Loading...
PLUMBING PERMITApproved Correction Re- Insp'n Fee MIAMI S`JRrS VILLAGE BUILDING DEPARTMENT 305- 795 -2204 Building Inspection Request Date Type Insp'n • , Permit No. Name Address o e. . Company Phone # Inspection Date_; Type Insp'n Permit o. Name Address Company Date3) )4 Inspection Date Approved Correction Re-Insp'n Fee MIAMI SHORES VILLAG BUILDING DEPARTMEN 305- 795 -2204 Building Inspection Request /LJ BUILDING PERMIT APPLICATION FBC 2001 Miami Shores Village Building Department Permit Type (circle): Building Electrical ame (Fee � SSiimnple Titlehh eE ), U t 1 AS 30 Owner's, Address l I k k G 1 O j 5T 1 Cit M ► tic-in I , hO State 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 Tenant/Lessee Name P/ /'r— Phone # u //}' Job Address (where the work is being done) City Miami Shores Village Is Building Historically Designated YES Contractor's Company Name 012 E p Ti C 7 apr i rJ r��hone i( 5 Contractor's Address 1 0 ,AQ i + C 1 City 1 V 0 (ZT4 4 f m' l State I Zip j 3 Qualifier Architect/Engineer's Name (if applicable) $ Value of Work For this Permit Notary $ Scanning $ Type of Work: ❑Addition ❑Alteration ❑New Describe Work: �� c j,..,10 ( 4_1 pp.m--)4) Submittal Fee $ Permit Fee $ * * * * * * * * * * * * * * * * * * * * * * * * * * ** F ees * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** �l S CO (GC1 Training/Education Fee $ Radon $ Adiei iv '7 3O �J F / 0157, County Miami -Dade Zip NO X Zoning Code Enforcement $ Structural Plan Review. $ Permit No. 1 10-( t Master Permit No. C has Q pr Ill zip 33 S Phone # Lo ll Total Fee Now Due $ �� , � � b0 (Continued on opposite side) Mechanical Roofing X Repair/Replace ❑ Demolition Sok) Square Footage Of Work: 3 OO j22A-i l �� CCF $ 1 & YOU CO /CC Technology Fee $ 31— Bond $ 300 CJ Bonding Company's Name (if applicable) /11 Bonding Company's Address City State Zip Mortgage Lender's Name (if applicable) k 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. 1[F 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 not be approved and a reinspection fee will be charged. I Contrac owledged before me thi The foregoing instrument was ackno !dged beforre a this 1 / day of ICil:t fl , 201.9, by fn1l / who is personally knowrl.Yo me or who has produced - 1:)...4)1_, who is personally known to me or who has produced [TALL" ,(,1" C6ya�7j0. &)`As identification and who did take an oath. Owner or Agent The foregoing instrument was ac ay o ,, . 20Dt b NOTAR 'UB C: Sign: Print: 414 nor My Conunission Expires: APPLICATION APPROVED BY Chc12 /15/03 as identification and who did take an oath. NOTARY PUBLI Sign: Print: My Commission Expires: v'xpins: Jul 13. 200',) (Certificate of Competency Holder) State Certificate or Registration No. Certificate of Competency No. * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** * * * ** ** ********************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** " r Plans Examiner Engineer Zoning CONSTRUCTION PERMIT FOR: [ ]New System [ ]Existing System [ ]Holding Tank [ ] Innovative Other X ]Repair [ ]Abandonment [ ]Temporary [ NA ] APPLICANT: Johnson, Irene & Douglas & CAGENT: SR0921116, PARILLA ROBERT PROPERTY STREET ADDRESS: 730 NE 101 St Miami Shores FL 33138 LOT: 3 [Section /Township /Range /Parcel N. PROPERTY ID #: 11- 3206 - 017 -2200 [OR TAX ID NUMBER] SYSTEM MUST BE CONSTRUCTED IN ACCORDANCE WITH SPECIFICATIONS AND STANDARDS OF CHAPTER 64E- 6,FA:2 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 THIP 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 3THER FEDERAL, STATE OR LOCAL PERMITTING REQUIRED FOR PROPERTY DEVELDPMENT. SYSTEM DESIGN AND SPECIFICATIONS T [ 900 ]Gallons SEPTIC TANK MULTI- CHAMBERED /IN AERIES: P. [ 0 ]Gallons MULTI - CHAMBERED /IN SERIES: N [ 0 ;GALLONS GREASE INTERCEPTOR CAPACITY K [ 0 ]GALLONS DOSING' TANK CAPACITY [ 0 ]GALLONS @ [ 0 ]DOSES PER 24 HPS a 'Tr :Pc: ; 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: Finished Floor Of Existing Res. 10.9' NGVD I ELEVATION OF PROPOSED SYSTEM SITE [ 1.2 ] [ FEET ] [ BELOW] BENCHMARK /REFERENCE PC:`:': E BOTTOM OF DRAINFIELD TO BE [ 3.7 ] [ FEET ] [ BELOW]BENCHMARK /REFERENCE L L FILL REQUIRED:[ 0.0 ]INCHES EXCAVATION REQUIRED: [ 30.0 ] INCHES OTHER REMARKS: 1- 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. 2- Install 300 sq. ft. drainfield in bed configuration. 3- Invert elevation of drainfield to be no less than 7.70' NGVD. 4- Bottom elevation of drainfield to be no less than 7.20' NGVD. THIS PERMIT IS NOT FOR ADDITION. SPECIFICATIONS BY: Andre, Paul APPROVED BY: Andre, Paul DA'_ E ISS'JE.D: 3/9/04 STATE OF FLORIDA DEPARTMENT OF HEALTH ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM CONSTRUCTION PERMIT BLOCK: 104 SUBDIVISION: Miami Shores TITLE: :r. 4,:E, i3/9' .,scietes previous editions which tuay not be used) CENTRAX s: 13 -SG -19954 DATE PAID: FEE PAID : $ RECEIPT . OSTDSNBR : 04 -0924- -R TITLE: Professional Engin Dade H: EXPIRATION DATE: 6/7/04 STATE OF FLORIDA DEPARTMENT OF HEALTH APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PERMIT .