SEPTIC & DRAINFIELD.41
Date 6 'ds.6 dPt,
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Job Address # tJ • �,2 11 - Tax Folio
Legal Description Historically Designated: Yes No
Owner/Lessee / Tenant 14 • y e/ 4 - A91, Master Permit # $
Owner's Address V ' 9 S"4,42.‘
Phone ® 76 - >>
(t7 �,
Contracting Co. fi���, �� � � ` � S j :)- �� � A- Address i / / 1 4/ i 4M2 ,,
Qualifier c-4-4 „ / • (---e i. le, 'ems, SS# Phone 1. .. ' r'' ,•.`.""' 4 V ` 7.14 7/
li
State # Municipal # Competency # Ins. Co.
Architect/Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type (circle one): BU ING ELECTRICAL PLUMBING MECHANICAL ROOF
WORK DESCRIPTION C 1 A",
T Cf 013
Square Ft. Estimated Cost (value)
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.
OWNERS AFFIDAVIT: I certify that all the f•regoing information is accurate and that all work will be done in compliance with all applicable laws regulating
construction and zo ' . Furthermore • • - the above -named contactor to do the work stated
gnature of owner and/or C
My Commission Expires:
4'S
J-®
APPROVED:
Zoning
Mechanical Plumbing
Date
Signature of Contractor or Owner - Builder i ate
G PAVING FENCE SIGN
Notary as to Owner and/or Condo President Date Notary as to Con or or Owner- Builder Date
My Commission Expires: - - -- t - ; c,:._ ;:c a::v ;171,2.i. ?t 7. — 067
l it `!1.!3 a:v7�J�2 ::::,,,,,, • $
��' :.:.r. �^ ^�Cfd��E
0 i ll — O 1 '� O� 74 .. r--
FEES: PERMIT RADON C.C.F. f ' NOTARY BOND c ®R
TOTAL DUE 'iT /- 4 0
Building Electrical
Structural Engineer
STATE OF FLORIDA
DEPARTMENT OF HEALTH
APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PERMIT
Permit Application Number
PART II - SITEPLAN
Scale: Each block represents 10 feet and 1 inch = 40 feet.
Notes:
DH 4015, 10/96 (Replaces HRS -H Form 4015 which may be used)
(Stock Number: 5744 -002 - 4015 -6)
Site Plan submitted by:
Plan Approved Not Approved Date
By County Health Department
ALL CHANGES MUST BE APPROVED BY THE COUNTY HEALTH DEPARTMENT
Page 2 of 4
CONSTRUCTION PERMIT FOR:
[ ] New System [ ] Existing System
[ ) Repair [ 1 Abandonment
APPLICANT:
PROPERTY STREET ADDRESS:
LOT:
PROPERTY ID #:
SYSTEM DESIGN AND SPECIFICATIONS
T
A
N
K
0
T
H
E
R
(
[
(
SPECIFICATIONS BY:
APPROVED BY:
DATE ISSUED:
STATE OF FLORIDA PERMIT #
DEPARTMENT OF HEALTH DATE PAID
ONSITE SEWAGE DISPOSAL SYSTEM FEE PAID
CONSTRUCTION PERMIT RECEIPT #
Authority: Chapter 381, FS &
BLOCK: SUBDIVISION:
DH 4016, 10/96 (Replaces HRS -H Form 4016 (page 11 which may be used)
(Stock Number: 5744- 001- 4016 -0)
Chapter 10D -6, FAC
[ ] Holding Tank [ ) Temporary /Experimental
[ J Other(Specify)
AGENT:
[SECTION /TOWNSHIP /RANGE /PARCEL NUMBER)
[OR TAX ID NUMBER]
SYSTEM MUST BE CONSTRUCTED IN ACCORDANCE WITH SPECIFICATIONS AND STANDARDS OF CHAPTER 10D -6,
FAC. REPAIR PERMITS AND HOLDING TANK PERMITS EXPIRE 90 DAYS FROM THE DATE OF ISSUE. ALL OTHER
PERMITS EXPIRE ONE YEAR FROM THE DATE OF ISSUE. DEPARTMENT OF HEALTH 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.
] [GALLONS / GPD] SEPTIC TANK /AEROBIC UNIT CAPACITY MULTI- CHAMBERED /IN SERIES:[ ]
] [GALLONS / GPD] CAPACITY MULTI- CHAMBERED /IN SERIES:[ ]
J GALLONS GREASE INTERCEPTOR CAPACITY [MAXIMUM CAPACITY SINGLE TANK: 1250 GALLONS]
] GALLONS PER DOSE DOSING TANK CAPACITY DOSE MATE [ ] PER 24 MRS NO. OF PUMPS: [
D [ ] SQUARE FEET PRIMARY DRAINFIELD SYSTEM
R [ ] SQUARE FEET SYSTEM
A TYPE SYSTEM: [ ] STANDARD [ ] FILLED [ ) MOUND
I CONFIGURATION: [ ] TRENCH [ ;] BED [ ]
N
F LOCATION OF BENCHMARK: �.."
I ELEVATION OF PROPOSED SYSTEM SITE [ ] [ INCHES /FT] [ABOVE /BELOW) BENCHMARK /REFERENCE POINT
E BOTTOM OF DRAINFIELD TO BE [ ] [INCHES /FT] [ABOVE /BELOW] BENCHMARK /REFERENCE POINT
D FILL REQUIRED: [ ] INCHES EXCAVATION REQUIRED: [ ] INCHES
TITLE:
TITLE:
[
7.1a
CD s`G0'
EXPIRATION DATE:
CHD
Page 1 of 2
INSTRUCTIONS:
PERMIT NUMBER: Permit tracking number by County Health Department.
APPLICATION FOR: Check type of permit; if "Other" specify type in blank.
APPLICANT: Property owner's full name.
