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94 NE 99 St (8)PERMIT APPLIC MIAMI SHORES VILLAGE Date y /q /e(/ Job Address 5 �� 7 / te S/ Tax Folio Historically Designated: Yes Nq �/ Oi o a AV Owner/Lessee / Tenant C�y�'�i h tet- L 25.,,, 2,, Master Permit # J / 7 Owner's Address Contracting C . . �i . C- � ' " ,. rni /�. .' � Address Legal Description Qualifi State # Municipal # Competency # Ins. Co. Architect/Engineer Address Bonding Company Address Mortgagor Address Permit Type (circle one): B DING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN 1;;// WORK DESCRIPTIO Phone SS# - �� -Phone to 9f579 Square Ft. / Estimated Cost (value) / 6:7 1- i i e 1 6 /60 .3 3 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 the work stated. Signature of owner and/or Condo 're- % -° Notary as to Owner and/or Condo President Date My Commission Expires: FEES: PERMIT RADON Date APPROVED: Zoning Mechanical Plumbing %.1 1 Signature of Contr • sr ; Own ':udder Date Notary as to Contractor or Owner- Builder Date My Commission Expires: D C.C.F. " '' NOTARY TOTAL DUE 3 we Building _ Electrical Engineering C A APR 19 '96 16:26 MR CS SEPTIC AND DRAIN INC 3056515610 DOM L41. Dr criptim Hnstorically Designated: Yes No >1 CoL_ Master Permit # Orden Address Phone Oemer,Lessee / Taman C,�gltacti Co. 0,5 , Address ?c (,9 3 0 39 Ca ad ss# l . 2 O797Phone gas 6s /- 781 wok. C. a Sm1 A:aite /Enginaa Address BgeldinS Ca ipeay Address Address htegairx Plmait Type (circle me): BUILDING ELECT CAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN /• (1 V IC DESCRW -5 TION , r �- c— i - a( k 90, de_ '` v.5� i ht, cJ &((),1 ( q1. n.�1 ` E Sarre Ft VliARNIPIG TO OWNER; YOU MUST RIBUL7i BY YOUR PA G TWICE FOR IMP CJNBVI.T WITH Y LENDER OR AN A Aplication is hereby made to obtain a permit to < minify thtt all work will be performed to meet the p.aits,ate required for ELECTRICAL, PLUMBIN 'S AFFIDAVIT: 1 unify that all the foreg lams regulating construction and zoning. Furthermor to Owner and/gr Condo President D asmisiasim Expires; I,: - 01- cf PERMIT APPLI IATION FOR MIAMI SHORES VILLAGE J a i A d d r e s s 94/ 06 i 9 9 oL'I t Tax Folio Municipal #PROVED: Zelitg Building — Ivealm ioal Plumb' Song= downer ' s • • o President D le TO: 214 596 9271 P01 Compete y Ins. Co. tc C.C.F. Estimated Cost (value) tD A NOTICE OF COMMENCEMENT AND YOUR FAILURE TO DO SO MAY D VEMENTS TO YOUR PROPERTY (IF YOU INTEND TO OBTAIN FINANCING, ORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT.) work and installation as indicated above, and on the attached addendum (if applicable). I tandards of all laws regulating construction in this jurisdiction. I understand that separate SIGNS, POOLS. ROOFING and MECHANICAL WORK. ing information is accurate and that all work will be done in compliance with all applicable , I authorize the above -named contractor to do the work stated. Siguatiirc of Contractor or Owner- Builder • : g as to Contractor or t?tvper -Builder • =mission Expires: ! / / /f/ /fSP c p. v p� 6 OFFICIAL NOTARY SEAL _ (. gW KATHERINE V DUCKORTH COMMISSION NUMBER ••, TII \ o CC418736 �c Q MY COMMISSION EXP. OF RP NOV. 14,1998 NOTARY TOTAL DUE Electrical Engineering 'r APPLICANT: LOT: PROPERTY ID #: T A N K D R A I N F I E L D 0 T H E R DATE ISSUED: SPECIFICATIONS BY: APPROVED BY: STATE OF FLORIDA DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES' ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PERMIT