PLUMBINGPERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Date 6 0 b0 Job Address 11R. E ` 01 ST Tax Folio I I — 52- 019 0 1 t 0
Legal Description 1..° 1 NtS1 - 0a S Sec t3 Historically Designated: Yes / No
Owner/Lessee / Tenant 10 N� K / e Master Permit # T7 , ,-, /7
Owner's Address 1189 Nf ar 1 h'1SIkCR,C-S Phone (005)667
Contracting Co. S (l C. GO N c1i O NC (t4 C
Qualifier f Ve I\ l SO L0t40
State # S p'KO9 to 4 7 8 Municipal # ' — Competency # Ins. Co.`s) L I,(B NI
Architect/Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type (circle one): BUILDING ELECTRICAL PkIVIBMS MECHANICAL ROOFING PAVING FENCE SIGN
(KSThAA, 10o Trt-* ' ,moo Sty DRPrrN19 ja
WORK DESCRIPTION
Square Ft. 300
WARNING TO OWNER: YOU MUST RECORD A NOTICE OF COMMENCEMENT AND YOUR FAILURE TO DO SO MAY RESULT IN YOUR
PAYING TWICE FOR JMPROVEMENTS 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
con and zoning. F • - enno e, I authorize the above -named contractor to do the work stated.
TERESA J. SO'
MY COMMISSION ='+
EXPIRES: Jul <:J03
1- 300-3-NOTARY Fla. Notary Service & Bonding Co.
to Owner
mmission E
FEES: PERMIT
APPROVED:
Zoning
Mechanical
te
C.C.F.
Address 1 Saco 01A Z P 223 Mt At 1. t
ss# P °) G6i -GC33
Estimated Cost (value) if 2POo , 00
0
1If
f 7ntractor
•
U •'i•7' 1'"�'�Ly t�
er- : " � , YS (VILIAR D
AMY VU13UC STATE OF FLORIDA
OMML iION . CQ14103
I,i.,19SI • EXP. MAR I .
Lirl r _ �NO
No
as to Contractor or
My Commission Expires:
NOTARY
Electrical
erwilder
16/(1' 81430/30
�,Ce 9
-3o -ov
BOND
TOTAL DUE
te
Structural Engineer
APPLICATION FOR:
(N . New System [ 64
J ], Existing System [ J Holding Tank
[)Q] Repair ( Abandonment (r.,1] Other(Specify)
APPLICANT: 0- opsr&t \ nor
AGENT:
MAILING ADDRESS: Iwo r may ,,. z2,3 316
TO. BE COMPLETED BY.APPLICANT,.: APPLICANT'S AUTHORIZED AGENT. ATTACH BUILDING PLAN AND TO- SCALE
SITE PLAN. SHOWING PERTINENT FEATURES REQUIRED BY CHAPTER 10D-6, FLORIDA ADMINISTRATIVE CODE.
PROPERTY INFORMATION [IF LOT IS NOT IN A RECORDED SUBDIVISION, ATTACH LEGAL DESCRIPTION OR DEED]
LOT: 1 BLOCK: ' SUBDIVISION: t S S ceG s eCv SUBDIVISION: 945
PROPERTY ID #: 1 1 - 320 5,,, os c _ o l i o , [Section /Township /Range /Parcel No.] ZONING: 0
ACRES [Sgft /43560] PROPERTY WATER SUPPLY: [ ] PRIVATE [, PUBLIC
PROPERTY SIZE:
PROPERTY STREET ADDRESS: g N i f 101 S- Tize 59) 1 f p
DIRECTIONS TO PROPERTY:
BUILDING INFORMATION
Unit.. Type of
No Establishment
1
2
3
4
J. Garbage Grinders /Disposals
] Ultra -low Volume Flush Toilets
APPLICANT °S SIGNATURE
DH 4015, 10/96 (Replaces HRS -H Form 4015 [Pagel] which niay.be.used)
(Stock Number: 5744 - 001. 40.15 -1)
iG Cor4NECYnor&, I t G
RV ]
PERMIT #
DATE PAID
FEE PAID $
RECEIPT #
,2 g'2
STATE OF FLORIDA
DEPARTMENT OF HEALTH
ONSITE SEWAGE DISPOSAL SYSTEM
APPLICATION FOR CONSTRUCTION PERMIT
Authority: Chapter 381, FS & Chapters 10D -6, FAC
Temporary /Experimental
TELEPHONE: (-30:7) 661 -6633
q S TO NvJ 1 03 s-r eser EST To NE -
PtvE soccit-k Zo NI % sieetr
To NE f2 iNve Noa-Tti To 1 o 0 ST TO iJ0gESS
(X] RESIDENTIAL [ ] COMMERCIAL
No. of Building # Persons Business Activity
Bedrooms Area Sgft Served For Commercial Only
'2121 a
[ ] Spas /Hot Tubs [ ] Floor /Equipment Drains
[ ] Other (Specify)
DATE: t CM
Page _l of 3
INSTRUCTIONS:
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, city, state and zip code mailing address for applicant or agent.
