165 NE 98 St (2)Miami Shores Village
10050 NE 2nd Avenue
Phone: 305 - 795 -2204
Printed: 12 /22/2003
Applicant: GILBERTO MEJIA
Owner: MEJIA GILBERTO
JOB ADDRESS: 165 NE 98 ST
Contractor ESSIG POOLS
Local Phone: 305 - 949 -0000
Parcel # 1132060132330
Plumbing Permit
Permit Number: PL2003 -326
Contractor's Address: 1800 N. E. 151 ST.
Legal Description: MIAMI SHORES SEC 1 AMD PB 10 -70 LOT 23 & E1/2 LOT 22 BLK 17 LOT SIZE
Fees: Description Amount
FEE2003 -8513 Building Fee $150.00
FEE2003 -8514 CCF $0.60
FEE2003 -8515 Training and Education Fee $0.20
FEE2003 -8516 Technology Fee $3.75
Total Fees: $154.55
Total Fees: $1,5a .
Total Receipts: 10.00
,J,&,.\ 1 °‘1
Permit Status: APPROVED Permit Expiration: 6/1/2004 Construction Value: $500.00
Work: RUN NEW PLUMBING FOR POOL
Signed: (INSPECTOR)
Page 1 of 1
()EC 2 3 PAID
@C_ g9G09,
In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations pertaining thereto and in strict
conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I assume responisibility for all work
done by either myself, my agent, servants or employes.
Signed: (Contractor or Builder) BY:
1Fr r
taci
BUILDING
PERMIT APPLICATION
FBC 2001
Permit Type (circle): Buildin
Owner's Name (Fee Simple Titleholder) G/L 9 Z D f7 ' e074 Phone # 7S 7 -1 zS `'
Owner's Address (6---1 9i 7w:4LT
City / .t04:4,5 State / z— Zip "1/.78
Tenant/Lessee Name Phone #
Job Address (where the work is being done) /44 f.a..
City Miami Shores Village County Miami -Dade Zip 33/ 3b
Is Building Historically Designated YES NO
Contractor's Company Name -J5/ (j,
Contractor's Address j$ o 0 "Jr- 1 5 7
City Aiatbr,t ,•-/ „y,{ eiAir_t•1 State f i
Qualifier )A,-,L
Architect/Engineer's Name (if applicable) - Phone #
Architect/Engineer's Address
City State Zip
$ Value of Work For this Permit
Miami Shores Village
Building Department
Number of: Bays Stories Families
Type of Work: ['Addition ❑Alterationew
Describe Work: g
_,LD
Plumbing
Master Permit No. 0 — 1 2Sq
Mechanical Roofing
Phone# 3 0kr a00c
Zip 3 3 f co'Z
Square Footage Of Work:
Bedrooms
❑ Repair/Replace
Permit No.
* * * * * * * * * * * * * * * * * * * * * * * * * ** *F * * * * * ** * * * * * * * * ** * * * * * **
County Escrow Fee $ .SU • v �'. k 1 t89�53 Permit Fee $ �` Notary $
Education/ Training Fee $ - a - 0 Tech $ Scanning $
Code Enforcement $ Bond $ Struct. $
Minus Plans Check Fee $ Total Fee Now Due $ )
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
pc, 0 3 -
Baths
Radon $
❑ Demolition
(Continued on opposite side)
Bonding Company's Name (if applicable)
Bonding Company's Address
City State Zip
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address
City State Zip
Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has
commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulating
construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRICAL WORK, PLUMBING, SIGNS,
WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and AIR CONDITIONERS, ETC
OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all
applicable laws regulating construction and zoning.
"WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR
PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING,
CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF
COMMENCEMENT."
Notice to Applicant: As a condition to the issuance of a building permit with an estimated value exceeding $2500, the applicant must
promise in good faith that a copy of the notice of commencement and construction lien law br'chure will be delivered to the person
whose property is subject to attachment. Also, a certified copy of the recorded notice o o encement must be posted at the job site
for the first inspection which occurs seven (7) days after the building permit is sued. / he absence of such posted notice, the
inspection will not be approv and a reinspection fee will be charged. Z
NOTARY PUBLI
Sign:
Print:
chc7n /o3
APPLICATION APPROVED BY: e
As identifica . n .1.d who did take an oath.
Signature
1
The forego trument was acknow edged before me this /'L The foregoinkinstrum e. as acknowledged before me this / 7
day of 1S.L) , 0(Z, by , day of A4' 1/ , 20 by
who is p orally know o me or who has produced
S
Print:
who is ] rsonally known t
tor
as identificatio
NOTARY PUB
otar
roduced
d who did take an oath.
i --
J % / /ial_h _ `HERMAN
- -
My comm. oxp. May 24, 2007 - N P
M Commission E Comm. No. DD 182405 r or, u;
Y xpires: My Commission Expires: y Comm. ex P. May 24
(Certificate of Competency Holder)
State Certificate or Registration No. / Certificate of Competency No.
