261 NE 102 St (10)INSTALL NEW DRAINFIELD
I Q
APP 0 3 2007
Inspector
Comments
Passed
Failed
Correction
Needed
Re- Inspection
Fee
($75)
No Additional Inspections can be scheduled until
re- inspection fee is paid.
M nspection Number INSP -
ern f Numbec PL2005-5
Inspection Date: 04/02/2007
Inspector: Levrack, James
Owner: OSTENDORP, THOMAS AND REBECCA
Job Address: 261 102 Street NE
Miami Shores Village, FL
Project: <NONE>
Contractor: STATEWIDE SEPTIC CONNECTIONS
Building Department Comments
Friday, March 30, 2007
Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
C.�
Block:
Permit Type: Imported Permit
Inspection Type: Final
Work Classification: <NONE>
Phone Number
Parcel Number 1132060134960
Lot:
Phone: 305 - 661 -6633
Page 2 of 2
Miami Shores Village
10050 NE 2nd Avenue
Phone: 305 - 795 -2204
Printed: 1 /14/2005
Applicant: JENNIFER MICHELLE
Owner: TRECO -SAGE
JOB ADDRESS: 261 NE 102
Parcel # 1132060134960
Signed: (INSPECTOR)
Plumbing Permit
Permit Number: PL2005 -5
TRECO -SAGE
JENNIFER MICHELLE
ST
Page 1 of 1
Contractor STATEWIDE SEPTIC CONNECTIONS Contractor's Address: 3590 SOUTH STATE ROAD 7, SUITE 26
Local Phone: 305 - 661 -6633
Permit Status: APPLIED Permit Expiration: 7/4/2005 Construction Value: $1,800.00
Work: INSTALL NEW DRAINFIELD
Legal Description: MIAMI SHORES SEC 1 AMD PB 10 -70 LOT 18 & LOT 19 & W1/2 OF LOT 20 BLK 36
Fees:
FEE2005 -68
FEE2005 -69
FEE2005 -70
FEE2005 -71
FEE2005 -72
FEE2005 -73
FEE2005 -74
Description
Building Fee
CCF
Notary Fee
Training and Education Fee
Technology Fee
Builders Bond
Scanning Fee
Total Fees:
Amount
$175.00
$1.20
$5.00
$0.40
$4.37
$300.00
$3.00
$488.97
Total Fees: $488.97
Total Receipts: $488.97
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:
Miami Shores Village
10050 NE 2nd Avenue
Phone: 305 - 795 -2204 Permit Number: PL2005 -5
Printed: 1/14/2005
Plumbing Permit
Applicant: JENNIFER MICHELLE TRECO -SAGE
Owner: TRECO -SAGE JENNIFER MICHELLE
JOB ADDRESS: 261 NE 102 ST
Parcel # 1132060134960
Permit Status: APPLIED Permit Expiration: 7/4/2005 Construction Value: $1,800.00
Work: INSTALL NEW DRAINFIELD
Signed:
(INSPECTOR)
Page 1 of 1
Contractor STATEWIDE SEPTIC CONNECTIONS Contractor's Address: 3590 SOUTH STATE ROAD 7, SUITE 26
Local Phone: 305 - 661 - 6633
Legal Description: MIAMI SHORES SEC 1 AMD PB 10 -70 LOT 18 & LOT 19 & W1/2 OF LOT 20 BLK 36
Fees: Description Amount
FEE2005 -68 Building Fee $175.00
FEE2005 -69 CCF- $1.20
FEE2005 -70 Notary Fee $5.00
FEE2005 -71 Training and Education Fee $0.40
FEE2005 -72 Technology Fee $4.37
FEE2005 -73 Builders Bond $300.00
FEE2005 -74 Scanning Fee $3.00
Total Fees: $488.97
Total Fees: $488.97
Total Receipts: $488.97
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:
BUILDING
PERMIT APPLICATION
FBC 2001
Permit Type (circle):
City )•i C Ci r-e State rid
State Certificate or Registration No. \ '"OO 1 0 4-
$ Value of Work For this Permit
1 �0
o
Type of Work: ❑Addition
Describe Work:
Submittal Fee $
Notary $ O Training/Education Fee $
Scanning $ ".] . 00 Radon $
Code Enforcement $
Total Fee Now Due $
(Continued on opposite side)
Permit Fee $
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
Miami Shores Village
Building Electrical
195,0o
Permit No. pi
Master Permit No.
Zip
Certificate of Competency No.
Architect/Engineer's Name (if applicable) N1 ' Phone #
Mechanical
Owner's Name (Fee Simple Titleholder) je F'r\� r 'eC°" l #
2 ,
Owner's Address ( 10 2... Si
Tenant/Lessee Name Phone #
Job Address (where the work is being done) 1 .1\ ■) 7 � .O2- S - k
City Miami Shores Village County Miami -Dade Zip - ' I.M
is Building Historically Designated YES NO I/
;��e ,I- k' # c-)° o,., I hC
`
Contractor's Company Name q " LO1(dl C 'G COO Phon S? 661 - G 0.
Contractor's Address O C. -. SA" `P-c - 1 # 2h
City L k k r O r'q li State pt.- Zip 2 3
Qualifier - Telee SG RA <a mOe∎
Square Footage Of Work: 3
❑Alteration ❑New '2 ace ❑ Demolition
tiv6 DYE r -€) t
* * * * * * * * * * * * * * * * * * * * * * * * * * ** F ees * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
REC VED
JAN 0 5 2e9
,—
Roofing
CCF $ 1,2n CO /CC
Technology Fee $ 4-.
Zoning Bond $ 5C-0 CO
Structural Plan Review. $
Bonding Company's Name (ifapplicable)
Bonding Company's Address 0 r
City State Zip
Mortgage Lender's Name (if applicable)
X Signature `
Owner
The foregoing instrument was
/_c_ , 20
day of 4 4, -- by
who is personally known to me or
NOTARY
S
My Commission Expires:
* * * * * * * * * * * * * * * * * * * * ** * * * * **
**** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
APPLICATION APPROVED BY:
Chc 05/13/03
*.
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 attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site
for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the
inspection will not be approved and aspection fee will be charged.
ent
wledged before me this
• L' Q 1
o las produced
As identification and who did take an oath.
