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284 NE 102 St (2)INSTALL DRAINFIELD e6:5 0 2 i • 1 � / Inspector Comments Passed Failed Correction Needed Re- Inspection Fee ($75) No Additional Inspections can be scheduled until re- inspection fee is paid. Inspection Date: 03/01/2007 Inspector: Levrack, James Owner: VUKOVIC, VLADIMIR Job Address: 284 102 Street NE Miami Shores Village, FL 33138- Project: <NONE> Contractor: STATEWIDE SEPTIC CONNECTIONS Buildin4 Deaartment Comments Wednesday, February 28, 2007 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 'Inspection Number: INSP -41667 ermit Number PL2005 -125 Block: Permit Type: Imported Permit Inspection Type: Final Work Classification: <NONE> Phone Number Parcel Number 1132060134710 Lot: Phone: 305 -661 -6633 Page 1 of 2 look and see if very bad condition so we can give bond Passed nspe o Co ents Failed Correction Needed Re- Inspection Fee ($75) No Additional Inspections can be scheduled re- inspection fee is paid. until 'Inspection Number: INSP- 3904 Inspection Date: 12/21/2005 Inspector: Grande, Claudio Owner: Job Address: Project: <NONE> VUKOVIC, VLADIMIR 284 102 Street NE Miami Shores Village, FL 33138- Contractor: STATEWIDE SEPTIC CONNECTIONS Building Department Comments Wednesday, December 21, 2005 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Block: Permit Number: PL2005 -125 Permit Type: Imported Permit Inspection Type: Septic Tank Work Classification: <NONE> Phone Number Parcel Number 1132060134710 Lot: Phone: 305- 661 -6633 Page 1 of 2 Miami Shores Village 10050 NE 2nd Avenue Phone: 305 - 795 -2204 Printed: 4/27/2005 Applicant: JANET VUKOVIC Owner: VUKOVIC JANET JOB ADDRESS: 284 NE 102 ST Parcel # 1132060134710 Signed: (INSPECTOR) Plumbing Permit Permit Number: PL2005 -125 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 1 & LOT 2 BLK 35 LOT SIZE Fees: Description Amount FEE2005 -5243 Building Fee $175.00 FEE2005 -5244 CCF $1.20 FEE2005 -5245 Notary Fee $5.00 FEE2005 -5246 Training and Education Fee $0.40 FEE2005 -5247 Technology Fee $4.37 FEE2005 -5248 Scanning Fee $3.00 FEE2005 -5249 Builders Bond $300.00 Total Fees: $488.97 Total Fees: $488.97 Total Receipts: $488.97 Permit Status: APPROVED Permit Expiration: 10/15/2005 Construction Value: $2,000.00 Work: INSTALL DRAINFIELD 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 APPLICATIO FBC 2001 Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 n_ nR --rte "P" U c�. Permit Type (circle): Building Electrical (Plumbig Mechanical Roofing �1 v )c c Owner's Name (Fee Simple Titleholder) .3 rf } U I ° d i r'•''iY Phone # Owner's Address =44- t•lti 102 ST City M; a W1 i ShOrtState Zip 331 3 8 Tenant/Lessee Name Phone # Job Address (where the work is being done) City Miami Shores Village County Miami -Dade Zip 331'3 Is Building Historically Designated YES NO Contractor's Company Name 3 +�ide � C GD , r C30s) :33 Contractor's Address 3 5 9 0 5A" 241 City M v CI r- A .r State t- Zip 33c13 Qualifier "reef S' SoAo '�(�''� State Certificate or Registration No. 3 M 091 126 2. Certificate of Competency No. Architect/Engineer's Name (if applicable) $ Value of Work For this Permit a0:00- Type of Work: ❑Addition Describe Work: Total Fee Now Due $ (Continued on opposite side) 04-6 et U‘ 250- N I 02 s NA ❑Alteration ❑New * * * * * * * * * * * * * * * * * * * * * * * * ** F ees * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** Code Enforcement $ Structural Plan Review. $ APR 1 h PAID Permit No. pi 0 J . (25 Master Permit No. Phone # Square Footage Of Work: 3 00 Repair /Replace ❑ Demolition Submittal Fee $ Permit Fee $ 1 15 - 0 CCF $ ( CO /CC Notary $ .00 Training /Education Fee $ Technology Fee $ 43�� Scanning $ ) C��; Radon $ Zoning Bond $ ` J)C)'CC) Bonding Company's Name (if applicable) Bonding Company's Address k1 A City State Zip • Mortgage Lender's Name (if applicable) Mortgage Lender's Address City State Zip Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRICAL WORK, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and AIR CONDITIONERS, ETC OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. "WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT." Notice to Applicant: As a condition to the issuance of a building permit with an estimated value exceeding $2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to 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 app oved and a reinspection fee will be charged. Signature r` Signatur 'P CJ -7--4:5 t . Owner or Agent Contractor The foregoing instrument was acknowledged before me this 18 The foregoing instrument was acknowledged before me this day of j 1 , 2005 , by MOI rr ,S 9N; Y 0 f Q Pr? 3` , day of , 20 _, by P. L' ret who is personally known to me or who has produced who is personally known to me or who has produce NO'vvP4s id e N did NOTARY PUB [ i13n7,L MY COMMISSION # DD250437 