PLUMBINGDate
Type Insp'n
Permit No.
Name
Address
Company
Phone #
Inspection Date
Approved
Correction
Re- Insp'n Fee
MIAMI SHORES VILLAGE
BUILDING DEPARTMENT
305- 795 -2204
Building Inspection Request
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MIAMI SHORES VILLAGE
BUILDING DEPARTMENT
305- 795 -2204
Building Inspection Request
Date8/5
Type Insp'n Uncergroc V
Permit No. ?I 04-
Name pou
tO3 Lt G K �-
Address
Approved
Correction
Re- Insp'n Fee
Company ouire r .rNtn p 1 I(--P
Phone #
Inspection Date BMW ,
1151/
Date
Type Insp'n
Permit No.
Name
Address
Company
Phone #
Inspection Date
Approved
Correction
Re- Insp'n Fee
MIAMI SHORES VILLAGE
BUILDING DEPARTMENT
305- 795 -2204
BuildirtgInspection Request v a�
7;t
og/s
Ain
BUILDING
ELECTRICAL
PLUMBING
T
Owner of
Building
Work to be
R 0 DER
MIAMI SHORES VILLAGE, FLORIDA
DATE 7/ 194
Contractor's
nse No
RMIT N? 7070
rmed under this Permit 'len
Architect
Contractor
or Builder
Legal
Description
Address of �/�
Building
This permit is granted to the con actor or buil r named above to construct the building or to install the equipment or w •vice $ e`eribed m the appli-
cation herefor in strict compliance with all ordinances pertaining thereto and with the understanding that the work will be performed ; compliance with any
plans, drawings, statements or specifications that may have been submitted to and approved by the proper municipal authorities. This ' errnit 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 r- sibility for a thorough knowle, e ord� and
regulations pertaining to the work covered hereby whether shown on the plans • awi a statements o specifications a � s es respon-
sibility for work done by his agents, servants or employees. �
Signed: 4 Aisl ot . t /.
SP OR
h consideration of the issuance to me of this permit I agree to perfo ��7. a work covered hereunder in compliance with all ordinances and regulations
pertainin thereto nd in strict • formity with the plans, drawin . • := r. or specific . dons- submitted to the proper authorities of Miami Shores Village.
In accep�his'p, I as , • esponsibility for .11 work don: . • elf, my a - • t, servant or employee.
Bl.
Subdi-
vision
Value of
Project
y eithe
BY
Amt. o
Permit
AUTHORITY
t °
15.
+
sr ATE
. � 1"
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Date / 7 Job Address /OS 2, xi C. q g s( Tax Folio
Legal Description Historically Designated: Yes No
Owner/Lessee / Tenant l� ` i Z° e.---T-1.1 3 /117 , Master Permit # 6 g /e D L 7 7 J
rf 6/2Y7�
Owner's Address /03 2 n) e.. 9 g.) ' Phone 7 Ste 1 - 'Z
/+�
Contracting Co. / e i s J E -7 / -
P7ic ' ^� Address l l 3 Z A" ' z /
Qualifier S-F..e *fn) L: . '–' ' J' SS# '
State # Municipal # Competency # Ins. Co.
Architect/Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type (circle one): BUILDING LECTRICAJ21 IMIBDBC MECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIPTION � C?c 2flci
Square Ft.
Signature of owner and/or President
Notary as to Owner an
My Commission Expir
PERMIT
RADON
Date
d/or Cond• 'resi e t Date
uer
P (2Y Ph OFFICI.�L NOTARY SE:
� BARBARA ANN FUGAZZI
*�� COMMISSION NUMBEr:
� dlY'r CC360191
4K�" QUO MY COMMISSION EXP.
aF F■. MAR. Zit, i ^"A
APPROVED:
Zoning Building
Mechanical Plumbing
Estimated Cost (valu "
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 Contractor or Owner- Builder
Notary as to Contractor or Owner - Builder
My Commission Expires:
C.C.F. ' NOTARY S� '
Electrical
tro
Date
Date
BOND 3 d
TOTAL DUE 3 tla b°
Engineering
f
LOT:
PROPERTY ID #:
D
R
A
I
N
F
I
E.
L
D
0
T
Ni
E
R
SPECIFICATIONS BY:
APPROVED BY :
DATE ISSUED:
STATE OF FLORID%
DEPARTMENT OF HEALTH AND RED
ONSITE SEWAGE DISPOSAL SYSTEM
CONSTRUCTION PERMIT
Authority: Chapter 381, FS & Cb
CONSTRUCTION PERMIT OR:
[ (•V New System [ Existing System
[ Repair f Abandonment
APP ICANT: '
E 1 24 , 1ito y AGENT:
`:
PROPERTY STREET ADDRESS:
BLOCK: 1 SUBDIVISION:
[3,00 SQUARE FEET
[ ) SQUARE FEET
TYPE SYSTEM:
CONFIGURATION:
LOCATION OF BENCHMARK: i `(
ELEVATION OF PROPOSED SYS S T
BOTTOM OF DRAINFIELD TO BE ( le i
FILL REQUIRED: ( �INES
k\ ___ 111
HRS-H Form 4016, Mar 92 (Obso(etes previous
(Stock Number: 5744. 001 -4016-0)
er 1OD -6,
Holding Tank
otber(Specify)
ti a if
RIMARY DRAINFIELD SYSTEM
SYSTEM
[ Se STANDARD [ FILLED [ DUND
[l ) TRENCH
INSTALL ERtCONTRACTOR
PERMIT # lR •
DATE PAID
FEE PAID
RECEIPT #
Temporar
ry
[SECTION /TOWNSHIP/RANGE /PARCEL NUMBER
(OR TAX ID NUMBER)
= *s =====*===== = == = === = = =3sS ====a =017tsss
SYSTEM MUST BE CONSTRUCTED IN ACCORDANCE WITH SPECIFICATIONS;AND STANDARDS VP R- 1OD -i, 'FAC
REPAIR PERMITS AND HOLDING $`.ANK- PERMITS EXPIRE 90 DAYS FROM`iHE DATE OF ISSUE. ALL R PERMITS
EXPIRE ONE YEAR FROM THE DATE OF ISSUE. MRS APPROV,AI,:OF SYSTEM DOA'$ NOT 'GU EE: BIATISPACVBRY
PERFORMANCE FOR ANY SPECIFIC PERIOD OF TIME ANY CHANGE IN MATERIAL FACTS WHICH OWED AS A
BASIS FOR ISSUANCE OF THIS PE "IT, - REQUIRE THE APPLICANT TO MOD/FY THE PERMIT AP I4 AS DN. =` NUM-
MODIFICATIONS MAY RESULT 114 BEING MADE NULL AND VOID.
