PLUMBING PERMITMIAMI SHORES VILLAGE, FLORIDA
BUILDING DATE,,
ELECTRICAL PERMIT N? 11615
PLUMBING
ROOFING 11 Work to be performed under this Permit
Owner of `" •
•
Building 1: •
I
ljI
Architect
Contractor
or Builder
Legal Lot
Description
Address of
Building /
Bl.
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 plane,
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 -pr in the statements or specifications and that he assumes responsibility for work
done by his agents, servants or employees.
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 agent, servant or employee.
Ire
CONTRACTOR OR BUILDER BY
Subdi-
vision ,fit '' ' /4 r.
Value of
Project $
Signed • BY /
195
Contractor's
License No
Amt. of j
Permit $ '
T
AUTHORITY
Permit No. ._ Date
.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 a'1 rules .uld 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 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 _ Remodeling Addition Repairs No. of Stories
CLOSETS
CONTR.
LIST
CHECK
CONTR.
LIST
CHECK
SEPTIC
TANK
BATH
TUBS
SHOWERS
SEWER DRAIN
CONN. FIELD
Size Septic Tank - - - - -- - -
Feet of Drain Tile
Nature of Water Supply: City —Well.
Amount of Permit $
STATE OF FLORIDA,
COUNTY OF DADE.
ss.
LAVA-
TORIES
SOAKAGE
PIT
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
SINKS
GREASE
TRAP
SLOP
SINKS
SOLAR
HEATER
Type of Tank
.. Dist. Feet of Tank or Drain Field from Well
Size of Soakage Pit
LAUNDRY' CATCH
TUBS URINALS BASIN
DEEP
WELL
(Signed)
(Signed) _. __
SPRKLR. I SWIM•G
SYSTEM POOL
FLOOR DRINKING,
DRAIN I FOUNT'NS
I II
Capacity Cals.
My Commission Expires Notary Public, State of Florida
Master Plumber.
TOTAL
FIXTURES
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 5960, 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-cont. cInpluyed by him in the work to be
performed under this permit; and will post or cause to he 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.
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and tnkc 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 foul
materials and /or workmanship.
Application is hereby mach 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
Registered Architect and /or Engineer____- ......... _
Employing Plumber's Name A.B.C. Septic Tank Service No._ 711 i_. I;. Street' "
Location and Legal Description Lot.____ _ ._____.__ _ _ —._ Blork Subdivision- _ ____.
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 Repairs No. of Stories_
Size Septic Tank ____ -- -- - -_ - -- Type of Tank
Feet of D r a i n Tile -____- - "- . ' `' _Dist. Feet of Tank or Drain Field from Well
Nature of Water Supply: City-Well. __.____ ____._Size of Soakage Pit
Amo
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
No._ 1120 11.E.
Street
Capacity Gals._
D ate 10- 1
Street
My Commission Expires Notary Public, State of Florida
92St /.
unt of Permit $ .. ( Signed)--------- - -__ -_
. 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 Peru anent Supplement, and has com-
plied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors a in cloyed by him in the work to be
performeA 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
requered by the Act. The undersigned agrees to employ only such sub- contractors, on work to be perforned under this permit, as are
licensed by Mimi Shores Village.
( Signed) -- - -
Master Plumber.
STATE OF FLORIDA, I
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.
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
KINKS
SLOP
SINKS
LAUNDRY
TUBE
U
URINALS
CATCH
BASIN
FLOOR
DRAIN
DRINK' NO
FOU NT' NS
TOTAL
FIKTUREB
CONTR.
LIST
CHECK
SEPTIC
TANK
SEWER
CONN.
DRAIN
FIELD
SOAKAGE
PIT
GREASE'
TRAP
SOLAR
HEATER
DEEP
WELL
SPRKLR.
SYSTEM
SW IM•0
POOL
COMTE.
LIST
-
CHECK
Application is hereby mach 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
Registered Architect and /or Engineer____- ......... _
Employing Plumber's Name A.B.C. Septic Tank Service No._ 711 i_. I;. Street' "
Location and Legal Description Lot.____ _ ._____.__ _ _ —._ Blork Subdivision- _ ____.
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 Repairs No. of Stories_
Size Septic Tank ____ -- -- - -_ - -- Type of Tank
Feet of D r a i n Tile -____- - "- . ' `' _Dist. Feet of Tank or Drain Field from Well
Nature of Water Supply: City-Well. __.____ ____._Size of Soakage Pit
Amo
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
No._ 1120 11.E.
Street
Capacity Gals._
D ate 10- 1
Street
My Commission Expires Notary Public, State of Florida
92St /.
unt of Permit $ .. ( Signed)--------- - -__ -_
. 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 Peru anent Supplement, and has com-
plied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors a in cloyed by him in the work to be
performeA 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
requered by the Act. The undersigned agrees to employ only such sub- contractors, on work to be perforned under this permit, as are
licensed by Mimi Shores Village.
( Signed) -- - -
Master Plumber.
STATE OF FLORIDA, I
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.
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.
