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1266 NE 101 St (12)MIAVI SHORES VILLAGE, FLA. JOB ADDRESS INSPECTION TIME READY /' ' ' \ ,r2 ' REMARKS: N9 8046 INSPECTOR DATE N9 800 Owner, Agent or Tenant of Building Lot Block T Subdivisio Street Address CERTIFICATE OF OCCUPANCY MIAMI SHORES VILLAGE, FLORIDA BUILDING DIVISION Miami Shores Village, Florida, 9 H L •=& ?..c 1266 TOTst Approved use by occupancy 2 ?!R Remarks• This Certificate of Occupancy is issued to the above named 01 Ar for building at above named location only upon the express provision that the applicant will abide by and comply with all conditions of Ordinances Nos. 92, 93, 94 and 97, known as the Zoning, Electrical, Plumbing and Building Ordinances of Miami Shores Village pertaining to the erection, construction, alteration or remodeling of buildings or structures. ..?" Cu'' 5 P 74 __eaALL BUILDING DIVISION '/ OWNER'S NAME P PRESENT ADDRESS r L LICENSE NO. P PHONE NO. JOB LOCATION (ST. OR AVE.) L LOT B BLOCK SUBDIVISION GENERAL CONTRACTOR A ADDRESS P PHONE NO. L LICENSE NO. BUILDING � DATE 7 P c350°' B BUILDE 'S BOND �� PERMIT N BUILDING PERMIT AND INSPECTION RECORD -MIAMI SHORES VILLAGE INSPECTIONS PERMIT NO. DATE I BY INSPECTIONS DATE BY FOUNDATION SEPTIC TANK SPECIAL PERMITS PERMIT NO. I ROOF SEWER TEMPORARY SERVICE BEAMS & LINTELS 7° P°$ -.1( I uA.17-j POOL $ FEAMING RANGE CONN. I AIR COND. $ FINAL `r•° �'d-5i". INSPECTIONS ��� - BY CLEAN UP BY RE- INSPECT I SLAB 7 -16-SY o v 7 �Ir ROUGHING � e..Q,.. / SLAB TUB & TOP OUT SPECIALS PERMITS PERMIT NO. DATE FEE TEMPORARY SERVICE • ' L) NEW BLDG. I ALTERATION 1 ADDITION $ SEPTIC TANK SPECIAL PERMITS PERMIT NO. DATE S SEWER TEMPORARY SERVICE $ SOLAR HEATER H. W. HEATER CONN. $ GAS RANGE CONN. S $ S INSPECTIONS DATE BY RE- INSPECT BY RE- INSPECT BY ROUGHING � e..Q,.. J ')--Vi--SYLASK6 TUB & TOP OUT SEWER SEPTIC TANK SOLAR HEATER FIXTURES e7 6 •er� 6 '` /-94 _. GAS CONTRACTOR , < ✓ �er i ,'/ C' PHONE RE - INSPECTI BY RE - INSPECTI PERMIT NO. . ('/ " I DATE �- ,,<---S , FEE Si /' • ' L) NEW BLDG. I ALTERATION 1 ADDITION REPAIRS SPECIAL PERMITS PERMIT NO. DATE FEE TEMPORARY SERVICE $ RANGE CONN. H. W. HEATER CONN. $ RANGE CONN. $ MOTORS $ FIXTURES $ I INSPECTIONS DATE BY RE - INSPECTI BY RE - INSPECTI BY TFMP SERVICE I ROUGHING H. W. HEATER CONN RANGE CONN. L " - , 1 1- 4,UILDIRT0 INSPECTIONS PLUMBING PERMITS & INSPECTIONS C CONTRACTOR a9 . L G i', -�-,, t�) /v PERMIT NO.7 1 DATE - ° Z- NEW BLDG. 1 ALTERATION"■ 1 ADDITION PHONE FEE $ REPAIRS ELECTRICAL PERMITS &„ INSPECTIONS FIXTURES & FINAL APPROVAL TO POWER CO. FOR SERVICE DATE BY MIAMI SHORES VILLAGE. FLORIDA ;MIMING ❑ . e. :LECTRICAL ® DATE r r 195' ' LUMBING ❑ PERMIT N? 7619 Contractor's License No < GOOFING ❑ ❑ Work to be performed under this Permit —_ )wner of � � �" i ; uilding ! +'1_ i/M . architect : ontractor , r Builder 1.7 f %' ` t le (--. .egal Lot I B1- )escription address of . uilding ! 6-- i° . / .' CONTRACTOR OR BUILDER Subdi- vision Sq. Ft Value of Project $ ( ,. Amt. of 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 application erefor in strict compliance with all ordinances pertaining thereto and with the understanding that the work will be performed in compliance with any plans, rawings, statements or specifications that may have been submitted to and approved by the proper municipal authorities. This Permit may be revoked at any 'me 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 ranted is the understanding that the contractor or builder named above assumes the responsibility for a thorough knowledge of the ordinances and regulations ertaining to the work covered hereby whether shown on the plans or drawings or in the statements,.or specifications and that he assumes responsibility for work one by his agents, servants or employees. Signed: BY • 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 ertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. n accepting this permit I assume responsibility for all work done by either, myself, my agent, servant or employee. / �•., 7 M BY AUTHORITY Dwner of 3uilding I .egal )escription Lot address of = uilding it Z (0+ ' CONTRACTOR OR BUILDER MIAMI SHORES VILLAGE. FLORIDA MIMING ❑ :LECTRICAL ❑ PERMIT N? PLUMBING N . '7 5 3 0 GOOFING ❑ ❑ Work to be performed under this Permit architect : ontractor )r Builder r ' BI. f Subdi- rr vision e -t Sq. Ft Value of Project $ DATE 195 Contractor's ' License No 7 h Amt. of Permit $ / f 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 application ierefor in strict compliance with all