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520 NE 92 St (6)LS MIAMI SHORES VILLAGE BUILDING DEPARTMENT 305- 795 -2204 Buildi g In7ction Request Date Type Insp'n � ' Q O V ` froL,utize_it, Permit No. Y L 06- Name Address ga /v 9 cif Company � L, Phone # ' / k (�J �� - J',d,y Inspection Date ?/2 t� Approved Correction Re- Insp'n Fee ❑ MIAMI SHORES VILLAGE UILDING DEPARTMENT 305- 795 -2204 Building Inspection Request Type Insp'n Permit No. N Address Dat Company Phone # For Inspecto� Approved Correction Re- Insp'n Fee 0 Time ate MIAMI SHORES VILLAGE BUILDING DEPARTMENT 305- 795 -2204 Bu'ldin Inspection Request Date Q 3 Time l O ` 2co Type Insp'n FC 1 lit I Permit No. PL 2003- 23, Name PO _ Address Sao N_, 12_ 3 9" Company fti-UtS PW N Phone # ♦ , cicl^ . - T For Inspector: Pi bifA Approved Correction ❑ Re- Insp'n Fee ❑ jok ■ .A, i `MIAMI SHORES VILL' BUILDING DEPARTMENT 305- 795 -2204 Building Inspection Request Dat . / - 1 Time Type Insp' Permit No. Name Addres Company Phone # -U 6 " For Inspectorb Approved Correction Re- Insp'n Fee Date Do3 ime Type Insp'n � Permit No. � �' Name ida ) Address _' lJ r ` u q- E;- . — Company Phone # For Inspector: Approved Correction Re- Insp'n Fee MIAMI SHORES VILLAGE BUILDING DEPARTMENT 305- 795 -2204 Building Inspection Request MIAMI SHORES VILLAGE BUILDING DEPARTMENT 305- 795 -2204 Bu1'lding Reque Date/ � L / / 03 Time Type Insp'n Permit N Name Addres � O Company (21;611 Bg-A4V-U-41 Phone #3 0 51 9 FOOK For Inspector ( Approved Correction Re- Insp'n Fee CONTRACTOR Name A TL 4 \S 2 4: License No. / 8902 Address 93/C/ /3 Telephone /?gat® Fax 3 �b 1/ ®Oek' / / ' ,44€4 Qualifier Name, G3, =9 /egS/ PROPERTY OWNER New Construction Enclosure Name ] l'.9Lt�' f"` k/ 4Aivi S O Address Repair Alteration Interior Demolish Home Telephone ..3 S 2 5 ,. „' 5 Business Telephone Add'l Attachment Other Fax Other TYPE OF MANAGEMENT (✓ ) New Construction Enclosure Alteration Exterior Repair Alteration Interior Demolish Relocation of Structure Shell Only Foundation Only Add'l Attachment Other Add'I Detachment Other Step 1. Job Address: • • • • • • • .• • • • • • • • • • • • • • • • ••• • • • • • • • • • • • • • • • • • • • ••••••• •••• • Master Permit No. (3 I ? co a O • • ••• • : • ubstdiiry.Permit No. . . . . • • • • • • • • •.• ••. ... PERMIT APPLICATION INSTRUCTIONS - The following steps must be taken to obtain a permit from the Miami Shores Village: ete the attached permit application whyt fhuat bt sued t•the piopertr owner and qualifier. Both signatures must be notarized. Please print . type to allow for a more accurate processinn.of y.ur apphaeti If roofing work will be done, a roofing application must be submit- • ted alo : 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 S b ��. � ST- Address Apt. !r✓J / igen/ o,e r City Folio Number Description of Work Lot Block Subdivision PB PG Zoning Linear Feet Current Use of Property Square Feet ff Units Floors Proposed Use of Property Value of Work tP VC 0 ` re Bldg Value Tenant Information Tax Assessed/Appraised Value Flood Zone 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 State 4-2 Zip Base Floor Elev. ENGINEER Name License No. Address Telephone Fax 41-\31.-qt( Page 2 IMPORTANT NOTICES 1. DO NOT BEGIN ANY WORK WITHOUT HAVING RICIiIVtD:YOUR VALII3AffED PHRMIT AND PERMIT CARD. Applying for a permit does not grant the right to begin construction. HOURS OF CONSTRUCTION ale limite'I'in: Monday thiough Friday from 7:30 a.m. to 6:00 p.m., and Saturday from 8:00 a.m. to 5:00 p.m. No inspections will be conducted on weekends or holidays. 2. All construction of demolition areas MUST BE MAINTAINED INA(LEAI1, NF SANITARY CONDITION free from construction debris. 3. STREETS AND NEIGHBORING PROPERTIES SHALL BE KEPT F Ef FROM 12IItIANDI7EBRIS. 4. SWALES MUST BE PROTECTED FROM BEING DAMAGED BY EQ ' MENT OR EI4ICLES, AND MAY NOT BE USED FOR STORAGE. A bond is • required for work in or near the street/sidewalk. • • ••• • • • • • • • • 5. CONSTRUCTION TRAILERS ARE PROHIBITED ON SINGLE FAMILY RESIDENTIAL CONSTRUCTION SITES. Other construction may have a trailer which requires a separate permit. 6. PORTABLE TOILETS for a construction site require a separate permit. 7. DO NOT DISCHARGE WATER INTO THE RIGHT OF WAY OR STORM DRAINS without approval from the Building, Planning and Zoning Department. 8. EQUIPMENT AND MATERIALS SHALL BE STORED at least 10 feet from the edge of pavement. 