PLUMBING PERMITPERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Date S Z Job Address di8 /fit i1 f JTee e / Tax Folio
Legal Description /07 / and Z- — Vocic 3 Historically Designated: Yes No
Owner/Lessee / Tenant Master Permit #
Owner's Address ; / g / � f ( 1 ?re Phone 7 S-700z, 5 -
Contracting Co. £SS ? y 17001, -.I 1 , Address /8O 0 P / S/ 1 %
Qualifier )t9N/ EL Est t, SS# Phone 9 Vi O O 0 0
State # COc O S ?.-f O S' Municipal # '— Competency #
398
Ins. Co. of w/7
Architect/Engineer LFY CoRJd (7'j r n Address S CS / t.✓ev / //"r' 'et"
Bonding Company r Address
Mortgagor - Address
Permit Type (circle one): BUILDING ELECTRICAL fLUMBIIj MECHANICAL ROOFING PAVING FENCE SIGN
-Poo c p t 11 5
WORK DESCRIPTION
Square Ft. Estimated Cost (value) / 800
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 w' rbe done in compliance with all applicable
laws regulating construction and zoning. Furthermore, I authorize the above -named Vi: ctor to do e1rk stated.
12 /a Signature f owner and/or Coresident
r`
.`� X5/9,6
ate
FEES: PERMIT 5 b. 0 RADON
ary as to 0 er an• or Condo President ate
My Commis ion Expires:
C.C.F.
ot as to C• actor or Owner - Builder D
My Commission Expires:
NOTARY
TOTAL DUE c.c an
APPROVED:
Zoning Building Electrical
Mechanical Plumbing Engineering
Amount of Permit
My Commission Expires
APPLICATION FOR PLUMBING PERMIT
Owners Name and Address C4, 41e$
Registered Architect and /or En ' e er
Employing Plumber's Name 61 41 - 5
Location and Legal Description Lot.
Street and Number where work is to be performed —No.
State work to be performed and purpose of building (By Floors)
New Building..__._-------- ......._.. Remodeling —_ ._._ —__ Addition
Size Septic Tank_.
Feet of Drain Tile
Nature of Water Supply: City —Well.
P 3d 7
5 -- -mss -
MIAMI SHORES VILLAGE £Xt c 9- ?.f
PLUMBING INSPECTION DEPARTMENT
Permit No...a eg -__ _•. �..__..._.-
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.
_Type of Tank__
- Feet of Tank or Drain Field from Well.. --
Size of Soakage Pit
Z_® - .p 1
No& / � /Y / Street_.LL_. -S ? .
subdivWon . L/ f bi dC
Street.._ ? /.._... S7".
( Signed n4
Repairs No. of Stories ...............
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 5968, Compiled General Laws of Florida Permanent Supplement, and hit( com-
plied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors employed by him in the wort- 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. -
L
STATE OF FLORIDA, 1 µ
COUNTY OF DADE.
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeared
to me well known, and who, being by me first duly sworn, upon oath deposes and says that he b the. ._ -. -- - -•- •_ -..._ _ _.... —.
of the above described construction, that he has carefully read the foregoing application, and that be did sign the same, and that all facts
therein by him stated are true.
Notary Public, State of Florida
Plumbing Inspector.
NOTE: A re- inspection fee of $1.00 will be made when snob ro•Inspeetfasf la asede by improper notice for Inspection, a faulty
materials and /or workmanship.
CLearre
BATH
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16
LAVA•
TORIES
SINKS
SLOP
SINKS
LAUNDRY
Tuna
URINALS
I
CATCH
BASIN
FLOOR
DRAIN
DRINK NO
FOUNT •N•
TOTAL
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LIST
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SEPTIC
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SEWER
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DRAIN
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SOAKAGE
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SOLAR
HEATER
DEEP
WELL
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SW I M'O
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t
LIST
CHECK
-
Amount of Permit
My Commission Expires
APPLICATION FOR PLUMBING PERMIT
Owners Name and Address C4, 41e$
Registered Architect and /or En ' e er
Employing Plumber's Name 61 41 - 5
Location and Legal Description Lot.
Street and Number where work is to be performed —No.
State work to be performed and purpose of building (By Floors)
New Building..__._-------- ......._.. Remodeling —_ ._._ —__ Addition
Size Septic Tank_.
Feet of Drain Tile
Nature of Water Supply: City —Well.
P 3d 7
5 -- -mss -
MIAMI SHORES VILLAGE £Xt c 9- ?.f
PLUMBING INSPECTION DEPARTMENT
Permit No...a eg -__ _•. �..__..._.-
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.
_Type of Tank__
- Feet of Tank or Drain Field from Well.. --
Size of Soakage Pit
Z_® - .p 1
No& / � /Y / Street_.LL_. -S ? .
subdivWon . L/ f bi dC
Street.._ ? /.._... S7".
( Signed n4
Repairs No. of Stories ...............
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 5968, Compiled General Laws of Florida Permanent Supplement, and hit( com-
plied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors employed by him in the wort- 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. -
L
STATE OF FLORIDA, 1 µ
COUNTY OF DADE.
