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166 NE 101 St (8)Date PERMIT APPLICATION FOR MIAMI SHORES VILLAGE J qqL Job Address ( 61, PJ e 10( Legal Description X Owner Lessee / Tenant �A..� ` ,) Owner's Address 14-L P - 10( Contracting Co. Dare . €-V c&9 2 4c_ Address Qualifier ut> ( , Phone State # Municipal # Architect /Engineer Bonding Company Mortgagor WORK DESCRIPTION authorize the ab `- -fed con ractor to do the work st SigiP�ture of owie '�' Ado President Date. s Coe slakes ItiL .A.r. Notary as to 1, - -NWIE, President My Commission Eater , =0% ** * * * * * * * * Tax Folio // 3- /3 /9_745' � 4S- Sec. //lle Master Permit # Phone Competency # I7L0 Ins.Co. rCIA- TA M✓l� Address Address Address Permit Type(circle one): BUILDINe ELECTRICA PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN ZrA wr.feArfl RqA-'r Square Ft. Estimated Cost(value) r I DO 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 regulatin: •nstruction and zoning. Furthermore, I 4 444.1. lSfl ature = •'.on Owner-Builder Date: Ott Notary as tat., 'AG My Commission' REr6 Owner- Builder * * * * * * * ** FEES: PERMIT M RADON C.C.F. ' NOTARY TOTAL DUE WO APPROVED: Fire Other Zoning Building Electrical Mechanical Plumbing C 1 - $1 Engineering Notes Site Plan Submitted by Plan Approved By STATE OF FLORIDA DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM Permit Application Number 7 HRS -H Form 4015, Feb 85 (Obsoletes previous editions which may not be used) (Stock Number: 5744 - 002 - 4015 -6) -0 Pi 2.j a 1 PART II - SITE PLAN ( cc f0 - E . j ( 1 SIGNATURE Not Approved L 6 )/1 c �. 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TITLE Date County Public Unit ALL CHANGES MUST BE APPROVED BY THE COUNTY PUBLIC HEALTH UNIT Page 2 of 3 STATE OF FLORIDA DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES ONSITE SEWAGE DISPOSAL SYSTEM APPLICATION FOR CONSTRUCTION PERMIT Authority: Chapter 381, FS & Chapter 1OD -6, FAC APPLICATION FOR: [ ] New System [ ] Existing System - [ ] Holding Tank [ ] Temporary /Experimental [ ] Repair [ ] Abandonment [ ] Other(Specify) APPLICANT: Jf\ y L TELEPHONE: AGENT: 4ENR)I D-' N L.. 5 P71 C MAILING„ADDRESS: 1 �T ( 1 k n \ t , \ CC? /\ v -� � 1 V /LJ TO BE COMPLETED BY APPLICANT OR APPLICANT'S AUTHORIZED AGENT. ATTACH BUILDING PLAN AND TO -SCALE SITE PLAN SHOWING PERTINENT FEATURES REQUIRED BY CHAPTER 1OD -6, FLORIDA ADMINISTRATIVE CODE. PROPERTY INFORMATION [IF LOT IS NOT IN A RECORDED SUBDIVISION, ATTACH LEGAL DESCRIPTION OR DEED] LOT: PROPERTY ID #: PROPERTY SIZE: BLOCK: DIRECTIONS TO PROPERTY: BUILDING INFORMATION [ ] RESIDENTIAL Unit Type of No. of No Establishment Bedrooms 1 2 3 4 APPLICANT'S SIGNATURE: PERMIT # DATE PAID FEE PAID RECEIPT # SUBDIVISION: (X1-4- DATE OF SUBDIVISION. / [Section /Township /Range /Parcel No.] ZONING: ACRES [Sgft /43560] PROPERTY WATER SUPPLY: [ ] PRIVATE PROPERTY STREET ADDRESS: / ) 6 J / o I S, Building Area Sgft [ HRS-H Form 4015, Mar 92 (Obsoletes previous editions which may not be�� (Stock Number: 5744- 001-4015 -1) 6J ys ] COMMERCIAL -4T- cad $ Alt). ( # Persons Business Activity Served For Commercial Only DATE: jG )C1 rfq 7 PUBLIC [ ] Garbage Grinders /Disposals ( ] Spas /Hot Tubs [ ] Floor /Equipment Drains [ ] Ultra -low flume Flush /oilets Page 1 of 3 'ENS'ilIIIIC IONS: APPL:CAT :C,:: ?0:3: Check type of permit, if °Other° :specify type in b:cn. APPLiCA? P,operty owner's full acme. TELEPHONE: Telephone number for applicant or agent. AGENT% Property owner's iegc._y cutho°ized acprecenictive MAEL''NC P.O. bore or •.tre t. rity- state rns. zip codo mci ; - , ct r e a far cpplicar - 2. c:: agent. LOT, :3..C, :a, SU3DNYSEC; : Lot block, rn, r :bc.lvts_on car .at (recorded or unrecorded crtudro:cca-:). ..!' Ice ncordef c_:;rvision, c ropy of the tot legal description or decd miss :'sc attached. DA'E OF SJ 3:3:V`'S`ON: Cffieici deli: of suildiv'_so- : ,nomad In ec :y ._ : :1 : ;cn'.ca (m i1 /r cyly : : :) or , .._.. _',3inaily c m.1c . Dividing cn approved sot into two or ; to'. ?creels fc'ti'_L' O 7oc c Gc`.vCyl_og ownerchie C' c consir1eres, c subdivisio: of the lot. PROP'S � "a' ): 27 character own er for property. (CP:vU may :.; ruin: pro,erdy ra._ ....,. 