The URL can be used to link to this page

285 NE 100 St (16)MIAMI SHORES VILLAGE BUILDING DEPART 305- 795 -2204 Building Inspection Request Date Type Insp'n Permit No. Name Address Company Phone # Inspection Date Approved Correction Re- Insp'n Fee MIAMI SHORES VILLAGE BUILDING DEPARTMENT 41 305- 795 -2204 Budding Inspection Request Date q 11 Type Insp'n . I " �� (r DrainG n Pro' Permit No. P to( t Name Address Phone # Company { 1Vc-Ici 1 JCdY Inspection Date Approved Correction Re- Insp'n Fee 9b s Na IC0 sa- i1I1U (3:L_ Miami Shores Village Building Department BUILDING PERMIT APPLICATION FBC 2001 Permit Type (circle): Building Electrical Plumbing Mechanical Roofing Owner's Name (Fee Simple Titleholder) r 14,7 T A)//?/LL:- `� Pl �il f/?/ Phone # Owner's Address //L /07)771 , DEL T Cit M t,gz{7 / , - -- 1.10W - - 74 State rL- e%/2/2)� Zip J �. Tenant/Lessee Name Phone # Job Address (where the work is being done) 73 A t< /co 2/ ' -/RL_•& l City Miami Shores Village County Miami -Dade Zip 3 5 /3 Is Building Historically Designated YES NO Master Permit No. 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 Permit No. el-- 7-4 S Contractor's Company Name L LO- 7) 4../(Z77 / ra ZL Phone # OS - %3 /' � .., �/ Contractor's Address `I t) A LAli , /0 717 c:3 7RCC T City /7 /Ii14 / State FL Zip 3 5-/6 r Qualifier LL 7C� CcCA 7 Architect/Engineer's Name (if applicable) Architect/Engineer's Address City State Zip $ Value of Work For this Permit 4 c Y 7). LV Phone # 1 030 6M._ SPA /C 7/7✓ ) ork: Number of: Bays Stories Families Bedrooms Baths Type of Work: ['Addition ['Alteration ❑New Repair/Replace ❑ Demolition Describe Work: RE-PLACE': & P7 C l 1 1 A.:51 * * * * * * * * * * * * * * * * * * * * * * * * * * ** F ees * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** County Escrow Fee $ e CO 0 Permit Fee $ 11 J -Q 0 . Notary $ 5 . CO . Education/Training Fee $ 1 Tech $ L i - 3 7 Scanning $ 3 .00 Radon $ Code Enforcement $ Bond $ 300 - . / Struct. $ Minus Plans Check Fee $ Total Fee Now Due $ 4-6 �O , 1 (Continued on opposite side) 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. -- Signatur NOTARY Sign: The foregoing instrument was acknowledged before me this Si/1 day of )Cc , 20 CV, by ' C8l Z 1,k (who is personally known tQor who has produced As ide 'on and who did take an oath. 1 < i4 ** OF F rix �• .CROCKED MY COMMISSION # DD 014762 .ontled Thru Budget Notary Services ): A Print: LL= 5 - My Commission Expires: chc7nro3 Owner or Agent State Certificate or Registration No. APPLICATION APPROVED BY: **** * * * * * * * * *** * * * * * * * * * * * * * * * * * ** ** * * * ** ****************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** Signature Contractor The foregoing instrument was acknowledg d before me this (11 day of C-4/1 201/b, by UV who i ersonally known to me or who has produced as identification and who did take an oath. NOTARY PUB Sign. Print: My Commission Ex xpires: Jul 13, 200 �... Bonded Thru * * * * * * * * * * * * * * * * * * * ** 4a}Q , ,. y wkiiitacini6rcirr , * * * ** petency Holder) Certificate of Competency No. " i Plans Examiner Engineer Zoning CONSTRUCTION PERMIT FOR: [ ]New System [ ]Existing System [ [ X ]Repair [ ]Abandonment APPLICANT: Bourne, Robert J. STATE OF FLORIDA DEPARTMENT OF HEALTH ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM CONSTRUCTION PERMIT AGENT: SR0001343, Crockett Lester PROPERTY STREET ADDRESS: 285 NE 100 St Miami Shores FL 33138 LOT: 21 BLOCK: 34 SUBDIVISION: Miami Shores Sec [Section /Township /Range /Parcel No.] PROPERTY ID #: 11- 3206 - 013 -4700 [OR TAX ID NUMBER] SYSTEM MUST BE CONSTRUCTED IN ACCORDANCE WITH SPECIFICATIONS AND STANDARDS OF CHAPTER 64E -6,FAC DEPARTMENT APPROVAL OF SYSTEM DOES NOT GUARANTEE SATISFACTORY PERFORMANCE FOR ANY SPECIFIC TIME PERIOD. 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 PROPERTY DEVELOPMENT. SYSTEM DESIGN AND SPECIFICATIONS T [ 900 ] Gallons SEPTIC TANK A [ 0 ] Gallons N [ 0 ]GALLONS GREASE INTERCEPTOR CAPACITY K [ 0 ]GALLONS DOSING TANK CAPACITY [ 0 ]GALLONS @ [0 D [ 300 ]SQUARE FEET PRIMARY DRAINFIELD SYSTEM R [ 0 ]SQUARE FEET SYSTEM A TYPE SYSTEM: [ N ]STANDARD [ N ]FILLED I CONFIGURATION: [ N ]TRENCH [ N ]BED N F LOCATION TO BENCHMARK: 12.60'NGVD FF E/R Invert elev. of drainfield no less than 8.60'NGVD Bottom of drainfield elev. no l€ss than 8.10'NGVD SPECIFICATIONS BY: RAM, APPROVED BY: Arrieta, Rolando DATE ISSUED: 1/2/04 TITLE: DH 4016, 03/97 (Obsoletes previous editions which may not be used) (Stock Number: 5744- 001 - 4016 -0) [ostds_cons_4016 -1] CENTRAX #: 13 -SG -19024 DATE PAID: FEE PAID : $ RECEIPT . OSTDSNBR : 03 -3937- -R ]Holding Tank [ ] Innovative Other ]Temporary [ NA ] MULTI- CHAMBERED /IN SERIES: [Y ] MULTI - CHAMBERED /IN SERIES: [Y ] ]DOSES PER 24 HRS # PUMPS[ 0 ] [ N ]MOUND [ N ] [ N ] I ELEVATION OF PROPOSED SYSTEM SITE [ 2.0 ] [ FEET ] [ BELOW BENCHMARK /REFERENCE POINT E BOTTOM OF