PLUMBING PERMITPERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Date AD Job Address d' & /J., f S/m4 Tax Folio
Legal Description Historically Designated: Yes 1 No
Owner/Lessee / Tenant O ' ` � - Zen a Z Master Permit # ? L
Owner's Address 7A /NA= f 2 S /M.. ( • Phone 3° S 1(7- a� v f
Contracting Co. / 1/ / / C ' C s ) `� L jr G r - � , l /l� Address ��J �/ 3 L Al ,—
Qualifier X-7-e- /e,, C• c -‘/rJ SS# Phone 5b5 ‚‚ -- T it f
State # Municipal # Competency # Ins. Co.
Architect/Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIPTION
Square Ft / ° u v Estimated Cost (value) .E5
5
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 OF 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 ow r aand/or Con do Pr si en
t
ss s
FEES: PERMIT (Ns4 RADON
APPROVED:
Zoning Building
Mechanical Plumbing
7/4-e-z- /ae__
Dafe
Notary as . • (� ' F � � elNlt l ate
comrT: s , ..•
My Commis
Signature of ontractor or Owner- der Date
as to Contr actor r b 4 it.. `t
sires .�a VELT,C Sig S D
cotagssi.V No.
No
My Commission E
C.C.F. I • - ° NOTARY
Electrical
7 -1f6
BOND °
/ U
TOTAL DUE �� b
Engineering
CONSTRUCTION PERMIT FOR:
[ t) New System ( 4 Existing System (.�) Holding Tank [ c }'Temporary /Experimental
V.1] Repair (�' *.,h Abandonment [A 'g Other(Specify)
APPLICANT:
LOT:
PROPERTY ID #:]
0
T
H
E
R
SPECIFICATIONS BY:
APPROVED BY:
DATE ISSUED:
STATE OF FLORIDA
DEPARTMENT OF HEALTH
ONSITE SEWAGE DISPOSAL SYSTEM
CONSTRUCTION PERMIT
Authority: Chapter 381, FS & Chapter 10D -6, FAC
PROPERTY STREET ADDRESS: 4 v r
BLOCK:
E e
SUBDIVISION: . .3: ,
DH 4016. 10/96 (Replaces HRS -H Form 4016 (page 11 which may be used)
(Stock Number: 5744 -001 - 4016 -0)
Applicant
AGENT: -e y� j
TITLE:
PERMIT ,f` ✓r_ ? E
DATE PAID Ir. r �
FEE PAID $
RECEIPT ,
[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 PE12MITS AND HOLDING TANK PERMITS EXPIRE 90 DAYS FROM THE DATE OF ISSUE. ALL OTHER
PERMITS EXPIRE ONE YEAR FROM THE DATE OF ISSUE. DEPARTMENT OF HEALTH APPROVAL OF SYSTEM DOES
NOT GUARANTEE SATISFACTORY. PERFORMANCE FOR ANY SPECIFIC PERIOD OF TIME. ANY CHANGE IN MATERIAL
FACTS WHICH SERVED AS A BASIS FOR ISSUANCE OF THIS PERMIT REQUIRE THE APPLICANT TO MODIFY THE
PERMIT APPLICATION. SUCH MODIFICATIONS MAY RESULT IN THIS PERMIT BEING MADE NULL AND VOID.
SYSTEM DESIGN AND SPECIFICATIONS
rl T [p ` - � [GALLONS / GPD] StPTIC TANK /AEROBIC UNIT CAPACITY MULTI- CHAMBERED /IN SERIES:O
A [ 1 [GALLONS / GPD] __ CAPACITY MULTI- CHAMBERED /IN SERIES:( )
N [ ] GALLONS GREASE INTERCEPTOR CAPACITY [MAXIMUM CAPACITY SINGLE TANK: 1250 GALLONS)
K [ 1 GALLONS PER DOSE DOSING TANK CAPACITY DOSE RATE [ ] PER 24 HRS NO. OF PUMPS: [ )
D [!4. SQUARE FEET PRIMARY DRAINFIELD SYSTEM
R [ ] SQUARE FEET SYSTEM
A TYPE SYSTEM: [) STANDARD F # ) FILLED [' J MOUND (•
I CONFIGURATION: ( "> ] TRENCH [ s,) BED [r,-;_ J
N
F LOCATION OF BENCHMARK: it � ,� , `° � �� "a Ur �w4• «_ ,M �, � �. y r� 0 , h`
I ELEVATION OF PROPOSED SYSTEM SITE [' 5 J
E BOTTOM OF DRAINFIELD TO BE ,i ]
L
D FILL REQUIRED: [ l %? r ] INCHES EXCAVATION REQUIRED: [ r ,` \ ) INCHES
(INCHES /FT)r[ABOVE /BgLoW) BENCHMARK /REFERENCE POINT
[ INNIHES /FT f [ABOVE /B BENCHMARK /REFERENCE POINT
1 @!