TELEPHONE: Telephone number for applicant or agent.
AGENT: Property owner's legally authorized representative.
MAILING ADDRESS: P.O. box or street mailing address for applicant or agent.
LOT, BLOCK, SUBDIVISION or
PROPERTY ID #: 27 character ID number for property. (Health Department may require property appraiser ID# or
section /township /range /parcel number.)
SYSTEM DESIGN AND
SPECIFICATIONS:
TANK: Minimum specifications from Chapter 10D -6, FAC.
DRAINFIELD: Minimum specifications from Chapter 10D -6, FAC.
OTHER: Other specifications, such as operating permit requirements, low- volume flush toilets, variance provisos.
SPECIFICATIONS BY: Name of individual providing specifications. If designed by a registered engineer must be sealed.
APPROVED BY: County Health Department personnel reviewing and approving permit.
DATE ISSUED: Date permit is issued by County Health Department.
-
EXPIRATION DATE: One year from date issued if the system has not been installed. Permits for system repairs become void 90 days from the
date issued.
APPLICATION FOR:
[ - "] 1 New System
[A Repair
APPLICANT:
AGENT:
MAILING ADDRESS:
PROPERTY
LOT: ^ ! r)
PROPERTY
PROPERTY SIZE:/,'r
PROPERTY STREET ADDRESS:
DIRECTIONS TO PROPERTY:
BUILDING INFORMATION
Unit Type of
No Establishment
1
2
3
4
INFORMATION
STATE OF FLORIDA
DEPARTMENT OF HEALTH
ONSITE SEWAGE DISPOSAL SYSTEM
APPLICATION FOR CONSTRUCTION PERMIT
Authority: Chapter 381, FS & Chapter
BLOCK:
ID
l (7
fAt
[6 Existing System [9] Holding Tank
[�_ ] Abandonment Other(Specify)
[IF LOT IS/NOT IN A
•
No. of
Bedrooms
[ ] Garbage Grinders /Disposals
[ ] Ultra -low Volume Flush Toilets
DH 4015, 10/96 (Replaces HRS -H Form 4015 [Page 1] which may be used)
(Stock Number: 5744- 001 - 4015 -1)
l
SUBDIVISION:
[i] RESIDENTIAL
Building
Area Sgft
•
10D -6, FAC
ACRES [Sgft /43560J PROPERTY WATER SUPPLY,: [
c,f C
[
PERMIT #
DATE PAID
FEE PAID $
RECEIPT #
/ / -
[)] Temporary /Experimental
TELEPHONE : �,� -
TO BE COMPLETED BY APPLICANT OR APPLICANT'S AUTHORIZED AGENT. ATTACH BUILDING PLAN AND TO -SCALE
SITE PLAN SHOWING PERTINENT FEATURES REQUIRED BY CHAPTER 10D -6, FLORIDA ADMINISTRATIVE CODE.
RECORDED SUBDIVISION, ATTACH LEGAL DESCRIPTION OR DEED]
Section /Township /Range /Parcel
Ci
] COMMERCIAL
# Persons
Served
Business Activity
For Commercial Only
DATE OF
SUBDIVISION:
No.] ZONING:
] PRIVATE
JJ t, dlf�
[
[ ] Spas /Hot Tubs [ ] Floor /Equipment Drains
[ ] Other (Specify) �.
APPLICANT'S SIGNATURE: = . DATE: � i; // rl
7
PUBLIC
Page 1 of 3
INSTRUCTIONS:
APPLICATION FOR: Check type of permit, if "Other" specify type in blank.
APPLICANT: Property owner's full name.
TELEPHONE: Telephone number for applicant or agent.
AGENT: Property owner's legally authorized representative.
MAILING ADDRESS: P.O. box or street, city, state and zip code mailing address for applicant or agent.
LOT, BLOCK,
SUBDIVISION:
PROPERTY SIZE:
WATER SUPPLY: Check private or public.
PROPERTY ADDRESS: Street address for property. For lots without an assigned street address, indicate street or road and locale in county.
DIRECTIONS: Provide detailed instructions to lot or attach an area map showing lot location.
BUILDING INFORMATION: Check residential or commercial.
# PERSONS: Number of persons residing, using, or working in establishment. For residential establishment, 2 persons per bedroom are
assumed.
Lot, block, and subdivision for tot (recorded or unrecorded subdivision). If lot is not in a recorded subdivision, a copy of the lot
legal description or deed must be attached.
DATE OF SUBDIVISION: Official date of subdivision recorded in county plat books (month /day /year) or date lot originally recorded. Dividing an approved
lot into two or more parcels for the purpose of conveying ownership shall be considered a subdivision of the lot.
PROPERTY ID#: 27 character number for property. (Health Department may require property appraiser ID# or section /township /range /parcel number.)
Net usable area of property in acres (square footage divided by 43,560 square feet) exclusive of all paved areas and prepared road
beds within public rights -of way or easements and exclusive of streams, lakes, normally wet drainage ditches, marshes, or other
such bodies of water. Contiguous unpaved and noncompacted road rights -of -way and easements with no subsurface obstructions
may be included in calculating lot area.
TYPE ESTABLISHMENT: List type of establishment from Table II, Chapter 10D-6, FAC. Examples: single family, single wide mobile home, restaurant,
doctor's office.
NO. BEDROOMS: Count all rooms designed primarily for sleeping and those areas expected to routinely provide sleeping accommodations for
occupants.
BUILDING AREA: Total square footage of enclosed habitable area of dwelling unit, excluding garage, carport, exterior storage shed, or open or fully
screened patios or decks. Based on outside measurements for each story of structure.
BUSINESS ACTIVITY: For commercial applications only. 'List number of employees, shifts, and hours of operation, or other information required by
Table II, Chapter 1OD -6, FAC.
FIXTURES: Mark each listed fixture with number installed or "NA" if not applicable.
