118 NE 102 St (14)3863
MIAMI SHORES VILLAGg
BUILDING DEPARTMENT
305- 795 -2204
Building Inspection Request
Date fri J os
Type Insp'n"/ �At GTP't�1f+C
Permit No. — ZZ
Name-- t -oeA-H- 2c &J IVSoN
Address 1 1 g INIkA4 102
Company 1.1.S d 1-Le I= "1"1 LTA,. +G
I305) - 762 — s533
Phone #
Inspection Date
Approved
Correction
Re- Insp'n Fee ❑
3(161 4
, MIAMI SHORES VILLAGE 3
BUILDING DEPARTMENT 14
305- 795 -2204 14
Building Inspection Request
Date 612q(O5
Type Insp'n / Fh
Permit No. 1 L 7—COS .217
Name 11 YS_ qth/CS0
Address 117 VW 1 UZ T
Company amshingt TG '"`)4(. CO.
Phone # 78 6 Z‘Z° / 5 /'
Inspection Date $ /
Approved
Correction ❑
Re- Insp'n Fee ❑
Plumbing Permit
Miami Shores Village
10050 NE 2nd Avenue
Phone: 305 -795 -2204 Permit Number: PL2005 -227
Printed: 7/29/2005
Applicant: DEBORAH ELIZABETH ROBINSON
Owner: ROBINSON DEBORAH ELIZABETH
JOB ADDRESS: 118 NW 102 ST
Contractor SUNSHINE SEPTIC TANK CO Contractor's Address: 2865 NW 167 TERR
Local Phone: 305 - 693 -7613
Parcel # 1131010220120
Legal Description: GOLD CREST A SUB PB 21 - 56 LOT 4 AND
Fees:
FEE2005 -10078
FEE2005 -10079
FEE2005 -10080
FEE2005 -10081
FEE2005 -10082
FEE2005 -10083
Description
Building Fee
CCF
Training and Education Fee
Technology Fee
Scanning Fee
Builders Bond
Total Fees:
Amount
$350.00
$2.40
$0.80
$8.75
$3.00
$300.00
$664.95
Total Fees: $664.95
Total Receipts: $0.00
Permit Status: APPROVED Permit Expiration: 1/17/2006 Construction Value: $4,000.00
Work: REPLACING THE SEPTIC TANK AND DRAINFIELD
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 accepting this permit I assume responisibility for all work
done by either myself, my agent, servants or employes.
Signed: (Contractor or Builder)
BY:
Page 1 of 1
BLK 2 W1/2 OF LOT 5 LOT
`JUL 2 9 PAID
BUILDING - eEIV�
PERMIT APPLICATION
FBC 2001 ' JUL 'ii1J5
Permit Type (circle): Building Ele
City I
City Miami Shores Village
Is Building Historically Designated YES
Contractor's Address ?- - 4 J U pJ ;.,i 35 . dk
City State
Qualifier ti,w
$ Value of Work For this Permit
Submittal Fee $
Notary $
Scanning $ 3.00.
Code Enforcement $
(Continued on opposite side)
Radon $
Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
}0.0100r e . /2,6644441one #
Owner's Name (Fee Simple Titleholder)
Owner's Address / 1 ( g N4- IA a
State � Zip 3 3 IS
Tenant/Lessee Name Phone #
Job Address (where the work is being done) 1 1 g N , 1 031. 5
Contractor's Company Name je+t.c...vt, ,�; Phone # i s 4 — 7¢ 13
State Certificate or Registration No. 5 R,t) f l 06 ( 7 Ly Certificate of Competency No,-s C Ci6e) 53
Architect/Engineer's Name (if applicable) Phone #
it
Total Fee Now Due $• CIS
County Miami-D e
NO
Zoning
Structural Plan Review. $
Permit No. P--QS
aster Permit No.
Zip
Zip 33 /
Square Footage Of Work:
* * * * * * * * * * * * * * * * * * * * * * * * * * ** F ees * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
Permit Fee $ ±` Al 4- ! 't .55 j .7) -
Training/Education Fee $ C= . ENO
Mechanical Roofing
3a i,5
Type of Work: EAddition ['Alteration New ❑ Repair /Replace ❑ Demolition
Describe Work: p1 «, n
��x
CCF $ 2 - 40 CO /CC
Technology Fee $ S- 75
Bond $ 3 c7
KX1f33
Bonding Company's Name (if applicable)
Bonding Company's Address
City State Zip
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address
City State Zip
Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has
commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulating
construction in this jurisdiction. 1 understand that a separate permit must be secured for ELECTRICAL WORK, PLUMBING, SIGNS.
WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and AIR CONDITIONERS, ETC
OWNER'S AFFIDAVIT: 1 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.
"WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT 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."
Notice to Applicant: As a condition to the issuance of a building permit with an estimated value exceeding $2500, the applicant must
promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person
whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site
for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the
inspection will not be approved and a reinsp ro ee will be charged.
Signature
* * * * * ** **
* * * * * * * * * * * * * **
Chc 05/13/03
nown to me or who has produced
APPLICATION APPROVED BY: 14 .
•
Signature
pires:
Sign:
Print:
My Commission Expires:
** 1 * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
**** ***************/* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
Owner or Agent Contractor
The foregoing instrument was acknowledged beeforee me this The foregoing instrument was acknowledged before me this 1 r
day of , 20 by lday of , 20 c_ by It. -. ?Is
ho.ls Dersonall who is personally known to me or who has produced F I - -<,
As identification and who did take an oath. ,,t as identification and who did take an oath.
NOTARY 'UB C: NOTARY PUBLIC:
Sign:
Print:
My Co
•
4,4/"%fee, ALEXANDER LUIS SAFI
M Y COMMISSION *DD444363
* * � * * * * 4 E8(8,18FIS* Adak t5 * * *
(407) 398-0153 wlo id* Nobly Swam corn
Zoning
* * * * * * * * * * **
Plans Examiner
Engineer
ADDENDUM TO BUILDING PERMIT APPLICATION
(AIIhPPLICATION FOR BUILDING PERMIT MUST ACCOMPANY THIS ADDENDUM. IF A MASTER PERMIT HAS B.
OBTAINED, THE OWNER'S NOTARIZED SIGNATURE NEED NOT BE PRESENT ON SUBSEQUENT APPLICATIONS.)
PLUMBING
ELECTRICAL
MECHANICAL
ITEM
BATH TUB
UNIT
FEE
ITEM
SWITCH OUTLETS
UNIT
FEE
ITEM
SPACE HEATERS
UNIT
FEE
BIDET
LIGHT OUTLETS
CENTRAL HEATING
RECEPTACLES
A/C (WIND)
DISHWASHER
DISPOSAL
SERVICE TEMPORARY
A/C (CENTRAL)
DRINKING FOUNTAIN
SERVICE SIZE IN AAPS
DUCT WORK
FLOOR DRAIN
SERVICE REPAIR/METER CHANGE
_
REFRIGERATION
GREASE TRAP
APPLIANCE OUTLETS
PROCESS AND PRESS PIPING
INTERCEPTOR
RANGE TOP
UNDERGROUND TANKS
LAVATORY
OVEN
ABOVE GROUND TANKS
LAUNDRY TRAY
WATER HEATER
U.F. PRESSURE VESSELS
CLOTHES WASHER
MOTORS 0- 1 HP
STEAM BOILERS
SHOWER
MOTORS OVER 1- 3 If
HOT WATER BOILERS
SINK, POT /3 COMP.
MOTORS OVER 3- 5 HP
MECHANICAL VENTILATION
SINK, RESIDENCE
MOTORS OVER 5- 8 HP
TRANSPORTING ASSEMBLIES
SINK, SLOP
MOTORS OVER 8- 10 HP
ELEVATORS/ESCALATORS
TEMPORARY WATER CLOSET
MOTORS OVER 10- 25 HP
FIRE SPRINKLER SYSTEMS
URINAL
MOTORS OVER 25-100 HP
COOLING TOWERS
WATER CLOSET
MOTORS OVER 100 HP
VIOLATION
INDIRECT WASTES -
A/C WINDOW
REINSPECTION
WATER SUPPLY TO:
AIR CONDITIONERS
A/C UNIT
STRIP HEATER
FIRE SPRINKLER
GENERATORS TRANSFORMERS
HEATER -NEW INST.