04" EXPIRE- epte .ber 16,2007 Sign: r 1 °r Y F N L ,may ••• i Print: My Commission Expires: ********************* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** ************************ * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** **** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** * * * ** APPLICATION APPROVED BY: chc 05/13/03 - etretSq SA o ra-. ake an oath. NOTARY PUBLIC: Sign: Print: My Commission Expires: as identification and who did take an oath. Plans Examiner Engineer Zoning - ''STATE OF FLORIDA DEPARTMENT OF HEALTH ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM CONSTRUCTION PERMIT 7 CONSTRUCTION PERMIT FOR: [ ]New System [ ]Existing System [ [ X ]Repair [ ]Abandonment APPLICANT: Vukovic, Janet & Vladimir AGENT: SA0021074, Solomon Teresa PROPERTY STREET ADDRESS: 284 NE 102 St Miami Shores FL 33138 LOT: 1 BLOCK: 35 SUBDIVISION: Miami Shores [Section /Township /Range /Parcel No.] PROPERTY ID #: 11- 3206 -013 -4710 [OR TAX ID NUMBER] SYSTEM DESIGN AND SPECIFICATIONS T [ 1050 ]Gallons SEPTIC TANK A [ 0 ]Gallons N [ 0 ]GALLONS GREASE INTERCEPTOR CAPACITY K [ 0 ]GALLONS DOSING TANK CAPACITY [ 0 )GALLONS © [0 D [ 400 ]SQUARE FEET PRIMARY DRAINFIELD SYSTEM R [ 0 ]SQUARE FEET SYSTEM A TYPE SYSTEM: [ ]STANDARD [ N ]FILLED I CONFIGURATION: [ NN ]TRENCH [ ] BED N F LOCATION TO BENCHMARK: FFE: 11.7 Ft NGVD I ELEVATION OF PROPOSED SYSTEM SITE [ 1.9 ] [ FEET E BOTTOM OF DRAINFIELD TO BE [ 4.4 ] [ FEET L D FILL REQUIRED: [ 0.0 ]INCHES OTHER REMARKS: THIS PERMIT IS NOT FOR ADDITION(s). SPECIFICATIONS BY: Andre, Paul APPROVED BY: Andre, Paul DATE ISSUED: 4/15/05 EXCAVATION REQUIRED: [ TITLE: DH 4016, 03/97 (Obsoletes previous editions w ch may not be used) (Stock Number: 5744 - 001 - 4016 -0) [ostds con8_4o16 -1] CENTRAX #: 13 -SG -24697 DATE PAID: FEE PAID : $ RECEIPT . OSTDSNBR : 05 -1284- -R ]Holding Tank [ ] Innovative Other ] Temporary [ NA ] 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. MULTI - CHAMBERED /IN SERIES: [Y ] MULTI - CHAMBERED /IN SERIES: [Y ] ]DOSES PER 24 HRS # PUMPS[ 0 ] [ N ]MOUND [ N ] [ N ] ] [ BELOW BENCHMARK /REFERENCE POINT ] [ BELOW BENCHMARK /REFERENCE POINT 30.0 ] INCHES 1. Install 300 sf of drainfield in bed configuration. 2. Existing 1050 gal. septic tank has to remain. 3. Existing 1050 gal. septic tank to be inspected for an appropriate pump -out and a solid vertical deflector installed on the outlet device. 4. Invert elevation of drainfield to be no less than 7.80' NGVD. 5. Bottom of drainfield elevation to be no less than 7.30' NGVD. TITLE: Professional Engin Dade EXPIRATION DATE: 7/14/05 CHD Page 1 of 2 STATE OF FLORIDA DEPARTMENT OF HEALTH ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM CONSTRUCTION PERMIT % CONSTRUCTION PERMIT FOR: [ ]New System [ ]Existing System [ ]Holding Tank [ ] Innovative Other [ X ]Repair [ ]Abandonment [ ]Temporary [ NA ] APPLICANT: Vukovic, Janet & Vladimir AGENT: SA0021074, Solomon Teresa PROPERTY STREET ADDRESS: 284 NE 102 St Miami Shores FL 33138 LOT: 1 BLOCK: 35 SUBDIVISION: Miami Shores [Section /Township /Range /Parcel No.] PROPERTY ID #: 11- 3206 - 013 -4710 [OR TAX ID NUMBER] 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. SYSTEM DESIGN AND SPECIFICATIONS T [ 1050 ]Gallons SEPTIC TANK MULTI- CHAMBERED /IN SERIES: [Y ] A [ 0 ]Gallons MULTI - CHAMBERED /IN SERIES: [Y ] N [ 0 ]GALLONS GREASE INTERCEPTOR CAPACITY K [ 0 ]GALLONS DOSING TANK CAPACITY [ 0 ]GALLONS @ [0 ]DOSES PER 24 HRS # PUMPS[ 0 ] D [ 400 ]SQUARE FEET PRIMARY DRAINFIELD SYSTEM R [ 0 ]SQUARE FEET SYSTEM A TYPE SYSTEM: [ N ]STANDARD [ N ]FILLED I CONFIGURATION: [ ]TRENCH [ ] BED N F LOCATION TO BENCHMARK: FFE: 11.7 Ft NGVD I ELEVATION OF PROPOSED SYSTEM SITE [ 1.9 ] [ FEET ] [ BELOW BENCHMARK /REFERENCE POINT E BOTTOM OF DRAINFIELD TO BE [ 4.4 ] [ FEET ] [ BELOW BENCHMARK /REFERENCE POINT L D FILL REQUIRED: [ 0.0 ]INCHES EXCAVATION REQUIRED: [ 30.0 ] INCHES OTHER REMARKS: 1. Install 300 sf of drainfield in bed configuration. 2. Existing 1050 gal. septic tank has to remain. 3. Existing 1050 gal. septic tank to be inspected for an appropriate pump -out and a solid vertical deflector installed on the outlet device. 4. Invert elevation of drainfield to be no less than 7.80' NGVD. 5. Bottom of drainfield elevation to be no less than 7.30' NGVD. THIS PERMIT IS NOT FOR ADDITION(s). APPROVED BY: Andre, Paul SPECIFICATIONS BY: Andre, Paul TITLE: DATE ISSUED: 4/15/05 EXPIRATION DATE: 7/14/05 DH 4016, 03/97 (Obsoletes previous editions w ch may not be used) (Stock Number: 5744- 001 - 4016 -0) [ostds cone 4oi6 -1] CENTRAX #: 13 -SG -24697 DATE PAID: FEE PAID : $ RECEIPT . OSTDSNBR : 05 -1284- -R [ N ]MOUND [ N ] [ N ] TITLE: Professional Engin Dade CHD Page 1 of 2 Scale: Each block represents 5 feet and 1 inch = 50 feet. t' r, - 1 r. d" 1 Notes: VV 0JIc, — 2 S, Ni I 0 St 33 C3 Site Plan submitted • y : `-1` ..4%C So( JJrA4) . 