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PLUMBINGralni Shores Village RECE.LIVIED Building Department MAR fl , � 2004 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 BUILDING PERMIT APPLICATION FBC 2001 Permit Type (circle): Building Electrical Owner's Name (Fee Simple Titleholder) (2 k) 77-1/4 f/4 /} 4Z Phone # Owner's Address / / fL `1 ol > 77f < THE / City /4/1(4 / . 5 State % L Tenant/Lessee Name A1/. t'J Job Address (where the work is being done) / / 7- /lf� 9 Fri./ c T OEj 7 City Miami Shores Village County Miami -Dade Zip 35/3 Is Building Historically Designated YES NO Contractor's Company Name LLD Y /lfO k7"h� f1Iq oL Contractor's Address D Al t4J. / TN •7 City / / /1/4 / State FL. Qualifier L « Z 7 L - COOC T? Architect/Engineer's Name (if applicable) $ Value of Work For this Permit I Coo. O V Type of Work: Describe Work: ['Addition ❑Alteration 3'77 4./ ENew T/ 74 Zip 3'34 3 Phone # Permit No. 'P )O4 Master Permit No. ?t D.00y O ) Phone # .303 /- 6- 76 zip 35i Phone # Square Footage Of Work: /1J Repair/Replace * * * * * * * * * * * * * * * * * * * * * * * * * * ** F ees * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** Mechanical Roofing Submittal Fee $ Permit Fee $ n5 5 .00 CCF $ • CO /CC Notary $ (5 V0 Training/Education Fee $ Technology Fee $ ` . 31- ❑ Demolition Scanning $ Radon $ Zoning Bond $ Code Enforce ent $ Structural Plan Review. $ Total Fee Now Due $ ZS r (Continued on opposite side) Bonding Company's Name (if applicable) Bonding Company's Address City State Zip Mortgage Lender's Name (if applicable) Mortgage Lender's Address City State Zip Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRICAL WORK, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and AIR CONDITIONERS, ETC..... 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. "WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT 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." Notice to Applicant: As a condition to the issuance of a building permit with an estimated value exceeding $2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued In the absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged Signature ` : Signature Owner or Agent The foregoing instrument was acknowledged before me this day of c1 , 20 , by CYn1TKl t Attic s personals known to me�or who has produced As ide i tifi NOT Sign: Print: Chc 12/15/03 LL My Commission Expires: 0 State Certificate or Registration No. APPLICATION APPROVED BY: i or 4114y 1t, 2c' LES't::r, E crocicErr MY COMMISSION # DD 01476TARY P EXPIRES: May 20, 2005 R,nMfA Thn, elut'et M•t -,y Cn.ve -ems S1 (Certificate of Competency Holder) My Commission Expires: Certificate of Competency No. Contractor // The foregoing instrument was acknowledged before me this 7�GL day of , 20 U_`t by 74 G' J c 2KG-?T s who is personally known to_meTr who has produced as identification and who did take an oath. ***************************************************************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** * * ** * ** *********************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** Plans Examiner Engineer Zoning .a • Miami Shores Village 10050 NE 2nd Avenue Phone: 305 - 795 -2204 Printed: 3/11/2004 Applicant: CONRAD BROWN Owner: BROWN CONRAD JOB ADDRESS: 117 NE 98 ST Permit Number: PL2004 -81 Parcel # 1132060132300 Plumbing Permit Contractor LLOYD NORTH DADE SEPTIC TANK SERVIOEdNtractor's Address: 750 NW 107 ST Local Phone: 305 - 754 -3375 Page 1 of 1 Legal Description: 1 53 41 6 53 42 MIAMI SHORES SEC 1 AMD PB 10 -70 E1/2 LOT 16 & ALL LOT 17 BLK Fees: Description Amount FEE2004 -2432 Building Fee $175.00 FEE2004 -2433 CCF $0.60 FEE2004 -2434 Notary Fee $5.00 FEE2004 -2435 Training and Education Fee $0.20 FEE2004 -2436 Technology Fee $4.37 Total Fees: $185.17 Total Fees: $185.17 Total Receipts: $185.17 Permit Status: APPROVED Permit Expiration: 9/5/2004 Construction Value: $900.00 Work: ABANDON TANK Signed: (INSPECTOR) In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I assume responisibility for all work done by either myself, my agent, servants or employes. Signed: (Contractor or Builder) BY: MIAMI. SHORES VILLAGE BUILDING DEPARTM 305- 795 -220 Building Inspection Request Dat Type Insp'n Permit No. Name Address Company Phone # Inspection Date Approved Correction Re -Insp' n Fee BUILDING ❑ MIAMI SHORES VILLAGE 3- " �, ELECTRICAL ❑ Date— 19_- PLUMBING ❑ PERMIT N? 9769 Contractor's ♦sx License No Z ROOFING ❑ ❑ Work to be performed under this Permit Owner of !� Building ma . £LO 12.