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230 NE 100 StPermit Type: Plumbing - Residential Work Classification: Well Job Address: 230 100 Street NE Additional Information Miami Shores Village, FL Building Department File Copy Applicant Signature Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL 33138 -0000 Phone: (305)795 -2204 Fax: (305)756 -8972 Permit Issue Date: 10/20/2006 Expires: 04/18/2007 Owner's Name: THOMAS AND LAUREN BENTON Contractor(s) MIDWAY WELL DRILLING Phone 305 - 624 -3494 Primary Contractor Yes Type of Work: WELL Additional Info: Classification: Residential Type of Piping: Bond Return : 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, servants, or employes. I understand that separate permits are required for ELECTRICAL, PLUMBING, MECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work. 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. Futhermore, I authorize the above -named contractor to do the work stated. Permit Status: APPROVED Permit Number: PL - - - 2615 Phone: (305)795 -2207 Parcel #: 1132060134480 Block: Lot: Section: PB: Total Square Feet: 0 Total Valuation: $ 1,000.00 Required Inspections Rough Final Fees Due Amount CCF $0.60 Education Surcharge $0.20 Permit Fee - Additions /Alterations $100.00 Scanning Fee $3.00 Technology Fee $2.50 Total: $106.30 Invoice Number PL - 10 - 06 - 26475 Total: Amt Due $106.30 0-0 Amt Paid OCT 2026 NOTICE: In addition to the requirements of this permit, there may be additional restrictions applicable to this property that may be found in the public records of this county. AND THERE MAY BE ADDITIONAL PERMITS REQUIRED FROM OTHER GOVERNMENTAL ENTITIES SUCH AS WATER MANAGEMENT DISTRICTS, STATE AGENCIES, OR FEDERAL AGENCIES . BUILDING PERMIT APPLICATION FBC 2004 Permit Type (circle): Building Electrical Owner's Name (Fee Simple Titleholder) TO 01 /Gb ✓ Owner's Address 2 7 City el t 4"; -C State F ( Tenant/Lessee Name Qualifier Name P h Q Q epnza I Value of Work For this Permit $ AD 1 1 0 0 (5° Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 6 („-,T-b.-/ Permit No. P i 0Cc) ' 26-)15 Master Permit No. Zip ) 3 /3v Architect/Engineer's Name (if applicable) Phone # Square / Linear Footage Of Work: Mechanical Roofing Phone# 30 1' 7 Tf- (t7`1 Phone # Job Address (where the work is being done) City Miami Shores Village County Miami -Dade Zip FOLIO / PARCEL # Is Building Historically Designated YES NO Contractor's Company Name V\ 11 aid\ ( A Contractor's Address 44 N ' 2 Dr City \.0 «� t- oS State ( Zip 3a) 5s Phone # 5 f (Jo _ 3gc(4 Phone # State Certificate or Registration No. Certificate of Competency No._ ___ )4 Type of Work: ❑' Ad ❑Alteration [New ❑ Repair/Replace ❑ Demolition Describe Work: ******* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** F ees * *********** * * * * * * * * * * * ** * * * * * * * * * * * * * * * * * ** Submittal Fee $ Permit Fee $ L Up CCF $ * W Q CO /CC Notary $ Training/Education Fee $ 120 Technology Fee $ 2• S® Scanning $ 5" Radon $ DPBR $ Zoning $ Bond $ Code Enforcement $ Double Fee $ Structural Review. $ Total Fee Now Due $ See Reverse side -a Bonding Company's Name (if applicable) Bonding Company's Address City State Zip Mortgage Lender's Name (if applicable) Mortgage Lender's Address City State Zip Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRICAL WORK, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and AIR CONDITIONERS, ETC 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. "WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT 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." Notice to Applicant: As a condition to the issuance of a building permit with an estimated value exceeding $2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the porson whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the joh ' ite for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. Signature Owner or Agent The foregoing instrument was acknowledged before me this day of ,20,by who is personally known to me or who has produced who is personally known to me or who has produced_ As identification and who did take an oath. as identification and who did take an oath. NOTARY : B IC: NOTARY :ti: LIC: inntle Int! • f ;Omit Sign: ►j �' Sign: Print: ' , a P, Print: My C mmission Expires: ° A' My Co fission Expire * * * ** * * * * * * * * * * * * * * * * * * * * * * ** APPLICATION APPROVED BY: (Revised 02/08/06) Signature Co actor The foregoing instrument was acknowledged before wd this day of a i , 20 , by I hr * * * * * * * * * * * * * * * * * * * * * * * * * * * ** * * * * * * * ** * * **.k * * * * * * ** 0 Zoning / 66 P ns