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833 NE 99 St (4)BUILDING PERMIT APPLICATION FBC 2001 City Miami Shores Village Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel i5 04 756.8972 Permit Type (circle): Building Electrical Plumbing Owner's Name (Fee Simple Titleholder) Mii%H/1,3 2E/r1 iv( (4, Phone # 0 - S Owner's Address a s 3 ? S' 'r City M i iq.IF -C ‘ S140 (LQ5 State !" (Q, Tenant/Lessee Name tt-j Job Address (where the work is being done) 8 3 ;3 ki : , q g S r-- County Miami -Dade Is Building Historically Designated YES NO State Certificate or Registration No.S ftpq '7 ( 276 Architect/Engineer's Name (if applicable) $ Value of Work For this Permit Code Enforcement $ Total Fee Now Due $ (Continued on opposite side) c. 1)0 7 t Structural Plan Review. $ Permit No. 1 "' 06 - f Qt?' Master Permit No. Mechanical Zip 33 j33-- Phone # Contractor's Company Name k (W It\ 1.J (a O ErtAu( (lop 0-(t.-Phone # Contractor's Address t 5 i roc.)eiT A l k/ e_ to1122 B City {L( t � k (V- State 4-114. Zip Qualifier r- O - 361(a tJ- Certificate of Competency No. Phone # Roofing zip 3 3/ g 6 786 -9og9 Square Footage Of Work: '7( a (2 r Type of Work: ['Addition ❑Alteration ['New Repair /Replace ❑ Demolition Describe Work: U'\ A (oSo 'Salkock,TK1Vk 64(-0 i5)l Sci tlfA,ti∎ ce1 Ae.) €) ) Se71( � - -e f * * * * * * * * * * * * * * * * * * * * * * * * * * ** F ees * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** Submittal Fee $ Permit Fee $ /7c+ J 7 � . 5VCCF $ �� �, C "� CO /CC 0 t Notary $ Training/Education Fee $ I 0 C� Technology Fee S & S Scanning $ 3 • 0 Radon $ Zoning Bond $ 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 a reinspection fee will be charged. Signature Owner or Agent The foregoing instrument was acknowledged before me this day of 4,0 , 20 i , by who is personally known to me or who has produced My Commission Expires: * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **. * APPLICATION APPROVED BY: Chc 05/13/03 As identification and who did take an oath. NOTARY PUBLIC: &JLQL9 Sign—J Print: .e, eN " 4- SA J. SOLOMON t ?- ° •'1t� @ ° M Y COMMISSION �i FB.09' EXPI ON # pp25� > * * * * * * * * * * * * * * * * * * * * * * * ** � . fl'OF IVbi� A * * * n i 9l att too * ** FL Notary Disc. nt Ass oc. Co. Signature , day of The foregoing instrument was acknowledged before me this who is personally known to me or who has produced as identification and who did take an oath. NOTARY PUBLIC• . Sign: Print: My Comm * * * * * * * * * * * ** Contractor , 20C;', by w Sion rn ** . MY COMMISSION # DD250437 � >�0 (Oe' Apy EXPIRES: September 16, 2007 1 - 800.3- 1.° * * * * * * * * * * * * * * * * * * * * * * * * * ** *...., FL Not sp iRt49sba6tet. *` * * * * * ** * * * * ** Plans Examiner Engineer Zoning ADDENDUM TO BUILDING PERMIT APPLICATION (AN APPLICATION FOR BUILDING PERMIT MUST ACCOMPANY THIS ADDENDUM. IF A MASTER PERMIT HAS B. OBTAINED, THE OWNER'S NOTARIZED SIGNATURE NEED NOT BE PRESENT ON SUBSEQUENT APPLICATIONS.) PLUMBING ELECTRICAL MECHANICAL ITEM BATH TUB UNIT FEE ITEM SWITCH OUTLETS UNIT FEE ITEM SPACE HEATERS UNIT FEE BIDET LIGHT OUTLETS CENTRAL HEATING DISHWASHER RECEPTACLES A/C (WIND) DISPOSAL SERVICE TEMPORARY A/C (CENTRAL) DRINKING FOUNTAIN SERVICE SIZE IN AMPS DUCT WORK FLOOR DRAIN SERVICE REPAIR/E7ER CHANGE REFRIGERATION GREASE TRAP APPLIANCE OUTLETS PROCESS AND PRESS PIPING INTERCEPTOR RANGE TOP UNDERGROUND TANKS LAVATORY OVEN ABOVE GROUND TANKS LAUNDRY TRAY WATER HEATER U.F. PRESSURE VESSELS CLOTHES WASHER MOTORS 0- 1 if STEAM BOILERS SHOWER MOTORS OVER 1- 3 HP HOT WATER BOILERS SINK, POT /3 