400 NE 100 StDate 2 - Od Job Address Q d NE / 4 d i / Tax Folio 1 , 7 2 Q 6 0/ 7 �
Legal )ascription L o7 /O // - 0/0d Si. f . J 9- Historically Designated: Yes No
?Lessee / Tenant
Owner's Address
Contracting Co.
er
fr
l i@sident
m Exp. 4/10/04
No. CC 926277
I I Personally Knoam I I Other I.D.
State # $ / 4 f. (o p 7z Z-- Municipal # Competency # Ins. Co.
Archit ct/Engineer
Bons' g Company
Mort y gor
Permi : Type (circle one): BUILDING ELECTRIC
WO ' C DESCRIPTION fic 4 /Y ?'a l
Square Ft.
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Zara
W ING 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 ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT.)
Applica ion 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 ,erfoimed to meet the standards of all laws regulating construction in this jurisdiction. I understand that separate permits are required for ELECTRICAL
PL t:ING, SIGNS, POOLS, ROOFING and MECHANICAL WORK.
0 "5 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.
Siina
My Co
-7
FEES: 'ERMIT (2. RADON C.C.F. / 6°' NOTARY & • BOND 300
APPRO BD: TOTAL DUE 3 sz_ L)
Zoning Building Electrical
Mechani ;al Plumbing
Date
Date S
G
Phone 5 " S'J /8/1 1 z
o✓yY c Address 7 7, / vv /1- /d/'frs- _ 3 3 Q/ !
SP ?/ - Phone 3 of 5'0 14 2
Address
Address
Address
Notary
My Co
MECHANICAL ROOFING PAVING FENCE SIGN
, air
Estimated Cost (value)
Master Permit #
Structural Engineer
[ 4� 99&/
Date
Date
CONSTRUCTION PERMIT FOR:
[ d] New System [ Existing System [ J] Holding Tank [. /J] Temporary /Experimental
( >] Repair [ Abandonment [ Other(Specify)
APPLICANT: C / 114
PROPERTY STREET ADDRESS:
LOT: J ] BLOCK:
PROP IRTY ID #:
7OO(
D
R
A
I
N
F
I
E
L
D
0
T
H
E
R
��:.., ,, � . .= .J..�,�,T ^ �;= 1J^' °�"L• "' l.�" ::h ,:a'•M ,V.n- .YVJ�� �.:- �:.� -;H ^^..4.�:,�,;,,; �+ n,. � :...y:Y' ,.nrw� - _, • -,
DATE I
STATE OF FLORIDA
DEPARTMENT OF HEALTH
ONSITE SEWAGE DISPOSAL SYSTEM
CONSTRUCTION PERMIT
Authority: Chapter 381, FS & Chapter 10D -6, FAC
SUBDIVISION:
AGENT:
PERMIT # jW _ i f't i
DATE PAID (j, 4 -0 p,
FEE PAID $ 7S.00
RECEIPT #
S S.,
•ci0'd dire• 106 33/3'
[SECTION /TOWNSHIP /RANGE /PARCEL NUMBER)
[OR. TAX ID NUMBER]
SYST :M MUST BE CONSTRUCTED IN ACCORDANCE WITH SPECIFICATIONS AND STANDARDS OF CHAPTER 10D -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. DEPARTMENT OF HEALTH APPROVAL OF SYSTEM DOES
NOT 4UARANTEE SATISFACTORY PERFORMANCE FOR ANY SPECIFIC PERIOD OF TIME. ANY CHANGE IN MATERIAL
FACT 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
61CrSbYl
T [ l OSOI I:.TIS'/ GPD] SEP 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: [ ]
[ 4 J] SQUARE FEET PRIMARY DRAINFIELD SYSTEM
[ 77 , ] SQUARE FEET SYSTEM
TY ?E SYSTEM: [ J, STANDARD [ ] FILLED [ ] MOUND [ ]
CONFIGURATION: [ ] TRENCH ( „' BED ( ]
LO:ATION OF BENCHMARK: I Z•0 1 " S iC F` - F. Qr/
ELEVATION OF PROPOSED SYSTEM SITE [5� /N ACRES• /' T] (ABOVE /�SELOW',j BENCHMARK/ ERENCE POINT"
l
BOTTOM OF DRAINFIELD TO BE [ 2. 0 7 1 [ _TRE T] (ABOVE�ELOWy BENCHMARK/ FERENCE'FOINT)
FILL REQUIRED:
[4pm
SPECI 'ICATIONS BY: /1 f
APPRO 'ED BY:
SSUED: '
co )60
6
INCHES
DH 4016, 10/96 (Replaces HRS -H Form 4016 [page 1) which may be used)
(Stock Nun ber: 5744- 001 - 4016 -0)
EXCAVATION REQUIRED: [3Q ) INCHES
C ',ate G 49A �, ° r�nnnf p oi rs �®
l: %�i, fi J� r-o }- ��: 7 Vf� 1� CJ'_ I...r • j' , '�, \� PC4P cn [I !1!')
