277 NE 101 St (14)Permit 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 or not. A copy of approved plans and specifications must be kept et
building during progress of work.
Owners Name and Address
Registered Architect and /or Engin
Employing Plumber's Name
Location and Legal Description Lot
Street and Number where work L to be performed -No
State work to be performed and purpose of building (By Floors)
New Building..__.. _ _ -- •---- ........_.. Remodeling____ ._..._. __ __ Addition.
Bloom •
Size Septic Tank_.. -Type of Tank --_
Feet of Drain Tile Dist. Feet of Tank or Drain Field from Well ..._- __.___
Nature of Water Supply: City -WeIL Size of Soakage lit
3no,a1
e �l :��J' `�"�'�•
Amount of Permit $ 1115 * (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 Iw' 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 arc
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)
No 7 7 N Street—IL/ .
. � _ � .. //� _ .
Street. . _ ..._.._
Repairs No. of Stories.
/ 2 9 {1 i
Muter 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 be 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 war minspeoticn 11a made by improper notice for inspection, or faulty
materials and /or worlananshnp.
CLOSITB
BATH
Tutus
aHOWIR
LAVA-
TORILS
al".
SINKS
LAUNDRY
TUBS
URINAL{
CATCH
BASIN
FLOOR
DRAIN
DRINKING
FOUNT 'N•
TOTAL
•IMTURES
CONTR.
LIST
CHICK
SEPTIC
TANK
SEWER
CONN.
DRAIN
FIELD
SOAKAOI
PIT
G
TRAP
SOLAR
HEATER
DUMP
WILL
$PRKLR.
SYSTEM
SW IM'0
POOL
CONTR.
LIST
CHECK
Permit 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 or not. A copy of approved plans and specifications must be kept et
building during progress of work.
Owners Name and Address
Registered Architect and /or Engin
Employing Plumber's Name
Location and Legal Description Lot
Street and Number where work L to be performed -No
State work to be performed and purpose of building (By Floors)
New Building..__.. _ _ -- •---- ........_.. Remodeling____ ._..._. __ __ Addition.
Bloom •
Size Septic Tank_.. -Type of Tank --_
Feet of Drain Tile Dist. Feet of Tank or Drain Field from Well ..._- __.___
Nature of Water Supply: City -WeIL Size of Soakage lit
3no,a1
e �l :��J' `�"�'�•
Amount of Permit $ 1115 * (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 Iw' 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 arc
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)
No 7 7 N Street—IL/ .
. � _ � .. //� _ .
Street. . _ ..._.._
Repairs No. of Stories.
/ 2 9 {1 i
Muter 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 be 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 war minspeoticn 11a made by improper notice for inspection, or faulty
materials and /or worlananshnp.
STATE OF FLORIDA
DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES
ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION AND INSTALLATION PERMIT .
Applicant _ Permit Number dir`-� /tjV>"
'
f �U E /jeL S t P c a. 6 3 �V
PART I - SYSTEM IN5TALLATION INSPECTION AND FINAL INSTALLATION APPROVAL-
Installer Gf%4/ - 1./ 112f T- G v�1���
Proper tank legend: Yes
No
Tanks watertight: Yes Tank size: gallons gallons gallons
Proper tank outlet device: Yes
Length Width Length Width
feet feet feet feet Length feet x feet= ft
feet feet feet feet Proper No. drainlines: Yes ,...../ o
feet feet feet feet Proper pipe separation: Yes No �,�
Total = ft Total = ft Distribution box level: Yes No
Systems located as permitted: Yes No
Systems including plumbing stub -outs installed at proper elevation: Yes No �/
Average depth to drainpipe invert from finished grade• ,2 3" Cinches Maximum depth: ' Inches
Average depth of drainfield gravel: �13 inches Minimum depth of gravel /Z_ inches
Proper gravel size: Yes LINO Gravel is suitable quality: Yes `...----- No
Backfill or fill material as required: (Quality) Yes (Quantity) Yes =--
Other findings: f •4. 4t
Inspected by: N c. -Tp2 44 nA11 tc !/g4/ Date Hi /V78r
Date
I
Approved by:
Drainfield Trench
AN APPROVED INSTALLATION DOES NO GUARANTEE PERFORMANCE
Note: Completed copies of this form will be provided to the applicant, installer and the building department.
