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PLUMBING PERMITBUILDING El MIAMI SHORES VILLAGE. FLORIDA ELECTRICAL ❑ DATE 195 PLUMBING ❑ PERMIT N9 7637 ROOFING ❑ Owner of Building Architect Contractor or Builder Legal Description Address of Building Lot CONTRACTOR OR BUILDER Bl. Work to be performed under this Permit_ Subdi- vision Contractor's License No Sq. Ft Value of Project $ Amt. 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 wo-k will be performed in compliance with any plans, drawings, statements or specifications that rnay 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 v.ork done by hii 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 w :th 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. BY AUTHORITY 17 .UHJDING ❑ :LECTRICAL ❑ 'LUMBING :OOFING ❑ )weer of uilding .rchitect : ontractor r Builder egal 3 escription .ddress of uilding Lot CONTRACTOR OR BUILDER MIAMI SHORES VILLAGE. FLORIDA PERMIT N9 7615 Bl. Work to be performed under this Permit_ _ Subdi- vision Sq. Ft Value of Project $ DATR 195 Contractor's 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 or device described in the application erefor in strict compliance with all ordinances pertaining thereto and with the understanding that the work will be performed in compliance with any plans, rawings, statements or specifications that may have been submitted to and approved by the proper municipa'. authorities. This Permit may be revoked at any me 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 ranted is the understanding that the contractor or builder named above assumes the responsibility for a thorough knowledge of the ordinances and regulations ertaining 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 one 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 regulation, ertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores \Tillage. accepting this permit I assume responsibility for all work done by either, myself, my agent, servant or employee. BY AUTHORITY MIAMI SHORES VILLAGE, FLORIDA BUILDING ❑ ELECTRICAL 0 PERMIT N? 2 610 Contractors PLUMBING ❑ License No. ROOFING ❑ ❑ Work to be performed under this Permit _ Owner of Building Architect Contractor or Builder Legal Description Address of Building Lot Signed. Bl. Subdi- vision Value of Project $ DATF 195 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 hereior 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. 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 for all work done by either, myself, my agent, servant or employee. CONTRACTOR OR BUILDER BY AUTHORITY u ar Permit No.___ _ Q 3 . C Amount of Permit $ STATE OF FLORIDA, COUNTY OF DADE. MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT Owner's Name and Address Registered Architect and /or En Employing Plumber's Name .. 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) _______— Block_ (Signed) - -`- ` Date Subdivisi (Signed) [ -G— /� — " /a 0 sa Capacity Gals..- ... _ My Commission Expires Notary Public, State of Florida Master Plumber. Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the building or ether 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. ... = - -_. Street . _ L ._ C _.. - - -- !T Street__ 5 q ► r9f! eet - - - - -- - - -- - - -•- - -- - - -- ---------- '-- •••• - - New Building_ _------ -- -- -- -- - ---_ -- Remodeling .. Addition - - - -- •--- ----- --__ -. Repairs -- .. No. of Stories.. - .. .... ..... Size Septic Tank_. .___..— Feet of Drain Tile. _ ,. ',././' - -� - -� _ s 'st. et of Tank or Drain Field from Well._.. Nature of Water Supply: City — Well.____.___ ...... ___________ __Size of Soakage Pit Plum g 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 5968, 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 undersigned agrees to employ only such sub - contractors, on work to be performed under this pernit. as are licensed by Miami Shores Village. Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personall ;' 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 SW IM'G POOL CONTR. LIST CHECK ` -' Permit No.___ _ Q 3 . C Amount of Permit $ STATE OF FLORIDA, COUNTY OF DADE. MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT Owner's Name and Address Registered Architect and /or En Employing Plumber's Name .. 