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PLUMBINGBUILDING PERMIT APPLICATION FBC 2001 Permit Type (circle): Building Electrical - Owner's Name (Fee Simple Titleholder)( Phone # Owner's Address \ 1 f 9 _ City Tenant/Lessee Name Job Address (where the work is being done) 1 1 a $ Value of Work For this Permit ) s Type of Work: Describe Work: Total Fee Now Due $ (Continued on opposite side) ❑ Addition ❑Alteration Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 Permit No. P 2,0 q' Master Permit No. Plumbing Mechanical Roofing State Zip Phone # City Miami Shores Village County Miami -Dade Zip Is Building Historically Designated YES NO Contractor's Company Name Phone # Contractor's Address City State Zip Qualifier Architect/Engineer's Name (if applicable) Phone # ❑New ❑ Repair/Replace ❑ Demolition ys, 7 Square Footage Of Work: * * * * * * * * * * * * * * * * * * * * * * * * * * ** F ees * * * * * * * * * * * * * * * * * * * * * * / * * * * * * ** Submittal Fee $ Permit Fee $ l 7s b CCF $ , 7) CO /CC Notary $5, o o Training/Education Fee $ r 1) Technology Fee $ Li , / Scanning $ Radon $ Zoning Bond $ Code Enforcement $ Structural Plan Review. $ Bonding Company's Name (if applicable) Bonding Company's Address City State Zip Mortgage Lender's Name (if applicable) Mortgage Lender's Address City State Zip Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRICAL WORK, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and AIR CONDITIONERS, ETC OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. "WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT." Notice to Applicant: As a condition to the issuance of a building permit with an estimated value exceeding $2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. The foregoing instrument was acknowledged before me this Th egoing instrument was ac ..wled„-d before day of , 20 _ , by d of , 2Z00 ,y g • ! a who is personally known to me or who has produced who is personally nown to me or who has produced as 1 ntifica on and who did take an oath. As identification and who did take an oath. Signature NOTARY PUBLIC: NOTARY P :LIC: Sign: Print: My Commission Expires: Sign: Contractor r My Commission ExpTr,FS,, ***************************************************************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** (Certificate of Competency Holder) State Certificate or Registration No. Certificate of Competency No. Chc 12/15/03 APPLICATION APPROVED B''i': * * * * * * * * * * * * * * * * * * * * * * * * * * * * *. poi * * ** ************************************ * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** �i7� / i/ Plans Examiner Engineer Zoning • Plumbing Permit Miami Shores Village 10050 NE 2nd Avenue Phone: 305- 795 -2204 Permit Number: PL2004 -146 Printed: 5/18/2004 Applicant: DIANE PATTAVINA Owner: PATTAVINA DIANE JOB ADDRESS: 112 NE 93 ST Contractor W P SEPTIC TANK CO INC Local Phone: 305 - 620 - 6320 Parcel # 1132060133140 Contractor's Address: 17235 NW 12 CT Page 1 of 1 Legal Description: MIAMI SHORES SEC 1 AMD PB 10 -70 LOTS 13 & 14 BLK 23 LOT SIZE Fees: Description Amount FEE2004 -5012 Building Fee $175.00 FEE2004 -5013 CCF $0.60 FEE2004 -5014 Notary Fee $5.00 FEE2004 -5015 Training and Education Fee $0.20 FEE2004 -5016 Technology Fee $4.37 Total Fees: $185.17 Total Fees: $185.17 Total Receipts: $185.17 Permit Status: APPROVED Permit Expiration: 11/14/2004 Construction Value: $450.00 Work: ABANDON TANK 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 thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I assume responisibility for all work done by either myself, my agent, servants or employes. Signed: (Contractor or Builder) BY: BUILDING ❑ ELECTRICAL UUMBING O r PERMIT ROOFING ❑ Owner of Building �° 5 _� C Architect Contractor or Builder r Legal Lot Description II Bi CONTRACTOR OR BUILDER MIAMI SHORES VILLAGE, FLORIDA N9 5666 DATE 19 Contractor's License No. Work to be performed under this Permit Subdi- vision Address of Value of 1 Amount of Building - Project $ 11 t Permit $ 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 applica- tion 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 respon- sibility for work done by his agents, servants or employees. 