260 NE 102 St (4)MIAMI SHORES VILLAGE
BUILDING DEPARTMENT
305- 795 -2204
Building Inspection Reque
a) g ime
Date
Type Insp'
Permit No.
Name
Address
Compan
Phone #
For Inspector l �D /0a
Approved
Correction ❑
Re- Insp'n Fee ❑
,60.„
MIAMI SHORES VILT AGE
BUILDING DEPARTMENT----
305- 795 -2204
Building Inspection Request
3b
Date Time
- --Type Ins
Permit No.
.0003 [16
Name `n
Address 9 (Q 0 / t& 1 DcP-LS
- -Company 1.6e. O .� —C—
Phone #
For Ins ector:
Appr
Correction
Re- Insp'n Fee
Date
PERMIT APPLICATION FOR.MIAMI SHORES VILLAGE
10050 N. 2nd Avenue • Miami Shores, Florida 33138 • Phone: 305- 795 -2204 • Fax: 305- 756 -8972
L
1
/O idd ress 2G0 Ne 102 CST Tax Folio it 32 069 - O t 3 I-p7 30
,al Description (% f B PA K ! Silcve u Historically Designated: Yes No
p-. D3 i
Owner /Lessee/Tenet
/owner's Address
(ntracting Co. `5 C‘
Qualifier T ra (0`'+ -›
Square Ft. `
Signature of owner and/or Condo President
Not t.. • wner and/or
My Commission Expires
\ - � - t w (lei( w
3C (S Ni R ye K etac
Permit Type (circle // one): BUILDING ELECTRICAL
WORK DESCRIPTION:t'1 r o\ n -e( C
MY commissigh& cC smso to
EXPIRES: Jul 16, 2003
1.800.3.NOTARY Fla. Notary SeMce & Bonding Co.
RADON C.C.F
FEES: PERMIT
APPROVED:
Zoning Building
Mechanical
Plumbing
Date Signat
Master Permit #
Phone
ommission
C' e".) ', � k , `C
(, CV'tkv F‘3 Address R1 9,07<- 37et - ( :( f:. of/
SS# ( S) 6: f — �?
State # �_�'aC� - 14_. Municipal # Competency # Ins. Co.
IF THERE IS NO PERMIT PACKAGE ACCESSIBLE ON THE JOB SITE FOR INSPECTORS TO VERIFY,
THERE WILL BE NO INSPECTION. RE- INSPECTION FEE IS $50.00 AND MUST BE PAID IN ADVANCE
BEFORE CALLING FOR ANOTHER "I ` ' ' CTION.
Estimated Cost (value) 'f cQ.C.W
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 ANY 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 all disciplines.
OWNERS AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws
regulating constru and •ning. Furthermore, I authorize the above named contractor to do the work stated.
j2 /)
actor or Owner Builder
/ I/ 7-, 03N
as to Coht ct4r or,V ��yy t�e 0 JO Date
,
::3A, I cg O y„ J'l,e..
D N
'I , jECNf1N NOIS INV400 'x + l
u k. z
iYPIA f SAC 1 0
I' !.iV.'( 1r 1 ; 1,x) P nd At.1
Expires v601.6000
NOTARY
MECHANICAL ROOFING
Date
BOND
TOTAL DUE
Electrical
Structural Engineer
Miami Shores Village
10050 NE 2nd Avenue
Phone: 305 - 795 -2204
tO Printed:4 /11/2003
, Applicant: IVEN
N Owner: STRAWDERMAN
, JOB ADDRESS: 260 NE 102
M
Local Phone: 305 - 661 -6633
Parcel # 1132060134730
T
(J � Status: Approved Permit Expiration:
Work: INSTALL DRAINFIELD
r51 Q) If •`-
'6,' fee i
N
cbo
TN;
ordinal
and ap
authori
ordinar
by his o
In con:
with the ,
myself, r,
8
Sign °
Fees:
FEE2003 -2110
FEE2003 -2111
FEE2003 -2112
FEE2003 -2113
PAY •
TO THE
ORDER OF
ACH RIT 083100277
Description
Builder's Bond
Building Fee
CCF
Notary Fee
Total Fees:
Plumbing Permit
Permit Number: PL2003 -100
10/8/2003
r — . . na 6red e,
OCEAN TERRACE HOTEL
E
7410 OCEAN TERRAC 2771
MIAMI BEACH,
STRAWDERMAN
IVEN
ST
O Contractor STATEWIDE SEPTIC CONNECTIONS Contractor's Address: 18800 N. W. 2nd Ave #223
D
Legal Description: MIAMI SHORES SEC 1 AMD PB 10 - LOT 5 BLK 35 LOT SIZE 50.000 X
Amount
$300.00
$80.00
$1.20
$5.00
$386.20
Construction VaIsm• ft9 nnn
DATE
Total Fees: $386.20
Total Receipts: $0.00
Page 1 of 1
8226
63 -4/630 FL
1035.
