PLUMBINGDate Job Address syq ,,,(.)e_t 1 `l , Tax Folio / 1 • 32 06 06 0I9Z D
Legal Description Historically Designated: Yes No
Owner/Lessee / Tenant OQE2N &2O &f Master Permit # 4637 37 1r r
,
Owner's Address / A) 6- . 7., S Phone
Contracting Co. Gk/Zi /0,).e, e Address > 2742, ii ,
Qualifier ' J ' llie _ P4.ce/e- SS# Phone ; aI, 42 — '7; .Re
State #
Architect/Engineer
Bonding Company
Mortgagor Address
Permit Type (circle one): BUILDING ELECTRICAL LUMBING MECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIP'T'ION
Square Ft. J Oa
Notary as to Owner and/o
My Commis xpir-
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
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.
s�
Signature of owner and/or Condo • esident Date Signature of Contractor or Owner - Builder
Date
Z/°6
4111 1
r esl -`
Exp. 3/14100 Date
By Service Ins
No. CC5400s9 y
It ream Caow od I. B
FEES: PERMIT
Municipal #
APPROVED:
Zoning Building
Mechanical Plumbing
Competency #
Address
Address
Estimated Cost (value) 627 ' (1 Al
1
My Commiss
RADON C.C.F. / 0 NOTARY
2 / 4 -V C°
Ins. Co.
•n� actor or 0 er-B Date
:• �, _tir • ' ' VEGA
My 3/14/00
Boded By SWAG* ins
CCS400s9
tes a 11 ' ' !
Electrical
BOND �� C�
TOTAL liUE 30
Engineering
Scale: Each block represents 10 feet and 1 inch = 40 feet.
L
I
I I
Notes:
Site Plan submitted by:
Plan Approved
STATE OF FLORIDA
DEPARTMENT OF HEALTH
APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PERMIT
+ I
- t- —
PART II - SITEPLAN
I
4
Permit Application Number
ALL CHANGES MUST BE APPROVED BY THE COUNTY HEALTH DEPARTMENT
Not 4ppfdved Date -
By County Health Department
DH 4015, 10/96 (Replaces HRS -H Form 4015 which may be used) Page 2 of 4
(Stock Number: 5744 - 002 - 4015 -6)
CONSTRUCTION PERMIT FOR:
[ ] New System [ ] Existing System
[ ] Repair [ ] Abandonment
APPLICANT:
PROPERTY STREET ADDRESS:
LOT:
PROPERTY ID #:
SYSTEM MUST BE CONSTRUCTED IN ACCORDANCE WITH SPECIFICATIONS AND STANDARDS OF CHAPTER 10D -6,
FAC. REPAIR PERMITS AND HOLDING TANK PERMITS EXPIRE 90 DAYS FROM THE DATE OF ISSUE. ALL OTHER
PERMITS EXPIRE ONE YEAR FROM THE DATE OF ISSUE. DEPARTMENT OF HEALTH APPROVAL OF SYSTEM DOES
NOT GUARANTEE SATISFACTORY PERFORMANCE FOR ANY SPECIFIC PERIOD OF TIME. ANY CHANGE IN MATERIAL
FACTS WHICH SERVED AS A BASIS FOR ISSUANCE OF THIS PERMIT REQUIRE THE APPLICANT TO MODIFY THE
PERMIT APPLICATION. SUCH MODIFICATIONS MAY RESULT IN THIS PERMIT BEING MADE NULL AND VOID.
SYSTEM DESIGN AND SPECIFICATIONS
T [
A [
N [
K [
D [ ] SQUARE FEET PRIMARY DRAINFIELD SYSTEM
R [ ] SQUARE FEET SYSTEM
A TYPE SYSTEM: [ ] STANDARD [ ] FILLED
I CONFIGURATION: [ ] TRENCH [ ] BED
N
F LOCATION OF BENCHMARK:
I ELEVATION OF PROPOSED SYSTEM SITE [
E BOTTOM OF DRAINFIELD TO BE [
L
D FILL REQUIRED: [ ] INCHES
0
T
E
R
SPECIFICATIONS BY:
APPROVED BY:
DATE ISSUED:
' 'STATE OF FLORIDA PERMIT #
DEPARTMENT OF HEALTH DATE PAID
ONSITE SEWAGE DISPOSAL SYSTEM FEE PAID $
CONSTRUCTION PERMIT RECEIPT #
Authority: Chapter 381, FS &
BLOCK: SUBDIVISION:
] [GALLONS / GPD] SEPTIC TANK /AEROBIC UNIT CAPACITY MULTI- CHAMBERED /IN SERIES:[ ]
] [GALLONS / GPD] CAPACITY MULTI- CHAMBERED /IN SERIES:(
] GALLONS GREASE INTERCEPTOR CAPACITY [MAXIMUM CAPACITY SINGLE TANK: 1250 GALLONS]
] GALLONS PER DOSE DOSING TANK CAPACITY DOSE •RATE [ ] PER 24 HRS NO. OF PUMPS: [ ]
DH 4016, 10/96 (Replaces HRS -H Form 4016 (page 1] which may be dSed)
(Stock Number: 5744- 001- 4016 -0)
Chapter 10D -6, FAC
[ ] Holding Tank [ ] Temporary /Experimental
[ J Other(Specify)
AGENT:
[SECTION /TOWNSHIP /RANGE /PARCEL NUMBER]
(OR TAX ID NUMBER]
[ } MOUND [
(
] [INCHES /FT] [ABOVE /BELOW] BENCHMARK /REFERENCE POINT
] [INCHES /FT] [ABOVE /BELOW] BENCHMARK /REFERENCE POINT
EXCAVATION REQUIRED: ( ) INCHES
TITLE:
TITLE: CHD
EXPIRATION DATE:
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 1OD -6, FAC.
