PLUMBINGBUILDING
ELECTRICAL
PLUMBING
ROOFING
Owner of
Building
/
❑ DATE `` 19
° PERMIT N9 4125 Contractor's ;
License No.
MIAMI SHORES VILLAGE, FLORIDA
Architect
Contractor
or Builder
Legal
Lot
Description Bl
4-
Address of .• f Value of I Amount of
Building Project $ I 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..
il
Signed r. % �••,,
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 as
cepting this permit I assume responsibility for all work done by either, myself, my agent, servant or employee.
CONTRACTOR OR BUILDER
Work to be performed under this Permit
Subdi-
vision
BY AUTHORITY
42BOT 'y�-
pen,* Nu
Amount of Peimit $
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
/? '
Da te M f
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 ]I-lt _' __ Efi 4 ,1 4% l e
Registered Architect and /or
Employing Plumber's Name___l_!. __ A _ e. 1i _ 4"( No._
Location and Legal Description Bl
Street and Number where work is to be performed —No
State work to be performed and purpose of building (By Floors)_.__________
No._ —___ 2— Street.__ Nk 9 / 6 T
_
Street_ __`11_ (5 7
Subdivision _
S treet � 9 .
New Building Remodeling______ Addition Repairs No. of Stories.
Size Septic Tank Type of Tank - Capacity Gals
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 his o • gations as an employer of labor
under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florid: nanent Supplement, and has com-
plied with the provisions thereof, and will require similar compliance from all contractors or sub -co . • actors mployed 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 th works h public notice or nptices as are
required by the Act. The undersigned agrees to employ only such sub- contractors, work to be . -rformed under this permit, as are
licensed by Miami Shores Village.
My Commission Expires Notary Public, State of Florida
aster Plumber.
STATE OF FLORIDA, sa.
COUNTY OF DADE.
Before me, the undersigned authority, a notary public, duly authorized to administe 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 $L00 will be made when such re- inspection is made necessary by improper notice for inspection, or faulty
materials and /or worlmtanship.
CLOSETS I
BATH S
SHOWERS L
LAVA- S
INKS B
SLOP L
LAUNDRY U
U RINALS C
CATCH F
FLOOR D
DRINK N6 T
TOTAL
CoNTR.
LIST
CHECK
SEPTIC S
SEWER D
DRAIN S
SOAKAGE GREASE S
SOLAR D
DEEP S
SPRKLR. S
SWIM•G
CONTR.
LIST —
—.
CHECK .
. ..:' ‘ _ . ry
• .. e
e �
�• . '. .
., .
.
Amount of Peimit $
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
/? '
Da te M f
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 ]I-lt _' __ Efi 4 ,1 4% l e
Registered Architect and /or
Employing Plumber's Name___l_!. __ A _ e. 1i _ 4"( No._
Location and Legal Description Bl
Street and Number where work is to be performed —No
State work to be performed and purpose of building (By Floors)_.__________
No._ —___ 2— Street.__ Nk 9 / 6 T
_
Street_ __`11_ (5 7
Subdivision _
S treet � 9 .
New Building Remodeling______ Addition Repairs No. of Stories.
Size Septic Tank Type of Tank - Capacity Gals
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 his o • gations as an employer of labor
under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florid: nanent Supplement, and has com-
plied with the provisions thereof, and will require similar compliance from all contractors or sub -co . • actors mployed 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 th works h public notice or nptices as are
required by the Act. The undersigned agrees to employ only such sub- contractors, work to be . -rformed under this permit, as are
licensed by Miami Shores Village.
My Commission Expires Notary Public, State of Florida
aster Plumber.
STATE OF FLORIDA, sa.
COUNTY OF DADE.
Before me, the undersigned authority, a notary public, duly authorized to administe 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 $L00 will be made when such re- inspection is made necessary by improper notice for inspection, or faulty
materials and /or worlmtanship.