DOLLARS 8
Bank of America.
aba malt/11,51n: • S41 -
0 0 90 L094
'6.13:42.2 6 : .;t:0 63000 47 - . 2 009 6
mpliance with all
peen submitted to
led without
<nowledge of the
ibility for work done
1 strict conformity
one by either
CONSTRUCTION PEB IT FOP•
EP] New .System [P3 Existing System [0] Holding Task
Abandonment (J ] .Temporary
f ca P em . c,
• [ X] Repair. • 0)
APPLICANT.: (/ t L4
PROPERTY ADDRESS: 7 (0 /J. C l Z S
LOT: ELOCX :
'PROPERTY' ID #:
SYSTEM MUST BE CONSTRUCTED • IN ACCORDANCE WITH SPECIFICATIONS AND STANDARDS OP SECTION 381.0065,
F.S., AND CHAPTER 64E -6, F.A.C. •DEPARTMENT APPROVAL OF SYSTEM DOES NOT GUARANTEE SAFTISPACTORY
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. ISSUANCE OF THIS PERMIT
DOES NOT EXEMPT THE APPLICANT FROM COMPLIANCE WITH OTHER '.FEDERAL, STATE, OR LOCAL PERMITTING
REQUIRED FOA DEVELOPMENT OF THIS PROPERTY.
.D
A
• I
N
F
I
D
T
E
E
• R
SYSTEM DESIGN AND SPECIFICATIONS
T [ GALLONS / • GPn SEPTIC • TANK /AEROBIC UNIT
A [ ] ..GALLONS / GPD '
N •] GALLONS GREASE. INTERCEPTOR CAPACITY
1C [ GALLONS DOSING TANK CAPACITY '• [ • ]
[ 3 U U] SQUARE FEET PRICY DRAINFIELD SYSTEM
— 3 SQUARE FEET SYSTEM
TYPE SYSTEM: [ ST,ANARD [ FILLED ' [' 3 ' MOUND
CONFIGURATION :: [ • TRENCH Pol BED [ ]
LOCATION OF' BENC ARK: f 2, t J • Iv
' •,. (
1 , V. b , F .F E' 1.e v.
ELEVATION OF PROPOSED SYSTEM SITE e S( [INCHES /FT] •[ /BELOW]
BOTTOM O8' DRAINFT��ELD TO BE • • '[ . 5r� , 0 [ CIN HES• /FT] • [ABOVE /BELOW}
FILL REQUIRED: [ 1 )U . ] • INCHES EXCAVATION REQUIRED: [ Y L ] INCHES
1 Z h A ' T(;FITa-
SPECIFICATIONS BY
APPROVED BY:
DATE ISSUED
4
DE 4016, 12/99 (Page
TO 39 d
STATE OF FLORIDA
DEPARTMENT OF REALTl3
ONSITE 'SEWAbE TREATMENT AND DISPOSAL SYSTEM
CONSTRUCTION PERMIT
!� 37..�. _ a) - 7 . 0
1) (Previous
SUBDIVISION: f/f(.r.rt.L Lil,.vlr a S Sv • i
/ q i�? 'BED' Es:A •.► Nt:11
Yl"�vP. 51<sC) • r •
• I �. ` '-,f.- 1 A •'TITLE: / " � � ._ !.., a 4 C'. CfID
Editions May Be Used)' •
pt, 1: Hc:illli Department. .
