9094MIAMI SHORES VILLAGE
PLUMBING- INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
Permit No._.
Application is hereby made for the approval of the detailed statement of the plans and specifications herewub
structure herein described. This application is made in compliance and conformity with the Building Ordinance of
and all provisions of the Laws of the State of Florida, all ordinances of Miami Shores Village and all rules and regul
of Miami Shores Village shall be complied with, whether herein specified or not. A copy of approved plans and
building during progress of work.
Owner's Name a n d Address__ * Y - s - _ No._- - Street
Registered Architect and /or En
Employing Plumber's N: __ -- - -- - _ _ ' o _ _ `— Stre
Location and Legal Description _.-. Block __ _ . _ __ -- _____,__ _ Subdi'
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__:.
No.ofS
Size Septic Tank_____.: - - - ---
Feet of Drain _____ _Dist. Feet of Tank or Drain Field from Well_-
Nature of Water Supply: City --Well --------_-_-__--
-
Type of Tank: -- -- - - - - --
Ii
The undersigned applicant for tbic building permit does hereby certify that he lerstands and accepts his obligations -
under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Permanent S
plied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors employed by
performed under this permit; and will post or cause to be posted for inspection on the 1. a of the work such -public ne
required by the Act. The undersigned agrees to employ only such sub- contractor work to be perf._ ands
Amount of Permit $ _
Capa+
licensed by Miami Shores Village.
(Sign
tb�
STATE OF FLORIDA, I
COUNTY OP DADE.
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledg3
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 appliesition, and that he
therein by him stated are true.
My Commission Expires
NOTE: A re- inspection fee of
materials and /or workmanship.
.00 will be mane when such re-inspection is
Notary Public, State
e.
are
y appeared
or
FLOOR
DRAIN
DRINKING
FOUNT 'NS
CLOSETS
BATH
TUBS
SHOWERS
LAVA-
: TORIES
SINKS
SLOP
SINKS
LAUNDRY
TUBS
..
RINALS
BASIN
TOTAL
FIXTURES
CONTR.
LIST
CHECK
SEPTIC
TANK
SEWER
CONN.
DRAIN
FIELD
AKAGE
PIT
GREASE.
TRAP
SOLAR
HEATER
DEEP
WELL
SPRKLR.
SYSTEM
SW IM'G
POOL
CONTR.
LIST
`
CHECK
Size Septic Tank_____.: - - - ---
Feet of Drain _____ _Dist. Feet of Tank or Drain Field from Well_-
Nature of Water Supply: City --Well --------_-_-__--
-
Type of Tank: -- -- - - - - --
Ii
The undersigned applicant for tbic building permit does hereby certify that he lerstands and accepts his obligations -
under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Permanent S
plied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors employed by
performed under this permit; and will post or cause to be posted for inspection on the 1. a of the work such -public ne
required by the Act. The undersigned agrees to employ only such sub- contractor work to be perf._ ands
Amount of Permit $ _
Capa+
licensed by Miami Shores Village.
(Sign
tb�
STATE OF FLORIDA, I
COUNTY OP DADE.
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledg3
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 appliesition, and that he
therein by him stated are true.
My Commission Expires
NOTE: A re- inspection fee of
materials and /or workmanship.
.00 will be mane when such re-inspection is
Notary Public, State
e.
are
y appeared
or
rM i fi ifa ce r 0;;I ii rreo' �•M tjiica iri Mcgak a fail
Issued 5 d 19
Amount 111014 i."1" 0h•••'
No. Houses
aiami Jhores91llage
F L O It 1 D A..
BUILDER'S BOND
KNOW ALL MEN BY THESE PRESENTS, t t I,
Address /..? 56 "�" . % •--9 ��
in consideration of the issuance to me by Miami Shores Village,
AT? 884
buildings at the following addresses:
G 7°2
Florida, o
a permit or permits to construct or repair a building or
do hereby deposit with Miami Shores Village,. Florida, the sum of , and I agree with said Village that, when such construction shall have
been completed by me within the meaning of the ordinances of said Village, I will clear all premises and repair any Village property damaged by me,
used for the deposit of material or equipment in the construction or repair and that, if I do not so clear and repair such premises immediately upon the
completion of such constructio i wi • the meaning of such ordinances, the Village may clear and repair the same and pay the costs of such clearance and
repairs . t of th aforesa
, and return the remainder to me; and that, if I shall clear and repair said property immediately, as aforesaid, then
shall be returned to me.
WITNESS MY HAND and Seal at Miami Shores Village, Florida, this
day
9 <7
INSTRUCTIONS TO BUILDER —When above mentioned construction is completed and t
Village Building Inspector and obtain his approval, after which Miami Shores Village will re
d you money in accordance
VILLAGE BUILDING INSPECTOR'S APPROVAL
I hereby certify that the construction contemplated under this Bond, has been completed and that the builder thereof has caused
the surrounding premises to be cleared and repaired in as good condition as they were before commencin said construction.
(Seal)
bond to the
agreement.
WHEN CLEARED AND REPAIRED BY THE VILL
Amount of Bond. .
Cost of clearing and repairs done by Village
Balance due Builder
grigraM
•.. ;. K••••.• ...
Cancelled
41111111 ,
tieillage _Inspector, +L? es Village
19 By
ry1C '•..••f ••. .- •lC••..r7�i� %,�r.".Nil�c•:.:� fY �::a7i�''•.��' .•''!i' .'�:• °li'F1tC• .'4". 1C'•...
VILLAG1
A
ELECTRICAL
• PLUMBING
Owner of
Building'
s
License No
Architect
Contractor
or Builder,
Legal
Description.
Address of
Building
tot
Subdi-
vision
Value of
Project
This permit is granted to the contractor or builder named above to construct the building or to install the
herefor in strict compliance with all ordinances pertaining thereto and with the understanding that the work
drawings, statements or specifications that may : have been submitted to and approved by the proper municipal a E;
time if the work is not-done in compliance with such ordinances or if the plans are changed without authorization.
granted is the understanding that the contractor or builder named above assumes the responsibility for a thorough' "",,
pertaining to the work covered hereby whether shown on the plans or drawings or in the statements yfr specifications
done by his agents, servants or employees.
Signed:.4. ,. BY
INSPECTOR
In consideration of the issuance to me of this permit I agree to p form ithe work covered hereunder in compliance
pertaining thereto and in strict conformity with the plans, drawings, state envy' " specifications .tnitted to the proper au
In acct= +ng is permit I ass responsibility for all w' -;k do by eit er, self, my agent, s or „. oyee. w,
CONTRA 0 • • " BUIL r ' g,
ordinances and r
of
• Shores V