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PT-09-1725
Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP- 127948 Permit Number: PT -10 -09 -1725 Scheduled Inspection Date: November 02, 2009 Permit Type: Paint Inspector: Bruhn, Norman Inspection Type: Final Owner: BUTLER, JACQUELINE Work Classification: New Job Address: 1461 NE 102 Street Miami Shores, FL 33138 -2621 Phone Number Parcel Number 1132050240140 Project: <NONE> Contractor: HOME OWNER nt comments October 30, 2009 For Inspections please call: (305)762 -4949 Page 10 of 18 Inspector Comments Passed ` ,/; CREATED AS REINSPECTION FOR INSP- 127405. Not Complete Failed Correction Needed ❑ Re- Inspection ❑ Fee No Additional Inspections can be scheduled until re- inspection fee is paid. October 30, 2009 For Inspections please call: (305)762 -4949 Page 10 of 18 Miami Shores Village 7 P0TIEMr 1 lb Building Department ALT 1.0050 N.E2nd Avenue. Miami Shores, Florida 33138 Tel: (305) 79`5.2204 Fax: (305) 756.8972 B1 :. ••••••� BUILDING Permit No. —1-1 G3 PERMIT APPLICATION Master Permit No. FBC 2004 Permit Type: PAINT PERMIT Owner's Name (Pee Simple Titleholder) '7 Y/ - J5-(Y 3 v -T — Owner's Address Cityt,�1 S(p5 State , Zip 3 3 \ 3$ Tenant /Lessee Name E -MAIL: Phone # Job Address (where the work is being done) 114 (,q 4_ � �_- (oz S� , City_ Miami Shores Village County Miami -Dade Zip 3 s 1 3F FOLIO / PARCEL # Is Building Historically Designated YES NO Contractor's Company Name _ 6mo µ���(. Phone # Contractor's Address City_________ Qualifier Name State Certificate or Registration No. OWNER BUILDER: I e-5 Value of Work For this Permit S Describe Work: State Zip Phone # Certificate of Competency No. Type of Work: ❑ Addition / ❑ Alteration / ❑New / ❑ Repair /Replace Oak AP_ Application is hereby made to obtain a permit to do the work and installations ae indicated. I certify that no work or installation has commenced prior to the iswance ol'a permit and that all wok will be perforni;d to meet the standards ol'all lavvs iL <(ula(ing construction in this jurisdiction. I understand (hat a separate permit nws( be secured lisr ELF("I'MCAI. WORK. PL.UMl3IN(, SIGNS. WELLS. POOLS, FURNACF ?S, BOILERS. HEATERS, TANKS and AIR CONDITIONERS, ETC..... "WARNING TO O\YNER: YOUR FAILURE TO RECORD A\ No,rI(.:E OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPL11TY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORi RECORDING YOUR NOTICE OF COMMENC:'EMEN'L" Notice to. I ppl icaru: a.c a condition to the issuance gl o building pertnit with an estimated value exceeding $2500. the applicant nnrat promise in good faith Thal a colt! of the, notice o(cornmencenteni and construction lien law hrochure will be delivered to the person whose property is subject to attachment. Also. a certified copy of the recorded notice of c•nntmencentew rmrsi he posted at the job silo for the first inspection which occurs seven (7) days ajler the building permit is issued. In the absence gf such posted notice. the inspection will not he approved and a reinspection fee will be charged. Permit Fee S rr'' CCF 0 C — Technology Fee: Training /Education cation Fee $ 0-E0. Notary $ S- Code Enforcement $ Double Fee S Zoning $ Total Fee Now Due $ C I - See Reverse side -> PAINT COLOR APPROVAL AND AGREEMENT All elements on the site must be listed and indicate the color to be nainted Directions: Please circle corresponding number to appropriate color sample. watts: I 2 ' 4 Attach color samples with name and number. - k Fascia: I 2 3 4 Drip Cap /Drip Edge: { 2 -- Soffit: I 4 2 Roof: 1 2 3 4 Flower Bins: I 2 3 4 Shutters: I 2 3 4 Awnings: I 2 3 4 Chimney: I 2 3 4 Doors and Door.lams: 1 2 3 4 Garage Doors: _ 1 2 3 4 Railings: 1 2 3 4 3 Fences: I 2 3 4 All brick (simulated or re(yular ): 1 2 3 4 Stucco Banding: 1 2 3 4 Any other Stucco Features: 1 2 3 4 4 Accessory Buildings Other: 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. Signature Qj�,�,C�� Lim- or Agent The tbie) in - it •trument \vas a nowleclgecl efore me is 1 1 day of 20� b� r who is pu rsonallw know to m - or who I as ploduccxl_ 0 � ljn(_ •ation an vho did �kiat� NOTAR P I F Qa Sign: Signature Contractor The foregoing instrument was acknowledged before me this day of 20 by ` who is personally known to me or who has produced as identification and who did take an oath. NOTARY PUBLIC: Sign: — Print: My Commission t:xpires: i My Commission Expires: % OT' %" %)C •x % % %1: % % %% % % %X' % %% '% %�. % %ti % % % %% % % % % % %Lt % % % % % % % %iC % % % % % % % % % % % % % % %�. % % % % % % % % % % %X %tC APPLICATION APPROVI'D BY: Plans Examiner Preservation hoard Code [ ;nRircement r + (Revised 04/24/0 asuORES y Miami Shores Village CCF 10050 N.E. 2nd Avenue Education Surcharge Miami Shores, FL 33138 -0000 Miscellaneous Fee Phone: (305)795 -2204 'FLORIDA $5.00 Project Address 1461 102 Street __...... Miami Shores, FL 33138 -2621 Owner Information JACQUELINE BUTLER Parcel Number 1132050240140 Block: Lot: 1461 102 Street MIAMI SHORES FL 33138 -2621 Contractor(s) Phone Cell Phone HOME OWNER 1pe of Work: Exterior olor: WHITE dditional Info: lassification: Residential olor: WHITE—Approved olor: WHITE_Approved_ Fees Due Amount CCF $0.60 Education Surcharge $0.20 Miscellaneous Fee $1.50 Notary Fee $5.00 Permit Fee $60.00 Scanning Fee $0.00 Total: $67.30 Code Comments: Color: WHITE Denied JACQUELINE BUTLER Cell I Valuation: $ 1,000.00 Total Sq Feet: 0 Invoice # Total Amt Paid Amt Due PT -10 -09 -36191 $ 67.30 $ 67.30 $ 0.00 Check #: 4660 For Inspections please call: (305)762 -4949 Available inspections: Inspection Type: Final 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 responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are required for ELECTRICAL, PLUMBING, MECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work. OWNERS 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. Futhermore, I authorize the above -named contractor to do the work stated. October 19, 2009 Authorized Signature: Owner / Applicant ! Contractor / Agent Date Building Department Copy October 19, 2009 1 02/13/96 10:31 P1SV PERMIT APPLICATION FOR MIAMI SHORES VILLAGE rata: Job Address ��— � 1- -Al f %D Tax.. Folio Demption I listoncally Designated: Ycs No 001 )wnWll.t=W /Teiutni JAGff l AF 13071—„(1 R - Master Pcrrrut# MmWs Aft= /4 (v ! j� / O z , j �: Ptrcxle outracting Co. f V v Address /2 05 e (_ h Lr N r Li L-- NJ xWjfier '& j6 N P� , YXP 15 A, N ��y'T�xs �, Phone S�G/% Y S 3 fate !i a. 3 % I % 'municipal # k xAng company c mpamc . # Ins. Co. Address Address Addrrs5 'ermh Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING .PAVING FENCE SIGN NORK DESCRU MON **_ �G � ,%2 %L�, -rte �' E t� 1't �14 C- quare Ft 15-- 2 0 __ -- - - _ - l stitnated Cm (value) 125°0,9.. 1NARNING TO OWNER: YOU MUST RECORD A NOTICE OF COMMENCEMENT AND YOUR FAILURE TO ado $O, MAY IESULT IN YOUR PAYING TWICE FOR I1riPROVEMENTa TO YOUR PROPERTY (IF YOU INTEND? TO OBTAIN FINANCING, :ONSULT 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 indimcd above, wid on the attached addendum (if applicable).,, I ertify that all work will be performed to meet the standards of all laws regulatll)g construction in this jurisdiction. I understand that separate )eruuts are required for ELECTRICAL. PLUMBING, SIGNS.. P001,S,1ZOOFING and ivECI I-AMCAI: WORK, )WNER'S AFFMAVIT: I earthy that all the foregoing informstitn is aws regulating construction and'2c:ntng. ? ttrtht rmore, I authorize the ah iigttature of owner and/or Condo President Date 'Iotaty as to Owner andkrr L:ondo President Date -.4y Cornrriission Expires: sit nd that all work will be dune in compliancc with all applicable ed cot 11i t c work stat -d. ature of Contractor of Owner- Builder Date ob- as tv Contractot tv Commtasfon Fxpiles: Gate L OFFtt� i l .77 '��/y� v ?` ?MARY Stq !0 Ay l' : PERMIT : _RADON C..C.F. ji NOTARY TOTAL DUI' - APPROVED: 7oising ! Building >rlcctrical KcC#ti¢tie� Plumbing _ _ Engineering -All Fclund 0.1 G[-. t . tO- U ' t Fp ,. , AS BUILT SURVEY T E ' hd 384,82' ►�M i.l.. 6-Z�u E\v.= 12.04' SCALE: / Tv,L, ibd�" ST. � �;scaynrL j3�vc� . 1" _ Z 0 Note: Bearings when shown refer to meridian VO4 Ci ;off, MIAMI SHORES VILLAGE BUILDING INSPECTION DEPARTMENT APPLICATION FOR BUILDING PERMIT 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 the work. Dto 19� ✓Owner's Name and Addres� 1� ✓(�f �11�i��A%2— No. Street 10.2— Registered Architect and/or Engineer r- ✓Name and address of licensed contractor d!!515VI .S 5- _Z &.Z./ 5 &J '7"&14& 1°0 YJj59� Location and legal cjescription of lot to be built on: Lot d Block Subdivision ifg`treet and Number where work is to be AS'tate work to be done and purpose of bi r New Building Remodeling Addition Repairs No. of To be constructed of Kind of foundation Roof Covering L-- stimated Total cost of improvements $ eo% a Amount of Permit $ 5 I y R! 6 Zone cubage required Distance to next nearest building Maximum live load to be borne by each floor Cubage of Building Lot and for no other purpose. I hereby submit all plans and specifications for said building. All notices with reference to the building and its construction may be sent to The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligatons as an employer of Labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida, Permanent Supplement, and has complied 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 subcontractors, n work to be performed under this permit, as are licensed by Miami Shores Village. j s Remarks STATE OF FLORIDA COUNTY OF DADE. Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeared to me well known, and who, being by me first duly sworn, upon oath deposes and says that he is the of the above described construction, that he has carefully read the foregoing application, and that he did sign the same, and that all facts therein by him stated are true. Iff Permit No. / Date Read, Sworn to and Subscribed before me. Disapproved . _ (Signed) Building Inspector My Commission Expires Notary Public, State of PLANNING BOARD DATE Chairman Member Member Member Member Member Council Approved Disapproved Date NOTE: A charge of $25.00 will be made for making corrections or changes to this application after approval has been obtained from the Planning Board. A re- inspection fee of $25.00 will be charged when such re- inspection is made necessary by improper notice for inspection or faulty materials and/or workmanship. I. kore��Ytffiiqe F L O D A PLANNING BOARD AGENDA OF 444 11 1 1 W ITEM NO. 10 Name of Owner /Appli cantJW$j)4 $. aIt."wei Phone No. Address of Property, and /or Legal Description %"I HS*" Nature of Request 14"UVA cif' $Q;IT tArY Present Zoning (L. %of Area of Present Building Area with Proposed Addition Parking Spaces Provided Parking Spaces Required with Addition Setbacks as per Code Setbacks Provided Variances /Exceptions /Zoning Change Council Action Required Date of Applicant Notification Planning Board Action hJ'Qjk , I Council Action Director of Building and Zoning Fm, " 4 mqpk Rug .ck AS BUILT SURVEY 14-1 Y SCALE: I- - 2 0 / FmA - 6 --win -777� ui .i W. E. % 0 Cr ~"' -aT, DATE: ZA k-? LC- ui .i W. E. % 0 Cr ~"' -aT, DATE: MIAMI SHORES VILLAGE BUILDING INSPECTION DEPARTMENT APPLICATION FOR BiTILDING PERMIT 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 the work. Date June 6, ,19 89 Owners Name and Address David Butter No 1461 N.E. 102nd Street Registered Architect and/or Engineer O b e n o u r Roofing 7357 N. W. Miami C t. Miami , FL 33150 Name and address of licensed contractor Location and leggdescription of lot to be built on: / C,� J Laj �� le Block I Subdivision A / j ,0. °� ®/a al Street and Number where work is to be done 1461 N.E. 10 2 n d S f r e e t State work to be done and purpose of building (by floors), state exterior cokes (submit samples) Reroof entire residence and install new white tile roofing. s 41 s g s . and for no other purpose. New Building Remodeling' P r 0 n f Addition Repairs No of Stories To be constructed of 1-300r--90 Kind of foundation wood Roof Covering tile Estimated Total coat of improvements s 11,535.00 Amount of permit 6 41.00 Zone cubage required Plan Cubage Distance to neat nearest building Size of Building Lot Maximum live load to be borne by each floor I hereby submit all plans and specifications for said building. All notices with reference to the building and its construction may be sent to Obenour Roofing 7357 N.W. Miami Ct. Miami, FL 33150 The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligatons as an employer of Labor under the Florida Workmen's Compensation Act, being Section 5866, Compiled General Laws of Florida, Permanent Supplement, and has complied with the provisions thereof, will require similar compliance from all contractors or sub contractors employed by him in the work to be performed under this per ' ;and will post or ca FF po sted for inspection on the site of the work such public notice or notices as are required by the Act. The undersigned agrees only such su work to be performed under this permit, as are licensed by Miami Shores Village. Remarks (Signed) 4 L-� STATE OF FLORIDA �ys� COUNTY OF DADE. } as Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments , personally appeared _ James D. Obenour to me well "kii"rn.. and who, being by me first duly sworn, upon oath deposes and says that he is the Contractor of the above described construction, that he has carefully read the foregoing application, and that 'd sign the same, and ffikat all facts therein by ism stated are true. Permit No. n ®� Date Read, to and Subscribed are Disapproved Date (Signed) uilding Inspector My Commission Ea V `oliC sut@ of Wide PLANNING BOARD �1DATE IS, 1993 Chairman Member Member Member Member Member Council Approved Disapproved Date NOTE: A charge of 625.00 will be made for making corrections or changes to this application after approval has been obtained from the Planning Board. A re- inspection fee of 625.00 will be charged when such re- inspection is made necessary by improper notice for inspection or faulty materials and/or workmanship. a-4& MI MI SHORES VILLAG�� ELECTRICAL INSPECTION DEPARTMENT APPLICATION FOR ELECTRICAL PE E RMIT .. . Permit No . .. ........ Da ...... . .......... 71 W.