- Permit Application Number (�` i� � � L- l �> PART II - SITE PLAN - Scale: Each bloc represents 5 feet and 1 inch = 50 feet. 1 4- • -4 4 1 • • ♦ • • • 4 • • • a • •• 4- • 4 • T 1 4-* t { - • • _4 • • 4 • • • . -• 4 • . . • ♦ . • . ♦ - 1 • t • • • • Notes: By 7 ° ALL CHANGES 4 014 4015. 1M6 (Replaces HRS-H Form 4015 which may bp used) (Stock Number: 5744-002 -4015- } Site Plan submittec{ by: �l - ,, 4 1 J v, i,� 0,0t'1 1 k-1 J ` / .• Signature Plan Approved ‘,/ - �� Not Approved • 4 f } • T BE APPROVED BY THE COUNTY HEALTH DEPARTMENT Title • Date County Health Department Page 2 of 3 STATE OF FLORIDA DEPARTMENT OF HEALTH PERMIT # ONSITE SEWAGE DISPOSAL SYSTEM SITE EVALUATION AND SYSTEM SPECIFICATIONS APPLICANT:-1 { _ � I i- "¢'��1� /t� �()h A,'ViAI110 LOT ((, { BLOCK: SUBDIVISION: I . , PROPERTY c [Section /Township /Range /parcel No. or Tax ID Number] ID #. i /, /7 aal/<J TO BE COMPLETED BY ENGINEER, HEALTH UNIT EMPLOYEE, PROVIDE REGISTRATION NUMBER AND SIGN AND SEAL EACH lr P1bPERTY SIZE CONFORMS TO SITE PLAN: ') YES [ ] TOTAL ESTIMATED SEWAGE FLOW: O U GALLONS AUTHORIZED SEWAGE FLOW: GALLONS UNOBSTRUCTED AREA AVAILABLE: gas SQFT SOIL PROFILE INFORMATION SITE 1 SITE EVALUATED BY: BENCHMARK /REFERENCE POINT LOCATION: ( 01 A, ELEVATION OF PROPOSED SYSTEM SITE IS J [INCHE F'T [ABOV THE MINIMUM SETBACK WHICH CAN BE MAINTAINED FROM THE SURFACE WATER: FT DITCHES/ W ALES: WELLS: PUBLIC: FT LIMITED USE: ti /} FT BUILDING FOUNDATIONS: ( j FT PROPERTY LINES: SITE SUBJECT TO FREQUENT FLOODING: [ ] YES 10 YEAR FLOOD ELEVATION FOR SITE: >h• yl✓j Mu un nsell # /4olor 7 19 — Texture 5 NA USDA SOIL SERIES: l / T( T ; De•th to • to to 0 to to to OBSERVED WATER TABLE: 7 INCHES [ABOVE ESTIMATED WET SEASON WATER TABLE ELEVA ION: HIGH WATER TABLE VEGETATION: [ ] YES NO IN 4015, 10/96 (Replaces HRS-H Form 4015 (Pape 3) which may be used) Stock Number: 5744 - 003 - 4015 -1) Lt OR OTHER QUALIFIED PERSON. ENGINEER'S MUST PAGE OF SUBMITTAL. COMPLETE ALL ITEMS. NO NET USABLE AREA AVAILABLE: D1 ) ACRES PER DAY [RESIDENCES -TABLE 1 / OTHER -TABLE 2] PER DAY r1 '$PD OR 2S GP A RE ) UNOBSTRUCTED AREA REQUIRED: J UO SQFT BE CHMARK REFERE PANT PRO OSED SYSTEM TO THE FOLLOWING FEATURES: A /� FT N9RMALLY WET? [ ] YES [ .(NO PRIVATE: /! //-) FT NON-POTABLE: - 7 s FT ` FT. OTABLE WATER LINES: / FT 1)(1 NO 10 YEAR FLOODING? [ ] YES ,K] NO FT MSL/ GVD SITE ELEVATION: -7 FT MS' /NGVD SOIL PROFILE INFORMATION SITE 2 Munsell olor i! SOIL TEXTURE /LOADING RATE FOR SYSTEM SIZING: ( / 1� jiE � 3 DRAINFIELD CONFIGURATION: [ ] TRENCH [)(] BED [ ) OTHER REMARKS /ADDITIONAL CRITERIA: ,,\\ Texture t AO to t0 to t0 — USDA SOIL SERIES:1 i i EXISTING GRADE. TYPE: PERCHED INCHES [ ABOVE ELOW ) EXIS OTTLING: [ ] YES ( ),j' EPTH: DEPTH OF EXCAVATION:73 0 INCHES (SPECIFY) // oA c co DATE: De.th to to to O APPARENT] G- QRADE. INCHES Page 3 of 3 APPLICANT: STATE OF FLORIDA DEPARTMENT OF HEALTH ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM EXISTING SYSTEM AND SYSTEM REPAIR EVALUATION Ah , �NT / AG NT: U DC L � " gfri A) •� �� �� i 0/0.P b ,p- _ I,OTo D BLOCK: 1 S UBDIV: t /1 /n J c 2 5 S ____- _ _;-- - _________________ 17 -. 00 TO BE COMPLETED BY FLORIDA REGISTERED ENGINEER, DEPARTMENT EMPLOYEE, SEPTIC TANK CONTRACTOR OR OTHER CERTIFIED PERSON. 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 C 50 5 — imp . ] ,6AIZbNS SEPTIC TA GPD ATU ] GALLONS SEPTIC TANK /GPD ATU J GALLONh''GREASE INTERCEPTOR. ] GALLONS DOSING TANK I CERTIFY THAT THE ABOVE NOTED STRII 1URALLY , 2D HAVE A SIGNATURE OF LICENSED CONTRACTOR EXISTING DRAINFIELD INFORMATION [c-�() l [ ] SQUARE FEET TYPE OF SYSTEM: [y] CONFIGURATION: [ ] DESIGN: [ ] STANDARD FILLED [ ] MOUND (, 1 TRENCH BED [ ] • HEADER D -BOX [y l GRAVITY SYSTE( ELEVATION OF BOTTOM OF DRAINFIELD IN RELATION TO EXISTING GRADE [ 1q5 [ 00 SITE CONDITIONS: NATURE OF FAILURE: FAILURE SYMPTOM: SUBMITTED BX: ::. •.•. 