LOT, BLOCK,
SUBDIVISION:
DATE OF SUBDIVISION: Official date of subdivision recorded in county plat books (month /day /year) or date lot originally recorded. Dividing an approved
lot into two or more parcels for the purpose of conveying ownership shall be considered a subdivision of the lot.
PROPERTY ID #: 27 character number for property. (Health Department may require property appraiser 1D# or section /township /range /parcel number.)
PROPERTY SIZE:
Lot, block, and subdivision for lot (recorded or unrecorded subdivision). If lot is not in a recorded subdivision, a copy of the lot
legal description or deed must be attached.
Net usable area of property in acres (square footage divided by 43,560 square feet) 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. Contiguous unpaved and noncompacted road rights -of -way and easements with no subsurface obstructions
may be included in calculating lot area.
WATER SUPPLY: Check private or public.
PROPERTY ADDRESS: Street address for property. For lots without an assigned street address, indicate street or road and locale in county.
DIRECTIONS: Provide detailed instructions to lot or attach an area map showing lot location.
BUILDING INFORMATION: Check residential or commercial.
TYPE ESTABLISHMENT: List type of establishment from Table II, Chapter 10D-6, FAC. Examples: single family, single wide mobile home, restaurant,
doctor's office.
NO. BEDROOMS: Count all rooms designed primarily for sleeping and those areas expected to routinely provide sleeping accommodations for
occupants.
BUILDING AREA: Total square footage of enclosed habitable area of dwelling unit, excluding garage, carport, exterior storage shed, or open or fully
screened patios or decks. Based on outside measurements for each story of structure.
# PERSONS: Number of persons residing, using, or working in establishment. For residential establishment, 2 persons per bedroom are
assumed.
BUSINESS ACTIVITY: For commercial applications only. List number of employees, shifts, and hours of operation, or other information required by
Table II, Chapter 1OD -6, FAC.
FIXTURES: Mark each listed fixture with number installed or "NA" if not applicable.
SIGNATURE: Signature of applicant or agent. Date application on day submitted to Health Department with appropriate fees and attachments.
ATTACHMENTS: A site plan drawn to scale, showing boundaries with dimensions, locations of residences or buildings, swimming pools, recorded
easements, onsite sewage disposal system components and location, slope of property, any existing or proposed wells, drainage
features, filled areas, obstructed areas, and surface water. Location of wells, onsite sewage disposal systems, surface waters, and
other pertinent facilities or features on adjacent property, if the features are with 75 feet of the applicant lot. Location of any
public well within 200 feet of lot.
For residences, a floor plan (residences) showing number of bedrooms and building area of each unit. For nonresidential
establishments, a floor plan showing the square footage of the establishment, all plumbing drains and fixture types, and other
features necessary to determine composition and quantity of wastewater.
• `/r AGENT: , i'`^1 C I� kv S y r ' 0 (�1�►S C
APPLICANT: , , ,� � n 5 +��
LOT: - 1 , . , A B (i ^r SUBDIVISION: N. L O / C � 3 r if `/
PROPERTY ID #: 520S-. 1 ( .., .