MIAMI SHORES VILLAGE
J\ BUILDING DEPARTMENT
0 305-795-2204
Building Inspection Request
J Date
Type Insp'n 71) f O / 'W "Ae
Permit No. el— v y - Q p
Name CratinV
Approved
Correction
Re- Insp'n Fee
Address N 7
?9 5
1
Company /2Q (,c M8. p
Phone# 9sV r 5; 3 7C,
Inspection Date r /0/6
6 i I W ' I
•
BUILDING
PERMIT APPLICATION
FBC 2001
Permit Type (circle): Building Electrical
Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
Owner's Name (Fee Simple Titleholder) £ / ill%/ / .',Y Phone # ` 3a).5 - 75 67 y
Owner's Address . ./2 /) 9 9
City /1/1/b97 5/ko4j. State ,C2
Tenant/Lessee Name 4
Job Address (where the work is being done) 9 5 2 z/ / 9 s
Zip
Permit No. Y 1 2604 — q "
Master Permit No. 6/ 3q
Phone #
Mechanical Roofing
City Miami Shores Village County Miami -Dade Zip
Is Building Historically Designated YES NO
G•; Phone # 9 r`i - S S - 3 s. 4 &
Contractor's Company Name,' � . � � e" c..- �
Contractor's Address hi n Aox .5:1i � Ll e971 '
City . Q" . State /'ro '' d �"- Zip 3 31 S 2
Qualifier .-ac -f "f .Z( 5" r •
Architect/Engineer's Name (if applicable) Phone #
$ Value of Work For this Permit. y.C 0. o f Square Footage Of Work:
Type of Work: ['Addition iteration ['New ❑ Repair/Replace ❑ Demolition
Describe Work. ..g ..g „ ' 1, - ( e / 3” 5e," 4 il,"( 6 X/: 7 , '`'1 5e, /.•c ` /°
A 94 flee- S Fi v T N d c. VA P It ei;4 :�.�� Z-4-4€0 0,,- .,(c,' --, , .'l �T
ot e
Submittal Fee $Jv -, 0O Permit Fee $ 4.7d ' '-. CCF $ ) , U 0
Notary $$', 0 d Training/Education Fee $ - 4) 6 Technology Fee $3. 0
Scanning $ Radon $ Bond $
Code Enforcement $ Structural Plan Review. $
Total Fee Now Due $ a0 . .4
(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 a reinspection fee will be charged
Signature r ,�,/,ldl \/
�� Signature
Owner or Agent
The foregoing instrument was acknowledged before me this 021 The foregoing instrument was ackno 1 de g -' before me this
day of iliartA , 20 Q �, by (i 2k el/Q � � �TG� day 20 Q '/by i _.
who is rsonally known to me > who has produced who is personally known to me or who has produced 1
As identification and who did take an oath. as identification and who did take an oath.
Chc 10/14/03
APPLICATION APPROVED BY(
NOTARY PUBLIC: • : = ii LI :
Sign: ., BONNIE DI FRANCO i t
OFFICIAL
te of ori 1.
Print: /�'� lseAL My Comm. expires Aup t1, Fl 20 r —
B. B0234 gns!r^r
My Commission Expires: 8/7/67 Bonded thru Arthurd. Gallagher 8 Cid Commission Expires:
(Certificate of Competency Holder)
State Certificate or Registration No. Certificate of Competency No.
* * * * * * * * * * * * * * * * * * * * * * * * * * * * *7 *. * * ** ************************************ * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
3 - 2__ Plans Examiner
Engineer
Zoning
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/METER 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 HP
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 If
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 COMAERCIAL
WATER SERVICE
SIGN TUBES
SEWER CONNECTIONS
SIGN TRANSFORMERS
UTILITY -SEWER
SIGN TIME CLOCK
UTILITY -WATER
FIXTLRES
SEPTIC TANK
ANTENNA
RELAY
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
QdoCR'7' /a .
