271 NE 101 St (4)MIAMI SHORES VILLAGE
BUILDING DEPARTMENT
305- 795 -2204
Building Inspection Request
Date
Type Insp'n �OJI 5 �; i 9
Permit No. P1 OS'S
Name pouse4
Address C9- ( Na, 1,0
{ �
CompanyBC YD
Phone #
Inspection Date
Approved
Correction
Re-Insp'n Fee
MIAMI SHORES VILLAGE
BUILDING DEPARTMENT
305- 795 -2204
Buil ing Inspection Request
Date 10
Type Insp'n 1 Poo c 1 h
Permit No. 2 1 O s - 33
Name 5e,1Z.ec
Address
Inspection Date
Approved
Correction
Re- Insp'n Fee
,a j N 10 1 5-}-
Compan y�'��
(C .
Phone #
Building Department
BUILDING
PERMIT APPLICATION
FBC 2001.
Permit Type (circle): Building Electrical
Name (Fee Simple Titleholder) /94:7
Owner's Address c7 / tic /o/ S
City 90-5 State
Tenant /Lessee Name
AJ//
.lob Address (where the work is being done)
City Miami Shores Village
Is Building Historically Designated YES
lvilami s nores v iiiage
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel:: x055795.2204 Fax: (305) 756.8972
f I
a NiE /0/ 5
County Miami -Dade Zip
NO v
Contractor's Company Name G' "/s c&-- ,'(-1- z 4 f�
/,
Contractor's Addres /6)..) , Ai a t' - � / v Sr
City A1, �J- Stale �)
Qualifier 6 5 /z-JJ fr f
Master Permit No.
Zip 33/ 35
Phone #
Stale Certificate or Registration No. 5 6, Certificate of C No.
* Architect /Engineer's Name (if applicable) /V Phone #
Value of Work For this Permit Qi ��/ t/,'
Type of Work: ❑Addition
Describe Work:
Total Fee Now Due $
(Continued on opposite side)
❑Alteration
464. r 7 t6111
['New
Permit No. ?10 S
Mechanical Roofing
, . Phone #
Phon6 3 i
Zip 3 3)62
Square Footage Of Work:
' Repair/Replace
331 -
* * * * * * * * * * * * * * * * * * * * * * * * * * ** F ees * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
Submittal Fee $ Permit Fee $ [75-0° CCF $ C v 0 CO/CC
Notary $ Training/Education Fee $ r i2 () Technology Fee $ 4.37-
Scanning $ . QU Radon $ Zoning Bond $ . 00 . 01
Code Enforcement $ Stnictural Plan Review. $
❑ Demolition
Bonding Company's Name (if applicable)
Bonding Company's Address
City State Zip
Mortgage Lender's Nanie (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
constniction 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 $2500, the applicant must
promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person
whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site
for the first inspection which occurs seven (7) days afier the building permit is issued. In the absence of such posted notice, the
inspe lion will not be approved a einspection fee will be charged.
Signatt
Owner or Agent
The foregoing instrument was acknowledged before me his (6 The foregoing instrument was acknowledged before me this
r~1 Nn
day of 20 b
,
who is personally known to me or who has produced
NOTARY P
Sign:
Print:
My Commission Expires:
* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
APPLICATION APPROVED BY:
Chc 05/13/03
Signature
ontractor
who is personally known to me or who has produced
As identification and who did take an oath. as identification and who did take an oath.