Examiner Engineer Inspection Date: 12/12/2006 Inspector: Levrack, James Owner: BENTON, THOMAS AND LAUREN Job Address: 230 100 Street NE Miami Shores Village, FL Project: <NONE> Contractor: MIDWAY WELL DRILLING Building Department Comments Monday, December 11, 2006 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP -30327 Permit Number: PL -10 -06 -2615 1 3 RFD Block: Permit Type: Plumbing - Residential Inspection Type: Final Work Classification: Well Phone Number (305)795 -2207 Parcel Number 1132060134480 Lot: Phone: 305 - 624 -3494 Page 2 of 2 V C.) /9„9- /3- 0 c Passed EZ In for Com ents . I Failed Correction Needed r' Re- Inspection Fee ($75) No Additional Inspections can be scheduled re- inspection fee is paid. 1 until Inspection Date: 12/12/2006 Inspector: Levrack, James Owner: BENTON, THOMAS AND LAUREN Job Address: 230 100 Street NE Miami Shores Village, FL Project: <NONE> Contractor: MIDWAY WELL DRILLING Building Department Comments Monday, December 11, 2006 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP -30327 Permit Number: PL -10 -06 -2615 1 3 RFD Block: Permit Type: Plumbing - Residential Inspection Type: Final Work Classification: Well Phone Number (305)795 -2207 Parcel Number 1132060134480 Lot: Phone: 305 - 624 -3494 Page 2 of 2 ITEM UNIT FEE ITEM UNIT FEE ITEM UNIT FEE BATH TUB SWITCH OUTLETS SPACE HEATERS DISHWASHER LIGHT OUTLETS CENTRAL HEATING DISPOSAL RECEPTACLES A/C (WIND) FLOOR DRAIN SERVICE TEMPORARY NC (CENTRAL) GREASE TRAP SERVICE SIZE IN AMPS DUCT WORK INTERCEPTOR SERVICE REPAIR/METER CHANGE REFRIGERATION LAVATORY APPLIANCE OUTLETS PROCESS AND PRESS PIPING LAUNDRY TRAY RANGE TOP UNDERGROUND TANKS CLOTHES WASHER OVEN ABOVE GROUND TANKS SHOWER WATER HEATER U.F. PRESSURE VESSELS SINK. POT /3 COMP. MOTORS 0 -1 HP STEAM BOILERS SINK, RESIDENCE. MOTORS OVER 1 -3 HP HOT WATER BOILERS SINK, SLOP. MOTORS OVER 3 -5 HP MECHANICAL VENTILATION TEMPORARY WATER CLOSET MOTORS OVER 5 -8 HP TRANSPORTING ASSEMBLIES URINAL MOTORS OVER 8 -10 HP ELEVATORS /ESCALATORS WATER CLOSET MOTORS OVER 10 -25 HP FIRE SPRINKLER SYSTEMS INDIRECT WASTES MOTORS OVER 25 -100 HP COOLING TOWERS WATER SUPPLY TO: MOTORS OVER 100 HP VIOLATION A/C UNIT A/C WINDOW REINSPECTION FIRE SPRINKLER AIR CONDITIONERS HEATER -NEW INST. STRIP HEATER HEATER - REPLACE GENERATORS TRANSFORMERS LAWN SPRINKLER -WELL GENERATORS TRANSFORMERS SWIMMING POOL GENERATORS TRANSFORMERS WATER SERVICE SPECIAL PURPOSE SEWER CONNECTIONS OUTLETS COMMERCIAL UTILITY -SEWER SIGN TUBES UTILITY -WATER SIGN TRANSFORMERS SEPTIC TANK SIGN TIME CLOCK RELAY FIXTURES FAINFIELD, 4" TILE /RES. ANTENNA PUMP & ABANDON SEPTIC TANK TELEVISION OUTLETS SOAKAGE PIT CU. FT. VIOLATION CATCH BASIN REINSPECTION 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 �� ti1A PLUMBING ADDENDUM TO BUILDING PERMIT APPLICATION AN APPLICATION FOR BUILDING PERMIT MUST ACCOMPANY THIS ADDENDUM. IF A MASTER PERMIT HAS BEEN OBTAINED, THE OWNER'S NOTARIZED SIGNATURE NEED NOT BE PRESENT ON SUBSEQUENT APPLICATIONS. ((�� PERMIT # e I O`=' - PLEASE CIRCLE 0 DISCIPLINE APPLIED FOR: ELECTRICAL MECHANICAL Miami Shores Village, Fla. OWNER '1) DATE / -00 1/ ADDRESS INSPECTION TIME READY PERMIT NO. CONTRACTOR X30 /lie /oo S TELEPHONE NO , 5 6 p t INSPECT DATE Miami Shores Village, Fla. OWNER Q JA-■\ DATE 'D ADDRESS 3 J 4 l V o .Q / INSPECTION TIME READY 5113 PERMIT NO. CONTRACTOR TELEPHONE NO. INSPECTOR 30S- S C) k DATE 0D 41 CONSTRUCTION PERMIT FOR: [N] [ APPLICANT: PROPERTY ADDRESS: LOT: New System Repair STATE OF FLORIDA DEPARTMENT OF HEALTH ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM CONSTRUCTION PERMIT [1.�] Existing System [ 1� Abandonment AH AV c 3-an iJc /00 BLOCK: 33 PROPERTY ID #: 11- 320C. _ A 13 - 4 448 0 Holding Tank Temporary PERMIT NO.00 -4./ G DATE PAID: to_ 1 6 FEE PAID: RECEIPT #:$pp / , 40e I _S - � Innovative SUBDIVISION: .4 f.') £ [SECTION, TOWNSHIP, RANGE, PARCEL NUMBER] [OR TAX ID NUMBER] SYSTEM MUST BE CONSTRUCTED IN ACCORDANCE WITH SPECIFICATIONS AND STANDARDS OF SECTION 381.0065, F.S., AND CHAPTER 64E -6, F.A.C. DEPARTMENT APPROVAL OF SYSTEM DOES NOT GUARANTEE SAFTISFACTORY 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. ISSUANCE OF THIS PERMIT DOES NOT EXEMPT THE APPLICANT FROM COMPLIANCE WITH OTHER FEDERAL, STATE, OR LOCAL PERMITTING REQUIRED FOR DEVELOPMENT OF THIS PROPERTY. T A N K D R A I N F I E L D SYSTEM DESIGN AND P CIFICATIONS `- 1 /JC) [/00 ] GALLONS / GPD SEPTIC TANK /AEROBIC UNIT CAPACITY MULTI- CHAMBERED /IN- SERIES [ ] [ ] GALLONS / GPD CAPACITY MULTI- CHAMBERED /IN- SERIES [ ] ( ] GALLONS GREASE INTERCEPTOR CAPACITY [MAXIMUM CAPACITY SINGLE TANK: 1250 GALLONS] [ ] GALLONS DOSING