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PLUMBING PERMITS
Date PERMIT APPLICATION FOR MIAMI SHORES VILLAGE 4I - O /Job Address q6/ Af 6 (615/44e4 5/'-4c'F Legal Description I Historically Designated: �( Ye (es ss �f No A Owner/Lessee / Tenant �'t'l�! ( ��c • Masfer`�ehgi �. �J 'z i— (16/0 Owner's Address 94 1 / 46 fD/ W Phone 5 - 7 C 1 d"Z' i f Contracting Co. NZ G / L— Address // 9 3 Z "J b. tat,— Qualifier , Le.....- CC-/ S S# YPhone c ((/ — 7 s 1 - State # unicipal # 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 OWNERS AFFID construction and 1 l c-v Notary as to Owner and/or Condo President Date Notary My Commission Expires: My Co FEES: PERMIT O RADON C.C.F. APPROVED: Zoning Building Mechanical Plumbing Tax Folio G(� 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 OF 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 perfonned 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. that all the foregoin: ' i ormation is accurate and that all work will be done in compliance with all applicable laws regulating e the above -named contractor to do the work state • or or guilder Date ss AM SEAL GLAD'YS J VILLAR NOTARY PUBL!CSTATE OF FLORIDA COMMISSION NO. CC714103 MY COMMISSION EXP. MAR. 1,2002 NOTARY BOND ZD Electrical TOTAL DUE V3/$ Date Structural Engineer 0 T H E R C28TRUCTION PERMIT FOR- [rA New System ] Existing System Repair [/■/J , Abandonment LOT: LICANT: SYSTEM DESIGN ADD S$E STATE OF FLORIDA . DEPARTMENT OF HEALTH ONSITE SEWAGE TREA .CONSTRUCTION PERMIT � e 7 PROPERTY ADDRESS: SPECIFICATIONS BY: APPROVED Y DATE ISSUED: W* Aka," DH 4016, 12/99 (Page 1) (Pre IC IrNS er T [15 GALLONS / GPD A [ ] GALLONS / GPD N ( ] GALLONS GREASE INTERCEPTOR CAPACITY K [ ] GALLONS DOSING TANK CAPACITY [. [;2 SQUARE FEET PRIMARY DRAINFIELD SYSTEM [ ] SQUARE FEET SYSTEM TYPE SYSTEM: ! ] STANARD [ FILLED CONFIGURATION: ( ] TRENCH (7] BED [ D R A I N F LOCATION OF BENCHMARK: I ELEVATION OF PROPOSED SYSTEM SITE [ i•$] E BOTTOM OF DRAINFIELD TO BE D FILL REQUIRED: [ 41D / gr] . INCHES E.6 � SAL SYSTEM [ Holding Tank [ NITemporary g 1 I' BLOCK: ' 0 SUBDIVISION: / 1 .4 DLL S ?] DLL S /FT] [ABOVE /BE EXCAVATION REQUIRED: [ S me UU tT LYe mAy f3 - 7r t +rr TITLE: PERMIT NO.10l■. d DATE PAID: FEE PAID: RE IPT# [ Innovative I'CY . / S : -� [SECTION, TOWNSHIP, RANGE, PARCEL NUMBS PROPERTY ID #: _ t �!3 .� O L / — (07a • [OR TAX ID NUMBER] SYSTEM MUST BE CONSTRUCTED IN ACCORDANCE WITH SPECIFICATIONS AND STANDARDS OF SECTION 381.0065, F.S., AND CHAPTER 64E -6, F.A.C. DEPARTMENT APPROVAL OF SYSTEM DOES NOT GUARANTEE SAFTISFACTORY 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. ISSUANCE OF THIS PERMIT DOES NOT EXEMPT THE APPLICANT FROM COMPLIANCE WITH OTHER FEDERAL, STATE, OR LOCAL PERMITTING REQUIRED FOR DEVELOPMENT OF THIS PROPERTY. /AEROBIC UNIT CAPACITY MULTI- CHAMBERED /IN- SERIES [ CAPACITY MULTI- CHAMBERED /IN- SERIES [ ] [MAXIMUM CAPACITY SINGLE TANK: 1250 GALLONS] ]GALLONS @ [ ] DOSES PER 24 HRS # PUMPS [ ] pt. 1: Health Department pt. 2: Applicant pt. 3: Installer /Contractor pt. 4: Building Department 6.4f <04 BENCHMARK /REFERENCE POINT BENCHMARK /REFERENCE POINT INCHES � , - SU5s' 1 r.'7 a 3 NOT FOR Dili t =Err i F- VATION - �_i✓� 691-1-a.2 OF n FIELDEth as td INSTRUCTIONS: PERMIT NUMBER: Permit tracking number assigned by CPHU. CONSTRUCTION PERMIT FOR: Check type of permit, if "Other" specify type in blank. APPLICANT: Property owner's full name. TELEPHONE: Telephone number for applicant or agent AGENT: Property owner's legally authorized representative. MAILING ADDRESS: P.O. Box