PL-05-184Miami Shores Village
10050 NE 2nd Avenue
Phone: 305 - 795 -2204
Printed: 6/13/2005
Permit Number: PL2005 -184
Applicant: BRENDA WESTHORP
Owner: WESTHORP BRENDA
JOB ADDRESS: 1184 NE 91 TERR
Contractor MR C'S SEPTIC TANK
Local Phone: 305 -651 -7859
Parcel # 1132050010460
Plumbing Permit
Contractor's Address: P 0 BOX 693239
Legal Description: 5 53 42 WATERSEDGE PB 9 -141 E45FT OF LOT 22 & W4OFT OF LOT 23
Fees: Description Amount
FEE2005 -8091 Building Fee $175.00
FEE2005 -8092 Building Fee $175.00
FEE2005 -8093 CCF $1.20
FEE2005 -8094 Training and Education Fee $0.40
FEE2005 -8095 Technology Fee $8.75
FEE2005 -8096 Scanning Fee $3.00
FEE2005 -8097 Notary Fee $5.00
FEE2005 -8098 Builders Bond $300.00
Total Fees: $668.35
Total Fees: $668.35
Total Receipts: $668.35
Permit Status: APPROVED Permit Expiration: 12/5/2005 Construction Value: $1,400.00
Work: DRIANFIELD SEPTIC
Signed: (INSPECTOR)
Page 1 of 1
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 responisibility for all work
done by either myself, my agent, servants or employes.
Signed: (Contractor or Builder) BY:
Miami Shores Village
10050 NE 2nd Avenue
Phone: 305 - 795 -2204
Printed: 6/13/2005
Plumbing Permit
Contractor MR C'S SEPTIC TANK
Local Phone: 305 - 651 -7859
Parcel # 1132050010460
Permit Number: PL2005 -184
Applicant: BRENDA WESTHORP
Owner: WESTHORP BRENDA
JOB ADDRESS: 1184 NE 91 TERR
Contractor's Address: P 0 BOX 693239
Page 1 of 1
Legal Description: 5 53 42 WATERSEDGE PB 9 -141 E45FT OF LOT 22 & W4OFT OF LOT 23
Fees: Description Amount
FEE2005 -8091 Building Fee $175.00
FEE2005 -8092 Building Fee $175.00
FEE2005 -8093 CCF $1.20
FEE2005 -8094 Training and Education Fee $0.40
FEE2005 -8095 Technology Fee $8.75
FEE2005 -8096 Scanning Fee $3.00
FEE2005 -8097 Notary Fee $5.00
FEE2005 -8098 Builders Bond $300.00
Total Fees: $668.35
Total Fees: $668.35
Total Receipts: $668.35
Permit Status: APPROVED Permit Expiration: 12/5/2005 Construction Value: $1,400.00
Work: DRIANFIELD SEPTIC
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 accepting this permit I assume responisibility for all work
done by either myself, my agent, servants or employes.
Signed: (Contractor or Builder) BY:
BUILDING
PERMIT APPLICATION
FBC 2001
Contractor's Company Name I ° `lf C s
Contractor's Address GIC‘ q o. ) L3
City
Qualifier
Total Fee Now Due $ � • 35
(Continued on opposite side)
Miami Shores Village
Building Department it) . 8 2925
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
Permit Type (circle): Building Electrical
Owner's Name (Fee Simple Titleholder) l' . L e 6+14 Or Fe. Phone #
Owner's Address r t V li� 9 / f r t
City p)�1 ® aM O S h S State 1Cl
Tenant/Lessee Name
State
Zip
Job Address (where the work is being done) 1 f R 2-i- N e 9 1 e ir
City Miami Shores Village County Miami -Dade Zip
Is Building Historically Designated YES NO
Permit No. PIC3S
Master Permit No.
Phone #
Architect/Engineer's Name (if applicable) Phone #
$ Value of Work For this Permit /C I `t 00
Square Footage Of Work:
�. EC l r
Mechanical Roofing
5B 3?
Phone # 'O 63s i
Zip 49
State Certificate or Registration No. Certificate of Competency No.
Type of Work: ['Addition ['Alteration ❑New ❑ Repair/Replace ❑ Demolition
Describe Work:
n - eui 9 — £Pfit
Ivrofrki D
****************************F
* * * * * * * *, * * * * * * * * **** * **
Submittal Fee $ Permit Fee $ 17 5 °° 4 \ r c } CCF $ 1 . 20 CO/CC
Notary $5 Training/Education Fee $ • 40 Technology Fee $ 87) J
Scanning $ 5 Radon $ Zoning Bond $
Code Enforcement $ Structural Plan Review. $
Bonding Company's Name (if applicable)
Bonding Company's Address
City State Zip
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address
City State Zip
Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has
commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulating
construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRICAL WORK, PLUMBING, SIGNS,
WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and AIR CONDITIONERS, ETC
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.
"WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT 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."
