PLUMBINGBUILDING ❑
ELECTRICAL ❑
PLUMBING ❑ PERMIT N? 8041
ROOFING ❑
0
Owner of
Building
Architect
Contractor
or Builder
Legal
Description
Address of •
Building ,• 4 '; '- :" j •
• .1 .
Lot 11
II Bi
MIAMI SHORES VILLAGE, FLORIDA
Work to be performed under this Permit
7 GO
Date
Contractor's r
License No. 1 V
Yif'io .
r ' "
t _ w_ ! �1 .3.
Subdi-
vision
Sq. Ft.
Value of II Amount of
Project $ 11 Permit $
' 1
1 9_x.'.
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 of drawings or in the statements or specifications and that he assumes respon-
sibility for work done by his agents, servants or employees. f
Signed •
ego
1/4
' ! '(INSPECTOR)
BY
In consideration of the issuance to me of this permit I agr a to perform the work covered hereunder in compliance with all ordinances and regulations
pertaining thereto and in strict conformity with the plans, drawi , statements or specifications submitted to the proper authorities of Miami Shores Village.
In accepting this permit I assume responsibility for all work dote by eithek, myself, my agent, servant or employee.
CONTRACTOR or BUILDER
BY AUTHORITY
.-
Qualifier
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Og F7 gV
r l Job Address (5) •6 9-5 Tax Folio 6
Date
Legal Description r
Owner/Lessee / Tenant 60 Q � `
Owner's Address 0(50 N lS bt ' rt .33 35 Phone
Contracting Co. /Li AAA. i 4 l C PoM E,Q Address
State # 4 d 1 8 , —a 71/-1 Municipal # Competency #
Address
Address
Historically Designated: Yes No J�
4 7
Master Permit #
305 °751 si4 S
/� �� A��I L l— 3 gio SS# / - Phone OS S t.0 '
Ins. Co.
Architect/Engineer
Bonding Company
Mortgagor Address
Permit Type (circle one): BUILDING ELECTRICAL PLUMING MECHANICAL
WORK DESCRIPTION
Square Ft.
Notary as to Owner and/or Condo President Date
My Commission Expires:
Carol G. Salta
1.1 MY COMMISSION # CC634419 EXPIRES
;: : July 14, 2001
% 4, * SONDE° TNRU TROY FAIN INSURANCE, INC.
FEES: PERMIT S RADON
APPROVED:
Zoning Building
Mechanical Plumbing
Estimated Cost (value) ,S0
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 construction and zoning. Furthermore, I authorize the above -named contractor to do the work stated.
?/07
ature of • ed and/or Condo President Date Signa e of Contractor or Owner - Builder Date
Notary as to Contractor or Owner - Builder Date
P53 �- ?e7o —e /..— 3V 0�
My Commission Expires:
J 0
C.C.F. C - NOTARY
Electrical
ROOFING PAVING FENCE
SIGN
BOND 3
TOTAL DUE 3
Engineering
LOT:
APPLICANT: wiA j co AGENT: L� %/ (� � ���
PROPERTY ID #:
STATE.OFTLORIDA PERMIT 1
q
DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES
ONSITE SEWAGE DISPOSAL SYSTEM
SITE EVALUATION AND SYSTEM SPECIFICATIONS
BLOCK: ���
SUBDIVISION:
TO BE COMPLETED BY ENGINEER, HEALTH UNIT EMPLOYEE, OR OTHER QUALIFIED PERSON. ENGINEER'S MUST
PROVIDE REGISTRATION NUMBER AND SIGN AND SEAL EACH PAGE OF SUBMITTAL. COMPLETE ALL ITEMS.
Y YES [ ] NO NET USABLE AREA AVAILABLE: 4/71/ACRES
GALLONS PER DAY [RESIDENCES -TABLE 1 / OTHER -TABLE 2]
GALLONS PER DAY [1500 GPD /ACRE OR 2500 GPD /ACRE]
SQFT UNOBSTRUCTED AREA REQUIRED: /WV SQFT
PROPERTY SIZE CONFORMS TO SITE PLAN: [
TOTAL ESTIMATED SEWAGE FLOW: 6p
AUTHORIZED SEWAGE FLOW: l� j
UNOBSTRUCTED AREA AVAILABLE: /14(
BENCHMARK /REFERENCE POINT LOCATION:
ELEVATION OF PROPOSED SYSTEM SITE IS
SOIL PROFILE INFORMATION SITE 1
[INCHES/ ] [ABOVE /BELOW] BENCHMARK /REFERENCE POINT
THE MINIMUM SETBACK WHICH CAN BE MAINTAINED FROM THE PROP ED SYSTEM TO THE FOLLOWING FEATURES:
SURFACE WATER: ,,d FT DITCHES /SW S: FT NO Y WET? [ ] YES [J40
WELLS: PUBLIC: FT LIMITED USE: FT PR V .- FT NON- POTABLE: FT
BUILDING FOUNDATION : 5 FT PROPER LINES: 7�l6 6 ,'FT POTABLE WATER LINES: FT
SITE SUBJECT TO FREQUENT FLOODING: [ ] yFS [ 144O 10 YEAR FLOODING? [ ] YES [M
10 YEAR FLOOD ELEVATION F,ORSITE: ,6e, FT MSL /NGVD SITE ELEVATIO?: / FT MSL /NGVD
Munsell # /Color
USDA SOIL SERIES:
Texture Vepth
�, -,�-- to I®'
to
to
to
to
to
to
to
- - to
[Section /Township /Range /Parcel No. or Tax ID Number]
SITE EVALUATED BY:
HRS-H Form 4015, Mar 92(Obsoletes previous editions which may not be used)
(Stock Number: 5744 - 003 - 4015-1)
SOIL•PROFILE INFORMATION SITE 2
sell ',Color +Texture Depth
7 9 - to
USDA SOIL SERIES:
OBSERVED WATER TABLE: INCHES [ABOVE / BELOW] EXISTING GRADE. TYPE: [PERCHED / APPARENT]
ESTIMATED WET SEASON WA ER TABLE ELEVATION: ,.5-/ INCHES [ ABOVE / BELOW ] EXISTIN5 GRADE.
