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PLUMBINGPERMIT APPLICATION FOR MIAMI SHORES VILLAGE Date Job Address /0 2 2/ A C. q 1 xit. Tax Folio Legal ption Historically Designated: Yes No Owner/ Lessee / Tenant o/z ioL " " 6 4 /4/6-"S Master Permit # Owner's Address ( a Z 2 /v , ` 7/ 7 Contractin Co. /4. C / G Oict,—)7/ Address l q7 3 Z " PJ• .2 ci, Qualifier - j% PIJC/J G / SS# Phone s '65" /- 41 5 State # Municipal # Competency # Ins. Co. Architect/Engineer Address Bonding Company Address Mortgagor Address Permit Type (circle one): BUILDING ELECitI CAL PLUMBING ECHANICAL ROOFING PAVING FENCE SIGN e '- ( WORK DESCRIPTION Square Ft. 3 Estimated Cost (value / 2-6 WARNING TO OWNER: YOU MUST RECORD A NOTICE OF COMMENCEMENT AND YOUR FAILURE TO DO SO MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY (IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT.) Application is hereby made to obtain a permit to do work and installation as indicated above, and on the attached addendum (if applicable). I certify that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that separate permits are required for ELECTRICAL, PLUMBING, SIGNS, POOLS, ROOFING and MECHANICAL WORK. OWNER'S AFFIDAVIT: I certify 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 -riamed contractor to do the work stated. - 4(A4n,„., A-1,A.4 ( Signature of owner and/or Condo President ate _=/ -74---------------- 6 Notary as to Owner and/or Condff President Date My Commission Expires: P j tn) FEES: PERMIT 3c RADON APPROVED: - Zoning Mechanical Plumbing Phone Signature of Contractor or Owner - Builder N My DEC. 17,2002 4as to Contracto r Owner - Builder Date My Commission E .' ly / f F 1 S Y P 1► N6 L - t / -- (C)3 SP • .0 p�lIF7 Mswam N N NU / it,; o 9 0 EXPIRES OF FA C.C.F. NOTARY 37- BOND TOTAL DUE 3 V Building : \ f 1 Electrical Engineering O T H E R SPECIFICATIONS BY: APPROVED BY: DATE ISSUED: STATE OF FLORIDA DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PERMIT Authority: Chapter 381, FS & Chapter 10D -6, FAC CONSTRUCTION PERMIT ] New System 4 Existing System AP ] Holding Tank )(_] Temporary /Experimental ] Repair [/t ] Abandonment [ // ] Other(Specify) APPLICANT : fay f /l CI /.. PROPERTY STREET ADDRESS: ,� 'f 0 `�-�- 4./E 9.f rc /� t.% LOT: BLOCK: SUBDIVISION: PROPERTY ID #:, � < _. t t), 6 aL) SYSTEM MUST BE CONSTRUCTED IN ACCORDANCE WITH SPECIFICATIONS AND STANDARDS OF CHAPTER 10D -6, FAC REPAIR PERMITS AND HOLDING TANK PERMITS EXPIRE 90 DAYS FROM THE DATE OF ISSUE. ALL OTHER PERMITS EXPIRE ONE YEAR FROM THE DATE OF ISSUE. HRS APPROVAL OF SYSTEM DOES NOT GUARANTEE SATISFACTORY PERFORMANCE FOR ANY SPECIFIC PERIOD OF TIME. ANY CHANGE IN MATERIAL FACTS WHICH SERVED AS A BASIS FOR ISSUANCE OF THIS PERMIT, REQUIRE THE APPLICANT TO MODIFY THE PERMIT APPLICATION. SUCH MODIFICATIONS MAY RESULT IN THIS PERMIT BEING MADE NULL AND VOID. SYSTEM DESIGN AND SP CIFICATIONS T ( � �GAi S / GPO _..SEPTIC TA /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: [ ] D (C.)4C] SQUARE FEET PRIMARY DRAINFIELD SYST iP1 R [ ] SQUARE FEET A TYPE SYSTEM: I CONFIGURATION: N SYSTEM [r'''] STANDARD [ ] FILLED [ ] MOUND [ ] [ ] TRENCH BED [ F LOCATION OF BENCHMARK :7, ',/ 4/ V 'st LF fi'' Fle1?f (F J 0 Ti /-fp - ,•y� +P'�/; R S,4' , 5;4 I ELEVATION OF PROPOSED SYSTEM SITE [/`• _ k- ES /FT] [ABO1�E /BELO ]BENCHMARLiREFERENCKPO E BOTTOM OF DRAINFIELD TO BE [ E - (J [INCHES /FT] [ABO /BELOW] BENCHMARK /REFERENCE POT L --�''' D FILL REQUIRED: [ ] INCHES EXCAVATION REQUIRED: lQ• TITLE: HRS -H Form 4016, Mar 92 (Obsoletes previous editions which may not be used) (Stock Number: 5744 - 001 - 4016 -0) APPLICANT TITLE: PERMIT # ! / ('c." 1 7 C7 DATE PAID - s} ° 7 7 FEE PAID $ 2,r; ew RECEIPT # ) INCHES AGENT: & C' •:.: err c. '1 k,4 � r t [SECTION /TOWNSHIP /RANGE /PARCEL NUMBER] [OR TAX ID NUMBER] o — — y . EXPIRATION DATE: i - 1 C, CPHU Page 1 of 2 Scale: Each block represents 5 feet and 1 inch = 50 feet. 1 J f 1:1 C1+ r J-- r a f rfloi J Plan Approved By STATE OF FLORIDA , DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PERMIT Permit Application Number PART II - SITE PLAN Not Approved 75 ALL CHANGES MUST BE APPROVED BY THE COUNTY PUBLIC HEALTH UNIT HRS -H Form 4015, Feb 85 (Obsoletes previous editions which may not be used) 'Stock Number. 5744-002-4015-6) - County Public Unit Page 2 of 3 Date.... Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the building or other structure herein described. This application is made in compliance and conformity with the Building Ordinance of Miami Shores Village, Florida, and all provisions of the Laws of the State of Florida, all ordinances of Miami Shores Village and all rules and regulations of the Building Division of Miami Shores Village shall be complied with, whether herein specified or not. A copy of approved plans and specifications must be kept at building during progress of work. , q� Owner's Name and Address " G._4 ��1_� /_e --------- --- -- - - -- No. _.���i,2.___. E Street 7l 5 T 7'C-771.44-- Registered Architect and /or _- ---�___ -- Employing Plumber's Name__ e S��T /_�__ 1Y�. SE, No . - � - _,7( Street. _ sr Permit No._ £ r Location and Legal Description Lot____. — ______— ..._.