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PLUMBINGMIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT Pernut No / Date v / 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 Miail%1 Shores Village shall be complied with, whether herein specified or not. A copy of approved plans and specifications must building during progress of work. Owner's Name and Address i3= Registered Architect and /or Engineer___ _____ Employing Plumber's Name Size Septic Tank Feet of Drain Tile - Nature of Water Supply: City —Well. Amount of Permit $ (Signed). be kept at __ No.________ __.________._ Street_ T No._____ — _________ Street_ Location and Legal Description Lot--- •-- ----- _-- --._ - -- -M __Ill ��oclk_ =' - ` Subdivision Street and Number where work is to be performed —No ,- Street State work to be performed and purpose of building (By Floors) ----_-------- -----------__ - _-- New Building _____________.._______ Remodeling___ _ _ Addition Repairs No. of Stories _ Type of Tank Capacity Gals st. Feet of Tank or Drain Field from Well _ _Size of Soakage Pit (Signed) _ mg Inspector. The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations a an employer of labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Permanent Supp ement, and bus 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 perinit, as are licensed by Miami Shores Village. aster Plumber. STATE OF FLORIDA, t 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. My 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. CLOSETS BATH TUBS SHOWER! LAVA- TORIES SINKS SLOP SINKS LAUNDRY. TUBS URINALS 1 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 CONTR. LIST A CHECK MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT Pernut No / Date v / 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 Miail%1 Shores Village shall be complied with, whether herein specified or not. A copy of approved plans and specifications must building during progress of work. Owner's Name and Address i3= Registered Architect and /or Engineer___ _____ Employing Plumber's Name Size Septic Tank Feet of Drain Tile - Nature of Water Supply: City —Well. Amount of Permit $ (Signed). be kept at __ No.________ __.________._ Street_ T No._____ — _________ Street_ Location and Legal Description Lot--- •-- ----- _-- --._ - -- -M __Ill ��oclk_ =' - ` Subdivision Street and Number where work is to be performed —No ,- Street State work to be performed and purpose of building (By Floors) ----_-------- -----------__ - _-- New Building _____________.._______ Remodeling___ _ _ Addition Repairs No. of Stories _ Type of Tank Capacity Gals st. Feet of Tank or Drain Field from Well _ _Size of Soakage Pit (Signed) _ mg Inspector. The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations a an employer of labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Permanent Supp ement, and bus 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 perinit, as are licensed by Miami Shores Village. aster Plumber. STATE OF FLORIDA, t 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. My 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. `, r PERMIT APPLICATION FOR MIAMI SHORES VILLAGE c J Date ° Job Address (7 9 pc, ( Tax Folio 1 / - 3 ( 9-0A — 0/ 3 - T / t O Legal i ripti. n LO) / q + 4o 7 / K. '3 0 Historically Designated: Yes No / Tenant (I b( _ TO hr.-7 S Master Permit # 147 ' / 7 I I // Owner's Address Contracting Co. S6 6 b 5 S p r; c + Qualifier State # S ✓_o 5 a m(,,, Municipal # Olt) R /E Competency # Ins. Co. Architect/Engineer Address Bonding Company Address Mortgagor Address Permit Type (circle one): BUILDING ELECTRICA PLUMBIN ECHANICAL ROOFING PAVING FENCE SIGN WORK DESCRIPTION 3 0 0 t i £ ,0/4) %e , Square Ft. 300 4 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 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. FEES: PERMIT C= RADON Signature of nclo President Date ataleziu Notary as to Owner and/or Condo President My Commission Expires: APPROVED: Zoning Building Mechanical Plumbing Date C. C.F. / - NOTARY BOND .g 00. TOTAL DUE ? .!6- go Phone )0,? NF' 1.3v ) /t),in .e SS# a .5 Ph/ 31' 5 p / /r n Sign . i e of Contrac • or Owner Notary as to Contractor or Owner- Builder My Commission Expires: Electrical ?7 0 0 -Bu a Date Structural Engineer P ICATION FOR: [ J New System [y] Repair APPLICANT: i9 ..oLt AGENT: r (D ‘De `• /173) MAILING ADDRESS: 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 