361 NE 100 St** *
APPROVED:
Date,/ /0 Job Address Y'/i/7, 5 Tax Folio //ego? /3 Ogi
Legal Description A®1 ,`i
Owner / Lessee / Tenant / i 9 U• Master Permit 41731,,
Owner's Address joy r ,v4" Q Phone r"
Contracting Co. P41, �Zyj Cren41/ Address L--) .'
Qualifier (f�l W/ /V /(//J/,f SS , - �� Pone ' - pj17
State # Municipal # Competency # iWr� Ins.Co.
Architect /Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type(circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING PENCE SIGN
WORK DESCRIPTION
Square Ft. 7Dv
WARNING TO OWNER: YOU MUST RECORD A NOTICE OF COMMENCEMENT AND YOUR FAILURE TO DO
SO MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY (IF YOU INTEND
TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR
NOTICE OF COMMENCEMENT).
Application is hereby made to obtain a permit to do work and installation as indicated above, and
on the attached addendum (if applicable). I certify that all work will be performed to meet the
standards of all laws regulating construction in this jurisdiction. I understand that separate
permits are required for ELECTRICAL, PLUMBING, SIGNS, POOLS, ROOFING and MECHANICAL WORK.
OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will
be done in compliance with all applicable laws regulating construction and zoning. Furthermore, I
authorize the above -named contractor to do the work stated.
Si atur o owner and /or Condo President
Date: // /7J
N/ ar as to • er
Commission Expir
Zoning
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
•
rri
ET
- 1 4 "
Mechanical
111111*
as COM
Plumbin
Estimated Cost(value) (/`ad
Signat of Contractor or Owner- Builder
Date:? y
SKL6 1 � 3 0N 41 a
ar .f as to Co ratPtAno et$S tL
My Commission E • ires : RAMWDOWSW
* * * * * * * * * * * **
FEES: PERMIT 8 0` D RADON C.C.F. I - NOTARY ..5 TOTAL DUE
a
Fire Other
Building Electrical
nl eering
APPLICATION FOR:
[ 1 New System
[ .;/] Repair
[ ] Existing System [ ] Holding Tank [ ] Temporary /Experimental
[ ] Abandonment [ ] Other(Specify)
AGENT: /
.,mo ,?7,„ ' f - %/J
APPLICANT:
MAILING ADDRESS: /e /5 2J/4i / a- /4J
TO BE COMPLETED BY APPLICANT OR APPLICANT'S AUTHORIZED AGENT. ATTACH BUILDING PLAN AND TO -SCALE
SITE PLAN SHOWING PERTINENT FEATURES,REQUIRED BY CHAPTER 1OD -6, FLORIDA ADMINISTRATIVE CODE.
PROPERTY INFORMATION [IF LOT IS NOT IN A RECORDED SUBDIVISION, ATTACH LEGAL DESCRIPTION OR DEED]
LOT:
PROPERTY ID #:
PROPERTY SIZE:
PROPERTY STREET ADDRESS: /,r &4
DIRECTIONS TO PROPERTY: I /ad ��� f
BUILDING INFORMATION
Unit Type of
No Establishment
1
2
3
4
STATE OF FLORIDA
DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES
ONSITE SEWAGE DISPOSAL SYSTEM
APPLICATION FOR CONSTRUCTION PERMIT
Authority: Chapter 381, FS & Chapter 10D -6, FAC
BLOCK:
SUBDIVISION:
APPLICANT' S SIGNATURE
DATE OF
SUBDIVISION:
[Section /Township /Range /Parcel No.] ZONING:
ACRES [Sqft/43560] PROPERTY WATER SUPPLY: [ ] PRIVATE [ A PUBLIC
TELEPHONE: 4 6 ( c 7 7 1
Bedrooms Area Sqft Served
PERMIT #
DATE PAID
FEE PAID
RECEIPT #
( f 1 -4) �.
$
/ °'
[4 RESIDENTIAL [ ] COMMERCIAL
No. of Building # Persons Business Activity
For Commercial Only
[ ] Garbage Grinders /Disposals [ ] Spas /Hot Tubs [ ] Floor /Equipment Drains
[ ] Ultra -low Volume Flush Toilets [ ] Other (Specify)
d
DATE: (4,
HRS-H Form 4015, Mar 92 (Obsoletes previous editions which may not be used) Page 1 of 3
(Stock Number: 5744 - 001-4015 -1)
• t: 1(
:yc of ....
ilL!Fr.11;;;;
r, ;377y
'73
!. •‘.../;.;
"• or public.
