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1050 NE 96 St (5)�i� 4 67A s� Date % � � .� � S Job Address /d ' Legal Description Owner / Lessee / Tenant Owner's Address /05'0 ,/✓6r q45 S f Contracting Co. ,/64Gt,d1, _S i-� 2 2-1/4 = Qualifier ncA'+ State # /LI Municipal # Competency # Ins.Co. Architect /Engineer Address Bonding Company Address Mortgagor Address Permit Type(circle one): BUILDING ELECTRICAL /PL,UMB ; MECHANICAL ROOFING PAVING FENCE SIGN WORK DESCRIPTION ,L.;.Jh // .f,2 i - k/ Square Ft. G) d.‘ Estimated Cost(value) /L✓8 fl 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 a be done in compliance with all applicable laws regulating construc authorize the above -named contractor to do the work stated. Signature of owner and Date: .n Notary as My Commi P►RMIT APPLICATION FOR MIAMI SHORES VILLAGE or Condo President N. 1 aS t% Owner and n Expires: '0,,,, „ , ; ;; ss# Phone gill "OFFICIAL SEAL” Time,:':: 2 . ,hang :l R1Sdent: as 7/22/913 Curninls „or; ktJC 217311 ** * * * * * * * * * FEES: PERMIT rio RADON C.C.F. } APPROVED: kfr'ff Fire Zoning Building Mechanical Address Tax Folio _TAW Master Permit # c)s - deoa, t Phone Go c ; sc✓ s`' Signat Date: re o 'Contractor or Owner- Builder J ' Notar _. ontractor or Owner- Builder My Co Fio�tiarat66aoYas:v n¢�... SANDRA ICJ NOit�YIF A. COMMISSION NUIV:RI741 .1a tr tv 1 2 6 a * * ** * w Zt 440:F: ITY COIF SSIrON AUG. 17.': TOTAL DUE OL to and that all work will d zoning. Furthermore, I Other Electrical Engineering_ LOT: A [ ] N [ K [ APPROVED BY: SPECIFICATIONS BY: PROPERTY STREET ADDRESS: / 6-® NE PROPERTY ID #: A v DATE ISSUED: BLOCK: SUBDIVISION: STATE OF FLORIDA DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PERMIT Authority: Chapter 381, FS & Chapter 1OD -6, FAC CONSTRUCTION PERMIT FOR: / [���] New System [ /]`Existing System [ Holding Tank [Temporary /Experimental ] Repair [pi Abandonment [ ] Other(Specify) AGENT: �(/j � � �•- '1`'� ©G7 � C ^ SYSTEM MUST BE CONSTRUCTED IN ACCORDANCE WITH SPECIFICATIONS AND STANDARDS OF CHAPTER 1OD -6, FAC REPAIR PERMITS AND HOLDING TANK PERMITS EXPIRE 90 DAYS FROM THE DATE OF ISSUE. ALL OTHER PERMITS EXPIRE ONE YEAR FROM THE DATE OF ISSUE. HRS APPROVAL OF SYSTEM DOES NOT GUARANTEE SATISFACTORY PERFORMANCE FOR ANY SPECIFIC PERIOD OF TIME. ANY CHANGE IN MATERIAL FACTS WHICH SERVED AS A BASIS FOR ISSUANCE OF THIS PERMIT, REQUIRE THE APPLICANT TO MODIFY THE PERMIT APPLICATION. SUCH MODIFICATIONS MAY RESULT IN THIS PERMIT BEING MADE NULL AND VOID. SYSTEM DESIGN PTFICATIONS ALLO / GPD] EPTIC TAN AEROBIC UNIT CAPACITY MULTI- CHAMBERED /IN SERIES:[ ] [GALLONS / GPD] CAPACITY MULTI- CHAMBERED /IN SERIES:[ ] GALLONS GREASE INTERCEPTOR CAPACITY [MAXIMUM CAPACITY SINGLE TANK: 1250 GALLONS] GALLONS PER DOSE DOSING TANK CAPACITY DOSE RATE [ ] PER 24 HRS NO. OF PUMPS: [ ] D [9e-1?