Signa
Contractor
e foregoing instrument was acknowledged � �before m this
ay ° � , 20Q5 , by — e.AI ,, � 3
onded Thru
who is personally
NOTARY PUBLIC
S'gn:
e lit:
— • - #DD32387
.aQ Expires: May 26, 20Q8Iy Commission Expires:
Bonded Thru
* * ** ****4493***Attattia BeadiugGekidna * * * * * * * *,t * * * * * * * * * * **
c &o f60,1 -yo,
e or who has produced '
entification and who did take an oath.
ppYP
- � , � Ma bel 'Vargas
• tntnissio i) 231984
ing
* * * * * * * * * * * * * * **
* r'***************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
l" ` - 0,
Plans Examiner
Engineer
Zoning
7
LOT: 18 BLOCK: 36
DATE ISSUED: 12/30/04
STATE OF FLORIDA
DEPARTMENT OF HEALTH
ONSITE SWAGE TREATMENT AND DISPOSAL SYSTEM
CONSTRUCTION PERMIT
CONSTRUCTION PERMIT FOR:
[ ]New System [ ]Existing System [ ]Holding Tank
[ X ]Repair [ ]Abandonment [ ]Temporary [ NA ]
APPLICANT: Treco -Sage, Jennifer AGENT: SA0021074, Solomon Teresa
PROPERTY STREET ADDRESS: 261 NE 102 St Miami Shores FL 33138
PROPERTY ID #: 11- 3206 - 013 -4960
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.
THIS PERMIT IS NOT FOR AN ADDITION.
D [ 300 ]SQUARE FEET PRIMARY DRAINFIELD
R [ 0 ] SQUARE FEET
A TYPE SYSTEM: [ ]STANDARD
I CONFIGURATION: [ A ]TRENCH
N
SUBDIVISION: Miami Shores Sec N 1
[Section /Township /Range /Parcel No.]
[OR TAX ID NUMBER]
SYSTEM DESIGN AND SPECIFICATIONS
T -[ 900 ] Gallons SEPTIC TANK
Ao[" 0 ]Gallons
N [ 0 ]GALLONS GREASE INTERCEPTOR CAPACITY
K ;[. 0 ]GALLONS DOSING TANK CAPACITY [ 0 ]GALLONS @ [0
SYSTEM
SYSTEM
[ N ]FILLED
[ yBED
F LOCATION TO BENCHMARK: Existing Finished Floor Elev.: 11.50
I ELEVATION OF PROPOSED SYSTEM SITE [ 1.6 ] [ FEET ] [
E BOTTOM OF DRAINFIELD TO BE [ 3.9 ] [ FEET ] [
L
D FILL REQUIRED: [ 0.0 ]INCHES
DH 4016, 03/97 (Obsoletes previous editions which may not be used)
(Stock Number: 5744- 001 - 4016 -0) (ostds_cons_4016 -11
[ ] Innovative Other
EXCAVATION REQUIRED: [ 28.0 ] INCHES
CENTRAX #: 13 -SG -23394
DATE PAID:
FEE PAID : $
RECEIPT .
OSTDSNBR : 04 -4344- -R
MULTI - CHAMBERED /IN SERIES: [Y ]
MULTI - CHAMBERED /IN SERIES: [Y ]
]DOSES PER 24 HRS # PUMPS( 0 ]
[ N ]MOUND [ N ]
[ N ]
Ft NGVD
BELOW BENCHMARK /REFERENCE POINT
BELOW BENCHMARK /REFERENCE POINT
OTHER REMARKS:
1. Install 300 sf of drainfield in bed configuration.
2. Existing 900 gal. septic tank to be inspected for an appropriate pump -out and a solid
vertical deflector installed on the outlet device.
3. Invert elevation of drainfield to be no less than 8.07' NGVD.
J
4. Bottom of drainfield elevation to be no less than 7.57' NGVD.
SPECIFICATIONS BY: Andre, Paul TITLE:
APPROVED BY: Andre, Paul TITLE: Professional Engin Dade CHD
EXPIRATION DATE: 3/30/05
Page 1 of 2
.,
Scale: Each block represents 5 feet and 1 inch = 50 feet.
s , Ill 1.1 .-i
i � Ii _
fi_fi
f
p it
_ _ i
,
Site Plan submitted ey:
STATE OF FLORIDA
DEPARTMENT OF HEALTH
APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PERMIT
Permit Application Number(, ,1; - 1 Y i )y)
Notes: T(t'C®— Sa. - 2e1 r4 E 102 S+ MShares 3138
1::) Qa - CI w - d ace. ( VQ' 1-PI d
On (j •
Signature
Plan Approved Not Approved Date
B County Health Department
ALL CHANGES MUST BE APPROVED BY THE COUNTY HEALTH DEPARTMENT
D44 4015. 10/96 (Replaces HRS-H Form 4015 which may be used)
(Stock Number: 5744 -002- 4015 -6)
L
- y.ra - -T ;">.
II i l L∎
I r r ra
PART II - SITE PLAN
Wr` c C4 3 r
Title
Page 2 of 3
STATE OF FLORIDA
DEPARTMENT OF HEALTH
ODNSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM
" CONSTRUCTION INSPECTION AND FINAL APPROVAL
APPLICANT: Treco -Sage, Jennifer AGENT: SA0021074,
PROPERTY STREET ADDRESS:261 102 St Miami Shores FL 33138
LOT: 18
BLOCK: 36
PROPERTY ID #: 11- 3206 -013 -4960
SUBDIVISION: Miami Shores Sec N 1
[Section /Township /Range /Parcel No.]
[OR TAX ID NUMBER]
CHECKED [X] ITEMS ARE NOT IN COMPLIANCE WITH CHAPTER 64E -6, FLORIDA ADMINISTRATIVE CODE.
