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867 NE 91 Terr (7)Da Type Insp'n Permit No. Nam Address Company Approve MIAMI SHORES VILLAGE BUILDING DEPARTM - , B ilding Inspection Reque Phone # Inspection Date " I! Correction Re- Insp'n Fee ❑ MIAMI SHORES VILLAGE BUILDING DEPARTMENT 305- 795 -2204 Building Inspection Request Dated il 1w Typelnsp'n PI TOP Cncl �J✓ pr�� 913003 ?- Name G r t nh W Address ;550 IV GI 4err. Company °4I fm r Phone # 2 Q L/ Permit No. Inspection Date Approved Correction Re- Insp'n Fee Miami Shores Village i Building Department DEC ti 2003 BUILDING PERMIT APPLICATION FBC 2001 Permit Type (circle): Building Electrical Owner's Name (Fee Simple Titleholder) C 4 Owner's Address ?, 7 ' l f / j�� City ' //9 S$f'VA24 State /^2._ Tenant/Lessee Name Al /g Job Address (where the work is being done) City Is Building Historically Designated YES NO X Contractor's Company Name t _ I�') l � PL p7 at-) Contractor's Address � ! LI S c t- . 71 n L L" City { 1 ' 1 0%14 State CC L it 5 F it—c )/L = L Qualifier Number of:Bays Type of Work: ❑Addition Describe Work: Minus Plans Check Fee $ - Z? 7 N c2 qr Miami Shores Village County Miami -Dade ❑Alteration ❑New Total Fee Now Due $ Mechanical Roofing Zip Permit No. Master Permit No. / /SS ' -K-4,7e# 3 C>5 ein C 33 /3' Phone # 3 06 759 - O v Q 1� Zip -' 3 2 Phone # 2-(/ 3 r11 Zip 3 /1r 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 Phone # Architect/Engineer's Name (if applicable) Architect/Engineer's Address City State Zip $ Value oI Yorrc Tior.this Permit .. % ° 2 Sgdare Fektaggbf Work: • ry' Stories ( Families / Bedrooms Baths / ❑ Repair/Replace ❑ Demolition 6-/4-1 (leo A, f;")q 1)-e}Legeo" ah,(..OV 7 � G / /ej * * * * * * * * * * * * * * * * * * * * * * * * * * ** F ees * * * *,t0 * * * * * * * * * * * * * * * * * * * * ** U J County Escrow Fee $ (► lid k tt Z4 -' Permit Fee $ / f � JDtary $ Education/Training Fee $ Tech $ Scanning $ ✓ Radon $ Code Enforcement $ Bond $ Struct. $ ■ (Continued on opposite side) 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 $2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issu )n the absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. 7 Signature 7 NOTARY PUBL Sign: Print: /1/iLc-(1 Owner or Agent ContracW The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this day of ,20_,by day of ,20_,by who is personally known to me or who has produced who is personally known to me or who has produced As identification and who did take an oath. `110 NMI IA I �. My Commission Expires: ? : cS \st 8, ?0, ; . ' `'� N , My Commiss'sonp�es: * * * * * * * * * * * * * * * ** A **; ► * **14 :14 * * * **14, * * * ** * ** * **** ** * ** * ** *** * * * * * # *, Syr ***ktms * * *it * *t * * * * * * * * * * * * ** NCC9596 State Certificate or Registration'$ • APPLICATION APPROVED . Y: chc7l7 /03 rtificate of Competency Holder) oondoto • c . 