k
7. /44
- x.33 ' "4 6 1
TITLE: CHD
EXPIRATION DATE: k '
Page 1 of 2
INSTRUCTIONS:
PERMIT NUMBER: Permit tracking number by County Health Department.
APPLICATION FOR: Check type of permit; if "Other" specify type in blank.
APPLICANT: Property owner's full name.
TELEPHONE: Telephone number for applicant or agent.
AGENT: Property owner's legally authorized representative.
MAILING ADDRESS: P.O. box or street mailing address for applicant or agent.
LOT, BLOCK, SUBDIVISION or
PROPERTY ID#: 27 character ID number for property. (Health Department may require property appraiser ID# or
section /township /range /parcel number.)
SYSTEM DESIGN AND
SPECIFICATIONS:
TANK: Minimum specifications from Chapter 10D -6, FAC.
DRAINFIELD: Minimum specifications from Chapter 1OD -6, FAC.
OTHER: Other specifications, such as operating permit requirements, low- volume flush toilets, variance provisos.
SPECIFICATIONS BY: Name of individual providing specifications. If designed by a registered engineer must be sealed.
APPROVED BY: County Health Department personnel reviewing and approving permit.
DATE ISSUED: Date permit is issued by County Health Department.
s
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.
I I too
.
,444■4•44.4..........444.......,4•4•
Notes:
11
Site Plan Submitted by_
Plan Approved
STATE OF FLORIDA
DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES
APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PERMIT ,
- •.
S-H Form 4015, Fcb 85 (Obsoletes previous editions which may not be used)
- Number 5744-00?-4015-6)
PART II SITE PLAN
..,=••••••
SIGNATURE
Not Approved
By
Permit Application Number
„ y of
- -1;13
77 440 n
• j
. ,
eyu. L 11 / a
trY
ALL CHANGES MUST BE APPROVEDSY THE COUNTY PUBLIC HEALTH UNIT
Ze.../ rrit voeC-
1
TITLE
, 6 7 '
e • •/:' • .4-
County Public Unit
Page 2 of 3
Owner's Name and Address Sion
Registered Architect and /or Engineer �- _
/ E lo cur ' =, Q �o i it
t I'S 014 leek
1t;ow Legal Pti
Street and Number where work is to be performed —No
Size Septic Tank._ -
Feet of Drain Tile.
—
Nature of Water Supply: City —Well.
Amount of Permit $-2 a
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
Permit No 2/15'114
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 et
building during progress of work.
.6'S No 72_6 Streetly i q
Block Subdivision d.,
Street B.
� q s
N.� .. � � "
State work to be performed and purpose of building (By Floors)_ —._._ - 4�rt - - -.4 �._ r D /1 /4104
New Building. -__. _ — ..... . Remodeling..___..._. _._._— Addition.. _.._ _..__..... Repairs V No. of Stories ..
— Type of Tank--_ -
_Dist Feet of Tank or Drain Field from Well ..._.__
Size of Soakage Pit
(Signed)-
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 hax com-
plied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors oye c by him in the worry to he
performed under this permit; and will post or cause to be posted' for inspection on the site of the work public • ce or notices u an.-
required by the Act. The undersigned agrees to employ only such sub - contractors, on work to be ` � � '� er this permit, as are
licensed by Miami Shores Village.
(Signed)
STATE OF FLORIDA, 1
COUNTY OF DADE.
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeared
Plumbing Inspector.
Master Plumber.
c7. 7
to me well known, and who, being by me first duly = worn, upon oath deposes and says that he is the - - -.._ .._ ......_. -.. -.. _ _ ..._.
of the above described construction, that be has carefully read the foregoing application, and that he did sign the trams, and that all facts
therein by him stated are true.
