PLUMBINGPermit No
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. A /�
Owner's Name and Address fie ` 2 No _g_0 2 S t r e e t _ . . I t L E 9 3 S
Registered Architect and /or Engineer
Employing Plumber's Nerve A�trl �
Location and Legal Description Lot._ Block Subdivision._.__
Street and Number where work is to be performed —No
Size Septic Tank__
Feet of Drain Tile
Nature of Water Supply: City—Well.
State work to be performed) and purpose of building (By Floors)____ ,!
Remodeling Addition.. ____.._ ... Repairs. No. of Stories
New Building .__.._._.__.._...-- ... - -• -- g— _._..._.._....— epairs. . ....
Amount of Permit $
City Gale
Type of Tan
r)ist. Feet of Tank or Drain Field from
Size of Soakage Pit.
The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations • employer of labor
under the Florida Workmen's Compensation Act, being Section 5986, Compiled General Laws of Florida Pennanent Su • ement, 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
licensed by Miami Shores Village. required by the Act. The undersigned agrees to employ only such sub - contractors, to be ' under this permit, as are
d,
STATE OF FLORIDA, f a~
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 be 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 Public, State of Florida
NOTE: A re- inspection fee of $1.00 will be made whoa aueb miupeotfine i. made•rMarary by improper notice for impaction, or faulty
materials and/or workmanship.
CLOSrt.
BATH
Tung
jNOWIRS
LAVA.
TORIES
jINK•
SLOP
SINKS
LAUNDRY
Tug•
URINALS
CATCH
BASIN
FLOOR
DRAIN
DRINKING
FOUNT N•
TOTAL
PI
CONTR.
LIST
CHICK
SEPTIC
TANK
SIWLR
CONN.
DRAIN
FIELD
SOAKAGI
PIT
GRIAU
TRAP
SOLAR
PI SATIN
DEEP
WILL
SPRKLR.
SYSTEM
SW IM'O
POOL
Corms.
LIST
CHICK
Permit No
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. A /�
Owner's Name and Address fie ` 2 No _g_0 2 S t r e e t _ . . I t L E 9 3 S
Registered Architect and /or Engineer
Employing Plumber's Nerve A�trl �
Location and Legal Description Lot._ Block Subdivision._.__
Street and Number where work is to be performed —No
Size Septic Tank__
Feet of Drain Tile
Nature of Water Supply: City—Well.
State work to be performed) and purpose of building (By Floors)____ ,!
Remodeling Addition.. ____.._ ... Repairs. No. of Stories
New Building .__.._._.__.._...-- ... - -• -- g— _._..._.._....— epairs. . ....
Amount of Permit $
City Gale
Type of Tan
r)ist. Feet of Tank or Drain Field from
Size of Soakage Pit.
The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations • employer of labor
under the Florida Workmen's Compensation Act, being Section 5986, Compiled General Laws of Florida Pennanent Su • ement, 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
licensed by Miami Shores Village. required by the Act. The undersigned agrees to employ only such sub - contractors, to be ' under this permit, as are
d,
STATE OF FLORIDA, f a~
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 be 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 Public, State of Florida
NOTE: A re- inspection fee of $1.00 will be made whoa aueb miupeotfine i. made•rMarary by improper notice for impaction, or faulty
materials and/or workmanship.
.111./.•
CLOSETS
BATH
TUBS
SHOWERS
LAVA-
TORIES
SINKS
SLOP
SINKS
LAUNDRY
TUBS
URINALS
CATCH
BASIN
FLOOR
DRAIN
DRINKING
FOUNT 'NS
/16,,,...
/4 A l"
TOTAL
FIXTURES
CONTR.
LIST
S
/
l
f
CHECK
........
/-
7 5►
'" )
SEPTIC
TANK
SEWER
CONN.
DRAIN
FIELD
SOAKAGE
PIT
GREASE
TRAP
SOLAR
HEATER
DEEP
WELL
SPRKLR.
SYSTEM
SW IM'G/41;4•7$
POOL
R c /'
4i
CONTR.
