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PLUMBINGPermit No - 7 ( cf 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___,�s�.__ .iL1(1 6 '�4___..__.._-.__ No.__ -- A._�-,' -_ Street__--�� .[ S Registered Architect and /or Engineer — ._ Employing Plumber's Name mbALARe /- 7. No.- 6. Street.- __ __ s -- Location and Legal Description Lot----------- __ - - -_— _ _ Block_ Subdivisio _____ ____.__......... __.____- --__-._ Street and Number where work is to be performed —No C / Street- -7 State work to be performed and purpose of building (By Floors) New Building — _- -- -- -- ------ .- __ -_ -- Remodeling__ -._ ___ Addition_- -- Repairs Size Septic Tank Feet of Drain Tile Nature of Water Supply: City — Well.___ Amount of Permit $.____ STATE OF FLORIDA, COUNTY OF DADE. j Type of Tank Capacity Gals __Dist. Fe -: of Tank or Drain Field from Well _Size of Soakage Pit MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT (Signed) umbing Inspector. The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations an employer of labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Permanent I pplement, 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)._ Date.. 4 No. of Stories- _ Master Plumber. Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgements, 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 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 worlonanship. CLOSETS BATH TUBS E SHOWERS LAVA- TORIES INKB SINKS SLOP SINKS LAUNDRY TUBS U 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 Permit No - 7 ( cf 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___,�s�.__ .iL1(1 6 '�4___..__.._-.__ No.__ -- A._�-,' -_ Street__--�� .[ S Registered Architect and /or Engineer — ._ Employing Plumber's Name mbALARe /- 7. No.- 6. Street.- __ __ s -- Location and Legal Description Lot----------- __ - - -_— _ _ Block_ Subdivisio _____ ____.__......... __.____- --__-._ Street and Number where work is to be performed —No C / Street- -7 State work to be performed and purpose of building (By Floors) New Building — _- -- -- -- ------ .- __ -_ -- Remodeling__ -._ ___ Addition_- -- Repairs Size Septic Tank Feet of Drain Tile Nature of Water Supply: City — Well.___ Amount of Permit $.____ STATE OF FLORIDA, COUNTY OF DADE. j Type of Tank Capacity Gals __Dist. Fe -: of Tank or Drain Field from Well _Size of Soakage Pit MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT (Signed) umbing Inspector. The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations an employer of labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Permanent I pplement, 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)._ Date.. 4 No. of Stories- _ Master Plumber. Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgements, 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 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 worlonanship. MIAMI SHORES VILLAGE, FLA. No REMARKS 2049 JOB ADDRESS t ; • � • - INSPECTION Q 1 c ,a TIME READY 4- ' ° C-, INSPECTOR DATE ______ MIAMI SHORES VILLAGE, FLA. N? 2051 JOB ADDRESS 1 , INSPECTION TIME READY REMARKS: INSPECTOR DATE _ - _ 1'err•it i�: /kir! MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT App 'ticatiou is Hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the building or, other structuta 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. Gwner's Name and Address Registered Architect and /or Eng eer Employing Plumber's Name Location and Legal Descriptip Block_____ Subdivision Street and Number where work is to be performed -No.__ 111 4/-C: 1" 7 Street State work to be performed and purpose of building (By Floors) ___._____.____ (New Buildings __.__ Remodeling____ _______ Addition. Amount of Permit $ ____ STATE OF FLORIDA, COUNTY OF DADE. My Commission Expires Date. -- - - -- -E // - 6 No._— _ ..... _______ Street 3 J L � (Signed)- Repairs No. of Stories. ..1 Size Septic Tank _ Type of Tank__ Capacity Gals. Feet of Drain Tile_ _Dist. Feet of Tank or Drain Field from Well Nature of Water Sup g: City Well. _ ____:__:_________- ____Size of Soakage Pit Plumbing Inspector. The undersigned applicant for this building permit does hereby certify that he understands and accepts is obligations as an employer of labor under the Florida Workmen's Compensation Act, being Section 5986, Compiled General Laws of Florida 'ennanent Supplement, and bus 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)_ ____ �` �� - ". _ 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. 