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PLUMBING3 MIAMI SNORES VILLAGE BUILDING DEPARTMENT 305- 795 -2204 Building Inspection Request Date q �o� Time Type Insp'n P tU f►roI Permit No. CI aoO3_ I50 Name I-I r iS Address Company Phone # For Inspector: Approved Correction Re- Insp'n Fee Ilbv c1gsA- 50Ferror ?Iui 1 :2 - 355 - 1(033 State# GFC 05,J927 PERMIT APPLICATION FOR MIAMI SHORES VILLAGE 10050 N.E. 2nd Avenue • Miami Shores, Florida 33138 • Phone: 305 - 795 -2204 • Fax: 305- 756 -8972 Date CG - "7 ` 0 l Job Address //6 V PE [ v Tax Folio Z 0 ' D _ 0 0 Legal Description Historically Designated: Yes Owner /Lessee/Tenet Fie f l/U Az. [ 6 6/e ei Master Permit # Owner's Address 1 i /o 0 / (J E ( A' -,0,7`. Phone /2C-1) Z y Contracting Co. S ,Z 0 0 6fic b /tic Address Qualifier � 8 EI / J 2 6 ti Abe,/ S gn ure of owner and/or Condo President Notary as to Owner and/or Condo President My Commission Expires Municipal # IF THERE IS NO PERMIT PACKAGE ACCESSIBLE ON THE JOB SITE FOR INSPECTORS TO VERIFY, THERE WILL BE NO INSPECTION. RE- INSPECTION FEE IS 850.00 AND MUST BE PAID IN ADVANCE BEFORE CALLING FOR ANOTHER INSPECTION. Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING WORK DESCRIPTION: `O : if -C '� it.) C A.) /le 7e#6-Ad Sm.> /‘ &WA/4S/f/4 ') /c�797,92-c Square Ft. Estimated Cost (value) 5 00 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 ANY ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT.) Application is hereby made to obtain a permit to do work and installation as indicated above, and on the attached addendum (if applicable). I certify that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that separate permits are required for all disciplines. 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. Furthermore, I authorize the above named contractor to do the work stated. FEES: PERMIT 7 RADON APPROVED: Zoning Building Mechanical Plumbing Date C SS# Phone 2.Cf -.5.• 6325 Competency # Ins. Co. /d-4.1 2e� -- (0-5= 03 Signature of Contractor or Owner Builder • Date p 1:162 X 7-7 Sg o2_A_ -° RY p O , 1CIALNOTARY SEAL GLADYS J v :LLAR Date Notary a o Contractor o My Commission Expires gyo S.W. 90 / NOTARY COMMISSION NUMBER DDuai uy4 O7Y COMMISSION EXPIRES OFF MAR. 1 7006 Date BOND TOTAL DUE Electrical Structural Engineer EM TH 1.8 UNIT FEE ITEM SWITC4 OUTLETS UNIT FEE ITEM SPACE WATERS - UNIT FEE OET LIGHT OUTLETS CENTRAL HEATING WASHER 1 RECEPTACLES A/C (WIN) SAL / SERVICE *IMAM — ' A/C (CENTRAL) INKING FOUNTAIN SERVICE SIZE INNS GMT WORK OCR DRAIN SERVICE REPAIR/VETER OVINCE REFRIGERATION EASE TRAP APPLIANCE CURETS PROCESS AND PRESS PIPING �iERCEPTOR RANGE TOP UNDERGROUND TANKS VATCRY OVEN ABOVE MOM TANKS UNDRY TRAY WATER HEATER U.F. PRESSURE VESSELS OTHES WASHER MOTORS 0- 1 FP STEAM BOILERS OWER MOTCRS OVER 1- 3 FP HOT WATER BOILERS W. POT/3 COMA. MOTORS OVER 3- 5 FP MECHANICAL VENTILATION tOt RESIDENCE MOTORS OVER 5- 8 FP TRANSPORTING ASSEMBLIES NX. SLOP MOTCRS OVER 8- 10 HP ELEVATORS/ESCALATORS WORAAY WATER CLOSET MOTORS OVER 10- 25 H' � FIRE SPRINKLER SYSTEMS `— INAL ^� MOTORS OVER 25-100 HP COOLING TOWERS ,TER CLOSET MOTORS OVER 100 FP VIOLATION ~— DIRECT WASTES A/C WINDOW RE INSPECTION ,TER SUPPLY T0: AIR CONDITIONERS - A/C UNIT STRIP HEATER FIRE SPRINKLER GENERATORS MUMMERS EATER -NEW INST. GENERATORS TWSFCRIERS HEATER- REPLACE GENERATORS TRARSPOWERS LAWN SPRINKLER -WELL SPECIAL PURPOSE —' SWIMMING POOL • CUTLETS 0144ACIAL WATER SERVICE SIGN TUBES ZR CONNECTIONS SIGN TRAJiSF:MRS ILITY -SEWER SIGN TIME C.00X I l ITY -WATER F IXTIRES ANTENNA — 'TIC TANK .AY TELEVISION WTLETS U NFIELO. 