DRAINFIELDBUILDING ❑
ELECTRICAL PLUMBING ❑ PERMIT
Architect
Contractor
or Builder
Legal
Description
Address of
Building
Lot
MIAMI SHORES VILLAGE, FLORIDA
r
2_
k t4
1r"
N9
6994
ROOFING
)/10-^^ In Work to be performed under this Permit 161.-
Owner of ---'" Building'
Subdi-
B1 vision
c e
( (, C t AI' I c fi
Value of
Project $
DATE 1 ' -, ` ,1 1(r ) %' � 19
Contractor's i p`Z
License No. •t
Amount of
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 understanc'.ing 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. "...J.._ „ , ...0_ f - • 463 i INSPECTOR
In consideration of the issuance to me of this permit I agree to perform the work covered hereunder comp
in ance with'Nail ordinances l�tlafbns
pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities o2+ivifami Shores Village. In a
cepting this permit I assume responsibility for ell work done by ither, m self,. my agent, servant or employee.
't It fi tir Ji-vd• 14 , . . a Y `f
CONTRACTOR PR BUILDER BY
AUTHORITY
sssor
>r
C
Permit No ___ - -- _ -- _ Date { 1 !r' —
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. e
Owner's Name and Address --- _�!...- ` rc.lS__ . �C: ? . S
-- - - - -- Street_ . -- -- - -- =• - --- --. ....1 '
Registered Architect and /or Engineer _______— _.___ ___________ _ �� _ t - _ . -_ -_ / �(� e
Employing Plumber's Name A t..21 LQ 4AiL_' �.c / r�C --�44 No._ L - -- Street-- l W • 1 ? ,! P
Location and Legal Description Lot ,� Block e� Subdivision -_ -- -• - -._ __- _ -__ -_ _ _
Street and Number where work is to be performed —No 141/ 1I J Y ,��� Strom
State work to be performed and purpose of building (By Floors)_
New Building Remodeling Addition
Size Septic Tank_ __
Feet of Drain Tile:
Amount of Permit $_
STATE OF FLORIDA, 185.
COUNTY OF DADE.
C
My Commission Expires
Nature of Water Supply: City — Well.__._________ _____________
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
_Type of Tank
Feet of Tank or Drain Field from Well.
__ Size of Soakage Pit
(Signed)-
Repairs -. -- -- . - -_. -- -• __ -- No. of Stories.... .... ...... ...
Notary Public, State of Florida
Plumbing , ctor.
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 - contractor;. 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 , Rhe work such public notice or notices as are
required by the Act The undersigned agrees to employ only such sub- contractors, on w to be perf9rjned m er this per•nit are
licensed by Miami Shores Village.
(Signed) - _ ., - a/1, t
Master Plumber.
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personall 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 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
SWIM'G
POOL
CONTR.
LNIT
CHECK
_
>r
C
Permit No ___ - -- _ -- _ Date { 1 !r' —
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. e
Owner's Name and Address --- _�!...- ` rc.lS__ . �C: ? . S
-- - - - -- Street_ . -- -- - -- =• - --- --. ....1 '
Registered Architect and /or Engineer _______— _.___ ___________ _ �� _ t - _ . -_ -_ / �(� e
Employing Plumber's Name A t..21 LQ 4AiL_' �.c / r�C --�44 No._ L - -- Street-- l W • 1 ? ,! P
Location and Legal Description Lot ,� Block e� Subdivision -_ -- -• - -._ __- _ -__ -_ _ _
Street and Number where work is to be performed —No 141/ 1I J Y ,��� Strom
State work to be performed and purpose of building (By Floors)_
New Building Remodeling Addition
Size Septic Tank_ __
Feet of Drain Tile:
Amount of Permit $_
STATE OF FLORIDA, 185.
COUNTY OF DADE.
C
My Commission Expires
Nature of Water Supply: City — Well.__._________ _____________
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
_Type of Tank
Feet of Tank or Drain Field from Well.
