705 NE 92 St (11)PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Date J"Job Address 7 725 BUG qoZ S ,14 Folio
Legal Description 2 G�
Owner / Lessee / Tenant 1L/) f} t.�F -- /-1' - 6R-7) (
i' O Master Permit # ✓ / A?
Owner's Address 3/ /hone "�7 ' F
Contracting Co. 4 1 ■ ddress /GTO / / 4f ,
Qualifier &AIMA `' a /d0 // f
Phone S. (o- / 9/O
State # g, 03,47 Municipal # Competency #,0001 ®a34?Ins.Co a, Am) fb 4
Architect /Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type(circle one): BUILDING ELECTRICAL UMBING MECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIPTION .1;t A 70 0 S42 , Fr„ .P.,/q /xe/ c,e.AzL, /7
Square Ft. Estimated Cost(value c; 1,,,100.
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.
f RACI -, � I.-. ignature of owner and /or ondo President
Date: Dat
APPROVED:
?D
Zoning
Buildin
Mechanical Plumbin
Signature of Contr -r or or Owner- Builder
Not • $E . . o President
My o1i is �F V . MONT1El
MI My C m>iyi s9troEl� ► e ARY SEAL
* COMMISSION NUMBER � SANDRA M MONTIEL MI
*t CC401261 * COMMISSION NUMBER
° *j
** *y M V OM MIS N EXP. � :U „ ; . Q CC401261
� sAO * * * * � r Q � MVO COMMIION EX*. * **
OF F� AUG. 17 1998 �v � OF F� U� G. 17,1998
FEES: PERMIT RADON C.C.F. f NOTARY TOTAL DUE 36
Notary as to Cnntrnetnr nr 0 ....v.r- Builder
Fire Other
Engineering,
Electrical
CONSTRUCTION PERMIT FOR:
[•' " New System [/-"] Existing System [ ] Holding Tank [/!] Temporary /Experimental
] Repair [ .-J] Abandonment [`' Other(Specify)
APPLICANT:
LOT:
PROPERTY ID #:
0
T
H
E
R
(.4 % b' w , f� r ,'
•
PROPERTY STREET ADDRESS:
SYSTEM MUST BE CONSTRUCTED IN ACCORDANCE WITH SPECIFICATIONS AND STANDARDS OF CHAPTER 1OD -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 [# ] [GALLONS
A [ ] [GALLONS
N [ ] GALLONS
K [ ] GALLONS
D [ _ ,] SQUARE FEET PRIMARY
R [ ] SQUARE FEET
A TYPE SYSTEM:
I CONFIGURATION:
N
F LOCATION OF BENCHMARK:
I ELEVATION OF PROPOSED SYSTEM
E BOTTOM OF DRAINFIELD TO BE [
L
D FILL REQUIRED: [ 1-i `. ] INCHES
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 1OD -6, FAC
I
BLOCK: SUBDIVISION:
/ GPD] SEPTIC TANK /AEROBIC UNIT CAPACITY MULTI- CHAMBERED /IN SERIES:[ ]
/ GPD] CAPACITY MULTI- CHAMBERED /IN SERIES:[ ]
GREASE INTERCEPTOR CAPACITY [MAXIMUM CAPACITY SINGLE TANK: 1250 GALLONS]
PER DOSE DOSING TANK CAPACITY DOSE RATE [ ] PER 24 HRS NO. OF PUMPS: [ ]
DRAINFIELD SYSTEM
SYSTEM
[ ] STANDARD [ ?'-'] FILLED
[s -1J TRENCH [, -'] BED
•
AGENT:
EXCAVATION REQUIRED:
•
APPLICANT
[SECTION /TOWNSHIP /RANGE /PARCEL NUMBER]
[OR TAX ID NUMBER]
•
SITE [.- -t' ] [INCHES /FT] [ABOVE /BELOW] BENCHMARK /REFERENCE POINT
_...