GENERATORS TRANSFORMERS
HEATER - REPLACE
GENERATORS TRANSFORMERS
LAWN SPRINKLER -WELL
SPECIAL PURPOSE
SWIMMING POOL
OUTLETS COMMERCIAL
WATER SERVICE
SIGN TUBES
SEWER CONNECTIONS
SIGN TRANSFORMERS
UTILITY -SEWER
SIGN TIME CLOCK
UTILITY -WATER
FIXTURES
SEPTIC TANK
C /
V
ANTENNA
RELAY
TELEVISION OUTLETS
DRAINFIELD, 4' TILE/RES.
V/
VIOLATION
PUMP & ABANDON SEPTIC TANK
REINSPECTION
SOAKAGE PIT CU. FT.
CATCH BASIN
DISCHARGE WELL
DOMESTIC WELL
AREA DRAIN
.
ROOF INLET
SOLAR WATER HEATER
•
FIRE STANDPIPE
POOL PIPING
LAWN SPRINKLER SYSTEM
GAS RANGE
METER SET (GAS)
GAS PIPING
ADDENDUM TO BUILDING PERMIT APPLICATION
(AIIhPPLICATION FOR BUILDING PERMIT MUST ACCOMPANY THIS ADDENDUM. IF A MASTER PERMIT HAS B.
OBTAINED, THE OWNER'S NOTARIZED SIGNATURE NEED NOT BE PRESENT ON SUBSEQUENT APPLICATIONS.)
PLUMBING
ELECTRICAL
MECHANICAL
STATE OF FLORIDA
DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM
CONSTRUCTION PERMIT
CONSTRUCTION PERMIT FORA e,
('. ] New System [ N ] Existing System [ t ] Holding Tank [ti] Innovative
q01 Repair (1 ] Abandonment [ N ] Temporary [_ 1
APPLICANT: l Q60 rcd j E• I?a b H
PROPERTY ADDRESS: IL g A) ( w ` i O Z if l 2 h') $ 1‹.,dY' P (,3 t ---ti
LOT: `f' BLOCK: z
SYSTEM DESIGN AND SPECIFICATIONS
SPECIFICATIONS BY:
APPROVED BY:
DATE ISSUED:
412216
C -3Pk?A
SUBDIVISION:
G 0 lc4 Cores+ .
[SECTION, TOWNSHIP, RANGE, PARCEL NUMBER]
PROPERTY ID #: if - 3 1' Q I d Z Z ' G [OR TAX ID NUMBER]
SYSTEM MUST BE CONSTRUCTED IN ACCORDANCE WITH SPECIFICATIONS AND STANDARDS OF SECTION 381.0065,
F.S., AND CHAPTER 64E -6, F.A.C. DEPARTMENT APPROVAL OF SYSTEM DOES NOT GUARANTEE SAFTISFACTOR!
PERFORMANCE FOR ANY SPECIFIC PERIOD OF TIME. ANY CHANGE IN MATERIAL FACTS, WHICH SERVED AS 2
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. ISSUANCE OF THIS PERMIT
DOES NOT EXEMPT THE APPLICANT FROM COMPLIANCE WITH OTHER FEDERAL, STATE, OR LOCAL PERMITTING
REQUIRED FOR DEVELOPMENT OF THIS PROPERTY.
T [q Q Q ] GALLONS / GPD SEPTIC TANK /AEROBIC UNIT CAPACITY MULTI- CHAMBERSR/IN- SERIES [
A [ -- ] GALLONS / GPD CAPACITY MULTI- CHAMBERED /IN- SERIES [ ]
N [ ] GALLONS GREASE INTERCEPTOR CAPACITY [MAXIMUM CAPACITY SINGLE TANK: 1250 GALLONS]
X [ ] GALLONS DOSING TANK CAPACITY [ ]GALLONS 40 [ ] DOSES PER 24 HRS # PUMPS [ ]
D [ Y 2 X ] SQUARE FEET PRIMARY DRAINFIELD SYSTEM
R ( ] SQUARE FEE SYSTEM
A TYPE SYSTEM: [ ] STANARD [ /] FILLED [ ] MOUND [ ] _
I CONFIGURATION: [ ] TRENCH N1 BED [ ]
N \ E E �^ -�
F LOCATION OF BENCHMARK: / 2 ,70 ik ` ci ` v ` b • ` E. ( /
e' '
I ELEVATION OF PROPOSED SYSTEM SITE [ ] (INCHES,/FT],[ABOVE /BELOW] BENCHMARK /REFERENCE POINR
E BOTTOM OF DRAINFIELD TO BE ( ,5O] [INCHES //FT] [ABOVE/BELOW] BENCHMARK /RE FERENCE POINT'
7
L
D FILL REQUIRED: [N I) d.L] INCHES EXCAVATION REQUIRED: [ 1 ] INCHES
� � . ;r
O Py%•=1.c:/-g ( f,I C p �Cl. ,t , I3 TALL.C7 . i- , -Yi: :i Hz) , -,,f
H �--1) A L C j A IJL-' 64,101 AC,/ = : _' - '&, _7.0
R
AT
PERMIT NO.
