PLUMBINGDate 4-'03-97 Job Address r 7 1 75 /v Go 9a
Legal Description
Owner/Lessee / Tenant 4606 ? D 4AJ ,6jlerit/ Master Permit # qa- L O2
Owner's Address 76 R/ 9 9,9-s T Phone
Contracting Co. ,4/ t /G 4/AI �dr1C1 70� CO . /� Address ArUrO, A/ ,
Qualifier #G6 / t'f / fJ SS# OPhone
dares - , S 4Tee4
State # Municipal # 91/45 77-7 Competency #/9-)00,6 Ins. Co ", ! ' .�
Architect/Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type (circle one): BUILDING ELECTRICA PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIPTION Tip} -i Z,j r /r r
. 1/7) &,psis 7L/Ar/ age d
Square Ft. Estimated Cost (value) /8' o
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.
gnature o
otary as to Owner and/orz; ando Pre ►-nt Date
My Co ' : i s �rtrN .
< ,� r ,
�- n :••. Naomi M. Vasquez ,
: • Notary Public, State of Florida i
.-.1. ; « � w ,;of Commission No. CC 655580 )
< •••••• . My Commission Exp.06 /15 /2001;
< Bonded Through Fla Notary Service & Bonding Co. f
(„,„„,..„,,<.„,,„„,,„<„...„.„.„„,„,„„„„,„ c
FEES: PERMIT S () RADON
APPROVED:
Zoning
Mechanical
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
of owner an d/or Condo President
Date
Tax Folio
to C ontro G Boil s/
My Notary C nmas is ir ri3XRactr �. ,.,,.�caner -,,,» > »»»»»�»
• .° . Naomi M. Vasquez
i Notary Public, Stag of Florida
'< ?., F..' Commission No. CC 655580 i
< •.,no.
< o My Commission Exp.06/15/2001
< Bonded Through Fla. Notary Service & Bonding Co.
C CCCC CCCCCC(((<C (( CCC<CKC(CC(CCCCC(KCC(CCCCCC(Z
C. C.F. /.
2-0
Historically Designated: Yes No
NOTARY
Electrical
Signature of Contractor or Owner - Builder
r
Date
BOND
TOTAL DUE CS Y.
Engineering
Permit No I a g 7�
Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the building or other
structure herein described. This application is made in compliance and conformity with the Building Ordinance of Miami Shores Village, Florida,
and all provisions of the Laws of the State of Florida, all ordinances of Miami Shores Village and all rules and regulations of the Building Division
of Miami Shores Village shall be complied with, whether herein specified or not. A copy of approved plans and specifications must be kept at
building during progress of work.
Owner's Name and Address
Registered Architect and /or En _ eer — __-
Employing Plumber's Name_
Sirs Septic Tank ______ - _____-- _ _____ - ------ ---- --- - - - - -- -Type of Tank
Feet of Drain Tile — __--Dist. Feet of Tank or Drain Field from Well
STATE OF FLORIDA,
COUNTY OF DADE.
p(t_ikiti
Min, 0 S fl00IES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION POI PLUMBING PiEwi IT
Amount of Permit $ S • b (Signed)-
o
Date __._.l- �_�— - __L
No. Street.
°Z CCA .street.. —_
Location and Legal Descripti ' Lot Block Subdivision---- - -- ___ -. _
Street and Number where work is to be performed —No 1 d1 �2
State work to be performed and purpose of building (By Floors) ------------- _- •
New Building _ -_ Remodeling — _- - ----- — -_ -- Addition----- -- _._- •--- -- ____ -- Repairs No. of Stories_ . _ .
Capacity Gals.
Nature of Water Supply: City — Well. - - - - -_ ----------------------- ___ —_ -- -Size of Soakage Pit
Plumbing Inspector.
The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations as an employer of labor
under the Florida Workmen's Compensation Act, being Section 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 pennit, 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 imposes 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 ouch re-inspection is made necessary by improper notice for insp ' or faulty
materials and /oor workmanship.
CLOIIQTS
BATH
TUBS
SHE
SHOWERS
LAVA-
TORIES
SINKS
SLOP
SINKS
LAUNDRY
TUBE
URINALS
CATCH
BASIN
FLOOR
DRAIN
DRINKING
FOUNT•NS
TOTAL
FIXTURES
CONTR.
LIDT
/
/
/
/
CHECK
- - --
SEPTIC
TANK
SEWER
CONN.
DRAIN
FIELD
SOAKAGE
PIT
GREASE
TRAP
SOLAR
HEATER
DEEP
WELL.
SPRKLR.
SYSTEM
SWIM'G
POOL
CONTR.
LIST
`!-
CHECK
Permit No I a g 7�
Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the building or other
structure herein described. This application is made in compliance and conformity with the Building Ordinance of Miami Shores Village, Florida,
and all provisions of the Laws of the State of Florida, all ordinances of Miami Shores Village and all rules and regulations of the Building Division
of Miami Shores Village shall be complied with, whether herein specified or not. A copy of approved plans and specifications must be kept at
building during progress of work.
Owner's Name and Address
Registered Architect and /or En _ eer — __-
Employing Plumber's Name_
Sirs Septic Tank ______ - _____-- _ _____ - ------ ---- --- - - - - -- -Type of Tank
Feet of Drain Tile — __--Dist. Feet of Tank or Drain Field from Well
STATE OF FLORIDA,
COUNTY OF DADE.
p(t_ikiti
Min, 0 S fl00IES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION POI PLUMBING PiEwi IT
Amount of Permit $ S • b (Signed)-
o
Date __._.l- �_�— - __L
No. Street.
°Z CCA .street.. —_
Location and Legal Descripti ' Lot Block Subdivision---- - -- ___ -. _
Street and Number where work is to be performed —No 1 d1 �2
State work to be performed and purpose of building (By Floors) ------------- _- •
New Building _ -_ Remodeling — _- - ----- — -_ -- Addition----- -- _._- •--- -- ____ -- Repairs No. of Stories_ . _ .
Capacity Gals.
Nature of Water Supply: City — Well. - - - - -_ ----------------------- ___ —_ -- -Size of Soakage Pit
Plumbing Inspector.
The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations as an employer of labor
under the Florida Workmen's Compensation Act, being Section 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 pennit, 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 imposes 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 ouch re-inspection is made necessary by improper notice for insp ' or faulty
materials and /oor workmanship.
MIAMI SHORES , VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
Permit No 97 —_ Date /1 1 .7
Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the building or . other
structure herein described. This application is made in compliance and conformity with the Building Ordinance of Miami Shores Village, Florida,
and all provisions of the Laws of the State of Florida, all ordinances of Miami Shores Village and all rules and regulations of the Building Division
of Miami Shores Village shall be complied with, whether herein specified or not. A copy of approved plans and specifications must be kept at
building during progress of work.
Owner's Name and Address BERNAga _ -- _ - _---- ^__ - -- _ No.___ Street _-275 - NTRE „ - _92 St
Registered Architect and /or Engineer_____ - WELL DRILLING
Employing Plumber's Name
Location and Legal Description Lot Block
Street and Number where work is to be performed —No 275 N.E. 92 St , Street
State work to be performed and purpose of building (By Floors) _ __
New Building _ -- Remodeling------ _ -_ - -- ---- ____ -- Addition
No..
