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1270 NE 100 St (10)Date 11 -26 -01 BP. b / .M PERMIT APPLICATION FOR MIAMI SHORES VILLAGE \ v/ Job Address 1270 N.E. 100th Street Tax Folio 1/ ',3a05' 0 b 0 3 G Legal Description Historically Designated: Yes No Owner/Lessee / Tenant Lois B. De0l i ve i ra Mir Permit # °3 Owner's Address 1270 N.F. 100th Street, Miami Shores. F1 33138 Phon 305- 756 -8739 contractingco. Coastal Plumbing Co. of Miami Address 285 N.E. 185th Street, Miami, F1 33179 Qualifier Robert E. Brincefield ss# Phone 305 - 651 -4429 State # CFCO -19042 Municipal # 6264 Competency # 6264 Ins. Co. Collinsworth, et al Architect/Engineer Address Bonding Company Address Mortgagor Address Permit Type (circle one): BUILDING ELECTRICAI(UMBING)MECHANICAL ROOFING PAVING FENCE SIGN WORK DESCRIPTION Repliace existing Natural gas water heater Square Ft. Estimated Cost (value) 5200.00 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. o 'wrier a. orCondoPr - ident OWNER'S construct' Signature AVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating d zoning. Furth • 4, : I authorize the above -named contractor to do the work stated. Notary as to Owner and/or ondo President Date My Commission Expires, e.u' Patricia Stover `: la% : E MY COMMISSION # CC839914 EXPIRES • In �l FEES PERMIT June 28, 2003 ' b BONDED THRU TROY FAIN INSURANCE, INC RADON APPROVED: Zoning Building Mechanical Plumbing 11 -26 -01 Date �J I C.C.F. -. ,b 0 NOTARY " BOND TOTAL DUE h 6 - 0 SZ i/244-zeee Signature of Contractor or Owner- d er Notary as to Contractor or l ' er- Builder Date My Commission Expirek :.t;:'P Patricia Stover 11• MY COMMISSION # CC839914 EXPIRES June 28, 2003 ,.JADED THRU TROY FAIN INSURANCE, INC Electrical 11 - 26 - 01 Date Structural Engineer ITEM BATH 11.8 UNIT FEE 'ITEM SWITCH OUTLETS UNIT FEE ITEM SPACE HEATERS UNIT FEE BIDET LIGHT OUTLETS CENTRAL HEATING DISHWASHER RECEPTACLES A/C (WIND) OI OSAL SERVICE TEMPORARY A/C (CENTRAL) DRINKING FOUNTAIN SERVICE SIZE IN AMPS DUCT WORK FLOOR DRAIN SERVICE REPAIR/TER CHANGE REFRIGERATION GREASE TRAP APPLIANCE OUTLETS PROCESS AND PRESS PIPING INTERCEPTOR RANGE TOP UNDERGROUND TANKS LAVATORY , OVEN ABOVE GROUND TANKS LAUNDRY TRAY WATER HEATER U.F. PRESSURE VESSELS CLOTHES WASHER MOTORS 0- 1 FP STEAM BOILERS SHOWER MOTORS OVER 1- 3 FP HOT WATER BOILERS SINK, POT /3 COMP. MOTORS OVER 3-. 5 FP MECHANICAL VENTILATION SINK, RESIDENCE MOTORS OVER 5- 8 FP TRANSPORTING ASSEMBLIES SINK, SLOP MOTORS OVER 8- 10 FP ELEVATORS/ESCALATORS TEWORARY WATER CLOSET MOTORS OVER 10- 25 HP FIRE SPRINKLER SYSTEMS L R I NUL MOTORS OVER 25-100 FP COOLING TOWERS WATER CLOSET MOTORS OVER 100 FP VIOLATION INDIRECT WASTES A/C WINDOW REINSPECTION WATER SUPPLY TO: AIR CONDITIONERS • A/C UNIT STRIP HEATER FIRE SPRINKLER GENERATORS TRANSFORMERS HEATER -NEW INST. GENERATORS TRANSFORMERS HEATER - REPLACE .