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PLUMBINGDate: PERMIT APPLICATION FOR MUNICIPALITIES OF DADE COUNTY (OWNER TO RETAIN COPY) Date_ / Job Address/30 NE E //$± Tax Folio /1 F/ Legal 1 :cription l s' 116q/ Owner / i a ssee / Tenant 64414 47,<W/ / Master Permit # 4 Owner's Address / ?i9 y&t Phone Contracting Co. r44i A -1A Address Qualifie ,, /' 2ti/i SS# - - Phone , 3V- /5 4? State 4k Municipal # Competency # �;93i ins.Co. Architect /Engineer Address Bonding Company Address Mortgagor Address __ - -- it Type(circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENC: SIGN WORK DESCRIPTION Square Ft. Estimated Cost(value) ', . 4 "V 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 AV/;? Si Signature of owner and/or Condo President Si r act 8n / Signature of Cont or or Owner- Builder Date: Notary as to Owner and /or Condo President Notary as to Contractor or Owner- Builder My Commission Expires: My Commission Expires: ** * * * * * * * * * * * * * * * ** FEES: PERMIT 3 6 RADON C.C.F. 5C2 NOTARY TOTAL DUE '-J 0 APPROVED: Fire Other Zoning Building Electrical Mechanical Plumbin: ' �" L' dgineering 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 spedficatiorts must be kept at building during progress of work. Owner's Name and Address EDWARD P I S E Z K N 1300 StreetW-- 94 STREET Registered Architect and/or Engineer Employing Plumber's Name PUBLIC GAS COMPANY Location and Legal Description Lot__ Size Septic Tank Feet of Drain Tile Nature of Water Supply: City -WeIL Amount of Permit $ u. MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT (SIS d) 1, to me well kno 'tea, and who, being by me first duly sworn, upon oath deposes and of the above described construction, that be has carefully read the foregoing therein by him stated are true. NOTARY PUBLIC, STATE OX M. MY COMMISSION EXPIRES. AOrii my Co Expires N NW 25 STREET $tor w Subdivision_____ Street and Number where work is to be performed -No 13 0 0 Street 9 4 STREET State work to be performed and purpose of building (By Floors) DELIVER & INSTALL 1 - 40 & 1 - GALLON _ WATER HEATER Now Building_._—_ _ - Remodeling Addition Repairs No. of Stories .......... T of Tantr >7lst. Feet of Tank a Drain Field from Well Size of Soakage Pit__-.__--_--. _-.-.._-..— ________.___.___. .__..__. ..Capacity Gals..__.._._._ _ ..__.._ (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 5988, Compiled General Laws of Florida Permanent Supplement, and lams 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 peblle notice ur notices as ar• required by the Act.. The undersigned agrees to employ only such sub-contractors, on work to be performed undue this per:oit, as are licensed by Miami Shores Village. STATE OF FLORIDA, t COUNTY OF DADE. Before me, the undersigned-authority, a notary public, daily authorized to administer oaths and take acknowledgments, personally appeared that he is the ... Matta :'lumber...... licatlon, and that he did sign the same, and that all facts NOTE: A re- inspection fee of $1.00 will be made whoa sue ro-laspeollos Y so•d••neeesaary by improper notice for 'impaction, or falsity materials and /or wor mmaaship. CLOSE" BATH Tuff " OWL " LAVA• TORIES •INKS SLOP •INKS LAUNDRY Tuff U CATCH BASIN FLOOR DRAIN DRINKING FOUNT' NS TOTAL FISTUR[S Comm LIST • CHECK SEPTIC TANK SEWER CONN. DRAIN FIELD SOAKAGE PIT GREASE TRAP SOLAR NEATER DEEP WELL • • •WIN'O POOL CONTR. LIST CHECK . 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 spedficatiorts must be kept at building during progress of work. Owner's Name and Address EDWARD P I S E Z K N 1300 StreetW-- 94 STREET Registered Architect and/or Engineer Employing Plumber's Name PUBLIC GAS COMPANY Location and Legal Description Lot__ Size Septic Tank Feet of Drain Tile Nature of Water Supply: City -WeIL Amount of Permit $ u. MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT (SIS d) 1, to me well kno 'tea, and who, being by me first duly sworn, upon oath deposes and of the above described construction, that be has carefully read the foregoing therein by him stated are true. NOTARY PUBLIC, STATE OX M. MY COMMISSION EXPIRES. AOrii my Co Expires N NW 25 STREET $tor w Subdivision_____ Street and Number where work is to be performed -No 13 0 0 Street 9 4 STREET State work to be performed and purpose of building (By Floors) DELIVER & INSTALL 1 - 40 & 1 - GALLON _ WATER HEATER Now Building_._—_ _ - Remodeling Addition Repairs No. of Stories .......... T of Tantr >7lst. Feet of Tank a Drain Field from Well Size of Soakage Pit__-.__--_--. _-.-.._-..— ________.___.___. .__..__. ..Capacity Gals..