TANK INSTALLATION
[01] TANK SIZE [1] 900 [2]
[02] TANK MATERIAL
[03] OUTLET DEVICE
[04] MULTI- CHAMBERS
[05] LEGEND N/A
[06] WATERTIGHT
[07] LEVEL
[08] DEPTH OF LID
DRAINFIELD INSTALLATION
[09] AREA [1] 300 [2] 300
[10] DISTRIBUTION BOX /HEADER
[11] NUMBER OF DRAINLINES 0
[12] DRAINLINE SEPARATION
[13] DRAINLINE SLOPE
[14] DEPTH OF COVER
[15] SYSTEM ELEVATION
[16] SYSTEM LOCATION
[17] DOSING PUMPS 0
[18] AGGREGATE SIZE
[19] AGGREGATE SOURCE
[20] AGGREGATE WASHED
[21] AGGREGATE DEPTH
FILL /EXCAVATION MATERIAL
[22] FILL AMOUNT
[23] FILL TEXTURE
[24] EXCAVATION DEPTH
[25] EXCAVATION AREA
[26] REPLACEMENT MATERIAL
EXPLANATION OF VIOLATIONS:
CONSTRUCTION [ APPROVED
FINAL SYSTEM [ APPROVED
0.0
] Capers, John
] Capers, John
DH 4016, 03/97 (Obsoletes previous editions which may not be used)
(Stock Number: 5744- 002 - 4016 -4) [ostds cins ao16 -21
,31s /64 £
CENT 7:13 -SG -23394
DATE PAID:
FEE PAID :
RECEIPT .
OSTDSNBR :04 4344 -
SETBACKS
[27] SURFACE WATER
[28] DITCHES
[29] PRIVATE WELLS
[30] PUBLIC WELLS
[31] IRRIGATION WELLS
[32] POTABLE WATER LINES
[33] BUILDING FOUNDATION
[34] PROPERTY LINES
[35] OTHER
FILLED /MOUND SYSTEM
[36] DRAINFIELD COVER
[37] SHOULDERS
[38] SLOPES
[39] STABILIZATION MATERIAL
ADDITIONAL INFORMATION
[40] UNOBSTRUCTED AREA
[41] STORMWATER RUNOFF
[42] ALARMS
[43] MAINTENANCE AGREEMENT
[44] BUILDING AREA
[45] PLUMBING FIXTURES
[46] FINAL SITE GRADING
[47] CONTRACTOR STATEWIDE
[48] OTHER
ABANDONMENT
[49] TANK PUMPED
[50] TANK CRUSHED AND FILLED
Dade CHD Date: 1/3/05
Dade CHD Date: 1/3/05
Page 2 of 2
4
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Date Job Address sc;(61 PI E foz Tax Folio
Legal Description Historically Designated: Yes No
Owner/Lessee / Tenant / • / JC , Y/rl fI C.2,
Owner's Address g6/ / - (O 4
Contracting Co.
q t-tilt4 E . 64,0
Qualifier
Square Ft.
•
otary as to Ovt¢i
My Commission
plA• G1 f rrm--
State # Municipal # Competency # Ins. Co.
Architect/Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type (circle one): BUILDING ELECTRICAL PLUMBING M
EC // CAL ROOFING PAVING FENCE SIGN
T( fit
FEES: PERMIT RADON
WORK DESCRIPTION :✓ H
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 LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT.)
Application is hereby made to obtain a permit to do work and installation as indicated above, and on the attached addendum (if applicable). I
certify that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that separate
permits are required for ELECTRICAL, PLUMBING, SIGNS, POOLS, ROOFING and MECHANICAL WORK.
OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable
laws regulating construction and zoning. Furthermore, I authorize the above -named contractor to do the work stated.
_3/o /9 9
of owner and/or Condo President Date
SiTgE n
State of Florida
My Comm. Exp: 08/04/0
Comm#: CC669180
APPROVED:
Zoning Building _ 1
Mechanical Plumbing
Master Permit # 9 3
Phone '3o5 T 7S4 71 3 7
Address /11 1 5 2 Ai L.J. 7 --
SS# Phone 651-71
Signature of
Not as to Contrac
My ommission E
C.C.F. NOTARY
Electrical
ARY SEAL
es: GIADYS J VILIAR
NOTARY PUBLIC STATE OF FLORIDA
COMMISSION NO. CC714103
COMMISSION EXP. MAR 1
BOND 3
TOTAL DUE
Date
iy
Engineering
1
CONSTRUCTION PERMIT F
[/ New System [Existing System [Holding Tank [ ]. Temporary/Experimental
[ y] Repair [Akc Abandonment [ rOther(Specify)
SYSTEM DESIGN AND SPE
0
T
H
E
R
SPECIFICATIONS BY:
APPROVED BY:
DATE ISSUED: - /7 7
STATE OF FLORIDA
DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES
ONSITE SEWAGE DISPOSAL SYSTEM
CONSTRUCTION PERMIT
Authority: Chapter 381, FS & Chapter 10D -6, FAC
APPLICANT: AGENT: C c
PROPERTY STREET ADDRESS:
LOT: B OCK: 4 SUBDIVISION:
PROPERTY ID #: 4( 6 Q /$7 G [SECTION /TOWNSHIP /RANGE /PARCEL NUMBER]
[OR TAX ID NUMBER]
SYSTEM MUST BE CONSTRUCTED IN ACCORDANCE WITH SPECIFICATIONS AND STANDARDS OF CHAPTER 10D -6, FAC
REPAIR PERMITS AND HOLDING TANK PERMITS EXPIRE 90 DAYS FROM THE DATE OF ISSUE. ALL OTHER PERMITS
EXPIRE ONE YEAR FROM THE DATE OF ISSUE. HRS APPROVAL OF SYSTEM DOES NOT GUARANTEE SATISFACTORY
PERFORMANCE FOR ANY SPECIFIC PERIOD OF TIME. ANY CHANGE IN MATERIAL FACTS WHICH SERVED AS A
BASIS FOR ISSUANCE OF THIS PERMIT, REQUIRE THE APPLICANT TO MODIFY THE PERMIT APPLICATION. SUCH
MODIFICATIONS MAY RESULT IN THIS PERMIT BEING MADE NULL AND VOID.
