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802 NE 100 St (5)Company Phone # Inspection Date Approved Correction Re- Insp'n Fee MIAMI SHORES VILLAGE BUILDING DEPARTMENT 305- 795 -2204 Building Inspection Reque t Date Type Insp'n Permit No. Name CJLXJ� Address O ` _ 1 001> 7604 II _� BUILDING PERMIT APPLICATION FBC 2001 Tenant/Lessee Name w . e Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 Permit No. 1? X04 —' 3. Master Permit No. Permit Type (circle): Building Electrical Plumbing" Mechanical Roofing 7.5` ' / d 3 Owner's Name (Fee Simpllee Titleholder) / i 6 `-s 6 .e Phone # Owner's Address bt% Z NE [Q a 5 Cit /LIani j StliveS State f Zip 3 Phone # Job Address (where the work is being done) 8' a /V i�S t7 City Miami Shores Village County Miami -Da Zip Is Building Historically Designated YES NO Contractor's Company Name WOICI f fJ.,J.Ct 7;J( Phone #,,S6/5 ' 3'2 0 Contractor's Address / 7'2 3 5 A A/ v / 2 c t' City /1/ t . ' State "= / Zip 33/5 Qualifier Architect/Engineer's Name (if applicable) 7V/4 $ Value of Work For this Permit f 06 d ❑Addition ['Alteration ENew 0/ epair/Replace ❑ Demolition Type of Work: � �� Describe Work: fL5Y� /1e..1"✓ -3o "Sel � T aPrr Q r v1 T && ^ / 4 o p t e xi's `n .5se Submittal Fee $ Permit Fee $ I / 1S - 0 0 CCF $ - 3 . CO /CC Notary $ Training/Education Fee $ e (- l J Technology Fee $ 33- Scanning $ 3 . (Y) Radon $ Zoning Bond $ - Code Enforcement $ Structural Plan Review. $ Total Fee Now Due $ 9g1 - I (Continued on opposite side) // c e ,iccdQ�_ Phone # Square Footage Of Work: � 6 * * * * * * * * * * * * * * * * * * * * * * * * * * ** F ees * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** Bonding Company's Name (if applicable) Bonding Company's Address s City State Zip Mortgage Lender's Name (if applicable) Mortgage Lender's Address City State Zip Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRICAL WORK, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and AIR CONDITIONERS, ETC 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. "WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT 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." Notice to Applicant: As a condition to the issuance of a building permit with an estimated value exceeding $2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is• issued. In the absence of such posted notice, the inspection will n• - ..proved an • • einspec 'on fee wil be charged. Owner o gent The foregoing instrument was acknowledged before me this \ 0 day of e JU 20 , by t 1 unG S (. y ' I , who is personally known to me or who has produced C 2)10 LIC: As identification and who did take an oath. NOTARY Sign: Print: My Commission Expires: Bonded T Aflantie Rondhng Co., C Inc. APPLICATION APPROVED B Chc 12/15/03 X 1 1 1 . 1' Commission #DD2319 1 as Signature/ Contractor The foregoing instrument was acknowledged before me this 10 day of , 2004, by I PII COQ PG' ... who is ersonally known to me or who has produced G ibo NOTARY PUBLI Sign: i 0 l 1 - " e r te Print: 1 My Commission Expires: as identification and who did take an oath. Mabel Vargas .mm'. in #DD231984 •s: Jul 13 2007 ,.