__.._._._ _ ..__.._ (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 5988, Compiled General Laws of Florida Permanent Supplement, and lams 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 peblle notice ur notices as ar• required by the Act.. The undersigned agrees to employ only such sub-contractors, on work to be performed undue this per:oit, as are licensed by Miami Shores Village. STATE OF FLORIDA, t COUNTY OF DADE. Before me, the undersigned-authority, a notary public, daily authorized to administer oaths and take acknowledgments, personally appeared that he is the ... Matta :'lumber...... licatlon, and that he did sign the same, and that all facts NOTE: A re- inspection fee of $1.00 will be made whoa sue ro-laspeollos Y so•d••neeesaary by improper notice for 'impaction, or falsity materials and /or wor mmaaship. t If Subsidiary or Revision provide Master Permit Number Job Address 13)c) Ni e 4L4 Sr. Suite , Folio 1132,65 /c / 2,0°z, Contractor's No. 07J j Contractor's Name i j E S'W., _, Al< 2 "a Qualifier's S.S.B L2 - e - / 1O Qualifier's Name ,�Ar� 04Ah5C Contractor's Address Ai/ /9 'awe& PE Lcmi vb. City � t fj0i 'b69. S StaterLI Zip /VA Circle the Correct Appl icat' Type: Addition Attached, Addition Detached, Alteration Interior, Alteratioi Exterior, Demolish, Enclose, New, Repair Fire Damage, Relocate, Foundation Only, Shell Only Circle the Correct Permit Type: (Building, Electrical Note: for permit type other than Building please complete the appropriate fee sheet. Category (Pick Code From Back if Building Permit) If Revision to an existing Permit please Circle one or more of the following: New Contractor, New Qualifier, Permit Extension, Renewal, Plan Revision, Supplemental Fee (must be for the same category of work as the original permit) Reinspection Fee (supplemental fee code A002) Sq. Ft. Units Floor Value of work Current Use of Property HOL),56 Proposed Use 0005 Contact Name-J y tltre,cnig Phone: ■94/4, /e//y Address 4//9 Tacee LEA g.Vh. City�/� � �Q �� State Zip & &i v(6 Architect /Engineer City °� State , Owner's Name /12 ' C2eK City Legal Description Description Bonding Company's Name Mortgage Lender's Name City City SIGNATURE OF OWNER SIGNATURE OF CONTRACTOR L �� Date NOTARY as to Owner My Commission Expires: Please see back for important information. DADE COUNTY BUILDING AND ZONING DEPARTMENT 111 N.W. 1ST STREET, SUITE #1010 MIAMI, FLORIDA 33128 -1974 PERMIT APPLICATION (Please fill out completely) State FLA LPGX Mechanical) State State Address Zip Code Address i3bt, MCg4 Zip Code 37kI k Address Zip Code Address Zip Code Application is hereby made to obtain a permit to do work and installation as indicated. I certify that all work will b' performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that separeate permits are required for ELECTRICAL, PLUMBING, SIGNS, POOLS, MECHANICAL AND ROOFING WORK. OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done n compliance with all applicable laws regulating construction and zoning. WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT 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. PRINT NAME PRINT NAME , / �F/e'if='S/ Le.219,4:St Date NOTARY as to Contractor My Commission Expires TAPS' 4 "!..d ii • a ,. , 1 ' FIRES: Feb. 15, 1995. BONDED TURTOTARY PUBL PU CATEGORY DESCRIPTION BUILDING PERMIT CATEGORI 01 CORAL BUILDING - COMMERCIAL 02 SUB - CORAL BUILDING - RESIDENTIAL 08 CANVAS AWNING 10 COMMUNICATION ¶I ER 15 DEMOLITION 18 FENCE 19 FLAGPOLE / SATELLITE 29 METAL AWNING & STORM SHUTTER 35 ORNAMENTAL IRON 44 ROOFING 48 SCREEN ENCLOSURES 51 SIGN (NON ELEXTRIC 1 55 SWIMMING POOL 56 TENNIS COURTS (SURFACE PAVING) 82 WINDOWS (GF) - NEW 83 WINECM INSTALLATION (GF) (S.F.) 84 WINDOW SCREENS (GF) ( e.iuRT WALL) 86 TRAILER TIE. DOWN 87 PARKING / OPEN LOT / PAVING 88 WALK -IN COOLER 91 MARINAS BTU Please be advised that Roadway Impact Fee may be required for Building Permit categories "01" Commercial, "02" Residential,. "18." Fence, "56" Tennis Courts and "86 "' Trailer Tie Down.. Please complete the following if your application for one of the above mentioned categories. Road Impact Fee, Fee Payer Name Address Phone No. Social Security /Tax Identification No. Please be:advised that any existing or proposed Development served or to be served with a septa tank requires:apjiroval from the State Department of Health and Rehabilitative Services (HRS) METROPOLITAN DADE COUNTY DEPARTMENT OF BUILDING & ZONING PLUMBING AND GAS FEE SHEET *Attention applicant: you are responsible for filling out this application correctly if you have any