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54 NE 101 St (8)PAY TO THE ORDER OF BOB'S SEPTIC & DRAIN, INC. 1020 NE 130TH ST. PH. 305 -558 -5818. NORTH MIAMI, FL 33161-4211 ctiban CITIBANK. F.S.B. BR. #37 2750 AVENTURA BOULEVARD AVENTURA, FL 33180 FOR 11 '004986 11 ' ': 266086554i: 0 / DATE 210 2 70606911' OLLARS 4986 63- 865537 2660 ,Ed XJ LOT: 6 STATE bF DEPARTMENT OF HEALTH ONSITE SEWAGE TREATMENT AN . D CONSTRUCTION PERMIT '\ \\\ ,.\ i A_ l SYSTEM DESIGN AND SPECIFICATIONS OTHER REMARKS: WDSPOS L SYSTEM CONSTRUCTION PERMIT FOR: [ ]New System [ ]Existing System [ ]Holding Tank [ ] Innovative Other [ X ]Repair [ ]Abandonment [ ]Temporary [ IN ] APPLICANT: Waites, Rodney AGENT: SR0921116, PARILLA ROBERT PROPERTY STREET ADDRESS: 54 NE 101 St Miami FL 33138 BLOCK: 10 SUBDIVISION: Miami Shores Sec [Section /Township /Range /Parcel No.] PROPERTY ID #: 11- 3206 - 013 -1350 [OR TAX ID NUMBER] CENTRAX #: 13 -SG -11322 DATE PAID: FEE PAID : $ RECEIPT OSTDSNBR : 01 -3893- -R 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. 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 [ 300 ]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: Finish Floor Of Exist. Res. Elevation 12.6' NGVD I ELEVATION OF PROPOSED SYSTEM SITE [ 2.1 ] [ FEET ] [ BELOW BENCHMARK /REFERENCE POINT E BOTTOM OF DRAINFIELD TO BE [ 4.1 ] [ FEET ] [ BELOW BENCHMARK /REFERENCE POINT L D FILL REQUIRED: [ 0.0 ]INCHES EXCAVATION REQUIRED: [ 30.0 ] INCHES Existing 900 Gallons Septic to remain. Install 300 Square feet Drainfield. Invert elevation of the Drainfield to be no less than 8.5' NGVD Bottom elevation of the Drainfield to be no less than 8.0' NGVD This Permit is not for addition. jc+, ;.r.��[ �j j`•.�1 '�" r t 't S '„ THIS PERMIT IS 6\r:JT FC7i Api M ) INVERT E'LE"3vTZ:1 -1 J_ I J (SOTTCM IMADIFCELD MEAT= a i/, d o SPECIFICATIONS BY: Andre, Paul TITLE: i - A E: - 1,{. APPROVED BY: Andre, Paul Ttr rfeRha , En in Dade CHD EXPIRATION DATE: 3/21/02 n ., � nn��n RogP1� P` Engin DATE ISSU ED: 12/21/01 © DH 4016, 03/97 (Obsoletes previous editions which may not be used) (Stock Number: 5744- 001 - 4016 -0) [ostds_cons_4016 -1] Page 1 of 2 • STATE OF FLORIDA DEPARTMENT OF HEALTH APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PERM Permit Application Number PART II - SITEPLAN Scale: Each block represents 10 feet and 1 inch = 40 T fe �� c� 1 , 1 5[----- C--- 44- SF' 0 EPA 4. 1 Notes: 3 .) � �3 041,A ), la 1O ;Site Plan submitte Plan Approved, `d By ALL CHANGE DH 4015, 10/96 (Replaces HRS -H Form 40 (Stock Number: 5744 - 002 - 4015 -6) 0 ON (- Pe (-- )Firrhc,TAIUL, � 1 rurto,2 o�-J » (a 5 CD a C PP2 G114 MUST BE APPROVED BY THE COUNTY HEALTH DEPARTMENT 5 which may be used) Page 2 of 4 I Not Approved . D - to 4 County Health Department CONTRACTOR Name 6 / Y b /1 ,` "ICS /� VVVIIL../// 07� Name 0 • SIRN ,t % 1 License N n el a l i l 6 Ir4.EJ 1 Business Telephone Address 1O 0E. 13 5710, ril 1, Telephon y / C Fax ?q 3 , 6 70 Q Q l Q V Qualifier Name () /7 '' ))4... PROPE WNER Name 6 / Y b /1 ,` "ICS /� VVVIIL../// 07� Address ) itE 1 d 1 Sr Home Telephone Business Telephone Fax TYPE OF MANAGEMENT (✓ ) New Construction Enclosure Alteration Exterior Repair Alteration Interior Demolish Relocation of Structure Shell Only Foundation Only Add'l Attachment Other Add'l Detachment Other INSTRUCTIONS - The following steps must be taken to obtain a permit