4' TILE/RES. VIOLATION *P & ABANDON SEPTIC TANK REINSPECTION :'(AGE PIT CU. FT. iCH BASIN URGE WELL «ESTIC WELL :A GRAIN :F DEFT -AR WATER HEATER tE STANDPIPE :L PIPING . Of SPRINKLER SYSTEM PAIGE I.R SET (GAS) PIPING is n r a� L \ ccsuzii n. D3TAINED, THE OWNER'S NOTARIZED SIGNATURE NEED NOT BE PRESENT ON SUBSEQUENT APPLICATIONS., PLUMBING ELECTRICAL MECHANICAL 0 A Miami Shores Village 10050 NE 2nd Avenue Phone: 305-795-2204 Printed: 6/6/2003 Applicant: GAIL Owner: ALLEGRA JOB ADDRESS: 1160 Contractor SUPERIOR PLUMBING INC Local Phone: Parcel # 1132050180390 Work: coo Permit Status: APPROVED Permit Expiration. INSTALL NEW iel -....e.u., ii . 5 '; it46; 1 49 ,. .,.., , v-- ---"e-c ' '-' ,.- N otAt, FL NE 98 m „ 1. Plumbing Permit Permit Number: PL2003-150 RICE FRAN ST Legal Description: 5 53 42 Contractor's Address: 7840 SW 90 AVE (Contractor or Builder) 63-1 8 BY: PB 43-69 REV PL MIAMI SHORES SEC 8 LOT 22 Page 1 of 1 Total Fees: tal Receipts: go cQc $0.00 and regulations pertaining thereto and in strict ....ge. In accepting this permit I assume responisibility for all work BLK 180 pen. No STATE OF FLORIDA, ss. COUNTY OF DADE. My Commission Expires 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 Miti.:711 Shores Village, Florida, and all provisions of the Laws of the State of Florida, all ordinances of Miami Shores Village and all rules and regulatica; of the Building Division of Miami Shores Village shall be complied with, whether herein specified or not. A copy of approved plans and specilications must be kcpt at building during progress of work. Owner's Name and Address. IsAgx 4._" 3 1 (3 No. ci Aegistered Architect and/or Engineer 11. ....5.11-075,0.A 4 ik 5 S Employing Plumber's Name lit LL SUR 9 Tusz q. NI No,L , . Bullet/1W a_17.1 """ Location and Legal Description Lot. Block Street and Number where work is to be performed—Noll (.4) N , , `e) 4 Street State work to be performed and purpose of building (By Floors) A t "* 5mA-a v- s E. 1siscW_41. New Building Remodeling Addition Repairs No. of Stories . Size Septic Tank__ of Tank_____ Feet of Drain Tile ___Dist. Feet of Tank or Drain Field from Well Nature of Water Supply: City—Well.__________. _______Size of Soakage Pit Amount of Permit $ 42 f Q (Signed)_ Capacity Gals Date Plumbing Inspector — The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations as an enployer of labor under the Florida Workmen's Compensation Act, being Section 5968, Compiled General Laws of Florida Permanent rum lement, and has com- plied with the provisions thereof, and will require similar compliance from all contractors or sub-contractors employed I y him in t' e wcrk o 1).> performed under this permit; and will post or cause to be posted for inspection on the site of the work such publi notice 1! no.icer ,ts required by the Act. The undersigned agrees to employ only such sub-oontractors, on work to be performed cs this is malt, ar , licensed by Miami Shores Village. (Signed) ‘ 7 _______ ............... Masts Plumber. Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personarr ppearec; 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 :acts therein by him stated are true. Notary Public, State of Florida NOTE: A re-inspection fee of $1.00 will be made when such minspection 1. mads•neoessary by improper notice for inspection, or fruity materials and/or worlananship. CLOSETS BATH T SHOWERS LAVA. TORIES SINK• SLOP SINKS LAUNDRY Tuna URINALS CATCH BASIN FLOOR 1 DRAIN DRINKING{ FOUNT'Ne TOTAL FIXTL RES CONTR. LICT -.. .-....