59 NE 101 St (10)PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Date /7- - - 96 Job Address 5 9' A/C / d / J T Tax Folio
Legal Description Historically Designated: Yes No
Owner/Lessee / Tenant d°Y 1-e ,. WrI c. ' Master Permit # yd742.
Owner's Address 5 44 /0 / sr. Phone , 7-3 - x- Z ce`O
Contracting Co. V 4Rt,0 f E V e kV Wtt 14 1 1/!2 (i . Address
Qualifier C 4- fL V D S (J e- ( . v SS# Phone 6 3r- f,f 7
S t a t e # Municipal # C o m p e t e n c y # Ins. Co. J 7 h l /v S
Architect/Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type (circle one): BUILDING ELECTRICA PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIPTION ..v a r"- r Or-4 /J4 / •e ( J
Square Ft. Estimated Cost (value) I / D
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 m- - se standards of all laws regulating construction in this jurisdiction. I understand that separate
permits are required for ELECTRICAL, UMB 6,,fi' IGNS, POOLS, ROOFING and MECHANICAL WORK.
OWNERS AFFIDAVIT: I certify that all the foregoing information is accurate and that all • will be done in compliance with all applicable
laws regulating construction and zoning. Furthermore, I authorize the above-named . or ' do the work stated.
Notary as to bwner and/or Condo President
My Commission Expires:
FEES: PERMIT
or Condo President Date
D 2 17 q (o x l o ).
1 6 C U.=
ate
OFFICIAL NOTARY SEAL
VELDA HORTON
NOTARY PUBLIC STATE OF FLORIDA
COMMISSION NO. CC436225
MY COMMISSION EXP. FEB. 9,1999
- RADON
APPROVED:
Zoning Building
Mechanical Plumbing
Signature of Contractor or Owner-Builder
Notary as to Contractor or Owner - Builder
My Commission Expires: OFFICIAL NOTARY SEAL
VELDA HORTON
NOTARY PUBLIC STATE OF FLORIDA
COMMISSION NO. CC436225
MY COMMISSION EXP. FEB. 9,1999
otc o O
C.C.F. / • NOTARY BOND 3.04
c"7
TOTAL DUE 3 •°�
Electrical
/3S- rw 3/
Date
41 cU,
Dae
Engineering
APPLICATION FOR:
[ ] New System] New System
[ y ] Repair
STATE OF FLORIDA
DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES DATE PAID /
ONSITE SEWAGE DISPOSAL SYSTEM FEE PAID $
APPLICATION FOR CONSTRUCTION PERMIT RECEIPT # /4,-;?n/
Authority: Chapter 381, FS & Chapter 10D -6, FAC
] Existing System
APPLICANT: /1I r . •
AGENT: \/
] Abandonment ] Other(Specify)
I— v f^
TO BE COMPLETED BY APPLICANT OR APPLICANT'S AUTHOR XD-AG 'ATTACH BUILDING PLAN AND TO -SCALE
SITE PLAN SHOWING PERTINENT FEATURES REQUIRED BY- CHAPTER FLORIDA ADMINISTRATIVE CODE.
MAILING ADDRESS:
/105‘0 F
PROPERTY INFORMATION [IF LOT IS NOT IN A RECORDED SUBDIVISION, ATTACH LEGAL DESCRIPTION OR DEED]
v
LOT: /d //9- BLOCK: SUBDIVISION: /►/ DATE OF /
SUBDIVISION: 1196'4C
[Section /Township /Range /Parcel No.] ZONING:
PROPERTY SIZE: o 2./ S � ACRES [Sqft /43560] PROPERTY WATER SUPPLY: [ ) PRIVATE [ PUBLIC
PROPERTY ID #:
PROPERTY STREET ADDRESS:
DIRECTIONS TO PROPERTY:
1
2
3
4
N
APPLICANT'S SIGNATURE:
A/A9
s y 3
] Garbage Grinders /Disposals
] Holding Tank [/(] Temporary /Experimental
59 NE /o/ f7.
BUILDING INFORMATION [" ] RESIDENTIAL [ t] COMMERCIAL
Unit Type of No. of Building # Persons Business Activity
No Establishment Bedrooms Area Sqft Served For Commercial Only
Spas /Hot Tubs Floor /Equipment Drains
] Ultra -low Volume Flush,Toil€ts ] Other (Specify)
PERMIT # 94/2 7
TELEPHONE: c2‘ - 7 J 7 8
DATE: /a - - S b
b-'
HRS -H Form 4015, Mar 92 (Obsoletes previous editions which may not be used) Page 1 of 3
(Stock Number: 5744- 001 - 4015 -1)
INSTRUCTIONS:
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, city, state and zip code mailing address for applicant or agent.
