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PLUMBINGPERMIT APPLICATION FOR MIAMI SHORES VILLAGE Date Y-3- 5'O Job Address / . 3 T / E / Q2 $I Tax Folio (( 3 2 05 023 C) 1 ` ,{ — 0 . Legal Description Historically Designated: Yes No 4 ?7 ' l ( . / Tenant if e n Owner's Address .) 3 T / S I— Phone 3 a f 7S 5 y- J G 4 Contracting Co. A fci J /) f r c .v k JW c. Address Qualifier ,4 n' U/ `v 2e r r/ State # y p '7, Municipal # Competency # Ins. Co. Architect/Engineer Address Bonding Company Address Mortgagor Address Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN WORK DESCRIPTION Square Ft. Cl f f1>O,- .z ce rZ2Grl/ soo $7P7' Kele to ignature of owner and/or Condo President a te 2 11�r 7, ' Q OF F.O OFFICIAL NOTARY SEAL BARBARA ANN FUOAZZI COMMISSION MISER CC723460 MY COMMISSION EXPIRES MAR. 29,2002 Notary as to Owner an My Commission Exp d' FEES: PERMIT „ RADON APPROVED: Zoning Building Mechanical Plumbing C.C.F. SS# Phone 5 65 ' 0 8•, k e ,9Q r» Estimated Cost (value) Master Permit # 77 o / 14//i /F /L e Of/435c 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 performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that separate permits are required for ELECTRICAL, PLUMBING, SIGNS, POOLS, ROOFING and MECHANICAL WORK. OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. Furthermore, I authorize the above -named contractor to do the worstated. m.. a of ; or • to C z �r Signa - 7 Electrical 2 G° - ) Owner - Builder / 00- •/3 -38- aS,2 -a otary '� o .: .: I� STATE OF ?to Co 1 ION NO. CC714103 CO MY COMMISSION EXP. MAR. 7.2002 �• 2, n NOTARY 5 / BOND 360 TOTAL DUE Date rff Date Engineering T H E R CONSTRUCTION PERMIT F9R: � [A) New System [/ Existing System (/"] Holding Tank [/.}- Temporary /Experimental (y) Repair ( ,t- (Abandonment ( ' Other(Specify) APPLICANT: / AGENT: A PROPERTY STREET ADDRESS: / 7 2 . 3 ) /0 Z LOT: o0.1. BLOCK: PROPERTY ID #: �� (SECTION /TOWNSHIP /RANGE /PARCEL NUMBER) (OR TAX ID NUMBER) SYSTEM MUST BE CONSTRUCTED IN ACCORDANCE WITH SPECIFICATIONS AND .STANDARDS OF CHAPTER 1OD -6, FAC. REPAIR PERMITS AND HOLDING TANK PERMITS EXPIRE 90 DAYS FROM THE DATE OF ISSUE. ALL OTHER PERMITS EXPIRE ONE YEAR FROM THE DATE OF ISSUE. DEPARTMENT OF HEALTH APPROVAL OF SYSTEM DOES NOT GUARANTEE SATISFACTORY 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. SYSTEM DESIGN AND SPECIFLCATIONS D [ 3 �- S RE T PRIMARY DRAINFIELD SY R ( J SQUARE - FEET SY A TYPE SYSTEM: [ ] STANDARD [ I CONFIGURATION: [ ) TRENCH N F LOCATION OF BENCHMARK: /0.7 Cam-, - I ELEVATION OF PROPOSED SYSTEM SITE ( . E BOTTOM OF DRAINFIELD TO BE [ Iry L D FILL R,E91j.I,RED: O t;, SPECIFICATIONS BY: APPROVED BY: DATE ISSUED: 7 ,- — STATE OF FLORIDA DEPARTMENT OF HEALTH ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PERMIT Authority: Chapter 381, FS i Chapter 10D -6, FAC /j% SUBDIVISION: :1 , . I DM 4016. 10196 (Replaces HRS -H Form 4016 (pope 1) which may bo usod) (Stock Number: 5744-001- 4016-0) ) ll STEM: • STEM FILLED C}. -BED EXCAVATION REQUIRED: TITLE: TITLE: APPLICANT T PERMIT # DATE PAID FEE'PAID' RECEIPT # S`_, �'� K E oT'C 7 [ ) MOUND [ ) [ INCHES /FT) [ABOVE /BELOW) BENCHMARK/REFERENCE—Pena' CjINCH] S7,FT) [ABOVE LOW BENCHM ° FERENCE .POIN T (� �- 1) ) G GPDJ SEPTIC TA�rK /AEROBIC UNIT CAPACITY MULTI- CHAMBERED /IN .SERIES:( ) A [' J [GALLONS / GPDJ CAPACITY MULTI- CHAMBERED /IN SERIES:( ) N [ ) GALLONS GREASE INTERCEPTOR CAPACITY [MAXIMUM CAPACITY SINGLE TANK: 1 GALLONS) K [. J GALLONS PER DOSE DOSING TANK CAPACITY' [ ) PER "24 HRS NO. OF PUMPS: [ J ( INCHES 2 c G EXPIRATION DATE: /0 -• /4/ Page 1 of 2 APPLICANT: D R A I N F I E L D 0 T H E R CONSTRUCTION PERMIT FpR: (A New System [A ] )existing System ) Repair [4.1 Abandonment /2 23 /vim /02 PROPERTY STREET ADDRESS: 6i sl LOT: Ail BLOCK: /0 SUBDIVISION: 40 PROPERTY ID 1: J ii [SECTION/TOWNSHIP/RANGE/PARCEL NUMBER).".