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PLUMBINGTank Manufacturer NA Proper tank legend: Yes. /t No Tank material 20 `V r4 '- Tank level: Yes_Pl& No Tank size gallons �- gallons / gallons Proper tank outlet device: Yes NIil No Manhole or marker to grade: Yes _ No Drainfield Trench Absorption Bed Length Width Length Width Length feet x feet = t9.2 ft feet feet feet _ feet Length - feet x S feet= / 1 ft feet feet /J feet feet Proper No. drainlines: Yes 3 No6 W feet feet feet _ feet Proper pipe separation: Yes ✓ No Total = ft Total = ft Distribution box level: Yes No A /re Systems located as permitted: ' Yes *✓ No Systems including plumbing stub -outs installed at proper elevation: Yes No '" Average depth to drainpipe invert from finished grade: i G inches Maximum depth• az q Inches i I f Installer Date STATE OF FLORIDA DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION AND INSTALLATION PERMIT Applicant a / — / Prmit Number F 7 - 7�� °Z 3 /01 3 7 AI c. �9� S �'� 02 7 0 0 0 PART II SYSTEM INSTALLATION 'INSPECTION AND FINAL INSTALLATION APPROVAL- / ..4 i'A-� Tanks watertight: Yes A)//a No Average depth of drainfield gravel: Inspected by: Lk. E-E vc 4- Approved by: PART I NSTALLATION APPROVAL- ( inches Minimum depth of gravel /02 inches Proper gravel size: Yes ✓ No Gravel is suitable quality: Yes ✓ No Backfill or fill material as required: (Quality) Yes ✓ No (Quantity) Yes _ No Other findings: ye Date 1 7 / /17fr � COUNTY PUBLIC HEALTH UNIT AN APPROVED INSTAL TION D +ES NOT GUARANTEE PERFORMANCE Note: Completed copies of this form will be provided to the applicant, installer and the building department. HRS —H Form 4016, Jan 86 (Replaces Feb 85 edition which may be used) (Stock Number: 5744-002-4016-4) Page 2 of 2 STATE OF FLORIDA DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION AND INSTALLATION PERMIT Applicant C "-/ Permit Number F 7 - T ! 3 / 3 7 A / , / 5 - �- _ ,7 7 C C - PART I1 - SYSTEM INSTALLATION INSPECTION AND FINAL INSTALLATION APPROVAL--------- -- - --- /n - e Installer Proper tank legend: Yes No Tank material 60 '` /C Tank level: Yes A No Tanks watertight: Yes 4/ No Tank size: gallons ______.---gallons Alh gallons Proper tank outlet device: Yes NJi9 No Manhole or marker to grade: Yes N )/14 No Drainfield Trench Absorption Bed Length Width Lymph width Length feet x feet = /9 -2 ft feet feet feet feet Length ` 3 feet x_6 feet = / 1 ft - feet feet /' feet feet Proper No. drainlines: Yes �Noi - feet feet feet __ feet Proper pipe separation: Yes ✓ No Total = ft Total = ft Distribution box level: Yes No /kJ/a' Systems located as permitted: Yes ✓ No - Systems including plumbing stub -outs installed at proper elevation: Yes No , P Average depth to drainpipe invert from finished grade: 1 6 inches Maximum depth oz"/ Inches Average depth of drainfield gravel Proper gravel size: Yes ✓ No Gravel is suitable quality. Yes ✓ No Backfill or fill material as required: (Quality) Yes ✓ No (Quantity) Yes No Other findings: NR Inspected by 29-L 1--e v E /, Date t� r�'11�9 1 Approved by: , HRS —H Form 4016, Jan 86 (Replaces Feb 85 edition which may be used) (Stock Number: 5744-002-4016-4) Tank. Manufacturer N /R' inches Minimum depth of gravel /o( inches O (/- Date VP VP 7 PART I - F A INSTALLATION APPROVAL- .............. ....__._.------ ....._........_. AN APPROVED INSTAL TION D • ES NOT GUARANTEE PERFORMANCE COUNTY PUBLIC HEALTH UNIT Note: Completed copies of this form will be provided to the applicant, installer and the building department. Page 2 of 2 uw r-f/nibeAcy Permit No Amount of Permit • kda- e - 7,5 7 - 06) 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 Registered Architect and/or Engineer MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT /01MI f SE'Pria- licagon ancLegal d /IN i Employ? riwooes limpetzfiv Lot_ il s6i9rte--r-,4444. No.. Subdivsion. 00Z Street and Number where work is to be performed—No ras 3 — 7 State work to be performed and purpose of building (By Floon)__k_ New Building.. Remodeling Addition_ Repairs 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. Size of Soakage Pit (signed)_ c PlumbingInspec tor. 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 I' with the provisions thereof, and will require similar compliance from all ntractors or sub-contractors employed by him in the wore to be performed under this permit; and will post or cause to be posted' for inspection on the site of the such public notice or notices as err required by tEe Act The undersigned agrees to employ only such sub-contractors, i work er this permit, as are licensed by Miami Shores Village. gir (Si No /a 37 street...4A e -F9 NCtRge street . o zO 1 / Master Plumber. ..... STATE OF FLORIDA, si. 