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5 NE 102 St (4)MIAMI SHORES VILLAGE BUILDING DEPARTMENT 305- 795 -2204 Building Inspection Request Date 7q5-\05 � Type Insp'n /�j'AA.,-/ A114, e Permit No. /C! 6' 03/.5- Name Address 5 /6R 5 Company Phone # Inspection Date Approved Correction Re- Insp'n Fee Date MIAMI SHORES VILL . E BUILDING DEPARTM 305- 795 -2204 Building nspection Reques 7 , Type Insp'n ae4%CGC.6 Permit No. AZ--- g:PA.5" Name RO Address 5 N / ' Company ! t Qc /c&r YI Phone # (30S-J WY- »33 Inspection Date Approved Correction Re- Insp'n Fee 0 y MIAMI SHORES VILLAGE BUILDING DEPARTMENT 305- 795 -2204 Building Inspection Request Dat Type Insp'n Permit No. Name Address Comp, ny Phone # Inspection Date Approved Correction Re- Insp'n Fee /1AP MIAMI SHORES VILLAGE BUILDING DEPARTMENT 305- 795 -2204 B i'ding Inspection Request Date 18 Type Insp'n Final Lcar dscOeIrn Permit No. Name Address Compan 1 ", K. , C Phone # Inspection Date Approved Correction Re -Insp' n Fee PIo4 -1 4 5 NE 1o2, s+ BUILDING PERMIT APPLICATION FBC 2001 Permit Type (circle): Building Owner's Name (Fee Simple Titleholder) //p,, $ ht Phone # Owner's Address 5 4/ • /U l City / -, J ii State Tenant/Lessee Name Job Address (where the work is being done) 5 Al - la City Miami Shores Village Is Building Historically Designated YES Contractor's Company Name /'1,e. Contractor's Address City '' ti 4,0 / State j,. "A Zip 3 3 /G Qualifier �✓ �"' L �lr State Certificate or Registration No. Certificate of Competency No. Architect/Engineer's Name (if applicable) Phone # $ Value of Work For this Permit Square Footage Of Work: Type of Work: EAddition Describe Work: ,D Submittal Fee $ Notary $s'. a t) Scanning $ Code Enforcement $ Total Fee Now Due $ 9 ES C r 7 (Continued on opposite side) Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 Electrical County Miami -Dade Zip NO C/ f 'erne_ ['Alteration ['New /;.,f ll Z / Jr� * * * * * * * * * * * * * * * * * * * * * * * * * * * *F Permit Fee $ Training/Education Fee $ Radon $ ,/7 ✓rte, --. Zoning c., ■Phone # S * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** Structural Plan Review. $ Permit No. Master Permit No f 2-, 0 ` ) y Mechanical Zip 33) 77 cc i Phone # 5 s '7 ? Roofing Repair/Replace ['Demolition CCF $ / — O CO /CC Technology Fee $ 9 ,, ? Bond $.3 0 Bonding Company's Name (if applicable) Bonding Company's Address City State Zip Mortgage Lender's Name (if applicable) Mortgage Lender's Address City State Zip Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRICAL WORK, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and AIR CONDITIONERS, ETC 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. "WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT 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." Notice to Applicant: As a condition to the issuance of a building permit with an estimated value exceeding $2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be approve. • - reinspection fee will be charged. Signature er or Agent The foregoing instrume was ac My Commission Expires: Chc 05/13/03 As identifica ledged before me this r2 017 e 1 .14 . z-signature day of , 21 _ , by day o , 200 b Sip two P who is personally known to me or who has produced who is personally known to me or who h produced -as identification and who did take an oath. .1 1. . •• . e an oath. Contractor The regoing instrument was acknowledged before me thi NOTARY PUBLI c ;r* 'P' STEPHEN E. COCKING NOTARY P MY COMMISSION # DD 031747 Sign:, EXPIRES: June 20, 2005 Sign: Print: P t: My Comrission Expires: % " Expires November 15, 3005 v �ng:gia N nr.» r.r m isSien 01)15 ***************************************************************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** ***************************************************************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** APPLICATION APPROVED BY: Plans Examiner Engineer Zoning STATE OF FLORIDA DEPARTMENT OF HEALTH ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM CONSTRUCTION PERMIT CONSTRUCTION PERMIT FOR: [ ]New System [ ]Existing System [ ]Holding Tank [ X ]Repair [ ]Abandonment [ ]Temporary [ NA ] APPLICANT: Saks, Robert AGENT: SR0931119, COCKING MSTEPHEN PROPERTY STREET ADDRESS: 5 NE 102 St Miami FL 33138 LOT: 13 BLOCK: N/A PROPERTY ID #: 11- 3206 - 013 -1640 SUBDIVISION: Miami Shores No. 1 [Section /Township /Range /Parcel No.] [OR TAX ID NUMBER] SYSTEM MUST BE CONSTRUCTED IN ACCORDANCE WITH SPECIFICATIONS AND STANDARDS OF CHAPTER 64E -6,FAC DEPARTMENT APPROVAL OF SYSTEM DOES NOT GUARANTEE SATISFACTORY PERFORMANCE FOR ANY SPECIFIC TIME PERIOD. 