DATE PAID:
FEE PAID: (Q Q
RECEIPT #: ` � U SQ1.1 /S061
EXPIRATION
DH 4016, 12/99 (Page 1) (Previous Editions May Be Used) Page 1 of 3
pt Hsaith Department
Aro;icant
'aJe . Oontractor
TITLE: �-� CS //2/05 CHD
DATE: , 61 Z Z 10 `f'
4 tPJ CAJITs
AGENT:
RIDA -
TREATMENT AND DIPOBAL SYSTEM
INSPECTION AND FINAL APPROVAL
am
td, Jo , --
LOT :11+ S BLOCK: .3 SUBDIVISION = t
PROPERTY ADDRESS:
CHECKED .[X] ITEMS ARE NOT IN COMPLIANCE WI
TANK INSTALLATION
[01] TANK SIZE [ yi [
[02] TANK MATERIAL ' � G
[03] OUTLET DEVICE
1
1
1
]
7
CONSTRUCTIO
FINAL SYS
(04] MULTI - CHAMBERED [CID/ N ] [
[OS] OUTLET FILTER z-',"4.4.-2 C.
[06] LEGEND sYr min — l/ . (
[07] WATERTIGHT -,`_ a"_ '��' % [
[08] �P � J [
[09] DEPTH TO LID/ IJ (
DRAINFIELD INSTALLATION
[10] AREA [111.2.42;4[2].c 7 6BQFT •
[11] DISTRIBUTION BOX READER ,<
(12'] ;;
[13] :::INL1]IRATION Ci
[14] DRAINLINE SLOPE
[ 15) DEPTH OF COVER
[16] ELEVATION [ADO
[17] SYSTEM LOCATION
[18] DOSING PUMPS ff y 4
[19] AGGREGATE SIZE
[20] AGGREGATE EXCES8IV*FINES
[21] AGGREGATE DEPTH 15- J.
FILL / EXCAVATION MATERIAL
[22] FILL AMOUNT
[23) PILL TEXTURE �'-
[24] EXCAVATION DEPTH
[25] AREA REPLACED
[26] REPLACEMENT MATERIAL
6
EXPLANNATION OF VIOLATIONS / REMARKS:
[APPROVED ISAPPROVED]
[APPRO /DISAPPROVED] : ;�,�,,,� ci / C- 21.-,- k
DE 4016, 10/97 vious Editions Nay Bs Used)
TN STATUTE OR RULI *iv MUST BE
PL 2473
SETBACKS
. (27] SURFACE WATER /V/4 FT
[28] DITCHES FT
[29] PRIVATE WELLS FT
[30] PUBLIC WELLS M i„,-; FT
[31) IRRIGATION WELLS
(32] POTABLE WATER LINES d'- r - ) FT
[331 BUILDING FOUNDATION FT
[34) PROPERTY LINES /D FT
(35] ,OTHER FT
FILLED / MOUND SYSTEM
[ ] (36) DRAINFIELD COVER
[ ) [37] SHO
1-1– P
#
[ ]
[ 1
hiPUCIT No. (75 / S
DATE PAID: C✓ _ /
FEE PAID:
RECEIPT 1:
PROPERTY ID #: 7/"'_ S /(J 0 `° ),2 a C:
UI.I�SitB
] [39)` iIZATIOu .
CORRECTED.
===te
ADDITIONAL INFORMATION
[40] UNOBSTRUCTED AREA
[ STATER RUNOFF
[42] ALARMS
[43] MAINTENANCE AGREEMENT
[44] BUILDING AREA
[45] LOCATION CONFORMS WITH SITE PLAN
[46] FINAL SITE NS
[ CONTRACTOR
[48) OTHER
ABANDONMENT
[49] TANK PUMPED /`
[50) TANK CRUSHED & FILLED S
a
[ ].