&G, Application is hereby made for -the approval of the detailed statement of the plans and specifications I structure herein described. This application is made in compliance and conformity with the Building Ordinance of M and all provisions of the Laws of the State of Florida, all ordinances of Miami Shores Village and all rules and regulatit of Miami Shores Village shall be complied with, whether herein specified or not. A copy of approved plans and sp building during progress qjvV*. Qwnees Name and Address... X)161.33. W.-M ................ No.4- ........ Registered Architect and/or Engineer ................. .. . .. ..... r2 ...... ....................................................................................... Employing Electriciailt's _199CE ..... !.......Street J for the building or other i Shores Village, Fludda, of the Building Division ications must he kept at . . ........... ..... I .......... .................. ..................... 921 � j A — AAmmonano Legai Lftsenpuon ....... — .............. I .... DIOCK ...... . ......... ........ . ........ OuDaivistow.".#... Street and Number where work is to be performed—No .................... .. ............................. Street t q 0 Z ...... M.4;4c,�5_ State work to be performed and purpose of building (By Floors.. E _* ............ a� New Building ................................ Remodeling ............................... Addition ............................. Itepairs .................................... . No. Of Stories .................. .. SWITCH LIGHT PLUG FIXTURES Ra►RIG. IRON RANGE RAN69 WATER W. HEAT. SPACE STRIP TOTAL OUTLETS OUTLET, Rzcz*P,T's No. LAMP* CUTLET OUTLET Oumvr CONN. NEATER CONN. NEATER NEATER Cow,rn. OaT CHECK ENT. DIST. SERVICE. Sanvica MOTORS MOTORS NEON RADIO TOTAL 8W. CAM. Temp. PKRM- 0-1 HP 1•6 HIP TRANS. CONTR. C"acm L4 2'0 � rid�,rgwnd Feeder3_V___J(:.> ..... Conduit.Q: .......... Main Swr. ...... 4> ............... Amps ..... U .. C> ...... Mai, Fusec. ...:f ........... I ...... Amps : nduit .... .................. Tubing ..... ... . ............ B.X1 ......................... Metal Moulding ........ .... I . ........ . ............. ................................ . ... . .............................................................. ..... ....... . ............. P .......... tl - 011-- -.11-1111*1 ............. 1 ....................................... -1 .......... i . ........ ...... ... .............. .. ......... I ....... .. ..... .... . .. . ... . ...... ............................. ......... ... ... - I ...... ...... Amount of Permit $ .......... 0_ ............... ... ...... . . .. ....... ..... .. ............. (Signed). The undersigned applicant for this building permit does hereby certify that he understands and accepts his 6 labor under the Florida Workmen's Compensation Act, being -Section 5966, Compiled General Laws of Florida has complied with the provisions thereof, and will require similar compliance from all contractors or sub-contract work to be performed under this permit; and will post or cause to be posted for inspection on the site of the work �lac are required by the Act. The undersigned. agrees to employ only such sub-contractors, on work to be performe ,licensed by Miami Shores Village. (Signed) C STATE OF FLORIDA, COUNTY OF DADE. Before me, the undersigned authority, a notary public, duty authorized to administer oaths and take appeared... ......:........... ...... .......................... ....... ....... ... .... . . ..... . .... .. ..................... ....... ...................................... ............ ...... ............................... Electrical Inspector. ,ations as an employer of ,-manent Supplement, and employed by him in the eh public notice or notices under this permit, as are personally 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, and he his carefully read the foregoing application, and that he ,-diai-gn"74 .... same, ... ...... an- -d- - t--h- -a- -a H............ f therein by him stated are true. .............................My .................. . **" ........ . ... . ................................................... Commission Expires Notary Public, iiiW NOTE: A re•inspection fee of $1.00 will be made when such re,inspecti on' is made necessary by improper notice for inspection, or faulty materials and/or workmanship. a MIAMI SHORES VILLAGE BUILDING INSPECTION DEPARTMENT APPLICATION FOR BUILDING PERMIT Application is hereby made foci the approA•al of the detailed statement or site plans and specifications herewith submitted for the build ine or other structure. herein',described. This application is made in compliance and conformity with the Building Ordinance of Miami whores Village, Florida. and all provisions of the Laws of the State of Florida all ordinances of Miami Shore age and all rules and regulations of the Building Division of Miami Shores Village shall be complied with, whether herein specified Pill not. A copy of approved plans and specifications must be kept at building during progress of the work. Date. � 8 7 ...19� Owner s Name and Address ...1.. ®.��__W(..1:« `. �Str4et �... ®« .........�. Registered Architect and /or Engineer .... . «...... ....r ••• »• »serer• err• -vnrm �"` mtramrrr......................... »• «• Name and address of licensed contactor... %` Location and legal description of lot to be built on: ® - � ° •� °' Q Lot .. ......... ......... .. .......... _......... Block. «.............. «.. «... Subdivision- .. « Y .. Street and Number where work is to be done..... «/ ...�'!« � .«...�.!._._ ._.._._.... � «.. «.. «.. «.....«... State work to be done and purpose of building (by floors). ��»_`.. .a..e�i�'« ....................w ........« .. ............ ...........,.....,.._ _ ........ ......_...._....._.. .............................. ...,_ .« «...«...... «««..... «.. .. .».«. »_«.».._..»»..»...j,.and for no other purpose. New Building ............................. Remodeling................. » Addition ......................... Repair... .................. No. of Stories ...... ... ... .... »._ To -be constructed of ......................... Kind of foundation:..«.._......... .............................. ... ... .... Roo Covering .... ................ ................_...._ Estimated Total cost of improvements ... ...._......._ » « »...... mount of Permit k. � Zaneeubage required ...... ..................... .........._..... _ « »..«_......«......_ «. Plan Cubage................... ».... « --------- ..«.... .... .............. .......... Distance -to next nearest building .............................. _ ... «.«....... «...._.«.Size of Building Lot ...... .. » »....... , .............«..._._ Maximum live load to be bome by each floor ................ I hereby submit all the plans and specifications for said building. All notices with reference 1 the buildi g and its construction may besent to .. .............................................................................................................................................. ............................... ... ... ............ The undersigned applicant for this building permit does hereby certify that he understands and accepts hi� obligations as an employer of labor under the Florida Workmen's Compensation Act, being Section $066, Compiled General Laws of Florida. Permanent Stipplemegt, and has complied with the rrovisions thereof, and will require similar compliance from all contractors or sub - contractors employed by him in the work to be performed under this permit; and will post or cause to be posted for inspection on the site o ,-the work such public notice or notices as are required by the Act. The undersigned agrees to employ only such subcc on work performed• ur� this permit, as are licensed by Miami Shores Village. Remarks... ............... _ .. .......... ._........... « «».. STATE OF FLORIDA, ` . COUNTY OF DADE. J ss Before me, .the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments. personally ap•, peared .... _ _ .._....,...«.._........_-_........... . ...... ............._.......___ ----------------- « ---- ........._....... « «««._._ _._ .._ _ ......__ ............... _ ..._.............._...« .. .... ......... _.....« _«....._. «_ ._� —to me well knownk 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 a�trque.. Permit No. « ► L ...I. 4 ...... Date. ...« �..i Read. Sworn to and Subscribed before nm Disapproved .. &60�_ Date,._.. ....._...... .............. ........ ... ......... Notary Public. State of Florida (Signed) ._ .. »!► ..................... « . ».... «.. «« Building Inspector My Commission Expires_....»,...,......' PLANNING BOARD-__...... Chairman ..« .. .. ........ ........._.._....»... ..«.........« ._.» . » ....... Member ........_.......... ... . «..............�. »..._.... ,..... «_ .Merrrber ....._._ ............. _ »_ «...» ..... ...... «._...»«.. Member » »«««....._««.......«..,a «««._.... «..«.« .. «._ Member..... ............ «.«....... ..... .......... ._....«...... ._.........._ Membeir «... «...... «.. ._.... ««..... .... «__...__« .«» CouncilApproved .....« .... ............. .. ........ _ ... . .... _. Disapproved ................ «.. ...... . ...... .�.................. .... ... ............ Date NOTE: A -charge of 51.00 will be made for making corrections or changes to this application after appr'm-al has hero obtained from lite Plannim;,, Board. A re•in.pet-tion fee of $1.00 will be charged when such re- inspection is trade necessary by improper notice for inspection or faulty materials anti /or workmanship. MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT 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"sp�dfications must be kept at building during progress of work. �. ! " Owner s Name and Address... OR! ..� No......,����-- :�.-�? Registered Architect and /or Engineer ........ ---- Employing Plumber's Name._ I! � S � .r'f _ , NO . (° A' , Location and Legal Descttption Lot— Blnr Subdivision- Sued and Number where work is to be performed —No. State work to be performed and purpose of building (By Fbxm) - _ -•_ —_ .. -_ —. —. ......- _.;_....._.. _ _..._............ New Building._.._._____- _- ._........ -.. Remodeling . _ Addition...___... -._..... Repairs.---.__........_.. _. No. of Stories......._ ...... . Size Septic Tangy -- -Type of Tae . __—Capacity C,als9___ _.._ Feat of Drain Tile Feet of Tank or Drain Field hams Well Nature of Water Supply: City —WOL -Size of Soakage Pit Amount Of Permit The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligatw as an employer of labor under the Florida Workmen's Compensation Act, being Section 5988, Compiled General Laws of Florida Pennane upplement, and liar 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 under this permit, as are licensed by Miami Shores Villages (Signed) 1 � Muter Plumber. STATE OF FLORIDA. l COUNTY OF DADE. b Before me, the undersigned authority, a notary public, duly anthorized to administer oaths and take acknowledgments, personally appeared o the well known, and who, being by me first duly sworn, lyre oath daoreea�� and app cation, and that he did sign ' aae�e, sod that Iijl facts of the above described construction, that he has carefully read the Soo F� therein by him stated are true. My Commission Expires Notary Public, Sm of Florida NOTE: A re- inspection fee of $1.00 will be made whey 104"Peotim is made•necauary by kwon �ce for Inspection. or faulty materials and /or woriinansbip. CLOSETS BATH TUBS SHOWERS LAVA. TOPICS SINKS SLOP SINKS LAUNDRY Tuns URINAU CATCH ®ASIN FLOOR DRAIN DRINKING FOUNT 'NE' ab••' /.jYf'� f R f' P'f TOTAL FIXTURKS LIST LtsT CHECK }" ®® GREASE TRAP SOLAR HEATER DEEP WELL SPRKLR. SYSTEM SWIM'O POOL � ! I SEPTIC TANK SEWER CONN. DRAIN FIELD SOAKAOX PIT CONTR. LIST CNECK �- Size Septic Tangy -- -Type of Tae . __—Capacity C,als9___ _.._ Feat of Drain Tile Feet of Tank or Drain Field hams Well Nature of Water Supply: City —WOL -Size of Soakage Pit Amount Of Permit The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligatw as an employer of labor under the Florida Workmen's Compensation Act, being Section 5988, Compiled General Laws of Florida Pennane upplement, and liar 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 under this permit, as are licensed by Miami Shores Villages (Signed) 1 � Muter Plumber. STATE OF FLORIDA. l COUNTY OF DADE. b Before me, the undersigned authority, a notary public, duly anthorized to administer oaths and take acknowledgments, personally appeared o the well known, and who, being by me first duly sworn, lyre oath daoreea�� and app cation, and that he did sign ' aae�e, sod that Iijl facts of the above described construction, that he has carefully read the Soo F� therein by him stated are true. My Commission Expires Notary Public, Sm of Florida NOTE: A re- inspection fee of $1.00 will be made whey 104"Peotim is made•necauary by kwon �ce for Inspection. or faulty materials and /or woriinansbip. dro .40 i y low a . U. ri t cif MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT Al 72 — G 7—'fl P APPLICATION FOR PLUMBING PERMIT f Permit No... .___7 w //CxE:) Date.( --1- Application is hereby made for the approval of the detailed statement of the plans and specifications herewith subm structure herein described. This application is made in compliance and conformity with the Building Ordinance of M and all provisions of the Laws of the State of Florida, all ordinances of Miami Shares Village' and all rules and regula of Miami Shores Village shall be complied with, whether herein Specified or not. A copy of approved plane and s building during progress of work. Owners Name and Address.. - 6�.- • ---��0 �' n -- -- No . 0 Street_ Registered Architect and /or Engineer ........ — Employing Plumbers Nemme._..1_.e 9-2: d!z' S ..��.— ...�°%° .� NQ,,,..-��1.®,,,. ,., 8tit� Location and Legal nesctiption L:ot Bloch Subdivw Street and Number where work is to be performed —No. Street ....... ...:. State work to be performed and purpose, of building (By Floon)- -- ..._ -- - ......__:_.._....._ New Building _.__.._......_ -. Remodeling .. Addition...r...... Repairs. » ----- ---------- - 27, "? v d for the building or other ki,Shores Village, Florida, ie of the Building Division ifications must be kept at LLZ ,1..�..,...... ,.,-... of Stories ................ P74,7 (✓ 7 7oTAL tm Size Septic Taliti Type of T�rk Feet of Drain Feet of Tack or Drain Field from Well _ Nature of Water Supply: City —Well Size of Soakage Pit _ _ .. _.... ._..n.® Amount of Permit The undersigned applicant for this building permit does hereby certify that he understands and accepts his oblig loons av employer of labor under the Florida Worlaneds Compensation Act, being Section 5988, Compiled General laws of Florida Pennanen�q Supp ement, and has com- plied with the provisions thereof, and will require similar compliance from all contractors or sub- contractors emplored 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 pubic 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. J Master Plumber. STATE OF FLORIDA, COUNTY OF DADE. Before me, the undersigned authority, a notary public, duly au&mized to administer oaths and take acknowledgments, personally appeared to me well known, and who, being by me first duly swan, upon oath and says that he is the_ .___..._. _ -. ... _ _ .... of the above described construction, that he bas carefully read the regeing applicatlon, and that he dW sign same, and that all facts therein by hum stated are true. MT - Expires Expires Notary Public, State of Florida NOTE: A re- inspection fee Of 41.00 will be rinds when such 104DBP000 a L niiade-00"I sal► by for inspection, a faulty materials and/or worlonanship. P BATH LAVA- SLOP LAUNDRY URINALS CATCH FLOOR DRINKING CLOSSTS TUGS SHOWERS TORIES SINKS SINKS TURK BASIN DRAIN FOUNT'N6 CONTR• LIST CHECK SEPTIC SEWER DRAIN SOAKAGE GREASE' SOLAR HEATER DEEP WELL SPRKLIt. SYSTEM SWIM'O POOL TANK CONN. FIELD PIT TRAP CONTR. LIST CHECK 27, "? v d for the building or other ki,Shores Village, Florida, ie of the Building Division ifications must be kept at LLZ ,1..�..,...... ,.,-... of Stories ................ P74,7 (✓ 7 7oTAL tm Size Septic Taliti Type of T�rk Feet of Drain Feet of Tack or Drain Field from Well _ Nature of Water Supply: City —Well Size of Soakage Pit _ _ .. _.... ._..n.® Amount of Permit The undersigned applicant for this building permit does hereby certify that he understands and accepts his oblig loons av employer of labor under the Florida Worlaneds Compensation Act, being Section 5988, Compiled General laws of Florida Pennanen�q Supp ement, and has com- plied with the provisions thereof, and will require similar compliance from all contractors or sub- contractors emplored 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 pubic 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. J Master Plumber. STATE OF FLORIDA, COUNTY OF DADE. Before me, the undersigned authority, a notary public, duly au&mized to administer oaths and take acknowledgments, personally appeared to me well known, and who, being by me first duly swan, upon oath and says that he is the_ .___..._. _ -. ... _ _ .... of the above described construction, that he bas carefully read the regeing applicatlon, and that he dW sign same, and that all facts therein by hum stated are true. MT - Expires Expires Notary Public, State of Florida NOTE: A re- inspection fee Of 41.00 will be rinds when such 104DBP000 a L niiade-00"I sal► by for inspection, a faulty materials and/or worlonanship. P MIAMI SHORES VILLAGE, FLORIDA BUILDING ❑ DATE -16 19 ELECTRICAL PLUMBING ❑ PERMIT N° 5492 Contractor's ' OOFING License No. ❑ ❑ A Work to be performed under this Permit � WZ Owner of Building Architect — Contractor or Builder Legal Lot Subdi- Description — I Bl. vision Address of Value of I Amount of Building Project $ — 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: __ — _ 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 Village. In ac- cepting this permit I assume responsibility for all work done by either, myself, my agent, servant or employee. CONTRACTOR OR BUILDER BY AUTHORITY x 0s ELECTRICAL PLUMBING ❑ El PERMIT ROOFING ❑ Owner of Building Architect Contractor or Builder Legal Lot Description �I Bl. Address of Building _ N? 2'769 Llii 1 L_ 1Z10- Contractor's License No. Work to be performed under this Permit 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 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. 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 Village. In ac- cepting this permit I assume responsibility for all work done by either, myself, my agent, servant or employee. Architect Contractor or Builder Legal Lot Description —_ Address of Building License No. Work to be performed under this M.I Subdi- vision Value of I Amount of Project $ 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: BY 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 Village. In ac- cepting this permit I assume responsibility for all work done by either, myself, my agent, servant or employee. ROOFING ❑ ❑ Owner of Building Architect Contractor or Builder Legal Lot Description —_ Address of Building License No. Work to be performed under this M.I Subdi- vision Value of I Amount of Project $ 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: BY 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 Village. In ac- cepting this permit I assume responsibility for all work done by either, myself, my agent, servant or employee. ELECTRICAL ❑ 1 P E R M I �' N® 2497 contractors �, PLUMBING ❑ - License No. ROOFING ❑ ❑ Work to be performed under this Permit Owner of Building Architect _- Contractor or Builder ? "' ;„,•.. - ' n+� 6 Legal Lot � :� r � � Subdi- Description — I Bl. vision -- Address of Value of ` 4" Amount of Building Project fa -, + Permit $ This permit is granted to the contractor or builder named above to co ruct the building or to install the equipment or device described in the application herefor in strict compliance with all ordinances pertaining thereto and wfth the understanding that the work will be performed in compliance with any plans, drawings, statements or specifications that may have been submitted to *nd 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 tsssumes the responsibility for ..a thorough knowledge of the ordinances and regulations pertaining to the work covered hereby whether shown on the plans or drq,� ngs or in the statements or spec umes reiponsibility for work done by his agents, servants or employees. Signed: 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 Village, In ac- cepting this permit I assume responsibility for all work done by either, myself, my agent, servant or employee. BUILDING ❑ ELECTRICAL PLUMBING ❑ ROOFING ❑ Owner of Building Architect Contractor or Builder Legal Lot Description — Address of Building MIAMI SHORES VILLAGE, FLORIDA PERMIT No 2555 Bl. Work to be performed under this Permit DATE 195 Contractor's License No. Subdi- vision Value of I Amount of Project Permit $ This permit is granted to the contractor or builder named above to construct the building or to install the equipment or device described in the application herefor in strict compliance with all ordinances pertaining thereto and with the understanding that the work will be performed in compliance with any plans, drawings, statements or specifications that may have been submitted to and approved by the proper municipal authorities. This Permit may be revoked at any time if the work is not done in compliance with such ordinances or if the plans are changed without authorization. A further condition upon which this permit is granted is the understanding that the contractor or builder named above assumes the responsibility for a thorough knowledge of the ordinances and regulations pertaining to the work covered hereby whether shown on the plans or drawings cr in the statements or specifications and that he assumes responsibility for work done by his agents, servants or employees. Signed:--- BY 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 Village. In ac- cepting this permit I assume responsibility for all work done by either, myself, my agent, servant or employee. BUILDING ELECTRICAL PLUMBING 300FING Dwner of 3uilding krchitect I ontractor )r Builder 10M DATE 195 PERMIT N° 6902 Contractor's ,f License No, Work to be performed under this Permit t �egal Lot j Subdi- Description Bl. -- vision address of r Value of j j Amount of 3uilding Project $ I 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 ierefor in strict compliance with all ordinances pertaining thereto and with the understanding that the work will be performed in compliance with any plans frawings, statements or specifications that may have been submitted to and approved by the proper municipal authorities. This Permit may be revoked at any ime 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 ;ranted is the understanding that the contractor or builder named above assumes the responsibility for a thorough knowledge of the ordinances and regulations Dertaining 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 lone by his agents, servants or employees. ` Signed: ° BY: — 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 )ertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In ac• :epting this permit I assume responsibility for all work done by either, myself, my agent, servant or employee. CONTRACTOR OR BUILDER BY AUTHORITY BUILDING ELECTRICAL PLUMBING Owner of Building . Architect MIAMI SHORES VILLAGE, FLORIDA C1 0 e c� p DATE 195 !� P E R M I T N? 6 2 8 3 Contractor's 1 ,% License No. cj*w Work to be performed under Contractor or Builder --- Legal Lot J ,. Description _ +l Bl. — Address of 1,4 .- : ,.- ,�.� Building u" : "'& Subdi- vision this Permit .Z f Value of j ,, , �j� '!V I Amount of Pro) ect $ / — !! 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 statement os'spe igiztions and that he assumes responsibility for work done by his agents, servants or employees. Signed: t / s ' BY: -- 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 pecitications submitted to the proper authorities of Miami Shores Village. In ac- cepting thf ermit I assume responsibility for work done by either, my lf, y a¢ent, servant or employee. 1417 A CONTWJCTCR OR BUILDER BY AUTHORITY 6 A�-Wrl:. MIAMI SHORES VILLAGE. FLORIDA BUILDING lei ❑ �`... DATE:_° 195,. ELECTRICAL r F PLUMBING ❑ PERMIT N? 6729 � contra 'A � ROOFING ❑ F4 ❑ Work to be performed under this Perini Owner of Building �+� j r'' '; Architect 1 Contractor or Builder Legal Description Address of Building Lot - - i�Bl.— t y � Subdi- vision l Value of Amount of Project $ 0 r H 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:` BY: 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 Village. In ac- cepting this permit I assume responsibility for all work done by either, myself, my agent, servant or employee. CONTRACTOR OR BUILDER BY AUTHORITY G ELECTRICAL PLUMBING ❑ ❑ PERMIT ROOFING ❑ Owner of Building Architect Contractor or Builder Legal Description Address of Building — Lot f:. DATE y 195 N? 2. 5 2. 9_ Contractor's License No. Work to be performed under this Subdi- vision Value of I Amount of Project $— I 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: BY 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 Village. In ac- cepting this permit I assume responsibility for all work done by either, myself, my agent, servant or employee. CONTRACTOR OR BUILDER BY AUTHORITY a. ELECTRICAL ❑ PLUMBING ❑ ROOFING ❑ -- .— .� - - -- ❑ Owner of Building Architect Contractor or Builder DATE t 195 PERMIT N? 2543 Contractor's License No. Work to be performed under this Permit_._..__- -�__ —. Legal Lot I Subdi- Description — Bl. vision . Address of Value of ; ( Amount of Building _ Project 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 ff 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: BY 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 Village. In ac- cepting this permit I assume responsibility for all work done by either, myself, my agent, servant or employee. CONTRACTOR OR BUILDER BY AUTHORITY 6 pt;. BUILDING ❑ ELECTRICAL ❑ PLUMBING ❑ ROOFING ❑ Owner of Building _ Architect . Contractor or Builder MIAMI SHORES VILLAGE, FLORIDA 8015 C Date _. �T PERMIT lr ? v Contractor's "` License No. r _ Work to be performed under this Permit Legal Lot Subdi- 19-_ x escrtption Bl. vision _ - - - - - -- Sq. Ft. Address of Value of Amount of Building _ __ Project $ 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:- (INSPECTOR) BY - -_ In consideration of the issuance to me of this permit I agree to perform the work covered hereunder in compliance with all ordinances and regulations pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I assume responsibility for all work done by either, myself, my agent, servant or employee. CONTRACTOR or BUILDER BY AUTHORITY OWNER'S NAME PRESENT ADDRESS LICENSE NO. PHONE NO. p 8 1461 W-r- 102nd -qf-pmtzf JOB LOCATION (ST. OR AVE.) LOT BLOCK SUBDIVISION 1461 N.E. 10 d Street 4� 9 '- 1S '� all l f 1 1 ilMiami Mi ho e GENERA ',CONTRACTOR ' ADDRESS PHONE N O. LICENSE NO. Owner Builder i 461'1 N.E. ' 1024d St. I r BUILDER'S BOND BUILDING PERMIT NO. '5729 DATE — I PE MIT FEE NO. DATE ADDITION I ZONE REQUIREMENTS CU. FT. Pi AN cuaE720 C . FT. EST. COST $ DATE DRAWINGS, SPECIFICATIONS. RESTRICTIONS AND CUBE CHECKED BY: 0. H III TYPE STORIES ROOF CONSTRUCTION INTERIOR CONSTRUCTION I NEW CONSTRUCTION CBS I ONE BURT UP CARA RAGE ROCU DESCRIPTION REPAIRS SAME FINISH A ALTERATION DESCRIPTION ADDITION APPROVED REJECTED] REFERRED TO COUNCIL REASONS SUBMITTED TO'PLANNIN 'BOARD RE- UB ITTEDI' TO PL A N NG BOARD REMARKS SUBMITTED TO VILLAGE COUNCIL G/F�tST� a CERTIFICATE OF OCCUPANCY NO. 7 SI'L ISSUED BY TO BUILDING PERMIT AND INSPECTION RECORD —MIAMI SHORES VILLAGE L gg6' I III ¢ Ili BUILDING INSPECTIONS INSPECTIONS DATE BY RE- INSPECT BY RE- INSPECT BY FOUNDATION SATE FEZ--- TEMPORARY SERVICE $ BEAMS & LINTELS $ SEWER FRAMING SOLAR HEATER $ GAS $ INSPECTIONS FINAL BY RE- INSPECT BY RE- INSPECT BY ROUGHING CLEAN -UP GAS' PLUMBING PERMITS & INSPECTIONS' CONTRACTOR PHONE PERMIT NO. DATE FEE $ NEW BLDG. I ALTERATION ADDITION REPAIRS SPECIAL PERMITS = fiPERMIT N07� SATE FEZ--- TEMPORARY SERVICE $ SEPTIC TANK $ SEWER $ SOLAR HEATER $ GAS $ INSPECTIONS DATE BY RE- INSPECT BY RE- INSPECT BY ROUGHING GAS' SEWER SEPTIC TANK SOLAR HEATER FIXTURES° ELECTRICAL PERMITS & INSPECTIONS CONTRACTOR 4 PHONE rJ PERMIT NO. ICS .9O z- DATE FEE St 0 NEW BLDG. ALTERATION ADDITION REPAIRS SPECIAL PERMITS PERMIT NO. DATE FEE TEMPORARY SERVICE $ H. W. HEATER CONN. $ -RANGE CONN. MOTORS $ FIXTURES $ INSPECTIONS DATE BY RE- INSPECT BY RE- INSPECT - BY TEMP. SERVICE ROUGHING H. W. HEATER CONN RANGE CONN. . FIXTURES& FINAL I I I I +_ 3 APPROMALE C POW NW-CO. VOW SE"ICE DATE -° - DY _ i { 1� f7 Lo As ing or other 0%ct Shores Village, Fla regulations of the I plans and specifica Owner's Name and A Registered Architect g Name and address of Location and teffaides r... W % , WIq Street and Number wl State work to!, done ..I- 1� MIAMI SHORES VILLA(SE BUILDING INSPECTION DEPARTMEN"�j APPLICATION FOR BUILDING PERMIT F Made for the yal of the detailed statement of th rein described. aR ro s application is made', in cmplianc4 nd all provisions of the Laws of the State of Florida ig Division of Miami Shores Village shall be complied iust be kept at building during progress of the work. or Engineer ...... . used contractor._..,&__L.