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440 NE 92 St (5)MIAMI SHORES VILLAGE 0 BUILDING DEPARTMENT 305- 795 -2204 Building Inspection Request Date Type Insp'n Permit No. Name Address Company Phone # For Inspect Approved Q Correction Re- Insp'n Fee 0 ij Date ID Time P � n Type Insp Lid Permit No. Name Address I- Company Phone # MIAMI SHORES VILLAGE BUILDING DEPARTMENT 305- 795 -2204 Building Inspection Request For Inspectorf /' Approved Correction Re- Insp'n Type Insp'n Permit No. Name Address MIAMI SHORES VILLAGE BUILDING DEPARTMENT 305- 795 -2204 Building Inspection Request Date 2 °0,ca Time For Inspector: 7-i 6-0 Approved Correction Re- Insp'n Fee Pif 1 &L.4-7,4 3 /2 q Company £ iV �,�., i4 Phone # 30c.T6 3 Mg' Date Type Insp'n Permit No. Name P MIAMI SHORES VILLAGE BUILDING DEPARTMENT 305- 795 -2204 Building Inspection Request For Inspector, Approved Correction Re- Insp'n Fee Time s r7p f\ Q.; p Address 4\4 C . Company c D Phone # 3 0-s:— (L,3 ( 0 OP ate Date ' a . Time Type Insp'n Permit N Name Address V /) ' 9 )2_*, Re- Insp'n Fee MIAMI SHORES VILLAGE BUILDING DEPARTMENT 305- 795 -2204 Building Inspection Request Company Phone # C 1S ` Y ' — For Inspector: `t (" ` o � Name & Date Approved ❑ Correction � oo a- 1 a l-1 Date Type Insp Permit No. Name Address Compa Phone # For Inspector: Approved Correction Re- Insp'n Fee MIAMI SHORES VILLAGE BUILDING DEPARTMENT 305- 795 -2204 Building Inspection Request El: -el ' -- T 5D, 0 0 /L9 9 -_,()-e- 19 .0 Cl 10-)\ Type Insp'n Permit No. Name Approved Correction Re- Insp'n Fee MIAMI SHORES VILLAGE BUILDING DEPARTMENT 305- 795 -2204 Building Inspection Request Date 41 Va. Time Address 1 ' r S 7 Company ✓''�'9 ;i& 9 Phone # ?EV 99V &W O For Inspector: 9 -/3 - 4 Na e & to MIAMI SHORES VILLAGE BUILDING DEPARTMENT 305- 795 -2204 Building " Inspection Request Date," `62 Time Type Insp'n Name ( (J114�1 + � Permit No. z -1 'o2 -33 / . /4Q, Address 4 4J/2 - 5r Company �^ �/ Phone # 9th / For lnspecto._A Name Approved Correction ❑ Re- Insp'n Fee ❑ MIAMI SHORES VILLAGE BUILDING DEPARTMENT 305- 795 -2204 Building Inspection Request Date 3'°a29'6 r2 Time Type Insp'n 9 i Permit No. FL �� a & � 2 /f ® Name 7 6 4 -- ��57 -0Ah� Address 4 ( 9 ' b ? Sr Company E J- ,I p`�`es, ✓ Phone # 30s / 3', cocee For Inspector: 3.. z8.D 2 Name & Date Approved ❑ Correction ❑ Re- Insp'n Fee ❑ PERMIT APPLICATION FOR MIAMI SHORES VILLAGE 10050 N.E. 2nd Avenue • Miami Shores, Florida 33138.305- 795 -2204 Date ? TA } Job Address `j ( Tax Folio Legal Description / f - ! ,'�( % �`' � � �1 1 G/, Historically Designated: Yes No Master Permit # 'J o.focc3, - 1 `7 Owner /Lessee/Tenet 6 (am() ) /?..-",/ / t J i t 41 / P" Owner's Address `1: / r Contracting Co. ', Qualifier () ,4/2 C r State # • `! / Municipal # IF THERE IS NO PERMIT PACKAGE ACCESSIBLE ON THE JOB SITE FOR INSPECTORS TO VERIFY, THERE WILL BE NO INSPECTION. RE— INSPECTION FEE IS $50.00 AND MUST BE PAID IN ADVANCE BEFORE CALLING FOR ANOTHER INSPECTION. Permit Type (circle one): BUILDING ELECTRICAL 1 UMBING MECHANICAL ROOFING �._ / ' 2 WORK DESCRIPTION: /21) ' ✓ J' / f Square Ft. Estimated Cost (value) 2 (,)0 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 ANY 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 all disciplines. OWNERS AFFIDAVIT: I certify that all the foregoing information is accurate and that all work i ,1I be done in compliance with all applicable laws regulating construction and zoning. Furthermore, 1 authorize the above named contractor to • o thrk stated. ure of owner and/o ido Presi ent r 1a. t o do Pr ate ure or No as to O net and/ My Commission Expires ident FEES: PERMIT l. RADON APPROVED: ;'' C_ C -'fit 'Vat:// C.C.F S Phone (70» l - q (-f / (- -/) Address - 11/:= l- .� �' -�� � C � rc , SS# Phone t Competency # Ins. Co. ntractor orDwner Builder Date "(I / )V' 1 \ ` i / L \ r \ Y 1 .k ,c . � �/ 11 .d" tary as to Cobtracto or. Owner uilder . Date My Commission Expires NOTARY li BOND C TOTAL DUE i s _ 0 Zoning Building Electrical Mechanical Plumbing Structural Engineer .e:a. _wzmccaL____swasuaarzaca--_ - PAY TO THE ORDER OF CHARLES W. YOCOM 4694 CUSTOM POOLS PH 954-961-1424 710 N 70TH TER HOLLYWOOD, FL 33024 L ArAC110114, Wachovia Bank, NA. Hollywood, FL 33024 FOR ' Lo r-' V 0- 004694o 406701,35644 DATE $ /C5/3 DOLLARS 63-1356/670 BRANCH 4301 NP -.o/c uworx.13,,,saaan .7• Miami Shores Village 10050 NE 2nd Avenue Phone: 305 - 795 -2204 Permit Number: PL2002 -141 Printed: 6/7/2002 Applicant: GLADSTONE PHILLIPS Owner: PHILLIPS GLADSTONE JOB ADDRESS: 440 NE 92 ST Contractor YOCOM, CHARLES WILLIAM Contractor's Address: 710 N 70 TERRACE Local Phone: 954 - 961 - 1424 Parcel # 1132060140050 Fees: Description Amount rJ FEE2002 -3209 ‘ Building Fee $90.00 I FEE2002 -3210 Notary Fee $5.00 Total Fees: $95.00 Permit Status: Approved Permit Expiration: 12/4/2002 Construction Value: $1,200.00 Work: POOL PIPING if there is no permit package accessible on the job -site for inspectors to verify, there will be no inspections. Re- inspection fee is $50.00, which must be paid in advance before calling for another inspection. -� 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 munici.al 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 a authorization. A further condition on 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 pedal ng 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 agen :, s an . or mploy es. Sighed: In con with the p myself, my a • Signed: Plumbing Permit Page 1 of 1 Legal Description: MIAMI SHORES SEC 2 PB 10 -37 W 5 IN OF LOT 6 & ALL LOTS 7 & 8 BLK 49 LOT Total Fees: $95.00 Total Receipts: $0.00 INSP CTOR) BY: 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 is or specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I assume responisibility for all work done by either employes. ntractor or Builder) BY: Miami Shores Village 10050 NE 2nd Avenue Phone: 305 - 795 -2204 Printed: 3/11/2002 (J Applicant: GLADSTONE Owner: PHILLIPS �rr Contractor E & M PLUMBING INC Local Phone: (305) 688 -9620 _4Parcel # 1132060140050 l Job Address: 440 NE 92 ST Fees: FEE2002 -1432 Permit Status: Approved Work: RELOCATE (2) EXISTING BATH! If there is no permit package accessib fee is $50.00, which must be paid in adv Signed In conside with the plans, myself, my age Signed: Address: 1575 NW 126 ST Cellular: Legal Description: MIAMI SHORES SEC 2 PB 10 - 37 W 5 IN OF LOT 6 & ALL LOTS 7 & 8 BLK 49 LOT Description Building Fee Total Fees: Permit Expir tinn: • This Permit is granted to the contractor or builder 1 e ordinances pertaining thereto and with the understan and approved by the proper m nicipal authorities. T authorization. A further cond' on upon which this Ix ordinances and regulations p fining to the work a by his agents, servants or e ployees. i, I PA Y TO THE ORDER OF FOR 0 006 46 Plumbing Permit Permit Number: PL2002 -70 PHILLIPS GLADSTONE Amount $75.00 $75.00 9/7/2002 Construction Value: $3,000.00 OCEAN BANK 780 N W 42ND AVE MIAMI, FLORIDA 33126 (Contractor or Builder) fill. • �kLr ��s - x•0 e i •ante to me of this pe �.