1 N
****** * * * * ** * * * # * * * * * * * * * * * * * * * **+k ## ilk * * ** ********************************** ** * * * * * * *** * *** ** * * * * ** * * *1 * * **
HERMAA
Plans Examiner
Engineer
Zoning
RECEIVED
OEC 0 4 2003
BUILDING
PERMIT APPLICATION
FBC 2001
Permit Type (circle): Building Electrical
Owner's Name (Fee Simple Titleholder) Cwt./3 £,."Ze t " ' f fl4 Phone #
Owner's Address ((DS kr 9 2' )4 $
City /414 -C•} ) Q 14 State Zip 33/ 3 b
Tenant/Lessee Name Phone # 6P '
Job Address (where the work is being done) 5 4 / d /J
City Miami Shores Village
Is Building Historically Designated YES
Contractor's Company Name i:537
County
t ��( J
Contractor's Address ( �� / �/ -r 7 7 T
=
City /v)/L1.1 Hi, f f AA State Zip 33/6
Qualifier U"%-i) t_ �_SS &
Architect/Engineer's Name (if applicable)
Architect/Engineer's Address
City State Zip
$ Value of Work For this Permit
2 5 J e0 J
Number of: Bays Stories
Type of Work: ['Addition ['Alteration
Describe Work: 3N5 Z•
* * * * * * * * * * * * * * * * * * * * * * * * * ** *F * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
ov
County Escrow Fee $_(j!_
Education/Training Fee $ E "'-
Code Enforcement $
Minus Plans Check Fee $
Miami Shores Village
Building Department
Plumbing Mechanical
NO
Miami -Dade Zip
Families Bedrooms Baths
Tew ❑ Repair/Replace
T�
3 Permit Fee $
Tech $c ,S
Bond $ 3c9O —
- Phone #
_3313V
Square Footage Of Work:
r Scanning $ 6
Struct. $ 5
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
Permit No.
Master Permit No. 1 Po J 1 S 3
Roofing
30S 7S7 (ZS`t
Phone # 3 :; j— y - 0 9 0 0
CCU
Radon $
Demolition
PA/6<-
S ; - 0 Notary $
*ammo
3 5 °
0--
Total Fee Now Due $ (Continued on opposite side)
Bonding Company's Name (if applicable)
Bonding Company's Address
City • State Zip
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address
City State Zip
Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has
commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulating
construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRICAL WORK, PLUMBING, SIGNS,
WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and AIR CONDITIONERS, ETC
OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all
applicable laws regulating construction and zoning.
"WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR
PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING,
CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF
COMMENCEMENT."
Notice to Applicant: As a condition to the issuance of a building permit with an estimated value exceeding $2500, the applicant must
promise in good faith that a copy of the notice of commencement and construction lien law brochure i 1 be delivered to the person
whose property is subject to attachment. Also, a certified copy of the recorded notice of commen -m: t must be posted at the job site
for the first inspection which occurs seven (7) days after the building permit is issued. In the sent a of such posted notice, the
inspection will not be app oved and a reinspection fee will be charged.
Signature
APPLICATION APPROVED BY:
Chc7/7/03
Own- .iA
EC 2 2 2003
The forego !T trument was acknow e • ged before me this / Z. The foregoing-ins ent was ackno , ledged before me this / 2
by
day of Nil , 200 by day of ' -
who is rsonally kn . e or who has produced who is ersonally known a or who produced
tition and who did take an oath. who did take an oath.
NOTARY
NOTARY PUBLIC.
Sign: //� t T H SH Sign: a
State tv MERMAN
Print: _ My mb cxu' May fR 2 gF lnr,G - Print: M tart' Public, H StateRMA��
My Commission Expires: mm• No, D D 1824b OO My Commission Expires Cpm cumin. May 24 Florida
No, 24, 2007
******************** ********************************************* * * * * * * ** * * * * * * * * * * * * * * * * * * * * * *V * 44205, * * * **
(Certificate of Competency Holder)
State Certificate or Registration No. Certificate of Competency No.
•
70-4_ / 2 / f frat-- Plans Examiner
Engineer
Zoning
ii
Miami Shores Village
Building Department
inDIN G CRITI 1 • SHEET
oPQ-lit■Az
10050 N.E.2nd Avenue
Miami Shores, 3 S 7952204
Te1:'( )
Fax: (305) 756.8972
Date
Type Insp
Permit No.
Name
Address
Compan
Phone #
Inspection Date
MIAMI SHORES VILLAGE
BUILDING DEPALTMENT
305- 795 -2204 v
Building Ins
1-4e lCo�' S3-
-- 55\
6 T
l z_ c
C r�
E E a E
,> L z < U a
.
