1250 NE 91 Terr (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 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 Harold Gardner_ _ No. 1230 Street N. E. 91st Terr. -
Registered Architect and/or Engineer _
Employing Plumber's Name RQ.S.e....antti_C._Tilk. CO . 4 , 111C s._ No. Z55
Location and Legal Description Lot
Street and Number where work is to be performed—No 1230
State work to be performed and purpose of building (By Floors)
Bloelc
Date
Feb. _ .
%vet_ 3rd_ Ay! Hialeah
Subdivision__ Fla •
s tmt N. E. 91st Terr.
New Building__._ X_ Addition Repairs No. of Stories.
Size Septic Tank-----9-00---gal..- Type of Tank _Precast Capacity Gals.
Feet of Drain Feet of Tank or Drain Field from Well
Nature of Water Supply: of Soakage Pit
1 - P1M_PQ3iI&abartrinn_existing.....,septic__tank___
- --------
Amount of Permit $
6.00
STATE OF FLORIDA, }
as.
COUNTY OF DADE.
LEL,
(Signed)
(Signed).
My Commission Expires Notary Public, State of Florida
- 4 (
Master Plumber.
...
..........
Plumbing Inspector.
The undersigned applicant for this building permit does hereby certify that he understands and accepts his ligations as an employer of labor
under the Florida Worlanen's Compensation Act, being Section S966, Compiled General Laws of Florida Pen 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
licensed by Miami Shores Village.
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 by improper notice for inspection, or faulty
materials and/or workmanship.
CLellET5
BATH
TUBS
SHOWERS
LAVA-
TORIES
SIN
SLOP
SINKS
LAUNDRY
T
URINALS
CATCH
BASIN
FLOOR
DRAIN
DRINKING
FOUNT'NS
TOTAL
FIXTURES
CONTR.
LIST
CHECK
SEPTIC SEWER
TANK CONN.
DRAIN
FIELD
SOAKAGE
PIT
GREASE
TRAP
SOLAR
HEATER
DEEP
WELL
SPRKLR.
SYSTEM
SWIM' G
POOL
IIVIJU
& abandon
C LIST •
900 gal.
w/75'
1
___
CHECK
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 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 Harold Gardner_ _ No. 1230 Street N. E. 91st Terr. -
Registered Architect and/or Engineer _
Employing Plumber's Name RQ.S.e....antti_C._Tilk. CO . 4 , 111C s._ No. Z55
Location and Legal Description Lot
Street and Number where work is to be performed—No 1230
State work to be performed and purpose of building (By Floors)
Bloelc
Date
Feb. _ .
%vet_ 3rd_ Ay! Hialeah
Subdivision__ Fla •
s tmt N. E. 91st Terr.
New Building__._ X_ Addition Repairs No. of Stories.
Size Septic Tank-----9-00---gal..- Type of Tank _Precast Capacity Gals.
Feet of Drain Feet of Tank or Drain Field from Well
Nature of Water Supply: of Soakage Pit
1 - P1M_PQ3iI&abartrinn_existing.....,septic__tank___
- --------
Amount of Permit $
6.00
STATE OF FLORIDA, }
as.
COUNTY OF DADE.
LEL,
(Signed)
(Signed).
My Commission Expires Notary Public, State of Florida
- 4 (
Master Plumber.
...
..........
Plumbing Inspector.
The undersigned applicant for this building permit does hereby certify that he understands and accepts his ligations as an employer of labor
under the Florida Worlanen's Compensation Act, being Section S966, Compiled General Laws of Florida Pen 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
licensed by Miami Shores Village.
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 by improper notice for inspection, or faulty
materials and/or workmanship.
BUILDING
ELECTRICAL
PLUMBING
ROOFING
Owner of yy I
Building t . t
or Builder
a., 4
CONTRACTOR OR BUILDER
MIAMI SHORES VILLAGE, FLORIDA
PERMIT
(-1 ,
Architect
Contractor •
Legal Lot
Description II Bl
Address of
� �� t. (1
K .
Building
N9 7216
Work to be performed under this Permit
r1L
Subdi- f ,
vision
Value of
Project $
DATE
Contractors e"
License No. �y
Amount of (
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 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 that he assumes respon-
sibility for work done by his agents, servants or employees.
BY AUTHORITY
t t s
1 6 ,
I rgit ti_
Signed- ' � ' _ _ INSPECTOR
In consideration of the issuance to me of this permit I agree to perform the work covered hereunder in complitire 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 cm
ceptinq this permit I assume responsibility for all work done by either, myself, my agent, servant or employee.
••SOT .'• -"