pL 2: Applicant
pt. 3: Installer /Contractor
pt. 4: Building Dcpartmcnl
SQiS0
[SECTION, TOWNSHIP, • RANGE, PARCEL NOD®ER]
[OR TAX ID NUMBER]
CAPACITY MULTI- CHAMBERED /IN- SERIES [
CAPACITY •• • MULTI- CHAMBERED /IN- SERIES [ 3
[MAXIMITM CAPACITY SINGLE TANK: 1250 GALLONS]
GALLONS ( ] DOSES PER 24 HRS # PUMPS [ ]
•
•
•
V:ri•'T :AM -% Til -= is
ZIJEETSSOE
PERMIT NO. 0 - 31-/O 2‘.
DATE PAID : — 2 - a 3
FEE PAID: 7
RECEIPT #: • C n . c-/3
- 3-SC)- l(,,ti
0 ] • xnaovative
[ ]•
� y UNTIED SO1
EXPIRATION. DATE.: "
•
/; -mss .7- • /3,
BENCHMARK/REFERENCE POINT
BENCHMARK/REFERENCE POINT
- 1
-,Liu
• Page. 1 oP .3
90 :01 600Z/TI/V0
STATE OF FLORIDA
•
- r d DEPARTMENT OF HEALTH AND. REHABILITATIVE SERVICES
ONSITE SEWAGE DISPOSAL SYSTEM
SITE EVALUATION AND SYSTEM SPECIFICATIONS
'' VU W G.�K��•'�
APPLICANT: \\191-\ Y ( e m Q AGENT: li p .c°✓h`
9
LOT: G- BLOCK: ,?543 SUBDIVISION: M c-V I
$o -
PROPERTY ID #: f1 - 0 9 '3- 41
TO BE COMPLETED BY ENGINEER, HEALTH UNIT EMPLOYEE, OR OTHER QUALIFIED PERSON. ENGINEER'S NUS:
PROVIDE REGISTRATION NUMBER AND SIGN AND SEAL EACH PAGE OF SUBMITTAL. COMPLETE ALL ITEMS.
PROPERTY SIZE CONFORMS TO SITE PLAN: [)] YES [ ] NO NET USABLE AREA AVAILABLE: ' ACRE!
TOTAL ESTIMATED SEWAGE FLOW: GALLONS PER DAY [RESIDENCES -TABLE 1 / OTHER-TABLE E - 2:
AUTHORIZED SEWAGE FLOW:
mod, GALLONS PER DAY [1500 GPD /ACRE OR 2500 GPD /ACRE]
UNOBSTRUCTED AREA AVAILABLE: Brx SQFT UNOBSTRUCTED AREA REQUIRED: Go.; SQF:
! ;
BENCHMARK /REFERENCE POINT LOCATION: FF ^ 17 • �
ELEVATION OF PROPOSED SYSTEM SITE IS '2. (INCHES , IABO� Pf 'E03] BENCHMARK/RERE,RESE POIN2
WEE MINIMUM SETBACK WHICH
SURFACE WATER: ( N. FT
WELLS: PUBLIC: , � P FT
BUILDING FOUNDATIONS:
Munsell /Color Texture Depth
tc3,NR Slt Gael UAW> 0t! to eut
to
to
to
t0
to.
to
t0
USDA SOIL SERIES: t
SITE SUBJECT TO PREVENT ODING: [ ,] ES [ ] NO
N
10 YEAR FLOOD ELEVATION FOR SITE: /4 FT MSL /NGVD
SOIL PROFILE INFORMATION SITE 1
REMARKS /ADDITIONAL CRITERIA:
CAN BE MAINTAINED FROM THE PROPOSED SYS'T'EM TO THE FOLLOWING FEATURES:
DITCHES /SWALES: NI4 FT NORMALLY WET? ( ] YES (N3 NC
LIMITED USE: FT PRIVATE: isJ f4 FT NON- POTABLE: (LA F7
- 7 FT PROPERTY LINES: IC) FT .POTABLE WATER LINES: F9
to
OBSERVED WATER TABLE: ►V0.- INCHES [AIDE r<EMQ>EXISTING GRADE. TYPE:
ESTIMATED WET SEASON WATER TABLE ELEVATION: - 44,4- INCHES ( ABOVE /
HIGH WATER TABLE VEGETATION: ( ] YES (i) NO MOTTLING:[ ] YES [X] NO
SOIL TESTURE /LOADING RATE FdR SYSTEM SIZING: r e'1 So�^� DEPTH OF EX
DRAINFIELD CONFIGURATION: [ ] TRENCH I] BED ( ] OTHER (SPECIFY)
r -,'
PERMIT # (.).;12-N":-/.;
, ..J
[Section /Township /Range /Parcel No. or Tax ID Number:
SOIL PROFILE INFORMATION SITE 2
/ f, : -
10 YEAR FLOODING? ( ] YES V] NC
SITE. ELEVATION: FT MSL /NGVI
l
e o.r Texture Depth
••
to
- `' to
to
to
to
to
USDA SOIL SERIES:
PERCHED PARE ]
] EXISTING' GRADE.
