150 NE 100 StDate
Type Insp'n
Permit No.
Name
Address
Compa y - C d
Phone # ` ;-
Inspection Date 2 11 10 y
l I
Approved
Correction
MIAMI SHORES VILL
BUILDING DEPARTME
305- 795 -2204
Building Inspection Request
Re- Insp'n Fee ❑
MIAMI SHORES VILLAGE
BUILDING DEPARTMESNT
305- 795 -2204
Building Inspection Request
Date l 1 Z 61 u '1 Time
Type Insp'
Permit
Name c
Address 15 n C. t D O i k
Compar(y �f , c 1 —.211174
Phone #
For Inspector: / / 2.6 /0
Approved
Correction ❑
Re- Insp'n Fee ❑
Date
BUILDING
PERMIT APPLICATION
FBC 2001
Permit Type (circle): Building Electrical Plumbii Mechanical Roofing
Owner's Name (Fee Simple Titleholder) T V J N 5h U 4 I i Phone # L0$ 7.5 /1 k 3
'✓Owner's Address /, 7 /V L /4 0 _..-1---
l t y M ` a v n i s hn r eCState FL- Zip 3 .3 /
Ter�at tLi essee-Natne N Phone #
Job Address (where the work is being done ✓5 y�� /A4 s+
City Miami Shores Village County Miami -Dade Zip 3 3 /3
Is Building historically Designated YES NO A e)
Contractor's Company Name ✓ � V. " 1. SOP 1,
yr 'Wart i' Lh C-
Contractor's AddresV /q9 3z N W . A✓e-
City (-/ M i a vri t State t" 1= L-- Zip ,) 33 z d 9
Qualifier V
Architect/Engineer's Name (if applicable) /A Phone #
5 Value of Work For this Permit — 24D0.06 , Square Footage Of Work:
(Continued on opposite side)
Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
Total Fee Now Due $ 1 5 P AID
Master Permit No.
Phone # v�J 6J 8's'?
Permit No.
* * * * * * * * * * * * * * * * * * * * * * * * * * ** F ees * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
Type of Work: ['Addition ['Alteration ENew ) Repair/Replace ❑ Demolition
Describe Work / .7P a / S r° �jtr G 1 1<
liopn w d rrli y P I d
Submittal Fee $ Permit Fee $ /2c CCF $ 1' �3 n O CO /CC
Notary $ S.. C7 i Training/Education Fee $ ' 0 Technology Fee $ 3 7
Scanning $3 .' Radon $ Zoning Bond $ 30D
Code Enforcement $ Structural Plan Review. $
Bonding Company's Name (if applicable)
Bonding Company's Address
City , State Zip
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address
City State Zip
Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has
commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulating
construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRICAL WORK, PLUMBING, SIGNS,
WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and AIR CONDITIONERS, ETC
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.
"WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT 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."
Notice to Applicant: As a condition to the issuance of a building permit with an estimated value exceeding $2500, the applicant must
promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person
whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site
for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the
inspection will not be approved and a reinspection fee will be charged. j
Signature
Signature v \
Contractor
The foregoing instrument was acknowledged before me this The forego' g instrument was acknowledged before me this
day of ,20O',by� v�p S IU4Plt, day of , ,by
who is personally known to me or who has produced who is
As identification and who did take an oath.
NOTAR LIC:
Sign:
Print.
wner or Agent
X A
eia
kiy 001gOAR
My Commission Expire cie Expires Movemtwr 15.2005
**************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
Chc 12/15/03
(Certif
me or who has produced
as identification and who did take an oath.
NOTARY PUBL
Sign:
,.1 CIAI NOTARY SEAL
Print: z , .. q n C NUMBER
ir:NII e s I p o• f•.,
My Comrnission -
r -...- P. ?Y COMMISSION EXPIRES
OF FV MAR 1,2006
* * * * * * * * * * * * * * * * * * * * * * * * * * ** i[ '*iriE* * * * * * * * * * * * * * * * * * * * * * **
to of Competency Holder)
State Certificate or Registration No. / Certificate of Competency No.
APPLICATION APPROVED BY. ■ � FA i tA / /ate Oa?' 0 Plans Examiner •
' _
Engineer
Zoning
02/05/2004 10:49 3056515610
STATE OF FLORIDA
DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM
CONSTRUCTION PBRMI'
MR C SEPTIC DRAIN CO
PAGE 03
CENTRAX #: 13 -SG -19194
DATE PAID:
FEE PAID : $
RECEIPT .
