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PLUMBINGMiami Shores Valage 10050 NE 2nd Avenue Plumbing Permit Phone: 305 - 795 -2204 Permit Number: PL2003 -158 Printed: 6/13/2003 Page 1 of 1 Applicant: ANN MARIE INDORF Owner: INDORF ANN MARIE I JOB ADDRESS: 1269 NE 99 ST O Contractor A ARON SUPER ROOTER Contractor's Address: 6022 SW 35 CT O IN) Local Phone: 305 - 944 - 8886 Parcel # 1132050090110 Legal Description: EARLETON SHORES PB 43 - 80 E1/2 LOT 14 & LOT 15 LESS E25FT Fees: Description Amount FEE2003 -3584 Building Fee $80.00 FEE2003 -3585 Builders Bond $300.00 Total Fees: $381.80 FEE2003 -3586 CCF $1.80 Total Receipts: $0.00 Total Fees: $381.80 P elo M Permit Status: APPROVED Permit Expiration: 12/10/2003 Construction Value: $2,400.00 Work: REPLACE DRAINFIELD AND DOSING TANK A AARON SUPER ROOTER, INC. 6022 SW 35TH CT. `MIRAMAR, FL 33023 • r PAY TO THE ORDER OF FIRST UNION NATIONAL BANK n OF FLORIDA �/ FOR 1 9 ct.- r QG 000967clo 1:06 70064 3 21: 209000 2004 7 79II' 9679 63- 643/670 DATE DOLLARS PIP ices and regulations pertaining thereto and in strict cepting this permit I assume responisibility for all work CONSTRUCTION PERMIT FOR: [p] New System [i Existing System Abandonment Vi Repair [ J] APPLICANT: J ( P ROP R1TY ADDRESS: 1 2 6,9 LOT: .1 ` �- 1 v BLOCK: SUBDIVISION: PROPERTY ID #: 1 (- 3 2 v - 0o .- 6 t 1 J R A I N F I E L D 0 T H E R APPROVED BY: DATE ISSUED: LOCATION OF BENCHMARK: 1 v ELEVATION OF PROPOSED SYSTEM SITE BOTTOM OF DRAINFIELD TO BE FILL REQUIRED: [ J ] INCHES SPECIFICATIONS BY: STATE OF_FLORIDA DEPARTMENT .OF HEALTH ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM 'CONSTRUCTION PEMIT DH 4016, 12/99 (Page 1) (Previous (-1 c 1 ci r Editions PERMIT NO. 030,. 17 DATE PAID: (n '4-03 FEE PAID: 77 ti, VA) RECEIPT #: 5)S . 3 1 /3 -5 - (ta ci!°i (dL Holding Tank (1J] Innovative [P] Temporary ( ] 0y ! O it clk't [SECTION, TOWNSHIP, RANGE, PARCEL NUMBER] [OR TAX ID 1WMBER4 SYSTEM MUST BE CONSTRUCTED IN ACCORDANCE WITH SPECIFICATIONS AND STANDARDS OF SECTION 381.0065, F.S., AND CHAPTER 64E -6, F.A.C. DEPARTMENT. APPROVAL OF SYSTEM DOES NOT GUARANTEE SAFTISFACTORS PERFORMANCE FOR ANY SPECIFIC PERIOD OF TIME. ANY CHANGE IN MATERIAL FACTS, WHICH SERVED AS 1 BASIS FOR ISSUANCE OF THIS PERMIT, REQUIRE THE APPLICANT TO MODIFY THE PERMIT APPLICATION. SUCH MODIFICATIONS MAY RESULT IN THIS PERMIT BEING MADE NULL AND VOID. ISSUANCE OF THIS PERMIT DOES NOT EXEMPT THE APPLICANT FROM COMPLIANCE WITH OTHER FEDERAL, STATE, OR LOCAL PERMITTING REQUIRED FOR DEVELOPMENT OF THIS PROPERTY. SYSTEM DESIGN AND SPECI FICATIONS ('Lr T [ ] GALLONS / GPD SEPTIC TANK /AEROBIC UNIT CAPACITY MULTI- CHAMBERED /IN- SERIES [ ] A [ -" ] GALLONS / GPD CAPACITY MULTI- CHAMBERED /IN- SERIES [ ] N [ ] GALLONS GREASE' INTERCEPTOR CAPACITY [MAXIMUM CAPACITY SINGLE TANK: 1250 GALLONS] K [ ] GALLONS DOSING TANK' CAPACITY [ ]GALLONS @ [ ] DOSES PER 24 HRS # PUMPS [ ] [ -ZO V ] SQUARE FEET PRIMARY DRAINFIELD SYSTEM [ ] SQUARE FEET SYSTEM TYPE SYSTEM: [ ] STANARD [ ].'FILLED [ ] MOUND CONFIGURATION: [ ] TRENCH [ .' BED [ ] [27 6,0] [INCHES /FT] [ABOVE /BELOW] BENCHMARK /REFERENCE POINT 6 , 0 ] [INCHES /FT] (ABOVE /BE O ] BENCHMARK /REFERENCE POINT EXCAVATION REQUIRED: [ 7') ] INCHES �p�l� ry� � y y ( gyp^ r yr gy+y'�vy �r q � [�� '§� ]NSi K�,�. � VII' 1�ICIT EL a.: RJi7TtD SO3L ES PEt IS NOT FC_'C :� l~E �� INVERT hTioN xvs 9 � (I I a 1/ti v , GN 1 �} s j phi z- piwyosta It TITLE: . r - L`-p� G / ��a,.i 1 4 d P CHI May Be Used) EXPIRATION DATE: / /‚' v j Part 1 - Health Department Part 2 - Applicant Part 3 - Installer /Contractor Part 4 - Building Department Page 1 of 3 By Notes: T t "I . • T , f-i > f t Scale: Each block represents 5 feet and 1 inch = 50 feet. T r -4- 4 ... -t- 4- : • 1 t • I . r 1 -; - - — , i-•-1 t .,, -t•- -i 4-t -r-- ±. t----f- •1--{ . -!