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PLUMBINGBUILDING PERMIT APPLICATION FBC 2001 Permit Type (circle): Building Electrical Owner's Name (Fee Simple Titleholder) .. IC j i0 ; A. Phone # Owners Address \L -# ''.. CA 1 "1 City I VY"ti ' f' State t: ii Zip f iP Tenant/Lessee Name Phone # ' ' , "_. Job Address (where the work is being done) v ` Citr Miami Shores Village County Miami -Dade Zip Is Building Historically Designated YES NO Contractor's Company Name (. 14-' ',.e 4z 4_ J 4 ,:a 1 Phont # ( - .;-�? " T C il t - ' Contractor's Address e d. .., , ' . a. ..,-?.' a ci i:. a.., 0 City L? t:49-4? ) State '�, . , . Zip .i ,�`-1 Qualifier P p.4fi(- 1 e j t.; c' kT '-r State Certificate or Registration No. Certificate of Competency No. e ti \( 44 Architect/Engineer's Name (if applicable) Total Fee Now Due $ (Continued on opposite side) Miami Shores Village • Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 Permit No. aster Permit No. L Plumbing Mechanical Roofing 7 Phone # C % if' $ Value of Work For this Permit Square Footage Of Work: Type of Work: 174.Addition ❑Alteration ❑New ❑ Repair/Replace ❑ Demolition Describe Work: Submittal Fee $ Permit Fee $ 2 (. CCF $ CO /CC Notary S Training/Education F e $ Technology Fee $ Scanning S Radon $ Zoning Bond S Code Enforcement $ Structural Plan Review. $ Bonding Company's Name (if applicable) • Bonding Company's Address . City State Zip Mortgage Lender's Name (if applicable) Mortgage Lender's Address City State Zip Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRICAL WORK, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and AIR CONDITIONERS, ETC 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. "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." Notice to Applicant: As a condition to the issuance of a building permit with an estimated value exceeding 82500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. Signature Y LIC: My Commission * * * * * * * * * * * * ** Chc 05/13/03 ,A" _ d Signature Ownefor Agent The foregoing instrument was acknowledged before me this :. °." y The foregoing instrument was ackno day of 20 F , b)' :� �� � _ � ,� " "< � � day o >COL! , 200 T , by (who is personally known me or who has produced who is personally known to me or w o has produced As identification and who did take an oath. . NOTARY PUB Sign: Print: NOT Sign:" Print �� Contractor ged before 5,e,.,th is as identification and wh take an oath. 3 RISTINA WILLIAMS MY COMMISSION #DD350i ' * e� �fhr D( PI* S * �4******************************************* * * * * * * * * * * * * * ** ** * * * * * * * * ** * *** • My Commission Expires: * * * * * * * * * * * * * * * * * * * * * * * * * * * ** ** * * ` *********************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** APPLICATION APPROVED BY t /3i `5 ------ Plans Examiner jr Engineer Zoning Df r r tor Lot B BL ' S Subdi- BUILDING ELECTRICAL PLUMBING ROOFING Owner Buildin Archite ontrac or Build Legal Descrip Addres Buildin MIAMI SHORES VILLAGE, FLORIDA J3ERMIT 1ST? 12516 DATE. Work to be performed under this Permit 195 Contractor's License No This permit is granted to the contractor or builder named above to construct the building or to install the equipment or device described in the application herefor in strict compliance with all ordinances pertaining thereto and with the understanding that the 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 perfnun 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 accepting this permit I assume responsibility for all work done by either, myself, my agent, servant or employee. CONTRACTOR OR BUILDER BY AUTHORITY BUILDING ELECTRICAL PLUMBING Owner of Building Architect Contractor or Builder MIAMI SHORES VILLAGE, FLORIDA DATE 194_ PERMIT N? 8892 Work to be performed under this Permit Contractor's License No. Legal Lot BI. Subdi- Description vision Address of Value of Building _ Project 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 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 responsibility for a thorough knowledge of the ordinances and regulations pertaining to the work covered hereby whether shown on the plans or drawings or in the statements or specifications and that he assumes respon- sibility for work done by his agents, servants or employees. Amt. of Permit 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 accepting this permit I assume responsibility for all work done by either myself, my agent, servant or employee. CONTRACTOR OR BUILDER BY AUTHORITY of :..t tor er — Lion Lot Bl. Subdi - vision S Of I Value of Project $ Amt. of Permit $ BUILDING ELECTRICAL PLUMBING Owner Buildin Archite ;,ontrac or Buil Legal Descrip Addres Buildin CONTRACTOR OR BUILDER MIAMI SHORES VILLAGE, FLORIDA PERMIT N° 9080 Work to be performed under this Permit DATE 195 Contractor's License No This permit is granted to the contractor or builder named above to construct the building or to install the equipment or device described in the application herefor in strict compliance with all ordinances pertaining thereto and with the understanding that the 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 tordinances 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 accepting this permit I assume responsibility for all work done by either, myself, my agent, servant or employee. BY AUTHORITY Permit No. . - '.--- -- ;� Date ' Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the building or other structure herein described. This application is made in compliance and conformity with the Building Ordinance of Miami Shores Village, Florida, and all provisions of the Laws of the State of Florida, all ordinances of Miami Shores Village and all rules and regulations of the Building Div ision 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 1, '// _:._ ;fit- `- '` e` No. Registered Architect and /or Engineer Location and Legal Description Lot New Building CONTR. LIST CHECK CONTR. LIST CHECK CLOSETS SEPTIC TANK BATH TUBS SHOWERS SEWER DRAIN CONN. FIELD Amount of Permit $ STATE OF FLORIDA, f COUNTY OF DADE. ss. Employing Plumber's Name ! V- °'s` No. Street and Number where work is to be performed —No. State work to be performed and purpose of building (By Floors)`______" t_!.____ .