My Commission Expires Notary Public, State of Florida
NOTE: A re- inspection fee of $1.00 will be Brach when mice se- baspaotbe le oadernaossemy by improper notice for Wrpaction, or faulty
materials Sad /or workmanship.
CLoscrs
BATH
TUS•
SHOWERS
LAVA.
TORIES
SINKS
SLOP
$INKS
LAUNORY
Twos
UR INALS
CATCH
BASIN
FLOOR
DRAIN
DRINKING
FOUNT'N•
TOTAL
•IETURES
Gwent.
LIST
-
CHECK
+
SEPTIC
TANK
SEWER
CONN.
DRAIN
FIELD
SOAKAGE
PIT
G
TRAP
SOLAR
HEATER
DEEP
WELL
S
SYSTEM
SW1M
POOL
CONTR.
LIST
CHECK
r-
Owner's Name and Address Sion
Registered Architect and /or Engineer �- _
/ E lo cur ' =, Q �o i it
t I'S 014 leek
1t;ow Legal Pti
Street and Number where work is to be performed —No
Size Septic Tank._ -
Feet of Drain Tile.
—
Nature of Water Supply: City —Well.
Amount of Permit $-2 a
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
Permit No 2/15'114
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 et
building during progress of work.
.6'S No 72_6 Streetly i q
Block Subdivision d.,
Street B.
� q s
N.� .. � � "
State work to be performed and purpose of building (By Floors)_ —._._ - 4�rt - - -.4 �._ r D /1 /4104
New Building. -__. _ — ..... . Remodeling..___..._. _._._— Addition.. _.._ _..__..... Repairs V No. of Stories ..
— Type of Tank--_ -
_Dist Feet of Tank or Drain Field from Well ..._.__
Size of Soakage Pit
(Signed)-
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 hax com-
plied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors oye c by him in the worry to he
performed under this permit; and will post or cause to be posted' for inspection on the site of the work public • ce or notices u an.-
required by the Act. The undersigned agrees to employ only such sub - contractors, on work to be ` � � '� er this permit, as are
licensed by Miami Shores Village.
(Signed)
STATE OF FLORIDA, 1
COUNTY OF DADE.
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeared
Plumbing Inspector.
Master Plumber.
c7. 7
to me well known, and who, being by me first duly = worn, upon oath deposes and says that he is the - - -.._ .._ ......_. -.. -.. _ _ ..._.
of the above described construction, that be has carefully read the foregoing application, and that he did sign the trams, and that all facts
therein by him stated are true.
My Commission Expires Notary Public, State of Florida
NOTE: A re- inspection fee of $1.00 will be Brach when mice se- baspaotbe le oadernaossemy by improper notice for Wrpaction, or faulty
materials Sad /or workmanship.
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
Permit No. I
Uri
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, . - • . •• herein specified or not. A copy of approved plans and specifications must be kept at
building during progress of w
Owner's Name and Address
Size Septic Tank—
Feet of Drain Tile
Nature of Water Supply: City —Well.
No 2 Street_.!", 4° .1 92
Registered Architect and /or EnOneer
Employing Plumb's NamQA I - Vfw' 1I'heti? . em t(' 7;V - -.r... No, ItrNR. .: '
Location and Legal Description Lot. Blom Subdiv on. ._ � . y .
Street and Number where work is to be performed —No Street.. L � r ._. __ '
2.
State work to be performed and purpose of building (By Floors) _ Ate= -.6 . .200 6i `f ' _ jH°v't " 4v ' ( j 2 _! $ '
New Building.__ ._._.._ _ _ Remodeling—__.—.._.__ Addition.. __-- ..____... Repairs 1,.' No. of Stories. .. ... ......... .....
Type of Tank_____ — - -- - _ -... -- -Capacity Gals.
_Dist. Feet of Tank or Drain Field from Well..._ _ _
Size of Soakage Pit..
Permit $ .._
Amount of (Signed) _ ► ` I_1Nkt .. . lu
P mbing 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 5968, 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 e , .loyed by him in the work to be
performed under this permit; and will post or cause to be posted for inspection on the sit the work c public notice or notices as are
required by the Act. The undersigned agrees to employ only such sub- contractors, to this permit, as are
licensed by Miami Shores Village.