NOTARY PUBLIC:
Sign:
4 Print:
Expros: Ju. 3 9 2007 My Commission Expires:
fronded Thru
v atookeockag t* *} ********************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
Plans Examiner
Engineer
Zoning
LGN$TR:.7CTION P /RM;T FOR:
[ ]New System [ ]'Existing System
[ x ]Repair [ ]Abandonment
APPLICANT: 8m1z.r., A1.xandr^ AGENT: $80921116, PARILLA ROBERT
STATE OF' FLORID:
DEPARTMENT Or 'H
CNSITE SEWAGE T
CoNSTRIYOTTON PR
SYSTEM DESIGN AND SPECIFICATIONS
T(
A [
K
A
T
F
I
D
TS/5 PRRHIT IR NOT FOR AN APAIT
ILL RUQ' Y'1EO : ( U . 0 ).NICHES EXCAVATION REQUIRED: ; 30.0 1 INCHES
n►; aa:.6, o3i9' (Ctrpla:tna pcovicvau many y:OL" bt veeo;
iStook NumbfI, 5744 -001- 4015 -01
TO 3JMd
[ 200 1SQUARE FEET PRIMARY DRASNFTELD .Y�TE:A
( 0 1 SQt1ARE FEET SYSTEM
TXk'E $'STEM: ( I ST'ANDAR1 [ M :PILLED
CON'FICitJPATICN ; [ At 1 TRENCFI [ ; 9ED
LocAr:cN TO 1 EN:I -MARI< : r➢'E: 12. SQrF,. .,.1'I c- - -------.---------
ELEVATION OF PROPOSED SYSTEM SITE [ 2.4 [ PUT
BOTTOM OF DPAINF1ELD TO BE [ 4.9 : [ P9fiT
SQis°
EM
CENTRA{
DATE PAD:
FEE PAID .
s:!EC9itr'C
OSTOSNBB
:4clding TAnk ( I Tnnovativ„
Temporary 1 NA )
PRO ?ERTY STREET ADDRESS: 271 NE 131 $t Miami 8'L 33138
L(T. ELCC 33 - SUBDIVISION: gianji. Shores $eckio.n
_ection /TorJft ipiR.Eers fe. . I1p77 T
N:ROi,ERTV ILA 1 11- 3206 -013 -4810 [OR TAY ID NW TM3EF.]
SYSTEM MUST BE CONSTRUCTED IN ACCORDANCE WITH SPECIFICATIONS AND ETANDARDS 01' i, :E'.;'.I
DEPARTMENT APPROVAL CP SYSTEM DOES NOT GUARANTEE SATISFACTORY PERFORMANCE Fat At—
PERIOD: ANY CHANGE IN MATERIAL FACTS WHICH SERVED AS A 9ASIS FOR '1'SSl17.t] g OY :r;i::
3ti;,`iO>3'IRE THE, APPLICANT TO MODrPY THE PERMIT APPT,. SUCH MODIFICATIONS
PERMIT BEING MAPS 'Witt, Ar ;W VOID. ISSUANCE OF THIS PERMIT DOES NOT EXEMPT TI-D:
COMPLIANCE WITH OTHER FEDERAL, STATE OR LOCAL PERMITTING 'REQUIR40 FOR PROPER"' E.;!.N;
•
750 ] Cs+llonsc SVPT7C TAUT
0 ]Gallons
0 ) 0ALLONS CREASE INTERCEPTOR. CAPACITY
0 1 c.4LLONS DOOTMG Tr�VK CAPACITY [ 0 1 GALLONS Q [ 0 MOSES PER. 24 i +19 4
MULTI - CRAMBERE: '• ': :t•'
MULTI - CHA.MAE5 2: n
[ N IM0r.D [ 1
( M )
] ( BBLOw Cr)'
1 ( BEZ.ow ) EENC'RMi .:
:(/:E
U'.: t:LR P..FcIP.8: S :
1. Install 200 sf of draintield in bad, nonfiguretior►.
2. existing 750 gee, septic tank has to remain.
3, Exiatifg 750 pal. septic hank to be inapented for an appropriate pump -ou: k2.
vertical deflector instalUr5 on the outlet device.
4. Invert elevation of draintisld to be no lass than 8.10' NGVD.
5. Bottom of draintield elevation to be no ,leas than 7.60' NOVD.
SP$•I''FICATIC!NS BY: And P: c T'IT'LE:
APPROVED 2Yc JareLr Pay.L i' 'i'w :: M ProPCsoioranl aregire
Wa.TE ISUE:>: 2 /0 /05 J"'XPIF.P.T :ON DA': :
233:4
1-- •R
M C42.6,FAr_
.EC'.J: tc TIME
TI IN TFf7S
• PROM
.0 WENT.
t;():'; c (
0
:)::c.ti CE POINT
'F',t:r•CE POINT
C. 05 _
L
P cgo 1 of 2
ZLREETSSOE OT :Qi Qa0i"c. /60/ 3
sr P.m • III • • .4 •
i :IL r C
Scale: Each block ippresents 5 feet and 1 inch feet, , •, ,
. . ,
fr 7i
f "•••••.-•;• • • •
• , • • , ,
•
A STATE OF FLORIDA
DEPARTMENT OF HEALTH
APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PE :1
Perm Application Number L
• : " "!' f
- .
