SEPTIC & DRAINFIELDate ( r 1314 Job Address
Legal Description 9 4' /� , 9{p , i f
Lessee / Tenant ,Nl k \ l) R (_ 0 q, VERKES Master Permit #5 -1-71 7
Owner's Address L( 3(s . (\1, II 1 o ( c j Phone
Contracting Co. IV- F() K b ( Sp IC .. Address
Qualifier "iii6 M/E SS# Phone .�.30 .-
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
State # Municipal # Competency #
Architect /Engineer Address
Bonding Company Address
Mortgagor � Address
Permit Type(circle one): BUILDING ELECTRICAL LPLUMBINCL)MECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIPTION 1
•
Square Ft. c i ob y W ( TIAi.1 K �°C S9 Estimated Cost(value) A 2 C c -), 0 0
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. rmore, I
authorize the above -named co tractor to do the work stated.
Signature of owner and /of Condo President
Date:
Notary as to
** *
APPROVED:
4 1.30 f■G f of .S(J Tax Folio /l .1016 / 1 2
nd /or Condo Preside f
NOTARY PUBLIC, STA ' OF FLORIDA.
MY COMMISSION EXPIRES: Dec. 29, I;9S.
BONDED THRU NOTARY PUBLIC UNDERWl r nn
* * * * * * *
My Commission Expires:
FEES: PERMIT9D RADON C.C.F. !'0 .
Zoning
Mechanical
11111 ,
N f ary /as to
Commissior
Fire
Building ,
Ins.Co.
S gnatu a of Contractor or Owner- Builder
Date: /i, /qj
`! .•` JOSEPHINE CHUM
'
f tYNy IRAm
,s.CC1l7
* * * * * * * **
NOTARY ' , D D TOTAL DUE II!/'
Other
Electrical
Engineering
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STATE OF FLORIDA
DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES
APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PERMIT
- 1
LI 1(, K. C 1 L (
HRS -H Form 4015, Feb 85 (Obsoletes previous editions which may not be used)
(Stock Number: 5744- 002 - 4015 -6)
PART II - SITE PLAN
Permit Application Number
Site Plan Submitted by:
SIGNATURE
Plan Approved Not Approved
By
ALL CHANGES MUST BE APPROVED BY THE COUNTY PUBLIC HEALTH UNIT
TITLE
,
Date/ O " 3-q)
1?"7/ County Public Unit
Page 2 of 3
CONSTRUCTION PERMIT FOR:
[ ] New System
[ Qom] Repair
APPLICANT:
LOT: // / /�fly V BLOCK:
PROPERTY ]] / T Y I D # :
SYSTEM DESIGN AND SPECIFICATIONS
D
R
A
I
N
F
I
E
L
D
H
E
R
STATE OF FLORIDA
DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES
ONSITE SEWAGE DISPOSAL SYSTEM
CONSTRUCTION PERMIT
Authority: Chapter 381, FS & Chapter 1OD -6, FAC
[
[
] Existing System
] Abandonment
d1/ • 6k7'
SPECIFICATIONS BY:
APPROVED BY:
DATE ISSUED: / /° -'
[ ]
[ ]
PROPERTY STREET ADDRESS: Cl, 3 U Al E / & / �L- --
C" -
SUBDIVISION:
Holding Tank [ ]
Other(Specify)
AGENT:
/`y 4
SQUARE FEET PRIMARY DRAINFIELD SYSTEM
] SQUARE FEET SYSTEM
TYPE SYSTEM: [ ] STANDARD [ ] FILLED
CONFIGURATION: [ ] TRENCH [GEED
LOCATION OF BENCHMARK: /
HRS -H Form 4016, Mar 92 (Obsoletes previous editions which may not be used)
(Stock Number: 5744 - 001 - 4016 - 0)
BUILDING DEPARTMENT
PERMIT # I5) a 2
DATE PAID
FEE PAID $
RECEIPT #
Temporary /Experimental
E.et
[SECTION /TOWNSHIP /RANGE /PARCEL NUMBER]
[OR TAX ID NUMBER]
SYSTEM MUST BE CONSTRUCTED IN ACCORDANCE WITH SPECIFICATIONS AND STANDARDS OF CHAPTER 1OD -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.