= wi gs, statements or specifications suu1111„ . servants or employes. BY: 0100 573744005 Page 1 of 1 Total Fees: $75.00 Total Receipts: $0.00 ,,�, s , - - - - - - -- — - E & M PLUMBING, INC. (73°1--- 6 31 42i -1% n l r• 1575 N.W. 126TH ST. NORTH MIAMI, FL 33167 DATE C /r4)-- $ 7 3 - 2 6466 6 3 - 1139/660 01 DOLLARS CONTRACTOR New Construction Name Enclosure /ter v � 1 � 6 , �/ O .1 ,, G License No. `/ c� o c / Address , S 7 S' J / t,cJ L NC { ? / (mrr • r • f 3 6. 3/ 7 Telephone(3 of) 63/ _ 00,17 Fax (34 ( / ri _ 9 d 8 Qualifier Name �� % f i ' o C k ye TYPE OF MANAGEMENT (✓ ) New Construction Enclosure Alteration Exterior Repair Alteration Interior Demolish Relocation of Structure Shell Only Foundation Only Add'I Attachment Other Add'I Detachment Other INSTRUCTIONS - The following steps must be taken to obtain a permit from the Miami Shores \illage: Step 1. Complete the attached permit application which must be signed by the property owner and qualifier. Both signatures must be notarized. Please print or type to allow for a more accurate processing of your application. If roofing work will be done, a roofing application must be submitted along with this permit application. Step 2. Submit the completed application with all necessary documents to the Building, Planning and Zoning Department for processing. During the processing of your application, you may be asked to submit additional information. APPLICATION XN Job Address: 1142 r j Se' Address Lot Tenant Information Block PERMIT TYPE (✓ ) Building Electrical Roofing Fence Other Mechanical Plumbin LPGX Apt. Folio Number // -3 _o/t/ -ooso PERMIT CHANGE (✓ ) Chg. Contractor Renewal Revision Extension Supplement Reinspection ARCHITECT Name License No. Address Telephone Fax PROPERTY OWNER Name Address Home Telephone Business Telephone Fax PERMIT APPLICATION Master Permit No. g-oco� —3 Subsidiary Permit No. cr j' • c2 0 c)1 • 9-0 • City State / Zip Xbescription of Work 12.Q..(ocde. (a) vir/�'H f ���r r oo.tig Subdivision PB /J PG Zoning Linear Feet Current Use of Property e X . ,f? Square Feet Units Floors Proposed Use of Property 0 (/ Value of Work 3, O 0 0 Bldg Value Tax Assessed/Appraised Value Flood Zone Base Floor Elev. ENGINEER Name License No. Address Telephone Fax ELECTRICAL TYPE. Minimum Fee QTY. TYPE Dryer QTY. TYPE Outlet, Appliance QTy. TYPE. Service Repair QTY. A/C Central 1 -3 Ton Dryer Vents, Number of Fan Ventilation, Cost Outlet, Wall Ductwork, Cost of Service, Temporary Periodic Inspections A/C Central 4 -7 Ton Fire Sprinkler System Fire Pump Outlet, Switch Fireplaces, Number of Signs A/C Central 8 -15 Ton Fixture - Fluorescent Oven Space Heater (kw) A/C Central 16-20 Ton Fixture Light Parking Lot Lights Spas/Hot Tubs A/C Central 20+ Ton Flood Lights Plugmold/Strip Subfeeds, No. of Amps A/C Window FPL - Load Central Posts Swim Pool, Commercial Air Conditioners Garbage Disposal Range/Range Top Swim Pool, Residential Chiller Generators, etc. Receptacles Switchboards Clear Violatibns Heat Recovery Refrigerator, Comm. (p/PH) Temp Serv., Construction Compactor / Low -volt, Burglar Refrigerator, Domestic Temp for Test - 30 days Deep Freezer / Low -volt, Fire Renew - Temp Service Water Closet Demolition Low -volt, Intercom/Teleph. Repair Circuits Water Heater Dishwasher Low -volt, Television 3 Service, Number of Amps Water Heater New MECHANICAL TYPE QTY. Minimum Fee TYPE Condensate Drain QTY. TYPE Generator QTY. TY QTY. Refrigeration, Tons A/C Central, Tons Cooling Tower - Heating Strips, each Vent Hood, Cost A/C Wall/Win. Tons Dryer Vents, Number of Paint Booth Ventilation, Cost Air Handler, Tons Ductwork, Cost of Piping, Flammable Liquid Periodic Inspections Barbecue Fire Sprinkler System - Process/Pressure Piping Bath Fan - Vented, # Fireplaces, Number of - Pressure Vessel PLUMBING TYPE A/C Condensate QTY. TYPE Drains, Roof QTY. TYPE Miscellaneous Fixture QTY. 'TYPE Soakage Pit QTY. Bath Tub / Drinking Fountain Miscellaneous Repairs Solar Water Heater Bidet Filter Replace Pool Piping Sprinkler Repair Cap - Fixture Fountain Pump and Abandon Sprinkler System Cap - Water Gas - Appliance Pump, Domestic Supply, AC Well Cap - Sewer Gas - Natural Pump, Fire Stand Temporary Toilet Catch Basin Gas - Propane Pump, Re- circulate Temporary Water Closet Clothes Washer Gas Piping Pump, Replace - Pool Urinal Dental Chair Grease Trap Pump, Sprinkler Utility - Sewer Discharge Well Ice Maker Pump, Sump Utility - Water Dishwasher / Indirect Wastes Relay Repair Vacuum Pump Disposal / Interceptor Roof Inlet Water Closet Domestic Well Laundry Tray Septic Connection Water Heater Drainfield, 4" Tile/Res. Lavatory 3 Septic Tank Water Heater New Drains, Area Meter Set (Gas) Sewer Connection Water Re -pipe Drains, Floor Minimum Fee Shower Water Service Drains, French Miscellaneous Equipment Sink / Well, Supply Page 3 PERMIT APPLICATION INSTRUCTIONS: Please indicate the type of work being performed and quantity(ies) in the space provided below. RECEIVED AND REVIEWED BY: DATE: CONSTRUCTION PERMIT FOR: [ X ]New System [ ]Existing System [ ]Repair [ ]Abandonment APPLICANT: Phillips, Gladstone PROPERTY STREET ADDRESS: 440 NE 92 St Miami FL 33138 LOT: 7 -8 [Section /Township /Range /Parcel No.] PROPERTY ID #: 11- 3206 - 014 -0050 [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 [ 1200 ]Gallons SEPTIC TANK A [ 0 ]Gallons N [ 0 ]GALLONS GREASE INTERCEPTOR CAPACITY K [ 0 ]GALLONS DOSING TANK CAPACITY [ 0 ]GALLONS @ D [ 714 ]SQUARE FEET PRIMARY DRAINFIELD SYSTEM R [ 0 ]SQUARE FEET SYSTEM A TYPE SYSTEM: [ Y ]STANDARD [ N ]FILLED I CONFIGURATION: [ N ]TRENCH [ Y ]BED N F I L D STATE OF FLORIDA DEPARTMENT OF HEALTH ONSITE SEWAGE TREATMENT AND DIS:'OSAL SYSTEM CONSTRUCTION PERMIT BLOCK: 49 SUBDIVISION: Miami Shores ]Holding Tank [ ] Innovative Other ] Temporary [ NA ] AGENT: SR0001343, Crockett Lester LOCATION TO BENCHMARK: FF E/R 10.75'NGVD ELEVATION OF PROPOSED SYSTEM SITE [ 22.4 ] [ INCHES BOTTOM OF DRAINFIELD TO BE [ 52.4 ] [ INCHES FILL REQUIRED: [ 0.0 ]INCHES EXCAVATION REQUIRED: [ 72.0 1 INCHES OTHER REMARKS: Install 1200 gls