�__ ion of lot to be built on: Block- - - ------- I ........ . ... . .... . work is to be I purpose of b e plans and specifications herewith submitted for the build- and conforini0Miami th the Building Village of Miami all ordinances Sliol e an all rules and with, whether specified or not. A copy of annroved 46 .. . . . . . ........... 119 NO.J. �-' - ----------------------------------- . .. ........... .......................................... , ?L7 11111d for no other purpose. New Rernodelhlg._,�, .............. Addition ......... k_� .......... Repairs ...... - - ------ - -------- No. of Stories .......................... To be constructed of .. . ...... . . ...... . . .. Kind of foundation- Covering_-----._._ .......................... . .. Estimated Total cost of improvements of Permit $.... - - ----- - - - . . .... . ..... . ........ . . . .. . .... Zone cubage rnmNq ----.Plan Cubage._______._ Distance to next building --------------- _Size of Building Lot ....... - - - — - - ----- - - ---------------_-------- --- - ------ Maximum live load to b� home by each floor---- ... ...... . .................. 1-hemb-v,! submit all the plans and specifications for said building. All notices with referencel to the building and its construction may besent to.... . ......... .... . .. . ......... . . -•-•- _•- ..---_......._._....... ...................... The undersigned ap�lhicaat for this building permit does h certify that he understands and accepts his obligations as an employer of labor under the Flora Workmen's Compensation Act, be:90"Ution 5966, Compiled General Laws of Florida, Permanent Supplement, and has complied with the previsions thereof, and will require similar compliance from all contractors or sub-contractors employed by him in the work to be perf � �X under this permit; and will post or cause to be posted for inspecti ! on the site of the work such public notice or notices as are require b the Act. The undersigned agrees to employ only such s= rntrwactGrs, on work to be performed under this permit, as are liceniedfy, Nami Shores Village. STATE OF fLORWJ COUNTY Or DADE. Before me, the un peared I — and who, by me of the above described therein by him stated x Permit No._,�7 _�l Disapproved � (Signed) LAS Chairman Member — Member .... . .... Council Approved_.,.. NOTE: A charge the Planning Board. A re-inspection fe materials an worlm i (Signed signed authority, a notary public, duly authorized to administer oaths.and take acknowledments. personally ap- sworn, upon oath deposes and says that he is x4 that he has carefully read the foregoing al me well known, sign the same, and that aH fads Date.. 4-- Read, Sworn to and S 'bscriW before me. Date— ...... . . Notary Public, State of Florida to PLANNING BOARD. Commission Member Member Member I - — --------------- - * -------- Disapproved_ _ _.... +.-_-_-_-•...........---• ... .................................. Date of $1.00 will be made for making corrections or changes to this application after approval has been obtained from of $1.00 will be charged when such re-inspection is made necessary y I improper notice for inspection or faulty "Iship. b s' OWNER'S NAME 1 PRESENT ADDRESS LICENSE NO. PHONE NO. Guernsey:Const_'ction Co., Inc, �... - JOB LOCATION (ST. OR AVE.) OT BLOCK I SUBDIVISION I 11;61 �.�1 102nd!. Street lq -,�1'' g i I!, Y-.SBP E,, ^t. GENERAL CONTRACTOR ADDRESS i'i PHONE NO. LICENSE NO. 111.V. Cuernsey . I BUILDER'S BOND 2 97 9 -12 -55 1 2-.. C, I BUILDING PERMIT NO. DATE PERMIT FEE NO. D TE O'er 329907 I 2 0 9000 ZONE REQUIRE ENTS CU. FT P''AN CUBE CU. FT. EST. COST $ DATE DRAWINGS. SPECIFICATIONS, RESTRICTIONS AND CUBE CHECKED'BY: TYPE STORIES 0 CONSTRUCTION INTERIOR CONSTRUCTION I CBS I 1 til? I MGr'�le aY�d oak doors, _tile NEW CONSTRUCTION DESCRIPTION - bdrm.- 3- baths -- garage - kitchen- living room. - dining room Fla. room REPAIRS DESCRIPTION P ALTERATION w ADDITION APPROVED REJECTED, REFERRED TO COUNCIL I REASONS SUBMITTEDTOIPLANNIN !BOARD r I �I RE- SUBMITTED'TO PLANNING BOARD REMARKS SUBMITTED VILLAGE iOUNCIL fz- CERTIFICATE F OCCUPANCY NO. �"� " ISSUED BY TO BUILDING PERMIT AND IN'SPECT�ON R�CORO —MIAMI SHORES VILLAGE BUILDING INSPECTIONS INSPECTIONS .,DATE BY RE- INSPECT BY RE- INSPECT BY FOUNDATION ° BEAMS & LINTELS FR ING t FINAL CLEAN -UP PLUMBING PERMITS & INSPECTIONS CONTRACTOR PHONE PERMIT NO. DATE FEE $ ,NEW BLDG. ALTERATION ADDITION REPAIRS SPECIAL PERMITS PERMIT NO. DATE FEE TEMPORARY SERVICE $ - SEPTIC TANK $ '. SEWER $ SOLAR HEATER _ - $ GAS, $ INSPECTIONS DATE BY RE- INSPECT BY REINSPECT BY ROUGHING 0 4 GAS SEWER, SEPTIC TANK SOLAR HEATER FIXTURES ELECTRICAL ERMITS & INSPECTIONS CONTRACTOR PHONE PERMIT NO. DATE �� I 6 FEE $ 02 Z9 NEW BLDG. ALTERATION ADDITION REPAIRS SPECIAL PERMITS PERMIT O. DATE FEE TEMPORARY SERVICE i H. W. HEATER CONN. RANGE CONN. $ MOTORS $ FIXTURES $ f INSPECTIONS DATE BY RE- INSPECT BY RE- INSPECT BY TEMP.. SERVICE, ROUGHING O �� H. W. HEATER CONN RANGE CONN. &IgR�ES & FINAL APPROVAL TO POWER CO. FOR 1SMMICE DATE �' �{j' 3 BY MIAMI SKORPES VII LL AME BUILDING INSPECTION DEPARTMENT APPLICATION FOR BUILDING PERMIT Application is here v made for the proyal of the detailed statement of the plans and 11 specifications herewith submitted for the build- ing or other structure rein described. afbis application 4s made in compliance and conformity with the Building Ordinance of Miami Shores Village, Florida d all provisions of the Laws of the State of Florida all ordinances of Miami Shores Village and all rules and re I g Division of Miami Shores Village shall be complied with, whether herein specified or not. A copy of approved regulations of the plans and specifications ust be kept at building during progress of the work. Owner's Name and A Registered Architect G Name and address of or Engineer...... _.- Date.------- I ------- . ............ . ..... I ...... NoY_ Street: 22 ... LA .. .............. _ _ - _,--------- ....-------- •- •- •• - - - -- -- - - - - -• - - -•- .••....... Location and legal descri tion of lot to be built on: 2' -C_ Lot JZ_Z Block--- .___,._ ..:.... - -- Subdivision. - .. Street and Number whoi e work is to be done-.- --..._..Q ` a — — -- - ---------- I State work to be done ;l purpose Of building (by floors )._L4 ------ - - .... . . . .....1_._ ........................... ................. . _.and for no other purpose. ------------- New Bu1ldfn9___ _,L_f .... . ..... Remodeling ..._........._....._... A, ...... , Repairs- ,--- ::-- - - - - -- --- - -. - - No. of Stories..... /,-** ....... 0 f� W Roof Covering ....... ro_414: .... . ............ . To be constructed of .. Kind of foundation-.- ..... Estimated Total cost of improvements of Permit . . ............... . ........ Zone cubage Cubage ........... C Ld:.� I .......• ..••• ... ..... 'aLW2 . ..... . .................. Distance to next nearest building.:._. .. . ... 7—o —Size of %ilding Lot-,_) 1Z -15 — .."INW." ..................... -40 ZE& Maximum live load to bo� home by each, floor—__ '4 . .. . . ...................... I hereby submit all the plans and specifications for said budding. All notices with reference to the building. and its construction may besent to------- — - - - ----------- - - -___..._. . .................. ....................... 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 complied with t6 provisions thereof, and will require similar compliance from all contractors or sub-contractors employed by him in the work to be perfol meA 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 require il by the Lt. The undersigned agrees to employ only such, subcon"drs, on work to be performed under this permit,' as are licenied by Miami Shores Village. Remarks--! . . ---- •- •- •---- _..._.. STATE OF FLORIDA,. SIL COUNTY OF DADE. Before me, the and i personably ap- peared — --- --------- ..• .... ........• .. .. . . . . ...... ... . ... . . . ............ . �___ . . . . ..... _- •--- _.._..... ._ -• - - -- ....... ---to we well known, and who, by me irst duly sworn, upon oath deposes and says that he is the__. ------ - ----------- - - _____________________- _- - - - -•_ of the above nit scribed *nstruction, that he has camfully read the foregoing application, and that he did sign the same, and tb therein by I Stated-1 toxe. 4ft Permit Not Date 7- Read, Sworn to and Subscribed before me. Disapproved Date ------- . ... . ........ . .... . .... Notary Public, State of Florida (Sigaed) u &"ingbk&10 r My Commission Expires------------- __....__...._..._._. PLANNING BOARD--. --DATE Chairman Member . . .. . ......... . .. . ...... — --------------- - - - - Member Member member ... . ... Member -- ----- Council Approved-- ----.-Date Disapproved ---------- - ---------------------------------------- ..................... Date NOTE: A charge f $1.00 will be made for making corrections or! changes to this application after approval has been obtained from n the Planning Board. A re-inspection fe �of $1.00 will be charged when such re-inspection is made necessary by improper notice for inspection or faulty materials and /or p. Albert 11. icussaint Registered Larva ::urveycr #9C7 State of Florida. Of 6, 3 30 Z `V ccLU r04' I 10`' -3 09 f1 = gr IK vt * r37, �3'ot 2i z C �. 1 MIAMI SHORES VILLAGE BUILDING INSPECTION DEPARTMENT APPLICATION FOR BUILDING PERMIT Application is hereby made for the approval of the detailed statement of the plans and specifications herewitl ing or other structure herein described. This, application is made in compliance and conformity with the Build Shores Village, Florida, and all provisions of the Laws of the State of Florida all ordinances of Miami Shores ' regulations of the Building Division of Miami Shores Village shall be complied with, whether herein specified or plans and specifications must be kept at building during progress of the work. Date -_— Owners Name and Address. J"OV. / / Y No._.____ -- ___ -__ Stree Registered Architect and/or Engineer ..... :.......... ...... ..._ ........ _ ------ - -_; _ .. _ .. _. �. - Name and address of licensed contractor ..---- ._......_ ......... ------- -------- ---------- -.--- ....-- ._...- • - -,_ -_ Location and legal description of lot to be built on; Lot----_-. .._ .... .............. _......... Block_ ............... _........... Sul Street and Number where work is to be done ................. _ State work to be done and purpose of building ( by floors) submitted for the build - r�g Ordinance of Miami ► ge and all rules and not. A copy of approved W. J!! _. ..... _.......... ....... - •--....... ........ --- ........... . -- --- ..... . d for no other purpose. New Building _._ -- ...._-- _ -_ - -_ Remodeling ................. I........ Addition .......................... Repairs ............... ......... No. of Stories .......................... To be constructed of --- _- - - - -_. -_- .- _: - - -- Kind of found�at�ioryn -- .._------------ ---------------- ------------ _. Roof Covering-, ................................ I ......... ... Estimated Total cost of improvements $---------- - -.`-! __.__ ,_..— Amount of Permit $ ........ . _ ............. . Zone cubaSe required._._. - -- _---_-----_Plan Cubage ---- _._--- ----- _ Distance to next nearest .buildua _ Size of Building Lot.:_- - g- - — - - _ _._ g _ ....... __ .............. _.......... Maximum live load to be borne by each floor__.___ -_ _ _ ... ______ :_ _ . < - -. _ - ---- I hereby submit all the plans and specifications for said building. All notices with reference', to the building and its construction may be sent to -__ ....... __---------- ----- The undersigned applicant for this building permit does hereby certify that he understands and accgpts of labor under the Florida Workmen's Compensation Act, being Section 5988, Compiled General Laws of I and has complied with the provisions thereof, and wi11 require similar compliance from all contractors or su in the work to be performed under this permit; and will post or cause to be posted for inspection on the site or notices as are required by the Act. The undersigned agrees to employ only such subcontractors, war] permit, as are licensed by Miami Shores Village. Remarks_ . _ Y______ ( Signed) __ STATE OF FLORIDA, COUNTY OF DADE. f 33. Before me, the undersigned authority, a notary public, duly', authorized to administer oaths and take ac peared . - - ---------------- — ---------- -_ - t -- igations as an employer Permanent Suppplement, actors employ him work such public notice performed under this tr-0 /4' C, personally ap- _ __ ___�_ _ _..- •- ....- •- ----------------- - -.... ...... _..._to me well known, and who, $ p says that he is the. - - - -- ..............----- --------------------- _ - --- -_ heir by me first duly sworn, upon oath deposes and }....__ _ of the above Ascribed construction, that a has carefully read the foregoing application, and that he did sign the same, and that all facts therein by him stated �are true. Permit No..___ __.. Date.,___ /f -� ® Read, Sworn to and Subscribed before joie. Disapproved _ __M______: Date— (signed) — _ -_ ......... - - - -- Building I r -- ---------------------------- Notary Public, State My Commission PLANNING BOARD_ ._._.._._ ------DATE Chairman Member - .._._.._-------- Member ------ - -_._. _ __ _ . Member Member _ _._ _.. _ ._ _ _ _ _ ._ Member Council Approved._._. _ _ __. ...-.- Date Disapproved -- _- _- _--- _.._ ------ _.- -.