DEPTHA}(A INCHES
CAVATION: INCHES
SITE EVALUATED B' f:
HRS -H Form 4015, Mar 92 previous editions which may not be used)
(Stock Number: 5744. 003 - 4015 -1)
ZO 39dd
SQSSO
ZLbEETSSOE
DATE:
Page 3 of 3
90 :01 E00Z /TT /170
By
I ;. iry. Y
Site Plan Submitted by:
STATE OF FLORIDA
DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES
APPLICATION FOR ONSJTE SEWAGE DISPOSAL SYSTEM CONSTRUCTIptgP
Permit Application Number
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Plan Approved I Not Approved
• i�•r- i- r••I - .
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1`R l-1 Fnrm d(4 F. Feb 8S (Obeo4,I provioun r- dilipnq whk h may riot be =Id) •
• E0 39V,=I
PART II - SITE PLAN
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SIGNATURE'
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SQiS0 ZLb££T990£
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Notes' S uJ d 2Y *NO Y\ 7 -GO IMF f 0 2 Si” 1 • Nt .ShO rc' 3
County Public•Unit
ALL C 1ANGES MUST BE APPROVED BY THE COUNTY PUBLIC HEAL KUNIT
OC.4
rrrLE
Date
90 :01 £003 /T-T /b0
ACCOUNT
org6 i
49 -
---. -
igetia
500
p 0
BAL. DUE
DATE d g003 No. 197647
RECEIVED FROM ,5>ta4M 46
=RENT 4 0144/id:: 7Jia4f#440-4
DOLLARS
0C p 131
CHECK
r")MONEY BY
ORDER 1 810.0,-0
1182
$86.20
/
APPLICANT:
AGENT:
PROPERTY ADDRESS:
LOT: .. BLOCK:
s ssssssssa
CHECKED [X] ITEMS ARE NOT IN COMPLIANCE WITS STATUTE OR RULE AND MUST BE CORRECTED.
s
1
l
1
1
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1
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'1
1
1
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1
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FILL
[
[13]
[
(25]
(26]
STATE OF FLORIDA
DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT AND DIPOSAL SYSTEM
CONSTRUCTION INSPECTION AND FINAL APPROVAL
SUBDIVISION:
TANK INSTALLATION
[01] TANK SIZE 11] - “, ;, [ Z] _
[02] TANK MATERIAL
[03] OUTLET DEVICE
(04] MULTI - CHAMBERED ('T / N ]
[05] OUTLET FILTER
[06] LEGEND
[07] WATERTIGHT
[08] LEVEL
[09] DEPTH TO LID
DRAINFIELD INSTALLATION h
[10] AREA [1] #7t ., %> [2] 1 SQFT
[11] DISTRIBUTION BOX HEADER -'
[11] NUMBER OF DRAINLINES
[13] DRAINLINE SEPARATION
[14] DRAINLINE SLOPE
[15] DEPTH OF COVER
[16] ELEVATION [ABOVE /BELOW] BM
[17] SYSTEM LOCATION
[18] DOSING PUMPS
[19] AGGREGATE SIZE
[20] AGGREGATE EXCESSIVE FINES
(11] AGGREGATE DEPTH
/ EXCAVATION MATERIAL
FILL AMOUNT
FILL TEXTURE
EXCAVATION DEPTH
AREA REPLACED
REPLACEMENT MATERIAL ( .