9
2
2
Type Insp'n
Per No.
Name
Address
Company
Phone #
Inspection Date
❑ ❑
a
0
6)
MIAMI SHORES \VILLAGE
305-795-2204 O BUILDING DEPALTMENT P
Building Inspection Request
Date , (D"
aim
1
s D
JOB ADDRESS
APPLICANT
PHONE #
CRITIQUE SHEET
77 57
APPLICATION "ad L
SHEET OF
MISCELLANEOUS
DATE
MUM
COMMENTS
AVO
PERMIT NO.
ADDRESS:
SECTION
ZONING
ELECTRICAL
MECHANICAL
PLUMBING
FIRE
PUBLIC WORKS
STRUCTURAL
BUILDING OFFICIAL
MIAMI SHORES VILLAGE
BUILDING / ZONING DEPARTMENT'
BY
DATE
3 trust be avallebte on
action wttt be conducted.
1. Subject to compliance with nit Fedetat, State,
County.Yillage totes and mutations. Vlttage e.ssuotes
no responsibility for accurecy oflor results from
these plans.
2. Thls copy of plan
tuning site or no tnsp
A flo ,t cc A.1 C / ,7 /7E- 2 7
INITIALS
SWIMMING POOL OWNER'S CERTIFICATION
Date // — o,
Miami Shores Village
Building and Zoning Department
Attention: Building Official
I certify that I am the legal owner of the property described as
dQa? Z zit / (...z)e_j_. 1 1
60Tirt Aog, / eVi 4. 70 , located at fly' "fg_ 9 64
I „cl a
In accordance with Section 33 -12(0, Code of Metropolitan Dade County, I certify that
I understand and agree that the swimming pool to be constructed at the above address cannot
be used or filled with water until a separate permit has been obtained for an approved safety
barrier, and such barrier erected, inspected and approved.
I further understand that this certification, however, does not eliminate the need for
obtaining a permit and erecting an approved barrier prior to final inspection and use of the pool.
Legal Owner
Note: This certification is to be submitted with a swimming poo permit application in duplicate.
J
•
CONTRACTOR
CONTRACTOR'S NAME
eft
�/
_ AVM/
A f IF
- itzt,e4Ttilar
BUILDING DEPARTMENT
10050 N.E. SECOND AVENUE
MIAMI SHORES. FLORIDA 33138.2382
TELEPHONE (305) 795.2204
FAX (305) 756-8972
NOTICE OF REQUIREMENTS
RESIDENTIAL SWIMMING POOL,
SPA AND HOT TUB SAFTY ACT
I (We) acknowledge that a new swimming pool, spa or hot tub will be constructed or
installed at / 1 V T ?P 5?' Miami Shores,. Fl., and hereby affirm that one of
the following methods will be used to meet the requirements of Chapter 515, Florida
Statutes.
(please initial the method(s) to be used)
The pool will be isolated from access from the home by an enclosure
that meets the pool barrier requirments of Florida Statute 515.29;
The pool will be equipped with an approved safty cover that
complies with ASTM F1346 -91;
All doors and windows providing direct access from the home to the
pool will be equiped with an exit alarm that has a minimum sound
pressure rating of 85 decibels at 10 feet;
All doors providing direct access from the home to the pool will be
equipped with self - closing, self - latching devices with release
mechanisms placed no lower than 54" above the floor or deck;
I understand that not having one of the above installed at the time of final inspection, or
when pool is completed f • contract purposes, will constitute a violation of Chapter 515,
F.S. and will be . • ide - • as committing a misdemeanor of the second degree, punishable
by fines up t s in jail as establishes in Chapter 775, F.S.
DATE
E PR1!6t JETH SHERid;Aly
Notary Public, State of f l,j,• .,:,
y Comm. exp. May 24, 2 >
D 1824°'
40!/• • Y Ji":
OWNER'S NAME
DATE
KENNETH SHERMAN
Notary Public, State of Florida
comm = . • May 24, 2007
omm. No. DD 182405
NOTICE OF COMMENCEMENT
A RECORDED COPY MUST BE POSTED ON THE JOB SITE AT TIME OF FIRST INSPECTION
PERMIT NO. TAX FOUO NO.
STATE OF FLORIDA:
COUNTY OF MIAMI -DADE:
THE UNDERSIGNED hereby gales notice that Improvements will be made to certain real
property, and In accordance with Chapter 713, Florida Statutes, the following information
Is provided In this Notice of Commencement.
