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57 NE 93 St (6)PERMIT APPLICATION FOR MIAMI SHORES VILLAGE Date 10 Q Job Address � ST Tax Folio Q O ° 3i`' 6- © 3" 0 00 Legal Description Le" \ 2 3 SS ,o red Owner/Lessee / Tenant , vn S Bk.tr/ Owners Address 51 a gr Jmi 0 , 1,3 0 3 8 Contracting Co. � �u �� �9 atom ' Address woo 2_ 2e 3 Qualifier State # Square Ft. Notary as Wy- Comndissio FEES: PERMIT `cc- A 5 % c? Architect/Engineer Bonding Company Address Mortgagor Address Permit Type (circle one): BUILDING ELECTRICAL I LUMBG MECHANICAL ROOFING PAVING FENCE SIGN WORK DESCRIPTION D FI E //! 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 IN'T'END TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT.) Application is hereby made to obtain a permit to do work and installation as indicated above, and on the attached addendum (if applicable). I certify that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that separate permits are required for ELECTRICAL PLUMBING, SIGNS, POOLS, ROOFING and MECHANICAL WORK. OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. Furthermore, I authorize the above -named contractor to do the work stated. Sign: e of owner and/or Condo President '* 7'FFP J. SOLOMON (� .,iv CC . ON +:` CC 854608 r 'f• :a Jt I J, ?003 1•800.3N0TAFiv .. & Bonding Co. E Saav a! RADON Municipal # APPROVED: Zoning Building Mechanical Plumbing acv ss# Phone(305)66f fit BOND Ins. Co. PJ" P t t ,2 2/I Signatar? of Contractor or Owner- Builder ' Date TOTAL DUE 3 I) Date STATE OF FLbRIDA DEPARTMENT OF HEALTH ONSITE SEWAGE TREATMENT ANDtISPOSAL SYSTEM CONSTRUCTION PERMIT CONSTRUCTION PERMIT FOR:, [] New System [(1 Existing System A Holding Tank [,, _ Innovative ] Repair (441 Abandonment Temporary [!> APPLICANT: T [ o c] A [ N [ K [ R A I N F I E L 0 T H E R APPROVED BY: PROPERTY ADDRESS: LOT: v ( 7 / cy BLOCK: PROPERTY ID #: 1 SYSTEM DESIGN AMID S ] SQUARE [ ] SQUARE TYPE SYSTEM: CONFIGURATION: 4 014010fr 140041 ECIFICATIONS LOCATION OF BENCHMARK: ELEVATION OF PROPOSED SYSTEM SITE BOTTOM OF DRAINFIELD TO BE � 1 FILL REQUIRED: [ Ayl INCHES At: SYSTEM MUST BE • IN ACCORDANCE WITH SPECIFICATIONS AND STANDARDS OF SECTION 381.0065, F.S., AND CHAPT - 64E -6, F.A.C. DEPARTMENT APPROVAL OF SYSTEM DOES NOT GUARANTEE SAFTISFACTORY PERFORMANCE FOR SPECIFIC PERIQD OF TIME. ANY CHANGE IN MATERIAL FACTS WHICH SERVED AS A BASIS FOR ISSUANC- OF THIS PERMIT, REQUIRE THE APPLICANT TO MODIFY THE PERMIT APPLICATION. SUCH MODIFICATIONS PL Y SULTN THIS PERMIT BEING MADE NULL AND VOID. ISSUANCE OF THIS PERMIT DOES NOT EXEMPT TF APICANT FROM COMPLIANCE W::TH OTHER FEDERAL, STATE, OR LOCAL PERMITTING REQUIRED FOR DEVELO Vf0F THIS PROPERTY. GALLONS / G GALLONS / GPD GALLONS GREASE INTERCEPTOR CAPACITY GALLONS DOSING TANK CAPACITY [ TIC T /AEROBIC UNIT CAPACITY MULTI- CHAMBERED /IN- SERIES [ ] CAPACITY MULTI- CHAMBERED /IN- SERIES [ ] [MAXIMUM CAPACITY SINGLE TANK: 1250 GALLONS] ]GALLONS @ [ ] DOSES PER 24 HRS # PUMPS [ ] FEET PRIMARY DRAINFIELD SYSTEM FEET SYSTEM [ STANARD [f FILLED [ 1, TRENCH [ BED I� V [INciws / t-‘ (111.] [ T CH e /FT] EXCAVATION REQUIRED: [ABOVE/ [ABOVE/ t SPECIFICATIONS BY: / „ TITLE: G� v2 DATE ISSUED: _:, " L. c i DH 4016, 12/99 (Page 1) (Previiuq Editions , May Be Used) PERMIT NO. 6 7 6Z . :. DATE PAID: FEE PAID: RECEIPT #: 2 f SUBDIVISION: \ c a 4' [SECTION, TOWNSHIP, RANGE, PARCEL NUMBER] [OR TAX ID NUMBER] MOUND [b_ BENCHMARK /REFERENCE POINT BENCHMARK /REFERENCE POINT [ INCHES K 4/7 l f' -rrn vSZasc,e I 1, Ai. 1: Health Deper