1' • INFIELD SYS [ [ 1 EET PR REMARKS /ADDITIONAL CRITERIA [ ] SEWAGE ON GROUND ( 1 PLUMBING BACKUP TANKS WERE SYSTEM NO. OF TRENCHES'[ [ ] [Y [ l SYSTEM FAILURE AND REPAIR INFORMATION SYSTEM INSTALLATION DATE TYPE OF WASTE GPD ESTIMATED SEWAGE FLOW BASED ON [ ] DRAINAGE STRUCTURES LEGEND: LEGEND: LEGEND: LEGEND: ] SLOPING PROPERTY (Y) HYDRAULIC OVERLOAD ( ] SOILS [ ] DRAINAGE / RUN OFR. [ ] ROOTS [ I TANK [ ] DH 4015, 10/96 Previous Editions may be used) [ ] POOL [ ] [ y] Nom • [ [ ] PERMIT MATERIAL: i MATERIAL: , MATERIAL: 'MATERIAL : 3 BAFFLED:[Y A/ BAFFLED: [ it PUMPS: [ Ni4_ PUMPED ON _3 / 7 / , HAVE THE VOLUMES SPECIFIED, F OUTLET FILTER DEVICE ] IN LE Rugs L p C -P D72/, -; b BUG. BUSINESS NAME NO. OF TRENCHES (/ l DIMENSIONS: 1 X ;3 ] DIMENSIONS: X [ l DAT DOSED SYSTEM INCHES [ ABOVE [ r] METERED W ER [/] TABLE 1, PATIO / DECK MAINTENANCE WATER TABLE [ ] D BOX /HEADER [y] DRAINFIELD TITLE /LICENSE4, DOMESTIC ( ] [ ] PARKING DATE [ ] SYSTEM DAMAGE [ ] COMMERCIi 64E -6, Fi Page 4 c Miami Shores Village 10050 NE 2nd Avenue Phone: 305 - 795 -2204 Printed: 3/16/2004 Applicant: IRENE Owner: JOHNSON JOB ADDRESS: 730 NE 101 Contractor BOBS SEPTIC & DRAIN INC Local Phone: 305 - 558 -5818 Parcel # 1132060172200 Fees: FEE2004 -2730 FEE2004 -2731 FEE2004 -2732 FEE2004 -2733 FEE2004 -2734 FEE2004 -2735 FEE2004 -2736 Description Building Fee CCF Notary Fee Training and Education Fee Technology Fee Scanning Fee Builders Bond Total Fees: Amount $175.00 $1.80 $5.00 $0.60 $4.37 $3.00 $300.00 $489.77 Total Fees: $489.77 Total Receipts: $489.77 Permit Status: APPROVED Permit Expiration: 9/7/2004 Construction Value: $2,500.00 Work: INSTALLING DRAINFIELD Signed: (INSPECTOR) Plumbing Permit Permit Number: PL2004 -88 JOHNSON IRENE ST Contractor's Address: 1020 NE 130 ST Page 1 of 1 Legal Description: AMD PL MIAMI SHORES SEC 4 LOT 3 & E4OFT LOT 4 PB 15 -14 BLK 104 LOT SIZE 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: STATE OF FLORIDA DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION AND INSTALLATION PERMIT Applicant J elAi9 C o f7 Pe 't Number % -- 6 C3 S . PA I11 - SYSTEM INSPECTION AND Fl A INSTALL APPROVAL Installer Proper tank legend: 4es No Tank material f is C ic' '-{? ank level: p el: Yes ri• No Tanks watertight: Yes No Tank size gallons „ gallons ' gallons Proper tank outlet device: Yes e/ No Manhole or marker to grade: Yes _ No Drainfleld Trench Absorption Bed Length Width Limb Width Length/ 0 feet x /S feet= - ft feet feet feet feet Length feetx feet= ft feet feet /9 feet feet Proper No. drainlines: Yes -" No feet feet feet feet Proper pipe separation: Yes .1/ No Total = ft Other findings Inspected by: Systems located as permitted: Yes No Systems including plumbing stub -outs installed at proper elevation: Yes/94 No Average depth to drainpipe invert from finished grade: / inches Maximum depth• vZ f Inches Average depth of drainfield gravel:11 V inches Minimum depth of gravel / ..inches Proper gravel size: Yes 7 No '/ Backfill or fill material as required: (Quality) Yes ' No (Quantity) Yes , No /''f" cR .- Ci s" . PART III - FINAL STALLATION APPROVAL / _ Date pproved by: � , '�- , �`�- .�S TYPUBL t HEALTH UNIT AN APPROVED INSTALLATION DOES NOT GUARANTEE PERFORMANCE Note: Completed copies of this form will be provided to the applicant, installer and the building department. HRS —H Form 4018, Feb 85 (Obsoletes previous editions which may not be used) (Stock Number. 5744-002-4016-0) Tank Manufacturer ✓v Total = ft Distribution box level: Yes No Gravel is suitable quality: Yes No Date 1--/Y-k7 Page 2 of 2 APPLICANT 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 ] 1 1 1 1 ] 1 FILL [ [ [ [ [ STATE OP FLORIDA PERMIT NO. DEPiARTMENT,.OP EEALTB DATE PAID: ONSITF.- SEWAGE TREATMENT AND DIPOSAL SYSTEM'" riot PAID: CONSTRUCTION INSPECTION MD PIMA'. APPROVAL nacaXPT 1: AGENT PROPERTY ADDRESS: L �% LOT: BLOCK: ' " SUBDI' tsrous �... . 'PROPERT'Y ID #: CEE D [Y1 ITEMS ARE NOT ME COMPLIANCE WITS tilts TANS INSTALLATION , [01] TANK SIZE (1] [2] [©21 TA NI MATERIAL [03] OUTLET DEVICE (041 MULTI .-CHAMBERED [ Y / (05] UW I T FIL` (06) LEGEND /, [07] WATERTIGHT [©81 ;'x; 1©1 EWE T0LID DRAXUVIELD WaSTALLA'TXON / EX VATX N MATERIAL FILL` •,' ' WILL TEXTURE EXCAVATION DEPTH AREA CTS REPLACEMENT AL EXPLANATION or VIOLATIONS / R TIRKU 1 [10] AREA [1]/ [ - SCI (111 DISTRIBUTION «A.Z SBADER [ 12] MUMMER or M ZN S [ 1:31 DRAWL,$ STIO1 [1G1 , RAINLINE SLOP; 115 ] a EFTA OF CO (16) ELEVATION. [ / ]' SU [17 j SYS . . . LOCATION [18] DOSIK:P 119] a: SORECIATE sxsa 99] OOREGATE EXCESSIVE IMAMS • STATUTa OR RULE AND MUST BE CORRECTED. .1 [ ( 1 l 1 l 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 CONSTRUCTION - (APP VfDISAPP ] FINAL SYSTEM PPROVED /DXB. Y VED] ti• DH 4016, 10/97 (Previous .Editions. May Bs Used) SETBACKS [27] SURFACE WATER [28] DITCSZS [29] [30] [31] [32] 133] [34] (35] OTHER WILLED / MOUND SYSTEM (34) DRAINPIELD COVER [37] SHOULDERS [38] SLOPES [39] STABILIZATION PRIVATE WELLS PUBLIC WELLS _ IRRIGATION WELLS - POTABLE WATER LINES BUILUI G FOUNDATION PROPERTY LINES FT rT PT FT FT FT PT FT FT ADDITIONAL INFORMATION 14J UNOBSTRUCTED AREin [413 STOW/MATER Rumor ' [ 42] ALARMS [ 43 ] MAINTENANCE ICE AG [44] DUX WO AREA (I45 ] LOCATIVE comma WIT ' SITE PLAN [46] FINAL SITE GRA.IM§ [4) CONTRACTOR [48] OTHER ABANDONMENT (4 TANK PUMPED [50] TANK CRUSHED & FILLF`+ DATE: : DATE: Page 2 of 3 Permit No at/aL__ MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT 26// 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 k.;_920 n r Street and Number where work is to be performed—No 7 101 State work to be performed and purpose of building (By Floors)_______ New Building _ Remodeling-- _ Addition_ (Signed) Type of Tank____ No 72 Street..