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1421 NE 101 St (7)Date et- i q -- « Job Address Tax Folio g- o - W c?1 . 410„,e, k /0/ sr Legal Description lo0 '1 /ya / /J ,E:'. /O/ sr. Historically Designated: Yes No LV Owner/Lessee / Tenant // u. j2 PERMIT APPLICATION FOR MIAMI SHORES VILLAGE Owner's Address / 4 /al / PI? / 0 / S Contracting Co. (1 / X / ` c c w `OGO W Address 7/0 /V 70 TC' i Qualifier l' / )4-it L (- 1 ( ' >/, co,_ ss# . 75 r‘/ —/ 4 0 4 / State # 0 n (J 056 q '1 Municipal # Competency # Ins. Co. Architect/Engineer Address Bonding Company Address Mortgagor ` Address Permit Type (circle one BUILDING.ECTRICAL WORK DESCRIPTION afL -s o f / i ' © &= L -' 7 /t4 i P A16 /0/ � 0 30o CCa9sT � 77 i v /Ndei squam -Ft" (N FEET- -` i o 3o2 (, e n PAM /r 4Tnica'e) 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 perfonned 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. 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. 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 Condo President Date My Commission Expires: FEES: PERMIT APPROVED: Zoning Mechanical iNloo RADON Date Si Phone (3 O S) (� 7 s MECHANICAL ROOFING PAVING FENCE SIGN Estimated Cost (value) X ,"0 No : ,' as t• Contrac M Commission Ex C.C.F. t 6.0 NOTARY BOND _S Electrical Master Permit # 754 ,? VILLAR 6TARY PUBLIC STATE OF FLORIDA COMMISSION NO. CC714103 MY COMMISSION EXP. MAIL 12002 2 — c '0 Date Date Structural Engineer CLASS V PERMIT FOR A TEMPORARY DEW ATERING PROJECT ISSUED TO: Ce c w ,,o r Metropolitan Dade County Department of Environmental Resources Management Water Management Division 33 S.W. 2nd Avenue Miami, Florida 33130 Phone # 372-6681 1.1 ' % w 371 -6f10 ESK OF HE YOU ARE TO NOTIFY THIS DEPARTMENT B UM FOItTY-EIGHT GHT (4 ) PRIO : COMPLIANCE SECTION AT 372 -6955 A MINIM COMMENCEMENT OF ANY DISCHARGE. THE APPROPRIATE DERM INSPECTOR WTI.. 13E ADVISED OF YOUR PROJECT START -UP AT TH AT TIME. Miami Dade County Class V Dewatering Permit No._ -- -- Date Issued -9/I A> Expiration Date - a lssucd by: FOR A TEMPORARY DEWATERDIG PROJECT ISSUED BY: CLASS OUNTY MIAMI -DADC G DI'EP RTMENT OP ENVIRONMEN AL RESOURCES MANAGEMI NT WATER MANAGEMENT DIVISION This Permit, issued to the contractor named herein is for a temporary dewatering project described he :in and further described by approved drawings attached hereto and made a part hereof. (A) Name of the Project, Purpose of the dewatering Work and Type of Equipment That will be 11 cd to Control Turbidity: it/e. /a/ 47 ;Pao G co,v r7 &' G✓�ez- A240 P .ry ri 7/ 7/P5✓f,/ old / 1 D //LAG Cr: Location of Dewatcring Site: 4,40 2$0 "ref eA/T of / V2 / A/O /a / £7 (13) (C) Location of Discharge Point to Water Body and Name of Water Body: /� af 2.ta (D) Pertnittee: Name, address and phone number of contractor who will perform the work. Nan( and phone number of on -site contact person. v con C /I oroe[F.1 • y 7/a /v 7a ,r e."e (pJY/ /_ /fez, / yf..do "P fZ 130 lJe (E) Performap e Bond: This permit shall require the posting of a performance bo' 1 of a✓ j (F) General Permit Conditions: This permit is issued subject to the following general I :run it conditions. I . Subs quent to your permit being issued, you are required to contact this office as folic vs: a ) By calling the Water Control Section at 372 -6681 a minimum of one (I) Heck before the commencement of dewatering in order to arrange a pre -work confer nce. b) By written notification to the Water Control Section of Dade County Departrn nt of Environmental Resources Management (DERM) a minimum• of forty -eigh (48) hours prior to the commencement of dewatering. Sheet 2 2. This permit, or a copy of it, along with a set of approved plans shall be kept on the job site at a � Limes in order for any inspector to determine that the dewatering operation is permitted by Da( : County, and is being conducted in accordance with the approved plans. �. The hcrmittcc shall install all turbidity control Equipmen(i.e. sedimentation im ma io t tanks, Wen, turbidity curtain, etc.), as shown on the attached approved tans, prior of the dewatering; operation. The permittee shall ensure that all turbidity control equipment, as shown on the approved plan shall remain in place and be fully operational and effective at all tunes during' the dewatering; operation. The turbidity, at the point past which no further treatment is given, shall not exceed 29 NI ti's s per Section 24- I.1 of the Metro Dade County Code. The permittee shall be responsible to mot slur the turbidity at this point, by using a turbidity meter to insure compliance. 