584 NE 102 StPERMIT APPLICATION FOR MUNICIPALITIES OF DADE COUNTY
(OWNER TO RETAIN COPY)
Date 7 -05 -91 Job Address 584 NE 102 STREET Tax Folior/ �/` o O 1 ,7 /e (
Master Permit # /&d
Legal Description
Owner / Lessee / Tenant
Owner's Address
l AmmmP a S zIseig
THOMAS LAUBENTHAL
584 NE 102 STREET, MIAMI 33138 Phone 751 -6118
Contracting Co. NORTH DADE SEPTIC TANK
Qualifier DENNIS NEVILLE Phone 754 -3375
State# Competency1 12842 Ins.Co. WAUSAU
Architect /Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL PAVING FENCE SIGN
WORK DESCRIPTION INSTALL DRAINFIELD
Address 800 NW 111 STREET, MIAMI 33168
Square Ft. g n Estimated Cost
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 1 regulating construction and zoning.
Furthermore authorize t•e above -named contractor o do th work
gr o
and /or Condo President
No I ry a to Owner and /or Condo President
My ;omission Expires:
Fire
Building
ate:
ture df /Contract : or or ner- Bu ilder
PERMIT FEE: _
Zoning
Mechanical Plumbing 3 V -py J
ti
Nijtary' as to Contractor or Owner - Builder
Commission Expires:
* * * * * * *
Other
Electrical
/lineering
BUILDING
ELECTRICAL
PLUMBING
Architect Gi o : ,,
Contractor ..
or Builder i -
Legal Lot Bl. f
Description
Address of
Building / / ` t
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 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• L 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 regula-
tions 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 pe y t' I assume responsibility for all work done by either myself, my agent, servant or employee.
Owner of
Building
Work to be performed under this Permit
rCON BUILDER
MIAMI SHORES VILLAGE, FLORIDA
DATE
PERMIT N9 3883
Subdi-
vision
Value of
Project
• :
of �G:,i�!p•
Surd is
ki.,9 vei rtt!!
Contractor's '
License No. /
Amt. of
Permit %
BY AUTHORITY
I' !at,
Size Septic Tank_-.._____.- - - - - --
Feet of Drain Tile.0
Nature of Water Supply: City—Well
Amount of Permit $
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
(Signed)._
The undersigned applicant for this building permit does hereby certify that he understands and accepts his ob
under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Penn
plied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors e
performed under this permit; and will post or cause to be posted for inspection on the of the
required by the Act. The undersigned agrees to employ only such sub- contractors, on ork
licensed by Miami Shores Village.
(Signed)._
ct
Date... . ........ .
rk
Avpi:cation is hereby roan.; 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_I441J C4 Lg.- + - -_ --- -.1-- --_ -_ - - -- No.J_-i�l-_g - 3lT.r1G / 37
Registered Architect and /or Engineer
--- -_.__- - - - -` _----- - - - - -_ _- - - - -- --- - - -. --
Employing Plumber's Name-_MPI(1G f � No.
Location and Legal Description Lot. --___.._.... Block_
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
Subdivision
Type of Tank
Dist. Feet of Tank or Drain Field from Well
Size of Soakage Pit
Capacity Gals
Plumbing Inspector.
s as an employer of labor
Supplement, and has corn -
oyed by him in the work to be
such publi
e pert
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.
My Commission Expires Notary Public, State of Florida
notice or notices as are
der this permit, as are
Master Plumber.
STATE OF FLORIDA, �.
COUNTY OF DADE. j
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeared
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
TUes
SHOWER•
LAVA
TORIES
SINKS
SLOP
SINKS
LAUNDRY
Tue6
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.
LIT
CHECK
I' !at,
Size Septic Tank_-.._____.- - - - - --
Feet of Drain Tile.0
Nature of Water Supply: City—Well
Amount of Permit $
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
(Signed)._
The undersigned applicant for this building permit does hereby certify that he understands and accepts his ob
under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Penn
plied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors e
performed under this permit; and will post or cause to be posted for inspection on the of the
required by the Act. The undersigned agrees to employ only such sub- contractors, on ork
licensed by Miami Shores Village.
