358 NE 101 St (6)Date 1/9/96
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Legal Description
Owner/Lessee / Tenant
Job Address 358 NE 101 STREET Tax Folio
SPRINGER Master Permit #
Owner'sAddress 358 NE 101 STREET. 33138 Phone 757 -5915
ContractingCo. NORTH T)ADE SEPTIC Address 800 NW 111 STREET, MIAMI 33168
Qualifier DENNIS NEVILLE SS# Phone 754 -3375
State # 025836 -8 Municipal #
Architect/Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIPTION INSTALL DRAINFEILD
Square Ft. 300 SQ FT
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 . that all work will be done in compliance with all applicable
laws regulating construction and zoning. Furthermore, I authorize the above -n ed ce. tractor to do the work stated.
c4
Signature of own r
AQ
No : WA Owner and/
My Commission Expire
FEES: PERMIT d RADON
do President Date
nd. Pr; ident Date
Building
Historically Designated: Yes No
Estimated Cost (value) $100000
My
ture of Colatra
s to Contract
ommission Exp
w.WstSt MV.. ttttttttttttttttttttt ttttttttt,W.
ae,e Teresa J. Felder
1 ' Notary Public, State of Florida
if Commission No. CC 480807
of & My Commission Expir. s 07/16/99
1.8100.3NOTARY • Fla. Notary Service & Bonging Co.
we eeeeeeeeteeee eeeeeeeeeeeeeeeeeeeeeea(eeeeeee a
C.C.F. _ SD NOTARY TOTAL DUE
APPROVED:
Zoning
Mechanical Plumbing
Competency# 12842 Ins. Co. ESIF /TRAVELERS
Electrical
- Builder Date
r- Builder Date
o cPev ° ° m r Teresa J. Felder
f' Notary Public, State of Florida
�
` Commission No. CC 480807
) ' yio My Commission Expires 07 /16/99 `
,
1400-1-NOTARY . Fla Notary Soria & Bonding Co. •
eee eeeetteeteeeeteetateetweeeteeeteetereeeeereee
Engineering
CONSTRUCTION PERMIT FOR:
[N ] New System [1,1 ] Existing System [N ] Holding Tank [ N] Temporary /Experimental
[T ] Repair [N ] Abandonment [N ] Other(Specify)
APPLICANT: SPRfiJir' <i
PROPERTY STREET ADDRESS: 358 NE 101 S UET, 33138
LOT:
PROPERTY ID #: [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. ANY 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. [ 900 ] [GALLONS / aMTUEPTIC TANK/AEVAWANWMTVRR 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:
D
R
A
I
N
F
I
E
L
D
0
T
H
E
R
[ 300 ] SQUARE FEET Pte]'fl DRAINFIELD SYSTEM
[ ] SQUARE FEET SYSTEM
TYPE SYSTEM: [ X] STANDARD [ ] FILLED
CONFIGURATION: [ ] TRENCH [ X] BED
LOCATION OF BENCHMARK:
ELEVATION OF PROPOSED SYSTEM SITE
BOTTOM OF DRAINFIELD TO BE [ ] [INCHES /FT] [ABOVE /BELOW]
FILL REQUIRED: [
SPECIFICATIONS BY: TITLE:
APPROVED BY:
INSTALL 12" OF LOAMY COARSE SAND UNDER ECTICl1 OF DRAINFIELD
Si;U ;IT 11,`.aa'NC,'L..ARK B'Eii'Cii INSPECTION. THIS ?Yana 1SN:iT Ali
ADDITION(S) . INVERT ELEVATION (NJN!MUM)
BOTIVI OF DRAINFIELD ELEVATION (J..LNI UUt•i) :
DATE ISSUED: $ f
STATE OF FLORIDA
DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES
ONSITE SEWAGE DISPOSAL SYSTEM
CONSTRUCTION PERMIT
Authority: Chapter 381, FS & Chapter 10D -6, FAC
} BLOCK: Nr SUBDIVISION:
(4
[ ] [INCHES /FT] [ABOVE /BELOW]
