PLUMBING PERMITDate 12 22 -Q9
Legal Description MI 1\ M 1 500R-es SK . Pimp Historically Designated: Yes No
Owner/Lessee / Tenant TO F}N 0 2 6a-EN Master Permit #
Owner's Address k k N E 91 S f2E Phone
Contracting Co. %WTI G C C * )3E ('&S' c Address ' P O Ro)( 3 S 6 I*o L1 \ w 0 t F/.
SS# Phone (305)O61- 663333°
Qualifier TES Si\ J. SO LO r10 rJ
State # E 9 $b l g Municipal # -- Competency # Ins. Co. N ft 7 1 Cti-LI S
Architect/Engineer — Address
Bonding Company Address
Mortgagor Address
Permit Type (circle one): BUILDING ELECTRICAL P . UMB 1 MECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIPTION
Square Ft. 34-
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
n NE qZ STQ.eec
Job Address Tax Folio kl - '20G-013-3160
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 AF"F7DAVIT: 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.
Signature of o er and/or Condo President
Zoning
Mechanical
Notary as ' Owner and/or C
My Commis ' ices:
I N 5-1- 4k,c Da-P uJ r k
519
P-1 ‘) I
...
V ..., lere:.a.i. Feld
Notary Punk, Siam of Fionub
Commission No. CC 4a080
n. �, itv Coau>.issiuu Exptres 1 16?
V li4uo., No1A4? . l IA Noon serrx e a' »_ xi4.
n• • •+ e: •44444ietiWrde'1iiAl'ollieild$47:
FEES: PERMIT, ' RADON C.C.F.
APPROVED:
2z 06 �g
Date
Estimated Cost (value) ID-00 1 '
Notary as • Contractor or
My Commission Expires:
1 NOTARY .J BOND
a S 12 u. �q
° if
MOT S
DYS NOTARY PUBLIC ST I AT E EO OF F LORIDA
COMMISSION NO. CC ?I4103
MY COMMISSION EXP. MAR. 12002
Electrical
Structural Engineer
STATE OF FLORIDA
DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES DATE PAID j2-/C)-
ONSITE SEWAGE DISPOSAL SYSTEM FEE PAID $
CONSTRUCTION PERMIT RECEIPT #
Authority: Chapter 381, FS & Chapter 10D -6, FAC
c
CON TRUCTION PERMIT FpR:
[ ] New System [N']r Existing System [Y]Iiolding Tank [Wi] Temporary /Experimental
[ y] Repair [ /4 Abandonment [ ` Other-(Specify)
APPLICANT: AGENT
PROPERTY STREET ADDRESS: N e q �/d
LOT: / 6 7 BLOCK: 23 SUBDIVISION: / 1/7/4 7- 4 ' , / Z'XIC9/T.C- Z5 AL G iL
PROPERTY ID #: [SECTION /TOWNSHIP /RANGE /PARCEL NUMBER]
// Z 0 G- O (a - 15 / 6C) [OR TAX ID NUMBER]
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 [ 9O3] s _ / GPDJ4EPTIC T /AEROBIC UNIT CAPACITY MULTI- CHAMBERED /IN SERIES:[ ]
} A [ ] [GALLONS / GPD] CAPACITY MULTI- CHAMBERED /IN SERIES:[ ]
N [ ] GALLONS GREASE INTERCEPTOR CAPACITY [MAXIMUM CAPACITY SINGLE TANK: 1250 GALLONS]
K [ ] GALLONS PER DOSE DOSING TANK CAPACITY DOSE RATE [ ] PER 24 HRS NO. OF PUMPS: [ ]
T
H
E
R
APPROVED BY:
DATE ISSUED:
D 009 SQUARE FEET PRIMARY DRAINFIELD SYSTE
R [ ] SQUARE FEET
A TYPE SYSTEM:
I CONFIGURATION:
N
SYSTEM
[ ] STANDARD [ ] FILLED [ ] MOUND
[ ] TRENCH [ D [ [
F LOCATION OF BENCHMARK: J� CC / N�'� l) ROF 6'/ /b0 �L.c1t)� `d 74/' f S f/ )
I ELEVATION OF PROPOSED SYSTEM SITE [ ] [INCHES /FT] [ABOVE / I.OW] BENCHMARK /REFERENCE PO - N . ,^-
E BOTTOM OF DRAINFIELD TO BE [ ]([INCHES /FT] [ABOV: BELO :• ENCHMARK EFERENCE POIN
L
D FILL REQUIRED: [ INCHES EXCAVATION REQUIRED: [-i? •] INCHES
LJL 6' C ■
/2.-/C-
SPECIFICATIONS BY: TITLE:
HRS -H Form 4016, Mar 92 (Obsoletes previous editions which may not be used)
(Stock Number: 5744-001- 4016 -0)
appLocaa4
PERMIT # ( 4 7A L.6K9
SS T" /e GO iV i1JC- 7
TITLE: CPHU
EXPIRATION DATE: 3 -0C^
Page 1 of 2
N Permit tracking number assigned by
A`'P : :.CA'i zcN b O Check type of permit, if °C.ther° sy /
Property owner's full name.