ELECTRICAL
MECHANICAL
Type Insp'n
MIAMI SHORES VILLAGE
BUILDING DEPARTMENT
305- 795 -2204
Building Inspection Request
Date
Approved
Correction
Re- Insp'n Fee
1 I
Permit No. PI ' 2 Q l - - - q
Name Ni 40) '
Address 231-o- Pt_ q - l-
Company
Phone #
Inspection Date
Miami Shores Village
10050 NE 2nd Avenue
Phone: 305 - 795 -2204 Permit Number: PL2004 -98
Printed: 4/27/2004
Applicant: DANIEL AULTON
Owner: AULTON DANIEL
JOB ADDRESS: 842 NE 99 ST
Contractor PIPELINE PLUMBING INC
Local Phone: 954- 680 -4415
Parcel # 1132060142430
Plumbing Permit
Contractor's Address: DOING BUS IN DADE CO
Page 1 of 1
Legal Description: MIAMI SHORES SEC 3 PB 10 -37 LOT 7 & E1/2 OF LOT 8 BLK 72 LOT SIZE
Fees: Description Amount
FEE2004 -4157 Building Fee $120.00
FEE2004 -4158 CCF $1.80
FEE2004 -4159 Notary Fee $5.00
FEE2004 -4160 Training and Education Fee $0.60
FEE2004 -4161 Technology Fee $3.00
Total Fees: $130.40
Total Fees: $1 0 .40
Total Receipts: 36.00
o. D
Permit Status: APPROVED Permit Expiration: 9/19/2004 Construction Value: $2,500.00
Work: INSTALL NEW 3" SEWER LINE TO EXISTING SEPTIC TANK TO HANDLE 5 FIXTURE UNITS IN NEW BATHROOM BEING BUILT
APR 2 8 EHTO
Signed: (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 responisibility for all work
done by either myself, my agent, servants or employes.
Signed: (Contractor or Builder) BY:
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.
Z
Owner's Name and Address 1 ✓ 4- c +.- No.__ 4 !' Street 4 . C • 14 — S2
Registered Architect and /or Engine N!Q con—It ....!!- 3___!3_ ::_t ________ 9„ I 'lt_6_ia..1L` C B. _ '7 4 _ L_ic N • & • Z' A'
Nature of Water Supply: City —Well
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
No..
Employing Plumber's Name
Location and Legal Description Lot________ _________ __..... Block______
Street and Number where work is to be performed —No. $ _ L N _'_ E �____.9 , S+ _ -. Street
State work to be performed and purpose of building (By Floors) ____ F___.___11_f�_I`a I 41".•
New B Remodeling_____ Addition____ Repairs
Size Septic Tank Type of Tank Capacity Gals.
Feet of Drain Tile Dist. Feet of Tank or Drain Field from Well
__Size of Soakage Pit
------ - - - - -- - +w , --
Amount of Permit $ - -- - - - - -- — - - -- — - -- (Signed) _
lumbing Inspectodr.
The undersigned applicant for this building permit does hereby certify that he understands and accepts his oblig.'s as an employer of labor
under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Pennanent 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) & .
Street___
Date 3 - Zo "1
Z
Subdivision
4 14.1.c., wt a 11,4, I•e7.k
No. of Stories
Master Plumber.
STATE OF FLORIDA, ss,
COUNTY OF DADE.
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeared
to me well known, and who, being by me first duly sworn, upon oath deposes and says that he is the
of the above described construction, that he has carefully read the foregoing application, and that he did sign the same, and that all facts
therein by him stated are true.
My Commission Expires Notary Public, State of Florida
� 4
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
LAUNDRY
TUBS
URINALS
CATCH
BASIN
FLOOR
DRAIN
DRINKING
FOUNT' NS
TOTAL
FIXTURES
CONTR.
LIST
CHECK
--
SEPTIC
TANK
SEWER
CONN.
DRAIN
FIELD
SOAKAGE
PIT
GREASE
TRAP
SOLAR
HEATER
DEEP
WELL
SPRKLR.
SYSTEM
$WIM'G
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.
Z
Owner's Name and Address 1 ✓ 4- c +.- No.__ 4 !' Street 4 . C • 14 — S2
Registered Architect and /or Engine N!Q con—It ....!!- 3___!3_ ::_t ________ 9„ I 'lt_6_ia..1L` C B. _ '7 4 _ L_ic N • & • Z' A'
Nature of Water Supply: City —Well
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
No..
Employing Plumber's Name
Location and Legal Description Lot________ _________ __..... Block______
Street and Number where work is to be performed —No. $ _ L N _'_ E �____.9 , S+ _ -. Street
State work to be performed and purpose of building (By Floors) ____ F___.___11_f�_I`a I 41".•
New B Remodeling_____ Addition____ Repairs
Size Septic Tank Type of Tank Capacity Gals.
Feet of Drain Tile Dist. Feet of Tank or Drain Field from Well
__Size of Soakage Pit
------ - - - - -- - +w , --
Amount of Permit $ - -- - - - - -- — - - -- — - -- (Signed) _
lumbing Inspectodr.