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 be has carefully read the foregoing application, and that be did slips 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 wiles mob reilsigsnotion is inede.neoessery by improper notice for inspection, or faulty materials and/or workmaaship. CLOSETS BATH Tu•• ....... ..... "'"'''''" LAVA. TORIES SIN SLOP •INKS LAUNDRY Tuns URINALS CATCH BASIN FLOOR DRAIN DRINKING FOUNVITS TOTAL FIXTUKES - Corent. LIST CHICK ...... SEPTIC TANK SEWER CONN. DRAIN FIELD SOAKAGE PIT G TRAP SOLAR NEATEN DIEILP WELL 5 SYSTEM SWIM POOL Comm. L187 CHECK uw r-f/nibeAcy Permit No Amount of Permit • kda- e - 7,5 7 - 06) 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 Registered Architect and/or Engineer MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT /01MI f SE'Pria- licagon ancLegal d /IN i Employ? riwooes limpetzfiv Lot_ il s6i9rte--r-,4444. No.. Subdivsion. 00Z Street and Number where work is to be performed—No ras 3 — 7 State work to be performed and purpose of building (By Floon)__k_ New Building.. Remodeling Addition_ Repairs 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. Size of Soakage Pit (signed)_ c PlumbingInspec tor. 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 I' with the provisions thereof, and will require similar compliance from all ntractors or sub-contractors employed by him in the wore to be performed under this permit; and will post or cause to be posted' for inspection on the site of the such public notice or notices as err required by tEe Act The undersigned agrees to employ only such sub-contractors, i work er this permit, as are licensed by Miami Shores Village. gir (Si No /a 37 street...4A e -F9 NCtRge street . o zO 1 / Master Plumber. ..... STATE OF FLORIDA, si. 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 be has carefully read the foregoing application, and that be did slips 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 wiles mob reilsigsnotion is inede.neoessery by improper notice for inspection, or faulty materials and/or workmaaship. 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. i „� t.._ r r �: Owner's Name and Address ' " No. Street Permit No ' Date Registered Architect and /or Engineer Employing Plumber's Name Location and Legal Description Lot___,z STATE OF FLORIDA, 1 COUNTY OF DADE. ss. MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT Amount of Permit $ ( Signed) No. Street Block Subdivision Street and Number where work is to be performed—No. __._, # �_ : y_�_ _ ______, Street___ _ State work to be performed and purpose of building (By Floors) New Building Remodeling Addition Repairs No. of Stories Size Septic Tank Type of Tank k Capacity Gals.__4:___L _ Feet of Drain Tile � Dist. Feet of Tank or Drain Field from Well Nature of Water Supply: City —Well Size of Soakage Pit 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) 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 fo regoing 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 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 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 CHECK . 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. i „� t.._ r r �: Owner's Name and Address ' " No. Street Permit No ' Date Registered Architect and /or Engineer Employing Plumber's Name Location and Legal Description Lot___,z STATE OF FLORIDA, 1 COUNTY OF DADE. ss. MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT Amount of Permit $ ( Signed) No. Street Block Subdivision Street and Number where work is to be performed—No. __._, # �_ : y_�_ _ ______, Street___ _ State work to be performed and purpose of building (By Floors) New Building Remodeling Addition Repairs No. of Stories Size Septic Tank Type of Tank k Capacity Gals.__4:___L _ Feet of Drain Tile � Dist. Feet of Tank or Drain Field from Well Nature of Water Supply: City —Well Size of Soakage Pit 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) 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 fo regoing 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 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. BUILDING ELECTRICAL PLUMBING Architect Contractor or Builder Legal Description Address of Building Lot [2 Work to be performed under this Permit— Owner of Building r MIAMI SHORES VILLAGE, FLORIDA PERMIT N° 10942 1 Bl. 6' Subdi- vision Value of Project $ This permit is granted to the contractor or builder named above to construct the building or to install the equipment or device described in the application herefor in strict compliance with all ordinances pertaining thereto and with the understanding that the work will be performed in compliance with any plans, drawings, statements or specifications that may have 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 a the statements or specifications and that he assumes responsibility for work done by his agents, servants or employees. Signed • //1 1 7 *` BY °y �i`` SP .CTOR ,•�/ - - DATE ...