Telephone number for applicant or
Property owner's legally authorizes
2. ^_A11.._N.; ADDRESS: P.O. box or street mailing acdreso c, cg-n,
3i OC;:C, SU3D VISION or
?utC?.3 TY IDO: 27 character id number for property. (C? :J -may r„ruire propery appm iser ID // or sectio_Jtpwr:_h /ra_,;c /parcel number)
SYSTEM DESIGN AND
SPEC 4ICA":IONS:
TAN:C: Minimum specifications from Chapin: s C:-'-G, FAC.
D` AYNFIELD: Minimum specifications from Cha, :.:: lC ::-d, :r'AC.
C','l;, Other specifications, such re operating 7ormit :cquiraments, loci- volume flush toilets, variance provisos.
SPEC. ICATIONS Bu: Name of individual providing spec.:ectiona. "desi :ned: y n registered engineer must be scales,.
APPROVED BL': County Public Health Unit (CPHU) personnel reviewing and approving permit.
DATA. SSSU "`D: Date permit is issued by CPHU.
EX ?1 ATION DATE: One year from date issued if the system has not been installed. Permits for system repairs become void 90 days from the date
issued.
}
APPLICANT:
j(04 N b RG2 .v
LOT: 1 ! ,-1 BLOCK: 2'5
PROPERTY ID 1 _ 32 O ( - 0) 3-. 31 ‘0
TO BE COMPLETED BY ENGINEER, HEALTH UNIT EMPLOYEE, OR OTHER QUALIFIED PERSON. ENGINEER'S MUST
PROVIDE REGISTRATION NUMBER AND SIGN AND SEAL EACH PAGE OF SUBMITTAL. COMPLETE ALL ITEMS.
PROPERTY SIZE CONFORMS TO SITE .PLAN :t ?r4
TOTAL ESTIMATED SEWAGE FLOW:
AUTHORIZED SEWAGE FLOW:
UNOBSTRUCTED AREA AVAILABLE:
BENCHMARK /REFERENCE POINT LOCATIO
ELEVATION OF PROPOSED-SYSTEM SITE IS [INCHESA5] [ABOVE/CO] N:
- -- •- EREN POINT
THE MINIMUM SETBACK WHICH
SURFACE WATER: O A FT
WELLS: PUBLIC: trAN FT
BUILDING FOUNDATIONS:
SITE SUBJECT TO FREQUENT FLOOD+NG:
10 YEAR FLOOD ELEVATION FOR SITi:
SOIL PROFILE INFORMATION SITE 1
Munsell # /Col "" or Texture
USDA SOIL ° SERIES:
Depth
to
to
to
to
2 t
l/
to
to
OBSERVED WATER TABLE: - Ii- INCHES [ABOVE /
ESTIMATED WET SEASON WATER TABLE ELEVATION:
HIGH WATER TABLE VEGETiTION: .[ ] YES ( NO
DRAINFIEL AppING AYM n
IGURAAbi EADr 5 1 �[
REMARKS /ADDITIONAL CRITERIA:
15,y120 15,y120
SITE EVALUATED BY:
STATE OF FLORIDA
DEPARTMENT OF HEALTH
ONSITE SEWAGE DISPOSAL SYSTEM
. SITE EVALUATION AND SYSTEM SPECIFICATIONS
CAN =E MAINTAINED FROM THE
DITCHES / <SWALES:
ITED USE: "iN 1N FT
FT PROPE]tTY_„LINES:
OH 4015, 10/96 (Replaces HRS -H Form 4015 [Page 3) which may be used)
(Stock Number: 5744- 003 - 4015 -1)
r'
SUBDIVISION: M FP M , slAorzes SE( 0,440
] YES [)r] NO NET USABLE AREA AVAILABLE: ,- 20 ACRES
.GALLONS PER DAY [RESIDENCES -TABLE 1 / OTHER -TABLE 2]
GA'0NSPE DAY [1500 GPD /ACRE OR 2500 GPD /ACRE]
UNBSTRUCTED AREA REQUIRED: 6,00(2 SQFT
F
[Section /Township /Range /Parcel No. or Tax ID Number]
Ne ' 2 ST, 33)38
AGENT: S 1, c x4164 N
x, c
PROPOSED SYSTEM -T
14; FT NORMALL
PRIVATE: NA FT
5 FT a POTABL
-t % X 10 • YEAR OODING? ( ].YES' tCM NO
(A YES ( ] ENO"µ
MSL /NGVD rtM S TE ELEVATI the-
d
�.� -- - "SO•I- L- .RRQF.I INFO
Munsell # /Color ` Texture
Ll/J
PERMIT # go e97
1 C
THE FOLLOWING FEATURES:
WET? [ ] YES [i ]
NON - POTABLE:
WATER LINES:
ION SITE 2
' ' Depth
$t to "7.2 "
t o
to
to
to
to
1 A
i �Q4 — ter/
NO
FT
FT
FT MSL /NGVD
USDA SOIL/SERIES: )
/ t
-
1 ID ' P / T ]
