565 NE 102 St (5)MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
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
Registered Architect and /or Engineer
Employing Plumber's NameAVNPA.
Location and Legal Description Lot.
Street and Number where work is to be performed —No
State work to be performed and purpose of building (By Floors)__
Amount of Permit $�
STATE OF FLORIDA,
COUNTY OF DADE.
My Commission Expires
..___ No.
(Signed)-
■ Street.
B1oelt 5ubdlviaion.. _ .._
s 1 '
New Building - -.__— _ -_ Remodeling —_.__... Addition.-- - -..__ ____ Repairs ti . No. of Stories.... ...... .....
Size Septic Tank__ .Type of Tank-..-_
Feet of Drain Tile- _... Feet of Tank or Drain Field from Well..._.
Nature of Water Supply: City—Well Size of Soakage Pit
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 5968, 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 : ' ed by him in the work to be
performed under this permit; and will post or cause to be posted' for inspection on the of the work : uch . ublic notice or notices as are
required by the Act. The undersigned agrees to employ only such sub -contra ' 8, on • k to pe armed under this permit, as are
licensed by Miami Shores Village.
t
•
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.
Notary Public, State of Florida
NOTE: A re- inspection fee of $1.00 will be made when such re-inspection is made•neceuary by improper notice for inspection, or faulty
materials and /or workmanship.
CLOSIlTB
BATH
TUBS
SHOWERS
LAVA•
TORIES
SINKS
SLOP
SINKS
LAUNDRY
Tinos B
URINALS
CATCH
BASIN
FLOOR
DRAIN
DRINKING
FOUNT'N6
TOTAL
FIXTURES
CONTR.
LIST
'
CHECK
—T
SEPTIC
TANK
SEWER
CONN.
DRAIN
FIELD
SOAKAGE
PIT
GREASE
TRAP
SOLAR
HEATER
DEEP
WELL
SPRKLR.
SYSTEM
SWIM'O
POOL
CONTR.
LIST
CHECK
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
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
Registered Architect and /or Engineer
Employing Plumber's NameAVNPA.
Location and Legal Description Lot.
Street and Number where work is to be performed —No
State work to be performed and purpose of building (By Floors)__
Amount of Permit $�
STATE OF FLORIDA,
COUNTY OF DADE.
My Commission Expires
..___ No.
(Signed)-
■ Street.
B1oelt 5ubdlviaion.. _ .._
s 1 '
New Building - -.__— _ -_ Remodeling —_.__... Addition.-- - -..__ ____ Repairs ti . No. of Stories.... ...... .....
Size Septic Tank__ .Type of Tank-..-_
Feet of Drain Tile- _... Feet of Tank or Drain Field from Well..._.
Nature of Water Supply: City—Well Size of Soakage Pit
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 5968, 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 : ' ed by him in the work to be
performed under this permit; and will post or cause to be posted' for inspection on the of the work : uch . ublic notice or notices as are
required by the Act. The undersigned agrees to employ only such sub -contra ' 8, on • k to pe armed under this permit, as are
licensed by Miami Shores Village.
t
•
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.
Notary Public, State of Florida
NOTE: A re- inspection fee of $1.00 will be made when such re-inspection is made•neceuary by improper notice for inspection, or faulty
materials and /or workmanship.
s �s
Company
Job
Address
Inspection
Time Ready
Date Ready
REQUES FOR INSPECTION
PHONE
APPROVED BY:
4 7d610104 ,‘ 'Vt". 1
MISCELLANEOUS INSPECTIONS
PERMIT NO. WILL GET
INSTALLED BY / -tip 4 ( , e" :4 _ DATE Y ra
et ADDRESS 5 A/E 0 2
OWNER'S NAME
LOT BLOCK SUBDIVISION
INSPECTION A. M.
RELAY DRAINFIELD 7 WELLS
GAS APPLIANCES WATER PIPING
SOLAR MISCELLANEOUS
CONDEMNED BY:
P .M.
BUILDING
ELECRRICAL
PLUMBING
Owner of
Building
Architect
Contractor
r Builder
egal Lot
Description
B Address of ..
uilding
MIAMI SHORES VILLAGE, FLORIDA,.. -
DATE
i
Contractb s
License Igo.
,PERMIT N° 9873
done by his agents, servants or employees.
Signed:
k to be performed under this Permit
Subdi-
vision
Value of
Project $
e,-
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
l'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
t 'me 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
ranted is the understanding that the contractor or builder named above assumes the responsibility fop a thorough knowledge of the ordinances and regulations
ertaining to the work covered hereby whether shown on the plans or dr ngs or jn the statements r specifications and that he assumes responsibility for work
4
INSPECTOR
In consideration of the issuance to me of this permit I agree to rform the work covered hereunder in compliance with,* ordinances and regulations
pertaining thereto and in strict conformity with the plans, drawings, sta or specifications submitted to the proper authofitieV of Miami Shores Village.
In
asseftg this permit I sume responsibility , er all wprk ne by either, myself, my gent, servant or employee.
BY
CONTRA cJ R OR BUILDER BY /' AUTHORITY