PLUMBING PERMITas t
Architect
Contractor
or Builder
Leggy;
De �crS i.
of
coNTirAC O!
Permit No/ v 7
Application is hereby made for the appreval 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 Addressa__' "a t ti No Street
Registered Architect and /or Engineer 1r-
Employing Plumber's Name Lj.(c _?.dr_siei ._ ' No
Location and Legal Description Lot _'____ __1 7 Is." Blloo`ck.._ [
. � 9/
Suubdivisio,
!'i ' 9 1 ` . Street !
Street and Number where work is to be performed —No
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
Date
Street `S
-s i
State work to be performed and purpose of building (By Floors)
New Building Remodeling Addition Repairs No. of Stories
Type of Tank_ Capacity Gals
Dist. Feet of Tank or Drain Field from Well
Nature of Water Suppl : City —Well. Size of Soakage Pit_
Size Septic Tank
Feet of Drain Tile
Amount of Permit $
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 hint 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 agz s to ,employ only such sub - contractors, on work to be performed under this permit, as are
licensed by Miami Shores Village.
7 0. v'1 �1.C�.tr.� Ct / t 1 ,
7 O
l- -
�- O
737,-.
(Signed)_
(Signed)
Master P17ber.
STATE OF FLORIDA, ss.
COUNTY OF DADE. ' zto
Before me, the undersigned author' , pu, duly authorized to administer oaths and take acknowledgments, personally appeared
to me well known, and who, being by me flfst 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
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.
Notary Public, State of Florida
CLOSETS
BATH
TUBS
SHOWERS
LAVA-
TORIES
SINKS
SLOP
SINKS
LAUNDRY
TUBS
URINALS
CATCH
BASIN
FLOOR
DRAIN
DRINKING
FOUNT•NS
TOTAL
FIXTURES
CONTR.
LIST
s •/
1
/
g
CHECK
�
/
�(
���/
�
/I� ��
`�`
�/ ✓
'
/, Isr
SEPTIC
TANK
SEWER
CONN.
DRAIN
FIELD
SOAKAGE
PIT
GREASE
TRAP
SOLAR
HEATER
DEEP
WELL.
SPRKLR.
SYSTEM
SWIM'G
POOL
CONTR.
LIST
CHECK
/
Permit No/ v 7
Application is hereby made for the appreval 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 Addressa__' "a t ti No Street
Registered Architect and /or Engineer 1r-
Employing Plumber's Name Lj.(c _?.dr_siei ._ ' No
Location and Legal Description Lot _'____ __1 7 Is." Blloo`ck.._ [
. � 9/
Suubdivisio,
!'i ' 9 1 ` . Street !
Street and Number where work is to be performed —No
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
Date
Street `S
-s i
State work to be performed and purpose of building (By Floors)
New Building Remodeling Addition Repairs No. of Stories
Type of Tank_ Capacity Gals
Dist. Feet of Tank or Drain Field from Well
Nature of Water Suppl : City —Well. Size of Soakage Pit_
Size Septic Tank
Feet of Drain Tile
Amount of Permit $
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 hint 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 agz s to ,employ only such sub - contractors, on work to be performed under this permit, as are
licensed by Miami Shores Village.
7 0. v'1 �1.C�.tr.� Ct / t 1 ,
7 O
l- -
�- O
737,-.
(Signed)_
(Signed)
Master P17ber.
STATE OF FLORIDA, ss.
COUNTY OF DADE. ' zto
Before me, the undersigned author' , pu, duly authorized to administer oaths and take acknowledgments, personally appeared
to me well known, and who, being by me flfst 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
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.
Notary Public, State of Florida
,;
;:f's-
Utak
. ,
axe4r/cars 01 APFRow& fP7
t° that fthal latepeeti 'Ssp‘is Teat et
taloa So 04 with Oath milt**
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Date - 7S Job Address 3S Ne, `j ) Sr' Tax Folio
Legal Description Historically Designated: Yes No
Owner/Lessee / Tenant Go Al E 2. Master Permit # 96- R A 3f�
Owner's Address S /V t., 9/ 5 Phone 9 e/ y - YC(�
Contracting Co. A Aa ro � c (co '-r.d— Address
Qualifier ) \nv 1 o r \ " " 1 / V SS# - / - Phone 5 g 1 `I V )
State # S e - p 000 Co '{ S Municipal # Competency # Ins. Co.