ment J`t ? .Pi$'icetr pt. 3: Installer/Contractor pt. 4: Building Department TIT:,E: �� � EXPIRATION DATE: ,/ a 3 Page 1 of 3 CHD INSTRUCTIONS: PERMIT NUMBER: CONSTRUCTION PERMIT FOR: APPLICANT: TELEPHONE: AGENT: MAILING ADDRESS: SYSTEM DESIGN AND SPECIFICATIONS: TANK: DRAINFIELD: OTHER: SPECIFICATIONS BY: APPROVED BY: DATE ISSUED: EXPIRATION DATE: Permit tracking number assigned by CPHU. Check type of permit, if "Other" specify type in blank. Property owner's full name. Telephone number for applicant or agent Property owner's legally authorized representative. P.O. Box or street mailing address for applicant or agent. LOT, BLOCK, SUBDIVISION or . PROPERTY ID #: 27 character id number for property. (CHD may require property appraiser ID # or section/township /range/parcel number) Minimum specifications from Chapter 64E-6, FAC. Minimum specifications from Chapter 64E-6, FAC. • Other specifications, such as operating permit requirements, low- volume flush toilets, variance provisos. Name of individual providing specifications. If designed by a registered engineer must be sealed. County Health Department (CHD) personnel reviewing and approving permit. Date permit is issued by CHD One year from date issued if the system has not been installed. Permits for system repairs become void 90 days from the date issued. 1 APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PERMIT Scale: Each block represents 5 feet and 1 inch = 50 feet. Notes: By D144015, 10/96 (Replaces HRS-H Form 4015 which may be used) (Stodr Number: 5744-002-4015-6) STATE OF FLORIDA DEPARTMENT OF HEALTH PART II SITE PLAN 1 ‘ 6:■ - .... , i i ' x N;t. il 4 ( irTh Site Plan submitted IDY: / t \ l' Signature Plan Approved Not Approved itr\'■ 00 VI Permit Application Number 4 P` 5- )-APAof 33;38 ezi\: ZVeg -1 6 0 tn: 0 ALL CHANGES MUST BE AP „ROVED BY THE COUNTY HEALTH DEPARTMENT ' Tile 1 141 ) - Date County Health Department Page 2 of 3 LOT: PROPERTY ID #: STATE OF FLORIDA DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES ONSITE SEWAGE DISPOSAL SYSTEM SITE EVALUATION AND SYSTEM SPECIFICAITIONS 0 BLOCK: 3 w r TO BE COMPLETED BY ENGINEER, HEALTH UNIT EMPLOYEE, OR OTHER QUALIFIED PERSON. ENGINEER'S MUST PROVIDE REGISTRATION NUMBER AND SIGN AND SEAL EACH PAGE OF SUBMITTAL. COMPLETE ALL ITEMS. PROPERTY SIZE CONFORMS TO SITE PLAN: [ ] YES [1'410 NET USABLE AREA AVAILABLE: 7;! ACRES TOTAL ESTIMATED SEWAGE FLOW: J O GALLONS PER DAY [RESIDENCES -TABLE 1 / OTHER -TABLE 2] AUTHORIZED SEWAGE FLOW: 5' �� GALLONS PER DAY [1500 GPD /ACRE OR 2500��GPD /ACRE] UNOBSTRUCTED AREA AVAILABLE: ,000 75'0 SQFT UNOBSTRUCTED AREA REQUIRED: C!5C SQFT / ELEVATION OF PROPOSED SYSTEM SITE IS .2).C7 [INCHED; /t) [ABOVE/4E ] BENCHMARK / REFERENCE POINT BENCHMARK /REFERENCE POINT LOCATION: THE MINIMUM SETBACK WHICH SURFACE WATER: 1! FT WELLS: PUBLIC: FT 'DING FOUNDATIONS: SITE SUBJECT TO FREQUENT FLOODING: [ ] YES [v]' NO 10 YEAR FLOOD ELEVATION FOR SITE: FT MSL /NGVD SOIL PROFILE INFORMATION SITE 1 M.insell # /Color Texture Depth !` ^ p i i j y to Ti .2. to USDA SOIL SERIES: II to to to to to OBSERVED WATER TABLE: °� INCHES [ABOVE / ESTIMATED WET SEASON WATER TABLE ELEVATION: HIGH WATER TABLE VEGETATION: [ ] YES [)1 NO BELO] EXISTING GRADE. TYPE: PERCHED / AOAREN] ���• INCHES [ ABOVE / ' ELOW ] EXISTING GRADE. MOTTLING: [ ] YES GI NO DEPTH: ` \t i) i INCHES SOIL TEXTURE /LOADING RATE FCR SYSTEM SIZING: � l DEPTH OF EXCAVATION: 21 INCHES DRAINFIELD CONFIGURATION: [ ] TRENCH [X] BED [ ] OTHER (SPECIFY) REMARKS /ADDITIONAL CRITERIA: SITE EVALUATED(BY: :IRS-H Form 4015, Mar 92 (0bso tes prevfous (SttIck Number: 5744 - -40- -1) CAN BE MAINTAINED FROM THu, DITCHES /SWALES: LIMITED USE: < FT FT PROPERTY LINES: tions which may not be used) AGENT: Se) PERMIT # SUBDIVISION: ;\.A i1 � S!,1 ��� c i � r'1 .TOIL PROFILE INFORMATION SITE 2 C r ?