PLUMBINGPERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Date /1/0 (p /9obAddress / 7 7 /1), is-, 9 0 sr; , Tax Folio
Legal Description Historically Designated:
/Lessee / Ten
adz/ De p / zi�D
Owner's Address / co 7 7 /(/,/ . / e7.57
Contracting Co. 1 .1 s P r/t , 1 /de- Address
Queer ( ?4 4 t2 y4D /(/c SS# AP ,2 --
State # ' ] - 3 ,3,1 7 Municipal # pop 90 c0 5 .2 7 Competency # 04:20 Q o 0_1.2 ?ins. Co. C Aen v j�}
Architect/Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type (circle one): BUILDING ELECTRICAL L B MECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIPTION /4157 3� Sri . cr D At iAlA
Square Ft. ,?c91.
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 cons zoning. Furthermore, I authorize the above -named contractor to do the work stated.
Signa a of o
Notary as to Own. rl r'!! I : o 'W
My Commission xpires:
FEES: PERMIT 3 S , RADON
OFFICIA ' a Y SEAL
TATIANA NASSAR
NOTARY PUBLIC STATE OF FLORIDA
COMMISSION NO. CC570170
MY COMMISSION EXP. JULY 17,2090
APPROVED:
Zoning
Mechanical Plumbing
Building
Estimated Cost (value)
Signature of Contractor wner- Builder Da e
C ( � 1 13"1 -(1 \
A /
Notary as t, C1i !'INMV 'e; ,
My Commi• :ion Expires:
OF 'SAL YSEAL
TATIANA NASSAR
NOTARY PUBLIC STATE OF FLORIDA
COMME51ON NO. CCS70I70
MY COMMISSION EXP. JULY 17,2080
C. C.F. I - AD NOTARY
Master Permit #
73-7- �3
/ofD / -1q-f/ ,1J, , ei liot
Phone
Electrical
Yes No
JKoo,
1 12/((
//
Date
TOTAL DUE
3 3‘•`
Engineering
CONSTRUCTION PERMIT FOR: -
UL New System [LP] Existing System [ 1�] Holding Tank [ l� Temporary Experimental
[LA Repair [ ,J] Abandonment [ �j Other(Specify)
APPLICANT: n ` LIE/ �e p � I AGENT: C PriL / L
0
T
H
E
R
SPECIFICATIONS BY:
APPROVED BY:
DATE ISSUED:
s
STATE OF FLORIDA PERMIT # 7 `I /C..02
DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES DATE PAID / / - 7 -
ONSITE SEWAGE DISPOSAL SYSTEM FEE PAID $ :SO ,
CONSTRUCTION PERMIT RECEIPT # / /6 Q
Authority: Chapter 381, FS & Chapter 10D -6, FAC
PROPERTY STREET ADDRESS: / 9 ' t E ez e
LOT: BLOCK: / , SUBDIVISION: /(-
PROPERTY ID #: f) [ SECTION /TOWNSHIP/RANG /PARCEL NUMBER]
�`J/ [OR TAX ID NUMBER-I
11 ."
SYSTEM MUST BE CONSTRUCTED IN ACCORDANCE *WITH'SPE!FICATIONS AND STANDARDS OF CHAPTER 10D -6, FAC
REPAIR PERMITS AND HOLDING TANK PERMITS EXPIRE 90 DAYS PROM THE DATE OF ISSUE. ALL OTHER PERMITS
EXPIRE. 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 ,75‘0] [GALLONS'/ GPD] SEPTIC TANK /AEROBIC UNIT CAPACITY MULTI- CHAMBERED /IN SERIES:[ ]
A [ ] [GALLONS / GPD] CAPACITY MULTI- CHAMBERED /IN SERIES:[ ]
N [ ] GALLONS GREASE INTERCEPTOR CAPACITY [ CAPACITY SINGLE TANK: 1250 GALLONS]
K [ ] GALLONS PER DOSE DOSING TANK CAPACITY DOSE RATE [ ] PER 24 HRS NO. OF PUMPS: [ )
D [300 ] SQUARE FEET PRIMARY ' DRAINFIELD SYSTEM
R [ ] SQUARE FEET SYSTEM
A TYPE SYSTEM: [ `r] STANDARD [1...)] FILLED [ i MOUND [OLI]
I CONFIGURATION: [kJ] TRENCH [ y] BED [
N , / 1 1 c
F LOCATION OF BENCHMARK: g O F 61 9 0
I' ELEVATION OF PROPOSED SYSTEM SITE [ 4,�y4 /i [INCHES /FT] [ABOVE /BELOW] BENCHMARK /REFERENCE POINT
!
