711 NE 94 St (3)UILDING
' :LECTRICAL
'LUMBING
:OOFING
)wrier of
wilding
PERMIT N° 3853
D
Irchitect
ontractor
)r Builder
.egal Lot
)ascription
address of
wilding
CONTRACTOR OR BUILDER
MIAMI SHORES VILLAGE. FLORIDA
DATE 195
Contractor's
License No.
Work to be performed under this Permit
Bl.
Subdi-
vision
Value of
Project $
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 application
ierefor in strict compliance with all ordinances pertaining thereto and with the understanding that the work will be performed in compliance with any plans,
rawings, statements or specifications that may have been submitted to and approved by the proper municipal authorities. This Permit may be revoked at any
me 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
ranted is the understanding that the contractor or builder named above assumes the responsibility for a thorough knowledge of the ordinances and regulations
.ertaining 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
one 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
•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.
BY AUTHORITY ate.
4illge of Miami Shores
JOB
ADDRESS E-a 0 c= - S 7 /( /U - 91
INSPECTION
TIME RE kDY
REMARKS
0
INSPECTOR
N9 4656
a e:, k- -eAt",
DATE
f
Jqo5
MOAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
Date...
_ Permit o _— 2�_ �°..— _..._.—
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. - ff� Q ;71
Owner 6 s Name and Address 1 /10"9 7 " 4 y 1/4-11;6 7 1 i ` A 6 e' Street_..— ' 7 J
Registered Architect and /or Engineer
E n ,l 1 i t N77.4 'ip �e _ _ ��� T >K _ �. . f . 6 0 ._...�.. sure[ et
Location and Legal Description Lot.. � t /i Bk 1 / Subdivision /&
Street and Number where work L to be performed —No // N ` � ' Street. .9
State work to be performed and purpose of building (By Floors)__. _G __. ....D44'.N.
New Building_.___._ _ _..- .........._.. Remodeling_._—_ - -- Addition.- - _.— ......__ Repairs t'
No. of Stories
Size Septic Tank_ .� _Type of Tangy _._.------ ..----- •. - -_ - -- Capacity Gal,..•_--- -
Feet of Drain Tile ,q0 D -i-sn Feet of Tank or Drain Field from Well . Nv --
Nature of Water Supply: City —Wells Size of Soakage Pit
Amount of Permit $ k5'° od
Signed
My Commission Expires Notary Public, State of Florida
aster Plumber.
3
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 Itur com-
plied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors employed by him in the worlr 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 err
required by the Act. The undersigned agrees to employ only such sub- contractors, on to be performed under this permit, as are
lionised by Miami Shores Village.
STATE OF FLORIDA, I ea.
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 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 wt snob Meapsotlae is moos nscomery by Improper nodes for inspection, or faulty
materials and /or wrork®anahip.
CLOSETS
BATH
TUBS
SNOwtRS
LAVA-
TORIES
SINKS
SLOP
RINK[
LAUNDRY
TU[e
RINALS
BAN
BASIN
FLOOR
DRAIN
NKINO
FO FOVNT'NS
TOTAL
FIXTURES
CONTII.
LIST
CHICK
SEPTIC
TANK
SKY/KR
CONN.
DRAIN
FIELD
SPAKAO[
PIT
GREASE
TRAP
SOLAR
NEATER
Mar
WILL
a
SYSTEM
SW /M•O
POOL
CONTR.
LIST
r-
CN[CK
f
Jqo5
MOAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
Date...
_ Permit o _— 2�_ �°..— _..._.—
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. - ff� Q ;71
Owner 6 s Name and Address 1 /10"9 7 " 4 y 1/4-11;6 7 1 i ` A 6 e' Street_..— ' 7 J
Registered Architect and /or Engineer
E n ,l 1 i t N77.4 'ip �e _ _ ��� T >K _ �. . f . 6 0 ._...�.. sure[ et
Location and Legal Description Lot.. � t /i Bk 1 / Subdivision /&
Street and Number where work L to be performed —No // N ` � ' Street. .9
State work to be performed and purpose of building (By Floors)__. _G __. ....D44'.N.
New Building_.___._ _ _..- .........._.. Remodeling_._—_ - -- Addition.- - _.— ......__ Repairs t'
No. of Stories
Size Septic Tank_ .� _Type of Tangy _._.------ ..----- •. - -_ - -- Capacity Gal,..•_--- -
Feet of Drain Tile ,q0 D -i-sn Feet of Tank or Drain Field from Well . Nv --
Nature of Water Supply: City —Wells Size of Soakage Pit
Amount of Permit $ k5'° od
Signed
My Commission Expires Notary Public, State of Florida
aster Plumber.
3
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 Itur com-
plied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors employed by him in the worlr 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 err
required by the Act. The undersigned agrees to employ only such sub- contractors, on to be performed under this permit, as are
lionised by Miami Shores Village.
STATE OF FLORIDA, I ea.
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 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 $1.00 will be made wt snob Meapsotlae is moos nscomery by Improper nodes for inspection, or faulty
materials and /or wrork®anahip.
Installer
Other findings:
Inspected by
STATE OF FLORIDA
DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES
ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION AND INSTALLATION PERMIT
Applicant 4 7. 14 be_s-
2/1 41 9.s27
PART II - SYSTEM INSTALLATION INSPECTIO
0�✓, WA.
Proper tank legend: Yes
Tanks watertight: Yes es✓ f No
Proper tank outlet device:
Length width
feet feet
feet feet
feet feet
Total = ft
Tank size gallons gallons allons
Manhole or marker to grade: Yes No
Absorption Bed
Length width Length 33 .' feet x y. 7$ feet = ft
feet feet Length feet x feet= ft
feet feet Proper No. drainlines: Yes
feet feet Proper pipe separation: Yes
Total = ft Distribution box level: Yes Ai
Yes____ No
Drainfield Trench
Systems located as permitted: Yes t� No
Systems including plumbing stub -outs installed at proper elevation: Yes No
Average depth to drainpipe invert from finished grade: e 9 inches Maximum depth
Average depth of drainfield gray l: 11., inches
HRS —H Form 4016, Feb 85 (Obsoletes previous editions which may not be used)
(Stock Number. 5744-002-4016-0)
Tank material
Pe ember r
AND FINAL INSTA PA PROVAL
Tank Manufacturer
Tank level: Yes
Minimum depth of gravel /2- inches
Proper gravel size: Yes `-" No Gravel is suitable quality: Yes c/ - No
Backfill or fill material as required: (Qu. lit ) Yes (/No (Quantit , Yes No
Date
Inches
PART III - IN T TION APPROVAL
Date Approved by: Irs S
COUNTY PUBLIC HEALTH UNIT
AN APPROVED INSTALLATION DOES NOT UARANTEE PERFORMANCE
Note: Completed copies of this form will be provided to the applicant, installer and the building department.
Page 2 of 2