questions concerning what category your work falls under, please see an inspector or processor for your trade. Refunds will not be given in case of error on your part and you will be charged a double fee for doing work without a permit. Category 01 (P001 Must have Bldg. Permit No., if not, send for processing.) P001 Rough /Plug (includes Roof Inlets) Aof Outlets P003 Sewer Connection (Stand Alone w/o Bldg Permit)(Must show proof of "19" Permit)(Must have WASA Form ASCC) P004 Sewer Capping P009 Condensate Drain P010 Water Service Connection P011 Water Connection for outlet /appliance not covered in P001 ie (Icemaker, Heat recovery) P015 Sump Pump P016 Repairs to Water Piping P032 Fixture /Set (includes Roof Inlets Floor Drain) P033 2" or less water service back flow assembly P034 2 1/2 or larger water service back flow assembly P038 Dental Vaccum system Category 02 - Gas Fitting (Natural Gas) (Must be on separate application.) (Installation verification must be attached to application) (If plans must be processed) P018 Natural Gas LP Outlets P019 Appliances /Set (Excluding water heater) P020 Meters P021 Repairs to Gas Pipes P023 Change of Company Category 03 - Lawn Sprinkler P012 Irrigation System /Underground Sprinkler Category 05 - Chemical Toilets P031 1st Temporary Toilets P036 Additional Temporary Toilets PO40 Renewal of Permit Category 06 - Install Septic Tank only P002 Septic Tanks /Relay A of Sewers A of Sewer Caps A of Outlet A Meters A of Connection A of Pumps est. value A of Fixtures A of Assemblies A of Assemblies A of Systems A of Outlets A of Appliances A of Meters A of Repairs A of Changes A of Zone A of Toilets A of Toilets Original Permit Fee A of Items 7- CZER.wc� z Flor 1A*- Nres) Category 07 - Solar Water Heater (Must be processed.) P013 Solar Water Heater Installation # Heaters P013 Replace Solar pannels or add # Heaters Category 09 - Swimming Pool Maintenance Only P014 Equipment (replacement only) Category 14 - Fire Water (Must be processed.) P010 Water Service Connection Category 18 - Lift Station (dust be p - — - P026 Lift Station Category 19 - Septic Tank Abandoment P002 Septic Tanks /Relay # Pools Category 10 - Pool Piping (must have Building Permit #) P014 Pool Piping Fee # of Pools P035 Pool Heater (set only) #of Heaters Category 11 - Well Drilling (Portable or irragation) P017 Wells # of Wells Category 12 - Swimming Pool Servicing P014 Replace or add equipment # of Pools # of Meters Category 15 - Site Utilities P024 Water Treatment Plant # of Piping P025 Sewer Treatment Plant # of Piping P027 Sewage Ejection # of Ejector P028 Water & Gas Mains # of Feet P029 Storm & Sanitary Collector Lines # of Feet P030 Manhole # of Manholes PO41 Incepter (set only) # of Incepter Category 17 - Exterior Rough only P010 Building Water Service Connection # of Connections P028 Building Sewer line # of Feet P039 Trailer or manufacter Home Connections # of Connections # of Stations # of Items LPGX Category 01 (Must be on separate application.) P018 LP Outlets /Regulators # of Outlets P019 Appliances /Set 0 of Appliances P020 Meters # of Meters P021 Major Repairs to Gas Pipes # of Repairs P022 Underground LP Tanks # of Tanks P023 Change of Company # of Changes P037 Above Ground Lp Tanks # of Tanks Owner / Lessee PERMIT APPLICATION FOR MUNICIPALITIES OF DADE COUNTY (OWNER TO RETAIN COPY) Date- 6 gg Job Address /34( 7/f 9 1 7 1- 51 ---- / > t Tax Foli'of / J2 o 5 /d Legal Description 9 t/ p , q 9/ / Tenant / 715. 6 ' 2 c / Owner's Address d or, /) E 9 4 57" Phone Contracting Co. ealE.e6-Ka /fdAd ",-4i nom. S Address //9 Pcii, PdCZ , -iiv 01 , 1P Qualifier .1 � . ..rald SS# Phone 44sq /014' State 4P Municipal # 075"i/ Competency # Ins.Co. Architect /Engineer Address Bonding Company Address Mortgagor Address Permit Type(circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING PENCE SIGN `WO DESCRIPTION /j %*7 cal les4�✓'7 / � TO 2 M4/7 ' Square Pt. Estimated Cost(value) %BO) x%' Master Permit # 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. Signature of owner and /or Condo President Date: ignature of Contractor or Owner- Builder Date: Notary as to Owner and /or Condo President Notary as to Contractor or Owner- Builder My Commission Expires: My Commission Expires: ** * * * * * * * * * * * * * * * ** FEES: PERMIT 6 RADON C.C.F. NOTARY TOTAL DUE '3 APPROVED: Fire Other Zoning Building Ele trical y G Mechanical Plumbi�� ( � Permit No MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT Date. .._!l- Application is hereby made for the approval of the detailed statement of the plans and specifications herewith sub (iit;c d for the building or other structure herein described. This application is made in compliance and conformity with the Building Ordinance of Mit, 71 Shores Village, Florida, and all provisions of the Laws of the State of Florida, all ordinances of Miami Shores Village and all rules and regulatic..