857 NE 97 St (14)B
PERMIT A N° 67
PLUMBING
O vner of Building
Architect and /or Engineer__*
Contractor or Builder
Proposed Location
LOT
NAME
NAME
BLOCK
NAME
d
— 7 11 C��e
SUB - DIVISION
ADDRESS
ADDRESS
ADDRESS
MIAMI SHORES VILLAGE
BUILDING INSPECTION DEPARTMENT
�a 6
74' J
LICENSE NO.
LICENSE NO.
NO. STREET
4 t
This permit is issued to '• '1"'= ' `' i " �' n 1 v ° tr To
the building above described, as per application, Plans and Specifications heretofore filed in this office. This permit is granted upon the express condition
that all facts stated in the application are true and that the construction complies strictly with the plans and specifications submitted, and in accordance
and compliance with the building laws of the State of Florida and with the building ordinances and zoning laws of Miami Shores Village, and rules and
regulations of the building department of Miami Shores Village. This permit may be revoked at any time upon the violation of any provisions of said
laws, ordinances s or rules and regulations, or upon any ',change in the plans and specifications unauthorized by the building inspector.
C,ryY v r; J i -� r t y
$ � __ti! � ' . t = ms` ` -j -- - f -- - -- ---------------------
AMOUNT I RECD. PAYMENT AC T. DEPT. INSPECTOR
jr
In consideration of the issuance to me of this permit I hereby agree to the proposed construction in strict conformity with the application and
p ans and specifications thereof heretofore by me submitted, and in compliance with all provisions of all building laws of the State of Florida, all the
building ordinances and zoning laws of Miami Shores Village and ,all rules and regulations of the building department of Miami Shores Village.
a 1 (.
Dated t ,' i '= c — — — — — - 19 ;Ja�s3iL�#�✓ —�� (v 't2(0
/ y , � , 4 „t ' .,, - (SEAL)
NOTE: A charge of $1.00 will be made for making corrections or changes to this application after approval has been obtained 4 rdm the 'Planning Board.
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.
Work done b
Address of work
Owner
Septic Tank
Drainfeld
Plumbing - Final
When ready
Received by
Date
Time
PLUMBING - INSPECTION
Permit No.
r fl
AM
PM
Address of work
Work done by
Owner
Septic Tank
Drainff_eld
Date
Time i:2_41
PLUMBIIIG - INSPECTION
S(:)wr
Gas
Permit No.
/
Plumbing l : Ro g TOD out
. 1 . ---
a-0?'- VI - ‘
/- 7
Received by }4/ N 52 •
PERMIT A N°
PLUMBING
•ner of Building4r! 4 ". / —
Architect and /or Engineer___
Contractor or Builder
NASA
RECD. PAYMENT ACCY. DEPT.
200 -
NAME
Proposed Location _ -_
LOT / BLOCK p VALE1- 15IVISION
ADDRESS
ADDRESS
rf
ADDRESS
0 a i /
MIAMI SHORES VILLAGE
BUILDING INSPECTION DEPARTMENT
y r
19
NO.
LICENSE NO.
STREET
LICENSE NO.
This permit is issued to ..'' - -- 4 - -- ti; f -, 1 ,W fv +,_.-�' {j To ti „ , `P-e-A a, .,.
the building above described, as-per application, Plans and Specifications heretofore filed in this office. This permit is granted upon the express condition
that all facts stated in the application are true and that the construction complies strictly with the plans and specifications submitted, and in accordance
and compliance with the building laws of the State of lorida and with the building ordinances and zoning laws of Miami Shores Village, and rules and
Villa regulations of the building department of Miami hot'S -. This permit may be revoked at any %time upon the ,violation!' of any provisions of said
laws, ordinances of and regulations, or upo y ng in the plans and specificano a nil d' by the building inspect r.
t
I
AMODNT
In consideration of the issuance to me of this permit I hereby agree to the proposed construction in strict conformity with the application and
ns and specifications thereof heretofore by me submitted, and in compliance with all provisions of all building laws of the State of Florida, all the
building ordinances and zoning la, s of Miami Shores Village and all rules and regulations of the building `department of Miami Shores Village. ,
Dated f 3 .9 Ls � y " y ' .,
w _ 19 _ . - = a y---:- - sir
(SEAL)
NOTE: A charge of $1.00 will be made for making corrections or changes to this application after approval has been obtained from. the Planning Board.
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.
INSPECTOR
MIAMI SHORES VILLAGE)
BUILDING INSPECTION DEPARTMENT
19
•
Owner of Building
LICENSE NO.
BUIEDINS
ELECTRIC:5kt
PLUMBING
PERMIT A N? 200
NAME ADDRESS
Architect and/or Engineer
NAME ADDRESS
Contractor or Builder
ADDRESS
NAME
Proposed Location
This permit is issued to
the building above described, as per application, Plans and Specifications heretofore filed in this office. This permit is granted , upon the express condition
that all facts stated in the application are true and that the construction complies strictly with the plans and specifications submitted, and in accordance
and compliance with the building laws of the State of Florida and with the building ordinances and zoning laws of Miami Shores Village, and rules and
regulations of the building department of Miami Shores Village. This permit may be revoked at any time upon the violation of any provisions Itlf said
4 ^
laws, ordinances or rules and regulations, or upon any change in the plans and specifications trnattterized by the building inspector.
$
AMOUNT
, c1
RECD. PAYMENT ACCT. DEPT.
LOT BLOCK SUB-DIVISION
LICENSE NO.
NO.