TITLE:
�p �� TG� L
TITLE: CHD
\
EXPIRATION DATE: rp , l erd
Applicant
Page 1 of 2
INSTRUCTIONS:
PERMIT NUMBER: Permit tracking number by County Health Department.
APPLICATION FOR: Check type of permit; if "Other" specify type in blank.
APPLICANT: Property owner's full name.
TELEPHONE: Telephone number for applicant or agent.
AGENT: Property owner's legally authorized representative.
MAILING ADDRESS: P.O. box or street mailing address for applicant or agent.
LOT, BLOCK, SUBDIVISION or
PROPERTY ID #: 27 character ID number for property. (Health Department may require property appraiser ID# or
section /township /range /parcel number.)
SYSTEM DESIGN AND
SPECIFICATIONS:
TANK: Minimum specifications from Chapter IOD -6, FAC.
DRAINFIELD: Minimum specifications from Chapter 10D -6, FAC.
OTHER: Other specifications, such as operating permit requirements, low- volume flush toilets, variance provisos.
SPECIFICATIONS BY: Name of individual providing specifications. If designed by a registered engineer must be sealed.
APPROVED BY: County Health Department personnel reviewing and approving permit.
DATE ISSUED: Date permit is issued by County Health Department.
EXPIRATION DATE: One year from date issued if the system has not been installed. Permits for system repairs become void 90 days from the
date issued.
APPL
[d]
1 /]
APPL :CANT:
AGEN :
MAIL NG ADDRESS:
PROP
LOT:
PROPERTY
PROPE
PROPE
DIREC
BUILD
Unit
No
1
4
:CATION FOR:
New System
Repair
ID #:
Type of
Establishment
Authority:
[ ]
[Al]
NG INFORMATION
S ��
/'%° J; o
ACRES
RTY STREET ADDRESS:
rIONS TO PROPERTY:
APPLICANT'S SIGNATURE:
STATE OF FLORIDA _
DEPARTMENT OF HEALTH / .
ONSITE SEWAGE DISPOSAL SYSTEM .
APPLICATION FOR CONSTRUCTION'PERMIT
9 BLOCK: , SUBDIVISION:
0 /7G3(5 - o
RTY SIZE: [Sgft /43560]
] (garbage Grinders /Disposals
] Ultra -low Volume Flush Toilets
Chapter 381, FS & Chapter 1OD -6, FAC
Existing System ..[ ] Holding Tank [/JJ Temporary /Experimental
Abandonment ''' [/1/ ] Other (Specify)
/ /a /VQ
TO BE COMPLETED BY APPLICANT OR APPLICANT'S AUTHORIZED AGENT. ATTACH BUILDING PLAN AND TO -SCALE
SITE PLAN SHOWING PERTINENT FEATURES REQUIRED BY CHAPTER 10D -6, FLORIDA ADMINISTRATIVE CODE.
