PLUMBING PERMITDate
Type Insp'n
Permit No.
Name
Address C9
Company
Phone #
For Inspector:
Approved
Correction
Re- Insp'n Fee
MIAMI SHORES VILLAGE
BUILDING DEPARTMENT
305- 795 -2204
Building Inspection Request
Time
Ai' I ' m • •
ai
PAY
TO THE
ORDER OF
FOR
Miami Shores Village
10050 NE 2nd Avenue
Phone: 305 - 795 -2204 Permit Number: PL2002 -345
Printed: 12 /19/2002
Applicant: NICKOLAS
Owner: BERRY
JOB ADDRESS: 295 NE 91
Contractor BOBS SEPTIC & DRAIN INC
Local Phone: 305 - 558 -5818
Parcel # 1132060133470
Fees: Description Amount
FEE2002 -7286 Buildier's Bond $300.00
FEE2002 -7287 Building Fee $80.00
FEE2002 -7288 Notary Fee $5.00
FEE2002 -7289 CCF $1.20
Total Fees: $386.20
Total Fees: $386.20
Total Receipts: $0.00
Permit Status: Approved Permit Expiration: 6/17/2003 Construction Value: $2,500.00
Work: 300 SQUARE FT DRAINFIELD
BOB'S SEPTIC & DRAIN, INC.
1020 NE 130TH ST. PH. 305 -558 -58
NORTH MIAMI, FL 33161 -4211
6COOL.) 1--1/114) cgliOt
c tibank'
CITIBANK, F.S.B. BR 137
2750 AVENTURA BOULEVARD
AVENTURA, 3318
Legal Description: MIAMI SHORES SEC 1 AMD PB 10 -70 LOTS 22 & 23 BLK 25 LOT SIZE
Plumbing Permit
BERRY
NICKOLAS
ST
Contractor's Address: 1020 NE 130 ST
DATE
0005474 I: 266086554 : 2 /0 270 69
63-865537
2660
$ 7 70 2 .
DOLLARS l
5474
Page 1 of 1
-inspection
:ion herefor in strict compliance with all
3tions that may have been submitted to
• if the plans are changed without
sibility for a thorough knowledge of the
t he assumes responsibility for work done
Pertaining thereto and in strict conformity
)onisibility for all work done by either
0
T
E
R
12.
SPECIFICATIONS BY:
x/2002 13:28 3055133472
sT,ATE CF FLORIDA
DEPARTMENT OF HEALTH
ONSITE SEWAGE DISPOSAL SYSTEM
0 CONSTRUCTION PERMIT
Authority: Chapter 381, PS & Chapter 10D -6,
CONSTRUCTION PERMIT FOR:
[ K] New System If Existing System
( i) Repair (r') Abandonment
APPLICANT:
•
• YRQ1 • +I I'Rf`L+'T ADDRESS: ) r7 i(-) r I •
7 Ni a :., '
[.oT O K
> 7 .1•, BL• • •
• • c � 4 ....-3 • Z 7 SUBDIVISION! _
•••••• • • •�t�_� ' /4 till ,� L'/ U }"'t'..� :: or. I
4 • 4ERTY . ,i • . ..
• • ' • • - - 0/ ' 0;3 - ? Q J SECTIomnowNS$IP /RANGE /PARC NUMBER
••••• [OR TAY ID NUMBER )
• • --- i..44 •"..t • ... :.3*YS4EM MLA'sT gE CONS tJCTED IN ACCORDANCE WITH SPECIFICATIONS AND STANDARDS OF CHAPTER 10D -6,
=ero -= G an= ==c =m=, =c
•• ..
AC7 REPAIR PERMIeTV, HOLDING TANK PERMITS EXPIRE 90 DAYS FROM THE DATE OF ISSUE. ALL OTHER
.
• �'ERMITS 616I14 ONt'4j FROM THE DATE OF ISSUE. DEPARTMENT OF HEALTH APPROVAL OF SYSTEM DOSS
• :DlGi.rUARANTEE SATtS^&A'CTORY PERFORMANCE FOR ANY SPECIFIC PERIOD OF TIME, ANY CHANGE IN MATERIAL
FACTS • k•9ERVED • AS A 3A813 FOR ISSUANCE OF THIS PERMIT REQUIRE
PERMIT APPLICATION. SUCH MODIFICATIONS Q THE APPLICANT MODIFY THE
ATIONS MAY RESULT TN THIS PERMIT BEING MADE NULL AND VOID.