• a�L �' DA s . sf at Architect Contractor 5rvis#70 or Builder 0r • ' 'it . ' �'' Legal Lot 11 Description BI a Address of --� Building I l� ' i. ) 9 Q This permit is granted to the contractor or builder named above to construct the building or to install the equipment or device describe in the applica- tion herefor in strict compliance with all ordinances pertaining thereto and with the understanding that the work will be performed in comp ance with any 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 for a thorough knowledge of the ordinances and regulations pertaining to the work covered hereby whether shown on the plans or drawings or in the statements or specifications and that he assumes respon- sibility for work done by his agents, servants or employ - Signed- CONTRACTOR or BUILDER 1 4 r Subdi- vision Sq Ft Value of 11 Amount of Project $ I I Permit $ SP OR) BY In consideration of the issuance to me of this permit I agree t• • rform the work covered hereunder in compliance with all ordinances and regulations pertaining thereto and in strict conformity with the plans, drawitmal ements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I assume responsibility for all work done`'* , either, myself, my agent, servant or employee. BY AUTHORITY Chapter 64E- 6.044(3)(a), F.A.C.: Date: 3 - 3 -oil Signature: DOW/ Q "WELL FORM" ---0 ie � A plan or plat of the lot or total site ownership drawn to scale, showing boundaries with dimensions, locations of residences or buildings swimming pools, recorded easements, the on -site sewage disposal system location, the general slope of the property and any existing or proposed wells, drainage features, filled areas, obstructed areas, and surface waters such as lakes, ponds, streams or canals. The location of wells, on -site sewage disposal systems, surface waters and other pertinent facilities or features on contiguous or adjacent property, if the features are within 75 feet of the applicant lot, must also be shown but need not be drawn to scale. The location of any public potable water system well, as defined in Chapter 64E- 6.002(40)(b),- within 200 feet, and the location of limited use non - community or other public wells, as defined in Chapter 64E- 6.002(40)(b), within 100 feet of the applicant lot must also be shown, or as defined in Chapter 64E- 6.002(4)a), F.A.C., within 75 feet from a private potable water well (well used only by four or less non- rental residences). Chapter 4616.1(p). South Florida Building Code: Wells shall be located as to be free of contamination from unsafe water supply and shall be at least 100 feet from a septic tank, drainfield, soakage pit or discharge well.... Under Chapter -6, F.A.C., underdrains connected to a drainage system are considered an extension of surface water. The minimum setback for lots platted prior to January 1, 1972 is 50 feet. The minimum setback for lots platted on or after January 1, 1972 is 75 feet. Where solid pipe is used to connect underdrains to an existing stormwater system, the setbacks would be applicable only to the underdrains, not the solid pipe. I have read the above and to the best of my knowledge I have provided the Department with full information regarding pertinent facilities and features on all adjacent properties. Furthermore, I understand that any Septic Tank Construction issued on the basis of said facilities and features as provided by me and found to be incorrect will be subject to revocation in accordance with the provisions of Chapter 120, Florida Statutes. Owners Name: CONRAD BROWN Property Address: 117 NE 98T STREET MIAMI SHORES, FL. 33138 LEGAL DESCRIPTION: FOLIO #: 11- 3206 - 013 -2300 East 1/2 of Lot 16 & ALL OF LOT 17, Block 17 of "MIAMI SHORES SEC 1 AMD" according to the plat thereof as recorded in Plat Book 10 at Page 70 of the Public Records of Dade County, Florida. SURVEYOR'S NOTES: 1) Not valid without the signature and the original raised seal of a Florida Licensed Surveyor and Mapper. 2) Additions or deletions to this certificate by other than the signing party or parties are prohibited without written consent of the signing party or parties. 3) This certificate elevation is for the purpose of septic and drains repair and /or construction. 4) This certificate elevation must not be use for the purpose of acquiring flood insurance 5) Elevations are based on the National Geodetic Vertical Datum of 1929. 6) Flood Zone: N/A Base Flood Elev.: N/A as per Dade County, Florida. FEMA Panel Number: 120652 - 0093 - J - MARCH 2, 1994 TOP OF BOTTOM FLOOR: TOP OF NEXT HIGHER FLOOR: ATTACHED GARAGE (at the door): GRADE @ DRAINFIELD AREA CROWN OF THE ROAD: Field Date: 2/25/04 ELEVATION CERTIFICATE C--(3P5/- 12.1' 12.6' 10.4' 11.1' 11.3' Pablo J. Alfonso P.S.M. Professional Surveyor & Mapper State of Florida Reg. No.5880 Aro O' Y 1 c IN LAND S U R V E Y O R S , I N C. 6175 NW 153 STREET, SUITE 103, MIAMI LAKES, FLORIDA 33014 Phone: 305 - 822 -6062 "" 305 - 698 -9468 "" Fax: 305 - 827 -9669 Miami Shores Village 10050 NE 2nd Avenue Phone: 305 - 795 -2204 Permit Number: PL2004 -80 Printed: 3/11/2004 Applicant: CONRAD BROWN Owner: BROWN CONRAD JOB ADDRESS: 117 NE 98 ST Parcel # 1132060132300 Signed: (INSPECTOR) Plumbing Permit Contractor LLOYD NORTH DADE SEPTIC TANK SERVIONdNtractor's Address: 750 NW 107 ST Local Phone: 305 - 754 - 3375 Page 1 of 1 Legal Description: 1 53 41 6 53 42 MIAMI SHORES SEC 1 AMD PB 10 -70 E1/2 LOT 16 & ALL LOT 