— . Registered Architect and/or Engineer .1:23 oird erti P D'' Employing Plumber's Nape n Lot54 Subdivisione2VALet. Street_ . .. Repairs No. of Stories My Commission Expires Notary Public, State of Florida Master Plumber. Size Septic Tank__ Feet of Drain Tile 200 '. • fl; •____Dist. Feet of Tank or Drain Field from Nature of Water Supply: City—Well. Size of Soakage Pit Amount of Permit 8 J (Signed)_ i .21;0: \- k: 'LL: Pit;mbinilnipector. 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 Itav com- plied with the provisions thereof, and will require similar compliance from all contractors or sub-contractors employed by him in the work to he 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 w to be performed under this permit, as are licensed by Miami Shores Village. STATE OF FLORIDA, } U. COUNTY OF DADE. Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take 'dux:iv/lodgments, personally appeared to me well 'mown, and who, being by me first duly sworn, upon oath deposes and says that be is the of the above described construction, that be bas carefully read the foregoing application, and that he did sign the stuns, and that all facts therein by him stated are true. NOTE: A re-inspection fee of $1.00 will be made whoa is re•buissatias madelsemasery by improper notice far bripactkm, at faulty materials and/or warkmaaabip. CLoarts BATH TUNS SHOWERS LAVA. To SINKS SLOP I'm,. LAUNDRY Tuve .. wRINALS CATCH BASIN FLOOPI DRAIN DRINKING FOUNTWS TOTAL rtrruies Coping. LIST — CHECK _ ..... SEPTIC TANK SEWER CONN. DRAIN FIELD SOAKAGE PIT G TRAP SOLAR HEATER DEEP WELL 5 . $ Swiwo POOL Comm. LIST CHECK Permit No at/aL__ MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT 26// 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 k.;_920 n r Street and Number where work is to be performed—No 7 101 State work to be performed and purpose of building (By Floors)_______ New Building _ Remodeling-- _ Addition_ (Signed) Type of Tank____ No 72 Street..— . Registered Architect and/or Engineer .1:23 oird erti P D'' Employing Plumber's Nape n Lot54 Subdivisione2VALet. Street_ . .. Repairs No. of Stories My Commission Expires Notary Public, State of Florida Master Plumber. Size Septic Tank__ Feet of Drain Tile 200 '. • fl; •____Dist. Feet of Tank or Drain Field from Nature of Water Supply: City—Well. Size of Soakage Pit Amount of Permit 8 J (Signed)_ i .21;0: \- k: 'LL: Pit;mbinilnipector. 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 Itav com- plied with the provisions thereof, and will require similar compliance from all contractors or sub-contractors employed by him in the work to he 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 w to be performed under this permit, as are licensed by Miami Shores Village. STATE OF FLORIDA, } U. COUNTY OF DADE. Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take 'dux:iv/lodgments, personally appeared to me well 'mown, and who, being by me first duly sworn, upon oath deposes and says that be is the of the above described construction, that be bas carefully read the foregoing application, and that he did sign the stuns, and that all facts therein by him stated are true. NOTE: A re-inspection fee of $1.00 will be made whoa is re•buissatias madelsemasery by improper notice far bripactkm, at faulty materials and/or warkmaaabip. Permit No...__ / ' g 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 Registered Architect and /or Engineer._____ - - - ,__ Employing Plumber's Name % -_JL - - --- - °I: No. G) c!) MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLCATION FOR PLUMBING PERMIT Location and Legal Description Lot Block Subdivision _.______._._._________ Street and Number where work is to be performed —No 1 36 - - / © l Street--.--.... _------- .-__ ............... _ _ -- ------ .._..�_ -__ -- State work to be performed and purpose of building (By Floors) ____ -- -------- _-- - -_ -_- _--- _- __ - - -. New Building____ _ -- _ -- Remodeling __--- - - - -__ __ Addition__ -- Repairs Size Septic ..... _ Type of Tank Feet of Drain Til 2- _ _Dist. Feet of Tank or Drain Field from Well Nature of Water Supply: ..... _ ___Size of Soakage Pit Date - - -�= - -� ---- -- — 0 ' Street ( _ 2 c t ; - Capacity Gals.. Street._ ' ` - ! 