925 NE 91 TerrMiami Shores Village
Permit Type (circle): Building Electrical
Owner's Name (Fee Simple Titleholder) V)( SC? r
Owner's Address 92
'� T
City H ,'�.4 b t S State 1 L
Tenant/Lessee Name
Architect/Engineer's Name (if applicable)
$ Value of Work For this Permit
Describe Work:
Total Fee Now Due $
(Continued on opposite side)
Building Department
10050 N.E.2nd Avenue, Miami Shore Florida 33138
Tel: (3 05) e �17�6.ft972
' Rec
BUILDING 3t1 % 2 ` 13" Permit No. P104,-014,
PERMIT APPLICATION _ :....._ . .-.7_:M ster Permit No. IOC( - ( 0, .
FBC 2001 � J�
A k _Sr. l c 'r .Phone # -, c 1 `i •
2;ip
Phone #
Mechanical Roofing
Job Address (where the work is being done) 2 5 `�
City Miami Shores Village County Miami -Dade Zip 3 1 f
Is Building Historically Designated YES NO
Contractor's Company Name rn•,
Contractor's Address 1 . ' S > t , SC . i ct
City State 1' t-
Qualifier L:: C, . -., 0
Phone # , s) r. C.. 5( Cc
Zip _') .�t.f
State Certificate or Registration No. Certificate of Competency No.
Phone #
Square Footage Of Work:
Type of Work: ['Addition ['Alteration ❑New R pair/Repla a ❑Demolition
V -N r \ ;
* * * * * * * * * * * * * * * * * * * * * * * * * ** F ees * * * * * * * *i: * * * * * * * * * * * * * * * * * * * **
Submittal Fee $ Permit Fee $ 115 00 CCF $ 170 CO /CC
Notary $ Training/Education Fee $ • ZO Technology Fee $ A.-31
Scanning $ Radon $ Zoning Bond $
Code Enforcement $ Structural Plan Review. $
1)50 p_0 t__ (q0
Bonding Company's Name (if applicable)
Bonding Company's Address
City State Zip
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address
City State Zip
Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has
commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulating
construction in this jurisdiction. I. understand that a separate permit must be secured for ELECTRICAL WORK, PLUMBING, SIGNS,
WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and AIR CONDITIONERS, ETC
OWNER'S 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 zoning.
"WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT 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."
Notice to Applicant: As a condition to the issuance of a building permit with an estimated value exceeding $2500, the applicant must
promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person
whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site
for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the
inspection will not be approved and a reinspection fee will be charged.
l L,�
Signature Signature
Owner or Agent
Contractor
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this I
day of , 20 , by , day of C. •�`0-t% 20 U by kfN' ■ t Ct I, • • t4LC.t- C. V (,
who is personally known to me or who has produced who is personally known to me or who has produced « k u •
As identification and who did take an oath. , c , t.'‘ as identification and who did take an oath.
NOTARY PUBLIC: NOTARY PUBLIC:
Si Si , k \,;ej,-, .S C.I, ti..C.
Print: Pr mot, =)t =, A'LC: - i`l.
My Commission Expires: My E
**************************,****************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
* * * * * * * * * * * * * * * * * * * * * * * * * ** ** * ** ***** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
APPLICATION APPROVED
Chc 05/13/03
ssion Expires:
* * ** * * * * * * * * * * * * * * * * * * **
i • , 4 • f, TEE FF pP �k J SOLOMON
* ti Mg *�KSK ,u-1:41, ember * *20 **
14 004- NOTARY FL Notary Discount Assoc. Co.
