930 NE 92 St (4)MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
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 work.
Owner's Name and Address . � ER �� �_._____.____ 93 Street__
Registered Architect and /or Engineer .....
- - - -_ --
Employing Plumber's Name S.I.A. _4_ j0_0_ No.------ - - ---
Location and Legal Description Lot_-_
Street and Number where work is to be performed —No
State work to be performed and purpose of building (By Floors)
New Building Remodeling — -- --_ --
Size Septic Tank
Feet of Drain Tile .....
_____
Nature of Water Supply: City —Well
Amount of Permit $
Bl
Addition Repairs
_Type of Tank__
_Dist. Feet of Tank or Drain Field from Well
_Size of Soakage Pit
( Signed) _
The undersigned applicant for this building permit does hereby certify that he understands and accepts his
under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida
plied with the provisions thereof, and will require similar compliance from all contractors or sub -con
performed under this permit; and will post or cause to be posted' for inspection on the site of work
required by tlie Act. The undersigned agrees to employ only such sub- contractors, ork to b
licensed by Miami Shores Village.
STATE OF FLORIDA,
COUNTY OF DADE.
My Commission Expires
Before me, the undersigned authority, a notary public, duly authorized to administ
3 ® Street_
Street___ k d `€
Capacity Gals.
Subdivision
91 92 7:
No. of Stories.
i spector.
tions as an ebployer of labor
anent Supplement, and has com-
ed by him in the work to be
p blic notice or notices as are
ed under this permit, as are
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
® / _ fez
aster Plumber.
NOTE: A re- inspection fee of $1.00 will be made when such re- inspection is made-necessary by improper notice for inspection, or faulty
materials and /or workmanship.
CLOSETS
BATH
TUBS
SHOWERS
LAVA-
TORIES
SINKS
SLOP
SINKS
LAUNDRY
TUBS
URINALS
INAS
CATCH
BASIN
FLOOR
DRAIN
DRINKING
FOUNT'N6
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 PERMIT
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 work.
Owner's Name and Address . � ER �� �_._____.____ 93 Street__
Registered Architect and /or Engineer .....
- - - -_ --
Employing Plumber's Name S.I.A. _4_ j0_0_ No.------ - - ---
Location and Legal Description Lot_-_
Street and Number where work is to be performed —No
State work to be performed and purpose of building (By Floors)
New Building Remodeling — -- --_ --
Size Septic Tank
Feet of Drain Tile .....
_____
Nature of Water Supply: City —Well
Amount of Permit $
Bl
Addition Repairs
_Type of Tank__
_Dist. Feet of Tank or Drain Field from Well
_Size of Soakage Pit
( Signed) _
The undersigned applicant for this building permit does hereby certify that he understands and accepts his
under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida
plied with the provisions thereof, and will require similar compliance from all contractors or sub -con
performed under this permit; and will post or cause to be posted' for inspection on the site of work
required by tlie Act. The undersigned agrees to employ only such sub- contractors, ork to b
licensed by Miami Shores Village.
STATE OF FLORIDA,
COUNTY OF DADE.
My Commission Expires
Before me, the undersigned authority, a notary public, duly authorized to administ
3 ® Street_
Street___ k d `€
Capacity Gals.
Subdivision
91 92 7:
No. of Stories.
i spector.
tions as an ebployer of labor
anent Supplement, and has com-
ed by him in the work to be
p blic notice or notices as are
ed under this permit, as are
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
® / _ fez
aster Plumber.
NOTE: A re- inspection fee of $1.00 will be made when such re- inspection is made-necessary by improper notice for inspection, or faulty
materials and /or workmanship.
Permit No.
Ready:
Condemned
Relay drainfield •
Cross connections
Gas service or house piping repairs
MIS LLA,:EOL"S IT.rS EC'IONS
Installed by x„
Owner's s name k%).
?ate /
Address of ;^cork 3 e) o
AM PM Ap' by
Sewer repairs
Cas appli-.nces
Waste, building drain, - Vent Water pinin`
Hot water, safe wastes, pit privies, water supply wells