PLUMBINGDate P ' Job Address 9IP' A.)4 9'L)2$ 7 Tax Folio
Legal Description Z....07 9 )k 10, e 1 ii 4 Y/UC Historically Designated: Yes No
Owner/Lessee / Tenan�t�p FA L' L_ (JR Apt' Master Permit #
Y
% 7
Owner's Address / ) %.) 4ID 57- Phone AK3 'q 4 " '7a
93 Aikti 10 97 (Yr
Contracting Co. LLOYD A. r -3 % /G
Q 1 II5 OR b G/�Lrr
State # i? 1 e
Square Ft. T)
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
11 g
of owner and/or Condo President Date
Notary `arid/ • r Condo President
My Commission Expires:
al moo um0141 attained I I
Iona
ZOYVaS As P0 ,
- dam tom A
imam ,3 11 113193 i �
moos
FEES: PERMIT RADON
APPROVED:
Zoning Building
Mechanical Plumbing
//?-a
Date
r6Ftl CROttnrr
pry .atnm xp. 5/20/2QO1
Bonged ]9y Service Ins
No. CC649326
1 Personally Known 11 Other I.D
Address
SS# , Phone 9S1 6-90
Municipal # Competency # Ins. Co.
Architect/Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIPTION 2_0 /R. (A) R - T / &Mz
Estimated Cost (value), r • 6D
WARNING TO OWNER: YOU MUST RECORD A NOTICE OF COMMENCEMENT AND YOUR FAILURE TO DO SO MAY
RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY (IF YOU INTEND TO OBTAIN FINANCING,
CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT.)
Application is hereby made to obtain a permit to do work and installation as indicated above, and on the attached addendum (if applicable). I
certify that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that separate
permits are required for ELECTRICAL, PLUMBING, SIGNS, POOLS, ROOFING and MECHANICAL WORK.
OWNE AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable
law, a sting cons tion and zoning. Furthermore, I authorize the abov amed • •ntractor to • • the work stated.
Signa
cto o owner Builder
Not as to Contractor or Owner- Builder
My ' : 'ssion Expires:
C.C.F. (. 2 0 NOTARY
Electrical
Date
Engineering
CONSTRUCTION PERMIT FOR:
[ ] New System [ ] Existing System
] Abandonment
[ ] Repair
APPLICANT:
PROPERTY STREET ADDRESS:
LOT:
PROPERTY ID :
0
T
H
E
R
SPECIFICATIONS BY:
APPROVED BY:
DATE ISSUED:
STATE OF FLORIDA
DEPARTMENT OF HEALTH
ONSITE SEWAGE DISPOSAL SYSTEM
CONSTRUCTION PERMIT
Authority: Chapter 381, FS &
BLOCK: SUBDIVISION:
N
F LOCATION OF BENCHMARK:
I ELEVATION OF PROPOSED SYSTEM SITE
E BOTTOM OF DRAINFIELD TO BE [
L
D FILL REQUIRED: ( ] INCHES
DH 4016, 10/96 (Replaces HRS -H Form 4016 [page 1) which may be used)
(Stock Number: 5744- 001 - 4016 -0)
PERMIT #
DATE PAID
FEE PAID $
RECEIPT #'
Chapter 1OD -6, FAC
[ ] Holding Tank [ ] Temporary /Experimental
[:':J Other(Specify)
AGENT:
[SECTION /TOWNSHIP /RANGE /PARCEL NUMBER]
(OR TAX ID NUMBER]
SYSTEM MUST BE CONSTRUCTED IN ACCORDANCE WITH SPECIFICATIONS AND STANDARDS OF CHAPTER 10D -6,
FAC. REPAIR PERMITS AND HOLDING TANK PERMITS EXPIRE 90 DAYS FROM THE DATE OF ISSUE. ALL OTHER
PERMITS EXPIRE ONE YEAR FROM THE DATE OF ISSUE. DEPARTMENT OF HEALTH APPROVAL OF SYSTEM DOES
NOT GUARANTEE SATISFACTORY PERFORMANCE FOR ANY SPECIFIC PERIOD OF TIME. ANY CHANGE IN MATERIAL
FACTS WHICH SERVED AS A BASIS FOR ISSUANCE OF THIS PERMIT REQUIRE THE APPLICANT TO MODIFY THE
PERMIT APPLICATION. SUCH MODIFICATIONS MAY RESULT IN THIS PERMIT BEING MADE NULL AND VOID.
SYSTEM DESIGN AND SPECIFICATIONS
T [ ] [GALLONS / GPD] SEPTIC TANK /AEROBIC UNIT CAPACITY MULTI- CHAMBERED /IN SERIES:[ ]
A [ l [GALLONS / GPI)] CAPACITY MULTI- CHAMBERED /IN SERIES:[ ]
N [ ] GALLONS GREASE INTERCEPTOR CAPACITY [MAXIMUM CAPACITY SINGLE TANK: 1250 GALLONS]
K [ ] GALLONS PER DOSE DOSING TANK CAPACITY DOSE KATE [ ] PER 24 HRS NO. OF PUMPS: [ ]
D [ ] SQUARE FEET PRIMARY DRAINFIELD SYSTEM
R [ ] SQUARE FEET SYSTEM
A TYPE SYSTEM: (' ) STANDARD [ ] FILLED [ /] MOUND [ ]
I CONFIGURATION: [ ] TRENCH [ ] BED [i 1
[INCHES /FT) (ABOVE /BELOW) BENCHMARK /REFERENCE POINT
] [INCHES /FT] [ABOVE /BELOW] BENCHMARK /REFERENCE POINT
EXCAVATION REQUIRED: [ ] INCHES
Applicant
TITLE:
TITLE: CHD
EXPIRATION DATE:
► Q -. � � J
Page 1 of 2
INSTRUCTIONS:
PERMIT NUMBER: Permit tracking number by County Health Department.
