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333 NE 102 St (5)Date /7 Contracting Co. � PERMIT APPLICATION FOR MIAMI SHORES VILLAGE Job Address Legal Description Owner/Lessee / Tenant /it ci Alt S �U- C.S'•// Master Permit # Owner's Address y y0 6/ o 2 S 7 Qualifier /" /,1 Co /` m , fl- S 10 / t/- L /0.2 SiTax Folio r DJJhih 7•4/1- 9.s Z'e ec Historically Designated: Yes No Phone )3 oS- 7 1 /oak, Address / f7.". w /3/ S> SS# P h o n e 3o d - 6 8/ - 632 2- State # Municipal # Competency # 96 0 00 2 /y Ins. Co. L, - .4- e 7lr /tit, 7 or/ Architect/Engineer Address Bonding Company Address Mortgagor Address Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN WORK DESCRIPTION L,/$ Cfi 4.. .g�-v. 4 - . ,- lip/ -e F . �x . S''.�Y// - �7i'kt (2 ZO�I • s) /tc. Signature of owner and/or Condo President "ate Not. • as to Owner and/or Condo President ate My Commission Expire, 3;,, Edward D. Elliott =R }J it: Commission # 00 866406 ' l Expir es Oct. 11, 2003 % ► $ nded Thru , d Atlantic Bonding Co., Inc. tool FEES: PERMIT q5" RADON APPROVED: Zoning Building Mechanical Plumbing C.C.F. s - NOTARY or or Owner- Builder Electrical r� Square Ft. Estimated Cost (value) d r a2 30 O • 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. ./,� �y as to Contractor or Owner - Builder ate My Commission Expire,,,,,, s Edward D. Elliott ' ''.Commisdfon # 00 866406 ?y� `',�'�' � Expires Oct. 11, 2003 /�,,,�� Bonded , �'��l;i�'�� , Atlantic Bonding Co., Ina BOND 300 / TOTAL DUE 3 9 6 Engineering �es, v ar4 i �1f� F1SS c// y90 ).L /o ,2 S7 Aa•9ml S //o PPS 'ye ‘4./ 11- ll? fi r! i News At' . iv( lf k- ,v 2. »€ (Z2...,`S) 4. s se 70.1. 5 ®o f v p £ /iA)r .Q 7 s.4o S•7.o 2.74ri yea •/' 111F14 . SthSeide 1 Date Legal Description -_p } 2 \ \J C hj(Yl'e . Historically Designated: Yes / � No (----- Owner/Lessee / Tenant j O� r t 1. 3 L "( 3 N Q L Master Permit # c%57 0 Owner's Address [ a 5() M ) 1 t Ll..) - Phone q10 1- q (C.' Contracting Co. )a.t - O t eQ - - 4 \ (Q (\4 lc Address 0 `aC -( - C-T c -( Qualifier) _. l ∎ a -en 7-- \ C N SS# State # P &t �) 1 t Ic Municipal # Competency # L Ins. Co. Notary My Co FEES: PERMIT 1L" PERMIT APPLICATION FOR MIAMI SHORES VILLAGE Q c. I V 0 Job Address E'i ) �)(Y �� Tax Folio f�k* Need C Architect/Engineer Address Bonding Company Address Mortgagor Address Permit Type (circle one): BUILDING ELECTRICAL PLUMBING ECHANICAL ROOFING PAVING FENCE SIGN WORK DESCRIPTION 1 NlS-t ,Q (I I )' C7 P 3 /L " i t )C 4(1 �� O�(;ts (Ivl� C Uve, q1. r�1c gQ ( c IN v c i CQ s �t C�( Si 1 ∎ ( �t Lc ActN� (Yaw eg �z j lE, Square Ft. Estimated Cost (value) Signature of owner as Own and/or Condo President %r • ^iy STEPHEN M. JOHNSON i' .1 MY COMMISSION # CC 103992 *: EXPIRES: October 31, 2003 :tit ,Ce a„nded Thru Notary Public Unrermitrrs RADON Building APPROVED: Zoning Mechanical Plumbing OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and tha construction and zoning. Furthennere, I authorize the above -named contractor to do 14 1 1 Date Date C.C.F. of Contractor ,f Owner - Builder NOTARY BOND Electrical OU 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. 11 work 'II be done in cofipliance with all applicable laws regulating toted. / Notary as to Contractor or Owner- Builder My Commissio _ ION STEPHEN M. JOHNSON .r- MY COMMISSION *CC 883992 EXPIRES: October 31, 2003 BanMd Thru Notary Pubra Underwriters TOTAL DUE 6 w I - 3)3 Date Date Structural Engineer Survey Sheet/Plans Customer Name: <3.0 A/,qU Address: /)f 4 Phone: 3 as 96/ 9/ - All work to comply with N.F.P.A. Code # S8' 0-ly So. Atlantic Service Corp 2120 Fletcher Street Hollywood, FL 33020 1 -888- 696 -7272 4/ /ZP/g c f.4 RI/ 4/ %c) L' /'4 4.1z /e ,S;fP / 7 (ask is / L.' log ' Pz Survey Sheet/Plans Customer Name: , %,,t u Address: ,/• 4 2 • 7i;p4 54e/6.5, "---‘ Phone: 3e/ Gas Piping ISO. -l/me T,P SZ o� /-7 ' yA p A So. Atlantic Service Corp 2120 Fletcher Street Hollywood, FL 33020 1- 888 - 696 -7272 PROPOSAL $UEMITTED TO: - - OESCPt1PTION OFJOS; MR BONAU J Job DONAU RESIDENCE