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PLUMBINGBUILDING ELECTRICAL PLUMBING MIAMI SHORES VILLAGE, FLORIDA PERMIT N? 8832 Contractor's License No. Work to be performed under this Permit Owner of Building DATE 194 Architect Contractor or Builder Legal Lot Bl. Subdi- Description vision Address of Value of Aint. of Building Project 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 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. 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 pemrit 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 195 PERMIT N° 9165 Work to be performed under this Permit Subdi- vision Contractor's License No Legal Lot Bl. Description Address of Building This permit is granted to the contractor or builder named above to construct the building or to install the equipment or device deribed 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. 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 Migini Shores Village. In accepting this permit I assume responsibility for all work done by either, myself, my agent, servant or employee. CONTRACTOR OR BUILDER Value of Project $ BY AUTHORITY PROPERTY OWNER Name awn �I pd/A2 i.Qaii /i sr/Ev/ Address //fs AzE q 7 5 T 101;90/ S)ES, PG .3,3 /3e Home Telephone S 73 o r`/ Business Telephone Repair Fax Alteration Interior TYPE OF MANAGEMENT (✓ ) New Construction Enclosure Alteration Exterior Repair Alteration Interior Demolish Relocation of Structure Shell Only Foundation Only Add'l Attachment Other Add'l Detachment Other INSTRUCTIONS - The following steps must be taken to obtain a permit from the Miami Shores Village: Step 1. Complete the attached permit application which must be signed by the proper y owner and qualifier. Both signatures must be notarized. Please print or type to allow for a more accurate processing of your application. If roofing work will be done, a roofing application must be submit- ted along with this permit application. Step 2. Submit the completed application with all necessary documents to the Building, Planning and Zoning Department for processing. During the processing of your application, you may be asked to submit additional information. APPLICATION )(Job Address: /tie F7 s #7, s. n_.5 Address Apt. City Folio Number Lot Block Subdivision nC ' PBS , / PG Current Use of Property 7Z�01f) F� - 6( k �. Proposed Use of Property Tenant Information PERMIT TYPE (✓ ) Building Electrical Mechanical Plumbing LPGX Roofing Fence Other PERMIT CHANGE (✓ ) Chg. Contractor Renewal Revision Extension Supplement Reinspection ARCHITECT Name License No. Address Telephone Fax D escription of Work Master Permit No. Subsidiary Permit No. PERMIT APPLICATION 7 ;7-- State G Zip Zoning Linear Feet Square Feet Units Floors (jai alue of Work (Luu Bldg Value Tax Assessed/Appraised Value Flood Zone Base Floor Elev. ENGINEER Name License No. Address Telephone Fax CONTRACTOR Name iqa mom Gv,G pl License No. OW 19.310 Address qOO GUS / Telephong�'j� / °�U /� Fax 5'4 , . Qualifier Name `"�j 0M Mc. ' '# � 7 1 Page 2 IMPORTANT NOTICES 1. DO NOT BEGIN ANY WORK WITHOUT HAVING RECEIVED YOUR VALIDATED PERMIT AND PERMIT CARD. Applying for a permit does not grant the right to begin construction. HOURS OF CONSTRUCTION are limited to: Monday through Friday from 7:30 a.m. to 6:00 p.m., and Saturday from 8:00 a.m. to 5:00 p.m. No inspections will be conducted on weekends or holidays. 2. All construction of demolition areas MUST BE MAINTAINED IN A CLEAN, NEAT AND SANITARY CONDITION free from construction debris. 3. STREETS AND NEIGHBORING PROPERTIES SHALL BE KEPT FREE FROM DIRT AND DEBRIS. 4. SWALES MUST BE PROTECTED FROM BEING DAMAGED BY EQUIPMENT OR VEHICLES, AND MAY NOT BE USED FOR STORAGE. A bond is required for work in or near the street/sidewalk. 5. CONSTRUCTION TRAILERS ARE PROHIBITED ON SINGLE FAMILY RESIDENTIAL CONSTRUCTION SITES. Other construction may have a trailer which requires a separate permit. 6. PORTABLE TOILETS for a construction site require a separate permit. 