Authority: Chapter 381, FS & Chapter 10D -6, FAC CON TRUCTION PERMIT FO ON] New System , xisting System [ ] olding Tank [ y Temporary /Experimental CONTRUCTION PERMITA Repair [ andonment [ ] Other(Specify) 44Y .PROPERTY STREET ADDRESS: BLOCK: SUBDIVISION: 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. HRS 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. SYSTEM DESIGN AND SPECIFICATIONS ENT : /L1 / GPD] [GALL / GPD] GALLONS GREASE INTERCEPTOR CAPACITY GALLONS PER DOSE DOSING TANK CAPACITY DOSE [ 3�� UAKE„ FE DRAINFIELD SYSTEM [ SQUARE FEET SYSTEM TYPE SYSTEM: [TANDARD [ ] FILLED CONFIGURATION: [ ] TRENCH [ aJ. ED LOCATION OF BENCHMARK: ELEVATION OF PROPOSED SYSTEM SITE [ C)" Z,] BOTTOM OF DRAINFIELD TO BE [, ] FILL RATOS1R��ELL }Zn 0FlLaifIVIV COARSE SAND ION SUBMIT �' !JN T I,D SUED 13:�oT^�; ^� i , ', jet _ >)) THIS P t .i.a Oh THIS IIN i tail l FOR <';- 2 2,—��' [SECTION / TOWNSHIP /RANGE /PARCEL NUMBER"]' [OR TAX ID NUMBER] MULTI- CHAMBERED /IN SERIES:[Ne CAPACITY MULTI- CHAMBERED /IN SERIES: ] [MAXIMUM CAPACITY SINGLE TANK: 1250 GALLONS] RATE [ ] PER 24 HRS NO. OF PUMPS: [ ] BIC UNIT CAPACITY TITLE: f7 . Y a p i.f HRS -H Form 4016, Mar 92 (Obsoletes previous editions which may not be used) (Stock Number: 5744 - 001 - 4016 - 0) APPLICANT [ ] ELOW] INCHES FERENCE P T] [ABOVE/ T] [ABOVE REQUIRED: [ 4/ - 0 ] INCHES TITLE: MOUND PERMIT # DATE PAID FEE PAID $ RECEIPT # BENCHMARK/ BENCHMARK rts ParelPED ANDA dYcsr� OR THE OUTLET TEE EXPIRATION DATE: 7^22 Page 1 of 2 ffi\ISTaUCTIONS: I?T1012.7 NUM 3E•: l.' crrn'2 tract;in , num;:cr assigned by c^f,'E•;[U. APP :�ECI� ' Ci; 7013: Cheer type of permit, if'Othe cpccify typo i A'„ 1 CCANT: : ?toperty owner o full natra. Er EPti:ONE; x elep on> number for applicant oa agent. A.;1ENT: ;?roperty owner's legally authorized sepses.. active. A:D.D°.i7;SS: i?.O. cons of stye :-:t ,.t ilirg addres3 fo° cpplicar_: CT agent. LOT, :3LCC., FUODEVES,:ON or 1. OyETi.7! )11: 27 character id numbs 2bs property. (CPI -n.1 may rquir pope7'2y cpprr.is ._ TO 0 or u�r.~ : :J:ou / : n /c::.0 ..c,) SYSTEM DESIGN AND SPECEIFECATEONS: b ANK: Minimum speci'Eeationn from Chapter 10D-6, IPAC. Minimum specifications front Cbaptes fl0:0 -6, 1FAC. O'S;i ,L?: Other r:oecificatic=r:, ; itch as operating pe rtit requirements, low -voha: ?ur toilets, v ^.t: SL ECl.FI A'7' :ONS 3 ": Nam,: of incu•" ;dual pr'ovidirg specifications. 'If designed by a regit erect; e:tginccr ann.. ",:a AP.K1OVCED BY: County Pub!i Health Unit (CPEIU) personnel reviewing and approving pe nr2t. DA 9: =SSUE J: Date permit is issued by CP} U. EXP'.'vK1'l: N DATE: On,_ year from date: issued 'f the system has not been installed. !Permits fc_ sy: :ten ,: ! i >s bccc -e vo :d ':0 days `.ortt L ?e scia issued. APPLICANT: LOT: PROPERTY ID #: STATE OF FLORIDA DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES ONSITE SEWAGE DISPOSAL SYSTEM SITE EVALUATION AND SYSTEM SPECIFICATIONS l /e4 ed AGENT: 3f/A` C. j( BLOCK: SUBDIVISION: 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: [ ] TOTAL ESTIMATED SEWAGE FLOW: , AUTHORIZED SEWAGE` FLOW: UNOBSTRUCTED AREA AVAILABLE: /000 BENCHMARK /REFERENCE POINT LOCATION: _ ELEVATION OF PROPOSED SYSTEM SIT IS [`INCHES / [ABOVE /BELOW BENCHMARK /REFERENCE POINT THE MINIMUM SETBACK WHICH CAN BE`MAINTAINED FROM THE PROPOSED SYSTEM TO THE FOLLOWING FEATURES,: SURFACE WATER: /L)t) FT ,. DITCHES /SWALES: /boa FT NORMALLY WET? [ ] YES [ 1NO WELLS: PUBLIC: ,',4 