PLUMBING PERMITS MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPUCATION FOR PLUMBING PERMIT cc
Permit No..'.�^' 1� I Date.._.. .... _
Application is hemby made for the approval of the detailed Statement of the plane and specifications herewith submitted for the building or other
structure hemi,described.This application Is made in compliance and conformity with the Budding Ordinance of Miami Shores Village, Florida.
and all provisions of the Laws of the State of Florida,all ordinances of Miami Shares Village and all rules and regulations of the Building Division
of Miami Shams Village shall be complied with,whether herein spedfiad or not. A copy of approved plans sad spedficaticsn MW be kept at
budding during progress of work. �♦ I
Owner's Name and Address.._.. 1" (AM�� No 1/23 Street-e y �����S7
Registered Architect ayyn��d/ , 1 tf ,._... _I...... ..- �� ..... .
Am
Employing Plumberi let A .., No-------
iMeR.=:.
Ieocadoa e"L,egal besctiptiar► lllack
Street and Number where work is to be Performed—No- I ccStreet�•''`� l/��..
State work to be performed and purpose of beading (By Floors) _ ..�2ki/_ �•. I�usrl'u+Qft• ..`..--.�.
New Building __ .._._. ReanodehingNo. of Stones........._.........
BATH aNOWtRe LAVA.
atNKs SLOP LAYNORv YRINAu CATCH FLOOR DRINKING TOTAL
CLoasTa TYsf TORIts a1NKs TYS6 BASIN DRAIN FOYNT'Nf PIIITYRt/
con".
LIST ..---..+-
CHICK
same etWIM DRAIN GOAKA09 oR[ASK GOLAN DZW 9PRKLR. aWIM'O
TANK CONN. FICLO PIT TRAP ""Tan WILL aTSTIM POOL
comm.
LIST
CHICK
Sine —TY"of Tank—._ ...-_--.-._Capacity Gels.-._..__.M. ___. ..__...
Feet of Drain''nae._---------- pint Feet of Tank or Drain Field from Well...
Nature of Water Supply: CdtY—We1L Size of Soakage Pit_._ .__.». _...__.. ......_.
Amount of Permit ts ) �d t _.tT�J ._� ...
Plumbing Inspector.
The undersigneda cant for thin building permit does hereby certify that he understands and accepts his obligations as an employer of labor
under the Florida Workmen's Compensation Ad.being Section 8988,Compiled General Laws of Florida Permanent Supplement, and lum com.
plied with the provisions thereof,and will require aimilalr compliance from all contractors or sub-contract ed by him in the wort' to be
performed under this permit:and will post or cause to be pow for inspection on the site of the work h blic notice or notices as am
required by t>;e Act. The undersigned agrees to employ only such sub-contractors, on to be this perkier as we
licensed by Miami Shore ViUaga
(Signed) _ .__. . ............._....._
Matter Plumber.
STATE OF FLORIDA. l 556COUNTY OF DADE. i
Before me,the undersigned authority,a notary public,duly andmized to administer oaths and take acb- ledgments, personally appeared
to me well know,.and who,being by me fiat duly sworn,up=cathand says that he is the_.._____ . ..___._ _... ..._._....... ....__.
of the above described construction, that be has camfuW read the regoing gwbmt b% and the he did sign the as=,% and that all fads
therein by him stated are true.
My Commission Expires Notary Public,State of Florida
NOTE: A re-hopection In of$1.00 will be made when wash rNaspeedoa IS ssade'aaosesan►by It noun icor lmpaedon. or faulty
materials and/or wodimanship.
