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DRAINFIELD/SEPTICPERMIT APPLICATION FOR MIAMI SHORES VILLAGE Date 1 !, Job Address q) ,4 c .101 ��/ -p4 Tax Folio Legal Description Historically Designated: Yes No Owner/Lessee / Tenant 19-fir '�i't 11- Master Permit # 9 0 f .I C. 1 D 1 r-1," cC Owner's Address Contracting Co. 1/44 (7.!c JF 1c n7- 7,`ed Qualifier ,cfE P Uc ea C.te_ / State # Municipal # Competency # Ins. Co. Architect/Engineer Address Bonding Company Address Mortgagor Address Permit Type (circle one): BU 77 ELECTRICAL PLUMBING MECHANICAL RO FING PAVING FENCE SIGN WORK DESCRIPTION Square Ft. g Z) L G6r3- /7Q-(079Z`.� /1 1 Notary as to ON 4r and/or Condo President (Date My Commtssl.•: ° STEPHEN E COCKING State of Florida My Comm. Exp: 08/04/ Comm# r Jl CC669 e., f,A!.AAAAR FEES: PERMIT 3 S 5 - RADON SS# C.C.F. My Address (a/ Phone 7 1 " Zo 65 1?9 32 AJJ -- Phone CSI — 7 L S `l Estimated Cost (value) . C.) , WARNING TO OWNER: YOU MUST RECORD A NOTICE OF COMMENCEMENT AND YOUR FAILURE TO DO SO MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY (IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR. LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT.) Application is hereby made to obtain a permit to do work and installation as indicated above, and on the attached addendum (if applicable). I certify that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that separate permits are required for ELECTRICAL, PLUMBING, SIGNS, POOLS, ROOFING and MECHANICAL WORK. OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. Furthermore, I authorize the above -named contractor to do the work stated. gna er and/or Condo President late ignature - 1/l X 97 ��� - // �2 �1 .A � . of Contractor or Owner - Builder / Date e ` O APPROVED: Zoning Building Mechanical Plumbing fO X AL t NOTARY SEAL OA w , SANDRA M MONTIEL n COMMISSION NUMBER 2 sqr. CC401261 g + try COMMISSION .EXP. OF f0 Au k �. otary as to Contractor or Owner- Date /f7 /a /g7 NOTARY J BOND -3 O CJ TOTAL DUE 3 ell -CJ Electrical Engineering PROPERTY STREET ADDRESS: 9,, "TT l a Tr, 1 -• .... LL SPECIFICATIONS BY: APPROVED BY: DATE ISSUED: /1 ice ORIDA PERMIT # 1 L T MENT OF HEALTH AND REHABILITATIVE SERVICES DATE PAID / TE SEWAGE DISPOSAL SYSTEM FEE PAID $ ONSTRUCTION PERMIT RECEIPT # /97 Authority: Chapter 381, FS & Chapter 10D -6, FAC li. C013STRUCTION PERMIT R: �,/' ] New System Existing System [/ ] Holding Tank [d Temporary /Experimental ) Repair [Abandonment VZ_-r Other(Specify) APPLICANT: D � 5 R J° 6-led /-7 , AGENT: 4f1 (7,„, .�.„. P.T „ 9®,Z / U / S-4- c4 LOT:J f 4 $aBLOCK: /() SUBDIVISION: 0,7/ PROPERTY ID #: � . 3 2-426 ® <3 (,3 [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_A LD P_ECIFICATIONS '77 T [906(... �GAI / GP SEPTIC TAN 7AEROBIC 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 [ SQUARE FEF PRIMARY DRAINFIELD SYSTEM R [ ) SQUARE FEET SYSTEM A TYPE SYSTEM: [ ] STANDARD [ ] FILLED [ ] MOUND [ I CONFIGURATION: [ ] TRENCH [ABED [ ] \ N F LOCATION OF BENCHMARK: 5 / ,1 / /''// I ELEVATION OF PROPOSED SYSTEM SITE gr. ]•rQ i FT) [ABOVE /BELOW] BENCHMARK/REFER CE PaItIT E BOTTOM OF DRAINFIELD TO BE [ , C,C INCHE FT] [ABOVQ BENCHMAR EFERENCE POINT) L D FILL