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BUILDING PERMITi nspection Number: INSP -11559 Inspection Date: 03/13/2006 Inspector: Grande, Claudio Owner: SEYBOTH, WOLFGANG Job Address: 1111 91 Terrace NE Miami Shores Village, FL 33138- Project: <NONE> Contractor: Building Department Comments Friday, March 10, 2006 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (05)795 -2204 Fax: (305)756 -8972 Block: Permit Number: RC -3-06 -591 Permit Type: Residential Construction Inspection Type: Re Occupancy Work Classification: Re- Occupancy Phone Number Parcel Number 1132050010120 Lot: Page 2 of 2 Passed ` Inspector Comments ,z,, Failed Correction Needed Re- Inspection Fee ($75) No Additional Inspections can be scheduled re- inspection fee is paid. until i nspection Number: INSP -11559 Inspection Date: 03/13/2006 Inspector: Grande, Claudio Owner: SEYBOTH, WOLFGANG Job Address: 1111 91 Terrace NE Miami Shores Village, FL 33138- Project: <NONE> Contractor: Building Department Comments Friday, March 10, 2006 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (05)795 -2204 Fax: (305)756 -8972 Block: Permit Number: RC -3-06 -591 Permit Type: Residential Construction Inspection Type: Re Occupancy Work Classification: Re- Occupancy Phone Number Parcel Number 1132050010120 Lot: Page 2 of 2 A . RE- OCCUPANCY C.,_3(16:5 AP-PLICAT -ON P_.rmit No � Loc ID Date (Rev. 10/02/03) 3-9 -0 Contact Name 4 - v AR- a- cP A Phone # 3&S — t4 1 — 09 S Buyer Seller Realtor ✓ Company Name Lea.l`. W tu-t 41-,-14 S Property Address 1/1/ Ate. ? / 7Z--2Z2 . City Miami Shores State Fl Zip 33 3 W I hereby certify that I understand that the zoning of the property is for single- family residential use and that it is unlawful for more than one family to reside therein. I also understand that any Certificate of Re- Occupancy that may be issued by Miami Shores Village certifies only that the referenced property is being used for single- family purposes and that such Certificate does not constitute any representation, warranty or certification as to the condition of the dwelling or other structures on the property. OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate. Applic.. me I I■142-.1 A- 0‘.) o t z-,n5 Signature The foregoing instrument was acknowledged before me this 9 day of i , 20 ot , I� , who is personally known to me or who has produced oaken. /i as identification and who did take an oath. NOTARY PUBLIC: by Ali yfiaihttai Sign: A iii j �, rilvf2 Print: , 440 " Dial My Commission Expires: Miami Shores Village Building Department MONICA USSETH DIAZ .. Y . : EXPIRES: October 20, 2009 cV Bonded Thu Notary Public Underwriters ee,. J Building Officials Approval: 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795 -2204 Fax: (305) 756 -8972 Re -Occ. $60.00 Notary $5.00 7/ CCF $0.60 Total 45, 6() DATE: 06 NAME OF PERSON REQUESTING FILE: \ A 11 �K-A ; S PHONE #: kg - - P3 YOUR ADDRESS: IN A NE Q i sr- r R ADDRESS OF FILE REQUESTED: 444 4 uC '?t $T 7E/ INFORMATION REQUESTED: - F100 P 7 tJ S I understand that all documents in this file are property of Miami Shores Village and that NO documents may be removed from this file. You may get 4 complementary copies (8x11) size, additional copies will be furnished at 0.15 cents per page, not including any blue prints. If blue prints are order please be aware that we are not responsible for the quality of the printed documents. Acknowledged by: FILE RETURNED TO: INITIAL Miami Shores Village Building Department 10050 NE 2 Ave, Miami Shores, Fl 33138 Tel: (305)795 -2204 • Fax; (305)756 -8972 PLEASE PRINT A O ,( TIME: S go Ali PERMIT APPLICATION FOR MIAMI SHORES VILLAGE Date 1 .0- ► / 9 J' Job Address //// E 9/ re— Tax Folio Legal Description Historically Designated: Yes No Owner/Lessee / Tenant Owner's A d d r e s s " .A L 9 / - T e---- -- Phone 1C / / 1 1 Contracting Co. Ar i on , Inc. Address 3723 Sw 129th Te rr . WORK DESCRIPTION Square Ft as to Owne My Commission Expires: FEES: PERMIT " 1 Rir'hard R_ Wynne t _, G a L•N ��� Condo President Date NOTARY PUBUC - STATE OF FLORIDA JENNIFER NAFTAL -PEREZ COMMISSION Ik CC588692 EXPIRES 10.11.2000 BONDED THRU ASA 1-888-NOTARY-1 RADON SS# Qualifier State # Municipal # 000013371 Competency # Ins. Co. Tin 1 i s c- h T nS Architect/Engineer Bonding Company Address Mortgagor