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PLUMBING (2)PERMIT APPLICATION FOR MIAMI SHORES VILLAGE Ddte ice' 1 1 I Job Address 10 1.JL I o2 sT Legal Description Owner / Lessee / Tenant tO r) LS Master Permit # Owner's Address lb t•- 1 O Z S T Phone Contracting Co.R2c) Qoc) { f. Address Qualifier l'A.\C -,A \ 0 R 11. SS# Phone 9Y0 043 State # Municipal # 1 Competency # Ins.Co. Architect /Engineer Address Bonding Company Address Mortgagor Address Permit Type(circle one): BUILDING ELECTRICAL LUMBING MECHANICAL ROOFING PAVING PENCE SIGN WORK DESCRIPTION _ 12: 2 -1 4 Square Pt. ,00f 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 thorize the above -named contractor to do the work sta d. 12- 47, r, President • { .s • Signature of owner and /or C Date: FT / - sy /7 Notary'as to Owner a My Commission Expire ** * * * FEES: PERMIT 35 APPROVED: 0 IAL NOTAR SEAL IRMA ROMAN NOTARY PUBLIC STATE OF FLORIDA COMMISSION NO. CC375231 COMM" I ION E*P. MAY 16,1998 00 RADON C.C.F. /. NOTARY - Mechanical Fire Building Plumbing Tax Folio Estimated Cost(value) /2_0(3- 0O Signature of Contractor or Owner- Builder Date: &J,,4 ,/ Notary as to My Commissio o for;o Co 0meri Bu 1dEr • * COMMISSION NUMBER CC255237 "" � MY COMM SSION EXP. * __ F'+. * J A i * 25 19 ** oc7 Y TOTAL DUE Other Electrical Engineering APPLICATION FOR: [AJ] New System [N] Existing System [Al] Holding Tank pi] Temporary /Experimental [y ] Repair (A)] Abandonment (IL)] Other(Specify) APPLICANT: :T 4 7 3)\/.... AGENT: A at- f 2 O PDQ �E MAILING ADDRESS: 0(03-7 r,S01O �2 . TO BE COMPLETED BY APPLICANT OR APPLICANT'S AUTHORIZED AGENT. ATTACH BUILDING PLAN AND TO -SCALE SITE PLAN SHOWING PERTINENT FEATURES REQUIRED BY CHAPTER 10D -6, FLORIDA ADMINISTRATIVE CODE. PROPERTY INFORMATION [IF LOT IS NOT IN A RECORDED SUBDIVISION, ATTACH LEGAL DESCRIPTION OR DEED] LOT: BLOCK: SUBDIVISION: I / ,�� j r � ), S DATE OF 6 $ E SUBDIVISION. PROPERTY ID #: [Section /Township /Range /Parcel No.] ZONING: PROPERTY SIZE: PROPERTY STREET ADDRESS: /D /UL / 0 Z �•r- 33 1 DIRECTIONS TO PROPERTY: BUILDING INFORMATION Unit Type of No. of No Establishment Bedrooms 1 2 3 4 Sbc STATE OF FLORIDA DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES ONSITE SEWAGE DISPOSAL SYSTEM APPLICATION FOR CONSTRUCTION PERMIT Authority: Chapter 381, FS & Chapter 10D -6, FAC [N ] Garbage Grinders /Disposals [,si] Ultra -low Volume Flush Toilets ACRES[Sgft /43560] PROPERTY WATER SUPPLY: [ ] PRIVATE [x ] PUBLIC [x ] RESIDENTIAL HRS-H Form 4015, Mar 92 (Obsoletes previous editions which may not be used) (Stock Number: 5744 - 001- 4015 -1) [m.1 COMMERCIAL Building # Persons Area Sgft Served PERMIT # DATE PAID FEE PAID $ RECEIPT # �r 2 4ti /.ff/Q 6 TELEPHONE: % i / 0.,)3( Business Activity For Commercial Only [Al] Spas /Hot Tubs [Al] Floor /Equipment Drains [A.,] Other (Specify) APPLICANT'S SIGNATURE � °�� -- %` DATE: 2' 3 . ! Y Page 1 of 3 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: PROPERTY SIZE: Lot, block, and subdivision for lot (recorded or unrecorded subdivision). If lot is not in a recorded subdivision, a copy of the lot legal description or deed must be attached. 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 IDI/: 27 character number for property. (CPHU may require property appraiser ID 1/ or section/township /range /parcel number. Net usable area of property in acres (square footage divided by 43,560 square feet) exclusive of all paved areas end 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 I0D-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. 11 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 II, Chapter 10D -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 of each 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 ONSITE SEWAGE DISPOSAL SYSTEM SITE EVALUATION AND SYSTEM SPECIFICATIONS APPLICANT: ,1 S AGENT: /I LL Zo /2 LOT: BLOCK: SUBDIVISION: PROPERTY ID #: /a ALL /O Z 57 TO BE COMPLETED BY ENGINEER, HEALTH UNIT EMPLOYEE, OR OTHER QUALIFIED PERSON. ENGINEER'S MUST PROVIDE REGISTRATION NUMBER AND SIGN AND SEAL EACH PAGE OF SUBMITTAL. COMPLETE ALL ITEMS. PROPERTY SIZE CONFORMS TO SITE PLAN: ['(] TOTAL ESTIMATED SEWAGE FLOW: 3c AUTHORIZED SEWAGE FLOW: 30a UNOBSTRUCTED AREA AVAILABLE: 000 BENCHMARK /REFERENCE POINT LOCATION: ELEVATION OF PROPOSED SYSTEM SITE IS r SOIL PROFILE INFORMATION SITE 1 Munsell # /Color Texture Depth Ron.., 'TO rSo f L. b to / 2 /Oki & SA- !