- - Jr L -- 1. t ...t+.{._,_ r 4 _ .t, .1._;,_.. - j - t -- - -- - - .----t ---, i--1 ' 1 Site Plan submitted by: Plan Approved / I 0H4015, 1W96 (Replaces HRS.H Form 4015 which may be used) APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRIJOYION:7 Permit Application Number , ..— 1----1 A , ------- r pl--- _.-1-1-;- MT - r rt 1 " — Trt . ... ,...,..— , 1 .....,. 1 ' _.....L. . i i -- I i ..--1-4--i-:-- - --4. 1. :-..1-- -- ,--, , ,- 4- 1 I 11 ..- - - I - 11 ;- 1 -+ - I - 1 - 1 1 - 1.--t-- 1_, i t !_ 1 . : -. 1 ' r I -I- L '[ I .....,.., . - , -...,..., ..1.....:„.. \tr) dor - (2601 NE goi msh.ort- 3 01 d. (XM ( Z-11 -f t \ Ce, d v ■4\--eld my( i\ew Niy‘p_ Ii STATE OF FLORIDA - :DEPARTMENT OF HEALTH PART II - SITE PLAN- t Signature ._ k 0, Vot Ikr!pgved Date ikk j Fi , . ALL CHANGES; MUST BE APPROVED BY THE COUNTY HEALTH DEPARTMENT • - T - - • +-+ -; • - • , t 11 • 1— ti ! ' - - ('41 4 --t t- t ' -r t tt -`• - I - 't . +V •-••••-- t - ' 4..• -1-------.-r-,--,- -4.------- i -.4-4 -- ,. i 4,- 4 -I- t- ! - - 1 1 !.■ ',! ,-- ' - - 'I ; ...1 A t - t . : . 1 1 6.1,„,,HT.V..,....1..... ....If:4 .: • : ......o "Tio7.-; , . • .. 'cke;‘._ . .1 t ear - li. !.„1- . ."- - • 10 i . , ! : 7 t , r-- •••+-' •i - -' - ---,- ,-4--- -:- .--:-.-- , i ,.. ' , 4 - 1 t 1- , -''' - ' ■ • ' - r -, • t ),!. - • --r t- t - j 6,4 4 . r L i - f rt 4 _ -1 . ; 1 ' 11 tl+L.4 - - f t t tt- 1 - 1- t t- 4 - ; - • 1- • - 'r t f -• I t rr County Health Departmen Page 2 of CONTRACTOR Name A. C (� o- I T i " Uorl License No. 0 641_9 Address Gcs.zz. as G.' ..z .M \ .re, yr Ot. , ri- 330 le Telephone ('� �`/ Qualifier Name b To ■ i PROPERTY OWNER New Construction Name 5co j TT ` 1 off p 7 Address s 2v3B Home Telephone Alteration Interior Business Telephone Relocation of Structure Fax Shell Only TYPE OF MANAGEMENT (✓ ) New Construction Enclosure Alteration Exterior Repair ✓ Alteration Interior Demolish Relocation of Structure Shell Only Foundation Only Add'I Attachment Other Add'I Detachment Other \ EE NTEB IN B, �ORID% PERMIT APPLICATION INSTRUCTIONS - The following steps must be taken to obtain a permit from the Miami Shores Viibige: PUN 2 2003 Job Address: 1269 Iv E 9°1 kree Address Apt. Proposed Use of Property Tenant Information PERMIT TYPE (✓ ) Building Electrical Mechanical Plumbing LPGX Roofing Fence Other 5 SLotl- �.d.o�� PERMIT CHANGE (✓ ) Chg. Contractor Renewal Revision Extension Supplement Reinspection ARCHITECT Name License No. Address k Telephone Fax Master Permit No. Subsidiary Permit N Step 1. Complete the attached permit application which must be signed by the property owner and qualifier. Both signatures must be notarized. Please print or type to allow for a more accurate processing of your application. If roofing work will be done, a roofing application must be submit- ted along with this permit application. Step 2. Submit the completed application with all necessary documents to the Building, Planning and Zoning Department for processing. During the processing of your application, you may be asked to submit additional information. APPLICATION )ut Oves City State '3 39 Zip Folio Number It 10 S— 00C1 — 0 I I O Description of Work D(Q 11 -i11-e ( It *. (2 OS\ TA )--0.c Lot 1 . t $ Block > 1 1 - • 4 ? i M10-- Subdivision '- LV.0.-N SV PG Zoning Linear Feet Current Use of Property 3 ea Square Feet 2.00 Units Floors Value of Work 4.2400 Bldg Value Tax Assessed /Appraised Value Flood Zone Base Floor Elev. ENGINEER Name License No. Address Telephone Fax Page 2 IMPORTANT NOTICES DO NOT BEGIN ANY WORK WITHOUT HAVING RECEIVED YOUR VALIDATED PERMIT AND PERMIT CARD. Applying for a permit does not grant the right to begin construction. HOURS OF CONSTRUCTION are limited to: Monday through Friday from 7:30 a.m. to 6:00 p.m., and Saturday from 8:00 a.m. to 5:00 p.m. No inspections will be conducted on weekends or holidays. 