Architect/Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIPTION s (f , b t oo S fi (>, : j l N t � (? r tOc4 ; ,••
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 to 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 contrac .r to do - work stated.
J
Signature of owner and/or Condo President Date Si a'e 4/ ' ntractor or caner- Builder Date
Notary as to Owner and/or Condo President Date
My Commission Expires: My Commission Exp
Notary as to Contract
Electrical
Date
: Not _TAMMY J SACHS
Public y Stat• of Florid,
�j .,:z. My F. yn- 05/0744
I// 0 Comma '.::480555 C j
e 1 6�
FEES: PERMIT 7 r NOTARY TOTAL DUE / + RADON C.C.F. �
APPROVED:
Zoning Building
Mechanical Plumbing ••I'' ••I'' s� 1 M' z 1q
f Engineering
APPLICANT:
PROPERTY SIZE:
DIRECTIONS TO PROPERTY:
BUILDING INFORMATION
Unit Type of
No Establishment
1
2
3
4
STATE OF FLORIDA ¢ . PERMIT #
DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES DATE PAID
ONSITE SEWAGE DISPOSAL SYSTEM. FEE PAID $
APPLICATION FOR CONSTRUCTION PERMIT RECEIPT #
Authority: Chapter 381, FS & Chapter 10D -6, FAC
APPLICATION FOR:
[/1 New System [ Existing System belt Holding Tank [s."] Temporary /Experimental
[,J Repair [J"] Abandonment [ Other(Specify)
TELEPHONE: 9 r JC Pt�
AGENT: :� _ /
09. "14 r^d! Su .at a, P n
MAILING ADDRESS: n
v
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, ATTACH LEGAL DESCRIPTION OR DEED]
LOT: BLOCK: SUBDIVISION: DATE OF ,,/ -.
SUBDIVISION
PROPERTY ID #: [Section /Township /Range /Parcel No.] ZONING:
PROPERTY STREET ADDRESS: -
ACRES [Sgft /43560] PROPERTY WATER SUPPLY: [ ] PRIVATE [,;PUBLIC
[6,1 RESIDENTIAL [ ] COMMERCIAL
`i] Garbage Grinders /Disposals L4.4 /Hot Tubs (,/1 Floor /Equipment Drains
(./) Ultra -low Volume Flush Toilets/ •' ( Other (Specify)
r
APPLICANT'S SIGNATURE: .— i� DATE: // ' "
No. of Building # Persons Business Activity
Bedrooms Area Sgft Served For Commercial Only
HRS-H Form 4015, Mar 92 (Obsoletes previous editions which may not be used)
(Stock Number: 5744 - 001 - 4015 -1)
Page 1 of 3
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By
Plan Approved
STATE OF FLORIDA
DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES
APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PF7MIT
Permit Application Number 3 -7 2
PART II - SITE PLAN
A/ C
Notes.
A C/ -
HRS-H Form 4015, Feb 85 (Obsoletes previous editions which may not be used)
(Stock Number: 5744-002-4015-6)
Not Approved
s
Site Plan Submitted by
NATURE
-
.3'36
4 -
CHANG S MUST BE APPROVED BY THE COUNTY PUBLIC HEALTH UNIT
TITLE
Date/
County Public Unit
Page 2 of 3
APPLICANT:
PROPERTY ID #:
STATE OF FLORIDA •
DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES
ONSITE SEWAGE DISPOSAL SYSTEM
SITE EVALUATION AND SYSTEM SPECIFICATIONS
LOT: 1 _ , ) / 14 BLOCK: 4 9 J" 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
TOTAL ESTIMATED SEWAGE FLOW:
AUTHORIZED SEWAGE FLOW:
UNOBSTRUCTED AREA AVAILABLE:
BENCHMARK /REFERENCE POINT LOCATION:
ELEVATION OF PROPOSED SYSTEM SITE IS
SOIL PROFILE INFORMATION SITE 1
Munsell # /Color
USDA SOIL SERIES:
Texture Depth
; 1 / to
to �.