] INCHES EXCAVATION REQUIRED: [RD] INCHES
TEE SEPTIC TANK SHALL BE ?1J `PED AND A
SOLID DEFLECTION DEVICE INSTALLED ON
THE CUTLET TEF,
HRS -H Form 4016, Mar 92 (Obsoletes previous editions which may not be used)
(Stock Number: 5744 - 001 - 4016 - 0)
APPLICANT
AGENT: N0 r
:0, (3 m. .f ,
TITLE:
PERMIT #
DATE PAID
FEE PAID $
RECEIPT #
[ 1
] MOUND [ ]
BENCHMARK /REFERENCE POINT
BENCHMARK /REFERENCE POINT
EXPIRATION DATE:
t
( 1 ( '` ' CPHU
k
e
Page 1 of 2
APPLICATION FOR:
(' ] New System
[ :' ] Repair
APPLICANT: S ?sue .KcEi2
AGENT:
1. "::31e TH JAM SE 3 T. C TANK
MAILING r';DDRESS: 80C 1.■Pi : I, z i S ?E` u.arti;:Ji. 3303
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]
LOT:
PROPERTY ID #:
PROPERTY SIZE:
BLOCK:
PROPERTY STREET ADDRESS:
DIRECTIONS TO PROPERTY:
BUILDING INFORMATION
1
2
3
4
-• 1
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
] Garbage Grinders /Disposa4s
[;. ] Ultra -low Volume Flue Tdilets
APPLICANT'S SIGNATURE:
[ ] Existing System (N] Holding Tank [N Temporary /Experimental
[j\?] Abandonment [N ] Other(Specify)
SUBDIVISION:
ACRES [Sqft /43560] PROPERTY WATER SUPPLY: [ ] PRIVATE [;1 PUBLIC
3 n :.0`. SST 'w,T. 33138
'` RESIDENTIAL
Unit Type of No. of
No Establishment Bedrooms
3 i1son
MRS -H Form 4015, Mar 92 (Obsotetes previous editions which m #y_not be used)
(Stock Number: 5744-001-4015-1) ;, % 5 a ;gip
ra j
•
[ ] COMMERCIAL
Building # Persons
Area Soft Served
[ Spas /Hot Tubs
[ 1 „Other (Specify)
PERMIT #
DATE PAID
FEE PAID $ i"l,,(
RECEIPT
TELEPHONE: . ! 7 j91
./5` -33Th
DATE OF Ia;'OtE !"l,
SUBDIVISION.
[Section /Township /Range /Parcel No.] ZONING:
Business Activity
For Commercial Only
[ 1;] Floor /Equipment Drains
7 , e
DATE: i /;.a /%
Page 1 of 3
APPLICANT: SPRINGER
LOT:
PROPERTY ID #:
STATE OF FLORIDA
DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES
ONSITE SEWAGE DISPOSAL SYSTEM
SITE EVALUATION AND SYSTEM SPECIFICATIONS
BLOCK: SUBDIVISION:
358 NE 101 STREET 33138
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 PLAN:
TOTAL ESTIMATED SEWAGE FLOW:
AUTHORIZED SEWAGE FLOW:
UNOBSTRUCTED AREA AVAILABLE:
THE MINIMUM SETBACK WHICH
100+ FT
100 FT
SURFACE WATER:
WELLS: PUBLIC:
BUILDING FOUNDATIONS:
SOIL PROFILE INFORMATION SITE 1
[ �] YES [ ]
GALLONS
GALLONS
SQFT
BENCHMARK /REFERENCE POINT LOCATION:
ELEVATION OF PROPOSED SYSTEM SITE IS [INCHES /FT] [ABOVE BENC
SITE SUBJECT TO FREQUENT FLOODING: [ YES
10 YEAR FLOOD ELEVATION FOR SITE:W•T° 4 . 0
Munsell #/Color Texture
BROWN SANDY
USDA SOIL SERIES: SANDY
0 "
Depth
to 72"
to
to
to
to
to
to
to
to
SOIL TEXTURE /LOADING RATE FOR SYSTEM SIZING: 1.25
DRAINFIELD CONFIGURATION: [ ] TRENCH [XX) BED
REMARKS /ADDITIONAL CRITERIA:
HRS-H Form 4015, Mar 92 Obs le es previ
(Stock Number: 5744- 003 -4' )
SITE EVALUATED BY:
[Section /Township /Range /Parcel No. or Tax ID Number]
NO NET USABLE AREA AVAILABLE: g B9 ACRES
PER DAY [RESIDENCES -TABLE 1 / OTHER -TABLE 2)
PER DAY [1500 GPD /ACRE OR 2500 GPD /ACRE]
UNOBSTRUCTED AREA REQUIRED: 6' SQFT.
