PLUMBINGPermit 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
2tegistered Architect and /or Engineer '
_Employing Plumber's Name .- i.!..I -t_ !'r.L1_t.(�]�l.
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)_._.- .._ ... ..__/ —Lai
New Building ........ .................. Remodeling
Size Septic Tank_ ----- - - - - -. — .------ - - - - -- ._Type of Tank__ -------- - -._..
Feet of Drain Tile._.__ — ____Dist. Feet of Tank or Drain Field from Well
Nature of Water Supply: City — Wall.— __.___._..____.__ _ ._____ _ _._Size of Soakage Pit
Amount of Permit $
STATE OF FLORIDA,
se.
COUNTY OF DADE.
My Conunission Expires
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
(,_61E-A/ No.__ G! is s Street...!!`! F 59
Block_ Subdivision.._.
g 3 str
Addition.. _..._ Repairs
(Signed) 1L i. .__. ...
Date.
s A
RA1 N __i. . 1..6..
No. of Stories
Capacity Gals -- ...
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 Worlanen's Compensation Act, being Section 5968, Compiled General Laws of Florida Permanent yuP4lement, and has corn-
plied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors em ' . yed l y him in ft e work (•o b.
performed under this permit; and will post or cause to be posted' for inspection on the site of the work su • p . bli, notice or notice. +as as
required by the Act. The undersigned agrees to employ only such sub- contractors, • ^ • k to be • rf, ed .�ca s :rnit, as ar,
licensed by Miami Shores Village.
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personals• eppearecl
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 be did sign the same, and that all facts
therein by him stated are true.
Notary Public, State of Florida ,
NOTE: A re inspection fee of $1.00 will be made when such re-ioipection b made•neoessary by improper notice for inspection, or faulty
materials and /or workmanship.
GLOiRi
BATH
TUBE
SHOWERS
LAVA-
TORIES
SINKB
SLOP
SINKS
LAUNDRY
TUB•
URINALS
CATCH
BASIN
FLOOR
DRAIN
DRINKING
FOUNT•NB
TOTAL
FIXTURES
CONTR.
LOOT
--
CHECK
SEPTIC
TANK
SEWER
CONN.
DRAIN
FIELD
SOAKAGE
PIT
GREASE
TRAP
SOLAR
HEATER
DEEP
WELL
SPRKLR.
SYSTEM
SWIM'O
POOL
CONTR.
LIST
ti
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
2tegistered Architect and /or Engineer '
_Employing Plumber's Name .- i.!..I -t_ !'r.L1_t.(�]�l.
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)_._.- .._ ... ..__/ —Lai
New Building ........ .................. Remodeling
Size Septic Tank_ ----- - - - - -. — .------ - - - - -- ._Type of Tank__ -------- - -._..
Feet of Drain Tile._.__ — ____Dist. Feet of Tank or Drain Field from Well
Nature of Water Supply: City — Wall.— __.___._..____.__ _ ._____ _ _._Size of Soakage Pit
Amount of Permit $
STATE OF FLORIDA,
se.
COUNTY OF DADE.
My Conunission Expires
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
(,_61E-A/ No.__ G! is s Street...!!`! F 59
Block_ Subdivision.._.
g 3 str
Addition.. _..._ Repairs
(Signed) 1L i. .__. ...
Date.
s A
RA1 N __i. . 1..6..
No. of Stories
Capacity Gals -- ...
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 Worlanen's Compensation Act, being Section 5968, Compiled General Laws of Florida Permanent yuP4lement, and has corn-
plied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors em ' . yed l y him in ft e work (•o b.
performed under this permit; and will post or cause to be posted' for inspection on the site of the work su • p . bli, notice or notice. +as as
required by the Act. The undersigned agrees to employ only such sub- contractors, • ^ • k to be • rf, ed .�ca s :rnit, as ar,
licensed by Miami Shores Village.
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personals• eppearecl
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 be did sign the same, and that all facts
therein by him stated are true.
Notary Public, State of Florida ,
NOTE: A re inspection fee of $1.00 will be made when such re-ioipection b made•neoessary by improper notice for inspection, or faulty
materials and /or workmanship.