WS NE la -o NI Poll
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: ;00
AUTHORIZED SEWAGE FLOW:
UNOBSTRUCTED AREA AVAILABLE:
BENCHMARK /REFERENCE POINT LOCATION:
ELEVATION OF PROPOSED SYSTEM SITE IS p.0 [INCHES] I ABOVE /y] BENCHMARK/R ERENCE PO
THE MINIMUM SETBACK WHICH CAN BE MAINTAINED FROM THE PROPOSED SYSTEM TO THE FOLLOWING FEATURES:
SURFACE WATER: �1p, FT DITCHES/SWALES: pyyp iV ATEF T Islas NON
NORMALLY ?POTABL�.�':�{,'`jy�(�{ FT
`J NO
WELLS: PUBLIC: ] FT LIMITED USE ���,
BUILDING FOUNDATIONS: 5 FT PROPERTY LINES : '',:k 1 FT POTABLE WATER LINES: 10 FT
SITE SUBJECT TO FREQUENT FLOODING: [ ] YES [;1] NO 10 YEAR FLOODING? [ ] YES [X] NO
10 ,YEAR FLOOD ELEVATION FOR SITE: /4(1 FT MSL /NGVD SITE ELEVATION: 8)3 FT MSL /NGVD
SOIL PROFILE INFORMATION SITE
\Pi .T. .0 IJI. 5:c - SOIL PROFILE INFORMATION SITE 2
Munsell #PCdXor Texture
Iola 5,9
USDA SOIL SERIES:4pe pt, 1k k)
Depth
to 72,
to
to
to
to
to
to
to
to
OBSERVED WATER TABLE: INCHES [ABOVE / BE OW] EXISTING GRADE. TYPE: [PERCHED / APPARENT]
ESTIMATED WET SEASON WA ER TABLE ELEVATION: INCHES [ ABOVE / ] EXISTING GRADE.
HIGH WATER TABLE VEGETATION: [ Ts [N NO' :c .,. OTTLINGrA ] YES [x] NO DEPTH: AAA INCHES
SOIL TEXTURE /LOADING RATE FOR SYSTEM SIZING: l
DEPTH OF EXCAVATION: "f/ INCHES
DRAINFIELD CONFIGURATION: [ ] TRENCH [ X] BED [ ] OTHER (SPECIFY)
REMARKS /ADDITIONAL CRITERIA:
SITE EVALUATED BY:
STATE OF FLORIDA
DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES
ONSITE SEWAGE DISPOSAL SYSTEM
SITE EVALUATION AND SYSTEM SPECIFICATIONS
1 a te` `1° 31 . °( - )1l k;i
[Section /Township /Range /Parcel No. or Tax ID Number]
YES [ ] NO NET USABLE AREA AVAILABLE: P, 2 g ACRES
GALLONS PER DAY [RESIDENCES -TABLE 1 / OTHER -TABLE 2]
21°1 GALLONS PER DAY [1500 GPD /ACRE OR 2500 GPD /ACRE] 4
SQFT UNOBSTRUCTED AREA REQUIRED: a 0 SQFT
FE 00
%Aoter&o-
6
HRS-H Form 4015, Mar 92 (ObsoS.efes previous editions which may not be used)
(Stock Number: 5744 -003 - 1)
1
PERMIT #
7
DATE : 8 � co
Munsell # /Color Texture Depth
104 -. S1 ° G S1 ( i ; O " t ° _ 2
to
t0
t0
t0
t0
t0
t0
t0
USDA SOIL SERIES: I,I[Zip3(P
Page 3 of 3
INSTRUCTIONS:
PERMIT 0: Permit tracking number assigned by CPHU.
APPLICANT: Property owner's full name.
AGENT: - Property owner's legally authorized representative.
LOT, BLOCK, SUBDIVISION: Lot, block, and subdivision for lot.
PROPERTY ID #: 27 character number for property. (property appraiser ID 0 or section/township /range /parcel number)
PROPERTY SIZE: Check if property size at site conforms to submitted site plan. Record net usable area available - lot oreo exclusive of
all paved area and prepared road beds within public rights -of -way or easements and exclusive of atrearm, lakes,
normally wet drainage ditches, marshes, or other such bodies of water.