MIAMI SHORES VILLAGE
BUILDING DEPARTMENT
305- 795 -2204
Building Inspection Request
Datel /3/ )OJ —Time
r t ` [
Permit No.
Name
Address
Company
PtIone #
For Inspector: 1 1 1
Approved
Correction
Re- Insp'n Fee
00
Name & Date
i/
•
Date
Type Insp'n
Permit No.
Name
Address
Company
Phone #
For Inspector:
/
Approved b
Correction
Re- Insp'n Fee
MIAMI SHORES VILLAGE
BUILDING DEPARTMENT
305- 795 -2204
Building Inspection Request
o
o
4
Time
1 Y i
& Date
Type Insp'n
Permit No.
Na
Address
Company
MIAMI SHORES VILLAGE
BUILDING DEPARTMENT
305- 795 -2204
Buil Inspection Request
6D 1d
Date i —/ ! 0 ime
0
Phone# Of cpti % y
For Inspector:' )5 /v Name & Date
Approved
Correction ❑
Re- Insp'n Fee ❑
3°\
Type Insp
Permit No.
MIAMI SHORES VILLAGE
BUILDING DEPARTMENT
Building Inspection Request \
305- 795 -2204
C.
►^
Dat- -' r Time
Nay l\. 6,4
Address l 144
Compan
Phone #
ForInspec3
Approved
Correction
Re- Insp'n Fee
PROPERTY OWNER'
Name
{NilIi
License No.
■
Address
Name Svc
�
\ _ J 5
Fax
Fax
Demolish
Relocation of Structure
Address 1` \ .,
Ali° q
` t
�
s\.b,t
)11- .
t lG..
33
\
3
8
Home Telephone
Add'l Detachment
Other
Business Telephone
Fax
]ENGINEER
Name
{NilIi
License No.
■
Address
Telephone
% S 1 5e ,
0` 33 \toL
Fax
Fax
TYPE OF MANAGEMENT (✓ )
New Construction
Enclosure
License No. ] —
Alteration Exterior
Repair
% S 1 5e ,
0` 33 \toL
Alteration Interior
Fax
Demolish
Relocation of Structure
6-55
Shell Only
Foundation Only
Add'l Attachment
Other
Add'l Detachment
Other
CONTRACTOR
w
-�
;C) \
Name C 55\ l�
License No. ] —
Address J i C0 f■ e
t 'AA• O.
% S 1 5e ,
0` 33 \toL
Telephone
Fax
Qualifier Name 1
6-55
Step 1.
Job Address:
INSTRUCTIONS - The following steps must be taken to obtain a permit from the Miami Shores Vi lage:
Complete the attached permit application which must be signed by the property owner and qualifier. Both signatures must be notarized. Please
print or type to allow for a more accurate processing of your application. If roofing work will be done, a roofing application must be submitted
along with this permit application.
Step 2. Submit the completed application with all necessary documents to the Building, Planning and Zoning Department for processing. During the
processing of your application, you may be asked to submit additional information.
APPLICATION
Folio Number
Lot Block 3
Subdivision Zi°.y , u rt. PB_`_ PG b3 Zoning Linear Feet
Current Use of Property Square Feet Q Units Floors
Proposed Use of Property Value of Work - ( O� Bldg Value
Tenant Information
PERMIT TYPE (✓ )
Building
Electrical
Mechanical
Plumbing
LPGX
Roofing
Fence
Other
‘\o\6 �C 9z_ S \- .
Address Apt.
PERMIT CHANGE (✓ )
Chg. Contractor
Renewal
Revision
Extension
Supplement
Reinspection
A��CmTECT
Name
License No.
Address
Telephone
Fax
Master Permit No. _
Subsidiary Permit No.
Description of Work
City State
a,\ p
Tax Assessed/Appraised Value
PERMIT APPLICATION
( y
Zip
Flood Zone Base Floor Elev.
Page 2
IMPORTANT NOTICES
1. DO NOT BEGIN ANY WORK WITHOUT HAVING RECEIVED YOUR VALIDATED PERMIT AND PERMIT CARD. Applying for a permit does not grant
the right to begin construction. HOURS OF CONSTRUCTION are limited to: Monday through Friday from 7:30 a.m to 6:00 p.m., and Saturday from 8:00 a.m.
to 5:00 p.m. No inspections will be conducted on weekends or holidays.
2. All construction of demolition areas MUST BE MAINTAINED IN A CLEAN. NEAT AND SANITARY CONDITION1free from construction debris.
3. STREETS AND NEIGHBORING PROPERTIES SHALL BE KEPT FREE FROM DIRT AND DEBRIS.
4. SWALES MUST BE PROTECTED FROM BEING DAMAGED BY EQUIPMENT OR VEHICLES, AND MAY NOT BE USED FOR STORAGE. A bond is
required for work in or near the street/sidewalk.
5. CONSTRUCTION TRAILERS ARE PROHIBITED ON SINGLE FAMILY RESIDENTIAL CONSTRUCTION SITES. Other construction may have a trailer
which requires a separate permit.
6. PORTABLE TOILETS for a construction site require a separate permit.
7. DO NOT DISCHARGE WATER INTO THE RIGHT OF WAY OR STORM DRAINS without approval from the Building, Planning and Zoning Department.
