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PLUMBING PERMIT� Permit No. Q lr c Date � ' �/ c / ,Application is hereby made for the approval of the detailed statement of the: plans and specifications herewith sub itted for the building or other structure herein described. This application is made in compliance and conformity with the Bnilding Ordinance o 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 no.. A copy of approved plans and specifications must be kept at building during progress of wor ) Owner's Name and Address - ` -e ______ Registered Architect and /or En 'neer___ _______ - ___ Employing Plumber's Name - - - - -_ Location and Legal Description Lot_--_____ ..... __ ..... ____ Size Septic Tank Feet of Drain Tile Amount of Permit $ Nature of Water Supply: City —Well ss. MIAMI SHORES VIL1 G PLUMBING INSPECTION DEPARTMEI< APPLICATION FOR PLUMBING No. __- .. No . Street 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 Repairs e2 Type of Tank Capacity Gals / 0 Dist. Feet of Tank or Drain Field from Well Size of Soakage Pit (Signed) _ 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, ; work to be performed under this permit, as are licensed by Miami Shores Village. Street_ on No. of Stories STATE OF FLORIDA, t COUNTY OF DADE. Before me, the undersigned authority, a notary public, duly authorized to aMninister 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 hint stated are true. My Commission Expires Notary Public, State of Florida er Plumber. 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 SHOWERS LAVA- TORIES SINKS SLOP SINKS LAUNDRY TUBE URINAL S 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 SWIM'G POOL CONTR. LIST CHUCK � Permit No. Q lr c Date � ' �/ c / ,Application is hereby made for the approval of the detailed statement of the: plans and specifications herewith sub itted for the building or other structure herein described. This application is made in compliance and conformity with the Bnilding Ordinance o 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 no.. A copy of approved plans and specifications must be kept at building during progress of wor ) Owner's Name and Address - ` -e ______ Registered Architect and /or En 'neer___ _______ - ___ Employing Plumber's Name - - - - -_ Location and Legal Description Lot_--_____ ..... __ ..... ____ Size Septic Tank Feet of Drain Tile Amount of Permit $ Nature of Water Supply: City —Well ss. MIAMI SHORES VIL1 G PLUMBING INSPECTION DEPARTMEI< APPLICATION FOR PLUMBING No. __- .. No . Street 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 Repairs e2 Type of Tank Capacity Gals / 0 Dist. Feet of Tank or Drain Field from Well Size of Soakage Pit (Signed) _ 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, ; work to be performed under this permit, as are licensed by Miami Shores Village. Street_ on No. of Stories STATE OF FLORIDA, t COUNTY OF DADE. Before me, the undersigned authority, a notary public, duly authorized to aMninister 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 hint stated are true. My Commission Expires Notary Public, State of Florida er Plumber. 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. BUILDING ELECTRICAL PLUMBING ROOFING Owner of Building � 1 Architect Contractor or Builder Legal Lot Description Address of Building MIAMI SHORES VILLAGE. FLORIDA ❑ PERMIT T° 4286 Work to be performed under this Permit Bl. • d Subdi- vision Value of Project $ DATE Contractor's License No. d 2 Amount of Permit $ 195 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 Pennit 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 1s 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 cr in the statements or specifications and that he assumes responsibility 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 -, ertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In ac- = epting this permit I assume responsibility for all work done by either, myself, my agent, servant or employee. CONTRACTOR OR BUILDER BY AUTHORITY/ e Village of Miami Shores JOB ADDRESS INSPECTION .S 1/a sr/ _ l� -../ j?t� i TIME READY - g- / � REMARKS t . )( INSPECTOR 2 „TO - C . s $ �.�, -Y 4A N° 4912 DATE 7 ° / -31 PROPERTY OWNER New Construction Namgi ,II /_. /4A/6//i . Enclosure Address Zf C' ,v 91 3 t A : Shc -z<=J t om/ Home Telephone .44 _ .2 2 O. Business Telephone d — 4/77 _ . 7 Z Demolish Fax Relocation of Structure TYPE OF MANAGEMENT (✓ ) New Construction Enclosure Alteration Exterior Repair Alteration Interior Demolish Relocation of Structure Shell Only Foundation Only Add'l Attachment Other Add'I Detachment Other r - The following steps must be taken to obtain a permit from the 1%Iiami Shores Village: ' Step 1. Complete the attached permit application which must be signed by the property owner and qualifier. Both signatures must be notarized. Please print or type to allow for a more accurate processing of your application. If roofing work will be done, a roofing application must be submitted along with this permit application. Step 2. Submit the completed application with all necessary documents to the Building, Planning and Zoning Department for processing. During the processing of your application, you may be asked to submit additional information. APPLICATION Job Address: V-6 /UE" Address PERMIT TYPE (✓ ) Building Electrical Mechanical Plumbing LPGX Roofing Fence Other l/ Apt. Folio Number / /.2O ei O% j / 6 � U y Z a Description of Work % 7 E 19 ' ' 7 v/C Lot C e ' Block /VI( Subdivision G / / n. 7 r' l PB PG Zoning Linear Feet Current Use of Property Square Feet Units Floors Proposed Use of Property Value of Work `7r .