991 ->N ::. s is Certificate of Competenc ‘ ************************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** • ` Signature NOTARY PUBL Sign: Print: as identification and 111 �Illll "are s• o 3 e an oath. Plans Examiner Engineer Zoning Date Inspection Date Approved Correction Re- Insp'n Fee MIAMI SHORES VILLAGE BUILDING DEPARTME 305- 795 -2204 Building Inspection Request Type Insp'n Il Permit No. PG O63 32 Name C O R Address 7 0) i V q I Company N-0 '[ V Phone # 'EM NTH 11B UNIT FEE ITEM SWITCH OUTLETS UNIT FEE ITEM SPACE HEATERS UNIT FEE !DET LIGHT OUTLETS CENTRAL HEATING !SMASHER RECEPTACLES A/C (WIND) .SPOSAL SERVICE TEMPORARY A/C (CENTRAL) HINKING FOUNTAIN SERVICE SIZE IN MPS DUCT WORK .00R ORM N SERVICE REPAIR/METER CHANGE REFRIGERATION LEASE TRAP APPLIANCE OUTLETS PROCESS AND PRESS PIPING rTERCEPTOR RANGE TOP UNDERGROUND TANKS 1VAT0RY - 1 OVEN ABOVE GROUND TANKS 1UNDRY TRAY WATER HEATER U.F. PRESSURE VESSELS .OTHES WASHER 1 MOTORS 0- 1 HP STEAM BOILERS -IOWER 1 MOTORS OVER 1- 3 FP HOT WATER BOILERS INK, POT /3 COMP. MOTCRS OVER 3- 5 HP MECHANICAL VENTILATION INK, RESIDENCE MOTORS OVER 5- 8 HP TRANSPORTING ASSEMBLIES INK, SLOP MOTORS OVER 8- 10 HP ELEVATORS/ESCALATORS EMPORARY WATER CLOSET MOTORS OVER 10- 25 HP FIRE SPRINKLER SYSTEMS 1INAL MOTORS OVER 25-100 HP COOLING TOWERS ATER CLOSET 1 MOTCRS OVER 100 HP VIOLATION DIRECT WASTES - A/C WINDOW REINSPECTION &TER SUPPLY TO: AIR CONDITIONERS A/C UNIT STRIP HEATER FIRE SPRINKLER GENERATORS TRANSFORMERS • HEATER -NEW INST. GENERATORS TRANSFORMERS I HEATER - REPLACE GENERATORS TRANSFORMERS LAWN SPRINKLER -WELL SPECIAL PURPOSE SW I M#I I NG POOL OUTLETS COM+€RC I AL WATER SERVICE SIGN TUBES EWER CONNECTIONS To S , rti-ci4 P SIGN TRANSFORMERS TILITY -SEWER SIGN TIME CLOCK TILITY -WATER - FIXTURES EPTIC TANK ANTENNA :LAY TELEVISION OUTLETS lAINFIELD, 4' TILE/RES. VIOLATION J* E ABANDON SEPTIC TANK REINSPECTION JAKAGE PIT CU. FT. &TCH BASIN ISCHARGE WELL JMESTIC WELL TEA DRAIN JOF INLET I MAR WATER HEATER IRE STANDPIPE 301 PIPING AWN SPRINKLER SYSTEM AS RANGE _TER SET (GAS) 4S PIPING ADDENDUM TO BUILDING PERMIT APPLICATION 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.) PLUMBING ELECTRICAL MECHANICAL Miami Shores Village 10050 NE 2nd Avenue Phone: 305 - 795 -2204 Printed: 12 /5/2003 Applicant: CAROLEE MCINTIRE Owner: MCINTIRE CAROLEE JOB ADDRESS: 867 NE 91 TERR Contractor NELMAR PLUMBING INC Local Phone: (305) 261 -3942 Parcel # 1132060050280 Plumbing Permit Permit Number: PL2003 -327 Contractor's Address: 4954 SW 75 AVE Page 1 of 1 Legal Description: GOLDEN GATE PARK ADDN PB 6 -130 LOT 23 & E10FT OF LOT 22 BLK 2 Fees: Description Amount FEE2003 -7849 Building Fee $180.00 FEE2003 -7850 Scanning Fee $3.00 FEE2003 -7851 CCF $1.20 FEE2003 -7852 Training and Education Fee $0.40 FEE2003 -7853 Technology Fee $5.00 Total Fees: $189.60 Total Fees: $16,9.6 Total Receipts: $ 13y.�a Permit Status: APPROVED Permit Expiration: 6/1/2004 Construction Value: $1,300.00 Work: ADDITION PLUMBING Signed: (INSPECTOR) 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 responisibility for all work done by either myself, my agent, servants or employes. Signed: (Contractor or Builder) BY: PERMIT APPLICATION FOR MIAMI SHORES VILLAGE Date 2 A ` 9 7' Job Address 2 / /7C %/ r Legal Description Z 3 ± F 1 0 Owner / Lessee / Tenant 43/62.0 ,'-e'S_ Owner's Address 0'6 7 /I Lf 9l '" ' ' Phone Contracting Co. 1 20 .t /L ( Qualifier G z mss. e /0 Ssi / ( Phone 6 3 State # Municipal 1 Competency # Ins.Co. Architect /Engineer Address Bonding Company Address Mortgagor A•dress Permit Type(circle one): BUILDING ELECTRICAL WORK DESCRIPTION 0 er A- e U Square Ft. � WARNING TO OWNER: YOU MUST RECORD A NOTICE OF COMMENCEMENT AND YOUR FAILURE TO DO SO 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). 