8. EQUIPMENT AND MATERIALS SHALL BE STORED at least 10 feet from the edge of pavement.
9. Department of Health and Rehabilitative Services (HRS) approval is required for applications involving septic tanks. Department of Environmental Resources
Management (DERM) and/or Miami -Dade Water and Sewer Department (MDWASD) approval is required for applications involving sewers.
AFFIDAVIT -. Please read carefully.
1
Application is hereby made to obtain a permit to do work and installation as indicated. I, the OWNER of the property, 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, POOL, EXTERIOR DOOR, MECHANICAL, WINDOW, FENCE, DRIVEWAY,
ROOFING and SIGNS and there may be additional permits required from other governmental agencies.
I, the OWNER of the property, have disclosed all information related to any work at the property performed in the prior twelve
months to the Building Official. Further, I am fully aware that if the cumulative cost of work to my home or business under this and
any other permit equals or exceeds fifty percent (50 %) of the fair market value of the structure, the entire structure must meet the
present federal flood criteria for finished floor elevation. I am also fully aware that if the total cost of \work to my home or business
under this and any other permit exceeds fifty percent (50 %) of the replacement cost of the structure, then the entire structure must
conform to the current code requirements of the Building Code.
WARNING TO OWNER: Your failure to record a NOTICE OF COMMENCEMENT may result in you paying twice for
improvements to your property. If you are spending more than $2,500 or intend to obtain financing, you may wish to consult with
your attorney or lender before recording your Notice of Commencement! The Notice of Commencement must be recorded at:
22 N.W. 1st Street, 1" Floor, (305) 679 -1078. Once recorded, the Notice of Commencement mit be POSTED AT THE JOB SITE in
accordance with Section 713 -35 of Florida Statutes. Review the br'ochu - . Villag- Hall on Construction Lien Law and
Choosing a Contractor.
STATE OF FLO,/ NTY OF MIAMI -DADE
Signature oer ///cir-k !i
Print Name
Print Name
grn to and subscribed .efore me this day of c:V7 , Sworn to and subscribed b
Gi ��
ig) . i+* ' I Not ary ' '
Pit o ary �' .. ,
ry ' ublic, State of Florida
/ comm. exp. May 24, 2003
Cnmm. No. CCRl9725
SEA :
Personally known
OR, Produced Identification
PERMIT APPLICATION
[DA, COUNTY\ OF MIAMI -DADE
me this ZIP day of 57Y
Si• .�� of Nota ublic - State of Floridad
KENNETH SHERMAN
S AL: Notary Public, State of Florida
My co ezp. May 24, 2003
• tlmm. NO CC819
Personally known
OR, Produced Identification
Type of Identification Produced: Type of Identification Produced:
ELECTRICAL
TYPE
Minimum Fee
QTY.
TYPE
Dryer
QTY.
TYPE
Outlet, Appliance
QTY.
TYPE
Service Repair
QTY.
A/C Central 1 -3 Ton
Cooling Tower
Fan
Heating Strips, each
Outlet, Wall
Vent Hood, Cost
Service, Temporary
A/C Wall/Win. Tons
A/C Central 4 -7 Ton
Dryer Vents, Number of
Fire Pump
Paint Booth
Outlet, Switch
Ventilation, Cost
Signs
Air Handler, Tons
A/C Central 8 -15 Ton
Ductwork, Cost of
Fixture - Fluorescent
Piping, Flammable Liquid
Oven
Periodic Inspections
Space Heater (kw)
Barbecue
A/C Central 16 -20 Ton
Fire Sprinkler System
Fixture Light
Process/Pressure Piping
Parking Lot Lights
Spas/Hot Tubs
Bath Fan - Vented, #
A/C Central 20+ Ton
Fireplaces, Number of
Flood Lights
Pressure Vessel
Plugmold/Strip
Subfeeds, No. of Amps
A/C Window
FPL - Load Central
Posts
Swim Pool, Commercial
Air Conditioners
Garbage Disposal
Range/Range Top
Swim Pool, Residential
Chiller
Generators, etc.
Receptacles
Switchboards
Clear Violations
Heat Recovery
Refrigerator, Comm. (p/PH)
Temp Serv., Construction
Compactor
Low -volt, Burglar
Refrigerator, Domestic
Temp for Test - 30 days
Deep Freezer
Low -volt, Fire
Renew - Temp Service
Water Closet
Demolition
Low -volt, Intercom/Teleph.
Repair Circuits
Water Ileater
Dishwasher
Low -volt, Television
Service, Number of Amps
Water Ileater New
MECHANICAL
TYPE'
Minimum Fee
QTY.
TYPE
Condensate Drain
QTY.
TYPE ,QTY.
Generator
TYPE
Refrigeration, Tons
QTY.
