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PLUMBING
, 2 O � Passed sp • C • ments . Failed Correction Needed Re- Inspection Fee ($75) No Additional Inspections can be scheduled re- inspection fee is paid. until Inspection Number: INSP -17864 wg Ego ci s... Inspection Date: 05/22/2006 Inspector: IMPARIMMINIOND Owner: SODBERG, ANNEMETTE Job Address: 1143 98 Street NE Miami Shores Village, FL 33138- Project: <NONE> Contractor: CHARLES CULPEPPER Building Department Comments Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 RC IZ,os*IML • Permit Number: PL2005 -324 Permit Type: Plumbing - Residential Inspection Type: Final Work Classification: Addition /Alteration Block: Phone Number 305 - 394 -9445 Parcel Number 1132050180270 Lot: Phone: 305 - 759 -8255 Friday, May 19, 2006 Page 1 of 2 SHOWER PAN 04/20/2006 INSP -15326 Rough 0/47.42006 INS7864 Final • APPROVED Pending Inspection James Levrack 4/20/2006 Claudio Grande Not Complete Friday, May 19, 2006 Page 1 of 1 PARTIAL ROUGH 41/1 k Ins If - 2.` r-- o 1 , Passed Failed i L 4 117' Correction Needed Re- Inspection Fee ($75) No Additional Inspections can be scheduled until re- inspection fee is paid. 'Inspection Number: INSP -10669 Inspection Date: 02/28/2006 Inspector: Levrack, James Permit Type: Plumbing - Residential Inspection Type: Rough Owner: SODBERG, ANNEMETTE Work Classification: Addition /Alteration Job Address: 1143 98 Street NE Miami Shores Village, FL 33138- Project: <NONE> Contractor: CHARLES CULPEPPER Building Department Comments Monday, February 27, 2006 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 K Block: V'O5 - I�U Permit Number: PL2005 -324 Phone Number 305 - 394 -9445 Parcel Number 1132050180270 Lot: Phone: 305 - 759 -8255 Page 2 of 2 BUILDING PERMIT APPLICATION FBC 2001 Permit Type (circle): Building Owner's Name (Fee Sim i le Titleholder) Owner's Address City alrn/ f /' State Tenant/Lessee Name Job Address (where the work is being done) ! / L j . City Miami Shores Villa e Is Building Historically Designated YES City //�� Q ualifier O/)a ` /e3 � erg I-- State Certificate or Registration No. i✓f&O 5 $ Value of Work For this Permit Type of Work: 4dditiop ❑Alteration ❑New Describe Work: 5 /� / )/1i') J"! l DiNto Total Fee Now Due $ 163. 35 (Continued on opposite side) e: • Miami Shores Village k-e- 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (3095 2204 Fax: (305) 756.8972 Contractor's Company Name NI /-eJ l l r Phone # Contractor's Address' SJ er/C� // �" eb ) e 7 - /iam m Architect/Engineer's Name (if applicable) Phone # Building Department I t, Electrical County Miami -Dade NO State /'f✓ Permit No. aster Permit No. Zip . Phone # Zip 5.3/ / Certificate of Competency No. Square Footage Of Work: Zip ig/ 3 L Submittal Fee $ Permit Fee $ /if CCF $ CO /CC Notary $ Training/Education Fee $ Technology Fee $ Zoos -�24 Mechanical Roofing Phone # / — - 373 ❑ Repair/Replace ❑ Demolition awd regvaYvt Scanning $ Radon $ Zoning Bond $ Code Enforcement $ Structural Plan Review. $ Bonding Company's Name (if applicable) Bonding Company's Address City State Mortgage Lender's Name (if applicable) Mortgage Lender's Address City Sta0e 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 and a reinspection fee will be charged. Signature Owner or Agent Contractor The foregoing instrument was acknowledged befyre me this f 4— The foregoing instrument was acknowledged before me thisg'/ day of ‘ LLIC=5\/ , 20 0,byA1..1 da who is personally known to me or who has produced As identification and who did take an oath. NOTA Y Sign: Print: My Comm chc 05/13/03 UBLIC: ,1 ITARY PUB IC•S ; OF ORID im) %/L.. it 41 A ll icaugitikAlf ire 27, 411/ ti dingCo.,Inc. * * * * * * * * * * * * * * * * * * * * * * * ** ***** * * * * * * * * * * * * * * * * * * * * * *** * * * * ** APPLICATION APPROVED BY: Signature NOTARY PUBL C: Zip . 111111e,/,./ ." 