7. DO NOT DISCHARGE WATER INTO THE RIGHT OF WAY OR STORM DRAINS without approval from the Building, Planning and Zoning Department. 8. EQUIPMENT AND MATERIALS SHALL BE STORED at least 10 feet from the edge of pavement. 9. Department of Health and Rehabilitative Services (HRS) approval is required for applications involving septic tanks. Department of Environmental Resources Management (DERM) and/or Miami -Dade Water and Sewer Department (MDWASD) approval is required for applications involving sewers. AFFIDAVIT - Please read carefully. Application is hereby made to obtain a permit to do work and installation as indicated. I, the OWNER of the property, 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, POOL, EXTERIOR DOOR, MECHANICAL, WINDOW, FENCE, DRIVEWAY, ROOFING and SIGNS and there may be additional permits required from other governmental agencies. I, the OWNER of the property, have disclosed all information related to any work at the property performed in the prior twelve months to the Building Official. Further, I am fully aware that if the cumulative cost of work to my home or business under this and any other permit equals or exceeds fifty percent (50 %) of the fair market value of the structure, the entire structure must meet the present federal flood criteria for finished floor elevation. I am also fully aware that if the total cost of work to my home or business under this and any other permit exceeds fifty percent (50 %) of the replacement cost of the structure, then the entire structure must conform to the current code requirements of the Building Code. WARNING TO OWNER: Your failure to record a NOTICE OF COMMENCEMENT may result in you paying twice for improvements to your property. If you are spending more than $2,500 or intend to obtain financing, you may wish to consult with your attorney or lender before recording your Notice of Commencement. The Notice of Commencement must be recorded at: 22 N.W. 1st Street, 1°' Floor, (305) 679 -1078. Once recorded, the Notice of Commencement must be POSTED AT THE JOB SITE in accordance with Section 713 -35 of Florida Statutes. Review the brochure at Village Hall on Construction Lien Law and Choosing a Contractor. SEAL: tary PS 'V • o � . .• � \ V o "'I,O OQ`O %O Personally known OR, Produced Identification TA j ORIDA, C - .',,'I� • � I -DADE % ' ♦ 4 ' �• Q I' �r L�4) Si ! o tary Pll$ h o f Flo ° • • J �/ B LI � , • Q °'. ....... \�% ei SEAL: PERMIT APPLICATION Personally known OR, Produced Identification Type of Identification Produced: Type of Identification Produced: Page 4 OFFICE USE ONLY CHECKLIST ❑ OWNER - BUILDER FORM (Attach) ❑ FIRE DEPARTMENT APPROVAL (Commercial / multi- family) ❑ CONCURRENCY (New Construction) ❑ OTHER (Specify & Attach) $3.00 per page (Scanning Fee) Miami Shores Village Bond Metropolitan Dade County (C.C.F.) Inspector State Educational Fund State DCA (Radon) Code Enforcement Fine Zoning Review Notary ❑ PROOF OF OWNERSHIP (Attach) ❑ HRS / DERM APPROVAL (Septic / Sewer) ❑ IMPACT FEE (New Construction) ❑ OTHER (Specify & Attach) SECTION Zoning Electrical Mechanical Plumbing Fire Public Works Structural Building Official BY DATE ( x .6. x/1000 (¢.005 / sq.ft_) (¢.01 /sq.ft.) PERMIT APPLICATION ❑ CONDO ASSOCIATION APPROVAL (Attach) ❑ BPR APPROVAL (Restaurants) ❑ CONTRACTOR REGISTRATION (On File) PERNIIT FEES TOTAL $ ISSUING OFFICIAL REVIEWED AND PREPARED BY: DATE: CONDITION OF APPROVAL Revised July 2001 10050 N.E. 2"° AVE., MIAMI SHORES, FL m (305) 795 -2207 ® FAX (305) 756 -8972 ® http : / /www.miamishoresvillage.com ELECTRICAL '1'VI'F Minimum Fee QTY. 