STREET d
/IL
.r
i r
To.
In consideration of the issuance to me of this permit I hereby agree to the proposed construction in strict conformity with the application and
, lans and specifications thereof heretofore by me submitted, and in compliance with all provisions of all building laws of the State of Florida, all the
-lading ordinances and zoning laws of Miami Shores Village and all rules and regulations of the building department of Miami Shores Village.
19
AL)
-40TE: A charge of $1.00 will be made for making corrections or changes to this application after approval has been obtained from the Planning Board.
le-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.
• INSPECTOR
e
Eft PERMIT A N° 163
PLUMBING
Owner of Building
NAME
Architect and /or Engineer
Contractor or Builder___:_
$
AMOUNT
Dated
NAME
NAME
Proposed Location
RECD. PAYMENT ACCT. DEPT.
ADDRESS
ADDRESS
ADDRESS
MIAMI SHORES VILLAGE
BUILDING INSPECTION DEPARTMENT
w �r
LICENSE
LICENSE NO.
LOT BLOCK SUB - DIVISION NO. STREET f
This permit is issued to _____ —. - --
the building above described, as per application, Plans and Specifications heretofore filed in this office. This permit is granted upon the express condition
that all facts stated in the application are true and that the construction complies strictly with the plans and specifications submitted, and in accordance
and compliance with the building laws of the State of Florida and with the building ordinances and zoning laws of Miami Shores Village, and rules and
regulations of the building department of Miami Shores Village. This permit may be revoked at any time upon the violation of any provisions of said
laws, ordinances or rules and regulations, or upon any change. in the plans and specifications unauthorized t ?y the building inspector. : %
INSPECTOR
In consideration of the issuance to me of this permit I hereby agree to the proposed construction in strict conformity with the application and
plans and specifications thereof heretofore by me submitted, and in compliance with all provisions of all building laws of the State of Florida, all the
building ordinances and zoning laws of Miami Shores Village and all rules and regulations of the building department of Miami Shores Village..
l f
-- , 19 -- - - - - -
NOTE: A charge of $1.00 will be made for making corrections or changes to this application after approval has been obtained from the Planning Board.
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.
'G
EL At PERMIT A N?
PLUMBING
Illvner of Building
Architect and /or Engineer
Contractor or BuilderZ1
Proposed Location '. '}*
LOT ��yy
This permit is issued to�� -9
the building above described, as per applicati
AMOUNT
building ordinances and zoning laws of Mia
Dated
NAME
NAME {
•
BLOCK --y SUB- D1VIS1 N
RECD. PAYMENT ACCT. DEPT.
, 19
163
MIAMI SHORES VILLAGE
BUILDING INSPECTION DEPARTMENT
STREET
To / t-td 1
, Plans and Specifications her tofore filed in this office. This permit is granted upon the express condition
that all facts stated in the application are true and that the construction complies strictly with the plans and specifications submitted, and in accordance
and compliance with the building laws of the State of Florida and with the building ordinances an zoning laws of Miami Shores Village, and rules and
regulations of the building department of Miami Shores Village. This permit may be revoke
laws, ordinances or rules and regulations, or upon at angif in the plans and specificatio
time upon the violation of any provisions 4 said
Ahoriz ji the lauding ins ctor.
e-
INSPECTOR
In consideration of the issuance to me of this permit I hereby agree to the proposed construction in striE confoirl w th tl/ application and
pa ns and specifications thereof heretofore by me submitted, and in compliance with all provisions of all c krtr dii . 1a , (of the tate2bf., Florida, ,..211 the
ores Village and all rules and regulations of the building�depar at of Mi a� ores. tllage,�i
y L)
NOTE: A charge of $1.00 will be made for making corrections or changes to this application after approval has been obtained from the Planning "1 oard.
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.
BUILDING
ELECTRICAL PERMIT A N° 67
PLUMBING
Owner of Building
.Architect and /or Engineer
Contractor or Builder
Proposed Location
LOT
NAME
NAME
NAME
Dated--------------------- - - - - -- -- — - - - - -� 19 - - - --
ADDRESS
ADDRESS
ADDRESS
MIAMI SHORES VILLAGE
BUILDING INSPECTION DEPARTMENT
, 19
LICENSE NO.
LICENSE NO.
BLOCK SUB- DIVISION NO. STREET
This permit is issued to -------- -- - - - - -- — --------- - - - - -- — - - -- - -- — - - -- — —_ -- To
the building above described, as per application, Plans and Specifications heretofore filed in this office. This permit is granted upon the express condition
that all facts stated in the application are true and that the construction complies strictly with the plans and specifications submitted, and in accordance
and compliance with the building laws of the State of Florida and with the building ordinances and zoning laws of Miami Shores Village, and rules and
regulations of the building department of Miami Shores Village. This permit may be revoked at any time upon the violation of any provisions of said
laws, ordinances or rules and regulations, or upon any change in the plans and specifications unauthorized by the building inspector.
AMOUNT RECD. PAYMENT ACCT. DEPT. INSPECTOR
In consideration of the issuance to me of this permit I hereby agree to the proposed construction in strict conformity with the application and
plans and specifications thereof heretofore by me submitted, and in compliance with all provisions of all building laws of the State of Florida, all the
building ordinances and zoning laws of Miami Shores Village and all rules and regulations of the building department of Miami Shores Village.
(SEAL)
NOTE: A charge of $1.00 will be made for making corrections or changes to this application after approval has been obtained from the Planning Board.
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.