Address Permit Type (circle one): BUILDING LECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN Address (4 'rte Cl 4 Estimated Cost (value) 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 authorize the above -named contractor to do the work stated. —r - .41a,f F -tom- - - (- 474 Signature of Qxner and/or Condo President Date Signature of Contractor or Owner- Builder o ary : to Contra My Commission E C.C.F. NOTARY Master Permit # 02' 251 1279 es: wner - Builder NOTARY PUBLIC - STATE OF FLORCA JENNIFER NAFTAL -PEREZ COMMISSION # CC588692 EXPIRES 10.11.2000 BONDED THRU ASA 14168-NOTARY -1 BOND P 2 ,1 1 Date Date TOTAL DUE 4 r O APPROVED: 0 Zoning Building 744 W Electrical Mechanical Plumbing Engineering BUILDING ELECTRICAL PLUMBING ROOFING Owner of Building Architect i o Legal Lot Description 1 Address of Building r MIAMI SHORES VILLAGE. FLORIDA ° PERMIT N? l Contractor or Builder - e f , CONTRACTOR OR BUILDER a 11 BI. Work to be performed under this et Subdi- vision 1• DATE {- Contractor's icens Sq. Ft Value of Project $ � "3 et.) Amt. of Permit $ BY AUTHORITY 1954_ 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 ands that he assumes responsibility for work done by his agents, servants or employees. ,, /4' ° Signed: 4f 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 either, myself, my agetit, servant or employee. I MIAMI SHORES VILLAGE, FLORIDA •� BUILDING lig ELECTRICAL El DATE i PLUMBING ❑ PERMIT NO ROOFING ❑ Owner of Building Architect Contractor or Builder Legal Description Address of Building 1 . r •c # it n Lot t ,4 . - r 1 Ir j r' CONTRACTOR OR BUILDER f,,, Bl. !; - Contractor's icens Work to be performed under this t - j ; I^ t ( 4 l ;r fir: "••i R4 �Cr 1 Subdi- vision / - Sq. Ft Value of Project $ / 5 BY P.. Amt. of ,. Permit $ f •' 1954_ 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: 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 either, myself, my age p t, servant or employee. AUTHORITY 7 OWNER'S NAME .. c.A J A 0.L e. s PRESENT ADDRESS 8 a, t. i-.1 . E.: . an h LICENSE NO. PHONE NO. JOB LOCATION (ST. OR AVE.) 1111 (.1,Z.. ' il re-+zQ_ LOT 14- 1s BLOCK 1 WA- SUBDIVISION z G-0 c. . GENERAL CONTRACTOR 1 : ) • , ' .ti... i.J t 3 -- Of 5 c FA N b ADDRESS 8 4 Kt . E. S 1, - S"' - r - PHONE NO. pL t- Z - e6 a LICENSE NO. 3 a sa BUILDING PERMIT NO. 1 Z 3 1 f, t- DATE `- 1- -a � PERMIT FEE $ BUILDER'S BOND NO. � �000 4-- DATE � -r ZONE Z o REQUIREMENTS -Z D CU FT. EST. COST j0 oab � �$''�o PLAN 'BE 1 3 3 i 3 CU. FT. I DATS 9- Z- DRAWINGS. SPECIFICATIONS. RESTRICTIONS AND CUBE CHECKED BY: C-• K_ 4 2 g... c� - NEW CONSTRUCTION TYPE Q--%S STORIES 04e- ROOF CONSTRU• ION TtL£ 1 INTERIOR CONSTRUCTION .3 g2_ `Z 3 .- 7 ,N ( REPAIRS D•SCRIPTION 7 -f# 2- Z 0 - )/}g•- Fe s � - s 7 �ESCR P?4-41-$'74-eV ALTERATION ADDITION 1' LELte . (0 61,9 t TrLc?'✓•._ SUBMITTED TO PLANNING BOARD APPROVED REJECTED REFERRE' TO COUNCIL REASONS RE- SUBMITTED TO PLANNING BOARD (2-&--V4 Y.-- � / 1 9.Z cL4 - ` (' F�'� S , t1 i '' SUBMITTED TO VILLAGE COUNCIL REMARKS CO /S c �"� ' 17 CERTIFICATE OF OCCUPANCY NO. 1 De ) c� I ISSUED +i ' 1 -� BY TO -K- Wit- ) .0 4-.,5 ALA- 27 ' kF: BUILDING PERMIT AND INSPECTION RECORD —MIAMI SHORES VILLAGE ■ INSPECTIONS DATE BY INSPECTIONS DATE BY FOUNDATION it pr ••,....��jra 1F Z .I. e.. G+ $ /¢03 ROOF I $ BEAMS & LINTELS I $ POOL $ FRAMING S AIR COND. DATE BY FINAL BY RE- INSPECT CLEAN UP ROUGHING $ SLAB . I S TUB & TOP OUT SLAB SPECIALS PERMITS PERMIT NO. DATE FEE TEMPORARY SERVICE NEW BLDG. 7 1 - 1 ALTERATION I ADDITION $ SEPTIC TANKcv∎Iitib- ...,._S it pr ••,....��jra 1F Z .I. e.. G+ $ /¢03 SEWER I $ SOLAR HEATER I $ GAS $ RANGE CONN. S INSPECTIONS DATE BY RE- INSPECT BY RE- INSPECT BY ROUGHING $ . I S TUB & TOP OUT SEWER SEPTIC TANK SOLAR HEATER FIXTURES GAS CONTRACTOR -14-.4.-4.- 8 C-- 2L Q... PHONE C PERMIT NO. / 3 2 1 DATE 5 S F FEE $ 2 3 • 0 Ci NEW BLDG. 7 1 - 1 ALTERATION I ADDITION REPAIRS SPECIAL PERMITS PERMIT NO. DATE FEE TEMPORARY SERVICE $ H. W. HEATER CONN. H. W. HEATER CONN $ RANGE CONN. RANGE CONN. $ MOTORS $ FIXTURES $ . I S INSPECTIONS DATE BY RE- INSPECT' BY RE- INSPECT BY TEMP. SERVICE ROUGHING H. W. HEATER CONN RANGE CONN. . I FPXTURES & FINAL CONTRACTOR PERMIT NO. NEW BLDG. APPROVAL TO POWER CO. FOR SERVICE DATE BUILDING INSPECTIONS S 3 e ta �1 PLUMBING \ PERMITS & INSPECTIONS Lc2 4, C._ /tN 7 ( ` s T I PHONE 11. 