'Fyl'F. Dryer QTY. TYPE, Outlet, Appliance (fry. TVPI: Service Repair Q'I'V. A/C Central 1 -3 Ton Dryer Vents, Number of Fan Ventilation, Cost Outlet, Wall Ductwork, Cost of Service, Temporary Periodic Inspections A/C Central 4 -7 Ton Fire Sprinkler System Fire Pump Outlet, Switch Fireplaces, Number of Signs A/C Central 8 -15 Ton Fixture - Fluorescent Oven Space Heater (kw) A/C Central 16-20 Ton Fixture Light Parking Lot Lights Spas/Hot Tubs A/C Central 20+ Ton Flood Lights Plugmold/Strip Subfeeds, No. of Amps A/C Window FPL - Load Central Posts Swim Pool, Commercial Air Conditioners Garbage Disposal Range/Range Top Swim Pool, Residential Chiller Generators, etc. Receptacles Switchboards Clear Violations Heat Recovery Refrigerator, Comm. (p/PH) Temp Serv., Construction Compactor Low -volt, Burglar Refrigerator, Domestic Temp for Test - 30 days Deep Freezer Low -volt, Fire Renew - Temp Service Water Closet Demolition Low -volt, Intercom/Teleph. Repair Circuits Water Heater Dishwasher Low -volt, Television Service, Number of Amps Water Heater New MECHANICAL '1'YIT QTY. Minimum Fee TYPE QTY. Condensate Drain TYPE Generator QTV. TYPE Q'I'Y. Refrigeration, Tons A/C Central, Tons Cooling Tower Heating Strips, each Vent Hood, Cost A/C Wall/Win. Tons Dryer Vents, Number of Paint Booth Ventilation, Cost Air Handler, Tons Ductwork, Cost of Piping, Flammable Liquid Periodic Inspections Barbecue Fire Sprinkler System Process/Pressure Piping Bath Fan - Vented, # Fireplaces, Number of Pressure Vessel PLUMBING TYPE A/C Condensate QTY. TYI'I; Drains, Roof QTY. TYPE Miscellaneous Fixture QTY. TVI'E Soakage Pit QTY. Bath Tub Drinking Fountain Miscellaneous Repairs Solar Water Heater Bidet Filter Replace Pool Piping Sprinkler Repair Cap - Fixture Fountain Pump and Abandon Sprinkler System Cap - Water Gas - Appliance Pump, Domestic Supply, AC Well Cap - Sewer Gas - Natural Pump, Fire Stand Temporary Toilet Catch Basin Gas - Propane Pump, Re- circulate Temporary Water Closet Clothes Washer Gas Piping Pump, Replace - Pool Urinal Dental Chair Grease Trap Pump, Sprinkler Utility - Sewer Discharge Well Ice Maker Pump, Sump Utility - Water Dishwasher Indirect Wastes Relay Repair Vacuum Pump Disposal Interceptor Roof Inlet Water Closet Domestic Well Laundry Tray Septic Connection Water Heater Drainfield, 4" Tile/Res. Lavatory Septic Tank Water Heater New Drains, Area Meter Set (Gas) Sewer Connection Water Re -pipe Drains, Floor Minimum Fee Shower Water Service Drains, French Miscellaneous Equipment Sink Well, Supply Page 3 PERMIT APPLICATION INSTRUCTIONS: Please indicate the type of work being performed and quantity(ies) in the space provided below. RECEIVED AND REVIEWED BY: DATE: Miami Shores Village 10050 NE 2nd Avenue Phone: 305 - 795 -2204 Printed: 12/11/2002 Applicant: EDWIN STEIVE Owner: STEIVE EDWIN JOB ADDRESS: 1115 NE 97 ST PAY TO THE ORDER OF Contractor THE NEW MIAMI SHORES PLUMBING Contractor's Address: 900 NW 144 ST Local Phone: 305 - 751 -2446 Parcel # 1132050170060 va Total Fees: $0.00 Total Receipts: $0.00 Permit Status: APPROVED Permit Expiration: 6/8/2003 Construction Value: $12,000.00 Work: RE ROUTE HOT & COLD WATER & DRAIN TO NEW LOCATION FOR KITCHEN SINK THE NEW MIAMI SHORES PLUMBING, INC. BLUE ACCOUNT COLONIAL BANK. / Miami Beach, Florida FOR �j Col l�ec n1-877.5 900 N.W. 144TH ST. MIAMI, FL 33168 ?ave., Signed: 1 V Plumbing Permit Permit Number: PL2002 -334 Legal Description: REV PL MIAMI SHORES SEC 8 i•OO L64811' 1:06700 LS L81: 80 278630 2 911' t_,UlltIMAUI LA °MUGS 1/ (0 63- 151/670 DATE ((( 01 s - r ,1_1_u ., uu . • Page 1 of 1 El Sec uriiy rn II anrrd d m S nark j drt , -3.:1 1698 1 $ DOLLARS 8 PB 43 -51 LOT 6 e- inspection BLK 180 LOT ation herefor in strict compliance with all cations that may have been submitted to or if the plans are changed without )nsibility for a thorough knowledge of the tat he assumes responsibility for work done is pertaining thereto and in strict conformity esponisibility for all work done by either 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. Owna 'a Name and Address___ t: h t 1 -. No.- /II 2 Emplo Registered Architect and /or Engin er.. —___ — ____� —___ _ Plumber's Name �- .��,r 3fing f No. — ..19 street :7a, Li_ _6. Location and Legal Description Lot___ --- ..... __— __.___.. __ —__ _ _ — Block___ _ Subdivision Street and Number where work is to be performed —No _ - --/�� Stree �- �---- �- •- � - -. .I State work to be performed and purpose of building (By Floors)__.