BUILDING
ELECTRICAL
PLUMBING
ROOFING
Owner of
Building
Architect
Contractor
or Builder
Legal
Description
Address of
Building
0
❑
MIAMI SHORES VILLAGE. FLORIDA
Lot
■
CONTRACTOR OR BUILDER
PERMIT N° 7128
B1
Subdi-
vision
Value of
Project $
DATF
195
Contractor's
License No.
Work to be performed under this Permit
Amount of
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 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 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 oS, the ordinances and regulations
pertaining to the work covered hereby whether shown on the plans or drawings cr in the statements or specifications and that hekssumes responsibility for work
done by his agents, servants or employees. p
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 ac•
cepting this permit I assume responsibility for all work done by either, myself, my agent, servant or employee.
BY AUTHORITY
Bonding Company's Name (if applicable) 01 el
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 $2500, 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 yryd a reinspection fee will be charged.
Signature )'t
Owner or Agent
The foreg 'ng instrument was acknowledged before me this /0
day of Whi—, 20 Dv , by
who is personally known to me or who has produced
As id u tification and who did take an oath.
Si
P
A,* 4
Trr
Ij F�,..s r+t 27876
My Commission
**************************** *** * * * * *** ***RR*** * ** ** ** * ** * ** * * * ****** ****
*********** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** * * * *, * ** i.
(*.*,
APPLICATION APPROVED BY:
Chc 05/13/03
Dirt
•
Contractor
The foregoing instrument was acknowledged before me this f
day of 1Sk , 20
who is personally known to me or who has produced
as identification and who did take an oath.
JULIETTE COLLADO
11 10 ,Iro
��� lit I,G�II�►
ion 3-
Ae • EXPIRES: January 1, 2008
1res:
TART FL Notary Dot Assoc. Co.
*
*
NOTAR
Si
P • 4
My Commi
**
**
by
Flans Examiner
Engineer
Zoning
Miami Shores Village
4
BUILDING
PERMIT APPLICATION
FBC 2001
Permit Type (circle): Building Electrical
Owner's Name (Fee Simple Titleholder) \ 4r /LKK CC2S
Owner's Addrreess t • q
City Q M State
Tenant/Lessee Name
Job Address (where the work is being done)
City Miami Shores Village
Is Building Historically Designated YES
Contractor's Company Name
Contractor's Address I P)?()
City f I nimi
Qualifier c J C)h 1°.-41
Architect/Engineer's Name (if applicable)
$ Value of Work For this Perm
Type of Work: ['Addition
Describe Work:
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) ! fax:, - ! _•_: •72
Total Fee Now Due $ 1 b . . 8
(Continued on opposite side)
Zip 3)
C .1z✓. I Phone # 3)
of r
County Miami -Dade
NO
3L 065T, -- I)
State +i.
—Pam®
State Certificate or Registration No i:r7f • Certificate of Competency No.
['Alteration ❑New
Submittal Fee $ Permit Fee $
Notary $ Training/Education Fee $ O•
Scanning $ 3.0z:2 Radon $
Code Enforcement $ Structural Plan Review. $
Permit No. PL 2 14
r Permit No.
Phone #
Phone # x /55'
Zip 33 0
Phone #
Mechanical
Zip 43
Square Footage Of Work:
❑ Repair/Replace
* * * * * * * * * * * * * * * * * * * * * * * * * * * *F * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
Zoning
CCF $ 0 .(=> O CO /CC
Technology Fee $ 4- O
Bond $
Roofing
❑ Demolition
ITEM
BATH TUB
UNIT
FEE
ITEM
SWITCH OUTLETS
UNIT
FEE
ITEM
SPACE HEATERS
UNIT
FEE
BIDET
LIGHT OUTLETS
CENTRAL HEATING
DISHWASHER
RECEPTACLES
A/C (WIND)
DISPOSAL
SERVICE TEMPORARY
A/C (CENTRAL)
DRINKING FOUNTAIN
SERVICE SIZE IN AM'S
DUCT WORK
FLOOR DRAIN
SERVICE REPAIR/METER CHANGE
REFRIGERATION
GREASE TRAP
APPLIANCE OUTLETS
PROCESS AND PRESS PIPING
INTERCEPTOR
RANGE TOP
UNDERGROUND TANKS
LAVATORY
OVEN
ABOVE GROUND TANKS
LAUNDRY TRAY
WATER HEATER
U.F. PRESSURE VESSELS
CLOTHES WASHER
MOTORS 0- 1 HP
STEAM BOILERS
SHOWER
MOTORS OVER 1- 3 HP
HOT WATER BOILERS
SINK, POT /3 COMP.
MOTORS OVER 3- 5 HP
MECHANICAL VENTILATION
SINK, RESIDENCE
MOTORS OVER 5- 8 HP
TRANSPORTING ASSEMBLIES
SINK, SLOP
MOTORS OVER 8- 10 HP
ELEVATORS/ESCALATORS
TEMPORARY WATER CLOSET
MOTORS OVER 10- 25 HP
FIRE SPRINKLER SYSTEMS
URINAL
MOTORS OVER 25-100 HP
COOLING TOWERS
WATER CLOSET
MOTORS OVER 100 HP
VIOLATION
INDIRECT WASTES -
A/C WINDOW
REINSPECTION
WATER SUPPLY TO:
AIR CONDITIONERS
A/C UNIT
STRIP HEATER
FIRE SPRINKLER
GENERATORS TRANSFORMERS
'HEATER -NEW INST.