DRAINFIELD: Minimum specifications from Chapter 10D -6, FAC.
OTHER: Other specifications, such as operating permit requirements, low- volume flush toilets, variance provisos.
SPECIFICATIONS BY: Name of individual providing specifications. If designed by a registered engineer must be sealed.
APPROVED BY: County Health Department personnel reviewing and approving permit.
DATE ISSUED: Date permit is issued by County Health Department.
EXPIRATION DATE: One year from date issued if the system has not been installed. Permits for system repairs become void 90 days from the
date issued.
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Date 4 -9 -01 Job AddressS99 N.E. 92nd Street Tax Folio
Legal Description Historically Designated: Yes No
Owner/Lessee / Tenant Marona Bradley Master Permit # 7 ,iy5
Owner's Address 899 N.E. 92nd Street, Miami Shores, F1 3313 P hone 305- 754 -4960
contracting Co. Coastal Plumbing Co. of Miami
Qualifier Robert E. Brincefield
Address
285 N.E. 185th Street, Miami, F1 33179
SS# Phone 305 - 651 -4429
State # CFCO -19042 Municipal # 6264 Competency # 6264 Ins. Co. Collinsworth, Alter,
et al.
Architect/Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type (circle one): BUILDING ELECTRICAL PLUMBIN MECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIPTION Replace existing Natural gas water heater
Square Ft. Estimated Cost (value) $200.00
WARNING TO OWNER: YOU MUST RECORD A NOTICE OF COMMENCEMENT AND YOUR FAILURE TO DO SO MAY RESULT IN YOUR
PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY (IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER
OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT.)
Application is hereby made to obtain a permit to do work and installation as indicated above, and on the attached addendum (if applicable). I certify that all work
will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that separate permits are required for ELECTRICAL
PLUMBING, SIGNS, POOLS, ROOFING and MECHANICAL WORK.
OWNERS AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating
construction and zoning. Furthermore, I authorize the above -named contractor to do the work stated.
/ 4 -9 -01
Signatur o' er • %►or Condo President Date
4 -9 -01
Notary as to Owner and/o Condo President Date
My Conunission Expires: .0%, Patricia Stover
:,, t* \* MY MY COMMISSION # CC839914 EXPIRES
„; June 28, 2003
BONDED THRU TROY FAIN INSURANCE, INC
FEES: PERMIT V Q
APPROVED:
Zoning Building
Mechanical Plumbing
7 /e/. ( erAe:,04 ' 4„x.e2efe-g-e;e
Signature of Contractor or Owner -Bui r
Notary as to Contractor or l er- Builder Date
My Commission Expires:
,� AYP� ••, Patricia Stover
r +4'%
MY COMMISSION # CC839914 EXPIRES
,; June 28, 2003
BONDED THRU TROY FAIN INSURANCE, INC.
RADON C.C.F. 40 NOTARY D ^ BOND
TOTAL DUE 4
Electrical
4 -9 -01
Date
4 -9 -01
Structural Engineer
ITEM
3ATH TUB
UNIT
FEE
ITEM
SWITCH OUTLETS
UNIT
FEE
ITEM
SPACE HEATERS
UNIT
FEE
3IDET
LIGHT OUTLETS
CENTRAL HEATING
DISHWASHER
RECEPTACLES
A/C (WIND)
DISPOSAL
SERVICE TEMPORARY
A/C (CENTRAL)
DRINKING FOUNTAIN
SERVICE SIZE IN AMPS
DUCT WORK
FLOOR DRAIN
SERVICE REPAIR/METER CHANGE
REFRIGERATION
GREASE TRAP
APPLIANCE OUTLETS
PROCESS AND PRESS PIPING
INTERCEPTOR
RANGE TOP
UNDERGROUND TANKS
LAVATORY
OVEN
ABOVE GROUND TANKS
LAUNDRY TRAY
WATER HEATER
U.F. PRESSURE VESSELS
CLOTHES WASHER
MOTORS 0- 1 HP
STEAM BOILERS
SHOWER
MOTORS OVER 1- 3 HP
HOT WATER BOILERS
SINK, POT /3 COMP.
MOTORS OVER 3- 5 HP
MECHANICAL VENTILATION
SINK, RESIDENCE
MOTORS OVER 5- 8 HP
TRANSPORTING ASSEMBLIES
SINK, SLOP
MOTORS OVER 8- 10 HP
ELEVATORS/ESCALATORS
TEMPORARY WATER CLOSET
MOTORS OVER 10- 25 HP
FIRE SPRINKLER SYSTEMS
URINAL
MOTORS OVER 25-100 HP
COOLING TOWERS
WATER CLOSET
MOTORS OVER 100 HP
VIOLATION
INDIRECT WASTES
A/C WINDOW
REINSPECTION
WATER SUPPLY 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
SWIMMING POOL
OUTLETS COWERCIAL
WATER SERVICE
SIGN TUBES
SEWER CONNECTIONS
SIGN TRANSFORMERS
UTILITY -SEWER
SIGN TIME CLOCK
UTILITY -WATER
FIXTURES
SEPTIC TANK
ANTENNA
RELAY
TELEVISION OUTLETS
DRAINFIELD, 4" TILE/RES.
