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260 NE 102 St (6)PERMIT APPLICATION FOR MIAMI SHORES VILLAGE Date 9 Job Address )60 N5 °a ' Tax Foliol( 5.206/ / 473e Legal Description J ( 7/mho Owner / Lessee / Tenant D)c); s �� `m�� Master Permit 4 � c ( / Owner's Address g I Met {omF3C nVe oo 13CJ) Phone 3°S 'i 732 Contracting Co. \- 51‘-f 19 I m - /t ( Address 60 / 3 )\(i.0 /6957 7))//20 R 3306 Qualifier PoaeRl Eoe\s 1 ern) SS# . - $ Phone 8 .)3 - 3 1 / 3 ? State # FL Municipal # Competency # l613c Ins .Co.c/ g Architect /Engineer Address Bonding Company Address Mortgagor Address Permit Type(circle one): BUILDING pp ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING PENCE SIGN WORK DESCRIPTION H Lo�'1e� Heir(E Square Ft. Estimated Cost(value) WARNING TO OWNER: YOU MUST RECORD A NOTICE OF COMMENCEMENT AND YOUR FAILURE TO DO SO MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY (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. 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 work stated. Signature of owner and /or Condo President Signature o Contractor or Owner- Builder Date: Date : 9�a� Notary as to Owner and /or Condo President My Commission Expires: ** * * * * * * * * * * * * * * * ** FEES: PERMI O -,O RADON C.C.F. .9 NOTARY 6.--;P° TOTAL DUE 36 '�� APPROVED: Fire Other Zoning Mechanical Building as to C y Commission So o Electrical 1, Engineering Job Address Legal Description 2 5 &Ay/ AMP Master Permit it .3! 7cZ State# Competency# 9 q 3 n Ins.Co. Architect /Engineer Address Bonding Company Address Mortgagor Address WORK DESCRIPTION Square Ft. 0/10:0 6: ignature of Owner and /or Condo President Date: PERMIT FEE: APPROVED: a 5'. 0 0 -Ow 77 3 0 0 o /as Zoning 17 Mechanical Fire Building Estimated Coste ' 35LYiO2 Other Electrical Engineering PERMIT APPLICATION FOR MUNICIPALITIES OF DADE COUNTY (OWNER TO RETAIN COPY) Tax Folio] / Jdz0W I3413DaZ Owner / Lessee / Tenant Q,G. (C- 5)fiefk Owner's Address XI r / )t1 � - $ phone Contracting Co. ��f// /f /�1 yji.' 0,}"Foediddress / 7 , (re- 'Le. /v1- Cp Qualifier WAr /ft I Z SS# phone �" p 1 Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL PAVING FENCE SIGN 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. 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. Furtherypre, I authorize the above -named contractor to do the work stated. Signatu of Contractor or Owner - Builder g ate: ^' /tt '97 ' Not y a to Owner and /of C ndo President ( N• ary as to Contractor or Owner- lde My omission Expires / /qfr' My Commission Expires: G * * * * * * * i 9a * Date of Application Type of Establishment Type of No. Bedrooms Residential (each dwelling unit) HRS-H Form 4015, Feb 85 (Obsoletes previous editions which may not be used) (Stock Number. 5744-001-4015-1) STATE OF FLORIDA DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PERMIT Authority Chapter 381, FS Chapter 10D -6, FAC PART I - APPLICATION TOTAL FLOW = Heated or Cooled Area (each dwelling unit) ft ft Permit Application Number / Name of Owner Ai 77t i// •d/ Telephone Number T ?-*-- 1 7 t Mailing Address of Owner A60 //l idol flA Owner's Agent b14 / ( - Lt AJ' 4 Builder ,� ' 2' 7 a l t/" /4 1 -- 7 -:;- ‘O 4 X537 Agents Mailing Address T Y Telephone No Property Street Address . G► 6 i j 'v - /A4 1/a Lot No. Block No. Subdivision Date Subdivided NOTE: IF NOT IN A SUBDIVISION ATTACH A METES AND BOUNDS DESCRIPTION This Application is for: New System Repair Existing System Sewage Flow Sewage Flow (Gallons per day) Based On No. Dwelling Sewage Flow Units (Gallons per day) Exact Directions to Property AUDIT CONTROL NO Applicant's Signature c�GC O Page 1 of 3 - �-r 1 ` • 1 • ' r t STATE OF FLORIDA DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PERMIT . .1/ ,t PART II - SITE PLAN s a/ N; sa /aa■a/sa ■ia■saaaasaaa■saaaaaN. nan ,Grua // as a� aa a //at /am / /a■/aaa■a //sa aasaam� ss ! i SIB a a n a iii s a u i � irT a ai a i las s a u a ■asilaaaaa.U.aaaaa ■Sawa ■aapMINSI /aaaaaa/ /as■a■aa ■a■a ■/ a •....a ri ■ ua r ie. a amuu.m i�=. 