965 NE 92 St (2)Date 9— 7'x 9 Job Address /��/� 9? S� Tax Folio / /- ,326 6' C k 7 ' C2 w)
Legal Description
6/(/-16,
Owner/Lessee / Tenant ■ ( G y y/ 2,
Owner's Address W,< 5
Contracting Co. , G,p S' f & Rrv)
Qualifier J r1 i ° J v Ft ,/ SS#
/cl /S /P(j-Jf /,'� / Municipal # Wc3 OC S'" Competency #
State #
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Architect/Engineer
Bonding Company
Mortgagor
Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIPTION � f r c -r
Square Ft. ‘'' C L7
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.
OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done
construction and zoning. Furthermore, I authorize the above -named contractor to do the work stat
Signature f owner and/or Condo
Notary a to Owner and/ofCondo President
My Commission Expires:
4..C‘YPO. Wm. MARK WOODARD
a a, <t-, COMMISSION # CC 625712
�^` c EXPIRES MAR 2, 2001
ONDD THRU
OF C‘..... ATLANTIC B BON CO., INC
9-7— Scf
Date
FEES: PERMIT RADON C.C.F.
APPROVED:
Zoning Building
Mechanical Plumbing
Historically Designated: Yes No
3 r S 'c /y - We �
S'c,) 5 r c t-
./ `/ hone f g6
Address
Address
Address
Address
Master Permit # ( Al t 0 /
Phone
Ins. Co.
OU
Estimated Cost (value) / Xoo
�s
f Owner-Builder Date
Signatur
(;i/41 4.)ce&r 5-7-rf
Notary as to Contractor or Owner- Builder Date
My Commission Expires:
�FY , Wm. MARK WOODARD
r.� o COMMISSION # CC 625712
nd
5 ^` , EXPIRES MAR 2, 2001 BONDED THRU
OF FS' ATLANTIC BONDING CO., INC.
NOTARY
Electrical
ompliance with all applicable laws regulating
BOND
TOTAL DUE
Structural Engineer
tiAIL343 ADDRESS:
LOT: ...1_.
•
INTILDZNG =Malan=
. 3.
2
3
4
SIGNATURE:
Dg 4015, 10/9
la3-3S 7
STATE OF FLORIDA
- DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT AND DIPOSAL
APPLICATION FOR CONSTRUCTION PERMIT
(4.] Existing System°
(4d 1 Abandonment
AGENT: ,424110 t S ,?Di
PROPER= ID 1: / / . 3 i o h . C. O 4 oo Yo. ZONING:
PZZOPERa'Y *am: 7c zo 3►cTzs —um= = sar L s [ l . .NAYS
Unit Typo of IIo. of
No Establishment: Bedroa
1 Sloor /Egaipeaea ' ,/. . ( 1
,[4/6ESrozziaais
Ucations
13E2
PERMIT NO.
DATE PAID:
SYSTEM um MD:
•
alb
APPLCATION PORI
[ 4A] ' Neu .pysteta
V01 nepa
APPLICANT: J• C c
Ego] Rol ding Tank [a ] Innovative
(? l Tt orarY . [ 1
•
T gom1E: 5 5
u _ .. •
TO BE COMPLETED BT APPLIC3NT OR APPISCART' 8 AUTUORILED ware. ammo oo UU T SE CouSimQCTF.D
SY A PERSON LICENSED PURSUANT TO 489.105(3) 60 OR 489.552, KARIDA STATUTES. IT YS THE
2 DPLICANTo S TO PROVIDE DOCOUCUTATION Or THE DATE TSE DDT . 1AS . C8E D OR
PLATTED (W4/DD /Z1) I .. VEQUESTINO COUSIDF.l1ATIOOt OB' STATUTORY OVAUDIATUER PROVIBIO •
PROPERTY zuroszt TI • . n
=CR: SUBDIVISIOmi: - �f�'f.., .� �T Pi< A.ti r Pte: /74
t/1(oR EQOIVALEUT:
IS SERER 1LVAIL118TL as tat 3aitoos5, 8'B? t /Y DISTAUC3:•TO SEWERs,/AA ST
PROPERTZ ADDRESS: 91067 91 ELts '/ # 3:1/3 2(
DT.RECTIOltB TO PROVEaTZ: 5S f Scx1/i ' �'J �� �a� 7'O n l �' �:—
S� r - de
[ ] CONtCTBL
Syst eta Design
SAC .