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 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. BY AUTHORITY ABBOT'. BUILDING ELECTRICAL PLUMBING ROOFING Owner of Building Architect Contractor or Builder Legal Description Lot CONTRACTOR OR BUILDER MIAMI SHORES VILLAGE, FLORIDA PERMIT N9 5653 Work to be performed under this Permit ' r t B1 DATE Contractor's License No. Subdi- vision Address of r _' Value of 1 Amount Building . , ' Project $ 1 Permit $ 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 applica- tion 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 respon- sibility for work done by his agents, servants or employees. of Signed. ' e , -( 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 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. BY AUTHORITY x.307 Permit No 4-6' £ 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 Registered Architect and/or Engineer Employing Plumber's Name _ MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT Location and Legal Description Lot____ Block Subdivision Street and Number where work is to be performed —No j ( � - Nolo— _ 1 -_ Street No Street + Date Street State work to be performed and purpose of building (By Floors) New Building Remodeling Addition Repairs No. of Stories Size Septic Tank____ Type of Tank 11/ F��^� Capacity Gals � OD Feet of Drain Tile Dist. Feet of Tank or Drain Field from Well Nature of Water Supply: City —Well _ Size of Soakage Pit Amount of Permit $ (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, on w to be perform d under this permit, as are licensed by Miami Shores Village. ire � SS. ( Signed) _ 2 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 chat all facts there& by him stated are true. o aster Plumber. STATE OF FLORIDA, 1 COUNTY OF DADE. Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeared My Commission Expires Notary Public, State of Florida NOTE: A re- inspection fee of $1.00 will be made when such re- inspection is made necessary by improper notice for inspection, or faulty materials and /or workmanship. CLOSETS BATH TUBS 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 Permit No 4-6' £ 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 Registered Architect and/or Engineer Employing Plumber's Name _ MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT Location and Legal Description Lot____ Block Subdivision Street and Number where work is to be performed —No j ( � - Nolo— _ 1 -_ Street No Street + Date Street State work to be performed and purpose of building (By Floors) New Building Remodeling Addition Repairs No. of Stories Size Septic Tank____ Type of Tank 11/ F��^� Capacity Gals � OD Feet of Drain Tile Dist. Feet of Tank or Drain Field from Well Nature of Water Supply: City —Well _ Size of Soakage Pit Amount of Permit $ (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, on w to be perform d under this permit, as are licensed by Miami Shores Village. ire � SS. ( Signed) _ 2 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 chat all facts there& by him stated are true. o aster Plumber. STATE OF FLORIDA, 1 COUNTY OF DADE. Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeared 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 C g i # 3 STATE OF FLORIDA, COUNTY OF DADE. MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT Amount of Permit $ Q _— _------- �__ -__ (Signed)_ 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 E. C. /� _ c" ELL y - - - -_ E / le No. _ Street. 3 57 ° Registered Architect and /or Engineer ..... _-- __ - - -_ ------ _----------------- - - -___ Employing Plumber's Name_1k : A € T � 5i �� i� �.R/l� -- �--- �-- - - - - -� — ��(I � ��Dt?C� No.----- •- - - - D /� �� Street____._. Location and Legal Description Lot______ —Block Subdivision __ ___.— ..______.._____. Street and Number where work is to be performed —No / / 17 /A ' 3 �d Street State work to be performed and purpose of building (By Floors)._ --------------_ -_ -- New Building Remodeling —_ - --___ -_ Addition._._____.___ Repairs No. of Stories. Size Septic Tank _----------- - - - - -- -- __ - - -- - - - - - -- -Type of Tank Feet of Drain Tile.__ / ?___.___Dist. Feet of Tank or Drain Field from Well Nature of Water Supply: City —Well. _____.______ —__. Size of Soakage Pit Capacity Gals My Commission Expires Notary Public, State of Florida Plumbing Inspector. The undersigned applicant for this building permit does hereby certify that he understandsla'nd 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 llas 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. i (Signed)._ 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. 