T [/) Ad [GALLONS / GPD] SEPTIC TANK /AEROBIC UNIT CAPACITY MULTI- CHAMBERED /IN SERIES:[
A [ ] [GALLONS / GPD] CAPACITY MULTI- CHAMBERED /IN SERIES:[ ]
N [ ] GALLONS GREASE INTERCEPTOR CAPACITY [MAXIMUM CAPACITY SINGLE TANK: 1250 GALLONS]
K [ ] GALLONS PER DOSE DOSING TANK CAPACITY DOSE RATE , [ ] PER 24 HRS NO. OF PUMPS: [ ]
[ ] MOUND [ ]
[ ]
ELEVATION OF PROPOSED SYSTEM SITE [ ] [INCHES /FT] [ABOVE /BELOW] BENCHMARK /REFERENCE POINT
BOTTOM OF DRAINFIELD TO BE [ -- ] [INCHES /FT] [ABOVE /BELOW] BENCHMARK /REFERENCE POINT
B FILL REQUIRED: [ • ] INCHES EXCAVATION REQUIRED: [ ]] � INCHES
O - ;2„7 , A4) \
Page 1 of 2
TITLE: } ,*ei& J f ! - ���
EXPIRATION DATE: 2 3 -17
INSTRUCTIONS:
PERMIT NUMBER: Permit tracking number assigned by CPHU.
APPLICATION FOR: Check type of permit, if "Other" specify type in blank.
APPLICANT: Property owner's full name.
TELEPHONE: Telephone number for applicant or agent.
AGENT: Property owner's legally authorized representative.
MAILING ADDRESS: P.O. box or street mailing address for applicant or agent.
LOT, BLOCK, SUBDIVISION or
PROPERTY ID#: 27 character id number for property. (CPHU may require property appraiser ID k or section/township /range /parcel number)
SYSTEM DESIGN AND
SPECIFICATIONS:
TANK: Minimum specifications from Chapter 10D-6, FAC.
DRAINFIELD: Minimum specifications from Chapter 1OD-6, FAC.
OTHER: Other specifications, such as operating permit requirements, low- volume flush toilets, variance provisos.
SPECIFICATIONS BY: Name of individual providing specifications. If designed by a registered engineer must be sealed.
APPROVED BY: County Public Health Unit (CPHU) personnel reviewing and approving permit.
DATE ISSUED: Date permit is issued by CPHU.
EXPIRATION DATE: One year from date issued if the system has not been installed. Permits for system repairs become void 90 days from the date
issued.
Permit No
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
Date.L.P.."' ./:_.. '7.............._ _
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 wi whether herein specified or not. A copy of approved plans and specifications must be kept at
building during progress of work.
•
Owners Name and Address Al K / t - V " I S; _ / a" - ' 'No. s saglj. r5 /
Registered Architect and /or Enainw 7 ' _ � �J - -
Employing Plumber's Ntune 6 �/� .... , Na,.,.. .._....! '. il�s�R�.�.....�......�,., .��..
Location and Legal Description
Street and Number where work
State work to be performed and
New Building. — _..---- ....•..
Amount of Permit
STATE OF FLORIDA, 1 is.
COUNTY OF DADE.
L to be performed- N i 8 /6 / " gtreet.. Subdivlafon
purpose of building (By Floors)_____ - - -_ _ Repair
Rep
Remodeling___-......._.. ___ Addition.
Jfl
Capacity
No. of Stories ........
Size Septic Tank_. _Type of Tank
Feet of Drain Tile € Q n —` Dist. Feet of Tank cc Drain Field from Well----- __.---- •_-- •- __ -_ -• ... _ --
Nature of Water Supply: City -WelL Size of Soakage Pit.
Plumbing In gpec
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 5988, Compiled General Laws of Florida Permanent Supplement, and ha.c com-
plied with the provisions thereof, and will require aimilar 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 Villages
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 be 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 81.00 will be mad* wham swot twissp*oNon it raada•naowt•ry by improper notice for inspection, or fealty
materials and /or workmanship.
CLOSETS
BATH
TUBS
6 ""a" a
LAVA•
TORIES
*INKS
SLOP
SINKS
LAUNDRY
TUaa
U RINALS
CATCH
SASIN
FLOOR
DRAIN
DRINKING
FOUNT
TI OTAL
PIETURES
CONTR.