SYSTEM DESIGN AND SPECIFICATIONS
T 1 =y 3 0 ) (GALLONS / GPI)) SEPTIC TANK /AERO$IC UNIT CAPACITY
A I J (GALLONS / GPD) MULTI-CHAMBERED /IN SERIS9t( )
N ( 1 GALLONS GREASE INTERCEPTOR CAPACITY CAPACITY MULTI- CHAMBERED /IN SERIES :( )
K ( �'--' ) GALLONg PER DOSE DOSING TANK CAPACITY (MAXIMUM
DOSE - RATE ( J PER APA J P 24 HIS NOo. . E SINGLE TA NO. 1250 GALLONS) OF PUMP9t ( )
D [ J i)) SQUARE FEET PRIMARY DRAINFZELD SYSTEM
R ( J SQUARE FEET
A TYPE SYSTEM: SYSTEM
I CONFIGURATION: ( A STANDARD ( ). FILLED [ J MOUND
N ( ) TRENCH ('- ) BED ( J
F LOCATION OF BENCHMARK: • I ELEVATION OF PROPOSED SYSTEM $ITE (3/, ZOI (INCHES. FT
E BOTTOM OF DRAlNFIELD TO BE ( C 7 ( 7 "--- ^ / ) (ABOVE BE,LOWj 8ENC81U►R!( /R_ �FER P OINT
L , 0 ) (1NCHZA/F -) (ABOVE/BELOW) BBNCBMAru /REFERENCE POINT_
D FILL REQUIRED: (,rJ,)' C)) INCHES EXCAVATION REQUIRED; ( 4- J INCHES
Z''
ON 4U14. 1 O;G8 (R.pue.0 NRl.M Form 0019 (pap. 11 whlcn i sy be used)
:9roek N\meee 6744•001- 4019 -0)
REPAIR
(J` Holding Tank
( r " otber(specify)
Applicant
PAC
PERMIT /
DATE PAID
FEE PAID $
RECEIPT #
J T emporary /Experimental
AGENT! / r i /
(
1
FAGE 83.
_r z - 17-72
- 7 cry
3 rJ v
^ _ `,
a --- -sat = —e
Page 1 of 2
TITLE
cxD
EXPIRATION DATE :3 — ,3
FLORIDA mr.Ea
1111 ..s„„.shinc
VILVA
.")'■ NI'
M I A M I
- 11 1999
CLASS: E
, SAFE DRIVE ::.•■;" - 17 - 996
000
1993
,I11111 I r ,y1i1 11 xv w
• e ' \ ,)
S099607 88
;UILDING
LECTRICAL
'LUMBING
)wner of
luilding
architect
: ontractor
•r Builder
•egal Lot
)escription
CONTRACTOR OR BUILDER
MIAMI SHORES VILLAGE, FLORIDA
PERMIT N° 5616
Work to be performed under this Permit
f
Bl•
e "
iddress of a „ '� Value of Amt. of , v ti
" Permit • , L., / Project Pe '�1
: uilding a L.,:
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-
ation herefor in strict compliance with all ordinances pertaining thereto and with the understanding that the work wil 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
t 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 d, swings or in the statements or specification a nd that he assm
ues respon-
ibility for work done by his agents, servants or employees. e- <,
Signed „ ; ". •_ ,' F ✓' B
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.
ri accepting this permit I assume responsibility for all work done by either myself, my agent, servant or employee.
gyp^ . �.� a.., �t..:- $•
Iwo
Subdi-
vision
BY
DATE 194 2
Contractor's
License No
AUTHORITY
UILDING ❑
LECTRICAL ❑ DATE " ' 195
LUMBING gi P E R M I T N9 7557 Contractors ;
License No
OOFING ❑ h '. /
❑ Work to be performed under this Permit . " '. l t
'wner of
uildfng
rchitect
ontractor
Builder
gal
escription
ddress of
uilding
Lot
7
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
=refor in strict compliance with all ordinances pertaining thereto and with the understanding that the work will be performed in compliance with any plans,
awings, statements or specifications that may have been submitted to and approved by the proper municipal authorities. This Permit may be revoked at any
me 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
anted is the understanding that the contractor or builder named above assumes the responsibility for a thorough knowledge of the ordinances and regulations
-rtaining to the work covered hereby whether shown on the plans or drawings or in the statements or sp cifications and that he assumes responsibility for work
one by his agents, servants or employees. ? f�^
Signed:• f . G _ : ti. BY
INSPECTOR
In consideration of the issuance to me of its permit I agree to perform the work covered hereunder in compliance with all ordinances and regulations
r.taining 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 OR BUILDER
MIAMI SHORES VILLAGE. FLORIDA
Bl.
Subdi-
vision
Sq. Ft
Value of
Project $
BY
• Jr'e
Amt. of
Permit $
AUTHORITY
I7
Permit No. :5 (3-0
Registered Architect and /or Engineer
Employing Plumber's Name
Location and Legal Description Lot__
Amount of Permit $
STATE OF FLORIDA,
as.
