702 NE 95 St (5)STATE OF FLORIDA
DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES
ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION AND INSTALLATION PERMIT
Applicant S' I ' ` . Permit Number 8' OJ
7o N.F. 95 ss /a/ ` .2 67a
PART II - SYSTEM INSTALLATION INSPECTION AND FINAL INSTALLATION APPROVAL
Installer 0,4t.. S /,', 4, Tank Manufacturer A//A
A/
Proper tank legend: Yes /i� No Tank material Tank level: Yes ,✓No
Tanks watertight: Yes t✓f A No Tank size• gallons gallons _� " gallons
Proper tank outlet device: Yes e/ No Manhole or marker to grade: Yes t./
Drainfieid Trench
Length Width
feet feet
feet feet
feet feet
Total = ft
Average depth of drainfield gravel 13 inches
Proper gravel size: Yes ✓ No
Backfill or fill material as required: (Quality) Yes
Other findings:
?/4
Inspected by: ke4A. q s 3
Date Approved by
d�
PART III
Length
feet
feet
feet
HRS —H Form 4016, Feb 85 (Obsoletes previous editions which may not be used)
(Stock Number. 5744-002-4016-0)
Width Length / feet x 17 feet = 2 C)6 ft
200
feet Length feet x feet= ft
feet Proper No. drainlines: Yes �No
feet Proper pipe separation: Yes (.Nlo C%
Total = ft Distribution box level: Yes i No
Absorption Bed
Minimum depth of gravel 12— inches
Gravel is suitable quality: Yes No
v No (Quantity) Yes v No
Systems located as permitted: Yes No
Systems including plumbing stub -outs installed at proper elevation: Yes No
Average depth to drainpipe invert from finished grade. Zb inches Maximum depth 29 Inches
STAL TION APPROVAL
AN APPROVED INSTALLATION DOES NOT GUARANTEE PERFORMANCE
Date er2//5
b4F
COUNTY PU HEALTH UNIT
Note: Completed copies of this form will be provided to the applicant, installer and the building department.
Page 2 of 2
BUILDING
ELECTRICAL
PLUMBING
ROOFING
Owner of II
Building C--
MIAMI SHORES VILLAGE, FLORIDA
PERMIT N° 4287
Architect
Contractor
or Builder
Legal Lot
Description !I Bl
Address of
Building ) t'
Work to be performed under this Permit
Value of
Project $
e.
DATP 195
Contractor's
License No.
at
Subdi-
vision
Amount of
Permit $
7 ,
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- 1 v.•` .,. .w.... $ `•.
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
,ertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In ac-
= epting this permit I assume responsibility for all work done by either, myself, my agent, servant or employee.
/ / /
CONTRACTOR OR BUILDER BY AUTHORITY / 'oleo
MIAMI SHORES VILLAGE
BUILDING INSPECTION DEPARTMENT
APPLICATION FOR BUILDING PERMIT
Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the build -
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 the work.
Owner's Name and Address .!
rs. ce p
Registered Architect and /or Engineer ,,,,•,,,,,,,,,-,. „ -..
Name and address of licensed contrj ctor a Cr . /9.y 5 e.p. is ._. //_K
Location and legal description of lot to be built on: 0 O 1 , L4.)
Lot Block Subdivision ._...._— .__
Street and Number where work is to be done �..�
State work to be done and purpose of building (by floors) /2 .s.
New Building Remodeling Addition
e/1 _._ _..._....
,19
Date... �._....�....._...
_ No . . Street.__..741?.._ N.i . 9S
and for no other purpose.
Repairs U No. of Stories
To be constructed of Kind of foundation Roof Covering
Estimated Total cost of improvements $ Amount of Permit S.
Zone cubage required plan Cubage
Distance to next nearest building Size of Building Lot
Maximum live load to be borne by each floor
I hereby submit all the plans and specifications for said building. All notices with reference to the building and its construction may
be sent to
The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations as an employer
of Libor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida, Permanent Supplement,
and has complied 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 subcontractors, on work to be performed under this
pennit, as are licensed by Miami Shores Village.
Remarks (Signed). , .
ary Public, State of Florida
AP
R 31
STATE OF FLORIDA,
COUNTY OF DADE. ss
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally ap-
peared - --
..... M _ ______ 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 truing application, and that he did sign the same, and that all facts
therein by him staSgrG tru `f' / J
Permit No.._.._ /// ( /_ Date ad, Sworn td and Subscribed before me.
Disapproved _._.<..
(Signed)
Building Ynsp ' r ” . mmission - . ires
PLANNING OARD DATE
Chairman Member
Member Member
Member ...... Member
Council Approved Date Disapproved Date
NOTE: A charge of $1.00 will be made for making corrections or changes to this application nfter approval has been obtained from
the Planning Board.
A re- inspection fee of $1.00 will be charged when such re- inspection is made necessary by improper notice for inspection or faulty
materials and /or workmanship.
BUILDING
ELECTRICAL
PLUMBING
11031
Owner of
Building
MIAMI SHORES VILLAGE, FLORIDA i
DATE 19
o PERMIT N° 6315
ti a / ,
Architect
Contractor I. �`' y '�
or Builder 1 �`` _ iI L4 :s f.ii -<---1C---• 1
Legal Lot
Description II Bl.
Address of �. -
Building :' � � S
This permit is granted to the contractor or builder named above to construct the building or to install the equipment or device described in the applica-
tion herefor in strict compliance with all ordinances pertaining thereto and with the understanding that the work will be performed in compliance with any
plans, drawings, statements or specifications that may have been submitted to and approved by the proper municipal authorities. This Permit may be revoked
at any time if the work is not done in compliance with such ordinances or if the plans are changed without authorization. A further condition upon which this
permit is granted is the understanding that the contractor or builder named above assumes the responsibility for a thorough knowledge of the ordinances and
regulations pertaining to the work covered hereby whether shown on the plans or drawings or in the statements or specifications and that he assumes respon-
sibility for work done by his agents, servants or employees.
Signed. INSPECTOR
In consideration of the issuance to me of this permit I agree to perform the work covered hereunder in compliance wi all ordinances d regulations
pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authoriti of Miami Shores Village. In as
cepting this permit I assume responsibility for all work done by either, myself, my agent, servant or employee.
•
CONTRACTOR OR BUILDER
Work to be performed under this Permit
elvt
BY
a A. (.- ,9 ` 1.A et.
Contractor's 2:z2_9__
License No
/ ( 4 - 0 6 0 �} 1 ( j CatJt
Subdi-
vision
Value of
Project $
Amount of
I Permit $
AUTHORITY
ABBOT 4E56,'
MIAMI SHORES VILLAGE, FLA.
JOB 0. A- rv► f
ADDRESS 76 ° a-•
= q." jT
N? 6844
INSPECTION St3
TIME READY • 4- /4,6,C
REMARKS •
INSPECTOR DATE
Village of Miami Shores
JOB /
ADDRESS ? di*" E •
INSPECTION r
TIME READY �j
REMARKS /,
INSPECTOR C /4
ce
N° 4913
DATE 4— c O — ��