• •(OR :ID - :- NUMBER:) • . == == __ =,. == ________` SYSTEM MUST BE CONSTRUCTED IN ACCORDANCE WITH SPECIFICATIONS AND STANDARDS OF CHAPTER 10D -6, FAC. REPAIR PERMITS AND HOLDING TANK PERMITS EXPIRE 90 DAYS FROM THE DATE OF ISSUE : ALL.OTHEI PERMITS EXPIRE ONE YEAR FROM THE DATE OF ISSUE'. DEPARTMENT OF HEALTH APPROVAL OF SYSTEM- DOE: NOT GUARANTEE SATISFACTORY PERFORMANCE FOR ANY SPECIFIC PERIOD OF TIME. ANY CHANGE IN MATERIAL FACTS WHICH SERVED AS A BASIS FOR ISSUANCE OF THIS PERMIT THE :APPLICANT TO MODIFY TR) PERMIT APPLICATION. SUCH MODIFICATIONS MAY RESULT IN THIS PERMIT BEING MADE NULL AND VOID. ____________ ___. = = = =: SYSTEM DESIGN AND SPEC,IFICATIONS ��`i T [c /C--0 J [GALLONS} GPD](SEPTIC TANK /AEROBIC UNIT CAPACITY . MULTI- CHAMBERED /IN SERIES :( . A [ 1 [GALLONS / GPDJ, CAPACITY MULTI- CHAMBERED /IN SERIES:( N [ J GALLONS GREASE INTERCEPTOR CAPACITY (MAXIMUM CAPACITY SINGLE TANK: 1250 GALLONS K ( ] GALLONS PER DOSE DOSING TANK CAPACITY DOSE - RATE•( ] PER 24 HRS NO. OF PUMPS: [ [ 3 ' SQUARE T PRIMARY DRAINFIELD SYSTEM [ ] SQUARE —FE'T SYSTEM TYPE SYSTEM: [ J STANDARD ( ) FILLED ( ) MOUND ( J CONFIGURATION: [ 1 TRENCH C} - ( CATION OF BENCHMARK: 0. C�'`��'' °� �T�' - •Pa� C 1 -7- LO r� 7 ; ELEVATION OF PROPOSED SYSTEM SITE (a (INCHES /FT] [ABOVE /BELOW] BENCHMARK /REFERENCE POIN BOTTOM OF DRAINFIELD TO BE ( 2 c4 ) INCHES FTJ [ABOVE ^LOW ' BENC FERENCE POIN FILL REQUIRED: [ J INCHES EXCAVATION REQUIRED: 1 INCHES SPECIFICATIONS BY: APPROVED BY: STATE OF FLORIDA DEPARTMENT OF HEALTH ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PERMIT Authority: Chapter 381, FS & ! `/U,- __ DATE ISSUED: 7 ,c/ z OH 4016. 10196 (Replaces HRS -H Form 4016 (page 1) which may be used) (Stock Humber: 5744. 001- 4016 -0) .Chapter: 10D -6:,• FAC. [A Holding. Tank WA" Temporary /Experimental (Other(Specify) TITLE: PERMIT i INSTALLER/CONTRACTOR DATE PAID FEE PAID' $ 7f RECEIPT # AGENT: A Se.4 SE p i TITLE : EXPIRATION DATE :, /U Page 1 of • 0 { ±» Y Permit No/ 6 7 /1 Size Septic Tank Feet of Drain Tile /" MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT Dist. Feet of Tank or Drain Field from Well 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. Owner's Name and Address ACM E SEPT, - TANK CO, No Street Registered Architect and /or Engineer P. _ O: _ _B-0X_100O Employing Plumber's Name HIAL - A - F+T_FL - +DA No. Street a Block Subdivision Street and Number where work is to be Location and Legal Description Lot performed—No . 7 3 Al 5 l a Z 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 Nature of Water Supply: City —Well Size of Soakage Pit Amount of Permit $ (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 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. ss. (Signed) My Commission Expires Notary Public, State of Florida NOTE: A re- inspection fee of $1.00 will be made when such re- inspection is made necessary by improper notice for ins materials and /or workmanship. Master Pluinber. STATE OF FLORIDA, 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 the has carefully read the foregoing application, and that he did sign the same, and -that all facts therein by him stated are true. 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 H EATER DEEP WELL SPRKLR. SYSTEM SW IM'G POOL CONTR. LIST • CHECK A . Y Permit No/ 6 7 /1 Size Septic Tank Feet of Drain Tile /" MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT Dist. Feet of Tank or Drain Field from Well 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. Owner's Name and Address ACM E SEPT, - TANK CO, No Street Registered Architect and /or Engineer P. _ O: _ _B-0X_100O Employing Plumber's Name HIAL - A - F+T_FL - +DA No. Street a Block Subdivision Street and Number where work is to be Location and Legal Description Lot performed—No . 7 3 Al 5 l a Z 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 Nature of Water Supply: City —Well Size of Soakage Pit Amount of Permit $ (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 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. ss. (Signed) My Commission Expires Notary Public, State of Florida NOTE: A re- inspection fee of $1.00 will be made when such re- inspection is made necessary by improper notice for ins materials and /or workmanship. Master Pluinber. STATE OF FLORIDA, 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 the has carefully read the foregoing application, and that he did sign the same, and -that all facts therein by him stated are true. ( Permit No._..s_ 4 _ 0 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 add 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 oz not. A copy of approved plans and specifications must be kept at building during progress of work. Owner's Name and Address 27 n• L MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMEW APPLICATION FOR PLUMBING . ' `;�, Registered Architect and /or Engineer______ _ ______�________ ____ i ,_ _..