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PLUMBINGPERMIT APPLICATION FOR MIAMI SHORES VILLAGE D a t e J o b Address F ' ( ( ) LI t . C P% v l Tax Folio Legal Description PJ1 rn Historically Designated: Yes No Owner/Lessee / Tenant t'( Owner's Address I (J . ki (--, i r - Phone 3Z - t / f59 C o n t r a c t i n g co. S a 1 - n ' 1 a I a .. rV / e Address a1 X F/ejchr QualifieOiry S Zoo j SS # -_ -( 7Phone g3/43,i—.5996,9& State # Vqa Municipal # Competency # J3 /Ins. Co. Architect/Engineer Address Bonding Company Address Mortgagor _ ; ' dress NECHANCAL WS Lir emu*, '.i F IHO3Q, Permit Type (circle one): BUILDING �ELECTRI 1.rthfC UC . Lof WORK DESCRIPTION w hQls uare Ft Estimated Cost (value)` //90. 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 OF 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. OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will construction and zoning. Furthermore, I authorize the above -named contractor to do . , ork stat Signature o APPROVED: Zoning Mechanical g_ President Date No as to Owner al id/or ?I '7' f ' "� (,p '' Date My Commission Expr s: ARY PUBLIC ST/tTE OF FLORIDA COMMISSION NO. CC714103 MY COMMi9S ON EXP. MAP. t,2002 RADON C.C.F. 9/ Master Permit # 95Lso ne in com ce with all applicable laws regulating Signs Notary as to Contractor or Owner - Builder My Commission Expires: ; - "° t .}� rsotory i' Pu is Electrical �• a NOTARY BOND of Contractor . r Owner - Builder / r ate RUTH A NESS!. Stz tc of FIot do My Comm. Exp: 09/23100; Camm#: CC683320 d /0 Date • TOTAL DUE Structural Engineer MR HISAWIMS STILES 14 1 LL 1 ci11 "141'3$411 PROPOSAL SUBMITTED TO: FAX 305 -756 -7104 SOUTHEF:r4. ATLANTxC. AA i manlike e mannerr according to s be r es prd p� eCAttee A,•y eAetationordI I. •p.Nkallone Involving extra coots will bra egecywd only pon written grim. and will be coulee n ewe c h. ry . over and above theeetlmele,All.gree ant. contingentube .tees, eoeldent, Of eebys beyond oVr control. Omer to arty nye. tornado end olh•r tnece sear w In..nce. Ovr workers we Wiry coveted by workmon'" compeneaeo4 � Acceptanc. 01 Propod •-- The above prices, epeolrlotatlons and conditions taro satisfactory and are hereb accepted You aro authorized to do tha work as necttled, Payment will be Matta pia of ril)nad abov0. ' Dote Accepted 305 =76 015 954 927 0529 SOUTHERN ATLANrl'XC SER viCE CO,RZ A G'.IS Delk- ACIXDEALER 2120 FLETCHER STREET HOLLYWOOD, FL 33010 934.921 .8999"1•888696. 7273"FAX 954417.0529 Job - HISAW/ STIL Pane No DEGCRIPTION OF JOB: Address t g' N(99 KESII)ENCF, Propos£ City MIAMI MORES, FL ti n NEW T WATER EATER P Iona wo tier Y V h1�l` 8 Pecip ` do andetUm to (pr tt te insta of a new LP gas, 40 a on o wa er ea er, replace the existing electric hot water heater, and the installation of new gas lines to service the fireplace, heater, dryer and stove, for the above referenced location. The work will include the following Install 20' (approximately) of new 6 /4" galvanized gas line above ground. Install 50' (approximately) of new TracPlpe through crawl space. Install 15' (approximately) of new Melee gas piping below ground. Install One (1) 40 gallon LP gas hot water heater on new approved stand. Removal of existing hot water heater. Necessary trenching and rough backfiti. New temperature and pressure relief valve, flue and Res piping. Connection of hot water heater. flrcplace (s!o valve in closet), dryer and stove from tank. All parts and labor. THERE LS A (1) ONE YEAR WARRANTY ON ALL PARTS AND LABOR SUPPLIED BY SOUTHERN ATLANTIC SERVICE'CORPORATION AND AN ADDITIONAL FIVE (5) YEARS MANUFACTURERS WARRANTY ON THE TANK LINER. ALL WORK IS TO BE PERFORMED INA PROFESSIONAL AND WORKMANLIKE MANNER, ACCORDING TO STANDARD PRACTICES, USING 1ST CLASS, U.L. APPROVED MATERIALS. ** PERMIT AND APPLICABLE FEES NOT INCLUDED.