RTY INFORMATION [IF LOT IS NOT IN A RECORDED SUBDIVISION, ATTACH LEGAL DESCRIPTION OR DEED]
[k RESIDENTIAL
No. of
Bedrooms
DH 4015, ' 0/96 (Replaces HRS -H Form 4015 [Page 1) which may be used)
(Stock Number: 5744- 001 - 4015 -1)
11 /' 1, ff 0 _s•.fe:6.
Building
Area Sgft
/ /-moo
[ ] COMMERCIAL
,be
] Spas /Hot Tubs
[ ] Other (Specify)
7
•
PERMIT # E-/ jr /rte/
DATE PAID 0`0
FEE PAID $ v7").! /,
RECEIPT #
TELEPHONE : j O 9 ,
H/// y5c/
DATE OF
SUBDIVISION:
[ Section /Township /Range /Parcel\No.] ZONING:
9.5
PROPERTY WATER SUPPLY: [ ) PRIVATE [PUBLIC
4- 7. ;,7. / Gam ! „/ .i
4 74' - S *fr-„ /) 9
Business Activity
Served For Commercial Only
[ ] F1-Oor/Equipment Drains
"Sr-. 3 .1 -- ‘ � l r
DATE:
Page 1 of 3
RNs a wc1:oNs:
APPLI CATION YOII: Chcc': type of permit, if "Doter° specify type in blank.
ropealy owner's full name.
'- PHONE.: "',:' p'tone number fu : or agent.
ACENT : ?roperty owner's legally authorized pre eat tine.
MAI ANC Ai3 ).: ESS: _'.C. box or street, city, stems and zip code naa_'iing as dregs: applicant or agent.
,ri J3D` : +I'iSi.GN:
5:Z' :
WAT'.'cR SUPPLY: Chccic private or public.
7, ADDRESS: Street address for properly. For lots without rn assigned :street address, indicate street or road and locale in county.
DlitECCiONS: �•rovidc detailed instructions to lot or anal. an area map mowing lot location.
`-3 J LDINC ;NI ORMA"' ION: Chcc'_: residential or commercial.
0
'tot, :deck, and subdivision for lot (recorded c: unn cord %t'•. subdivision). Lf tot la not in a recorded subdivision a copy of the lot
�1 encriptioa or sieed must be attached.
)A C.? 5J:" DIVIS`ON: Cfiicial date of subdivision recorded in cotir y pi_t boa's:; (month/day/year) or date !ot originally recorded. Dividing an approved
lot trio two or more pnrccls for the perposc of conveying, ownership shall he considered a subdivision of the lot..
?30p T1 .D /: i7 character number for property. (Health ire; :attmeni may require pt,iperty appraiser ID# or section/township/range/parcel number.)
Net urn_ :ble area o ?,-_uperty in acres (egtua :,t fcct'ige c %?vat.:;:; iv 6.3,560 cq,r_r. Feet) exclusive of al! paved crepe and prepares road
beds within pubis ii,?ittr of way or easement} and ettcla v:: of streams, `alsea, normally wet drainage ditches, rrwrrhes, oz c' er
such bodies of water. Contiguous unpaved ant? nonce:api :c :d r,.ad rights- of-way and easements with no subsurface obstructions
may be included in ca! !sting lot area.
T't ?E I_ie.t typo of estrblir!iment from 'E able IF, Chapter Examples: single family, single wide mobile home, restaurant,
doctor's office.
NO. 3EDROOMS: Count all rooms designed primarily for sleeping and those areas expected to routinely provide sleeping accommodations for
occupants.
3JlLD!NC fiiltEA: - twist square footage of enclosed habitable eras of &vciling unit, cxcludinz garage, carport, exterior storage shed, or open or fully
screened patio:: or tieelts. Eased on outside n:easureman:': for each starry of structure.