S::: . •.:: • ;•:•:
?!.1.r,:. LI:
: f!!!!o.,:t::; . ,;:ileicatizi a: CL171r,";:i7i.:‘,...
- • . '
z)fiice.
::y "fr, • . .)",. ' '17, •
' : ".,":";;;',::'. • '
27T 7 • - "' ". 1."'„.
hc
:;
, . ,
CONSTRUCTION PERMIT FOR:
[ ] New System [ ] Existing System [ ] Holding Tank [ ] Temporary /Experimental
p] Repair [ ] Abandonment [ ] Other(Specify)
APPLICANT: r I n[ l � +. 4 74 AGENT: p I
'w ,� G+
PROPERTY STREET ADDRESS:
LOT:
PROPERTY ID #:
SYSTEM MUST BE CONSTRUCTED IN ACCORDANCE WITH SPECIFICATIONS AND STANDARDS OF CHAPTER 1OD -6, FAC
REPAIR PERMITS AND HOLDING TANK PERMITS EXPIRE 90 DAYS FROM THE DATE OF ISSUE. ALL OTHER PERMITS
EXPIRE ONE YEAR FROM THE DATE OF ISSUE. HRS APPROVAL OF SYSTEM DOES NOT GUARANTEE SATISFACTORY
PERFORMANCE FOR ANY SPECIFIC PERIOD OF TIME. ANY CHANGE IN MATERIAL FACTS WHICH SERVED AS A
BASIS FOR ISSUANCE OF THIS PERMIT, REQUIRE THE APPLICANT TO MODIFY THE PERMIT APPLICATION. SUCH
MODIFICATIONS MAY RESULT IN THIS PERMIT BEING MADE NULL AND VOID.
SYSTEM DESIGN AND SPECIFICATIONS
T [ ] [GALLONS / GPD] SEPTIC TANK /AEROBIC UNIT CAPACITY MULTI- CHAMBERED /IN SERIES:[
A [ ] [GALLONS / GPD] CAPACITY MULTI- CHAMBERED /IN SERIES:[ ]
N [ ] GALLONS GREASE INTERCEPTOR CAPACITY [MAXIMUM CAPACITY SINGLE TANK: 1250 GALLONS]
K [ ] GALLONS PER DOSE DOSING TANK CAPACITY DOSE RATE [ ] PER 24 HRS NO. OF PUMPS: [ ]
D 1 &t) ] SQUARE FEET PRIMARY DRAINFIELD SYSTEM
R [ ] SQUARE FEET SYSTEM
A TYPE SYSTEM: [ ] STANDARD [ ] FILLED
I CONFIGURATION: [ ] TRENCH ] BED
F LOCATION OF BENCHMARK:
I ELEVATION OF PROPOSED SYSTEM SITE [ ] [INCHES /FT] [ABOVE /BELOW] BENCHMARK /REFERENCE POINT
E BOTTOM OF DRAINFIELD TO BE [
L
D FILL REQUIRED: [ ] INCHES EXCAVATION REQUIRED: [ ] INCHES
O '2 0/
a /
E
R
5 - 0 32 1
DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES DATE PAID 2.
ONSITE SEWAGE DISPOSAL SYSTEM FEE PAID $ -
CONSTRUCTION PERMIT RECEIPT #
Authority: Chapter 381, FS & Chapter 1OD -6, FAC
STATE OF FLORIDA PERMIT #
BLOCK: SUBDIVISION:
SPECIFICATIONS BY: TITLE:
APPROVED BY: TITLE:
DATE ISSUED: ,-
HRS -H Form 4016, Mar 92 (Obsoletes previous editions which may not be used)
(Stock Number: 5744- 001 - 4016 -0)
APPLICANT
likt Yi4r
[SECTION /TOWNSHIP /RANGE /PARCEL NUMBER]
[OR TAX ID NUMBER]
EXPIRATION DATE:
[ ] MOUND [ ]
[
] [INCHES /FT] [ABOVE /BELOW] BENCHMARK /REFERENCE POINT
CPHU
Page 1 of 2
Site Plan Submitted by i
/
SIGN U RE
Plan Approved
By
STATE OF FL( A
DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES
APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PERMIT
Permit Application Number
PART II - SITE PLAN
Not Approved
HRS-H Form 4015, Feb 85 (Obsoletes previous editions which may not be used)
(Stock Number 5744-002-4015-6)
ALL CHANGES MUST BE APPROVED BY ThE COUNTY PUBLIC HEALTH UNIT
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Site Plan Submitted by i
/
SIGN U RE
Plan Approved
By
STATE OF FL( A
DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES
APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PERMIT
Permit Application Number
PART II - SITE PLAN
Not Approved
HRS-H Form 4015, Feb 85 (Obsoletes previous editions which may not be used)
(Stock Number 5744-002-4015-6)
ALL CHANGES MUST BE APPROVED BY ThE COUNTY PUBLIC HEALTH UNIT
JI_IJ LI_
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)t4111-1'1-- TITLE
Notes
Date
County Public Unit
Page 2 of 3
Amount of Permit $
Owner's Name and Address
STATE OF FLORIDA, 1 �.