7 r' No. of Stories ............... (Signed)- -- — -- - -- ����._ L r ,._ �` 1� t Plum Inspector. The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations as mployer of labor under the Florida Workmen's Compensation Act, being Section 5988, Compiled General Laws of Florida Permanent Sup a ent, and has com- plied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors employed b im in the work to be performed under this permit; and will post or cause to be posted for inspection on the si of the work such public notice or notices as are required by the Act. The undersigned agrees to employ only such sub- contractors, . ' work to be performed under this permit, as are licensed by Miami Shores Village. Amount of Permit $ STATE OF FLORIDA, COUNTY OF DADE. (Signed 2 e e e Master Plumber. Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeared to me well known, and who, being by me first duly sworn, upon oath deposes and says that he is the of the above described construction, that he has carefully read the foregoing application, and that he did sign the same, and that all facts therein by him stated are true. My C Expires Notary Public, State of Florida NOTE: A re- inspection fee of $1.00 will be made whew such re-inspection is made 'necessary by improper notice for insi 1, or faulty materials and/or workmanship. CLOSETS BATH TUBS SHOWERS LAVA- TORIES SINKS SLOP SINKS LAUNDRY TUBS URINALS I NALS CATCH BASIN FLOOR DRAIN DRINKING FOUNT' NS TOTAL FIXTURES CONTR. LIST CHICK SEPTIC TANK SEWER CONN. DRAIN FIELD SOAKAGE PIT GREASE TRAP SOLAR HEATER DEEP WELL SPRKLR. SYSTEM SW IM•G POOL CoNrR. LIST _ CHICK Permit No...__ / ' g 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 Registered Architect and /or Engineer._____ - - - ,__ Employing Plumber's Name % -_JL - - --- - °I: No. G) c!) MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLCATION FOR PLUMBING PERMIT Location and Legal Description Lot Block Subdivision _.______._._._________ Street and Number where work is to be performed —No 1 36 - - / © l Street--.--.... _------- .-__ ............... _ _ -- ------ .._..�_ -__ -- State work to be performed and purpose of building (By Floors) ____ -- -------- _-- - -_ -_- _--- _- __ - - -. New Building____ _ -- _ -- Remodeling __--- - - - -__ __ Addition__ -- Repairs Size Septic ..... _ Type of Tank Feet of Drain Til 2- _ _Dist. Feet of Tank or Drain Field from Well Nature of Water Supply: ..... _ ___Size of Soakage Pit Date - - -�= - -� ---- -- — 0 ' Street ( _ 2 c t ; - Capacity Gals.. Street._ ' ` - ! 7 r' No. of Stories ............... (Signed)- -- — -- - -- ����._ L r ,._ �` 1� t Plum Inspector. The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations as mployer of labor under the Florida Workmen's Compensation Act, being Section 5988, Compiled General Laws of Florida Permanent Sup a ent, and has com- plied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors employed b im in the work to be performed under this permit; and will post or cause to be posted for inspection on the si of the work such public notice or notices as are required by the Act. The undersigned agrees to employ only such sub- contractors, . ' work to be performed under this permit, as are licensed by Miami Shores Village. Amount of Permit $ STATE OF FLORIDA, COUNTY OF DADE. (Signed 2 e e e Master Plumber. Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeared to me well known, and who, being by me first duly sworn, upon oath deposes and says that he is the of the above described construction, that he has carefully read the foregoing application, and that he did sign the same, and that all facts therein by him stated are true. My C Expires Notary Public, State of Florida NOTE: A re- inspection fee of $1.00 will be made whew such re-inspection is made 'necessary by improper notice for insi 1, or faulty materials and/or workmanship. BUILDING ELECTRICAL PLUMBING ROOFING Owner of Building Architect Contractor or Builder Legal Description Address of wildi Lot MIAMI SHORES VILLAGE. FLORIDA ❑ PERMIT N? 2675 Work to be performed under this Permit Bl. Signed. 