PLUMBINGBUILDING
ELECTRICAL
PLUMBING
Owner of
Buildin
PERMIT N? 7983
Work to be performed under this Permit
Architect
Contractor 7 Builder
Legal Lot
Description
Address of
Building
This permit is grantee to e contractor or ilder named above to construct the building or to install the equipment or device described in the appli
cation herefor in strict cotpliance 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 "revolmd
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 tlds
permit is granted is the understanding that the contractor or builder named above assumes the respo nsibility for a thorough knowledge of the ordinances and
regulations pertaining to the work covered hereby whether shown on the plans or drawings or in the statements or specifications and that he assumes respon-
sibility for work done by his agents, servants or employees.
MIAMI SHORES VILLAGE, FLORIDA
Bl.
ye
Signed:
In consideration of the issuance to me of this permit I agree to perform th
pertaining thereto and in strict conf•rmity with the plans, drawings, statement
In accepting this pe • 't assume � • onsibility fo 11 work done by either my
SrQSdi-
ion
Value of
Project
DAT
Amt. of
Permit
rk covered hereunder in compliance with all
pecifications submitted to the pier authoriti
ent, servant or emplo ee.
tractor's
icense No.
1947
AUTHORITY
ens and regulations
litres Village.
Address of
Building
Contractor L
or Builder
BUILDING ❑
ELECTRICAL PLUMBING � ° , PERMIT
ROOFING 0
• c ! er,.71 1,.. t..
Legal Lot
Description
MIAMI SNORES VILLAGE, FLORIDA
DATE I lair
Owner of
Building
Architect
L.
(1. tot rit
N9 7357
Signed:
14. ce
In consideration of the issuance to me of this permit I agree to perform the work covered hereunder in compliance
pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper auth
opting thi* perm as res> sibility f9r all work done by either, myself, my agent, servant or employes.
CONTRAC'laOR OR BUILDER BY
Contcaclor's Ir 7 St
License No
Work to be performed under this Permit
i
- PO etb
Subdi-
vision
Value of 1 Amount of
Project $ Permit $
111...a�s.. N
/// A. s
This permit is granted to the contractor or builder named above to construct the building or to install the equipment or devke described in the
tion herefor in strict compliance with all ordinances pertaining thereto and with the understanding that the Work will be performed ht
plans, drawings, stilt meets or specifications that may have been submitted to and approved by the proper mu pal authorities. Tide
at any time if the work it not done in compliance with such ordinances or if the plans are changed without authoriaadon. A further
permit is granted is the understanding that the contractor or builder named above assumes the responsibility for a thorough
regulations pertaining to the work covered hereby whether shown on the plans or drawings oi the statements speciflcattonii
sibility for work done by his agents, servants or employees.
adds Gad
Miami Shores Villa" la
AUTHORITY ABM?
300
building at
$
Total $
Village Plumbing Ins
Receive Payment by
etQTili cJ hOreS 11e_
i L Q • I D A
PLUMBING PERMIT Nt ' 1116
pitl►ing plumbing, in accordance tltith the laws, statutes and regu-
' i11a , Florida and the State of Florida, governing plumbing and
done i y ami Shores Village, Flojdae
,
atom
ems
Now
MMVE
IrMSE
ErTIIIME
NWEE
SEW
IFIraran—
i OWNS&
LOT
BLOCK
SUBDIVISION
•
yy��r
Llama/ 'fit✓ \ " -.1.1.
A? Ait ,.
j
I , Q 1 ' .
wrr -
e at—
e
e K! 'co
building at
$
Total $
Village Plumbing Ins
Receive Payment by
etQTili cJ hOreS 11e_
i L Q • I D A
PLUMBING PERMIT Nt ' 1116
pitl►ing plumbing, in accordance tltith the laws, statutes and regu-
' i11a , Florida and the State of Florida, governing plumbing and
done i y ami Shores Village, Flojdae
,
atom
ems
Now
MMVE
IrMSE
ErTIIIME
NWEE
SEW
IFIraran—
Ling Permits i108E3 - 1116 Incl.