INFORMATION [IF LOT IS NOT IN A RECORDED SUBDIVISION, ATTACH LEGAL DESCRIPTION OR DEED] PROPERTY DIRECTIONS TO PROPERTY: BUILDING INFORMATION Unit Type of No Establishment 1 9/ /c 2 3 4 [ ] Garbage Grinders /Disposals [ ] Ultra -low Volume Flush Tpil e APPLICANT'S SIGNATURE: STATE OF FLORIDA DEPARTMENT OF HEALTH ONSITE SEWAGE DISPOSAL SYSTEM APPLICATION FOR CONSTRUCTION PERMIT Authority: Chapter 381, FS & Chapter 10D -6, FAC [A Existing System [4J] Holding Tank [j] Abandonment [Ai] Other(Specify) DH 4015, 10/96 (Replaces HRS -H Form 4015 [Page 1) which may be used) (Stock Number: 5744- 001 - 4015 -1) 0 he 5 TELEPHONE /3 ) _ s '�e 6, r,f!q.33 11, AR, 7 l 0 ` LOT: / BLOCK: 30 SUBDIVISION: / i 4 i t°'3 / 7 1Q/ � " �'" SUBDIVISION q PROPERTY ID #: 0 1 .: 6 [Section/Township/Range/Parcel No.] ZONING: PROPERTY SIZE: Q1/ Q ACRES [Sqf 43560 PROPERTY WATER SUPPLY: [ ] PRIVATE [y] PUBLIC STREET ADDRESS: 9 79 l� e 1( '5r ?3c, c sr —fc 7- q 5oe4 i T'. etc- 5-r r . (j # 6'6T /toe Ai/o TN 0) 3,o &.- l 1G — re) igQArei SS n [y] RESIDENTIAL [ ] COMMERCIAL No. of Building Bedrooms Area Sq #� PERMIT # DATE PAID FEE PAID $ 1 5 RECEIPT 15n#' [1i] Temporary /Experimental # Persons Business Activity Served For Commercial Only 3 ] Spas /Hot Tubs [ ] Floor /Equipment Drains ] Other (Specify) A01G4 5 /20 1e., (5,0/2-2c/ Page 1 of 3 INSTRUCTIONS: 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. AGENT: Property owner's legally authorized representative. MAILING ADDRESS: P.O. box or street, city, state and zip code mailing address for applicant or agent. LOT, BLOCK, SUBDIVISION: Lot, block, and subdivision for lot (recorded or unrecorded subdivision). If lot is not in a recorded subdivision, a copy of the lot legal description or deed must be attached. DATE OF SUBDIVISION: Official date of subdivision recorded in county plat books (month /day /year) or date lot originally recorded. Dividing an approved lot into two or more parcels for the purpose of conveying ownership shall be considered a subdivision of the lot. PROPERTY ID #: PROPERTY SIZE: 27 character number for property. (Health Department may require property appraiser ID# or section /township /range /parcel number.) Net usable area of property in acres (square footage divided by 43,560 square feet) exclusive of all paved areas and prepared road beds within public rights -of way or easements and exclusive of streams, lakes, normally wet drainage ditches, marshes, or other such bodies of water. Contiguous unpaved and noncompacted road rights -of -way and easements with no subsurface obstructions may be included in calculating lot area. WATER SUPPLY: Check private or public. PROPERTY ADDRESS: Street address for property. For lots without an assigned street address, indicate street or road and locale in county. DIRECTIONS: Provide detailed instructions to lot or attach an area map showing lot location. BUILDING INFORMATION: Check residential or commercial. TYPE ESTABLISHMENT: List type of establishment from Table II, Chapter 10D-6, FAC. Examples: single family, single wide mobile home, restaurant, doctor's office. NO. BEDROOMS: Count all rooms designed primarily for sleeping and those areas expected to routinely provide sleeping accommodations for occupants. BUILDING AREA: Total square footage of enclosed habitable area of dwelling unit, excluding garage, carport, exterior storage shed, or open or fully screened patios or decks. Based on outside measurements for each story of structure. # PERSONS: Number of persons residing, using, or working in establishment. For residential establishment, 2 persons per bedroom are assumed. BUSINESS ACTIVITY: For commercial applications only. List number of employees, shifts, and hours of operation, or other information required by Table I1, Chapter 10D -6, FAC. FDCTURES: Mark each listed fixture with number installed or "NA" if not applicable. SIGNATURE: Signature of applicant or agent. Date application on day submitted to Health Department with appropriate fees and attachments. ATTACHMENTS: A site plan drawn to scale, showing boundaries with dimensions, locations of residences or buildings, swimming pools, recorded easements, onsite sewage disposal system components and location, slope of property, any existing or proposed wells, drainage features, filled areas, obstructed areas, and surface water. Location of wells, onsite sewage disposal systems, surface waters, and other pertinent