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. ISSUANCE OF THIS PERMIT DOES NOT EXEMPT THE APPLICANT FROM COMPLIANCE WITH OTHER FEDERAL, STATE OR LOCAL PERMITTING REQUIRED FOR PROPERTY DEVELOPMENT. SYSTEM DESIGN AND SPECIFICATIONS T [ 900 ]Gallons•SEPTIC TANK A [ 0 ]Gallons N [ 0 ]GALLONS GREASE INTERCEPTOR CAPACITY K [ 0 ]GALLONS DOSING TANK CAPACITY [ 0 ]GALLONS @ [0 ]DOSES PER 24 HRS # PUMPS[ 0 ] D [ 200 ]SQUARE FEET PRIMARY DRAINFIELD SYSTEM R [ 0 ]SQUARE FEET SYSTEM A TYPE SYSTEM: [ N ]STANDARD [ N ]FILLED [ N ]MOUND [ N ] I CONFIGURATION: [ N ]TRENCH [ N ]BED [ N ] N F LOCATION TO BENCHMARK: Finished Floor Of Exist. Res. 13.30' NGVD I ELEVATION OF PROPOSED SYSTEM SITE [ 2.2 ] [ FEET ] [ BELOW]BENCHMARK /REFERENCE POINT E BOTTOM OF DRAINFIELD TO BE [ 4.5 ] [ FEET ] [ ]BENCHMARK /REFERENCE POINT L D FILL REQUIRED: [ 0.0 ]INCHES EXCAVATION REQUIRED: [ 28.0 ] INCHES OTHER REMARKS: 1- Install 900 gals. septic tank category 3 with an approved outlet filter. 2 -The existing septic tank must be abandoned properly, the pump -out receipt shall be provided prior to the granting of the final approval. 3- Install 200 square feet in bed Configuration. 4- Invert elevation of drainfield to be no less than 9.27' NGVD. 5- B9_ttom of drainfield elevation to be no less than 8.77' NGVD. SPECIFICATIONS BY: Andre, Paul APPROVED BY: Andre, Paul TITLE: DH 4016, 03/97 (Obsoletes previous editions which may not be used) icy....\. T1.....1... ']AA_nni_Anic_n\ r -- .__- CENTRAX #: 13 -SG -21317 DATE PAID: FEE PAID : $ RECEIPT . OSTDSNBR : 04 -2267- -R [ ] Innovative Other MULTI - CHAMBERED /IN SERIES: [Y ] MULTI - CHAMBERED /IN SERIES: [Y ] TITLE: Professional Engin Dade DATE ISSUED: 6/25/04 EXPIRATION DATE: 9/23/04 CHD D',. 1 r f 7 STATE OF FLORIDA $ • DEPARTMENT OF HEALTH a ,� APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PE r MJ I t Application Number 1 Scale: Each block represents 5`feet and 1 inch. 5,0 feet.. Notes: Fitt, j(F,= coca �Q IFrr Ict•�r< . T , (2-e ' ` ' lG (C/< <� {��rt /�� 1�f j Site Plan submitted by: 1 . • - - - Plan Approved I) By DH 4015, 10/96 (Replaces HRS-H Form 4015 which may be used) (Stock Number: 5744 - 002. 4015.6) PART II - SITE PLAN Signature Not Approved ,4 %/le./.1 • Title Date County Health Department ALL CHANGES -MUST BE APPROVED BY THE COUNTY HEALTH DEPARTMENT Page 2 of 3 Miami Shores Village 10050 NE 2nd Avenue Phone: 305 - 795 -2204 Permit Number: PL2004 -184 Printed: 6/29/2004 Applicant: ROBERT Owner: SAKZ JOB ADDRESS: 5 Contractor MR C'S SEPTIC TANK Local Phone: 305 - 651 - 7859 Parcel # 1132060131640 NE 102 Signed: (INSPECTOR) Plumbing Permit SAKZ ROBERT ST Contractor's Address: P 0 BOX 693239 Permit Status: APPROVED Permit Expiration: 12/26/2004 Construction Value: $2,000.00 Work: TO INSTALL 200 SQ. FT DRAINFIELD Page 1 of 1 Legal Description: MIAMI SHORES SEC 1 AMD PB 10 -70 LOTS 13 & 14 LOT SIZE IRREGULAR OR Fees: Description Amount FEE2004 -6484 Building Fee $175.00 FEE2004 -6485 CCF $1.20 FEE2004 -6486 Notary Fee $5.00 FEE2004 -6487 Training and Education Fee $0.40 FEE2004 -6488 Technology Fee $4.37 FEE2004 -6489 Builders Bond $300.00 Total Fees: $485.97 Total Fees: $485.97 Total Receipts: $485.97 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 responisibility for all work done by either myself, my agent, servants or employes. Signed: (Contractor or Builder) BY: MIAMI SHORES VILLAGE. FLORIDA 1 UILDING ❑ LECTRICAL ❑ DATE 1954_ ❑ PERMIT N9 8472 LUMBING OOFING ❑ wner of ?ilding rchftect _,ntractor Builder ,gal =scription -dress of iilding Lot , / c 81. 