2. All construction of demolition areas MUST BE MAINTAINED IN A CLEAN, NEAT AND SANITARY CONDITION free from construction debris. 3. STREETS AND NEIGHBORING PROPERTIES SHALL BE KEPT FREE FROM DIRT AND DEBRIS. 4. SWALES MUST BE PROTECTED FROM BEING DAMAGED BY EQUIPMENT OR VEHICLES, AND MAY NOT BE USED FOR STORAGE. A bond is required for work in or near the street/sidewalk. 5. CONSTRUCTION TRAILERS ARE PROHIBITED ON SINGLE FAMILY RESIDENTIAL CONSTRUCTION SITES. Other construction may have a trailer which requires a separate permit. 6. PORTABLE TOILETS for a construction site require a separate permit. 7. DO NOT DISCHARGE WATER INTO THE RIGHT OF WAY OR STORM DRAINS without approval from the Building, Planning and Zoning Department. 8. EQUIPMENT AND MATERIALS SHALL BE STORED at least 10 feet from the edge of pavement. 9. Department of Health and Rehabilitative Services (HRS) approval is required for applications involving septic tanks. Department of Environmental Resources Management (DERM) and/or Miami -Dade Water and Sewer Department (MDWASD) approval is required for applications involving sewers. AFFIDAVIT - Please read carefully. Application is hereby made to obtain a permit to do work and installation as indicated. I, the OWNER of the property, certify that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that separate permits are required for ELECTRICAL, PLUMBING, POOL, EXTERIOR DOOR, MECHANICAL, WINDOW, FENCE, DRIVEWAY, ROOFING and SIGNS and there may be additional permits required from other governmental agencies. I, the OWNER of the property, have disclosed all information related to any work at the property performed in the prior twelve months to the Building Official. Further, I am fully aware that if the cumulative cost of work to my home or business under this and any other permit equals or exceeds fifty percent (50 %) of the fair market value of the structure, the entire structure must meet the present federal flood criteria for finished floor elevation. I am also fully aware that if the total cost of work to my home or business under this and any other permit exceeds fifty percent (50 %) of the replacement cost of the structure, then the entire structure must conform to the current code requirements of the Building Code. WARNING TO OWNER: Your failure to record a NOTICE OF COMMENCEMENT may result in you paying twice for improvements to your property. If you are spending more than $2,500 or intend to obtain financing, you may wish to consult with your attorney or lender before recording your Notice of Commencement. The Notice of Commencement must be recorded at: 22 N.W. 1st Street, 1" Floor, (305) 679 -1078. Once recorded, the Notice of Commence vz. t must be POSTED AT THE JOB SITE in accordance with Section 713 -35 of Florida Statutes. Review the brochure at V; l.e Hall on Construction Lien Law and Choosing a Contractor. OF FL • ' IDA, CO NTY OF M MI -DADE Signature of Own AA, / M 414c.1d /0.• A:1612c Print Name Sworn to to and subscribed before me this 1 day of J V d•Q, Ai — i. i ehnda • TERE J. SOLOMON 4 1 9, MY COMMtDOIO1 # CC 854608 !�t (=XPIHt C: Jul 10, 8003 1- 6003■0TARY Fta Ratan Service & BervIng Co. Signa SEAL: Personally known Q � PERMIT APPLICATION 1.1 OR, Produced Identificatio Type of Identification Produced: D' i_t Ca^ U `'- STATE OF Sign SEAL: ,f te : • • ctor / Qualifier A, COUNTY OF MIAMI -DADE Signature of Co Print Name S om to and s •scribed before me this day of vse � -1 - d MY ty ®MM1S= ®f9 ®w3 zM r totftw, Jul Jo, g : , :® i Nf A�V RI: IOW daoies 8 Bat lre Co Personally known OR, Produced Identificatwn I Cep-Se Type of Identification Produced: d' ELECTRICAL Tt'PI: Minimum Fee QTY. 