*. of the Building Division of Miami Shores Village shall be complied with, whether herein specified or not. A copy of approved plans and spec'fications must be kept at building during progress of work. p Owner's Name and Address N r/K St cf ,Aegist: red Architect and /or Engineer .� Employing Plumber's Name ... - B/ f2 / rS e/ » 0 c / fig► NO,. - � ,. ���:� stleet...Zl.,,, . . ..,�. -.. Location and Legal Description Lot_ � B Blor 1 k Street and Number where work is to be performed —No ,76. _.( 9 ' street State work to be performed and purpose of building (By Floors)__ New Building _ Remodeling_ ______ Addition..._ -_.__ Repairs No. of Stones.. .... Size Septic Tank ® � G - -Type of Tank Feet of Drain Tile._.__ ____ _._Dist. Feet of Tank or Drain Field from Well _•---- • - - - -. Nature of Water Supply: City — Well.__ __._.._._____.__ _ _______ ...Size of Soakage Pit Amount of Permits ' S (Signed) _ Q $ t Capacity Goals y 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 5988, Compiled General Laws of Florida Permanent £uptlement, and liar corn_ plied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors employed I y him in ` e work o b� performed under this permit; and will post or cause to be posted' for inspection on the site of the work such pub]: notice 75 no ices as a.* required by the Act. The undersigned agrees to employ only such sub - contractors, on opt t be performed - ? c'u Irr.�il, x au licensed by Miami Shores Village. (Signed) Mast,a, Plumber. STATE OF FLORIDA, b COUNTY OF DADE. Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, persorwl ;• a ppearea, 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 'acts therein by him stated are true. My Coaunission Expires Notary Public, State of Florida NOTE: A re- inspection fee of $1.00 will be made when such re-inspection is mode' necessary by improper notice for Inspection, (Ir ioultq materials and/or workmanship. CLO[CTS BATH TUBS bHOW [RS LAVA• TONICS SINKS SLOP SINKS LAUNDR Tugs URINALS CATCH BASIN FLOOR DRAIN DRINKING FOUNT'Ne Tors.t. FIKTI RCS CONTR. Li 'A' __ CHECK SEPTIC TANK SEWER CONN. DRAIN FIELD SOAKAGE PIT GRCA:C TRAP SOLAR M DEEP WELL SPRKLR. SYSTEM SWIM'O POOL CON7A. LIST __ CHECK Permit No MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT Date. .._!l- Application is hereby made for the approval of the detailed statement of the plans and specifications herewith sub (iit;c d for the building or other structure herein described. This application is made in compliance and conformity with the Building Ordinance of Mit, 71 Shores Village, Florida, and all provisions of the Laws of the State of Florida, all ordinances of Miami Shores Village and all rules and regulatic..*. of the Building Division of Miami Shores Village shall be complied with, whether herein specified or not. A copy of approved plans and spec'fications must be kept at building during progress of work. p Owner's Name and Address N r/K St cf ,Aegist: red Architect and /or Engineer .� Employing Plumber's Name ... - B/ f2 / rS e/ » 0 c / fig► NO,. - � ,. ���:� stleet...Zl.,,, . . ..,�. -.. Location and Legal Description Lot_ � B Blor 1 k Street and Number where work is to be performed —No ,76. _.( 9 ' street State work to be performed and purpose of building (By Floors)__ New Building _ Remodeling_ ______ Addition..._ -_.__ Repairs No. of Stones.. .... Size Septic Tank ® � G - -Type of Tank Feet of Drain Tile._.__ ____ _._Dist. Feet of Tank or Drain Field from Well _•---- • - - - -. Nature of Water Supply: City — Well.__ __._.._._____.__ _ _______ ...Size of Soakage Pit Amount of Permits ' S (Signed) _ Q $ t Capacity Goals y 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 5988, Compiled General Laws of Florida Permanent £uptlement, and liar corn_ plied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors employed I y him in ` e work o b� performed under this permit; and will post or cause to be posted' for inspection on the site of the work such pub]: notice 75 no ices as a.* required by the Act. The undersigned agrees to employ only such sub - contractors, on opt t be performed - ? c'u Irr.�il, x au licensed by Miami Shores Village. (Signed) Mast,a, Plumber. STATE OF FLORIDA, b COUNTY OF DADE. Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, persorwl ;• a ppearea, 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 'acts therein by him stated are true. My Coaunission Expires Notary Public, State of Florida NOTE: A re- inspection fee of $1.00 will be made when such re-inspection is mode' necessary by improper notice for Inspection, (Ir ioultq materials and/or workmanship. Villa of Miami Shores JOB ' '•` ' ADDRESS >-- INSPECTION A . TIME READY • A • N? 4757 REMARKS INSPECTOR DATE • Village of Miami Shores N° 3727 JOB ,z) ADDRESS INSPECTION r `, TIME READY f REMARKS INSPECTOR DATE BUILDING ELECTRICAL PLUMBING ROOFING Owner of Building Architect Contractor or Builder Legal Description Address of Building Lot MIAMI SHORES VILLAGE, FLORIDA DATF 195 ❑ PERMIT N° 4143 Contractors License No. " t 0 Work to be performed under this Permit Bl. Subdi- vision Value of 11 Amount of Project $ I Permit $ This permit is granted to the contractor or builder named above to construc the building or to install the equipment or device described in the application herefor in strict compliance with all ordinances pertaining thereto and with the understanding that the work will be performed in compliance with any plans, drawings, statements or specifications that may have been submitted to and approved by the proper municipal authorities. This Permit may be revoked at any time if the work is not done in compliance with such ordinances or if the plans are changed without authorization. A further condition upon which this permit is granted is the understanding that the contractor or builder named above assumes the responsibility for a thorough knowledge of the ordinances and regulations pertaining to the work covered hereby whether shown on the plans or drawings or in the statements or specifications and that he assumes responsibility for work done by his agents, servants or employees. Signed `BY INSPECTOR In consideration of the issuance to me of this permit I agree to perform the work covered hereunder in compliance with all ordinances and regulations pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In ac- cepting this permit I assume responsibility for all work done by either, myself, my agent, servant or employee. -- y CONTRACTOR OR BUILDER °" BY AUTHORITY e. UILDING a.ECTRICAL LUMBING OOFING )wrier of uilding MIAMI SHORES VILLAGE, FLORIDA 0 ❑ DATF 195 p PERMIT N° 3103 Contractor's 1 License No. ❑ Work to be performed under this Permit rchitect ontractor Builder Yga1 Lot oscription ddress of Aiding CONTRACTOR OR BUILDER Bl Subdi- vision Value of Project $ 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 refor in strict compliance with all ordinances pertaining thereto and with the understanding that the work will be performed in compliance with any plans, ?wings, statements or specifications that may have been submitted to and approved by the proper municipal authorities. This Permit may be revoked at any ie 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 jnted is the understanding that the contractor or builder named above assumes the responsibility for a thorough knowledge of the ordinances and regulations rtaining 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 ne by his agents, servants or employees. Signed. BY INSPECTOR In consideration of the issuance to me of this permit I agree to perform the work covered hereunder in compliance with all ordinances and regulations rtaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In ac- 'ling this permit I assume responsibility for all work done by either, myself, my agent, servant or employee. BY AUTHORITY 6 Permit No New Building - ---- __ -•-• •- --_.. Remodeling Addition Amount of Permit $ as. MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMEiti` : APPLICATION FOR PLUMBING (Signed)____ 4j _. - -•- ( Signed )! _ O ua Date _._.. / Application is hereby made for the approval of the detailed statement of flu, plans and specifications herewith submitted for the building or other structure herein described. This application is made in compliance and conf;r•i:y with the wilding 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 e - nr?. A copy of approved plans and specifications must be kept at building during progress of work. er'o Name and Address___ la. e l _ / �-- --- .. -�. N o i ? _ _ Stree Registered Architect and /or Engineer - -- - ___ -- �fv 4)1 _ 1 Employing Plumber's Name _ _____�� �_ ._._ No. Location and Legal Description Blook____ Street and Number where work is to be performed —No I e 6; Street C� = State work to be performed and purpose of building (By Street__ 7z7; -- _ . Subdivision _. C?b_f _ , Size Septic Tank Feet of Drain Tile Nature of Water Supply: City —Well. if My Commission Expires Notary Public, State of Florida Repairs No. of Stories Type of Tank__ Capacity Gals ____Dist. Feet of Tank or Drain Field from 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 retpe ed 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. 