GENERATORS TRANSFORMERS
HEATER - REPLACE
GENERATORS TRANSFORMERS
LAWN SPRINKLER -WELL
SPECIAL PURPOSE
SWIMMING POOL
OUTLETS COMMERCIAL
WATER SERVICE
SIGN TUBES
SEWER CONNECTIONS
:SIGN TRANSFORMERS
UTILITY -SEWER
SIGN TIME CLOCK
UTILITY -WATER
FIXT1. ES
SEPTIC TANK
ANTENNA
RELAY
TELEVISION OUTLETS
DRAINFIELD, 4 TILE/RES.
VIOLATION
PUWP & ABANDON SEPTIC TANK
REINSPECTION
SOAKAGE PIT CU. FT.
CATCH BASIN
DISCHARGE WELL
DOMESTIC WELL
AREA DRAIN
ROOF INLET
SOLAR WATER HEATER
FIRE STANDPIPE
POOL PIPING
1
LAWN SPRINKLER SYSTEM
GAS RANGE
METER SET (GAS)
GAS PIPING
ADDENDUM TO BUILDING PERMIT APPLICATION
(AN,APPLICATION FOR BUILDING PERMIT MUST ACCOMPANY THIS ADDENDUM. IF A MASTER PERMIT HAS B.
OBTAINED, THE OWNER'S NOTARIZED SIGNATURE NEED NOT BE PRESENT ON SUBSEQUENT APPLICATIONS.)
PLUMBING
ELECTRICAL
MECHANICAL
Tree
Date X
CUSTOM POOLS
Review
This review
BY
CERTIFIED GUNITE COMPANY, INC. INCORPORATED IN FLORIDA AUGUST, 1964
TREE SURVEY
Project Name OlLt44))/ •
Address P /VJ '77 v -r, // /4 t
❑ There are no trees on the subjects property that conflicts
with the construction of the swimming pool and
deck.
❑ There are conflicts between the construction of the
swimming pool and /or deck However, all trees that
conflict with the construction are less than
eighteen (18) inches in diameter.
There are trees greater than eighteen (18) inches in
diameter that conflict with the construction of the
swimming pool. However, this /these tree(s) is /are
of the following species that do not require permit for
removal:
❑ Ficus
*ruit tree
❑ Australian Pine
❑ Brazilian Pepper
❑ Malaleuca
was accomplished by JaAi---
G - /o --o7
❑ Biachofia
❑ Earleaf Acacia
❑ Northfolk Island Pine
❑ Sc. eler
13250 S.W. 131 STREET, SUITE 100 MIAMI, FLORIDA 33186 (305) 255 -5315
NOTICE OF REQUIREMENTS
RESIDENTIAL SWIMMING POOL,
SPA AND HOT TUB SAF'TY ACT
I (We) acknowledge that a new swimming pool, spa or hot tub will be constructed or
nstalled at 8r7c A/L- 9 7 fr. Miami Sho res Fl., and hereby affirm that one of
he following methods will be used to meet the requirements of Chapter 515, Florida
Statutes.
:please initial the method(s) to be used)
SLe4Tilla
BUILDING DEPARTMENT
10050 N.E. SECOND AVENUE
MIAMI SHORES. FLORIDA 33138.2382
TELEPHONE (305) 795.2204
FAX (3051 756.8972
The pool will be isolated from access from the home by art enclosure
that meets the pool barrier requirments of Florida Statute 515.29;
The pool will be equipped with an approved safty cover that
complies with ASTM F1346 -91;
All doors and windows providing direct access from the home to the
pool will be equiped with an exit alarm that has a minimum sound
pressure rating of 85 decibels at 10 feet;
All doors providing direct access from the home to the pool will be
equipped with self - closing, self - latching devices with•release
mechanisms placed no lower than 54" above the floor or deck;
I understand that not having one of the above installed at the time of final inspection, or
when pool is completed for contract purposes, will constitute a violation of Chapter 515,
F.S. and will be considered as committing a misdemeanor of the second degree, punishable
by fines up to $500 and /or up to 60 days in jail as established in Chapter 775, F.S.
CONTRACTOR'S NAME (PLEASE PRE NT) .
CTOR'S SIGNATURE & DATE
OWNER'S SIGNATURE & DATE
M A /Z /_ /I,LA> A., ) /
OWNERS NAME ( PLEASE PRINT)
SWIMMING POOL OWNER'S CERTIFICATION
Date 6 - / o
Miami Shores Village
Building and Zoning Department
Attention: Building Official
I certify that I am the legal owner of the property described as
497 4-X, I9 / 36 .7 M'I4 • Si. / 0 37, located at 8sJ 7 ?7 5r,
kb/1m( F L .
In accordance with Section 33 -12(0, Code of Metropolitan Dade County, I certify that
I understand and agree that the swimming pool to be constructed at the above address cannot
be used or filled with water until a separate permit has been obtained for an approved safety
barrier, and such barrier erected, inspected and approved.
I further understand that this certification, however, does not eliminate the need for
obtaining a permit and erecting an approved barrier prior to final inspection and use of the pool.
Legal Owner
Note: This certification is to be submitted with a swimming pool permit application in duplicate.
CUSTOM POOLS
13250 S.W. 131 STREET, SUITE 100
MIAMI, FLORIDA 33186
PHONE (305) 255 -5315
ACKNOWLEDGEMENT OF POOL OWNER'S RESPONSIBILITY
DATE: - (o _
TO: V/4/(4/
ATTENTION: Building Official
the roe located at: / 7 / l//_ 5 7 S-3-- mi 4 . Bias, Ft_ I am the owner of property rt
I hereby acknowledge that I have received a copy of the portion of the State of Florida Building Code
effective January 1, 2002, describing the requirements for swimming pool barriers and alarms, con-
tained in sections 424.2 through 424.2.23. I understand and agree that is is my responsibility to
comply with these building code requirements.