-- Bo ed ding C R dinQCo.,Inc. (Certificate of Competency Holder) State Certificate or Registration No. Certificate of Competency No. * * * * * * * * * * * * * * * * * * * * * * * * * * * ** ** * ** ******************************* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** Plans Examiner Engineer Zoning .STATE OF FLORIDA fi :h IR DEPARTMENT OF HEALTH ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM CONSTRUCTION PERMIT CONSTRUCTION PERMIT FOR: [ ]New System [ ]Existing System [ ]Holding Tank [ ] Innovative Other [ X ]Repair [ ]Abandonment [ ]Temporary [ NA ] APPLICANT: Carter, Francis R &/W Alba AGENT: WALLACE P, Ponder Wallace PROPERTY STREET ADDRESS: 802 NE 100 St Miami Shores FL 33138 LOT: 11 BLOCK: 10 SUBDIVISION: Miami Shores [Section /Township /Range /Parcel No.] PROPERTY ID #: 11- 3206 - 034 -0080 [OR TAX ID NUMBER] SYSTEM MUST BE CONSTRUCTED IN ACCORDANCE WITH SPECIFICATIONS AND STANDARDS OF CHAPTER 64E -6,FAC DEPARTMENT APPROVAL OF SYSTEM DOES NOT GUARANTEE SATISFACTORY PERFORMANCE FOR ANY SPECIFIC TIME PERIOD. 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. ISSUANCE OF THIS PERMIT DOES NOT EXEMPT THE APPLICANT FROM COMPLIANCE WITH OTHER FEDERAL, STATE OR LOCAL PERMITTING REQUIRED FOR PROPERTY DEVELOPMENT. SYSTEM DESIGN AND SPECIFICATIONS T [ 900 ]Gallons SEPTIC TANK MULTI- CHAMBERED /IN SERIES: [Y ] A [ 0 ]Gallons MULTI- CHAMBERED /IN SERIES: [Y ] N [ 0 ]GALLONS GREASE INTERCEPTOR CAPACITY K [ 0 ]GALLONS DOSING TANK CAPACITY [ 0 ]GALLONS @ [0 ]DOSES PER 24 HRS # PUMPS[ 0 ] D [ 200 ]SQUARE FEET PRIMARY DRAINFIELD SYSTEM R [ 0 ]SQUARE FEET SYSTEM A TYPE SYSTEM: [ N ]STANDARD [ N ]FILLED [ N ]MOUND [ N ] I CONFIGURATION: [ N ]TRENCH [ N ]BED [ N ] N F LOCATION TO BENCHMARK: 13.40'NGVD FF E/R I ELEVATION OF PROPOSED SYSTEM SITE [ 2.1 ] [ FEET ] [ BELOW BENCHMARK /REFERENCE POINT E BOTTOM OF DRAINFIELD TO BE [ 4.8 ] [ FEET ] [ BELOW BENCHMARK /REFERENCE POINT L D FILL REQUIRED: [ 0.0 ]INCHES EXCAVATION REQUIRED: [ 32.0 ] INCHES OTHER REMARKS: This permit is for a unique blackwater, standard, gravity and single -bed system to remain serving the existing single - family residence, it is NOT FOR ADDITION. Existing 900 gals. septic tank to be inspected for an appropriate pump -out and a solid vertical deflector installed on the outlet device. The pump -out receipt shall be provided prior to the granting of the final approval. Install no less than 200 sq. ft. new positioned, drainfield, draining to the certified existing suitable soil in the site previous confirmation of the aforementioned condition in the entire area plus in the 12" wide around the perimeter to 44" deep. Invert elevation of drainfield to be no less than 9.13' NGVD. Bottom of drainfield elevation to be no less than 8.63' NGVD. SPECIFICATIONS BY: RAM, Arrieta, Roland TITLE: APPROVED BY: Arrieta, Rolando TITLE: Engineer I Dade CHD DATE ISSUED: 3/5/04 EXPIRATION DATE: 6/3/04 DH 4016, 03/97 (Obsoletes previous editions which may not be used) (Stock Number: 5744- 001 - 4016 -0) Iostds cons 4016 -1) CENTRAX #: 13 -SG -19789 DATE PAID: FEE PAID : $ RECEIPT . OSTDSNBR : 04 -0758- -R Page 1 of 2 APPLICANT: AGENT: MAILING ADDRESS: PROPERTY INFORMATION DIRECTIONS TO PROPERTY: BUILDING INFORMATION Unit Type of No Establishment 3 4 SIGNATURE: [ ] Floor /Equipment Drains STATE OF FLORIDA DEPARTMENT OF HEALTH ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM APPLICATION FOR CONSTRUCTION PERMIT APPLICATION FOR: 1 [ f ] New System [/ Existin g System , ' (/ , ^ Y _� Y stem If ✓ / Holding Tank Innovative [ ] Repair [ N] Abandonment ['"J Temporary [ ] Fnancs C4- 41/2 LC' /IA ,— LOT: / BLOCK: /d SUBDIVISION: PROPERTY ID # : li 32C6 '03Y `Gv k o nos [ RESIDENTIAL ] Other (Specify) DH 4015, 10/97 (Previous Editions May Be Used) //l SAo [ ] COMMERCIAL PERMIT NO. DATE PAID: FEE PAID: RECEIPT #: / X6_ S c N Si TELEPHONE: - 2Cix TO BE COMPLETED BY APPLICANT OR APPLICANT'S AUTHORIZED AGENT. SYSTEMS MUST BE CONSTRUCTED BY A PERSON LICENSED PURSUANT TO 489.105(3)(m) OR 489.552, FLORIDA STATUTES. IT IS THE APPLICANT'S RESPONSIBILITY TO PROVIDE DOCUMENTATION OF THE DATE THE LOT WAS CREATED OR PLATTED (MM /DD /YY) IF REQUESTING CONSIDERATION OF STATUTORY GRANDFATHER PROVISIONS. ZONING: /4/4 I/M OR EQUIVALENT: [ Y / N ] PROPERTY SIZE: /12? IS SEWER AVAILABLE AS PER 381.0065, FS? [ Y / 0 DISTANCE TO SEWER: PROPERTY ADDRESS: 33/ : 9 PLATTED: / P$� ACRES WATER SUPPLY: [ ] PRIVATE PUBLIC [ i.I < =2000GPD [ ] >2000GPD No. of Building Commercial /Institutional System Design Bedrooms Area Sqft Table 1, Chapter 64E -6, FAC Page 1 or 4 FT DATE : Scale: Each block represents 5 feet and 1 inc = _ 1 eet. ................ 