - of the above described construction, that be has carefully read the foregoing application, and that he did sign the same, and that all facts therein by hires stated are true. NOTE: A re- inspection fee of $1.00 will be made wham amok seispeotiam Y mede by improper notice for Yspection, or faulty materials and /or walmnanahnp. CLOSETS BATH Tu.• aHOWERd LAVA- TORIES SINK• SLOP SINKS LAUNDRY Tuns URINALS CATCH SASIN FLOOR DRAIN DRINKING FOUNT' N• TOTAL FIXTURES CONTR. LIST CHECK SEPTIC TANK SEWER CONN. DRAIN FIELD SOAKAGE PIT G TRAP SOLAR HEATER DEEP WELL SPRKLR. 1 SW 114 '0 POOL (GI , O' ^;J,!/i^�+ COMM L1ST CHICK I ( t Permit No""W 67 My Commission Expires MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT Location and Legal Description Lot. Bkxlr Street and Number where work L to be performed —No /`d` 5 State work to be performed and purpose of building (By Floors )_—_21 New Building - - -_ -- --- ._.........._._ Remodeling__ ___ Addition. Amount of Permit $ —.i..t ` " " (Signed) 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. No. i/2 Owner's Name and Address Registered Architect and /or En ' eer J £zxtployin; Plumber's Name 01"---2-4 d . , Na O «..�........ ItrN! _ (y : _• • - Subdivision....._ Street_.._ — Repairs No. of Stories Size Septic Tank_ -. -Type of Tank__ Feet of Drain Tile Dist Feet of Tank or Drain Field from WeU ..._. __. -- __._------ •- -... -- - - -•— Nature of Water Supply: City —Well. Size of Soakage Pit Notary Public, State of Florida /P'5 Plumbing I... , tor. 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 hay 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 the site of the work such public notice or notices as arr required by the Act. The undersigned agrees to employ only such sub - contractors, on wor to be performed under this perini as are licensed by Miami Shored Village. STATE OF FLORIDA, l 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 swan, upon oath deposes and says that he is the .__ - of the above described construction, that be has carefully read the foregoing application, and that he did sign the same, and that all facts therein by hires stated are true. NOTE: A re- inspection fee of $1.00 will be made wham amok seispeotiam Y mede by improper notice for Yspection, or faulty materials and /or walmnanahnp. 5 L 1 LONE STAR PLUMBING, INC. 12605-A N.E. 14th AVENUE NO. MIAMI, FLORIDA 33161 Phone 895-1340 2 ■ 4/0 YD, 400 / ao