776 NE 95 St (3)Permit No. .3
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 the progress of work.
Owner's Name and Address /d! J AA at Fe thz 7' ft b s9 7 7 6 Ai street 9s
New Building
Amount of Permit $
MOAN SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPUCzTOON FOR PLUM BONG O G PERRI
Remodeling Addition
No.
Repairs
Date /
Registered Architect and/or Engineer
0
Employing P be e 0/ 7 ,i f lli No. / S -49 // .!/C' Street ? A 64 V C
Location and Legal ptioLot F Blo Subdivision g�
e
Street and Number where work is to be performed — No. 7 7 t!o i e ? c irY
Street
State work to be performed and purpose of building (By Floors)
(Signed) / 30e v�
(Signed)
ss.
No. of Stories
Size Septic Tank Type of Tank Capacity Gals.
Feet of Drain Tile Dist. Feet of Tank or Drain Field from Well
Nature of Water Supply: City - Well Size of Soakage Pit
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 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 sub - contractors, on work to be performed under this permit, as are licensed by Mia ores Village.
Master Plumber.
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 him stated
are true.
My Commission Expires Notary Public, State of Florida
NOTE: A re- inspection fee of $25.00 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
FOUNTAINS
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
?C'
CHECK
Permit No. .3
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 the progress of work.
Owner's Name and Address /d! J AA at Fe thz 7' ft b s9 7 7 6 Ai street 9s
New Building
Amount of Permit $
MOAN SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPUCzTOON FOR PLUM BONG O G PERRI
Remodeling Addition
No.
Repairs
Date /
Registered Architect and/or Engineer
0
Employing P be e 0/ 7 ,i f lli No. / S -49 // .!/C' Street ? A 64 V C
Location and Legal ptioLot F Blo Subdivision g�
e
Street and Number where work is to be performed — No. 7 7 t!o i e ? c irY
Street
State work to be performed and purpose of building (By Floors)
(Signed) / 30e v�
(Signed)
ss.
No. of Stories
Size Septic Tank Type of Tank Capacity Gals.
Feet of Drain Tile Dist. Feet of Tank or Drain Field from Well
Nature of Water Supply: City - Well Size of Soakage Pit
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 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 sub - contractors, on work to be performed under this permit, as are licensed by Mia ores Village.
Master Plumber.
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 him stated
are true.
My Commission Expires Notary Public, State of Florida
NOTE: A re- inspection fee of $25.00 will be made when such re- inspection is made necessary by improper notice for inspection, or faulty materials
and/or workmanship.
/, 1Cf9 AAL
STATE OF FLORIDA
DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES
APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PERMIT
Date of Application
r / A/ < � � ' Authority: Chapter 381, FS
Chapter 10D -6, FAC
Name of Owner
Mailing Address of Owner
Owner's Agent ®Ai^✓l /
Agent's Mailing Address / gG / / PU U' A v
Property Street Address 7 7 (0 ' C 9
Type of No. Bedrooms
Residential (each dwelling unit)
PART I — APPLIC TI N
�7
:71:1) A A) f i (2 e — J'/ 136 Telephone Number
- 7 �,, / 9 s �
Lot No. Block No Subdivision Date Subdivided
NOTE: IF NOT IN A SUBDIVISION ATTACH A METES AND BOUNDS DESCRIPTION
This Application is for: New System Repair Existing System
Type of Sewage Flow Sewage Flow
Establishment (Gallons per day) Based On
g E5 o E ()TIR (
TOTAL FLO
HRS -H Form 4015, Feb 85 (Obsoletes previous editions which may not be used)
(Stock Number: 5744 -001 - 4015-1)
Permit Application Number
(
L
Heated or Cooled Area
(each dwelling unit)
3 ft
ft
AUDIT CONTROL NO 116 ll 56 Applicant's Signature
Builder
Telephone No 6 1 S 9
No. Dwelling
Units
Exact Directions to Property
O L;
Sewage Flow
(Gallons per day)
Page 1 of 3