-.._ NOTE: A charge of $1.00 will be made for making corrections or changes to this application after al the Planning Board. A reins ection fee of $1.00 will be charged when such re- inspection is made necessary by improper materials and/or workmanship. has been obtained from for inspection or faulty MIAMI SHORES VILLAGE: PLUMBING INSPECTION DEPARTMEN e_, APPLICATION FOR PLUMBING "A&MIT Permit No.- (� Application is hereby mat de for the approval of the detailed statement of the plans and specifications herewith su structure herein described This application is made in compliance and conformity with the Building Ordinance of and all provisions of the Laws of the State of Florida, all ordinances of Miami Shores Village and all toles and reg of Miami Shores Village shall be complied with, whether herein specified or not. A copy of approved plans and building during progress of wor Owner's Name and Address. _— = " ' ` " _L1'___ No.- Street Registered Architect and /or Engineer Employing Plumber's Name !! _ Location and Legal Description Street and Number where work is to be performed —No- State work to be performe8 and purpm of building (By bmitted for the building or. other M and Shores Village, Florida, ulat ons of the Building Division cations must be kept at New Building Remodelling Addi+�� - - -- _ . Repairs.,_._.- _ ------- __-____ No. of Stories._...__.___ ....... -____- CLOSETS Size Septic Tank — - I� r— --Type of TA�c�'� Capacity Gals._ __ -.. -- •- - - - - -- Feet of Drain Tile.._" f`' ` nm Feat of Tank or Drain Field from Well.. -_ Nature of Water Supply: City —We1L .Size of Soakage Amount of Permit $ 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 Permanen Supplement, and has com- plied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors employ, 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 pub is notice or notices as are required by We Act. The undersigned agrees to employ only such sub - contractors, on work to be performed under this permit, as are horsed by Miami Shores Vfhge. �M pi m6r. STATE OF FLORIDA, COUNT` 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, upIm.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 a same, and that all facts therein by him stated are true. My Commission Expires Notary Public, Stab) of Florida A re- inspection fee of $1.00 will be made when such winspecttou Is made-neoessaryi by improper no ce for Inspection, or faulty ma ' and /or worli manship. BATH TUBS SHOWERS LAVA- TORIES StNKB SLOP SINKS LAUNDRY IJRIINAL.S TUBS CATCH BASIN FLOOR DRAIN DRINKING FOUNT'NS TOTAL FIXTURES CONTR. LIST CHECK SEPTIC TANK SEWER CONN. DRAIN FIELD .SOAKAGE PIT ¢REASW TRAP SOLAR HEATER DEEP SPRKLR. WELL SYSTEM SWIM'G - POOL CONTR. LIST CHECK Size Septic Tank — - I� r— --Type of TA�c�'� Capacity Gals._ __ -.. -- •- - - - - -- Feet of Drain Tile.._" f`' ` nm Feat of Tank or Drain Field from Well.. -_ Nature of Water Supply: City —We1L .Size of Soakage Amount of Permit $ 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 Permanen Supplement, and has com- plied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors employ, 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 pub is notice or notices as are required by We Act. The undersigned agrees to employ only such sub - contractors, on work to be performed under this permit, as are horsed by Miami Shores Vfhge. �M pi m6r. STATE OF FLORIDA, COUNT` 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, upIm.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 a same, and that all facts therein by him stated are true. My Commission Expires Notary Public, Stab) of Florida A re- inspection fee of $1.00 will be made when such winspecttou Is made-neoessaryi by improper no ce for Inspection, or faulty ma ' and /or worli manship. I 'IAMI SHORES VILLAGi PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT' -�- Permit No.._ Date_ (� - / ® �Plcture li on is hereb made for the a of'the detailed t of th cat Y PP> statelnen a plans and specificatio>is herewith subm tted for the building or other 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 _r flt__t l+L�__ Mall___ _1_11 L_ ____7,__1 _.tat', ...L_aL _.. L_i_ __ __. ♦ _____ _r _- _____'._.. T. ..��._ ��_� . —o- ^'^ - -- '-'��- .- -- - -'-^ ^�� - -� _ -_ '� ^r� �- ••rr•"•w y......a, wa.a v building during progress of woI aa: "-xxa Ulu" u0 acyl, at /y Owneet's Name and Addr •No.- StII ..... ... Architect registered and/or Employing Plumber's Name_ _. N Street _ and Legal Description B Sn S Street and Number where work is to be ec-No Street__ -__ State work to be performed and purpose of building (BY Flom)— 0. of New.Building ____._ Remodeling Addition ___ Repairs_._.--._ ..... --- N ' CLOSETS BAT"' TUBS $"OWERS LAVA- TORIES i�, I� SINKS SLOP SINKS LAUNDRY - TUBS URINALS CATCH BASIN FLOOR '�DRA1N DRINKIN FOUNT• TOTAL RI %TYRES LIST / CNSCIC oa �/ 366 / :7;67) SEPTIC TANK SEWER CONN. DRAIN FIELD .SOAKAGE' PIT GREASE' , TRAP HEATER DEEP SPRKLR. WELL SYSTEM SWIM•G' PC*S. ONTR. LIST � i cK st $in Septic Tank_ Type of Tank __ _____Capacity Feet of Drain Tile — �_ - `- Dist. Fed of Tank or Drain Field from Well_'� �ature of Water Suppl q City Well, -T-u� _.Size of Soakage Pit ___ _ --- a.r. . I t of Permit Plumbing Inspector. The undersigned applicant for this building 1permit does hereby certify that he understands and accepts his obli ons as an employer of labor iurder the Florida Workmen's Compensation Act, Ding Section 5988, Compiled General Laws of Florida Permanen�Supplement, and has com- I)W with the provisions thereof, and will require similar compliance from all contractors or sub - contractors emplo by him In the work to be $arformed under this permit; and will post or cause to be posted for inspecgion on the site of the work such pub c notice or notices as are by the A& The undersigned agrees to employ only such sub - contractors, on work to be performed by Miami Shores Village. under this t, as are o�rsed (Signed) -- .-. - 1 " -' - Phunber. STATE OF FLORIDA, 1 COUNTY OF DADE. j f i Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowleI ents, personally appeared to me well known, and who, being by me Prat duly sworn, upon oath deposes and -says that he is the _ of the ribed construction, that he hay carefully read the ffooregoing application, and that he did sign We same, and that all facts fides we tru My Commission Expires Niu w Public, S of Flrnida A re-ingpection fee of $1.00 will be made when such re- iaspeotian is made-necessary by improper noUce, for inspection, or faulty tNp? d /cs vvor)mranship. 'Ili l II MI APPLIC, Application is hereby made for the ap r ing or other structure herein described. Shores Village, Florida, and all provisions of regulations of the Building Division of Miam plans and specifications must be kept at boil M1 SHORES H RED' VILLA 6 E LDING INSPECTION +,DEPARTMENT MON FOR BUILDING P RMLT I ,al of the detailed statement of the fans and p spe�cationa herewi ` submitted for. the build - ipplication is made in compliance and conformi with the Boil' gg Ordinance of Miami se Laws of 'the State of Florida all ordinances c F Miami Shores illage and all rules and Shores Village shall be complied with, whether h ein specified not.. A copy of approved ing during progress. of the work. Date Ocs Ober, 5 '' ,19_55 Owner's Name and Address IffiGrI S Wnction CO- No. 231 Str� DO . 13th: Ave • T Registered Architect and /or Engineer Name and address of licensed contractor $he et Me! Location and legal description of lot to be built on: Lot Block Subi Street and Number where work is to be donq 1461 I State work to he done and purpose of building (by floors)- Specialty 00* 0 10266 street Roofing on new 573 N, W 71st Street I' uilding Remodeling': Addition Addition Re aus and for no New B other purpose. P ' No: Stories OII© To be constructed of • B • $ • Kind of foundation Roof covering i le & built Up Estimated Total cost of improvements $ 922.00 Amount of Permit 65.00 Zone cubage required plan cubage Distance to neat nearest building Size of Building Lot Maximum live load to be borne by each floor I hereby submit all the plans and specifications for said building. All notices with re_ference'j to the building', d its construction.may be' sent to r 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 complied with the provisions thereof and will require similar compliance from all contractors or sub - contractors ern Toyed 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 su�public notice or notices as are required by the Act. The undersigned agrees to employ only such subco atraetoxs, on work to be performed under this permit, as are licensed by Miami Shores Village. Remarks (Signed) SHEET ,METAL. $_ P P;IALTX COO - STATE OF FLORIDA, �. COUNTY OF DADE. - I Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take aclmowledgments, personally ap- peared _ it and who, being by me first duly sworn, i of the above described construction, that therein by him stated are true. Permit No., Disapproved _ DE c ( Signed) Chairman Member Member _ Council Approved____ =___ NOTE: ' A charge of -$1.00 will be i the Planning Board. �i re -ms ection fee of $1.00 will be mat/nals and /or workmanship. : to me well known, L,'' oath deposes and says that he is the' ;i ias carefully read the foregoing application, and that he did sign the same, and that all facts Read, Sworn to and Subscribed before ni�. NotaryPubli State of Florida j M Y Commission E $P ir' iec NG BOARD--- _DA Member 11 r4 k Member + Member ii —Date Disapproved ate for making corrections or changes to this applicaon after apprbv has been obtained from ed when such re- g inspection is made necessary b improper noti cje for inspection or faulty , II } MIAMI SHORES VILLAME ELECTRICAL INSPECTION DEPARTMENT APPLICATION FOR ELECTRICAL PERMIT Permit No.......: 14. • Date. ................ Z. Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submit structure herein described. This application is made in compliance and conformity with the Building Ordinance of U and all provisions of the Laws of the State of Florida, all ordinances of Miami Shores Village and all rules and regulat! of Miami Shores Village shall be mplied with, whether herein specified or not. A copy of approved plans and q building during progress of wor . �, ......�. ,.....- ..Street.... Owners Name and Address... ..... ... ........... ....:� ..... ....... :... Registered Architect and /or En r ....... ......... ................ ......._ .......... Employing Electrician's Name..... . ..... ................ ¢ �...... No....... 4 - 9,. � :._ ........... Street_ Location and Legal Description Lot ........ .... ZLIF .. 4..Bia ... ............ L .................. »...Subdivision Street and Number where work is to be performed—No ...... Street ........ ,� State work to be perfa ed and purpose of building (By Floors)...................... . ...................... _...... .................... New Building ...... ................ ....... Remodeling .............................. . Addition .............................. Repairs..... ..... ..... 4 . - I for the building or other ai Shores Village, Florida, s of the Building Division ifieation must be kept at V.7Z ... djo,% .: ............. ............ ®.. ..._ ................ of Stories. ................... SWITCH LIGHT PLUG FIXTURES REFRIG. IRON RANGE RANGE WATER W. HEAT. gp ACa STRIP a� TOTAL OUTLETS OUTLETS RECE'P'T'S NO. LAMPS OUTLET OUTLET OUTLET CONN. HEATER CONN. HiZAT6R HSATER CIST LIST L /)4 / r7 1 11.5 (� CHECK O c /1 V ENT. SW, DIET. CAS. SERVICE TEMP. SERVICE - PERM. c .I ' =� MOTORS 0.1 HP MOTORS 1•5 HPNS. 'NEON �� -RADIO TOTAL _ CLIST IST �- CHECK A V tko 0 U f "A a, Servi Undergroun ize Feede 9.... -- - - -- Conduit .... .........Main Sw,.... .®...... _.... .Amps.....1`.....:.........Main Fuses.... ...Amps Type o n ahon— Conduit ..... ......... » ..... Tubing ........................ B.X.L........................ Metal Moulding ................... ... ...... »...................:.... .. .......... .. ...................... ..... ................ _ ........................................... .. .......... ........................... ......................1........ ......... »... ............................ ......._ ....... ......... ».........,....... »... ».......... ............. ............................... ...... .. ......... _ ....... _....... ......... .�........... .. ... »....... Amountof Permit $ ... ....... .. ....... .�.a.L...� ®....... ............................... ( Signed ) ................. _........ ., .... .. ,... ,.„, ... ... ... .. ...... ...................... .... ... ................ ..... Electrical 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 ermanent Supplement, and has complied with the provisions thereof, and will require similar I compliance from all contractors or sub-contra rs 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 subcontractors, on work' to be performei under this permit, as are licensed by Miami Shores Village. ( Signed) ... ..........................r. ».. » ».... _...... .. ............ Maw Electrician. STATE OF FLORIDA, COUNTY OF DADE. s'' Before me, the undersigned authority, a notary public, duly authorized to administer o ths 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, and 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: re inspection fee of $1.00 will be made when such re-inspection is made necessary by improper n0ce for inspection, or fault} materials or workmanship. MIAMI SHORES VILLAGE BUILDING INSPECTION DEPARTMENT APPLICATION FOR BUILDING PERMIT Application is hereby made for the ap royal of the detailed statement of the plans and specifications herewi submitted for the build- ing or other structure her described. This application is made in compliance and conformity with the Buil gg Ordinance of Miami Shores Village, Florida, and all provisions of the Laws of the State of Florida all ordinances of Miami Shores illage and all rules and regulations of the Building Division of Miami Shores Village shall be, complied with, whether herein specified o3 not. A copy of approved plans and specifications must be kept at building during progress of the work. /I Owner's Name and Address ...._._ -• _ ....... ...........• -- - -_ NoS�L_._._ _1.----••---•---- Registered Architect and /or Engineer.-...- ... ......_---- - -� - -- -- ---- .