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 dory in compliance with all applicable laws regulating construction and zoning. Furthermore, I autho ze the ab•.;e -named contractor to do the work state Signature jf owner and /or Condo President Date: (Y C‘ Notary as to Own My Commission Ex RADON Zoning * C.C.F. Tax Folio Address ‘D'c ) t ; 542 _�S'" C IL Estimated Cost(value) CHANICAL ROOFING PAVING FENCE SIGN * COMMISSION NUMBER CC255237 �s. MY COMMISSION EXP. ** * * * it * FEES: PERMIT 3 APPROVED: Fire Buildin Mechanical Plumbin Signature of Contractor or • er- Builder Date' ty Notary as t My Commissi * NOTARY 5 C TOTAL DUE It:/% 00 t:/ /0 00 o s aa-a Master Permit #-3 o7j OFFICIAL NOTARY SEAL •: E skTHIWWWIRIc • CC255237 MY COMMISSION EXP. er OF FL JAN 2E'i1997 ** Other Electrical ngineering, PERMIT # q4. 86471 STATE OF FLORIDA •be.PAR?MENT OF HEALTH AND REHABILITATIVE SERVICES DATE PAID 2- - )• u ' ONSITE SEWAGE DISPOSAL SYSTEM FEE PAID $ CONSTRUCTION PERMIT RECEIPT # Authority: Chapter 381, FS & Chapter 1OD -6, FAC CONSTRUCTION PERMIT FOR: [ ] New System [ ] Existing System [ ] Holding Tank [ J Temporary /Experimental [)] Repair [ ] Abandonment [ ] Other(Specify) APPLICANT: ✓ lC AGENT: V PROPERTY STREET ADDRESS: {j ! L]' / J LOT: PROPERTY ID #: BLOCK: SUBDIVISION: E BOTTOM OF DRAINFIELD TO BE [ L D FILL REQUIRED: [ ] INCHES 0 T H E R SPECIFICATIONS BY: APPROVED BY: DATE ISSUED: - -if_ p HRS -H Form 4016, Mar 92 (Obsoletes previous editions which may not be used) (Stock Number: 5744- 001 - 4016 -0) [SECTION /TOWNSHIP /RANGE /PARCEL NUMBER] [OR TAX ID NUMBER] SYSTEM MUST BE CONSTRUCTED IN ACCORDANCE WITH SPECIFICATIONS AND STANDARDS OF CHAPTER 10D -6, FAC REPAIR PERMITS AND HOLDING TANK PERMITS EXPIRE 90 DAYS FROM THE DATE OF ISSUE. ALL OTHER PERMITS EXPIRE ONE YEAR FROM THE DATE OF ISSUE. HRS APPROVAL OF SYSTEM DOES NOT GUARANTEE SATISFACTORY PERFORMANCE FOR ANY SPECIFIC PERIOD OF TIME. ANY CHANGE IN MATERIAL FACTS WHICH SERVED AS A BASIS FOR ISSUANCE OF THIS PERMIT, REQUIRE THE APPLICANT TO MODIFY THE PERMIT APPLICATION. SUCH MODIFICATIONS MAY RESULT IN THIS PERMIT BEING MADE NULL AND VOID. SYSTEM / AND SPECIFICATIONS / T ( r (GALLONS / GPD] SEPTIC TANK /AEROBIC UNIT CAPACITY MULTI- CHAMBERED /IN SERIES:[ ] A [ ] [GALLONS / GPD] CAPACITY MULTI- CHAMBERED /IN SERIES:( ] N [ ] GALLONS GREASE INTERCEPTOR CAPACITY [MAXIMUM CAPACITY SINGLE TANK: 1250 GALLONS] K [ ] GALLONS PER DOSE DOSING TANK CAPACITY DOSE RATE [ ] PER 24 HRS NO. OF PUMPS: [ ] D (',1O] SQUARE FEET PRIMARY DRAINFIELD SYSTEM R [ ] SQUARE FEET SYSTEM A TYPE SYSTEM: [ ] STANDARD [ ) FILLED I CONFIGURATION: [ ] TRENCH [Al BED F LOCATION OF BENCHMARK: I ELEVATION OF PROPOSED SYSTEM SITE [ ] [INCHES /FT] [ABOVE /BELOW] BENCHMARK /REFERENCE POINT ] [INCHES /FT] [ABOVE /BELOW] BENCHMARK /REFERENCE POINT EXCAVATION REQUIRED: [ ] INCHES TITLE: [ ] MOUND [ ] [ TITLE: G ) BUiLD9!0 DEPARTMENT : /'k- (—CA- J 1, CPHU EXPIRATION DATE: Si 1/ Page 1 of 2 _ Notes Site Plan Submitted by v .i Plan Approved By STATE OF FLORIDA _DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PERMIT PART II - SITE PLAN SIGNATURE Not Approved C Permit Application Number 1 I i 1: Iwy.