STATE OF FLORIDA
DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES
ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION AND INSTALLATION PERMIT
pp cant Permit Number �S O d63
J+4 Go. /173 i'I.E. /o roe P/ d 6 /17
.;FART-11 SYSTEM INSTALLATIOLN INSPECTION AND FINAL INSTALLATION APPROVAL -
Installer iat Q� eer z ^- Tank Manufacturer
-Proper tank legend: Yes No Tank material Tank level: Yes No
Tanks watertight: Yes No Tank size: gallons gallons gallons
I
Proper tank outlet device: Yes No Manhole or marker to grade: Yes No
Drainfield'trench Absorption Bed
Length Width Lt g1h Width Length 310•°feet x :5-y feet= /10 ft2
feet feet feet feet Lengthy® feet x s-0 feet= 150 ft2
feet feet feet feet Proper No. drainlines: Yes I-- No
feet feet feet feet Proper pipe separation: Yes to-,, No
Total= ft2 Total= ft2 Distribution box level: Yes No
Systems located as permitted: Yes ke-"No
Systems Including plumbing stub-outs installed at proper elevation: Yes No
Average depth to drainpipe invert from finished grade:0 2-17 inches Maximum depthAqy Inches
Average depth of drainfield gravel: 11-W Inches Minimum depth of gravel: /0" Inches
Proper gravel size: Yes "/" No Gravel is suitable quality: Yes / No
Backfill or fill material as required: (Quality) Yes No (Quantity) Yes No
Other findings:
Inspected by: &I Ct + r :5 5 O Date F-eU -�5
- ---- —P$kRT III--r-MAL T L TION APPROVAL
r
Date 2'Q� Approved by. �'_ 2
UNW PUBLIC HEALTH UNIT
AN APPROVED'I ALLATION DOES NOT GUARANTEE PERFORMANCE
Note: Completed copies of this form will be provided to the applicant, installer and the building department.
HRS--H Form 4016.Feb BB(Obsotetes previous editions which may not be used)
(stock Number.6744-002-401") Page 2 of 2
j PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Date 7 Op Job Add= Zzzm 0" /03 '' '`rax Folio
Legal Desm#don Historically Designated Yes No
Ovmwimw/Tenant-.�m � / /.•r -w" Master Permit#
Ownet's Address 61.7-J7,414 /D.-3 Phone — ?.
Conir ingJr s'C Address dgz&.Ja-/��
QualiFer SS#
state#4!AZJXAA MwdcgW# Cmnpeterxy# Ins.Co.
Architect/Engmeer Ams
Booming Compal Address
Mortgagor Address
Permit Type(circle one): BUILDING ELECTRICAL PLUMBMECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCREMON SctM LO �.e Tim l!./AV—O& �!`edow"+ ',6
zg;;; Y/ !�� /10.x,.
Sq=Ft. Estimated Cost(value) _�G'r- 400
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 zonxi D TO Owum FINANCING,CONSULT WITH YOUR LENDER
OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT.)
Application is hereby trade 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 peaformed 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:
OWIqERS 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 caning Furthermore,I authorize the above-named contractor to do the work stated
tgnatur a of oww Presidat Date gii2die of Contiktafor Owner Builds Date
OFFICIAL NOTARY SEAL
®AMIE
A 0-10
as to Notaryas to Date
My Ca®missi #Hno,:}N MARIE My ON 1tJ(P.MAR 2t;
.. "SS10N I CO SSi744
K` Pikta.November3,2003
'
13onwo Ti"No"Pwa 1fl*mkms
FEES: PERNIlT ® RADON C.0 F. ® NOTARY BOND
APPROVED: TOTAL DUE uD, b 0
Zoning Building Electrical
Mechanical Pltmnbing Struchnal Pik !F
4/140/6 - - - - - - - - - -
L
40
73l�-r /03 ST `
N 1AM
7-0
i
5`
�1
�bo L) Ro L^iu CQ t z
• ti/�ll � � � � �fg-'lU LS � +
! Ti�iK •LP � w �. � � �
MIJV
e �N rriate- r..1s�.a s qbr 3
J`m �/cQisr
a
T.�
MIAMI SHORES ' VILLAGE, °
l PLUMBING INSPECTION DEPAItTMENT
APPLICATION FOR PWMBING PERMIT
L2.' nate
Permit No, "I
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 de=bed.This application is made in compliance and conformity with the Building Ordinance of Miami Shorn 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'Budding 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 Imo'/ �®/� No.-�/7� Street Ar /O� •
Registered Architect and/or
EmployingName i'1jCd � ��' No lot Street ��'• 'lA�
Location and Legal Description Ila. i Alock � Subdivide n.