1 DATE f -10- I FEE $ ... •E) Y._ 1 ALTERATION 1 ADDITION ELECTRICAL PERMITS & INSPECTIONS REPAIRS BY ITEMS SUB CONTRACTORS RS I& SUPPLIERS AMOUNT 1. Architectural Fee lans //- '- /�z,/,� 2. Asphalt walks, drives, etc. •- o aff d, 3. Cabinets - Bath Vanit 4. Cabinets - Kitchen „ y 04 ,vim �,-,1 A�'i o n - �lP. � 6,9y /.9_16 , ,i - 7/ 3 , o • ; .^ . A - ; /, . , - •, , I �� v - a o� u. i��� _- �y g• /. ,-.c y 5. Cabinets - Medicine 6. Cabinets - Unit Closet 7. Cleaning 8. Clearing Site 9. Concrete - Foundation Slabs Beams 10. Concrete - Walks drives etc. 11. Contractors Fee 12. Electric Fixtures 13. Electric Wiring 14. Equipment Rental , 15. Excavation rI> a 16. Fill for Slab .". -. / • 0o/o , / Si 17. Floors - Finish wood & kitchen 1g Sr ..0" ; /A „2/u/ r/W s S 4 •- . os E/" re"? ,¢) ,•o � • 7 SO r 1•l e 3' • 0 o_ . ,A1 o ve - AI I stt - A - •-- Ma �/.�r I..:- , o L ) . 1.5,. 18. Floors - Terrazzo 19. Garage Doors 20. Glass Sliding Doors 21. Hardware - Finish 22. Hardware - Rouh 23. Heatin• - ..... ,M 24. Insurance - Liability,comp,-bond 25. Labor - Payroll -, - , , -,j• 26. Labor - Contract 27. Labor - Contract �--y / y - ,.'ss 0 ; , , ,. „ c. 28. Landsca ing Fill, Grading 29. Lath Plaster Stucco 30. Lumber All WOW ...,,,. 31. Masonry Labor �j��11 W �%1 �1�-, / '4' 32. Masonry Materials, Block 33. Millwork 34. Miscellaneous LIFFAIV : . , 7 e - n 101,51111W 1/ 35. Ornamental Iron Work 36. Oven & Plate - Built -in 37. Overhead 38. Painting DM! W - 39. Permits Tem orar Power 40. P,iIing Foundation AR' L ANIMEAW. , S J 41. Plumbin Corn lete 42. Pool - Swimmin_ --- 43. Roofin: & Sheet Metal Work A _ - // [ S ,c , w/ ' :��„ l- ilier ; /WALM 44. Roof Trusses - Pre -fab. 45. Screen Enclosures / ,r/ ri,, /ii i.e 16 Tank or Sewerage . .__Septic 47. Shower or Tub Enclosures , e - � , ,. • »E /o ' �� 48. Steel - Reinforcin: & strl. "L - 9 �i // ARM 49. Supervision 50. Surveys NW v c 4 / 51. Tile & Marble APARRIONOWN14111100111111111 52. Water - Public 53. Water - Well & Pump OI;INE': "C -.✓ LOT L/- /,.S BLOCIC / BUILDER / /9/ A fCiVA/ i�/� - -- DAY LABOR . / / /// /V a-* 7' v c JOB ADDRESS / /// SUB. 279s ezS y <.._ CONTRACT DATE L2L __19 9 _: No._ _____ `-___ . _ Date //1" Applica[ ion is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the building 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. Owr.er's Name and Address___ _ ..121 Registered Architect and /or Engineer---- ^ - - -_ — --- � Employing Plumber's Name__ -- --- -- -- 4- k 4 - -_ _. _ -- '1 Street 444'' Location and Legal Description Lot----- - - - -__ _ - - -_ -- Block Subdivision --___ -- Street and Number where work is to be performed —No Street State work to be performed and purpose of building (By Floors) _ -__ New Building_ _ Size Septic Tank.---------------- - - - - -- —• - - -- Type of Tank_ Feet of Drain Tile__ ________________ _______Dist. Feet Tank or Drain Field from Well Nature of Water Supply: City — Well.____________ _______ - f ________....... -__ -- ____Size of Soakage Pit l Amount of Permit $___ ....... - _- ..... C STATE OF FLORIDA, 1 COUNTY OF DADE. j Remodeling MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT Addition______ Repairs No. of Stories. (Signed) No,tt r" Capacity Gals a _ (Signed) My C Expires Notary Public, State of Florida Master Plumber. P nmbing Inspector. The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligatio, as an employer of labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Pennanent 'upplement, and Ilas com- plied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors employ d 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 p I.lic o or notices as are seq-*ed by the Act. The undersigned agrees to employ only such sub- contractors, on work to be p s 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 hin stated are true. NOTE: A re- inspection fee of 31.00 will be made when such re- inspection is made •necessary by improper notice for inspection, or faulty materials and /or workmanship. .. CLOSZTU BATH TUBS SHOWERS LAVA- TORIES SINKS SLOP SINKS LAUNDRY TUBE UR URINALS CATCH BAGIN FLOOR DRAIN DRINKING FOUNT' NS TOTAL FIXTURE6 CONTR. LIST CHICK SEPTIC TA3X SEWER CONN. DRAIN FIELD SOAKAGE PIT GREASE TRAP SOLAR HEATER DEEP WELL SPRKLR. SYSTEM SW IM'G POOL. CONr. 61ST CHECK -___- 9 _: No._ _____ `-___ . _ Date //1" Applica[ ion is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the building 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. Owr.er's Name and Address___ _ ..121 Registered Architect and /or Engineer---- ^ - - -_ — --- � Employing Plumber's Name__ -- --- -- -- 4- k 4 - -_ _. _ -- '1 Street 444'' Location and Legal Description Lot----- - - - -__ _ - - -_ -- Block Subdivision --___ -- Street and Number where work is to be performed —No Street State work to be performed and purpose of building (By Floors) _ -__ New Building_ _ Size Septic Tank.