4 FC l ®. g
CAN BE MAINTAINED FROM THE PROPOSED SYSTEM TO THE FOLLOWING FEATURES:
DITCHES /SWALES: ®' FT NORMALLY WET? [ ] YES [] NO
LIMITED USE: FT PRIVATE: FT NON - POTABLE: — FT
5 FT PROPERTY LINES: 5 FT POTABLE WATER LINES: 15 FT
1
MS NGVD
AGENT : NORTH DADE SEPTIC TANK
[ ] OTHER (SPECIFY)
PERMIT # %"l ('/
:I
10 YEAR FLOODING? ] YES [xx] NO
SITE ELEVATION: m . 1_ FT MSL /NGVD
SOIL PROFILE INFORMATION SITE 2
E POINT
Munsell # /Color Texture
BRO'&YN SANDY
USDA SOIL SERIES: SANDY
Depth
0" tc 2"
to
to
to
to
to
to
to
to
OBSERVED WATER TABLE: 01- INCHES CUM / BELOW] EXISTING GRADE. TYPE: f'.E1i H D / APPARENT]
ESTIMATED WET SEASON WATER TABLE ELEVATION: 108 INCHES [ A`H` / BELOW ] EXISTING GRADE.
HIGH WATER TABLE VEGETATION: [ ] YES [X4 NO MOTTLING: [ ] YES [X4 NO DEPTH: INCHES
DEPTH OF EXCAVATION: 30 INCHES
DATE: 1/09/96
s edition •° which may not be used) Page 3 of 3
STATE OF FLORIDA
DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES
APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PERMIT
Permit Application Number ' '/4 ( /N
Site Plan submitted b
Plan Approved
By
OLD SYSTa;A OVERLFCiJING.
PART II - SITE PLAN
Scale: Each block represents 5 feet and 1 inch = 50 feet.
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■ ■ ■ ■ ■ ■ ■ ■ ■■ 9vPMMI■ralili:1■h5II►1i ■ A■■■■■■■■■■■■■■■■■■■■■ ■■ ■ ■■ ■■ ■■ ■■■ ■ ■ ■ ■ ■■■ ■■■■■ ■ ■ ■■■■■
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Notes: SPRINGER: 358 NE 101 STREET, 33138
SIGNATURE
Not Approved
ALL CHAN MUST BE APPROVED BY THE COUNTY PUBLIC HEALTH UNIT
HRS -H Form 4015, Feb 85 (Obsoletes previous editions which may not be used)
(Stock Number. 5744-002-4015-6)
TITLE
Date 1- d � — IC
County Public Unit
Page 2 of 3
Permit No _7_
Registered Architect and /or Engineer__
Employing Plumber's Name °'t-T H ___ —
Size Septic Tank--____
Feet of Drain Tile_
Amount of Permit $
Nature of Water Supply: City —Well
STATE OF FLORIDA, t
COUNTY OF DADE.
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 at
building during progress of work. (('
. L_ . I-1- £ 1.1 34 _ Street N • - 1 ° 1 a'G
Owner's Name and Address ----- ____ -- t_�!' ---------------- _ -__ -- No._. _-------- --- _ - -_ -- -- -.- ■ • -__ • •-
Location and Legal Description Lot Block_ . Subdivision
Street and Number where work is to be performed —No X5-8' N • E. 1 ( -� — street s�i� ee 7 __ r
State work to be performedl and purpose of building (By Floors) — Z F T: Dz 0 4 4 N
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
( Signed) _
Date - - - -- ------------ ....__- - - - - -•
Street.
L'4..7
Plumbing Inspector.
The undersigned applicant for this building permit does hereby certify that he understands and accepts If bligations 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.
( 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.
