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PLUMBING PERMITPERMIT APPLICATION FOR MIAMI SHORES VILLAGE Job Address 3 u L 6 L PT'• Tax Folio Legal Description Historically Designated: Yes No Owner/Lessee / Tenant T P IS C�OC 9 t Master Permit # 2 J h 4S Owner's Address - 3 2 — ( ! Phone Contracti Co AAA 1 ‘ 6.36t U PcDoE Address e t 00 aurae p Qualifier t4C--PitAtIZ-0 UJ • AL SS# - ��Jp›. State # C Municipal # Competency # Ins. Co. 6 A, Architect/Engineer Address Bonding Company Address Signature of owner and/or Condo President Date Notary as to Owner and/or Condo President Date My Commission Expires: A FEES: PERMIT 0 ,g RADON APPROVED: Zoning Building Mechanical Plumbing C.C.F. Address Mortgagor Permit Type (circle one): BUILDING ELECTRICAL MB t► s MECHANICAL ROOFING PAVING FENCE SIGN WORK DESCRIPTION (. /5 l w Square Ft. Estimated Cost (value) 350 «) 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). 1 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 d . at all work will be done in compliance with all applicable laws regulating construction and zoning. Furthermore, I authorize the above -n: ed • ontractor to do the work stated. gnature of Contractor or Owner - Builder At At." Notary as to Contractor or Owner- : ld My Commission Expires: wp� oFr;c; . , NOT, . :: 0. �� ®41RE!�i�A C ,l'v . 7 �° acv co;.,a�lssro 0e aF F NOTARY Electrical BOND Date Date Q. Engineering ITEM BATH 11.8 UNIT FEE ITEM SWITCH CUTLETS UNIT FEE ITEM SPACE HEATERS UNIT FEE BIDET LIGHT CUTLETS CENTRAL HEATING DISHWASHER ( RECEPTACLES A/C (WIND) DISPOSAL SERVICE TEMPORARY A/C (CENTRAL) DRINKING FOUNTAIN SERVICE SIZE IN AMPS DUCT WORK FLOOR CRAIN 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 1 WATER HEATER U.F. PRESSURE VESSELS CLOTHES WASHER MOTORS 0- 1 HP STEAM BOILERS SHOWER MOTORS OVER 1- 3 FP HOT WATER BOILERS SINK. POT /3 COMP. MOTORS OVER 3- 5 If MECHANICAL VENTILATION SINK, RESIDENCE 1 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 HP 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 -HELL SPECIAL PURPOSE SWIMMING POOL OUTLETS COMMERCIAL WATER SERVICE SIGN TUBES SEWER CONNECTIONS SIGN TRANSFORMERS UTILITY -SEWER SIGN TIME CLOCK UTILITY -WATER FIXTURES SEPTIC TANK ANTENNA RELAY TELEVISION OUTLETS GRAINFIELD, 4" TILE/RES. VIOLATION PULP & ABANDON SEPTIC TANK REINSPECTION SOAKAGE PIT CU. FT. CATCH BASIN DISCHARGE WELL DOMESTIC WELL AREA DRAIN ROOF INLET SOLAR WATER HEATER FIRE STANDPIPE POOL PIPING LAWN SPRINKLER SYSTEM 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 BEEN OBTAINED, THE OWNER'S NOTARIZED SIGNATURE NEED NOT BE PRESENT ON SUBSEQUENT APPLICATIONS.) PLUMBING ELECTRICAL MECHANICAL UILDING LECTRICAL LUMBING � wner of adding I kchitect ontractor Builder egal Lot Bl. escription ddress of l idding 1 ' CONTRACTOR OR BUILDER MIAMI SHORES VILLAGE, FLORIDA DATE 194 PERMIT N° 8560 Work to be performed under this Permit Subdi- vision Value of Project Contractor's License No. Amt. 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 appli- tion herefor in strict compliance with all ordinances pertaining thereto and with the understanding that the work will be performed in compliance with any ans, drawings, statements or specifications that may have been submitted to and approved by the proper municipal authorities. This Permit may be revoked 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 srmit is granted is the understanding that the contractor or builder named above assumes the responsibility for a thorough knowledge of the ordinances and gulations pertaining to the work covered hereby whether shown on the plans or drawings or in the statements or specifications and that he assumes respon- ,ility for work done by his agents, servants or employees. / / // Signed• ! By INSPECTOR PECTOR 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 ataining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. accepting this permit I assume responsibility for all work done by either myself, my agent, servant or employee. BY AUTHORITY Permit No. __I) MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the building or other structure herein described. This application is made in compliance and conformity with the Building Ordinance of Miami Shores Village, Florida, and all provisions of the Laws of the State of Florida, all ordinances of Miami Shores Village and all rules and regulations of the Building Division of Miami Shores Village shall be complied with, whether herein specified or not. A copy of approved plans and specifications must be kept at building during progress of work. Owner's Name and Address No. Street . Registered Architect and /or Engineer — - Employing Plumber's Name__.____. ______. No. Street Location and Legal Description Lot •'" ______ B1ock_______: __ 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 - /. __ 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 Nature of Water Supply: City —Well Size of Soakage Pit Amount of Permit $ s s. ( Signed) L. • 1_,%. .• 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 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. ( Signed) / Date My Commission Expires Notary Public, State of Florida - - - - - - - - - - - -- Master Plumber. STATE OF FLORIDA, ! 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 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. 