-- .----- _. - - -az Name and address of licensed contractor._. 0��l�l - - - ---- _. ......-- •------ •- .._.... Location and legal description of lot to be built on: . Lot............ - ............... _--- _-- - - - - -- Block ....................._...._.. » on. ......•... ------ • - - - -- - ---_. ...... ;7 S Street and Number where work is to be done ... .......... .._6! _._ vi, - _ ---------- - -- State work to be done and purpose of building ( floors)- _ 21,'.- ---- G•,(•.. and for no other purpose. New Building _.___._ .... _ ........ _..... Remodeling ..... . .......... ..__ ... Addition ...... _-------- --- - - - -- Repairs ................ _........ No. of Stories ................... ------- Estimated Total cost of improvements $ ....... _ _:_ Amount of Permit $ --------- g . .._._..._. ............................. .. To be constructed of ... ... ................. .. . Kind off .0 da ovRoof Cerin .,. Zane cubage required ._-__-.--- _-- _- _- ---- _- _--- .-- -- - - - -__ .._.__ _ _ a _.Plan Cubage .................... _. Distance to next nearest building -- __-- _--- _-------- --- - - - --- _..__ _ ._._. ._Size of Building Lot ....... ___ MCI hereby submit all the plans and each pecifications for said building. All notices with reference to the buildin � -- - -....-----struction may - _ g and its construction may be sent to- --- --- ' The undersigned applicant for this building permit does hereby certify that he understands sand accepts his obligations as an employer of labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Flork a, Permanent Supplement, and has complied with the provisions thereof, and will require similar compliance from all contractors or su tractors employed by, him in the work to be performed under this permit; and will post or cause to be posted for ' ection on the site of t ie work such public notice or notices as are required by the Act. The undersigned agrees to, employ only such ntractors, on work to be rmed under this ores permit, as are licensed by Miami Sh Vi 1140. 7 Remarks.-._— ._..._._. _ .._.. . - (Signed) _— - _ - STATE OF FLORIDA, SL r � COUNTY OF DADE. Before me, the undersigned authority, a -notary public, duly authorized to administer oaths and take acknowledgments, personally ap- peared_ - -- ._--------- __._.. _._ __ _�_ --- •----- • - - -._ __ _.___ __._ _ _., __.__— _ - -- _ ---------- - -_ _ _ _ __ _.to me well known, of dthe above described construction, that he has cardepos read ' says that he is the — - . - - -.- ............. .. . . . . .. .,. .................... _.•...__ heir by me first duly sworn,, upon oath deposes and the foregoing application, and that he did sign a same, and that all facts therein by him stated are true. Permit No. �� ; ____.__. Date- ..� __ Read, Sworn to and Subscribed before e. Disapproved ___ D e:, ___. •._._- •_----- .._._.__ -- ---- _ -_ -_ _._ Notary Public, State of Florida _ - - Si Signed) _ _ c �) _ �� _ — Spector MY Commission Expires------ _----- __ —. °- ---- --------------- -..__. PLANNING Chairman, .. ....... _........ ... __ _ _ _ .-- - - -• -• Member _ ................... '_ ---_-----.---_.___ ... ........ _ ......... _ _ Member_.,_ - - _ _ .._.......... _ _ __ Member . _-- - _- .... •--- •-• - - -- ... - .......... --••••.__ ... - Member -------- _. __._.._ __.... _ Member Council Approved ___ . _ ..____ r_ _ .__ - -Date Disapproved _-- - -- - -- • - .. - - -. -- -Date NOTE: A charge of $1.00 will be made for making corrections or .changes to this application after apprc»al has been obtained from the Planning Board. A re- inspection fee of $1.00 will be charged when such re- inspection is made necessary by improper notice for inspection or faulty materials and /or workmanship. i t MIA : SHORES VILLAGE, FLA. m ftjt�f �w W? 7482 INSPECTOR DATE - � - -- n 484 IAMI SHORES VILLAGE, FLA. N • JOB ��t5 � o.✓ ��� v ;ADDRESS — — INSPECTION G, TIME READY i. REMARKS: ok' DATE INSPECTOR I iAMI SHORES VILLAGE ELECTRICAL INSPECTION DEPARTMENT APPLICATION FOR ELECTRICAL PERMIT Permit No..... ...� >... ' Date .................. Application is hereby made for the approval of the detailed statement of the plans and specifications herewith sub: structure herein described. This application is made in compliance and conformity with the Building Ordinance of and all provisions of the Laws of the State of Florida, all ordinances of Miami Shores Village and all rules and regal of Miami Shores Village shall be complied with, whether herein specified or not. A copy of approved plans and building during progress of work. Owner's Name and Address ............. N........1":E..49.. for the building or other i Shores Village, Florida, of the Building Division ieations must be kept at RegisteredArchitect and /or Engineer.. �J .........................................................._.................................. ............................. » ......... .. .... .............................. Employing Electricians Name..... .... i/L� er- ?Pl. e... .a.No ...... ..;.�1-c.® ... ..... ........ Street.... —&W... .f ... ......... Location and Legal Description Lot ................................... ............................... Block.................... ......... .. Subdivisionl............... ............................... Street and Number where work is to be State work to be performed and purpose of building (By New of Stories. ................... Service Overhead Sue Feeders .................... Conduit...............Main Sw.......................... .Am p s. Vau derground Type of Installation — Conduit .............. .. Tubing .......................DXL.......................... Metal Moulding.......... . Amount of Permit $ ..... 1� .�� ...`.::........._ .............. ............................... (Signed) The undersigned applicant for this building permit does hereby certify that he understands and accepts ltis a labor under the Florida Workmen's Compensation Act, being Sectign 5966, Compiled General Laws of Florida PI has complied with the provisions thereof, and will require similar compliance from all contractors or sub•contractan work to be performed under this permit; and will post or cause to be posted for inspection on the site of the worksl as are required by the Act. The undersigned agrees to employ only such subcontractors, on work to be performe licensed by Miami Shores Village. STATE OF FLORIDA, COUNTY OF DADE. 8. Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take 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, and he has carefully read the foregoing application, and that he did sign therein by him stated are true. ..... .............................My Commission .Bxp ires... ............................... ... ».......................Notary Public, SI NOTE: A re inspection fee of $1.00 will be made when such re-inspection is made necessary by improper materials and /or workmanship. Ele4cal Inspector. rations as an employer of ananent Supplement, and employed by him in the ch public notice or notices under this permit, as are Master Electrician. personally came, and that all facts for inspection, or faulty SWITOH LIGHT PLUG FLIITUREs REFRIG. IRON RANGE RANGE WATER W. HEAT. 8$AC6 STRIP TOTAL OUTLETS OUTLETS REQE'P'T'S NO. LAMPS OUTLET OUTLET CUTLET CONN. HEATER CONN. H TER HEATER CLIST LIST oy yam. 0, CHECK ENT. OIST. SERVICE SERVICE MOTORS MOTORS NEON RADIO TOTAL SW.. -CAS. TEMP. PERM. 0.1 HP 1•5 HP TRANS. CONTR. LIST CHICK Service Overhead Sue Feeders .................... Conduit...............Main Sw.......................... .Am p s. Vau derground Type of Installation — Conduit .............. .. Tubing .......................DXL.......................... Metal Moulding.......... . Amount of Permit $ ..... 1� .�� ...`.::........._ .............. ............................... (Signed) The undersigned applicant for this building permit does hereby certify that he understands and accepts ltis a labor under the Florida Workmen's Compensation Act, being Sectign 5966, Compiled General Laws of Florida PI has complied with the provisions thereof, and will require similar compliance from all contractors or sub•contractan work to be performed under this permit; and will post or cause to be posted for inspection on the site of the worksl as are required by the Act. The undersigned agrees to employ only such subcontractors, on work to be performe licensed by Miami Shores Village. STATE OF FLORIDA, COUNTY OF DADE. 8. Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take 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, and he has carefully read the foregoing application, and that he did sign therein by him stated are true. ..... .............................My Commission .Bxp ires... ............................... ... ».......................Notary Public, SI NOTE: A re inspection fee of $1.00 will be made when such re-inspection is made necessary by improper materials and /or workmanship. Ele4cal Inspector. rations as an employer of ananent Supplement, and employed by him in the ch public notice or notices under this permit, as are Master Electrician. personally came, and that all facts for inspection, or faulty MIAMI SHORES VILLAGE BUILDING INSPE=CTION DEPARTMENT APPLICATION FOR BUILDING PERMIT Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the build- ing 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 the work. Date X797 T_ 19__64 Owne's Name and Address 1- M_ r a i anann No.- 1461 Str ' _ — - - Registered Architect and /or Engineer_ -- Name and address of licensed contractor ITTY NOLEN, 1 _ ,,, 600 N _ W 7 XVP-nUe-,r-Z1iaM.4 Fla Location and legal description of lot to be built on: Lot. � Block Subdivision _ _ Street and Number where work is to be done 1461- N _ E& 102 Street, -- d__S s_,__F1a,, State work to be done and purpose of building (by floors) _ for no other purpose. New Building _ Remodeling lUPi Repairs_— ___ -__ No. of Stories ------ —_--- - - - - -- To be constructed of —_ - Kind of CMS _ _ __ ___ -- Roof Covering- w ---- — _- ------- -_� Estimated Total cost of improvements $ Q®,' Amount of Permit $ 5 rn o Zone cubage required — plan Cubage 39V000 Distance to neat nearest building in. Fm Size of Building Maximum live load to be borne by each I hereby submit all the plans and specifications for said building. All notices with reference to the building and its construction may be sent to _ The undersigned applicant for this building permit Aoes 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 Supplenient, and has complied with the provisions thereof, and will require similar compliance from all contractors or sub- contractors employ 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 work such public notice or notices as are required by the Act. The undersigned agrees to employ only such subcontractors. on work to r�rrned under " permit, as are licensed by Miami Shores Villa g e. \ \ \\ Remarks STATE OF FLORIDA, COUNTY OF DADE. I 5s' Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally ap- peared - 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 th same, and that all facts therein by him stated are true. � �- Permit No. Date % -/D � YT Read, Sworn to and Subscribed before Vie. Disapproved Notary Public, State of Florida. ( Signed) Building Inspect My Commission Expires— Chairman Chairman Member Member PLANNING BOARD __ -DATE Member Member Member Council Approved Date Disapproved NOTE: A charge of $1.00 will be made for making corrections br changes to this application after approval has been obtained from the Planning Board. i A remspection fee of $1.00 will he charged when such re- inspection is made necessary -by improper notice for inspection or faulty materials and /or workmanship. MIAMI SHORES VILLAGE BUILDING INSPECTION DEPARTMENT APPLICATION FOR BUILDING PERMIT Application is hereby made for the ag�V of the detailed statement of the plans and specifications- herewith submitted for the build- tag or other structure herein described. is 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 bregulations of the Building Division of Miami Shores Village shall be complied with, whether herein specified or not. A copy of approved ans specifications must be kept at building during progress of the work. Date__Z_495� ----- 19 Owners Name and Address___J.J_k...&A7_/,5_' Z74j_fA6.r,.oC --- - ------ __ No.------ .......... ___ Street------ I Registered Architect and/or Engineer- ..___------- _ - -.__- ----------- -------------- ------- ------- . ............... ............... . Name and address of licensed contractor ---- --------- CAz;0 Location and legal description of lot to be built on: Lot - - - - -- Block - - - - -- Subdivision_----- - - -.__ Street and Number where work is to be done - /_ Z ZZ&V State work to be done and purpose of building (by floors)_Z_l ._'s Kew � - ----- "A.. F_ J, r-11111 Ir It.- - r — and for no other purpose. New Building . .......... ____ Remodeling_----- -_ - - -- - - - - -- Addition----- ----------- -_- - -- Reps------ --- --- ------ - - - - -- No. of Stories .......... ...... . . — To be constructed Kind of foundation-------- — ---- ---------- — ------------------- ----------- Roof Covering- ._.....__- _-- - -._._ . ..... Estimated Total cost of improvements of Permit $ -- - - - ------------ - --- - --------- - -- Zone cubage required-- - --- - --- ____ -.---------Plan Cubage — ------- — — - ---- - ------- Distance to next nearest building-------------.-.. ----- - -------Size of Building Maximum live load to be home by each I hereby submit all the plans and specifications for said budding. I All notices with reference to the building and its construction may be ant to.---- - - ----------- The undersigned applicant for this building permit t, ereby certify that he understands and accepts his o ligation as an employer Section 5966, Compiled Cenral Laws of Florida Permanent Supplement, of labor under the Florida Workmen's Compensation Act, ng and has complied with the provisions thereof, and will re1q-similar compliance from all contractors or sob -con actors em in the work to be performed under this permit; and will post ;r cause to be posted for inspection employed by him Of work uublic notice or notices as are required by the Act., The undersigned agrees to employ only such subcon 10 perform under this permit as are licensed by Miami Shores Village. Remarks_ (signed)------ STATE OF FLORIDA, COUNTY OF DADE. Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally ap- peared — — - - - - - -- --- — --- me well lmo'Wn' and who, being by me first duly sworn, upon oatjhdd deposes and says that he is the- ------------- - ---- - ---- - — - — - ---------- - --- - --- of the above described construction, that he has 2dly read the foregoing application, and that he did sign the same, and that all facts therein by him Skatedjprp&%r6: 0�1 Read, SWOM to and Subscribed before me. Permit No. -W' Date.________ re— Date Disapproved t — ----------- Date Notary Public, State of Florida -- -------- (Signed) - Building In . spect�r — ----- ------ Building My Commission Expires-- -- ____------ -- -- __ - -._ P NING BOARD--------_-_ -.----.-----DATE Chairman Member ------ — -- - --------- - Member Member ------------ - ----- Member -------- -- - - ---------- Member Council Approved - - - --- - ------- - -------- - -- - -- -Date Disapproved ------------------ _ ----------- ------------ --- _- -- -- ---- -.Date NOTE: A charge of $1.00 will be made for making corrections or changes to this application after approval has been obtained from the Planning Board. A re-inspection fee of $1.00 will be charged when such re-inspection is made necessary by improper notice for inspection or faulty materials and/or workmanship. 7S0, Y 0 --; a - ---- , dsi oa —4"Oft AppgUVOO subject to b i wd'ing, Plumbing, electrical and zos6;ng codes ai fhorts Village. The Architect and builder axec n k. wwledge of all bui'ding regulations whether **cifi--a]IY indicated, erein. AP reinforced steel, at--ftm-4-* - 'ft mint, PlumbinZ, electrical wiring and roof (I&Shing Wt, -�Qt be concealed before inspection. �jc>— M MIAMI SHORES VILLAGE ELECTRICAL INSPECTION DEPARTMENT APPLICATION FOR ELECTRICAL PERMIT Permit NO. «1. i l .. . ....... o " '7 0 Date............_ ,l _ ................. �I l j>1 Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the building or other structure herein described. This application is made in compliance and conformity, with the Building Ordinance of Mf iami Shores Village, Florida, and all provisions of the Laws of the State of Florida, all ordinances of Miami Shores Village and all rides 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....... . /.. hi. R. aJ ....... .......................................... No... l� ......... .. ........... Street ..... �. �i9.� .� � :......... RegisteredArchitect -and/or Engineer ... .... ....................� ... ...1 .... ....� ......................................»...............:.. Employing Electrician's Name ...BR O. q x......... ..................._.... ». ...... ...... ......' .. �.....eAl.. .........No...IZZ4 ...A4, ....... Street --- Locationand Legal Description Lot ...... _ ........................................ .. ................. Block ................................ _ ........ Subdivision ................. _............................ Streetand Number where work is to be performed— No .................... ............................ .. .......... _ ............. Street.............................. Statework to be performed and purpose of building (By Floors) ......... _ ................ _ .... .......... _ ...... .. ............................... .. ....................... .. ......... _................ New Building ......Remodelin ».. Addition ._ .......................... Repairs. ............................... _ .... No. of Stories.................... erhead d!'e- pu Ile q ff, Ae9 AV Je- 0.vrcc- , >ii- °eeA/ ^welts _jIZ -s Service: Underground Size Fceders...,...». ... ...... Conduit ...............Main Sw ........................ ..... Am ps ..........................Main Fuses ...... _...................Amps Type of Installation--Conduit...— .................. Tubing ....................... B.X.L ......................... Metal Moulding ............... .. .............. _ .................................. ..... ...... ............._........_...._... ............... _. .. _.... ....._. ................ Amount of Permit The undersigned applicant for this building permit does hereby certify that he understands and accepts ecamopi"es gations as an employer of.. labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Flo rmanent Supplement, and has complied with the provisions thereof, and will require similar compliance from all contractors or subco employed by him in the work to he 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 subcontractors, on work to be performed under this permit, as are licensed by Miami Shores Village. (Signed) .. kz . .» ..��..��..��'.�".... .......... Master Electrician. STATE OF FLORIDA, 1 COUNTY OF DADE. I 88' 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, and he has carefully read the foregoing application, and that he did sign the same, and that all facts therein by him stated are true. I ............»........ ».... »My' Commission ...... .. . _......_ ....................... .. .............._..:Notary.Fublic, State of Flo ride...... »........ »... ».... 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. SWITCH LIGHT PLUG FIXTURES REFRIG. IRON RANGE RANGE WATER W. HEAT. SPACE STRIP OUTLETS OUTLETS RECE'P'T'S NO. LAMPS i OUTLET OUTLET OUTLET CONN. HEATER CONN. HEATER HEATER TOTAL CONTR. LIST CHECK ENT. DIET. SERVICE SERVICE MOTORS MOTORS NEON SW. CAS TEMP. PERM. 0.1 HP I.S HP TRANS. RADIO TOTAL. CO 111, LIST CHECK erhead d!'e- pu Ile q ff, Ae9 AV Je- 0.vrcc- , >ii- °eeA/ ^welts _jIZ -s Service: Underground Size Fceders...,...». ... ...... Conduit ...............Main Sw ........................ ..... Am ps ..........................Main Fuses ...... _...................Amps Type of Installation--Conduit...— .................. Tubing ....................... B.X.L ......................... Metal Moulding ............... .. .............. _ .................................. ..... ...... ............._........_...._... ............... _. .. _.... ....._. ................ Amount of Permit The undersigned applicant for this building permit does hereby certify that he understands and accepts ecamopi"es gations as an employer of.. labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Flo rmanent Supplement, and has complied with the provisions thereof, and will require similar compliance from all contractors or subco employed by him in the work to he 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 subcontractors, on work to be performed under this permit, as are licensed by Miami Shores Village. (Signed) .. kz . .» ..��..��..��'.�".... .......... Master Electrician. STATE OF FLORIDA, 1 COUNTY OF DADE. I 88' 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, and he has carefully read the foregoing application, and that he did sign the same, and that all facts therein by him stated are true. I ............»........ ».... »My' Commission ...... .. . _......_ ....................... .. .............._..:Notary.Fublic, State of Flo ride...... »........ »... ».... 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. MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT 417-� ° eel - 9I/.° Permit No.—J— 72 / ,Fi 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 Ordivauce 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 spedfied or not, A Copy Of approved plans and specifications must be kept at building during progress of work. Owner's Name and Address. A- ......_....._...._. treat.. _. Registered Architect and /or Engineer Woft Flu mwl Liocation and t Legal Description Lo Rl�1r SI,<6diri�. Street and Number when work is to be performed No- g State work to be performe8 and purpose of building (By Flom)— New Building ___. -....- Remodelin8 Addition_.___ _ N o.«O f S - Repairs-- ._......._......... No. Of Stert.w Size Septic Tam 'Type Of Tank _ _- .._.__Capacity Gals,__. _.. _. Feet of Drain Tiles Feet of Tank or Drain Field fiats Well_ Nature of Water Supply: City Well- Size of Soakage Pit._......_... Amount of Permit $- z Z �— (Signed)- _ Plumbing Inspector. The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations as u employer of labor under the Florida provisions her Compensation Act, -bring Section 5988, Compiled General Laws Of Florida Permanent Supplement, and has cam. plied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors employed by him in the work to be performed under this permit; and will post or cause to be posted for inspection On the Site of the work such public notice or notices as are required by tlie Act. The undersigned agrees to employ only such sub - contractors, on work to be p licensed by Miami Shores Village. / A --A ed under this permit, as are STATE OF FLORIDA, Maier Plumbee.� —•- 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 "sworn, upon Oath deposes and says that he is the_ of the above described construction, that he has carefuDy read tit foregoing application, and that he did sip orate, and that a11 faces therein by him stated are true. My Commission Er9kes Notary Public, State of FWda NOTE: A re�ee of $1.40 WM be made when aeeb ='fu Is sotion is madil'=00MY by . �s (a �ect�, or faulty materials and /or CLOSETS BATH TUBS SHOWERS LAVA. TORIti SINKS SLOP SINKS LAUNDRY URINALS CATCH FLOOR T�uie BASIN DRINKING TOTAL _ DRAIN FOYNT•NS FIXTURES CONTR. ��— LIST CHr.CK SEPTIC SEWER DRAIN SOAKAGE GRCASC SOLAR DEEP SPRKLR. Swim,* sv TANK CONN. FIELD PIT TRAP HEATER WELL SYSTEM POOL A'14 C ONTR. ---_ LIST CHECK Size Septic Tam 'Type Of Tank _ _- .._.__Capacity Gals,__. _.. _. Feet of Drain Tiles Feet of Tank or Drain Field fiats Well_ Nature of Water Supply: City Well- Size of Soakage Pit._......_... Amount of Permit $- z Z �— (Signed)- _ Plumbing Inspector. The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations as u employer of labor under the Florida provisions her Compensation Act, -bring Section 5988, Compiled General Laws Of Florida Permanent Supplement, and has cam. plied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors employed by him in the work to be performed under this permit; and will post or cause to be posted for inspection On the Site of the work such public notice or notices as are required by tlie Act. The undersigned agrees to employ only such sub - contractors, on work to be p licensed by Miami Shores Village. / A --A ed under this permit, as are STATE OF FLORIDA, Maier Plumbee.� —•- 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 "sworn, upon Oath deposes and says that he is the_ of the above described construction, that he has carefuDy read tit foregoing application, and that he did sip orate, and that a11 faces therein by him stated are true. My Commission Er9kes Notary Public, State of FWda NOTE: A re�ee of $1.40 WM be made when aeeb ='fu Is sotion is madil'=00MY by . �s (a �ect�, or faulty materials and /or MIAM4 ;- SNORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT 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 spedfied or rot. A copy of approved plans and specifications must be kept at building during progress of work. Owner's Name and Address... e S/ ,.� ,� FF No. 4 `.Z, A/ Registered Architect and /or Engineer FAploft Fluor o Nate, . ;et s s ! ATE G y Al _ _ .. ..... Location and Legal Description i.,t Block— Street and Number where work is to be performed —No g State work to be performea and purpose of building (By Flom) _ Now Building_.._.._ Remodeling No Addition _. of Stor[es..........._..... �... Repairs.._.._.......__...... . Size Septio Tank Type of Tmk —__ — Capacity Feet of Drain Tile .Dist. Feet of Tank or Drain Field from Well... Nature of Water Supply: City—Well. ..Size of Soakage Pit Amount of Permit $---- 'r (.Signed) --- _._ ...._.... Plumbing Inspector, The undersigned applicant for this building permit does hereby certify that he understands and accepts his Obligations as as employer of labor under the Florida Workmen's Compensation Act, being Section 8988, Compiled General Laws of Florida Permanent Supplement, and lugs 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 pow for inspection on the site of the work such public notice or notices as are regesired by the Act. The undersigned agrees to empkry only suds sub - contractors, on work to be performed under this licensed by Miami Shores Village. permit, as are STATE OF FLORIDA, COUNTY OF DADE. (Signed) Master Phnunber.�� Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take adaowledgmentb, 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 desk construction, that he has carefully read the foregoing application, and that he dtdwsign the some, and that all ftda therein by him stated are trues MY Ciummission Expires Notary P"% State of Florida materials and/or e-to pecti bi fee of $1.00 will be mails whom ate rB40apsotlori b anade•reoeafsey by Imps Bolles fot tnsPKAI n, or featly p. CLOSETS BATH Tung SNOW611n LAVA- TORIKS SINKS SLOP SINKS LAUNDRY URINALS CATCH Tuns BASIN FLOOR DRAIN DRINKING FOYNT'NS TOTAL TOTAL CONTR. LIST CHECK SEPTIC TANK SEWER CONN. DRAIN FIELD SDAKAOE PIT GREASE' TRAP SOLAR HEATER DEEP SPRKLR. SWIM'O W� hr� WELL SYSTEM POOL tovti R*ia l` CON71l. LIST � CHECK Size Septio Tank Type of Tmk —__ — Capacity Feet of Drain Tile .Dist. Feet of Tank or Drain Field from Well... Nature of Water Supply: City—Well. ..Size of Soakage Pit Amount of Permit $---- 'r (.Signed) --- _._ ...._.... Plumbing Inspector, The undersigned applicant for this building permit does hereby certify that he understands and accepts his Obligations as as employer of labor under the Florida Workmen's Compensation Act, being Section 8988, Compiled General Laws of Florida Permanent Supplement, and lugs 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 pow for inspection on the site of the work such public notice or notices as are regesired by the Act. The undersigned agrees to empkry only suds sub - contractors, on work to be performed under this licensed by Miami Shores Village. permit, as are STATE OF FLORIDA, COUNTY OF DADE. (Signed) Master Phnunber.�� Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take adaowledgmentb, 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 desk construction, that he has carefully read the foregoing application, and that he dtdwsign the some, and that all ftda therein by him stated are trues MY Ciummission Expires Notary P"% State of Florida materials and/or e-to pecti bi fee of $1.00 will be mails whom ate rB40apsotlori b anade•reoeafsey by Imps Bolles fot tnsPKAI n, or featly p. i' 7 1 p / - Ft LOOT /� a Al$ AM nn 40 S �/w N , /02 .v� sSzeiEr ATLAS SECTION � DA - SCALE MI 364 N. E. 123 +h STREET NORTH MIA, FLORIDA P/?0p 6CR1/' C , 7°0 SiXWE SHEET 1 of UF- /�; >", �� .� -. J. b. DWG. BX�� A. F. E. PmS W917 Square Ft. , Estimated Cost(value) WARNINO` TO,,, OR , YOU MUST RECORD A NOTICE OF COMMENCEMENT AND YOUR FAILURE TO DO S4 R : , . ,''T' I!N Y)01 iR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPE TY (IF YOU INTEND TO O N I`WtI, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEF� RECORDING4 YOUR NOTICE NO ) . A lica:` 1#1 eby to obtain a permit to do work and installation as indicated above, and on the a' tikobed wk1eadum (if applicable). I certify that all work will be performed to meet the scan e:of'all laws relating construction in this jurisdiction. I understand that separate Permits a s° it i for ELECTRICAL, PLUMBING, SIGNS, POOLS, ROOFING and MECEANIGAL WORK. 'fIT« I certify that all the foregoing inf ortaati ' s accurate a d tall work will be done; to 1 � with all applicable laws regulating nstruc 'on a zo thermore, I authorir,a °tom . . e contractor to do the work sta ed. PERMIT APPLICATION FOR MIAMI SHORES VILLAGE Date Job Address�� �� Z S�� Tax Folio Legal Descripti Owner / Lessee / Tenant `S cLcQ V j , \-vt . L kA7"R29__ Master Permit # Owner's Address 61 l0 2 / Phoneme_ Contracting Co. 96LZ rs �,L` %/' Ly �C�%�% dress w01- � Qualifier G�/v �% %/C/� SS# Phone State #^ -103g7 Municipal # Competency # Da0'lOa.3,4 s.Co._ Architect /Engineer Address Bonding Co y Address Mortgagor Address Permit T (circle one): BUILDING ELECTRICAL L N MECHANICAL ROOFING PAVING FENCE SIGN WORK DESCRIPTION Square Ft. S3 CPO Estimated Cost(value) 9 00., 0 C7 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 aslindicated above, and on the attached addendum (if applicable). I certify that all work will be 0 erformed to meet the standards of all laws regulating construction in this jurisdiction. I unde stand that separate permits aro required for ELECTRICAL, PLUMBING, SIGNS, POOLS, ROOFING and MECHANICAL WORK. OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. Furthermore, I authorize the above - named contractor to do the work stated. t 1 'Of r andiR tc�ty "' ".' Signature of ContracQr_� ••/• :�''••' JOHN '��' = `O.• JOHN OLMO • MAMA • rya to er andf or Condo Presi eWCompWon ary t Contract r Nam lssi n Expires: s � Q, •' Commission Expires P. Nov. f91S '• .a _ A.Z cc 8m AIR FEES: PERMIT RADON C.C.F. % NOTARY TOTAL DUE 3 4. Fire Other Zoning` Buildinit Electrical 3 �. mechanical Plumbini Engineetinu ml�- STATE OF` FLORIDA PERMIT # f/ FlERARTMENT OF HEALTH AND REHABILITATIVE SERVICES DATE PAID .3- 3 ONSITE- SEWAGE DISPOSAL SYSTEM FEE PAID $ CONSTRUCTION PERMIT RECEIPT we Authority: , Chapter 381, FS & Chapter IOD' -6, FAC CO�UCTION PERMIT F�O� I } New System { /&E 'sting System {'� ding Tank [ 4- a Repair [ ndonment [ Other(Specify) PLICANT: f ,3 --'._- AGENT:��� % S"73TJC+ �Ul PROPERTY STREET ;ADDRESS: j L' %GJ z LOT: BLOCK - UBDIVISION: PROPERTY ID [SECTION/ TOWNSHIP /RANGE /PARCEL NUMBER) [OR TAX ID NUMBER] 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 PERM17_BEING MADE NULL AND VOID. SYSTEM DESIGN AND SPEC IFACATIONS ` T ( ,J� V ) 0 J 9FT�I�C TAN %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: ( J. D [ } SQUARE FEET PRIMARY DRAINFIELD'SYSTEM R [ } SQUARE FEET SYSTEM A TYPE SYSTEM: [ ] STANDARD [ ] FILLED (; J MOUND [ L I CONFIGURATION:` { ] TRENCH {4,4,4ED I J F, LOCATION OF BENCHMARK: rd / l I 'ELEVATION OF PROPOSED SYSTEM SITE 1//2 N FT] [ OVE Q ENCIRIMM/1RE FERENCE P E BOTTOM OF DRAINFIELD TO BE I ,?!7, 3 [INCHES/ T] ['ABO LOW BEN EFERENCE PINT L D' FILL REQUIRED:( J INCHES EXCAVATION REQUIRED: [ J INCHES o INSTALL 12" OF LOAMY COARSE SAND T IJND H sumi"ENCHMARK E THIS PERMIT is Jq0 It TOR ADDff 9 _ R INVERT ELEMION ]BOTTOM OF DRAINFIE SPECIFICATIONS BY: TITLE: APPROVED BY: TITLE: _�_.� CPHU v zz DATE I$SUED: �y r� � EXPIRATION DATE: rE6i�E�sEpq*DEY CE INSTALLED Uaid THE OUT ET TEE e 1 of 2 tuts -H Form 4016;' Nar 92 (Obsotetes previous editiohs which may n ®tEEL��] T TEE 1 (Stock Number: 5744-001-4016 -0) APPLICANT INSTRUCTIONS: PERMIT NUMBER: Permit tracking number assigned by CPHU. r APPLICATION FOR: Check type of permit, if "Other' specify type in blank. APPLICANT: Property owner's full name. TELEPHONE: Telephone number for applicant or agent. AGENT: Property owner's legally authorized representative. MAILING ADDRESS: P.O. box or street mailing address for applicant or agent. LOT, BLOCK, SUBDIVISION or PROPERTY ID#: 27 character id number for property. (CPHU may require property appraiser ID // or section /township /range /parcel number) SYSTEM DESIGN AND SPECIFICATIONS: TANK: Minimum specifications from Chapter IOD-6, FAC. DRAINFIELD: Minimum specifications from Chapter IOD-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 a 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. STATE OF FLORIDA DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES ONSITE SEWAGE DISPOSAL SYSTEM SITE EVALUATION AND SYSTEM SPECIFICATIONS PERMIT , <+00(.r d��A `r !If IL APPLICANT: / 5. /� � t YL Z,� AGENT: (` �{, S `� L'� �� +� -✓1�? L MYC "i LOT: BLOCK: (`L� SUBDIVISION: PROPERTY .ID #: [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. --------------------------------------------------- PROPERTY SIZE CONFORMS TO SITE PLAN: [x] YES [ j NO NET USABLE AREA AVAILABLE: ACRES TOTAL ESTIMATED SEWAGE FLOW: O(� GALLONS PER DAY [RESIDENCES -TABLE 1 / -0 ER-TABLE 2] AUTHORIZED SEWAGE FLOW: GALLONS PER DAY 11500 GPD /ACRE OR 2500 GPD /ACRE] UNOBSTRUCTED AREA AVAILABLE: X0 0 SQFT UNOBSTRUCTED AREA REQUIRED: - 4,0 O . SQFT BENCHMARK / REFERENCE POINT LOCATION: 19 '.5 ELEVATION OF PROPOSED SYSTEM SITE _I5S[ CHE FTj {ABOVE/ FERENCE POINT THE MINIMUM SETBACKWHICH CAN BE MAINTAINED FROM THE P49POSED SYSTEM TO THE FOLLOWING FEATURES: SURFACE WATER: Vltf FT DITCHE S /S S: RMALLY WET? [ ] YES NO WELLS: PUBLIC: FT LIMITED USE: FT iVATE: FT FT NON- POTABLE: FT_ BUILDING FOUNDATIO S: - FT PROPER LINES: FT POTABLE WATER LINES: FT Y SITE SUBJECT TO FREQUENT FLOODING: [ ] YES [/Y NO 10 YEAR FLOODING? [ ] YES X NO 10 YEAR FLOOD ELEVATION FOR SITE: FT MSL /NGVD SITE ELEVATION: M /NGVD SOIL PROFILE INFORMATION SITE 1 SOIL PROFILE INFORMATION SITE 2 i Munsell Color Texture Depth Ito to to to to to -to- to- to USDA SOIL SERIES: Huns ell Color, Texture Depth L to 6 " to to to to to to to to USDA SOIL SERIES: OBSERVED WATER TABLE: INCHES [ABOVE / LO EXISTING GRADE. TYPE' ERCHED / ESTIMATED WET SEASON WATER TABLE ELEVATION: 71 INCHES [ ABOVE / EL ] EXISTING GRADE. $IGHvWATER TABLE VELETA ION: [ ] YES [� NO MOTTLING: [ ] YES [�N = DEPTH: - - INCHES STEXTURE /LOADING RA FOR SYSTEM,;= Z ING: / /-A DEPTH OF EXCAVATION: INCHES CONFIGURATION(, [ ]'TRENCH [�] BED [ ] OTHER (SPECIFY) KS /ADDITIONAL CRITERIA: SITE EVALUATED BY: HRS-H Form 4015, 'Moir 92 (0bsoletes previous- erliti (Stock Number: 5744- 003 - 4015 -1) which may not be uF ) DATE: Page 3 of (52 1 1 Permit tracking number assigned by CPHU. Property owner's full name. Property owner's legally authorized representative. Lot, block, and subdivision for lot. 27 character number for property. (property appraiser H) # or section/lownshiptrangetparcel number) Check if property size at site conforms to submitted site plan. Record net usable area available - lot area exclusive of all paved areas and prepared road beds within public rights -of- -way or easements and exclusive of streams, lakes, normally wet drainage ditches, marshes, or outer such bodies of water. SEWAGE FLOW: Record the estinsatrd sewage flow for she establishment from Table I (residences) or Table 2 (non- residential), Chapter I OI3 -6, FAC. Record the authorized sewage flow for the tot based on not usable area and enter supply (1500 gallons per clay per acm for private water supplies and 2500 gird per acre for public seater supplies), If authorized sewage flow does not eq;tal or exceed the estimated sewage flow, she application must be denied, UNOBSTRUCTED AREA: Record the square feet of unobstructed area available and the amount required. Unobstructed area must be at least 2 tunes as large as the drainfreld absorption area and at least 75 percent of the unobstructed area must meet minimum setbacks in Chapter IOD-6, FAC. The unobstructed area must be contiguous to the drainfieid, BENCHMARK INFORMATION: Record the location of the benchmark. If using a surveyor's benchmark record the actual elevation, Record the elevation of the proposed system site in relation (above or below) to the benchmark. MINIMUM SETBACKS: Record minimum setbacks which can be meet to all listed features, Actual measurements must be recorded or 'NA" for non applicable feamres. Features on site plan or within 75 feet of the applicant lot must be measured. The location of any public drinking well within 200 feet of the applicant's lot must also be verified. FLOOD INFORMATION: Record information on lot's subject to flooding. For lots subject to flooding record Iii year flood elevation for site and actual site elevation, SOIL. PROFILE INFORMATION: Two soil profiles within the proposed absorption area to a minimum depth of 6 feet or refusal are required. Soil identification will use USIA Soil Classification methodology (Munseil colors and USDA soil textures), Refusals must be clearly documented. Provide USDA soil series if available, record 'UNK" if the series cannot be determined. WATER TABLE: Record the depth of the observed water table at the time of the evaluation. Mark "perched" or "apparent" as appropriate. Record the estimated wet season water table elevation basest on site evaluation, USDA soil maps, and historical information, Indicate if there is high water table vegetation present. Indicate if mottling is present and depth. SOIL TEXTURE: Record soil texture or loading rate for system sizing. DEPTH OF EXCAVATION: If applicable record depth of excavation required. Record "NA" if not applicable. l7RAINFIELD CONFIGURATION: Check drainfield configuration required. If other, specify type. ADDITIONAL CRITERIA: Record any additional remarks pertinent to site or installation. Ex. dosing required, SITE EVALUATED BY: Signature of evaluator, title, and date of evaluation, Professional engineers crust seal all documentation submitted, ELEVATION WORKSHEET ELEVATION OF BENCHMARK t REFERENCE POINT IS: BENCHMARK SITE I SITE 2 SITE 3 [-4-) SHOT. ILL H,1, H.I. H.I. [ -j SHOT [ -) SHOT [ -] SHOT STATE OF FLORIDA PERMIT- OS DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES DATE PAID ONSITE SEWAGE DISPOSAL SYSTEM FEE PAID $ d!; APPLICATION FOR CONSTRUCTION PERMIT RECEIPT # 20_2 � Authority: Chapter 381, FS & Chapter OD -6, FAC APPLICATION FOR: { j New System [ ] Existing System [ } Holding Tank [ ] Temporary /Experimental Repair [ ] Abandonment [ ] Other(Specify) APPLICANT : TELEPHONE: rj f AGENT: ,4 1 �' L&Atr MAILING ADDRESS: TO BE COMPLETED BY APPLICANT OR ,APPLICANT'S AUTHORIZED AGENT. ATTACH BUILDING PLAN AND TO-SCALE SITE PLAN SHOWING PERTINENT' FEATURES REQUIRED BY CHAPTER 1OD -6, FLORIDA ADMINISTRATIVE CODE. PROPERTY INFORMATION (IF LOT IS NOT IN A_RECORDE SUBDIVISION, ATTACH LEGAL DESCRIPTION OR DEED) LOT: BLOCK: UBDIVISION: DATE OF CONSTRUCTION: PROPERT LID#: / [Section /Township /Range /Parcel No.] ZONING: PROPERTY SIZE: //�, ACRES '[Sgft /43560] PROPERTY WATER SUPPLY: [ J PRIVATE [J PUBLIC PROPERTY STREET ADDRESS: ��%� / / /� /r / C s S DIRECTIONS TO PROPERTY: BUILDING INFORMATION , [K] RESIDENTIAL [ ] COMMERCIAL Unit Type of No. of Building # Persons Business Activity No Establishment Bedrooms Area Saft Served For Commercial Only 1 z 3 4 ] Garbage Grinders /Disposals [ ] Spas /Hot Tubs [ ] Floor /Equipment Drains [ ] Ultra -low Volume Flush Toilets ( ] Other (Specify) APPLICANT'S SIGNATURE: DATE: HRS -H Form 4015, Mar 92 (obsoletes previous editions which may not be used) Page 1 of 3 (Stock Number: 5744- 001 - 4015 -1) j npi, Pug Vowo, "u-ni o"', nf pus Wwwo IAPM S ��Srv,,�, wwo vpnp uqPWj SOR, wyn pm I"n P=WMP VMS pqy W"y",q, BWMP sym PWWWd W symm to 4v"Wv MW vyyn goo swZOMY"; WON; 1WOMP nXIMM !&Yyq a Ww"Ps a 4. 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"qmt 9q pus SWzp; �KLTALLW MIKHRIM ,,,P —uco-,4P-,q lad sufnuad °a a,szTs ;q jog �SNOMd jo,(JoJO qnw Jqj Sjunw1insv1W ZP!51no Uo, PaFvq qn,-P -o> d p,ulnana kIP,j, m uado jo °palla j0powl tiodlen In'lalaff Alpyna "PI 2tujl,-,�Arjo, Vale Nyqyq PoIns P PSMA, Isloj- =v 71v ONICITIRIff -foveMlo- jqj 2uldlofa pmwd psupol of papIdN-, 4Onip anoT Put h4vM jqj Qpmyd pm2pp swml;,jr, vinoD �SIII00,dG3 IH 01N , Wwo S AWWP 'Jue,wr'sJ81.1 louloq "llptow aPs afRutF 'A[!Ul" 112U!s- ;szjdufexg -3vj 1 9-c(3j J�IdoqL) 11 a W1 Wol rPWWq"WI jo nd l 13!-1 :.D4311qHSI-IavjISU HdAL lv!WaUitucga 10 �N'011YIN-dOANI PStCiiiil ,U0!jvnoj lol ffulmmIs dvilt own us q1vue so Iq 01 ;SN01jI)3UIG Amnon U! zjo�oj pug Paw if) pans aWqPUj Asoppu PMP PWRYM up mow's, sullio-4 -4Ijdojd jqj Ssnjppt 110,11S �SSMIGCIV kLH3dUdd Inqj Widdlis -vaje joj',?unujnnjca u! patmja,,o �qkvu; ou q,,,m puu "'k R',s, -jo-sm2li pawl P"Ing(julonuou pug Pa,svdun 'JI-tv"n jo sqpq qmo as Per Jo Is,-tis'lova Isnqnpp z9vtURIP I-VA%, 5111RIJOU '9a-,JOJ 'SVU9:UlWj0 OAufn]WO PUP lQUOU30500 10 SOO 10-MVP nqWW UqMM s Inou pmodwd put some Invaud no jo onisqaxi kj�j aarnbs 0991j,tr Aq pap!s!p a2lrex�j aitnbs,, sw3v cal kpadvmdjo twt<!,,,-trsn as -'371S 'U'llf3doHd x3qounc # C11 Kiladoid tunbw Ken' f111, O) °SWdOid-TQJ i`Uo-lou €n ,re --'gtpf LP. -#CYT AILIdadMid ,4,nj xpjo uo!s,,�opqn r pampluava nq IpW Illosmao 2U!SIAU0-j0 tsodirul aM am qzmvd aRnu jo ow orl ml pohoaddo on DWIMCI not MP n 0wQAMqmm* slooq void Amnon ua papawo uq,jq ,p, vjnp ju! a»j_aC 1013TAIGqns 10 3XVG Towem: aq vnm PUP lo, v,,)!j,,IynsaP juSaj M PT jo S&O a y1spawnpis, tofp1olas a w, jou -31 tor 11 (uopU?opqn5 p-piox1jun if-I uo!S!nIrqos n:;t "Nacriff 'voi °ju,,Rq 34) juw,!jddeiqi sssippn Iu!pezu 1-pol d1z put sinvzSqz xoq -0-,j �MUGGV DNIIIVN ,Jua,ln c juwl!-?ddo 1qj J qwou aumf&1n-1 ,aWru is S,J--,W, ko Xpsthoj a*g it -'k ds , 3,,� mo, j 1 o -, d X 11,- �I[Od NUMIKKIdOf SN(-'II3fjW-LSNI