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 worlunanship. CLOBiTe BATH TUBS SHOWERS LAVA TORIES $ INKS SLOP SINKS LAUNDRY TUBS URINALS CATCH BASIN FLOOR DRAIN DRINKING FOUNT•NS TOTAL FIKTUREB 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 C g i # 3 STATE OF FLORIDA, COUNTY OF DADE. MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT Amount of Permit $ Q _— _------- �__ -__ (Signed)_ 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 E. C. /� _ c" ELL y - - - -_ E / le No. _ Street. 3 57 ° Registered Architect and /or Engineer ..... _-- __ - - -_ ------ _----------------- - - -___ Employing Plumber's Name_1k : A € T � 5i �� i� �.R/l� -- �--- �-- - - - - -� — ��(I � ��Dt?C� No.----- •- - - - D /� �� Street____._. Location and Legal Description Lot______ —Block Subdivision __ ___.— ..______.._____. Street and Number where work is to be performed —No / / 17 /A ' 3 �d Street State work to be performed and purpose of building (By Floors)._ --------------_ -_ -- New Building Remodeling —_ - --___ -_ Addition._._____.___ Repairs No. of Stories. Size Septic Tank _----------- - - - - -- -- __ - - -- - - - - - -- -Type of Tank Feet of Drain Tile.__ / ?___.___Dist. Feet of Tank or Drain Field from Well Nature of Water Supply: City —Well. _____.______ —__. Size of Soakage Pit Capacity Gals My Commission Expires Notary Public, State of Florida Plumbing Inspector. The undersigned applicant for this building permit does hereby certify that he understandsla'nd 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 llas 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. i (Signed)._ 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. 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 worlunanship. Approved Correction Re- Insp'n Fee MIAMI SHORES VILLAGE BUILDING DEPARTMENT 305- 795 -2204 Building Inspection Requ Type Insp' Permit No. PI O Name Address - 1 1 \ E 9 3 Company Phone # Inspection Date • •, • • BUILDING PERMIT APPLICATION FBC 2001 City flf a,rh � c‘ta✓ State Tenant/Lessee Name 5 i/vt C° Contractor's Address City / , /? Qualifier $ Value of Work For this Permit Type of Work: ❑Addition Describe Work: Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 Permit Type (circle): Building Electrical Plumbing Mechanical Roofing Owner's Name (Fee Simple Titleholder) VD h D � ` ,� , c Pcal a Vini k Phone # Owner's Address // Z /V r� 93 -74- Job Address (where the work is being done) S/2 vn. C City Miami Shores Village County Miami -Dade Zip Is Building Historically Designated YES NO Contractor's Company Name lit P �� �i ^ � �� ti► K ico Phone #3 d:= -C 20 —,$'3 /I/ 4/ / c - State h ) Zip e / /fig C e lo,47 t� Architect/Engineer's Name (if applicable) Phone # ENew Zip Permit No. L 0 4 ` 1 Master Permit No. Phone # Square Footage Of Work: •*" T l { e;n • e ='; J./Replace. ^ * * * * * * * * * * * * * * * * * * * * * * * * * * ** F ees * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** T emolition Code Enforcement $ Structural Plan Review. $ Total Fee Now Due $ "I d C(1,4}.) (Continued on opposite side) raw 7 / Submittal Fee $ Permit Fee $ /'7 . • 0 CCF S / , 8 (0 CO /CC Notary $ Training/Education Fee $ -. 17 0 Technology Fee $(, ? Scanning $ Radon $ Zoning Bond $ QV Bonding Company's Name (if applicable) Bonding Company's Address City State Zip Mortgage Lender's Name (if applicable) Mortgage Lender's Address City State Zip Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRICAL WORK, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and AIR CONDITIONERS, ETC OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. "WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT." Notice to Applicant: As a condition to the issuance of a building permit with an estimated value exceeding $2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be approved and a rein.spection fee will be charged. Signature l• , t Sv &_ 4 l Owner or Agent '-' tt ument was ackn Jedged before me this ±` 0 _ by The foregoin day of who is NOT Sign: Print: Chc 12/15/03 State Certificate or Registration No. or who has produced * ** ** 1 W (Certificate of Competency Holder) Contractor The foregoing, tstrument was acknowle d for day of VV►► , 20 b who is pers NOTARY P Sign: Print: sMy Comm Certificate of Competency No. * * * * * * * * * * * * * * * * * * * * * * * * * * ** * ********************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** APPLICATION