SIGNATURE: Signature of applicant or agent. Date application on day submitted to Health Department with appropriate fees and attachments.
ATTACHMENTS: A site plan drawn to scale, showing boundaries with dimensions, locations of residences or buildings, swimming pools, recorded
easements, onsite sewage disposal system components and location, slope of property, any existing or proposed wells, drainage
features, filled areas, obstructed areas, and surface water. Location of wells, onsite sewage disposal systems, surface waters, and
other pertinent facilities or features on adjacent property, if the features are with 75 feet of the applicant lot. Location of any
public well within 200 feet of lot.
For residences, a floor plan (residences) showing number of bedrooms and building area of each unit. For nonresidential
establishments, a floor plan showing the square footage of the establishment, all plumbing drains and fixture types, and other
features necessary to determine composition and quantity of wastewater.
APPLICANT:
LOT: i✓ 6:,.
PROPERTY ID #:
STATE OF FLORIDA
DEPARTMENT OF HEALTH
ONSITE SEWAGE DISPOSAL SYSTEM
SITE EVALUATION AND SYSTEM SPECIFICATIONS
BLOCK:
'
PROPERTY SIZE CONFORMS TO SITE
TOTAL ESTIMATED SEWAGE FLOW:
AUTHORIZED SEWAGE FLOW:
UNOBSTRUCTED AREA AVAILABLE:
10 YEAR FLOOD ELEVATION FOR SITE:
SUBDIVISION:
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.
PLAN:
/
a :
BENCHMARK /REFERENCE POINT LOCATION:
ELEVATION OF PROPOSED SYSTEM SITE IS
[ ]
THE MINIMUM SETBACK WHICH CAN BE MAINTAINED FROM THE PROPOSED SYSTEM TO THE FOLLOWING FEATURES
SURFACE WATER: //) DITCHES / SWALES : / % « C FT NORMALLY WET? [ ] YES [ _ 4 NO
WELLS: PUBLIC: FT LIMITED USE: FT PRIVATE: FT NON - POTABLE: FT
BUILDING FOUNDATIONS: ;I- FT PROPERTY LINES: FT POTABLE WATER LINES: d FT
SITE SUBJECT TO FREQUENT FLOODING: [ ] YES (✓j NO
FT MSL /NGVD SITE ELEVATION: FT MSL /NGVD
SOIL PROFILE INFORMATION SITE 1
Cf a rk
Munsell # /Color Texture Depth
n / to
USDA SOIL SERIES: �- ,1 /A ) G '�a ,
;t0
to
to
to
to
to
to
to
'7k ::)
OBSERVED WATER TABLE: G�;" INCHES [ABOVE / BELOW] EXISTING GRADE. TYPE: [PERCHED / APPARENT]
ESTIMATED WET SEASON WATER TABLE ELEVATION: «, 3 .INCHES [ ABOVE / BELOV) ] EXISTING GRADE.
HIGH WATER TABLE VEGETATION: [ ] YES ( NO MOTTLING: [ ] YES [_I NO DEPTH: INCHES
SOIL TEXTURE /LOADING RATE FOR SYSTEM SIZING: �.??
DRAINFIELD CONFIGURATION: [ ] TRENCH [ 4 BED [
REMARKS /ADDITIONAL CRITERIA:
DH 4015, 10/96 (Replaces HRS -H Form 4015 [Page 3) which may be used)
(Stock Number: 5744- 003 - 4015 -1)
AGENT: G%
r'7" t
Mansell #/Color
7 (f C a1 �a
' �o� //.4
USDA SOIL SERIES:
`e
PERMIT #
4
1 ;7
[Section /Township /Range /Parcel No. or Tax ID Number]
YES [ ) NO NET USABLE AREA AVAILABLE: ' ' ;-'. ACRES
GALLONS PER DAY [RESIDENCES -TABLE 1 / OTHER -TABLE 2)
GALLONS PER DAY [1500 GPD /ACRE OR 2500 GPD /ACRE]
SQFT UNOBSTRUCTED AREA REQUIRED: )) 4: SQFT
(� N 1 1 < '
, ° > [INCHES/ Mt [ABOVE /'BELOW)) BENCHMARK /REFERENCE POINT
10 YEAR FLOODING? [ ] YES [') NO
SOIL PROFILE INFORMATION SITE 2
Texture Depth
to
f
to
to
to
to
to
to
to
DEPTH OF EXCAVATION: ) a INCHES
` y 7
] OTHER (SPECIFY)
yk1
SITE EVALUATED BY: DATE: f,�
Page 3 of 3
INSTRUCTIONS: '�" •
•
PERMIT NUMBER: Permit tracking number by County Health Department.
APPLICANT: Property owner's full name.
AGENT: Property owner's legally authorized representative.
LOT, BLOCK, SUBDIVISION: Lot, block, and subdivision for lot.
PROPERTY ID NUMBER: 27 character number for property (property appraiser ID number or section /township /range /parcel number).
PROPERTY SIZE: Check if property at site conforms to submitted site plan. Record net usable area available - lot area exclusive of
all paved areas and prepared road beds within public rights -of -way or easements and exclusive of streams, lakes,
normally wet drainage ditches, marshes, or other such bodies of water.
SEWAGE FLOW:
UNOBSTRUCTED AREA:
Record the estimated sewage flow for the establishment from Table 1 (residence) or Table 2 (non - residential),
Chapter I OD -6, FAC. Record the authorized sewage flow for the lot based on net usable area and water supply
(1500 gallons per day per acre for private water supplies and 2500 gpd per acre for public water supplies). If
authorized sewage flow does not equal or exceed the estimated sewage flow, the application must be denied.
