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877 NE 91 Terr (9)Type Insp'n MIAMI SHORES VILLA BUILDING DEPARTME 305- 795 -2204 Building Inspection Request Dat t y Permit No. V P L 0 L. 1 1 11 Name 7"" :) Address ET/ E 1 l 7-0AA • Inspection Date Approved Correction Re- Insp'n Fee Company (.Mt( Q Phone # TS \k' l VILLAGE C;gy MIAMI S O S VILLAGE BUILDING DEPARTMENT 305- 795 -2204 Building Inspection Request Date t 1 A Type Insp'n' 1 nC11 Sl.( l'b'1rr1Fy " S Permit No. P100 — 1 1 T cc4 -1 Name f2 Address NE oft ___T Company C "L � t�l , ' ' �: JC-Jt S Phone # Inspection Date\ U 1.Cj Approved Correction Re -Insp' n Fee ❑ Miami Shores Village 10050 NE 2nd Avenue Phone: 305 - 795 -2204 Printed: 6/21/2004 Applicant: MAURIZIO Owner: FLORIO JOB ADDRESS: 877 NE 91 Contractor ULTIMATE POOLS, INC. Local Phone: 954 - 797 - 6246 Parcel # 1132060050290 Signed: (INSPECTOR) Plumbing Permit Permit Number: PL2004 -167 FLORIO MAURIZIO TERR Page 1 of 1 Contractor's Address: 4450 S. W. 61ST AVE. UNIT 8 Legal Description: GOLDEN GATE PARK ADDN PB 6 -130 LOT 24 & W1/2 LOT 25 BLK 2 LOT SIZE Fees: FEE2004 -6315 FEE2004 -6316 FEE2004 -6317 FEE2004 -6318 Description Building Fee CCF Training and Education Fee Technology Fee Total Fees: Amount $150.00 $1.80 $0.60 $3.75 $156.15 Total Fees: $1 Total Receipts: -_$0 00 S Permit Status: APPROVED Permit Expiration: 12/5/2004 Construction Value: $3,000.00 Work: REPLACE SKIMMERS AND RETURN LINES 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: wilding Department BUILDING PERMIT APPLICATION FBC 2001 Permit Type (circle): Building Electrical Plumbing ' Mechanical Roofing Owner's Name (Fee Simple Titleholder) PA t /2 /61 ; S . $5Phone # 3 ' t S - 7 , 7 C ` 1 £ ? � Owner's Address i7 ? A q / 777- 2 City /)iii) '/ S`U 41 S State f Tenant/Lessee Name ._r Job Address (where the work is being done) City • Miami Shores Village Is Building Historically Designated YES Miami Shores Village 50 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 Contractor's Company Name 1 I J ! liit h(4._ 1 L`t / S /1 ( Phone # 9.c? 71 2 y Contractor's Address 'f f ', � P. 6 /.4 1., City J)IR, / f j State f Zip Y r Qualifier /4,4 /') State Certificate or Registration No. C te 0 tie/ ? Certificate of Competency No. Architect/Engineer's Name (if applicable) Phone # $ Value of Work For this Permit Type of Work: ❑Addition Describe Work: )17 (Continued on opposite side) ❑Alteration ENew S'4- /l1/ m F Total Fee Now Due $ t b C, Permit No. PI- Master Permit No. 3P7064 — - 7 a. Zip 25/ ? Phone # County Miami -Dade Zip .9,/ 7,P NO Square Footage Of Work: � G 0 3 , 9 FT Repair/Replace ❑ Demolition C t_ (U )33 * * * * * * * * * * ** * * * * * * * * * * * * * * ** Fees* C w* * * * * * * * * * * * * ** * * * * * * ** Submittal Fee $ Fit) .(J Permit Fee $ MC, CCF $ I , 8 - 0 CO /CC Notary $ Training/Education Fee $ t ( p 6 Technology Fee $ 3, Scanning $ Radon $ Zoning Bond $ Code Enforcement $ Structural Plan Review. $ Bonding Company's Name (if applicable) Bonding Company's Address City State Zip t: 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 not be approved and a reinspection fee will be charged. Signatur) Owner or Agent The foregoing instrument was acknowledged before me this day of To Nt , 206 , by , day of -✓ who is rsonally known to NOTARY Sign: Print: My Commission Expires: 1 * * * * * * * * * * * * * * * * * * * * * ** * * * * * * * * * * * * * * * * * * * * * * * * * * * ** APPLICATION APPROVED Chc 05/13/03 who has produced As identification and who did take an oath. Signature * * * * * * * * * * * * * * * * * * * * * * * ** **** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** kvazA eZ( /01,/frw Contractor The foregoing instrument was acknowledged before me this Gi# 200 , by r z'c? l d A1) 4err, - or who has produce entification and who did take an oath. is personally know n to as i .0. 