134 NE 102 St (12)BUILDING
PERMIT APPLICATION
FBC 2001
Permit Type (circle): Building Electrical
Mechanical Roofing
Owner's Name (Fee Simple Titleholder) Chj41OXA La A ke�pt�l hone # 3 7 0.70c 77
Owner's Address //1 /0.2 4r�"
City / . State ff._..... Zip ______3_3_10
Tenant/Lessee Name
Job Address (where the work is being done) / ,i9. 70,,1 r
City Miami Shores Village County Miami-Dade Zip
Is Building Historically Designated YES NO
Contractor's Company Name 1(/ / � � / 0 7 ci 7,LJ A Phone #
Contractor's � #5 793 O �/
Address /tied ! 4 l r l
City { i Q State_L— Zip 7 r ?
Qualifier 794 R. r d�/o a J,
$ Value of Work For this Permit
Total Fee Now Due $
(Continued on opposite side)
Architect/Engineer's Name (if applicable) Phone #
Type of Work: ❑Addition DAlteration
T it/ Describe Work: � deA/ /1! /
* * * * * * * * * * * * * * * * * * * * * * * * * * ** F ees * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
Submittal Fee $ Permit Fee $ / – 7 5 • 00
Notary $ S • 0 0 Training/Education Fee $ < IV
Scanning $ 3.60 Radon $ Zoning
Code Enforcement $
Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
Structural Plan Review. $
❑New
id Off' 'T
e
Master Permit No.
Phone #
Square Footage Of Work:
Permit No. Pi 2A
0 2 m a
Il xepair/Replace ❑ Demolition
CCF $ f ° 2. CO /CC
Technology Fee $ 37
Bond $ 'VC) ((L2
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. I 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: 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.
"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 attachmenntAlso, a certified copy of the recorded notice of commencement must be posted at the job site
for the first inspectr r which occur. seven (7) days after the building permit is issued. In the absence of such posted notice, the
inspection wit t b a�proved reinspection fee will be charged.
,ASignatur
NOTARY P U:
Sign: /A
Owner or Agent
The foregoing instrument was acknowledged before f e this l (''' The foregoing instrument was acknowledged before me this 11
.�
day of PM . :ti 20 �,y by�� jjl-l�l1 n ht( „ 11 t . _
1
(0o is personally known for who has produced who is personally known to me or who has produced
As identification and who did take an oath. as and who did take an oath.
•
Print: / �1'j� s . ' .e"" '' MARIA J. GARCIA ■ 1 .r :._ MY CUMMIS # UU 215(05
o EXPIRES: May 26, 2007
�' v 'A ° Raided Thru Ndery Lin Underwriters
My Commission Expires:
APPLICATION APPROVED BY.
Chc 12/15/03
* * * * * * * * * * * * * * * * * * * * * * * * * * * ** * i * .. * �� * ►► *
/"
Signature
Contractor
NOTARY PUBLIC:
Sign:
Print:
(Certificate of Competency Holder)
My Commission Expires:
* * *** * * ** * * * * * * * * * * ** * * * ** r,
State Certificate or Registration No. Certificate of Competency No.
- .
1vlabe Vargas
a£ mi44 # X31 **
Expires: Ju
IirmdedThn
Al tt
riJp,;,t'r, Ir,c
*********************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
Engineer
Zoning
Plans Examiner
==
EXISTING TANK INFORMATION
=
STATE OF FLORIDA
DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM
EXISTING SYSTEM AND SYSTEM REPAIR EVALUATION
APPLICANT: ck r it d 0 1 ge
/ AGENT: ! Wo 1• /101-c_ .
Pone) Y
C 1
LOT: / BLOCK: jy SUBDIV: / / /3 SAO( C ID #: / /'324X- (.:
TO BE COMPLETED BY FLORIDA REGISTERED ENGINEER, DEPARTMENT EMPLOYEE, SEPTIC TANK CONTRACTOR OF
OTHER CERTIFIED PERSON. SIGN AND SEAL ALL SUBMITTED DOCUMENTS. COMPLETE ALL APPLICABLE ITEM:
COMPLETE TANK CERTIFICATION BELOW OR ATTACH LETTER FROM A PERMITTED SEPTAGE DISPOSAL SERVICE.