TANK CAPACITY [ ] GALLONS @ [ ] DOSES PER 24 HRS # PUMPS [ ] [ 3(, ] SQUARE FEET PRIMARY DRAINFIELD SYSTEM [ 1 SQUARE FEET 6_/ SYSTEM [ TYPE SYSTEM: J STANARD [�4 FILLED d] 41A TRENCH [ BED ,/ d LOCATION OF BENCHMARK: ^ it./) re} J () / ... ti Mr.._ • / /- 2, #J4. V ' ELEVATION OF PROPOSED SYSTEM SITE [ i ] [I OVE /B BENCHMARK /REFERENCE POINT 7 /411P[ BENCHMARK /REFERENCE POINT CONFIGURATION: MOUND BOTTOM OF DRAINFIELD TO BE a7_2] /FT] [ABOVE/ FILL REQUIRED: [/J( I ] INCHES EXCAVATION REQUIRED: [ pg INCHES DH 4016, 12/99 (Page 1) (Previous Editions May Be Used) pt. 1: Health Department pt. 2: Applicant pt. 3: Instal ler /Contractor pt. 4: Building Department BOTTOM Cf' CtJt l:-c:1�1`�to� 6/ l V "e'l :'i � .._ � t V) SPECIFICATIONS BY: TITLE: '' APPROVED BY: _ �,/!��'r, TITLE:2 `, jC 1 CHD DATE ISSUED: i Co D 1 EXPIRATION DATE: II d LI o 0 Page 1 of 3 cssig "ot:-.. s ty2e SYSTEM DESIGN AND SPECIFICATIONS: TANK: Minimum specifications from Chapter 64E-6, FAC. ?roperty owner's :ega::y nunoriz.ed re DDRESS: P.O. Box or street m• address for apcant or cent. LW'. BLOCK, SI1BDIVISION or l'ian'ERTY 27 character isi number :or property. may ret3nire property appraiser ED # or section/townshirp/rnqie/parceI number) DRAIN FIELD: Nlinimum specifications from Chapter 64E-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 it be sealed. APPROVED BY: County Health Department (CHD) personnel reviewing and approving permit. DATE ISSI'F.11): Date permit is issued by ('HD EXPIRATION DATE: One year from date issued if the system Los not been installed. Permits for system repairs become void 90 days from the date issued. ,0 APPLICANT: AGENT: PROPERTY ADDRESS: - LOT: STATE OF FLORIDA DEPARTMENT OF HEALTH ONSITE SEWAGE TREATMENT AND DIPOSAL SYSTEM CONSTRUCTION INSPECTION AND FINAL APPROVAL BLOCK: SUBDIVISION: zzzazazzzsszaaszzazasaz CHECKED [X] ITEMS ARE NOT IN COMPLIANCE =================rnimummw EXPLANATION N OF VIOLATIONS / REMARKS: i CONSTRUCTION [APPROVED /DISAPPROVED] FINAL SYSTEM [APPROVED /DISAPPROVEDW WITS DH 4016, 10/97 (Previous Editions May Be Used) STATUTE OR Building Dep trnent SETBACKS [27] SURFACE WATER [28] DITCHES , PERMIT NO. DATE PAID: FEE PAID: RECEIPT #: PROPERTY ID 1: RULE AND MUST BE CORRECTED. FILLED / MOUND SYSTEM [36] DRAINFIELD COVER [37] SHOULDERS [38] SLOPES [39] STABILISATION zssazzzzzzzz FT FT [29] PRIVATE WELLS FT [30] PUBLIC WELLS FT [31] IRRIGATION WELLS FT [32] POTABLE WATER LINES FT (33] BUILDING FOUNDATION , ' FT [34] PROPERTY LINES FT [35] OTHER FT ADDITIONAL INFORMATION [40) UNOBSTRUCTED AREA [41] STORMWATER RUNOFF [42] ALARMS [43] MAINTENANCE AGREEMENT (44] BUILDING AREA (45] LOCATION CONFORMS WITH SITE PLAN [46] FINAL SITE GRADING (47) CONTRACTOR " i [48] OTHER ABADMODUMT l (49] TANK PUMPED ] (50) TANK CRUSHED & FILLED _ / A / �� CHD DATEV r CHD DATE': Page 2 of 3 APPLICANT: Property owners full name. AGENT: Property owners legally authorized representative. MAILING ADDRESS: P.O. box or street mailing address for applicant or agent. LOT, BLOCK, SUBDIVISION Lot, Block and Subdivision for lot or PROPERTY ID #: 27 character number for property. (property appraiser ID* or GIS location) COUNTY HEALTH DEPARTMENT CHECKS [X] ITEMS NOT IN COMPLIANCE WITH CONSTRUCTION PERMIT AND STATUTE OR RULE. INFORMATION IS COMPLETED BY CHD ON FOLLOWING ITEMS: TANK SIZE (gallons) AS BUILT INSTALLATION SKETCH TANK MATERIAL (curio Fite, fiberglass, etc) OUTLET FILTER (manufacturer, make, model) LEGEND (manufacturer code) DRAINFIELD AREA (square feet) DISTRIBUTION BOX / HEADER (check box) NUMBER OF DRAINLINES (number installed) SYSTEM ELEVATION (in relation to BM) DOSING PUMPS (number installed) SETBACKS (record actliAl sn hacks in ft) SETBACKS OTHER (as required) STABILIZATION (date stabilized) CONTRACTOR (contractor installing system) ADDITIONAL INFORMATION (as required) ABANDONMENT TANK PUMPED (date) TANK CRUSHED AND FILLED (date) EXPLANATION OF VIOLATIONS: Record item number, explanation of violation, and required CONSTRUCTION APPROVAL: Circle approved or disapproved, CHD signature and date. FINAL APPROVAL: Circle approved or disapproved. CHD signature and date of approval. Final approval shall not be granted unit the CHD has confirmed that building construction and lot grading are in substantial compliance with plans and specifications submitted wii`: the permit application. ELEVATION WORKSHEET ELEVATION OF BEN MARK OR REFERENCE POINT: [ +] SHOT H.I ELEVATION [i EXISTING GROUND - -- — H I [ -1 SHOT TOP OF AGGREGATE H.I [ -] SHOT • Site Plan sutagtted by: Plan Approved By STATE OF FLORIDA DEPARTMENT OF HEALTH APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PER