440 SCOT A. FRIEDERS ,,JfkmirosioN # DD302415 1.8063441GRY FI. Navy Daoamt Moot Co. SCOTT A. FRIEDERS � MY 302 Itrlgs 1Mi f, 80 ** Of S. *Hay Jiaoant Co. 1a004NOrARY NOTARY PUBLIC: Sign: My Commission f,d 1,' s * * * * * * * * * * * * * * * * * * * * * * * * * ** Plans Examiner Engineer Zoning ITEM BATH TUB UNIT FEE ITEM SWITCH OUTLETS UNIT FEE ITEM SPACE HEATERS UNIT FEE BIDET LIGHT OUTLETS CENTRAL HEATING DISHWASHER RECEPTACLES A/C (WIND) DISPOSAL SERVICE TEMPORARY A/C (CENTRAL) DRINKING FOUNTAIN SERVICE SIZE IN AMPS DUCT WORK FLOOR DRAIN SERVICE REPAIR/METER CHANGE REFRIGERATION GREASE TRAP APPLIANCE OUTLETS PROCESS AND PRESS PIPING INTERCEPTOR RANGE TOP UNDERGROUND TANKS LAVATORY OVEN ABOVE GROUND TANKS LAUNDRY TRAY WATER HEATER U.F. PRESSURE VESSELS CLOTHES WASHER MOTORS 0— 1 HP STEAM BOILERS SHOWER MOTORS OVER 1— 3 HP HOT WATER BOILERS SINK, POT /3 COMP. MOTORS OVER 3— 5 HP MECHANICAL VENTILATION SINK, RESIDENCE MOTORS OVER 5— 8 HP TRANSPORTING ASSEMBLIES SINK, SLOP MOTORS OVER 8— 10 HP ELEVATORS/ESCALATORS TEMPORARY WATER CLOSET MOTORS OVER 10— 25 HP FIRE SPRINKLER SYSTEMS URINAL MOTORS OVER 25-100 HP COOLING TOWERS WATER CLOSET MOTORS OVER 100 If VIOLATION INDIRECT WASTES - A/C WINDOW REINSPECTION WATER SUPPLY TO: AIR CONDITIONERS A/C UNIT STRIP HEATER FIRE SPRINKLER GENERATORS TRANSFORMERS HEATER —NEW INST. GENERATORS TRANSFORMERS ■ HEATER — REPLACE GENERATORS TRANSFORMERS LAWN SPRINKLER —WELL SPECIAL PURPOSE SWIMdING POOL OUTLETS COMMERCIAL WATER SERVICE SIGN TUBES SEWER CONNECTIONS SIGN TRANSFORMERS UTILITY —SEWER SIGN TIME CLOCK UTILITY —WATER FIXTlRES SEPTIC TANK ANTENNA RELAY _ TELEVISION OUTLETS DRAINFIELD, 4' TILE/RES. ,. VIOLATION PUMP & ABANDON SEPTIC TANK REINSPECTION SOAKAGE PIT CU. FT. CATCH BASIN DISCHARGE WELL DOMESTIC WELL AREA DRAIN ROOF INLET SOLAR WATER HEATER FIRE TANT ID ' PIPING STEM GAS RANGE METER SET (GAS) GAS 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 PERMIT APPLICATION FOR MIIAMI SHORES VILLAGE D a t e ( 3 . J o b A d d r e s s ?77 N e q Tax ho (— , D Coo o3 ( q Legal Descriptio ( :::S\d r O 'e_ Historically Designated: Yes No Owner/Lessee / Tenant Klou'2 I c b t Master Permit # 4b 75 Owner's Address ( [ NS S q Phone 3 73(Q - (O� Contractin CoS k- Q bin 4- to Address q) I - Qualifier UJ 11 < (CiCY k( InI2t State # Municipal # Competency #CQT I `4(ns. Co. Architect/Engineer Address Bonding Company Address Mortgagor Address Permit Type (circle one): BUILDING ELECTRICAL PLUMBING ECHANICAL ROOFING PAVING FENCE SIGN WORK DESCRIPTION stn 1 p-P V .0 l ,n 1 11 K �l'te� Phut K P - ►2n � Ora i � I ? ,�o� i l ' I � rY -19-T-Is-Acrri 80SCPrif Square Ft. Estimated Cost (value) gap , 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 done in compliance with all applicable laws regulating construction and zoning. Furthermore, I . orize the above -named contractor to dQ the wor stated Signature of owner Notary as to Owner and/or rondo President My Commission Expires: D S - �6 vc7 'dent Date 5 ;MY STEPHEN M. JOHNSON -' �• = MY COMMISSION # CC 883992 °V,p h Bonde ) RE N9 Public 31, rtI APPROVED: Zoning Building Mechanical Plumbing to ( Notary as to Contra My Commission E C.C.F. NOTARY BOND SS# PhoneC& -( 4cQ (Kcp q Electrical �* '''s' STEPHEN M. JOHNSON MY COMMISSION # CC 883992 o ` EXPIRES: October 31, 2003 'bp' Bonded Thru Notary Public Underwriters Structural Engineer Survey Sheet/Plans Customer N ..5 0.er✓c p Address: .P7' AA l S/ S?( / 2 51 gPS Phone: 3o,r -• All work to comply with N.F.P.A. Code # .36 " ‘F lsA`i'r.✓ %.t r e-o s` e i i ar /9- 4q m' Gas A t?`e -4 f 1 1G Fa 442 6 14 , So. Atlantic Service Corp 2120 Fletcher Street Hollywood, FL 33020 1- 888 - 696 -72 Survey Sheet/Plans Customer Name: F2 , p Address: c'77 ni ', /�! 