6. If turbidity exceeds 29 NTU's at the point at which no further treatment is given, the permittee shall immediately CEASE AND DESIST from dewatering to thc water body and notify the W tc! Control Section of DERM. The permittee shall submit revised plans to DERM with additiona or modified turbidity control equipment in order to comply with Dade County water quality standards. If said plan is approved by DERM or his•designee, the permittee may, after installi g or modifying this project in accordance with the new approved plan, proceed with the dewatering The permittee shall continue to monitor his discharge to ensure that it complies with the limits �s described herein. 7 Upon completion of the dewatering work authorized by this permit, the permittee shall clean t the work site and restore any areas impacted by the work within the Bay or other affected Walt body to its condition prior to the commencement of the work covered by this permit. This includes, but is not limited to, the removal of any fine sediments that have accumulated on the bottom of the water body and the removal of all pipelines, sedimentation tanks, sand bags. turbidity curtains and their supporting pilings. In the event that a publicly owned storm•sewer system is used as a conveyance to the water body, said conveyance system shall be cleaned, tr thc satisfaction of DERM, of all sediment prior to the turbidity control structures in the water bod being removed. his permit ii S. The permittee shall CEASE AND DESIST dewatering ho has determined that said dew feting oper::iort ordered to do so by a representative of DERM, is violating a condition or special condition of this permit, or is violating any portion of the D. :e County Environmental Protection Ordinance (Chapter 24', Metro Dade County Code). The permittee shall not resume the work until authorized to do so by DERM or his designee. 9. This permit shall be valid for Chet not be oddesignated DBRM or his designechEach exten this sior. if document. Extensions may or may granted by granted, will require the payment of an additional permit fee to cover departmental inspection costs. Sheet 3 10. Any deviation from the approved plans for this project shall be submitted to and approved by the Water Control Section of DORM, prior to the cornmencement of the dcwatering operation. f 1 . If the dcwatering work authorized by this permit involves a discharge to tidal waters, the pet shall mitigate for the unavoidable impacts of the work covered by this permit, by doing one of die following within thirty (30) days of the completion of the dcwatering work: ,,) The placement he discttarge'apointrcrior riptap(1 thirty in (30) diameter) along the shoreline five (5) i�1u� adjacent to yards of riprap shall he placed. /\ cash contribution to the Biscayne 13ay I3nvironnrcntal titcement 'Trust Fund :r it rate of $40 /cubic yard or riprap equivalent to the volume required by (a) above. I Agencies other than the Department of Flivire mental Resource Maini ;ennent from v..i, ,.`:: approval may be necessary (as checked): State of Florida Department of Transportation Dade County Public Works Department, for use of explosives Dade County Building and Zoning Department U.S. Army Corps of Engineers State of Florida Department of Environmental Regulation State of Florida Department of Natural Resources City of South Florida Water Management District U.S. Environmental Protection Agency (0) Special Permit Condition: Sheet 4 Recommended: ATTEST: DATE Secretary Water Control Section iN wrrNESS WHEREOF the said DADE COUNTY, FLORIDA, lias causal this permit to be execute• rn its name by the Director of the Department of Environmental Resources Management or his designer. uitl contractor have caused this permit to be executed in their name(s). \1'I lH. 1111.,;.cON RACI_OR IS AN INDIVIDUAL. OF PARRTNEI:SHO' Signed, Sealed and Delivered in the Presence of (Witnesses) (Contractor) WHEN THE CONTRACTOR IS A CORPORATION ISSUED ON: _ - 0-e) BY . ,d►►•e e 4./ . Yoc0 ..cdr -rrary "0 4.1 (Correct Name of Corporation) DADE COUNTY Director, Environmental Resources Management or his Designee Sheet 5 SIGN DATE (Affix Corporate Seal) r -� INFORMATIONAL NOTICE REGARDING DEWATERING OPERATIONS WHICH REQUIR T[IC DISCHARGE OF WATERS INTO A FRESHWATER BODY OR BISCAYNE BAY, OR ANY STORM SEWER LEADING INTO A SURFACE WATER OR BISCAYNE I3AY am requesting your cooperation in our program to control construction site dewatering in ()MCI" to bell r protect natural and manmade water bodies in Dade County. Our goal is to allow construction activities proceed on