195 Contractor's License No. Subdi- vision Value of Project $ Amount of Permit $ This permit is granted to the contractor or builder named above to construct the building or to install the equipment or device described in the application herefor in strict compliance with all ordinances pertaining thereto and with the understanding that the work will be performed in compliance with any plans, lrawings, statements or specifications that may have been submitted to and approved by the proper municipal authorities. This Permit may be revoked at any time if the work is not done in compliance with such ordinances or if the plans are changed without authorization. A further condition upon which this permit is granted is the understanding that the contractor or builder named above assumes the responsibility for a thorough knowledge of the ordinances and regulations pertaining to the work covered hereby whether shown on the plans or drawings cr in the statements or specifications and that he assumes responsibility for work lone by his agents, servants or employees. BY INSPECTOR In consideration of the issuance to me of this permit I agree to perform the work covered hereunder in compliance with all ordinances and regulations pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In ac- -epting this permit I assume responsibility for all work done by either, myself, my agent, servant or employee. CONTRACTOR OR BUILDER BY AUTHORITY ems' BUILDING ELECTRICAL PLUMBING ROOFING Owner of Building Architect Contractor or Builder Legal Description Address of Building Lot MIAMI SHORES VILLAGE. FLORIDA PERMIT N° 2743 Contractor's License No. El ❑ Work to be performed under this Permit B1 Subdi- vision DATE f / 195 Value of ;' Amount of Project $_ I+ Permit $ This permit is granted to the contractor or builder named above to construct the building or to install the equipment or device described in the application herefor in strict compliance with all ordinances pertaining thereto and with the understanding that the work will be performed in compliance with any plans, drawings, statements or specifications that may have been submitted to and approved by the proper municipal authorities. This Permit may be revoked at any time if the work is not done in compliance with such ordinances or if the plans are changed without authorization. A further condition upon which this permit is granted is the understanding that the contractor or builder named above assumes the responsibility for a thorough knowledge of the ordinances and regulations pertaining to the work covered hereby whether shown on the plans or drawings or in the statements or specifications and that he assumes responsibility for work done by his agents, servants or employees. Signed. BY INSPECTOR In consideration of the issuance to me of this permit I agree to perform the work covered hereunder in compliance with all ordinances and regulations pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In ac- cepting this permit I assume responsibility for all work done by either, myself, my agent, servant or employee. CONTRACTOR OR BUILDER BY AUTHORITY as�: BUILDING INSPECTION DEPARTMENT APPLICATION FOR BUILDING PERMIT Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the build- ing 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 specifications the Building t ing Division ivi ion of Miami Shores of hores Village sh be t co plied with, whether herein specified or not. A copy of approved Owner's Name and Address._ x %? " MIAMI SHORES VILLAGE Date No r , 3 Street_ . ! ....a.. f Registered Architect and /or Engineer Name and address of licensed contractor Location and legal description of lot to be built on: Lot Block Subdivision Street and Number where work is to be done State work to be done and purpose of building (by floors) 7 4�� and for no other purpose. New Building Remodeling Addition Repairs No. of Stories To be constructed of Kind of foundation Roof Covering 0 Estimated Total cost of improvements $ Amount of Permit $ Zone cubage required Plan Cubage Distance to next nearest building Size of Building Lot Maximum live load to be borne by each floor I hereby submit all the plans and specifications for said building. All notices with reference to the building and its construction may be sent to The undersigned applicant for this building pennit 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 complied 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 by the Act. They undersigned agrees to employ only such subcontractors, on work to be performed under this permit, as are (Signed) 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 he foregoing application, and that he did sign the same, and that all facts therein by him stated are true. ) Permit No ( ' Date j ( Read, Sworn to and Subscribed before me. Disapproved Date + Notary Public, State of Florida (Signed) Building Inspector My Commission Expires PLANNING BOARD DATE Chairman Member Member Member Member ..... Member Council Approved Date Disapproved Date NOTE: A charge of $1.00 will be made for making corrections or changes to this application after approval has been obtained from the Planning Board. A re- inspection fee of $1.00 will be charged when such re- inspection is made necessary by improper notice for inspection or faulty materials and /or workmanship. STATE OF FLORIDA, ss COUNTY OF DADE. J Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally ap- peared Permit No Application is hereby z/ade for the approval of the detailed statement of the plans and specifications herewith submitted for the building or other structure herein descried. 