[ 3)Z000GPD
p 1 or 4 •
Permit No._ -_ ' c( —�
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 4'Z' s Name and Address a.M . .0
Registered Architect and /or En inee ._—
Employing Plumber's Name. ® No....L r/ 3 Street
Location and Legal Description Lot_______________ _ _, Block
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
Size Septic Tank
Feet of Drain Tile_
Nature of Water Supply: City— Welfl.____ ___ _________ of Soakage Pit
Amount of Permit $
STATE OF FLORIDA,
COUNTY OF DADE.
> r9
MI *MI SH ®'DES: VILLAGE
PLUMBING INSPECTION; DEPARTMENT
Q[DpLCAlleN1 FOE ` °' } LJMBING PERMIT
_Type of Tank__
_Dist. Feet of Tank or Drain Field from Well
(Signed)-
The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligatigrfs as an employer of labor
under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Permane ' Supplement, and has cam -
plied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors emplbyed 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 Shares Village.
rt
Date__
No. Street_W:
Subdivision.
6- /? 7 %
6. -49
Street
No. of Stories........._....
Capacity Gals
lumbing Inspector.
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 $LOO will be made when such re- inspection is made necessary by improper notice for ins -
materials and /or workmanship.
-I, or faulty
CLOSETS
TUBE
TUBS
SNOWERB
LAVA
TORIES
SI°
SINKS
SLOP
SINK°
LAUNDRY
TUBS
U
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
C TR.
LIST
A
l
-_.-
CHECK
Permit No._ -_ ' c( —�
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 4'Z' s Name and Address a.M . .0
Registered Architect and /or En inee ._—
Employing Plumber's Name. ® No....L r/ 3 Street
Location and Legal Description Lot_______________ _ _, Block
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
Size Septic Tank
Feet of Drain Tile_
Nature of Water Supply: City— Welfl.____ ___ _________ of Soakage Pit
Amount of Permit $
STATE OF FLORIDA,
COUNTY OF DADE.
> r9
MI *MI SH ®'DES: VILLAGE
PLUMBING INSPECTION; DEPARTMENT
Q[DpLCAlleN1 FOE ` °' } LJMBING PERMIT
_Type of Tank__
_Dist. Feet of Tank or Drain Field from Well
(Signed)-
The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligatigrfs as an employer of labor
under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Permane ' Supplement, and has cam -
plied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors emplbyed 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 Shares Village.
rt
Date__
No. Street_W:
Subdivision.
6- /? 7 %
6. -49
Street
No. of Stories........._....
Capacity Gals
lumbing Inspector.
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 $LOO will be made when such re- inspection is made necessary by improper notice for ins -
materials and /or workmanship.
-I, or faulty
MIAMI SHORES VILLAGE
BUILDING DEPARTMENT
� G 't 305- 795 -2204
— Building Inspection Request
Date Time,
/j Type Insp'r>
Permit No. Cj rte` /(/(
Name
Address / c-e'
Company L
Phone #
For Inspector:
Approve '
Correction
Re- Insp'n Fee
1 y �o
ate
a1���
Date � 7
Contracting Co.
Si
Da
Notary as to Owner and /or
My Commission Expires:
: FC
Mo.ol *
APPROVED:
PERMIT APPLICATION FbR MIAMI SHORES VILLAGE
Job Address
9 (05 N E c‘ 2 sT
Legal Description / f/�
(O -caner )/ Lessee / Tenant JOSS- Cl�h� Master Permit # (5►DI G
Owner's Address to 5 k) E 92
Qualifier Jos h Lev /� SS4f
Phone / - 0 °
#W10P7Ins . Co . 9
A dr
4
der
Ohev,foiorMarNOWW0tBkii der
ISABEL C DOS IIC14,=010:
7 - * COMNISSION i' UMEIF.R
CC279114
ct MY COMMISSION i :X
• F11L C .PH�.
**
FEES: PERMIT /il" RADON C.C.F.
Fire Other
Zoning Buildin
NOTARY TOTAL DUE
Electrical
Engineering
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
Bi Engineer__________ Rg ?D
Registered Architect and /or En meer _
Employing Plumber's Name % 1 t2) Y - No.-_i _2- S . -._ Lz treet-._. S
Location and Legal Description Lott- -._ _ - -- -- __-. -. _Block Subdivisiont) O - � I ? i ( )"
Street and Number where work is tO be performed-No.________ 2±3i_i_ Street_ 2 ,S 7
State work to be performea and purpose of building (By Floors)_
New Building _______ ........ Remodeling__ -___-____ Addition Repairs No. of Stories.
