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PLUMBING (2)Date Time Type Insp'n` Permit No. 1, - Name VO ? •K L S 7 Address L `� l / 9 Company Phone # For Inspector Approved Correction Re- Insp'n Fee MIAMI SHORES VILLAGE BUILDING DEPARTMENT 305- 795 -2204 Building Inspection Request ate • c ONTRACTOR New Construction Name F.0:913 / 4C`// g ,�rn � €�' License No. J Oo g 7 2 9 L p2. x / 7 9 Alteration Exterior Address 1 L O tJ.- m (4., eift nri /A,/ ,/ 33- / 47 Repair Telephon Zap - �� q_ (79 ax 61/.... 6 / r/ - 7S Qualifier Name , e /o /? , �, Demolish PROPERTY OWNER New Construction 1j I tee /7A /Z N 64 -ER�T€ oI � €�' Address -7 7 44 r • 9Y- Alteration Exterior Home Telephone 30./.-: Repair Business Telephone Alteration Interior Fax Demolish TYPE OF MANAGEMENT (✓ ) New Construction Enclosure Alteration Exterior Repair Alteration Interior Demolish Relocation of Structure Shell Only Foundation Only Add'l Attachment Other Add'I Detachment Other INSTRUCTIONS - The following steps must be taken to obtain a permit from the Miami Shores Village: Step I. Complete the attached permit application which must be signed by the property owner and qualifier. Both signatures must be notarized. Please print or type to allow for a more accurate processing of your application. If roofing work will be done, a roofing application must be submit- ted along with this permit application. Step 2. Submit the completed application with all necessary documents to the Building, Planning and Zoning Department for processing. During the processing of your application, you may be asked to submit additional information. A I'PLICATION • Job Address: 307 M C Address ggS Foil Number �Description of Work , S I R i 4'i Mew_ oz/& Lot Block Subdivision PB PG Zoning Linear Feet Current Use of Property quare Feet Units Floors Proposed Use of Property Value of Work L., V 2 o Bldg Value Tenant Information PERMIT TYPE (✓ ) Building Electrical Mechanical Plumbing LPGX Roofing Fence Other PERMIT CHANGE (✓ ) Chg. Contractor Renewal Revision Extension Supplement Reinspection PERMIT APPLICATION Master Permit No. Subsidiary Permit No. -l ' m (98E5 �I City State Zip Tax Assessed/Appraised Value Flood Zone Base Floor Elev. ENGINEER Name License No. Address Telephone Fax l Page 2 PERMIT APPLICATION INIPORTANT NOTICES DO NOT BEGIN ANY WORK WITHOUT HAVING RECEIVED YOUR VALIDATED PERMIT AND PERMIT CARD. Applying for a permit does not grant the right to begin construction. HOURS OF CONSTRUCTION are limited to: Monday through Friday from 7:30 a.m. to 6:00 p.m., and Saturday from 8:00 a.m. to 5:00 p.m. No inspections will be conducted on weekends or holidays. 2. All construction of demolition areas MUST BE MAINTAINED IN A CLEAN, NEAT AND SANITARY CONDITION free from construction debris. 3. STREETS AND NEIGHBORING PROPERTIES SHALL BE KEPT FREE FROM DIRT AND DEBRIS. 4. SWALES MUST BE PROTECTED FROM BEING DAMAGED BY EQUIPMENT OR VEHICLES, AND MAY NOT BE USED FOR STORAGE. A bond is required for work in or near the street/sidewalk. 5. CONSTRUCTION TRAILERS ARE PROHIBITED ON SINGLE FAMILY RESIDENTIAL CONSTRUCTION SITES. Other construction may have a trailer which requires a separate permit. 6. PORTABLE TOILETS for a construction site require a separate permit. 7. DO NOT DISCHARGE WATER INTO THE RIGHT OF WAY OR STORM DRAINS without approval from the Building, Planning and Zoning Department. 8. EQUIPMENT AND MATERIALS SHALL BE STORED at least 10 feet from the edge of pavement. 9. Department of Health and Rehabilitative Services (HRS) approval is required for applications involving septic tanks. Department of Environmental Resources Management (DERM) and/or Miami -Dade Water and Sewer Department (MDWASD) approval is required for applications involving sewers. AFFIDAVIT - Please read carefully. Application is hereby made to obtain a permit to do work and installation as indicated. I, the OWNER of the property, certify that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that separate permits are required for ELECTRICAL, PLUMBING, POOL, EXTERIOR DOOR, MECHANICAL, WINDOW, FENCE, DRIVEWAY, ROOFING and SIGNS and there may be additional permits required from other governmental agencies. I, the OWNER of the property, have disclosed all information related to any work at the property performed in the prior twelve months to the Building Official. Further, I am fully aware that if the cumulative