PLUMBINGApplicant
Inspected by
STATE OF FLORIDA
DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES
ONSITE SEW GE DISPOSAL YSTEM CONSTRUCTION AND INSTALLATION PERMIT
Permit Number
PA
L II - SYST NSTALLAT AND FIN INSTA APPROVAL
,_..
Installer / N o ri G Ki b C
Proper tank legend: Yes No 4/A
Tanks watertight: Yes i✓No
Proper gravel size: Yes _.7 No
Tank size
HRS —H Form 4016, Jan 86 (Replaces Feb 85 edition which may be used)
(Stock Number: 5744-002- 4016 -4)
Tank Manufacturer n//A
Tank materi- __C / -r Tank level: Yes No G
t(
gallons gallons gallons
Average depth to drainpipe invert from finished grade: L It( inches
t( i
Average depth of drainfield gravel: I inches Minimum depth of gravel• 12-
Proper tank outlet device: Yes V No
Drainfield Trench
Length Width Length Width
feet feet feet feet Length feet x feet= ft
feet feet feet feet Proper No. drainline�rYes No
feet feet 4 feet feet Proper pipe separation: Yes No
Total = ft / Total = ft Distribution box level: Yes No A
Systems located as permitted: Yes _C No
Systems including plumbing stub -outs installed at proper elevation: Yes
Gravel is suitable quality: Yes ✓ No
PART III - FINAL INSTALLATION APPROVAL
N o
Absorption Bed
Length Zt feet x L _ feet - ft
Manhole or marker to grade: Yes
No J+ A
Maximum depth:7 Inches
Backfill or fill material as required: (Quality) Yes Z_ No (Quantity) Yes V No
Other findings /S l �- -' [mil. ' /2"
D F 6g,8 VWL
6
Date /r 8 - .
Date " 8 Approved by: � .� O e
NTY PUBL HEALTH UNIT
AN APPROVED INSTALLATION DOES NOT UARANT PERFORMANCE
Note: Completed copies of this form will be provided to the applicant, installer and the building department.
Page 2 of 2
BUILDING
ELECTRICAL
PLUMBING
ROOFING
Architect
Contractor
or Builder
Legal Lot
Description —
Address of
Building
MIAMI SHORES VILLAGE. FLORIDA
❑ DATF17 195
r P E R M I T N? _ 2465 Contractor's
License No.
0
❑ Work to be performed under this Permit
Owner of
Building �, • �. _. , - �� -.� . .}
CONTRACTOR OR BUILDER
Subdi-
vision
Value of
Project $
BY AUTHORITY
Amount of
Permit $
This permit is granted to the contractor or builder named above to construc 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 cr in the statements or specifications and that he assumes resp�nsibility for work
done by his agents, servants or employees. ,. •
Signed _ _ . ,..... ' ...a r : ... 's BY �i.�. - -- ! .; J .. 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 ac-
p , by either, myself, my gget!t` servant or employee. - .,,, _
t
v 41,
.. �• responsibility r" r r ..
ce ting thi permit assume resit � r � work done,
,," , . ,;
BUILDING
ELECTRICAL
PLUMBING
ROOFING ❑
km
Owner of.
Building
Architect
Contractor
or Builder
Legal
Description
Address of
Building
Lot
MIAMI SHORES VILLAGE. FLORIDA
PERMIT, N? _ 2640
CONTRACTOR OR BUILDER
Work to be performed under this Permit
B1
Value of
Project $
DATE 0
Contractor's
License No.
Amount of
Permit $
BY AUTHORITY
Subdi-
vision
195 '+Y
This permit is granted to the contractor or builder named above to construc 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.hor6ugh 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.
Signed A 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 as'tune responsibility for all work done by either, myself, my agent, servant or employee.
1 , , 7-7—
CHECK j '' /
Ta
26 4o
Permit No ............
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the building or other
structure herein described. This application is made in compliance and conformity with the Building Ordinance of Miami Shores Village, Florida,
and all provisions of the Laws of the State of Florida, all ordinances of Miami Shores Village and all rules and regulations of the Building Division
of Miami Shores Village shall be complied with, whether herein specified or not. A copy of approved plans and specifications must be kept at
building during progress of work.