Size Septic Tank
Feet of Drain Tile. - ___.
Nature of Water Supply City= ell
Amount of Permit $ Z
STATE OF FLORIDA,
COUNTY OF DADE.
,J121/11t. t, No.-
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
(Signed)
Type of Tank
_Dist. Feet of Tank or Drain Field from Well
_ Size of Soakage Pit
Plumbing Inspect
The undersigned applicant for this building permit does hereby certify that he understands and accepts his o • . : + Lions as an employer of labor
under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Pert - . ent Supplement, and has com-
plied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors employed by him in the work to be
performed under this permit; and will post or cause to be posted for inspection on the site of the work such public notice or notices as are
segtriree. by the Act. The undersigned agrees to employ only such sub- contractors, on work to be performed under this permit, as are
lip d by Miami Shores Village.
( Signed
Date_
Street
Capacity Gals
My C Expires Notary Public, State of Florida
Master Plumber.
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeared
to me well known, and who, being by me first duly sworn, upon oath deposes and says that he is the
of the above described construction, that he has carefully read the foregoing application, and that he did sign the same, and that all facts
therein by him stated are true.
NOTE: A re- inspection fee of $1.00 will be made when such re- inspection is made•necessary by improper notice for inspection, or faulty
materials and /or workmanship.
CLOSETS
BATH
TUBS
SHOWER!
LAVA.
TORIES
SINKS
SLOP
SINKS
LAUNDRY
TUBS
INALS
URINALS
CATCH
BASIN
FLOOR
DRAIN
DRINKING`
FOUNT'NS
/
U J� C�
I r �-
-`A
��s. ��l,
TOTAL
FIXTURES
CONSTTR.
I
/
I
CHECK
P
--
SEPTIC
TANK
SEWER
CONN.
DRAIN
FIELD
SOAKAGE
P1T
GREASE
TRAP
S 4C
R
DEEP
WELL
SPRKLR.
SYSTEM
SWIM'G
POOL
LIST
CHECK
V
v�'d
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
Bi Engineer__________ Rg ?D
Registered Architect and /or En meer _
Employing Plumber's Name % 1 t2) Y - No.-_i _2- S . -._ Lz treet-._. S
Location and Legal Description Lott- -._ _ - -- -- __-. -. _Block Subdivisiont) O - � I ? i ( )"
Street and Number where work is tO be performed-No.________ 2±3i_i_ Street_ 2 ,S 7
State work to be performea and purpose of building (By Floors)_
New Building _______ ........ Remodeling__ -___-____ Addition Repairs No. of Stories.
Size Septic Tank
Feet of Drain Tile. - ___.
Nature of Water Supply City= ell
Amount of Permit $ Z
STATE OF FLORIDA,
COUNTY OF DADE.
,J121/11t. t, No.-
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
(Signed)
Type of Tank
_Dist. Feet of Tank or Drain Field from Well
_ Size of Soakage Pit
Plumbing Inspect
The undersigned applicant for this building permit does hereby certify that he understands and accepts his o • . : + Lions as an employer of labor
under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Pert - . ent Supplement, and has com-
plied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors employed by him in the work to be
performed under this permit; and will post or cause to be posted for inspection on the site of the work such public notice or notices as are
segtriree. by the Act. The undersigned agrees to employ only such sub- contractors, on work to be performed under this permit, as are
lip d by Miami Shores Village.
( Signed
Date_
Street
Capacity Gals
My C Expires Notary Public, State of Florida
Master Plumber.
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeared
to me well known, and who, being by me first duly sworn, upon oath deposes and says that he is the
of the above described construction, that he has carefully read the foregoing application, and that he did sign the same, and that all facts
therein by him stated are true.
NOTE: A re- inspection fee of $1.00 will be made when such re- inspection is made•necessary by improper notice for inspection, or faulty
materials and /or workmanship.
I: 7 Permit
Amount of 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
cf 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 / pp�� q
Owner's Name and Address ----- ____ - _ _ -- _ _ -_ -- � No.___ � - ,�_� Street -Pi °
Registered Architect and /or E • ' eer___ __ —__ ��pp�� __
Employing Plumber's Name. !g1:.__ _ __ " No. _ — oY 4.— Street__XE __i l.
