Loading...
PLUMBINGDate Legal Description Owner/Lessee / Tenant rho y �� (ten Q . Master Permit # Owner's Address 3 ) , ) (o Contracting Co. l V i t‘ b RO/A State # - C- CC CC_ 3 3? °Municipal # Competency # Ins. Co. Architect/Engineer Address Bonding Company Address Mortgagor Address Permit Type (circle one): BUILDING ELECTRICAL o _ I .r xrk - Yk - e.3 4 WORK DESCRIPTION ��// PERMIT APPLICATION FOR MIAMI SHORES VILLAGE // `1� Job Address 9 , - ) �j J q ' Tax Folio Square Ft. Estimated Cost (value) 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 zonin;. Furthermore, I au •rite the above -named contractor to do the work stated. Signature o owner and/or Condo'President ► ate Notary as to Owner and/or Condo President Date My Commission Expires: FEES: PERMIT S RADON APPROVED: Zoning Building Mechanical Plumbing �3- ^^��� �1I. G.2 Address C.C.F. Historically Designated: Yes No ) ; /k)r2 CJ SS# - -% Phone q_ S r ?6 MECHANICAL ROOFING PAVING FENCE SIGN ilk Notary as to My Commiss NOTARY e of Contractor or Owner- Builder , 7 ado Phon �� e —q(Yp(C7 Electrical 0 e. 1\ISKY My Cororn L t. 9-26 -99 1.3o ndad LJyr S rvice Ins No. CC476759 resogar Known 1IOtb rI. D. TOTAL DUE -g-f' ate Engineering - 4 I a-- Date / / G Applicai!a' i3 bereb'..nau 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 ::11 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 RC- No._____-__— ._ ... - .--- •-- _ - - - -- Street__ Registered Architect and /or Engineer _______________ Employing Plumber's Name. - -- PrQ lV_ 1Q+ -- �- No..!_ SP __. _ Street__ N 6-13 4% / Location and Legal Description Lot 3 rJ Blgc] f— - rt - Subdivision' - 41egf." Street and Number where work is to be performed —No 7- J State work to be perforrme8 and purpose of building (By l?loars) ___._---- .. - 6 New Building __ __. __._..._.__. Remodeling____ Addition Repairs No. of Stories- - - . ... Size Septic Tank_ Feet of Drain Tile___ —_ . Feet of Tank or Drain Field from Well Nature of Water Supply: City— Well._____ -- ..... _- ___- ____....... ______._Size of Soakage Pit Amount of Permit $ My Commission Expires MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT Type of Tank_—_ Capacity Gals . .._ _ Street- (Signed ) - Plumbing Inspector. The undersigned applicant for this building permit does hereby certify that he understands and accepts his obli ations as an employer of labor uncial the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Pers a ent Supplement, and has com- plied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors a ployed 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 rr,-liiro.d 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. Notary Public, State of Florida r� Master Plumber. STATE OF FLORIDA, a at 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. NOTE: A re- inspection fee of ;1.00 will be made when such re- inspection is made•necesaary by improper notice for inspection, or faulty materials and /or workmanship. "Wig" TUBS SHOWERS LAVA. TORIES SINKS SLOP SINKS LAUNDRY TUBE CATCH BASIN FLOOR DRAIN DRINKING FOU NT' NS ` �Y DUN./ f ! TOTAL FI %TURES CONTR. LIST - CHECK _ _ __ fJ� I t 3 / I -- SEP T:C TASK SEWER CONN. DRAIN FIELD SOAKAGE PIT GREASE TRAP SOLAR HEATER DELP WELL SPRKLR. SYSTEM SW IM'G POOL ^- -- CONS R. LIST CHECK - - - 4 I a-- Date / / G Applicai!a' i3 bereb'..nau 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 ::11 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 RC- No._____-__— ._ ... - .--- •-- _ - - - -- Street__ Registered Architect and /or Engineer _______________ Employing Plumber's Name. - -- PrQ lV_ 1Q+ -- �- No..!_ SP __. _ Street__ N 6-13 4% / Location and Legal Description Lot 3 rJ Blgc] f— - rt - Subdivision' - 41egf." Street and Number where work is to be performed —No 7- J State work to be perforrme8 and purpose of building (By l?loars) ___._---- .. - 6 New Building __ __. __._..._.