The undersigned applicant for this building permit does hereby certify that he understands and accepts his oblig.'s as an employer of labor
under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Pennanent 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) & .
Street___
Date 3 - Zo "1
Z
Subdivision
4 14.1.c., wt a 11,4, I•e7.k
No. of Stories
Master Plumber.
STATE OF FLORIDA, ss,
COUNTY OF DADE.
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeared
to me well known, and who, being by me first duly sworn, upon oath deposes and says that he is the
of the above described construction, that he has carefully read the foregoing application, and that he did sign the same, and that all facts
therein by him stated are true.
My Commission Expires Notary Public, State of Florida
� 4
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.
No
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
(Signed)- -- - -/C _,- ----
Capacity Gals
Y Z 6
•
Date.
Application is hereby made fox the approval of the detailed statement of the plans and specifications herewitlf 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 111 _ reA- hf iz. t,, N t= e' No. I ,C ' t/Lf. Street 9) q
Registered Architect and /or Engineer ..... _ _.
Employing Plumber's Name 1 ' 4 e C ! r g ? ' I C dG a Q _ No.._ 7 a 1 AE Streeti4A v
Location and Legal Description Bloek 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 Addition._.______________ ______ Repairs No. of Stories
Type of Tank
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 obligati s " s 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 tlie Act. The undersigned agrees to employ only such sub- contractors, on work to be performed under this permit, � q are
licensed by Miami Shores Village.
!� - _ -�°
(sign �. : _ _ _ —_ _ --
Master Plumber.
STATE OF FLORIDA,
COUNTY OF DADE. j
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 Conunission 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 worl®anship•
CLOSETf
BATH
TUBS
SHOWERS
LAVA.
TORIES
SINKS
SLOP
SINKS
LAUNDRY
TUBS
U
URINALS
CATCH
BASIN
FLOOR
DRAIN
DRINKING
FOUNT'NS
TOTAL
FIXTURES
CONTR.
LIST
CHECK
.
�_^
SEPTIC
TANK
SEWER
CONN.
DRAIN
FIELD
SOAKAGE
PIT
GREASE
TRAP
SOLAR
HEATER
DEEP
WELL
SPRKLR.
SYSTEM
SWIM•G
POOL
CONTR.
LIST
CHECK
No
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
(Signed)- -- - -/C _,- ----
Capacity Gals
Y Z 6
•
Date.
Application is hereby made fox the approval of the detailed statement of the plans and specifications herewitlf 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 111 _ reA- hf iz. t,, N t= e' No. I ,C ' t/Lf. Street 9) q
Registered Architect and /or Engineer ..... _ _.
Employing Plumber's Name 1 ' 4 e C ! r g ? ' I C dG a Q _ No.._ 7 a 1 AE Streeti4A v
Location and Legal Description Bloek 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 Addition._.______________ ______ Repairs No. of Stories
Type of Tank
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 obligati s " s 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 tlie Act. The undersigned agrees to employ only such sub- contractors, on work to be performed under this permit, � q are
licensed by Miami Shores Village.
!� - _ -�°
(sign �. : _ _ _ —_ _ --
Master Plumber.
STATE OF FLORIDA,
COUNTY OF DADE. j
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 Conunission 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 worl®anship•
a�
--go°
Registered Architect and /or Engineer.-
MIAMI SHORES VILLAGE
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 8 4 2 F L.
BUILDING INSPECTION DEPARTMENT
APPLICATION Igo G°3 F=;UILDING 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 Dept at building during progress of the work.
Date
Owner's Name and Address
/ — • — No. Z Street
ic y
State work to be done and purpose of building (by floors)
y2 '`'. ®v e .p el. T 1D 4r C L-01) 'LC " f .- (,, Vc; (Li, c' et `x 2• a i '-lr) and for no other purpose.
New Building Remodeling Addition Repairs No. of Stories
To be constructed of Kind of pundatit nog. Cover
Estimated Total cost of improvements $ i ® 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 Laws of Florida, Permanent Supplement,
and has complied 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 i pection on the si =. • the work such public notice
or notices as are required by the Act. The undersigned agrees to employ only such su - ntractors, on • ,.- o be performed under this
permit, as are licensed by Miami Shores Village.
