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290 NE 101 St (3)• PERMIT APPLICATION FOR MIAMI SHORES VILLAGE Date 1/05/96 Job Address 290 NE 101 STREET Tax Folio Legal Description Historically Designated: Yes No Owner/Lessee / Tenant SUTTON Owner's Address 290 NE 101 STREET, 33138 Phone 751 -4589 ContractingCo. NORTH DADE SFPTTC TANK Address 800 NW 111 STREET, MIAMI 33168 Qualifier DENNIS NEVILLE SS# Phone 754 -3375 State # 025836 -8 Municipal # Competency # 12842 Ins. CoTRAVELERS /ESIF Architect/Engineer Address Bonding Company Address Mortgagor Address Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN WORK DESCRIPTION INSTALL DRIANFIELD Square Ft. 200 Estimated Cost (value) $1000.00 WARNING TO OWNER: YOU MUST RECORD A NOTICE OF COMMENCEMENT AND YOUR FAILURE TO DO SO MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY (IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT.) Application is hereby made to obtain a permit to do work and installation as indicated above, and on the attached addendum (if applicable). I certify that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that separate permits are required for ELECTRICAL, PLUMBING, SIGNS, POOLS, ROOFING and MECHANICAL WORK. OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that al will be done in compliance with all applicable law w egulating construc ign and zoning. Furthermore, I authorize the above -named con , .r to • . the work stat Signature of o a No : fir' Owner and/o My Commission Expires: FEES: PERMIT 1 cQ ale and/or Condo President D to sident Date o 1 ► • �Y p4 A Teresa J. Felder Nc ary Public, State of Florida • o ` Commission No. CC 480807 ''• ti°! My Commission Expires 07/16/99 1.800.3NOTARY - Fla Notary Service & Sending Co. !!!!!!!!!!!!!!!!K!!!!!!! uceet cceicceeare to APPROVED: Zoning Building Mechanical Plumbing 4 Notary a to Co tractor or 0 My Commission Expires: Master Permit # e04 RADON C.C.F. 5— NOTARY TOTAL DUE Electrical eqvc- Date cf Bui er Date t sc. a ««curs.. c «<s «ti «a t t«mw. .er op a r Teresa J. Felder Notary Public, State of Florida � 7 o Commission No. CC 480807 '`'o,na My Commission Expires 07/16/99 4 1-800-3-NOTARY • Fla. Notary Service & Bonding Co. ete(ee eeeee(eeeeee ee /eee(eeeeeeeeee(!!!!tee(ee/ / Engineering APPLICANT: SUTTON LOT: ] BLOCK: 1J . SUBDIVISION: 0 T H E R STATE OF FLORIDA. DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PERMIT Authority: Chapter 381,,FS & Chapter 10D -6, FAC PROPERTY STREET ADDRESS: 290 NE 101 STREET, 33138 CONSTRUCTION PERMIT FOR: [N ] New System [N] Existing System [N] Holding Tank [N ] Temporary /Experimental [Y ] Repair [N ] Abandonment "., [ N ] Other(Specify) AGENT: p PROPERTY ID #: N/A [SECTION /TOWNSHIP /RANGE /PARCEL NUMBER] [OR TAX ID NUMBER] SYSTEM 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. HRS APPROVAL OF SYSTEM DOES NOT GUARANTEE SATISFACTORY PERFORMANCE FOR ANY SPECIFIC PERIOD OF TIME. AIRY CHANGE IN MATERIAL FACTS WHICH SERVED AS A BASIS FOR ISSUANCE OF THIS PERMIT, REQUIRE THE APPLICANT TO MODIFY THE PERMIT APPLICATION. SUCH MODIFICATIONS MAY RESULT IN THIS PERMIT BEING MADE NULL AND VOID. SYSTEM DESIGN AND SPECIFICATIONS EXISTING T [ 750] [GALLONS / Ted SEPTIC TANK/400mo= 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: [ ] iI,) [ 2w ' ] SQUARE FEET MITONEk DRAINFIELD SYSTEM R• [- 1 SQUARE FEET SYSTEM A TYPE SYSTEM: [X] STANDARD [ ] FILLED [ ].MOUND I CONFIGURATION: [ ] TRENCH [X] BED [ 1 N F LOCATION OF BENCHMARK: ! ge, /2 0.s .. ,f l I ELEVATION OF PROPOSED SYSTEM SITE [ ] [INCHES /FT] [ABOVE /BELOW] BENCHMARK /REFERENCE POINT E BOTTOM OF DRAINFIELD TO BE [ ] [INCHES /FT] [ABOVE /BELOW] BENCHMARK /REFERENCE POINT L D FILL REQUIRED: [ ] INCHES EXCAVATION REQUIRED: [ ] INCHES INSTALL 12 OF LOAMY COARSE SAND UNDER BOTTOM OF DRAINFIF:LO SUBMIT J3ENUHMARIC MORE INSPECTION. THIS PERMIT ISNOT NOR ADDITiuN (5) . INVERT ELEVATION (MINIMUM) : 4 l3U'1 "1OP1 Up' DRAINFIELD ELEVATION (MINIMUM) : 14,g; SPECIFICATIONS BY: TITLE: APPROVED BY: DATE ISSUED: /„. c, ,_ 76 HRS-H Form 4016, Mar 92 (Obsoletes (Stock Number: 5744-001- 4016 -0) TITLE: THE SEPTIC TANK SHALL BE PUMPED AND A SOLID DEFLECTION DEVICE INSTALLED ON THE OUTLET TEE. previous editions which may not be used) APPLO©I T PERMIT # DATE PAID FEE PAID $ RECEIPT # NORTH DADE SEPTIC [ CPHU EXPIRATION DATE:iL,6prX Page 1 of 2 • L:I L i U Notes: By STATE OF FLORIDA ,� ���,� DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES /4 -' 1 • APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PERMIT 9 Permit Application Number PART 11 - SITE PLAN Scale: Each block represents 5 feet and 1 inch = 50 feet. ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■ ■■■■■■■■■A■■■■■■■ ■.■■ ■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■ c. 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BY 2kUNTY PUBLIC HEALTH UNIT Page 2 of 3 HRS -H Form 4015, Feb 85 (Obsoletes previous editions which may not be used) (Stock Number. 5744-002-4015-6) SIG RE Not Approved l� /0 0 TITLE Date i"q . +�o.....o w� APPLICANT: SUTTON LOT: 0 PROPERTY ID #: STATE OF FLORIDA DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES ONSITE SEWAGE DISPOSAL SYSTEM SITE EVALUATION AND SYSTEM SPECIFICATIONS BLOCK: SUBDIVISION: [Section /Township /Range /Parcel No. or Tax ID Number] l TO BE COMPLETED BY ENGINEER, HEALTH UNIT EMPLOYEE, OR OTHER QUALIFIED PERSON. ENGINEER'S MUST PROVIDE REGISTRATION NUMBER AND SIGN AND SEAL EACH PAGE OF SUBMITTAL. COMPLETE ALL ITEMS. PROPERTY SIZE CONFORMS TO SITE PION: [ ` YES ( ] NO NET USABLE AREA AVAILABLE: ► 1 .3 7 ACRES TOTAL ESTIMATED SEWAGE FLOW: GALLONS PER DAY [RESIDENCES -TABLE 1 / OTHER -TABLE 2] AUTHORIZED SEWAGE FLOW: GALLONS PER DAY [1500 GPD /ACRE OR 2sop GPD /ACRE] UNOBSTRUCTED AREA AVAILABLE: �,. SQFT UNOBSTRUCTED AREA REQUIRED: ® ® SQFT. BENCHMARK /REFERENCE POINT LOCATION: ELEVATION OF PROPOSED SYSTEM SITE IS .._- [' /FT] (ABOVE/B THE MINIMUM SETBACK WHICH CAN BE MAINTAINED FROM THE PROPOSED SYSTEM TO THE FOLLOWING FEATURES: 100+ FT DITCHES /SWALES: °- FT NORMALLY WET? [ ] YES [Xt NO 100 FT LIMITED USE: — FT PRIVATE: FT NON - POTABLE: — FT 5 FT PROPERTY LINES: 5 FT POTABLE WATER LINES: + 15 FT SURFACE WATER: WELLS: PUBLIC: BUILDING FOUNDATIONS: SITE SUBJECT TO FREQUENT FLOODING: ( ] YES [X] NO 10 YEAR FLOOD ELEVATION FOR SITE: W.T. 3.0 FT SOIL PROFILE INFORMATION SITE 1 Munsell # /Color Texture BROWN SANDY USDA SOIL SERIES: SANDY Depth 0" to 72 to to to to to to to to SITE EVALUATED BY: HRS -H Form 4015, Mar 92 (Obsolet -s previous editios whic) (Stock Number: 5744 - 003 - 4015 -1) %0. o3 : I • E OBSERVED WATER TABLE: £ INCHES AMX/ BELOW] EXISTING GRADE. TYPE: fiikKakff / APPARENT] ESTIMATED WET SEASON WATER TABLE ELEVATION: 108 INCHES [ / BELOW ] EXISTING GRADE. HIGH WATER TABLE VEGETATION: [ ] YES [X] NO MOTTLING: ( ] YES [X] NO DEPTH: INCHES