mace by c nc l lr tion of `er: tzt
DETACH BEFORE DEPOSITING
MIAMI SHORES VILLAGE
AMOUNT
T (970 )
N? 2191
LESS NET AMOUNT
46.13
Issued to
aiami cfhores9llage
F L O R 1 D A
PLUMBING PERMIT ITT° 109
BLOCK
4703
SUBDIVI
to install the followiKig described plumbing, in accordance with the laws, statutes and refit
lations of Miami Shores Village, Florida and the State of Florida, governing plum
drainage work done in Miami Shores Village, Florida. f49/
For astory b uilding at e 271 ^
Fixtures �
Fixtures /1 $ eR " l
/ wer / $ i �¢ s
, e
is Tank $
Total $
Village Plumbing Inspector
Received Payment by
OWN; '
LOT
BLOCK
SUBDI ON
iami Jhores
F L O E I D A
PLUMBING PERMIT
to install the following d : cribed plumbing, in accordance with the laws, statutes and regu-
lations of Miami Sho • s ilia e, Florida and the State of Florida, governing pl sel
drainage work done a Shores Village, Flo
For a_Lstory building at fi)
Fixtures
Fixtures $
Sewer $
tic Tank $ �
Total $
Village Plumbing Inspector
Received Payment by
N? 11
ZQnti cJ [torte /•�
t L O � i !1 ' A
PLUMBING PERMIT
to install the foll described plumbing, in accordance with the
lations of Miami Shores Village, Florida and the State of :Florida,
drainage work dos as Sipes Village, Florida.
For ao n► + build . Olt
Fixtures
Fixtures
Sewer
$ PI
Septic Tank $,
Total $
Village Plumbing Inspector
Received Payment by
-
Permit No __? J
Amount of Permit $
STATE OF FLORIDA,
COUNTY OF DADE. J
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
t
Location and Legal Description Lot Bloorllr Su — _______ _
Street and Number where work is to be performed -No (Pi � Street Ai y
State w o r k to be performe8 and purpose of building (By Fl ) _ - -- - - G . i7-.. _e ' :
New Building ___ Remodeling_ - ______ Addition________._ Repairs No. of St
Ct
My Commission Expires Notary Public, State of Florida
(P/f/K
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 _ No.
Registered Architect and /or Engin _____________ _
Employing Plumber's Name __ ___ V- /_v!7 '3 /& Z'_�___ No. /3 Street_4 "L"_ 13
Street- t/ 1 4i 4i i7 .3 T `
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
Cam!
tubing Inspector.
The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligatio s an employer of labor
under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Permanent : • pplement, 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 )a- .perfor ed under this permit, as are
licensed by Miami Shores Village.
Master 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.
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
I NALS
CATCH
BASIN
FLOOR
DRAIN
DRINKING
FOUNT'NS
TOTAL
FIXTURES
Co. NTR
LIST
/
/
CHICK
SEPTIC
TANK
SEWER
CONN.
DRAIN
FIELD
SOAKAGE
PIT
GREASE
TRAP
SOLAR
HEATER
DEEP
WELL
SPRKLR.
SYSTEM
SW IM'G
POOL
CONrR.
LIST
CHECK
Permit No __? J
Amount of Permit $
STATE OF FLORIDA,
COUNTY OF DADE. J
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
t
Location and Legal Description Lot Bloorllr Su — _______ _
Street and Number where work is to be performed -No (Pi � Street Ai y
State w o r k to be performe8 and purpose of building (By Fl ) _ - -- - - G . i7-.. _e ' :
New Building ___ Remodeling_ - ______ Addition________._ Repairs No. of St
Ct
My Commission Expires Notary Public, State of Florida
(P/f/K
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 _ No.
Registered Architect and /or Engin _____________ _
Employing Plumber's Name __ ___ V- /_v!7 '3 /& Z'_�___ No. /3 Street_4 "L"_ 13
Street- t/ 1 4i 4i i7 .3 T `
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
Cam!
tubing Inspector.
The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligatio s an employer of labor
under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Permanent : • pplement, 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 )a- .perfor ed under this permit, as are
licensed by Miami Shores Village.
Master 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.
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.
APPLICATION FOR PLUMBING PERMIT
Permit No. o t C'r
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. %%'',rr��
Owner's Name and Address 2214/4 �l
Se�Lf
Registered Architect and /or Engine
Employing Plumber's Name
Location and Legal Description Lot
•
Street and Number where work is to be performed —No.
New Building Remodeling
Amount of Permit $ e____ (""4/
MIAMI SHORES VILLAGE
My Commission Expires
PLUMBING INSPECTION DEPARTMENT
B lock
,No
Size of Soakage Pit
(Signed)
licensed by Miami Shores Village.
i
(Signed)
f c T _._ s treet )
Dist. Feet of Tank or Drain Field from Well
Date
Street
St
Size Septic Tank Type of Tank . Capacity Gals.