Location and Legal Description Lot__ _______________________________ Block_
Streit and Number where work is to be performed —No 8126" 4(
S ✓Co work to be performed and purpose of building (By Floors)_
New Building — Remodeling___ _________ Addition_________._ Repairs No. of Stories.
Sze Septic Tank — Type of Tank_ Capacity Gals.
Feet of Drain Tile
Nature of Water Supply: City—Well.
STATE OF FLORIDA, i
COUNTY OF DADE.
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMEN''
APPLICATION FOR PLUMBING ",L•I, IIT
f -IpPv
Date _._ OW 1
Subdivision
Street 47C7_�:&
___Dist. Feet of Tank or Drain Field from Well
__Size of Soakage Pit
- - - - --- (steed)- - - ✓ /l�
Plumbing Inspector.
The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations as an employer of labor
under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Pennanent Supplement, and has com-
plied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors employed by him in the work to be
performed under this permit; and will post or cause to be posted' for inspection on the site of the work such public notice or notices as are
req 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.
3: fore me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeared
is 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
th erein 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 'necessary by improper notice for inspection, or faulty
materials and /or workmanship.
CLOSETS
BATH
Tuns
SHOWERS
LAVA-
TORIES
S INKS
SLOP
SINKS
LAUNDRY
TUBS
U RINALS
CATCH
BASIN
FLOOR
DRAIN
DRINKING
FOUNT' NS
TOTAL
FIXTURES
corm. I
LIF3T
LIST
� .s / I
�/��I
f'✓/,
'/7� A� 0
--- - "d� + I. , 1
./Ir4 a.,
Y _
CXECK
SEPTIC
TANK
SEWER
CONN.
DRAIN
FIELD
SOAKAGE
PIT
GREASE
TRAP
SOLAR
HEATER
DEEr
WELL
SPRKLR.
SYSTEM
SW IM'G
POOL
COWTR.
LIST
_
CHECK
I: 7 Permit
Amount of 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
cf 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 / pp�� q
Owner's Name and Address ----- ____ - _ _ -- _ _ -_ -- � No.___ � - ,�_� Street -Pi °
Registered Architect and /or E • ' eer___ __ —__ ��pp�� __
Employing Plumber's Name. !g1:.__ _ __ " No. _ — oY 4.— Street__XE __i l.
Location and Legal Description Lot__ _______________________________ Block_
Streit and Number where work is to be performed —No 8126" 4(
S ✓Co work to be performed and purpose of building (By Floors)_
New Building — Remodeling___ _________ Addition_________._ Repairs No. of Stories.
Sze Septic Tank — Type of Tank_ Capacity Gals.
Feet of Drain Tile
Nature of Water Supply: City—Well.
STATE OF FLORIDA, i
COUNTY OF DADE.
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMEN''
APPLICATION FOR PLUMBING ",L•I, IIT
f -IpPv
Date _._ OW 1
Subdivision
Street 47C7_�:&
___Dist. Feet of Tank or Drain Field from Well
__Size of Soakage Pit
- - - - --- (steed)- - - ✓ /l�
Plumbing Inspector.
The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations as an employer of labor
under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Pennanent Supplement, and has com-
plied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors employed by him in the work to be
performed under this permit; and will post or cause to be posted' for inspection on the site of the work such public notice or notices as are
req 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.
3: fore me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeared
is 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
th erein 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 'necessary by improper notice for inspection, or faulty
materials and /or workmanship.
Estimated
Qtantity
Actual
Quantity
Size
-, ` — - - --
Description
Retirement
Disposition
Pipe andicate Type)
Cocks, Lube
!ittings
‘c.m4? 4
4 A34
Sci Q I -
Description:
YLccation
Lnicipal Permit:
PGS — EC 7
51-AS c ' r 9 11-6 9�-
JOB ORDER SHEET
Itor
Nb0 Of Risers
9rpe Of Service
Residence
lb. Of Apt. Units
Commercial Thx District ✓'ll /J ' J
INSPECTOR'S REPORT:
Status Of Wilding:
Estimated Irnstallation Date: Remarks:
Date Reinspected Remarks:
pV
Date
"E"` JJ,O! Nbo —M
LOLL Fro. 6 / - ` -
Date Issued
",G'o" 17.0. N•o 0
Inspector
Approved By: Shpt, Date Job Completed
N
f\I
+ ST
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 wcrk.