__ Size of Soakage Pit
(Signed)-
Repairs -. -- -- . - -_. -- -• __ -- No. of Stories.... .... ...... ...
Notary Public, State of Florida
Plumbing , ctor.
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 - contractor;. 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 , Rhe work such public notice or notices as are
required by the Act The undersigned agrees to employ only such sub- contractors, on w to be perf9rjned m er this per•nit are
licensed by Miami Shores Village.
(Signed) - _ ., - a/1, t
Master Plumber.
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personall 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 by improper notice for inspection, or faulty
materials and /or workmanship.
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
..S
Date A/ ,
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 Divisior
of Miami Shc.e.s Village shall be complied with, whether herein specified or not. A copy of approved plans and specifications must be kept al
building during progress of work.
No. -_ (. ' -i . _'__- -°
Owner's Na.- e and Address
Registered Architect and /or Engineer
Employing Plumber's Name /, r� %' � � � � , Al ____ No / 5
Location and Legal Description Lot Block -- - - -•- -- __ -__ -- Subdivision A
Street and Number where work is to be performed —No s __ 1_ _� ___ ____________ Street 9 _.9._.5 l •
State work to be performed and purpose of building (By Floors)
New Building _
Amount of Permit $
Type of Tank___ r
No. Street
l
(Signed)
Remodeling Addition.______________ ________ Repairs
Capacity Gals..
Street____/'��� '� 1
No. of Stories
Size Septic Tank V 0 "f °',
Feet of Drain Tile ._ i- % i __Dist. Feet of Tank or Drain Field from Well
Nature of Water Supply: City —Well — Size of Soakage Pit
Notary Public, State of Florida
u y - ,
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 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 arc
licensed by Miami Shores Village. {,
(Signed)_ lL E L - / ✓v L_
Master Plumber.
STATE OF FLORIDA,
COUNTY OF DADE. j
Before me, the undersigned authority, a notary public, duly authorized to administer paths and take acknowledgments, personally appeare
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 foe'
therein by him stated are true.
My Commission Expires
NOTE: A re- inspection fee of $1.00 will be made when such re- inspection is made necessary by improper notice for inspection, or f:ml
materials and /or workmanship.
CLOSETS
BATH
TUBS
SHOWERS
LAVA-
TORIES
SINKS
SLOP
SINKS
LAUNDRY
TUBE
URINALS
CATCH
BASIN
FLOOR
DRAIN
DRINKING
FOUNT' N5
TOTAL
FIXTURE!
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
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
..S
Date A/ ,
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 Divisior
of Miami Shc.e.s Village shall be complied with, whether herein specified or not. A copy of approved plans and specifications must be kept al
building during progress of work.
No. -_ (. ' -i . _'__- -°
Owner's Na.- e and Address
Registered Architect and /or Engineer
Employing Plumber's Name /, r� %' � � � � , Al ____ No / 5
Location and Legal Description Lot Block -- - - -•- -- __ -__ -- Subdivision A
Street and Number where work is to be performed —No s __ 1_ _� ___ ____________ Street 9 _.9._.5 l •
State work to be performed and purpose of building (By Floors)
New Building _
Amount of Permit $
Type of Tank___ r
No. Street
l
(Signed)
Remodeling Addition.______________ ________ Repairs
Capacity Gals..
Street____/'��� '� 1
No. of Stories
Size Septic Tank V 0 "f °',
Feet of Drain Tile ._ i- % i __Dist. Feet of Tank or Drain Field from Well
Nature of Water Supply: City —Well — Size of Soakage Pit
Notary Public, State of Florida
u y - ,
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 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 arc
licensed by Miami Shores Village. {,
(Signed)_ lL E L - / ✓v L_
Master Plumber.
STATE OF FLORIDA,
COUNTY OF DADE. j
Before me, the undersigned authority, a notary public, duly authorized to administer paths and take acknowledgments, personally appeare
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 foe'
therein by him stated are true.