VIOLATION
PUMP R. ABANDON SEPTIC TANK
REINSPECTION
SOAKAGE PIT CU. FT.
CATCH BASIN
DISCHARGE WELL
DOMESTIC WELL
AREA DRAIN
ROOF INLET
SOLAR WATER HEATER
FIRE STANDPIPE
POOL PIPING
LAWN SPRINKLER SYSTEM
3AS RANGE
METER SET (GAS)
3AS 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
P•
No
Owner's Name and Address
Amount of Permit $
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
Applica I Ill - • • '+ e approval of the d statement of the plans and specifications herewith submitted for the building or other
structure herein described. This application is made 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.
/,'dg
Registered Architect and /or Engineer ._—
Employing Plumber's Name - .:760L -"E z 0 e - "e/T ghth4f 6eJG 6'04/
Size Septic Taa]c_.— _- - - - - -- .- - - -_-- - Typo of Tam_ C
Feet of Drain Tile._.__ -- _- -Dist. Feet of Tank or Drain Field from Well. _.. - -_ —
Nature of Water Supply: City—Well. Size of Soakage Pit
(Signed)_
No.__. Street..._ ____....._... --
Location and Legal Description Lot. di
glom Subdivision.._......._ _. _�.
( l q c
Street and Number where work is to be performed —No v / / 1), E' Street. ,/ °� T
State work to be performed and purpose of building (By Floors) _ __._
New Building ._. -- Remodeling ._.__ V _ .__ Addition
Repairs
Plu g 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 5968, Compiled General Laws of Florida Permanent Sup.: ent, 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 notices as are
required by the Act. The undersigned agrees to employ only such sub - contractors, on work to be 1= under c�. snit, as are
licensed by Miami Shores Village.
Notary Public, State of F orida
No. of Stories
STATE OF FLORIDA, t se.
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.
My Commission Expires
NOTE: A re- inspection fee of $1.00 will be made when ezzls re- in,peotton is made necessary by improper notice for inspection, or faulty
materials and /or workmanship.
d
CLOSETS T
BATH L
SHOWER{ T
LAVA• 6
61NK{ S
SLOP L
LAUNDRY U
URINAL{ C
CATCH F
FLOOR D
DRINKING T
TOTAL
CONTR.
LIST
/
CHECK
•
SEPTIC S
SEWER D
DRAIN S
SOAKAGE G
GREASE S
SOLAR D
DEEP S
SPRKLR• S
SWIM'CI f
f;;a4g4..Qcc
�
CONTR.
LIST
CHECK
No
Owner's Name and Address
Amount of Permit $
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
Applica I Ill - • • '+ e approval of the d statement of the plans and specifications herewith submitted for the building or other
structure herein described. This application is made 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.
/,'dg
Registered Architect and /or Engineer ._—
Employing Plumber's Name - .:760L -"E z 0 e - "e/T ghth4f 6eJG 6'04/
Size Septic Taa]c_.— _- - - - - -- .- - - -_-- - Typo of Tam_ C
Feet of Drain Tile._.__ -- _- -Dist. Feet of Tank or Drain Field from Well. _.. - -_ —
Nature of Water Supply: City—Well. Size of Soakage Pit
(Signed)_
No.__. Street..._ ____....._... --
Location and Legal Description Lot. di
glom Subdivision.._......._ _. _�.
( l q c
Street and Number where work is to be performed —No v / / 1), E' Street. ,/ °� T
State work to be performed and purpose of building (By Floors) _ __._
New Building ._. -- Remodeling ._.__ V _ .__ Addition
Repairs
Plu g 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 5968, Compiled General Laws of Florida Permanent Sup.: ent, 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 notices as are
required by the Act. The undersigned agrees to employ only such sub - contractors, on work to be 1= under c�. snit, as are
licensed by Miami Shores Village.
Notary Public, State of F orida
No. of Stories
STATE OF FLORIDA, t se.
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.
My Commission Expires
NOTE: A re- inspection fee of $1.00 will be made when ezzls re- in,peotton is made necessary by improper notice for inspection, or faulty
materials and /or workmanship.
d
Permit No
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.
Oicner's Name and Address. .L ' ' (% --- --- ........ Y &k .5- No. __ Street
Registered Architect and /or Engineer __- - -_____
/ '� .G/
Employing Plumber's Nance, • - Adz -o e� - -- No.-------- - - - - -_ Street_.
Location and Legal Description Lot
Street and Number where work is to be performed —No
New Building Remodeling_
Size Septic Tank
Feet of Drain Tile_
Nature of Water Supply: City —Well
Amount of Permit $
My Commission Expires
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING ;L.AJOT
State work to be performed and purpose of building (By Floors)
Type of Tank_
_Dist. Feet of Tank or Drain Field from Well
__Size of Soakage Pit
Block__
Addition..._ Repairs No. of Stories. -
(Signed) _
bing Inspector.
The undersigned applicant for this building permit does hereby certify that he understands and acce t - is obligations as an employer of labor
under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Flori. a 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. e n
( Signed)
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 hire 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 worlmtanship.
Date' /.
Subdivision-------- - -__ -- - -- - ---- _ -_ - --
Street ‘,
Capacity Gals
Notary Public, State of Florida
Master Plumber.