1 • Si_n: ri ► p '0• D 1 4 . rn' • ' is9oLb x * ,,..44 * * * id U e y tv'a n � 41 lo * 6dc iCA . l who has produced fication and who did take an oath. , , ..,i e • ejO- / / ~ /p. 0 3 - * * # * * * * * * * * ** Plans Examiner Engineer Zoning ,ADDENDUM 'TO BUILDING PERMIT APPLICATION c (AN AZIEfICATION FOR BUILDING PERMIT MUST ACCOF2ANY THIS ADDENDUM. IF A MASTER PERMIT HAS B. OBTAfNED, THE OWNER'S NOTARIZED SIGNATURE NEED NOT BE PRESENT ON SUBSEQUENT APPLICATIONS.) PLUMBING ELECTRICAL MECHANICAL UNIT FEE ITEM SWITCH OUTLETS UNIT FEE ITEM SPACE HEATERS UNIT FEE ITEM BATH TLB BIDET I LIGHT OUTLETS CENTRAL HEATING I RECEPTACLES A/C (WIND) DISHWASHER SERVICE TEMPORARY A/C (CENTRAL) DISPOSAL DRINKING FOUNTAIN SERVICE SIZE IN AMPS DUET WORK FLOOR DRAIN SERVICE REPAIRAETER CHANGE REFRIGERATION GREASE TRAP APPLIANCE OUTLETS PROCESS AND PRESS PIPING RANGE TOP UNDERGROUND TANKS INTERCEPTOR LAVATORY OVEN ABOVE (MOUND TANKS LAUNDRY TRAY WATER HEATER U.F. PRESSURE VESSELS CLOTHES WASHER MOTORS 0- 1 ID STEAM BOILERS S MOTORS OVER 1- 3 FP HOT WATER BOILERS SINK, POT /3 COMP. MOTORS OVER 3- 5 If I MECHANICAL VENTILATION SINK, RESIDENCE MOTORS OVER 5- 8 HP TRANSPORTING ASSEMBLIES SINK, SLOP MOTORS OVER 8- 10 If ELEVATORS/ESCALATORS TEMPORARY WATER CLOSET MOTORS OVER 1C- 25 If FIRE SPRINKLER SYSTEMS URINAL MOTORS OVER 25-100 If COOLING TOWERS WATER CLOSET MOTORS OVER 100 HP VIOLATION INDIRECT WASTES ( A/C WINDOW RE1NSP.ECTJON WATER SUPPLY TO: 1 AIR CONDITIONERS A/C UNIT I ( STRIP HEATER l FIRE SPRINKLER I I GENERATORS TRANSFORMERS f i HEATER -NEW INST. I GENERATORS'TRANSFORhERS HEATER - REPLACE 1 I GENERATORS TRANSFORMERS LAWN SPRINKLER -WELL SPECIAL PURPOSE l I SWIMAING POOL OUTLETS COMMERCIAL WATER SERVICE SIGN TUBES SEWER CONNECTIONS 1 SIGN TRANSFORMERS UTILITY -SEWER [ SIGN TIME CLOCK _ UTILITY -WATER FIXTURES SEPTIC TANK ANTENNA RELAY I TELEVISION OUTLETS GRAINFIELD, 5' TILE/RES. VIOLATION PUMP I. ABANDON SEPTIC TANK RE I NSPECT ION SOAKAGE PIT CU. FT. CATCH BASIN DISCHARGE WELL DOMESTIC WELL AREA DRAIN ROOF INLET SOLAR WATER HEATER FIRE STANDPIPE POOL PIPING LAWN SPRINKLER SYSTEW GAS RANGE I AFTER SET (GAS) I GAS PIPIN 7 I ,ADDENDUM 'TO BUILDING PERMIT APPLICATION c (AN AZIEfICATION FOR BUILDING PERMIT MUST ACCOF2ANY THIS ADDENDUM. IF A MASTER PERMIT HAS B. OBTAfNED, THE OWNER'S NOTARIZED SIGNATURE NEED NOT BE PRESENT ON SUBSEQUENT APPLICATIONS.) PLUMBING ELECTRICAL MECHANICAL Issue Date: 12/9/2005 Owner's Name: ANNEMETTE SODBERG Permit Type: Plumbing - Residential Work Classification: Addition /Alteration Job Address: 1143 98 Street NE Contractor(s) CHARLES CULPEPPER Phone 305 - 759 -8255 Primary Contractor Yes Additional Information Miami Shores Village, FL 33138- Expires: 11107/2006 Type of Work: INTERIOR RENOVATION Additional Info: Type of Piping: In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are required for ELECTRICAL, PLUMBING, MECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work. OWNERS 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. Futhermore, I authorize the above -named contractor to do the work stated. Fees Due CCF Education Surcharge Notary Fee Permit Fee - Additions /Alterations Plan Review Fee (Engineer) Scanning Fee Technology Surcharge Total: Amount $1.20 $0.40 $5.00 $100.00 $50.00 $3.00 $3.75 $163.35 Building Department File Copy Applicant SigryAture Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL 33138 -0000 Phone: (305)795 -2204 Fax: (305)756 -8972 Permit Parcel #: Block: Section: Permit Status: APPROVED Permit Number: PL2005 -324 Phone: 305- 394 -9445 1132050180270 Lot: PB: Total Square Feet: Total Valuation: Required Inspections 0 $ 1,500.00 Underground Rough Water Main Top Out Main Drain Lavatory Water Service Re Pipe Heater Final Invoice Number PL - 12 - 05 - 22971 Total: ,DEC 0 9 PAID Amt Due $163.35 c2 ) eT C—�L. Amt Paid (03. NOTICE: In addition to the requirements of this permit, there may be additional restrictions applicable to this property that may be found in the public records of this county. AND THERE MAY BE ADDITIONAL PERMITS REQUIRED FROM OTHER GOVERNMENTAL ENTITIES SUCH AS WATER MANAGEMENT DISTRICTS, STATE AGENCIES, OR FEDERAL AGENCIES. �" dam PERMIT APPLICATION FOR MIAMI SHORES VILLAGE Date W ` Oa m Job Address ' `�v `5 Ave, J�- Tax Folio Legal Description r Historically Designated: Yes No Owner/Lessee essee /Tenant 9 P� o �eW�/1( f ,4 Master P t # 0026 Owner's Address //K3 / Y • G • g0 i �'F/ A414:(4 ✓ 7J7 /Od46 Contractin Co. MINI 1 ViaMbIn 3 Address Q( kW /iJJ --/ stree Qualifier d� , j S MC LI.