G ' EiSONS: Number of persons residing, using, or wo: %ing in estz'olisltment. For esidential establishment, 2 persons per bedroom are
assumed.
3'JSINESS AC I.VY" ": Iiier commercial applications only. List 'umber of employees, shifts, and isours of operation, or other information required by
Table 11, Chapter !OD -6, FAC.
i`C s Ut�'E Mara each Listed fixture with number imsu,llcd or "NA" ii not applicable.
Si.CNATUItE: Si mature of applicant or agent. Date application on da) .uhntittcd to I l.alth Department with appropriate fees and attachments.
ATTACHMENTS: A site plan drawn to scale, showing boundaries with din ;anions, locations of residences or buildings, swimming pools, recorded
easements, onsite ;towage disposal system components ra' i location, slope of property, any existing or proposed wells, drainage
features, filled areas, obstructed areas, t:nd surface sitter. Location of wells, onsite sewage disposal systems, surface waters, and
otter pertinent facilities or features on adjacent property, if the features cr. with 75 feet of the applicant lot. Location of any
public well within 200 foci of lot.
u:• residences, a Floor plan (residences) _towing numb:;_ of 5cdrooraa c building c on of each unit. For nonresidential
establishments, c floor plan showing the square footage of the establishment, all plumbing drains and fixture types, and ot-hcr
features necessary to determine composition and quantity of wastewater.
ice..
'I
APPL:[ CANT :
LOT:
g://,-1. d / 7--,44- 5 f �1 f �9 fe � i az 17
C
9'16-/if BLOCK: re-1 SUBDIVISION: //i ?/ ay )F c
PROPERTY ID #: [Section /Township /Range /Parcel No. or Tax ID Number]
l/ ' - 7 zGiC® Oi 9 °G3,e0
TO BE, COMPLETED BY ENGINEER, HEALTH UNIT EMPLOYEE, OR OTHER QUALIFIED PERSON. ENGINEER'S MUST
PROVIIDE REGISTRATION NUMBER AND SIGN AND SEAL EACH PAGE OF SUBMITTAL. COMPLETE ALL ITEMS.
PROPERTY SIZE CONFORMS TO SITE LAN: [YES ( ] NO NET USABLE AREA AVAILABLE: /1:0 ACRES
TOTAII ESTIMATED SEWAGE FLOW: LOO GALLONS PER DAY [RESIDENCES -TABLE 1 / OTHER -TABLE 2]
AUTHORIZED SEWAGE FLOW:6 ® GALLONS PER DAY [1500 GPD /ACRE OR 2500 GPD /ACRE]
UNOBSTRUCTED AREA AVAILABLE: G 0 SQFT UNOBSTRUCTED AREA REQUIRED: e (O 0 SQFT
BENCHMARK /REFERENCE POINT LOCATION: 12,2 / ii SJQ l /GO, C ° 1/
ELEVAITION OF PROPOSED SYSTEM SITE IS [INCHES /FT] (ABOV %BELOW] ENCHMARK /REFERENCE POINT
3 2 , 00
THE I NIMUM SETBACK WHICH CAN BE MAINTAINED FROM THE PROPOSED SYSTEM TO THE FOLLOWI G FEATURES:
SURFACE WATER: O// d / 1...-0 , FT DITCHES /SWALES: FT NORMALLY WET? [krYES [ ] NO
WELLS: PUBLIC: 4-- FT LIMITED USE: FT PR IVATE: FT NON - POTABLE: FT
Q /
BUILDING FOUNDATIONS: / FT PROPERTY LINES: t t2 FT POTABLE,WATER LINES: 7 0 FT
10 YEAR FLOODING? [ ) YES [
10 YE4R FLOOD ELEVATION FOR SITE: FT MSL /NGVD SITE ELEVATION: '9, ( FT MSL /NGVD
SITE SUBJECT TO FREQUENT FLOODING: [ ] YES [6
SOIL ?ROFILE INFORMATION SITE 1
STATE Off' FLORIDA '
DEPARTMENT OF HEALTH
ONSITE SEWAGE DISPOSAL SYSTEM
SITE EVALUATION AND SYSTEM SPECIFICATIONS
Mu ±sill Color Textu a Depth
:rep 42 to
tom
to
to
to
(i , to
to
to
. to
USDA SOIL SERIES: 6 / ,-4 i. �6'r/ r!