Owner's Name and Address
Registered Architect and/or Engineer___________________— _
No. / 0 street
Employing Plumber's Name _
Location and Legal Description Lot Block
Street and Number where work is to be performed—No-________12.- Street
State work to be performed and purpose of building (By Floors)._ — --
New Building Remodeling. Addition Repairs
Size Septic Tank Type of Tank
Feet of Drain .......... ..... Feet of Tank or Drain Field from Well
Nature of Water Supply: City—Well. _ Size of Soakage Pit
Amount of Permit .
My Commission Expires
(signed)..
(Signed)._
Date 0
StreeL le/ er ..
Subdivision .
4/,
No. of Stories
Capacity Gals
.. _
Plumbing Inspector.
The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations as an employer of labor
under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Permanent Supplement, and has com
plied with the provisions thereof, and will require similar compliance from all contractors or sub-contractors employed by him in the work to be
performed under this permit; and will post or cause to be posted for inspection on the site of the work such public notice or notices as are
required by the Act. The undersigned agrees to employ only such sub-contractors, on work to be performed under this permit, as are
licensed by Miami Shores Village.
Master Plumber.
STATE OF FLORIDA,
ss.
COUNTY OF DADE.
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeared
to me well known, and who, being by me first duly sworn, upon oath deposes and says that he is the.
of the above described construction, that he has carefully read the foregoing application, and that he did sign the same, and that all facts
therein by him stated are true.
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.
CLOUTS T
BATH L
SHOWERS T
LAVA- S
SINKS S
SLOP L
LAUNDRY C
URINALS B
CATCH F
FLOOR D
DRINKING T
TOTAL
CONTR.
LIST
CHECK
SEPTIC S
SEWER D
DRAIN S
SOAKAGE G
GREASE SOLAR D
DEEP S
SPRKLR. S
SWING
.
LIST /
/. ? 'C .
. 90,, /7 e
e/ '
'' /
26 4o
Permit No ............
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the building or other
structure herein described. This application is made in compliance and conformity with the Building Ordinance of Miami Shores Village, Florida,
and all provisions of the Laws of the State of Florida, all ordinances of Miami Shores Village and all rules and regulations of the Building Division
of Miami Shores Village shall be complied with, whether herein specified or not. A copy of approved plans and specifications must be kept at
building during progress of work.
Owner's Name and Address
Registered Architect and/or Engineer___________________— _
No. / 0 street
Employing Plumber's Name _
Location and Legal Description Lot Block
Street and Number where work is to be performed—No-________12.- Street
State work to be performed and purpose of building (By Floors)._ — --
New Building Remodeling. Addition Repairs
Size Septic Tank Type of Tank
Feet of Drain .......... ..... Feet of Tank or Drain Field from Well
Nature of Water Supply: City—Well. _ Size of Soakage Pit
Amount of Permit .
My Commission Expires
(signed)..
(Signed)._
Date 0
StreeL le/ er ..
Subdivision .
4/,
No. of Stories
Capacity Gals
.. _
Plumbing Inspector.
The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations as an employer of labor
under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Permanent Supplement, and has com
plied with the provisions thereof, and will require similar compliance from all contractors or sub-contractors employed by him in the work to be
performed under this permit; and will post or cause to be posted for inspection on the site of the work such public notice or notices as are
required by the Act. The undersigned agrees to employ only such sub-contractors, on work to be performed under this permit, as are
licensed by Miami Shores Village.
Master Plumber.
STATE OF FLORIDA,
ss.
COUNTY OF DADE.
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeared
to me well known, and who, being by me first duly sworn, upon oath deposes and says that he is the.
of the above described construction, that he has carefully read the foregoing application, and that he did sign the same, and that all facts
therein by him stated are true.
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.
Permit No ° L 'ElQ �l .
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. _ _ __.y No ._._--- _---- ----- ---- --- __ -___ Street
Registered Architect and /or Engineer
Employing Plumber's Name__1�-
2
Location and Legal Description Lot___________________ _____ Block
'
Street and Number where work is to be performed —No f 'O )2 I �� st
State work to be performed and purpose of building (By Floors) _ —. __—
New Building — Remodeling _ Addition Repairs No. of Stories
Size Septic Tank_ — 7 — — - Type of Tank _ -- __ — -- --- --- __ - -
Feet of Drain Tile___• P'' ._ __ _ st. Feet of Tank or Drain Field from Well
Amount of Permit $
- Go
My Commission Expires
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
(Signed)_
Date 3., ../
Street.
Subdivision
__Capacity Gals.
Nature of Water Supply: City — Well._______ ____ Size of Soakage Pit
' Plumbing Inspector.