___- -___ —_ — Block Street and Number where work is to be performed —No State work to be performed and purpose of building (By Floors) ______ _ New Building ______ Remodeling_ ___ Addition________. Repairs No. of Stories. _ Size Septic Tank.. . _------ .--- ____ -_ _. - - -- Type of Tank. -- Capacity Gals Feet of Drain Tile2M.A2C.A___4 Feet of Tank or Drain Field from Well Nature of Water Supply: City —Well. Amount of Permit $ STATE OF FLORIDA, I COUNTY OF DADE. . MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT Subdivision ....... ____ __ --° / 1,4 Street 11 _Size of Soakage Pit My Commission Expires Notary Public, State of Florida r Plumbing Inspector. The undersigned applicant for this building permit does hereby certify that he understands and accepts his ,,o . gations as an employer of labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida P4 anent Supplement, and has com- plied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors employed by him in the work to be performed under this permit; and will post or cause to be posted' for inspection on the site of the work such public notice or notices as are required by tlie Act. The undersigned agrees to employ only such sub- contractors, on work to be performed under this permit, as are licensed by Miami Shores Village. ( Signed yt: Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeared to me well known, and who, being by me first duly sworn, upon oath deposes and says that he is the of the above described construction, that he has carefully read the foregoing application, and that he did sign the same, and that all facts therein by him stated are true. NOTE: A re- inspection fee of $1.00 will be made when such re- inspection is made necessary by improper notice for inspection, or faulty materials and /or workmanship. CLOSETS BATH TUBS SHOWERS LAVA- TORIES SINKS SLOP SINKS LAUNDRY Tulsa URINALS CATCH BASIN FLOOR DRAIN DRINKING FOUNT'N6 TOTAL FIXTURES CoNTR. LIST CHECK SEPTIC TANK SEWER CONN. DRAIN FIELD SOAKAGE PIT GREASE TRAP SOLAR HEATER DEEP WELL SPRKLR. SYSTEM SW IM'G POOL CONTR. LINT CHECK Date.... Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the building or other structure herein described. This application is made in compliance and conformity with the Building Ordinance of Miami Shores Village, Florida, and all provisions of the Laws of the State of Florida, all ordinances of Miami Shores Village and all rules and regulations of the Building Division of Miami Shores Village shall be complied with, whether herein specified or not. A copy of approved plans and specifications must be kept at building during progress of work. , q� Owner's Name and Address " G._4 ��1_� /_e --------- --- -- - - -- No. _.���i,2.___. E Street 7l 5 T 7'C-771.44-- Registered Architect and /or _- ---�___ -- Employing Plumber's Name__ e S��T /_�__ 1Y�. SE, No . - � - _,7( Street. _ sr Permit No._ £ r Location and Legal Description Lot____. — ______— ..._.___- -___ —_ — Block Street and Number where work is to be performed —No State work to be performed and purpose of building (By Floors) ______ _ New Building ______ Remodeling_ ___ Addition________. Repairs No. of Stories. _ Size Septic Tank.. . _------ .--- ____ -_ _. - - -- Type of Tank. -- Capacity Gals Feet of Drain Tile2M.A2C.A___4 Feet of Tank or Drain Field from Well Nature of Water Supply: City —Well. Amount of Permit $ STATE OF FLORIDA, I COUNTY OF DADE. . MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT Subdivision ....... ____ __ --° / 1,4 Street 11 _Size of Soakage Pit My Commission Expires Notary Public, State of Florida r Plumbing Inspector. The undersigned applicant for this building permit does hereby certify that he understands and accepts his ,,o . gations as an employer of labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida P4 anent Supplement, and has com- plied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors employed by him in the work to be performed under this permit; and will post or cause to be posted' for inspection on the site of the work such public notice or notices as are required by tlie Act. The undersigned agrees to employ only such sub- contractors, on work to be performed under this permit, as are licensed by Miami Shores Village. ( Signed yt: Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeared to me well known, and who, being by me first duly sworn, upon oath deposes and says that he is the of the above described construction, that he has carefully read the foregoing application, and that he did sign the same, and that all facts therein by him stated are true. NOTE: A re- inspection fee of $1.00 will be made when such re- inspection is made necessary by improper notice for inspection, or faulty materials and /or workmanship. BUILDING ELECTRICAL PLUMBING ROOFING Owner of Building t Architect _ .1 Contractor or Builder MIAMI SHORES VILLAGE, FLORIDA ❑ DATE. 19 4. PERMIT 4051 Contractor ❑ Work to be performed under this Permit Legal Lot Description CONTRACTOR Ol}'BUILDER ii a Address of Val ue of I Amount of Building "� ` 4 ' t Pr oject $ 11 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. 1/ License No. Subdi- vision 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 aad regulations pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In ao• cepting this permit I assume responsibility for all work done by either, myself, my agent, servant or employee. BY AUTHORITY A