502 NE 94 St (11)MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
NA'S • 9c -- 0 9 it APPLICATION FOR PLUMBING PERMIT
SObbt
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 Dopy of approved plans and specifications must be kept at
building during progress of work.
Size Septic Tank__ .L
Feet of Drain Tile ■ 25
Nature of Water Supply: City —Well.
—
Amount of Permit $__4. $__4. Y
. ! ` 0
My Commission Expires
(Si
,56 6 c n&—
Street.. 9
Repairs
_Type of Tan ... ____Capacity Cals... _.. I
mi Feet of Tank or Drain F from Well
Size of Soakage Pit.
(Signed)_ J. LEVEROCK
7 S'S
/ 7
Date
Date ... -
Owner's Name and Address
Registered Architect and /or En
1 J `i( L nd L�eegaa� l3 ption Lot_ //`t.1 s2— -_ Bloat v Subdivldon.i
Street and Number where work is to be performed —No c.56c2 /??Z:- 9 LS Street
State work to be performed and purpose of building (By Floors • --__ -- ._.�.__
New Building- - - - - -- — _.._..........._.. Remodeling —___ .-.— _— Addition.
No. of Stories...
Notary Public, State of Florida
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 liar 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 work such public notice or notices as are
required by the Act. The undersigned agrees to employ only such sub-contr j k to be performed under this perinit, as are
licensed by Miami Shores Village.
aster Plumber.
STATE OF FLORIDA, I µ
COUNTY OF DADE.
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, persorsally appeared
to me well known, and who, being by me first duly sworn, upon oath deposes and says that be is the. -__.._ .._. _ _.... _..
of the above described construction, that be has carefully read the foregoing application, and that be 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 whoa snob miespectlan >r soada•staosssssry by improper notice for inspection, or faulty
materials and /or workmanship.
CLOCLOSETS
BATH
TUe[
SHOWERS
LAVA•
Tonics
somas
SLOP
SINK[
LAUNDRY
Tun[
URINAL/
I NAL/
CATCH
OA[IN
FLOOR
DRAIN
DRINKING
FOUNVN [
TOTAL
FIXTURE[
CONTR.
LIST
CHECK
SEPTIC
TANK
SEWER
CONN.
DRAIN
FIELD
SOAKAGE
PIT
GREASE
TRAP
SOLAR
P/ [ATM
DEEP
WELL
SPRKLR.
5 M
SW 1$1
POOL
CONTR.
LIST
CHICK
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
NA'S • 9c -- 0 9 it APPLICATION FOR PLUMBING PERMIT
SObbt
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 Dopy of approved plans and specifications must be kept at
building during progress of work.
Size Septic Tank__ .L
Feet of Drain Tile ■ 25
Nature of Water Supply: City —Well.
—
Amount of Permit $__4. $__4. Y
. ! ` 0
My Commission Expires
(Si
,56 6 c n&—
Street.. 9
Repairs
_Type of Tan ... ____Capacity Cals... _.. I
mi Feet of Tank or Drain F from Well
Size of Soakage Pit.
(Signed)_ J. LEVEROCK
7 S'S
/ 7
Date
Date ... -
Owner's Name and Address
Registered Architect and /or En
1 J `i( L nd L�eegaa� l3 ption Lot_ //`t.1 s2— -_ Bloat v Subdivldon.i
Street and Number where work is to be performed —No c.56c2 /??Z:- 9 LS Street
State work to be performed and purpose of building (By Floors • --__ -- ._.�.__
New Building- - - - - -- — _.._..........._.. Remodeling —___ .-.— _— Addition.
No. of Stories...
Notary Public, State of Florida
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 liar 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 work such public notice or notices as are
required by the Act. The undersigned agrees to employ only such sub-contr j k to be performed under this perinit, as are
licensed by Miami Shores Village.
aster Plumber.
STATE OF FLORIDA, I µ
COUNTY OF DADE.
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, persorsally appeared
to me well known, and who, being by me first duly sworn, upon oath deposes and says that be is the. -__.._ .._. _ _.... _..
of the above described construction, that be has carefully read the foregoing application, and that be 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 whoa snob miespectlan >r soada•staosssssry by improper notice for inspection, or faulty
materials and /or workmanship.
1
Date cP Job Address •)2 A'E ITs
Legal Description
Owner / Lessee / Tenant kt e, L'72 r■5b5y Master Perm 373
�, I L _- r
Owner's Address 5v,. �• (= .5' 4 / � Phone 539- Pico
co. Me. ( � S C f"(2 A';J Address �• 793Z Mid �
cl 9h' Jw C ti &. ss# Phone (s1J lu I 7g<'?
Contracting
Qualifier
State # Municipal #
Architect /Engineer
Bonding Company
Mortgagor
Type(circle one): BUILDING
Square Ft.
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Tax Folio
Competency # Ins.Co.
Address
Address
r Address
WORK DESCRIPTION
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 construc in this jurisdiction. I understand that separate
permits are required for ELECTRICAL, PLUMBING, SIGNS, POOLS, ROOFING and MECHANICAL WORK.
OWNER'S.AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will
be done in compliance with all applicable laws regulating construction and zoning. Furthermore, I
authorize the above -named contractor to do the work stated.
Signature ,)
of�wner an -
Date:
/ �__ --ate
Condo President
otary as to Owner and o .