from the Miami Shores Village: Step 1. Complete the attached permit application which must be signed by the property owner and qualifier. Both signatures must be notarized. Please print or type to allow for a more accurate processing of your application. If roofing work will be done, a roofing application must be submitted along with this permit application. Step 2. Submit the completed application with all necessary documents to the Building, Planning and Zoning Department for processing. During the processing of your application, you may be asked to submit additional information. Address Apt. Folio Number // 3 a - O (3 1:S51 Lot C Block 10 Subdivision 1Th 4 5/ 0 P PG Zoning Linear Feet Current Use of Property uare Feet �1 ?its Floors Proposed Use of Property iV of Work �V (J �� p Bldg Value Tenant Information Tax Assessed/Appraised Value Flood Zone Base Floor Elev. PERMIT TYPE (✓ ) Building Electrical Mechanical Plumbing LPGX Roofing Fence Other PERMIT CHANGE (✓ ) Chg. Contractor Renewal Revision Extension Supplement Reinspection ARCHITECT Name License No. Address Telephone Fax Description of Work PERMIT APPLICATION Master Permit No. Subsidiary Permit No. SD ti 6 ENGINEER Name License No. Address Telephone Fax Page 2 IMPORTANT NOTICES 1. DO NOT BEGIN ANY WORK WITHOUT HAVING RECEIVED YOUR VALIDATED PERMIT AND PERMIT CARD. Applying for a permit does not grant the right to begin construction. HOURS OF CONSTRUCTION are limited to: Monday through Friday from 7:30 a.m. to 6:00 p.m., and Saturday from 8:00 a.m. to 5:00 p.m. No inspections will be conducted on weekends or holidays. 2. All construction of demolition areas MUST BE MAINTAINED IN A CLEAN, NEAT AND SANITARY CONDITION free from construction debris. 3. STREETS AND NEIGHBORING PROPERTIES SHALL BE KEPT FREE FROM DIRT AND DEBRIS. 4. SWALES MUST BE PROTECTED FROM BEING DAMAGED BY EQUIPMENT OR VEHICLES, AND MAY NOT BE USED FOR STORAGE. A bond is required for work in or near the street/sidewalk. 5. CONSTRUCTION TRAILERS ARE PROHIBITED ON SINGLE FAMILY RESIDENTIAL CONSTRUCTION SITES. Other construction may have a trailer which requires a separate permit. 6. PORTABLE TOILETS for a construction site require a separate permit. 7. DO NOT DISCHARGE WATER INTO THE RIGHT OF WAY OR STORM DRAINS without approval from the Building, Planning and Zoning Department. 8. EQUIPMENT AND MATERIALS SHALL BE STORED at least 10 feet from the edge of pavement. 9. Department of Health and Rehabilitative Services (HRS) approval is required for applications involving septic tanks. Department of Environmental Resources Management (DERM) and/or Miami -Dade Water and Sewer Department (MDWASD) approval is required for applications involving sewers. AFFIDAVIT - Please read carefully. Application is hereby made to obtain a permit to do work and installation as indicated. I, the OWNER of the property, 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, POOL, EXTERIOR DOOR, MECHANICAL, WINDOW, FEN CE, DRIVEWAY, ROOFING and SIGNS and there may be additional permits required from other governmental agencies. I, the OWNER of the property, have disclosed all information related to any work at the property performed in the prior twelve months to the Building Official. Further, I am fully aware that if the cumulative cost of work to my home or business under this and any other permit equals or