FT LIMITED USE: N4 FT PRIVATE: N FT NON - POTABLE: OVA,,, FT BUILDING FOUNDATIONS: fD FT PROPERTY LINES: Z. F79 SILBLE WATER LINES: FT SITE SUBJECT TO FREQUENT FLOODING: [ ] YES [ 00 10 YEAR FLOODING? ) YES [ }/NO 10 YEAR FLOOD ELEVATION FOR SITE: FT MSL /NGVD SITE ELEVATION: \ FT MSL /NGVD SOIL PROFILE INFORMATION SITE 1 OBSERVED WATER TABLE: ICJ CHE [ABOVE / BELO ESTIMATED WET SEASON WATER TAB EVATION: HIGH WATER TABLE VEGETATION: [ ] YES [beN0 [Section /Township /Range /Parcel No. or Tax ID Number] YES [ ] NO NET USABLE AREA AVAILABLE e% ©.:NI/ ACRES GALLONS PER DAY [RESIDENCES -TABLE 1 / OTHER -TABLE 2] GALLONS PER DAY [1500 GPD /ACRE OR 250 GPD /ACRE) SQFT UNOBSTRUCTED AREA REQUIRED: SQFT /19. 1' �`ii✓ l EXISTING GRADE. TYPE: [PERCHED / APPARENT] INCHES [ ABOVE / BELOW ] EXISTING GRADE. MOTTLING: [ ] YES [ [j/NO DEPTH: INCHES SOIL TEXTURE /LOADING RATE FOR SYSTEM SIZING• DEPTH OF EXCAVATION: 90 INCHES DRAINFIELD CONFIGURATION: [ ] TRENCH [ED [ ] OTHER (SPECIFY) REMARKS /ADDITIONiCRITERIA: • SITE EVALUATED BY: HRS -N Form 4015, Mar 92 (Obsoletes previous editions is (Stock Number: 5744- 003 - 4015 -1) PERMIT # � (o r � 7 • SOIL PROFILE INFORMATION SITE 2 Munsell Color xtu e Depth / 'to /I d �'1 SCSwG� 2 e 10 to to to to f to to USDA SOIL SERIES: ::NslauCTIONS: PERMI(.7 8: Permit tracking number assigned+ by CPH"..i. APFLICAN7: Property owner's full zmme. Af3ENr.:: Property O'S legally authorized represeariztive. BLOCK, SUBDTVIKON: Lot, block, and subdivision for tot. PRO7EX.:'Y :D11: 27 character number for property. (pmperty appraissr :7.) C or aection/towns:!:ir.dranr;c/y.(treel Check if property size at site conforms to submitter.: site 2lan. 7ord no? :a:ar.:le asrsrs. - r.rJr, exclnrivc of all paved crecc c.r.c1 prepared ror.d beds within public sigh:tr.-of-way eccententrs 2c1;;;, normally dmirLage elitchea, marrhes, or OtheT 1,1:1;i1 5GC:e3 of water. S"-! AREA: Record the ectir.tr.ted sewr.ge flow to:: the estz'olichmeat front 7.'abic ("A,113i!L:F7'.;CI1) c:: 7, ( :), OD-6, FAC. accord the r.sstkor sewage nor: for 11::; '7123'. c :Ec.Y.c c•z{, (7.:;;;;;r3cLon per cLj pc: acre for private wr.ter supplies cnt: 25C0 gy.sl ;;;;!: (seri for public w(it does not equal or exestsrl t..he catirnated, sewage f:ow, o application Record the squarc feet of unobstructed cc available and tisrs 11:7 times r.s large C3 t27,f; drainfletd cbaorption area and at learn 75 :2srcert sf d arca setbrcks in Chapter 100-6, FAC. The ttnobatructed aran (7_tta: be contig-mss fr Ftl„torci the location el' the ::.enslt_rns...,:t. :-. sunrsr,!yer'n bc!..-..chrstrrlt (It:yr:flan of the pro0s44 system site in relL!Gr. (above or below) to the 'LC:C Cra. cord minimum setbacks which can be rzt..,:et o c!! listed torturer!. Acttsr." rsor.MIL'L;Za;7.1:Ii :nun or "NA" for non applicable fbatures. :Features on c;:r' or /5 feet of the sly,?licr.nt lot —str' !:Issar• Tao lssa:ion of any public drinking well within 2CD fee: cif the applicant's lot mast alto be verified. C0 Tl2ATCN: Record informr:ion on lot's subject 7.0 2z,cei.xj. 732 lots czbject to cloodirtg cv,ac: fox: :;:k) actual site elevation. VP:.: proles withirs )ze ;?rapccesi cmc To c aLur cc ;:f 5 feet or -....s;ftst!!.1 irlesstirscation use USDA Soil Clissaifleatior. met:-.cdrtlssly C.V.:tante!! f Ln JST Co'' be clearly documented. Provide 'StISDA roii Z.,..E if avallabl cannot be detcrrr.irrssd. Record the depth of tbc obrervecl wrter table at the time