LIST
CHICK
.
SEPTIC
TANK
SEWER
Comm.
DRAIN
F1[LD
SOAKAGE
PIT
G
TRAP
SOLAR
NEATER
DEEP
WELL
*PRKLR.
SYSTEM
SWIM
P001.
CONTR.
LIST
-
CHICK
Permit No
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
Date.L.P.."' ./:_.. '7.............._ _
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 wi whether herein specified or not. A copy of approved plans and specifications must be kept at
building during progress of work.
•
Owners Name and Address Al K / t - V " I S; _ / a" - ' 'No. s saglj. r5 /
Registered Architect and /or Enainw 7 ' _ � �J - -
Employing Plumber's Ntune 6 �/� .... , Na,.,.. .._....! '. il�s�R�.�.....�......�,., .��..
Location and Legal Description
Street and Number where work
State work to be performed and
New Building. — _..---- ....•..
Amount of Permit
STATE OF FLORIDA, 1 is.
COUNTY OF DADE.
L to be performed- N i 8 /6 / " gtreet.. Subdivlafon
purpose of building (By Floors)_____ - - -_ _ Repair
Rep
Remodeling___-......._.. ___ Addition.
Jfl
Capacity
No. of Stories ........
Size Septic Tank_. _Type of Tank
Feet of Drain Tile € Q n —` Dist. Feet of Tank cc Drain Field from Well----- __.---- •_-- •- __ -_ -• ... _ --
Nature of Water Supply: City -WelL Size of Soakage Pit.
Plumbing In gpec
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 5988, Compiled General Laws of Florida Permanent Supplement, and ha.c com-
plied with the provisions thereof, and will require aimilar 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 Villages
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 be 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 81.00 will be mad* wham swot twissp*oNon it raada•naowt•ry by improper notice for inspection, or fealty
materials and /or workmanship.
H 3 )___0
th-ro S v V
CH
/7 Y
STATEMENT
HENRY'PRIEST
A B C BUSINESS FORMS - MIAMI
SC A M W f
ABC
SEPTIC TANK SERVICE
3123 N.W. 54th STREET
MIAMI, FLORIDA
Miami Shores Village Plumbing Department.
10050 N. E. 2nd Avenue
Miami Shore, Florida
Permit for
32' Block Drain Relay
Malcolm Wisehart
430 N.E. 101st Street
Sorry we were out of permits
DATE
PHONES: PL 1 -1177
NE 5-2723
July 9, 1 963
s3
0 0
Permit No �3�3
Date- - - - -- L - :3-
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__M 1- o G.___5!v N- K No. �'`� Street • E - t b 1," 4-4.-
Registered Architect and /or Engineer .- ... -- -------- - - -_._ __-- -_------ . ___ ---
Employing Plumber's Name 1\-%-c--- �P �c� - T - 444 , 4--- ,No.__ — -2 " 3
Location and Legal Description Lot.
- - --- - - - - - --
Amount of Permit $
STATE OF FLORIDA,
COUNTY OF DADE.
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
Blocti
Subdivision.
---- .- .-- _ -.---
Street and Number where work is to be performed -No 4 "' 3 iJ - E - Lot Street _
State work to be performed and purpose of building (By Floors) _? 1 Z)(2.-,
New Building Remodeling_____ ___._____ Addition Repairs
Type of Tank__ Capacity Gals
Size Septic Tank
Feet of Drain Tile Dist. Feet of Tank or Drain Field from Well
Nature of Water Supply: City - Well.._______ ................ ________.......... ________Size of Soakage Pit
(Sh _ 1`. et-'t. -.
Plumbing Inspector.
The undersigned applicant for this building permit does hereby certify that he understands and accept4"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 work to be performed under this permit, as are
licensed by Miami Shores Village.
Master Plumber.
Street — :W • ��-- S
No. of Stories ... .......................
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.
CLOSITB
BATH
TUBS
SHOWERS
LAVA-
TORIES
SINKS
SLOP
SINKS
LAUNDRY
TUBE
URINALS
CATCH
BASIN
FLOOR
DRAIN
DRINKING
FOUNT'NB
F XTUREB
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.