[ l
[ ] '�
[ ] •
1' 1) C CND DATE: - V_ Q —
J i J C CND DATE: - 2 t % • –
Page 2 of 3
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
Permit No /fIr Date. .._ . F 76 M..._._
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, Flosida,
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 whether herein specified or not. A copy of approved plans and specifications must be kept at
building during f work
progress of
Owners Name and Address L
Registered Architect and /or Engineer {� _
Employlng Plumber's Name l z( '� . 1 �!�C -�c << _!z , No .,..� � .
Block Subdivision___.
f
Street and Number where work is to be performed —No. / dX (, N/ /0" Si-- Street.
State work to be performed and purpose of building (By Fkwrs)__._— _ -- �„,.--,,, /see -e..,_
New Building ..__._----- •-- ..... - - - -.. Remodeling___ _ . __ Addition..._ __..__ Repairs No. of Stories ....
Location and Legal Description Lot
Size Septic Taal
Feet of Drain Tile '' - 7
Nature of Water Supply: City —Well.
Amount of Permit 8 0-17)
Type �f Tanlr
That. Feet of Tank or Drain Field from Well
Size of Soakage Pit
(Sim)
o Street_ ._ •
(Signed)
Plumbing l lf�. .
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 5968, Compiled General Laws of Florida Pennanent Supplement, and hug com-
plied with the provisions thereof, and will require similar compliance from all contractors or sub - contractor 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 die 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.
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 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 he did sign the same, and that all facts
therein by him stated are true.
My Commission Expires Notary Public', State of Floslda
NOTE: A re inspection fee of 81.00 will be made wham Nei ,rispaotla* Y saade.neosasary by bups'oper notice for inspection. or faulty
materials and /err wrorl®aoshlp.
CLOSETS
BATH
TUG[
a NOW[Ra
LAVA•
TORIES
aINKt
SLOP
SINK[
LAUNDRY
Tuns
URINALS
CATCH
BASIN
FLOOR
DRAIN
DRINKING
FOUNT' N•
TOTAL
FIXTURES
CONTR.
LIST
CHECK
-
-
-
SEPTIC SEWER
TANK CONN.
DRAIN
FIELD
SOAKAGE
PIT
GREASE
TRAP
SOLAR
H[AT[R
DEEP
W[LL
5
SYSTEM
SWIM'G
POOL
.
'
Carr*.
LIST
,
CHECK
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
Permit No /fIr Date. .._ . F 76 M..._._
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, Flosida,
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 whether herein specified or not. A copy of approved plans and specifications must be kept at
building during f work
progress of
Owners Name and Address L
Registered Architect and /or Engineer {� _
Employlng Plumber's Name l z( '� . 1 �!�C -�c << _!z , No .,..� � .
Block Subdivision___.
f
Street and Number where work is to be performed —No. / dX (, N/ /0" Si-- Street.
State work to be performed and purpose of building (By Fkwrs)__._— _ -- �„,.--,,, /see -e..,_
New Building ..__._----- •-- ..... - - - -.. Remodeling___ _ . __ Addition..._ __..__ Repairs No. of Stories ....
Location and Legal Description Lot
Size Septic Taal
Feet of Drain Tile '' - 7
Nature of Water Supply: City —Well.
Amount of Permit 8 0-17)
Type �f Tanlr
That. Feet of Tank or Drain Field from Well
Size of Soakage Pit
(Sim)
o Street_ ._ •
(Signed)
Plumbing l lf�. .
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 5968, Compiled General Laws of Florida Pennanent Supplement, and hug com-
plied with the provisions thereof, and will require similar compliance from all contractors or sub - contractor 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 die 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.
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 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 he did sign the same, and that all facts
therein by him stated are true.
My Commission Expires Notary Public', State of Floslda
NOTE: A re inspection fee of 81.00 will be made wham Nei ,rispaotla* Y saade.neosasary by bups'oper notice for inspection. or faulty
materials and /err wrorl®aoshlp.
BUILDING
ELECTRICAL
PLUMBING
ROOFING
Owner of
Building
Architect
Contractor
or Builder
Legal
Description.