1. Legal description of property and streeVaddress: -- s /z cif- Lo? 2 Z
AA ig 4)-42 1 4 - 4 )7,4 e - 7 0
1.JV. G o ? ?� . -c�c � 1 7/
/ e i' e--// r c cis / /z 37/ 3 8
2. Description of Improvement: /f1.-4.A) 'sw r
3. Owner(s) name and address: l/--a T ' t
Interest In property:
Name and address of fee simple titleholder.
differe to I
Notary Public
Print Notary's Name
My commission expire
123.01 -52 PAGE 4 B/02
SIgna"re •f
Prl t Owner's Name
Sworn to and subscribed before e thi
4. Contractor's name and address: G
5. Surety: (Payment bond required by owner from contractor, If any)
Name and address:
Amount of bond $
6. Lender's name and address:
7. Persons within the state of Florida designated by Owner upon whom notices or other documents may be served as
provided by Section 713.13(1)(a)7., Florida Statutes,
Name and address:
8. In addition to himself, Owners designates the following person(s) to receive a copy of the Lienor's.Notice as provided
In Section 713.13(1)(b), Florida Statutes.
Name and address:
9. Expiration • ate of this Notice of Commencement: (the expiration date Is 1 year from the date of recording unless a
Cnmm No. DD 182405
1111111 111111111111111 (11111111111 I I I I I I I I I l I
CFi4 2003R0876521
OR Bk 21851 P9 1335; Ups)
RECORDED 11/25/2003 14:34:05
HARVEY RUVIN? CLERK OF COURT
MIAMI -DADE COUNTY, FLORIDA
LAST PAGE
Prepared by l°. ��
, 20L5 c% ["s-s,>
Address:• / ?' ,vt /57 r'
JC✓ .!� -- -•-mot 33 a- e
Miami Shores Village
10050 NE 2nd Avenue
Building Permit
Phone: 305- 795 -2204 Permit Number: BP2003 -1893
Printed: 12 /22/2003
Applicant: GILBERTO
Owner: MEJIA
JOB ADDRESS: 165 NE 98
Contractor ESSIG POOLS
Local Phone: 305 - 949 -0000
Parcel # 1132060132330
DEC 2 3 PAID
Signed: (INSPECTOR)
MEJIA
GILBERTO
ST
Contractor's Address: 1800 N. E. 151 ST.
Legal Description: MIAMI SHORES SEC 1 AMD PB 10 -70 LOT 23 & E1/2 LOT 22 BLK 17 LOT SIZE
Fees: Description Amount
FEE2003 -8517 Building Fee $850.00
FEE2003 -8518 CCF $15.00
FEE2003 -8519 Training and Education Fee $5.00
FEE2003 -8520 Technology Fee $21.25
FEE2003 -8521 Scanning Fee $6.00
FEE2003 -8522 Builders Bond $300.00
FEE2003 -8523 CO /CC $50.00
Total Fees: $1,247.25
Total Fee41,247.15
Total Receipts:
eceipts 0:0(P
Sq 9
Permit Status: APPROVED Permit Expiration: 6/1/2004 Construction Value: $25,000.00
Work: NEW SWIMMING POOL
Page 1 of 1
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 responisibility for all work
done by either myself, my agent, servants or employes.
Signed: (Contractor or Builder) BY:
og
Treeioi
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
Size Septic Tank.._ _Type 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 $ ( Signed ) _
(Si
No i
Permit No X5
Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the building or other
structure herein described. This application is made in compliance and conformity with the Building Ordinance of Miami Shores Village, Florida,
and all provisions of the Laws of the State of Florida, all ordinances of Miami Shores Village and all rules and regulations of the Building Division
of Miami Shores Village shall be complied with, whether herein specified or not. A copy of approved plans and specifications must be kept at
building during progress of work.
street...
Owners Name and Address
Registered Architect and /or Engine — -
]EstplPying Plumber's Name
a��. � : ;� , .., No....— !' S...-'-
Location and Legal Description Lot. Bko SubdivWo_n. —_� _..
Street and Number where work is to be performed —No _ ./��L Street_.. _ �1 Cj `r
r
State work to be performed and purpose of building (By Floor)_-- .._ —_.. Li.r.a . _ -_t_ lAi ‘,! , _IL 6 J
New Building.__._ _ _.._ _.. Remodeling_-___._ ._._. -.__ Addition...____..._ Repairs L No. of Stories....
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 liar com-
plied with the provisions thereof, and will require similar compliance from all contractors or sub - contracto employed by him in the wort- to he
performed, under this permit; and will post or cause to be posted for inspection on the site of the w such public notice or notices as are
required by the Act. The undersigned agrees to employ only such sub - contractors, k . .. or�ned under this permit, As are
licensed by Miami Shores Village.
STATE OF FLORIDA, 1
COUNTY OF DADE.
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take aclmowledgments, personally appeared
to me well known, and who, being by me first duly sworn, upon oath deposes and says that he is the -._ - .------ -_ - -.. _ _. - - - --
of the above described construction, that he has carefully read the foregoing application, and that be did sign the same, and that all facts
therein by him stated are true.
