312 NE 101 St (14)PERMIT APPLICATION FOR
( TO RETAIN COPY)
Date Id Job Address 3 is N. tot ,
Legal Description 1q' /94 // 3 AI,_ Master
/ Lessee / Tenant ll.6&n m . SGT.' Va,
Owner's Address - 71 0( i N (la St
1'
Contracting Co.
Qualifier (/V:-$ / /e4 SS4k4Y - 3 46 Phone 7 C
Ins. Co. DA,. r
State# - ( x )63 /J" Competency#
Architect /Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type (circle one) BUILDING ELECTRICAL PLUMBING MECHANICAL PAVING FENCE SIGN
WORK DESCRIPTION
Square Ft.,P O d Estimated Cost d `S-
WARNING TO OWNER: YOU MUST RECORD A NOTICE OF COMMENCEMENT AND YOUR FAILURE TO
DO SO MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. (IF YOU
INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE
RECORDING YOUR NOTICE OF COMMENCEMENT).
Application is hereby made to obtain a permit to do work and installation as indicated above, and
on the attached addendum (if applicable). I certify that all work will be performed to meet the
standards of all laws regulating construction in this jurisdiction. I understand that separate
permits are required for ELECTRICAL, PLUMBING, SIGNS, POOLS, ROOFING, and MECHANICAL work.
OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work
will be done in compliance with all applicable laws regulating construction and zoning.
Furthermore, I authorize the above -named contractor to 1d the 'ork j ated.
'ji
i
Signature of Owner and /or Condo President
Date:
Not a✓ to Owner and /o Condo President
My fmmission Expires: 1 ///09' i-
PERMIT FEE:
Nu4di
APPROVED:
Zoning
Mechanical
•"
Address p? // 7
Fire
MUNICIPALITIES OF DADE COUNTY
Tax
P
ignature of Contractor or Owner - Builder
Date:
;LY l
ary as to Contractor or Owner-Builder
M Commission Expires:
Other
Permit #
Electrical
Engineering
Fol io a ZO /, 6":1;2
3 f9/6
l -754-34?)
VA/A/
* * *
STATE OF`FtORIDA
DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES
APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PERMIT
Authority: Chapter 381, FS
Chapter 100 -6, FAC
Date of Application
; _ .
'/7
7
Name of Owner ------(7///n
7
Mailing Address of O.yvn /er X7,\> (/ _
Owner's Agent // / I i "'1 i -f 4 ! Builder
Agent's Mailing Address / / - f ii , � 1� � ' 3 ' Telephone No
Property Street Address
Lot No. Block No Subdivision Date Subdivided
NOTE: IF NOT IN A SUBDIVISION ATTACH A METES AND BOUNDS DESCRIPTION
This Application is for: New System
�r %
Type
/' Estalishment
7 / /4,-1
,r 1 a
` l
Type of No. Bedrooms
Residential (each dwelling unit)
AUDIT CONTROL NO
! �.
HRS-H Form 4015, Feb 85 (Obsoletes previous editions which may not be used)
(Stock Number. 5744 -001- 4015 -1)
PART 1 - APPLICATION
Permit Application Number
TOTAL FLOW =
Teleph7 Number
Repair
Sewage Flow
(Gallons per day)
Heated or Cooled Area
(each dwelling unit)
ft
ft
Applicant's Signature i
-
.c
Existing System
Sewage Flow
Based On
No. Dwelling Sewage Flow
Units (Gallons per day)
Exact Directions to Property
Page 1 of 3
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Notes* (7)
APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PE
Permit Application Number
HRS -H Form 4015, Feb 85 (Obsoletes previous editions which may not_ be_usedl
STATE OF FLORIDA
DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES
4 '
PART II - SITE PLAN
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SIGNATURE
_
¢_I
Site Plan Submitte
Plan Approved
By
Not Approved
ALL CHANGES MUST BE APPROVED BY THE COUNTY PUBLIC HEALTH UNIT
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Date
County Public Unit
Permit No
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING "' baMIT
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 AddressO
Registered Architect and /or ngineer .....
__.._
Employing Plumber'
Location and Legal D ptio Lot_ ____— _ Block
Street and Number where work is to be performed —No c J
State work to be performed and purpose of building (By Floors) ..____.._.__.____..________._._
New Building ___ Remodeling_____ Addition- _.____._ Repairs No. of Stories.