9. Department of Health and Rehabilitative Services (HRS) approval is required for applications involving septic tanks. Department of Environmental Resources Management (DERM) and/or Miami -Dade Water and Sewer Department (MDWASD) approval is required for applications involving sewers. AFFIDAVIT - Please read carefully. Application is hereby made to obtain a permit to do work and installation as indicated. I, the OWNER of the property, 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, POOL, EXTERIOR DOOR, MECHANICAL, WINDOW, FENCE, DRIVEWAY, ROOFING and SIGNS and there may be additional permits required from other governmental agencies. I, the OWNER of the property, have disclosed all information related to any work at the property performed in the prior twelve months to the Building Official. Further, I am fully aware that if the cumulative cost of work to my home or business under this and any other permit equals or exceeds fifty percent (50 %) of the fair market value of the structure, the entire structure must meet the present federal flood criteria for finished floor elevation. I am also fully aware that if the total cost of work to my home or business under this and any other permit exceeds fifty percent (50 %) of the replacement cost of the structure, then the entire structure must conform to the current code requirements of the Building Code. WARNING TO OWNER: Your failure to record a NOTICE OF COMMENCEMENT may result in you paying twice for improvements to your property. If you are spending more than $2,500 or intend to obtain financing, you may wish to consult with your attorney or lender before recording your Notice of Commencement. The Notice of Commencement must be recorded at: 22 N.W. 1st Street, 1" Floor, (305) 679 -1078. Once recorded, the Notice of Commencement must be POSTED AT THE JOB SITE in accordance with Section 713 -35 of Florida Statutes. Review the brochure at Village Hall on Construction Lien Law and Choosing a Contractor. STATE OF FLORIDA, COUNTY OF MIAMI -DADE ' Signature of Owner f*'- e . Contractor / Qualifier 7 7 Print Name Print Name Sworn to and subscribed before me this day of Signature of Notary Public - State of Florida SEAL: • • • • • • • • ••• • • • • • • • • • • • • • • • • • • • • • • • • • orn to and subscribed before me this day of SEAL: S 1 TE FLO' IDA, COU. I -DADE Signature of Notary Public - State of Florida PERMIT APPLICATION Personally known OR, Produced Identification Personally known OR, Produced Identification Type of Identification Produced: Type of Identification Produced: ELECTRICAL T1'PG Minimum Fee QTY. TYPE Dryer Q'. Y. • ', Yi'IE • QuOet, Apppance QTY. TYPE Service Repair QTY. A/C Central 1 -3 Ton Fan • . • bullet; Wall Service, Temporary A/C Central 4 -7 Ton / Fire Pump Outlet, Switch 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 Z Demolition Low -volt, Intercom/Teleph. Repair Circuits Water Heater Dishwasher Low -volt, Television 3 Service, Number of Amps Water Heater New MECHANICAL TYPE Minimum Fee QTY. TYPE Condensate Drain QTY. TYPE Generator QTY. TYPE Refrigeration, Tons QTV. 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 Supply, AC Well Bath Fan - Vented, # Fireplaces, Number of Pressure Vessel Temporary Toilet PLUMBING TYPE A/C QTY. TYPE Drains, Roof QTY. TYPE Miscellaneous Fixture QTY. TVPE 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 Z 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 ''ork being gerfore uric quantity(ies) in the space provided below. RECEIVED AND REVIEWED BY: DATE: Page 4 OFFICE USE ONLY ❑ OWNER - BUILDER FORM (Attach) ❑ FIRE DEPARTMENT APPROVAL (Commercial / multi- family) ❑ CONCURRENCY (New Construction) ❑ OTHER (Specify & Attach) $3.00 per page (Scanning Fee) Miami Shores Village Bond Metropolitan Dade County (C.C.F.) Inspector State Educational Fund State DCA (Radon) Code Enforcement Fine Zoning Review Notary ••• • • •• • • • •• •• • • • • • • • • • • • • • ••• • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • S o0 SECTION Zoning Electrical Mechanical Plumbing Fire Public Works Structural Building Official BY DATE • CHECKLIST ❑ PROOF OF OWNLRS?1 P •' • ❑ CONDO ASSOCIATION APPROVAL (Attach) •• ••• •• • • • O HRS ; D'ERP►A��ttoV ?L; • 40e/ • • • • ❑ IMPACT FEE (New Construction) • ❑ OTHER (Specify & Attach) • x ¢f t. 1000 $ (¢.005 /sq.ft.) $ (¢.01 /sq.ft.) •• • •• (Attach) PERMIT APPLICATION • • ❑ BPR APPROVAL (Restaurants) • ❑ CONTRACTOR REGISTRATION (On File) PERMIT FEES TOTAL $ _ O a ISSUING OFFICIAL REVIEWED AND PREPARED BY: DATE: CONDITION OF APPROVAL Revised July 2001 10050 N.E. 2N AVE., MIAMI SHORES, FL • (305) 795 -2207 • FAX (305) 756 -8972 • http : / /www.miamishoresvillage.com Miami Shores Village 10050 NE 2nd Avenue Phone: 305 - 795 -2204 Permit Number: PL2003 -23 Printed: 1/29/2003 Applicant: LUCRECIA ADAMS Owner: ADAMS LUCRECIA JOB ADDRESS: 520 NE 92 ST Contractor ATLAS PLUMBING INC Local Phone: (305) 597 -9800 Parcel # 1132060141190 r'"k \ 3 0 o S , 0 D t 3 S -U 0 Total Fees: $040 Total Receipts: $0.00 Permit Status: Approved Work: PLUMBING If there is no permit package accer . ;k nn +h° inh -cltA for inspectors to verify, there will be no inspections. Re- inspection fee is $50.00, which must be paid in This Permit is granted to the contractor or buii ordinances pertaining thereto and with the under and approved by the proper muni ipal authoritie: authorization. A further conditio upon which the ordinances and re.ula • ns pe -ining to the wo by his agents, s Sign In consideration of the issuance to me of this with the plans, drawings, statements or specific myself, my agent, sery r employes. • Cinnr]rl• loyees. �fiLC Plumbing Permit Legal Description: MIAMI SHORES SEC 2 PB 10 -37 LOT 4 & 5 BLK 58 LOT SIZE 100.000 X Permit Expiration: 7/28/2003 Construction Value: Contractor's Address: 9314 NW 13 ST 8 ATLAS PLUMBING, INC. 9314 NW 13TH ST., BAY 8 PH. 305 -597 -9800 MIAMI, FL 33172 T AY Pi �` // , �7 ,. O THE c�7e.ea ; C • ORDER OF / r Page 1 of 1 DATE FOR Mellon United National Bank Miami, Florida k/C= ?2-sr ,,. P'1 1 1 11 1 iaa -�7v3 - � ^ 4 670 I $ /3S',�� DOLLARS a s i 1148 PERMIT APPLICATION FOR MIAMI SHORES VILLAGE Date c) Job Address ' Ai e ' d S `r Tax Folio Legal Description zol 9 <1- S / I3 /O e k 5 Historically Designated: Yes No Owner/Lessee / Tenant / or ;2,, r9 i il /) do) M 5 Master Permit # G 75 Owner's Address _4 AJ ' „2 s y Phone 2 c Z— 75 - 3 e 1 9 Contracting Co. -A , D I ' %vl t y 6' r v i - ..-___e Address P 0, 4o X /4, / 1 A 1�Y, 3 di2 Qualifier / 2 t &, e 4 0 z , u j q SS# . ,' Phone 3c 5-- 6 7 - �,-26 a ' i State# P F. (�O 7/ / Square Ft. Municipal #, ?1) • - l t 3 C,C // t,/.,Competency # CC ' pO 3 Cns Co. Architect/Engineer Address Bonding Company Address Mortgagor Address Permit Type (circle one): BUILDING ELECTRIC PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN WORK DESCRIPTION P 4 U caA,1 a N p 6 A a , c - i.3 -A-- h o A.4 — 4 —i 3,e ( r ,e o Estimated Cost (value) C C° , CJ 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 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. mmissjon CC662977 Signature of own No q My Commission Expires: dent FEES PERMIT :J RADON APPROVED: to OD on CC662977 s July 13, 2001 ontractor or Owner- Builder =mission Expires: C.C.F. / f g( NOTARY BOND Electrical $ / c,20 Structural Engineer ITEM BATH TUB UNIT FEE ITEM SWITCH OUTLETS UNIT FEE ITEM SPACE HEATERS UNIT FEE BIDET LIGHT OUTLETS CENTRAL HEATING DISHWASHER / RECEPTACLES A/C (WIN)) DISPOSAL / SERVICE TEMPORARY A/C (CENTRAL) DRINKING FOUNTAIN SERVICE SIZE IN MPS DUCT WORK FLOOR DRAIN SERVICE REPAIR/1€TER CHANGE REFRIGERATION GREASE TRAP APPLIANCE CURETS PROCESS AND PRESS PIPING INTERCEPTOR RANGE TOP UNDERGROUND TANKS LAVATORY .2 OVEN ABOVE GROUND TANKS LAUNDRY TRAY WATER HEATER U.F. PRESSURE VESSELS CLOTHES WASHER MOTORS 0- 1 If STEAM BOILERS SHOWER MOTCRS OVER 1 - 3 HP HOT WATER BOILERS SINK, POT /3 COMP. MOTCRS 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 MOTORS OVER 25-100 HP COOLING TOWERS WATER CLOSET 2 MOTORS OVER 100 If VIOLATION INDIRECT WASTES A/C WINDOW REINSPECTION WATER SLPPLY TO: AIR CONDITIONERS A/C UNIT STRIP HEATER FIRE SPRINKLER GENERATORS TRANSFORMERS ' HEATER -NEW INST. GENERATORS TRANSFORMERS HEATER - REPLACE GENERATORS TRANSFORMERS LAWN SPRINKLER -WELL SPECIAL PURPOSE SWIM4IING POOL OUTLETS COMMERCIAL WATER SERVICE -� SIGN TUBES ;EWER CONNECTIONS SIGN TRANSFORMERS ITILITY -SEWER SIGN TIME CLOCK TILITY -WATER / FIXTURES EPTIC TANK ANTENNA ELAY TELEVISION OUTLETS RAINFIELO, 4' TILE/RES... VIOLATION UhP & ABANDON SEPTIC TANK REINSPECTION OAKAGE PIT CU. FT. ATCH BASIN ISCHARGE WELL 7MESTIC WELL . TEA DRAIN )OF INLET )LAR WATER HEATER IRE STANDPIPE CL PIPING 1WN SPRINKLER SYSTEM ',S RANGE :TER SET (GAS) S PIPING ADDENDUM TO BUILDING PERMIT APPLICATION . (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 ELECTRICAL MECHANICAL /I PERMIT APPLICATION FOR MIAMI SHORES VILLAGE Date Job Address a 0 A) (E- q'(a s( Tax Folio Legal Description Historically Designated: Yes No Owner/Lessee / Tenant 1 i41 -(, ('Z.k C f Master Permit # 3 9/ 6 L/ Owner's Address ,5 r , () /V E V < S Phone Contracting Co. P YY1 -e, t'k> PLAJ rn 6 l -4; / Address (0 g 8 W- 4 , ST l vq, (,a., h Qualifier C , h,2ti'J ()' 6YL I El -)" SS# ,� Phone 2'o? 1 3 S State # C r C- 45 t i l l I `f i -( Municipal # Competency # U v S Ins. Co. / AL, lea S