M Commission Expos Notary Public, State of Florida
NOTE: A re- inspection fee of $1.00 will be made whoa snob rwisspaotke V soads by improper notice for inspection, or faulty
materials and /or worlamanshtp.
CLOSETS
BATH
Tuns
SNOW[Ra
LAVA-
Tonics
aINKS
SLOP
SINKS
LAUNDRY
Tugs
URINALS
CATCH
BASIN
FLOOR
DRAIN
DRINKING
FOUNT•N[
TOTAL
FIXTURES
--
CONTR.
LIST
CHICK
i
SEPTIC
TANK
SEWER
CONN.
DRAIN
FIELD
SOAKAO[
PIT
G
TRAP
SOLAR
HEATER
D[IP
WELL
SPRKLR.
SYSTEM
SW IM'O
POOL
GOMTL
LIST
CNECK
_
�--
Treeioi
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
Size Septic Tank.._ _Type 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 $ ( Signed ) _
(Si
No i
Permit No X5
Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the building or other
structure herein described. This application is made in compliance and conformity with the Building Ordinance of Miami Shores Village, Florida,
and all provisions of the Laws of the State of Florida, all ordinances of Miami Shores Village and all rules and regulations of the Building Division
of Miami Shores Village shall be complied with, whether herein specified or not. A copy of approved plans and specifications must be kept at
building during progress of work.
street...
Owners Name and Address
Registered Architect and /or Engine — -
]EstplPying Plumber's Name
a��. � : ;� , .., No....— !' S...-'-
Location and Legal Description Lot. Bko SubdivWo_n. —_� _..
Street and Number where work is to be performed —No _ ./��L Street_.. _ �1 Cj `r
r
State work to be performed and purpose of building (By Floor)_-- .._ —_.. Li.r.a . _ -_t_ lAi ‘,! , _IL 6 J
New Building.__._ _ _.._ _.. Remodeling_-___._ ._._. -.__ Addition...____..._ Repairs L No. of Stories....
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 liar com-
plied with the provisions thereof, and will require similar compliance from all contractors or sub - contracto employed by him in the wort- to he
performed, under this permit; and will post or cause to be posted for inspection on the site of the w such public notice or notices as are
required by the Act. The undersigned agrees to employ only such sub - contractors, k . .. or�ned under this permit, As are
licensed by Miami Shores Village.
STATE OF FLORIDA, 1
COUNTY OF DADE.
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take aclmowledgments, personally appeared
to me well known, and who, being by me first duly sworn, upon oath deposes and says that he is the -._ - .------ -_ - -.. _ _. - - - --
of the above described construction, that he has carefully read the foregoing application, and that be did sign the same, and that all facts
therein by him stated are true.
M Commission Expos Notary Public, State of Florida
NOTE: A re- inspection fee of $1.00 will be made whoa snob rwisspaotke V soads by improper notice for inspection, or faulty
materials and /or worlamanshtp.
7718 N. E. 2ND AVENUE
›fc
JOHN F. GAFFNY
PLUMBING CONTRACTOR
MIAMI, FLA.
0,21ft`t,/,
f A
PHONE 7-5284
*
er r
k 1JL
;t.
BUILDING
ELECTRICAL
PLUMBING
ROOFING
Owner of
Building
11
f. ,r
n
PERMIT 'NA 12298
Work to be performed under this Permit
Architect
Contractor
or Builder
Legal Lot BL
Description.
Address of
Building
MIAMI SHORES VILLAGE, FLORIDA
Subdi-
vision
Value of
Project $
DATF / r' -' 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.
CONTRACTOR OR BUILDER
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.
7
Owner's Name and Address ____U; '
Registered Architect and /or Engineer
Employing Plumber's Name ) ?Lk., - 4 - 4 :-/+- No. Street l ..
Location and Legal Description Lot Block Subdivision
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 67i X .S
Feet of Drain Tile
7
STATE OF FLORIDA, 1
j ss.
COUNTY OF DADE.
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
Type of Tank____ i
Dist. Feet of Tank or Drain Field from Well
Date
No. 6
street ___2 • L • __
Capacity Gals
Street 72 - - Q_
40
Nature of Water Supply: City —Well. Size of Soakage Pit
--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ______________
Amount of Permit $ � - s__ol ' / 0 c _- _______ (Signed)
Plumbing Inspector.
The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations as an employer of labor
under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Permanent Supplement, and has com-
plied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors employed by him in the work to be
performed under this permit; and will post or cause to be posted for inspection on the site of the work such public notice or notices as are
required by the Act. The undersigned agrees to employ only such sub - contractors, on work to be performed under this permit, as are
licensed by Miami Shores Village.
