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295 NE 94 St (17)MIAMI SHORES VILLA BUILDING DEPARTMEN 305- 795 -2204 Buildin Inspection Request Date Type Insp'n Permit No. Name Address IS . C . 9 \AA- Company C , Q QO .0 Phone # For Inspector: ( � /03 Approved Correction ❑ Re- Insp'n Fee ❑ U Time Registered Architect and/or'' 'i ineer MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT Permit No .._f Date f �! Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the buil ing 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 wArk. //G /1 o � = Street �, //' -r Employing Plumber's -Naihe Location and Legal Descriptioj'i Lot Street and Number where work is to be performed —No Street State work to be performed and purpose of building (By Floors) New Building Remodeling Addition Repairs Size Septic Tank Type of Tank Capacity Gals _ _Dist. Feet of Tank or Drain Field from Well tl A r r Feet of Drain Tile Nature of Water Supply: City—Wen,'_:_i -- Amount of Permit ___ ss. Block - Size of, Soakage l_ o ( Signed), Plumbing Inspector. r1 C✓ / Street___L _! i Subdivision My Commission Expires Notary Public, State of Florida No. of Stories 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 -e --o ork such public notice or notices as are required by the Act. The undersigned agrees to employ only such sub - contracto ; " o orkT "to �e performed under this permit, as are licensed by Miami Shores Village. j �� �° " (Signed )- _ 4 ' / / ` /7 7 Master Plum er. K 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. 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 SWIM'G POOL CONTR. LIST — CHECK Registered Architect and/or'' 'i ineer MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT Permit No .._f Date f �! Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the buil ing 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 wArk. //G /1 o � = Street �, //' -r Employing Plumber's -Naihe Location and Legal Descriptioj'i Lot Street and Number where work is to be performed —No Street State work to be performed and purpose of building (By Floors) New Building Remodeling Addition Repairs Size Septic Tank Type of Tank Capacity Gals _ _Dist. Feet of Tank or Drain Field from Well tl A r r Feet of Drain Tile Nature of Water Supply: City—Wen,'_:_i -- Amount of Permit ___ ss. Block - Size of, Soakage l_ o ( Signed), Plumbing Inspector. r1 C✓ / Street___L _! i Subdivision My Commission Expires Notary Public, State of Florida No. of Stories 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 -e --o ork such public notice or notices as are required by the Act. The undersigned agrees to employ only such sub - contracto ; " o orkT "to �e performed under this permit, as are licensed by Miami Shores Village. j �� �° " (Signed )- _ 4 ' / / ` /7 7 Master Plum er. K 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. 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 Building Architect Contractor or Builder Legal Description MIAMI SHORES VILLAGE, FLORIDA D' DATE f /- �J 194 Contractor's �/ r� License No. X r3 PERMIT N? 5835 Work to be performed under this Permit �,. / Lot 6 1 Bl. Address Of 7 ,, - Pi e i ?? C 1 � � Value of Amt. of (�, Buil ,� •,," / - `�` , . — . K∎ , Project Permit This permit is granted to th contractor or builder named above to c onstruct the building or to install the equipment or device described in the 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 . assuiihes the responsibility for a thorough kno dge of the o ances'and regulations pertaining to the work covered hereby whether shown on the plans oir in , atements.;or specification anyl -!thh the as es respon- l By sibility for work done by his agents, servants or employees. CONTRACTOR OR BUILDER In consideration of the issuance to me of this permit I agree pertaining thereto and in strict conformity with the plans, drawi In accepting this permit I assume responsibility for all work do f Subdi- vision F overed hereunder in compliance with srdinances and e ons atigns submitted to the proper author dt of Miami Shores Vi ge. ant or employee. AUTHORITY 'Village of Miami Shores JOB ADDRESS a 5 4` ' c INSPECTION TIME READY REMARKS 7Th N? 4238 INSPECTOR DATE o / ° BUILDING ELECTRICAL PLUMBING ROOFING Architect Contractor or Builder Legal Description Address of Building Lot MIAMI SHORES VILLAGE. FLORIDA El ❑ DATE 195 PERMIT N? _ 3644 Contractor's License No. El ❑ Work to be performed under this Permit o" Owner of Building CONTRACTOR OR BUILDER Bl. Subdi- vision Value of Amount of Project $ Permit $ This permit is granted to the contractor or builder named above to construc 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. BY 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- cepting this permit I assume responsibility for all work done by either, myself, my agent, servant or employee. BY AUTHORITY Date 3 v , PERMIT APPLICATION FOR MIAMI SHORES VILLAGE Legal Description Owner/Lessee / Tenant J otto Job Address t 5 of. 5 Tax Folio Owner's Address a 9 pj. E, a) , rye n & .` Phone 3 6 -C- 7 �1- �S-C 7. Contractin Co. 0 f Ia . So k A L. Address Qei Q 31 4 0 V e2 ' - awl- ° r .a Qualifier 414J E. (kk/ SS# ` Phone 30b'6_.<l "w sl, 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 Yl [ V Square Ft. r 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 constA • oning. Furthermore, I authorize the above -named contractor to do the work stated. a e of er and/or Condo President Date 3 /` � Notary as to Owner and/or Condo President ate My Commission Expires: FEES: PERMIT 0\ RADON APPROVED: Zoning Building Mechanical Plumbing Historically Designated: Yes No Master Permit # Estimated Cost (value) a te Signature o. Contractor or Owner ,,s - lde� as to o • C • : nuniss� • ; t 3I IC STA'L'E OF FIDRIDA C01/1_ I9SION NO. CC714103 u ( ISSION EXP. MAR.1 No . My Co C.C.F. J : NOTARY BOND � j 0 V Electrical TOTAL DUE Date Structural Engineer CON TRUCTION PERMIT FOR ]r New System [ Repair APPLICANT: PROPERTY ADDRESS: to C Pr9 M t- 7 l/ -' r LOT: BLOCK: d/"` G9 SUBDIVISION: A ���1 , _ Q [SECTION, TOWNSHIP, RANGE, PARCEL NUMBER] ®� PROPERTY ID #: [OR TAX ID NUMBER] SYSTEM MUST BE CONSTRUCTED IN ACCORDANCE WITH SPECIFICATIONS AND STANDARDS OF SECTION 381.0065, F.S., AND CHAPTER 64E -6, F.A.C. DEPARTMENT APPROVAL OF SYSTEM DOES NOT GUARANTEE SAFTISFACTORY 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. ISSUANCE OF THIS PERMIT DOES NOT EXEMPT THE APPLICANT FROM COMPLIANCE WITH OTHER FEDERAL, STATE, OR LOCAL PERMITTING REQUIRED FOR DEVELOPMENT OF THIS PROPERTY. SYSTEM DESIGN AND SPEC FICAIONS / T ' l � r L- T [ 00 G � ', GALLONS / GPD EPT T /AEROBIC UNIT CAPACITY A [ ] GALLONS / GPD CAPACITY N [ ] GALLONS GREASE INTERCEPTOR CAPACITY [MAXIMUM K [ ] GALLONS DOSING TANK CAPACITY [ ]GALLONS D [—r---] SQUARE FEET PRIMARY DRAINFIELD SYSTEM R [ ] SQUARE FEET A TYPE SYSTEM: [ I CONFIGURATION: (r N F