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1450 NE 101 St (6)MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT Date "-"C Permit No Application is herby 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 o - Owner's Name and Address 1 1 _ u -._• _ No.___________ . ____._._ Street Registered Architect and /or Engine __._ __ _ __ _ y _ - .. _ __ -.�_ _ _____------ . - _ - __ - Employing Plumber's Name ( a� _ -Y _ �________ No..___.._________ Street-- Location and Legal Description Lot__--._ _ .... ___________._____._ ______ Block 1 Subdivision Street and Number where work is to be performed —No .1 4415—° L � - £ • L f7 / Street State work to be performe8 and purpose of building (By Floors) ___.____ New Building ____ Remodeling__ —_ _- AddiHon._._ Repairs No. of Stories . . ....................... Size Septic Tank C ----- _ - -_ -_ Type of Tank -2 ' .-._ - apacity Gals.___.. Feet of Drain Tile__ " -_Dist. Feet of Tank or Drain Field from Well Nature of Water Supply: City —Well. ---- --- - - -- Amount of Permit $ — - — — — -- (Signed) - -_. ___� ��c- Ln.rs`- C- 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 crnn- 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 t}ie 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. STATE OF FLORIDA, COUNTY OF DADE. Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeared to me well known, and who, being by me first duly sworn, upon oath deposes and says that he is the of the above described construction, that he has carefully read the foregoing application, and that he did sign the same, and that all facts therein by 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 /orvorkmanship. My Commission Expires _.Size of Soakage Pit (Signed). Notary Public, State of Florida Master Plumber. CLOSETS BATH TUBS W SHOWERS LAVA- TORIES SINKS SLOP SINKS LAUNDRY TUBS R INALS 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 WELL SPRKLR. SYSTEM SWIM•G POOL G IST le 0 - -- CHECK MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT Date "-"C Permit No Application is herby 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 o - Owner's Name and Address 1 1 _ u -._• _ No.___________ . ____._._ Street Registered Architect and /or Engine __._ __ _ __ _ y _ - .. _ __ -.�_ _ _____------ . - _ - __ - Employing Plumber's Name ( a� _ -Y _ �________ No..___.._________ Street-- Location and Legal Description Lot__--._ _ .... ___________._____._ ______ Block 1 Subdivision Street and Number where work is to be performed —No .1 4415—° L � - £ • L f7 / Street State work to be performe8 and purpose of building (By Floors) ___.____ New Building ____ Remodeling__ —_ _- AddiHon._._ Repairs No. of Stories . . ....................... Size Septic Tank C ----- _ - -_ -_ Type of Tank -2 ' .-._ - apacity Gals.___.. Feet of Drain Tile__ " -_Dist. Feet of Tank or Drain Field from Well Nature of Water Supply: City —Well. ---- --- - - -- Amount of Permit $ — - — — — -- (Signed) - -_. ___� ��c- Ln.rs`- C- 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 crnn- 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 t}ie 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. STATE OF FLORIDA, COUNTY OF DADE. Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeared to me well known, and who, being by me first duly sworn, upon oath deposes and says that he is the of the above described construction, that he has carefully read the foregoing application, and that he did sign the same, and that all facts therein by 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 /orvorkmanship. My Commission Expires _.Size of Soakage Pit (Signed). Notary Public, State of Florida Master Plumber.