> j > to - 7a to to to to to to to USDA SOIL SERIES: v- 1)0 t ) ,•- SITE EVALUATED BY �/ HRS-H Form 4015, Mar 92 (Obsoletes previous editions which may not be (Stock Number: 5744 - 003 - 4015-1) PERMIT # / ie 0,2 ` [Section /Township /Range /Parcel No. or Tax ID Number] YES [ ] NO NET USABLE AREA AVAILABLE: ACRES GALLONS PER DAY [RESIDENCES -TABLE 1 / OTHER -TABLE 2] GALLONS PER DAY [1500 GPD/ACRE OR 2500 GPD /ACRE) SQFT UNOBSTRUCTED AREA REQUIRED: (OO SQFT [INCHES /FT] [ABOVE /BELOW] BENCHMARK /REFERENCE POINT THE MINIMUM SETBACK WHICH CAN BE MAINTAINED FROM THE PROPOSED SYSTEM TO THE FOLLOWING FEATURES: SURFACE WATER: /opt FT DITCHES /SWALES: FT NORMALLY WET? [ ] YES [rNI NO WELLS: PUBLIC: - 01- FT LIMITED USE: FT PRIVATE: -- FT NON- POTABLE: FT BUILDING FOUNDATIONS: ' FT PROPERTY LINES: FT POTABLE WATER LINES: 7 FT SITE SUBJECT TO FREQUENT FLOODING: [ ] YES yC] NO 10 YEAR FLOODING? [ ] YES (x'] NO 10 YEAR FLOOD ELEVATION FOR SITE: 5.a FT MSL /NGV 2 ,SITE(ELEVATION: 7 0 FT MSL /NGVD SOIL PROFILE INFORMATION SITE 2 Munsell # /Color Texture Depth 1` ,ecr-z.,s TbPSo. CD to / Z to �.Z to t to to to to to to USDA SOIL SERIES: ° As... -) (I ), c.,._ OBSERVED WATER TABLE: 6 INCHES [ABOVE / BELOW] EXISTING GRADE. TYPE: [PERCHED / APPARENT] ESTIMATED WET SEASON WATER TABLE ELEVATION: 4< 2 INCHES [ ABOVE / BELOW ] EXISTING GRADE. HIGH WATER TABLE VEGETATION: [ ] YES [x] NO MOTTLING: [ ] YES [ NO DEPTH: INCHES SOIL TEXTURE /LOADING RATE FOR SYSTEM SIZING: /. Y DEPTH OF EXCAVATION: 3 C.. INCHES DRAINFIELD CONFIGURATION: [ ] TRENCH [;k-] BED [ ] OTHER (SPECIFY) REMARKS /ADDITIONAL CRITERIA: ed) • Page 3 of 3 INSTRUCTIONS: PERMIT 11: 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 t1 or aection/township /range /parcel number) PROPERTY SIZE: Check if property size at site conforms to submitted site plan. Record net usable area available - lot eras exclusive of all paved areas and prepared road beds within public rights-of-way or easements and exclusive of screen, lakes, normally wet drainage ditches, marshes, or other such bodies of water. SEWAGE FLOW: UNO3STRUCi'ED AREA: MINIMUM SETBACKS: Record the estimated sewage flow for the establishment from Table 1 (residences) or Table 2 (non - residential), Chapter 10D -6, FAC. Record the authorized sewage flow for the lot based on net usable area and water supply (1500 gallons per day per acre for private; water supplies and 2500 gpd per acre for public water supplies). IIf author zed sewage flow does not equal or exceed the estimated sewage flow, the application must be denied. Record the square feet of unobstructed area available and the amount required. Unobstructed area mei be at least 2 times as large as the drainfield absorption area and at least 75 percent of the unobstructed area must net minimum setbacks in Chapter 10D -6, FAC. The unobstructed area must be contiguous to the drainfield. BENCHMARK INFORMATION: Record the location of the benchmark. If using a surveyor's benchmark record the actual elevation. accord the elevation of the proposed system site in relation (above or below) to the benchmark. Record minimum setbacks which can be meet to all listed features. Actual measurements must be 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 flooding record 10 year flood elevation for site and actual site elevation. SOIL PROFILE INFORMATION: Two soil profiles within the proposed absorption 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 "UNK" 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 histo.ical 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 