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415 NE 102 StfRMIT APPLICATION FOR MUNICIPALITIES OF DADE COUNTY (OWNER TO RETAIN COPY) Job Address 1 1(5" NE /DA S v Tax Folio /J 3�Olp / Legal Description J / � 4/0/) 0 j // g)We %Master Permit # f s Owner / Lessee / Tenant /146 , re , I R, Owner's Address S e Contracting 'Co. /Ien 9 &nne //S Qualifier An1c s State # 73 ^ Architect /Engineer Bonding Company Mortgagor Square Ft. Permit Type (circle one): ILDING ELE PLUMBING ECHANICAL PAVING FENCE SIGN WORK DESCRIPTION 2 S 6 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. 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 c' . *ruction and zoning. Furthermore, I authorize the above -named contractor t do the work st efahlikt Signatura�df Cwner,at;.c; /or Condo Presiden Dat , Notary as to Miner, • d or Condo President My Commission' Expi : State of Florida * * ;. yk111Mission fires Feb. it. 1994 * PERMIT FEE: APPROVED: Fire Zoning IJ 1A L S ep - tr c mpetency# ss ## q6' - a /q l�1 C j Building Address /86/I i. cc) . 2- Aden& Address Address Address Estimated Cost Notary as to Co My Commission * * phone phony 3C.6 ) (a(- 07 JAriALI 4.1c, Ins. C rac tar e r Coiner =tv lder p i re s C a State r es Florida 1 5, 1994 .Other Electrical Mechanical Plumbing -' 9 Owner's Agent :e .;: �+t�` !.�a'' T T °"9.•y L%�,r`t PART I APPLICATION TOTAL FLOW = Builder f ; *- m1 e STATE OF FLORIDA DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES APPLICATION FOR ONSITE SEWAGE DISPOSAL SY - STEM CONSTRUCTION PERMIT Authority Chapter 381, FS Chapter 10D -6, FAC Date of Application 1 / 13 I Z Permit Application Number 9 Name of Owner Iv `r Cris eior Telephone Number Mailing. Address of Owner o f S vie [02 , Agent's Mailing Address 131.0 ( ( fJC.J b}e-- Telephone No. 621 7 j 5 Property Street Address Lot No. ' Block No. Subdivision Date Subdivided NOTE: IF NOT IN A SUBDIVISION ATTACH A METES AND BOU S DESCRIPTION This Application is for New System Repair Existing System Type of Sewage Flow Sewage Flow Establishment (Gallons per day) Based On Type of No. Bedrooms Heated or Cooled Area No. Dwelling Sewage Flow Residential (each dwelling unit) (each dwelling unit) Units (Gallons per day) Exact Directions to Property AUDIT CONTROL NO Applicant's Signature HRS-H Fetal 4015. Feb 85 (Obsoletes previous editions which may not be used) (Stock Number 5744- 001 - 4015.1) Page .1 of 3 Notes: STATE OF FLORIDA DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES APPLICATION FOR ONSITE SEWAGE DISPOSAL S Y S T E M CONSTRUCTION P E R M I T � ) Permit Application Number d` j PART II - SITE PLAN i■/ .i.t ... tali■■/■www.■!w■;■ .w.w ww ■wwwww■w.MMwww■. // Mari .taw /ww /wti■ww��! ■■sw.■.!!■. .•.......■/. !! m/ I!!!!■/■!!!■■!/■■/!/■■■w!/!!■■!■■/■/■/!!/! m■■/!■!!!!!!!■■!■!!■ !■ /■!■ ■ /■■!/ / ■ /■■■!! ■!! ■ ■ ■/■■ ■ .M■ MM ■■M■■!■■■!■■!■■■■!!'M /■!!MM! /!! ■■/!/! Ml. r■■■!//■/■!/■!■■!■■/■ /■■ ■■■;■■ /w / ■!■! ■ ■!i•!!!/■■■u ■! 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Mw. ri.w Mw.... ww.M..w �tw. ww.ww.w.■..M.M..w..MMwM.■.■..w. .. 1 /•- I Site Plan Submitt- • Plan Approved By County Public Unit HRS -H Form 4015, Feb 85 (Obsoletes previous editions which may not be used) (Stock Number: 5744- 002 - 4015 -6) Not Approved ALL CHANGES MUST BE APPROVED BY THE COUNTY PUBLIC HEALTH UNIT TITLE Date Page 2 of 3 BUILDING ELECTRICAL PLUMBING Owner of i Building Architect Contractor or Builder Legal Description Address of Building Lot r t i F1 CON ACTOR OR BUILDEI}t/ MIAMI SHORES VILLAGE, FLORIDA PERMIT N° 9739 Work to be performed under this Permit 7 Subdi- vision Value of Project $ DATE' . -< ' 1951E Contractors, License No Amt. 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 or in the statements or specifications and that he assumes responsibility for work done by his agents, servants or employees. Signed • ,s r ._ f r • / kv. / 7 . :•'- :- y . INSPECTOR In consideration of the issuance to me of this permit I agree to perform the work covered hereunder in compliance with all or,. nances and regulations pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the .proper authorities'"of1 Miami Shores Village. In acceptinyhis permit I aptaSe, iesponsibilitz for all work done by either, myself, my agent, servant or employee. BY AUTHORITY Permit No 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 and Address No Street Registered Architect and /or F ri nepr Employing Plumber's Name Location and Legal Description Lot Nature of Water Supply: City —Well • ss. MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT No Street Block L Subdivision r I Street and Number where work is to be performed—No J �! - 4 1 Street State work to be performed and purpose of building (By Floors) New Building Remodeling 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 Size of Soakage Pit Amount of Permit $___ _ i ( Signed 1 __ 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 corn - plied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors employed by him in the work to be pprforrned under this permit; and will post or cause to be posted for inspection on the site of the work such public notice or notices as are required by the Act. The undersigned agrees to employ only such sub - contractors, on work to be performed under this permit, as are licensed by Miami Shores Village. (Signed) er Plumber. STATE OF FLORIDA, t COUNTY OF DADE. Before me, the .undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeared to me well known, and who, being by me first duly sworn, upon oath deposes and says that he is the 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 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 , y'� a� CHECK • Permit No 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 and Address No Street Registered Architect and /or F ri nepr Employing Plumber's Name Location and Legal Description Lot Nature of Water Supply: City —Well • ss. MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT No Street Block L Subdivision r I Street and Number where work is to be performed—No J �! - 4 1 Street State work to be performed and purpose of building (By Floors) New Building Remodeling 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 Size of Soakage Pit Amount of Permit $___ _ i ( Signed 1 __ 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 corn - plied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors employed by him in the work to be pprforrned under this permit; and will post or cause to be posted for inspection on the site of the work such public notice or notices as are required by the Act. The undersigned agrees to employ only such sub - contractors, on work to be performed under this permit, as are licensed by Miami Shores Village. (Signed) er Plumber. STATE OF FLORIDA, t COUNTY OF DADE. Before me, the .undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeared to me well known, and who, being by me first duly sworn, upon oath deposes and says that he is the 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 workmanship. -