LOT, BLOCK,
SUBDIVISION:
DATE OF SUBDIVISION: Official date of subdivision recorded in county plat books (month /day /year) or date lot originally recorded. Dividing an approved
lot into two or more parcels for the purpose of conveying ownership shall be considered a subdivision of the lot.
PROPERTY ID#: 27 character number for property. (CPHU may require property appraiser ID q or section/township /range /parcel number.
PROPERTY SIZE:
Lot, block, and subdivision for tot (recorded or unrecorded subdivision). If lot is not in a recorded subdivision, a copy of the lot
legal description or deed must be attached.
Net usable area of property in acres (square footage divided by 43,560 square feet) exclusive of all paved areas and prepared road
beds within public rights -of way or easements and exclusive of streams, lakes, normally wet drainage ditches, marshes, or other
such bodies of water. Contiguous unpaved and noncompacted road rights -of -way and easements with no subsurface obstructions
may be included in calculating lot area.
WATER SUPPLY: Check private or public.
PROPERTY ADDRESS: Street address for property. For lots without an assigned street address, indicate street or road and locale in county.
DIRECTIONS: Provide detailed instructions to lot or attach an area map showing lot location.
BUILDING INFORMATION: Check residential or commercial.
TYPE ESTABLISHMENT: List type of establishment from Table II, Chapter 1OD -6, FAC. Examples: single family, single wide mobile home, restaurant,
doctor's office.
NO. BEDROOMS: Count all rooms designed primarily for sleeping and those areas expected to routinely provide sleeping accommodations for
occupants.
BUILDING AREA: Total square footage of enclosed habitable area of dwelling unit, excluding garage, carport, exterior storage shed, or open or fully
screened patios or decks. Based on outside measurements for each story of structure.
# PERSONS: Number of persons residing, using, or working in establishment. For residential establishment, 2 persons per bedroom are
assumed.
BUSINESS ACTIVITY: For commercial applications only. List number of employees, shifts, and hours of operation, or other information required by
Table 1I, Chapter IOD -6, FAC.
FIXTURES: Mark each listed fixture with number installed or "NA' if not applicable.
SIGNATURE: Signature of applicant or agent. Date application one day submitted to the CPHU with appropriate fees and attachments.
ATTACHMENTS: A site plan drawn to scale, showing boundaries with dimensions, locations of residences or buildings, swimming pools, recorded
easements. onsite sewage disposal system components and location, slope of property, any existing or proposed wells, drainage
features, filled areas, obstructed areas, and surface water. Location of wells, onsite sewage disposal systems, surface waters, and
other pertinent facilities or features on adjacent property, if the features are with 75 feet of the applicant lot. Location of any
public well within 200 feet of lot.
For residences, a floor plan (residences) showing number of bedrooms and building area ()leach unit. For nonresidential
establishments, a floor plan showing the square footage of the establishment, all plumbing drains and fixture types, and other
features necessary to determine composition and quantity of wastewater.
STATE OF FLORIDA
DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES
APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PERMIT
Permit Application Number 9� 2 42
8
PART II - SITE PLAN
Scale: Each block represents 5 feet and 1 inch = 50 feet.
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CA a 1
•
Site Plan submitted by:
Plan Approved
By
---- "37e. r .NATURE
Not Approved
HRS-H Form 4015, Feb 85 (Obsoletes previous editions which may not be used).
(Stock Number. 5744-002-4015-6)
ALL CHANGE MUST BE APPROVED BY THE COUNTY PUBLIC HEALTH UNIT
County Public Unit
Page 2 of 3
J
5'T ram► 42.k zt
TITLE
Date /2- 51
PROPERTY ID #:
SOIL PROFILE INFORMATION SITE 1
STATE OF FLORIDA
DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES
ONSITE SEWAGE DISPOSAL SYSTEM
SITE EVALUATION AND SYSTEM SPECIFICATIONS
APPLICANT: MA- :70 /t G ?