COMP. MOTORS OVER 3- 5 HP MECHANICAL VENTILATION SINK, RESIDENCE MOTORS OVER 5- 8 HP TRANSPORTING ASSEMBLIES SINK, SLOP MOTORS OVER 8- 10 HP ELEVATORS/ESCALATORS TEMPORARY WATER CLOSET MOTORS OVER 10- 25 HP FIRE SPRINKLER SYSTEMS URINAL MOTORS OVER 25-100 HP COOLING TOWERS WATER CLOSET MOTORS OVER 100 HP VIOLATION INDIRECT WASTES- ' A/C WINDOW REINSPECTION WATER SUPPLY TO: AIR CONDITIONERS A/C UNIT STRIP HEATER FIRE SPRINKLER GENERATORS TRANSFORMERS 'HEATER -NEW INST. GENERATORS TRANSFORMERS HEATER - REPLACE GENERATORS TRANSFORMERS LAWN SPRINKLER -WELL SPECIAL PURPOSE SWIMMING POOL OUTLETS COMMERCIAL ' WATER SERVICE SIGN TUBES . SEWER CONNECTIONS SIGN TRANSFORMERS UTILITY -SEWER SIGN TIME CLOCK UTILITY -WATER FIXTURES SEPTIC TANK It ANTENNA RELAY t TELEVISION OUTLETS . DRAINFIELD, 4' TILE/RES. VIOLATION PUMP & ABANDON SEPTIC TANK REINSPECTION SOAKAGE PIT CU. FT. CATCH BASIN DISCHARGE WELL DOMESTIC WELL AREA DRAIN ROOF INLET SOLAR WATER HEATER FIRE STANDPIPE POOL PIPING LAWN SPRINKLER SYSTEM GAS RANGE . METER SET (GAS) GAS PIPING ADDENDUM TO BUILDING PERMIT APPLICATION (AN APPLICATION FOR BUILDING PERMIT MUST ACCOMPANY THIS ADDENDUM. IF A MASTER PERMIT HAS B. OBTAINED, THE OWNER'S NOTARIZED SIGNATURE NEED NOT BE PRESENT ON SUBSEQUENT APPLICATIONS.) PLUMBING ELECTRICAL MECHANICAL LOT: 16 DATE ISSUED: 6/17/05 STATE OF FLORIDA DEPARTMENT OF HEALTH ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM CONSTRUCTION PERMIT CONSTRUCTION PERMIT FOR: [ ]New System [ ]Existing System [ [ X ]Repair [ ]Abandonment SYSTEM DESIGN AND SPECIFICATIONS THIS PERMIT IS NOT FOR " ADDITION ". DH 9016, 03/97 (Obsoletes previous editions which may not be used) (Stock Number: 5794- 001 - 4016 -0) [ostds_cons_4016 -1] PROPERTY STREET ADDRESS: 833 NE 99 St Miami Shores FL 33138 BLOCK: 169 SUBDIVISION: Miami Shores T [ 900 ]Gallons SEPTIC TANK A [ 0 ]Gallons N [ 0 ]GALLONS GREASE INTERCEPTOR CAPACITY K [ 0 ]GALLONS DOSING TANK CAPACITY [ 0 ]GALLONS @ [0 APPLICANT: Zeichner, Adam & Teresa AGENT: SA0021077, Bolanos Jose [Section /Township /Range /Parcel No.] PROPERTY ID #: 11- 3206 - 034 -0120 [OR TAX ID NUMBER] category of tank in accordance with sec. 64E- 6.013(3)(f), FAC. 3.- Install 200 sf of drainfield in bed configuration. 4.- Invert elevation of drainfield to be no less than 8.10' NGVD. 5.- Bottom of drainfield elevation to be no less than 7.60' NGVD. CENTRAX #: 13 -SG -25470 DATE PAID: FEE PAID : $ RECEIPT . OSTDSNBR : 05 -2046- -R ]Holding Tank [ ] Innovative Other ]Temporary [ NA ] SYSTEM MUST BE CONSTRUCTED IN ACCORDANCE WITH SPECIFICATIONS AND STANDARDS OF CHAPTER 64E -6,FAC DEPARTMENT APPROVAL OF SYSTEM DOES NOT GUARANTEE SATISFACTORY PERFORMANCE FOR ANY SPECIFIC TIME PERIOD. ANY CHANGE IN MATERIAL FACTS WHICH SERVED AS A 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 PERMIT DOES NOT EXEMPT THE APPLICANT FROM COMPLIANCE WITH OTHER FEDERAL, STATE OR LOCAL PERMITTING REQUIRED FOR PROPERTY DEVELOPMENT. MULTI - CHAMBERED /IN SERIES: [Y ] MULTI - CHAMBERED /IN SERIES: [Y ] ]DOSES PER 24 HRS # PUMPS[ 0 ] D [ 200 ]SQUARE FEET PRIMARY DRAINFIELD SYSTEM R [ 0 ]SQUARE FEET SYSTEM A TYPE SYSTEM: [ N ]STANDARD [ N ]FILLED I CONFIGURATION: [ N ]TRENCH [ N ]BED N F LOCATION TO BENCHMARK: Existing Finished Floor El.:9.60' NGVD I ELEVATION OF PROPOSED SYSTEM SITE [ 1.9 ] [ FEET ] [ BELOW BENCHMARK /REFERENCE POINT E BOTTOM OF DRAINFIELD TO BE [ 3.9 ] [ FEET ] [ BELOW BENCHMARK /REFERENCE POINT L D FILL REQUIRED: [ 0.0 ]INCHES EXCAVATION REQUIRED: [ 18.0 ] INCHES [ N ]MOUND [ N ] [ N OTHER REMARKS: ••• 1.- Install 900 gal. category -2 septic tank equipped with an approved filter. 