exceeds fifty percent (50 %) of the fair market value of the structure, the entire structure must meet the present federal flood criteria for finished floor elevation. I am also fully aware that if the total cost of work to my home or business under this and any other permit exceeds fifty percent (50 %) of the replacement cost of the structure, then the entire structure must conform to the current code requirements of the Building Code. WARNING TO OWNER: Your failure to record a NOTICE OF COMMENCEMENT may result in you paying twice for improvements to your property. If you are spending more than $2,500 or intend to obtain financing, you may wish to consult with your attorney or lender before recording your Notice of Commencement. The Notice of Commencement must be recorded at: 22 N.W. 1st Street, 1" Floor, (305) 679 -1078. Once recorded, the Notice of Commencement must be POSTED AT THE JOB SITE in accordance with Section 713 -35 of Florida Statutes. Review the brochure at Village Hall on Construction Lien Law and Choosing a Contractor. STAT OF .' O DA, P TY OF MIAMI -DADE Signature of Owner SEAL: f� Personally known Type of Identification Produced: :) O e o�v�• °Type of Identification Produced: Personally known otary Pub1i- 'Stat4 -sf h7D ..a Q Ct;71.:'3R."'47 OR, Produced Identification ature of otary STATE 0 Signat Print Name Sworn to : nd subscribed before me this SEAL: blic -ttate Fldrida r. � PERNIITAPPLICATION -DADE OR, Produced Identification ELECTRICAL TYPE Minimum Fee QTY. TYPE Dryer QTY. TYPE Outlet, Appliance QTY. TYPE Service Repair QTY. A/C Central 1 -3 Ton Fan Dryer Vents, Number of Outlet, Wall Ventilation, Cost Service, Temporary Air Handler, Tons A/C Central 4 -7 Ton Piping, Flammable Liquid Fire Pump Outlet, Switch Fire Sprinkler System Signs A/C Central 8 -15 Ton Bath Fan - Vented, # Fixture - Fluorescent - Pressure Vessel Oven Space Heater (kw) A/C Central 16-20 Ton Fixture Light Parking Lot Lights Spas/Hot Tubs A/C Central 20+ Ton Flood Lights Plugmold/Strip Subfeeds, No. of Amps A/C Window FPL - Load Central Posts Swim Pool, Commercial Air Conditioners Garbage Disposal Range/Range Top Swim Pool, Residential Chiller Generators, etc. Receptacles Switchboards Clear Violations Heat Recovery Refrigerator, Comm. (p/PH) Temp Serv., Construction Compactor Low -volt, Burglar Refrigerator, Domestic Temp for Test - 30 days Deep Freezer Low -volt, Fire Renew - Temp Service Water Closet Demolition Low -volt, Intercom/Teleph. Repair Circuits Water Heater Dishwasher Lavatory Low -volt, Television Service, Number of Amps Water Heater New MECHANICAL TYPP. Minimum Fee QTY. TYPE Condensate Drain QTY. TYPE Generator QTY. TYPE Refrigeration, Tons QTY. A/C Central, Tons Cooling Tower Heating Strips, each Vent Hood, Cost A/C Wall/Win. Tons Dryer Vents, Number of Paint Booth Ventilation, Cost Solar Water Heater Air Handler, Tons Ductwork, Cost of Piping, Flammable Liquid Periodic Inspections Barbecue Fire Sprinkler System - Process/Pressure Piping Cap - Fixture Bath Fan - Vented, # Fireplaces, Number of - Pressure Vessel Pump and Abandon PLUMBING TYPE A/C Condensate QTY. 