/-;] [INCHES /FT] [ABOVE /BELOW] BENCHMARK /REFERENCE POINT
MOUND
PERMIT # `2 15 04 $7 e
DATE PAID � ' - /? - 9.J
FEE PAID $
RECEIPT # ef,re
r'`j •-* c„
1] INCHES
ilUi Tat '1,414
MECTIn° Ir rlDr7111Fn F,`^, fib?F
HRS-H Form 4016, Mar 92 (Obsoletes previous editions which may not be used)
(Stock Number: 5744 - 001 - 4016-0)
";i7. •
Page 1 of 2
INSTRUCTIONS:
PERMIT NUMBER: Permit tracking number assigned by CPHU. •
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/f: 27 character id number for property. (CPHU may require property appraiser ID (1 or section/township /range /parcel number)
SYSTEM DESIGN AND
SPECIFICATIONS:
TANK: Minimum specifications from Chapter 1OD-6, FAC.
DRAINFIELD: Minimum specifications from Chapter IOD-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 muse be sealed.
APPROVED BY: County Public Health Unit (CPHU) personnel reviewing and approving permit.
DATE ISSUED: Date permit is issued by CPHU.
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.
APPLICANT:
LOT:
PROPERTY ID #:
STATE OF FLORIDA
DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES
ONSITE SEWAGE DISPOSAL SYSTEM
SITE EVALUATION AND SYSTEM SPECIFICATIONS
BLOCK: SUBDIVISION:
PROPERTY SIZE CONFORMS TO SITE PLAN:
TOTAL ESTIMATED SEWAGE FLOW:
AUTHORIZED SEWAGE FLOW:
UNOBSTRUCTED AREA AVAILABLE:
SOIL PROFILE INFORMATION SIT1•;"1
Munsell # /Color Texture Depth
to
to
USDA SOIL SERIES:
to
to
to
to
to
to
SITE EVALUATED BY:
HRS-H Form 4015, Mar 92 (Obsoletes previous editions which may not be used)
(Stock Number: 5744 - 003 - 4015 -1)
AGENT:
PERMIT #
[Section /Township /Range /Parcel No. or Tax ID Number]
TO BE COMPLETED BY ENGINEER, HEALTH UNIT EMPLOYEE, OR OTHER QUALIFIED PERSON. ENGINEER'S MUST
PROVIDE REGISTRATION NUMBER AND SIGN AND SEAL EACH PAGE OF SUBMITTAL. COMPLETE ALL ITEMS.
[74- YES [ ] NO NET USABLE AREA AVAILABLE: �' a,:t ACRES
GALLONS PER DAY [RESIDENCES -TABLE 1 / OTHER -TABLE 2]
r GALLONS PER DAY [1500 GPD /ACRE OR 2500 GPD /ACRE]
SQFT UNOBSTRUCTED AREA REQUIRED: /40 SQFT
BENCHMARK REFERENCE POINT LOCATION: '�� ¢
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? [ ] YES [440
WELLS: PUBLIC: FT LIMITED USE °f'. A FT PRIVATE ::' FT NON - POTABLE: a FT
BUILDING FOUNDATIONS: _ ' FT PROPERTY LINES: FT POTABLE WATER LINES: %; FT
SITE SUBJECT TO FREQUENT FLOODING: [ ] YES [= j - NCO 10 YEAH FLOODING? [ ] YES -. [ 1 - NO
10 YEAR FLOOD ELEVATION FOR SITE: FTMSL /4GVD SITE ELEVATION: PT MSL /NGVD
SOIL PROFILE INFORMATION SITE 2
Munsell # /Color Texture Depth
(- to
to
to
to
to
to
to
to
to
USDA SOIL SERIES:
OBSERVED WATER TABLE: INCHES [ABOVE / BELOW] EXISTING GRADE. TYPE:_I?ERCHED / APPARENT -
ESTIMATED WET SEASON WATER TABLE ELEVATION: INCHES [ ABOVE / BELOW] EXISTING GRADE.
HIGH WATER TABLE VEGETATION: [ ] YES [ } - - NO MOTTLING: [ ] YES [A -'N0 DEPTH: -- -- -INCHES
SOIL TEXTURE /LOADING RATE FOR SYSTEM SIZING: DEPTH OF EXCAVATION: 5':' INCHES
DRAINFIELD CONFIGURATION: [ ] TRENCH [ ; 1 ,. -BED [ ] OTHER (SPECIFY)
REMARKS /ADDITIONAL CRITERIA:
DATE:
Per
"S u`:171: 1:ONS:
is J.'in: U: Permit tracking ru._2 ec assigned by C7 -KUT.