Feet of Drain Tile
Nature of Water Supply: City —Well.
Notary Public. State of Florida
Subdiv'sion__4_ _ ____t_____
State work to be performed and purpose of building (By Floors)
Addition ________________________ Repairs No. of Stories
Plumbing Inspector.
The undersigned applicant for this building permit does hereby certify that he understands and accepts (s 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 e .toyed by him in the work to be
performed under this permit: and will post or cause to be posted for inspection on the .•ce of the work . public notice or not as are
required by the Act. The under signed agrees to employ only such sub - contractors, }vo o be • r o ed and r �•'; a4 are
aster • i .. ber.
STATE OF FLORIDA, 1
i ss.
COUNTY OF DADE.
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally
appeared
to me well known, and who, being by me first duly sworn, upon oath deposes and says that he is the
of the above described construction, that he has carefully read the foregoing application, and that he did sign the same, and that all facts
therein by him stated are true.
NOTE: A re- inspection fee of $1.00 will be made when such re- inspection is made necessary by improper notice for inspection, or faulty
materials and /or workmanship. _
3 7kg 7.
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
SWI 'G
OL
CONTR.
LIST
CHECK
APPLICATION FOR PLUMBING PERMIT
Permit No. o t C'r
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. %%'',rr��
Owner's Name and Address 2214/4 �l
Se�Lf
Registered Architect and /or Engine
Employing Plumber's Name
Location and Legal Description Lot
•
Street and Number where work is to be performed —No.
New Building Remodeling
Amount of Permit $ e____ (""4/
MIAMI SHORES VILLAGE
My Commission Expires
PLUMBING INSPECTION DEPARTMENT
B lock
,No
Size of Soakage Pit
(Signed)
licensed by Miami Shores Village.
i
(Signed)
f c T _._ s treet )
Dist. Feet of Tank or Drain Field from Well
Date
Street
St
Size Septic Tank Type of Tank . Capacity Gals.
Feet of Drain Tile
Nature of Water Supply: City —Well.
Notary Public. State of Florida
Subdiv'sion__4_ _ ____t_____
State work to be performed and purpose of building (By Floors)
Addition ________________________ Repairs No. of Stories
Plumbing Inspector.
The undersigned applicant for this building permit does hereby certify that he understands and accepts (s 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 e .toyed by him in the work to be
performed under this permit: and will post or cause to be posted for inspection on the .•ce of the work . public notice or not as are
required by the Act. The under signed agrees to employ only such sub - contractors, }vo o be • r o ed and r �•'; a4 are
aster • i .. ber.
STATE OF FLORIDA, 1
i ss.
COUNTY OF DADE.
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally
appeared
to me well known, and who, being by me first duly sworn, upon oath deposes and says that he is the
of the above described construction, that he has carefully read the foregoing application, and that he did sign the same, and that all facts
therein by him stated are true.
NOTE: A re- inspection fee of $1.00 will be made when such re- inspection is made necessary by improper notice for inspection, or faulty
materials and /or workmanship. _
3 7kg 7.
�?�:
Permit No.
Application is hereby made for the approval of the detailed statement of the plans and specifications herewith sn
structure herein described. This application is made in compliance and conformity with the Building Ordinance of
and kapervisions of the Laws of the State of Florida, all ordinances of Miami Shores Village and all rules and r
.of Waled Shores Village shall be complied with, whether herein specified or not. A copy of approved plans and
building during progress of work.
Owner's Name and Address 4 1.g. C B/40 No— S
Registered Architect kuid/or Engineer_
Employing Plumber's Name 11. /,/ Al/rfrS No. /.7 Street
Location and Legal bescription Lot_ Block________________ Subdi
Street and Number Where work is to be performed—No. g Ya Strect_____
State work to be performed and purpose of building (By Floors )______ifiatit_40
New Building Remodeling Addition Repairs
CONTR.
LIST .
CHICK
CONTR.
LIST
ctiacx
Size Septic Tank______ae ________Type of Tank Capacity
Feet of Drain Feat of Tank or Drain Field from
Nature 0 Water Supply: Size of Soakage Pit
Amount of Permit $. 0
The undersigned applicant for this building permit does hereby certify that he ds and accepts his ob
under the Florida Worlonen's Compensation Act, being. Section net enmigled Laws of Pkorkla Permanent.
lied vrith the provisions thereof, and will require similar complhakee from isif contractors or sub-contractors
craned ender this permit; and will Pi* or came to be posted for itestection on the site of the work such
by the Act. The undersigned agrees to employ only inch sob-contractors, on work to be
ceased by Miami Shores Vilbge.