APPLICATION FOR: Check type of permit; if "Other" specify type in blank.
APPLICANT: Property owner's full name.
TELEPHONE: Telephone number for applicant or agent.
AGENT: Property owner's legally authorized representative.
MAILING ADDRESS: P.O. box or street mailing address'for applicant or agent.
LOT, BLOCK, SUBDIVISION or
PROPERTY ID #: 27 character ID number for property. (Health Department may require property appraiser ID# or
section /township /range /parcel number.)
SYSTEM DESIGN AND
SPECIFICATIONS:
TANK: Minimum specifications from Chapter 1OD -6, FAC.
DRAINFIELD: Minimum specifications from Chapter 10D -6, FAC.
OTHER: Other specifications, such as operating permit requirements, low- volume flush toilets, variance provisos.
SPECIFICATIONS BY: Name of individual providing specifications. If designed by a registered engineer must be sealed.
APPROVED BY: County Health Department personnel reviewing and approving permit.
DATE ISSUED: Date permit is issued by County Health Department.
4
I
• EXPIRATION DATE: One year from date issued if the system has not been installed. Permits for system repairs become void 90 days from the
date issued.
•
APPLICATION FOR:
New System
Repair
FS'
[ -,//)
APPLICANT:
AGENT:
t
MAILING ADDRESS:
PROPERTY SIZE:
0
1
2
3
4
y
Gi"
STATE OF FLORIDA
DEPARTMENT OF HEALTH
ONSITE SEWAGE DISPOSAL SYSTEM
APPLICATION FOR CONSTRUCTION PERMIT
Authority: Chapter 381, FS & Chapter 1OD -6,
U,1,] Existing System
j] Abandonment
TO BE COMPLETED BY APPLICANT OR APPLICANT'S AUTHORIZED AGENT. ATTACH BUILDING PLAN AND TO -SCALE
SITE PLAN SHOWING PERTINENT FEATURES REQUIRED BY CHAPTER 1OD -6, FLORIDA ADMINISTRATIVE CODE.
PROPERTY INFORMATION [IF LOT IS NOT IN A RECORDED SUBDIVISION, ATTACH LEGAL DESCRIPTION OR DEED]
LOT: // / BLOCK: J� SUBDIVISION: DATE OF
SUBDIVISION.
PROPERTY ID #: // �a / A o xffro [Section /Township /Range /Parcel No.] ZONING:
PROPERTY STREET ADDRESS:
DIRECTIONS TO PROPERTY:
PI A 1. 6.7,-1/V-6
BUILDING INFORMATION
Unit Type of
No Establishment
I i / Ail: .
[x] Garbage Grinders /Disposals
[ Ultra -low Volume Flush Toilets
No. of
Bedrooms
. i (
APPLICANT'S SIGNATURE % ; ^ � 1 C / 7' )/
DH 4015, 10/96 (Replaces HRS -H Form 4015 [Page 1] which may be used)
(Stock Number: 5744- 001 - 4015 -1)
(C //]
1,21
Holding Tank
Other(Specify)
PERMIT #
DATE PAID
FEE PAID
RECEIPT #
FAC
TELEPHONE: Y
ACRES [Sgft /43560] PROPERTY WATER SUPPLY: [ ] PRIVATE [ PUBLIC
Gv?D!' joie . )
RESIDENTIAL [ ] COMMERCIAL
Building # Persons
Area Sgft Served
(b) Spas /Hot Tubs
/
Temporary /Experimental
Business Activity
For. Commercial Only
% -�
DATE:
[d] Floor /Equipment Drains
[AA Other (Specify)
Page 1 of 3
INSTRUCTIONS:
APPLICATION FOR: Check type of permit, if "Other" specify type in blank.
APPLICANT: Property owner's full name.
TELEPHONE: Telephone number for applicant or agent.
AGENT: Property owner's legally authorized representative.
MAILING ADDRESS: P.O. box or street, city, state and zip code mailing address for applicant or agent.
LOT, BLOCK,
SUBDIVISION:
Lot, block, and subdivision for lot (recorded or unrecorded subdivision). If lot is not in a recorded subdivision, a copy of the lot
legal description or deed must be attached.
DATE OF SUBDIVISION: Official date of subdivision recorded in county plat books (month /day /year) or date lot originally recorded. Dividing an approved
lot into two or more parcels for the purpose of conveying ownership shall be considered a subdivision of the lot.
PROPERTY ID #: 27 character number for property. (Health Department may require property appraiser ID# or section/township/range/parcel number.)
PROPERTY SIZE:
WATER SUPPLY: Check private or public.
Net usable area of property in acres (square footage divided by 43,560 square feet) exclusive of all paved areas and prepared road
beds within public rights -of way or easements and exclusive of streams, lakes, normally wet drainage ditches, marshes, or other
such bodies of water. Contiguous unpaved and noncompacted road rights -of -way and easements with no subsurface obstructions
may be included in calculating lot area.
