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PLUMBING PERMITMIAMI SHORES VILLAGE BUILDING DEPARTMENT 305 -795 -2204 Building Inspection Request Date V I i Time Type Insp'n firtif nO rG ► f Permit No. PI Q003- .44 Name 1 )ect _ Address () ICY . GaS f Company 1 166 n . Phone # For Inspector: 10 1 ) Approved Correction ❑ Re- Insp'n Fee ❑ MIAMI SHORES VILLAGE BUILDING DEPARTMENT �b 305- 795 -2204 Building Inspection Request Date 0 3 Time Type Insp'n Cl B 1 1 npt Permit No. PL oC Name te-- L . Address V\ 0 Company Phone # For Inspector:1f Approved Correction Re- Insp'n Fee Type Insp'n Permit Noo Date / 1 Inspection Date'' Approved Correction Re- Insp'n Fee MIAMI SHORES VILLAGE BUILDING DEPARTMENT 305- 795 -2204 Building Inspection Request Z o3 Name Address 1°1 r el . Company Phone # 3os ' 4—C MIAMI SHORES VILLAGE BUILDING DEPARTMENT 305- 795 -2204 Building Inspection Requ Date a Time Type Insp'n Permit No. N av; Addres Phone # For Inspecto Approved Correction Re- Insp'n Fee W ° Name & Date AzLoucebty BUILDING PERMIT APPLICATION FBC 2001 Miami Shores Village Building Department Permit Type (circle): Building Electrical � e e Plumbing Mechanical Roofing Owner ' s Name (Fee Simple Titleholder ) /� P J�J e �/� Phone # �0 o S) V '9 � Owner's Address / 0 o 2/ 9 2- Sf/ e City/fh * 54 State r L- Zip J•? /?P Tenant/Lessee Name Phone # Job Address (where the work is being done) / O7 d 4" 9 2_ 5/ City Miami Shores Village County Miami -Dade Zip 3 /.?4, Is Building Historically Designated YES NO Contractor's Company Name / h / a v1 /dm ' Phone # G 9 J 2 / 2 e r y . . �G Contractor's Address /OD O ,9 7 A fi ` C 34 City y ,a-k 0 � / e 4 State r C Zip 3 I a Qualifier / 1, rj/! q / Architect/Engineer's Name (if applicable) ` Ke' 'f� � � ' "71 . Phone # C. q S) 9 1 � 2 d U /� L Architect/Engineer's Address 3 2 - 0 0 0"D rf Oya E' City 'rf' Leu/j,/e'ci /e State L Zip .733 $ Value of Work For this Permit 6 a� Square Footage Of Work: Number of: Bays Stories Families Bedrooms Baths Type of Work: ['Addition ['Alteration DNew / ❑ Repair/Replace ❑ Demolition AV Describe Work: / V / /L1 G / 17''a "1 et kie/ 'c o/ f / * * * * * * * * * * * * * * * * * * * * * * * * * * ** F ees * * * ** , * * * * * * * * * * * * * * * * * ** County Escrow Fee $ Permit Fee $ / 0 Notary $ Education/Training Fee $ Tech $ Scanning $ Radon $ Code Enforcement $ Bond $ Struct. $ Minus Plans Check Fee $ Total Fee Now Due $ (Continued on opposite side) A PP° Fee 30.00 CheCK# 1 150 Master Permit No. 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 Permit No. PLa • a 4 1 Bonding Company's Name (if applicable) Bonding Company's Address City State Zip Mortgage Lender's Name (if applicable) Mortgage Lender's Address City State Zip Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRICAL WORK, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and AIR CONDITIONERS, ETC OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. "WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT." Notice to Applicant: As a condition to the issuance of a building permit with an estimated value exceeding $2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is. subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. Signature wner or Agent The foregoing instrument was acknowledged before me this ler /" no day of i9 - , 20 O), by e•its ,o 71-4 At?eG�C who is personally known to me or who has produced As identification and who did take an oath. NOTARY PUBLIC. Sign: Chc7r1 /03 / „ orF��;•' Bonded through Print. IRnn -4 -4241 Florida Notary Assn., Inc My Commission Expires: My Commission Expires: (Certificate of Competency Holder) Certificate of Competency No. State Certificate or Registration No. GARY KILGORE NOTARY issiorl # DD0103451 Expires 4/8/2006 Signature M Contractor The foregoing instrument was acknowledged before met this / 'G bf day of /�ii . , 20 03 , by /'af v4y01 jel�7Gdvaz who is personally known to me or who has produced as identification and who did take an oath. PUBLIC: GARY KILGORE Sign: comm iod # D Expires Print: 1 800- 432 -4254) Florida Notary Assn., Inc ****** * * * * * * * * * * * * * * * * * * * * * * * * * * ** * * * * * ******************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** t APPLICATION APPROVED BY: _, 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 (WIN)) 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 FP 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 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 -WELL 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 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 STANDPIPE POOL PIPING LAWN SPRINKLER SYSTEM GAS RANGE METER SET (GAS) GAS PIPING PLUMBING i 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.) ELECTRICAL MECHANICAL Permit No D 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. � / Owners Name and Address P 8. ll Registered Architect and /or Engineer �.