15315MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
Permit No.
Date 1 b " . 1.4
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 $uilding 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. _M _ -
Registered Architect and /or Engineer
Employing Plumber's Name_.
No
Street
1
_ - -_ -_ No Street__ -_
Location and Legal Description Lot - Block_._ subdivision __
Street and Number where work is to be performed —No (7 ._ treet ._..._
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___
Capacity Gals.
Amount of Permit $_._____.
(Signed) "
Plumbing Inspector.
The undersigned applicant for this building permit does hereby certify that he understands an accepts his obligations as ft employer of labor
under the Florida Workmen s Compensation Act, being Section 5966, Compiled General Laws of Florida Pennanent Supplement, and hus Con -
plied with the provisions thereof, and will require similar compliance from all contractors or subcontractors employed by him an 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 penult, as are
licensed by Miami Shores Village.
STATE OF FLORIDA,
COUNTY OF DADE. ss.
Before me, the undersigned authority, a notary public, duly authorized to administer oatl;s and take acknowledgments, personally uppeare°
/ //:
aster Plumber.
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, an d that all tac
therein by him stated are true,
My Commission Expires
NOTE: A re- inspection fee of $1.00 will be made when such re- inspection is made necessary by :Improper notice for inspection, or f,,ul
materials and /or workmanship.
Notary Public, State of Florida
CLOSETS'
BATH
TUBS
SHOWEIiO
LAVA-
TORIES
SINKS
SLOP
SINKS
LAUNDRY
Tung
URINALS
URS
CATCH
BASIN
FLOOR
DRAIN
DRI NKINO
FOUNT
/� /
1,41 �`K
TOTAL
FIXTURE!
GLIST
LIST
I
ly,
)
(
/
00
CHECK
t�^1q
/ G V
•�+ /,
.
11
1'
./
SEPTIC
TANK
SEWER
CONN.
DRAIN
FIELD
SOAKAGE
PIT
GREASE
TRAP
SOLAR
HEATER
DEEP
WILL
SPRKLR.
SYSTEM
SWIM 0
POOL
CLST
LIST
CHECK
/ 0.0
�r
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.
Amount of Permit $_._____.
(Signed) "
Plumbing Inspector.
The undersigned applicant for this building permit does hereby certify that he understands an accepts his obligations as ft employer of labor
under the Florida Workmen s Compensation Act, being Section 5966, Compiled General Laws of Florida Pennanent Supplement, and hus Con -
plied with the provisions thereof, and will require similar compliance from all contractors or subcontractors employed by him an 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 penult, as are
licensed by Miami Shores Village.
STATE OF FLORIDA,
COUNTY OF DADE. ss.
Before me, the undersigned authority, a notary public, duly authorized to administer oatl;s and take acknowledgments, personally uppeare°
/ //:
aster Plumber.
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, an d that all tac
therein by him stated are true,
My Commission Expires
NOTE: A re- inspection fee of $1.00 will be made when such re- inspection is made necessary by :Improper notice for inspection, or f,,ul
materials and /or workmanship.
Notary Public, State of Florida
®.
L./
Vie•
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BUILDING
ELECTRICAL
PLUMBING
MIAMI SHORES VILLAGE .f "' ORIDA
DA
PERMIT N? 15315
ROOFING 0 Work to be performed under this Permit
Owner of
Building .i_.r
Architect
Contractor
Or Builder ;a....i,^ '•.,r',,,,,
Legal
:Description..
Address of
Building
This permit is ted to the contractor or builder earned above to construct the building, or w install the
herefor in strict comp 'dice with all ordinances pertaining thereto and with the understanding that the work wilt:
drawings, state rents or specifications that may have been submitted to and approved by the proper municipal au
time if the wo is not done in compliance with such ordinances or if the plans. are changed without, authorization.
granted is the understanding that _ate contractor or builder named above assumes the responsibility for a thotaug k rd. the
Peening to the work covered hereby whether shown on the plans or drawings or in the statements or•;spediieat a fie h
done by his agents, servants or employees.
Signed •
In consideration of the issuance to me of this permit L agree to perktm the work covered' hereunder in compliance . ; ' ail o� i d . -
pertaining thereto and in strict.conforinity with the plans, drawings, statements or cificatsnnar.� to the proper: oriel .:of:Miami,9hore, Vilese....,.
In accepting this permit. I assume responsibility for all work done by,either, myself, my age* want or employee.
.
,"_�
CONTRA(," Pa3$, OR BUILDER
ad spphication
ce> an'yas,
7 duany.
p is
dens
aawumeg work.;.
BY