MY COMMISSION * DD250437
Plans Examiner
Engineer
Zoning
*
*
1
Miami Shores Village
10050 NE 2nd Avenue
Phone: 305 - 795 -2204
Printed: 10 /18/2004
Applicant: BARBARA
Owner: ABSALOM
JOB ADDRESS: 925 NE 91
Parcel # 1132060030060
Signed: (INSPECTOR)
Plumbing Permit
Permit Number: PL2004 -293
ABSALOM
BARBARA
TERR
Contractor A AMERICAN SEPTIC & PLUMBING INC Contractor's Address: 17027 W. DIXIE HWY
Local Phone: (305) 866 -5600
Page 1 of 1
Legal Description: PL OF BISCAYNE RIDGE PB 39-41 W31FT LOT 7 & LOT 8 & E2FT LOT 9 LESS
Fees: Description Amount
FEE2004 -10010 Building Fee $175.00
FEE2004 -10179 CCF $0.60
FEE2004 -10180 Training and Education Fee $0.20
FEE2004 -10181 Technology Fee $4.37
Total Fees: $180.17
Total Fees: $180.17
Total Receipts: $180.17
Permit Status: APPROVED Permit Expiration: 4/10/2005 Construction Value: $400.00
Work: PUMP & ABANDONMENT EXISTING SEPTIC TANK
OCT 15 PAID
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 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 I assume responisibility for all work
done by either myself, my agent, servants or employes.
Signed: (Contractor or Builder) BY:
MI�ORE9 VILLAGE
BUILDING DEPARTMENT
305- 795 -2204
Bui d Inspection Request
Date d�
Type Insp'n '1�t ( 1 k AI 1 JA Air
Permit No. PI �� ��` i & no.
Name�CS
Address / - !v /`-r o
f ,
Company II /� 1 ,
Phone #
Inspection Date co 12K
Approved �1
Correction ❑
Re- Insp'n Fee ❑
(r(at,c0/
3
BUILDING
PERMIT APPLICATI
FBC 2001
Permit Type (circle): Building
Owner's Name (Fee Simple Titleholder)
Owner's Address
Qualifier
City / ciiLL,. % A, State
Tenant/Lessee Name
Job Address (where the work is being done)
City Miami Shores Village
Is Building Historically Designated YES
Architect/Engineer's Name (if applicable)
Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
304225.2204 Fax: (305) 756.8972
� -1
Contractor's Company Name A A m 2v : i s&v
Contractor's Address
City PO vi
iJv lkt iArv, vvoori Q r d
EC ETVE
2004
OCT
Electrical
G, : tDcr vt`
J r'
MO MOO 0.11
Plumbiig
State Certificate or Registration No. L Certificate of Competency No.
Phone #
Master Permit No.
fim Phone # 13
County Miami-Dade
NO t �
Zip 3)/3
Phone #
Zip
11 `:. Phone# L' -k i d
State r'L Zip "_ i ee I
$ Value of Work For this Permit Zit Square Footage Of Work: /
Type of Work: DAddition ❑Alteration
Describe Work:
Submittal Fee $ Permit Fee $ 1 .0 0
Notary $ Fee $
Scanning $ On Radon $
Code Enforcement $
Total Fee Now Due $ ' "1 7
(Continued on opposite side)
[New
1+1 b -irk o 1 \""'
MI X
pair/Rplace
* * * * * * * * * * * * * * * * * * * * * * * * * * *, F ees * * * * * *:t * * * * * * *** * * * * * * * * * * * * **
Structural Plan Review. $
to ( 1go\
Permit No. PIN, acg.
Mechanical Roofing
❑ Demolition
CCF $ I : gU A CO /CC
Technology Fee $ A .. 3 1
Zoning Bond $ • GCJ
Bonding Company's Name (if applicable)
Bonding Company's Address
City State Zip
Mortgage Lender's Name (if applicable) I '
Mortgage Lender's Address
City State Zip
Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has
commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulating
construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRICAL WORK, PLUMBING, SIGNS,
WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and AIR CONDITIONERS, ETC
OWNER'S 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 zoning.
"WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT 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."
Notice to Applicant: As a condition to the issuance of a building permit with an estimated value exceeding $2500, the applicant must
promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person
whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site
for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the
inspection will not be approved and a reinspection fee will be charged.
day of
who is pers
Chc 05/13/03
L' 4'L—_
Owner or Agent 4+IoScau+�-
The foregoing instrument was ack oowledg before me this "'I
(..t _ 20 , by in � V •1 it":( f b z (C
Signature
NOTAR
Sign:
Print:
My Co ission Expi es:
known to me or who has produced
As identification and who did take an oath.