____ c Employing Plumber's Name ( d 4 - "4?? ___ _N ��_ _' -__ No.. .37.91_2 ee _ - -• -. -_"µ Amount of Permit $___P, � Location and Legal Description Lot --------- - - ----- ._---- - -____ _ Block-_ �� Street Street and Number where / O Z re work is to be performed —No / 2 3 n c State work to be performed and purpose of building (By Floors)_ -_> New Building _ -- Remodeling_-__- _ -_ Addition. %1J N / Z) 3 Stunt // G 10 2 S f, Repairs No. of Stories Size Septic Tank -- - --- - - -- Capacity Gals. Eeet of Drain Tile Dist. Feet of Tank or Drain Field from Well n Nature of Water Supply: :.City— Well.__________ 2- Size of Soakage Pit ,0 (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. ` (Signed), / - -7 -� Date Subdivision_ STATE OF FLORIDA, I 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•necessary by improper notice for inspection, or faulty materials and /or workmanship. CLOSETS BATH TUBS SHOWERS LAVA- TORIES SINKS SLOP SINKS LAUNDRY TUBB 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 A ( Permit No._..s_ 4 _ 0 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 add 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 oz not. A copy of approved plans and specifications must be kept at building during progress of work. Owner's Name and Address 27 n• L MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMEW APPLICATION FOR PLUMBING . ' `;�, Registered Architect and /or Engineer______ _ ______�________ ____ i ,_ _..____ c Employing Plumber's Name ( d 4 - "4?? ___ _N ��_ _' -__ No.. .37.91_2 ee _ - -• -. -_"µ Amount of Permit $___P, � Location and Legal Description Lot --------- - - ----- ._---- - -____ _ Block-_ �� Street Street and Number where / O Z re work is to be performed —No / 2 3 n c State work to be performed and purpose of building (By Floors)_ -_> New Building _ -- Remodeling_-__- _ -_ Addition. %1J N / Z) 3 Stunt // G 10 2 S f, Repairs No. of Stories Size Septic Tank -- - --- - - -- Capacity Gals. Eeet of Drain Tile Dist. Feet of Tank or Drain Field from Well n Nature of Water Supply: :.City— Well.__________ 2- Size of Soakage Pit ,0 (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. ` (Signed), / - -7 -� Date Subdivision_ STATE OF FLORIDA, I 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•necessary by improper notice for inspection, or faulty materials and /or workmanship. Permit Application structure herein described. and all provisions of the of Miami Shores Villa building during pro ' e f d Feet of Drain Tile Nature of Water Supply: Amount of Permit $ proval of the detailed statement of the plans and specifications her ith submitted for the building or other ation is made in compliance and conformity with the Building Qr nance of Miami Shores Village, Florida, e State of Florida, all ordinances of Miami Shores Village and all r�les and regulations of the Building Division e complied with, whether herein specified or not. A copy of approved plans and specifications must be kept at Owner's Nam d ss D. A. Pr 4 1 / ^ No Street Registered Ar% t c and /or Engineer r II � , Street �` ' f I ' fe C. r C ( 2/ - F- Employing PI . er s Name P �? __ �__i___ __ _� No ■ Location and ekal Description Lot Block Subdivision Street and Number where work is to be 'performed —No 1.1 - Street f'r ' C • 1 C 7, 5 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 ss. MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT is Feet of Tank or Drain Field from Well Size of Soakage Pit The undersigned applicant for this building permit does hereby certify t a • . -rstands and accepts his obligations as an employer . labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Permanent Supplement, and h s com- plied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors employed by him in the woo k 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 notice as are required by the Act. The undersigned agrees to employ only such sub - contractors, on work to be,,p r orme under this permit, as are licensed by Miami Shores Village. (Signed) STATE OF FLORIDA, 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 necessary by improper notice for inspection, or