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PLUMBING PERMITBUILDING ELECTRICAL PLUMBING ROOFING Owner of Building J Architect Contractor or Builder Legal Description MIAMI SHORES VILLAGE, FLORIDA „,, ❑ DATE-2 t4 1910,to ❑ PERMIT N? 7249 Contractor's License No. ; 4 ❑ Work to be performed under this Permit__ Lot Bl Address of t Value of I I Amount of .� 0 Building: t 1 / f Project $ II Permi+ $ Z 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• f r * . ! - INSPECTOR In consideration of the issuance to me of this permit 1 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 as cepting this permit I assume responsibility for all work done by either, myself, my agent, servant or employee. CONTRACTOR OR BUILDER Subdi- vision • BY • . _ - 7 , z r N , 2 = Av4 AUTHORITY n•eor *L t ,�F BUILDING ELECTRICAL PLUMBING Work to be performed under this Permit Owner of Building Architect Contractor or Builder MIAMI SHORES VILLAGE, FLORIDA HERMIT. N° 5247 DATE 194 7 Contractor's License No.�✓ l � Legal Lot Bl. Subdi- Description / `' v .../ vision Address of Value of Amt. of Building 1,- c t ) i..- i 1 r Project Permit 1 '' 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 appli- cation 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 assum6 the responsibility for a thorough knowledge of the ordinances and regulations pertaining to the work covered hereby whether shown on the plans drawings or in'the statements or specifications and. that 1 msumes respon- sibility for work done by his agents, servants or employees. - ," Signed: 1 ✓ :2 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 accepting this permit I assume responsibility for all work done by either myself, my agent, servant or employee. f L L0f -- L'0"41...14-" - V ``� CONTRACTOR OR BUILDER BY AUTHORITY BUILDING ELECTRICAL PLUMBING Owner of Building Architect Contractor /6 or Builder �` Legal Lot Description CONTRACTOR OR BUILDER MIAMI SHORES VILLAGE, FLORIDA Work to be performed under this Permit `s, ,tt .. Bl. 17 At Subdi- vision BY f DATE Address of � � r � Value of Amt. of Building s � V / / f \ i • Project Permit j AUTHORITY 1944 Contractor's License No. permit is granted to the contractor r builder named above to construct the building or to install the equipment or device described in the appli- cation 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 pla . : re changed without authorization. A further condition upon which this permit is granted is the understanding that the contractor or builder named above .• .mea. respgnsibility for a thorough knowledge of the ordin ces and regulatidns pertaining to the work covered hereby whether shown on the plans o i aw s in tile statements or specifications and tI a Ife assufy s respon- sibility for work done by his agents, servants or employees. f 4 f 7, " "' " Signed. f ' ,t`m B • Y .,.i INSPECTOR y 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. BUILDING ELECTRICAL PLUMBING `, - Owner of` • Building Architect Contractor or Builder /: `- ) Legal Description Address of . 1 ,✓ « Project Permit xr� This permit is granted to the contractoiror builder named above to construct the building or to install the equipment or device described in the appli- cation herefor in strict compliance with all ordinances pertaining thereto and w th 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 pla re changed without authorization. A further condition upon which this permit is granted is the understanding that the contractor or builder named above as-tt* responsibility for a thorough knowledge of ordinances and regulations pertaining to the work covered hereby whether shown on the plans as• or in the statements or specifications and a e assumes respon- sibility for work done by his agents, servants or employees. Signed = i " * �" By y+ ± INSPECTOR Lot 1 CONTRACTOR OR BUILDER MIAMI SHORES VILLAGE, FLORIDA Work to be performed under this Permi Bi. 