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1301 NE 101 St (5)Qualifier State # PERMIT APPLICATION FOR MIAMI SHORES VILLAGE Date 7 Job Address /3P N E - 0 1 S ( Tax Folio Legal Description /)/f Owner/Lessee / Tenant I ' b 0 /J 13 °1 ,J e, Co t 5ti-SQ5 Contracting Co. K.. C s Dry c:li , APPROVED: Zoning Mechanical Owner's Address WORK DESCRIPTION Square Ft. 566 Municipal # Notary as to Owner and/or Condo President My Commission Expires: `� / p11 6 I /, e FEES: PERMIT ✓ RADON Building Plumbing Architect/Engineer Bonding Company Mortgagor Address Permit Type (circle one): BUILDING ELECTRICAL P MECHANICAL ROOFING PAVING FENCE SIGN /C Ceti 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 zoning. Furthermore, I autho ' the a ve -n contractor to d the work stated. �P.23V' 5 - sS -yY -D PL Add" C.C.F. Historically Designated: Yes No Master Permit # 4 /7 l 'Q Phone vS ' i r Q- o i W132 Ali d /Lc- Address p ss# °�6Jl _2 O S/ G I Ins. Co. Competency # Address Address Estimated Cost (value) i 170 In) Signature Contractor or ld, / Notgiy as to Contractor or Owner - Builder My Conunission Expires: NOTARY Electrical BOND v TOTAL DUE 3 rd -- _7_)( -O Date 7 ,2i -O0 Date Structural Engineer PROPERTY ID #: K [ •L D O H E R SPECIFICATIONS BY: APPROVED BY: DATE ISSUED: STATE OF FLORIDA DEPARTMENT OF HEALTH ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PERMIT Authority: Chapter 381, FS & Chapter 10D- CONSTRUCTION PERMIT FOR: [J] New System. [AM Existing System [ 4 Holding Tank [ Repair Y Abandonment [ j Other(Specify) API LICANT PROPERTY STREET ADDRESS: LOT: ,1, BLOCK: 'SUBDIVISIONe f 01JA t iFT69fti:3 (' [SECTION /TOWNSHIP /RANGE /PARCEL =ER] ' • = ' - eX 0 [OR TAX ID NUMBER]'' • SYSTEM. MUST BE CONSTRUCTED IN ACCORDANCE WITH SPECIFICATIONS AND STANDARDS OF CHAPTER 1OD - 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 C T [ 4 i 0 ] [GALLONS / GPD] SEPTIC TANK /AEROBIC UNIT. CAPACITY MULTI- CHAMBERED /IN SERIES:[ ] A [ ] / GPD] CAPACITY MULTI- CHAMBERED /IN SERIES:[ N [ ] GALLONS GREASE INTERCEPTOR CAPACITY [MAXIMUM CAPACITY SINGLE "TANK: GALLONS] GALLONS PER DOSE DOSING TANK CAPACITY DOSE.RATE [ ] PER 24 HRS NO. OF PUMPS: [ [ 4 431 ' SQUARE.FEET PRIMARY DRAINFIELD SYSTEM . [ ] SQUARE FEET SYSTEM A ,TYPE SYSTEM: [,] STANDARD [ 1J FILLED [ MOUND I CONFIGURATION: [4] TRENCH [ BED. [ ] v� F LOCATION OF BENCHMARK: I ELEVATION OF PROPOSED SYS2 EM SITE [ C . s INCHES - ] [ /M [AB • BOTTOM OF DRAINFIELD TO BE [ e ] [INf $/ [ABOVE /B FILL REQUIRED: [ �] INCHES EXCAVATION REQUIRED: [, INCHES LT "Or5�,IThuU Huu'��.�Pi k/`S.et Ft' 0,9A, c AB E '..+ �,,- ✓.. .r'4:s:. f +,+�..;:�1.r -xr ..�ri'S.. "`. ^t`;�'•_ : " ^- , ..�..n� ��1, '` AGENT: A,$ rZ.. TITLE: TITLE: , FAC EXPIRATION Sc .! C ,iliEt` sr t SCUD H OH 4016, 10/96 (Replaces HRS - Form 4016 DEFLECTION DEVICE s��PALLED ON Q� (page 1) which may be THE OUTLET T (Stock Number: 5744- 001- 4016 -0) Y Y Y.G ��� used) PERMIT (Der/ .2 DATE PAID / p . • FEE PAID si RECEIPT #$Od, 7 Q k iremporary/Experimental • BENCH FERENCE POINT BENCHMARK /REFERENCE POINT n.k z. QpCC _ vp IlfN V.l�4llll 1 eJ c- rn Zti "N'7111'' [ o V � rrrnnnrSr1 ..�.?L��� ^�"'1 t {. a .., e . ^ • ! (°.•$ 6..0�..� w p • �U �.EA3T 2.0 F t1�nt r�^�, a {t1i♦ n F� ; :. ;�. �t?;� THE !b� h 41 r��1�U�' I,.�A � POOPOZED - UA:P..dQ'1, G DRz §i etiti :TA 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 1OD -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 BY: 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. 