38 NE 102 St (12)Permit No
Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the building or other
structure herein described. This application is made in compliance and conformity with the Building Ordinance of Miami Shores Village, Florida,
and all provisions of the Laws of the State of Florida, all ordinances of Miami Shores Village and all rules and regulations of the Building Division
of .Miami Shores Village shall be complied 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 V%/1 LSOY1
Registered Architect and/or Engingi
rt m e eft
Employin Plum ,to No 0. 13.7
a
Lotion d Legal Description 4/
Street and Number where work is to be performed—No
State work to be performed and purpose of building (By Floors)_____
New Building__ . Remodeling
Size Septic Tank--
Feet of Drain Tile_____
Nature of Water Supply: City—WelL
Or
1 k , 1
(Signed)
The undersigned applicant for this building permit does hereby certify that he understan and accepts his obligations as an employer of labor
under the Florida Workmen's Compensation Act, being Section 5968, Compiled General Laws of Florida Perinanent Supplement, and haw com
plied with the provisions thereof, and will require similar compliance from all contractors or sub-contractors employed by him in the wort- to he
performed under this permit; and will post or cause to be posted' for inspection on the site of the • such public notice or notices as arr
required by the Act. The undersigned agrees to employ only such sub-contractors, on work to under , this permit, as are
licensed by Miami Shores Village.
4
Amount of Permit $
My Commisaion Expires
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
3•3
Addit
Type of Tank__
_Dist. Feet of Tank or Drain Field from Well .
Size of Soakage Pit
No. 3g /02_ S
NO t••••••••••••••11111:11111•12.511.1 I.st ..... AS••••
BicA subdivision.271 / AAP
7. ..4 .r‘S.7..47}_l
7 1 m
sr
ion. Repairs. 1/ ...'° No. of Stories.
(Si
- 7
Notary Public, State of Florida
Plumbing Inspector.
Master Plumber.
STATE OF FLORIDA, }
1.15.
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 epplication, and that be did sign the same, and that all facts
therein by him stated are true.
NOTE: A re-inspection fee of $1.00 will be made whoa mob re•lospeceitm is made .aeoessery by improper notice, for lespection, or falsity
materials and/ar worlananship.
CLoscra
BATH
'rums
""/".
LAVA-
TORIES
SINK•
SLOP
s,".
LAUNDRY
Tuns
URINALS
CATCH
DAWN
FLOOR
DRAIN
DRINKING
FOUNTWS
TOTAL
FIXTURES
CONTR.
LIST
CHECK
SEPTIC
TANK
SEWER
CONN.
DRAIN
raw>
SOAKAGE
PIT
G
TRAP
SOLAR
HEATER
DEEP
WELL
5 .
SYSTEM
SW I M•0
POOL
Corm.
LIST
-
-
CHECK
Permit No
Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the building or other
structure herein described. This application is made in compliance and conformity with the Building Ordinance of Miami Shores Village, Florida,
and all provisions of the Laws of the State of Florida, all ordinances of Miami Shores Village and all rules and regulations of the Building Division
of .Miami Shores Village shall be complied 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 V%/1 LSOY1
Registered Architect and/or Engingi
rt m e eft
Employin Plum ,to No 0. 13.7
a
Lotion d Legal Description 4/
Street and Number where work is to be performed—No
State work to be performed and purpose of building (By Floors)_____
New Building__ . Remodeling
Size Septic Tank--
Feet of Drain Tile_____
Nature of Water Supply: City—WelL
Or
1 k , 1
(Signed)
The undersigned applicant for this building permit does hereby certify that he understan and accepts his obligations as an employer of labor
under the Florida Workmen's Compensation Act, being Section 5968, Compiled General Laws of Florida Perinanent Supplement, and haw com
plied with the provisions thereof, and will require similar compliance from all contractors or sub-contractors employed by him in the wort- to he
performed under this permit; and will post or cause to be posted' for inspection on the site of the • such public notice or notices as arr
required by the Act. The undersigned agrees to employ only such sub-contractors, on work to under , this permit, as are
licensed by Miami Shores Village.
4
Amount of Permit $
My Commisaion Expires
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
3•3
Addit
Type of Tank__
_Dist. Feet of Tank or Drain Field from Well .