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 ,. .g, 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
2 Z
�
---
-
Permit No _7_
Registered Architect and /or Engineer__
Employing Plumber's Name °'t-T H ___ —
Size Septic Tank--____
Feet of Drain Tile_
Amount of Permit $
Nature of Water Supply: City —Well
STATE OF FLORIDA, t
COUNTY OF DADE.
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 at
building during progress of work. (('
. L_ . I-1- £ 1.1 34 _ Street N • - 1 ° 1 a'G
Owner's Name and Address ----- ____ -- t_�!' ---------------- _ -__ -- No._. _-------- --- _ - -_ -- -- -.- ■ • -__ • •-
Location and Legal Description Lot Block_ . Subdivision
Street and Number where work is to be performed —No X5-8' N • E. 1 ( -� — street s�i� ee 7 __ r
State work to be performedl and purpose of building (By Floors) — Z F T: Dz 0 4 4 N
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
( Signed) _
Date - - - -- ------------ ....__- - - - - -•
Street.
L'4..7
Plumbing Inspector.
The undersigned applicant for this building permit does hereby certify that he understands and accepts If bligations 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.
( 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.
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 ,. .g, or faulty
materials and /or workmanship.
BUILDING / ❑
ELECTRICAL j ❑ PERMIT N? 11062
PLUMBING
ROOFING
Owner of
Building
Architect
i ontractor
�r Builder
egal
)escription
Address of
Building
MIAMI SHORES VILLAGE, FLORIDA
ork to be Srf • •• ed under this Permit / \.
Subdi-
vision
Value of
Project
BY
DAT
IN eR
Contractor s
License No
Permit
AUTHORITY
1954
This permit its ggr nte. • e contractor or builder named above to construct the buildin: . r to inst . i the equipment or device de 'bed in the appT ajjon
herefor in strict compliance with all ordinances pertaining thereto and with the understandi _ that the ork will be performed in compliance with any plans,
drawings, statements or specifications that may have been submitted to and . •proved by the roper icipal authorities. This Permit may be revoked at any
time if the work is not done in compliance with such ordinances or if the pla are changed ithout orization. A further condition upon which this permit is
granted is the understanding that the contractor or builder named above ass es the respo sib' ' for a thorough knowledge of the ordinances and regulations
pertaining to the work covered hereby whether shown on the plans or drawi gs or in th • . • ments or cificat'• • responsibility for work
done by his agents, servants or employees.
In consideration of the issuance to me of this perm I agree to perfo the work covered hereunder in compliance with all o nances and r lations
pertaining thereto and in strict conformity with the plans, awings, statement or specifications submitted to the proper authoritie Miami Shor Village.
In accepting this permit I assume/it sponsibility for all work •one by either, yself, my agent, servant or employee.
c0 c0,0 OR I DER
Permit No.
Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the building or other
structure herein described. This application is made in compliance and conformity with the Building Ordinance of Miami Shores Village, Florida,
and all provisions of the Laws of the State of Florida, all ordinances of Miami Shores Village and all rules and regulations of the Building Division
of Miami Shores Village shall be complied with, whether herein specified or not. A copy of approved plans and specifications must be kept at
building during progress of work.
Owner's Name and Address
Registered Architect and /or Enginee _ ___ _{L _______ __
Employing Plumber's Nara =:. -1
APPLICATION FOR PLUMBING PERMIT
.Location and Legal Description Lot
Street and Number where work is to be performed -No .5'=--�. ,. j Street
State work to be performed and purpose of building (By Floors) 4_ -- -i: . k. (-1-3
New Building Remodeling Addition _ _Repairs ________
Size Septic Tank
Feet of Drain Tile
Nature of Water Supply: City-Well
Amount of Permit $
ss.
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
t. __ No ) 7 Street)) ,o t f'. 4
1- Block
s, r
No. Street ,11_,4...,
1 -- , a► x t� .
Subdivision
___Type of Tank __ , .Capacity Gals
Dist. Feet of Tank or Drain Field from Well
Size of Soakaga Pit_
7-
(Signed)
,, •
Plumbing Inspector
The undersigned applicant for this building pe does hereby certify that he understands and accepts his obligations as an employer of Libor
under the Florida Workmen's Compensation Act, being ction 5966, Compiled .G ral Laws of Florida Permanent Supplement, and has com-
plied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors employed by him in the work to be
Performed under this permit; and will post or cause to be posted for inspection on the site of the work such public notice or notices as are
required by the Act. The undersigned agrees to employ only such sub - contractors, on work to be performed under this permit, as are
licensed by Miami Shores Village.