new, multi - chambered s/t equipped w/ an approved filter. Install 572 sq.ft. d/f Invert elev. of d/f no less than 6.88'NGVD Bottom of d/f elev. no less than 6.38'NGVD SPECIFICATIONS BY: RAM, , APPROVED BY: Arrieta, Rolando DATE ISSUED: 02 /21 /02 2'v C Z TITLE: DH 4016, 03/97 (Obsoletes previous editions which may not be used) (Stock Number: 5744 -001- 4016 -0) Iostds_cons_4016 -11 CENTRAX #: 13 -SG -11732 DATE PAID: FEE PAID : RECEIPT OSTDSNBR : 02 -0339- -N MULTI - CHAMBERED /IN SERIES: [Y ] MULTI - CHAMBERED /IN SERIES: [Y ] [0 ]DOSES PER 24 HRS # PUMPS[ 0 1 [ N ]MOUND [ N ] [ N ] [ BELOW BENCHMARK /REFERENCE ] [ BELOW ] BENCHMARK/REFERENCE IH',kRT ELEVATION +EC _0TrOffi OF DRAT AFIELD ELEVATION TITLE: Engineer I Dade EXPIRATION DATE: OS /21/ON POINT POINT CHD Page 1 of 2 12.34 CONSTRUCTION PERMIT FOR: [ ]New System [ ]Existing System [ ]Holding Tank [ ] Innovative Other [ X ]Repair [ ]Abandonment [ ]Temporary [ IN ] Infiltrator APPLICANT: Gladstone, Phillips AGENT: SR0001343, Crockett Lester PROPERTY STREET ADDRESS: 440 NE 92 St Miami Shores FL 33138 LOT: 7 -8 STATE OF FLORIDA DEPARTMENT OF HEALTH ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM C ONSTRUCTION PERMIT '.i BLOCK: 49 SUBDIVISION: Miami Shores [Section /Township /Range /Parcel No.] PROPERTY ID #: 11- 3206 - 014 -0050 [OR TAX ID NUMBER] SYSTEM DESIGN AND SPECIFICATIONS {U c2w T [ 1050 ]Gallons SEPTIC TANK A [ 0 ]Gallons N [ 0 ]GALLONS GREASE INTERCEPTOR CAPACITY K [ 0 ]GALLONS DOSING TANK D [ 400 ]SQUARE FEET PRIMARY DRAINFIELD SYSTEM R [ 0 ]SQUARE FEET SYSTEM A TYPE SYSTEM: [ ]STANDARD [ N ]FILLED I CONFIGURATION: [ N ]TRENCH [ ]BED N F LOCATION TO BENCHMARK: Finished Floor of E /R, 10.75' NGVD. I ELEVATION OF PROPOSED SYSTEM SITE [ 2.3 ] [ FEET ] [ E BOTTOM OF DRAINFIELD TO BE [ 4.8 ] [ FEET ] [ L D FILL REQUIRED: [ 0.0 ]INCHES EXCAVATION REQUIRED: [ 30.0 ] INCHES OTHER REMARKS: Cs'?23`fiE] BET ,GE [' L]J`SL S OCR UNE ©OLtT U[ Li SPECIFICATIONS BY: Icaza, Carlos APPROVED BY: Icaza, Carlos DATE ISSUED: 11/27/01 TITLE: DH 4016, 03/97 (Obsoletes previous editions which may not be used) (Stock Number: 5744- 001 - 4016 -0) [ostds_oor,s_an6 -1] CENTRAX #: 13 -SG -11035 DATE PAID: iI- 2'l-al FEE PAID : $ RECEIPT . OSTDSNBR : 01 -3626- -R SYSTEM MUST BE CONSTRUCTED IN ACCORDANCE WITH SPECIFICATIONS AND STANDARDS OF CHAPTER 64E -6,FAC DEPARTMENT APPROVAL OF SYSTEM DOES NOT GUARANTEE SATISFACTORY PERFORMANCE FOR ANY SPECIFIC TIME PERIOD. ANY CHANGE IN MATERIAL FACTS WHICH SERVED AS A BASIS FOR ISSUANCE OF THIS PERMIT, REQUIRE THE APPLICANT TO MODIFY THE PERMIT APPLICATION. SUCH MODIFICATIONS MAY RESULT IN THIS PERMIT BEING MADE NULL AND VOID. ISSUANCE OF THIS PERMIT DOES NOT EXEMPT THE APPLICANT FROM COMPLIANCE WITH OTHER FEDERAL, STATE OR LOCAL PERMITTING REQUIRED FOR PROPERTY DEVELOPMENT. MULTI - CHAMBERED /IN SERIES: [Y ] MULTI - CHAMBERED /IN SERIES: [Y ] CAPACITY [ 0 ]GALLONS @ [0 ]DOSES PER 24 HRS # PUMPS[ 0 ] [ N ]MOUND [ N ] [ N ] BELOW] BENCHMARK /REFERENCE POINT BELOW ] BENCHMARK/REFERENCE POINT "It is strongly recommended to verify high water consumption, this should be a cause for system failure. This permit is not for addition (s) *Install a new 1050 gl. septic tank. *Install 400 sq. ft. of drainfield. *Invert elevation to be no less than 6.46' NGVD. *Bottom elevation to be no less than 5.96' NGVD. [07 If^D. GMET,Z,7 R L rr . , —6. -b 106*"") oO fu11 GC J' F I d.`:ME",tJ ! _IMUMJ_ 5- 9 6 1•." TITLE: Engineer I Dade EXPIRATION DATE: 2/25/02 CHD Page 1 of 2 APPLICANT: LOT: BLOCK: PROPERTY ID 0: 7 STATE OF FLORIDA SITE EVALUATED BY: SOIL PROFILE INFORMATION SITE 1 DH 4015, 10/96 (Replaces HRS -H Form 4015 (Page 3] which may be used) (Stock Number: 5744 -003 - 4015 -1) PROPERTY SIZE CONFORMS TO SITE PLAN:` TOTAL ESTIMATED SEWAGE FLOW: AUTHORIZED SEWAGE FLOW: UNOBSTRUCTED AREA AVAILABLE: -_` SQFT Munsell 0 /Color USDA SOIL SERIES: Texture Depth to to to to • to 'to to to t0 d • DEPARTMENT OF HEALTH 'ONSITE SEWAGE DISPOSAL SYSTEM SITE EVALUATION AND SYSTEM SPECIFICATIONS AGENT: SUBDIVISION: p y - // SOIL TEXTURE /LOADING RATE FOR SYSTEM SIZING: DRAINFIELD CONFIGURATION: [ ] TRENCH [• -] BED REMARKS /ADDITIONAL CRITERIA: PERMIT 0 [Sectiofl /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. YES [ ] NO NET USABLE AREA AVAILABLE: 2' ACRES GALLONS PER DAY 1RESIDENCES- TABLE"0 OTHER -TABLE 2] GALLONS PER DAY (1500 GPD /ACRE OR 2500,GPD /ACRE] UNOBSTRUCTED AREA REQUIRED: SQFT BENCHMARK /REFERENCE POINT LOCATION: ELEVATION OF PROPOSED SYSTEM SITE IS [INCHESM) [ABOVE/BELOW) BENCHMARK /REFERENCE POINT THE MINIMUM SETBACK WHICH CAN BE MAINTAINED FROM THE PROPOSED SYSTEM TO THE FOLLOWING FEATURES: SURFACE WATER: FT DITCHES /SWALES: ' FT NORMALLY WET? [ ] YES [ ] NO WELLS: PUBLIC: FT _ LIMITED USE: FT • PRIVATE: FT NON- POTABLE: FT BUILDING FOUNDATIONS: FT PROPERTY LINES: FT POTABLE WATER LINES: FT SITE SUBJECT TO FREQUENT FLOODING: ( ) YES ( ) NO 10 YEAR FLOOD ELEVATION FOR SITE: ` =>.c FT MSL /NGVD SITE ELEVATION: � A FT MSL /NGVD SOIL PROFILE INFORMATION SITE 2 10 YEAR FLOODING? ( ] YES [ ] NO Munsell 0 /Color Texture • Depth to to to 9,v to t0 t0 to • to U 4 to USDA SOIL SERIES: WATER TABLE: - ' ` INCHES [ABOVE / BELOW] EXISTING GRADE. TYPE: [PERCHED / APPARENT] ESTIMATED WET SEASON WATER TABLE ELEVATION: ,,-(,"\-" , -(, a 'INCHES ' ABOVE , /;-BELOW . EXISTING GRADE. HIGH WATER TABLE VEGETATION: [ ) YES [: -]` MOTTLING: [ ) YES [ ]' NO DEPTH: INCHES DATE: DEPTH OF EXCAVATION: INCHES ] OTHER (SPECIFY) Page 3 of 3 Notes: STATE OF FLORIDA DEPARTMENT OF HEALTH APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PERMIT ,, Permit Application Number ( ^�!� tOt% Scale: Each block represents 10 feet and 1 inch = 40 feet. Site Plan submitted,Sy: Plan ApprQvIkdd J DH 4015, 10/96 (Replaces HRS-H Form 4015 which may be used) (Stock Number. 5744 - 002 - 4015 -6) PART II - SITEPLAN 27 ALL CHANGES MUST BE APPROVED BY THE COUNTY HEALTH DEPARTMENT N `1 /�- 4COC DV/j =RL nA //,,iZ �? � 1 1�? /� !/(/ S ri Not Approved Date By � County Health Department „� Jo Page 2 of 4 CONTRACTOR Name LLOYD A j ' 7i / rn� YE-PVC Q �� / License No. ?, 0 Q a 41 J iu Address t - s W. io r/f / m /, /_L 33/61/ Telephone 3 .9 7 _ a1i_ Fax R� f ,- (F 7b Qualifier Name / � ,�� 7� �._ O acrwf�7 PROPERTY OWNER ry� Name 6 - Li1D� /DAJE ? i 7 Address [ �l � / ( � f0 Art; 9 . 