[ SQUARE FEET P,7tIMARY DRAINFIELD SYSTEM R [ ] SQUARE FEET SYSTEM A TYPE SYSTEM: [ ] STANDARD [ ] FILLED I CONFIGURATION: [ ] TRENCH [ ] BED N F LOCATION OF BENCHMARK: I ELEVATION OF PROPOSED SYSTEM SITE [ ] [INCHES /FT] [ABOVE /BELOW] BENCHMARK /REFERENCE E BOTTOM OF DRAINFIELD TO BE [ L D FILL REQUIRED: [ ] INCHES EXCAVATION REQUIRED: [ ] INCHES [ SECTION /TOWNSHIP /RANGE /PARCEL NUMBER] [OR TAX ID NUMBER] ] [INCHES /FT] [ABOVE /BELOW] BENCHMARK /REFERENCE O ! 2 tt - T VI /p 1O H i ---Y' �" l�" - ,b.-4,4-nAjZ7 j1F,J1_,_ TITLE: TITLE: HRS -H Form 4016, Mar 92 (Obsoletes previous editions which may not be used) (Stock Number: 5744 - 001-4016 - 0) QPPLO CART PERMIT # DATE PAID FEE PAID $ RECEIPT # [ ] MOUND [ ] [ ] (111 .!',111' 111:1 CK62.5e7 POINT POINT - 7 , ;) ¢ CPHU EXPIRATION DATE: .. - 20'dr Page 1 of 2 SPECIFICATIONS: INSTRUCTIONS: PERMIT NUMBER: Permit tracking number assigned by CPHU. APPLICATION FOR: Check type of permit, if "Other specify type in blank. APPLICANT: Property owner's full name. TELEPHONE: Telephone number for applicant or agent. AGE NIT. 12g:IP r_TrecentutiVe MAILING ADDRESS: P.O. box or street mailing address for applicant or agent. LOT, BLOCK, SUBDIVISION or PROPERTY IDk: 27 character id number for property. (CP }IU may require property appraiser ID # or section/township /range /parcel number) SYSTEM DESIGN AND TANK: Minimum specifications from Chapter 10D-6, FAC. DRAINFIEiLD: Minimum specifications from Chapter 10D-6, FAC. OTHER: Other specifications, such as operating permit requirements, low- volume flush toilets, variance provisos. SPECIFICATIONS BY: Name of individual providing speciGeationa. If designed by a registered engineer must be sealed. APPROVED BY: County Public Health Unit (CPHU) personnel reviewing and approving permit. DATE ISSUED: Date permit is issued by CPHU. EXPIRATION DATE: One year from date issued if the system has not been installed. Permits for system repairs become void 90 days from the date issued. ch block represtents .5`-feet drictl inch = 50 feet. 1 1 1 1 • _ • • - or■ri>■ si _ ■n■■n■■11 • •ri■■u 1 1 11 7 _ _ a F � r I _ , i I' 1 11 4 111U1 ` 1 , r ., ^ ` • • • X ii r ' i T T . ` •I r 1 — ■ •■■■■rile■ , ,1 are � i■ 1 als - r . , -' 1 11•11,1 a —� / A . 1111 ■ J J C , ( r T ] ) - i 1 1111 C7 • • _ L _ I_ _ ■ . ■ ■ � I .e ■ I I I I_I_ I I _ _ r I • � r■� r� . . � • • • • • .� I • I MIEN 1 11 ■ ■ � ® ®a■ l _ I . .iN■S 1 EII I L I.II.! ■ _ ■■ 1 E _ 1 a= 1 -- - - ■, - - -- a 1 - R 1 - - � 1 1 1: C C:.0 • • - OE ■ ri: i i • • 1 1 r . J I 1 I I . f - ■ ■ ■ _ _ — .�i I J_ ■ ■ f — 1 L - JJ4 • ■ ■■ M M 1 1 - I - - -- • • ■ ■ 1 11 ■ ■ ■ ■' - I ■ 1 -I I r ■ ■ ■ ■ � • I I • :.I- - • _ ___. I - -I . . -� _ J _ ` = _ I- • • ■ ` I l 1 I 1 _ ! PIM M MN . ■ I �� I I I i J - - - - r r r r T" �� i i • •1 r r 1 .• ■ 1■ • ■ r r r F i 1 1 I I 111 ■ ■ U U■■ ■ ■■ I I ■ i 1 1 r - I I By I li lt L Notes: STATE OF FLORIDA DEPARTMENT CIF,H.EALTH_ANID.REHABILITATIVE SERVICES / y - { APPLICATION FOR ONSI SEWAGE DISIPOSAL SYSTEM CONSTRUC PERMIT "105 Permit Application Number/0 ' r ^, Site Plan submit by: Plan Approved L_ HRS-H Form 4015, Feb 85 (Obsoletes previous editions which may not be used) (Stock Number. 