47 NE 93 StSTATE OF FLORIDA
DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES
ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION AND INSTALLATION PERMIT
Appilcant�' ^e rmi Nu ber
417_ �
PAR II - SYSTEM INSTALLATION INSPECTION AND INAL I STA� APPROVAL- --------- • - -•
lr.stalier
Proper tank legend: Yes Ir k No
if-Inks watertight: Yes ` • No
',oiler tank exit/et device: Yes No
o'P'.Y -'rth Width
4 cet feet
feet feet
feet feet
`?otaG = ft
Systems located as permitted: Yes No
Systems including plumbing stub -outs installed at proper elevation: Yes / No
evi
Average depth to drainpipe invert from finished grade' inches Maximum depth: fi'
A\..rage depth of drainfield gravel I Z. inches Minimum depth of gravel: re:— inches
gravel size: Yes No Gravel is suitable quality: Yes No
;- acizfill or fill material as required: (Quality) Yes No (Quantity) Yes No
�d :I T ei
wected by:
iZ ,J,.
I
Dra)nfield Trench
I.7 C.10 ."ov.n.o®m.mo- a-- =3- a ®......a..- so-- ®- . -o ®®a ®. PART
Tank Manufa?turer y�^�
Tank material Tank level: Yes
No
Tank size: —'1 gallons gallons gallons
i o
Lengths Width
Man role or marker to grace: Yes
LLATION APPROVAL-
Absorption
AN APPROVED INSTALLAT!ON DOES NOT GUARANTEE PERFORMANCE
Approved by:
Length 34. Beet x )� reat = ` t 2
feet fl eet Length _ feet x ' "eet == ft
d�
feet feet Proper No. drainlines: Yes __ No —'
feet feet Proper pipe separation: Yes__ _ No
Total = ft Distribution box level: Yes __ No
inches
Date 4 3 " v
COUNTY PUBLIC HEALTH UNIT
No:e: Completed copies of this form will be provided to the applicant, installer and the building department.
For 4096, Jan 86 (Replaces Feb 85 edition which may be used)
(Stock Number: 5744-002-4016-4) ?age 2 of 2
BUILDING
ELECTRICAL Pi
PLUMBING LI
ROOFING III
Lit
Owner of
Building
MIAMI SHORES VILLAGE:, FLORIDA
PERMIT N. 4128
Worir to he performed under this Permit
Architect
Gcnfractor
or Builder
Legal Lot Subct,
Description Bl. vision
DATE
Contractor's
Lican_se No.
Address of Value of
Building i Project $ Arrifet_sat :',
Permit F.I_
This permit is granted to the contractor or b11 named above to construct the building or to install he Equipment or dcya.c ile ril,c(1 in di t' al,p'ii(•;1-
tion herefor in strict compliance with all ordinances pertaining the tato and with the understanding tht the NA irh will he perft)rint d it ewnpliallec with
plans, drawings, statements or specifications that may have been submitted to and approved ly the proper m inicipal : 11; V i
' 1 . 3.S . Iray 1,c re \ Okt'd
at any time if the work is net done in compliance with such ordinances or if the plans tire changed without authorization. A further rendition upon which thi.
permit is granted is the understanding that the contractor or 3uileler named above assumes the responsibility 'or a t toreugh knowledge of the ordinance. and
regulations pertaining to the work covered hereby whether shown on the plans or drawings or in the itaterneuts (17 tpecifications and that he a91.11/12s n'
sibility for work done by his agents, servants or employees.
Signed:
In consicioradon of the isec.anci to ra P. of this pmmit I agree to perform the covered heroundcr t with :111 cri.rlonces and regalatior,
pertaining thoroto and in atriet conformity with the plans, drawings, statements or specifecations sulomittoc, to the :repot- cuhoriooe of 111 ,::11,--,res Village. To ac-
cepting this permit I assume responsibility for all work dono by either, myself, my ago at, : or employee
CONTRACTOR OR BUILDER
BY ATITT,-;: 11,1
BUILDING
ELECTRICAL
PLUMBING
ROOFING
Owner of ,
Building
Architect
Contractor
or Builder
Legal
Description
Lo: .:
Q PERMIT N? 9551
Address of .)