•
MIAMI SHORES VILLAGE
BUILDING INSPECTION DEPARTMENT
APPLICATION FOR BUILDING PERMIT
Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the build-
ing or other structure herein described. This application is made in compliance and conformity with the Building Ordinance of Miami
Shores Village, Florida, and all provisions of the Laws of the State of Florida, all ordinances of Miami Shores Village and all rules and
regulations of the Building Division of Miami Shores Village shall be complied with, whether herein specified or not. A copy of approved
plans and specifications must be kept at building during progress of the work.
Peter M. Kastning
Owner's Name and Address No X Street N..E, 99 .St...
Registered Architect and /or Engineer Monarch Pump Rr FC1.nt . CO.
1532 N.W. • 62nd St., Miami, Florida
Name and address of licensed contractor
Location and legal description of lot to be built on:
Lot Block Subdivision
Street and Number where work is to be done
State work to be done and purpose of building (by floors)
l -- -2 ;-rye- -o- pen - ellabo> t 40- feet- -c ee -p- far w- at- e- r- -ing -- -lawn
and for no other purpose.
New Building Remodeling Addition Repairs No. of Stories
To be constructed of Kind of foundation Roof Covering
Estimated Total cost of improvements $ Amount of Permit $
Zone cubage required .Plan Cubage
Distance to next nearest building Size of Building Lot
Maximum live load to be borne by each floor
I hereby submit all the plans and specifications for said building. All notices with reference to the building and its construction may
be sent to
The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations as an employer
of labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Law , Florida, Permanent SuPplement,
and has complied with the provisions thereof, and will require similar compliance fro all contractors su.- contractors employed by him
in the work to be performed under this permit; and will post or cause to be poste fo i pection on th of the work such public notice
or notices as are required by the Act. The undersigned agrees to employ only suc s c actors, on o to be .,rformed under this
permit, as are licensed by Miami Shores Village. / \ t, narc • at q Ut . Co.
Remarks (Signed) - - I ,
/i
STATE OF FLORIDA,
COUNTY OF DADE. j ss
Disapproved
(Signed)
Building Inspector
Chairman
Member
Member
Council Approved Date
NOTE: A charge of $1.00 will be made for
the Planning Board.
A re- inspection fee of $1.00 will be charged
materials and /or workmanship.
Date
May 27, 1957
Date ., 19
843-- -N-. E . -B t -ore
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally ap-
peared
PLANNING BOARD DATE
to me well known,
and who, being by me first duly sworn, upon oath deposes and says that he is the
of the above described construction, that he has carefully read the foregoing application, and that he did sign the same, and that all facts
therein by him stated are true.
Permit No S r S 3 Date___L11 / . . / !2 Read, Sworn to and Subscribed before me.
Notary Public, State of Florida
My Commission Expires
Member
Member
Member
Disapproved Date
making corrections or changes to this application after approval has been obtained from
when such re- inspection is made necessary by improper notice for inspection or faulty
TO THE
PAY 4 MUM C1LCI
ORDER OF
qfit 1°42."
THE PERMIT PROFESSIONALS
P.O. BOX 8205
CORAL SPRINGS, FL 33075
UNION BANK
Where Your Business Is Big Business.
954-910-4444
nionbk.com
FOR
10001-13 21.0° 1:06 700 770 31:
DATE
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Address. '0_3 449 99.97
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&aller S.S. # 262-3796
U Home Gas Corp
Vg 1060 SW 27 Ave
Miami Fl 33135
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CONTRACTOR
New Construction
/ ^ CT , /' /�
Name /ICY /J 60ci C, de,
License No./6 / (�
Address
/o 6o 5 '6 c.l 7
° /
Telephone G V3 .. /..5 . 71
Fax Gy3vc -/Z,
Qualifier Name /76 e d
(5024 z.
PROPERTY OWNER
New Construction
Name /
0 :Tee y 6q DTI ✓v
/
Address s e 3 0 O gg 54—
N1111- 11.t../C15, 'Cr.— 3
'5
9'
Home Telephone
.3 73'4- .5773
Business Telephone
$ 77 g�
Fax
Foundation Only
TYPE OF MANAGEMENT (✓ )
New Construction
Enclosure
Alteration Exterior
Repair
Alteration Interior
Demolish
Relocation of Structure
Shell Only
Foundation Only
Add'I Attachment
Other
Add'I Detachment
Other
INSTRUCTIONS - The following steps must he taken to obtain a permit from the Miami Shores Village:
Step 1.