* * * * * * * * * * * * * * * * ** * * * * * * * * * * * * **
******* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
APPLICATION APPROVED BY: /` r � ,� ' / �r� Plans Examiner
ylaga5
ommission #DD23198
tic Bonding Cu•', Inc
Signature
Contractor
The foregoing instrument was acknowledged before me this II
day of 0 ( 4 20 u4; by iN ►1t irtve) i~.►k) 4 L •t'
who is personally known to me or who has produced
as identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
My Co ission E s ires:
**** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
Engineer
Zoning
:ONSTRUCTION PERMIT FOR:
[ ]New System [ ]Existing System [ ]Holding Tank [ ] Innovative Other
[ X ]Repair [ ]Abandonment [ ]Temporary [ NA ]
kPPLICANT: Absalom, Barbara P. AGENT: SR0001342, Woodard William
?ROPERTY STREET ADDRESS: 925 NE 91 Ter Miami Shores FL 33138
.OT: 7 BLOCK: 1 SUBDIVISION: Biscayne Ridge
[Section /Township /Range /Parcel No.]
PROPERTY ID #: 11 - 3206 - 003 - 0060 [OR TAX ID NUMBER]
SYSTEM MUST BE CONSTRUCTED IN ACCORDANCE WITH SPECIFICP.,TIONS AND STANDARDS OF CHAPTER 64E -6,FAC
DEPARTMENT APPROVAL OF SYSTEM DOES NOT GUARANTEE SATISFACTORY PERFORMANCE FOR ANY SPECIFIC TIME
PERIOD. ANY CHANGE IN MATERIAL FACTS WHICH SERVED AS A BASIS FOR ISSUANCE OF THIS PERMIT,
REQUIRE THE APPLICANT TO MODIFY THE PERMIT APPLICATION. SUCH MODIFICATIONS MAY RESULT IN THIS
PERMIT BEING MADE NULL AND VOID. ISSUANCE OF THIS PERMIT DOES NOT EXEMPT THE APPLICANT FROM
2OMPLIANCE WITH OTHER FEDERAL, STATE OR LOCAL PERMITTING REQUIRED FOR PROPERTY DEVELOPMENT.
SYSTEM DESIGN AND SPECIFICATIONS
T [ 900 ]Gallons SEPTIC TANK MULTI- CHAMBERED /IN SERIES: [Y ]
A [ 0 ]Gallons MULTI- CHAMBERED /IN SERIES: [Y ]
✓ [ 0 ]GALLONS GREASE INTERCEPTOR CAPACITY
0 ] GALLONS DOSING TANK CAPACITY [ 0 ] GALLONS C4? [ 0 ] DOSES PER 24 HRS # PUMPS [ 0 ]
D [ 150 ]SQUARE FEET PRIMARY DRAINFIELD SYSTEM
R [ 0 ]SQUARE FEET SYSTEM
A ; TYPE SYSTEM: [ N ]STANDARD [ N ]FILLED [ N ]MOUND [ N ]
I CONFIGURATION: [ N ]TRENCH [ N ]BED [ N ]
a
F LOCATION TO BENCHMARK: Existing Finished Floor Elev.: 12.40 FT NGVD
I ELEVATION OF PROPOSED SYSTEM SITE [ 0.0 ] [ FEET ] [ BELOW ]BENCHMARK /REFERENCE POINT
E BOTTOM OF DRAINFIELD TO BE [ 0.0 ] [ FEET' ] [ ]BENCHMARK /REFERENCE POINT
u
D FILL REQUIRED: [ 0.0 ]INCHES EXCAVATION REQUIRED: [ 0.0 ] INCHES
DTHER REMARKS:
STATE OF. FLORIDA
DEPARTMENT OF HEALTH
-
ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM
C. NSTAUCTION PERMIT
CENTRAX #: 13 - - 22506
DATE PAID:
FEE PAID : $
RECEIPT .
OSTDSNBR : 04 - 3455 - -
1. Install 900 gals. category -1 septic tank equipped with an approved filter.
, 2.fThe licensed contractor installing the system is responsible for installing the minimum
category of tank in accordance with sec. 64E- 6.013(3)(f), FAC.
