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487 NE 100 St (13)Date (5 1 Job Address 427 /U.C. /00 sr . Tax Folio -- �os�SO 0 765 d Legal Description M a /7n .SA)rz°s Sec. Owner/Lessee / Tenant jr Pee. I Historically Designated: Yes /, / No L i q73 Permit # r ( i 73 c7 /1 Owner's Address 7 AL t ' i O0 31 Phone3O " / J 9--. 5099 Contracting Co. 707?-/d ( � f Address (D? 5 W / ?-T 74Z Qualifier A- -NN/ 5 , j/4h CI( SS# / Phone "f �.5 Y - ?3 7 3 State # C/� C. 0 Municipal # Competency # C R Z s. Co. Architect/Engineer Bonding Company Mortgagor Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN WORK DESCRIP'T'ION Pep //k °2. P, i- o 'Ce ld Square Ft. ' U v Estimated Cost (value) / 0 w 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 abov-named contractor to do the work stated. Signature of owner and/or Condo President Date LAOLAUSA I ( My Com* /or are Condo Grate Pre sident Date Notary as t 19 5 MMISSION * C 5 5 5 9 O B EXPIRES MAY 2000 ' BONDED THRU X000 F B. ATLANTIC BONDING CO., INC. FEES: PERMIT i RADON PERMIT APPLICATION FOR MIAMI SHORES VILLAGE APPROVED: Zoning Building Mechanical Plumbing Address Address Address gnature of Contractor or • wner- Builder wn - uilder Date . Marie Gratz- Smulowitr c, COMMISSION # CC 555898 EXPIRES MAY 19, 2000 Of top ATLANTIC BONDING CO., INC. Notary as to Contra My Commissio Electrical C.C.F. r. 0 NOTARY — D BOND ' O O Date 5- \ / 2 0 TOTAL DUE .3.3 (O Engineering D R A I N F I E L D C TRUCTION PEf2MIT ' r ] Repair APPLICANT: PROPERTY STREET LOT: [44°] TYPE SYSTEM: SPECIFICATIONS•BY: APPROVED $Y DATE ISSUED! STA :C1 ,bRIDA. PERMIT # "bEPA* MEMT OF' HEALTH AND REHABILITATIVE ERVECES •DATE PAID ONSITE SEWAGE DISPOSAL SYSTEM FEE PAID "'CONSTRUC PERMIT RECEIPT # Authority.: Chapter 381, FS & Chapter 10D -6, FAC i�istiiig Systeiri .; Abandonm S BETTER BUBOV699 FOAMS Tallahassee, Fl — (904) 878-5401 [ ] SQUARE FEET SYSTEM [ [ CONFIGURATION: [ ] TRENCH LOCATION OF BENCHMARKt' :. Q. ' v ELEVATION OF PROPOSED SYSTEM SITE [ BOTTOM OF DRAINFIELD TO BE [ /, 2 0 0 1238033 0 ) ldi$ yTaiik `'' , ' mporary /Experimenta'1 Other(Specify) AGENT* d ��� /cpc) . 617 e—t / G /TOWNSHIP /RANGE /PARCEL NUMBER] [OR TAX ID NUMBER] • SYSTEM 'MUST BE CONSTRUC'TEt1:'IZ?i ACCORDANCE' WITH Si4CIFICATIOIfIS ANbSTANDARDS OF CHAPTER' IOD -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 Off' SYSTEM DOES NOT GUARANTEE SATISFACTORY PERFORMANCE FOR ANY, SPECIFIC PERIOD OF TIME:. ANY CHANGE IN MATERIAL FACTS WHICH SERVED AS A 'BASIS FOR ISSUANCE OVTHIS APPLICANT TO MODIFY THE PERMIT APPLICATION.' SUCH MODIFICATIONS MAY RESULT IN THIS PERMIT BEING MADE NULL AND VOID. SYSTEM DESIGN.Akb - S C^ FICATIONS T [ ] uAidA NSi GPD] SEPTIC TANKTAE,HOBIC UNIT CAPACITY A [ .[ GALLONS /. GPD ] CAPACITY MULTI- CHAMBERED /IN SERIES:[ ] ] ..., ' N [ ] GALLONS .GREASE INTERCEPTOR CAPACITY [MAXIMUM CAPACITY SINGLE TANK: 1250 GALLONS] K [ ] GALLONS PER DOSE .'DOSING TANK CAPACITY DOSE RATE [ ] PER 24.HRS NO. OF PUMPS: [ ] 41.-.41 s ,T . , ... SYS [ ] STANDARD 077 $ r / MULTI- CHAMBERED /IN SERIES:( ] FILLED [ ] MOUND �LBED [ ] if [ CHES /FT] [ABOVE /BELOW] BENCHMARK REFEREN . NT RENCE POIN PILL RE EDi [ .];INCHES ..EXCAVATION REQUIRED: [$J INCHES INSTALL 12" OF LOAMY COARSE SAND UNDER BOTTOM OF DRAINFIELD SUBMIT • BENCHMARK 3EFOR.I. INSPECTION THIS PERMIT IS NOT FOR Ai'.D1TION INVERT RUINATION . . /0. BOTTOM OF •I)RAINFIFI. I =J PVATIE)N .: ? fT TITLE: F ] [ ABOVE('BELZ M/ BENCHMARK/ EXPIRATION DATE: Date 1/5/98 PERMIT APPLICATION FOR MIAMI SHORES VILLAGE Job Address 487 N. E. 100 St. Tax Folio Legal Description Historically Designated: Yes No X Owner/Lessee / Tenant Mr . Marcell Frank Master Permit # 4i4?.? Owner's Address 487 N. E . 