cost of work to my home or business under this and any other permit equals or exceeds fifty percent (50 %) of the fair market value of the structure, the entire structure must meet the present federal flood criteria for finished floor elevation. I am also fully aware that if the total cost of work to my home or business under this and any other permit exceeds fifty percent (50 %) of the replacement cost of the structure, then the entire structure must conform to the current code requirements of the Building Code. WARNING TO OWNER: Your failure to record a NOTICE OF COMMENCEMENT may result in you paying twice for improvements to your property. If you are spending more than $2,500 or intend to obtain financing, you may wish to consult with your attorney or lender before recording your Notice of Commencement. The Notice of Commencement must be recorded at: 22 N.W. 1st Street, 1" Floor, (305) 679 -1078. Once recorded, the Notice of Commencement must be POSTED AT THE JOB SITE in accordance with Section 713 -35 of Florida Statutes. Review the brochure at Village Hall on Construction Lien Law and Choosing a Contractor. STATE OF FLORIDA, CO NTY OF 7AMI -DA \ ADE OF ri • RIDA, CO TY OF MIAMI -DADE Signature of 0 fore me ... DAGOBE MY O F GUARDIA SION # DD 091884 PIRES June 11, 2006 Bonded Thru Notary Public Underwriters 1 Print Na(ne Sworn ubscri Signature of N SEAL: 1O da 00c esEQ, Personally known OR, Produced Identification Signature of SEAL: "gnature of Contractor / Qualifier -R/0 Print Name A 1 /� fore me ..'s f 0 da of io 4 Fi:IGUARDIA 3' ON # DD 091884 :June 11, 2006 otary Public Underwriters Sw m to and subscri Personally known OR, Produced Identification Type of Identification Produced: Type of Identification Produced: ELECTRICAL TYPI. Minimum Fee QTY. TYPE. Dryer QTV. TYPE Outlet, Appliance QTY. 'rYPr: Service Repair QTY. A/C Central 1 -3 Ton Fan Dryer Vents, Number of Outlet, Wall Ventilation, Cost Service, Temporary Air Handler, Tons A/C Central 4 -7 Ton Piping, Flammable Liquid Fire Pump Outlet, Switch Fire Sprinkler System Signs A/C Central 8 -15 Ton Bath Fan - Vented, # Fixture - Fluorescent Pressure Vessel Oven Space Heater (kw) A/C Central 16-20 Ton Fixture Light Parking Lot Lights Spas/Hot Tubs A/C Central 20+ Ton Flood Lights Plugmold/Strip Subfeeds, No. of Amps A/C Window FPL - Load Central Posts Swim Pool, Commercial Air Conditioners Garbage Disposal Range/Range Top Swim Pool, Residential Chiller Generators, etc. Receptacles i Switchboards Clear Violations Heat Recovery Refrigerator, Comm. (p/PH) Temp Serv., Construction Compactor Low -volt, Burglar Refrigerator, Domestic Temp for Test - 30 days Deep Freezer Low -volt, Fire Renew - Temp Service Water Closet Demolition Low -volt, Intercom/Teleph. Repair Circuits Water Heater Dishwasher Low -volt, Television Service, Number of Amps Water Heater New 1\1ECHAN1CAL ,, p,. Minimum Fee QTY. TYPE Condensate Drain QTY TYPE Generator QTY. TYPE Refrigeration, Tons Q . Q . V . A/C Central, Tons Cooling Tower Heating Strips, each Vent Hood, Cost A/C Wall/Win. Tons Dryer Vents, Number of - Paint Booth Ventilation, Cost Solar Water Heater Air Handler, Tons Ductwork, Cost of Piping, Flammable Liquid Periodic Inspections Barbecue Fire Sprinkler System Process/Pressure Piping Cap - Fixture Bath Fan - Vented, # Fireplaces, Number of Pressure Vessel Pump and Abandon PLUMBING TYPE. A/C Condensate QTY. TYPI: Drains, Roof QTY. 'TYPE': Miscellaneous Fixture QTY. TYPE Soakage Pit Q'r Y. Bath Tub Drinking Fountain Miscellaneous Repairs Solar Water Heater Bidet Filter Replace Pool Piping Sprinkler Repair Cap - Fixture Fountain Pump and Abandon Sprinkler System Cap - Water Gas - Appliance Pump, Domestic Supply, AC Well Cap - Sewer Gas - Natural Pump, Fire Stand Temporary Toilet Catch Basin Gas - Propane Pump, Re- circulate Temporary Water Closet Clothes Washer Gas Piping Pump, Replace - Pool Urinal Dental Chair Grease Trap Pump, Sprinkler i Utility - Sewer Discharge Well Ice Maker Pump, Sump Utility - Water Dishwasher Indirect Wastes Relay Repair Vacuum Pump Disposal Interceptor Roof Inlet Water Closet Domestic Well Laundry Tray Septic Connection Water Heater Drainfield, 4" Tile/Res. Lavatory Septic Tank Water Heater New Drains, Area Meter Set (Gas) Sewer Connection Water Re -pipe Drains, Floor Minimum Fee Shower Water Service Drains, French Miscellaneous Equipment Sink Well, Supply SPAT /et8 / Page 3 PERMIT APPLICATION INSTRUCTIONS: Please indicate the type of work being performed and quantity(ies) in the space provided below. RECEIVED AND REVIEWED BY: DATE: Page 4 OFFICE USE ONLY CHECKLIST ❑ OWNER - BUILDER FORM (Attach) ❑ FIRE DEPARTMENT APPROVAL (Commercial / multi - family) ❑ CONCURRENCY (New Construction) ❑ OTHER (Specify & Attach) ❑ PROOF OF OWNERSHIP (Attach) ❑ HRS / DERM APPROVAL (Septic / Sewer) ❑ IMPACT FEE (New Construction) ❑ OTHER (Specify & Attach) $3.00 per page (Scanning Fee) $ Miami Shores Village Bond Metropolitan Dade County (C.C.F.) Inspector State Educational Fund $ State DCA (Radon) $ Code Enforcement Fine $ Zoning Review Notary SECTION Zoning Electrical Mechanical Plumbing Fire Public Works Structural Building Official BY DATE ( x .6U x/1000 ) (¢.005 /sq.ft.) (¢.01 /sq.ft.) PERMIT APPLICATION ❑ CONDO ASSOCIATION APPROVAL (Attach) ❑ BPR APPROVAL (Restaurants) ❑ CONTRACTOR REGISTRATION (On File) PERMIT FEES TOTAL $ ISSUING OFFICIAL REVIEWED AND PREPARED BY: DATE: CONDITION OF APPROVAL Revised July 2001 10050 N.E. 2ND AVE., MIAMI SHORES, FL • (305) 795 -2207 • FAX (305) 756 -8972 • http : / /www.miamishoresvillage.com Miami Shores Village 10050 NE 2nd Avenue n Phone: 305-795-2204 Printed: 10 /22/2002 Applicant: MARGUERITE Owner: VOORHEES fl JOB ADDRESS: 307 NE F``\ ontractor ALEMAN PABLO Local Phone: 308 - 681 - 5788 Parcel # 1132060135480 and approved by the pro authorization. A further c ordinances and regulation by his agents, servants or Signed In consider with the plans, d myself. my agent. y -✓ Permit Status: Approved r ermit Expiration: Work: SPRINKLER WELL t If there is no permit fee is $50.00, which must 1 This Permit is granted to the con ordinances pertaining thereto and v r munici; dition u pertaini ploye. nce t s. men! ants or empi 3 Tel. PAY TO THE ORDER OF PABLO ALEMAN WELL DRILLING 1405 N.W. 121st St. 681 -5788 Miami, FL 33167 Plumbing Permit Permit Number: PL2002 -281 VOORHEES MARGUERITE 99 ST Legal Description: MIAMI SHORES SEC 1 AMD PB 10 -70 LOT 13 & 14 4/20/2003 Contractor's Address: 1405 NW 121 ST c c ,h-e) Construction Value: $400.00 7 / i /5 9 g C5 First Union National Bank N firstunion.com Qrg. 003 R/7 067006432 Page 1 of 1 FOR IEPAr /C 4mta 136lhh 11 i :06 70064 3 242 L66SO3407 L9411' Total Fees: WOO Total Receipts: $0.00 BLK 40 LOT SIZE 100.000 o v PABLO ALEMAN WELL DRILLING 63- 643/670 BRANCH 13093 © DATE DOLLARS 5963 a 64 U.I.it. sn OEM PERMIT APPLICATION FOR MIAMI SHORES VILLAGE Date (o -5 — YOU Job Address 30 7 NE 6 1 q SrreeTTax Folio /1 3 ao G 0/ 3 3— X 8 Legal Description 0+/ / O Historically Designated: Yes No Owner/Lessee / Tenant Ma r9 v e r il . ()o o►rh ee S Master Permit # �ji gd t 6 Owner's Address i l Phone 3 U2 - 7 57-- 3 & Contracting Co. !3 b` S S c Pt i c -i-- J ') Il.) Address 103-0 1V £ 130 5 Qualifier n b re + T:, ?ict-iti i SS# Phone(3 s s - s"P State # S 4-0 9 ? I I l ( Municipal # v kl T I / C Competency # Ins. Co. Architect/Engineer Address Bonding Company Address Mortgagor Address �1 Signature of owner Notary as to Own My Co APPROVED: Zoning Mechanical Condo President or Condo President Date TAR TEL z � �V T j 9 s 77 OO'.`. 2SfON EXPIRES Op ��P -� 7 ?002 Permit Type (circle one): BUILDING ELECTRIC A1 PLUMBING ECHANICAL ROOFING PAVING FENCE SIGN WORK DESCRIPTION 'OO TVA; v- F c) i 274 ly O✓J L ^� T0ft ij Square Ft. Ob Estimated Cost (value) r . c2SOD. WARNING TO OWNER: YOU MUST RECORD A NOTICE OF COMMENCEMENT AND YOUR FAILURE TO DO SO MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY (IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT.) Application is hereby made to obtain a permit to do work and installation as indicated above, and on the attached addendum (if applicable). I certify that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that separate permits are required for ELECTRICAL PLUMBING, SIGNS, POOLS, ROOFING and MECHANICAL WORK. OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. Furthermore, I authorize the above -named contractor to do Signaturd of"Contrac Owner - Builder k te Notary as to Contractor or Owner - Builder Date My Commission Expires: ijO 1 FEES: PERMIT 4 - 5 79 RADON C.C.F. • NOTARY BOND 2.00 TOTAL DUE Electrical Structural Engineer STATE OF FLORIDA DEPARTMENT OF HEALTH ONSITE SEWAGE DISPOSAL SYSTEM SITE EVALUATION AND SYSTEM SPECIFICATIONS rl X-iig ; lk 4, AGENT: fed) gc/9 LOT: 8y ./g /4. BLOCK: 40 