'I'YI'E Drains, Roof QTY. TYPE Miscellaneous Fixture QTY. TYPE Soakage Pit QTY. Bath Tub Drinking Fountain Miscellaneous Repairs Solar Water Heater Bidet Filter Replace Pool Piping Sprinkler Repair Cap - Fixture Fountain Pump and Abandon Sprinkler System Cap - Water Gas - Appliance Pump, Domestic Supply, AC Well Cap - Sewer Gas - Natural Pump, Fire Stand Temporary Toilet Catch Basin Gas - Propane Pump, Re- circulate Temporary Water Closet Clothes Washer Gas Piping Pump, Replace - Pool Urinal Dental Chair Grease Trap Pump, Sprinkler Utility - Sewer Discharge Well Ice Maker Pump, Sump Utility - Water Dishwasher Indirect Wastes Relay Repair Vacuum Pump Disposal Interceptor Roof Inlet Water Closet Domestic Well t aundry Tray Septic Connection Water Heater Drainfield, 4" Tile/Res. Lavatory Septic Tank Water Heater New Drains, Area Meter Set (Gas) Sewer Connection Water Re -pipe Drains, Floor Minimum Fee Shower Water Service Drains, French Miscellaneous Equipment Sink Well, Supply Page 3 INSTRUCTIONS: Please indicate the type of work being performed and quantity(ies) in the space provided below. RECEIVED AND REVIEWED BY: DATE: PERMIT APPLICATION Page 4 OFFICE USE ONLY CHECKLIST ❑ OWNER - BUILDER FORM (Attach) ❑ FIRE DEPARTMENT APPROVAL (Commercial / multi- family) ❑ CONCURRENCY (New Construction) ❑ OTHER (Specify & Attach) $3.00 per page (Scanning Fee) Miami Shores Village Bond Metropolitan Dade County (C.C.F.) Inspector State Educational Fund State DCA (Radon) Code Enforcement Fine Zoning Review ❑ PROOF OF OWNERSHIP (Attach) ❑ HRS / DERM APPROVAL (Septic / Sewer) ❑ IMPACT FEE (New Construction) O OTHER (Specify & Attach) $ 40, () 0 $� 1 $ l ( F0 (sq.ft. = x/1000 x 0.60) $ (¢.005 /sq.ft.) $ (¢.O1 /sq.ft.) s- o 0 REVIEWED AND PREPARED BY: SECTION Zoning Electrical Mechanical Plumbing Fire Public Works Structural Building Official BY DATE PERMIT APPLICATION ❑ CONDO ASSOCIATION APPROVAL (Attach) ❑ BPR APPROVAL (Restaurants) ❑ CONTRACTOR REGISTRATION (On File) PERMIT FEES TOTAL a‘ 4,3 lJ ISSUING OFFICIAL DATE: CONDITION OF APPROVAL Revised July 2001 10050 N.E. 2ND AVE., MIAMI SHORES, FL • (305) 795 -2207 • FAX (305) 756 -8972 • http : / /www.miamishoresvillage.com PERMIT APPLICATION FOR MIAMI SHORES VILLAGE Dated 110 ( Job Address J 7 / J /Z7/ Tax Folio Legal Description Historically Designated: Yes No Owner/Lessee / Tenant //✓ 4A y 7 .6 , f M aster Permit # ii g 2 7 7 Owner's Address /Oa /e9 /U /9if / 1 V ' 2 o 42 3 (, ' 7 w Contracting Co. 1 U AA.L „, &P Address 1 40 t.0 Q t 1 4 0 U c Qualifier c TPtA C , 4 Phonk — 22— � State # A G SS &.3 1 00 Municipal # Competency # ?' 2 ns. Co. Architect/Engineer /4/1 /(/ 1/,IZCZ- Bonding Company Address .--- Mortgagor Address Permit Type (circle one): BUILDING ELECTRIC L PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN WORK DESCRIPTION CO 4 b t,L L W! 1U' 341 Square Ft. Estimated Cost (value) 1 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. OWNERS AFFIDAVIT: I certify that all foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. Furthermorguthorize the above -named contractor to do the Sign e of own: and/or Condo President N t SEPT 21,2003 M Cit (7 FEES: PERMIT Cl RADON C.C.F. D'' NOTARY �� BOND APPROVED: Zoning Building Mechanical Plumbing 0 e Date Address Signa er- Builder Po o" Liiiiiirt1.22.-.- / : 1 :l�� ;v`7 i .7.: ' t '( 10.% crwft' etcrir)" '' r^Vr 11_2013 Electrical Structural Engineer / / D/ Date TOTAL DUE )3b Date ITEM BATH 1LB UNIT FEE :.ITE1,1 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 AMPS DUCT WORK FLOOR DRAIN SERVICE REPAIR/IETER CHANGE REFRIGERATION GREASE TRAP APPLIANCE OUTLETS PROCESS AND PRESS PIPING INTERCEPTOR RANGE TOP UNDERGROUIO TANKS LAVATORY OVEN ABOVE GROUND TANKS LAUNDRY TRAY WATER HEATER U.F. PRESSURE VESSELS CLOTHES WASHER i MOTORS 0- 1 HP STEAM BOILERS SHOWER MOTORS OVER 1- 3 HP HOT WATER BOILERS SINK, POT /3 COMP.