PROPERTY ADDRESS: Street address for property. For lots without an assigned street address, indicate street or road and locale in county.
O
DIRECTIONS: Provide detailed instructions to lot or attach an area map showing lot location.
BUILDING INFORMATION: Check residential or commercial.
TYPE ESTABLISHMENT: List type of establishment from Table II, Chapter 10D-6, FAC. Examples: single family, single wide mobile home, restaurant,
doctor's office.
NO. BEDROOMS: Count all rooms designed primarily for sleeping and those areas expected to routinely provide sleeping accommodations for
occupants.
BUILDING AREA: Total square footage of enclosed habitable area of dwelling unit, excluding garage, carport, exterior storage shed, or open or fully
screened patios or decks. Based on outside measurements for each story of structure.
# PERSONS: Number of persons residing, using, or working in establishment. For residential establishment, 2 persons per bedroom are
assumed.
BUSINESS ACTIVITY: For commercial applications only. List number of employees, shifts, and hours of operation, or other information required by
Table II, Chapter 10D -6, FAC.
FIXTURES: Mark each listed fixture with number installed or "NA" if not applicable.
SIGNATURE: Signature of applicant or agent. Date application on day submitted to Health Department with appropriate fees and attachments.
ATTACHMENTS: A site plan drawn to scale, showing boundaries with dimensions, locations of residences or buildings, swimming pools, recorded
easements, onsite sewage disposal system components and location, slope of property, any existing or proposed wells, drainage
features, filled areas, obstructed areas, and surface water. Location of wells, onsite sewage disposal systems, surface waters, and
other pertinent facilities or features on adjacent property, if the features are with 75 feet of the applicant lot. Location of any
public well within 200 feet of lot.
For residences, a floor plan (residences) showing number of bedrooms and building area of each unit. For nonresidential
establishments, a floor plan showing the square footage of the establishment, all plumbing drains and fixture types, and other
features necessary to determine composition and quantity of wastewater.
APPLICANT: � �r
ry LOT: / BLOCK:
PROPERTY ID #:////-
STATE OF FLORIDA
DEPARTMENT OF HEALTH
ONSITE SEWAGE DISPOSAL SYSTEM
SITE EVALUATION AND SYSTEM SPECIFICATIONS
PROPERTY SIZE CONFORMS TO SITE
TOTAL ESTIMATED SEWAGE FLOW:
AUTHORIZED SEWAGE FLOW:
UNOBSTRUCTED AREA AVAILABLE:
DH 4015, 10/96 (Replaces HRS -H Form 4015 [Page 31 which may be used)
(Stock Number: 5744- 003 - 4015 -1)
SUBDIVISION:
Munsell # /Color
�✓ °��� ,) %
to
to
9;; to
47, ap to
^,? to
to77
USDA SOIL SERIES: l , .• ;%,, %i
Texture
`� v 'I
Depth
_ to
to 6
/ 7 -to
SOIL TEXTURE /LOADING RATE FOR SYSTEM SIZING
DRAINFIELD CONFIGURATION: [ ] TRENCH ] BED
REMARKS /ADDITIONAL CRITERIA:
SITE EVALUATED BY: -l• 1' , ," ` u 7 ' � �`- )7-
AGENT: � / c //
PERMIT # C ?� A,y< �•.
[Section /Township /Range /Parcel No. or
SITE SUBJECT TO FREQUENT FLOODING: [ ] YES [ U] NO
10 YEAR FLOOD ELEVATION FOR SITE: FT MSL /NGVD SITE ELEVATION: i-4
WAJ7 el
SOIL PROFILE INFORMATION SITE 1 SOIL PROFILE INFORMATION SITE 2
DATE:
Tax ID Number]
TO BE COMPLETED BY ENGINEER, HEALTH UNIT EMPLOYEE, OR OTHER QUALIFIED PERSON. ENGINEER'S MUST
PROVIDE REGISTRATION NUMBER AND SIGN AND SEAL EACH PAGE OF SUBMITTAL. COMPLETE ALL ITEMS.
PLAN: [l'] YES [ ] NO NET USABLE AREA AVAILABLE: �i s.a ACRES
,-0( GALLONS PER DAY [/tESIDENCES TABLE ,. / OTHER -TABLE 2]
' ( i GALLONS PER DAY [ 1500 GOD/ACRE OR ;:2500 GPD /ACRE12
�j SQFT UNOBSTRUCTED AREA REQUIRED: - ,(/ ` SQFT
BENCHMARK /REFERENCE POINT LOCATION: G � �
ELEVATION OF PROPOSED SYSTEM SITE IS tfNCHES 'T] [ABOVV /BELOW BENCHMARK /REFERENCE POINT
V \
THE MINIMUM SETBACK WHICH CAN BE MAINTAINED FROM THE PROPOSED SYSTEM TO THE FOLLOWING FEATURES:
SURFACE WATER: . /i< FT DITCHES /SWALES: 1U /-. FT NORMALLY WET? [ ] YES 14i[ ] NO
WELLS: PUBLIC: ' FT LIMITED USE K, / FT PRIVATE: / FT NON- POTABLE: _ FT
BUILDING FOUNDATIONS: ti��� FT PROPERTY LINES: • _
FT POTABLE WATER LINES: � ��� FT
10 YEAR FLOODINp ? [] YES [ ] NO
FFT MSLtmGVD
Munsell # /Color
/
OV
OC
Ou
USDA SOIL SERIES:
Dry
Depth
_y !/ to
—.t
i - t o
to
to
to
to
to
tom
OBSERVED WATER TABLE: // % •/ • INCHES [ABOVE / BELOW] EXISTING GRADE. TYPE := jPFRCHED / APPARENT]
ESTIMATED WET SEASON WATER TABLE ELEVATION. //9 / \ [ ABOVE/ BELOW) EXISTING GRADE.