3. Existing 900 gals. septic tank to be inspected for an appropriate pump -out and properly
abandoned. The pump -out receipt shall be provided prior to the granting of the final
approval.
4 Existing 150 sq. ft. primary drainfield has to remain.
Ti
is permit is not for an addition.
SPECIFICATIONS BY: Andre, Pau TITLE:
APPROVED BY: Andre, Paul , TITLE: Professional Engin Dade CHD
DATE ISSUED: 10/8/04 ... EXPIRATION DATE: 1/6/05
Miami -Dade My Home Page 2 of 2
http: / /gisin .comiami- dade.ff /niyhome /propmap. asp ?app= none&bytool= AI)DR&cmd:... 7/28/2004
Miami -Dade My Home Page 2 of 2
http: / /gi sim2. copiami- dade.fl.us /myhome/propmap. asp ?app= none &bytool= ADDR&cmd :... 7/28/2004
cale: Each block represents 5 feet and 1 inch = 50 feet.
• - -L_
3S:
Plan submitted by:
Approved
STATE OF FLORIDA 'L
7-74 f
DEPARTMENT OF HEALTH / " --
-APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PERMIT-i
''' At. 51/5
Permit Application umber
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si
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ec ounty Health Department
ALL CHAN S MU E APPROVED BY THE COUNTY HEALTH DEPARTMENT
PART II SITE PLAN-
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MiAMt_SHORES VILLAGE 05
BUILDING DEPARTMENT
305- 795 -2204
Building Inspection Request
Date (fr '
Type Insp' n s0 Vh` " j
Permit No.
Name
Address
Company
Phone #
Inspection Date
Approved
Correction
Re- Insp'n Fee
1
AN-it 2 k •
❑
• 06:1'3/2075 15:11
t .
t
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[
[
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APPL1CANT t 727„..e.,4-1.4 4 ,
1G a - jSf
PROPERTY ADDRESAt
LoTt Imo= t 1
-^--- ssf== ItZk.atiasr saarnmr-
CHECKED [I] ITEM ARE NOT IN COMPLIANCR KITH STATUTE OR RULE AND 1RT1CT SS CORRAC'T*D.
11011r
1
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FINAL SY
TANK INsTALLATI(
[01] TAMA sIM
(03 ] TANK 11AT61
(03] ° TTI.= DS!
[04] MULTI- c71N
[05 ] OUTLET ?II
[06] LSAEND a
1071 WATERTIOEM
[08]
[
D1tAINFIELD TASTE 6LATI011
5 6 J' '
[10] MBA (116 Xl 2 ] �?
[11] DI8TRI5DT:; 311 BOX MEADER
(123 NOMER OF )RAINLIREE i,
(13) DRAINLINF IEP*RATLON
DRAMILD1E ILOPit
DEPTH OF t )VS2
[14]
(15)
[161
[
[18]
[
1
f211
P111
[
[
(
(25]
(
EXPLANATION OF VLGLATI
CONSTRUCTI
3055133472
STATE + 7 FLORIDA
DEPART ENT OP =A7.TN
O)I ITA $$RAGE TARATKEZZT AND DIPOBAL BYSTRI[
CONSTA'CTXON INSPECTION AND FINAL APPROVAL
5 • 3 �` ► � ¢- - --
SiT9DIgI8201Pt ID Ps
LRVS[.
DEP"TB TO ]' ID
(
LAL
ctle 4 ---
Y
[
ELEVATION
stsTEA LC( ITION
( [
AGGREGATE 1ISa j" C7 0 7-; [
AQGRJOATA antissIvE FINES [
AOQRS0ATR TSPTR p Z 0) [
[
DOSING PUN !S
)
/ NXCAVATIC f TSRi1AI.
mots ots r / Z .