IT Permit Application Number Scale: Each block represents 5 feet and 1 inch = 50 feet / l DH 4015, 10/86 (Replaces HRS•H Form 4015 which may be used) (Stock Number: 5744 -002- 4015.6) PART II - SITE PLAN nature Sieo q,Pe {�• Not Approved ALL CHANGES MUST BE AO D BY THE COUNTY HEALTH DEPARTMENT County Health Department Page 2 of 3 ;300 ///C (+00 St C&J--974) BUILDING ❑ • ELECTRICAL ❑ PLUMBING cf PERMIT ROOFING ❑ �; ❑ w�r 'L..1 Owner of Building Architect Contractor or Builder ' /- f Legal Lot I i Description " BI. , •, Address of , Building / . N ` , _ '' MIAMI SHORES VILLAGE, FLORIDA Date 1 9� Contractor's License No. Work to be performed under this Permit - Permit: CCF: Subdi- Notary: vision r •�� �� Bond: Sq. Ft.: Radon: Value of 4 Amount of Project $ ''is 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 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 lave 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. Signed • ` e' • !_ '-‘, (INSPECTOR) BY 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 PERMIT APPLICATION FOR MIAMI SHORES VILLAGE Date / 4 OU Job Address (9.3 (9.3 Q/ - PO 5 1-- Tax Folio // J 3 �O U / 3 �/ T 44 O Legal ription ( Qr ?-i" / I� / Historically Designated: Yes No V Master Permit # y 7(0 ! U // Phone Contracting Co. [O b 5 ✓C p-1 2 ; •f- J n 4 _4 C'�. Address 6 2- 0 L&2. / 30 ST Owner/Lessee / Tenant TO rn ' I J e Ar T c L_ Owner's Address (I Qualifier 2 State # ito 2'1 1 f 0/t-/ / / i /, . Municipal #; / C� Competency # Ins. Co. Architect/Engineer Address Bonding Company Address Mortgagor Address Permit Type (circle one): BUILDING ELECTRIC PLUMBIN ECHANICAL ROOFING PAVING FENCE SIGN WORK DESCRIPTION ) ,tj Sr- Square Ft. Estimated Cost (value) / ?'"O 0, - Z2 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. Signature of owner and/or Condo President Notary as to Owner and/or Con My Commission Expires: FEES: PERMIT V RADON APPROVED: Zoning Building Mechanical Plumbing /o%° Date /0 OFFICIAL NOTARY ¢SE:.i O 4iY PU <9 BARBARA ANN FUCTZ4I A 1 ' J h0 CO?ARSIS37oa NUMBER VI i Q CC7234 8 Y ,' . `'t Q nv COPJiMISVON EXPIRES `‘ GFXP N9-a1i. 249 C.C.F. )' ? 0 NOTARY SS# Phone (3° S ) SS -8. 3—Pe r 7) 17 A ; ,L, - 0/( Signature' . ontra � or Owner -Bui D e A T.. Notary .: s to Contractor W Date My Commission Expires: Electrical BOND 3P o i TOTAL DUE Structural Engineer • • I o ovf No .. l 7 76 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. •d Owner's Name and Address Registered Architect and /or E C� Employing Plumber's Name 0(44 QE - 11 T � �.. No.......�...._...... ....»... Street.._. Location and Legal Description Lot Bloc!' Subdivision Street and Number where work is to be performed —No 2. 0 Na- Strom /aa 5 -7-- 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 Amount of Permit $ STATE OF FLORIDA, u. COUNTY OF DADE. MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT Zo/A Type of Tank_ ay 3.2 __Dist. Feet of Tank or Drain Field from Well Nature of Water Supply: City—Well. Size of Soakage Pit (Signed) _ No. 2 3 e2 y2i treet .. BOO �a Capacity Cals. My Commission Expires Notary Public, State of Florida Plumbing Inspector. The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligatio.: as an employer of labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Permanent Sup ement, 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, o, work to be performed under this permit, as are licensed by Miami Shores Village. l26 f 4 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 — _ that all s therein by him stated are true. y regaing application, and that he did sign tl�e same, and that all facts materials NOTE: Ar e inspecti Mp ee of $1.00 will be made when such re- inspection is made.neceatary by improper notice for inspection, or faulty CLOSETS BATH TUBE SHOWERS LAMA. TORIES SINKS SLOP SINKS LAUNDRY Tune U CATCH BASIN FLOOR DRAIN DRINKING FOUNT'N6 TOTAL FIXTURES CONTR. LIST CHECK SEPTIC TANK SEWER CONN. DRAIN FIELD SOAKAGE PIT GREASE TRAP SOLAR HEATER DEEP WELL SPRKLR. SYSTEM SWIM'O POOL CONTR. LIST Y2 CHECK No .. l 7 76 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. •d Owner's Name and Address Registered Architect and /or E C� Employing Plumber's Name 0(44 QE - 11 T � �.. No.......�...._...... ....»... Street.._. Location and Legal Description Lot Bloc!' Subdivision Street and Number where work is to be performed —No 2. 