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899 NE 99 StDate Job Address 4 1 0 A5' C • loth Tax Folio ) 3 lJ /j D i'f Z) 0 p 1) Legal Description E" 1 r / /c4 �- l L Historically Desi Yes No Owner/Lessee / Tenant 6 '4 'JM � /`� 1 Master Permit # Owner's Address qi 0 S t1 G ' ! �t,� -►� Contracting Co. / "k • Ci � I fce-tic 4 00.4..) Qualifier 54 /�^-� E (�o�, L l r` �° b State # Municipal # Architect/Engineer Address Bonding Company Address Mortgagor Address Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN fe_ WORK DESCRIPTION ! /Q CA, Square Ft. .3 cyo 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 fo b. g information is accurate and that all work will be done in compliance with all applicable laws regulating construction • • • . • g. F • • re, I a -��: ture o ,,n <. and/or r ondo President No . as to • er and/or Condo President D e My Commission Expires: tb ., y iHia0viivvl :i: FEES: PE STEPHEN E COCKING State of Florid ' �� My Comm. Exp: 08/0 Comm #: CC669180 APPROVED: Zoning Mechanical Plumbing PERMIT APPLICATION FOR MIAMI SHORES VILLAGE Building Pat Address the above -named contractor to do the work stated. Phone 3 - gal-8 0 32-- iff 3 /4 '^1 ' ss# Phone 2C4 j 611-71 S Competency # Ins. Co. Estimated Cost (value) 1, 40 a `� ' / /;o � S , • • ture of Contractor or • i er- Builder 2 Date A Aritta A / • 'III' r- Builder 2. D to otary a o Contractor or Own My Commission Exp es: 2 �t C.C.F. 1 .. c D NOTARYS D D Electrical PU NOTARY / ANGELA M e BECKER � — (, cOM OSSIOH nvMSER • CC786697 comasSJOH EXPIRES OF F\. NOV . 15,2002 BOND h0 � n ()) TOTAL DUE3.1213. , ) O Structural Engineer CONSTRUCTION PERMIT FOR: New System [?^] Existing System Repair [ ] Abandonment [ ] APPLICANT: PROPERTY STREET ADDRESS: LOT: PROPERTY ID #: D R A I N F I E L D 0 T 11 E R [ SPECIFICATIONS BY: APPROVED BY: DATE ISSUED: STATE OF FLORIDA DEPARTMENT OF HEALTH ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PERMIT Authority: Chapter 381, FS & BLOCK: [ ] SQUARE FEET [ ] SQUARE FEET TYPE SYSTEM: CONFIGURATION: C e c • SUBDIVISION: Erc DH 4016. 10/96 (Replaces HRS -H Form 4016 (page 1J which m6 tiret1) -- (Stock Number: 5744- 001 - 4016 -0) Applicant Chapter 10D -6, FAC PERMIT # DATE PAID /ems •• (9 - CDC FEE PAID $ ' ';.-?'- RECEIPT # e 'er ® ;? A L/ F) `/ ® . M`j ( ) i 014114 =tank ( a'...4 ] Temporary /Experimental [ ] Other(Specity) AGENT: 1 [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. SYSTEM DESIGN AND. SPECIFI`CA IOnONS T (�!f ] [GALLONS / GPD] SEPTIC TANK/,AEROBIC UNIT CAPACITY A [ ] [GALLONS / GPD] CAPACITY N K MULTI- CHAMBERED /IN SERIES:[ ] MULTI CHAMBERED /IN SERIES:[ ] ] GALLONS GREASE INTERCEPTOR CAPACITY [MAXIMUM CAPACITY SINGLE TANK: 1250 GALLONS] ] GALLONS PER DOSE DOSING TANK CAPACITY DOSE •RATE [ ] PER 24 HRS NO. OF PUMPS: PRIMARY DRAINFIELD SYSTEM SYSTEM STANDARD [ 0] FILLED C.- ] MOUND [ j TRENCH [ ) BED [ ., LOCATION OF BENCHMARK: ;' A; � f iG ; ° 6 ELEVATION OF PROPOSED SYSTEM SITE [ ] [INCHES BOTTOM OF DRAINFIELD TO BE [ 4,2-% /' ./ ] [INCHES /FT] [ ABOVE /BELOW) BENCHMARK /REFERENCE POINT [ABOVE /_BELOW) BENCHMARK /REFERENCE POINT FILL REQUIRED: [i d � ] INCHES EXCAVATION REQUIRED: ( INCHES ' � / fit TITLE: TITLE: a OD CO'. / , 11-11.1 'I; I CHD EXPIRATION DATE: 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. w 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. By I__ _I__ 1+ 1 • 1 1 I f ' ' I IT ' f I In I ( 1 1.1 f"!" !I'm ' I "!! I - 1" ! I • , !; 1 64P4 I ! 6-1 fl ! I 0ct . 400. t. • H • 1 1 I 1 I b •_y_ " ! ! ""-- 11, 11 Plan Approved STATE OF FLORIDA DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PERMIT Permit Application Number (: %Y..)k ' • I I I I 1 , ■O' "....