COUNTY OF DADE.
Size Septic Tank .........
Feet of Drain Tile_
Nature of Water Sup • '- City —Well.
Street and Number where work is to be performed —No
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the building or . other
structure herein described. This application is made in compliance and conformity with the Building Ordinance of Miami Shores Village, Florida,
and all provisions of the Laws of the State of Florida, all ordinances of Miami Shores Village and all rules and regulations of the Building Division
of Miami Shores Village shall be complied with, whether herein specified o not. A copy of approved plans and specifications must be kept at
building during progress of work.
Location and Legal Description Lot. _ __ _.________.- ._ Block
z
State work to be performed and purpose of building (By Floors) _. __________
New Building - -- _ -- Remodeling—._ —M - -- Addition
W
No s? , Street L_
Registered Architect and /or 7gineer __Employing Plumbei s Name_ -'_i �_.. ` o..._ 711 Street-- _- -__..l _
_ j/jkf
(Signed ) - -- -`
Su —
Street ! e e
Repairs
Date — 1 _ " -
.
^� Type of Tank Capacity Gals.
O Dist. Feet of Tank or Drain Field from Well
__Size of Soakage Pit
(Signed)..
Is Inspector.
The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations ks an employer of labor
under the Florida Workmen's Compensation Act, being Section 5968, Compiled General Laws of Florida Pennanent Sup ement, and has cmn-
plied with the provisions thereof, and will require similar compliance from all contractors or sub- contractors employed by im 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 nder 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
No. of Stories.
er Plumber.
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
Toss
S
LAVA•
TORIES
INK
SINKS
SLOP
SINKS
LAUNDRY
TUS6
U
CATCH
BASIN
FLOOR
DRAIN
DRINKING
FOUNT'N6
TOTAL
FIXTURES
CONTR.
LIST
CHECK
SEPTIC
TANK
SEWER
CONN.
DRAIN
FIELD
SOAKAGE
PIT
GREASE
TRAP
SOLAR
HEATER
DEEP
WELL
SPRKLR.
SYSTEM
SWIM'G
POOL.
COWS.
LAST
CHECK
CHECK
Amount of Permit $
Owner's Name and Address
STATE OF FLORIDA, 1 �.
COUNTY OF DADE.
Size Septic Tank .........
Feet of Drain Tile_
Nature of Water Sup • '- City —Well.
Street and Number where work is to be performed —No
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the building or . other
structure herein described. This application is made in compliance and conformity with the Building Ordinance of Miami Shores Village, Florida,
and all provisions of the Laws of the State of Florida, all ordinances of Miami Shores Village and all rules and regulations of the Building Division
of Miami Shores Village shall be complied with, whether herein specified o not. A copy of approved plans and specifications must be kept at
building during progress of work.
Location and Legal Description Lot. _ __ _.________.- ._ Block
z
State work to be performed and purpose of building (By Floors) _. __________
New Building - -- _ -- Remodeling—._ —M - -- Addition
W
No s? , Street L_
Registered Architect and /or 7gineer __Employing Plumbei s Name_ -'_i �_.. ` o..._ 711 Street-- _- -__..l _
_ j/jkf
(Signed ) - -- -`
Su —
Street ! e e
Repairs
Date — 1 _ " -
.
^� Type of Tank Capacity Gals.
O Dist. Feet of Tank or Drain Field from Well
__Size of Soakage Pit
(Signed)..
Is Inspector.
The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations ks an employer of labor
under the Florida Workmen's Compensation Act, being Section 5968, Compiled General Laws of Florida Pennanent Sup ement, and has cmn-
plied with the provisions thereof, and will require similar compliance from all contractors or sub- contractors employed by im 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 nder 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
No. of Stories.
er Plumber.