OBSER I Ell WATER TABLE: �/; INCHES [ABOVE / BELOW EXISTING E . TYPF•� ` CHED / c PARENTj�
ESTIMATED WET SEASON WA R TABLE ELEVATION: ? % 7 INCHES [ ABOVE (BELO EXISTING GRADE.
HIGH WATER TABLE VEGETATION: [ ] YES ( NO MOTTLI : [ ] YES [1440 DEPTH: Z--9 INCHES
SOIL 7 /LOADING RATE FOR SYSTEM SIZING: /,(,". /� & DEPTH OF EXCAVATION: ...T4 INCHES
DRAINFIIELD CONFIGURATION [ ] TRENCH ( k' BED [ ] OTHER (SPECIFY)
REMARItS /ADDITIONAL CRITERIA:
SITE E
VALUATED BY:
DH 4015, 10/96 (Replaces HRS -H Form 4015 [Page 3) which may be used)
(Stock Nurttber: 5744- 003 - 4015 -1)
PERMIT #
SOIL PROFILE INFORMATION SITE 2
Munsell # /Color Textur Depth
/o y2 9- 2 XL c) tO
to�
Mir
Pee
y/ /Y
USDA SOIL SERIES:
to
to
to
/.. to
to
to
to
DATE : �- 5 - G
Page 3 of 3
i'crntA .tiri.er.r by Coun• •
Pro!3orty
. 1 ot. lor
Nt :Z7 clrut foi property ',ryroptorr..!,• ri tor . .t) tolr• or scci•onlrownsiiip/rF.mgeT2ctect
Thee!: ic1:4) ■ ' r r.ntrbltr. tr.r.r.rt:::: co: 1cl U.
rrrtr-crt re,•... r • , •-.• • orr i.try• tr.rlogivc of r.t.trtrrtrrl.;.
no •• • trict, :314.;
- r 1; - „Yr. 1 {rt.t7i ot• 10010 2 (no,i- •„
y initt..,r • ...4■Zt., • I'. . . •,r-
• • -..••• rt •• .•
• Yi.'■•,1 - . . t;-•.;
norcc ' • ' tr. 'L )ST. ... 0L tr.r ttru; • crit.rst. '
1. :„L • ';■": ‘S. 'JCL, i•1L t, yr'
C*,,..:0?2, It, • -lc, . c
, •
' ' , '•. 1 .o
•• H.: :1 : •1 fr-. 10 bt
:r_t. • • - • -• Lori • , • ; • I irci:.)1:t °fez 7 1:11oet
•
rr,
•
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' 1 • 2 [1. V(' r It;: r .
r:rr . • ir T.1 Ult. 1 '
.•-• 1 •• t • • co'; ItrtC
• ,c .
cr.• : , :
' • ,
N
STATE OF FLORIDA
DEPARTMENT OF HEALTH
APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PERMIT) i(
Permit Application Number � P� 6 b
/
te r; /-
DH 4015, 10/96 (Replaces HRS -H Form 4015 which may be used)
(Stock Number: 5744 -002 - 4015 -6)
PART II - SITEPLAN
Scale: Each block represents 10 feet and 1 inch = 40 feet.