LOT: 0/4- BLOCK: ,u/ /'- SUBDIVISION:
[Section /Township /Range /Parcel No9r Tax ID Number]
TO BE COMPLETED BY ENGINEER T UI EMPL9YEE,f0it OT ED PERSON. ENGINEER'S MUST
PROVIDE REG RATION NUMBER SIGN AND SEAL EACH PAGE OF S MITTAL. COMPLETE ALL ITEMS.
tMS /TO SITE PLAN: f 1 YES f 1 NO NET USABLE AREA AVAILABLE: 4.- Z:/,5 ACRES
- TOAL ESTIMATED SEWA /ORW: 2- "...- GALLONS PER DAY [RESIDENCES-TABLE 1 / OTHER-TABLE 2]
AUTHORIZED SEWAGE FLOW: 5 GALLONS PER DAY ' [1500 GPD/ACRE OR 2500 GPD/ACRE]
UNOBSTRUCTED AREA AVAILABLE: (2 v-73 SQFT UNOBSTRUCTED AREA REQUIRED: COO SQFT
BENCHMARK/REFERENCE POINT LOCATION: g/ 40 iik/4 J.-( Se7 1- Y -4 - --(2- 1 -
6
10 YEAR FLOOD ELEVATION FOR SITE: FT MSL /NGVD
Munsell /Color Texture Depth
• .
to
to
to
to
to
to
to
to
USDA SOIL SERIES:
SITE EVALUATED BY:-
� f
HRS-H Form 4015, Mar 92 (obsoletes,,previous editions which nay not be used)
(Stock Number: 5744- 003 - 4015 -1) .�
AGENT:
4/Z. e v -5
(
PERMIT # 9� 'z 2 7/ef-
ELEVATION OF PROPOSED SYSTEM SITE IS /7, Z [INCHES /FT] [ABOVE /BELOW] BENCHMARK /REFERENCE POINT
THE MINIMUM SETBACK WHICH CAN BE MAINTAINED THE PROPOSED SYSTEM TO THE FOLLOWING FEATURE
SURFACE WATER: '- DITCHES /SWALES: FT NORMALLY WET? [ ] YES [ NO
WELLS: PUBLIC: FT LIMITED USE: FT PRIVATE: FT NON - POTABLE: FT
BUILDING FOUNDATIONS: FT ,PROPERTY LINES: S' FT POTABLE WATER LINES: fO "t" FT
SITE SUBJECT TO FREQUptT FLOODING:" [ ] YES [ NO 10sYEAR FLOODING? [ ] YES [V] NO
SITE ELEVATION: 7. D "FT MSL /NGVD
SOIL PROFILE INFORMATION SITE 2
Mun ell #/ olor Textu a Depth
�/ /ritR�l 0 to - 22--
to
to
to
t0
USDA SOIL SERIES:
to
•
'7') �2)
OBSERVED WATER TABLE: INCHES [ABOVE / BELOW] EXISTING GRADE. TYPE: [PERCHED / APPARENT]
ESTIMATED WET SEASON WATER TABLE ELEVATION• INCHES [ ABOVE /, BELOW ] EXISTING GRADE.
HIGH WATER TABLE VEGETATION: [ ] YES [I-NO MOTTLING: [ ] YES [ NO DEPTH: INCHES
•
SOIL TEXTURE /LOADING RATE FOR SYSTEM SIZING:
DRAINFIELD CONJ GURATION: ( ] TRENCH [/ BED C `[ ] OTHER (SPECIFY)
REMARKS /ADDITI -ONAL CRITERIA: /.
DEPTH OF EXCAVATION: 3 INCHES
DATE:
Page 3 of 3
INSTRUCTIONS:
PERMIT 1): Permit tracking number assigned by CPHU.
APPLICANT: Property owner's full name.
AGENT: Property owner's legally authorized representative.
LOT, BLOCK, SUBDIVISION: Lot, block, and subdivision for lot.
