261 NE 102 St (12)•
Date Job Address
Legal Description
Owner / Lessee / Tenant C# r i S 7 3 1 4 4 e- Master
Owner's Address / /l/ 6 /(); S 7cre21/ I A 1,, X33 )37 Phone
Contracting Co. /�' -A- 1 64'5 = C
J ( C� Address 9 -.. C) /C.(..4) . L (57 4 -
Qualifier PO Y ()t GleC SS# ( Phone 63 ( -6
State #� C0035 Iunicipal 11 Competency # Ins.Co. 0 ^' 1 " 7
Address
Address
Architect /Engineer
Bonding Company
Mortgagor
Permit Type(circle
WORK DESCRIPTION Z'5+4 7r &pm Z k "9, 9 6-tie
coo k
Square Ft. Estimated Cost(value) /17S
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
author.. 1 the above -name cont , =ctor to do the work stated.
Signa
Date:
Notary as to 1 . er and/or Cndo Presiden T(iL4gM I L Notary as to Con
My Commi-si •- Expire My Commission Ex
F�Ts R vC 5 A i Cr F;�oarDA
CO�1SX. °S�Ci ! �� h` y C. CL C- ry2
** * * DAY Ca1�rmitt o.N AP. MAR. *.
APPROVED:
Buildin
Mechanical Plumbin
Zoning
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
((2 / f(7? St Tax Folio eo l Af (R�JC icy- 1 ? Acre;
J�i��,� ..sk cv .s
one): BUILDING ELECTRICAL
resident
RADON C.C.F. ► NOTARY
Address
MECHANICAL ROOFING PAVING PENCE SIGN
Signat
Date:
Fire Other
3 6 7 9
Permit # 'v /`�
e of Contractor or Owner-Builder
jer P!/ OFFICIAL NOTARY SEAL
k 7 7 . <. BARBARA ANN FUGAZZI
j * COMMISSION NUMBER
'Il 'r CC360191
U2
1 Q
o M* COMMI4SION EXO*
-F F� MAR. 29.199
TOTAL DUE
Electrical
Engineering
s 0, D.
/k)(
7
,. a .11
• :14 .c •
• . _
3
Permit No..
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. �d //
Owner's Name and Address - r7 - , �? �� __ No. __ oo�� %&� Street. /
Registered Architect and /or Engineer ____ ___.__ _________..___..
Employing Plumber's Name No.__._4 � Street. ..:- e ���'�� ,
Location and Legal Description Lot.._
New Building
Amount of Permit $
Street and Number where work is to be performed —No
State work to be performed and purpose of building (By Floors)_
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMEi
APPLICATION FOR PLUMBING
Block__ Subdivision
Remodeling_ ____.... _______ Addition._.___._ Repairs No. of Stories
Size Septic Tank _ Type of 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 )__
Capacity Gals
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 5986, 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.
Date
Street
Master Plumber.
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
TUBE
URINALS
CATCH
BASIN
FLOOR
DRAIN
DRINKING
FOUNT' NS
TOTAL
FI %TURES
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
/
O -
CHECK
{�
Permit No..
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. �d //
Owner's Name and Address - r7 - , �? �� __ No. __ oo�� %&� Street. /
Registered Architect and /or Engineer ____ ___.__ _________..___..
Employing Plumber's Name No.__._4 � Street. ..:- e ���'�� ,
Location and Legal Description Lot.._
New Building
Amount of Permit $
Street and Number where work is to be performed —No
State work to be performed and purpose of building (By Floors)_
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMEi
APPLICATION FOR PLUMBING
Block__ Subdivision
Remodeling_ ____.... _______ Addition._.___._ Repairs No. of Stories
Size Septic Tank _ Type of 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 )__
Capacity Gals
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 5986, 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.
Date
Street
Master Plumber.
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 No ./J 6 _.
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 0 -• -___ --� � No._ Street 4
Registered Architect and /or Engineer__ —__ ___
Employing Plumber's Name
Location and Legal Descriptio
Nature of Water Supply: City —Well.
Amount of Permit $
STATE OF FLORIDA, ss,
COUNTY OF DADE.
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
Block
Subdivision
Street and Number where work is to be performed —No "' . Street
State work to be performed and purpose of building (By Floors) _-_--_,94 . f.e—"
New Building __— .____.______._______ Remodeling_____ Addition__________ Repairs No. of Stories
Septic ..... -- --------- - - - - -- -Type of Tank— -e_ , 2-__° 2_c. ,;,4- Capacity Gals. - - -- ��
Feet of Drain Tile__._ ' e x ist: Feet of Tank or Drain Field from Well
. Size of Soakage Pit
(Shgned)-
No.___ -- % - Street_ Y
( Signed
Date
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.
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.
NOTE: A re- inspection fee of $1.00 will be made when such re- inspection is made by improper notice for inspection, or faulty
materials and /or workmanship.
CLOsET6
BATH
TUBS
SHOWERS
LAVA-
TORIES
SINKS
SLOP
SINKS
LAUNDRY
TUBS
URINALS
CATCH
BASIN
FLOOR
DRAIN
DRINKING
FOUNT'N6
44e1
z, 1, /^< r' •
",.....t,` A
�
IU!/
TOTAL
FIXTURES
co. NTR
LIST
N
/
J
CHICK
/ !
/h /)
/ SEPTIC
�
/ 5'
/�
/
rJ C/
/ �l
�I
S .
TANK
SEWER
CONN.
DRAIN
FIELD
SOAKAGE
PIT
GREASE
TRAP
SOLAR
H EATER
DEEP
WELL
SPRKLR.
SYSTEM
SW IM'G
POOL
—
COMM
LI sr
CHICK
/
/
4.
- --
Jr
I Q
_
Permit No ./J 6 _.
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 0 -• -___ --� � No._ Street 4
Registered Architect and /or Engineer__ —__ ___
Employing Plumber's Name
Location and Legal Descriptio
Nature of Water Supply: City —Well.
Amount of Permit $
STATE OF FLORIDA, ss,
COUNTY OF DADE.
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
Block
Subdivision
Street and Number where work is to be performed —No "' . Street
State work to be performed and purpose of building (By Floors) _-_--_,94 . f.e—"
New Building __— .____.______._______ Remodeling_____ Addition__________ Repairs No. of Stories
Septic ..... -- --------- - - - - -- -Type of Tank— -e_ , 2-__° 2_c. ,;,4- Capacity Gals. - - -- ��
Feet of Drain Tile__._ ' e x ist: Feet of Tank or Drain Field from Well
. Size of Soakage Pit
(Shgned)-
No.___ -- % - Street_ Y
( Signed
Date
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.
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.
NOTE: A re- inspection fee of $1.00 will be made when such re- inspection is made by improper notice for inspection, or faulty
materials and /or workmanship.