COUNTY OF DADE.
(Signed)
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. ,f
Owner's Name and Address 7 el J ___ No. -S Street X4
__Dist. Feet of Tank or Drain Field from Well
Date .1 — c-f —
Type of Tank__ Capacity Gals
My Commission Expires Notary Public, State of Florida
No._ _�sz� --- -Street_
Block_______— Subdivision
Street and Number where work is to be performed— No.__________ ___�_
State work to be performed and purpose of building (By Floors) _
New Building Remodeling Addition Repaid No. of/Stories.
treet
Size Septic Tank
Feet of Drain Tile
Nature of Water Supply: City —Well Size of Soakage Pit
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 5968, Compiled General 1 aws of Florida Permanent Supplement, and has com-
plied with the provisions thereof, and will require similar compliance from all contracto .r sub -con : •tors employed by him in the work to be
performed under this permit; and will post or cause to be posted for inspection on the of the or such public notice or notices as are
required by the Act. The undersigned agrees to employ only such sub- contractors, performed under this permit, as are
licensed by Miami Shores Village.
aster Plumber.
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.
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
OWERS
LAVA-
TORIES
S INK6
SLOP
SINKS
LAUNDRY
TUBS
URINALS
RINALS
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
AO 1
la
--- -__
CHECK
Permit No. :5 (3-0
Registered Architect and /or Engineer
Employing Plumber's Name
Location and Legal Description Lot__
Amount of Permit $
STATE OF FLORIDA,
as.
COUNTY OF DADE.
(Signed)
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. ,f
Owner's Name and Address 7 el J ___ No. -S Street X4
__Dist. Feet of Tank or Drain Field from Well
Date .1 — c-f —
Type of Tank__ Capacity Gals
My Commission Expires Notary Public, State of Florida
No._ _�sz� --- -Street_
Block_______— Subdivision
Street and Number where work is to be performed— No.__________ ___�_
State work to be performed and purpose of building (By Floors) _
New Building Remodeling Addition Repaid No. of/Stories.
treet
Size Septic Tank
Feet of Drain Tile
Nature of Water Supply: City —Well Size of Soakage Pit
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 5968, Compiled General 1 aws of Florida Permanent Supplement, and has com-
plied with the provisions thereof, and will require similar compliance from all contracto .r sub -con : •tors employed by him in the work to be
performed under this permit; and will post or cause to be posted for inspection on the of the or such public notice or notices as are
required by the Act. The undersigned agrees to employ only such sub- contractors, performed under this permit, as are
licensed by Miami Shores Village.
aster Plumber.
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.
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. ______� ) 7
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.
Owner's Name and Address
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTME
APPLICATION FOR PLUMBING "°' ••;; 11'
Date V
l�jsr ? 5
No._. ___. _..__ Street__
Registered Architect and /or Engineer _____ _ __________�
Employing Plumber's Name. /Y � 1 _ c• No .... _____ .... — Street______ ...... ____
Location and Legal Description Lot__._____ — .... _____ ______ / Block _ Subdivision —
Street and Number where work is to be performed— No._ —Yf, /r e _!_/ f J Street_
State work to be performed and purpose of building (By Floors)
New Building Remodeling ___ Addition Repair _..- . ___ No. of Stories.
Size Septic Tank
Feet of Drain Tile
/ Type of Tank Capacity Gals
/ ' ___Dist. Feet of Tank or Drain Field from Well
Nature of Water Supply: City — Well._-------------------- --- -- _•- _____ ..... ___ -__ -- -Size of Soakage Pit
Amount of Permit $
STATE OF FLORIDA,
COUNTY OF DADE. j
-- - ----- -
-- -- �- - - — — — ( S�ed ) - - •`-
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- 'ork such public notice or notices as are
required by the Act. The undersigned agrees to employ only such sub- contractors, on wo k" be performed under this permit, as are
licensed by Miami Shores Village.
( Signed )_.
P umbing Inspector.
Master Plumber.
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
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
Twits
B
SHOWERS
S
LAVA-
TORIES
SINKS
SLOP
SINKS
LAUNDRY
TUBS
RINALS
URINALS
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
- - --
CHECK
Permit No. ______� ) 7
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.
Owner's Name and Address
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTME
APPLICATION FOR PLUMBING "°' ••;; 11'
Date V
l�jsr ? 5
No._. ___. _..__ Street__
Registered Architect and /or Engineer _____ _ __________�
Employing Plumber's Name. /Y � 1 _ c• No .... _____ .... — Street______ ...... ____
Location and Legal Description Lot__._____ — .... _____ ______ / Block _ Subdivision —
Street and Number where work is to be performed— No._ —Yf, /r e _!_/ f J Street_
State work to be performed and purpose of building (By Floors)
New Building Remodeling ___ Addition Repair _..- . ___ No. of Stories.