__L GENERATORS TRANSFORMERS LAN SPRINKLER -WELL SPECIAL PURPOSE E SWIM4MIN;G POOL CUTLETS COMMERCIAL MATER SERVICE SIGN TUBES EWER CONNECTIONS 7 SIGN TRANSFORMERS ILITY- SEWER SIGN TIME CLOCK T I L I TY -WATER FIXTURES EPTIC TANK ANTENNA . :LAY TELEVISION OUTLETS RAINFIELD, 4' TILE/RES. VIOLATION OR & ABANDON SEPTIC TANK REINSPECTION ) AGE PIT CU. FT. ATC-I BASIN ISO'HARGE. WELL - - JMESTIC WELL lEA [MAIN )JF INLET )LAR WATER HEATER IRE STANDPIPE ))L PIPING 1'WN SPRINKLER .SYSTEM �-- LS RANGE :TER SET (GAS) S PIPING ADDENDUM TO BUILDING PERMIT APPLICATION (AN APPLICATION FOR BUILDING PERMIT MUST ACCOMPANY THIS ADDENDUM. IF A MASTER PERMIT HAS B. OBTAINED, THE OWNER'S NOTARIZED SIGNATURE NEED NOT BE PRESENT ON SUBSEQUENT APPLICATIONS.) PLUMBING ELECTRICAL MECHANICAL PLIMiMI APPLICATIQN FQfl MUNICIPALI 1 [ES CIF DADE COUNTY (OWNER TO RETA±N COPY) Date' C -11-61 I Job Addreee 1 a o , 51- Tax Folio 11 - 3� b5.r.eo� - 0 030 Legal Description L ° 3 S to E f4r -le + S� w reS Raster Permit. / Lessee / Tenant -57( M E Owner's Address N E QQ Phone - Contracting Co. , r Address qualifier 880 _ - - Phone Stated Competency 0 4/// Ins. Co. Architect /Engineer Address Bonding Company Address .Mortgagor • Address fermit Type (circle one), BUILDIN ELECTRICAL PLUMBING MECHANICAL bIORK DESCRIPTION ,�!.,s I h_1( PAVING FENCE SIGN Square Ft. Estimated Cost \,0 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 Mork will be performed to meet .the ltandard• of all laws regulating construction in tliis jurisdiction. I understand that separate Permits are required for ELECTRICAL. PLUMBING, BiaNB; PQOLS, ROOTING, and MECHANICAL work. OWNER'S AVIIDAVITt I certify that all the foregoing information is accurate and that all work will b done in compliant with all applicable laws regulating construction and aoniag. Fiat ,ly•re, I authorite t above -named contractor to do the Work stated. S net N '"ary as to Owner std /or Condo Pre My Commission -expires! ,��NoF * * fit • . * ) * APPAOVBDI P Zoning Building, . Electrical Mechanical �^. Plumbiag�' ^ q k I Of , gineering 't-'S i5, 19g1 PERMIT MI IA 0 d /or Condo President Signature of Contractor or Owner- Builder Date: Notary as to Contractor or Owner- Builder *y Commission Expires: Other I •c r'1):41117'!",1_171. .`_.. i.T Ili =L•ra?1 � . �_ ':_: r•. 7; �_ T" ��v Z?6F�$'�iT."��7a.i'.�TJ('1i"; � NZ 7 4 ":11T s! {EniL'FE774 rn,M'Y r" Tr: •r-�.. •,.,... ,.�- ...�r�.�.��- - --- PgS 2;17 Rev 11/79 1. LOCATE AND PROTECT ALL UTILITIES IN AREA OF COUSIRIJCTION. UNCLE 111-800-432-4770 2. RESTORE ALL AREAS TO PRIOR CONDITION. 3. ALL CONSTRUC11011 TO FOLLOW JURISDICTIONAL GOVERNMENT AND PgS SIANDAROS. 6iisf. 2 : 4 6M SECTION , 4- iz SCALE DWG. BY v1/4 k 9 . yr 7. g 1 �. G;C� e i 00 2'. 12-70 NE: 10 5013' VOL-tick) _ . s es‹. ., .: eop1 GAS S YS'x'M Inc. . %2" �taba.� OF 1270 NE NI i F.Nt i �Fb2,�5 DATE' ' 5 - a1- -SHEET o I J.o. M - 7 5 82 A.EE.010t -7C00Q OZ TIME PLANS ARE APPROVED FOR ISSUANCE 0.= A BUILDING PERMIT ® WITH NO VIJRIA^!CE? C7 WITH v. RIAP:CE(S) LISTED IN "REMARKS* NO OTHER DEVIATIO .S :'ft'.::oi T "f: ',1'.'