] EXISTING O E. T E• PERCHED. AP i
C.,i, INCHES [ ABOVE / fiELJA ] EXISTING20ADE.
MOTTLING: [ ] YES, ) ] NO DEPTH: / '-- / i NCHp:S
jP1EPTH OF.-- EXCAVATION • O INCHES
•OTHER (SPECIFY)
3 ' t 7
INSTRUCTIONS:
PERMIT NUMBER: Permit tracking number by County Health Department.
APPLICANT: Property owner's full name.
AGENT: Property owner's legally authorized representative.
LOT, BLOCK, SUBDIVISION: Lot, block, and subdivision for lot.
PROPERTY ID NUMBER: 27 character number for property (property appraiser ID number or section /township /range /parcel number).
PROPERTY SIZE: Check if property at site conforms to submitted site plan. Record net usable area available - lot area exclusive of
all paved areas and prepared road beds within public rights -of -way or easements and exclusive of streams, lakes,
normally wet drainage ditches, marshes. or other such bodies of water.
SEWAGE FLOW:
UNOBSTRUCTED AREA:
MINIMUM SETBACKS:
Record the estimated sewage flow for the establishment from Table 1 (residence) or Table 2 (non - residential),
Chapter 10D-6, FAC. Record the authorized sewage flow for the lot based on net area and water supply
(1500 gallons per day per acre for private water supplies and 2500 gpd per acre for public water supplies). If
authorized sewage flow does not equal or exceed the estimated sewage flow, the application must be denied.
Record the square feet of unobstructed area available and the amount required. Unobstructed area must be at
least 2 times as large as the drainfield absorption area and at least 75 percent of the unobstructed area must meet
minimum setbacks in Chapter 1OD -6, FAC. The unobstructed area must be contiguous to the drainfield.
BENCHMARK INFORMATION: Record the location of the benchmark. If using a surveyor's benchmark record the actual elevation. Record the
elevation of the proposed system site in relation (above or below) to the benchmark.
Record minimum setbacks which can be meet to all listed features. Actual measurements must be recorded or
"NA" for nonapplicable features. Features on site plan or within 75 feet of the applicant lot must be measured.
The location of any public drinking well within 200 feet of the applicant's lot must also be verified.
FLOOD INFORMATION: Record information on lot's subject to flooding. For lots subject to flooding record 10 year flood elevation for
site and actual site elevation.
SOIL PROFILE INFORMATION: Two soil profiles within the proposed absorption area to a minimum depth of 6 feet or refusal are required. Soil
identification will use USDA Soil Classification methodology (Munsell colors and USDA soil textures). Refusals
must be clearly documented. Provide USDA soil series if available, record "UNK" if the series cannot be
determined.
WATER TABLE: Record the depth of the observed water table at the time of the evaluation. Mark "perched" or "apparent" as
appropriate. Record the estimated wet season water table elevation based on site evaluation, USDA soil maps,
and historical information. Indicate if there is high water table vegetation present. Indicate if mottling is present
and depth.