of the evalurtion. Vrr "prr.citerl" "cp,srrant" ts!: appropriate. RCCO:f; the estimated wet crown water table elevation brsed or: 3ito cvislt!ation, f:oil historical information. indicate if there in high water tab! vs:gelation ;ndicr.to srssng is accord soil texture or loading rote for system. sizing. :1:2;.?".:H OF EXt....'AVA"i1ON: lf applicable record depth of excavation required. Loco: "NA if rsot applicable. CO,NF:C Check drainfield configutation required. if other, specify tsysse. A0TKONAL C1.17a1:1A: Record any addition.al remarks pertinent to site o inatallation. o. dosing assqui-,•osil. EVALUAlrED BY: Signatur e. of evaluator, title, and date of evaluation. Professional engineers must seal all c;ccurnerstation WO:INSHlciET ELEVATION OIF BENCHMAXK / EF ENCE LK`Z.N 1:S: BENCHMARK SITE 1 SI;...: 2 Shicili 3 [-l-] SHOT: HI. H.II. FI SHOT -] SHOT FI SHOT APPLICATION FOR: New System ] Existing System 0 Holding Tank fl 4]- Temporary /Experimental `L ] Repair [/rl1J Abandonment WA] Other(Specify) APPLICANT: AGENT: STATE OF FLORIDA PERMIT 1 c `7 / DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES DATE PAID ONSITE SEWAGE DISPOSAL SYSTEM FEE PAID $ APPLICATION FOR CONSTRUCTION PERMIT RECEIPT # Authority: Chapter 381, FS & Chapter 10D -6, FAC e4v/ea /6-1gwv ' C �t ,f 4 MAILING ADDRESS: A). I 6f3 2 247 4 1 et *rem 33 TO BE COMPLETED BY APPLICANT OR APPLICANT'S AUTHORIZED AGENT. ATTACH BUILDING PLAN AND TO -SCALE SITE PLAN SHOWING PERTINENT FEATURES REQUIRED BY CHAPTER 1OD -6, FLORIDA ADMINISTRATIVE'CODE. PROPERTY INFORMATION [IF LOT IS NOT IN A RECORDED SUBDIVISION, ATTACH LEGAL DESCRIPTION OR FEED] LOT: PROPERTY ID #: PROPERTY SIZE: BLOCK: PROPERTY STREET ADDRESS: DIRECTIONS TO PROPERTY: BUILDING INFORMATION Unit Type of No. of Building # Persons Business Activity No Establishment Bedrooms Area Sqft Served For Commercial Only ✓r &�/ t 3 3 4 [j Garbage Grinders /Disposals [ #1 Ultra -low Volume Flush Toilets APPLICANT'S SIGNATURE: SUBDIVISION: 9Y/Y FE? rititi DATE OF SUBDIVISION. [Section /Township /Range /Parcel No.] ZONING: ACRES [Sqft/43560] PROPERTY WATER SUPPLY: [ ] PRIVATE [Pi PUBLIC [I/RESIDENTIAL [ ] COMMERCIAL /4x71) A WA] Spas /Hot Tubs 1( Floor /Equipment Drains [ Other (Specify) DATE: r Pi g1 4, HRS -H Form 4015, Mar 92 (Obsoletes previous editions which may not be used) (Stock Number: 5744 - 001-4015-1) TELEPHONE: 4 2///...5741 0 1 7 6 6167... Page 1 of 3 • t STATE OF FLORIDA DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PERMIT Permit Application Number 9 /7�7 Scale: Each block represents 5 feet and 1 inch = 50 feet. /JE. ?tiff- . ( sozoy Slab 1 Sclif oft f 1 1 L1 Notes: 6 15 , Drams eirk ` ' L- wit Site Plan submitted by!--- Plan Approved By PART II - SITE PLAN Imo- wAU goo - Tusk s 3o ' owl dAat'AlleliS .✓ c-e) &riE7c J HRS -H Form 4015, Feb 85 (Obsoletes previous editions which may not be used) (Stock Number. 5744-002-4015-6) SIGNATURE TI Not Approved Date • County Public Unit ALL CHANGES MUST BE APPROVED BY THE COUNTY PUBLIC HEALTH UNIT Page 2 of 3 Permit No Owners Name and Address Registered Architect and /or Engineer Employing Plumber's Mane Al6tvi. 