'T I • •
; ` •
. ,
1-1
•-,-- ,--
-1.-1- ' -4 ' :" ..".. t • I ''... • ' ; l• ' '
1
ri :...,„; i.. ..-...
• , ,
71-
';
! • F .tf )
• /"''
I" • 1
Site Plan submitted by:
Plan Approved
By
PART It - SITE PLAN-
.
1 %
I.'
' ', —. • 1 . ' -I. -; - - ' • j • : 1 ; 1.. ; - . • • ." • ' ..
...1 ,',, •,: . . i - ••••• 1 ' '. 1 -7-- 5 : - i
--".•-• :, i ! --•;• r ••1 ? . •,- 1. •••:••••1••;- 1 •• • i ',•• 1 • • l' • •. . + - : - 17 7. •; T ••• i. ' I
• ; - •• : •-,..., - ' •! i : • r '. : 1
1 • ' : • ' ; .; " -: • • -.- -* '• ' ' ' '; S T '' , I . .. '
I , ; ; ,•••.; • : . ;, ; . -- •- , • , ‘• ‘ -- r •••••• ,• • - -" • • ; • • . •?• • - : , . -.„. • , • •,. • • , ; , . ,
-..- •-, • ,••• . ,• ,•-,, • 1 i• -,• • ,•. ..i..,_,.. , . . , .
7 , ••., : • : • :•
t ., .........4...;...„ :,...1. i ..;...., .,..;..., ,.... .; ... ..,. ] .
• •• ; -
1 • --;“ , • • , • • f ' . • .. : . ; .. • ; •• . .; • '..• , 1 I
Notes:
F , ST (. /14 $;A
41.! ``-d
4
^,1
L-.7-girroki.. 014 - 6t - Z. !
si.epq,"
121-4441
Not Approvecl D:;Itt?
! Departmery
ALL CHA E$ T . BE APPROVED BY THE COUNTY HEALTH DEPA r
te4). (Roam HAS44 rem A01101011 lo
nirwm Nurpows74.4402-4411•41
A.S■tY.
SaiSD
ig. ••■••■•• - 411•1.
•
. .
1 'Noel : 54)1' I*
)!floi.,;11•
. . •
; VI • I • • , "
•''' • • f !- I •
.; -":
I Q.
.460....!ip.1
",--• • 1 •
.411.004,
•
.; •
7110.1
. . • •• ,•
....• . • '
/0; ••- 4 . - ..-J••• • •• • •
-1 r • • • • •
7) P.:4. ICCO11 St :c,T Qc4C47 41:.Ct /7
Page 2 of
02/10/2005 09:46
3056966402
3056966402
NEXT APPO1
DR
PHONE
Orthopedic
Speci� ' is
q f Swath FYorlda
PALMETTO MEDICAL PLAZA
7100 WEST 20TH AVENUE - SUITE 101
HIALEAH, FLORIDA 33016
(306) 822 -0401 • FAX (306) 824 -1748
•- CERTIF1C
PATIENT'S NAME
MIAMI SHORES P WORKS PAGE 01
ORESTES G. ROSABAL, M.D.
KENNETH J. EASTERLING. M.D.
ENRIQUE KRIKORIAN, M.D.
ROLANDO AMADEO. M.D.
TONY DIAZ, D.O.