17 BLK Fees: Description Amount FEE2004 -2425 Building Fee $175.00 FEE2004 -2426 CCF $1.20 FEE2004 -2427 Notary Fee $5.00 FEE2004 -2428 Training and Education Fee $0.40 FEE2004 -2429 Technology Fee $4.37 FEE2004 -2430 Builders Bond $300.00 FEE2004 -2431 Scanning Fee $3.00 Total Fees: $488.97 Total Fees: $488.97 Total Receipts: $488.97 Permit Status: APPROVED Permit Expiration: 9/5/2004 Construction Value: $1,200.00 Work: REPLACE DRAINFIELD AND SEPTIC TANK 900 GAL In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I assume responisibility for all work done by either myself, my agent, servants or employes. Signed: (Contractor or Builder) BY: APPLICANT: AGENT: PROPERTY ADDRESS: LOT: EXPLANATION OF VIOLATIONS / REMARKS: E ✓{ FINES / EXCAVATION MATERIAL FILL AMOUNT FILL TEXTURE EXCAVATION DEPTH AREA REPLACED , REPLACEMENT MATERIAL / f /ry t <c / t `t rid• ,1 SUBDIVISION: ! { I (6. 4,t )1.1 ' CHECKED [X] ITEMS ARE NOT IN COMPLIANCE WITH STATUTE OR RULE AND MUST BE CORRECTED. ================= ==========c TANK INSTALLATION f ri-ij ] [01] TANK SIZE [1i ) [2] ] [02] TANK MATERIAL / << {', 1 [03] OUTLET DEVICE , i, ] [04] MULTI - CHAMBERED [ IY,' j ?_Ri' I 1 [05] OUTLET FILTER , Alin . [(i I ] , (06] LEGEND f_ � 4 - ? , .c,' /! , _ ; U [ ] ] [07] WATERTIGHT '. [ ] [08] LEVEL [ ] (09] DEPTH TO LID [ ] [10] AREA [1] % ` [2] - SQFT ' ] (11] DISTRIBUTION BOX _ HEADER _ [ ] (12] NUMBER OF DRAINLINES [13] DRAINLINE SEPARATION [14] DRAINLINE SLOPE [15] DEPTH OF COVER [16] ELEVATION [ABOVE /BELOW] BM [17] SYSTEM LOCATION [18] DOSING PUMPS [19] AGGREGATE SIZE '`,';', [20] AGGREGATE EXCESSIVE [21) AGGREGATE DEPTH ;' I\ ] I I I I I I I I CONSTRUCTION'•[APPROVED /DISAPPROVED]: -\JO L FINAL SYSTEM • (APPROVED /DISAPPROVfD]: DH 4016, 10/97 (Previous Editions May Be Used) • Installer / Contractor PERMIT NO. DATE PAID: FEE PAID: RECEIPT #: PROPERTY ID #: SETBACKS [27] SURFACE WATER (28] DITCHES [29] PRIVATE WELLS (30]- PUBLIC WELLS [31] IRRIGATION WELLS (32] POTABLE WATER LINES (33] BUILDING FOUNDATION [34] PROPERTY LINES [35] OTHER FILLED / MOUND SYSTEM (36] DRAINFIELD COVER (37] SHOULDERS [38] SLOPES [39] STABILIZATION MIEMW. asaaaaa ==xa=== ADDITIONAL INFORMATION [40] UNOBSTRUCTED AREA [41] STORMWATER RUNOFF (42] ALARMS [43] MAINTENANCE AGREEMENT [44] BUILDING AREA [45] LOCATION CONFORMS WITH SITE PLAN [46] FINAL SITE GRADING' [47] CONTRACTOR L� [48] OTHER ( , ( r' • (,•.1 - •; :, -(• FT FT FT FT FT FT FT FT FT ABANDONMENT [49) TANK PUMPED _ / / [50] TANK CRUSHED & FILLED _ / CND DATE: l _ CHD DATE s Page 2 of 3 4c • MIRMI SHORES VILLAGE BUILDING DEPARTME 305- 795 -2204 Building Inspection Request Date: O Type Insp'n Permit No. Name Address ` 1 rt fY\ Company Phone # Inspection Date Approved Correction Re- Insp'n Fee Mi/WI SHORES VILLAGE BUILDING DEPARTMENT 305- 795 -2204 Building Inspection Requ Daa Type Insp'n �[ Permit No. P ` O ( J)6 Name Address Company Phone # Inspection Date Approved Correction Re- Insp'n Fee Bonding Company's Name (if applicable) + • r Bonding Company's Address City State Zip Mortgage Lender's Name (if applicable) Mortgage Lender's Address City State Zip Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRICAL WORK, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and MR CONDITIONERS, ETC 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. "WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT 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." Notice to Applicant: As a condition to the issuance of a building permit with an estimated value exceeding $2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued In the absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged Signature l.2rytlL Owner or Agent The foregoing instrument was acknowledged before me this 19i4 day of , nitkr L, 200L/, by C'& 1il)A who is personally known to me who has produced NO Sign: Print: Chc 12/15/03 As identificatio rn alp 0 . y KETT * MY COMMISSION # DD Nr3 EXPIRES: May 20, 2005 pp f, O'' Bonded Thru Budges Plotary Services Signature YP Sign: Q - Contractor The foregoing instrument was acknowledged before me this day of , 2004L, by 1.455 Z �DC, ETT w 10 is personally known to m?r who has produced as identification and who did take an oath. My Commission Expires: n4 'qv, 1 .2.0 . (Certificate of Competency Holder) State Certificate or Registration No. Certificate of Competency No. My Commission Expires: ***** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** * ** ********************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** APPLICATION APPROVED BY Ai 0 Plans Examiner Engineer Zoning Miami Shores Village r,u ilding Department I 10054 N.E.2nd Avenue, Miami Shores, Florida 33138 MAR 0 .i 2054 BUILDIN - === PERMIT APPLICATION FBC 2001 Permit Type (circle): Building Electrical Owner's Name (Fee Simple Titleholder) Q/4.