I further understand and agree that CUSTOM POOLS is not required to complete the pool or make it
operational until an inspection is made to determine compliance with these statutes by the building
inspector of the appropriate municipality having jurisdiction. I understand that the final building
inspection of the swimming pool will not be approved until I have complied with these building
code requirements pertaining to swimming pool barriers and alarms.
(Municipality /County)
A CERTIFIED GUNITE COMPANY
INCORPORATED IN FLORIDA AUGUST, 1964
STATE OF FLORIDA
CONTRACTOR'S CERTIFICATION
No. CPCO56434
G
roperty • ner's sign. - (Date)
(Property owner's signature) (Date)
CUSTOM POOLS
13250 S.W. 131 STREET, SUITE 100
MIAMI, FLORIDA 33186
PHONE (305) 255 -5315
ACKNOWLEDGEMENT OF POOL OWNER'S RESPONSIBILITY
DATE: - /° °,
TO: /A/A A" 1 1
ATTENTION: Building Official
I am the owner of the property located at g `O Pr,
I hereby acknowledge that I have received a copy of the Florida Statues 515.21- 515.37, SWIMMING
POOL SAFETY ACT, effective October 1, 2000. I understand and agree that it is my responsibility to
comply with the requirements of this State of Florida statue.
I further understand and agree that CUSTOM POOLS is not required to complete the pool and make
it operational until an inspection is made to determine compliance with this statute by the building
inspector of the appropriate municipality having jurisdiction. I understand that the final building
inspection of the swimmi pool will not be approved until I have complied with the statute
requirements.
(Municipality /County)
(Property owner's signature) (Date)
(Property owner's signature) (Date)
A CERTIFIED GUNITE COMPANY
INCORPORATED IN FLORIDA AUGUST, 1964
STATE OF FLORIDA
CONTRACTOR'S CERTIFICATION
No. CPCO56434
•
This property described as:
The East 1/2 of Lot 19,
and all of Lot 20, Block 73,
MIAMI SHORES SECTION 3,
according to the Plat
thereof, as recorded in
Plat Book 10, Page 37
of the Public Records'of
Miami -Dade County, Florida.
a•
••
•
Page 1 of 2
1.35
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NOT VALID WITHOUT THE SIGNATURE AND
THE ORIGINAL RAISED SEAL OP FLORIDA
LICENSED SURVEYOR AND MAPPER
S • o,
oo
PROPERTY OF: Or l a n d i,
14.�S
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9.50 /AsPHac;
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A BOUNQARY SURVEY
I hereby certify that the survey represented
hereon meets the minimum technical
standards set forth by the Board of Land
Surveyors In chapter II1O11.0 Florida
AdminlstralWe Code pursuant to Section
472.021 Fla. Statute'. Thor. ere no encroach
mints, overlap., easements appearing on
the Plat. other than as shown hereto
/
FL. PROF. Mayon AND MArrEn No.y,67
4
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Mark, 857 N.E. 97th Street,
FIELD DATE
06.27- -
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007.42,
L °G /D"T"I oN-
Miami Shores, Florida 33138
LANNES AND GARCIA, INC.
L.B. #2098
Surveyors - Mappers -Land Planners
BEALE SMITII, PSM #5238
2c
57.43
Office Address: 359 Alcazar Ave, Coral Gables, FL 33134
(305) 666.7909 (954) 523 -8663
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Permit No.
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT / 0
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 ___._ _ ~ _ t___= .________ d _ : ��; 1 No Street
Registered Architect and /or Engineer ��
d
Employing ' __'
Plumber's Name
b - - -� No y _ _ l C Street
Location and Legal Description Lot y� / , ' _6 Block )
Subdivision
� FA I �f • y
Street and Number where work is to be erformed —No
p I ��_::_ Street
State work to be performed and purpose of building (By Floors)
New Building Remodeling Addition Repairs No. of Stories.___��
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. —a t ' 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 under signed agrees to employ only such sub - contractors, on work to be perfortn0 under this permit, as are
licensed by Miami Shores Village.
4
(Signed)
My Commission Expires
Notary Public, State of Florida
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 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
FOUNT' NS
TOTAL
FIXTURES
C L ST
i
®
C/
U
CHECK
SEPTIC
TANK
SEWER
CONN.
DRAIN
FIELD
SOAKAGE
PIT
GREASE
TRAP
SOLAR
HEATER
DEEP
WELL
SPRKLR.
SYSTEM
SWIM'G
POOL
CONTR.
LIST
/
CHECK
Permit No.
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT / 0
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 ___._ _ ~ _ t___= .________ d _ : ��; 1 No Street
Registered Architect and /or Engineer ��
d
Employing ' __'
Plumber's Name
b - - -� No y _ _ l C Street
Location and Legal Description Lot y� / , ' _6 Block )
Subdivision
� FA I �f • y
Street and Number where work is to be erformed —No
p I ��_::_ Street
State work to be performed and purpose of building (By Floors)
New Building Remodeling Addition Repairs No. of Stories.___��
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. —a t ' 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 under signed agrees to employ only such sub - contractors, on work to be perfortn0 under this permit, as are
licensed by Miami Shores Village.
4
(Signed)
My Commission Expires
Notary Public, State of Florida
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 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.
Permit No.