A ?i ri�HCANZ�: Property owner's Cull name.
ACE NT: Property owcerr':,1egally authored reprocE ctive.
OQ, BLOC'S, SU3DEV.°.SHON: Lot, blocks, and subdivision for lot.
3O, ?ERtT'tr IiDt /: 27 character number for property. (property appraiser ID 0 CC c.;ctiort/townShi- s /:Eng; /i:c^sc7 number)
?ROPzaTY a:ZE: Check if properly sire at site conforms to nub:titted site plan. "accord not :Table .roc cvciicb:e -
all paved areas and preprred road beds within public rights-of-way or easements n:_s; cnclun've of =3=5, rose,,
normally we drainage ditches, marshes, or o hen such bodies of victor.
SEWAGE O�Y:
".1NO3S7:1JC^ O AREA:
M:NDaTiVI SETBACKS:
Record the estimated sewage 2s: i for ._ establishment from Table (-:.,_d.,rces) ea' ` :b!c 2 (ran -recido _fiat), ""E �tor
10D -6, IFAC. Record the cut :torzed sewage navy Toy +U}a rl 7:acd on r-,t scc'i_e arc find ester rah iy (:15C3
per day per ccr for private we ^ter cuppiicc and 25C0 opal yet ecru for ac pica). ::I W_c :ia ; z"r7c c !: a
does not equal of enceed CIO estimated sewage flow, the c ?-?!.icatio:n dcr2e6.
Record the equate feet of unabst a a cvaiic' ^!e and the c^tcant cW_ ed. 2
trines as large as the drernfieid absorption area and at !eon 75 pc :xc -, crc:tc; cr.ebcta.:c ^.sal ate:: r"�:.at :T::rt -�r•��_ -^
setbacks in Chapter 10D-6, ',PAC. The unobntruc^ ed aria mus3'�c co ?ig.:oaa is the drain ie7i:,.
E ENC iI ARX HNIFOLIMAT:ON: Record the locction of the benchmark. is using n curtreyoc'a bcnck.:' rs ::-:,cord the rs> ci c_avctio_a.
elevation of the proposed system site in relation (above or below) to the benchmark.
Record minimum setbacks which car. be meet to all listed features. Actuc: r:icccutv:r:e :3n must be recorded or °_`.'A°
for non applicably features. Features ore site plain or within 75 feet of the applicant ict =at be c_ ocsu:rc :. 77.1; 'csc.`a
of any public drinking well within /CD fee of the applicant's lot 211.uc3 also be verified.
'..COD :N;rORMAT)ON: Record information on lot's subject to flooding. For lots subject to flooding, record 10 year flood e :evc^ion for site c:
actual site elevation.
SOY.- PROFILE ',INFORMATION: Two roil profiles within the propoed abeorption area to a minimum depth of 6 feet or :oruMi are :.e ui ed.
identification will use USDA Soil Classification methodology (Muir ell colors and 'USDA coil tosstu ms). L erue^.in
be clearly documented. Provide USDA soil series if available, record °JNK" if the scene cam ca be determined.
WATER TABLE: Record the depth of the observed water table at the time of the evaluation. Mark "pcsci.ed° or °apparent° as
appropriate. Record the estimated wet seaean water table elevation based on site evaluations, USDA coil,:- e7c, and
hi: torical information. Indicate if theme is high water table vegetation pr :r,son1. ll diccte if mot3•sieg is pmt nt and
SOIL
TEXTURE: Record sail temp or loading rate for system sizing.
i'3;ETA7-7. Off' ILXCAVA7CN: II applicable record depth of cttcavation required. Record 'NA' if not cppiicable.
D:RAHNP; L, CONFIGURATION: Check drainfteld configuration required. If other, specify type.
A:;3D6I'EONA7,. :A:
SITE EVALUATED 3Y:
E::-EVAT:ON WORKSHEET
Record any additional remarks pertinent to site or installation. En. dosing required.
Signature of evaluator, title, and date of evaluation. Professional engineers must ma', all Issue :ma :Ion r fisric^.er2.
