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PLUMBINGBUILDING ELECTRICAL PLUMBING ROOFING Architect Contractor or Builder Legal Description MIAMI SHORES VILLAGE, FLORIDA PERMIT N9 292 Coni ucio {s .., License No. ^' ❑ Work to be performed under this Permi Owner of Building J .‘ t i , J ...; C . Lot Bl. Address of Building / C) r , ? I tL Value of Project $ f DATE 1 19 ' II Amount of 11 Permit $ { As, tk3 Subdi- vision o 0 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 may 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 far a thorough knowledge of the ordinances sad regulations pertaining to the work covered hereby whether shown on the glans or drawj,ags or in the statements or specifications and that he assumes respon- sibility for work done by his agents, servants or employees. Signed- L v ; f ' , ^ j BY: INSPECTOR d -• In consideration of the issuance to me of this permit I agree t rform the work coveted Yh'ereunder in compliance with all ordinances and regulations pertaining thereto and in strict conformity with the plans, drawings, steents or apecificationK fitted to the proper authorities of Miami Shores Villags. In as ceptinq this permit I assume responsibility for all work done by ei yself, my agent, snt or employee. CONTRACTOR OR BUILDER BY AUTHORITY A /pT PRINT '�I CI- T - - T "{ � £ £NOWERB T TORIES S S SLOP L LAUNDRY C URINAL T CATCH F FLOOR D DRINKING TOTAL I } . / l / t ( - ye ti C.NOiCK T- • SEPTIC S SEWER D DRAIN S SOAKAGE G GREASE S SOLAR D DEEP S SPRKLR. S SWIM'G t l t ` _ Appiicllon is llercbf made fo, the approval of the detailed statement of the plans and specifications herewith submitted for the building or other structure herein described. This a,mllcation 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 build:qg euria progress of work. Owner's Name and Address ( No._ Street Registered Architect and /or Engineer --- _---- __ - - -_ _ Employing Plumber's Name .... - - --- _'_ L __-- ��___._ Location and Legal Description Lot__ Block Subdivision -- fit.. Street and Number where work is to be performed— No.__/ ��� i _� _ 7 $ _ Street Staie work to be performed and purpose of building (By Floors)------- ____ _-------------- -_..._ i New Building _ _ _ ___ Remodeling________ ___ Addition______- Repairs No. of Stories. J MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT Date -- (.' (.n 6 Street__ Size Septic Tank --------------------- - - - - -- Type of Tank Feet of Drain Tile .... ___________ ____...___________________Dist. Feet of Tank or Drain Field from Well Nature of Water Supply("City— Well.__________ _______ Size of Soakage Pit Amount of Permit $ ( Signed)_ Capacity Gals. 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 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, on work to be performed under this permit, as are licensed by Miami Shores Village. (Signed)_ _ Master Plumber STATE OF FLORIDA, } es. 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 $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 (0)Z4 Job Address WO 0 - ( ice' > . T Tax Folio / / o. €' 33 6o/.0 t /� `" Legal Description ( / -�l C y- ...��a� L Master Permit / 4�,/ - �Yi1 Owner / Lessee / Tenant �- t- - ` >��c Owner's Address U) (∎ - 7 kJ j 'k `" ► Phone Contracting Co. ff ( 1t. I Address ( , c. • ) , Cr # lwmi i () Qualifier 1`k 1LAN' v '. (- ( 1 1,..! SS# - - Phone c1(O(2 (J1 7 State # Municipal # Competency # Ins.Co. Architect /Engineer Address Bonding Company Address Mortgagor Address Permit Type(circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN r WORK DESCRIPTION ���' v ' 1ic , _ , ctt L C Square Ft. . e, / '04 Estimated Cost(value) 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. Signature of owner and /or Condo President Date: Notary as to Owner and /or Condo President My Commission Expires: * * * * * * * * * * * * * * * * * ** FEES: PERMIT �� ` RADON C.C.F. '► t/ V. NOTARY TOTAL DUO/ OD APPROVED: Zoning Buildin: Electrical Mechanical Fire Other Plumbin ii ure pf Con ra for o Owne er NOVARY MY COMM EXP 3•t )•9b 'sc o stx�oeD sr sERVI E INS t0 as Contra Owner- er My Commi ion Fa '.rye : i ngineering CONSTRUCTION PERMIT FOR: [ ] Existing System [ ] Holding Tank [ ] Temporary /Experimental [ ] Abandonment [ ] Other(Specify) [ ] New System . [X] Repair APPLICANT: PROPERTY STREET ADDRESS: LOT: PROPERTY ID #: SYSTEM DESIGN AND SPECIFICATIONS 0 T H E R SPECIFICATIONS BY: APPROVED BY: DATE ISSUED: / Z 7_ 7 <; STATE OF FLORIDA DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PERMIT Authority: Chapter 381, FS & Chapter 10D -6, FAC / o 0 '� Ai; BLOCK: SUBDIVISION: ] INCHES AGENT: PERMIT # DATE PAID FEE PAID $ RECEIPT # O e":&. [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. [GALLONS / GPD] SEPTIC TANK /AEROBIC UNIT CAPACITY MULTI- CHAMBERED /IN SERIES:( ] [GALLONS / GPD] CAPACITY MULTI- CHAMBERED /IN SERIES:( ] GALLONS GREASE INTERCEPTOR CAPACITY [MAXIMUM CAPACITY SINGLE TANK: 1250 GALLONS] GALLONS PER DOSE DOSING TANK CAPACITY DOSE RATE [ ] PER 24 HRS NO. OF PUMPS: [ ] D 1-4:P SQUARE FEET PRIMARY DRAINFIELD SYSTEM R [ ] SQUARE FEET SYSTEM A TYPE SYSTEM: [ ] STANDARD [ ] FILLED [ ] MOUND [ ] I CONFIGURATION: [ ] TRENCH [X] BED [ ] F LOCATION OF BENCHMARK: I ELEVATION OF PROPOSED SYSTEM SITE [ E BOTTOM OF DRAINFIELD TO BE [ L D FILL REQUIRED: [ HRS -H Form 4016, Mar 92 (Obsoletes previous editions which may not be used) (Stock Number: 5744 - 001-4016 - 0) ] [INCHES /FT] [ABOVE /BELOW] BENCHMARK /REFERENCE POINTI ] [INCHES /FT] [ABOVE /BELOW] BENCHMARK /REFERENCE POINT REQUIRED: [ ] INCHES TITLE: TITLE: INSTALLER /CONTRACTOR C CPHU EXPIRATION DATE: / I Page 1 of 2_ IINSTRUCTIONS: ?; Ev' NU 3 TR: Permit tracking number assigned by C: APPLICATION FOR: Check type of permit, if 'Other° specify type in blank. APPLECAN77: Property owner's full Mme. 7TELE°P} ONE: Telephone number for applicant or agent. AGENT: Property owner's legally authorized representative. MAILING ADDRESS: P.O. box or street mailing address for applicant or agent. LOT, BLOCK, SUBDIVISION or PROPERTY &tDO;: 27 character id number for property. (CPI-EU may require property appraiser ID 1) o- rectiovJtownship /range /percel number) SYSTEM DESIGN AND SPECIFICATIONS: TANK: Minimum specifications from Chapter 10D-6, FAC. DRAINFIELD: Minimum specifications from Chapter 10D-6, FAC. OTHER: Other specifications, such as operating permit requirements, low - volume flush toilets, variance provisos. SPECIFICATIONS BY: Name of individual providing specifications. If designed by a registered engineer must be sealed. APPROVED BY: County Public Health Unit (CPHU) personnel reviewing and approving permit. DATE ISSUED: Date permit is issued by CPHU. EXPIRATION DATE: One year from date issued if the system has not been installed. Permits for system repairs become void 90 days from the date issued. Scale: Each block represents 5 feet and 1 inch = 50 feet. Notes: Site Plan submitted by: Plan Approved By STATE OF FLORIDA DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PERMIT Permit Application Number I !< PART II - SITE PLAN LY --� z ..._� SIGNATURE Not Approved ALL CHANGES MUST BE APPROVED HE I OU HRS -H Form 4015, Feb 85 (Obsoletes previous editions which may not be used) (Stock Number. 5744-002-4015-6) - 5 /21(4 TITLE Date /c i ^ lam' 41 County Public Unit R I HEALTH UNIT Page 2 of 3 BUILDING ❑ ELECTRICAL ❑ PLUMBING ROOFING ❑ Owner of Building Architect Contractor or Builder 1 r . MIAMI SHORES VILLAGE, FLORIDA DATE 7- 1 4- Contractor's Li cense No. PERMIT N? 482 ❑ Work to be performed under this Permit 4 7) -7 . 