FOR WORK
• UNABLE TO WORK EFFECTIVE
• ALE TO RETURN TO REGULAR DUTY EFFECTIVE
ABLE TO RETURN TO LIGHT UTY EFFECf1V� J
LIMITATIONS • ValAMMIMMIUMES A
• NO LIGHT DUTY AVAILABLE, THEN UNABLE TO WORK
• CONTINUE TO WORK
• CONTINUE TO. WORK tiara DUTY
• CONTINUE OUT OF WOR
DATE
D
9
b‘ 9 SO - p - r) - 171:06
\. 7/ Aje /01 ST px) i4pic)014-(
APPLICANT: t
AGENT:
PROPERTY ADDRESS;
LOT: BLOCK: SUBDIVISION;
:- .-- -scat. -_:-== m; 1m:>: sr = : :.> =.r*smama;.sssirum.ss.=m.. Haas. a. :a ::swrssa...�..:..>m. :>Iexs as = ==:: :.
CHECKED {I] ITEMS ARE NOT IN COMPLIANCE WITH STATUTE OR RULE AND MUST BE CORRECTED.
=========== m========- r= :. :v--- asa- asrntsss---r• -ssut =L$YC =l.ii- >Q-- 1Q$==== = =..
STATE OF FLORIDA
DEPARTMENT OF HEALTH
ONBITE SEWAGE TREATMENT AND DIPOSAL SYSTEM
CONSTRUCTION INSPECTION AND FINAL APPROVAL
TANK INSTALLATION
[01) TANK SIZE [1] [
(02) TANK MATERIAL
[031 OUTLET DEVICE
(04) MULTI- CHAMBERED
[05) OUTLET FILTER
[06] LEGEND
[07] FIATERTIOHT
(08] LEVEL
(09] DEPTH TO LID
1 Y / N 1
DRAINFIELD INSTALLATION
(10) AREA (1),..•.2..°, :1[2] SOFT
(11] DISTRIBUTION Box HEADER
[12) NUMBER OF DRAINLINES
[13] DRAINLINE SEPARATION
(14] DRAINLINE SLOPE
[15) DEPTH of COVER
[16) ELEVATION [ABOVE /BELOW] BM
[17) SYSTEM LOCATION
(18) DOSING PUMPS
[19] AGGREGATE SIZE
[20] AGGREGATE EXCESSIVE FINES
[21] AGGREGATE DEPTH
PILL / EXCAVATION MATERIAL
122 ) FILL AMOUNT
[23] FILL TEXTURE
(24] EXCAVATION DEPTH
[25) AREA REPLACED
(26) REPLACEMENT 1LATERIAL;
EXPLANATION OF VIOLATIONS / REMARKS:
[ 1
[ )
[ 1
[ 1
CONSTRUCTION [APPROVED /DISAPPROVED]
FINAL SYSTEM (APPROVED /DISAPPROVED) :
DH 4016, 10/97 (Previous Editions Nap B- Undid)
l
]
1
1
1
1
1
(401
[41]
[42]
[
[
[
(46)
(47)
(
INSTALLER ! CONTRA,..:
PERMIT NO.
DAWN 'AID:
'Rs PAID:
RECEIPT /;
PROPERTY ID f:
SETBACEs
(27] SURFACE WATER
(2) D I TcRB
[29] PRIVATE WELLS
(30] PUBLIC WELLS
(31 ] IRRIGATION WELLS
FILLED / MOUND GIST=
[36] DRAINFIELD COVER
[37) SHOULDERS
(35) SLOPES
[39] STABILIZATION
[32] POTABLE WATER LINES
[33] BUILDING FOUNDATION
[34] PROPERTY LINES
(35] OTHER
ADDITIOINAL INFORMATION
UNOBSTRUCTED AREA
STORMWATER RUNOFF
rr
FT
FT
FT
rr
Fz
FT
FT
FT
ALARMS
MAINTENANCE AGREEMENT
BUILDING AREA
LOCATION CONFORMS WITH SITS PLAN
FINAL SITE GRADING
CONTRACTOR ..'
OTHER
ABANDONMENT
]
(49] TANS PUMPED _ / / •,__„
) [50] TANI CRUSHED & FILLED _ /
PT 1: Ap hcanl
PT 2. InsislIgr /Cw ;n••
PT .1 .1» J11 1: •44I.:rn
1
CND DATE:.