00b ] GALLONS SEPTIC TANK /GPD ATU LEGEND: MATERIAL: 2 BAFFLED: [Y /
[ 1 GALLONS SEPTIC TANK /GPD ATU LEGEND: MATERIAL: BAFFLED :[Y /
[ ] GALLONS GREASE INTERCEPTOR LEGEND: MATERIAL:
[ • ] GALLONS DOSING TANK LEGEND: MATERIAL: # PUMPS:(
I CERTIFY THAT THE ABOVE NOTED TANKS WERE PUMPED ON Z / /4/ D
HAVE THE )VO S.SPECIFIED, A
TER DEVI INSTALLED.
i
DATE
STRU ' Y SOUND, AND HA A [ SOLIDS DEFLECT DEVICE
SIGNATURE OF LICENSED CONTRACTOR BUS :SS NAME
EXISTING DRAINFIELD INFORMATION
( 1 O ] SQUARE FEET PRIMARY DRAINFIELD SYSTEM NO. OF TRENCHES [ ] DIMENSIONS: 7,0 X l6
[ 1 SQUARE FEET SYSTEM NO. OF TRENCHES [ ] DIMENSIONS: X
TYPE OF SYSTEM: [ 4STANDARD ( 1 ±LLED [ ] MOUND ( 1
CONFIGURATION: ( ] iirlCH ( � ( 1
DESIGN: [ HEAADER [ ] D -BOX [ ] GRAVITY SYSTEM [ ] DOSED SYSTEM
ELEVATION OF BOTTOM OF DRAINFIELD IN RELATION TO EXISTING GRADE „..5 INCHES ( ABOVE pcig
SYSTEM FAILURE AND REPAIR INFORMATION
[
J3 Z ] SYSTEM INSTALLATION DATE TYPE OF WASTE [ ] DOMESTIC [ ] COMMERCIA
[ ] GPD ESTIMATED SEWAGE FLOW BASED ON [ ] METERED WATER [ ] TABLE 1, 64E -6, FAI
SITE [ i.T DRAINAGE STRUCTURES [ ] POOL [ ] PATIO / DECK [ ] PARKING
CONDITIONS: [ ] S ING PROPERTY [
REMARKS /ADDITIONAL CRITERIA
_
DH 4015, 10/96 (Previous Editions may be used)
___ =■■■■= ■■■■==
_
PERMIT # ` - V S , \
_
NATURE OF [ ()/HYDRAULIC OVERLOAD [ ] SOILS [ ] MAINTENANCE [ ] .SYSTEM DAMAGE
FAILURE: [ ] DRAINAGE / RUN OFF [ ] ROOTS [ ] WATER TABLE [ ]
FAILURE [ ] SEWAGE ON GROUND [ ] TANK [ ] D BOX /HEADER ( DRAINFIELD
I SYMPTOM: [ ] PLUMBING BACKUP [ 1 I
SUBMITTED BY: ./L ICENSE DATE 7 -3-n
Page 4 of
APPLICATION FOR:
[ ] New System
[Ai] Repair
PROPERTY INFORMATION
INFORMATION
LOT: / BLOCK: 19 SUBDIVISION:
IS SEWER AVAILABLE AS PER 381.0065, FS? [ Y / V]
BUILDING INFORMATION
Unit Type of
No Establishment
1
2
3
4
[ ] Floor /Equipment Drains [ ] Other (Specify)
SIGNATURE:
5
STATE OF FLORIDA PERMIT NO.
DEPARTMENT OF HEALTH DATE PAID:
ONSITE SEWAGE TREATMENT AND DISPOSAL FEE PAID:
SYSTEM RECEIPT #:
APPLICATION FOR CONSTRUCTION PERMIT
[
I
Existing System
Abandonment
Z 2 7
DH 4015, 10/97 (Prprinna trA9t:,.... v....