DRAINFIELD TO BE [ 4.5 ] [ FEET ] [ BELOW BENCHMARK /REFERENCE POINT L D FILL REQUIRED: [ 0.0 ]INCHES EXCAVATION REQUIRED: [ 30.0 ] INCHES OTHER REMARKS: This repair permit is for a unique blackwater, standard, gravity and single -bed system to remain serving the existing single - family residence, it is NOT FOR ADDITION. Install 900 gals. dual - chambered septic tank minimum category 1 [under installer responsability per sec. 64E- 6.013(3)(f) F.A.C.], equipped with an approved filter and a vertical deflector on the outlet device. Install no less than 300 sq. ft. drainfield, replacing the existing and draining to the suitable soil in the side [as per contractor certification], previous confirmation of aforementioned condition in the entire required area plus the 12" wide all around the perimeter to 42" deep. TITLE: Engineer I Dade CHD EXPIRATION DATE: 4/1/04 Page 1 of 2 Scale: Ea block represents 5 feet and 1 inch = 50 feet. fi r 1 11 t 4j1ii'~1 a ]..._ � IT i 1 - t —r T ' Notes: e icawz.t c ,te c '` i1.t • S -- Xte 6, .. ,&a,2J ut,fry t ie G�, . X P iii -(AiJf - t / j ' 2 e%1er; ' eU /Z• 33/3 r Site Plan submitted by: _ Le."- 67E.:.,2. C ( oCke j Signatture Plan Approved vx.oritel0 Arriets (Eng -) Not Approved M la mi Dade County ►' ®STDS Eng'U` on ALL CHANGES MUST BE APPROVED BY THE COUNTY HEALTH DEPARTMENT DH 4015. 10/98 (Replaces HRS•H Form 4015 which may be used) Mod( Number: 5744 - 002. 40158) By STATE OF FLORIDA DEPARTMENT OF HEALTH APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM CCN TRtQ�G�TION \ R� Permit Applica ion Num er - H D epartm ent 1 PART II - SITE PLAN id 7 5EPPC, Qu' °' Title Date D//02 /of County Health Department Page 2 of 3 STATE OF FLORIDA DEPARTMENT OF HEALTH ONSITE SEWAGE DISPOSAL SYSTEM SITE EVALUATION AND SYSTEM SPECIFICATIONS PPPLICANT: ?DoL_,2T ��fUG AGENT: L L-®VD A) %i-/ . ?,L'� Z-PT /C LOT: p +,9) BLOCK: , 3 SUBDIVISION: mwmi of /o,& SC 4 PROPERTY ID #: //_ 30/ ®/5 , a . [Section /Township /Range /Parcel No.,or Tax ID Number] 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: [DYES [ ] NO NET USABLE AREA,AVAILABLE: O 4 ACRES TOTAL ESTIMATED SEWAGE FLOW: GALLONS PER DAY [R ESIDENCES-TABLE/ OTHER -TABLE 2] AUTHORIZED SEWAGE FLOW: SO GALLONS PER DAY [15 00 / ] 00 GPD ACRE OR 2500 GPD ACRE UNOBSTRUCTED AREA AVAILABLE: I SQFT UNOBSTRUCTED AREA REQUIRED: 6,071 SQFT BENCHMARK /REFERENCE POINT LOCATION: F /R.J /5/ /LZ FL171),1 g ELEVATION OF PROPOSED SYSTEM SITE IS [INCHES /FT] [ABOVE /BELOW] BENCHMARK /REFERENCE POINT ,•v THE MINIMUM SETBACK WHICH CAN BE MAINTAINED FROM THE PROPOSED SYSTEM TO THE FOLLOWING FEATURES: SURFACE WATER: AJ -A• FT DITCHES /SWALES: A.J•P1' FT NORMALLY WET? [ ] YESOa/h[ ] NO WELLS: PUBLIC: /• FT LIMITED USE: dJ•A• FT PRIVATE: AJA• FT NON- POTABLE: rJ FT BUILDING FOUNDATIONS: FT PROPERTY LINES: FT POTABLE WATER LINES: /0 FT SITE SUBJECT TO FREQUENT FLOODING: [ ] YES /NO 10 YEAR FLOODING? [ ] YES []NO 10 YEAR FLOOD ELEVATION FOR SITE: �j7 FT MSL /NGVD SITE ELEVATION: /O1 . a e MS NGVD Z � SOIL PROFILE INFORMATION SITE 2 SOIL PROFILE INFORMATION SITE 1 Texture Depth Munsell # /Color / 0 YR A / o L.0141/14Y o » to 5 W t /®tt , A / /0 to A'P j/ iwi to / / to / i, to '1 11 to 1 1! to / / // to 7,..149 UR g4JJL14AJb USDA SOIL SERIES: OBSERVED WATER TABLE: AJ.i INCHES [ABOVE / B •W] s � EXIS NG GRADE. TYPE.: -- PERCHED / APPARENT] ESTIMATED WET SEASON WATER TABLE ELEVATIO : •mod- - j [ ABOV r7 BELOW EXI GRADE. HIGH WATER TABLE VEGETATION: [ ] YES [d NO MOTTLING: [ YES [] NO DEPTH: A. V* INCHES SOIL TEXTURE /LOADING RATE FOR SYSTEM SIZING' /' DRAINFIELD CONFIGURATION: [ k,TRENCH ( B REMMI�RKS /ADDITIONAL CRITERI4: !w j: ..Z1711,4074,2- ()/Vk4, Ai w SITE EVALUATED BY: �Iad DH 4015. 10/96 (Replaces HRS -H Form 4015 [Page 3] which may be used) (Stock Number: 5744- 003 - 4015 -1) # /Color Texture Depth / i LCOM2/ Of' to 5RAJD to /0 9 /0 '/P /2 o /o" to (Ze Y 50411, to 11 /1 to 11 1/ to // /1 to /1 - to 11 to-1 USDA SOIL SERIES: UP A34J 4.4l ■ DEPTH OF EXCAVATION: INCHES t L �� - i ppc4-7 ] OTHER (SPECIFY) l i DATE: /..)- 30-03 Page 3 of 3 INSTRUCTIONS: PERMIT NUMBER: Permit tracking number by County Health Department. APPLICANT: Property owner's full name. AGENT: Property owner's legally authorized representative. LOT, BLOCK, SUBDIVISION: Lot, block, and subdivision for lot. PROPERTY ID NUMBER: 27 character number for property (property appraiser ID number or section /township /range /parcel number). PROPERTY SIZE: Check if property at site conforms to submitted site plan. Record net usable area available - lot area 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. SEWAGE FLOW: UNOBSTRUCTED AREA: MINIMUM SETBACKS: Record the estimated sewage flow for the establishment from Table 1 (residence) or Table 2 (non - residential), Chapter I0D -6, FAC. Record the authorized sewage flow for the lot based on net usable area and 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 must be at 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 I0D -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 actual elevation. Record the elevation of the proposed system site in relation (above or below) to the benchmark. Record minimum setbacks which can be meet to all listed features. Actual measurements must be recorded or "NA" for nonapplicable features. Features on site plan or within 75 feet of the applicant lot must be measured. 