3 / % � - ^ 9 y _/ ` ^ � ,640 / ©2Z3, /" 3 C l � � / 7 /T ' Home Telephone 376 , j , 7,2e r Business Telephone _ �� / p - 99 l 7 Fax TYPE OF MANAGEMENT (✓ ) New Construction Enclosure Alteration Exterior Repair Alteration Interior Demolish Relocation of Structure Shell Only Foundation Only Add'I Attachment Other Add'I Detachment Other INSTRUCTIONS - The following steps must be taken to obtain a permit from the Miami Shores Village: Step 1. Complete the attached permit application which must be signed by the property owner and qualifier. Both signatures must be notarized. Please print or type to allow for a more accurate processing of your application. If roofing work will be done, a roofing application must be submitted along with this permit application. Step 2. Submit the completed application with all necessary documents to the Building, Planning and Zoning Department for processing. During the processing of your application, you may be asked to submit additional information. APPLICATION Job Address: 94O A). E- Q AJD J774E n t3H0 42 -oR/ 55/3, State Zip / f ` , 44 ) 2)VA/�1�! ?JY- Address Apt. Fol.. Number // "�+ (°� �/'�" 6'a�® Lot /4Lor4 d Block ` / q Subdivision PiOVOR-F5aC PG Current Use of Property K E.g / Proposed Use of Property R /DO= Tenant Information PERMIT TYPE (✓ ) Building Electrical Mechanical Plumbing LPGX Roofing Fence Other PERMIT CHANGE (✓ ) Chg. Contractor Renewal Revision Extension Supplement Reinspection ARCHITECT Name License No. Address Telephone Fax P < 0 . / 1:) PERMIT APPLICATION Master Permit No. —5 OS Subsidiary Permit No. City Description of Work 4.1 r Zoning Linear Feet Square Feet _ Units Value of Work Tax Assessed/Appraised Value Flood Zone Base Floor Elev. Floors Bldg Value ENGINEER Name License No. Address Telephone Fax ELECTRICAL TYPE Minimum Fee QTV. TYPE Dryer QTY. TYPE Outlet, Appliance QTY. TYPE Service Repair Q"I'Y. A/C Central 1 -3 Ton Dryer Vents, Number of Fan Ventilation, Cost Outlet, Wall Ductwork, Cost of Service, Temporary Periodic Inspections A/C Central 4 -7 Ton Fire Sprinkler System Fire Pump Outlet, Switch Fireplaces, Number of Signs A/C Central 8 -15 Ton Fixture - Fluorescent Oven Space Heater (kw) A/C Central 16-20 Ton Fixture Light Parking Lot Lights Spas/Hot Tubs A/C Central 20+ Ton Flood Lights Plugmold/Strip Subfeeds, No. of Amps A/C Window FPL - Load Central Posts Swim Pool, Commercial Air Conditioners Garbage Disposal Range/Range Top Swim Pool, Residential Chiller Generators, etc. Receptacles Switchboards Clear Violations Heat Recovery Refrigerator, Comm. (p/PH) Temp Serv., Construction Compactor Low -volt, Burglar Refrigerator, Domestic Temp for Test - 30 days Deep Freezer Low -volt, Fire Renew - Temp Service Water Closet Demolition Low -volt, Intercom/Teleph. Repair Circuits Water Heater Dishwasher Low -volt, Television Service, Number of Amps Water Heater New MECHANICAL TYPE, Minimum Fee QTV. TYPE Condensate Drain QTY. TYPE Generator Q'I'V. TYPE QTY. Refrigeration, Tons A/C Central, Tons Cooling Tower - Heating Strips, each Vent Hood, Cost A/C Wall/Win. Tons Dryer Vents, Number of Paint Booth Ventilation, Cost Air Handler, Tons Ductwork, Cost of Piping, Flammable Liquid Periodic Inspections Barbecue Fire Sprinkler System - Process/Pressure Piping Bath Fan - Vented, # Fireplaces, Number of - Pressure Vessel PLUMBING TYPI, A/C Condensate QTY TY Drains, Roof Q . L . Tvl , I ,, Miscellaneous Fixture QTY Till. Soakage Pit QTY. Bath Tub Drinking Fountain Miscellaneous Repairs Solar Water Heater Bidet Filter Replace Pool Piping Sprinkler Repair Cap - Fixture Fountain Pump and Abandon Sprinkler System Cap - Water Gas - Appliance Pump, Domestic Supply, AC Well Cap - Sewer Gas - Natural Pump, Fire Stand Temporary Toilet Catch Basin Gas - Propane Pump, Re- circulate Temporary Water Closet Clothes Washer Gas Piping Pump, Replace - Pool Urinal Dental Chair Grease Trap Pump, Sprinkler Utility - Sewer Discharge Well Ice Maker Pump, Sump Utility - Water Dishwasher Indirect Wastes Relay Repair Vacuum Pump Disposal Interceptor Roof Inlet Water Closet Domestic Well Laundry Tray Septic Connection Water Heater Drainfield, 4" Tile/Res. Lavatory Septic Tank Water Heater New Drains, Area Meter Set (Gas) Sewer Connection Water Re -pipe Drains, Floor Minimum Fee Shower Water Service Drains, French Miscellaneous Equipment Sink Well, Supply Page 3 PERMIT APPLICATION INSTRUCTIONS: Please indicate the type of work being performed and quantity(ies) in the space provided below. RECEIVED AND REVIEWED BY: DATE: PAY TO THE ORDER OF LLOYD NORTH DADE SEPTIC 750 NW 107TH ST. MIAMI, Fl 33168 Washington Mutual Washington Mutual Bank. FA North Miami/7th Avenue Financial Center 1746 12600 NW. 7 Avenue 1 - 900. 788 - 7000 North Miami, Ft. 33 24 tour tamer Sconce FOR 1 7 /4 /0 A.). L— - 000 208 Sig' 1: 26 ?084 l 3 L': il9 3uut 2009 2 3""t 50 DATE /1 7 - o / DOLLARS u 2085 63- 8413/2670 I $ 43/0 Po on So. PROPERTY OWNER Name j74 012 Address Home Telephone Business Telephone Fax TYPE OF MANAGEMENT (✓ ) New Construction Enclosure Alteration Exterior Repair Alteration Interior Demolish Relocation of Structure Shell Only Foundation Only Add'I Attachment Other Add'I Detachment Other Irfe hy �'Nr� °y ORIio. (:5O3 D Master Permit No. Subsidiary Permit No. INSTRUCTIONS - The following steps must be taken to obtain a permit from the Miami Shores Village: Step 1. Proposed Use of Property Tenant Information Numb Lot J t 7 / cP Block ( cy PERMIT TYPE (✓ ) Building Electrical Mechanical Plumbing LPGX Roofing Fence Other p .0 /,IDoc t 05 Complete the attached permit application which must be signed by the property owner and qualifier. Both signatures must be notarized. Please print or type to allow for a more accurate processing of your application. If roofing work will be done, a roofing application must be submitted along with this permit application. Step 2. Submit the completed application with all necessary documents to the Building, Planning and Zoning Department for processing. During the processing of your application, you may be asked to submit additional information. Subdivisi°��` PG Current Use of Property \I PERMIT CHANGE (✓ ) Chg. Contractor Renewal Revision Extension Supplement Reinspection ARCHITECT Name License No. Address Telephone Fax Description of Work PERMIT APPLICATION State Zip cOicutkAIN $4,1074 Zoning Linear Feet Square Feet Units Floors Value of Work )� 0 Oa- ® 7 Bldg Value Tax Assessed/Appraised Value Flood Zone Base Floor Elev. ENGINEER Name License No. Address Telephone Fax CONTRACTOR Name License No. Address Telephone Fax Qualifier Name ELECTRICAL TYPE Minimum Fee QTY. TYPE Dryer QTY. TYPE Outlet, Appliance QTY. TYPE Service Repair QTY. A/C Central 1 -3 Ton - Heating Strips, each Fan Outlet, Wall Service, Temporary - Paint Booth A/C Central 4 -7 Ton Fire Pump