SOIL TEXTURE: Record soil texture or loading rate for system sizing.
DEPTH OF EXCAVATION: If applicable record depth of excavation required. Record "NA" if not applicable.
DRAINFIELD CONFIGURATION: Check drainfield configuration required. If other, specify type.
ADDITIONAL CRITERIA: Record any additional remarks pertinent to site or installation. Ex. dosing required.
SITE EVALUATED BY: Signature of evaluator, title, and date of evaluation. Professional engineers must seal all documents submitted.
ELEVATION WORKSHEET ELEVATION OF BENCHMARK / REFERENCE POINT IS:
BENCHMARK SITE 1 SITE 2 SITE 3
[ + ] SHOT H.1. H.I. H.I.
H.1. [ - ] SHOT [ - 1 SHOT [ - ] SHOT
Site Plan submitted by:
Plan Approved t
By c _— r•.�;,.
STATE OF FLORIDA
DEPARTMENT OF HEALTH 514 it i0647
APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PERMIT
Permit Application Number qPR C li
PART II - SITEPLAN
Scale: Each block represents 10 feet and 1 inch = 40 feet.
.Notes: QO.C N ° 9'1 I•1= 92, ST, 33138
0 S \/ M vv(z .uv,i tNG.
JQ
b ArA
Not Approved
NI
Date —q
M D C_ County Health Department
ALL CHANGES MUST BE PROVED BY THE COUNTY HEALTH DEPARTMENT
DH 4015, 10/96 (Replaces HRS -H Form 4015 which may be used) -,
(Stock Number: 5744 -002 -4015 -6)
Page 2 of 4
•
MI
.......
-
MINIMUM=
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;
x
i.....:
1
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,
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--
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•
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Site Plan submitted by:
Plan Approved t
By c _— r•.�;,.
STATE OF FLORIDA
DEPARTMENT OF HEALTH 514 it i0647
APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PERMIT
Permit Application Number qPR C li
PART II - SITEPLAN
Scale: Each block represents 10 feet and 1 inch = 40 feet.
.Notes: QO.C N ° 9'1 I•1= 92, ST, 33138
0 S \/ M vv(z .uv,i tNG.
JQ
b ArA
Not Approved
NI
Date —q
M D C_ County Health Department
ALL CHANGES MUST BE PROVED BY THE COUNTY HEALTH DEPARTMENT
DH 4015, 10/96 (Replaces HRS -H Form 4015 which may be used) -,
(Stock Number: 5744 -002 -4015 -6)
Page 2 of 4
BUILDING ❑
ELECTRICAL ❑ 195
PLUMBING 0 PERMIT N? 7689
ROOFING ❑
❑ Work to be performed under this Permit
Owner of c t
Building �~
Architect
Contractor
or Builder kt
Legal Lot
Description
Address of
Building
1'
CONTRACTOR OR BUILDER
MIAMI SHORES VILLAGE. FLORIDA
DATE
Contractor's
License No
Bi.
f.;
•
Signed:
Subdi-
vision
Sg. Ft
Value of
Project $
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.
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
Amt. of
Permit $ c
AUTHORITY
BY
t
i E W1 1 r
Pirnmit No
Nature of Water Supply: City —Well
--- - -- --- - - - -- Amount of of Permit $
c12 ,L9MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMEiV
APPLICATION FOR PLUMBING r b,,M1 tl
plication is hereby made for the approval of the detailed statement of the plans and specifications herewith sulnitted 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 plat a d specifications must be kept at
P I — fi
building during progress of work.
No/ Street.
Owner's Name and Address..
Registered Architect and /or Engineer -----
_________
Employing Plumber's Name /&eYielZ— t? -- No 3_
Location and Legal Description Lot__.__.___-------- __ ..... ___________ _ —._ Block___ _ Subdivision
Street and Number where work is to be performed —No J P-i 5'Z + _ Street
State work to be performed and purpose of building (By Floors) ________________
New Building Remodeling_ __J' _ - -- Addition__
(Signed)
- - - - -
1 . c—
a.. J u
Dat� � /_53 (7 s 1
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.