1 I I , ! ' ■ _4_ 1, i 7 1 ■ 1 _ 7 1 . . _,..., . ....._4... j___,,.....,_ :.. _.. 1 1 MINIX ,, _ ...,,... __ - H 1 NEN 14 1 I i_L i , i_ ___,_, ' ! 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I A . 4, i 1 , I - - 7 # 911 STATE OF FLORIDA DEPARTMENT OF HEALTH APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEVCONSTRUCTION PERMIT Permit Application Number U PART H - SITE PLAN DH 4015, 10/98 (Replaces HRS-H Form 4015 which may be used) (Stodc Number: 5744-032-40154) Site Plan submitted by:. / -- Signature Plan Approved fft\ (1 Not 1 L.4/ . Rolando Ariieta (PO i • A - By Miami-Dade County f...2 4- ",/(25/ 2624 f -. County Health Department Health Department OSTDS Engineering Section . ALL CHANGES MUST BE APPROVED BY THE COUNTY HEALTH DEPARTMENT 4_, Page 2 of 3 STATE OF FLORIDA DEPARTMENT OF HEALTH APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PERMIT Permit Application Application Number k,- Scale: Each block represents 5 feet and 1 inch =50 feet. 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PT `, 1--t a / liw i p t i ummin T7---1, .- ...,_ 4- -t HiLl--t1 -. : 1 71 i i, STATE OF FLORIDA DEPARTMENT OF HEALTH APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PERMIT Permit Application Application Number k,- Scale: Each block represents 5 feet and 1 inch =50 feet. Plan Approved DH 4015. 10/98 (Replaces HRS-H Form 4015 which may be used) (SW& Number:5744-002-40154) PART II SITE PLAN- Site Plan submitted. by: Signature NotApproved ALL CHANGES MUST BE APPROVED BY THE COUNTY HEALTH DEPARTMENT Date 11-e- By County Health Department Page 2 of 3 L• STATE OF FLORIDA DEPARTMENT OF HEALTH ONSITE SEWAGE DISPOSAL SYSTEM SITE EVALUATION AND SYSTEM SPECIFICATIONS APPLICANT: F'\ LOT: / / BLOCK: ` z) SUBDIVISION: PROPERTY SIZE CONFORMS TO SITE PLAN: [ TOTAL ESTIMATED SEWAGE FLOW: 24 d AUTHORIZED SEWAGE FLOW: 6 Y Y UNOBSTRUCTED AREA AVAILABLE: 70 r NOCHMAHK/REFERENCE POINT LOCATION: ELEVATION OF PROPOSED SYSTEM SITE IS 2 „ SOIL PROFILE INFORMATION SITE 1 Munsel Color Texture Depth `) . 1 a L/ to (OW / ,- to b I UY ✓e / 6If l 1 / to .� . ` \ 1 to < / \ 1 to \ I 1 \ to \ / i ' to / sort s � E USDA sort SERIES: , hi,”- SITE EVALUATED BY: 244,41,40,---- 4 DH 4015, 10/96 (Replaces HRS -H Form 4015 [Page 3) which may be used) (Stock Number: 5744- 003 - 4015 -1) AGENT: , [INCHES/el [ABOVE W /(A P 6(21.0 � 11, 5 PROPERTY ID #: 2 (Section /Township /Range /Parcel No. or ax ID Number] p es TO BE COMPLETED BY ENGINEER, HEALTH UNIT EMPLOYEE, ORCQTHRR_QinT.TFIED PER OS N J ENGINEER'S MUST PROVIDE REGISTRATION NUMBER AND SIGN AND SEAL EACH PAGE OF SUBMITTAL. COMPLETE ALL ITEMS. YES [ ] NO NET USABLE 'A AVAILABLE: ,02 6 ACRES GALLONS PER DAY ID (Rt ABLE 1 / OTHER -TABLE 2) GALLONS PER DAY [1500 GPD /ACRE OR D CRE] SQFT UNOBSTRUCTED AREA REQUIRED: .Sa SQFT PERMIT # 01 REFERENCE POINT THE MINIMUM SETBA WHICH CAN BE MAINTAINED FROM THE PROPOSED SYSTEM TO THE FOLLOWING FEATURES:_ SURFACE WATER: ,v41 FT DITCHES / S WALES : A,��7 FT N A� ORMALLY WET? [ ] YES s L..KNO WELLS: PUBLIC: A//1 FT LIMITED USE: `ijv/�fy FT PRIVATE: ?KO FT NON - POTABLE: AP.22V