FAX NUMBER 305-538.6168 e el(7res 1250 NE 102 STREET Ctty MIAMI SHORES, FL 331'i NEW GAS LINES P Phone 305- 961 -9426 ' 'eta 01/11/00 We Hereby Submit speCIflaretions II/111 estimates for me installation of new LP gag lines to connect cook top, to be located at the above referenced location. _ The work will include the following : lnetallation of ( approximately )15'of1 /,"gativanized gas Eats above ground. Installation of (approximately)25'of " /.'Trac pipe above ground Set ff200 LP tank above ground (supplied by Peoples Gas). New temperature and pressure relief valve, flue and ilex piping. Connection of gas and gets lines to stove. All parts and labor. THERE IS A (1) ONE YEAR WARRANTY ON ALL PARTS AND NINETY DAYS ON LABOR SUPPLIED BY SOUTHERN ATLANTIC SERVICE CORPORATION. TECO ALLOWANCES OTHER THAN' STATED ON THIS PROPOSAL ARE REBATED DIRECTLY 70 CUSTOMER. BY TECO AFTER OAS TURN ON. ALL WORK IS TO eE PERFORMED IN A PROFESSIONAL AND WORKMANLIKE MANNER, ACCORDING TO STANDARD PRACTICES, USING 1ST CLASS, U.L. APPROVED MATERIALS •PERIM AND ApP1„rc4BLE FEES NOT 1NC.LUDFD- 40303071,311 1J:1 L, 5.x11'1 - l.D IL r1r- la -28 -00 11:4'3 PM SOUTHERN. IITLIRNTIC c 1 Acceptance of Proposal — The stove prlaen. soec.itcellohn end conditions are eatinfectory and ern hereby aceeptod. You we authorized to do ' :he work as specified. Payment will 100 made as outlined iWove, Data Accepted sou'I'HERN SERVICE CORP. 2120 FLETCHEA STREET - HOLt.YW000, FLORIDA 03030 9AOWARD: (3oM fF21.e90 JbADE! (300) 043-4944 W. PALM DEAGH: (407) 714-2M POMPANO: (00 os {.6311 IQMt:aTe1 (000) ro4.0780 • Wo Hereby Propose to furnish labor and material* completo tr rdence with the above c pea lost ens, for the $423,00 (DOES NOT INCLUDE PERMIT) sum of S DEPOSIT OF $225.00 IS UE UPON ACCEETANCE. BALANCE With payment to be made as foltowo: ' I l OF $200.00 PLUS PERMIT FEES IS DUE UPON COMPLETION. M material b 01.41rantee0 0o D• aa apft.111ed. NI wort( Is to bM o:T a work- Ambrized m.nIh.a a M10b or11 Unlautppr oothse0 :My eta:~e0� Or d VM t on sbo e ap•critc•0 fr•••m s a �wcosts wal'tr. or .+pen.wrtlhrr•r4 and will B,Qnaturo - • bwrimi +v1 dons va •bwa tn• 1111119,1•11. An aril iml era ib uben Note: propCSat may b w ith_ midges. Inwrwnc • man our •anon. own r m e ear in by otter � aY ,, v1X fully cowed by aerfn+snti a n sa0on drawn u8 tt tr ot sec ed w lthl� day!. $I0nalturo Signature 9 *4 9Z7 FIZZ, I UU: P•02 Page No. of.r.,Pages Proposal a tJd -C' - S -- ,e,, j IJ ►rte- �, s btc, wt�� l�.f (. G91�•LL t 4' C 1,4 ,vv r-{ %At * , l?(e�4�� Car 12-1-1 3o5' 1 S t r`(o d -tam •••: •7‘■ ' • . •'. ' , • : • ' • • '1 1 (For SI unioc 1 413048 M) (For Si Unite 1 Is 42048 in) . . . 4441 A PY gna " " a Past gill. "V edit NFPA &ammo ht u aciaded for isforiasaanalptapaser only. pawl space opening, windows, or astaust tan Note 1: &ft mmum tom rebel valve in any di:salon away tam any essasks aucce of Ignition ( Zoning:I into OW tint appliances. amino:al vsnedauan air imam Ream Note (b) (1) under rabbi 3 Note 2: U Ihe DOT cylinder is filled on sits from a bulk bum. Us tilling connection and vent vakte must be at bast 10 It bum any extedor source ignidan. openings into diva-vent appliances. or mechanical van &grimes. Rider to Nots (b) (3) under Thbis 3422 Note 3:eger to Note (0) (1) undo' TAW 342.2. /Irani 14 DOT eythselanu alb A vant tar illanzatire purposes Gain t AEU govers4 • •:■:, • ? Wits a) DOTcylinder as site blim bulk trucS: • , Pennit No / 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 Addre � � / ?' _ _ No. __�� Registered Archisect and /or Engineer ____________ Employing Plumber's Name ' Location and Legal Description Lot_ ___..._____ -_- ____._________.._ Street and Number where work is to be performed —No Size Septic Tank Feet of Drain Tile_ Nature of Water Supply: City —Well. Amount of Permit $ - -- `� - - - -- --- - - - - -- SI ATE OF FLORIDA, 1 u. C.MIN Y OF DADE. MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING .""`,►.,gVdT No.