` ^.. -• A /;')+3 :Section /Township /Range /Parcel No. or Tax ID Number] PROPOSED SYSTEM TO THE FOLLOWING FEATURES: A FT NORMALLY WET? [ ] YES r.. NO PRIVATE: NI NI:" FT NON - POTABLE: . \' : • FT 1- FT POTABLE WATER LINES: FT 10 YEAR FLOODING? j ] YES [ -( NO SITE ELEVATION: �() : FT I(ST.YNGVD Munsell # /Color Texture Depth, %) to c, % "l to USDA SOIL SERIES: to to to to to to to DATE: , 0 Page 3 of 3 INSTRUCTIONS: PERM1T U: Petri' trackinu a¢3i2reed by CPU. • APPLICAN 7 : Property owner's full name. AGENT: Property owner's icgaily authorized ..OT, iBLOCi(, SUBDIVISION: Lot, block, and subdivision for lot. PROPERTY /D1/:. 27 character number for property. (property apprai er ID (/ are c ^stia .r number) PROPERTY SIZE: Check if property size at site conforms to submitted site plat_. i.eco ::..t usable area available -'.Y: a_ a c:tc:d! of all paved areas and prepared roc bee:, within public rights -of way cr ^_ ;. nests and enalucive of ctceaxz, lakes, normally wet drainage ditches, marshes, or other such bodies of water. SEWAGE FLOW: UNOBSTRUCTED AREA: MINIMUM SETBACKS: Record the estimated sewage flow for the establishment from Table 1 (r‘miderses) or 7cT !e 2 (nor- rosidenthil), Chapter 10D -6, FAC. Record the authorized sewage flow for the lot based on r_ uaable area and water supply (1513 3a!!o. per day per acre for private water supplies and 2500 gpd per acre for E::.:311c water at•ppliea;. If authorized cawage :1cw does not equal or exceed the estimated sewage flow, the application r tra be denied. Record the square feet of unobstructed area available and the amount tcruired. U:tob ;acted area must he c¢ !eca2 2 times as large as the drainfield absorption area and at least 75 percent of the unobatructcd area must meet minimum setbacks in Chapter 10D -6, FAC. The unobstructed area must be contijuous to the drainfield. BENCHMARK INFORMATION: Record the location of the benchmark. If using a curveyor'a benchmaru record the actual elevation. Record the elevation of the proposed system site in relation (above or below) to the benchmark. tA Record minimum setbacks which can be meet to all listed features. Actual measurements must be recorded or "NtP0 for non applicable features. Features on site plan or within 75 feet of the applicant lot trust be measured. The lacatio�. 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 Tots 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 aeries 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 coil maps, and historical information. Indicate if there is high water table vegetation present. Indicate if mottling is precent 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. SrrE EVALUATED BY: Signature of evaluator, title, and date of evaluation. Professional engineers must seal all documentation submitted. ELEVATION WORKSHEET ELEVATION OF BENCHMARK / REFERENCE POINT IS: (BENCHMARK SITE 1 SITE 2 SITE 3 [ +] SHOT: H.I. 1b.I. [ -] SHOT [ -1 SHOT [ -] SHOT MIAMI SW* RES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT P Pc;aenng Rio 13 ctr- Date-- -_..__ 4 if 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 Oune3 o Name and Address __ It _ . ?� Y6 S No.