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)_ New Building_. Size Septic Tank_ Feet of Drain Tile Nature of Water Supply: City —Well. Amount of Permit $ MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the building or other structure herein described. This application is made in compliance and conformity with the Building Ordinance of Miami Shores Village, Florida, and all provisions of the Laws of the State of Florida, all ordinances of Miami Shores Village and all rules and regulations of the Building 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. ✓ " o ` No —2 Street..:." " 99 s/ _. seek Jim / Na ._.......... - .. .ve, • g - _ .._.. Remodeling - .._.—_ -- Addition.. -_ - - -_ . Repairs. 1 No. of Stories Type of Tank nisi. Feet of Tank or Drain Field from Well Size of Soakage Pit. Plumbing Inspector. The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations as an employer of labor under the Florida Workmen's Compensation Act, being Section 5968, Compiled General Laws of Florida Pennanent 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 suc ublic notice or notices as are required by the Act. The undersigned agrees to employ only such sub - contractors, on � to be - • . under this permit, as are licensed by Miami Shores Village. STATE OF FLORIDA, u. COUNTY OF DADE. j Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take aclmowledgments, personally appeared to me well known, and who, being by me first duly sworn, upon oath deposes and says that he is the of the above described construction, that be has carefully Bead 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 whoa snob solospeotlon is mede•aeomeary by Improper motley for iaspectioa, or faulty marshals and /ar wro k snahip. Subdivision__ �; T Street �/ � - . (Signed) T. ' 7 "1 J (Signed) Master Plumber. CLOSET[ BATH TUBS SHOWER[ LAVA. TORIES S SLOP SINK[ LAUNDRY Tuss URINAU CATCH SAWN FLOOR DRAIN DRINK NO FOUNT' NS T Ft cows. LIST CHECK SEPTIC TANK SEWER CONN. DRAIN FIELD *CACAOS PIT GRIMM TRAP SOLAR HEATER DEEF WELL S SYSTEM SWIM'0 POOL CONTR. LIST r -- CHICK Permit No Owners Name and Address Registered Architect and /or Engineer Employing Plumber's Mane Al6tvi. 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)_ New Building_. Size Septic Tank_ Feet of Drain Tile Nature of Water Supply: City —Well. Amount of Permit $ MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the building or other structure herein described. This application is made in compliance and conformity with the Building Ordinance of Miami Shores Village, Florida, and all provisions of the Laws of the State of Florida, all ordinances of Miami Shores Village and all rules and regulations of the Building 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. ✓ " o ` No —2 Street..:." " 99 s/ _. seek Jim / Na ._.......... - .. .ve, • g - _ .._.. Remodeling - .._.—_ -- Addition.. -_ - - -_ . Repairs. 1 No. of Stories Type of Tank nisi. Feet of Tank or Drain Field from Well Size of Soakage Pit. Plumbing Inspector. The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations as an employer of labor under the Florida Workmen's Compensation Act, being Section 5968, Compiled General Laws of Florida Pennanent 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 suc ublic notice or notices as are required by the Act. The undersigned agrees to employ only such sub - contractors, on � to be - • . under this permit, as are licensed by Miami Shores Village. STATE OF FLORIDA, u. COUNTY OF DADE. j Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take aclmowledgments, personally appeared to me well known, and who, being by me first duly sworn, upon oath deposes and says that he is the of the above described construction, that