[ ugt'1((r) SS# (_ - - ` 9alPhone 3o5/7 ale? (Q c;�C o tgaos State # Architect/Engineer Bonding Company Mortgagor PLUMB Permit Type (circle one): BUILD G ELECTRICA WORK DESCRIPTION- Si _,:,ilT* rsi - � ►7� , 0 Notary as to t ' Vi i'. �" &MD P tsl '@ Date My Commiss No. CC 923399 ( 1 Poisoniy Known Other ID. FEES: PERMIT S 4 RADON APPROVED: Zoning Building Mechanical Plumbing Municipal # Competency # Ins. Co. Zeil 1 Address Address Address G MECH AN AL ROOFING PAVING FENCE SIGN I P A2ce n vlu,r ��ci Square Ft. Estimated Cost (value) 1 ' 13'4 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 perfonned 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 zo s ' g. Furthermore, I authorize the above -named contractor to d the. work stated. ` ?O'tO Date Signs of ntractor or Owner- Builder LA VEDA_ X 923599 II Otto, ID. .a- ! C I v.• �` irr�i� My co, ',-A ' C.C.F. ° p '0 NOTARY —0 BOND Electrical TOTAL DUE ' O Date Date Structural Engineer Permit No / 7 I c Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the building or other structure herein described. This application is made in compliance and conformity with the Building Ordinance of Miami Shores Village, Florida, and all provisions of the Laws of the State of Florida, all ordinances of Miami Shores Village and all rules and regulations of the Building Division of Miami Shores Village shall be complied with, whether herein specified or not. A copy of approved plans and specifications must be kept at building during progress of work. Owner's Name and Address Registered Architect and/or Engineer Employing Pltunbees Name ../Ve.. zfesz.e .72 .6_ Location and Legal Description Lot_ Street and Number where work is to be performed—No State work to be performed and purpose of building (By Floors) Size Septic Tank___________________Type of Tank_ Amount of Permit $ MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT 69 No.iNt3 9rg-7‘ New Building Remodeling Addition. e-/7 Date Subdivision__________ //iz 3 /V e" st f Block (Signed)_ ( Si Repairs No. of Stories Capacity Gals. Feet of Drain __Dist. Feet of Tank or Drain Field from Well Nature of Water Supply: City—Well.— —_—___Size of Soakage Pit Plumbing Inspector. The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations as an employer of labor under the Florida Workmen's Compensation Act, being Section 5988, 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 not; as are required by the Act. The undersigned agrees to employ only such sub-contractors, on work to be perfo under this per it, as are licensed by Miami Shores Village. ../:.4( Master Plumber. STATE OF FLORIDA, ss. 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 be did sign the same, and that all facts therein by him stated are true. My COMMiS5i011 Expires Notary Public, State of Florida NOTE: A re-inspection fee of $1.00 will be made wheel ouch re-Inspection is mede by hnproper notice for inspection, or faulty materials and/or workmanship. CLOSETS BATH TUBS SHOWER• LAVA. TORIES S SLOP SINKS LAUNDRY TUBS URINALS CATCH BASIN FLOOR DRAIN DRINKING FOUNT' NS TOTAL FIXTURES Coara. LIST - ...■...■ CHECK SEPTIC TANK SEWER CONN. DRAIN F IELD SOAKAGE PIT GREASE TRAP SOLAR H EATER DEEP WELL SPRKLR. SYSTEM SW IWO POOL. C OPCYR . LIST -/---- CHICK Permit No / 7 I c Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the building or other structure herein described. This application is made in compliance and conformity with the Building Ordinance of Miami Shores Village, Florida, and all provisions of the Laws of the State of Florida, all ordinances of Miami Shores Village and all rules and regulations of the Building Division of Miami Shores Village shall be complied with, whether herein specified or not. A copy of approved plans and specifications must be kept at building during progress of work. Owner's