1 �S Signature Plan Approved =j B County Health Department ALL CHANGES MUST BE APPROVED BY THE COUNTY HEALTH DEPARTMENT 01.4 4015, 10/96 (Replaces HRS-H Form 4015 which may be used) (Stock Number: 5744 - 002- 4015.6) STATE OF FLORIDA DEPARTMENT OF HEALTH Y APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PERM T w A�9 Permit Application Number PART II - SITE PLAN 7) Qie N.1 D kn3 Not Approved Date Title Page 2 of 3 LOT: 1 -2 BLOCK: 35 STATE OF FLORIDA ;0 DEPARTMENT OF HEALTH ONSITE SEWAGE TREATMENT AND DiSPC SYSTEM CONSTRUCTION PERMIT CONSTRUCTION PERMIT FOR: [ ]New System [ ]Existing System [ [ ]Repair [ ]Abandonment APPLICANT: Vladamir Vukovic PROPERTY STREET ADDRESS: 284 NE 102 St Miami FL 33138 [Section /Township /Range /Parcel No.] PROPERTY ID #: 11- 3206 - 013 -4710 [OR TAX ID NUMBER] 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. SYSTEM DESIGN AND SPECIFICATIONS T [ 1200 ]Gallons SEPTIC TANK A [ 0 ]Gallons N [ 0 ]GALLONS GREASE INTERCEPTOR CAPACITY K [ 0 ]GALLONS DOSING TANK CAPACITY [ 0 ]GALLONS @ [0 D [ 54 ]SQUARE FEET PRIMARY DRAINFIELD SYSTEM R [ 0 ]SQUARE FEET SYSTEM A TYPE SYSTEM: [ N ]STANDARD [ N ]FILLED I CONFIGURATION: [ N ]TRENCH [ Y ]BED N F LOCATION TO BENCHMARK: 11.33'nqvd F.F.Elev. I ELEVATION OF PROPOSED SYSTEM SITE [ 17.2 ] [ INCHES ] [ BELOW] BENCHMARK /REFERENCE POINT E BOTTOM OF DRAINFIELD TO BE [ 36.8 ] [ INCHES ] [ ABOVE]BENCHMARK /REFERENCE POINT L D FILL REQUIRED: [ 0.0 ]INCHES EXCAVATION REQUIRED: [ 72.0 ] INCHES OTHER REMARKS: The licensed contractor installing the system is responsible for installing the minimum category of tank in accordance with s. 64E- 6.013(3)(f), FAC. [CP] Soil replacement required. Install 54 sf of drainfield. Install 42" of slightly limited soil under the bottom of drainfield. Perimeter of excavation area shall be at least 2 ft. wider and longer than the proposed absortion bed or trench. Invert elevation of drainfield to be no less than 7.90' NGVD. Bottom of drainfield elevation to be no less than 7.40' NGVD. SPECIFICATIONS BY: Millan, Jorge DH 4016, 03/97 (Obsoletes previous editions which may not be used) (Stock Number: 5744- 001 - 4016 -0) (ostds_cons_4016 -11 AGENT: SA0021074, Solomon Teresa SUBDIVISION: Miami Shores TITLE: APPROVED BY: Milian, Jorge TITLE: Engineer I CENTRAX #: 13 -SG -25901 DATE PAID: FEE PAID : $ RECEIPT . OSTDSNBR : 05-2470--M ]Holding Tank [ ] Innovative Other ]Temporary [ NA ] MULTI - CHAMBERED /IN SERIES: [Y ] MULTI - CHAMBERED /IN SERIES: [Y ] ]DOSES PER 24 HRS # PUMPS[ 0 ] [ Y ]MOUND [ N ] [ N ] Dade CHD DATE ISSUED: 7/27/05 \ EXPIRATION DATE: 1/27/07 Page 1 of 2 MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT Permit No 70 tel*1 Dateruary 4, 19,8.6..._ 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 et building during progress of work. Owner's Name and Address Dan Mi1nre Registered Architect and/or Engineer Eqoployins r1 Nsprt h e Seglio Tank No _80012 . 14 . 1 . strest 3 3 1 6 8 Location and Leg al pito / Lot Block Subdivision / 4242 // icAmo 4 Street and Number where work is to be performed—No 284 NE 102 Street. State work to be performed and purpose of building (By Floors)_ New Building. _. Remodeling-- Addition. _ Size Septic Tank__ _Type of Tank__ Feet of Drain Tile sq_._f_t_._Dist. Feet of Tank or Drain Field frosn Well._ Nature of Water Supply: City—Well. Size of Soakage Pit c 00 Amount of Permit $ My Commission Expires (signed nis_ 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 5960, Compiled General Laws of Florida Permanent Supplement, and hie com- plied with the provisions thereof, and will require similar compliance from all contractors or sub-contractors employed by him in the wor're 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 pr to be perf under permit, as are licensed by Miami Shores Village. (Signed) No ....211_4N2_102 Street_ Miami_ hores Repairs No. of Stories Notary Public, State of Florida .... • - • •• •-• • Master Plumber. STATE OF FLORIDA, so. 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 be is the of the above described construction, that be has carefully read the foregoing application, and that be did sign the same, and that all facts therein by him stated are true. NOTE: A re-litspection fee of $1.00 will be made whoa Rs& selaspection midelasosentry by insproper soden for isivecdon, or faulty materials and/or workmanship. CLoscrs BATH Tuns ""a" LAVA. TONICS 11 " 4 " SLOP •INPIS LAUNORY T URINALS CATCH salmi FLOOR DRAIN DRINKING FOUNT'N• TOTAL P Copan. LIST CHECK SEPTIC TANK SLWILR CONN. DRAIN FIELD SOAKAGE PIT G TRAP SOLAR HEATER DEEP WELL SPRKLR. 5 •V•1141•0 POOL Gown. LIST CHECK MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT Permit No 70 tel*1 Dateruary 4, 19,8.6..._ 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 et building during progress of work. Owner's Name and Address Dan Mi1nre Registered Architect and/or Engineer Eqoployins r1 Nsprt h e Seglio Tank No _80012 . 