facilities or features on adjacent property, if the features are with 75 feet of the applicant lot. Location of any public well within 200 feet of lot. For residences, a floor plan (residences) showing number of bedrooms and building area of each unit. For nonresidential establishments, a floor plan showing the square footage of the establishment, all plumbing drains and fixture types, and other features necessary to determine composition and quantity of wastewater. CONSTRUCTION PERMIT FOR: r ] New System [;' ] Existing System r.,:] ] Repair [ ] Abandonment APPLICANT: PROPERTY STREET ADDRESS: , LOT: PROPERTY ID 1: 0 T H E R D FILL REQUIRED: [ * -'a r ] INCHES SPECIFICATIONS BY: - APPROVED BY: DATE ISSUED: STATE OF FLORIDA 1 PERMIT 1 "' DEPARTMENT OF HEALTH DATE PAID ONSITE SEWAGE DISPOSAL SYSTEM FEE PAID $ r,` '- CONSTRUCTION PERMIT RECEIPT ,1E Authority: Chapter 381, FS & BLOCK: , - SUBDIVISION: r`, ; . ; ,1 ; 1 _:b d °. sr DH 4016, 10/96 (Replaces HRS -H Form 4016 (page 1) which may be used) (Stock Number: 5744 -001- 4016 -0) Chapter 10D -6, FAC ] Holding Tank ( ] Temporary /Experimental ] Other(Specify) Applicant AGENT: [SECTION /TOWNSHIP /RANGE /PARCEL NUMBER] (OR TAX ID NUMBER] 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. DEPARTMENT OF HEALTH 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 AND SPECIFICATIONS T [ F i" , ] ( ✓GALLONS./ GPD]6SEPTIC TANK%AEROBIC UNIT CAPACITY MULTI- CHAMBERED /IN SERIES:[ ] A ( .r- ] [GALLONS / GPD] r CAPACITY MULTI- CHAMBERED /IN SERIES:[ 1 N [ ] GALLONS GREASE INTERCEPTOR CAPACITY [MAXIMUM CAPACITY SINGLE TANK: 1250 GALLONS] K ( - 3 GALLONS PER DOSE DOSING TANK CAPACITY DOSE.RATE D (:��'J] SQUARE FEET PRIMARY DRAINFIELD SYSTEM R ( __• ] SQUARE FEET SYSTEM A TYPE SYSTEM: [ "J STANDARD ( ] FILLED [ ] MOUND I CONFIGURATION: ( ) TRENCH [ A BED ( J N F LOCATION OF BENCHMARK: I E BOTTOM OF DRAINFIELD TO BE [ a ] .INCHES /FT] L ELEVATION OF PROPOSED SYSTEM SITE ( F .'] [INCHHEES/*FT] (] EXCAVATION REQUIRED: ( ] INCHES TITLE: TITLE: PER 24 HRS NO. OF PUMPS: [ ] [ABOVEABELOW) BENCHMARK /REFERENCE POINT [ ABOVE /BELOWVBENCHMARK /REFERENCE POINT; .1 a EXPIRATION DATE: Page 1 of 2 INSTRUCTIONS: PERMIT NUMBER: Permit tracking number by County Health Department. 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. AGENT: Property owner's legally authorized representative. MAILING ADDRESS: P.O. box or street mailing address for applicant or agent. LOT, BLOCK, SUBDIVISION or PROPERTY ID #: 27 character ID number for property. (Health Department may require property appraiser ID# or section /township /range /parcel number.) SYSTEM DESIGN AND SPECIFICATIONS: TANK: Minimum specifications from Chapter 10D -6, FAC. DRAINFIELD: 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 specifications. If designed by a registered engineer must be sealed. APPROVED BY: County Health Department personnel reviewing and approving permit. DATE ISSUED: Date permit is issued by County Health Department. 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. PART II - SITEPLAN ' . - Scale: Each block represents 10 feet and 1 inch = 40 feet. By ST3T,,E OF FLORIDA DEPARTMENT OF HEALTH APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PE IT Permit Application Number 'k 0/2 ° / Site Plan submitted,by: Plan Approved T • • A I T 0 e 5 - . 14 ' 0 4 5 fo�� / "� l P q ; No ALL bHANGES MUST BE APPROVED BY THE COUNTY HEALTH DEPARTMENT DH 4015, 10/96 (Replaces HRS -H Form 4015 which may be used) (Stock Number: 5744 - 002 - 4015 -6) Notes: - ..... ,� � . - -- t () / 1/ ; C ,NL'' Date Page 2 of 4 County Health Department BUILDING ❑ MIAMI SHORES VILLAGE, FLORIDA ELECTRICAL ❑ Date PLUMBING PERMIT N° 8381 Contractor's ROOFING ❑ License No. ❑ Owner of _ Building .Lim "4 . t {1 Architect Contractor or Builder 1%1 e,' 'Y f i Li, t 1 - I r` 7 t C Legal Lot ii Description 1 1 B1 Address of 76' Building 2 -7 7 J • i 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 applica- tion 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 worjc 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 whetheyshown on the plans or drawings or in the statements or specifications and that he assumes respon- sibility for work done by his agents, sery • nts, employee,!. Signed • In consideration of the issuance to me of this permit I agree pertaining thereto and in strict conformity with the plans, drawing In accepting this permit I assume responsibility for all work don CONTRACTOR - r BUILDER t Work to be performed under this Permit ✓ 1 (C) , . t._ BY -74 ,! r 1. 