4 N S P B STATE OF FLORIDA DEPARTMENT OF HEALTH APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION P Permit Application Number DH 4015, 10/96 (Replaces HRS -H Fo 4015 which may be used) (Stock Number: 5744 -002 - 4015 -6) PART II - SITEPLAN Scale: Each block represents 10 feet and 1 inch = 40 feet. ALL CHA GES MUST BE APPROVED BY THE COUNTY HEALTH DEPARTMENT o /b 6 cup 1 Not / .Approved Ifrid f ly- / m :� , i p i rd r ,I - ite Plan submitt d by: Ian Approved y )ji A (1/ 1 ?> 6 /d / /e /rte Date 7/P/ 4b' -- Caunty Health ppartment Page 2 of 4 PERMIT APPLICATION FOR MIAMI SHORES VILLAGE Date /0 -9 _ 7 D Job Address / ° (� 1 /1). E . /01 Sr . Tax Folio Legal Description 'Of AI G6 / L s $ / p &ot)e� Historically Designated: Yes No Owner/Lessee / Tenant ///ARV //l) SToI eE y �� TEL Master Permit # Owner's Address 1.3o1 N k , lot Sr , Phone gas"- S- 75 g- 6 a C o n t r a c t i n g Co. ' Pik / 4 4 /iv e _ A d d r e s s 7 DDS 4/ W�9 6 eit 1 4 / 1 , 9 /- Qualifier i v 0 2 i n c to te,p r.10 SS # - Phone 7 .5 - y o2 0 state # C r i ! O S C 7 Municipal # Competency # Ins. Co. Architect/Engineer Address Bonding Company Address Mortgagor Address Permit Type (circle one): BUILDING ELECTRICAL LUMBING MECHANICAL ROOFING PAVING FENCE SIGN WORK DESCRIPTION e..1G e e , 1 cldt N S/ s'v k. 4 n 4 ( j ) ri4r S e D V £ i R L ,'/4 4 e, Square Ft. Estimated Cost (value) 1/V ,. 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 zoning. Furthermore, I authorize the above -named contractor to do the work stated. ondo President 1 at Signa r of owner and/o Notary as to Owner and/ / ondo Pr ` .y Commission•Expire PATRICIA 1. DOUGAN My Comm Exp. 4/02/00 . Watt Icy In X43037 "w 1 FEES: 4. • Date APPROVED: r C.C.F. 11- 3 4A OS -0c 33 -©096 N N . Signature of Contractor or Owner- Notary as to ntractor // Owner - Builder My Commission Expir a�. PATRICIA .I. DOUGAN My Comm Exp. 4102/00 pied By Service Ins No. CC545037 l � � • a • � a K m . , I I agar L NSTARY : .BOND. TOTAL DUE Date ITEM BATH TUB UNIT FEE ITEM SWITCH OUTLETS UNIT FEE ITEM SPACE HEATERS UNIT FEE BIDET LIGHT OUTLETS CENTRAL HEATING DISHWASHER _ f RECEPTACLES A/C (WIND) DISPOSAL / SERVICE TEMPORARY A/C (CENTRAL) DRINKING FOUNTAIN SERVICE SIZE IN AMPS DUCT WORK FLOOR DRAIN SERVICE REPAIR/METER 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 HP STEAM BOILERS SHOWER MOTORS OVER 1- 3 HP HOT WATER BOILERS SINK, POT /3 COMP. MOTORS OVER 3- 5 HP MECHANICAL VENTILATION SINK, RESIDENCE i MOTORS OVER 5- 8 HP TRANSPORTING ASSESLIES SINK, SLOP MOTCRS OVER 8- 10 HP ELEVATORS/ESCALATORS TEMPORARY WATER CLOSET MOTORS OVER 10- 25 HP FIRE SPRINKLER SYSTEMS URINAL MOTORS OVER 25-100 HP - COOLING TOWERS WATER CLOSET MOTORS OVER 100 HP 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 GENERATORS TRANSFORMERS LAWN SPRINKLER -WELL SPECIAL PURPOSE . SWIMdING POOL OUTLETS COM1,ERCIAL WATER SERVICE SIGN TUBES SEWER CONNECTIONS _ SIGN TRANSFORMERS UTILITY -SUER SIGN TIME CLOCK UTILITY -WATER FIXTI.RES SEPTIC TANK ANTENNA RELAY TELEVISION OUTLETS DRAINFIELD, 4' TILE/RES. VIOLATION " PUMP & ABANDON SEPTIC TANK REINSPECTION " SOAKAGE PIT CU. FT. CATCH BASIN DISCHARGE WELL DOMESTIC WELL " AREA DRAIN • ROOF INLET SOLAR WATER HEATER " FIRE STANDPIPE POOL PIPING LAWN SPRINKLER SYSTEM GAS RANGE " METER SET (GAS) GAS PIPING . t 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 Date S 7.-es - 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. Permit No Owner's Name and Address____Z 3/L ?