Building
MIAMI SHORES VILLAGE, FLORIDA
This permit is g;-anted to the contractor or builder na nod above to constr
tion herefor in strict compliance with all ordinances pertaining thereto and with
plans, drawings, statements or specifications that may have been r ibmitted to and
at any time if the work is not done in compliance with such ordinances or if the
permit is granted is the understanding that the contractor or builder named above
regulations pertaining to the work covered hereby whether showr. on the plans or
sibility for work done by his agents, servants or employees.
CONTRACTOR or BUILDER BY
Work to be performed under this Permit
r`
Suhd'-
r itiion
Sq. Ft.
Valle of
Project $
Date_
Contractor's
License No.
Permit
AU'I'ili'RI'I'Y
19
uct tae building or to install the equipment or der`co in th;
the understanding that tile work ss be perfor IICC in runt1 ::m I \each a il
approved b) the proper rot nicipa' authorities. 'Phi- Permit ma re n' cr
plans are changed without ;authorization. A furti or cnnelition upon ■shic`1 :hi-
assumes the responsibility for a thorough knowletlp the ur,iinanrc
drawing.; of in the statement, or specifications :n:1 t'':: her rt-nt
Signed • (INSPEC'FOR) BY -
In consideration of tic issuance to me of this permit J. agree to perform the work covered hereunciec in compliance with :"I u - lit inru and r: git it
pertaining thereto and in strict conformity with the plans, drawings, statements or specifications subm.tted to the proper authnritie' of Miami Fhuee Vi l:__.:
In accepting this permit I assume responsibility for all work done by either, myself, my agent-, servant or employee.
OWNER•S NAME
. 4 . 0/42,1 (.c c e....,. 6® iit,,wtriei
PRESENT ADDRESS
47 Al. 4y 3 " fr.
LICENSE NO.
PHONE NO.
JOB LOCATION / (ST. OR AVE.)
��
4-, Gi. t�G• 7.7 � 4
LOT
/7 4 4 a c.
BLOCK
1 ``5
( � SUBDIVISION
®hi e►.no i dm4ecsi ..rec, is I nh,p,r1
GENERAL CONTRACTOR
C, ij 66 ie.
ADDRESS
6 5c S.� . i3 4 .
PHONE NO.
LICENSE NO.
/k.R9 i
�}
BUILDING PERMIT NO. S
DATE o /° 4 7
PERMIT FEE S ICI.
BUILDER'S BOND
NO. DATE
Add IS'o ®rJ
ZONE REQUIREMENTS CU. FT.
®�
PLAN CUBE'�T®IM CU. FT.
a
EST. COST S 41.11-c::,
p Q )
DRAWINGS. SPECIFICATIONS, RESTRICTIONS AND CUBE CHECKED BY: 61 �°' �/ mi•-�
BUILDING PERMIT AND INSPECTION RECORD — MIAMI SHORES VILLAGE
DAT�
NEW CONSTRUCTION
TYPE
it 5,
STORIES
pie
ROOF CONSTRUCTION
c e.. ®li C� ®.
INTERIOR CONSTRUCTION
0 A. e5
REPAIRS
DESCRIPTION
p aa DE ° �l T LION ..[ p i
GfP I $v".- v VI . ' w 4P / BA R 7 4 '°-P� p�.ut.4da•c. Id 0. C rw.
N DESCRIPTION
ALTERATION
(� A
ADDITION ce, 7 oaf �SOt �3+�s =b G'+ Ts+e• -®,,, 0 8 ie +Sfl 5 —
SUBMITTED TO PLANNING BOARD
APPROVED
REJECTED
REFERRED TO COUNCIL
REASONS
RE- SUBMITTED TO PLANNING BOARD
SUBMITTED TO VILLAGE COUNCIL
REMARKS
CERTIFICATE OF OCCUPANCY NO. I ISSUED
BY
TO
p Q )
DRAWINGS. SPECIFICATIONS, RESTRICTIONS AND CUBE CHECKED BY: 61 �°' �/ mi•-�
BUILDING PERMIT AND INSPECTION RECORD — MIAMI SHORES VILLAGE
DAT�
INSPECTIONS
DATE
BY
INSPECTIONS
DATE
BY
FOUNDATION
PERMIT NO.
