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1270 NE 98 StSTATE OF FLORIDA DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES ONSITE SEWA of G i DISPOSAL SYSTEM CONSTRUCTION AND INSTALLATION PERMIT [ ' n Q J /7.2i Applicant t P rmit d PART II - SYSTEM INSTALLATION INSPECTION AND FINAL INSTALLATION APPROVAL Number i v‘k g.er. T■ Installer 0. 6- ).lord - Proper tank legend: Yes No Tank material Tank level: Yes No Tankswatertight: Yes No Drainfield Trench Systems located as permitted: Yes No Inspected by P y �r� STA LATION APPROVAL Date -4 ` Px Approved by: AN APPROVE HRS —H Form 4016, Feb 85 (Obsoletes previous editions which may not be used) (Stock Number. 5744 -002- 4016 -0) Tank Manufacturer Tank size' gallons gallons gallons Proper tank outlet device: Yes No Manhole or marker to grade: Yes No Absorption Bed Length Width Length Width Lengti -0 feet x/& •O feet =35 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 ' Total = ft Total = ft Distribution box level: Yes No Systems including plumbing stub -outs installed at proper elevation: Yes ✓ No Average depth to drainpipe invert from finished grade:026a inches Maximum depth -_y Inches Average depth of drainfield , gravel: /6 -a inches Minimum depth of gravel• f Z•� inches Proper gravel size: Yes N o Gravel is suitable quality: Yes 17 No Backfill or fill material as required: (Quality) Yes No (Quantity) Yes ✓ No Other findings INSTALLATION DOES NOT GUARANTEE PERFORMANCE Date 2 COUNTY PUBLIC HEALTH UNIT Note: Completed copies of is form will be provided to the applicant, installer and the building department. Page 2 of 2 Permit No Amount of Permit $ MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT Street and Number where work is to be performed—No _I 270 NE 9 Street. State work to be performed and purpose of building (By Floon)__ _ New Building. _ Remodeling____. _____ Addition. _ Size Septic Tank-- _Type of Tank__ Feet of Drain Tile 300 sq • f Feet o f Tank or D rain ma w f rom wan Nature of Water Supply: City—We1L Size of Soakage Pit. (Ssed) My Commission Expires Notary Public, State of Florida K July 30, 1985 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. No] 770 NE 98_ Straiii.arni_Share.s . . Owners Name and Address S anti n Registered Architect and/or Engineer Endeyins Plumbic's Name OG. Lloyd Septic Taqk S m licailen g ption Lot. /. 7 Blo4 Repairs No. of Stories • .. . . ... _ Plumbing lnvector. The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations as an employer of labor under the Florida Workmen's Compensation Act, being Section 5988, Compiled General Laws of Florida Permanent Supplement, and limx com- plied with the provisions thereof, and will require similar compllance from all contractors ors b-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 • e work such public notice or notices as err required by tlie Act. The undersigned agrees to employ only such sub-contractors, on work to be perfojd under this permit, as are licensed by Miami Shores Village. aster Plumber. STATE OF FLORIDA, } as. 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 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 made when mob swisspeodos is mede.neossinry by improper notice for inspection, or faulty materials and/or workmanship. C4e411.11 BATH Tullis SHOWER• LAVA. T onic s SINK• SLOP SINKS LAUNOPY Tuns URINALS CATCH sAsIN FLOOR DRAIN DRINK I NO FOUNT NO TOTAL FIXTURES Gomrn. LIST CHICK SEPTIC TANK SEWER CONN. DRAIN Mu) SOAKAGE PIT G TRAP SOLAR HEATER OW WELL SPRKLR. SYSTEM SW IM' 0 POOL Comm. LIST CHECK Permit No Amount of Permit $ MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT Street and Number where work is to be performed—No _I 270 NE 9 Street. State work to be performed and purpose of building (By Floon)__ _ New Building. _ Remodeling____. _____ Addition. _ Size Septic Tank-- _Type of Tank__ Feet of Drain Tile 300 sq • f Feet o f Tank or D rain ma w f rom wan Nature of Water Supply: City—We1L Size of Soakage Pit. (Ssed) My Commission Expires Notary Public, State of Florida K July 30, 1985 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. No] 770 NE 98_ Straiii.arni_Share.s . . Owners Name and Address S anti n Registered Architect and/or Engineer Endeyins Plumbic's Name OG. Lloyd Septic Taqk S m licailen g ption Lot. /. 