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. For 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 soil 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 documents submitted. ELEVATION WORKSHEET ELEVATION OF BENCHMARK / REFERENCE POINT IS: BENCHMARK SITE I SITE 2 SITE 3 [ + ] SHOT H.I. H.I. H.I. H.1. [ - jSHOT ( - ]SHOT [ - ]SHOT Miami Shores Village 10050 NE 2nd Avenue Phone: 305 - 795 -2204 Printed: 1/6/2004 Applicant: BOB Owner: BOUNE JOB ADDRESS: 285 NE 100 Parcel # 1132060134700 Signed: (INSPECTOR) Plumbing Permit Permit Number: PL2004 -5 BOUNE BOB ST Contractor LLOYD NORTH DADE SEPTIC TANK SERVICtEdNgactor's Address: 750 NW 107 ST Local Phone: 305 - 754 -3375 Permit Status: APPROVED Permit Expiration: 7/4/2004 Construction Value: $600.00 Work: REPLACE SEPTIC TANK Page 1 of 1 Legal Description: MIAMI SHORES SEC 1 AMD PB 10 -70 E1/2 OF LOT 21 & LOTS 22 & 23 BLK 34 LOT Fees: FEE2004 -68 FEE2004 -69 FEE2004 -70 FEE2004 -71 FEE2004 -72 FEE2004 -73 FEE2004 -74 Description Building Fee CCF Notary Fee Training and Education Fee Technology Fee Scanning Fee Builders Bond Total Fees: Amount $175.00 $0.60 $5.00 $0.20 $4.37 $3.00 $300.00 $488.17 Total Fees: $488.17 Total Receipts: $488.17 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: Miami Shores Village 10050 NE 2nd Avenue Plumbing Permit Phone: 305 - 795 -2204 Permit Number: PL2004 -4 Printed: 1 /6/2004 Applicant: BOB BOUNE Owner: BOUNE BOB JOB ADDRESS: 285 NE 100 ST Contractor LLOYD NORTH DADE SEPTIC TANK SERVItdNt? actor's Address: 750 NW 107 ST Local Phone: 305 - 754 - 3375 Parcel # 1132060134700 Legal Description: MIAMI SHORES SEC 1 AMD PB 10 -70 E1/2 OF LOT 21 & LOTS 22 & 23 BLK 34 LOT Fees: Description Amount FEE2004 -62 Building Fee $175.00 FEE2004 -63 CCF $1.20 FEE2004 -64 Notary Fee $5.00 FEE2004 -65 Technology Fee $4.37 FEE2004 -67 Training and Education Fee $0.40 Total Fees: $185.97 Total Fees: $185.97 Total Receipts: $185.97 Permit Status: APPROVED Permit Expiration: 7/4/2004 Construction Value: $2,000.00 Work: REPIAR DRAINFIELD Signed: (INSPECTOR) Page 1 of 1 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 PERMIT APPLICATION '1 °. FBC 2001 Miami Shores Village Building Department Permit Type (circle): Building Electrical Plumbing Mechanical Roofing Owner's Name (Fee Simple Titleholder) ' A0,32: - -Z7 - .ILE Phone # Owner's Address ,. �J AJ % /01Y 7H City Y1l f/ll' l/ .5)40,2G-J State fLOT I al Zip 33-/3P Tenant/Lessee Name Phone # Job Address (where the work is being done) ;VS kJ& /a) 77/ E City Miami Shores Village County Miami -Dade Zip 3 3/ 311' Is Building Historically Designated YES NO Contractor's Company Name L LOyZ /Lk 7?'! RE Contractor's Address 7S) /U• t- / 0:7774 %,QL City /er/ State Qualifier Z-1 7-5-70 Architect/Engineer's Name (if applicable) Phone # Architect/Engineer's Address City State Zip $ Value of Work For this Permit $J-40. 01)0 Number of: Bays Stories Families Bedrooms .Baths Type of Work: []Addition DAlteration DNew Repair/Replace - ❑ Demolition Describe Work: RC7)fa /7 r in Permit No. iP1 ZOOY L( `Master Permit No. Phone # 3 " -l ,- ;106 Zip Square Footage Of Work: 3-an 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 Fees * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** County Escrow Fee $ 1..2U'' 11 , Permit Fee $ 19 5- 0 . Notary $ 5.00 • Education/Training Fee $ 1'10 Tech $ 4 - 1 7 _ Scanning $ Radon $ Code Enforcement $ Bond $ ) Struct. $ Minus Plans Check Fee $ Total Fee Now Due $ l C I — 4 - (Continued on opposite side) }Ra, d- ∎ vt ulL e.,tk L%1. 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. Signature O 4 . Signature APPLICATION APPROVED NOTARY IC• Sign: Print: My Commission Expires: chc7/7 /03 Owner or Agent EXPIRES: May20, 2005 e Bonded Thru Budget Notary Services * * * * * * * * * * * * * * * ** * * * * * * * * * ** NOTARY PugiL Contractor The foregoing instrument was acknowledged before me this 3111 The foregoing instrument was acknowledged before me thi day oflc t , 20 by ---- ?\C E3 ;� i t✓/11 day of J �,. 20 W by (who is personally known to m r who has produced w is ersonally known to me or who has produced As identification and who did take an oath. identification and who did take an oath. o r iS fl #1: t gnttc : on• ml_t My Commission Expires: ** flit * ** ** * * * * * * * ** * * * ****** *** ** (Certificate of Competency Holder) State Certificate or Registration No. / Certificate of Competency No. ********************************* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** Plans Examiner Engineer Zoning APPLICANT: • AGENT : PROPERTY ADDRESS: LOT ? BLOCK SUBDIVISION: ;((' I (;1,. . )f; .