� ■ --- _ ■Ni■N■ ■N■ Np■■ • UMW t ■ ■■■■ ■mummr ■ ■■■a■aaN■ ■ ■® N $■I■ �■■(�■ I■aN ■■ N■■i■Ni■ ■i�ua■ �■ ■ �■■t■■■ ■ ■ ■ a a■■■ ■■■■ ■■■■■■a ■a■ ■N■ ■■1NSl■■l■i 8 ■ ■ ■■■■■■■■■ ■■ ■ ■ ■ ■ ■■■i ■ ■■i■■■ ■N ■ ■■i ■■ ■■•' ■ ■ ■B�■ ■■■ ■jam■ ■■a IMMININSIMMINIM -4 4N.. 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'L C ' / 7 /Ze ALL CHANGES MUST BE APPROVy D BY THE COUNTY PUBLIC HEALTH UNIT HRS -Fi Form 4015, Feb 85 (Obsoletes previous editions which may not be used) 'Stock Number. 5744 -002- 4015 -6) ,., -'� t , j TITLE Date ^" -----" County Public Unit Pace, 2 of 3 L-- T . ` .1_.�_._._ +-,_ »-..L- . ) , — — ` � li t »..•- te -k- • ��i, . �_ _ _ .._..... , ' '_ - _..,...,.._ .- .._ . - - - - y a a ■ � �` 1111111111111111•111 ON 111111•11111111111 , , i 1 , NMI I 1 t �■ ■■■■ yp SUM : ■i[N ■.!� ■■a■�■ �{�r�� ■■■M■■■, I i 1 rt � � / d 'r■�■ ■�■■■■!■■ f 1■ a■ _ t ■H■ i' . ? r . t■ qt' NI'■ NUN ■ !■H<■ �i ■t ■�i��! ■■i ■NN■■'� ■■■■i ■ ■■N■ ■■■ ■■ ■■ ■ iii ■■ ■N I ■ ■!■■t ■ ■■■N t • ■ ■/k■ ■ ■■■aN■ n■ ■NM■N■■■8■■ , 1 • ■ R , _ Notes Site Plan Submitted by v .i Plan Approved By STATE OF FLORIDA _DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PERMIT PART II - SITE PLAN SIGNATURE Not Approved C Permit Application Number 1 I i 1: Iwy.� ■ --- _ ■Ni■N■ ■N■ Np■■ • UMW t ■ ■■■■ ■mummr ■ ■■■a■aaN■ ■ ■® N $■I■ �■■(�■ I■aN ■■ N■■i■Ni■ ■i�ua■ �■ ■ �■■t■■■ ■ ■ ■ a a■■■ ■■■■ ■■■■■■a ■a■ ■N■ ■■1NSl■■l■i 8 ■ ■ ■■■■■■■■■ ■■ ■ ■ ■ ■ ■■■i ■ ■■i■■■ ■N ■ ■■i ■■ ■■•' ■ ■ ■B�■ ■■■ ■jam■ ■■a IMMININSIMMINIM -4 4N.. I. ■■■■NNE ■ Ax �a■aN■a ■■ wx MINININ I■N■■■ ■■ IIII■ ■■■a ■■ ■■I■■■■■ INIMMIIIIIIIMIIIMINT !f SIMAIGIMI 8■ ■ ■IMME■ t j ■■f■■■■�■i �� iuLIm , ■�■■■■■ `IIII■■■aq■■N■■■MIM N■■■■■■ 111 A MISIONIMMISNI INa■a ■aa■ ■■■■f■■ no Rs M -' :` $---- . — 1i N■■ ■■__ e? 'L C ' / 7 /Ze ALL CHANGES MUST BE APPROVy D BY THE COUNTY PUBLIC HEALTH UNIT HRS -Fi Form 4015, Feb 85 (Obsoletes previous editions which may not be used) 'Stock Number. 5744 -002- 4015 -6) ,., -'� t , j TITLE Date ^" -----" County Public Unit Pace, 2 of 3 MIAMI SHORES VILLAGE, FLORIDA BUILDING ❑ ELECTRICAL ❑ PERMIT N? 15108 PLUMBING R''' ROOFING Owner of .r Building [7 �Y t ❑ Work to be performed under this Permit Architect Contractor ,e or Builder d /T • �t i, -:. `e ' 42 „ti Legal Lot Bl. r Subdi- Description vision Address of �! Value of Amt. of Building ' ' 1 ') • t _ i'/ .147 `- `-'4'0 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 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. ,, Signed: ✓ 't'i' . I��� BY r�"" CONTRACTOR OR BUILDER INSPECTOR 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 work done by ei her, my_felf, rj agent, servant or employee. BY DATE r)//,?