374 NE 100 St (2)/)nn 30 zrioi 636
PERMIT APPLIICATION FOR MIAMI SHORES VILLAGE
Date U Job Address 73 79 / / 00 5± Tax Folio
Legal Description Historically Designated: Yes No
Owner/Lessee / Tenant 1 D t.A. rU Master Permit #
Owner's Address ✓ .7 L l Ai. . /Sree+ /M' Phone 20S 7 /n ,S e r Y d
Contracting Co. 60/4:5 ✓ /e e c)/'I. // S Address l f f vO /'/ OL 0.
QualifierG/ /,J . f ve_72 CJAt ' /f
SS# - Phone l/
Competency # /4 , cY J Ins. Co.
Architect/Engineer Address
State #,A no %7 ? ( Municipal #
Bonding Company Address
Mortgagor Address
Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIPTION -111,Dc`) 1 " ,� 1 One Jk i t
Square Ft. Estimated Cost (value) c7.K)C
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.
4 ignature of owner and/or Condo President Date
Signature of Contractor or Owner -B ilder / Date
Notary as to Owner and/or Condo President Date Not. as to Contractor Expi �s r Owner- Builder
My Commission Expires: My ' o res:
4.0 Po MELINDA K. EDELSB
z° ,•, � g, COMMISSION # CC 722658
���� EXPIRES MAR 8, 20
w^`� BONDED THRU
' OF tti ATLANTIC BONDING CO., INC.
FEES: PERMIT x 3�� tADON C.C.F. NOTARY
TOTAL DUE
D.te
APPROVED:
Zoning Building Electrical
Mechanical Plumbing Engineering
ITEM
BATH TU8
UNIT
FEE
IT61
SWITCH OUTLETS
UNIT
V
FEE
ITEM
SPACE EATERS
UNIT
FEE
BIOET
LIGHT OUTLETS
r�.I
CENTRAL HEATING
_
DISHWASHER
RECEPTACLES
,
A/C (WIND)
OIS?OSAL
SERVICE TBFUURY
A/C (CENTRAL)
DRINKING FOUNTAIN
SERVICE SIZE IN ASS
OLCT 1QRK
FLCCR DRAIN
SERVICE REPAIR/1ETE.R NICE
R FRr IGERATION
GREASE TRAP
APPLIANCE OUTLETS
1
PRCCESS AND PRESS PIPING
I NTEERCEPTCR
I RANGE TrP
llIOERCRQ?0 TAW
LAVAT(RY
_
Ma
ABOVE MIND TANKS
LAUNDRY TRAY
RATER HEATER
U.F. PRESSURE VESSEI.s
CLOTFES WASHER
►UTCRS 0- 1 FP
STEAM BOILERS
SLOWER
10TCRS OVER t- 3 FP
FAT HATER BOILERS
SINK, POT/3 CCMP.
1ATCRS OVER 3- 5 FP
IRC'1ANICAL VENTILATION
SINK, RESIDENCE
1ATCRS OVER 5- 8 If
TRAITING ASSEMBLIES
SINK, SLCP
1QTCRS OVER 8- 10 FP
ELEVATCRS/ESCALATIRS
TEWFORARY WATER CLOSET
1OTCRS OVER 10- 25 If
FIRE SPRINKLER SYSTEMS
URINAL
_
moron OVER 25.100 FP
COOLING TOWERS
RATER CLOSET
10XRS OVER 100 FP
VIOLATION •
INDIRECT WASTES
A/C WINDOW
RE INSPECTION
WATER SUPPLY TO:
AIR CONDITIONERS
-
A/C UNIT
STRIP HEATER
FIRE SPRINKLER
GENERATORS TRAIWCA1ERS
'
. FEATER -NE'A INST.
GENERATORS TRANWERNERS
.
HEATER -REPL 4L
_
GENERATORS �
LAWN SPRINKL4-WEJJ.
SPECIAL PURPOSE
SWIMMING POOL
'
OUTLETS CO. CIAL
WATER SERVICE
•
SIGN TUBES
SEWER CONNECTIONS
SIGN TRANSFORICIS
UTILITY - SETTER
SIGN TIME CLOCK
UTILITY-WATER
FIXTURES T
SEPTIC TANK
ANTENNA •
'
RELAY
TELEVISION OUTLETS
ORAINFIELD, 4' TIL/RES.