4 / 5, '" TeeR- Phone: 30„5 7J - /cP ?- dros me ? iee4. 4)/691.5 . \ Gas Pipin S0. 4m - 44 � 9' So. Atlantic Service Corp 2120 Fletcher Street Hollywood, FL 33020 1- 888 - 696 -7272 4/ 4"'Icerpa 4.79-v PROPOSAL SUBMITTED TO: DESCRIPTION OF JOB: FLORIO RESIDENCE Job MAURISIO FLORIO FAX NUMBER 000 -000 -0000 Address 877 NE 91 TERRACE City MIAMI SHORES, FL 33b § NEW NATURAL GAS LINES Phone 305 - 756 -1820 Date 05/09/00 We Hereby Submit specifications and estimates for The installation of a new 40 gallon Natural gas hot water heater, gas lines to connect the water heater, stove and future dryer (by others), to be located at the above referenced location. The work will include the following : Install 36' (approximately) of %" galvanized gas line above ground. Furnish and install one (1) 40 gallon Natural gas hot water heater with stand. New flue, flex and T &P connections. Connection of gas and water lines to heater, stove and future dryer (by others) from meter. All parts and labor. THERE IS A (1) ONE YEAR WARRANTY ON ALL PARTS AND NINETY DAYS ON LABOR SUPPLIED BY SOUTHERN ATLANTIC SERVICE CORPORATION AND AN ADDITIONAL FIVE (5) YEARS MANUFACTURERS WARRANTY ON THE TANK LINER. TECO ALLOWANCES OTHER THAN STATED ON THIS PROPOSAL ARE REBATED DIRECTLY TO CUSTOMER BY TECO AFTER GAS TURN ON. ALL WORK IS TO BE PERFORMED IN A PROFESSIONAL AND WORKMANLIKE MANNER, ACCORDING TO STANDARD PRACTICES, USING 1ST CLASS, U.L. APPROVED MATERIALS. *PERMIT AND APPLICABLE FEES NOT INCLUDED* *TECO ALLOWANCE REPRESENTS A PROGRAM WITH TECO PEOPLES GAS WHEREIN THE CUSTOMER PAYS TO TECO PEOPLES GAS INSTALLMENTS OF $ 6.99 PER MONTH FOR SIXTY (60) MONTHS FOR THEIR NEW GAS WATER HEATER. I SOUTHERN ATLANTIC SERVICE CORP. 2120 FLETCHER STREET HOLLYWOOD. FLORIDA 33020 Broward 921 -8999 No. Dade 954 - 921 -8999 Other Areas 1-888-696-7272 Page No of Pages Proposal We Hereby Propose to furnish labor and materials complete in accordance with the above specifications, for the sum of $ With payment to be made as follows: /yl $98700- $750.00 = 285.00 (DOES NOT INCLUDE PERMIT) OF $118.00 PLUS PERMIT FEE IS DUE UPON COMPLETION. All material Is guaranteed to be as specified. All work Is to be completedAn a work- manlike manner according to standard practices. Any alteration or deviation frdm above specifications Involving extra costs will be executed only upon written orders, and will become an extra charge over and above the estimate. All agreements contingent upon strikes, accidents or delays beyond our control. Owner to carry fire, tornado and other necessary Insurance. Our workers are fully covered by workmen's compensation Insurance DEPOSIT OF $118.00 IS DUE UPON ACCEPTANCE, BALANCE Authorized Signature Note: This proposal may be with- drawn by us if not accepted within days. Acceptance of Proposal — The above prices, specifications and conditions are satisfactory and are hereby accepted. You are authorized to do the work as specified. Payment will be made as outlined above. Date Accepted Signature Signature J BUILDING ELECTRICAL PLUMBING Owner of Building Architect Contractor or Builder Legal Description Address of Building MIAMI SHORES VILLAGE, FLORIDA PERMIT N° 9365 Work to be der thks Permit BY DA f ie fs e_ BY 1 I arOR S AUTHORITY y Lot II Bl. Subdi- vision /7) ) # f. Value of (I Amt. of i ( / _ - A -e 4 ,, Project $ Permit This permit is granted to the contractor or builder named above to construct the building or to install the uipment or device descried 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 f a thorough knowledge of the ordinances and regulation pertaining to the work covered hereby whether shown on the plans or drawings or in the statemen• •r