CLOSETS
BATH
TUBS
SHOWERS
LAVA-
TToms 8
SINKS
SLOP
SINKS
LAUNDRY
TUBS
URINALS
I NALS
CATCH
BASIN
FLOOR
DRAIN
DRINKING
FOUNT' NS
TOTAL
FI %TURES
CONTR.
LIST
S9G
44' ' {l1':°
Ii.ft_
4C4,2
CHECK
SEPTIC
TANK
SEWER
CONN.
DRAIN
FIELD
SOAKAGE
PIT
GREASE
TRAP
SOLAR
HEATER
DEEP
WELL
SPRKLR.
SYSTEM
SW IM'O
POOL
CONTR.
LIST
CHECK
Permit No
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.
Oicner's Name and Address. .L ' ' (% --- --- ........ Y &k .5- No. __ Street
Registered Architect and /or Engineer __- - -_____
/ '� .G/
Employing Plumber's Nance, • - Adz -o e� - -- No.-------- - - - - -_ Street_.
Location and Legal Description Lot
Street and Number where work is to be performed —No
New Building Remodeling_
Size Septic Tank
Feet of Drain Tile_
Nature of Water Supply: City —Well
Amount of Permit $
My Commission Expires
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING ;L.AJOT
State work to be performed and purpose of building (By Floors)
Type of Tank_
_Dist. Feet of Tank or Drain Field from Well
__Size of Soakage Pit
Block__
Addition..._ Repairs No. of Stories. -
(Signed) _
bing Inspector.
The undersigned applicant for this building permit does hereby certify that he understands and acce t - is obligations as an employer of labor
under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Flori. a 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. e n
( Signed)
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 hire 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 worlmtanship.
Date' /.
Subdivision-------- - -__ -- - -- - ---- _ -_ - --
Street ‘,
Capacity Gals
Notary Public, State of Florida
Master Plumber.
BUII.DING
ELECTRICAL
PLUMBING
ROOFING •
Owner of
Building
II
Architect
Contractor
or Builder
Legal Lot
Description
Address of
Building � ! i J . +< : , . •
MIAMI SHORES VILLAGE, FLORIDA
PERMIT 'N? 12371
Work to be performed under this Permit
Bl.
r a '
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 application
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 in the statements or specifications and that, e assumes resjonsibilityy fo w rk
done by his agents, servants or employees.
Subdi-
vision
Value of
Project $
•
INSPECTO1%
In consideration of the issuance to me of this permit I agree t .4erform the work covered hereunder in compliance with all ordinances and regulations
pertaining thereto and in strict conformity with the plans, drawings, statements _pr specifications submitted to the proper authorities of Miami Shores Village.
yself, ply agent, servant or employee.
Signed•
In accepting this permit I assume responsibility for all work done by either
4
CONTRACTOR OR BUILDER
BY
DATE 11 i ` ° - j 1 195
Contractor's
License No
BY
Amt. of
Permit $
4
O tt
AUTHORITY
BUILDING
ELECTRICAL
PLUMBING
Contractor
or Builder d
Work to be performed under this Permit
Owner of
Building 1 1 , � = `; { £ ++� f =
Architect
MIAMI SHORES VILLAGE, FLORIDA
DATE /}
PERMIT N9 2414
Legal Lot
Description
• Address of Value of
Building t f r "' � ..r;. w ▪ 'f", Project
Bl.
Subdi-
vision
Amt. of
Permit
Contractor's
License No.
y , r .
1941
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
application 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 responsibility 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 regula-
tions 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.
CONTRACTOR OR BUILDER BY AUTHORITY
Permit No.._.i " "
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.
Owner's Name and Address No Street
Registered Architect and /or Engineer _:G/ E.__ ! r
Employing Plumber's Name _— No Street
Location and Legal Description Lot_________ ___ Subdivision_
Street and Number where work is to be performed —No /
Street__ ,,_.,__.y.— __ ,_: -I--_ 2 . 7
State work to be performed and purpose of building (By Floors) ____ 2 ��s1 -__ __ _ __; w :.1 'J' I L
Repairs No. of Stories _____.__..__
New Building _____________________________ Remodeling Addition
Size Septic Tank__ __ �— Type of Tank . Capacity Gals
Feet of Drain ________ ___ Dist. Feet of Tank or Drain Field from Well
Nature of Water Supply: City —Well — Size of Soakage Pit.
Amount of Permit (Signed)
Plumbing Inspector.
The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations as an employer of labor
under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Permanent Supplement, and has com-
plied with the provisions thereof, and will require similar compliance from all 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 under signed 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,
COUNTY OF DADE.
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally
ss.
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
Block
Date--- -- - -- - ---
r
(Signed)
Master Plumber.
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.
My Commission Expires 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
URINALS
CATCH
BASIN
FLOOR
DRAIN
DRINKING
FOUNT' NS
TOTAL
FIXTURES
CONTR.
LIST
CHECK
SEPTIC
TANK
SEWER
CONN.
DRAIN
FIELD
SOAKAGE
PIT
GREASE
TRAP
SOLAR
HEATER
DEEP
WELL
SPRKLR.
SYSTEM
SW IM'G
POOL
CONTR.
LIST
CHECK
Permit No.._.i " "
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.