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 authoPit� of Miami Shdte$ (STiII ge. In accepting this permit I assume responsibility for all work done by either myself, my agent, servant or employee. Subdi- vision v BY ■ DATE" J{ Contractor's License No. /7 194 AUTHORITY Permit No..__ __ ._ V V__ MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT Date /7//;',-,71,1 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 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 �, / .,' ✓ /;1/ : ! {� .r. No. Street Owner's Name and Address Registered Architect and /or'Engin __,_ z __ _ Employing Plumber's Name t� tee- 'G - ' C- v 4 - tee . -G . N Location and Legal Description Lot Street and Number where work is to be performed —No State work to be performed and purpose of building (By Floors) ___ New Building _. Block Street ivis ion c"7/5 �,� - No. of Stories Remodeling Addition Repairs Street • Size Septic Tank Feet of Drain Tile Nature of Water Supply y Amount of Permit $ Plumbing Inspector. The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations as an employer of labor under the Florida Workmen's Compensation Act, being Section 5986, Compiled General Laws of Florida Permanent Supplement, and has com- plied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors employed by him in the work to be performed under this permit; and will post or cause to be posted for inspection on the site of the work such public notice or notices as are required by the Act. The undersigned agrees to employ only such sub - contractors, on work to be performed under this permit, as are licensed by Miami Shores Village. STATE OF FLORIDA, 1 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. 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. I. / /'�`"� Type of Tank Capacity Gals. r� Dist. Feet of Tank or Drain Field from Well City—Well Size of Soakage Pit ss. (Signed) (Signed) - ----- - - - - -- ---- - - - - -- Master Plumber. My Commission Expires Notary Public, State of Florida CLOSETS BATH TUBS SHOWERS LAVA - TORIES SINKS SLOP SINKS LAUNDRY TUBS URINALS CATCH BASIN FLOOR DRAIN DRINKING FOUNT•N3 TOTAL FIXTURES CONTR. LIST CHECK SEPTIC TANK SEWER CONN. DRAIN FIELD SOAKAGE PIT GREASE TRAP SOLAR HEATER DEEP WELL. SPRKLR. SYSTEM SWIM'G POOL CONTR. I sT LIST J( !�— CHECK Permit No..__ __ ._ V V__ MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT Date /7//;',-,71,1 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 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 �, / .,' ✓ /;1/ : ! {� .r. No. Street Owner's Name and Address Registered Architect and /or'Engin __,_ z __ _ Employing Plumber's Name t� tee- 'G - ' C- v 4 - tee . -G . N Location and Legal Description Lot Street and Number where work is to be performed —No State work to be performed and purpose of building (By Floors) ___ New Building _. Block Street ivis ion c"7/5 �,� - No. of Stories Remodeling Addition Repairs Street • Size Septic Tank Feet of Drain Tile Nature of Water Supply y Amount of Permit $ Plumbing Inspector. The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations as an employer of labor under the Florida Workmen's Compensation Act, being Section 5986, Compiled General Laws of Florida Permanent Supplement, and has com- plied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors employed by him in the work to be performed under this permit; and will post or cause to be posted for inspection on the site of the work such public notice or notices as are required by the Act. The undersigned agrees to employ only such sub - contractors, on work to be performed under this permit, as are licensed by Miami Shores Village. STATE OF FLORIDA, 1 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. 