or street mailing address for applicant or agent. LOT, BLOCK, SUBDIVISION or \ PROPERTY ID #: 27 character id number for property. (CHD may require property appraiser ID # or section /township /range/parcel number) SYSTEM DESIGN AND SPECIFICATIONS: TANK: Minimum specifications from Chapter 64E-6, FAC. DRAINFIELD: Minimum specifications from Chapter 64E -6, FAC. OTHER: Other specifications, such as operating permit requirements, low - volume flush toilets, variance provisos. SPECIFICATIONS BY: Name of individual providing specifications. If designed by a registered engineer must be sealed. APPROVED BY: County Health Department (CHD) personnel reviewing and approving permit. DATE ISSUED: Date permit is issued by CHD EXPIRATION DATE: One year from date issued if the system has not been installed. Permits for system repairs become void 90 days from the date issued. ci Notes: - 1R ) 0 l i ez U - STATE -OF FLORIDA DEPARTMENT OF /HEALTH AND REHABILITATIVE SERVICES APPLICATION FOR ONSI' E SEWAGE DISPOSAL SYSTEM CONSTRUCTION PERMIT PART II - SITE PLAN Permit Application Number •••• 'a illlmmlllwa wmwma>•s aaiEEaa>•a Emrmla aaaira awmaaaaarmmwwmu aiaa•: ••■ r• raa•••ra••r••a•••a••a•••r■•••a1 '.'!r•r!ma:l•Nrr rf' �meamra.a ■r ■ ■!■ arr•■ ■ralmonnurarrr•Y, it ■a ■ ■■ ■•A`I■•, rrrr•••u■••■ r.• r••••.•. ..••••r■■••pr..m!YvaemimmelP {,ur•ur••••r■■••■a!••• r ■,r ■rrlrr•mmiti�'r ■a■■ ■i(1:IrI. t•■• . r■■■■■■■■ ra■aa.rrr........ar ■•.Air ■ ■■■■:/• rrinummni•• ■•••rrr■■■■■r■■•■••■•■■■L'ri .F........•■ '/•••!■ t•a■ m! arr■ r�onemmmiamm elomrinom'ommoimina■r ■a■ ■■ mummum! ■rrrrrr ■!ra■ ■.arr ■r ■ ■ ■r ■rrrr ■a ■ ■ ■ ■! ■bi' M•••a!!•ra•i•t Amira•r••r• ■ar;iI••• ■•■ ■•••■U•• •r•••••a■ a■•••• •u ■•a.• /■ r■•a■ r■ rr■ •r•■■/ rr ■■r ■�■!!•.•.•ru•••u ■ uui r • •r ■ ■a• rrr•••••••• rrrr •r• ■ ■•ra•raaYirr•••••a•a ■� raaaa!■ ■rrrr■ •••arr ■•arr •■rrra••••, a•a•ia •r••aa•••••r••r■al em s Z� ••r•• ■a• ■•!Mlrrraa•arr••a•••M• ■•••r■ •••. rlr•■a ••■r.•.••••r•a.•ei ii .. .... . ... .. . ..... .... ■ ■•r■•a. • ■•r ■. array • ■r ■ ■ ■ ■•a•.a ■a• ■ ■ ■ ■ ' ii••• ■••rrrr ■rrrr•M( rrrr! ■•aura• ■• ■•r;•• ■••■ ■ ■•rr•f ■■ ■ ■a...•■. 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M..•llr.• ■��ta•rrr!!1!r ■•a!h . i�•.ar•■ ■. ■s••r•ra ■.•.■(■••••■►'It■ ■•l. ; M■■• ••••••a•••a ►■a■•••••••••a a!liMr!'lti�'Mt! NUO lir,••lrar!!..''ra •rrrr ■•••.a■ ■••••r ■•.ai■rrrr■• Craw.11e•mm.lrasl.•.•a. wumm •••rows r uttwursam r siwo. amen •u !iii.ul•�eti miumuww.•asriwil_•.•••a /arr. for — - fJ / 1 L �A�4 1, YODSL � �laa 4 /24A /. �c� Site Plan Submitted SIGNATURE Plan Approved v Not Approved ALL CHANGES MUS EBT APPROVED' BY THE COUNTY PUBLIC HEALTH UNIT y HRS -H Form 4015, Feb 85 (Obsoletes previous editions which may not be used) J f (Stock Number: 5744-002-4015-6) /70 12 i TIT,I.E Date 2. ) County Public Unit Page 2 of 3 Date..._ -.4 _ -•- of the d statement of the and specifications herewith submitted for the buildiD Application is hereby made for the approval th detailed plans a d specs ca g 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. �-^ L - r Owner f s Name and Address ` , Prk �r i L ) No / Street_ L ' / S / ' Registered Architect and /or Engineer Employing Plumber's Name. l.i At A.1 Location and Legal Description Lot Mork _ 7 Street and Number where work is to be performed —No _! Str _.. ..J LC I S( State work to be performed and purpose of building (By Floors) _____ -- - 41� N -- U — 4 A � N ' Permit No ) 41 MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT i New Building.____ _ ------- ........_.. Remodeling__ _- _.