479 NE 102 St (6)PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Date 1/19/95 Job Address 479 NE 102 STREET Tax Folio
Legal Description
Owner / Lessee / Tenant SHANE WILLENS Master Permit # 3 7; 47 9
Owner's Address 479 NE 102 STREET, MIAMI SHORES 33138 Phone 759 -3975
Contracting Co. NORTH DADE SEPTIC TANK
Qualifier DENNIS NEVILLE
State # 025836 -8 Municipal # Competency # 12842 Ins.Co,TRAVELERS /ESIF
Architect /Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type(circle one): BUILDING ELECTRICAL ( PLUMBING) MECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIPTION INSTALL DRAINFIELD
Square Ft. 100 SQ FT
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 t
be done in cp►pliance with al
authorize above -gamed con
//��
Signat4ire of owner and /or Condo President
Date:
** *
No =ry to Ownr •tary =s to Co' ra for or Owner-Builder
M y Mission s •
ill G 51nTE CE fSa�14A Al 1..4:1.•.):: My STATE OF FLORIDA AT LARGE
MY COMMISSION EX^:'1=5 1 1995 MY
StON. ➢:RLS JUNE 13, 1995
l'ONDED THRU HUC::LESE^RY R ASSOCIATE'S BONDED THaU HUCKLc.3Eit$Y ?. ASSOCIATES
* * * * * * * * **
o f n
FEES: PERMIT !4 RADON C.C.F. /, NOTARY TOTAL DUE "/ . ,
Fire Other
My Commission Ex
APPROVED:
a
SS#
ondo President
Zoning Buildin
Mechanical Plumbin
Address 800 NW S T R E E T , 33168
Phone 754 -3375
Estimated Cost(value) $1800.00
at all the foregoing information is accurate and that all work will
pplicable laws regulating const . on and zoning. Furthermore, I
ctor to do the work stated.
Co trac
Si
Dat
.8O
or or Owner- Builder
Electrical
Engineering
APPLICATION FOR:
[ N] New System [ N] Existing System [ jj Holding Tank [ N] Temporary /Experimental
[ Y ] Repair [ N] Abandonment [ Other(Specify)
APPL WILLENS
AGENT: NORTH DADE SEPTIC TANK
MAILING ADDRESS: 800 NW 111 STREET, MIMMI 33168
TO BE COMPLETED BY APPLICANT OR APPLICANT'S AUTHORIZED AGENT. ATTACH BUILDING PLAN AND TO -SCALE
SITE PLAN SHOWING PERTINENT FEATURES REQUIRED BY CHAPTER 10D -6, FLORIDA ADMINISTRATIVE CODE.
PROPERTY INFORMATION [IF LOT IS NOT IN A RECORDED SUBDIVISION, ATTACH LEGAL DESCRIPTION OR DEED]
LOT:
PROPERTY ID 1:
PROPERTY SIZE:
ACRES [Sgft /43560]
PROPERTY S ADDRESS: t 479 NE 102 STREET, 33138
DIRECTIONS TO PROPERTY:
BUILDING INFORMATION
Unit Type of
No Establishment
1
2
3
4
STATE OF FLORIDA
DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES
ONSITE SEWAGE DISPOSAL SYSTEM
APPLICATION FOR CONSTRUCTION PERMIT
Authority: Chapter 381, FS & Chapter 10D -6, FAC
BLOCK:
SUBDIVISION:
SFR 4 BEDROOMS
DATE OF
SUBDIVISION :
[Section /Township /Range /Parcel No.] ZONING:
PROPERTY WATER SUPPLY: [ ] PRIVATE [ y] PUBLIC
[XK] RESIDENTIAL [ ] COMMERCIAL
No. of Building # Persons Business Activity
Bedrooms Area Sgft Served
PERMIT ,f
DATE PAID
FEE PAID $
RECEIPT #
TELEPHONE:
759-3975
754-3375
For Commercial Only
[N] Garbage Grinders /Disposals [ N] Spas /Hot Tubs
[N] Ultra -low Volume .Flush Toilets [N] Other (Specify)
APPLICANT'S SIGNATURE•
HRS -H Form 4015, Mar 92 (Obsoletes previous editions which may not be used)
(Stock Number: 5744 - 001 - 4015 -1)
[ N J Floor /Equipment Drains
Page 1 of 3
APPLICANT: WILLENS
LOT:
PROPERTY ID #::
STATE OF FLORIDA
DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES
ONSITE SEWAGE DISPOSAL SYSTEM
SITE EVALUATION ANDvSYSTEM.SPECIFICATIONS
BENCHMARK /REFERENCE POINT LOCATION:
ELEVATION OF PROPOSED SYSTEM SITE IS
BLOCK: SUBDIVISION:
PROPERTY-'SIZE CONFORMS TO SITE PLAN: [ ]
TOTAL ESTIMATED SEWAGE FLOW: 600
AUTHORIZED SEWAGE FLOW:
UNOBSTRUCTED AREA AVAILABLE: 800
PERMIT #
AGENT: NORTIODADE SEPTIC TANK
[Section /Township /Range /Parcel No. or Tax ID Number]
TO BE COMPLETED BY ENGINEER, HEALTH - - UNIT EMPLOYEE, OR OTHER QUALIFIED PERSON. ENGINEER'S MUST
PROVIDE REGISTRATION NUMBER AND SIGN AND SEAL EACH PAGE OF SUBMITTAL. COMPLETE ALL ITEMS.