OSTDSNBR : 04 -0163- - R.
[ ]New System [ ]Existing System [ )
CONSTRUCTION PERMIT FOR: Holdin Tank [ ] Innovative Other
g [ NA ]
[! X )Repair [ ]Abandonment [
APPLICANT: Shutelt, 8ve1 AGENT: SA0021074, Solomon Teresa
PROPERTY STREET ADDRESS: 150 NE 100 St Miami Shores FL 33138
LOT: 8 BLOCK: 16 SUBDIVISION: [ /Range Parcel No
[OR TAX ID NUMBER]
SYSTEM DESIGN AND SPECIFICATIONS
T
A
N
K
D
R
A
I
N
F
I
E
L
D
[ 300 ]SQUARE
[ 0 ]SQUARE
TYPE SYSTEM:
CONFIGURATION:
TXIS PERMIT IS NOT POR ADDITION.
SPECIFICATIONS BY: Andr4, Paul
APPROVED BY: Andre, Paul
DATE ISSUED: 1/21/04
3Temporary
750 ]Gallons SEPTIC TANK
0 ]Gallons
0 ]GALLONS GREASE INTERCEPTOR CAPACITY
0 ]GALLONS DOSING TANK CAPACITY [ 0 ]GALLONS cs�
FEET PRIMARY DRAINFIELD 5YSTEM
FEET SYSTEM
[ Y 3 STANDARD [ N ] FILLED
[ N ]TRENCH [ y ]BED
DH 4016, 03/97 (obsoletes Previous editions which may not be used)
fcr,s,- nY..mh,.r• 6'7GA- O11- 401F -01 :o4tda corm 401 -11
PROPERTY ID #: 11- 3206 - 013 -2140
SYSTEM
PART EN BE C S ONSUCTED
SYSTEM DOES R NOT CGU WITH
ARANTEE SPECIFICATIONS
SATISFACTORY PERFORMANNCESFOR ANY SPECIFIC CHAPTER 6
SPECIFICTIME
DEPARTMENT APPROVAL OF
PERIOD. ANY CHANGE IN MATERIAL FACTS WHICH SERVED AS A BASIS FOR ISSUANCE OF THIS PERMIT,
REQUIRE THE APPLICANT TO MODIFY THE PERMIT CE OF APPLICATION.
PERMIT BEING MADE NULL AND VOID. ISSUANCE
WITH OTHER FEDERAL, STATE OR LOCAL PERMITTING REQUIRED FOR PROPERTY DEVELOPMENT.
FILL REQUIRED: [ 0.0 ]INCHES EXCAVATION REQUIRED: [ 30.0
OTHER REMARKS:
1 - Existing 750 gallons Septic Tank to remain.
2 - Install 300 square feet of drainfield in bed configuration.
3 Invert elevation of the drainfield to be no less than 8.40 ft NQVD
4 - Bottom elevation of the drainfield to be no less than 7.90 ft NOVD
MULTICHAMBERED /IN SERIES: [Y ]
MULTI- CHAMBERED /IN SERIES: [Y ]
[0 ]DOSES PER 24 HRS # PUMPS[ 0 ]
( N ]MOUND [ N ]
[ N
LOCATION TO BENCHMARK: Existing Finished Floor El.:12.80 Ft Navd.
