1208 NE 95 St (3)BUILDING INSPECTION DEPARTMENT
P PLICATION FOR BUILDING PERMIT
Application is he made for the approval of the detailed statement of the plans and specifications herewith submitted for the build -
ing or other structure.,herein described. This application is madc 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 the work.
Date.
Owner's Name and Address \V• ';l!! r , Y v � ‘vore _ No. l StreetM.. `?�`;.lL•
Registered Architect and /or Engineer
Sta� to and purpose of building (by floora)1,
1
MIAMI SHORES VILLAGE
New Building
Lei' 1 -1;
" * . t. fie700
Eztleivelfori
Fame and address of licensed contractor ..,Q'...V.e
Location and legal description of lot to be but on:
Lot.. / '/ 4' Block �•� S /sae
Street and Number where work is to be done i €e a a
a 0 ilAto .Mkr-
and for no other purpose.
Addition Repairs No. of Stories 1 _
To be constructed of Kind ��of��,,fooun��dation . Roof Covering _
Estimated Total cost of improvements $....Idea.. 1 uny .e7t Amount of Permit $.
Zone cubage required .Plan Cubage
Distance to next nearest building.. Size of Building Lot
Maximum live load to be borne by each floor
I hereby submit all the plans and specifications for said building. All notices with reference to the building and its construction may
be sent to
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 complied 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 ublic notice
or notices as arc required by the Act. The undersigned agrees to employ only such s � ntractors, on work be performed under this
pennit, as are licensed by Miami Shores Village.
Remarks..._ (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 ap-
peared
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.
Permit No..- --__._ Date Read, Sworn to and Subscribed before me.
Disapproved .__....._._.__ Date
Notary Public, State of Florida
(Signed)
Building Inspector My Commission Expires
PLANNING BOARD DATE
Chairman Member
Member Member
Member ...... _.._._..-- •- ---_._ •.- •-- •- -...
Member _ .- ._....
Council Approved Date Disapproved Date
NOTE: c i.itge of $1.00 will be made for making corrections or changes to this application after approval has heen obtained from
the Plannir. Board.
A re - ii pcction♦ fee of $1.00 will be charged when such re- inspection is made necessary by improper notice for inspection or faulty
materials a . /or wt)rkrnanship.
Permit No..._....� I "
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the building or other
structure herein described. This application is made in compliance and conformity with the Building Ordinance of Miami Shores Village, Florida,
and all provisions of the Laws of the State of Florida, all ordinances of Miami Shores Village and all rules and regulations of the Building
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.
Owners Name and Address
Registered Architect and /or Engineer
Employing Plumber's Nam
Location and Legal Description
Street and Number where work is to be performed —No.
No /. o Street..E
Street.. .W .._. / 6444
Block Subdivision
State work to be performed and purpose of bulling (By Floor)_,_,___.
New Building._... Remodeling Addition..._.._......__ Repairs ......_ ....... No. of Stories.... ....... _...........
Size Septic Tanks
Feet of Drain Tile
_Type of Tank
_Dist Feet of Tank or Drain Field from Well
Nature of Water Supply: City—Well. Size of Soakage Pit:
Amount of Permit $
STATE OF FLORIDA,
COUNTY OF DADE. f
(Signed)
(Signed)
lumbing Inspector.
The undersigned applicant for this building permit does hereby certify that he understands and accepts his obi' :•: ons as an employer of labor
under the Florida Workmen's Compensation Act, being Section 5988, 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 perfo , . under this permit, as are
licensed by Miami Shores Village.
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take aclnwwledgments, 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
mater OTE: A e inspecti fee of $1.00 will be made when such re Inspection is made necessary by improper notice for inspection, or faulty
Master Plumber.
CLOSETS
BATH
Tula
SHO
LAVA.
TORIES
SINKS
SLOT
SINKS
LAUNDRY
Tull
URINALS
CATCH
BASIN
FLOOR
GRAIN
—
DRINKING
FOUNT'NS
TOTAL
FIXTURES
Corms.
LIST
CHICK
.—'
SEPTIC
TANK
SEWER
Comm.
DRAIN
FIELD
SOAKAGE
PIT
GREASE
TRAP
SOLAR
NEATER
DICP
WELL
SPRKLR.
SYSTEM
SWIM'O
POOL
CONTR.
LIST
CHICK
Permit No..._....� I "
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the building or other
structure herein described. This application is made in compliance and conformity with the Building Ordinance of Miami Shores Village, Florida,
and all provisions of the Laws of the State of Florida, all ordinances of Miami Shores Village and all rules and regulations of the Building
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.