2. -The licensed contractor installing the system is responsible for inntal'].ing •• • .0000. • •• 000. • • • • • 000000 • • •• •• .••••• • • • • • • • • • • •• • SPECIFICATIONS BY: Andre, Paul TITLE: APPROVED BY: Test II, !W TITLE: EH Specialist I Dade • • •.•• 0000 •• t minimum. • •..• • • • • ••••.• •• • • •• • • • • • • • • • • •••• • • ••• • • • •• EXPIRATION DATE: 9/15/05 • • 0 .0.00 •..•• • • •0•.• ••••.• • CHD • 000000 •••• • • • • ••• •••••• Page 1 of 2 Plan Approved f By STATE OF FLORIDA • DEPARTMENT OF HEALTH APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION M1--T Permit Application Numb f -- zocq, Scale: Each block represents 5 feet and 1 inch = 50 feet. PART II - SITE PLAN- Y } I �i. + +�� 141 { te l - 1 i t { r i t < r " ( t tt f _ ; _ • • • • • s • t f . 1. ' t S 1 _«_ _,.t '- �. t 1 • • •i.�• ■ ,�� f L ? _7, ®C/ Qje - - 3 f .9q r 1Y�1�• g .0 • DH 4015, 10/96 (Replaces HRS-H Form 4015 which may be used) (Stock Number: 5744 -002. 4015 -8) Signature Not Approved • •••• •• • • • • • • • •• • •• ••••• P)ri_01-4 e CL to LA) /Week.- ffoa/f&. t W •::::• •• .. • • •••••• • . • ""` 1� • •.•. •....• • Site Plan submitted o y.'. • • ••• • • ••• Title Date ALL CHA ES MU T BE APPROVED BY THE COUNTY HEALTH DEPARTMENT County Health Department Page 2 of 3 0000 O 0 000000 0000 0 0 O 0 0 0 O 0000 0 00 O 0 0 0 000000 0 00 000600 0 O o 0 000000 000000 O 0 0 00 0000 O 0 0 0 0 00000 00 0 0000 O 6 00000 0000 000000 O 0 0 0 000000 0000 00 00 6 O 0 000000 O 0 0 0 000000 0000 0 0 O 0 O 0 0000 0 0 000000 0 0 0 O 0 o0e o 0 00 O 0 0 O 00 t Miami Shores Village 10050 NE 2nd Avenue Phone: 305- 795 -2204 Permit Number: PL2005 -198 Printed: 6/22/2005 Applicant: ADAM Owner: ZEICHNER JOB ADDRESS: 833 NE 99 Parcel # 1132060340120 Signed: (INSPECTOR) Plumbing Permit ZEICHNER ADAM ST Contractor MIAMI DADE ENVIROMENTAL Contractor's Address: 9591 FOUNTAINE BLUE BLVD #208 Local Phone: 786 -251 -4099 Legal Description: MIAMI SHORES SEC 8 PB 14 -33 E1/2 OF LOT 16 & LOT BLK 169 17 LOT SIZE Fees: Description Amount FEE2005 -8601 Building Fee $350.00 FEE2005 -8602 CCF $3.00 FEE2005 -8605 Training and Education Fee $1.00 FEE2005 -8606 Technology Fee $8.75 FEE2005 -8607 Scanning Fee $3.00 FEE2005 -8608 Builders Bond $300.00 Total Fees: $665.75 Total Fees: $665.75 Total Receipts: $0.00 Permit Status: APPROVED Permit Expiration: 12/17/2005 Construction Value: $665.75 Work: INSTALL A 1050 GALLON TANK AND 571 DRAINFIELD Page 1 of 1 JUN 2 3 PAID 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: BUILDING ELECTRICAL PLUMBING ROOFING Owner of Building Architect Contractor or Builder Legal Description Lot MIAMI SHORES VILLAGE, FLORIDA 2/ PERMIT N9 7040 ❑ Work to be performed under this Permit 1 - % -- CONTRACTOR OR BUILDER Bl • DATE 19 Co ntractor s Lice No. Subdi- vision Address of � � : '6 Value of Amount of Building �` i j Project $— 1 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 applica- tion 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 respon- sibility for work done by his agents, servants or employees. Signed• INSPECTOR In consideration of the issuance to me of this permit I agree to perform the work covered hereunder in compliance wit 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 edl work done by either, myself, my agent, servant or employee. BY AUTHORITY MOT Permit No. 4.1°L° MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT Application is hereby. made .for the approval of the detailed statement of the plans and specifications herewith submitted for the building or. other structure herein described. This application is made in compliance and conformity with the Building Ordinance of Miami Shores Village, Florida, and all 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 No. — 2 3 - - -__ Street_ Date I 7. — 'L 99 Registered Architect and/or 'Engineer._.. —.r - - ----- _-- _- -- - - -_ Employing Plumber's Narne,.: No. ....7 Street. Location and Leg,a1 Description Lot_ Blocir Subdivision Street and Number where work is to be performed—No._ . 