Size of Soakage Pit
No. 3g /02_ S
NO t••••••••••••••11111:11111•12.511.1 I.st ..... AS••••
BicA subdivision.271 / AAP
7. ..4 .r‘S.7..47}_l
7 1 m
sr
ion. Repairs. 1/ ...'° No. of Stories.
(Si
- 7
Notary Public, State of Florida
Plumbing Inspector.
Master Plumber.
STATE OF FLORIDA, }
1.15.
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 epplication, and that be did sign the same, and that all facts
therein by him stated are true.
NOTE: A re-inspection fee of $1.00 will be made whoa mob re•lospeceitm is made .aeoessery by improper notice, for lespection, or falsity
materials and/ar worlananship.
BUILDING
ELECTRICAL
PLUMBING
ROOFING
Owner of
Building
MIAMI SHORES VILLAGE, FLORIDA
DATE
°� PERMIT N9 6558
0
Contractor's r '�
License No. a /
❑ Work to be performed under this Permit f) :l °-
.A
Architect
Contractor x '
or Builder
Legal Lot
Description II Bl
Address of
Building
Subdi-
vision
Value of
Project $
Amount of
Permit $
This permit is granted to the contractor or builder named above to construct the building or to install the equipment or device described in the applica-
tion herefor in strict compliance with all ordinances pertaining thereto and with the understanding that the work will be performed in compliance with any
plans, drawings, statements or specifications that may have been submitted to and approved by the proper municipal authorities. This Permit may be revoked
at any time if the work is not done in compliance with such ordinances or if the plans are changed without authorization. A further condition upon which this
permit is granted is the understanding that the contractor or builder named above assumes the responsibility for a thorough knowledge of the ordinances and
regulations pertaining to the work covered hereby whether shown on the plans or drawings or in the statements or specifications and that he assumes respon-
sibility for work done by his agents, servants or employees.
Signed• i f ' N r • , ati INSPECTOR
In consideration of the issuance to me of this permit I agree to perform the work covered hereunder in compliance with tall 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 as
cepting this permit I assume responsibility for all work done by either, myself, my agent, servant or employes.
CONTRACTOR OR BUILDER
BY
AUTHORITY
AS DOT 'Cy
STATE OF FLORIDA
DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES
ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION AND INSTALLATION PERMIT
Applicant e L
1ACJ /
S orl P rmit Number ? 1 7 ,5" PART 1I - SYS INSTALLATION INSPECTION AND Fl AL INSTALLATION APPROVAL
Installer / - �-r ; V n 7 c
Proper tank legend: Yes No
Tanks watertight: Yes_pNo
Tank Manufacturer /416-
Tank material ,-f¢ -'Tank level: Yeser No
Tank size• gallons gallons Ayr- , gallons
Manhole or marker to grade:. Yes 4 - No
Absorption Bed
Width Length cge feet x c2 0 feet= ft
feet Length feet x = ft
feet Proper No. drainlines: Yes —1.1 No( S)
feet Proper pipe separation: Yes A./ No
Total = ft Distribution box level: Yes No �
Systems located as permitted: Yes t No
Proper tank outlet device: Yes /"
Length Width
feet feet
feet feet
1 feet feet
Total = ft
Other findings
Inspected by
Drainfield Trench
Proper gravel size: Yes c--1
PART 11
Length
feet
feet
feet
Systems including plumbing stub -outs installed at proper elevation: Yes Not/fin,
Average depth to drainpipe invert from finished gr
depth of drainfield gravel: 13 inches
Backfill or fill material as required: (Quality) Yes
Approved by:
AN APPROVED. INSTAL
Note: Completed copies of this form will be
HRS —H Form 4016, Jan 86 (Replaces Feb 85 edition which may be used)
(Stock Number: 5744-002- 4016 -4)
rade inches Maximum depth .24 Inches
Minimum depth of gravel
APPROVAL
inches
Gravel is suitable quality: Yes 1 No
v No (Quantity) Yes No
COUNTY PUBLIC HEALTH UNIT —/`
Date / 0 /0 7(4 7
ION D ES NOT GUARANTEE PERFORMANCE
provide ' to the applicant, installer and the building department.
Page 2 of 2