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PLUMBING
Date 6/27/94 Job Address 126 NE 93 STREET Legal Description Owner / Lessee / Tenant RAY Master Permit # � 6 S � Owner's Address 126 NE 93 STREET, MIAMI SHORES 33138 Contracting Co. NORTH DADE SEPTIC TANK Address 800 NW 111 STREET Qualifier DENNIS NEVILLE State # 0258368 Municipal # Competency 4i 12842 Ins.Co. TRAVELERS Architect /Engineer Address Bonding Company Address Mortgagor Address Permit Type(circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN WORK DESCRIPTION INSTALL DRAINFIELD Square Ft. 300 WARNING TO OWNER: YOU MUST RECORD A NOTICE OF COMMENCEMENT AND YOUR FAILURE TO DO SO MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY (IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT). Application is hereby made to obtain a permit to do work and installation as indicated above, and on the attached addendum (if applicable). I certify that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that separate permits are required for ELECTRICAL, PLUMBING, SIGNS, POOLS, ROOFING and MECHANICAL WORK. OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable 1 ws regulating construction and zoning. Furthermore, I authorize the above -named contractor to the work sta Not =ry : to Owner =nd or Condo President My Commission Eres: r• r5r rr i ** * APPROVED: Zoning PERMIT APPLICATION FOR MIAMI SHORES VILLAGE er and /or Condo resident SS# Phone 754 -3375 * * * Buildin Mechanical Plumbin Estimated Cost(value) $1500.00 y as t My Commissi Tax Folio ted tor or Owner- Builder xp Phone 757 -7605 tor or Owner- Builder es: FEES: PERMIT "4 RADON C.C.F. 1 NOTARY TOTAL DUE 11 Fire Other Electrical Engineering .Zon m APPLICANT: RAY LOT: STATE OF FLORIDA DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES ONSITE SEWAGE DISPOSAL SYSTEM SITE EVALUATION AND SYSTEM SPECIFICATIONS BLOCK: SUBDIVISION: PROPERTY ID #: (Section /Township /Range /Parcel No. or Tax ID Number] 126 NE 93 STREET, 33138 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: [ ] YES [ ] NO NET USABLE AREA AVAILABLE: ACRES TOTAL ESTIMATED SEWAGE FLOW: 450 GALLONS PER DAY [RESIDENCES -TABLE 1 / OTHER -TABLE 2] AUTHORIZED SEWAGE FLOW: UNOBSTRUCTED AREA;AVAILABLE: BENCHMARK /REFERENCE POINT LOCATION: ELEVATION OF PROPOSED SYSTEM SITE IS bUO SQFT UNOBSTRUCTED AREA REQUIRED: �� SQFT THE MINIMUM SETBACK WHICH CAN BE MAINTAINED FROM THE PROPOSED SYSTEM TO THE FOLLOWING FEATURES: SURFACE WATER: NO FT DITCHES /SWALES: NO FT NORMALLY WET? [ ] YES [ ] NO WELLS: PUBLIC: 110 FT LIMITED USE: NO FT PRIVATE: NOFT NON- POTABLE* ) : ;0 FT BUILDING FOUNDATIONS: 5 FT PROPERTY LINES: 5 FT POTABLE WATER LINES: T . 5 FT SITE SUBJECT TO FREQUENT FLOODING: [ ] YES p)1 NO 10 YEAR FLOODING? [ ] YES [ NO 10 YEAR FLOOD ELEVATION FOR SITE: S S FT MSL /NGVD SITE ELEVATION: 8.6 FT MSL /NGVD SOIL PROFILE INFORMATION SITE 1 SOIL PROFILE INFORMATION SITE 2 Munsell # /Color Texture USDA SOIL SERIES: SITE EVALUATED BY: BR UN SANDY C c� Depth to 72 to to to to to to to to AA/t-t HRS -H Form 4015, Mar 92 (Obsoletes previous editions which may not be used) (Stock Number: 5744- 003-4015 -1) PERMIT # AGENT: NORTH DAD]: SEE GALLONS PER DAY [1500 GPD /ACRE OR 2500 GPD /ACRE] [INCHES /FT] [ABOVE /BELOW] BENCHMARK /REFERENCE POINT Munsell # /Color Texture BROWN S A = USDA SOIL SERIES: Depth ©,, to 72" to to to to to to to to OBSERVED WATER TABLE: 74 INCHES [ABOVE / BELOW] EXISTING GRADE. TYPE: [PERCHED / APPARENT] ESTIMATED WET SEASON WATER TABLE ELEVATION: 9_q INCHES [ ABOVE / BELOW ] EXISTING GRADE. HIGH WATER TABLE VEGETATION: [ ] YES (=NO MOTTLING: [ ] YES [X][ NO DEPTH: INCHES SOIL TEXTURE /LOADING RATE FOR SYSTEM SIZING: /I r2 DE PTH OF EXCAVATION: ` , INCHES DRAINFIELD CONFIGURATION: [ ] TRENCH al BED [ ] OTHER (SPECIFY) REMARKS /ADDITIONAL CRITERIA: DATE: 6/2 / /SA Page 3 of 3 lu'°�tS'„RNCI'EONS: PERIVIET :1: Permit tracking nu,..Ser assigned by CL;tiJ. AP?;LECANT: Property owner's fu!! `tame. ACEN'E': ]Property owner's legally authorized reprer er_tative. 3I.CCX, SUBDIVISION: Lot, bloc'&, and subdivision for lot. 7:10: ? :fi :2' ?C RD//: 27 character numbe: for property. (p epe:.gy appraiser RD 0 or section . /township /:•cn;e /parcel lumber) 7.107/11T1' SSZIE: Check if property sire at site conforms to submitted site plan. Reco :::: set &weber cva!!cble - _ay c: ,: :tc : :.c a :; oc all paved areas and prepared road been within public : -of -way or ecc;,:T -Zits C! us :s ;u :vc: a:': trec :r,, _sitter, normally wet drain =g,: siitc<h :.r, marshes, o. Diner such bodies of water. iL A: M:NE70J:J7v S rI3AC GS: Record the ccsimeted sewage f_ew for the establishment Fort Table ! ;residences) ces) c_ ;;able 2 (r_on- :ss;n.ini), 10D -6, ?AC. :Record ... , cutlhotized , et /aye flea:. Tor the let 'aau,d - :eta ; "s`!e c:c.s and vats... • ap p_y (: ..Y per acy pc. cc b. :.: - vat^ w,:_;. ssr2puss c_ s: `t,5GC y : per acre for public water supplies). E c .cc: sec, covjcr:e f?a�i does rot e „uc! o= ;,nceee: the ()climate's: ar.v.tage arc./ , _c cppliicatio,_ s:_uai be de _'es.. E cCOfC the t4gld£re << ^._L ^ ^.: the amou r; :" q ..... '.1 _ ^_II6Lia;L€ :CJ L_..., _.m.._ .... ..'. times as _ - ge C3 the etrinfie!d abso:Ttic_ c.roc ._ ^d !scat 75 peace:_', of ic_.^. zr_ bstr'C:ed setbacks in Chapte: 10 -6, IFAC. The uscbatewcled r: eu must be coraiguous to the a'minfielsi. ENL O1iv AT' -ON: Record the location of ti':; beneh_amrk. f using c alsrveyar's benchmark Ica :si the actual c ovctla :_. ?ecc_i the elevation of the proposed system site in relation (above es; below) to the benchmark. Record minimum sntbaclts which can he _-s:c3 r._i listed features. Actaal measurements _tut eso cc^ c: "NA" for non applicable fecturrn. 