•..r= ? �! i Employing Plumber's Nam ® = -:b""= /Mfg Sit 0 .,,... No...ea�..�..�,.a_. Location and Legal Descrlpti / 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 Ad • ion_._— `.._._ Repairs No. of Stories. B1or4 Size Septic Task_ _ _ _..__.— Type of Tank._.__ 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 $ b L D My Commission I p m: ,y�'� 4 .__ r (Signed) No. / 59- (9 y5 L __ StreetLUI 4.e. r° 144L Aril/ 51-70W Subdivision StreetjP ,L 0_:.6,_ 7 ( signe d ) :5 ,C 1)1 J J Capacity Cals..._..._.. ..__.... 5114 /icy 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 Pennanent 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 publ c noti ' or notices as are required by the Act. The undersigned agrees to employ only such sub- contractors, on work to be perform .4 nder s permit, as are licensed by Miami Shores Village. - Muter Plumber. STATE OF FLORIDA, COUNTY OF DADE. Before me, the undersigned authority, a notary public, duly authorized to ainist oaths and take acknowledgments, personally appeared t t AA 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, a that he did sign therein by him stated are true. otary Public, State of 11''lai e, and that all facts mater r o Ls fee of $1.00 will be made when such re- inspection Jr s ade'rarssaey by improper nu+1c a for inspection, or faulty CLOSRS BATH TUBE SHOWERS LAVA. TORIES SINKS SLOP SINKS LAUNDRY TUNIS URINALS CATCH BASIN FLOOR DRAIN DRINK NG FOUNT' NS TOTAL FIXTURES CONTR. LIST CHECK 5P-A SEPTIC TANK SEWER CONN. DRAIN FIELD SOAKAGE PIT GREASE TRAP SOLAR HEATER DEEP WELL SPRKLR. SYSTEM POOL CONTR. LIST CHICK �pp A t 00 Permit No D 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. � / Owners Name and Address P 8. ll Registered Architect and /or Engineer �.•..r= ? �! i Employing Plumber's Nam ® = -:b""= /Mfg Sit 0 .,,... No...ea�..�..�,.a_. Location and Legal Descrlpti / 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 Ad • ion_._— `.._._ Repairs No. of Stories. B1or4 Size Septic Task_ _ _ _..__.— Type of Tank._.__ 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 $ b L D My Commission I p m: ,y�'� 4 .__ r (Signed) No. / 59- (9 y5 L __ StreetLUI 4.e. r° 144L Aril/ 51-70W Subdivision StreetjP ,L 0_:.6,_ 7 ( signe d ) :5 ,C 1)1 J J Capacity Cals..._..._.. ..__.... 5114 /icy 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 Pennanent 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 publ c noti ' or notices as are required by the Act. The undersigned agrees to employ only such sub- contractors, on work to be perform .4 nder s permit, as are licensed by Miami Shores Village. - Muter Plumber. STATE OF FLORIDA, COUNTY OF DADE. Before me, the undersigned authority, a notary public, duly authorized to ainist oaths and take acknowledgments, personally appeared t t AA 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, a that he did sign therein by him stated are true. otary Public, State of 11''lai e, and that all facts mater r o Ls fee of $1.00 will be made when such re- inspection Jr s ade'rarssaey by improper nu+1c a for inspection, or faulty Permit No X/00 k 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. Owners Name and Address (1.2 I ill? l 0 P N No / 0 e l Off_.!.. L Street... S- Registered Architect and /or Engineer Employing Plumber's Name %a ,6 , - QY r: (Ime,a r ° : 1 J ./ 22 .. Location and Legal Description Lot_ a Bk,c4 Subdivision______. Size Septic Tank_ Feet of Drain Tile Nature of Water Supply: City —Well. Amount of Permit $ Street and Number where work is to be performed —No d C ✓ C State work to be performefl and purpose of building (By Floors) New Building. __- Remodeling —_ — ._.__ —_ Addition. Repairs Type of Tank nut. Feet of Talc or Drain Field from Well Size of Soakage Pit. Street. _.. (signed) ri WA .Capacity Cals... _.. _...__ No. of Stories. ....... 