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440 NE 94 St (16)MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT Permit No G .- _ (.. "1 4 D 7 Date.---. ..... —App _28 . - -.__ 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 ......... .__Dean Claussen ___ _- _ N __ 0_ N„E- ___ Street 94 Registered Architect and /or Engineer• __________._— __..__._..___. -.. Employing Plumber's Name O'Neal Septic Tank Co. No,8350 N,W — S Street Location and Legal Description Lot Block Subdivision ._ —.___ _______________.__....... Street and Number where work is to be performed —No 0 N + E, street 9ZIth _Street State work to be performed and purpose of building (By Floors)_____ . New Building-- -___._ _._ Remodeling_______._. _.___ Addition Size Septic Tank_ ------ ___ -10 �------- - - - - -- -Type of Tank___..SSQptiC...Tafk. Feet of Drain Tile._-- 49_9 _ S q f ts- -Dist. Feet of Tank or Drain Field from Well Nature of Water Supply: of Soakage Pit ca Amount of Permit $ 1 ( Signed ) _ mbing Inspector. The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligati as an employer of labor under the Florida Workmen's Compensation Act, being Section 5988, Compiled General Laws of Florida Permanenfupplement, and has com- plied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors empl ,.. ed 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 required by the Act. The undersigned agrees to employ only such sub- contractors, on work to be performed under this permit, as licensed by Miami Shores Village. STATE OF FLORIDA, } COUNTY OF DADE. (Signed) Repairs No. of Stories . . . ...... .. ...... .... gize„e} My Commission Expires Notary Public, State of Florida Master Plumber. are 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. 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 worl®anship. CLOSETS BATH Tu88 S LAVA- TORIES SS INK SLOP SINKS LAUNDRY Tues U RINALS CATCH BASIN FLOOR DRAIN DRINKING FOUNT'N6 TOTAL FIXTURES CONTR. LIST CHECK SEPTIC TANK SEWER CONN. DRAIN FIELD SOAKAGE PIT GREASE TRAP SOLAR HEATER DEEP WELL SPRKLR. SYSTEM SWIM•G POOL CONTR. LIST CHECK - MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT Permit No G .- _ (.. "1 4 D 7 Date.---. ..... —App _28 . - -.__ 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 ......... .__Dean Claussen ___ _- _ N __ 0_ N„E- ___ Street 94 Registered Architect and /or Engineer• __________._— __..__._..___. -.. Employing Plumber's Name O'Neal Septic Tank Co. No,8350 N,W — S Street Location and Legal Description Lot Block Subdivision ._ —.___ _______________.__....... Street and Number where work is to be performed —No 0 N + E, street 9ZIth _Street State work to be performed and purpose of building (By Floors)_____ . New Building-- -___._ _._ Remodeling_______._. _.___ Addition Size Septic Tank_ ------ ___ -10 �------- - - - - -- -Type of Tank___..SSQptiC...Tafk. Feet of Drain Tile._-- 49_9 _ S q f ts- -Dist. Feet of Tank or Drain Field from Well Nature of Water Supply: of Soakage Pit ca Amount of Permit $ 1 ( Signed ) _ mbing Inspector. The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligati as an employer of labor under the Florida Workmen's Compensation Act, being Section 5988, Compiled General Laws of Florida Permanenfupplement, and has com- plied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors empl ,.. ed 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 required by the Act. The undersigned agrees to employ only such sub- contractors, on work to be performed under this permit, as licensed by Miami Shores Village. STATE OF FLORIDA, } COUNTY OF DADE. (Signed) Repairs No. of Stories . . . ...... .. ...... .... gize„e} My Commission Expires Notary Public, State of Florida Master Plumber. are 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. 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 worl®anship.