SOIL TEXTURE /LOADING RATE FOR SYSTEM SIZING: 1.25 DRAINFIELD CONFIGURATION: ( ] TRENCH [X ] BED [ ] OTHER (SPECIFY) REMARKS /ADDITIOf144 CRITERIA: not be 10 YEAR FLOODING? ) YES [x) NO NGVD SITE ELEVATION: �° FT MSL /NGVD SOIL PROFILE INFORMATION SITE 2 AGENT: Munsell # /Color Texture Depth BROWN SANDY _ " to 72" to to USDA SOIL SERIES: SANDY to to to to to to ed) ■ PERMIT # &WOO NORTH DADE SEPT aA tI( C/ BENC DEPTH OF EXCAVATION:30 DATE: 1/08/96 POINT INCHES Page 3 of 3 Thi\TS7',11.ICIT:ONS: 0: ?e-mit :lumber cnc y ?ropey civrter'a ful! name. LCNT: 1?ropey Legel]y bubdivicion cc.; 27 ellS.1*LC:.;:.* fOr cc ;C. no's cvci7rblo - or: *•' *;;* • z " • - op - 1: ‘....co T.1 • - •2c: . AGENT: NORTH DADE SEPTIC TANK MAILING s=;DDRESS: 800 NW 111 STREET, MIAMI 33168 LOT: BLOCK: 1 SUBDIVISION: PROPERTY #: PROPERTY 1 PROPERTY SIZE: PROPERTY STREET ADDRESS: DIRECTIONS TO PROPERTY: BUILDING INFORMATION Unit Type of No Establishment 1 2 3 4 SFR APPLICANT'S SIGNATURE: STATE OF FLORIDA DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES ONSITE SEWAGE DISPOSAL SYSTEM APPLICATION FOR CONSTRUCTION PERMIT Authority: Chapter 381, FS & Chapter 10D -6, FAC 290 NE 101 STREET, 33138 Ca] RESIDENTIAL [ ] COMMERCIAL No. of Bedrooms 2 BEDROOMS HRS -H Form 4015, Mar 92 (Obsolete' previous editions which may not be used) (Stock Number: 5744 - 001- 4015 -1) PERMIT # DATE PAID FEE PAID $ � /O .G U RECEIPT # APPLICATION FOR: (N J New System [ N] Existing System [ N] Holding Tank [ N] Temporary /Experimental [X ] Repair [ N] Abandonment [ Ni Other(Specify) APPLICANT: TELEPHONE: SUTTON n 751 -4589 754-3375 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. PROPERTY INFORMATION [IF LOT IS NOT IN A RECORDED SUBDIVISION, ATTACH LEGAL DESCRIPTION OR DEED] DATE OF SUBDIVISION: 72 [Section /Township /Range /Parcel No.] ZONING: j ACRES [Sqft /43560] PROPERTY WATER SUPPLY: [ ] PRIVATE DiDa PUBLIC Building # Persons Business Activity Area Sqft Served For Commercial Only! [N ] Garbage Grinders /Disposal [ as /Hot Tubs [N ] Floor /Equipment. Drains IN ] Ultra -low Volume Flush oilets „ �`[N ] Othe Specify) DATE: 1/05/96 Page 1 of 3 • 't l:._ - _...cS (, ?!F •• `c: tot (re c. Sit 1C.L::. c Q;fi ABC _._..:. ..�.. .. .. „ (C ` - • ?c; :ui ":10 :115 '3c En. _ aorr_ c`v`sior., n copy Ent ;r::.. air .:.. • ., ua: r : _' •., w�:,. _:_�+ _i2'i. :':V:£ : 3 ` JCS .:... occo,nro_n =., 13121;', ,r. _...., • BUILDING ❑ ELECTRICAL PLUMBING ❑ ROOFING Owner of Building ❑ PERMIT N? 15865 ❑ Work to be performed under this Permit Architect Contractor or Builder Legal Lot II BL Description Address of Building k CONTRACTOR OR BUILDER MIAMI SHORES VILLAGE, FLORIDA Subdi- vision Value of Project $ BY DATE K ' t4 195 Contractor's License No Amt. of Permit $ This permit is granted to the contractor or builder named above to construct the building or to install the equipment or device described in the 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: „ -- 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 agent, servant or employee. AUTHORITY JOB: BUILDING ELECTRICAL PLUMBING • • • • • • Inspector's Roport: • • • • • • • ▪ • • • • • • • • • • • • • • • WORK • DONE BY: • The following is ready for Inspection: REQUESTED 90 ),i€/ • • • • 3 ' • • • • • • • : WILL BE READY • • • JOB: r t� JOB 2" . bbb _��, ? f . � � AD / ® 3 �`f1 BUILDING ELECTRICAL PLUMBING The following is ready for Inspection: Inspector's Report: • • WORK • DONE BY : c J - • • REQUEST • • • • • • • • • • • • • • : WILL BE READY Permit No..