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) _______— Block_ (Signed) - -`- ` Date Subdivisi (Signed) [ -G— /� — " /a 0 sa Capacity Gals..- ... _ My Commission Expires Notary Public, State of Florida Master Plumber. Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the building or ether 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. ... = - -_. Street . _ L ._ C _.. - - -- !T Street__ 5 q ► r9f! eet - - - - -- - - -- - - -•- - -- - - -- ---------- '-- •••• - - New Building_ _------ -- -- -- -- - ---_ -- Remodeling .. Addition - - - -- •--- ----- --__ -. Repairs -- .. No. of Stories.. - .. .... ..... Size Septic Tank_. .___..— Feet of Drain Tile. _ ,. ',././' - -� - -� _ s 'st. et of Tank or Drain Field from Well._.. Nature of Water Supply: City — Well.____.___ ...... ___________ __Size of Soakage Pit Plum g 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 5968, 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 undersigned agrees to employ only such sub - contractors, on work to be performed under this pernit. as are licensed by Miami Shores Village. Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personall ;' 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. CHECK 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 I)i' ision of Miami Shores Village shall be complied with, whether herein specified or not. A copy of approved plans and specifications must he kept at building during progress of work. Nor <' r t i; , _• Owner's Name and Address - , __ t'_ A/ . _ No.____________I____.L_C Street 0E, Registered Architect and /or Engineer__ _ Employing Plumber's Nameedi [/.� 'i` _ - _t ±_ � e _ No Street Location and Legal Description Lot Block Subdivision �j ,� Street and Number where work is to be performed —No. C j Street Al State work to be performed and purpose of building (By Floors) New Building MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT Remodeling.__.__ _ Addition. Repairs - No. of Stories _. Size Septic Tank_ Mist. of Tank_ Y i __L_J I)_ _ , A /49 1.. . - -- .Capacity Gals. Feet of Drain Tile ZS F ! tak t''C 1_. ist. Feet of Tank or Drain Field from Well Nature of Water Supply: City —Well. Amount of Permit $ - STATE OF FLORIDA, COUNTY OF DADE. ss. Size of Soakage Pit.. (Signed) (Signed) Plumbing Inspector. The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations as an employer of labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Permanent Supplement, and has 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 perfonned under this permit; and will post or cause to be posted for inspection on the site of the work such public notice or notices as are required by the Act. The undersigned agrees to employ only such sub - contractors, on work to be performed under this permit, as are licensed by Miami Shores Village. Master Plumber. Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeared to me well known, and who, being by me first duly sworn, upon oath deposes and says that he is the of the above described construction, that he has carefully read the foregoing application, and that he did sign the same, and that all facts therein by him stated are true. My Commission Expires Notary Public, State of Florida NOTE: A re- inspection fee of $1.00 will be made when such re- inspection is made necessary by improper notice for inspection, or faulty materials and /or workmanship. CLOSETS T BATH S SHOWERS L LAVA- S SINKS S SLOP L LAUNDRY U URINALS C CATCH F FLOOR D DRINKING T TOTAL CONTR. LIST CHECK SEPTIC SEWER D DRAIN S SOAKAGE G GREASE S SOLAR D DEEP S SPRKLR. S SWIM'G 1 LIST 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 I)i' ision of Miami Shores Village shall be complied with, whether herein specified or not. A copy of approved plans and specifications must he kept at building during progress of work. Nor <' r t i; , _• Owner's Name and Address - , __ t'_ A/ . _ No.____________I____.L_C Street 0E, Registered Architect and /or Engineer__ _ Employing Plumber's Nameedi [/.