318 NE 101 St (4)M1151`Ez 1 *1
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE.
' 0A a R l o
Date ?' 9-99 Job Address 3 ' )\)L._ )61
Legal Description LL__
�1wner Lessee / Tenant � 7 Master Permit # ;7 im
Owne Address 3 101 4 51 " Phone O
Contracting Co CY ) 1-1 TS1i.i 1 L D Address W) ' (��i ,Noy. HOLZrODO,
Qualifier 41) i DON It LikNOYTWO SS# Phone(16i) � _ D5
State JAOS` CIR Municipal # Competency # Ins.Co. 4'VIJ)ONtL 1 45_
Architect /Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type(circle one): BUILDING � y ELECTRICAL MECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIPTION (�.�CL S�11OW ak PAID ` � ( - y)011 -
Square Ft. Estimated Cost(value) 1 366-
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 state
Signature of owner and /or Condo President
Date:
Notary as to Owner and /or Condo President
My Commission Expires:
FEES: PERMIT RADON C.C.F.
APPROVED: Fire Other
Zoning Buildin
Mechanical Plumbin
Tax Folio
Signature of Contractor or OwneflBuilder
Notary as t
My Commissi
NOTARY 1 5!
• :,,.1 AgtetT i a T 4 -Odll • er
i � COMMISSION NUMOE
Q CC255237
F
MY COMMISSION EXP.
P�N , * . J A ;. * **
TOTAL DUE .0' ° `)
Electrical
Engineering
ITEM
BATH TUB
UNIT
FEE
ITEM
SWITCH OUTLETS
UNIT
FEE
ITEM
SPACE HEATERS
UNIT
FEE
BIDET
LIGHT OUTLETS
CENTRAL HEATING
DISHWASHER
RECEPTACLES
A/C (WIND)
DISPOSAL
SERVICE TEMPORARY
A/C (CENTRAL)
DRINKING FOUNTAIN
SERVICE SIZE IN MPS
DUCT WORK
FLOOR DRAIN
SERVICE REPAIR/IETER CHANGE
REFRIGERATION
GREASE TRAP
APPLIANCE OUTLETS
PROCESS AND PRESS PIPING
INTERCEPTOR
RANGE TOP
UNDERGROUND TANKS
LAVATORY
OVEN
ABOVE GROUND TANKS
LAUNDRY TRAY
WATER HEATER
U.F. PRESSURE VESSELS
CLOTHES WASHER
MOTORS 0- 1 HP
STEAM BOILERS
SHOWER 01. f N
I
MOTORS OVER 1- 3 HP
HOT WATER BOILERS
SINK, POT /3 COMP.
MOTORS OVER 3- 5 HP
MECHANICAL VENTILATION
SINK, RESIDENCE
MOTORS OVER 5- 8 HP
TRANSPORTING ASSEMBLIES
SINK, SLOP
MOTORS OVER 8- 10 HP
ELEVATORS /ESCALATORS
TEMPORARY WATER CLOSET
MOTORS OVER 10- 25 HP
FIRE SPRINKLER SYSTEMS
URINAL
MOTORS OVER 25-100 HP
COOLING TOWERS
WATER CLOSET Re Sri
/
MOTORS OVER 100 HP
VIOLATION
INDIRECT WASTES
A/C WINDOW
REINSPECTION
WATER SUPPLY TO:
AIR CONDITIONERS
A/C UNIT
STRIP HEATER
FIRE SPRINKLER
GENERATORS TRANSFORMERS
HEATER -NEW INST.
GENERATORS TRANSFORMERS
HEATER- REPLACE
GENERATORS TRANSFORMERS
LAWN SPRINKLER -WELL
SPECIAL PURPOSE
SWIMMING POOL
OUTLETS COMMERCIAL
WATER SERVICE
SIGN TUBES
SEWER CONNECTIONS
SIGN TRANSFORMERS
UTILITY -SEWER
SIGN TIME CLOCK
UTILITY -WATER
FIXTURES
SEPTIC TANK
ANTENNA
RELAY
TELEVISION OUTLETS
DRAINFIELD, 4' TILE/RES.
VIOLATION
PUMP & ABANDON SEPTIC TANK
REINSPECTION
SOAKAGE PIT CU. FT.
CATCH BASIN
DISCHARGE WELL
DOMESTIC WELL
AREA CRAIN
ROOF INLET
SOLAR WATER HEATER
FIRE STANDPIPE
POOL PIPING
LAWN SPRINKLER SYSTEM
GAS RANGE
METER SET (GAS)
GAS PIPING
ADDENDUM TO BUILDING PERMIT APPLICATION
(AN APPLICATION FOR BUILDING PERMIT MUST ACCOMPANY THIS ADDENDUM. IF A MASTER PERMIT HAS BEEN
OBTAINED, THE OWNER'S NOTARIZED SIGNATURE NEED NOT BE PRESENT ON SUBSEQUENT APPLICATIONS.)
PLUMBING
ELECTRICAL
MECHANICAL
9'f I
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 _ e T / - _. -1__ f '' G No.