Owners Name and Address
Registered Architect and /or Engineer
Employing Plumber's Nam
Location and Legal Description
Street and Number where work is to be performed —No.
No /. o Street..E
Street.. .W .._. / 6444
Block Subdivision
State work to be performed and purpose of bulling (By Floor)_,_,___.
New Building._... Remodeling Addition..._.._......__ Repairs ......_ ....... No. of Stories.... ....... _...........
Size Septic Tanks
Feet of Drain Tile
_Type of Tank
_Dist Feet of Tank or Drain Field from Well
Nature of Water Supply: City—Well. Size of Soakage Pit:
Amount of Permit $
STATE OF FLORIDA,
COUNTY OF DADE. f
(Signed)
(Signed)
lumbing Inspector.
The undersigned applicant for this building permit does hereby certify that he understands and accepts his obi' :•: ons as an employer of labor
under the Florida Workmen's Compensation Act, being Section 5988, 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 perfo , . under this permit, as are
licensed by Miami Shores Village.
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take aclnwwledgments, 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
mater OTE: A e inspecti fee of $1.00 will be made when such re Inspection is made necessary by improper notice for inspection, or faulty
Master Plumber.
(Signed)
MIAMI SHORES VILLAGE
BUILDING INSPECTION DEPARTMENT
APPLICATION FOR BUILDING PERMIT
Application is hereby made for the approval of the detailed statc,nent ur we plans and specifications herewith submitted for the build
in 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 progreu of the work.
August 15, 19 86
' Date..._..._.. —.._._-_—_......__..—
Owner's Name and Address
Mr. . Barry Swope 1208 ,_„ S trom N . E . 95 St.
Registered Architect and /or Engineer
.
Name and adc1xc s of llccnsed contractor Obenour Roofing Co. 73 N.W. Ct. Miami
Location and legal description of lot to be uilt on: Q�� '� ��// /
Lot....f `�' /1 Block _.c"'' n. ./ 81,22 �l . i .. i 1/00-3
e: work is to be done 1208 N.E. 95 t. .
Street and Number where . ..........._....._._..._ _ __...._. —..._ _ — --F—
State work to be done and purpose of building (by floors)...__ — ».._...__..._
Reroof res with new white tile and built up gravel
32 32 - s s . _._....._
q _ _..._........and for no other purpose.
New Building Remodeling Addition Repairs ?eroof No. of Stories _
To be constructed of 1 - 30, 1 - 9 Q•rnd of foundation wood Roof Covering ti le/gr. avel___
35.00
Estimate Total cost of improvements $ 8 , 300 Amount of Permit S.
Zone cubage required .Plan Cubage
Distance • to next nearest building.. Size of Building Lot
Maximum live load to be borne by each floor
I hereby submit all the plans and specifications for said building. All notices with reference to the building and its construction may
be sent to.. 7357.•.N...W.•••• Miami •••Ct•. Miami, ••••F•I, 3.3L50
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 %Vorknien•s Compensation Act. being Section 5966. Compiled Ceneral Laws of Florida, Permanent Supplement,
anti has complied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors employed by him
in tl:c 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 subcontractors, on work to by, performed under
pcnnit, as are licensed by Miami Shores Village.
Remarks... (Signed ,l�T
STATE OF FLORIDA.
COUNTY OF DADE. i ss.
Before me, the undersigned authority. a notary public, duly authorized to administer oaths and take acknowledgments, personally ape
James D. Obenour
peared __—.._ . _ ....._..._
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 apptircation, and that he did sign the same, and that all facts
therein by him stated are true.
Permit No...C
Date 4-- ! _ f J& . ea/Sworn to and Sub •m .
��- \ •....... Date.._ _ — _.._ LL k otary P
Notary Public, State of Florida
Disapproved
Building Inspector
to me well known,
My Commission Expires NDIARY.RUBLIC$TATE (F41 :.—.
MY COMMISSION EXPIRES FEB. 18. 1989
PLANNING BOARD DATE
Ch airman Member _......._............_
Ucu,ber Member
Member .. .. Member _
Council Approved Date Disapproved Date
NOTE: A charge of $1.00 will be made for making corrections or changes to this application after approval has hero obtained from
the I'l.urnir,g Board.
A re•in fce of 51.00 will be charged when such re- inspection is made necessary by improper notice for inspection or faulty
materials anti /or workmanship.
• PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Date g- A2 - 96 Job Address f 5 NF Sr „s j Tax Folio
Legal Description Historically Designated: Yes No
Owner/Lessee / Tenant /056 0.1M ty SWOP E Master Permit # yQ .3.