__ 2. Street and Number where work is to be performed —No. Nature of Water Supply: City —Well. Amount of Permit $ _ ..._ STATE OF FLORIDA, COUNTY OF DADE. ss. APPLICATION FOR PLUMBING PERMIT Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the building or other structure herein described. This application is made in compliance and conformity with the Building Ordinance of Miami Shores Village, Florida, and all provisions of the Laws of the State of Florida, all ordinances of Miami Shores Village and all rules and regulations of the Building Division of Miami Shores Village shall be complied with, whether herein specified or not. A copy of approved plans and specifications must be kept at building during progress of work. , ✓ 4,..... ' F--/- 7 Owner's Name and Address - --•1 } _Y__�_ --- - - - -__ No._____SZ! ---- -— - -: s treet- - -J___ Registered Architect and /or E e Al a 2 ,. Employing Plumber's Name __ _ _'}__ ___ No.______f_ -___ Street_ *` Location and Legal Description Lot___—__ _____— ____--- _—_- _- -___- ___ -___ Block_ _ ________ _______________________ Subdivision__ -_______-__-_-__-- _-- _-- _- -_--. 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 feet -of –Drain Tile_ ___. ____ ___ —_ ____ Dist. Feet of Tank or Drain Field from Well______ My Commission Expires MIAMI SHORES VI LLAG E PLUMBING INSPECTION DEPARTMENT Size of Soakage Pit _____ –_____ -------_-------------------- _— __- -_ -__r Date__ _ 4 _Capacity Notary Public. State of Florida re Plumbing Inspector. The undersigned applicant for this building permit does hereby certify that he understands and &ccepts his obligations as an employer of labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Permanent Supplement, and has com- plied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors employed by him in the work to be performed under this permit; and will post or cause to be posted for inspection on the site of the work such public notice or notices as are required by the Act. The under signed agrees to employ only such sub - contractors, on work to be performed under this permit, as are licensed by Miami Shores Village. � �.� -°` (Signed) Master Plumber. Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeared -- – — — to me well known, and who, being by me first duly sworn, upon oath deposes and says that he is the. of the above described construction, that he has carefully read the foregoing application, and that he did sign the same, and that all facts therein by him stated are true. NOTE: A re- inspection fee of $1.00 will be made when such re- inspection is made necessary by improper notice for inspection, or faulty materials and /or workmanship. CLOSETS BATH TUBS SHOWERS LAVA- TORIES SINKS SLOP SINKS LAUNDRY TUBS URINALS CATCH BASIN FLOOR DRAIN DRINKING FOUNT' NS TOTAL FIXTURES CONTR. LIST CHECK SEPTIC TANK SEWER CONN. DRAIN FIELD SOAKAGE PIT GREASE TRAP SOLAR H EATER DEEP WELL SPRKLR. SYSTEM SWIM'G POOL CONTR. LIST CHECK Permit No..