APPROVED B V: - �:� Z t �.._ ' /0i Plans Examiner Engineer Zoning STATE OF FLORIDA DEPARTMENT OF HEALTH ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM CONSTRUCTION PERMI CONSTRUCTION PERMIT FOR: [ ]New System [ ]Existing System [ X ]Repair [ ]Abandonment ]Holding Tank [ ] Innovative Other [ [ ]Temporary [ NA ] APPLICANT: Pattavina, John & Diane AGENT: WALLACE P, Ponder Wallace PROPERTY STREET ADDRESS: 112 NE 93 St Miami Shores FL 33138 LOT: 13 BLOCK: 23 PROPERTY ID #: 11- 3206 -013 -3140 SUBDIVISION: Miami Shores [Section /Township /Range /Parcel No.] [OR TAX ID NUMBER] CENTRAX #: 13 -SG -20754 DATE PAID: FEE PAID : $ RECEIPT . OSTDSNBR : 04-1704- -R SYSTEM MUST BE CONSTRUCTED IN ACCORDANCE WITH SPECIFICATIONS AND STANDARDS OF CHAPTER 64E -6,FAC DEPARTMENT APPROVAL OF SYSTEM DOES NOT GUARANTEE SATISFACTORY PERFORMANCE FOR ANY SPECIFIC TIME PERIOD. ANY CHANGE IN MATERIAL FACTS WHICH SERVED AS A BASIS FOR ISSUANCE OF THIS PERMIT, REQUIRE THE APPLICANT TO MODIFY THE PERMIT APPLICATION. SUCH MODIFICATIONS MAY RESULT IN THIS PERMIT BEING MADE NULL AND VOID. ISSUANCE OF THIS PERMIT DOES NOT EXEMPT THE APPLICANT FROM COMPLIANCE WITH OTHER FEDERAL, STATE OR LOCAL PERMITTING REQUIRED FOR PROPERTY DEVELOPMENT. SYSTEM DESIGN AND SPECIFICATIONS T [ 900 ]Gallons SEPTIC TANK A [ 0 ]Gallons N [ 0 ]GALLONS GREASE INTERCEPTOR CAPACITY K [ 0 ]GALLONS DOSING TANK CAPACITY [ 0 ]GALLONS D [ 300 ]SQUARE FEET PRIMARY DRAINFIELD SYSTEM R [ 0 ]SQUARE FEET SYSTEM A TYPE SYSTEM: [ N ]STANDARD [ N ]FILLED I CONFIGURATION: [ N ]TRENCH [ N ]BED N F LOCATION TO BENCHMARK: Top of Bottom Floor, 11.20' NGVD. I ELEVATION OF PROPOSED SYSTEM SITE [ 1.3 ] [ FEET g 4.0 ] [ FEET L D FILL REQUIRED: [ 0.0 ]INCHES EXCAVATION REQUIRED: [ 0.0 ] INCHES BOTTOM OF DRAINFIELD TO BE OTHER REMARKS: *Replace existing broken septic tank by a new 900 gl. with its approved outlet filter. *Install 300 sq.ft. of drainfield. *Invert elevation to be no less than *Bottom elevation to be no less than SPECIFICATIONS BY: Icaza, Carlos APPROVED BY: Icaza, Carlos DATE ISSUED: 5/10/04 7.73' NGVD. 7.23' NGVD. TITLE: DH 4016, 03/97 (Obsoletes previous editions which may not be used) (Stock Number: 5744- 001 - 4016 -0) lostds_cons_4016 -1) MULTI - CHAMBERED /IN SERIES: [Y ] MULTI- CHAMBERED /IN SERIES: [Y ] ▪ [0 ]DOSES PER 24 HRS # PUMPS[ 0 ] septic tank. [ N ]MOUND [ N ] [ N ] [ BELOW BENCHMARK /REFERENCE POINT [ BELOW BENCHMARK /REFERENCE POINT ATINLY INSTALLED ct p 11i Yf t i , �•rrr� .. r. dPfEUbl1 /IN1:: E l S rrp .. ( r fiiPPEI o WED OUTLET FIE b g TITLE: Engineer I Dade EXPIRATION DATE: 8/8/04 CHD Page 1 of 2 Scale: Each block represents 5 feet and 1 inch = 50 feet. ■ Notes: Site Plan submitted by: Plan Approved By County Health Department ALL CHANGES MUST BE APPROVED BY THE COUNTY HEALTH DEPARTMENT DH 4015. 10/96 (Replaces HRS-H Form 4015 which may be used) (Stock Number: 5744-CM-4015A STATE OF FLORIDA DEPARTMENT OF HEALTH APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PERMIT Application Number `� ° /2dY ®® PART II - SITE PLAN Signature Not Approved Title Date S ° 5-6 Page 2 of 3 APPLICANT: LOT: 13 ,, 1 s t BLOCK: z STATE OF FLORIDA DEPARTMENT OF HEALTH ONSITE SEWAGE DISPOSAL SYSTEM SITE EVALUATION AND SYSTEM SPECIFICATIONS Jp A ,V', 1 / 12 r� f e),Hb vil r) AGENT: /(7 1fC7c E a SUBDIVISION: // m ' S e PROPERTY ID #: // .72O( _ 012 « 3 /y0Section /Township /Range /Parcel No. or ax ID Nu TO BE COMPLETED BY ENGINEER, HEALTH UNIT EMPLOYEE, OR OTHER • • RSON ENGINEER'S MUST PROVIDE REGISTRATION NUMBER AND SIGN AND SEAL EACH PAGE OF SUBMITTAL. COMPLETE ALL ITEMS. Munsell #/Color Texture Depth 1 OM 41_5 St aC, '0 to /_ i t btn/ K to W S6 to n < to to 1 ( to ) to ( to / to USDA SOIL SERIES: M „S SITE EVALUATED BY: DH 4015, 10/96 (Replaces HRS -H Form 4015 [Page 3] which may be used) (Stock Number: 5744- 003 - 4015 -1) PERMIT # /z /7c3/' PROPERTY SIZE CONFORMS TO SITE PLAN: [� YES [ ] NO NET USABLE AREA AVAILABLE: „A T ACRES TOTAL ESTIMATED SEWAGE FLOW: 00 GALLONS PER DAY SIDF.N 1 / OTHER -TABLE 2] AUTHORIZED SEWAGE FLOW: ,� 2 GALLONS PER DAY [1500 GPD /ACRE OR 500'Gk. ACRE] UNOBSTRUCTED AREA AVAILABLE: _OQ SQFT UNOBSTRUCTED AREA REQUIRED:"]cC SQFT BENCHMARK /REFERENCE POINT LOCATION: ELEVATION OF PROPOSED SYSTEM SITE IS / ' [INCH S� [ABOVE /�Q 'IE CHNAR REFERENCE POINT THE MINIMUM SETBACK WHICH CAN BE MAINTAINED FROM PEE �P SYSTEM TO THE FOLLOWING FEATURES; SURFACE WATER: Al/ i DITCHES /SWALES: ///' Al/i FT Ail' WET? [ ] YES [4i] NO /01 WELLS: PUBLIC: A//A FT LIMITED USE: / FT PRIVATE: /V� FT NON - POTABLE: 4/14 FT BUILDING FOUNDATIONS: 5- FT PROPERTY LINES: ,/,' FT POTABLE WATER LINES: /f FT SITE SUBJECT TO FREQUENT FLOODING: [ ] YES [ NO 10 YEAR FLOODING? „0 ] YES [ ] NO 10 YEAR FLOOD ELEVATION FOR SITE: FT MSL /NGVD SITE ELEVATION: S 54 FT MSL /NGVD 5. < IV/ SOIL PROFILE INFORMATION SITE 1 SOIL PROFILE INFORMATION SITE 2 Munsell # /Color Texture /') V .k Y/ 3<J e) to (g , //.2 , /( kl S it.a -/ :,: to ley y %.,lt to >> J, ,i1` to / V to \. , } to ,"` to / 4 to USDA SOIL SERIES: „tf'' Depth OBSERVED WATER TABLE: /0 INCHES [ABOVE / BELOW], XISTING GRADE. TYP • �ERL / APPARENT] ESTIMATED WET SEASON WATER TABLE ELEVATIONy g INCHES [ ABOVE / BELQy1)] EXISTING GRADE. HIGH WATER TABLE VEGETATION: [ ] YES [ \/NO MOTTLING: [ ] YES [ NO DEPTH: �/1 INCHES SOIL TEXTURE /LOADING RATE FOR SYSTEM SIZING: / /j) f;j DEPTH OF EXCAVATION: _;" INCHES DRAINFIELD CONFIGURATION: [ ] TRENCH (VI BED [ ] OTHER (SPECIFY) REMARKS /ADDITIONAL CRITERIA: DATE: S - Page 3 of 3 Miami Shores Village 10050 NE 2nd Avenue Phone: 305 - 795 -2204 Permit Number: PL2004-145 Printed: 5/18/2004 Applicant: DIANE PATTAVINA Owner: PATTAVINA DIANE JOB ADDRESS: 112 NE 93 ST Contractor W P SEPTIC TANK CO INC Local Phone: 305 - 620 - 6320 Parcel # 1132060133140 Plumbing Permit Contractor's Address: 17235 NW 12 CT Page 1 of 1 Legal Description: MIAMI SHORES SEC 1 AMD PB 10 -70 LOTS 13 & 14 BLK 23 LOT SIZE Fees: Description Amount FEE2004 -5007 Building Fee $175.00 FEE2004 -5008 CCF $1.80 FEE2004 -5009 Training and Education Fee $0.60 FEE2004 -5010 Technology Fee $4.37 FEE2004 -5011 Builders Bond $300.00 Total Fees: $481.77 Total Fees: $481.77 Total Receipts: $481.77 Permit Status: APPROVED Permit Expiration: 11/14/2004 Construction Value: $2,388.00 Work: NEW DRAINFIELD AND SEPTIC TANK 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 thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I assume responisibility for all work done by either myself, my agent, servants or employes. Signed: (Contractor or Builder) BY: PERMIT APPLICATION FOR MIAMI SHORES VILLAGE Date 7 20/00 Job Address / / 2 /)e 9 S1 Tax Folio Legal Description /1 > 7 /3 /i hG 2 $ Owner/Lessee / Tenan Owner's Address / / 0 tie �j3 Contractin Co. C' .S S /S 740 Qualifier 111 / state# CPC— ® V25 0 Architect/Engineer p Municipal # Bonding Company 0 J / L Address Mortgagor Permit Type (circle on • ): BUILDIN ELECTRICA WORK DESCRIPTION ( -A 0 r ( S P,- Po oc_ S P A- Square Ft. OWNER'S AFFIDAVIT: I certify that all the foregoing inform: '•n is accurst laws regulating construction and zoning. Furthermore, I authorize the above -n A er ETH g ent Date My Commission E Notary Public, State of Florida My comm. exp. May 24, 2003 omm. No. CC819725 ,w go 47, a FEES: PERMIT , 8 O RADON APPROVED: Zoning il Mechanical Historically Designated: Yes No Master Permit # Phone 3 (7 Address /0 Z0 /f E /r/ 1 /� SS# Phone /� � o c o 0 / Competency # Ins. Co. !/ --- 61...e lc//I Address r 7 Address PLUMBNN MECHANICAL ROOFING PAVING FENCE a 6 a - 2 3 ( C/ ' I C peril tart' : i ontractor or Own er -B d y Con ��IAN Notary Public, State of Florida exp. May 24, 2003 A comm. m . N CC819 C.C.F. , f NOTARY — O Engineering 1 SIGN Estimated Cost (value) Poe3L / 0 0 - •_ It 3 OD o WARNING TO OWNER: YOU MUST RECORD A NOTICE OF COMMENCEMENT AND YOU FAILURE TO D 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, PO and MECHANICAL WORK. will .. one in compliance with all applicable work stated. BOND 1 TOTAL DUE Electrical /04, u y i s d e 3 //o/ A RECORDED COPY MUST BE IEOSTED ON THE JOB SITE AT TIME OF FIRST INSPECTION PERMIT NO. TAX FOLIO NO. • STATE OF FLORIDA: _ COUNTY OF DADE: 008375 15 1 2000 AUG 03 12:34 THE UNDERSIGNED hereby gives notice that improvements will be made to certain real property, and in accordance with Chapter 713, Florida Statutes, the following information is provided in this Notice of Commencement. , 1. Legal description of property and street address: //, /0_ 9 S' //1 r. i'i 2. Description of improvement: / D DZ.