HIGH WATER TABLE VEGETATION: [ ] YES r-f NO MOTTLIkG7 ] YES [ f NO DEPTH: INCHES
DEPTH OF EXCAVATION: < %T INCHES
] OTHER (SPECIFY)
Page 3 of 3
INSTRUCTIONS:
al
PERMIT NUMBER: Permit tracking number by County Health Department.
APPLICANT: Property owner's full name.
AGENT: Property owner's legally authorized representative.
LOT, BLOCK, SUBDIVISION: Lot, block, and subdivision for lot.
PROPERTY ID NUMBER: 27 character number for property (property appraiser ID number or section /township /range /parcel number).
PROPERTY SIZE: Check if property at site conforms to submitted site plan. Record net usable area available - lot area exclusive of
all paved areas and prepared road beds within public rights -of -way or easements and exclusive of streams, lakes,
normally wet drainage ditches, marshes, or other such bodies of water.
SEWAGE FLOW:
UNOBSTRUCTED AREA:
Record the estimated sewage flow for the establishment from Table 1 (residence) or Table 2 (non - residential),
Chapter 10D -6, FAC. Record the authorized sewage flow for the lot based on net usable area and water supply
(1500 gallons per day per acre for private water supplies and 2500 gpd per acre for public water supplies). If
authorized sewage flow does not equal or exceed the estimated sewage flow, the application must be denied.
Record the square feet of unobstructed area available and the amount required. Unobstructed area must be at
least 2 times as large as the drainfield absorption area and at least 75 percent of the unobstructed area must meet
minimum setbacks in Chapter 10D -6, FAC. The unobstructed area must be contiguous to the drainfield.
BENCHMARK INFORMATION: Record the location of the benchmark. if using a surveyor's benchmark record the actual elevation. Record the
elevation of the proposed system site in relation (above or below) to the benchmark.
MINIMUM SETBACKS:
Record minimum setbacks which can be meet to all listed features. Actual measurements must be recorded or
"NA" for nonapplicable features. Features on site plan or within 75 feet of the applicant lot must be measured.
The location of any public drinking well within 200 feet of the applicant's lot must also be verified.
FLOOD INFORMATION: Record information on lot's subject to flooding. For lots subject to flooding record 10 year flood elevation for
site and actual site elevation.
SOIL PROFILE INFORMATION: Two soil profiles within the proposed absorption area to a minimum depth of 6 feet or refusal are required. Soil
identification will use USDA Soil Classification methodology (Munsell colors and USDA soil textures). Refusals
must be clearly documented. Provide USDA soil series if available, record "UNK" if the series cannot be
determined.
WATER TABLE: Record the depth of the observed water table at the time of the evaluation. Mark "perched" or "apparent" as
appropriate. Record the estimated wet season water table elevation based on site evaluation, USDA soil maps,
and historical information. Indicate if there is high water table vegetation present. Indicate if mottling is present
and depth.
SOIL TEXTURE: Record soil texture or loading rate for system sizing.
DEPTH OF EXCAVATION: If applicable record depth of excavation required. Record "NA" if not applicable.
DRAINFIELD CONFIGURATION: Check drainfield configuration required. If other, specify type.
ADDITIONAL CRITERIA: Record any additional remarks pertinent to site or installation. Ex. dosing required.
SITE EVALUATED BY: Signature of evaluator, title, and date of evaluation. Professional engineers must seal all documents submitted.
ELEVATION WORKSHEET ELEVATION OF BENCHMARK / REFERENCE POINT IS:
BENCHMARK SITE 1 SITE 2 SITE 3
[ + ] SHOT H.I. H.I. H.I.
H.I. [ - ] SHOT [ - ] SHOT [ - ] SHOT
Scale: Each block represents 10 feet and 1 inch = 40 feet.
Site Plan submitted by:
STATE OF FLORIDA
DEPARTMENT OF HEALTH
APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PERMIT
Permit Application Number
PART II - SITEPLAN
I
T
Notes:
Plan Approved Not Approved Date
By - „= County Health Department
ALL CHANGES MUST BE APPROVED BY THE COUNTY HEALTH DEPARTMENT
DH 4015, 10/96 (Replaces HRS -H Form 4015 which may be used) Page 2 of 4
(Stock Number: 5744 - 002 -4015 -6)
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING r' -;KMIT
Permit No. �L
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.
p
Owner jam= 55 s Name and Address �� .d5. 1 N- -' o. Street
Registered Architect and /or Engineer_____________ ______ __- ------ •-- _--------- __ - --
Employing Plumber's Name a3 P No.. 5 G � =V Street._
State work to be performed and purpose of building (By Floors)___ 3_
Size Septic Tank
Feet of Drain Tile__
Nature of Water Supply: City —Well.