STATE OF FLORIDA, 1
COUNTY OF DADE. j
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 be has carefully read the foregoing application, and that be did sign the nuns, and that all facts
therein by him stated are true.
M Commission Expires Notary Public, State of Florida
NOTE: A re- inspection fee of $1.00 will be made whoa snob re•kaspectbn is made•aemesery by improper notice for inspection, or fault'
materials and/or warkmsnabip.
CLOSETS
BATH
TUSS
gNOW[R/
LAVA.
TORIES
SINKS
SLOP
SINKS
LAUNDRY
TUSI1
URINALS
CATCH
BASIN
FLOOR
DRAIN
DRINKING
FOUNT' NS
TOTAL
FIXTURES
CONT1.
LIST
CHECK
SEPTIC
TANK
SEWER
CONN.
DRAIN
FIELD
SOAKAGE
PIT
GREASE
TRAP
SOLAR
NEATER
DEEP
WELL
SYSTEM
SWIM'G
POOL
CONTR.
ST
L IST
CHICK
�-
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
Permit No. I
Uri
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, . - • . •• herein specified or not. A copy of approved plans and specifications must be kept at
building during progress of w
Owner's Name and Address
Size Septic Tank—
Feet of Drain Tile
Nature of Water Supply: City —Well.
No 2 Street_.!", 4° .1 92
Registered Architect and /or EnOneer
Employing Plumb's NamQA I - Vfw' 1I'heti? . em t(' 7;V - -.r... No, ItrNR. .: '
Location and Legal Description Lot. Blom Subdiv on. ._ � . y .
Street and Number where work is to be performed —No Street.. L � r ._. __ '
2.
State work to be performed and purpose of building (By Floors) _ Ate= -.6 . .200 6i `f ' _ jH°v't " 4v ' ( j 2 _! $ '
New Building.__ ._._.._ _ _ Remodeling—__.—.._.__ Addition.. __-- ..____... Repairs 1,.' No. of Stories. .. ... ......... .....
Type of Tank_____ — - -- - _ -... -- -Capacity Gals.
_Dist. Feet of Tank or Drain Field from Well..._ _ _
Size of Soakage Pit..
Permit $ .._
Amount of (Signed) _ ► ` I_1Nkt .. . lu
P mbing 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 5968, 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 e , .loyed by him in the work to be
performed under this permit; and will post or cause to be posted for inspection on the sit the work c public notice or notices as are
required by the Act. The undersigned agrees to employ only such sub- contractors, to this permit, as are
licensed by Miami Shores Village.
STATE OF FLORIDA, 1
COUNTY OF DADE. j
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 be has carefully read the foregoing application, and that be did sign the nuns, and that all facts
therein by him stated are true.
M Commission Expires Notary Public, State of Florida
NOTE: A re- inspection fee of $1.00 will be made whoa snob re•kaspectbn is made•aemesery by improper notice for inspection, or fault'
materials and/or warkmsnabip.
BUILDING
ELECTRICAL
PLUMBING
ROOFING
Owner of / ?
Building
Architect
Contractor
or Builder i
Legal
Description
Lot
MIAMI SHORES VILLAGE, FLORIDA
DATE 19
o PERMIT
0
0
Address of , Value of I Amount of
Building � r " Project $ I 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: ' INSPECTOR
In consideration of the issuance to me of this permit I agree to perform the work covered hereunder in compliance with all ordinances and regulations
pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In. .ac
ceptinq this permit I assMtte responsibility for all work done by either, myself, my agent, servant or employee.
.'
J
CONTRACTOR OI(BUILD ' BY AUTHORITY ABBOT i,.
B1
N? 5973
Work to be performed under this Permi
Contractor's I -
License No.