Remarks ( Signed)
C•r(bG.'E
"or ,/,6„,._,/t.6-‘_/
STATE OF FLORIDA, I
COUNTY OF DADE. Ss.
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally ap-
peared
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 Date Read, Sworn to and Subscribed before me.
Disapproved Date
(Signed)
Notary Public, State of Florida
Building Inspector My Commission Expires
PLANNING BOARD DATE
Chairman Member
Member Member
Member Member
Council Approved Date Disapproved Date
NOTE: A charge of $1.00 will be made for making corrections or changes to this application after approval has been obtained from
the Planning Board.
A re- inspection fee of $1.00 will be charged when such re- inspection is made necessary by improper notice for inspection or faulty
materials and /or workmanship.
C--. 4-
a: r
MIAMI SHORES VILLAGE, FLORIDA
BUILDING 0
ELECTRICAL 0 Date 19-.
PLUMBING 0 PERMIT N? 8484 Contractor's
404t
ROOFING El License No.
111 Work to be performed under this PermitA tt4o4i - - • II
Owner of
Building t"'" # 4 ti
Architect
Contractor
or Builder e:3‘..„.
Legal Lot . 11
Description 11 BI.
Address of -f e -qt.- a. 4 ---k
Building
• 4 .
t
4 4( ;4 ‚-
o fa
Subdi-
vision
r'1
Sq Ft
.1e2r
Value of I Amount of
r;,)0 —
Project $ 11 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 :I._ (-11s1S BY
In donsideration of the issuance to me of this permit I agree to erform the work covered hereunder in compliance with all ordinances and regulations
pertainingithereto and in strict conformity with the plans, drawings, sta ments or specifications submitted to the proper authorities of Miami Shores Village.
In accepting this permit L'asviiie responsibility for all work done I/ ither, myself, my agent, servant or employee.
".;
j CONTRACTOR4r BUILDER BY AUTHORITY
BUILDING ❑ MIAMI SHORES VILLAGE, FLORIDA
ELECTRICAL ❑
PLUMBING Q PERMIT N° 8480 Contractor's
License No
ROOFING ❑
Address of
Building
❑
Owner of
Building
Architect
Contractor r ,
or Builder 4 ' a N .• %
Legal
Description
Lot
Work to be performed under this Permit
1 4 ' +%. t.
Date 1947
Subdi-
vision
Sq Ft
Value of I I Amount of
Project $ I 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 plar or drawings or in the statements or specifications and that he assumes respon-
sibility for work done by his agents, servants or employees. +'
Signed: (,R - ` x 3' (INSPECTOR) BY
In consideration of the issuance to me of this permit I agreq o perform the work covered hereunder in compliance with all ordinances and regulations
pertaining thereto and in strict conformity with the plans, drawing, tatements or specifications submitted to the proper authorities of Miami Shores Village.
In accepting this permit I assume responsibility for all work do ne'dy either, my my agent, servant or employee.
CONTRACTOR or BUILDER BY AUTHORITY
/
MIAMI SHORES VILLAGE, FLORIDA
BUILDING ❑ date '24 19107
ELECTRICAL ❑
PLUMBING 1 PERMIT N? 8521 Contractor's
License No. 0
ROOFING ❑ 0 11 1 `t» .
Owner of
Building "
Architect
Contractor
or Builder
Legal
Description
Lot
= rim ►k .;c _I.
Address of .. '".--
Building L
❑ Work to be performed under this Permit
CONTRACTOR or BUILDER
t
BI
BY
2 f t X _ t
Subdi-
vision
Sq. Ft.
Value of H Amount of
Project $ II Permit $
741
AUTHORITY
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 ploees�
Signed, is�.„�%`` -E�'1VSPECTOR) BY
In consideration of the issuance to me of this permit I agree to erform the work covered hereunder in compliance with all ordinances and regulations
pertaining thereto and in strict conformity with the plans, drawings, s atements or specifications submitted to the proper authorities of Miami Shores Village.
In accepting this permit I assume responsibility for all work done b either, myself, my agent, servant or employee.
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 _ __ __
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
Registered Architect and /or _.._. _ _____
Date_
cc I
ai4.4 No. _Y__ — - -_ Street__?