Size Septic Tank
Feet of Drain Tile
/ Type of Tank Capacity Gals
/ ' ___Dist. Feet of Tank or Drain Field from Well
Nature of Water Supply: City — Well._-------------------- --- -- _•- _____ ..... ___ -__ -- -Size of Soakage Pit
Amount of Permit $
STATE OF FLORIDA,
COUNTY OF DADE. j
-- - ----- -
-- -- �- - - — — — ( S�ed ) - - •`-
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- 'ork such public notice or notices as are
required by the Act. The undersigned agrees to employ only such sub- contractors, on wo k" be performed under this permit, as are
licensed by Miami Shores Village.
( Signed )_.
P umbing Inspector.
Master Plumber.
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
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 -P ��
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.
No._ S j` , Street
Owner's Name and Address _— _ G : !-_
Size Septic Tank
Feet of Drain Tile__aSI
Nature of Water Supply: City —Well
Amount of Permit $ °3
STATE OF FLORIDA,
ea
COUNTY OF DADE. 1
My Commission Expires
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
R egistered Architect and/ Engineer —_ - -- ---- -_---- - - -___ _�-- --- --- -- -_ -- -_ --_ --
/� � - --- ---- - --- --
Employing Plumber's N e ' _ ?`1 e 7 -4- :d .C. !"J/ ' No., / )- 3__ A `' � Street__ -S
L
Location and Legal Description Lo!/ _____ ______ —____ Block_ Subdi n_ _ _
Street and Number where work is to be performed—No. . Street __ !-' %�'!l '
State work to be performed and purpose of building (By Floors)
New Building Remodeling_ --
Addition____ Repairs No. of Stories. -
Type of Tank
J ; I _Dist. Feet of Tank or Drain Field from Well
__Size of Soakage Pit
(Signed)- " / , • 1
( Signed - ___
Plumbin ns ,c
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 perfo d under is permit, as are
licensed by Miami Shores Village. , j a
636
—
Date 3 6 �
Capacity Gals.
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.
Notary Public, State of Florida
aster 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.
CLOBETB
BATH
TUBS
SHOWERS
LAVA-
TORIES
SIN"
SINKS
LAUNDRY
TUBS
URINALS
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
SW IM'G
POOL
CONTR.
LIST
_.
CHECK
Permit No -P ��
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.
No._ S j` , Street
Owner's Name and Address _— _ G : !-_
Size Septic Tank
Feet of Drain Tile__aSI
Nature of Water Supply: City —Well
Amount of Permit $ °3
STATE OF FLORIDA,
ea
COUNTY OF DADE. 1
My Commission Expires
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
R egistered Architect and/ Engineer —_ - -- ---- -_---- - - -___ _�-- --- --- -- -_ -- -_ --_ --
/� � - --- ---- - --- --
Employing Plumber's N e ' _ ?`1 e 7 -4- :d .C. !"J/ ' No., / )- 3__ A `' � Street__ -S
L
Location and Legal Description Lo!/ _____ ______ —____ Block_ Subdi n_ _ _
Street and Number where work is to be performed—No. . Street __ !-' %�'!l '
State work to be performed and purpose of building (By Floors)
New Building Remodeling_ --
Addition____ Repairs No. of Stories. -
Type of Tank
J ; I _Dist. Feet of Tank or Drain Field from Well
__Size of Soakage Pit
(Signed)- " / , • 1
( Signed - ___
Plumbin ns ,c
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 perfo d under is permit, as are
licensed by Miami Shores Village. , j a
636
—
Date 3 6 �
Capacity Gals.
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.
Notary Public, State of Florida
aster 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.
i c
BUILDING
ELECTRICAL
PLUMBING
Owner o
Building
444 .01
Architect
Contracto
or Build
Legal Lot
Description
Address of 7 if
Building Y f / Is'`
�� f /Th"
CONTRACTOR OR BUILDER
MIAMI SHORES VILLAGE, FLORIDA
ERMIT N° 5653
Work to be pj4or . r e under this Permit
Bl.
This permit is granted to the contractor or builder named above to construct the building or to install
cation herefor in strict compliance with all ordinances pertaining thereto and with the understanding that the
plans, drawings, statements or specifications that may have been submitted to and approved ;. the proper
at any time if the work is not done in compliance with such ordinances or if the plans � an: lout
permit is granted is the understanding that the contractor or builder named above ass es - ':.
regulations pertaining to the work covered hereby whether shown on the R
sibility for work done by his agents, servants or employees.
Signed.
j In consideration of the issuance to me of this permit I agree to perform the work covere
�
pertain thereto and trict conformity with t1}� Tans, drawin statements or specificati
In accepting this perm' I a sume respon lity fgf wont done either myself, my agent,
Pe
i
Subdi-
vision
Value of
Project
DATE
4
Contractor's
License No.
