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1130 NE 100 St (4)MIAMI SHORES VILLAGE BUILDING INSPECTION DEPARTMENT APPLICATION FOR BUILDING PERMIT Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the build- ing or other structure herein described. This application is made in compliance and conformity with the Building Ordinance of Miami Shores Village, Florida, and all provisions of the Laws of the State of Florida, all ordinances of Miami Shores Village and all rules and regulations of the Building Division of Miami Shores Village shall be complied with, whether herein specified or not. A copy of approved plans and specifications must be kept at building during progress of the work. Owner's Name and Address L Y /1/ Disapproved (Signed) Date._ Date 3 D , 19 7 / No // O Street 6 /a a \/' y Registered Architect and /or Engineer Name and address of licensed contractor ' 0 wA 0/ y Z/7 3 Location and legal description of lot to be built on: Lot Block Subdivision Street and Number where work is to be done //304/6" /0er �/'7` ",747) V///4./-. /.. State work to be done and purpose of building (by floors) 1 V GP 6 0 06,i_ ,i_ 6/%7775/20 d/Lj SC 16 C/ 6ti, New Building Remodeling 17 Addition Repairs No. of Stories To be constructed of Kind of foundation � f Covering Estimated Total cost of improvements $ 3 Y €_Q kmount of Permit $ Zone cubage required _Plan Cubage Distance to next nearest building Size of Building Lot Maximum live load to be borne by each floor I hereby submit all the plans and specifications for said building. All notices with reference to the building and its construction may • be sent to The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations as an employer of labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida, Permanent Supplement, and has complied with the provisions thereof, and will require similar compliance from all contr .rs or sub - contractors employed by him in the work to be performed under this permit; and will post or cause to be posted for inspectio . the site of the work such public notice or notices as are required by the Act. The undersigned agrees to employ only such subcontra n work to be performed under this permit, as are licensed by Miami Shores Village. Remarks____ (Signed) and for no other purpose. STATE OF FLORIDA, COUNTY OF DADE. ss. Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally ap- peared to me well known, and who, being by me first duly sworn, upon oath deposes and says that he is the of the above described construction, that he has carefully read the foregoing application, and that he did sign the same, and that all facts therein by him stated are true 7 -' Permit No /3. 7 Date I � ° ,) Read, Sworn to and Subscribed before me. Notary Public, State of Florida Building Inspector My Commission Expires PLANN BOARD DATE Chairman Member Member Member Member Member Council Approved Date Disapproved Date NOTE: A charge of $1.00 will be made for making corrections or changes to this application after approval has been obtained from the Planning Board. • A re-inspection fee of 51.00 will be charged when such re- inspection is made necessary by improper notice for inspection or faulty materials and /or workmanship. Permit No Amount of Permit $ 2 ' MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT • Date 7J 0 / '/ Ir 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 En ineer Employing Plumber's Name � � /!__`t.3. "No Street - Location and Legal Description Lot Block Subdivision // Street and Number where work is to be performed— No._ ,/!_3 0 j Street State work to be performed and purpose of building (By Floors) New Building Remodeling Addition / yJ Repairs No. of Stories No Street Size Septic Tank- ________ Type of Tank Feet of Drain Tile Dist. Feet of Tank or Drain Field from Well Nature of Water Supply: City —Well — Size of Soakage Pit (Signed) Capacity Gals �(y Inspector. The undersigned applicant for this building permit does hereby certify that he Grfderstands and accepts his obligations 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. STATE OF FLORIDA, I COUNTY OF DADE. ss. (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. My Commission Expires . Notary Public, State of Florida NOTE: A re- inspection fee of $1.00 will be made when such re- inspection is made necessary by improper notice for inspection, or faulty materials and /or workmanship. CLOSETS BATH TUBS SHOWERS LAVA - TORIES SINKS SLOP SINKS LAUNDRY TUBS URINALS CATCH BASIN FLOOR DRAIN DRINKING FOUNT' NS TOTAL FIXTURES CONTR. LIST i / 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 Amount of Permit $ 2 ' MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT • Date 7J 0 / '/ Ir 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 En ineer Employing Plumber's Name � � /!__`t.3. "No Street - Location and Legal Description Lot Block Subdivision // Street and Number where work is to be performed— No._ ,/!_3 0 j Street State work to be performed and purpose of building (By Floors) New Building Remodeling Addition / yJ Repairs No. of Stories No Street Size Septic Tank- ________ Type of Tank Feet of Drain Tile Dist. Feet of Tank or Drain Field from Well Nature of Water Supply: City —Well — Size of Soakage Pit (Signed) Capacity Gals �(y Inspector. The undersigned applicant for this building permit does hereby certify that he Grfderstands and accepts his obligations 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. STATE OF FLORIDA, I COUNTY OF DADE. ss. (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. My Commission Expires . Notary Public, State of Florida NOTE: A re- inspection fee of $1.00 will be made when such re- inspection is made necessary by improper notice for inspection, or faulty materials and /or workmanship.