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
IAMI SHORES VILLAGE, FLA. N? 2436
JOB R. C 64-) e t L r ei
ADDRESS
e
INSPECTION / 6').
TIME READY fAcit
REMARKS:
INSPECTOR DATE
/
Pas. it /9 /
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the building or . other
structure herein described. This application is made in compliance and conformity with the Building Ordinance of Miami Shores Village, Florida,
and all provisions of the Laws of the State of Florida, all ordinances of Miami Shores Village and all rules and regulations of the Building Division
of Miami Shores Village shall be complied with, whether herein specified or not. A copy of approved plans and specifications must be kept at
building during progress of work.
Owner's Name and Address__ .t_ e.._ ___ ____i __._2 __. /� ___ No. 3 6 l _____ -_ Street 7 ,{,i . - . - v r
Registered Architect and /or Engineer
Employing Plumber's Name No..__..__ _ __._.. _ Street- - __
Location and Legal Description Lot. -____— ____— ___..____— _ ----._ , _.-- Blocti Subdivision
Street and Number where work is to be performed —No 3 C 1 A-i.- / e C . Street_ 5 I
State work to be performed and purpose of building (By Floors)_._.-• -�i ._..4... -_ v"J - _ ,-, - -. i. 4 -L�w . _LI'{', // �
Remodeling .-- •--- .---- -_._.__.._ Addition__ -_ Repairs No. of Stones. _ .._....0 ...........
New Building
Nature of Water Supply: City —Well.
Type of Tank
Size Septic
Feet of of Drain Tile_ _Dist. Feet of Tank or Drain Field from Well
Capacity Gals
- -Size of Soakage Pit
-_ -._
.__ - ._._r
Amount of Permit $_ -_ -------------- - - - - -- — n� .. .-
(Signed) --; . -7, -
5 umbing Inspector.
The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligat as an employer of labor
under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Pennanen upplement, 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.
t.
Date
My Commission Expires Notary Public, State of Florida
( S i g n e d ,... '� .
Mast umber.
STATE OF FLORIDA, f
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
TATS
TUBS
SHOWER.
LAVA-
TORTE.
S INKS
SLOP
SINK.
LAUNDRY
TUB.
UR
CATCH
BASIN
FLOOR
DRAIN
NKIN
FO
FOUNT' NS
.
.A7 a
S
, t C
!•
TOTAL
FIXTURES
CONTR.
LIST
CHECK
i
SEPTIC
TANK
SEWER
CONN.
DRAIN
FIELD
SOAKAGE
PIT
GREASE
TRAP
SOLAR
HEATER
DEEP
WELL
SPRKLR.
SYSTEM
SWIM'G
POOL
CONTR.
LI ST
.
CHECK
Pas. it /9 /
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the building or . other
structure herein described. This application is made in compliance and conformity with the Building Ordinance of Miami Shores Village, Florida,
and all provisions of the Laws of the State of Florida, all ordinances of Miami Shores Village and all rules and regulations of the Building Division
of Miami Shores Village shall be complied with, whether herein specified or not. A copy of approved plans and specifications must be kept at
building during progress of work.
Owner's Name and Address__ .t_ e.._ ___ ____i __._2 __. /� ___ No. 3 6 l _____ -_ Street 7 ,{,i . - . - v r
Registered Architect and /or Engineer
Employing Plumber's Name No..__..__ _ __._.. _ Street- - __
Location and Legal Description Lot. -____— ____— ___..____— _ ----._ , _.-- Blocti Subdivision
Street and Number where work is to be performed —No 3 C 1 A-i.- / e C . Street_ 5 I
State work to be performed and purpose of building (By Floors)_._.-• -�i ._..4... -_ v"J - _ ,-, - -. i. 4 -L�w . _LI'{', // �
Remodeling .-- •--- .---- -_._.__.._ Addition__ -_ Repairs No. of Stones. _ .._....0 ...........
New Building
Nature of Water Supply: City —Well.
Type of Tank
Size Septic
Feet of of Drain Tile_ _Dist. Feet of Tank or Drain Field from Well
Capacity Gals
- -Size of Soakage Pit
-_ -._
.__ - ._._r
Amount of Permit $_ -_ -------------- - - - - -- — n� .. .-
(Signed) --; . -7, -
5 umbing Inspector.
The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligat as an employer of labor
under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Pennanen upplement, 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.
t.