EXPLANATION OF VIOLATIONS / REMARKS:
I
(
CONSTRUCTION [APPROVED /DISAPPROVE;]:
FINAL SYSTEM [APPROVED /DISAPPROVED]:
l!
DH 4016, 10/97 (Pr.vious Editions May Be Used)
SETBACKS
SURFACE WATER
DITCHES
PRIVATE WELLS
PUBLIC WELLS
[
[
(29]
[30]
pi]
[32]
[33]
(34]
[35]
FILLED / MOUND SYSTEM
[36] DRAINFIELD COVER
[37] SHOULDERS
[38] SLOPES
[39] STABILIZATION
ADDITIONAL INFORMATION
(40]
(41]
[42]
[43]
[44]
[45]
[46]
(47]
[48]
Building Department
PERMIT NO.
DATE PAID:
FEE PAID:
RECEIPT 1:
PROPERTY ID 1:
IRRIGATION WELLS
POTABLE WATER LINES
BUILDING FOUNDATION
PROPERTY LINES
OTHER
ssssssssssssss==
FT
FT
FT
FT
FT
- L,wi 4 FT
FT
f FT
FT
UNOBSTRUCTED AREA
STORMWATER RUNOFF
ALARMS
MAINTENANCE AGREEMENT
BUILDING AREA
LOCATION CONFORMS WITH SITE PLAN
FINAL SITE GRADING
CONTRACTOR
OTHER
ABANDONMENT
[49] TANK PUMPED _ / /
[50] TANK CRUSHED & FILLED //
CHD DATE:
CHD DATE
Page 2 of 3
PERMIT NUMBER: Permit tracking number assigned by CHD.
APPLICANT: Property owner's full name.
AGENT: Property owner's legally authorized representative.
MAILING ADDRESS: P.O. box or street mailing address for applicant or agent.
LOT, BLOCK, SUBDIVISION Lot, Block and Subdivision for lot or
PROPERTY ID#: 27 character number for property. (property appraiser ID # or GIS location)
COUNTY HEALTH DEPARTMENT CHECKS [X] ITEMS NOT IN COMPLIANCE WITH CONSTRUCTION PERMIT AND
STATUTE OR RULE. INFORMATION IS COMPLETED BY CHD ON FOLLOWING ITEMS:
TANK SIZE (gallons)
TANK MATERIAL (concrete, fiberglass, etc)
OUTLET FILTER (manufacturer, make, model)
LEGEND (manufacturer code)
DRAINFIELD AREA (square feet)
DISTRIBUTION BOX / HEADER (check box)
NUMBER OF DRAINLINES (number installed)
SYSTEM ELEVATION (in relation to BM)
DOSING PUMPS (number installed)
SETBACKS (record actual setbacks in ft)
SETBACKS OTHER (as required)
STABILIZATION (date stabilized)
CONTRACTOR (contractor installing system)
ADDITIONAL INFORMATION (as required)
ABANDONMENT TANK PUMPED (date)
TANK CRUSHED AND FILLED (date)
EXPLANATION OF VIOLATIONS: Record Item number, explanation of violation, and required
CONSTRUCTION APPROVAL: Cirde approved or disapproved, CHD signature and date.
i
AS BUILT INSTALLATION SKETCH
FINAL APPROVAL: Cirde approved or disapproved. CHD signature and date of approval.
Final approval shall not be granted unit the CHD has confirmed that'building construction and lot grading are in substantial
compliance with plans and specifications submitted with the permit application.
ELEVATION WORKSHEET ELEVATION OF BENCHMARK OR REFERENCE POINT:
EXISTING GROUND TOP OF AGGREGATE
[4.] SHOT H.I. H.I. H.I.
H.I. [ -] SHOT 1-1 SHOT [ -] SHOT
ELEVATION
AGENT:
(17]
(l8]
(191
(20]
($1)
STATE O8 _F3.ORIDA PERMIT MO.