2 1 -- Street XI Y7 Lif State work to be performed and purpose of building (By Floors) New Building___________ , . Remodeling Addition Repairs Size Septic Tank_ Feet of : Drain Tile�.a'�I Nature of Water Supply: :City- Well. Amount of Permit $ 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. (Signed)_ No. of Stories Type of Tank___ Capacity Gals _Dist. Feet of Tank or Drain Field from Well _ _Size of Soakage Pit (Signed)._ �` _ ^_ ,/ //L'e " Master Plumber. „ STATE OF FLORIDA, :: COUNTY OF DADE.: Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeared to me well known, and who, :being by me first duly sworn, upon oath 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. `. 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: aMOWERE LAVA- TORIES SINKS SLOP SINKS LAUNDRY TUBS URINALS CATCH BASIN FLOOR DRAIN DRINKING FOUNT•NS TOTAL FIXTURES CONTR. LIST CHECK SEPTIC TANK SEWER CONI:. ^ DRAIN FIELD SOAKAGE PIT GREASE TRAP SOLAR HEATER DEEP WELL SPRKLR. SYSTEM SWIM'G POOL — CONTR. LIST CHECK Permit No. 4.1°L° MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT Application is hereby. made .for the approval of the detailed statement of the plans and specifications herewith submitted for the building or. other structure herein described. This application is made in compliance and conformity with the Building Ordinance of Miami Shores Village, Florida, and all 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 No. — 2 3 - - -__ Street_ Date I 7. — 'L 99 Registered Architect and/or 'Engineer._.. —.r - - ----- _-- _- -- - - -_ Employing Plumber's Narne,.: No. ....7 Street. Location and Leg,a1 Description Lot_ Blocir Subdivision Street and Number where work is to be performed—No._ . 2 1 -- Street XI Y7 Lif State work to be performed and purpose of building (By Floors) New Building___________ , . Remodeling Addition Repairs Size Septic Tank_ Feet of : Drain Tile�.a'�I Nature of Water Supply: :City- Well. Amount of Permit $ 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. (Signed)_ No. of Stories Type of Tank___ Capacity Gals _Dist. Feet of Tank or Drain Field from Well _ _Size of Soakage Pit (Signed)._ �` _ ^_ ,/ //L'e " Master Plumber. „ STATE OF FLORIDA, :: COUNTY OF DADE.: Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeared to me well known, and who, :being by me first duly sworn, upon oath 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. `. 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. MIAMI SHORES VILLAGE. FLORIDA 7 ELECTRICAL El DATR 195 PLUMBING 0 PERMIT N9 8576 Contractor s License No BUILDING ❑ ROOFING ❑ 0 Work to be performed under this Permit Owner of Building Architect Contractor or Builder Legal Description Address of Building Lot CONTRACTOR OR BUILDER Bl. Signed• Subdi- vision Sq. Ft Value of Project $ 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. 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. BY AUTHORITY Permit No Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the uilding 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. Employing Plumber's Name STATE OF FLORIDA, u. COUNTY OF DADE. Owner's Name and Address. - of Registered Architect and /or Engineer ..... ______.