* • signature Signature g y Authorized Signature Note: This proposal may be with. drawn by us It not accepted within an.a me t.t cice4.ftrtiWKS 4 Fl ,A CTLTK CC NO.CFCO54803" CC. NO. CAAC003.1800 4 T► 0000934 • WO Horoby Propose to furnish lakor and me rials com accordance wl the above specifications, for the • sum of S S 1190.00 LESS TECO ALLOWANCE (3750.00) • S440,00+ PERMIT FEES With payment to be made as follows: A DEPOSTT OF 5220.00 UFON ACCEPTANCE; BALANCE OF S2211,00 AND PERM1T FEES DUE UPON COMIPLETION OF THE INSTALL TION. days. .t Survey Sheet/Plans Customer Name: ' Address: Phone: All work to comply with N.F.P.A. Code # . 9 > 411 ' '�yt rr 1 / 1 ;V' /9< ;» ? ,Plexom ,./PP vke Z pig 446, �q S /1l ;soli (5l,ifel.s. F< ,33,C1 r /6436'41.7- r 9 e•- au Poc , a0 pv.E0 f, 6/, i So. Atlantic Service Corp 2120 Fletcher Street Hollywood, FL 33020 1 -888- 696 -7272 s (96' GL� iV 5'dApoc G S I0C - ou3 �so.yfl� !� a4 Survey Sheet/Plans Customer Name: /7 e i S Res r Address: / 74-9 ‘ fr / ipI ,,10/ , 33/.54k - Phone: / 3 Ar` 7ri - 'sc 9)- Weg* '5 44;74 .v.,,e49 c•%.4e .74 tp/ Gas Piping ISO. • r 1 .� ■ �Iw - ." f r 4 4E 01 0 Ee/ ors hTV -Aft So. Atlantic Service Corp 2120 Fletcher Street Hollywood, FL 33020 1- 888 - 696 -7272 .5° E'RpJr ERs c. 2e ( -et ReErai Permit No _ ... Air i 1 17, 1972 Application is hereby • made for the approval of the detailed statement of the plane and specifications herewith submitted for the building or other structure herein described. This application L 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 gauged or not A copy of approved plans and specifications must be kept at building during progress of work. Owner's Name and Address.......... Ralph Swanson .�.. No..,.. ..._ .... Street. Registered Architect and /or Engineer MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT Employing Plumber's Name . Sprinkler Company Na 880 N.W .34th. Street . Street— Location and Legal Description Lot Blot& Street and Number where wosk i to be pafesaad —Ns. 1296 N _E . 993.11 Street State work to be performeA and purpose of Wang (By Floors) _..._ New Bs than ...__.,. Remodeling. Addition ...._._...... Repairs...._.._ No. of Stories. _s Size S e p t i c Tank— T y p e o f Tads.... C s p a d t y Feet of o f D r a i n T i l e m i s t . F e a t of Tank or D r a i n Field hem W e l l Nature of Water Supply: GYty— Wef..____ We 11 Aso of Soakage Pit_ _ Amount of Permit $ 10_00 _ ( g� ) Inspector. The undersigned applicant for this building permit does bareby certify Shat be understands and accepts 'obligations u an employes of labor under the Florida Workmen's Compensation Act, being Section SON, Compiled General Laws of Florida anent Supplement, and has cons- plied with the provisions thereof, and will require similar amnplisace 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 tkie Act. The undersigned agrees to employ only such sub.ccs1tractors, on work o erformed and y . . ermit, as are licensed by Miami Shores Village. STATE OF FLORIDA, e COUNTY OF DADE. Before me, the undersigned authority, a notary pub*, dab► anlbariasd,in administer oaths and take acknowledgments, personally appeared 1296 N.E. 99th. Street SubdivWon. Street._ Plumber. to me well known. Sad who, being by me first duly eweesLopon oath deem and am 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 himare true M y g Commission Expires Notary Fttbilo, State of Florida materials and/or NOTE: a � h1 pec of 11.00 will be made vibes each mbrpaetioa le nuele.neosseary by improper notice for inspection, or faulty CLOSITM 'T OATH UBS •NOWERE LAVA. Tomas SINKS _ isms YUU URINALS BASIN DRAIN FO NT Ni FIXTURE. CON't I. . LIST CMS= 8c,nc TANK liawast CONN. DRAIN FIELD SOAKAGE PIT CREASE TRAP SOLAR NEATER Oral• WALL $.em.1. SYSTEM SWIM'O POOL 1 CONTR. o LIST 1 1 — CNDCK , Permit No _ ... Air i 1 17, 1972 Application is hereby • made for the approval of the detailed statement of the plane and specifications herewith submitted for the building or other structure herein described. This application L 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 gauged or not A copy of approved plans and specifications must be kept at building during progress of work. Owner's Name and Address.......... Ralph Swanson .