'TYPE Dryer QTY. TYPP. Outlet, Appliance QTY. 1'1'1'1•: Service Repair QTY. A/C Central 1 -3 Ton _ Fan Outlet, Wall Service, Temporary A/C Central 4 -7 Ton Fire Pump Outlet, Switch Signs A/C Central 8 -15 Ton Fixture - Fluorescent Oven Space Heater (kw) A/C Central 16 -20 Ton Fixture Light Parking Lot Lights Spas/Hot Tubs A/C Central 20+ Ton Flood Lights Plugmold/Strip Subfeeds, No. of Amps A/C Window FPL - Load Central Posts Swim Pool, Commercial Air Conditioners Garbage Disposal Range/Range Top Swim Pool, Residential Chiller Generators, etc. Receptacles Switchboards Clear Violations Heat Recovery Refrigerator, Comm. (p/PH) Temp Serv., Construction Compactor Low -volt, Burglar Refrigerator, Domestic Temp for Test - 30 days Deep Freezer Low -volt, Fire Renew - Temp Service Water Closet Demolition Low -volt, Intercom/Teleph. Repair Circuits Water Heater Dishwasher 1 Low -volt, Television Service, Number of Amps Water Heater New MECHANICAL TYPE Minimum Fee QTY TYPE Condensate Drain QTY. , T1'I'E Generator QTY. TYPE Refrigeration, Tons QTY A/C Central, Tons _ Cooling Tower Heating Strips, each Vent Hood, Cost A/C Wall/Win. Tons Dryer Vents, Number of Paint Booth Ventilation, Cost Air Handler, Tons Ductwork, Cost of Piping, Flammable Liquid Periodic Inspections Barbecue Fire Sprinkler System Process/Pressure Piping Supply, AC Well Bath Fan - Vented, # Fireplaces, Number of Pressure Vessel Temporary Toilet PLUMBING TYPE A/C Condensate QTY. TYPE Drains, Roof QTY. TYPE Miscellaneous Fixture QTY. TYPE Soakage Pit QTY. Bath Tub Drinking Fountain Miscellaneous Repairs Solar Water Heater Bidet Filter Replace Pool Piping Sprinkler Repair Cap - Fixture Fountain Pump and Abandon Sprinkler System Cap - Water Gas - Appliance Pump, Domestic Supply, AC Well Cap - Sewer Gas - Natural Pump, Fire Stand Temporary Toilet Catch Basin Gas - Propane Pump, Re- circulate Temporary Water Closet Clothes Washer Gas Piping Pump, Replace - Pool Urinal Dental Chair Grease Trap Pump, Sprinkler Utility - Sewer Discharge Well Ice Maker Pump, Sump Utility - Water Dishwasher Indirect Wastes Relay Repair Vacuum Pump Disposal Interceptor Roof Inlet Water Closet Domestic Well Laundry Tray Septic Connection Water Heater Drainfield, 4" Tile/Res. 1 Lavatory Septic Tank Water Heater New Drains, Area Meter Set (Gas) Sewer Connection Water Re -pipe Drains, Floor Minimum Fee Shower Water Service Drains, French Miscellaneous Equipment Sink Well, Supply Page 3 PERMIT APPLICATION INSTRUCTIONS: Please indicate the type of work being performed and quantity(ies) in the space provided below. RECEIVED AND REVIEWED BY: DATE: Page 4 OFFICE USE ONLY CHECKLIST EI OWNER - BUILDER FORM (Attach) ® FIRE DEPARTMENT APPROVAL (Commercial / multi - family) • CONCURRENCY (New Construction) El OTHER (Specify & Attach) $3.00 per page (Scanning Fee) Miami Shores Village Bond Metropolitan Dade County (C.C.F.) Inspector State Educational Fund State DCA (Radon) Code Enforcement Fine Zoning Review Notary LI PROOF OF OWNERSHIP (Attach) ® HRS / DERM APPROVAL (Septic / Sewer) ® IMPACT FEE (New Construction) LI OTHER (Specify & Attach) $ 8 0 $ 3 0 � -k8 $ 0 (sq.ft. = x/1000 x0.60) $ (¢.005 /sq.ft.) $ (¢.01 /sq.ft.) SECTION Zoning Electrical Mechanical Plumbing Fire Public Works Structural Building Official BY DATE PERMIT APPLICATION ® CONDO ASSOCIATION APPROVAL (Attach) LI BPR APPROVAL (Restaurants) LI CONTRACTOR REGISTRATION (On File) PERMIT FEES TOTAL $ 32 I . ? O ISSUING OFFICIAL REVIEWED AND PREPARED BY: DATE: CONDITION OF A PPROVAL Revised July 2001 10050 N.E. 2ND AVE., MIAMI SHORES, FL m (305) 795 -2207 ® FAX (305) 