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308 NE 99 St (16)MIAMI SHORES VILLAGE BUILDING DEPARTMEI[T 305- 795 -2204 ir Inspection Re Date 1 Approved Correction Re- Insp'n Fee Type Insp'n I /`� Permit No. 1 v 1 4 3 (25 4) Name r (acs Address == Q� S� Company f C- Phone # Inspection Date Type Insp' Permit No. Phone # MIAMI SHORES VILL BUILDING DEPARTME 305- 795 -2204 c ilding Inspectio Date I 1 C . Name Yt3 ( Address 3() l — l 3) Compan P 1' ` Ao1q IC . Inspection Date Approved Correction Re- Insp'n Fee Miami Shores Village 10050 NE 2nd Avenue Phone: 305 - 795 -2204 Permit Number: PL2004 -253 Printed: 9/2/2004 - Applicant: LUIS KARAM Owner: KARAM LUIS - JOB ADDRESS: 308 NE 99 ST Contractor MR C'S SEPTIC TANK Local Phone: 305 - 651 -7859 Parcel # 1132060135590 Signed: (INSPECTOR) Plumbing Permit Contractor's Address: P 0 BOX 693239 Page 1 of 1 Legal Description: MIAMI SHORES SEC 1 AMD PB 10 -70 LOTS 9 & 10 BLK 41 LOT SIZE 100.000 Fees: Description Amount FEE2004 -8918 Building Fee $175.00 FEE2004 -8919 CCF $1.20 FEE2004 -8920 Notary Fee $5.00 FEE2004 -8921 Training and Education Fee $0.40 FEE2004 -8922 Technology Fee $4.37 FEE2004 -8923 Scanning Fee $3.00 FEE2004 -8924 Builders Bond $300.00 Total Fees: $488.97 Total Fees: $488.97 Total Receipts: $488.97 Permit Status: APPROVED Permit Expiration: 2/23/2005 Construction Value: $2,000.00 Work: TO REPLACE DRAINFIELD 400 SQ FT AND TANK 1050 GAL In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I assume responisibility for all work done by either myself, my agent, servants or employes. Signed: (Contractor or Builder) BY: BUILDING PERMIT APPLICATION FBC 2001 Contractor's Company Name Contractor's Address /99 3 Z / VP- City /14 /1140#44,1 State t`j Qualifier '/4./ Miami Shores Village Building Department 10050 N.E.2nd Avenue, IMMtami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 /4. c (' RECEIVD M162 2014 Permit No. Pi d`i - .45e3 Master Permit No. Mechanical Roofing Permit Type (circle): Building � Electrical Owner's Name (Fee Simple Titleholder) I'� 0 lo ( 01,4 1 Phone # 34 — ft" p Owner's Address 11 f City J44 c Y1.. ‘4 s "y State ' /,. Zip 3 fad Tenant/Lessee Name ('� �'t1.F ^'� 13tAd r b M 4dC &4J - Phone # .758 -91‘,4 Job Address (where the work is being done) 3a8 ,e✓ 6. f 9 si City Miami Shores Village County Miiami•Dade Zip Is Building Historically Designated YES NO Phone # 3o,' -4f 1 7h'$ Zip ? 1I State Certificate or Registration No. Certificate of Competency No. Architect/Engineer's Name (if applicable) .ai $ Value of Work For this Permit Qir Type of Work: ❑Addition DAlteration Describe Work: ' Phone # Square Footage Of Work: V i ew ffiRepair/Replace, 0 Demolition * * * * * * * * * * * * * * * * * * * * * * * * * *** P ees * * * * * * * * * * * * * * * * * * * * * * * * * * * * * Submittal Fee $ Permit Fee $ l 3 •• 0 CCF $1 + ate • CO/CC Notary $ 5 . 00) Training/Education Fee $ 1 4 V Technology Fee'$ LI -31- Scanning $ • CC) Radon $ ZoninR Bond 5500 - Q 0 Code Enforcement $ Structural Plate Review. $ Total Fee Now Due $ i - 0 k 7 5s 5 (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 will be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be approved and . ' nspection fee will be charged. nt cat1.0.11,1iNwL.icocKING commassioN k DO 011747 • ,,,, bonuao Thru Notary Public , r,� +era NOTARY PUBLI Sign: �-- Print: My Commission Expires: *** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** 0 * APPLICATION APPROVED BY: „:„,,) Chc 05/13/03 an oath. NOTARY PUBL C: Sign: Print: My Commission Expi Atlantic Contractor The foregoing instrument was acknowledged before me this2. Owner or Agent The foregoing instrument was acknowledged before me this day of , 20 _, by day of 20 by ,,� who is personally known to me or who has produced who is personally known to e or who has produced •K , _ n 'r 'tonded'No onding as ' cation and who did take an oath. **** ************************ * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** '/ 2- Plans Examiner Engineer Zoning ** CO STRUCTION PERMIT FO [N] New System [ ] [X(] Repair EN] APPLICANT: L V t•S /( ad e4 c44 . PROPERTY ADDRESS: LOT: ! ( 0 BLOCK: y PROPERTY ID #: ' ' 3 2 0' - 0 1 3 GE` 1 1 SYs L 'STATE OF FLORIDA DEPARTMENT OF HEALTH,.. ONSITE SEWAGE TREATMENT CONSTRUCTION PERMIT 7 IGN AND SPECIFICATIONS D FILL REQUIRED: [ {vCrKJ ] INCHES SPECIFICATIONS BY: APPROVED BY: DATE ISSUED: Existing System Abandonment j 'IF.r; , r a i`� t 23 , SE A - t 0 g hJ, s '�'. SUBDIVISION: DE 4016, 12/99 (Page 1) (Previous Editions May Be Used) AND DISPOSAL SYSTEM 7'L Holding Tank Temporary SITE [20, [INCHES /FTl [ABOVE /BELOW] (r, 3a [ s/FT] [ABOVE /BELOW] PERMIT NO. 0- 3 I 27 DATE • PAID(„ FEE PAID: 1 0 0 0 0 RECEIPT #: S 0 TO & Now 1 1 3 2 2 ° 7 7 7 [ N ] Innovative [ ] tOr wj SC F' 3 Vae /Cc144 1 5 t.CW [SECTION, TOWNSHIP, RANGE, PARCEL NUMBER] [OR TAX ID NUMBER] SYSTEM MUST BE CONSTRUCTED IN ACCORDANCE WITH SPECIFICATIONS AND STANDARDS OF SECTION 381.0065 F.S., AND CHAPTER 64E -6, F.A.C. DEPARTMENT APPROVAL OF SYSTEM DOES NOT GUARANTEE SAFTISFACTOR: PERFORMANCE FOR ANY SPECIFIC PERIOD OF TIME. ANY CHANGE IN MATERIAL FACTS, WHICH SERVED AS BASIS FOR ISSUANCE OF THIS PERMIT, REQUIRE THE APPLICANT TO MODIFY THE PERMIT APPLICATION SUCH MODIFICATIONS MAY RESULT IN THIS PERMIT BEING MADE NULL AND VOID. ISSUANCE OF THIS PERMI: DOES NOT EXEMPT THE APPLICANT FROM COMPLIANCE WITH OTHER FEDERAL, STATE, OR LOCAL PERMITTIN( REQUIRED FOR DEVELOPMENT OF THIS PROPERTY. T [ 0'0 ] GALLONS / GPD SEPTIC TANK /AEROBIC UNIT CAPACITY MULTI- CHAMBERED /IN- SERIES [ )] A [ ] GALLONS / GPD CAPACITY MULTI- CHAMBERED /IN- SERIES [ ] N [ ._ ] GALLONS GREASE INTERCEPTOR CAPACITY [MAXIMUM CAPACITY SINGLE TANK: 1250 GALLONS] K [ } ] GALLONS DOSING TANK CAPACITY 1 ]GALLONS Q [ ] DOSES PER 24 ERS # PUMPS [ ] D [3 0 V ] SQUARE FEET PRIMARY DRAINFIELD SYSTEM R [ -- ] SQUARE FEB7 SYSTEM[ A TYPE SYSTEM: [ v ] STANARD [A FILLED [ ] MOUND I CONFIGURATION: [ ] TRENCH [".1 BED 1 1 N F LOCATION OF BENCHMARK: 1 1 . 7 0 ' ' 1, (. 4 6 . - f- . E / e c/ I ELEVATION OF PROPOSED SYSTEM[ E BOTTOM OF DRAINFIELD TO BE EXCAVATION REQUIRED: [ 4 ( ] INCHES INSTALL L 2 07 SUGTirr -t( z ... • BENCHMARK /REFERENCE POINT BENCIDtARK /REFERENCE PoIN9 0 T EXPIRATION DATE: Part 1 - Health Department 4 - ..-' R *emu 11IZ� /o Page 1 of 3 STATE OF FLORIDA DEPARTMENT OF MALTA. ONSITE SEWAGE DISPOSAL SYSTEM APPLICATION FOR CONSTRUCTION P*RMIT =ass-- --- sssssss PROPERTY ID #: r 72 f / /4 Abiding Tank APPLICATION FOR: [ l New p Systea ( 1 Existing System [�] Repair [ ] Abandonment , APPLICANT: Li( f AGENT: lug. l s fpi ! - NAILING ADDRESS ; V • u 4 30x £ 33 23 nlw a .4A P 'g'11.4 - 1 l Temporary PROPERTY INFORMATION LOT: 4 4/1> BLOCK: 1 A SUBDIVISION: AIM; MG 1,L PEaIT aO." L(4J tuns PAID: FEE PAID: IPT 1: ] Innovative l TELEPHONE: la -1 ;? 7 � c • TO BE COMPLETED BY APPLICANT OR APPLICANT'S AUTHORIZED AGENT. SYSTEMS MUST BE CONSTRUCTED BY A PERSON LICENSED PURSUANT TO 489.105(3)(a) OR 489.552, FLORIDA STATUTES. PLATTED: /%/ ZONING: I/11 OR EQUIVALENT: [ Y / N ] PROPERY 8IZE: 414 ' EE J SUPPLY: [ ] PRIVATE PUBLIC [- )<=2000GPD [ ✓]>2000GPD IS SEWER AVAILABLE AS PER 381.0065, FS? [ Y 4:10 DISTANCE TO SEWER: PT PROPERTY ADDRESS: ( TO PROPERTY: BUILDING INFORMATION Unit Type of No Establishment 2 3 4 3 O g /J6 (/A 131 8 • A/& 2 i /VC 9y (1I -./- EA 11.e4 DH 4015, 10/97 — Page 1 (Previous editions may be used) Stock Number: 5744 -001- 4015 -1 ( V] RESIDENTIAL [ ] • COIOWRCIAL '3 7 371 /4/P No. of Building Commercial /Institutional System Design Bedrooms Area Sgft Table' 1, Chapter 648 -6, PAC [ ] Floor /Equipmen sins ( ] Other (Specify) SIGNATURE: E � ' l 1 ( p i 6 . e . r ' DATE: g764 Page 1 of 3 DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES gi n.. 