SEWAGE FLOW:
UNOBSTRUCTED AREA:
Record the estimated sewage flow for the establishment from Table 1 (residences) or Table 2 (non- resid:mtial), Chapter
10D -6, FAC. Record the authorized sewage flow for the lot based on net usable creo cnd 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 mut,: be et 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 cctucl elevation. I::;cord the
elevation of the proposed system site in relation (above or below) to the benchmark.
MINIMUM SETBACKS:
Record minimum setbacks which can be meet to all listed features. Actual measurements must be reco-•ded or "NA"
for non applicable features. Features on site plan or within 75 feet of the applicant lot must be measa:ed. The location
of any public drinking well within 200 feet of the applicant's lot must also be verified.
FLOOD INFORMATION: Record information on lot's subject to flooding. LFor lots subject to flooding record 10 year flood elevation for site and
actual site elevation.
SOIL PROFILE INFORMATION: 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.
WATER TABLE: 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 coil maps, and
historical information. Indicate if there is high water table vegetation present. Indicate if mottling is present and depth.
SOIL TEXTURE: Record soil texture or loading rate for system sizing.
DEPTH OF EXCAVATION: 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 documentation submitted.
ELEVATION WORKSHEET ELEVATION OF BENCHMARK / REFERENCE POINT IS:
BENCHMARK SITE 1 SITE 2
[ +] SHOT: H.I. H.I.
H.I. [ -] SHOT [ -] SHOT
SITE 3
H.I.
[ -] SHOT
Scale: Each-block represents 5 feet and 1 inch = 50 feet.
Iffli...
� ••••• •
WINSOME' ■iG N IS IO N■ N ■ t� ii N ■
SEM II M Q ■■r■■INIMM■■■�■ UM
J - '
i
r tI ,
r r 1 ,„
STATE OF FLORIDA
DEPARTMENT OF HEALTH
APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PERMIT
Permit Application Number OC)k
32' cis
Site Plan submitted v:
DH 4015, 10!96 (Replaces HRS-H Form 4015 which may be used)
(Stock Nurrter: 5744 -002- 4015.6)
PART II - SITE PLAN
Sign'ure
Plan Approved Not Approved
Date 03d J b-u
1- ; - L o 20 County Health Department
By � jj 67 _ 1L
ALL HANGES MUST BE APPROVED BY THE COUNTY HEALTH DEPARTMENT
,
w4.
Page 2 of 3
CONSTRUCTION PERMIT FOR:
New System • [X ] Existing System
Repair [X] Abandonment
APPLICANT: • t30�IJN� kP N
Q c
5
PROPERTY ` ADDRESS:' '. �.8 r4 F7 1
[ '(1
[1]
STATE -OF FLORIDA
DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM
CONSTRUCTION PERMIT
PROPERTY ID # : � , " 220S-.. 0)9 - o 110
SYSTEM DESIGN AND SPECIFICATIONS
D
R
A
I
N
F
I
E
L
D
0
T
H.
E
R
FILL REQUIRED: [ Ndv1/44 1 INCHES
SPECIFICATIONS BY:
APPROVED/BY:
DATE ISSUED:
DH 4016, 12/99
g a()
o)
-C,4tAs Inc
(Page 1) (Previous Editions May Be
jit. 1: Health Department
"pt. 2: Applicant
pt. 3: Installer/Contractor
pt. 4: Building Department
[ 1•
S1 •I•N'ECTto11S INC
STReel 33138
[)S] ._Holding Tank
[)C] Temporary
LOT: 1 BLOCK: �6 SUBDIVISION: ( PkI St\OR.FS SEC i3 I2EV.
[SECTION, TOWNSHIP, RANGE, PARCEL NUMBER]
[OR TAX ID NUMBER]
SYSTEM MUST BE CONSTRUCTED IN ACCORDANCE WITH SPECIFICATIONS AND STANDARDS OF SECTION 381.0065,
F.S., AND CHAPTER 64E -6, F.A.C. DEPARTMENT APPROVAL OF SYSTEM DOES NOT GUARANTEE SAFTISFACTORY
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. ISSUANCE OF THIS PERMIT
DOES NOT EXEMPT THE APPLICANT FROM COMPLIANCE WITH OTHER FEDERAL, STATE, OR LOCAL PERMITTING
REQUIRED FOR DEVELOPMENT OFTHIS PROPERTY.