FT BUILDING FOUNDATIONS: S FT PROPERTY LINES: FT POTABLE WATER LINES: 2r) FT SITE SUBJECT TO FREQUENT FLOODING: [ ] YES [ NO 10 YEAR FLOODING? [ ] YES [ 4./N0 10 YEAR FLOOD ELEVATION FOR SITE: FT MSL/NGVD SITE ELEVATION: /`$ FT MSL /NGVD <W ZS'2 SOIL PROFILE INFORMATION SITE 2 t. OBSERVED WATER TABLE: 4 INCHES [ABOVE / BELOW] EXISTING GRADE. ';TYPE PERCHED / APPARENT] ESTIMATED WET SEASON WATER TABLE ELEVATION Q '? } , 6 INCHES [ ABOVE / ] EXISTING GRADE. HIGH WATER TABLE VEGETATION: [ ], YES [1 N0 MOTTLING: [ ] YES [ NO DEPTH: 4"4- INCHES SOIL TEXTURE /LOADING RATE FOR,SYSTEM SIZING: )/G .5 DEPTH OF EXCAVATION:32 INCHES DRAINFIELD CONFIGURATION: [ ') TRENCH [ ] BED [ ] OTHER (SPECIFY) REMARKS /ADDITIONAL CRITERIA: P. DATE: Page 3 of 3 APPLICANT: CONTRACTOR LOT: X 1 1 TO BE COMPLETED_BY FLORIDA REGISTERED ENGINEER, DEPARTMENT EMPLOYEE, SEPTIC TANK CONTRACTOR OR OTHER CERIIEIBD °4R D SIGN AND SEAL ALL SUBMITTED DOCUMENTS. COMPLETE ALL APPLICABLE ITEMS. COMPLETE TANK CERTIFICATION BELOW OR ATTACH LETTER FROM A PERMITTED SEPTAGE DISPOSAL SERVICE. EXISTING TANK INFORMATION STATE OF FLORIDA DEPARTMENT OF HEALTH ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM EXISTING SYSTEM AND SYSTEM REPAIR EVALUATION [ `00 ] GALLONS SEPTIC TANK /GPD ATU LEGEND: [ ] GALLONS SEPTIC TANK /GPD ATU LEGEND: [ ] GALLONS GREASE INTERCEPTOR LEGEND: [ ] GALLONS DOSING TANK LEGEND: his r (.‘ ik, tfe 1iN � t�v� [ 1C 7 BLOCK: 10 SUBDIV: � / / 1 1� e � Q { ^� ID# : ("or( I CERTIFY THAT THE ABOVE NOTED TANKS WERE PUMPED ON Z /?3/64, HAVE THE VOLUMES SPECIFIED, ARE STRUCTPRALLY SOUND, • ,I HAVE A [ SOLIDS DEF ECTIO DEVICE / 1UU4,gm rr Ir•TE D�EVY ] INSTALLED. c SIGNATURE OF LICENSED CONTRACTOR BUSINESS NAME DATE EXISTING DRAINFIELD INFORMATION [2o0 ] SQUARE FEET PR •Y DRAINFIELD SYSTEM NO. OF TRENCHES [ ] DIMENSIONS: /0 X ? D [ ] SQUARE FEET SYSTEM NO. OF TRENCHES [ ] DIMENSIONS: X TYP OF SYSTEM: [ STANDARD [ ] ILLED [ ] MOUND [ ] CONFIGURATION: [ ] ENCH [ BED [ ] DESIGN: [ HEADER [ ] D -BOX [ ] GRAVITY SYSTEM [ ] DOSED SYSTEM ELEVATION OF BOTTOM OF DRAINFIELD IN RELATION TO EXISTING GRADE 32_ INCHES [ ABOVE / LOW)) SYSTEM FAILURE AND REPAIR INFORMATION [ /96/ ] SYSTEM INSTALLATION DATE TYPE [ ,ix ] GPD ESTIMATED SEWAGE FLOW BASED ON [ ZOO SITE [ DRAINAGE STRUCTURES [ ] POOL CONDITIONS: [ l S -•ING PROPERTY 1 1 NATURE OF [ HYDRAULIC OVERLOAD [ ] SOILS FAILURE: [ ] DRAINAGE / RUN OFF [ ] ROOTS FAILURE [ ] SEWAGE ON GROUND SYMPTOM: [ ] PLUMBING BACKUP REMARKS /ADDITIONAL CRITERIA [ ] TANK [ ] DH 4015, 10/96 (Previous Editions may be used) 0 MATERIAL. MATERIAL: MATERIAL: MATERIAL: PERMIT # ( 1 - 0 l b 3 STE [ ] DOMESTIC [ ] COMMERCIAL TERED WATER [ 41--rKBLE 1, 64E -6, FAC [ ] PATIO / DECK [ ] PARKING [ ] MAINTENANCE [ ] SYSTEM DAMAGE [ ] WATER TABLE [ ] [ ] D BOX /HEADER [- DRAINFIELD BAFFLED:[Y /,0 BAFFLED:[Y / N] # PUMPS:[ SUBMITTED BY: / 4f /� TITLE /LICENSE (,2 DATE: Z - 2S-'V 6 Page 4 of 4 Miami Shores Village 10050 NE 2nd Avenue Printed: 3/12/2004 Applicant: ALBA CARTER Owner: CARTER ALBA JOB ADDRESS: 802 NE 100 ST Contractor W P SEPTIC TANK CO INC Local Phone: 305 - 620 -6320 Parcel # 1132060340080 Signed: (INSPECTOR) Plumbing Permit Phone: 305 - 795 -2204 Permit Number: PL2004 -83 Contractor's Address: 17235 NW 12 CT Page 1 of 1 Legal Description: 5 -6 53 42 MIAMI SHORES SEC 8 PB 14 -33 LOT 11 & W1/2 OF 10 BLK 169 LOT Fees: Description Amount FEE2004 -2506 Building Fee $175.00 FEE2004 -2507 CCF $1.20 FEE2004 -2508 Notary Fee $5.00 FEE2004 -2509 Training and Education Fee $0.60 FEE2004 -2510 Scanning Fee $3.00 FEE2004 -2511 Technology Fee $4.37 FEE2004 -2512 Builders Bond $300.00 Total