HRS —H Form 4016, Feb 85 (Obsoletes previous editions which may not be used)
(Stock Number. 5744 - 002.4016.0)
Tank material (PVC.✓e fQ Tank level: Yes No
0
Tank Manufacturer
PART III - Fl INSTALLATION APPROVAL
Manhole or marker to grade: Yes No
Absorption Bed
Length a /
2 feet x� feet= 3t ft
COUNTY PUBLIC HEALTH UNIT
Page 2 of 2
i'erznit No .__. -__4.
3
Size Septic Tank_
Feet of Drain Tile.
Nature of Water Supply: City—Well.
Amount of Permit $
STATE OF FLORIDA, } as
COUNTY OF DADE. •
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
Registered Architect and /or Engineer_____ n �______—
Employing Plumber's Name_1►^'ril3a_!_!� =`an �1�°�« )1- _____ No..
(Signed)...
176
44 T
Date pfi
t
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. C "�
Owners Name and Address 4� A/N'l61_Z HAM_ No._ g_ 7. Street_ A 7
Street__' V 4--S-6" 5T
Location and • Legal Description Lot_______________________ __.-_— Blo4 • Subdivision
ex 7 7 F
-_ 7 Street and Number where work is to be performed— No.___ _ _ _. Street
t _
State work to be performed and purpose of building (By Floors)_— ____Z_�______ LO . CX 13.A
New Building — - Remodeling_ ____ _ ...._._ Addition_______._ Repairs .�
No. of Stories . . .......................
Type of Tank_ Capacity Gals
_Dist. Feet of Tank or Drain Field from Well
__. _Size of Soakage Pit
ng Inspector.
The undersigned applicant for this building permit does hereby certify that he understands and accepts his oblig 1'ns as an employer of labor
under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Perna pt Supplement, and has coin-
plied with the provisions thereof, and will require similar compliance from all contractors or sub - contras - .� 6yed 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 .r s public notice or notices as • are
required by the Act. The undersigned agrees to employ only such sub-contract • on work t• be erformed under this permit, as are
licensed by Miami Shores Village.
Master Plumber.
Before me, the undersigned authority, a notary public, duly authorized to adminis er 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
S INKS
SLOP
SINKS
LAUNDRY
TUBE
URINALS
CATCH
BASIN
FLOOR
DRAIN
DRINKING
FOUNT'NS
TOTAL
FIXTURES
CONTR.
LIST
CHECK
SEPTIC
TANK
SEWER
CONN.
DRAIN
FIELD
SOAKAGE
PIT
GREASE
TRAP
SOLAR
HEATER
DEEP
WELL
SPRKLR.
SYSTEM
$WIM•G
POOL
CONTR.
LIST
CHECK
i'erznit No .__. -__4.
3
Size Septic Tank_
Feet of Drain Tile.
Nature of Water Supply: City—Well.
Amount of Permit $
STATE OF FLORIDA, } as
COUNTY OF DADE. •
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
Registered Architect and /or Engineer_____ n �______—
Employing Plumber's Name_1►^'ril3a_!_!� =`an �1�°�« )1- _____ No..
(Signed)...
176
44 T
Date pfi
t
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. C "�
Owners Name and Address 4� A/N'l61_Z HAM_ No._ g_ 7. Street_ A 7
Street__' V 4--S-6" 5T
Location and • Legal Description Lot_______________________ __.-_— Blo4 • Subdivision
ex 7 7 F
-_ 7 Street and Number where work is to be performed— No.___ _ _ _. Street
t _
State work to be performed and purpose of building (By Floors)_— ____Z_�______ LO . CX 13.A
New Building — - Remodeling_ ____ _ ...._._ Addition_______._ Repairs .�
No. of Stories . . .......................