-- 9'00 ] ' / GPD �8'$TIC' TnVAEROBIC UNIT CAPACITY MULTI- CHAMBERED /IN- SERIES [ ]
A I 1 S / GPD CAPACITY MULTI- CHAMBERED /IN- SERIES [ ]
N [ — ] GALLONS GREASE INTERCEPTOR CAPACITY [MAXIMUM CAPACITY SINGLE TANK: 1250 GALLONS]
K [ ] GALLONS DOSING TANK CAPACITY [ ]GALLONS ® [ ] DOSES PER 24 HRS # PUMPS [ ]
(5 () D 1, SQUARE FEET. PRIMARY DRAINFIELD SYSTEM
[ ] SQUARE FEET SYSTEM
TYPE SYSTEM: [X] STANARD [ ] FILLED [ ] MOUND
CONFIGURATION: [ ] TRENCH p-�� [x] BED T [ ] /
LOCATION OF BENCHMARK: la 4 f 4 ..S . ! T - f ` / e '
ELEVATION OF PROPOSED SYSTEM. SITE [$4(/
BOTTOM OF DRAINFIELD TO BE ( ( NCHEg
IN :1: tom+ [ABOVE/
[ABOVE/
EXCAVATION REQUIRED " 3'0 ,' _ ]
TITLE:
Used)
PERMIT NO.
DATE PAID:
FEE PAID:
RECEIPT #:
nnovative
BEN
BENCHMARK/gIMERTPUTVW
INSTALL 92° OF LOAMY COARSE SAN
UNDER BOTTOM OF DRAINFIELD
60J;`, BENCHMARK b i-Uhit iNsPi=te 1 IUW
ooR298]
8-3o-o0
15. 00
xoo R3 0o0
oraao o- ��Wwll 1 Ia i'u FG s�E�i38 jOid(S)
uavc "�unT �d�V TiCiiv - ' /
rneronenerert n, P°d eit ATPrVII WA 'V
1,• u u mss..,.. wu .• u.. •••••om •• . to ...
TITLE: COI.T.IA-C1Qe.._.
1Z
EXPIRATION DATE:
•
F4 rad„- D 6.4., CHn
/M o1
ev
s
Page 1 of 3
INSTRUCTIONS:
PERMIT NUMBER: Permit tracking number assigned by CPHU.
CONSTRUCTION
PERMIT 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. (CHD may require property appraiser ID # or section /township /range/parcel number)
SYSTEM DESIGN AND
SPECIFICATIONS:
" t.
TANK: Minimum specifications from Chapter 64E-6, FAC.
DRAINFIELD: Minimum specifications from Chapter 64E-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 (CHD) personnel reviewing and approving permit.
DATE ISSUED: Date permit is issued by CHD
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.
BUILDING
ELECTRICAL
PLUMBING
Owner of
Building
Architect
Contractor
or Builder
Legal
Description
Lot
MIAMI SHORES VILLAGE, FLORIDA
PERMIT N? 7079
Bl.
DATEfc-
194_
Contractor'
License No.
Work to be performed under this Permit
Subdi-
vision
Address of 3 Value of Amt. of
Building Project Permit
This permit is granted to the contractor or builder named above to construct the building or to install the equipment or deu ce described in the appli-
cation herefor in strict compliance with all ordinances pertaining thereto and with the understanding that the work wil be perform d in compliance with any
plans, drawings, statements or specifications that may have been submitted to and approved by the proper municipal authorities. T s 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 asst mes the e-res 'onsibility for a thorough knowledge of the ordinances and
regulations pertaining to the work covered hereby whether shown on the plans or drawing's dr in the statements or specification t a s and-tha assumes respon-
Signed / / / sibility for work done by his agents, servants or employees. �
1' � � =�1. _ .. B
INSPECTOR
In consid -. on of the issuance to . of this permit I agree to "perform the work covered hereunder in compliance with all ordinances and regulations
hg a ict conformit i with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village.
ccep it I assume res•o iii 'ty for a work done by either myself, my agent, servant or employee.