_e n ____l..l_ 1?!d ________------- •- -___ -- No._ d1 _ N t Street. .3 Registered Architect and /or Engineer — __— Employing Plumber's Name Gib 1?_5- _ do /A✓C No .___ " "_ S� 7�// - Street__ T/R Location and Legal Description Lot__ Street and Number where work is to be performed— No.__/ 3 �� _ �L/F _ _. _ -. Street 10 3 5-7: State work to be performed and purpose of building (By New Building _!- Remodeling ______ Addition. Size Septic Tank Type of Tank__ Capacity Gals Feet of Drain Tile Dist. Feet of Tank or Drain Field from Well __Size of Soakage Pit Nature of Water Supply: City —Well Amount of Permit $ 4 STATE OF FLORIDA, 1 COUNTY OF DADE. es. MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT Block (p (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 5988, Compiled General Laws of Florida Permanent Supplement, and Ilas 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. Subdivision_ Repairs No. of Stories ( 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 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 TUBE URINALS CATCH BASIN FLOOR DRAIN DRINKING FOUNT'N6 w a.S ph � f� C P /S H Wa 54 1 FIXTURES CONTR. LIST �) 'C / / / • / CHECK SEPTIC TANK SEWER CONN. DRAIN FIELD SOAKAGE PIT GREASE TRAP HEATER DEEP WELL SPRKLR. SYSTEM SWIM'G POOL (,{/50 Comm. LIFT 7 � / CHECK Date S 7.-es - 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. Permit No Owner's Name and Address____Z 3/L ?_e n ____l..l_ 1?!d ________------- •- -___ -- No._ d1 _ N t Street. .3 Registered Architect and /or Engineer — __— Employing Plumber's Name Gib 1?_5- _ do /A✓C No .___ " "_ S� 7�// - Street__ T/R Location and Legal Description Lot__ Street and Number where work is to be performed— No.__/ 3 �� _ �L/F _ _. _ -. Street 10 3 5-7: State work to be performed and purpose of building (By New Building _!- Remodeling ______ Addition. Size Septic Tank Type of Tank__ Capacity Gals Feet of Drain Tile Dist. Feet of Tank or Drain Field from Well __Size of Soakage Pit Nature of Water Supply: City —Well Amount of Permit $ 4 STATE OF FLORIDA, 1 COUNTY OF DADE. es. MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT Block (p (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 5988, Compiled General Laws of Florida Permanent Supplement, and Ilas 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. Subdivision_ Repairs No. of Stories ( 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 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. BUILDING ELECTRICAL PLUMBING ROOFING Owner of Building Architect Contractor or Builder Description. Lot II Bi. n Address of Building 1 / .. MIAMI SHORES VILLAGE. FLORIDA PERMIT N° 14284 ❑ Work to be performed under this Permit 1 Subdi- vision DATE Contractor's License No. Value of Amt. of Project $ Permit $ on 195 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. } 1,,,,r ''' BY + I. 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 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 responsibility for all work done by either, myself, my agent, servant or employee. CONTRACTOR OR BUILDER BY AUTHORITY BUILDING ❑ ELECTRICAL PLUMBING ROOFING Owner of Building Architect Contractor or Builder *.. Legal Lot II BI. Description Address of +►»» Building MIAMI SHORES VILLAGE, FLORIDA ❑ PERMIT N? 14766 ❑ Work to be performed under this Permit CONTRACTOR OR BUILDER Subdi- vision Value of Project $ DATE 195 x' 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. f . 