Type of Tank_ Capacity Gals
_Dist. Feet of Tank or Drain Field from Well
__. _Size of Soakage Pit
ng Inspector.
The undersigned applicant for this building permit does hereby certify that he understands and accepts his oblig 1'ns as an employer of labor
under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Perna pt Supplement, and has coin-
plied with the provisions thereof, and will require similar compliance from all contractors or sub - contras - .� 6yed 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 .r s public notice or notices as • are
required by the Act. The undersigned agrees to employ only such sub-contract • on work t• be erformed under this permit, as are
licensed by Miami Shores Village.
Master Plumber.
Before me, the undersigned authority, a notary public, duly authorized to adminis er 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.
Permit No.
Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted fo the building or othe
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 at
building during progress of work.
Owner's Name and Address
Registered Architect and /or Engineer
Employing Plumber's Name 4/1 ___L---U e C q1
Location and Legal Description Lot__
Street and Number where work is to be performed —No
Size Septic Tank
Feet of Drain Tile
Amount of Permit $
y?-RoLf
Nature of Water Supply: City —Well
f/
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
No
11 No ..
_ Block
A 7
(Signed)
277
Street
State work to be performed and purpose of building (By Floors) __ C4._ , i Y
New Building Remodeling Addition__._ Repairs
Date
Street
Subdivision
40
z
2
.74x'
No. of Stories
Type of Tank___ Capacity Gals
_Dist. Feet of Tank or Drain Field from WeIL
__Size of Soakage Pit
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 wor to be •rformed un is emit, as are
licensed by Miami Shores Village.
STATE OF FLORIDA, 1
COUNTY OF DADE. j
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 f:u'
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
TUBS
SHOWERS
LAVA-
TORIES
SINKS
SLOP
SINKS
LAUNDRY
TUBE
URINALS
CATCH
BASIN
FLOOR
DRAIN
DRINKING
FOU NT'NS
TOTAL
FIXTURE!
CONTR.
LIST
--
CHECK
SEPTIC
TANK
SEWER
CONN.
DRAIN
FIELD
SOAKAGE
PIT
GREASE
TRAP
SOLAR
HEATER
DEEP
WELL
SPRKLR.
SYSTEM
SW IM' O
POOL
CONTR.
LIST
CHECK
Permit No.
Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted fo the building or othe
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 at
building during progress of work.
Owner's Name and Address
Registered Architect and /or Engineer
Employing Plumber's Name 4/1 ___L---U e C q1
Location and Legal Description Lot__
Street and Number where work is to be performed —No
Size Septic Tank
Feet of Drain Tile
Amount of Permit $
y?-RoLf
Nature of Water Supply: City —Well
f/
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
No
11 No ..
_ Block
A 7
(Signed)
277
Street
State work to be performed and purpose of building (By Floors) __ C4._ , i Y
New Building Remodeling Addition__._ Repairs
Date
Street
Subdivision
40
z
2
.74x'
No. of Stories
Type of Tank___ Capacity Gals
_Dist. Feet of Tank or Drain Field from WeIL
__Size of Soakage Pit
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 wor to be •rformed un is emit, as are
licensed by Miami Shores Village.
STATE OF FLORIDA, 1
COUNTY OF DADE. j
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 f:u'
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.
BUILDING
ELECTRICAL
PLUMBING
ROOFING
Owner of
Building
Architect
Contractor
or Builder
Legal
Description
Address of
Building
Lot
PERMIT IT? 12804
I1
MIAMI SHORES VILLAGE, FLORIDA
n Work to be performed under this Permit
1
Bl.
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 •
Subdi-
vision
Value of
Project $
DATE .195
Contractor's
License No
Amt. of
Permit $
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,.iny agent, servant or employee.
CONTRACTOR OR BUILDER By, AUTHORITY