7 Blo4 Repairs No. of Stories • .. . . ... _ Plumbing lnvector. The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations as an employer of labor under the Florida Workmen's Compensation Act, being Section 5988, Compiled General Laws of Florida Permanent Supplement, and limx com- plied with the provisions thereof, and will require similar compllance from all contractors ors b-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 • e work such public notice or notices as err required by tlie Act. The undersigned agrees to employ only such sub-contractors, on work to be perfojd under this permit, as are licensed by Miami Shores Village. aster Plumber. STATE OF FLORIDA, } as. 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 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 made when mob swisspeodos is mede.neossinry by improper notice for inspection, or faulty materials and/or workmanship. MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT Permit No 2 3 r` D.,......kwygm2., _1282_ — 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. Owners Name and Address San.ti no Casi a No.] NE 98 Street)4 Registered Architect and/or Engineer Employing Plu,mbees Name° ,GA U4 S e ptic acr.. Location and Legal Description Lot. Mork Street and Number where work is to be performed—No. 1 270 .NE 98 street. FL_ Shores 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__ Feet of Dram Tile 200 sq . f Feat of Tank cc Drain Field from Well n Nature of Water Supply: City—Well. Sim of Soakage Pit_ Amount of Permit $ 0 (Signed) Capacity (Signed) Cl c" ..... Plumbing Invector. 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 Worlanen's Compensation Act, being Section 5986, Compiled General Laws of Florida Permanent Supplement, and hi v com- plied with the provisions thereof, and will require similar compliance from all contractors or sub-contractors employed by him in the work to !,e performed under this permit; and will post or MUSS to be posted' for inspection on the site of the work such public 9otice or notices as are required by the Act. The undersigned agrees to employ only such sub-contractors, on jork to be performed under this permit, as are licensed by Miami Shores Village. My Commission Expires Notary Public, State of Florida Master Plumber. STATE OF FLORIDA, } sr. 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 mit miugmotioss b mode isemesery by improper notice for btapection, or faulty materials aad/or warlosmaship. CLOSETS OATH T Smowses LAVA. Tennis SINKS SLOP SINKS LAUNDRY Tuns URINALS CATCH BASIN FLOOR DRAIN DRINKI NO FOUNT• NIB TOTAL •IKTUR ES CONTR. LUST CHICK ....... .... SEPTIC TANK SEWER CONN. DRAIN FIELD SOAKAGE PIT G TRAP SOLAR HEATER DILKP WELL SPRKLR. SYSTEM SW 114'0 POOL CONT. LIST CHECK ..... MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT Permit No 2 3 r` D.,......kwygm2., _1282_ — 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. Owners Name and Address San.ti no Casi a No.] NE 98 Street)4 Registered Architect and/or Engineer Employing Plu,mbees Name° ,GA U4 S e ptic acr.. Location and Legal Description Lot. Mork Street and Number where work is to be performed—No. 1 270 .NE 98 street. FL_ Shores 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__ Feet of Dram Tile 200 sq . f Feat of Tank cc Drain Field from Well n Nature of Water Supply: City—Well. Sim of Soakage Pit_ Amount of Permit $ 0 (Signed) Capacity (Signed) Cl c" ..... Plumbing Invector. 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 Worlanen's Compensation Act, being Section 5986, Compiled General Laws of Florida Permanent Supplement, and hi v com- plied with the provisions thereof, and will require similar compliance from all contractors or sub-contractors employed by him in the work to !,e performed under this permit; and will post or MUSS to be posted' for inspection on the site of the work such public 9otice or notices as are required by the Act. The undersigned agrees to employ only such sub-contractors, on jork to be performed under this permit, as are licensed by Miami Shores Village. My Commission Expires Notary Public, State of Florida Master Plumber. STATE OF FLORIDA, } sr. 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 $1.00 will be made when mit miugmotioss b mode isemesery by improper notice for btapection, or faulty materials aad/or warlosmaship. l/ v ° 3 4. E /�- 8 L3 0 bd / e tetaed myself,. b A BUILDING ❑ ELECTRICAL 0 PLUMMI$ING ROOFING 0 0 Owner of k. Building Architect Contractor or Builder Legal Lot Description Address of Building t77o CONTRACTOR OR This permit is granted to the contractor or bulkier no herefor in strict compliance with all ordinances pert a. drawings, statements or specifications that may have time if the work is not done in compliance with granted is the understanding that the contractor pertaining to the work covered hereby whether s done by his agents, servants or employees. In consideration of the issuance to me of pertaining thereto and in strict conformity with th In accepting this permit I assume responsibility f Pernut No Date___ -- . -- 1 ,,2/_... -- f 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 wok 7 Z h( crL- / /) No. _1_Y /// Street_ Street____ &P Owner's Name and Address Registered Architect and /or Engineer __________ —___ Employing Plumber's Name1Z L_'Y AA..