A/C Central, Tons
"lath Tub
Cooling Tower
Drinking Fountain
Heating Strips, each
Miscellaneous Repairs
Vent Hood, Cost
olar Water Heater
A/C Wall/Win. Tons
73idf.tt
Dryer Vents, Number of
Filter Replace
Paint Booth
Pool Piping
Ventilation, Cost
prinkler Repair
Air Handler, Tons
Cap - u
Ductwork, Cost of
Fountain
Piping, Flammable Liquid
Pump and Abandon
Periodic Inspections
Sprinkler System
Barbecue
Cap - Water
Fire Sprinkler System
Gas - Appliance
Process/Pressure Piping
Pump, Domestic
Supply, AC Well
Bath Fan - Vented, #
Cap - Sewer
Fireplaces, Number of
Gas - Natural
Pressure Vessel
Pump, Fire Stand
Temporary Toilet
_ PLUMBING
TYPE
A/C Condensate
QTY.
TYPE
Drains, Roof
QTY.
TYPE
Miscellaneous Fixture
QTY.
TYPE
Soakage Pit
QTY.
"lath Tub
Drinking Fountain
Miscellaneous Repairs
olar Water Heater
73idf.tt
Filter Replace
Pool Piping
prinkler Repair
Cap - u
Fountain
Pump and Abandon
Sprinkler System
Cap - Water
Gas - Appliance
Pump, Domestic
Supply, AC Well
Cap - Sewer
Gas - Natural
Pump, Fire Stand
Temporary Toilet
Catch Basin
Gas - Propane
Pump, Re- circulate
Temporary Water Closet
Clothes Washer
Gas Piping
Pump, Replace - Pool
Urinal
Dental Chair
Grease Trap
Pump, Sprinkler
Utility - Sewer
Discharge Well
Ice Maker
Pump, Sump
Utility - Water
Dishwasher
Indirect Wastes
Relay Repair
Vacuum Pump
Disposal
Interceptor
Roof Inlet
Water Closet
Domestic Well
Laundry Tray
Septic Connection
Water Ileater
Drainfield, 4" 'file/Res.
Lavatory
Septic Tank
Water Ileater New
Drains, Area
Meter Set (Gas)
Sewer Connection
Water Re -pipe
Drains, Floor
Minimum Fee
Shower
Water Service
Drains, French
Miscellaneous Equipment
Sink
Well, Supply
Page 3
PERMIT APPLICATION
INSTRUCTIONS: Please indicate the type of work being performed and quantity(ies) in the space provided below.
RECEIVED AND REVIEWED BY: DATE:
SECTION
BY
DATE
Zoning
Electrical
Mechanical
- /
Plumbin •
/ -oi
Fire
— IF
Public Works
Structural
Building Official
Page 4
OFFICE USE ONLY
CHECKLIST
❑ OWNER - BUILDER FORM
(Attach)
❑ FIRE DEPARTMENT
APPROVAL (Commercial /
multi- family)
❑ CONCURRENCY
(New Construction)
❑ OTHER
(Specify & Attach)
❑ PROOF OF OWNERSHIP
(Attach)
❑ HRS / DERM APPROVAL
(Septic / Sewer)
❑ IMPACT FEE
(New Construction)
❑ OTHER
(Specify & Attach)
PERMIT FEES
$3.00 per page (Scanning Fee) $
Miami Shores Village
Bond
Metropolitan Dade County (C.C.F.)
Inspector State Educational Fund $
State DCA (Radon) $
Code Enforcement Fine $
Zoning Review
$ X24 "
(¢.005 /sq.ft.)
(¢.01 /sq.ft.)
REVIEWED AND PREPARED BY:
DATE:
PERMIT APPLICATION
❑ CONDO ASSOCIATION APPROVAL
(Attach)
❑ BPR APPROVAL (Restaurants)
❑ CONTRACTOR REGISTRATION
(On File)
TOTAL $ [ ko_n
ISSUING OFFICIAL
CONDITION OF APPROVAL
Revised July 2001
10050 N.E. 2ND AVE., MIAMI SHORES, FL • (305) 795 -2207 • FAX (305) 756 -8972 • http : / /www.miamishoresvillage.com
FOR
Miami Shores Village
10050 NE 2nd Avenue
Phone: 305 - 795 -2204
Printed: 10 /25/2002
Applicant: DAVID MARKUS
Owner: MARKUS DAVID
JOB ADDRESS: 1190 NE 92 ST
Contractor ESSIG POOLS
Local Phone:
Parcel # 1132050270460
Permit Status: Approved
Work: POOL PIPING
Miami, Florida
ESSIG POOLS, INC.