REQUIRED: [ ] INCHES EXCAVATION REQUIRED: [3-6 ] INCHES a'S 'IlhLL 2 2” OY LOAMY C OARSh SAWED O UNDEP. BOTTOM OF DRAINFLZL T SUBMIT BENCHMARK K BEF1 k TINSX ECC'XON TEIS PERMIT gS NOT r®la /t ENTTION(S R, ELEVAIXON' TITLE: TITLE: HRS-H Form 4016, Mar 92 (Obsoletes previous editions which may not be used) (Stock Number: 5744- 001 - 4016-0) INSTALLER /CONTRACTOR EXPIRATION DATE: o Page 1 of 2 ?ermit C J. 1;erriiii... if Al??1.7X. Prontir:y owner's fun LEHONE: 'Telephone numb,..r fo pp:ienn: or ckc.M. AC 2ronerty owner's legolly cutborized rep:er.t1v:3. ADD:LESS: 2.0. bo:: or street avilir crss for upplictont or S or iOX :j)O 2 chcracter d nuilibc: or property. (:_"....=;-:oU li "1.117 : • Tr. S DES:0N AND M.inIcaum sp,:citicLiions Croi !C7)-3, spccificr.Licns frc: 1Cher .AC. Othe Jo,:fiction, such r.. Qtii 101:/-V0/.12:11. 73-x1°4;J:fr... ECCKfGNS V: NLIfilt: u irICIIV:ellsil■ Cour:4' :=Liblic (C1 piJrsorincl arc! 4p9:,.ov:.11: :71C1.1".. unit is issued by C?-L. ON issueLlo ,i"' _ _. a iiiMI •-_ _._ ._ Iiiiiiiii_ iillawiiiraiid iiiii iiiiirr iin..mi'llie lliiii c • `.■ El ili i:■1iinai _:.e-_ m Irlr ■■t■I;I■■■■M■AIII■■■■OMMEMMEMr 1111111MOMMITI11111111111111 111114P1111 1 :;, 1 111111 _ j I Ill 111 1 [ eir�r" - kip a iii i iiii�E alii!iiaiiii ■iiiila.WAIINif•••■ ••I 1 Ii/r.J��/ IP Ili■lMlI■1111■=it7■■I% ■■■■■ ■■IMM■P:i I ■CMOIN■MEI i IldrArillINIIMIIMEGNININWAISIIIIIIIMPIIIIM ■ 1INFA iiiin iniriii lii ■■lIMMEM M, • INIPSIM!?NIPMIN i19V' !7 ■IJ E MIMI ■IIMI■f1 ■it ■■■■■■■EN■■ ■ ■ ■LiLANIII■fit A cM WAMME s MMUUN RxMEM® ■o ■OMMUMI• ■riirr. ■iuiiu .■■ ■ ■_ ■ ■ ■ ■ ■ ■: i;MEM■_i -. i>ii■r■ Ilrr o©■ ■®mmummow==: C;' .'ICiii■I:1 ■ ■■■o■■■■ ■■►ila••■ ••■i It ■ — 41112111I7 ■O ENIMPAILMI ■■ ■L9 ■ ■■IMMAIMPrr MINA• ■■l!MMIN■MOII it ■■•1011111%1i9■ It'J■/��,���J'�IIS;IMBI ■f�1[1t f�1i ?L�'f"3I /■■■ ■■■1'� ■�F ■��■��1�EM a■MMINI 1 nifi : �l■■■■NIIMME•Uii I ■�1 U ■ii' iillo ili ■iii iii.fagiNE im ■iimin1 ■ ■r�' ■mn I lin MIMIIIIIT1111111021111111111111 111! ill 1111111111 I* I Cli ■i IFININEil Gr1i® OliffiooiO ®GFiEGnirTiriiii%er VSi: a ••11111 in I 111= Mma1 rani V 1111■ ■ III■■ I.I■1►IIII■AN■m7I■C1e;i■I■••1■■■,n test coo i P OM Q/ �' t 1 4" i�+� w( vi tit Abl Scale: Each block represents 5 feet and 1 inch = 50 feet. Site Plan submitted by: t 4�1, iq.) — 7 Plan Approved By STATE OF FLORIDA DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES .LJCATION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PERMIT Permit Application Number / !>l. % G PART II - SITE PLAN I..Q. l ®c' TZ )(a'14,,0 i �r 1 J I^t G &de', J . Not Approved ALL CHANGES 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) 177k- Pg P 44/ y -1t TITL Date County Public Unit Page 2 of 3 Date 3/3/k) Job Address FEES: PERMIT 3 67 RADON APPROVED: Zoning Mechanical PERMIT APPLICATION FOR MIAMI SHORES VILLAGE Legal Description Historically Designated: Yes No Owner/Lessee / Tenant �dAg 16/44 Master Permit # 4 f // 78 Owner's Address 90 i" • / / ,f Phone Contracting Co. Cr %�'! l ' ! ' , i G �,e?'