E BOTTOM OF DRAINFIELD TO BE [ /L yr e ] [ABOVE /BELOW] BENCHMARK /REFERENCE POINT
L ' JQ
D FILL REQUIRED: [kJ/ WINCHES EXCAVATION REQUIRED: [ Z O ] INCHES
THE SEPTIC TANK SHALL RE PUMPED AND A SOLID
DEFLECTION DEVICE INSTALLED ON THE OUTLET TEE
HRS -H Form 4016, Mar 92 (Obsoletes previous editions which may not be used)
(Stock Number: 5744 - 001 - 4016 -0)
APPLICANT
TITLE:
TITLE:
INSTAI L 19" n7 0 Q..MY COARSE SAND
U tDE 1 20170M 0i= Dr AINFiELD
SUBM:T .TF' C•,-;':5ARK F:E.FO IN5PEC: IuN
iii t
L5urcM 3F DRA;N :LD ELEVAT'ail eif �3 i
EXPIRATION DATE:
CPHU
Page 1 of 2
ZN.97.1UCTF.ONS:
IL' tme1,7 as:Lig:red by CPZU.
APPI.MATEON FOR Check type of r.a.tinit, i Olace cpacify type in blarilt.
APi?1..CANT: ?roperty CWFICY'S full ram..3.
Teephor_e uuc fo applies o:: csont.
AGENT: Prcpurty owner's leBally authorized reprecentative.
IVIA.IL:NC ADDRESS: L.O. bon or straez zmilints Cd4N53 fez applicant 37 raw:,
SUBDLVISION o:.-
FROTER'.7Y 2.7 character ie., number for yoperiy. (CP1IU pre: :y appra:.ael S.:. (Joy
SYST17.7, DE..VGN AND
STECZFECATIONS:
TANK: nirnum specifiesticp.s from Chspte? O4, IFAV.
IiANiELD: . specifications from FAC.
011ie:: s)ecifications, suck as cperati73 perm: low-vo1nr.7a. va7icneu
SPLCF.T.CATiONS BY: Nam e. of individual p7oviding spftertions. f dcsi)::_ed riy 7,‘Eir:e.;:ti iT11.151
APPROVED BY: County Public Iliesith Unit (CPHU) personnel reviewing ansi ai:on.oving per .
DATE :SKIED: Date permit is issued by
LX2TfiATION DATE: One yc7r from este issued if ths system has r.a.l'asen system suociLs 1;ecome !X. facm
issued.
Scale:
STATE OF FLORIDA
DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES
APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTt� i t
Permit Application Number //��,,,, CCJJ
'1 //('
Each block represents 5 feet and 1 inch = 50 feet.
c oe G.174
z
1
7 W.11
//
3
kJ
(1/4)
0,1
Notes: /NS/ /fX / 3 00 .
4
•
FP/9//i
A67,
Site Plan submitted by:
Plan Approved
1
PART 11 - SITE PLAN
SIG ATURE
ti ST701 /- _504 /0 - 0 4 rioir/
7 .
Not Approved
By ��/ -� County Public Unit
ALL CHANGES MUST BE APPRO'V : D BY THE COUNTY PUBLIC HEALTH UNIT
HRS -H Form 4015, Feb 85 (Obsoletes previous editions which may not be used)
(Stock Number: 5744-002-4015-6)
Page of 3
.•fie T!�E
/y
<as
STATE OF FLORIDA PERMIT # .9 71 2 3 V
DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES
ONSITE SEWAGE DISPOSAL SYSTEM
SITE EVALUATION AND SYSTEM SPECIFICATIONS
.COp'N'E'TfN /
APPLICANT: A t .z7F f7,471r ,/�
D
LOT: BLOCK:
PROPERTY ID #: /4/77
TO BE COMPLETED B ENGINEER, HEALTH UNIT EMPLOYEE, OR OTHER QUALIFIED PERSON. ENGINEER'S MUST
PROVIDE REGISTRAT ±ON NUMBER AND SIGN AND SEAL EACH PAGE OF SUBMITTAL. COMPLETE ALL ITEMS.