- CHECK --.. SEPTIC TANK SEWER CONN. DRAIN FIELD SOAKAGE PIT GREASE TRAP SOLAR 11 DEW WELL 13Pot Km SYSTEM Sw im' 0 POOL Cowrie . LIST ON e- _ CHECK pen. No STATE OF FLORIDA, ss. COUNTY OF DADE. My Commission Expires 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 Miti.:711 Shores Village, Florida, and all provisions of the Laws of the State of Florida, all ordinances of Miami Shores Village and all rules and regulatica; of the Building Division of Miami Shores Village shall be complied with, whether herein specified or not. A copy of approved plans and specilications must be kcpt at building during progress of work. Owner's Name and Address. IsAgx 4._" 3 1 (3 No. ci Aegistered Architect and/or Engineer 11. ....5.11-075,0.A 4 ik 5 S Employing Plumber's Name lit LL SUR 9 Tusz q. NI No,L , . Bullet/1W a_17.1 """ Location and Legal Description Lot. Block Street and Number where work is to be performed—Noll (.4) N , , `e) 4 Street State work to be performed and purpose of building (By Floors) A t "* 5mA-a v- s E. 1siscW_41. New Building Remodeling Addition Repairs No. of Stories . Size Septic Tank__ of Tank_____ Feet of Drain Tile ___Dist. Feet of Tank or Drain Field from Well Nature of Water Supply: City—Well.__________. _______Size of Soakage Pit Amount of Permit $ 42 f Q (Signed)_ Capacity Gals Date Plumbing Inspector — The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations as an enployer of labor under the Florida Workmen's Compensation Act, being Section 5968, Compiled General Laws of Florida Permanent rum lement, and has com- plied with the provisions thereof, and will require similar compliance from all contractors or sub-contractors employed I y him in t' e wcrk o 1).> performed under this permit; and will post or cause to be posted for inspection on the site of the work such publi notice 1! no.icer ,ts required by the Act. The undersigned agrees to employ only such sub-oontractors, on work to be performed cs this is malt, ar , licensed by Miami Shores Village. (Signed) ‘ 7 _______ ............... Masts Plumber. Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personarr ppearec; 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 :acts therein by him stated are true. Notary Public, State of Florida NOTE: A re-inspection fee of $1.00 will be made when such minspection 1. mads•neoessary by improper notice for inspection, or fruity materials and/or worlananship. NOTE : FOR SECTION E -E SEE SHEET No. a SOLAR rot LFCTOR TYPICAL PIPING DIAGRAMS IM 3 PANELS PARALLEL 1 PANELS PARALLEL_ PRESSURE RELIEF SET 15 PSI (WATTS 8P 30) ALUM. FXPANSION TANK 3 GAL. CAPACITY- ALLOY 3003 COLLECTOR SENSOR OUT CIRCULATING PUMP J MARCH 00G - 115 V. GO C YC. 30 WATT our SERVICE VALVE 1 TYPE L COPPER,SILVER GRAZED .045 MIN. WALL TH ICKNESS DRAIN GATE VALVE PUMP CONTROL ALL SUNPOWER, INC. ,.....Nor to soli .."""► ...2-2.1-% 1 NOT SUPPLY PERIN COLD SUPPLY SYSTEM DRAWING 145•F �RMIT I 3 1♦ 14 8' � -Jr U U• U U U U SEE DETAIL A, S. C. D, FRONT VIEW TAIL 'K DETAIL 'B DETAIL'C' TE OR TRu0D TO VARIABLE • 5 , 1 ' . SIDE 'VIEW DETAIL 'D' 3o 40mP ROOF o/ I t x BRACKET (TYP) OPEN BEAM CEILING I/t r BOLT (TYP. ) FLAT ROOF MOUNT .r 2.- 2.4 -7 NOTES: I. ALL BRACKET AND . COLLECTOR MATERIAL GOBI -TL ALUMINUM 2. ALL COLLECTOR BOLTS fie DIA. 3. ALL BRACKET BOLTS YL DIA. ALL SUNPOWER, INC. tz- INSTALLATION DIAGRAM • • is ; } :7 Iillij cc, rw_r I„ )Ai. �1ii�,ti��'; �� a � �t>: °;n ".1 rN �..