My Commission Expires
NOTE: A re- inspection fee of $1.00 will be made when such re- inspection is made necessary by improper notice for inspection, or f:ml
materials and /or workmanship.
Date ra- Job Address 1 g 57 Al'L- 9 v Tax Folio
Legal Description Historically Designated: Yes No
Master Permit. # (97,e9)
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Owner/Lessee / Tenant /' `° t )ad_ tsI? CL
Owner's Address 425/ /VC 99 54 , Phone 7.5 - Pily '
�i 16 Contracting Co. .! DI /C. c�lei e Address /5 /I/6 • / /4 �it,�1--.
Qualifier _ - b / ✓ (:,-A:"" SS# ,</- ;° .
State # aunicipal # 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 � / � ; : ` � - c ' : '
Square Ft.
FEES: PERMIT
RADON
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 constructioyand zoning. Furthermore, I authorize the above -named contractor to do the work stated.
Signature of Contractor or Owner - Builder 'bate
F C,� t % 4600, 3/0 zvy �� 3/a /9
Notary as to Owner and/or Cond President Date Notary as to Contractor or Owner- dwidei' Date
My Commission Expires:
2//d-
of owner and/or Condo President D
APPROVED:
Zoning /
Mechanical Plumbing t,.1
Estimated Cost (value) /57-31.
My Commission Expires:
C.C.F. 1 "1 NOTARY
Electrical
Engineering
TOTAL DUE
2
3
4
APP ICATION FOR:
(/. J New System
[y] Repair
49' aRee-o-
AGENT: . 3A 3 Z3 9 y RealU, l -/ 332 •
APPLICANT:
MAILING ADDRESS:
TO BE COMPLETED BY APPLICANT OR APPLICANT'S AUTHORIZED AGENT. ATTACH BUILDING PLAN AND TO -SCALE
SITE PLAN SHOWING PERTINENT FEATURES REQUIRED BY CHAPTER 10D -6, FLORIDA ADMINISTRATIVE CODE.
PROPERTY INFORMATION [IF LOT IS NOT IN A RECORDED SUBDIVISION, ATTACH LEGAL DESCRI ION OR DEED]
LOT: BLOCK: SUBDIVISION:
PROPERTY ID #:
PROPERTY SIZE:
BUILDING INFORMATION
Unit Type of
W e.;&„-kt
r r • /]
■PPLICANT'S SIGNATURE
STATE OF FLORIDA PERMIT #` nA. ---5; Y 7 DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES DATE PAID 7/2 1-7
ONSITE SEWAGE DISPOSAL SYSTEM FEE PAID $ /
APPLICATION FOR CONSTRUCTION PERMIT RECEIPT 1` r
Authority: Chapter 381, FS & Chapter 10D -6, FAC
[4/] Existing System Vi/A Holding Tank
] Abandonment [!,/] Other(Specify)
PROPERTY STREET ADDRESS:
DIRECTIONS TO PROPERTY:
// - 326 -o , -OD
ACRES [Sqft/43560]
as-7 ,</E.
7) s/�
({' ] RESIDENTIAL
No. of
No Establishment Bedrooms
Garbage Grinders /Disposals
Ultra -low Volume Flush Toilets
3
RS -H Form 4015 Mar 92 (ObSOI,+toc nro..i.0 c
DATE 4f
g Mld�N : /� �/
[ /Township /Rae /Parcel No.] ZONING:
PROPERTY WATER SUPPLY:
get s://
Building
Area Sqft
go
[
[r4 Spas /Hot Tubs
Other (Specify)
lNJ Temporary /Experimental
TELEPHONE: 7s26
(
DATE:
1
PRIVATE
- ;//7177
(
] COMMERCIAL
# Persons Business Activity
Served For Commercial Only
[/".] Floor /Equipment Drains
LOT:
SITE EVALUATED BY:
STATE OF FLORIDA
DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES
ONSITE SEWAGE DISPOSAL SYSTEM
SITE EVALUATION AND SYSTEM SPECIFICATIONS
<. T_c/L ' 7 ' ,.4.4.10 .