PROPERTY ID//: 27 character number for property. (property appraiser ID Li or section/township /range /parcel number)
PROPERTY S1ZF.: Check if property size at site coaforma to submitted site plan. Record net usable area available - lot area exclusive of
all paved areas and prepared road beds within public rights -of -way oe• easementa end exclusive of streams, lakes,
normally wet drainage ditches, marshes, or other such bodies of water.
SEWAGE FLOW:
:l t. ^.:35 IRUCT D AREA:
Recoed the estimated sewage flow for the establishment from Table 1 (residences) or Table 2 (non - residential), Chapter
10D -6, FAC. Record the authoti: ed sewage flow for the lot based on net usable area and water supply (1500 gallon
per day per acre for private water supplies end 2500 gpd per acre for public water supplies). If authorized sewage flow
dons not equal or exceed the estimated sewage flow, the application must be denied.
Record the square feet of unobstructed arec available and the amount required. Unobstructed area must be at least 2
times as large as the droinfield cbaorption area and at least 75 percent of the unobstructed area must meet minimum
setbacks in Chapter 10D -6, t~ AC. The unobstructed area must be. contiguous to the droinfield.
BENC777,`. fl] NFO: — MAT:ON: Record the location of the benchmark. df using a surveyor'a benchmark record the actual elevation. Record the
elevation of the proposed system site in relation (above or below) to the benchmark.
?II /1\ 1;0.111M SETBACKS:
Record minimum setbacks which can be meet to all listed features. Actual measurements must to recorded or "NA'
for non applicable features. Features on site plan or within 75 feet of the applicant lot must be measured. The location
of any public drinking well within 200 feet of the applicant's lot must also be verified.
FLOOD INFORMATION: Record information on lot's subject to flooding. For lots subject to Gooding record 10 year flood elevation for site and
actual site elevation.
SOIL PROFILE 111;rORN/AT1ON: Two soil profiles within the proposed abaoiption area to a minimum depth of 6 feet or refusal are required. Soil
identification will use USDA Soil Classification methodology (Munsell colors and USDA soil textures). Refusals must
be clearly documented. Provide USDA soil series if available, record "LINK" if the series cannot be determined.
WATER TABLE: Record the depth of the observed water table at the time of the evaluation. Mark "perched" or "apparent" as
appropriate. Record the estimated wet season water table elevation based on site evaluation, USDA soil maps, and
historical information. Indicate if there is high water table vegetation present. Indicate if mottling is present and depth.
SOIL TEXTURE: Record soil texture or loading rate for system sizing.
DEPTH OF EXCAVATION: If applicable record depth of excavation required. Record "NA" if not applicable.
DRAINFIELD CONFIGURATION: Check drainfeld configuration required. If other, specify type.
ADDITIONAL CRITERIA: Record any additional remarks pertinent to site or installation. Ex. dosing required.
SITE EVALUATED 13Y: Signature of evaluator, title, and date of evaluation. Professional engineers must seal all documentation submitted.
ELEVATION WORKSHEET ELEVATION OF BENCHMARK / REFERENCE POINT IS:
BENCHMARK SITE 1 SITE 2 SITE 3
[ +] SHOT: H.I. H.I. H.I.
H.I. [ -] SHOT [ -] SHOT [ -] SHOT
STATE OF FLORIDA
DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES
ONSITE SEWAGE DISPOSAL SYSTEM
CONSTRUCTION PERMIT
Authority: Chapter 381, FS & Chapter 1OD -6, FAC
CO ,STRUCTION PERMIT OR: �
[v] New System Existing System P ] olding Tank Temporary /Experimental
r Repair Abandonment (�] Other(Specify)
APPLICANT:
PROPERTY STREET ADDRESS:
PROPERTY D #
SYSTEM DES L &..ANQ, SPECIFICATIONS
SPECIFICATIONS BY:
APPROVED BY:
DATE ISSUED: Z
G AZ AGENT:
NE /0/41'‘
LOT: / A BLOCK: /^ / BDIVISION: A ,
0
T
H
E
R &)T i M CF .
[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.