;
Owner's Name and Address - - ^ Street.—
_
Registered Architect and/or Engineer_ _ ..._
Employing Plumber's Name___f_.,.:_ le(- ‘ ___ No. Street_
4 -; .,-,
Location and Legal Description Lot_ Block Subdivision _
-,
Street....
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_
Size Septic Tank_ Type of Tank_
--------
Amount of Permit $
STATE OF FLORIDA,
ss.
COUNTY OF DADE.
(Signed)_
(Signed )-
, c '
Repairs No. of Stories.
Capacity Gals
.........
Feet of Drain Tile. / L. __Dist. Feet of Tank or Drain Field from Well
Nature of Water Supply: City—Well Size of Soakage Pit
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 bus com-
plied with the provisions thereof, and will require similar compliance from all contractors or sub-contractors employed by him in the work to be
performed under this permit; and will post or cause to be posted' for inspection on the site of the work such public notice or notices as are
required by 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.
My Commission Expires Notary Public, State of Florida
Master Plumber.
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeared
to me well known, and who, being by me first duly sworn, upon oath deposes and says that he is the
of the above described construction, that he has carefully read the foregoing application, and that he did sign the same, and that all facts
therein by him stated are true.
NOTE: A re-inspection fee of $1.00 will be made when such re-inspection is made riecessary by improper notice for inspection, or faulty
materials and/or worlananship.
CLOSETS
BATH
Tuss
SHOWERS
LAVA.
TORIES
SINKS
SLOP
SINKS
LAUNDRY
TUB&
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
CHICK
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 wcrk.
;
Owner's Name and Address - - ^ Street.—
_
Registered Architect and/or Engineer_ _ ..._
Employing Plumber's Name___f_.,.:_ le(- ‘ ___ No. Street_
4 -; .,-,
Location and Legal Description Lot_ Block Subdivision _
-,
Street....
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_
Size Septic Tank_ Type of Tank_
--------
Amount of Permit $
STATE OF FLORIDA,
ss.
COUNTY OF DADE.
(Signed)_
(Signed )-
, c '
Repairs No. of Stories.
Capacity Gals
.........
Feet of Drain Tile. / L. __Dist. Feet of Tank or Drain Field from Well
Nature of Water Supply: City—Well Size of Soakage Pit
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 bus com-
plied with the provisions thereof, and will require similar compliance from all contractors or sub-contractors employed by him in the work to be
performed under this permit; and will post or cause to be posted' for inspection on the site of the work such public notice or notices as are
required by 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.
My Commission Expires Notary Public, State of Florida
Master Plumber.
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeared
to me well known, and who, being by me first duly sworn, upon oath deposes and says that he is the
of the above described construction, that he has carefully read the foregoing application, and that he did sign the same, and that all facts
therein by him stated are true.
NOTE: A re-inspection fee of $1.00 will be made when such re-inspection is made riecessary by improper notice for inspection, or faulty
materials and/or worlananship.
BUILDING
ELECTRICAL
PLUMBING
Owner of
Building
Legal Lot
Description
Address of
Building
MIAMI SHORES VILLAGE, FLORIDA
PERMIT N° 3111
Work to be performed under this Permit
Architect
Contractor
or Builder
Bl.
Subdi-
vision
Value of
Project
DATE 194
Contractor's .-' r "►
License No.
Amt. of ` '
Permit ,!.}
This permit is granted to the contractor or builder named above to construct the building or to install the equipment pr 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: , • f .. �. ,
Signed _ B y
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 regula-
tions 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.
'
''i {
' 1 t t ,t ' t
AUTHORITY
CONTRACTOR OR BUILDER BY F
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 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 No " Street_:_i 1
Location and Legal Description Lot Block Subdivision_
Street and Number where work is to be performed —No j t Street
State work to be performed and purpose of building (By Floors)
New Building Remodeling Addition Repairs No. of Stories
Amount of Permit $
STATE OF FLORIDA,
COUNTY OF DADE.