BLOCK: SUBDIVISION:
PROPERTY ID #: // - 3Z4,5 -0/0 -00S-6
PROPERTY SIZE CONFORMS TO SITE PLAN: [ ]
TOTAL ESTIMATED SEWAGE FLOW: Jett
AUTHORIZED SEWAGE FLOW: S g
UNOBSTRUCTED AREA AVAILABLE: /Ace,
^t= BET
Tallahassee. FL — TER BUSI NEOB9 FORMS -5401 1201727
/00W 5
.
[Section /Township /Range /P No. or Tax
YES [ ]
GALLONS
GALLONS
SQFT
AGENT:
rj
PERMIT 11 9
fri< f,ft 1 ���.r✓
ID Number]
TO BE COMPLETED BY ENGINEER, HEALTH UNIT EMPLOYEE, OR OTHER QUALIFIED PERSON. ENGINEER'S MUST
PROVIDE REGISTRATION NUMBER AND SIGN AND SEAL EACH PAGE OF SUBMITTAL. COMPLETE ALL ITEMS.
NO NET USABLE AREA AVAILABLE: 2/52 ACRES
PER DAY [RESIDENCES -TABLE 1 / OTHER -TABLE 2]
PER DAY [1500 GPD /ACRE OR 2500 GPD /ACRE]
UNOBSTRUCTED AREA REQUIRED: 75 SQFT
BENCHMARK /REFERENCE POINT LOCATION: 8 .S :/ /f, 17; A
ELEVATION OF PROPOSED SYSTEM SITE IS 4, •,S [INCHES /FT] [ABOVE /BELOW] BENCHMARK /REFERENCE POINT
THE MINIMUM SETBACK WHICH CAN BE MAINTAINED FROM THE PROPOSED SYSTEM TO THE FOLLOWING FEATURE
SURFACE WATER: /W A FT DITCHES / ALES: A FT RMALL,Y WET? [ ] YES [� NO
WELLS: PUBLIC: /✓ FT LIMITED USE: FT PRIVATE: FT NON - POTABLE: FT
BUILDING FOUNDATIONS: /0 FT PROPERTY LINES: a FT POTABLE WATER LINES: 71 FT
SITE SUBJECT TO FREQUENT FLOODING: [ ] YES [(A
10 YEAR FLOOD ELEVATION FOR SITE: FT MSL /NGVD SITE ELEVATION: 7 ., — FT MSL /NGVD
SOIL PROFILE INFORMATION SITE 1
Munse4.1 # /Color
USDA SOIL SERIES:
Texture
Depth
p //
to
to
to
to
t
to
to
to
10 YEAR :FLOODING? [ ] YES [yYN0
SOIL PROFILE INFORMATION SITE 2
Muns- 1 Color Texture Depth
f'P-✓� / v to j Z
to
to
to
to
to
to
to
to
USDA SOIL SERIES:
OBSERVED WATER TABLE: ‘0 NCHE [ABOVE BE ] EXISTING GRADE. TYPE: [PERCHED / APPARENT]
ESTIMATED WET SEASON WATER ELEVATION: INCHES [ ABOVE / BELOW ] EXISTING GRADE.
HIGH WATER TABLE VEGETATION: [ ] YES NI MOTTLING: [ ] YES [1, NO DEPTH: INCHES
SOIL TEXTURE /LOADING RATE FOR SYSTEM SIZING: DEPTH OF EXCAVATION: J INCHES
DRAINFIELD CONFIGURATION: [ ] TRENCH [1,./1 BED [ ] OTHER (SPECIFY)
REMARKS /ADDITIONAL CRITERIA:
name. Z./1.41/07
f :
Notes: 1 "
l
Site Plan Submitted by:
STATE OF FLORIDA
DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES
APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PERMIT
Permit Application Number
1
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