HIGH WATER TABLE VEGETATION: [ ] YES 04/NO MOTTLING: [ ] YES [ �,]�O DEPTH: 4 ' . INCHES
SOIL TEXTURE /LOADING RATE FOR SYSTEM SIZING• DEPTH OF EXCAVATION:
DRAINFIELD`CONFIGURATION: [ ] TRENCH [ BED [ ] OTHER (SPECIFY)
REMARKS /ADDITIONAL CRITERIA:
to
to
to
to
to
to
to
to
INCHES
Page 3 of 3
:31c:;,
27 T1 '70.; ,
SZ
•
7:0
•
• •
1.133:: 3: •
o r (my 91.:11 •
on :3Yr.....■1jL:■•: •
7 1T .1-2 o - • .: •
. .
c1rIy 3L1: J2 J1
to of
..1t;k:::,:rd the C.:1:::17..02; ..• :
Iiisturici.:1 in:ft= ..
11
7.7.37_73c:3)
DIE:7.77-2 art - •
. .•
1,..1 f: :',7f:, •
coi! 1-.13.
-
Scale:
STATE OF FLORIDA
DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES
APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCT)pl, PERMIT,
Permit Application Number /
PART II - SITE PLAN
Each block represents 5 feet and 1 inch = 50 feet.
■■■■■■■■■■■■■■■■ ■ ■ ■ ■ ■ ■ ■■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■MMOM ■ ■■■■■■■■■■■■■■■■■■ ■ ■■ ■ ■ ■ ■ ■ ■ ■ ■ ■■
■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ EMM■■■■■■■ I:OVR IMME MM■■■■■■■■■■■■■■■■■■■■■■■■■■■■
■■■■■■■■■■■■■■■ ■ ■ ■ ■ ■ ■ ■O■■■■■ ■■■ai.������!!MOI ii■
M M ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■■
■■■■■■■■■■■■■■■ ■ ■ ■ ■ ■ ■ ■11■■ ■■■■■■■ ■■■■■ ■■IINMan . .!I■■■■ ■■■■■ ■ ■ ■ ■ ■ ■■
■■■■■■■■■■■■■■■■■■■■■■ 1i■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■ ■ ■■■■ ■ ■ ■ ■ ■! ■ ■ ■ ■ ■ ■■■■■ ■ ■■■■■■
■■■■■■■■■■■■■■■■■■■■■■ 11■■■■ E■■■■■ E■■■■■■■■■■■■■■■ ■■■■■■■■■■ ■E■■■ ■ ■■■ ■■ ■P ■ ■ ■E ■ ■E■
■■■■■■■■■■■■■■■■■■■■■ EMMEM■■■■■■■■■■■■■■■■■■■■■■ ■■ ■■■ ■■ ■■■■ ■■■■ ■ ■ /■ ■ ■ ■ ■ ■ ■■
■■■■■■■■■■■■■■■■■■■■■■ 11■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■ ■■■■■■■■N■■■CA ■ilRA ■ ■ ■ ■ ■ ■ ■ ■ ■■
■■■■■■■■■■■■■■■■■■■■■■ II■■■■■■■■■■■■■■■■■■■■■■■■■■ ■ ■■ ■■■■ ■■■■ ■ ■■■I ■W ■ ■ ■ ■ ■ ■■ ■ ■■■■
■■■■■■■■■■■■■■■■■■■■■■I IE■■■■■■■■■■■■■■■■■■■■■■■■■ E■ ■ ■■■ ■EMMEMER ■ ■■ ■ ■■■ ■ ■■■
■■■■■■■■■■■■■■■■■■■►■■ n■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■ ■■■■■ ■n■r ■■■■■■ ■■ ■ ■ --- --
■■■■■ ■1■■■ ■■ ■ ■■■■■ ■a ■Eli; ■■■■■■■■■■■ 1iA■■■■■■■ E■■■■mm■ ■■■ ■/D!E ■ ■Z■■■■■■■ ■E■■■■■ ■■
■■■■■■■■■■■■■■■■■►.■■ 7. I1I■■■■■ ■ ■■■■ ■11■ ■■■■E■ ■E ■If■uM•■■i ■ ■■ ASEME ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■■
■■ ■■ ■■■■■ ■ ■ ■ ■■■■I.N ■►/i/ III■■■■ ■ ■■■ ■■■■I I■ ■►.1■■ ■■ ■II■so■■ ■■ ■■■II,u■■ ■■ ■ ■1! ■1 ■■■■■■ ■■■■
■■■■■■■■■■■■■■■L E1■ I, I■■ 1i■■■■■■■■■■ ■ ■11 ■I ■'/!i1/li1■IiIEIi /■ ■■■■■■■ 4ID/■[1MEMME ■AMAM ■E■■ ■ ■ ■■■
■■■■■■■■■■■■■■■ Iir/ fiiMMIN I1i■■■■■■■■■■■ ■11 ■EDIMACAMiu■N ■■ ■■■■■■■ ■KIEM !I■'■■ ■VMM11 ■ ■ ■E■■■■ ■■