__ __ — Street 9 B Str Employing Plumber's Name ..... - _ � � � ? _ e L C �� Li d � N � � 2 No..__ -- ___._�_ �� c Location and Legal Description Lot___ _- 1- "/A— 2 - I Block 3 Subdivision J:149 ec ' Street and Number where work is to be performed —No _ & ; street 5 1 " S - State work to be performed and purpose of building (By Floors)_ _ _.------•--_--_.—_--- New Building _ -_ - _ -- Remodeling -- — ._.___ Addition__ -- Repairs Registered Architect and /or En Amount of Permit $ STATE OF FLORIDA, I COUNTY OF DADE. Size Septic Tank____—_ __- ......... ----- ---- --- -- -- - -- -Type of Tank_ Feet of Drain Tile ___._ Dist. Feet of Tank or Drain Field from Well Nature of Water Supply: City— Well.________ _ __ ____________— ____Size of Soakage git Plum •' g nspector. 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 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 )__.__ Capacity Cals. ci&a No. of Stories.. Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeared to me well known, and who, being by me first duly sworn, upon oath deposes and rays that he is the of the above described construction, that he has carefully read the foregoing application, and that he did sign the same, and that all facts therein by him stated are true. My Comnussion Expires Notary Public, State of Florida Mast,:' Plumber. NOTE: A re- inspection fee of $1.00 will be made when such re- inspection io made by improper notice for inspection, or faulty raatials 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 CHICK SEPTIC TANK SEWER CONN. DRAIN FIELD SOAKAGE PIT GREASE TRAP SOLAR HEATER DEEP WELL SPRKLR. SYSTEM SWIM•G POOL PO04!... p p, n /„e 1 - �`�V - - -- CONTR. LIST CHUCK MIAMI SW* RES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT P Pc;aenng Rio 13 ctr- Date-- -_..__ 4 if 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 Oune3 o Name and Address __ It _ . ?� Y6 S No.__ __ — Street 9 B Str Employing Plumber's Name ..... - _ � � � ? _ e L C �� Li d � N � � 2 No..__ -- ___._�_ �� c Location and Legal Description Lot___ _- 1- "/A— 2 - I Block 3 Subdivision J:149 ec ' Street and Number where work is to be performed —No _ & ; street 5 1 " S - State work to be performed and purpose of building (By Floors)_ _ _.------•--_--_.—_--- New Building _ -_ - _ -- Remodeling -- — ._.___ Addition__ -- Repairs Registered Architect and /or En Amount of Permit $ STATE OF FLORIDA, I COUNTY OF DADE. Size Septic Tank____—_ __- ......... ----- ---- --- -- -- - -- -Type of Tank_ Feet of Drain Tile ___._ Dist. Feet of Tank or Drain Field from Well Nature of Water Supply: City— Well.________ _ __ ____________— ____Size of Soakage git Plum •' g nspector. 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 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 )__.__ Capacity Cals. ci&a No. of Stories.. Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeared to me well known, and who, being by me first duly sworn, upon oath deposes and rays that he is the of the above described construction, that he has carefully read the foregoing application, and that he did sign the same, and that all facts therein by him stated are true. My Comnussion Expires Notary Public, State of Florida Mast,:' Plumber. NOTE: A re- inspection fee of $1.00 will be made when such re- inspection io made by improper notice for inspection, or faulty raatials and /or workmanship. UILDING LECTRICAL LUMBING tw ner of uilding rchitect 4 : ontractor r Builder ' MIAMI SHORES VILLAGE, FLORIDA DATE L, 194 PERMIT N2 5439 •egal Lot Bi. Subdi- )escription _ vision ddress 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 in the appli- -tion herefor in strict compliance with all ordinances pertaining thereto and with the understanding that the work will be performed in compliance with any tans, drawings, statements or specifications that may have been submitted to and approved by the proper municipal authorities. This Permit may be revoked any tirne 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 crmit is granted is the understanding that the contractor or builder named above assumes the responsibility for a thorough knowledge of the ordinances and =gulations pertaining to the work covered hereby whether shown on the plans or drawings or in the statements or specifications pnd ghat he astames respon- bility for work done by his agents, servants or employees. OAP or / "v ..J:Ai. T . de I � Work to be performed under this Permit t f f s.Ca.• Value of Project Contractor's License No. Signed: e t 4! ,? ► By IstPECTOR Amt. of Permit 8 , r In consideration of the issuance to me of this permit I agree to perform the work covered hereunder in compliance with all ordinances and regulations rtaining thereto and in strict conformity with the plans, drawings, statements or speifications submitted to the proper authorities of Miami Shores Village. accepting this permit I assume responsibility for all work done by either myself, my agent, servant or employee. BY AUTHORITY BUILDING ELECTRICAL PLUMBING Owner of Building Architect Contractor or Builder Legal Description PERMIT N9 5439 Work to be performed under this Permit{ z: ; rlr MIAMI SHORES VILLAGE, FLORIDA DATE 6- 3 1947 Lot � CT R OR BU ER Bl. Subdi- vision Address of Z �. t - Value of Amt. o Ito Building 1• .i r Project Perms/ + 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 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 n that he assumes respon- sibility for work done by his agents, servants or employees. Signe ^ .. t t. *' et By SPECTOR y In consideration of the issuance to me of this permit I agree to perform the work coverers hereunder in compliance with A lLordinances and pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authattlis of Miami Shoes -Village. In accepting this permit I assume responsibility for all work done by either myself, my agent, servant or employee. ''.. 0 4 0. iv et ley" SI Contractor's License No / AUTHORITY Permit No. .. - 3 Registered Architect and /o7 En ineer - ______,...._ Employing Plumber's Name _ 0/ ' /cc 14',12,4 e , __l1_- _ s':f.:________. __ No. State work to be performed and purpose of building (By Floors) New Building.___- _- ________ __ Remodeling___ Addition Size Septic Tank Type of Tank Feet of Drain Tile f rr + Dist. Feet of Tank or Drain Fie d Nature of Water Supply: City—Well. Size of Soakage Pit STATE OF FLORIDA, COUNTY OF DADE. ss. MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT 3_. _ 1 ( Sign 3d) 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 ihores 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. ? y+ �/ Owner's Name and Address __ L 'S'` 5y G1�"� No. Street Ili /_.