(i'1. p r 4x (^ PROPERTY ID 1: / / - 3) UG- )72,_ :a�aasasssssssa :ss CHECKED [X] ITEMS ARE NOT IN COMPLIANCE WITH STATUTE OR RULE AND MUST BE CORRECTED. ==-- -•,•----============ TANK INSTALLATION [01] [02] [03] [04] [05] [06] [07] [08] [09] DRAINFIELD INSTALLATION [10] AREA [1] ! [ 2] }C�t: SQFT [11] DISTRIBUTION BOX _ [13] NUMBER OF DRAINLINES [13] DRAINLINE SEPARATION (14] DRAINLINE SLOPE [15] DEPTH OF COVER [16] ELEVATION [ABOVE /BELOW] BM [17] SYSTEM LOCATION (18] DOSING PUMPS • !` 4- (19] AGGREGATE SIZE Ah / ) . d i [20] AGGREGATE EXCESSIVE FINES [21] AGGREGATE DEPTH FILL [ [43] (24] [25] [26] STATE OF FLORIDA DEPARTMENT OF HEALTH ONSITE SEWAGE TREATMENT AND DIPOSAL SYSTEM[ CONSTRUCTION INSPECTION AND FINAL APPROVAL / '.- / /G 1.R?4w LEGEND WATERTIGHT LEVEL DEPTH TO LID r ,Ai TANK SIZE [1] /x) (1] TANK MATERIAL C t` OUTLET DEVICE MUTLTI-CHAMBERED [ j/ N ] S OUTLET FILTER \/!; ` / ' k:a !. / EXCAVATION MATERIAL FILL AMOUNT r FILL TEXTURE EXCAVATION DEPTH AREA REPLACED REPLACEMENT MATERIAL! r s= EXPLANATION OF VIOLATIONS / REMARKS: [ [ [ [ ',p b' r, [\t) (27 ] [ j ] [ [/] [ 29 ] [( 1 [30] [ /4 l [ [ l [ [ ] [33] [ ] [34] [ ] [35] l l 1r SETBACKS PERMIT NO. DATE PAID: FRE PAID: RECEIPT 1: � - ' SURFACE WATER DITCHES PRIVATE WELLS PUBLIC WELLS IRRIGATION WELLS POTABLE WATER LINES I, BUILDING FOUNDATION /'i PROPERTY LINES OTHER FILLED / MOUND SYSTEM [36] DRAINFIELD COVER [37] SHOULDERS [38] SLOPES [39] STABILIZATION ABANDONMENT (49] TANK PUMPED [50] TANK CRUSHED & FILLED // 7. i'1 "1 2 J -1`i�' J ;iP l` /_/ FT FT FT . FT FT FT FT FT FT ADDITIONAL INFORMATION [40] UNOBSTRUCTED AREA [41] STORMWATER RUNOFF [42] ALARMS [43] MAINTENANCE AGREEMENT (44] BUILDING AREA • [45] LOCATION CONFORMS WITH SITE PLAN [46] FINAL SITE GRADING / ��, [47] CONTRACTOR /, / , , ' (1 (> T / ! k d [48] OTHER CONSTRUCT ION([ APPROVED` /DISAPP ROVED ]: •. ,. v t,,,.. 1 � `,7.C.A,S / 4-1 0 c.• am DATE: 1- / (�Li FINAL SYSTEM [APPROVED /DISAPPROVED] : , ..., fS(r f4/144 CND DATE: f ?E ' `Y �.. DE 4016, 10/97 (Previous Editions. May Be Used) Page 2 of 3 ]nstaU[cr / Contractor MIAMI SHORES VILLAGE, FLA. NO 6314 J OB " ",.., S ADDRESS 2 5e'. INSPECTION -°-Jf" _ TIME READY `lel. INSPECTOR REMARKS • DATE BUILDING ELECTRICAL PLUMBING ROOFING Owner of Building • Architect Contractor or Builder CONTRACTOR OR BUILDER MIAMI SHORES VILLAGE, FLORIDA PERMIT N9 5755 Work to be performed under this Perini Legal Lot II Subdi- Description Bl vision Address of r ; , i.�- / & Value of I Amount of 4 • Building k �' '`� �' Projec $ I 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 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 } f, 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 as cepting this permit I assume responsibility for all work done by either, myself, my agent, servant or employee. • DATE 19 -- Contractor's License No. BY AUTHORITY ABBOT Amount of Permit $ $4.00 Permit No Date 12.5-69 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. Dr. Hattesen Owners Name and Address ........ ____--_---_-__--_- ......... _______________ No. Street Registered Architect and /or Engineer Employing Plumber's Name Rose _S- pti_c.. hn)C _ Cn_ P.Q.Rpg_ o,- -H1a1eah._-__— Street_ - Location and Legal Description Lot Block Subdivision ____- __-- __ ..... _____ --__ - � Street and Number where work is to be performed —No 285 N .E,.O .Qth street Street State work to be performed and purpose of building (By Floors) New Building __ -- Remodeling Size Septic Tank _-___— _...... ___- _- _- _-------- - - - -.. Type of Tank_____ Capacity Gals.__ - ._ Feet of Drain Tile _________Dist. Feet of Tank or Drain Field from Well Nature of Water Supply: City — Well.________ ...... _....... ___________...... -_________Size of Soakage Pit My Commission Expires MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT Addition.________ Repairs No. of Stories. (Signed)_ 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- plier 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. Plumbing Inspector. 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 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 TUB6 SHOWERS LAVA- TORIES SINKS SLOP SINKS LAUNDRY TUBS UR CATCH BASIN FLOOR DRAIN DRINKING FOUNT'NS TOTAL FIXTURES CONTR. LIST CHCCK _ - SEPTIC TANK SEWER CONN. DRAIN FIELD SOAKAGE PIT GREASE TRAP SOLAR HEATER DEEP WELL SPRKLR. SYSTEM SWIM'G POOL CONTR. LIST 1 - CHECK 3 Amount of Permit $ $4.00 Permit No Date 12.5-69 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. Dr. Hattesen Owners Name and Address ........ ____--_---_-__--_- ......... _______________ No. Street Registered Architect and /or Engineer Employing Plumber's Name Rose _S- pti_c.. hn)C _ Cn_ P.Q.Rpg_ o,- -H1a1eah._-__— Street_ - Location and Legal Description Lot Block Subdivision ____- __-- __ ..... _____ --__ - � Street and Number where work is to be performed —No 285 N .E,.O .Qth street Street State work to be performed and purpose of building (By Floors) New Building __ -- Remodeling Size Septic Tank _-___— _...... ___- _- _- _-------- - - - -.. Type of Tank_____ Capacity Gals.__ - ._ Feet of Drain Tile _________Dist. Feet of Tank or Drain Field from Well Nature of Water Supply: City — Well.________ ...... _....... ___________...... -_________Size of Soakage Pit My Commission Expires MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT Addition.________ Repairs No. of Stories. (Signed)_ 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- plier 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. Plumbing Inspector. 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 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. Permit No S 5 - Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted fore 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. L' Owner's Name and Address — - = -. V1 • __�IL,, ..__ _ No._ _ S ..N 1 Street . �' _o.. - _ l ._ : Registered Architect and /or E 'neer Employing Plumber's Name -- - ! < . / , ,�i " //�i ! trees Location and Legal Description Lot Block Subdivision__._ ________ Street and Number where work is to be performed —No State work to be performed and purpose of building (By Floors) New Building Remodeling ------ - - - - -- --- ----- - - - - -- - --- - - - - -- Size Septic Tank _ Type of Tank - -- Feet of Drain Tile __Dist. Feet of Tank r Drain F' d from Well Nature of Water Supply: City — Well.___._ _— ___... __ Size of Soakage Pit _____ ._. Amount of Permit $_ ° _. STATE OF FLORIDA, ss, COUNTY OF DADE. My Commission Expires MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT Addition -- -..- -•_-- ----- _ --_ -- Repairs-- -- ._ -_ --. •-_ _ -- _ --. No. of Stories.... .... . .... • - -. (Signed) - — - p ..... 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 coin - 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 thi permit. as are licensed by Miami Shores Village. ( Signed) Street Capacity Gals. /a' -. Notary Public, State of Florida Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments , personall.' 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 TUBS TUBS SHOWERS LAVA- TORIES SINKS SLOP SINKS LAUNDRY TUBS URINALS CATCH BASIN FLOOR DRAIN DRINKING FOUNT' NS TOTAL FI %TORES CONTR. LIST CHICK SEPTIC TANK SEWER CONN. DRAIN FIELD SOAKAGE PIT GREASE TRAP SOLAR HEATER DEEP WELL SPRKLR. SYSTEM SWIM'G POOL CONTR. LIST CHICK Permit No S 5 - Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted fore 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. L' Owner's Name and Address — - = -. V1 • __�IL,, ..__ _ No._ _ S ..N 1 Street . �' _o.. - _ l ._ : Registered Architect and /or E 'neer Employing Plumber's Name -- - ! < . / , ,�i " //�i ! trees Location and Legal Description Lot Block Subdivision__._ ________ Street and Number where work is to be performed —No State work to be performed and purpose of building (By Floors) New Building Remodeling ------ - - - - -- --- ----- - - - - -- - --- - - - - -- Size Septic Tank _ Type of Tank - -- Feet of Drain Tile __Dist. Feet of Tank r Drain F' d from Well Nature of Water Supply: City — Well.___._ _— ___... __ Size of Soakage Pit _____ ._. Amount of Permit $_ ° _. STATE OF FLORIDA, ss, COUNTY OF DADE. My Commission Expires MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT Addition -- -..- -•_-- ----- _ --_ -- Repairs-- -- ._ -_ --. •-_ _ -- _ --. No. of Stories.... .... . .... • - -. (Signed) - — - p ..... 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 coin - 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 thi permit. as are licensed by Miami Shores Village. ( Signed) Street Capacity Gals. /a' -. Notary Public, State of Florida Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments , personall.' 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. do APPLICATION FOR PLUMBING PERMIT r n Date • " �f V 3 1 6/ For.nlf Nc. -� 0 7 -..__ . 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 yvith, whether herein specified or not. A copy of approved plans and specifications must be kept at building during progress of k wor . b Z SL No .•-_ __Q S Owner's Name and Address Registered Architect and /or Engineer Employing Plumber's Name- 1►!111h 1 L e_L __ Amount of Permit $ MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT (SigIIed)_ _ (Signed Street-mE / &v 6/-. " _Pt(C 7 *JIS No._ _-- -_ - - - 7 street_ _A/E ‘ -ST Location and Legal Description Lot.___ ___- __-_-__- _- ___.- __.________ Block___ � .,,__ _ Subdivis ion Street ---- S('147 Street and Number where work is to be performed -No / ._ State work to be performed and purpose of building (By Floors)_ _ � ,;'�it1 1+ � !'IAC New Building _ Remodeling _._.