Owner's Name and Address No Street
Registered Architect and /or Engineer _:G/ E.__ ! r
Employing Plumber's Name _— No Street
Location and Legal Description Lot_________ ___ Subdivision_
Street and Number where work is to be performed —No /
Street__ ,,_.,__.y.— __ ,_: -I--_ 2 . 7
State work to be performed and purpose of building (By Floors) ____ 2 ��s1 -__ __ _ __; w :.1 'J' I L
Repairs No. of Stories _____.__..__
New Building _____________________________ Remodeling Addition
Size Septic Tank__ __ �— Type of Tank . Capacity Gals
Feet of Drain ________ ___ Dist. Feet of Tank or Drain Field from Well
Nature of Water Supply: City —Well — Size of Soakage Pit.
Amount of Permit (Signed)
Plumbing Inspector.
The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations as an employer of labor
under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Permanent Supplement, and has com-
plied with the provisions thereof, and will require similar compliance from all 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 under signed 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,
COUNTY OF DADE.
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally
ss.
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
Block
Date--- -- - -- - ---
r
(Signed)
Master Plumber.
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.
My Commission Expires 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.
Permit No.
Owner's Name and Address { :rFLS.r
Registered Architect and /or Engineer - l';e .-=. . __
Employing Plumber's Name
Location and Legal Description Lot_
Size Septic Tank_
Feet of Drain Tile____
Amount of Permit $
My Commission Expires
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.
Street and Number where work is to be performed—No ._________ 7
Block__
o. Street
State work to be performed and purpose of building (By Floors) ____C1tl ef_
New Building _ Remodeling Addition 4 " Repairs
7 "
Date __
Street
Subdivision___
•
-e
No. of Stories____.
Type of Tank . Capacity Gals._
Dist. Feet of Tank or Drain Field from Well
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 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 under signed agrees to employ only such sub - contractors, on work to be performed under this permit, as are
licensed by Miami Shores Village. �,.•
(Signed)
Notary Public. State of Florida
Master Plumber.
STATE OF FLORIDA, }
COUNTY OF DADE. es.
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
2.
_g.._
2
CHECK
SEPTIC
TANK
SEWER
CONN.
DRAIN
FIELD
SOAKAGE
PIT
GREASE
TRAP
SOLAR
HEATER
DEEP
WELL
SPRKLR.
SYSTEM
SW IM'G
POOL
CONTR.
LIST
CHECK
Permit No.
Owner's Name and Address { :rFLS.r
Registered Architect and /or Engineer - l';e .-=. . __
Employing Plumber's Name
Location and Legal Description Lot_
Size Septic Tank_
Feet of Drain Tile____
Amount of Permit $
My Commission Expires
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.
Street and Number where work is to be performed—No ._________ 7
Block__
o. Street
State work to be performed and purpose of building (By Floors) ____C1tl ef_
New Building _ Remodeling Addition 4 " Repairs
7 "
Date __
Street
Subdivision___
•
-e
No. of Stories____.
Type of Tank . Capacity Gals._
Dist. Feet of Tank or Drain Field from Well
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 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 under signed agrees to employ only such sub - contractors, on work to be performed under this permit, as are
licensed by Miami Shores Village. �,.•
(Signed)
Notary Public. State of Florida
Master Plumber.
STATE OF FLORIDA, }
COUNTY OF DADE. es.
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.
DATE
ISSUED TO
FOR A / STORY
FIXTURES
FIXTURES
SEWER
MIAMI SHORES VILLAGE
PLUMBING PERMIT
BUILDING AT
• SEPTIC TANK
TOTAL $ ,;,;d
VILLAGE PLUMBING INSPECTOR
to install the following 'described plumbing, in accordance with
the laws, statutes and regulations of Miami Shores Village,
Florida and the State of Florida, governing plumbing and drain-
age work done in Miami Shores Village, Florida,
BY
NO. 632
•
•
DATE
ISSUED TO
FORA
MIAMI SHORES ' V ILLAGE
PLUMBING PERMIT
NO. `i2
to install the following described plumbing, in accordance with
the laws, statutes and regulations of Miami Shores Village,
Florida and the State of Florida, governing plumbing and drain-
age work done in Miami Shores Village, Florida,
STORY BUILDING AT
FIXTURES 1% ,-
-
FIXTURES
SEWER '3
/
SEPTIC TANK
TOTAL
VILLAGE PLUMBING INSPECTOR
BY
JOB:
BUILDING
ELECTRICAL
PLUMBING
/7
Inspector's Report:
•
WORK
• DONE BY:
. . :
: • : REQUESTED : WILL BE READY
4 //
•
•
•
• •
• • :
• •
The following is ready for Inspection:
AD: � /'
•
•
•
•
•
•
•
•
•
•
Work Classification: Septic
Job Address: 899 92 Street NE
Additional Information
Miami Shores Village, FL
Comments:
DRAINFIELD, ABANDOMENT AND SEPTIC TANK
Fees Due
Bond Type - Contractors Bond
CCF
Education Surcharge
Miscellaneous Fee
Notary Fee
Permit Fee - Additions /Alterations
Scanning Fee
Technology Fee
Total:
Amount
$300.00
$3.00
$1.00
$175.00
$5.00
$175.00
$3.00
$8.75
$670.75
Building Department File Copy
Miami Shores Village
10050 N.E. 2nd Avenue
Miami Shores, FL 33138 -0000
Phone: (305)795 -2204 Fax: (305)756 -8972
Permit
Issue Date: 1/10/2006 Expires: 01/06/2007
Owner's Name: BARRY AND HELEN BARAK
Permit Type: Plumbing - Residential
Contractor(s)
MIAMI DADE ENVIROMENTAL
Phone
786 - 251 -4099
Primary Contractor
Yes
Type of Work:
Additional Info:
Classification: Residential
Type of Piping:
Bond Return :
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 accepting this permit I
assume responsibility for all work done by either myself, my agent, servants, or
employes. I understand that separate permits are required for ELECTRICAL,
PLUMBING, MECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING
POOL work.