Notice to Applicant: As a condition to the issuance of a building permit with an estimated value exceeding $2500, the applicant must
promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person
whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site
for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the
inspection will not be approvepa a reinspection fee will be charged
Signature /
NOTARY PUBLI
Sign:
Print:
Chc 05/13/03
Signature
Owner or ge Contractor
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
day of ,20_,by day of ,20 , by
who is personally known to me or who'has produced who is personally known to me or who has produced
As identification and who did take an oath. as identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
My Commission Expires:
************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
My Commission Expires:
* * * * * * * * * * * * * * * * * * * **
1'71'11 ; r MY COMMISSION # DD 0317
EXPIRES: June 20, 2005
*** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
APPLICATION APPROVED BY:
************************* * * * * * * * * ** * * * * * * * * * * * * * * * * * * * **
ro Plans Examiner
Engineer
Zoning
Notes:
Plan Approved
By
APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PERMIT
f .•
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PART II SITE PLAN
Site Plan submitted by: ,--
- Srgnature —
Not Approved
DH 4015. 10/9B (Replaces HRSH Form 4015 vAdch may be used)
(Stock Nuinban 6744-002-401545
STATE OF FLORIDA
DEPARTMENT OF, HEALTH 7
Title
Date
ALL CHANGE MUST BE APPROVED BY THE COUNTY HEALTH DEPARTMENT
-
4
County Health Department
Page 2 of 3
CONSTRUCTION PERMIT` FOR
[ ] New. System
1)(1 Repair
APPLICANT:
PROPERTY ADDRESS:
LOT: BLOCK: "' SUBDIVISION :, ` 0 . �
[SECTION, TOWNS IP, RANGE, PARCEL NUMBER]
PROPERTY ID #: ' ' . " 0 0 0 (OR TAX ID NUMB R]
SYSTEM MUST BE CONSTRUCTED IN ACCORDANCE WITH SPECIFICATIONS AND STANDARDS. OF SECTION 381.0065,
F.S., AND CHAPTER 64E-6, F.A.C. DEPARTMENT APPROVAL OF SYSTEM DOES NOT GUARANTEE SAFTISFACTORY
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 `TEE ;PERMIT ABPLICATION.
SUCH MODIFICATIONS MAY RESULT IN THIS PERMIT BEING_ MADE NULL AND VOID., ISSUANCE OF THIS PERMIT
DOES NOT EXEMPT THE APPLICANT FROM COMPLIANCE WITH OTHER_ FEDERAL, STATE, OR LOCAL PERMITTING
REQUIRED FOR DEVELOPMENT. OF THIS PROPERTY.
SYSTEM DESIGN AND SPECIFICATIONS
T U-146 ] GALLON / GPD SEPTIC TANK /AEROBIC UNIT . CAPACITY
A [ _;. ] GALLONS / GPD CAPACITY MUL
N [ ] GALLONS GREASE INTERCEPTOR CAPACITY [MAXIMUM CAPACITY
R [ ] GALLONS DOSING TANK CAPACITY L 1GALLONS @ [ ] DOSE
D
R
A
I
N
F
I
E
L
D
0
E T
8
[ ZOO ] SQUARE
SQUARE
TYPE SYSTEM :
CONFIGURATION:
FILL REQUIRED:
STATE OF FLORIDA
DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM
CONSTRUCTION' PERMIT
]• Existing System
[,] Abandonment
FEET PRIMARY DRAINFIELD SYSTEM
FEET SYSTEM
L l '") STANARD 1 °] FILLED [
] TRENCH {" 1 BED [
[I'] Holding Tank
[ ] Temporary
{
PERMIT NO .
DATE PAID:
FEE. PAID:
RECEIPT #:
3
l
Innovative
LOCATION OF BENCHMARK:
ELEVATION OF PROPOSED' SYSTEM SITE 0,1C] [INCHES /FT] [ABOVE /BELOW] BENCHMARK /REFERENCE'POINT
BOTTOM OF DRAINFIELD TO. BE { ] [INCHES /FT] [ABOVE/WANT BENCHMARK /REFERENCE POINT
[ INCHES
r
SPECIFICATIONS BY: is a " ` "°" +�. " ' r��Y> ' M1! • •4
APPROVED BY:
DATE ISSUED: �+
DE 4016, 12/99 (Page 1) (Previous Editions May Be Used)
l l
TITLE:
j
,1
EXPIRTION DATE:
t
Page 1 of 3
t r �
EXCAVATION REQUIRED: { (, ] =ORES
L
nism L OF SUGI ]L L D SOIL
� Boumm OF DF A R 1 15
FC fi =g°' 1t
F • �. a� ,-, F
AT �.,
L 2.0 FEET WIDER AND
pt. 1: Health Department
pt. 2: Applicant
pt. 3: Installer /contractor
pt. 4: Building Department
1 Q O. 00
I- CHAMBERED /IN- SERIES. [Al
I- CHAMBERED /IN- SERIES [
SINGLE TANK: 2250 GALLONS]
PER 24 HRS # [ l
INSTRUCTIONS:
SYSTEM DESIGN AND
SPECIFICATIONS:
issued.
PERMIT NUMBER: Permit tracking number assigned by CPHU.
CONSTRUCTION
PERMIT 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. (CHD may require property appraiser ID # or section/township /range/parcel number)
TANK: Minimum specifications from Chapter 64E-6, FAC.
DRAINFIELD: Minimum specifications from Chapter 64E-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 Health Department (CHD) personnel reviewing and approving permit.
DATE ISSUED: Date permit is issued by CHD
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