-17 /1�C Phone # 7 St -' Owner's Address / / 7 AJL q PT/-( STREET City 144 1 4041 5 .1- 1 0,12 C6 State FL, Tenant/Lessee Name �' el: (305) 795.2204 Fax: (305) 756.8972 Master Permit No. Zip 33/3 P/ Phone # Job Address (where the work is being done) /17 AZ: 9P / City Miami Shores Village County Miami -Dade Zip 33/3 P" Is Building Historically Designated YES NO Contractor's Company Name L L DYE nio•7 /../ Contractor's Address Z) A) (itJ / o 'q 7 / �T,PCL -7 City ( q14'/ i State FL Qualifier Z C 'U Architect/Engineer's Name (if applicable) Phone # $ Value of Work For this Permit 4 /3'"D . Square Footage Of Work: ISZ) Type of Work: ❑Addition ❑Alteration New [r Re air/Re lace p � p ❑Demolition Describe Work: 7L - LI OL bRA / � �� �� ge p k S-P f Goy e�alC� �V �- * * * * * * * * * * * * * * * * * * * * * ** * * * * ** F * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** Submittal Fee $ Permit Fee $ I ) S - 00 CCF $ 1 • 20 CO /CC Notary $ 5.00 Training/Education Fee $ . 4 U Technology Fee $ 4 - 3 Bond $ vim . Cr) Scanning $ 3 •00 Radon $ Zoning Code Enforcement $ Structural Plan Review. $ Total Fee Now Due $ E O ' 9 R- (Continued on opposite side) er aa03 t g� -�� �r 1 yu3 4300.0 Permit No. PI C I — ga Mechanical Roofing Phone # 3 T— j � 76-;74 Zip 5 /(off' ' STATE OF FLORIDA 44EPARTMENT OF HEALTH ONSITE SEWAGE DISPOSAL SYSTEM SITE EVALUATION AND SYSTEM SPECIFICATIONS PERMIT t# APPLICANT: LOT: /// / BLOCK: / SUBDIVISION: f i d/ A / c527:C.1 /4447) PROPERTY ID #: 0_ � _ 0/3_ .) TO BE COMPLETED BY ENGINEER, HEALTH UNIT EMPLOYEE, OR OTHER QUALIFIED PERSON. ENGINEER'S MUST PROVIDE REGISTRATION NUMBER AND SIGN AND SEAL EACH PAGE OF SUBMITTAL. COMPLETE ALL ITEMS. 1 PROPERTY SIZE CONFORMS TO SITE PLAN: [1 TOTAL ESTIMATED SEWAGE FLOW: 3- AUTHORIZED SEWAGE FLOW: 11� UNOBSTRUCTED AREA AVAILABLE: 6,2 BENCHMARK /REFERENCE POINT LOCATION: ri/l /,,f /[) FLVa /m2• / ELEVATION OF PROPOSED SYSTEM SITE IS /7, NCH y FT] [ABOV t /SELO ) BENCHMARK /REFERENCE POINT THE MINIMUM SETBACK WHICH CAN BE MAINTAINED FROM THE PROPOSED SYSTEM TO THE FOLLOWING FEATURES: SURFACE WATER: /114, FT DITCHES /SWALES: /OA. FT NORMALLY WET? [ ] YESA [ ] NO WELLS: PUBLIC: FT LIMITED USE: AJ./q. FT PRIVATE: Ad-/-1. FT NON - POTABLE: • St1 FT BUILDING FOUNDATIONS: FT PROPERTY LINES: J FT POTABLE WATER LINES: /0 FT SITE SUBJECT TO FREQUENT FLOODING: [ ] YES [ ] NO 10 YEAR FLOOD ELEVATION FOR SITE: 3 ) � S, T41GVD SITE ELEVATION: / /•/ / {'FT MSL NGVD 5 / wT SOIL PROFILE INFORMATION SITE 1 Depth O" to to /(?'' Munsell # /Color Texture /0 ‘if4 t / / Z. DAyYl \! 7 - -!P .�/ / .5i7=1a)7) /0 " to G - t -`/ Si `Y-rNg) to /1 /r to // /) to )/ /l to f /r to " \ If to :"On USDA SOIL SERIES: !)P r1?A)L. /-1/tJL OBSERVED WATER TABLE: /1JA INCHES [ABOVE / BEIIOW) EXISTING GRADE. TYPE: [PERCHED / APPARENT] ESTIMATED WET SEASON WATER TABLE ELEVATION• 7�• ( ES)[ ABO �BELO �J EXISTING G RADE. HIGH WATER TABLE VEGETATION: [ ] YES [ NO MOTTLING: — [ - ]] YES [ NO DEPTH: /]�.�• I NCHES SOIL TEXTURE /LOADING RATE FOR SYSTEM SIZING: 7 /.0 /1` DEPTH OF EXCAVATION: ,f INCHES DRAINFIELD CONFIGURATION: [ ] TRENCH [ elBED [ ] OTHER (SPE CIFY) REMARKS /ADDITIONAL CCRITE IA: ( ( a4 4 -4! )1/ _ / r / W -_Y!a / 4,07( // SITE EVALUATED BY: DH 4015, 10/96 (Replaces HRS -H Form 4015 (Pape 3) which may be used) (Stock Number: 5744- 003 - 4015 -1) YES [ ] NO NET USABLE AREA AVAILABLE: %`-,, k "'ACRES GALLONS PER DAY [RESIDENCES -TABLE 1 / OTHER -TABLE 2) GALLONS PER DAY (1500 GPD /ACRE OR 2500 GPD /ACRE] SQFT UNOBSTRUCTED AREA REQUIRED: 6e7r) SQFT AGENT: L £ o Y Z tid j! / C� P 7 /� [Section /Township /Range /Parcel No. or Tax ID Number] 10 YEAR FLOODING? [ ] YES J NO SOIL PROFILE INFORMATION SITE 2 Munsell # /Color Texture Depth "I) `/.) . /I L />/a -/ O " to 6 Ri= `/ %?1' -711 i) to ITy' `/R ..S /J 'I/4 /D /0" t o r., Pt. 011/0 to /1 1' to /( /r to II /' to /1 /1 USDA SOIL SERIES: to to :2) CJ AI L ) !i DATE: 3 67" Page 3 of 3 tt. Scale: Each block represents 5 feet and 1 inch = 50 feet. - t - .• r 7 --; T _ - t ; - r ; HJE . . t 4 V --t 44:1 I t t T T-..1 • 1- TT- ; -- 1 44 II 1-4 - -4-- r t - 14,1 f , I • f 1 Site Plan submitted Plan Approved By STATE OF FLORIDA DEPARTMENT OF HEALTH APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PERMIT 0 Permit Application Number L.1 , C"Pcc ALL CHANGES MUS BE APP DH 4015. 1096 (Replaces HRS-H Form 4015 which may be used) (Stock Nurtbsr: 5744-002-40154) PART II - SITE PLAN- r et c lot Approved ' ; r , Alf& :r f • , ; . ; ! 4 1 1 . t « 1 1 r t t 1 : • : I -4- 1 I OVED BY THE COUNTY HEALTH DEPARTMENT ° ° • ; -1- - -t- .! 4 _•_. iT LI L. ^ 4 ; • _ ,z__. 1 H ■ i 44 -4- 'V' I 4 1 ■ i "1 -- t -'---!-- --- --1 - - 1 ---'-- " -4----- , - H i 1 t I 4 1 f : ' ' - ' 4-4--- i . T L . j . , 1 1 1 H ' 1 11 447: 4 - 4 4 1 - 1 . - 4 - 1T - 1 ' • T t -- 1 --- f --- • -- -1.- - T . ' -4-4 .. -4- -4 H 1 ; 1 1 -L-.1-4-4 t d I 1 M 0 i f i..4 I t - 1 2,:„A±;_i t _i1_.:11_,___;i..,_...z..;_i_14_,_li_izt i i___ ,--'--"- : -----tH-t-H I ----i-H--H- Hh-; ; , , ±. H {H ; : : ---- :" ' "H ---4-1----:- :' - : - 1 - '-'-': . -- ` L- t - H - t ---- i - ---- Notes: OCO4 /2. ...) /34-1-7.."4.