1800 NE 151ST STREET
NORTH MIAMI, FL 33162
Mellon United National Bank
a
v087 L 261I' 40670096464 00 2 L L330 20v
Plumbing Permit
Permit Number: PL2002 -288
Contractor's Address:
Legal Description: BAY LURE PB 44 -63 LOT 8
Fees: Description Amount
FEE2002 -6072 Building Fee $120.00
Total Fees: $120.00
Total Fees: $120.00
Total Receipts: $0.00
Permit Expiration: 4/23/2003 Construction Value: $900.00
If there is no permit package accessible on the job -site for inspectors to verify, there will be no inspections. Re- inspection
DATE
I lr Op a�
PAY
TO THE
gAg
63 -42
1 670 96
87126
ORDER 0 DOLLARS
Page 1 of 1
BLK 3 LOT SIZE 75.000 X 125 OR
nation herefor in strict compliance with all
ifications that may have been submitted to
s or if the plans are changed without
)onsibility for a thorough knowledge of the
that he assumes responsibility for work done
.ns pertaining thereto and in strict conformity
•esponisibility for all work done by either
Page 4
OFFICE USE ONLY
CHECKLIST
❑ OWNER - BUILDER FORM
(Attach)
❑ FIRE DEPARTMENT
APPROVAL (Commercial /
multi - family)
❑ CONCURRENCY
(New Construction)
Cl OTHER
(Specify & Attach)
$3.00 per page (Scanning Fee)
Miami Shores Village
Bond
Metropolitan Dade County (C.C.F.)
Inspector State Educational Fund
State DCA (Radon)
Code Enforcement Fine
Zoning Review
Notary
❑ PROOF OF OWNERSHIP
(Attach)
❑ HRS / DERM APPROVAL
(Septic / Sewer)
❑ IMPACT FEE
(New Construction)
❑ OTHER
(Specify & Attach)
( x .6 x/1000
0)
$ (¢.005 / sq.ft.)
$ (¢.01 /sq.ft.)
SECTION
Zoning
Electrical
Mechanical
Plumbing
Fire
Public Works
Structural
Building Official
BY
DATE
PERMIT APPLICATION
❑ CONDO ASSOCIATION APPROVAL
(Attach)
❑ BPR APPROVAL (Restaurants)
❑ CONTRACTOR REGISTRATION
(On File)
PERMIT FEES
TOTAL
ISSUING OFFICIAL
REVIEWED AND PREPARED BY: DATE:
CONDITION OF APPROVAL
Revised July 2001
10050 N.E. 2"° AVE., MIAMI SHORES, FL • (305) 795 -2207 • FAX (305) 756 -8972 • http : / /www.miamishoresvillage.com
ELECTRICAL
TYPE
Minimum Fee
QTY.
'I YI'I;
Dryer
QTY.
TYI'L
Outlet, Appliance
Q'I'V.
TN P1.;
Service Repair
(,)'I'Y.
A/C Central 1 -3 Ton
Fan
Outlet, Wall
Service, Temporary
A/C Central 4 -7 Ton
Fire Pump
Outlet, Switch
Signs
A/C Central 8 -15 Ton
Fixture - Fluorescent
Oven
Space Heater (kw)
A/C Central 16-20 Ton
Fixture Light
Parking Lot Lights
Spas/Hot Tubs
A/C Central 20+ Ton
Flood Lights
Plugmold/Strip
Subfeeds, No. of Amps
A/C Window
FPL - Load Central
Posts
Swim Pool, Commercial
Air Conditioners
Garbage Disposal
Range/Range Top
Swim Pool, Residential
Chiller
Generators, etc.
Receptacles
Switchboards
Clear Violations
Heat Recovery
Refrigerator, Comm. (p/PH)
Temp Serv., Construction
Compactor
Low -volt, Burglar
Refrigerator, Domestic
Temp for Test - 30 days
Deep Freezer
Low -volt, Fire
Renew - Temp Service
Water Closet
Demolition
Low -volt, Intercom/Teleph.
Repair Circuits
Water Heater
Dishwasher
Low -volt, Television
Service, Number of Amps
Water Heater New
MECHANICAL
TYPE
Minimum Fee
QTY.
TYPE
'Condensate Drain
QTY.
TYPE
Generator
Q'I'V'.
'I'YI'E
Refrigeration, Tons
QTY.
A/C Central, Tons
Cooling Tower
Heating Strips, each
Vent Hood, Cost
A/C Wall/Win. Tons
Dryer Vents, Number of
Paint Booth .
Ventilation, Cost
Air Handler, Tons
Ductwork, Cost of
Piping, Flammable Liquid
Periodic Inspections
Barbecue
Fire Sprinkler System
Process/Pressure Piping
1
Bath Fan - Vented, #
Fireplaces, Number of
Pressure Vessel
Temporary Toilet
PLUM BING
TYPE
A/C Condensate
QTY.
TYPE
Drains, Roof
QTY.
TYPE
Miscellaneous Fixture
QTY.
'fYI'I:
Soakage Pit
Q'I'Y.
Bath Tub
Drinking Fountain
Miscellaneous Repairs
Solar Water Heater
Bidet
Filter Replace
Pool Piping
Sprinkler Repair
Cap - Fixture
Fountain
Pump and Abandon
Sprinkler System
Cap - Water
Gas - Appliance
Pump, Domestic
Supply, AC Well
Cap - Sewer
Gas - Natural
Pump, Fire Stand
Temporary Toilet
Catch Basin
Gas - Propane
Pump, Re- circulate
Temporary Water Closet
Clothes Washer
Gas Piping
Pump, Replace - Pool
Urinal
Dental Chair
Grease Trap
Pump, Sprinkler
Utility - Sewer
Discharge Well
Ice Maker
Pump, Sump
Utility - Water
Dishwasher
Indirect Wastes
Relay Repair
Vacuum Pump
Disposal
Interceptor
Roof Inlet
Water Closet
Domestic Well
Laundry Tray
Septic Connection
Water Heater
Drainfield, 4" Tile/Res.