___ ......... ___.___._ Addition Repairs 'Lo. of Stories.... ............. Size Septic Tank _- .- _---- -__ - -- _-Type of Tank___ Capacity Gals Feet of Drain Tile ..... ______ ___ _______________________.__Dist. Feet of Tank or Drain Field from Well Nature of Water Supply: City - Well.______ _ —_._ -Size of Soakage Pit 4 • -- - Plumbing Inspector. The undersigned applicant for this building permit does hereby certify that he understands and accepts his oblig t'•ns as an employer of labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Pernnan t Supplement, and bus com- plied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors d by him in the work to be performed under this permit; and will post or cause to be posted' for inspection on the site •f the work ch p •lic notice or notices as are required by the Act. The undersigned agrees to employ only such sub- contractors, o to b = perfor • ed under this permit, as are licensed by Miami Shores Village. er Plumber. STATE OF FLORIDA, 1 COUNTY OF DADE. I Before me, the undersigned authority, a notary public, duly authorized to administer •aths 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. CLO66T8 BATH TUBS SHOWERS LAVA. TORIES SINKS SLOP SINKS LAUNDRY TUS6 U CATCH BASIN FLOOR DRAIN DRINKING FOUNT'NS TOTAL FIXTURES CONTR. LIrsT CHECK SXPTIC TANK SEWER CONN. DRAIN FIELD SOAKAGE PIT GREASE TRAP SOLAR HEATER DEEP WELL SPRKLR. SYSTEM SWIM'G POOL CONTIt. LIST CHECK do APPLICATION FOR PLUMBING PERMIT r n Date • " �f V 3 1 6/ For.nlf Nc. -� 0 7 -..__ . 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 yvith, whether herein specified or not. A copy of approved plans and specifications must be kept at building during progress of k wor . b Z SL No .•-_ __Q S Owner's Name and Address Registered Architect and /or Engineer Employing Plumber's Name- 1►!111h 1 L e_L __ Amount of Permit $ MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT (SigIIed)_ _ (Signed Street-mE / &v 6/-. " _Pt(C 7 *JIS No._ _-- -_ - - - 7 street_ _A/E ‘ -ST Location and Legal Description Lot.___ ___- __-_-__- _- ___.- __.________ Block___ � .,,__ _ Subdivis ion Street ---- S('147 Street and Number where work is to be performed -No / ._ State work to be performed and purpose of building (By Floors)_ _ � ,;'�it1 1+ � !'IAC New Building _ Remodeling _._.___ ......... ___.___._ Addition Repairs 'Lo. of Stories.... ............. Size Septic Tank _- .- _---- -__ - -- _-Type of Tank___ Capacity Gals Feet of Drain Tile ..... ______ ___ _______________________.__Dist. Feet of Tank or Drain Field from Well Nature of Water Supply: City - Well.______ _ —_._ -Size of Soakage Pit 4 • -- - Plumbing Inspector. The undersigned applicant for this building permit does hereby certify that he understands and accepts his oblig t'•ns as an employer of labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Pernnan t Supplement, and bus com- plied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors d by him in the work to be performed under this permit; and will post or cause to be posted' for inspection on the site •f the work ch p •lic notice or notices as are required by the Act. The undersigned agrees to employ only such sub- contractors, o to b = perfor • ed under this permit, as are licensed by Miami Shores Village. er Plumber. STATE OF FLORIDA, 1 COUNTY OF DADE. I Before me, the undersigned authority, a notary public, duly authorized to administer •aths 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. `•?t Z F o a —__ - — - Date Application is hereby niade for the approval of the detailed statement of the plans and specifications herewith subn{itted for thibuilding or, other structure herein described. This application is made in compliance and conformity with the Building Ordinance of Miami Shores Village, Florida, end 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 n• 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_4JJ— Location and Legal Description Street and Number where work is to be performed —No State work to be performe8 and purpose of building (By Floors) New Building ___._ Remodeling____ — .___.__ Addition.____ No. of Stories. _ Size Septic Tank Amount of Permit $ My Commission Expires MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT Block - Sub • vision ...... ____......... ____._ (� , mo o /00 Repairs — - — — -- ( Signed)-- - ad /C- Street 1 Street__ Type of Tank__ Capacity Gals. Feet of Drain Tile_________ ____________Dist. Feet of Tank or Drain Field from Well Nature of Water Supply: City — Well._-_----------- ....... _.