-- (3 Bldg Value Tenant Information PERMIT CHANGE (✓ ) Chg. Contractor Renewal Revision Extension Supplement Reinspection ARCHITECT Name License No. Address Telephone Fax Master Permit No. Subsidiary Permit No. pfr ' ,=2 a • City State Zip Tax Assessed/Appraised Value PERMIT APPLICATION Flood Zone Base Floor Elev. ENGINEER Name License No. Address Telephone Fax CONTRACTOR Name License No. Address Telephone Fax Qualifier Name ' Page 2 IMPORTANT NOTICES 1. DO NOT BEGIN ANY WORK WITHOUT HAVING RECEIVED YOUR VALIDATED PERMIT AND PERMIT CARD. Applying for a permit does not grant the right to begin construction. HOURS OF CONSTRUCTION are limited to: Monday through Friday from 7:30 a.m. to 6:00 p.m., and Saturday from 8:00 a.m. to 5:00 p.m. No inspections will be conducted on weekends or holidays. 2. All construction of demolition areas MUST BE MAINTAINED IN A CLEAN, NEAT AND SANITARY CONDITION free from construction debris. 3. STREETS AND NEIGHBORING PROPERTIES SHALL BE KEPT FREE FROM DIRT AND DEBRIS. 4. SWALES MUST BE PROTECTED FROM BEING DAMAGED BY EQUIPMENT OR VEHICLES, AND MAY NOT BE USED FOR STORAGE. A bond is required for work in or near the street/sidewalk. 5. CONSTRUCTION TRAILERS ARE PROHIBITED ON SINGLE FAMILY RESIDENTIAL CONSTRUCTION SITES. Other construction may have a trailer which requires a separate permit. 6. PORTABLE TOILETS for a construction site require a separate permit. 7. DO NOT DISCHARGE WATER INTO THE RIGHT OF WAY OR STORM DRAINS without approval from the Building, Planning and Zoning Department. 8. EQUIPMENT AND MATERIALS SHALL BE STORED at least 10 feet from the edge of pavement. 9. Department of Health and Rehabilitative Services (HRS) approval is required for applications involving septic tanks. Department of Environmental Resources Management (DERM) and/or Miami -Dade Water and Sewer Department (MDWASD) approval is required for applications involving sewers. AFFIDAVIT - Please read carefully. Application is hereby made to obtain a permit to do work and installation as indicated. I, the OWNER of the property, 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, POOL, EXTERIOR DOOR, MECHANICAL, WINDOW, FENCE, DRIVEWAY, ROOFING and SIGNS and there may be additional permits required from other governmental agencies. I, the OWNER of the property, have disclosed all information related to any work at the property performed in the prior twelve months to the Building Official. Further, I am fully aware that if the cumulative cost of work to my home or business under this and any other permit equals or exceeds fifty percent (50 %) of the fair market value of the structure, the entire structure must meet the present federal flood criteria for finished floor elevation. I am also fully aware that if the total cost of work to my home or business under this and any other permit exceeds fifty percent (50 %) of the replacement cost of the structure, then the entire structure must conform to the current code requirements of the Building Code. WARNING TO OWNER: Your failure to record a NOTICE OF COMMENCEMENT may result in you paying twice for improvements to your property. If you are spending more than $2,500 or intend to obtain financing, you may wish to consult with your attorney or lender before recording your Notice of Commencement. The Notice of Commencement must be recorded at: 22 N.W. 1st Street, 1s' Floor, (305) 679 -1078. Once recorded, the Notice of Commencement must be POSTED AT THE JOB SITE in accordance with Section 713 -35 of Florida Statutes. Review the brochure at Village Hall on Construction Lien Law and Choosing a Contractor. STATE OF FLORIDA, COUNTY OF MIAMI -DADE STATE OF FLORIDA, COUNTY OF MIAMI -DADE Signature of Owner Signature of Contractor / Qualifier Print Name / v Print Name Sworn to and subscribed before me this I J day of , ate 4, 1 Ai Ignature 8 I SI . SEAL: - Sta of Florida PERMIT APPLICATION Sworn to and subscribed before me this day of Signature of Notary Public - State of Florida OFFICIAL PtOTAt •■ - ANGELA NI (e0.QitER ech wacaoN NNMBER CC7000Q My commioelQro exwAEs Personally known _- F 200_ Personally known OR, Produced Identification • v. 1a, SEAL: of identification Produced: ELECTRICAL TYPE Minimum Fee QTY. TYPE Dryer QTY TYPE Outlet, Appliance QTV TYPE Service Repair QTY. A/C Central 1 -3 Ton Fan Outlet, Wall Service, Temporary A/C Central 4 -7 Ton Fire Pump Outlet, Switch Signs A/C Central 8-15 Ton Fixture - Fluorescent Oven Space Heater (kw) A/C Central 16-20 Ton Fixture Light Parking Lot Lights Spas/Hot Tubs A/C Central 20+ Ton Flood Lights Plugmold/Strip Subfeeds, No. of Amps A/C Window FPL - Load