Street,/ '
Subdivision
Employing Plumber's Name
Location and Legal Descriptn Lot_____.__ _ _...._..._.._.___ _ — . — Block_
Street and Number where work is to be performed— No._____
State work to be performed and purpose of building (By Floors)
New Building —_ Remodeling____ _....___ Addition Repairs No. of Stories
Street
Size Septic Tank__-_---------------------- _.__--- - -_ - -_ Type of Tank
Feet of Drain Tile____ ______ _Dist. Feet of Tank or Drain Field from Well
y _ _____
Nature of Water Supply: City—Well. Size of Soakage Pit � _.a�.._____�_________.__
Capacity Gals
Plumbing Inspector. -
The undersigned applicant for this building permit does hereby certify that he understands and accepts his • . P. ations as an employer of labor
under the Florida Workmen's Compensation Act, being Section 5968, Compiled General Laws of Florida P ent Supplement, and has com-
plied with the provisions thereof, and will require similar compliance from all contractors or sub - contractor ' mployed 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 wor such public notice or notices as are
required by the Act. The undersigned agrees to employ only such sub- contractors, on work to be performed under this permit, as are
licensed by Miami Shores Village.
STATE OF FLORIDA, I as.
COUNTY OF DADE.
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeared
to me well known, and who, being by me first duly sworn, upon oath deposes and . says that he is the
of the above described construction, that he has carefully read the foregoing application, and that he did sign the same, and that all facts
therein by him stated are true.
My Commission Expires Notary Public, State of Florida
Master Plumber.
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 worlmtanship.
CLOSETS
TUBS
TUBS
SHOWERS
LAVA
TORIES
SINKS
SLOP
SINKS
LAUNDRY
TUBE
U RINALS
CATCH
BASIN
FLOOR
DRAIN
DRINKING
FOUNT'NS
TOTAL
FIXTURES
CONTR.
LIST
CHECK
SEPTIC
TANK
SEWER
CONN.
DRAIN
FIELD
SOAKAGE
PIT
GREASE
TRAP
SOLAR
HEATER
DEEP
WELL
SPRKLR.
SYSTEM
SWIM'G
POOL
CONTR.
LIST
-
CHECK
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 _ __ __
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
Registered Architect and /or _.._. _ _____
Date_
cc I
ai4.4 No. _Y__ — - -_ Street__?
Street,/ '
Subdivision
Employing Plumber's Name
Location and Legal Descriptn Lot_____.__ _ _...._..._.._.___ _ — . — Block_
Street and Number where work is to be performed— No._____
State work to be performed and purpose of building (By Floors)
New Building —_ Remodeling____ _....___ Addition Repairs No. of Stories
Street
Size Septic Tank__-_---------------------- _.__--- - -_ - -_ Type of Tank
Feet of Drain Tile____ ______ _Dist. Feet of Tank or Drain Field from Well
y _ _____
Nature of Water Supply: City—Well. Size of Soakage Pit � _.a�.._____�_________.__
Capacity Gals
Plumbing Inspector. -
The undersigned applicant for this building permit does hereby certify that he understands and accepts his • . P. ations as an employer of labor
under the Florida Workmen's Compensation Act, being Section 5968, Compiled General Laws of Florida P ent Supplement, and has com-
plied with the provisions thereof, and will require similar compliance from all contractors or sub - contractor ' mployed 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 wor such public notice or notices as are
required by the Act. The undersigned agrees to employ only such sub- contractors, on work to be performed under this permit, as are
licensed by Miami Shores Village.
STATE OF FLORIDA, I as.
COUNTY OF DADE.
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeared
to me well known, and who, being by me first duly sworn, upon oath deposes and . says that he is the
of the above described construction, that he has carefully read the foregoing application, and that he did sign the same, and that all facts
therein by him stated are true.
My Commission Expires Notary Public, State of Florida
Master Plumber.
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 worlmtanship.
I DING
ECTRICAL
tJMBING
3 OFING
ner of
lding
hitect
tractor
uilder
'1 Lot
Tiption
ress of
ling
I1
n
❑ Work to be performed under this Permit
CONTRACTOR OR BUILDER
MIAMI SHORES VILLAGE, FLORIDA
PERMIT IN? 11362
Bt.