Date
My Commission Expires Notary Public, State of Florida
( S i g n e d ,... '� .
Mast umber.
STATE OF FLORIDA, f
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.
Pern!it No..__ °
Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the building or. other
struc3ure 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 4414:7 L. F ` No e/ / --
Registered Architect and /or Engineer__ — _ -- --
Employing Plumber's Name a - 4 0 ' 6 ! - - - -- No.— /, - -- Street__ - -2 fr . &-
Location and Legal Description Lot - -- ___ ___.— Block_ — _ _— ._.._._.___ Subdivision
Street and Number where work is to be performed—No. __ ___... Street.
State work to be performed and purpose of building (By Floors) ---------- .-- __.._--------- __ -_ -_
New Building —. ___ Remodeling_-___ __— Addition Repairs No. of Stories.
Amount of Permit $---- - - - - -- �'
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
(Signed)_
(Signed)
Date •' 7 - 6,
Street
Size Septic Tank_ .......... Type of Tank_ /® _ �� O -• -- Capacity Gals
Feet of Drain Tile-- _Dist. Feet of Tank or Drain Field from Well
Nature of Water Supply: City — Well .____. _ ____.._._______._Size of Soakage PIt
Plumbing Inspector.
The undersigned applicant for this building permit does hereby certify that he understands and accepts hi .ligations as an employer of labor
under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida P anent 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.
e2 7
Master Plumber.
STATE OF FLORIDA, }
COUNTY OF DADE.
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeared
to me well known, and who, being by me first duly sworn, upon oath deposes and says that he is the _..
of the above described construction, that he has carefully read the foregoing application, and that he did sign the same, and that all facts
therein by him stated are true.
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 worlmtanship.
CLOSETG
BATH
TUBE
SHOWER•
LAVA.
TORIES
6114"
SLOP
SINK•
LAUNDRY
TUBE
URINALS
CATCH
BASIN
FLOOR
DRAIN
DRINKING
FOUNT•N8
TOTAL
FIXTURES
CONTR.
LIST
CHECK
....-w
SEPTIC
TANK
SEWER
Comm
DRAIN
FIELD
SOAKAGE
PIT
GREASE
TRAP
SOLAR
HEATER
DEEP
WELL
SPRKLR.
SYSTEM
SWIM'S
POOL
CONTE.
LIST
_
CHECK
Pern!it No..__ °
Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the building or. other
struc3ure 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 4414:7 L. F ` No e/ / --
Registered Architect and /or Engineer__ — _ -- --
Employing Plumber's Name a - 4 0 ' 6 ! - - - -- No.— /, - -- Street__ - -2 fr . &-
Location and Legal Description Lot - -- ___ ___.— Block_ — _ _— ._.._._.___ Subdivision
Street and Number where work is to be performed—No. __ ___... Street.
State work to be performed and purpose of building (By Floors) ---------- .-- __.._--------- __ -_ -_
New Building —. ___ Remodeling_-___ __— Addition Repairs No. of Stories.
Amount of Permit $---- - - - - -- �'
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
(Signed)_
(Signed)
Date •' 7 - 6,
Street
Size Septic Tank_ .......... Type of Tank_ /® _ �� O -• -- Capacity Gals
Feet of Drain Tile-- _Dist. Feet of Tank or Drain Field from Well
Nature of Water Supply: City — Well .____. _ ____.._._______._Size of Soakage PIt
Plumbing Inspector.
The undersigned applicant for this building permit does hereby certify that he understands and accepts hi .ligations as an employer of labor
under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida P anent 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.
e2 7
Master Plumber.
STATE OF FLORIDA, }
COUNTY OF DADE.
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeared
to me well known, and who, being by me first duly sworn, upon oath deposes and says that he is the _..
of the above described construction, that he has carefully read the foregoing application, and that he did sign the same, and that all facts
therein by him stated are true.
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 worlmtanship.
BUILDING
ELECTRICAL
PLUMBINE
The following is ready for inspection:-
Inspector's Report:-
4
WORK
DONE BY:
REQUP°T
0'1;
/
, MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
Permit No..____ ___!_____
Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the building or other
structure herein described. This application is made in compliance and conformity with the Building Ordinance of Miami Shores Village, Florida,
and all provisions of the Laws of the State of Florida, all ordinances of Miami Shores Village and all rules and regulations of the Building Division
of Miami Shores Village shall be complied with, whet Ja,¢tl her eJ<t s ed 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 Engine r
Employing Plumber's Name
Location and Legal Description Lot_____
Street and Number where work is to be performed —No
State work to be performed and purpose of building (By Floors)
No. 3.6 ____ Street 1
1_ No76 31 Street .1/ _ 1 e�
Block
Date____
Street
New Building Remodeling Addition Repairs No. of Stories_____
Size Septic Tank___— __—__________________ — _______ Type of Tank . W_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
Amounc of Permit S_ v _
_ (Signed)
(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-
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.