Owner's Name and Address —
Registered Architect and /or Engineer
Employing Plumber's Name
Location and Legal Description Lot__„ _:t
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
No
._______Block
'
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, . Street__
Street
Subdivision____,[ _
Street
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 Repairs No. of Stories___a/
Amount of Permit $__v
SS.
Type of Tank Capacity Gals._
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
_(Signed)
Plti ntbfig In spector.
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 under signed 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,
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 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
Master Plumber.
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
FOUNT' 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
•
Permit No.
Owner's Name and Address —
Registered Architect and /or Engineer
Employing Plumber's Name
Location and Legal Description Lot__„ _:t
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
No
._______Block
'
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, . Street__
Street
Subdivision____,[ _
Street
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 Repairs No. of Stories___a/
Amount of Permit $__v
SS.
Type of Tank Capacity Gals._
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
_(Signed)
Plti ntbfig In spector.
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 under signed 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,
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 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
Master Plumber.
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.
Permit No 7 / z '(
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 /1 1r.:11
__.t�1t.,Cl
Registered Architect and /or Engin veer______..— .___- ------- ,, - - -- S� � g ? 9 / ,
Employing Plumber's Name__` /941 y 5 � d G!' No._- / — _ _ Street.- " /
Location and Legal Description Lot______ .... .... __ Block--._ Subdivision
Street and Number where work is to be performed— No.__ _ s Street '6
State work to be performed and purpose of building (By Floors) -_.__
New Building _ -_- Remodeling____ -_ ____ Addition
Sire Septic Tank
Feet of Drain Tile__
Nature of Water Supply: City —Well.
Amount of Permit $' / /
STATE OF FLORIDA, }
COUNTY OF DADE.
IAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING C' ;MM1MIT
Type of Tank
No.__.__
Repairs No. of Stories . . ........ ............
Capacity Gals
__Dist. Feet of Tank or Drain Field from Well
_Size of Soakage Pit
Plumbing Inspecto
The undersigned applicant for this building permit does hereby certify that he understands and acce is obligations as an employer of labor
under the Florida Workmen's Compensation Act, being Section 5986, Compiled General Laws of Flo a 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.
a
( Signed) _4
Date
Street_
ti
My Commission Expires 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
SHOWERS
LAVA-
TORIES
INKS
SINKS
SLOP
SINKS
LAUNDRY
Tugs
I AS
URINALS
CATCH
BASIN
FLOOR
DRAIN
DRINKING
FOUNT'N8
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
__ -
_
CHUCK
Permit No 7 / z '(
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 /1 1r.:11
__.t�1t.,Cl
Registered Architect and /or Engin veer______..— .___- ------- ,, - - -- S� � g ? 9 / ,
Employing Plumber's Name__` /941 y 5 � d G!' No._- / — _ _ Street.- " /
Location and Legal Description Lot______ .... .... __ Block--._ Subdivision
Street and Number where work is to be performed— No.__ _ s Street '6
State work to be performed and purpose of building (By Floors) -_.__
New Building _ -_- Remodeling____ -_ ____ Addition
Sire Septic Tank
Feet of Drain Tile__
Nature of Water Supply: City —Well.
Amount of Permit $' / /
STATE OF FLORIDA, }
COUNTY OF DADE.
IAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING C' ;MM1MIT
Type of Tank
No.__.__
Repairs No. of Stories . . ........ ............
Capacity Gals
__Dist. Feet of Tank or Drain Field from Well
_Size of Soakage Pit
Plumbing Inspecto
The undersigned applicant for this building permit does hereby certify that he understands and acce is obligations as an employer of labor
under the Florida Workmen's Compensation Act, being Section 5986, Compiled General Laws of Flo a 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.
a
( Signed) _4
Date
Street_
ti
My Commission Expires 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.
Permit No.___,A
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 wo
Owner's Name and Address No.
Registered Architect and /or En :i' i j
Employing Plumber's Name `' ` PP• .3 �
Location and Legal Description L�=" Block Subdivision s`
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
ss.
Street and Number where work is to be performed —No
G�-
State work to be performed and purpose of building (By Floors)
New Building Remodeling Addition
Size Septic Tank__ ) a
Feet of Drain Tile _ Dist. Feet of Tank or brain Field from Well
My Commission Expires
Type of Tank. f�.� -_ �._'''��� Capacity Gals.
(Signed)
Repairs
Date
s ir
No. of Stories
Nature of Water Supply: City —Well �. - -' r .Size of Soakage Pit
Amount of Permit $__/ K'7 (Signed) ' It
f G:
P-11Unbigg 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 under signed agrees to employ only such sub - contractors, on work to be performed under this permit, as are
licensed by Miami Shores Village.
/r
6, 4 ^ 66
Gl p
4: L� h k 6 I
STATE OF FLORIDA,
COUNTY OF DADE.
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally
appeared 7 l
to me well known, and who being by me first duly sworn, upon oath deposes and says ,thy 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 i, made n es �fy `Sy improper notice for irfspectSba; faulty
materials and /or workmanship. �� �� ef,
CLOSETS
BATH
TUBS
SHOWERS
LAVA -
TORIES
SINKS
SLOP
SINKS
LAUNDRY
TUBS
U RINALS
CATCH
BASIN
FLOOR
DRAIN
DRINKING
FOUNT'NS
TOTAL
FIXTURES
CONTR.
LIST
CHECK
SEPTIC
TANK
SEWER
CONN.
DRAIN
FIELD
SOAKAGE
PIT
GREASE
TRAP
SOLAR
H EATER
DEEP
WELL
SPRKLR.