My Commission Expires:
"'won. Met 22, 1998
** * * * * *
3 0. 0o
FEES: PERMIT 30t' C) RADON
/ 0 e 0c) p.,94-
APPROVED: 140 ,0a
Zoning
Mechanical
ELECTRICAL LUMBING MECHANICAL ROOFING PAVING FENCE SIGN
Szrb
d'
Buildin
Plumbin
Estimated Cost(valu
Signat
Date
N tar /nte *gi@1'H1er- Builder
y Comma : w Expxjeliesion CC4090s7
* Expires Sep. 22, 1998
Bonded by HAI
4 4" OP 800- 422 -1555
* * ,
/ ma y
C.C.F. / NOTARY TOTAL DUE /‘
Fire Other
O tZlt J dre—
* *
or or Owner- Builder
1
**
Electrical
Engineering
APPLICATION FOR:
[ ] New System
i4 Repair
APPLICANT: AA
.
MAILING ADDRESS:
AGENT:
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 DESCRIPTION OR DEED]
LOT:
PROPERTY ID #:
PROPERTY SIZE:
BLOCK:
PROPERTY STREET ADDRESS:
DIRECTIONS TO PROPERTY:
BUILDING INFORMATION
2
3
4
STATE OF FLORIDA PERMIT I ' `- 0 _�"
DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES DATE PAID
ONSITE SEWAGE DISPOSAL SYSTEM FEE PAID $
APPLICATION FOR CONSTRUCTION PERMIT RECEIPT 1
Authority: Chapter 381, FS & Chapter 10D -6, FAC
] Existing System [ ] Holding Tank [ ] Temporary /Experimental
] Abandonment [ ] Other(Specify)
(icerwl)9?
esa.n
SUBDIVISION:
DATE OF ' � /97
SUBDIVISI ,)
[Section /Township /Range /Parcel No.] ZONING:
ACRES [Sgft /43560] PROPERTY WATER SUPPLY: [ ] PRIVATE [%/ePUBLIC
542. kiivig 9iPte Miam
[ ,.4 RESIDENTIAL
[
] COMMERCIAL
TELEPHONE:794_
4&t A 339
Unit Type of No. of Building 1 Persons Business Activity
No Establishment Bedrooms Area Saft Served For Commercial Only
[ ] Garbage Grinders /Disposals [ ] Spas /Hot Tubs ( ] Floor /Equipment Drains
[ ] Ultra -low Volume Flush Toilets [ ] Other (Specify)
s.PPLICANT'S SIGNA
DATE:
' Form 4015, Mar 92 (Obsotetes previous editions which may not be used) Page 1 of 3
- Number: 5744- 001 - 4015 -1)
G
T
A
N
K
D
R
A
I
N
F
I
E
L
D
CONSTRUCTION PERMIT FOR:
[ ] New System
[ ] Repair
APPLICANT:
PROPERTY STREET
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. HRS 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
[GALLONS
[GALLONS
GALLONS
GALLONS
SQUARE
SQUARE
TYPE SYSTEM:
CONFIGURATION:
LOCATION OF BENCHMARK:
STATE OF FLORIDA
DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES
ONSITE SEWAGE DISPOSAL SYSTEM
CONSTRUCTION PERMIT
Authority: Chapter 381, FS & Chapter 10D -6, FAC
( ] Existing System [ ] Holding Tank [ ] Temporary/Experimental
[ ] Abandonment [ ] Other(Specify)
ADDRESS: 511 ))6--yflit (; 6f. CF
BLOCK: SUBDIVISION:
FEET
FEET
[ 1
[ 1
STANDARD
TRENCH
ELEVATION OF PROPOSED SYSTEM SITE [
BOTTOM OF DRAINFIELD TO BE [
/ GPD] SEPTIC TANK /AEROBIC UNIT CAPACITY MULTI- CHAMBERED /IN SERIES:[
/ GPD] CAPACITY � MULTI[- CHAMBERED /IN SERIES:[ ]
GREASE INTERCEPTOR CAPACITY (MAXIMUM CAPACITY SINGLE TANK: 1250 GALLONS)
PER DOSE DOSING TANK CAPACITY DOSE RATE [ ] PER 2j4 HRS NO. OF PUMPS: [ ]
PRIMARY DRAINFIELD SYSTEM
SYSTEM
[ ] FILLED
[Al BED
FILL REQUIRED: [ ] INCHES EXCAVATION
° <1972 BOTTOM OF DRAINFIELD
T ( " /A3OVE WET SEASON WATER TABLE
H
SPECIFICATIONS BY:
APPROVED BY:
DATE ISSUED:
AGENT:
TITLE:
S -H Form 4016, Mar 92 (Obsoletes previous editions which may not be used)
?ck Number: 5744 - 001- 4016-0)
PERMIT #
DATE PAID
FEE PAID
RECEIPT #
[ ] MOUND
[SECTION /TOWNSHIP /RANGE /PARCEL NUMBER]
[OR TAX ID NUMBER]
] [INCHES /FT] [ABOVE /BELOW] BENCHMARK /REFERENCE POINT
] [INCHES /FT] [ABOVE /BELOW] BENCHMARK /REFERENCE POINT
REQUIRED: [ ] INCHES
cis- )4o1
s 4-p
7(
INSTALL 12" OF LOAMY COAP.37 SAND
UNDER BOTTO ?✓'! `➢ °;.....a.'
SUBMIT LEIw^l -IfvL F'N
TI-IIS
BOTTOM OF
TITLE: T
EXPIRATION DATE:
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