0 c_ c raiee cc arahi. /range /pa_•ce! number. Net UCb :. :v ::. G .=r (r ^sr: 'i :! r ro_def by rirLtaixo fe, ^, ; crc :naive o" c.'. paved cr..co and prepared rood `er' _xeu, ; wet earrt!.r2 ditcher, m .tires, or other .. 'C Le!'1� ... Y. CXGeL!alva O: c :...a _ ._v:____. :: u ,vompccted ro ad :ghee -of way r.. _ ,.ree m enio with ro subsurface obstructions le: erg :e. E %✓A SUPPLY: Check private or public. PROPERTY ADDRESS: Street address for property. For lots without an assigned street address, indicate stree: or road and /male in county. DIRECT IO :::: Provide detailed it tractions to lot or attach £n area map showing lot location. WILDING kNFCRMATION: Check residential or commercial. TYPE ESTABLISHMENT: List type of establishment from Table EY, Chapter I0D-6, FAC. IExc,n tea: tingle family, single wide mobile home, restaurant, doctor's office. NO. BEDROOMS: Count all ro. ms designed primarily for sleeping and those areas expected to routinely provide sleeping accommodations for occupams. BUILDING AR ;'Ai Total : q61:- . _ - ,7`. . e habitable eras. of dwelling unit, excluding garage, carport, exterior storage shed, or open or fully screened pa... . is -. Nn outside measurements for each story of structure. PERSONS: Number : na, or working in establishment. Lo r residential establishment, 2 persons per bedroom are assume. ^L;SINESS , C - 7" - V7.7 1, For commercial cpplication° only . List number of employees, shifts, cnd hours of operation, or other information required by Table Ii. Chapter .CD-6. PAC. FIXTURES: Mark each its'. d fixture e.'tt ur.,b_r installed or "NA" if not applicable. SIGNATURE: Signature ` a. r. ;.r.: d submitted to the C7- U with appropriate fees and attachments. iCl MEY S' For residences, c floor plan (residences) chewing number of bedrec:-_u and buiidio' area of each unit. IFor nonresidential establishments, n floor p!£n showing the ce ueru footage of the ecr._;:irbmcrw, ^Ii : °l1itobing drains cr_d fixture types, end other features necessary to c>c :e <__stine composition end quantity of was :evertor. s ,1 f . , di rev- : cctions of residences or buildings, swimming pools, recorded and location, slope of propr::y, ony existing or proposed wells, drainage features, filled :seas, onstrinted areas, an^ rurfr.ce water. Location of wells, or'ui sewage disposal, systems, surface waters, and other pertinent facilities c: features on adjacent. property, if the fc: _:_:;u erg with 75 feet of the applicant lot. Location of any public we :l within 200 feet of lot. CONSTRUCTION PERMIT FOR: [ ] New System [ ] Existing System [ ] Holding Tank [ ] Temporary /Experimental [_,/] Repair [ ] Abandonment PROPERTY STREET ADDRESS: /6 i� J^ APPLICANT: LOT: PROPERTY ID #: , STATE OF FLORIDA DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PERMIT Authority: Chapter. 381, FS & Chapter 1OD -6, FAC BLOCK: SUBDIVISION: 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. HRS 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 T [ A [ N [ K [ ] [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 PER DOSE DOSING TANK CAPACITY DOSE RATE [ ] PER 24 HRS NO. OF PUMPS: [ ] D [ .3 (- W ] SQUARE FEET PRIMARY DRAINFIELD SYSTEM R [ ] SQUARE FEET SYSTEM A TYPE SYSTEM: [ ] STANDARD [ ] FILLED [ ] MOUND [ ] I CONFIGURATION: [ ] TRENCH [ 41 BED [ ] N F LOCATION OF BENCHMARK: I ELEVATION OF PROPOSED SYSTEM SITE [ --- ] [INCHES /FT] [ABOVE /BELOW] BENCHMARK /REFERENCE POINT E BOTTOM OF DRAINFIELD TO BE [ ] [INCHES /FT] [ABOVE /BELOW] BENCHMARK /REFERENCE POINT L D FILL REQUIRED: [ _ ] INCHES EXCAVATION REQUIRED: [ ] INCHES r 4 A . T ✓ H E R SPECIFICATIONS BY: APPROVED BY: DATE ISSUED: /,.. TITLE: HRS -H Form 4016, Mar 92 (Obsoletes previous editions which may not be used) (Stock Number: 5744 - 001 - 4016 -0) [ ] Other(Specify) AGENT: 7 [SECTION /TOWNSHIP /RANGE /PARCEL NUMBER] [OR TAX ID NUMBER] TITLE: 7 e 9 MOLDOE:12 o EP,MVi ClaMS' PERMIT # ! DATE PAID 0 ..) FEE PAID $ ''/ is �� ) RECEIPT # , CPHU EXPIRATION DATE:_ =.C/ Page 1 of 2 INSTRUCTIONS: PERMIT NUMBER: Permit tracking number assigned by CPEdU. 