4 194 Legal Lot II Sulxfi- Description Bl. r vision Address of Building Value of II Amount of Project $ II Permit This permit is granted to the contractor or builder named above to construct the building or to install the equipment or device descri tion herefor in strict compliance with all ordinances pertaining thereto and with the understanding that the work will be pe d in compl plans, drawings, statements or specifications that may have been submitted to and approved by the proper pal audio ' es. This Permit at any time if the work is not done in compliance with such ordinances or if the plans are changed without a sat3on. A urther condition upon wtit$ permit is granted is the understanding that the contractor or builder named above assumes iii responsibili or a { ` ', knowledge of the ordinal** —_ regulations pertaining to the work covered hereby whether shown on the pia or :drawings Jr in the statements ecifi ono and that he assumes respon- sibility for work done by his agents, servants or employees. 1 / ' Signed. 0" t. ,y-" !� �.._.,. INSPECTOR In consideration of the issuance to me of this permit I agree to perform the work covered he - der in compliance with all ordinances and regulations pertaining thereto and • • strict • formity th the plans, drawin 8, statements or specifi -. • . to the proper authoriAgat Miami Shores Village. In as ceptin • tai t I e • • all ne either, T - elf .5g.,,ag _ > or employee. j ®, ' + Ri te e • '� DER -.. •l .. AUTHORITY PRINT • _____~ —,.r_ Cn:cK 1 C;_t.> `• i 6.. - - T,,,, SHOWERS LAVA. TORIES SINKS SLOP SINKS LAUNDRY Tuns URINALS CATCH BASIN FLOOR DRAIN DRINKING FOUNT'NS TOTAL FIXTURES f j ' SEPTIC TANK SEWER CONN. DRAIN FIELD SOAKAGE PIT GREASE TRAP SOLAR HEATER DEEP WELL SPRKLR. SYSTEM SWIM'G POOL {".t1 NYR. LIST ` -- CHECK ttgie Ativlirrstion is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the building or other sa :ctwe herein described. This application is made in compliance and conformity with the Building Ordinance of Miami Shores Village, Florida, and s1 provisions of the Laws of the State of Florida, all ordinances of Miami Shores Village and all rules and regulations of the Building Division f Miami Shores Village shall be complied with, whether herein specified or not. A copy of approved plans and specifications must be kept at t +ui' during progress of work. Owm:r'S Name and Address .... LAS. GG=L..A. No._ - — - — Street Registered Architect and /or E n eer_ ' Q_ - - - - E pi yang ' f � �- E CE'� c-G mploying Plumber's Name - _ -,e�{ — - -- No._______ -___- _ Street_- -- 7,c:adon and Legal Description Lot_______ / Subdivision Street and Number where work is to be performed —No / ° � ' F 11 :L1 , ,L _ Suite work to be performed and purpose of building (By Floors) _-- •--- _-------- __ - -- - _. ___ N =uw Building _______ -- _ -- -- - -• -- - - - -- Remodeling__ -- _ - -- Addition__ -- Repairs No. of Stories. - - .. ....... ... -_ -_. Size Septic Tank _h _ i - Feet of Drain Nature of Water Supply: City—Well.. • Amo:nt of Permit $--- - - - - -- My Commission Expires MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT of Tank____ Date (Signed)_ Capacity Gals.__ . eet of Tank or Drain Field from Well Size of Soakage Pit P1 Bing Inspector. - The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations . s : employer of labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Permanent S •pleinent, and has com- plied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors employe • yhim 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 pu • 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 )-- __..--- ��---- - - - - -- 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.