Subdi-
vision
c 1 iqc4--
1
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. g 6 a —
Owner's Name and Address A J_f ,,➢ -) . _ No. --__ 7 -- .__ -- Street_ E9? 6
Permit No S 1 S
Registered Architect and /or Engineer_____
Employing Plumber's Name / � Imo_' 1 D ' i f ea
Location and Legal Description Lot - - - - -- _ - - - - -- __ - --_ -- -._ - -- Block_
Street and Number where work is to be performed —No St m t_
State work to be performed and purpose of building (By Floors) _.___._____.2. &_.__ g t _Or K
New Building ___ Remodeling___ -- .. Addition.-•_ -- -_. Repairs
Amount of Permit $_
My Commission Expires
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
e we. J< No.____ — . 1- Street- Ai &
Date__
Subdivision_
No. of Stories.
Size Septic Tank. Type of Tank Capacity Gals.
Feet of Drain Tile _Dist. Feet of Tank or Drain Field from Well
Nature of Water Supply: City —Well.
_Size of Soakage Pit
(Signed)_
lumbing Inspe ar,
The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligati as an employer of labor
under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Permanent pplement, and has com-
plied with the provisions thereof, and will require similar compliance from all contractors or sub -contr ors e ployed by him in the work to be
performed under this permit; and will post or cause to be posted' for inspection on th • : of the ork suc public notice or notices as are
required by the Act. The undersigned agrees to employ only such sub - contract s, on ork o be per rm under this permit, as are
licensed by Miami Shores Village.
STATE OF FLORIDA, }
COUNTY OF DADE.
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeared
to me well known, and who, being by me first duly sworn, upon oath deposes and says that he is the
of the above described construction, that he has carefully read the foregoing application, and that he did sign the same, and that all facts
therein by him stated are true.
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 workmanship.
CLOSETS
BATH
TUBS
SHOWERS
LAVA-
TORIES
SINKS
SLOP
SINKS
LAUNDRY
TUBS
U
URINALS
CATCH
BASIN
FLOOR
DRAIN
DRINKING
FOUNT•N6
TOTAL
FIXTURES
CONTR.
LIST
_
CHICK
SEPTIC
TANK
SEWER
CONN.
DRAIN
FIELD
SOAKAGE
PIT
GREASE
TRAP
SOLAR
HEATER
DEEP
WELL
SPRKLR.
SYSTEM
SWIM•G
POOL
CONTR.
LIST
CuEeK
c 1 iqc4--
1
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. g 6 a —
Owner's Name and Address A J_f ,,➢ -) . _ No. --__ 7 -- .__ -- Street_ E9? 6
Permit No S 1 S
Registered Architect and /or Engineer_____
Employing Plumber's Name / � Imo_' 1 D ' i f ea
Location and Legal Description Lot - - - - -- _ - - - - -- __ - --_ -- -._ - -- Block_
Street and Number where work is to be performed —No St m t_
State work to be performed and purpose of building (By Floors) _.___._____.2. &_.__ g t _Or K
New Building ___ Remodeling___ -- .. Addition.-•_ -- -_. Repairs
Amount of Permit $_
My Commission Expires
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
e we. J< No.____ — . 1- Street- Ai &
Date__
Subdivision_
No. of Stories.
Size Septic Tank. Type of Tank Capacity Gals.
Feet of Drain Tile _Dist. Feet of Tank or Drain Field from Well
Nature of Water Supply: City —Well.
_Size of Soakage Pit
(Signed)_
lumbing Inspe ar,
The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligati as an employer of labor
under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Permanent pplement, and has com-
plied with the provisions thereof, and will require similar compliance from all contractors or sub -contr ors e ployed by him in the work to be
performed under this permit; and will post or cause to be posted' for inspection on th • : of the ork suc public notice or notices as are
required by the Act. The undersigned agrees to employ only such sub - contract s, on ork o be per rm under this permit, as are
licensed by Miami Shores Village.
STATE OF FLORIDA, }
COUNTY OF DADE.
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeared
to me well known, and who, being by me first duly sworn, upon oath deposes and says that he is the
of the above described construction, that he has carefully read the foregoing application, and that he did sign the same, and that all facts
therein by him stated are true.
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 workmanship.
� '�
CLueeTS
BATH
TU86
SNOW
LAVA.
TORIES
SINKS
SLOP
SINKS
LAUNDRY
TUDB
URINALS
CATCH
BASIN
FLOOR
DRAIN
DRINKING DRINK
FOUNT' NS
TOTAL
FIXTURES
CONT...
LIST _
CHSCK
T --
` -. ...