SUBDIVISION: A 3 ^6 PROPERTY ID #: //- 3ac . � � 5 [Section /Township /Range /Parcel No. or Tax ID Number] 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. PROPERTY SIZE CONFORMS TO SITE PLAN: [d) YES ( ] NO NET USABLE AREA AVAILABLE: 4 X, ACRES 00 GALLONS PER DAY [RESIDENCES -TABLE 1 / OTHER -TABLE 2) GALLONS PER DAY [1500 GPD /ACRE OR , 150a G D A ) SQFT UNOBSTRUCTED AREA REQUIRED: 4,00 SQFT 1 U TOTAL ESTIMATED SEWAGE FLOW: AUTHORIZED SEWAGE FLOW: UNOBSTRUCTED AREA AVAILABLE: er50 BENCHMARK /REFERENCE POINT LOCATION: ELEVATION OF PROPOSED SYSTEM SITE IS THE MINIMUM SETBACK WHICH CAN BE MAINTAINED FROM THE P OPOSED SYSTEM TO THE FOLLOWING FEATURE$'( SURFACE WATER: FT DITCHES /SWALES: AJ/04 FT NORMALLY WET? [ ] YES [ ] NO WELLS: PUBLIC: r FT LIMITED USE: A FT PRIVATE: 4011 FT NON- POTABLE: 4 FT BUILDING FOUNDATIONS: 5 FT PROP Y LINES: FT / POTABLE WATER LINES: /0 FT SITE SUBJECT TO FREQUENT FLOODING: [ ] YES [ 10 YEAR FLOODING? [ ] YES [11 10 YEAR FLOOD ELEVATION FOR SITE: FT MSL /NGVD SITE ELEVATION: q, / FT MSL /NGVD SITE EVALUATED BY: SOIL PROFILE INFORMATION SITE 1 SOIL PROFILE INFORMATION SITE 2 Munsell T olor Texture Depth 5 q,,A 0" to to to pya ill spw4 W to t,1 H � t to to to 14" USDA SOIL SERIEST OBSERVED WATER TABLE: LC) INCHES [ABOVE ESTIMATED WET SEASON WATER TABLE ELEVATION: HIGH WATER TABLE VEGETATION: [ ] YES (4 NO DH 4015, 10/96 (Replaces HRS -H Form 4015 [Page 3) which may be used) (Stock Number: 5744- 003 - 4015 -1) • • q [INCHES PERMIT # OD Munsell /0E /,Color Texture Depth IOp� 2 $ S A 1(JA 0'9 to l gp Qt t to to SAM d 11 to to 0 - sJ/ USDA SOIL SERIES: l h to 0 to ERENCE POINT' XISTING GRADE. TYPE : ( �F PARENTA.) CHES [ ABOVE / EXISTING GRADE. MOTTLING: ( ] YES [ VNO DEPTH: 0 INCHES SOIL TEXTURE /LOADING RATE FOR SYSTEM SIZING: 3/1/143 DEPTH OF EXCAVATION:d4 INCHES DRAINFIELD CONFIGURATION: [ ] TRENCH [X ] BED [ ] OTHER (SPECIFY) REMARKS /ADDITIONAL CRITERIA: 0 . J g a- , J / ; DATE : Page 3 of 3 INSTRUCTIONS: • PERMIT NUMBER: Permit tracking number by County Health Department. APPLICANT: Property owner's full name. AGENT: Property owner's legally authorized representative. LOT, BLOCK, SUBDIVISION: Lot, block, and subdivision for lot. PROPERTY ID NUMBER: 27 character number for property (property appraiser ID number or section /township /range /parcel number). PROPERTY SIZE: Check if property at site conforms to submitted site plan. Record net usable area available - lot area exclusive of all paved areas and prepared road beds within public rights -of -way or easements and exclusive of streams, lakes, normally wet drainage ditches, marshes, or other such bodies of water. SEWAGE FLOW: UNOBSTRUCTED AREA: MINIMUM SETBACKS: FLOOD INFORMATION: SOIL PROFILE INFORMATION: WATER TABLE: SOIL TEXTURE: DEPTH OF EXCAVATION: Record the estimated sewage flow for the establishment from Table 1 (residence) or Table 2 (non - residential), Chapter 10D -6, FAC. Record the authorized sewage flow for the lot based on net usable area and water supply (1500 gallons per day per acre for private water supplies and 2500 gpd per acre for public water supplies). If authorized sewage flow does not equal or exceed the estimated sewage flow, the application must be denied. Record the square feet of unobstructed area available and the amount required. Unobstructed area must be at least 2 times as large as the drainfield absorption area and at least 75 percent of the unobstructed area must meet minimum setbacks in Chapter 1OD -6, FAC. The unobstructed area must be contiguous to the drainfield. BENCHMARK INFORMATION: Record the location of the benchmark. If using a surveyor's benchmark record the actual elevation. Record the elevation of the proposed system site in relation (above or below) to the benchmark. Record minimum setbacks which can be meet to all listed features. Actual measurements must be recorded or "NA" for nonapplicable features. Features on site plan or within 75 feet of the applicant lot must be measured. The location of any public drinking well within 200 feet of the applicant's lot must also be verified. Record information on lot's subject to flooding. For lots subject to flooding record 10 year flood elevation for site and actual site elevation. Two soil profiles within the proposed absorption area to a minimum depth of 6 feet or refusal are required. Soil identification will use USDA Soil Classification methodology (Munsell colors and USDA soil textures). Refusals must be clearly documented. Provide USDA soil series if available, record "UNK" if the series cannot be determined. Record the depth of the observed water table at the time of the evaluation. Mark "perched" or "apparent" as appropriate. Record the estimated wet season water table elevation based on site evaluation, USDA soil maps, and historical information. Indicate if, there is high water table vegetation present. Indicate if mottling is present and depth. Record soil texture or loading rate for system sizing. If applicable record depth of excavation required. Record "NA" if not applicable. DRAINFIELD CONFIGURATION: Check drainfield configuration required. If other, specify type. ADDITIONAL CRITERIA: Record any additional remarks pertinent to site or installation. Ex. dosing required. SITE EVALUATED BY: Signature of evaluator, title, and date of evaluation. Professional engineers must seal all documents submitted. ELEVATION WORKSHEET ELEVATION OF BENCHMARK / REFERENCE POINT IS: BENCHMARK SITE 1 SITE 2 SITE 3 [ + ] SHOT H.I. H.I. H.1. H.1. [ - ] SHOT [ - ] SHOT [ - ] SHOT CONSTRUCTION PERMIT FOR: [d] New System [0] Existing System [,-.01 Repair [41..)] Abandonment PROPERTY ID #: SYSTEM ESIGN AND S P F ,C T [/O D R A I N F I E L D 0 T H E R [ ®] SQUARE [ ] SQUARE TYPE SYSTEM: CONFIGURATION: LOCATION OF BENCHMARK: f A 11� t FILL REQUIRED: (0 114 INCHES SPECIFICATIONS BY: APPROVED BY: DATE ISSUED: STATE OF FLORIDA DEPARTMENT OF HEALTH ONSITE SEWAGE DISPOSAL SYSTRIA CONSTRUCTION PERMIT d Authority: Chapter 381, F. 'r ,: Fh pt -) PERMIT ,# ea .g -6t q DATE PAID - - FEE PAID $ `. ✓A RECEIPT # I�] APPLICANT: /1 41.4, ve: , A oft ottit AGENT: 01' g PROPERTY STREET ADDRESS: LOT: i 3 / BLOCK: o SUBDIVISION: t „ , t f lett SYSTEM MUST BE CONSTRUCTED IN ACCORDANCE WITH SPECIFICATIONS AND STANDARDS OF CHAPTER 10D -6, FAC. REPAIR PERMITS AND HOLDING TANK PERMITS EXPIRE 90 DAYS FROM THE DATE OF ISSUE. ALL OTHER PERMITS EXPIRE ONE YEAR FROM THE DATE OF ISSUE. DEPARTMENT OF HEALTH APPROVAL OF SYSTEM DOES NOT GUARANTEE SATISFACTORY PERFORMANCE FOR ANY SPECIFIC PERIOD OF TIME. ANY CHANGE IN MATERIAL FACTS WHICH SERVED AS A BASIS FOR ISSUANCE OF THIS PERMIT REQUIRE THE APPLICANT TO MODIFY THE PERMIT APPLICATION. SUCH MODIFICATIONS MAY RESULT IN THIS PERMIT BEING MADE NULL AND VOID. CATIONS [GALLONS / GPD](SEPTICTANK [GALLONS / GPD] GALLONS GREASE INTERCEPTOR CAPACITY GALLONS PER DOSE DOSING TANK CAPACITY DH 4018, 10/96 (Replaces HRS -H Form 4018 [page 1) which may be ueed) (Stock Number: 5744- 001 - 4016 -0) Applicant FAC Holding Tank [04 Temporary /Experimental Other(Specify) [SECTION /TOWNSHIP /RANGE /PARCEL NUMBER] [OR TAX ID NUMBER] EROBIC UNIT CAPACITY MULTI- CHAMBERED /IN SERIES:( CAPACITY MULTI- CHAMBERED /IN SERIES:[ ] [MAXIMUM CAPACITY SINGLE TANK: 1250 GALLONS] DOSE•RATE [ ] PER 24 HRS NO. OF PUMPS: [ ] FEET PRIMARY DRAINFIELD SYSTEM FEET SYSTEM � / . [` ] STANDARD [04 FILLED [A., MOUND [ ] ( /j] TRENCH 1 '] BED ( e ELEVATION OF PROPOSED SYSTEM SITE [l.`8 ] (IN /0 [ABOVE /B 'fi :� BENCHMARK /REFERENCE POINT BOTTOM OF DRAINFIELD TO BE ( 4 ] [I{VKJEj�' /FT] [ABOVE /BE "► BENCHMARK /REFERENCE POINT EXCAVATION REQUIRED: (.01 INCHE() � ) INSTALL L OF LOAMY COARSE SAND UNDER BOTTOM OF DRAmer1 n TITLE: TITLE: rte= a3C- 4. I �o EXPIRATION T 7 SEPTIC TANK SHALL BE PUMPED AND P run DZ =' ECTION DEVICE INSTALLED ON THE OUTL T t INVERT ELEVATIOUI 17 - `^ V BOTTOM [yF IErNAMExI D ELEVAI?Id '7 -1 N (3 V �" PE11IiVIt 7 E3 Cc AVAI t 1 Ai EA SHALL GCE $J LEAST 2.6 FEET 6,iWEfi i 3 LCo:nE 3 T AL7 T�ot F ?C ?13ES SORPTION) EEO OR GRAM `tREMLN 11-7: DATE: CHD Page 1 of 2 INSTRUCTIONS: PERMIT NUMBER: Permit tracking number by County Health Department. APPLICATION FOR: Check type of permit; if "Other" specify type in blank. APPLICANT: Property owner's full name. TELEPHONE: Telephone number for applicant or agent. AGENT: Property owner's legally authorized representative. MAILING ADDRESS: P.O. box or street mailing address for applicant or agent. LOT, BLOCK, SUBDIVISION or PROPERTY ID #: 27 character ID number for property. (Health Department may require property appraiser ID# or section /township /range /parcel number.) SYSTEM DESIGN AND SPECIFICATIONS: TANK: Minimum specifications from Chapter 10D -6, FAC. DRAINFIELD: Minimum specifications from Chapter I0D -6, FAC. OTHER: Other specifications, such as operating permit requirements, low- volume flush toilets, variance provisos. SPECIFICATIONS BY: Name of individual providing specifications. If designed by a registered engineer must be sealed. APPROVED BY: County Health Department personnel reviewing and approving permit. DATE ISSUED: Date permit is issued by County Health Department. EXPIRATION DATE: One year from date issued if the system has not been installed. Permits for system repairs become void 90 days from the date issued. a J • , — r T T 7 , i _ �+± w t I J _ I — t ■ .