5744- 002 - 4015-6) „ p,,ART 11,- ,: ;ITE PLAN Not Approved ALL CHANGE i1IIUST BE APPROVED BY TH. C O4 1 ,,- Page 2 of 3 Date /. County Public Unit HEALTH UNIT APPLICATION FOR: 1[�_rNew System [ 71 Repair APPLICANT: AGENT: MAILING ADDRESS: STATE OF FLORIDA DEPARTMENT OF HEALTH AND REHABIL SERVICES ONSITE SEWAGE DISPOSAL SYSTEM APPLICATION FOR CONSTRUCTION PERMIT Authority: Chapter 381, FS & Chapter 10D -6, FAC ,[e -Existing System [ 'I] Holding Tank (4) Temporary /Experimental 14t-Abandonment 0 ] Other(Specify) (4/1 I V' a ;&-t PERMIT # DATE PAID FEE PAID $ RECEIPT # TELEPHONE: TO BE COMPLETED BY APPLICANT OR APPLICANT'S AUTHORIZED AGENT. ATTACH BUILDING PLAN AND TO -SCALE SITE PLAN SHOWING PERTINENT FEATURES REQUIRED BY CHAPTER 10D -6, FLORIDA ADMINISTRATIVE CODE. PROPERTY LOT: PROPERTY ID #: PROPERTY SIZE: 1 2 3 4 INFORMATION [IF LOT IS NOT IN A RECORDED SUBDIVISION, ATTACH LEGAL DESCRIPTION OR DEED] / BLOCK: SUBDIVISION: ( DATE OF SUBDIVISIOND `[Section /Township /Range /Parcel No.] ZONING: PROPERTY STREET ADDRESS: DIRECTIONS TO PROPERTY: BUILDING INFORMATION [RESIDENTIAL Unit Type of No Establishment ; ACRES [Sgft /43560] PROPERTY WATER SUPPLY: [ ] PRIVATE 4 '77 .' a [ ] Spas /Hot Tubs [ . ] COMMERCIAL No. of Building # Persons Bedrooms Area Snft Served • [ ] Garbage Grinders /Disposals [ ] Ultra -low jTolume Flush To [ ] Otiier (Specify) 9 n APPLICANT'S SIGN 41,1 a HRS -H Form 4015, Mar 92 (Obsoletes previ s editions which may not be usedi= (Stock Number: 5744 - 001 - 4015-1) DATE: 0 i' Business Activity For Commercial Only `W •1 ; ' o f_ 1 PUBLIC ] Floor /Equipment, Drains Page 1 of 3 INSJ'R(J( 1'1ON:i: <; 1: C'';'1.:r.0 =yP of 9c nii, 1:alu, „ u ,i .:r. .,.1'.... t1 :'�It�ilin s. c:• fit!!u. !L.._ . r.., c... ..f.. T. :,.:. •y f, .fr:. .:::... Ct iillt� :CCII : ... :ec deb •ii do !, to Iot o' RE. •))12 m?. rr.;: c trlf19 ahotning lot location. is c c.?y o' " ^AC. ':at_.;1� ?a.;: r, , i;!;r'y, w t �r:.4t:talui, tiu.:tal''.; Ofill't:. 'tt . " 7'P�; i. i :1c :.: a :v1CS (`;.,J::C"5:6..O i'C J'1?(:Iy i;. DVtC t !;i 'CJ IL; :�4:k,C IL:L.,flttC:O?}4 Po" V :Illilr 17 :0: cacti ,to?.y of'ri 0 �P:" ii n0i urulir.:hic. i s r +' c_ open c:' Yi( ?iy �t . a io:' c- r. , t. : arir „i. `Y STATE OF FLORIDA DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES ONSITE SEWAGE DISPOSAL SYSTEM SITE EVALUATION AND SYSTEM SPECIFICATIONS BLOCK: SUBDIVISION: [Section /Township /Range /Parcel No. or Tax ID Number] BENCHMARK /REFERENCE POINT LOCATION: ELEVATION OF PROPOSED SYSTEM SITE IS SOIL PROFILE INFORMATION SITE 1 SITE EVALUATED BY: /// PROPERTY ID #: / p'1 phi 6 TO BE COMPLETED BY ENGINEER, HEALTH UNIT EMPLOYEE, OR OTHER QUALIFIED PERSON. ENGINEER'S MUST PROVIDE REGISTRATION