(Signed)) +� 1 - t
_Master Plumber.
• V
Date __
No of Stories - ----- ------ - ___ --
STATE OF FLORIDA, f
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
Permit No.
Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the building or other
structure herein described. This application is made in compliance and conformity with the Building Ordinance of Miami Shores Village, Florida,
and all provisions of the Laws of the State of Florida, all ordinances of Miami Shores Village and all rules and regulations of the Building Division
of Miami Shores Village shall be complied with, whether herein specified or not. A copy of approved plans and specifications must be kept at
building during progress of work.
Owner's Name and Address
Registered Architect and /or Enginee _ ___ _{L _______ __
Employing Plumber's Nara =:. -1
APPLICATION FOR PLUMBING PERMIT
.Location and Legal Description Lot
Street and Number where work is to be performed -No .5'=--�. ,. j Street
State work to be performed and purpose of building (By Floors) 4_ -- -i: . k. (-1-3
New Building Remodeling Addition _ _Repairs ________
Size Septic Tank
Feet of Drain Tile
Nature of Water Supply: City-Well
Amount of Permit $
ss.
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
t. __ No ) 7 Street)) ,o t f'. 4
1- Block
s, r
No. Street ,11_,4...,
1 -- , a► x t� .
Subdivision
___Type of Tank __ , .Capacity Gals
Dist. Feet of Tank or Drain Field from Well
Size of Soakaga Pit_
7-
(Signed)
,, •
Plumbing Inspector
The undersigned applicant for this building pe does hereby certify that he understands and accepts his obligations as an employer of Libor
under the Florida Workmen's Compensation Act, being ction 5966, Compiled .G ral Laws of Florida Permanent Supplement, and has com-
plied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors employed by him in the work to be
Performed under this permit; and will post or cause to be posted for inspection on the site of the work such public notice or notices as are
required by the Act. The undersigned agrees to employ only such sub - contractors, on work to be performed under this permit, as are
licensed by Miami Shores Village.
(Signed)) +� 1 - t
_Master Plumber.
• V
Date __
No of Stories - ----- ------ - ___ --
STATE OF FLORIDA, f
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.
APPLICATION FOR PLUMBING PERMIT
Permit No _ 7 ‘3
Application s hereby made for the approval of the detailed statement of the plans and specifications herewith sfmitted for the building or other
structure herein described. This appiication 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 hEn specified or not. A copy of approved plans and specifications must be kept at
building during progress of work.
Owner's Name and Address
Street and Number where work is to be performed
Size Septic Tank_
yYi
W le!K2 No
My Commission Expires
M I SHORES VILLAGE
UMBING INSPECTION DEPARTMENT
0
Type of Tank Y_ (
Feet of Drain Tile_____ -__ -_ 4 Dist. Feet of Tank or Drain Field from $cell__
Amount of Permit $_ (Signed)
(Signed)
Date
v Y WL
Street 42
Registered Architect and /or Engine
Employing Plumber's Name ____ _ '_ 5.,,_ 3t___ __ No._ Of Ile /r
Location and Legal Description Lot___�l____ —___ __ __ Block ___ .,3__ 9 Subdivision ___
NE _ Street-- -- i Y - - ___________ ___
State work to be performed and purpose of building (By Floors)
New Building Remodeling Addition Repairs No. of Stories___
Capacity Gals.
Notary Public, State of Florida
Nature of Water Supply: City— tlli►. Size of Soakage Pit
Master Plumber.
Plumbing Inspector.
The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations as an employer of labor
under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Permanent Supplement, and has com-
plied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors employed by 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. a/Y41,4
STATE OF FLORIDA,
COUNTY OF DADE. j SS.
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
Count.
LIST
CHUCK
SEPTIC
TANK
SEWER
CONN.
DRAIN
FIELD
SOAKAGE
PIT
GREASE
TRAP
SOLAR
HEATER
DEEP
WELL
SPRKLR,
SYSTEM
SWIM'G
POOL
CONTR.