- - .:)4 , 14,et1ei/ 4. L 6 .ite C 1%-rAi -6-N 7t at- b let- C-- JAI / , A u4: MA ,fr.t/tI 64/Li C:b4..g_ i --6AA C/A4.14.& -0 - SLZ Title Date County Health Department Page 2 of 3 ACRE IS SEWER AVAILABLE AS PER PROPERTY ADDRESS: //7 DIRECTION TO PROPERTY: /,974 / Dcs5 BUILDING INFOR Unit Type of No Establishment 3 4 2 TO BE COMPLETED BY APPLICANT OR _______________ _ BY A PERSON LICENSED AP PLICANT'S _____ _________________- __________ _ ____________ APPLICANTS PURSUANT ANTS AUTHORIZED AGENT. SYSTEMS TED RES PONSIBILITY URS A p PROVIDE DOC UMENTATION (m) OR 489 .552, UST BE CONSTRUCTED APPLICANT'S (MM /DD/ O IF REQUESTING OF FLORIDA STATUTES --_ ___ /--_ QUESTING CONSIDE THE DATE THE LOT WAS IT Is THE PROPERTY INFORMATION OF ST ATUTORY CREATED OR RMATION ____ ________________ __ GRANDFATHER PROVISIONS. LOT: /�i /7 BLOCK: ________________________________ --__ OCR: = SII BDiViSION : YYI /lgYY// =3/4 flZI eTLT !1 / -77172) PLATTED: /9).,3- PROPERTY ID #: //- ?OG -C)/3 - � � ZONING: PROPERTY SIZE: 1 > f 7-7147/4/Z-Y [ N] Floor STATE OF FLORIDA DEPARTMENT OF HEALTH ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM APPLICATION FOR CONSTRUCTION PERMIT APPLICATION FOR: [ NJ New System [ 4) Of] Repair [JO Existing System Ab andonment APPLICANT OW 77--/ / AIL MAILING ADD —7 ��? /CL TELEPHONE: /9. [" J RESIDENTIAL [ 4)]. Other (Specify) DH 4015 - C,CkG7 -/ 10/99 (Previous Editions Mav no „ SIGNATURE eat Dra [AJ) Holding Tank Temporary S WATER SUPPLY: ['] PRIVATE 381.0065, FS? [ Y / N ] [ ) COMMERCIAL No. of Building Commercial /Institutional S �e� 648 -6, FA Table 1, Cha ter C Design C i DATE: 3 - 3 -64/- j PERMIT NO. DATE PAID: FEE PAID: — RECEIPT #: 'aayv�c / ] Innovative I/M OR E QUIVALENT : [ Y / N ] PUBLIC [!/ ] <= 20 00GPD [ ] >2000GPD DISTANCE TO SEW FT Z7"7-7-57- •gin STATE OF FLORIDA DEPARTMENT OF HEALTH ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM EXISTING SYSTEM AND SYSTEM REPAIR EVALUATION APPLICANT: EXISTING TANK INFORMATION Qi,&i / in /? CONTRACTOR / AGENT: LLpyD A.Jv27-/ ), L 52 /C 7gN,e c/ ✓/C LOT: 42 /7 BLOCK: / SIIBDIV: /91//7111/ .52-/O WO ? /'r/'v/.L. ID #: TO BE COMPLETED BY FLORIDA REGISTERED ENGINEER, DEPARTMENT EMPLOYEE, SEPTIC TANK CONTRACTOR OR OTHER CERTIFIED PERSON. SIGN AND SEAL ALL SUBMITTED DOCUMENTS. COMPLETE ALL APPLICABLE ITEMS. COMPLETE TANK CERTIFICATION BELOW OR ATTACH LETTER FROM A PERMITTED SEPTAGE DISPOSAL SERVICE. [ 10Z) ] GALLONS SEPTIC TANK /GPD ATU LEGEND: /V•/9' [ ] GALLONS SEPTIC TANK /GPD ATU LEGEND: [ ] GALLONS GREASE INTERCEPTOR LEGEND: [ ] GALLONS DOSING TANK LEGEND: IFY THAT THE ABOVE NOTED TANKS WERE PUMPED ON .A/c.2 /O`T, HAVE THE VOLUMES SPECIFIED, ARE VE A [ SOLIDS DEFLECTION DEVICE / OUTLET FILTER DEVICE ] INSTALLEp. EXISTING DRAINFIELD INFORMATION SED CONTRACTOR BUSINESS NAME DATE [ jai)] SQUARE FEET PRIMARY DRAINFIELD SYSTEM NO. OF TRENCHES [ ] DIMENSIONS: .6 X/0 [ ] SQUARE FEET/ SYSTEM NO. OF TRENCHES [ ] DIMENSIONS: X TYPE OF SYSTEM: [ f] STANDARD [ ]/ FILLED [ ] MOUND [ ] CONFIGURATION: [ ] TRENCH I q, [ ] DESIGN: [ ] HEADER [ D -BOX [GRAVITY SYSTEM [ ] DOSED SYSTEM ELEVATION OF BOTTOM OF DRAINFIELD IN RELATION TO EXISTING GRADE 30 INCHES [ ABOVE BELOW, ■ SYSTEM FAILURE AND REPAIR INFORMATION SITE CONDITIONS: NATURE OF FAILURE: FAILURE [ ],,SEWAGE ON GROUND i SYMPTOM: [•4 PLUMBING BACKUP SUBMITTED BY: SYSTEM INSTALLATION DATE GPD ESTIMATED SEWAGE FLOW BASED ON [ ] DRAINAGE STRUCTURES [ ] POOL [ ] SLOPING PROPERTY [ ] [v1 HYDRAULIC OVERLOAD [ ] SOILS [ ] DRAINAGE / RUN OFF [ ] ROOTS L63T G C c k c=` T [ ] TANK [ ] DH 4015, 10/96 (Previous Editions may be used) PERMIT # Oq -10/9 MATERIAL: (2JAXRL"Z BAFFLE W[Y / N) MATERIAL: BAFFLED:[Y / N] MATERIAL: MATERIAL: # PUMPS:[ TYPE OF WASTE [ V(DOMESTIC [ ] COMMERCIAL [ ] METERED WATER [ TABLE 64E -6, FAC [ ] PATIO / DECK [4 PARKING [ ] MAINTENANCE [ ] WATER TABLE [ ] D BOX /HEADER [ ] SYSTEM DAMAGE [ ] I , -"r - DRAINFIELD REMARK /ADDITIONAL CRITERIA <704/ �� Ca ,r � C (�� ��� ^ WA A L a /24/1/1 - 144 V TITLE /LICENSE 5 /" //G a/V �Q DATE: 3 - 3 -o9 Page 4 of S Permit No __-r IAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT Application i• hereby made for the approval of the detailed statement of the plans and specifications herewith submitted f the build ng 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 th ' Building Dig' sion 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_ ! 4 - lag) o G r - No. ___J__L-_ — Street- - !/" _4 9 Y Registered Architect and /or Engineer _ Employing Plumber's Name __ _ _ /_/ fe_ Location and Legal Description Lot Street and Number where work is to be performed —No State work to be performed and purpose of building (By Floors)_ New Building Amount of Permit $ _ STATE OF FLORIDA, COUNTY OF DADE. My Commission Expires No._ - Street . Block_ Subdivision.._ _._ 17 / _72 .._9_ES p. Remodeling ____ -- - -- -_ _- -- Addition._._ _ _ __. ____ -.. Repairs- L,/ _ _-. No. of Stories _ . 