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. I. / /'�`"� Type of Tank Capacity Gals. r� Dist. Feet of Tank or Drain Field from Well City—Well Size of Soakage Pit ss. (Signed) (Signed) - ----- - - - - -- ---- - - - - -- Master Plumber. My Commission Expires Notary Public, State of Florida BUILDING ELECTRICAL • PLUMBING • • Owner of • Building Architect° Contractor , , if or Builder 's �''� A Legal Lot /i ' / BI . «+� Descriptio Address of ' Value of Amt. of, 4 .. Building . 1 / t /+/'f Project Permit /it 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 appli- cation herefor in strict compliance with all ordinances pertaining thereto and w th 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 nged with t authorization. A further condition upon which this permit is granted is the understanding that the contractor or builder named above ass the .ors ility a thorough knowledge of the ordinances and regulations pertaining to the work covered hereby whether shown on the plans or dr mgs t ' e° a a or specifications an. lint ssumes respon- sibility for work done by his agents, servants or employees. t Signed• By ..:7-4 * i KSBECTdR 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 acre ting this permit I assume respon • ility for all work done by either myself, my agent, servant or employee. `" DA ra PERMIT Work A 1 CONTRACTOR OR BUILD MIAMI SHORES VILLAGE, FLORIDA DATE a /0 194_7 N? � r� 2 1 License r�actNro. -- ) 0 " s " r ! to be performed under this Permit 41t 1 Subdi- vision rig BY AUTHORITY 11,x'5 Owner's Name and Address____ Feet of Drain Tile Amount of Permit $ / STATE OF FLORIDA, t COUNTY OF DADE. ss. Nature of Water Supply: City —Well. Size of Soakage Pit r -- Dist. Feet of Tank or Drain Field from Well My Commission Expires MIAMI SHORES VILLAGE PLUMBING ItISPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT a O / ar L'�1 e O36o yf No a C Z Date (Signed) (Signed) per ,. r 'r' ` p r' Permit No. \1 - Application is 1:ereby made for the approval of the detailed statement of the plans and specifications herewith su mitted 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. Street Q/ 31' /G"/1.7 Registered Architect and /or En ilSeer Employing Plumber's Name.__ �LG ! No / #4 C. Street / 0 1 "2.7 Location and Legal Description Lot - _________ S • / / G — _ - _-- ---- - -- Block Subdivision A° " (ems / Street and Number where work is to be performed— No.__..L J•� 2 • _ AT Street State work to be performed and purpose of building (By Floors) New Building _ ✓ Remodeling Addition Repairs __- Notary Public, State of Florida No. of Stories / Size Septic Tank Type of Tank Capacity Gals. Plumbing Inspector. The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations as an employer of labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Permanent Supplement, and has 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 performed under this permit, as are licensed by Miami Shores Village. Master Plumber. Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeared to me well known, and who, being by me first duly sworn, upon oath deposes and says that he is the of the above described construction, that he has carefully read the foregoing application, and that he did sign the same, and that all facts therein by him stated are true. NOTE: A re- inspection fee of $1.00 will be made when such re- inspection is made necessary by improper notice for inspection, or faulty materials and /or workmanship. -4 CLOSETS BATH TUBS SHOWERS LAVA- TORIES SINKS SLOP SINKS LAUNDRY TUBS .. RINALS BASIN FLOOR DRAIN DRINKING FOUNT' NS 11 � TOTAL FIXTURES CONTR. , 3 / / CHECK SEPTIC TANK SEWER CONN. DRAIN FIELD SOAKAGE PIT GREASE TRAP SOLAR HEATER DEEP WELL