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 SWIM'G POOL CONTR. LIST CHECK - Permit No. __I) MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the building or other structure herein described. This application is made in compliance and conformity with the Building Ordinance of Miami Shores Village, Florida, and all provisions of the Laws of the State of Florida, all ordinances of Miami Shores Village and all rules and regulations of the Building Division of Miami Shores Village shall be complied with, whether herein specified or not. A copy of approved plans and specifications must be kept at building during progress of work. Owner's Name and Address No. Street . Registered Architect and /or Engineer — - Employing Plumber's Name__.____. ______. No. Street Location and Legal Description Lot •'" ______ B1ock_______: __ 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 - /. __ 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 Nature of Water Supply: City —Well Size of Soakage Pit Amount of Permit $ s s. ( Signed) L. • 1_,%. .• 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 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. ( Signed) / Date My Commission Expires Notary Public, State of Florida - - - - - - - - - - - -- Master Plumber. STATE OF FLORIDA, ! 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 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. Permit No r / Owner's Name and Address Registered Architect and /or Engineer____—___. Employing Plumber's Name... � ee' Location and Legal Description Lot_ Amount of Permit $ STATE OF FLORIDA, COUNTY OF DADE. MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT Date .. t v.±` , ....jJ._7 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. Street and Number where work is to be performed —No State work to be performe8 and purpose of building (By Floors) New Building —_ ___ Remodeling____________ Addition._ No :3 g Street_ 9/. . -- C 7 street. —dam. Block 31- 1 Street Repairs No. of Stories. Stories ................. Size Septic Tank— — _— ______—_—__—______ ----Type of Tank—_— - ---- __ -- _ Capacity Gals. Feet of Drain Tile_— ____ - -- — --Dist. Feet of Tank or Drain Field from Wen _----_--_--_ -• —•— Nature of Water Supply: City—Well. Size of Soakage Pit ...... (Si (Signed) The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations a under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Permanent Sup plied with the provisions thereof, and will require similar compliance from all contractors or sub- contractors em performed under this permit; and will post or cause to be posted' for inspection on the site . f the work su required by the Act. The undersigned agrees to employ only such sub- contractors, • . wor' to be licensed by Miami Shores Village. My Commission Expires Notary Public, State of Florida P1 bang Inspector. employer of labor ent, and has com- �.. in the work to be notice or notices as are unit, as are er Plumber. Before me, the undersigned authority, a notary public, duly authorized to administ oaths and take aclmowledgments, 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 insp.. ;'n, of faidty materials and /or workmanship. CLOSETS B ATH TUBS SHOWERS LAVA TORIES SINKS SLOP SINKS LAUNDRY TUBE URINALS CATCH BASIN FLOOR DRAIN DRINK! DRINKING FOUNT 'NS TOTAL FIXTURES CONTR. LIST CHECK SEPTIC TANK SEWER CONN. DRAIN FIELD SOAKAGE PIT GREASE TRAP SOLAR H EATER DEEP WELL SPRKLR. SYSTEM SWIM•G POOL CONTR. LIST - CHECK Permit No r / Owner's Name and Address Registered Architect and /or Engineer____—___. Employing Plumber's Name... � ee' Location and Legal Description Lot_ Amount of Permit $ STATE OF FLORIDA, COUNTY OF DADE. MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT Date .. t v.±` , ....jJ._7 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. Street and Number where work is to be performed —No State work to be performe8 and purpose of building (By Floors) New Building —_ ___ Remodeling____________ Addition._ No :3 g Street_ 9/. . -- C 7 street. —dam. Block 31- 1 Street Repairs No. of Stories. Stories ................. Size Septic Tank— — _— ______—_—__—______ ----Type of Tank—_— - ---- __ -- _ Capacity Gals. Feet of Drain Tile_— ____ - -- — --Dist. Feet of Tank or Drain Field from Wen _----_--_--_ -• —•— Nature of Water Supply: City—Well. Size of Soakage Pit ...... (Si (Signed) The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations a under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Permanent Sup plied with the provisions thereof, and will require similar compliance from all contractors or sub- contractors em performed under this permit; and will post or cause to be posted' for inspection on the site . f the work su required by the Act. The undersigned agrees to employ only such sub- contractors, • . wor' to be licensed by Miami Shores Village. My Commission Expires Notary Public, State of Florida P1 bang Inspector. employer of labor ent, and has com- �.. in the work to be notice or notices as are unit, as are er Plumber. Before me, the undersigned authority, a notary public, duly authorized to administ oaths and take aclmowledgments, 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 insp.. ;'n, of faidty materials and /or workmanship.