5 ii ATZ OF FLORIDA, t COUNTY OF DADE. Eiefore 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 move 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 TUBE URINALS IAS CATCH BABIN FLOOR DRAIN DRINKING FOUNT' NS TOTAL FIXTURES CON4:2. LIST CHECK SEPTIC TANK SEWER CONN. DRAIN FIELD SOAKAGE PIT GREASE TRAP SOLAR H EATER DEEP WELL SPRKLR. SYSTEM SW IM'G POOL CONTR. LIST CHECK Permit No New Building - ---- __ -•-• •- --_.. Remodeling Addition Amount of Permit $ as. MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMEiti` : APPLICATION FOR PLUMBING (Signed)____ 4j _. - -•- ( Signed )! _ O ua Date _._.. / Application is hereby made for the approval of the detailed statement of flu, plans and specifications herewith submitted for the building or other structure herein described. This application is made in compliance and conf;r•i:y with the wilding 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 e - nr?. A copy of approved plans and specifications must be kept at building during progress of work. er'o Name and Address___ la. e l _ / �-- --- .. -�. N o i ? _ _ Stree Registered Architect and /or Engineer - -- - ___ -- �fv 4)1 _ 1 Employing Plumber's Name _ _____�� �_ ._._ No. Location and Legal Description Blook____ Street and Number where work is to be performed —No I e 6; Street C� = State work to be performed and purpose of building (By Street__ 7z7; -- _ . Subdivision _. C?b_f _ , Size Septic Tank Feet of Drain Tile Nature of Water Supply: City —Well. if My Commission Expires Notary Public, State of Florida Repairs No. of Stories Type of Tank__ Capacity Gals ____Dist. Feet of Tank or Drain Field from 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 retpe ed 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. 5 ii ATZ OF FLORIDA, t COUNTY OF DADE. Eiefore 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 move 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. Permit No Nature of Water Supply: City —Well. MIAMI SH'GRtS VILAGE 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 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 _ 2 - 'x__ —_ —__ No.- _ �2- ________ Street_ _ Registered Architect and /or Engireet __.'_'? ?� _ 1' #� :e!_�____ _ _ _ Employing Plumber's Name ' _ _d Street_ — / 2 - - —i .i�4sd _ —__?�? _� t� No._ — G_ �_____ —� Location and Legal Description Lot / / Block Street and Number where work is to be performed—No. _ ,1 o L' State work to be performed and purpose of building (By Floors) New Building_____!____ ____ Remodeling Addition Repairs Size Septic Tank Type of Tank Feet of Drain Tile______—_____— _______ —_—___ Dist. Feet of Tank or Drain Field from We ll________ _—_— ____________________— ___—__ Size of Soakage Pit ..... __ ____ _____ —__�� Amount of Permit $______—_-- _-- _-- __- ___ -___ (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 Supple and has com- plied with the provisions thereof, and will require similar compliance from all contractors or sub - contract• s employed by the w to be performed under this permit; and will post or cause to be posted for inspection on the site of the •rk pub ce o as are required by the Act. The under signed agrees to employ only such sub - contractors, on wor S be nder this t, are licensed by Miami Shores Village. (Signed) _ Capacity Gals I Date__ L/7 s1 — Subdivisions°`: Street =h �y -i ,44: -- - No. of Stories____ 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. 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 TUBS SHOWERS LAVA- TORIES SINKS SLOP SINKS LAUNDRY TUBS �OfT CATCH BASIN FLOOR DRAI DAN4{NG M FANNr'Tf Id � i / 4.- 4 646FIXTURES TOTAL CONTR. I / / / / / / CHECK SEPTIC TANK SEWER CONN. DRAIN FIELD SOAKAGE PIT GREASE TRAP SCR. HEATER DEEP WELL SPRKLR. SYSTEM SWIM•G POOL 1�.� r�',, / Lf /11(:x./ e1 '%. • CONTR. LIST 2 'j CHECK Permit No Nature of Water Supply: City —Well. MIAMI SH'GRtS VILAGE 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 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 _ 2 - 'x__ —_ —__ No.- _ �2- ________ Street_ _ Registered Architect and /or Engireet __.'_'? ?� _ 1' #� :e!_�____ _ _ _ Employing Plumber's Name ' _ _d Street_ — / 2 - - —i .i�4sd _ —__?