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Ian Approved J Not Approved ? c� ( County Public Unit SIGNATURE Date Z I , c v I u Miami Shores Village 10050 NE 2nd Avenue Phone: 305 - 795 -2204 Printed: 9/2/2004 • Applicant: LUIS KARAM Owner: KARAM LUIS • JOB ADDRESS: 308 NE 99 ST Contractor MR C'S SEPTIC TANK Local Phone: 305 - 651 -7859 Parcel # 1132060135590 Signed: (INSPECTOR) Plumbing Permit Permit Number: PL2004 -254 Contractor's Address: P 0 BOX 693239 Page 1 of 1 Legal Description: MIAMI SHORES SEC 1 AMD PB 10 -70 LOTS 9 & 10 BLK 41 LOT SIZE 100.000 Fees: Description Amount FEE2004 -8913 Building Fee $175.00 FEE2004 -8914 CCF $0.60 FEE2004 -8915 Notary Fee $5.00 FEE2004 -8916 Training and Education Fee $0.20 FEE2004 -8917 Technology Fee $4.37 Total Fees: $185.17 Total Fees: $185.17 Total Receipts: $185.17 Permit Status: APPLIED Permit Expiration: 2/23/2005 Construction Value: $500.00 Work: ABANDONMENT 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: BUILDING PERMIT APPLICATION FBC 2001 Permit Type (circle): Building Electrical 1(i11 Z c i Owner's Name (Fee Simple Titleholder) Owner's Address O' / ttE 'U 1 City !t'1l State / Tenant/Lessee Name /14, fit sb .W'ir Job Address (where the work is being done) 3o' , �fc l g SI City Miami Shores Village County Miami - Dade Is Building Historically Designated YES NO Contractor's Company Name /1/4, Contractor's Address t9 31-- Cit 1 State Qualifier `4/ X �+! State Certificate or Registration No. $ Value of Work For this Permit —441 00 Type of Work: ❑Addition Describe Work: Submittal Fee $ Notary $ c5. Scanning $ Code Enforce i nt $ 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 • Tel: (305) 795.2204 Fax: (305) 756.8972 Permit No. 9 1o`1--5L1 Master Permit No. Miami Shores Village Building Department Plumbing Total Fee Now Due $ l 63 X-4— 4 C 535 (Continued on opposite side) Mechanical Rooms Phone # 346 - 7�C Zip 331 Phone it Ar 7 -vie Phone # Zip 134 I Square Footage Of Work: ❑New ® Rep eplace * * * * * * * * * * * * * * * * * * * * * * * * * * ** Fees * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** Permit Fee $ 1 1 S • 00 CCF $ 00 • CO /CC n - Training/Education Fee $ , a0 Technology Fee $ Radon $ Zoning Bond $ Structural PIan Review. $ Zip 'q ' `ta Certificate of Competency No. Architect/Engineer's Name (if applicable) Phone # ❑ Demolition 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 will be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. Signature Signatur Owner or Agent The foregoing instrument was acknowledged before me this The fore ing instrument was acknowledged before me s -') ^ thi day of , 20 _, by day of k ,�� , 20 04, by r J` , who is personally known to me or who has produced who is person y kn to me or who has produced As identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC Sign: Sign: Print: Print: My Commission Expires: APPLICATION APPROVED BY: Chc 05/13/03 cao My Commission Expires: Contractor 3.1 dentification and who did take an oath. ***************************************************************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** **************************************** 4*** w******************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** ,� 0l F Plans Examiner Engineer Zoning Permit No.. ' O649 Owner's Name and Address tegistered Architect and /or Engineer mploying Plumber's Name. 1!i!ivtai.Reeer1 .A�1 Location and Legal Description Lot_ Street and Number where work is to be performed —No State work to be performed and purpose of building (By Floors)_ New Building Remodeling Amount of Permit $ STATE OF FLORIDA, COUNTY OF DADE. MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT Addition..._...__ Repairs l< - - -- -- 1 f2 O (Signed)--- _ — . - __ - 14 - /31.7 __. Capacity Gals. No. of Stories 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 My Commission Expires Notary Publlo, State of Florida 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. ZE- ...