drainfield configuration required. If other, specify type. ADDITIONAL CRITERIA: Record any additional remarks pertinent to site or installation. Ex. dosing required. SITE EVALUATED BY: 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 s, . LOT: 1 STATE OF FLORIDA DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES 'ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PERMIT Authority: Chapter 181, FS & Chapter 10D -6, FAC BLOCK: SYSTEM DESIGN AND 4PECIFICATIONS SUBDIVISION: PERMIT # DATE PAID FEE PAID $ RECEIPT # ... g 2z 5162 3- q5 40 O 42- 9'C' CONFRUCTION PERMIT FOR: WI New System [ ( _,]'Existing System [4/i Holding Tank [ ] Temporary /Experimental 7 ' ] Repair [A/] Abandonment [ Other(Specify) APPLICANT: 7-0 N 6- AGENT: A L C 'Pg..© PROPERTY STREET ADDRESS: /& NZ / G z 1 5 - 1 4 PROPERTY ID #: /1/ [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 [ / a ] [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: [ ] D ( SQUARE FEET PRIMARY DRAINFIELD SYSTEM R [ ] SQUARE FEET SYSTEM A TYPE SYSTEM: [ ] STANDARD [ ] FILLED [ ] MOUND [ ] I CONFIGURATION: [ ] TRENCH [C BED [ N F LOCATION OF BENCHMARK: I ELEVATION OF PROPOSED SYSTEM SITE [ -°"] [INCHES /FT] [ABOVE /BELOW] BENCHMARK /REFERENCE POINT E BOTTOM OF DRAINFIELD TO BE [ ] [INCHES /FT] [ABOVE /BELOW] BENCHMARK /REFERENCE POINT L D FILL REQUIRED: r- INCHES EXCAVATION REQUIRED: [ P- INCHES APPROVED BY: DATE ISSUED: f ,.- /2 '1 � it �C �ot�_� 1s-'vVt l /F�� % � �` f i° � CJ / 7 CO v E R SPECIFICATIONS BY: TITLE: HRS-H Form 4016, Mar 92 (Obsoletes previous editions which may not be used) (Stock Number: 5744-001- 4016 -0) TITLE: w CPHU EXPIRATION DATE: _ APPLICANT Page 1 of 2 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. SYSTEM DESIGN AND SPECIFICATIONS: LOT, BLOCK, SUBDIVISION or PROPERTY ID#: 27 character id number for property. (CPHU may require property appraiser ID # or section/township /range /parcel number) TANK: Minimum specifications from Chapter IOD-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. STATE OF FLORIDA DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PERMIT Permit Application Number 9' 4 2 2- PART II - SITE PLAN Scale: Each block represents 5 feet and 1 inch = 50 feet. 11111 1111 1111/11/ 111111 1 11 11111111 1 11 11111 111 11111111111111111 11 11111111111 IIIIIIIIIIIIIllH IIIIIIIIIIIIIIIIIIIIIIIIHIIIIIIIIIII 11 11111111 1 1 U11 11 ■ ■ ■ ■.■.■.■..■■.■■.■■. ■■■■■■.■ .■ 1111111111111 11 111■ 11111.:6:1■ ■1111 ■■..■■.■■ ■ ■■.■■.■■.■■. ■1 ■1 ■ ■ ■ ■ ■■ 1111 ■N ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ =R ,� ■■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■■ ■■■■■ ■■■■■■■■.■_.■.■■.■■■■■■.■■.■.■■ !I .■■■■■■■ ■■■■ ■■ ■■ ■ ■■■■■ ■■ ■■■ ■ ■ ■■■ ■ ■ ■■■■ ■■... ■■ ■■. ■■ ■ ■■.■ ■ ■ ■■■ ■■ ■ ■ ■■ ■■■ ■■ ■ ■. ■■■ ■■ ■ ■ ■ ■ ■■. 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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 tha 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. Owner's Name and Address_ /0 Registered Architect and /or En ineer _ ___________ _ _- •- _ - -_ -- --- _.___ -• Employing Plumber's Name C.,2ZIO 44E1 c "fl L No.- _ Location and Legal Description Lot__._ __ ..... ___________ — • —_ —.__ Block_._ . Subdivision_._ _______ ............ . . --. - -. Street and Number where work is to be performed —No t -i 45 ' Street._.- /_� t . State w o r k to be performed and purpose of building (By F l o o r s ) _ New Building Remodeling_ Size Septic Tank Feet of Drain Tile Nature of Water Supply: City—W STATE OF FLORIDA, I COUNTY OF DADE. MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT Amount of Permit $ ,— ---- ,--- - - - - -- _ _---- -_ -._/ . Addition. ._--- -_ -__ . -Type of Tank _.____ . � r / e Capacity Gals.._ ___- __Dist. Feet of Tank or Drain Field from Well. U. . Size Size of Soakage Pit . . (Signed) (Signed) Z kreet Repairs_ . •. _ -_ No. of Stories _ .. .._ . . 