Record the square feet of unobstructed area available and the amount required. Unobstructed area must be at
least 2 times as large as the drainfield absorption area and at least 75 percent of the unobstructed area must meet
minimum setbacks in Chapter 1OD -6, FAC. The unobstructed area must be contiguous to the drainfield.
BENCHMARK INFORMATION: Record the location of the benchmark. If using a surveyor's benchmark record the actual elevation. Record the
elevation of the proposed system site in relation (above or below) to the benchmark.
MINIMUM SETBACKS:
Record minimum setbacks which can be meet to all listed features. Actual measurements must be recorded or
"NA" for nonapplicable features. Features on site plan or within 75 feet of the applicant lot must be measured.
The location of any public drinking well within 200 feet of the applicant's lot must also be verified.
FLOOD INFORMATION: Record information on lot's subject to flooding. For lots subject to flooding record 10 year flood elevation for
site and actual site elevation.
SOIL PROFILE INFORMATION: Two soil profiles within the proposed absorption area to a minimum depth of 6 feet or refusal are required. Soil
identification will use USDA Soil Classification methodology (Munsell colors and USDA soil textures). Refusals
must be clearly documented. Provide USDA soil series if available, record "UNK" if the series cannot be
determined.
WATER TABLE: Record the depth of the observed water table at the time of the evaluation. Mark "perched" or "apparent" as
appropriate. Record the estimated wet season water table elevation based on site evaluation, USDA soil maps,
and historical information. Indicate if there is high water table vegetation present. Indicate if mottling is present
and depth.
SOIL TEXTURE: Record soil texture or loading rate for system sizing.
DEPTH OF EXCAVATION: If applicable record depth of excavation required. Record "NA" if not applicable.
DRAINFIELD CONFIGURATION: Check drainfield configuration required. If other, specify type.
ADDITIONAL CRITERIA: Record any additional remarks pertinent to site or installation. Ex. dosing required.
SITE EVALUATED BY: Signature of evaluator, title, and date of evaluation. Professional engineers must seal all documents submitted.
ELEVATION WORKSHEET ELEVATION OF BENCHMARK / REFERENCE POINT IS:
BENCHMARK SITE 1 SITE 2 SITE 3
[ + ] SHOT H.I. H.I. H.I.
H.I. [ - ]SHOT [ - ]SHOT [ - ]SHOT
MIAMI SHORES VILLAGE, FLA.
JOB G.> .)
ADDRESS El ,/ - r 9'z 5
INSPECTION 1 A-e
TIME READY-4)1A, 6 ' i -S7
REMARKS:
N? 6223
INSPECTOR =' DATE r
Permit No SI 2 -3
Application is hereby made for the approval of the detailed statement of the plans and specifications herewith bmitted for t'le 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 ,fit
building during progress of work. %
Owner's Name and Address _ ��_ =, Street
Registered Architect
Employing Pl e r:d
Location and Legal sc ption Lot__
Street and Number where work is to be performed —No
State work to be performed and purpose of building (By Floors)
New Building Remodeling
Amount of Permit $
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING F''; iV IT
-_ Block
Size Septic Tank Type of Tank
Feet of Drain Tile_
_--._-------------------_--
Nature of Water Supply: City —Well.
Addition______.__.________._ Repairs
Capacity Gals.
t. Feet of Tank or Drain Field from Well
'p ing nspector.
The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations .! an employer of labor
under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Permanent S plement, and has com-
plied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors employe • y him in the work to be
performed under this permit; and will post or cause to be posted' for inspection on the of the work such public notice or notices as are
required by the Act. The undersigned agrees to employ only such sub- contractor0 I o performed under this permit, as are
licensed by Miami Shores Village. ,r �
My Commission Expires
-- - ---- (Signed)_
(Sign
Date
Stre
�sidn
Street_
1/4
Notary Public, State of Florida
No. of Stories .. .......................
Master Plumber.
STATE OF FLORIDA, I
COUNTY (OF DADE. )
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeared
to me well known, and who, being by me first duly sworn, upon oath deposes and says that he is the
of the above described construction, that he has carefully read the foregoing application, and that he did sign the same, and that all facts
eceTe.n 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
Tugs
URINALS
CATCH
BASIN
FLOOR
DRAIN
DRINKING
FOUNT•NS
TOTAL
FIXTURES
CONTR.
LIST
CHECK
SEPTIC
TANK
SEWER
CONN.
DRAIN
FIELD
SOAKAGE
PIT
GREASE
TRAP
SOLAR
HATER
DEEP
WELL
SPRKLR.
SYSTEM
SWING
POOL
R.
Corr m.
LIST
- .
CHECK
Permit No SI 2 -3
Application is hereby made for the approval of the detailed statement of the plans and specifications herewith bmitted for t'le 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 ,fit
building during progress of work. %
Owner's Name and Address _ ��_ =, Street
Registered Architect
Employing Pl e r:d
Location and Legal sc ption Lot__
Street and Number where work is to be performed —No
State work to be performed and purpose of building (By Floors)
New Building Remodeling
Amount of Permit $
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING F''; iV IT
-_ Block
Size Septic Tank Type of Tank
Feet of Drain Tile_
_--._-------------------_--
Nature of Water Supply: City —Well.
Addition______.__.________._ Repairs
Capacity Gals.
t. Feet of Tank or Drain Field from Well
'p ing nspector.
The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations .! an employer of labor
under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Permanent S plement, and has com-
plied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors employe • y him in the work to be
performed under this permit; and will post or cause to be posted' for inspection on the of the work such public notice or notices as are
required by the Act. The undersigned agrees to employ only such sub- contractor0 I o performed under this permit, as are
licensed by Miami Shores Village. ,r �
My Commission Expires
-- - ---- (Signed)_
(Sign
Date
Stre
�sidn
Street_
1/4
Notary Public, State of Florida
No. of Stories .. .......................
Master Plumber.