Step 2. Submit the completed application with all necessary documents to the Building, Planning and Zoning Department for processing. During the
processing of your application, you may be asked to submit additional information.
APPLICATION
Job Address:
i 3 /
Lot I ��. tJ a 1� Block / 6 1
Subdivision f r S$;Pc_ PB PG Zoning Linear Feet
Current Use of Property �-s Square Feet C Units Floors
K Value of Work , 3� � • d U Bldg Value
Tax Assessed/Appraised Value
Flood Zone Base Floor Elev.
Folio Number
Proposed Use of Property# c 3
Tenant Information
Complete the attached permit application which must be signed by the property owner and qualifier. Both signatures must be notarized. Please
print or type to allow for a more accurate processing of your application. If roofing work will be done, a roofing application must be submitted
along with this permit application.
PERMIT TYPE (✓ )
Building
Electrical
Mechanical
Plumbing
LPGX
Roofing
Fence
Other
1/14 /64-elii 5 pee $
Address Apt. City
$ °3 roe et et 54.
D 1 poclo
PERMIT CHANGE (✓ )
Chg. Contractor
Renewal
Revision
Extension
Supplement
Reinspection
ARCHITECT
Name
License No.
Address
Telephone
Fax
Master Permit No.
Subsidiary Permit No. ()
Description of Work 6-45
F C_.
State
PERMIT APPLICATION
33i� 8�
Zip
ENGINEER
Name
License No.
Address
Telephone
Fax
Page 2
PERMIT APPLICATION
IMPORTANT NOTICES
1. DO NOT BEGIN ANY WORK WITHOUT HAVING RECEIVED YOUR VALIDATED PERMIT AND PERMIT CARD. Applying for a permit does not grant
the right to begin construction. HOURS OF CONSTRUCTION are limited to: Monday through Friday from 7:30 a.m. to 6:00 p.m., and Saturday from 8:00 a.m.
to 5:00 p.m. No inspections will be conducted on weekends or holidays.
2. All construction of demolition areas MUST BE MAINTAINED IN A CLEAN, NEAT AND SANITARY CONDITION free from construction debris.
3. STREETS AND NEIGHBORING PROPERTIES SHALL BE KEPT FREE FROM DIRT AND DEBRIS.
4. SWALES MUST BE PROTECTED FROM BEING DAMAGED BY EQUIPMENT OR VEHICLES, AND MAY NOT BE USED FOR STORAGE. A bond is
required for work in or near the street/sidewalk.
5. CONSTRUCTION TRAILERS ARE PROHIBITED ON SINGLE FAMILY RESIDENTIAL CONSTRUCTION SITES. Other construction may have a trailer
which requires a separate permit.
6. PORTABLE TOILETS for a construction site require a separate permit.
7. DO NOT DISCHARGE WATER INTO THE RIGHT OF WAY OR STORM DRAINS without approval from the Building, Planning and Zoning Department.
8. EQUIPMENT AND MATERIALS SHALL BE STORED at least 10 feet from the edge of pavement.
9. Department of Health and Rehabilitative Services (HRS) approval is required for applications involving septic tanks. Department of Environmental Resources
Management (DERM) and/or Miami -Dade Water and Sewer Department (MDWASD) approval is required for applications involving sewers.
AFFIDAVIT - Please read carefully.
Application is hereby made to obtain a permit to do work and installation as indicated. I, the OWNER of the property, certify that all
work will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that separate permits
are required for ELECTRICAL, PLUMBING, POOL, EXTERIOR DOOR, MECHANICAL, WINDOW, FENCE, DRIVEWAY,
ROOFING and SIGNS and there may be additional permits required from other governmental agencies.
I, the OWNER of the property, have disclosed all information related to any work at the property performed in the prior twelve
months to the Building Official. Further, I am fully aware that if the cumulative cost of work to my home or business under this and
any other permit equals or exceeds fifty percent (50 %) of the fair market value of the structure, the entire structure must meet the
present federal flood criteria for finished floor elevation. I am also fully aware that if the total cost of work to my home or business
under this and any other permit exceeds fifty percent (50 %) of the replacement cost of the structure, then the entire structure must
conform to the current code requirements of the Building Code.