__ New Building ___- Remodeling —_ -- _ _-____ Addition Permit No._ .Y11S S' Sentic Tank. -_ ' Fee's of Drain Tile. Nature of Water Supply: City —Well. ------------ Aknount r.ff Permit ........ - -- STATE OF FLORIDA, COUNTY OF DADE. J stJe- My Conunission Expires MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT PPLICATION FOR PLUMBING ThvaViOT Type of Tank_ (Signed). Date_...1 221_. 3 - -6_- -? Street-_A__1_ ` '?* 7/ Repairs No. of Stories.... ........ ........ Capacity Gals. __Dist. Feet of Tank or Drain Field from Well _Size of Soakage Pit umbing In or. 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 5968, Compiled General Laws of Florida Perinanent 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 requi2ed by the Act. The undersigned agrees to employ only such sub - contractors, on work to be performed under this permit, as are lloensad by Miami Shores Village. fl Master Plumber. afore me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeared te 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 $1.00 will be made when such re- inspection is made nec'ssRry by improper notice for inspection, or faulty materials and /or workmanship. CLOSETS BATH TUBS S LAVA. TORIES SINKS SLOP SINKS LAUNDRY Tuns U RINALS CATCH BASIN FLOOR DRAIN DRINK NO FOUNT' NS TOTAL FIXTURES CONTR. LIST CHECK SEPTIC TANK SEWER CONN. DRAIN FIELD SOAKAGE PIT GREASE TRAP SOLAR HEATER DEEP WELL SPRKLR. SYSTEM SW IM'G POOL LIG? CHECI: 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. Owna 'a Name and Address___ t: h t 1 -. No.- /II 2 Emplo Registered Architect and /or Engin er.. —___ — ____� —___ _ Plumber's Name �- .��,r 3fing f No. — ..19 street :7a, Li_ _6. Location and Legal Description Lot___ --- ..... __— __.___.. __ —__ _ _ — Block___ _ Subdivision Street and Number where work is to be performed —No _ - --/�� Stree �- �---- �- •- � - -. .I State work to be performed and purpose of building (By Floors)__.__ New Building ___- Remodeling —_ -- _ _-____ Addition Permit No._ .Y11S S' Sentic Tank. -_ ' Fee's of Drain Tile. Nature of Water Supply: City —Well. ------------ Aknount r.ff Permit ........ - -- STATE OF FLORIDA, COUNTY OF DADE. J stJe- My Conunission Expires MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT PPLICATION FOR PLUMBING ThvaViOT Type of Tank_ (Signed). Date_...1 221_. 3 - -6_- -? Street-_A__1_ ` '?* 7/ Repairs No. of Stories.... ........ ........ Capacity Gals. __Dist. Feet of Tank or Drain Field from Well _Size of Soakage Pit umbing In or. 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 5968, Compiled General Laws of Florida Perinanent 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 requi2ed by the Act. The undersigned agrees to employ only such sub - contractors, on work to be performed under this permit, as are lloensad by Miami Shores Village. fl Master Plumber. afore me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeared te 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 $1.00 will be made when such re- inspection is made nec'ssRry by improper notice for inspection, or faulty materials and /or workmanship. For Inspector Approve Correction Re-Insp'n Fee IAMI SHORES VILLAGE BUILDING DEPARTMENT 305- 795 -2204 Building Inspection Request Date Type Insp' Permit No. Name _' CJ 11,/ Address Company Phone # ti _ Time t3e-f Zboj CLOSETS BATH TUBS SHOWERS LAVA- TORIES SINKS SLOP SINKS LAUNDRY TUBS URINALS CATCH BASIN FLOOR DRAIN DRINKINGI A. L.G " FOUNT'NS .y TOTAL FIXTURES CONTR. ,-) LIST _ _ CHECK SEPTIC TANK SEWER CONN. DRAIN FIELD SOAKAGE PIT GREASE TRAP SOLAR HEATER DEEP WELL SPRKLR. SYSTEM SW IM'G POOL — — CONTR. LIST CHECK 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 specifications must be kept at building during progress of work. Owner's Name and Address ._ _,. I f No. Street Registered Architect and /or Engineer ',, Employing Plumber's Name .. __ _ , - -' __r' r No. Street .__ _ .