(Signed) . \ �
aster 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
LAUNDR
TUBS
URINALS
CATCH
BASIN
FLOOR
DRAIN
DRINKING
FOUNT'NS
TOTAL
FIXTURES
CONTR.
LIST
I
CHECK
/ 0
7 s
7s
SEPTIC
TANNK
SEWER
CONN.
DRAIN
FIELD
SOAKAGE
PIT
GREASE
TRAP
SOLAR
HEATER
DEEP
- WELL
SPRKLR.
SYSTEM
SWIM'G
POOL
CONTR.
LIST
-
X
/
/
/ , Q
f7
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.
7
Owner's Name and Address ____U; '
Registered Architect and /or Engineer
Employing Plumber's Name ) ?Lk., - 4 - 4 :-/+- No. Street l ..
Location and Legal Description Lot Block Subdivision
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 67i X .S
Feet of Drain Tile
7
STATE OF FLORIDA, 1
j ss.
COUNTY OF DADE.
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
Type of Tank____ i
Dist. Feet of Tank or Drain Field from Well
Date
No. 6
street ___2 • L • __
Capacity Gals
Street 72 - - Q_
40
Nature of Water Supply: City —Well. Size of Soakage Pit
--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ______________
Amount of Permit $ � - s__ol ' / 0 c _- _______ (Signed)
Plumbing Inspector.
The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations as an employer of labor
under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Permanent Supplement, and has com-
plied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors employed by him in the work to be
performed under this permit; and will post or cause to be posted for inspection on the site of the work such public notice or notices as are
required by the Act. The undersigned agrees to employ only such sub - contractors, on work to be performed under this permit, as are
licensed by Miami Shores Village.
(Signed) . \ �
aster 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.
PLUMBING IN MIAMI 30 YEARS
i r
NORTON PLUMBING CO.
CONTRACTING - REPAIRING
MAINTENANCE
80H N. W. IST PLACE PHONE 7-3897
MIAMI 38. FLORIDA
3
*4 ESTIMATES CHEERFULLY GIVEN
7'
2
C
c 41 iami �hores9 llage
F L O A 1 D A
PLUMBING PERMIT N9 1226
LOT BLOCK SUBDIV ION
to in all the following described pluml4ng, in accordance with the laws, statutes and regu-
lations of Miami Shores Village, Florida and the State of Florida, governing plumbing and
drainage work done in,.l 1iami Shores Village, Florida.
For a_story /4
building at
Fixtures
Fixtures $
Sewer $
*tic Tank /
Total $
Village Plumbing Inspector
Received Payment by
i
f OWNER f
;COT
BLOCK
SUBDIVISION
�.
/il. "'v •
1/
• J f
)`t f ', / G
.2 3 -f'�
i,,,_ � ji
/7
c 4 1iami Aores91 9l
L O
PLUMBING PERMIT
to install the following described plumbing, in accordance with the laws, statutes and regu-
lations of Miami Shores Village, Florida and the State of Florida, governing plumbing and
drainage work done in Miami Shores Village, Florida.
For a�story � �- - -( •�- •
buildin at €
i
�' � /// /
`•
Fixtures •., f ,
Fixtures '71 $
Sewer $ / ' 0
•ic Tank $
Total $ !l
Village Plumbing Inspector Kl
J
Received Payment by
N9 1161
BUILDING
ELECTRICAL
PLUMBING
ROOFING
Owner of
Building
Architect
Contractor
or Builder
Lot II BL
Description.
Address of
Building 1 1
MIAMI SHORES VILLAGE, FLORIDA
n PERMIT N? 12286
❑ Work to be performed under this Permit
Subdi-
vision
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 app don
herefor in strict compliance with all ordinances pertaining thereto and with the understanding that the work will be performed in compliance with any s,
drawings, statements or specifications that may have been submitted to and approved by the proper municipal authorities. This Permit may be revoked 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 p . is
granted is the understanding that the contractor or builder named above assumes the responsibility for a thorough knowledge of the ordinances and `
pertaining to the work covered hereby whether shown on the plans or drawings or in the statements or specifications and that he Assumes responsibil work
done by his agents, servants or employees.
INSPE
In consideration of the issuance to me of this permit I agree to perfd' 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.
CONTRACTOR OR BUILDER
Signed•
DATE / • ""' . " «J/ 195
Contractor's
License No
BY
Amt. of
Permit
G
AUTHORITY
BATH
CL3SETb TUBS
SHOWERS
LAVA-
TORIES
SINKS
SLOP
SINKS
LAUNDRY
rues
URINALS
CATCH
BASIN
FLOOR
DRAIN
DRINKING
FOU NT' NS
TOTAL
FIXTURES
CONTR.
Llel
CHECK •----- ---- -^
--
~—'
SEPTIC
TANK
SEWER
CONN.
