PLUMBINGPERMIT APPLICATION FOR MIAMI SHORES VILLAGE
�7
Date I . 11 -00 Job Address /oZS Al E C ? 9 5k e+ Tax Folio
Legal Description Historically Designated: Yes No ` '
Owner/Lessee / Tenant M C �fG40�c7 Master Permit # 7 0 1 s `''l 7 t
Owner's Address o E Ala m Fe,-( M i Gm i S 11o(tS Phone
Contracting Co. MOM,/ rn j ‘ a t/ / Address gs50 k.03.3.1 (;1,-,-,Q,4 ( M / G r)1 t 1L
I SS# Phone 30$^J9) - 0427
State # f FC 0 3 a 5/ a Municipal # Competency # Ins. Co. G h' . C'o.
Architect/Engineer Address
Qualifier 'RQ4 d O i G 2
Bonding Company Address
Mortgagor Address
Permit Type (circle one): BUILDING ELECTRICAL C LUMBING MECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIPTION ( 1 (4 N\V. 1S cC f 1-k ?. &Yl J f Q• pt c Q- -Y, V41,1.. ,c • f h a 5 rYi i
Square Ft. Estimated Cost (value) OpNn - O Z�
WARNING TO OWNER: YOU MUST RECORD A NOTICE OF COMMENCEMENT AND YOUR FAILURE TO DO SO MAY RESULT IN YOUR
PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY (IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER
OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT.)
Application is hereby made to obtain a permit to do work and installation as indicated above, and on the attached addendum (if applicable). I certify that all work
will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that separate permits are required for ELECTRICAL
PLUMBING, SIGNS, POOLS, ROOFING and MECHANICAL WORK.
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.
Signature of owner and/or Condo Presid ' Date
Notary as to Owne d/or Condo President Date
My Commiss
APPROVED:
Zoning
Mechanical
xpires:
FEES: PERMIT . D
RADON
C.C.F.
Signature of Co actor or Owne,
Notary o Contractor or Owner- Builder Date
My Commission es:
AP Marlene Perdomo
*,� J * My Commission CC592133
Expires Oct. 09, 2000
r F OF Ft.
NOTARY ---19 " BOND
Building Electrical
/ TOTAL DUE J kf
7
Date
Plumbing Structural Engineer
ITEM
BATH TLB
UNIT
•1
FEE
ITEM
SWITCH OUTLETS
UNIT
FEE
ITEM
SPACE'HEATERS
UNIT
FEE
BIDET
LIGHT OUTLETS
CENTRAL HEATING
DISHWASHER
RECEPTACLES
A/C (WINO)
DIS?OSAI
SERVICE TEMPORARY
A/C (CENTRAL)
DRINKING FOUNTAIN
SERVICE SIZE IN AMPS
DUCT WORK
FLOOR DRAIN
SERVICE REPAIR/MIETER CHANGE
REFRIGERATION
GREASE TRAP
APPLIANCE OUTLETS
PROCESS AND PRESS PIPING
INTERCEPTOR
RANGE TOP
UNDERGROUND TANKS
LAVATORY
1
OVEN
ABOVE GROUND TANKS
LAUNDRY TRAY
WATER HEATER
U.F. PRESSURE VESSELS
CLOTHES WASHER
MOTORS 0— 1 HP
STEAM BOILERS
SHOWER •
1
KITORS OVER 1— 3 If
HOT WATER BOILERS
SINK, POT /3 COMP.
MOTCRS OVER 3— 5 FP
MECHANICAL VENTILATION
SINK, RESIDENCE
MOTCRS OVER 5- 8 HP
TRANSPORTING ASSEMBLIES
SINK, SLOP
MOTCRS OVER 8— 10 HP
ELEVATORS/ESCALATORS
TEMPORARY WATER CLOSET
MJTCRS OVER 10— 25 HP
FIRE SPRINKLER SYSTEMS
URIN
MOTORS OVER 25.100 HP
COOLING TOWERS
MATER CLOSET
I
MOTORS OVER 100 If
VIOLATION
INDIRECT WASTES
A/C WINDOW
REINSPECTION
• TER 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
CUTLETS COM€RCIAL
WATER SERVICE
SIGN TUBES
EWER CONNECTIONS
SIGN TRANSFORMERS
TILITY — SEWER
SIGN TIME CLOCK
TILITY —WATER
FIXTURES
EPTIC TANK
ANTENNA
:LAY
TELEVISION OUTLETS
AAINFIELO, 4' TILE/RES... .
VIOLATION
'IMP & ABANDON SEPTIC TANK
REINSPECTION
JAKAGE PIT CU. FT.