By
L
AUTHORITY
194_
Amt. of
Permit
the equipment or device described in the appli-
work will be performed in compliance with any
uthorities. This Permit may be revoked
on. A further conditio ppon hich this
knowled e of a dr n ces and
specifications and IY� es respon-
•
ereunder in compliance with ¢I1 ordinances�n� r r lio
s submitted to the proper authorities of Miami Shores Village.
ervant or employee.
Permit No
Nature of Water Supply: City —Well
Amount of Permit $____
STATE OF FLORIDA,
COUNTY OF DADE.
ss.
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
( Signed)
_c°A��
(Signed) SA1 f7 '' #N� 8' 6
Date
•
S � P T (G el /V p �SRM i ► 7dF l�`v 0 F�' J �(PF � /
Size Septic Tank Type of Tank Capacity Gals
My Commission Expires Notary Public, State of Florida
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.
Owner's Name and Address - 2Z4 �� . ` '40 C!a- No Street
Registered Architect and /or Engineer rr
Employing Plumber's Name �� / T t 6 0 S No /1__ie. Street NO 7 4" -1/ °
Location and Legal Description Lot .,� `� ` � Block r SSuufbbdivisio
Street and Number where work is to be performed—No .� ' 5 1) 4-1 ' °Q �� n
State work to be performed and purpose of building (By Floors)
New Building / Remodeling
Addition Repairs No. of Stories
Feet of Drain Tile Dist. Feet of Tank or Drain Field from Well
__Size of Soakage Pit
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, on work to be performed under this pmt, as are
licensed by Miami Shores Village.
Master Plumber.
Before nee, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeared
to me well known, and who, being by nie 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.
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
TU
SHOWERS
LAVA-
TORIES
SINKS
SLOP
SINKS
LAUNDRY
TUBS
URINALS
CATCH
BASIN
FLOOR
DRAIN
DRINK ING
FOUNT' NS
•
TOTAL
FIXTURES
C LIST
Cam-
/
< `y . �ti' I .^..+"'
�_- , DRAIN
b
p'y
CHECK
SEPTIC
TANK
SEWER
CONN.
DRAIN
FIELD
SOAKAGE
PIT
GREASE
TRAP
SOLAR
H EATER
DEEP
WELL
SPRKLR.
SYSTEM
SWIM'G
POOL
A- 4 � P - G � 7 AL'
,, t* =''
CONTR.
LIST
/
CHECK
Permit No
Nature of Water Supply: City —Well
Amount of Permit $____
STATE OF FLORIDA,
COUNTY OF DADE.
ss.
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
( Signed)
_c°A��
(Signed) SA1 f7 '' #N� 8' 6
Date
•
S � P T (G el /V p �SRM i ► 7dF l�`v 0 F�' J �(PF � /
Size Septic Tank Type of Tank Capacity Gals
My Commission Expires Notary Public, State of Florida
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.
Owner's Name and Address - 2Z4 �� . ` '40 C!a- No Street
Registered Architect and /or Engineer rr
Employing Plumber's Name �� / T t 6 0 S No /1__ie. Street NO 7 4" -1/ °
Location and Legal Description Lot .,� `� ` � Block r SSuufbbdivisio
Street and Number where work is to be performed—No .� ' 5 1) 4-1 ' °Q �� n
State work to be performed and purpose of building (By Floors)
New Building / Remodeling
Addition Repairs No. of Stories
Feet of Drain Tile Dist. Feet of Tank or Drain Field from Well
__Size of Soakage Pit
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, on work to be performed under this pmt, as are
licensed by Miami Shores Village.
Master Plumber.
Before nee, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeared
to me well known, and who, being by nie 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.
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.
QPI
O
tr"
(
.60
I VI
i
BUILDING
ELECTRICAL
PLUMBING
Owner of
Building
Architect
Contractor s f -
or Builder
Legal Lot
Description cQ 4 1' 3
Address of
Building 3
44 777 / 0 • 00 " 43
UILDER
CONTRACTOR OR
MIAMI SHORES VILLAGE, FLORIDA
. PERMIT N? 5602
v
Work to be performed under this Permit te
Bl. ev S ,,
vision
Subdi- 99
•
•
Value of
Project
DATE
Contractor's
License No
F
Amt. of 9z
Permit / 4 .
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-
cation 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 plan drawings o in the tatements or specificatio d that l�p,assumes respon-
sibility for work done by his agents, servants or employees.
/•
Signed • Pl By lsl. 2'i
I _
/ 35/,
194
In consideration of the issuance to me of this permit I agree to perform the work covered ereunder in compliance wit ordinances and rggulitions
pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper autlfflMes of Miami Sl4s.r&Villlaget
In accepting. permit I assume esponsibility for all work done by either mysel/,any agent, servant or employee.