FILL TEiTC tE
T)
EXCAVATION DEP ANNA Mom MD
REPLACES ! IOITERIAL
]
3
1
NS / RE11 RK81
APPROVED OISAPPRAV>CD)I
[APPROVED WSAPP*OVISDj
D11 4• • , 10/97 (Previa s Rditio is ltaf Me Used)
OSTDS
1
1
3
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3
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PAGE. 04
M
PRA I°P NO.•0
DATA PAIDt MIDI
I1D t
R*C1uIPT /e d
BiTNAcEN
(27] SURFACE NAM ) ) t'
(24] DITCHES ,,y f
1291 PRIVA'TS WELLS
[301 PUBLIC =LLB
1311 IPAIGATION WELLS
(323 POTAELE NETER LINES 7A
[33] SuILDVAS FOUNDATION
(34] PROPERTY LINEA
[351 OT &
7G
e
PT
PT
7
PT
Tr
FT
PT
FT
FILLaD / MONAD SYSTEM =Amax= Am1FIRT D COMER
[37] MOULDERS
[381 SLOP= (39 j $TABILIAATIon
ADDITIONAL INFORMATION
[40] DNONSTRUCTED AMA
[41] 8TO1ti(QOSTER =Nor?
1421 AI.* Lffi
[43] NAIAZ'RMiCA ADRENAL=
(44 ] Du17.DI1Ri AREA
[45) LOCATION CONFORMS MITA *ITN PLAN 'y
[46) FINAL SITE
[47) COETRA
[44] mT sa
ABANDONMENT
(491 8'7110[ num _ELI) a' 2 3
(50] TA11>< mama= A FII.IaD
PT 1: Applicant
PT 2' 1nS10:IDNCnnhociar
PT 3: t AtInp Department
OT •l: 14,06 D4De■dm
•
DATE t t S ! a
DATED - J 'd
Page 2 of 3
06/12/2005 15:11 3 055133472
r
STATE OF It
DEPARTMENT
ONSITE SEW)
: CONSTRUCTIC •
APPLICANT: �]
AGENT: )I
PROPERTY
L'E'T t 2 BLOCK t
EXPLANATION
t ]
]
f ]
[ 1
DRAINFIELD INSTALLA
(10] AREA 11] _.._..-
1111 DISTRIBUTIOIN
[12) NUMBER OF DRA
(131 DRP,INLxNB SEP
1141 DRAINLINE SLC
(151 DEPTH OF COVE
(161 ELEVATION [Au
[17] SYSTEM LOCATI
.ORIDA
OP HEALTH
GE TREATMENT AND
INSPECTION AND
' A /
16f
ADDRESS: . - ; )
St 3DIVXS ION ;
CHECKED [X] ITEMS ARE NOT IN COMPLIANCE wITE STATUTE OR RTTLE AND MUST BE CORRECTED.
TANX INSTALLATION
[ ] (01) TAIGIC SIZE [11 /6410 [21
[ ] [02] TANK MATERIAL
[ ] [03] OUTLET DEVICS (;D ' e
[ ] [04] MULTI CHAMBER D [a-/ N ]
[ 1 [05 ] OUTLET FILTER � L
[ 3 (06) LEGEND �7"t
[ ] [071 WATERTIGHT
[ ] [08] LEVEL
[ 1 [091 DEPTH TO LID
DOSING PUMPS,
AGGREGATE'; SIZ
AGGREGATE EXC
AGGREGATE DEP
FILL / EXC•A.vATZON M tTERWAL
[22) FILL AMOUNT
[231 FILL TEXTURE
[24) EXCAVATION DE TII
(25) AREA REPLACE.'
[26] REPLACEMENT N !FERIA.
OF VIOLATIONS
,o N
[21 SQFT
DX _HEADER
NLINES
RATION
lVE /BEiL0W1 BM_
+1}7
,SS.TVE FINES
/ ERS :
CONSTRUCT/0 I /14R ] ;APPROVE : `-,L 1.
a
FINAL SYST 7 !APPROVE 'D1 ;APPROVEDI : Si
DH 4016, 10/97 \( evioue :ditions May Be Used)
ZRZ
HORES VILIT GE
G EPA• NT
BU 305 - 795 -2214 2C13
Building Inspecti Request
Date •
T Insp'
Permit No.
Name
Address
r
Company
Phone #
Inspection Date
Appr oved
Correction
R -Insp' n f
C f
'PERMIT NO.