14 . 1 . strest 3 3 1 6 8 Location and Leg al pito / Lot Block Subdivision / 4242 // icAmo 4 Street and Number where work is to be performed—No 284 NE 102 Street. State work to be performed and purpose of building (By Floors)_ New Building. _. Remodeling-- Addition. _ Size Septic Tank__ _Type of Tank__ Feet of Drain Tile sq_._f_t_._Dist. Feet of Tank or Drain Field frosn Well._ Nature of Water Supply: City—Well. Size of Soakage Pit c 00 Amount of Permit $ My Commission Expires (signed nis_ 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 5960, Compiled General Laws of Florida Permanent Supplement, and hie com- plied with the provisions thereof, and will require similar compliance from all contractors or sub-contractors employed by him in the wor're 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 pr to be perf under permit, as are licensed by Miami Shores Village. (Signed) No ....211_4N2_102 Street_ Miami_ hores Repairs No. of Stories Notary Public, State of Florida .... • - • •• •-• • Master Plumber. STATE OF FLORIDA, so. 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 be is the of the above described construction, that be has carefully read the foregoing application, and that be did sign the same, and that all facts therein by him stated are true. NOTE: A re-litspection fee of $1.00 will be made whoa Rs& selaspection midelasosentry by insproper soden for isivecdon, or faulty materials and/or workmanship. App is nt <1009.I /4 J /v n/ Ppr iit umber y 0 ,8J aou-ess ite4 -57 NY/ PART II - SYSTEM INSTALLATION INSPECTION AND FINAL INSTALLATION APPROVAL Installer A/© , 0,3 - cle. Tank Manufacturer AJ, 19 Proper tank legend: Yes A No Tank material C33/1 c 0-9 Ze Tank level: Yes N , n No Tankswatertight: Yes A/S No Tank size L gallons gallons gallons Proper tank outlet device: Yeses• ' No Manhole or marker to grade: Yes No Drainfield Trench Absorption Bed Length Width Length Width Length o 6 feet x_V feet = p2 8 ft feet feet feet feet Length feetx feet = ft feet feet j/ feet feet Proper No. drainlines: Yes V No feet feet feet feet Proper pipe separation: Yes iNo Total = ft Total = ft Distribution box level: Yes No Systems located as permitted: Yes (f No Systems including plumbing stub -outs installed at proper elevation: Yes No °° °°// Average depth to drainpipe invert from finished grade a `f inches Maximum depth: Inches Average depth of drainfield gravel: inches Minimum depth of gravel 4.2/ inches Proper gravel size: Yes V No Gravel is suitable quality: Yes 1/ No Backfill or fill material as required: (Quality) Yes No Other findings Inspected by: £i— /E G kVA %G (s') Date STATE OF FLORIDA DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION AND INSTALLATION PERMIT 6t 4 - e_A-7:4 . f. 4 id Approved by: AN APPROVED I ALLATIO Note: Completed copies of this form will be pro ided to the applicant, installer and the building department. HRS —H Form 4016, Feb 85 (Obsoletes previous editions which may not be used) (Stock Number. 5744 -002- 4016 -0) PART III - IN . L STALLATION APPROVAL (Quantity) Yes i✓ No DOES NOT GUARANTEE PERFORMANCE Date #2(1 0 4 COUNTY PUBLIC HEALTH UNIT Page 2 of 2 �_- CLOSETS BATH TUBS SHOWER, LAVA- TORIES SINKS SLOP SINKS LAUNDRY TUBE URINALS CATCH BASIN FLOOR DRAIN DRINKI NO 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 CHICK X _. Permit No 29 . !__ Application is hereby mane 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 cf 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 ............ rs ill o _ N 284_ NE 102 S _ eet . __ Registered Architect and /or Engineer .__ _.. j�ELL � I�I j , FR W Gra yson dba A•MERICANIMppggt�OVEMENTS 16 Employing Plumber s Fame Nb :___.__-- _..__ -_ .._. 4 Ny1 Aye Location and Legal Description Lot._ -_ _ ....__1______.__ _ _ _ ._ Block 3 5 Subdivisi • ` is _ i Shores Street and Number where work is to be performed— No._ 284 street. State work to be performed and purpose of building (By Floors _ . New Building Amount of Pennit $_ u. Remodeling_ 10050 NE Second Avenue MIAMI S HOR-ES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT 3 Date 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 (Signed) The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations as : employer of labor under the Florida Workmen's Compensation Act, being Section 5968, Compiled General Laws of Florida Permanent Sup • 'ment, and has com- plied with the provisions thereof, and will require similar compliance from all contractors or sub . n : ctors employed by him in the work to be performed under this permit; and will post or cause to be posted' for inspection the site o the ork such public notice or notices as are required by the Act. The undersigned agrees to employ only such sub-contra on k be performed under this permit, as are