__ 2. Street and Number where work is to be performed —No. Nature of Water Supply: City —Well. Amount of Permit $ _ ..._ STATE OF FLORIDA, COUNTY OF DADE. ss. APPLICATION FOR PLUMBING PERMIT Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the building or other structure herein described. This application is made in compliance and conformity with the Building Ordinance of Miami Shores Village, Florida, and all provisions of the Laws of the State of Florida, all ordinances of Miami Shores Village and all rules and regulations of the Building Division of Miami Shores Village shall be complied with, whether herein specified or not. A copy of approved plans and specifications must be kept at building during progress of work. , ✓ 4,..... ' F--/- 7 Owner's Name and Address - --•1 } _Y__�_ --- - - - -__ No._____SZ! ---- -— - -: s treet- - -J___ Registered Architect and /or E e Al a 2 ,. Employing Plumber's Name __ _ _'}__ ___ No.______f_ -___ Street_ *` Location and Legal Description Lot___—__ _____— ____--- _—_- _- -___- ___ -___ Block_ _ ________ _______________________ Subdivision__ -_______-__-_-__-- _-- _-- _- -_--. 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 feet -of –Drain Tile_ ___. ____ ___ —_ ____ Dist. Feet of Tank or Drain Field from Well______ My Commission Expires MIAMI SHORES VI LLAG E PLUMBING INSPECTION DEPARTMENT Size of Soakage Pit _____ –_____ -------_-------------------- _— __- -_ -__r Date__ _ 4 _Capacity Notary Public. State of Florida re Plumbing Inspector. The undersigned applicant for this building permit does hereby certify that he understands and &ccepts his obligations as an employer of labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Permanent Supplement, and has com- plied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors employed by him in the work to be performed under this permit; and will post or cause to be posted for inspection on the site of the work such public notice or notices as are required by the Act. The under signed agrees to employ only such sub - contractors, on work to be performed under this permit, as are licensed by Miami Shores Village. � �.� -°` (Signed) Master Plumber. Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeared -- – — — to me well known, and who, being by me first duly sworn, upon oath deposes and says that he is the. of the above described construction, that he has carefully read the foregoing application, and that he did sign the same, and that all facts therein by him stated are true. NOTE: A re- inspection fee of $1.00 will be made when such re- inspection is made necessary by improper notice for inspection, or faulty materials and /or workmanship. PLUMBING INSPECTION DEPARTMENT • Permit No.... 1 APPLICATION FOR PLUMBING PERMIT MIAMI SHORES VILLAGE (Signed J Date -- I -- , 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. , p , "� la ;` rs 7 Owner's Name and Address _ i _ f ��_ v . S F r �._____ -- --- '-------------- ____ -- No._____ -- ------- _______ Street____ __ Registered Architect and /or Eggi ,-, i.. r ' 1__ _ _________________ + ! __ ` Employing Plumber's Name �_______ � - ----- ----- - - -- -- No ?_ .. Street - - ----=- --- --- - -L---- 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 Size Septic Tank_____ ____ Type of Tank . _ _Capacity Gals._______---____ Feet of Drain Tile_____ _____ Dist. Feet of Tank or Drain Field from Well-__ Nature of Water Supply: City —Well — — Size of Soakage Pit of Permit (Signed) *�3 e Rf �' A mount o – - a-- – — -- — -- – -- __ Plumbing Inspector. 