STATE OF FLORIDA, I
COUNTY (OF DADE. )
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeared
to me well known, and who, being by me first duly sworn, upon oath deposes and says that he is the
of the above described construction, that he has carefully read the foregoing application, and that he did sign the same, and that all facts
eceTe.n by him stated are true.
NOTE: A re- inspection fee of $1.00 will be made when such re- inspection is made necessary by improper notice for inspection, or faulty
materials and /or workmanship.
BUILDING
ELECTRICAL
PLUMBING
Owner of
Building s
Architect
Contractor
or Builder
Legal
Description
Address of
Building
Lot
MIAMI SHORES VILLAGE, FLORIDA
- PERMIT N? 5998
Work to be performed under this Permit [ t
Bl.
` I .r'.
Signed:
Subdi-
vision
Value of
Project
DATE
Contractor's
License No.
Lj By
INSPECTOR
'_ .
„«' /" Amt. of
.: /' ' ,/ f---. /yr I , l Permit
This pernht is granted to the contrrractor or bu named above to construct the building or to install the equipment or d(vice 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 rdinances and
regulations pertaining to the work covered hereby whether shown on the plans or drawings or in the statements or specifications and that he sumes respon-
sibility for work done by his agents, servants or employees.
In consideration of the issuance to me of this permit I agree to perform the work covered her6under`tcompliance 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
f lit for all work done by either myself, my ogent, servant or employee.
� 4/ y B / +
GS'I' on �.
CONTRA OR BUILDER
AUTHORITY
BUILpING
ELEC FRICAL
PLUMBING fi t
•
Owner of ..
Building / I c F
Architect
Contractor
or Builder
Legal Lot
Description
MIAMI SHORES VILLAGE, FLORIDA
DATE ( /6 1941_
1
PERMIT Nn 5998
Work to be performed under this Permit
;4e C
Bl.
Address of ` 3 � Value of
Building e ' mo t i .. .2 `�i' , Project
This per it is granted to the contractor or builder named above to c nstruct 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 t ordinances and
regulations pertaining to the work covered hereby whether shown on the plans or drawings or in thlr or specifications an at e ssumes respon-
sibility for work done by his agents, servants or employees. ,..
Signed:, . By
Ii
Subdi-
vision
Contractor's / ("- 2 r
License No. f
Amt. of
Permit
INS 'E 0
In consideration of the issuance to me of this permit I agree to perform the work covered her undeNif compliance with all ordinances and regulations
pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authottIs of Miami Shres
In accepting this permit I assume responsibility for all work done by either myself, my ent, servant or employee.
AUTHORITY
Permit No.
Amount of Permit $ -
Nature of Water Supply: City —Well.
STATE OF FLORIDA, t
COUNTY OF DADE.
ss.
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
Date
-- -- (Signed)
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 No ' Street
Registered Architect and /or Engineer
Employing Plumber's Name
Location and Legal Description Lot Block Subdivision .
Street and Number where work is to be performed —No Street
>•��.wfw1�•w./Y yy6 +M7.w: a.Y.�!a..Y wCs
State work to be performed and purpose of building (By Floors)
No. ______ Street
Street 1
My Commission Expires Notary Public, State of Florida
New Building __... Remodeling Addition. Repairs _... No. of Stories
Size Septic Tank Type of Tank Capacity Gals.
of Drain Tile Dist. Feet of Tank or Drain Field from Well
Size of Soakage Pit
Plumbing Inspector.
The undersigned applicant for this building permit does hereby certify that he understands and accepts 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.
(Signed)
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
the above described construction, that he has carefully read the foregoing application, and that he did sign the same, and that all facts
therein by him stated are true.
NOTE: A re- inspection fee of $1.00 will be made when such re- inspection is made necessary by improper notice for inspection, or faulty
materials and /or workmanship.
CLOSETS
BATH
TUBS
SHOWERS
LAVA-
TORIES
SINKS
SLOP
SINKS
LAUNDRY
TUBS
URINALS
CATCH
BASIN
FLOOR
DRAIN
DRINKING
FOUNT' NS
TOTAL
FIXTURES
CONTR.
LIST
CHECK
SEPTIC
TANK
SEWER
CONN.
DRAIN
FIELD
SOAKAGE
PIT
GREASE
TRAP
SOLAR
HEATER
DEEP
WELL
SPRKLR.
SYSTEM
SWIM'G
POOL
CONTR.
LIST
CHECK
Permit No.
Amount of Permit $ -
Nature of Water Supply: City —Well.
STATE OF FLORIDA, t
COUNTY OF DADE.
ss.
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
Date
-- -- (Signed)
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 No ' Street
Registered Architect and /or Engineer
Employing Plumber's Name
Location and Legal Description Lot Block Subdivision .
Street and Number where work is to be performed —No Street
>•��.wfw1�•w./Y yy6 +M7.w: a.Y.�!a..Y wCs
State work to be performed and purpose of building (By Floors)
No. ______ Street
Street 1
My Commission Expires Notary Public, State of Florida
New Building __... Remodeling Addition. Repairs _... No. of Stories
Size Septic Tank Type of Tank Capacity Gals.
of Drain Tile Dist. Feet of Tank or Drain Field from Well
Size of Soakage Pit
Plumbing Inspector.
The undersigned applicant for this building permit does hereby certify that he understands and accepts 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.
(Signed)
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
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.
Date.. - / ‘, (e9 A -- — 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 C2 w FU f2
No. 4- 3 K/c street_.._ ` Z .s ....._..� ...
Permit No.-
Registered Architect and /or Engineer
EuWlQyl
ske-
rittplbw s Ntna ti .
Location and Legal Description Lot
Subdivision
Street and Number where work is to be performed —No. 4 3 4767- Sheet_. q Z.. S
State work to be performed and purpose of building (By Floors)___.__
New Building_ _ __ . Remodeling _ ___ Addition.- - - - - -- ..__ Repairs No. of Stories. ........._
Size Septic Tank
Feet of Drain Tile. V t9-
Nature of Water Supply: City—Well.
