PLUMBINGBUILDING
PERMIT APPLICATION
FBC 2001
Permit Type (circle): Building Electrical
Owner's Name (Fee iple Titleholder)
7
Owner's Address
City 1 15))/7_ „-- State / Zip
Tenant/Lessee Name Phone #
Contractor's Company Name , J / yr, J Phone
Contractor's Address /1)6 17oS
City /1)) i , }' State 't
Qualifier
State Certificate or Registration No. Certificate of Competency No.
Architect/Engineer's Name (if applicable) Phone #
$ Value of Work For this Permit
Miami Shores Village
Builel*DepoOm.ent
10050 N.E.2knd Avenue, Miami glides, Florida 33138
Tel: (105) 7P .22Q4 gam ,(3O5) 756.8972
� k
4
.o c
Type of Work: ❑Addition ['Alteration ❑New
Describe Work:
Code Enforcement $ Structural Plan Review. $
* * * * * * * * * * * * * * * * * * * * * * * * * * ** F ees * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
Submittal Fee $ Permit Fee $ 1 1 5 • C0
Notary $ • 0 C Training/Education Fee $ • .ICI
Scanning $ Radon $ Zoning
Total Fee Now Due $ 1 &S • I 4644
(Continued on opposite side)
Square Footage Of Work:
Permit No. PI d —” 2J
Master Permit No.
Phone #
Mechanical Roofing
Job Address (where the work is being done) r e/ 3 Air 7,G7
City Miami Shores Villag County Miami -Dade Zip
Is Building Historically Designated YES NO
Zip
❑ Repair/Replace ❑ Demolition
CCF $ • 60 CO /CC
Technology Fee $ 439--
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 Signature
Owner or Agent Contractor
The foregoing instr was acknowledged before me this The foregoing instrument was ackno
day of , 20 _ , by , day of — , 20 by
who is personally known to me or who has produced who i
As identification and who did take an oath.
NOTARY PUBLIC: NOTARY PUBLIC:
Sign: Sign:
Print: Print:
My Commission Expires:
APPLICATION APPROVED BY:
Chc 05/13/03
sonally known
ed before me this
rA
e or who has produced
fication and who did take an oath.
a
My Commission Expires `<6
****************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** * * * * * * * * * * * * * * * * * * * * * * **
Zoning
r
******* * * *k * * * * * * * * * * ** * * * * ** * ** * * * * ** " * * * * ** * * * ** * * *' ****************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
( Plans Examiner
Engineer
Miami Shores Village
10050 NE 2nd Avenue
Phone: 305- 795 -2204 Permit Number: PL2005 -25
Printed: 1/25/2005
Applicant: ROBERT HANNAU
Owner: HANNAU ROBERT
JOB ADDRESS: 813 NE 97 ST
Contractor BOBS SEPTIC & DRAIN INC
Local Phone: 305 - 558 -5818
Parcel # 1132060142590
Permit Status: APPROVED Permit Expiration: 7/17/2005 Construction Value:
Work: ABANDON SEPTIC TANK
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.
Plumbing Permit
Contractor's Address: 1020 NE 130 ST
Page 1 of 1
Legal Description: MIAMI SHORES SEC 3 PB 10 - 37 LOT 14 & W1/2 OF LOT 15 BLK 73
Fees: Description Amount
FEE2005 -1075 Building Fee $175.00
FEE2005 -1076 CCF $0.60
FEE2005 -1077 Notary Fee $5.00
FEE2005 -1078 Training and Education Fee $0.20
FEE2005 -1079 Technology Fee $4.37
Total Fees: $185.17
Total Fees: $185.17
Total Receipts: $185.17
Signed:
(INSPECTOR)
$50.00
Signed: (Contractor or Builder) BY:
Miami Shores Village
10050 NE 2nd Avenue
Printed: 1/25/2005
Applicant: ROBERT HANNAU
Owner: HANNAU ROBERT
JOB ADDRESS: 813 NE 97 ST
Contractor BOBS SEPTIC & DRAIN INC
Local Phone: 305 - 558 -5818
Parcel # 1132060142590
Permit Status: APPROVED Permit Expiration: 7/17/2005 Construction Value:
Work: ABANDON SEPTIC TANK
Plumbing Permit
Phone: 305 - 795 -2204 Permit Number: PL2005 -25
Contractor's Address: 1020 NE 130 ST
Legal Description: MIAMI SHORES SEC 3 PB 10 - 37 LOT 14 & W1/2 OF LOT 15 BLK 73
Fees: Description Amount
FEE2005 -1075 Building Fee $175.00
FEE2005 -1076 CCF $0.60
FEE2005 -1077 Notary Fee $5.00
FEE2005 -1078 Training and Education Fee $0.20
FEE2005 -1079 Technology Fee $4.37
Total Fees: $185.17
Total Fees: $185.17
Total Receipts: $185.17
$50.00
Page 1 of 1
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:
'Village b f Miami Shores N° 3645
4
JOB L
7
ADDRESS
INSPECTION ■f P T -, �� AJ lam.