Architect/Engineer Address Bonding Company Address Mortgagor Address Permit Type (circle one): BUILDING ELECTRICAL ' LUMBIN MECHANICAL ROOFING PAVING FENCE SIGN WORK DESCRIPTION QC.p.lh Square Ft tx s5,„ 1F + - Estimated Cost (value) , S m • CDC) WARNING TO OWNER: YOU MUST RECORD A NOTICE OF COMMENCEMENT AND YOUR FAILURE TO DO SO MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY (IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT.) Application is hereby made to obtain a permit to do work and installation as indicated above, and on the attached addendum (if applicable). I certify that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that separate permits are required for ELECTRICAL, PLUMBING, SIGNS, POOLS, ROOFING and MECHANICAL WORK. OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. Furthermore, I authorize the above -named contractor to do the work stated. Signature of owner and/or Condo President Date Signature' Contractor or Owner- Builder 4/, t Date My Commission Expires: FEES: PERMITr RADON APPROVED: Zoning Mechanical Notary as to Owner and/or Condo President Date Notary as to Contractor or Owner- Builder My Commission Expires: C.C.F. oS6 NOTARY S at) TOTAL DUE Date �t . STATE OF FLORIDA DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTI PERMIT, 0 Permit Application Number ` ®�< ?1 PART I I - SITE PLAN Scale: Each block represents 5 feet and 1 inch = 50 feet. ■■■■ I■■■■■■!■■■■■■■■■■■■■■■■■■■■■■!■■!■!• w■■ I■■■ w■ a■ ■■■ ■■■ ■■ ■■■■I•■■■■■■■■■■■■■■i■ ■■■■ I■■■■■■►\■■■■■■■■■■■■■■■■■■■■■■■* raFzifi7■■ n■■■ ■U ■P0 ■ ■ ■! ■d ■■■ ■■ ■ ■ ■ ■■■ ■ ■ ■ ■■ ■ ■ ■■ ■■■ UI■ ■ ■■ ■■■■■■ ■■■ ■■■■■■■■■■ ■■■■■ ■ m. ■ivra 1vii■ ■'• ■A. .iuru ■A.■ ix ■■■■■ ■ ■■■ ■■■■■■■■ ■riu ■■■■ 1■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ aIi■■ ifiil■■■■■■ ■ ■ ■■ ■■■■■:■■■ ■ ■■■■■■■■■ ■ ■■■ ■■1■ 1111 ■ ■I■1111■■■Ik ■r1!ri, a■11■■■11■■ ■■■■■ ■■11 ■■■■■■■■■ III■■■■■ ■■■■ ■11■■■I■■■■■■■■■■■■11■■■11■ ■■11 ■■■■I■■■■■■■ vas■ haa■■■■■■■■■■■■■■■ u■■■■■■■■ itI■!■■■■■■ ■■■,■■■■I■■■■■■■■■■■■■■!■■ ■■ ■I■ II ■i ■■■ ■ ■■11■■1 •■■ uI ■■!'.�l111�111■! ■ ■E■■■ ■■11 ■■I■ 11•.■ I■■■ ■ ■■ ■ ■■ ■ ■■■■ ■ ■ ■ ■■ ■ ■ ■ ■■ ■■■■•11M !M ! ■ ' 1■ 1111••■ ■ C 11■2 i! r111N11 ■ ■ ■ ■ ■ ■ ■ ■■ 11 ■I■ ■ ■■■■■■■ ■■■■ ■■■■ ■ ■ ■■ 1 11 • A LI ■■ ■ iiI I I W W 'Ir IJt i I��l ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■■I■ ■■■ I■■■■■■■■ 11■■ ■ ■ ■ ■! ■ ■ ■ ■ ■ ■ ■ ■! ■ ■ ■ ■! ■'! ■ ■ ■ ■ ■ ■ ■ ■I 1111 ■11■ ■I■■■■■■!■■■■■ ■11■■■■ ■ ■■ ■ SO MMii■!a ■e■■■! ■ ■ ■■■■■ ■ ■ ■■■■■ ■■ ■■ ■■I■■■■■■■■■■■■■■ ■ ■■■ ■■■■■■■mai E* I®m■■■■■\I?mII■■■ VIII■■ ■ ■ ■ ■■■ ■ ■I■■■■■■■■■ ■■■ ■■.!■■■II■ ■■■■ 1■■■■■■■■■■■ 11111■■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■l1113.11■■Il■i!■ ■ ■ ■ ■ ■■ 111 ■ ■ ■■Y ■■ OI•11•■1 ■1■■■■■ ■ ■■■■■ ■ ■ ■ •••••I■ 1��11 ■■■! 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JEW11■■■■■■■■■■■■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■■ ■■■■■■■■■■■■■■■■■■ I■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■ ■■ ■ ■ ■ ■ ■fi ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■.. ■ ■ ■ ■ ■I■ 1■■■ I■■ 11■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■11 ■ ■ ■ ■ ■ ■'■ •••■1•••••■ ■ •■••••• ■ ■ ■■■■ ■■■■■ ■111 ■ ■■■■ ■■ ■ ■ ■ ■ ■ ■ ■ ■■■■ ■ ■■ ■■■■ ■■■ ■ ■ ■ ■■ ■■ICE! MJ■■ 1lM'sJ ■ ■ ■ 3[�■I!R ■]!f ■■■■■■■ ■ ■ ■ ■■ ■■■ ■ •■ ■! ••••fix / ■ ■ ■■■;■ ■■■■■■■■■■■■■■■■■■'■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■� ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■�A ■ ■ ■ ■ ■ ■■■■ I■■■■■■■■■■■■■■'■■■■■■■■■ ■■■ ■ ■ ■■■■■■■ ■ ■■■■ ■ ■ ■■■ ■ ■■ ■■■■■■ ■1•i■■■■■■ ■ ■ ■■■■ ■I• ■ ■■ ■ ■■■■ I■■■■■■■■■■■■■■!■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■ ■ ■ ■■■:■■■ ■ ■ ■ ■ ■ ■ ■ ■ ■■LJ■■■I ■ ■ ■■I ■ ■■■■ ■11■ ■ ■ ■■■■' ■ ■ ■ ■ ■ ■ ■■ 111111 ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■■■ ■1111 ■11■■■■ ■■■■ ■■ ■ ■■ ■■ ■■ ■ ■■■ MEMOMMiiii:iiiiii:iiNEEMMI MEMEN.. iiiiIMII ME iiiii ii iiiiiii•i:iiiiiiiiiiii =i■•ie■IU ■■■■ I■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■■ ■■■■ 1■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■!■■■■■ ■■ ■■ ■ ■ ■■ ■ ■ ■ ■■■ ■■ ■ ■■ ■ ■■ ■■ ■■■■■ ■■■ ■■■■ 1 ■■11■ ■11■ ■ ■■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■■ ■ ■ ■■■1 alliKILA ■ ■ ■■APIEMI !■■! !11■111.11I1IIw! ■ ■■■ ■■■■■ ■ ■ ■■ ■ ■ ■ ■ ■■■ u■■■■■■■■ m■■■■■■■■■■■■■■■■ m■ a■■■ ■■ ■ ■a ■■om ■ewww ■Ira;miumuadum ■ai■1111■ ■ ■■ ■ ■ ■ ■ ■■ ■1111 ■e ■■■■ I■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■ ■■■■■■■■■■■ ■ ■■ ■ ■■ ■■■■ I■■ 11■■■■■ 11■■■■■■■■■■■■■■!■■■ 11■!■■■■■■!■■■■■■■■ ■■■■■■■■■ ■ ■11■■■■■11■■■■■■■■ ■■■ ■ ■■ ■I■■■■■■■■11■■■■■■■ ■■■■■inilmo SIUM ■�■■■■■■■ ■ ■ ■ ■■ ■1111■■ ■11■■■■■■!