DEPARTMENT OF HEALTH DATE PAID:
ONBITE SEWAGE TREATMENT AND DIPOSAL SYSTEM[ PEE PAID:
CONSTRUCTION INSPECTION AND FINAL APPROVAL RECEIPT #_
/ •. -.} - ,,. ,
;t
•
PROPERTY ADDRESS! : 3 .
LOTS t BLOCK* SUBDIVISION: • �..
sssossssssasss
CHECKED (I] ITEMS ARE NOT IN COMPLIANCE WITH
ssssssssss:ssss
TANK INSTALLATION
(01] TANK SIZE (1] ?s, +1 [ _
(02 ] TANK MATERIAL
(031 OUTLET DEVILS
(04 ] MULTI - CHAMBERED . ( N
(05] OUTLET FILTER
[06] LEGEND • N �?
(07] WATERTIGHT
(08) LEVEL
[09] DEPTH TO LID
DRAINFIELD INSTALLATION 3sv
AREA [ 1] 11 < l [ 2] 3 7 t1 SQFT 1/4 1
DISTRIBUTION BOX _ HEADER L" 11 ]
NUMBER OF DRAINLINES (f [ ]
DRAINLINE SEPARATION
` (
DRAINLINE SLOPE
DEPTH OF COVER
ELEVATION [ABOVE /BELOW] BM
SYSTEM LOCATION
DOSING PUMPS ti i
AGGREGATE SIZE
AGGREGATE EXCESSIVE FINES
AGGREGATE DEPTH
"IL / EXCAVATION MATERIAL
111 MILL AMOUNT 12 r '
MILL :TEXT�JRE .
t AZCAVATION DEPTH
: IUMA REPLACED ...:,:: 1
I NPLACEMENT MATERIAL E' )
# 411 Or VIoLATZONs
. A
0 APPROVED /DrSAPP� s :.
tifilipt .,
. , . D i*+ � II1+PROVBD %DI SAPPAOVED 1
Pr evions Editions May Be Used)
PROPERTY ID # ::'.=
STAMM OR RULE AND MUST ' BE CORRECTED.
SETBACKS
[27] SURFACE WATER. FT
[28] AnTCHES F'1'
[19] PRIVATE WELLS FT
(303 PUBLIC WELTS FT
[ 31 ] IRRIGATION WELLS • FT
[34] POTABLE WATER LINES 104 FT
[33) BUILDING FOUNDATION /6 •• FT
[34] PROPERTY LINES S' FT
[35] OTHER. FT
FILLED / MOUND SYSTEM.
[36] •DRAINFIELD COVER
[37] SHOULDERS .. •
[38] SLOPES
(39] STABILIZATION
ADDITIONAL INFORMATION
UNOBSTRUCTED AREA
STORMWATER RUNOFF
ALARMS
] (40]
1 [
] [
] [43] MAINTENANCE AGREEMENT
] [44] BUILDING AREA •
] [45] LOCATION CONFORMS WITH
];. [46] FINAL SITE GRADING
(47 ] ' .CONTRACTOR ; •'� = :_ , , 'L
l [48] OTHER •
(49] TAN= PUMPED /-
[50] TANKCRUSHED i FILLED
Building Department
SITE PLAN
•
-I/
Page 2 of
,
•
�
\
`
,
^
•
Permit No
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 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 _-_ -- _ _r ‘0)C. ___ - - -•
Employing Plumber's NameF iJ AY1!)_ tee_ c t ri ► r No.__
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
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 $
STATE OF FLORIDA,
COUNTY OF DADE.
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
,
Block Subdivision. - - - - -� _ --
Ottlim/ A-43
Addition.___ Repairs No. of Stories
(Signed)_
No.--- - - 6D _ - - - - -- Street ' " E /0 2 N � Sf
2- 6 D eet - / d z
Capacity Gals
7_
under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Penn
plied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors
performed under this permit; and will post or cause to be posted for inspection on • f the work
required by the Act. The undersigned agrees to employ only such sub - contract s, on wor to be
licensed by Miami Shores Village.
D ate e _32, L79
Street__ J
My Commission Expires Notary Public, State of Florida
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.
NOTE: A re- inspection fee of 0.00 will be made when such re- inspection is made necessary by improper notice for inspection, or faulty
materials and /or workmanship.