__ - -- Location and Legal Description Lot Block Subdivision - Street Street and Number where work is to be performed—No . _____ - ____ New Building Size Septic Tank Feet of Drain Tile STATE OF FLORIDA, I COUNTY OF DADE. SS. MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT State work to be performned and purpose of building (By Floors) Remodeling Addition _ _ Repairs_ Type of Tank Dist. Feet of Tank or Drain Field from Well Nature of Water Supply: City —Well. - -_ Size of Soakage Pit ____ Date. Capacity Gals. No. of Stories Amount of Permit $ - -- ` l - (Signed) pct #' ! , 1 Plumbing Inspector. The undersigned applicant for this building permit does hereby certify that he understands and accepts his ohlitions as an employer of labor under the Florida Workmen's Compensation Act, being Section 5968, 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. (Signed) , 4_ R Master Plumber. Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeared My Commission Expires Notary Public, State of Florida 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. jJ ('// ( / • , 6 ' / , , — 11 �vv, Permit No. Owner's Name and Address New Building Amount of Permit $ STATE OF FLORIDA, t COUNTY OF DADE. ss. MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT Registered Architect and /or Engineer Employing Plumber's Name Location and Legal Description Lot Street and Number where work is to be performed —No State work to be performed and purpose of building (By Floors) Remodeling No. Addition (Signed'' (Signed) No._. 1--1 k 1 _Block 1 Street . Size Septic Tank Feet of Drain Tile _ ___ - �'`+ - -- Dist. Feet of Tank or Drain Field from Well Nature of Water Supply�City —Well. — Size of Soakage Pit_ ?' C ci ��jj Date .& .. ',Z -J �_ (..;(* Application is 1,ereby made for the approval of the detailed statement of the plans and specifications herewith suhnfitted 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 he complied with, whether herein specified or not. A copy of approved plans and specifications trust he kept at building during progress of work. Type of Tank - __ — Ur -- r - - QJJ _TZ2 _..._.Capacity Gals.. _ ( ' _ C _ " _ Street N2 Street Subdivision ctAkt No. of Stories My Commission Expires Notary Public, State of Florida lt - 7 1 Plunibteg 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 kiln in the work to he I 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 abov 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 niaterials and /or workmanship. CLOSETS BATH TUBS SHOWERS LAVA- TORIES SINKS SLOP SINKS LAUNDRY TUBS URINALS CATCH BASIN FLOOR DRAIN DRINKING FOU NT' NSI — 1 TOTAL FIXTURES CONTR. LIST I I CHECK SEPTIC TANK SEWER CONN. DRAIN FIELD SOAKAGE PIT GREASE TRAP SOLAR HEATER DEEP WELL SPRKLR. SYSTEM SW I POOL. CONTR. LIST ' �_- / r CHECK I a , Permit No. Owner's Name and Address New Building Amount of Permit $ STATE OF FLORIDA, t COUNTY OF DADE. ss. MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT Registered Architect and /or Engineer Employing Plumber's Name Location and Legal Description Lot Street and Number where work is to be performed —No State work to be performed and purpose of building (By Floors) Remodeling No. Addition (Signed'' (Signed) No._. 1--1 k 1 _Block 1 Street . Size Septic Tank Feet of Drain Tile _ ___ - �'`+ - -- Dist. Feet of Tank or Drain Field from Well Nature of Water Supply�City —Well. — Size of Soakage Pit_ ?' C ci ��jj Date .& .. ',Z -J �_ (..;(* Application is 1,ereby made for the approval of the detailed statement of the plans and specifications herewith suhnfitted 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 he complied with, whether herein specified or not. A copy of approved plans and specifications trust he kept at building during progress of work. Type of Tank - __ — Ur -- r - - QJJ _TZ2 _..._.Capacity Gals.. _ ( ' _ C _ " _ Street N2 Street Subdivision ctAkt No. of Stories My Commission Expires Notary Public, State of Florida lt - 7 1 Plunibteg 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 kiln in the work to he I 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 abov 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 niaterials and /or workmanship.