L
PROPERTY SIZE CONFORMS TO SITE PLAN: YES [ ] NO NET USABLE AREA AVAILABLE: / ACRES
TOTAL ESTIMATED SEWAGE FLOW: . r.0 GALLONS PER DAY [RESIDENCES -TABLE 1 / •THER -TABLE 2]
AUTHORIZED SEWAGE FLOW: _3 or) GALLONS PER DAY [1500 GPD /ACRE OR 2500 GPD /ACRE]
UNOBSTRUCTED AREA AVAILABLE: / (`)Q SQFT UNOBSTRUCTED AREA REQUIRED: 4. ./ SQFT
BENCHIARK /REFERENCE POINT LOCATION: D/V T 'if� / .S
e�2
ELEVA ON OF PROPOSED SYSTEM SITE IS .gyp
THE MINIMUM SETBAC
SURFACE WATER:
WELLS: PUBLIC:
BUILDING FOUNDATI•NS:
SITE SUBJECT TO FREQUENT FLOODING: [ ] YES
10 YEAR FLOOD ELEVATION FOR SITE:
SOIL PROFILE INFORMATION SITE 1
Munsell # /Color Texture Depth
r �P ic _s/Y A3 f/ 0 to'
to
to
USDA SOIL SERIES:
to
to
to
to
to
to
OBSERVED WATER TABLE: 6 D INCHES [ABOVE / -ELO EXISTING GRADE. TYPE: ERCHED /(a;;;;] ESTIMATED WET SEASON WATER TABLE ELEVATION: 0 INCHES [ ABOVE / B LOW ] EXISTING GRADE.
HIGH WATER TABLE VEGETATION: [ ] YES 00 NO MOTTLING: [ ] YES 0 N• •EPTH: — INCHES
SOIL TEXTURE /LOADING RATE FOR SYSTEM SIZING: 4,Z 6 P2. DEPTH OF EXCAVATION: Q INCHES
DRAINFIELD CONFIGURATION: [ ] TRENCH [x] BED [ ] OTHER (SPECIFY)
REMARKS /ADDITIONAL CRITERIA:
HRS -H Form 4015, Mar 92 (Obsoletes previous editions which may not be used)
(Stock Number: 5744 - 003 - 4015 -1)
SITE EVALUATED BY:
WHICH CAN BE MAINTAINED FROM THE PROPOSED SYSTEM TO THE FOLLOWING FEATURES:
/P FT DITCHES/SWALES:
FT LIMITED USE: /V 1.4 FT
SUBDIVISION:
[Section /Township /Range /Parcel No. or Tax ID Number]
[4 NO
FT MSL /NGVD
AGENT: (Wi J s Tie //e
/FT] [ABOVE /
/REFERENCE POINT
FT NORMALLY WET? [ ] YES
R VATE: /0. FT NON- POTABLE:
,1" FT PROPERTY LINES: �S FT POTABLE WATER LINES: /v9
SOIL PROFILE INFORMATION SITE 2
NO
FT
FT
10 YEAR FLOODING? [ ) YES 0 NO
SITE ELEVATION: t/„„7/2 FT MSL /NGVD
Munsell #/ olor Texture Depth
cif /U,D f /0/ to -'
to
to
to
to
to
to
to
to
USDA SOIL SERIES:
DATE: 0/97
T
Page 3 of 3
INSTRUCTIONS:
PERMIT 0: Permit tracking number assigned by CPWil.
APPLICANT: Properly owner's full name.
AGENT: Properly owner's legally authorized reprreynlative.
LOT, BLOCK, SUBDIVISION: Lot, block, and subdivision for lot.
PROPERTY ID#: 27 character number for property. (property appraiser ID 0 or tectlon/toww,nip /range /parcel number)
PROPERTY SIZE: Check if property size at site conforms to cubmitted site plan. Record net usable aroa tivailt:bie - io2 area exe :: : :!ve �f
all paved areas and prepared road beds within public rights - of-way of eanernFnta and enema ve of atreams, !.:'.cu,
normally wet drainage ditches, marshes, or other such bodies of water.