OWNERS 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. Futhermore, I authorize the above -named contractor to do the work
stated.
Parcel #:
Block:
Section:
Permit Status: APPROVED
Permit Number: PL- 1 -06 -50
Phone:
1132060050020
Lot:
PB:
Total Square Feet:
Total Valuation:
Required Inspections
0
$ 5,000.00
Abandonment
Rough
Landscaping
HRS Approval
Final
Invoice Number
PL - 1 - 06 - 23357
Total:
Amt Due
$670.75
Amt Paid
$670.75
$670.75
NOTICE: In addition to the requirements of this permit, there may be
additional restrictions applicable to this property that may be found in the
public records of this county.
AND THERE MAY BE ADDITIONAL PERMITS REQUIRED FROM OTHER
GOVERNMENTAL ENTITIES SUCH AS WATER MANAGEMENT
DISTRICTS, STATE AGENCIES, OR FEDERAL AGENCIES.
BUILDING
PERMIT APPLICATION
FBC 2001
Permit Type (circle): Building Elect l Ciiumbin) Mechanical Roofing
Owner's Name (Fee Simple Titleholder)�� !�rl
Owner's Address chi
City l State L I C<k, Zip
Tenant/Lessee Name Phone #
Job Address (where the work is being done) S� T (j g F .
City Miami Shores Village County Miami -Dade Zip •-
Is Building Historically Designated YES NO
• Contractor's Company Name i '�� ;i 1 �\ i� k' • �, L. i �1 t - �, , r Phone #
1 C ` °� �
Contractor's Address c7 it 1 ( I . t. ; O.\ `„ Q tA
City f��? as tai r � , State r ( Zip ?, -: /
� t
Qualifier ., -L \, -� C 11,1
State Certificate or Registration No.(
Architect/Engineer's Name (if applicable) N) 0-
Total Fee Now Due $
(Continued on opposite side)
Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
Master Permit No.
Permit No.
1 .
Certificate of Competency No. Cal, (;(
Phone #
$ Value of Work For this Permit C C �1 . �i C -(. L Square Footage Of Work:
Type of Work: DAddition QAlteration ['New ❑ Repair/Replace
Describe Work: ci yy t ``� �� k
L; ! A.
* * * * * * * * * * * * * * * * * * * * * * * * * * ** Fees * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
Scanning $ ';. ( y( Radon $ Zoning Bond S
Code Enforcement $ Structural Plan Review. $
❑ Demolition
Submittal Fee $ Permit Fee $ 1 l • I ' CCF $ , CO /CC
Notary 53' - Training/Education Fee $ 1 % T echnology Fee $ � � ,
Bonding Company's Name (if applicable)
Bonding Company's Address
City State Zip
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address
City State Zip
Application is hereby made to obtain a permit to do the work and installations as indicated. 1 certify that no work or installation has
commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulating
construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRICAL WORK, PLUMBING, SIGNS,
WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and AIR CONDITIONERS, ETC
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.
"WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT 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."
Notice to Applicant: As a condition to the issuance of a building perinit with an estimated value exceeding $2500, the applicant must
promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person
whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site
for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the
inspection will not be appr 'edFarda reinspection fee will be charged.
signature
The foregoing instrument was acknowledged before me this q
day ofj P- LI , 20 b6by JAN
who is personally known to me or who has produced
I D
NOTARY PUBLIC:
Owner or Agent
NO T YpL'l3LI
Sign: TAB •F ;Si •RI1.
Print: ii — 1r* • e
My Commis on E : "► h i • t,•
* * * * * * * * ** * * * * * * * * * * * * * * * *. * * * * **
# *** * ** ## ## ## ## # ### # ### # ### # ## ## # # # # # # * #. #.- . # # ## # # # * * * * * * * * * * * # # # # # # # # # # #�k # # # # # # # # # # # # # # # # # #
APPLICATION APPROVED BY:
chc 05/13/03
U.
As identification and who did take an oath.
* * * * * * * * * * * ** * **
Signature
Contractor
The foregoing ' strument was acknowledged before me this ro
day of "! ,2f by JO—SE
who is personally known to we or who has produced
l ► -' as identif j nd who did take an oath.
NOTARY PUBL
Sign:
Print:
My Com issio es:
X47 1,0c0
OF FLORIDA
Or. f'ly Hernandez
455
* * * * * * * * * ** * * * * * * * * * * * * * * * * * * * * * * **
Plans Examiner
r Engineer
Zoning
CONSTRUCTION PERMIT FOR:
[ ]New System [ ]Existing System
[ X ]Repair [ ]Abandonment
APPLICANT: Bhbjw Management Corp
PROPERTY STREET ADDRESS: 899 NE 92 St Miami Shores FL 33138
LOT: 1 BLOCK: 1
PROPERTY ID #: 11- 3206 - 005 -0020
SYSTEM DESIGN AND SPECIFICATIONS
T [
A [
N [
K [
D
R
•A
I
N
F
I
E
L
D
THIS PERMIT IS NOT FOR "ADDITION(s)."