........■•--`
SEPTIC
TANK
SEWER
CONN.
DRAIN
FIELD
SOAKAGE
PIT
GREASE
TRAP
SOLAR
HEATER
DEEP
WELL
SPRKLR.
SYSTEM
SW IM•G
POOL
COW. C2.
LIST
CHECK
-
Gat :�3 . _
Applicz: Ion is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the building or other
strl:ctu-c herein described. This application is made in compliance and conformity with the Building Ordinance of Miami Shores Village, Florida,
an 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 Minrei 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.
Ow+i 's Name and Address lr't1 - --
Registe.ed Architect and/or ,E gineer_
Employing Plumber's Nau>�P .4,1neLl _
Size Septic Tank ?T . ,
Feet of Drain
My Commission Expires
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
Amount of Permit $- (Signed)___
Date
�''
No. 'I J t v _ ` 1 ) Street_.____ 9.V
No. -- -- Street.!
S bdivisio___
Nature of Water Supp : City — Well.______ ..... _ ....... - • --__ -- _... _____________Size of Soakage Pit
( Signed
Location and Legal Description Lot________ _ ._- .._.____— .Bll��o ck_
Street and Number where work is to be performed—No. 1,�/ `' //�__
&ate work to be performed and purpose of building (By Floors ) _-------------- .------ ____._..
New Building —_ Remodeling _ ____ Addition_..____ Repairs No. of Stories . . ........ ..............
Street
Type of Tank Capacity Gals
f_ Dist. Feet of Tank or Drain Field from Well
-/Y-6a
ss
Plu I• ing 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 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.
STATE OF FLORIDA, 1
COUNTY OF DADE.
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeared
to me well known, and who, being by me first duly sworn, upon oath deposes and says that he is the
of the above described construction, that he has carefully read the foregoing application, and that he did sign the same, and that all facts
therein by him stated are true.
Notary Public, State of Florida
Master Plumber.
NOTE: A re- inspection fee of $1.00 will be made when such re- inspection is made by improper notice for inspection, or faulty
matorals and /or workmanship.
Date _ ^ -- ..11_ -• -�
Ap;?lac:aiion is hereby i.iaae for the approval of the detailed statement of the plans and specifications herewith submitted for the building or, other
ctructe,:, hezcin 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
inii:''.ng during progress of work.
Owner's Name and Address__n_____ ` e1LL
Registered Architect and /or Engineer__________ . - M �•-- _-- ,------ -_____
Employing Plumber's Name -01.19- a� r � � < � "; .�
No.______ _ Street_ 4
_
Amount of Permit $_
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
Location and Legal Description Block_
Street and Number where work is to be performed —No
State work to be performed and purpose of building (By Floors)__ .............
New Building -___ -- _ Remodeling___- ___ Addition_
No .1//,..%C.0 Street
Size Sep•c Tank __._ __-- _- _--- _- _------ -_Type of Tank_
Fee of Drain ................. __________Dist Feet of Tank or Drain Field from Well
Nciore of Water Supply: City— Woll.__ ____— .............. ___._____.......... __-____-_Size of Soakage Pit
(Signed )
Subdivision -
Street - - -- 2 .
44 -y P--40
Repairs No. of Stories_ _
Capacity Gals
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 5988, Compiled General Laws of Florida Permanent Supplement, and has com-
plied with the previsions thereof, and will require similar compliance from all contractors or sub - contractors em oyed by him in the work to be
pericrmad under this permit; and will post or cause to be posted' for inspection on the site of the work su pblic notice or notices as • are
req-z rci by the Act. The undersigned agrees to employ only such sub- contractors, on w ork to be z perf ed.,under > this permit, as are
licensed by Miami Shores Village.
(Signed).
STATE OF FLORIDA,
COUNTY OF DADE. j
Before me, the undersigned authority, a notary public, duly authorized to administ oaths and take acknowledgments, personally appeared
My Commission Expires Notary Public, State of Florida
.vr
ter Plumber.
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.
SLOSETB
BATH
TUBS
SH
LAVA-
TORIES
SINKS
SLOP
SINKS
LAUNDRY
TUBS
URINALS
U
CATCH
BASIN
FLOOR
DRAIN
DRINKING
FOUNT'NS
TOTAL
FIXTURES
comm.