Repairs
Size Septic Tank
Feet of Drain Tile______ -Dist. Feet of Tank or Drain Field from Well
Nature of Water Supply: City — Well._____.. _____ ___._ ..... _- ____... __.____ -____ -.Size of Soakage Pit
Amount of Permit $
.-Type of Tank_ Capacity Gals
- ;SUY.t'LY
( Signed)_
(Signed)._
eaQ
Street_
Subdivision
No. of Stories
e applicant for this building permit does hereby certify that he understands and a obligations as an employer of labo
The undersigned pp g p Y Y g labor
under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Permanent Supplement, and has com-
plied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors employed by him in the work to be
performed under this permit; and will post or cause to be posted' for inspection on the site of the work such public notice or notices as are
required by the Act. The undersigned agrees to employ only such sub- contractors, on work to be performed under this permit, as are
licensed by Miami Shores Village.
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.
My Commission Expires Notary Public, State of Florida
NOTE: A re- inspection fee of $1.00 will be made when such re- inspection is made•necessary by improper notice for inspection, or faulty
materials and /or worlmaanship.
Plumbing Inspector.
Master Plumber.
CLOS6T6
OATH
TU86
SHOWERS
LAVA.
TORIES
SINKS
S
SLOP
SINKS
LAUNDRY
TUBS
U
CATCH
BASIN
FLOOR
DRAIN
DRINKING
FOUNT'NS
TOTAL
FIXTURES
CONTR.
LIOT
CHICK
...------
SEPTIC
TANK
SEWER
CONN.
DRAIN
FIELD
SOAKAGE
PIT
GREASE'
TRAP
SOLAR
HEATER
DEEP
WELL
SPRKLR.
SYSTEM
SWIM'G
POOL
CONTc2.
LIST
-
CHECK
MIAMI SHORES , VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
Permit No 97 —_ Date /1 1 .7
Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the building or . other
structure herein described. This application is made in compliance and conformity with the Building Ordinance of Miami Shores Village, Florida,
and all provisions of the Laws of the State of Florida, all ordinances of Miami Shores Village and all rules and regulations of the Building Division
of Miami Shores Village shall be complied with, whether herein specified or not. A copy of approved plans and specifications must be kept at
building during progress of work.
Owner's Name and Address BERNAga _ -- _ - _---- ^__ - -- _ No.___ Street _-275 - NTRE „ - _92 St
Registered Architect and /or Engineer_____ - WELL DRILLING
Employing Plumber's Name
Location and Legal Description Lot Block
Street and Number where work is to be performed —No 275 N.E. 92 St , Street
State work to be performed and purpose of building (By Floors) _ __
New Building _ -- Remodeling------ _ -_ - -- ---- ____ -- Addition
No..
Repairs
Size Septic Tank
Feet of Drain Tile______ -Dist. Feet of Tank or Drain Field from Well
Nature of Water Supply: City — Well._____.. _____ ___._ ..... _- ____... __.____ -____ -.Size of Soakage Pit
Amount of Permit $
.-Type of Tank_ Capacity Gals
- ;SUY.t'LY
( Signed)_
(Signed)._
eaQ
Street_
Subdivision
No. of Stories
e applicant for this building permit does hereby certify that he understands and a obligations as an employer of labo
The undersigned pp g p Y Y g labor
under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Permanent Supplement, and has com-
plied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors employed by him in the work to be
performed under this permit; and will post or cause to be posted' for inspection on the site of the work such public notice or notices as are
required by the Act. The undersigned agrees to employ only such sub- contractors, on work to be performed under this permit, as are
licensed by Miami Shores Village.
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.
My Commission Expires Notary Public, State of Florida
NOTE: A re- inspection fee of $1.00 will be made when such re- inspection is made•necessary by improper notice for inspection, or faulty
materials and /or worlmaanship.
Plumbing Inspector.
Master Plumber.
1UILDING ❑
- :LFCTmCAL ❑ PERMIT o
'LUMBING N. 8409
;OOF ING
)caner of
; uilding
architect
: ontractor
r Builder
egal
)escription
.ddress of
uilding
Lot
MIAMI SHORES VILLAGE. FLORIDA
❑ Work to be performed under this Permit
CONTRACTOR OR BUILDER
Bl.
Subdi-
vision
Sq. Ft
Value of
Project $
DATE = 195
Contractor's
License No
Amt. of
Permit $
This permit is granted to the contractor or builder named above to construct the building or to install the equipment or device described in the application
erefor in strict compliance with all ordinances pertaining thereto and with the understanding that the work will be performed in compliance with any plans,
rawings, statements or specifications that may have been submitted to and approved by the proper municipal authorities. This Permit may be revoked at any
me if the work is not done in compliance with such ordinances or if the plans are changed without authorization. A further condition upon which this permit is
ranted is the understanding that the contractor or builder named above assumes the responsibility for a thorough knowledge of the ordinances and regulations
ertaining 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
one by his agents, servants or employees.
Signed • BY
INSPECTOR
In consideration of the issuance to me of this permit I agree to perform the work covered hereunder in compliance with all ordinances and regulations
= rtaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village.
accepting this permit I assume responsibility for all work done by either, myself, my agent, servant or employee.
BY AUTHORITY
&Mist. 17
BUILDING ❑ MIAMI SHORES VILLAGE, FLORIDA
Date 19 -_ 7
ELECTRICAL ❑
PLUMBING ni PERMIT Np 9431 Contractor's
ROOFING ❑ License No.
❑ Work to be performed under this Permit
Owner of
Building
Architect
Contractor
or Builder
Legal Lot
Description 1 B1
Address of 4.
Building
CONTRACTOR or BUILDER
Subdi-
vision
Sq Ft
Value of
Project
Amount of
Permit $
This permit is granted to the contractor or builder named above to construct the building or to install the equipment or device described in the applica-
tion herefor in strict compliance with all ordinances pertaining thereto and with the understanding that the work will be performed in compliance with any
plans, drawings, statements or specifications that may have been submitted to and approved by the proper municipal authorities. This Permit may be revoked
at any time if the work is not done in compliance with such ordinances or if the plans are changed without authorization. A further condition upon which this
permit is granted is the understanding that the contractor or builder named above assumes the responsibility for a thorough knowledge of the ordinances and
regulations pertaining to the work covered hereby whether shown on the plans or drawings or in the statements or specifications and that he assumes respon-
sibility for work done by his agents, servants or employees.
Signed • `"°' , (INSPECTOR) BY
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, t agent, servant or employee.
BY AUTHORITY
OWN
L6T
BLOCK
SUBDIVISION
,
G :
Issued to 1 e s x
4
to in4all the following d'cribed plumbing, in accordance
lations of Miami Shores Village, Florida and the State of
drainage work done in Miami Shores Village, Florida.
For a story
Fixtures
Fixtures
Sewer
aiami .bores94.11age
F L O & ID A
PLUMBING PERMIT ■9 1002
building at
*tic Tank $
Total $
with the laws, statutes and regu-
Florida, governing plumbing and
_r f
Village Plumbing Inspector
Received Payment by
Se
Issued to
OWNER
aiami A o
F L O
PLUMBING PERMIT N9 699
to install the following described plumbing, in accordance with the laws, statutes and regu-
lations of Miami Shores Village, Florida and the State of Florida, governing plumbing and
drainage work done in Miami Shores Village, Florida.