■■■■■ ■ ■■■ ■ ■■■■■C % ■ ■ ■ ■ ■1IH ■ ■■ ■■■ ■ ■ ■ ■I IE■[isA ■ ■E■ ■ ■ ■ ■ ■ ■■ ■■■■W I ■ ■'Y ■■ ■ ■GCJ ■ACME■■■■■■■
■■■■■■■■■■■■■■■■■■■■■■ I° I■■■■■■■■■■■ ■1I■■■■■!1■IWUR:E:■■ ■iriurii l■■■■I!rM ri:'a■■■■ ■■■■
■■■■■■■■■■■■■■■■■■■■■■ 11■■■■■■■■ ■■ ■ ■II ■ ■■FWA ■ ■MPAM ■■■■■MMMEMUMM ; ■ ■NaMM■ ■ ■ ■ ■ ■ ■ ■ ■■
■ ■ ■ ■■■ MEMO■■■■■■ ■E■ ■E ■11 ■■ ■ ■ ■■ ■■ ■ ■■■I 1 ■ ■ ■ ■ /Mill■MAMEMI ■■■ ■ ■ ■■MEMMW ■rtaEill11 A■■ ■■ ■■■■ ■■
■ ■ ■ ■ ■■ ■ ■ ■■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■I i ■ ■ ■ ■■ ■ ■■■■■ ■t i■■ ■■[IGU■ ■ ■E■ ■ ■ ■■■■ ►■ ■ ■•■•■II■Aiir\f I ■ ■ ■ ■ ■ ■ ■ ■ ■ ■■
■■■■■■■■■■■■■■■■■■■■■■ li■■■■■■■■■■■■ II■■■■■■ E■E■■■■■■■■ ■■\ \IIE■E■Oi■MEUW■■ ■E■■■ ■E ■E■
■■■ ■■ ■■■■■ ■ ■■■ ■■ ■■ ■■ ■■1 i ■■■■ ■ ■■■ ■ ■ ■■11 ■ ■ ■ ■ ■ ■ ■ ■ ■■E ■ ■■■■ ■MAIM ■►a■M ■■IA■ ■1! ■E■■■■■■■■■■■
■■■■■■■■■■■■■■■■■■■■■■ II■■■■■■■■■■■■ RNMEM■■■■■■■■■■■ ■ ■■ ■■ ■IW■ ■II\i■■■■■■ ■■■■■■ ■ ■■■
■■■■■■■■■■■ ■ ■■■■■■■■■■1-i■ ■ ■■■ ■ ■■ ■■ ■ ■1➢■■■ ■IEEE ■■■■■ ■ ■■■i ■■MEMI \' \■I■\ ■EE ■ ■ ■ ■ ■E ■■ ■■■■
■■■■■■ ■ ■■■■■ ■ ■ ■■■■ ■■■ ■IMMEM ■E ■■■ ■■ ■L: ■rle■E ■ ■t, ■ViM! ■ ■E\ ■ ■M■■■■■■■■■ ■ ■■■■
■■■■■■■■■■■■■■■■■ E■■■■ 11■■■■■■■■■■■■■■■■■■ EE■■■■■■■ M■■► V/L71iWMEME■ ■ ■ ■ ■ ■ ■ ■ ■E■ ■E■
■■ ■■■■ ■ ■■■■■ ■ ■■■■■■■■ Eli ■■■ ■■■■■■ ■■■■■■ ■■■■■■ ■■■■■ ■■■i 'L'mri u.. ■uJ ■ ■ ■a■■■■■■ ■ ■ ■ ■■■■
■■■■■■■■■■■■■■■■■■■■ ■ ■11■■■■■■■ ■ ■ ■■■■■■■ ■ ■■■ ■■ ■■■e= ■11■ ■R ■I ■C■■■■■_■■■■■■■■
■■■■■■■■■■■■■■■■■■■■■ ■1 i■■■■■■■■■■■■■■■■ ■■■■ ■■■■■nd■■im■■■R!mw ∎ ■Ll ■fi ■■ ■■■■■ ■■■■■■■■
■■■■■■■■■■■■■■■■■■■■ ■■I i■■■■■■■■■■■■■■■■■■■■■■■■■ I9■ II1 ■■■■■'Ii ■°■ ►II■ ■■ ■ ■ ■■■■■ ■■■■■■■
■■■■■■■■■■■■■■■■■■■■■■ 1i■■■■■■■■■■■■■■■■■■■ E■■■■■ NWIA ME ■ ■■ ■MMIIMMEMM■ ■ ■■ ■■ ■ ■■■ ■ ■■
■■■■■■■■■■■■■■■■■■■ ■■ ■Ii ■ ■ ■E ■ ■■■■ ■ ■ ■ ■ ■ ■■ ■ ■ ■■ ■■ ■WMM 1■■ ■E■MAMEMMMEM ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■■
■■■■■■■■■■■■■■■■■■ il■■■ fI■■■■■■■■■■■■■■■■■■■ e■■ I■■\ O■■ ■■ ■■■■■AMAMM ■ ■ ■ ■■ ■■■■ ■■■■■■■
■ ■■■■■■■■1i■■■ ■■■ ■■ ■E■■I I■ E■■■■■■■■■■■■■■■■■■■ r.mmwua ■■■■ ■■r/■■■m■■■E■E■■■EE■■ ■■E■
■■■■■■■■■■■■■■■■■■ ■ ■■II ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■I. ■E %■ PEA RMOMME■ ■v■■ ■II■■■■■■■■■ ■■■ ■■■■■
■■■■■■■■■■■■■■■■■■■■■■ 1i ■■■ ■ ■ ■ ■■ ■ ■ ■■ ■■■ ■ ■'a ■/.E■nmarr E ■%■7■■ ■■ ■a1AII ■ ■ ■ ■■■■ ■■■■ ■ ■■■■■
■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■■■■■■■■■■I I■■ I!■■■ O■■ IU■ M■■ i■► A■ I■■ 7■ PI■ I■ T/i1■GSaM■ ■ ■ ■ ■ ■■■ ■ ■ ■■ ■ ■ ■ ■■
■■ ■ ■ ■ ■E■ ■ ■■■■■ ■■ ■ ■■■ ■■I I■■ ■■■■■■■ ■E■■■■■■RM ■ ■■■Il•■ ■I ■r!. Ile %[:IC■Li /HMEM ■EE■■■ ■E■■ ■E ■E■
■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■1 i■ 0■■■■■■■■■■■■■■■: a■■■■ Y■ M■.■■ A:■ ■ ■■■IYLl.M■ ■ ■■■ ■■ ■ ■■■ ■■■■ ■■