licensed by Miami Shores Village. WM ( "Gr ayson . • a A r IliA 'NON VEMRNT Phone MU 1718 Plum • : Inspector. STATE OF FLORIDA, I 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. M Commission Expires Notary Public, State of Florida NOTE: A re- inspection fee of $1.00 will be made when such re- inspection is made•neeessary by improper notice for inspection, or faulty materials and /or workmanship. Permit No. S Date 0 1/- 7 Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted fort 7 J5 1 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 wor Owner's Name and Addres Registered Architect and /or Engineer____ _________ _ — Employing Plumber's Name M l/_M i - iirt24�_ -- - - (l2C /'v)( --- _ -_ - -- No. -- Location and Legal Description Lot__ . — ___—_________________.______ Block_ Subdivision Street and Number where work is to be performed —No _2 g Street A/ it 1 02 'S State work to be performed and purpose of building (By Floors)___ � ___bN -VCR 2L OCif S Q OOI OMM L. / f 1 63LO CA( M■ New Building_ Remodeling_ __— — ___ —__ Addition- ________ Repairs No. ...E Stories. Size Septic Tank ........... _ -... Feet of Drain Tile. Nature of Water Supply: City —Well Amount of Permit $______ Type of Tank_ Capacity Gals. _ Dist. Feet of Tank or Drain Field from Well _ Size of Soakage Pit ao MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT 5.4.4- I- 0 No._ — — ??T5 _ ______ -_ Street-J E /e (Sed) - -- - The undersigned applicant for this building permit does hereby certify that he understands under the Florida Workmen's Compensation Act, being Section 5988, Compiled General Laws plied with the provisions thereof, and will require similar compliance from all contractors or s performed under this permit; and will post or cause to be posted for inspection on the site required by the Act. The undersigned agrees to employ only such sub- contractors, on licensed by Miami Shores Village. My Conunission Expires ( Signed ).._ STATE OF FLORIDA, COUNTY OF DADE. Before me, the undersigned authority, a notary public, duly authorized to administer oa ( 7= __ 7 6 Street__- PE 1/4a Sz Plumbing Inspector. and accepts his obligations as an employer of labor of Florida Permane t Supplement, and has corn - contractors el : oy' d by him in the work to be work su' p slic notice or notices as are be p rfo e ?un. i permit, as are s 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 er Plumber. NOTE: A re- inspection fee of $1.00 will be made when such re- inspection is made•necessary by improper notice for inspection, or faulty materials and /or workmanship. CLOSETS BATH TUB S SHOWER• LAVA. TORIES SINKS SLOP SINKS LAUNDRY TUBS URINALS R INALS 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 P001. CONTR. LIST CHECK Permit No. S Date 0 1/- 7 Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted fort 7 J5 1 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 wor Owner's Name and Addres Registered Architect and /or Engineer____ _________ _ — Employing Plumber's Name M l/_M i - iirt24�_ -- - - (l2C /'v)( --- _ -_ - -- No. -- Location and Legal Description Lot__ . — ___—_________________.______ Block_ Subdivision Street and Number where work is to be performed —No _2 g Street A/ it 1 02 'S State work to be performed and purpose of building (By Floors)___ � ___bN -VCR 2L OCif S Q OOI OMM L. / f 1 63LO CA( M■ New Building_ Remodeling_ __— — ___ —__ Addition- ________ Repairs No. ...E Stories. Size Septic Tank ........... _ -... Feet of Drain Tile. Nature of Water Supply: City —Well Amount of Permit $______ Type of Tank_ Capacity Gals. _ Dist. Feet of Tank or Drain Field from Well _ Size of Soakage Pit ao MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT 5.4.4- I- 0 No._ — — ??T5 _ ______ -_ Street-J E /e (Sed) - -- - The undersigned applicant for this building permit does hereby certify that he understands under the Florida Workmen's Compensation Act, being Section 5988, Compiled General Laws plied with the provisions thereof, and will require similar compliance from all contractors or s performed under this permit; and will post or cause to be posted for inspection on the site required by the Act. The undersigned agrees to employ only such sub- contractors, on licensed by Miami Shores Village. My Conunission Expires ( Signed ).._ STATE OF FLORIDA, COUNTY OF DADE. Before me, the undersigned authority, a notary public, duly authorized to administer oa ( 7= __ 7 6 Street__- PE 1/4a Sz Plumbing Inspector. and accepts his obligations as an employer of labor of Florida Permane t Supplement, and has corn - contractors el : oy' d by him in the work to be work su' p slic notice or notices as are be p rfo e ?un. i permit, as are s 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 er Plumber. NOTE: A re- inspection fee of $1.00 will be made when such re- inspection is made•necessary by improper notice for inspection, or faulty materials and /or workmanship. mtmr• m■ \ New Building Remodeling Permit No 4 Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted f . 