For a . story building at
Fixtures
Fixtures / $ j
Sewer $
•tic Tank $
Total $/ 2.
Village Plumbing Inspector r
Received Payment by
•
LOT
BLOCK
SUBDIVISION
Date
OWNER
dd�iami cfhores9llage
F L O R D A
PLUMBING PERMIT N9 1002
Issued to
LOT
BLOCK
SUBDIVISION
to install the following described plumbing, in accordance with the laws, statutes and regu-
lations of Miami Shores Village, Florida and the State of Florida, governing plumbing and
drainage work done in Miami Shores Village, Florida.
Fora story building at
Fixtures
Fixtures $ \
Sewer $
Septic Tank $
Total $
Village Plumbing Inspector
Received Payment by
Date
aiami cJhoresllage
F L 0 R 1 D A
PLUMBING PERMIT N9 699
Issued to
OWNER
LOT
BLOCK
SUBDIVISION
to install the following described plumbing, in accordance with the laws, statutes and regu-
lations of Miami Shores Village, Florida and the State of Florida, governing plumbing and
drainage work done in Miami Shores Village, Florida.
For a story building at
Fixtures
Fixtures $
Sewer $
Septic Tank $
Total $
Village Plumbing Inspector
Received Payment by
BUILDING
ELECTRICAL
PLUMBING
PERMIT N9 3006
Work to be performed under this Permit
Owner of
Building
MIAMI SHORES VILLAGE, FLORIDA
DATE 194 2..•
Architect
Contractor
or Builder
Legal Lot Bl.
Description
Address of
Building
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 longs or in the statements or specifications and
that he assumes responsibility for work done by his agents, servants or employees.
Signed- By
INSPECTOR
In consideration of the issuance to me of this permit I agree to perform the work covered hereunder in compliance with all ordinances and 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 permi I assume responsibility for all work done by either myself, my agent, servant or employee.
CONTR 0 R O BIKER BY AUTHORITY
GI`
Subdi-
vision
Value of
Project
Contractor's
License No.
Amt. of
Permit
I herewith submit the following application for a permit covering
the installation of a Septic Tank
Feet of drain tile:
For a (Store:
(Res:
Bedrums
Owner or Agent:
Lot No. Bloom" No.
Size of Soakage Pit:
Additional information:
MIAMI SHORES VILLAGE, FLA.
PPLICATION FOR SEPTIC TANK PERMIT
lippivisioN OF PLUMBING INSP410ION
Garage wash floor:
Ready for Inspection: Date:
APPROVED BY: ONiW ,
Remarks:
PERMIT NO./064 —
Date: / /S G T
•
Soakage Pit: Relaying: New:
Installed by: 1 /7
Address:
1
(NEB( Old: Stor- Addition: Remodeled:
Garage: Apt: Hotel: Office Bldg.
Building has: Stores; Offices; Apts; Hotel Rms;
44
SUBDIVISION
Address of work: � % 1
No. of Plumbing Fixtures: g Laundry Tubs: Floor Drains:
Nature of water supply: City: Well: Feet Distant from all
wells: a Type of tank installed: Tank capacity in
gallons:
Purpose of same:
VVdaste water from a:
CONDEMNED BY:
y . Time: I
0
*� c A
.a�r
Permit ■No
Application is hereby made for the approval
structure herein described. This application is
and all provisions of the Laws of the State of
of Miami Shores Village shall be complied
building during progress of work. ,,,,^
Owner's Name and Address --- -- _--[✓_h-t..
Registered Architect and /or Enginee
Employing Plumber's Name _____
Location and Legal Description Lot
State work to be performed and purpose of building (By
New Building _ _ Remodeling
s
MIAMI SHORES M1LLAGE
PLUMBING INSPE DEPARTMENT
APPLICATION FOR :PLUMBING PERMIT
2 L� _ P. No �__/ Street
Floors)
Date -
of the detailed statement of the plans and specifications herewith submitted for the building or other
made in compliance and conformity with the Building Ordinance of Miami Shores Village, Florida,
Florida, all ordinances of Miami Shores Village and all rules and regulations of the Building Division
with, whether herein specified or not. A copy of approved plans and specifications must be kept at
/f2 No L _ 4 „,_4_ _/_.__ Street./ - _ -A. '.
v Block Subdivision_ _ -_-..... ________--- ____________
Street and Number where work is to be performed —No. Street
Addition Repairs _____ No. of Stories ______
___.___.
Amount of Permit $_
Size Septic Tank _ ____ _______ Type of Tank _ Capacity Gals _____ _______________
Feet of Drain Tile___________ Dist. Feet of Tank or Drain Field from Well_______________
Nature of Water Supply: City—Well. _ Size of Soakage Pit
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.
STATE OF FLORIDA,
COUNTY OF DADE.
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally
8S.
My Commission Expires
(Signed)
Notary Public. State of Florida
_(Signed) – - - -- -- – – -- – Plumbing Inspector.
ster Plumber.
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
R / D P
i� WELL
SPRKLR.
SYSTEM
SWIM'G
POOL
CONTR.
LIST
1
-„---
tCAA'
CHECK
®
o-�
r
Permit ■No
Application is hereby made for the approval
structure herein described. This application is
and all provisions of the Laws of the State of
of Miami Shores Village shall be complied
building during progress of work. ,,,,^
Owner's Name and Address --- -- _--[✓_h-t..
Registered Architect and /or Enginee
Employing Plumber's Name _____
Location and Legal Description Lot
State work to be performed and purpose of building (By
New Building _ _ Remodeling
s
MIAMI SHORES M1LLAGE
PLUMBING INSPE DEPARTMENT
APPLICATION FOR :PLUMBING PERMIT
2 L� _ P. No �__/ Street
Floors)
Date -
of the detailed statement of the plans and specifications herewith submitted for the building or other
made in compliance and conformity with the Building Ordinance of Miami Shores Village, Florida,
Florida, all ordinances of Miami Shores Village and all rules and regulations of the Building Division
with, whether herein specified or not. A copy of approved plans and specifications must be kept at
/f2 No L _ 4 „,_4_ _/_.__ Street./ - _ -A. '.
v Block Subdivision_ _ -_-..... ________--- ____________
Street and Number where work is to be performed —No. Street
Addition Repairs _____ No. of Stories ______
___.___.
Amount of Permit $_
Size Septic Tank _ ____ _______ Type of Tank _ Capacity Gals _____ _______________
Feet of Drain Tile___________ Dist. Feet of Tank or Drain Field from Well_______________
Nature of Water Supply: City—Well. _ Size of Soakage Pit
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.
STATE OF FLORIDA,
COUNTY OF DADE.
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally
8S.
My Commission Expires
(Signed)
Notary Public. State of Florida
_(Signed) – - - -- -- – – -- – Plumbing Inspector.
ster Plumber.
appeared
to me well known, and who, being by me first duly sworn, upon oath deposes and says that he is the .
of the above described construction, that he has carefully read the foregoing application, and that he did sign the same, and that all facts
therein by him stated are true.
NOTE: A re- inspection fee of $1.00 will be made when such re- inspection is made necessary by improper notice for inspection, or faulty
materials and /or workmanship.
Permit 'No. ____.