____. ------------------------------ - - - - -- Amount of Permit $ _�_.�- tfo My Commission Expires MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING P! w;,MIT 4 A A No. __S 2 3J __ -J G Street_ - .. -� N0.4151227 ._!L Location and Legal Description Lot____ __— — ..______. ._ __ Block ._,.___... Street and Number where work is to be performed —No 4 31 M f g Str State work to be performed and purpose of building (By s) a t New Building Remodeling.____ _______ Addition (Signed)- ( Signed Date /6 Street.. L Repairs No. of Stories .................. Size Septic Tank Type of Tank. Capacity Cals Feet of Drain Tile Dist. Feet of Tank or Drain Field from Well Nature of Water Supply: City —Well ______________ __._Size of Soakage Pit Plumbing Inspector. The undersigned applicant for this building permit does hereby certify that he understands and accepts h'. obligations as an employer of labor under the Florida Workmen's Compensation Act, being Section 5988, Compiled General Laws of Florida ' ermanent Supplement, and has com- plied with the provisions thereof, and will require similar compliance from all contractors or sub -contr a ' ors 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 required by the Act. The undersigned agrees to employ only such sub- contractors, on work to be performed under this permit, licensed by Miami Shores Village. Master Plumber. Notary Public, State of Florida as are as are 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 wort manship. CLOSETS BATH TUBS SHOWERS LAVA- TORIES SINKS SLOP SINKS LAUNDRY TUBE URINALS CATCH BASIN FLOOR DRAIN DRINKING FOUNT'N8 TOTAL FIXTURES CONTR. LIST CHECK SEPTIC TANK SEWER CONN. DRAIN. FIELD SOAKAGE PIT GREASE TRAP SOLAR HEATER DEEP WELL SPRKLR. SYSTEM SWIM'G P001. 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 uilding 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. Employing Plumber's Name STATE OF FLORIDA, u. COUNTY OF DADE. Owner's Name and Address. - of Registered Architect and /or Engineer ..... ______.____. ------------------------------ - - - - -- Amount of Permit $ _�_.�- tfo My Commission Expires MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING P! w;,MIT 4 A A No. __S 2 3J __ -J G Street_ - .. -� N0.4151227 ._!L Location and Legal Description Lot____ __— — ..______. ._ __ Block ._,.___... Street and Number where work is to be performed —No 4 31 M f g Str State work to be performed and purpose of building (By s) a t New Building Remodeling.____ _______ Addition (Signed)- ( Signed Date /6 Street.. L Repairs No. of Stories .................. Size Septic Tank Type of Tank. Capacity Cals Feet of Drain Tile Dist. Feet of Tank or Drain Field from Well Nature of Water Supply: City —Well ______________ __._Size of Soakage Pit Plumbing Inspector. The undersigned applicant for this building permit does hereby certify that he understands and accepts h'. obligations as an employer of labor under the Florida Workmen's Compensation Act, being Section 5988, Compiled General Laws of Florida ' ermanent Supplement, and has com- plied with the provisions thereof, and will require similar compliance from all contractors or sub -contr a ' ors 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 required by the Act. The undersigned agrees to employ only such sub- contractors, on work to be performed under this permit, licensed by Miami Shores Village. Master Plumber. Notary Public, State of Florida as are as are 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 wort manship.