T 7 / GPD SEPTIC TAN 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: [ ]
D [RE , RIMARY DRAINFIELD SYSTEM
R [ ] SQUARE FEET SYSTEM
A TYPE SYSTEM: [ ] STANDARD [ ] FILLED [ ] MOUND
I CONFIGURATION: [ ] TRENCH [ BED [ ]
-
F LOCATION OF BENCHMARK: j " / cf c
I ELEVATION OF PROPOSED SYSTEM SITE [ [INCH S /FT] [ABOVE /BE ►OW] BENCHMARK /REFERS DINT
E BOTTOM OF DRAINFIELD TO BE [ 4 3 O [INCHE /FT] [ABOVel:BLO,.SENCHMARK EFERENCE POIN
L
D ,FILL REQUIR 1 , [ U i- ij I CH S 0, s a1 EX y CAVA , t ION REQUIRED: [ 3 ] INCHES
31'T . i� F i (.:1M. OF D1;, ,S 1 e ° :.r)
S0.]a?'1 I i. .3l _ :. 1''.ei-'1t':t_ 6_PL' .7,1: IN v
THIS P'' 1,:s "' :.: iT O_R� i,.L� f� , - 1
'Nit, (:.;
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TITLE:
TITLE:
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?iu9i (l p�D6. r1!1111, .S6lQ0.SE
C�� � )s �tic�£ bt36 pC'LL<L�J , Q 3® Q a,
HRS -H Form 4016, Mar 92 etes previous editions which may not be used) ��IVQ�p �� �
(Stock Number: 5744-001- 4016 -- 4016-0)
APPLICANT
PERMIT #
.76 z7//
DATE PAID /2
FEE PAID $
RECEIPT # /e 7.0(
EXPIRATION DATE:
Page 1 of 2
PEIM:iii NUMBER: Permit tracking number assigned by CPI- J.
APPS iC a %iON FOR: Check type of permit, if Other specify Type it Man's.
APPLY:CAiV T, : Property owner's full name.
TELEPHONE: Telephone number for applicant or agent.
AGENT: Property owner's legally authorized representative.
?v Ai ag ADDRESS: • P.O. boz or street mailing address for applicant or agent.
W, BLOCK, SUBDIVISION or •
PR2OPERTY IDB: 27 character id number for property. (CP`}IU may require property appraiser ID 11 or section/township /range /parcel number)
SYSTEM DESIGN AND
SPECIF:lCATIONS:
TANK: Minimum specifications from Chapter 10D-6, FAC.
DRAIN,FIELD: Minimum specifications from Chapter 10D -6, FAC.
OTHER: Other specifications, such as operating permit requirements, low - volume flush toilets, variance provisos.
SPEC - AP /CATIONS BY: Name of individual providing specifications. If designed by c registered engineer must be sealed.
APPROVED BY: County Public Health Unit (CPHU) personnel reviewing and approving permit.
DATE °_SSUED: Date permit is issued by CPHU.
EX? RATION 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
6/
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 AV SKI _
Registered Architect and /or Engineer_________ _________ __ _�_ _
1 �_ ��e
Size Septic Tank
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
Employing Plumber's Name M �p!l1
ying --219 L °P.iR .Ll ^_!!1' No.____________ t2
Location and Legal Description Lot-- ------ -- _-- -_----- - -- --_ -- Block
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
Date MAY /
No. — S 2 Street A � t / 7 '
-� Y A/
Street ive S72- - S7
Subdivision
41fL0/ 6
No. of Stories
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
Ca
Amount of Permit $
STATE OF FLORIDA,
COUNTY OF DADE.
My Commission Expires
(Si
(Signed)_
The undersigned applicant for this building permit does hereby certify that he understands and accepts his oblige
under the Florida Workmen's Compensation Act, being Section 5968, Compiled General Laws of Florida Penman
plied with the provisions thereof, and will require similar compliance from all contractors or sub - contract
performed under this permit; and will post or cause to be posted' for inspection on e of the
required by die Act. The undersigned agrees to employ only such sub - contractor work t
licensed by Miami Shores Village.
Notary Public, State of Florida
lumbing Inspector.
as an employer of labor
pplement, and bus corn -
d by him in the work to be
blic notice or notices as are
ed under this permit, as are
Master Plumber.