100 St . Phone 759 -0300 ContractingCo. Carl's Septic Service Inc. Qualifier Carl Cundiff SS# Phone 826 -1418 State #97 -0327 Municipal# Competency# 000900327 Ins. Co. Granada Architect/Engineer Address Bonding Company Address Mortgagor Address Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN WORK DESCRIPTION Relay Drainfield Square Ft. 3 0 0 Estimated Cost (value) $17 0 0 .0 0 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 AF laws regulatin Signature of owner and/or Condo President ertify that all the foregoing information is accurate and that all work will be done in compliance with all applicable and zoning. Furthermore, I authorize the above -named contractor to do the work stated. 5 Datel ♦ A/0.14 Z� ru/I4 l Notary as to Owner and/or Cons P. eside / Date My Commission Expires: ` P,RY PU6, 07F;CIA. idCTARY T ai BARBARA ANN FUCAXi.: 2 sl , 0 ! co�Mnnissiom wucsE�P1 . N @•- ' 4 , Q CC350191 � " e { ^.v COI'1!i_iISSION EXP. OFFS ����� 6,-)r11,1 FEES: PERMIT 3 c RADON APPROVED: Zoning Building Mechanical Plumbing gr Z C.C.F. l • NOTARY (5 BOND TOTAL DUE 3 e/, Address 10801 B N.W.So. River Dr. Signature of Contractor / 'owner- Builder 7 / Date Aja/(‘?i /th Notary as to Contractor or Owner de Date My Commission Expires: - - _ -_ - 1 Y P ,`P,RY PC/ CFF:ClAi. NC AwV 3 d�"':. I O. ��. ANN FU�A'.:::'1 T 6-t41( ,,l y } COMMISSION NI.X.;;r:i. i. " ;6 iy..v COC".f. sw.cR ::I : :'. • ' O OP RFiC I) Electrical Engineering APPLICANT: g g7,9( X f , T l AGENT: /, e/ s s j fte hoe, LOT:23 21 BLOCK: ga SUBDIVISION: ow /� dl_ l/ CT PROPERT ID 1: /I 5 ! v1 ° [Section/Township/Range/Parcel /Range /Parcel No. or Tax ID Number] t �o / 7 0 y S 7 to Lo D STATE OF FLORIDA DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES ONSITESEWAGE DISPOSAL SYSTEM SITE EVALUATION AND SYSTEM SPECIFICATIONS TO BE COMPLETED BY ENGINEER, HEALTH UNIT EMPLOYEE, OR OTHER QUALIFIED PERSON. ENGINEER'S MUST PROVIDE REGISTRATION NUMBER AND SIGN AND SEAL EACH PAGE OF SUBMITTAL. COMPLETE ALL ITEMS. PROPERTY SIZE CONFORMS TO SITE PLAN: 00 TOTAL ESTIMATED SEWAGE FLOW: _200 9v� AUTHORIZED SEWAGE FLOW: UNOBSTRUCTED AREA AVAILABLE: 01„ BENCHMARK /REFERENCE POINT LOCATION: (.� ©rl./ r (� 1 D 'J /v/ � � SS A - (a!E_) / /C / ELEVATION OF PROPOSED SYSTEM SITE IS [ HE /FT [k /BELOW] ENC /REFERENCE POINT THE MINIMUM SETBACK WHICH CAN BE MAINTAINED FROM THE 1 POSED SYSTEM TO THE FOLLOWING FEATURES: SURFACE WATER: FT DITCHES/ WALES: / I FT 0RRMALLY WET? [ ] YES ii NO WELLS: PUBLIC: FT LIMITED USE: FT RIVATE: FT NON-POTABLE' / A FT BUILDING FOUNDATIONS: FT PROPERTY LINES: Q FT POTABLE WATER LINES: /(rJ _ FT SITE SUBJECT TO FREQUENT FLOODING: 10 YEAR FLOOD ELEVATION FOR SITE: SOIL PROFILE INFORMATION SITE 1 ( YES [ ] NO NET USABLE AREA AVAILABLE: TI ACRES GALLONS PER DAY [RESIDENCES -TABLE 1 / 0 HER -TABLE 2] GALLONS PER DAY 41500 GPD /ACRE OR 2500 GPD /ACRE) SQFT UNOBSTRUCTED AREA REQUIRED: 6 ' SQFT Munsell # /Color Texture atArFy USDA SOIL SERIES: f4 i Depth t o jt / to C to to to to to to YES [ NO FT MSL /NGVD 10 YEAR FLOODING? [ ] YE [}C] NO SITE ELEVATION: 4 ,/r2,21 SOIL PROFILE INFORMATION SITE 2 Munsell Color Texture USDA SOIL SERIES: i s - 1.1l r Depth Off' to 11 to to to to to to to to OBSERVED WATER TABLE: 4/ INCHES [ABOVE /] GRADE. TYPE* ERCHED / ESTIMATED WET SEASON WATER TABLE ELEVATION: ip`7" INCHES [ ABOVE / BELO ] EXIST E. HIGH WATER TABLE VEGETATION: [ ] YES JXJ NO MOTTLING: [ ] YES (4 NO DEPTH: b A' INCHES SOIL TEXTURE /LOADING RATE FOR SYSTEM SIZING: / / 6P.;v, DEPTH OF EXCAVATION: 3 © INCHES DRAINFIELD CONFIGURATION: [ ] TRENCH (V...] BED [ ] OTHER (SPECIFY) REMARKS /ADDITIONAL CRITERIA: SITE EVALUATED BY:.