Central Posts Swim Pool, Commercial Air Conditioners Garbage Disposal Range/Range Top Swim Pool, Residential Chiller Generators, etc. Receptacles Switchboards Clear Violations Heat Recovery Refrigerator, Comm. (p/PH) Temp Serv., Construction Compactor Low -volt, Burglar Refrigerator, Domestic ' Temp for Test - 30 days Deep Freezer Low -volt, Fire Renew - Temp Service Water Closet Demolition Low -volt, Intercom/Teleph. Repair Circuits Water Heater Dishwasher Low -volt, Television Service, Number of Amps Water Heater New MECHANICAL TYPE Minimum Fee QTY. TYPE Condensate Drain ()Ty. TYPE Generator QTV. TYPE Refrigeration, Tons QTY. A/C Central, Tons Cooling Tower Heating Strips, each Vent Hood, Cost A/C Wall/Win. Tons Dryer Vents, Number of Paint Booth Ventilation, Cost Air Handler, Tons Ductwork, Cost of Piping, Flammable Liquid Periodic Inspections Barbecue Fire Sprinkler System Process/Pressure Piping Supply, AC Well Bath Fan - Vented, # Fireplaces, Number of Pressure Vessel Temporary Toilet PLUMBING TY A/C Condensate QTY. TYPE Drains, Roof QTY. TYPE Miscellaneous Fixture QTY. 'FITE Soakage Pit QTY. Bath Tub Drinking Fountain Miscellaneous Repairs Solar Water Heater Bidet Filter Replace Pool Piping Sprinkler Repair Cap - Fixture Fountain Pump and Abandon Sprinkler System Cap - Water Gas - Appliance Pump, Domestic Supply, AC Well Cap - Sewer Gas - Natural Pump, Fire Stand Temporary Toilet Catch Basin Gas - Propane Pump, Re- circulate Temporary Water Closet Clothes Washer Gas Piping Pump, Replace - Pool Urinal Dental Chair Grease Trap Pump, Sprinkler Utility - Sewer Discharge Well Ice Maker Pump, Sump Utility - Water Dishwasher Indirect Wastes Relay Repair Vacuum Pump Disposal Interceptor Roof Inlet Water Closet Domestic Well Laundry Tray Septic Connection Water Heater Drainfield, 4" Tile/Res. Lavatory Septic Tank Water Heater New Drains, Area Meter Set (Gas) Sewer Connection Water Re -pipe Drains, Floor Minimum Fee Shower Water Service Drains, French Miscellaneous Equipment Sink Well, Supply Page 3 PERMIT APPLICATION INSTRUCTIONS: Please indicate the type of work being performed and quantity(ies) in the space provided below. RECEIVED AND REVIEWED BY: DATE: Page 4 OFFICE USE ONLY HECK LIST • OWNER - BUILDER FORM (Attach) ID FIRE DEPARTMENT APPROVAL (Commercial / multi- family) • CONCURRENCY (New Construction) D OTHER (Specify & Attach) $3.00 per page (Scanning Fee) Miami Shores Village Bond Inspector State Educational Fund State DCA (Radon) Code Enforcement Fine Zoning Review Metropolitan Dade County (C.C.F.) $ LI PROOF OF OWNERSHIP (Attach) • HRS / DERM APPROVAL (Septic / Sewer) • IMPACT FEE (New Construction) D OTHER (Specify & Attach) 'PERMIT FEES (sq.ft. = x/1000 x ¢.60) $ (¢.005 / sq.ft.) $ (¢.01 /sq.ft.) REVIEWED AND PREPARED BY: SECTION Zoning Electrical Mechanical Plumbing Fire Public Works Structural Building Official BY DATE 2 -O/ 3--r, PERMIT APPLICATION D CONDO ASSOCIATION APPROVAL (Attach) • BPR APPROVAL (Restaurants) CI CONTRACTOR REGISTRATION (On File) TOTAL $ g O r ISSUING OFFICIAL DATE: CONDITION OF APPROVAL Revised July 2001 10050 N.E. 2ND AVE., MIAMI SHORES, FL • (305) 795 -2207 • FAX (305) 756 -8972 • http : / /www.miamishoresvillage.com PERMIT APPLICATION FOR MIAMI SHORES VILLAGE ' Date r' cf 6 Job Address t 14a '1 /S+.. Legal Description Owner/Lessee / Tenant 140(,, DE. ( Master Permit # Owner's Address N ( . • 9 Contracting Co f n - R) pc,„4-pk ( :1 c_ Qualifie ( � l) �-(�( SS# State # Municipal # Architect/Engineer Bonding Company Mortgagor Permit Type (circle one): BUILDING ELECTRICAL WORK DESCRIPTION pg A, n ri i t� Signature of owner and/or Condo President Date FEES: PERMIT 3,5 RADON APPROVED: Zoning Mechanical otary as r• 0 • er and/or Condo President Date My Commission Expires: S'- 07 -q `k v w � t' ..r'v '•u'r'i: Nota _TAMMY J SACHS .. Pubik State of Florida :;› My Comm. Exp: 05/07/994 / / i1ii'‘ � ‘• Comm#: CC480555 $ M'I�MgN '.AAA Tax Folio Historically Designated: Yes No Address Competency # Address Address Address Signature o C.C.F. ( NOTARY Phone — 7 3 — g(.4 C r y c. >. a-7 4 .( 2f( Phone (c3 9 St t' PS' (Ft , ' CZ MECHANICAL ROOFING PAVING FENCE SIGN 4 ' :i Square Ft. Estimated Cost (value) 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 fo 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 laws regulating construction and zoning. Furthermore, I authorize the above -named contract • o do e work stated. Ins. Co. r or Owner- Builder 3 73 / TOTAL DUE ,J ( Date `?— 1 —Q (n Notary as to Victor or Owner - Builder Date My Commission Expires:." 01 -99 a;‘�tl1//' TAMMY J SACHS , 1 , zrz=St ate of Florida b �. My Comm. Exp: O5/O7/99: // Comm#: CC460555 Q NFRUCTION PERMIT FO ] New System [ xisting System } Repair [Abandonment Ci/tvQI PROPERTY STREET ADDRESS: [l, ire Err- LOT: PROPERTY - ID #: rU SPECIFICATIONS BY: STATE. OF FLORIDA DEPARTMENT OF HEALTH AND REHABILITATIVE * SERVICES . :ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PERMIT Authority: Chapter 381, FS & Chapter 10D -6, FAC BLOCK: SUBDIVISION: • SYSTEM MUST BE CONSTRUCTED 'IN - ACCORDANCE WITH SPECIFICATIONS AND'STANDARDS OF CHAPTER 10D -6, FAC REPAIR PERMITS AND HOLDING TANK PERMITS EXPIRE 90 DAYS FROM THE DATE OF ISSUE. ALL OTHER PERMITS EXPIRE ONE YEAR FROM THE DATE OF ISSUE.' HRS APPROVAL OF SYSTEM DOES NOT GUARANTEE SATISFACTORY PERFORMANCE FOR ANY SPECIFIC PERIOD OF TIME. 