Outlet, Switch Piping, Flammable Liquid Signs A/C Central 8 -15 Ton Fixture - Fluorescent - Process/Pressure Piping Oven Space Heater (kw) A/C Central 16-20 Ton Pressure Vessel Fixture Light Parking Lot Lights Spas/Hot Tubs A/C Central 20+ Ton Flood Lights Plugmold/Strip Subfeeds, No. of Amps A/C Window FPL - Load Central Posts Swim Pool, Commercial Air Conditioners Garbage Disposal Range/Range Top Swim Pool, Residential Chiller Generators, etc. Receptacles Switchboards Clear Violations Heat Recovery Refrigerator, Comm. (p/PH) Temp Serv., Construction Compactor Low -volt, Burglar Refrigerator, Domestic Temp for Test - 30 days Deep Freezer Low -volt, Fire Renew - Temp Service Water Closet Demolition Low -volt, Intercom/Teleph. Repair Circuits Water Heater Dishwasher Low -volt, Television Service, Number of Amps Water Heater New MECHANICAL TYPE Minimum Fee QTY. TYPE Condensate Drain QTY. TYPE Generator QTY. TYI'E Refrigeration, Tons QTY. A/C Central, Tons QTY. Cooling Tower - Heating Strips, each Vent Hood, Cost A/C Wall/Win. Tons Dryer Vents, Number of - Paint Booth Ventilation, Cost Air Handler, Tons Ductwork, Cost of Piping, Flammable Liquid Periodic Inspections Barbecue Fire Sprinkler System - Process/Pressure Piping Pump and Abandon Bath Fan - Vented, # Fireplaces, Number of Pressure Vessel Gas - Appliance PLUMBING TYPE A/C Condensate QTY. TYPE Drains, Roof QTY. TYPE Miscellaneous Fixture QTY. TYPE Soakage Pit QTY. Bath Tub Drinking Fountain Miscellaneous Repairs Solar Water Heater Bidet Filter Replace Pool Piping Sprinkler Repair Cap - Fixture Fountain Pump and Abandon Sprinkler System Cap - Water Gas - Appliance Pump, Domestic Supply, AC Well Cap - Sewer Gas - Natural Pump, Fire Stand Temporary Toilet Catch Basin Gas - Propane Pump, Re- circulate Temporary Water Closet Clothes Washer Gas Piping Pump, Replace - Pool Urinal Dental Chair Grease Trap Pump, Sprinkler Utility - Sewer Discharge Well Ice Maker Pump, Sump Utility - Water Dishwasher 'Indirect Wastes elay Repair Vacuum Pump Disposal 'Interceptor w.`oof Inlet Water Closet Domestic Well Laundry Tray Septic Connection Water Heater Dra5unft'ie2d, 4" Tile/Res. Lavatory Septic Tank Water Heater New Drains, Area Meter Set (Gas) Sewer Connection Water Re -pipe Drains, IFlaar Minimum Fee Shower Water Service Drains, ]French Miscellaneous Equipment Sink Well, Supply Page 3 PERMIT APPLICATION INSTRUCTIONS: Please indicate the type of work being performed and quantity(ies) in the space provided below. RECEIVED AND REVIEWED BY: DATE: Amount of Permit $ - - -- -- - -- My Commission Expires MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT Permit No. ° Date- _• - - -�� �� �' 6 Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the building or other structure herein described. This application is made in compliance and conformity with the Building Ordinance of Miami Shores Village, Florida, and all provisions of the Laws of the State of Florida, all ordinances of Miami Shores Village and all rules and regulations of the Building Division of Miami Shores Village shall be complied with, whether herein specified or not. A copy of approved plans and specifications must be kept at building during progress of work. Owner's Name and Address Iii , l7, . 1:e ?/4' No.__ ! �/ 0 li. �' Street ___ � Registered Architect and /or Engineer __________ —_____ - --_ - Employing Plumber's NameA a 1a 7Q DA v 0 A _a No.--------- - - - - -_ Street_ _- - Location and Legal Description Lot_ _________ ___ ___________ -- Block_— Subdivision Street and Number where work is to be performed —No...e___...9 IN ' Street A State work to be performed and purpose of building (By Floors New Building ________________ ______ Remodeling_ _____ Addition Repairs No. of Stories. Size Septic Tank _ Type of Tank__ Capacity Gals Feet of Drain Tile _Dist. Feet of Tank or Drain Field from Well Nature of Water Supply: City— Well._______________________ — ____Size of Soakage Pit (Signed)_ (Signed) PI ;' bing Inspector. The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations + s : ` employer of labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Pennanent S .•p ment, and has com- plied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors employed im 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 rk to be performed under this permit, as are licensed by Miami Shores Village. 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. 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 worlmnanship. CLOSETS BATH TU SHOWERS LAVA TORIES SINKS N SLOP SINKS LAUNDRY TUBE URINALS CATCH BASIN FLOOR DRAIN DRINKING FOUNT•N6 TOTAL. FI%TURes CONTR. LIST ppp / / (f �(( ll �� �; / r ' •r CHECK SEPTIC TANK SEWER CONN. DRAIN FIELD SOAKAGE PIT GREASE TRAP SOLAR HEATER DEEP WELL SPRKLR. SYSTEM SWIM•G POOL CONTR. LIST - CHECK Amount of Permit $ - - -- -- - -- My Commission Expires MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT Permit No. ° Date- _• - - -�� �� �' 6 Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the building or other structure herein described. This application is made in compliance and conformity with the Building Ordinance of Miami Shores Village, Florida, and all provisions of the Laws of the State of Florida, all ordinances of Miami Shores Village and all rules and regulations of the Building Division of Miami Shores Village shall be complied with, whether herein specified or not. A copy of approved plans and specifications must be kept at building during progress of work. Owner's Name and Address Iii , l7, . 1:e ?/4' No.__ ! �/ 0 li. �' Street ___ � Registered Architect and /or Engineer __________ —_____ - --_ - Employing Plumber's NameA a 1a 7Q DA v 0 A _a No.--------- - - - - -_ Street_ _- - Location and Legal Description Lot_ _________ ___ ___________ -- Block_— Subdivision Street and Number where work is to be performed —No...e___...9 IN ' Street A State work to be performed and purpose of building (By Floors New Building ________________ ______ Remodeling_ _____ Addition Repairs No. of Stories. Size Septic Tank _ Type of Tank__ Capacity Gals Feet of Drain Tile _Dist. Feet of Tank or Drain Field from Well Nature of Water Supply: City— Well._______________________ — ____Size of Soakage Pit (Signed)_ (Signed) PI ;' bing Inspector. The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations + s : ` employer of labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Pennanent S .•p ment, and has com- plied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors employed im 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 rk to be performed under this permit, as are licensed by Miami Shores Village. 