� ( DATE: HRS-H Form 4015, Mar 92 (Obsoletes previous editions which may not be used) (Stock Number: 5744- 003 - 4015 -1) PERMIT # g /NGVD Page 3 of 3 INSTRUCTIONS: PERMIT 0: Permit tracking number assigned by CPHU. APPLICANT: Property owner's full name. AGENT: Property owner's legally authorized representative. LOT, BLOCK, SUBDIVISION: Lot, block, and subdivision for lot. PROPERTY ID#: 27 character number for property. (property appraiser ID t1 or section /township /range /parcel number) PROPERTY SIZE: Check if property size at site conforms to submitted site plan. Record net usable area available - lot area exclusive of all paved areas and prepared road beds within public rights -of -way or easements and exclusive of streams, lakes, normally wet drainage ditches, marshes, or other such bodies of water. SEWAGE FLOW: UNOBSTRUCTED AREA: MINIMUM SETBACKS: Record the estimated sewage flow for the establishment from Table 1 (residences) or Table 2 (non - residential), Chapter 10D -6, FAC.. Record the authorized sewage flow for the lot based on net usable area and water supply (1500 gallons per day per acre for private water supplies and 2500 gpd per acre for public water supplies). If authorized sewage flow does not equal or exceed the estimated sewage flow, the application must be denied. Record the square feet of unobstructed area available and the amount required. Unobstructed area must be et least 2 times as large as the drainfield absorption area and at least 75 percent of the unobstructed area must meet minimum setbacks in Chapter 1OD-6, FAC. The unobstructed area must be contiguous to the drainfield. BENCHMARK INFORMATION: Record the location of the benchmark. If using a surveyor's benchmark record the actual elevation. Record the elevation of the proposed system site in relation (above or below) to the benchmark. Record minimum setbacks which can be meet to all listed features. Actual measurements must be recorded or "NA" for non applicable features. Features on site plan or within 75 feet of the applicant lot must be measured. The location of any public drinking well within 200 feet of the applicant's lot must also be verified. FLOOD INFORMATION: Record information on lot's subject to flooding. For lots subject to flooding record 10 year flood elevation for site and actual site elevation. SOIL PROFILE INFORMATION: Two soil profiles within the proposed absorption area to a minimum depth of 6 feet or refusal are required. Soil identification will use USDA Soil Classification methodology (Munsell colors and USDA soil textures). Refusals must be clearly documented. Provide USDA soil series if available, record "UNK° if the series cannot be determined. WATER TABLE: Record the depth of the observed water table at the time of the evaluation. Mark "perched" or °apparent° as appropriate. Record the estimated wet season water table elevation based on site evaluation, USDA soil maps, and historical information. Indicate if there is high water table vegetation present. Indicate if mottling is present and depth. SOIL TEXTURE: Record soil texture or loading rate for system sizing. DEPTH OF EXCAVATION: If applicable record depth of excavation required. Record "NA* if not applicable. DRAINFIELD CONFIGURATION: Check drainfield configuration required. If other, specify type. ADDITIONAL CRITERIA: Record any additional remarks pertinent to site or installation. Ex. dosing required. SITE EVALUATED BY: Signature of evaluator, title, and date of evaluation. Professional engineers must seal all documentation submitted. ELEVATION WORKSHEET ELEVATION OF BENCHMARK / REFERENCE POINT IS: BENCHMARK SITE 1 SITE 2 SITE 3 [ +] SHOT: H.I. H.I. H.1. H.I. 