�.,�� BUILDING ELECTRICAL PLUMBING" Owner of Building /` Architect tf. Contractor or Builder r r Lot a MIAMI SHORES VILLAGE, FLORIDA DATE � ./ - 3 194 PERMIT N? 6609 'trac to r 's License No Work to be performed under this Permit Legal' Description Address of Building This permit is grant :. to th contrac or or build "r named above 'to construct the building or to install the equipment or device described in the appli- cation herefor in strict co •liance with all ordinances pertaining thereto and w th the understanding that the work will be performed in compliance with any plans, drawings, statements or specifications that may have been submitted to and approved by the proper municipal authorities. This Permit may be revoked at any time if the work is not done in compliance with such ordinances or if the plans are changed without authorization. A further condition upon which this permit is granted is the understanding that the contractor or builder named above assumes the responsibility for a thorough knowledge of the ordinances and regulations pertaining to the work covered hereby whether shown on the plans or drawings or in the,staternents or specifications and that he assumes respon- sibility for work done by his agents, servants or employees. f ' t ' I Signed. i t By B e _ ' INSPE TOR In consideration of the issuance to me of this permit I agree to perform the work covered hereunder in compliance with4l. ordinances And4eggliiionV pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami h' es NVrfllllaage. In ac opting this ermit I as 'responsibility for A work done by either myself, my agent, servant or employee. . CONTRACTOR OR BUILDER Subdi- vision Value of Project BY Amt. of Permit AUTHORITY 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 "eh ~, L- No Street Amount of Permit $_ a Registered Architect and /or En 'neer Employing Plumber's Name ! ,.c ___- _ No. J ;:^ Street Location and Legal Description Lot Block ss. My Commission Expires MIAMI SHORES VILLAGE • PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT 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 Size Septic Tank Type of Tank Feet of Drain Tile l Dist. Feet of Tank or Drain Field from Well Nature of Water Supply: City —Well Size of Soakage Pit (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 by performed der tlyis per it, as are licensed by Miami Shores Village. a �^ (Signed) Date - Subdivision Street A. 14 Capacity Gals. _____ 1 %,::__,� STATE OF FLORIDA, 1 COUNTY OF DADE. J Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeared to me well known, and who, being by me first duly sworn, upon oath deposes and says that he is the of the above described construction, that he has carefully read the foregoing application, and that he did sign the same, and that all facts therein by him stated are true. Notary Public, State of Florida '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 FIIELLO SOAKAGE PIT GREASE TRAP SOLAR HEATER DEEP WELL SPRKLR. SYSTEM SWIM'G POOL CONTR. LIST / �,y /// J/ ^ - CHECK Permit No. Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the building or other structure herein described. This application is made in compliance and conformity with the Building Ordinance of Miami Shores Village, Florida, and all provisions of the Laws of the State of Florida, all ordinances of Miami Shores Village and all rules and regulations of the Building Division of Miami Shores Village shall be complied with, whether herein specified or not. A copy of approved plans and specifications must be kept at building during progress of work. Owner's Name and Address "eh ~, L- No Street Amount of Permit $_ a Registered Architect and /or En 'neer Employing Plumber's Name ! ,.c ___- _ No. J ;:^ Street Location and Legal Description Lot