YES [ ] NO NET USABLE AREA AVAILABLE: ACRES
GALLONS PER DAY [RESIDENCES -TABLE 1 / OTHER -TABLE 2]
GALLONS PER DAY [1500 GPD /ACRE OR 2500 GPD /ACRE]
SQFT UNOBSTRUCTED AREA REQUIRED: 800 SQFT
[INCHES /FT] [ABOVE /BELOW] BENCHMARK /REFERENCE POINT
THE MINIMUM SETBACK WHICH CAN BE MAINTAINED FROM THE PROPOSED SYSTEM TO THE FOLLOWING FEATURES:
SURFACE WATER: 7 FT DITCHES /SWALES: - -- FT NORMALLY WET? [ ] YES [ ] NO
WELLS: PUBLIC: 100 FT LIMITED USE: - °- FT PRIVATE: --- FT NON- POTABLE: °°° FT
BUILDINc 5 FT PROPERTY LINES: 5 FT POTABLE WATER LINES: FT
`SITE SUBJECT TO FREQUENT FLOODING:
40 YEAR FLOOD ELEVATION FOR SITE:
SOIL INFORMATION SITE 1
Munsell jjColor Texture
OWN SANDY
USDA SOIL SERIES:
Depth
0 " to 72"
to
to
to
to
to
to
to
to
OBSERVED WATER TABLE: INCHES [ABOVE / BELOW] EXISTING GRADE. TYPE: [PERCHED / APPARENT]
ESTIMATED WET SEASON WATER TABLE ELEVATION: 108 INCHES [ ABOVE / BELOW ] EXISTING GRADE.
HIGH WATER TABLE VEGETATION: [ ] YES [g] NO MOTTLING: [ ] YES [ NO DEPTH: 24 INCHES
SOIL TEXTURE /LOADING RATE FOR SYSTEM SIZING: 1.25 DEPTH OF EXCAVATION: 24 INCHES
DRAINFIELD CONFIGURATION: [ ] TRENCH [ x ] BED [ ] OTHER (SPECIFY)
REMARKS /ADDITIONAL CRITERIA:
SITE EVALUATED BY:
HRS-H Form 4015, Mar 92 (Obsoletes previous editions which may not be used)
(Stock Number: 5744- 003 - 4015 -1)
j YES [ X] NO 10 YEAR FLOODING? [ ] YES [x) NO
De FT MSL /NGVD SITE ELEVATION: 7 . 2 FT MSL /NGVD
SOIL PROFILE INFORMATION SITE 2
Munsell # /Color Texture
BROWN SANDY
USDA SOIL SERIES:
Depth
°I" to 7 2 "
to
to
to
to
to
to
to
to
DATE :1 /19/95
Page 3 of 3
STATE OF FLORIDA
DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES
ONSITE SEWAGE DISPOSAL SYSTEM
CONSTRUCTION PERMIT
Authority: Chapter 381, FS & Chapter 1OD -6, FAC
[I
CONSTRUCTION PERMIT F R:
] New System [ft Existing System [ ] olding Tank ` ] Temporary /Experimental
[ ) Repair [ ] Abandonment [ Other(Specify)
APPLICANT: kb /4
LOT:
PROPERTY ID #:
PROPERTY STREET ADDRESS: 4 4 7 7 i v E. ,o z
BLOCK: SUBDIVISION:
SYSTEM MUST BE CONSTRUCTED IN ACCORDANCE WITH SPECIFICATIONS AND STANDARDS OF CHAPTER 1OD -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.