0 Na- Strom /aa 5 -7-- 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 Amount of Permit $ STATE OF FLORIDA, u. COUNTY OF DADE. MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT Zo/A Type of Tank_ ay 3.2 __Dist. Feet of Tank or Drain Field from Well Nature of Water Supply: City—Well. Size of Soakage Pit (Signed) _ No. 2 3 e2 y2i treet .. BOO �a Capacity Cals. My Commission Expires Notary Public, State of Florida Plumbing Inspector. The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligatio.: as an employer of labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Permanent Sup ement, 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, o, work to be performed under this permit, as are licensed by Miami Shores Village. l26 f 4 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 — _ that all s therein by him stated are true. y regaing application, and that he did sign tl�e same, and that all facts materials NOTE: Ar e inspecti Mp ee of $1.00 will be made when such re- inspection is made.neceatary by improper notice for inspection, or faulty Permit No.. } • MIAMI SHOI?E,S VILLAGE PLUMBING INSPEcTICIN DEPARTMENT APPLICATION FOR PLUMBING PERMIT 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. Owner's Name and Address — -- – No _ Street Registered Architect and /or Engineer a ;_ a ;_ .-:-:"_ "T"" Employing Plumber's Name _ y� No. Y 5 _ 5treeC Location and Legal Description ot__ ; l _Block_ J Subdivision_ ' �' 4 Street and Number where work is to be performed —No F I k n ` t State work to be performed and purpose of building (By Floors) Street New Building___________________ Remodeling V Addition Repairs Size Septic ______________________ Type of Tank . Capacity Gals.__________ ____ ____ Feet of Drain ________________ Dist. Feet of Tank or Drain Field from Well ? + Nature of Water Supply: City —Well. Size of Soakage Amount of Permit $__ My Commission Expires (Signed) (Signed) _,1��_ i -1 The undersigned applicant for this building permit does hereby certify that 'understands and accepts his obligations as an e loyer 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 under signed agrees to employ only such sub - contractors, on work to be performed under this permit, as are licensed by Miami Shores Village. t - �% STATE OF FLORIDA, COUNTY OF DADE. ss, Before me, the undersigned authority, a notary public, duly authorized to administer oaths and talc‘ 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 No. of Stories Plumbing )fispector. 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 f . ulty materials and /or workmanship. CLOSETS BATH TUBS SHOWERS LAVA- TORIES SINKS SLOP SINKS LAUNDRY TUBS URINALS CATCH BASI FLOOR DRAIN DRINKING FOUNT'NS TOTAL FIXTURES CONTR. LIST CHECK SEPTIC TANK SEWER CONN. DRAIN FIELD SOAKAGE PIT GREASE TRAP SOLAR H EATER DEEP WELL SPRKLR. SYSTEM SWIM'G POOL CONTR. LIST V : i- � CHECK Permit No.. } • MIAMI SHOI?E,S VILLAGE PLUMBING INSPEcTICIN DEPARTMENT APPLICATION FOR PLUMBING PERMIT 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. Owner's Name and Address — -- – No _ Street Registered Architect and /or Engineer a ;_ a ;_ .-:-:"_ "T"" Employing Plumber's Name _ y� No. Y 5 _ 5treeC Location and Legal Description ot__ ; l _Block_ J Subdivision_ ' �' 4 Street and Number where work is to be performed —No F I k n ` t State work to be performed and purpose of building (By Floors) Street New Building___________________ Remodeling V Addition Repairs Size Septic ______________________ Type of Tank . Capacity Gals.__________ ____ ____ Feet of Drain ________________ Dist. Feet of Tank or Drain Field from Well ? + Nature of Water Supply: City —Well. Size of Soakage Amount of Permit $__ My Commission Expires (Signed) (Signed) _,1��_ i -1 The undersigned applicant for this building permit does hereby certify that 'understands and accepts his obligations as an e loyer 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 under signed agrees to employ only such sub - contractors, on work to be performed under this permit, as are licensed by Miami Shores Village. t - �% STATE OF FLORIDA, COUNTY OF DADE. ss, Before me, the undersigned authority, a notary public, duly authorized to administer oaths and talc‘ 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 No. of Stories Plumbing )fispector. 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 f . ulty materials and /or workmanship. APPLICATION FOR PLUMBING PERMIT Permit No. .____.__ ,>' MIAMI SHORES VILLAGE Feet of Drain Tile__ STATE OF FLORIDA, COUNTY OF DADE. My Commission Expires PLUMBING INSPECTION DEPARTMENT r .