faulty materials and /or workmanship. Date_ 4:7Lisd. Master Plumber. CLOSETS BATH TUBS SHOWERS LAVA- TORIES SINKS SLOP SINKS LAUNDRY TUBS URINALS CATCH BASIN FLOOR DRAIN DRINKING FO NT' Ns ,` y,I 1 TOTAL FIXTURES CONTR. LIST /� V CHECK , i SEPTIC TANK SEWER CONN. DRAIN FIELD SOAKAGE PIT GREASE TRAP SOLAR H EATER DEEP WELL SPRKLR. SYSTEM SW IM•G POOL ./� �/ CONTR. LIST it=Z0 3 CHECK / Permit Application structure herein described. and all provisions of the of Miami Shores Villa building during pro ' e f d Feet of Drain Tile Nature of Water Supply: Amount of Permit $ proval of the detailed statement of the plans and specifications her ith submitted for the building or other ation is made in compliance and conformity with the Building Qr nance of Miami Shores Village, Florida, e State of Florida, all ordinances of Miami Shores Village and all r�les and regulations of the Building Division e complied with, whether herein specified or not. A copy of approved plans and specifications must be kept at Owner's Nam d ss D. A. Pr 4 1 / ^ No Street Registered Ar% t c and /or Engineer r II � , Street �` ' f I ' fe C. r C ( 2/ - F- Employing PI . er s Name P �? __ �__i___ __ _� No ■ Location and ekal Description Lot Block Subdivision Street and Number where work is to be 'performed —No 1.1 - Street f'r ' C • 1 C 7, 5 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 ss. MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT is Feet of Tank or Drain Field from Well Size of Soakage Pit The undersigned applicant for this building permit does hereby certify t a • . -rstands and accepts his obligations as an employer . labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Permanent Supplement, and h s com- plied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors employed by him in the woo k 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 notice as are required by the Act. The undersigned agrees to employ only such sub - contractors, on work to be,,p r orme under this permit, as are licensed by Miami Shores Village. (Signed) STATE OF FLORIDA, 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 necessary by improper notice for inspection, or faulty materials and /or workmanship. Date_ 4:7Lisd. Master Plumber. BUILDING ELECTRICAL PLUMBING ROOFING Owner of Building Architect Contractor or Builder Legal Description Address of Building Lot MIAMI SHORES VILLAGE, 0 ❑ PERMIT 0 0 • CONTRACTOR OR BUILDER Signed. Work 81 N? 2849 to be performed under this Permit Subdi- vision Value of Project $ FLORIDA DATE / 3 Contractor's License No. 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 t orough knowledge of the ordinances and regulations pertaining to the work covered hereby whether shown on the plans or drawings cr in the statements or sp cifications and that he assumes responsibility for work done by his agents, servants or employees. / Amount of Permit $ 195 BY INSPECTOR In consideration of the issuance to me of this permit I agree to perform the work co red 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. BY AUTHORITY a BUILDING ELECTRICAL PLUMBING ROOFING Legal Description Lot Address of wilding MIAM D Owner of Building Architect Contractor or Builder PERMIT t ? 4..r w .! Bl. -��- CONTRACTOR OR BUILDER I SHORES VILLAGE. FLORIDA Signed. Work to be performed under this Permit AN This permit is granted to the contractor or builder named above to construc 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, irawings, statements or specifications that may 'have been submitted to and approved by the proper municipal authorities. This Permit may be revoked at any ime 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 ;ranted is the understanding that the contractor or builder named above assumes the responsibility for a thorough knowledge of the ordinances and regulations , ertaining to the work covered hereby whether shown on the plans or drawings cr„'n the statements or speg lone by his agents, servants or employees. ■9 2805 BY Subdi- vision Value of Project $ ,. ✓` DATE f Contractor's License No. tions and that he assurq`es responsibility for work BY Amount of Permit $ r V 195( 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 :ertaining 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. AUTHORITY 6 qf ; s '.-1;;;;'"