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. CLO2aTg BATH TUBS SHOWERS LAVA. TORIES KS SINKS SLOP SINKS LAUNDRY TUBS URINAL S CATCH BASIN FLOOR DRAIN DRINKING FOUNT'NS TOTAL FIXTURES LIST % � E6 CHECK SEPTIC TANK SEWER CONN. DRAIN FIELD SOAKAGE PIT GREASE TRAP 13O1MR HEATER DEEP WELL SPRKLR. SYSTEM SWIM•G POOL (.1_; /�f 0/ COWS. LIST CHECK 1 / / t . , - - --- 1'err•it i�: /kir! MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT App 'ticatiou is Hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the building or, other structuta 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. Gwner's Name and Address Registered Architect and /or Eng eer Employing Plumber's Name Location and Legal Descriptip Block_____ Subdivision Street and Number where work is to be performed -No.__ 111 4/-C: 1" 7 Street State work to be performed and purpose of building (By Floors) ___._____.____ (New Buildings __.__ Remodeling____ _______ Addition. Amount of Permit $ ____ STATE OF FLORIDA, COUNTY OF DADE. My Commission Expires Date. -- - - -- -E // - 6 No._— _ ..... _______ Street 3 J L � (Signed)- Repairs No. of Stories. ..1 Size Septic Tank _ Type of Tank__ Capacity Gals. Feet of Drain Tile_ _Dist. Feet of Tank or Drain Field from Well Nature of Water Sup g: City Well. _ ____:__:_________- ____Size of Soakage Pit Plumbing Inspector. The undersigned applicant for this building permit does hereby certify that he understands and accepts is obligations as an employer of labor under the Florida Workmen's Compensation Act, being Section 5986, Compiled General Laws of Florida 'ennanent Supplement, and bus 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)_ ____ �` �� - ". _ 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. 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. 10050 N.E. 2nd Avenue • Miami Shores, Florida 33138.305- 795 -2204 7 qq (OL C qq Sr TFO I O // - 3o : l - 6 i4 Date / J Address p/ Legal Description L _i T / Bt Kx 0 Historically Designated: Yes No �" Owner's Address Square Ft. Sig ure of PERMIT APPLICATION FOR MIAMI SHORES VILLAGE ssee/Tenet 1 RAJA Y ft- l /d i t Master Permit # P V go 0 a • s3 • + -- Phone n ' /� Contracting Co. /50 J 3 SEFFIC-- lJ s 1030 /v O , £ t , 13 � ti 0114_ Qualifier ) b PA1I 1L0 SS# ' K )✓ /t // Sf.0 c1 iii D State # Municipal # iu TT I t Competenc # • » Ins. Co. " IF THERE IS NO PERMIT PACKAGE ACCESSIBLE ON THE JOB SITE FOR INSPECTORS TO VERIFY, THERE WILL BE NO INSPECTION. RE- INSPECTION FEE IS $50.00 AND MUST BE PAID IN ADVANCE BEFORE CALLING FOR ANOTHER INSPECTION. Permit Type (circle one): BUILDING ELECTRICAL WORK DESCRIPTION: 11 iA��lill SI1O22 fYr LA timated Cost (value) ht a i a • For Se tic Ian n _f r rfj ����{" WARNING TO OWNER: YOU Ws I K A C"E OP'tivty1MENCEMENT AND YOUR FAILURE TO DO SO MAY RESULT IN YOUR PAYING TWIN FtItaittIPi M T9- }'�Q L1 ' �'ERTY (IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH • YOUR LENDER OR T O� Y BEFORE, RECD I ! UR NOTICE OF COMMENCEMENT.) la Is re Application is herebr*kvo � .tb51 work installation as indicated above, and on the attached addendum (if applicable). I certify that all work will be performed to meet the st.n.arch deall re at£ kra ction in this jurisdiction. I understand that separate permits are required for all disciplines. OWNERS 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 the work stated. or Condo President VarA Date otary • 0 0} rr ':�; a . drid&fires9dtnt —. My CormissiO'h x ..r 's c,. O • APPROVED: Zoning Building Mechanical Plumbing otary as to My Commission MECHANICAL ROOFING FEES: PERMIT 2` J RADON C.C.F 1 .C? 0 NOTARY 5. 