VIOLATION
PUMP & ABANDON SEPTIC TANK
_
REINSPECTION
SOAKAGE PIT CU. FT.
CATCH BASIN
0 I SC -LARGE WELL
DOMESTIC WELL _
1
AREA CRAIN
ROOF INLET
SOLAR WATER HEATER
FIRE STANDPIPE
POOL PIPING
.
LAWN SPRINKLER SYSTEM
GAS RANGE
METER SET ii (GAS)
GAS PIPING
ADDENDUM TO BUILDING PERMIT APPLICATION
(AN APPLICA__CN FOR 3UILD_ING PERMIT RUST ACCOM??NT THIS ADDENDUM. IT A MASTER PERMIT HAS B.
OBTAINED, _ _. CWNEP' S NOTARIZED SIGNATURE NEED NOT BE ?RESENT ON SUBSEQUENT APPLICAT_TONS. )
PLUMBING
ELECTRICAL
MECHANICAL
Permit No
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
Application is hereby made for the approval of the detailed statement of the plans and specifications herewith fitted for the building or other
structure herein described. This application is made in compliance and conformity with the Building Ordinanc Miami Shores Village, Florida,
and all provisions of the Laws of the State of Florida, all ordinances of Miami Shores Village and all rules an egulations 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 ���� (('/'/�� �,� a��
Owner's Name and Address �%t_lt� - -J No. (177 S e~�-- / "� Street._,C_' -_..._
Registered Architect and /or Engineer
Employing Plumber's Name
Location and Legal Description
Street and Number where work
State work to be performed gni
New Building
Amount of Permit $
Lot. �y Bloc&
is to be performed —No 3 / c5 _/ �� /� Street
purpose of building (By Floor �4�.cli
) � - L�'Ll,.�`I.
Remodeling____. -- - -.___ ...___ Addition - - -__ - Repairs
Size Septic Tank __-- _- --- ----- --- --- --- -- ---- ._Type of Tank__
Feet of Drain Tile___ -- — — ---fit. Feet of Tank or Drain Field from Well.
Nature of Water Supply: City — Well.___— ___-__- _- - - - -- -- - - - - -- -Size of Soakage Pit
(Signed) _
(Silk)
5ubdividon.__•-- _�- _ - -+. --
cde
No. of Stories
Capacity Gals.
My Commission Expiry Notary Public, State of Florida
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 Ilan 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.
Muter Plumber.
STATE OF FLORIDA, I
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 hire stated are true.
NOTE: A re- inspection fee of $1.00 will be made wheat awl re-inspection is made.neoessary by improper notice for inspection, or faulty
materials and /or workmanship.
CLOSETS
BATH
TUBS
SNOWERS
LAVA-
TORIES
61NKS
SLOP
SINKS
LAUNDR
Tuts
URINALS
CATCH
OA SI N
FLOOR
DRAIN
DRINKING
FOUNT' NS
TOTAL
FIRTUROil
CONTR.
LIST
CHECK
SEPTIC
TANK
SEWER
CONN.
DRAIN
FIELD
SOAKAGE
PIT
GREASE
TRAP
SOLAR
HEATER
DEEP
WELL
SPRKLR.
SYSTEM
SWIM'G
POOL
CONTR.
LIST
'- --
CHICK
Permit No
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
Application is hereby made for the approval of the detailed statement of the plans and specifications herewith fitted for the building or other
structure herein described. This application is made in compliance and conformity with the Building Ordinanc Miami Shores Village, Florida,
and all provisions of the Laws of the State of Florida, all ordinances of Miami Shores Village and all rules an egulations 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 ���� (('/'/�� �,� a��
Owner's Name and Address �%t_lt� - -J No. (177 S e~�-- / "� Street._,C_' -_..._
Registered Architect and /or Engineer
Employing Plumber's Name
Location and Legal Description
Street and Number where work
State work to be performed gni
New Building
Amount of Permit $
Lot. �y Bloc&
is to be performed —No 3 / c5 _/ �� /� Street
purpose of building (By Floor �4�.cli
) � - L�'Ll,.�`I.
Remodeling____. -- - -.___ ...___ Addition - - -__ - Repairs
Size Septic Tank __-- _- --- ----- --- --- --- -- ---- ._Type of Tank__
Feet of Drain Tile___ -- — — ---fit. Feet of Tank or Drain Field from Well.