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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. T [ g ®ND] [GALLONS / GPD] SEPTIC TANK /AEROBIC UNIT CAPACITY MULTI- CHAMBERED /IN SERIES:[ ) A [ ] [GALLONS / GPD] CAPACITY MULTI- CHAMBERED /IN SERIES:[ ] N [ ] GALLONS GREASE INTERCEPTOR CAPACITY [MAXIMUM CAPACITY SINGLE TANK: 1250 GALLONS] K [ ] GALLONS PER DOSE DOSING TANK CAPACITY DOSE RATE [ J PER 24 HRS NO. OF PUMPS: [ ] SYSTEM [ yi STANDARD [ 04 FILLED [ MOUND [44 [6J TRENCH [ 7] BED [ A� N ® �Q F LOCATION OF BENCHMARK: �+' ? �6d J I /&. -, . A ri (AN i ® . 5 S I I. ELEVATION OF PROPOSED SYSTEM SITE [ /* INCHES /FT] [ABOVE /BELOW] BENCHMARK /REFERENCE POINT E BOTTOM OF DRAINFIELD TO BE [ e ] [INCHES /FT] [ABOVE /BELOW] BENCHMARK /REFERENCE POINT EXCAVATION REQUIRED: [ 26 0] INCHES TITLE: APPLICANT r , • INSTALL 12" OF ILOP "VM r 00 :1:a7 TILE t `.�- t PERMIT # 1 AZ ° ®0O/ DATE PAID S•- 78 FEE PAID $ $®Q* RECEIPT # 4? 43 /.SZ l�� IS ICJ ��II nor r r P � ' :.d L, C Id (rd J � UU HRS-H Form 4016, Mar 92 (Obsoletes previous editions whichmayio go �ti� ° YEE (Stock Number: 5744- 001 - 4016-0) EXPIRATION DATE: -/ CPHU Page 1 of 2 i}iS JC; CNS: pn :t :.:. "r 1JeTide3_a: a r nit tracking cumber rriigneci by C? 5. Ai?Pr-_CA? C.N ?-01.: type of permit, if "Other' specify type ir. blan_t. APPL= CAN'S': Property own. r'c full name. TE c?HONi5: Telephone number for applicant or agent. ACENT: Property owner's legally authorized represe_vtive. iVAI :LING ADDRZSS: P.O. bon or street mailing address for applicant or agent. SYSTEM DESIGN AND SPECIFICATIONS: LO °, 3LOCi(, SJSDeVISION or i'RO2ERTY 27 character id number for property. (CPHU may require property appraiser ID /1 or section /township /range /parcel number) TANK: Minimum specifications from Chapter 10D -6, FAC. DPAINFIELD: Minimum specifications from Chapter 10D -6, FAC. OTEER: Other specifications, such as operating permit requirements, low - volume flush toilets, variance provisos. SPECIFICATIONS 3Y: Name of individual providing specifications. If cesignad by a registered engineer must be sealed. Ada LOVED BY County Public Health Unit (CPHU) personnel reviewing and approving permit. DATE ISSUED: Date permit is issued by CPHU. E71;'?IRATION 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 ❑ PLUMBING ❑ ROOFING ❑ Owner of 12 Building 'p "' Architect Contractor f _ A l or Builder C, MIAMI SHORES VILLAGE, FLORIDA -. DATE I 19 PERMIT 7114 Contractor's License No. Work to be performed under this Permit Legal Lot Subdi_ Description Bl vision r Address of r -1 Value of �� 7 ` „�; °' Building �,.,..� it d Project $ � Amount of Permit $ This permit is granted to the contractor or builder named above to construct the building or to install the equipment or device descr i n the applica- tion herefor in strict compliance with all ordinances pertaining thereto and with the understanding that the work will be performed in compliance with any plans, drawings, statements or specifications that may 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 respon- sibility for work done by his agents, servants or employees. l+ y4 Signed. !.0 -' ._n+C... r� INSPECTOR Inconsideration of the issuance to me of this permit