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the building or other
structure herein described. This application is made in compliance and conformity with the Building Ordinance of Miami Shores Village, Florida,
and all provisions of the Laws of the State of Florida, all ordinances of Miami Shores Village and all rules and regulations of the Building Division
of Miami Shores Village shall be complied with, whether herein specified or not. A copy of approved plans and specifications must be kept at
building during progress of work.
Owner's Name and Address t _. i ) No ,d _ Street_ /
Registered Architect and /or Enginee
Employing Plumber's Name _____,,?
Location and Legal Description Lot -_ Block —___ Subdivision _____ _____ _-- ___ ___ _________
Street and Number where work is to be performed —No Street
State work to be performed and purpose of building (By Floors)
New Building Remodeling Addition Repairs
MIAMI SHORES VILLAGE
No./
Date --- - -- --- - -- -- � -, -- ---� -- ----
Street -_i_,
Type of Tank . Capacity Gals.____________— _______
Dist. Feet of Tank or Drain Field from We11_______ —__
Size Septic Tank___
Feet of Drain Tile__
Nature of Water Supply: City —Well Size of Soakage Pit
Amount of Permit $_
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.
STATE OF FLORIDA,
COUNTY OF DADE.
My Commission Expires
�»r
- (Signed)
Plumbing Inspector.
(Signed)
No. of Stories______________
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
'ster Plumber.
NOTE: A re- inspection fee of $1.00 will be made when such re- inspection is made necessary by improper notice for inspection, or faulty
materials and /or workmanship.
CLOSETS
BATH
TUBS
SHOWERS
LAVA-
TORIES
SINKS
SLOP
SINKS
LAUNDRY
TUBS
URINALS
CATCH
BASIN
FLOOR
DRAIN
DRINKING
FOUNT'NS
TOTAL
FIXTURES
CONTR.
LIST
CHECK
SEPTIC
TANK
SEWER
CONN.
DRAIN
FIELD
SOAKAGE
PIT
GREASE
TRAP
-�
t
- r� - �
f I
DEEP
WELL
SPRKLR.
SYSTEM
SWIM'G
POOL
CONTR.
LIST
CHECK
Hl '
l
Permit 'No. ____.
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the building or other
structure herein described. This application is made in compliance and conformity with the Building Ordinance of Miami Shores Village, Florida,
and all provisions of the Laws of the State of Florida, all ordinances of Miami Shores Village and all rules and regulations of the Building Division
of Miami Shores Village shall be complied with, whether herein specified or not. A copy of approved plans and specifications must be kept at
building during progress of work.
Owner's Name and Address t _. i ) No ,d _ Street_ /
Registered Architect and /or Enginee
Employing Plumber's Name _____,,?
Location and Legal Description Lot -_ Block —___ Subdivision _____ _____ _-- ___ ___ _________
Street and Number where work is to be performed —No Street
State work to be performed and purpose of building (By Floors)
New Building Remodeling Addition Repairs
MIAMI SHORES VILLAGE
No./
Date --- - -- --- - -- -- � -, -- ---� -- ----
Street -_i_,
Type of Tank . Capacity Gals.____________— _______
Dist. Feet of Tank or Drain Field from We11_______ —__
Size Septic Tank___
Feet of Drain Tile__
Nature of Water Supply: City —Well Size of Soakage Pit
Amount of Permit $_
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.
STATE OF FLORIDA,
COUNTY OF DADE.
My Commission Expires
�»r
- (Signed)
Plumbing Inspector.
(Signed)
No. of Stories______________
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
'ster Plumber.
NOTE: A re- inspection fee of $1.00 will be made when such re- inspection is made necessary by improper notice for inspection, or faulty
materials and /or workmanship.
Permit No « _
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. n _ �/ �7 J..
Owner's Name and Address. MRS _1Z _ __ �Ah / ?/2-. - -- - -_ No.____ _ Street 9
Registered Architect and /or Engineer _ —
Employing Plumber's Name r G / e/ # r TC L7 ' �1 f rO t f . No.__ 2 / /_ _ Street. G C -
�.__ -� - - - - -- - - -- - -- - Y - -� _ 6 -- - - - - -- - --
' j A fSh bdivision
Street and Number where work is to be performed —No e �' c "� � � � Street
State work to be performed and purpose of building (By Floors) _ _____
New Building __ Remodeling_ _�__ Addition_..__._ _ Repairs No. of Stories.
Location and Legal Description Lot________________ �________�__�� Block
Size Septic Tank Type of Tank_
Feet of Drain Tile Dist. Feet of Tank or Drain Field from Well
Nature of Water Supply: City —Well — Size of Soakage Pit
Amount of Permit $
ss.
GAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING "IAMlT
(Signed)- - -- _
Capacity Gals
( Signed )_
Date "eat .7 S'
_ ---` `Plumbing Ins°pec or.
The undersigned applicant for this building permit does hereby certify that he understands and accept 's obligations as an employer of labor
under the Florida Workmen's Compensation Act, being Section 5988, Compiled General Laws of Flori ennanent Supplement, and has com-
plied with the provisions thereof, and will require similar compliance from all contractors or subcontractors 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 • the work such public notice or notices as are
required by the Act. The undersigned agrees to employ only such sub - contractors, o or to be pgrfo u • : er s rmit, as are
licensed by Miami Shores Village.
My Commission Expires Notary Public, State of Florida
Master Plumber.
STATE OF FLORIDA, t
COUNTY OF DADE.
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments , personally appeared
to me well known, and who, being by me first duly sworn, upon oath deposes and says that he is the
of the above described construction, that he has carefully read the foregoing application, and that he did sign the same, and that all facts
therein by him stated are true.
NOTE: A re- inspection fee of $1.00 will be made when such re- inspection is made•neeessary by improper notice for inspection, or faulty
materials and /or worlcmanship.
CLOSETS
BATH
TUBS
SHOWERS
LAVA-
TORIES
SINKS
SLOP
SINKS
LAUNDRY
TUBS
URINALS
I A
CATCH
BASIN
FLOOR
DRAIN
DRINKING
FOUNT'NS
TOTAL
FIXTURES
CONTR.
LIST
L )
I
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 « _
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. n _ �/ �7 J..
Owner's Name and Address. MRS _1Z _ __ �Ah / ?/2-. - -- - -_ No.____ _ Street 9
Registered Architect and /or Engineer _ —
Employing Plumber's Name r G / e/ # r TC L7 ' �1 f rO t f . No.__ 2 / /_ _ Street. G C -
�.__ -� - - - - -- - - -- - -- - Y - -� _ 6 -- - - - - -- - --
' j A fSh bdivision
Street and Number where work is to be performed —No e �' c "� � � � Street
State work to be performed and purpose of building (By Floors) _ _____
New Building __ Remodeling_ _�__ Addition_..__._ _ Repairs No. of Stories.
Location and Legal Description Lot________________ �________�__�� Block
Size Septic Tank Type of Tank_
Feet of Drain Tile Dist. Feet of Tank or Drain Field from Well
Nature of Water Supply: City —Well — Size of Soakage Pit
Amount of Permit $
ss.
GAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING "IAMlT
(Signed)- - -- _
Capacity Gals
( Signed )_
Date "eat .7 S'
_ ---` `Plumbing Ins°pec or.