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 �� Y ' _•--- ____.._ No.__ ..... Street____ Registered Architect and /or Engineer Employing Plumber's Name MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT Location and Legal Description Lot- Block Subdivision____—___________ Street and Number where work is to be performed —No 73 0 Gf / ® Street State work to be performed and purpose of building (By Fl Dora)_____ _________ _______________- ____ -_ New Building ti Remodeling___ ___ Addition_________________ Repairs No. of Stories. Size Septic Tank ....... _ - -�- -- =- Amount of Permit $_11 — STATE OF FLORIDA, COUNTY OF DADE. Type of Tank (Signed)_ No. Street. Date Capacity Gals Feet of Drain Tile________J f' ___Dist. Feet of Tank or Drain Field from Well Nature of Water Supplvi(e6 ty 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 5968, 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 postett 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. (signed) ____ ���K �!__�__ 1 : r' 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. TE: 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. CLOSSTS BATH TUBS SHOWERS LAVA, TORIES SINKS SLOP SINKS LAUNDRY TUBS URINALS CATCH BASIN FLOOR DRAIN DRINK NO FOUNT' NS th,,:/ „ j" . r `° { • t y , TOTAL FIXTURES LIST G OAT / / / c�a d i CHECK SEPTIC TANK SEWER CONN. DRAIN FIELD SOAKAGE PIT GREASE TRAP sou= HEATER DEEP WELL SPRKLR. SYSTEM SW IM•G POOL CONTR. LI ST / - - CHECK Permit No Application is hereby z/ade for the approval of the detailed statement of the plans and specifications herewith submitted for the building or other structure herein descried. 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 �� Y ' _•--- ____.._ No.__ ..... Street____ Registered Architect and /or Engineer Employing Plumber's Name MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT Location and Legal Description Lot- Block Subdivision____—___________ Street and Number where work is to be performed —No 73 0 Gf / ® Street State work to be performed and purpose of building (By Fl Dora)_____ _________ _______________- ____ -_ New Building ti Remodeling___ ___ Addition_________________ Repairs No. of Stories. Size Septic Tank ....... _ - -�- -- =- Amount of Permit $_11 — STATE OF FLORIDA, COUNTY OF DADE. Type of Tank (Signed)_ No. Street. Date Capacity Gals Feet of Drain Tile________J f' ___Dist. Feet of Tank or Drain Field from Well Nature of Water Supplvi(e6 ty 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 5968, 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 postett 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. (signed) ____ ���K �!__�__ 1 : r' 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. TE: 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. f it/ BUILDING ELECTRICAL PLUMBING ROOFING MIAMI SHORES VILLAGE. FLORIDA ❑ DATP��� :y 195 Qom' PERMIT N° 2457 Contractor's License No. 0 ❑ Work to be performed under this Permit Owner of �_...._ Building Architect Contractor or Builder Legal Lot Description Address of Building B1 CONTRACTOR OR BUILDER BY v Subdi- vision Value of Project $ Amount of Permit $ '/ - This permit is granted to the contractor or builder named above to construct the building or to install the equipment or device described in the application herefor in strict compliance with all ordinances pertaining thereto and with the understanding that the work will be performed in compliance with any plans, drawings, statements or specifications that may have been submitted to and approved by the proper municipal authorities. This Permit may be revoked at any time if the work is not done in compliance with such ordinances or if the plans are changed without authorization. A further condition upon which this permit is granted is the understanding that the contractor or builder named above assumes the responsibility for a thorough knowledge of the ordinances and regulations pertaining to the work covered hereby whether shown on the plans or drawings or in the statements or specifications and that he assumes responsibility for work done by his agents, servants or employees. Signed. - BY INSPECTOR In consideration of the issuance to me of this permit I agree to perform the work covered hereunder in compliance with all ordinamces 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 ac- cepting this