1■■■■■■■■■■■■■■■■■■■■■ II■■■■■■ ■ ■■ ■ ■■■ ■ ■ ■■ ■►■ ■■■■►■■■■■ ■ ■ ■■ ■e %iii■■■■■ ■■■ ■ ■■■ ■■■ ■■
■■■■■■■■■■■■■■■■■■■■■■ IIE■■■■■■■■■■■■■■■■■■ Eg\■■ r■ E■■ ■■■■MMIPA ■■ ■■■ ■■■■■ ■ ■■■■■■
■■■■■■■■■■■■■■■■■■■■■■ 11■■■■■■■■■■■■■■■■■■ EE■ E.! M■■■ ■■ ■ ■MIIM/-MMEM ■ ■ ■ ■ ■ ■ ■ ■■ ■E■■ ■ ■■■
■■■■■■■■■■■■■■■■■■■■■■ 1!■■ ■ ■ ■ ■MMOMMM ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■U•UU! iii■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■■
■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ iEM■■■■■ 17MM■■■ 7R■■■■ ■ ■■uiLioimimi ■ ■ ■ ■■E■■■■■ ■EE■■■
■■■■■■■■ ■ ■■■■■■ ■■ ■ ■■■■■■■■■■■■■■ ■■■■■II exmlow i■■■■■■■■ ■■■ ■■ ■■■■■■■■■■■■■■Eli■■■■■■
■■■■■■■■■■■■■■■■■■■■ E■■■■■■■■■■■■■■ mam i% niccit ■ ■ ■ ■ ■■■ ■■■■■■ ■■■■■■ ■ ■ ■ ■ ■■■■■■ ■■■ ■E■
■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ IMI ME ■■■■ ■■■■■■■■■■■■■■■■■■■■ ■■■■■■■ ■■■■■■
■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ E■■ ■■■■■■■E■■■E■■■■■■■■■■■■■■■■■■il
■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ 11■■■ ■■■■■■■■■■ ■■■■ ■■■■ ■■■■ ■■ ■■■ ■■■■
■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■ ■E■■■■■■■■■■E■■E■■■■ ■EE■■ ■■■■
■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■ ■■■■■■E■■ ■■■■■E■■■
■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■ ■■E■■■■■■■■■■■■■ ■■■■E■■■■ ■E■
■■■■■■■■■■■■■■■■■■■■■■■■■■■■ II■■■■■■■■■■■■■■■■■■■■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■■■■■ ■■ ■■ ■ ■■■■
■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■ ■E■■■■■■■■■■■
■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■ ■ ■ ■■■ ■ ■■■■■ ■■ ■■■ ■ ■ ■■■■ ■■■■ ■ ■■■
■■■■■■■■■■■■■■■■■■■■■■®■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■ ■■E■■■■■■■■■■■■■■■■ ■■■■■■■
■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■ ■ ■ ■■ ■■■■■■ ■ ■■■ ■■E■■■■■■■■ ■E■■■
■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■ ■■■■■■■■E■ ■■■■■■ ■■■■EE■■■■■■
■■■■■■■■■■■■■■■■■■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■■ ■MEMO■ ■E■■■■■■■■■■■■■■■ ■E■■■■■■
Notes:
Site Plan submitted by:
HRS -H Form 4015, Feb 85 • •soletes previous editions which may not be used)
'ceock Number. 5744- 002 - 4015-6)
1
E
Plan Approved Not Approved Date
B County Public Unit
ALL ' HAI- GESAUST BE APPROVED BY THE COUNTY PUBLIC HEALTH UNIT
Page 2 of 3
AP LICATION FOR:
() New System
Repair
APPLICANT:
AGENT:
MAILING ADDRESS:
STATE QE FLORIDA
DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES
ONSITE SEWAGE DISPOSAL SYSTEM
APPLICATION FOR CONSTRUCTION PERMIT
Authority: Chapter 381, FS & Chapter 1OD -6, FAC
� �a
t ".