•7
-
Permit No �3�3
Date- - - - -- L - :3-
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__M 1- o G.___5!v N- K No. �'`� Street • E - t b 1," 4-4.-
Registered Architect and /or Engineer .- ... -- -------- - - -_._ __-- -_------ . ___ ---
Employing Plumber's Name 1\-%-c--- �P �c� - T - 444 , 4--- ,No.__ — -2 " 3
Location and Legal Description Lot.
- - --- - - - - - --
Amount of Permit $
STATE OF FLORIDA,
COUNTY OF DADE.
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
Blocti
Subdivision.
---- .- .-- _ -.---
Street and Number where work is to be performed -No 4 "' 3 iJ - E - Lot Street _
State work to be performed and purpose of building (By Floors) _? 1 Z)(2.-,
New Building Remodeling_____ ___._____ Addition Repairs
Type of Tank__ Capacity Gals
Size Septic Tank
Feet of Drain Tile Dist. Feet of Tank or Drain Field from Well
Nature of Water Supply: City - Well.._______ ................ ________.......... ________Size of Soakage Pit
(Sh _ 1`. et-'t. -.
Plumbing Inspector.
The undersigned applicant for this building permit does hereby certify that he understands and accept4"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 work to be performed under this permit, as are
licensed by Miami Shores Village.
Master Plumber.
Street — :W • ��-- S
No. of Stories ... .......................
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.
BUILDING
ELECTRICAL
PLUMBING
ROOFING
Owner of
Building
Architect
Contractor !" actor . or Bu""`� Nut°
Legal
Description
Address of
Building
Lot
n PERMIT N? 13514
In consideration of th'`e, issuance to me of this permit I
pertaining thereto and in strict conformity with the plans, dra
In accepting this permit I assume responsibility for all work
y ` .
o ff,v i k
CONTRACT& OR BUILDER
MIAMI SHORES VILLAGE. FLORIDA
.
DATE 1954—
Work to be • = rfontied under this Permit
0 kat rC
Subdi-
visio
Value of
3644 /11 / Project
Contractor's
License N
Amt. of
Permit $
This permit granted to the contractor or builder named above to construct the building or to install the equipment or device described in the ap
herefor in strict compliance with all ordinances pertaining thereto and wit
drawings, statements or specifications that may have been submitted
time if the work is not done in compliance with such ordinanc s or if
granted is the understanding that the contractor-orbuilder n y; =d
pertaining to the work covered hereby whether shown on
done by his agents, servants or employees.
tion
e-nnderstanding that the work will be performed in compliance with any pThhs,
to approved by a proper municipal authorities. This Permit may be revoked at any
e plans are change ithout authorization. A further condition upon which this permit is
ove assumes t onsibility for a thorough knowledge of the ordinances and regulations
s . in the statements or specifications and that he ass es responsibility for work
INSPECT°
agree 'o perform the work covered hereun compliance with ordinances and regulations
gs, statements or specifications submitted to the proper authori ses of Miami Shores Village.
ne by either, myself, my agent, servant or employee.
BY
AUTHORITY
BUILDING
ELECTRICAL
PLUMBING
ROOFING
Owner of
Building
Contractor
or Builder k
Legal Lot
Description
Address of
Building
PERMIT IT? 13084
Architect
11 81.
J . ! F r t
CONTRACTOR OR BUILDER
MIAMI SHORES VILLAGE, FLORIDA
Work to be performed under this 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 d ings -off in the statements or specifications and that ,he -a umes responsibility for work
done by his agents, servants or employees. -
Signed• r '"'a""" _k'"`yr BY
INSPECTO
Subdi-
vision
Value of
Project $
BY
r ,t
DATE I 02 � Z 195
Contractor's
License No
s''
Amt. of Q
Permit $ ammoomi
In consideration of the issuance to me of this permit I agree to p - , .« 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
Permit N o .
Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the building or other
structure herein described. This application is made in compliance and conformity with the Building Ordinance of Miami Shores Village, Florida
and all provisions of the Laws of the State of Florida, all ordinances of Miami Shores Village and all rules and regulations of the Building Divisior
of Miami Shores Village shall be complied with, whether herein specified or not. A copy o f approved plans and specifications must be kept al
building during progress of work.
Owner's Name and Address
Block ____.__.