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. Owners Name and Address Registered Architect and /or Engineer Employing Plumber's Name" 4A,A C. e MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT No. .22'4— street. E /0 2 6 T Location and Legal Description Lot.___.__ Blooti Street and Number where work is to be performed—No •Z State work to be performed and purpose of building (By Floors) i �f'�`�'► No. __ _ .� 76 Street.. S s T Subdivision....._ __.. oc K Atte �% T ,Eris t�uG oc PM/ 4 Addition No. of Stories Size Septic Tank ..___...Type of Tank_. __ Capacity Gals. - 1 Feet of Drain Tile. -__. L D- °� —Olaf. Feet of Tank or Drain Field from Well Nature of Water Supply: City—Well. Size of Soakage Pit 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 5968, Compiled General Laws of Florida Pennanent Supplement, and has com- plied with the provisions thereof, and will require similar compliance from all contractors or sub -con • • .. 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 th wor such public notice or notices as are required by the Act. The undersigned agrees to employ only such sub - contra .. on to perform j under this permit, as are licensed by Miami Shores Village. STATE OF FLORIDA, t is. 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 Master Plumber. NOTE: A re inspection fee of $1.00 will be made when such re- inspection is made . necessary by improper notice for inspection, or faulty materials and /a wwE]rmanship. CLOUTS TUBS TUBS "OW LAVA. TORIES BINKa SLOP SINKS LAUNDRY Tuns URINALS CATCH SASIN FLOOR DRAIN DRINKING FOUNT' NS TOTAL FIXTURES CONTR. LIST CHECK SEPTIC TANK SEWER CONN. DRAIN FIELD SOAKAGE PIT GREASE' TRAP SOLAR HEATER DEEP WILL SPRKLR. SYSTEM SWIM' POOL comm. LIST CHECK New Building Remodeling Permit No 4 Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted f . 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. Owners Name and Address Registered Architect and /or Engineer Employing Plumber's Name" 4A,A C. e MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT No. .22'4— street. E /0 2 6 T Location and Legal Description Lot.___.__ Blooti Street and Number where work is to be performed—No •Z State work to be performed and purpose of building (By Floors) i �f'�`�'► No. __ _ .� 76 Street.. S s T Subdivision....._ __.. oc K Atte �% T ,Eris t�uG oc PM/ 4 Addition No. of Stories Size Septic Tank ..___...Type of Tank_. __ Capacity Gals. - 1 Feet of Drain Tile. -__. L D- °� —Olaf. Feet of Tank or Drain Field from Well Nature of Water Supply: City—Well. Size of Soakage Pit 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 5968, Compiled General Laws of Florida Pennanent Supplement, and has com- plied with the provisions thereof, and will require similar compliance from all contractors or sub -con • • .. 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 th wor such public notice or notices as are required by the Act. The undersigned agrees to employ only such sub - contra .. on to perform j under this permit, as are licensed by Miami Shores Village. STATE OF FLORIDA, t is. 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 Master Plumber. NOTE: A re inspection fee of $1.00 will be made when such re- inspection is made . necessary by improper notice for inspection, or faulty materials and /a wwE]rmanship. ;UILDING ;LECTRICAL 'LUMBING :OOFING ❑ DATE___ i — 195 ❑ PERMIT 11T° 2659 Contractor's License No El ❑ Work to be performed under this Permit )caner of uilding rchitect .ontractor r Builder egal Lot )escription _ddress of j uilding � } MIAMI SHORES VILLAGE. FLORIDA I/ B1 This permit is granted to the contractor or builder named above to construc the building or to install the equipment or device described in the application erefor in strict compliance with all ordinances pertaining thereto and with the understanding that the work will be performed in compliance with any plans, swings, statements or specifications that may have been submitted to and approved by the proper municipal authorities. This Permit may be revoked at any ae 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 anted is the understanding that the contractor or builder named above assumes the responsibility for a thorough knowledge of the ordinances and regulations ,rtaining to the work covered hereby whether shown on the plans or drawings or in the statements or specifications and that he assumes responsibility for work ne by his agents, servants or employees. Signed BY INSPECTOR In consideration of the issu l ance to 2 of this permit I agree to perform the work covered hereunder in compliance with all ordinances and regulations :rtaining thereto and in - "strict conformit ith crwings, statements or specifications submitted to the proper authorities of Miami Shores Village. In ac- -pting this permit, I assun}eres n ity for �t11 work d by either, myself, my agent, servant or employee. 