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. SYSTEM DESIGN AND SPECIE ATI.ONS T [ / 64) ] rLLONS GPD], ROBIC UNIT CAPACITY MULTI- CHAMBERED /IN SERIES:[ ] A [ ] [GALLONS / GPD] CAPACITY MULTI- CHAMBERED /IN SERIES:[ ] N [ ] GALLONS GREASE INTERCEPTOR CAPACITY [MAXIMUM'CAPACITY SINGLE TANK: 1250 GALLONS] K [ ] GALLONS PER DOSE DOSING TANK CAPACITY DOSE RATE [ ] PER 24 HRS NO. OF PUMPS: [ ] D (2..C)2)] • • a P • IMARY DRAINFIELD SYSTEM R [ ] SQUARE FEET SYSTEM A TYPE SYSTEM: [ ] STANDARD [ ] F LLED [ ] MOUND [ ] I CONFIGURATION: [ ] TRENCH [ . BED [ [ N F LOCATION OF BENCHMARK: I ELEVATION OF PROPOSED SYSTEM SITE [ ] [INCHES /FT] [ABOVE /BELOW] BENCHMARK /REFERENCE POINT ' E BOTTOM OF DRAINFIELD TO BE [ ] [INCHES /FT] [ABOVE /BELOW] BENCHMARK /REFERENCE POINT L D FILL REQUIRED: [ ] INCHES . EXCAVATION REQUIRED: [ ] INCHES INSTALL 12" OF LOAMY COARSE SAND o UNDER BOTTOM OF DRAINFIELD T 5U'tMIT E 1NC't-4 vIAM< H TgIS 1 .?. " l' FOR. ADDILi »T(S) E ]NV ._ T ELEVATION R BOTTOM OF DRAINFIELD ELEVATION CC , APPROVED BY: TITLE: DATE ISSUED: - r . 6 " HRS -H Form 4016, Mar 92.(Obsotetes previous editions which may not be used) (Stock Number: 5744 - 001 - 4016 PERMIT # DATE PAID FEE PAID $ RECEIPT '# 1 77 I diding Tank [ A)- emporary /Experimental Other(Specify) AGENT [ SECTION /TOWNSHIP /RANGE /PARCEL NUMBER] [OR TAX ID 'NUMBER] TITLE: APPLOCART EXPIRATION DATE: ?NE SEPTIC TAW SHALL DE PUMPED 4WD A SOLID DEFLECTI ®Ca DRICE INSTALLED Olt THE CUTLET TEE CPHU 7 c Page 1 of 2 INSTRUCTIONS: PERMIT NUMBER: Permit tracking number assigned by CPHU. APPLICATION FOR: Check type of permit, if °Other' specify type in blank. APPLICANT: Property owner's full name. TELEPHONE: Telephone number for applicant or agent. AGENT': Property owner's legally authorized representative. MAILING ADDRESS: P.O. box or street mailing address for applicant or agent. LOT, BLOCK, SUBDIVISION or PROPERTY ID#: 27 character id number for property. (CPHU may require property appraiser ID H or section/township /range /parcel number) SYSTEM DESIGN AND SPECIFICATIONS: TANK: Minimum specifications from Chapter 10D-6, FAC. DRAINFIELD: Minimum specifications from Chapter 1OD -6, FAC. OTHER: Other specifications, such as operating permit requirements, low - volume flush toilets, variance provisos. SPECIFICATIONS BY: Name of individual providing specifications. If designed by a registered engineer must be sealed. APPROVED BY: County Public Health Unit (CPHU) personnel reviewing and approving permit. DATE ISSUED: Date permit is issued by CPHU. EXPIRATION DATE: One year from date issued if the system has not been installed. Permits for system repairs become void 90 days from the date issued. Ewf coy N} 1 APPLICANT: LOT: gas PROPERTY ID #: STATE OF FLORIDA PERMIT 1 no2 D CO 63 DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES ,ONSITE SEWAGE DISPOSAL SYSTEM -A•SITE EVALUATION AND SYSTEM SPECIFICATIONS C� W �' 1 ( AGENT: PA-Pcn EcNVan-FFP BLOCK: SUBDIVISION: TO BE COMPLETED BY ENGINEER, HEALTH UNIT EMPLOYEE, OR OTHER QUALIFIED PERSON. ENGINEER'S MUST PROVIDE REGISTRATION NUMBER AND SIGN AND SEAL EACH PAGE OF SUBMITTAL. COMPLETE ALL ITEMS. PROPERTY SIZE CONFORMS TO SITE PLAN: [ TOTAL ESTIMATED SEWAGE FLOW: 1 -40...0 AUTHORIZED SEWAGE FLOW: L I aO UNOBSTRUCTED AREA AVAILABLE: � 01 C7 BENCHMARK /REFERENCE POINT LOCATION: ELEVATION OF PROPOSED SYSTEM SITE IS THE MINIMUM SETBACK SURFACE WATER: WELLS: PUBLIC: BUILDING FOUNDATIO SITE EVALUATED BY: SOIL PROFILE INFORMATION SITE 1 ] SITE SUBJECT TO FREQUENT FLOODING: , [ ] YES [ \ NO Depth () l to ex Mansell # /Color ture USDA SOIL SERIES: to to ` Q f to ! to to to a to to to HRS -H Form 4015, Mar 92 (Obsoletes pre ous . � r which y tOt be used) (Stock Number: 5744 - 003 - 4015 -1) [Section /Township /Range /Parcel No. or Tax ID Number] YES [ ] NO NET USABLE AREA AVAILABLE: ACRES GALLONS PER DAY [RESIDENCES -TABLE 1 / OTHER -TABLE 2] GALLONS PER DAY [1500 GPD /ACRE OR 2508 GPD /ACRE] SQFT UNOBSTRUCTED AREA REQUIRED: C) SQFT [INCHES /rFT] [ABOVE /BELOW] BENCHMARK /REFERENCE POINT 1 s ICH CAN BE MAINTAINED FROM THE PR P SED SYSTEM TO THE FOLLOWING FEATURE : FT DITCHE /SW S: FTMALLY WET? [ ] YES, NO FT LIMITED USE: FT PR VATE: FT NON - POTABLE: FT FT (O FT PROPER Y LINES: 15 'FT.. POTABLE WATER LINES: 10 YEAR FLOODING? [ ]_ YES [ NO 10 YEAR FLOOD ELEVATION FOR SITE: FT MSL /NGVD SITE ELEVATION: A FT MSL /NGVD SOIL PROFILE INFORMATION SITE 2 OBSERVED WATER TABLE: TINCHES [ABOVE / BELO EXISTING GRADE. TYPE: [PERCHED / APPARENT] ESTIMATED WET SEASON WATE TABLE ELEVATION: (q INCHES [ ABOVE BELOW ] EXISTING GRADE. HIGH WATER TABLE VEGETATION: ( ] YES [ NO MOTTLING: [ ] YES 4[�NO DEPTH: INCHES SOIL TEXTURE /LOADING RATE FOR SYSTEM SIZING: d "` T ' D P4 OF EXC 6IO '" INCHES DRAINFIELD CONFIGURATION: [ ] TRENCH [ <J BT/4[ ] QTHSR�(SP CIFY) 4:: s /' REMARKS /ADDITIONAL CRITERIA: -// �.. Munsell # /Color Texture ur ►�► - 