� 'i` _ - _t ±_ � e _ No Street Location and Legal Description Lot Block Subdivision �j ,� Street and Number where work is to be performed —No. C j Street Al State work to be performed and purpose of building (By Floors) New Building MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT Remodeling.__.__ _ Addition. Repairs - No. of Stories _. Size Septic Tank_ Mist. of Tank_ Y i __L_J I)_ _ , A /49 1.. . - -- .Capacity Gals. Feet of Drain Tile ZS F ! tak t''C 1_. ist. Feet of Tank or Drain Field from Well Nature of Water Supply: City —Well. Amount of Permit $ - STATE OF FLORIDA, COUNTY OF DADE. ss. Size of Soakage Pit.. (Signed) (Signed) Plumbing Inspector. The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations as an employer of labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Permanent Supplement, and has 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 perfonned under this permit; and will post or cause to be posted for inspection on the site of the work such public notice or notices as are required by the Act. The undersigned agrees to employ only such sub - contractors, on work to be performed under this permit, as are licensed by Miami Shores Village. Master Plumber. Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeared to me well known, and who, being by me first duly sworn, upon oath deposes and says that he is the of the above described construction, that he has carefully read the foregoing application, and that he did sign the same, and that all facts therein by him stated are true. My Commission Expires Notary Public, State of Florida NOTE: A re- inspection fee of $1.00 will be made when such re- inspection is made necessary by improper notice for inspection, or faulty materials and /or workmanship. 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. S / f� l 1 ��T� Owner's Name and Address l =- - - -- - 1a d� --- ��: ------ -- ---- _--- - - - - -- No.— _---- _•-- -_ - - -_ Street Registered Architect and /or Enginee _ — Employing Plumber's Name ` _� r — Lacation and Legal Description L Street and Number where work is to be performed— No._ —_ 9 e) /✓ .______V Street State work to be performed and purpose of building (By Floors) --_._--__ - - -- New Building __ -- _ -- Remodeling __ -_- -- Addition__ Sze Septic Tank---- - Feet of Drain Tile_—._ - Nature of Water Supply: City —Well. Amount of Permit $ My Conmission Expires MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING r4 ;k.ivirr Type of Tank__ Capacity Gals _Dist. Feet of Tank or Drain Field from Well _ __Size of Soakage Pit ( Signed) __ Block-_ (Signed)- _ - -. - � Date 1 `( Street_ Subdivision Repairs No. of Stories. Plumbing Inspector. The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations as an employer of labor undez the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Permanent Supplement, 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 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 rc ulred by the Act. The undersigned agrees to employ only such sub- contractors, on work to be performed under this permit, as are Beensei by Miami Shores Village. 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. S x \TE OF FLORIDA, COUNTY OF DADE. j Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeared 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 TUB6 SHOWERS LAVA- TORIES SINKS SLOP SINKS LAUNDRY TUBS U RINALS CATCH BASIN FLOOR DRAIN DRINKING FOUNT' NS TOTAL FIXTURES C IST IST L / / / CN2C -�- SEPTIC TANK SEWER CONN. DRAIN FIELD SOAKAGE PIT GREASE TRAP SOLAR HEATER DEEP WELL SPRKLR. SYSTEM SWIM'G POOL CcwTR. / __ - - -- CCS=IS 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. S / f� l 1 ��T� Owner's Name and Address l =- - - -- - 1a d� --- ��: ------ -- ---- _--- - - - - -- No.— _---- _•-- -_ - - -_ Street Registered Architect and /or Enginee _ — Employing Plumber's Name ` _� r — Lacation and Legal Description L Street and Number where work is to be performed— No._ —_ 9 e) /✓ .