LIST
CHECK
SEPTIC
TANK
SEWER
CONN.
DRAIN
FIELD
SOAKAGE
PIT
GREASE
TRAP
SOLAR
HEATER
DEEP
WELL
SPRKLR.
SYSTEM
SWIM'G
POOL
CONTR.
LIST
CHECK
Date _ ^ -- ..11_ -• -�
Ap;?lac:aiion is hereby i.iaae for the approval of the detailed statement of the plans and specifications herewith submitted for the building or, other
ctructe,:, hezcin 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
inii:''.ng during progress of work.
Owner's Name and Address__n_____ ` e1LL
Registered Architect and /or Engineer__________ . - M �•-- _-- ,------ -_____
Employing Plumber's Name -01.19- a� r � � < � "; .�
No.______ _ Street_ 4
_
Amount of Permit $_
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
Location and Legal Description Block_
Street and Number where work is to be performed —No
State work to be performed and purpose of building (By Floors)__ .............
New Building -___ -- _ Remodeling___- ___ Addition_
No .1//,..%C.0 Street
Size Sep•c Tank __._ __-- _- _--- _- _------ -_Type of Tank_
Fee of Drain ................. __________Dist Feet of Tank or Drain Field from Well
Nciore of Water Supply: City— Woll.__ ____— .............. ___._____.......... __-____-_Size of Soakage Pit
(Signed )
Subdivision -
Street - - -- 2 .
44 -y P--40
Repairs No. of Stories_ _
Capacity Gals
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 5988, Compiled General Laws of Florida Permanent Supplement, and has com-
plied with the previsions thereof, and will require similar compliance from all contractors or sub - contractors em oyed by him in the work to be
pericrmad under this permit; and will post or cause to be posted' for inspection on the site of the work su pblic notice or notices as • are
req-z rci by the Act. The undersigned agrees to employ only such sub- contractors, on w ork to be z perf ed.,under > this permit, as are
licensed by Miami Shores Village.
(Signed).
STATE OF FLORIDA,
COUNTY OF DADE. j
Before me, the undersigned authority, a notary public, duly authorized to administ oaths and take acknowledgments, personally appeared
My Commission Expires Notary Public, State of Florida
.vr
ter Plumber.
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.
BUILDING
ELECTRICAL
PLUMBING
Owner of r'
Building
Lot
MIAMI SHORES VILLAGE, FLORIDA
DATE / / 194
E R M I T N? 6 013 Licensector s / C f
Work to be performed under this Permit A I'. r : r1'' l�
_.
Architect
Contractor/
or Builder
Legal
Description
Address of
Building
This per is granted to the contractor or builder named above to construct the building or to install the equipment or device described in e 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 and that he aI5 rues respon-
sibility for work done by his agents, servants or employees. 1./
Signed. By �' `�/ /
INSI O /
In consideration of the issuance to me of this permit I agree to perform the work covered hereunder i comp '(nce with all ordinances and regulations
pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village.
In accepting this permit I assume responsibility for all work done by either myself, my agent, servant or employee.
`?
✓
Bl.
Subdi-
vision
Value of
Project
e 6444/.4'4e-- 4 -°
CONTRACTOR OR BUIL BY
Amt. of ,r1'
Permit /1�
c
AUTHORITY
BUILDING
ELECTRICAL
PLUMBING
Owner of
Building
Architect
Contracto . f
or Builde
Legal Lot
Description
Address of
Building
MIAMI SHORES VILLAGE, FLORIDA
Subdi-
vision
BY
IN
DATE
194
E R M I T No 6 013 Contractor's /gq
License No.
Work to be performed under this Permit " fG� 4
This pe t is granted to the contractor or bui . er named above to construct the building or to install the equipment or device described in i e appli-
cation herefor i 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 responsibilik 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 sta ments orispecif and t.lie Imes respon-
sibility for work done by his agents, servants or employees. t
Signed.
By f- V
In consideration of the issuance to me of this permit I agree to perform the work covered hereunder ' compZfance with all ordinances and regulations
pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authoriti s of Miami Shores VilTage.
In accepting this permit I assume , responsibility for all work done by either myself, my agent, servant or employee.
CONTRACTOR OR BU DER
AUTHORITY
•