TIME READY
REMARKS 2- cf / / '— J A A —
INSPECTOR
DATE
Date I I H 00 Job Address n � -' 4 S Tax Folio l . a 0 N o 3 y )f 0
Legal Description Ns SP r2 1 *A a Historically Designated: Yes No
9g 93
Phone CS3c) Lt2,2.
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Owner/Lessee / Tenant 1 -- - (X —14
Owner's Address Sn
Contracting Co.
Qualifier
State# 1 —J 743
Architect/Engineer
Bonding Company
Mortgagor Address
Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
Square Ft.
WARNING TO OWNER: YOU MUST RECORD A NOTICE OF COMMENCEMENT AND YOUR FAILURE TO DO SO 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.)
Application is hereby made to obtain a permit to do work and installation as indicated above, and on the attached addendum (if applicable). I 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, SIGNS, POOLS, ROOFING and MECHANICAL WORK.
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. Furthermore, I authorize the above -named contractor to do thdwork stated.
ture of owner and/or Condo Presi
L D coo_
tary as t 4 Owner
My Commission Expires:
FEES: PERMIT( D.
APPROVED:
Zoning
Mechanical
.,., 111.
a2
CIAL NOTARY
2 .14' � O e. ANGELA M BECKER
* , COMMISSION NVY3ER
'IU' its Q CC786697
7 . re, p
OF q MY COMMISSION EXPIRES
F `Q NOV. 15,2002
RADON
Municipal #
1'/ 00
°? -Date
ba 0
L J'1 /
Competency #
Address
Address
Estimated Cost (value)
My Commission Expires:
Master Permit #
Address / S57,440 G.
ss#
Ins. Co.
i°
vv �
Si : ture of Contractor or Owner - Builder
• I� . lo S 3b -8. q
•
o tary as t Contra
ontract. or • a eFIC —'
0 'G ANGELA M BECKER
2 l ( n coot ssoH NUMBER
.0
'ID '-4►: . CC786697
Date
NOV. 15,2002
C.C.F. ( � 0 N O T A R R 5 _ f ) () BONDS
TOTAL DUE - L Cue? O
ate
Electrical
Structural Engineer
CON TRUCTION PERMIT FOR:
[ New System [ 4 Existing System
[ -' ] Repair (i ,) Abandonment
APPLICANT:
PROPERTY STREET ADDRESS:
LOT: � a
PROPERTY ID
SYSTEM DESIGN AND SPECIFICATIONS
T
A
N
K
D
R
A
I
N
F
I
E
L
D
0
T
H
E
R
[
]
SQUARE
SQUARE
TYPE SYSTEM:
CONFIGURATION:
LOCATION OF BENCHMARK: -, -f
ELEVATION OF PROPOSED SYSTEM SITE
BOTTOM OF DRAINFIEID TO BE [
FILL REQUIRED:
SPECIFICATIONS BY:
APPROVED BY:
DATE ISSUED:
le
STATE OF.FLORIDA
DEPARTMENT OF HEALTH
ONSITE SEWAGE DISPOSAL ,SYSTEM
CONSTRUCTION PERMIT
Authority: Chapter 381, P'$ &
BLOCK: /4 Ao SUBDIVISION:
GALLONS
FEET
FEET
,._• A +'7
4 0;
aR
[ TRENCH
.4
*' A
DH 4016, 10/96 (Replaces HRS -H Form 4016 (page 1] which may be uses.
(Stock Number: 5744- 001- 4016 -0) t ,.
[ /+r..
[ JJ
Chapte 10D-6, FAC
Holding Tank (J ( Temporary /Experimental
Other(Specify)
t•' 1.