---------------- - - - - -- —• - - -- Type of Tank_ Feet of Drain Tile__ ________________ _______Dist. Feet Tank or Drain Field from Well Nature of Water Supply: City — Well.____________ _______ - f ________....... -__ -- ____Size of Soakage Pit l Amount of Permit $___ ....... - _- ..... C STATE OF FLORIDA, 1 COUNTY OF DADE. j Remodeling MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT Addition______ Repairs No. of Stories. (Signed) No,tt r" Capacity Gals a _ (Signed) My C Expires Notary Public, State of Florida Master Plumber. P nmbing Inspector. The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligatio, as an employer of labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Pennanent 'upplement, and Ilas com- plied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors employ d 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 p I.lic o or notices as are seq-*ed by the Act. The undersigned agrees to employ only such sub- contractors, on work to be p s 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 hin stated are true. NOTE: A re- inspection fee of 31.00 will be made when such re- inspection is made •necessary by improper notice for inspection, or faulty materials and /or workmanship. .. Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the build- ing 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 the work. Owner's Name and Address.... A /11 eft' f e N A // T _/ 4/t' /E-3__ No. ._.1 // Registered Architect and /or Engineer Name and address of licensed contractor ' ' J t � '/d1 _/ .LS Location and legal description of lot to be built on: ,,11 Lot / `7 / 5 Block / Subdivision e-LJ./` _7 / ?..5 Street and Number where work is to be done .__- _ -. //I L A Y State work to be done and purpose of building (by floors) and for no other purpose. New Building. e 5 ( PCA/eaemodeling Addition Repairs No. of Stories To be constructed of Kind of foundation Roof Covering._ ( IC: ^ / c -' f LT U p 8 c Estimated Total cost of improvements $.. Amount of Permit $ Zone cubage required plan Cubage Distance to next nearest building Size of Building Lot Maximum live load to be borne by each floor I hereby submit all the plans and specifications for said building. All notices with reference to the building and its construction may be sent to 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 complied 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 subcontractors, on work to be performed under this permit, as are licensed by Miami Shores Village. Remarks (Signe STATE OF FLORIDA, COUNTY OF DADE. j Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally ap- peared 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, therein by him stated are pie.- Permit No j4 G' Date z'" e� Read, Sworn to Disapproved Date (Signed) ng Inspector MIAMI SHORES VILLAGE BUILDING INSPECTION DEPARTMENT APPLICATION FOR BUILDING PERMIT Date S eiT — 2- 1 / 4 F ,19 Street__,/L _ ?/ 5r 7 Er? /Z to me well known, and that he did sign the same, and that all facts and Subscribed before me. Notary Public, State of Florida My Commission Expires PLANNING BOARD DATE Chairman Member Member Member Member Member Council Approved Date Disapproved Date NOTE: A charge of $1.00 will be made for making corrections or changes to this application after approval has been obtained from the Planning Board. A re- inspection fee of 51.00 will be charged when such re- inspection is made necessary by improper notice for inspection or faulty materials and /or workmanship. Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the build- ing 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 the work. ,Q / Date , 19 Owner's Name and Address.. �'/ 4 f/ 9 4 // T // / ,S No Stree __ �lv / ' Registered Architect and /or Engineer...... -. - - C . • i oc 67 Name and address of licensed contractor x?.