1 o
Amount of Permit $ 1 — - - --
My Commission Expires
(Sled) -
Date
Location and Legal Description Lot_____.._ ......... _._____..... ________._,.._ Block_ Subdivision
Street and Number where work is to be performed— No._ -_�_ 7 / JL Y �= L ___________ Street_ 5 1
E 1�
New Building ___ Remodeling______ ___ Addition.______._ Repairs No. of Stories.
Type of Tank Capacity Gals.
Dist. Feet of Tank or Drain Field from Well
__Size of Soakage Pit
C
Plumbing Inspector.
The undersigned applicant for this building permit does hereby certify that he understands and accepts his oblig ions as an employer of labor
under the Florida Workmen's Compensation Act, being Section 5988, Compiled General Laws of Florida Pennant 't Supplement, and has com-
plied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors emp'oyed by him in the work to be
performed under this permit; and will post or cause to be posted' for inspection on the site of the work such public notice or notices as are
required by the Act. The undersigned agrees to employ only such sub- contractors, on work to be performed under this permit, as are
licensed by Miami Shores Village.
( Signed)
0
Master Plumber.
STATE OF FLORIDA,
COUNTY OF DADE. 1
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.
Notary Public, State of Florida
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
S
LAVA.
TORIES
INKS
SINKS
SLOP
SINKS
LAUNDRY
Tues
U RINALS
CATCH
BASIN
FLOOR
DRAIN
DRINKING
FOUNT'NG
TOTAL
FIXTURES
CONTR.
LIST
CHECK
SEPTIC
TANK
SEWER
CONN.
DRAIN
FIELD
SOAKAGE
PIT
GREASE
TRAP
SOLAR
HEATER
DEEP
WELL
SPRKLR.
SYSTEM
SWIM•G
POOL
CONTR.
LIST
CHECK
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING r' -;KMIT
Permit No. �L
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.
p
Owner jam= 55 s Name and Address �� .d5. 1 N- -' o. Street
Registered Architect and /or Engineer_____________ ______ __- ------ •-- _--------- __ - --
Employing Plumber's Name a3 P No.. 5 G � =V Street._
State work to be performed and purpose of building (By Floors)___ 3_
Size Septic Tank
Feet of Drain Tile__
Nature of Water Supply: City —Well.
1 o
Amount of Permit $ 1 — - - --
My Commission Expires
(Sled) -
Date
Location and Legal Description Lot_____.._ ......... _._____..... ________._,.._ Block_ Subdivision
Street and Number where work is to be performed— No._ -_�_ 7 / JL Y �= L ___________ Street_ 5 1
E 1�
New Building ___ Remodeling______ ___ Addition.______._ Repairs No. of Stories.
Type of Tank Capacity Gals.
Dist. Feet of Tank or Drain Field from Well
__Size of Soakage Pit
C
Plumbing Inspector.
The undersigned applicant for this building permit does hereby certify that he understands and accepts his oblig ions as an employer of labor
under the Florida Workmen's Compensation Act, being Section 5988, Compiled General Laws of Florida Pennant 't Supplement, and has com-
plied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors emp'oyed by him in the work to be
performed under this permit; and will post or cause to be posted' for inspection on the site of the work such public notice or notices as are
required by the Act. The undersigned agrees to employ only such sub- contractors, on work to be performed under this permit, as are
licensed by Miami Shores Village.
( Signed)
0
Master Plumber.
STATE OF FLORIDA,
COUNTY OF DADE. 1
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.
Notary Public, State of Florida
NOTE: A re- inspection fee of $1.00 will be made when such re- inspection is made•necessary by improper notice for inspection, or faulty
materials and /or workmanship.
PERMIT APPLICATION FOR MUNICIPALITIES OF DADE COUNTY
(OWNER TO RETAIN COPY)
Job Address
Architect /Engineer
Bonding Company
Mortgagor
Permit Type (circle on
WORK DESCRIPTION
91T 9as
Legal Description �r 6q Je T' 7 Master Permit
Owner / Lessee / Tenant ) )A)eJ . — trc 5 ' (L) -
Owner's Address
Contracting Co.
Qualifier SS# - - phone
State #
c/A c /19-6007_
Competency #
Address
0t_
Square Ft. ;L5 Estimated Cost
Tax Folio /' o6 "'gas'
l�
phone
Ins. Co.
1/977
Address
Address
Address
BUILDING _ ' ELECTRICAL PLUMBING MECHANICAL PAVING FENCE SIGN
- 75.00
WARNING TO OWNER: YOU MUST RECORD A NOTICE OF COMMENCEMENT AND YOUR FAILURE TO
DO SO MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY (IF YOU
INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE
RECORDING YOUR NOTICE OF COMMENCEMENT).
Application is hereby made to obtain a permit to do work and installation as indicated. I certify
that all work will be performed to meet the standards of all laws regulating construction in this
jurisdiction. I understand that separate permits are required for ELECTRICAL, PLUMBING, SIGNS,
POOLS, ROOFING, and MECHANICAL work.
OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work
will be done in compliance with all applicable laws regulating construction and zoning.
Furthermore, I authorize the above -named contractor to do the work stated.