otes:
L7
/0
® Ty
/�i t7 v✓-^ / e Ga /J
Site Plan submitted / 7/
Plan Approved n\ P Gti Not Approved
/ 7._
/ (�' —�--
t /— �s ri y > P� ,7%!3- G p.: : e- "
N c
By
ALL CHANGES MUST BE APPROVED BY THE COUNTY HEALTH DEPARTMENT
J r,
Date
County Health Department
Page 2 of 4
f
Permit No ! V J
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 Mr Keene __ - -_ No. 400N.E. Street 100 Street
Registered Architect and /or Engineer _ - - - -_ __— ____-- ,-- ------- ------ _ -- -._
Employing Plumber's Name O'Neal Septic Tank Co. No. P.0 • BOX 629
Location and Legal Description Lot
Street and Number where work is to be performed —No 1+00 N.E.
Size Septic Tank
STATE OF FLORIDA,
COUNTY OF DADE.
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
Block
Pu_mp and abandon old tank
Amount of Permit $ 4,00 ( Signed) _
Jan. 5th, ?2
Date
Street Tamiami Station
Miami, Flori 3314/+
Subdivision. - - -- _ - -_ -- _
Street 100 Street
State work to be performed and purpose of building (By Floors)- _ - -_ -_ _-.-----------__ -_ --
New Building __ ___ Remodeling__ __- .-- -- -- --- _ -- --_ Addition_ -- X _ ..__ Repairs No. of Stories- _ • • It .... ...... . ..
1050 gal. _Type of Tank
100
Feet of Drain .............. Feet of Tank or Drain Field from Well
Nature of Water Supply: City — Well.___ —__ ______________.__.____.___Size of Soakage Pit
Capacity Gals.
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 leas 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.
( Signed)-- __ —___ _- _ r��'� -te'
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 insp. - in, or faulty
materials and /or workmanship.
CLOSETS
BATH
TUBS
OWERS
SHOWERS
LAVA-
TORIES
SINKS
SLOP
SINKS
LAUNDRY
TUBE
RINAL8
URINALS
CATCH
BASIN
FLOOR
DRAIN
DRINKING
FOUNT'NS
TOTAL
FIXTURES
CONTR.
LIST
CHICK
SEPTIC
TANK
SEWER
CONN.
DRAIN
FIELD
SOAKAGE
PIT
GREASE
TRAP
SOLAR
HEATER
DEEP
WELL
SPRKLR.
SYSTEM
SWING
POOL
CONTR.
LIST
I
- - --
CHECK
Permit No ! V J
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 Mr Keene __ - -_ No. 400N.E. Street 100 Street
Registered Architect and /or Engineer _ - - - -_ __— ____-- ,-- ------- ------ _ -- -._
Employing Plumber's Name O'Neal Septic Tank Co. No. P.0 • BOX 629
Location and Legal Description Lot
Street and Number where work is to be performed —No 1+00 N.E.
Size Septic Tank
STATE OF FLORIDA,
COUNTY OF DADE.
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
Block
Pu_mp and abandon old tank
Amount of Permit $ 4,00 ( Signed) _
Jan. 5th, ?2
Date
Street Tamiami Station
Miami, Flori 3314/+
Subdivision. - - -- _ - -_ -- _
Street 100 Street
State work to be performed and purpose of building (By Floors)- _ - -_ -_ _-.-----------__ -_ --
New Building __ ___ Remodeling__ __- .-- -- -- --- _ -- --_ Addition_ -- X _ ..__ Repairs No. of Stories- _ • • It .... ...... . ..
1050 gal. _Type of Tank
100
Feet of Drain .............. Feet of Tank or Drain Field from Well
Nature of Water Supply: City — Well.___ —__ ______________.__.____.___Size of Soakage Pit
Capacity Gals.
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 leas 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.
( Signed)-- __ —___ _- _ r��'� -te'
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 insp. - in, or faulty
materials and /or workmanship.
MIAMI SHORES VILLAGE. FLORIDA j
BUILDING ❑
ELECTRICAL ❑ DATE ; 195
PLUMBING B PERMIT N9 9632 Contractors
License No
ROOFING ❑
Owner of
Building
Architect
Contractor
or Builder
Legal
Description
Address of
Building
Lot
❑ Work to be performed under this Permit
Bl.