- - -- — === === ==== = == = = ===t * *- uxaeas_ut= = = = ==asmsameaae a ges=ai imiitamsss
SYSTEM DESIGN AND SPFI C ATIONS
T [ 104) [GALL / GPD) SEPTIC TANK/AEROBIC UNIT CAPACITY MULTI-CHAMBERED/10' Intl( 1
N [ ] GALLONS GREASE INTERCEPTOR CAPACITY [MAXIMUM CAPACITY SINGLE TAMH4 12t0 GALLONS]
K f ] GALLONS PER DOSE DOSING TANK CAPACITY DOSE RATE f ] PER 24 HRS NO. OP PUMPS: 1 )
_
BED
1"10 • —
WINCHES/FT). [AZiDVE /BELOW) BENCHMARK/ REFERENCE POINT,
) (INCHES /FT) [ABOVE /BELOW) BENCHMARK/REFERENCE POINT
EXCAVATION REQUI�_ _ [ ! INCHES foir
c E R O'
t
•
1
Fs; �,'� >fkalli
7 Amfr W Wif
TE7 - #1149V 31i11-13
di :y±a iclt fiat nor �a+seA� .y a .iK' ' '� `:.J }! Jivr:F
EXPIRATION DOS:
•
.:triiit.ii
.
. ! a .::i: 1i0 ! .•.c :..•.mot....
"un • . _... ..._
'.! =.:5S ,Lt.: i ._,Hued by
•
C
•
z.�
•
STATE OF FLORIDA (t /
DEPARTMENT, OF HEALTH AND REHABILITATIVE, S RVICES
, APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCT
PART II - SITE PLAN
I
,, ,'
t ,
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� 011111 X1101N11111111111101111•N ∎•1■111•111111111111111■tr'MMIMRiNI►.�IIIMINIMa _.IIu•u.uu111M uNIuiu
� No1m1isimismi1ENI11N1NINI■INIIII NN� Imrz.2-.:.. 8 u MIIMINIMM1
■'■"■■1 11111111111111111111111111►i1111i1111111111111111111111111H11
........mm.............1111MWINNIIIIIIIIIIIIIMMININIMINMIIINMONfit WWI *Lino MAK
1111e111ee111101111eeee11MMISM MMINIMMImmummumummuessolibli111111001111111
� ammma iumi mimic 4 OMRO T P+ne9911MlAlla111011 1141111.111uai
MIIeIIIIeeIIN— eeeIIIIIIIIIIeIIIIMIIIIIIIIIIIIMt KAP11r .`,111 uaii111N/111Ir /111111111MINIM
uIIIIIIIII.111I� IIIIIIIIIIIIIHIHI
� ■1•N11•111111•11111M11111111111111tAA111w111■111111 ■111111111111111111 !11<1111I0•1 111K1111111MI <III■
MININIIIIIIIIMMN1•N1•iENNllNli•1111IIMINNININ ■NIN■IIIIN •..../t/NN.u.•111M1
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Scale: Each block represents 5 feet and 1 inch = 50 feet.
r J
Site Plan submitted by:
Plan Approved v
By
ALL CHANGES MUST B AP
HRS -H Form 4015, Feb 85 (Obsoletes previous editions which may not be -a /ed)
(Stock Number. 5744.OQ1,0045.6)
SIGNATURE
Not Approved
Permit Application Number
16 sk4-4
22J j' 7 •
L
Date
County ub c Unit
ED BY THE * COUNTY PUBLIC HEALTH UNIT
I I
Page t -
BUILDING
ELECTRICAL
PLUMBING
Owner,of 6 . : 7 - 77:77
.-- "
Buildgig
Architect
Contractor r
o
7
r B1der
Legal Lot
Description
/
Address of of Amt. of
Building Project Permit r/
This permit is granted to the contractor or builder named above to construct the building or to install the equipment or r -vi described in the appli-
cation 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 Veen 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 chanted witho authorization. A further condi a upon which thi°
permit is granted is the understanding that the contractor or builder named aboy ssumes spo • si. ity for a thorough knowled..,:a:y`is . t , a nances an
regulations pertaining to the work covered hereby whether shown on the pl. . orrawin•. or in ements or speci cations a at p s es respon-
sibility for work done by his agents, servants or employees. '� �/� /
In consideration of e issuance to me of this permit I agree to perf. the work covered hereunder in compliance with all ordinances and regulations
g the nd 'J.trict ,� nfo wi .lass, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village.
done by either myself, my agent, servant or employee.
CONTRACTOR OR BUILDER
MIAMI SHORES VILLAGE, FLORIDA
DATE ..+
PERMIT N? 7089
Work to be pe ormed under this Permit
B1 /?
Subdi-
vision
Signed:
INSPECTOR
BY
Contractor's
License No
B
AUTHORITY