�.. No..,.. ..._ .... Street. Registered Architect and /or Engineer MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT Employing Plumber's Name . Sprinkler Company Na 880 N.W .34th. Street . Street— Location and Legal Description Lot Blot& Street and Number where wosk i to be pafesaad —Ns. 1296 N _E . 993.11 Street State work to be performeA and purpose of Wang (By Floors) _..._ New Bs than ...__.,. Remodeling. Addition ...._._...... Repairs...._.._ No. of Stories. _s Size S e p t i c Tank— T y p e o f Tads.... C s p a d t y Feet of o f D r a i n T i l e m i s t . F e a t of Tank or D r a i n Field hem W e l l Nature of Water Supply: GYty— Wef..____ We 11 Aso of Soakage Pit_ _ Amount of Permit $ 10_00 _ ( g� ) Inspector. The undersigned applicant for this building permit does bareby certify Shat be understands and accepts 'obligations u an employes of labor under the Florida Workmen's Compensation Act, being Section SON, Compiled General Laws of Florida anent Supplement, and has cons- plied with the provisions thereof, and will require similar amnplisace 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 tkie Act. The undersigned agrees to employ only such sub.ccs1tractors, on work o erformed and y . . ermit, as are licensed by Miami Shores Village. STATE OF FLORIDA, e COUNTY OF DADE. Before me, the undersigned authority, a notary pub*, dab► anlbariasd,in administer oaths and take acknowledgments, personally appeared 1296 N.E. 99th. Street SubdivWon. Street._ Plumber. to me well known. Sad who, being by me first duly eweesLopon oath deem and am 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 himare true M y g Commission Expires Notary Fttbilo, State of Florida materials and/or NOTE: a � h1 pec of 11.00 will be made vibes each mbrpaetioa le nuele.neosseary by improper notice for inspection, or faulty Owner's Name and Address. Registered Architect and /or meer — Employing Plumber's Name Size Septic Tank -- Feet of Drain Tile Nature of Water Supply: City —Well . 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 mp g No. - - - - -- Location and Legal Description Lot______� Pi Block Street and Number where work is to be performed —No State work to be performed and purpose of building (By Floors) New Building ___ -•- Remodeling Addition_ No.___ _...___.___._.______.. Street. __Type of Tank— Capacity Gals _Dist. Feet of Tank or Drain Field from Well Size of Soakage Pit / ' ^P � b✓� t ! r...c .0 I' -- ' _: — -- Amount of Permit S = -- - --- ____---------- - -_ - -- (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 5968, 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. STATE OF FLORIDA, 1 COUNTY OF DADE. (Signed)._ Street.. Date se Subdivision Street Repairs No. of Stories. 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 81.00 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 Tim, URINALS CATCH BASIN FLOOR DRAIN DRINKING FOUNT'NS TOTAL FIXTURES CONTR. LIST — -- CHECK SEPTIC TANK SEWER CONN. DRAIN FIELD SOAKAGE PIT GREASE TRAP SOLAR HEATER DEEP WELL SPRKLR. SYSTEM SWIM'G POOL CONTR. LIST • CHECK Owner's Name and Address. Registered Architect and /or meer — Employing Plumber's Name Size Septic Tank -- Feet of Drain Tile Nature of Water Supply: City —Well . 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 mp g No. - - - - -- Location and Legal Description Lot______� Pi Block Street and Number where work is to be performed —No State work to be performed and purpose of building (By Floors) New Building ___ -•- Remodeling Addition_ No.