,
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
Permit No 5% D 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 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.
Owner's Name and Address__ Ad 4ri S
Registered Architect and /or E ineer
Employing Plumber's Name_ Er^ / 0f /.)i 0
Location and Legal Description Lot '
New Building •
No
Block )-
No Street
Street and Number where work is to be performed —No 6 " Street
State work to be perfclrnied and purpose of building (By Floors)
Remodeling Addition
Size Septic Tank
Nature of Water Supply: City —Well •
Amount of Permit $
ss.
Type of
Feet of Drain Tile____ Dist. Feet of Tank or Drain Field from WelL
Size of Soakage Pit
(Signed)
(Signed)
0
"3 9 sue,/
�treet_
Subdivision
Capacity Gals
c, 0
7
Repairs No. of Stories
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 corn-
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. under �. .
e
STATE OF FLORIDA,
COUNTY OF DADE. j
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
SHOWERS
LAVA
TORIES
SINKS
SLOP
SINKS
LAUNDRY
TUBS
URINALS
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
SW IM'G
POOL
CONTR.
LIST
CHECK
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
Permit No 5% D 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 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.
Owner's Name and Address__ Ad 4ri S
Registered Architect and /or E ineer
Employing Plumber's Name_ Er^ / 0f /.)i 0
Location and Legal Description Lot '
New Building •
No
Block )-
No Street
Street and Number where work is to be performed —No 6 " Street
State work to be perfclrnied and purpose of building (By Floors)
Remodeling Addition
Size Septic Tank
Nature of Water Supply: City —Well •
Amount of Permit $
ss.
Type of
Feet of Drain Tile____ Dist. Feet of Tank or Drain Field from WelL
Size of Soakage Pit
(Signed)
(Signed)
0
"3 9 sue,/
�treet_
Subdivision
Capacity Gals
c, 0
7
Repairs No. of Stories
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 corn-
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. under �. .
e
STATE OF FLORIDA,
COUNTY OF DADE. j
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
9')
4_r
State work to be performed and purpose of building (By Floors) __._._ _DrAi LiCl
Street and Number where work is to be performed —No
New .... ...._.. Remodeling____ ___.__ Addition
Size Septic Tank_. -
Feet of Drain Tile
Nature of Water Supply: City —WeIL
Amount of Permit ;L—�
My Commission Expires
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
Type of Tank __ - - -- -- - - - - -- - - -.
_Dist. Feet of Tank or Drain Field from Well
Size of Soakage Pit.
( Signed ) _
(Signed) C_
r,P
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 L 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 specificatlosu must be kept at
building during progress of work. Q�C
Owner's Name and Address �S.I0N4- ' �' JC �1_ No 2 S�
Registered Architect and /or Engineer
n rat yi /lum yen Vaal on Lot _ 1 �.._.....�........ ietwt.v.W r ...-
,,��,0 ` � � C_
Nor
t on and Legal p �
tt �,2 3 Blom a SubdivLdon..7 ei)
Street-- -- - - - - ... . ... ...
-- .
Street... 7 /. _.
•
Repairs No. of Stories..
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 Ilan crnm-
piied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors employed by him in the worn to he
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.
aster Plumber..._
ti STATE OF FLORIDA, I u.
' 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 be did sign the same, and that all facts
therein by him stated are true.
Notary Public, State of Florida
NOTE: A re- inspection fee of $1.00 will be made when meal, ale•iaspettion le mede•aaoaasary by bnproper notion for baspection, re faulty
materials and /or worlanaaahip.
CLOUTS
BATH
TOLL
b
LAVA.
TORI[L
SINKS
SLOP
SINK[
D t
LAUN TuLL R
URINAL[
A
C TC N
PALIN
FLOOR
DRAIN
DRINKING
FOUNT' NS
TOTAL
IIAtURt•
--
CONTN.
LIST
CN[CK
+
SEPTIC
TANK
SI LR
CONN.
DRAIN
FILLD
SOAKAO[
PIT
G
TRAP
SO LAR
HUTU
DRIP
WtLL
BPRKLR.
5
•W um' a
POOL
CONTR.
LIST
7 '" 7'
�-
/
CHICK
Permit No
9')
4_r
State work to be performed and purpose of building (By Floors) __._._ _DrAi LiCl
Street and Number where work is to be performed —No
New .... ...._.. Remodeling____ ___.__ Addition
Size Septic Tank_. -
Feet of Drain Tile
Nature of Water Supply: City —WeIL
Amount of Permit ;L—�
My Commission Expires
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
Type of Tank __ - - -- -- - - - - -- - - -.