BY
AUTHORITY
BUILDING
ELECTRICAL
PLUMBING
„,-# CONTRACTOR OR BUILDER
MIAMI SHORES VILLAGE, FLORIDA
ERMIT N? 6946
Work to be performed under this Permi
Architect
Contractor
or Builder
Legal �'Lot Bl.
Description A ddress of Zif I T J Value of
Buildin" Project
Signed.
In consideration of the issuance to me of this permit I agree to perform
pertaining thereto and in strict conformity with the plans, drawings, statem
In accepting this permit I assume responsibility for all work done by either
Subdi-
vision
BY
DATE 194!
Coitrator's
Lice#ISe)No.
This permit is granted to the contractor or builder named above to construct the building or to install the equipment or devicfdescribed in the appli-
cation herefor in strict compliance with all ordinances pertaining thereto and with the understanding that the work will be performed in complian wi any
plans, drawings, statements or specifications that may have been submitted to and approved by the ro.er municipal authorities. This Permit m be re+o ed
3t any time if the work is not done in compliance with such ordinances or if the plans are c :raged is out authorizatioq(A further conditionypon whit',' this
permit is granted is the understanding that the contractor or builder named above : ssumes e re o sibility for a thb bugh knowledge of the ordina"
regulations pertaining to the work covered hereby whether shown on the plans or . a or ' "statterneits'oi' cifications and that e assu
sibility for work done by his agents, servants or employees.
I
INSPECTOR
e work covered hereunder in compliance with allPordinances andge af)ons
s or specifications submitted to the proper authorities of Miami Shores Village.
self, my agent, servant or employee.
AUTHORITY
idt
LDING
ECTRICAL
PLUMBING
Owner of
Building
Architect
Contractor'
or Builder
Legal
Description
Address of
Building
Work to
MIAMI SHORES VILLAGE, FLORIDA
DATE ` 6 1942)
Contractor's
License N
r /
b_ ; N. 1* =401T /a.
:MAW
.! • All 4 4
AP"' 0-4/` ` `J ■W—d
Subdi-
vision
Value of
Project
Amt. of
Permit
PERMIT N? 6860
erformed under this Permi
This iie i is granted to the con ac or or bui der named abo e to construct the building
cation herefor in strict compliance with all ordinances pertaining thereto and with the understandin
plans, d drawings, statements or specifications that may have been submitted to and approved by the
at any,time if the work is not done in compliance with such ordinances or if the plans are hanged
re
permit is granted is the understanding that the contractor or builder named above as
regulations pertaining to the work covered hereby whether shown on the plans o . . gs
sibility for wol'k done by his agents, servants or employees.
Sign
BY
OR
install the equipment or de ice de ribed in the appli-
that the work will be performed i. compliance with any
proper municipal authorities. This ermit may be revoked
without authorization. A further condi on upon which this
ility for a thorough knowled • • y �. a ordinances and
atements or specifications
By
assumes respon-
In consideration of the issuance to me of this permit I agree to rform,' e ork covered hereunder• in compliance with asirdinances and relgultiti
pertaining thereto and in strict conformity with the plans, drawings, s te -nts or specifications submitted to the proper authorities of Miami Shorg V111 '
In accepting this permit I assume responsibility for all work done by eith4r myself, my agent, servant or employee.
AUTHORITY
BUILDING
ELECTRICAL
PLUMBING
Architect
Contractor
or Builder
Legal
Description
Lot
MIAMI SHORES VILLAGE, FLORIDA i
DATE 194 -
,,PERMIT N? 6946
Work to be performed under this Permit / `
Owner of >'' 1` c` f . (
Building""'
J
Bl.
Address of ■3
Project Permit /
This permit is granted to the contractor or builder named above to construct the building or to install the equipment or devi described in the appli-
cation herefor in strict compliance with all ordinances pertaining thereto and w th the understanding that the work will be perform in compliancoVith any
plans, drawings, statements or specifications that may have been submitted to and approved by the proper municipal authorities. This Permit may/be ievok9d
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 up6n which ,this
permit is granted is the understanding that the contractor or builder named above assumes tbe resnon ibility for a thorough knowledge of thy ordinances andt
regulations pertaining to the work covered hereby whether shown on the plans or drawingsior in i.' tih statements,or and thatpe assume Qss.90
sibility for work done by his agents, servants or employees.