Signature of Owner
Date:
i ary / -s to Owner and /or Condo President
My Commission Expires: 1/'6/,g
* * *
or Condo President Signature of Contractor or Owner - Builder
Date:
Notary as to Contractor or Owner - Builder
My Commission Expires:
* * * * * * * *
PERMIT FEE: APPROVED: Fire Other
Zoning Building 96 9' Electrical
echanical Plumbing Engineering
Permit No
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 loot. A copy of approved plans and specifications must be kept at
building during progress of work.
Owner's Name and Addreu No 911$' Ni:: street —..
Registered Architect and/or Engineer
$ Plum 's Name Fax-To r \ 3..ai..N...... Itre et.SQL0 STh
-.---' , .- No., sawn _ am. ^'W:aosoaeleess,
StAbahigiOILAM 2/-
9 t.. 9. sr-
E i
wcation an
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
g i f Lot
ic Block
,
State work to be performed and purpose of building (By Floors)3C_C 1 WATt1 ifaft? iC
Street and Number where work is to be performed-No
New Building- Remodeling-- -.______ Addition. Repairs No. of Stories..
Size Septic Tank--
Feet of Drain Tile.
Nature of Water Supply: City-Well.
Amount of Penult g '
(Signed)_
. ....
Plumbing Ingpector.
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 hag com-
plied with the provisions thereof, and will require similar compliance from all contractors or sub-contractors employed by him in the work to he
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 err
required by the Act. The undersigned agrees to employ only such sub-contr• on work to be performed under this permit, as are
licensed by Miami Shores Village.
I It
11
_Type of Tank_
__Dist. Feet of Tank or Drain Field from Well.
Size of Soakage Pit
(Signed)
STATE OF FLORIDA,
ss.
COUNTY OF DADE.
Before me, the undersigned authority a notary public, duly authorized to administer oaths and take acknowlalgments, personally appeared
to me well known, and who, being by me first duly sworn, upon oath deposes and says that he
of the above described construction, that be has cerefully read the foregoing application,
therein by him stated
1v
r ).46;1!■ I! .1:1. 1 NCil AK"!
My Commission Expires
NOTE: A re-inspection fee of SIM will Ins made what mai re•inspection is made
materials and/ar workmanship.
State of illmida
• ...... •
Master Plumber.
end that all facts
notice kr inspection, of fealty
CLOSITIS
BATH
Tue.
SHowcee
LAVA.
n ,
To "
Sines
SLOP
SINKS
LAUNOR
u s ,
URINALS
fsAA•IP414
PLOOR
DRAIN
DRINKING
POUNT•N•
TOTA L
rIxTuars
Comm
LIST
CHECK
.....
Itv, 1 w•G
POOL
SEPTIC
TANK
SEWER
CONN.
DRAIN
rtaLe
SOAKAGE
PIT
GREASE
TRAP
souk.,
HEATER
Ow
WIELL
8Pesut.
8
CONTR.
Lein'
Omen
Permit No
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 loot. A copy of approved plans and specifications must be kept at
building during progress of work.
Owner's Name and Addreu No 911$' Ni:: street —..
Registered Architect and/or Engineer
$ Plum 's Name Fax-To r \ 3..ai..N...... Itre et.SQL0 STh
-.---' , .- No., sawn _ am. ^'W:aosoaeleess,
StAbahigiOILAM 2/-
9 t.. 9. sr-
E i
wcation an
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
g i f Lot
ic Block
,
State work to be performed and purpose of building (By Floors)3C_C 1 WATt1 ifaft? iC
Street and Number where work is to be performed-No
New Building- Remodeling-- -.______ Addition. Repairs No. of Stories..
Size Septic Tank--
Feet of Drain Tile.
Nature of Water Supply: City-Well.
Amount of Penult g '
(Signed)_
. ....
Plumbing Ingpector.
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 hag com-
plied with the provisions thereof, and will require similar compliance from all contractors or sub-contractors employed by him in the work to he
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 err
required by the Act. The undersigned agrees to employ only such sub-contr• on work to be performed under this permit, as are
licensed by Miami Shores Village.
I It
11
_Type of Tank_
__Dist. Feet of Tank or Drain Field from Well.
Size of Soakage Pit
(Signed)
STATE OF FLORIDA,
ss.
COUNTY OF DADE.
Before me, the undersigned authority a notary public, duly authorized to administer oaths and take acknowlalgments, personally appeared
to me well known, and who, being by me first duly sworn, upon oath deposes and says that he
of the above described construction, that be has cerefully read the foregoing application,
therein by him stated
1v
r ).46;1!■ I! .1:1. 1 NCil AK"!
My Commission Expires
NOTE: A re-inspection fee of SIM will Ins made what mai re•inspection is made
materials and/ar workmanship.
State of illmida
• ...... •
Master Plumber.
end that all facts
notice kr inspection, of fealty
CLOSETS
f
/f '
BATH
TUBS
SHOWERSI LAVA-
I TORIES
SINKS
SLOP
SINKS
LAUNDRY
TUBS
URINALS
CATCH
BASIN
FLOOR
DRAIN
DRINKING
FOUNT'NS
TOTAL
FIXTURES
r
1
A -244 5M 3-36
I herewith submit the following plan of plumbing for approval:
Employing Plumber q 1 , 4' t -; Work executed by
New Old ❑ Story ❑ / Addition ❑ Remodeled ❑
For a
Dwelling ❑ ( Store ❑ Garage ❑ Apartment ❑ Hotel ❑ Office Bldg. ❑
e
Owner or Agent !* <. , el Address
Builder or Contractor is
Lot No.