______V Street State work to be performed and purpose of building (By Floors) --_._--__ - - -- New Building __ -- _ -- Remodeling __ -_- -- Addition__ Sze Septic Tank---- - Feet of Drain Tile_—._ - Nature of Water Supply: City —Well. Amount of Permit $ My Conmission Expires MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING r4 ;k.ivirr Type of Tank__ Capacity Gals _Dist. Feet of Tank or Drain Field from Well _ __Size of Soakage Pit ( Signed) __ Block-_ (Signed)- _ - -. - � Date 1 `( Street_ Subdivision Repairs No. of Stories. Plumbing Inspector. The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations as an employer of labor undez the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Permanent Supplement, 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 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 rc ulred by the Act. The undersigned agrees to employ only such sub- contractors, on work to be performed under this permit, as are Beensei by Miami Shores Village. 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. S x \TE OF FLORIDA, COUNTY OF DADE. j Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeared 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. BUILDING ELECTRICAL PLUMBING ROOFING Owner of Building Architect Contractor or Builder Legal Lot Description Address of Building MIAMI SHORES VILLAGE, FLORIDA PERMIT Bl. N9 6030 Work to be performed under this Permit_ .L DATE_ Contractor's License No. Subdi- vision Value of I ! Amount of Project $— I! Permit $ -z CONTRACTOR OR BUILDER BY AUTHORITY 19v 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 applica tion 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 respon- sibility for work done by his agents, servants or employees. Signed: ' /- INSPECTOR In consideration of the issuance to me of this permit I agree to perform the work covered hereunder in compliance with all ordinainratid 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 for all work done by either, myself, my agent, servant or employee. ANROT 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 ........ ___ -- IS.` �'� — "_.0 ��./i,,, __-- No. Street_ Registered Architect and /or Engineer _ Emp°oying Plumber's Name l .__; Location and Legal Description Lot --.- °-_----- __- __-_ - -.__ __ _ __ Blork Street and Number where work is to be performed —No / t r 4 State work to be performed and purpose of building (By Floors)__ New Building_-- Amount of Permit $ -___ Remodeling licensed by Miami Shores Village. /7 STATE OF FLORIDA, } COUNTY OF DADE. My Commission Expires MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT Addition__ (Signed)- (Signed)_ Date ' - C _ - 1 -- ; Subdivision Street G ^ %' ✓ - " Repairs No. of Stories.. ____ ............ ______ Capacity Gals. Size Septic Tank_.___-- -- -- -- -- - - - -� � Type of Tank c ' � // Feet of Drain Tile.__ = _ 1 - ..,_, }_ _ -L_Dist. Feet of Tank or Drain Field from Well Nature of Water Supply City;- Well.______ .ka______________- ____._____ 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 5986, 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 otice or notices as are required by the Act. The undersigned agrees to employ only such sub - contractors, ori'w k to be perfo ed der this permit, as are 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 er 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 matials and /or workmanship. CLOSETS BATH TU BS SHOWERS LAVA- TORIES S INKS SLOP SINKS LAUNDRY TUBE URINALS CATCH BASIN FLOOR DRAIN DRINKING FOUNT NS TOTAL FIXTURES CONTR. LIST CHECK _ ---•— /� G ° J �C� i■ SEPTIC TANK SEWER CONN. DRAIN FIELD SOA KAP.E P IT GREASE TRAP SOLAR HEATER D EEP WELL SPRKLR. SYSTEM SW IM'G POOL A''),-,, .✓, --,-' - /., ,. : v '; —�--- // , ( CONTR. Li 154 / A �i / ✓ � CHECK ,/ �' % '' ''�� _ JJ /r,/ : _ / 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 ........ ___ -- IS.` �'� — "_.0 ��./i,,, __-- No. Street_ Registered Architect and /or Engineer _ Emp°oying Plumber's Name l .__; Location and Legal Description Lot --.- °-_----- __- __-_ - -.__ __ _ __ Blork Street and Number where work is to be performed —No / t r 4 State work to be performed and purpose of building (By Floors)__ New Building_-- Amount of Permit $ -___ Remodeling licensed by Miami Shores Village. /7 STATE OF FLORIDA, } COUNTY OF DADE. My Commission Expires MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT Addition__ (Signed)- (Signed)_ Date ' - C _ - 1 -- ; Subdivision Street G ^ %' ✓ - " Repairs No. of Stories.. ____ ............ ______ Capacity Gals. Size Septic Tank_.