756 -8972 o http : / /www.miamishoresvillage.com BUILDING ELECTRICAL PLUMBING ROOFING Owner of Building Architect Contractor or Builder Legal Lot Description II Bl CONTRACTOR OR BUILDER MIAMI SHORE "1/ILL FLORIDA PERMIT N° 5068 DATE Contractors License No. Work to be performed under this Permit _I.. • 19 Subdi- vision Address of $ �- v Value of Amount of t Building ,, ' . . � ; I- �° . . r ' ''e r Project $ I Permit $ This permit is granted to the contractor or biker named y above to construct the building or to install the equipment or device described in the applica- tion herefor in strict compliance with all ordinances pertaining thereto and with the understanding that the work will be performed in compliance with any plans, drawings, statements or specifications that may have been submitted to and approved by the proper municipal authorities. This Permit may be revoked at any time if the work is not done in compliance with such ordinances or if the plans are changed without authorization. A further condition upon which this permit is granted is the understanding that the contractor or builder named above assumes the responsibility for a thorough knowledge of the ordinances and regulations pertaining to the work covered hereby whether shown on the plans or drawings or in the statements or specifications and that he assumes respon- sibility for work done by his agents, servants or employees. Signed. INSPECTOR In consideration of the issuance to me of this permit I agree to perform the work covered hereunder in compliance with all ordinances•• regulations pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In ao cepting this permit I assume responsibility for all work done by either, myself, -my agent, servant or employee. BY AUTHORITY ABBOT 4 MIAMI CHORES VILLAGE, FLA. No 5789 JOB ADDRESS /c71 4? :Lea_ ••■■■■1 INSPECTION TIME READY REMARKS : 3' INSPECTOR_ DATE r New . Building Amount of Permit $ STATE OF FLORIDA, COUNTY OF DADE. j MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT Permit Ne., 5 i�l Date_ / 1M C // / /_ 9 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. Owners Name and Address LO /4/ No. __— _ _2 6.9 • -_ - - -- Street ^ v _. My Commission Expires Registered Architect and /or Engineer____ Employing Plumber's Name___M _ :M! _ t1BUL_ 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) __ _._ Remodeling_ _________ ______ Addition-_ Block Street! S'6 Subdi vision___ -.__ -- _ -_ -- 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.___ _ _ __ __ _ ___ _ _ ._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 5988, Compiled General Laws of Florida Pe -. - • t Supplement, and has com- plied with the provisions thereof, and will require similar compliance from all contractors or sub - contrac : s employ d 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 irk such pu is notice or notices as are required by the Act. The undersigned agrees to employ only such sub -contr n work be perfo d under this permit, as are licensed by Miami Shores Village. Before me, the undersigned authority, a notary public, duly authorized to a• • ster 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 TUBE SHOWERS LAVA- TORIES SINKS SLOP SINKS LAUNDRY TUBE U URINALS CATCH BABIN 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 CHECK r New . Building Amount of Permit $ STATE OF FLORIDA, COUNTY OF DADE. j MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT Permit Ne., 5 i�l Date_ / 1M C // / /_ 9 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. Owners Name and Address LO /4/ No. __— _ _2 6.9 • -_ - - -- Street ^ v _. My Commission Expires Registered Architect and /or Engineer____ Employing Plumber's Name___M _ :M! _ t1BUL_ 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) __ _._ Remodeling_ _________ ______ Addition-_ Block Street! S'6 Subdi vision___ -.