WARNING TO OWNER: Your failure to record a NOTICE OF COMMENCEMENT may result in you paying twice for
improvements to your property. If you are spending more than $2,500 or intend to obtain financing, you may wish to consult with
your attorney or lender before recording your Notice of Commencement. The Notice of Commencement must be recorded at:
22 N.W. 1st Street, 1" Floor, (305) 679 -1078. Once recorded, the Notice of Commencement must be POSTED AT THE JOB SITE in
accordance with Section 713 -35 of Florida Statutes. Review the brochure at Village Hall on Construction Lien Law and
Choosing a Contractor.
STATE OF ORIDA, COUNTY OF MIAMI -DADE
Signature of Owner
(4. ie.a vkACr,il
2c Print Name
Sworn to and subscribed before me this5 day of
SEAL:
Personally known
dak BECI(�W
' n eoCZass:oti tautsoen
CC"! 65697
.^9s
OR, Produced Identification
NO V
STATE OF FLO OF ' %IAMI -DADE
e of Contrac .r / Qualifier
,f qed 606/z
Print Name U) Prn 0 (
Sworn to and subscribed before me this day of
U'
Signature of Nota
SEAL:
6Iic - State of Florida
4 .y,, Tammy B Valdes
2 +� *} My Commission CC965584
Ettpirps September 05, 2004
Personally known OR, Produced Identification
Type of Identification Produced: 1-4 .4 t 40, 5 - 35 ? I t 9 - 3 2349 Type of Identification Produced:
ELECTRICAL
TYPE
Minimum Fee
QTY.
'TYPE
Dryer
QTY.
'1'1'1'1:
Outlet, Appliance
QTY.
TYPE
Service Repair
QTY.
A/C Central 1 -3 Ton
Heating Strips, each
Fan
Outlet, Wall
Service, Temporary
- Paint Booth
A/C Central 4 -7 Ton
Fire Pump
Outlet, Switch
Piping, Flammable Liquid
Signs
A/C Central 8 -15 Ton
Fixture - Fluorescent
Process/Pressure Piping
Oven
Space Heater (kw)
A/C Central 16-20 Ton
Pressure Vessel
Fixture Light
/
Parking Lot Lights
Spas/Hot Tubs
A/C Central 20+ Ton
Flood Lights
Plugmold/Strip
Subfeeds, No. of Amps
A/C Window
FPL - Load Central
/
Posts
Swim Pool, Commercial
Air Conditioners
Garbage Disposal
Range/Range Top
Swim Pool, Residential
Chiller
Generators, etc.
Receptacles
Switchboards
Clear Violations
Heat Recovery
Refrigerator, Comm. (p/PH)
Temp Serv., Construction
Compactor
Low -volt, Burglar
Refrigerator, Domestic
Temp for Test - 30 days
Deep Freezer
Low -volt, Fire
Renew - Temp Service
Water Closet
Demolition
Low -volt, Intercom/Teleph.
Repair Circuits
Water Heater
Dishwasher
Low -volt, Television
Service, Number of Amps
Water Heater New
MECHANICAL
TYPE
Minimum Fee
QTY.
TYPE
Condensate Drain
QTY. TYPE
Generator
QTY. 'Tl'I'F;
Refrigeration, Tons
QTY.
A/C Central, Tons
QTY.
Cooling Tower
Heating Strips, each
Vent Hood, Cost
A/C Wall/Win. Tons
Dryer Vents, Number of
- Paint Booth
Ventilation, Cost
Air Handler, Tons
Ductwork, Cost of
Piping, Flammable Liquid
Periodic Inspections
Barbecue
Fire Sprinkler System
Process/Pressure Piping
Pump and Abandon
Bath Fan - Vented, #
Fireplaces, Number of
Pressure Vessel
Gas - Appliance
/
PLUMBING
TYPE
A/C Condensate
QTY.
TYPE;
Drains, Roof
QTY.
'TYPE
Miscellaneous Fixture
QTY.
TvPE
Soakage Pit
QTY.