��x.ii1(%5� ' .7i -37 V Location and legal description of lot to be built on: Lot 0 5 /f Block / Subdivision. _._.__ /./ Street and Number where work is to be done A I Sate work to be done and purpose of building (by floors) ...___._... / ._- ._ E/A11- /. y ffL S C1, S ci_�.i__ -. - -- .-- _3.j._A Tr/ and for no New Building 1-1 Remodeling Addition Repairs No. of Stories Tc be constructed of Kind of foundation Roof Covering Estimated Total cost of improvements $.../4 Amount of Permit $. ._ feee Zone cubage required „`.- _0. plan Cubage __..7_ Distance to next nearest building Size of Building Lot Maximum live load to be borne by each floor I hereby submit all the plans and specifications for said building. All notices with reference to the building and its construction may be sent to 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 complied 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 subcontractors, on work to be performed under this permit, as are licensed by Miami Shores Village. • Remarks (Signed). C 1 STATE OF FLORIDA, COUNTY OF DADE. j ss Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally ap- peared 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 T are true. ,l Permit No Z ,l Date ` 2" Disapproved (Signed) Chairman Member Member MIAMI SHORES VILLAGE APPLICATION FOR BUILDING PERMIT 35 Building Inspector. BUILDING INSPECTION DEPARTMENT Date Read, Sworn to and Subscribed before me. My Notary Public, State of Florida PLkNNINC BOARD DATE other purpose. mission Expires Member Member Member Council Approved Date Disapproved Date NOTE: A charge of $1.00 will be made for making corrections or changes to this application after approval has been obtained from the Planning Board. A re- inspection fee of $1.00 will be charged when such re- inspection is made necessary by improper notice for inspection or faulty materials and /or workmanship. /1 aftr-it 2 7Loi l x g.2 0" - )7 D" ;= A0- j" .20 / )( r 4,t o Li- /7 ■•••••• A ± / ifg / 1 1 3 73(2 /0 = 4 / . 3 ) 3 - 2:7 1 7 1 Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the build- ing 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 the work. -7 9/61 Af -dam � Date Z `/ , 19 Owner's Name and Address.. _;f� .; j'ei � No Rive; _V1= �l li.�./ �' a Registered Architect and /or Engineer...... _ . - _ . : : i C ..„... e.S • � ( S._. _ 6.t_!_ _� N Name and address of licensed contractor 22r!.k4..r._tt123. - ' /1- z), • s f..,'').- evo Location and legal description of lot to be built on: Lot / 7 4 ' ' ' ' / Block Street and Number where work is to be done 1/1 Jk 2= c' i.. State work to be done and purpose of building (by floors) / _ f2f9117_.rLe. ., ;_ , New Budding 1 �_./ Remodeling Addition Tc be constructed of Kind of foundation Estimated Total cost of improvements $__./ 6' Zone cubage required :__ Y.! . , -. Distance to next nearest building Maximum live load to be borne by each floor I hereby submit all the plans and specifications for said building. All notices with reference to the building and its construction may be sent to The undersigned applicant for this building pennit 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 complied 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 subcontractors, on work to be performed under this permit, as are licensed by Miami Shores Village. • Remarks (Signed )_.._ c' �sr- i -•C /.- e):-Of 1 STATE OF FLORIDA, COUNTY OF DADE. ss Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally ap- peared 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. Permit No Disapproved (Signed) BUILDING INSPECTION DEPARTMENT 7 APPLICATION FOR BUILDING PERMIT I , , MIAMI SHORES VILLAGE Subdivision F' Date ' " 7 Read, Sworn to and Subscribed before me. D _ , 1 Building Inspector PLANNING BOARD DATE Chairman Member Member c Member Member ...... Member Council Approved Date Disapproved Date NOTE: A charge of $1.00 will be made for making corrections or changes to this application after approval has been obtained from the Planning Board. A re- inspection fee of $1.00 will be charged when such re- inspection is made necessary by improper notice for inspection or faulty materials and /or