Owner's Address /2. 0 c? v$ S Phone
Contractin Co. 013,1r* /V ( Ii & ( Address Rollo Bis e, PAQ, l?,v.
Queer /?0,8k A T N e SS# Phone 893-6 79 .
State # L Municipal # l V40 6 Competency # /y� e13-' Ins. Co. , 4A Q5
Architect/Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type (circle one): BUILDING ELECTRICAL PLUMBING p MECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIPTION r ESSU E CI,. E-A /) I' r A/!'A /P ( ,TAr 7> 4F R 0 F C)//,'T '
70 lx/
Square Ft. c A Z m
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 in compliance with all applicable
laws regulating construction and zoning. Furthermore, I authorize the above -named contractor to do the work stated.
Condo Pre nt Date
Notary as to Owner and/or Condo President
My Commission Expires:
APPROVED:
Zoning
Mechanical
Buildin
ez7 P4 2,0)il °7
Date
FEES: PERMIT 1461- RADON C.C.F. •
citto
Estimated Cost (value) 90
Signature of Contractor or Owner - Builder Date
Notaryy as to Contractor or Owner - Builder
My Commission Expires:
•
J v NOTARY
on-c- 8-,2 7 - s-�
Electrical
TOTAL DUE
Plumbing Engineering
Date
Application is he chy wade for the approval of the detailed statement of the plans and specifications herewith submitted for the build -
ing or other structure t herein described. This application is made in compliance and conformity with the Building Ordinance of Miami
Shores Village, Florid t. 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, whcther herein specified or not. A copy of approved
plans and specifications must be kept at building during progress of the work.
Owner's Name and Address WV
Registered Architect and /or Engineer
Name and address of licensed contractor..
be sent to
STATE OF FLORIDA,
COUNTY OF DADE. ss.
MIAMI SHORES VILLAGE
BUILDING INSPECTION DEPARTMENT
BUILDING INSPECTION DEPARTMENT
PPLICATION FOR BUILDINL, PER
PPLICATION FOR BUILDING PERMIT
•
Disapproved Date
(Signed)
Date..._...._.
1
// /� 9.._ �jj am�_ X 19 15,E
_ No./ ' . StreetL -E.. 9��_ ".lL • .
f!1
Repairs
Notary Public, State of Florida
d Iwo
Location and legal description of lot to be built on:
Lot...e Block �/ Subdivisi . /OW
�,g{Q
Street and Number where work is to be done /�w.� ...�
Stat wor to d and purpose of budding (by floors)/ a - -(� ......i / ._ __....__...
and for no other purpose.
Ekf 110SEI
New Building - iiastsesrsg Addition
To be constructed of Kind of foundation
Estimated Total cost of improvements $. �CIT/�1. � Amount of Permit S.
Zone cubage required _'Ian Cubage
Distance to next nearest building Size of Building Lot
Maximum live load to be borne by each floor
I hereby submit all the plans and specifications for said building. All notices with reference to the building and its construction may
No. of Stories J. _
Roof Covering
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 Ceneral.Laws of Florida, Permanent Supplement,
and has complied 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 arc required by the Act. The undersigned agrees to employ only such su ntractors, on work be performed under this
permit, as are licensed by Miami Shores Village.
Remarks..._ (Signed
Before me, the undersigned authority, a notary public, duly authorizcd to administer oaths and take acknowledgments, personally ap-
peared
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.
Permit No.._____ Date Read, Sworn to and Subscribed before me.
Building Inspector My Commission Expires
to me well known,
PLANNING BOARD DATE
Chairman Member
Member lrfembcr
Member _._..__._._._._ ._.._ Member .--- _ ............. .. .�
Council Approved Date Disapproved Date
NOTE: c )atge of $1.00 will be made for making corrections or changes to this application after approval has been obtained from
the Plannin• Board.)
A r - ii pcctiony fee of 51.00 will be charged when such re inspection is made necessary by improper notice for inspection of faulty
materials a ' /or wkinanship.
Location and legal description of lot to be bus on:
Lot J / Block
Distance to next nearest building
STATE OF FLORIDA,
COUNTY OF DADE. ss.
MIAMI SHORES VILLAGE
BUILDING INSPECTION DEPARTMENT
PPLICATION FOR BUILDING PER
BUILDING INSPECTION DEPARTMENT
PPLICATION FOR BUILDING PERMIT
Application is hekcby made for the approval of the detailed statement of the plans and specifications herewith submitted for the build -
ing or other structure. t 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 Bu'lcling 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 the work.