____ Addition - - - -__ _..__ Repairs (Si Subdividon- ________ . No. of Stories. Size Septic Tank_ ..Type of Tatk . Feet of Drain Tile n+3*- Feet of Tank or D,niln Field from .... . Nature of Water Supply: City —Well. Size of Soakage Pit. My Commission Expires Notary Public. State of Florida Plumbing Inspector. The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations as an employer of labor under the Florida Workmen's Compensation Act, being Section 5988, 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 public notice or notices as are required by the Act. The undersigned agrees to employ only such sub - contractors, . work to i ormed under thb permit, as are licensed by Miami Shores Village. ©-. Muter Plumber. STATE OF FLORIDA, 1 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 dep oses and says that he is the .--- • -. - -_. of the above described construction, that he has carefully read ike 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 whoa sues se mite pection h nade•neoes cry by improper nonce for inspection, or faulty materials and /or w otkmanabip. GLO[aTa BATH Tu[[ aMOW[RS LAVA. tomes SINKS SLOP SINKS LAUNDRY TUB[ 11R11YALa CATCH BASIN FLOOR DRAIN DRINK NO FOUNT' NS TOTAL FI[TUR[S CONT11. LIST CHICK _ -� SEPTIC TANK S[WIR CONN. DRAIN FIELD SOAKAOI PIT GREASE TRAP SOLAR H [AT[R D[aP WILL SPR KLR. SYSTEM eWIM'O POOL CONTR. LIST - - CHICK Date..._ -.4 _ -•- of the d statement of the and specifications herewith submitted for the buildiD Application is hereby made for the approval th detailed plans a d specs ca g 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. �-^ L - r Owner f s Name and Address ` , Prk �r i L ) No / Street_ L ' / S / ' Registered Architect and /or Engineer Employing Plumber's Name. l.i At A.1 Location and Legal Description Lot Mork _ 7 Street and Number where work is to be performed —No _! Str _.. ..J LC I S( State work to be performed and purpose of building (By Floors) _____ -- - 41� N -- U — 4 A � N ' Permit No ) 41 MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT i New Building.____ _ ------- ........_.. Remodeling__ _- _.____ Addition - - - -__ _..__ Repairs (Si Subdividon- ________ . No. of Stories. Size Septic Tank_ ..Type of Tatk . Feet of Drain Tile n+3*- Feet of Tank or D,niln Field from .... . Nature of Water Supply: City —Well. Size of Soakage Pit. My Commission Expires Notary Public. State of Florida Plumbing Inspector. The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations as an employer of labor under the Florida Workmen's Compensation Act, being Section 5988, 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 public notice or notices as are required by the Act. The undersigned agrees to employ only such sub - contractors, . work to i ormed under thb permit, as are licensed by Miami Shores Village. ©-. Muter Plumber. STATE OF FLORIDA, 1 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 dep oses and says that he is the .--- • -. - -_. of the above described construction, that he has carefully read ike 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 whoa sues se mite pection h nade•neoes cry by improper nonce for inspection, or faulty materials and /or w otkmanabip. Permit No Amount of Permit $ My Commission Expires (Signed) ( Signed) MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT Date Application is hereby `ma Ie for the approval of the detailed statement of the plans and specifications herew�i submitted for the building or other structure herein described. This application is made in compliance and conformity with the Building_ OrtpRnce 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 �'.