The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations as an employer of labor
under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Permanent Supplement, and has com-
plied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors employed by him in the work to be
performed under this permit; and will post or cause to be posted' for inspection on the site of the work such public notice or notices as are
required by the Act. The undersigned agrees to employ only such sub- contractors, on work to be perfo ed under this permit, are
licensed by Miami Shores Village. * , .o•�c i
-7��--
(Signed) / aster Plumber
STATE OF FLORIDA, t
COUNTY OF DADE.
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeared
to me well known, and who, being by me first duly sworn, upon oath deposes and says that he is the
of the above described construction, that he has carefully read the foregoing application, and that he did sign the same, and that all facts
therein by him stated are true.
Notary Public, State of Florida
NOTE: A re- inspection fee of $1.00 will be made when such re- inspection is made•necessary by improper notice for inspection, or faulty
materials and /or workmanship.
CLOSETS
BATH
TUBS
SHOWERS
O
LAVA
TORIES
SI NKS
SLOP
SINKS
LAUNDRY
TUBS
URINALS
CATCH
BASIN
FLOOR
DRAIN
DRINKING
FOUNT'NS
TOTAL
FIXTURES
CONTR.
LIST
CHECK
SEPTIC
TANK
SEWER
CONN.
DRAIN
FIELD
SOAKAGE
PIT
GREASE
TRAP
SOLAR
HEATER
DEEP
WELL
SPRKLR.
SYSTEM
SWIM•G
POOL
CONTR.
LIST
- --
CHECK
Permit No ° L 'ElQ �l .
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. _ _ __.y No ._._--- _---- ----- ---- --- __ -___ Street
Registered Architect and /or Engineer
Employing Plumber's Name__1�-
2
Location and Legal Description Lot___________________ _____ Block
'
Street and Number where work is to be performed —No f 'O )2 I �� st
State work to be performed and purpose of building (By Floors) _ —. __—
New Building — Remodeling _ Addition Repairs No. of Stories
Size Septic Tank_ — 7 — — - Type of Tank _ -- __ — -- --- --- __ - -
Feet of Drain Tile___• P'' ._ __ _ st. Feet of Tank or Drain Field from Well
Amount of Permit $
- Go
My Commission Expires
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
(Signed)_
Date 3., ../
Street.
Subdivision
__Capacity Gals.
Nature of Water Supply: City — Well._______ ____ Size of Soakage Pit
' Plumbing Inspector.
The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations as an employer of labor
under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Permanent Supplement, and has com-
plied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors employed by him in the work to be
performed under this permit; and will post or cause to be posted' for inspection on the site of the work such public notice or notices as are
required by the Act. The undersigned agrees to employ only such sub- contractors, on work to be perfo ed under this permit, are
licensed by Miami Shores Village. * , .o•�c i
-7��--
(Signed) / aster Plumber
STATE OF FLORIDA, t
COUNTY OF DADE.
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeared
to me well known, and who, being by me first duly sworn, upon oath deposes and says that he is the
of the above described construction, that he has carefully read the foregoing application, and that he did sign the same, and that all facts
therein by him stated are true.
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.
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Date 22 95 Job Address x /Z3 D F /02
Legal Description 2 n Historically Designated: Yes
l " `.
Owner/Lessee / Tenant Wcdt f -nAr- Master Permit # 9 7 2 A 1
Owner's Address 1 3 O iv / 0 2_ Phone S /6.3 0
C o n t r a c t i n g Co. l 0 L,&j D PL A / ey Address c o_ fi 5 c(.. / 07
Qualifier 0 5/11/p 0 /2-r - E - 0 A - -SS# () ? Phone X3 - Sr / (( )3r
,
State # F 0043 0 03 Municipal # 2o q5 u Competency # / � / Z 1 3 Ins. Co.
Architect/Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIPTION
To ter / L4
Square Ft. Estimated Cost (value)
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 LENpER
OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT.)
Application is hereby made to obtain a pennit 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.
My C
ture o own and/or Condo
4 /� o
01 . A
AL NOT we SEAI.
iii2nidoTiesident
STATE. OP FLORIDA
NO CC4i'9G66
MY COMMISSION EXP. AUG. 5,1999
Tax Folio
be"
Notary as . Contractor or Owner- Builder Date
My Commissi. expires: ti P� 1 . Poe RENE TUMA
c COMMISSION #1 CC 451645
(3. EXPIRES APR 9,1999
^
1:1 0F F\ ATLANTIC BONDING CO., INC.