'eatires en rite plc:_ er r.! :i2!^ 75 feet :• :el mans, .__...:_1: \:6. The of any public drn'ting within 2C0 '. c ct of the ap lot must also be verified. :'.N roRMATEON: Record info :r ion , lo:'$ cub c: to 'lees: ins !O c: _ jo in � =e: lots subject 20 �lacd:_.,, record ..0 ye�_ Lccs. :,_ :,vat :c - _c ::N actual site elevation.. '%:10 SNFOTti`.IAT °ON: Twc soil profiles wit : ±;u t,e proposes' absorption area to e minirttu:n icp of 6 toe: c: :else! a :•e :red identification will use JS:)/. Sol! Classificat ;on methcso'_ogy (iVunseil cc ?ors and JSti:A ^,c!! text ::_^n). 3 r be clearly dccurented. :?:ov'tde ;;1S4)A tai! c .es if available, recerc. "JNES" if t:_c r^ "!A"'; ?r TABLE: Record the depth of CI:, ohiery €ci water stab: :: at _; time sT the evaluation. ::ass "peached" o: ° cr t a :•ht appropriate. ,'.record the estimated wet season waver table elevation based on site evaluation, °JSE'A soil maps, ark historical information. °_tdicate if here is h!gi: Ovate: table vegetation present_. a?dtcate :1 mertlin g '.6 ?aCL^;!; L:rS depth. SOIL T liE: Record soil texture or loading rate for sybte:l sizing. )E7 li ^7 ::? :F`tCAVAT ON: If applicable reco :d depth of excavation requie . Record "NA" if not applicable. :):1A:N 77.... :: CONFIGURATION: Check drair_field configumtien required. Ef other, specify type. AD:):" TONA°_. 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 documentation submitted. • E I ]ELEVATION OF BENCHMARK /REIF1E.'iiENCiE',POINLES: BENCHMARK SITE 1 SE iE 2 [+] SHOT: H.R. 4{I.E. Hi!. [ -] SHOT [ -] SHOT 4 APPLICATION FOR: [ ;'I New System [ MExisting System [ 0 Holding Tank [m] Temporary /Experimental [Y ] Repair [ p,A Abandonment [ N] Other(Specify) APPLICANT: RAY AGENT: MAILING ADDRESS: STATE OF FLORIDA DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES ONSITE SEWAGE DISPOSAL SYSTEM APPLICATION FOR CONSTRUCTION PERMIT Authority: Chapter 381, FS & Chapter 10D -6, FAC NORTH DADE 'SEPTIC TANIK TO BE COMPLETED BY APPLICANT OR APPLICANT'S AUTHORIZED AGENT. ATTACH BUILDING PLAN AND TO -SCALE SITE PLAN SHOWING PERTINENT FEATURES REQUIRED BY CHAPTER 10D -6, FLORIDA ADMINISTRATIVE CODE. PROPERTY INFORMATION [IF LOT IS NOT IN A RECORDED SUBDIVISION, ATTACH LEGAL DESCRIPTION OR DEED] LOT: PROPERTY ID #: PROPERTY SIZE: 1 2 3 4 SFR BLOCK: DIRECTIONS TO PROPERTY: Unit Type of No Establishment APPLICANT'S SIGNATURE: 800 NU 111 STREET, MIM I 33168 SUBDIVISION: ACRES [Sgft /43,560] PROPERTY STREET ADDRESS: 126 NE 93 STREET, 6$138 BUILDING INFORMATION ( A RESIDENTIAL 3 BEDROOMS No. of Bedrooms Building # Persons Area Soft Served PERMIT # DATE PAID FEE PAID $ + °! 1 0/9 RECEIPT # r%///9 , TELEPHONE: 757 754 -: 3s5 DATE OF SUBD°I d S [Section /Township /Range /Parcel No.] Zb G: PROPERTY WATER SUPPLY: [ ] PRIVATE [xFS] PUBLIC ] COMMERCIAL Business Activity For Commercial Only ( j Garbage Grinders /Disposals [Spas /Hot Tubs [ Floor /Equipment Drains , [ . Ultra -low Volume Flush ets [ �' Other (Specify) DATE: ( J27 94 HRS -H Form 4015, Mar 92 (Obsoletes previous editions which may not be used) Page 1 of 3 (Stock Number: 5744 - 001 - 4015 -1) :7 lopfray 3 fuP nuin'e:::.• for r.pplicts.nt r.eaft. f 7...7 „ i3: 0 fee mi • r..7 -.. q" . ---- 0,7;• • au 4 1f:: :7.77 C.' ••" • : —a; :e 7r1udesi calev'ittin.L let an:e. :e'lletcic private or public. ADDR ESS.: r strea' - :;fl‘ - ess, indicate Ltreet or roar: Ifni locale in ce:f.nly. ?rovide retailed inst teflon to lot or attaci rtr-,c nrp r:howin!,7 lot location. •,7.\!:FCRIVIA77.0N: rhee`f residential or COM.ITIQIVIC. tist type of en......1"lahrnerr. Cfs...pter 1. :Examples: ainBie lfca doctor's office. :17.,.^:KS: Ccur. all morns clned primvy for sieepire, and lhose c.'ere effpected to routinely provide s1eepint3 accornf eccupants. sc footc3c l cm; of ewe:lin:3: 7fatit, cnciudinf, ca.:?cat, exterior 5:.o• 7tt'y rcreened patios or (ccks. 3ased on outside rneasuer_ta 7or eac h. story of structi.=. usin!;, % iz ea":alf..is! enta.blifni 2 pnrzonz :70: commercial r.pplicatlen.7, only. 1. of err..:loyees, and hours of c::::ration, CT :tai e Chzpter r.FAC. 'ACEtris each listed fixture with number installed or °NA" if not applicable. SiErutture ol'r.pplicant c atjkr.11. :3rfe r.3.-plicatlen one C..cy r.121 to the CPINU with irp?roprizte fec:; anf', A tt.; plan. C1tV 0 L:0/W 7IL oi l0:calla:y:3 of reside:es° eas..a ensile fly; 7 r.::17" C!..1".730 paopc any e;t.lati.: filler' '2.T V./L:0r% onrife celatng. el,isponal ft.„: Tao: lel% v wii:11.1": CC ic .:.:sidencee, C.enidenetfa; nr.e1 'bui!disr eac cz. ": `.1zer: 'sy7;:3, :neccoar:,-y to tnia,ntify STATE OF FLORIDA DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PERMIT Authority: Chapter 381, FS & Chapter 10D -6, FAC CONSTRUCTION PERMIT OR: [/,1] New System [N] Existing System [fi Holding Tank [ /A Temporary /Experimental 01 ] Repair [ ] Abandonment [ ] Other(Specify) li y AGENT: �] ! a tl � � PROPERTY STREET ADDRE S: APPLICANT: LOT: PROPERTY ID #: BLOCK: SUBDIVISION: SYSTEM MUST BE CONSTRUCTED IN ACCORDANCE WITH SPECIFICATIONS AND STANDARDS OF CHAPTER 10D -6, FAC REPAIR PERMITS AND HOLDING TANK PERMITS EXPIRE 90 DAYS FROM THE DATE OF ISSUE. ALL OTHER PERMITS EXPIRE ONE YEAR FROM THE DATE OF ISSUE. HRS APPROVAL OF SYSTEM DOES NOT GUARANTEE SATISFACTORY PERFORMANCE FOR ANY SPECIFIC PERIOD OF TIME. ANY CHANGE IN MATERIAL FACTS WHICH SERVED AS A BASIS FOR ISSUANCE OF THIS PERMIT, REQUIRE THE APPLICANT TO MODIFY THE PERMIT APPLICATION. SUCH MODIFICATIONS MAY RESULT IN THIS PERMIT BEING MADE NULL AND VOID. SYSTEM DESIGN AND SPECIFICATIONS T A N [ K [ D [ 0 ] SQUARE FEET PRIMARY DRAINFIELD