STATE OF FLORIDA,
COUNTY OF DADE.
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
� CG - Ne/, _ _� „.,,, $ t =1=2a: ....:r:=1. ., a
Bloc&
_Type of Tank_ -__
Feet of Tank or Drain Field from Well_._. _ .� _. _.._ •
Size of Soakage Pit_
(Signed)_
lumbing Inspector.
The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligati . . s as an employer of labor
under the Florida Workmen's Compensation Act, being Section 5988, Compiled General Laws of Florida Pennanen 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
(Signed)
Capacity Gals..--.. ....... ________
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeared
to me well known, end 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
Master Plumber.
N ,
� OT : A re of $1.00 will be made when such re- inspection is made necessary by improper notice for inspection, or faulty
CLOSETS
BATH
TUBS
SHOWER.
LAVA.
TORIES
SINKS
SLOP
SINKS
LAUNDRY
TUDS
URINALS
CATCH
BASIN
FLOOR
DRAIN
DRINKING DRINK
FOUNT' NS
TOTAL
FIXTURES
CONTR.
LIST
CHECK
SEPTIC
TANK
SEWER
CONN.
DRAIN
FIELD
1 E V
SOAKAGE
PIT
GREASE
TRAP
SOLAR
HEATER
DEEP
WELL
SPRKLR.
SYSTEM
SWIM'O
POOL
Cowrie.
LIST
CHECK
Date.. - / ‘, (e9 A -- — 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 C2 w FU f2
No. 4- 3 K/c street_.._ ` Z .s ....._..� ...
Permit No.-
Registered Architect and /or Engineer
EuWlQyl
ske-
rittplbw s Ntna ti .
Location and Legal Description Lot
Subdivision
Street and Number where work is to be performed —No. 4 3 4767- Sheet_. q Z.. S
State work to be performed and purpose of building (By Floors)___.__
New Building_ _ __ . Remodeling _ ___ Addition.- - - - - -- ..__ Repairs No. of Stories. ........._
Size Septic Tank
Feet of Drain Tile. V t9-
Nature of Water Supply: City—Well.
STATE OF FLORIDA,
COUNTY OF DADE.
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
� CG - Ne/, _ _� „.,,, $ t =1=2a: ....:r:=1. ., a
Bloc&
_Type of Tank_ -__
Feet of Tank or Drain Field from Well_._. _ .� _. _.._ •
Size of Soakage Pit_
(Signed)_
lumbing Inspector.
The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligati . . s as an employer of labor
under the Florida Workmen's Compensation Act, being Section 5988, Compiled General Laws of Florida Pennanen 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
(Signed)
Capacity Gals..--.. ....... ________
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeared
to me well known, end 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
Master Plumber.
N ,
� OT : A re of $1.00 will be made when such re- inspection is made necessary by improper notice for inspection, or faulty
38 MIAMI SH ES VILLAGE
BUILDING DEPARTMENT
305- 795 -2204
Building Inspection Request
Date I la k5
Type Insp'n�
Permit No. " — � (=G
Name 'P2• S
Address 453 YJ 2. .11
Compan)3 ' "Pc-CJM(L
Phone # (3c5)
Inspection Date
Approved ► IR
' M ‘ Correction ❑
Re-Insp'n Fee ❑
Date r ` Zp (?Job Address A), , c 1 ), t Tax Folio
Legal Description Owner/L essee /Tenant
1O
Owner's Address 7` S C� % g 2.,
Contracting Co. ir,ti,lb / " " ���� Address
//_ ,?S /() / – k , 1W _
Qualifier libl-e.l i / SS# Phone 1 li S " 17 -Z Z J
State # c Pc C Si' 7 M unicipal #
Signature of owner and/or Condo President Date
My Commission Expires:
FEES: PERMIT
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
RADON
APPROVED:
Zoning Building
Mechanical Plumbing
Architect/Engineer
Bonding Company
Mortgagor Address
Permit Type (circle one): BUILDING ELECTRICAL LIJM G MECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIPTION , //e L ^ .�.
Square Ft. Estimated Cost (value) 5 C3 G
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.
OWNERS AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be in complian _with all applicable laws regulating
construction and zoning. Furthermore, I authorize the above -named contractor to do the ork stated.
Notary as to Owner and/or Condo President Date Notary
Historically Designated: Yes
")14(1A-a
Competency #
Address
Address
My Commission Expir
C.C.F. NOTARY S ^O 0 BOND
TOTAL DUE 1
Phone ?0
Electrical
Master Permit
No
3
Ins. Co. a,1A:e"-
z2 Do
) 2/d
te
� p..RY po OFFICIAL NOTARv SEAL
B � A BECKER
� � Cl corsOOb .u:azEn
a : tic CC786697
CF F�O�`o �v c?. 3510: EXPIRES
Q2
Structural Engineer
ITEM
BATH TUB
UNIT
i
FEE
ITEM
SWITCH CUTLETS
UNIT
FEE
ITEM
SPACE HEATERS
UNIT
FEE
BIDET
1')
L I G1iT CURETS
CENTRAL HEATING
DISHWASHER
I
RECEPTACLES
A/C (WIND)
DISPOSAL
1
SERVICE TEMPORARY
A/C (CENTRAL)
DRINKING FOUNTAIN
SERVICE SIZE IN AMPS
DUCT WORK
FLOOR GRAIN
SERVICE REPAIR/METER CHANGE
REFRIGERATION
GREASE TRAP
APPLIANCE CURETS
PROCESS AND PRESS PIPING
INTERCEPTOR
RANGE TCP
UNDERGROUND TANKS
LAVATORY
OVEN
ABOVE GROUIO TANKS
LAUNDRY TRAY
WATER HEATER
U.F. PRESSURE VESSELS
CLOTHES WASHER
/
MOTORS 0- 1 HP
STEAM BOILERS
SHOWER
MOTORS OVER 1- 3 If
HOT WATER BOILERS
SINK, POT /3 COMP.