SPRKLR. SYSTEM SWIM'G POOL •t f ^(, CONTR. LIST CHECK Owner's Name and Address____ Feet of Drain Tile Amount of Permit $ / STATE OF FLORIDA, t COUNTY OF DADE. ss. Nature of Water Supply: City —Well. Size of Soakage Pit r -- Dist. Feet of Tank or Drain Field from Well My Commission Expires MIAMI SHORES VILLAGE PLUMBING ItISPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT a O / ar L'�1 e O36o yf No a C Z Date (Signed) (Signed) per ,. r 'r' ` p r' Permit No. \1 - Application is 1:ereby made for the approval of the detailed statement of the plans and specifications herewith su mitted 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. Street Q/ 31' /G"/1.7 Registered Architect and /or En ilSeer Employing Plumber's Name.__ �LG ! No / #4 C. Street / 0 1 "2.7 Location and Legal Description Lot - _________ S • / / G — _ - _-- ---- - -- Block Subdivision A° " (ems / Street and Number where work is to be performed— No.__..L J•� 2 • _ AT Street State work to be performed and purpose of building (By Floors) New Building _ ✓ Remodeling Addition Repairs __- Notary Public, State of Florida No. of Stories / Size Septic Tank Type of Tank Capacity Gals. Plumbing Inspector. The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations as an employer of labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Permanent Supplement, and has 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 performed under this permit, as are licensed by Miami Shores Village. Master Plumber. Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeared to me well known, and who, being by me first duly sworn, upon oath deposes and says that he is the of the above described construction, that he has carefully read the foregoing application, and that he did sign the same, and that all facts therein by him stated are true. NOTE: A re- inspection fee of $1.00 will be made when such re- inspection is made necessary by improper notice for inspection, or faulty materials and /or workmanship. -4 -4' . 0, C 4 r IP • PERMIT APPLICATION FOR MIAMI SHORES VILLAGE 3/01/96 235 NE 91 STREET Date Job Address Tax Folio Legal Description Historically Designated: Yes No Owner/Lessee / Tenant YOKOSE Master Permit # Owner's Address 235 NE 91 STREET, MIAMI SHORES, 33138 Contracting Co. NORTH DADE SEPTIC TANK Qualifier DENNIS NEVILLE SS# Phone 754 -3375 State# 025836 -8 Municipal# Competency #12842 Ins. Co.TRAVELERS /ESIF Architect/Engineer Bonding Company Mortgagor Permit Type (circle one): ptaltAlykxklAcHgcffi PLUMBINAX FA K RIlh Ay R laxgg WORK DESCRIPTION INSTALL DRAINFEILD Square Ft. 400 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 an i :t all work will be done in compliance with all applicable laws regulating construction and zoning. Furthermore, I authorize the above - name' ..n actor to do e work stated. Signature o weer and/or Condo President Date Not o Owner an ondo 'resident Date My Commission Ex , }l� Not=; _ for' MyCcru .� . L' ;:c::' >,i7 ":•;., i • 14300-3-NOTARY - FLT i:ottzy !! ! !! ! ! e e ! ! e e ee e f t e e t ! e e ! ! ! t ! f i a 1: ! , : ; . Y ,, : r ::' t ! ;' FEES: PERMIT c RADON APPROVED: Zoning Mechanical ``�ti.i �>ic �cr�;ac; ti.y c:. .�;it� sac. " c�c Building Address Address Address Estimated Cost (value) $1100.00 Signa Address 800 NW 111 STREET, MIAMI 33168 s to Contr My Commission E Phone C.C.F. O . 0 NOTARY Electrical 759 -2357 g Q 3 tor or • • er- Builder Date er- Builder Date r r,'r e Ccm.r:ai;:: i' o. cc 4SL?.