SYSTEM R [ ] SQUARE FEET SYSTEM A TYPE SYSTEM: [ ] STANDARD [ ] FILLED [ ] MOUND [ I CONFIGURATION: [ ] TRENCH ] BED [ [ N F LOCATION OF BENCHMARK: I ELEVATION OF PROPOSED SYSTEM SITE [ ] [INCHES /FT] [ABOVE /BELOW] BENCHMARK /REFERENCE POINT E BOTTOM OF DRAINFIELD TO BE [ ] [INCHES /FT] [ABOVE /BELOW] BENCHMARK /REFERENCE POINT L D FILL REQUIRED: [ ] INCHES 0 T H E R ] [GALLONS / GPD] SEPTIC TANK /AEROBIC UNIT CAPACITY MULTI- CHAMERED /IN SERIES:[ ] [ �`v ] [GALLONS / GPD] CAPACITY MULTI - CHAMBERED /IN SERIES:[ ] ] GALLONS GREASE INTERCEPTOR CAPACITY [MAXIMUM CAPACITY SINGLE TANK: 1250 GALLONS] ] GALLONS PER DOSE DOSING TANK CAPACITY DOSE RATE [ ] PER 24 HRS NO. OF PUMPS: [ ] APPROVED BY:6 SPECIFICATIONS BY: DATE ISSUED: TITLE: HRS -H Form 4016, Mar 92 (Obsoletes previous editions which may not be us t14 (Stock Number: 5744- 001 - 4016 - 0) [SECTION /TOWNSHIP /RANGE /PARCEL NUMBER] [OR TAX ID NUMBER] EXCAVATION REQUIRED: [ ] INCHES APPLICANT TITLE: L. v ' PERMIT # 4 F ' c/` 4 DATE PAID /f FEE PAID $ RECEIPT # '0 ✓ 6 ] EXPIRATION DATE: CPHU Page 1 of 2 INSTRUCTIONS: PERMIT NUMBER: Permit tracking number assigned by CPHU. APPLICATION FOR: Check type of permit, if `Other° specify type in blank. APPLICANT: Property owner's full name. TELEPHONE: Telephone number for applicant or agent. AGENT: Property owner's legally authorized represen drive. MAILING ADDRESS: P.O. box or street mailing address for applicant or agent. LOT, BLOCK, SUBDIVISION or PROPERTY IDN: 27 character id number for property. (CPHU may require property appraiser ID // or section/township /range /parcel number) SYSTEM DESIGN AND SPECIFICATIONS: TANK: Minimum specifications from Chapter 10D-6, FAC. DRAINFIELD: Minimum specifications from Chapter 10D-6, FAC. OTHER: Other specifications, such as operating permit requirements, low- volume flush toilets, variance provisos. SPECIFICATIONS BY: Name of individual providing specifications. If designed by a registered engineer must be sealed. APPROVED BY: County Public Health Unit (CPHU) personnel reviewing and approving permit. DATE ISSUED: Date permit is issued by CPHU. EXPIRATION DATE: One year from date issued if the system has not been installed. Permits for system repairs become void 90 days from the date issued. ■ ■ ■ ■ •■ ■ ■■ r r Im m•0 ■__ i 1. •_111 1 / _ ■r_ __�__ - _IL ma ■u. Mix • ' ' ■r r 11.1-- 1 1 i mks wig ■ 1 J 1 7 �I ISM MUM MEMO 0 ERNE* ERWIN EP_ 1 _ r ■M 1.11•110• i h F - . • • • " rr 1 _Q r IJ n i I 1 i - r j_r I I • r ■r ■ I�' LI O J J_Il I !MC' 0 Li . 1 � ■ r MIN rR ■ r rl R • ■ • _IJ_IJ I ❑ ! I n I I � .1 CO •� ■ n _ I I r I:`I I I n__I Inalli k - 1 _I -1 '_ 1-1-11 l-L1J t 1-L.1 1 .1. x- OM -' - 1 .11. ■ r r •• - • l_ lr _ I_ I I_l L . C 1 4. " � J ■I ►l �r • 1 - `r!1 is � C 1 lim 1�! r 0 CI 0 n_ _1 F1 r I _ I rl I_(_l I ■ MI ORIta••• _ [ �1�,RR r . AA.. mi - � � -+J -1 1 1 1_.1 -J�r k . RR 1 ' _. �_ _ t.I Irll"': - r I f l I IJ L f- - - - - -_ n - ■■ 1 - - -- . . . .. - ..- _ . . �■ W • r S EE. r 1 ■ S ■ Te r I r r ■ r I L -� L r E .. ■ ■ ■ • •■ ■ ■ - ■ . M E EWE E E. A AI I II m � r ' ■ ■ ik ■ r . am M Mumma i imi N NANA 7 o _ mil • • � rii■ ■ ■ ' • , � I_ I - 7 1 - 11 - 1 L I EHHER - I '. • EE I o • M MEW R R 1 1� � _ i _ ' - _ I , � r r MI M MEW* M MI � rM • • E EEri r r�"�rrr • , i � ' ow m m i i•• ■ ■r ■ ■ I_ Lt u E3 r ■ ■ ■■ i ��,� R As mom l lik ■ 1 R R■ .�:•■ A i ■ RIr■ R ■ • O ■. t Om REM ■ ■r .Rl ■ Rui ■ ■ ■ ■R■ ■ ■ ■ ■■ ■ ■ m mull Rom m �u ■■R R m�1 � ■r J MI ■ ■ 1 x s� i � ■ ■ ■ ■ 1 x i t _ � ow saw o R R R � r A ■ ANEW ' ' C ■ � _ O _ CFCL OTIDEECE, ; ■ ■ R ■ min A LIJECTILL1 • • ■.. • �__Ci__ ■R ■ i I non r . ; 111 1 1elm _ R■ r N NR:! r ■■ • ••r s im r ■ ■ • swA F-0 L Fr IL I LL fl 1-1 i s m moue A • PP RR ILLL 1 7 1 11: L LL: !„..„ Elf.1,11 E]--1 Notes: r�.�� ;25 ET '8 STR:I-;;?s. 33p.38 Site Plan Submitted by y Plan Approved By STATE OF FLORIDA DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PERMIT Permit Application Number PART II - SITE PLAN SIGNATURE a TITLE Not Approved Date G o County Public Unit ALL CHANGES MUST BE APPROVED BY THE COUNTY PUBLIC HEALTH UNIT HRS -H Form 4015, Feb 85 (Obsoletes previous editions which may not be used) (Stock Number:5744- 002 - 4015 -6) Page 2 of 3 Qualifier I r PERMIT APPLICATION FOR MIAMI SHORES VILLAGE Date 6 I O J o f Job Address 12G NI E q3 ST Tax Folio 11 32 0G— 013- 3130 Legal Description Lo-{- 11-\2 81K Z3 Ka nil S Historically Designated: Yes No Owner/Lessee / Tenant 32 A r ,t■Q lJi Owner's Address ■26) Ne q3 S iseefi 1-AS 3 3 Contracting Co.SE. .0 VON1b4E.CTI.OAS 1 Is) G State # v iNti 1 E Municipal # Competency # Ins. Co. PN-KTILANT4s Architect/Engineer b. Address Bonding Company 141 \ Address Mortgagor VA Address Permit Type (circle one): BUILDING ELECTRICAL A MBII I MECHANICAL ROOFING PAVING FENCE SIGN WORK DESCRIPTION IN gTMu. titIN -1 tJc1 4 T Pc—t . Square Ft. 400 WARNING TO OWNER: YOU MUST RECORD A NOTICE OF COMMENCEMENT AND YOUR FAILURE TO DO SO MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY (IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT.) Application is hereby made to obtain a permit to do work and installation as indicated above, and on the attached addendum (if applicable). I certify that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that separate permits are required for ELECTRICAL PLUMBING, SIGNS, POOLS, ROOFING and MECHANICAL WORK. OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. Furthermore, I authorize the above -named contractor to do the work stated. Signa of o . er T .r Condo Presid 2S Date I • lb( :: S . on ideit RESA t oMON MY COMMISSION # CC 854608 EXPIRES: Jul 10, 2003 1.800.3NOTA11V Fin. Notary Service & Bonding Co. Notary as ires: FEES: PERMIT . t.; • Owner : • • ssion E • TILES - TEILESa &DLn m4- RADON APPROVED: Zoning Building Mechanical Plumbing SS# / Signs C.C.F. Address Master Permit # g 0 if Phone Po eoX 3860 t FL 33083 Phone (30:.0 -6 6Y3 Estimated Cost (value) *2000. 