PLUMBINGt
MIA-MI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT j
A PPLICATION FOR PLUMBING PERMIT
1
_)
, Permit No.
Application is hereby made for the approval of the detailed statement of the plans and specifications herewith subnu(ted for th or other
structure herein described. This app 'cation is made in compliance and conformity with the Building Ordinance of Miami Shores Village, Florida,
and all provisions of the Laws of thei 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__EM
Registered Architect and /or Engineer J -
Employing Plumber's Name_S!• 6 , " sl r`
Location and Legal Description Lo
Street and Number where work is to be performed —N
State work to be performed and purpose of building (By Floors)
New Building_____
CLOSETS
BATH
TUBS
SHOWESS
URINALS
LAVA-
' TORIES
SINKS
SLOP
SINKS
LAUNDRY
TUBS
CATCH
BASIN
FLOOR
DRAIN
DRINKING
FOUNT'NS
CONTR.
LIST
CHECK
CONTR.
LIST
CHECK
SEPTIC
TANK
SEWER
CONN.
Size Septic Tank_— Type of Tank Capacity Gals
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 Permit $---
DRAIN
FIELD
ss.
Remodeling
SOAKAGE
PIT
My Commission Expires
GREASE
TRAP
Street
ock Subdivision
SOLAR
HEATER
DEEP
WELL
SPRKLR.
SYSTEM
SwIM'G
POOL
(Signed)
No 1Z,/
Date
Plumbing Inspector.
The undersigned applicant for{ this building permit does hereby certify that he understands and accepts his obligations as an employer of labor
under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Permanent Supplement, and has com-
plied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors employed by him in the work to be
performed under this permit; and will post or cause to be posted for inspection on the site of the work such public notice or notices as are
required by the Act. The undersigned agrees to employ only such sub - contractors, on work to be performed under this permit, as are
licensed by Miami Shores Village.
( Signed)
Notary Public, State of Florida
TOTAL'
FIXTURE?
STATE OF FLORIDA,
COUNTY OF DADE.
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.
BUILDING
ELECTJJICAL
PLUMBING
Owner of
Building
MIAMI SHORES VILLAGE, FLORIDA
MIT N° 6254
/
Work to be performed under this Permit af(aj 1
Architect
Contractor
or Build
Lega Lot Bl.
Des& lion
Subdi-
vision
Signed' (/
DATE
Contract6r's
License No
0
Amt. ofj - G
Permit +.wr
•
C
Address of ,,,,, -- /
Building G
This permit is granted to the contractor or builder named above to construct the b d .g or to install the equipment or device described in the appli-
cation 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 responsibilit for a thgru� h knowledge of the or nces and
regulations pertaining to the work covered hereby whether shown on the plans r awm s or • the stat ents or @o ea ons and that .lit a s respon-
sibility for work done by his agents, servants or employees. r i , ,. o . _,<
INSPECTOR By 2(
In consideration of the issuance to me of this permit I agree to perform the work covered hereunder compliance with , 11 ordinances and agu atggons
pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Sh rVilrage..
In ac{ ptin^ / / thh y i it I ass /1 resp9n,sibility f.r all work dpne by either myse , ray,�gent, servant,Qr employee. .r v or
i ki. 1.. lie CONTRACTOR OR BU D
AUTHORITY
CLOSETS
BATH
TUBS
SHOWERS
LAVA-
TORIES
SINKS
SLOP
SINK•
LAUNDRY
TUaa
URINALS
CATCH
BASIN
FLOOR DRINKING
DRAIN FOUNT'N•
TOT..L
FIAT/ RES
CONTR.
LI T
CHECK
SEPTIC
TANK
SEWER
CONN.
DRAIN
FIELD
SOAKAGE
PIT
s a - ft,
G SOLAR
TRAP H
DEEP
WELL
SPRKLR.
SYSTEM
SWIMcG
POOL
- --
CONTR.
LIST
-300
— $10.00
,—
CHECK
Penn, Nu...
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
is hereby mode for the approval of the detailed statement of the plans and specifications herewith subr i,• .'i for the building or other
structure herein described. This application is made in compliance and conformity with the Building Ordinance of MI ± Shores Village, Florida,
sad 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
rat rtiami Shores Village shall be complied with, whether herein specified or not. A copy of approved plans and spec ficatlons must be kept at
'luilding during progress of work.
')wneis Name and Address_. J ohn McLeod
.cgist: red Architect and /or Engineer
employing Plumber's Name
Rose Septic Tank Co .887 - 5590.._ - --
P.O.Box 344 Hialeah 33011
Location and Legal Description Lot_ Mock
Street and Number where work is to be performed —No. 561 N.E. 95th street Street
State work to be performed and purpose of building (By Floors) _....._.._____..__
New Building Remodeling_ ..... Addition..._---_ Repairs
No. Street.
Size Septic Tarrk_.__-- __ ......... ______•-..___---- -•- -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 Permit $ 10
STATE OF FLORIDA, f
as.
COUNTY OF DADE.
(Signed).
Capacity ^ .als..
No of Stones
(S igned) _ J e W' , 00.. L
Plumbing Inspector
The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations as on a n;,lpvei of !allot
under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Permanent Cum lement, and has oeff
t lied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors employed I y him in • I, cal rk c.' b-
performed under this permit; and will post or cause to be posted' for inspection on the site of the work such publ' notice r no leer is a:
requ+red by the Act. The undersigned agrees to employ only such sub - contractors, on work to be performed 'a this � r1 sic as .
licensed by Miami Shores Village.
Before me, the undersigned authori a notary public, duly utborized to a • 'star oaths and take acknowledgments, per orrt ; . ppearec.
to me well known, and who, being by me first duly upon oath deposes and says that he is the . .___- ..._...
of the above described construction, that he has carefu lly read the foregoing application, and that he did sign the same, and nut all acts
therein by him stated are true.
NOTE: A re- inspection fee of 11.00 will be made when such re- inspection L maderneoessary by improper notice for inepe•.t!on, tr bully
materials and /or workmanship.