__.._•' Remodeling Addition LAVA- TORIES SOAKAGE PIT My Commission Expires t ' a p MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT SINKS GREASE TRAP SLOP SINKS SOLAR H EATER 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 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 hint 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. 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. LAUNDRY TUBS URINALS Of SPRKLR. WELL SYSTEM (Signed) Block Subdivision f 1 Street Repairs. CATCH BASIN SWIM•G POOL (Signed) FLOOR DRAIN Street %' ,k-. ,2 ";" Street. AA'' :' ?- DRINKING • FOUNT' NS No. of Stories . Notary Public, State of Florida Mester-Phrartber. TOTAL FIXTURES Permit No. / MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT 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 Registered Architect and /or Engineer, - Employing Plumber's Name APPLICATION FOR PLUMBING PERMIT Location and Legal Description Lot Block - r— Street and Number where work is to be performed—No.? t t Street State work to be performed and purpose of building (By Floors) New Building .. ` - BATH CLOSETS TUBS SHOWERS LAVA- TORIES SINKS SLOP SINKS LAUNDRY Toes URINALS CATCH BASIN FLOOR DRAIN CONTR. LIST CHECK CONTR. LIST CHECK SEPTIC SEWER DRAIN TANK CONN. FIELD Amount of Permit $ ss. Remodeling Addition SOAKAGE PIT GREASE TRAP SOLAR HEATER DEEP WELL No. Street No. _ Street SPRKLR. SYSTEM Repairs SWIM'G POOL W Date__ • DRINKING FOUNT' NS� 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 - ( Signed) Subdivision _- _________ .__-_____ _ --_ -- - - _ - No. of Stories _ TOTAL FIXTURES (Signed)_ _ 'y9rr x Plumbing Inspector. The undersigned applicant for this building permit does hereby certify that he undelstands and accepts his obligatidns 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 arc licensed by Miami Shores Village. Master Plumber. 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 lie 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. biy Commission Expires Notary Public, State of Florida NOTE: A re- inspection fee of $1.00 will be made when such re- inspection is made necessary by improper notice for inspection, or faulty materials and /or workmanship. New Building._ Amount of Permit $- STATE OF FLORIDA, ! COUNTY OF DADE. MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT Permit No. Date Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the building or other structure herein described. This application is made in compliance and conformity with the Building Ordinance of Miami Shores Village, Florida, and all provisions of the Laws of the State of Florida, all ordinances of Miami Shores Village and all rules and regulations of the Building 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 No Street Registered Architect and /or Engineer._ Employing Plumber's Name No Street__ - -_ Location and Legal Description Lot___________ _________________— _____— _ —_ Block Subdivision Street and Number where work is to be performed —No. Street___: State work to be performed and purpose of building (By Floors) Remodeling _ Addition Size Septic Tank__ — Type of Tank__- — Feet of Drain Tile Dist. Feet of Tank or Drain Field from Well of Water Supply: City —Well Size of Soakage Pit_ _ (Signed) Repairs _Capacity Gals. ----------- - - - --- - -- - — (Signed) - h ` f No. of Stories Conunission Expires Notary Public, State of Florida Plumbing Inspector. The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligati6ns as an employer of labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Permanent Supplement, and has com- plied with the provisions thereof, and will require similar compliance from all contractors or sub- contractors employed by him in the work to he 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. Master Plumber. Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeared to me well known, and who, being by me first duly sworn, upon oath deposes and says that he is the .- _. .. of the above described construction, that he has carefully read the foregoing application, and that he did sign the same, and that all facts therein by him stated are true. NOTE: A re- inspection fee of $1.00 will be made when such re- inspection is made necessary by improper notice for inspection, or faulty materials and /or workmanship. CLOSETS BATH TUBS SHOWERS LAVA- TORIES SINKS SLOP SINKS LAUNDRY TUBS URINALS CATCH BASIN FLOOR DRAIN DRINKING FOU NT' NS `' 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 New Building._ Amount of Permit $- STATE OF FLORIDA, ! COUNTY OF DADE. MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT Permit No. Date Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the building or other structure herein described. This application is made in compliance and conformity with the Building Ordinance of Miami Shores Village, Florida, and all provisions of the Laws of the State of Florida, all ordinances of Miami Shores Village and all rules and regulations of the Building 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 No Street Registered Architect and /or Engineer._ Employing Plumber's Name No Street__ - -_ Location and Legal Description Lot___________ _________________— _____— _ —_ Block Subdivision Street and Number where work is to be performed —No. Street___: State work to be performed and purpose of building (By Floors) Remodeling _ Addition Size Septic Tank__ — Type of Tank__- — Feet of Drain Tile Dist. Feet of Tank or Drain Field from Well of Water Supply: City —Well Size of Soakage Pit_ _ (Signed) Repairs _Capacity Gals. ----------- - - - --- - -- - — (Signed) - h ` f No. of Stories Conunission Expires Notary Public, State of Florida Plumbing Inspector. The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligati6ns as an employer of labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Permanent Supplement, and has com- plied with the provisions thereof, and will require similar compliance from all contractors or sub- contractors employed by him in the work to he 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. Master Plumber. Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeared to me well known, and who, being by me first duly sworn, upon oath deposes and says that he is the .- _. .. of the above described construction, that he has carefully read the foregoing application, and that he did sign the same, and that all facts therein by him stated are true. 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. s It• i L C. 0