■ ■11 ■■■■■ ■ ■ ■■■■ ■ .■ ■■■■ I■■ ■■ ■ ■11■■■■■■■■■■■■■hCERMICEIri ■■ aiidr■■■■■■■■■■■■ ■■■■■■■■■■ ■■■■■■11 ■ ■■■■■ ■ ■ ■M■ ■ ■ ■■ IIIIII■■■■■■■■■■■ ■■11■ML7■■■t■C! ■ 11► 1v■■■■■■■■■■ ■ ■ ■ ■ ■■■■■■ ■■ ■ ■■■■ ■■■■ ■■■■ ■■ ■ ■ ■ ■■■■ I■■■■■■■ ■ ■U■■■■■■■■■■■■■■■■■■! ■ ■■■■ ■UI. 111111■ 11■■! IIU■■! ■■!■ ■11 ■A!■■!!! ■■11AM•••••■ ■■■■ I■■■■■■■■ 11■■■■■■■■■ IIII IM■■■■■■■ 11■■■■■■■■■■ 11■■■ ■ ■ ■■ ■ ■■■■■■ ■ ■ ■ ■ ■ ■ ■1 ■ ■ ■ ■ ■ ■ ■■ ■■ Notes: if 76 HRS -H Form 4015, Feb 85 (Obsoletes previous editions which may not be used) (Stock Number. 5744 - 002 - 4015-6) SIGNATURE ; `o rl `p Site Plan submitted by: ) Jr. Plan Approved ` Not Approved Date 1l By - r County Public Unit ALL CHANGES MUST BE APPROVED BY THE COUNTY PUBLIC HEALTH UNIT TITLE Page 2 of 3 LOT: BLOCK: PROPERTY ID #: STATE OF FLORIDA PERMIT # DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES ONSITE SEWAGE DISPOSAL SYSTEM SITE EVALUATION AND SYSTEM SPECIFICATIONS � A AGENT: ' e J /C W *1 } / 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 [ ] NO NET USABLE AREA AVAILABLE: ACRES TOTAL ESTIMATED SEWAGE FLOW: GALLONS PER DAY [RESIDENCES -TABLE 1 / OTHER -TABLE 2] AUTHORIZED SEWAGE FLOW: ar/ GALLONS PER DAY [1500 GPD /ACRE OR 2500 GPD /ACRE] UNOBSTRUCTED AREA AVAILABLE: Pco SQFT UNOBSTRUCTED AREA REQUIRED: Pc SQFT BENCHMARK /REFERENCE POINT LOCATION: CAZ C4 Y_nASa q. I� ELEVATION OF PROPOSED SYSTEM SITE IS [INCHES /FT] [ABOVE /BELOW] BENCHMARK /REFERENCE POINT THE MINIMUM SETBACK WHICH CAN BE MAINTAINED FROM THE PROPOSED SYSTEM TO THE FOLLOWING FEATURES: SURFACE WATER: , /( "? °'FT DITCHES /SWALES: — FT NORMALLY WET? [A- YES [ ] NO WELLS: PUBLIC: - FT LIMITED USE: FT PRIVATE: FT NON - POTABLE: -- FT BUILDING FOUNDATIONS: FT PROPERTY LINES: R FT POTABLE WATER LINES: /0 FT SITE SUBJECT TO FREQUENT FLOODING: [ ] YES []" NO 10 YEAR FLOOD ELEVATION FOR SITE: r"' FT MSL /NGVD SOIL PROFILE INFORMATION SITE 1 Munsell # /Color Texture Depth G to 2 - j to 4 to - 72 to to to to to to USDA SOIL SERIES: cN OBSERVED WATER TABLE: 2'6' INCHES [ABOVE /6 XISTING GRADE. TYPE: [PERCHED / ESTIMATED WET SEASON WATER TABLE ELEVATION: INCHES [ ABOVE / BELOW ] EXISTING 000E- HIGH WATER TABLE VEGETATION: [ ] YES NO MOTTLING: [ ] YES [NO DEPTH: INCHES SOIL TEXTURE /LOADING RATE FOR SYSTEM SIZING: DRAINFIELD CONFIGURATION: [ ] TRENCH [ BED [ ] OTHER (SPECIFY) REMARKS /ADDITIONAL CRITERIA: SITE EVALUATED BY:* HRS-H Form 4015, Mar 92 (Obsoletes previous edj (Stock Number: 5744 - 003 - 4015 -1) 1(L SUBDIVISION: tionS. ay used }'r [Section /Township /Range /Parcel No. or Tax ID Number] 10 YEAR FLOODING? [ ] YES [9 NO SITE ELEVATION: FT MSL /NGVD SOIL PROFILE INFORMATION SITE 2 Munsell # /Color Texture Depth ‘ �N r, to Z 1 2!-\ to w'G to 7� to o to to to to to USDA SOIL SERIES: DEPTH OF EXCAVATION: INCHES DATE: / / ��i�P Page 3 of 3 17aeltlnq, nunfae: anrif owne..'n Li! rcoerty cor's le3ally autitc:•l7,nre hie, anal subdivision fo: lot. ellaract: nurnba7 for propeaty. (property aaloattirar Lectl-an/tcn.t.r"tip/.7 cnfamir. to aubalittar" al.te - ;:' • •••• - noifoLIlly or at.".t.t.: \: '2 . 1 finy pc: • •-- 0: 7. J. ...Lord "cc ation f bereln7atalo. urip::: 3.11'svc:/:-.7'u • • ?rc aite raiatiL.: (allovn heiroo; to :ha :::anchar accord lrinimurn setbacks vlh. can Pe mac: to all lister: foartlaoa. Act:a' aa • - 'oa fo7 non ....pnlica)le featuroa. il on 15 ol:thc ao it a.: of any pualle well 2C3 feat_ c5t.ha applicant's let - a.v.at airr: v accord iiii011111:1 021 :CV!: :..1.:11iCCI to ficerliori,. :Faa !eta: anhject to 51coa"la:5 "C; 1;.G.C{: ' olevation. Two roll 21 v. thc oaoporad. L'ocorptio, ',":7:;f; zaa itiontification wU ure USDI. So!! Clerrifiectla.: 7nothorl.al.o ( ." nnsaII eco:; tanturza.). 'atta bo clearly docurnantori. l?rovirle. :US,DA Larlan if avt.ilabie, c7Jhl:C" • • ezaortet. Record the depth of the obLe,-veci tim e of ilia a.valuaticn. “cppcaent" appropriate. Accord foo estimated V L.CtLC. water table elevrtlon Peca.r! on rite avaluat'on, JSDA anapa, alit; historical information. InclIG...to if there is ricter tahlle var;ata.tion p:;: -1. :±lertta otlin /13 2::•■:::.S::12 c: a:r..te for sr:tat:2 sizing. 011; Y.; applicable aacord ("I.:pill of avation mquirntl. 1eco76 "Wi." if not applica7.1!... ..; eonfigurr.tion required. ;:f other, rpecif troaa. ill A: l;:ecoo . any additional rerrtar'os pertinent tr.: aitu 0: in: 1!c:. cloalns SiL of evaluator, titla, and date of evontation. •:afassla.