— —. No ` ] ®F Street..' JC ....9 9 6.7 Street. & '�• -.�?,/ Block +y /� Suubd di i _L Street_ ' v ,f- v4 �? ar Plumber. 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 L upi.lement, and has com- plied with the provisions thereof, and will require similar compliance from all contractors or sub- contractors e •yed ly him In tLe wcrk performed under this permit; and will post or cause to be posted for inspection on the .too the work ch •ubif , notice lr no'ices as am required by the Act. The undersigned agrees to employ only such sub - contractors, on to licensed by Miami Shores Village. this yirluit as an Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personalty 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 sarne, and that all facts therein by him stated are true. NOTE: A re- inspection fee of $1.00 will be made when mach re-inspection is mederneosssary by improper notice for inspection, or faulty materials and /or workmanship. CLOSETS BATH ma, b HOW[R• LAVA. TORTE• SINKS SLOP YINK• LAUNDRY Tugs UR INAL{ CATCH BASIN FLOOR DRAIN DRINKING FOUNT'N• TOTAL FIXTURES CONTR. LIST CHECK — SEPTIC TANK SEWER CONN. DRAIN FIELD SOAKAGE PIT G TRAP SOLAR H DEEP WELL SPRKLR. SYSTEM SWIM•G POOL - -' CONT1 . LIST CHECK Permit No.. ' O649 Owner's Name and Address tegistered Architect and /or Engineer mploying Plumber's Name. 1!i!ivtai.Reeer1 .A�1 Location and Legal Description Lot_ Street and Number where work is to be performed —No State work to be performed and purpose of building (By Floors)_ New Building Remodeling Amount of Permit $ STATE OF FLORIDA, COUNTY OF DADE. MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT Addition..._...__ Repairs l< - - -- -- 1 f2 O (Signed)--- _ — . - __ - 14 - /31.7 __. Capacity Gals. No. of Stories 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 My Commission Expires Notary Publlo, State of Florida 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. ZE- ...— —. No ` ] ®F Street..' JC ....9 9 6.7 Street. & '�• -.�?,/ Block +y /� Suubd di i _L Street_ ' v ,f- v4 �? ar Plumber. 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 L upi.lement, and has com- plied with the provisions thereof, and will require similar compliance from all contractors or sub- contractors e •yed ly him In tLe wcrk performed under this permit; and will post or cause to be posted for inspection on the .too the work ch •ubif , notice lr no'ices as am required by the Act. The undersigned agrees to employ only such sub - contractors, on to licensed by Miami Shores Village. this yirluit as an Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personalty 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 sarne, and that all facts therein by him stated are true. NOTE: A re- inspection fee of $1.00 will be made when mach re-inspection is mederneosssary by improper notice for inspection, or faulty materials and /or workmanship. Permit No Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the building or other structure herein described. This application is made in compliance and conformity with the Building Ordinance of Miami Shores Village, Florida, and all provisions of the Laws of the State of Florida, all ordinances of Miami Shores Village and all rules and regulations of the Building Division of Miami Shores Village shall be complied with, whether herein specified or not. A copy of approved plans and specifications must be kept at building during progress of work. Owner's Name and Address Registered Architect and /or En ginle Employing Plumber's Name .t. Q_ Location and Legal Description Lot Amount of Permit $ IS ss. MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT 21,4Z— No. Size Septic Tank_ , �� •. - - -• Type of Tank Feet of Drain Tile._ -__..? 9- u�== - - -- t. Feet of Tank or Drain Field from Well Nature of Water Supply: City—Well. ._____.____.Size of Soakage Pit (Signed)- No ,.. .1,.._.,............m....... a S treet..a.... (Sim) (.T' 1 / Date. _.._.._--- ••--- -...