■ �� I ` ■ 1 ! — 1 �■ ■ ! !'i + t 111 Li ■ — 4 - --,-- i _ "L z .C, 'I I � k �F4 -: �. - t ,� _ . ® _ y� " rit , \ L ■ I _ L Scale: Each block represents 0 feet and 1 inch = 40 feet. STATE OF FLORIDA �� w DEPARTMENT OF HEALTH APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PE IT Permit Application Number �a Notes: e 6� 4, 1 '. III Site Plan submitted by: Plan Approved By DH 4015, 10/96 (Replaces HRS -H Form 4015 which play be used) (Stock Number: 5744 - 002 - 4015 -6) PART II - SITEPLAN _-Not App oved 6 Date Counlr- Health' ALL CHANGES MUST BE APPROVED BY THE COUNTY HEALTH DEPARTMENT Department Page 2 of 4 • Permit No.___ J _� z � 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 emitted 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. (0 pr- h £ es — Date__ Owner's Name and Address__ - No. _4------- _----- - - - Street Pi E . ? j " d `� Registered Architect and /or _-.° _-----___-- No. _ 2—__ I— Street - F° Employing Plumber's Name ._^__ 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). 192 e New Building _ -- Remodeling g Addition Repairs V -". 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 Amount of Pennit $_ STATE OF FLORIDA, COUNTY OF DADE. Block Subdivision Street (Signed)_ —_ \ " ( Signed) __- - .d_ ._ e Plumbing Inspecto The undersigned applicant for this building permit does hereby certify that he understands and accepts his obli.rions as an employer of labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Perin. ' nt Supplement, and has com- plied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors employed by him in the work to be performed under this permit; and will post or cause to be posted' for inspection on the site of the work such public notice or notices as are required by the Act. The undersigned agrees to employ only such sub- contractors, on work to be performed under this permit, as are licensed by Miami Shores Village. My Commission Expires Notary Public, State of Florida 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 $LOO will be made when such re- inspection is made•necessary by improper notice for inspection, or faulty materials and /or workmanship. CLOSETS BATH TUBS SHOWER/ LAVA- TORIES SINKS SLOP SINKS LAUNDRY TUBE URINALS CATCH BASIN FLOOR DRAIN DRINKING FOUNT'N8 TOTAL FIXTURES Comm 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.___ J _� z � 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 emitted 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. (0 pr- h £ es — Date__ Owner's Name and Address__ - No. _4------- _----- - - - Street Pi E . ? j " d `� Registered Architect and /or _-.° _-----___-- No. _ 2—__ I— Street - F° Employing Plumber's Name ._^__ 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). 192 e New Building _ -- Remodeling g Addition Repairs V -". 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 Amount of Pennit $_ STATE OF FLORIDA, COUNTY OF DADE. Block Subdivision Street (Signed)_ —_ \ " ( Signed) __- - .d_ ._ e Plumbing Inspecto The undersigned applicant for this building permit does hereby certify that he understands and accepts his obli.rions as an employer of labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Perin. ' nt Supplement, and has com- plied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors employed by him in the work to be performed under this permit; and will post or cause to be posted' for inspection on the site of the work such public notice or notices as are required by the Act. The undersigned agrees to employ only such sub- contractors, on work to be performed under this permit, as are licensed by Miami Shores Village. My Commission Expires Notary Public, State of Florida 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 $LOO will be made when such re- inspection is made•necessary by improper notice for inspection, or faulty materials and /or workmanship. TYPE NUMBER RGH SET FEE BUILDING PLUMBING PERMIT NO. PERMIT NO. BATH TUB Contractor 1 .11 1 "_ Ar�-..' -' i_.