ELEVATION OF BENCHMARK / RIEFIERIENCIE POINT IIS:
i'IIENCH MARX SITE 1 SITE 2
[ S: -OT: 1-1.11. H.R.
HH.H. [ -1 SHOT [ -1 SHOT
ShTIE 3
HH.H.
[-1 SHOT
, J
1
I '
1 .111
4
- ' -
i
• -
•
• •
•
STATE OF FLORIDA
DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES
APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PERMIT
/
Permit Application Number
PART II - SITE PLAN
I ,
I ' I
I I
I I 1 I
, 1
I „
I 1 • •
11 '
I I
Notes • e-
By
7;1 ,
E /
Site Plan Submitted by
Plan Approved
•
,
HRS-H Form 4015, Feb 85 (Obsoletes previous editions which may not be used)
(Stock Number: 5744-002-4015-6)
iri,SIGNATURE
Not Approved
I
st,
/ •
77/ f1/1
ALL CHANGMMUST BE APPROVED BY THE COUNTY PUBLIC HEALTH UNIT
, 4 °
„
t
- • 1 -
• t'
I
(1)
2
TITLE
Date /
-
7 Lt
County Public Unit
Page 2 of 3
1
2
3
4
APPLICATION FOR:
[ ] New System
[ ] Repair
APPLICANT:
AGENT:
MAILING ADDRESS:
LOT:
PROPERTY ID #:
PROPERTY SIZE:
PROPERTY STREET ADDRESS:
DIRECTIONS TO PROPERTY:
Unit Type of
No Establishment
[ ] Garbage Grinders /Disposals
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
PROPERTY INFORMATION [IF LOT IS NOT IN A RECORDED SUBDIVISION, ATTACH LEGAL DESCRIPTION OR DEED]
[ ] Existing System [ ] Holding Tank [ ] Temporary /Experimental
[ ] Abandonment [ ] Other(Specify)
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.
BLOCK:
SUBDIVISION:
BUILDING INFORMATION [ ] RESIDENTIAL
DATE OF
SUBDIVISION:
[Section /Township /Range /Parcel No.] ZONING:
ACRES [Sgft /43560] PROPERTY WATER SUPPLY: [ ] PRIVATE- [ : PUBLIC
No. of
Bedrooms
]COMMERCIAL
PERMIT #
DATE PAID
FEE PAID $
RECEIPT #
TELEPHONE:
` ,
Building # Persons Business Activity
Area Sgft Served
For Commercial Only
[ ] Spas /Hot Tubs [ ] Floor /Equipment Drains
[ ] Ultra -low Voluie Flush Toilets [ ] Other (Specify)
APPLICANT'S SIGNATURE: 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)
/77.O N 702: Check type of permit, if' Oiir specify type in Wank.
Property owner's full name.
Telephone number fo: applicant or agent.
7 owner's legally cutho:ized reps
A:):D:171SS: ?.O. box or street, city, state mid zip see mailing add7eso applicant agent..
block, and subdivision fo: ot (recoa or utreco:ded subdivision). :f :•"ot .c.1'',"re lot
'.cgal description oa deed must Se attached.
Dfficial date of eubdivision iz co::nty plat bcolca (r 077 •
If:: into two of nim pair cls 7of parpoce .c...ceonveyins oi coasle • ,'"'!!"-::
:?!.71C:?1:.:17 27 character num.13 fo: proc:cty. (O-.1 reryi;:a c
Net usable ares of propetrty it -.el.es (2,560 or_vene
beds within public rights-of wry Cr.007.7'.07110 :24 mtalt.alvo of att-cams, rcc, -.1c: v. -• •
inch bodies of \VP707. anc..voc" rnd road. •• •.•, •
may be included in celculatirg lot arcn.
Check private or public.
l?Rol?ElITY ADDRESS: Street address for property. :or lots without en assigned street address, indicate street or 7 end locelc in ccunuy.
DIRECTIONS: Provide detailed instructions to lot or attach an area map shoving lot location
13:17...DING INFORMATION: Check residential or commercial.
l7...KTAt3L'SHMENT. : List type of establishment from Table I!, Chapter 10D-5, FAC. Exam.pks: sing!: id o mobil. :tome, fcaausant,
doctor's office.