Registered Architect and /or Engineer
Employing Plumber's Name -_L
Location and Legal Description Lot
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.
Permit No
Size Septic Tank_ . __.--- - - - - - - -� -- _____Type of Tank,_
Feet of Drain Ti1e._._/.2-
Nature of Water Supply: City - Well. __,_---- .- . -__ -- - - -_ —.. -Size of Soakage Pit
Amount of Permit $
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
_Dist. Feet of Tank or Drain Field from Well.
Bloch
(Signed)
LA-2
Date.. 3..:
Capacity Cals.
Street._ -3C P.._:. , ti o l s
Street
Repair No. of Stories
Plunt
, ... C
i g Inspecto,,
employer of labor
The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations as
under the Florida Workmen's Compensation Act, being Section 5968, Compiled General Laws of Florida Permanent Sul ement, and Isar 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 perinit, as are
licensed by Miami Shores Village.
Master Plumber.
STATE OF FLORIDA, I µ
COUNTY OF DADE.
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeared
to me well known, and who, being by me first duly sworn, upon oath deposes and says that he is the ...- __ -. -- ... .......... . ..... .. ....._ _..
of the above described construction, that he has carefully read the foregoing application, and that he did sign the same, and that all facts
therein by him stated are true.
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 neoasary by improper notice for inspection, or faulty
materials and /or workmanship.
CLOSETS
BATH
Tuef
HOW
SHOWERS
LAVA•
Tomlin
SINKS
SLOP
SINKS
LAUNDRY
Tuse
URINALS
CATCH
DAAIN
FLOOR
DRAIN
DRINKING
FOUNT'NS
TOTAL
FIXTURE[
CONTR.
LIST
CHECK
SEPTIC
TANK
SEWER
CONN.
DRAIN
FIELD
SOAKAGE
PIT
GREASE
TRAP
SOLAR
HEATER
DRIP
WELL
SPRKLR.
SYSTEM
SWING
POOL
Co. NTR
LIST
CHECK
9'f I
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 _ e T / - _. -1__ f '' G No.
Registered Architect and /or Engineer
Employing Plumber's Name -_L
Location and Legal Description Lot
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.
Permit No
Size Septic Tank_ . __.--- - - - - - - -� -- _____Type of Tank,_
Feet of Drain Ti1e._._/.2-
Nature of Water Supply: City - Well. __,_---- .- . -__ -- - - -_ —.. -Size of Soakage Pit
Amount of Permit $
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
_Dist. Feet of Tank or Drain Field from Well.
Bloch
(Signed)
LA-2
Date.. 3..:
Capacity Cals.
Street._ -3C P.._:. , ti o l s
Street
Repair No. of Stories
Plunt
, ... C
i g Inspecto,,
employer of labor
The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations as
under the Florida Workmen's Compensation Act, being Section 5968, Compiled General Laws of Florida Permanent Sul ement, and Isar 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 perinit, as are
licensed by Miami Shores Village.
Master Plumber.
STATE OF FLORIDA, I µ
COUNTY OF DADE.
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeared
to me well known, and who, being by me first duly sworn, upon oath deposes and says that he is the ...- __ -. -- ... .......... . ..... .. ....._ _..
of the above described construction, that he has carefully read the foregoing application, and that he did sign the same, and that all facts
therein by him stated are true.
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 neoasary by improper notice for inspection, or faulty
materials and /or workmanship.
Permit No.
Nature of Water Supply: City —Well.
Amount of Permit $
STATE OF FLORIDA,
ss.
COUNTY OF DADE.
My Commission Expires
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
3 (F3
Size Septic Tank Type of Tank
Feet of Drain AN -------- Dist. Feet of Tank or Drain Field from Well--_-__
(Signed) —
Date_
Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submi(ted for e 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 $� �1_'�______ No 81 _
Registered Architect and /or Engineer ____ —____ ___ — /'
Employing Plumber's Name _ ,f�_ _r_,� !!_[_ No._____ Street_�s • • d /
Location and Legal Description Lot____ — JL 1C_____Block --
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
Street
Subdivision
Capac' y Gals
.Size of Soakage Pit ____________ ______ ______________
The undersigned applicant for this building permit does hereby certify that heLt derstands and accepts his obligations as an(gytfployer 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
No. of Stories
Plum Inspector.
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'G
POOL
CONTR.
LIST
CHECK
Permit No.
Nature of Water Supply: City —Well.
Amount of Permit $
STATE OF FLORIDA,
ss.
COUNTY OF DADE.
My Commission Expires
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
3 (F3
Size Septic Tank Type of Tank
Feet of Drain AN -------- Dist. Feet of Tank or Drain Field from Well--_-__
(Signed) —
Date_
Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submi(ted for e 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 $� �1_'�______ No 81 _
Registered Architect and /or Engineer ____ —____ ___ — /'
Employing Plumber's Name _ ,f�_ _r_,� !!_[_ No._____ Street_�s • • d /
Location and Legal Description Lot____ — JL 1C_____Block --
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
Street
Subdivision
Capac' y Gals
.Size of Soakage Pit ____________ ______ ______________
The undersigned applicant for this building permit does hereby certify that heLt derstands and accepts his obligations as an(gytfployer 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
No. of Stories
Plum Inspector.