0" CONTRACTOR OR BUILD& Work to be performed under this Permit Subdi- vision Sq. Ft Value of Project Contractor's t License No. Amt. of Permit $ '.•y 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 refor in strict compliance with all ordinances pertaining thereto and with the understanding that the work will be performed in compliance with any plans, =wings, statements or specifications that may have been submitted to and approved by the proper municipal authorities. This Permit may be revoked at any ie 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 anted is the understanding that the contractor or builder named above assumes the responsibility for a thorough knowledge of the ordinances and regulations staining to the work covered hereby whether shown on the plans or drawings or in the statemeerts or specifications and that he assumes responsibility for work ne by his agents, servants or employees. Signed: BY INSPECTOR • In consideration of the issuance to me of this permit I agree to perform the work covered hereunder in compliance with all ordi nces and regulations taining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. accepting this permit I assume responsibility for ell work done by either, myself, my agent, servant or employee. r r BY AUTHORITY 1 17 Permit No Amount of Permit $ -. STATE OF FLORIDA, COUNTY OF DADE. MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING V- t riitAIT (Signed)— (Signed). Date - _ _Aire ? 2 5" `5 5 .S My Commission Expires Notary Public, State of Florida CD 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 / Owners Name and Address � !U i 5 U T T b i" No. Street ' " l a 2 Registered Architect and /or Engineer ..... __________________ Y._ ___ ____.____ - - - -_ Employing Plumber's Name L-A tE * SHAW X p _b i.: - 6 0..i o 3 s Street_ —4 1 __9 1 6- a a, Location and Legal Description Lot _____ ________.___._..—._.._._ __.___ Block Subdivision. _._..______________ _ Street and Number where work is to be performed— No.._..__ �____ Str State work to be performed and purpose of building (By Floors)_ �E' e t E� - - �e. New Building 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 Capacity Gals Plumbing Inspector. The undersigned applicant for this building permit does hereby certify that he understands and accepts his oblige lions as an employer of labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Pennan9ht 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 thjs . ennit, as are licensed by Miami Shores Village. Master 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 hire stated are true. NOTE: A re- inspection fee of $1.00 will be made when such relnspection is made necessary by improper notice for inspection, or faulty materials and /or worlcmanship. CLOSETS BATH TUBS SHOWERS HOW LAVA. TORIES INK SINKS SLOP SINKS LAUNDRY Turn URINALS L6 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 TR. CONTR. CON LIST CHECK -. - - - _ _. - __ .. -_.___ - - -- Permit No Amount of Permit $ -. STATE OF FLORIDA, COUNTY OF DADE. MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING V- t riitAIT (Signed)— (Signed). Date - _ _Aire ? 2 5" `5 5 .S My Commission Expires Notary Public, State of Florida CD 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 / Owners Name and Address � !U i 5 U T T b i" No. Street ' " l a 2 Registered Architect and /or Engineer ..... __________________ Y._ ___ ____.____ - - - -_ Employing Plumber's Name L-A tE * SHAW X p _b i.: - 6 0..i o 3 s Street_ —4 1 __9 1 6- a a, Location and Legal Description Lot _____ ________.___._..—._.._._ __.___ Block Subdivision. _._..______________ _ Street and Number where work is to be performed— No.._..