PRIMARY DRAINFIELD SYSTEM
SYSTEM
[ „ J,. STANDARD [ " J•'4FILLED
'[ , , ) BED
AGENT: ) r
lot
TITLE:
Installer /Contractor
ls�
- 1 z
PERMIT # 41
DATE PAID
FEE PAID $
RECEIPT ..# G. ;ei/
rsi4 ab �e
a 4! [SECTION /TOWNSHIP /RANGE /PARCEL NUMBER]
[OR TAX ID NUMBER]
SYSTEM MUST BE CONSTRUCTED IN ACCORDANCE WITH SPECIFICATIONS AND STANDARDS OF CHAPTER 10D -6,
FAC. REPAIR PERMITS AND HOLDING TANK PERMITS EXPIRE 90 DAYS FROM THE DATE OF ISSUE. ALL OTHER
PERMITS EXPIRE ONE YEAR FROM THE DATE OF ISSUE. DEPARTMENT OF HEALTH APPROVAL OF SYSTEM DOES
NOT GUARANTEE SATISFACTORY PERFORMANCE FOR ANY SPECIFIC PERIOD OF TIME. 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.
[GALLONS / GPD] SEPTIC TANK/AEROBIC UNIT CAPACITY MULTI- CHAMBERED /IN SERIES:[
[GALLONS / GPD] CAPACITY MULTI- CHAMBERED /IN SERIES:( )
GALLONS GREASE INTERCEPTOR CAPACITY [MAXIMUM CAPACITY SINGLE TANK: 1250 GALLONS)
PER DOSE DOSING TANK CAPACITY DOSE KATE [ ] PER 24 HRS NO. OF PUMPS:
CA. MOUND
(/ x�
°] 4[I BS/FT] [ABOVE /tEL0 BENCHMARK /REFERENCE POINT
] [INCU£S/FT] [ABOVE/BELOW] BENCHMARK /REFERENCE POINT
INCHES EXCAVATION REQUIRED: [ ) INCHES
1
A z
S
EXPIRATION DATE:
TITLE: N % t , , '!
• ' '.7
'F
I) 1
[ ]
CHD
Page 1 of 2
INSTRUCTIONS:
PERMIT NUMBER: Permit tracking number by County Health Department.
APPLICATION FOR: Check type of permit; if "Other" specify type in blank.
APPLICANT: Property owner's full name.
TELEPHONE: Telephone number for applicant or agent.
AGENT: Property owner's legally authorized representative.
MAILING ADDRESS: P.O. box or street mailing address for applicant or agent.
LOT, BLOCK, SUBDIVISION or
PROPERTY ID #: 27 character ID number for property. (Health Department may require property appraiser ID# or
section /township /range /parcel number.)
SYSTEM DESIGN AND
SPECIFICATIONS:
TANK: Minimum specifications from Chapter 10D -6, FAC.
DRAINFIELD: Minimum specifications from Chapter 10D -6, FAC.
OTHER: Other specifications, such as operating permit requirements, low- volume flush toilets, variance provisos.
SPECIFICATIONS BY: Name of individual providing specifications. If designed by a registered engineer must be sealed.
APPROVED BY: County Health Department personnel reviewing and approving permit.
DATE ISSUED: Date permit is issued by County Health Department.
EXPIRATION DATE: One year from date issued if the system has not been installed. Permits for system repairs become void 90 days from the
date issued.
APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PERMIT
Permit Application Number
PART II - SITE PLAN -
Scale: Each block represents 5 feet and 1 inch = 50 feet.
♦ 6
Notes: /44 t 1-'7-14>
a STATE OF FLORIDA
DEPARTMENT OF HE6LTH
4
Oft
DH 4015. 101913 (Replaces HRS-H Form 4015 which may be used)
(Stock Number: 5744.002. 4015.6)
f
Signature
Not Approved
J
Site Plan submitted by:
Plan Approved
By County Health Department
ALL CHANGES MUST BE APPROVD BY THE COUNTY HEALTH DEPARTMENT
Title
,141
Page 2 of 3
MIAMI SHORES VILLAGE
BUILDING DEPARTMENT t!