DRAIN
FIELD
SOAKAGE
PIT
GREASE'
TRAP
SOLAR
HEATER
DEEP
WELL
SPRKLR.
SYSTEM
SW IM'G
POOL
CONTR.
LIST
CHECK
,,,,/
Permit No.._. l..- - - -�� --
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.
f 9�
Owner's Name and Address-- .. /
Registered Architect and /or Engineer _____. _ __ - _--- •------ _-- -_----- ____ - •
Employing Plumber's Name. a i�
___ Block_
Street and Number where work is to be performed —No / pp
State work to be performed and purpose of building (By Floors)_._DI ...._.D_y_____
New Building ........... - ...____. - -..__. Remodeling ___ -_ _ _____ Addition
Location and Legal Description Lot--
Size Septic Tank
Feet of Drain Tile
Nature of Water Supply: City—Well.
Amount of Permit $_
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
Z C11 - - -- No._- 3 . -_ Street �
(Signed)...
/Ii
Date _ � // 6 / /
Street..1 V
subdivision- .__ -__ -_ _ --
Streek r ........
l
My Commission Expires Notary Public, State of Florida
/ -71
r
Repairs No. of Stories . . . ....
Type of Tank_ Capacity Gals
—Dist. Feet of Tank or Drain Field from Well
------- .-- -___ -_ _ - -- -Size of Soakage Pit
Plumbing Inspector.
The undersigned applicant for this building permit does hereby certify that he understands and accepts his obli tions as an employer of labor
under the Florida Workmen's Compensation Act, being Section 5988, Compiled General Laws of Florida Perina{fent Supplement, and has com-
plied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors empFoyed 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)..1.____'..._ y..+ - ,. __ :I� _..�,_ ' r te : ,1
Master Plumber.
STATE OF FLORIDA, l
COUNTY OF DADE. I
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.
BUILDING
ELECTRICAL
PLUMBING
ROOFING
Owner of
Building
Architect
Contractor
or Builder
Legal
Description
Address of
Building
❑ DATE
PERMIT N? 6986 Contractor s
❑ Work to be performed under this Permit
Lot
CONTRACTOR OR BUILDER
MIAMI SHORES VILLAGE. FLORIDA
BI
z
License No.
195 "
Subdi-
vision
Value of I Amount of
Project $ " 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- $Y.
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 ac•
cepting this permit I assume responsibility for all work done by either, myself, my agent, servant or employee.
BY AUTHORITY
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING n-,kiMIT
(� l
Permit No " � ____ Date L i"
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 A >______ ____ ___ ____ No. 6 _ Street__
Registered Architect and /or Engineer _ ___.____ —__
c
Employing Plumber's Name __.l c -! f__� -� No.
Location and Legal Description Lot.
Amount of Permit $
Block
Addition.
-- L�
(Signed)._
Street LY' '
Subdivision
Street and Number where work is to be performed- No.______ __ Street_
State work to be performed and purpose of building (By Floors)
New Building Remodeling_
Repairs No. of Stories.
Capacity Gals
Size Septic Tank .......... ---- _ - - - - Type T
Ms
Feet of Drain Tile 4 .21 st. Fee of TMC or Drain Field from Well
Nature of Water Supply: City-Well.
__Size of Soakage Pit
1'
Plumbing Inspector.
undersigned applicant for this building permit does hereby certify that he understands and accepts his ob)t ations as an employer of labor
under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Pennanent Supplement, and bus 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
regained by the Act. The undersigned agrees to employ only such sub- contractors on w to be performed under this permit, as are
licensed by Miami Shores Village.
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
Master Plumber.
STATE OF FLORIDA, 1 as.
COUNTY OF DADE.
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeared
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 worlananship.
CLOSETS
BATH
TUBS
SHOWERS
LAVA-
TORIES
INK
SS
SLOP
SINKS
LAUNDRY
Tuef
U RINAL{
CATCH
BASIN
FLOOR
DRAIN
DRINKING
FOUNT'NS
TOTAL
FI %TORES
CONTR.
LIST
CHECK
SEPTIC
TANK
SEWER
CONN.
DRAIN
FIELD
SOAKAGE
PIT
GREASE
TRAP
SOLAR
HEATER
DEEP
WELL
SPRKLR.
SYSTEM
SW IM' O
POOL
CCNTR.
LIST
_.
CHECK
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING n-,kiMIT
(� l
Permit No " � ____ Date L i"
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 A >______ ____ ___ ____ No. 6 _ Street__
Registered Architect and /or Engineer _ ___.____ —__
c
Employing Plumber's Name __.l c -! f__� -� No.
Location and Legal Description Lot.
Amount of Permit $
Block
Addition.
-- L�
(Signed)._
Street LY' '
Subdivision
Street and Number where work is to be performed- No.______ __ Street_
State work to be performed and purpose of building (By Floors)
New Building Remodeling_
Repairs No. of Stories.