SEWAGE FLOW:
UNOBSTRUCTED AREA:
MINIMUM SETBACKS:
Record the estimated sewage flow for the establishment from Table l (residences) or Table 2 (non - residential) s :Ita?ti
10D -6, FAC. Record the authorized sewage flow for the lot based on Pet usable me and wetev supply (150::
per day per acre for private water supplies and 2533 gpd per cern for public water supplica). If authorized reeiee ;e Low
does not equal or exceed the estimated cewage flow, the application must be denied.
Record the square feet of unobstructed even available and the amount cequircri. Unobstructed area must be e : :c;
times as large as the drainfield absorption area and at least 75 percent of the unobstructed area must o et
setbacks in Chapter 1OD -6, FAC. The unobstructed area must be contiguous to the drainfield.
BENCHMARK INFORMATION: Record the location of the benchmark. If using a surveyor's benchmark record the actual elevation. Record t e
elevation of the proposed system site in relation (above or below) to the benchmark.
Record minimum setbacks which can be meet to all listed features. Actuel measurements Must be recorded o: 'NA"
for non applicable features. Features on site plan or within 75 feet of the applicant lot :rue'- ',IC measured. E: Ieeation
of any public drinking well within 200 feet of the applicant's lot must also be verified.
FLOOD INFORMATION: Record information on lot's subject to flooding. For lots subject to flooding record 10 year Good elevc:ioa fov cute arid
actual site elevation.
SOIL PROFILE INFORMATION: Two soil profiles within the proposed absorption area to a minimum depth of G feet or refusal ere required. Sail
identification will use USDA Soil Classification methodology (Munsell colors and USDA soil textures). Refs ^a, must
be clearly documented. Provide USDA soil aeries if available, record "UNK" if the rcrica eennot be determined.
WATER TABLE: Record the depth of the observed water table at the firm; of the evaluation. Mark "perched" or "apparent' as
appropriate. Record the estimated wet season water table elevation bared ore site evaluation, USDA :,ail r±ap;c,
historical information. Indicate if there is high water table vegetation present. Indicate if mottling is present c .ttt depth.
SOIL TEXTURE: Record soil texture or loading rate for system stain;.
DEPTH OF EXCAVATION: If applicable record depth of excavation required. Record 'NA" if not applie eble.
DRAINFIELD CONFIGURATION: Check drainfield configuration required. If other, specify type..
ADDITIONAL CRITERIA: Record any additional remarks pertinent to site or installation. Ex. dosing t.quired.
SITE EVALUATED BY: Signature of evaluator, title, and date of evaluation. Professional engineers must seal all documentation sub oitte I.
ELEVATION WORKSHEET ELEVATION OF BENCHMARK / REFERENCE POINT IS:
BENCHMARK SITE 1 SITE 2 li : 3
[- J SHOT: H.I. H.I. 1+3.1.
H.I. [ -J SHOT f -] SH3CrE [ -J SHOT
Permit No 192‘
Date..._.._.
New Building_.__._ _ _.._........._.___ Remodeling —__ ._.— . __ Addition
Size Septic Tank—
Feet of Drain Tile
Nature of Water Supply: City—Well.
Amount of Permit $
STATE OF FLORIDA,
COUNTY OF DADE. I
ss.
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
Blo.4 Subdivision._
Type of Tangy
_Dist Feet of Tank or Drain Field from
Size of Soakage Pit.
\ice 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 heroin specified or not. A copy of approved plans and specifications must be kept at
building during progress of work. ` /
Owner's Name and Address i'► k 1 r ` I , v No. l G -7 7 Street_.. N ' o
Registered Architect and /or Engineer
Employing Plumber's Niue
Location and Legal Description Lot.
Street and Number where work is to be performed —No r U -7 7 Street/L . � 5 /
State work to be performe8 and purpose of building (By Floors)___..__ _ � .._. � fad,-
`/ _ _._ ■•• Na„_...._.,. .NSIIM....... S tree!. EMMINIMM_..:........ ......... .....,..
Repairs. " No. of Stories ....................
umbing 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 5988, 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 nder th}s permit, Ks are
licensed by Miami Shores Village.
Master Plumber.
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 depoees and says that be is the —..__.... --
of the above described construction, that be has carefully read the foregoing application, and that be 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 whoa rani swispamios is ssude•aeosssary by improper aotior for Inspection, or faulty
materials and /or workmanship.
CLOSETS
BATH
T
SHOWERS
LAVA.