I agree to perform the work covered hereunder in compliance with all ordinances and regulations in strict c lormity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In as ssulpe spqisibillty for all work done by either, myself, my agent, servant or employee. ft CONTRACTOR" OR BUILDER BY AUTHORITY •a eon °` Permit No Owner's Name and Address__ State work to be performed and purpose of building (By Floors)_ New. Building Remodeling _____ Addition_ Size Septic Tank Amount of Permit $_ The undersigned applicant for this building permit does hereby certify that he understands under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws plied with the provisions thereof, and will require similar compliance from all contractors or performed under this permit; and will post or cause to be posted' for inspection on the site required by the Act. The undersigned agrees to employ only such sub - contractors, o licensed by Miami Shores Village. STATE OF FLORIDA, COUNTY OF DADE. My Commission Expires MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT (Signed) _ (Signed). Date Registered Architect and /or Engineer .... ____� — __ — __ _ Employing Plumber's Name_ - _ _.5�E _ _Y__ ! � _ 7 7;44/2 No. __ *_ Stree s�/ _ ........ __ - Location and Legal Description Lot_- ---------- _---- -_ - -_ Street and Number where work is to be performed —No V L_S�_ Street Subdivision_ Ai_ J:194C 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 / . Alf Street Repairs No. of Stories T Type of Tank Capacity Gals Feet of Drain - ff - - 'st. Feet of Tank or Drain Field from Well Nature of Water Supply: City — Well.___ _ _ _ _ _ — ____Size of Soakage Pit Plumbing Inspector. and accepts his obligations as an employer of labor of Florida Permanent Supplement, and has com- - contractors employed by him in the work to be e work such public once or notices as are to erforrygd y J r this permit, as are 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 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'N6 TOTAL FIXTURES CONTR. LIST _ CHECK - SEPTIC TANK SEWER CONN. DRAIN FIELD SOAKAGE PIT GREASE TRAP SOLAR HEATER DEEP WELL SPRKLR. SYSTEM SWIM'G POOL CONTR. LIST CHECK Permit No Owner's Name and Address__ State work to be performed and purpose of building (By Floors)_ New. Building Remodeling _____ Addition_ Size Septic Tank Amount of Permit $_ The undersigned applicant for this building permit does hereby certify that he understands under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws plied with the provisions thereof, and will require similar compliance from all contractors or performed under this permit; and will post or cause to be posted' for inspection on the site required by the Act. The undersigned agrees to employ only such sub - contractors, o licensed by Miami Shores Village. STATE OF FLORIDA, COUNTY OF DADE. My Commission Expires MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT (Signed) _ (Signed). Date Registered Architect and /or Engineer .... ____� — __ — __ _ Employing Plumber's Name_ - _ _.5�E _ _Y__ ! � _ 7 7;44/2 No. __ *_ Stree s�/ _ ........ __ - Location and Legal Description Lot_- ---------- _---- -_ - -_ Street and Number where work is to be performed —No V L_S�_ Street Subdivision_ Ai_ J:194C 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 / . Alf Street Repairs No. of Stories T Type of Tank Capacity Gals Feet of Drain - ff - - 'st. Feet of Tank or Drain Field from Well Nature of Water Supply: City — Well.