DATE
ROOF
TEMPORARY SERVICE
BEAMS & LINTELS
$
SEPTIC TANK
POOL
$
FRAMING
H. W. HEATER CONN
AIR COND.
SOLAR HEATER
FINAL
$
GAS
CLEAN UP
$
SLAB
$
INSPECTIONS
DATE
SLAB
RE- INSPECT
BY
RE- INSPECT
BY
ROUGHING
CONTRACTOR
PHONE
PERMIT NO. I DATE
FEE $
NEW BLDG. • I ALTERATION I ADDITION
REPAIRS
SPECIALS PERMITS
PERMIT NO.
DATE
FEE
TEMPORARY SERVICE
$
SEPTIC TANK
$
SEWER
H. W. HEATER CONN
$
SOLAR HEATER
$
GAS
$
$
INSPECTIONS
DATE
BY
RE- INSPECT
BY
RE- INSPECT
BY
ROUGHING
TUB & TOP OUT
SEWER
SEPTIC TANK
SOLAR HEATER
FIXTURES
GAS
CONTRACTOR �FC..7iL, 0._ J i . vice.
PHONE
PERMIT NO. 7 ,rJY- I DATE I - ®"' P
FEE $ Fr. Q'tz
NEW BLDG. I ALTERATION X. I ADDITION
REPAIRS
SPECIAL PERMITS
PERMIT NO.
DATE
FEE
TEMPORARY SERVICE
$
H. W. HEATER CONN.
$
RANGE CONN.
H. W. HEATER CONN
$
MOTORS
$
FIXTURES
$
$
INSPECTIONS
DATE
BY
RE - INSPECT
BY
RE- INSPECT
BY
TEMP. SERVICE
ROUGHING
H. W. HEATER CONN
RANGE CONN.
FIXTURES & FINAL
BUILDING INSPECTIONS
PLUMBING PERMITS & INSPECTIONS
ELECTRICAL PERMITS & INSPECTIONS
APPROVAL TO POWER CO. FOR SERVICE DATE
BY
- 10 *
CON OR
S NU.. FRL F N I ADORES:2
i
•.• " *
H.C7D
r/..-![
CU. ET.
LID 0 F ZIC
:LSE
PLAN CUBE
11 : T 0000 =L CV NO. I SSLIEZ)5 EY -a 0 --0
LG P17.6:V.IT AND INSPECTION PECORI3--MIAA,I: SHOR
S 4.1.,,,s;
NO. L - '.0.
CU. FT. I-! COST
C CJEIE cH;:r..zro
ETOR:ES 000F CONSTRUCTION
7= (. 51
DESCRIPTION
DESOR
AFPROVEC REJECTL!1) REFERRED TO COUNCIL REASONS
REVARKS
I ILE:IC/SE F .11:
CONS
INSP CTIONS
DATE
BY
RE- INSPECT
BY
RE- INSPECT
BY
FOUNDATION
PERMIT NO.
-
FEE
TEMPORARY SERVICE
/ —3 / —s7
✓
$ /O u
BEAMS& LINTELS
6 7-1.3- b /
3--3—.-11
/ / / /'
/
7
L
5 .......2.4 4I
$ I WP,...........'
$
SEWER
SOLAR HEATER
FRAM I;
MOTORS
$
GAS
S
FIXTURES
S
FINAL J_./.-4.r/
11
INSPECTIONS
DATE
CLEAN -UP
RE- INSPECT
BY
RE- INSPECT
BY
ROUGHING
CONTRACTOR;�„��
PHONE
• PERMIT NO. ,'d DATE o ° Q ^
0
FEE $
NEW BLDG. I ALTERATION
ADDITION
REPAIRS
SPECIAL PERMITS
PERMIT NO.