LIST
CHECK
Permit No
1. ' • 4
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMEN
APPLICATION FOR PLUMBING PE
` 00
/So
/z5
r •
Da t t f7;+. �`-- / g �~ A
Application is hereby made for the approval of the detailed statement of the plans. and specifications r ilf'tnbmitted for the building or other
structure herein described. This application is made in compliance and conformity with the Building Or finance 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.
q 4
Owner's Name and Address e "�''L - �° ' ' No Street
Registered Architect and /or Engineer
Employing Plumber's Name � �- �"
Location and Legal Description
Street and Number where work is to be performed —No.
State work to be performed and purpose of building (By Floors)
t I'_
New Building Remodeling Addition
No (- I g L Street___ J
Block Subdivision
e Street
Repairs No. of Stories___.p
Size Septic Tank Type of Tank_
Capacity Gals
Feet of Drain Tile Dist. Feet of Tank or Drain Field fr ell_
Nature of Water Suppl:'City -Well Size of So. Pit
Amount of Permit $
STATE OF FLORIDA, 1
COUNTY OF DADE.
ss.
The undersigned applicant for this building permit does hereby certify that he u . erstands and accepts his obliga ons as an emplo -r of labor
under the Florida Workmen's Compensation Act, being-Section 5966, Compiled Ge - eral Laws of Florida Permanent Supplement, a v has com-
plied with the provisions thereof, and will require similar comp i. . tractors or sub - contractors employed by him in th 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 n tices 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)
My Commission Expires Notary Public, State of Florida
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.
BUSINESS
ADDRESS
TRADE
NAME Roselle Leo Plumbin
CORP.
NAME
MAILING
ADDRESS
CITY
STATE
ZIP
MUNICIPAL CONTRACTOR'S OCCUPATIONAL LICENSE
OCT. 1ST 1 1 SEPT. 30 1972 41569 5
DUE EXPIRES THIS LICENSE VALID ONLY IN
IPA t,• p LISTED BELOW:
THIS LICENSE ISSUED IN PURSUANCE OF METROPOLITAN DADE COUNTY ORDINANCE - 66.2 MUNIC r
-r> k r 1Gt�JST REGISTER .
k
r � ." '". i fih IN ORK IS DONE
VA t. tt ;'..O COM ET C Y
Y.r gr
U. i? ti'
2501 NW ?9 St
Miami F1 33177
IS HEREBY LICENSED AND AUTHORIZED TO DO BUSINESS
AS A CONTRACTOR AS SPECIFIED HEREON.
* * * *pd L21625 10/19/71 200.00 * **
AMOUNT 200 ..00
AMYL CATEGORIES
• 200.00
TOTAL AMOUNT
PAYMENT RECEIVED AS CERTIFIED ABOVE - DADE COUNTY TAX COLLECTOR. MIAMI. FLORIDA
BAL HARBOUR
BAY HARBOR ISLANDS
BISCAYNE PARK
CORAL GABLES
EL PORTAL
FLORIDA CITY
HIALEAH GARDENS
ISLANDIA
MIAMI
MIAMI BEACH
MIAMI SHORES
NORTH BAY VILLAGE
NORTH MIAMI
NORTH MIAMI BEACH
OPA LOCK
PENNSUCO
SOUTH MIAMI
SURFSIDE
SWEETWATER
VIRGINIA GARDENS
WEST MIAMI
• THIS FORM BECOMES A RECEIPT ONLY WHEN VALIDATED BY RECEIPTINO MACHINE SHOWING NUMBER - DATE - AMOUNT PAID
This is to certify that
LEO ROSSELLE PLUMB?. 1Z INC..
.,, • CEITRACTOk'S
(ALIOIT NUMBER , CERTIFICATE OF COMPETENO' — BUSINESS
•
METROPOLITAN DADE COUNTY
377 7/
Fog, 12.3.01.16 REV. 1971
(501,E PROPRIETOR 0. PARTNERSHIP 0, FIRM 0. OR CORPORATIONt)
having met the requirements under Chapter 10, Code of Metropolitan
done under the direct supervision and control of the following named qualifying agent:
NAME: H. L. ROSSELLE. JR.
TYPE NAME
OF BUSINESS
ORGANIZATION
AND
MAIL TO
BUSINESS
ADDRESS
LEO ROSSELLE PLUY,BING, INC.