305- 795 -2204
Bu lding Inspection Request
Date
Type Insp' n `!' 5P n bt-(-12-1/
Permit No T t o v
Name DOA-11 r — '-
Address 7S nrE_ otq
Company
Phone # i
Inspection Date
Approved
Correction
Re- Insp'n Fee
MIAMI SHORES VILLAGE
BUILDING DEPARTMENT
305- 795 -2204
Bui I ding Inspection Request
'Date
Type Insp'n Oo I S p
Permit No. 1
Name )
Address ,C> Q- )3 N t ( 5 -I--
Company &T_D
Phone #
Inspection Date ) c
Approved
Correction
Re- Insp'n Fee
Miami Shores Village
10050 NE 2nd Avenue
Phone: 305 - 795 -2204 Permit Number: PL2005 -22
Printed: 1/25/2005
Applicant: LORETTA DALY
Owner: DALY LORETTA
JOB ADDRESS: 875 NE 99 ST
Contractor AFFORDABLE IRRIGATION INC Contractor's Address: 198 NW 139 ST
Local Phone: 305 - 681 -6322
Parcel # 1132060340150
Plumbing Permit
Page 1 of 1
Legal Description: MIAMI SHORES SEC 8 PB 14 -33 LOT 21 & W1/2 OF LOT 22 BLK 169
Fees: Description Amount
FEE2005 -1061 Building Fee $175.00
FEE2005 -1062 Technology Fee $4.37
FEE2005 -1064 Scanning Fee $3.00
FEE2005 -1065 Training and Education Fee $0.20
FEE2005 -1066 CCF $0.60
Total Fees: $183.17
Total Fees: $183.17
Total Receipts: $183.17
Permit Status: APPROVED Permit Expiration: 7/13/2005 Construction Value: $1,000.00
Work: LAWN SPRINKLER INSTALLATION
Signed: (INSPECTOR)
!.IAN 2 6 PAID
In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations pertaining thereto and in strict
conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I assume responisibility for all work
done by either myself, my agent, servants or employes.
Signed: (Contractor or Builder) BY:
BUILDING
PERMIT APPLICATION
FBC 2001
Permit Type (circle): Building Electrical
Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel (W79f 4 — 5 756.8972
114 "1 4. 4 :
Owner's Name (Fee Simple Titleholder) ) (DI(e TI a 1 ' DQ I Phone # 3) 5- 1 51- Li L(22
Owner's Address S 7 5> N E q q S (' e-e -I-
City m'cinNi Sho►reS State L Zip _331
Tenant/Lessee Name
Phone #
Job Address (where the work is being done) � 6 N "Ivl (e
Architect/Engineer's Name (if applicable) Phone #
$ Value of Work For this Permit
Describe Work:
LC-
Submittal Fee $
Notary $
la (on Spri idev I nc1 - � - i =:
1 ar� ras.S ,, • +
•
Permit Fee $
Training/Education Fee $
r7s
Scanning $ Radon $ Zoning
Code Enforcement $ Structural Plan Review. $
Total Fee Now Due $
(Continued on opposite side)
�
Permit No. Y 1 rr,, U�'2z.
Nilaster Permit No.
City Miami Shores Village County Miami -Dade Zip .31 3
Is Building Historically Designated YES NO
Contractor's Company Name 4 Y(71 a k e 1 lQQ -�'lln Phone # 3 " CUSI — CO 32-2
Contractor's Address q B N (..A...) 1 C? J S ee e -I-
Cit ni'(a r .1 State f L Zip j3) 05'
Qualifier (Q(C O .R OSlA S
State Certificate or Registration No. C ertificate of Competency No. `7 �P .D ci 9
Square Footage Of Work:
Type of Work: ❑Addition ❑Alterationw ' .,: "' . . ❑ Demolition
*.•* * * * * ** ** * ** * ** * * * * * ** Fees, * * * * * * * * * * * * * * * * * * *** * * * **
Mechanical Roofing
CCF $ CO /CC
Technology Fee $
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 m 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 f7 ��
J Owner or Agent
The foregoing instrument was acknowledged[ before me this /rl.. -a The foregoing instrument was acknowledged before me this /3
day of ' i1,j < , 20 cg` , by , day of Qft)u , 20 OS, by ik-{p 6 505 •
who is personally known to me or who has produced who i:ah' + 0 . 41e. e or who has produced
As identification and who did take an oath. as identification and who did take an oath.
NOTARY P C: � NOTARY PUBLIC:
Sign:. l" ) �� 1 � 2 v/' Sign:
Print: " Print:
My Commission Expires: My Commis3
1 � � g r 'iy 11 Ij�Lls;:'
s ires: AUG. 22, 2068
Bonded Thra
� ;.� A clandc Bonding Co, tic.
* * * * * * * * * * * * * * * * ** . * * * */lrirr itrt► *tt * * * * * * * * * * * * * * * * * * * * ** �4S�st�E * * * * * * * * * * * * * * * * * * * * * * * * * * * **
APPLICATION APPROVED BY:
Cho 05/13/03
1
**** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** k * * ** • * * * ** * ** „ ******************* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
ans Examiner
Engineer
Zoning
Lo 2 P. 77041
441_4 s
tE )2,
f y
CC# 96P000219
Affordable Irrigation, Inc.