Name and Address Registered Architect and/or Engineer Employing Pltunbees Name ../Ve.. zfesz.e .72 .6_ Location and Legal Description Lot_ Street and Number where work is to be performed—No State work to be performed and purpose of building (By Floors) Size Septic Tank___________________Type of Tank_ Amount of Permit $ MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT 69 No.iNt3 9rg-7‘ New Building Remodeling Addition. e-/7 Date Subdivision__________ //iz 3 /V e" st f Block (Signed)_ ( Si Repairs No. of Stories Capacity Gals. Feet of Drain __Dist. Feet of Tank or Drain Field from Well Nature of Water Supply: City—Well.— —_—___Size of Soakage Pit Plumbing Inspector. The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations as an employer of labor under the Florida Workmen's Compensation Act, being Section 5988, 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 not; as are required by the Act. The undersigned agrees to employ only such sub-contractors, on work to be perfo under this per it, as are licensed by Miami Shores Village. ../:.4( Master Plumber. STATE OF FLORIDA, ss. 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 be did sign the same, and that all facts therein by him stated are true. My COMMiS5i011 Expires Notary Public, State of Florida NOTE: A re-inspection fee of $1.00 will be made wheel ouch re-Inspection is mede by hnproper notice for inspection, or faulty materials and/or workmanship. CLOSETS BATH TUBS SHOWERS LAVA- TORIES L+ SINKS / S p ' - . Y'w�ft� - 7 LAUNDRY TUBS /FJ «! ['f URINALS 'R J '�.et/ e FLOOR DRAIN `] DRINKING FOUNT'NS 5/ / /(e'1'e „ ^. - JJ ( _ � � TOTAL FIXTURES C LIST I 2 CHECK Z CD t vo 1 50 E ASE SEPTIC TANK SEWER CONN. DRAIN FIELD SOAKAGE PIT GREASE TRAP Strrert HEATER „ DEEP WELL SPRKLR. SYSTEM SWIM'G POOL 2, CONTR. LIST I 1 CHECK 1 et ! /� ©�/ A � Application is hereb structure herein desc and all provisions of t' L of Miami Shores Village sha building during progress New Building___ Remodeling MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT AP : CATION FOR PLUMBING PERMIT elailed statement of the plans and specifications herewith submitted for the building or other ade in compliance and conformity with the Building Ordinance of Miami Shores Village, Florida, of Florida, all ordinances of Miami Shores Village and all rules and regulations of the Building Division mplied with, whether herein specified or not. A copy of approved plans and specifications must be kept at Owner's Name an. d - -// - Employing lumber' e__ L ' . ' ! f _Z__ Nl C_ Si_._ X r_' is No.__ j_4 Street J_ :,?__....1' . __ r <r x Location and Legal 1 escription Lot � Block / /9 Subdivision_ `. l LV / 4.1 .�' Street and Numb- wh,tre work is to be performed —No Street/ / d i 4 Ar ,�» State work to be per ormed and purpose of building (By Floors) Addition Repairs No. of Stories Size Septic Tank Type of Tank___�F ` a .: Capacity Gals._ t Feet of Drain Tile Ze ` �_ Dist. Feet of Tank or Drain Field from Well Nature of Water Supply: City —Well Size of Soakage Pit Amount of Permit $___l_ -__ STATE OF FLORIDA, COUNTY OF DADE. ss. (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) Date Y l.n/' !_ ik/ e. Street 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. ., a • {/61/- '• . .��' • - - / e ;,..y / • ; e / / - - SrnK'• s `i v: r •; p, O ,tc G., SING =MAL ThG ^o , • ctor 'piton Address of Bui g , 1 { .� er of r Air 'r'tett e , der r Legal Lot II Bl. T 7 _Y.. r': CONTRACTOR OR BUILDER MIAMI SHORES VILLAGE, FLORIDA DATE-195_LI. Contractors Litense No PERMIT Ta 9744 Work to be performed under this Permit Subdi- vision 4 Value of Project $ B u Amt. 