�? _� t� No._ — G_ �_____ —� Location and Legal Description Lot / / Block Street and Number where work is to be performed—No. _ ,1 o L' State work to be performed and purpose of building (By Floors) New Building_____!____ ____ Remodeling Addition Repairs Size Septic Tank Type of Tank Feet of Drain Tile______—_____— _______ —_—___ Dist. Feet of Tank or Drain Field from We ll________ _—_— ____________________— ___—__ Size of Soakage Pit ..... __ ____ _____ —__�� Amount of Permit $______—_-- _-- _-- __- ___ -___ (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 Supple and has com- plied with the provisions thereof, and will require similar compliance from all contractors or sub - contract• s employed by the w to be performed under this permit; and will post or cause to be posted for inspection on the site of the •rk pub ce o as are required by the Act. The under signed agrees to employ only such sub - contractors, on wor S be nder this t, are licensed by Miami Shores Village. (Signed) _ Capacity Gals I Date__ L/7 s1 — Subdivisions°`: Street =h �y -i ,44: -- - No. of Stories____ 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. 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. • 1 4 v Permit Date Application is hereby made for the approval of the detailed statement of :plans and speci,'uations herewith submitted for the building or other structure herein described. This application is made in compliance and coaf:A ' with the Y wilding Ordinance of Miami Shores Village, Florida, and all provisions of the Laws of the State of Florida, all ordinances of Miami ;;,ipres Vivage aad all rules and regulations of the Building Division of liie: Shores Village shall be complied with, whether herein spe &: F. cop; - i' approved plans and specifications must be kept at building during progress of work. Owner's Name end Address /— Amount of Permit $ STATE OF FLORIDA, COUNTY CIF DADE. Registered Arch:',tect and /or Engineer ..... ---__----.............. __.-- •- _--- _- _•---- •.- _ - -. -- -__ Employing Plumber's Name �_1i? � � Y - - - -_ No .__. • ___ - -. Street_ ________. -- Location and Legal Description Lot__ Street and Number where work is to be performed —No / A 'a ( Street 9 (f " — State work to be performed and purpose of building (By Floors) __._._. New Building Remodeling______ ___ Addition____---_._--- --- - - - ---- Repairs No. of Stories. Size Septic Tank . U ° !) Type of Tank Feet of Drain Tile. - 2 ---Dist. Feet of Tank or Drain Field from Well Nature of Water Supply: City — Well.__ ___..... - ....... _____—________- ______Size of Soakage Pit_. APPLICATION FOR PLUMBING Subdivision--_.._- ( Signed) Capacity Gals.___ My Commission Expires Notary Public, State of Florida 5 Dr MIAMI SI'BORns VI: '.AtV PLUMBING INSPECTION DEPARTMEt<'' lac ___.- .--- _-- __________ - -- Street. (Signed)----- .___.___ Plumbing Inspector. The undersigned applicant for this building permit does hereby certify that he understapds and accepts his obligations 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 performed under this permit, as are licensed by Miami Shores Village. M aster Plumbers 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 `;ROWERS LAVA- TORIES SINKS S SLOP SINKS LAUNDRY Tulsa URINALS CATCH BASIN FLOOR DRAIN DRINKING FOUNT'NB TOTAL FIXTURES CONTR. LIST CHECK SEPTIC TANK SEWER CONN. DRAIN FIELD SOAKAGE PIT GREASE TRAP SOLAR HEATER DELP WELL SPRKLR. SYSTEM SWIM•G POOL CONTR. LIST CHECK Permit Date Application is hereby made for the approval of the detailed statement of :plans and speci,'uations herewith submitted for the building or other structure herein described. This application is made in compliance and coaf:A ' with the Y wilding Ordinance of Miami Shores Village, Florida, and all provisions of the Laws of the State of Florida, all ordinances of Miami ;;,ipres Vivage aad all rules and regulations of the Building Division of liie: Shores Village shall be complied with, whether herein spe &: F. cop; - i' approved plans and specifications must be kept at building during progress of work. Owner's Name end Address /— Amount of Permit $ STATE OF FLORIDA, COUNTY CIF DADE. Registered Arch:',tect and /or Engineer ..... ---__----.............. __.-- •- _--- _- _•---- •.- _ - -. -- -__ Employing Plumber's Name �_1i? � � Y - - - -_ No .__. • ___ - -. Street_ ________. -- Location and Legal Description Lot__ Street and Number where work is to be performed —No / A 'a ( Street 9 (f " — State work to be performed and purpose of building (By Floors) __._._. New Building Remodeling______ ___ Addition____---_._--- --- - - - ---- Repairs No. of Stories. Size Septic Tank . U ° !) Type of Tank Feet of Drain Tile. - 2 ---Dist. Feet of Tank or Drain Field from Well Nature of Water Supply: City — Well.