workmanship. ?L / —T7 ? ?4 ' - f . and for no other purpose. Repairs No. of Stories Roof Covering Amount of Permit $.. fez Plan Cubage , e 1 _. -`d / 7 Size of Building Lot Notary Public, State of Florida y . .mmission Expires It 3 '.6c(7.A a1xfc. — = ii-g if 7 • ■••■••h 24-1,44 ,2c' ( e7t A -11 - k-ba • E on. or >0 z: /5TY22 z. 3732 it. o ( 77 II A • tr. — / 3 3j3 t(- TArAf._ A C_ Z-Z" CS, 01 to re- occupy the single family residence.known as : (address) 111 0„ Q ( TCEO_ Legal Description: Lot: Block PB & PG: • I hereby certify that I understand that zoning of the property is for single - famiy iesideatial use • and that it is unlawful for more than one family to reside therein. I also understand that any Certificate of Re= Occupancy that may be issued by Miami Shores Village, certifies only that the referenced property is being used for single -family purposes and that such Certificate does not . constitute any representation, warranty or cerafrcation as to the condition of the dwelling or other stru - sucf • : • erty. Date 3" 7 c3 Apphc • ,, II Print Name I"�` **** * * * * * * * ** * * * * * * * * * * * * * * * * * * * * ** visa.******* *** * * ** * * * * * *** * * * * ** * *** *** * ** For purposes of conducting the inspection required by Section 902 of the Miami Development and Zoning Code, please contact: Contact Name: Lap n 1 _ IUiL; Realtor V Company Name Buyer Inspected by. Comments: APPLICATa0N FOR CERTIFICATE OF RE- OCCUPANC Application Fee (S50) paid: Cash • Seller PAGE I OF 2 • , hereby apply *for a c , Miami Shores, Florida. elephone. Check No. L cu u__ A fie— Approved L- Denied Date Shores Land ao� - i-H r6 505-15* 7e? -F CERTIFICATE OF RE-OCCUPANCY • • On behalf of Miami Shores Village, Florida, the undersigned certifies that the property described in the above application has been inspected for purposes of re- occupancy pursuant to Sections 901.and 902 of the Miami Shores Land Development and Zoning Code and that such property may be re- occupied by the above applicant for single -family residential purposes. • THIS CERTIFICATE VERIFIES THAT THE REFERENCED PROPERTY HAS BEEN INSPECTED BY IvLIAMI SHORES VILLAGE AND HAS BEEN DETERMINED TO PRESENTLY COMPLY WITH THE SCHEDULE OF REGULATIONS OF THE MIAMI SHORES LAND AND DEVELOPIA T CODE PERTAINING SOLELY TO THE REQUIREMENT THAT EACH ONE-FAMILY DWELLING IS USED AND INTENDED TO BE USED FOR A ONE - FAMILY DWELLING PURPOSE ONLY; HOWEVER, THIS CERTIFICATE DOES NOT CONSTITUTE ANY REPRESENTATION OR WARRANTY AS TO THE CONDITION . OF THE DWELLING OR OTHER STRUCTURES ON THE PREMISES DESCRIBED HEREIN, OR ANY ASPECT OF SUCH • CONDITION, AND INTERES'lhll PERSONS ARE ADVISED AND ENCOURAGED TO MAKE THEIR OWN INSPECTION OF THE PREMISES IN ORDER TO DE 1t.RMENE THE CONDITION, THEREOF. By: PAGE OF Date of Certification: MIAMI SHORES VILLAG , FLORIDA INSPECTIONS DATE BY INSPECTIONS DATE BY FOUNDATION $ SEPTIC TANK0.5%It.A. ROOF et / 4 3 44 SEWER BEAMS & LINTELS S SOLAR HEATER POOL S GAS FRAMING S SEWER AIR COND. s FINAL S FIXTURES CLEAN UP $ SLAB FIXTURES & FINAL S SOLAR HEATER SLAB FIXTURES SPECIALS PERMITS PERMIT NO. I DATE FEE TEMPORARY SERVICE BY I $ SEPTIC TANK0.5%It.A. P, ,,w. a,a L It Z' N., et / 4 3 44 SEWER S SOLAR HEATER 1 S GAS 1 S SEWER 1 s INSPECTIONS DATE BY RE- INSPECT BY RE- INSPECT BY ROUGHING PERMIT NO. DATE FEE TEMPORARY SERVICE TUB & TOP OUT H. W. HEATER CONN. H. W. HEATER CONN $ RANGE CONN. SEWER S MOTORS S FIXTURES SEPTIC TANK $ FIXTURES & FINAL S SOLAR HEATER FIXTURES GAS CONTRACTOR - IL.a- 8 c- See z re, L 'e_. , PHONE PERMIT NO. 5 3 Z e l I DATE 5- S f FEE 2 -3. 0 o NEW BLDG. 7 I ALTERATION 1 ADDITION REPAIRS SPECIAL PERMITS PERMIT NO. DATE FEE TEMPORARY SERVICE $ H. W. HEATER CONN. H. W. HEATER CONN $ RANGE CONN. RANGE CONN. S MOTORS S FIXTURES $ FIXTURES & FINAL S INSPECTIONS DATE BY RE - INSPECT BY RE- INSPECT BY TFMP. SERVICE ROUGHING H. W. HEATER CONN RANGE CONN. FIXTURES & FINAL u3 �' 44. oft S _ BUILDING INSPECTIONS 3 e $� PLUMBING PERMITS & INSPECTIONS CONTRACTOR ry-rv. E/L t,CR,S 472 S 1 PHONE 'n PERMIT NO. 113 I 1 DATE { FEE $ �+ - NEW BLDG. 1 ALTERATION 1 ADDITION REPAIRS ELECTRICAL PERMITS & INSPECTIONS APPROVAL TO POWER CO. FOR SERVICE DATE BY • - OWNER'S NAME E2.-1 0.-,-A.1 4-r2 — I-4.e ` s PRESENT ADDRESS 8 4't 14 . C . &5 LICENSE NO. PHONE NO. JOB LOCATION (ST. OR AVE.) it 1 t t1. 