_Dist. Feet of Tank or Drain Field from Well
Size of Soakage Pit.
( Signed ) _
(Signed) C_
r,P
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 L 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 specificatlosu must be kept at
building during progress of work. Q�C
Owner's Name and Address �S.I0N4- ' �' JC �1_ No 2 S�
Registered Architect and /or Engineer
n rat yi /lum yen Vaal on Lot _ 1 �.._.....�........ ietwt.v.W r ...-
,,��,0 ` � � C_
Nor
t on and Legal p �
tt �,2 3 Blom a SubdivLdon..7 ei)
Street-- -- - - - - ... . ... ...
-- .
Street... 7 /. _.
•
Repairs No. of Stories..
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 Ilan crnm-
piied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors employed by him in the worn to he
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.
aster Plumber..._
ti STATE OF FLORIDA, I u.
' 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 be did sign the same, and that all facts
therein by him stated are true.
Notary Public, State of Florida
NOTE: A re- inspection fee of $1.00 will be made when meal, ale•iaspettion le mede•aaoaasary by bnproper notion for baspection, re faulty
materials and /or worlanaaahip.
SEPTIC TANKS
COMMERCIAL • RESIDENTIAL
SPECIALISTS IN CLEAN OUTS o PUMPS OUTS
o WE INSTALL AND REPAIR DRAIN FIELDS o
o WE INSTALL SEPTIC TANKS o
688 -4403
24 HOUR SERVICE
1 6 WASHINGTON AVENUE o OPA -LOCKA 33054
,c2
(7-
APPLICANT:
AGENT:
PROPERTY ADDRESS:
LOT: �d
/,3 BLOCK: ?c" SUBDIVISION: Ili SA 5 57 ' �
=s = —as _____ as
CHECKED (X] ITEMS ARE NOT IN COMPLIANCE WITH
____- = ====s= ===== ===wa=s:=
TANK INSTALLATION
[01] TANK SI8E [1] 900 [2]
[02] TANK MATERIAL l= G^C -r°Ye
[03] OUTLET DEVICE ¢
[04] MULTI- CHAMBERED [ Y / ]
,[05] OUTLET FILTER
'106] LEGEND /11
[07] WATERTIGHT
[08] LEVEL / n 1 !
'[09•) DEPTH TO LID - - r J' / (
•
1
1
1
l
1
1
1
1
1
[115]
[16]
CONSTRUCT
FINAL
r 1'
STATE OF FLORIDA
DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATXHNT AND DIPOSAL SYSTEM[
CONSTRUCTION INSPECTION AND FINAL 'APPROVAL
L1 J�
se
FILL / EXCAVATION MATERIAL
[22] FILL AMOUNT
(23] FILL TEXTURE
[24] EXCAVATION DEPTH
(25] AREA REPLACED.
[26) REPLACEMENT MQ►TERIAL
[APPRO
29 P(I qI 97
EXPLANATION OF VIOLATIONS / REMARKS:
(APPROVED/DISAPPROVED]:
VED /DISAPPROVED]:
2�^
DRAINFIELD INSTALLATION 3e36
[10] AREA [1]/Or/ SQFT
[11] DISTRIBUTION BOX _ HEADER
[12] NUMBER OF DRAINLINES. t
(13] DRAINLINE SEPARATION
(14] DRAINLINE SLOPE
DEPTH OF COVER
ELEVATION.[ABOVE /BELOW] BM
[17] SYSTEM LOCATION
[18] DOSING PUMPS ti14
[19] AGGREGATE
[20) AGGREGATE EXCESSIVE FINES
(21] AGGREGATE DEPTH
STATUTE OR RULE AND MUST BE CORRECTED.
DH 4016, 10/97 (Previous, Editions May Be Used)
/DISAPPROVED] : •J f
]unstalller / Contractor
PROPERTY ID 1 :J/ 3206 74
SETBACKS
(27] SURFACE WATER
[28] DITCHES
(29] PRIVATE 'WELLS
(30] PUBLIC WELLS
[31 ] IRRIGATION WELLS 7s •
[32) POTABLE WATER LINES ,$()
[33] BUILDING FOUNDATION /0
[34] PROPERTY LINES /9 - FT
[35] OTHER FT
FILLED / MOUND SYSTEM
[36] DRAINFIELD COVER
[37] SHOULDERS
(38] SLOPES
(39] STABILIZATION
ADDITIONAL INFORMATION
[40] UNOBSTRUCTED AREA
[41] STORMWATER RUNOFF
[42] ALARMS
[43] MAINTENANCE AGREEMENT
[44] BUILDING AREA
[45] LOCATION CONFORMS WITH SITE PLAN
[46]. FINAL SITE.GRADING //
[47] CONTRACTOR P, /5
( 0T
ABANDONMENT
] (49] TANK PUMPED _,/_ /
] (50] TANK CRUSHED i FILLED _ /_/
Mt)
PERMIT NO.