ELEVATION OF PROPOSED SYSTEM SITE [ 2.4 1 [ FEET ] [ BELOW ]SENCHMARK /REFERENCE
BOTTOM OF DRAINFIELD TO BE [ 4.9 ] [ FEET ] [ BELOW I BENCHMARK/REFERENCE
] INCHES
POINT
POINT
TITLE:
TITLE: Professional Engin Dade CHD
EXPIRATION DATE: 4/20/04
Page 1 of 2
02/05/2004 10:14
APPLICANT
AGENT t
PROPERTY' ADDREss:
LOT, .6 BLOCK: /
imprommormummunimain
CBECXED (I) ITEMS ARK NOT IN COMPLIANCE
o wmi1li mu====afMU r
TANK INSTALLATION
1
l
l
1
1
I
l
1
1
(01]
(02)
(03)
[p
105]
[06]
(07)
(OS)
[04]
3056515610
3056515610
STATX O* FLORIDA '
IMPARTMENT OF HALTS
°MITE S$NAQE TREATMENT AND DIPOBAL BYBTIE
CONSTRUCTION INSPECTION AND FINAL APPROVAL
/ 7ftt./ W
z L C
/76 NC- / /
SUSDIVISI4 ; f/116: 5/11145 Al / mom= ID S // - 3 6G. 6f5 l0U
LEGEND N 1r1
WATERTIGHT
LSVIEL
DEPTS TO LID
WITS
TANK SIZE (1]� c v� (2
TANK =MENIAL Lrx
OOTLET CIVICS f0R-Jc 10v
MULTI- CNANBERID ( I
ounicy PILTsa /06
tosszsrtsul missmaaTICN Sop
001 A R I A ( if 3 0 PI ] 3 e SOFT (/ )
[II] DIS &IEDTION IOZ maws V (j]
(12 ] NUMBER OF D1AIX1 i 5 (( )
IA ]
DRAIRLINI SEPARATION 3 4 rr
DRAINLIEN SLOPD
DIPTN OF COVER
E LEVATION [ABOVS /IILOW] SIM _
S TSTNN LOCATION
DOSING PUMPS
:41a
A4 QR LATH ens IJa . (l.
AGGREGATE EICISSIVN.,FINSD
AGGRIAAMS DEPTS r a
FILL / IIGAVArION MATERIAL
(22] FILL AMOUNT
(233 FILL TEXTURI
(24] EXCAVATION mar=
(25 ) AMA ENFLAMED
( 26) ENPL ACENE NT $IATIRIAL
IIPI,.AN(ATION of VIOLA.TIOES / RAMARws $
[
[
1
1
l
CONSTEUCT`Ioir (APF*WVEI /DISAPPROVED]: .. 1 t (; r
1
� Q Lt's ,
FINAL STITES' (A r /DISAPPROVID] : -¢X
DI 4016, 10/97 (Previous Editions May Bs Used)
r1R C SEPTIC DRAIN CO
SETBACK'
[ 27] SULFA= WATER
[2S) DITCRES
PERMIT NO.
RATS PAID:
P PA['D
RECEIPT i/:
STATUTE OR RULE AND MOST BR CORRECTED.
rs
FT
[39] PRIVATE WELLS PT
(30 MILT C WELLS r'T
01 ] IRRIGATION (MOMS PR
(32) FORAMS MATER LIARS /e' FT
(33) BUILDING (FOUNDATION FT
[34] PROoPIRTT LINES PT
(35) 7 FT
FII.iiD / MOONS STORM
(34 ) D AIRIFIRLD COVER
1 SIDULDIRE
(31) SLOPIS
(39] STABILISATTION
ADDITIONAL INFORMATION
[40] UNOBSTRUCTED ANNA
(411 STORMMATIR RUNOFF
(42]
(43]
(44)
(
(46)
14
(
ALAR>Ss
NRIWTEN NCE AGREEMENT
BUILD/NO AREA
LOCATION CONFORMS NYTII s
FIN11L BITE GRADING
CONTRACTOR (} -.
magi
] (49) TAss. PUMPSt
]
[so] TANK =NM= eL F
ti.-, !0 C.
PAGE 01
smiarsiammwtriorgimple
nassinsunitensounlivarimas
•
CID DATA: /' . • C 4
r� L ' CHD DATE: 1 ,? 3 L i
Pegs.2 of 3
02/05/2004 10:49 3055515610
Scale: Each block represents 5 feet and 1 Inch = 50 feet.
I . . . ..I , .. {• r 1 ■
, • • 4 .. A ' 4 . ,
I . , . i ., . . •
j ..1 •. I
II
1 y .. 4
i .■ w4•. .F...
r'
•
•
. j . • I . ,
ii
Notes:
Q
Site Plan submitted by:
Plan Approved -
By
PART II - SITE PLAN
Signature
Not Approved
MR C SEPTIC DRAIN CO
PAGE 04
STATE OF FLORIDA
DEPARTMENT OF HEALTH
APPLICATION FOR ONStTE SEWAGE DISPOSAL SYSTEM CONSTRUCTION fon Number L) L) � �� e23
-0 ..r --
•
I j . L I�Jt
o
S Ik:: jet
I b
lit
Date I
County Health Department
ALL CHANGES MUST BE APPROVED BY THE COUNTY HEALTH DEPART7EIT
oM �o� a , awe (wp.o.. Nae k Form 401a which may a u -- y (�
�....