specifications and that he assumes responsibility for work done by his agents, servants or employees. In consideration of the issuance to me of this permit I agree to • the work covered hereunder in compliance with all • J nces and regulations pertaining thereto and in strict conformity with the plans, drawings, star : or specifications submitted to the proper authorities -. Miami Shores Village. In accepting this permit I assume responsibilitx4=11 work done by ei • er, myself, my agent, servant or employee. BUILDING ELECTRICAL PLUMBING Owner of f Building -*-- CONTRACTOR' OR' B 1 DER MIAMI SHORES VILLAGE. F'LORI DA PERMIT N° 9660 Work to be performed Mader this Permit Architect Contractor ` or Builder Legal Lot II Bl. Description Address of ' Building ,} / / Subdi- vision Value of Project $ 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 plane are changed without authorization. A further condition upon which this permit is granted is the understanding that the contractor or budder named above assumes the responsibility for orough knowledge of the ordinances and regulations pertaining to the work covered hereby whether shown on the plans or d • or in the statements o 'fications and that he aesymea responsibility for work done by his agents, servants or employees. C. to ,rn j....c .. nurse-roe In consideration of the issuance to me of this permit I agree to pe rm the work covered hereunder in compliance wi o manes wad regulations pertaining and in strict conformity with ••e drawings, statements or specifications submitted to the proper auth 'ties f Miami Shores Village. In accept• s p it I assume - Y , • r either, myself, my agent, servant or employee. BY - Liarsnse l Amt. of Permit AUTHORITY ` 195 � Permit No �� 6 1 G � 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. /7 j Owner's Name and Address Registered Architect and /or Employing Plumber's Name Gr___st_sr__ =e Location and Legal Description Lot 7 ' Street and Number where work is to be performed —No State work to be performed and purpose of building (By Floors) New Building Remodeling AdditiorY Repairs No. of Stories Size Septic Tank Feet of Dram Tile Amount of Permit $ STATE OF FLORIDA, 1 COUNTY OF DADE. 1 ss. My Commission Expires MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT Type of Tank 1,jS+ "YYD.._ Capacity Gals SP _ Dist. F et of Tank or Drain Field from Well / P` Nature of Water Supply: City — Well No (r7 ! Street g/ No. . ? Street Subdivision y 1 G► 2 —• fr� )..\( Bock Y 7 Street q_t 0-‘4.1e- Size of Soakage Pit � r • (Signed) -'" •' c Plumbing Inspector. The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations an employer of labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Permanent $ttpplement, 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) 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. 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. Notary Public, State of Florida CLOSETS BATH TUBS SHOWERS LAVA- TORIES SINKS SLOP SINKS LAUNDRY TUBS URINALS 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 SW IM'G POOL CONTR. LIST CHECK � Permit No �� 6 1 G � 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. /7 j Owner's Name and Address Registered Architect and /or Employing Plumber's Name Gr___st_sr__ =e Location and Legal Description Lot 7 ' Street and Number where work is to be performed —No State work to be performed and purpose of building (By Floors) New Building Remodeling AdditiorY Repairs No. of Stories Size Septic Tank Feet of Dram Tile Amount of Permit $ STATE OF FLORIDA, 1 COUNTY OF DADE. 1 ss. My Commission Expires MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT Type of Tank 1,jS+ "YYD.._ Capacity Gals SP _ Dist. F et of Tank or Drain Field from Well / P` Nature of Water Supply: City — Well No (r7 ! Street g/ No. . ? Street Subdivision y 1 G► 2 —• fr� )..