PLUMBINGPermit No. ____` T LQ
Owner's Name and Address
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 Divisior
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 wor
7
•
Registered Architect and /or Engineer
Employing P;lglili is Name
Location and Legal Description Lot_-
Street and Number where work is to be performed -No 2"
— G _ - - v L - - p j A treat
State work to be performed and purpose of building (By Floors) _h dw y S -w•.
New Building Remodeling Addition Repairs No. of Stories
rimirk* co
D O
No.. /'2 6 Street N L 7 ' x"
Block
(Signed).
No 3 79 /
Date
Street
Subdivision
Size Septic Tank Type of Tank.___ Capacity Gals.___._____
Feet of Drain Tile. Dist. Feet of Tank or Drain Field from WeIL
Nature of Water Supply: City -Well v i t w d t #"_._ Size of Soakage Pit
(Signed)
Plumbing Inspector.
The undersigned applicant for this building perm' : oes hereby certify that he understands and accepts his obligations as an employer of labor
under the Florida Workmen's Compensation Act, • ng Section 5986, Compiled General Laws of Florida Perinanent 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.
,oz,1114.-.6.(/
My Commission Expires Notary Public, State of Florida
MwwM.
STATE OF FLORIDA,
COUNTY OF DADE. J
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeare
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 fat.
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 faul
materials and /or workmanship.
CLOSETS
BATH
TUBS
SHOWERS
LAVA-
TORIES
SINKS
SLOP
SINKS
LAUNDRY
TUBS
URINALS
CATCH
BASIN
FLOOR
DRAIN
DRINKING
FOUNT' NS
TOTAL
FIXTURE,
CONTR.
UST
_
__
CHECK
TANK
SEWER
CONN.
DRAIN
FIELD
SOAKAGE
PIT
GREASE
TRAP
SOLAR
HEATER
DEEP
WELL
SPRKLR.
SYSTEM
SWIM 'G
POOL
CONTR.
LIST
CHECK
Permit No. ____` T LQ
Owner's Name and Address
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 Divisior
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 wor
7
•
Registered Architect and /or Engineer
Employing P;lglili is Name
Location and Legal Description Lot_-
Street and Number where work is to be performed -No 2"
— G _ - - v L - - p j A treat
State work to be performed and purpose of building (By Floors) _h dw y S -w•.
New Building Remodeling Addition Repairs No. of Stories
rimirk* co
D O
No.. /'2 6 Street N L 7 ' x"
Block
(Signed).
No 3 79 /
Date
Street
Subdivision
Size Septic Tank Type of Tank.___ Capacity Gals.___._____
Feet of Drain Tile. Dist. Feet of Tank or Drain Field from WeIL
Nature of Water Supply: City -Well v i t w d t #"_._ Size of Soakage Pit
(Signed)
Plumbing Inspector.
The undersigned applicant for this building perm' : oes hereby certify that he understands and accepts his obligations as an employer of labor
under the Florida Workmen's Compensation Act, • ng Section 5986, Compiled General Laws of Florida Perinanent 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.
,oz,1114.-.6.(/
My Commission Expires Notary Public, State of Florida
MwwM.
STATE OF FLORIDA,
COUNTY OF DADE. J
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeare
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 fat.
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 faul
materials and /or workmanship.
1111111M
Pew;
d
of Dr
Permit No
05:57
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 b 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. w / 1 /l
Owner's Name and Address u 1 /4/ �Q �; •" le /je •
Registered Architect and /or Epgineer
/ II I rr1 I in aw sC sL
o �,,
ig
and Legal p on Lot �otr Bksllt �J Subdi
State work to be performed and purpose of building (By Flom) __._ e-4 -V_Pn A r 1 et-C)
• .._._
Street and Number where work is to be performed —No
New Building- -_ - - -_ -- .- _....... - -._.. Remodeling__ - -. __ ._— Addition.
Size Septic Tank—.
Feet of Drain Tile 3OO l 1
Nature of Water Supply: City—We1L
Amount of Permit $-2-fiS
9
My Commission Expires
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
(SI
No. ) 24 d
(Signed)__ ‘V.IV;30N,
St 9T s7
Notary Public, State of Floefde
Repairs No. of Stories ...... ..........