1 ( 7 - LOT 14 - t BLOCK 1 SUBDIVISION W a - r >r 2S G- go c- r , GENERAL CONTRACTOR 1. y..., % hi t� --°it ST EPA at e , ADDRESS g ¢6 I-1 . E. 81, 1-- S'T PHONE NO. pt_. ( - ?tog LICENSE NO. 3.4-ro BUILDING PERMIT NO. 3 1 DATE c ` -/ " -r i PERMIT FEE $ S. BUILDER'S BOND NO. ' 1 '- 40 `0 DATE �7--r Z ZONE 2. o REQUIREMENTS Z? °d am CU. FT. EST. COST $ f0, o.b PLAN 'BE Z 3 3 , t 3 CU. FT. DAT= 9 i- Z '.1 - 7 DRAWINGS. SPECIFICATIONS. RESTRICTIONS AND CUBE CHECKED BY: C-• K 4 2(L.6 - L NEW CONSTRUCTION TYPE Q.-% S STORIES o4€ ROOF CONSTRU ION 'C' LE INTERIOR CONSTRUCTION I 3 a._ `Z 3 ,7ii ( REPAIRS D SCRIPTION `T->2.42A Z 2 C - 64-1L F,yF.)iz; ?LAAW' y e -7 6.- )j(_4_t_c y ESCRIPTION ALTERATION oo ADDITION ' LE � LL4 -- ?.....),m„.0 Ql9--3 Lam' t -pe_r/Y ✓`_ SUBMITTED TO PLANNING BOARD APPROVED REJECTED REFERRE TO COUNCIL REASONS RE- SUBMITTED TO PLANNING BOARD I � �°-- ///� kJ /' Q f iZ Cl. •A s P /-- SUBMITTFD TO VILLAGE COUNCIL REMARKS CO ,g ` u / -/ 1 1 (7 C, CERTIF OF OCCUPANCY NO. I, ®e uf ISSUED It ! -�J i :'-' :'-' BY (3 707 TO " L tC-►4,3 /T6..--7 lej " ' ^ BUILDING PERMIT AND INSPECTION RECORD —MIAMI SHORES VILLAGE Ii - ITEMS SUB CONTRACTORS & SUPPLIERS & ADDRESS //- -s - /,/- = AMOUNT 1. Architectural Fee (•lans) 2. As •halt walks drives etc. IIMIgir . Cabinets - Bath UanitRffir !,� o - /,, 4. Cabinets - Kitchen 5. Cabinets - Medicine ; ...„ 6. Cabinets - Unit Closet 7. Cleani . , c 8. Clearin: Site A. -7/ 3 ,._ 9. Concrete - Foundation Slabs Beams 10. Concrete - L �� ' 11. Contractors Fee Do ` „�v - 6 vo w 12. Electric Fixtures `j7��,- Wel d - 13. Electric Wiring 14. E.ui.ment Rental 15. Excavation , 16. Fill for Sl ?.b > .,e 17. Floors - Finish wood & kitchen A5� 18. Floors -- Terrazzo •415-MIIMMILEITIWINA !Mr. +.t o E ' 19. Gara e Doors 20. Glass Slidin. Doors _,+ EM 21. Hardware - Finish 22. Hardware - Rou_h 23. Heating - .� �, ,. .� 24. Insurance - Liabilit come. -bond IIWA- - , ,•,� 25. Labor - Pa oll 26. Labor - Contract 27. Labor - Contract 28. Landscaping, Fill Grading / o/Z 29. Lath Plaster, Stucco A7 +4,4t 30. Lunber (All) ,e,Qh .(,y 7 7- S7A/f,-. 31. IIasonr Labor - c • 32. Masonr Materials Block 33. Millwork rj,PAM #A1Z .- �'1 j9, : � AI P NIIIIII 34. Miscellaneous 35. Ornamental Iron Work _ / ,l - g D 36. Oven & Plate - Built -in ,�,� -/P s n-, , 4' ,. L . 37. Overhead 38. Painting__ 10 -� 39. Permits. Tem.orar Power 40. PAlimow Foundation AN. 41. Plumbin: Com lete , /,.,B / jj ' �� - f • 42. Pool - Swimmin: --- 43. Roofin: & Sheet Metal Mork , _ 12-. //v ; S I. w i --• 7�1/ / '1 AMP" S AM 44. Roof Trusses - Pre -fab. 45. Screen Enclosures -- -�� / 46. Se •tic Tank or Sewera:e 47. Shower or Tub Enclosures /_ /; , /�,� ,,. P � . fA ' - 4I yl>) L./o 1‘ All 48. Steel - Reinforcin: & strl. i ,. c., .,, - 9. , //; - f' 49. Su.ervision 50. Surve s li!i A/ o c • 51. Tile & Marble �,� - ` ,' W r ..eMNI 52. Water - Public 53. Water - Well & Pum. 54. Windows - Glazing & Screens . ; ��/ 55. Window Frames - Concrete J.' w - SID = , • Prior to a final inspection this application must be filled out; if sub contractors have failed to take out permits the general contractor shall be responsible for the permit and fee. A final : ispection must be made prior to the release to Florida Power and Light Co, and the issueance of a certificate of occupancy. / /// NC S,, .rf' OWNER PrIC�,✓ � / /e / irC JOB ADDRESS /1/44/ 2- SUB. / `p..1 ed J c LOT j ac /,S BLOCK // BUILDER BMeiffe Wve_A 44 //// - 6e DAY LABOR CONTRACT DATE e 19 Miami Shores Village APPLICATION FOR FINAL INSPECTION TOTAL STATE OF FLORIDA, COUNTY OF DADE. ss MIAMI SHORES VILLAGE BUILDING INSPECTION DEPARTMENT APPLICATION FOR BUILDING PERMIT Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the build- ing 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 the work. Date 3 e — 2 , 19 - r t /' Owner's Name and Address.... ._ I`/ 6 ?t / e N A t T .r V. L'ZE. No. // Street _. ,/We 2/ 'r7" i A. Registered Architect and /or Engineer Name and address of licensed contractor G //,, /6A/4. Location and legal description of lot to be built on: Lot / ` � — / S Block / Subdivision al . i ?3 • Q_ Street and Number where work is to be done /7/ /V State work to be done ^ and purpose of building (by floors) L_5 a and for no other purpose. New Building"? Y /PC.