Block ss. My Commission Expires MIAMI SHORES VILLAGE • PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT 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 Size Septic Tank Type of Tank Feet of Drain Tile l Dist. Feet of Tank or Drain Field from Well Nature of Water Supply: City —Well Size of Soakage Pit (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 by performed der tlyis per it, as are licensed by Miami Shores Village. a �^ (Signed) Date - Subdivision Street A. 14 Capacity Gals. _____ 1 %,::__,� STATE OF FLORIDA, 1 COUNTY OF DADE. J Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeared to me well known, and who, being by me first duly sworn, upon oath deposes and says that he is the of the above described construction, that he has carefully read the foregoing application, and that he did sign the same, and that all facts therein by him stated are true. Notary Public, State of Florida '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. Application is hereby ma a for the approval of the detailed statement of the plans and specifications herewith submitted for the building or other structure herein describe . 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 pla as and specifications must be kept at building during progress of work. Owner's Name and Address I • / Registered Architect and /or Engi r Employing Plumber's Name New Building Amount of Permit $___ ss. MIAMI SHORES VILLAGE . PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT �JC v Location and Legal Description Lot z y Block / 7 ° / ,,. , __ Subdiv' on Street and Number where work is to be performed —No 0 i 0 t___—:‘,.,-7-44"......- State State work to be performed and purpose of building (By Floors (Signed) ( Signed) Date No Street No Street 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 —W911. Size of Soakage Pit ir My Commission Expires Notary Public, State of Florida 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. Master Plumber. STATE OF FLORIDA, 1 COUNTY OF DADE. 1 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 1 .7 / 3 / / CHECK SEPTIC TANK SEWER CONN. DRAIN FIELD SOAKAGE PIT GREASE TRAP SOLAR HEATER DEEP WELL SPRKLR. SYSTEM SWIM'G POOL , r‘ �" ' 7 / G ti� CONTR. LIST CHECK • Permit No. Application is hereby ma a for the approval of the detailed statement of the plans and specifications herewith submitted for the building or other structure herein describe . 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 pla as and specifications must be kept at building during progress of work. Owner's Name and Address I • / Registered Architect and /or Engi r Employing Plumber's Name New Building Amount of Permit $___ ss. MIAMI SHORES VILLAGE . PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT �JC v Location and Legal Description Lot z y Block / 7 ° / ,,. , __ Subdiv' on Street and Number where work is to be performed —No 0 i 0 t___—:‘,.,-7-44"......- State State work to be performed and purpose of building (By Floors (Signed) ( Signed) Date No Street No Street 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 —W911. Size of Soakage Pit ir My Commission Expires Notary Public, State of Florida 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. Master Plumber. STATE OF FLORIDA, 1 COUNTY OF DADE. 1 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. ‘g3SL LOaL 1)641 '-' ()t CCU._ Cir.a M.710% Soliti `gtozsz... ws 3 5, -J C'zy€6 1u G/ rit"' • • ••■••••■ •••••••• • ••••••••••-•,•-•-•,•-•-•-•••••-• • iir•••••■••11,11711/71/•••••• • 16, 1,5* Z S 2_4 g 3 S 3 1 M43 G.33 ? •PT•1 v-w■lor 2-19 3.S 61 "‘ 0