.NII PINS BUILDING AND ZONING ORDINANCES WILL OE PE 7 .,:+1 i T F.:). U.it E 3 SPECIFICALLY LISTED BELOW. All OTHER APP:ICAB!.E 3T.1TE AND C()IJ TY LAWS MUST BE COMPLOED '11TH BY ALL PARTIES. Aieo i'ei Sign'ture Da ° FIRE DEP "CT:..:_t i PIMIC 7.ORNNS POLICE DEPAi3Ti,lEN i BIALDING DIRECTOR C'LANi.ING & ZONING VILLAGE COUNCIL PRELLMO IARVg REMARKS: WPifIIVAI r COMPLIANCE 6 ^JiTHi THE SOUTH FLORIDA BUILDING CODE AS ADOPTED V L'AOAMI SHORES VILLAGE IS REQUIRED. THE ARCHITECT, BUILDER & SUB CONTRACTORS ARE Clir•R'Ff) IT" T:dr VOWLEDGE OF ALI BUUILD- CN0 C3EGULATCONS METHEE3 Og NO? a MAL(.V Ci` cz HEREIN. r Druyi.I-T APPLICATION FOB MUNICIPAL' I IES Ur DADE COUNTY (OWNER TO 40*±H COPY) Tax Folio Permit. -5/7t5:2 ) c3 ) Oats' 5-73-Cf I Job AddreSe r 1 0 Al E • o Leg al De r ip t ion L 4 3 E 1-c-t� S 1 " c Master 4;0 / Leese. / Tenant Owner's Addrea12- Contracting Co. / e-- CYC&'" Address (Lualif ler eff30 ( 8eoih21: ..w6 ph st At. # .efoo Competency # ,g2 Architect/Engineer Address Bonding Company Addreis Mortgagor Address .0; 1. • 'XI , fermit Type (circle one ) i<BO/LDINO ELECTRICAL PLUMBINO MECHANICAL PAVINO fame' SIGN VIORK DESCRIPTION ,9-- ,..7& 6-7A1-72.79k- 5gusts Ft. . 'Ottimated Cos c,20, WARNING TO OWNER! YOU MUST RECORD.A NOTICE oF COMMENCEMENT AND YOUR FAILL6E DO SO MAY RESULT IN YOUR PAYING TWICE F0414PROVEMENTS YOUR PROPERTY1IF YOU INTEND TO OBTAIN FINANCIN(, CONSULT WITH Y UR LENDER OR AN ATTORNEY BEFORE. RECORDING YOUR NOTICE OE' COMMENCEMENT).. 1 Application is hereby made to obtain a permit to do rik and installation as indicated abo4e, and .• 1 ' on the attached addendum (if applicable):1 l'Oeitiftthat ili work'Wili.te performed to Miitihe ltandardi of all li4rs rigUlating consii4CtiOil 411,i )il jtirisdiotion: 1 understand thit'ooParite formite tie required for ELECTRICAL, ELGMBiNG,'Sitafil POOLS, HOOFING, and MECHANICAL work: .'. . • '• , • l'ttit tf • . OWNER'S AFFIDAVITI / certify that all the foregoing,information in accurete and that ail l will •41 done in compli as with all iPpliaithi4iiwi regulatin4:1141etruction and 'ioniin. . 4 . rU ore, I authori the above contritOk t ,., . a ior . • _. ., • ' .'1. 1 , .1. . ... /411' / 411411646111111111111P-Anii-1 3 gn trei 0 It ( ATE 1 OF FLORID: b of Owneluend/or Co do President $ nature of Contr or o ; der t NOTARY PUB % ii t / I ? bitil . . COMMIS --:-4: 1- 1I. . -Ifi' D a s di /A A-4 :' - otary as to Owner and/or C Anliggent atary 48 to Contractor or Own - .Builder .•. • . • . • - .... Hy commission Expiremi mrftmmitearres401 * , y.Commieeion li(pireei * * * * . * il: * * Other----------- ERMIT TEE! APPROVED! • Baiding Mechanical 15 1 9 91 ' • 15: lr ran: vu r' r • 1■• Phone 1;)- 73 ins. co. A /7 9a- •■•■• 14; t5)9/Eriginearing-- Permit No ._ _ _ Application i hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the build ng 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 th Building Div`sion of Miami Shores Village shall be comphed 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. .......... F . R • Peeb le s Registered Architect and /or Engineer _ Employing Plumber's Name Location and Legal Description Lot ___ _. --- - . —. -•_ - - -_ _ - -._- _._ Block___ Subdivision. Street and Number where work is to be performed —No 1270 N . E . 100 St . Street - State work to be performed and purpose of building (By Floors) _ _ _ New Building Remodelin _ __ __ Addition__.