permit I assume responsibility for all work done by either, myself, my agent, servant or employee. AUTHORITY e r Permit No `443 Registered Architect and /or Engineer, Employing Plumber's Name Location and Legal Description Amount of Permit $ ", ,i ATE or FLORIDA, f as. ,DIMITY OF DADE. IAMI SHORES VII:_ .GZ PLUMBING INSPECTION DEPARTMEo:''' APPLICATION FOR PLUMBING Application is hereby made for the approval of the detailed statement of t17, plans and specifications herewith submitted for the building or other structure herein described. This application is made in compliance and co.;6:. with the :. Wilding Ordinance of Miami Shores Village, Florida, and all provisions of the Laws of the State of Florida, all ordinances of Miam4 Snares Viilagsa and all rules and regulations of the Building Division of Miami Shores Village shall be complied with, whether herein specified er rel... A copy of approved plans and specifications must be kept at building during progress of work. Owner's Name and Address No.__� ; ' �--- - - ----- -- �- - - -- -- - -� Street__ No. -- Block Street and Number where work is to be Street State work to be performed and purpose of building (By Floors) New Building Remodeling_____ _______ Addition._______ Repairs No. of Stories. Type of Tank__ Capacity Gals Size Septic Tank Feet of Drain Tile ______Dist. Feet of Tank or Drain Field from Well Nature of Water Supply: City, Well _______Size of Soakage Pit (Signed) (Signed). Date / / ""__ - Street__ My Commission Expires Notary Public, State of Florida Subdi vision -- _------ _--- ._.--- _-- _ �__ - . - Master Plumber. 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 requi' e3 by Ilia Act. The undersigned agrees to employ only such sub- contractors, on work to be performed under this permit, as are licensad by Miami Shores Village. ? e ore me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeared to ae well known, and who, being by me first duly sworn, upon oath deposes and says that he is the of the above described construction, that he has carefully read the foregoing application, and that he did sign the same, and that all facts therein by him stated are true. NOTE: A re- inspection fee of $1.00 will be made when such re- inspection is made•necessary by improper notice for inspection, or faulty materials and /or workmanship. CLOSETS BATH TUBS SHOWERS LAVA- TORIES SINKS SLOP SINKS LAUNDRY Tuns 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. L.I ST - - -- CHECK r Permit No `443 Registered Architect and /or Engineer, Employing Plumber's Name Location and Legal Description Amount of Permit $ ", ,i ATE or FLORIDA, f as. ,DIMITY OF DADE. IAMI SHORES VII:_ .GZ PLUMBING INSPECTION DEPARTMEo:''' APPLICATION FOR PLUMBING Application is hereby made for the approval of the detailed statement of t17, plans and specifications herewith submitted for the building or other structure herein described. This application is made in compliance and co.;6:. with the :. Wilding Ordinance of Miami Shores Village, Florida, and all provisions of the Laws of the State of Florida, all ordinances of Miam4 Snares Viilagsa and all rules and regulations of the Building Division of Miami Shores Village shall be complied with, whether herein specified er rel... A copy of approved plans and specifications must be kept at building during progress of work. Owner's Name and Address No.__� ; ' �--- - - ----- -- �- - - -- -- - -� Street__ No. -- Block Street and Number where work is to be Street State work to be performed and purpose of building (By Floors) New Building Remodeling_____ _______ Addition._______ Repairs No. of Stories. Type of Tank__ Capacity Gals Size Septic Tank Feet of Drain Tile ______Dist. Feet of Tank or Drain Field from Well Nature of Water Supply: City, Well _______Size of Soakage Pit (Signed) (Signed). Date / / ""__ - Street__ My Commission Expires Notary Public, State of Florida Subdi vision -- _------ _--- ._.--- _-- _ �__ - . - Master Plumber. 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 requi' e3 by Ilia Act. The undersigned agrees to employ only such sub- contractors, on work to be performed under this permit, as are licensad by Miami Shores Village. ? e ore me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeared to ae well known, and who, being by me first duly sworn, upon oath deposes and says that he is the of the above described construction, that he has carefully read the foregoing application, and that he did sign the same, and that all facts therein by him stated are true. NOTE: A re- inspection fee of $1.00 will be made when such re- inspection is made•necessary by improper notice for inspection, or faulty materials and /or workmanship.