/?'t YWere ®ata No.�
Owner's Name and Address .... V. !.! AV
Registered Architect and /or Engineer
Name and address of licensed contractor..4,. t.At� j
lil
Str
��jj0 Su O
/ Street and Number where work is to be done .4 t?g q
Ss war to d and purpose of building (by foors)i� a �!', ►'y^'� .. -..
if1
and for no other purpose.
New Building - Addition Repairs No. of Stories I.
To be constructed of Kind of foundation Roof Covering
Estimated Total cost of improvements $.. -. •• ...J. Amount of Permit .
Zone cubage required plan Cubage
Size of Building Lot
Maximum live load to be borne by each floor
I hereby submit all the plans and specifications for said building. All notices with reference to the building and its construction may
be sent to .... - ..--
The undersigned applicant for this building permit does hereby certify that he •inderstands 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 complied 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 su ntractors, on work ,� be performed !artier this
pennit, as are licensed by Miami Shores Village.
Remarks (Signed) .
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personalty ap-
peared —
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.
Permit No..___._ Date Read, Sworn to and Subscribed before me.
Disapproved Date
Notary Public, State of Florida
(Signed)
Building Inspector My Comm scion Expires —
to me well known,
PLANNING BOARD DATtb
Chairman Member
Jfcrrbcr Member
Member ...... — - -._ ... - Member — Council Approved Date Disapproved Date
NOTE: l.ttge of $1.00 will be made for making corrections or changes to this afaplieaBien after approval has :seen obtained fman
the Plannirr hoard.
A re -ii pec•tionj ice of $1.00 will be charged when such re- inapectioat is c ea nccc cry bg inapraper notices for impaction or faulty
materials a /or w
ilr
kananship.
Permit No
... L__.. — Application is 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 Nam
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
NoAol
Location and Legal Description , Bl Subdivision
Street and Number where work is to be performed —No. /310 sr Street.._. - - State work to be performed and purpose of building (By Floors) - _ - - -._ ___ — _ — _. — _ — .. - • - •__ - -- --
New Building_ —. _ _.____. Remodeling_____ —._ -_ Addition.
Size Septic Tank
Feet of Drain Tile
-Type of Tank
mist Feet of Tank or Drain Field from Well ...
Nature of Water Supply: City—Well. Size of Soakage Pit.
Amount of Permit $
STATE OF FLORIDA, f
COUNTY OF DADE.
My Commission Expires
(Signed)
(Signed)
Repairs ----- .__......--- -.. No. of Stories. ...... . . . ..
lumbing Inspector.
The undersigned applicant for this building permit does hereby certify that he understands and accepts his obi'; ons 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 undersigned agrees to employ only such sub - contractors, on work to be perfo 4 d under this permit, as are
licensed by Miami Shores Village.
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 be did sign the same, and that all facts
therein by him stated are true.
Notary Public, State of Florida
Master Plumber.
mater rw� fee of $1.00 will be made when such re- inspection is rnade'neoessary by improper notice for inspection, or faulty
CLO[Rf
BATH
TUee
S
LAVA.
TORIES
SINK6
SLOP
SINKS
LAUNDRY
rues
U RINALS
CATCH
BASIN
FLOOR
DRAIN
-.
DRINKING
FOUNT' NS
i
7 ^
TOT AL
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
... L__.. — Application is 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 Nam
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
NoAol
Location and Legal Description , Bl Subdivision
Street and Number where work is to be performed —No. /310 sr Street.._. - - State work to be performed and purpose of building (By Floors) - _ - - -._ ___ — _ — _. — _ — .. - • - •__ - -- --
New Building_ —. _ _.____. Remodeling_____ —._ -_ Addition.
Size Septic Tank
Feet of Drain Tile
-Type of Tank
mist Feet of Tank or Drain Field from Well ...
Nature of Water Supply: City—Well. Size of Soakage Pit.
Amount of Permit $
STATE OF FLORIDA, f
COUNTY OF DADE.
My Commission Expires
(Signed)
(Signed)
Repairs ----- .__......--- -.. No. of Stories. ...... . . . ..
lumbing Inspector.
The undersigned applicant for this building permit does hereby certify that he understands and accepts his obi'; ons 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 undersigned agrees to employ only such sub - contractors, on work to be perfo 4 d under this permit, as are
licensed by Miami Shores Village.
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 be did sign the same, and that all facts
therein by him stated are true.
Notary Public, State of Florida
Master Plumber.
mater rw� fee of $1.00 will be made when such re- inspection is rnade'neoessary by improper notice for inspection, or faulty