- _ _ __ 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. We 1 L___ __ Si' a of Soakage Pit STATE OF FLORIDA, 1 COUNTY OF DADE. MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT Date - 7 -18 -72 - - 1270 N.E. 100th. Street - - --- ••-_...... No. -- - - .. - - _- — Street . ....... . Brooks Sprinkled Co. 880 N.W. 54th. Street No. I (Signed)__ , Street - - -- - - - -- = - - - -- _ _ . .__ No. of Stories _ Capacity Gals. /4, o Plumber. Amount of Permit $ J.0.00__ -- _ — __ -- _ -- _ . -- . _ (Signed) Plumbing In :pecto. 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 5988, Compiled General Laws of Florida Permanent Supplement, and I as <,om- 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 no ices as are required by the Act. The undersigned agrees to employ only such sub- contractors, on work to be i fo. ed under i per nit, as are licensed by Miami Shores Village. Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take aclmowledgnients, personall 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 .acts 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 TUBE SHOWER[ LAVA- TORIES SINKS SLOP SINKS LAUNDRY TUBE URINALS CATCH BASIN FLOOR DRAIN DRINKING FOUNT'NS TOTAL F'XTURES CONTR. LIST CHECK SEPTIC TANK SEWER CONN. DRAIN FIELD SOAKAGE PIT GREASE TRAP SOLAR HEATER DEEP WELL SPRKLR. SYSTEM SWIM'G POOL COPT!. LIST 1 1 -- CHECK Permit No ._ _ _ Application i hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the build ng 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 th Building Div`sion of Miami Shores Village shall be comphed 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. .......... F . R • Peeb le s Registered Architect and /or Engineer _ Employing Plumber's Name Location and Legal Description Lot ___ _. --- - . —. -•_ - - -_ _ - -._- _._ Block___ Subdivision. Street and Number where work is to be performed —No 1270 N . E . 100 St . Street - State work to be performed and purpose of building (By Floors) _ _ _ New Building Remodelin _ __ __ Addition__.- _ _ __ 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. We 1 L___ __ Si' a of Soakage Pit STATE OF FLORIDA, 1 COUNTY OF DADE. MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT Date - 7 -18 -72 - - 1270 N.E. 100th. Street - - --- ••-_...... No. -- - - .. - - _- — Street . ....... . Brooks Sprinkled Co. 880 N.W. 54th. Street No. I (Signed)__ , Street - - -- - - - -- = - - - -- _ _ . .__ No. of Stories _ Capacity Gals. /4, o Plumber. Amount of Permit $ J.0.00__ -- _ — __ -- _ -- _ . -- . _ (Signed) Plumbing In :pecto. 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 5988, Compiled General Laws of Florida Permanent Supplement, and I as <,om- 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 no ices as are required by the Act. The undersigned agrees to employ only such sub- contractors, on work to be i fo. ed under i per nit, as are licensed by Miami Shores Village. Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take aclmowledgnients, personall 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 .acts 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. BUILDING ELECTRICAL PLUMBING ROOFING Owner of Building r { 4 t Architect Contractor or Builder Legal Description. Address of Building Lot �•-•• ,. 