Street and Number where work is to be performed —No ° :3 _0__ :_2.w_____ S treet
State work to be performed and purpose of building (By Floors)._ 1__
New Building Remodeling Addition Repairs
Location and Legal Description Lot
Amount of Permit $
My Commission Expires
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
(Signed)
(Signed)._
Date
P- -
No Street
Registered Architect and /or Engineer
Employing Plumbei s Name ‘,4 No . Street
Subdivision
1 ®1
No. of Stories
Size Septic Tank Type of Tank___ Capacity Gals.
Feet of Drain Tile __Dist. Feet of Tank or Drain Field from We1L
Nature of Water Supply: City —Well. — Size of Soakage Pit
Notary Public, State of Florida
Plumbing_fnspertdr.
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 5988, 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 work to be performed under this permit, as art
licensed by Miami Shores Village.
n i Master Plumber.
STATE OF FLORIDA, 1
COUNTY OF DADE.
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeare
to me well known, and who, being by me first duly sworn, upon oath deposes and says that he is the
of the above described construction, that he has carefully read the foregoing application, and that he did sign the same, and that all fay
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 faul
materials and /or workmanship.
CLOSETS
BATH
TUBS
SHOWERS
LAVA-
TORIES
SINKS
SLOP
SINKS
LAUNDRY
TUBS
INALS
URINALS
CATCH
BASIN
FLOOR
DRAIN
DRINKING
FOUNT' NS
TOTAL
FIXTURE:
CONTR.
LIST
- --
CHECK
SEPTIC
TANK
SEWER
CONN.
DRAIN
FIELD
SOAKAGE
PIT
GREASE
TRAP
SOLAR
HEATER
DEEP
WELL
SPRKLR.
SYSTEM
SW IM'G
POOL.
CONTR.
LIST
CHECK
Permit N o .
Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the building or other
structure herein described. This application is made in compliance and conformity with the Building Ordinance of Miami Shores Village, Florida
and all provisions of the Laws of the State of Florida, all ordinances of Miami Shores Village and all rules and regulations of the Building Divisior
of Miami Shores Village shall be complied with, whether herein specified or not. A copy o f approved plans and specifications must be kept al
building during progress of work.
Owner's Name and Address
Block ____.__.
Street and Number where work is to be performed —No ° :3 _0__ :_2.w_____ S treet
State work to be performed and purpose of building (By Floors)._ 1__
New Building Remodeling Addition Repairs
Location and Legal Description Lot
Amount of Permit $
My Commission Expires
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
(Signed)
(Signed)._
Date
P- -
No Street
Registered Architect and /or Engineer
Employing Plumbei s Name ‘,4 No . Street
Subdivision
1 ®1
No. of Stories
Size Septic Tank Type of Tank___ Capacity Gals.
Feet of Drain Tile __Dist. Feet of Tank or Drain Field from We1L
Nature of Water Supply: City —Well. — Size of Soakage Pit
Notary Public, State of Florida
Plumbing_fnspertdr.
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 5988, 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 work to be performed under this permit, as art
licensed by Miami Shores Village.
n i Master Plumber.
STATE OF FLORIDA, 1
COUNTY OF DADE.
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeare
to me well known, and who, being by me first duly sworn, upon oath deposes and says that he is the
of the above described construction, that he has carefully read the foregoing application, and that he did sign the same, and that all fay
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 faul
materials and /or workmanship.
Permit No. /1 / Yy
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.
F
• Owner's Name and Address__ .iL,_`_ .L•et4, .! � _ ___ No. `` Street i ,c,tt
Registered Architect and /or Engineer
Employing Plumber's Name /
Location and Legal Description Lot
1
No
t 1
Block Subdivision
Street and Number where work is to be performed— No._______________________` Street
State work to be performed and purpose of building (By Floors)
ss.
p�
� !� Street % • ��
G C�
New Building Remodeling Addition Repairs __ No. of Stories
Size Septic Tank Type of Tank Capacity Gals
Feet of Drain Tile Dist. Feet of Tank or Drain Field from Well ri i
Nature of Water Supply: City— Well � , a t i Size of Soakage Pit
Amount of Permit $ (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 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.
Date �F
I
My Commission Expires Notary Public, State of Florida
r
L t t4
(Signed) e _
Master Plumber.
STATE OF FLORIDA, t
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
P IT
GREASE
TRAP
SOLAR
H EATER
DEEP
WELL
SPRKLR.