1111=111 USDA SOIL SERIES: Depth to to to to to to to to to d-L `( DATE: 3- 9' 6 Page .3 of 3 :NSTRUC,°TIONS: ?ERMIT h: Permit tracking number assigned by CP} U. APPLICANT: Property owner's full name. j C ENT: Property owner's legally authorized representative. LOT, BLOCK, SUBDIVISION: Lot, block, and subdivision for lot. PROPERTY 1D1l: 27 character number for property. (proper y appraiser ID 0 or section/township /range /parcel number) PROPERTY SIZE: Check if property size at site conforms to submitted site plan. Record net usable area available - lot area exclusive of all paved areas and prepared road beds within publ :c rights-of-way or easements and exclusive of streams, taker, normally wet drainage ditches, marshes, or other such bodies of water. SEWAGE FLOW: UNOBSTRUCTED AREA: MINIMUM SETBACKS: Record the estimated sewage flow for the establishment from Table 1 (residences) or Table 2 (non- residential), Chapter 1OD -6, FAC. Record the authorized Devi 1,�e flow for the tot based on net usable area and water supply (1503 gallons per day per acre for private water supplis .lnd 2500 god per acre for public water supplies). If authorized aewcge flow does not equal or exceed the estimated aewsge flow, the application must be denied. Record the square feet of unobstructed ores available and the amount required. Unobstructed area must be ct least 2 times as large as the drainfield absorption area and ct least 75 percent of the unobstructed area must meet minimum setbacks in Chapter 10D -6, FAC. The unobst.ucted area must be contiguous to the drainfield. BENCHMARK INFORMATION: Record the location of the benchmark. If using a surveyor's benchmark record the actual elevation. Record the elevation of the proposed system site in relation (above or below) to the benchmark. Record minimum setbacks which can be meet to all listed features. Actual measurements must be recorded or "NA" for non applicable features. Features on site plan or within 75 feet of the applicant lot must be measured. The location of any public thinking well within 200 feet of the applicant's lot must also be verified. FLOOD INFORMATION: Record information on lot's subject to flooding. For lots subject to flooding record 10 year flood elevation for site and actual site elevation. SOIL PROFILE INFORMATION: Two soil profiles within the proposed absorption area to a minimum depth of 6 feet or refusal are required. Soil identification will use USDA Soil Classification methodology (Munsell colors and USDA soil textures). Refusals must be clearly documented. Provide USDA soil series if available, record "UNK" if the series cannot be determined. WATER TABLE: Record the depth of the observed water table at the time of the evaluation. Mark "perched" or "apparent" as appropriate. Record the estimated wet season water table elevation based on site evaluation, USDA soil maps, and historical information. Indicate if there is high water table vegetation present. Indicate if mottling is present and depth. SOIL TEXTURE: Record soil texture or loading rate for system sizing. DEPTH OF EXCAVATION: If applicable record depth of excavation required. Record "NA" if not applicable. DRAINFIELD CONFIGURATION: Check drainfield configuration required. If other, specify type. ADDITIONAL CRITERIA: Record any additional remarks pertinent to Site or installation. Ex. dosing required. SITE EVALUATED 3Y: Signature of evaluator, title, and date of evaluation. Professional engineers must seal all documentation submitted. ELEVATION WORKSHEET ELEVATION OF BENCHMARK / REFERENCE POINT IS: BENCHMARK SITE 1 SINE 2 SITE 3 [ -] SABOT: H.1. H.'. H.1. H.1. [ -1 SHOT [ -1 SHOT [ -J SHOT Scale: 3O MT, 9( S�-. STATE OF FLORIDA DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PERMIT 0 6 k5 Each block represents 5 feet and 1 inch = 50 feet. 'g- - �- - i� mwmAm ' - imCa Cm f mCm�mm.C1111111 ICC CC Mi ■CiCC 1 CCCCCCC� i mmu ■.. .. ■■. ■C C ■■■■■ ■.. ■.II■■■ C . ■■■ ■ ■ ...u.uu.. '... ■ .... i h ......U.UIU........... .. ■ . ■. . ■. j. ■. ... ■. . .. CCCCCC CCCCC�.I ■ ■■■■ . 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Site Plan submitted by: Plan Approved C/ By ALL CHAN HRS -H Form 4015, Feb 85 (Obsofetes previous editions which may not be used) (Stock Number. 5744- 002- 4015 -6) PART II - SITE PLAN SIGNATURE ayri Permit Application Number Not Approved / ),, < TITLE Date ea County Public Unit UST BE APPROVED BY THE COUNTY PUBLIC HEALTH UNIT Page 2 of 3 APPLICATION FOR: [N] New System [N] Existing System [N([ Repair (NJ Abandonment APPLICANT: AGENT: . MAILING ADDRESS: LOT: BLOCK: SUBDIVISION: PROPERTY ID #: PROPERTY SIZE: ACRES [Sqft/43560] PROPERTY STREET ADDRESS: 757 DIRECTIONS TO PROPERTY: BUILDING INFORMATION Unit Type of No. of No Establishment Bedrooms 1 S .V- . (-2 Goo 2 3 " 4 STATE OF FLORIDA DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES ONSITE SEWAGE DISPOSAL SYSTEM APPLICATION FOR CONSTRUCTION PERMIT Authority: Chapter 381, FS & Chapter 10D -6, FAC [4] Garbage Grinders /Disposals [N] Spa& /Hot Tubs [WI Ultra -low Volume Flush Toiets APPLICANT'S SIGNATURE: 4 3L35 /Y/r126/924 ( X ] RESIDENTIAL ( ] COMMERCIAL 2 - •PP C, HRS -H Form 4015, Mar 92 (Obsoletes previous editions which may not be used) (Stock Number: 5744 - 001 - 4015-1) TELEPHONE: L3W 3 PERMIT # DATE PAID FEE PAID $ RECEIPT # 77 7,? Holding Tank [4] Temporary /Experimental [ [Ni(? �] Other(Specify) )9 YN -M6 DATE OF SUBDIVISION: — [Section /Township /Range /Parcel No.] ZONING: DATE: 3 — Lj Building # Persons Business Activity Area Sqft Served For Commercial Only TO BE COMPLETED BY APPLICANT OR APPLICANT'S AUTHORIZED AGENT. ATTACH BUILDING PLAN AND TO -SCALE SITE PLAN SHOWING PERTINENT FEATURES REQUIRED BY CHAPTER 10D -6, FLORIDA ADMINISTRATIVE CODE. PROPERTY INFORMATION [IF LOT'IS NOT IN A RECORDED SUBDIVISION, ATTACIPLEGAL DESCRIPTION OR DEED] PROPERTY WATER SUPPLY: [ ] PRIVATE Is PUBLIC [J Floor /Equipment" Drains [ Mh Othhr (Specify) Page 1 of 3 INSTRUCTIONS: APPLICATION FOR: Check type of permit, if "Other" specify type in blank. APPLICANT: Property owner's full name. TELEPHONE: Telephone number for applicant or agent. AGENT: Property owner's legally authorized representative. MAILING ADDRESS: P.O. box or street, city, state and zip code mailing address for applicant or agent. LOT, BLOCK, SUBDIVISION: PROPERTY SIZE: Lot, block, and subdivision for lot (recorded or unrecorded subdivision). If lot is not in a recorded subdivision, a copy of the lot legal description or deed must be attached. DATE OF SUBDIVISION: Official date of subdivision recorded in county plat books (month /day /year) or date lot originally recorded. Dividing an approved lot into two or more parcels for the purpose of conveying ownership shall be considered a subdivision of the lot. PROPERTY IDN: 27 character number for property. (CPHU may require property appraiser ID 11 or section/township /range /parcel number. Net usable area of property in acres (square footage divided by 43,560 square feet) exclusive of all paved areas and prepared road beds within public rights -of way or easements and exclusive of streams, lakes, normally wet drainage ditches, marches, or other such bodies of water. Contiguous unpaved and noncompacted road rights -of -way and easements with no subsurface obstructions may be included in calculating lot area. WATER SUPPLY: Check private or public. PROPERTY ADDRESS: Street address for property. For lots without an assigned street address, indicate street or road and locale in county. DIRECTIONS: Provide detailed instructions to lot or attach an area map showing lot location. BUILDING INFORMATION: Check residential or commercial. TYPE ESTABLISHMENT: List type of establishment from Table II, Chapter 1OD-6, FAC. Examples: single family, single wide mobile home, restaurant, doctor's office. NO. BEDROOMS: Count all rooms designed primarily for sleeping and those areas expected to routinely provide sleeping accommodations for occupants. BUILDING AREA: Total square footage of enclosed habitable area of dwelling unit, excluding garage, carport, exterior storage shed, or open or fully screened patios or decks. Based on outside measurements for each story of structure. 1l PERSONS: Number of persons residing, using, or working in establishment. For residential establishment, 2 persons per bedroom are assumed. BUSINESS ACTIVITY: For commercial applications only. List number of employees, shifts, and hours of operation, or othet information required by Table II, Chapter 1OD -6, FAC. FIXTURES: Mark each listed fixture with number installed or "NA" if not applicable. SIGNATURE: Signature of applicant or agent. Date application one day submined to the CPHU with appropriate fees and attachments. ATTACHMENTS: A site plan drawn to scale, showing boundaries with dimensions, locations of residences or buildings, swimming pools, recorded easements, onsite sewage disposal system components and location, slope of property, any existing or proposed wells, drainage features, filled areas, obstructed areas, and surface water. Location of wells, onsite sewage disposal systems, surface waters, and rt other pertinent facilities or features on adjacent property, if the features are with 75 feet of the applicant lot. Location of any public well within 200 feet of lot. For residences, a floor plan (residences) showing number of bedrooms and building area of each unit. For nonresidential establishments, a floor plan showing the square footage of the establishment, all plumbing drains and fixture types, and other features necessary to determine composition and quantity of wastewater. Permit No ) �. 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 conforxrity 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 AA Registered Architect and /or Engineer Employing Plumber's Name_ H ' ' ± S P a '_ N /r /e No• - - - -- a-.... 