The undersigned applicant for this building permit does hereby certify that he understands and accept 's obligations as an employer of labor
under the Florida Workmen's Compensation Act, being Section 5988, Compiled General Laws of Flori ennanent Supplement, and has com-
plied with the provisions thereof, and will require similar compliance from all contractors or subcontractors 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 • the work such public notice or notices as are
required by the Act. The undersigned agrees to employ only such sub - contractors, o or to be pgrfo u • : er s rmit, as are
licensed by Miami Shores Village.
My Commission Expires Notary Public, State of Florida
Master Plumber.
STATE OF FLORIDA, t
COUNTY OF DADE.
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments , personally appeared
to me well known, and who, being by me first duly sworn, upon oath deposes and says that he is the
of the above described construction, that he has carefully read the foregoing application, and that he did sign the same, and that all facts
therein by him stated are true.
NOTE: A re- inspection fee of $1.00 will be made when such re- inspection is made•neeessary by improper notice for inspection, or faulty
materials and /or worlcmanship.
Fermit
New Building.
Amount of Perm 2
it $. • 00
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
Application is hereby Inskle 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.
MI:S....Bernard
Street 275 N.E. 92nd.St.
Owner's Name and Address ........... No.
Registered Architect and/or Engineer .....
Leo 's PlumbinB Service,_Inc N. W. 7 Ave.
Employing Plumber L
's Name stma14350
Location and Legal Description Block
Street and Number where work is to be performed—No Street 275 N. E, 92nd. St.
State work to be performed and purpose of building (By Floors)__
Remodeling-- Addition Repairs No. of Stories.
Size Septic Tank__ Type of Tank_
Feet of Drain Tile _Dist. Feet of Tank or Drain Field from Well
Nature of Water Supply: City—Well _Size of Soakage Pit
( 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 5968, Compiled General Laws of Florida Pennanent 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
ratitliri by tlie 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).
Capacity Gals
Date July 12 1962
Subdivision
Master Plumber.
STATE OF FLORIDA,
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 by improper notice for inspection, or faulty
materials and/oz workmanship.
CLOSET°
BATH
TUBS
SHOWERS
LAVA-
TORIES
SINKS
SLOP
SINKS
LAUNDRY
TUBS
URINALS
CATCH
BASIN
FLOOR
DRAIN
DRINKING
FOUNT' NS
TOTAL
FIXTURES
comm.
LIST
CHECK
...........
SEPTIC
TANK
SEWER
CONN.
DRAIN
FIELD
SOAKAGE
PIT
GREASE
TRAP
SOLAR
HEATER
DEEP
WELL
SPRKLR.
SYSTEM
SW I PC G
POOL
CONTE.
LIST
X
CHECK
Fermit
New Building.
Amount of Perm 2
it $. • 00
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
Application is hereby Inskle 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.
MI:S....Bernard
Street 275 N.E. 92nd.St.
Owner's Name and Address ........... No.
Registered Architect and/or Engineer .....
Leo 's PlumbinB Service,_Inc N. W. 7 Ave.
Employing Plumber L
's Name stma14350
Location and Legal Description Block
Street and Number where work is to be performed—No Street 275 N. E, 92nd. St.
State work to be performed and purpose of building (By Floors)__
Remodeling-- Addition Repairs No. of Stories.
Size Septic Tank__ Type of Tank_
Feet of Drain Tile _Dist. Feet of Tank or Drain Field from Well
Nature of Water Supply: City—Well _Size of Soakage Pit
( 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 5968, Compiled General Laws of Florida Pennanent 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
ratitliri by tlie 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).
Capacity Gals
Date July 12 1962
Subdivision
Master Plumber.
STATE OF FLORIDA,
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 by improper notice for inspection, or faulty
materials and/oz workmanship.
Permit No. ®�
Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the building or other
structure herein described. This application is made in compliance and conformity with the Building Ordinance of Miami Shores Village, Florida,
and all provisions of the Laws of the State of Florida, all ordinances of Miami Shores Village and all rules and regulations of the Building Division
of Miami Shores Village shall be complied with, whether herein specified or not. A copy of approved plans and specifications must be kept at
building during progress of work.
Owner's Name and Address ,___!
Registered Architect and /or Engine, rr_.____
Employing Plumber's Name
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
N Biding .__.___ Remodeling ___________________..__.__ Addition Repairs No. of Stories _
Size Septic Tank / b"-'l°'
Feet of Drain Tile .
Nature of Water Supply: City —Well
Amount of Permit $
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
No._-_----- _--- ____ -_ Street.
rA.
_Block_ _ ____ Subdivision
Type of Tank_ Capacity Gals
st. Feet of Tank or Drain Field from Well
— __ __Size of Soakage Pit
( Signed) ___ -__ -\
( Signed )---
Date______ 7/./
Street__
Street
lumbing Inspector.
The undersigned applicant for this building permit does hereby certify that he understands and acce s obligations as an employer of labor
under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Flori s . 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.
My Commission Expires Notary Public, State of Florida
2/
Master Plumber.
STATE OF FLORIDA, ss.
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 • neces ary by improper notice for inspection, or faulty
materials and /or workmanship.
CLOSa TS
BATH
TUBS
SHOWERS
LAVA-
TORIES
SINKS
SLOP
SINKS
LAUNDRY
TUBS
INAL8
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. ®�
Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the building or other
structure herein described. This application is made in compliance and conformity with the Building Ordinance of Miami Shores Village, Florida,
and all provisions of the Laws of the State of Florida, all ordinances of Miami Shores Village and all rules and regulations of the Building Division
of Miami Shores Village shall be complied with, whether herein specified or not. A copy of approved plans and specifications must be kept at
building during progress of work.
Owner's Name and Address ,___!
Registered Architect and /or Engine, rr_.____
Employing Plumber's Name
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
N Biding .__.___ Remodeling ___________________..__.__ Addition Repairs No. of Stories _
Size Septic Tank / b"-'l°'
Feet of Drain Tile .
Nature of Water Supply: City —Well
Amount of Permit $
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
No._-_----- _--- ____ -_ Street.
rA.
_Block_ _ ____ Subdivision
Type of Tank_ Capacity Gals
st. Feet of Tank or Drain Field from Well
— __ __Size of Soakage Pit
( Signed) ___ -__ -\
( Signed )---
Date______ 7/./
Street__
Street
lumbing Inspector.
The undersigned applicant for this building permit does hereby certify that he understands and acce s obligations as an employer of labor
under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Flori s . 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.
My Commission Expires Notary Public, State of Florida
2/
Master Plumber.
STATE OF FLORIDA, ss.
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 • neces ary by improper notice for inspection, or faulty
materials and /or workmanship.
pJOB:
BUILDING
ELECTRICAL
•
PL r BING
cf � cs-
ADD:
WORK
DONE BY:
The Following is ready for inspection:.
Inspectorts Report:
REQUESTED : WILL BE READY
•
�%
BUILDING
ELECTRICAL
PLUMBING
Contractor -'`'
or Builder /
Owner of "
Building - (7
Legal Lot ° L
Description
Address of
MIAMI SHORES VILLAGE, FLORIDA
DATE'` ``;r � 194 ,
`contract or's
License No.