__. Remodeling____ Addition Repairs No. of Stories- - - . ... Size Septic Tank_ Feet of Drain Tile___ —_ . Feet of Tank or Drain Field from Well Nature of Water Supply: City— Well._____ -- ..... _- ___- ____....... ______._Size of Soakage Pit Amount of Permit $ My Commission Expires MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT Type of Tank_—_ Capacity Gals . .._ _ Street- (Signed ) - Plumbing Inspector. The undersigned applicant for this building permit does hereby certify that he understands and accepts his obli ations as an employer of labor uncial the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Pers a ent Supplement, and has com- plied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors a ployed 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 rr,-liiro.d 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. Notary Public, State of Florida r� Master Plumber. STATE OF FLORIDA, a at 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. NOTE: A re- inspection fee of ;1.00 will be made when such re- inspection is made•necesaary by improper notice for inspection, or faulty materials and /or workmanship. (Continued on opposite side) RE EOVE 1 0 1004 BUILDING PERMIT APPLICATION FBC 2001 Owner's Name (Fee Simple Titleholder) Owner's A dress qi f A . f9 3T City /?1 Ai dress 5 i State 17 Architect/Engineer's Name (if applicable) $ Value of Work For this Permit Type of Work: ['Addition ['Alteration Describe Work: Notary $ 5.00 . Training/Education Fee $ + (DO Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 Permit NoD DOO Master Permit No. Permit Type (circle): Building Electrical Plumbing Mechanical Roofing hone # ' 7S 7‘ Zip 3 1 �• Tenant/Lessee Name f Phone # Job Address (where the work is being done) 9 q' S� City Miami Shores Village County Miami -Dade Zip 3 Is Building Historically Designated YES NO 1/ � 1 C � Tr, Contractor's Company Name b(' rE�C" ?/Y1 Phone 1 � S `� { St.,Se u Contractor's Address ) O O Nr . / 30 S� City LCY q OA State 1 t Zip ' 3) L. 1 Qualifier O ) 1 X2.1 l J ['New ( \ * * * * * * * * * * * * * * * * * * * * * * * * * * ** F ees * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** Submittal Fee $ Permit Fee $ 1 1 • 00 Structural Plan Review. S Total Fee Now Due $ I 1 $ `1 • 1 C t. (o(5 3 Phone # Square Footage Of Work: Rep lace ❑ Demolition CCF S , _ gU CO /CC Technology Fee $ 4-3 Scanning $ - 00 Radon $ Zoning Bond $ 300 • Cr ) Code Enforcement $ FEB 10 PAID Bonding Company's Name (if applicable) 611/4- Bonding Company's Address City State Zip Mortgage Lender's Name (if applicable) AIM" 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 The foregoing ins day of I-- , who is personally known to er or Agent nt was acknowledged before me this 10 2() by - Q ) C - 1 _ 1 0 • , , ho has producedlZ_ • As identification and who did take an oath. e or My Commission Expires: * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** APPLICATION APPROVED BY: Chc 12/15/03 day of NOT ; ,U&OTARY PURL Sign: * *= Exp _ :Jul 13, 2007 ` ' , � \ I WI Print: +�,� A L, a' c Bonding Co., Inc. ��Are t My Commission Expires:y, W ' III 13, 2007 y'►o Bonded Thru (Certificat of Competency Holder) Sign: Print: The foregoing instrument was acknow State Certificate or Registration No. Certificate of Competency No. who is personally known to me or who has produced identification and who did take an oath. as * * ** ****************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** 01--/61 t Plans Examiner Engineer Zoning MIAMI SHORES VILLAGE BUILDING DEPARTMENT 305- 795 -2204 Building Inspection Request Date JI 1 Type Insp'n / ` Permit No. Name TO Op . Address G5S NE 6 18 - S-1 - Company 80 k e j7hc Phone # Inspection Date 3 Approved Correction Re- Insp'n Fee A N x STATE OF FLORIDA_ DEPARTMENT OF HEALTH ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM CONSTRUCTION PERMIT i; • j -4 W it CONSTRUCTION PERMIT FOR: ( ]New System [ IExisting System [ )Holding Tank [ ] Innovative ( X ]Repair [ )Abandonment [ ;Temporary [ NA ) o APPLICANT: Aragunai, Annabelle AGENT: SR0921116, PARILLA ROBERT PROPERTY STREET ADDRESS: - 955 NE 98 St Miami Shores FL 33138 LOT: 3 _ BLOCK: 80 SUBDIVISION: Miami Shores ISaction /Township Rarge Parcel No.) PROPERTY ID #: 11 - 3206 -014 -3360 OR TAX ;.D `UMBER) SYSTEM .V3ST BE CONSTRUCTED IN ACCORDANCE WITH SPECIFICATION'S AND STANDARDS OF CHAPTER 64E-SF AQ, DEPARTMENT APPROVAL OF SYSTEM DOES NOT GUARANTEE SATISFACTORY PERFORMANCE FOR ANY SPECIFIC TIME PERIOD. ANY CHANGE IN MrATERIAL FACTS WHICH SERVED AS A Elu3 t'S FOR ISSUANCE OF THIS PERMIT, REQUIRE THE APPLICANT TO MODIFY THE PERMIT APPLICATION. SUCH MODIFICATIONS MAY 'RESULT IN THIS PERMIT BEING MADE NULL AND VOID. ISSUANCE OP THIS PERMIT t!OES NOT EXEMPT THE APpL:U. :A TT FRON COMPLIANCE WITH OTHER FEDERAL, STATE OR LOCAL PERMITTING REQUIRED Ff.R PROPERTY DEVELOPMENT SYSTEM DESIGN AND SPECIFICATIONS 9C0 ;Gallons SEPTIC TANK o ]Gallons O ]GALLONS GREASE INTERCEPTOR CAPACI: a 0 ] GALLONS DOSING TANK CAPACITY ( 0 )GALLONS 27 [ 300 :SQUARE FEET PRIMARY DPAINFIELp SYSTEM R [ 0 )SQUARE I"EET SYSTEM A TYPE SYSTEM: [ Y ]STANDARD [ N ;FILLED [ N jMOUND [ N ] I CONFIGURATION: [ N )TRENCH [ 7 ) BE [ N ) N ✓ LOCATION TO BENCHMARK: 10.9' N d At 8. F. of Sri6t. 8i4gp. I ELEVATION OF PROPOSED SYSTEM SITE : 13.0 1 [ //t/ " ] [ BELOW1 BENCHMARSZI REFERENCE POINT E BOTTOM OF DRAINFIEL)0 TO BE [ 30.0 ] (jRrGAWS 1 [ re ] T PONT ;; L D FILL REQUIRED: [ 0.0 ]INCHES EXCAVATION REQUIRED: f 36.0 ) INCHES OTHER REMARKS House 3 bedrooms built in 1962. Site elevation 9.:1' ngvd HSWT contour map:4.0' met Install 12" Of slightly limited soil under the button of drain field Invert elevation: 9.9' 1gv. Botton of drain field :7.4' ngvd Install a new septic tank with double compartment and aproved filter Category No.2. The licensed Contractor installing the eystyem is responsible e minimum category of tank in accordesnce with 64E-6.013(3)(f) 1 TItI3 PERMIT IS NOT FOR ADDITION SPECIFICATIONS *BY: APPROVED BY: Lopez, W CATE ISSUED. 2/6/04 TALE: TITLE DH 4016, 03/97 (Obe:�leteE previous editions which :nay not be used) (3topk N:.mubcr: 5744-nni _nn7c..n‘ • , , T7) OSTDSN.BR 7.04-0400- -R MULTI - CHAMBERED /IN SERIES: [f ] IULTI- CHAMBERED /IN SERIES: [t ] ( [ 0 )DOSES PER 24 HPS $,! PUMFS I 0 CENTRAX #: 1 .3 >SG -19431 DATE PAID: FEE PAID : $ RECEIPT for Ot er installing . Dade CFA, EXPIRATION DATE: 5/6/04 ZLbEE ! 1 :,SOE ZF, :9T. bll©I� /c6 /70 r Miami Shores Village 10050 NE 2nd Avenue Plumbing Permit Phone: 305 - 795 -2204 Permit Number: PL2004 -45 Printed: 2/12/2004 Applicant: ANNABELLE ARAGUNAI Owner: ARAGUAN ANNABELLE JOB ADDRESS: 955 NE 98 ST Contractor BOBS SEPTIC & DRAIN INC Local Phone: 305 - 558 - 5818 Parcel # 1132060143360 Contractor's Address: 1020 NE 130 ST Page 1 of 1 Legal Description: 5 -6 53 42 MIAMI SHORES SEC 3 PB 10 -37 LOT 4 & SWLY2OFT OF LOT 3 BLK 80 Fees: Description Amount FEE2004 -1470 Building Fee $175.00 FEE2004 -1471 CCF $1.80 FEE2004 -1472 Notary Fee $5.00 FEE2004 -1473 Training and Education Fee $0.60 FEE2004 -1474 Technology Fee $4.37 FEE2004 -1475 Scanning Fee $3.00 FEE2004 -1476 Builders Bond $300.00 Total Fees: $489.77 Total Fees: $489.77 Total Receipts: $489.77 Permit Status: APPROVED Permit Expiration: 8/8/2004 Construction Value: $2,500.00 Work: REPLACE LEAKING SEPTIC TANK IN SAME AREA ANED INSTALL A 300 SQ. FT. DRAINFIELD Signed: (INSPECTOR) In consideration of the issuance to me of this permit, 1 agree to perform the work covered hereunder in compliance with all ordinances and regulations pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I assume responisibility for all work done by either myself, my agent, servants or employes. Signed: (Contractor or Builder) BY: MIAMI SHORES V}L-LQGE BUILDING DEPARTMEN 305- 795 -2204 Building Inspection Reques Dat2 - I Type Insp'n Permit No., Pl0if Name Address Company Phone # O5 SSJ 5 Inspection Date/ 2S/ D y Approved Correction ‘‘.. Re- Insp'n