NUMBER AND SIGN AND SEAL EACH PAGE OF SUBMITTAL. COMPLETE ALL ITEMS. PROPERTY SIZE CONFORMS TO SITE PLAN: OYES [ ] NO NET USABLE AREA AVAILABLE: ACRES TOTAL ESTIMATED SEWAGE FLOW: O GALLONS PER DAY [RESIDENCES -TABLE 1 / OTHER -TABLE 2] AUTHORIZED SEWAGE FLOW: t GALLONS PER DAY [1500 GPD /ACRE OR 2500 GPD /ACRE] UNOBSTRUCTED AREA AVAILABLE: i t'-o SQFT UNOBSTRUCTED AREA REQUIRED: ((,)0 SQFT SITE SUBJECT TO FREQUENT FLOODING: [ ] YES [) NO Munsell # /Color Texture Depth to to i tom to cf-e fir. 2 � f to 3-f to to to USDA SOIL SERIES: HRS-H Form 4015, Mar 92 (Obsoletes pr- is editions which may not be used) (Stock Number: 5744 - 003 - 4015 -1) PERMIT # AGENT: L :_ \ o 0 [INCHES /FT] [ABOVE /BELOW] BENCHMARK /REFERENCE POINT THE MINIMUM SETBACK WHICH CAN BE MAINTAINED FROM THE PROPOSED SYSTEM TO THE FOLLOWING FEATURES: SURFACE WATER: /12, FT DITCHES /SWALES: FJA FT NORMALLY WET? [ ] YES (J NO WELLS: PUBLIC: e FT LIMITED USE: 7; >/4 FT PRIVATE: FT NON - POTABLE: (L 4 FT BUILDING FOUNDATIONS: 43 ' FT PROPERTY LINES: r) FT POTABLE WATER LINES: A 4 FT 10 YEAR FLOODING? [ ] YES [c4 NO 10 YEAR FLOOD ELEVATION FOR SITE: fr, FT MSL /NGVD SITE ELEVATION: `7, a, FT MSL /NGVD SOIL PROFILE.INFORMATION SITE 2 Munsell # /Color Texture Depth to to to to to to to to to. USDA SOIL SERIES: OBSERVED WATER TABLE: ,:.4 INCHES [AB9 / BELOW] EXISTING GRADE. TYPE: [PERCHED / APPARENT] ESTIMATED WET SEASON WATER TABLE ELEVATION: INCHES [ ABOVE / BELOW ] EXISTING GRADE. HIGH WATER TABLE VEGETATION: [ ] YES [ NO MON) TTLI: [ ] YES [ ] NO DEPTH: VP, "INCHES SOIL TEXTURE /LOADING RATE FOR SYSTEM SIZING: l/, S / f DEPTH OF EXCAVATION: V �f/ INCHES DRAINFIELD CONFIGURATION: [ ] TRENCH ['] [ ] OTHER (SPECIFY) REMARKS /ADDITIONAL CRITERIA: DATE: Page 3 of 3 • P e • W or PERMIT APPLICATION FOR MIAMI SHORES VILLAGE Date ./ Legal Description Owner / Lessee / Tenant 41t, l h k(S /9AV /OSO /ye" fb Contracting Co. _ ��/ /J I V Z //1 Owner's Address Qualifier t �%?5 4we, WORK DESCRIPTION 41. APPROVED: Job Address /106 3 ^ orp.-r ,.1 Address State #0e/I35OaWMu�icipal # Competency # Ins.Co. Architect /Engineer Address Bonding Company Address Tax Folio 1/ 5gt96 /4' J5$ Cv(c6 0,105e) o (ofri9kry Master Permit # ,P/ ;?7 Phone 9 ?b/ 50 gs s� Phone 7-73 - 1138 Mortgagor Address Permit Type(circle one): BUILDING ELECTRICAL Rik MECHANICAL ROOFING PAVING FENCE SIGN Square Ft. Estimated Cost(value) .0 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 constructio d z•nin:. Furthermore authorize the above -named contractor to do the work stated. ' V ; : � ^ " 1;;;:, JOSEPHINE NUM i j?. *,err • .. y Public, State d Honda �I i� i_,j Comm�sson Sl 1 Signature of owner and /or Condo President Signatu 441..