PERMIT N° 8192
Work to be performed under this Permi
f
BL /
Architect
Subdi-
vision
Z
Z1.1
.A
4 t Value of
Building --' , :,x 7 • ` -- ; , . = Project
This permit i granted to the contractor or builder named above to construct the building or to install the equipment or device described in the appli-
cation herefor in strict compliance with all ordinances pertaining thereto and with the understanding that the work will be performed in compliance with any
plans, drawings, statements or specifications that may have been submitted to and approved by the proper municipal authorities. This Permit may be revoked
at any time if the work is not done in compliance with such ordinances or if the plans are changed without authorization. A further condition upon which this
permit is granted is the understanding that the contractor or builder named above assumes the responsibility for a thorough knowledge of the ordinances and
regulations pertaining to the work covered hereby whether shown on the plans or drawings or in the statements s and that he assumes respon-
sibility for work done by his agents, servants or employees. „
Signed• " . " "
INSPECTOR
Amt. of
Permit
In consideration of the issuance to me of this permit I agree to perform th work covered hereunder in compliance with all ordin4rlbes and rg,gu ti s
pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authori e ed M of Miami Shorade.
In accepting this permit I a rme responsibility for all work done by either myself, my agent, servant or employee.
1
CONTRACTOR tpni $tXILDER
ell , f
BY AUTHORITY
Permit No._ 1_,
Date �y
Application is hereby made for the approval of the detailed statement of the plans and specifications herewith su mitted for the building or dEher
structure herein described. This application is made in compliance and conformity with the Building Ordinance of Miami Shores Village, Florida,
and all provisions of the Laws of the State of Florida, all ordinances of Miami Shores Village and all rules and regulations of the Building Division
of Miami Shores Village shall be complied with, whether herein specified or not. A copy of approved plans and specifications must be kept at
building during progress of work.
Owner's Name and Address
Registered Architect and /or Engineer
Employing Plumber's Name
Location and Legal Description Lot
Street and Number where work is to be performed —No 7 .S
State work to be performed and purpose of building (By Floors)
New Building Remodeling Addition Repairs No. of Stories __ _.
Size Septic Tank Type of Tank Capacity Gals
Feet of Drain Tile oa Dist. Feet of Tank or Drain Field from Well
Nature of Water Supply: City —Well _ Size of Soakage Pit
Amount of Permit $_
s s.
My Commission Expires
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
No Street
Block Subdivision
y,. Street
The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations as an employer of labor
under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Permanent Supplement, and has corn-
plied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors employed by him in the work to be
performed under this permit; and will post or cause to be posted for inspection on the site of the work such public notice or notices as are
required by the Act. The undersigned agrees to employ only such sub - contractors, on work to be performed under this permit, as are
licensed by Miami Shores Village.
( Signed ) __
• Street_:. -'f
.�x.
Notary Public, State of Florida
Plumbing Inspector.
Master Plumber.
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
SINKS
SLOP
SINKS
LAUNDRY
TUBS
URINALS
CATCH
BASIN
FLOOR
DRAIN
DRINKING
FOUNT'NS
TOTAL
FIXTURES
CONTR.
LIST
_ —_
CHECK
SEPTIC
TANK
SEWER
CONN.
DRAIN SOAKAGE
FIELD PIT
GREASE
TRAP
SOLAR
H EATER
DEEP
WELL
SPRKLR.
SYSTEM
SWIM'G
POOL
CONTR.
LIST
/ -
d
CHECK
Permit No._ 1_,
Date �y
Application is hereby made for the approval of the detailed statement of the plans and specifications herewith su mitted for the building or dEher
structure herein described. This application is made in compliance and conformity with the Building Ordinance of Miami Shores Village, Florida,
and all provisions of the Laws of the State of Florida, all ordinances of Miami Shores Village and all rules and regulations of the Building Division
of Miami Shores Village shall be complied with, whether herein specified or not. A copy of approved plans and specifications must be kept at
building during progress of work.
Owner's Name and Address
Registered Architect and /or Engineer
Employing Plumber's Name
Location and Legal Description Lot
Street and Number where work is to be performed —No 7 .S
State work to be performed and purpose of building (By Floors)
New Building Remodeling Addition Repairs No. of Stories __ _.
Size Septic Tank Type of Tank Capacity Gals
Feet of Drain Tile oa Dist. Feet of Tank or Drain Field from Well
Nature of Water Supply: City —Well _ Size of Soakage Pit
Amount of Permit $_
s s.
My Commission Expires
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
No Street
Block Subdivision
y,. Street
The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations as an employer of labor
under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Permanent Supplement, and has corn-
plied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors employed by him in the work to be
performed under this permit; and will post or cause to be posted for inspection on the site of the work such public notice or notices as are
required by the Act. The undersigned agrees to employ only such sub - contractors, on work to be performed under this permit, as are
licensed by Miami Shores Village.
( Signed ) __
• Street_:. -'f
.�x.
Notary Public, State of Florida
Plumbing Inspector.
Master Plumber.
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.
- -w
REQUEST FOR INSPECTION
Company % ,
Job
2
Address G Q \ )
-
/7 - A
' H E
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Date 'Job Address 4"-Z , d,e 94 , ,! Tax Folio
Legal Description Historically Designated: Yes No
Owner/Lessee / Tenant JJQ.A Nue Master Permit # 37 KKj
Owner's Address / .„1 . Phone - r7d
Contracting Co. 6 /0. /1 ,D ,)�. Address / 7 ji "(_)4) /2 7
Qualifier A /777/4
SS# Phone 4
State # Municipal # Competency # Ins. Co.
Architect/Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type (circle one): BUILDING ELECTRICAL
MECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIPTION I). 4) ) , i,.tJ 4'( jfl d../)
Square Ft. f(.Ci Estimated Cost (value) AGJBD °.d0
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.
) ,c/7.0,z/r,r-
Signature of owner and/or Condo President Date
Not
My
om 18RPqfiflfAlAL BUB-
O e. SANDRA iBi 4151131811-
0 , . r _ ._Q COS!a�Clo- imitunti
91 � ` '� ' 4 MY COM@IIS8t4Y IWA.
OF FL AUG. 17i9 1
FEES: PERMIT 3 0 - RADON
APPROVED:
Zoning Building
Mechanical Plumbing
C.C.F.
1.
Signature of Contractor or Owner- Builder
Date �Noir as to Contractor or Owner-Builder
1VLi C i n A I* : NOTARY SEAL
O 1 <i SANDRA IA MONTIEL
.� 7r * C NUMBER
C.II Q CC401261
7/F �' cv Q0 MY COMMISSION .EXP.
OF FL AUG. 17 1998
NOTARY TOTAL DUE 6
Electrical
Date
Date
tee)
Engineering
7 8TRUCTION PERMIT F
] New System
] Repair
LOT:
PROPERTY ID #: A
T
A
N [
K [
0
T
H
E
R
STATE OF FLORIDA
DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES
ONSITE SEWAGE DISPOSAL SYSTEM
CONSTRUCTION PERMIT
Authority: Chapter 381, FS & Chapter 10D -6, FAC
R:
[e/r Existing System
Abandonment
APPLICANT: 6 2)Z u
PROPERTY STREET ADDRESS: 2 2)„,f---4/,
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 SP CLFICATIONS
[ GALLON / G
•
PD SEPTI /AEROBIC UNIT CAPACITY MULTI- CHAMBERED /IN SERIES:[ ]
; l d ] [GALLONS / GPD] COY
CAPACITY MULTI- CHAMBERED /IN SERIES:[ ]
] GALLONS GREASE INTERCEPTOR CAPACITY [MAXIMUM CAPACITY SINGLE TANK: 1250 GALLONS]
RATE
] GALLONS PER DOSE DOS r TAj+iK
D 020 OYJARE FEET ?RIMARY DRAINFIELD
R [ ] SQUARE FEET
A TYPE SYSTEM: [ ] STANDARD
I CONFIGURATION: [ ] TRENCH
F LOCATION OF BENCHMARK:A/LC
_
I ELEVATION OF PROPOSED SYSTEM SITE [
E BOTTOM OF DRAINFIELD TO BE [
L
D
FILL REQUIRED: [ ] INCHES EXCAVATION REQUIRED: [
INEZALL ]12 OF LOAMY COARm �ANfl
�..,•s ...;a;_td i•t J."Jy d'u� tDDI1 Y f i- )
,A o.