] Existing System ( Holding Tank
] Abandonment [ ] Other(Specify)
,iezoi-
r.-ftitd)
PERMIT #
DATE PAID
FEE PAID
RECEIPT #
TELEPHONE:
$ .'Hqdep4
Temporary /Experimental
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.
- t
PROPERTY INFORMATION [ LOT IS NOT IN A RECORDED SUBDIVISION, ATTACH LEGAL DESCRIPTION OR DEED]
LOT: 66040 BLOCK:
PROPERTY ID #:
PROPERTY SIZE:
•
PROPERTY STREET
DIRECTIONS TO PROPERTY:
MI6 ..f.vi/
BUILDING INFORMATION
Unit Type of
No Establishment
1
2
3
4
ACRES [Sgft /43560]
DRESS:
SUBDIVISION:
,L),F,
RESIDENTIAL
No. of
Bedrooms
[ /3) Garbage Grinders/Disposals
[bh Ultra -low Volume Flush Toilets
APPLICANT'S SIGNATURE: (ejalif
HRS -H Form 4015, Mar 92 (Obsoletes previous editions which may,;-not be used)
(Stock Number: 5744-001- 4015 -1)
DATE 0
SUBDIVISION:
[Section /Township /Range /Parcel No.] ZONING:
/4 A
PROPERTY WATER SUPPLY: - -[
9
[
] COMMERCIAL
Building # Persons
Area Sqft Served
)
] PRIVATE
• 1 ( 6 cj ( ., )7c < <.9 ;
Business Activity
For Commercial Only
[,J] S ash /Hot Tubs - [ Floor /Equipment Drains
WI Other (Specify)
DATE: 1-- ((:-
Page 1 of 3
?ROPE:R r....0(1:
SiZE:
• .t.rj nuo ia:7
- 's
.?.C. 1`7." . •
1".;..!:) IC4 CO;;"
Or
dat,: of subcilv;c7iyr , , t t; -
into tvict or mon. 9r:cc:I.; for ihr. WI 07
27 character nurnb,...- - rr.:party. Iva
' • •
bdcls win public efay or '. :sr - c:
wa.er. Cc TItiguous onoa■. c
may be in..tudee. in ealculLti lot afez.
VAT ER Check private or publie.
Street address for property. 1- lots viithout an ctd0r, • and 10 eodniy.
DIRECT:iGNS! instractiod., 0) 10 or L..1101t1.1 310V/01S,
3ij1LDINC T.N Clicc l. residential or comraera:d!.
TYPtE,' type ; a, 10; AC. Earts f - : .
doctor's office.
NO. 3F.D.Z00iViS: Count
rooinS designee: prtr-trily .", sccon 'or
occupraits.
BUILDINC ARSA: na1 squard footaL;e of enr:osed 00 ;1 ; -; , -
0: °13' 0: a
screened patios or decits. '1"sed on oulsid,. ao c , 'llY
ff PERSONS: N,,rn„r using, n i innt.