- 2'.2. Block Street Street Subdivision 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 _Dist. Feet of Tank or Drain Field from Well Size of Soakage Pit ----------- — (Signed )_ („— j/.7 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 corn - 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 ret :aired by the Act. The undersigned agrees to employ only such sub- contractors work to be ed under this permit, as are licensed by Miami Shores Village 1% Mester Plumber. - Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments , personally appeared to me wd i known, and who, being by me first duly sworn, upon oath deposes and says that he is the_ of tae 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 Toes S LAVA- TORIES SINKS SLOP SINKS LAUNDRY rues U RINALS CATCH BASIN FLOOR DRAIN DRINKING FOUNT' NS TOTAL FIXTURES CONTR. LIST CHECK SEPTIC TANK SEWER CONN. DRAIN SOAKAGE FIELD PIT GREASE TRAP SOLAR HEATER DEEP WELL SPRKLR. SYSTEM SWIM'G POOL CoNTR. LIST /// // // - -- CHECK , Pennit No / 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 Addre � � / ?' _ _ No. __�� Registered Archisect and /or Engineer ____________ Employing Plumber's Name ' Location and Legal Description Lot_ ___..._____ -_- ____._________.._ Street and Number where work is to be performed —No Size Septic Tank Feet of Drain Tile_ Nature of Water Supply: City —Well. Amount of Permit $ - -- `� - - - -- --- - - - - -- SI ATE OF FLORIDA, 1 u. C.MIN Y OF DADE. MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING .""`,►.,gVdT No.- 2'.2. Block Street Street Subdivision 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 _Dist. Feet of Tank or Drain Field from Well Size of Soakage Pit ----------- — (Signed )_ („— j/.7 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 corn - 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 ret :aired by the Act. The undersigned agrees to employ only such sub- contractors work to be ed under this permit, as are licensed by Miami Shores Village 1% Mester Plumber. - Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments , personally appeared to me wd i known, and who, being by me first duly sworn, upon oath deposes and says that he is the_ of tae 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. BUILDING ELECTRICAL PLUMBING Owner of Building Architect Contractor or Builder CONTRACTOR OR BUILDER MIAMI SHORES VILLAGE, FLORIDA PERMIT N? 8806 1 Work to be performed under this Permit f' ' r Legal Lot Bl. Description Address of f � ) 1 / _ c1 Building i / l 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 appli- cation herefor in strict compliance with all ordinances pertaining thereto and w th 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 s ements or specifications and that he assumes respon- sibility for work done by his agents, servants or employees. i Signed 1 • .'',/ !J C'" By INSPECTOR In consideration of the issuance to me of this permit I agree to perform the work covered hereunder in compliance with all oclina es and regulations pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of ami Shores Village. In accepting this permit I assume responsibility for all work done by either myself, my agent, servant or employee. Subdi- vision DATE ) • Value of Amt. of rf Project I Permit . Contractor's License No. BY AUTHORITY tom ► r+q� 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 —4' -.([,. Registered Architect and /or Engineer' Employing Plumber's Name • --- "- s No.__1_ . 3 Location and Legal Descriptidsr Lot_______!___ d k ~�" J L >> jj Block / Subdivision Street and Number where work is to be performed —No.,.. f!___ G, t • Street Permit No. - ` " Date Amount of Permit $ ss. 1 -0" . MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT State work to be performed and purpose of building (By Floors) New Building ` Remodeling Addition ' Repairs __ -. - -_ t r "•` No. Street Size Septic Tank Type of Tank Capacity Gals. Feet of Drain Tile Dist. Feet of Tank or Drain Field from Well Nature of Water Supply � We11. Size of Soakage Pit _ (Signed) a, (Signed)— . �1 v - I stye 7 No. of Stories - ___ My Commission Expires Notary Public, State of Florida Master Plumber. Plumbing Inspector. f The undersigned applicant for this building permit does hereby certify that he understands and accepts his obliions 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. 