/ Address (9 9 -/� G✓' �2 t�L''`� L.0,.././, ss# Phone CF‘' Qualifier 7 7a Plr6r/ CG. State # Municipal # Competency # Ins. Co. Architect/Engineer Address Bonding Company Address Mortgagor Address Permit Type (circle one): BUILDING ELECTRICAL PLUM G MECHANICAL ROOFING PAVING FENCE SIGN WORK DESCRIPTION Wria !1— i�� C /-K Square Ft. Estimated Cost (value) /072 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. • T: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable tion and zoning. Furthermore, I authorize the above -named contractor to do the work stated. 3'3149 X\ignature of owner and/or Condo President Date l J� 'n2cp-t-Ei as to Owner and/or Condo President Date My Commission Expires: 2/-7 F,V.Y P P4/ V � • 0,)- C.7 lt;:' C.r . Building Plumbing fo Tax Folio gnature of Contractor or Owner- Builder Notary as to Contractor or Owner- Builder Date My Commission Expires: r Bed :nn?. C.C.F. - NOTARY J TOTAL DUE Electrical Date 6a Engineering STATE OF FLORIDA CON /TRUCTION F [ ] New System [ ] xisting System [A/ ] ding Tank [Temporary /Experimental [ )/J Repair [ Abandonment [ Other(Specify) APPLICANT: p aci m 23 / A7 AGENT: c r j r Sap, _L ....pc_ 4 PROPERTY STREET ADDRESS: c7 ) 1i'. / , LOT: /0 /1 SUB PROPERTY ID #: /f32, C� f c i ' f . i [SECTION /TOWNSHIP /RANGE /PARCEI: 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. SYSTEM DESIGN AND SPECIFICATIONS r T [ W2) ] ALLONS 2 / G SEPTIC ANK /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 [ (2, SQUARE FEET 1 )RIMARY DRAINFIEI;D SYSTEM SYSTEM [ ] STANDARD [ ] FILLED [ ]_ , TRENCH [4ED F LOCATION OF BENCHMARK: � J �f r coo I ELEVATION OF PROPOSED S YSTEM SITE [ (,. ] [INCHES FT [ABOVE /BELOW] BENCHMARK /REFERENC +.NT E BOTTOM OF DRAINFIELD TO BE [ L 'P"� [INCHES /F ] [ABOV ELOW� BENCHMARK / `:EFE•ENCE POIN �¢- D FILL REQUIRED: [ ] INCHES EXCAVATION REQUIRED: [] INCHES i��. 1 ._ iii i_t _l'. ._. - s`..bi _ . 0 .2[ '.i. \' 7.7 O i.. O 1 \.7.: _.'i 'lnn Clf` k P.. 7 . ` �r.i:)) E ] GALLONS PER DOSE DOSING TANK CAPACITY DOSE RATE [ PER 24 HRS NO. OF PUMPS: [ ] R [ ] SQUA A TYPE SYSTEM: I CONFIGURATION: SPECIFICATIONS BY: APPROVED BY: DATE ISSUED: -; PERMIT # / 7g,Q73 DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES DATE PAID -3-3/-7 ONSITE SEWAGE DISPOSAL SYSTEM FEE PAID $ .S CONSTRUCTION PERMIT RECEIPT # V-C Authority: Chapter 381, FS & Chapter 10D -6, FAC TITLE: TITLE: APPLICANT [ ] MOUND [ ] [ ] CPHU EXPIRATION DATE: 7 - / , 17' s7y7..s on s3F.In HRS Form 4016, Mar 92 (Obsoletes previous editions which may not beEusea i �'euo�d6h:��trcs�'s >aG69``s Gl7Ou CZL1 Page 1 of 2 (Stock Number: 5744- 001 - 4016 -0) ',INSTRUCTIONS: PERMIT NUMBER: Fermi: 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 IDI: 27 character id number for property. (CPHU may require property appraiser ID it 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. • r. 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MOMS* ■• ■ ■••.•[•ri Mis _ ■ ■NAmmai■ a ~ N NN ANNA •� g ■ S ■# MOM ■ I l 1 • � p ■III.■ � �• . S I .: S . id ■. MOSS: I ww UMW rnil■■■ • 'Uri■ ■. ��i ' Ir . - 7ryg mI � ira I e )♦�.. ,±1" _ U• 4". . % Ali MUE N mV �1... ._rs... �1,mm�� .U)♦u UU Notes: Site Plan Submitted by�` Plan Approved By STATE OF FLORIDA DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PERMIT Permit Application Number t //? 