TE OF FLORIDA, as.
NTY OF DADE.
ore me, the undersigned authority, a notary public, duly authorised to administer oaths and take actrow
ON,
CLOSETS
ell known, and who, being by me first duly sworkk_upon oath deposes and says that he is the
above described construction, that he has caratelly read the horegoing application, and 'that he did sign the
by hire stated are true.
MIAMI SHORES VILLAGE
PLUMING IMPLIION DemettAgra
APPLICATION POO PLUMING prim
(Signed ) _
(Signed)
Date_
fee of $1.00 will be made when such re-inspection is made necessary by improper notice foe
My Commission Expires Notary Public, State of NOW-
Job
Address
Inspection
Time Ready
Date Ready
1
Permit No.. -_!`
Size Septic Tank
Feet of Drain Tile
Amount of Permit $
Owner's Name and Address
Nature of Water Supply: City —Well
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 Kuilding or othei
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 al
building during progress of work.
/10 No. aio Street A/E ? FS r
Registered Architect and / or Engineer. _._ __
Employing Plumber's Name M'kM_!_-__t o'!? � - ° el 4. 't'` V No / 76 Street__
Location and Legal Description Lot Block Subdivider
Street and Number where work is to be performed —No ,_
State work to be performed and purpose of building (By Floors ) __
New Building__-. Remodeling Addition_--_
‘c1 _ Type of Tank_ _ Capacity Gals
Dist. Feet of Tank or Drain Field from W
(S
rmit does hereby certify
Section 5988, Compi
compliance from
sted for inspection on the site
The undersigned applicant for this building
under the Florida Workmen's Compensation Act, be
plied with the provisions thereof, and will require sim
performed under this permit; and will post or cause to be
required by the Act. The undersigned agrees to employ only such sub- contracto
licensed by Miami Shores Village.
Date
1 14: /95Z
79
------ - -__ -- Street___
L- _EE L}44/4, it 4 p
Size of Soakage
( Signed )____ _
Repairs _- __ _ ___ No. of Stories
understands and accepts
neral Laws of Florida
ntractors or sub- contrac
of the wor
ork to
mbing Inspector.
ligations an employer of labor
ermanent Su • .lement, and has com-
loyed b him in the work to be
public notice or notices as are
this permit, as are
er Plumber.
STATE OF FLORIDA, i �,
COUNTY OF DADE. j
Before me, the undersigned authority, a notary public, duly authorized to adminis r 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 far
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 faul
materials and /or workmanship.
CLOSETS
BATH
TUBS
SHOWERS
LAVA-
TORIES
SINKS
SLOP
SINKS
LAUNDRY
Tuns
URINALS
CATCH
B ASIN
FLOOR
DRAIN
DRINKING
FOUNT' NS
TOTAL
FIXTURE:
CONTR.
LIST
__
CHECK
SEPTIC
TANK
SEWER
CONN.
DRAIN
FIELD
SOAKAGE
PIT
0
TRAP
SOLAR
H
DEEP
WELL
SPRKLR.
SYSTEM
SW IM'O
POOL
CONTR.
LIST
CHECK
Permit No.. -_!`
Size Septic Tank
Feet of Drain Tile
Amount of Permit $
Owner's Name and Address
Nature of Water Supply: City —Well
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 Kuilding or othei
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 al
building during progress of work.
/10 No. aio Street A/E ? FS r
Registered Architect and / or Engineer. _._ __
Employing Plumber's Name M'kM_!_-__t o'!? � - ° el 4. 't'` V No / 76 Street__
Location and Legal Description Lot Block Subdivider
Street and Number where work is to be performed —No ,_
State work to be performed and purpose of building (By Floors ) __
New Building__-. Remodeling Addition_--_
‘c1 _ Type of Tank_ _ Capacity Gals
Dist. Feet of Tank or Drain Field from W
(S
rmit does hereby certify
Section 5988, Compi
compliance from
sted for inspection on the site
The undersigned applicant for this building
under the Florida Workmen's Compensation Act, be
plied with the provisions thereof, and will require sim
performed under this permit; and will post or cause to be
required by the Act. The undersigned agrees to employ only such sub- contracto
licensed by Miami Shores Village.