Street and Number where work is to be,pedis med--No- — /N� � �'; S -Street`
- State work to be performed and p:ulwse of i building (BY Flom)1J � -�---- --7- ��►t".. .�--��- .
New Building Remodeling Addition Repairs No. of Stories
CLOSETS SAS LAVA- SLOP LAUNDRY CATCH FLOOR DRINKING TOTAL
TUBS SHOWERS TORIES SINKS - SINKS Tues URINALS BASIN DRAIN- FOUNT•N8 FIXTURES
,LIST
CHECK '
SEPTIC SEWER -DRAIN SOAK,%*I IRI SOLAR DEEP SPRKLR. � SWIM'G
TANK `CONN. . 'FIELD' '. PI .TRAP PATER Wtur. EM
. SYSTPOOL`.
LIST - -
CHECK
Size SepTan Type of Tank Capacity Gals.
Feet
of
Drain
Tfle
Feet of Tank or Drain Field from Weil
Nature of water Supply: City Well..x;�1 00 Size of Soakage Pim
i
Amount of Permit'$ �� ... (Signed)
,/ Plumbing Inspector.
The undersigned appIicxmt for this building permit does hereby certify that he derstands and accepts his obligations,as an employer of labor
under the Florida Workmen s Compenstatioo Act,being Section 59M,Compiled General Laws of Florida Permanent Supplement, and has cam-
plied with the provisions thereof,and will require similes compliance mpliancep from all contractors•or sub-contractors employed by him in the work to be
performed under this Permit;and will post to be posted for inspection on the site of the work such public notice or notices as are
required by the Act. The undersigned al to employ only sack sub-contractors, on,work to be performed under this permit, as are,
lid by Miami Shores Village.
Ano-lc4w
STATE or FLORIDA,
DE.'
COUNTY QF VA, _
Before me,the undersigned Guth .s notary public,duly authorized to administer oaths and take aclmowledgments, personally appeared
- to me,well known,and who,being by a duly sworn,upon oath deposes and says that he Is the
Of the above described construction, ' has carefully read the fforegoing application, and that he did sign the same, and that all facts
therein by him stated are true.
- My Commission rapires Notary Public,.State of Florida
NOTE: A re-inspection fee of$1.00 will be'made_when such re-inspection is made necessary by improper notices for inspection, or faulty .
materials and/or worlmmanship. {
MIAMI SHORES VILLAGE, FLORIDA
WILDING DATE 194_
LECTRICAL PERMIT N° 8622 Contractor's
LUMBING License No.
Work to be performed under this Permit
wner of
uilding -
chitect
ontractor
r Builder `
egal Lot Bl. Subdi-
escription vision
ddress of / Value of II Amt.of
uilding _` !� t "Project I Permit r
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 appli-
tion herefor in strict compliance with all ordinances pertaining thereto and with the understanding that the work will be performed in compliance with any
lans, drawings, statements or specifications that may have been submitted to and approved by the proper municipal authorities. This Permit may be revoked
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
ermit is granted is the understanding that the contractor or builder named above assumes the responsibility for a thorough knowledge of the ordinances and
gulations pertaining to the work covered hereby whether shown on the plans or drawings or in the statements or specifications and that he assumes respon-
bility for work done by his agents,servants or employees.
Signed: ; • — — 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 regulations
rtaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village.
accepting this permit I assume responsibility for all work done by either myself,,my agent,servant or employee.