:3:JSrNiSSS O.. 1 11:: . • . • .` •
7 31211.nklCd 0:
CMISTRUCTION PERMIT FOR:
[/J] New System [ Existing System [ 9' Holding Tank [ Temporary /Experimental
[ Repair [ J Abandonment [ Other(Specify)
APPLICANT: AGENT:
PROPERTY STREET ADDRESS: 4=ir 570
0
T
H
E
R
SPECIFICATIONS BY:
APPROVED BY:
DATE ISSUED:
STATE OF FLORIDA PERMIT # )
DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES DATE PAID
ONSITE SEWAGE DISPOSAL SYSTEM FEE PAID $
CONSTRUCTION PERMIT RECEIPT # d A
Authority: Chapter 381, FS & Chapter 10D -6, FAC
WICHES
Yk
TITLE:
HRS-H Form 4016, Mar 92 (0bsoletes pr• ious editions= ich may,not.be used),
(Stock Number: 5744 - 001 - 4016-0)
APPL.4n_ZT
LOCK: __SUBDIVISION:
[SECTION /TOWNSHIP /RANGE /PARCEL NUMBER]
[OR TAX ID NUMBER]
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
T [ 4 i ® ®) [GALLONS / GPD] SEPTIC TANK /AEROBIC UNIT CAPACITY MULTI- CHAMBERED /IN SERIES:[ ]
A [ ] [GALLONS / GPD]
CAPACITY MULTI- CHAMBERED /IN SERIES:( ]
N [ ] GALLONS GREASE INTERCEPTOR CAPACITY [MAXIMUM CAPACITY SINGLE TANK: 1250 GALLONS]
K [ ] GALLONS PER DOSE DOSING TANK CAPACITY DOSE RATE [ ] PER 24 HRS NO. OF PUMPS: [ ]
D [ ( ]OSQUARE FEET PRIMARY DRAINFIELD SYSTEM
R [ ] SQUARE FEET SYSTEM
A TYPE SYSTEM: [.j STANDARD [ ] FILLED [ ] MOUND
I CONFIGURATION: [ ] TRENCH [ BED [ ]
N
F LOCATION OF BENCHMARK:
I ELEVATION OF PROPOSED SYSTEM SITE [
E BOTTOM OF DRAINFIELD TO BE [
L
D FILL REQUIRED:
4 1[INCHES/FT] [ABOVE /BELOW] BENCHMARK /REFERENCE POINT
[INCHES /FT] [ABOVE /BELOW] BENCHMARK /REFERENCE POINT
EXCAVATION REQUIRED: [ ' 34)] INCHES
TITLE: E1
EXPIRATION DATE:
CPHU
Page 1 of 2
• aur.iber h!.■ 0? ••:.:1;.
of permi7, "Cfner'' spat ify
?ro?erzy owner's full :tame.
hone number for uppliecria or
7rop.::ty owner'e Iy culilosized
?.0. bou or c:roet applicz:r:: or
• 3LCCIK, SU3DTVXSTON C7
charactor ic nu:.: for p:oporzy. (c?YJ mr.;,r :ma)
ESM DaS:f2N AND
?:EC:IF:CATECNS:
Minim•r:ra acccificctione from:: Chapler
Minimum spociartions from. Chc:Ier
Cf::HER: Othcr specifications, such cs operating permit mouirem.ents,
3?C7:CATIONS 3Y: Name of individual providing speciacatiols. 7.f C:zsiszed i3y !
APPROVED 3Y: County ?ublic Hoalth 'Unit (C2H1T) persenne: :pprovng
DATE ISSUED: Dalt: permit is issued by CiPHIJ.
EN,PATiON DATE: One year from date issued if the system has not been insteti. Permits for eecome vo le 90 days from the dc:::
issucci.
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
Permit No S ® - -__ Date- --•-_-.-.--- .1.- __.!
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. / q
Owner's Name and Address' 22 ____,�C ✓_0k ra g_ __ --- _ �- _____.. No.__ 0 -- _- - - - -_� Street,( • - •S S
Registered Architect and /or Engineer — ._— ____ ___ - ___ _____ -
Employing Plumber's Names V I ' R 0 OO__0'I1'S S ye- No.IJLV 5' _ Street- w - -22- 5 L
Location and Legal Description Lot Block
Street and Number where work is to be performed—No. 9..5 / :e-__ 9.6i_— Street_
State work to be performed and purpose of building (By Floors)_ _________
New Building k ___ Remodeling Addition
Size Septic Tank Type of Tank__ Capacity Gals
Feet of Drain Tile .....
___ -_- ,/
Nature of Water Suppl ell .____ -_—__& (7 '
Amount of Permit $__ Q
_Dist. Feet of Tank or Drain Field from Well
__Size of Soakage Pit
(Signed)_ __fa!� - -:
Repairs
Subdivision - --- _----- -- _---- _ --_.—
Plumbin' spector.
The undersigned applicant for this building permit does hereby certify that he understands and accepts his .. . ations as an employer of labor
under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Per . ent 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 of the work such public notice or notices as are
required by the Act. The undersigned agrees to employ only such sub- contractors, o to be p ed under this permit, as are
licensed by Miami Shores Village.
STATE OF FLORIDA, �,
COUNTY OF DADE. j
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take aclmowledgments, 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
No. of Stories ....
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
SIN"
SLOP
SINKS
LAUNDRY
Tues
URI
CATCH
BASIN
FLOOR
DRAIN
DRINKING
FOU NT'NS
t t,ES/{El
I
TOTAL
FIXTURE6
`L TR.
9
—'^--
/
--
CHECK
SEPTIC
TANK
SEWER
CONN.
DRAIN
FIELD
SOAKAGE
PIT
GREASE
TRAP
SOLAR
HEATER
DEEP
WELL
SPRKLR.
SYSTEM
SW 114'G
POOL
Etc
.J ri
__
Di 5 F'
_______
CONTR.
LIST
CHECK
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
Permit No S ® - -__ Date- --•-_-.-.--- .1.- __.!
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. / q
Owner's Name and Address' 22 ____,�C ✓_0k ra g_ __ --- _ �- _____.. No.__ 0 -- _- - - - -_� Street,( • - •S S
Registered Architect and /or Engineer — ._— ____ ___ - ___ _____ -
Employing Plumber's Names V I ' R 0 OO__0'I1'S S ye- No.IJLV 5' _ Street- w - -22- 5 L
Location and Legal Description Lot Block
Street and Number where work is to be performed—No. 9..5 / :e-__ 9.6i_— Street_
State work to be performed and purpose of building (By Floors)_ _________
New Building k ___ Remodeling Addition
Size Septic Tank Type of Tank__ Capacity Gals
Feet of Drain Tile .....