Before me, the undersigned authority, a notary public, duly authorized to a• I ster 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 hire stated are true.
NOTE: A re- inspection fee of $L00 will be made when such re- inspection is made•necessary by improper notice for inspection, or faulty
materials and /or workmanship.
CLOSURES
TUBS
TUBS
SHOWERS
LAVA.
TORIES
SINKS
SINKS
T LAUNDRY
TU6
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'O
POOL
CoNTR.
LIST
_ --
CHICK
/+ /
Permit No
6/
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 AV SKI _
Registered Architect and /or Engineer_________ _________ __ _�_ _
1 �_ ��e
Size Septic Tank
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
Employing Plumber's Name M �p!l1
ying --219 L °P.iR .Ll ^_!!1' No.____________ t2
Location and Legal Description Lot-- ------ -- _-- -_----- - -- --_ -- Block
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
Date MAY /
No. — S 2 Street A � t / 7 '
-� Y A/
Street ive S72- - S7
Subdivision
41fL0/ 6
No. of Stories
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
Ca
Amount of Permit $
STATE OF FLORIDA,
COUNTY OF DADE.
My Commission Expires
(Si
(Signed)_
The undersigned applicant for this building permit does hereby certify that he understands and accepts his oblige
under the Florida Workmen's Compensation Act, being Section 5968, Compiled General Laws of Florida Penman
plied with the provisions thereof, and will require similar compliance from all contractors or sub - contract
performed under this permit; and will post or cause to be posted' for inspection on e of the
required by die Act. The undersigned agrees to employ only such sub - contractor work t
licensed by Miami Shores Village.
Notary Public, State of Florida
lumbing Inspector.
as an employer of labor
pplement, and bus corn -
d by him in the work to be
blic notice or notices as are
ed under this permit, as are
Master Plumber.
Before me, the undersigned authority, a notary public, duly authorized to a• I ster 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 hire stated are true.
NOTE: A re- inspection fee of $L00 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
MIAMI SHORES VILLAGE, FLORIDA
❑ DATE `"`
o PERMIT Na 4161 Contractor's
License No.
❑ Work to be performed under this Permit
Owner of
Building r '<
Architect
Contractor
or Builder
Legal Lot
Description
Address of
Building
EJ
B1
J
19
Subdi-
vision
Value of I Amount of �
Project $ 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 applica-
tion 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. 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 ac
cepting this permit I assume responsibility for all cork done by either, myself, my agent, servant or employee.
CONTRACTOR OR BUILDER BY AUTHORITY ABBOT:
BUILDING
ELECTRICAL
PLUMBING
ROOFING
Architect
Contractor
or Builder
Legal Lot
Description
Address of '/
Building
CONTRACTOR OR BUILDER
MIAMI SHORES VILLAGE. FLORIDA
PERMIT N? 3474
DATE
Contractor's
License No
195
Work to be performed under this Permit
Owner of
Building
II Subdi-
B1 vision
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
ne if the work is not done in compliance with such ordinances or ff the plans are changed without authorization. A further condition upon which this permit is
anted is the understanding that the contractor or builder named above assumes the responsibility for a thorough knowledge of the ordinances and regulations
taining to the work covered hereby whether shown on the plans or drawings cr in the statements or specifications and that he assumes responsibility for work
by his agents, servants or employees.
Signed. BY 147-
INSPECTOR
BY
Value of Amount of
Project $ Permit $
In consideration of the issuance to me o#• this permit I agree to perform the work covered hereunder in compliance with all ordinances and regulations
ng thereto and in strict Conformity withrthe plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In ac-
this permit I assume responsibility for,all cork done by either, myself, my agent, servant or employee.
AAA
AUTHORITY e
Permit No 3 / b
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 confol•_•nity with the Building Ordinance of Miami Shores Vdlage, 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 net. A copy of approved plans and specifications must be kept at
building during progress of work. \'� C
Owner's Name and Address s___..,. .�(/6 ._.._ No._.. . ) �1 c.�
- .______ Street-- _ -_ - - -_
Registered Architect and /or
Employing Plumber's Name21_ l_A1!1_I. $tc.,_�V..4
Location and Legal Description Lot Block_
Sfs et.-.lv.. i J C / (s..r
Street and Number where work is to be performed—No
AA
State work to be performed and purpose of building (By Floors) - ..(2._ ! -.