& ss. PM--4 Date Size Septic Tank—________---- ----- Type of Tank . . Capacity Gals Dist. Feet of Tank or Drain Field from Well Notary Public. State of Florida • 4 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 �' 'may 1 �_t �_ _�_ T -- t No Registered Architect and /or Engineer __ p ,r Employing Plumber's Name --' __ter __ _ "_r Location and Legal Description __Block Street and Number where work is to be performed —No '--' fy '.1_r_}_ Street __________— _____________ —__ State work to be performed and purpose of building (By Floors) New Building_ Remodeling V Addition Repairs ____ No. of Stories Street t t t l Nature of Water Supply: City —Well. Size of Soakage P(.0 f_ Amount of Permit 5_ —_ (Signed) ' Plumbing spector. The undersigned applicant for this building permit does hereby certify that understands and accepts his obligations as an a Toyer 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 under signed agrees to employ only such sub - contractors, on work to be performed under this permit, as are licensed by Miami Shores Village. } (Signed) ai.C].t�: '� jl• (� — – .� Master Plumber. Before me, the undersigned authority, a notary public, duly authorized to administer oaths and to 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. 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 CHECK SEPTIC TANK SEWER CONN. DRAIN FIELD SOAKAGE PIT GREASE TRAP SOLAR H EATER DEEP WELL SPRKLR. SYSTEM SWIM'G POOL CONTR. LIST ✓ 40...'- CHECK APPLICATION FOR PLUMBING PERMIT Permit No. .____.__ ,>' MIAMI SHORES VILLAGE Feet of Drain Tile__ STATE OF FLORIDA, COUNTY OF DADE. My Commission Expires PLUMBING INSPECTION DEPARTMENT r .& ss. PM--4 Date Size Septic Tank—________---- ----- Type of Tank . . Capacity Gals Dist. Feet of Tank or Drain Field from Well Notary Public. State of Florida • 4 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 �' 'may 1 �_t �_ _�_ T -- t No Registered Architect and /or Engineer __ p ,r Employing Plumber's Name --' __ter __ _ "_r Location and Legal Description __Block Street and Number where work is to be performed —No '--' fy '.1_r_}_ Street __________— _____________ —__ State work to be performed and purpose of building (By Floors) New Building_ Remodeling V Addition Repairs ____ No. of Stories Street t t t l Nature of Water Supply: City —Well. Size of Soakage P(.0 f_ Amount of Permit 5_ —_ (Signed) ' Plumbing spector. The undersigned applicant for this building permit does hereby certify that understands and accepts his obligations as an a Toyer 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 under signed agrees to employ only such sub - contractors, on work to be performed under this permit, as are licensed by Miami Shores Village. } (Signed) ai.C].t�: '� jl• (� — – .� Master Plumber. Before me, the undersigned authority, a notary public, duly authorized to administer oaths and to 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. NOTE: A re- inspection fee of $1.00 will be made when such re- inspection is made necessary by improper notice for inspection, or faulty materials and /or workmanship. _,.. PLUM3Ii4G - IiSPECTION * 1/ Permit No. Work done by: ' " , • Address of work Owner _ Sortie Tank / Suwer Gas Plumbing - Final Rouej:2 Top out When ready 4/ AM PI\ ( L MBING Ow r er of Building_ PERMIT A N? .4 { ddd je NA ., Arcitect 211itargiueerict_ twS' NAME RECD. PAYMENT ACCT. DEPT. MIAMI SHORES VILLAGE BUILDING INSPECTION DEPARTMENT "0F - 2 tO , 191? ADDRESS LICENSE NO. ADDRESS ADDRESS LICENS O. 0 Co'i� 4wal iMer `!(e _ NAME Proposed Location I " ia.g. iii ° p- - -w_ .0_ei)i -- -- 14 1," LOT 4L'OCK SVD- DIVISION _ *TREET This permit is issued to___ .�$ ° L __ the building above described, as per application, tans and Specifications heretofore filed in this office. This permit is granted upon the express condition that g all facts stated in the application are true and that the construction complies strictly with the plans and specifications submitted. and in accordance and (compliance with the building laws of the State of Florida and with the building ordinances and zoning laws of Miami Shores Village, and rules and regulations of the building department of Miami Shores Village. This permit may be revoked at any a upon the 94 4o' lation of any provisions of said laws ordinances or rules and regulations, or upon any change in the plans and specifications t ed b the bullins 'ctor. , INSPECTOR In consideration of the issuance to me of this permit I hereby agree to the proposed construction in strict conformity with the application and ni and specifications thereof heretofore by me submitted, and in compliance with all provisions of all, building laws of the State of Florida, all the building ordinances an l zoning laws of Miami Shores Village and all rules and regulations of the buil4(g department of M4arttl Shores Village. 