Capacity Gals
Size Septic Tank .......... ---- _ - - - - Type T
Ms
Feet of Drain Tile 4 .21 st. Fee of TMC or Drain Field from Well
Nature of Water Supply: City-Well.
__Size of Soakage Pit
1'
Plumbing Inspector.
undersigned applicant for this building permit does hereby certify that he understands and accepts his ob)t ations as an employer of labor
under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Pennanent Supplement, and bus 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
regained by the Act. The undersigned agrees to employ only such sub- contractors on w to be performed under this permit, as are
licensed by Miami Shores Village.
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
Master Plumber.
STATE OF FLORIDA, 1 as.
COUNTY OF DADE.
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeared
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 worlananship.
CLOSETS
BATH
TUBS
SHOWERS
LAVA -
TORIES
SINKS
/
SLOP
SINKS
LAUNDRY
TUBS
URINALS
CATCH
BASIN
FLOOR
DRAIN
DRINKING
FOUNT' NS
TOTAL
FIXTURES
1
-ell
A -244 5M 5 -39
Address
DIVISION OF PUBLIC INSPECTION
DEPARTMENT OF PUBLIC SERVICE
MIAMI, FLORIDA
I herewith submit the following plan of plumbing for approval:
Employing Plumber
New
For a
Dwelling jg
Owner or Agent
Builder or Contractor is
Ground Rough -In Rain Leader
Approved by
Condemned by
ROUGH -IN INSPECTION
Plan No e
Date /
REMARKS
Old ❑ Story
Store ❑ Garage ❑
t 1 " Address
Address
Lot No.2. .: jf 22Block No. 17 Subdivision
)‘.
Date
SEWER INSPECTION
A M P.M A M P.M.
Approved by
Condemned by
REMARKS
Sewer Permit No
Work executed by
❑ Addition ❑ Reu(odeled ❑
Apartment ❑ Hotel ❑ Office Bldg. ❑
r
, 197
Sewer Connections At center of St. ❑ At curb ❑ At property line ❑ Existing in alley ❑ Existing bldg. sewer
To septic tank Ca Existing bldg. drain ❑ To dry well
A charge of $1.00 will be made for correcting any inaccuracies in the foregoing information.
DO NOT WRITE IN SPACE BELOW. THIS IS FOR THE USE OF THE DIVISION OF PLUMBING INSPECTION ONLY.
0
Date
FINAL INSPECTION
AM PM
Approved by
Condemned by
REMARKS
THIS SPACE FOR ELEVATION SKETCH
In alterations to existing work show the old work in red ink and the new in black ink. Letter each stack
to correspond with the opening shown in floor plan or ground plan on opposite page.
A PERSPECTIVE SKETC
PROVIDED THE WORK t.
Sketch position of building and lot lines in square (which represents an entire city block), showing on which
street the building and lot faces; also show exact locations of "Y" in street and position of lateral or septic
tank. Show sewer and any change in direction same may make. The purpose of this plan is to have an accurate
layout of all underground pipes for future references.
WEST
NORTH
A
EAST
Remarks :
NORTH
SOUTH
WILL BE SUFFICIENT
.N BE CLEARLY SHOWN
THIS SPACE FOR PLAN SKETCH
Show location of stacks and horizontal drains inside building, lettering each opening to correspond with the
stack connections as shown on the elevation sketch on opposite page. Where ground work is concealed, draw
floor plan of building showing location of walls, partitions, columns, etc., and the location of all horizontal
soil and waste pipes, in reference to same.
Installed by:
(
NEw
:
For a (Store:
Owner or A:en :
Remarks:
PERMIT NO.
Relaying:
(Garage wash floor:
LOT N044305- 12 - BLOCK N0.
Address of work: /6.0 J. G .
No. of Plumbing Fixtures:
Nature of water supply:
Type of tank installed:
Size of Soakage Pit:
Additional information:
Ready for Inspection: Date:
APPROVED BY: r;'.. r
DADE COUNTY ZONING VICE
Form #11
DIVISION OF PLUMBING INSPECTION
I herewith submit the following application for a permit covering the installation
of a Septic Tank ‘/ /
Soakage Pit: :
New: ✓ : Feet of drain tile: ,s
Address:
Q ,4
Old: Story: if Addition: Remodeled:
Garage; Apt.:
Building has: .,�_ Stores; Offices; Apts.; Hotel Rms; 2- Bedrms
Laundry Tubs:
Well:
161-1% Tank capacity in : ,5 71
leeogIamlb
Waste water from a:
SUBDIVISION 3
Purpose of same:
CONDEMNED BY:
Date:
Address:
Time: 0
Floor Drains:
Hotel: Office Bldg: Res: /
Feet distant from all wells:
(
•
\ `
4-