DATE PAID:
DISPOSAL SYSTEM PEE PAID:
FINAL APPROVAL RECEIPT #:
OST DS
SETBACKS
[27]
[28]
(29)
[3!0]
152]
[33]
[ 341
[35]
12
1:73
[3.8)
[39]
[ ] [40]
[ 1 [41]
[. 1 1421
[ 3 [
r 1 (443
[ [45)
[ ] [
1 2 [47)
[ ] 1
[
[
PROPERTY ID
__ILI
+, • tom
PT 1: App!ICnnt
PT 2:1ns1allcdtontractar
PT 3: Rtlilrllrlp Oepartinen:
PT 4. H.- lth bnperrtmxra
PAGE a5
Y. — 3 •t 3l R-
/cf•_?_
SURFACE [ WATER F r
DITCHES FT
PRIVATE WELLS FT
PUBLIC WELLS FT
IRRIGATION WELLS FT
POTABLE WATER LINES ) FT
BUILDING FOUNDATION If FT
PROPERTY LINES FT
OTHER
FILLED / MOUND SYSTEM
DRAINFIELD COVER
SHOULDERS
SLOPES
STABILIZATION
ADDITIONAL INFORMATION
FT
UNOBSTRUCTED AREA
STORMWATER RUNOFF
ALARMS
MAINTENANCE AGREEMENT
BUILDING AREA
LOCATION CONFORMS WITH SIZE PLAN
FINAL SIZE GRDII3T
CONTRACTOR 1- 7 20 V 11 ,742 4
OTHER
ABANDONMENT
] [49 ] TANK PUMPED // .__,
] [50] TALC CRUSHED & FILLED
__V CIID DATE' : 'qf
CED DATE:
Page 2 of 3
MIAMI SHORES VILLAGE, i LA.
APPLICATION FOR SEPTIC TANK PERMIT
• DIVISION OF PLUMBINSNSPECTION
Date: -�:
I herewith submit the following applicAtidn for a.permit covering
the installation of a Septic Tan r
New:
Soakage Pit: Relaying:
Feet of drain tile:
Installed by: Address:
sue„ y
:
(NEW: Old( Story: // Addition: Remodeled:
For a (Store: Garage: Apt: Hotel: Office Bldg.
(Res: 4( Garage wash floor: taste water from a:
Building has: Stores; Offices; Apts; Hotel Rms;
Bedrums
Owner or Agent: ti .� ? = _. , 'Address: �2' �-
Lot No. ; Block No. / SUBDIVISION •r ��
Address of work: 4 ,' , . � / ` 7° . .s
N o. of g Plumbin ixtures: . Laundry Tubs: Floor Drains:
Nature of water supply: City: Well: Distant from all
wells: Type of tank installed: Tank capacity in
gallons: '�+;��"
Size of Soakage Pit: Purpose of same:
Additional information:
Ready for Inspection: Date:
APPROVED BY:
Remarks:
PERMIT NO.
ONDEMNEII BY:
Time:
Permit No ___ _-) _,_ __ C
Application 1 hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the build ng or other
structure herem 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 th Building Di ' snon
of Miami Shores Village shall be comphed 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_ Cathey Const .Co .
Registered Architect and /or Engineer _
Location and Legal Description Lot
Street and Number where work is to be perfoflned -No 976 N .E,. Al Ter 'jStreet
State work to be performed and purpose of building
New Building__.___- _____ _ _ - - -- - _.__ -- Remodeling -____. _._ .. __ - _ Addition__ X_ _ .__ __ -- ... . Repairs_
Size Septic Tank_._ _
Feet of Drain Tile
Nature of Water Supply. City-Well.
Amount of Permit $ _ 16.00
STATE OF FLORIDA,
COUNTY OF DADE.
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
Date _____ -.Dec -9.,_.1969 -
No. _ 545 ____ -_- Street_ . N K.. 122 S t
(Signed). .. -_hT
(signed)._
M.
Employing Plumber's Name __.Qualif Plumbing_ Co. , Inc._ No.. 1083 _ Street _
BIocTr= '_ ?.y Subdivision.
Type of Tank _ - --- _ -- - •• _ Capacity Gals.
__ _Dist. Feet of T a n k or Drain F i e l d f r o m W e l l . . . . . City __ _ Si 3 of Soakage Pit
... No. of Stories .