NO. BEDROOMS: Count all rooms designed p for sleeping and those areas expet:tei to 7.: p:twids. :!ccping accommodations for
occupants.
13:117_DiNG AREA: Total square footc,ge of :11..1osed habitable ryes of dwelling unit, enzludirl. er t bed. 07 0:7:::71 fully
screened patios or decks. aas,r: on outside measurements for each stors of
Number of persons residing, using, or working in establishment. Fo reridcntJ establi, ons sic! ' fdresom
assumed.
DUSTNT-ISS AC'',77.1/1TY: For commercial applications only. List number of employees, shifts, and • informat•ori 1- !
Table 11, Chapter 10D-6, FAC.
FDCTURES Mark each listed fixture with number installed or °NA " if not applicable.
Signatur.:. of appli:ant or agent. Dale sh)li,:atior. cr,e clay submi:ted to d's Cr" l.'s: v. 7 end La...
AT.
-i.e _ : s:,.le, ..•
_ sr,v/f,v, s.! :•:•• - -
Latures, filled areas, dbent. un rcL. .
oilier pertinent facilities or ferturea on adjacent p1opet ifthe features om with '15 feet of the , e. . nt. . c:iio' cf :ny
public well within 200 feet of lot.
For residences, c floor plan (esidences) iowin rarrthea of bedrooms and building auct: of ce,.:11
ustalolishment c fios plan .1. the count fc.rbtar,k.: sftbe el! plumbing 4 art: typos,
features necessary to determine composition end quantity of wastewater.
1
r
DADE COUNTY DEPARTMENT
OF
PUBLIC HEALTH
1 1:‘, ,
). a
ld ..firn ,.� Fer (^.---
..w t i,-1a - 4a a _.:Aau,lA
A„, 8/6/65
,tom" . C5 - 264
DATE August 6 , 196 S fot thf; ^r( ^.ink
E: 7WSAPrm,V IS NO III1 i DED (0 COVER S1RUCIURAL DESIGN
4 UNIT APT. FOR
THE MR. HENNA LOCATED AT 705 NE 92nd St.
HAS BEEN REVIINED BY THIS DEPARTMENT AND APPROVED x UNAPPROVED
PROVIDED:
1. For sewage disposal install a 1400 gallon septic tank and
336 square feet of block type drainfield as indicated on the
plans. A precast 1200 gal. septic tank with sidewalls built up to
afford a capacity of 1400 gals. may be used.
2. The finished ground elevation at the building and over the septic
tank drainfield shall be not less than the flood criteria for this
area
3. Excavate the drainfield trenches through all fill and impervious
material and extend at least 12" into the underlying pervious soil.
4. All drainfield trenches that extend more than 30" below the flood
criteria of this area shall be backfilled with an approved filter
type sand upward to an approved drainfield installation. The depth
of sand will vary in accordance with the depth of the trench, but
in no case shall the depth of sand be less than 24 ".
5. The water supply for this building will be obtained from the
City of Miami water distribution system.
6. All water lines shall be located a minimum horizontal distance
of 10' from all septic tanks, drainfields, sewer lines, etc.
7. The plumbing layout, sizes and slopes shall be approved by the
Village of Miami Shores Plumbing Department before installation.
8. The owner shall maintain these facilities in a sanitary condition
at all times. In the event that the sear, =_ disposal facilities prove
to be inadequate, it shall be the owners responsibility to immediately
install adequate facilities.
9. There may be county, municipal or other local regulations or
restrictions to be complied with by the : Dwner prior to c^nstruction
of the facilities represented by the referred to plans and we
therefore recommend that appropriate local agencies be consulted
before starting construction.
10. Construction on this project must be commenced within one year
from the date of th.s ap; - :oval otherwise plans and specifications
must be resubmitted for approval by this department.
P.
Permit No
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
Date
//
/ el/5
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
Registered Architect and /or Engineer
Employing Plumber's Name J °
Location and Legal Description Lot G�jBI Subd
Street and Number where work is to be performed —No �,� 1r ° , c iA-4/ 1 - 1( Street.
State work to be performed and purpose of building (By Floors)-
Size Septic Tank.-
)1/
Feet of Drain Tile______ g
Amount of Permit $
STATE OF FLORIDA, I
COUNTY OF DADE.