TOR1ta
SINKS
SLOP
SINKS
LAUNDRY
Tuns
URINALS
CATCH
SABIN
FLOOR
DRAIN
DRINK NO
FOUNT NS
TOTAL
FIXTURES
CONTR.
LIST
CHICK
SEPTIC
TANK
SEWLA
CONK.
DRAIN
F IELD
SOAKAGE
PIT
GREASE'
TRAP
SOLAR
MEATIER
Darr
WILL
11
SYSTEM
SWIM'0
POOL
CONTR.
LIST
.---
CHICK
Permit No 192‘
Date..._.._.
New Building_.__._ _ _.._........._.___ Remodeling —__ ._.— . __ Addition
Size Septic Tank—
Feet of Drain Tile
Nature of Water Supply: City—Well.
Amount of Permit $
STATE OF FLORIDA,
COUNTY OF DADE. I
ss.
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
Blo.4 Subdivision._
Type of Tangy
_Dist Feet of Tank or Drain Field from
Size of Soakage Pit.
\ice 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 heroin specified or not. A copy of approved plans and specifications must be kept at
building during progress of work. ` /
Owner's Name and Address i'► k 1 r ` I , v No. l G -7 7 Street_.. N ' o
Registered Architect and /or Engineer
Employing Plumber's Niue
Location and Legal Description Lot.
Street and Number where work is to be performed —No r U -7 7 Street/L . � 5 /
State work to be performe8 and purpose of building (By Floors)___..__ _ � .._. � fad,-
`/ _ _._ ■•• Na„_...._.,. .NSIIM....... S tree!. EMMINIMM_..:........ ......... .....,..
Repairs. " No. of Stories ....................
umbing 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 5988, 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 nder th}s permit, Ks are
licensed by Miami Shores Village.
Master Plumber.
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 depoees and says that be is the —..__.... --
of the above described construction, that be has carefully read the foregoing application, and that be 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 whoa rani swispamios is ssude•aeosssary by improper aotior for Inspection, or faulty
materials and /or workmanship.
Permit No /.9) ` C--( /
Owner's Name and Address
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
Date..._..
Application is hereby made for the approval of the detailed statement of the plans and specifications herewith sul>diitted 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 comp with, whether herein specified or not. A copy of approved plans and specifications must be kept at
building during progress of work.
No 77 ..L Street_._ .. / .. ..._.._
Registered Architect and /or Engineer
Employing plumber': Ntlmo = . � S7 ! /"' Street 1 1 !.4(
Location and Legal Description Lot_ Block-- Subdivision._.__ .
Street and Number where work is to be performed —No -7 Street._. ti..2$S
State work to be performed and purpose of building (By Floors)__.__
New Building.__._ _ ------- ........_.. Remodeling — Addition _.
Size Septic Tank_ 9 - -� . Type of Tank
Feet of Drain Tile Feet of Tank or Drain Field from Well
Nature of Water Supply: City—Well. Size of Soakage Pit.
Amount of Permit $ (' v (Signed)
(Signed
Repairs. No. of Stories. ........... ..
r 77
Plumbing In.+pec
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 hiss com-
plied with the provisions thereof, and will require similar compliance from all contractors or sub- contractors employed by him i • work to be
performed under this permit; and will post or cause to be posted' for inspection on the site of th work such p lic noti • 'ces as are
required by die Act. The undersigned agrees to employ only such sub - contractors, on to be perfop1dd u :,. • ., mit, as are
licensed by Miami Shores Village.
Master Plumber.
STATE OF FLORIDA,
COUNTY OF DADE. J
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 imposes 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.
M Commission Expires Notary Public, State of Florida
NOTE: A re inspection fee of $1.00 will be made whoa snob rfa•hspeotlara Y mode'neosseary by improper notice for inspection, or faulty
materials and/at worlomanahip.
CLOSETS
BATH
TUBS
SHOWERS
LAVA.
TORIES
SIN"
SLOP
SINKS
LAUNDRY
TUBS
URINALS
CATCH
BASIN
FLOOR
DRAIN
DRINKING
FOUNT'NS
TOTAL
FIXTURES
CONTR.
LIST
CHECK
SEPTIC
TANK
SEWER
CONN.
DRAIN
FIELD
SOAKAGE
PIT
GREASE
TRAP
SOLAR
HEATER
DEEP
WELL
SPRKLR.
SYSTEM
SWIM•G
POOL
CONTR.
