500 NE 102 St (10)Date
PERMIT APPLICATION FOR MUNICIPALITIES
(OWNER TO RETAIN COPY)
,15 -m®
Job Address S'70.0 N & / 2 Tax
Descriatdon / /. /a qij 6Au fl11 m q Master
Legal
Owner / Lessee /. Tenant j4s4.e2 S t
Owner's Addresj
Contracting Co. I-I. � ,aa -P4
Qualifier
COD Ne /IDZ
Permit Type (circle one): LBUILDING ELECTRICAL
WORK DESCRIPTION
:o ary s o Owner and /or Condo President
iy Commission Expires Notary Public, State of Florida at Lar
k * . * idy Commission Expires *n. 21, 19*
Bonded thru Agent's Notary Brokerage
Ire
'ERMIT FEE: APPROVED: rF
Zoning Building
Mechanical umbing L/ M
Phone
Address / ''(«t( t.U) 2?
SS# 7 L9 - 96 - Z( °t( Phone
OF DADE COUNTY
6,21 F56 j
State# . e7 - cr771 Competency# /WS h/ Ins. Co. 2: Lao_
Architect /Engineer Address
Bonding Company Address
Mortgagor Address
ignatu O wner and/ .C ondo President Sig:ature o
late:
Date:
Folio // gaa
Permit 0 -/X.14/
MECHANICAL PAVING FENCE SIG2:
Square Ft. Estimated Cost 2 '�
Other
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.
C
ner- Builder
otary a- to Contractor or Owner - Builder
My Commiss ion Expires :NcterYPublic, State of Florida at Lar
* * * *My Commi*i n Expired Jan. 21, 3
Bonded thru Agent's Notary Brokerage
Electrical
9 /Engineering
Chapter 100 -6, FAC
S
Date of Application
STATE OF .FLORIDA
DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES
APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PERMIT
Name of Owner. & ¢-S 51.,t_.?)AAJ
Mailing Address of Owner cap P >✓ 1 0Z
Owner's Agent r tor)pu e_U C, Builder
Agent's Mailing Address ' {3C2 < < Iwo '1 f v A Telephone No
Property Street Address v N C= 1 0 S-1
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 v/ Existing System
Type of Sewage Flow Sewage Flow
Establishment (Gallons per day) Based On
Type of
Residential
HRS-H Form 4015, Feb 85 (Obsoletes previous editions which may not be used)
(Stock Number. 5744. 001.4015-1)
Authority: Chapter 381, FS
---- -- -PART 1 - APPLICATION
Permit Application Number
TOTAL FLOW =
No. Bedrooms
(each dwelling unit)
AUDIT CONTROL NO N° 240905 Applicant's Signatur
Telephone Number
Heated or Cooled Area No. Dwelling Sewage Flow
(each dwelling unit) Units (Gallons per day)
ft2
ft
Exact Directions to Property J
Page 1 of 3
BUILDING
ELECTRICAL
PLUMBING
ROOFING
Owner of
Building
Address of
Building
CONTRACTOR OR BUILDER
MIAMI SHORES VILLAGE. FLORIDA
o PERMIT N° 7045
r�k
4„1 1.4.„ l i;
Architect
Contractor
or Builder r' E' C-
Legal Lot
Description — � Bl
Signed.
✓4
DATE `' ` 195
Contractor's r
License No.
Work to be performed under this Permit
Subdi-
vision
Value of
Project $
INSPECTOR
Amount of
Permit $
f
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 furthe -.condition upon which this permit is
granted is the understanding that the contractor or builder named above assumes the responsibility for a thorough knowl ge of the ordinances and regulations
pertaining to the work covered hereby whether shown on the plans or drawings?cr in the starents or specifications.and at he assumes responsibility for work
done by his agents, servants or employees. ,� /"
In consideration of the issuance to me of this permit I agree to perform the work covered hereunder in compliance with all ordinaa 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
6 . 1r
BUILDING ❑ DATE 3 195 1
ELECTRICAL. Pi PERMIT 'N° 11888 Contractor's
PLUMBING License No
ROOFING 1r Work to be performed under this Permit
Owner of
Building
Architect
Contractor
or Builder
Legal
Description
Address of
Building
Lot
CONTRACTOR OR BUILDER
MIAMI SHORES VILLAGE, FLORIDA
Bl.
Subdi-
vision
Value of
Project $
Amt. of
Permit $
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
h`erefor 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 thorough knowledge of the ordinances and regulations
pertaining to the work covered hereby whether shown on the plans or drawings or in the statements or specifications and that he assumes responsibility for work
done 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 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 reffonsibility for all work done by either, myself, my agent, servant or employee.
BY AUTHORITY
Permit No //RV
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
Date g• / 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.
• C^
Owner's Name and Address /__�__ Sal) ) 4 /0 Z
AAJ k No
Registered Architect and /or Engineer
Employing Plumber's Name_ _". -.k'
Location and Legal Description Lot_________ Block o Subdivision
Street and Number where work is to be performed —No. _ Street /
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
Feet of Drain Tile Dist. Feet of Tank or Drain Field from Well
Size of Soakage Pit
Nature of Water Supply: City —Well
Amount of Permit $
ss.
My Commission Expires
.12,i' : -' . r _ No
( Signed)
( Signed)
)s •
Street
Street
Plurnbimgr 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 Pennanent 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 urder this permit, as are
licensed by Miami Shores Village.
Notary Public, State of Florida
STATE OF FLORIDA,
'e COUNTY OF DADE. 1
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
SW IM'G
POOL
CONTR.
LIST
7
}
CHECK
Permit No //RV
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
Date g• / 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.
• C^
Owner's Name and Address /__�__ Sal) ) 4 /0 Z
AAJ k No
Registered Architect and /or Engineer
Employing Plumber's Name_ _". -.k'
Location and Legal Description Lot_________ Block o Subdivision
Street and Number where work is to be performed —No. _ Street /
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
Feet of Drain Tile Dist. Feet of Tank or Drain Field from Well
Size of Soakage Pit
Nature of Water Supply: City —Well
Amount of Permit $
ss.
My Commission Expires
.12,i' : -' . r _ No
( Signed)
( Signed)
)s •
Street
Street
Plurnbimgr 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 Pennanent 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 urder this permit, as are
licensed by Miami Shores Village.
Notary Public, State of Florida
STATE OF FLORIDA,
'e COUNTY OF DADE. 1
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.