__ -- _ -_ -- 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.___ _ _ __ __ _ ___ _ _ ._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 5988, Compiled General Laws of Florida Pe -. - • t Supplement, and has com- plied with the provisions thereof, and will require similar compliance from all contractors or sub - contrac : s employ d 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 irk such pu is notice or notices as are required by the Act. The undersigned agrees to employ only such sub -contr n work be perfo d under this permit, as are licensed by Miami Shores Village. Before me, the undersigned authority, a notary public, duly authorized to a• • ster 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. BUILDING ❑ ELECTRICAL ❑ DATE PLUMBING ;c] PERMIT N? 9393 ROOFING ❑ 0 Owner of Building ✓.. F , . .4 Architect Contractor or Builder Legal Lot Description. Address of Building !, CONTRACTOR /OR BUILDER MIAMI SHORES VILLAGE. FLORIDA Bl. Work to be performed under this Permit ` z ' ' 4 Alt Subdi- vision Sq. Ft Value of Project $ 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 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 statements or pQcifir ions and that he assumes responsibility for work done by his agents, servants or employees. Signed • J x 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 accepting this permit I assume responsibility for all work done by either, myself, my agent, servant or employee. BY 195 Contractor's '7 License No > Amt. of Permit AUTHORITY 7 Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the build- ing 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 the work. Owner's Name and Address Registered Architect and /or Engineer..._._ :1 __... Name and address of licensed contractor /._l.� _/7�'_ -9 �- Z J' � /i`1 G ! �1 d O ' E T Location and legal description of lot to be built on: Lot Block Subdivision Street and Number where work is to be done /24 9 7' • STATE OF FLORIDA, COUNTY OF DADE. f ss APPLICATION FOR BUILDING PERMIT Date /d / / /s/ , 19 e- AA .11�l,J 4o/vo No.. /. -(�--- Street.. 1;7 5 7 MIAMI SHORES VILLAGE BUILDING INSPECTION DEPARTMENT State work to be done and purpose of building (by floors) and for no other purpose. New Building Remodeling Addition ice' Repairs No. of Stories To be constructed of Kind of foundation Roof Covering Estimated Total cost of improvements $ Amount of Permit $ V Zone cubage required Plan Cubage Distance to next nearest building___________________ Size of Building Lot Maximum live load to be borne by each floor I hereby submit all the plans and specifications for said building. All notices with reference to the building and its construction may be sent to 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 complied 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 o the work such ublic notice or notices as are required by the Act. The undersigned agrees to employ only such contractors, .n wor . o nder tl permit, as are licensed by Miami Shores Village. - � — K .� Remarks (Signe Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally ap- peared 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. Permit No 1_- Date 0 —/ Y - Read, Sworn to and Subscribed before me. Disapproved D (Signed) - ----- uilding Inspector My Commission Expires Notary Public, State of Florida PLANNING BOARD DATE Chairman Member Member Member Member .......... Member Council Approved Date Disapproved Date 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 charged when such re- inspection is made necessary by improper notice for inspection or faulty materials and /or workmanship.