61..�..,...,�.,I3..,,.&..1 � �*�.� Page 2 of 3
Miami Shores Village
10050 NE 2nd Avenue
Phone: 305 - 795 -2204
Printed: 2/9/2004
Applicant: EVELYN SHUFELT
Owner: SHUFELT EVELYN
JOB ADDRESS: 150 NE 100 ST
Contractor MR C'S SEPTIC TANK
Local Phone: 305 - 651 - 7859
Parcel # 1132060132140
Signed:
(INSPECTOR)
Plumbing Permit
Permit Number: PL2004 -36
Contractor's Address: P 0 BOX 693239
Page 1 of 1
Legal Description: MIAMI SHORES SEC 1 AMD PB 10 -70 LOTS 8 & 9 BLK 16 LOT SIZE 100.000
Fees: Description Amount
FEE2004 -1208 Building Fee $175.00
FEE2004 -1209 Builders Bond $300.00
FEE2004 -1210 Notary Fee $5.00
FEE2004 -1211 CCF $1.80
FEE2004 -1212 Scanning Fee $3.00
FEE2004 -1213 Technology Fee $4.37
FEE2004 -1214 Training and Education Fee $0.60
Total Fees: $489.77
Total Fees: $489.77
Total Receipts: $489.77
P ot • D
Permit Status: APPROVED Permit Expiration: 8/3/2004 Construction Value: $2,600.00
Work: SEAL SEPTIC TANK CONNECT AND MAKE NEW DRAINFIELD
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 responisibility for all work
done by either myself, my agent, servants or employes.
Signed: (Contractor or Builder) BY:
BUILDING ❑ MIAMI SHORES VILLAGE, FLORIDA
ELECTRICAL ❑
PLUMBING PERMIT N° 8537
ROOFING ❑
Owner of
Building
Architect
Contractor
or Builder
Legal
Description
Address of
Building
Lot
CONTRACTOR or BUILDER
Work to be performed under this Permit
f
.�
,� 1 B1
i /4
at
Contractor's
License No X 49 , 6 7/
Date ,3 . / 19V
.f:
ire 4
Subdi-
vision
Sq Ft
Value of Amount of
Project $ 1 1 Per $
This permit is granted to the contractor or builder named above to construct the building or to install the equipment or device described in the applica-
tion herefor in strict compliance with all ordinances pertaining thereto and with the understanding that the work will be performed in compliance with any
plans, drawings, statements or specifications that may have been submitted to and approved by the proper municipal authorities. This Permit may be revoked
at any time if the work is not done in compliance with such ordinances or if the plans are changed without authorization. A further condition upon which this
permit is granted is the understanding that the contractor or builder named above assumes the responsibility for a thorough knowledge of the ordinances and
regulations pertaining to the work covered hereby whether shown on the plans or drawings or in the statements or specifications and that he assumes respon-
sibility for work done by his agents, servants or employees.
Signed • ✓ � �'1 �t*'`+ '� . °•i` (INSPECTOR) BY .�t ` . - -F
In consideration of the issuance to me of this pezid t 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.
a' r -`=�
BY AUTHORITY
Permit No._ F5
Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the building or other
structure herein described. This application is made in compliance and conformity with the Building Ordinance of Miami Shores Village, Florida,
and all provisions of the Laws of the State of Florida, all ordinances of Miami Shores Village and all rules and regulations of the Building Division
of Miami Shores Village shall be complied with, whether herein specified or not. A copy of approved plans and specifications must be kept at
building during progress of work.
Owner's Name and Address
Registered Architect and /or Engineer � __.__
Employing Plumber's Name ... 1 _ do/e_Z - SC'No..__ -. Street. _ L
Location and Legal Description Lot____.______ —_.___ _ _ __ _ _ Block_
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 Repairs No. of Stories_ ...
Size Septic Tank
Feet of Drain Tile ___Dist. Feet of Tank oreDrain Field from Well
Nature of Water Supply: City—Well.
Amount of Permit $_
STATE OF FLORIDA, 1
COUNTY OF DADE. J
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
1T- `! / - - - - - --
No. _.. _j - Q- -_ _ Street... .e
Type of Tank_ Capacity Gals.