___ _...___.___._.______.. Street. __Type of Tank— Capacity Gals _Dist. Feet of Tank or Drain Field from Well Size of Soakage Pit / ' ^P � b✓� t ! r...c .0 I' -- ' _: — -- Amount of Permit S = -- - --- ____---------- - -_ - -- (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 5968, 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. STATE OF FLORIDA, 1 COUNTY OF DADE. (Signed)._ Street.. Date se Subdivision Street Repairs No. of Stories. 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 81.00 will be made when such re- inspection is made •necessary by improper notice for inspection, or faulty materials and /or workmanship. BUILDING ELECTRICAL PLUMBING ROOFING Owner of Building Architect Contractor or Builder Legal Description. Address of Building Lot n PERMIT IN? 12171 Work to be performed under this Permit_ CONTRACTOR OR BUILDER MIAMI SHORES VILLAGE, FLORIDA Bl. • Subdi- vision Value of Project $ BY 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 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. AUTHORITY Permit No 1 1 '1] 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. Owndr's Name and Address Is No Street Registered Architect and /or Engineer Employing Plumber's Name r " " Location and Legal Description Lot Block Subdivision Street and Number where work is to be performed —No 1___7 11 Street. _//,- 1 State work to be performed and purpose of building (By Floors) New Building L./- Remodeling Addition, Repairs Size Septic Tank Feet of Drain Tile Nature of Water Supply: City —Well Amount of Permit $ 'G Dist. Feet of Tank or Drain Field from Well G Size of Soakage Pit ss. MCI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT Type of Tank ,No E - Street____ i Plumbing Inspector. The undersigned appli ant for this building permit does hereby certify that he und:'ds and accepts his obligations as an employer of labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled Genera aws 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) ( Signed) Capacity Gals._ I • No. of Stories 7 �P? Master Plumber. STATE OF FLORIDA, 1 COUNTY OF DADE. Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeared to me well known, and who, being by me first duly sworn, upon oath deposes and says that he is the of the above described construction, that he has carefully read the foregoing application, and that he did sign the same, and that all facts therein by him stated are true. My Commission Expires Notary Public, State of Florida NOTE: A r inspection fee of $1.00 will be made when such re- inspection is made necessary by improper notice for inspection, or faulty materials and /giworkmanship. CLOSETS BATH TUBS SHOWERS LAVA- TORIES SINKS SLOP SINKS LAUNDRY TUBS URINALS CATCH BASIN FLOOR DRAIN DRINKING FOUNT'NS ! M® r' D, 14 1 TOTAL FIXTURES CONTR. LIST - "r J �/ / ( 2.J ._1 ,( / 7g / Imo ! )*- / 7J / 7 l CHECK 2 S pp �1 / / r SEPTIC TANK SEW / ER CONN. DRAIN FIELD SOAKAGE PIT GREASE TRAP ,$Q1.4fi H EATER DEEP WELL SPRKLR. SYSTEM SWIM'G POOL 1t, T �•t . CONTR. LIST / j 1 • CHECK / , 0 0 ��pp,�➢ yy J . 0,0 _pq�� 1 � �,./ ,`/ 1 � �,1 Permit No 1 1 '1] 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. Owndr's Name and Address Is No Street Registered Architect and /or Engineer Employing Plumber's Name r " " Location and Legal Description Lot Block Subdivision Street and Number where work is to be performed —No 1___7 11 Street. _//,- 1 State work to be performed and purpose of building (By Floors) New Building L./- Remodeling Addition, Repairs Size Septic Tank Feet of Drain Tile Nature of Water Supply: City —Well Amount of Permit $ 'G Dist. Feet of Tank or Drain Field from Well G Size of Soakage Pit ss. MCI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT Type of Tank ,No E - Street____ i Plumbing Inspector. The undersigned appli ant for this building permit does hereby certify that he und:'ds and accepts his obligations as an employer of labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled Genera aws 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) ( Signed) Capacity Gals._ I • No. of Stories 7 �P? Master Plumber. STATE OF FLORIDA, 1 COUNTY OF DADE. Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeared to me well known, and who, being by me first duly sworn, upon oath deposes and says that he is the of the above described construction, that he has carefully read the foregoing application, and that he did sign the same, and that all facts therein by him stated are true. My Commission Expires Notary Public, State of Florida NOTE: A r inspection fee of $1.00 will be made when such re- inspection is made necessary by improper notice for inspection, or faulty materials and /giworkmanship. 5 • 6 iJ t.- - L t. MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT 6 ' 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. �/ c� No :! / .,,,L 6 street..__ Z. C7 7 ? f T Owner's Name and Address `'` Z Registered Architect and /or Engineer Employing Plumb's Name 5 Location and Legal Desetiptton Lot. Street and Number where work is to be performed —No /2 9 6 State work to be performed and purpose of building (By Floors) New Building__.___ _.._ _.. Remodeling _ Addition or' �o� Ss pjc- G -f4 Mash Subdivision. _______.___— Street.. L L _ r 7---- Repairs No. of Stories... / -. Size Septic Tank_ Type of Tank--- Feet of Drain Tile / Z ' so EITLINst. Feet of Tank or Drain Field from Well Nature of Water Supply: City—Well. Size of Soakage 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 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. Amount of Permit $ (Sly) Master Plumber. STATE OF FLORIDA, COUNTY OF DADE. Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeared to me well known, and who, being by me first duly sworn, upon oath dep ones 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 Pub& State of Florida NOTE: A re- inspection fee of $1.00 will be made whoa sack st■laspwtlos it ssrade•aeos-sery by improper notice for inspection, or fault' materials and /or workmanship. CLOSETS BATH TUB[ 54 R. LAVA. TORIES SINKS SLOP SINKS LAUNDRY TUBS URINALS CATCH BASIN FLOOR DRAIN DRINKING FOUNT'NE TOTAL FIXTURE[ CoNTR. LIST CHECK SPRKLR. SYSTEM SWIM'G POOL SEPTIC TANK SEWER CONN. DRAIN FIELD SOAKAGE PIT GREASE TRAP SOLAR NEATER DEEP WELL LIST CHECK MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT 6 ' 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. �/ c� No :! / .,,,L 6 street..__ Z. C7 7 ? f T Owner's Name and Address `'` Z Registered Architect and /or Engineer Employing Plumb's Name 5 Location and Legal Desetiptton Lot. Street and Number where work is to be performed —No /2 9 6 State work to be performed and purpose of building (By Floors) New Building__.___ _.._ _.. Remodeling _ Addition or' �o� Ss pjc- G -f4 Mash Subdivision. _______.___— Street.. L L _ r 7---- Repairs No. of Stories... / -. Size Septic Tank_ Type of Tank--- Feet of Drain Tile / Z ' so EITLINst. Feet of Tank or Drain Field from Well Nature of Water Supply: City—Well. Size of Soakage 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 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. Amount of Permit $ (Sly) Master Plumber. STATE OF FLORIDA, COUNTY OF DADE. Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeared to me well known, and who, being by me first duly sworn, upon oath dep ones 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 Pub& State of Florida NOTE: A re- inspection fee of $1.00 will be made whoa sack st■laspwtlos it ssrade•aeos-sery by improper notice for inspection, or fault' materials and /or workmanship.