�i " No Street a Registered Architect and /or Engineer � y� Employing Plumber's Name "`� "''� �'� -d No 4. -1 t b 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 r Type of Tank_ Capacity Gals Feet of Drain Tile 7 Dist. Feet of Tank or Drain Field from Well Nature of Water Supply: City —Well Size of Soakage Pit 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 Workinen's Compensation Act, being Section 5966, Compiled General Laws of Florida Permanent Supplement, and has com- _ plied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors employed by him in the work to be performed under this permit; and will post or cause to be posted for inspection on the site • of the work such public notice or notices as are required by the Act. The undersigned agrees to employ only such sub - contractors, on work to be performed under this permit, as are licensed by Miami Shores Village. Notary Public, State of Florida Plumbing Inspector. Master Plumber. STATE OF FLORIDA, ss. COUNTY OF DADE. Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appearec 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 fac• 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 fau 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 Amount of Permit $ My Commission Expires (Signed) ( Signed) MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT Date Application is hereby `ma Ie for the approval of the detailed statement of the plans and specifications herew�i submitted for the building or other structure herein described. This application is made in compliance and conformity with the Building_ OrtpRnce 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 �'.�i " No Street a Registered Architect and /or Engineer � y� Employing Plumber's Name "`� "''� �'� -d No 4. -1 t b 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 r Type of Tank_ Capacity Gals Feet of Drain Tile 7 Dist. Feet of Tank or Drain Field from Well Nature of Water Supply: City —Well Size of Soakage Pit 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 Workinen's Compensation Act, being Section 5966, Compiled General Laws of Florida Permanent Supplement, and has com- _ plied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors employed by him in the work to be performed under this permit; and will post or cause to be posted for inspection on the site • of the work such public notice or notices as are required by the Act. The undersigned agrees to employ only such sub - contractors, on work to be performed under this permit, as are licensed by Miami Shores Village. Notary Public, State of Florida Plumbing Inspector. Master Plumber. STATE OF FLORIDA, ss. COUNTY OF DADE. Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appearec 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 fac• 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 fau materials and /or workmanship. APPLICATION FOR PLUMBING PERMIT Permit No. _____. 6 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. ,,a Owner's Name and Address _�___ __„.,c,iL__.r� �� sit r Street r4 Registered Architect and /or Enginee Employing Plumber's Name + "" ' No Street Location and Legal Description Lot Street and Number where work is to be performed —No Street State work to be performed and purpose of building (By Floors) Size Septic Tank_ New Building Remodeling Addition Repairs Feet of Drain Tile Dist. Feet of Tank or Drain Field from Well_ Nature of Water Supply: City ��, eell._ SO Amount of