Fees: $489.17 Total Fees: $489.17 Total Receipts: $489.17 Permit Status: APPROVED Permit Expiration: 9/6/2004 Construction Value: $2,000.00 Work: INSTALL A NEW 300 SQ FT DRAINFIELD ON EXISTING SEPTIC TANK 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 responisibility for all work done by either myself, my agent, servants or employes. Signed: (Contractor or Builder) BY: Date PERMIT APPLICATION " P PL FOR MIAMI SHORES VILLAGE Oa Job Address oa� ' . C. k) d 5T. Tax Folio Legal De§cription Owner/Lessee / Tenant X Carter Owner's Address ��- ` , c� c� 5 r Contracting Co. Historically Designated: Yes QualifierIU 1604 State # CMG 63 7O 7L_ Municipal # Architect/Engineer Bonding Company Mortgagor Permit Type (circle one): BUILDING ELECTRIC PL MBIN WORK DESCRIPTION ,) L( 4- Notary as to My C '2:.zGrw 73 � er and/or Condo President Date Ill i tDescIAL NOTARY SEAL O \ O. S MARGARITA M ONTIEL v i H i n COMMISSION NUMBER "�t 1 5 `;% .0 CC797277 - J �O MY COMMISSION EXPIRES OF f.1. DEC. 17,2002 FEES: PERMIT 3 RADON APPROVED: Zoning Mechanical Plumbing Competency # Address Address Address 4 ssa ( c) 7 / ? Address S cg e.D' G Z SS #bo7 - 4S - 2 SePhonc[306 - j 7V .166° Master Permit # Phone MECHANICAL ROOFING PAVING FENC E..... SIGN Square Ft. Estimated Cost (value 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 • ning. Furthermore, I a • the above- ed contractor ork . tate7 Signature of owner and/or , • Presi : t Signa : of Co�or o 4i ► Date - Builder tractor or Owner - Builder O fl S °5o�l a .h ez * ,_y *My Commission CC662977 44.0,„ Expires July 13, 2001 No 3 1 / 1 7 4 7— i/ 67e( Ins. Co. C.C.F. • 60 NOTARY vr-- BOND TOTAL DUE 000 Date Building Electrical Structural Engineer .ep 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 AWS DUCT WORK FLOOR DRAIN SERVICE REPAIR/METER CHANGE REFRIGERATION GREASE TRAP APPLIANCE OUTLETS PROCESS AND PRESS PIPING INTERCEPTOR RANGE TOP UNDERGROUND TANKS LAVATORY OVEN ABOVE (MOUND TANKS LAUNDRY TRAY WATER HEATER U.F. PRESSURE VESSELS CLOTHES WASHER MOTORS 0- 1 HP STEAM BOILERS SHOWER MOTORS OVER 1- 3 HP HOT WATER BOILERS SINK, POT /3 COMP. MOTCRS 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 MOTCRS OVER 10- 25 HP FIRE SPRINKLER SYSTEMS URINAL MOTORS OVER 25-100 HP COOLING TOWERS WATER CLOSET MOTORS OVER 100 If 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 f SIGN TUBES SEWER CONNECTIONS SIGN TRANSFORMERS JTILITY -SEWER SIGN TIME CLOCK ITILITY -WATER FIXTLRES ;EPTIC TANK ANTENNA -• IELAY TELEVISION OUTLETS IRAINFIELD, 4' TILE/RES. VIOLATION tNf 8 ABANDON SEPTIC TANK REINSPECTION OAKAGE PIT CU. FT. ATCH BASIN DISCHARGE WELL :OMESTIC WELL REA DRAIN OOF INLET OLAR WATER HEATER IRE STANDPIPE OOL PIPING AWN SPRINKLER SYSTEM AS RANGE _TER SET (GAS) AS PIPING (AN APPLICATION FOR BUILDING PERMIT MUST ACCOMPANY THIS ADDENDUM. IF A MASTER PERMIT HAS B. OBTAINED, THE0 'S NOTARIZED SIGNATURE NEED NOT BE PRESENT ON SUBSEQUENT APPLICATIONS.) ADDENDUM TO BUILDING PERMIT APPLICATION ELECTRICAL MECHANICAL Date / 2 / /�l/Job Address 76 A /06 Tax Folio Legal Description Historically Designated: Yes l / No Owner/Lessee / Tenant ∎ / e gJ<< �i�,e r t e .4e_ Master Permit # �1 / �/ /o2� Owner's Address 1 XUG / a e, S r - Phone 30S - 75 - /703 Contracting Co. /1d,p ■ff S a • Address /B g ..) d2 7 /Q ae Qualifier /4 k /!/ pc/ Z SS # Phone a>5 �' 3 -457 State # Municipal # Competency # Ins. Co. Architect/Engineer Address Bonding Company Address Mortgagor Address Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN WORK DESCRIPTION /` J A) Y ¢ S d t cry" a, L.0 i 1e-, / 1e-, "el)" - C cit Se r lco L - L. P. c s' MI5 _ E Ft. Estimated Cost (value) ‘ D O 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. r-- `? 