/ 195 :mac. Contractor's License No. AUTHORITY $ .r MIAMI SHORES VILLAGE. FLORIDA BUILDING ❑ / ELECTRICAL ❑ DATE L9 X 195 r PLUMBING z PERMIT N? 7363 Contractors License No. ROOFING ❑ ❑ Work to be performed under this Permit Owner of Building L / t t i Architect Contractor or Builder Legal Description Address of Building r r Lot 11 31 ie _ CONTRACTOR OR BUILDER ( /5/ Subdi- vision Value of Project $ 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 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 thystatements or specifions and that he assumes responsibility for work done by his agents, servants or employees. 1_-1 Signed -.. ._, -- :.r^ -... BY INSPECTOR In consideration of the issuance to me of this permit I agree to perform the work cove d hereunder in compliance with all ordances and regulations pertaining thereto and in strict conformity wi the plans, drawings, statements or specificatio submitted to the proper authorities of Miami Shores Village. In ac- cepting permit sume responsibility #r all work done by either, myself, my agent, ervant or employee. BY AUTHORITY 6 Permit No ....... ALL_ Amount of Permit $- Owners Name and Address____..__ Registered Architect and /or Engineer_--- -- ��------ - - -__- _ - --___ ----- ____ -_ Nature of Water Supply: City —Well STATE OF FLORIDA, COUNTY OF DADE. j MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING NkNor __— No ._IL__�__ No. _____ (Signed)- (Signed) -- Street Subdivision eet. Date 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. Employing Plumber's Name Location and Legal Description Street and Number where work is to be performed —No State work io 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 _Dist. Feet of Tank or Drain Field from Well b Size of Soakage Pit 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 5986, 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 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. My C Expires Notary Public, State of Florida Street /VI / Master Plumber. 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 worlmianship. CLOSETS BATH TUBS SHOWERS LAVA- TORY SINKS SLOP SINKS LAUNDRY Tulsa URINALS U RINALS CATCH 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'S POOL CONTR. LIST CHECK Permit No ....... ALL_ Amount of Permit $- Owners Name and Address____..__ Registered Architect and /or Engineer_--- -- ��------ - - -__- _ - --___ ----- ____ -_ Nature of Water Supply: City —Well STATE OF FLORIDA, COUNTY OF DADE. j MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING NkNor __— No ._IL__�__ No. _____ (Signed)- (Signed) -- Street Subdivision eet. Date 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. Employing Plumber's Name Location and Legal Description Street and Number where work is to be performed —No State work io 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 _Dist. Feet of Tank or Drain Field from Well b Size of Soakage Pit 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 5986, 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 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. My C Expires Notary Public, State of Florida Street /VI / Master Plumber. 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 worlmianship.