Signed. / i 4 4 ,. i.. t,_.. By
INSPECTOR
In consideration of the issuance to me of this permit I agree to perform the work covered hereunder in compliance with all ordinances and regulations
pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village.
In accepting this permit I assume responsibility for all work done by either myself, my agent, servant or employee.
Subdi-
vision
CONTRACTOR OR BUILDER BY
Contractor's
License No
AUTHORITY
Permit No
Application s hereby mad for the approval of the detailed statement of the plans and specifications herewith sub pitted for the uilding 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 5ornplied with, whether herein specified or not. A copy of approved plans and specifications must be kept at
building during progress of wor
Owner's Name and Address.
Registered Architect and /or Engineer
Employing Plumber's Name
Location and Legal Description Lot
STATE OF FLORIDA, l ss.
COUNTY OF DADE.
Amount of Permit $__/ -
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
Block
( Signed)
Date
Street
�p
__ Subdivision
Street and Number where work is to be performed —No Street
State work to be performed and purpose of building (By Floors)
New Building Remodeling Addition Repairs No. of Stories
Size Septic Tank j Type of Tank Capacity Gals
Feet of Drain Tile 9 Dist. Feet of Tank or Drain Field from Well
Nature of Water Supply: City —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 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 th ite of the work such public notice or notices as are
required by the Act. The undersigned agrees to employ only such sub - contractor. j " work to be performed) under his permit, as are
licensed by Miami Shores Village.
( Signed)
Street
•
Before me, the undersigned authority, a notary public, duly authorized to admini er oaths and take acknowledgments, p: s., ally 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
er.
NOTE: A re- inspection fee of $1.00 will be made when such re- inspection is made necessary by improper notice for inspection, or fault'
materials and /or workmanship.
CLOSETS
BATH
TUBS
SHOWERS
LAVA•
TORIES
-SINKS
SLOP
SINKS
LAUNDRY
TUBS
URINALS
U
CATCH
BASIN
FLOOR
DRAIN
DRINKING
FOU NT' NS
TOTAL
FIXTURES
CONTR.
LIST
CHECK
SEPTIC
TANK
SEWER
CONN.
DRAIN
FIELD
SOAKAGE
PIT
GREASE
TRAP
SOLAR
HEATER
DEEP
WELL
SPRKLR.
SYSTEM
SW IM'G
POOL
CONTR.
LIST
CHECK
I
Permit No
Application s hereby mad for the approval of the detailed statement of the plans and specifications herewith sub pitted for the uilding 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 5ornplied with, whether herein specified or not. A copy of approved plans and specifications must be kept at
building during progress of wor
Owner's Name and Address.
Registered Architect and /or Engineer
Employing Plumber's Name
Location and Legal Description Lot
STATE OF FLORIDA, l ss.
COUNTY OF DADE.
Amount of Permit $__/ -
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
Block
( Signed)
Date
Street
�p
__ Subdivision
Street and Number where work is to be performed —No Street
State work to be performed and purpose of building (By Floors)
New Building Remodeling Addition Repairs No. of Stories
Size Septic Tank j Type of Tank Capacity Gals
Feet of Drain Tile 9 Dist. Feet of Tank or Drain Field from Well
Nature of Water Supply: City —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 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 th ite of the work such public notice or notices as are
required by the Act. The undersigned agrees to employ only such sub - contractor. j " work to be performed) under his permit, as are
licensed by Miami Shores Village.
( Signed)
Street
•
Before me, the undersigned authority, a notary public, duly authorized to admini er oaths and take acknowledgments, p: s., ally 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
er.
NOTE: A re- inspection fee of $1.00 will be made when such re- inspection is made necessary by improper notice for inspection, or fault'
materials and /or workmanship.
r
Permit No
Size Septic Tank Type of Tank
Amount of Permit
STATE OF FLORIDA, 1
COUNTY OF DADE.
ss.
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
(Signed)
(Signed)
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 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. 1 Z ( - 77. `/ Street
Registered Architect and /or Engineer
Employing Plumber's Name z ___ No
Location and Legal Description Lot r� Block .