0 O BOND 3 X2 0 0 TOTAL DUE Electrical Structural Engineer CONSTRUCTION PERMIT FOR: [ . _) New System [• ] Existing System [ ^] Holding Tank [ "�� Temporary /Experimental [ .'] Repair ('] Abandonment [ ] Other(Specify) APPLICANT: AGENT: PROPERTY STREET ADDRESS: LOT: BLOCK: ,' SUBDIVISION: PROPERTY ID #: D ( ] SQUARE FEET PRIMARY DRAINFIELD SYSTEM R [ ] SQUARE FEET SYSTEM A TYPE SYSTEM: I CONFIGURATION: N F LOCATION OF BENCHMARK: ".J I ELEVATION OF PROPOSED SYSTEM SITE [ E BOTTOM OF DRAINFIELD TO BE [ L D FILL REQUIRED: 0 T H E R STATE OF FLORIDA DEPARTMENT OF HEALTH ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PERMIT Authority: Chapter 381, FS & Chapter 10D -6, FAC , INCHES DH 4018, 10/96 (Replaces HRS-I-1 Form 4016 [page 1] which may be used) (Stock Number: 5744 - 001 - 4016 -0) [ 4,1 STANDARD [ l TRENCH e [ [ ,'] Applicant FILLED BED PERMIT # ; DATE PAID FEE PAID $ " RECEIPT # [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 SPECIFICATIONS (GALLONS / GPD)'SEPTIC TANK /AEROBIC UNIT CAPACITY MULTI- CHAMBERED /IN SERIES:[ A [ ] [GALLONS / GPD) CAPACITY MULTI- CHAMBERED /IN SERIES:( ] N [ ] GALLONS GREASE INTERCEPTOR CAPACITY [MAXIMUM CAPACITY SINGLE TANK: 1250 GALLONS] K [ -• ) GALLONS PER DOSE DOSING TANK CAPACITY DOSE .RATE [ ] PER 24 HRS NO. OF PUMPS: [ ) J MOUND [ ] ] ] [INCHES /FT] [ABOVEjBELOW] BENCHMARK /REFERENCE POINT" 1 jINCHESJ FT] [ABOVE /,BELOW) BENCHMARK /REFERENCE POINT EXCAVATION REQUIR [ems ] INCHES a a SPECIFICATIONS BY ' ° TITLE: APPROVED BY: .A, -` TITLE: ;�> 3 "; <- CHD DATE ISSUED: 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 13Y: 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. Scale: Each block represents 5 feet and 1 inch = 50 feet. y f ' > , A IteW ' ) • ' -; , ' 't ' ' ; T 1 ti' , „Tii,t '''' — 1 — -1, -- f T - , — 1 -i ? t I , ---r ' .1- ' -i t + arr - ,_ 7 ". ' --- t - +T... - i1/2 1-;:.--tt--- s ' [ i 4 , , .,.., '', i i I 1 t 4 --" -; i ". . -- - •1) . 1- L I ''''''' 1 ' 11'1-161q,I.40/ , 1 t 1 4 . ,. . i , . ', I ' I ' ;--1-1- riL iry:,.'t, — 1" Notes: Ati T bi / • _Lic7 pir I) if,s Site Plan submitted by: Signature Plan Approved \ Not APproVed '' `) .'-'':- . - 41 1 ir fi Date I'/ ?ci 0 , By ., 1 , .^, , i, L - ‘ i ' j-i 4 '".(-1 iri . N, p1 ---- County Health Department • i n , ,,. , ALL CHANGES MUST BE APPROVED BY THE COUNTY HEALTH DEPARTMENT DEPARTMENT .. , i DH 4015. 10/9e (Replaces HRS-H Forte 4015 Macyathy used) i . f' (Stock Neater: 5744-002-40154) Page 2 0 3 STATE OF FLORIDA DEPARTMENT OF HEALTH % • APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PERJ.41 Permit Application Number • - at....rjr.r.;•■•Ir.r1 1 PART II SITE PLAN tt, 141.14g4iSiTizatif,4, 1 - - "r -- r• i ' i '' ■ r r L. , ' 1 : I I f ', I I ' ' ' , • 1 t r I. 1I J ... 1 , i 1 , , Y , • ' i I 1., '... i 4 r, .. " H- 4 ,-{ - ', ' - ' 1 _LI , ' j t .I' I tl- i 1 . . 1 • i ' ; _ . .. ,, ' . r_ _Li .., 1 .',„. T. _,._ 1 f _t 771g4`firi 5 r. 5,_z_e(21,2),44 W Z UW M y g Zv The Sunshine State LICENSE NLMBER V416- 216-60 -176-0 ENRIQUE RAFAEL VALVERDE 980 NE 99 STREET MIAM$ SHORES, FL 33138-0000 BIRTH DATE SEX HOT. REST. ENDORSE. 05 -1660 M 6-06 ISSUED EXPIRES OUPLUCATE 06 -1247 06 -16-03 00-00.00 SAFE DRIVER 9o00706120003 Operation d a motor vehicle constitutes consent to any sobriety test required by law. MIAMI SHORES VILLAGE, FLA. N? 2064 JOB er:rx,3 ADDRESS 5, INSPECTION e e TIME READY REMARKS: INSPECTOR 4 :2 . " INSPECTOR DATE BUILDING ❑ ELECTRICAL ❑ PLUMBING ❑ ROOFING ❑ Owner of Building MIAMI SHORES VILLAGE, FLORIDA / DATE - lc 19 ` ^ PERMIT c, . r "VI N9 7474 CONTRACTOR OR BUILDER BY Work to be performed under this Permit Contractor's go , 2 License No. 8 r ., Sr Architect Contractor or Builder i" v •...t 1 t , t e , Legal Lot s Description II Bl vision o Address of �' t""� Value of Amount of Building l7 f . L i t Project $ 1 Permit $ This permit is granted to the contractor or builder named above to con truct 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. {, ' ,_ .