Lavatory
Septic Tank
Water Heater New
Drains, Area
Meter Set (Gas)
Sewer Connection
Water Re -pipe
Drains, Floor
Minimum Fee
Shower
Water Service
Drains, French
Miscellaneous Equipment
Sink
Well, Supply
Page 3
PERMIT APPLICATION
INSTRUCTIONS: Please indicate the type of work being performed and quantity(ies) in the space provided below.
RECEIVED AND REVIEWED 1#Y: DATE:
Page 2
IMPORTANT NOTICES
DO NOT BEGIN ANY WORK WITHOUT HAVING RECEIVED YOUR VALIDATED PERMIT AND PERMIT CARD. Applying for a permit does not grant
the right to begin construction. HOURS OF CONSTRUCTION are limited to: Monday through Friday from 7:30 a.m. to 6:00 p.m., and Saturday from 8:00 a.m.
to 5:00 p.m. No inspections will be conducted on weekends or holidays.
2. All construction of demolition areas MUST BE MAINTAINED IN A CLEAN, NEAT AND SANITARY CONDITION free from construction debris.
3. STREETS AND NEIGHBORING PROPERTIES SHALL BE KEPT FREE FROM DIRT AND DEBRIS.
4. SWALES MUST BE PROTECTED FROM BEING DAMAGED BY EQUIPMENT OR VEHICLES, AND MAY NOT BE USED FOR STORAGE. A bond is
required for work in or near the street/sidewalk.
5. CONSTRUCTION TRAILERS ARE PROHIBITED ON SINGLE FAMILY RESIDENTIAL CONSTRUCTION SITES. Other construction may have a trailer
which requires a separate permit.
6. PORTABLE TOILETS for a construction site require a separate permit.
7. DO NOT DISCHARGE WATER INTO THE RIGHT OF WAY OR STORM DRAINS without approval from the Building, Planning and Zoning Department.
8. EQUIPMENT AND MATERIALS SHALL BE STORED at least 10 feet from the edge of pavement.
9. Department of Health and Rehabilitative Services (HRS) approval is required for applications involving septic tanks. Department of Environmental Resources
Management (DERM) and/or Miami -Dade Water and Sewer Department (MDWASD) approval is required for applications involving sewers.
1.
AFFIDAVIT - Please read carefully.
Application is hereby made to obtain a permit to do work and installation as indicated. I, the OWNER of the property, 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, POOL, EXTERIOR DOOR, MECHANICAL, WINDOW, FENCE, DRIVEWAY,
ROOFING and SIGNS and there may be additional permits required from other governmental agencies.
I, the OWNER of the property, have disclosed all information related to any work at the property performed in the prior twelve
months to the Building Official. Further, I am fully aware that if the cumulative cost of work to my home or business under this and
any other permit equals or exceeds fifty percent (50 %) of the fair market value of the structure, the entire structure must meet the
present federal flood criteria for finished floor elevation. I am also fully aware that if the total cost of work to my home or business
under this and any other permit exceeds fifty percent (50 %) of the replacement cost of the structure, then the entire structure must
conform to the current code requirements of the Building Code.
WARNING TO OWNER: Your failure to record a NOTICE OF COMMENCEMENT may result in you paying twice for
improvements to your property. If you are spending more than $2,500 or intend to obtain financing, you may wish to consult with
your attorney or lender before recording your Notice of Commencement. The Notice of Commencement must be recorded at:
22 N.W. 1st Street, 1g Floor, (305) 679 -1078. Once recorded, the Notice of Commencement must be POSTED AT THE JOB SITE in
accordance with Section 713 -35 of Florida Statutes. Review the brochure at Village Hall on Construction Lien Law and
Choosing a C•ntractor.
Print Name
Sworn to and subscribed before me this
t �;': ?l 1 / . 01
My comm. m exp. jLv 5
Coa �„ ���
STATE 0
Signature
Signature of Notary Public - State of Flo
DA, COUNTY OF MIAMI -DADE
N
Iorida
, 2003
Print Name
SEAL: SEAL:
Personally known OR, Produced Identification
STA 0 ORIpA, CO Y OF MIAMI -DADE
r ature of Contractor / Qualifier ,
C.c
Sworn to and sub
Signature of Notary Public - S
PERMIT APPLICATION
Personally known OR, Produced Identification
Type of Identification Produced: Type of Identification Produced:
CONTRACTOR
Name
/ (.O r),,,//
License No. J� o f/ 6 1 L
(� `7
Address
Telephone 6 c.y 3 t 9 Fa
Qualifier Name /9-Lt Gid 60(1' (.e 1
PROPERTY OWNER
New Construction
Name /j 1 2' 1/ "� /�� yvc
Alteration Exterior
Address
r
/(9 O C '
1
(�
V
Home Telephone j `71
4 ( t
Business Telephone
Fax
Shell Only
TYPE OF MANAGEMENT ( )i
New Construction
Enclosure
Alteration Exterior
Repair
Alteration Interior
Demolish
Relocation of Structure
Shell Only
Foundation Only
Addi 1 Attachment
Other
Add, l Detachment
Other
INSTRUCTIONS - The following steps must be taken to obtain a permit from the Miami Shores Village:
Step 1.