be has carefully Bead 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 whoa snob solospeotlon is mede•aeomeary by Improper motley for iaspectioa, or faulty marshals and /ar wro k snahip. Subdivision__ �; T Street �/ � - . (Signed) T. ' 7 "1 J (Signed) Master Plumber. Size Septic Tank Feet of Drain Tile Permit No.f __/ _ C.. F Date Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the building or other structure herein described. This application is made in compliance and conformity with the Building Ordinance of Miami Shores Village, Florida and all provisions of the Laws of the State of Florida, all ordinances of Miami Shores Village and all rules and regulations of the Building Divisior of Miami Shores Village shall be complied with, whether herein specified or not. A copy of approved plans and specifications must be kept at building during progress of work. Owner's Name and Address C li 4 No. 9 c. Street 7, Registered Architect and /or Engineer Employing Plumber's LY__ Name. X24( Location and Legal Description Lot Street and Number where work is to be performed —No. 5 ! e State work to be performed and purpose of building (By Floors) New Building Remodeling Nature of Water Supply: City -Well Amount of Permit $ The undersigned applicant for this building permit does hereby certify under the Florida Workmen's Compensation Act, being Section 5968, Com plied with the provisions thereof, and will require similar compliance fro performed under this permit; and will post or cause to be posted for inspe required by the Act. The undersigned agrees to employ only such sub - licensed by Miami Shores Village. My Commission Expires MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT Block Addition__ (Si (Signed)- — . No /— 3 3 CI- Street a Subdivision Repairs No. of Stories Capacity Gals._.. Type of Tank_ ._--Dist. Feet of Tank or Drain Field from WeIL Size of Soakage Pit___ lumbing I Spector. at he un rstands and accepts his obligat •ns as an emplo er of labor iled General Laws of Florida Permanent Supplement, an has com- all contra tors or sub - contractors employed by him in the ork to be on on the site of the work such public notice or noti es as are ntrac • rs, on work to be pe rmed under this permit, as arc Notary Public, State of Florida Master Plumber. STATE OF FLORIDA, } COUNTY OF DADE. Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeare to me well known, and who, being by me first duly sworn, upon oath deposes and says that he is the of the above described construction, that he has carefully read the foregoing application, and that he did sign the same, and that all fu' therein by him stated are true. NOTE: A re- inspection fee of $1.00 will be made when such re- inspection is made necessary by improper notice for inspection, or faul materials and /or workmanship. CLOSETS BATH TUeS SHOWERS LAVA- TORIES SINKS SLOP SINKS LAUNDRY Tuns URINALS CATCH BASIN FLOOR DRAIN DRINKING FOUNT'NS TOTAL FIXTURE! 