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 Las 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 o the work such public notice or no ^ices as are required by the Act. The undersigned agrees to employ only such sub- contractors, on : to be perform . under this per nit, as are licensed by Miami Shores Village. aster Plumber. Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personal! . 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 .acts therein by him stated are true. My Commission Expires - -- - Fl - - _ Y Exp' Notary Publi c, -- St - 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 worinnanship. CLOSETS BATH TUBS SHOWERS) LAVA- TORIES SINKS SLOP SINKS LAUNDRY TUBS URINALS-" : 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 Date ---- - Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the bulking 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 tha 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. Owner's Name and Address_ /0 Registered Architect and /or En ineer _ ___________ _ _- •- _ - -_ -- --- _.___ -• Employing Plumber's Name C.,2ZIO 44E1 c "fl L No.- _ Location and Legal Description Lot__._ __ ..... ___________ — • —_ —.__ Block_._ . Subdivision_._ _______ ............ . . --. - -. Street and Number where work is to be performed —No t -i 45 ' Street._.- /_� t . State w o r k to be performed and purpose of building (By F l o o r s ) _ New Building Remodeling_ Size Septic Tank Feet of Drain Tile Nature of Water Supply: City—W STATE OF FLORIDA, I COUNTY OF DADE. MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT Amount of Permit $ ,— ---- ,--- - - - - -- _ _---- -_ -._/ . Addition. ._--- -_ -__ . -Type of Tank _.____ . � r / e Capacity Gals.._ ___- __Dist. Feet of Tank or Drain Field from Well. U. . Size Size of Soakage Pit . . (Signed) (Signed) Z kreet Repairs_ . •. _ -_ No. of Stories _ .. .._ . . 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 Las 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 o the work such public notice or no ^ices as are required by the Act. The undersigned agrees to employ only such sub- contractors, on : to be perform . under this per nit, as are licensed by Miami Shores Village. aster Plumber. Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personal! . 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 .acts therein by him stated are true. My Commission Expires - -- - Fl - - _ Y Exp' Notary Publi c, -- St - 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 worinnanship. BUILDING ELECTRICAL 'D • PLUMBING p PERMIT N. 10406 ROOF NG .a Owner of .-7 'i k, Building , =ar1 . a I ,+'''t' . Architect I I II BI Contractor ,,, '�+ • or Builder `F Legal Description Address of Building MIAMI SHORES VILLAGE, FLORIDA Work to be performed under this Permit Date Subdi- vision Sq Ft Value of II Amount of 0-2 Project $ I I Permit $ Contractor's 1 License No. This permit is granted to the contractor or builder named above to construct the building or to install the equipment or device described in the applica- tion herefor in strict compliance with all ordinances pertaining thereto and with the understanding that the work will be perforrtred 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 pla or drawings or in the statements or specifications and that he assumes respon- sibility for work done by his agents, servants o . plo e =>rr Signed t:. ' � - . �.r. (INSPECTOR) BY 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 permit I assume responsibility for all work done by either, myself, my agent, servant or employee. t e CONTRA9tOR or UILDER BY AUTHORITY BUILDING ❑ ELECTRICAL ❑ PLUMBING ❑ ROOFING ❑ c.Pt - ❑ s < < Own of Building -Atr•J .2. Architect Contractor or Builder Legal Description Address of Building J' as• r::.' MIAMI SHORES VILLAGE. FLORIDA DATE " e 195 PERMIT N° 2948 Contractor's License No. 7 to r r e' 410 Lot Bl. Work to be performed under this Permit pc, to 7 At La — 2 " � aa ►n.►C c ... 