6 q j ALL CH NGES MUST HRS -H Form 4015, Feb 85 (Obsoletes previous editions which may not be used) (Stock Number: 5744- 002- 4015 -6) PART II - SITE PLAN SIGNATURE Not Approved 3 NTY PUBLIC HEALTH UNIT r177 •!" 777 7 ' i> / ()- v , tic to P -- /C T ✓ \ Date County Public Unit Page 2 of 3 Date 1/11/94 Legal Description Owner / Lessee / Tenant BLAKE Owner ' s Address 90 NE 101 STREET Contracting Co. NORTH DADE SEPTIC TANK QualifierDENNIS NEVILLE State # 025836 -8 Municipal # Competency # 12842 Ins.Co. Architect /Engineer Address Bonding Company Address Mortgagor Address Permit Type(circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING PENCE SIGN WORK DESCRIPTION INSTALL DRAINFIELD Square Ft. 200 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. FFIDAVIT: I certify that all the foregoing informat is accurate and that all work will liance with all applicable laws regulating uction ars -z ning. Furthermore, I the :, ve -named contractor to do the work state PERMIT APPLICATION FOR MIAMI SHORES VILLAGE Job Address 90 NE 101 STREET Sig ature of owner and /or Condo President Date APPROVED: N tar as`to My ommissgn Condo President res. • ;VOTARY PUEtCC; 7.4TE ;".R;4119A AT LARGE r : COMiyitS5K]414, E ukp J!>£ Fs '995 $ONDE'J T1+RU HUCit 3E;tRY $ ASSC_L TES FEES:. .PERMIT 3 RADON Zoning Buildin Mechanical Plumbin Master Permit # 855 Phone 758 -3476 Address 800 NW 111 STREE SS# Phone 751-7676 Estimated Cost(value) $1000.00 Si Date: Tax Folio // -/- /3 ure of Contra o : as ontr:ctor or Owner- Builder My Commis ;:•; A �83E£ ATE f;O�dD�'ATLARGE' Y COMMt5.9011 P t S JE.'UE Ty, 1995 ., BONDED NM/ HUtllt.Z3EURY & AS&OCIATE$ * * * * * * * *' /., ** NOTARY TOTAL DUE "U ` C.C.P. Fire Other or or Owner- Builder Electrical Engineering Permit No SS-1 (°_ 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 Engineer j. _ Employing Plumber's Name d am_ -F -__- i» we __ No._. j 2 3 Street -___ . 4: -- Location and Legal Description Lot_- Block Subdivision _____. ----- _ ... --- _._______ -_- Street and Number where work is to be performed- No. - -g_j - __ _____— ___. -____ . _. Street___ Zr l d/ State work to be performed and purpose of building (By Floors) _ _______ New Building . - -- --- Remodeling_ - --_ --___ Addition._ Size Septic Tank - Type of Tank Capacity Gals Feet of Drain Tile q_.1n - _ -_ -_ _ _Dist. Feet of Tank or Drain Field from Well Nature of Water Supply: City -Well. Amount of Permit $ MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT Repairs No. of Stories .Size of Soakage Pit (Signed)- Plumbing Inspector. The undersigned applicant for this building permit does hereby certify that he understands and accepts his obl':atio s as an employer of labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Perm . ent supplement, and has com- plied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors el plo d by him in the work to be performed under this permit; and will post or cause to be posted' for inspection 011 the site of the work su' , . ublic 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 t/ Date �11.iC.p� Master Plumber. STATE OF FLORIDA, ! as, 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 hire 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 TUBE SHOWERS LAVA- TORIES SINKS SLOP SINKS LAUNDRY TUBS URINALS INALS CATCH BASIN FLOOR DRAIN DRINKING FOUNT'N6 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 SS-1 (°_ 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 Engineer j. _ Employing Plumber's Name d am_ -F -__- i» we __ No._. j 2 3 Street -___ . 