4/1 Street__ 6 y Location and Legal Description Lot_ Block_____ _ . Subdivision Street and Number where work is to be performed —No._ , o �✓ Street 9 p State work to be performed and purpose of building (By Floors)_____ -- _/Y s r_f_a // / /f g s l k i /v /re. k 'S /SfeAM New Building Remodeling Size Septic Tank Type of Tank Capacity Gals Feet of Drain Tile _____Dist. Feet of Tank or Drain Field from Well Nature of Water Supply: City —Well 2 " e — __ __Size of Soakage Pit 3 S e G o NS ,3 o Amount of Permit $ ABAMI SHORES VII"lAGZ PLUMBING INSPECTION DEPARTME APPLICATION FOR PLUMBING N' c C Gl 7 e o 6/ Addition____ Repairs No. of Stories . . .............. ....... e, g'o LIZ? - - - - -- - -- - - - -- - -- ( signed)_ (Signed)_ J' Date _._. - - No 0 5`•6 - Street - - -- G ' bing Inspe .r. 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 Pertnanent Supplement, and bus 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. 01-00 /r' S S /� d i W /r / e h co. STATE OF FLORIDA, COUNTY OF DADE. 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 Commission Expires Notary Public, State of Florida Master Plumber. 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 SFInWERB LAVA TORIES SINKS SLOP SINKS LAUNDRY TUBE URIN URINALS CATCH BASIN FLOOR DRAIN DRINKING FOUNT' NS TOTAL FIXTURES CONTR. LIST CHQCK SEPTIC TANK SEWER CONN. DRAIN FIELD SOAKAGE PIT GREASE TRAP SOLAR HEATER DEEP WELL SPRKLR. SYSTEM SWIM'G POOL CONTR. LILT �o A e. ds , CHECK Permit No ) �. 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 conforxrity 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 AA Registered Architect and /or Engineer Employing Plumber's Name_ H ' ' ± S P a '_ N /r /e No• - - - -- a-.... 4/1 Street__ 6 y Location and Legal Description Lot_ Block_____ _ . Subdivision Street and Number where work is to be performed —No._ , o �✓ Street 9 p State work to be performed and purpose of building (By Floors)_____ -- _/Y s r_f_a // / /f g s l k i /v /re. k 'S /SfeAM New Building Remodeling Size Septic Tank Type of Tank Capacity Gals Feet of Drain Tile _____Dist. Feet of Tank or Drain Field from Well Nature of Water Supply: City —Well 2 " e — __ __Size of Soakage Pit 3 S e G o NS ,3 o Amount of Permit $ ABAMI SHORES VII"lAGZ PLUMBING INSPECTION DEPARTME APPLICATION FOR PLUMBING N' c C Gl 7 e o 6/ Addition____ Repairs No. of Stories . . .............. ....... e, g'o LIZ? - - - - -- - -- - - - -- - -- ( signed)_ (Signed)_ J' Date _._. - - No 0 5`•6 - Street - - -- G ' bing Inspe .r. 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 Pertnanent Supplement, and bus 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. 01-00 /r' S S /� d i W /r / e h co. STATE OF FLORIDA, COUNTY OF DADE. 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 Commission Expires Notary Public, State of Florida Master Plumber. 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 MIAMI SHORES VILLAG PLUMBING INSPECTION DEPARTMEL' : APPLICATION FOR PLUMBING ,MIT (Signed)-- ___ STATE OF FLORIDA, } ss. COUNTY OF DADE. 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 confor.riiy 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___.%, i-- 2�U4�A- '_^''� No Registered Architect and /or Engineer ..... -__--_--____- -- -- --- ---_---- --- -- ^ -- —7 Employing Plumber's Name _ �"'� _ No.' �° 4/14-i 7Stiget Location and Legal Description Lot _._____________________ —_____ �— Block__ — _ Subdivision Street and Number where work is to be performed— No.b — _._..... Street State work to be performed and purpose of building (By Floors) New Building Remodeling ___ Addition.___ Repairs No. of Stories. Street_ Size Septic Tank Type of Tank Capacity Gals. Feet of Drain Tile __Dist. Feet of Tank or Drain Field from Well �( Nature of Water Supply: City Size of Soakage Pit Amount of Permit $ e -- - - - - -- - -- - - - -- — - -- ( Signed) 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 coin - 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 die 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. Date / S S'" 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 Commission Expires Notary Public, State of Florida Ma4ter Plumber. 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 OWERS SHOWERS LAVA- TORIES SINKS SLOP SINKS LAUNDRY um URINALS CATCH BASIN FLOOR DRAIN DRINKING FOUNT' N8 TOTAL FIXTURES CONTR. LIST CHECK SEPTIC TANK SEWER CONN. DRAIN FIELD SOAKAGE PIT GREASE TRAP SOLAR HEATER DEEP WELL SPRKLR. SYSTEM SW IN'G POOL CONTR. LIST CHECK _ -'.- /\ Permit No MIAMI SHORES VILLAG PLUMBING INSPECTION DEPARTMEL' : APPLICATION FOR PLUMBING ,MIT (Signed)-- ___ STATE OF FLORIDA, } ss. COUNTY OF DADE. 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 confor.riiy 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___.%, i-- 2�U4�A- '_^''� No Registered Architect and /or Engineer ..... -__--_--____- -- -- --- ---_---- --- -- ^ -- —7 Employing Plumber's Name _ �"'� _ No.' �° 4/14-i 7Stiget Location and Legal Description Lot _._____________________ —_____ �— Block__ — _ Subdivision Street and Number where work is to be performed— No.b — _._..... Street State work to be performed and purpose of building (By Floors) New Building Remodeling ___ Addition.___ Repairs No. of Stories. Street_ Size Septic Tank Type of Tank Capacity Gals. Feet of Drain Tile __Dist. Feet of Tank or Drain Field from Well �( Nature of Water Supply: City Size of Soakage Pit Amount of Permit $ e -- - - - - -- - -- - - - -- — - -- ( Signed) 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 coin - 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 die 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. Date / S S'" 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 Commission Expires Notary Public, State of Florida Ma4ter Plumber. 