Address of
Building
r
Lot
In consideration of the issuance to me of this permi
pertaining thereto and in strict confo .ity with the lans, d
In accepting this permit I assume res r • nsibil' f • all work
MIAMI SHORES VILLAGE, FLORIDA
n PERMIT IT? 11994
El '' Work to be performed under this Permit
LLisTt iz
HJ
Bi
Subdi-
vision
Value of
Project $
This permit is granted to the contractor or builder named above to onstruct the bu
herefor in strict compliance with all ordinances pertaining thereto and with the and
drawings, statements or specifications that may have been submitted to and approv
time if the work is not done in compliance with such ordinances or if the p1. s are
granted is the understanding that the contractor or builder named above as mes
pertaining to the work covered hereby whether shown on the plans or dra ings o
done by his agents, servants or employees.
DAT
Contractor;
License No
1 / ♦ C r
lac
195j_
Amt. of
Permit $
ding or to install the equipment or device described in the applica 'on
ing that the work will be performed in compliance with any plans,
e proper municipal authorities. This Permit may be revoked at any
without authorization. A further condition upon which this permit is
onsibility for a thorough knowledge of the ordina , es and regulations
statements or specifications and that he assume r-. f onsibility for work
INSPECTOR
to rform the work covered hereunder in comp ith all ordin
ements or specifications submitted to the proper authorities of
y either, myself, ant, servant or employee.
ces and regulations
iami Shores Village.
Permit No. V.Z - _'_ __-_ = ` l Date
Application is hereby made VI- 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 - L- - - -- No r Street
Registered Architect and /or E , winee f r —__ _____— _____________ _ ________
..
Employing Plumber's Name .. I No Street
Location and Legal Description Lot
Size Septic Tank
Feet of Drain Tile
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
Block
Street and Number where work is to be performed —No Street
State work to be performed and purpose of building (By Floors)
Remodeling Addition Repairs __ No. of Stories
New Building B airs
p
Type of Tank Capacity Gals.
Dist. Feet of Tank or Drain Field from Well
Size of Soakage Pit
( Signed) _
The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations as an employer of labor
under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Permanent Supplement, and has corn-
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 ygrees to employ only such sub - contractors, on work to be performed under this permit, as are
licensed by Miami Shores Village.
d--O
(Signed)_
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.
Subdivision
My Commission Expires Notary Public, State of Florida
Plumbing Inspector.
Master Plumber.
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
) �
76
7 4 ( ----_
SEPTIC
TANK
SEWER
CONN.
DRAIN
FIELD
SOAKAGE
PIT
GREASE
TRAP
SOLAR
HEATER
SLOP'
WELL
SPRKLR.
SYSTEM
SWIM'G
POOL
CONTR.
LIST
CHECK
Permit No. V.Z - _'_ __-_ = ` l Date
Application is hereby made VI- 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 - L- - - -- No r Street
Registered Architect and /or E , winee f r —__ _____— _____________ _ ________
..
Employing Plumber's Name .. I No Street
Location and Legal Description Lot
Size Septic Tank
Feet of Drain Tile
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
Block
Street and Number where work is to be performed —No Street
State work to be performed and purpose of building (By Floors)
Remodeling Addition Repairs __ No. of Stories
New Building B airs
p
Type of Tank Capacity Gals.
Dist. Feet of Tank or Drain Field from Well
Size of Soakage Pit
( Signed) _
The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations as an employer of labor
under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Permanent Supplement, and has corn-
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 ygrees to employ only such sub - contractors, on work to be performed under this permit, as are
licensed by Miami Shores Village.
d--O
(Signed)_
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.
Subdivision
My Commission Expires Notary Public, State of Florida
Plumbing Inspector.
Master Plumber.
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
Architect
MIAMI SHORES VILLAGE, FLORIDA
PERMIT N° 4047
Work to be performed under this Permit . , —
i
Owner of �
Building 1. 1 » e.,'±
Contractor
or Builder
Legal Lot
Description _
Bl.
Subdi-
vision
Address of
Building
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 pertOning to the work covered hereby whether shown on the plans or drawings or in the statements specifications and that he assumes respon-
sibility for work done by his agents, servants or employees.
Value of
Project
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 accepting this permit I assume responsibility for all work done by either myself, my agent, servant or employee.
„w
CONTRACTOR OR 1}UILDER
BY
1
DATE
Contractor's
License No.
Amt. of
Permit
qtr% 1944
By 24,
AUTHORITY