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. 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 worlmnanship. BUILDING ELECTRICAL PLUMBING ROOFING MIAMI SHORES VILLAGE, FLORIDA DATE_ 19— i " PERMIT N9 7447 Contractor's - -, ?r License No. `� 0 Owner of Building Architect Contractor or Builder , . c Legal Lot Description Address of Building CONTRACTOR OR BUILDER t 1 Work to be performed under this Permit— __ e- r e _ ; t �� . Subdi- vision Value of Project $ This permit is granted to the contractor or builder named above to construct the building or to install the equipment or device described in the 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: �. : ' ( �+... ! .c .� � •; INSPECTOR In consideration of the issuance to me of this permit I agree to perform the work covered hereunder in compliance with all ordinances and regulations pertaining thereto and in strict conformity with the plans, drawings, tatements or specifications submitted to the proper authorities of Miami Shores Village. In ao cepting this permit I assume responsibility for all work done by either, myself, my agent, servant or employee. 11 Amount of '� 1! Permit $ BY AUTHORITY Meer BUILDING ELECTRICAL PLUMBING ROOFING ❑ PERMIT N^ 0 Owner of _ Building Architect Contractor � or Builder r+ Legal Lot 11 Description 11 Bl. 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 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 t mployees. CONTRACTOR or BUILDER MIAMI SHORES VILLAGE, FLORIDA Work to be performed under this Permit r' Signed • ' ti r. ' h (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 regulation, pertaining thereto and in strict conformity with the plans, drawings, stat,inents or specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I assume responsibility for all work done by either, myself, my agent, servant or employee. 8 213 Contractor's License No. Date BY AUTHORITY Subdi- vision Sq Ft. Value of 11 Amount of Project $ 11 Permit $ - M SHORES VILLAGE ELIOLMING ONSPtECTION DEPARTMENT A,PPILOMATRUN FAR BUILDING PE MIT Application is hereoy mode for the approyal of the detailed statement of the plans and specifications herewith submitted for the build- ing or other structure Pilerein 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 the work. / � �/ 5 - < 9 6 Ems' , 19. --, Date-- _ --_ -- . /��/— /� Owner's Name and Address. �._�_. _ - � .0 . - -- / 76 Streets /' e! 9 No. Registered Arch-tect and /or Engineer . _ -- Name and address of licensed contractor____ 6 '44' 4 E -4 - __ ,?, — Location and legal description of lot to be built on: New Building To be constructed of Kind of foundation Roof Covering Estimated Total cost of improvements $ ) rip _ Amount of Permit $ . - -_. -- Lo. Block _ Subdivision._. Street and Number where work is to be done l!L , Ste wok to be done and purpose of building (by floors ) _ _ _ _ / 2 of �U__ln%1�11.111 U b - �V (5 :e � el r hcp �l ��- ` eir LA-La-it - d-ez -- and for no other purpose. Remodeling ______. Addition Repairs No. of Stories Zone cubage required __ __. Plan Cubage Distance to next nearest building Size of Building Lot Maximum live load to be borne by each floor II hereby submit all the plans and specifications for said building. All notices with reference to the building and its construction may be sent to__ 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, Pennanent Supplement, and has complied 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 suph subcontractors, on wor be ,performed nder this permit, as are licensed by Miami Shores Village. Remarks ___ _ _ - (Signed) STATE OF FLORIDA, COUNTY OF DADE. ss Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally ap- peared 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 ed tie. Permit No _____ - _ - . -- Date. J l ____ ____- �' ' Read, Sworn to and Subscribed before me. Disapproved Date (Signed) Chairman . _ Member _ Member Council Approved.___ Building Inspecto to me well known, ING BOARD DATE Member Member _ - Notary Public, State of Florida My Commission Expires Member Date Disapproved Date NOTE: A charge of $1.00 will be made for making corrections or changes to this application after approval has been obtained from the Planning Board. A re- inspection fee of $1.00 will be charged when such re- inspection is made necessary by improper notice for inspection or faulty materials and /or workmanship. MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT Permit No Date Owner's Name and Address- __.,- _.4 --- r zec-6,„ Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the building or other structure herein described. This application is made in compliance and conformity with the Building Ordinance of Miami Shores Village, Florida, and all provisions of the Laws of the State of Florida, all ordinances of Miami Shores Village and all rules and regulations of the Building Division of Miami Shores Village shall be complied with, whether herein specified or not. A copy of approved plans and specifications must be kept at building during progress of work. Street 9 Registered Architect and /or Engineer _____ ____--------------- - - -___ Employing Plumbers Name ' ' No.T= - Street__ Location and Legal Description Lot_______ __ __ Block___ ___ ________________________ Subdivision Street and Number where work is to be performed -No._- �d '_\P ° •__. i '..7 ) j State work to be performed and purpose of building (By Floors) _ ______ New Building Remodeling — ____ Addition Repairs Size Septic Tank Feet of Drain Tile Nature of Water Supply: City -Well Amount of Permit $ My Conunission Expires Notary Public, State of Florida No. of Stories. Type of Tank_ __Dist. Feet of Tank or Drain Field from Well _ _Size of Soakage Pit Capacity Gals (Signed)- Plumb : Inspector. The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations as a I em loyer of labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Permanent Supple'e and has com- plied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors employed by him in the work to be performed under this permit; and will post or cause to be posted for inspection on the site of the work such public notice or notices as are required by the Act. The undersigned agrees to employ only such sub - contractors, on. work to be performed under this permit, as are licensed by Miami Shores Village. Master Plumber. STATE OF FLORIDA, 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 workniRnship. CLOf3[RL3 BATH