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 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 responsibility for all work done by either, myself, my agent, servant or employee. Contractor's License No Amt. of Permit $ BY AUTHORITY l4a3eih 2 CgalJ, E5 10121 SV.E. 13th cl{venue, SV(fami cs/Zotea, 9!otida 33138 P L ) -.b" 7 7 e—O—vAk ,,puo-L761 J3 ®/ Y a € . /o [ - -�_ c jj 74_ ,e_t_ -e&o„ Storer BROADCASTING COMPANY CLYDE C. MCCLYMONDS VICE PRESIDENT FOR SPECIAL SERVICES 866 1177 Kane Concourse, Miami Beach 54, Florida Permit No. .__ :_1 a8# Owner's Name and Address__ Registered Architect and /or Engine Employing Plumber's Nam . Feet of Drain Tile Nature of Water Supply Amount of Permit $ ell le g My Commission Expires )/)1 lD /,4 /,5 e MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT ___ _ ______ ( Signed) _ No i0 . 16 /4 a. 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 Divisior 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. / No 3 Street Location and Legal Description Lot Block_.___ _ _ Subdivision Street and Number where work is to be performed —No — ' 011L Street 1 O 1 ' ' State work to be performed and purpose of building (By Floors) ____ New Building Remodeling Addition Repairs No. of Stories Size Septic Tank Type of Tank_ _ Capacity Gals (Sign Dist. Feet of Tank or Drain Field from We1L fl _ Size of Soakage Pit 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 art licensed by Miami Shores Village. STATE OF FLORIDA, COUNTY OF DADE. Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeare 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 tat. therein by him stated are true. Notary Public, State of Florida Plumbing Inspector. 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 faul materials and /or workmanship. CLOSETS BATH TUBS SHOWERS LAVA TORIES SINKS SLOP SINKS LAUNDRY TUBS URINALS CATCH BASIN FLOOR DRAIN DRINKING FOU NT•NS J,o�!?i 1L i n� /c3 .. TOTAL FIXTURE: _ CONTR. LIST LIST 3 �[ 2 A / / 4 / CHECK c 2 . 'D I '"O 5') e r� IW d l�R HEATER DEEP WELL SEPTIC TANK SEWER CONN. DRAIN FIELD `6 SOAKAGE PIT GREASE TRAP SPRKLR. SYSTEM SW IM'G POOL CONTR. LIST / / I ITT) CHECK Permit No. .__ :_1 a8# Owner's Name and Address__ Registered Architect and /or Engine Employing Plumber's Nam . Feet of Drain Tile Nature of Water Supply Amount of Permit $ ell le g My Commission Expires )/)1 lD /,4 /,5 e MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT ___ _ ______ ( Signed) _ No i0 . 16 /4 a. 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 Divisior 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. / No 3 Street Location and Legal Description Lot Block_.___ _ _ Subdivision Street and Number where work is to be performed —No — ' 011L Street 1 O 1 ' ' State work to be performed and purpose of building (By Floors) ____ New Building Remodeling Addition Repairs No. of Stories Size Septic Tank Type of Tank_ _ Capacity Gals (Sign Dist. Feet of Tank or Drain Field from We1L fl _ Size of Soakage Pit 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 art licensed by Miami Shores Village. STATE OF FLORIDA, COUNTY OF DADE. Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeare 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 tat. therein by him stated are true. Notary Public, State of Florida Plumbing Inspector. 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 faul materials and /or workmanship.