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 5968, 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 Bite 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 Mauer Plumber. STATE OF FLORIDA, } u. COUNTY OF DADE. Before me, the undersigned authority, a notary public, duly authorized to administer 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 be did sign the same, and that all facts therein by him stated are true. My Commission Expires Notary Public, State of Florida NOTE: A re- inspection fee of $1.00 will be made when snob reogyeetloa is snade.neoawry by improper notice for Inspection, or faulty materials and /or workmanship. CLOSETS BATH TUBS SNOWERE LAVA. TORIES SINKS SLOP SINKS LAUNDRY Tuna URINALS CATCH SABIN FLOOR DRAIN DRINKING FOUNT' NS TOTAL FIXTURES CO NTR IST • L 3 Y y 3 f / (l �s ii o (*le ' t CHECK SEPTIC TANK SEWER CONN. DRAIN FIELD SOAKAGE PIT GREASE TRAP SOLAR MUTER DEEP WELL SPRKLR. SYSTEM SW Ile G POOL 401Q6P X /1 V Come. LIST �� � r 1 � ��/ CHECK J y'y/� �' i�;S. Gc C• �'S• !. . _ P Permit No X/00 k 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. Owners Name and Address (1.2 I ill? l 0 P N No / 0 e l Off_.!.. L Street... S- Registered Architect and /or Engineer Employing Plumber's Name %a ,6 , - QY r: (Ime,a r ° : 1 J ./ 22 .. Location and Legal Description Lot_ a Bk,c4 Subdivision______. Size Septic Tank_ Feet of Drain Tile Nature of Water Supply: City —Well. Amount of Permit $ Street and Number where work is to be performed —No d C ✓ C State work to be performefl and purpose of building (By Floors) New Building. __- Remodeling —_ — ._.__ —_ Addition. Repairs Type of Tank nut. Feet of Talc or Drain Field from Well Size of Soakage Pit. Street. _.. (signed) ri WA .Capacity Cals... _.. _...__ No. of Stories. ....... 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 5968, 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 Bite 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 Mauer Plumber. STATE OF FLORIDA, } u. COUNTY OF DADE. Before me, the undersigned authority, a notary public, duly authorized to administer 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 be did sign the same, and that all facts therein by him stated are true. My Commission Expires Notary Public, State of Florida NOTE: A re- inspection fee of $1.00 will be made when snob reogyeetloa is snade.neoawry by improper notice for Inspection, or faulty materials and /or workmanship. � 0 ' Permit No. _ MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT Date 1 -22 -79 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 aoe Pk NO No. 1 .090 N.E. Street 92nd Street Registered Architect and /or Employing Plumber's Name O'Nea eptic_ ark Ca. N 8 50 N.J. st eat 56th Street Location and Legal Description Lot J.Il4O N + - —92nd Blork Street and Number where work is to be performed — 1090 N . Sam 92nd Street State work to be performed and purpose of building (By New Building x- _ __.------ .__... -.. Remodeling — —_. Addition. Repairs___ No. of Stories. Size Septic Tank__ __---- __ _ 1050 gal __Type of Tank septic Feet of Drain Tile_ _ _ _ 400 sq. ft • — Dist. Feet of Tank or Drain Field from Well Nature of Water Supply: City—Well Size of Soakage Pit Capacity Gals. A m o u n t of Permit $ ' 6 a t - o D (S led) — J Q flg a 1 _Q' M _ - — STATE OF FLORIDA, COUNTY OF DADE. 1 1050 My Commission Expires Notary Public, State of Florida 1 Plumbing Insp 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 Pennanent Supplement, and bus 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 tlie Act. The undersigned agrees to employ only such sub- contractors, on work to be performed under this penult, 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 $1.00 will be made when such re- inspection is made •necessary by improper notice for inspection, or faulty materials and /or workmanship. CLOUTS BATH rues S LAVA. TORIES SINK$ SLOP $INKt LAUNDRY Tuss URIN CATCH BASIN FLOOR DRAIN DRINKI NO FOUNT 'NB 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 � 0 ' Permit No. _ MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT Date 1 -22 -79 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 aoe Pk NO No. 1 .090 N.E. Street 92nd Street Registered Architect and /or Employing Plumber's Name O'Nea eptic_ ark Ca. N 8 50 N.J. st eat 56th Street Location and Legal Description Lot J.Il4O N + - —92nd Blork Street and Number where work is to be performed — 1090 N . Sam 92nd Street State work to be performed and purpose of building (By New Building x- _ __.------ .__... -.. Remodeling — —_. Addition. Repairs___ No. of Stories. Size Septic Tank__ __---- __ _ 1050 gal __Type of Tank septic Feet of Drain Tile_ _ _ _ 400 sq. ft • — Dist. Feet of Tank or Drain Field from Well Nature of Water Supply: City—Well Size of Soakage Pit Capacity Gals. A m o u n t of Permit $ ' 6 a t - o D (S led) — J Q flg a 1 _Q' M _ - — STATE OF FLORIDA, COUNTY OF DADE. 1 1050 My Commission Expires Notary Public, State of Florida 1 Plumbing Insp 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 Pennanent Supplement, and bus 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 tlie Act. The undersigned agrees to employ only such sub- contractors, on work to be performed under this penult, 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.