___... Street- Subdlvidon.._.________.__.____ � Bloc Street and Number where work is to be performed —No 3 6 r + ' ] ' `G / 9 Street State work to be performed and purpose of building (By Floors) ___.__.__._.._ New Building Remodeling _ _ __.__._._ Addition. Repairs No. of Stories Capacity Gals._._...--- - - - - - _ -- ••- mbing Inspector. The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligati• 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- contractors employed by him in the work to be performed under this permit; and will post or cause to be posted' for inspection on the site of the work such public notice or notices as are required by the Act. The undersigned agrees to employ only such sub- contractors, on work to be performed under this permit, as are licensed by Miami Shores Village. Master Plumber. STATE OF FLORIDA, 1 COUNTY OF DADE. 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 be has carefully read the foregoing application, and that he did sign the same, and that all facts therein by him stated are true. M Conunission Expo Notary Public, State of Florida NOTE: A re- inspection fee of 0.00 will be made when such r.-inspection is made•neoeetary by improper notice for inspection, or faulty materials and /or workmanship. CLOSETS BATH TUBS "" LAVA• TORIES SIN" SLOP SINKS LAUNDRY TUSS URINALS CATCH BASIN FLOOR DRAIN DRINKING FOUNT'NS TOTAL FIXTURES CONTR. LIST CHICK SEPTIC TANK SEWER CONN. DRAIN FIELD SOAKAGE PIT G TRAP SOLAR H DEEP WELL SPRKLR. SYSTEM Swim.* POOL CONTR. LIST CHECK Permit No Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the building or other structure herein described. This application is made in compliance and conformity with the Building Ordinance of Miami Shores Village, Florida, and all provisions of the Laws of the State of Florida, all ordinances of Miami Shores Village and all rules and regulations of the Building Division of Miami Shores Village shall be complied with, whether herein specified or not. A copy of approved plans and specifications must be kept at building during progress of work. Owner's Name and Address Registered Architect and /or En ginle Employing Plumber's Name .t. Q_ Location and Legal Description Lot Amount of Permit $ IS ss. MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT 21,4Z— No. Size Septic Tank_ , �� •. - - -• Type of Tank Feet of Drain Tile._ -__..? 9- u�== - - -- t. Feet of Tank or Drain Field from Well Nature of Water Supply: City—Well. ._____.____.Size of Soakage Pit (Signed)- No ,.. .1,.._.,............m....... a S treet..a.... (Sim) (.T' 1 / Date. _.._.._--- ••--- -...___... Street- Subdlvidon.._.________.__.____ � Bloc Street and Number where work is to be performed —No 3 6 r + ' ] ' `G / 9 Street State work to be performed and purpose of building (By Floors) ___.__.__._.._ New Building Remodeling _ _ __.__._._ Addition. Repairs No. of Stories Capacity Gals._._...--- - - - - - _ -- ••- mbing Inspector. The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligati• 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- contractors employed by him in the work to be performed under this permit; and will post or cause to be posted' for inspection on the site of the work such public notice or notices as are required by the Act. The undersigned agrees to employ only such sub- contractors, on work to be performed under this permit, as are licensed by Miami Shores Village. Master Plumber. STATE OF FLORIDA, 1 COUNTY OF DADE. 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 be has carefully read the foregoing application, and that he did sign the same, and that all facts therein by him stated are true. M Conunission Expo Notary Public, State of Florida NOTE: A re- inspection fee of 0.00 will be made when such r.-inspection is made•neoeetary by improper notice for inspection, or faulty materials and /or workmanship.