2 ONTR_A,C7f OR OR BUILDER BY Subdi- vision Value of Amount of Project $ Permit $ AUTHORITY 'Tphis pit is granted to thei c0 herefer in ,strict compliance wiei all , ord draw" ,scat eats or specffieatibnh tit tie if the work is not done core klairc tkd is.ths..tmdersta€�ding that the e �. tit'the work e,pvered hereby:' I on y is agents, servants or e _ oSbes. Signed consideration of the issuance to the of this penult 4 agree to p pertaining thereto and in'stdct con/formity,With. the plans, dra zings, stake- In acce p. ng this permit 'aissume responsibility for all 'work done by either, Subdi- vision Value of 1�rolept $ Amt. of Permit $�.' * r�'i tZMB /NG O OFING Over of Building Architect Contractor or Builder Legal Description., Address of Bulking A GOF'E'Rt 014 B XWER RAE VILLAGE, FLORIDA 4 . DA':B x 19 Contrator's License No - -- l Work jo be performed under this Peth i Or or builder named above t6 construct the building or to install the equipment or device described in the application d es pertaining thet460 ntl with the Understanding that the wet& will be performed in compliance with any plans, ,'.have beers pertaining, to 4nd. 0,pproved by the proper m niciial authorities, This Permit may be revoked at any sub . ordinance or if the ns are'changed without author] ation. A further condition upon which thisjpermit is actor or 'builder , naffed above assumes the responsibility for a t brou knowledge of the ordinances and regulations rat shown. ors" 'plaans or drawings or in the statements or specifications and that he assumes responsibility for work SP,ECTOR BY work covered hereunder in compliance with all specifications submitted' to the proper authorities f, my agent, servant or employee. i6 IA) BY AUTHORITY ordinances and regulations of Miami Shores Village. INSTALLED BY CAAt PERMIT NO. OWNER IS NAME 044d ADDRESS > » c ./ v SvL MISCELLANEOUS INSPECTIONS WILL GET �/ t� DATE 6 ` / V t )` , LOT BLOCK SUBDIVISION INSPECTION A. M. P. M. RELAY DRAINFIELD to / WELLS GAS APPLIANCES WATER PIPING SOLAR MISCELLANEOUS CONDEMNED BY: APPROVED BY: REMARKS Permit No. Installed by Owner's Name Lot Inspection Relay Drainfield Gas Appliances Solar Remarks MISCELLANEOUS INSPECTIONS Block VN Will Get Date Address Subdiv. A. M. ^Wells // Water Piping Miscellaneous Approved by Condemned by P.M. BUILDING ELECTRIC/ PLUMBING Owner of Building v Architect Contractor ' or Builder Legal Lot Bl. Description MIAMI SHORES VILLAGE, FLORIDA DATA r.� .,,��✓ .* ._' 194\ contractor's License No. PERMIT N? 7975 Work to be performed under this Permit Subdi- vision Value of Project Address of A o T'7 :7 Building .) P ,/ a' — Permit `f�+ � This permit is grante to the contractor or builder named above to construct the building or to install the equipment or device described in the appli- cation herefor in strict compliance with all ordinances pertaining thereto and with the understanding that the work will be performed in compliance with any plans, drawings, statements or specifications that may have been submitted to and approved by the proper municipal authorities. This Permit may be revoked at any time if the work is not done in compliance with such ordinances or if the plans are changed without authorization.1A 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 state ents or specification'; and that he assumes respon- sibility for work done by his agents, servants or employees. e ,� �/ •• Signed. '°..._� ;. By * ._ ... t / INSPECTOR In consideration of the issuance to me of this permit I agree to perform ,th work covered hereunder in compliance with all ordi ces and regulijogso pertaining thereto and in strict conformity with the plans, drawings, stateme is or specifications submitted to the proper authdli s of Sho1ec i gelS In accepting this permit I assume responsibility for a work done by either myself, my agent, servant or employee. CONTR OR • R : T DER r -'.�.. _- </Le•' - 1. AUTHORITY BUILDING ELECTRICAL PLUMBING Owner of Building Architect Contractor or Builder Legal Lot Description • 1 Work to be performed under this Permi Address of -•y,(1 Building This permit is granted to the contractor •r builder named above to construct the building or to install the equipment or a evice • scribed in the appli- cation herefor in strict compliance with all ordinances pertaining thereto and w'th the understanding that the work wil be pe orrned ' 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. INSPECTOR In consideration of the issuance to me of this permit I agree to perform the work covered hereunder in compliance with all ordinances and regulations pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Vi11a