T [ 2J ] G ALLONS / GPD] 4PTIC KfAEROBIC UNIT CAPACITY MULTI- CHAMBERED /IN SERIES:[ ]
A [ ] [GALLONS / GPD] CAPACITY MULTI- CHAMBERED /IN SERIES:[ ]
N [ ] GALLONS GREASE INTERCEPTOR CAPACITY [MAXIMUM CAPACITY SINGLE TANK: 1250 GALLONS]
K [ GALLONS PER DOSE DOSING ANK CAPACITY DOSE RATE [ ] PER 24 HRS NO. OF PUMPS: [ ]
3- ,-� 7 uw A-0 g f 4 fr (-e
D [4t57-7 J SQUARE FEET PRIMARY DRAINFIELD SYSTEM
R [ SQUARE FEET
A TYPE SYSTEM:
I CONFIGURATION:
N S
F LOCATION OF BENCHMARK: /f 4Aa i - l 1 /'� C /-7/ -
I ELEVATION OF PROPOSED SYSTEM SITE [ /C ] gaNCHESWT] [ABOVE :ELOW = ENCHMARK EFERENCE P OTN
E BOTTOM OF DRAINFIELD TO BE [ t(' [INCHES /FT] [ABOV BELOWrBENCHMARK
D FILL REQUIRED: [ ] INCHES EXCAVATION REQUIRED: 02-] INCHES
SYSTEM
[ ] STANDARD [ ] FILLED
[ ] TRENCH [ cr]- BED
V
TITLE:
HRS -H Form 4016, Mar 92 (Obsoletes previous editions which may not be used)
(Stock Number: 5744 - 001 - 4016 -0)
TITLE:
BUILDING DEPARTMENT
[ ] MOUND
PERMIT #
crik o C.0
DATE PAID 3 - jgr: 71?
FEE PAID $ 7 ) 1
RECEIPT #
[
EFERENCE POINT
CPHU
EXPIRATION DATE: c i[ q
Page 1 of 2
INSTRUCTIONS:
PERMIT NUMBER: Permit tracking number assigned by CPU,.
APPLICATION FOR: Check type of permit, if 'Other" specify type in blank.
APPLICANT: Property owner's full name.
TELEPHONE: Telephone number for applicant or agent.
AGENT Property owner's legally authorized representative.
MA /LIN ADDRESS: P.O. box or street mailing address for applicant or agent.
LOT, 3LOCX, SUBDIVISION or
?ZOPERTY IDB: 27 character id number for property. (CPI may ^eci,:tire property appraiser ID 0 or saction / :ownrti1:4_ iurriee.
SYSTEM DESIGN AND
SPECIFICATIONS:
TANK: Minimum specifications from Chapter 10D -6, FAC.
DRAINFiELD: Minimum specifications from Chapter I0D -6, FAC.
OTHER: Other specifications, such as operating permit requirements, low - volume flush toilets, variance n:ovirt;3.
SPECIFICATIONS BY: Name of individual providing specifications. If designed by a registered engineer must be sealed.
APPROVED BY: County Public Health Unit (CPCiU) personnel reviewing and approving permit.
DATE ISSUED: Date permit is issued by CPHU.
EXPIRATION DATE: One year from date issued if the system has not been installed. Permits for system repairs become void 90 days from the d ,tt:
issued.
STATE OF FLORIDA
DEPARTMENT OF HEALTH
APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PERMIT
Permit Application Number '�/?o G 0 S
(- - 1 - 1 - -0-1-0-3-1-1 - -- 1 I-- L 1 _ 1 __1
7111 -11(1
J 1 Bill (I III I
I L_I_I 1 f( 1 - Ai L_I
i I l I II i I
._Lu u I 1 I - n nl_,I_Ju 1 LL_I_I
1 1
_ 1I
i_I I ' I I I - 1_ I I I I l ( I I I_ 11
I _I I ,_I 11 I I I._ I I -17 f
LLI_ L- I ( 11_I 4 1 L IiL I 1
1 1 1 1 1 1 1 1 1 I I l lI 1 i I _ill_
I I
PART II - SITE PLAN-
1
I _I
I l 1
IJ 111_1_1_ LI
114_0_1 1 _1_ J
'-!--!--1.--
Notes:
By
Site Plan submitted by:
Plan Approved
- I I
- -
1111l
I ____1
_JI"I -
I I I _iII I I I1
_II__IJ_L II ,
I I LIJ_I IL
_]_I___ .J 1
JLII_ — C , 0
I Iii(1 1 1
I 1_1_ r_ c r_2 i iJ
i
r1_ 71-61 H 4 11-311"7D-
- U 1 _
I I -I-I:1 l I I �"'I i t I "7 ( (
I I - I I I l 1 1 (1 � � U ( �i
1 (-1-1 (,;, 1 I
DH 4015, 10/96 (Replaces HRS-H Form 4015 which may be used)
(Stock Number: 5744-00 2-4015-6)
L _= NMI I __Clip I l. _L 1 _i I (2; - >~i__ I_ I - I__ 1_I
1 1 _ u I 1 1_ ; I �I CI_ -!_I
- I ( I 1 1 (i I_J I _I tic-__ �
� 1 - 1 _ _(-1 I 4- - _ J 1_ ��_
II 1
I I J L 1 �Il �J _ l L I (- 1 =L [ [�i Li_,C L
Li =LI 1 -i i_ 1 C 1 I L �J 1 _' -L 1_(_i i 1 r 7 I I_r
I J IJ 1 I I I 1 I i I 1 1 l L� I_
- - 1 'I I I I C4.-J On 111 (x I
I_ I ID _ Lj I I _L.
r
1 1 4 _1 1 1 Fit 1
. i l _1 I L•� �d-•a
sD IL
3(04,6) rG l am`<< 1 kgeti&I
Signature
Not Approved
1 421.2 ° 26r? °'
Date
County Health Department
ALL CHANGES MUST BE APPROVED BY THE COUNTY HEALTH DEPARTMENT
Page 2 of 3
•
r
PERMIT APPLICATION FOR MUNICIPALITIES OF DADE COUNTY
(OWNER TO RETAIN COPY)
Job Address
Legal Description ef6 41(}4W 34 7/61d Master Permit #
Owner / Lessee / Tenant /
Owner's Address eA 1 ,. / /
Contracting Co. Aj' 1/ it �,,{� /,Address
#
Qualifier M(7/ ri6�f � -
State#
Architect /Engineer
Bonding Company
Mortgagor
Signature
Date:
Note[
My
*
PERMIT FEE:. APPROVED:
Zoning
Mechanical
/a4. 4 91 .
ry as /t Owner and /or Co o
ommission Expires: 1//!/72
* * * *
Competency #
President
*
Address
Address
Address
Tax Folio // , faod IV/910J •
.� /,'-
zr-?,_
Phone
phone
Ins. Co.
Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL PAVING FENCE SIGN
WORK DESCRIPTION 1.) / 4 f 4j
Square Ft. V � Estimated Cos
WARNING TO OWNER: YOU MUST RECORD A NOTICE OF COMMENCEMENT AND YOUR FAILURE TO
DO SO MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY (IF YOU
INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE
RECORDING YOUR NOTICE OF COMMENCEMENT).
Signature of Contractor
Date:
Other
�3,S�Dr do
Application is hereby made to obtain a permit to do work and installation as indicated. 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 authors a the above -named contractor to do the work stated.
jf& L e
lt Imo,
of Owner and /or Condo President
or Owner - Builder
44(
ry to Contractor or Owner - Builder
* My v Commission Ex pires: .t///f2
Fire
Building g E l lectrical
Plumbing 1 #Engineering
Date of Application
Name of Owner
Mailing Address of Owner l6/,( - /a
Owner's Agent
Agent's Mailing Address
Property Street Address
S TATE OF FLORIDA
DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES
APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PERMIT
r
Type of
Establishment
HRS-H Form 4015, Feb 85 (Obsoletes previous editions which may not be used)
(Stock Number. 5744- 001 - 4015 -1)
Authority: Chapter 381, FS
Chapter 10D -6, FAC
Permit Application Number
PART I - APPLICATION -
Telephone Number
Lot No. Block No Subdivision Date Subdivided
NOTE: IF NOT IN A SUBDIVISION ATTACH A METES AND BOUNDS DESCRIPTION
This Application is for: New System Repair
TOTAL FLOW =
Type of No. Bedrooms Heated or Cooled Area
Residential (each dwelling unit) (each dwelling unit)
Sewage Flow
(Gallons per day) Based On
ft
ft
Telephone No
A
773'
Builder
Existing System
Sewage Flow
No. Dwelling Sewage Flow
Units (Gallons per day)
Exact Directions to Property
AUDIT CONTROL NO / , f •
Applicant's Signatur Q � 41
7
;7./ 'J )
Page 1 of 3
- -,
CLOtfCTB
BATH"
TUBS
SHOWER/
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
SWIM'G
POOL
CONYR.
Liar
CHECK
..
-
Penult. No. 1
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. .
Otto G 261 N.E. 1024).d St
Owner's Name and Address __ —_ No. ---------- •-- -___ -� Street_.:____. -_
Registered Architect andior Engineer____
Employing Plumber's Name • Rose Septic Tank — - -__ -_-- NO. 55 _._ _. - Street. W. 3rd Ave. ,Hialeah
— --
Location and Legal Description Lot Block Subdivision __.__ - --
261 N.E..102nd S
Street and Number where work is to be performed —No Street
State work to be performed and purpose of building (By Floors) ______ 1 _Elk. Dr . Relay
New Building____- _ —__._ -._ Remodeling______ ____. _ Addition_-__ -____ Repairs
• •
. Size Septic Tank _- ... ______._---- ____ -- - -__— Type of Tank—_
Feet of Drain Tile 25 Rela —Dist. Feet of Tank or Drain Field from Well
Nature of Water Supply: City — Well
Amount of Permit $3
----- '- _ -------- - - - - --
The undersigned applicant for this building permit does hereby certify that he understands and accepts his ob
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 e
performed under this permit; and will post or cause to be posted' for inspection on the site of the work su
required by the Act. The undersigned agrees to employ only such sub - contractors, on work to be pe
licensed by Miami Shores Village.
My Commission Expires
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
__Size of Soakage Pit
--- (Signed )---
( Signed)__
Capacity Gals
No. of Stories
" Notary Public, State of Florida
3 : .
Date 6/15/61
Plumbing Inspector.
s as an employer of labor
pplement, and has coin -
by him in the work to be
is notice or notices as • are
d under this permit, as are
• Master Plumber.
STATE OF FLORIDA,
COUNTY OF DADE.
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeared
to me well known, and who, being by me first duly sworn, upon oath deposes and . says that he is the
of the above described construction, that 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 $L00 will be made when such re- inspection is made necessary . by improper notice for inspection, or faulty
materials and/or workmanship.
Permit N ) °-(17
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.
New Building __--- -_---- -.• - -- - -- -_ -- Remodeling
My Commission Expires
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING E `►y;a IT
Amount of Permit $ 1.00 each - - -- _ _ — _ (Signed) ____ - - --
Date April 7, 1958
261 N. E. Street 102 Street
Owner's Name and Address ________ ntto _H _ _ No.
Registered Architect and /or Engineer___—_._—_.— _._____..__— ______— _--
Employing Plumber's Name___STERN__ c...aFFER CONST. CO. No. .__— �500 Street. N•_. Miami Avenue
Location and Legal Description Lot _ Block
Street and Number where work is to be performed —No 237
State work to be performed and purpose of building (By Floors) _ t w11 —
__--------- -___ -_- Subdivision
st N. E. 102nd Street
Addition-- .----- •-- .----- _ -• -•- Repairs No. of Stories ... .......................
Size Septic Tank Type of Tank___ Capacity Gals
Feet of Drain Tile._ Dist. Feet of Tank or Drain Field from Well
Nature of Water Supply: City —Well _________Size of Soakage Pit
Notary Public, State of Florida
Plumbing Inspector.
The undersigned applicant for this building permit does hereby certify that he understands and accept is obligations as an employer of labor
under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws o Florida Permanent Supplement, and has com-
plied with the provisions thereof, and will require similar compliance from all contractors or s • . tractors 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 • th work such public notice or notices as are
required by the Act. The undersigned agrees to employ only such sub- contractors, on k to be perfo - :d under this permit, as are
licensed by Miami Shores Village. $ ' ; , ' 1 T / � ' . • i� 1 ��
►i l �
�.i 4, !//
G. Jaff :'� / / Master Plumber.
TON CO.
STATE OF FLORIDA, t 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 swom, 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.
re- inspection fee of $1.00 will be made when such re- inspection is made necessary by improper notice for inspection, or faulty
/or workmanship.
CLOSETS
BATH
TUBS
SHOWERS
LAVA.
TORIES
S INKS
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 N ) °-(17
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.