- _____________________ -Size of Soakage Pit 3 Master Plumber. Notary Public, State of Florida Pluming 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 Perin nent Supplement, and has com- plied with the provisions thereof, and will require similar compliance from all contractors or sub- • ac ors e,f ployed by him in the work to be performed under this permit; and will post or cause to be posted' for inspection on th site of a wo such public notice or notices as . are refired by the Act. The undersigned agrees to employ only such sub - contra' ors, o w.. to . - performed under this permit, as are licensed by Miami Shores Village. STATE OF FLORIDA, f 19. COUNTY OF DADE. Before me, the undersigned authority, a notary public, duly authorized to a ter 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. "" BATH TUBS SHOWERS LAVA- TORIES SINKS SLOP SINKS LAUNDRY TUBE URINALS CATCH BASIN FLOOR DRAIN DRINKING FOUNT•NS TOTAL FIXTURES CONTR. LIG? CHECK SEPTIC TANK SEWER CONN. DRAIN. FIELD SOAKAGE PIT GREASE TRAP SOLAR HEATER DEEP WELL SPRKLR. SYSTEM SWIM'G POOL CONTR. LIST - CHECK `•?t Z F o a —__ - — - Date Application is hereby niade for the approval of the detailed statement of the plans and specifications herewith subn{itted for thibuilding or, other structure herein described. This application is made in compliance and conformity with the Building Ordinance of Miami Shores Village, Florida, end 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 n• 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_4JJ— Location and Legal Description Street and Number where work is to be performed —No State work to be performe8 and purpose of building (By Floors) New Building ___._ Remodeling____ — .___.__ Addition.____ No. of Stories. _ Size Septic Tank Amount of Permit $ My Commission Expires MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT Block - Sub • vision ...... ____......... ____._ (� , mo o /00 Repairs — - — — -- ( Signed)-- - ad /C- Street 1 Street__ Type of Tank__ Capacity Gals. Feet of Drain Tile_________ ____________Dist. Feet of Tank or Drain Field from Well Nature of Water Supply: City — Well._-_----------- ....... _.- _____________________ -Size of Soakage Pit 3 Master Plumber. Notary Public, State of Florida Pluming 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 Perin nent Supplement, and has com- plied with the provisions thereof, and will require similar compliance from all contractors or sub- • ac ors e,f ployed by him in the work to be performed under this permit; and will post or cause to be posted' for inspection on th site of a wo such public notice or notices as . are refired by the Act. The undersigned agrees to employ only such sub - contra' ors, o w.. to . - performed under this permit, as are licensed by Miami Shores Village. STATE OF FLORIDA, f 19. COUNTY OF DADE. Before me, the undersigned authority, a notary public, duly authorized to a ter 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. BUILDING ELECTRICAL ' PLUMBING Owner of Building or Builder r t f/ i 4t or Builr .� Legal Lot Description Address of Building • P RMIT N2 6292 Work to,be L -�-t t °r CONTRACTOR OR BUILDER MIAMI SHORES VILLAGE, FLORIDA erformed under this Permit r Architect! Bl. Subdi- vision Value of Project This permi granted to the co tractor or builder named above to construct the building or to install the equipment or .evice described in the appli- cation 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 respopsibility for a thorough knowledge' of t}i. rdinances and regulations pertaining to the work covered hereby whether shown on the plans or drawings or in tatements or sPecifications and tt he ssumes respon- sibility for work done by his agents, servants or employees. ,, e" Signed f' al E /F S CTOR B/ ~_ / ` In consideration of the issuance to me of this permit I agree to perform the work covered hereunder in compliance with ordinances anti re. i ion! pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authb es of Miami Sh6rEYV9.Mage. In accepting this permit I assume responsibility for all work done by eiater m elf,,y agent, servant or employee. Y BY DATE Contractor's License No. Amt. of Permit f 194 G AUTHORITY • Owner's Name and Address STATE OF FLORIDA, 1 COUNTY OF DADE. ss. M ■AMI 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/or t1 >>jlding or other` structure herein described. This application is made in compliance and conformity with the Building Ordinance of Miai i 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. Registered Architect and /or Engineer Employing Plumber's Name_ 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 Date Street Subdivision Street My Commission Expires Notary Public, State of Florida No. of Stories 1 Size Septic Tank Type of Tank_ Capacity Gals Feet of Drain Tile / C F Dist. Feet of Tank or Drain Field from Well Nature of Water Supply: City —Well Size of Soakage Pit Amount of Permit $� ,_. ( Signed) 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 qr 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) 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 FOUNT'NS TOTAL FIXTURES CONTR. LIST CHECK SEPTIC TANK SEWER CONN. DRAIN FIELD SOAKAGE PIT GREASE TRAP SOLAR H EATER DEEP WELL