to
to
to
to
to
to
SITE EVALUATED BY:
PLAN: [ "] YES [ ] NO NET USABLE AREA AVAILABLE: ACRES
4 GALLONS PER DAY [RESIDENCES -TABLE 1 / OTHER -TABLE 2]
GALLONS PER DAY [1500 GPD /ACRE OR 2500 GPD /ACRE]
SQFT UNOBSTRUCTED AREA REQUIRED: ' SQFT
THE MINIMUM SETBACK WHICH CAN BE MAINTAINED FROM THE PROPOSED SYSTEM TO THE FOLLOWING FEATURES:
SURFACE WATER: • ' FT DITCHES /SWALES: 1 FT NORMALLY WET? [ ] YES [; -J NO
WELLS: PUBLIC: a:Y' FT LIMITED USE: FT PRIVATE: , ," FT NON - POTABLE: FT
BUILDING FOUNDATIONS: __ FT PROPERTY LINES: 7` FT POTABLE WATER LINES: - FT
SITE SUBJECT TO FREQUENT FLOODING: [ ] YES [-] NO 10 YEAR FLOODING? [ ] YES [ r NO
10 YEAR FLOOD ELEVATION FOR SITE: ,Q/ FT MSL /NGVD SITE ELEVATION: f °' FT MSL /NGVD
OBSERVED WATER TABLE: ' INCHES [ABOVE / BELOW] EXISTING GRADE. TYPE: [PERCHED / APPARENT]
ESTIMATED WET SEASON WATER TABLE ELEVATION: INCHES [ ABOVE / BELOW ] EXISTING GRADE.
HIGH WATER TABLE VEGETATION: [ ] YES [;] NO MOTTLING: [ ] YES [4- DEPTH: INCHES
I
SOIL TEXTURE /LOADING RATE FOR SYSTEM SIZING: /,, DEPTH OF EXCAVATION: - { ` INCHES
DRAINFIELD CONFIGURATION: [ ] TRENCH [ BED [ ] OTHER (SPECIFY)
REMARKS /ADDITIONAL CRITERIA:
h
s
HRS -H Form 4015, Mar 92 (Obsoletes previous - �
may w y not be used)
(Stock Number: 5744- 003 - 4015 i
AGENT:
PERMIT #
(s--
[Section /Township /Range /Parcel No. or Tax ID Number]
[INCHES /FT] [ABOVE /BELOW] BENCHMARK /REFERENCE POINT
SOIL PROFILE INFORMATION SITE 2
Munsell.# /Color Texture
USDA SOIL SERIES:
Depth
to
to
to
to
to
to
to
to
to
DATE: %
Page 3 of 3
i'
.'': _�Z . :rscrc: t:.o !c: _'.!c_. c � .:::rs�r:' -: ;. � ,.....:..� ✓.;;/ ^_ ;, ,_. __.., sc .. , .
c!cvsti:.. olthe ::::"1.!)1.-2 :a.
acco:.. minimum cc:brr,'ts which cn n s:.
for non c!Jpl!c Obld cctu:.16. .•CC:iU_; 3 . 7 :. Q"12',.4!!_ /:: '_..,? _ ^. !'J:1!SGt:_ _C_ ._...., z ___.,e..;__.... .. _3., icca: :di:
9 i .. within . ^
'i &P.y public US?Il�C!_ ^..�� CJC!_ 1%!!n 9Ci., •::: ". of VE `.f_. ^.:,.
in or:nction on. _o:'c cubjcc: to ' _ o.a _ ,;:c° to ccs :n5 _sozr. :0 y .. ` c ;vc?'c - ; 7 c _:, One.
ECtuw::;:te "elevation.