BONDED THRU
FEES: PERMIT c/ . RADON C.C.F. ' 6 D NOTARY ---0 ..
APPROVED: TOTAL DUE
Zoning Building Electrical
Mechanical Plumbing Structural Engineer
Permit No. 2210_6 3
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
Size Septic Tank_ _Type of Tank____.
Foot o f D Til _100 sq L..Dlst Feet of Tank or Drain Field from Well._
Nature of Water Supply: City—Well. Size of Soakage Pit.
Amount of Permit $
My Commission Expires
(signed) s 3
(Signed)
12-1-87
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.
Hamilton on . NE 102 ST
Owner's Name and Address No st
Registered Architect and/or Engineer
North Dade SEPTIC 800 NW 111. ST
EzripIoying yiumbies mum
j 05 IS a /40 c° ""iiS
Location and Legal bctlpt1on Lot. °? Blor4 Subdi
1230 NE 102 ST
Street and Number where work is to be performed—No 123 Street
State work to be performed and purpose of building (By Floors
New Building Remodeling Addition.
............. ....
X X X
Repairs No. of Stories .. ...
. ......
Plumbing In vector.
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 Permanent Supplement, and buy com-
plied with the provisions thereof, and will require similar compliance from all contractors or sub-contractors employed by him in the wore to be
performed under this permit; and will post or cause to be posted' for inspection on the site of the work such public notice or notices as are
required by the Act. The undersigned agrees to employ only such sub-contractors, on wiz Peri er this 't, as are
licensed by Miami Shores Village.
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 be has carefully read the foregoing application, and that he did sign the same, and that all facts
therein by him stated are true.
Notary Public, State of Florida
NOTE: A re-inspection fee of $1.00 will be made whoa omb re-lospeedos is male weassrery by improper notice for boppection, or faulty
materials and/or workmanship.
CLOSETS
BATH
TUBS
SHOWERS
LAVA.
Tonic*
SIN"
SLOP
SINKS
LAUNDRY
Tune
URINALS
CATCH
BAsim
FLOOR
DRAIN
DRINKING
FOUNT'1411
TOTAL
Ft/TURES
CONTR.
LIST
CHICK
SEPTIC
TANK
SEWER
CONN.
DRAIN
FIELD
SOAKAGE
PIT
G
TRAP
SOLAR
HEATER
DRIP
WILL
II .
SYSTEM
SWI14•0
POOL
CONTR.
LIST
CHECK
Permit No. 2210_6 3
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
Size Septic Tank_ _Type of Tank____.
Foot o f D Til _100 sq L..Dlst Feet of Tank or Drain Field from Well._
Nature of Water Supply: City—Well. Size of Soakage Pit.
Amount of Permit $
My Commission Expires
(signed) s 3
(Signed)
12-1-87
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.
Hamilton on . NE 102 ST
Owner's Name and Address No st
Registered Architect and/or Engineer
North Dade SEPTIC 800 NW 111. ST
EzripIoying yiumbies mum
j 05 IS a /40 c° ""iiS
Location and Legal bctlpt1on Lot. °? Blor4 Subdi
1230 NE 102 ST
Street and Number where work is to be performed—No 123 Street
State work to be performed and purpose of building (By Floors
New Building Remodeling Addition.
............. ....
X X X
Repairs No. of Stories .. ...
. ......
Plumbing In vector.
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 Permanent Supplement, and buy com-
plied with the provisions thereof, and will require similar compliance from all contractors or sub-contractors employed by him in the wore to be
performed under this permit; and will post or cause to be posted' for inspection on the site of the work such public notice or notices as are
required by the Act. The undersigned agrees to employ only such sub-contractors, on wiz Peri er this 't, as are
licensed by Miami Shores Village.
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 be has carefully read the foregoing application, and that he did sign the same, and that all facts
therein by him stated are true.
Notary Public, State of Florida
NOTE: A re-inspection fee of $1.00 will be made whoa omb re-lospeedos is male weassrery by improper notice for boppection, or faulty
materials and/or workmanship.
Permit No 3")
Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the building or other
structure herein described. This application is made in compliance and conformity with the Building Ordinance of Miami Shores Village, Florida,
and all provisions of the Laws of the State of Florida, all ordinances of Miami Shores Village and all rules and regulations of the Building Division
of Miami Shores Village shall be complied with, whether herein specified or not. A copy of approved plans and specifications must be kept at
building during progress of wo
Owner's Name and Addres ... �C .- _- _2r_--_ __ - =.. No._ _ Street 1 E ® 01 ;---P'::
Registered Architect and /or Engineer
Employing Plumber's Name
Feet of Drain Tile._
Amount of Permit $
STATE OF FLORIDA, D
COUNTY OF DADE.