Street_ r-
Subdivision -
•
Street and Number where work is to be performed —No Street / T
State work to be performed and purpose of building (By Floors)
New Building Remodeling Addition Repairs No. of Stories
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
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.
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.
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 faulty
materials and /or workmanship.
1
CLOSETS
BATH
TUBS
SHOWERS
LAVA-
TORIES
SINKS
SLOP
SINKS
LAUNDRY
TUBS
URINALS
C
{� 1
/
FLOOR
/ DRAIN
DRINKING
FOUNT' NS
t ' "t f
,
F� I L.--
TOTAL
FIXTURES
--t
/ '
CONTR.
LIST
d
i
6, _
t
/
CHECK
-
SEPTIC
TANK
SEWER
CONN.
DRAIN
FIELD
SOAKAGE
PIT
GREASE
TRAP
SOLAR
HEATER
DEEP
WELL
SPRKLR.
SYSTEM
SW IM'G
POOL
63:4., ':)
CONTR.
LIST
I
CHECK
r
Permit No
Size Septic Tank Type of Tank
Amount of Permit
STATE OF FLORIDA, 1
COUNTY OF DADE.
ss.
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
(Signed)
(Signed)
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 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. 1 Z ( - 77. `/ Street
Registered Architect and /or Engineer
Employing Plumber's Name z ___ No
Location and Legal Description Lot r� Block .
Street_ r-
Subdivision -
•
Street and Number where work is to be performed —No Street / T
State work to be performed and purpose of building (By Floors)
New Building Remodeling Addition Repairs No. of Stories
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
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.
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.
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 faulty
materials and /or workmanship.
1
Permit No
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__ ____1_C-`_ __I -
Registered Architect and /or- Engineer
Employing Plumber's Na me_
___l,'
Location and Legal Description Lot
Street and Number where work is to be performed —No
State work to be performed an ose of building. (By Floors)
New Building - Remodeling__ Addition Repairs • No. of Stories
Amount of Permit $
Nature of Water Supply: City—Well
ss.
MIAMI SHORES VILLA
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
tr. _ 1.-1q 'o. Street
( Signed)
0
Z
Date 2 6,/W,ci
Street
Subdivision
My Commission Expires Notary Public, State of Florida
Size Septic Tank Type of Tank___ Capacity Gals
Feet of Drain Tile Dist. Feet of Tank or Drain Field from Well
Size of Soakage Pit ,.---
(Signed) I
Plumbing Inspector.
The undersigned plicant for this building permit does hereby certify that he understands and accepts Ms obligations as an employer of labor
under the Florida Wor en'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.
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 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
CATCH
BASIN
FLOOR
DRAIN
DRINKING
FOUNT'NS
® (. !
--
TOTAL
FIXTURES
CONTR.
LIST
./�
v
�Y
/
/
— I
CHECK
SEPTIC
TANK
SEWER
CONN.
DRAIN
FIELD
SOAKAGE
PIT
GREASE
TRAP
SOLAR
HEATER
DEEP
WELL'
SPRKLR.
SYSTEM
SWIM'G
POOL
01-.
ide V
/
7 L
CONTR.
LIST
/
CHECK
//
Permit No
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__ ____1_C-`_ __I -
Registered Architect and /or- Engineer
Employing Plumber's Na me_
___l,'
Location and Legal Description Lot
Street and Number where work is to be performed —No
State work to be performed an ose of building. (By Floors)
New Building - Remodeling__ Addition Repairs • No. of Stories
Amount of Permit $
Nature of Water Supply: City—Well
ss.
MIAMI SHORES VILLA
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
tr. _ 1.-1q 'o. Street
( Signed)
0
Z
Date 2 6,/W,ci
Street
Subdivision
My Commission Expires Notary Public, State of Florida
Size Septic Tank Type of Tank___ Capacity Gals
Feet of Drain Tile Dist. Feet of Tank or Drain Field from Well
Size of Soakage Pit ,.---
(Signed) I
Plumbing Inspector.
The undersigned plicant for this building permit does hereby certify that he understands and accepts Ms obligations as an employer of labor
under the Florida Wor en'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.
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 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.