SYSTEM DESIGN AND
T I0 GQiiS./ GPD SEPTIC TAIIC/0_1 ALL AEROBIC 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 TANK CAPACITY 'DOSE RATE [ ] PER 24 HRS NO. OF PUMPS: [ ]
PECIFICATIONS
D [!(JD] SQUARE FEET PRIMARY DRAINFIELD SYSTEM
R [ ] SQUARE FEET SYSTEM
A TYPE SYSTEM: [ ] STANDARD [ ] FILLED
I CONFIGURATION: [ ] TRENCH [ ] BED
N
F LOCATION OF BENCHMARK:
I ELEVATION OF PROPOSED SYSTEM SITE [
E BOTTOM OF DRAINFIELD TO BE [
L
D FILL REQUIRED: [
0 r2 f/
T // (
H
E ®-i''-
R
EXCAVATION REQUIRED: [ ] INCHES
at& Jtjd:A=. y
-S
SPECIFICATIONS BY:
APPROVED BY:
DATE ISSUED 7 __ 3P
] INCHES
AGENT: c z i , ,7, ,Th9 s i 7 c l t/
s %-
[SECTION /TOWNSHIP /RANGE /PARCEL NUMBER]
[OR TAX ID NUMBER]
] [INCHES /FT) [ABOVE /BELOW) BENCHMARK /REFERENCE POINT
] [INCHES /FT] [ABOVE /BELOW] BENCHMARK /REFERENCE POINT
TITLE:
APPLICANT
57 �s t� n
rirP, !✓ `7� 1E: (;" n n `-f; Pnro� ,:n ni �C: LAC
�� �.a� �1. �. f L Jt
�� ,. I 'L�.'L .u.Y !�w c,l•.('i� r...�i 71:1
HRS -H Form 4016, Mar 92 (Obsoletes previous editions which may not be used)
(Stock Number: 5744 - 001- 4016 - 0)
PERMIT # 5 o Z7r
DATE PAID
FEE PAID $
RECEIPT #
[ ] MOUND [ ]
[
Page 1 of 2
tNNSTl2UC'I'IONS:
PM MIT NUMBER: Permit tracking number assigned by CPHU.
APPLICA T ION 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 represen_tetive.
NAILING ADDRESS: P.O. box or street mailing address for applicant or agent.
LOT, BLOCK, SUBDIVISION or
PROPERTY IDI /: 27 character id number for property. (CPHU may require property appraiser
SYSTEM DESIGN AND
SPECIFICATIONS:
111
II or section/township /range /parcel number)
TANK: Minimum specifications from Chapter 1OD-6, FAC.
DRAINFIELD: Minimum specifications from Chapter 10D-6, FAC.
OTHER: Other specifications, such as operating permit requirements, low- volume flush toilets, variance provisos.
SPECIFICATIONS BY: Name of individual providing specifications. If designed by c registered engineer must be sealed.
APPROVED BY: County Public Health Unit (CPHU) 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 date
issued.
Scale: Each block represents 5 feet and 1 inch = 50 feet.
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. 11 6
Notes:
STATE OF FLORIDA
DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES
APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM ; CONSTRUCJ I N PERMIT
Permit Application Numbe / S - J
PART II - SITE PLAN
1 J_ J__
WILLENS: 479 NE 102 STREET 33138
OLD SYSTEM OVERELWOING.
Site Plan submittedjoy
S ATURE
/ 1.
Plan Approved Not,Approved Date - 2 3-/-f
By �.� County Public Unit
AL ANGES MUST BE APPROVED BY TH CO TY PU HEALTH UNIT
HRS-H Form 4015, Feb 85 (Obsoletes previous editions which may not be used)
(Stock Number. 5744.002- 4015 -6)
ELEVATION:
TITLE
Page 2 of 3
CE
t9
Per;sait No.. /b
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
Date__ L _- - _ 9e /9160
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.