-Type of Tank--
—Dist Feet of Tank or Drain Field from Well..._.__. ----._. ...-- .-- •... _---- •--- ...... _._.
Size of Soakage Pit
Plumbing Impector.
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 lave 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 . 9 such public notice or notices as are
required by the Act. The undersigned agrees to employ only such sub-contractors, on work • perf • . under this permit, as are
licensed by Miami Shores Village.
1/
Master Plumber.
STATE OF FLORIDA, I w
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 be is the • -_ - - -...- - - of the 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.
NOTE: A re- inspection fee of $1.00 will be shade when such misspeotlan is asede.neoassery by improper notice far bsepection, or faulty
materials and /or workmanship.
CLosrrs
BATH
TUs•
SHOWIER/
LAVA-
TORNIO
"KS
SLOP
LAUNOR
URINALS
CATCH
/LOON
DRINK! NO
TOTAL
CONTR.
LIST
CHICK
SEPTIC
TANK
SEWER
CONN.
DRAIN
FIELD
SOAKAOt
PIT
G
TRAP
SOLAR
MEATIER
MCP
WILL
IPRKLR.
a N
SW IM'0
POOL
CONTR.
tier
CHECK
Permit No
05:57
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 b 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. w / 1 /l
Owner's Name and Address u 1 /4/ �Q �; •" le /je •
Registered Architect and /or Epgineer
/ II I rr1 I in aw sC sL
o �,,
ig
and Legal p on Lot �otr Bksllt �J Subdi
State work to be performed and purpose of building (By Flom) __._ e-4 -V_Pn A r 1 et-C)
• .._._
Street and Number where work is to be performed —No
New Building- -_ - - -_ -- .- _....... - -._.. Remodeling__ - -. __ ._— Addition.
Size Septic Tank—.
Feet of Drain Tile 3OO l 1
Nature of Water Supply: City—We1L
Amount of Permit $-2-fiS
9
My Commission Expires
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
(SI
No. ) 24 d
(Signed)__ ‘V.IV;30N,
St 9T s7
Notary Public, State of Floefde
Repairs No. of Stories ...... ..........
-Type of Tank--
—Dist Feet of Tank or Drain Field from Well..._.__. ----._. ...-- .-- •... _---- •--- ...... _._.
Size of Soakage Pit
Plumbing Impector.
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 lave 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 . 9 such public notice or notices as are
required by the Act. The undersigned agrees to employ only such sub-contractors, on work • perf • . under this permit, as are
licensed by Miami Shores Village.
1/
Master Plumber.
STATE OF FLORIDA, I w
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 be is the • -_ - - -...- - - of the 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.
NOTE: A re- inspection fee of $1.00 will be shade when such misspeotlan is asede.neoassery by improper notice far bsepection, or faulty
materials and /or workmanship.
Applicant
/CP %19
PART II - SYSTEM INSTAL
Installer !�
Proper tank legend: Yes No
Tanks watertight: Yes No Tank size
Proper tank outlet device: Yes At. No
Drainfield Trench
Other findings: Add
Inspected
Date 4pproved by:
STATE OF FLORIDA
DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES
ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION AND INSTALLATION PERMIT
Pe unit Number S6J
T .' INSPECTION AND FINAL INSTALLATION APPROVAL
Tank Manufacturer /� /if
H Form 4016, Feb 85 (Obsoletes previous editions which may not be used)
Number. 5744-002-4016-0)
Tank materialC, Tank level: Yes
Manhole or marker to grade: Yes
PART III - FINAL I STALLATION APPROVAL
Absorption Bed
AN APPROVED INSTALLATION DOES NOT GUARANTEE PERFORMANCE
0
gallons gallons gallons
No
Length width Length width Lengths ,-2. feetx 1 feet = /2 ft
feet feet feet feet Length feet x feet= = ft
feet feet feet feet Proper No. drainlines: Yes No
feet feet feet feet Proper pipe separation: Yes No
Total = ft Total = ft Distribution box level: Yes No
Systems located as permitted: Yes IV No
Systems including plumbing stub-outs installed at proper elevation: Yes No �/
Average depth to drainpipe invert from finished grade/ 7 inches Maximum depth:c . � L Inches
Average depth of drainfield gravel ) 3 inches Minimum depth of gravel L inches
Proper gravel size: Yes 1 No Gravel is suitable quality: Yes '' No
Backfill or fill material as required: (Quality) Yes No (Quantity) Yes `, No
Date ‘ a
COt3F1TY PUBLIC HEALTH U
)te: Completed copies of this form will be provided to the applicant, installer and the building department.