40•••""--- of Stories Mastf'r Plumber. The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations as an employer of labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Permanent Supplement, and has com- plied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors employed by him in the work to be performed under this permit; and will post or cause to be posted for inspection on the site of the work such public notice or notices as are required by the Act. The under signed agrees to employ only such sub - contractors, on work to be performed dduer this as are licensed by Miami Shores Village. 1'J ° s ' < ..,. r qz_ STATE OF FLORIDA, ss COUNTY OF DADE.. Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeared to me well known, and who, being by me first duly sworn, upon oath deposes and says that he is the. of the above described construction, that he has carefully read the foregoing application, and that he did sign the same, and that all facts therein by him stated are true. My Commission Expires Notary Public. State of Florida NOTE: A re- inspection fee of $1.00 will be made when such re- inspection is made necessary by improper notice for inspection, or faulty materials and /or workmanship. CLOSETS BATH TUBS SHOWERS LAVA- TORIES SINKS SLOP SINKS LAUNDRY TUBS URINALS CATCH BASIN FLOOR DRAIN DRINKING FOUNT'NS TOTAL FIXTURES CONTR. LIST CHECK SEPTIC TANK SEWER CONN. DRAIN FIELD SOAKAGE PIT GREASE TRAP SOLAR HEATER DEEP WELL SPRKLR. SYSTEM SWIM •G POOL CONTR. LIST CHECK PLUMBING INSPECTION DEPARTMENT • Permit No.... 1 APPLICATION FOR PLUMBING PERMIT MIAMI SHORES VILLAGE (Signed J Date -- I -- , 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. , p , "� la ;` rs 7 Owner's Name and Address _ i _ f ��_ v . S F r �._____ -- --- '-------------- ____ -- No._____ -- ------- _______ Street____ __ Registered Architect and /or Eggi ,-, i.. r ' 1__ _ _________________ + ! __ ` Employing Plumber's Name �_______ � - ----- ----- - - -- -- No ?_ .. Street - - ----=- --- --- - -L---- 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 Size Septic Tank_____ ____ Type of Tank . _ _Capacity Gals._______---____ Feet of Drain Tile_____ _____ Dist. Feet of Tank or Drain Field from Well-__ Nature of Water Supply: City —Well — — Size of Soakage Pit of Permit (Signed) *�3 e Rf �' A mount o – - a-- – — -- — -- – -- __ Plumbing Inspector. 40•••""--- of Stories Mastf'r Plumber. The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations as an employer of labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Permanent Supplement, and has com- plied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors employed by him in the work to be performed under this permit; and will post or cause to be posted for inspection on the site of the work such public notice or notices as are required by the Act. The under signed agrees to employ only such sub - contractors, on work to be performed dduer this as are licensed by Miami Shores Village. 1'J ° s ' < ..,. r qz_ STATE OF FLORIDA, ss COUNTY OF DADE.. Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeared to me well known, and who, being by me first duly sworn, upon oath deposes and says that he is the. of the above described construction, that he has carefully read the foregoing application, and that he did sign the same, and that all facts therein by him stated are true. My Commission Expires Notary Public. State of Florida NOTE: A re- inspection fee of $1.00 will be made when such re- inspection is made necessary by improper notice for inspection, or faulty materials and /or workmanship.