CHD DATE:
Page 2 of 3
Contractor BOBS SEPTIC & DRAIN INC
Local Phone: 305 - 558 -5818
Parcel # 1132060134810
Plumbing Permit
Miami Shores Village
10050 NE 2nd Avenue
Phone: 305 - 795 -2204 Permit Number: PL2005 -53
Printed: 2/16/2005
Applicant: CARL .PAULSEN
Owner: PAULSEN CARL
JOB ADDRESS: 271 NE 101 ST
Contractor's Address: 1020 NE 130 ST
Permit Status: APPROVED Permit Expiration: 8/9/2005 Construction Value: $2,500.00
Work: 200 SQ FT DRAINFIELD
Page 1 of 1
Legal Description: MIAMI SHORES SEC 1 AMD PB 10 -70 LOT 19 & W1/2 OF LOT 20 BLK 35 LOT SIZE
Fees: Description Amount
FEE2005 -1770 Building Fee $175.00
FEE2005 -1771 CCF $1.80
FEE2005 -1772 Training and Education Fee $0.60
FEE2005 -1773 Notary Fee $5.00
FEE2005 -1775 Technology Fee $4.37
FEE2005 -1776 Scanning Fee $3.00
FEE2005 -1777 Builders Bond $300.00
Total Fees: $489.77
Total Fees: $489.77
Total Receipts: $489.77
Signed: (INSPECTOR)
In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations pertaining thereto and in strict
conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I assume responisibility for all work
done by either myself, my agent, servants or employes.
Signed: (Contractor or Builder) BY:
Permit No.- __5 a�
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___ C&\.
Registered Architect and /or Engineer___
Employing Plumber's Name__
Location and Legal Description Lot___
Nature of Water Supply: City —Well.
Amount of Permit $ - e - �� - - - - --
STATE OF FLORIDA, }
COUNTY OF DADE.
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
( Signed)
No.
lock
Street and Number where work is to be performed —No 9.0 7 / 91,4'
c / 0 / Street_
State work to be performed and purpose of building (By Floors)________ ___ .
New.Building ______ Remodeling--_ ___ -___
(Signed)-
No.,th,___ Street a 1__ cW/te-•
Date.
epairs
. — - — - - Street/re • i- / { -46
Size Septic Tank ______Type of Tank —_
Feet of Drain Tile ___Dist. Feet of Tank or Drain Field from Well
__Size of Soakage Pit
No. of Stories _
Capacity Gals
CAR P _
umbing Inspector.
The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations as an employer of labor
under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Permanent Supplement, and has com-
plied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors employed by him in the work to be
performed under this permit; and will post or cause to be posted for inspection on the site of the work such public notice or notices as are
required by the Act. The undersigned agrees to employ only such sub - contractors, on work to be performed under this permit, as are
licensed by Miami Shores Village.
Master Plumber.
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments , personally appeared
to me well known, and who, being by me first duly sworn, upon oath deposes and says that he is the
of the above described construction, that he has carefully read the foregoing application, and that he did sign the same, and that all facts
therein by him stated are true.
My Commission Expires Notary Public, State of Florida
NOTE: A re- inspection fee of $1.00 will be made when such re- inspection is made•necessary by improper notice for inspection, or faulty
materials and /or workmanship.
CLOSETS
BATH
TUBS
SHOWERS
LAVA-
TORIES
SINKS
SLOP
striae KB
LAUNDRY
TUBS
URINALS
CATCH
BASIN
FLOOR
DRAIN
DRINKING
FOUNT' NS
TOTAL
FIXTURES
CONTR.
LIST
-
CHECK
SEPTIC
TANK
SEWER
CONN.
DRAIN
FIELD
SOAKAGE
PIT
GREASE
TRAP
SOLAR
HEATER
DEEP
WELL
SPRKLR.
SYSTEM
SW I
POOL
CONTR.
LIST
CHECK
-
Permit No.- __5 a�
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___ C&\.
Registered Architect and /or Engineer___
Employing Plumber's Name__
Location and Legal Description Lot___
Nature of Water Supply: City —Well.
Amount of Permit $ - e - �� - - - - --
STATE OF FLORIDA, }
COUNTY OF DADE.