- Co t ,4 '�P �- Builder Date: Date: is f • • - Print t pe or stamp name of Notary Public 410414 < My known MR Pr LD. �► Notary as to Owner and /or Condo President otafy as to CoTWractonlor • t a� ild ? My Commission Expires: My Commission ExpirpAt DID take an oath, or DID NOT take an oath. ** * * * * * * * * * * * GG * * * * ** FEES: PERMIT`S Q 4 ®° RADON C.C.F. , , !0' 2 ✓ NOTARY 5:4 TOTAL DUE J -5 Fire Other Zoning Building V Electrical l'' Mechanical lumbin�; �/ " �ineering_ Amount of Permit $ STATE OF FLORIDA, } COUNTY OF DADE. Permit No 07 /47- Owner's Name and Address My Commission Expires Registered Architect and /or Engineer Employing Plumber's Name J L_I� 1l " 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) _ New Building ______ Remodeling _ _ _____ Addition. (Signed)__ MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT 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. No._ _L_ G_" Street ___l No. - -_ /-' 3 - — Street._1. _ - 7 Block Subdivision ...... _— _ -_ —_- Street Repairs No. of Stories. Size Septic Tank ..... 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 — -- — (Signed)_________ .... ------------------------ - - - - -- 7 — Capacity Gals. 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. Notary Public, State of Florida 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 $1.00 will be made when such re- inspection is made•necessary by improper notice for inspection, or faulty materials and /or workmanship. CLOSETS BATH TUBS SHOWERe LAVA- TORIES SINKS SLOP SINKS LAUNDRY TUBE URINAL$ CATCH BASIN FLOOR DRAIN DRINKING 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 COMM . LILT . ��'���/ i.��,. I�� `S _ �—. CHECK Amount of Permit $ STATE OF FLORIDA, } COUNTY OF DADE. Permit No 07 /47- Owner's Name and Address My Commission Expires Registered Architect and /or Engineer Employing Plumber's Name J L_I� 1l " 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) _ New Building ______ Remodeling _ _ _____ Addition. (Signed)__ MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT 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. No._ _L_ G_" Street ___l No. - -_ /-' 3 - — Street._1. _ - 7 Block Subdivision ...... _— _ -_ —_- Street Repairs No. of Stories. Size Septic Tank ..... 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 — -- — (Signed)_________ .... ------------------------ - - - - -- 7 — Capacity Gals. 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. Notary Public, State of Florida 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. MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT Permit No. - 2 . 7 D 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----- - - - - -- -- - - - -- Registered Architect and /or Engineer Employing Plumber's Name No.____.._______— Street. Location and Legal Description t Bloelr Street and Number where work is to be performed —No Jo ® • i� Street State work to be performed and purpose of building (By Floors)_--__-_--•-----------------____-- Remodeling____ _. - - -_ Addition Size Septic Tank ..... _..__ -- Type of Tank Capacity Gals. Feet of Drain Tile. 1 s _Dis Fee of Tank or Drain Field from Well Nature of Water Supply: Well..