5 5 Subdi- vision Value of Amount of i=,�t S Project $ +I P ermit $ 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. i! Signed. C_J � "I, BY 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 work done by either, myself, my agent, servant or employee. CONTRACTOR OR BUILDER BY AUTHORITY e .1- Permit No Application is hereby mode for the approval of the detailed statement of the plans and specifications herewith submitted for the building or other structure herein describe . 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 /f-- Registered Architect and /or Engineer-- - - - - -- _ _____- ___ -- _-------_- -•-------------------- •----------- _ - -____ i Q C Employing Plumber's Name -_____ ___ _ 4t% 8.1/-54 1/ e 4 ►'li_�d!aJoo.___. - - -- -- - - -• -- — Street. - Location and Legal Description Lot 2 Z-0 7) • Block ( 0a Subdivision 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 No. of Stories. Septic Tank--- $ - -- 7 Feet of Drain Tile_ _____ / G Nature of Water Supply: City —Well. Amount of Permit $ 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 con- plied with the provisions thereof, and will require similar compliance from all contractor sub - contract. . 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 f the wo uch public notice or notices as are required by die Act. The undersigned agrees to employ only such sub - contractors on B ork to perfo d • e this permit, as are licensed by Miami Shores Village. STATE OF FLORIDA, COUNTY OF DADE. Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeared to me well lmown, 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.' MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT , t /O? t Virn'i Date_____ No — -- - — - - Street Type of Tank_ _ 5.1 Capacity Gals __-__Dist. Feet of Tank or Drain Field from Well Size of Soakage Pit ( Signed) (Signed) My Commission Expires Notary Public, State of Florida NO • : A re- inspection fee of $1.00 will be made when such re- inspection is made •necessary by improper notice for inspection, or faulty and /c: workmanship. CLOSETS BATH TU86 SHOWERS LAVA- TORIES SINKS SLOP SINKS LAUNDRY TUBS URINALS CATCH BASIN FLOOR DRAIN DRINKING FOUNT' N6 TOTAL FIXTURES CONTR. LIST CHECK —^ SEPTIC TANK SEWER CONN. DRAIN FIELD SOAKAGE P IT GREASE TRAP SOLAR HEATER DEEP WELL SPRKLR. SYSTEM SWIM'G POOL Corms. LIST i CHECK .1- Permit No Application is hereby mode for the approval of the detailed statement of the plans and specifications herewith submitted for the building or other structure herein describe . 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 /f-- Registered Architect and /or Engineer-- - - - - -- _ _____- ___ -- _-------_- -•-------------------- •----------- _ - -____ i Q C Employing Plumber's Name -_____ ___ _ 4t% 8.1/-54 1/ e 4 ►'li_�d!aJoo.___. - - -- -- - - -• -- — Street. - Location and Legal Description Lot 2 Z-0 7) • Block ( 0a Subdivision 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 No. of Stories. Septic Tank--- $ - -- 7 Feet of Drain Tile_ _____ / G Nature of Water Supply: City —Well. Amount of Permit $ 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 con- plied with the provisions thereof, and will require similar compliance from all contractor sub - contract. . 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 f the wo uch public notice or notices as are required by die Act. The undersigned agrees to employ only such sub - contractors on B ork to perfo d • e this permit, as are licensed by Miami Shores Village. STATE OF FLORIDA, COUNTY OF DADE. Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeared to me well lmown, 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.' MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT , t /O? t Virn'i Date_____ No — -- - — - - Street Type of Tank_ _ 5.1 Capacity Gals __-__Dist. Feet of Tank or Drain Field from Well Size of Soakage Pit ( Signed) (Signed) My Commission Expires Notary Public, State of Florida NO • : A re- inspection fee of $1.00 will be made when such re- inspection is made •necessary by improper notice for inspection, or faulty and /c: workmanship.