- i et— 1 ii i C" : 1 . ' 1 1 ; i i , 6*;.. '• . trxio 4' 1 HRS-H Form 4015, Feb 85 (Obsotetes previous editions which may not be used) (Stock Number: 5744-002-4015-6) -.4 . 1 I I (t/r' ,),e14 ..) Site Plan Submitted by SIGNATURE ( A , County Public Unit ALL CHANGES MUST BE APPROVED BY THE COUNTY PUBLIC HEALTH UNIT e PART II SITE PLAN /46115f- Not Approved • • i ' I ' ! • 1 . • ' , / I I # • I Date Page 2 of 3 MIAMI SHORES VILLAGE, FLA. `ne (ca )e 19 7 NNE 9 ?, f- INSPECTION 1 e- (LIB " TIME READY REMARKS• /15 J SP' JOB ADDRESS N_ 129 INSPECTOR DATE Permit No Amount of Permit $ -__ STATE OF FLORIDA, I COUNTY OF DADE. MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT Location and Legal Description Lot Block Street and Number where work is to be performed —No 899 N.E. State work to be performed and purpose of building (By Floors)._ New Building __ -- Remodeling • _Type of Tank Septic ( Signed)- My Commission Expires Notary Public, State of Florida April 13th, 76 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. Dean Clausen 899 N.E. 99th St. Owners Name and Address ............ --______--_._ ._____— ________.__— ...--- - - -._. No. - -_ -- Street Registered Architect and /or Engineer - ---- _- - - --__ _ .�-------- _-- ___ - -- O'Ne Septic Tank Co. 8350 N.W 56th Street Employing Plumber's Name No.______— _____� Street___—___ _._____.__-- .-- _- __._...- -._ -.. . Street 99th Street Addition__ X_._.______________ Repairs No. of Stories. _ .._. _ __..__... . 1 Capacity Gals Size Septic Tank...__ -_ Feet of Drain Tile_ 200 sC3 s ft. _ 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 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. ( Signed)- ___— ___.__ — e S� f Master Plumber Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeared to me well lmown, 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 insp. . ' n, or faulty materials and /or workmanship. CLOSETS BATH TUBE SHOWERS LAVA TORIES INKS SINKS SLOP SINKS LAUNDRY TUBS U RINALS CATCH BASIN FLOOR DRAIN DRINKING FOUNT' NS TOTAL FIXTURES COMM. LIST CHICK SEPTIC TANK SEWER CONN. DRAIN FIELD SOAKAGE PIT GREASE TRAP SOLAR HEATER DEEP WELL SPRKLR. SYSTEM SWIM'G POOL CONTR. LIST X CHICK Permit No Amount of Permit $ -__ STATE OF FLORIDA, I COUNTY OF DADE. MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT Location and Legal Description Lot Block Street and Number where work is to be performed —No 899 N.E. State work to be performed and purpose of building (By Floors)._ New Building __ -- Remodeling • _Type of Tank Septic ( Signed)- My Commission Expires Notary Public, State of Florida April 13th, 76 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. Dean Clausen 899 N.E. 99th St. Owners Name and Address ............ --______--_._ ._____— ________.__— ...--- - - -._. No. - -_ -- Street Registered Architect and /or Engineer - ---- _- - - --__ _ .�-------- _-- ___ - -- O'Ne Septic Tank Co. 8350 N.W 56th Street Employing Plumber's Name No.______— _____� Street___—___ _._____.__-- .-- _- __._...- -._ -.. . Street 99th Street Addition__ X_._.______________ Repairs No. of Stories. _ .._. _ __..__... . 1 Capacity Gals Size Septic Tank...__ -_ Feet of Drain Tile_ 200 sC3 s ft. _ 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 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. ( Signed)- ___— ___.__ — e S� f Master Plumber Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeared to me well lmown, 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 insp. . ' n, or faulty materials and /or workmanship. Permit No Registered Architect and /or Engineer Employing Plumber's Name 674 Location and Legal Description Lot.