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PLUMBINGPERMIT APPLICATION FOR MUNICIPALITIES OF DADE COUNTY (OWNER TO RETAIN COPY) Tate T,egal Description i Tuner / Lessee / Tenant 3/9/93 Job Address owner's Address 1076 NE 98 ST. Contracting Co. BROOKS AMERICAN SPRINKLER CO. Qualifier VANN ELLIOTT State # FLORIDA Architect /Engineer Bonding Company Mortgagor Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL PAVING FENCE SIGN WORK DESCRIPTION Square Ft. Estimated Cost WA", 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, PLUMB/NO, 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 t work stated. Signature of Owner and /or Coy President mate: i''tary as to Owner and / 'ty Comm E xpires: tobp' is rF RMIT FEE: APPROVED: / F Zoning Mechanical 1076 NE 98 ST. ED McINTYRE LAWN IRPFCATIQN Competency# 0193 It:'A MARIE HIOOENS ''Snhl # CC 2i3Be0 EXPI Presideeat:e, Me f'otary as ea+om mm rn°r m imam, is~ My. Commis * * * * Fire Building Master Permit # Phone Address 2430 N.W. 79 ST. SS# Address Address Address Tax Folio ,/- 32 - 05- Oa- 0 3}/0r • Phone 691 -1182 Ina. Co. LIBERTY MUTUAL ContracW.or Bu �Rar ion Expires�9��• 3 . •4 * 0 1 O ff;••• is ..�`` ` Other Electrical l' Engineering ITEM BATH TUB UNIT FEE ITEM SWITCH OUTLETS UNIT FEE ITEM SPACE HEATERS UNIT FEE BIDET 0 LIGHT OUTLETS CENTRAL HEATING DISHWASHER RECEPTACLES A/C (WIND) DISPOSAL SERVICE TEMPORARY A/C (CENTRAL) DRINKING FOUNTAIN SERVICE SIZE IN AMPS DUCT WORK FLOOR DRAIN SERVICE REPAIR/METER CHANGE REFRIGERATION GREASE TRAP APPLIANCE OUTLETS PROCESS AND PRESS PIPING INTERCEPTOR RANGE TOP UNDERGROUND TANKS LAVATORY OVEN ABOVE GROUND TANKS LAUNDRY TRAY WATER HEATER U.f. PRESSURE VESSELS CLOTHES WASHER MOTORS 0- 1 HP STEAM BOILERS SHOWER MOTORS OVER 1- 3 HP HOT WATER BOILERS SINK, POT /3 COMP. MOTORS OVER 3- 5 HP MECHANICAL VENTILATION SINK, RESIDENCE MOTORS OVER 5- 8 HP • TRANSPORTING ASSEMBLIES SINK, SLOP MOTORS OVER 8- 10 HP ELEVATORS/ESCALATORS TEMPORARY WATER CLOSET MOTORS OVER 10- 25 HP FIRE SPRINKLER SYSTEMS URINAL MOTORS OVER 25-100 HP COOLING TOWERS WATER CLOSET MOTORS OVER 100 HP VIOLATION INDIRECT WASTES A/C WINDOW REINSPECTION WATER SUPPLY TO: AIR CONDITIONERS A/C UNIT STRIP HEATER FIRE SPRINKLER GENERATORS TRANSFORMERS HEATER -NEW INST. GENERATORS TRANSFORMERS HEATER - REPLACE GENERATORS TRANSFORMERS LAWN SPRINKLER -WELL pi SPECIAL PURPOSE SWIMMING POOL OUTLETS COMMERCIAL WATER SERVICE SIGN TUBES SEWER CONNECTIONS SIGN TRANSFORMERS UTILITY -SEWER SIGN TIME CLOCK UTILITY -WATER FIXTURES SEPTIC TANK ANTENNA RELAY TELEVISION OUTLETS DRAINFIELD, 4' TILE/RES. VIOLATION PUMP & ABANDON SEPTIC TANK REINSPECTION SOAKAGE PIT CU. FT. CATCH BASIN DISCHARGE WELL DOMESTIC WELL AREA DRAIN ROOF INLET 70LAR WATER HEATER FIRE STAPUPIPE !'OOL PIPING 'AWN SPRINKLER SYSTEM /lo: 2 SAS RANGE "ETER SET (GAS) :AS PIPING 60 i • e714 - ADDENDUM TO BUILDING PERMIT APPLICATION (AN APPLICATION FOR BUILDING PERMIT MUST ACCOMPANY THIS ADDENDUM. IF A MASTER PERMIT HAS BEEN OBTAINED, THE OWNER'S NOTARIZED SIGNATURE NEED NOT BE PRESENT ON SUBSEQUENT APPLICATIONS.) PLUMBING ELECTRICAL MECHANICAL tf)J2 Y eA,. Date Application is hereby 1.'stde 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. 9,....".„ Owners Name and Address Registered Architect and /or Eng' Employing Plumber's Name Location and Legal Description Amount of Permit $____ .... MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT No. -_ - - - ` `Street_ _ _-_— Block Street and Number where work is to be performed -No._ in 7 6 9 Street. State work to be performed and purpose of building (By Floors) _. New Building Remodeling Addition Repairs (Signed) _ - 'r ) ( Signed). No.