Address
Sewer Connections
DIVISION OF PLUMBING INSPECTION
DEPARTMENT OF PUBLIC SERVICE
MIAMI, FLORIDA
Block No. Subdivision
At center of St. ❑ At curb ❑
Address
19
i
At property line ❑ Existing in alley ❑ Existing bldg. sewer ❑
To septic tank [1r Existing bldg. drain ❑ To dry well ❑
A charge of $1.00 will be made for correcting any inaccuracies in the foregoing information.
DO NOT WRITE IN SPACE BELOW. THIS IS FOR THE USE OF THE DIVISION OF PLUMBING INSPECTION ONLY.
s l +
Date
ROUGH -IN INSPECTION
Ground Rough -In Rain Leader
A M P M
Approved by
Condemned by
REMARKS
/;
Plan No. ' , F f Sewer Permit No
Date
SEWER INSPECTION
AM / P M
Approved by
Condemned by
REMARKS
Date
FINAL INSPECTION
AM PM
Approved by i
Condemned by
REMARKS
APPLICATION FOR PLUMBING PERMIT
Permit No �J / 3 ��
D ate... - - �
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 " f `! �h eE / No ct ' ,(1 Street = 5 _....
Registered Architect and /or Engineer
Employing Plum's Name Ce Z- , ..drVZ � Pt - ...— -
Location and Legal Description Lot. Block SubdivsIon..___— ..
Street and Number where work is to be performed —No _ ,,_. Street_
State work to be perform ew and purpose of building (By Floess) ...._. �:.. .4:�...
New Building .__._— _.._..........._.. Remodeling— _...-.._.___ Additiaaa...___ _. _. Repairs. No. of Stories ....................
Size Septic Tank__
Feet of Drain Tile
Nature of Water Supply: City—Well.
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
P1 mbing Insp
The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations s an employer of labor
under the Florida Workmen's Compensation Act, being Section 5988, Compiled Cenral Laws of Florida Permanent S .element, and has corn -
plied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors employed by him in the work to he
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.
Type of Tangy _
Nat. Feet of Tank or Drain Field from
Size of Soakage Pit_ ....__......�___ �.
(Signed)
STATE OF FLORIDA, l µ
COUNTY OF DADE. r
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 fads
therein by Dim stated are true.
My Commisdon Expires Notary Public, State of Florida
NOTE: A re- inspection fee of $1.00 win be mad. wham oat gsdaspaolloa M ®ada•necesaary by hnpraixe notice far laspectlan, or hay
materials and /at worl®ansbip.
CLOStTS
BATH
Tue•
SHOWERS
LAVA-
TORIES
SINKS
SLOP
SIMKO
LAUNDRY
TUGS
URINALS
CATCH
BASIN
FLOOR
DRAIN
DRINKING
FOUNT'NG
TOTAL
FIXTURES
Copra.
LIST
CHECK
_
SEPTIC
TANK
SEWER
CONK.
DRAIN
FIELD
SOAKAGE
PIT
GREASE
TRAP
SOLAR l DEEP
NEATER WELL
SPRKLR.
SYSTEM
S1NIM'O
POOL
CLNTR.
LIST
�
CHECK
APPLICATION FOR PLUMBING PERMIT
Permit No �J / 3 ��
D ate... - - �
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 " f `! �h eE / No ct ' ,(1 Street = 5 _....
Registered Architect and /or Engineer
Employing Plum's Name Ce Z- , ..drVZ � Pt - ...— -
Location and Legal Description Lot. Block SubdivsIon..___— ..
Street and Number where work is to be performed —No _ ,,_. Street_
State work to be perform ew and purpose of building (By Floess) ...._. �:.. .4:�...
New Building .__._— _.._..........._.. Remodeling— _...-.._.___ Additiaaa...___ _. _. Repairs. No. of Stories ....................
Size Septic Tank__
Feet of Drain Tile
Nature of Water Supply: City—Well.
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
P1 mbing Insp
The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations s an employer of labor
under the Florida Workmen's Compensation Act, being Section 5988, Compiled Cenral Laws of Florida Permanent S .element, and has corn -
plied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors employed by him in the work to he
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.
Type of Tangy _
Nat. Feet of Tank or Drain Field from
Size of Soakage Pit_ ....__......�___ �.
(Signed)
STATE OF FLORIDA, l µ
COUNTY OF DADE. r
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 fads
therein by Dim stated are true.
My Commisdon Expires Notary Public, State of Florida
NOTE: A re- inspection fee of $1.00 win be mad. wham oat gsdaspaolloa M ®ada•necesaary by hnpraixe notice far laspectlan, or hay
materials and /at worl®ansbip.
F
N
W
Sketch position of building and lot lines in square (which represents an entire city block) , showing on which street
the building and lot faces; also show exact locations of "Y" in street and position of lateral or septic tank. Show
sewer and any change in direction same may make. The purpose of this plan is to have an accurate layout of all
underground pipes for future references.
WEST
NORTH
A
EAST
Remarks:
NORTH
SOUTH
OWNER
LOT
BLOCK
SUBDIVISION
j d
, ∎ i'f,-
Issued to
iami �horesllage
F L O A I D A
PLUMBING PERMIT N9 964
Total $
to install the following described plumbin in accordance with the laws, statutes and regu-
lations of Miami Shores Village, Florida and the State of Florida, governing plumbing and
drainage work done in Miami Shores Village, Florida.