BLOCK
7 Plumbing Inspector.
The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations as an employer of labor
lement, and has com-
im in the work to be
•e or notices as are
this permit, as are
Before me, the undersigned authority, a notary public, duly authorized to administer oa I s and take acknowledgments, personally appeared
CLOSETS
BATH
TUBS
SHOWERS
LAVA-
TORIES
SINKS
SLOP
SINKS
LAUNDRY
TUBE
URINALS
CATCH
BASIN
FLOOR
DRAIN
DRINKING
FOUNT' NS
TOTAL
FI %TURES
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
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 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 _-_ -- _ _r ‘0)C. ___ - - -•
Employing Plumber's NameF iJ AY1!)_ tee_ c t ri ► r No.__
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
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 $
STATE OF FLORIDA,
COUNTY OF DADE.
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
,
Block Subdivision. - - - - -� _ --
Ottlim/ A-43
Addition.___ Repairs No. of Stories
(Signed)_
No.--- - - 6D _ - - - - -- Street ' " E /0 2 N � Sf
2- 6 D eet - / d z
Capacity Gals
7_
under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Penn
plied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors
performed under this permit; and will post or cause to be posted for inspection on • f the work
required by the Act. The undersigned agrees to employ only such sub - contract s, on wor to be
licensed by Miami Shores Village.
D ate e _32, L79
Street__ J
My Commission Expires Notary Public, State of Florida
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.
NOTE: A re- inspection fee of 0.00 will be made when such re- inspection is made necessary by improper notice for inspection, or faulty
materials and /or workmanship.
BLOCK
7 Plumbing Inspector.
The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations as an employer of labor
lement, and has com-
im in the work to be
•e or notices as are
this permit, as are
Before me, the undersigned authority, a notary public, duly authorized to administer oa I s and take acknowledgments, personally appeared
MIAMI SHORES VILLAGE, FLORIDA r/
BUILDING ❑ DATE 7 - / `t r/ 19
ELECTRICAL ❑
PLUMBING ❑ PERMIT N? 5453 5 3 Contract — -
ROOFING License No. r r:
Work to be performed under this Permit t ~ `
Owner of
Building
Architect
Contractor
or Builder
Legal Lot 11
Description Bl
Address of
Building
CONTRACTOR OR BUILDER
Subdi-
vision
Value of
Project $
Amount of
Permit $
This permit is granted to the contractor or builder named above to construct the building or to install the equipment or device described in the applica-
tion 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 respon-
sibility for work done by his agents, servants or employees.
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 cold regulations
pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In as
cepting this permit I assume responsibility for all work done by either, myself, my agent, servant or employee.
BY AUTHORITY
Ali SOT
M A SHORES VILLAGE, FLA.
N9 6522
JOB 74+ 05 04 7r5
ADDRESS 2. (0 0 # C 1 c Z -� 0
INSPECTION SC-P6"1 i C- 1 A-,4-0 I j2 c e -'`�
'/ 7 TIME READY A' �' / V -�
REMARKS.
INSPECTOR DATE
�
Permit No
X73 /
Registered Architect and /or Engineer ..... __-
Employing Plumber's Name___/4_4A_ry►_J___ c /A^'/ (_
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
Size Septic Tank
Feet of Drain Tile..
Nature of Water Supply: City —Well
Amount of Permit $
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING niMIT
(Signed)-
(Signed)_
STATE OF FLORIDA, }
COUNTY OF DADE.
Before me, the undersigned authority, a notary public, duly authorized to a
Date
My Conunission Expires Notary Public, State of Florida
4)6
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 ______S "/�1 S No.
v 6 Street--__ e
Street.
Block
264
� Subdivision
str
Repairs No. of Stories. . ...... ..............
Type of Tank Capacity Gals.
__Dist. Feet of Tank or Drain Field from 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 5968, 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 rmed under this permit, as are
licensed by Miami Shores Village.
Master Plumber.
ster oaths and take acknowledgments, personally appeared
to me well known, and who, being by me first duly sworn, upon oath deposes and says that he is the
of the above described construction, that he has carefully read the foregoing application, and that he did sign the same, and that all facts
therein by hire stated are true.
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
INKS
SLOP
SINKS
LAUNDRY
TUBS
RINALS
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
Comm.