\( Bock Y 7 Street q_t 0-‘4.1e- Size of Soakage Pit � r • (Signed) -'" •' c Plumbing Inspector. The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations an employer of labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Permanent $ttpplement, 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) 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. 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. Notary Public, State of Florida Dated __ _ ,/fff ./".5 Application is hereby made for the approval of the detailed statement of the plans and specifications herewith sub fitted 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 /0 __ . late No. 9/C )L__ ._ Street Street./ - 1- _ - Registered Architect and /or En ineer p � � Employing Plumber's Name__ C ' a� -4.�.R !' 1_ f: -.t * No.__ ( treet___ __i2__■ 4 ^- r ' Location and Legal Description Lot _ -_ ( _ - _ _ _ Str n, � � � t?� �� Block Sul�divisi � A t , Street and Number where work is to be performed —No eet / State work to be performed and purpose of building (By Floors) ') (/':r New Building 1! or Remodeling Addition Repairs Permit No MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT No. of Stories) Size Septic Tank Type of Tank Capacity Gals Feet of Drain Tile Dist. Feet of Tank or Drain Field from Well Size of Soakage Pit Nature of Water Supply City —Well Amount of Permit $ 7, 2 STATE OF FLORIDA, 1 COUNTY OF DADE. ss. My Commission Expires ( Signed) ( Signed) ___ I__1"Y'' Plumbing Inspector. The undersigned applicant for this building permit does hereby certify that he understands and accepts his oblig ons 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 performed under this permit, as are licensed by Miami Shores Village. 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 bym a 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. 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. CLOSETS BATH TUBS SHOWERS LAVA - TORIES SINKS SLOP SINKS LAUNDRY TUBS URINALS CATCH BASIN FLOOR DRAIN DRINKING FOUNT'NS TOTAL FIXTURES GUST LIST I / —1--.__Z_-1--_ �J —F /. CHECK SEPTIC TANK SEWER CONN. DRAIN FIELD SOAKAGE PIT GREASE TRAP iI�IT HEATER DEEP WELL SPRKLR. SYSTEM SWIM'G POOL CONTR. LIST / CHECK Dated __ _ ,/fff ./".5 Application is hereby made for the approval of the detailed statement of the plans and specifications herewith sub fitted 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 /0 __ . late No. 9/C )L__ ._ Street Street./ - 1- _ - Registered Architect and /or En ineer p � � Employing Plumber's Name__ C ' a� -4.�.R !' 1_ f: -.t * No.__ ( treet___ __i2__■ 4 ^- r ' Location and Legal Description Lot _ -_ ( _ - _ _ _ Str n, � � � t?� �� Block Sul�divisi � A t , Street and Number where work is to be performed —No eet / State work to be performed and purpose of building (By Floors) ') (/':r New Building 1! or Remodeling Addition Repairs Permit No MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT No. of Stories) Size Septic Tank Type of Tank Capacity Gals Feet of Drain Tile Dist. Feet of Tank or Drain Field from Well Size of Soakage Pit Nature of Water Supply City —Well Amount of Permit $ 7, 2 STATE OF FLORIDA, 1 COUNTY OF DADE. ss. My Commission Expires ( Signed) ( Signed) ___ I__1"Y'' Plumbing Inspector. The undersigned applicant for this building permit does hereby certify that he understands and accepts his oblig ons 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 performed under this permit, as are licensed by Miami Shores Village. 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 bym a 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. 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. qb