DATE
FEE
TEMPORARY SERVICE
/ —3 / —s7
✓
$ /O u
S
SEPTIC TANK 'p..,4`Q�
/ / / /'
/
7
L
5 .......2.4 4I
$ I WP,...........'
$
SEWER
SOLAR HEATER
S
MOTORS
$
GAS
S
FIXTURES
S
S
INSPECTIONS
DATE
BY
RE- INSPECT
BY
RE- INSPECT
BY
ROUGHING
4v 6R- fi
o
GAS
ROUGHING
-- ,. 3_. s-i
eh,
SEWER
TANK
~
°,p? SEPTIC (J tea
_
SOLAR HEATER
FIXTURES , I-' 51
FIXTURES & FINAL
,c—/- 3 I
p c
7-5)
( pq
CONTRACTOR #, {44it�
PHONE 4
PERMIT NO. // O / 7 DATE 2 ° C - /
FEES , ::*? •
NEW BLDG. I ALTERATION I ADDITION
REPAIRS
SPECIAL PERMITS
PERMIT NO.
DATE
FEE
TEMPORARY SERVICE
/ D 7 7 Y
/ —3 / —s7
✓
$ /O u
H. W. HEATER CONN.
/
$
RANGE CONN.
S
MOTORS
S
FIXTURES
S
$
INSPECTIONS
DATE
BY
RE- INSPECT
BY
RE- INSPECT
BY
TEMP. SERVICE
ROUGHING
-- ,. 3_. s-i
eh,
H. W. HEATER CONN
RANGE CONN.
FIXTURES & FINAL
,c—/- 3 I
p c
7-5)
( pq
BUILDING INSPECTIONS
LS MBING PERMITS tit INSPECTIONS
ELECTRICAL PERMITS et INSPECTIONS
APPROVAL TO POWER CO. FOR SERVICE DATE 6
•
BY 271,3
1169
Approved use bv occupancy_
Remarks:
CERTIFICATE OF OCCUPANCY
MIAMI SHORES VILLAGE, FLORIDA
BUILDING DIVISION
Miami Shores Village, Fla.,_
Owner, Agent or Tenant of Building _
L.ot Block
Street Address_
Subdivision
This Certificate of Occupancy is issued to the above named.
for building at above named location only upon the czpress provision that the applicant will
abide by and comply with all conditions of Ordinances Nos. 92, 93, 94 and 97, known : s the
Zoning, Electrical, Plumbing and Building Ordinances of Miami Shores Village pertaining to
the erection, construction, alteration or remodeling of buildings or structures.
BUILDING DIVISION
OWNER'S NAME
'
NEW CONSTRUCTION
PRESENT ADDRESS
• ' •' y
'S
LICENSE NO.
PHONE NO.
JOB LOCATION (ST. OR AVE.)
REPAIRS
LOT
BLOCK
ALTERATION
I SUBDIVISION
GENERAL CONTRACTOR
ADDITION
ADDRESS
bb
d
APPROVED''
PHONE NO.
LICENSE NO.
. �=
BUILDING PERMIT NO. �' r % -
DATE
•••-.). _
PERMIT FEE S 1 °
0
'
BUILDER'S BOND
NO. DATE
ZONE REQUIREMENTS
CU. FT.
�
PLAN CUBE 2 Pi
CU. FT.
EST. COST S c %( )
DRAWINGS. SPECIFICATIONS, RESTRICTIONS AND CUBE CHECKED BY: :r•• • C�
BUILDING PERMIT AND INSPECTION RECORD — MIAMI SHORES VILLAGE
•
DAT:
NEW CONSTRUCTION
TYPE
STORIES
ROOF CONSTRUCTION
INTERIOR CONSTRUCTION <,—
REPAIRS
DESCRIPTION
<3r',a°'2r, �- �'>( •�- /'.,L.c�, • - i(� Pa" r� ? „'? ;, '�r�l (3.,•, ,,,,'(%
ALTERATION
u DESCRIPTION
J / i •
e = -,F', --,-- C , !in Il n. % � - • -�, n 'l o� l� - Y� 6• o c.