9 NOTE: A charge of $1.00 will be made for making corrections or changes to this application after approval has been obta f t: P ing Board. A re 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. • - ENOSLOW•6 Etremtlact PERMIT A N9 94 PLUMBING •ner of Building__ 111 1 NAM.t ADDRESS LICENSE NO. Architect avrei7 Contractor car_Bmikler ' ADI5RESS NLICENS 0 . ss f To / ,---?' di ir , 1 2...___Ate * 4 17 4* 4 0 4 , NO. _, 15 se STREE This permit is issued to 1 LOT 9L SUS-DIVISION ,r the building above described, as per application, lans and Specifications heretofore filed in this office. This permit is granted upon the express condition that all facts stated in the application are true and that the construction complies strictly with the plans and specifications submitted, and in accordance and compliance with the building laws of the State of Florida and with the building ordinances and zoning laws of Miami Shores Village, and rules and regulations of the building department of Miami hor es Village. This permit may be revoked at any ' e upon the violation of any provisions of aid laws, ordinances or rules and regulations, or upo , ank chat* in the plans and specifications,o t ed b the bbilclifig ins ctor. e .„,. 1 1 4 * 40 < —..–,,.- -,1L4L." Proposed Location NAME • NAME Lt_ ECD. PAYMENT ACCT. DEPT. MIAMI SHORES VILLAGE BUILDING INSPECTION DEPARTMENT /iv 'mai" if ADDRESS 1 9 INSPECTOR 0 ans and specifications thereof heretofore by me submitted, and in compliance with all provisions of all 9 In consideration of the issuance to me of this permit I hereby agree to the proposed construction in strict conformity with the application and uilding laws of the State of Florida, all the building ordinances an zoning laws of Miami Shores Village and all rules and regulations of the bui g department of M i Shores Village. • •t• rt.) NOTE: A charge of $1.00 will be made for making corrections or changes to this application after approval has been obta P1. ning Board. 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. "s Permit No f 7 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 .luilding 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. s Fr i n r4 x Owner's Name and Address __- ._ * -___ f No._ ti; Stre !� r � • Registered Architect aa.a / ^- � -Q' k _ � _}! % Employing Plumber's Name Size Septic Tank Feet of Drain Tile__ appeared APPLICATION FOR PLUMBING PERMIT Location and Legal Description Lot Street and Number where work is to be performed—No State work to be performed purpose of building (By Floors) New Building Remodeling Addition De) s s. The undersigned applicant for this building permit does hereby ce under the Florida Workmen's Compensation Act, being Section 5966, plied with the provisions thereof, and will require similar compliance performed under this permit; and will post or cause to be posted for required by the Act. The under signed agrees to employ only such licensed by Miami Shores Village. STATE OF FLORIDA, COUNTY OF DADE. Before me, the undersigned authority, a notary public, duly to me well known, and who, being by me first duly sworn, upon oath of the above described construction, that he has carefully read the therein by him stated are true. My Commission Expires MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT Block l ) eI Street Z stree Subdi vision, .. " /e Repairs No. of Stories Type of Tank /x 1 Capacity Gals et of Tank or Drain Field from Well Nature of Watcr Supply: City —Well. � .,. Size of Soakage Pit Amount of Permit $___,C \ (Signed) lilT_ Plu ing Inspector. rtify that he understands and accepts his obligations as an employer of labor Compiled General Laws of Florida Permanent Supplement, and has com- from all contractors or sub - contractors employed by him in the work to be inspection on the site of the work such public notice or notices as are sub - contractors, on work to be performed under this permit, as are (Stgn �i, r authorized to administer oaths and take acknowledgments, personally deposes and says that he is the foregoing application, and that he did sign the same, and that all facts T;. / Notary Public. State of Florida te 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 DRINKING FOUNT' NS TOTAL FIXTURES CONTR. LIST CHECK SEPTIC TANK r 7i SEWER CONN. °' 9 �N DRAIN FIELD SOAKAGE PIT GREASE TRAP SOLAR HEATER DEEP W #LL SPRKLR. SYSTEM SWIM'G POOL CONTR. LIST CHECK :i/'j A lr i AHit I® "s Permit No f 7 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 .luilding 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. s Fr i n r4 x Owner's Name and Address __- ._ * -___ f No._ ti; Stre !