C :r
Subdi-
vision
Value of
Project $
Signed• ` ; ' BY
INSPECTOR
DATE'S 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
or in strict compliance with all ordinances pertaining thereto and with the understanding that the work will be performed in compliance with any plans,
ings, statements or specifications that may have been submitted to and approved by the proper municipal authorities. This Permit may be revoked at any
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
fed is the understanding that the contractor or builder named above assumes the responsibility for a thorough knowledge of the ordinances and regulations
ining 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
by his agents, servants or employees. - 4
)
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
sing thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village.
-epting this" permit I assume responsibility for all work done by either, -mjiie t, .my agent, servant or employee.
BY
AUTHORITY
L.
Permit No ! / v
Registered Architect and /or Engineep
7'
Employing Plumber's Name ' A a
E Y 2 .
Location and Legal Description Lot '7
Amount of Permit $
Size Septic Tank
Feet of Drain Tile - -
Nature of Water Supply: City —Well
ss.
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
Type of Tank
Date_
Application is hereby made for the approval of the detai ed statement of the plans and specifications herewith submitted for the building or other
structure herein described. This application is made in comniliance 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
di d uring progress of k , a i3`� E> e. < e '4' \ j / R�eivc
Owner's Name and Address ' Ca L ^'
No Street
No Street
Subdivision M l0 yL ^4. 6 '
Block - 2 2 --
Street and Number where work is to be performed —No f i� F (: t
State work to be performed and purpose of building (By Floors
New Building Y Remodeling Addition Repairs No. of Stories
Street
Dist. Feet of Tank or Drain Field from Well
Size of Soakage Pit
(Signed)
Capacity Gals
umbingspector.
The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations as an emiloyer of labor
under the Florida Workmen's Cpmpensation Act, being Section 5966, Compiled General Laws of Florida Permanent Supplement, at \ cl has com-
plied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors employed by him in the'\vork 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. c J Ya
( Signed) %”"
Master Plug
STATE OF FLORIDA, t
COUNTY OF DADE.
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appea •d
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 faregoing 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.
4
CLOSETS
BATH
TUBS
SHOWERS
LAVA-
TORIES
SINKS
SLOP
SINKS
LAUNDRY
TUBS
URINALS
CATCH
BASIN
FLOOR
DRAIN
DRINKING
FOU NT' NS
TOTAL
FIXTURES
CONTR.
In
/
/
V
/ A
CHECK
/ 7a`
7j
73
45 „-- 6 ,
/ 1 -
. .;, „...-
SEPTIC
TANK
SEWER
CONN.
DRAIN
FIELD
SOAKAGE
PIT
GREASE
TRAP
SOLAR
HEATER
DEEP
WELL.
SPRKLR.
SYSTEM
SW IM'G,
POOL.
5,g�- 4,,
/
CNId`N
r ' .4si E
CONTR.
LIST
,
/
o C °a
/
/
/ I
0
�7
/�
{r �
} V V
I
CHECK
,T3
L.
Permit No ! / v
Registered Architect and /or Engineep
7'
Employing Plumber's Name ' A a
E Y 2 .
Location and Legal Description Lot '7
Amount of Permit $
Size Septic Tank
Feet of Drain Tile - -
Nature of Water Supply: City —Well
ss.
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
Type of Tank
Date_
Application is hereby made for the approval of the detai ed statement of the plans and specifications herewith submitted for the building or other
structure herein described. This application is made in comniliance 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
di d uring progress of k , a i3`� E> e. < e '4' \ j / R�eivc
Owner's Name and Address ' Ca L ^'
No Street
No Street
Subdivision M l0 yL ^4. 6 '
Block - 2 2 --
Street and Number where work is to be performed —No f i� F (: t
State work to be performed and purpose of building (By Floors
New Building Y Remodeling Addition Repairs No. of Stories
Street
Dist. Feet of Tank or Drain Field from Well
Size of Soakage Pit
(Signed)
Capacity Gals
umbingspector.
The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations as an emiloyer of labor
under the Florida Workmen's Cpmpensation Act, being Section 5966, Compiled General Laws of Florida Permanent Supplement, at \ cl has com-
plied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors employed by him in the'\vork 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. c J Ya
( Signed) %”"
Master Plug
STATE OF FLORIDA, t
COUNTY OF DADE.
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appea •d
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 faregoing 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.
4
t a
N
r;