- MOTORS OVER 3- 5 If MECHANICAL VENTILATION SINK, RESIDENCE ` , MOTORS OVER 5- 8 If 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 MOTORS OVER 100 HP ' VIOLATION INDIRECT WASTES A/C WINDOW REINSPECTION iATER SLPPLY 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 OUTLETS COMIERCIAL SWIMMING POOL WATER SERVICE SIGN TUBES 'EWER CONNECTIONS SIGN TRANSFORMERS TILITY -SEWER SIGN TIME CLOCK ` TILITY -WATER FIXTURES • EPTIC TANK ANTENNA ELAY TELEVISION OUTLETS RAINFIELO, 4" TILE/RES. VIOLATION 1,4 & ABANDON SEPTIC TANK REINSPECTION JAKAGE PIT CU. FT. ETCH BASIN ISCHARGE WELL 7MESTIC WELL . REA DRAIN 70F INLET ILAR WATER HEATER IRE STANDPIPE OL PIPING ;WN SPRINKLER SYSTEM S RANGE 'TER _ SET (GAS) S PIPING ADDENDUM TO BUILDING PERMIT APPLICATION (AN APPLICATION FOR BUILDING PERMIT MUST ACCOMPANY THIS ADDENDUM. IF A MASTER PERMIT HAS B. OBTAINED, THE OWNER'S NOTARIZED SIGNATURE NEED NOT BE PRESENT ON SUBSEQUENT APPLICATIONS.) PLUMBING ELECTRICAL MECHANICAL MIAMI SHORES VILLAGE, FLA. , d' N9 5494 • JOB TAT: — �J ADDRESS o INSPECTION � ,* TIME READY REMARKS- ` 7 INSPECTOR - ICJ DATE / iUILDING F,LECTRICAL PLUMBING KOOFING MIAMI SHORES VILLAGE. FLORIDA / s DA / u 19 ❑ ❑ PERMIT N° 4852 Contractors t ® License No. 0 0 Work to be performed under this Perm 'architect contractor )r Builder . S Subdi- _egal Lot 1I Bl vision description 1 • Value of II Amount r o == 'address of , ` . '' Project $ application wilding plans, and with the understanding that the work authorities. will be o This Permit compli y be revoked B at m an , granted to the contractor or builder named above to construct the building or to install the equipment or device described in the ap This permit statements gra approved by the proper municipal �erefor in strict compliance with all ordinances pertaining thereto i me if the work is not specifications n com that with have been submitted to and app specifications A d that he assumes respoc th for work ' above assumes the responsibility for a thorough knowledge of the ordinances and regulations ime if the wor k is not done in compliance with such ordinances or if the plans are changed without s authorization. A k fu � rther condition upon w ac granted is the understanding that the contractor or builder pertaining to the work covered hereby whether shown on the plans or drawings or in the stat € �s �,� � ',� one by his agents, servants or employees. d , , BY Signed: � ---- INSPECTOR ° specifications covered submitted here to the proper compliance wi th all o of Miami noes a Village. Ina 5 once to me of this pr the work covere hereunder in compce with all regulations In consideration of the issu hiermit I agree to perform statements p :opting this thereto and ss strict conformity with the plans, drawings, agent, servant or employee. :opting this permit I (resume responsibility for all work done by either, myself, my g AUTHORITY • r �I ,e .s' .