,
SPECIFICATIONS BY:
SYSTEM
SYSTEM
[ ] FILLED
DATE ISSUED:
f
APPROVED BY:
HRS-H Form 4016, Mar 92 (Obsoletes
(Stock Number: 5744- 001 - 4016 -0)
CA AC Y DOSE
TITLE:
TITLE:
previous editions which may not be used)
[ ]
PERMIT #
DATE PAID
FEE PAID $
RECEIPT #��'
[ olding Tank Temporary /Experimental
[K] Other(Specify)
PER
[SECTION /TOWNSHIP /RANGE /PARCEL NUMBER]
[OR TAX ID NUMBER]
24 HRS
[ ] MOUND [ ]
[
] [INCHES /FT] [ABOVE /BELOW]
] [INCHES /FT] [ABOVE /BELOW]
] INCHES
C' 3'YEA
NO. OF
PUMPS:
[
BENCHMARK /REFERENCE POINT
BENCHMARK /REFERENCE POINT
v CPHU
EXPIRATION DATE: >
Page 1 of 2
' .
7 i:kir'f?, numbc
' TON F331: of permit, :•' tpsicify ty
JnLf full
number for or agent.
L'AVi1C.7
:". ?.C. '7W: or street me■ll'ig rens for cppliecn: o: age.
su3D!V:: x f.37
;D!): numb e• (CPE211 ".; "."aircr E) C Lection/town number;
ANTI'
;••:
'.•„•-• •-••••' 1017:-6,
• specitiectiol.
. • -.1: op, cerirtiti.:L;i:iremer vcrirnec piroviLris.
NLme o: individual p:ovidl• ',pecifications. :must ;IC seal,d.
3t'' personnel eviewing
'nit is issued
DATE: One from date i ui die system has r systerr_ repcirs beco.re void 90 days from the drte
is"Aied.
•• • ,
• .
11
Scale: Each block represents 5 f
feet and 1 inch = 50 f
feet
■■ 1
■d 1
111111111111111 111111111111111 ■
I 7
NI I
7 -
IN
I ■ 1
11 •
• ■
■■■ 1
1111111111•1111•• ■
.■ .
• •
■■■■■ ■
■■
■ ■ ■■■.■■■
L J
—L 0
0111.11111.11111 ■
UU� ■
■ ■ ■■ U ■
ri !
■ •
•11111111.111111 J
J I
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,
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L1_ -I
I
IT
I I?
Plan Approved
By
STATE OF FLORIDA
DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES
APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUC R
Permit Application Number /..- 9N EICA 4J
HRS -H Form 4015, Feb 85 (Obsoletes previous editions which may not be used)
(Stock Number. 5744-002-4015-6)
PART II - SITE PLAN 1377./"E,
f " -
Not Approved
ALL CHAN S MUST BE APPROVED BYTHE COUNTY PUBLBC HEALTH UNIT
I_ J_I_ I
e R �
// r
Site Plan submi>�'bjr: j� ° - ~aG
SIGNAT R TITLE
Date � � v � 9 r
County Public Unit
Page 2 of 3
APPIJICATION FOR:
[A4 New System [ Existing System [,] Holding Tank [J] Temporary /Experimental
y ] Repair [ ] Abandonment [ Other(Specify)
LICANT: 0#4(.4924
AGENT: n r 5 /l
MAILING ADDRESS: / 7 K.
TO BE COMPLETED BY APPLICANT OR APPLICANT'S AUTHORIZED AGENT. ATTACH BUILDING PLAN AND TO -SCALE
SITE PLAN SHOWING PERTINENT.FEATURRS REQUIRED BY CHAPTER 10D -6, FLORIDA ADMINISTRATIVE CODE.
PROPERTY INFORMATION [IF LOT IS NOT IN A RECORDED SUBDIVISION, ATTACH LEGAL DESCRIPT ON OR DEED]
LOT: BLOCK: SUBDIVISION:
PROPERTY ID #:
PROPERTY SIZE:
`T
PROPERTY STREET ADDRESS:
DIRECTIONS TO PROPERTY:
BUILDING INFORMATION
Unit Type of No. of
No Establishment Bedrooms
1
2
3
a 4
STATE OF FLORIDA
DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES
ONSITE SEWAGE DISPOSAL SYSTEM
APPLICATION FOR CONSTRUCTION PERMIT
Authority: Chapter 381, FS & Chapter 1OD -6, FAC
[ ] Garbage Grinders /Disposals
[ ] Ultra- low,34ume Flush Toilets
[ � 1 RESIDENTIAL
APPLICANT'S, SIGNATURE: 6 GL-' DATE:
HRS-H Form 4015, Mar 92 (Obsoletes previous editions which ma
(Stock Number: 5744-001-4015-1)
DATE OF
SUBDIVISION:
[Section /Township /Range /Parcel No.] ZONING:
ACRES [Sgft /43560] PROPERTY WATER SUPPLY: [ ] PRIVATE [
9 `
Buil erson 4 iness Activity
Area S erve or Commercial Only
•
[ ] COMMERCIAL
[ ]/Spar/Hot Tubs ,,. [ ] Floor /Equipment Drains
[ ]'Other (Specify)--
bad be
PERMIT #
DATE PAID
FEE PAID $
RECEIPT #
( 7
TELEPHONE: ey7
1
2- PA /
Page 1 of 3
:Pro •'vne.'n full -
of ^ :.._. it ' ° .. _,.,C ?E• ? A
rr - ,_'_t'OSdie ., (',^,CC:C ^.SL or L :CO?CsC ' .. , ..... _,^ c Ed;:s:v c: , o copy 0! C:
.. 0� iV]C .. H. C , ..:,C'� Ht tt� - fC_'aC.. .''!'F' 1° LC "`n
O Ct
uc as in cc.!r.!):'..
:::te O: ?ublic.
•r Ca.7.7' � s: G ?' L :..ss for pi0pC Oi. ^, tvithou? :n i �:r:'CCs C� ..,.. _ . .: "1!CC =C !: :t T:c: or rand End loro!e in county.
wit 9: U!'IC :: G:G.?t!CCi 111.5trUCi :(. _.. ..: or attach an. A: - .:1'. _: 7 'w ?C'J:: .. !CC: :ion.
r - .....,, ..
cor.
o.. ^ ±c o: " 2 ' < `' ' . . 1 .2.;177.y, aing!e w.c0 :.:o-)ta, roc:curant,
ce.