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 IDII: 27 character id number for property. (CPHU may require property appraiser ID 11 or section/township /range /parcel number) SYSTEM DESIGN AND SPECIFICATIONS: TANK: Minimum specifications from Chapter 10D -6, FAC. DRAINFIELD: Minimum specifications from Chapter 10D-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 Public Health Unit (CPHU) personnel reviewing and approving permit. DATE ISSUED: Date permit is issued by CPHU. 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. BUILDING ELECTRICAL 91 PLUMBING Owner of Building Architect Contractor or Builder Legal Description PERMIT N? 5718 Cto4/10•0 Work to be performed under this Permit diA7:444 et kar/640. Subdi- vision Address of j I 672E. Value of Project Building -., This permit is granted td the contractor or builder named above to construct the building or to install the equipment or device described in-the appli- cation herefor in strict compliance with all ordinances pertaining thereto and w th 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 ab sumes the responsibility for a thorough know dge of the o inances and regulations pertaining to the work covered hereby whether shown on the pl 11;ga-ow Ate Armen or specifications at he sumes respon- sibility for work done by his agents, servants or employees. Signed By INS CTOR . 'on of the issuance to me of this permit I agree to perform the work covered hereunder in compliance with all ordinances and regulation' s nd • • t ' onformity with the lans, drawings, statements or specifications submitted to the proper auth • of Miami ShoiesyStge. r onsi ility for work d ne by ither myself, my agent, servant or employee. /n era perta ret In ac thi pe CONTRACTOR OR BUILDER MIAMI SHORES VILLAGE, FLORIDA BY DATE • Contractor's License No. /1-/ /9fry Amt. o f // Permit AUTHORITY 1942_ Permit No 1 Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the buildir or other structure herein described. This application is made in compliance and conformity with the Building Ordinance of Mian;i 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 c plied with,4 bets er herein specified or not. A copy of approved plans and specifications must be kept at building during progress of work. MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT Lot/ Date S 7'`. ✓ '1 Owners Name and Address___— �: __ "�a Ng, � -' /or" Stree ____ Registered Architect and _ r r .,— �, 1 � f � �� � ° Employing Plumber's Name_./-_ � ,� � " .� - -- --- .� No � , � � ` °' � ,�` � ` ‘/' #'C Location and Legal Description Block Subdivision 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 Size Septic Tank Type of Tank Capacity Gals � >, - N .- t' � � ' 1 �� Feet of Drain Tile Dist. Feet of Tank or Drain Field from Well i Nature of Water Supply: City —Well. Size of Pit 1 Q t . mew f c t + if. i v Jae r- ` ,rte 4.. ,F :' ' _C- 2 Z--/..C... • PP _ Amount of Permit $___! __,_ (Signed) �* . Plumbing Inspector. T 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 corn- 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, btk o be , Aerformed under this permit, as are licensed by Miami Shores Village. STATE OF FLORIDA, t COUNTY OF DADE. ss. 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 (Signed) Notary Public, State of Florida No. of Stories Master Plumber. r • NOTE: A re- inspection fee of $1.00 will be made when such re- inspection is made necessary by improper notice for jnsz ection, or faulty materials and /or workmanship. CLOSETS BATH TUBS SHOWERS LAVA- TORIES SINKS SLOP SINKS LAUNDRY TU BS 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 SW IM'G POOL ' CONTR. LIST CHECK ( r � Ef I t / Permit No 1 Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the buildir or other structure herein described. This application is made in compliance and conformity with the Building Ordinance of Mian;i 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 c plied with,4 bets er herein specified or not. A copy of approved plans and specifications must be kept at building during progress of work. MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT Lot/ Date S 7'`. ✓ '1 Owners Name and Address___— �: __ "�a Ng, � -' /or" Stree ____ Registered Architect and _ r r .,— �, 1 � f � �� � ° Employing Plumber's Name_./-_ � ,� � " .� - -- --- .