-11 cair at.lor t. anal all docutnentztion ITZ V A e t 0 - 1\1 / CO sTRUCTION PERMIT FOR: [ New System [71] xisting System [] Repair Abandonment LOT: PROPERTY ID #: 0 T 11 E R SPECIFICATIONS BY: APPROVED BY: DATE ISSUED: STATE OF FLORIDA DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PERMIT Authority: Chapter 381, FS & Chapter 10D -6, FAC BLOCK: SUBDIVISION: [ �jj [ 71 APPLICANT: f s// &/a PROPERTY STREET ADDRESS: ) (-7,3 "' D [ e t / - J SQUARE FEW PRIMARY DRAINFIELD SYSTEM R [ ] SQUARE FEET SYSTEM A TYPE SYSTEM: [ ] STANDARD [ ] FILLED [ ] MOUND I CONFIGURATION: [ ] TRENCH [ (-}%1lED [ ] N F LOCATION OF BENCHMARK: I ELEVATION OF PROPOSED SYSTEM SITE [ E BOTTOM OF DRAINFIELD TO BE [ L D FILL REQUIRED: [ ] INCHES HRS -H Form 4016, Mar 92 (Obsoletes previous editions which may not be used) (Stock Number: 5744 - 001 - 4016 -0) PERMIT # /'l% � ` / DATE PAID FEE PAID $ C -l. e; RECEIPT # Holding Tank [/ 4'Temporary /Experimental Other(Specify) AGENT: i TITLE: , /7/,*". - 7/ _ [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. HRS APPROVAL OF SYSTEM DOES NOT GUARANTEE SATISFACTORY PERFORMANCE FOR ANY SPECIFIC PERIOD OF TIME. ANY CHANGE IN MATERIAL FACTS WHICH SERVED AS A BASIS FOR ISSUANCE OF THIS PERMIT, REQUIRE THE APPLICANT TO MODIFY THE PERMIT APPLICATION. SUCH MODIFICATIONS MAY RESULT IN THIS PERMIT BEING MADE NULL AND VOID. SYSTEM DESIGN AND SPECIFICATIONS T [ ri ] ;[GALLONS GPD] EPTIC TANK/AEROBIC UNIT CAPACITY MULTI- CHAMBERED /IN SERIES:[ ] A [ ] [GALLONS / GPD] CAPACITY MULTI- CHAMBERED /IN SERIES:[ ] N [ ] GALLONS GREASE INTERCEPTOR CAPACITY [MAXIMUM CAPACITY SINGLE TANK: 1250 GALLONS] K [ ] GALLONS PER DOSE DOSING TANK CAPACITY DOSE RATE [ ] PER 24 HRS NO. OF PUMPS: [ ] ] [INCHES /FT] [ABOVE /BELOW] BENCHMARK /REFERENCE POINT ] [INCHES /FT] [ABOVE /BELOW] BENCHMARK /REFERENCE POINT EXCAVATION REQUIRED: [ ] INCHES TITLE: �j, n ('4 G� / 7 - CPHU EXPIRATION DATE: o� l it �r [ Page 1 of 2 ao3• cr. ..,...... ?d,,..,.. °c;• c, o • t.r;a z. 7,i e ' t .....,,• .. ! iy � y p7_..' i F_-n_.. ; AN :'07Ci to fror Clt,:ntcr 1OJ 6, AC. ns, r permit oci vctu� c u;h `.Ic1s, vcai_rcc -_ vit cs. ..._...�.. :J:$... ytecitic�!to:_. such to op,:;.ain Fi'',,.'.„ '.; A CNS 3Y: Narna of individui:l uroviciing ::peci'iertion::•. of desiPncd by r, r.:!;is rtee. must be :.....::;i . A. 3CV :) 3Y: County aiblia Health Unit (C:'i-1J) pc_sor_;tcl t'eviewins e:-ci approving permit. Cana permit. i:3 issued by C iJ. On your from date i , .vad if :;t; system E:cs not ',nun inrtcil,:F'. :?;:r:ni:': for sy.i i ap h;::ro ; void O days frost to c rr::: ilsucd. LOT: [ [ [ TANK [01] [02] [03] [04] [05] [06] [07] [08] APPLICANT: PROPERTY STREET ADDRESS: PROPERTY ID #: STATE OF FLORIDA DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION INSPECTION AND FINAL APPROVAL Authority: Chapter 381, FS & Chapter 10D -6, FAC BLOCK: INSTALLATION TANK SIZE [1] TANK MATERIAL OUTLET DEVICE MULTI- CHAMBERS LEGEND WATERTIGHT LEVEL DEPTH OF LID EXPLANATION OF VIOLATIONS: FILL /EXCAVATION MATERIAL [22] FILL AMOUNT [23] FILL TEXTURE [24] EXCAVATION DEPTH [25] EXCAVATION AREA [26] REPLACEMENT MATERIAL DRAINLINE SEPARAT DRAINLINE SLOPE / DEPTH OF COVER SYSTEM ELEVATION SYSTEM LOCATION DOSING PUMPS AGGREGATE SIZE AGGREGATE SOURCE AGGREGATE WASHED AGGREGATE DEPTH CONSTRUCTION (APPROVED /DISAPPROVED): SUBDIVISION: CHECKED [X] ITEMS ARE NOT IN COMPLIANCE WITH CHAPTER 10D -6, FLORIDA ADMINISTRATIVE CODE. [2l DRAINFIELD INSTALLATION _ [ [09] AREA [1];:i' ✓�- [2] i %� SQFT [ ] [10] DISTRIBUTION BAXJHEADgR' [ `�] [11) NUMBER OF DRAINLINES ,/ [ [ ,] [ ( ] [28] [ e.1 [ (/:'] [30] [ ] [31] [ ] [ [ ] [33] (,„../ [34] [ ] [35] A • AGENT:' s4t ry SETBACKS FINAL SYSTEM [APPROVED /DI §APPROVED] : / 7 HRS -H Form 4016, Mar 92 (Obsoletes previous editions which may not be used) (Stock Number: 5744- 002-4016 -4) PERMIT # RECEIPT FEE PAID $ DATE PAID [SECTION /TOWNSHIP /RANGE /PARCEL NUMBER] [OR TAX ID NUMBER] SURFACE WATER DITCHES PRIVATE WELLS PUBLIC WELLS IRRIGATION WELLS POTABLE WATER LINES BUILDING FOUNDATION PROPERTY LINES OTHER FILLED /MOUND SYSTEM [36] DRAINFIELD COVER [37) SHOULDERS [38] SLOPES [39] STABILIZATION MATERIAL -'ADDITIONAL INFORMATION [' J [40] UNOBSTRUCTED AREA ] [41] STORMWATER RUNOFF [a ] (42] ALARMS 1 ] [43]. MAINTENANCE AGREEMENT [ ;] [44] BUILDING AREA [ ] [45] PLUMBING FIXTURES [ j [46] FINAL SITE p Rim 1 [ ] 47 ] CONTRACTOR > 't ya 7 ' [ ] [48] OTHER ABANDONMENT ] [49] TANK PUMPED /7-/ •in2 ] [50] TANK CRUSHED AND FILLED 1 CPHU DATE: CPHU DATE : !