%r- / V• !! 1951_ Contractor's License No e Amt. of Permit $ In consideration of the issuance to me of this permit I agree t perform the work covered hereunder in compliance with all ordinances art:regulations pertaining thereto and in strict conformity with the plans, drawin tements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I assu i responsibilit or all work done either, myself, my agent, servant or employee. AUTHORITY CONTRACTOR ft BUILDER ��� BY MIAMI SHORES VILLAGE, FLORIDA _SIG P I DATE / .3 195.7L TRICAL I ! PERMIT N? 10891 Contractor's IBING License No Work to be performed under this Permit— 1 :r of ' ..� -actor gilder 1 ription ress of ling tect Lot ic-.-‘7 3 7 _,-)/ y CONTRACTOR OR BUILDER Bl. Subdi- vision Value of F'roject $ I Amt. of Permit $ 4. 1 Thi9, permit is granted to the contractor or builder named above to construct the building or to install the equipment or device described in the application ,r in ttrict compliance with all ordinances pertaining thereto and with the understanding that the work will be performed in compliance with any plans, ngs, statements or specifications that may have been submitted to and approved by the proper municipal authorities. This Permit may be revoked at any , f the VLork is not done in compliance with such ordinances or if the plans are changed without authorization. A further condition upon which this permit is -d iS the understanding that the contractor or builder named above assumes the responsibility for a thorough knowledge of the ordinances and regulations ling to the work covered hereby whether shown on the plans or drawings or in the statements or specifications and that he assumes responsibility for work ,y his agents, servants or employees. ✓ y / r Signed:, BY : K In consideration of the issuance to me of this permit I agre( / perform the wor covered hereunder in compliance with all ordinances and regulations 'ng thereto and in strict conformity with the plans, drawings, atements or specifications submitted to the proper authorities of Miami Shores Village. pting this permit I assume responsibility for all work dote/by either, myself, my agent, servant or employee. AUTHORITY Permit No / '7/ 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 Employing Plumber's Name___. �.Ar4~�"+ No Location and Legal Description Lot 4;1.A Street and Number where work is to be performed —No._! / 3 7 ____ __ • Street State work to be performed and purpose of building (By Floors) New Building v Remodeling Addition Repairs No. of Stories Registered Architect and /or Engineer 7 Size Septic Tank Feet of Drain Tile Nature of Water Suppl STATE OF FLORIDA, COUNTY OF DADE. ss. MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT £.L &ti a No Street (Signed) _ _, - - -1 Block 1 Type of Tank Capacity Gals Dist. Feet of Tank or Drain Field from Well Date _ S7 te" a CC J 2- a _ Subdivision__!�_ _ Size of Soakage Pit 7 J 70' s fU Amount of Permit $/ ( 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 w to be performed under this permit, as are licensed by Miami Shores Village. aster 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 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 $1.00 will be made when such re- inspection is made necessary by improper notice for inspection, or faulty materials and /or workmanship. CLOSETS BATH TUBS SHOWERS LAVA- TORIES SINKS SLOP SINKS LAUNDRY 'TUBS URINALS CATCH BASIN FLOOR DRAIN DRINKING FOUNT' NS W/10M TOTAL FIXTURES CONTR. LIST / ` CHECK �- . yi �. '/$�., 0 09 f I e ��/ r SEPTIC TANK SEWER CONN. DRAIN FIELD SOAKAGE PIT GREASE TRAP SOLAR H EATER DEEP WELL SPRKLR. SYSTEM SW IM'G POOL W,.S, kit/. M CONTR. LIST / / 3 CHECK /� a ?— �0 3 Permit No / '7/ 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 Employing Plumber's Name___. �.Ar4~�"+ No Location and Legal Description Lot 4;1.A Street and Number where work is to be performed —No._! / 3 7 ____ __ • Street State work to be performed and purpose of building (By Floors) New Building v Remodeling Addition Repairs No. of Stories Registered Architect and /or Engineer 7 Size Septic Tank Feet of Drain Tile Nature of Water Suppl STATE OF FLORIDA, COUNTY OF DADE. ss. MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT £.L &ti a No Street (Signed) _ _, - - -1 Block 1 Type of Tank Capacity Gals Dist. Feet of Tank or Drain Field from Well Date _ S7 te" a CC J 2- a _ Subdivision__!�_ _ Size of Soakage Pit 7 J 70' s fU Amount of Permit $/ ( 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 w to be performed under this permit, as are licensed by Miami Shores Village. aster 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 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 workmanship.