Step 2. Submit the completed application with all necessary documents to the Building, Planning and Zoning Department for processing. During the
processing of your application, you may be asked to submit additional information.
APPLICATION
Job Address: / 1 4'O J C S 2- .07/4 4.1
Folio Number
Lot
Subdivision
Current Use of Property
Proposed Use of Property
Tenant Information
Complete the attached permit application which must be signed by the property owner and qualifier. Both signatures must be notarized. Please
print or type to allow for a more accurate processing of your application. If roofing work will be done, a roofing application must be submit-
ted along with this permit application.
Address
Apt.
Block
PB PG Zoning Linear Feet
Square Feet Units Floors
Value of Work 7 0 0 Bldg Value
Tax Assessed/Appraised Value
Flood Zone Base Floor Elev
PERMIT TYPE (✓ )
Building
Electrical
ec amcal
Plumbing
Roofing
Fence
Other
7
PERMIT CHANGE (✓ )
Chg. Contractor
Renewal
Revision
Extension
Supplement
Reinspection
ARCHITECT
Name
License No.
Address
Telephone
Fax
PERMIT APPLICATION
Master Permit No.
Subsidiary Permit No.
/4 J V6 0 v 4 - 1
City
Description of Work
State
/4 r7 q— //
Zip
ENGINEER
Name
License No.
Address
Telephone
Fax
0
cD
Miami Shores Village
10050 NE 2nd Avenue
Phone: 305 - 795 -2204
Printed: 10 /29/2002
Applicant: DAVID
Owner: MARKUS
JOB ADDRESS:
Contractor
Local Phone:
Parcel # 1132050270460
Permit Status: APPROVED Permit Expiration:
Work: INSTALL 3" WELL
Signe
Signed:
1190 NE 92
r V ) 2,0
Plumbing Permit
Permit Number: PL2002 -290
MARKUS
DAVID
ST
Contractor's Address:
Legal Description: BAY LURE PB 44 -63 LOT 8
Page 1 of 1
Fees:
FEE2002 - 6086
Description Amount
Building Permit Application Fee $60.00
Total Fees: $60.00
Total Fees: $60.00
Total Receipts: $0.00
4/27/2003
Construction Value:
$700.00
If there is no permit package accessible on the job -site for inspectors to verify, there will be no inspections. Re- inspection
BLK 3 LOT SIZE 75.000 X 125 OR
...fee is $50.00, which must be paid in advance before calling for another inspection.
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 .roper 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 furth-r 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 regul -tions 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 - agent — se ant.-or- employees. - —
(INSPECTOR) BY:
In considerati• n ;j 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 responisibility for all work done by either
myself, my age t, servant or employes.
(Contractor or Builder) BY:
• • ■1•• • •VA • (.1•:" ,••••■cv _..—.■•••••■•••••.•14011 •
,Isnrogto senevnonarf "nzum volvint ,,,,,
ESSIG POOLS, INC.
1 144.
-71 /A
1800 NE 151ST STREET
TO THE
ORDER OFI &/1/( )
NORTH MIAMI, FL 33162
-69
$13 6 0
63-964
DATE
670
1
PAY
Azat
( (.° Mellon United National Bank
Miami. Florida
FOR seQ-;
ils087Ls?us 1:0670096461: 002L L33020"
DOLLARS
44
87157
BUILDING
ELECTRICAL
PLUMBThIG
ROOFING
Owner of
Building`
n Work to be performed under this Permit
PERMIT N? 11340
Architect
ontractor
or Builder , '
Legal
Description
Address of
Building
Lot/
MIAMI SHORES VILLAGE, FLORIDA
�l.
Subdi-
vision
DATE ° r
■
195_1
Contractor's
License No
Value of Amt, of
r s Project $ Permit $ i
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: .' , BY
INSPECTOIV
In consideration of the issuance to me of this permit I agree to rform the work covered hereunder in compliance with all ordinances and regulations
pertaining thereto and in strict conformity with the plans, drawings, ments or specifications submitted to the proper authorities of Miami Shores Village.
In accepting this permit I assume responsibili' ' f all work done 10r. either, myself, my 'gent, servant„or employee.
Permit No. =--
Size Septic Tank
Feet of Drain Tile___
Nature of Water Supply: City— Well.
STATE OF FLORIDA, 1 ss.
COUNTY OF DADE.
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 . ____ - 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
Amount of Perrnit $ . -/ - (Signed)
( Signed)._
Repairs
Type of Tank
Dist: Feet of Tank or Drain Field from Well
Size of Soakage Pit
Date
Capa:ity Gals..
No. of Stories
Plumbing Inspector.