�-,-_ Contror's Addres gW/ N 14/, Ph. e BIDET ���e" ��ti DISHWASHER /D 2 DISPOSAL DRINKING FOUNTAIN Owner's Name Phone �./ -l� FLOOR DRAIN GREASE TRAP Job Address ,"307 N/: 99 INTERCEPTOR LAVATORY Lot Block Subdivision LAUNDRY TRAY CLOTHES WASHER Present or Proposed Use of Building SHOWER SINK, POT /3 -COMP. Old / New No. of Bedrooms 2 SINK RESIDENCE SINK, SLOP Applica ion is hereby made to obtain a permit to do the work and installa- Lions as hereon indicated. I certify that no work or installation has been effected prior to the issuance of said permit and that all work will be per- formed meet the standards of all laws regulating construction in Dade Count TEMPORARY WATER CLOSET URINAL WATER CLOSET INDIRECT WASTES Signature of M er Plumber Insurance Date Lf _ • caner 2g--- 66 Issued By: valid until signed by an authorized repre- Dade County Building and Zoning paid and receipt acknowledged in the space WATER SUPPLY TO: AIR CONDITIONING UNIT FIRE SPRINKLER HEATER, NAT.- BOT. GAS /ELEC. LAWN SPRINKLER This permit does not become sentative of the Director, Metropolitan Deportment and all fees are provided. SWIMMING POOL WATER SERVICE PLUMBING INSPECTIONS SEWER CONNECTIONS UTILITY -SEWER GROUND UTILITY -WATER ROUGH SEPTIC TANK RE LAY / / 9" y, ©(2 TUB & WATER PIPE DRAINFIELD, 4" TILE /RESERVOIR SEWER PUMP & ABANDON SEPTIC TANK SOAKAGE PIT -CU. FT. SEPTIC TANK WELL DISCHARGE WELL SUPPLY WELL POOL PIPING AREA DRAIN ROOF INLET SOLAR WATER HEATER FIRE STANDPIPE FINAL PLUMBING POOL PIPING LAWN SPRINKLER SYSTEM REMARKS TOTAL FEE fq 123.03 -6 METROPOLITAN DADE COUNTY BUILDING AND ZONING 1351 N. W. 12 ST. . 'BOX 52 -655 MIAMI, FLORIDA 33125 PLUMBING PERMIT APPLICATION CO ?1 FOR OFFICE USE ONLY Permit No MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT I �d / Date... ✓__. - / ..I -- - 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 . r _ — Employing Plumber's Name .62/ - ii.a/C NO„ 4� „. — .,,.... Street. Gil, , a ' - -• . - Location and Legal Description Lot ____.L 1 ¢ Block Subdivision -____ p / y�� ( /�f�c'u'' Street and Number where work is to be performed -No J D 7 street_ yam , 79` -:- State work to be performed and purpose of buiWlwg (By Floors)_ ems -"-0 . 0 '22 - ' F << - New Building Remodeling Addition .P Repairs No. of Stories Size Septic Tank_ __/..(2- -1 D g � -______ ______Type of Tank_ :_.Y./ No. _ 5 d Feet of Drain Tile_ - -__ - 0 6 -- __ _Dist. Feet of Tank or Drain Field from Well. -_ Nature of Water Supply: City- Wpil.._.______- _______ --- -- - -- ---Size of Soakage Pit 7 . 2 Amount of Permit $ ...� (Signed)_ _ Capacity Cala Street.. /V k ? f . _1 umbing Inspector. The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligati s as an employer of labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Pennanen upplement, 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. 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 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 misspsctfon L mado by improper notice for inspection, or faulty materials and /or workmanship. CLOSITS BATH TUGS SHOWERS LAVA- TORIES SINKS SLOP SINKS LAUNDRY TUBS URINAL/ CATCH BASIN FLOOR DRAIN DRINKING FOUNT'NS TOTAL r IXTURts CONTR. LIST — CHICK SEPTIC TANK SEWER CONN. DRAIN FIELD SOAKAGE PIT GREASE TRAP SOLAR HEATER DEEP WELL SPRKLR. S SWIM'O POOL C TIE. LIST • CHICK / / lt —_ -- / P (? Permit No MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT I �d / Date... ✓__. - / ..I -- - 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 . r _ — Employing Plumber's Name .62/ - ii.a/C NO„ 4� „. — .,,.... Street. Gil, , a ' - -• . - Location and Legal Description Lot ____.L 1 ¢ Block Subdivision -____ p / y�� ( /�f�c'u'' Street and Number where work is to be performed -No J D 7 street_ yam , 79` -:- State work to be performed and purpose of buiWlwg (By Floors)_ ems -"-0 . 0 '22 - ' F << - New Building Remodeling Addition .P Repairs No. of Stories Size Septic Tank_ __/..(2- -1 D g � -______ ______Type of Tank_ :_.Y./ No. _ 5 d Feet of Drain Tile_ - -__ - 0 6 -- __ _Dist. Feet of Tank or Drain Field from Well. -_ Nature of Water Supply: City- Wpil.._.______- _______ --- -- - -- ---Size of Soakage Pit 7 . 2 Amount of Permit $ ...