APPLICANT: ( N RP, (buvS
AGENT: ! /I I a ( 1 (�C . P
MAILING ADDRESS: 172 2 3 5 / V ti/
Holding Tank
Temporary
[ W RESIDENTIAL [ ] COMMERCIAL
TELEPHONE:
DATE:
!3 —x_498
'[ /.if Innovative
[
TO BE COMPLETED BY APPLICANT OR APPLICANT'S AUTHORIZED AGENT. SYSTEMS MUST BE CONSTRUCTE
BY A PERSON LICENSED PURSUANT TO 489.105(3)(m) OR 489.552, FLORIDA STATUTES. IT IS THE
APPLICANT'S RESPONSIBILITY TO PROVIDE DOCUMENTATION OF THE DATE THE LOT WAS CREATED OR
PLATTED (MM /DD /YY) IF REQUESTING CONSIDERATION OF STATUTORY GRANDFATHER PROVISIONS.
PLATTED: /f3c
PROPERTY ID #: II ` 3206 - Q/ 1 Z t ZONING: /V61 I/M OR EQUIVALENT: [ Y / N ]
PROPERTY SIZE: 44$00 ACRES WATER SUPPLY: [ ] PRIVATE PUBLIC [ <= 2000GPD [ ] >2000GPI
DISTANCE TO SEWER: N/4 FT
PROPERTY ADDRESS: ! L � /0 Z < f /1 ;c4 .v. '' / F 3 3 / 3
DIRECTIONS TO PROPERTY: / V 1 ' 0 t-
No. of Building Commercial /Institutional System Design
Bedrooms Area Sgft Table 1, Chapter 64E -6, FAC
CONSTRUCTION PERMIT FOR:
[ ]New System [ ]Existing System
[ X ]Repair [ ]Abandonment
APPLICANT: Bellows, Christopher N.
LOT: 70 BLOCK: 14
STATE OF FLORIDA
DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM
CONSTRUCTION PERMIT
PROPERTY ID #: 11- 3206 - 013 -1880
SYSTEM DESIGN AND SPECIFICATIONS
OTHER REMARKS:
SPECIFICATIONS BY: RAM, Arrieta, Roland
APPROVED BY: Arrieta, Rolando
DATE ISSUED: 3/5/04
LUIV MMil
DH 4016, 03/97 (Obsoletes previous editions which may not be used)
(Stock Number: 5744- 001 - 4016 -0) [ostds_cons_4016 -1]
[ ]Holding Tank [ ] Innovative Other
[ )Temporary [ NA ]
AGENT: WALLACE P, Ponder Wallace
PROPERTY STREET ADDRESS: 134 NE 102 St Miami Shores FL 33138
SUBDIVISION: Miami Shores
[Section /Township /Range /Parcel No.]
[OR TAX ID NUMBER]
CENTRAX #: 13 -SG -19853
DATE PAID:
FEE PAID : $
RECEIPT .
OSTDSNBR : 04 -0823- -R
SYSTEM MUST BE CONSTRUCTED IN ACCORDANCE WITH SPECIFICATIONS AND STANDARDS OF CHAPTER 64E -6,FAC
DEPARTMENT APPROVAL OF SYSTEM DOES NOT GUARANTEE SATISFACTORY PERFORMANCE FOR ANY SPECIFIC TIME
PERIOD. 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. ISSUANCE OF THIS PERMIT DOES NOT EXEMPT THE APPLICANT FROM
COMPLIANCE WITH OTHER FEDERAL, STATE OR LOCAL PERMITTING REQUIRED FOR PROPERTY DEVELOPMENT.