��7 ct oF F+. ° MyCommiss:cT ;ires0 /15/99 k, 1 .800- 3- W3TARY - Fla tlottry ;.':1-;:;c• 12 Goading Co. TOTAL DUE ,.4Ge/ Plumbing Engineering APPLICATION FOR: [ ....] New System [ :,] Repair APPLICANT: AGENT: 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 RECORDED SUBDIVISION, ATTACH LEGAL DESCRIPTION OR DEED] LOT: PROPERTY ID #: PROPERTY SIZE: BLOCK: PROPERTY STREET ADDRESS: DIRECTIONS TO PROPERTY: BUILDING INFORMATION [ '] RESIDENTIAL Unit Type of No Establishment 1 2 3 4 STATE OF FLORIDA DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES ONSITE SEWAGE DISPOSAL SYSTEM APPLICATION FOR CONSTRUCTION PERMIT Authority: Chapter 381, FS & Chapter 1OD -6, FAC Existing System [ ` ] Holding Tank [ . ;,;] Temporary /Experimental ,] Abandonment [ ?] Other(Specify) APPLICANT'S SIGNATURE: [ '7] Garbage Grinders /Disposals [ ] Ultra -low Volume Flush Toilets f t SUBDIVISION: No. of Bedrooms DATE OF SUBDIVISION: [Section /Township /Range /Parcel No.] ZONING: ACRES [Sqft /43560] PROPERTY WATER SUPPLY: [ ] PRIVATE [ 1 PUBLIC [ HRS -H Form 4015, Mar 92 (Obsoletes previous editions which may not be used) (Stock Number: 5744 - 001 - 4015-1) PERMIT # DATE PAID ' FEE PAID $ RECEIPT # TELEPHONE: 1 - a ., ] COMMERCIAL // Building # Persons Business Activity Area Sqft Served For Commercial Only [ '__] Spas /Hot Tubs [ Floor /Equipment Drains [] Other (Specify) DATE: !` r Page 1 of 3 INS T RUCTHONS: APPL'_CATION 1F0:.3: Check type of permit, if "Otter" specify typo in.. blank. APPLICANT: Property owner's full name. TELEPHONE: Telephone number for applicant or ^gent. AGENT: Property owner's legally authorized representative. MA:;JNG ADD iES3: P.O. box or street, city, state cod zip cede mailing address for applicant o agent. LOT, BLOCK, , SUBDIVISION: DATE OF SUEDIViSION: Official date of subdivision roeorded in county plat books (mont ?3 /clay /ycr4 or date lot originally recorded. Ivividirg r" approved lot into two or more parcels for the purpose of conveying, ownership shall .se considered c subdivision of t e lot. PROPERTY ID(/: 2 / character number for property. (CallU may require property appraise:. 0 or cectiortho Jns:'tip /range /parts! number. PROPERTY S'ZE: Lot, block, and subdivision for lot (recorders or unrecorded subdivision). ::r" tot is not in c recorded subdivision, c copy oft . lot legal de;eription or deed muse lee attached. Net uecblc area of prope:iy in acres (ssIuar.: icotage r;ivic?e by 43, :it50 square fee :) ozcl'tsive o ' al! pavccii a•_ cc and 7:.pto:; sl rand bed„ within public right:. -of way or oar meats and exclusive of streams, lc: cos, r.ormelly wet drnincr e s `.tci:te, :711:;T:.`!:;;1, o� tae such bodies of water. Contiguous unpaved and nonccrpactcd rand rights -of -way cr:d oct:ments wish no rrub °urfccc ob. ^ may be included in calculating to area. WA T E1? SUPPLY: Check private or public. P110 ?ERTY ADDRESS: Street address for property. For lots without an assigned street address, i. dieate street o•• road and locale in county. DIRECTIONS: Provide detailed instructions to lot or attach an area map showing tot locr.ticn. 131E1 :DING INFO ?t'J'ATION: Check residential or commercial. TY ?E ,`S'E'A13;. TSE:MENT: List type of establishment from t Cabte i, Chapter IOD-6, FAC. Exasipl <'. cinglc tcc.ily, single •„rich mobil„; urant, doctor's office. NC. BEDROOMS: Count all rooms designed primarily for sleeping acs: those areas expectsl to routinely provide slecrin .: acco:mmodatir:se f0•: occupants. 3:i :LDYNG AREA: Total square footage of enclosed habitable area of dwelling unit., excluding garage, ct:^•pert, ext2ricr storage Wheel, or o ; ;c'.'a fully acreer..:d patios or decks. Based on outside :meant :rr,: for eceb story of st: f) PERSONS: Number of persons residing, using, or working it e.' ?bliO3trnent. For residc^'lr' eetahlir.:urnent, 2 7e:: c,t9 pct iced c:._n assumed. BUSINESS ACTiN1Tv: For commercial applications only. List e:.amber of cmployurs, alliaa, :r' ::tcocr o'operttion, c • r ;'a 'nfb:. +c:iion rs, irer 'ay Table i:, Chapter 10D-6, FAC. F:I U'RES: Mark each listed fixture with number installed 0: 'NA" if not applicable. SIGNATURE: Signature of applicant or agent. ?gate application one day submitted to 4.tc Cis TJ with upproprietc feet, and citacad..;r_ :s. ATTACHMENTS: A site plan drawn to scale, showing boundaries with dimensions, tsetse ^a of res:dentcc o: b. :itdia e, scumming pawls, : ca:Cmenta, onSite sewr,go disyp v:. system components cnd 1.1til.o; of :operiy. 