� No � , � � ` °' � ,�` � ` ‘/' #'C Location and Legal Description Block Subdivision 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 Size Septic Tank Type of Tank Capacity Gals � >, - N .- t' � � ' 1 �� Feet of Drain Tile Dist. Feet of Tank or Drain Field from Well i Nature of Water Supply: City —Well. Size of Pit 1 Q t . mew f c t + if. i v Jae r- ` ,rte 4.. ,F :' ' _C- 2 Z--/..C... • PP _ Amount of Permit $___! __,_ (Signed) �* . Plumbing Inspector. T 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 corn- 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, btk o be , Aerformed under this permit, as are licensed by Miami Shores Village. STATE OF FLORIDA, t COUNTY OF DADE. ss. 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 (Signed) Notary Public, State of Florida No. of Stories Master Plumber. r • NOTE: A re- inspection fee of $1.00 will be made when such re- inspection is made necessary by improper notice for jnsz ection, or faulty materials and /or workmanship. BUILDING ELECTRICAL PLUMBING MIAMI SHORES VILLAGE, FLORIDA ERMIT N9 3250 Work to be performed under this Permit Owner of Building Architect Contractor j or Builder Legal Lot Bl. Description Address of Building Subdi- vision Value of Project DATE INSPECTOR Contractor's License No Amt. of / Permit 194 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 tye 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 In consideration of the,issuance to me of this permit I agree to perform the work covered hereunder in compliance with all ordinances and regula- tions pertaining thereto and in strict conformity with the plans, drawings, staterrients or specifications submitted to the proper authorities of Miami Shores Village. In accebti2p this permit I assume responsibility for all work done by either myself, my agent, servant or employee. y , .. r' CONTRACTOR OR BUILDER BY AUTHORITY 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 work. Owner's Name and Address vv Registered Architect and /or Engineer �V� Employing Plumber's Name 01 Amount of Permit $_ STATE OF FLORIDA, COUNTY OF DADE. APPLICATION FOR PLUMBING PERMIT My Commission Expires MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT No 6 Date__________ /6 - 3 Street_ ..J ___ _ Location and Legal Description Lot_______r _ _ _ __ ________Block Subdivision.. Street and Number where work is to be performed —No 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 . Feet of Drain ___________ Dist. Feet of Tank or Drain Field from Well__ Nature of Water Supply: City —Well — — _______________.Size of Soakage Pit Street - - - - -- – -- – – ______ -- _____ - - - - -- ---- _Capacity Gals.______________ .(Signed) - - --- – – — -- — — - - -- Plumbing Inspector. The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations as an employer of labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Permanent Supplement, and has com- plied with the provisions thereof, and will require sirnilar 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 wojk such public notice or notices as are required by the Act. The under signed agrees to employ only such sub - contractors, on w9rk t be!' performed under thli permit, as are / licensed by Miami Shores Village. /z Str Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeared _ to me well known, and who, being by me first duly sworn, upon oath deposes and says that he is the. of the above described construction, that he has carefully read the foregoing application, and that he did sign the same, and that all facts therein by him stated are true. Notary Public. State of Florida •h 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 SEWER CONN. DRAIN FIELD SOAKAGE PIT GREASE TRAP S LAR EATER DEEP WELL SPRKLR. SYSTEM SWIM'G POOL CONTR. LIST CHECK 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 work. Owner's Name and Address vv Registered Architect and /or Engineer �V� Employing Plumber's Name 01 Amount of Permit $_ STATE OF FLORIDA, COUNTY OF DADE. APPLICATION FOR PLUMBING PERMIT My Commission Expires MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT No 6 Date__________ /6 - 3 Street_ ..J ___ _ Location and Legal Description Lot_______r _ _ _ __ ________Block Subdivision.. Street and Number where work is to be performed —No 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 . Feet of Drain ___________ Dist. Feet of Tank or Drain Field from Well__ Nature of Water Supply: City —Well — — _______________.Size of Soakage Pit Street - - - - -- – -- – – ______ -- _____ - - - - -- ---- _Capacity Gals.