New Building __ .--- _...._.._._. _ Remodeling_____ -_--_-- ...____ Addition...- _— _. -.__. Rapairs.._...L — No. of Stories
Size Septic Tank --_____..__ ..... _ . ._ _ __ ___ .._...Type of Tank-_--.-_-- --
Feet of Drain Tile._..._ _ ._ . _ —Dist. Feet of Tank or Drain Field from WA
Nature of Water Supply: City —Well.
Amount of Permit $
The undersigned applicant for this building permit do
under the Florida Worlanen's Compensation Act, being Sec
plied with the provisions thereof, and will require atmilar q
performed under this permit; and will post or cause to be pi
required by the Act. The undersigned agrees to employ I
licensed by Miami Shores Village.
STATE OF FLORIDA, ss.
COUNTY OF DADE. 1
Before me, the undersigned authority, a notary public,
My Commission Expires
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING r
i
`Village of Miami Shores
JOB
ADDRESS ' 1 79 ''
INSPECTION Okkei2
TIME READY
REMARKS
to me well known, and who, being by me first duly sworn, ui
of the above described construction, that he has carefully
therein by him stated are true.
1 INSPECTOR
NOTE: A re- inspection fee of $1.00 will be made whey
materials and /or workmanship.
...... Subdivision_._-....- _..._...
Capacity Gals.
N? 4043
DATE 7 �G�Y�
CLOSETS
BATH
TUBE
$MOWERS
LAVA-
TORIES
SINKS
SLOP
SINKS
LAUNDRY
Tues
URINALI
CATCH
GAEIN
FLOOR
DRAIN
DRINKING
FOUNT'Ns
TOTAL
FIXTURES
CONTR.
LIST
CHECK
SEPTIC
TANK
SEWER
CONN.
DRAIN
FIELD
SOAKAOE
PIT
GREASE'
TRAP
SOLAR
NEATER
DEEP
WELL
SPRKLR.
swam.
SW1H'O
POOL
-
-
I__
LIST
CHECK
-
r
Permit No 3 / b
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 confol•_•nity with the Building Ordinance of Miami Shores Vdlage, 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 net. A copy of approved plans and specifications must be kept at
building during progress of work. \'� C
Owner's Name and Address s___..,. .�(/6 ._.._ No._.. . ) �1 c.�
- .______ Street-- _ -_ - - -_
Registered Architect and /or
Employing Plumber's Name21_ l_A1!1_I. $tc.,_�V..4
Location and Legal Description Lot Block_
Sfs et.-.lv.. i J C / (s..r
Street and Number where work is to be performed—No
AA
State work to be performed and purpose of building (By Floors) - ..(2._ ! -.
New Building __ .--- _...._.._._. _ Remodeling_____ -_--_-- ...____ Addition...- _— _. -.__. Rapairs.._...L — No. of Stories
Size Septic Tank --_____..__ ..... _ . ._ _ __ ___ .._...Type of Tank-_--.-_-- --
Feet of Drain Tile._..._ _ ._ . _ —Dist. Feet of Tank or Drain Field from WA
Nature of Water Supply: City —Well.
Amount of Permit $
The undersigned applicant for this building permit do
under the Florida Worlanen's Compensation Act, being Sec
plied with the provisions thereof, and will require atmilar q
performed under this permit; and will post or cause to be pi
required by the Act. The undersigned agrees to employ I
licensed by Miami Shores Village.
STATE OF FLORIDA, ss.
COUNTY OF DADE. 1
Before me, the undersigned authority, a notary public,
My Commission Expires
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING r
i
`Village of Miami Shores
JOB
ADDRESS ' 1 79 ''
INSPECTION Okkei2
TIME READY
REMARKS
to me well known, and who, being by me first duly sworn, ui
of the above described construction, that he has carefully
therein by him stated are true.
1 INSPECTOR
NOTE: A re- inspection fee of $1.00 will be made whey
materials and /or workmanship.
...... Subdivision_._-....- _..._...
Capacity Gals.
N? 4043
DATE 7 �G�Y