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. 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 N �' i+ TOTAL FIXTURES CONTR. LIST �'- Z / / CHECK SEPTIC TANK SEWER CONN. DRAIN FIELD SOAKAGE PIT GREASE TRAP SOLAR HEATER DEEP WELL SPRKLR. SYSTEM SW IM'G POOL CONTR. LIST CHECK tom ► r+q� 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 —4' -.([,. Registered Architect and /or Engineer' Employing Plumber's Name • --- "- s No.__1_ . 3 Location and Legal Descriptidsr Lot_______!___ d k ~�" J L >> jj Block / Subdivision Street and Number where work is to be performed —No.,.. f!___ G, t • Street Permit No. - ` " Date Amount of Permit $ ss. 1 -0" . MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT State work to be performed and purpose of building (By Floors) New Building ` Remodeling Addition ' Repairs __ -. - -_ t r "•` No. Street Size Septic Tank Type of Tank Capacity Gals. Feet of Drain Tile Dist. Feet of Tank or Drain Field from Well Nature of Water Supply � We11. Size of Soakage Pit _ (Signed) a, (Signed)— . �1 v - I stye 7 No. of Stories - ___ My Commission Expires Notary Public, State of Florida Master Plumber. Plumbing Inspector. f The undersigned applicant for this building permit does hereby certify that he understands and accepts his obliions 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. 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. 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. '7 .* t • - 3 Permit No. 1 ! 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__:_ `` 1.1 ' _ No. Registered Architect and /or Engineer ---------- Employing Plumber's Name _. Location and Legal Description Lot _ 1 __1 __- Block_____J 7 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 Repairs____ _____ ____ __ ___ _ No. of Stories Amount of Permit $ / . - STATE OF FLORIDA, COUNTY OF DADE. MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT ( Signed) ___ t. N oJ ' Street 7- Street / Street 6- O My Commission Expires Notary Public, State of Florida Subdivision•'✓` Size Septic Tank C Type of Tank___ Capacity Gals. _. Feet of Drain Tile 7 - Dist. Feet of Tank or Drain Field from Well Nature of Water Supply: City —Well. Size of Soakage Pit ( Signed) Plumbing Inspector. The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligatifGis 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 perniit; 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. Mas 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. 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 HEATER DEEP WELL SPRKLR. SYSTEM SWIM•G POOL CONTR. L IST CHECK _ Permit No. 1 ! 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__:_ `` 1.1 ' _ No. Registered Architect and /or Engineer ---------- Employing Plumber's Name _. Location and Legal Description Lot _ 1 __1 __- Block_____J 7 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 Repairs____ _____ ____ __ ___ _ No. of Stories Amount of Permit $ / . - STATE OF FLORIDA, COUNTY OF DADE. MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT ( Signed) ___ t. N oJ ' Street 7- Street / Street 6- O My Commission Expires Notary Public, State of Florida Subdivision•'✓` Size Septic Tank C Type of Tank___ Capacity Gals. _. Feet of Drain Tile 7 - Dist. Feet of Tank or Drain Field from Well Nature of Water Supply: City —Well. Size of Soakage Pit ( Signed) Plumbing Inspector. The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligatifGis 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 perniit; 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. Mas 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. 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.