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
( Signed)
No.
lock
Street and Number where work is to be performed —No 9.0 7 / 91,4'
c / 0 / Street_
State work to be performed and purpose of building (By Floors)________ ___ .
New.Building ______ Remodeling--_ ___ -___
(Signed)-
No.,th,___ Street a 1__ cW/te-•
Date.
epairs
. — - — - - Street/re • i- / { -46
Size Septic Tank ______Type of Tank —_
Feet of Drain Tile ___Dist. Feet of Tank or Drain Field from Well
__Size of Soakage Pit
No. of Stories _
Capacity Gals
CAR P _
umbing Inspector.
The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations as an employer of labor
under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Permanent Supplement, and has com-
plied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors employed by him in the work to be
performed under this permit; and will post or cause to be posted for inspection on the site of the work such public notice or notices as are
required by the Act. The undersigned agrees to employ only such sub - contractors, on work to be performed under this permit, as are
licensed by Miami Shores Village.
Master Plumber.
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments , personally appeared
to me well known, and who, being by me first duly sworn, upon oath deposes and says that he is the
of the above described construction, that he has carefully read the foregoing application, and that he did sign the same, and that all facts
therein by him stated are true.
My Commission Expires Notary Public, State of Florida
NOTE: A re- inspection fee of $1.00 will be made when such re- inspection is made•necessary by improper notice for inspection, or faulty
materials and /or workmanship.
BUILDING
ELECTRICAL
PLUMBING
ROOFING
Owner of
Building
Architect
Contractor $
or Builder r-
Legal Lot
Description Bl.
CONTRACTOR OR BUILDER
MIAMI SHORES VILLAGE, FLORIDA
PERMIT
N° 4238
Work to be performed under this Permit
4-
r0'
DATE 19
Contractors y
License No.
Subdi-
vision
Address of " i Value of 1 Amount of
Building Project $ 1 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. 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.
BY AUTHORITY
AS BOTH
BUILDING
ELECTRICAL
PLUMBING
ROOFING
0
Owner of
Building .•,
Architect
Contractor
or Builder
Legal Lot
Description II Bl
Address of Value of 11 Amount of
Building Project $ II 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.
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
ceptinq this permit I assume responsibility for all work done by either, myself, my agent, servant or employee.
CONTRACTOR OR BUILDER`
MIAMI SHORES VILLAGE, FLORIDA
PERMIT N° 4221
Work to be performed under this Permit__
BY
DATE 19
Contractor's t4
License No.
Subdi-
vision
Signed- INSPECTOR
AUTHORITY •oeor '°i
Permit No
Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the building or other
structure herein described. This application is made in compliance and conformity with the Building Ordinance of Miami Shores Village, Florida,
and all provisions of the Laws of the State of Florida, all ordinances of Miami Shores Village and all rules and regulations of the Building Division
of Miami Shores Village shall be complied with, whether herein specified or not. A copy of approved plans and specifications must be kept at
building during progress of work.
Owner's Name and Address
Registered Architect and /or Engineer
Employing Plumber's Namel_.
Location and Legal Description Lot------ ....... Subdivision
Street and Number where work is to be performed —No 0-- Street.
State work to be performed and purpose of building (By Floors -__ -- _---------_-_-_ - --
New Building Remodeling______ —_ Addition Repairs No. of Stories
Size Septi
c Tank ype of Tank__ Capacity Gals
--
i
Feet of Drain Tile' _ _ _ . Feet of Tank or Drain Field from Well
Nature of Water Supply: of Soakage Pit
Amount of Permit $
The undersigned applicant for this building permit does hereby certify that he understands and accepts his oJ ations as an employer of labor
under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida p&r 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.
STATE OF FLORIDA, 1
COUNTY OF DADE.
60
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
(Signed)_
Date
No. Street
Street__
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 Commissio Expires Notary Public, State of Florida
6 A3 2
-
Plumbing Inspector.
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
SH
SHOWERS
LAVA-
TORIES
SINKS
S
SLOP
SINKS
LAUNDRY
rues
URINALS
CATCH
BASIN
FLOOR
DRAIN
DRINKING
FOUNT' NS
TOTAL
FIXTURES
CONTR.