LIST
-
-
CHECK
�
Permit No
X73 /
Registered Architect and /or Engineer ..... __-
Employing Plumber's Name___/4_4A_ry►_J___ c /A^'/ (_
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
Size Septic Tank
Feet of Drain Tile..
Nature of Water Supply: City —Well
Amount of Permit $
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING niMIT
(Signed)-
(Signed)_
STATE OF FLORIDA, }
COUNTY OF DADE.
Before me, the undersigned authority, a notary public, duly authorized to a
Date
My Conunission Expires Notary Public, State of Florida
4)6
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 ______S "/�1 S No.
v 6 Street--__ e
Street.
Block
264
� Subdivision
str
Repairs No. of Stories. . ...... ..............
Type of Tank Capacity Gals.
__Dist. Feet of Tank or Drain Field from 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 5968, 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 rmed under this permit, as are
licensed by Miami Shores Village.
Master Plumber.
ster oaths and take acknowledgments, personally appeared
to me well known, and who, being by me first duly sworn, upon oath deposes and says that he is the
of the above described construction, that he has carefully read the foregoing application, and that he did sign the same, and that all facts
therein by hire stated are true.
NOTE: A re- inspection fee of $1.00 will be made when such re- inspection is made necessary by improper notice for inspection, or faulty
materials and /or workmanship.
BUILDING
ELECTRICAL
PLUMBING
ROOFING
Owner of
Building
Architect
Contractor
or Builder
Legal Lot
Description
Address of
Building / it
CiONTRACTOR OR BUIL
MIAMI SHORES VILLAGE. FLORIDA
❑ DATE ;='"-
PERMIT N° 5931 Contractor's
License No. 1 �y
❑ Work to be performed under this Permit
B1
Subdi-
vision
Value of
Project $
Amount of
Permit $
This permit is granted to the contractor or builder named above to construct the building or to install the equipment or device described in the application
herefor in strict compliance with all ordinances pertaining thereto and with the understanding that the work will be performed in compliance with any plans
drawings, statements or specifications that may have been submitted to and approved by the proper municipal authorities. This Permit may be revoked at any
time if the work is not done in compliance with such ordinances or if the plans are changed without authorization. A further cond4tion upon which this permit is
granted is the understanding that the contractor or builder named above assumes the responsibility for a thorough knowledge o &the ordinances and regulations
pertaining to the work covered hereby whether shown on the plans or drawings --cr in the sta ments or specifications and that he sumes responsibility for work
done by his agents, servants or employees. r� '\
BY
Signed
INS
SPEZOR
In consideration of the „Walla a to me of this permit I agree to perform the work covered hereunder in compliance with all ordinances ▪ and regulations
pertaining th- et and in strit t ity with the plans, drawings, statements or specifications submittefto the proper authorities of Miami Shores Village. In ac-
cepting thi/pe it I ass res r. ' • t work done by either, myself, my agent, servant or employee.
AUTHORITY
6
BUILDING
ELECTRICAL
PLUMBING
Owner of
Building
Architect
Contractor =
or Builder L
Legal Lot
Description
Address of
Building -..4 U r if,? `✓
Contractor's l
License No. / 1 1 _ -
Work to be performed under this Permit
This permit is granted to the contractor or builder named above to construct the building or to install the equipment or device described in the appli..
cation herefor in strict compliance with all ordinances pertaining thereto and w th 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 respon-
sibility for work done by his agents, servants or einployees.
MIAMI SHORES VILLAGE, FLORIDA
P - RMIT N° 4659
In consideration of the issuance to me of this permit I agree to perform the work covered hereunder in compliance with allnances and regultliOs
pertaining thereto and in strict conformity with th plans, drawings, statements or specifications submitted to the proper authoritie Miami Shore3�'Villflage.
In accepting this permit I assume responsibility for all work done by either myself, my agent, servant or employee.
CONTRACTOR OR BUILDER
a lr5 - 5 te r � BY
Bl.
/4.4
Signed.
Subdi-
vision
Value of
Project
t PECTOR
DATE r - 'f -
Aint. of
Permit
B y %/, ! x
AUTHORITY
x,
194