The undersigned applicant for this building permit does hereby certify that he understands and accepts s obligations as an employer of labor
under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Permanent Supplement, and bus com-
plied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors employed by him in the work to be
performed under this permit; and will post or cause to be posted for inspection on the site of the work such public notice or notices as are
required by the Act. The undersigned agrees to employ only such sub- contractors, on work to be performed under this permit, as are
licensed by Miami Shores Village.
(Signed)
Master Plumber.
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 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.
My Conunission 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
TUBS
TUB6
SHOWERS
LAVA-
TORIES
SINK6
SLOP
SINKS
LAUNDRY
TUBS
U
CATCH
BASIN
FLOOR
DRAIN
DRINKING
FOUNT'NS
TOTAL
FIXTURES
CONTR.
LIST
/
/
/
• J
3
CHECK
SEPTIC
TANK
SEWER
CONN.
DRAIN
FIELD
SOAKAGE
PIT
GREASE
TRAP
SOLAR
HEATER
DEEP
WELL
SPRKLR.
SYSTEM
SWIM'G
POOL
CONTR.
LIST
/
CHECK
i E W1 1 r
Pirnmit No
Nature of Water Supply: City —Well
--- - -- --- - - - -- Amount of of Permit $
c12 ,L9MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMEiV
APPLICATION FOR PLUMBING r b,,M1 tl
plication is hereby made for the approval of the detailed statement of the plans and specifications herewith sulnitted 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 plat a d specifications must be kept at
P I — fi
building during progress of work.
No/ Street.
Owner's Name and Address..
Registered Architect and /or Engineer -----
_________
Employing Plumber's Name /&eYielZ— t? -- No 3_
Location and Legal Description Lot__.__.___-------- __ ..... ___________ _ —._ Block___ _ Subdivision
Street and Number where work is to be performed —No J P-i 5'Z + _ Street
State work to be performed and purpose of building (By Floors) ________________
New Building Remodeling_ __J' _ - -- Addition__
(Signed)
- - - - -
1 . c—
a.. J u
Dat� � /_53 (7 s 1
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.
The undersigned applicant for this building permit does hereby certify that he understands and accepts s obligations as an employer of labor
under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Permanent Supplement, and bus com-
plied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors employed by him in the work to be
performed under this permit; and will post or cause to be posted for inspection on the site of the work such public notice or notices as are
required by the Act. The undersigned agrees to employ only such sub- contractors, on work to be performed under this permit, as are
licensed by Miami Shores Village.
(Signed)
Master Plumber.
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 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.
My Conunission 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.
Registered Architect and/or Engineer
MIAMI SHORES NaLLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
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.
f h No I Street _ __Y Z
Owner's Name and Address i . /
Employing Plumber's Name r
Location and Legal Description Lot_
Street and Number where work is to be performed—No
_Block_
No. Street
Subdivision_ -------
2) n_-;' •
Street 9
State work to be performed and purpose of building (By Floors)
New Building Remodeling Addition Repairs No. of Stories
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
Size Septic Tank__
Amount of Permit $_
STATE OF FLORIDA,
ss.
COUNTY OF DADE.
/to
_(Signed)
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 under signed agrees to employ only such sub-contractors, on work to be performed under this permit, as are
licensed by Miami Shores Village.
(Signed)
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
lambing Inspector.
Master Plumber.
NOTE: A re 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
BAN'-
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
SWING
POOL
CONTR.
LIST
CHECK
Permit No.
Registered Architect and/or Engineer
MIAMI SHORES NaLLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
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.
f h No I Street _ __Y Z
Owner's Name and Address i . /
Employing Plumber's Name r
Location and Legal Description Lot_
Street and Number where work is to be performed—No
_Block_
No. Street
Subdivision_ -------
2) n_-;' •
Street 9
State work to be performed and purpose of building (By Floors)
New Building Remodeling Addition Repairs No. of Stories
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
Size Septic Tank__
Amount of Permit $_
STATE OF FLORIDA,
ss.
COUNTY OF DADE.
/to
_(Signed)
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 under signed agrees to employ only such sub-contractors, on work to be performed under this permit, as are
licensed by Miami Shores Village.
(Signed)
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
lambing Inspector.
Master Plumber.
NOTE: A re 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.
MIAMI SHORES VILLAGE
Permit No.._____ , _G
Amount of Permit $_ –_ irt 0
STATE OF FLORIDA,
COUNTY OF DADE. ss.