4ny ;ri tinL'... prapocedi CJC...C, features, filled areas. ob.itr'1Ctec :gene, nod surface % /ate_. ,acrtioo of wells, omit' ceL.'a e di :? al :y°1.er. 3 f_urcoao v '.: :a, orti other pertinent !hcilitiea or feett :es on adjacent prop,:tty, if 6.o fectutes :re with 75 feet of'the applicant 102. :c :ton si any public well within 200 abet of lot. ;Foe relic ±encas, n 'iloor olca (residences) allowing number of bedrooms Wed ouildinp ores of each .rat. >ror establishments, c floor plan showing the aluare footag,c of the cstcbli-'t:-ent, air plumbing drains and fixture ty,pa.n, and other features necessary to determine composition and guarii:y of wastewater. APPLICANT: LOT: PROPERTY ID #: 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 P TOTAL ESTIMATED SEWAGE FLOW: AUTHORIZED SEWAGE FLOW: UNOBSTRUCTED AREA AVAILABLE: BENCHMARK /REFERENCE POINT LOCATION: ELEVATION OF PROPOSED SYSTEM SITE IS - _ -r- - INCHEi /FT] (ABOVE /BELOW] BENCHMARK /REFERENCE POINT THE MINIMUM SETBACK WHICH CAN BE MAINTAINED FROM THE PROPOSED SYSTEM TO THE FOLLOWING FEATURES: SURFACE WATER: FT DITCHES /SWALES: FT NORMALLY WET? [ ] YES [;] NO WELLS: PUBLIC: ..:: FT LIMITED USE: FT PRIVATE: FT NON- POTABLE: FT BUILDING FOUNDATIONS: _s PROPERTY LINES: FT POTABLE WATER LINES: FT SITE SUBJECT TO FREQUENT FLOODING: [ ] YES [.J NO 10 YEAR FLOODING ? A J YES [;] NO 10 YEAR FLOOD ELEVATION FOR SITE .. , .. FT(SSI� !NWS D SITE ELEVATION: e' ;• FT MSt /NGVD SOIL PROFILE INFORMATION SITE 1 BLOCK:i; , SUBDIVISIONG STATE OF FLORIDA DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES ONSITE SEWAGE DISPOSAL SYSTEM SITE EVALUATION AND SYSTEM SPECIFICATIONS Munsell # /Color Texture Depth to 9* USDA SOIL SERIES: to to to to to to to to OBSERVED WATER TABLE: INCHES [AB9LVE / BELOW] EXISTING GRADE. TYPE: tPER9JB>D / APPARENT] ESTIMATED WET SEASON WATER TABLE ELEVATION: INCHES [ .;ABOVE / BELOW ] EXISTING GRADE. HIGH WATER TABLE VEGETATION: [ ] YES t_J NO MOTTLING: [ J YES ['] NO DEPTH: INCHES SOIL TEXTURE /LOADING RATE FOR SYSTEM SIZING: DRAINFIELD CONFIGURATION: [ ] TRENCH [„ ] BED REMARKS /ADDITIONAL CRITERIA: SITE EVALUATED BY: j v �> PERMIT # AGENT: _�.:..., ��.'...:..� • [Section /Township /Range /Parcel No. or Tax ID Number] [ ✓] YES [ ] NO NET USABLE AREA AVAILABLE :o; rTh ACRES GALLONS PER DAY [RESIDENCES -TABLE 1 / OTHER -TABLE 2] GALLONS PER DAY [1500 GPD /ACRE OR 2500 GPD /ACRE] SQFT UNOBSTRUCTED AREA REQUIRED: "= SQFT SOIL PROFILE INFORMATION SITE 2 Munsell # /Color Texture USDA SOIL SERIES: «, > "; \' Depth to to to to to to to to to DEPTH OF EXCAVATION: INCHES J OTHER (SPECIFY) DATE: HRS -H Form 4015, Mar 92 (Obsoletes previous editions which may not be used) Page 3 of 3 (Stock Number: 5744 - 003 - 4015 -1) INSTRUCTIONS: PERMIT 11: Permit tracking number assigned by CPIIU. APPLICANT: Property owner's full name. AGENT: Property owner's legally authorized representative. LO1, BLOCIt, SUBDIVISION: Lot, block, and subdivision for lot. PROPERTY ID! /: 27 character number for property. (property appraiser 113 0 or cection/towrtr ltip /range /paece! number) P?RO ?ERTY SIZE: Check if property size at site conform; to submitted site plan. Record a at usa1,'° send. nv,ilab'.e - lot r. :.::::sck.:„° > of all paved areas and prepared coed beds within public ght; -oo , .vay or easements clad exclusive of etee^r..a, normally wet drainage ditches, marshes, or other such bodies of water. SEWAGE FLOW: UNOBSTRUCTED AREA: iiiiiNiMUM SETBACKS: Record the estimated sewage flow for the establishment from n r.ble 1 (residences) or Table 2 (_- ^n- residcttti tl), Chcpte2 10D -6, FAC. Record the authorized aroinge flow for tee lot xrsed nn net usable a and wrier sup,, , (l.")i O 'arts per day per acre for private water supplies and 2500 gpd per for public wr.tet c tinge its•;+ • does not equal or exceed the estimated sewage flow, the application must be de ni„ d. Record the square feet of unobstructed atca available and the catoz t: cettuirr:. times os large as 4;e drain(1e!d absorption area and at !east 75 2tar err of the u ?ectcd r:cc must cetbacks in Chapter 10D -6, fAC. The unobstructed area rr_•! be contiguous to :he radar ale. :3 alC} / -% iN 38MAT ON: Record the locitian of th.e benchmark. L icing a deyor'c :tencitr,a.Ark eeca.-d the sett, iI elevctio elevation of the p :ropoced system site in relation (above or below) to the bFrcfimark. Record minimum setbacks which can be meet to all hrted fect':res. Actual meastrannents must be m carder: o "NA' for son raplie::ble features. Fenturcs on site plan or within 75 fee of the app!ic:,nt lot :noel be trar^.:.rn :d. of any public drinking well within 2C:) fee, of the applicant's lot must also be verified. FLOOD INFORMATION: Record information on lot's subject to flooding. Fo: !ors kubject to flooding record 10 year flout e?..vatien for site aril actual site elevation. SOS- PROFILE iNFORMATIOi !: Two soil profiles within the proposed absorption are to c niriimuin depth of 6 feet or cefurtal n: ^r? :ai,t ,. Se:.' identification will use USDA Soil Clascificc:ion methodology (la9unsell color; and USDA soil tc xtt:toc). t cfutolo mur' be clearly documented. Provide USDA soil series if available, record "UNE(" if the seiea cannot ba detc : -:mated. WATER TABLE: Record the depth of the observed water table at the time of the evaluation. Mark °perched° or "apparent" an appropriate. Record the estimated wet season water table elevation based on site evaluation, US ;',A soil maps, and historical information. Indicate if there is high water table vegetation present. indicate if mottling is present and dept',. 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. DRAINFIELD 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 must seal all documentation submitted. ELEVATION WORKSHEET ELEVATION OF BENCHMARK / REFERENCE POINT IS: BENCHMARK SITE 1 SITE 2 SITE 3 [ +J SHOT: H.I. H.I. H.I. H.I. [ -J SHOT [ -J SHOT [ -J SHOT CONSTRUCTION PERMIT FOR: [: :] New System [: ] Existing System [ A Holding Tank [ :. ] Temporary /Experimental [ ] Repair [ ] Abandonment [ ..A Other(Specify) APPLICANT: PROPERTY STREET ADDRESS: p_ LOT: L D FILL REQUIRED: [ ] INCHES 0 T H E R SPECIFICATIONS BY: APPROVED BY: DATE ISSUED: f } STATE OF FLORIDA DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PERMIT Authority: Chapter 381, FS & Chapter 10D -6, FAC .� �.'... AGENT: " . . ,.. . BLOCK: SUBDIVISION: STANDARD TRENCH PROPERTY ID #: [SECTION /TOWNSHIP /RANGE /PARCEL NUMBER] [OR TAX ID NUMBER] 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 SPECIFICATIONS T [ ] [GALLONS / GRDI SEPTIC TANK /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 [ ;; ] SQUARE FEET PRIMARY DRAINFIELD SYSTEM R [ ] SQUARE FEET SYSTEM A TYPE SYSTEM: [ : ;] I CONFIGURATION: [ N F LOCATION OF BENCHMARK: [ ] FILLED BED HRS -H Form 4016, Mar 92 (Obsoletes previous editions which may not be used) (Stock Number: 5744- 001 - 4016 -0) [ ] MOUND [ ] [ I ELEVATION OF PROPOSED SYSTEM SITE [ ] [INCHES /FT] [ABOVE /BELOW] BENCHMARK /REFERENCE POINT E BOTTOM OF DRAINFIELD TO BE [ ] [INCHES /FT] [ABOVE /BELOW] BENCHMARK /REFERENCE POINT EXCAVATION REQUIRED: [ ] INCHES TITLE: PERMIT # DATE PAID FEE PAID $ ': r RECEIPT # TITLE: U 1i �. EXPIRATION DATE: CPHU Page 1 of 2 INSTRUCTIONS: PERMIT NUMBER: Permit tracking number assigned by CPHU. 