__� � x Street __ Capacity Gals. (. from Well My Commission Expires Notary Public, State of Florida T -- Location and Legal Description Lot Subdivision S tr eet and Number where work is to be performed —No il �' Street /7 ' Repairs / No. of Stories Master Plumber. to Amount of Permit $ - -- ( Signed) Plumbing Inspector. The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations as an employer of labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Permanent Supplement. and has com- plied with the provisions thereof, and will require similar compliance from all , : ontractors 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 -cont actors, on work to be performed under this permit, as are licensed by Miami Shores Village. 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 foregoim; 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- inspectio 1 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 - SW IM'G POOL 1 4 I CONTR. LIST / - CHECK Permit No. .. - 3 Registered Architect and /o7 En ineer - ______,...._ Employing Plumber's Name _ 0/ ' /cc 14',12,4 e , __l1_- _ s':f.:________. __ No. State work to be performed and purpose of building (By Floors) New Building.___- _- ________ __ Remodeling___ Addition Size Septic Tank Type of Tank Feet of Drain Tile f rr + Dist. Feet of Tank or Drain Fie d Nature of Water Supply: City—Well. Size of Soakage Pit STATE OF FLORIDA, COUNTY OF DADE. ss. MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT 3_. _ 1 ( Sign 3d) 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 ihores 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. ? y+ �/ Owner's Name and Address __ L 'S'` 5y G1�"� No. Street Ili /_.__� � x Street __ Capacity Gals. (. from Well My Commission Expires Notary Public, State of Florida T -- Location and Legal Description Lot Subdivision S tr eet and Number where work is to be performed —No il �' Street /7 ' Repairs / No. of Stories Master Plumber. to Amount of Permit $ - -- ( Signed) Plumbing Inspector. The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations as an employer of labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Permanent Supplement. and has com- plied with the provisions thereof, and will require similar compliance from all , : ontractors 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 -cont actors, on work to be performed under this permit, as are licensed by Miami Shores Village. 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 foregoim; 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- inspectio 1 is made necessary by improper notice for inspection, or faulty materials and /or workmanship. OWNER LOT BLOCK SUBDIVISION rti ) ,' iami cShores�illage F L O A 1 A PLUMBING PERMIT N9 667 to ' � ed to to install the following described plumbing, in accordance with the laws, statutes and regu- lations of [vliami Shores Village, Florida and the State of Florida, governing plumbing and drainage work done in Miami Shores Village, Florida. For a - story ` �, building at = l Fixtures Fixtures $ Sewer $ 1 Se tic Tank / $ Total $ / (' Village Plumbing Inspector Received Pa ment b ° Y Y �<° il Date OWNER ddliami Aores F L O R ID A PLUMBING PERMIT ■9 664 Issued to LOT BLOCK SUBDIVISION to install the following described plumbing, in accordance with the laws, statutes and regu- lations of Miami Shores Village, Florida and the State c Florida, governing plumbing and drainage work done in Miami Shores Village, Florida. For a \ story building at lj Fixtures Fixtures $ Sewer $ Septic Tank $ Total $ Village Plumbing Inspector Received Payment by OWNER LOT BLOCK SUBDIVISION Date ddtiami Jhores allage F L O A I D A PLUMBING PERMIT N9 667 Issued to 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 For a_story Fixtures Fixtures $ Sewer �` $ 0 Septic Tank ,� $ Total $ ,' Village Plumbing Inspector Received Payment by