T [ 900 ]Gallons SEPTIC TANK
A [ 0 ]Gallons
N [ 0 ]GALLONS GREASE INTERCEPTOR CAPACITY
K [ 0 ]GALLONS DOSING TANK CAPACITY [ 0 ]GALLONS Q [0
D [ 200 ]SQUARE FEET PRIMARY DRAINFIELD SYSTEM
R [ 0 ]SQUARE FEET SYSTEM
A TYPE SYSTEM: [ N ]STANDARD [ N )FILLED
I CONFIGURATION: [ N ]TRENCH [ N ]BED
N
F LOCATION TO BENCHMARK: 12.60'NGVD FF E/R
I ELEVATION OF PROPOSED SYSTEM SITE [ 1.6 ] [ FEET ] [
E BOTTOM OF DRAINFIELD TO BE [ 4.3 ] [ FEET ] [
L
D FILL REQUIRED: [ 0.0 ]INCHES EXCAVATION REQUIR
"SEE SPECIFICATIONS ON REVERESE SIDE"
TITLE:
TITLE: Engineer I
MULTI- CHAMBERED /IN SERIES: [Y
MULTI- CHAMBERED /IN SERIES: [Y
]DOSES PER 24 HRS # PUMPS[ 0
[ N ]MOUND [ N ]
[ N
BELOW ] BENCHMARK/REFERENCE POINT
BELOW BENCHMARK /REFERENCE POINT
ED: [ 32.0 ] INCHES
Dade
EXPIRATION DATE: 6/3/04
]
]
]
CHD
Page 1 of 2
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STATE OF FLORIDA
DEPARTMENT OF HEALTH
APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PERM!'
Permit Application Nurnber " f1-g
Scale: Each block represents 5 f and 1 inch = 50 feet.
PART II - SITE PLAN-
Site Plan submitted by:
Signature
Dat -3 -
3y County Health Department
ALL CHANGES MUST BE APPROVED BY THE COUNTY HEALTH DEPARTMENT
?Ian Approved Not Approved
DH 4015, 10/98 (Replaces HRS-H Form 4015 which may be used)
(Stock Number:5744- 002. 40154)
v •• v• II •1 •w• •
DEPARTMENT OF HEALTH
APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PERMIT )
Permit Application Number 0 i1.
Scale: Each block represents 5 feet and 1 inch = 50 feet.
PART II - SITE PLAN
.1, rr % f /0.0 4/r LI c) 0
Site Plan submitted by: ..44 ?
Signature
Plan Approved 7/ e of Approved
I 4a�a10 !�.t�c �3
Miami -Dade Comity
By 1 /y ,�� 1katill Department 3' o` U(/ County Health Departmen
f J6 n W) 1:ngri.Wttri tg SW11011
Dat
ALL CHANGES MUST BE APPROVED BY THE COUNTY HEALTH DEPARTMENT
Page 2 of
STATE OF FLORIDA
DEPARTMENT OF HEALTH
ONSITE SEWAGE DISPOSAL SYSTEM
SITE EVALUATION AND SYSTEM SPECIFICATIONS
APPLICANT: d_ k )r [ ( s 4...0 hey E M A AGENT: V �,� J / I c r . / 0 0 ri d n
LOT: BLOCK: SUBDIVISION: iiiiti,,vt V l/{ 1.
PROPERTY ID #: Ji j 0 _ 0 e GD [Section /Township /Range /Parcel No. o .gax 1 u r�
mbee
TO BE COMPLETED BY ENGINEER, HEALTH UNIT EMPLOYEE, OR
PROPERTY SIZE CONFORMS TO SITE PLAN:
TOTAL ESTIMATED SEWAGE FLOW: ZO
AUTHORIZED SEWAGE FLOW: 6 A
UNOBSTRUCTED AREA AVAILABLE: 0
BENCHMARK /REFERENCE POINT LOCATION:
ELEVATION OF PROPOSED SYSTEM SITE IS
Munsell # /Color exture
Bb'& V?
ow":
C 0 J
USDA SOI SERIES:
A..