Subdi-
vision
Sq. Ft
Value of
Project $
This permit is granted to the contractor or builder named above to construct the building or to install the equipment or device described in the application
herefor in strict compliance with all ordinances pertaining thereto and with the understanding that the work will be performed in compliance with any plans,
drawings, statements or specifications that may have been submitted to and approved by the proper municipal authorities. This Permit may be revoked at any
time if the work is not done in compliance with such ordinances or if the plans are changed without authorization. A further condition upon which this permit is
granted is the understanding that the contractor or builder named above assumes the responsibility for a thorough knowledge of the ordinances and regulations
pertaining to the work covered hereby whether shown on the plans or drawings or in the statements or specifications and that he assumes responsibility for work
done by his agents, servants or employees.
CONTRACTOR OR BUILDER
Signed • BY
INSPECTOR
In consideration of the issuance to me of this permit I agree to perform the work covered hereunder in compliance with all ordinances and regulations
pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village.
In accepting this permit I assume responsibility for all work done by either, myself, my aggnt, servant or employee.
f
BY
Amt. of
Permit $
AUTHORITY
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__._�a
Registered Architect and /or Engin��e''err____ _ _._____
Employing Plumber's Name �1
Location and Legal Description Lot_--_.. r — ...____.____ ___ Block Subdivision
Street and Number where work is to be performed —No._ -6 /e/4 Street
State work to be performed and purpose of building (By Floors) ___.__________
New Building Remodeling _ Addition._
Nature of Water Supply: City —Well
rss� - --
Amount of Permit $
STATE OF FLORIDA, }
COUNTY OF DADE.
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMEiti:
APPLICATION FOR PLUMBING `' •b:,l�
( Signed) _
Date
No.__._ _ Street
Street._
Repairs
(
Signed)- L
My Commission Expires Notary Public, State of Florida
No. of Stories
Size Septic Tank _ ____ of Tank__ Capacity Gals.
Feet of Drain Tile Dist. ee o " ank or Drain Field from Well
Size of Soakage Pit
Plumbing Ins.ector.
The undersigned applicant for this building permit does hereby certify that he understands and accepts hi/obligations as an employer of labor
under the Florida Workmen's Compensation Act, being Section 5988, Compiled General Laws of Florida P manent Supplement, and has com-
plied with the provisions thereof, and will require similar compliance from all contractors or sub - contracto ' 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 wor 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.
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
N
SLOP
SINKS
LAUNDRY
TUBS
URINALS
U
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 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__._�a
Registered Architect and /or Engin��e''err____ _ _._____
Employing Plumber's Name �1
Location and Legal Description Lot_--_.. r — ...____.____ ___ Block Subdivision
Street and Number where work is to be performed —No._ -6 /e/4 Street
State work to be performed and purpose of building (By Floors) ___.__________
New Building Remodeling _ Addition._
Nature of Water Supply: City —Well
rss� - --
Amount of Permit $
STATE OF FLORIDA, }
COUNTY OF DADE.
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMEiti:
APPLICATION FOR PLUMBING `' •b:,l�
( Signed) _
Date
No.__._ _ Street
Street._
Repairs
(
Signed)- L
My Commission Expires Notary Public, State of Florida
No. of Stories
Size Septic Tank _ ____ of Tank__ Capacity Gals.
Feet of Drain Tile Dist. ee o " ank or Drain Field from Well
Size of Soakage Pit
Plumbing Ins.ector.
The undersigned applicant for this building permit does hereby certify that he understands and accepts hi/obligations as an employer of labor
under the Florida Workmen's Compensation Act, being Section 5988, Compiled General Laws of Florida P manent Supplement, and has com-
plied with the provisions thereof, and will require similar compliance from all contractors or sub - contracto ' 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 wor 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.