Nature of Water Supply: City — Well.___— ___-__- _- - - - -- -- - - - - -- -Size of Soakage Pit
(Signed) _
(Silk)
5ubdividon.__•-- _�- _ - -+. --
cde
No. of Stories
Capacity Gals.
My Commission Expiry Notary Public, State of Florida
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 Ilan 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.
Muter Plumber.
STATE OF FLORIDA, I
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 hire stated are true.
NOTE: A re- inspection fee of $1.00 will be made wheat awl re-inspection is made.neoessary by improper notice for inspection, or faulty
materials and /or workmanship.
Permit No.. ._ 6 .
$ -29 -73
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.
Owners Name and Address OBS.a r Ma r.Z e 1 No. 37A street N . E. .. 10Street .
Registered Architect and /or Engineer -
Employing Plumber's Name BrQQks-AArra } r
Location and Legal Description Lot.
Street and Number where work is to be performed —No
State work to be performe8 and purpose of building (By
Amount of Permit $
STATE OF FLORIDA,
u.
COUNTY OF DADE.
My Commission Expires
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
street.._N.Wr...7.�....Street.
Blo 4r Subdivision
3 74 street _---- - - -i�T . E .-- -1.0Q.
m ,) Lawn Sprinkler installation
New ...... ._.._._ Remodeling_____ -._-_._..__ Addition._._ _._._ _.... Repairs No. of Stories.
Size Septic Tank_ -Type of Tank__
Feet of Drain Tile._— __.._ N __ _Dist. Feet of Tank or Drain Field from Well
Nature of Water Supply: City—Well We 11 Size of Soakage Pit.
Capacity
Plumbing Inspector.
The undersigned applicant for this building permit does hereby certify that he understands and accepts his .��igations as an employer of labor
under the Florida Workmen's Compensation Act, being Section 5968, Compiled General Laws of Florida Perm: ent 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 wRrk to be performed u_. er this permit, as are
licensed by Miami Shores Village.
(Signed)_ _
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
Master Plumber.
NOTE: A re- inspection fee of $1.00 will be made when such re-Inspection is msdolme ssary by improper notice for inspection, or faulty
materials and /or workmanship.
CLOSRS
BATH
TUBE
SHOWERS
LAVA.
TORIES
SINKS
SLOP
SINKS
LAUNDRY
Tugs
URINAL[
CATCH
BASIN
FLOOR
DRAIN
DRINK NO
FOUNT'NE
TOTAL
FIXTURES
CONTR.
LIST
CHECK
SEPTIC
TANK
SEWER
CONN.
DRAIN
FIELD
SOAKAGE
PIT
GREASE
TRAP
SOLAR
HEATER
DEEP
WELL
BPRKLR.
SYSTEM
SW IM' O
POOL.
CONTR.
LIST
v
11
CHECK
Permit No.. ._ 6 .
$ -29 -73
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.
Owners Name and Address OBS.a r Ma r.Z e 1 No. 37A street N . E. .. 10Street .
Registered Architect and /or Engineer -
Employing Plumber's Name BrQQks-AArra } r
Location and Legal Description Lot.
Street and Number where work is to be performed —No
State work to be performe8 and purpose of building (By
Amount of Permit $
STATE OF FLORIDA,
u.
COUNTY OF DADE.
My Commission Expires
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
street.._N.Wr...7.�....Street.
Blo 4r Subdivision
3 74 street _---- - - -i�T . E .-- -1.0Q.
m ,) Lawn Sprinkler installation
New ...... ._.._._ Remodeling_____ -._-_._..__ Addition._._ _._._ _.... Repairs No. of Stories.
Size Septic Tank_ -Type of Tank__
Feet of Drain Tile._— __.._ N __ _Dist. Feet of Tank or Drain Field from Well
Nature of Water Supply: City—Well We 11 Size of Soakage Pit.
Capacity
Plumbing Inspector.
The undersigned applicant for this building permit does hereby certify that he understands and accepts his .��igations as an employer of labor
under the Florida Workmen's Compensation Act, being Section 5968, Compiled General Laws of Florida Perm: ent 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 wRrk to be performed u_. er this permit, as are
licensed by Miami Shores Village.
(Signed)_ _
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
Master Plumber.
NOTE: A re- inspection fee of $1.00 will be made when such re-Inspection is msdolme ssary by improper notice for inspection, or faulty
materials and /or workmanship.