A ? ) / c ,(
Owners Name and Address r 1 � __ ___- !�4/ _� L L 'v_S1 No.__. Street !� ° /
Registered Architect and /or Engi _ __ ___________________ __— __
Employt g Plumber's Name '�
� o�l< �77-C N0 ._ _1 ,, ..__ Street bL (A /
S ubdivision
Street_A t / •
Location and Legal Description Lot____________._____________ Block
Street and Number where work is to be performed —No.__ 9
------------------ - - - - -- - - --
Amount of Permit $ --
(S ed) - --
(Sign
State work to be performed and purpose of building (By Floors)-
------------------_--------____--
New Building — ___ Remodeling____ __._._ Addition____ Repairs___ No. of Stories_
Size Septic Tank_ ----- � r � v T o Capacity Gals.. .....
Feet of Drain Tile Dist. et o Tank o Drain Field from Well
Nature of Water Supply: City —Well. Size of Soakage Pit
Plumbing Inspector.
The undersigned applicant for this building permit does hereby certify that he understands and acce • s his obligations as an employer of labor
under the Florida Workmen's Compensation Act, being Section 5988, Compiled General Laws of Flo , • a 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 I • .ce or n a
required by the Act. The undersigned agrees to employ only such sub- contractors, on w• ! to performe
licensed by Miami Shores Village.
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
STATE OF FLORIDA,
COUNTY OF DADE. D
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take aclmowledgments, personally appeared
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
U RINALS
CATCH
BASIN
FLOOR
DRAIN
DRINKING
FOUNT' NS
TOTAL
FI %TURE6
Comm
LISY
- ^-
CHECX
SEPTIC
TANK
SEWER
CONN.
DRAIN
FIELD
SOAKAGE
PIT
GREASE
TRAP
SOLAR
HEATER
DEEP
WELL
SPRKLR.
SYSTEM
SW IM'G
POOL
CONTR.
LIST
-
CHECK
t9
Per;sait No.. /b
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
Date__ L _- - _ 9e /9160
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.
A ? ) / c ,(
Owners Name and Address r 1 � __ ___- !�4/ _� L L 'v_S1 No.__. Street !� ° /
Registered Architect and /or Engi _ __ ___________________ __— __
Employt g Plumber's Name '�
� o�l< �77-C N0 ._ _1 ,, ..__ Street bL (A /
S ubdivision
Street_A t / •
Location and Legal Description Lot____________._____________ Block
Street and Number where work is to be performed —No.__ 9
------------------ - - - - -- - - --
Amount of Permit $ --
(S ed) - --
(Sign
State work to be performed and purpose of building (By Floors)-
------------------_--------____--
New Building — ___ Remodeling____ __._._ Addition____ Repairs___ No. of Stories_
Size Septic Tank_ ----- � r � v T o Capacity Gals.. .....
Feet of Drain Tile Dist. et o Tank o Drain Field from Well
Nature of Water Supply: City —Well. Size of Soakage Pit
Plumbing Inspector.
The undersigned applicant for this building permit does hereby certify that he understands and acce • s his obligations as an employer of labor
under the Florida Workmen's Compensation Act, being Section 5988, Compiled General Laws of Flo , • a 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 I • .ce or n a
required by the Act. The undersigned agrees to employ only such sub- contractors, on w• ! to performe
licensed by Miami Shores Village.
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
STATE OF FLORIDA,
COUNTY OF DADE. D
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take aclmowledgments, personally appeared
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.
Permit No
/3
Size Septic Tank
Feet of Drain Tile___-_ -t,1 Z •--r
Nature of Water Supply: City —Well.
a&
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING ir,AIT
Date / Z —
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. Q —Al
Owner's Name and Address W � !y� __ ils No. _� 7 / " L Street / 2 ��
Registered Architect and /or Engineer____________
Employing Plumber's Name ..-- _Qs0-; ` ®`No:_ . Street
Location and Legal Description Lot---_-. __._____.__._._______- -____.—__ Block_ - Subdivision
9 Street and Number where work is to be performed —No I/ 7 / 4" !O L' Street
State w o r k to be performed and purpose of building (By Floors) _._ -42- / 0 _ A L
New Building ___ Remodeling Addition__
Type of Tank
_Dist. Feet of Tank or Drain Field from Well
Size of Soakage Pit
Amount of Permit $ --------- - - - - -- — - -- - -- (Sid) - -- 1/ � 1 - 1'
Capacity Gals.
Plumbing Inspector.
The undersigned applicant for this building permit does hereby certify that he understands and accepts h' '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 undersigned agrees to employ only such sub- contractors, on work to be perf ed under this permit, as are
licensed by Miami Shores Village.