Size Septic Tank
Feet of Drain Tile
Type of Tank_ Capacity Gals
_Dist. Feet of Tank or Drain Field from Well
Nature of Water Supply: Cit. —Well — _____Size of Soakage Pit
Amount of Permit $
STATE OF FLORIDA, }
COUNTY OF DADE.
No _2.1 Street X6./ Q
Street. • 1 . k ._.7/
Plumbing nspector.
(Signed
S
Street_
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 w. to be performed under this permit, as are
licensed by Miami Shores Village.
Date- --- - -• -- / 2L — 5
O1' -
My Commission Expires Notary Public, State of Florida
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 by improper notice for inspection, or faulty
materials and /or worlananship.
CLOSETS
BATH
TUBS
SHOWERS
LAVA
TORIES
INKS
SINKS
SLOP
81NK8
LAUNDRY
Tues
URINALS
CATCH
BASIN
FLOOR
DRAIN
DRINKING
FOUNT•N8
TOTAL
FIXTURES
CONTR.
LIST
CHECK
i �
SEPTIC
TANK
SEWER
CONN.
DRAIN
FIELD
SOAKAGE
PIT
GREASE
TRAP
SOLAR
HEATER
DEEP
WELL
SPRKLR.
SYSTEM
SWIM•O
POOL
CONTR.
LIST
CHECK
Permit No
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING "' baMIT
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 AddressO
Registered Architect and /or ngineer .....
__.._
Employing Plumber'
Location and Legal D ptio Lot_ ____— _ Block
Street and Number where work is to be performed —No c J
State work to be performed and purpose of building (By Floors) ..____.._.__.____..________._._
New Building ___ Remodeling_____ Addition- _.____._ Repairs No. of Stories.
Size Septic Tank
Feet of Drain Tile
Type of Tank_ Capacity Gals
_Dist. Feet of Tank or Drain Field from Well
Nature of Water Supply: Cit. —Well — _____Size of Soakage Pit
Amount of Permit $
STATE OF FLORIDA, }
COUNTY OF DADE.
No _2.1 Street X6./ Q
Street. • 1 . k ._.7/
Plumbing nspector.
(Signed
S
Street_
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 w. to be performed under this permit, as are
licensed by Miami Shores Village.
Date- --- - -• -- / 2L — 5
O1' -
My Commission Expires Notary Public, State of Florida
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 by improper notice for inspection, or faulty
materials and /or worlananship.
C ' OWNER
LOT
BLOC K
SUBDIVISION
Z:#.4•Tlit—c 44". 4.ei
Ar4.01
3
V S '
t o
ssued to
3
iami chiores9llage
F L O R D A
, PLUMBING PERMIT
id‘ 44';
� I ■
to install the folloii6ing describedumbing, in accordance with the laws, statutes and regu-
lations of Miami Shores Village, Florida and the State of Florida, governing plumbing a d
drainage work done in lvi.iami Shores Village, Florida.
�y � yf `
For aLstory building at l /� 1/
Fixtures
Fixtures $
Sewer $ j
tic Tank $ r/ -
Total $
Village Plumbing Inspector
Received Payment by
■9 797
4-"64#1" •
MIAMI SHORES VILLAGE, FLA. •
N? 5700
•
JOB No? 4 -
ADDRESS - 1 0
INSPECTION I E 13 cc-K.
TIME READY s ' '(
REMARKS:
`. -ate ;"'k
INSPECTOR DATE
BUILDING
ELECTRICAL
PLUMBING
ROPFINF
Owner of
Building
Architect
Contractor
or Builder
Legal
Description
Address of
Building
Lot
PERMIT
CONTRACTOR OR BUILDER
MIAMI SHORES VILLAGE. FLORIDA
Work to be performed under this Permit
Bl.
N? 5038
BY
Subdi-
vision
Value of
Project $
DATE 195
Contractor's
License No.
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 'lie assumes responsibility for work
done by his agents, servants or employees.
Signed. .BY.
INSPECTOR
Amount of
Permit $
In consideration of the issuance to me of this permit I agree to perform the work covered here /nder in compliance with all ordinances and regulations
pertaining thereto and in strict conformity with the plans, drawings, statements or secifications submitted to the proper authorities of Miami Shores Village. In ac-
cepting this permit I assume responsibility for all work done by either, myself, ddiy agen' servant or employee.
AUTHORITY