.
Pl, mb rig In:pecto.
The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations as an e nployer of labor
under the Florida Workmen's Compensation Act, being Section 5988, Compiled General Laws of Florida Permanent Supplement, ,n:l 1 as om
plied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors employed by hin 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 no ices as are
required by the Act. The undersigned agrees to employ only such sub contractors, on work to be perfo. ed under this per nit, as are
licensed by Miami Shores Village.
E. - - -23 Street - Hialeah
Master Plumber.
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgn ents, personall 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 .acts
therein by him stated are true.
My Commission Expires 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 notice for inspection, or faulty
materials and /or workmanship.
CLOSETS
BATH
TUBS
S
SHOWERS
LAVA.
TORIES
SINKS
SLOP
SINKS
LAUNDRY
TU88
URINALS
BASIN
FLOOR
DRAIN
DRINKING
FOU "T'N6
H H. W W.
lIPaf'e
1
TOTAL
F XTUREB
4
cONTR.
LIST
1
1
1
CHECK
SEPTIC
TANK
SEWER DRAIN
CONK. FIELD
SOAKAGE
PIT
GREASE
TRAP
SOLAR
HEATER
DEEP
WE_L
SPRKL'A.
SYSTEM
SW IM'G
POOL
CO NT .
IST
1 Con
zection
CHECK
Permit No ___ _-) _,_ __ C
Application 1 hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the build ng or other
structure herem 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 th Building Di ' snon
of Miami Shores Village shall be comphed 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_ Cathey Const .Co .
Registered Architect and /or Engineer _
Location and Legal Description Lot
Street and Number where work is to be perfoflned -No 976 N .E,. Al Ter 'jStreet
State work to be performed and purpose of building
New Building__.___- _____ _ _ - - -- - _.__ -- Remodeling -____. _._ .. __ - _ Addition__ X_ _ .__ __ -- ... . Repairs_
Size Septic Tank_._ _
Feet of Drain Tile
Nature of Water Supply. City-Well.
Amount of Permit $ _ 16.00
STATE OF FLORIDA,
COUNTY OF DADE.
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
Date _____ -.Dec -9.,_.1969 -
No. _ 545 ____ -_- Street_ . N K.. 122 S t
(Signed). .. -_hT
(signed)._
M.
Employing Plumber's Name __.Qualif Plumbing_ Co. , Inc._ No.. 1083 _ Street _
BIocTr= '_ ?.y Subdivision.
Type of Tank _ - --- _ -- - •• _ Capacity Gals.
__ _Dist. Feet of T a n k or Drain F i e l d f r o m W e l l . . . . . City __ _ Si 3 of Soakage Pit
... No. of Stories .
.
Pl, mb rig In:pecto.
The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations as an e nployer of labor
under the Florida Workmen's Compensation Act, being Section 5988, Compiled General Laws of Florida Permanent Supplement, ,n:l 1 as om
plied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors employed by hin 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 no ices as are
required by the Act. The undersigned agrees to employ only such sub contractors, on work to be perfo. ed under this per nit, as are
licensed by Miami Shores Village.
E. - - -23 Street - Hialeah
Master Plumber.
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgn ents, personall 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 .acts
therein by him stated are true.
My Commission Expires 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 notice for inspection, or faulty
materials and /or workmanship.
Permit No. ____ -_1
Amount of Permit $ LI ' &&
STATE OF FLORIDA,
COUNTY OF DADE.
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
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.
Owners Name and Address GU iI,fi'anz A'tivate4
Registered Architect and /or Engineer_____-__ � �_
Employing Plumber's Name 0 'Neat K.fock, & Septic Javzk Co. No./ 368 N. GU. 29th. street_
State work to be performed and purpose of building (By Floors) _ ______
New Building __ -______-_____- ____.____ -_- Addition
(Sign
92 S N. C. . 91 ge
3 Septembeic 1969
Date - - -- — - -- —
Location and Legal Description Lot Blodr Subdivision
Street and Number where work is to be performed —No 925 N. 9l �e�vca Street
Repairs No. of Stories . . ................ .
