560 NE 102 StPERMIT APPLICATION FOR MUNICIPALITIES OF DADE COUNTY
(OWNER TO RETAIN COPY) / `
Date , ? /J� /Job Address Q� 4 / /� . S / Tax oli i�C (19/7/'j� fL 0
Legal Description �j ,/ /./ 7z/ r 7 �� 4M �'Maaer er it ikY /f1
/ Lessee / Tenant .3 /'j/ � _ /5 ce
S D /2 P-- -3z73
Owner's Address
-0/DZ _s �E>io- Address .!5: /1/ Z
Phone 0^
Contracting Co.
Qual if ie
i
State# Competency
Architect /Engineer
Bonding Company
Mortgagor
Permit Type (circle one):
WORK DESCRIPTION
My Commission Expires:
* . * .*
PERMIT FEE:
APPROVED:
Zoning
Mechanical
. , `et
Square Ft. Estimated Cost 0
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.
Address
Address
Address
BUILDING ELECTRICAL PLUMBING MECHANICAL PAVING FENCE SIGN
Ins. Co.
e of Owner , • vpraZ::: Signature of Contract Owner-Builder
D t
Signat
a e . MY Cd'nSSiai EXP. FEB.2 .1493
INS. MD.
hided Expires May 22 NNW 11iY1
, 199y _�' �„ � - „`
rhFli 7..,r 1„ : ur a n ,
No ary as to Owner and /or Condo President
tary as to Contractor or Owner - Builder
My Commission Expires:
* * * * * * * *
Fire
Building
Plumbing _- Or--
Other
Electrical
Engineering
1
51, /Y & / D.2 SkYee k
i4 on(' Sk0 %.
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a 42
BUILDING
ELECTRICAL
PLUMBING
Owner of
Building
v
MIAMI SHORES VILLAGE, FLORIDA
DATE
PERMIT N?
Work to be erformed under this Permi '0' -
V I ,,/ CONTRACTOR OR BUILDER </
•
5096
Subdi-
vision
BY
)1 I
Contractor' /.,(`"'
License No /
IN$ T O By
In consideration of the issuance to me of this permit I agree to perform the work coverettereunder in compliance with all ordinances
pertain thereto and in strict conformity with the plans, drawings, statements or specifica ns submitted to the proper author es of Mia
In a this permit I assume responsibility for all work done by either myself, my agent, servant or employee.
AUTHORITY
1941
Architect
Contracto
or Builder
Legal
Description
Address of Value of Amt. o
Building V U �` - � Project Pe '"
This permit is granted to the contractor or builder amed above to construct the building or to install the equipment or device Aescribed 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 assures the re onsibility for a thorough knowledge of the ordinances and
regulations pertaining to the work covered hereby whether shown on the plans or dings the stAaterne t `fur specifications and that he assumes respon-
sibility for work done by his agents, servants or employees.
gulations
V„ialagel
Permit No.
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
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 No Street
Architect and /or Engineer
Employing Plumber's Name___,____ No.__ Street
Location and Legal Description Lot Block Subdivision
Street and Number where work is to be performed —No._ __L___ % 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
Feet of Drain Tile Dist. Feet of Tank or Drain Field from Well
Nature of Water Supply: City —Well Size of Soakage Pit
of Permit $ - / - -- ( Signed)
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.
STATE OF FLORIDA, t
COUNTY OF DADE.
ss.
Capacity Gals.
( Signed)
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
DRINK NGI
FOUNT'N5
TOTAL.
FIXTURES
CONTR.
LIST
�.-�
I / (
i
72 - ' ,
- : ,
—
j
/
CHECK
4
SEPTIC
TANK
SEWER
CONN.
DRAIN
FIELD
SOAKAGE
PIT
GREASE
TRAP
SOLAR
HEATER
DEEP
WELL
SPRKLR.
SYSTEM
SW IM'G
POOL
CONTR.
LIST
CHECK
Permit No.
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
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 No Street
Architect and /or Engineer
Employing Plumber's Name___,____ No.__ Street
Location and Legal Description Lot Block Subdivision
Street and Number where work is to be performed —No._ __L___ % 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
Feet of Drain Tile Dist. Feet of Tank or Drain Field from Well
Nature of Water Supply: City —Well Size of Soakage Pit
of Permit $ - / - -- ( Signed)
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.
STATE OF FLORIDA, t
COUNTY OF DADE.
ss.
Capacity Gals.
( Signed)
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.
Permit No
ke\\\ MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
) A PPLICATION FOR PLUMBING PERMIT
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 or nances of Miami Shores Village and all rules and regulations of the Building Division
of Miami Shores Village shall be complied with, whet lf herein specified or not. A copy of approved plans and specifications must be k eSt' at
building during progress of work.
�_ r ` No '�` Street__ __ - ? L____ —�.
Owner's Name and Address
Registered Architect a or E ineer _________�
Employing Plum er's Name .L_� a L .; r' r ' ', ' T . 7 " 6
Location and Legal Description
Street and Number where work is to be performed— No Street / / ! ___w______r�`
Feet of Drain Tile__
Amount of Permit $_ L ' ird
My Commission Expires
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.___— ______ —__—__
Dist. Feet of Tank or Drain Field from Well ______ ___________________ ________
Nature of Water Supply: City—Wel Size of oakage Pit
t
_(Signed)
Date_
(Signed, /�__ l
' '; Master Plumber.
Notary Public. State of Florida
Street
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.
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 under signed agrees to employ only such sub - contractor;, on work to
licensed by Miami Shores Village. f Q j
be performed under this permit, as are
,' � , f• . �,
4 .4 k. fs
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.
CLOSETS
BATH
TUBS
SHOWERS
LAVA-
TORIES
SINKS
$LOP
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.
LIST
CHECK
Permit No
ke\\\ MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
) A PPLICATION FOR PLUMBING PERMIT
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 or nances of Miami Shores Village and all rules and regulations of the Building Division
of Miami Shores Village shall be complied with, whet lf herein specified or not. A copy of approved plans and specifications must be k eSt' at
building during progress of work.
�_ r ` No '�` Street__ __ - ? L____ —�.
Owner's Name and Address
Registered Architect a or E ineer _________�
Employing Plum er's Name .L_� a L .; r' r ' ', ' T . 7 " 6
Location and Legal Description
Street and Number where work is to be performed— No Street / / ! ___w______r�`
Feet of Drain Tile__
Amount of Permit $_ L ' ird
My Commission Expires
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.___— ______ —__—__
Dist. Feet of Tank or Drain Field from Well ______ ___________________ ________
Nature of Water Supply: City—Wel Size of oakage Pit
t
_(Signed)
Date_
(Signed, /�__ l
' '; Master Plumber.
Notary Public. State of Florida
Street
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.
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 under signed agrees to employ only such sub - contractor;, on work to
licensed by Miami Shores Village. f Q j
be performed under this permit, as are
,' � , f• . �,
4 .4 k. fs
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.