- A J Ca "$ 7 ' ✓ C CX 3. Owner(s) name and address: 1)) 4-0 / / l �7, ✓✓ //J i / // NG S7ve� / / f / / ffo � Interest in property: Name and address of fee simple titleholder: 4. Contractor's name and address: O L. S Moo RA 1st SI A. rritgatt eL. S 5. Surety:(Payment bond required by owner from contractor, if any) Name and address: Amount of bond $ 6. Lender's name and address: 7. Persons within the State of Florida designated by Owner upon whom notices or other documents may be served as provided by Section 713.13(1)(a)7., Florida Statutes, Name and address: 8. In addition to himself, Owner designates the following person(s) to receive a copy of the Lienor's Notice as provided in Section 713.13(1)(b), Florida Statutes. Name and address: _ ,A 9. Expiration date of this Notice of Commencement: (the expirati a is 1 year from the date of recording unless a different date is specified) . of Owner Print Owners Name Sworn to and sub Notary Public Print Notary's • ' e My Commissi• Expifes:..� r• `. fr s •ed bef• a thi day of NOTICE OF COMMENCEMENT Nota P ' 1' eigAeLt KENNETH SHERMAN My comm. exp. May 24, 2003 nnn. No. CC819725 iC OF FLOC: C' OF DADE ' CEq T;ry r■;i: V �'rn By Prepared by: Address: tcJ$Sz (� Do 461 -rI 30(6) 12301.52 2.93 . CRITIQUE SHEET JOB ADDRESS )I A / > 5 k4Z APPLICANT E 5(� 4:91.5 PHONE It APPUCAT1ON t€ SHEET OF MISCELLANEOUS DATE PERMIT NO. ADDRESS: MIAMI SHORES VILLAGE BUILDING / ZONING DEPARTMENT' SECTION BY l DATE ZONING ELECTRICAL MECHANICAL PLUMBING FIRE PUBLIC WORKS STRUCTURAL BUILDING OFFICIAL 1. Sub{ad to compliance with alt Fedetai. State. Cocmty, Wage tales and tagutattaas. V&tage assume= na tespanstbtltty for accutrcy oflot cesutts fro* these ptans. Z Th1s copy of plans must be ;meltable ca building site or ao Inspection Mil be coadactad. 2 e' /x'6 tG COMMENTS INITIALS . & 0E4 /MK. Sit vey qg /y /rr ‘5 h4 6 .4. CO/ 5,q if VGAy 7 6 . 7 - - /..5 / fer '5 6* 5i,1 s /yotV��f s,Q 1 a WILL" , /�tC L T - 5ie 1 C.J . emu E ivct� s0/ '-E - r ' ..se(i' c lose/ .h t' &5 ((e.4 ? 5Tia(,cc ttatiL -Y - 5¢66(4 LIN' r eta Mr(o /v 3 s' tkuSF 3c r` `1` 9/7/ K_Lif./.461/4„, // LL i0: Ste: Pa 7761 V/ 4e - / / 2 /VV 9 3 sT L , D'- 71Z5/00 TYPE OF Raw : S u, - / u ,-a,f COL'_ =ON 4-o 2, 24 .7, g/ fro 01 head needs 10 be dr excav i-j See + 5c ale a cvo r5 a dv' t,.) ©u/d 7o /J ri • 5ajgec� e,t fesF F re) 6k. ;S, e PAGE Lcr..zriaT C A rS • f r' &eX (wr 47 Dr ro of ¢-v hovt5� ✓l /cZe Sec 12;v t, 6nde . S - uJAej vaa -etS u v'e s i.}18 b e fa- .eat o p1/ilec 41(e o , I veYl t v 112-1/Lee b e re C 2 L e ` le v t fv-awL, cam, v vl Govt 11, e von Y 5o a 1 7cezt va v I-0 4 er i �Gf� -1 1 eV&_-1 - Permit No Size Septic Tank__.______ Feet of Drain Tile__ Nature of Water Supply: City —Well. Amount of Permit $_— STATE OF FLORIDA, } COUNTY OF DADE. XJDQG O MORES VW z ©[ PLUMBING INSPECTION DEPARTMENT APPLiCA'DON FOR PLUMBO ©PI PER ,M ( Signed) ( Signed) `. Date.. January 2. 19/IP 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 __..__Dr . _ E.C. _Geiger _ _ — No. 11 — — Street N.E. 93 S t . Registered Architect and /or Engineer — ----------___ - _ - Employing Plumber's hae__. Txia g.].ga.s__Tt n.,.p.f__.F_llzri No. 2540 S� Ave. m Location and Legal Description Lot__ - _ - - - -- _ - __ —_ -- Block_ Street and Number where work is to be performed —No 112 N.E. 9 3 S treet Street State work to be performed and purpose of building (By Floors) New Building _____ ___ Remodeling______ Addition Repairs No. of Stories . . . ... .. ... Subdivision _Type of Tank _Dist. Feet of Tank or Drain Field from Well -- -- -. ---- -_ --�_ -- - Size of Soakage Pit __Capacity Gals. Plumbing nspe ctor. The undersigned applicant for this building permit does hereby certify that he understands and accepts his obliga • I s as an employer of labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Permanen upplement, 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. �LL G 48916 by Commission Expires Notary Public, State of Florida 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. NOTE: A re- inspection fee of $1.00 will be made when such re- inspection is made•ne:essary by improper notice for insp - 'n, or faulty materials and /or workmanship. CLODETB BATH 'rues UB6 SHOWERO LAVA- TORIES SINKS SLOP SINKS LAUNDRY TUBS URINALS CATCH BASIN FLOOR DRAIN DRINKING FOUNT' NS TOTAL FIXTURES CONTR. LIDT CHECK SEPTIC TANK SEWER CONN. DRAIN FIELD SOAKAGE PIT GREASE TRAP SOLAR HEATER DEEP WELL SPRKLR. SYSTEM SWIM'G POOL Gas Grill 1GAh 1.00 COMM LIOT 1.00 CHECK Permit No Size Septic Tank__.______ Feet of Drain Tile__ Nature of Water Supply: City —Well. Amount of Permit $_— STATE OF FLORIDA, } COUNTY OF DADE. XJDQG O MORES VW z ©[ PLUMBING INSPECTION DEPARTMENT APPLiCA'DON FOR PLUMBO ©PI PER ,M ( Signed) ( Signed) `. Date.. January 2. 