TUBS SHOWERS LAVA- TORIES SINKS SLOP SINKS LAUNDRY TU URINALS CATCH BASIN FLO9R DRAIN DRINKING FOU NT' NE , „ „ A n,� � `�J , 1 A rv0 TOTAL FIXTURES CONTR. LIST nBS /( L6 �� � CHECK SEPTIC TANK SEWER CONN. DRAIN PIELD SOAKAGE PIT GREASE TRAP SOLAR HEATER DEEP WELL SPRKLR. SYSTEM SWIM'G POOL J L c^ 11 0 _ - -- CONTR. LIST CHECK MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT Permit No Date Owner's Name and Address- __.,- _.4 --- r zec-6,„ Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the building or other structure herein described. This application is made in compliance and conformity with the Building Ordinance of Miami Shores Village, Florida, and all provisions of the Laws of the State of Florida, all ordinances of Miami Shores Village and all rules and regulations of the Building Division of Miami Shores Village shall be complied with, whether herein specified or not. A copy of approved plans and specifications must be kept at building during progress of work. Street 9 Registered Architect and /or Engineer _____ ____--------------- - - -___ Employing Plumbers Name ' ' No.T= - Street__ Location and Legal Description Lot_______ __ __ Block___ ___ ________________________ Subdivision Street and Number where work is to be performed -No._- �d '_\P ° •__. i '..7 ) j State work to be performed and purpose of building (By Floors) _ ______ New Building Remodeling — ____ Addition Repairs Size Septic Tank Feet of Drain Tile Nature of Water Supply: City -Well Amount of Permit $ My Conunission Expires Notary Public, State of Florida No. of Stories. Type of Tank_ __Dist. Feet of Tank or Drain Field from Well _ _Size of Soakage Pit Capacity Gals (Signed)- Plumb : Inspector. The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations as a I em loyer of labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Permanent Supple'e and has com- plied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors employed by him in the work to be performed under this permit; and will post or cause to be posted for inspection on the site of the work such public notice or notices as are required by the Act. The undersigned agrees to employ only such sub - contractors, on. work to be performed under this permit, as are licensed by Miami Shores Village. Master Plumber. STATE OF FLORIDA, 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 workniRnship. Permit No. 2 r Amount of Permit $ ---- STATE OF FLORIDA, 1 COUNTY OF DADE. ss. Owner's Name and Address No. MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT ( Signed) >• / Date Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the building or other structure herein described. This application is made in compliance and conformity with the Building Ordinance of Miami Shores Village, Florida, and all provisions of the Laws of the State of Florida, all ordinances of Miami Shores Village and all rules and regulations of the Building Division of Miami Shores Village shall be complied with, whether herein specified or not. A copy of approved plans and specifications must be kept at building during progress of work. Street___ Registered Architect and /or Engineer Employing Plumber's Name No Street_____ Location and Legal Description Lot Block Subdivision Street aqd Number where work is to be performed —No. Street State work to be performed and purpose of building (By Floors) New Building Remodeling Addition - Repairs No. of Stories My Commission Expires Notary Public, State of Florida 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. S ize of Soakage Pit 1 1 _ r _ 1_;_ _ __ __- __.____ j (Signed) Plumbing Inspector. The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations as an employer of labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Permanent Supplement, and has com- plied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors employed by him in the work to be performed under this permit; and will post or cause to be posted for inspection on the site of the work such public notice or notices as are required by the Act. The undersigned agrees to employ only such sub- contractors, on work to be performed under this permit, as are licensed by Miami Shores Village. Master Plumber. Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeared to me well known, and who, being by me first duly sworn, upon oath deposes and says that he is the of the above described construction, that he has carefully read the foregoing application, and that he did sign the same, and that all facts therein by him stated are true. NOTE: A re- inspection fee of $1.00 will be made when such re- inspection is made necessary by improper notice for inspection, or faulty materials and /or workmanship. CLOSETS BATH TUBS SHOWERS LAVA- TORIES SINKS SLOP SINKS LAUNDRY TUBS URINALS CATCH BASIN FLOOR DRAIN DRINKING FOUNT' NS TOTAL FIXTURES CONTR. LIST i / — CHECK SEPTIC TANK SEWER CO NN. / f DRAIN FIELD SOAKAGE PIT GREASE TRAP SOLAR HEATER DEEP WELL SPRKLR. SYSTEM SWIM'G POOL CONTR. LIST CHECK Permit No. 2 r Amount of Permit $ ---- STATE OF FLORIDA, 1 COUNTY OF DADE. ss. Owner's Name and Address No. MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT ( Signed) >• / Date Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the building or other structure herein described. This application is made in compliance and conformity with the Building Ordinance of Miami Shores Village, Florida, and all provisions of the Laws of the State of Florida, all ordinances of Miami Shores Village and all rules and regulations of the Building Division of Miami Shores Village shall be complied with, whether herein specified or not. A copy of approved plans and specifications must be kept at building during progress of work. Street___ Registered Architect and /or Engineer Employing Plumber's Name No Street_____ Location and Legal Description Lot Block Subdivision Street aqd Number where work is to be performed —No. Street State work to be performed and purpose of building (By Floors) New Building Remodeling Addition - Repairs No. of Stories My Commission Expires Notary Public, State of Florida 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. S ize of Soakage Pit 1 1 _ r _ 1_;_ _ __ __- __.____ j (Signed) Plumbing Inspector. The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations as an employer of labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Permanent Supplement, and has com- plied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors employed by him in the work to be performed under this permit; and will post or cause to be posted for inspection on the site of the work such public notice or notices as are required by the Act. The undersigned agrees to employ only such sub- contractors, on work to be performed under this permit, as are licensed by Miami Shores Village. Master Plumber. Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeared to me well known, and who, being by me first duly sworn, upon oath deposes and says that he is the of the above described construction, that he has carefully read the foregoing application, and that he did sign the same, and that all facts therein by him stated are true. NOTE: A re- inspection fee of $1.00 will be made when such re- inspection is made necessary by improper notice for inspection, or faulty materials and /or workmanship. UILDING LECTRICAI LUMBING MIAMI SHORES VILLAGE, FLORIDA PERMIT N° 5488 Work to be performed under this Permit DATE Contractor's License No. 194 )caner of uilding rchitect : ontractor r Builder - .ega1 Lot Bl. Subdi- )escription vision .ddress of r Value of Amt. of /,1 . uilding � Project , Permit This permit is granted to the contractor or builder named above to construct the building or to install the equipment or device described in the appli- ation herefor in strict compliance with all ordinances pertaining thereto and with the understanding that the work will be performed in compliance with any •lans, drawings, statements or specifications that may have been submitted to and approved by the proper municipal authorities. This Permit may be revoked t 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 .ermit is granted is the understanding that the contractor or builder named above assumes the responsibility for a thorough knowledge of the ordinances and egulations pertaining to the work covered hereby whether shown on the plans or drawings or in the statements or specifications and that he asffiumes respon- ibility for work done by his agents, servants or employees. ... Signed: - By .+ INSPECTOR In consideration of the issuance to me of this permit I agree to perform the work covered hereunder in compliance with all ordinances and regulations )ertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami 'Shores Village. n accepting this permit I assume resppnsibility for all work done by either myself, my agent, servant or employee. /• 1 ? ! - . P V i CONTRACTOR OR BUILDER BY AUTHORITY lUILDING LECTRICAL 'LUMBING Work to he performed under this Permit Jwner of MIAMI SHORES VILLAGE, FLORIDA PERMIT N° 4455 'architect :ontractor Jr Builder .egal Lot Bl. )escription address of ; uilding This permit is granted to the contractor or builder named above to construct the building or to install the equipment or device described the appli- !ation herefor in strict compliance with all ordinances pertaining thereto and with the understanding that the work will be performed in compli ce with any ,lans, drawings, statements or specifications that may have been submitted to and approved by the proper municipal authorities. This Pe 't • ay be revoked , t any time if the work is not done in compliance with such ordinances or if the plans are changed without authorization. A further conditi, • pon which this 3e rmit is granted is the understanding that the contractor or builder named above assumes the responsibility for a thorough knowledge of t e ordinances and egulations pertaining to the work covered hereby whether shown on the plans or drawings or in the statements or specifications and that he assumes respon- ibility for work done by his agents, servants or employees. f - . i - ♦ � � 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 3 e rtaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. n pf ting this permit I assume responsibility for all work done by either myself, my agent, servant or employee. a i .r CONTRACTOR OR B y f , > �,. a (� , y . BY f r ■ Subdi- vision Value of Project DATE 194 4 Contractor's License No. Amt. of Permit f AUTHORITY 1 BUILDING ELECTRICAL PLUMBING Owner of Building v e CONTRACTOR OR BUILDER MIAMI SHORES VILLAGE, FLORIDA PERMIT N° 5488 Work to be performed under this Permit Architect Contractor • or Builder Legal Lot Description P1. Subdi- vision Address of f /, Value of �, Amt. of Building e . f � , Project s � " Permit "44,. This permit is granted to the contractor or builder named above to construct the building or to install the equipment or device described in the appli- cation herefor in strict compliance with all ordinances pertaining thereto and w th the understanding that the work will be performed in compliance with any plans, drawings, statements or specifications that may have been submitted to and approved by the proper municipal authorities. This Permit may be revoked at any time if the work is not done in compliance with such ordinances or if the plans are changed without authorization. A further condition upon which this permit is granted is the understanding that the contractor or builder named above assumes the responsibility for a thorough knowledge of the ordinances and regulations pertaining to the work covered hereby whether shown on the plans ,qr, drawings or in the statements or specifications and that he assumes respon- sibility for work done by his agents, servants or employees. .: , Signed '-'• , , 4 t :" E ' By 'it INSPECTOR In consideration of the issuance to me of this permit I agree to perform the work covered hereunder in compliance with.alf,ordinances and 2egula ions pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authoritift of Miami Shores Village. In acce Ling thirmit I assume responsibility for all work done by either myself, my agent, servant or employee. DATE 1` x 194 Contractor's License No 7 BY AUTHORITY 0 ed to >� OWNER aiami cJhores9llage F L O R ID A Fixtures $ Sewer $ Septic Tank $ • Total $ PLUMBING PERMIT N° 658 Village Plumbing Inspector Received Payment by LOT 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 ' `Y Fixtures BLOCK SUBDIVISION Date Issued to / For a story c 7Y1iami cShoresrillage F L O A I D A PLUMBING PERMIT N9 658 Fixtures $ Sewer $ Septic Tank $ 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. building at y ° • Fixtures Total $ 1 Village Plumbing Inspector d" Received Payment by OWNER LOT BLOCK SUBDIVISION s r.1 r ) i. T �"�'' `,• Date Issued to / For a story c 7Y1iami cShoresrillage F L O A I D A PLUMBING PERMIT N9 658 Fixtures $ Sewer $ Septic Tank $ 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. building at y ° • Fixtures Total $ 1 Village Plumbing Inspector d" Received Payment by