LIST
1
CHECK
APPLICATION FOR PLUMBING PERMIT
Permit No _ 7 ‘3
Application s hereby made for the approval of the detailed statement of the plans and specifications herewith sfmitted for the building or other
structure herein described. This appiication 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 hEn specified or not. A copy of approved plans and specifications must be kept at
building during progress of work.
Owner's Name and Address
Street and Number where work is to be performed
Size Septic Tank_
yYi
W le!K2 No
My Commission Expires
M I SHORES VILLAGE
UMBING INSPECTION DEPARTMENT
0
Type of Tank Y_ (
Feet of Drain Tile_____ -__ -_ 4 Dist. Feet of Tank or Drain Field from $cell__
Amount of Permit $_ (Signed)
(Signed)
Date
v Y WL
Street 42
Registered Architect and /or Engine
Employing Plumber's Name ____ _ '_ 5.,,_ 3t___ __ No._ Of Ile /r
Location and Legal Description Lot___�l____ —___ __ __ Block ___ .,3__ 9 Subdivision ___
NE _ Street-- -- i Y - - ___________ ___
State work to be performed and purpose of building (By Floors)
New Building Remodeling Addition Repairs No. of Stories___
Capacity Gals.
Notary Public, State of Florida
Nature of Water Supply: City— tlli►. Size of Soakage Pit
Master Plumber.
Plumbing Inspector.
The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations as an employer of labor
under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Permanent Supplement, and has com-
plied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors employed by 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. a/Y41,4
STATE OF FLORIDA,
COUNTY OF DADE. j SS.
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.
Job
Address
Inspection
Time Ready
RE UEST F R NSPEcTI
- ) .
ey4
v
Company )(=
4
or. -
(•--d '
400
Date Ready
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
Permit No. _j„a__ ___ Date '" .e►
Application s hereby made for the approval of the detailed statement of the plans and specifications herewith , Ilbmitted 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
Employing Plumber's Name
New Building
STATE OF FLORIDA,
ss
My Commission Expires
_466 No
Registered Architect and /or Engineer
- No. _ ■J1. J/ Street )
14 . r
Location and Legal Description Lot__ Block___,_ Subdivision �1 • '
I - y � a'M
Street and Number where work is to be performed o � _ 1t __ Street_ /i I • 1;-
State work to be performed and purpose of building (By Floors)
Remodeling Addition Repairs No. of Stories .___/
Size Septic Tank ' / Type of Tank _ ` �` "
Feet of Drain Tile 74 Dist. Feet of Tank or Drain Field from Well_
Nature of Water Supply: City —tNi1. Size of Soakage Pit.
Amount of Permit $___ __(Signed)
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 rk to b gerformed under this permit, as are
L
licensed by Miami Shores Village. 4
(Signed)
k V + ? . Street /-t;
Capacity Gals.____________ ___ __ _�__�_
de 744.
6r
Notary Public, State of Florida
ite
Plumbing Inspector.
Master Plumber.
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.
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
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
Permit No. _j„a__ ___ Date '" .e►
Application s hereby made for the approval of the detailed statement of the plans and specifications herewith , Ilbmitted 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
Employing Plumber's Name
New Building
STATE OF FLORIDA,
ss
My Commission Expires
_466 No
Registered Architect and /or Engineer
- No. _ ■J1. J/ Street )
14 . r
Location and Legal Description Lot__ Block___,_ Subdivision �1 • '
I - y � a'M
Street and Number where work is to be performed o � _ 1t __ Street_ /i I • 1;-
State work to be performed and purpose of building (By Floors)
Remodeling Addition Repairs No. of Stories .___/
Size Septic Tank ' / Type of Tank _ ` �` "
Feet of Drain Tile 74 Dist. Feet of Tank or Drain Field from Well_
Nature of Water Supply: City —tNi1. Size of Soakage Pit.
Amount of Permit $___ __(Signed)
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 rk to b gerformed under this permit, as are
L
licensed by Miami Shores Village. 4
(Signed)
k V + ? . Street /-t;
Capacity Gals.____________ ___ __ _�__�_
de 744.
6r
Notary Public, State of Florida
ite
Plumbing Inspector.
Master Plumber.
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.
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.