( Signed)...
Repairs
3L
No. of Stories
( ,)
Master Plumber.
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 necessary by improper notice for inspection, or faulty
materials and /or workmanship.
CLOSETS
BATH
TUBS
SHOWERS
LAVA.
TORIES
SINKS
SLOP
SINKS
LAUNDRY
Tues
U RINALS
CATCH
BASIN
FLOOR
DRAIN
DRINKING
FOUNT' NB
TOTAL
FIXTURES
CONTR.
LIST
CHECK
-_
SEPTIC
TANK
SEWER
CONN.
DRAIN
FIELD
SOAKAGE
PIT
GREASE
TRAP
SOLAR
HEATER
DEEP
WELL
SPRKLR.
SYSTEM
SW IM'G
POOL
CONTR.
LIST
-
CHECK
Permit No
/3
Size Septic Tank
Feet of Drain Tile___-_ -t,1 Z •--r
Nature of Water Supply: City —Well.
a&
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING ir,AIT
Date / Z —
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. Q —Al
Owner's Name and Address W � !y� __ ils No. _� 7 / " L Street / 2 ��
Registered Architect and /or Engineer____________
Employing Plumber's Name ..-- _Qs0-; ` ®`No:_ . Street
Location and Legal Description Lot---_-. __._____.__._._______- -____.—__ Block_ - Subdivision
9 Street and Number where work is to be performed —No I/ 7 / 4" !O L' Street
State w o r k to be performed and purpose of building (By Floors) _._ -42- / 0 _ A L
New Building ___ Remodeling Addition__
Type of Tank
_Dist. Feet of Tank or Drain Field from Well
Size of Soakage Pit
Amount of Permit $ --------- - - - - -- — - -- - -- (Sid) - -- 1/ � 1 - 1'
Capacity Gals.
Plumbing Inspector.
The undersigned applicant for this building permit does hereby certify that he understands and accepts h' '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 undersigned agrees to employ only such sub- contractors, on work to be perf ed under this permit, as are
licensed by Miami Shores Village.
( Signed)...
Repairs
3L
No. of Stories
( ,)
Master Plumber.
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 necessary by improper notice for inspection, or faulty
materials and /or workmanship.
BUILDING
ELECTRICAL
PLUMBING
ROOFING
Owner of
Building
Archi tect
Contractor
or Builder
MIAMI SHOD
❑
❑ PERMIT
r ( -
Legal Lot
Description — � Bl
Address of
Building
CONTRACTOR OR BUILDER
A w.
,.•
Signed•
♦ tr
In consideration of the issuance to me of this permit I agree, X 10 Pe
pertaining thereto and in strict conformity with the plans, drawings,
cepting this permiit -I assume 'responsibility for all work done by ei
;
, • moo .14
ILLAGE. FLORIDA
6450
Work to be performed under this Permit
Value of
Project $
DATE
Contractor's
License No.
Subdi-
vision
This permit is granted to the contractor or builder named above to cotiItruct 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 an apprbvedj by the proper municipal authorities. This Permit may be revoked at any
time it the work is not done in compliance with such ordinances or if the plans aie 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, cliawing0 or in the or specifications and that he assumes responsibility for work
done by his agents, servants or employees. -
4 .
BY'.
195
Amount of
Permit $
INSPECTOR ,
the work " 'bred hereunder in compliance with all ordinance .,and regulations
specifications submitted,.to the proper authorities of Miami Shores Village. In ac•
my agent, servant or employee.
AUTHORITY
;UILDING
:LECTRICAL
'LUMBING
GOOFING
)caner of
• uilding '
rchitect
:ontractor
r Builder
egal
'escription
ddress of
uilding
. t
Lot
p PERMIT N ?
fLJ
(3
COIVTIACTOR OR BUILDER
MIAMI SHORES
Work to be performed under this Permit
a a1
VILLAGE.
4058
BY
FLORIDA
DATE )
Subdi-
vision
Value of
Project $
Contractor's
License No. f l `'
Amount of
Permit $
�f
f
195_
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
erefor in strict compliance with all ordinances pertaining thereto and with the understanding that the work will be performed in compliance with any plans,
awings, statements or specifications that may have been submitted to and approved by the proper municipal authorities. This Permit may be revoked at any
ue 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.
„, `^x.