LIST
CHECK
/(p
SEPTIC
TANK
SEWER
CONN.
DRAIN
FIELD
SOAKAGE
PIT
GREASE
TRAP
l
SOLAR
HEATER
DEEP
WELL
SPRKLR.
SYSTEM
SWIM'G
POOL
Comm.
LIST
CHECK
_ --
Permit No
Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the building or other
structure herein described. This application is made in compliance and conformity with the Building Ordinance of Miami Shores Village, Florida,
and all provisions of the Laws of the State of Florida, all ordinances of Miami Shores Village and all rules and regulations of the Building Division
of Miami Shores Village shall be complied with, whether herein specified or not. A copy of approved plans and specifications must be kept at
building during progress of work.
Owner's Name and Address
Registered Architect and /or Engineer
Employing Plumber's Namel_.
Location and Legal Description Lot------ ....... Subdivision
Street and Number where work is to be performed —No 0-- Street.
State work to be performed and purpose of building (By Floors -__ -- _---------_-_-_ - --
New Building Remodeling______ —_ Addition Repairs No. of Stories
Size Septi
c Tank ype of Tank__ Capacity Gals
--
i
Feet of Drain Tile' _ _ _ . Feet of Tank or Drain Field from Well
Nature of Water Supply: of Soakage Pit
Amount of Permit $
The undersigned applicant for this building permit does hereby certify that he understands and accepts his oJ ations as an employer of labor
under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida p&r 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.
STATE OF FLORIDA, 1
COUNTY OF DADE.
60
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
(Signed)_
Date
No. Street
Street__
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 Commissio Expires Notary Public, State of Florida
6 A3 2
-
Plumbing Inspector.
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.
LIST ff -
CHECK
Oa
er::;it Nu._
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
Block
Date_.
Application is hereby rne.Ae 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.
- -_ - � 1 ---- - -____ _._ _ 0 a i
Owaer's Name and Address i • 1________ Q ___t!�._— No._ —_ Street
___
Registered Architect and /or Engineer ..... ___ —_— _ _ n
Employing Plumber's Name � S_ r 1 `t-Lkl� �aLt - - - -- No.I c 5� . _ __.____ Street___ w l
Subdivision_ -- ___________________
Street and Number where work is to be performed —No t. .a L Street 5_, 10 1 S -t _
State work to be performed and purpose . of building (By Floors) _______________
New Building __. ___ Remodeling _ —__ —_____ Addition_______. Repairs No. of Stories.
and. Legal Description' Lot_
Size Septic Tank ------ - - - - --
Feet of Drain Tile__-____
Nature of Water Supply: City— Well._____:
Amount of Permit $_
STATE OF FLORIDA,
COUNTY OF DADE.
• My Commission Expires
Type of Tank__ Capacity Gals
_ —Dist. Feet of Tank or Drain Field from Well
Size of Soakage Pit
( Signed) _ ___! ! i
iumb nspector.
The undersigned applicant for this building permit does hereby certify that he understands and accepts his,'igations 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 cmn-
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.
(Signed)
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. .
Notary Public, State of Florida
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.
•
CLOUTS T
BATH S
SHOWERS L
LAVA- S
SINKS S
SLOP L
LAUNDRY U
URINALS C
CATCH F
FLOOR D
DRINKING T
TOTAL
CONTII.
LIST
CHECK
SEPTIC S
SEWER D
DRAIN. S
SOAKAGE G
GREASE' S
SOLAR D
DEEP S
SPRKLR. S
SWIM'G
,
Com -
---
Oa
er::;it Nu._
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
Block
Date_.
Application is hereby rne.Ae 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.
- -_ - � 1 ---- - -____ _._ _ 0 a i
Owaer's Name and Address i • 1________ Q ___t!�._— No._ —_ Street
___
Registered Architect and /or Engineer ..... ___ —_— _ _ n
Employing Plumber's Name � S_ r 1 `t-Lkl� �aLt - - - -- No.I c 5� . _ __.____ Street___ w l
Subdivision_ -- ___________________
Street and Number where work is to be performed —No t. .a L Street 5_, 10 1 S -t _
State work to be performed and purpose . of building (By Floors) _______________
New Building __. ___ Remodeling _ —__ —_____ Addition_______. Repairs No. of Stories.
and. Legal Description' Lot_
Size Septic Tank ------ - - - - --
Feet of Drain Tile__-____
Nature of Water Supply: City— Well._____:
Amount of Permit $_
STATE OF FLORIDA,
COUNTY OF DADE.