LIST
rte'
CHECK
Permit No /.9) ` C--( /
Owner's Name and Address
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
Date..._..
Application is hereby made for the approval of the detailed statement of the plans and specifications herewith sul>diitted for the building or other
structure herein described. This application is made in compliance and conformity with the Building Ordinance of Miami Shores Village, Florida,
and all provisions of the Laws of the State of Florida, all ordinances of Miami Shores Village and all rules and regulations of the Building Division
of Miami Shores Village shall be comp with, whether herein specified or not. A copy of approved plans and specifications must be kept at
building during progress of work.
No 77 ..L Street_._ .. / .. ..._.._
Registered Architect and /or Engineer
Employing plumber': Ntlmo = . � S7 ! /"' Street 1 1 !.4(
Location and Legal Description Lot_ Block-- Subdivision._.__ .
Street and Number where work is to be performed —No -7 Street._. ti..2$S
State work to be performed and purpose of building (By Floors)__.__
New Building.__._ _ ------- ........_.. Remodeling — Addition _.
Size Septic Tank_ 9 - -� . Type of Tank
Feet of Drain Tile Feet of Tank or Drain Field from Well
Nature of Water Supply: City—Well. Size of Soakage Pit.
Amount of Permit $ (' v (Signed)
(Signed
Repairs. No. of Stories. ........... ..
r 77
Plumbing In.+pec
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 hiss com-
plied with the provisions thereof, and will require similar compliance from all contractors or sub- contractors employed by him i • work to be
performed under this permit; and will post or cause to be posted' for inspection on the site of th work such p lic noti • 'ces as are
required by die Act. The undersigned agrees to employ only such sub - contractors, on to be perfop1dd u :,. • ., mit, as are
licensed by Miami Shores Village.
Master Plumber.
STATE OF FLORIDA,
COUNTY OF DADE. J
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 imposes 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.
M Commission Expires Notary Public, State of Florida
NOTE: A re inspection fee of $1.00 will be made whoa snob rfa•hspeotlara Y mode'neosseary by improper notice for inspection, or faulty
materials and/at worlomanahip.
B WING
ELECTRICAL
PLUMBING
ROOFING
Owner of
Building
Architect
Contract
or Builder
MIAMI SHORES VILLAGE, FLORIDA
PERMIT N9 5639
0
0 Work to be performed under this Pe i
Legal Lot
Description
Address of
Building orrn AO/ 44,.
In consideration of
pertaining - . and in
ceptinck i- . pertit I ass .
the issuance to me of this permit I agree to perform the work covered hereunder i,a
trict conformity with the plans, drawings, statements or specifications sttbmined to the pr
e responS bility for all work done by either, myself, ra gent, servant or employee.
ACTOR OR BUILDER
DATZ
Contactot's l i p
License No. awa
Subdi-
vision
Value of II Amount of
Project $ l+ Permit $
This permit is granted to the contractor or builder named abaye to construct the building er to install the eg weir device described in the a
tion herefor in strict compliance with all ordinances pertaintnt We-and with the understanding that the work ws be performed in sotnpfance
plans, drawings, statements or specifications that may have .e h teed to and approved by the g roper municipal"authorkiee. This Permit pray be
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
permit is granted is the understanding that the contractor or builder named shove assumes the responsibititx for a thorough knowledge of the
regulations pertaining to the work covered hereby whether shown on the plans or drawings or in the statements tie specifications and that he assn
sibility for work done by his agents, servants or employees.
40-
Signed:
AUTHORITY oduss
•
Permit No.
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
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_ - -1_ �-`�_.-_______ ` No. _ _IC 7_7_ -_ Street_.IVE S +
Registered Architect and/or
'' Engi // neer - id ''L - -- - --- _ Fl --- -- - - -- __---- _--- _----- - - - - -_
Employing Plumber's Name._l___ Fit/in b I i; ?fir , I Lf- No.__ / 6 - 8 Street_ _10 / t /1 k�
Location and Legal Description Lot_____________. _ ______ ___._ — Block _ Subdivision
Street and Number where work is to be performed -No .111:7 "7 Street- NF S f
State work to be performed and purpose of building (By Floors) _ _____
New Building _ -_ -.- _-- Remodeling Addition.
Size Septic Tank Type of Tank.
Feet of Drain Tile Dist. Feet of Tank or Drain Field from Well
__Size of Soakage Pit
Nature of Water Supply: City -Well.