ordinances pertaining thereto and with the understanding that the work will be performed in compliance with any plans, lrawings, statements or specifications that may have been submitted to and approved by the proper municipal authorities. This Permit may be revoked at any ime 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 ,ranted is the understanding that the contractor or builder named above assumes the responsibility for a thorough knowledge of the ordinances and regulations ,ertaining to the work covered hereby whether shown on the plans or drawings or in the statements or specifications and that he assumes responsibility for work lone by his agents, servants or employees. f ~ y , Signed _ w . z r BY 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"' ulations •ertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores ge. n accepting this permit I assume responsibility for all work done by either, myself, my agent, servant or employee. BY AUTHORITY address of wilding CONTRACTOR 'OR BUILDER MIAMI SHORES VILLAGE. FLORIDA ° PERMIT N9 7620 ;MIMING :LECTRICAL 'LUMBING :OOFING )caner of c" wilding 1%2.1 1 e' e' f architect : ontractor it Builder / t t t !� 00-,y r •' •egal Lot Bl. )escription Work to be performed under this Permit Subdi- vision Sq. Ft Value of Project BY DATE +: r Contractor's License No 4 Z Amt. of Permit $ AUTHORITY J 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 application ierefor in strict compliance with all ordinances pertaining thereto and with the understanding that the work will be performed in compliance with any plans, ;rawings, statements or specifications that may have been submitted to and approved by the proper municipal authorities. This Permit may be revoked at any ime 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 ranted is the understanding that the contractor or builder named above assumes the responsibili y for a thorough knowledge of the ordinances and regulations ,ertaining to the work covered hereby whether shown on the plans or drawin s or )n the statements or specifications and that he assumes responsibility for work Zone by his agents, servants or employees. // , s Signed: (t t . ;;:t ., BY }1 , INSPECTOR In consideration of the issuance to me of this permit I agree to perform the work covered hereunder in compliance with all ordir ices and regulations ,ertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miasoi Shores Village. n accepting this permit I assume responsibility for all work done by either, myself, my agent, sekrvant or employee. 195L_ is 17 BUILDING ELECTRICAL PLUMBING ROOFING Owner of Building r Architect Contractor or Builder Legal Description Lot z In consideration of the issuance to me pertaining thereto and in strict conformity with cepting this permit I assume responsfbilit MIAMI SHORES VILLAGE. FLORIDA CONTRACTOR OR BUILDER PERMIT N? 7465 Work to be performed under this Permit .1 B1 Subdi- vision P ro ddress of t Value of 'Building ! Project 'DATE 'Y Contractor's License No. BY AUTHORITY 195 Amount of 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 application 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 responsibility for work done by his agents, servants or employees. Signed . BY: INSPECTOR !� of this permit I agree to perform the work covered/ hereunder in compliance with all ordinances and regulations the plans, drawings, statements or specifications sulmitted to the proper authorities of Miami Shores Village. In ac• all work done by either, myself, my agent, servant or employee. 6 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. Date ,19 •4 - -- � .�' 4 Street. ��0. -/ Owner's Name and Address. - � No.. Registered Architect and /or Engineer ...... . .. .. . ... �.._ Name and address of licensed contractor �' =E Location and legal description of lot to be built on: Lot I Block / Subdivisii5> Street and Number where work is to be done Start work to be done and purpose of b. ilding (by floors)._ � - 1 G > (._/ New Building Remodeling Kind of To be constructed of foundation_. Roof Covering Estimated Total cost of improvements $ f .