New Building __--- -_---- -.• - -- - -- -_ -- Remodeling
My Commission Expires
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING E `►y;a IT
Amount of Permit $ 1.00 each - - -- _ _ — _ (Signed) ____ - - --
Date April 7, 1958
261 N. E. Street 102 Street
Owner's Name and Address ________ ntto _H _ _ No.
Registered Architect and /or Engineer___—_._—_.— _._____..__— ______— _--
Employing Plumber's Name___STERN__ c...aFFER CONST. CO. No. .__— �500 Street. N•_. Miami Avenue
Location and Legal Description Lot _ Block
Street and Number where work is to be performed —No 237
State work to be performed and purpose of building (By Floors) _ t w11 —
__--------- -___ -_- Subdivision
st N. E. 102nd Street
Addition-- .----- •-- .----- _ -• -•- Repairs No. of Stories ... .......................
Size Septic Tank Type of Tank___ Capacity Gals
Feet of Drain Tile._ Dist. Feet of Tank or Drain Field from Well
Nature of Water Supply: City —Well _________Size of Soakage Pit
Notary Public, State of Florida
Plumbing Inspector.
The undersigned applicant for this building permit does hereby certify that he understands and accept is obligations as an employer of labor
under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws o Florida Permanent Supplement, and has com-
plied with the provisions thereof, and will require similar compliance from all contractors or s • . tractors 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 • th work such public notice or notices as are
required by the Act. The undersigned agrees to employ only such sub- contractors, on k to be perfo - :d under this permit, as are
licensed by Miami Shores Village. $ ' ; , ' 1 T / � ' . • i� 1 ��
►i l �
�.i 4, !//
G. Jaff :'� / / Master Plumber.
TON CO.
STATE OF FLORIDA, t 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 swom, 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.
re- inspection fee of $1.00 will be made when such re- inspection is made necessary by improper notice for inspection, or faulty
/or workmanship.
A_pril I 1258
Permit No 7 ° -2- 3 Date
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 Otto ET, a011 e and Address No 261 Street 1 \L, .IL, 102 Straet.
Registered Architect and/or Engineer_____
Employing Plumber's Name STERN Re CONST. No. 2500
Location and Legal Description Lot_____
Street and Number where work is to be performed—No 261
State work to be performed and purpose of building (By Fl s 1 2 - 2 13 1 - Y wells
New Building Remodeling__ Addition.
Size Septic Tank Type of Tank_
Feet of Drain Tile __Dist. Feet of Tank or Drain Field from Well
Size of Soakage Pit
Nature of Water Supply: City—Well
Amount of Permit $ (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 o th work such public notice or notices as are
required by the Act. The undersigned agrees to employ only such sub-contractors, on o be performed under this permit, as are
licensed by Miami Shores Village.
JAFri ION CO.
( Signed • /0 4" /
R■IL G. JAFF0 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.
My Commission Expires
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
''Is and/or worlcmanship.
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING 'MIT
Block
Subdivision
Street N. E.102 Street
Repairs No. of Stories.
Capacity Gals
Notary Public, State of Florida
CLOSETS
BATH
TUBS
SHOWERS
LAVA,
TORIES
SINKS
SLOP
SINKS
LAUNDRY
Tuns
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 I M G
POOL
CONTR.
LIST
---
CHECK
A_pril I 1258
Permit No 7 ° -2- 3 Date
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 Otto ET, a011 e and Address No 261 Street 1 \L, .IL, 102 Straet.
Registered Architect and/or Engineer_____
Employing Plumber's Name STERN Re CONST. No. 2500
Location and Legal Description Lot_____
Street and Number where work is to be performed—No 261
State work to be performed and purpose of building (By Fl s 1 2 - 2 13 1 - Y wells
New Building Remodeling__ Addition.
Size Septic Tank Type of Tank_
Feet of Drain Tile __Dist. Feet of Tank or Drain Field from Well
Size of Soakage Pit
Nature of Water Supply: City—Well
Amount of Permit $ (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 o th work such public notice or notices as are
required by the Act. The undersigned agrees to employ only such sub-contractors, on o be performed under this permit, as are
licensed by Miami Shores Village.
JAFri ION CO.
( Signed • /0 4" /
R■IL G. JAFF0 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.
My Commission Expires
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
''Is and/or worlcmanship.
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING 'MIT
Block
Subdivision
Street N. E.102 Street
Repairs No. of Stories.
Capacity Gals
Notary Public, State of Florida
BUILDING
ELECTRICAL
PLUMBING
ROOFING
❑ PERMIT N? 7023
❑
Owner of
Building
Architect
Contractor
or Builder -
Legal
Description
Lot
Address of
Building
CONTRACTOR OR BUILDER
MIAMI SHORES VILLAGE. FLORIDA
Work to be performed under this Permit
B1
INSPECTOR
Value of
Project $
DATE
Contractor's
License No.
Subdi-
vision
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 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 responsibility for work
done by his agents, servants or employees.
Signed BY.
In consideration of the issuance to me of this permit I agree to perform the work covered hereunder in compliance with all ordinances and regulations
pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In ac-
cepting this permit I assume responsibility for all work done by either, myself, my agent, servant or employee.
BY AUTHORITY
195
BUILDING
ELECTRICAL
PLUMBING
ROOFING
Owner of
Building
Architect
Contractor '.
Address of /
Building ,
MIAMI SHORES VILLAGE. FLORIDA
_,
❑ DATE . 'r - 79''7 1951
® PERMIT N9 4521 Contractor's
License No. • /T f f
❑ Work to be performed under this Permit 1 y f A e .P - , e-i- -tA + r A ∎a
/
or Builder /a
Legal L ot
Description
P
Bl.,
BY
r/
Subdi-
vision
Value of
Project $
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 aslu tt es the responsibility for a thorough knowledge of the ordinances and regulations
pertaining to the work covered hereby whether shown on the 'plans or.drg,.fvings or in the statem ents or specifeions,ae d that he assumes responsibility for work
done by his agents, servants or employees. f /
Signed: , f /X I• ,,� !_A� ( ,' ,o r
INSI
Amount of
Permit $
In consideration of the issuance to me of this permit I agree to perform the work covered hereunder in compliance with all ordinances and regulations
pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In ac-
cepting this permit I assume responsibility for_gll work donee by either, myself, my agent, servant or employee.