• My Commission Expires
Type of Tank__ Capacity Gals
_ —Dist. Feet of Tank or Drain Field from Well
Size of Soakage Pit
( Signed) _ ___! ! i
iumb nspector.
The undersigned applicant for this building permit does hereby certify that he understands and accepts his,'igations 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 cmn-
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.
(Signed)
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. .
Notary Public, State of Florida
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.
Permit Nql__/
Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the building or other
structure herein described. This application is made in compliance and conformity with the Building Ordinance of Miami Shores Village, Florida,
and all provisions of the Laws of the State of Florida, all ordinances of Miami Shores Village and all rules and regulations of the Building Division
of Miami Shores Village shall be complied with, whether herein specified or not. A copy of approved plans and specifications must be kept at
building during progress of work.
Owner's Name and Address _ --- No. ___ r a-
Registered Architect and /or Engineer
Employing Plumber's Name f
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
-- __
Location and Legal Description Lot_ ______.
Street and Number where work is to be performed —No Street — _'
State work to be performed and purpose of building (By Floors)
Addition Repairs No. of Stories
New Building Remodeling
Size Septic Tank
Feet of Drain Tile
ss.
Type of Tank
No
Block Subdivision
Date
- 0
Street 7/
Capacity Gals._ - _.__
- Street
Dist. Feet of Tank or Drain Field from Well
Nature of Water Supply: City—Well a _w 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 hint in the work to be
Performed under this permit; and will post or cause to be posted for inspection on the site of the work such public notice or notices as are
required by the Act. The undersigned agrees to employ only such sub- contractors, on work to be performed under this permit, as are
licensed by Miami Shores Village.
( Signed) i
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 fo regoing 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
1 7
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.
L
CLOSETS
BATH
TUBS
SHOWERS
LAVA-
TORIES
SINKS .
SLOP
SINKS
LAUNDRY
TUBS
URINALS
CATCH
BASIN
FLOOR
DRAIN
DRINKING
FOUNT'NS
TOTAL
FIXTURES
CONTR.
LIST
CHECK
SEPTIC
TANK
SEWER
CONN.
DRAIN
FIELD
SOAKAGE
PIT
GREASE
TRAP
SOLAR
HEATER
DEEP
WELL
SPRKLR.
SYSTEM
SWIM'G
POOL
.
CONTR.
LIST
CHECK
*'
Permit Nql__/
Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the building or other
structure herein described. This application is made in compliance and conformity with the Building Ordinance of Miami Shores Village, Florida,
and all provisions of the Laws of the State of Florida, all ordinances of Miami Shores Village and all rules and regulations of the Building Division
of Miami Shores Village shall be complied with, whether herein specified or not. A copy of approved plans and specifications must be kept at
building during progress of work.
Owner's Name and Address _ --- No. ___ r a-
Registered Architect and /or Engineer
Employing Plumber's Name f
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
-- __
Location and Legal Description Lot_ ______.
Street and Number where work is to be performed —No Street — _'
State work to be performed and purpose of building (By Floors)
Addition Repairs No. of Stories
New Building Remodeling
Size Septic Tank
Feet of Drain Tile
ss.
Type of Tank
No
Block Subdivision
Date
- 0
Street 7/
Capacity Gals._ - _.__
- Street
Dist. Feet of Tank or Drain Field from Well
Nature of Water Supply: City—Well a _w 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 hint in the work to be
Performed under this permit; and will post or cause to be posted for inspection on the site of the work such public notice or notices as are
required by the Act. The undersigned agrees to employ only such sub- contractors, on work to be performed under this permit, as are
licensed by Miami Shores Village.
( Signed) i
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 fo regoing 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
1 7
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.
L