2501 N.J14.79 Street .
Miami, Fla. 33147
CONT CUPY •• CONTRACTOR'S
1111 Nt 5 1 ,N ,-- UM firl BER 40,n-
.A. D
10.00
2301
PLUMB I Na ti - 5 7 7 C. 0 3 •Th A , 1 0 .00
Dade County, as amended, is hereby certified AS A CONTRACTOR, with oil work to be
, ADDRESS: 1210 N E. 82 Street, nand., Fla.
(0prou.,...) 33.3d
•
This certificate is valid on a countywide basis in theUnincorporated
Areas and in all Dodo County Municipalities. Th• qualifying agent and
organization listed herein have been duly qualified by the Construction
Trades Qualifying Board. This certificate becomes null and void ot such
time as the qualifying agent named herein is no longer associated with
the , a)overriamed
'•organization. /,
_ .1.•
TiLitS C E R.TIF / IC AT / ? E IS .GOOD UNTIL SEPTEMBER 30, 1973
la . '''':. •
(Secraory,Construction Board)
(Chairman Construction Trades Qualifying Boord)
/ORM 123.01 -13 REV. 1071
OVC' t 0111:�Ul.bdti9 ∎ .0
(AUDI r NUMBER) CERTIFICATE OF COMPETENCY — BUSINESS
METROPOLITAN DADE COUNTY
This is to certify that
LEO ROSSELLE PLUMBING, INC.
(SOLE RROPPIETOR 0, PARTNERSHIP ❑, FIRM 0, On CORPORATION a)
having met the requirements under Chapter 10, Code of Metropolitan
HEATING I(
Dade County, as emended, is hereby certified AS A PRESSURE & PR ES
done under the direct supervision and control of the following named qualifying agent:
NAME: HIRAM L. ROSSELLE JR
TYPE NAME
OF BUSINESS
ORGANIZATION
AND
MAIL TO
BUSINESS
ADDRESS
LEO ROSSELLE PLUMBING, INC.
2501 NOE 79 ST.. •
Irlitiva,FLA. 33147
CONTRAC 9RjC 6 C CCNr A 280Y
N UME3ER
(
Pf1TG 6 !S 2 4
ADDRESS•
(OF QUALIFIER)
�--. 0.00
CONTRACTOR,.with all work to be
1210 1T -E - RP Sr.
This certificate is valid on a countywide basis in the Unincorporated
Areas and in all Dade County Municipalities. The qualifying agent and
organization listed herein have been duly qualified by the Construction
Trades Qualifying Board. This certificate becomes null and void at such
time as the qualifying agent named herein is no longer associated with
the above namod grganization.
FR'T
THIS C FICAT I IS G00D UNTIL EPTEMBER 30, 1973
t/ ih _. . `::xs•a !.:•",:t' A . �
(Secret ry Const radp 0 'lifying Board)
cc rmBn Co r1'struct4n aes uaIifying Board) .
0.00
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
Permit No Pi
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 herds specified or not. A copy of approved plans and specifications must be kept at
building during progress of work. ' I �� �° ' ^� �J /
Owner's Name and Address F1LL- --7.1 - -.1 . _A No._' 2 4
� !� Street ..rG .... -- F ..._.. 3 S T
Registered Architect and /or Engineer f Employ ing Plumber's Name d-- ® �R f� L � r .P0....m.,.....: street Al,LkiriT .S
Location and Legal Description Lot. Block Subdiv1son.._- .._-- _ -__ -._ Sr
Street and Number where work is to be performed —No . 1), 0 Street., .g..__.._77 3 ° ____
State work to be performed and purpose of building (By F1ocp)__._-_ -. 71 . .12 0 9 « /11...-S . L- 0.
New Building..- •-- .----- •- ... ............... Remodeling__ -- -_ Addition.. - - - -_ Repairs No. of Stories..............
Amount of Permit S
STATE OF FLORIDA, b
COUNTY OF DADE.
$s.