CONTRACTOR OX BUILDER BY AUTHORM
MIAMI SHORES VILLAGE. F'LbR°`16ABURDING
.
ELECTRICAL ❑ DATg- 195 .
P� MIT
PLYING � '�`� N9 044 Contractors
' ROOFING ❑ � i License No
D Work to be perform thi
®d under s Permit
Owner of
Building . ; °} ;. a
Architdct
Contractor
or Builder
LegalLot I BL Subdi- -
Description - vision
Address of `' Vclue of Aint of
Building ��`` �F_.,; Project
This permit is granted to the contractor or l builder named above to construct the budding or.to install the equipment or device deacdbed in the application'i '
herefor in strict compliance with all ordinances pertaining thereto and with the understanding'that the work will be performed in compliance with any,pl4ne;
drawings; statements or specifications that may Iii*e 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 sueh ordinances or if the plans are changed without authorization. A further condition upon which phis _ t.is
granted is the understanding-that the contractor'or builder named above assumes the responsibility for a thorough knowledge of the ordinances and regions,
pertaining to the work covered hereby whether 9�v�n on the plans or drawings or in the-Itemente or specifications anct that lie assumes responsbilit� or work #
done by his agents, servants or employees.. s r
" 1 f
Signed: AA
I1dS1ECTOR "�AA t
.. _
In consideration of the issuance to me of the permit i agree to perform the work covered hereunder in compliance with all ordinances and irW' ations
peening therefandstrict conformity with.thq plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores VillageIa accepting thiesposibilitgp all.work done either, myself, mytor employee.
elf, r
�CQItil VA OR tin t { 'ta° , -' - AtMMIttir
77
1
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMEN
APPLICATION FOR PLUMBING n-'ik IT
Permit No.__.._. Date_— �=' �`-�" -------
Application
.
Application is hereby made for the a$proyal of the detailed statement of the plans and specifications herewith submitted for the building or/other
structure herein described.This appli"is made in compliance and conformity with the Building Ordinance of Miami Shores Village, Florida,
and all pwvisicros 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 comp 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 Street._
Registered Architect and or E —
Employing P 's aura._
Location and Legai Description Lot Block Su
Street and Number where work is to be peprformed No l f T 3 Street
State work to be peaformeil and purpose of building (By Floors) ---
New.Building _ RemodoNag Additio __ Ropairs....-...._.-____..__ No. of Starter.-_......_._.....- _.
CLOSETS BAT" SHOWERS SINKS SLOP LAUNDRY URIPtl1L8 CATCH FLOOR DRINKING TOTAL
TUBS TOR ES SIMKB TUBS BASIN DRAIN FOUNT'NS FIXTURES
C I NTR.
LIST
CHECK
SEPTIC SEWER DRAIN SOAK�06 GREASE' SOLAR Daae SPRKLR. 8WIM'O
TANK CONN. FIELD PI TRAP HEATER WELL SYSTEM POOL
CONTR.
LIST -
CHECK
Sime Septic T of T _ ----Capacity
Feat of Drain Tile - Dist.Feet Tank or Drain Field froma Well_
Nature of Water Supply: Well r Size of Soakage Pit--.—
Amount
it_._._—.Amount of Permit $ (Signed) _.-----
The undersigned applicant for this buii�ng permit does hereby certify that he mrdelrstandn
andccepts ligations as an employer of labor
under the Florida Workmen's Compensation l"being Seection 8988,Compiled General Laworida t Supplement, and has camu-
plied with the pmvistoas thereof,and vtill Hire similar compliance from all contras or tractors employed by him is the work to be
performed under.this permit;and will pbst cause to be posted for iuspeation on the site of the work such public notice or notices as are
1rPgi*ed by We Act. The undyed to employ only such sub-contractors, on work to be performed under this permit, as are
licensed by Miod Shares Wages
(Siped)�
Master Flambe.
STATE OF FLORIDA, C
COUNTY OF DADE.