__ �____ Str State work to be performed and purpose of building (By Floors)_ �E' e t E� - - �e. New Building 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 Capacity Gals Plumbing Inspector. The undersigned applicant for this building permit does hereby certify that he understands and accepts his oblige lions as an employer of labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Pennan9ht 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 thjs . ennit, as are licensed by Miami Shores Village. Master 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 hire stated are true. NOTE: A re- inspection fee of $1.00 will be made when such relnspection is made necessary by improper notice for inspection, or faulty materials and /or worlcmanship. BUILDING ELECTRICAL :'LUMBING "architect :' ontractor )r Builder Jwner of wilding L s , v , r MIAMI SHORES VILLAGE, FLORIDA DATE 194_ PERMIT N° 8649 Contractor's ,License No Work to be performed under this Permit .egal Lot Bl. )escription 1 iddress of / luilding 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- ation herefor in strict compliance with all ordinances pertaining thereto and with the understanding that the work will be performed in compliance with any Jams, drawings, statements or specifications that may have been submitted to and approved by the proper municipal authorities. This Permit may be revoked t 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 w )iich this ,ermit is granted is the understanding that the contractor or builder named above assumes the responsibility for a thorough knowledge of the ordinances and egulations pertaining to the work covered hereby whether shown on the plans or drawings„ or in the statements or specifications and that he assumes respon- ibility for work done by his agents, servants or employees. Subdi- vision Value of Project Amt. of Permit s Signed By 1 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. accepting this permit I assume responsibility for all work done by either myself, my agent, servant or employee. CONTRACTOR OR BUILDER BY AUTHORITY 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. r„, v Owner's Name and Address 4' L Cr 1 715 A/ Permit No. Registered Architect and /or Engineer,,, Employing Plumber's Name /0 U / /t/ Location and Legal Description Lot Street and Number where work is to be performed —No Nature of Water Supply City ' ._ Amount of Permit $__ STATE OF FLORIDA, ss. COUNTY OF DADE. MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT ' No c if C ( Signed) Date No Street a/gi42 /aI 4 " "heave Street ' /I/ � � Block bdivision 4/4-- Street State work to be perforn and purpose of building (By Floors) New Building v Remodeling Addition Repairs No. of Stories Size Septic Tank 7 u Type of Tank___ Capacity Gals 7 o Feet of Drain Tile / YS Dist. Feet of Tank or Drain Field from Well Size of Soakage Pit lumbing Inspector. The undersigned applicant for this building permit does hereby certify that he hnderstands and accepts his obliga 1. 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 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. My Commission Expires Notary Public, State of Florida Master 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 ma • / , / CHECK SEPTIC TANK SEWER CONN. DRAIN FIELD SOAKAGE PIT GREASE TRAP SOLAR HEATER DEEP WELL SPRKLR. SYSTEM SWIM'G POOL L � CONTR. LIST / / ' CHECK 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. r„, v Owner's Name and Address 4' L Cr 1 715 A/ Permit No. Registered Architect and /or Engineer,,, Employing Plumber's Name /0 U / /t/ Location and Legal Description Lot Street and Number where work is to be performed —No Nature of Water Supply City ' ._ Amount of Permit $__ STATE OF FLORIDA, ss. COUNTY OF DADE. MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT ' No c if C ( Signed) Date No Street a/gi42 /aI 4 " "heave Street ' /I/ � � Block bdivision 4/4-- Street State work to be perforn and purpose of building (By Floors) New Building v Remodeling Addition Repairs No. of Stories Size Septic Tank 7 u Type of Tank___ Capacity Gals 7 o Feet of Drain Tile / YS Dist. Feet of Tank or Drain Field from Well Size of Soakage Pit lumbing Inspector. The undersigned applicant for this building permit does hereby certify that he hnderstands and accepts his obliga 1. 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 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. My Commission Expires Notary Public, State of Florida Master 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.