ELEVATION OF PROPOSED SYSTEM SITE [
BOTTOM OF DRAINFI,F,LD TO. BE
OTHER REMARKS:
STATE OF FLORIDA
DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM
CONSTRUCTION PERMIT
SPECIFICATIONS BY: Andre, Paul
APPROVED BY: Andre, Paul
DATE ISSUED: 11/21/05
DH 4016, 03/97 (Obsoletes previous editions which ay not be used)
(Stock Number: 5744- 001 - 9016 -0) [ostds cons 4016 -1]
]Holding Tank [ ] Innovative Other
]Temporary [ NA ]
AGENT: SR0001343, Crockett Lester
SUBDIVISION: Golden Gate Park Add
[Section /Township /Range /Parcel No.]
[OR TAX ID NUMBER]
SYSTEM MUST BE CONSTRUCTED IN ACCORDANCE WITH SPECIFICATIONS AND STANDARDS OF CHAPTER 64E -6,FAC
DEPARTMENT APPROVAL OF SYSTEM DOES NOT GUARANTEE SATISFACTORY PERFORMANCE FOR ANY SPECIFIC TIME
PERIOD. 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. ISSUANCE OF THIS PERMIT DOES NOT EXEMPT THE APPLICANT FROM
COMPLIANCE WITH OTHER FEDERAL, STATE OR LOCAL PERMITTING REQUIRED FOR PROPERTY DEVELOPMENT.
900 ]Gallons SEPTIC TANK
0 ]Gallons
0 ]GALLONS GREASE INTERCEPTOR CAPACITY
0 ]GALLONS DOSING TANK CAPACITY [ 0 ]GALLONS @
[ 300 ]SQUARE FEET PRIMARY DRAINFIELD SYSTEM
[ 0 ]SQUARE FEET SYSTEM
TYPE SYSTEM: [ N ]STANDARD [ N ]FILLED
CONFIGURATION: [ N ]TRENCH [ N ]BED
LOCATION TO BENCHMARK: EFF El.:14.80'NGVD
FILL REQUIRED: [ 0.0 ]INCHES EXCAVATION REQUIRED: [ 18.0 ] INCHES
[0 ]DOSES PER 24 HRS # PUMPS[ 0 ]
1. 6' ] [ FEET ] [ BELOW ] BENCHMARK/REFERENCE POINT
3.1 ] [ FEET ] [ BELOW] BENCHMARK /REFERENCE POINT
1.- Install 900 gal. category -3 septic tank equipped with an approved filter.
TITLE:
TITLE: Professional Engin
CENTRAX #: 13 -SG -27090
DATE PAID:
FEE PAID :
RECEIPT .
OSTDSNBR : 05 -3657- -R
MULTI - CHAMBERED /IN SERIES: [Y ]
MULTI - CHAMBERED /IN SERIES: [Y ]
[ N ]MOUND [ N ]
[ N ]
2. -The licensed contractor installing the system is responsible for installing the minimum
category of tank in accordance with sec. 64E- 6.013(3)(f), FAC.
3.- Install 300 sf of drainfield in bed configuration.
4.- Invert elevation of drainfield to be no less than 12.20' NGVD.
5.- Bottom of drainfield elevation to be no less than 11.70' NGVD.
Dade
EXPIRATION DATE: 2/19/06
CHD
Page 1 of 2
•
Scale: Each block represents 5 feet and 1 inch = 50 feet. -y
Notes:
STATE OF FLORIDA
DEPARTMENT OF HEALTH
APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PERMIT
Permit Application Number
FI
•
Site Plan submitted by:
Plan Approved \I ''''
\ ,
By 4 Ix :
DH 4015. 10/96 (Replaces HRS-H Form 4015 which may be : ed)
(Stock Number: 5744.002- 4015.6)
•
• i
•
; Signature
PART II - SITE PLAN-
Not Approved
Tide
ALL CHANG S MUST = E APPROVED BY THE COUNTY HEALTH DEPARTMENT
Date
County Health Department
Page 2 of 3
v/Q
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIV
Permit . f _ 3 J Date__
Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the building or other
structure herein described. This application is made in compliance and conformity with the Building Ordinance of Miami Shores Village, Florida,
and all provisions of the Laws of the State of Florida, all ordinances of Miami 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.
Owners Name and Address__________..____..____ .8: �..._..- ______._....... No.__._"_ _. `_ ....__._— Street
Registered Architect and /or Engineer___
Employing Plumber's Namef�l / 2f_IL_(
Location and Legal Description Lot
Street and Number where work is to be performed —No
New Building _ -- Remodeling
Size Septic Tank_
Feet of Drain Tile_
Nature of Water Supply: City — Well.__
Amount of Permit $
STATE OF FLORIDA,
COUNTY OF DADE. j
Block
c ' _ No._____ Q_ 7 __ - 2
Addition__ _____._. Repairs
(Signed)-
StreeL-_v _ -
Subdivision.
^ ��Street
State work to be performed and purpose of building (By Floors)-_-__ -,� � -- _s._JL_� Y _ — ft4 a e
My Commission Expires Notary Public, State of Florida
?g37
No. of Stories
Capacity Gals
_Type of Tank_
__Dist. Feet of Tank or Drain Field from Well
------- ____ -- _ -- -_Size of Soakage Pit
Plum Tng Inspector.
The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations as :r employer of labor
under the Florida Worlanen's Compensation Act, being Section 5966, Compiled General Laws of Florida Permanent Sup J and has com-
plied with the provisions thereof, and will require similar compliance from all contractors or sub- contracto, e n Toyed by him in the work to be
performed under this permit; and will post or cause to be posted' for inspection on the ite of the wo ..' such public notice or notices as are
required by the Act. The undersigned agrees to employ only such sub- contractors, work to a pe ;�y�. and - 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/at workmanship.