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.
3
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 ___ (, — ___,/'!_ft��!!_.__________ No.
Registered Architect and /or Engineer
Employing Plumber's Name __ _ _ _ T
Location and Legal Description Lot_____— 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 No. of Stories_
Septic Tank_-___ — _— .— ______ Type of Tank
Feet of Drain Tile_____ Q___- __- __-- -__ Dist. Feet of Tank or Drain Field from Well
Nature of Water Supply: City —Well
Amount of Permit $_
APPLICATION FOR PLUMBING PERMIT
_too
ss.
My Commission Expires
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
3ir
2Lt treet../ o/
No.__ Street----- aC__i!�c - _�r ✓�
Size of Soakage Pit
(Signed) _________
Date_
apac' y Gals._ O _�_____��
Notary Public. State of Florida
(Signed)
Plumbing Inspector. --
The undersigned applicant for this building permit does hereby certify that heLutiderstands and accepts his obligations as an gplployer 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 ate
licensed by Miami Shores Village.
STATE OF FLORIDA,
COUNTY OF DADE.
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally
appeared
to me well known, and who, being by me first duly sworn, upon oath deposes and says that he is the
of the above described construction, that he has carefully read the foregoing application, and that he did sign the same. and that all facts
therein by him stated are true.
NOTE: A re- inspection fee of $1.00 will be made when such re- inspection is made necessary by improper notice for inspection, or faulty
materials and /or workmanship.
CLOSETS
BATH
TUBS
SHOWERS
LAVA-
TORIES
SINKS
SLOP
SINKS
LAUNDRY
TUBS
URINALS
CATCH
BASIN
FLOOR
DRAIN
DRINKING
FOUNT'N5
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.
3
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 ___ (, — ___,/'!_ft��!!_.__________ No.
Registered Architect and /or Engineer
Employing Plumber's Name __ _ _ _ T
Location and Legal Description Lot_____— 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 No. of Stories_
Septic Tank_-___ — _— .— ______ Type of Tank
Feet of Drain Tile_____ Q___- __- __-- -__ Dist. Feet of Tank or Drain Field from Well
Nature of Water Supply: City —Well
Amount of Permit $_
APPLICATION FOR PLUMBING PERMIT
_too
ss.
My Commission Expires
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
3ir
2Lt treet../ o/
No.__ Street----- aC__i!�c - _�r ✓�
Size of Soakage Pit
(Signed) _________
Date_
apac' y Gals._ O _�_____��
Notary Public. State of Florida
(Signed)
Plumbing Inspector. --
The undersigned applicant for this building permit does hereby certify that heLutiderstands and accepts his obligations as an gplployer 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 ate
licensed by Miami Shores Village.
STATE OF FLORIDA,
COUNTY OF DADE.
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally
appeared
to me well known, and who, being by me first duly sworn, upon oath deposes and says that he is the
of the above described construction, that he has carefully read the foregoing application, and that he did sign the same. and that all facts
therein by him stated are true.
NOTE: A re- inspection fee of $1.00 will be made when such re- inspection is made necessary by improper notice for inspection, or faulty
materials and /or workmanship.
OWNER
LOT
BLOCK
SUBDIVISION
Date
Issued to
ddliami cfhores9 llage
F L O A ID A
to install the following described plumbing, in accordance with the laws, statutes and regu-
lations of Miami Shores Village, Florida and the State of Florida, governing plumbing and
drainage work done in Miami Shores Village, Florida.
For a_i_story building at '
PLUMBING PERMIT N9 743
Fixtures
Fixtures 1'
Sewer / $
Septic Tank $
Total $
Village Plumbing Inspector
Received Payment by
1� `
` OWNER
LOT
BLOCK
SUBDIVISION
.i'/1// 4 LA f11/ir,4/
9 r LC /r).
2/2_
� :t ;', At _A:r ,
e 7/ /
ssued to -t 1
iarni �hores' llage
F L O A 9 D A
PLUMBING PERMIT N9 743
4 !/t. t_ .
to install the following described plumbing, in accordance wf h the laws, statutes and regu-
lations of Miami Shores Village, Florida and the State of Florida, governing plumbing and
drainage work done in Miami Shores Village, Florida. f ^' i 7
For a _.story _ / ' ° ,, . j ,, 44 building at �Jr' / 9 % (:7 / / ,,,,r r
Fixtures .ts o pt 1./ CI e m e z !,: ';4, /, -, 4 -0 �� c. f . v ,:,/,:,
/ - . ,i, , / fr f r
Fixtures p $
Sewer
tic Tank
Total
$
$
Village Plumbing Inspector (( /* ,
Received Payment by s' � � 4r.
JXC%
e t-