7 ,4 A7_T Signature of owner and/or Condo President Date Signature of Contractor or Owner- Builder Date Notary as to Owner and/or Condo President Date Notary as to Contractor or Owner- Builder Date My Commission Expires: FEES: PERMIT , D RADON PERMIT APPLICATION FOR MIAMI SHORES VILLAGE My Commission Expires: C.C.F. ° NOTARY BOND APPROVED: TOTAL DUE ‘6) Zoning Building Electrical Mechanical Plumbing , Structural Engineer 11 - 7 ( S //:5 ,.�;l a) o /,),rv'Xu.. aN NOS °Pewee =4t = 5 r G 1' c) Date /P « )::i Legal Dtioe .....__..... _ .. Ai tE (e3 'i•frr O nlar/I c + Tenant Owner's Address Dal I2 • /D© Contracting Co. bike ( Qualifier /00- E::l t..t e; SSB ./ Phone S't 0 Architect/finttirrc er -- - Bonding Carnpany Mortgagor Square Ft. !1j Jots ,Address ri4 160 Tax Folio istorically .Dcsignatid. 1 'cy_�,_ ._r,. , . —. N ^ —_... _.�.. -•-- -- Masu :r Permit 1i - PERMIT APPLICATION FOR MIAMI SHORES VILLAGE Muutipal # Permit 'Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOMING PAVING FENCE SIGN WORK DESCRIPTION i 111t ■ + {J r 't Oh Lt r »�e.ct ;r!`l[� ++ ( .irt <'Y' J/'',4_ Cr WARNING TO OWNER: YOU MUST RECORD A NOTICE OF COMMENCEMENT AND YOUR FAII,UHE TO DO SO MA RESU[.T IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY (1F YOU INTEND TO OBTAIN )I,NANCINt CONSULT WITH YOUR TENDER 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) certify that all work will be perforated to nwct the standards of all laws: regulating ciin tnictiOtt in this jurisdiction 1 ttralerctand that serum. permits are required for ELECTRICAL PL(,1MBINCi, SIGNS. I'OOLS, ROOFING and MECHANICAL WORK. OWNER'S AFFIDAVIT: 1 oxatify that all thc foregoing information is accurate and that all work will be done ire twrriplitinet with all applicat laws regulating construction and Liming. Furthermore, I authorize the above - named contractor to do thc work stated. 1 gnat of owner aridlor Condo t'resrdun! if9 #- C3 6 -2S6 3 - a ‘7 Notary as to Owner and/or. Col resident Date My Commission Expires: "R Howard Gouz * _• *My Commission CC655430 %N rte Expires June 15, 2001 FEES: FEn l t RADON APPROVED: Zoning Builda>t �_ Mechanical Plumbing _...... Tom. ,: eta 5OE 10 3Jtid 'LIST £b9 502 :01 Mow f ' 7.`:, /- Z 3 Addtcss A.163 >tt , f <' — - - Ccnnpctt my lns. Co. Address Addrus Estimated Cost (value) n �) v - (..X:) tractor or (iwner- Roilder — ; Date AV Commission Expires: /� ►�. 113130 Femaldet # *My Comm I ten C0000099 �..� Expires Am0 23, 2001 t .(..L-. NOI AR _. DOND Electrical - U'fA1,. 1.l11["s Engineering uof~�te„aod -�o7 sej eurovi vac) 60 00- 132 - uee b00L 626 - S02 :W0213 12:01 0002- 82 -Nbf Permit No. ' Y 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 he 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 Nan. °__s___�"�' �-�_�- K_ - _.,_._ _________ _— No. Street Location and Legal Description Lot_ ____t_ Block____ ) Subdivision Nature of Water Supply: City —Well Amount of Permit $ STATE OF FLORIDA, 1 ss. COUNTY OF DADE. MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT (Signed) Date- ---- ---- No } ' Street Street and Number where work' is to be performed —No Street State work to be performed and purpose of building (By Floors) New Building t , Remodeling Addition Repairs No. of Stories Size Septic Tank i Type of Tank Capacity Gals Feet of Drain Tile 1_ ' , Dist. Feet of Tank or Drain Field from Well Size of Soakage Pit 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- contractM, on work to be ,performed under this permit, as are licensed by Miami Shores Village. (Signed) ..y 