__ ___..... - ....... _____—________- ______Size of Soakage Pit_. APPLICATION FOR PLUMBING Subdivision--_.._- ( Signed) Capacity Gals.___ My Commission Expires Notary Public, State of Florida 5 Dr MIAMI SI'BORns VI: '.AtV PLUMBING INSPECTION DEPARTMEt<'' lac ___.- .--- _-- __________ - -- Street. (Signed)----- .___.___ Plumbing Inspector. The undersigned applicant for this building permit does hereby certify that he understapds and accepts his obligations 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 performed under this permit, as are licensed by Miami Shores Village. M aster Plumbers 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. A 4 .1dt Ppec Permit No Size Septic Tank__ Feet of Drain Tile_ Amount of Permit $ STATE OF FLORIDA, COUNTY OF DADE. j My Commission Expires MIAMI SI1STIES VILLAGE PLUMBING INSPECTION DEPARTMENT QC FUCQ46 G F <s' 3 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 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 42 -645- -- -- �_ � ----- .___ C:116.:2_ _ ___.._.. No._�! --- - - - - -� street/le:el :V_._5r . _ - _ ...... Registered Architect and /or Engineer__ f�4A2( C � �� - - - - -- Employing Plumber's Name p �����a � Street. —_ Location and Legal Description Lot Blork Subdivision Street and Number where work is to be performed —No Street State work to be performed and purpose of building (By gari New Building — ..__.___ Remodeling__ ____ _____ Addition____ - - - - -_ Repairs No. of Stories... ......... ______Type of Tank____- ____—Dist. Feet of Tank or Drain Field from Well Nature of Water Supply: City— Well._______ ______ -______—_________ ____Size of Soakage Pit (Signed)_ Date - �� ir Capacity Gals. Plumbing In..:ctor. The undersigned applicant for this building permit does hereby certify that he understands and accepts his obli >ttions as an employer of labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Perm ant 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 required by the Act. The undersigned agrees to employ only such sub- contractors, on work be • er o , ed 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 he did sign the same, and that all facts therein by him stated are true. Notary Public, State of Florida NOTE: A re- inspection fee of $1.10 will be made when such re- inspection is made 'necessary by improper notice for insp - ', or faulty materials and /or workmanship. CLOSETS BATH TUBS SHOWERS LAVA TOR IED INK SS SLOP SINKU LAUNDRY TUBE URINALS RINALS CATCH BABIN FLOOR DRAIN DRINKING FOUNT' NS TOTAL FI %TURES coNTR. LIST ,��/ � jJ CHECK SEPTIC A „,,, 4R RK SEWER CONN. DRAIN FIELD SOAKAGE PIT GREASE TRAP SOLAR H EATER DEEP WELL SPRKLR. SYSTEM SW IM'G POOL C d y e r CONTR. 1 LIST CHECK 760,4 P ' A 4 .1dt Ppec Permit No Size Septic Tank__ Feet of Drain Tile_ Amount of Permit $ STATE OF FLORIDA, COUNTY OF DADE. j My Commission Expires MIAMI SI1STIES VILLAGE PLUMBING INSPECTION DEPARTMENT QC FUCQ46 G F <s' 3 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 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 42 -645- -- -- �_ � ----- .___ C:116.:2_ _ ___.._.. No._�! --- - - - - -� street/le:el :V_._5r . _ - _ ...... Registered Architect and /or Engineer__ f�4A2( C � �� - - - - -- Employing Plumber's Name p �����a � Street. —_ Location and Legal Description Lot Blork Subdivision Street and Number where work is to be performed —No Street State work to be performed and purpose of building (By gari New Building — ..__.___ Remodeling__ ____ _____ Addition____ - - - - -_ Repairs No. of Stories... ......... ______Type of Tank____- ____—Dist. Feet of Tank or Drain Field from Well Nature of Water Supply: City— Well._______ ______ -______—_________ ____Size of Soakage Pit (Signed)_ Date - �� ir Capacity Gals. Plumbing In..:ctor. The undersigned applicant for this building permit does hereby certify that he understands and accepts his obli >ttions as an employer of labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Perm ant 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 required by the Act. The undersigned agrees to employ only such sub- contractors, on work be • er o , ed 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 he did sign the same, and that all facts therein by him stated are true. Notary Public, State of Florida NOTE: A re- inspection fee of $1.10 will be made when such re- inspection is made 'necessary by improper notice for insp - ', or faulty materials and /or workmanship.