Date
1 14: /95Z
79
------ - -__ -- Street___
L- _EE L}44/4, it 4 p
Size of Soakage
( Signed )____ _
Repairs _- __ _ ___ No. of Stories
understands and accepts
neral Laws of Florida
ntractors or sub- contrac
of the wor
ork to
mbing Inspector.
ligations an employer of labor
ermanent Su • .lement, and has com-
loyed b him in the work to be
public notice or notices as are
this permit, as are
er Plumber.
STATE OF FLORIDA, i �,
COUNTY OF DADE. j
Before me, the undersigned authority, a notary public, duly authorized to adminis r 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 far
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 faul
materials and /or workmanship.
CLOSETS
BATH
TUBS
s
LAVA-
TORIES
SINKS
SLOP
SINKS
LAUNDRY
TUBS
URINALS
CATCH
BASIN
FLOOR
DRAIN
DRINKING
FOUNT•NS
TOTAL
FIXTURES
3
2-
1
7
17
1
1.1
Sketch position of building and lot lines in square (which represents an entire city block), sh
the building and lot faces: also show exact locations of "Y" in street and position of lateral
sewer and any change in direction same may make. The purpose of this plan is to have an
underground pipes for future references.
NORTH
A
Remarks:
NORTH
SOUTH
. •
. . ,
• .•
g on which street
ptic tank. Show
rate layout of all
J.tq
ge17 00
Store 0
lock No. 73
cU
Sewer Connections At center of St. 0
Address 5' c;/,: /vE, 9s
Address 4/1
A-244 5M 3-38
Employing Plumber
For a
Owner or Agent
Builder or Contractor is
Lot No. /
Address
Ground
A M PM
Approved by
( Condemned by
REMARKS
I herewith submit-the following plan of plumbing for approval:
New 0
Dwelling
DIVISION OF PLUMBING INSPECTION
DEPARTMENT OF PUBLIC SERVICE
MIAMI, FLORIDA
Old 0 Story 0
Garage 0
At curb 0
executed by
At property line 0 Existing in alley 0 Existing bldg. sewer 0
To septic tank Existing bldg. drain 0 To dry well
A charge of $ 1.00 will be made for correcting any inaccuracies in the foregoing information.
DO NOT WRITE IN SPACE BELOW. THIS IS FOR THE USE OF THE DIVISION OF PLUMBING INSPECTION ONLY.
Date
ROUGH-IN INSPECTION
Rough-In Rain Leader
*t
Date
SEWER INSPECTION
AM P . M.
Approved by
Condemned by
REMARKS
Addition 0
s?-
Apartment 0 Hotel 0
REMARKS
, 1 9
t - Remodeled
Office Bldg. CI
Date
FINAL INSPECTION
AM P
Approved by
Condemned by
'' . '"1 - 0 r rTL' ■nf" or Polak, No, „tik, a
THIS SPACE FOR ELEVATION SKETCH
In alterations to existing work show the old work in red ink and the new in black ink. Letter each stack to correspond
with the opening shown in floor plan or ground plan on opposite page.
A PERSPECTIVE SKETCH WILL BE SUFFICIENT THIS SPACE FOR PLAN SKETCH
PROVIDED THE WORK CAN BE CLEARLY SHOWN
Show location of stacks and horizontal drains inside building, lettering each opening to correspond with the stock con-
nections as shown on the elevation sketch on opposite page. Where ground work is concealed, draw floor plan of build-
ing showing location of walls, partitions, columns, etc., and the location of all horizontal soil and waste pipes, in ref-
erence to same.
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PERMIT APPLICATION FOR MIAMI SHORES � VILLLA / GE
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Date �Q - ,R0 C) e Job Address Al 3 f 5/ >' Tax Folio 1 1 ' �/ DoYo • (/(`T v L// 4O
Legal Description Historically Designated: Yes No
Owner/Lessee / Tenant
Owner's Address 5 %C. 11Z
•
Contracting Co. ,447c' Po " , , !,o
Qualifier c u (!
State # `jG r 0c0 (, Sic? Municipal # Competency # Ins. Co.
