PLUMBING PERMITAmount of Permit $
Permit No / a ' Pt
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____::_°_' ;:t
Registered Architect and /or En m r__ r
g F r
- ./ = — =— =_ / / � `�� -
Employing Plumber's Name __ k No. Street ° ` `' °� I �
Location and Legal Description Lot Block Subdivision
Street and Number where work is to be performed —No. Street
State work to be performed and purpose of building (By Floors)
New Building Remodeling Addition Repairs No. of Stories
Size Septic Tank Type of Tank Capacity Gals
Feet of Drain Tile Dist. Feet of Tank or Drain Field from Well
STATE OF FLORIDA, 1
COUNTY OF DADE. r
ss.
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
No .
P e 8
Date'
Street
1
Size of Soakage Pit
(Signed)
The undersigned ap cant for this building permit does hereby certify that he underst s and accepts his obligations as an employer of labor
under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Permanent Supplement, and has com-
plied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors employed by him in the work to be
performed under this permit; and will post or cause to be posted for inspection on the site of the work such public notice or notices as are
required by the Act. The undersigned agrees to employ only such sub - contractors, on work to be performed under this. permit, as are
licensed by Miami Shores Village.
�..
(Signed)
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
Plumbing Inspecto
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
�.
,�'�
,
- r
TOTAL
FIXTURES
CONTR.
LIST
: �
u
CHECK
I
f
J
SEPTIC
TANK
SEWER DRAIN
CONN. FIELD
SOAKAGE
PIT
GREASE
TRAP
SOLAR
HEATER
DEEP
WELL
SPRKLR.
SYSTEM
SWIM'G
POOL
CONTR.
LIST
f/
_ ,
CHECK
) 0.t;
/� y
Amount of Permit $
Permit No / a ' Pt
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____::_°_' ;:t
Registered Architect and /or En m r__ r
g F r
- ./ = — =— =_ / / � `�� -
Employing Plumber's Name __ k No. Street ° ` `' °� I �
Location and Legal Description Lot Block Subdivision
Street and Number where work is to be performed —No. Street
State work to be performed and purpose of building (By Floors)
New Building Remodeling Addition Repairs No. of Stories
Size Septic Tank Type of Tank Capacity Gals
Feet of Drain Tile Dist. Feet of Tank or Drain Field from Well
STATE OF FLORIDA, 1
COUNTY OF DADE. r
ss.
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
No .
P e 8
Date'
Street
1
Size of Soakage Pit
(Signed)
The undersigned ap cant for this building permit does hereby certify that he underst s and accepts his obligations as an employer of labor
under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Permanent Supplement, and has com-
plied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors employed by him in the work to be
performed under this permit; and will post or cause to be posted for inspection on the site of the work such public notice or notices as are
required by the Act. The undersigned agrees to employ only such sub - contractors, on work to be performed under this. permit, as are
licensed by Miami Shores Village.
�..
(Signed)
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
Plumbing Inspecto
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.
n
BUILDING
ELECTRICAL
PLUMBING
ROOFING
Owner of
Building
Architect
Contractor
or Builder
Legal
Description.
Address of
Building
Lot
MIAMI SHORES VILLAGE, FLORIDA
PERMIT N° 12181
❑ Work to be performed under this Permit
BL
Subdi-
vision
Value of
Project $
DATP
Contractor's
License No
Amt. 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
195
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 responsibility for all work done by either, myself, my agent, servant or employee.
CONTRACTOR OR BUILDER
BY
AUTHORITY