Owner's Name and Address
Registered Architect and /or Engineer
Nature of Water Supply: City —Well
Amount of Permit $
STATE OF FLORIDA,
COUNTY OF DADE.
SS.
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
State work to be performed and purpose of building (By Floors)
New Building -____. Remodeling Addition Repairs V�
(Signed)
(Signed) _
Date .�
Permit N
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 confonnity 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.
No.3 - !l — Street - Street--- -_--. d 144- --411 - 1 )4
Employing Plumber's Name No Street
Location and Legal Description Lot Block Subdivisi n
Street and Number where work is to be performed —No S __ ___V �j_. ' , Street___. d_.c
No. of Stories
Size Septic Tank Type of Tank Capacity Gals
Feet of Drain Tile -__ / a-6 Dist. Feet of Tank or Drain Field from Well
Size of Soakage Pit
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 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.
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 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'S
POOL
CONTR.
LIST
/ M
U �/ •
CHECK
Owner's Name and Address
Registered Architect and /or Engineer
Nature of Water Supply: City —Well
Amount of Permit $
STATE OF FLORIDA,
COUNTY OF DADE.
SS.
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
State work to be performed and purpose of building (By Floors)
New Building -____. Remodeling Addition Repairs V�
(Signed)
(Signed) _
Date .�
Permit N
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 confonnity 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.
No.3 - !l — Street - Street--- -_--. d 144- --411 - 1 )4
Employing Plumber's Name No Street
Location and Legal Description Lot Block Subdivisi n
Street and Number where work is to be performed —No S __ ___V �j_. ' , Street___. d_.c
No. of Stories
Size Septic Tank Type of Tank Capacity Gals
Feet of Drain Tile -__ / a-6 Dist. Feet of Tank or Drain Field from Well
Size of Soakage Pit
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 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.
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 inspection, or faulty
materials and /or workmanship.
Permit No . d
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..-C
Owner's Name and Address
Registered Architect and /or Engi
Size Septic Tank
Feet of Drain Tile___-- _ —____
Nature of Water Supply: City — Well.__
STATE OF FLORIDA,
COUNTY OF DADE.
ss.
My Commission Expires
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
Employing Plumber's Name No
Location and Legal Description Lof_ —_____ ___-___- _— __-_--____— _-__---_____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 —___ No. of Stories__-_-_........
Type of Tank . _- Capacity Gals ..... Dist. Feet of Tank or Drain Field from Well
------------ - - - - -- - -- —
Amount of Permit $ � _____ _—___________— __— _____ ________ (Signed)
Street.
Street
Size of Soakage Pit
if 'Y
(Sighed)
l / /
Master Plumber.
-----------
Plumbing Inspector.
The undersigned applicant for this building permit does hereby certify that 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.
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
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
WELL
SPRKLR.
SYSTEM
SWIM'S;
POOL
CONTR.
LIST
CHECK
Permit No . d
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..-C
Owner's Name and Address
Registered Architect and /or Engi
Size Septic Tank
Feet of Drain Tile___-- _ —____
Nature of Water Supply: City — Well.__
STATE OF FLORIDA,
COUNTY OF DADE.
ss.
My Commission Expires
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
Employing Plumber's Name No
Location and Legal Description Lof_ —_____ ___-___- _— __-_--____— _-__---_____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 —___ No. of Stories__-_-_........
Type of Tank . _- Capacity Gals ..... Dist. Feet of Tank or Drain Field from Well
------------ - - - - -- - -- —
Amount of Permit $ � _____ _—___________— __— _____ ________ (Signed)
Street.
Street
Size of Soakage Pit
if 'Y
(Sighed)
l / /
Master Plumber.
-----------
Plumbing Inspector.
The undersigned applicant for this building permit does hereby certify that 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.
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
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.
Issued to
41111
p • ;.
to install the following described ph
.• /
lations of Miami Shores Village,
drainage work done in Miami Shor
ye
For al—story
Fixtures
Fixtures
Sewer
•ic Tank
atilt
F L
PLUM r-
.*/
Total
Village Plun
Received Pa)
SPECIFY
FLoRlli
CEMENT
•
.■■
dd[iami Aores9'llage
F L O & D A
PLUMBING PERMIT
OWNER
Received Payment by
LOT
Y , i"
, d
i
to install t e folloch described plumbing, in accordance
lations of Miami Shores Village, Florida and the State of
drainage work done in Miami Shores Village, Florida.