Page 2 of 2
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
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 • i l ay)
G - No _ 6 0 ,,,,..77E9F5
Registered Architect and /or «eeee . -
J oc ROn� Le g . -�•, Lot r
Street and Number where work is to be performed —No
State work to be performed and purpose of buckling (By FIo s)__._._.
New Building- - - - - -- _ -- .-- ........._._ Remodeling___. - -- Addition.- - -- _ . - -- ..... Repairs
._
Size Septic Tank— Type of Tank
Feet of Drain Tile Dist- Feet of Tank or Drain Field from Well ..._.__..__
Nature of Water Supply: City —Wells Size of Soakage Pit.
Amount of Permit $ / a6-- (Signed)_S-.1.
No. of Stories
y1i ... Na,.� . .. Itrse._.
Bloom v ubdlvWou &/ - //�t' .�s�/f
Yee �� ___2 PP► ! ......!.t'!-
vP,
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 5988, Compiled Ceneral Laws of Florida Pennanent Supplement, and liav com-
plied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors employed by him in the work to he
performed under this permit; and will post or cause to be posted for inspection on the site of the public notice or notices as arT•
required by the Act. The undersigned agrees to employ only such sub- contractors, on work to ormed Dieu this permit, as are
licensed by Miami Shores Village.
(
Si
STATE OF FLORIDA, 3
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
•
Muter Plumber.
NOTE: A re- inspection fee of $1.00 will be mad. when .snob r laspaotioa Is made - aaoaasary by Improper notice for inspection, or faulty
materials and/or workmanship.
CLOSETS
BATH
TuaS
aHOWERn
LAVA.
Tom'.
LIN KS
INKS
BLOT
LAUNDRY
Tuns
URINALS
CATCH
BAS
FLOOR
DRAIN
DRINKI NO
FOUNT' NO
TOTAL
•IKTURES
Comm.
LIST
CHECK
SEPTIC
TANK
SEWER
CONN.
DRAIN
PHILO
SOAKAGE
PIT
G
TRAP
SOLAR
HEATER
DEEF
WELL
SPRKLR.
•
SW IM'O
POOL
CONY*.
LIST
CHICK
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
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 • i l ay)
G - No _ 6 0 ,,,,..77E9F5
Registered Architect and /or «eeee . -
J oc ROn� Le g . -�•, Lot r
Street and Number where work is to be performed —No
State work to be performed and purpose of buckling (By FIo s)__._._.
New Building- - - - - -- _ -- .-- ........._._ Remodeling___. - -- Addition.- - -- _ . - -- ..... Repairs
._
Size Septic Tank— Type of Tank
Feet of Drain Tile Dist- Feet of Tank or Drain Field from Well ..._.__..__
Nature of Water Supply: City —Wells Size of Soakage Pit.
Amount of Permit $ / a6-- (Signed)_S-.1.
No. of Stories
y1i ... Na,.� . .. Itrse._.
Bloom v ubdlvWou &/ - //�t' .�s�/f
Yee �� ___2 PP► ! ......!.t'!-
vP,
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 5988, Compiled Ceneral Laws of Florida Pennanent Supplement, and liav com-
plied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors employed by him in the work to he
performed under this permit; and will post or cause to be posted for inspection on the site of the public notice or notices as arT•
required by the Act. The undersigned agrees to employ only such sub- contractors, on work to ormed Dieu this permit, as are
licensed by Miami Shores Village.
(
Si
STATE OF FLORIDA, 3
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
•
Muter Plumber.
NOTE: A re- inspection fee of $1.00 will be mad. when .snob r laspaotioa Is made - aaoaasary by Improper notice for inspection, or faulty
materials and/or workmanship.