schedule by advising permit applicants on the necessary measures to control turbidity prior o the commencement of construction. it is suggested that the following guidelines and attached list of general conditions, which are nuldc a p Of every issued dewatering permit, be disseminated among your staff to ensure that the proposed dischai of turbid water from construction sites and utility trenches is properly planned and designed to comply with County standards. The following guidelines and requirements are to be applied for any construction activity which rcquii dewatering into a freshwater ': ody, or Biscayne Bay, or any storm sewer ? ding into a surface water w Biscayne Bay. A well point system for dewatering should be used as the preferred form of dewatering when' :r possible. If a well point system is not feasible, then adequate measures for the reduction of turbid :y should be used in the following order of priority: a) Pumping into an excavation within the construction site which is separated from the work arc ... b) Pumping into a sedimentation (settling) pond outside of the construction site, if arrangemc is can be made with the owner of an adjacent vacant lot. c) Pumping into a sedimentation tank, Klondike box or similar sedimentation tank, which sho Id be sized to allow for an acceptable holding time to effectively reduce the turbidity level of ne effluent. 2. The evaluation of proposed dewatering operations will include the possible environmental effects In the receiving waters with particular attention to impacts on existing biological resources and w: .er quality. It should be noted that Biscayne Bay is considered an environmentally sensitive arei (a State Aquatic Preserve), which warrants additional protection. Therefore, dewatering operati ns proposing to discharge directly to Biscayne Bay will be discourageo. If alternative method1 or discharge locations are not feasible, a more detailed environmental evaluation will be required nd additional mitigation measure may be necessary: 3. For any project expected to dewater either directly or indirectly (e.g. through a stormwater sec er) into any water body, the City's or County's Public Works and/or Building and Zoning Depattm' nts should amend their permit application process to include a requirement for the applicant to obta .t a Class V permit from the Dade County Department of Environmental Resources Managcn =nt (DERM). IS: ms 4. When obtaining a Class V Permit, the contractor will be required to post a performance bond in order to guarantee compliance with the permit requirements. Also, permit fees will be assessed as per the current fee schedule. The currcnt schedule is as foIlocvs: Permit Duration Fees 6 days or Icss 7 days to 30 days 31 days to 90 $350.00 $450.00 $650.00 All dcwatcring operations required in connection with a Remedial Action Ilan (RAP), such as fo, thc.rcnoval and replacement of an underground fuel tank and subsequent aquifer recovery thruui4I1 an air stripping tower or other means, requ the prior review and approval of the Storage Tani; Remediation Section. Other dcwatcring in contaminated areas may required prior approval of t11:: Pollution Prevention Division. In general, contaminated groundwater will not be allowed to be reintroduced into the aquifer without prior treatment. Replacement of stormwater drainage in areas where•a RAP is taking place requires special review and approval. Under these circumstances, stormwater runoff may have to be rerouted and disposed of outside of the existing contamination plume. It is the intent of this Department to strictly enforce the provisions of all Class V Dewatering Permits. Failure to obtain a permit or failure to comply with permit conditions will result in the issuance of a Cease and Desist Order by this Department. Repeated violations or failure to Cease and Desist when so ordered shall result in the appropriate legal action. We appreciate your cooperation in this effort which will alleviate the need for enforcement - oriented responses to turbid discharges, and which will also protect our valuable marine and freshwater resource. If you have any further questions or would care to discuss this matter further, please contact Mr. Isaac Sznol, P.E., Chief of the Water Control Section at 372 -6681. Sincerely, ENVIRONMENTAL RESOURCES MANAGEMENT John W. Renfrow, P.E., Director Legal Description Square Ft. PERMIT APPLICATION FOR MUNI` >:PALITIES OF DADE COUNTY (OWNER TO RETAIN COPY) Date 5/� 42- Job Address / 1- 7 L--1 /A 7---- Z/ /17-' f o /S Tax Folio /1 , &24Y =230 ®7® Owner Lessee / Tenant r- / -7- 5 (NN Master Permit #_3÷ Owner's Address Phone Contracting Co. /4 =1‹.