Bath Tub
Drinking Fountain
Miscellaneous Repairs
Solar Water Heater
Bidet
Filter Replace
Pool Piping
Sprinkler Repair
Cap - Fixture
Fountain
Pump and Abandon
Sprinkler System
Cap - Water
Gas - Appliance
/
Pump, Domestic
Supply, AC Well
Cap - Sewer
Gas - Natural
Pump, Fire Stand
Temporary Toilet
Catch Basin
Gas - Propane
/
Pump, Re- circulate
Temporary Water Closet
Clothes Washer
Gas Piping
Pump, Replace - Pool
Urinal
Dental Chair
Grease Trap
Pump, Sprinkler
Utility - Sewer
Discharge Well
Ice Maker
Pump, Sump
Utility - Water
Dishwasher
Indirect Wastes
Relay Repair
Vacuum Pump
Disposal
Interceptor
Roof Inlet
Water Closet
Domestic Well
Laundry Tray
Septic Connection
Water Heater
Drainfield, 4" Tile/Res.
Lavatory
Septic Tank
Water Heater New
Drains, Area
Meter Set (Gas)
Sewer Connection
Water Re -pipe
Drains, Floor
Minimum Fee
Shower
Water Service
Drains, French
Miscellaneous Equipment
Sink
Well, Supply
Page 3
PERMIT APPLICATION
INSTRUCTIONS: Please indicate the type of work being performed and quantity(ies) in the space provided below.
RECEIVED AND REVIEWED BY: DATE:
SECTION
BY
DATE
Zoning
Electrical
Mechanical
AI •
Plumbin:
A'
/i - -v
Fire
Public Works
Structural
Building Official
Page 4
OFFICE USE ONLY
MBOMOU
01 OWNER - BUILDER FORM
(Attach)
01 FIRE DEPARTMENT
APPROVAL (Commercial /
multi- family)
CONCURRENCY
(New Construction)
ID OTHER
(Specify & Attach)
$3.00 per page (Scanning Fee)
Miami Shores Village
Bond
Metropolitan Dade County (C.C.F.) $
Inspector State Educational Fund $
State DCA (Radon) $
Code Enforcement Fine
Zoning Review
CD PROOF OF OWNERSHIP
(Attach)
• HRS / DERM APPROVAL
(Septic / Sewer)
D IMPACT FEE
(New Construction)
m OTHER
(Specify & Attach)
PERMIT FEES
$
$
( sq.ft. = x/1000
x ¢.60)
(¢.005 /sq.ft.)
(¢.01 /sq.ft.)
PERMIT APPLICATION
Li CONDO ASSOCIATION APPROVAL
(Attach)
® BPR APPROVAL (Restaurants)
• 01 CONTRACTOR REGISTRATION
(On File)
TOTAL $ ) ) S 6
REVIEWED AND PREPARED BY:
DATE:
CONDITION OF APPROVAL
Revised July 2001
10050 N.E. 2ND AVE., MIAMI SHORES, FL o (305) 795 -2207 o FAX (305) 756 -8972 o http : / /www.miamishoresvillage.com
BUILDING
ELECTRICAL
PLUMBING
ROOFING
Owner of
Building
Architect
Contractor
or Builder
Legal
Description
Address of
Building
Lot
MIAMI SHORES VILLAGE. FLORIDA
❑
r e J
P r
■; r 2 c tir
O 3 id .
CONTRACTOR OR BUILDER
PERMIT N? 5583
co 0 4,9 f is 3 2— -1 t0.. . ( -•
Subdi-
Bl. vision
Work to be performed under this Permit "
Signed
Value of
Project $
This permit is granted to the contractor or builder named above to construct the building or to install the equipment or device described in the application
herefor in strict compliance with all ordinances pertaining thereto and with the understanding that the work will be performed in compliance with any plans
drawings, statements or specifications that may have been submitted to and approved by the proper municipal authorities. This Permit may be revoked at any
time if the work is not done in compliance with such ordinances or if the plans are changed without authorization. A further condition upon which this permit is
granted is the understanding that the contractor or builder named above assumes the responsibility for a thorough knowledge of the ordinances and regulations
pertaining to the work covered hereby whether shown on the plans or drawings or in the statements or specificatioryand that he assumes responsibility for work
done by his agents, servants or employees.
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.