®c
Size Septic Tank_ .----- - - - -.— -- — - - -- - 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
Capacity Gals
The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligati. s :: an employer of labor
under the Florida Workmen's Compensation Act, being Section 5968, Compiled General Laws of Florida Permanent a ..plement, 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 _perfo . ed under this permit, a are
licensed by Miami Shores Village. d
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 Public, State of Florida
NOTE: A re- inspection fee of ;1.00 will be made when ouch re-lnepeotion is misde by improper notice for inspection, or faulty
materials and /or workmanship.
CLOSE TS
BATH
TuBe
SHOW[R•
LAVA.
TORIES
SINKS
SLOP
SINKS
LAUNDRY
T ugs
URINAL[
CATCH
BASIN
FLOOR
DRAIN
DRINKING
FOUNT'NS
TOTAL
FIXTURES
(.
/
'
—
LIST
CHICK
SEPTIC
TANK
SEWER
CONN.
DRAIN
FIELD
SOAKAOI
PIT
GREASE'
TRAP
SOLAR
H EATER
DIIP
WELL
SPRKLR.
SYSTEM
6WIM'0
POOL
CONTR.
LIST
CHECK
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
Permit No Pi
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 herds specified or not. A copy of approved plans and specifications must be kept at
building during progress of work. ' I �� �° ' ^� �J /
Owner's Name and Address F1LL- --7.1 - -.1 . _A No._' 2 4
� !� Street ..rG .... -- F ..._.. 3 S T
Registered Architect and /or Engineer f Employ ing Plumber's Name d-- ® �R f� L � r .P0....m.,.....: street Al,LkiriT .S
Location and Legal Description Lot. Block Subdiv1son.._- .._-- _ -__ -._ Sr
Street and Number where work is to be performed —No . 1), 0 Street., .g..__.._77 3 ° ____
State work to be performed and purpose of building (By F1ocp)__._-_ -. 71 . .12 0 9 « /11...-S . L- 0.
New Building..- •-- .----- •- ... ............... Remodeling__ -- -_ Addition.. - - - -_ Repairs No. of Stories..............
Amount of Permit S
STATE OF FLORIDA, b
COUNTY OF DADE.
$s.
®c
Size Septic Tank_ .----- - - - -.— -- — - - -- - 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
Capacity Gals
The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligati. s :: an employer of labor
under the Florida Workmen's Compensation Act, being Section 5968, Compiled General Laws of Florida Permanent a ..plement, 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 _perfo . ed under this permit, a are
licensed by Miami Shores Village. d
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 Public, State of Florida
NOTE: A re- inspection fee of ;1.00 will be made when ouch re-lnepeotion is misde by improper notice for inspection, or faulty
materials and /or workmanship.
Permit No. ( _ 7 __1 1
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 Divisior
of Miami Shores Village shall be complied with, whether herein specified or not. A copy of approved plans and specifications must be kept al
building during progress of work.
Owner's Name and Address ,l-_
d
Registered Architect and /or Engineer_.__.___._______
Employing Plumber's Name_
Amount of Permit $
STATE OF FLORIDA,
as.
COUNTY OF DADE.
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
No. - -- Z - - -____ Street- ✓�
Location and Legal Description ' 1' ot..- _-- ..._.- _ ........... _- ..... _._ _ Block_.___ __... Subdivision
Street and Number where work is to be performed —No ,L %% __ /' ' . J
State work to be performed and purpose of building (By Floors)_
New Building emodeli3r _ Addition___. .............. Repairs No. of Stories
( Signed)
Street
Date /0 _ ��
Size Septic Tank__ 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 • 1x ( 4 - .1 4 - " - i
Capacity Gals.
(Signed) - ll�Z.p
My Conunission Expires Notary Public, State of Florida
Plumbing Inspector.
The undersigned applicant for this building permit does hereby certify that he understands and : cepts I's obligations as an employer of labor
under the Florida Workmen's Compensation Act, being Section 5988, Compiled General Laws of Fl • • 'errnanent Supplement, and has com-
plied with the provisions thereof, and will require similar compliance from all contractors or sub-contractors employed by him in the work to be
performed under this permit; and will post or cause to be posted for inspection on the site of the work such public notice or notices as are
required by the Act. The undersigned agrees to employ only such sub- contractors, on work to be performed under this permit, as are
licensed by Miami Shores Village.
Master Plumber.