__ 5' "f 7/, i /' No. Street__ Location and Legal Description Lot___ _____.__ —_____ ____ _ Block Subdivision. _ Street and Number where work is to be performed —No.*/ "V �______ Street_ __,Z/ . T S State work to be performed and purpose of building (By Floors)._ New Building _.__ _._ Remodeling_ ___ _______ Addition_______ _ Repairs No. of Stories Size Septic Tank Feet of Drain Tile__ Nature of Water Supply: City —Well Amount of Permit $ My Commission Expires MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING r`i».MIT j -57 Capacity Gals Type of Tank___ ' ' ` r ' c' Feet of Tank or Drain Field from Well __Size of Soakage Pit ( Signed) Plumbing Inspector. The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations as an employer of labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Permanent Supplement, and has com- plied with the provisions thereof, and will require similar compliance from all contractors or sub- contractors employed by him in the work to be performed under this permit; and will post or cause to be posted' for inspection on the site of the work such public notice or notices as are required by the Act. The undersigned agrees to employ only such sub- contractors, on work to be performed under this permit, as are licensed by Miami Shores Village. ( Signed) - - , . - -t . - Master Plumber. STATE OF FLORIDA, 1 COUNTY OF DADE. Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeared to me well known, and who, being by me first duly sworn, upon oath deposes and says that he is the of the above described construction, that he has carefully read the foregoing application, and that he did sign the same, and that all facts therein by him stated are true. Notary Public, State of Florida NOTE: A re- inspection fee of $1.00 will be made when such re- inspection is made necessary by improper notice for inspection, or faulty materials and /or workmanship. CLOSETS Toss BATH Toss LAVA- TORIES SINKS SLOP SINKS LAUNDRY Tues U RINALS 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 Pernut No Date___ -- . -- 1 ,,2/_... -- f 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 wok 7 Z h( crL- / /) No. _1_Y /// Street_ Street____ &P Owner's Name and Address Registered Architect and /or Engineer __________ —___ Employing Plumber's Name1Z L_'Y AA..__ 5' "f 7/, i /' No. Street__ Location and Legal Description Lot___ _____.__ —_____ ____ _ Block Subdivision. _ Street and Number where work is to be performed —No.*/ "V �______ Street_ __,Z/ . T S State work to be performed and purpose of building (By Floors)._ New Building _.__ _._ Remodeling_ ___ _______ Addition_______ _ Repairs No. of Stories Size Septic Tank Feet of Drain Tile__ Nature of Water Supply: City —Well Amount of Permit $ My Commission Expires MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING r`i».MIT j -57 Capacity Gals Type of Tank___ ' ' ` r ' c' Feet of Tank or Drain Field from Well __Size of Soakage Pit ( Signed) Plumbing Inspector. The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations as an employer of labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Permanent Supplement, and has com- plied with the provisions thereof, and will require similar compliance from all contractors or sub- contractors employed by him in the work to be performed under this permit; and will post or cause to be posted' for inspection on the site of the work such public notice or notices as are required by the Act. The undersigned agrees to employ only such sub- contractors, on work to be performed under this permit, as are licensed by Miami Shores Village. ( Signed) - - , . - -t . - Master Plumber. STATE OF FLORIDA, 1 COUNTY OF DADE. Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeared to me well known, and who, being by me first duly sworn, upon oath deposes and says that he is the of the above described construction, that he has carefully read the foregoing application, and that he did sign the same, and that all facts therein by him stated are true. Notary Public, State of Florida NOTE: A re- inspection fee of $1.00 will be made when such re- inspection is made necessary by improper notice for inspection, or faulty materials and /or workmanship.