ATCH BASIN
ISCHARGE WELL
;MESTIC WELL
a EA GRAIN
:OF INLET
3LAR WATER HEATER
!RE STANDPIPE
AL PIPING
.
;WN SPRINKLER SYSTEM
,S RANGE
:TER SET (GAS)
S PIPING
ADDENDUM TO BUILDING PERMIT APPLICATION
(AN APPLICATION FOR BUILDING PERMIT MUST ACCOMPANY THIS ADDENDUM. IF A RASTER PERMIT HAS B.
OBTAINED, THE OWNER'S NOTARIZED SIGNATURE NEED NOT BE PRESENT ON SUBSEQUENT APPLICATIONS.)
(as iL) . pia . -
PLUMBING ELECTRICAL
MECHANICAL
BUILDING
ELECTRICAL
PLUMBING
ROOFING ❑
Owner of
Building
❑ PERMIT N° 15722
Architect
Contractor
or Builder
Legal Lot II Bl.
Description
Address of
Building
CONTRACTOR OR BUILDER
MIAMI SHORES VILLAGE, FLORIDA
Work to be performed under this Permit
Subdi-
vision
Value of
Project $
DATE 195
Contractor's
License No
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
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 responsibility for work
done by his agents, servants or employees.
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
,ertafning thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village.
n accepting this permit I assume responsibility for all work done by either, myself, my agent, servant or employee.
BY 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 Divisior
of Miami Shores Village shall be complied with, whether herein specified or not. A copy of approved plans and specifications must be kept al
building during progress of work.
Owned s Name and Address..
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
Registered Architect and /or Engine er.._ -. -- -_ -• -- — ._��.._. __ _ —___. - - -- _ --
Employing Plumber's Name. a 4 V5 ° mo d .___. No. _1 street__ - .Ji. •
State work to be performed and purpose of building (By Floors)__ -_.
New Building. -_. Remodeling _..- Addition.
Size Septic Tank... Type of Tank_
No. E _ Street '
(Signed)
Feet of Drain Tile Dist. Feet of Tank or Drain Field from WeIL
Nature of Water Supply: City—Well ......... -__- .---- ...... __:._..__..... .___._ _ -.Size of Soakage Pit
Date
Block- -_____.. t Subdivision
Location and Legal Description Lot..
Street and Number where work is to be performed —No tY
Repairs. - .. ✓..._- No. of Stories
Capacity Cals
Amount of Permit K -------- - - - --- ----- - - - - -- -- (Signed)-_-- _._. -.._ 1 .- - - --
Plumbing Inspector.
The undersigned applicant for this building permit does hereby cerify that he understands and accepts his obligations as nn employer of labor
under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Pennanent Supplement, and h..s 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 sib - contractors, on work to be performed under this p €_rmit, as an
licensed by Miami Shores Village.
My Commission Expires Notary Public, State of Florida
sylt-
Master Plumber.
STATE OF FLORIDA, as.
COUNTY OF DADE.
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally .ippeare
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 tat.
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 f,nul
materials and /or workmanship.
CLOSETS
BATH
TUBS
SHOWER,
LAVA.
TORIES
SINKS
SLOP
SINKS
LAUNDRY
TUBE
URLS
INA
CATCH
BABIN
FLOOR
DRAIN
DRINKING
FOUNT'NS
TOTAL
FIXTURtI
CONTR.
LIST
CHECK
�_ -_
SEPTIC
TANK
SEWER
CONN.
DRAIN
FIELD
SOAKAGE
PIT
GREASE
TRAP
OWNS
HEATER
DEEP
WELL
SPRKLR.
SYSTEM
SWIM 0
POOL
-_-
CONTR.
LIST
CHECK
7
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 Divisior
of Miami Shores Village shall be complied with, whether herein specified or not. A copy of approved plans and specifications must be kept al
building during progress of work.
Owned s Name and Address..
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
Registered Architect and /or Engine er.._ -. -- -_ -• -- — ._��.._. __ _ —___. - - -- _ --
Employing Plumber's Name. a 4 V5 ° mo d .___. No. _1 street__ - .Ji. •
State work to be performed and purpose of building (By Floors)__ -_.
New Building. -_. Remodeling _..- Addition.
Size Septic Tank... Type of Tank_
No. E _ Street '
(Signed)
Feet of Drain Tile Dist. Feet of Tank or Drain Field from WeIL
Nature of Water Supply: City—Well ......... -__- .---- ...... __:._..__..... .___._ _ -.Size of Soakage Pit
Date
Block- -_____.. t Subdivision
Location and Legal Description Lot..
Street and Number where work is to be performed —No tY
Repairs. - .. ✓..._- No. of Stories
Capacity Cals
Amount of Permit K -------- - - - --- ----- - - - - -- -- (Signed)-_-- _._. -.._ 1 .- - - --
Plumbing Inspector.