CONTRA-aTOR OR BUILDER
AUTHORITY 6
Permit No _____ __ -- ®.._ 1 _ - -�-
Application is hereby made for the approval of the detailed statement of the plans and specifications herewith subdiitted fofthe 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
Nature of Water Supply: City —Well.
Amount of Permit $ - - --
ss.
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
(Signed)
( Signed).
ifIL2 Cd5e--‘05
No.___ Street
Registered Architect and /or Eng r - -__
_7,
Employing Plumber's Name__ 8 = - / -' il' i c _ No._r _ _.__ Street__
Location and Legal Description Lot_ -- .__-- _------ _ L/ ._ Block Subdivision
Street and Number where work is to be performed—No. __y _ Street
State work to be performed and purpose of building (By Floors)
New Building _ Remodeling____ -_- — Addition.
, 114?-9,"
Repairs No. of Stories _
Size Septic Tanks - - -- Type of Tank Capacity Gals.____ re) _ f')
Feet of Drain Tile___ I _A___._ Dist. Feet of Tank or Drain Field from Well
Size of Soakage Pit
l umbing 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 tlie Act. The undersigned agrees to employ only such sub- contractors, on work to be performed under this permit, as are
licensed by Miami Shores Village.
Master Plumber.
STATE OF FLORIDA,
COUNTY OF DADE.
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeared
to me well known, and who, being by me first duly sworn, upon oath deposes and says that he is the —
of the above described construction, that he has carefully read the foregoing application, and that he did sign the same, and that all facts
therein by him stated are true.
My Commission Expires Notary Public, State of 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 worlananship.
CLOSETS
BATH
T UBS
SHOWERS
LAVA
TORIES
SINKS
SLOP
SINKS
LAUNDRY
TUBE
URINALS
CATCH
BASIN
FLOOR
DRAIN
DRINKING
FOUNT'NS
TOTAL
FIXTURES
CoNTR.
LIST
CHECK
SEPTIC
TANK
SEWER
CONN.
DRAIN
FI ELD
SOAKAGE
PIT
GREASE
TRAP
SOLAR
HEATER
DEEP
WELL
SPRKLR.
SYSTEM
SWIM•G
POOL
CONTR.
LIST
CHICK
r
-
Permit No _____ __ -- ®.._ 1 _ - -�-
Application is hereby made for the approval of the detailed statement of the plans and specifications herewith subdiitted fofthe 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
Nature of Water Supply: City —Well.
Amount of Permit $ - - --
ss.
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
(Signed)
( Signed).
ifIL2 Cd5e--‘05
No.___ Street
Registered Architect and /or Eng r - -__
_7,
Employing Plumber's Name__ 8 = - / -' il' i c _ No._r _ _.__ Street__
Location and Legal Description Lot_ -- .__-- _------ _ L/ ._ Block Subdivision
Street and Number where work is to be performed—No. __y _ Street
State work to be performed and purpose of building (By Floors)
New Building _ Remodeling____ -_- — Addition.
, 114?-9,"
Repairs No. of Stories _
Size Septic Tanks - - -- Type of Tank Capacity Gals.____ re) _ f')
Feet of Drain Tile___ I _A___._ Dist. Feet of Tank or Drain Field from Well
Size of Soakage Pit
l umbing 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 tlie Act. The undersigned agrees to employ only such sub- contractors, on work to be performed under this permit, as are
licensed by Miami Shores Village.
Master Plumber.
STATE OF FLORIDA,
COUNTY OF DADE.
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeared
to me well known, and who, being by me first duly sworn, upon oath deposes and says that he is the —
of the above described construction, that he has carefully read the foregoing application, and that he did sign the same, and that all facts
therein by him stated are true.
My Commission Expires Notary Public, State of 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 worlananship.
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
Permit No I ,
Date- --- - --
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 al , roles „and, =.>:egulneions..of, lle Building Division
of Miami Shores Village shall be complied with, w' - - plans - '- S ' - kept at
building during progress of work.
Owner's Name and Address ______- .___ No _____ ° Street___s
Registered Architect and /or Engineer
Employing Plumber's Name
Location and Legal Description
Street and Number where work is to be performed —No Street
State work to be performed and purpose of building I(By Floors)
New Building Remodeling___ Addition Repairs No. of Stories
No.
Street_
Size Septic Type of Tank Capacity Gals.______
Dist. Feet lof Tank or Drain Field from Well__________— _________________�_�_________
Feet of Drain Tile
Nature of Water Supply: City —Well
/
Amount of Permit $_________ _______________
Size of Soakage Pit
My Commission Expires Notary Public. State of Florida
NOTE: A re- inspection fee of $1.00 will be made
materials and /or workmanship.
(Signed)
(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 under signed agrees to employ only such sub- contraett"rs, on work to be performed under this permit, as are
licensed by Miami Shores Village.
- r
Master Plumber.
STATE OF FLORIDA,
COUNTY OF DADE. ss.
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.
when such re- inspection is made necessary by improper notice for inspection, or faulty
CLOSETS
BATH
TUBS
SHOWERS
LAVA
TORIES
SINKS
SLOP
SINKS
LAUNDRY
TUBS
URINALS
CATCH
BASIN
FLOOR
DRAIN
DRINKING
FOUNT'NS
TOTAL
FIXTURES
CONTR.
LIST
I
CHECK
SEPTIC
TANK
SEWER
CONN.
DRAIN
FIELD
SOAKAGE
PIT
GREASE
TRAP
SOLAR
HEATER
DEEP
WELL
SPRKLR.
SYSTEM
SWIM•G
POOL
CONTR.
LIST
4
CHECK
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
Permit No I ,
Date- --- - --
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 al , roles „and, =.>:egulneions..of, lle Building Division
of Miami Shores Village shall be complied with, w' - - plans - '- S ' - kept at
building during progress of work.
Owner's Name and Address ______- .___ No _____ ° Street___s
Registered Architect and /or Engineer
Employing Plumber's Name
Location and Legal Description
Street and Number where work is to be performed —No Street
State work to be performed and purpose of building I(By Floors)
New Building Remodeling___ Addition Repairs No. of Stories
No.