19/IP 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 __..__Dr . _ E.C. _Geiger _ _ — No. 11 — — Street N.E. 93 S t . Registered Architect and /or Engineer — ----------___ - _ - Employing Plumber's hae__. Txia g.].ga.s__Tt n.,.p.f__.F_llzri No. 2540 S� Ave. m Location and Legal Description Lot__ - _ - - - -- _ - __ —_ -- Block_ Street and Number where work is to be performed —No 112 N.E. 9 3 S treet Street State work to be performed and purpose of building (By Floors) New Building _____ ___ Remodeling______ Addition Repairs No. of Stories . . . ... .. ... Subdivision _Type of Tank _Dist. Feet of Tank or Drain Field from Well -- -- -. ---- -_ --�_ -- - Size of Soakage Pit __Capacity Gals. Plumbing nspe ctor. The undersigned applicant for this building permit does hereby certify that he understands and accepts his obliga • I s as an employer of labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Permanen upplement, 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. �LL G 48916 by Commission Expires Notary Public, State of Florida 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. NOTE: A re- inspection fee of $1.00 will be made when such re- inspection is made•ne:essary by improper notice for insp - 'n, or faulty materials and /or workmanship. ' wr MIAMI SHORES VILLAGE, FLA. JOB .ti °o e i / N9 6251 ADDRESS '1 INSPECTION . o � . TIME READY . c REMARKS • INSPECTOR DATE Permit No __`_v__(- ___ __ ___ 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 • Owner's Name and Ad. / ss 1, ..lS.�.b Registered Architect and /or Engineer Employing Plumber's Name J-0") e __— Location and Legal Description Lot__ _ -__—_ ________ ______--- -______ _� — Block__-___._ 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 STATE OF FLORIDA, i COUNTY OF DADE. My Commission Expires Aho am S4' -M ORES VILLAGE PLUMBING INSPECTION DEPARTMENT QppLDCMD©o l FOR PLUMBING PER IT No.__— //;' Street__X r E l ( Signed) _ No.__ .9-C3 Street_ Subdivision Street Date `1 _ J — y ai 7. 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: City —Well Size of Soakage Pit Amount of Permit _ (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, on work to be performed under this permit, as are licensed by Miami Shores Village. ci 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 swom, 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 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. CLOHaTB BATH TUBS S HOWERD LAVA- TORIES SINKS SLOP SINKS LAUNDRY TUBE URINALS CATCH BASIN FLOOR DRAIN DRINKING FOUNT' NS TOTAL FIXTURES CONTE!. LIST CHICK — SEPTIC a, _ SEWER CONN. DRAIN FIELD SOAKAGE PIT GREASE TRAP SOLAR HEATER DEEP WELL SPRKLR. SYSTEM SWIM 'G POOL CL ior LIST -- — CHICK Permit No __`_v__(- ___ __ ___ 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 • Owner's Name and Ad. / ss 1, ..lS.�.b Registered Architect and /or Engineer Employing Plumber's Name J-0") e __— Location and Legal Description Lot__ _ -__—_ ________ ______--- -______ _� — Block__-___._ 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 STATE OF FLORIDA, i COUNTY OF DADE. My Commission Expires Aho am S4' -M ORES VILLAGE PLUMBING INSPECTION DEPARTMENT QppLDCMD©o l FOR PLUMBING PER IT No.__— //;' Street__X r E l ( Signed) _ No.__ .9-C3 Street_ Subdivision Street Date `1 _ J — y ai 7. 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: City —Well Size of Soakage Pit Amount of Permit _ (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, on work to be performed under this permit, as are licensed by Miami Shores Village. ci 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 swom, 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 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 ❑ PERMIT N° 15933 ❑ Work to be performed under this Permit Architect Contractor or Builder Legal Lot II BI. Description Address of Building CONTRACTOR OR BUILDER MIAMI SHORES VILLAGE, FLORIDA Subdi- vision Value of Project $ DATE 195 Contractor's License No Amt. of Permit $ 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 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. 