'fir n PERMIT N? 12472 LsCf n Work to be performed under this Permit ray N Value of Amt. of 4 .,r -7 to ^i y * • t f; L) Project $ Permit $ ' This permit is wanted • o the" contractor or builder named above to construct the building or Co install the equipment or device described in the' application herefor in strict corn is kte 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 j s the statements or specifications and at he assumes responsibility for work done by his agents, servants or employees. i e BY Signed• " "',:. %,, � r* ' INSPECTOR ' In consideration of the issuance to me of this permit I agree to p o the work covered hereunder in compliance with all ordinances and regulations pertaining thereto and in strict conformity with the plans, drawings, state rda*S or specifications submitted to the proper authorities of Miami Shores Village. In accepting this perq it I assume responsibility for all work done by either, mystlf, my agent, servant or employee. l : r coNPRA OR BUILDER MIAMI SHORES VILLAGE, FLORIDA Bl. Subdi- vision Br— DA-TR ,/ . - 7 Contractor's License No AUTHORITY 195 l "k..J -44-11,s � Permit No. 1 l_ _ Owner's Name and Address Registered Architect and /or Engineer Street and Number where work is to be performed —No Amount of Permit $ STATE OF FLORIDA, 1 COUNTY OF DADE. 7-� ss. My Commission Expires 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. a C-r■-kiLA-42.-- et,. Employing Plumber's Name ,�C — '- __ . No Street Location and Legal Description of ______ Block Subdivisio No Street ,/,‘ Street / • S • . k performed and purpose of building (By Floors) Remodeling Addition Repairs No. of Stories Size Septic Tank 6 -& Feet of Drain Tile 1 6 Dist. Feet of Tank or Drain Field from Well___ Nature of Water Suppl Well 0 Size of Soakage Pit__ Type of Tank Capacity Gals. (Signed) 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) Date._ __.J • 7 - - 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 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 DRINK ING FOUNT'NS ✓ �� / "' ..1* /7t A7i '°i7� ,/t�yvr L the / 1 V '` TOTAL FIXTURES -- CONTR. LIST # � SEWER CONN. / v1- 1 • / _- 1 CHECK SEPTIC TANK I.� / J� / . V 7 A - ,/� / Ste. N /� DRAIN FIELD SOAKAGE PIT GREASE TRAP SOLAR HEATER DEEP WELL SPRKLR. SYSTEM SW IM'G POOL T'/ f CONTR. LIST 1 1 j CHECK / 6 / c U Permit No. 1 l_ _ Owner's Name and Address Registered Architect and /or Engineer Street and Number where work is to be performed —No Amount of Permit $ STATE OF FLORIDA, 1 COUNTY OF DADE. 7-� ss. My Commission Expires 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. a C-r■-kiLA-42.-- et,. Employing Plumber's Name ,�C — '- __ . No Street Location and Legal Description of ______ Block Subdivisio No Street ,/,‘ Street / • S • . k performed and purpose of building (By Floors) Remodeling Addition Repairs No. of Stories Size Septic Tank 6 -& Feet of Drain Tile 1 6 Dist. Feet of Tank or Drain Field from Well___ Nature of Water Suppl Well 0 Size of Soakage Pit__ Type of Tank Capacity Gals. (Signed) 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) Date._ __.J • 7 - - 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 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.