Signed. • ,.w � . w,,,B•Y�
INSPECTOR A, -.'^•
In consideration of the issuance to me of this permit I agree to perform the work covered hereun r in compliance with all ordinances and regulations
rtaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted t the proper authorities of Miami Shores Village. In ac-
, pting this permit I assume responsibility for all work done by either, myself, my agent, servant or em oyes.
i .i
AUTHORITY ems,
Permit No
Owner's Name and Address
Feet of Drain Tile__
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
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.
No. __ / 0) Street_]
g Engineer
Registered Architect and/or
Employing Plumber's Name No.' f: !_.1‘, ' Street.
Location and Legal Description Lot k Subdivision
Street and Number where work is to be performed—No 1.43__?_,(11- / a
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
e a Dist. Feet of Tank or Drain Field from Well
No. of Stories
Nature of Water Supply: City—Well Size of Soakage Pit
. Amount of Permit $
The undersigned applicant for this building permit does hereby certify that he understands and accepts his o igations as in employer of labor
under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Perm: nent Supplement, and has corn -
plied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors einployed by him in the work to be
performed under this permit; and will post or cause to be posted for inspection on the site of the work such public notice or notices as are
required by the Act. The undersigned agrees to employ only such sub-contractors, on work to be performed under this permit, as are
licensed by Miami Shores Village.
STATE OF FLORIDA, 1
COUNTY OF DADE.
ss.
( Signed) _
(Signed)
My Commission Expires Notary Public, State of Florida
PIylinbing Inspector.
Master Plumber.
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 $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
HEATER
DEEP
WELL
SPRKLR.
SYSTEM
SWIM'G
POOL
CONTR.
LIST
CHECK
Permit No
Owner's Name and Address
Feet of Drain Tile__
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
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.
No. __ / 0) Street_]
g Engineer
Registered Architect and/or
Employing Plumber's Name No.' f: !_.1‘, ' Street.
Location and Legal Description Lot k Subdivision
Street and Number where work is to be performed—No 1.43__?_,(11- / a
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
e a Dist. Feet of Tank or Drain Field from Well
No. of Stories
Nature of Water Supply: City—Well Size of Soakage Pit
. Amount of Permit $
The undersigned applicant for this building permit does hereby certify that he understands and accepts his o igations as in employer of labor
under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Perm: nent Supplement, and has corn -
plied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors einployed by him in the work to be
performed under this permit; and will post or cause to be posted for inspection on the site of the work such public notice or notices as are
required by the Act. The undersigned agrees to employ only such sub-contractors, on work to be performed under this permit, as are
licensed by Miami Shores Village.
STATE OF FLORIDA, 1
COUNTY OF DADE.
ss.
( Signed) _
(Signed)
My Commission Expires Notary Public, State of Florida
PIylinbing Inspector.
Master Plumber.
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 $1.00 will be made when such re- inspection is made necessary by improper notice for inspection, or faulty
materials and /or workmanship.
BUILDING
ELECTRICAL
PLUMBING
ROOFING
Owner of
Building
Architect
Contractor
or Builder
Legal
Description
Address of
Building
Lot
11
PERMIT 'N? 13162
Work to be performed under this Permit
;�- j4JILt.Jj
-6 IT:404
BI
Riff /02-'J
This permit is granted to tliE contractor or builder named above to
herefor in strict compliance with all ordinances pertaining thereto and wi
drawings, statements or specifications that may have been submitted to and
time if the work is not done in compliance with such ordinances or if the pla
granted is the understanding that the contractor or builder named above ass
pertaining to the work covered hereby whether show
done by his agents, servants or employees.
In consideration of the issuance to me of this permit I a
pertaining thereto and in strict conformity with • glans, d wings,
In accepting this permit I assume res "ty .r all wor• done
CONTRACTOR OR BUILDER
MIAMI SHORES VILLAGE, FLORIDA
4
•
Subdi-
vision
Value of
ect $
DAT
uilding or to install the equipment or device described in t lication
anding that the work will be performed in compliance with an ns,
the proper municipal authorities. This Permit may be revoked at any
d without authorization. A further condition upon which this permit is
ponsibility for a thorough knowledge of the ordinances and regulations
e stat nts o _. nd that he .su s responsibility for work
INSPECTOR
orm the work covered hereunder in corn
nts or specifications submitted to t
f, my agent, servant or
Contractor
License No
Amt. of
Permit
BY AUTHORITY
s i‘o
195
finances andl'egulations
f Miami Shores Village.