Size Septic Tank_ , 9_00 pt -------- - - - - -- -Type of Tank 1 Capacity Gals .__- 9QQ__ - fit.
Feet of Drain Tile_�__ __________ ^_Dist. Feet of Tank or Drain Field from Well
Nature of Water Supply: City— Well.______ ....... _— _________Size of Soakage Pit
(Signed)_ - - -Q
Plumbing ispector.
The undersigned applicant for this building permit does hereby certify that he understands and accepts his oblations 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 are
licensed by Miami Shores Village.
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.
My C E Notary Public, State of Florida
Master Plumber.
NOTE: A re- inspection fee of $1.00 will be made when such re- inspection is made•neeessary by improper notice for inspection, or faulty
materials and /or workmanship.
CLOSITS
BATH
TUBS
SHOWERS
LAVA.
TORIES
SINKS
SLOP
SINKS
LAUNDRY
TUBS
URINALS
CATCH
BASIN
FLOOR
DRAIN
DRINKING
FOUNT' NS
TOTAL
FIXTURES
CONTR.
LIST
CHICK
^-
SEPTIC
TANK
SEWER
CONN.
DRAIN
FIELD
SOAKAGE
PIT
GREASE
TRAP
SOLAR
HEATER
DEEP
WELL
SPRKLR.
SYSTEM
SWIM•G
POOL
CONTR.
LIST
CHECK
X
_
_
Permit No. ____ -_1
Amount of Permit $ LI ' &&
STATE OF FLORIDA,
COUNTY OF DADE.
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
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.
Owners Name and Address GU iI,fi'anz A'tivate4
Registered Architect and /or Engineer_____-__ � �_
Employing Plumber's Name 0 'Neat K.fock, & Septic Javzk Co. No./ 368 N. GU. 29th. street_
State work to be performed and purpose of building (By Floors) _ ______
New Building __ -______-_____- ____.____ -_- Addition
(Sign
92 S N. C. . 91 ge
3 Septembeic 1969
Date - - -- — - -- —
Location and Legal Description Lot Blodr Subdivision
Street and Number where work is to be performed —No 925 N. 9l �e�vca Street
Repairs No. of Stories . . ................ .
Size Septic Tank_ , 9_00 pt -------- - - - - -- -Type of Tank 1 Capacity Gals .__- 9QQ__ - fit.
Feet of Drain Tile_�__ __________ ^_Dist. Feet of Tank or Drain Field from Well
Nature of Water Supply: City— Well.______ ....... _— _________Size of Soakage Pit
(Signed)_ - - -Q
Plumbing ispector.
The undersigned applicant for this building permit does hereby certify that he understands and accepts his oblations 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 are
licensed by Miami Shores Village.
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.
My C E Notary Public, State of Florida
Master Plumber.
NOTE: A re- inspection fee of $1.00 will be made when such re- inspection is made•neeessary by improper notice for inspection, or faulty
materials and /or workmanship.
,
- 7 / r OWNER (�
LOT
BLOCK
SUBDIVISION
t � f �1t'�':�Lt
Y1 G
x
,
Date 1
Issued to
Received Payment by
cY Liam cJhores'9illage
F 1. 0 R 1 D A
PLUMBING PERMIT ■9 1133
to install the following described plumbing, in accordance with the laws, statutes and regu-
lations of Miami Shores Village, Florida and the State of Florida, governing plumbing and
drainage work done in Miami Shores Village, Florida.
For a_story building at
Fixtures
Fixtures $
Sewer $
Septic Tank f : $
Total $ ,f
Village Plumbing Inspector
OWNER
LOT
BLOCK
SUBDIVISION
_'
` _ .
/
d ate - j -
/
Issued to
For a_Lstory
Miami cShores9llage
F L O R D A
Total $
Village Plumbing Inspector
Received Payment by
PLUMBING PERMIT N9 1090
to install the following described plumbing, in accordance with the laws, statutes and regu-
lations of Miami Shores Village, Florida and the State of Florida, governing plumbing and
drainage work done in Miami Shores Village, Florida.
building at'
Fixtures
Fixtures
Sewer $
Septic Tank $