CLOSETS
BATH
TUBS
SHOWERS
LAVA-
TORIES
S INKS
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
v/Q
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIV
Permit . f _ 3 J Date__
Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the building or other
structure herein described. This application is made in compliance and conformity with the Building Ordinance of Miami Shores Village, Florida,
and all provisions of the Laws of the State of Florida, all ordinances of Miami 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.
Owners Name and Address__________..____..____ .8: �..._..- ______._....... No.__._"_ _. `_ ....__._— Street
Registered Architect and /or Engineer___
Employing Plumber's Namef�l / 2f_IL_(
Location and Legal Description Lot
Street and Number where work is to be performed —No
New Building _ -- Remodeling
Size Septic Tank_
Feet of Drain Tile_
Nature of Water Supply: City — Well.__
Amount of Permit $
STATE OF FLORIDA,
COUNTY OF DADE. j
Block
c ' _ No._____ Q_ 7 __ - 2
Addition__ _____._. Repairs
(Signed)-
StreeL-_v _ -
Subdivision.
^ ��Street
State work to be performed and purpose of building (By Floors)-_-__ -,� � -- _s._JL_� Y _ — ft4 a e
My Commission Expires Notary Public, State of Florida
?g37
No. of Stories
Capacity Gals
_Type of Tank_
__Dist. Feet of Tank or Drain Field from Well
------- ____ -- _ -- -_Size of Soakage Pit
Plum Tng Inspector.
The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations as :r employer of labor
under the Florida Worlanen's Compensation Act, being Section 5966, Compiled General Laws of Florida Permanent Sup J and has com-
plied with the provisions thereof, and will require similar compliance from all contractors or sub- contracto, e n Toyed by him in the work to be
performed under this permit; and will post or cause to be posted' for inspection on the ite of the wo ..' such public notice or notices as are
required by the Act. The undersigned agrees to employ only such sub- contractors, work to a pe ;�y�. and - 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/at workmanship.
Permit No.
Size Septic Tank
Feet of Drain Tile
25' Relay
Nature of Water Supply: City — Well.
Amount of Permit $ ;
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING ° " i, NIT
(Signed )-
(Signed)_
Date..
L/
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 'a Name and Address Hayes
Registered Architect and /or
Employing Plumber's Name Rose SeptjC g _ ._.__ No. __2.5_52
Location and Legal Description Lot.- - ----_ -- --- . - -- -_ - --___. _ _ _ Block
Street and Number where work is to be performed —No 899
State work to be performed and purpose of building (By Floors ). _______
New Building - _.._.. Remodeling---------- .- •------- ____ -- Addition
899 N.E. 92nd St
No._ ------ •----- • ____ -- Street
Street-- �W. 3 AvoLliia1ea i.
Su vision_
Street N E. 92nd St.
Repairs No. of Stories
Type of Tank. Capacity Gals
__Dist. Feet of Tank or Drain Field from Well
_.Size of Soakage Pit
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 5988, 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.
Master Plumber.
STATE OF FLORIDA, I
COUNTY OF DADE.
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeared
to me well known, and who, being by me first duly sworn, upon oath deposes and says that he is the
of the above described construction, that he has carefully read the foregoing application, and that he did sign the same, and that all facts
theaein by him stated are true.
My Commission Expires 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 worlcmanahip.
CLOSETS
BATH
TUBS
SHOWBRn
LAVA
TORIES
SINK6
SLOP
SINK6
LAUNDRY
Tuns
URINALS
CATCH
BASI
FLOOR
DRAIN
DRINKING DRINK
FOUNT' NS
TOTAL
FI %TORES
CONTR.
LIST
CHECK
SEPTIC
TANK
SEWER
CONN.
DRAIN
FIELD
SOAKAGE
PIT
GREASE
TRAP
SOLAR
HEATER
DEEP
WELL
SPRKLR.
SYSTEM
SW IM'G
POOL
CONTR.
LIST
-
CHECK
Permit No.
Size Septic Tank
Feet of Drain Tile
25' Relay
Nature of Water Supply: City — Well.
Amount of Permit $ ;
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING ° " i, NIT
(Signed )-
(Signed)_
Date..
L/
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 'a Name and Address Hayes
Registered Architect and /or
Employing Plumber's Name Rose SeptjC g _ ._.__ No. __2.5_52
Location and Legal Description Lot.- - ----_ -- --- . - -- -_ - --___. _ _ _ Block
Street and Number where work is to be performed —No 899
State work to be performed and purpose of building (By Floors ). _______
New Building - _.._.. Remodeling---------- .- •------- ____ -- Addition
899 N.E. 92nd St
No._ ------ •----- • ____ -- Street
Street-- �W. 3 AvoLliia1ea i.
Su vision_
Street N E. 92nd St.
Repairs No. of Stories
Type of Tank. Capacity Gals
__Dist. Feet of Tank or Drain Field from Well
_.Size of Soakage Pit
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 5988, 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.
Master Plumber.
STATE OF FLORIDA, I
COUNTY OF DADE.
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeared
to me well known, and who, being by me first duly sworn, upon oath deposes and says that he is the
of the above described construction, that he has carefully read the foregoing application, and that he did sign the same, and that all facts
theaein by him stated are true.
My Commission Expires 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 worlcmanahip.