___ -_- ,/
Nature of Water Suppl ell .____ -_—__& (7 '
Amount of Permit $__ Q
_Dist. Feet of Tank or Drain Field from Well
__Size of Soakage Pit
(Signed)_ __fa!� - -:
Repairs
Subdivision - --- _----- -- _---- _ --_.—
Plumbin' spector.
The undersigned applicant for this building permit does hereby certify that he understands and accepts his .. . ations as an employer of labor
under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Per . ent 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 of the work such public notice or notices as are
required by the Act. The undersigned agrees to employ only such sub- contractors, o to be p ed under this permit, as are
licensed by Miami Shores Village.
STATE OF FLORIDA, �,
COUNTY OF DADE. j
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take aclmowledgments, 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
No. of Stories ....
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.
Amount of Permit $
.0f-x
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
(Signed)-
( Signed) __&22r_
Date .....______
Street
Repairs
Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitte8 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.
Owner's Name and Address___ ----- No. Street.
Registered Architect and /or En ineer___ -_—
Location and Legal Description Lot________________ ____- ____.___ / Block Subdivision. _.__.__�____— ______.—_—
Street and Number where work is to be performed —No 91 g_ �� Street
State work to be performed and purpose of building (By Floors )_-- _— _________________— ____
New Building ____ Remodeling Addition_
No. of Stories.
Size Septic Tank / /y am / A° Air - - - -- Type of Tank__ Capacity Gals
Feet of Drain Tile___ - Y____ __ k - -- -Dist. Feet of Tank or Drain Field from Well
Nature of Water Supply: City — Well _-- ____--- __ — -- _ _ -- - Size of Soakage Pit
The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations :.:n e , • .yer -of labor
under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Permanent Supplement, and bus con -
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 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 Miami Shores Village.
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
/6
Plumbing Inspector.
Master Plumber.
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
U
URINALS
CATCH
BASIN
FLOOR
DRAIN
DRINKING
FOUNT' NS
TOTAL
FI%TURES
CONTR.
LIST
CHECK
SEPTIC
TANK
SEWER
CONN.
DRAIN
FIELD
SOAKAGE
PIT
GREASE
TRAP
SOLAR
HEATER
DEEP
WELL
SPRKLR.
SYSTEM
SW IM'G
POOL
CONTR.
LIST
-
CHECK
Amount of Permit $
.0f-x
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
(Signed)-
( Signed) __&22r_
Date .....______
Street
Repairs
Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitte8 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.
Owner's Name and Address___ ----- No. Street.
Registered Architect and /or En ineer___ -_—
Location and Legal Description Lot________________ ____- ____.___ / Block Subdivision. _.__.__�____— ______.—_—
Street and Number where work is to be performed —No 91 g_ �� Street
State work to be performed and purpose of building (By Floors )_-- _— _________________— ____
New Building ____ Remodeling Addition_
No. of Stories.
Size Septic Tank / /y am / A° Air - - - -- Type of Tank__ Capacity Gals
Feet of Drain Tile___ - Y____ __ k - -- -Dist. Feet of Tank or Drain Field from Well
Nature of Water Supply: City — Well _-- ____--- __ — -- _ _ -- - Size of Soakage Pit
The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations :.:n e , • .yer -of labor
under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Permanent Supplement, and bus con -
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 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 Miami Shores Village.
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
/6
Plumbing Inspector.
Master Plumber.
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.
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Date 1 \\g QA Job Address J 4 C:1 S SI Tax Folio
Legal Description Historically Designated: Yes No
Owner/Lessee / Tenant a\--(-4\MW Master Permit # g3
Owner's Address CSO A \ S PS ) 1 S CD- vA L `-
Contracting Co. N I Rho, Inc, . Address q' O ,N W '42-1 s\-1--,
Qualifier 7c n►rl i s Mc Lip L J o h ); n SS# Phone ')5 - 7 / - a)-1.
State # r 'pr o O (OS Municipal # Competency # Ins. Co.
Architect/Engineer Address
Bonding Company Address
Mortgagor
Permit Type (circle one): BUILDING ELECTRICA
WORK DESCRIPTION
a e of owner
or Condo President Date
eke I
Notary as J • v er Zior Con; o President Date
My Commission Exp u - s:
pr�,,, Gloria E Suvlllage
* t . *My Commission CC881145
Expires August 18, 2001
FEES: PERMI
RADON
APPROVED:
Zoning Building
Mechanical Plumbing
Address
&4S I •
MECHANICAL ROOFING PAVING FENCE SIGN
Square Ft. Estimated Cost (value)
WARNING TO OWNER: ° OU 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 construction and zoning. Furthermore, I authorize the abov ontractor to do the work stated.
Contractor or Owner-Builder
jaa
Notary as Co - Builder Date
My Commission Expires:
• .u' %' % Gloria E Suvillage
*My Commission CC881145
'+s : fifes August 18, 2001
C.C.F. f NOTARY - 0 BOND
Electrical
TOTAL DUE
1 •/9.99
Date
� • / qc
Engineering
Permit No a
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.