__Size of Soakage Pit
(Sired)- 4 � - %d
( Signed).
3- 23 -6
Date__
Subdivision
Street
Pl umbing 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.
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.
CLOSETS
BATH
TUBS
SHOWERS
LAVA-
TORIES
SINKS
SLOP
SINKS
LAUNDRY
TUBE
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
SW IM'G
POOL
CONTR.
LIST
` -_-
CHECK
Permit No._ F5
Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the building or other
structure herein described. This application is made in compliance and conformity with the Building Ordinance of Miami Shores Village, Florida,
and all provisions of the Laws of the State of Florida, all ordinances of Miami Shores Village and all rules and regulations of the Building Division
of Miami Shores Village shall be complied with, whether herein specified or not. A copy of approved plans and specifications must be kept at
building during progress of work.
Owner's Name and Address
Registered Architect and /or Engineer � __.__
Employing Plumber's Name ... 1 _ do/e_Z - SC'No..__ -. Street. _ L
Location and Legal Description Lot____.______ —_.___ _ _ __ _ _ Block_
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 Repairs No. of Stories_ ...
Size Septic Tank
Feet of Drain Tile ___Dist. Feet of Tank oreDrain Field from Well
Nature of Water Supply: City—Well.
Amount of Permit $_
STATE OF FLORIDA, 1
COUNTY OF DADE. J
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
1T- `! / - - - - - --
No. _.. _j - Q- -_ _ Street... .e
Type of Tank_ Capacity Gals.
__Size of Soakage Pit
(Sired)- 4 � - %d
( Signed).
3- 23 -6
Date__
Subdivision
Street
Pl umbing 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.
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.
9 , 3
Permit No.
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING b ";.,MIT
New Building Remodeling _____ Addition
Amount of Permit $
STATE OF FLORIDA,
COUNTY OF DADE. j
(Signed)_
(Signed) -___
The undersigned applicant for this building permit does hereby certify that he understands and accepts
under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida
plied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors
performed under this permit; and will post or cause to be posted' for inspection on the site of the work
required by the Act. The undersigned agrees to employ only such sub - contract l work to b
licensed by Miami Shores Village.
Date. 4 -v6 usl � s
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 STAI _N 6
Registered Architect and /or Engineer (`
Employing Plumber's Name. M .PiLMf _ S�& CZ LS No. -_- - - --_1 r 6 Street_- /V _ s 7
Location and Legal Description Lot _.._ ---_........ Block_ _- _ - Subdivision
Street and Number where work is to be performed— No._-_-_ ._._.__.______ / A/4 / erO
State work to be performed and purpose of building (By ............ 4..ArA fuF1k L aocir
� - ----- N � OQ
No.----- - - - - -- --- - - - - -- Street_ ------ •----- -•• - --
Size Septic Tank Type of Tank_
Feet of Drain Tile_ _____Dist. Feet of Tank or Drain Field from Well
Nature of Water Supply: City —Well __Size of Soakage Pit
Capacity Gals.
My Commission Expires Notary Public, State of Florida
Master Plumber.
Repairs 1l No. of Stories
Plumbing Inspector.
ligations as an employer of labor
rmanent Supplement, and has corn -
employed by him in the work to be
public notice or notices as are
nder this permit, as are
Before me, the undersigned authority, a notary public, duly authorized to adminis 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 by improper notice for inspection, or faulty
materials and /or workmanship.
CLOSETS
BATH
TUBS
W
SHOWERS
LAVA-
TORIES
SINKS
SLOP
SINKS
LAUNDRY
TUBS
UR
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
SWIM'G
POOL
CONTR.
LIST
-
- - --
-- ._
- .
-
CHECK
-
9 , 3
Permit No.
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING b ";.,MIT
New Building Remodeling _____ Addition
Amount of Permit $
STATE OF FLORIDA,
COUNTY OF DADE. j
(Signed)_
(Signed) -___
The undersigned applicant for this building permit does hereby certify that he understands and accepts
under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida
plied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors
performed under this permit; and will post or cause to be posted' for inspection on the site of the work
required by the Act. The undersigned agrees to employ only such sub - contract l work to b
licensed by Miami Shores Village.