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. _ _ Si . e of Soakage Pit - (Signed)_ •- -- -- - - -- (Si � eA0 PkA-St rr hi(e i spec Tan _ Capacity Gals. The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations as an e nployer of labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Permanent Supplement, -'n•l I a : om • plied with the provisions thereof, and will require similar compliance from all contractors or sub - contractor np .yed by hin in the woik to be performed under this permit; and will post or cause to be posted' for inspection on th site of the wo such blic notice or no ices as are required by the Act. The undersigned agrees to employ only such sub contractors work to , e per i der this per nit, as are licensed by Miami Shores Village. Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgn ents, personal) 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 .acts 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. • / ex. E'AALy Prs 6° Date Master Plumber. Pl..mb In:pecto. BATH TUBE SHOWERS LAVA. TORIES S SLOP SINKS LAUNDRY TUBE URINALS CATCH BASIN FLOOR DRAIN DRINKING FOUYT•NE TOTAL F XTURES CONTR. LIST CHECK SEPTIC TANK SEWER CONN. DRAIN FIELD SOAKAGE PIT GREASE TRAP SOLAR HEATER DEEP WELL SPRKLR. SYSTEM SWIM'G POOL CONTR. LIST CHECK Permit No __-r IAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT Application i• hereby made for the approval of the detailed statement of the plans and specifications herewith submitted f the build ng 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 th ' Building Dig' sion 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_ ! 4 - lag) o G r - No. ___J__L-_ — Street- - !/" _4 9 Y Registered Architect and /or Engineer _ Employing Plumber's Name __ _ _ /_/ fe_ Location and Legal Description Lot Street and Number where work is to be performed —No State work to be performed and purpose of building (By Floors)_ New Building Amount of Permit $ _ STATE OF FLORIDA, COUNTY OF DADE. My Commission Expires No._ - Street . Block_ Subdivision.._ _._ 17 / _72 .._9_ES p. Remodeling ____ -- - -- -_ _- -- Addition._._ _ _ __. ____ -.. Repairs- L,/ _ _-. No. of Stories _ . 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. _ _ Si . e of Soakage Pit - (Signed)_ •- -- -- - - -- (Si � eA0 PkA-St rr hi(e i spec Tan _ Capacity Gals. The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations as an e nployer of labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Permanent Supplement, -'n•l I a : om • plied with the provisions thereof, and will require similar compliance from all contractors or sub - contractor np .yed by hin in the woik to be performed under this permit; and will post or cause to be posted' for inspection on th site of the wo such blic notice or no ices as are required by the Act. The undersigned agrees to employ only such sub contractors work to , e per i der this per nit, as are licensed by Miami Shores Village. Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgn ents, personal) 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 .acts 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. • / ex. E'AALy Prs 6° Date Master Plumber. Pl..mb In:pecto. Permit No 1 S Amount of Permit $ STATE OF FLORIDA, t es. COUNTY OF DADE. MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT State work to be performed and purpose of building (By Floors) _ New Building-- -____t _ -- Remodeling____________ __ Addition (Signed)- — ( Si Date Subdivisi - 27- " 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 _ f% Es�l`! - -- _ - - - - -- --- -..___ No. J' ? _ !f/F — street 9, Re Architect and /or _ �� Employing Plumber's Name`VG_ Citg. /7/4_,C _ _dl(_e ^ - - -___ No._ .Z-Y1✓� Street. c�1/ -- _--- ______ - Location and Legal Description Lot Blocti Street and Number where work is to be performed —No L l7 W d _ s T"' Street Repairs No. of Stories . . ............... .... Size Septic Tank_. Type of Tank_ Capacity Gals.__ Feet of Drain Tile______- _______________ Feet of Tank or Drain Field from Well Nature of Water Supply: City— Well.____.______ ..... _______-_- --__--_____Size of Soakage Pit 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 Pennanent Supplement, and lids 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 perfo j under this pen as are licensed by Miami Shores Village. 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 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 Plumbing Inspector. Master Plumber. 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 TUBS URINALS CATCH BASIN FLOOR DRAIN DRINK NG FOUNT' NS N✓d�t' "� " {� 4 I TOTAL FIXTURES CONTR. LIST 1 CHECK — SEPTIC TANK SEWER CONN. DRAIN FIELD SOAKAGE PIT GREASE TRAP SOLAR HEATER DEEP WELL SPRKLR. SYSTEM SW IM'G POOL CONTR. LIST CHICK Permit No 1 S Amount of Permit $ STATE OF FLORIDA, t es. COUNTY OF DADE. MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT State work to be performed and purpose of building (By Floors) _ New Building-- -____t _ -- Remodeling____________ __ Addition (Signed)- — ( Si Date Subdivisi - 27- " 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 _ f% Es�l`! - -- _ - - - - -- --- -..