1155 NE 100 StPermit No. 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 mus be kegt,4 building during the progress of work.
Owner's Name and Address /J /l) acs.$ //S .3 AL , /OD it No. /4 Street /0 0
Registered Architect and/or Engineer ,/
Employ g Pl ber's rNam /9/1 d U A)v At. S C P // & Sit IP(� No .�� G - J `7�/ 8 St / 9(2 3 4)406 ' f f�cfi
�/.3/ �y Slit' . 3 0�
Location and Legal Description Lot �� Blocckk_/ 7 Subdivision Q4
Street and Number where work is to be performed — No. // .57. ®. J
Street
State work to be performed and purpose of building (By Floors)
New Building Remodeling Addition
4 /1 gX
Size Septic Tank
Feet of Drain Tile c0
Nature of Water Supply: City - Well e /r(
Amount of Permit $ °" QO
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
Type of Tank OoNc
Dist. Feet of Tank or Drain Field from Well
Date /be.7f
Repairs No. of Stories
Capacity Gals. 75(9
Size of Soakage Pit
(Signed) tta / ,ii I
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 complied with the provisions
thereof, and will require similar compliance from all contractors or sub - contractors employed by him in the work to be performed under this permit; and will
post or cause to be posted for inspection on the site of the work such public notice or notices as are required by the Act. The undersigned agrees to employ
only such sub - contractors, on work to be performed under this permit, as are licensed by Miami Shores Village.
(Signed) C `C ` %-
132 7 ^ 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 $25.00 will be made when such re- inspection is made necessary by improper notice for inspection, or faulty materials
and/or workmanship.
ss.
My Commission Expires Notary Public, State of Florida
CLOSETS
BATH
TUBS
SHOWERS
LAVA-
TORIES
SINKS
SLOP
SINKS
LAUNDRY
TUBS
URINALS
CATCH
BASIN
FLOOR
DRAIN
DRINKING
FOUNTAINS
TOTAL
FIXTURES
CONTR.
LIST
CHECK
SEPTIC
TANK
SEWER
CONN.
DRAIN
FIELD
SOAKAGE
PIT
GREASE
TRAP
SOLAR
HEATER
DEEP
WELL
SPRKLR.
SYSTEM
SWIM'G.
POOL
CONTR.
LIST
CHECK
Permit No. r,./).
Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the building or other structure
herein described. This application is made in compliance and conformity with the Building Ordinance of Miami Shores Village, Florida, and all provisions
of the Laws of the State of Florida, all ordinances of Miami Shores Village and all rules and regulations of the Building Division of Miami Shores Village shall
be complied with, whether herein specified or not. A copy of approved plans and specifications mus be kegt,4 building during the progress of work.
Owner's Name and Address /J /l) acs.$ //S .3 AL , /OD it No. /4 Street /0 0
Registered Architect and/or Engineer ,/
Employ g Pl ber's rNam /9/1 d U A)v At. S C P // & Sit IP(� No .�� G - J `7�/ 8 St / 9(2 3 4)406 ' f f�cfi
�/.3/ �y Slit' . 3 0�
Location and Legal Description Lot �� Blocckk_/ 7 Subdivision Q4
Street and Number where work is to be performed — No. // .57. ®. J
Street
State work to be performed and purpose of building (By Floors)
New Building Remodeling Addition
4 /1 gX
Size Septic Tank
Feet of Drain Tile c0
Nature of Water Supply: City - Well e /r(
Amount of Permit $ °" QO
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
Type of Tank OoNc
Dist. Feet of Tank or Drain Field from Well
Date /be.7f
Repairs No. of Stories
Capacity Gals. 75(9
Size of Soakage Pit
(Signed) tta / ,ii I
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 complied with the provisions
thereof, and will require similar compliance from all contractors or sub - contractors employed by him in the work to be performed under this permit; and will
post or cause to be posted for inspection on the site of the work such public notice or notices as are required by the Act. The undersigned agrees to employ
only such sub - contractors, on work to be performed under this permit, as are licensed by Miami Shores Village.
(Signed) C `C ` %-
132 7 ^ 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 $25.00 will be made when such re- inspection is made necessary by improper notice for inspection, or faulty materials
and/or workmanship.
ss.
My Commission Expires Notary Public, State of Florida
Date of Application
HRS-H Form 4015, Feb 85 (Obsoletes previous editions which may not be used)
(Stock Number. 5744- 001 - 4015.1)
STATE OF FLORIDA
DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES
APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PERMIT
Type of
Establishment
Authority: Chapter 381, FS
Chapter 10D -6, FAC
PART I - APPLICATION
Name of Owner '� ��'� f1'S.S Telephone Number
TOTAL FLOW =
Permit Application Number
e / 7 /.
Mailing Address of Owner
A4 /00 S 7%
c,/,e. s s 6 - Pr,e s
Owner's Agent Builder
Agent's Mailing Address /-3 3 �!,(i, ( ,, 7 /9- /° Telephone No G -/ 4/
Property Street Address / ' /00
Lot No. Block No Subdivision Date Subdivided
NOTE: IF NOT IN A SUBDIVISION ATTACH A METES AND BO r) ,R TJ t
This Application is for: New System Repair v /> Existing System •
Sewage Flow Sewage Flow
(Gallons per day) ' Based On
Type of No. Bedrooms Heated or Cooled Area No. Dwelling • Sewage Flow
Residential (each dwelling unit) (each dwelling unit) Units (Gallons per day)
ft
ft2
Exact Directions to Property
° 2 4 414 5 �� 4 ra� _�`' .
AUDIT CONTROL NO. Applicant's Signature
Page 1 of 3
Permit No._Q___, _9_
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 AddressC- __ R
2 ran i -- _
Registered Architect and /or g nee r
Employing Plumber's Name Y a�
Location and Legal Description Lot__
Street and Number where work is to be performed—No-it-IS
State work to be performed and purpose of building (By Floors)
New Building 4 Remodeling Addition Repairs No. of Stories
Size Septic Tank O e
Feet of Drain Tile
Nature of Water Supply: City —Well
Amount of Permit $__
STATE OF FLORIDA, 1
ss.
COUNTY OF DADE.
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
✓ 11 1 6 ..s... 44 " No Street
Type of Tank Capacity Gals
Dist. Feet of Tank or Drain Field from Well
Size of Soakage Pit
(Signed)
No Street
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 w k to be perfori -d under t11i• permit, as are
licensed by Miami Shores Village.
Street
(Signed)__ -_i
Date f 0 — z-4/ v°9
Subdivision
My Commission Expires Notary Public, State of Florida
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
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
4r
CHECK
Permit No._Q___, _9_
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 AddressC- __ R
2 ran i -- _
Registered Architect and /or g nee r
Employing Plumber's Name Y a�
Location and Legal Description Lot__
Street and Number where work is to be performed—No-it-IS
State work to be performed and purpose of building (By Floors)
New Building 4 Remodeling Addition Repairs No. of Stories
Size Septic Tank O e
Feet of Drain Tile
Nature of Water Supply: City —Well
Amount of Permit $__
STATE OF FLORIDA, 1
ss.
COUNTY OF DADE.
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
✓ 11 1 6 ..s... 44 " No Street
Type of Tank Capacity Gals
Dist. Feet of Tank or Drain Field from Well
Size of Soakage Pit
(Signed)
No Street
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 w k to be perfori -d under t11i• permit, as are
licensed by Miami Shores Village.
Street
(Signed)__ -_i
Date f 0 — z-4/ v°9
Subdivision
My Commission Expires Notary Public, State of Florida
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.