SYSTEM
SWIM'G
POOL
CONTR.
LIST
/�
p
CHECK
Permit No.___,A
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 wo
Owner's Name and Address No.
Registered Architect and /or En :i' i j
Employing Plumber's Name `' ` PP• .3 �
Location and Legal Description L�=" Block Subdivision s`
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
ss.
Street and Number where work is to be performed —No
G�-
State work to be performed and purpose of building (By Floors)
New Building Remodeling Addition
Size Septic Tank__ ) a
Feet of Drain Tile _ Dist. Feet of Tank or brain Field from Well
My Commission Expires
Type of Tank. f�.� -_ �._'''��� Capacity Gals.
(Signed)
Repairs
Date
s ir
No. of Stories
Nature of Water Supply: City —Well �. - -' r .Size of Soakage Pit
Amount of Permit $__/ K'7 (Signed) ' It
f G:
P-11Unbigg 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 under signed agrees to employ only such sub - contractors, on work to be performed under this permit, as are
licensed by Miami Shores Village.
/r
6, 4 ^ 66
Gl p
4: L� h k 6 I
STATE OF FLORIDA,
COUNTY OF DADE.
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally
appeared 7 l
to me well known, and who being by me first duly sworn, upon oath deposes and says ,thy 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 i, made n es �fy `Sy improper notice for irfspectSba; faulty
materials and /or workmanship. �� �� ef,
PLUMBLjG - IirSPECTION
Permit
Work done
Address of work
- — — — - -
Owner
Sortie Tank
Drainff_eld
!Ialen ready_4,
:eceived by
Date J/4.
Pime ' r
Ga
Roun-h
TOD
AM
PM
4
Permit No
Owner's Name and Address _LA ,� __
Registered Architect and /or Engineer
Street and Number where work is to be performed —No
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.
Employing Plumber's Name ___' S_s "r.` /� � No
Location and Legal Description Lot � n' ,___ ___Block Subdivision
r
5 ,1 _ Street
State work to be performed and purpose of building (By Floors)
New Building Remodeling Addition Repairs No. of Stories..
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. _x__ .Size of Soakage Pit
Amount of Permit $ C ° (Signed)
STATE OF FLORIDA,
COUNTY OF DADE.
ss.
My Commission Expires
No Street
Street ;` ii
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 under signed agrees to employ only such sub - contractors: on work to be performed under this permit, as are
licensed by Miami Shores Village. / r �r�, �x /4. •
(Signed)
MasterPlum}ier.
rt. fr
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
{
NOTE: A re- inspection fee of $1.00 will be made when such re- inspects n is made necessary by improper notice for inspection, or faulty
materials and /or workmanship. /�
a
'1/4 ��� • � 0 ", •
CLOSETS
BATH
TUBS
SHOWERS
LAVA-
TORIES
SINKS
SLOP
SINKS
LAUNDRY
TUBS
URINALS
CATCH
BASIN
FLOOR
DRAIN
DRINKING
FOUNT'NS
TOTAL
FIXTURES
CONTR.
LIST
d '
d $
C
/
`
CHECK
d�
v
�.
I`
SEPTIC
TANK
SEWER
CONN.
DRAIN
FIELD
SOAKAGE
PIT
GREASE
TRAP
SOLAR
HEATER
DEEP
WELL
SPRKLR.
SYSTEM
SWIM'G
POOL
CONTR.
LIST
IST
CHECK
d
Permit No
Owner's Name and Address _LA ,� __
Registered Architect and /or Engineer
Street and Number where work is to be performed —No
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.
Employing Plumber's Name ___' S_s "r.` /� � No
Location and Legal Description Lot � n' ,___ ___Block Subdivision
r
5 ,1 _ Street
State work to be performed and purpose of building (By Floors)
New Building Remodeling Addition Repairs No. of Stories..
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. _x__ .Size of Soakage Pit
Amount of Permit $ C ° (Signed)
STATE OF FLORIDA,
COUNTY OF DADE.
ss.
My Commission Expires
No Street
Street ;` ii
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 under signed agrees to employ only such sub - contractors: on work to be performed under this permit, as are
licensed by Miami Shores Village. / r �r�, �x /4. •
(Signed)
MasterPlum}ier.
rt. fr
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
{
NOTE: A re- inspection fee of $1.00 will be made when such re- inspects n is made necessary by improper notice for inspection, or faulty
materials and /or workmanship. /�
a
'1/4 ��� • � 0 ", •
/J;: // / ;;
MIAMI SHORES VILLAGE
/9//' PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
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 r!
Nature of Water Supply: City —Well.
ss.
My Commission Expires
Registered Architect and /or`'Enginee
o
Employing Plumbes_Name _� �__ � L m �-
Location and Legal Description Lot___g Z " lO d / Block
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 Repairs
Size Septic Tank Type of Tank
Attount of Permit $_� °� (Signed)
Date
9
7___ ,a__ Street
Street
Subdivision ___ ________ __
lam_.
/
No. of Stories 4/
Capacity Gals.. tic
Feet of Drain Tile Dist. Feet of Tank or Drain Field from Well r
Sia.sf Soakage Pit -4t
Plumting nspector.
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 under signed agrees to employ only such sub - contractors, on work to be performed under this permit, as are
licensed by Miami Shores Village.
(Signed)
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 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 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
FOUNT'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
MIAMI SHORES VILLAGE
/9//' PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
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 r!
Nature of Water Supply: City —Well.
ss.