'', c p
For a_ story + ' building at , + ` C
d
with the laws, statutes and regu-
Florida, governing plumbing and
N? 1157
Fixtures
Fixtures $ fl
Sewer $ ��
t'l
•tic Tank $
Total $ � v
Village Plumbing Inspector �► , " ° j =A`" ? " `'"
I herewith submit the following application for a permit covering the installation
of a Septic Tank
rl:
( : V
For a (Store:
(Garage wash floor:
Building has:
Owner or Agent:
LOT NO.
Address of work:
Additional information:
PERMIT NO.
BLOCK Nb.:ti
.37!!" ,7„/,
DADE COUNTY ZONING OFFICE
Form #11
DIVISION OF PLUMBING INSPECTION
Old: Story:
Soakage Pit:
Feet of drain tile:
New:
Date:
Installed by: Addre
Address:
SUBDIVISION
/e;
Ready for Inspection: Date:
APPROVED BY: a /// , ;,> CONDEMNED BY:
Remarks: e e , s - , y .
5
1'
Addition: Remodeled:
Floor Drains:
No. of Plumbing Fixtures:, Laundry Tubs:
Nature of water supply: City: ✓ Well:
Type of tank installed: Ae Ca C 7 Tank capacity in gallons:
Size of Soakage Pit: Purpose of same:
Feet distant from all wells:
Garage: Apt.; Hotel: Office Bldg: — Res: k
Waste water from a:
Stores; Offices; Apts.; Hotel Rms; /Bedrms
58
Permit No SI
Amount of Permit $
Owner's Name and Address
Nature of Water Supply: City —Well
licensed by Miami Shores Village.
ss.
State work to be performed and purpose of building (By Floors)
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
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 specific or not. A copy of approved plans and specifications must be kept at
building during progress of work.
Registered Architect and /or Engineer r
Employing Plumber's Name —.14/ _��( -' ! t . • No 6 f Street_
Location and Legal Description Lot - ____ Block ` r C Subdivision 1
'412' -•tip t
Street and Number where work is to be performed —N -3 7 !' Street______, c "' '
11
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
Size of Soakage Pit
(Signed)
(Signed)
Date T
Zumbing 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
Street
Master Plumber.
No. of Stories
STATE OF FLORIDA, 1
COUNTY OF DADE. 1
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeared
to me well known, and who, being by me first duly sworn, upon oath deposes and says that he is the
of the above described construction, that he has carefully read the foregoing application, and that he did sign the same, and that all facts
therein by him stated are true.
My Commission Expires Notary Public, State of Florida
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
T UBS
SHOWERS
LAVA-
TORIES
SINKS
SLOP
SINKS
LAUNDRY
TUBS
URINALS
CATCH
BASIN
FLOOR
DRAIN
DRINKING
FOUNT 'NS
TOTAL
FIXTURES
CONTR.
UST
L—
CHECK
SEPTIC
TANK
SEWER
CONN.
DRAIN
FIELD
SOAKAGE
PIT
GREASE
TRAP
SOLAR
H EATER
DEEP
WELL
SPRKLR.
SYSTEM
SW IM'G
POOL.
CONTR.
LIST
CHECK
Permit No SI
Amount of Permit $
Owner's Name and Address
Nature of Water Supply: City —Well
licensed by Miami Shores Village.
ss.
State work to be performed and purpose of building (By Floors)
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
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 specific or not. A copy of approved plans and specifications must be kept at
building during progress of work.
Registered Architect and /or Engineer r
Employing Plumber's Name —.14/ _��( -' ! t . • No 6 f Street_
Location and Legal Description Lot - ____ Block ` r C Subdivision 1
'412' -•tip t
Street and Number where work is to be performed —N -3 7 !' Street______, c "' '
11
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
Size of Soakage Pit
(Signed)
(Signed)
Date T
Zumbing 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
Street
Master Plumber.
No. of Stories
STATE OF FLORIDA, 1
COUNTY OF DADE. 1
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeared
to me well known, and who, being by me first duly sworn, upon oath deposes and says that he is the
of the above described construction, that he has carefully read the foregoing application, and that he did sign the same, and that all facts
therein by him stated are true.
My Commission Expires Notary Public, State of Florida
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.