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.
A,rchitect
Contractor
or Builder
Legal Lot II M.
Description.
Address of
Building '-t
CONTRACTOR OR BUILDER
MIAMI SHORES VILLAGE, FLORIDA
BUILDING ❑ DATE 'i , 195
ELECTRICAL ❑ PERMIT N° 14 516 Contractor's
PLUMBING 0 License No -
ROOFING ❑ Work to be performed under this Permit
Owner of
Building _
Subdi-
vision
Value of
Project $ f .
Amt. of
Permit $ �,r
This permit is granted to the contractor or builder named above to construct the building or to install the equipment or device described in the application
herefor in strict compliance with all ordinances pertaining thereto and with the understanding that the work will be performed in compliance with any plans,
drawings, statements or specifications that may have been submitted to and approved by the proper municipal authorities. This Permit may be revoked at any
time if the work is not done in compliance with such ordinances or if the plans are changed without authorization. A further condition upon which this permit is
granted is the understanding that the contractor or builder named above assumes the responsibility for a thorough knowledge of the ordinances and regulations
pertaining to the work covered hereby whether shown on the plans or drawings or in the statements or specifications and that he assumes responsibility for work
done by his agents, servants or employees.
Signed • }.t: ; , . BY J i
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 responsibility for all work done by either, myself, my agent, servant or employee.
BY AUTHORITY
Permit No. .._NS
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 Divisior
of Miami Shores Village shall be complied with whether herein specified or not. A copy of approved plans and specifications must be kept al
building during progress of work.
Owner's Name and AddresU.Cy4 No.__..._ Street
Registered Architect and /or Engineer
Employing Plumber's Name
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
Size Septic Tank Type of Tank___ Capacity Gals .._..._.__._ -
Feet of Drain Tile Dist. Feet of Tank or Drain Field from Well
Size of Soakage Pit
Nature of Water Supply: City -Well.
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
. No._
(Signed)-
Amount of Permit $ !!- ----- -- - - -- - -� -- ( Signed ) -
Date 4 /7 �
Street
Plumbing Inspector.
The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations as an employer of labor
under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Pennanent 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.
x .7 4
Master Plumber.
STATE OF FLORIDA, ss.
COUNTY OF DADE.
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeare
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 tae
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 faul
materials and /or workmanship.
CLOSETS
BATH
TUe9
SHOWERS
LAVA.
TORIES
S INKS
SLOP
SINKS
LAUNDRY
TU88
URINALS
CATCH
BASIN
FLOOR
DRAIN
DR; NKIN@
FOU NT' NS
TOTAL
FI[TURCI
CONTR.
LIST
--
CHECK
_-
SEPTIC
TANK
SEWER
CONN.
DRAIN
FIELD
SOAKAGE
PIT
GREASE
TRAP
SOLAR
HEATER
DEEP
WELL
SPRKLR.
SYSTEM
SWIM'G
P001.
CONTR.
UST
CHECK
Permit No. .._NS
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 Divisior
of Miami Shores Village shall be complied with whether herein specified or not. A copy of approved plans and specifications must be kept al
building during progress of work.
Owner's Name and AddresU.Cy4 No.__..._ Street
Registered Architect and /or Engineer
Employing Plumber's Name
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
Size Septic Tank Type of Tank___ Capacity Gals .._..._.__._ -
Feet of Drain Tile Dist. Feet of Tank or Drain Field from Well
Size of Soakage Pit
Nature of Water Supply: City -Well.
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
. No._
(Signed)-
Amount of Permit $ !!- ----- -- - - -- - -� -- ( Signed ) -
Date 4 /7 �
Street
Plumbing Inspector.
The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations as an employer of labor
under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Pennanent 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.
x .7 4
Master Plumber.
STATE OF FLORIDA, ss.
COUNTY OF DADE.
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeare
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 tae
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 faul
materials and /or workmanship.