The undersigned applicant for this building permit does hereby cerify that he understands and accepts his obligations as nn employer of labor
under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Pennanent Supplement, and h..s 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 sib - contractors, on work to be performed under this p €_rmit, as an
licensed by Miami Shores Village.
My Commission Expires Notary Public, State of Florida
sylt-
Master Plumber.
STATE OF FLORIDA, as.
COUNTY OF DADE.
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally .ippeare
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 tat.
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 f,nul
materials and /or workmanship.
MIAMI SHORES VILLAGE, FLORIDA
BUILDING ❑ DATE i / . L 3 1954
ELECTRICAL. il, , i PERMIT i■° 11061
PLUMB *G
ROOFING ❑ Work to be performed under this Permit
Owner of f , V. Building M
Architect
:ontractor � �., /'
a'''
•egcd Lot Subdi-
)escription. vision
Address of '� ' ' � '�° Value of Amt. of I y
Building ' Project $ Permit $
It This permit is granted to the contractor or builder named above to1onstruct the building or to install the equipment or device described in the app DCl�ipn
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 anx_ _
time if the work is not done in compliance with such ordinances or if the plans are anged without authorization. A further condition upon which this permit is
granted is the understanding that the contractor or builder named above assumes a responsibility for a thorough knowledge of the ordinances and regulations
pertaining to the work covered hereby whether shown on the plans or drawings in the statements or specifications and that he assumes responsibility for work
done by his agents, servants or employees.
Signed'
Contractor's
License No
INSPECTOR
In consideration of the issuance to me of this permit I agree to ;perform the work covered hereunder in compliance th all ordinances and regulations
pertaining thereto and in strict confo ity with the plans, drawings, statements or specifications submitted to the proper au • •rities of Miami Shores Village.
In accepting thi permit I assurgc'ite¢bonsibility for all work done by either, myself, my agent, servant or employee.
Permit No
Owner's Name and Address
Amount of Permit $
STATE OF FLORIDA, t
COUNTY OF DADE.
ss.
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 prbvisions 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.
Registered Architect and /or En, neer
Employing Plumber's Name 4-- _6! -_ 0 N
Location and Legal Description Lot Block
Street and Number where work is to be performed—No
State work to be performed and purpose of building (By Floors)
ti No / 1 C Street
(Signed)
(Signed)
1
Date__
Street__
Subdivisi
New Building Remodeling Addition Repairs Rio. of Stories
Size Septic Tank Type of Tank Capacity Gals
Feet of Drain Tile__ __/ OD r ,; ez, _Dist. Feet of Tank or Drain Field from Well
Nature of Water Supply: City—Well 4- 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 5966, Compiled General Laws of Florida Permanent Supplement, and has corn-
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.
•
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeared
to me well known, and who, being by me first duly sworn, upon oath deposes and says that he is the
of the above described construction, that he has carefully read the foregoing application, and that he did sign the same, and that all facts
therein by him stated are true.
My Commission Expires Notary Public, State of Florida
NOTE: A re- inspection fee of $1.00 will be made when such re- inspection is made necessary by improper notice for inspection, or faulty
materials and /or workmanship.
CLOSETS
BATH
TUBS
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
H EATER
DEEP
WELL
SPRKLR.
SYSTEM
SWIM'G
POOL.
CONTR.
LI ST
CHECK
.
Permit No
Owner's Name and Address
Amount of Permit $
STATE OF FLORIDA, t
COUNTY OF DADE.
ss.
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 prbvisions 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.
Registered Architect and /or En, neer
Employing Plumber's Name 4-- _6! -_ 0 N
Location and Legal Description Lot Block
Street and Number where work is to be performed—No
State work to be performed and purpose of building (By Floors)
ti No / 1 C Street
(Signed)
(Signed)
1
Date__
Street__
Subdivisi
New Building Remodeling Addition Repairs Rio. of Stories
Size Septic Tank Type of Tank Capacity Gals
Feet of Drain Tile__ __/ OD r ,; ez, _Dist. Feet of Tank or Drain Field from Well
Nature of Water Supply: City—Well 4- 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 5966, Compiled General Laws of Florida Permanent Supplement, and has corn-
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.
•
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeared
to me well known, and who, being by me first duly sworn, upon oath deposes and says that he is the
of the above described construction, that he has carefully read the foregoing application, and that he did sign the same, and that all facts
therein by him stated are true.
My Commission Expires Notary Public, State of Florida
NOTE: A re- inspection fee of $1.00 will be made when such re- inspection is made necessary by improper notice for inspection, or faulty
materials and /or workmanship.