LOCATION OF BENCHMARK: I ELEVATION OF PROPOSED SYSTEM SITE E BOTTOM OF DRAINFIELD TO BE L D FILL REQUIRED: [AA/ ] INCHES 0 T H E R APPROVED BY: ST,iTE OF FLORIDA o bEPARTMENT OF HEALTH ONSITE SEWAGE TREATMENT--- ANDrDISPOSAL SYSTEM CONSTRUCTION PERM4T� f Existing System Abandonment ° link ELO BENC-I ft I /REFERENCE POINT BENCHMARK /REFERENCE POINT � f SYSTEM STANARD [Gl FILLED TRENCH [ BED [ G+ .2 • [IN S/ (f S /FT] EXCAVATION REQUIRED: Holding Tank Temporary MOUND SPECIFICATIONS BY: [ABOVE /B [ABOVE I [ ] INCHES pt. 2: Applicant pt. 3: Installer /Contractor pt. 4: Building Department PERMIT NO. * O Q DATE PAID: FEE PAID: ("le) RECEIPT #:A 7 6-. 63,2D6a7 Innovative MULTI- CHAMBERED /IN- SERIES [ ] MULTI- CHAMBERED /IN- SERIES [ ] CAPACITY SINGLE TANK: 1250 GALLONS] [ ] DOSES PER 24 HRS # PUMPS [ ] [[y37 .LL 4 Ln#t (OARSs� SAND U:017 9 X n 1 O DRAINFIELD SL!'""p T P =11x.";4 , 11'7iK EEFC iE INSPECTION �1l PEM,Mi 3 r y FOn AUCI t Iut' itTLEi1 OF y . t:NFELD :_?. Yi ;ITT TITLE: 9 ° °ca vc'7.fil�iC� CHD DATE ISSUED: 11 U �r; 77177) DATE: SOM t1J .m Lv'. i �; � :f9uF C tec,.� k Pi DH 4016, 12/99 (Page 1) (Previous Edit ons�May . Used) 1.5 ALLED CU0 � � o -L f ge 1 of 3 pt. 1: Heal Departmen INSTRUCTIONS: PERMIT NUMBER: Permit tracking number assigned by CPHU. CONSTRUCTION PERMIT 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. (CHD may require property appraiser ID # or section/township /range/parcel number) SYSTEM DESIGN AND SPECIFICATIONS: TANK: Minimum specifications from Chapter 64E -6, FAC. DRAINFIELD: Minimum specifications from Chapter 64E -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 (CHD) personnel reviewing and approving permit. DATE ISSUED: Date permit is issued by CHD 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. 1- F n I_0, 1_1 Notes: 11) (c n,Tde f p lit Site Plan Submitted by: ii Plan Approved Vi __STATE OF FLORIDA s DEPARTMENT O HEALTH AND REHABILITATIVE SERVICES ,t - APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PERMIT Permit Application Number HRS -H Form 4015, Feb 85 (Obsoletes previous editions which may not be used) (Stock Number: 5744- 002 - 4015 -6) PART II - SITE PLAN SIGNATURE Not Approved By frt / ,f/b) 3 1 , 6 , (7 "..) 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' li�■■ '■■ww ■`■�.�■ ■ • •■ $ •i ma • • i mign • • ' ■■ •rr• ■ ■•■lr ■ ■s • ■ *••••••1•0• • 000 • ..0 R wl m ■ w w . I_. m _ ■ 1111 ■]■• •■J•t..klR;.( ,� l..�Q•• ■■: ■■�1■ •.. ■1 ■[• ■Nr AWANUOg 3 .I■1m■ (Cdr, 47 , TITLE ma y. Date County Public Unit Page 2 of 3 BUILDING ELECTRICAL PLUMBING CONTRACTOR OR BUILDER MIAMI SHORES VILLAGE, FLORIDA PERMIT N2 5835 DATE Work to be performed under this Permit Owner of Building BY AUTHORITY 194_ Contractor's License No. Architect Contractor or Builder Legal Lot Bl. Subdi- Description vision Address of Value of Amt. of a Building Project Permit I 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 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 assumes respon- sibility for work done by his agents, servants or employees. Signed • By INSPECTOR In consideration of the issuance to me of this permit I agree tgcperform the work covered hereunder in compliance with all ordinances and regulations pertaining thereto and in strict conformity with the plans, drawing, statementsar specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I assume responsibility for a work dong'hy either myself, my agent, se!vant or employee. .