'evc rofiiles within t. _ p:opo,: _ _ . o, -? :o
icient`.`icat?on will tic 'JS'.A So:_
b.: c:ccrly d.ocumsrs! rl, -ovics `JS.,,, •o;' v <._.r :_ '" iZr S" = e c . a
�r r : , i
..idCO.. �. X10 depth or the OJSC i'VEt. ':J �..... i ".JIP .: ; : :1 � � C °.? >:V.. 1V.<:.LIO._.
acCO. 5. J &C.. .. , : "!'__... J 72/1 ._-
n15[C :`cri .......... ; _. .
..SCF:.... l '.T: :: .... ..
ant. r _... ::•
:C.
Square Ft.
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Date Z - 2 ` / 2 Job Address gf /f4: 7/ Tax Folio //.. .3204 - O /3 - O / e
Legal Description Historically Designated: Yes No
Owner/Lessee / Tenant :4 o 4/
2 �O�G ��C /
.t/ Master Permit # ( S 7
Owner's Address -/� : e, ' Phone p ` / ��
Contracting Co. � i�?�� /cq� - �� C - 7 7 9 - 4/4 - ' 4'/f Address 7,- ,1 /l/• /
Qualifier e--1 o S >G 4 , �tr CA 772G SS# Phone
State # O:G N SEPF7o $ Municipal # Competency # Ins. Co.
Architect/Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIPTION . � /ex/k--
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 to 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 contractor to do the work stated.
t�1�� W .0. l Ninn
C. of owner and/or Condo Presid nt Date
N otary as to Owner and/or Condo President Date Notary as t: Co a • i wner- Builder
My Commission Expires: . "--°1-7 My Commissi. - xpires:
4" JOSE A RODRIGUEZ
* My Commission CC528535
Expires Jan 29,2000
APPROVED:
Zoning Building
Mechanical Plumbing
Estimated Cost (value)
Signature of , 'actor or Owner - Builder
*
(A
�lE O F
FEES: PERMIT 3 RADON C.C.F. / t 26 NOTARY BOND
TOTAL DUE,a "I / ,
Electrical
- 2 -,
Date
Date
f iq i7� Engineering
CONSTRUCTION PERMIT F R:
[/v] New System PERMIT
System [Pi Holding Tank [J,J Temporary /Experimental
[ ] Repair [Al Abandonment [/�]eOther(Specify)
y
APPLICANT: 6� AGENT:
PROPERTY STREET ADDRESS: ^D
LOT: / BLOCK: ,i b SUBDIVISION: A'1
PROPERTY ID #:
STATE OF FLORIDA
DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES
ONSITE SEWAGE DISPOSAL SYSTEM
CONSTRUCTION PERMIT
Authority: Chapter 381, FS & Chapter 10D -6, FAC
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 SPECIFICATIONS
T [ 7/ GALLONS / GPD] $EPTIC TANK/AEROBIC UNIT CAPACITY MULTI- CHAMBERED /IN SERIES:[✓]
A [ ] [GAL ONS / GPD) CAPACITY MULTI- CHAMBERED /IN SERIES:[
N [ ] GALLONS GREASE INTERCEPTOR CAPACITY [MAXIMUM CAPACITY SINGLE TANK: 1250 GALLONS]
K [ ] GALLONS ER DOSE DOSING TANK CAPACITY DOSE RATE [ ] PER 24 HRS NO. OF PUMPS: [ ]
s- /[.% E (7/ -7
D SQUARE FEET RIMARY DRAINFIELD SYSTEM
R [ ] SQUARE FEET SYSTEM
A TYPE SYSTEM: [ ] STANDARD [ ] FILLED
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
o I(' E (J L",„, c— , � / -T r c T.6✓v�L.
T
H
E
R
SPECIFICATIONS BY:
APPROVED BY:
DATE ISSUED:
g
TITLE:
TITLE: C
HRS -H Form 4016, Mar 92 (Obsoletes previous editions which may not be used)
(Stock Number: 5744 - 001 - 4016 -0)
[SECTION /TOWNSHIP /RANGE /PARCEL NUMBER]
[OR TAX ID NUMBER]
BUILDING DEPARTMENT
PERMIT #
DATE PAID
FEE PAID $
RECEIPT #
[ ] MOUND [ ]
[ )
CPHU
EXPIRATION DATE: "..1":_...
Page 1 of 2
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