` --D Amount 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 pennit 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 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 bcontractors rk to be .crformed ury r this permit, as are licensed by Miami Shores Village. Remarks (Signe STATE OF FLORIDA, COUNTY OF DADE. j ss Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally ap- peared and who, being by me first duly sworn, upon oath deposes an of the above described construction, that he has carefully read \ therein by him state are true Y Permit No._- C. Disapproved (Signed) MIAMI SHORES VILLAGE BUILDING INSPECTION DEPARTMENT ate Addition Lz Building Inspector Date 11 PLAN - ING BOARD Chairman Member Member Council Approved 1 and for no other purpose. Date Repairs No. of Stories to me well known, ays that tie is the fpreg•ing application, and that\he did sign the same, and that all facts Read, Sworn toand' §ubscribed before me. Notary Public, State of Florida My Commissi • . Expires Member Member Member 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 $1.00 will be charged when such re- inspection is made necessary by improper notice for inspection or faulty materials and /or workmanship. Permit No a t Owner's Name and Address MIAMI SHORES VILLAGE ELECTRICAL INSPECTION DEPARTMENT APPLICATION FOR ELECTRICAL PERMIT No l P,4 !!r. 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. in E. /t Registered Architect and /or Engineer ,^ Employing Electrician's Name No G / k 1 7SlseR e.... A. / Location and Legal Description Lot / Block l �1 p Subdivision. Street and Number where work is to be performed —No 1.2,...6:'........71... / L w�'1 ....Street State work to be performed and purpose of building (By Floors) New Building Remodeling Addition Repairs No. of Stories 3 ` (� 11 Service Overhead Size Feeders. I a 1 ` � C.onduit 2 Main Sw g Underground Gr'' " Amps Main Fuses Amps Type of Installation— Conduit Tubing B.X.L Metal Moulding Amount of Permit $ (Signed) Electrical 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 complied with the provisions thereof, and will require similar compliance from all contractors or subcontractors 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 subcontractors, on work to be performed under this permit, as are licensed by Miami Shores Village. (Signed). cf A ,, l � ... . ..... Master E ctrician. STATE OF FLORIDA, t COUNTY OP DADE. I e °' 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, and 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. SWITCH OUTLETS LIGHT OUTLETS PLUG RECE'P'T'8 FIXTURES NO. LAMPS RE ►RIO. OUTLET IRON OUTLET RANGE OUTLET RANGE CONN. WATER HEATER W. HEAT. CONN. g� HE ATER STRIP HEATER TOTAL CONTR. L ST / / 6 /-3 CHECK ENT. SW. DIST. CAB. SERVICE TEMP. SERVICE PERM. MOTORS 0.1 HP MOTORS I. HP NEON TRANS. RADIO TOTAL CONTR. LIST C CHECK N ., Permit No a t Owner's Name and Address MIAMI SHORES VILLAGE ELECTRICAL INSPECTION DEPARTMENT APPLICATION FOR ELECTRICAL PERMIT No l P,4 !!r. 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. in E. /t Registered Architect and /or Engineer ,^ Employing Electrician's Name No G / k 1 7SlseR e.... A. / Location and Legal Description Lot / Block l �1 p Subdivision. Street and Number where work is to be performed —No 1.2,...6:'........71... / L w�'1 ....Street State work to be performed and purpose of building (By Floors) New Building Remodeling Addition Repairs No. of Stories 3 ` (� 11 Service Overhead Size Feeders. I a 1 ` � C.onduit 2 Main Sw g Underground Gr'' " Amps Main Fuses Amps Type of Installation— Conduit Tubing B.X.L Metal Moulding Amount of Permit $ (Signed) Electrical 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 complied with the provisions thereof, and will require similar compliance from all contractors or subcontractors 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 subcontractors, on work to be performed under this permit, as are licensed by Miami Shores Village. (Signed). cf A ,, l � ... . ..... Master E ctrician. STATE OF FLORIDA, t COUNTY OP DADE. I e °' 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, and 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. 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. Date.. () Ly -JO , 19-S76 Owner's Name and Address . _Hit . T?- . __ sl/(_F.NM1sr14_...... No./Z,� 4 Registered Architect and /or Engineer \Y 4, . 14 .. - ). (D 6 — fL -- Name and address of licensed contractor \V '4\ 1 : 5 C /A1 Location and legal description of lot to be built on: Lot ( Block ( Subdivision / n R o .i 0 t Street and Number where work is to be done ._..rL..4!.