198 NW 139 Street
Miami, FL 33168
S7/2ee7
S A
i A. • 7oAo g- 7o .11.41
lL 207;r ce ?07011-4-
L ,4j uis7 04
• ?ont, 2641_1A)
rf(
ti
Village of Miami Shores N° 3665
JOB N
TIME READY em.
ADDRESS f /yZ
INSPECTION ' ni,} c.
A _1 c, 14
72 Z
REMARKS
2!c / NS ?c y.
INSPECTOR DATE d - t'`" -S-6,
SEPTIC SEWER DRAIN SOAKAGE GREASE °60emt DEEP SPRKLR. SWIM'G
TANK CONN. PIELD PIT TRAP HEATER WELL SYSTEM POOL.
CONTR.
LIST l / ( ®
//�� f ��11
CHECK /Cc / `L ' /MO '7W
Permt 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. n�
Owners Name and Address e Ale% _ ____. ....... No.__- __ - - ° rr
Registered Architect and /or Engineer----- __ -_ -- ----- __---- _- _ ___ --
Employing Plumber's Name s -- _1 - - No._.______ —_._ ____ _ Street-- — __.__
Location and Legal Description Lot _.____ —______— _ __Block Subdivision
Street and Number where work is to be performed —No S Z.-
Street
State work to be performed and purpose of building (By Fl oors)- __- _-------------- - - - - -- - --
New Building _v rm Remodeling_____ Addition____ Repairs
Size Septic Tank.__ -_____ ®- _-------- __ - - -- Type of Tank_:_._ Capacity Gals
Feet of Drain Tile? _ , ®c/I K eetthist. Feet of Tank or Drain Field from Well
Nature of Water Supp
Amount of Permit $ - -1 -r
STATE OF FLORIDA,
COUNTY OF DADE.
$s.
1,6
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
Size of Soakage Pit
( Signed )_
F Jr '
Date / a- _ S
No. of Stories.
My Conunission Expires Notary Public, State of Florida
Plumbing Inspector.
The undersigned applicant for this building permit does hereby certify that he under :1', . accepts his obligations as an employer of labor
under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Permanent Supplement, and has com-
plied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors employed by him in the work to be
performed under this permit; and will post or cause to be posted for inspection on the site of the work such public notice or notices as are
required by the Act. The undersigned agrees to employ only such sub- contractors, on work to be performed under this permit, as are
licensed by Miami Shores Village.
Master Plumber.
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeared
to me well known, and who, being by me first duly sworn, upon oath deposes and says that he is the
of the above described construction, that he has carefully read the foregoing application, and that he did sign the same, and that all facts
therein by him stated are true.
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.
CLOSSTB B
BATH S
SHOWER. S
LAVA- S
SINKS L
SLOP L
LAUNDRY U
U C
CATCH F
FLOOR D
DRINKING T
TOTAL
CONTR.
CHECK
Permt 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. n�
Owners Name and Address e Ale% _ ____. ....... No.__- __ - - ° rr
Registered Architect and /or Engineer----- __ -_ -- ----- __---- _- _ ___ --
Employing Plumber's Name s -- _1 - - No._.______ —_._ ____ _ Street-- — __.__
Location and Legal Description Lot _.____ —______— _ __Block Subdivision
Street and Number where work is to be performed —No S Z.-
Street
State work to be performed and purpose of building (By Fl oors)- __- _-------------- - - - - -- - --
New Building _v rm Remodeling_____ Addition____ Repairs
Size Septic Tank.__ -_____ ®- _-------- __ - - -- Type of Tank_:_._ Capacity Gals
Feet of Drain Tile? _ , ®c/I K eetthist. Feet of Tank or Drain Field from Well
Nature of Water Supp
Amount of Permit $ - -1 -r
STATE OF FLORIDA,
COUNTY OF DADE.
$s.
1,6
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
Size of Soakage Pit
( Signed )_
F Jr '
Date / a- _ S
No. of Stories.
My Conunission Expires Notary Public, State of Florida
Plumbing Inspector.
The undersigned applicant for this building permit does hereby certify that he under :1', . accepts his obligations as an employer of labor
under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Permanent Supplement, and has com-
plied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors employed by him in the work to be
performed under this permit; and will post or cause to be posted for inspection on the site of the work such public notice or notices as are
required by the Act. The undersigned agrees to employ only such sub- contractors, on work to be performed under this permit, as are
licensed by Miami Shores Village.
Master Plumber.
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeared
to me well known, and who, being by me first duly sworn, upon oath deposes and says that he is the
of the above described construction, that he has carefully read the foregoing application, and that he did sign the same, and that all facts
therein by him stated are true.
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.
A t
OS
g
C ,