______________ .(Signed) - - --- – – — -- — — - - -- Plumbing Inspector. The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations as an employer of labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Permanent Supplement, and has com- plied with the provisions thereof, and will require sirnilar 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 wojk such public notice or notices as are required by the Act. The under signed agrees to employ only such sub - contractors, on w9rk t be!' performed under thli permit, as are / licensed by Miami Shores Village. /z Str Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeared _ to me well known, and who, being by me first duly sworn, upon oath deposes and says that he is the. of the above described construction, that he has carefully read the foregoing application, and that he did sign the same, and that all facts therein by him stated are true. Notary Public. State of Florida •h 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. MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT Permit No 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 • • Registered Architect and /or Engineer __ __ �, Employing Plumber's Name [f+'T s..0 .) __ ' ___ ._ ' '' (� __•� �_. - '.p � .� C.�:St o Location and Legal Description Lot____ _ _�_____ - -- _______ ______Block__ 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 Size Septic Tank____ _— ________________________ Type of Tank _ Capacity Gals._____________ Feet of Drain Tile___ _______________________________ Dist. Feet of Tank or Drain Field from Well_____— _ —_ —__ Nature of Water Supply: City —Well — Size of Soakage Pit Amount of Permit $_ 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. j� ss My Commission Expires . #mss _s__ No _(Signed) -- - - -- -- - -- — - - -----------__—_ - Plumbing 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 wok such public notice or notices as are sub - contractors, on work to be performed under this permit, as are (Sign h t-' Street r Strout: 4 it Subdivision ___ ______ ______— __-- _________ No. of Stories Master Plumber. Before me, the undersigned authority, a notary public, duly 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. authorized to administer oaths and take acknowledgments, personally Notary Public. State of Florida t/: 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 SOLAR TRAP /HEATER F DEEP WELL SPRKLR. SYSTEM SWIM 'G POOL CONTR. LIST - / E V CHECK MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT Permit No 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 • • Registered Architect and /or Engineer __ __ �, Employing Plumber's Name [f+'T s..0 .) __ ' ___ ._ ' '' (� __•� �_. - '.p � .� C.�:St o Location and Legal Description Lot____ _ _�_____ - -- _______ ______Block__ 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 Size Septic Tank____ _— ________________________ Type of Tank _ Capacity Gals._____________ Feet of Drain Tile___ _______________________________ Dist. Feet of Tank or Drain Field from Well_____— _ —_ —__ Nature of Water Supply: City —Well — Size of Soakage Pit Amount of Permit $_ 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. j� ss My Commission Expires . #mss _s__ No _(Signed) -- - - -- -- - -- — - - -----------__—_ - Plumbing 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 wok such public notice or notices as are sub - contractors, on work to be performed under this permit, as are (Sign h t-' Street r Strout: 4 it Subdivision ___ ______ ______— __-- _________ No. of Stories Master Plumber. Before me, the undersigned authority, a notary public, duly 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. authorized to administer oaths and take acknowledgments, personally Notary Public. State of Florida t/: 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.