Owner's Name and Address
Registered Architect and /or
Employing Plumber's Name___ -
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
No.3 /2r2.ZY Street
Location and Legal Description Lot_ ___________.__ --- - - - - -- _ -- Block. _ _-- --____ y Subdivision._ --.----
Street and Number where work is to be performed —No 9S® .e� Street - -,lam �w�1 ?�-°� . : : ? s '� -_
State work to be performed and purpose of building (By Floors)
New Building Remodeling__._ —__ Addition._.__ ____ Repairs
Size Septic Tank_
- ___- -
Feet of Drain Tile
Nature of Water Supply: City — Well._ ' /1 n -14. 4t4 1 __ Size of Soakage Pit
Amount of Permit $_ ______.
— Q-
My Commission Expires
Type of Tank
Dist. Feet of Tank or Drain Field from Well
Capacity Gals
(Signed)
The undersigned applicant for this building permit does hereby certify that he understands and accepts his obh ns as an employer of labor
under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Perma9 Supplement, and has com-
plied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors emloyed 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 Miami Shores Village.
( Signed) __ -✓�,'
..... �- --
No. of Stories.
Plumbing Inspector.
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.
Notary Public, State of Florida
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
H EATER
DEEP
WELL
SPRKLR.
SYSTEM
SW IM'O
POOL
CONTR.
Lin'
CHECK
X. '
/
''
, /
v
Permit No a
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.
Owner's Name and Address
Registered Architect and /or
Employing Plumber's Name___ -
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
No.3 /2r2.ZY Street
Location and Legal Description Lot_ ___________.__ --- - - - - -- _ -- Block. _ _-- --____ y Subdivision._ --.----
Street and Number where work is to be performed —No 9S® .e� Street - -,lam �w�1 ?�-°� . : : ? s '� -_
State work to be performed and purpose of building (By Floors)
New Building Remodeling__._ —__ Addition._.__ ____ Repairs
Size Septic Tank_
- ___- -
Feet of Drain Tile
Nature of Water Supply: City — Well._ ' /1 n -14. 4t4 1 __ Size of Soakage Pit
Amount of Permit $_ ______.
— Q-
My Commission Expires
Type of Tank
Dist. Feet of Tank or Drain Field from Well
Capacity Gals
(Signed)
The undersigned applicant for this building permit does hereby certify that he understands and accepts his obh ns as an employer of labor
under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Perma9 Supplement, and has com-
plied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors emloyed 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 Miami Shores Village.
( Signed) __ -✓�,'
..... �- --
No. of Stories.
Plumbing Inspector.
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.
Notary Public, State of Florida
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.
Permit No Date_____: C7 d / 9v
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.
Owner's Name and Address R_ t ?_! No. ____ " ._ _ Street __ _______
Registered Architect and /or Engineer
Employing Plumber's Name "A_w'_L!`_9.
Location and Legal Description Lot________ Block Subdivision
Street and Number where work is to be performed —No aLLl■C° Street
State work to be performed and purpose of building (By Floors) ______ E _L._i_ ! ___ "' f • PLO 3 E
New Building ____ -- Remodeling
Size Septic Tank
Amount of Permit $
My Commission Expires
(l
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
Addition________ Repairs
!Co SPFc
ves P- /1
e l f ( N o . _ / -- Street_.J_AL
No. of Stories.
_Type of Tank__ Capacity Gals
Feet of Drain Tile _Dist. Feet of Tank or Drain Field from Well
Nature of Water Supply: City — Well. - - - - -- ------- of Soakage Pit
(Signed)_
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 Pertnanent 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 of the work such .. . is • otice or notices as are
required by the Act. The undersigned agrees to employ only such sub- contractors, on work be pe armed d this permit, as are
licensed by Miami Shores Village.
(Signed) - - -
Notary Public, State of Florida
/4
er Plumber.
STATE OF FLORIDA, } as.
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
NALS
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
SW IM'G
POOL
CONTR.
LIST
-
CHECK
Permit No Date_____: C7 d / 9v
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.
Owner's Name and Address R_ t ?_! No. ____ " ._ _ Street __ _______
Registered Architect and /or Engineer
Employing Plumber's Name "A_w'_L!`_9.
Location and Legal Description Lot________ Block Subdivision
Street and Number where work is to be performed —No aLLl■C° Street
State work to be performed and purpose of building (By Floors) ______ E _L._i_ ! ___ "' f • PLO 3 E
New Building ____ -- Remodeling
Size Septic Tank
Amount of Permit $
My Commission Expires
(l
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
Addition________ Repairs
!Co SPFc
ves P- /1
e l f ( N o . _ / -- Street_.J_AL
No. of Stories.
_Type of Tank__ Capacity Gals
Feet of Drain Tile _Dist. Feet of Tank or Drain Field from Well
Nature of Water Supply: City — Well. - - - - -- ------- of Soakage Pit
(Signed)_
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 Pertnanent 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 of the work such .. . is • otice or notices as are
required by the Act. The undersigned agrees to employ only such sub- contractors, on work be pe armed d this permit, as are
licensed by Miami Shores Village.
(Signed) - - -
Notary Public, State of Florida
/4
er Plumber.
STATE OF FLORIDA, } as.
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.