DATE PAID*
FEE PAID:
RECEIPT #t
4'�- 3Ss8/L
l - /7—aa
c-
•
FT
FT
FT
FT
PT
FT
FT
CHD DATE: /,7 26-01_
CND DATE : 17- 1 17 -
Page 2 of 3
PERMIT NUMBER: Permit tracking number assigned by CHD.
APPLICANT: Property owners fun name.
AGENT: Property owners legally authorized representative.
MAILING ADDRESS: P.O. box or street mailing address for applicant or agent.
LOT, BLOCK, SUBDIVISION Lot, Block and Subdivision for lot or
PROPERTY ID#: 27 character number for property. (property appraiser ID* or GIS location)
COUNTY HEALTH DEPARTMENT CHECKS [X] ITEMS NOT IN COMPLIANCE WITH CONSTRUCTION PERMIT AND
STATUTE OR RULE. INFORMATION IS COMPLETED BY CHD ON FOLLOWING ITEMS:
TANK SIZE (gallons)
TANK MATERIAL (concrete, fiberglass, etc)
OUTLET FILTER (manufacturer, make, model)
LEGEND (manufacturer code)
DRAINFIELD AREA (square, feet)
DISTRIBUTION BOX / HEADER (check box)
NUMBER OF DRAINLINES (number installed)
SYSTEM ELEVATION (in relation to BM)
DOSING PUMPS (number installed)
SETBACKS (record actual setbacks in ft)
SETBACKS OTHER (as required)
STABILIZATION (date stabilized)
CONTRACTOR (contractor installing system)
ADDITIONAL INFORMATION (as required)
ABANDONMENT TANK PUMPED (date)
TANK CRUSHED AND FILLED (date)
EXPLANATION OF VIOLATIONS: Record item number, explanation of vitiation, and required
CONSTRUCTION APPROVAL: Circle approved or disapproved, CHD signature and date.
AS BUILT INSTALLATION SKETCH
FINAL APPROVAL: Circle approved or disapproved. CHD signature and date of approval.
Final approval shall not be granted unit the CHD has confirmed thatbuilding construction and lot grading are in substantial
compliance with plans and specifications submitted withth'e permit application.
ELEVATION WORKSHEET ELEVATION OF BENCHMARK OR REFERENCE POINT:
EXISTING GROUND TOP OF AGGREGATE
[+1 SHOT H.I. H.I. H.I.
H.I. [ -] SHOT [ SHOT [ ] SHOT
ELEVATION
STATE OF FLORIDA
DEPARTMENT OF HEALTH AND REHABILITATIVE.SERVICES
ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION AND INSTALLATION PERMIT
Applicant (ZJ, y , l e �li� /oc / y�l Permit Number g7 M INSTAL TI
PART II - SYSTEbN I NSPECTION AND FINAL INSTALLATION APP -
Installer /J 0/I/2 9/7 Tank Manufacturer �/
Proper tank legend: Yes /V�l Tank material Tank level: Yes 47
Tanks watertight: Yes /il� Tank size• ons gallons — gallons
Proper tank outlet device: Yes No !/ Manhole or marker to grade: Yes _ZP)*(c>
Dralnfield Trench Absorption Bed
Length Width Leigth Width Length - - - S feetx CM'S feet= 2)6
feet feet feet feet Length '_... feet x feet ft
feet feet feet feet Proper No. drainlines: Yes v No
/
feet feet feet feet Proper pipe separation: Yes N oo
Total = ft Total = ft Distribution box level: Yes ___F,106. ,fQ�
Systems located as permitted: Yes " No
Systems including plumbing stub -outs installed at proper elevation:
Average depth to drainpipe invert from finished grade: 2 inches
Average depth of drainfield gravel I ` inches Minimum depth of gravel inches
Proper gravel size: Yes V" No Gravel is suitable quality: Yes v No
Backfill or fill material as required: (Quality) Yes
Other findings• i< -ice f9/
„U
�_- - : �
/-,4- 57 0-14
Inspected by: C.)
Date / - a :Approved by:
AN APPROVED INSTALLATION DOES NOT GUARANTEE PERFORMANCE
!e: Completed copies of this form will be provided to the applicant, installer and the building department.
Form 4016, Jan 86 (Replaces Feb 85 edition which may be used)
/ oau mbar: 5744-002-4016-4)
Yes /v x(0
Maximum depth C`' Inches
L - No (Quantity) Y-s t/-
PART III - FINAL INSTALLATION APPROVAL
f�
Date /— ?_ $�
UNTY PUBLIC HEALTH UNIT
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