� (Signed)_ _ Capacity Cala Street.. /V k ? f . _1 umbing Inspector. The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligati s as an employer of labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Pennanen upplement, 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. 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 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 misspsctfon L mado by improper notice for inspection, or faulty materials and /or workmanship. BUILDING ELECTRICAL PLUMBING ROOFING Owner of Building MIAMI SHORES VILLAGE, FLORIDA ❑ J DATE o PERMIT Na 6763 Contractor's ❑ License No. 0 ❑ Work to be performed under this Permit Architect Contractor r or Builder I Legal Lot Description 11 B1 r: r ♦i > Subdi- vision Address of Value of 1 Amount of Building Project $ 1 Permit $ t:- 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 applica- tion 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 in the statements or specifichtions and that he assumes respon- sibility for work done by his agents, servants or employees. Signed. `t 4 INSPECTOR In consideration of the issuance to me of this permit I agree to perform the work covered hereunder in complianc4 with all ordinances gulations pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In as cepting this permit I assume responsibility for ex11 work done by either, myself, my agent, servant or employee. CONTRACTOR OR BUILDER BY AUTHORITY +.BOT Permit No. __ /(/_�.! D J MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT • =M i 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. 1,/e-44 Owner's Name and Address f "V' • No 0 7 Street -- '. Registered Architect and /or Engineer r• Employing Plumber's Name -a__ Location and Legal Description Lot Block Subdivision Street and Number where work is to be performed —No Street State work to be performed and purpose of building (By Floors) i New Building Remodeling Addition Repairs L `. / Date Street No. of Stories Size Septic Tank Type of Tank Capacity Gals Feet of Drain Tile___ /0o Dist. Feet of Tank or Drain Field from Well Natute of Water Supply: City —Well Size of Soakage Pit 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 work to be performed under this permit, as are licensed by Miami Shores Village. STATE OF FLORIDA, 1 COUNTY OF DADE. i s s. (Signed) Master Plumber. Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeared to me well known, andtvho, 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 it-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 H EATER DEEP WELL SPRKLR. SYSTEM SW IM'G POOL CONTR. LIST CHECK • 0 — r Permit No. __ /(/_�.! D J MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT • =M i 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. 1,/e-44 Owner's Name and Address f "V' • No 0 7 Street -- '. Registered Architect and /or Engineer r• Employing Plumber's Name -a__ Location and Legal Description Lot Block Subdivision Street and Number where work is to be performed —No Street State work to be performed and purpose of building (By Floors) i New Building Remodeling Addition Repairs L `. / Date Street No. of Stories Size Septic Tank Type of Tank Capacity Gals Feet of Drain Tile___ /0o Dist. Feet of Tank or Drain Field from Well Natute of Water Supply: City —Well Size of Soakage Pit 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 work to be performed under this permit, as are licensed by Miami Shores Village. STATE OF FLORIDA, 1 COUNTY OF DADE. i s s. (Signed) Master Plumber. Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeared to me well known, andtvho, 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 it-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 # Permission is herby gran r ` MIAMI SHORES VILLAGE Plumbing As Shown on attached approved plans. FIXTURES ROUGHED IN FIXTURES SET SEWER SEPTIC TANK $ TOTAL.' ;:ff i r / ,/ Village P Inspector Miami. Shpre Village, • • • to install the following described plumbing, in accordance with the laws, statutes and regulations of Miami Shores Village, Florida and the State of Florida, governing plumbing and drainage work done in Miami Shores Village, Florida. / j► For a , 4 ;; ,,� At No. Lot Block L .a Subdiv}son Fixtures j�' -_ . Payment Received / .a By This permit issued subject to approval of County Plumbing Inspector Work done b Se'vtic Tank Drainfield Plumbing - Final Dato Time PLUMBIliG - li'SPECTION Permit No. I:dd.ress of work Owner When ready L4e r %..... AM PM Received by 7L RouEh Top out • :2