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MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT My Commission Expires Street and Number where work is to be performed —No State work to be performed and purpose of building (By Floors) _ New Building Remodeling Addition (Signed) V #� Application is hereby mad 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 wo Owner's Name and Addre s`' r -1 7C —1 c„) No 4 0 Street Registered Architect and /or Engineer _ ' r"e / �/ ® )" k ^T ` Employing Plumber's Name _ No Street Location and Legal Description Lot Block S Subdivisioon � eet Date t� / �! _ Amount of Permit $_ (Signed Notary Public, State of Florida I1 4 Repairs No. of Stories Size Septic Tank Type of Tank apacity Feet of Drain Tile Dist. Feet of Tank or Drain Field from ell UUU Nature of Water Supply: City —Well Size of Soakage Pit Plumbin nspector. The undersigned applicant for this building permit does hereby certify that he understands and accepts his obli ions as an a j`.loyer of labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Permanent Suppleme and has com- plied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors employed by him in the work to be performed under this permit; and will post or cause to be posted for inspection on the site of the work such public notice or notices as are required by the Act. The under signed agrees to employ only such sub - contractors, on work to be performed under this permit as are licensed by Miami Shores Village. Master Plumber. STATE OF FLORIDA, } ss. COUNTY OF DADE. Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally 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. NOTE: A re- inspection fee of $1.00 will be made when such re- inspection is made necessary by improper notice for inspection, or faulty materials and /or workmanship. CLOSETS BATH TUBS SHOWERS LAVA- TORIES SINKS SLOP SINKS LAUNDRY TUBS URINALS CATCH BASIN FLOOR DRAIN DRINKING FOUNT' NS TOTAL FIXTURES CONTR. LIST CHECK SEPTIC TANK SEWER CONN. DRAIN FIELD SOAKAGE PIT GREASE TRAP SOLAR HEATE EEP WELL SPRKLR. SYSTEM SWIM'G POOL CONTR. LIST • CHECK / / A MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT My Commission Expires Street and Number where work is to be performed —No State work to be performed and purpose of building (By Floors) _ New Building Remodeling Addition (Signed) V #� Application is hereby mad 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 wo Owner's Name and Addre s`' r -1 7C —1 c„) No 4 0 Street Registered Architect and /or Engineer _ ' r"e / �/ ® )" k ^T ` Employing Plumber's Name _ No Street Location and Legal Description Lot Block S Subdivisioon � eet Date t� / �! _ Amount of Permit $_ (Signed Notary Public, State of Florida I1 4 Repairs No. of Stories Size Septic Tank Type of Tank apacity Feet of Drain Tile Dist. Feet of Tank or Drain Field from ell UUU Nature of Water Supply: City —Well Size of Soakage Pit Plumbin nspector. The undersigned applicant for this building permit does hereby certify that he understands and accepts his obli ions as an a j`.loyer of labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Permanent Suppleme and has com- plied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors employed by him in the work to be performed under this permit; and will post or cause to be posted for inspection on the site of the work such public notice or notices as are required by the Act. The under signed agrees to employ only such sub - contractors, on work to be performed under this permit as are licensed by Miami Shores Village. Master Plumber. STATE OF FLORIDA, } ss. COUNTY OF DADE. Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally 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. 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.