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 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 FOU NT' NS TOTAL FIXTURES CONTR. LIST CHECK _ SEPTIC TANK SEWER CONN. DRAIN FIELD SOAKAGE PIT GREASE TRAP SOLAR HEATER DEEP WELL SPRKLRR. SYSTEM SW IM•G POOL CONTR. LIST _ CHECK Permit No. ' Y 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 he 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 Nan. °__s___�"�' �-�_�- K_ - _.,_._ _________ _— No. Street Location and Legal Description Lot_ ____t_ Block____ ) Subdivision Nature of Water Supply: City —Well Amount of Permit $ STATE OF FLORIDA, 1 ss. COUNTY OF DADE. MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT (Signed) Date- ---- ---- No } ' Street Street and Number where work' is to be performed —No Street State work to be performed and purpose of building (By Floors) New Building t , Remodeling Addition Repairs No. of Stories Size Septic Tank i Type of Tank Capacity Gals Feet of Drain Tile 1_ ' , Dist. Feet of Tank or Drain Field from Well Size of Soakage Pit 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- contractM, on work to be ,performed under this permit, as are licensed by Miami Shores Village. (Signed) ..y 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 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. Permit No Nature of Water Supply: City —Well . MIAMI SHORES VILLAGE . PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT Owner's Name and Address Registered Architect and /or Employing Plumber's Name____. - 41- -«tt- No._ Amount of Permit $ (Signed) 7r V Date C Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the buildiii g or othe 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 c9mplied with, whether herein specified or not. A copy of approved plans and specifications must be kept at building during progress of work. No Street Mr/...A/ Street 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 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 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 erformed under this pe;init, as ar— licensed by Miami Shores Village. ) l • •� ' a �� ( Signed / - f%4/1 ,x/ l AA s r Plumber. STATE OF FLORIDA, ss. ` 0.._ G COUNTY OF DADS. ) a Before me, the undersigned authority /a no a p blic, 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 constriction, 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 TUBS SHOWERS LAVA- IES TORIES SINKS INKS SLOP SINKS LAUNDRY TUBS URINALS CATCH BASIN FLOOR DRAIN DRINKING FOUNT'NS TOTAL FIXTURES CLISTR ,•;-, J ( / / CHECK / ;,� .."7_9 ..- P 01 g (2j...... Li'-- ,A ♦ ..-.9 yam SEPTIC TANK SEWER CONN. DRAIN FIELD SOAKAGE PIT GREASE TRAP SOLAR HEATER DEEP WELL SPRKLR. SYSTEM SWIM'G POOL G6 - - a ,.,j n t / :;t �� CONTR. LIST / CHECK O' /�4- Permit No Nature of Water Supply: City —Well . MIAMI SHORES VILLAGE . PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT Owner's Name and Address Registered Architect and /or Employing Plumber's Name____. - 41- -«tt- No._ Amount of Permit $ (Signed) 7r V Date C Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the buildiii g or othe 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 c9mplied with, whether herein specified or not. A copy of approved plans and specifications must be kept at building during progress of work. No Street Mr/...A/ Street 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 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 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 erformed under this pe;init, as ar— licensed by Miami Shores Village. ) l • •� ' a �� ( Signed / - f%4/1 ,x/ l AA s r Plumber. STATE OF FLORIDA, ss. ` 0.._ G COUNTY OF DADS. ) a Before me, the undersigned authority /a no a p blic, 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 constriction, 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. Registered Architect and /or Engineer Size Septic Tank_._ Feet of Drain Tile Nature of Water Supply: City —W. Amount of Permit $ STATE OF FLORIDA, COUNTY OF DADE. MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT Permit No P / 7 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- - -C_c_ __ e_nn ______ ---- - -.