___ _ _ _ _ _ — ____Size of Soakage Pit Plumbing Inspector. and accepts his obligations as an employer of labor of Florida Permanent Supplement, and has com- - contractors employed by him in the work to be e work such public once or notices as are to erforrygd y J r this permit, as are 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 inspection, or faulty materials and /or workmanship. Address of Building • CONTRACTOR OR BUILDER MIAMI SHORES VILLAGE. FLORIDA BUILDING ❑ ELECTRICAL ❑ P ERMIT N? PLUMBING 52 8 3 2 4 ROOFING ❑ Owner of Building Architect Contractor or Builder f - r', Legal Lot Bl. Description Subdi- vision DATE Contractor's License No P f Work to be performed under this Permit Sq. Ft Value of Project $ Amt. of Permit $ ) 195" 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 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 accepting this permit I assume responsibility for all work done by either, myself, my agent, servant or employee. BY AUTHORITY ;UILDING LECTRICAL 'LUMBING Jwner of 3uilding ".rchitect L'ontractor )r Builder Lf % - .egal Lot Description CONTRACTOR OR UILDER MIAMI SHORES VILLAGE, FLORIDA DATE +7— 1944. 'PERMIT N° 4758 V eye" Bl. Signed• Subdi- vision Contractor's License No Work to be performed under this Permit .idt kddress of Value of Amt. of Cd ',uilding AA Project Permit This permit is granted to the contractor or builder named above to construct the building or to install the equipment or device described in the appli- °ation herefor in strict compliance with all ordinances pertaining thereto and w th the understanding that the work will be performed in compliance with any ,lans, drawings, statements or specifications that may have been submitted to and approved by the proper municipal authorities. This Permit may be revoked it 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 lermit is granted is the understanding that the contractor or builder named above assumes the responsibility for a thorough knowledge of the ordinances and - egulations pertaining to the work covered hereby whether shown on the plans or drawings or in the statrents or specifications and that he assumes respon- sibility for work done by his agents, servants or employees. C ..., By 1 k INSPECTOR In consideration of the issuance to me of this permit I agree to perform the work covered hereundef in compliance with all ordinances and regulations )ertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. n accepting this permit I assume responsibility for all work done by either myself, my agent, servant or employee. BY AUTHORITY BUILDING ELECTRICM. PLUMBING Owner of Building Architect Contractor or Builder 8 -- Legal Lot Description sibility for work done by his agents, servants or employees. a CONTRACTOR ORIBUILDER ergo MIAMI SHORES VILLAGE, FLORIDA DATE 7 /� ' 7 ' 6 1944_ PERMIT N9 4758 Work to be performed under this Permi Subdi- vision Contractor's License No • /4) 9' Address of - Value of Amt. of (d`� Building Project Permit This permit is granted to 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 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'stat rents or specifications and that he assumes respon- gn By Signed. - INSP CTOR B In consideration of the issuance to m of is p 't I agree to perform the work covered hereundc in: compliance with Alt andlegiationSF pertaining thereto and in strict conformity with the ans, drawings, statements or specifications submitted to the proper authornt of Miami Shore i]ljl'age. In accepting this permit I assume responsibility for a. work done by either myself, lny agent, servant or employee. BY AUTHORITY