SPRKLR. SYSTEM SWIM'G POOL CONTR. LIST L t CHECK • Owner's Name and Address STATE OF FLORIDA, 1 COUNTY OF DADE. ss. M ■AMI 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/or t1 >>jlding or other` structure herein described. This application is made in compliance and conformity with the Building Ordinance of Miai i 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. Registered Architect and /or Engineer Employing Plumber's Name_ 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 Date Street Subdivision Street My Commission Expires Notary Public, State of Florida No. of Stories 1 Size Septic Tank Type of Tank_ Capacity Gals Feet of Drain Tile / C F Dist. Feet of Tank or Drain Field from Well Nature of Water Supply: City —Well Size of Soakage Pit Amount of Permit $� ,_. ( Signed) 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 qr 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) 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. _ �/` `] Permit No' J_.__ /__ Owner's Name and Address Registered Architect and /or Engineer ___', Employing Plumber's Name Location and Legal Description Lot__n:.� Amount of Permit $__ STATE OF FLORIDA, } COUNTY OF DADE. ss. MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT Date ! i 1.1_,. Application is hereby made for the approval of the detailed statement of the plans and specifications herewith sutmitted 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. j No. -- Street___,._* t2 No Street___ _Block Street and Number where work is to be performed —No Street,_,__ State work to be performed and purpose of building (By Floors) / __{', - _,::r New Building_ Remodeling Addition 1 Repairs No. of Stories_ Size Septic Tank 4___ ______________________ Type of Tank . _____r:_ " :'_s = Capacity Gals ‘el_ __ , :_ ! Feet of Drain Tile__ ____I1_, _____ ____— _______ Dist. Feet of Tank or Drain Field from Well Nature of Water Supply: City —Well Size of Soakage Pit ____________ _ ____________ _ _____ _ _____________________M_________ (Signed) (Signed) My Commission Expires Notary Public. State of Florida 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 under signed 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. 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- TORIE 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 SWIM'G POOL i CONTR. LIST CHECK _ �/` `] Permit No' J_.__ /__ Owner's Name and Address Registered Architect and /or Engineer ___', Employing Plumber's Name Location and Legal Description Lot__n:.� Amount of Permit $__ STATE OF FLORIDA, } COUNTY OF DADE. ss. MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT Date ! i 1.1_,. Application is hereby made for the approval of the detailed statement of the plans and specifications herewith sutmitted 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. j No. -- Street___,._* t2 No Street___ _Block Street and Number where work is to be performed —No Street,_,__ State work to be performed and purpose of building (By Floors) / __{', - _,::r New Building_ Remodeling Addition 1 Repairs No. of Stories_ Size Septic Tank 4___ ______________________ Type of Tank . _____r:_ " :'_s = Capacity Gals ‘el_ __ , :_ ! Feet of Drain Tile__ ____I1_, _____ ____— _______ Dist. Feet of Tank or Drain Field from Well Nature of Water Supply: City —Well Size of Soakage Pit ____________ _ ____________ _ _____ _ _____________________M_________ (Signed) (Signed) My Commission Expires Notary Public. State of Florida 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 under signed 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. 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. BUILDING ELECTRICAL PLUMBING Legal Lot Bi. Description Address of wilding "' MIAMI SHORES VILLAGE, FLORIDA r DATE ' 1944_ Contractor's License No. PERMIT N9 1798 Work to be performed under this Permit Owner of 3uilding Architect Contractor or Builder 1 " Subdi- vision 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 'plication herefor in strict compliance with all ordinances pertaining thereto and with the understanding that the work will be performed in compliance ith any plans, drawings, statements or specifications that may have been submitted to and approved by the proper municipal authorities. This Permit may 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 pon which this permit is granted is the understanding that the contractor or builder named above assumes the responsibility for a thorough knowledge of .e ordinances and regulations pertaining to the work covered hereby whether shown on the plans or drawings or in the statements or specifications and at 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 regula- ns pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Ilage. In accepting this permit I assume responsibility for all work done by either myself, my agent, servant or employee. CONTRACTOR OR BUILDER BY AUTHORITY