�jP . . ___� - ,d__I 5 State work to be done and purpose of building (by floors) A- P_17.t1- L_c_n“ ATEt New Building Remodeling To be constructed of Kind of Estimated Total cost of improvements $ Zone •cubage required MIAMI SHORES VILL BUILDING INSPECTION DEPARTMENT > � / and for no other purpose. L Addition..... Repairs No. of Stories foundation 0 t4' C__ Roof Cog ring f3i t,,f -* 0 P LaRAvE L. � OCR Amount of Permit $ 0 _Plan Cuba e- .._ � �' 1---- (.. / 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 '�� /A ` 414_t_.0_ The undersigned applicant for this building pennit 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 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 subcontractors, on work to be performed under this permit, as are licensed by Miami Shores Village. �j Remarks (Signed) __.e 7 ,I 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 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 foegoing application, and that he did sign the same, and that all facts therein by him stated arptrue. Permit No.__ 6 ' Date � ' (— Read, Sworn to and Subscribed before me. Disapproved (Signed) to me well known, Date._ ..C�l_ .l Notary Public, State of Florida Building Insp: •r y Commission Expires LANNING 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 $1.00 will be charged when such re- inspection is made necessary by improper notice for inspection or faulty materials and /or workmanship. 2 z r e, . /2 7 Permit No 74 Owner's Name and Address 14 4__ ,' /Vic: No. ___._ .:L2.__ r°_._ _ Registered Architect and /or Engineer Employing Plumber's Name. .GEO -C k4 G_ &__P-/ ._... No. 3_/ _.. ? -- Location and Legal Description Lot_..___— ._..__ ._ Block Street and Number where work is to be performed— No.___J 7 6 6 State work to be performed and purpose of building (By Floors)_ New Building Remodeling __ Addition_ Amount of Permit $ MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING °'' ;L,MIT (Signed) Date Application is hereby made for the approval of the detailed statement of the plans and specifications herewithbmitted Cdr 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. Street_ hi E /0/ S Street_&' W l 7 6 - 4" / l Subdivision U L 2 ex" .f f{ d Street. 41 / / Sr Repairs No. of Stories. Size Septic Tank _ Type of Tank__ Capacity Gals Feet of Drain Tile__.__ _ __Dist. Feet of Tank or Drain Field from Well Nature of Water Supply: City— Well. _- .____C 1 T Y_________ ___._ Size of Soakage Pit cT ac, (Signed)_ Plumbing Inspector. The undersigned applicant for this building permit does hereby certify that he understands and accepts his o. gations as an employer of labor under the Florida Workmen's Compensation Act, being Section 5968, 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. ati caci, My Commission Expires Notary Public, State of Florida Master Plumber. 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 hirr, stated are true. NOTE: A re- inspection fee of $L00 will be made when such re- inspection is made•necessary by improper notice for inspection, or faulty materials and /or worinnanship. CLOSETS BATH TUGS SHOWERS LAVA- TORIES SINKS INK6 SLOP SINKS LAUNDRY TUBS U URINALS CATCH BASIN FLOOR DRAIN DRINKING FOUNT'NB TOTAL FIXTURES CONTR. LIST a 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 74 Owner's Name and Address 14 4__ ,' /Vic: No. ___._ .:L2.__ r°_._ _ Registered Architect and /or Engineer Employing Plumber's Name. .GEO -C k4 G_ &__P-/ ._... No. 3_/ _.. ? -- Location and Legal Description Lot_..___— ._..__ ._ Block Street and Number where work is to be performed— No.___J 7 6 6 State work to be performed and purpose of building (By Floors)_ New Building Remodeling __ Addition_ Amount of Permit $ MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING °'' ;L,MIT (Signed) Date Application is hereby made for the approval of the detailed statement of the plans and specifications herewithbmitted Cdr 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. Street_ hi E /0/ S Street_&' W l 7 6 - 4" / l Subdivision U L 2 ex" .f f{ d Street. 41 / / Sr Repairs No. of Stories. Size Septic Tank _ Type of Tank__ Capacity Gals Feet of Drain Tile__.__ _ __Dist. Feet of Tank or Drain Field from Well Nature of Water Supply: City— Well. _- .____C 1 T Y_________ ___._ Size of Soakage Pit cT ac, (Signed)_ Plumbing Inspector. The undersigned applicant for this building permit does hereby certify that he understands and accepts his o. gations as an employer of labor under the Florida Workmen's Compensation Act, being Section 5968, 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. ati caci, My Commission Expires Notary Public, State of Florida Master Plumber. 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 hirr, stated are true. NOTE: A re- inspection fee of $L00 will be made when such re- inspection is made•necessary by improper notice for inspection, or faulty materials and /or worinnanship.