SYSTEM
SWIM'G
POOL
0/4 V
CONTR.
LIST
CHECK
Permit No. /1 / Yy
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.
F
• Owner's Name and Address__ .iL,_`_ .L•et4, .! � _ ___ No. `` Street i ,c,tt
Registered Architect and /or Engineer
Employing Plumber's Name /
Location and Legal Description Lot
1
No
t 1
Block Subdivision
Street and Number where work is to be performed— No._______________________` Street
State work to be performed and purpose of building (By Floors)
ss.
p�
� !� Street % • ��
G C�
New Building Remodeling Addition Repairs __ No. of Stories
Size Septic Tank Type of Tank Capacity Gals
Feet of Drain Tile Dist. Feet of Tank or Drain Field from Well ri i
Nature of Water Supply: City— Well � , a t i Size of Soakage Pit
Amount of Permit $ (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 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.
Date �F
I
My Commission Expires Notary Public, State of Florida
r
L t t4
(Signed) e _
Master Plumber.
STATE OF FLORIDA, t
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.
Nature of Water Supply: City —Well
Amount of Permit $_
STATE OF FLORIDA,
COUNTY OF DADE.
ss.
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
( Signed)
&45 ... .f
h,!
(Signed)- --- -- t` --
•
Permit No.__ Date' ,y
Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submit ' 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 Engineer
Employing Plumber's Name � 1.�'_ ��_ �c _�_�''_1 - � No Street
Location and Legal Description Lot Block Subdivision
Street and Number where work is to be performed —No - �° r Street
State work to be performed and purpose of building (By Floors)
New Building Remodeling Addition Repairs No. of Stories
No Street
Size Septic Tank Type of Tank Capacity Gals — 7 Q__
Feet of Drain /5 Zti...41 Feet of Tank or Drain Field from Well
Size of Soakage Pit
Plumbing Inspector.
The undersigned applicant for this building permit does hereby certify that hh understands and accepts his obi' ns 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 work to be performed under this permit, as are
licensed by Miami Shores Village.
A 1 ` 4.4 r, � 2 ° wi� ./l t
Mast r Plumber.
Before mc, 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
Nature of Water Supply: City —Well
Amount of Permit $_
STATE OF FLORIDA,
COUNTY OF DADE.
ss.
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
( Signed)
&45 ... .f
h,!
(Signed)- --- -- t` --
•
Permit No.__ Date' ,y
Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submit ' 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 Engineer
Employing Plumber's Name � 1.�'_ ��_ �c _�_�''_1 - � No Street
Location and Legal Description Lot Block Subdivision
Street and Number where work is to be performed —No - �° r Street
State work to be performed and purpose of building (By Floors)
New Building Remodeling Addition Repairs No. of Stories
No Street
Size Septic Tank Type of Tank Capacity Gals — 7 Q__
Feet of Drain /5 Zti...41 Feet of Tank or Drain Field from Well
Size of Soakage Pit
Plumbing Inspector.
The undersigned applicant for this building permit does hereby certify that hh understands and accepts his obi' ns 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 work to be performed under this permit, as are
licensed by Miami Shores Village.
A 1 ` 4.4 r, � 2 ° wi� ./l t
Mast r Plumber.
Before mc, 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.
BUILDING
ELECTRICAL
PLUMBING
Owner of
Building
Architect
Contractor lie /-'-'
�, 4-- or Builder
Legal ,v ' 1 e
t '
Description
v CONTRACTOR OR BUILDER
MIAMI SHORES VILLAGE, FLORIDA
PERMIT N? 8038
Work to be performed under this Permit
x .
DATE
1 '
Subdi`
vision
1942
refractor's
kiense No
Address of fi t' ,/ Value of Amt. of V t .
Building , ) � -, Jr Project Permit I( J
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 appli-
cation 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 respon-
sibility for work done by his agents, servants or employees.
Signed. ... , :.i4% -, �+ • By y % �,
`: A INSPECTOR
BY
In consideration of the issuance to me of this permit I agree to perform ` the / work covered hereunder in compliance with all rdina e�G, -p
ndes and ns
pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper author bf_Ivliami Shor�i
In accepting this permit I assume responsibility for all work done by either myself, my agent, servant or employee.
AUTHORITY