Amount of Permit $
The undersigned applicant for this building permit does hereby certify that he understands and accepts his obliga ofis'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.
My Commission Expires
(Signed) - - -.L
(Signed)._
Date
-tt-
Repairs No. of Stories.
Capacity Gals
umbing Inspector.
STATE OF FLORIDA, I
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
TUBE
URINALS
CATCH
BASIN
FLOOR
DRAIN
DRINKING
FOUNT' NS
TOTAL
FIXTURES
Comm
LIST
I
'
/
CHECK
Z
Z
--
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.
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
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_ - -1_ �-`�_.-_______ ` No. _ _IC 7_7_ -_ Street_.IVE S +
Registered Architect and/or
'' Engi // neer - id ''L - -- - --- _ Fl --- -- - - -- __---- _--- _----- - - - - -_
Employing Plumber's Name._l___ Fit/in b I i; ?fir , I Lf- No.__ / 6 - 8 Street_ _10 / t /1 k�
Location and Legal Description Lot_____________. _ ______ ___._ — Block _ Subdivision
Street and Number where work is to be performed -No .111:7 "7 Street- NF S f
State work to be performed and purpose of building (By Floors) _ _____
New Building _ -_ -.- _-- Remodeling Addition.
Size Septic Tank Type of Tank.
Feet of Drain Tile Dist. Feet of Tank or Drain Field from Well
__Size of Soakage Pit
Nature of Water Supply: City -Well.
Amount of Permit $
The undersigned applicant for this building permit does hereby certify that he understands and accepts his obliga ofis'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.
My Commission Expires
(Signed) - - -.L
(Signed)._
Date
-tt-
Repairs No. of Stories.
Capacity Gals
umbing Inspector.
STATE OF FLORIDA, I
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
Amount of Permit $ 2.00
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 s' """ l�"L �' plr�— No.--_ Street_
Registered Architect and /or Engineer_________.____ ____ —
Employing Plumber's Name DADE' GAS COMPANY N
b 940 NW 27 Avenue
____.._______.___ - -• -- Street_-_.
Location and Legal Description Lot .____.________._____.__..____ Block Subdivision
Street and Number where work is to be performed —No 1077 NE .28 St • Street
State work to be performed and purpose of building (By Floors)
New Building x_________________ __ -- Remodeling____ __ ____ Addition________.__ Repairs No. of Stories
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING r LMIT
Date 8/26161
Size Septic Tank ............. - ......... - -- -......... ---- -- -- - -- -Type of Tank__ 2 - 100'# Capacity Gals.
Feet of Drain Tile._--___ __................. -- .... ------ -Dist. Feet of Tank or Drain Field from Well
Nature of Water Supply: City—Well . - - -___ _ _ _ __._Size 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 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).
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.
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 worlmvanship.
Master Plumber.
CLOSETS
TUBS
TUBS
SHOWERS
LAVA-
TORIES
NK
SINKS
SLOP
SINKS
LAUNDRY
TUBS
URINALS
CATCH
BASIN
FLOOR
DRAIN
DRINKING
FOUNT' NS
ias
T _
P _ R f_ 0 LJ P - ARE
TOTAL
FIXTURES
CONTR.
ST
LIST
CHECK
X
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
Amount of Permit $ 2.00
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 s' """ l�"L �' plr�— No.--_ Street_
Registered Architect and /or Engineer_________.____ ____ —
Employing Plumber's Name DADE' GAS COMPANY N
b 940 NW 27 Avenue
____.._______.___ - -• -- Street_-_.
Location and Legal Description Lot .____.________._____.__..____ Block Subdivision
Street and Number where work is to be performed —No 1077 NE .28 St • Street
State work to be performed and purpose of building (By Floors)
New Building x_________________ __ -- Remodeling____ __ ____ Addition________.__ Repairs No. of Stories
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING r LMIT
Date 8/26161
Size Septic Tank ............. - ......... - -- -......... ---- -- -- - -- -Type of Tank__ 2 - 100'# Capacity Gals.
Feet of Drain Tile._--___ __................. -- .... ------ -Dist. Feet of Tank or Drain Field from Well
Nature of Water Supply: City—Well . - - -___ _ _ _ __._Size 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 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).
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.
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 worlmvanship.
Master Plumber.
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