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeare
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 fat.
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 foul
materials and /or workmanship.
CLOSETS
BATH
TUBS
SHOWERS
LAVA.
TORIES
SINKS
SLOP
SINKS
LAUNDRY
TUSK
URINALS
INAL
CATCH
BASIN
FLOOR
DRAIN
OR INKING
FOUNT'NS
TOTAL
FIXTURE!
comm.
LIST
--
-.-
CHECK
/ D O
SEPTIC
TANK
SEWER
CONN.
DRAIN
FIELD
SOAKAGE
PIT
GREASE
TRAP
SOLAR
HEATER
DEEP
WELL
SPRKLR.
SYSTEM
SWIM'O
POOL
CONTR.
LIST
/
-
/
CHECK
` b-3
/ ®‘''
Permit No. ( _ 7 __1 1
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 Divisior
of Miami Shores Village shall be complied with, whether herein specified or not. A copy of approved plans and specifications must be kept al
building during progress of work.
Owner's Name and Address ,l-_
d
Registered Architect and /or Engineer_.__.___._______
Employing Plumber's Name_
Amount of Permit $
STATE OF FLORIDA,
as.
COUNTY OF DADE.
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
No. - -- Z - - -____ Street- ✓�
Location and Legal Description ' 1' ot..- _-- ..._.- _ ........... _- ..... _._ _ Block_.___ __... Subdivision
Street and Number where work is to be performed —No ,L %% __ /' ' . J
State work to be performed and purpose of building (By Floors)_
New Building emodeli3r _ Addition___. .............. Repairs No. of Stories
( Signed)
Street
Date /0 _ ��
Size Septic Tank__ 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 • 1x ( 4 - .1 4 - " - i
Capacity Gals.
(Signed) - ll�Z.p
My Conunission Expires Notary Public, State of Florida
Plumbing Inspector.
The undersigned applicant for this building permit does hereby certify that he understands and : cepts I's obligations as an employer of labor
under the Florida Workmen's Compensation Act, being Section 5988, Compiled General Laws of Fl • • 'errnanent Supplement, and has com-
plied with the provisions thereof, and will require similar compliance from all contractors or sub-contractors employed by him in the work to be
performed under this permit; and will post or cause to be posted for inspection on the site of the work such public notice or notices as are
required by the Act. The undersigned agrees to employ only such sub- contractors, on work to be performed under this permit, as are
licensed by Miami Shores Village.
Master Plumber.
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeare
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 fat.
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 foul
materials and /or workmanship.
'Subdi-
vision
Value of
Project
t construct the bui
ith the unders
a d approved • • th
e ans are ch ged
e a umes the
#012stAi
BUILDING ❑
ELECTRICAL ❑ PERMIT 'N? 11865
PLUMBING
t
ROOFING Cl Work to be,pformed udder this Permit
Owner of
Building
Architect
Contractor
or Buil
Legal
Description
Address of
Building
C
Bl.
This permit is granted to the contractor ofbuilder named above
herefor in strict compliance with all ordinances pertaining thereto and
drawings, statements or specifications that may have been submitted
time if the work is not done in compliance with such ordinances or if tti
granted is the understanding that the contractor or builder named above
to the work covered hereby whether shown on the plans o
done by his agents, servants or employees.
In consideration of the issua
pertainin• . in strict co
In a r a fs .ermit I assum
to me of this
purity ith the
reap ility for
RACTO OR BUILD %
MIAMI SHORES VILLAGE, FLORIDA
Signed•
DAT
Contractor's
License No
Amt. of
Permit $
g or to install the equipment or device described in the ap• ' .tion
g that the work will be performed in compliance with any p
proper municipal authorities. This Permit may be revoked at any
ithout authorization. A further condition upon which this permit is
nsibility for a thorough knowledge of the ordinances and regulations
e statements or spec'fic.tio.. and that he assumes respo..'bility for work
SPECTOR
rmit I agree • . erform the work covered hereunder in compliance ith all ordinance and regulations
ns, dr . f tements or specifica '.ns submitted to the proper thorities of Mia. ' Shores Village.
11 work .. ne by either, myself, my v: nt, se : nt or employee.
�ig
AUTHORITY
195