MOTORS OVER 3- 5 HP
MECHANICAL VENTILATION
SINK, RESIDENCE
/
MOTORS OVER 5- 8 HP
TRANSPORTING ASSEMBLIES
SINK, SLOP
MOTORS OVER 8- 10 HP
ELEVATORS/ESCALATORS
TEMPORARY WATER CLOSET
MOTORS OVER 10- 25 HP
FIRE SPRINKLER SYSTEMS
URINAL
MOTCRS OVER 25-100 HP
COOLING TOWERS
WATER CLOSET
MOTORS OVER 100 HP
VIOLATION
INDIRECT WASTES
A/C WINDOW
REINSPECTION
HATER SUPPLY TO:
AIR CONDITIONERS
A/C UNIT
STRIP HEATER
FIRE SPRINKLER
GENERATORS TRANSFORMERS
•
HEATER -NEW INST.
GENERATORS TRANSFORMERS
HEATER - REPLACE
J
GENERATORS TRANSFORMERS
LAWN SPRINKLER -WELL
SPECIAL PURPOSE
SWIMMING POOL
OUTLETS COMMERCIAL
WATER SERVICE
/
'
SIGN TUBES
SEWER CONNECTIONS
SIGN TRANSFORMERS
JTILITY -SEWER
SIGN TIME CLOCX
JTILITY -WATER
FIXTURES
SEPTIC TANK
ANTENNA
RELAY
TELEVISION OUTLETS
)RAINFIELD, 4' TILE/RES.
VIOLATION
'UMW & ABANDON SEPTIC TANK
REINSPECTION
OAKAGE PIT CU. FT.
:ATCH BASIN
IISCHARGE WELL
AMIEST IC WELL
A REA DRAIN
100E INLET
ZLAR WATER HEATER
IRE STANDPIPE
COL PIPING
•
AWN SPRINKLER SYSTEM
`
AS RANGE
ETER SET (GAS)
- r
AS PIPING
(AN APPLICATION FOR BUILDING PERMIT MUST ACCOMPANY THIS ADDENDUM. IF A MASTER PERMIT HAS B.
OBTAINED, THE OWNER'S NOTARIZED SIGNATURE NEED NOT BE PRESENT ON SUBSEQUENT APPLICATIONS.)
•
PLUMBING
ADDENDUM TO BUILDING PERMIT APPLICATION
ELECTRICAL
MECHANICAL
JILDING
L.LECTRICAL
PLUMBING
Owner o
Building
Architect
Contracts
i or Builde
CONTRACTOR OR BUILDER
MIAMI SHORES VILLAGE, FLORIDA
PERMIT N° 2057
DATE
Work to be performed under this Permit
194_Z
Contractor's
License No.
Legal
Descripti
Address r
Building 4 `
This permit is granted to the contractor or builder named above to construct the building or to install the equipment or device described in thee.«X'
application herefor in strict compliance with all ordinances pertaining thereto and with the understanding that the work will be performed in compliance.
,Ivtth 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 specificatiopfs 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-
.taining thereto and in strict conformity with the plans, drawings, statements or specifications submijte� �o th rpro}ser authorities of Miami Shores
In accepting this permit I assume responsibility for all work done by either myself, my agent, servant or etiio
BY AU T1 3RuTY
)r J
J P
P
Jn V
Lot B
Bl. S
Subdi-
vision
Of P
Value of A
Amt. of ,
, r f
f ' •
• �� <
<
JILDING
L.LECTRICAL
PLUMBING
Owner o
Building
Architect
Contracts
i or Builde
CONTRACTOR OR BUILDER
MIAMI SHORES VILLAGE, FLORIDA
PERMIT N° 2057
DATE
Work to be performed under this Permit
194_Z
Contractor's
License No.
Legal
Descripti
Address r
Building 4 `
This permit is granted to the contractor or builder named above to construct the building or to install the equipment or device described in thee.«X'
application herefor in strict compliance with all ordinances pertaining thereto and with the understanding that the work will be performed in compliance.
,Ivtth 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 specificatiopfs 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-
.taining thereto and in strict conformity with the plans, drawings, statements or specifications submijte� �o th rpro}ser authorities of Miami Shores
In accepting this permit I assume responsibility for all work done by either myself, my agent, servant or etiio
BY AU T1 3RuTY
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
Permit No.;C`__. ' Date .;-,—
Application is hereby yhade 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 Engineer
Employing Plumber's Name __L
Location and Legal Description Lot___—_—- __________ / — _________Bloc //
Street and Number where work is to be performed —No
State work to be erformed and purpose of building
P P P g (By Floors)
Amount of Permit
STATE OF FLORIDA,
COUNTY OF DADE.
The undersigned applicant for this
under the Florida Workmen's Compensa
plied with the provisions thereof, and
performed under this permit; and
required by the Act. The under
licensed by Miami Shores Village.
My Commission Expires
(Signed)
No._ - -`- 1.
)/
•
Dist. Feet of Tank or Drain Field from Well
- - - -- _____
•
Street
Subdivision_
Size Septic Tank___._ _______________________________ _ Type of Tank . Capacity Gals._____
Feet of Drain Tile__ _
Nature of Water Supply: City —Well.
Notary Public, State of Florida
New Building _______ Remodeling __ Addition Repairs No. of Stories
.Size of Soakage Pit. _ _
- (Signed) — — -- -- -- — — r
Iv a ?er Plumber.