✓�'`_CD /4;;;'■l?c Qualifier —/� � Z cg SS# Signature of owner and /or Condo President Date: Notary as to Owner and /or Condo President My Commission Expires: ** * * * * * * * * - i'EES: PERMIT .5 RADON C.C.F. Address Phone State # Municipal # Competency # Ins.Co. Architect /Engineer Address Bonding Company Address Mortgagor Address Permit Type(circle one): BUILDING ELECTRICAL <PLTT$ MECHANICAL ROOFING PAVING FENCE SIGN WORK DESCRIPTION : 9 2 — - Estimated Cost(value) J I S o `? 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, ROOPING 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 state Signature o Contractor or Owner- Builder te: WALL (91.X • Notary as to Contractor or Owner - Builder My Commission Expi N O � RY PUBLIC STATE OF FEORIDA MY COMMISSION EXPIRES 5/09/94 * * * Bonded Niru Stemider- Adam *& Sweet ** NOTARY o'�� TOTAL DUE 1 APPROVED: Fire Other Zoning Building Electrical f4 Mechanical Plumbing? t✓ 1 ''�'� eerin�x N70 -432 787 -4 ; :4t-}. d'o Permit No._ __I 2 7 2i) 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 1C_ _JOHNS JOHNSON _— - - - -_ - -- _ __ No. - 14 2 1 '_ - _ 1 _ Street .__ „E, 101St - - - - • -- Registered Architect and /or Engineer--- ---- - - - - -- _ ___ �_____— __----- _---- __- - - -_ -- _ - Employing Plumber's Name PEOPLES GAS SYSTEM N _ _ 564 Street_ __N ,E 125s ....... Location and Legal Description Lot. Street and Number where work is to be performed —No Street. 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 Nature of Water Supply: City — Well.___. _ _________________— _____._Size of Soakage Pit 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 die 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. Amount of Permit 4 _. (4 .rb STATE OF FLORIDA, COUNTY OF DADE. j MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT _Type of Tank Bloch —Dist. Feet of Tank or Drain Field from Well Date AUGUST 26 1970 Capacity Gals._ (Signed)... 9 V _A_ My Commission Expires Notary Public, State of Florida Master Plumber. Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeared to me well known, and who, being by me first duly sworn, upon oath deposes and says that he is the. of the above described construction, that he has carefully read the foregoing application, and that he did sign the same, and that all facts therein by him stated are true. NOTE: A re- inspection fee of $1.00 will be made when such re- inspection is made necessary by improper notice for insp... or faulty materials and/or workmanship. CLOSETS BATH TUBS SHOWERS LAVA- TORIES SINKS SLOP SINKS LAUNDRY TUBE URINALS CATCH BASIN FLOOR DRAIN DRINKING FOUNT' NS water heater TOTAL FIXTURES co s LIST 1 1 2 CHECK SEPTIC TANK SEWER CONN. DRAIN FIELD SOAKAGE PIT GREASE TRAP SOLAR HEATER DEEP WELL SPRKLR. SYSTEM SWIM'G POOL 1 - .- LiST CHECK N70 -432 787 -4 ; :4t-}. d'o Permit No._ __I 2 7 2i) 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 1C_ _JOHNS JOHNSON _— - - - -_ - -- _ __ No. - 14 2 1 '_ - _ 1 _ Street .__ „E, 101St - - - - • -- Registered Architect and /or Engineer--- ---- - - - - -- _ ___ �_____— __----- _---- __- - - -_ -- _ - Employing Plumber's Name PEOPLES GAS SYSTEM N _ _ 564 Street_ __N ,E 125s ....... Location and Legal Description Lot. Street and Number where work is to be performed —No Street. 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 Nature of Water Supply: City — Well.___. _ _________________— _____._Size of Soakage Pit 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 die 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. Amount of Permit 4 _. (4 .rb STATE OF FLORIDA, COUNTY OF DADE. j MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT _Type of Tank Bloch —Dist. Feet of Tank or Drain Field from Well Date AUGUST 26 1970 Capacity Gals._ (Signed)... 9 V _A_ My Commission Expires Notary Public, State of Florida Master Plumber. Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeared to me well known, and who, being by me first duly sworn, upon oath deposes and says that he is the. of the above described construction, that he has carefully read the foregoing application, and that he did sign the same, and that all facts therein by him stated are true. NOTE: A re- inspection fee of $1.00 will be made when such re- inspection is made necessary by improper notice for insp... or faulty materials and/or workmanship. BUILDING ,ELECTRI9L _PLUMBING ROOFING Owner of Building MIAMI SHORES VILLAGE. FLORIDA 0 ❑ DATR ❑ PERMIT N° 2533 0 0 Architect Contractor or Builder Legal Lot Description Address of Building CONTRACTOR OR BUILDER BI 195 Contractor's License No Work to be performed under this Permit Subdi- vision Value of Project $ I Amount of Permit $ This permit is granted to the contractor or builder named above to construc the building or to install the equipment or device described in the application herefor in strict compliance with all ordinances pertaining thereto and with the understanding that the work will be performed in compliance with any plans, drawings, statements or specifications that may have been submitted to and approved by the proper municipal authorities. This Permit may be revoked at any time if the work is not done in compliance with such ordinances or if the plans are changed without authorization. A further condition upon which this permit is granted is the understanding that the contractor or builder named above assumes the responsibility for a thorough knowledge of the ordinances and regulations pertaining to the work covered hereby whether shown on the plans or drawings or in the statements or specifications and that he assumes responsibility for work done by his agents, servants or employees. Signed. BY INSPECTOR 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 ac- cepting this permit I assume responsibility for all work done by either, myself, my agent, servant or employee. BY AUTHORITY o�� Permit No - 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 wo Registered Architect and /or Eng' eer. _-- -. -_ Employing Plumber's Name - - - -- Location and Legal Description Lot._______ ..... _. Street and Number where work is to be performed —No./ _ Street State work to be performed and purpose of building (By Floors) __._— _---- _— __— - -- Owner's Name and Addres ew Buil Remodeling —__.. —____ Addition _ —Dist. Feet of Tank or Drain Field from Well Amount of Permit $ ____ STATE OF FLORIDA, ( y 7 COUNTY OF DADE. 1 MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT (Signed) Date Z — /0 ^ Street / Street ubdivx ion V My Commission Expires Notary Public, State of Florida Repairs No. of Stories ... . Type of Tank_— Capacity Gals Size Septic Tank__ Feet of Drain Tile . Nature of Water Supply: Well. __ - ' 6 ---------- _ -_ —_- -.Size of Soakage Pit 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. 3 (Si Master Plumber. Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeared to me well known, and who, being by me first duly sworn, upon oath deposes and says that he is the of the above described construction, that he has carefully read the foregoing application, and that he did sign the same, and that all facts therein by him stated are true. NOTE: Aon fee of $1.00 will be made when such re- inspection is made-necessary by improper notice for inspection, or faulty materials a *i workmanship. CLOSETS BATH TUBS SHOWERS LAVA- TORIES SINKS SLOP SINKS LAUNDRY Tues U CATCH BASIN FLOOR DRAIN DRINKING FOUNT' NS /Ij/� Iy C4 /I� , TOTAL FIXTURES LIST � ®TI y � , V C) CHECK r� /, S ( / ^1 ` P 7 .1 � O " e '� ` / . A SEPTIC TANK SEWER CONN. DRAIN FIELD SOAKAGE PIT GREASE TRAP HEATER DEEP WELL SPRKLR. SYSTEM SWIM'G POOL CONTR. LIST D - -- CHECK 1Q V 5 Permit No - 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 wo Registered Architect and /or Eng' eer. _-- -. -_ Employing Plumber's Name - - - -- Location and Legal Description Lot._______ ..... _. Street and Number where work is to be performed —No./ _ Street State work to be performed and purpose of building (By Floors) __._— _---- _— __— - -- Owner's Name and Addres ew Buil Remodeling —__.. —____ Addition _ —Dist. Feet of Tank or Drain Field from Well Amount of Permit $ ____ STATE OF FLORIDA, ( y 7 COUNTY OF DADE. 1 MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT (Signed) Date Z — /0 ^ Street / Street ubdivx ion V My Commission Expires Notary Public, State of Florida Repairs No. of Stories ... . Type of Tank_— Capacity Gals Size Septic Tank__ Feet of Drain Tile . Nature of Water Supply: Well. __ - ' 6 ---------- _ -_ —_- -.Size of Soakage Pit 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. 3 (Si Master Plumber. Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeared to me well known, and who, being by me first duly sworn, upon oath deposes and says that he is the of the above described construction, that he has carefully read the foregoing application, and that he did sign the same, and that all facts therein by him stated are true. NOTE: Aon fee of $1.00 will be made when such re- inspection is made-necessary by improper notice for inspection, or faulty materials a *i workmanship.