DATE in
Contractor's
License No. J Y i /
BY AUTHORITY
4 195aD
Amount of 0
Permit $
BY •
Permit No. f '�
Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the building or othei
structure herein described. This application is made in compliance and conformity with the Building Ordinance of Miami Shores Village, Florida
and all provisions of the Laws of the State of Florida, all ordinances of Miami Shores Village and all rules and regulations of the Building Divisior
of Miami Shores Village shall be complied with, whether herein specified or not. A copy of approved plans and specifications must be kept at
building during progress of work. (� //�
Owner's Name and Address "' ' `"'� -- - No.__ Street
Registered Architect and /or Engil. er
STATE OF FLORIDA,
COUNTY OF DADE.
ss.
Employing Plumber's Name_ �l! '' --- li_---- - - -- No.___ - -- ._ _ _ ___._ Street_ Location and Legal Description Lot_ -__L 1' J GU _r_Y_f -1 pp __-__ ____ Block_._. / �?. .,c Subdivision
Street and Number where work is to be performed —No F`� 3 Al 6 . 1 y ! ms ___ Street.
State work to be perf / ormed and purpose of building (By Floors)_.__
New Building__._ -_ -ate Remodeling ___ Addition_
My Commission Expires
9 -b
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
Size Septic Tank -_ 6 - 12- - 0 Type of Tank- _ , Capacity Gals.
/
Feet of Drain Tile_ 1 00 .__ _Dist. Feet of Tank or Drain Field from WelL
Nature of Water Supply• Well. f — --- - - - - -- Size of Soakage Pit
Amount of Permit $ _ -_ -- _ - - -_ -_ -- — ._�_.�_ (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 corn -
plied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors employed by him in the work to be
performed under this permit; and will post or cause to be posted for inspection on the site of the work such public notice or notices as are
required by the Act. The undersigned agrees to employ only such sub- contractors, on work to be performed under this permit, as are
licensed by Miami Shores Village. / 7)
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeare
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 lac
therein by him stated are true.
(Signed)._
Date
Repairs
2- 02
Notary Public, State of Florida
No. of Stories
Master Plumber.
OTE: A re- inspection fee of $1.00 will be made when such re- inspection" is made necessary by improper notice for inspection, or f,.ul
matelrials and /or workmanship.
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7-
Permit No. f '�
Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the building or othei
structure herein described. This application is made in compliance and conformity with the Building Ordinance of Miami Shores Village, Florida
and all provisions of the Laws of the State of Florida, all ordinances of Miami Shores Village and all rules and regulations of the Building Divisior
of Miami Shores Village shall be complied with, whether herein specified or not. A copy of approved plans and specifications must be kept at
building during progress of work. (� //�
Owner's Name and Address "' ' `"'� -- - No.__ Street
Registered Architect and /or Engil. er
STATE OF FLORIDA,
COUNTY OF DADE.
ss.
Employing Plumber's Name_ �l! '' --- li_---- - - -- No.___ - -- ._ _ _ ___._ Street_ Location and Legal Description Lot_ -__L 1' J GU _r_Y_f -1 pp __-__ ____ Block_._. / �?. .,c Subdivision
Street and Number where work is to be performed —No F`� 3 Al 6 . 1 y ! ms ___ Street.
State work to be perf / ormed and purpose of building (By Floors)_.__
New Building__._ -_ -ate Remodeling ___ Addition_
My Commission Expires
9 -b
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
Size Septic Tank -_ 6 - 12- - 0 Type of Tank- _ , Capacity Gals.
/
Feet of Drain Tile_ 1 00 .__ _Dist. Feet of Tank or Drain Field from WelL
Nature of Water Supply• Well. f — --- - - - - -- Size of Soakage Pit
Amount of Permit $ _ -_ -- _ - - -_ -_ -- — ._�_.�_ (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 corn -
plied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors employed by him in the work to be
performed under this permit; and will post or cause to be posted for inspection on the site of the work such public notice or notices as are
required by the Act. The undersigned agrees to employ only such sub- contractors, on work to be performed under this permit, as are
licensed by Miami Shores Village. / 7)
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeare
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 lac
therein by him stated are true.
(Signed)._
Date
Repairs
2- 02
Notary Public, State of Florida
No. of Stories
Master Plumber.
OTE: A re- inspection fee of $1.00 will be made when such re- inspection" is made necessary by improper notice for inspection, or f,.ul
matelrials and /or workmanship.