00 \f IA►. • ..ar e of Contra or • Owner - Builder Notary as to Contractor or Owner - Builder My Commission Expires: NOTARY BOND Electrical TOTAL DUE 8/28 /0 Date Date Structural Engineer STATE OF FLORIDA (.; ;�- DEPARTMENT OF HEALTH -= L ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM CONSTRUCTION PERMIT CONSTRUCTION PERMIT FOR: [ ]New System [ ]Existing System [ ]Holding Tank [ X ]Repair [ )Abandonment [ ]Temporary APPLICANT: Ray, Jeffrey AGENT: SEPTIC CO, Solomon Teresa PROPERTY STREET ADDRESS: 126 NE 93 St Miami FL 00000 LOT: 11 -12 BLOCK: 23 SUBDIVISION: Miami Shores [Section /Township /Range /Parcel No.] PROPERTY ID #: 11- 3206 - 013 -3130 [OR TAX ID NUMBER] 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 [ 1050 ]Gallons SEP C TANK MULTI - CHAMBERED /IN SERIES: [i/�] A [ 0 ]Gallons MULTI - CHAMBERED /IN SERIES: [ //4 ] N [ 0 ]GALLONS GREASE INTERCEPTOR CAPACITY K [ 0 ]GALLONS DOSING TANK CAPACITY [ 0 1GALLONS @ [0 ]DOSES PER 24 HRS # PUMPS[ 0 ] D ( 400 ]SQUARE FEET PRIMARY DRAINFIELD SYSTEM R ( 0 1SQUARE FEET SYSTEM A TYPE SYSTEM: [ ]STANDARD [ N ]FILLED [ N ]MOUND [ N ] I CONFIGURATION: [ N ]TRENCH [ y ]BED [ N ] N F LOCATION TO BENCHMARK: 11.20'NGVD FF E/R I ELEVATION OF PROPOSED SYSTEM SITE [ 1.6 ] [ FEET ] [ BELOW] BENCHMARK /REFERENCE POINT E BOTTOM OF DRAINFIELD TO BE [ 3.6 ] [ FEET ] [ BELOW]BENCHMARK /REFERENCE POINT L D FILL REQUIRED: [ 0.0 ]INCHES EXCAVATION REQUIRED: [ 24.0 ] INCHES OTHER REMARKS: Install 1050 gls new multi - chambered s/t equipped w/ an approved filter. Install 400 sq. ft. or available d/f using undisturbed loamy sand, previous confirmation of that condition in the complete area to 36" depth. The existing s/t shall be pumped, crush or rupture bottom, fill w/ suitable soil and provide the pump out receipt; aat the same time of the final inspection or apply after or before for a separate abandonment costruction permit. Invert elev. of d/f no less than 8.10'NGVD Bottom of d/f elev. no less than 7.60'NGVD This permit is not for addition. T1f3 PERMIT € HST FOP A M1TIC4(S) Baru tar Qt:!-MELD E.1.EWIL:f tU 7. Go' MCwi7 SPECIFICATIONS BY: RAM APPROVED BY: Arrieta, Rolando TITLE: DATE ISSUED: 8/23/01 EXPIRATION DATE: 11/21/01 DH 9016, 03/97 (Obsoletes previous editions which may not be used) (Stock Number: 5749- 001 - 9016 -0) tostds cons_4016 -1t TITLE: Engineer I CENTRAX #: 13 -SG -10064 DATE PAID: FEE PAID : $ RECEIPT OSTDSNBR : 01-2650- -R [ ] Innovative Other [ .] Dade CHD Page 1 of 2 co THE s.:4 con wE APPLICANT: l � LOT: . - i = BLOCK: ' PROPERTY ID 0: TOTAL ESTIMATED SEWAGE FLOW: AUTHORIZED SEWAGE FLOW: UNOBSTRUCTED AREA AVAILABLE: THE MINIMUM SETBACK WHICH C SURFACE WATER: '1 P FT WELLS: PUBLIC: , AA FT BUILDING FOUNDATIONS: STATE OF FLORIDA DEPARTMENT OF HEALTH ONSITE SEWAGE DISPOSAL SYSTEM SITE EVALUATION AND SYSTEM SPECIFICATIONS PROPERTY SIZE CONFORMS TO SITE PLAN: [a{] 4- ;) J Munsell 0 /Color Texture (? 1= - L.0 A--, (c,.[) USDA SOIL SERIES: 1 -1 L Att0 Depth '1" to to to to to to to to to OHSERVED WATER TABLE: s R - INCHES [ABOVE / E TIMATED SEASON WATER TABLE ELEVATION: HIGH WATER TABLE VEGETATION: [ ] YES y] NO SOIL TEXTURE /LOADING RATE FOR SYSTEM SIZING: DRAINFIELD CONFIGURATION: [ ] TRENCH [ ] REMARKS /ADDITIONAL CRITERIA: SITE EVALUATED BY: SOLore-fiN DH 4015, 10196 (Replaces HRS -H Form 4015 (Page 3) which may De used) (Stock Number: 5744 -003 - 4015 -1) AGENT: SUBDIVISION: t'�� te .}Tart �t- PERMIT 0 1/4 . „ . 1 ) ti [Section /Township /Range /Parcel No. or Tax ID Number] { t'. TO BE COMPLETED BY ENGINEER, HEALTH UNIT EMPLOYEE, OR OTHER QUALIFIED PERSON. ENGINEER'S MUSS PROVIDE REGISTRATION NUMBER AND SIGN AND SEAL EACH PAGE OF SUBMITTAL. COMPLETE ALL ITEMS. YES [ ] NO NET USABLE AREA AVAILABLE: . 2 "1 ACRE: GALLONS PER DAY [RESIDENCES -TABLE ]1 / OTHER -TABLE 2] GALLONS PER DAY [1500 GPD /ACRE OR 2500 GPD /ACRE] SQFT UNOBSTRUCTED AREA REQUIRED: I *uti: SQF1 r I,G BENCHMARK /REFERENCE POINT LOCATION: ELEVATION OF PROPOSED SYSTEM SITE IS ) (, [INCHES] [ABOVE/ EtOW] BENCHMARK /REFE1:tENCE POIN4 AN BE MAINTAINED FROM THE PROPOSED SYSTEM TO THE FOLLOWING FEATURES: DITCHES /SWALES: M Y FT NORMALLY WET? [ ] YES '[t'] NC LIMITED USE: r.0 FT PRIVATE: F;' FT NON- POTABLE: N.A F4 C ; FT PROPERTY LINES: FT POTABLE WATER LINES: .CL ) FI 10 YEAR FLOODING? [ ] YES [,l] NC SITE SUBJECT TO FREQUENT FLOODING: [ ] YES t,/ NO 10 YEAR FLOOD ELEVATION FOR SITE: FT MSL /NGVD SITE ELEVATION: `1,: FT MSL /NGVI , l c) SOIL PROFILE INFORMATION SITE 1 SOIL PROFXLE INFORMATION SITE 2 Munsell 0 /Color Texture f k. S1( 614 / _01'•?'ffi1 J L'i r 7 1 USDA SOIL SERIES: Li 12 15, L. r-4 J Depth to "12. to to to to to to to to lkI] EXISTING GRADE. TYPE: [PERCHED / AEPAENT] -- ? ?j .2 INCHES [ ABOVE /-- EL9W ] EXISTING GRADE. MOTTLING: [ ] YES [X] NO DEPTH: NA INCHE: g DEPTH OF EXCAVATION :24- INCHE: BED [ ] OTHER (SPECIFY) r. /0\ DAT S I B 3 Page 3 of STATE OF FLORIDA DEPARTMENT OF HEALTH APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PERMIT Permit Application Number 0 - (a SO ^' Scale: Each block represents 10 feet and 1 inch = 40 feet. PART II - SITEPLAN _e f Notes: RO< - 1 260 N\E ( 13 REV S )4c)aE5 33136 eZyCk•G "Baoice,N "' RE11J - C�°�►k- 0 N Site Plan submitted b 00 t-S c Plan Approved Not Approved Date 8 /03f o 1 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) Page 2 of 4 (Stock Number: 5744 - 