-- _.._________ __ _ ___._ Owner's Name and Address 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. 4 L d v No. - - - / Street. LN No. i Subdivision Street Date - - - -- - -- / r ! _ / 91 r c, P Street 24 J ) P Street and Number where work is to be performed -No 8 I y f1. • State work to be performed and purpose of building (By Floors) New Building __._ Remode ling___._____________________ Addition____ Repairs No. of Stories . . ..... ..... . .. Size Septic Tank_ - Meth' - - - - -- -Type of Tank— Capacity Gals Feet of Drain Tile S__o_{.__� '�!'"__ -Dist. Feet of Tank 'or Drain Field from Well Nature of Water Supply: City-Well. _ ______Size of Soakage Pit Amount of Permit $_ STATE OF FLORIDA, �. COUNTY OF DADE. J (Signed)- Plumbing Inspector. s as an employer of labor pplement, and has com- 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. The undersigned applicant for this building permit does hereby certify that he understands and accepts his obliga under the Florida Workmen's Compensation Act, being Section 5968, Compiled General Laws of Florida Pennane plied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors emplo 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 insp' materials and /or workmanship. n as are as are (Signed) -_� i %VtAA-e ..N /► C ,�, „ , a Q n / aster 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. n, or faulty CLOSETS BATH TUBS E SHOWERS LAVA- TORIES INKS SINKS SLOP SINKS LAUNDRY TUBS URINALS RINALS CATCH BASIN FLOOR DRAIN DRINKING FOUNT•NS TOTAL FIXTURES CONTR. LIST CHECK SEPTIC TANK SEWER CONN. DRAIN FIELD SOAKAGE PIT PIT GREASE TRAP SOLAR H EATER DEEP WELL SPRKLR. SYSTEM SWIM'G POOL CONTR. LIST CHECK �te✓1 I — ` —.— Permit No Registered Architect and /or Engineer Employing Plumber's Name 674 Location and Legal Description Lot.-- _.._________ __ _ ___._ Owner's Name and Address 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. 4 L d v No. - - - / Street. LN No. i Subdivision Street Date - - - -- - -- / r ! _ / 91 r c, P Street 24 J ) P Street and Number where work is to be performed -No 8 I y f1. • State work to be performed and purpose of building (By Floors) New Building __._ Remode ling___._____________________ Addition____ Repairs No. of Stories . . ..... ..... . .. Size Septic Tank_ - Meth' - - - - -- -Type of Tank— Capacity Gals Feet of Drain Tile S__o_{.__� '�!'"__ -Dist. Feet of Tank 'or Drain Field from Well Nature of Water Supply: City-Well. _ ______Size of Soakage Pit Amount of Permit $_ STATE OF FLORIDA, �. COUNTY OF DADE. J (Signed)- Plumbing Inspector. s as an employer of labor pplement, and has com- 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. The undersigned applicant for this building permit does hereby certify that he understands and accepts his obliga under the Florida Workmen's Compensation Act, being Section 5968, Compiled General Laws of Florida Pennane plied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors emplo 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 insp' materials and /or workmanship. n as are as are (Signed) -_� i %VtAA-e ..N /► C ,�, „ , a Q n / aster 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. n, or faulty BUILDING ❑ MIAMI SHORES VILLAGE FLORIDA ELECTRICAL ❑ Date 1 . PLUMBING © PERMIT Np 8519 Contractor's 7 0 ROOFING ❑ License No. '" 0 Owner of Building 4- . fi I. . ._z tt� Architect Contractor Builder 6 -- l ` • • i _ t �% . t r Legal Lot 11 Description 11 Bl Address of Building ' 7 � • -' cwt , 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 )ermit 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 