�� BY CONTRACTOR OR BUILDER Size Septic Tank ...... _____ Amount of Permit $_ MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING '? :MIT Permit No Date Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the building or other structure herein described. This application is made in compliance and conformity with the Building Ordinance of Miami Shores Village, Florida, and all provisions of the Laws of the State of Florida, all ordinances of Miami Shores Village and all rules and regulations of the Building Division of Miami Shores Village shall be complied with whether herein specified or not. A copy of approved plans and specifications must be kept at building during progress of work. ( ,/ 11. Owner's Name and Address_____ "" No. 5 V ___ Streeili C / CC • Registered Architect and /or Engine — Employing Plumber' s Name `'-' __ -/ No. Street__! Location and Legal Description Lot_. -____-. ... _______ =.___ _ _ __ ____ Block Street and Number where work is to be performed— No._ Street State work to be performed and purpose of building (By Floors)___ ____)X • New Building Remodeling_ _.____ Addition._____._._ Repairs No. of stories Type of Tank__ Capacity Gals Feet of Drain Tile________ __Dist. Feet of Tank or Drain Field from Well Nature of Water Supply: City — Well.__________ ...... - ....... ________ __...... ________Size of Soakage Pit (Signed) _ 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 Ilas 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. Subdivision ..________ ..... _......... _ - ._ Plumber. STATE OF FLORIDA, I es. 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•neeAss1ry by improper notice for inspection, or faulty materials and /or workmanship. CLOSETS BATH TUBS SHOWERS LAVA. TORIES S INKS SLOP SINKS LAUNDRY TUBE INAS 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 DELP WELL SPRKLR. SYSTEM SWIM'S; POOL CONTR. LIST CHECK Size Septic Tank ...... _____ Amount of Permit $_ MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING '? :MIT Permit No Date Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the building or other structure herein described. This application is made in compliance and conformity with the Building Ordinance of Miami Shores Village, Florida, and all provisions of the Laws of the State of Florida, all ordinances of Miami Shores Village and all rules and regulations of the Building Division of Miami Shores Village shall be complied with whether herein specified or not. A copy of approved plans and specifications must be kept at building during progress of work. ( ,/ 11. Owner's Name and Address_____ "" No. 5 V ___ Streeili C / CC • Registered Architect and /or Engine — Employing Plumber' s Name `'-' __ -/ No. Street__! Location and Legal Description Lot_. -____-. ... _______ =.___ _ _ __ ____ Block Street and Number where work is to be performed— No._ Street State work to be performed and purpose of building (By Floors)___ ____)X • New Building Remodeling_ _.____ Addition._____._._ Repairs No. of stories Type of Tank__ Capacity Gals Feet of Drain Tile________ __Dist. Feet of Tank or Drain Field from Well Nature of Water Supply: City — Well.__________ ...... - ....... ________ __...... ________Size of Soakage Pit (Signed) _ 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 Ilas 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. Subdivision ..________ ..... _......... _ - ._ Plumber. STATE OF FLORIDA, I es. 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•neeAss1ry by improper notice for inspection, or faulty materials and /or workmanship.