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. Y Z ° 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 confor,:nity 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 net. A copy of approved plans and specifications must be kept at building during progress of work. c. m � T L „ Owner's Name and Address._ _PE /l/ ( / j -S Registered Architect and /or Engineer _- _________ }� Employing Plumber's Name P Ne_S __.1 -L_ ,113l A No .. Street__ G Location and Legal Description Lot______ 6 ? -__7 Block____ --3 ___ Subdivision _S Street and Number where work is to be performed—No._ .• - 5-6 /ll _.9 / ''''' Street State work to be performed and purpose of building (By Floors ) _ New Building I Remodeling MIAMI SHORES VILLAGE' PLUMBING INSPECTION DEPARTMEi'.' APPLICATION FOR PLUMBING ..'' ;r,AAIT No.... _ L ° Street_ Pi . 6 . S / S= ri S Addition_____.__.______________ Repairs No. of Stories Size Septic Tank Type of Tank_ Capacity Gals. Feet of Drain Tile _____Dist. Feet of Tank or Drain Field from Well Nature of Water Supply Well Size of Soakage Pit Amount of Permit $ Plurli Bing 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 are licensed by Miami Shores Village. / STATE OF FLORIDA, COUNTY OF DADE. 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 Commission Expires (Sid)- ( Signed) - = Master Plumber. 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 SHOWERS LAVA- TORIES SINKS SINKS LAUNDRY TUBS URINALS URL CATCH BASIN FLOOR DRAIN DRINKING FOUNT' NS TOTAL FIXTURES CONTR. LIST ( 3 / / CHECK SEPTIC TANK SEWER CONN. DRAIN FIELD SOAKAGE PIT GREASE TRAP S HEATER DEEP WELL SPRKLR. SYSTEM SW IM' G POOL b/5 ) 4_. u � K. CONTR. 1.151 --Z-- / / / - -_- _ CHECK Permit No. Y Z ° 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 confor,:nity 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 net. A copy of approved plans and specifications must be kept at building during progress of work. c. m � T L „ Owner's Name and Address._ _PE /l/ ( / j -S Registered Architect and /or Engineer _- _________ }� Employing Plumber's Name P Ne_S __.1 -L_ ,113l A No .. Street__ G Location and Legal Description Lot______ 6 ? -__7 Block____ --3 ___ Subdivision _S Street and Number where work is to be performed—No._ .• - 5-6 /ll _.9 / ''''' Street State work to be performed and purpose of building (By Floors ) _ New Building I Remodeling MIAMI SHORES VILLAGE' PLUMBING INSPECTION DEPARTMEi'.' APPLICATION FOR PLUMBING ..'' ;r,AAIT No.... _ L ° Street_ Pi . 6 . S / S= ri S Addition_____.__.______________ Repairs No. of Stories Size Septic Tank Type of Tank_ Capacity Gals. Feet of Drain Tile _____Dist. Feet of Tank or Drain Field from Well Nature of Water Supply Well Size of Soakage Pit Amount of Permit $ Plurli Bing 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 are licensed by Miami Shores Village. / STATE OF FLORIDA, COUNTY OF DADE. 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 Commission Expires (Sid)- ( Signed) - = Master Plumber. 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. i i I ry Lod. BUILDING ELECTRICAL PLUMBING ROOFING Owner of '. Building Architect Contractor or Builder Legal Description Address of Building MIAMI SHORES VILLAGE. FLORIDA 0 ❑ DA PERMIT N° 4200 is 4'7 Lot CONTRACTOR OR BUILDER Work to be performed under this Permit Bl. This permit is granted to the contractor or builder named above to construc 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. , ;; / r Signed. _ BY INSPECTOR /j 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 ac- cepting this permit I assume responsibility for all work done by either, myself, my agent, servant or employee. Value of Project $ Contractor's License No. '`-, 195 Subdi- vision Amount of Permit $ BY AUTHORITY BUILDING ELECTRICAL PLUMBING ROOFING Owner of Building Architect Contractor • y or Builder Legal Description Address of Building Lot MIAMI SHORES VILLAGE. FLORIDA PERMIT N° 4676 wr Work to be performed under this Permit B1 Value of Project $ Subdi- vision C„ 4, Contractor's License No DATF f d' Amount of Permit $ 4 195'L This permit is granted to the contractor or builder named above to construc 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 ff 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. .0 is Signed' 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 pertaining hereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In ac- ceptin9llthhis permit a assume respo ability for all work done by either, myself, my agent, servant or employee. CONTR%CFOR:OR.BUILDER,,,_ , , BY AUTHORITY e Village of Miami Shores JOB /-cb ADDRESS C 1 � INSPECTION INSPECTOR N° 4641 TIME READY e :24 / 3/3 ? ° 2 7` 5 REMARKS (9t t , DATE 7 ° f 7 -_ Village of Miami Shores JOB h n �, g rk n� ° S l/�lZ r �r�? ADDRESS '$ c • Fl f $2. V_ INSPECTION ' 6 p _ . n A a 9 Pc .n.. pa . TIME READY AJ Z • REMARKS N? 4826 INSPECTOR DATE V Z—; — S7