Architect/Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type (circle one): BUILDINGELECTRICA PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
J� r
WORK DESCRIPTION
Square Ft
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 m compliance with all applicable
laws regulating construction and zoning. Furthermore, I authorize the above -named contractor to do the work : t=
•
- td/o Po, President Date
6 _ -
Notary as to 1 an' , • do President
My Commission xpires:
FEES: PERMIT
Date
0000
Master Permit # c'<'/ 2 , .2 6 V 43421
Phone G , y''�CL�
Address l� o 5 LL `•, >" C,t - p , te a
SS# / .„ - /?Phone iG-
Estimated Cost (value) COO
O
Signature of C
RADON C.C.F. (- a 0 NOTARY BOND 2 ao
c -)O -111
Date
ao - rd�
Notary as to Contrac •r or Owner- Builder Date
My Commission Expires:
YP efd , Wm. MARK WOODARD
co. .1.4 # CC 625712
14, L KPIRE :OAP 2, 2001
BONDED THRU
OT F% ATLANTIC BONDING CO., INC.
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TOTAL DUE .7.3@
APPROVED:
Zoning Building Electrical
M
Mechanical Plumbing � Engineering
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STATE OF FLORIDA
DEPARTMENT OF HEALTH
ONSITE SEWAGE DISPOSAL SYSTEM
CONSTRUCTION PERMIT
Authority: Chapter 381, FS &`Chapter 10D -6, FAC
C0NpTRUCTION PERMIT F
DV) New System [ ) E isting System
c y) Repair ( Abandonment
APPLICANT:
PROPERTY ID 1: A J-
SPECIFICATIONS BY:
APPROVED BY:
DATE ISSUED:
OH 4016. 10146 (Replaces HRS-H Form 4016 )peps 1) which may be wad) v
(Stock Number: 5744. 001 - 4016 -0)
[ /1"Y Ho
(
1 T F"` AGENT: ,�1 el /c0 N Sc-i f
PROPERTY STREET ADDRESS: g � � 9 G
LOT: /4_ BLOCK: / SUBDIVISION:
[SECTION /TOWNSHIP /RANGE /PARCEL. Wit;
( `TAI ID''
s=ac=s = =c=ame===_ aMMMMies m=ssssasssmssm
SYSTEM MUST BE CONSTRUCTED IN ACCORDANCE WITH SPECIFICATIONS AND STANDARDS OF CHAPTER 10D4,
FAC. REPAIR PERMITS AND HOLDING TANK PERMITS EXPIRE 90 DAYS FROM THE DATE OF 28tr.R
PERMITS EXPIRE ONE YEAR FROM THE DATE OF ISSUE. DEPARTMENT OF HEALTH APPROVAL OV
NOT GUARANTEE SATISFACTORY PERFORMANCE FOR ANY SPECIFIC PERIOD OF TIME. 'ANY CHANGE IN:NATERIAL
FACTS WHICH SERVED AS A BASIS FOR ISSUANCE OF THIS HERMIT REQUIRE APPLICANT TO MOOP,T
PERMIT APPLICATION. SUCH MODIFICATIONS MAY RESULT IN THIS PERMIT BEING MADE NULL AND VOID.
_ _===== r== as s== a =sssss = ============ =ma=mas= ==s mssssmssssssssssasmm
SYSTEM DESIGN AND SPE.CIFICATIONS
T i / GP4:ii UNIT CAPACITY MULTI-CHAMBERED/IN SCRIM( )
N [- ) GALLONS GREASE INTERCEPTOR CAPACITY (MAXIMUM CAPACITY SINGLE TANK1 ouzo's'
K ( . ) GALLONS PER DOSE DOSING TANK CAPACITY DOSE .RATE ( ) PER 24 HRS NO. OF PUMPStj 1
D ($ ' SOUARE F ,T.P IMARY DRAINFIELD SYSTEM
R ( ) SQUARE FEET SYSTEM
A TYPE SYSTEM: [ ) STANDARD [ ) FILLED
I CONFIGURATION: ( j TRENCH [
F LOCATION OF BENCHMARK: ,t/ F F Ce ,»
I ELEVATION OF PROPOSED SYSTEM SITE [ /6'') INCHES /FT) [ABOVE /BELOWI BENCHMARK
E BOTTOM OF DRAINFIELD TO BE ( w ) ) (ABOVE BENCHMARK
L
D FILL RE t p , ( j It(CHES,
FXCAVA TION REQUIRED: (-3l) INCHES
• D OTT O:vi A L...
ing Tank ( Temporary /Experimental
tber(Specify)
TITLE:
TITLE. •
APPLICA
PERMIT #
DATE PAID
*HE , PAID $
RECEIPT #
( ) MOUND [ )
( ) _
■
EXPIRATION DATE: //. Q ,qf
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 1OD -6, FAC.
DRAINFIELD: Minimum specifications from Chapter 10D -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.