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.
My Commission Expires Notary Public. State of Florida
frfr G'
Master ber.
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'O
POOL
CONTR.
LIST
CHECK
, MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
Permit No..____ ___!_____
Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the building or other
structure herein described. This application is made in compliance and conformity with the Building Ordinance of Miami Shores Village, Florida,
and all provisions of the Laws of the State of Florida, all ordinances of Miami Shores Village and all rules and regulations of the Building Division
of Miami Shores Village shall be complied with, whet Ja,¢tl her eJ<t s ed 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 Engine r
Employing Plumber's Name
Location and Legal Description Lot_____
Street and Number where work is to be performed —No
State work to be performed and purpose of building (By Floors)
No. 3.6 ____ Street 1
1_ No76 31 Street .1/ _ 1 e�
Block
Date____
Street
New Building Remodeling Addition Repairs No. of Stories_____
Size Septic Tank___— __—__________________ — _______ Type of Tank . W_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
Amounc of Permit S_ v _
_ (Signed)
(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-
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.
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.
My Commission Expires Notary Public. State of Florida
frfr G'
Master ber.
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.
.� ---- --
CLOBETG
BATH
TUBS
SHOWERS
LAVA-
TOf
SINKS
SLOP
SINKS
LAUNDRY
Turn
BE
U
CATCH
BASIN
FLOOR
DRAIN
DRINKING
FOUNT' NS
TOTAL
FIXTURES
Corm.
LIST
CHOCK
a.
��
SEPTIC
TANK
SEWER
CONK.
DRAIN
FIELD
SOAKAGE
PIT
GREASE'
TRAP
SOLAR
HEATER
DEEP
WELL
SPRKLR.
SYSTEM
SW IM'O
POOL
CONTR.
Lin
_
CNECK
Permit No.._ -1- 6
Owner's Name and Address �C /.!0 ®L
Street and Number where work is to be performed —No
State work to be performed and purpose of building (By Floors)_.
Size Septic Tank
Feet of Drain Tile_ -_ -_
Nature of Water Supply: City —Well
Amount of Permit 8____ .... -_-
My Commission Expires
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
Type of Tank_ /
(Signed)-
( Signed)
Date
Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the building or. other
struc3ure 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.
No.__ - /___ - yam
Registered Architect and /or Engineer_ _-------- _------------ _-- _____ - --
Employing Plumber's Name a-40 ® ' ' 1 4244 No._ 7/ ____/✓�
Street.
/e a° S-7
Street.. _.1 Er .
Location and Legal Description Lot_ __ Block_ Subdivision
Street —
New Building .._______ Remodeling_-____ _ Addition_________ Repairs No. of Stories.
Capacity Gals
__Dist. Feet of Tank or Drain Field from Well
Size of Soakage Pit
Notary Public, State of Florida
Plumbing Inspector.
The undersigned applicant for this building permit does hereby certify that he understands and accepts hi .' ligations as an employer of labor
under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida P: " anent Supplement, and has com-
plied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors employed by him in the work to be
performed under this permit; and will post or cause to be posted' for inspection on the site of the work such public notice or notices as are
required by the Act. The undersigned agrees to employ only such sub- contractors, on work to be performed under this permit, as are
licensed by Miami Shores Village.
Master Plumber.
STATE OF FLORIDA, }
COUNTY OF DADE.
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeared
to me well known, and who, being by me first duly sworn, upon oath deposes and says that he is the_
of the above described construction, that he has carefully read the foregoing application, and that he did sign the same, and that all facts
therein by him stated are true.
NOTE: A re- inspection fee of 81.00 will be made when such re- inspection is made necessary by improper notice for inspection, or faulty
materials and /or workmanship.
BUILDING
ELECTRICAL
PLUMBIND
Inspector's Report :-
1 h
,el
4
n/'
ADD.
The following is ready for inspection:-
,ORK
DONE BY:
REQU'PoT
BE READY
/-� y/
' ' '
4
c