Depth
to
to
to
to
to
to
to
to
O
110
(
(ITE EVALUATED BY:
Ni 4015, 10/96 (Replaces HRS -H Form 4015 [Page 3] which may be used)
Stock Number: 5744- 003 - 4015 -1)
PROVIDE REGISTRATION NUMBER AND SIGN AND SEAL EACH PAGE OF SUBMITTAL. COMPLETE ALL ITEMS.
YES ( ] NO NET USABLE AREA AVAILABLE:
GALLONS PER DAY _,ID » �`; ABLE
GALLONS PER DAY [1500 GPD /ACRE OR
SQFT UNOBSTRUCTED AREA REQUIRED:
/2, 6 /d -
[INCHES T [ABOVE /] M:filD REFERENCE POINZ
THE MINIMUM SETBACK WHICH CAN BE MAINTAINED FROM THE PROPOSED SYSTEM TO THE FOLLOWING FEATURES:
SURFACE WATER: gi/ 71 ' FT DITCHES /SWALES: 1/�' FT NORMALLY WET? [ ) YES [
'JELLS: PUBLIC: rip FT LIMITED USE: /VA FT PRIVATE: A■Vt FT NON- POTABLE: Ain FT
BUILDING FOUNDATIONS: FT PROPERTY LINES: /2 FT POTABLE WATER LINES: 20 FT
SITE SUBJECT TO FREQUENT FLOODING: [ ] YES ( (10 10 YEAR FLOODING? [ ] YES [ (],,,,,NO
10 YEAR FLOOD ELEVATION FOR SITE: FT MSL /NGVD SITE ELEVATION: /0 0 FT MSL /NGVD
< 1 / 4 r 7
SOIL PROFILE INFORMATION SITE 1 SOIL PROFILE INFORMATION SITE -2
Munsell # /Color Texture
USDA SOIL SERIES:
PERMIT # 0
ENGINEER'S MUST
.®2t ACRE:
OTHER -TABLE 2]
ACRE]
SQF1
Depth
. to
to ; e c
to
to
)BSERVEU WATER TABLE: iJA INCHES [ABOVE / BEL W] EXISTING GRADE. TYPE: [PERCHED / APPARENT]
STIMATED WET SEASON WATER TABLE ELEVATION CO INCHES [ ABOVE / ] EXISTING GRADE.
UGH WATER TABLE VEGETATION: [ ] YES [(j/NO ' MOTTLING: [ ] YES [ O DEPTH: A.W INCHES
)OIL TEXTURE /LOADING RATE FOR SYSTEM SIZING: ' /9 DEPTH OF EXCAVATION:, ' INCHES
)RAINFIELD CONFIGURATION: [ ] TRENCH [ ] BED [ ] OTHER (SPECIFY)
:EMARKS /ADDITIONAL CRITERIA:
DATE: ...?'",..? o
Page 3 of 3
Miami Shores Village
10050 NE 2nd Avenue
Phone: 305 - 795 -2204
Printed: 5/13/2004
Applicant: CHRISTOPHER
Owner: BELLOWS
JOB ADDRESS: 134 NE 102 ST
Contractor WALLACE PONDER SEPTIC
Local Phone: 305 - 620 - 8320
Parcel # 1132060131880
Plumbing Permit
Permit Number: PL2004 -138
BELLOWS
CHRISTOPHER
Contractor's Address: 17235 NW 12 CT
Permit Status: APPROVED Permit Expiration: 11/7/2004 Construction Value: $2,000.00
Work: DRAINFIELD
Page 1 of 1
Legal Description: 1 53 41 6 53 42 MIAMI SHORES SEC 1 AMD PB 10 -70 LOTS 10 & 11 BLK 14
Fees: Description Amount
FEE2004 -4906 Building Fee $175.00
FEE2004 -4907 CCF $1.20
FEE2004 -4908 Notary Fee $5.00
FEE2004 -4909 Training and Education Fee $0.40
FEE2004 -4910 Technology Fee $4.37
FEE2004 -4911 Scanning Fee $3.00
FEE2004 -4912 Builders Bond $300.00
Total Fees: $488.97
Total Fees: $488.97
Total Receipts: $488.97
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:
Company
REQUEST FOR INSPECTION
Time Ready
Date Ready
Job
• 41114 •
Address A 4 41. , ,
v't
_
Inspection 7—
A.M. P.M.