. _.`°c.y provide alcepin5 ccco.. oslctiona for
. , ..1h. ..'?ti Or r.. ..7!' Or L-i SL'-'� , , C:Ce" "irS; or open O. _L
O. dCc!.,. .... C!i� , .. -. ._.. • , . C"..
•
q
.... ."__c_.__...- _..... ;3 '
C
-of Clay f C..3 :2C'sf} CJ?i7.:o cul)tr _ir.7ccC C.) ^u "s.;iCii4.13
Cta, .:co:c::r.
STATE OF FLORIDA
DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES
ONSITE SEWAGE DISPOSAL SYSTEM
SITE EVALUATION AND SYSTEM SPECIFICATIONS
APPLICANT: epg / 6 / 4 /0
LOT: �� BLOCK: SUBDIVISION:
PROPERTY ID #: �r^ [ Section /Township /Range /Parcel No. or Tax ID Number]
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 [0 NO NET USABLE AREA AVAILABLE: ACRES
TOTAL ESTIMATED SEWAGE FLOW: 5/5 GALLONS PER DAY [RESIDENCES -TABLE 1 / OTHER -TABLE 2]
AUTHORIZED SEWAGE FLOW:
V GALLONS PER DAY [1500 GPD /ACRE OR 2500 GPD /ACRE] e l -
UNOBSTRUCTED AREA AVAILABLE: SQFT UNOBSTRUCTED AREA REQUIRED : SQFT
BENCHMARK /REFERENCE POINT LOCATION:
ELEVATION OF PROPOSED SYSTEM SITE IS [INCHES /FT] (ABOVE /BELOW] BENCHMARK /REFERENCE POINT
THE MINIMUM SETBACK WHICH CAN BE MAINTAINED FROM THE PROPOSED SYSTEM TO THE FOLLOWING FEATURE A:
SURFACE WATER: ,4461 FT DITCHES /SWALES: ��ff FT NORMALLY WET? [ ] YES ( NO
WELLS: PUBLIC: ,tines FT LIMITED USE: vh FT R IV}►TE: 60t FT NON - POTABLE: A FT
BUILDING FOUNDATIONS: /d FT PROPELINES: 1 FT POTABLE WATER LINES: id FT
SITE SUBJECT TO FREQUENT FLOODING: [ ] ES [1,4 NO 10 YEAR FLOODIN ? ] YES WNO
10 YEAR FLOOD ELEVATION FOR SITE: FT MSL /NGVD SITE ELEVATION: 1 FT MSL /NGVD
SOIL PROFILE INFORMATION SITE 1
Munsell # /Color exture � Depth
to
to
to
to
to
to
to
to
to
USDA SOIL SERIES:
OBSERVED WATER TABLE: A j, INCHES [ABOVE / BELOW) EXISTING GRADE. TYPE: [PERCHED / APPARENT]
ESTIMATED WET SEASON WA R TABLE ELEVATION: ,�! INCHES [ ABOVE,/ BELOW ] EXISTING GRADE.
HIGH WATER TABLE VEGETATION: [ ] YES [ ] NO (( MOTTLING: ( ] YES [(I NO DEPTH: Gj! INCHES
SOIL TEXTURE /LOADING RATE FOR SYSTEM SIZING: ��t"l. DEPTH OF EXCAVATION: 4 INCHES
DRAINFIELD CONFIGURATION: ( ] TRENCH [V] BED [ ] OTHER (SPECIFY)
REMARKS /ADDITIONAL CRITERIA:
SITE EVALUATED BY:
e
ie
AGENT: /, /li4 fpF :4
PERMIT # / V
SOIL PROFILE INFORMATION SITE 2
Munsell # /Color
2
USDA SOIL SERIES:
Texture Depth
to g; '
to
C to
to
to
to
to
to
to
DATE:
HRS-H Form 4015, Mar 92 (Obsoletes previous editions which may not be used) Page 3 of 3
(Stock Number: 5744 - 003 - 4015 -1)
arg..al/CTIONS:
1?1 0: Permit tracking number cosigned by CPMU.
A.??1,:CAPrIr: Property owner's fill name.
AC:ENT: Property owner'n ,ally authorized reprvsentative.
I3LOCK, SU3DIVISiON: Lot, block, and subdivision for lot.
:73.C71! MO: 27 character run: for property. (property apprair:er DC :sr etai.097./tOkYnrhip/rnnge/parcel number)
KZE: Check if prorty nt site conforms zo submit!es: EL.; pIr_r.. accord eel usable area available - 2ot area exclusive of
all paved areas are. 1r4poevd road beds v,ithii pt.c rifc.. or. easements and exclusive of ctrentns, /atter!,
normally we: drain-;:: ditches, !!!Dra. or other sn.CL Goclini of water.
:Record the i.ews5e. flOV! Co: (residences) or 'Table 2 (non-:residential), Chapter
IFAC. 21.:,se the nuthori;cee, fn.:. :Is Iv; Cr! EZI",, ECCb!e crcc /ctr supp!y (t5C3 gcllosta
rler day per ::en Co: p..iva:c aups:iJs arm:, 2LC s•sr:: c.rized aewe.rza flew
cloen no: ccv 3'7 !:313C3e 7;1::
Jenard the .: of unolsm aval7r.G:s ilaebulnze:ccl am] Ernan
times as /ergo c ?e,-..cen: of she :1.nobrzrzc:cd amp ir...!2f3:".. moel mi.nimum
r.,:curcics in FAC. 711:: :::arfantrunt .1 Go ccni3uous - ,10 the drcimlield.
the . .AInC17.177;2% ::CCO::(:. the act:ml clevction. accord tae.
ley Ltion of s3 relstior ::,;:sw) to :ho bertchmark.
Ilecord - - • Ct.17 • • Go rscorded or "i\li
!o: : The
of a:::y pub lic • 2C0 sl sr:
• yea:: flood cIevatior. f'or cite
el
2.'o soil pro' - y:opcsos: f n/.".5 Cee: 07 LT/Iln. r.r0 Soil
• .; Solt color cnc: '3S:DA col! textcres). 12e5.:nals muss
Se clearly :Frovicie :3SA coil nari:r if if :he aeries cr.n2zo: determinnd.
record the d,mth c observed 1, :sble of. evaluation. Mark "perched' or "apparent" as
r the estimated we', socson wr,:e7 or, site evaluation, us IDA roil maps, ar.d
historical I V.1.0:3 j:;!/.",!0,77. 2rat,e,:12. 1 if tlins pmcont and depth.
SC accose coil IC :or2C1113 Mt) fo:: f:yneM
0:F; :EXCAVA7T.ON: ,:f applicable r:opth of excavation raquiree.. "ikI.A" if no: applicable.
Check drain:lc: C12rEtiOrl requimd. crAcIL'y
CR.77:1,11A: accord any tdditiOILL:1 reissue pertinent to site a:- dosing required.
rii:VA:1-7,JAT1ED 3Y: Signature of cvalur.'.or, title, and date of evaluation. :7 erp3ineem must seal all documentation submitted.
WO:IXSHEL 21.2VATiON C:F :3:i•INCIKMA2N / .7a. ES:
:3:ENCHMAEILK
SHOT:
SiTiF. 1
H.T.
[-] SHOT
SRTE 2
H.R.
[-] SHOT
•