___. Street. No. of Stories Capacity Gals. My Commission Expires Notary Public, State of Florida Subdivision 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 Plum : ing Inspector. The undersigned applicant for this building permit does hereby certify that he understands and accepts his : • ligation as an employer of labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Pe anent Supplement, and leas com- plied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors mployed 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, ss. 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 /ce workmanship. CLOSETS BATH TUBS SHOWERS LAVA- TORIES SINKS SLOP SINKS LAUNDRY Tuns URINALS CATCH BASIN FLOOR DRAIN DRINKING FOUNT'NS - - OTAL FIXTURES CONTR. CL LIST ----- CHECK SEPTIC TANK SEWER CONN. DRAIN FIELD SOAKAGE PIT GREASE TRAP SOLAR HEATER DEEP WELL SPRKLR. SYSTEM SWIM'G POOL CONTR. UST CHECK � - -- — tf)J2 Y eA,. Date Application is hereby 1.'stde 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. 9,....".„ Owners Name and Address Registered Architect and /or Eng' Employing Plumber's Name Location and Legal Description Amount of Permit $____ .... MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT No. -_ - - - ` `Street_ _ _-_— Block Street and Number where work is to be performed -No._ in 7 6 9 Street. State work to be performed and purpose of building (By Floors) _. New Building Remodeling Addition Repairs (Signed) _ - 'r ) ( Signed). No.___. Street. No. of Stories Capacity Gals. My Commission Expires Notary Public, State of Florida Subdivision 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 Plum : ing Inspector. The undersigned applicant for this building permit does hereby certify that he understands and accepts his : • ligation as an employer of labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Pe anent Supplement, and leas com- plied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors mployed 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, ss. 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 /ce workmanship. ➢S X S4 T NOM A materials andtor TEL. 4 -2580 S. E. VAAN N PLUMBING AND HEATING CONTRACTOR SEPTIC TANKS 1 _ A _L.,4_ 1 _ t 4617 LEJEUNE ROAD CORAL GABLES, FLA. Permit No 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 hereia specified or not. A Dopy of approved plans and specifications must be kept at building during progress of work. , ^ n � L Owner' s Name and Address fri(-----1 1 W��� -Ee-___ Registered Architect and/orikgineer . ,, p Employing Plumber's Nano �¢) t F 3 _7- �4/Q-7/ C T % ., Na....,..4. ..... Itreet.—iX.. ..e`y ._.1� ' Location and Legal Description Lot. $low Subdivision._____ Street and Number where work is to be performed -No )0 Street.. -.. ` -� _... _. __ State work to be performed and purpose of building (By Floors)___. e 1..A -- 200 Sc Fr .- _. lA /N1 ! r ,. ! . New Building..__.._ _ _.._...- ... - - -_ -- Remodeling___- _.__._____ Addition.. _ ___..__ Repairs.. - .---- No. of Stories Amount of Permit $ STATE OF FLORIDA, µ COUNTY OF DADE. J My Comnd.sion Expires MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT (SI Street . V d./ E<5 Size Septic Tank__ +' -Ty l r e of Tan Feet of Drain Tile 2_ °QC -1' ___-Dist. Feet of Tank or Drain Fidel from Well..-- .— .--- _._....__._..... _ Nature of Water Supply: City-WeIL Size of Soakage Pit (Si V ! k- . 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 5968, Compiled General Laws of Florida Permanent Supplement, and hur com- plied with the provisions thereof, and will require similar compliance from all contractors or sub- contractors employed by him in the worir to be performed under this permit; and will post or cause to be posted' for inspection on the site of the ch public notice or notices as err required by the Act. The undersigned agrees to employ only such sub-contractors, work • -. under this permit, as are licensed by Miami Shores Village. Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take aclatowledgments, 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 wW be made when ash r•issp•otlas is spad•' namesary by improper sodas for ispecdon, or faulty materials and /or workmanship. GLOacra BATH Tu•S SHOWERS LAVA• TORIES SIN" SINKS LAUNDRY TuvE URINALS CATCH OASIS FLOOR DRAIN DRINKING FOUNT'S' TOTAL FistURES GONTR. LIST CHICK SEPTIC TANK 'EWER CONN. DRAIN FIELD SOAKAGE PIT G TRAP SOLAR HEATER DEEP WELL 5 . a SWIM•G POOL CONTR. LIST .-- CHECK Permit No 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 hereia specified or not. A Dopy of approved plans and specifications must be kept at building during progress of work. , ^ n � L Owner' s Name and Address fri(-----1 1 W��� -Ee-___ Registered Architect and/orikgineer . ,, p Employing Plumber's Nano �¢) t F 3 _7- �4/Q-7/ C T % ., Na....,..4. ..... Itreet.—iX.. ..e`y ._.1� ' Location and Legal Description Lot. $low Subdivision._____ Street and Number where work is to be performed -No )0 Street.. -.. ` -� _... _. __ State work to be performed and purpose of building (By Floors)___. e 1..A -- 200 Sc Fr .- _. lA /N1 ! r ,. ! . New Building..__.._ _ _.._...- ... - - -_ -- Remodeling___- _.__._____ Addition.. _ ___..__ Repairs.. - .---- No. of Stories Amount of Permit $ STATE OF FLORIDA, µ COUNTY OF DADE. J My Comnd.sion Expires MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT (SI Street . V d./ E<5 Size Septic Tank__ +' -Ty l r e of Tan Feet of Drain Tile 2_ °QC -1' ___-Dist. Feet of Tank or Drain Fidel from Well..-- .— .--- _._....__._..... _ Nature of Water Supply: City-WeIL Size of Soakage Pit (Si V ! k- . 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 5968, Compiled General Laws of Florida Permanent Supplement, and hur com- plied with the provisions thereof, and will require similar compliance from all contractors or sub- contractors employed by him in the worir to be performed under this permit; and will post or cause to be posted' for inspection on the site of the ch public notice or notices as err required by the Act. The undersigned agrees to employ only such sub-contractors, work • -. under this permit, as are licensed by Miami Shores Village. Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take aclatowledgments, 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 wW be made when ash r•issp•otlas is spad•' namesary by improper sodas for ispecdon, or faulty materials and /or workmanship. STATE OF FLORIDA DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION AND INSTALLATION PERMIT Applicant A(.1. /1» c eRJ m Permit N ber d G - O / 7 2 Aol ddr-d ss f /o 7 ,,. `" ,E . l 4 A ly 09 6 SL ` � 9 PART 1I - SYSTEM INSTALLATION INSPECTION AND FINAL INSTAL APPRO AL- V Proper tank legend: Yes o Tank material ank level: Y- - No ( NI Tankswatertight: Yes No Tank size: gallons gallons gallons Proper tank outlet de ice: Yes No Manhole or m er to grade: Yes No Drainfield Trench Absorption Bed Installer / Length Width feat feet feet feet feet Total = Date ft Inspected by: J �/- le' Approved by: Systems located as permitted: Yes No Systems including plumbing stub -outs installed at proper elevation: Yes No Average depth to drainpipe invert from finished grade: inches Maximum depth Inches Average depth of drainfield gravel JV inches Minimum depth of gravel inches Proper gravel size: Yes 1/ No Gravel is suitable quality: Yes ✓ No Backfill or fill material as required: (Quality) Yes ✓ No (Quantity) Yes L- No Other findings )v di c/ `/ o C? AN APPROVED, TAL sN DOES NOT GUARANTEE PERFORMANCE Note: Completed copies of this fo m will be provided to the applicant, installer and the building department. HRS —H Form 4016, Feb 85 (Obsoletes previous editions wh ch may not be used) (Stock Number. 5744 -002- 4016 -0) Length Width fee . feet Length feet x feet = — ft feet feet Proper No. drainlines: Yes No Proper pipe separation: Yes ■Io Distribution box level: Yes No eet eet Total = ft Tank Manufacturer PART III - ,FINAL INSTALLATION APPROVAL Length _r./1)! feet x /0 feet= 3 a° ft 1 /7 - e.eT M ,i61c'l/ Date A / -t_ COUNTY PUBLIC HEALTH UNIT Page 2 of 2 «* , 6 : \d [