Permit No.
72
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.
h4o o k)//. APO
Owner's Name and Address
Registered Architect and /or Engineer
Employing Plumber's Name
Subdivision
Street and Number where work is to be performed —No 434 Street__ /
Location and Legal Description Lot Block
State work to be performed and purpose of building (By Floors)
New Building Remodeling Addition__ .__ Repairs
Size Septic Tank
Feet of Drain Tile � Dist. Feet of Tank or Drain Field from Well
Nature of Water Sup y: City —Well. Size of Soakage Pit
ss.
My Commission Expires
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
Type of Tank
'No — 9/4 Street 2 2 / Y
No
(Signed)
Date
Capacity Gals.
Notary Public, State of Florida
/ " --Street_.__ �►•JZe -G1
No. of Stories .__ _. __..
Amount of Permit $ , e"4 ( Signed) Y' -± ••_.t__f..r_ l
Plumbing Inspector.
/
The undersigned applicant for this building permit does hereby certify that he up1de tands and accepts his obligatjfi9 as an employer of labor
under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Permanent !! upplement, and has com-
plied with the provisions thereof, and will require similar compliance from all contractors or sub- contractors employed by hint 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, 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
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.
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
SEPTIC
TANK
SEWER
CONN.
DRAIN
FIELD
SOAKAGE
PIT
GREASE
TRAP
SOLAR
HEATER
DEEP
WELL
SPRKLR.
SYSTEM
SW IM'G
POOL
CONTR.
LIST
CHECK
Permit No.
72
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.
h4o o k)//. APO
Owner's Name and Address
Registered Architect and /or Engineer
Employing Plumber's Name
Subdivision
Street and Number where work is to be performed —No 434 Street__ /
Location and Legal Description Lot Block
State work to be performed and purpose of building (By Floors)
New Building Remodeling Addition__ .__ Repairs
Size Septic Tank
Feet of Drain Tile � Dist. Feet of Tank or Drain Field from Well
Nature of Water Sup y: City —Well. Size of Soakage Pit
ss.
My Commission Expires
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
Type of Tank
'No — 9/4 Street 2 2 / Y
No
(Signed)
Date
Capacity Gals.
Notary Public, State of Florida
/ " --Street_.__ �►•JZe -G1
No. of Stories .__ _. __..
Amount of Permit $ , e"4 ( Signed) Y' -± ••_.t__f..r_ l
Plumbing Inspector.
/
The undersigned applicant for this building permit does hereby certify that he up1de tands and accepts his obligatjfi9 as an employer of labor
under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Permanent !! upplement, and has com-
plied with the provisions thereof, and will require similar compliance from all contractors or sub- contractors employed by hint 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, 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
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.
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. 9/
/
Owner's Name and Address � -t -- 3 '"
Registered Architect and /or Eng• ee, _
Employing Plumber's Name I rL_1 ..: -,--,
Size Septic Tank____ —
Feet of Drain Tile__
Nature of Water Supply: City
Amount of Permit $_
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 b, complied with, whether herein specified or not. A copy of approved plans and specifications must be kept at
building during progress of
ss.
My Commission Expires
No =, Stree
The undersigned applicant
under the Florida Workmen's Compensation
plied with the provisions thereof, and will
performed under this permit; and will post
required by the Act. The under signed agr ees to employ only such
licensed by Miami Shores Village.