My Commission Expires
Registered Architect and /or`'Enginee
o
Employing Plumbes_Name _� �__ � L m �-
Location and Legal Description Lot___g Z " lO d / Block
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 Repairs
Size Septic Tank Type of Tank
Attount of Permit $_� °� (Signed)
Date
9
7___ ,a__ Street
Street
Subdivision ___ ________ __
lam_.
/
No. of Stories 4/
Capacity Gals.. tic
Feet of Drain Tile Dist. Feet of Tank or Drain Field from Well r
Sia.sf Soakage Pit -4t
Plumting nspector.
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 under signed agrees to employ only such sub - contractors, on work to be performed under this permit, as are
licensed by Miami Shores Village.
(Signed)
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 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 necessary by improper notice for inspection, or faulty
materials and /or workmanship.
Permit
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
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 _.4._ . No
Registered Architect and /or Engineer/ —__.. 1
� ti /
Employing Plumber's Name ��.�:_ _ ,,�._._ =� �� �_F_ -...- __�_:1 -_�No f
Block ,
Street and Number where work is to be performed —No.
Location and Legal Description Lot �_ y
Size Septic
Feet of Drain Tile__
Type of Tank
Date /
Street,—
Subdivision_
Street__
Gals.
Dist. Feet of Tank or Drain Field from Well
Street___..___:
State work to be performed and purpose of building (By Floors)
New Building Remodeling Addition Repairs —___ No. of Stories
Nature of Water Supply: City —Welt Size of Soakage Pit
Amount of Permit $-__
The undersigned applicant for this building permit does hereby ce
under the Florida Workmen's Compensation Act, being Section 5966,
plied with the provisions thereof, and will require similar compliance
performed under this permit: and will post or cause to be posted for
required by the Act. The under signed agrees to employ only such
licensed by Miami Shores Village.
STATE OF FLORIDA,
COUNTY OF DADE.
My Commission Expires
(Signed)
(Signed)
Notary Public, State of Florida
4 Q Inspector
rtify that he understands and accepts his obligations as an employer of labor
Compiled General Laws of Florida Permanent Supplement, and has com-
from all contractors or sub - contractors employed by him in the work to be
inspection on the site of the work such public notice or notices as are
sub - contractors, on work to be performed under this permit, as are
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
FOUNT' 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
Permit
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
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 _.4._ . No
Registered Architect and /or Engineer/ —__.. 1
� ti /
Employing Plumber's Name ��.�:_ _ ,,�._._ =� �� �_F_ -...- __�_:1 -_�No f
Block ,
Street and Number where work is to be performed —No.
Location and Legal Description Lot �_ y
Size Septic
Feet of Drain Tile__
Type of Tank
Date /
Street,—
Subdivision_
Street__
Gals.
Dist. Feet of Tank or Drain Field from Well
Street___..___:
State work to be performed and purpose of building (By Floors)
New Building Remodeling Addition Repairs —___ No. of Stories
Nature of Water Supply: City —Welt Size of Soakage Pit
Amount of Permit $-__
The undersigned applicant for this building permit does hereby ce
under the Florida Workmen's Compensation Act, being Section 5966,
plied with the provisions thereof, and will require similar compliance
performed under this permit: and will post or cause to be posted for
required by the Act. The under signed agrees to employ only such
licensed by Miami Shores Village.
STATE OF FLORIDA,
COUNTY OF DADE.
My Commission Expires
(Signed)
(Signed)
Notary Public, State of Florida
4 Q Inspector
rtify that he understands and accepts his obligations as an employer of labor
Compiled General Laws of Florida Permanent Supplement, and has com-
from all contractors or sub - contractors employed by him in the work to be
inspection on the site of the work such public notice or notices as are
sub - contractors, on work to be performed under this permit, as are
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.
....■-
CLO[[T[
BATH
Tus[
a NOW[Ra
LAVA.
TORIES
$INKS
SLOP
SINK[
LAUNDRY
Tuns
URINALS
CATCH
BASIN
FLOOR
DRAIN
DRINK NO
FOUNT'NO
TOTAL
•I /TUX IS
CONTR.
LIST
CHICK
_
SEPTIC
TANK
$EWER
CONN.
DRAIN
r
SCAKAGI
P1T
GR[ASI
TRAP
SOLAR
HEATS*
MCP
WILL
SPRKLR.
SYSTEM
SWIM'O
POOL
..
CONTR.
LIST
CHICK
Permit No V'
Amount of Permit $
STATE OF FLORIDA, I oh
COUNTY OF DADE.
.o�
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
(signed) ------ - --•-- -_ -_ --
(S1 )
Date....1 4y
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 specificatioru must be kept at
building during progress of work.
Owners Name and Address Xen n e th Mt^ A dam s No 8 5 7 N E 9 7 Street-. 11.4Lr P. S ..._...
Registered Architect and /or Engineer
Employing Plumber': StrwR.dlij .x....33,.6- $...... -- _
Location and Legal ]description Lot.. Block SubdivaIon-_____-
857 RTE 97 Street lei Shores
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
Size Septic Tank__ Type of Taub
Feet of Drain Tile 2 4Q 9.a-- 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 5968, Compiled General Laws of Florida Permanent Supplement, and he I com-
plied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors employed by him in the worir 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 to be performed under this perinit, as are
ltoeased by Miami Shores Village.
Master Plumber.
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acimowledgments, 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 be 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 spade when snob rolaspeorfos Y apede•aeowrary by hapeper notice for ilnpectloa, er faulty
materials and /or workmanship