(l e ernodeling Addition Repairs No. of Stories To be constructed of Kind of foundation Roof Covering.. f Estimated Total cost of improvements $.... J Amount of Permit $ Zone cubage required Plan Cubage Distance to next nearest building Size of Building Lot Maximum live load to be borne by each floor I hereby submit all the plans and specifications for said building. All notices with reference to the building and its construction may be sent to 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 complied 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 subcontractors, on work to be performed under this permit, as are licensed by Miami Shores Village. Remarks (Signe � � ta z Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally ap- peared 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— _ Permit No.___ L Date ' "y `e Read, Sworn to and Subscribed before me. Disapproved (Signed) Y.' / ._ .7) uilding Inspector Notary Public, State of Florida My Commission Expires PLANNING BOARD DATE Chairman Member Member Member Member Member Council Approved Date Disapproved Date NOTE: A charge of $1.00 will be made for making corrections or changes to this application after approval has been obtained from the Planning Board. A re- inspection fee of $1.00 will be charged when such re- inspection is made necessary by improper notice for inspection or faulty materials and /or workmanship. 4: Permit No ____________ __ -- State work to be perform nd purpose of building (By Floors) _ 7Y roa!i i i- New Building _ - _ -- Remodeling- Size Septic Tank Nature of Water Supply: City —Well. --------- ----- - - - - -- - -- -- Amount of Permit $__ �l� - STATE OF FLORIDA, } COUNTY OF DADE. MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING "' ;kaMIT Addition_ (Signed)._ No. .._._ /t1J - -.-°=• {- •- --- - Date _ 3 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. Owners Name and Address G[-� Registered Architect and /or Eng er_ � _— Employing Plumber's Name ,e _ z -c_( _ No.. . J Location and Legal Description Lot---_.. _ — _ Block Street and Number where work is to be performed —No -C--_j_ .�-° Street. Street.. �+ Subdivisior6 `�?--- Street---- Repairs No. of Stories. _ _.- - - - - -- - .Type of Tank__ _ Capacity Gals. Feet of Drain Tile______._____ Feet of Tank or Drain Field from Well __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 he Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Permanent Su plement, and Ilas 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 publi ' 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. 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. Master Plumber. Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeared My Commission Expires 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 Tues W SHOWERS LAVA TORIES SINKS SLOP SINKS LAUNDRY Tuns 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 SWIM•G POOL COMM LIST CHECK 4: Permit No ____________ __ -- State work to be perform nd purpose of building (By Floors) _ 7Y roa!i i i- New Building _ - _ -- Remodeling- Size Septic Tank Nature of Water Supply: City —Well. --------- ----- - - - - -- - -- -- Amount of Permit $__ �l� - STATE OF FLORIDA, } COUNTY OF DADE. MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING "' ;kaMIT Addition_ (Signed)._ No. .._._ /t1J - -.-°=• {- •- --- - Date _ 3 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. Owners Name and Address G[-� Registered Architect and /or Eng er_ � _— Employing Plumber's Name ,e _ z -c_( _ No.. . J Location and Legal Description Lot---_.. _ — _ Block Street and Number where work is to be performed —No -C--_j_ .�-° Street. Street.. �+ Subdivisior6 `�?--- Street---- Repairs No. of Stories. _ _.- - - - - -- - .Type of Tank__ _ Capacity Gals. Feet of Drain Tile______._____ Feet of Tank or Drain Field from Well __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 he Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Permanent Su plement, and Ilas 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 publi ' 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. 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. Master Plumber. Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeared My Commission Expires 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.