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 here or 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 • if the *ork is not done in compliance with such ordinances or if the plans are changed without authorization. A further condition upon which this permit is is the understanding that the contractor or builder named above assumes the responsibility for a thorough knowledge of the ordinances and regulations ing to the work covered hereby whether shown on the plans or drawings or in the statements or specifications and that he assumes responsibility for work do . by his agents, advents or employees. ti f Signed INSPECTOR .1( BY , ! ' In consideration of the issuance to me of this permit I agree to perform the work covered hereunder in compliance with all irdinances and regulations pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. l ea 4ccepting this permit I assume responsibility for all work done by either, myself, my agent,-servant or employee. AUTHORITY ■' 1( I P : : k 9 ji6 C9 c qo G?" Registered Architect and /or En Employing Plumber's Name ... atita Owner's Name and Address...° ' _ aTP b MIAMI SHORES VILLAGE 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. Street.fe sr Location and Legal Description Lot Block Street and Number where work is to be performed —No a13 £' State work to be performed and purpose of building (By Floors) _ New Building ........ _____ ........ ........ Remodeling____ —..___ Addition..- __ - -__ Repairs No. of Stories Street. I Si) ad au __.. of Tank— Size Septic Teak_ - _ - - - - -- • -- Feet of Drain Tile. ` 00 _Dist. Feet of Tank or Drain Field from Well Nature of Water Supply: City—Well. M -- - - - --- -Size of Soakage Pit etr Amount of Permit $ �F STATE OF FLORIDA, ss. COUNTY OF DADE. (Signed) -115! ` (Signed Capacity Gab oi �-- - ...... -- - - aster Plumber. P1 •"ring Inspector. The undersigned applicant for this building permit does hereby certify that he understands and accepts hi bligattons as an employer of labor un der the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida P: nanent Supplement, and Ilan com- plied with the provisions thereof, and will require similar compliance from all contractors or sub - contractor / 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, work to be performed under this permit, as are licensed by Miami Shores Village. _52(,,4( K,aK61., 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 be 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 0.00 will be made when such re- inspection is made by improper notice for inspection, or faulty materials and /cr workmanship. CATCH eA.IN FLOOR DRAIN DRINKING FOUNT'N• TOTAL FIXTURES CLOSETS BATH TUee SHOWERS LAVA- TORIES S SLOP SINKS LAUNDRY Twos URINALS CONTst. LIST CHECK SEPTIC TANK SEWER CONN. DRAIN FIELD SOAKAGE PIT GREASE TRAP SOLAR H MCP WELL SPRKLR. 6 SWIM'O POOL COHTR. VS �® r -- LIST CHECK Registered Architect and /or En Employing Plumber's Name ... atita Owner's Name and Address...° ' _ aTP b MIAMI SHORES VILLAGE 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. Street.fe sr Location and Legal Description Lot Block Street and Number where work is to be performed —No a13 £' State work to be performed and purpose of building (By Floors) _ New Building ........ _____ ........ ........ Remodeling____ —..___ Addition..- __ - -__ Repairs No. of Stories Street. I Si) ad au __.. of Tank— Size Septic Teak_ - _ - - - - -- • -- Feet of Drain Tile. ` 00 _Dist. Feet of Tank or Drain Field from Well Nature of Water Supply: City—Well. M -- - - - --- -Size of Soakage Pit etr Amount of Permit $ �F STATE OF FLORIDA, ss. COUNTY OF DADE. (Signed) -115! ` (Signed Capacity Gab oi �-- - ...... -- - - aster Plumber. P1 •"ring Inspector. The undersigned applicant for this building permit does hereby certify that he understands and accepts hi bligattons as an employer of labor un der the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida P: nanent Supplement, and Ilan com- plied with the provisions thereof, and will require similar compliance from all contractors or sub - contractor / 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, work to be performed under this permit, as are licensed by Miami Shores Village. _52(,,4( K,aK61., 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 be 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 0.00 will be made when such re- inspection is made by improper notice for inspection, or faulty materials and /cr workmanship. 0 t L o ,/Q--? ID ✓L-