___ —___ Size of Soakage Pit Amount of Permit ..... — -- - - - - -- ( Signed ) NOTE: A re- inspectoo materials and wor No.__________- ___ --- _ Street. My Commission Expires Subdivision Repairs No. of Stories 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 Ilas 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. c 7 G (Signed)._ / Master Plumber. STATE OF FLORIDA, COUNTY OF DADE. j 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 e of $1.00 will be made when such re- inspection is made •necessary by improper notice for inspection, or faulty CLOSETS BATH Toss S LAVA- TORIES SINKS SLOP SINKS LAUNDRY TUBS U CATCH BASIN FLOOR DRAIN DRINKING FOUNT'NS TOTAL FIXTURES Comic I ST LIST a� L . / / CHECK � j ( L.:=6, -a /7 7 C� "/ 3 f� / ho — -- SEPTIC TANK � SEWER CONN. DRAIN FIELD SOAKAGE PIT GREASE TRAP CSR H EATER ! DEEP WELL SPRKLR. SYSTEM SWIM'G POOL . CONTR. LIST / / O A � � CHECK 6 v � I MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT Permit No. - 2 . 7 D 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----- - - - - -- -- - - - -- Registered Architect and /or Engineer Employing Plumber's Name No.____.._______— Street. Location and Legal Description t Bloelr Street and Number where work is to be performed —No Jo ® • i� Street State work to be performed and purpose of building (By Floors)_--__-_--•-----------------____-- Remodeling____ _. - - -_ Addition Size Septic Tank ..... _..__ -- Type of Tank Capacity Gals. Feet of Drain Tile. 1 s _Dis Fee of Tank or Drain Field from Well Nature of Water Supply: Well..___ —___ Size of Soakage Pit Amount of Permit ..... — -- - - - - -- ( Signed ) NOTE: A re- inspectoo materials and wor No.__________- ___ --- _ Street. My Commission Expires Subdivision Repairs No. of Stories 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 Ilas 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. c 7 G (Signed)._ / Master Plumber. STATE OF FLORIDA, COUNTY OF DADE. j 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 e of $1.00 will be made when such re- inspection is made •necessary by improper notice for inspection, or faulty '911 d 61) ▪ A 1' , \ I ..- tx e., -L1 ■ ,S 0 t; le !....-,' 60 tA) ... i . ...,- 0 ....,,, , e -p ./..7' .fc, Date Cy (2 Job Address ` )050 I % Tax Folio//"M % - 0)y j$c2 Legal Description 0" 1) O Lo ► \ Al 1 L / 1 / Lessee / Tenant 's 2 ( v� ?` 1r70� Master Permit # ✓Y'�i7�� Owner's Address / U Phone PERMIT APPLICATION FOR MIAMI SHORES VILLAGE / - �G��% t/ C1 (7e /e&� Contracting Co. Address �7 v ,�/ 1( I' k C�L�.} /!