For a / story fir / f N building at ,/1''
Fixtures ,r " i ' 11 ,' ^- / '
•
Fixtures
$ a. '''
Sewer / $ 1' `/ is
Septic Tank 1 $ ,/,'" ''
Village Plumbing Inspector
Received Payment by
s
i d
ssued to 1
Fixtures
Fixtures
Sewer
Miami JhorescYlla
ee.-1
1. 0 A 1 D A
PLUMBING PERMIT
to install the following described plumbiilg, in accordance
lations of Miami Shores Village, Florida and the State of
drainage work done in Miami Shores Village, Florida.
For a _ / story buildin at
$
$ f
tic Tank $ 1" -
Total $
Village Plumbing Inspector
Received Payment by
N9 964
with the laws, statutes and regu-
Florida, governing plumbing and
OWNER
LOT
BLOCK
SUBD1V1SION
-(
/ 1" : 5,
(6.7;
ssued to 1
Fixtures
Fixtures
Sewer
Miami JhorescYlla
ee.-1
1. 0 A 1 D A
PLUMBING PERMIT
to install the following described plumbiilg, in accordance
lations of Miami Shores Village, Florida and the State of
drainage work done in Miami Shores Village, Florida.
For a _ / story buildin at
$
$ f
tic Tank $ 1" -
Total $
Village Plumbing Inspector
Received Payment by
N9 964
with the laws, statutes and regu-
Florida, governing plumbing and
BUILDING
ELECTRICAL
PLUMBING
ROOFING
Owner of
Building
Architect
Contractor
or Builder
Legal Lot
Description
Address of
Building
MIAMI SHORES VILLAGE. FLORIDA
PERMIT N? 7065
0
Bl.
CONTRACTOR OR BUILDER BY
DATE f 195 fi
Contractor's
License No.
Work to be performed under this Permit
Subdi-
vision
Value of
Project $
it
Amount of
Permit $
This permit is granted to the contractor or builder named above to construct the building or to install the equipment or device described in the 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 cr in the statements or specifications and that he assumes responsibility for work
done by his agents, servants or employees.
Signed- BY:
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 ac-
cepting this permit I assume responsibility or all work done by either, myself, my cgeilt, servant or employee. "` R - -..._
r ` a
AUTHORITY
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING r k.MIT
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 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 wort
Owner's Name and Address
Amount of Permit $
No.
Registered Architect and /or ' eer_ _ -_- _
Employing Plumber's Name_ 'J Zz ei _ No.____--- Street.-____
Location and Legal Description Lot._ ________ __._____- _ Block - Subdivision _---- - -_.__
(r i 9 t _.-
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 . . . ......... ..... ........
Street
f, TYp
o ar
Size Septic Tank ,
) �
Feet of Drain Tile___ -� f/ a s t. IF'eeE' si Field
from Well
Nature of Water Supply: City -Well.
Capacity Gals
__Size of Soakage Pit
(
fr
(Signed)- -
Plu ing Inspector - �
The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations a an employer of labor
under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Permanent Sup 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 ar
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) ._4_z_ 7, _s � �¢ . ..<'4- ,;,,_,, ,y e „ . _,,_ A
1 Master Plumber.
STATE OF FLORIDA,
COUNTY OF DADE.
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeared
to me well known, and who, being by me first duly sworn, upon oath deposes and says that he is the
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•nerssary by improper notice for inspection, or faulty
materials and /or worloaanship.
CLOSETS
BATH
TUBS
SHOWERS
LAVA-
TORIES
INK
SINKS
SLOP
SINKS
LAUNDRY
TUSB
URINALS
CATCH
BASIN
FLOOR
DRAIN
DRINKING
FOUNT'NS
TOTAL
FIXTURES
CONTR.
LIST
CHECK
SEPTIC
TANK
SEWER
CONN.
DRAIN
FIELD
SOAKAGE
PIT
GREASE
TRAP
SOLAR
HEATER
DEEP
WELL
SPRKLR.
SYSTEM
SWIM'G
POOL
CONTR.
LIST
-
-
CHBCK
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING r k.MIT
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 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 wort
Owner's Name and Address
Amount of Permit $
No.
Registered Architect and /or ' eer_ _ -_- _
Employing Plumber's Name_ 'J Zz ei _ No.____--- Street.-____
Location and Legal Description Lot._ ________ __._____- _ Block - Subdivision _---- - -_.__
(r i 9 t _.-
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 . . . ......... ..... ........
Street
f, TYp
o ar
Size Septic Tank ,
) �
Feet of Drain Tile___ -� f/ a s t. IF'eeE' si Field
from Well
Nature of Water Supply: City -Well.
Capacity Gals
__Size of Soakage Pit
(
fr
(Signed)- -
Plu ing Inspector - �
The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations a an employer of labor
under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Permanent Sup 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 ar
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) ._4_z_ 7, _s � �¢ . ..<'4- ,;,,_,, ,y e „ . _,,_ A
1 Master Plumber.
STATE OF FLORIDA,
COUNTY OF DADE.
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeared
to me well known, and who, being by me first duly sworn, upon oath deposes and says that he is the
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•nerssary by improper notice for inspection, or faulty
materials and /or worloaanship.