ADDITION
SUBMITTED TO PLANNING BOARD
APPROVED''
REJECTED
REFERRED TO COUNCIL
REASONS
RE- SUBMITTED TO PLANNING BOARD
S URMITTFI) TO VILLAGF COUNCIL
REMARKS
CERTIFICATE OF OCCUPANCY NO. f 1 l • / � l
ISSUED / - - 4
BY /// '
�. /
TO t/,'' /,i , ,
DRAWINGS. SPECIFICATIONS, RESTRICTIONS AND CUBE CHECKED BY: :r•• • C�
BUILDING PERMIT AND INSPECTION RECORD — MIAMI SHORES VILLAGE
•
DAT:
INSPECTIONS
DATE
BY
INSPECTIONS
/ DOE
BY
FOUNDATION
$
SEPTIC TANK
ROOF
TEMPORARY SERVICE
$
BEAMS & LINTELS
$
TUB & TOP OUT
POOL
SOLAR HEATER
S
FRAMING
$
GAS
AIR COND.
MOTORS
S
FINAL
S
FIXTURES
CLEAN UP
SEPTIC TANK
S
SLAB
S
SOLAR HEATER
SLAB
SPECIALS PERMITS
PERMIT NO.
DATE
FEE
TEMPORARY SERVICE
RE- INSPECT
BY
$
SEPTIC TANK
FEE
TEMPORARY SERVICE
$
SEWER
$
TUB & TOP OUT
$
SOLAR HEATER
S
RANGE CONN.
$
GAS
SEWER
MOTORS
S
RANGE CONN.
S
FIXTURES
S
INSPECTIONS
DATE
BY
RE- INSPECT
BY
RE- INSPECT
BY
ROUGHING
DATE
FEE
TEMPORARY SERVICE
ROUGHING
$
TUB & TOP OUT
S
RANGE CONN.
SEWER
MOTORS
RANGE CONN.
S
FIXTURES
SEPTIC TANK
S
S
SOLAR HEATER
FIXTURES & FINAL
FIXTURES
GAS
CONTRACTOR e - C- Aa_C) GE •6L. -\ NA. p.", 'i:.`L -
PHONE
PERMIT NO. 4a,-fel I DATE C.-1.1-C.
FEE c $�-
3
NEW BLDG. I ALTERATION ty / I ADDITION
REPAIRS
SPECIAL PERMITS
PERMIT NO.
DATE
FEE
TEMPORARY SERVICE
ROUGHING
$
H. W. HEATER CONN.
S
RANGE CONN.
$
MOTORS
RANGE CONN.
S
FIXTURES
S
S
INSPECTIONS
DATE
BY
RE- INSPECT
BY
RE- INSPECT BY
TFMP. SERVICE
ROUGHING
H. W. HEATER CONN
RANGE CONN.
FIXTURES & FINAL
CONTRACTOR
PERMIT NO.
NEW BLDG.
PLUMBING PERMITS & INSPECTIONS
DATE
I ALTERATION
APPROVAL TO POWER CO. FOR SERVICE DATE
Cc,
BUILDING INSPECTIONS OZara/ I_ a.
I ADDITION
ELECTRICAL PERMITS & INSPECTIONS
PHONE
FEE $
REPAIRS
BY
CERTIFICATE OF OCCUPANCY
MIAMI SHORES VILLAGE, FLORIDA
BLThDL r G DIVISION
Lot ' -) Block___
Street Address ° "-'" )‚
Remarks
Owner, Agent or Tenant of Building_
Miami Shores Village, Florida,
Approved use by occupancy
Subdivision ';%?'