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeared
to me well known, and who, being by me first duly sworn, upon oath deposes and says that he b the. ._ -. -- - -•- •_ -..._ _ _.... —.
of the above described construction, that he has carefully read the foregoing application, and that be did sign the same, and that all facts
therein by him stated are true.
Notary Public, State of Florida
Plumbing Inspector.
NOTE: A re- inspection fee of $1.00 will be made when snob ro•Inspeetfasf la asede by improper notice for Inspection, a faulty
materials and /or workmanship.
PqS •2:17 Rev 11/79
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Permit No
Owner's Name and Address I
�legistered Architect)nd /or Engineer J49
Employs$ Flumboo's Name 4��
Location and Legal Description Lot
Street and Number where work is to be pe
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the building or other
structure herein described. This application is made in compliance and conformity with the Building Ordinance of Miami Shores Village, Florida,
and all provisions of the Laws of the State of Florida, all ordinances of Miami Shores Village and all rules and regulations of the Building Division
of Miami Shores Village shall be complied with, whether herein specified or not. A copy of approved plans and specifications must be kept at
building during progress of work.
State work to be performed and purpose of building (By Floors)______
Now Building.------ .._.........._._ Remodeling —_ _._..__ Addition
2
4 No 2 9e a/ / / 9
1
Block 3 Subdivision -/ ` ?'•J4
rformed —No . 9 B street..(L 9 /.s t
street #1 9/ 0. _.._
Repairs No. of Stories... .. ..........
Size Septic Tank— Type of Tanfr
Feet of Drain Tile Diat. Feet of Tank or Drain Field from Wen... _ .___..__
Nature of Water Supply: City —Well. Size of Soakage Pit
Amount of Permit $ 1/' ‘' 460 (Signed) - ` / ® t
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 5988, Compiled General Laws of Florida Permanent Supplement, and has mm-
piled with the provisions thereof, and will require similar compliance from all contractors or sub - contractors employed by him in the worir to he
performed under this permit; and will post or cause to be posted for inspection on the of the work such public notice or notices as err
required by the Act. The undersigned agrees to employ only such sub- contractors, k to be under this permit, as are
licensed by Miami Shores Villages
(Signed)
Master Plumber.
STATE OF FLORIDA, ss.
COUNTY OF DADE.
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeared
to me well known, and who being by me first duly 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 Commission Expires Notary Pubho, State of Florida
NOTE: A re- inspection fee of $1.00 will be made wham mob srispaotlon Y s>,ad rnemesery by improper notice for inspection, er levity
materials and /err workmanship..
c.o.r ra
BATH
T
SNOWERa
LAVA•
TORIES
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SLOP
SINKS
LAUNDRY
Tuna
URINALS
CATCH
BASIN
FLOOR
DRAIN
DRINK
FOUNT' Ns
w!lt •
Sv
TOTAL
•I7ITUR[a
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SEWER
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PIT
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HEATER
SPRKLR.
SYSTEM
SW IM'o
POOL
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CHECK
Permit No
Owner's Name and Address I
�legistered Architect)nd /or Engineer J49
Employs$ Flumboo's Name 4��
Location and Legal Description Lot
Street and Number where work is to be pe
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the building or other
structure herein described. This application is made in compliance and conformity with the Building Ordinance of Miami Shores Village, Florida,
and all provisions of the Laws of the State of Florida, all ordinances of Miami Shores Village and all rules and regulations of the Building Division
of Miami Shores Village shall be complied with, whether herein specified or not. A copy of approved plans and specifications must be kept at
building during progress of work.
State work to be performed and purpose of building (By Floors)______
Now Building.------ .._.........._._ Remodeling —_ _._..__ Addition
2
4 No 2 9e a/ / / 9
1
Block 3 Subdivision -/ ` ?'•J4
rformed —No . 9 B street..(L 9 /.s t
street #1 9/ 0. _.._
Repairs No. of Stories... .. ..........
Size Septic Tank— Type of Tanfr
Feet of Drain Tile Diat. Feet of Tank or Drain Field from Wen... _ .___..__
Nature of Water Supply: City —Well. Size of Soakage Pit
Amount of Permit $ 1/' ‘' 460 (Signed) - ` / ® t
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 5988, Compiled General Laws of Florida Permanent Supplement, and has mm-
piled with the provisions thereof, and will require similar compliance from all contractors or sub - contractors employed by him in the worir to he
performed under this permit; and will post or cause to be posted for inspection on the of the work such public notice or notices as err
required by the Act. The undersigned agrees to employ only such sub- contractors, k to be under this permit, as are
licensed by Miami Shores Villages
(Signed)
Master Plumber.
STATE OF FLORIDA, ss.
COUNTY OF DADE.
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeared
to me well known, and who being by me first duly 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 Commission Expires Notary Pubho, State of Florida
NOTE: A re- inspection fee of $1.00 will be made wham mob srispaotlon Y s>,ad rnemesery by improper notice for inspection, er levity
materials and /err workmanship..