My Commission Expires
No.
Type of Tank
Building _- Remodeling -- - -.- _ -_ --- Addition Repairs
. Feet of Tank or Drain Field from Well
Street -
Capacity Gals.
Nature of Water Supply: City— Well. ____ _Size of Soakage Pit
(Signed) _----- - -�--� � :' - - -- � ... . .. .. ....._
Plumbing Inspector.
The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations as employer of labor
under the Florida Workmen's Compensation Act, being Section 5986, Compiled General Laws of Florida Permanent Supp etnent, and has com-
plied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors employed by iim 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 perinit. as are
licensed by Miami Shores Village.
No. of Stories.... ........... . ...
(Signed) _ 7 ___._._- _____1._ -- _ ? _ - .
aer 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.
Notary Public, State of Florida
NOTE: A re- inspection fee of $1.00 will be made when such re- inspection is made necessary by improper notice for inspection, or faulty
materials and /or worlcmanship.
CLOSERS
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
P.
Permit No
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
Date
//
/ el/5
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
Registered Architect and /or Engineer
Employing Plumber's Name J °
Location and Legal Description Lot G�jBI Subd
Street and Number where work is to be performed —No �,� 1r ° , c iA-4/ 1 - 1( Street.
State work to be performed and purpose of building (By Floors)-
Size Septic Tank.-
)1/
Feet of Drain Tile______ g
Amount of Permit $
STATE OF FLORIDA, I
COUNTY OF DADE.
My Commission Expires
No.
Type of Tank
Building _- Remodeling -- - -.- _ -_ --- Addition Repairs
. Feet of Tank or Drain Field from Well
Street -
Capacity Gals.
Nature of Water Supply: City— Well. ____ _Size of Soakage Pit
(Signed) _----- - -�--� � :' - - -- � ... . .. .. ....._
Plumbing Inspector.
The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations as employer of labor
under the Florida Workmen's Compensation Act, being Section 5986, Compiled General Laws of Florida Permanent Supp etnent, and has com-
plied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors employed by iim 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 perinit. as are
licensed by Miami Shores Village.
No. of Stories.... ........... . ...
(Signed) _ 7 ___._._- _____1._ -- _ ? _ - .
aer 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.
Notary Public, State of Florida
NOTE: A re- inspection fee of $1.00 will be made when such re- inspection is made necessary by improper notice for inspection, or faulty
materials and /or worlcmanship.
MIAMI SHORES VILLAGE, FLORIDA
BUILDING ❑ DATE ii ` 19 t 1
ELECTRICAL ° PERMIT N9 s 9 s 5 Contractor's
PLUMBING ® License No. `
ROOFING ❑
❑ Work to be performed under this Permit
Owner of
Building
Architect
Contractor
or Builder
Legal
Description
EL I
r'
Lot
B1
Subdi-
vision
, y r.)
Address of ! Value of 11 Amount of
Building • t Project $ 11 Permit $
This permit is granted to the contractor or builder named above to construct the building or to install the equipment or device described in the applica-
tion herefor in strict compliance with all ordinances pertaining thereto and with the understanding that the work will be performed in compliance with any
plans, drawings, statements or specifications that may have been submitted to and approved by the proper municipal authorities. This Permit may be revoked
at any time if the work is not done in compliance with such ordinances or if the plans are changed without authorization. A further condition upon which this
permit is granted is the understanding that the contractor or builder named above assumes the responsibility for a thorough knowledge of the ordinances and
regulations pertaining to the work covered hereby whether shown on the plans or drawings or in the statements or specifications and that he assumes respon-
sibility for work done by his agents, servants or employees.
Signed.
f "` .INSPECTOR
In consideration of the issuance to me of this permit I agree to perform the work covered hereunder in compliance witli 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 as
cepting this permit I assume responsibility for all work done by either, myself, my agent,,,servant or employee.
i. .'f i �, f 5 '• ., .. f �
. A 4 $ , .. �, , 1. `
.2.„4 , . , , ,,
-. 4' {' , d f J ' f ,l A' .t, '.',..4.1 . - --Yei-a� °
CONTRACTOR OR BUILDER BY AUTHORITY • SOOT