Date. 4 -v6 usl � s
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 STAI _N 6
Registered Architect and /or Engineer (`
Employing Plumber's Name. M .PiLMf _ S�& CZ LS No. -_- - - --_1 r 6 Street_- /V _ s 7
Location and Legal Description Lot _.._ ---_........ Block_ _- _ - Subdivision
Street and Number where work is to be performed— No._-_-_ ._._.__.______ / A/4 / erO
State work to be performed and purpose of building (By ............ 4..ArA fuF1k L aocir
� - ----- N � OQ
No.----- - - - - -- --- - - - - -- Street_ ------ •----- -•• - --
Size Septic Tank Type of Tank_
Feet of Drain Tile_ _____Dist. Feet of Tank or Drain Field from Well
Nature of Water Supply: City —Well __Size of Soakage Pit
Capacity Gals.
My Commission Expires Notary Public, State of Florida
Master Plumber.
Repairs 1l No. of Stories
Plumbing Inspector.
ligations as an employer of labor
rmanent Supplement, and has corn -
employed by him in the work to be
public notice or notices as are
nder this permit, as are
Before me, the undersigned authority, a notary public, duly authorized to adminis 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 by improper notice for inspection, or faulty
materials and /or workmanship.
BUILDING ❑
ELECTRICAL ❑ 1' PERMIT M I T o
PLUMBING ® N . 9132
ROOFING ❑
Owner of
Building
Architect
Contractor
or Builder
Legal
Description
Address of
Building
Lot
9F r
El
I9'
MIAMI SHORES VILLAGE. FLORIDA
CONTRACTOR OR BUILDER(
1
Bl.
DATE `,., 1954_
Contractor's s'
License No '.*- = *'
Work to be performed under this Permit
; r"
%y4
Subdi-
vision
Sq. Ft
Value of
Project $
Amt. of
Permit $
This permit is granted to the contractor or builder named above to construct the building or to install the equipment or device described in the application
herefor in strict compliance with all ordinances pertaining thereto and with the understanding that the work will be performed in compliance with any plans,
drawings, statements or specifications that may have been submitted to and approved by the proper municipal authorities. This Permit may be revoked at any
time if the work is not done in compliance with such ordinances or if the plans are changed without authorization. A further condition upon which this permit is
granted is the understanding that the contractor or builder named above assumes the responsibility for a thorough knowledge of the ordinances and regulations
pertaining to the work covered hereby whether shown on the plans or drawings or in the statements or specifications and that,he assumes responsibility for work
done by his agents, servants or employees.
Signed • , 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 respogrflibili{y'Vor4ll work done by either, myself, my agent, or employee.
1
BY AUTHORITY
17
UILDING
ECTRICAL
LUMBING
wner of
uilding
/ I
ontractor kip
J
Builder li
egal Lot
escription
ddress of
uilding
CO AC OR OR B
MIAMI SHORES VILLAGE, FLORIDA
PE RM IT N? 7423
Work to be performed under this Permit
rchitect
Value of
Project
This permit is grante to t e contractor or builder named above t
:tion herefor in strict compliance with all ordinances pertaining thereto
ans, drawings, statements or specifications that may have been submitted to and. prove
any time if the work is not done in compliance with such ordinances or if the' plans are than
Xmit is granted is the understanding that the contractor or builder named above assumes the
.gulations pertaining to the work covered hereby whether shown on the plans \er draw' u • s or
bility for work done by his agents, servants or employees.
construct the building or to install the equipment or device descr
d w th the understanding that the work will be performed in compliant
the proper municipal authorities. This Permit may be r
Signed.
In consideration of the issuance to me of this permit I agree to perfo
rtgining thereto and in strict conformity with the plans, drawings, state
accepting this permit I assume resp • i sibility for all work done by either
BY
DATE
Contractor's
License No
Amt. of
Permit
194
the appli-
ith any
ked
ed without authorization. A further condition upon which this
esponsibility for a thorough knowledge of the ordinances and
the.tement or sp ifications and that he assu.ees respon-
INSPE TO
vered hereunder in compliance with a ordinances
cations submitted to the proper authorities of Miam
gent, servant or employee.