Plumbin Inspector.
building permit does hereby certify that he understtttds and accepts his obligations as an employer of labor
tion Act, being Section 5966, Compiled General Laws of Florida Permanent Supplement, and has corn-
will require similar compliance from all contractors or sub - contractors employed by him in the work to be
will post or cause to be posted for inspection on the site of the work such public notice or notices as are
signed agrees to employ only such sub - contractors, on k 9 be �erfop fed under this. permit' as are
L .■■•'''' :15.; ' ---2" t
authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally
Before me, the undersigned
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 NE.
TOTAL
FIXTURES
CONTR.
LIST
CHECK
SEPTIC
TANK
SEWER
CONN.
DRAIN
FIELD
SOAKAGE
P IT
GREASE
TRAP
SOLAR
HEATER
DEEP
WELL
SPRKLR.
SYSTEM
SWIM•G
POOL
CONTR.
LIST
CHECK
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
Permit No.;C`__. ' Date .;-,—
Application is hereby yhade 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 Engineer
Employing Plumber's Name __L
Location and Legal Description Lot___—_—- __________ / — _________Bloc //
Street and Number where work is to be performed —No
State work to be erformed and purpose of building
P P P g (By Floors)
Amount of Permit
STATE OF FLORIDA,
COUNTY OF DADE.
The undersigned applicant for this
under the Florida Workmen's Compensa
plied with the provisions thereof, and
performed under this permit; and
required by the Act. The under
licensed by Miami Shores Village.
My Commission Expires
(Signed)
No._ - -`- 1.
)/
•
Dist. Feet of Tank or Drain Field from Well
- - - -- _____
•
Street
Subdivision_
Size Septic Tank___._ _______________________________ _ Type of Tank . Capacity Gals._____
Feet of Drain Tile__ _
Nature of Water Supply: City —Well.
Notary Public, State of Florida
New Building _______ Remodeling __ Addition Repairs No. of Stories
.Size of Soakage Pit. _ _
- (Signed) — — -- -- -- — — r
Iv a ?er Plumber.
Plumbin Inspector.
building permit does hereby certify that he understtttds and accepts his obligations as an employer of labor
tion Act, being Section 5966, Compiled General Laws of Florida Permanent Supplement, and has corn-
will require similar compliance from all contractors or sub - contractors employed by him in the work to be
will post or cause to be posted for inspection on the site of the work such public notice or notices as are
signed agrees to employ only such sub - contractors, on k 9 be �erfop fed under this. permit' as are
L .■■•'''' :15.; ' ---2" t
authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally
Before me, the undersigned
appeared
to me well known, and who, being by me first duly sworn, upon oath deposes and says that he is the
of the above described construction, that he has carefully read the foregoing application, and that he did sign the same, and that all facts
therein by him stated are true.
NOTE: A re- inspection fee of $1.00 will be made when such re- inspection is made necessary by improper notice for inspection, or faulty
materials and /or workmanship.
JOB:
BUILDING
PLUMBING
ELECTRICAL .
The following is ready for Inspection:
Inspector's Report:
ONO
•
•
•
•
•
•
f
: WORK
: DONE BY:
•
REUESTED • W I, BE READY
•
•
•
•
•
•
•
•
•
•
•
•
•
f / APPLICATION FOR PLUMBING PERMIT
�d � �/
Permit No. _____ Date c _
Application is hereby M ade 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.
i
Owner's Name and Address .L_L_Lt __
Registered Architect and /or Engine
•
- -� -1
Employing Plumber's Name
Location and Legal Description Lot_
Amount of Permit $_
STATE OF FLORIDA,
COUNTY OF DADE.
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
Street and Number where work is to be performed —No
State work to be performed and purpose of building (By Floors
No.
Block_, __.o. Subdivision_
New Building_________ _ — Remodeling Addition Repairs
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 o
_ (Signed)
The undersigned applicant for this building permit does hereby certify that he unders ' ds 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 .ublic notice or notices are
required by the Act. The under signed agrees to employ only such sub - contractors, on 'J� -'r ed unde i permit as are
licensed by Miami Shores Village.
(Signed)
1.
°(.3 tiC 'Street_�'� 4 4
My Commission Expires Notary Public, State of Florida
•
No. of Stories
Capacity
Plumbid Inspector.
er 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
TORIES
SINKS SINKS
SLOP
SINKS
LAUNDRY
TUBS
URINALS
CATCH
BASIN
FLOOR
DRAIN
DRINI. I NG
FOUNT'NS
TOTAL
FIXTURES
CONTR.
LIST
CHECK
SEPTIC
TANK
SEWER
CONN.
DRAIN
FIELD
SOAKAGE
PIT
GREASE
TRAP
SOLAR
H EATER
DEEP
WELL
SPRKLR.
SYSTEM
SW IM'G
POOL
CONTR.
LIST
CHECK
f / APPLICATION FOR PLUMBING PERMIT
�d � �/
Permit No. _____ Date c _
Application is hereby M ade 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.
i
Owner's Name and Address .L_L_Lt __
Registered Architect and /or Engine
•
- -� -1
Employing Plumber's Name
Location and Legal Description Lot_
Amount of Permit $_
STATE OF FLORIDA,
COUNTY OF DADE.
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
Street and Number where work is to be performed —No
State work to be performed and purpose of building (By Floors
No.
Block_, __.o. Subdivision_
New Building_________ _ — Remodeling Addition Repairs
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 o
_ (Signed)
The undersigned applicant for this building permit does hereby certify that he unders ' ds 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 .ublic notice or notices are
required by the Act. The under signed agrees to employ only such sub - contractors, on 'J� -'r ed unde i permit as are
licensed by Miami Shores Village.
(Signed)
1.
°(.3 tiC 'Street_�'� 4 4
My Commission Expires Notary Public, State of Florida
•
No. of Stories
Capacity
Plumbid Inspector.
er 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.