\ SS# / Phone Qualifier 4 Ll /,90-6(7 , eY65 Municipal it / Signature of owner and /or Condo President Date: Notary as to Owner and /or Condo President My Commission Expires: APPROVED: Competency # Address A Ins.Co. 9/2P State # Architect /Engineer Address Bonding Company Mortgagor Address Permit Type(circle one): BUILDING ELECTRICAL PLUMBING MEC ROOFING PAVING FENCE SIGN WORK DESCRIPTION � /�' % / -' � v ` /�i / /� C- 41" "V Square Ft. Estimated Cost(value) WARNING TO OWNER: YOU MUST RECORD A NOTICE OF COMMENCEMENT AND YOUR FAILURE TO DO SO MAY RESULT IN YOUR PAYING TWICE FOR IMP:ROVEMENTS 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 mandi I. No ary as to Contra or o er- Builder My Commission li s ., 81.. IC STAR' OF F 1.OR ?Or. fs`'Y Ca *',4::SIGW EXP. APP. ; .•4 * * * * * * * * * * * ** FEES: PERMIT 30 i RADON C.C.F. • • J NOTARY TOTAL DUE 3v� °�' Fire Other Zoning Building Electrical Mechanical Plumbini `-� � Engineering Date Legal Owner I�LHNil I APPLILA I IUN 1 MUN1LU ALt I its Ur UAUt UUUN I Y Owner's Address Contracti Qualifie State # lb5 /).tee ct6 kd f C1 c,L2 Lu)- Architect /Engineer Bonding Company Mortgagor Permit Type: ROOFING BUILDING ELECTRICAL PLUMBING MECHANICAL PAVING FENCE SIGN WORK DESCRIPTION Square Ft. (21M/13 Job Address Description 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 :ulat _ onstruction and zoning. Furthermore, I authorize the above -named contractor, o do tated. Signature of Property Owner Sworn to & subscribed before me this of ��k) , 19 AdiligLARIF Signaturei6f Notary Inc MICHAa A pi! 5etvt o t My 00)114 �. � �� t .� t e'. 'SCo Name) noA;,Ci ' i,1° OR Produced I.D. a 1 PerxmliarCia 1w ca TYPE OF I.D. PRODUCED Per FEE °e✓ S -2- Zoning Mechanical or Condo Pres. o President Tenant Address ;nn 5 aster Permit # Day -Time Phone SS# - - Phone Competency# Ins. Co. Building Address Address Address of Estimated Cost ur Contra ay Sworn to & subscrib before me this day (Print, Type, or Stamp Commissioned Name) Personally Known n OR Produced I.D. n TYPE OF I.D. PRODUCED Plumbing Engineering Tax Folio I I- 32o■ - 01N -3S 20 Electrical , 19 Qualifier Date Legal Description �1, Historically Designated: Yes ` /v /'� / Tenant C L Owner's Address Contracting Co. Lit/ Sign APPROVED: Zoning Mechanical s to Owner My Commission Exp FEES: PERMIT PERMIT APPLICATION FOR MIAMI SHORES VILLAGE Job Address Tax Folio //-302C65. 0 / -3.L.246 D.O NC 9G sr w State #er- �t,evy5-y Municipal # Competency # Ins. Co. Architect/Engineer Address Bonding Company Address Mortgagor _ Address Permit Type (circle one): BUILDING ELECTRIC WORK DESCRIPTION � �( �//� 0 Square Ft. Estimated Cost (valu v t) • 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. 0 0 r an es: or .n Ts esident ate z AO Al r or Owner er -Bur er — OFFIC NOTARY A.L BUD TU ORD NOTARY pIJB JJ.0 STATE O FLORIDA COMMISSION NO. 2 MY COMMISSION EX. • APR R.1 ° C4 Signature of Contra x uilder Date 'a► ident NOTARY FO :_t Or• FLORIDA COMM IC)N NO. CC�43 3 MY COMMISSION EX I2 1,2C32 ( RADON Building Plumbi n/Li&I.S /a/t) o-ej /1 Commission Master Permit # Phone C.C.F. , 0 NOTARY No Vt;-1 757 w / Address �y ss /� f/ ECHANICAL ROOFING PAVING FENCE SIGN TOTAL DUE d Date Electrical Engineering