___ No. J' ? _ !f/F — street 9, Re Architect and /or _ �� Employing Plumber's Name`VG_ Citg. /7/4_,C _ _dl(_e ^ - - -___ No._ .Z-Y1✓� Street. c�1/ -- _--- ______ - Location and Legal Description Lot Blocti Street and Number where work is to be performed —No L l7 W d _ s T"' Street Repairs No. of Stories . . ............... .... Size Septic Tank_. Type of Tank_ Capacity Gals.__ Feet of Drain Tile______- _______________ Feet of Tank or Drain Field from Well Nature of Water Supply: City— Well.____.______ ..... _______-_- --__--_____Size of Soakage Pit 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 Pennanent Supplement, and lids 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 perfo j under this pen as are licensed by Miami Shores Village. 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 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 Plumbing Inspector. Master Plumber. 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 1 L 9 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 L • AGN ES f?N.1 No. / - ------ Registered Architect and /or En Employing Plumber's Name ' 11.4 da TIG - 74aK�r No._ Location and Legal Description Lot Bloch Street and Number where work is to be performed —No -1/7 60e ei. Street State work to be performed and purpose of building (By Floors) _____ -_ _----------- - -_ - -- _ __ -- New Building __- Remodeling __ __ -_ -- Addition _ -•- _- _--- _ -_ -._ Repairs No. of Stories _ - _. $1zp Septi Tank_ -- -- - -- -- -- --- -- -Type of Tank_-- Capacity Gals 3 --- 0 15 Lock< t). r eet of Drain f ie_ _______ _ __Ihst. Feet of Tank or Drain Field from Well Nature of Water Supply: City — Well. — v__. _Size of Soakage Pit -CP Amount of Permit $ q------- - - - - -- — ( Signed )_- ..--- 1 -) -�_ CO.. `2_f- - - - - -. Plu bing Spector. 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 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). Date - - / -"' Jf '- - — 1‘ Xi Master Plumber. STATE OF FLORIDA, t 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 •n --scary by improper notice for insp -n, or faulty materials and /or workmanship. CLOBR6 BATH TUBS S LAVA. TORIES SINKS SLOP SINKS LAUNDRY TUBE U URINALS CATCH BASIN FLOOR DRAIN DRINKING FOUNT' NS TOTAL FIXTURES CONTR. LIST CHECK SEPTIC TANK SEWER CONN. DRAIN FIELD SOAKAGE PIT GREASE TRAP SOLAR H EATER DEEP WELL SPRKLR. SYSTEM SWING POOL CONTR. LIFT - - CHECK Permit No 1 L 9 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 L • AGN ES f?N.1 No. / - ------ Registered Architect and /or En Employing Plumber's Name ' 11.4 da TIG - 74aK�r No._ Location and Legal Description Lot Bloch Street and Number where work is to be performed —No -1/7 60e ei. Street State work to be performed and purpose of building (By Floors) _____ -_ _----------- - -_ - -- _ __ -- New Building __- Remodeling __ __ -_ -- Addition _ -•- _- _--- _ -_ -._ Repairs No. of Stories _ - _. $1zp Septi Tank_ -- -- - -- -- -- --- -- -Type of Tank_-- Capacity Gals 3 --- 0 15 Lock< t). r eet of Drain f ie_ _______ _ __Ihst. Feet of Tank or Drain Field from Well Nature of Water Supply: City — Well. — v__. _Size of Soakage Pit -CP Amount of Permit $ q------- - - - - -- — ( Signed )_- ..--- 1 -) -�_ CO.. `2_f- - - - - -. Plu bing Spector. 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 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). Date - - / -"' Jf '- - — 1‘ Xi Master Plumber. STATE OF FLORIDA, t 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 •n --scary by improper notice for insp -n, or faulty materials and /or workmanship. 4 4 Permit Na. - - .... Owner's Name and Addre Registered Architect and /or Engi Employing Plumber's Name Location and Legal Description Lot._ Street and Number where work is to be performed —No Amount of Permit $_ 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 w State work to be performed and purpose of building (By Floors)- _ _______.____ New Building _._ _ -- Remodeling — --- .--- -__ —_.___ Addition. No. .2/Z Le._. Street S f t --- • - - - -._ Block Subdivision. Street. Repairs No. of Stories. Size Septic Tank_ ..... ... ...... ..... -.... - -- - -- --- ---Type of Tank__ 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 formed under this permit as are licensed by Miami Shores Village. Date. - /� Stref 9f ( Signed ) My Commission Expires Notary Public, State of Florida aster Plumber. STATE OF FLORIDA, t se. 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 /or worlomanship. CLOSETS BATH TUBS SHOWERS LAVA. TORIES SINKS SLOP SINKS LAUNDRY TUBS URINALS CATCH BASIN FLOOR DRAIN DRINKING FOUNT'NS TOTAL FIXTURES CONTR. LIST CHECX SEPTIC TANK SEWER CONN. DRAIN FIELD SOAKAGE PIT GREASE TRAP SOLAR HEATER DEEP WELL SPRKLR. SYSTEM SWING POOL CON:'R. LIST CHECK v 4 4 Permit Na. - - .... Owner's Name and Addre Registered Architect and /or Engi Employing Plumber's Name Location and Legal Description Lot._ Street and Number where work is to be performed —No Amount of Permit $_ 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 w State work to be performed and purpose of building (By Floors)- _ _______.