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 pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I assume responsibility for all work done by either, myself, my agent, servant or employee. BY AUTHORITY BUILDING ELECTRICAL PLUMBING MIAMI SHORES VILLAGE, FLORIDA DATE 194 PERMIT N° 5120 Work to be performed under this Permit Owner of Building Contractor's License No Architect Contractor or Builder Legal Lot Bl. Subdi- Description vision - y Address of Value of Amt. of Building Project Permit 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 w th 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 respon- sibility 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 pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this 'permit I assume responsibility for all work done by either myself, my agent, servant or employee. e CONTRACTOR OR BUILDER BY AUTHORITY BUILDING ELECTRICAL PLUMBING Owner of ri -Building Contractor's License No. n r Work to be performed under this Permit /iA- � Architect Contractor , f J - or Builder V v t— i -ti ;. ,-? Legal Lot a it � y jp V Bl. Description Address of Building CONTRACTOR OR BUILDEE". MIAMI SHORES VILLAGE, FLORIDA DATE c� 5120 Subdi- ,! vision .U� n ,� f � p Value of Amt. of � " n Project Permit BY AUTHORITY 194'7 This permit is granted to the contract. `or builder ed above to construct the building or to install the equipment or . - rice . 'scribed in the appli- cation herefor in strict compliance with all ordinances pertaining thereto and with the understanding that the work will be performed ' 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 changedwithout authorization. A further condition upon which this permit is granted is the understanding that the contractor or builder named above assumes the're a thorough knowledge of the ordinances and regulations pertaining to the work covered hereby whether shown on the plans or swings -or'in the statetueritsecifications and that he assumes respon- sibility for work done by his agents, servants or employees. % _ n. � Signed. r 'Y� � �G, By 0. 9ENSPECTOR In consideration of the issuance to me of this permit I agree to perform the work covered hereunder in compliance with all ordinances and re tions pertaining thereto and in strict confomrity with the plans, drawings, statements• or specifications submitted to the proper authanies of Miaai ghof lage. In accepting this permit I"assume responsibility for all work done by either myself, my agent, servant or employee. ( . < 7 .- - ^ -i Nature of Water Supply: City —Well Amount of Permit $_ ss. MIAMI SHORES VILLAGE • PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT Owner's Name and Address Registered Architect and /or Engineer Employing Plumber's Name - No Street • (Signed) _ (Signed) • Permit No �� �� _ _ -- 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. • No Street Location and Legal Description Lot _ Block_______________ Subdivision 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 No. of Stories / Size Septic Tank Type of Tank Capacity Gals Feet of Drain Tile Dist. Feet of Tank or Drain Field from Well Size of Soakage Pit Plumbing Inspector. 11 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. Master Plumber. STATE OF FLORIDA, t 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 I therein by him stated are true. My Commission Expires Notary Public, State of Florida NOTE: A re- inspection fee of $1.00 will be made when such re- inspection is made necessary by improper notice for. inspection, or faulty materials and /or workmanship. • CLOSETS BATH TUBS SHOWERS LAVA- TORIES SINKS SLOP SINKS LAUNDRY TUBS URINALS CATCH BASIN FLOOR DRAIN DRINKING FOUNT 'NS TOTAL FIXTURES CONTR. LIST b CHECK SEPTIC TANK SEWER CONN. DRAIN FIELD SOAKAGE PIT GREASE TRAP SOLAR H EATER DEEP WELL SPRKLR. SYSTEM SW IM'G POOL A 4 09/72 .e. 7/ - [_,w5 0* / CONTR. LIST ____.3 lO �• CHECK Nature of Water Supply: City —Well Amount of Permit $_ ss. MIAMI SHORES VILLAGE • PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT Owner's Name and Address Registered Architect and /or Engineer Employing Plumber's Name - No Street • (Signed) _ (Signed) • Permit No �� �� _ _ -- 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. • No Street Location and Legal Description Lot _ Block_______________ Subdivision 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 No. of Stories / Size Septic Tank Type of Tank Capacity Gals Feet of Drain Tile Dist. Feet of Tank or Drain Field from Well Size of Soakage Pit Plumbing Inspector. 11 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. Master Plumber. STATE OF FLORIDA, t 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 I 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. • • ... 46 tytoi • • • "7 I ) -4- 4 1 # , - •