AUTHORITY
regulations
ores Village.
e/
•
BUILDING
ELECTRIciAL
PLUMBING
Owner of
Building
Architect
Contractor
or Builder
Legal
Description
U____
PERMIT N? 7423
Address of
Building
This permit is granted to the contractor or builder named above t
catic herefor in strict compliance with all ordinances pertaining thereto
plann% drawings, statements or specifications that may have been submitted to aqd ..prove
at4:ny time if the work is not done in compliance with such ordinances or if th plans are cha
permit is granted is the understanding that the contractor or builder named ab've assumes the
regulations pertaining to the work covered hereby whether shown on the plans .r draw'
sibility for work done by his agents, servants or employees.
Signed:
In consideration of the issuance to me of this permit I agree to perfo
pertaining thereto and in strict conformity with the plans, drawings, state
In accepting this permit I assume resp• . sibility for all work done by eithe
CO AC OR OR Bo DER
MIAMI SHORES VILLAGE, FLORIDA
Value of
Project
DATE
Work to be performed under this Permit
Amt. of
Permit
194
Contractor's
License No.
construct the building or to install the equipment or device descri the appli-
d with the understanding that the work will be performed in complianc 'th any
the proper municipal authorities. This Permit may be r ked
ed without authorization. A further condition upon which this
esponsibility for a thorough knowledge of the ordinances and
the atemen ; or sp ifications and that he . ss
BY
INSPECTOR
vered hereunder in compliance with .I "ordinances a
cations submitted to the proper authorities of Miami
agent, servant or employee.
AUTHORITY
es respon-
d regulations
ores Village.
Permit No.__ V-
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 Vic: __s1 No. Street
Registered Architect and /or Engineer
Employing Plumber's Name
r
Location and Legal Description Lot 9 ) 9 Block ___ Subdivision, I. A y
Street and Number where work is to be performed —No. j4-0,
State work to be performed and purpose of building (By Floors)
New Building Remodeling Addition Repairs No. of Stories
Size Septic Tank
Feet of Drain Tile
Nature of Water Supply:
Amount of Permit $
L2'D Type of Tank____ d. _`_l e g?j Capacity Gals
�1 Zi Dist. Feet of Tank or Drain Field from Well
City —Well Size of Soakage Pit �^
umbing In ctor.
The undersigned applicant for this building permit does hereby certify that he under ands and accepts his obligations as an employer of labor
under the Florida Workmen's Compensation Act, being Section 5966, Compiled Gerier Laws of Florida Permanent Supplement, and has com-
plied with the provisions thereof, and will require similar compliance from all contra ors 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 o e site of the work such public notice or notices as are
required by the Act. The undersigned agrees to employ only such sub -contra tors, on work to be performed under this permit, as are
licensed by Miami Shores Village.
ss.
My Commission Expires
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
(Signed)
(Signed)
Date___ 1 _4_
Notary Public, State of Florida
1t
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
CHECK
SEPTIC
TANK
SEWER
CONN.
DRAIN
FIELD
SOAKAGE
PIT
GREASE
TRAP
SOLAR
HEATER
DEEP
WELL
SPRKLR.
SYSTEM
SW IM'G
POOL
CONTR.
LIST
CHECK
Permit No.__ V-
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 Vic: __s1 No. Street
Registered Architect and /or Engineer
Employing Plumber's Name
r
Location and Legal Description Lot 9 ) 9 Block ___ Subdivision, I. A y
Street and Number where work is to be performed —No. j4-0,
State work to be performed and purpose of building (By Floors)
New Building Remodeling Addition Repairs No. of Stories
Size Septic Tank
Feet of Drain Tile
Nature of Water Supply:
Amount of Permit $
L2'D Type of Tank____ d. _`_l e g?j Capacity Gals
�1 Zi Dist. Feet of Tank or Drain Field from Well
City —Well Size of Soakage Pit �^
umbing In ctor.
The undersigned applicant for this building permit does hereby certify that he under ands and accepts his obligations as an employer of labor
under the Florida Workmen's Compensation Act, being Section 5966, Compiled Gerier Laws of Florida Permanent Supplement, and has com-
plied with the provisions thereof, and will require similar compliance from all contra ors 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 o e site of the work such public notice or notices as are
required by the Act. The undersigned agrees to employ only such sub -contra tors, on work to be performed under this permit, as are
licensed by Miami Shores Village.
ss.
My Commission Expires
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
(Signed)
(Signed)
Date___ 1 _4_
Notary Public, State of Florida
1t
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.