(Signed)._
ct
Date... . ........ .
rk
Avpi:cation is hereby roan.; 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_I441J C4 Lg.- + - -_ --- -.1-- --_ -_ - - -- No.J_-i�l-_g - 3lT.r1G / 37
Registered Architect and /or Engineer
--- -_.__- - - - -` _----- - - - - -_ _- - - - -- --- - - -. --
Employing Plumber's Name-_MPI(1G f � No.
Location and Legal Description Lot. --___.._.... Block_
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
Subdivision
Type of Tank
Dist. Feet of Tank or Drain Field from Well
Size of Soakage Pit
Capacity Gals
Plumbing Inspector.
s as an employer of labor
Supplement, and has corn -
oyed by him in the work to be
such publi
e pert
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.
My Commission Expires Notary Public, State of Florida
notice or notices as are
der this permit, as are
Master Plumber.
STATE OF FLORIDA, �.
COUNTY OF DADE. j
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeared
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.
Owner of `
Building `-V ..k) •
Architect
Contractor
or Builder
Legal
Description
Address of
Building
Lot
CONTRACTOR OR BUILDER
MIAMI SHORES VILLAGE, FLORIDA
BUILDING ❑ DATE 1" ! ' ' S Z 195
ELECTRICAL ❑ PERMIT iN? 12652 contractors
PLUMBING ( License No
ROOFING ❑ Work to be performed under this Permit
,n ?.; q., I L.)4
Bl.
}
Subdi-
vision
Value of
Project $
i
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
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
tune 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 , y 1 , " " "" BY .. •' . _l" _ �:'"'"' --
INSPECTOR
In consideration of the issuance to me of this permit I agree to pert si1i 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 1 assume responsibility for all work done by either, myself, my agent, servant or employee.
BY AUTHORITY (
v .4
Permit 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 Divisior
of Miami Shores Village shall be complied with, whether herein specified or not. A copy of approved plans and specifications must be kept al
building during progress of work.
Owner's Name and Address __. - -
t�
Registered Architect and /or Engineer
Employing Plumber's Name, V (/
Subdivision
Street and Number where work is to be performed—No-2-1 ‘.1d d '
_ --_. Street
State work to be performed and purpose of building (By Floors)
Location and Legal Description Lot
Amount of Permit $
Nature of Water Supply: City —Well
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
Block
(Signed)
(Signed)._
No
Street
e R ( ' Street ' �% •
2'
New Building Remodeling Addition Repairs - No. of Stories
Size Septic Tank Type of Tank___ Capacity Gals.
Feet of Drain Tile ��c� f Dist. Feet of Tank or Drain Field from WeIL
.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 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 arc
licensed by Miami Shores Village.
Master Plumber.
STATE OF FLORIDA, }
COUNTY OF DADE.
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeare
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 fac
therein by him stated are true.
My Commission Expires 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 flail
materials and /or workmanship.
CLOSETS
BATH
TUBS
SHOWERS
LAVA-
TORIES
SINKS
SLOP
SINKS
LAUNDRY
Tints
URINALS
URINALS
CATCH
FLOOR
DRAIN
DRINKING
FOUNT•NS
TOTAL
FIXTUREI
--
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. ____ ) ; - 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 Divisior
of Miami Shores Village shall be complied with, whether herein specified or not. A copy of approved plans and specifications must be kept al
building during progress of work.
Owner's Name and Address __. - -
t�
Registered Architect and /or Engineer
Employing Plumber's Name, V (/
Subdivision
Street and Number where work is to be performed—No-2-1 ‘.1d d '
_ --_. Street
State work to be performed and purpose of building (By Floors)
Location and Legal Description Lot
Amount of Permit $
Nature of Water Supply: City —Well
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
Block
(Signed)
(Signed)._
No
Street
e R ( ' Street ' �% •
2'
New Building Remodeling Addition Repairs - No. of Stories
Size Septic Tank Type of Tank___ Capacity Gals.
Feet of Drain Tile ��c� f Dist. Feet of Tank or Drain Field from WeIL
.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 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 arc
licensed by Miami Shores Village.
Master Plumber.
STATE OF FLORIDA, }
COUNTY OF DADE.
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeare
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 fac
therein by him stated are true.
My Commission Expires 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 flail
materials and /or workmanship.