Street_
Size Septic Type of Tank Capacity Gals.______
Dist. Feet lof Tank or Drain Field from Well__________— _________________�_�_________
Feet of Drain Tile
Nature of Water Supply: City —Well
/
Amount of Permit $_________ _______________
Size of Soakage Pit
My Commission Expires Notary Public. State of Florida
NOTE: A re- inspection fee of $1.00 will be made
materials and /or workmanship.
(Signed)
(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 under signed agrees to employ only such sub- contraett"rs, on work to be performed under this permit, as are
licensed by Miami Shores Village.
- r
Master Plumber.
STATE OF FLORIDA,
COUNTY OF DADE. ss.
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.
when such re- inspection is made necessary by improper notice for inspection, or faulty
BUILDING
ELECTRICAL
PLUMBING
Owner of
Building
v
Architect
Contractor
or Builder
Legal Lot
Description
Address of
Building
z(ei
ONTRAC a` "sR : ILDER
MIAMI SH
Bi.
m
PERMIT N9 3332
Work to be performed under this Permit
(„tet,../' '• ='
RES VILLAGE, FLORIDA
DATE * 194
Contractor's 777
License No
r i m
Value of
Project
WARNING: This Construction may tie in lrlalan of
War Production Board General limitations Order
'ou are cautioiEd to consult your War Pio6,,c
Ilyd office before starting the work author;z..t ;
swi - permit.
vision
Amt. of
Permit
1 r
BY AUTHORITY
474
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 knay 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 ordi ces or if the plans are changed without authorization. A further condition
upon which this permit is granted is'the understanding that the contractor builder named above assumes the responsibility for a thorough knowledge of
the ordinances and regulations pertaining to the work covered hereby whet er shown o the pia t_ . drawings or in the statements cifications and
Signed. Illi
that he assumes responsibility for work done by his agents, servants or empoyees.
INSPECTOR By
In con ' oration of the issuance to me of this permit I agree to perform the workccovered hereunder in compliance with all ordinances and regula-
tions pert ' i „ here o and • .strict conformity with the plans 'drawings, statements or specifications submitted to the proper authorities of Miami Shores
Village. acceptinJthi a I assume responsibility for all work done by either myself, my agent, servant or employee.
/UILDING
"/ ELECTRICAL
PLUMBING
Owner of
Building ��W✓*
Architect
Contractor
or Builder
Legal 1' Lot •
Description
Address of
Building
MIAMI SHORES VILLAGE, FLORID
DATE
PERMIT
r
Work to be perfo
Ite
N9 3162 r
under th i Perini
•
Subd'i-
vision
Value of
Project
BY
w• • , it
Amt.
Perri*
By
Z.
, 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 ordnances pertaining thereto and with the understanding that the work will bb performed in compliance
with any plans, drawings, statements or specifications that may have been submitted o and approved by the propeinunicipal authorities This Permit may
be revoked at any time if the work is not done in compliance with such ordinance : if the .labs are changed wit out aurhorizati2n.. fu her condition
upon which this permit is granted is the u rstand, that the contractor or burl r a. bpve ; s es he responsibility for a t . °knowledge of
the ordinances and regulations pertaining to the work covered hereby whether s'hd� . plan ,� #' ra "a� � r,�in the statement . e .cations and
•
that he assumes responsibility for work done by his 'agents servants or employees .; s •O• ,` • •
• Signed _ _ ___ _. _.
In consideration of the issuance to me of this; permit I agree to perform the work covered hereunder, in compliance with al ordinances and regula-
tions pertaining thereto acid in strict conftwmity with the .lans, drawingsstatements, specifications submitted to the proper authorities of Miami Shores
Village. In acce ti 't I as • me , s y flit ' .r a� work done by;eiti er myself, my•agent, servant or employee
•
AUTHORITY
Nature of ate Supply: City —W
Amount of Permit $_
MIAMI
PLUMB!
APPLICATION FOR PLUMBING PERMIT
Date_ __ -"�!
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 co i ,, whether herein specified or not. A copy of approved plans and specifications must kept at
building during progress of work.
Qwner's Name and Address ___ ______
Registered Architect and /or Engineer
Employing Plumber's Name __ No Street
Location and Legal Description Lot____ _ �______ _________________________Block
Street and Number where work is to be performed —No Street
State work to be performed and purpose of building (By Floors)
New Building — Remodeling Addition Repairs
Size Septic Tank______ ______— _______________________ Type of Tank . Capacity Gals._
Feet of Drain Tile ______________________— _______ Dist. Feet of Tank or Drain Field from Well
My Commission Expires
SHORES VI LLAG E
NG INSPECTION DEPARTMENT
No 26k
Street ! e72
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 under signed agrees to employ only such sub- contra�r6c - �? o . ork to be performed under this permit, as are
licensed by Miami Shores Village.
(Sign
STATE OF FLORIDA,
COUNTY OF DADE. ss.
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.
No. of Stories
Master Plumber.
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.
DRAI
FIE
SOAKAGE
PIT
GREASE
TRAP
SOLAR
HEATER
DEEP
WELL
SPRKLR.
SYSTEM
SWIM 'G
POOL
CONTR.
LIST
CHECK
Nature of ate Supply: City —W
Amount of Permit $_
MIAMI
PLUMB!
APPLICATION FOR PLUMBING PERMIT
Date_ __ -"�!
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 co i ,, whether herein specified or not. A copy of approved plans and specifications must kept at
building during progress of work.
Qwner's Name and Address ___ ______
Registered Architect and /or Engineer
Employing Plumber's Name __ No Street
Location and Legal Description Lot____ _ �______ _________________________Block
Street and Number where work is to be performed —No Street
State work to be performed and purpose of building (By Floors)
New Building — Remodeling Addition Repairs
Size Septic Tank______ ______— _______________________ Type of Tank . Capacity Gals._
Feet of Drain Tile ______________________— _______ Dist. Feet of Tank or Drain Field from Well
My Commission Expires
SHORES VI LLAG E
NG INSPECTION DEPARTMENT
No 26k
Street ! e72
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 under signed agrees to employ only such sub- contra�r6c - �? o . ork to be performed under this permit, as are
licensed by Miami Shores Village.
(Sign
STATE OF FLORIDA,
COUNTY OF DADE. ss.
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.
No. of Stories
Master Plumber.