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 Size Septic Tank Feet of Drain Tile Permit No.f __/ _ C.. F Date Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the building or other structure herein described. This application is made in compliance and conformity with the Building Ordinance of Miami Shores Village, Florida and all provisions of the Laws of the State of Florida, all ordinances of Miami Shores Village and all rules and regulations of the Building Divisior of Miami Shores Village shall be complied with, whether herein specified or not. A copy of approved plans and specifications must be kept at building during progress of work. Owner's Name and Address C li 4 No. 9 c. Street 7, Registered Architect and /or Engineer Employing Plumber's LY__ Name. X24( Location and Legal Description Lot Street and Number where work is to be performed —No. 5 ! e State work to be performed and purpose of building (By Floors) New Building Remodeling Nature of Water Supply: City -Well Amount of Permit $ The undersigned applicant for this building permit does hereby certify under the Florida Workmen's Compensation Act, being Section 5968, Com plied with the provisions thereof, and will require similar compliance fro performed under this permit; and will post or cause to be posted for inspe required by the Act. The undersigned agrees to employ only such sub - licensed by Miami Shores Village. My Commission Expires MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT Block Addition__ (Si (Signed)- — . No /— 3 3 CI- Street a Subdivision Repairs No. of Stories Capacity Gals._.. Type of Tank_ ._--Dist. Feet of Tank or Drain Field from WeIL Size of Soakage Pit___ lumbing I Spector. at he un rstands and accepts his obligat •ns as an emplo er of labor iled General Laws of Florida Permanent Supplement, an has com- all contra tors or sub - contractors employed by him in the ork to be on on the site of the work such public notice or noti es as are ntrac • rs, on work to be pe rmed under this permit, as arc Notary Public, State of Florida Master Plumber. STATE OF FLORIDA, } COUNTY OF DADE. Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeare to me well known, and who, being by me first duly sworn, upon oath deposes and says that he is the of the above described construction, that he has carefully read the foregoing application, and that he did sign the same, and that all fu' therein by him stated are true. NOTE: A re- inspection fee of $1.00 will be made when such re- inspection is made necessary by improper notice for inspection, or faul materials and /or workmanship. Issued to is ni C.ChOreS 1, 0 It Y D PLUMBING PERMIT to install the following described plumbing, in accordance with the laws, state lations of Miami Shores Village, 'Florida and the State of Florida, governs drainage work done in M Shores Village, Florida. For a_story building a Fixtures Fixtures $ Sewer $ tic Tank $ , Total $ Village Plumbing Inspector Received Payment by 1001 12 - Tg - ^rrntt .• * • , :V7 ■Xt%,s'' ,Z) 2 ° : For a (Store: (Res: MIAMI SHORES VILLAGE, FLA, APPLICATION FOR SEP`l'I TANK PERMIT • DIVISION OF PLUMB' NSPECTI{N I herewith submit the following application for a permit co ern the installation of a Septic Tank Relaying: Soakage Pit: Feet of drain tile: /9 Installed by: Date: Address: NEW: Old: Story: ( Addition: Remodeled : Garage: Garage wash floor: Apt: Hotel: Building has: Stores; Offices; _Apes; Hotel Rua; Bedrums Owner or Agent: � ,7 Additional information: PERMIT NO. j /61 Address: Lot No./* ')-•. Block No.q/G/ SUBDIVISI/N Address of work: No. of Plumbing Fixtures: Laundry Tube: Nature of water supply: City: Well: Fee Distant from all wells: Type of tank installed: gallons: Size of Soakage Pit: Purpose of same: Ready for Inspecti.n: Date: APPROVED BY: eONDEMN > ' BY: Remarks: ro New: Office Bldg. Waste water from a: Floor Drains: Tank capacity in Time: r •