002 - 4015 -6) Scale: Each block represents 10 feet and 1 inch = 40 feet. Site Plan submitted by Plan Approved By STATE OF FLORIDA DEPARTMENT OF HEALTH APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PERMIT Permit Application Number 0 ~� go PART II - SITEPLAN Not Approved Notes: Roc) ° 12X0 �1E' . , q 3 Si ger, m; ,S taEs 33)55 a 1c `° RE R.. J C Date 6 ALL CHANGES MUST BE APPROVED BY THE COUNTY HEALTH DEPARTMENT County Health Department DH 4015, 10/96 (Replaces HRS -H Form 4015 which may be used) Page 2 of 4 (Stock Number: 5744 - 002 - 4015 -6) - MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT e for the approval of the detailed statement of the plans and specifications herewith ' 7 pl rmi pp p d submitted for the - huilding or other is hereby a. This application is made in compliance and conformity with the Building Ordinance of Miami Shores Village, Florida, App e herein des Y Laws of the State of Florida, all ordinances of Miami Shores Village and all rules and regulations of the Building Division s 1 provisionYillage shall be complied with, whether herein specified or not. A copy of approved plans and specifications must be kept at /'Miami Shoj�rogress of work. / UuUdfng di•' / L ' / ,ame and Address No O .ered Architect and /or Engineer _,mploying Plumber's Name Date „_ � .� ,1177. izozac, - -__ No Street Location and Legal Description Lot Bllocck__ Subdi ,� eY'y _ _ _ _ _ _ Street 1--- 7--- _L.,._ 7 Repairs No. of Stories 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 L.. Size Septic Tank Type of Tank Feet of DraM Tile Dist. Feet of Tank pr Drain Field from Well ize of Soakage Pit Nat yf / Water Supply: Amount of Permit $ Plumbfn Inspectb The undersigned applicant for this building permit does hereby certify that he un erstands and accepts his obligations as an employer o� under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Permanent Supplement, and has com- plied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors employed by him in the work to be performed under this permit; and will post or cause to be posted for inspection on the site of the work such public notice• or notices as are required by the Act. The undersigned agrees to employ only such sub - contractors, on work to be performed under this permit, as are licensed by Miami Shores Village. STATE OF FLORIDA, 1 COUNTY OF DADE. y —Well - ss. My Commission Expires (Signed) ( Signed) _._ Notary Public, State of Florida /7 Z - Street --- L ._ 9 � S Capacity Gals Master )number. 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 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 SWIM'G POOL CONTR. LIST — CHECK MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT e for the approval of the detailed statement of the plans and specifications herewith ' 7 pl rmi pp p d submitted for the - huilding or other is hereby a. This application is made in compliance and conformity with the Building Ordinance of Miami Shores Village, Florida, App e herein des Y Laws of the State of Florida, all ordinances of Miami Shores Village and all rules and regulations of the Building Division s 1 provisionYillage shall be complied with, whether herein specified or not. A copy of approved plans and specifications must be kept at /'Miami Shoj�rogress of work. / UuUdfng di•' / L ' / ,ame and Address No O .ered Architect and /or Engineer _,mploying Plumber's Name Date „_ � .� ,1177. izozac, - -__ No Street Location and Legal Description Lot Bllocck__ Subdi ,� eY'y _ _ _ _ _ _ Street 1--- 7--- _L.,._ 7 Repairs No. of Stories 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 L.. Size Septic Tank Type of Tank Feet of DraM Tile Dist. Feet of Tank pr Drain Field from Well ize of Soakage Pit Nat yf / Water Supply: Amount of Permit $ Plumbfn Inspectb The undersigned applicant for this building permit does hereby certify that he un erstands and accepts his obligations as an employer o� under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Permanent Supplement, and has com- plied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors employed by him in the work to be performed under this permit; and will post or cause to be posted for inspection on the site of the work such public notice• or notices as are required by the Act. The undersigned agrees to employ only such sub - contractors, on work to be performed under this permit, as are licensed by Miami Shores Village. STATE OF FLORIDA, 1 COUNTY OF DADE. y —Well - ss. My Commission Expires (Signed) ( Signed) _._ Notary Public, State of Florida /7 Z - Street --- L ._ 9 � S Capacity Gals Master )number. 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. JOB° BUILDING ELECTRIC4L : WORK • : DUE BY: .) PLUMBINB • ‘ • REQ,UESTED /WILL BE READY The following is ready for inspection:- Inspectorls Report:- ADD: (E 73 / e t-›t-4 . /1 3 4/ 1 7 1 (e- Permit No.. "' MIAMI SHORES VILLAGE 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. No.___ Street Owner's Name and Address � a• y.IP Registered Architect and /or Engineer // _______ Employing Plumber's Name _ �!� t' ��"� No._SL1a1 • Location and Legal Description Lot_ —_ _ — 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 Repairs No of Stories____ Subdivision Street Size Septic Tank___________ _ —__—___ _____ _______ Type of Tank . Capacity — Gals.__--__—__- - I Feet of Drain Tile___- -_ __—_______ Dist. Feet of Tank or Drain Field from We11_____ ____— __-- ______— __— ___________ __ 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 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) My Commission Expires Notary Public. State of Florida STATE OF FLORIDA, COUNTY OF DADE. Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeared --- -- -_ —_-- to me well known, and who, being by me first duly sworn, upon oath deposes and says that he is the of the above described construction, that he has carefully read the foregoing application, and that he did sign the same, and that all facts therein by him stated are true. 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 Permit No.. "' MIAMI SHORES VILLAGE 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. No.___ Street Owner's Name and Address � a• y.IP Registered Architect and /or Engineer // _______ Employing Plumber's Name _ �!� t' ��"� No._SL1a1 • Location and Legal Description Lot_ —_ _ — 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 Repairs No of Stories____ Subdivision Street Size Septic Tank___________ _ —__—___ _____ _______ Type of Tank . Capacity — Gals.__--__—__- - I Feet of Drain Tile___- -_ __—_______ Dist. Feet of Tank or Drain Field from We11_____ ____— __-- ______— __— ___________ __ 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 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) My Commission Expires Notary Public. State of Florida STATE OF FLORIDA, COUNTY OF DADE. Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeared --- -- -_ —_-- to me well known, and who, being by me first duly sworn, upon oath deposes and says that he is the of the above described construction, that he has carefully read the foregoing application, and that he did sign the same, and that all facts therein by him stated are true. 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 PLU,i1BING Owner of Building Architect Contractor or Builder Legal Lot Description CONTRACTOR OR BUILDER MIAMI SHORES VILLAGE, FLORIDA DATE PERMIT N? 7591 Work to be performed under this Permit Bl. S igned Subdi- vision Value of Project • ,r 194 Contractor's License No. Address of Building This permit is granted to the contractor o .uilder 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. — II Amt. of J �) By INSPECTOR In consideration of the issuance to me of this permit I agree to perfo work covered hereunder in compliance with ordinar e(and,reggi}ll1asions pertaining thereto and in strict conformity with the plans, drawings, state en or specifications submitted to the proper authors es of Miami Sh4es`Vil age. In accepting this permit I assume responsibility for all work done by either myself, my agent, servant or employee. AUTHORITY 2Z-7 Permit No. MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING r- ;kMIT $2. 00 Date November 3, 1961 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 C. _ 4G !__ No._ 126 NE ° 93 Street Registered Architect and /or Engineer ..... _------____ Employing Plumber's Name D GAS COMPANY 6 NW 2 Avenue Location and Legal Description Lot_______.______ _ . Blorti Subdi vision_ ..__.___. Street and Number where work is to be performed —No 126 AT St. St State work to be performed and purpose of building (By Floors)_______________ New Building _ Remodeling_ _____ Addition. 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. Amount of Permit $ 2 . 00 (Signed) _ Capacity Gals. _Size of Soakage Pit L20Qi __ PBQPAME) Plumbing Inspector. The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations as an employer of labor under the Florida Workmen's Compensation Act, being Section 5968, Compiled General 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 ?icensed by Miami Shores Village. (Signed). Master Plumber. Repairs No. of Stories. STATE OF FLORIDA, t es. COUNTY OF DADE. Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeared to me well known, and who, being by me first duly sworn, upon oath deposes and says that he is the_ of the above described construction, that he has carefully read the foregoing application, and that he did sign the same, and that all facts therein by him stated are true. My Commission Expires Notary Public, State of Florida NOTE: A re- inspection fee of $1.00 will be made when such re-inspection is made•necoccs+ry by improper notice for inspection, or faulty materials and /or workmanship. CLOSETS BATH Tiles U SHOWERS LAVA- TORIES SINKS SLOP SINKS LAUNDRY Tura; U RINALS CATCH BASIN FLOOR DRAIN DRINKING DRINK FOUNT' NS RANG � TOTAL FIXTURES CONTR. LIST f CHECK s7L SEPTIC TANK SEWER CONN. DRAIN FIELD SOAKAGE PIT GREASE TRAP SOLAR HEATER DEEP WELL SPRKLR. SYSTEM SW IM'O POOL CONTR. LIST CHECK - 2Z-7 Permit No. MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING r- ;kMIT $2. 00 Date November 3, 1961 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 C. _ 4G !__ No._ 126 NE ° 93 Street Registered Architect and /or Engineer ..... _------____ Employing Plumber's Name D GAS COMPANY 6 NW 2 Avenue Location and Legal Description Lot_______.______ _ . Blorti Subdi vision_ ..__.___. Street and Number where work is to be performed —No 126 AT St. St State work to be performed and purpose of building (By Floors)_______________ New Building _ Remodeling_ _____ Addition. 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. Amount of Permit $ 2 . 00 (Signed) _ Capacity Gals. _Size of Soakage Pit L20Qi __ PBQPAME) Plumbing Inspector. The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations as an employer of labor under the Florida Workmen's Compensation Act, being Section 5968, Compiled General 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 ?icensed by Miami Shores Village. (Signed). Master Plumber. Repairs No. of Stories. STATE OF FLORIDA, t es. COUNTY OF DADE. Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeared to me well known, and who, being by me first duly sworn, upon oath deposes and says that he is the_ of the above described construction, that he has carefully read the foregoing application, and that he did sign the same, and that all facts therein by him stated are true. My Commission Expires Notary Public, State of Florida NOTE: A re- inspection fee of $1.00 will be made when such re-inspection is made•necoccs+ry by improper notice for inspection, or faulty materials and /or workmanship. BUILDING ELECTRICAL PLUMBING Owner of - f Building Architect Contractor or Builder Legal Lot Description Address of i / - I Building ..�', ' 4 j ...0a.s" P r OR OR BUILDER '' MIAMI SHORES VILLAGE, FLORIDA DATE PERMIT N9 3404 Work to be performed under this Permit Bl. Subdi- vision Value of Project Contractor's 5( License No. O WARNING: This Construction may hie in rioiarari ;If 'dr' C 7 .:.'I dt PPIS O d i t- You are tautionr d to consult yoir War Production Board office Retort sarong me work autnoriZed In this permit. Amt. of Permit AUTHORITY 194— 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 INSPE TOR In consideration of the issuance to me of this permit I agree to perform the work 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 pert jassume responsibility for all work done by either myself, my agent, servant or employee. � f ' �. C CONTRA QR BY 'IBUILDING ❑ E CTRICAL ❑ PL BING ❑ ROO Owner of Building Address of Building Architect Contractor ; ).' or Builder Legal Lox Description IJ This permit is granted to tion herefor in strict complian plans, drawings, statements or at any time if the work is no permit is granted is the unde regulations pertaining to the sibility for work done by his In consideration of t pertaining thereto and in s In accepting this permit I CONTRACTC4R - or - - BUILDER MIAMI SHORES VILLAGE, FLORIDA / Date / PERMIT Np 9563 Work • to be performed under this Permit_ II BI 1 Contractor's License No. ' �� 19_ , Subdi- vision Sq Ft Value of II Amount of Project $ II Permit $ e contractor or builder named above to construct the building or to insi ; all the equipment or device described in the applica- with all ordinances pertaining thereto and with the understanding that the work will be performed in compliance with any pscifications that may have been submitted to and approved by the proper municipal authorities. This Permit may be revoked done in compliance with such ordinances or if the plans are changed without authorization. A further condition upon which this standing that the contractor or builder named above assumes the responsibility for a thorough knowledge of the ordinances and ork covered hereby whether shown on SIle plans or drawings or in the statements or specifications and that he assumes respon- agents, seryants or gmployees. ned• 4; ; e issuance to me of this permit gree to perform the work covered hereunder in compliance with all ordinances and regulation. ict conformity with the plans, awings, statements or specifications submitted to the proper authorities of Miami Shores Village. ssume responsibility for all w rk done by either, myself, my aglnt, servant or employee. (INSPECTOR) BY / L .r BY AUTHORITY Permit No Size Septic Tank Feet of Drain Tile. � f Nature of Water Supply: City —Well Amount of Permit . STATE OF FLORIDA, 1 COUNTY OF DADE. Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the building or other structure herein described. This application is made in compliance and 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. /4 �_ i0 My Commission Expires MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT . Registered Architect and /or Engineer__ '_------- -_ -_ -- Employing Plumber's Name_f4! _ A / FF6 , �� � 1 "� _ . .No._____ -- / Street_ Location and Legal Description Lot_ - __._ Street and Number where work is to be performed —No Block Subdivision_- .__.___. __-------- _____.�._.... Street C '. State work to be performed and purpose of building (By s) __ ___._- � . fd __ � ?C� 0 �✓ ^ New Building Remodeling_ Addition__ _____.__— Repairs No. of Stories. Type of Tank No._ 1 ______ Street _d! �'"� //, Capacity Gals P re __ __Dist. Feet of Tank or Drain Field from Well Size of Soakage Pit (Signed) _ Plumbing Inspector. The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations as an employer of labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Permanent Supplement, and has com- plied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors employed by him in the work to be performed under this permit; and will post or cause to be posted for inspection on the site of the work lr public notice or notices as are required by the Act. The undersigned agrees to employ only such sub-contractors, work to be2perf ed under this permit, as are licensed by Miami Shores Village. � / ' ' ( Signed) ____ Date Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeared to me well known, and who, being by me first duly sworn, upon oath deposes and says that he is the of the above described construction, that he has carefully read the foregoing application, and that he did sign the same, and that all facts therein by him stated are true. Notary Public, State of Florida 2 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 SIN" SLOP SINK! LAUNDRY TU88 URINALS CATCH BASIN FLOOR DRAIN DRINKING FOUNT•NS TOTAL FIXTURES CONTR. LIST CHECK SEPTIC TANK SEWER CONN. DRAIN FIELD SOAKAGE PIT GREASE TRAP SOLAR HEATER DEEP WELL SPRKLR. SYSTEM SWIM'G POOL CoNTR. LIST CHECK Permit No Size Septic Tank Feet of Drain Tile. � f Nature of Water Supply: City —Well Amount of Permit . STATE OF FLORIDA, 1 COUNTY OF DADE. Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the building or other structure herein described. This application is made in compliance and 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. /4 �_ i0 My Commission Expires MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT . Registered Architect and /or Engineer__ '_------- -_ -_ -- Employing Plumber's Name_f4! _ A / FF6 , �� � 1 "� _ . .No._____ -- / Street_ Location and Legal Description Lot_ - __._ Street and Number where work is to be performed —No Block Subdivision_- .__.___. __-------- _____.�._.... Street C '. State work to be performed and purpose of building (By s) __ ___._- � . fd __ � ?C� 0 �✓ ^ New Building Remodeling_ Addition__ _____.__— Repairs No. of Stories. Type of Tank No._ 1 ______ Street _d! �'"� //, Capacity Gals P re __ __Dist. Feet of Tank or Drain Field from Well Size of Soakage Pit (Signed) _ Plumbing Inspector. The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations as an employer of labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Permanent Supplement, and has com- plied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors employed by him in the work to be performed under this permit; and will post or cause to be posted for inspection on the site of the work lr public notice or notices as are required by the Act. The undersigned agrees to employ only such sub-contractors, work to be2perf ed under this permit, as are licensed by Miami Shores Village. � / ' ' ( Signed) ____ Date Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeared to me well known, and who, being by me first duly sworn, upon oath deposes and says that he is the of the above described construction, that he has carefully read the foregoing application, and that he did sign the same, and that all facts therein by him stated are true. Notary Public, State of Florida 2 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 95-6 3 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._/l_ :__- - __1�L_------ _ -__ -- No.__- - -- - lip..____ -_ -_ Street___ ) ( Registered Architect and /or L t f a / 2 G�_ V S �s- _ ��yNo.. _1 Employing Plumber's Name___ . _ _ Location and Legal Description Lot____ ____. .... __— ____________,_ �i�— �Blocck Subdivision Street and Number where work is to be performed —No._ � / __i __I 3 !s 7 __ Street_ State work to be performed and purpose of building (By Floors) _ ______ New Building ____ Remodeling ______ ... -- _-- ______ -_ Addition__ Size Septic Tank Feet of Drain Tile 3 Nature of Water Supply: City —Well. Amount of Permit $ C _ Type of Tank___ Capacity Gals. �f k1 r• _-L$% _Dist. Feet of Tank or Drain Field from Well . .Size of Soakage Pit My Commission Expires MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT (Signed) - Date 1 Repairs 91� No. of Stories_ Plumbing Inspector. The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations as an employer of labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Permanent Supplement, and has 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 die Act. The undersigned agrees to employ only such sub- contractors, on ..rk to be perform under this permit, as are licensed by Miami Shores Village. ( Sign - M _ er Plumber. STATE OF FLORIDA, I COUNTY OF DADE. Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments , personally appeared to me well known, and who, being by me first duly sworn, upon oath deposes and says that he is the of the above described construction, that he has carefully read the foregoing application, and that he did sign the same, and that all facts therein by him stated are true. 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 SH LAVA- TORIES SINKS INK SLOP SINKS LAUNDRY TUBS RINALS URINALS CATCH BASIN FLOOR DRAIN DRINKING FOUNT' NS TOTAL FIXTURES CONTR. LIST CHECK SEPTIC TANK SEWER CONN. DRAIN FIELD SOAKAGE PIT GREASE TRAP SOLAR HEATER DEEP WELL SPRKLR. SYSTEM SW IM'O POOL CoNTR. LIST ��_ CHECK v Permit No 95-6 3 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._/l_ :__- - __1�L_------ _ -__ -- No.__- - -- - lip..____ -_ -_ Street___ ) ( Registered Architect and /or L t f a / 2 G�_ V S �s- _ ��yNo.. _1 Employing Plumber's Name___ . _ _ Location and Legal Description Lot____ ____. .... __— ____________,_ �i�— �Blocck Subdivision Street and Number where work is to be performed —No._ � / __i __I 3 !s 7 __ Street_ State work to be performed and purpose of building (By Floors) _ ______ New Building ____ Remodeling ______ ... -- _-- ______ -_ Addition__ Size Septic Tank Feet of Drain Tile 3 Nature of Water Supply: City —Well. Amount of Permit $ C _ Type of Tank___ Capacity Gals. �f k1 r• _-L$% _Dist. Feet of Tank or Drain Field from Well . .Size of Soakage Pit My Commission Expires MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT (Signed) - Date 1 Repairs 91� No. of Stories_ Plumbing Inspector. The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations as an employer of labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Permanent Supplement, and has 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 die Act. The undersigned agrees to employ only such sub- contractors, on ..rk to be perform under this permit, as are licensed by Miami Shores Village. ( Sign - M _ er Plumber. STATE OF FLORIDA, I COUNTY OF DADE. Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments , personally appeared to me well known, and who, being by me first duly sworn, upon oath deposes and says that he is the of the above described construction, that he has carefully read the foregoing application, and that he did sign the same, and that all facts therein by him stated are true. 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.