My Commission Expires
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
No
(Signed)
(Signed)
Date _ : __
Street
Size Septic Tank Type of Tank . Capacity Gals
Feet of Drain Tile__ {_ r •° � Dist. Feet of Tank or Drain Field from Well
Nature of Water Supply: City —Well. Size of Soakage Pit __________________________ ______ ___ _________________
________�_____
/
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 com-
plied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors employed by him in the work to be
performed under this permit; and will post or cause to be posted for inspection on the site of the work such public notice or notices as are
required by the Act. The under signed agrees to employ only such sub - contractors, on work to be performed under this permit, as are
licensed by Miami Shores Village.
Notary Public. State of Florida
Master Plumber.
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally
appeared _
to me well known, and who, being by me first duly sworn, upon oath deposes and says that he is the
of the above described construction, that he has carefully read the foregoing application, and that he did sign the same, and that all facts
therein by him stated are true.
NOTE: A re- inspection fee of $1.00 will be made when such re- inspection is made necessary by improper notice for inspection, or faulty
materials and /or workmanship.
CLOSETS
BATH
TUBS
SHOWERS
LAVA
TORIES
SINKS
SLOP
SINKS
LAUNDRY
TUBS
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
CHECK
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 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 No " Street_:_i 1
Location and Legal Description Lot Block Subdivision_
Street and Number where work is to be performed —No j t Street
State work to be performed and purpose of building (By Floors)
New Building Remodeling Addition Repairs No. of Stories
Amount of Permit $
STATE OF FLORIDA,
COUNTY OF DADE.
My Commission Expires
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
No
(Signed)
(Signed)
Date _ : __
Street
Size Septic Tank Type of Tank . Capacity Gals
Feet of Drain Tile__ {_ r •° � Dist. Feet of Tank or Drain Field from Well
Nature of Water Supply: City —Well. Size of Soakage Pit __________________________ ______ ___ _________________
________�_____
/
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 com-
plied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors employed by him in the work to be
performed under this permit; and will post or cause to be posted for inspection on the site of the work such public notice or notices as are
required by the Act. The under signed agrees to employ only such sub - contractors, on work to be performed under this permit, as are
licensed by Miami Shores Village.
Notary Public. State of Florida
Master Plumber.
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally
appeared _
to me well known, and who, being by me first duly sworn, upon oath deposes and says that he is the
of the above described construction, that he has carefully read the foregoing application, and that he did sign the same, and that all facts
therein by him stated are true.
NOTE: A re- inspection fee of $1.00 will be made when such re- inspection is made necessary by improper notice for inspection, or faulty
materials and /or workmanship.
Amount of Permit $_
MIAMI SHORES VILLAGE
0
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 No Street_
Auchitect 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 1 't Street
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 . Capacity Gals _
Feet of Drain Tile__ �!
1
�_ !_1!_:_ _' —_ ____ Dist. Feet of Tank or Drain Field from Well
Nature of Water Supply: City —Well Size of Soakage Pit
My Commission Expires Notary Public. State of Florida
plaster Plumber.
(Signed) ,�f j = .: – - –" -- _____
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 com-
plied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors employed by him in the work to be
performed under this permit; and will post or cause to be posted for inspection on the site of the work such public notice or notices as are
required by the Act. The under signed agrees to employ only such sub - contractors, on work to be performed under this permit, as are
licensed by Miami Shores Village.
(Signed)
STATE OF FLORIDA,
COUNTY OF DADE. ss.
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
SINKS
SLOP
SINKS
LAUNDRY
TUBS
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
S.RKLR.
SYSTEM
SWIM 'G
POOL
CONTR.
LIST
CHECK
Amount of Permit $_
MIAMI SHORES VILLAGE
0
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 No Street_
Auchitect 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 1 't Street
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 . Capacity Gals _
Feet of Drain Tile__ �!
1
�_ !_1!_:_ _' —_ ____ Dist. Feet of Tank or Drain Field from Well
Nature of Water Supply: City —Well Size of Soakage Pit
My Commission Expires Notary Public. State of Florida
plaster Plumber.
(Signed) ,�f j = .: – - –" -- _____
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 com-
plied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors employed by him in the work to be
performed under this permit; and will post or cause to be posted for inspection on the site of the work such public notice or notices as are
required by the Act. The under signed agrees to employ only such sub - contractors, on work to be performed under this permit, as are
licensed by Miami Shores Village.
(Signed)
STATE OF FLORIDA,
COUNTY OF DADE. ss.
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.
JOB:
BUILDING
ELECTRICAL
PLUMBINB
Inspector is Re port :
The following is ready for inspection:- ,
WILL BE READY
.,/
/
/