The undersigned applicant for this building permit does hereby certify that he understands and accents his obligations as an employer of labor
under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Floridl I.crnuu:cut Supplement, and has com-
plied with the provisions thereof, and will r9quire similar compliance from all contractors or sub - contractors c mployed by him in the work to be
performed under this permit; and w1. 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 aufr'gritY, 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 such re- inspection is made necessary by iciproper notice for inspection, or faulty
materials and /or workmanship.
CLOSETS
BATH
TUBS
SHOWERS
LAVA-
TORIES
SINKS
SLOP
SINKS
LAUNDRY
TUBS
URINALS
CATCH
BASIN
FLOCR
DRAIN
DRINKING
FOUNT'Ns
I }
7t / 7 .- ? I
i t
TOTAL
FIXTURES XTTURES
CONTR.
LIST
f e.....1
..
CHECK
-,
��
SEPTIC
TANK
SEWER
CONN.
DRAIN
--FIELD
SOAKAGE
PIT
GREASE
TRAP
SOLAR
HEATER
DEEP
WELL
SPRKLR.
SYSTEM
SWIM'G
POOL
CONTR.
LIST
7
-
CHECK
Permit No. =--
Size Septic Tank
Feet of Drain Tile___
Nature of Water Supply: City— Well.
STATE OF FLORIDA, 1 ss.
COUNTY OF DADE.
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 . ____ - 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
Amount of Perrnit $ . -/ - (Signed)
( Signed)._
Repairs
Type of Tank
Dist: Feet of Tank or Drain Field from Well
Size of Soakage Pit
Date
Capa:ity Gals..
No. of Stories
Plumbing Inspector.
The undersigned applicant for this building permit does hereby certify that he understands and accents his obligations as an employer of labor
under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Floridl I.crnuu:cut Supplement, and has com-
plied with the provisions thereof, and will r9quire similar compliance from all contractors or sub - contractors c mployed by him in the work to be
performed under this permit; and w1. 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 aufr'gritY, 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 such re- inspection is made necessary by iciproper notice for inspection, or faulty
materials and /or workmanship.
C. fi'' def
Miami Shores Village
Florida
Gentlemen:
Plumbing Inspection Department
.Please send us a supply of the attached
form. Thank you.
DAD.E GAS COMPANY
6940 1117 27 Ave.
Permit No
Size Septic Tank
Feet of Drain Tile
/9 2
92.00
Nature of Water Supply: City—Well
Amount of Permit $ 2.00
STATE OF FLORIDA,
COUNTY OF DADE.
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 w°ric./ — Cippes
Owner's Name and Address 9 990 .VE 92 St No. Street
Registered Architect and/or Engineer
6940 27 Ave
Employing Plumber's Name DADS GAS 01_1(pARY N
Location and Legal Description Lot_ ___ Block Subdivision
F
Street and Number where work is to be perfon 1190 AT 92 St
ned—No Street
State work to be performed and purpose of building (By Floors)_
New Building Remodeling. Addition Repairs
Type of Tank
_Dist. Feet of Tank or Drain Field from Well
Size of Soakage Pit
(Signed)_
// 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 ccnn-
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 perfornj under this penult, as are
licensed by Miami Shores Village.
( Signed)
Date November 19 1963
No. of Stories.
Capacity Gals
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
Master Plumber.
NOTE: A re-inspection fee of $1.00 will be made when such re-inspection is made by improper notice for inspection, or faulty
materials and/or worlananship.
CLOSE"
BATH
TUBS
SH
LAVA-
TORIES
SINKS
SLOP
SINKS
LAUNDRY
TUBE
URINALS
CATCH
BASIN
FLOOR
DRAIN
DRINKING
FOUNT'NS
a
TOTAL
FIXTURES
cotera.
LIST
.
-
X
CHECK
,----
4 -
SEPTIC
TANK
SEWER
CONN.
DRAIN
FIELD
SOAKAGE
PIT
GREASE
TRAP
SOLAR
HEATER
DEEP
WELL
SPRKLR.
SYSTEM
SWING
POOL
CONTR.
LIST
CHECK
Permit No
Size Septic Tank
Feet of Drain Tile
/9 2
92.00
Nature of Water Supply: City—Well
Amount of Permit $ 2.00
STATE OF FLORIDA,
COUNTY OF DADE.
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 w°ric./ — Cippes
Owner's Name and Address 9 990 .VE 92 St No. Street
Registered Architect and/or Engineer
6940 27 Ave
Employing Plumber's Name DADS GAS 01_1(pARY N
Location and Legal Description Lot_ ___ Block Subdivision
F
Street and Number where work is to be perfon 1190 AT 92 St
ned—No Street
State work to be performed and purpose of building (By Floors)_
New Building Remodeling. Addition Repairs
Type of Tank
_Dist. Feet of Tank or Drain Field from Well
Size of Soakage Pit
(Signed)_
// 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 ccnn-
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 perfornj under this penult, as are
licensed by Miami Shores Village.
( Signed)
Date November 19 1963
No. of Stories.
Capacity Gals
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
Master Plumber.
NOTE: A re-inspection fee of $1.00 will be made when such re-inspection is made by improper notice for inspection, or faulty
materials and/or worlananship.