Location and Legal Description Lot__________
Street and Number where work is to be performed —No
State work to be performed and purpose of building (By Floors)
New Building ________ ___________________ Remodeling Addition Repairs
.... _________________ Type of Tank Capacity
Dist. Feet of Tank or Drain Field from Well ______ ___ _-_-____--__--- _.______— ___ ___._
—Well. Size of Soakage Pit
(Signed)
for this building permit does hereby certify that he understands and accepts his obligations as an employer of labor
Act, being Section 5966, Compiled General Laws of Florida Permanent Supplement, and has com-
require similar compliance from all contractors or sub - contractors employed by him in the work to be
or cause to be posted for inspection on the site of the work such public notice or notices as
sub - contractors, on wo 10 be prrformed under this permit, as
�-- - - - - - --
f" Master Plumber.
(Signed
Date —f- //VII
Street? � ! "
Plumbing Inspector.
Street - - --- – _ - -_ – – -- —_ —_— – –
No. of ______
are
are
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 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
LAVA-
TORIES
SINKS
SLOP
SINKS
LAUNDRY
TUBS
URINALS
CATCH
BASIN
FLOOR
DRAIN
DRINKING
FOUNT'NS
TOTAL
FIXTURES
CONTR.
LIST
CHECK
SEPTIC
TANK
SEWER
CONN.
DRAIN SOAKAGE
FIELD PIT
GREASE
TRAP
SOLAR
HEATER
DEEP
WELL
SPRKLR.
SYSTEM
SWIM'G
POOL
CONTR.
LIST
(/
CHECK
� /
Permit No. 9/
/
Owner's Name and Address � -t -- 3 '"
Registered Architect and /or Eng• ee, _
Employing Plumber's Name I rL_1 ..: -,--,
Size Septic Tank____ —
Feet of Drain Tile__
Nature of Water Supply: City
Amount of Permit $_
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 b, complied with, whether herein specified or not. A copy of approved plans and specifications must be kept at
building during progress of
ss.
My Commission Expires
No =, Stree
The undersigned applicant
under the Florida Workmen's Compensation
plied with the provisions thereof, and will
performed under this permit; and will post
required by the Act. The under signed agr ees to employ only such
licensed by Miami Shores Village.
Location and Legal Description Lot__________
Street and Number where work is to be performed —No
State work to be performed and purpose of building (By Floors)
New Building ________ ___________________ Remodeling Addition Repairs
.... _________________ Type of Tank Capacity
Dist. Feet of Tank or Drain Field from Well ______ ___ _-_-____--__--- _.______— ___ ___._
—Well. Size of Soakage Pit
(Signed)
for this building permit does hereby certify that he understands and accepts his obligations as an employer of labor
Act, being Section 5966, Compiled General Laws of Florida Permanent Supplement, and has com-
require similar compliance from all contractors or sub - contractors employed by him in the work to be
or cause to be posted for inspection on the site of the work such public notice or notices as
sub - contractors, on wo 10 be prrformed under this permit, as
�-- - - - - - --
f" Master Plumber.
(Signed
Date —f- //VII
Street? � ! "
Plumbing Inspector.
Street - - --- – _ - -_ – – -- —_ —_— – –
No. of ______
are
are
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 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 $1.00 will be made when such re- inspection is made necessary by improper notice for inspection, or faulty
materials and /or workmanship.
BUILDING
ELECTRICAL
PLUMBING
Lot
PERMIT
Work to be performed
N9 3291
under this Permit
Owner of
Building t' +
Bl.
1
Subdi-
vision
Value of
Project
CONTRACTOR OR BUILDER BY
MIAMI SHORES VILLAGE, FLORIDA
DATE ' 19
Contractor's
License No.
'NARNING: This Construction may be in violation of
u. Production Board General Limitations Order L-41
.,u are cautioned to consult your War Prod;ictior;
-.mitt office beiur stoning tiro woe k authorized ir+
' pt,$ permit.
Architect
Contractor
or Builder
Legal
Description
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
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.
Signed• 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 regula-
tions pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores
Village. In accepting thus permit I assume responsibility for all work done by either myself, my agent, servant or employee
Amt. of
Permit
4 1 - • ./ 1^
AUTHb TrY
I
J