1✓ oZ ?S3 Subdi- vision Sq. Ft. C '�- Value of 11 Amount of Project $ II Permit $ N CTOR) BY erform the work covered hereunder in compliance with all ordinances and regulation, statements or specifications submitted to the proper authorities of Miami Shores Village. y'either, myself, gent, servant or employee. AUTHORITY BUILDING ❑ MIAMI SHORES VILLAGE, FLORIDA Date - ELECTRICAL ❑ PLUMBING © PERMIT NA 8325 Contractor's ROOFING ❑ License No. r f Owner of Building — . Architect Contractor or Builder Address of --. Building • Legal Lot Description ❑ Work to be performed under this Permit 1 ...� t 1 r: 1 • • t BI 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 applica- tion 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 hereb whether shown on the plans or drawjt,gs or in the statements or specifications and that he assumes respon- sibility for work done by his agents, servnts or nployees( n 'I J r Signed t - In consideration of the issuance to me of this permit I agree to pertaining thereto and in strict conformity with the plans, drawings, st In accepting this permit I assume responsibility for all work done by, e CONTRACTOR or BUILDER v Ia v J .., L IY � •. v • 194' -f • Subdi- vision Sq Ft. Value of 11 Amount of Project $ II Permit $ i (1-N CTOR) BY— rform the work covered hereunder in compliance with all ordinances and regulation. tglrtents or spec /cations submitted to the proper authorities of Miami Shores Village. e,F, myself, m agent, servant or employee. BY AUTHORITY Permit No ? ` 2; h MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT JAN- Z.o •�g��,, 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. Date A d d r e s s _ No. 511 j - __-.__ Sae - C e L" / 'NJ /4 VE _ Registered Architect and /or Engineer-_ - c • M A pt g eL � . __ -_._� _ --- _�_______ Employing Plumber's Name II' Q-0 Et F 1 y M but _ Se'lvt a 7 'Mt No.- 5� 0 - -- Street N W _ 1 A V E, • _ -- Location and Legal Description Lot. _la _. = �':►: 1 q Bloel 3 D _ n t__§.± ' e Z Street and Number where work is to be performed — o _�_ Street p N•e. !b 57' ________- State work to be performed and purpose of building (By New Building _ _- - -- Remodeling —___ Addition__ epairs No. of Stories 1 Size Septic Tank __- _--- -• -_ -- Type of Tank. Capacity Gals. Feet of Drain ....... __________Dist. Feet of Tank or Drain Field from Well Nature of Water Supply: City — Well.-______ _ __ __ ._..________ -Size of Soakage Pit Amount of Permit $ (Signed) - - -- — - - -- 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) STATE OF FLORIDA, ' :s. COUNTY OF DADE. Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take aclmowledgments, 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. My 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. CLOIRB BATH TUBS SH LAVA- TORIES SINKS SLOP SINKS NDRY rips rips URINALS RINALS CATCH BASIN FLOOR DRAIN DRINKING FOUNT' NS TOTAL FIXTURES CONTR. LIST CHICK SEPTIC TANK SEWER CONN. DRAIN FIELD SOAKAGE PIT GREASE TRAP iiSIM1R DEEP WELL SPRKLR. SYSTEM SWIM'G POOL StDJ1 e l, RR1��B - HEATER CONTR. UST CHECK Permit No ? ` 2; h MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT JAN- Z.o •�g��,, 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. Date A d d r e s s _ No. 511 j - __-.__ Sae - C e L" / 'NJ /4 VE _ Registered Architect and /or Engineer-_ - c • M A pt g eL � . __ -_._� _ --- _�_______ Employing Plumber's Name II' Q-0 Et F 1 y M but _ Se'lvt a 7 'Mt No.- 5� 0 - -- Street N W _ 1 A V E, • _ -- Location and Legal Description Lot. _la _. = �':►: 1 q Bloel 3 D _ n t__§.± ' e Z Street and Number where work is to be performed — o _�_ Street p N•e. !b 57' ________- State work to be performed and purpose of building (By New Building _ _- - -- Remodeling —___ Addition__ epairs No. of Stories 1 Size Septic Tank __- _--- -• -_ -- Type of Tank. Capacity Gals. Feet of Drain ....... __________Dist. Feet of Tank or Drain Field from Well Nature of Water Supply: City — Well.-______ _ __ __ ._..________ -Size of Soakage Pit Amount of Permit $ (Signed) - - -- — - - -- 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) STATE OF FLORIDA, ' :s. COUNTY OF DADE. Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take aclmowledgments, 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. My 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. 3 ‘<s.