__. No. 0__z- _________ Street_ / G /9 0 Employing Plumber's Name j/!'1_'Lr' 1 V'jJ f / N C / O No.__P ` 3 Street.L" tL Location and Legal Description Lot J Block Street and Number where work is to be performed —No I'7 0 2 C' / Street , b /00 S ` State work to be performed and purpose of building (By Floors)___ Su L >____(,t1S._L1-__-__.k_Ei__C_( sS dlytr.Oe C.y- 5147.4 -) New Building_ ._______ Remodeling_____ Addition Repairs No. of Stories ...................... Type of Tank_ Capacity Gals._ __Dist Feet of Tank or Drain Field from Well _Size of Soakage Pit l ' '� - _ (Signed)--- - - - - -- _.. - - - - - -- bing Inspecto The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations : an employer of labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Permanent S • • ement, and has com- plied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors employed •y 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 required by the Act. The undersigned agrees to employ only such sub - contractors, on work to be performed under this permit, as licensed by Miami Shores Village. ( Signed). 1e =5� Master Plumber. are are 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 insp-. •° nn, or faulty materials and /or workmanship. CLOSETS BATH TUBS SHOWERS LAVA- TORIES SINKS SLOP SINKS LAUNDRY TUBE URINALS CATCH BASIN FLOOR DRAIN DRINKING FOUNT'NS TOTAL FIXTURES CONTR. LIST CHECK SEPTIC TANK SEWER CONN. DRAIN FIELD SOAKAGE PIT GREASE TRAP SOLAR HEATER DEEP WELL SPRKLR. SYSTEM SWIM'G POOL CONTR. LIST y ( x + - - CHECK Registered Architect and /or Engineer Size Septic Tank_._ Feet of Drain Tile Nature of Water Supply: City —W. Amount of Permit $ STATE OF FLORIDA, COUNTY OF DADE. MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT Permit No P / 7 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- - -C_c_ __ e_nn ______ ---- - -.__. No. 0__z- _________ Street_ / G /9 0 Employing Plumber's Name j/!'1_'Lr' 1 V'jJ f / N C / O No.__P ` 3 Street.L" tL Location and Legal Description Lot J Block Street and Number where work is to be performed —No I'7 0 2 C' / Street , b /00 S ` State work to be performed and purpose of building (By Floors)___ Su L >____(,t1S._L1-__-__.k_Ei__C_( sS dlytr.Oe C.y- 5147.4 -) New Building_ ._______ Remodeling_____ Addition Repairs No. of Stories ...................... Type of Tank_ Capacity Gals._ __Dist Feet of Tank or Drain Field from Well _Size of Soakage Pit l ' '� - _ (Signed)--- - - - - -- _.. - - - - - -- bing Inspecto The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations : an employer of labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Permanent S • • ement, and has com- plied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors employed •y 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 required by the Act. The undersigned agrees to employ only such sub - contractors, on work to be performed under this permit, as licensed by Miami Shores Village. ( Signed). 1e =5� Master Plumber. are are 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 insp-. •° nn, or faulty materials and /or workmanship.