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
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