Qr employees. (1 j \4 Signedt 'f (... .t. -•"C : . •_ '(INSPECTOR) BY In consideration of the issuance to me of this permit I agr perform the work covered hereunder in compliance with all ordinances and regulations pertaining thereto and in strict conformity with the plans, drawin s tatements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I assume responsibility for all work do y einier, myself, my agent, servant or employee. CONTRACTOR or BUILDER Work to be performed under this Permit Z ' Subdi- vision Sq Ft Value of 11 Amount of "'- Project $ 11 Permit $ BY AUTHORITY Permit No MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT Date 4 h . °4 °4 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. p Al/E. p q zgi Owner's Name and Address____ �f.1 ___°�--_a_� P. _�_' _C_l 7 L _ No. __ g Street_ Registered Architect and /or Engineer______-_ ________ __ ____ _____ _.7 Employing Plumber's Name acki _ a' ` C ea Street_ Location and Legal Description Lot________ ______ —,, Block_ - Subdivision Str �_ eet and Number where work is to be performed— No._.2. ..!�.! _g_t___ _ __ — Street 9 / _ 721 State work to be performed and purpose of building (By Floors)._ New Building Remodeling____ __.____ Addition Repairs No. of Stories.... ________ ........ Size Septic Tank Type of Tank_____ Capacity Gals Feet of Drain Tit 2 -f 1 l CK ® R/ st. Feet of Tank or Drain Field from Well Nature of Water Supply: City —Well ____ ___-- __------- - - - - -_ -Size of Soakage Pit Amount of Permit $ (Signed) (Signed). Plumbing Inspector. The undersigned applicant for this building permit does hereby certify that he understands and accepts his ob'gations 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. 6 STATE OF FLORIDA, 1 COUNTY OF DADE. Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeared to me well known, and who, being by me first duly sworn, upon oath deposes and says that he is the of the above described construction, that 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 workmanship. CLOSETS BATH TUBS SHOWERS LAVA- TORIES SINKS SLOP SINKS LAUNDRY TUBS URINALS CATCH BASIN FLOOR DRAIN DRINKING FOUNT' N5 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 Permit No MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT Date 4 h . °4 °4 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. p Al/E. p q zgi Owner's Name and Address____ �f.1 ___°�--_a_� P. _�_' _C_l 7 L _ No. __ g Street_ Registered Architect and /or Engineer______-_ ________ __ ____ _____ _.7 Employing Plumber's Name acki _ a' ` C ea Street_ Location and Legal Description Lot________ ______ —,, Block_ - Subdivision Str �_ eet and Number where work is to be performed— No._.2. ..!�.! _g_t___ _ __ — Street 9 / _ 721 State work to be performed and purpose of building (By Floors)._ New Building Remodeling____ __.____ Addition Repairs No. of Stories.... ________ ........ Size Septic Tank Type of Tank_____ Capacity Gals Feet of Drain Tit 2 -f 1 l CK ® R/ st. Feet of Tank or Drain Field from Well Nature of Water Supply: City —Well ____ ___-- __------- - - - - -_ -Size of Soakage Pit Amount of Permit $ (Signed) (Signed). Plumbing Inspector. The undersigned applicant for this building permit does hereby certify that he understands and accepts his ob'gations 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. 6 STATE OF FLORIDA, 1 COUNTY OF DADE. Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeared to me well known, and who, being by me first duly sworn, upon oath deposes and says that he is the of the above described construction, that 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 workmanship.