My Commission Expires
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
(Signed)
(Signed)
Date__ N."
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 i ' 71: 6- ° �° ' / • • r J.1"
/:. t? -r> :: Street-- -- – -- -
Registered Architect and /or Engineer
Employing Plumber's Name t1 !' r� ______ _ �= �P� No. ° s r5 Street /Val a 6
Location and Legal Description Lot__ _Block _ Subdivision- -______
______— __�— _________
Street and Number where work is to be perforated —No 1 2 '
State work to be performed and purpose of building (By Floors)
New Building— — ___ —___— Remodeling Addition Repairs No. of Stories
Size Septic Type of Tank . Capacity Gals _________
Feet of Drain � —_ —__ Dist. Feet of Tank or Drain Field from Well--_________
Nature of Water Supply: City — Well. ___— __ Size of Soakage Pit
Notary Public. State of Florida
lumbing 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 under signed agrees to employ only such sub - contractors, on work to be performed under this permit, as are
licensed by Miami Shores Village.
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 workmanship.
CLOSETS
BATH
TUBS
SHOWERS
LAVA-
TORIES
$INKS
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
SWIM•G
POOL
"
.
CONTR.
LIST
CHECK
MIAMI SHORES VILLAGE
Permit No.._____ , _G
Amount of Permit $_ –_ irt 0
STATE OF FLORIDA,
COUNTY OF DADE. ss.
My Commission Expires
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
(Signed)
(Signed)
Date__ N."
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 i ' 71: 6- ° �° ' / • • r J.1"
/:. t? -r> :: Street-- -- – -- -
Registered Architect and /or Engineer
Employing Plumber's Name t1 !' r� ______ _ �= �P� No. ° s r5 Street /Val a 6
Location and Legal Description Lot__ _Block _ Subdivision- -______
______— __�— _________
Street and Number where work is to be perforated —No 1 2 '
State work to be performed and purpose of building (By Floors)
New Building— — ___ —___— Remodeling Addition Repairs No. of Stories
Size Septic Type of Tank . Capacity Gals _________
Feet of Drain � —_ —__ Dist. Feet of Tank or Drain Field from Well--_________
Nature of Water Supply: City — Well. ___— __ Size of Soakage Pit
Notary Public. State of Florida
lumbing 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 under signed agrees to employ only such sub - contractors, on work to be performed under this permit, as are
licensed by Miami Shores Village.
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 workmanship.
iii n .
Aeffel
•
- Wholesale Distributors
PIPE
AND SUPPLY COMPANY
3120 N.E. SECOND AVE. MIAMI , FLORIDA
• PIPE • VALVES • FITTINGS •
BRIGGS d�e
Plumbing Fixt� Water Heaters
ELJER
Fine Plumbing
Fixtures
PHONE YOUR ORDER TODAY - FRANKLIN 4 -1766
OFFICE OF COUNTY PLUMB INSPECTOR
Dade County Cour se
----Plumbing Per
Permit # 240 MAXI SHORES VILLAGE Miami , Fla / 4 4 , 10
Permission is hereby granted l3�a
to install the following described plumbing, in accordance with the
laws, statutes and regulations of the State of Florida, governing
plumbing and drainage work done in Dade County, Florida.
For a � r �' At NoJ ;`?0 , E. 0 9Aw
Lot. "
Sewer
Permit
Total
lock Subdivision
approved plans
4 0e)
4 $ �. p
Fixtures��
As shown on attached
Fixtures Roughed in
Fixtures Set
0
BUILDING
ELECTRICAL
PLUMBIN3
vit
The following is ready for inspection: -
Inspector's Report:-
: WORK
K
RE), - E}'ED
WILL BE/ READY
S7.
® xit,e.Ar
BUILDING
ELECTRICAL
PLUMBING
Owner of
Building
Work to be performed under this Permit
Architect
Contractor
or Builder
Legal Lot Bl.
Description
Address of
Building
1
r
MIAMI SHORES VILLAGE, FLORIDA
DATE 194
PERMIT N9 3232
Subdi-
vision
Value of
Project
Contractor's
License No.
Amt. of
Permit
/ j
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.: ;
) r
Signed• By INSPECTOR
In consideration of the issuance to me of this permit I agree to perform the .>vork covered hereunder in compliance with all ordinances and regula-
tions 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.
CONTRACTOR OR BUILDER BY AUTHORITY