Fee 4 MIAMI. SHORES VILLAGE BUILDING DEPARTMENT 305 -79 2204 Buildir}g Inspection Reques Date Type Insp'n Permit No. 1 5 Name J t 1 q "0 . Q , r Address 1 SS . Company bon _MO t C C. - � 5 - 5$ti Phone # � � Inspection Date 01 04 J 777 Approved 1 Correction ❑ Re- Insp'n Fee ❑ BUILDING ELECTRICAL PLUMBING ROOFING Owner of Building Architect Contractor or Builder Legal Description Lot PERMIT N? 3686 0 MIAMI SHORES VILLAGE, FLORIDA Address of L Value of � I Amount of ; - ft Building ' - - Project $ 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 specificatiens at he assumes respon- sibility for work done by his agents, servants or employees. In consideration of the issuance to me pertaining thereto and in strict conformity with ceptinq this permit assumey ; ibility for CONTRACTOR OR BUILD Work to be performed under this Perini Bl. Signed .+ [' INSPECTOR of this permit I agree to perform the work covered hereunder in compliance with all ordinances and regulation the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In act all work done by either, myself, my agent, se p' or employee. BY DATE ; /* r ft • J Contractors License No. Subdi- vision ,i ce AUTHORITY PtlMT eV Permit No._-_4_ ; ? Date _________ / __ /_ 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. Registered Architect and /or Eng eer Employing Plumber's Name __41 __ New Building Size Septic Tank - Feet of Drain Tile Nature of Water Supply: City —Well. Amount of Permit $ C - ' — '-� 1 Remodeling MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT No._ Location and Legal Description Lot-______ _— lock_ Subdivision Street and Number where work is to be performed —No I/5 .0 . Street_ State work to be performed and purpose of building (By Floors)_-____ Addition._._____ Repairs No. of Stories. _ _ .._.__._._....____ . Type of Tank_ Capacity Gals ist Feet of Tank or Drain Field from Well Size of Soakage Pit (Signed) --_���.� - -L�!- P1 . ing 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). Street__ My Commission Expires Notary Public, State of Florida Street STATE OF FLORIDA, COUNTY OF DADE. Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeared to me well known, and who, being by me first duly sworn, upon oath deposes and says that he is the of the above described construction, that he has carefully read the foregoing application, and that he did sign the same, and that all facts therein by him stated are true. 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. CLOSES BATH Tu BS SHOWERS LAVA- TORIES SINKS SLOP SINKS LAUNDRY Twee U RINAL/ 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 SW I POOL CONTR. LIST CHECK eV Permit No._-_4_ ; ? Date _________ / __ /_ 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. Registered Architect and /or Eng eer Employing Plumber's Name __41 __ New Building Size Septic Tank - Feet of Drain Tile Nature of Water Supply: City —Well. Amount of Permit $ C - ' — '-� 1 Remodeling MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT No._ Location and Legal Description Lot-______ _— lock_ Subdivision Street and Number where work is to be performed —No I/5 .0 . Street_ State work to be performed and purpose of building (By Floors)_-____ Addition._._____ Repairs No. of Stories. _ _ .._.__._._....____ . Type of Tank_ Capacity Gals ist Feet of Tank or Drain Field from Well Size of Soakage Pit (Signed) --_���.� - -L�!- P1 . ing 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). Street__ My Commission Expires Notary Public, State of Florida Street STATE OF FLORIDA, COUNTY OF DADE. Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeared to me well known, and who, being by me first duly sworn, upon oath deposes and says that he is the of the above described construction, that he has carefully read the foregoing application, and that he did sign the same, and that all facts therein by him stated are true. 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.