-- Page 2 of 2 APPLICATION FOR: y(., ] New System ,( ] Existing System iy( ] Holding Tank aM ] Temporary /Experimental (° ] Repair ;'4 ] Abandonment : /( ] Other(Specify) APPLICANT: AGENT: MAILING ADDRESS: PROPERTY SIZE: 1 2 3 4 STATE OF FLORIDA DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES ONSITE SEWAGE DISPOSAL SYSTEM APPLICATION FOR CONSTRUCTION PERMIT Authority: Chapter 381, FS & Chapter 10D -6, FAC BUILDING INFORMATION Unit Type of No Establishment A, !) . `; PROPERTY STREET ADDRESS: ] RESIDENTIAL [ ] COMMERCIAL Bedrooms Area Saft Served PERMIT # DATE PAID FEE PAID $ RECEIPT # TELEPHONE : k ' 1 C ■ TO BE COMPLETED BY APPLICANT OR APPLICANT'S AUTHORIZED AGENT. ATTACH BUILDING PLAN AND TO -SCALE SITE PLAN SHOWING PERTINENT FEATURES REQUIRED BY CHAPTER 1OD -6, FLORIDA ADMINISTRATIVE CODE. PROPERTY INFORMATION [IF LOT IS NOT IN A RECORDED SUBDIVISION, ATTACH LEGAL DESCRIPTION OR DEED] LOT: BLOCK: SUBDIVISION: DATE OF ,•a SUBDIVISION: ID #: [Section /Township /Range /Parcel No.] ZONING: ACRES [Sgft /43560] PROPERTY WATER SUPPLY: [ ] PRIVATE c{.] PUBLIC DIRECTIONS TO PROPERTY: \ f 7. )U ..._ - ‘1k, 4 i "4 ;�'� 1 1 U N, No. of Building # Persons Business Activity For Commercial Only { ] Garbage Grinders /Disposals .4- ] Spas /Hot Tubs a[ - f ] Floor /Equipment Drains { ] Ultra -low Volume Flush Toilets f - J Other (Specify) • APPLICANT'S SIGNATURE: a�, r,, ✓ a DATE:, / HRS -H Form 4015, Mar 92 (Obsoletes previous editions which may not be used) Page 1 of 3 (Stock Number: 5744-001-4015-1) ' :'Y. : :0 .0 u .t -� i .:) Permit No. v 1 Owner's Name and Address Employing n g Plumber's Name P New Building Remodeling_ Amount of Permit $___ STATE OF FLORIDA, COUNTY OF DADE. Ss. MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the building or other structure herein described. This application is made in compliance and conformity with the Building Ordinance of Miami Shores Village, Florida, and all provisions of the Laws of the State of Florida, all ordinances of Miami Shores Village and all rules and regulations of the Building Division of Miami Shores Village shall be complied with, whether herein specified or not. A copy of approved plans and specifications must be kept at building during progress of work. Registered Architect and /or Engineer t f No Location and Legal Description Lot __ a ° r Block__ • ll ,. r � Street and Number where work is to be performed —No — ____________ . `•:1., t ' ( Street State work to be performed and purpose of building (By Floors) Addition No ' i { ' it Street 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) !L_ Repairs Date My Commission Expires Notary Public, State of Florida • +. Street ' } __ ` i et > � No. of Stories 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 $1.00 will be made when such re- inspection is made necessary by improper notice for inspection, or faulty materials and /or workmanship. CLOSETS BATH TUBS SHOWERS LAVA- TORIES SINKS SLOP SINKS LAUNDRY TUBS URINALS CATCH BASIN FLOOR DRAIN DRINKING FOUNT'NS TOTAL FIXTURES CONTR. LIST CHECK 3 f I / • � � N ,• � l /I SEPTIC TANK SEWER CONN. DRAIN FIELD SOAKAGE PIT GREASE TRAP SOLAR H EATER DEEP WELL SPRKLR. SYSTEM SWIM'G POOL ,$. -x C' S ) 1 0 1 A 7 � ,'Y k._ CONTR. LIST 4. f CHECK -� i .:) Permit No. v 1 Owner's Name and Address Employing n g Plumber's Name P New Building Remodeling_ Amount of Permit $___ STATE OF FLORIDA, COUNTY OF DADE. Ss. MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the building or other structure herein described. This application is made in compliance and conformity with the Building Ordinance of Miami Shores Village, Florida, and all provisions of the Laws of the State of Florida, all ordinances of Miami Shores Village and all rules and regulations of the Building Division of Miami Shores Village shall be complied with, whether herein specified or not. A copy of approved plans and specifications must be kept at building during progress of work. Registered Architect and /or Engineer t f No Location and Legal Description Lot __ a ° r Block__ • ll ,. r � Street and Number where work is to be performed —No — ____________ . `•:1., t ' ( Street State work to be performed and purpose of building (By Floors) Addition No ' i { ' it Street 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) !L_ Repairs Date My Commission Expires Notary Public, State of Florida • +. Street ' } __ ` i et > � No. of Stories 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. 716 • •F 4 Permit No - 1 Location and Legal Description Lot ' 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 $ ss. MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT (Signed) ( Signed) Date Application is hereby ma dk 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 En5itieer Employing Plumber's Name :_______- — No Street r Block Subdivision --)// - L.