____ New Building _._ _ -- Remodeling — --- .--- -__ —_.___ Addition. No. .2/Z Le._. Street S f t --- • - - - -._ Block Subdivision. Street. Repairs No. of Stories. Size Septic Tank_ ..... ... ...... ..... -.... - -- - -- --- ---Type of Tank__ 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 formed under this permit as are licensed by Miami Shores Village. Date. - /� Stref 9f ( Signed ) My Commission Expires Notary Public, State of Florida aster Plumber. STATE OF FLORIDA, t se. 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 /or worlomanship. Permit No. 7- • Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for t e building or other structure herein described. This application s 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 wo Owner's Name and Addres Registered Architect and /or Employing Plumber's Nam Gam' No Size Septic Tank__ Feet of Drain Tile Nature of Water Supply: City —Well Amount of Permit $ STATE OF FLORIDA, 1 COUNTY OF DADE. ss. My Commission Expires NOTE: A re- inspection fee of $1.00 materials and /or workmanship. MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT _Size of Soaka ( Signed) The undersigned applicant for this building permit does hereby certify that under the Florida Workmen's Compensation Act, being Section 5966, Compiled plied with the provisions thereof, and will performed under this permit; and will pos required by the Act. The undersigned agrees to employ only such sub - contractors, licensed by Miami Shores Village. (Signe No. /J 7 9 Location and Legal Description Lot Block Date_ _____ /f�_� Subdivision Street and Number where work is to be performed —No State work to be performed and purpose of building (By Floors) New Building Remodeling Addition Repairs Street — No. of Stories Type of Tank Capacity Gals Dist. Feet of Tank or Drain Field from Well e Pit jun Inspector. ands and accepts his obligati s an employer of labor a Laws of Florida Permanent upplement, and has com- require similar compliance from all contractors or sub - contractors employed by him in the work to be or cause to be posted for inspection on the si `f the work such public notice or notices as ork to be perfonj�der this permit, as are are Before me, the undersigned authority a notary public, duly authorized to administer oaths and take acknowledgments, personally appeared Master Plumber. 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 will be made when such re- inspection is made necessary by improper notice. for inspection, or faulty CLOSETS BATH TUBS SHOWERS LAVA- TOR��IES SINKS SLOP SINKS LAUNDRY TUBS URINALS CATCH BASIN FLOOR DRAIN DRINKING FOUNT'NS TOTAL FIXTURES CONTR. LIST CHECK SEPTIC TANK SEWER CONN. DRAIN FIELD SOA GE IT GREASE TRAP SOLAR HEATER DEEP WELL SPRKLR. SYSTEM SWIM•G POOL . CONTR. LIST CHECK Permit No. 7- • Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for t e building or other structure herein described. This application s 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 wo Owner's Name and Addres Registered Architect and /or Employing Plumber's Nam Gam' No Size Septic Tank__ Feet of Drain Tile Nature of Water Supply: City —Well Amount of Permit $ STATE OF FLORIDA, 1 COUNTY OF DADE. ss. My Commission Expires NOTE: A re- inspection fee of $1.00 materials and /or workmanship. MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT _Size of Soaka ( Signed) The undersigned applicant for this building permit does hereby certify that under the Florida Workmen's Compensation Act, being Section 5966, Compiled plied with the provisions thereof, and will performed under this permit; and will pos required by the Act. The undersigned agrees to employ only such sub - contractors, licensed by Miami Shores Village. (Signe No. /J 7 9 Location and Legal Description Lot Block Date_ _____ /f�_� Subdivision Street and Number where work is to be performed —No State work to be performed and purpose of building (By Floors) New Building Remodeling Addition Repairs Street — No. of Stories Type of Tank Capacity Gals Dist. Feet of Tank or Drain Field from Well e Pit jun Inspector. ands and accepts his obligati s an employer of labor a Laws of Florida Permanent upplement, and has com- require similar compliance from all contractors or sub - contractors employed by him in the work to be or cause to be posted for inspection on the si `f the work such public notice or notices as ork to be perfonj�der this permit, as are are Before me, the undersigned authority a notary public, duly authorized to administer oaths and take acknowledgments, personally appeared Master Plumber. 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 will be made when such re- inspection is made necessary by improper notice. for inspection, or faulty Company__ Job__ REQJJEST FOR INSPECTION • Address-2/ , — Inspection_ _ _ - - Time Ready Date PHONE A.M. P.M.