___-- -- -- -- -- - - - -� � Type of Tank c ' � // Feet of Drain Tile.__ = _ 1 - ..,_, }_ _ -L_Dist. Feet of Tank or Drain Field from Well Nature of Water Supply City;- Well.______ .ka______________- ____._____ 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 5986, 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 otice or notices as are required by the Act. The undersigned agrees to employ only such sub - contractors, ori'w k to be perfo ed der this permit, as are 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 er 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 matials and /or workmanship. APPLICANT: AGENT: PROPERTY ADDRESS: LOT: BLOCK: SUBDIVISION: CHECKED [X] ITEM ARE NOT IN COMPLIANCE WITH STATUTE OR RULE AND MUST BE CORRECTED. l l l l l l l l l l l STATE OF FLORIDA PERMIT NO. DEPARTMENT OF HEALTH DATE PAID: ONSITE SEWAGE TREATMENT AND DIPOSAL SYSTEM FEE PAID: CONSTRUCTION INSPECTION AND FINAL APPROVAL RECEIPT #: TANK INSTALLATION TANK SIZE [1] [2] TANK MATERIAL OUTLET DEVICE MULTI - CHAMBERED [ Y / [01] [02] [03] [04] [05] [06] LEGEND [ [08] [09] OUTLET FILTER WATERTIGHT LEVEL DEPTH TO LID DRAINFIELD INSTALLATION AREA (1] ,_[2], SQFT DISTRIBUTION BOX _ HEADER _ NUMBER OF DRAINLINES:' , DRAINLINE SEPARATION DRAINLINE SLOPE DEPTH OF COVER ELEVATION [ABOVE /BELOW] SYSTEM LOCATION DOSING PUMPS AGGREGATE SIZE AGGREGATE EXCESSIVE FINES AGGREGATE DEPTH (10] [11] [12] [13] [14] [15] [16] [ [18] [19] [20] [21] FILL [ [23] [24] [25] [26) / EXCAVATION MATERIAL FILL AMOUNT FILL TEXTURE EXCAVATION DEPTH AREA REPLACED REPLACEMENT MATERIAL EXPLANATION OF VIOLATIONS / REMARKS: EM l 1 l l [ ] [ l [29] [30] (31] (32] [33] [34] [35] PROPERTY ID #: SETBACKS [27] SURFACE WATER [28] DITCHES PRIVATE WELLS PUBLIC WELLS IRRIGATION WELLS POTABLE WATER LINES BUILDING FOUNDATION PROPERTY LINES OTHER FILLED / MOUND SYSTEM [36] DRAINFIELD COVER (37] SHOULDERS (38] SLOPES (39] STABILIZATION ADDITIONAL INFORMATION [40] UNOBSTRUCTED AREA [41] STORMWATER RUNOFF [42] ALARMS [43] MAINTENANCE AGREEMENT [44] BUILDING AREA (45] LOCATION CONFORMS WITH SITE PLAN (46] FINAL SITE GRADING (47] CONTRACTOR ( OTHER [49] TANK PUMPED _ /___/ [50] TANK CRUSHED & FILLED CONSTRUCTION (APPROVED/DISAPPROVED]:: - CHID DATE: FINAL SYSTEM (APPROVE /DISAPPROVED] : CHD DATE DH 4016, 10/91 (Previous Editions May Be Used) PT 1: 4pp::a_n1 PT 2: 'nstc.".cr /Cantrector PT 3: 3u:''.enp Dcpartrr.cnt PT 4: :-Icett 1 Dcpartmcnt FT FT FT FT FT FT FT FT FT Page 2 of 3 PERMIT NUMBER: APPLICANT: AGENT: MAILING ADDRESS: LOT, BLOCK, SUBDIVISION PROPERTY ID#: Permit tracking number assigned by CHD. Property owner's full name. Property owner's legally authorized representative. P.O. box or street mailing address for applicant or agent. Lot, Block and Subdivision for lot or 27 character number for property. (property appraiser ID # or GIS location) COUNTY HEALTH DEPARTMENT CHECKS [X] ITEMS NOT IN COMPLIANCE WITH CONSTRUCTION PERMIT AND STATUTE OR RULE. INFORMATION IS COMPLETED BY CHD ON FOLLOWING ITEMS: TANK SIZE (gallons) TANK MATERIAL (concrete, fiberglass, etc) OUTLET FILTER (manufacturer, make, model) LEGEND (manufacturer code) DRAINFIELD AREA (square feet) DISTRIBUTION BOX / HEADER (check box) NUMBER OF DRAINLINES (number installed) SYSTEM ELEVATION (in relation to BM) DOSING PUMPS (number installed) SETBACKS (record actual setbacks in ft) SETBACKS OTHER (as required) STABILIZATION (date stabilized) CONTRACTOR (contractor installing system) ADDITIONAL INFORMATION (as required) ABANDONMENT TANK PUMPED (date) TANK CRUSHED AND FILLED (date) EXPLANATION OF VIOLATIONS: Record item number, explanation of violation, and required CONSTRUCTION APPROVAL: Circle approved or disapproved, CHD signature and date. AS BUILT INSTALLATION SKETCH FINAL APPROVAL: Circle approved or disapproved. CHD signature and date of approval. Final approval shall not be granted unit the CHD has confirmed that building construction and lot grading are in substantial compliance with plans and specifications submitted with the pemit application. ELEVATION WORKSHEET ELEVATION OF BENCHMARK OR REFERENCE POINT: [ +] SHOT H.I. ELEVATION EXISTING GROUND H.I. [ -] SHOT TOP OF AGGREGATE H.I. [ -] SHOT H.I. [ -] SHOT FLORIDA DEPARTMENT OF HEALTH APPROVED D •