Before me,the undersigned authority,a#otary public,duly audwrized to admiaiatm oaths and take admowledgmcets, personally appeared
to me well known,and who,being by me duly sworn,upon'oath and.mys that he is the _.
�h above hdes im rbc construction, that has carefully read the foregoing application, and that he did sips the same, and that all facts
My Commission Fja*w Notary Pubo,State of Florida
NOTE: A re- fee of $1.00 be made when on&se-inspectim is mmde•neoessary by improper notice for inspection, or faulty
materials and/or wadinimship.
•t(
,q !
ol
x
s�OWtR
wIle
Z
'y.• �� vI—i�i� s .. T cwt:
p
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r
> f n• t
MIA I SHORES VIL.L.AGEt. FLOFVDA '
i
BUILDING DAT ;'"" qq _
RECTRICAL PERMI N? 7799 Cdn'tractoes
PLUMBING License No.
Work to bepert rmed under this Permit 11
Owner of
Building
Architect
Contractor 4
or Builder Ar
Legal BL S"_ _
j Description vision
Address ofI , Value of . �I Amt.of
Bu3ldin Prolect Permit
This is granted to the contractor,orb named'above to constrnc the budding'or to install the equipmeat or device described in the appli-
cation herefor in strict compliance with all; thereto and with the understanding tl,a-the work w ll be performed in compliance with any
plans,drawIngssstatemeats or s�eeifittions thatma ve been submitted to and approved by the proper municipal authorities. This Permit may be irevoked
at any lime if a work is not done in c�apliauce such ordinances or if the plans are changed without anthorization.A farther condition upon which this
permit is grouted is the understanding that the cin or builder named.above assumes the responsibility for a knowledge of the ordinances and
regulations pertaining to the work covered hereb wh shown on the plans or drawings or in the statements or tions and that he assumes respon-
sib4lify for work done by his agents,servants or '
Signed: _ By
In consideration of the issuance to me of_this I agree to Pelfimmwork covered hereunder in com i'
retaining thereto and in siriet conformity with the pFOiA
dra Pace with or ands and
accepting this permit I assume responsibility for all ��' stat my or specifications age
4 ser submitted to the proper an Miami S
� done b either self.my agent,servant or employee. _
-CON72ACM CFL DU IDER BY ADTSORrrr
is
'! MIAMI' �HDIIES- VILLAGEt FLOR4DA-
BUILDING oar 154 ,
ELECTRICAL PERMIT" N? 7750 Contraetoras
PLUMBING2r
No.
Pork to be penfo4ed tandet this Permit-
Owner of
Studding Ee
-
Architect
lJVlitractc.
• .
Or Budld
Legal Lot 1L Subdi-
DescriptionVision
Addron Value of
Buildn of . �� II MIA ..r '
This is to the contractor or. named above to construct the building or to install the equipment or device described in theappli-
cation herefor in strict compliance with all ordinan+ees g thereto and with the unde standing that the work will be performed in compliance with any
plans,twin==or specifications that may ve been submitted to and approved by the prop municipal authorities. This Permit may be revoked
at any time if a work is not dome in compliance with ordinances-or if the plans are changed without authorization.A further condition upon which this
permit is granted is the understanding that the am or builder named above assumes the responsibility for a thorqugh knowledge of the ordinances and,
s regulations perEsining to the work covered hereby w shown on the plans or drawings or in the statements or specifications and-that he assimmes respon-
sibility for work done by his agents,servants or
Signed: By
XNSMCTOR 4
In consideration of the issuance to me of this t I agree to perform work covered hereunder in compliance with all or and re
ac�athereto and is strut conformity with the p1�ns, drawings, statannen or specifications submitted to the proper autos of Srt�
p�g this pernnit I assume responsibility fob all ork done by eSther myself,my agent servant or employee.
CONTRACTOR'OR bunmim BY AUTHORITY
� Ii