-- t Street and Number where work is to be performed —No Street ___ ______________ No. of Stories My Commission Expires Notary Public, State of Florida Type of Tank Capacity Gals. 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. ' .. Master Plumber. STATE OF FLORIDA, l COUNTY OF DADE. i 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 FOU NT' NS TOTAL FIXTURES CONTR. LIST - 0/1/ / �" / / / _. CHECK SEPTIC TANK SEWER CONN. DRAIN FIELD SOAKAGE PIT GREASE TRAP SOLAR H EATER DEEP WELL SPRKLR. SYSTEM SW IM'G POOL - F r . t' • CONTR. LIST / tr CHECK • Permit No - 1 Location and Legal Description Lot ' 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 $ ss. MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT (Signed) ( Signed) Date Application is hereby ma dk 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 En5itieer Employing Plumber's Name :_______- — No Street r Block Subdivision --)// - L.-- t Street and Number where work is to be performed —No Street ___ ______________ No. of Stories My Commission Expires Notary Public, State of Florida Type of Tank Capacity Gals. 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. ' .. Master Plumber. STATE OF FLORIDA, l COUNTY OF DADE. i 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. INSTALLATIONS • REPAIRS • SEPTIC TANKS • SOLAR WATER HEATING BLACKWELL PLUMBING COMPANY REGISTERED MASTER PLUMBERS 530 NORTHWEST 54th STREET MIAMI 38, FLORIDA PHONE 7 -3204 HARDWARE and PAINTS • MIAMI SHORES VILLAGE, FLORIDA BUILDING ELECTRICAL PLUMBING Owner of Building Architect i 3 � �1l r, or Builder Contractor /%t Legal Lot . ,d,., j -1 Bl. Description Address of Building ' ,,...• _ . �. 1 Subdi- vision Value of Project DATE E R M I T N? 5159 Contractor's License No. Work to be performed under this Permit l "" Of This permit is granted to the contractor or b der named above to construct the building or to install the equipment or . evice i escribed i. the appli- cation herefor in strict compliance with all ordinances pertaining thereto and w th the understanding that the work will be performed in complia• e 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 ch • ed without authprization. A further condition upon which this permit is granted is the understanding that the contractor or builder named above assum • • a resp. * .ility fp a th. ough knowledge of the ordinances and regulations pertaining to the work covered hereby whether shown on the plans er-.draw ;rc s or , t tatem is or: ' pecifications and that he assumes .respon- sibility for work done by his agents, servants or employees. CONTRACTOR OR BUILDER Signed. pel BY Amt. o Permit 194.# AUTHORITY • IN In consideration of the issuance to me of this permit I agree to perform the work coffered h eunder in compliance with all ordinances and pertain'. the to an in strict conformity with the lans, drawings, statements or specifications submitted to the proper auth6rl s of MiamlS In ac. ;.ti. . is p iti.,assume responsibility for all work done by either myself, my agent, servant or employee. BUILDING ELECTRICAL PLUMBING Owner of Building Architect Contractor or Builder MIAMI SHORES VILLAGE, FLORIDA ERMIT N° 5159 Work to be performed under this Permit t -/. r /1•••4.4•44 �' L+L Legal Lot t Bl. Subdi Description '` vision Building net.) Address of y Z Value of / �/ . C. �' Project This permit is granted to the contractor or b der named above to construct the building or to install the equipment or d vice scribed in a appli- cation herefor in strict compliance with all ordinances pertaining thereto and with the understanding that the work will be performed in complian with any plans, drawings, statements or specifications that may have been submitted to and approved by the proper municipal authorities. This Permit may e 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 assume.5.d respollity for a thorough knowledge of the ordinances and regulations pertaining to the work covered hereby whether shown on the plans or dxawi or 1 • e . atemeats or ecifications and that he assumes respon- sibility for work done by his agents, servants or employees. �►` ; . .w.. r ,, By NS A BY � DATE 194_1 Contractor's License No. ` ,1 L✓ Amt. of Permit - In consideration of the issuance to me of this permit I agree to perform the work covl ed he • under in compliance with all ordinances and r lations pertain' , • then: o and 'n strict conformity with the plans, drawings, statements or specifications bmitted to the proper authorities of Miami Sho s Village. In ac )ssume responsibility for all work done by either myself, my agent, servant or employee. AUTHORITY