� ( C Signed. t INSPECTOR In consideration of the issuance to me of this permit I agree to perform the work covered hereunder in compliance, }ri all ordintffices and regulations pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper author tes of Miami Shores Village. In ac. cepting this permit I assume responsibility for ell work done by either, myself, my agent ant or employee. ' AUTHORITY (.. "`z AIloi 4 Cn ' -- -- - -�f 1 — — Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the building mother stricture; 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 M d � .e__ _j. _ - -- - - _ _ _ No._._ Street Registered Architect and /or Engi r �_�___�___— i Employing Plumber's Name � Location and' Legal Description Lot- -__-_- ..... ________ Block__ Street and Number where work is to be performed— No.__7 * ' $ ._ - treet State work to be performed and purpose of building (By Floors)_-____ New Building._______ ___ Remodeling_.___ _._ Addition Repairs No. of Stories. Size Septic Tank_ Feet of Drain Tile._ Nature of Water Supply: City —Well. Amount of Permit $_______ The undersigned applicant for this building permit does hereby certify that he understands and accepts his o • ations as an employer of labor under the Florida Workmen's Compensation Act, being Section 5968, Compiled General Laws of Florida Pen •4nt 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 tiie 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. My Commission Expires MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT ype of Tank.__._ Capacity Gals. . Feet of Tank or Drain Field from Well __Size of Soakage Pit (Signed)_ No. _ __._____— Street__ ( Signed )____/ L___ Date b_s/4/ Subdivision STATE OF FLORIDA, 1 COUNTY OF DADE. Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take aclmowledgments, personally appeared to me well known, and who, being by me first duly sworn, upon oath deposes and says that he is the of the above described construction, that he has carefully read the foregoing application, and that he did sign the same, and that all facts therein by him stated are true. Notary Public, State of Florida 7 i Plumbing Inspector. _ NOTE: A re- inspection fee of $1.00 will be made when such re- inspects is made•necessary by improper notice for inspection, or faulty materials and /or workmanship. Master Plumber. CLOSETS BATH TUBS SHOWERS LAVA- TORIES SINKS SLOP SINKS LAUNDRY Tulle URINALS CATCH BASIN FLOOR DRAIN DRINKING FOUNT'NB 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 -- -- - -�f 1 — — Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the building mother stricture; 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 M d � .e__ _j. _ - -- - - _ _ _ No._._ Street Registered Architect and /or Engi r �_�___�___— i Employing Plumber's Name � Location and' Legal Description Lot- -__-_- ..... ________ Block__ Street and Number where work is to be performed— No.__7 * ' $ ._ - treet State work to be performed and purpose of building (By Floors)_-____ New Building._______ ___ Remodeling_.___ _._ Addition Repairs No. of Stories. Size Septic Tank_ Feet of Drain Tile._ Nature of Water Supply: City —Well. Amount of Permit $_______ The undersigned applicant for this building permit does hereby certify that he understands and accepts his o • ations as an employer of labor under the Florida Workmen's Compensation Act, being Section 5968, Compiled General Laws of Florida Pen •4nt 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 tiie 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. My Commission Expires MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT ype of Tank.__._ Capacity Gals. . Feet of Tank or Drain Field from Well __Size of Soakage Pit (Signed)_ No. _ __._____— Street__ ( Signed )____/ L___ Date b_s/4/ Subdivision STATE OF FLORIDA, 1 COUNTY OF DADE. Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take aclmowledgments, personally appeared to me well known, and who, being by me first duly sworn, upon oath deposes and says that he is the of the above described construction, that he has carefully read the foregoing application, and that he did sign the same, and that all facts therein by him stated are true. Notary Public, State of Florida 7 i Plumbing Inspector. _ NOTE: A re- inspection fee of $1.00 will be made when such re- inspects is made•necessary by improper notice for inspection, or faulty materials and /or workmanship. Master Plumber.