My Commission Expires
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
. APPLICATION FOR PLUMBING PERMIT
Location and Legal Description Lot______________ _______._ _ Block
Street and Number where work is to be performed —No
Sta work to be performed and purpose of building (By Floors)___
Size Septic Tank_--_._________ _ ....... _______________Type of Tank__
No._(
Date
Street _ 7
Subdivision. __
Street_ /7 4 —
Dist. Feet of Tank or Drain Field from Well
Notary Public, State of Florida
Remodeling Addition Repairs No. of Stories.
Capacity Gals
Nature of Water Supply:' City Well .______________ 0 — __ Size of Soakage Pit
( Signed )
Plumbing Inspector.
The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations as an employer of labor
under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Permanent Supplement, and has com-
plied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors employed by him in the work to be
performed under this permit; and will post or cause to be posted' for inspection on the site of the work such public notice or notices as are
required by the Act. The undersigned agrees to employ only such sub- contractors, on work to be performed under this permit, as are
licensed by Miami Shores Village. 6-0
�+
1 0 (Signed)._ -
Master Plumber.
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeared
to me well known, and who, being by me first duly sworn, upon oath deposes and says that he is the
of the above described construction, that he has carefully read the foregoing application, and that he did sign the same, and that all facts
therein by him stated are true.
NO re- inspection fee of $1.00 will be made when such re- inspection is made•necessary by improper notice for inspection, or faulty
ma and /or workmanship.
CLOSETS
BATH
TUBS
SHOWER.
/ -
` gD / �
LAVA-
TORIES
3
SINKS
J
SLOP
SINKS
LAUNDRY
TUBS
URINALS
CATCH
BASIN
FLOOR
DRAIN
DRINKING
FOUNT'N6
A/� ,
TOTAL
FIXTURES
CONTR.
LIST
/
CHECK
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TANK
SEWER
CONN.
DRAIN
FIELD
SOAKAGE
PIT
GREASE'
TRAP
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DEEP
WELL
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SYSTEM
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POOL
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LIST
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CHECK
00
—D
Permit No 3")
Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the building or other
structure herein described. This application is made in compliance and conformity with the Building Ordinance of Miami Shores Village, Florida,
and all provisions of the Laws of the State of Florida, all ordinances of Miami Shores Village and all rules and regulations of the Building Division
of Miami Shores Village shall be complied with, whether herein specified or not. A copy of approved plans and specifications must be kept at
building during progress of wo
Owner's Name and Addres ... �C .- _- _2r_--_ __ - =.. No._ _ Street 1 E ® 01 ;---P'::
Registered Architect and /or Engineer
Employing Plumber's Name
Feet of Drain Tile._
Amount of Permit $
STATE OF FLORIDA, D
COUNTY OF DADE.
My Commission Expires
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
. APPLICATION FOR PLUMBING PERMIT
Location and Legal Description Lot______________ _______._ _ Block
Street and Number where work is to be performed —No
Sta work to be performed and purpose of building (By Floors)___
Size Septic Tank_--_._________ _ ....... _______________Type of Tank__
No._(
Date
Street _ 7
Subdivision. __
Street_ /7 4 —
Dist. Feet of Tank or Drain Field from Well
Notary Public, State of Florida
Remodeling Addition Repairs No. of Stories.
Capacity Gals
Nature of Water Supply:' City Well .______________ 0 — __ Size of Soakage Pit
( Signed )
Plumbing Inspector.
The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations as an employer of labor
under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Permanent Supplement, and has com-
plied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors employed by him in the work to be
performed under this permit; and will post or cause to be posted' for inspection on the site of the work such public notice or notices as are
required by the Act. The undersigned agrees to employ only such sub- contractors, on work to be performed under this permit, as are
licensed by Miami Shores Village. 6-0
�+
1 0 (Signed)._ -
Master Plumber.
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeared
to me well known, and who, being by me first duly sworn, upon oath deposes and says that he is the
of the above described construction, that he has carefully read the foregoing application, and that he did sign the same, and that all facts
therein by him stated are true.
NO re- inspection fee of $1.00 will be made when such re- inspection is made•necessary by improper notice for inspection, or faulty
ma and /or workmanship.
00