ge. In accepting this permit I assume responsibility for all work done by either myself, my agent, servant or employee. !. • ) 1 9.. ( CONTRACTOR OR BUILDER 1 MIAMI SHORES VILLAGE, FLORIDA DATE PERMIT N? 4842 Bl. Signed. Subdi- vision Value of Project BY Contractor's License No. Amt. of Permit By AUTHORITY 194 °wner o Building Architect C ontraceor or Balder '" • Legal ; Lot Description A deI r ress of w, Building In den ideratian of the sOA ti sail p e rt t 11e rttq and iO4 ( X leis pe a sty- This permit ii g0nted t.c _'' crinora "tiro `fiild�e a , pIicati n herefot in , trio co t ce s I . nn with not l s draw scat ,' . e ;' b� t 'l be revo� aY,t�a� >�im� the "t9 up on which t ts' permit is' ti the ottiloirteLii, i id regiiliatigns, p rte chat he as ses respon ibiiity iv Y iYiTt �f y am. +err e building or to install 1 he equipment or 'device described in the G c e'underscanding rc0 Ate wd4 C,will be. gierfortned in compl'ia; ce approved by th -,: over nnici;pa�l authorities. this Permit m y .f h e plans are dh? .� wa"thQ.1.t aut ho as ion A f`urther condition a ed above asst e he responsibility for a, thorough knowled te he p ans t or in the sratements or specifications and .. 'INSPEcrOlk i wok covered= hereunder to compliance with all ordi..nances and keg n enitp r speeificatious submitted •ro the proper authorities of Miami �Sho ''m i ithery my agent, rserv or etrfploy+ee. Permit No.. t 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 building during progress of work Feet of Drain Tile appeared to me well known, and of the above described therein by him stated ar MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT v Owner's Name and Address Registered Architect and /or Engineer _ Employing Plumber's Name ___ ! _ 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 ss. My Commission Expires Amount of Permit $--- ----- -------------- _____________________(Signed) Repairs Size Septic Tank____________ ______ Type of Tank Capacity Gals Nature of Water Supply: City —Well. Size of Soakage Pit (Signed) not. A copy o Date No. ____ Street ,fee _ ; �!!'__ r©ued.p s.and,specifcat gps, must be kept at Street Street! Notary Public, State of Florida Block Subdivision_ _______________,_______________ No. of Stories Dist. Feet of Tank or Drain Field from We ll_____________ _______________________________ il77 0 Plumbing Inspector. The undersigned applicant for this building permit does hereby certify th/'''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 - contractors, on work to be performed under this permit, as are licensed by Miami Shores Village. 1 er Plumber. r� STATE OF FLORIDA, COUNTY OF DADE. Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally who, being by me first duly sworn, upon oath deposes and says that he is the construction, that he has carefully read the foregoing application, and that he did sign the same, and that all facts 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 materials and /or workmanship. CLOSETS BATH TUBS SHOWERS LAVA- TORIES SINKS SLOP SINKS LAUNDRY TUBS URINALS CATCH BASIN FLOOR DRAIN DRINKING FOUNT' NS TOTAL FIXTURES CONTR. LIST CHECK SEPTIC TANK SEWER CONN. DRAIN FIELD SOAKAGE PIT GREASE TRAP SOLAR H EATER DEEP WELL SPRKLR. SYSTEM SWIM'G POOL CONTR. LIST CHECK Permit No.. t 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 building during progress of work Feet of Drain Tile appeared to me well known, and of the above described therein by him stated ar MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT v Owner's Name and Address Registered Architect and /or Engineer _ Employing Plumber's Name ___ ! _ 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 ss. My Commission Expires Amount of Permit $--- ----- -------------- _____________________(Signed) Repairs Size Septic Tank____________ ______ Type of Tank Capacity Gals Nature of Water Supply: City —Well. Size of Soakage Pit (Signed) not. A copy o Date No. ____ Street ,fee _ ; �!!'__ r©ued.p s.and,specifcat gps, must be kept at Street Street! Notary Public, State of Florida Block Subdivision_ _______________,_______________ No. of Stories Dist. Feet of Tank or Drain Field from We ll_____________ _______________________________ il77 0 Plumbing Inspector. The undersigned applicant for this building permit does hereby certify th/'''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 - contractors, on work to be performed under this permit, as are licensed by Miami Shores Village. 1 er Plumber. r� STATE OF FLORIDA, COUNTY OF DADE. Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally who, being by me first duly sworn, upon oath deposes and says that he is the construction, that he has carefully read the foregoing application, and that he did sign the same, and that all facts 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 materials and /or workmanship.