4: -- Location and Legal Description Lot_- Block Subdivision _____. ----- _ ... --- _._______ -_- Street and Number where work is to be performed- No. - -g_j - __ _____— ___. -____ . _. Street___ Zr l d/ State work to be performed and purpose of building (By Floors) _ _______ New Building . - -- --- Remodeling_ - --_ --___ Addition._ Size Septic Tank - Type of Tank Capacity Gals Feet of Drain Tile q_.1n - _ -_ -_ _ _Dist. Feet of Tank or Drain Field from Well Nature of Water Supply: City -Well. Amount of Permit $ MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT Repairs No. of Stories .Size of Soakage Pit (Signed)- Plumbing Inspector. The undersigned applicant for this building permit does hereby certify that he understands and accepts his obl':atio s as an employer of labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Perm . ent supplement, and has com- plied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors el plo d by him in the work to be performed under this permit; and will post or cause to be posted' for inspection 011 the site of the work su' , . ublic 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 t/ Date �11.iC.p� Master Plumber. STATE OF FLORIDA, ! as, 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 hire 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 - tE Architect Contractor or Builder I I Leggy Lot ' s Description Address of Building PERMIT IN? 12074 MIAMI SHORES VILLAGE, FLORIDA ri Work to be performed under this Permit BV Subdi- vision Value of Project $ DATE Contractor's License No Amt. of Permit This permit is granted to the contractor or builder named above to construct the building or to install the equipment or device described in the application herefor in strict compliance with all ordinances pertaining thereto and with the understanding that the work will be performed in compliance with any plans, drawings, statements or specifications that may have been submitted to and approved by the proper municipal authorities. This Permit may be revoked at any time if the work is not done in compliance with such ordinances or if the plans are changed without authorization. A further condition upon which this permit is granted is the understanding that the contractor or builder named above assumes the responsibility for a thorough knowledge of the ordinances and regulations pertaining to the work covered hereby whether shown on the plans or drawings or in the statements or specifications and that he assumes responsibility for work done by his agents, servants or employees. 7 Signed. . s !` i + i r ' .r . •'..- BY ` .- s ,r • t INSPECTOR In consideration of the issuance to me of this permit I agree to perform the work covered hereunder in compliance with all ordinances and regulations pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I assume rem bility for all work done by either, myself, my agent, servant or employee. 195