� r � • Registered Architect aa.a / ^- � -Q' k _ � _}! % Employing Plumber's Name Size Septic Tank Feet of Drain Tile__ appeared APPLICATION FOR PLUMBING PERMIT Location and Legal Description Lot Street and Number where work is to be performed—No State work to be performed purpose of building (By Floors) New Building Remodeling Addition De) s s. The undersigned applicant for this building permit does hereby ce under the Florida Workmen's Compensation Act, being Section 5966, plied with the provisions thereof, and will require similar compliance performed under this permit; and will post or cause to be posted for required by the Act. The under signed agrees to employ only such licensed by Miami Shores Village. STATE OF FLORIDA, COUNTY OF DADE. Before me, the undersigned authority, a notary public, duly to me well known, and who, being by me first duly sworn, upon oath of the above described construction, that he has carefully read the therein by him stated are true. My Commission Expires MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT Block l ) eI Street Z stree Subdi vision, .. " /e Repairs No. of Stories Type of Tank /x 1 Capacity Gals et of Tank or Drain Field from Well Nature of Watcr Supply: City —Well. � .,. Size of Soakage Pit Amount of Permit $___,C \ (Signed) lilT_ Plu ing Inspector. rtify that he understands and accepts his obligations as an employer of labor Compiled General Laws of Florida Permanent Supplement, and has com- from all contractors or sub - contractors employed by him in the work to be inspection on the site of the work such public notice or notices as are sub - contractors, on work to be performed under this permit, as are (Stgn �i, r authorized to administer oaths and take acknowledgments, personally deposes and says that he is the foregoing application, and that he did sign the same, and that all facts T;. / Notary Public. State of Florida te 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. Permit No MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT Type of Tank 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 cord 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 __ i :� Registered Architect l _ Employing Plumber's Name No. Street Location and Legal Description Lot _ Block Subdivision) /l2.ie ``'L .JC___ • 1 Street and Number where work is to be performed —No Z__0 �_!_Ql_!_ _ iitreet 7� State work to be performed purpose of building (By Floors) �-__— -t_� New Building Remodeling Addition Repairs —___ No. of Stories No._a }2S _.,�_: Street j ,! Capacity Gals Size Septic Tank Feet of Drain Tile _________ -D D D' t. eet of Tank or Drain Field from Well k !I..- Size of Soakage Pit Amount of Permit $- Nature of Water Supply: City —Well. STATE OF FLORIDA, COUNTY OF DADE. ss. My Commission Expires (Signed) (Sign Plu ng 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 under signed agrees to employ only such sub - contractors on work to be performed under this permit, as are licensed by Miami Shores Village. 7 administer oaths Master Plumber. Before me, the undersigned authority, a notary public, duly authorized to 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. and take acknowledgments, personally 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 CHECK SEPTIC TANK SEWER CONN. DRAIN FIELD SOAKAGE PIT GREASE TRAP SOLAR HEATER DEEP SPRKLR. WELL SYSTEM SWIM'G POOL CONTR. LIST / CHECK 4:b . A_ i .>.. .... n/ Permit No MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT Type of Tank 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 cord 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 __ i :� Registered Architect l _ Employing Plumber's Name No. Street Location and Legal Description Lot _ Block Subdivision) /l2.ie ``'L .JC___ • 1 Street and Number where work is to be performed —No Z__0 �_!_Ql_!_ _ iitreet 7� State work to be performed purpose of building (By Floors) �-__— -t_� New Building Remodeling Addition Repairs —___ No. of Stories No._a }2S _.,�_: Street j ,! Capacity Gals Size Septic Tank Feet of Drain Tile _________ -D D D' t. eet of Tank or Drain Field from Well k !I..- Size of Soakage Pit Amount of Permit $- Nature of Water Supply: City —Well. STATE OF FLORIDA, COUNTY OF DADE. ss. My Commission Expires (Signed) (Sign Plu ng 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 under signed agrees to employ only such sub - contractors on work to be performed under this permit, as are licensed by Miami Shores Village. 7 administer oaths Master Plumber. Before me, the undersigned authority, a notary public, duly authorized to 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. and take acknowledgments, personally 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.