This Certificate of •ccupancy is issued to the above named
for building at above named location only upon the express provision that the applicant will
abide by and comply with all conditions of Ordinances Nos. 92, 93. 94 and 97, known as the
Zoning, Electrical, Plumbing and Building Ordinances of Miami Shores Village pertaining to
the erection, construction, alteration or remodeling of builclin9s or structur
M 1,6rt e ()
BUILDING DIVISION
AL M J:ss 47 :7. 93rd St:raat
7Lo `d & 1 251 Lot 6, 13:.ock 3
LEGAL, i ,r,; 8horss Sec .1 A.,rdo RECORD (3A,RBA,E E TAX
?AID BY
YEAR ANNUAL TAX
PERIOD USED
AMOUNT PAID
DATE PAID
RECEIPT
;VUFA6ER
1
1
/1
,,, ,tip- ;• "\s';'ti
/ ' ;
r ; .
! %4°.`,,,,
,
L.,2
AL M J:ss 47 :7. 93rd St:raat
7Lo `d & 1 251 Lot 6, 13:.ock 3
LEGAL, i ,r,; 8horss Sec .1 A.,rdo RECORD (3A,RBA,E E TAX
Legal Description:
Inspected by:
Comments:
APPLICATION FOR CERTIFICATE OF RE- OCCUPANCY
I, rv1 GIa-Q_ I
to re- occupy the single family residence known as : (address)
1 , Miami Shores, Florida.
Lot: Block PB & PG:
I hereby certify that I understand that the zoning. of the property is for single -fam ly residential use
and that it is unlawful for more than one family to reside therein. I also understand that any
Certificate of Re- Occupancy that may be issued by Miami Shores Village, certifies only that the
referenced property is being used for single -family purposes and that such Certificate does not
constitute any representation, warranty or certification as to the condition of the dwelling or other
structures on such property.
Applicant "'" \, c ,,,\ Date J 1— l5 - o < �
Print Name k }v\ i C H �L , (\o y q&f
* * * * * * * * ** * * * * * * * * * * * * * * * * * * * * * * * * * * ** ******* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
For purposes of conducting the inspection required by Section 902 of the Miami Shores Land
Development and Zoning Code, please contact:
I � �.� �, ® 99 l oas,� 3
Contact Name:
1 Telephoner 305 -
Buyer Seller Realtor x Company Name
Application Fee ($50) paid: Cash Check No. 75/ 7
PAGE 1 OF 2
X Denied
, hereby apply for a certificate
Date 11/16/00
CER'i 1■ICATE OF RE- OCCUPANCY
On behalf of Miami Shores Village, Florida, the undersigned certifies that the property
described in the above application has been inspected for purposes of re- occupancy pursuant to
Sections 901 and 902 of the Miami Shores Land Development and Zoning Code and that such
property may be re- occupied by the above applicant for single- family residential purposes.
PAGE 2 OF 2
MIAMI SH RES VILLAGE, FLORIDA
By:
a4g,
Date of Certification: 11/16/00
THIS CER 1 . 1FICATE VERIFIES THAT THE REFERENCED
PROPERTY HAS BEEN INSPECTED BY MIAMI SHORES
VILLAGE AND HAS BEEN DETERMINED TO PRESENTLY
COMPLY WITH THE SCHEDULE OF REGULATIONS OF THE
MIAMI SHORES LAND AND DEVELOPMENT CODE
PERTAINING SOLELY TO THE REQUIREMENT THAT EACH
ONE-FAMILY DWELLING IS USED AND INTENDED TO BE
USED FOR A ONE- FAMILY DWELLING PURPOSE ONLY;
HOWEVER, THIS CERTIFICATE DOES NOT CONSTITUTE ANY
REPRESENTATION OR WARRANTY AS TO THE CONDITION
OF THE DWELLING OR OTHER STRUCTURES ON THE
PREMISES DESCRIBED HEREIN, OR ANY ASPECT OF SUCH
CONDITION, AND INTERES 1ED PERSONS ARE ADVISED AND
ENCOURAGED TO MAKE THEIR OWN INSPECTION OF THE
PREMISES IN ORDER TO DETERMENE THE CONDITION,
THEREOF.