Permit $_ / _S STATE OF FLORIDA, k COUNTY OF DADE. ss. My Commission Expires MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT Block Type of Tank . Capacity __(Signed) Size of Soarge Pit._ (Signed) _ ! __ - - - - The undersigned applicant for this building permit does hereby certify tha e understands and accept is obligations as an employer of labor under the Florida Workmen's Compensation Act, being Section 5966, Compile 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, An wort'- 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 lumbing Inspector. Master Plumber. NOTE: A re- inspection fee of $1.00 will be made when such re- inspection is made necessary by improper notice for inspection, or faulty materials and /or workmanship. CLOSETS BATH TUBS SHOWERS LAVA- TORIES SINKS SLOP SINKS LAUNDRY TUBS URINALS CATCH BASIN FLOOR DRAIN DRINKING FOUNT' NS TOTAL FIXTURES CONTR. LIST CHECK SEPTIC TANK SEWER CONN. DRAIN FIELD SOAKAGE PIT GREASE TRAP SOLAR HEATER DEEP WELL SPRKLR. SYSTEM SWIM'G POOL CONTR. LIST CHECK APPLICATION FOR PLUMBING PERMIT Permit No. _____. 6 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. ,,a Owner's Name and Address _�___ __„.,c,iL__.r� �� sit r Street r4 Registered Architect and /or Enginee Employing Plumber's Name + "" ' No Street Location and Legal Description Lot Street and Number where work is to be performed —No Street State work to be performed and purpose of building (By Floors) Size Septic Tank_ New Building Remodeling Addition Repairs Feet of Drain Tile Dist. Feet of Tank or Drain Field from Well_ Nature of Water Supply: City ��, eell._ SO Amount of Permit $_ / _S STATE OF FLORIDA, k COUNTY OF DADE. ss. My Commission Expires MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT Block Type of Tank . Capacity __(Signed) Size of Soarge Pit._ (Signed) _ ! __ - - - - The undersigned applicant for this building permit does hereby certify tha e understands and accept is obligations as an employer of labor under the Florida Workmen's Compensation Act, being Section 5966, Compile 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, An wort'- 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 lumbing Inspector. 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. BUILDING. • • • • • • ELECTRICAL : Inspector's Report: • • • • • WORK PLUMBING : / ,- DONE BY: The following is ready for Inspection: AD:44//d/z1--. REQUESTED WILL BE EADY p 4 0.-4( • BUILDING ELECTRICAL PLUMBING • Gs '-' Work to be performed under this Permit Owned, Buildin CONTRACTORS a R -BUIL s ER 4 MIAMI SHORES VILLAGE, FLORIDA DATE //i' i 194 r Contractor's -License No PERMIT N? 6091 Subdi- vision Architect. Contractor or Builder Legal Lot Description Address of Building - if This permit ' _ = : • or • • er ' °' • co struct 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 . e ordinances and regulations pertaining to the work covered hereby whether shown on the plans or aw" s o in the st "tements or specifications and the hh assumes respon- sibility for work done by hisagents, servants or employees. .- ri , 4, Signed t ` - B ii • INSP CTor In consideration of the issuance to me of this permit I agree to perform the work covered hereundgr in compliance with all ordinances and regulat/ons pertaining thereto and ,in strict : conformity with t Tans, drawings, statements or specifications submitted to the proper authorities of Miami Shpres Village. In accepting this permit L- assume responsib Yf6r all work done by either myself, m y agent, servant or employee. - a -' i ``�- er AUTHORITY 1