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 t1 or section/township /range /parcel number) SYSTEM DESIGN AND SPECIFICATIONS: TANK: Minimum specifications from Chapter 10D-6, FAC. DRAINFIELD: Minimum specifications from Chapter 10D -6, FAC. OTHER: Other specifications, such as operating permit requirements, low- volume flush toilets, variance provisos. SPECIFICATIONS BY: Name of individual providing specifications. If designed by 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. Scale: Each block represents 5 feet and 1 inch = 50 feet. By STATE OF FLORIDA DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PERMIT ‘/(!, /(" 00 • _ ¥. -t Notes: Site Plan submitted by: A , HRS -H Form 4015, Feb 85 (Obsoletes previous editions which may not be used) (Stock Number. 5744- 002 - 4015 -6) PART II - SITE PLAN 7 ,• - Permit Application Number t' t 4 t t 4- i, t t � „- SIGNATURE TITLE Plan Approved ° - Not Approved Date County Public Unit ALL= RANGES MUST BE APPROVED BY THE COUNTY PUBLIC IiEALTH UNIT Page 2 of 3 MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT /L < c? 3 Permit No Date--- -. -_ -- -. Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the building or other structure herein described. This application is made in compliance and conformity with the Building Ordinance of Miami Shores Village, Florida, and all provisions of the Laws of the State of Florida, all ordinances of Miami Shores Village and all rules and regulations of the Building Division of Miami Shores Village shall be complied with, whether herein specified or not. A copy of approved plans and specifications must be kept at building during progress of work. Owner's Name and Address r ' S Registered Architect and /or Engineer Employing Plumber's Name .. /v 0 Ora Da Sq2rI . rf€ IK co Block Location and Legal Desctiption Lot. 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 Tangy —.— - — — — - - -- _...Type of Tank__ Feet of Drain Tile.____ — - ---Die. Feet of Tank or brain Field from Well Nature of Water Supply: City — Well. --- .____ -- ...Sias of Soakage Pit Amount of Permit $ umbing Inspector. The undersigned applicant for this building permit does horeby certify that he understands and accepts his obligati es an employer of labor under the Florida Workmen's Compensation Act, being Section 5 , Compiled General Laws of Florida Permanent pplement, and has com- plied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors employed by him in the work to be performed under this permit; and will post or cause to be posted' for inspection on the site of the work such public notice or notices as are required by the Act. The undersigned agrees to employ only such sub - contractors, on wrh to be performed under this permit, as are Deemed by Miami Shores Village. No. -2 3 / /..-- Street (Signed) __ -- �! Capacity Gels. Street My Commission Expos Notary Public, State of l 'ios -da STATE OF FLORIDA, t COUNTY OF DADE. Before me, the undersigned authority, a notary p b1ic, duly authorized to administer oaths and take acknowledgments, personally appeared to me well known, and who, being by me first duly worn, elirz oath deposes and says that he is the._._--- -.. -.- •- - --.. _.. of the above described construction, that he has carefully toad She regoing application, and that he did sign the gees, and that all facts therein by him stated are true. NOTE: A re- inspection fee of *1.00 will b nrado To1i to-atapectittm to enade'neoasaso-ry by tmprop% notice for inspection, or faulty materials and /or workmanship. CLOSETS BATH TUBS fiNOWLR• LAVA- Tomas CrINKB SLOP SINKS LAUNDRY Tugs URINALS CATCH BASIN FLOOR DRAIN DRINKING FOUNT'NO TOTAL FIXTURES CONTR. LIST CHECK - - -_ - -_ SEPTIC TANK SEWER COHN. DRAIN FIELD SOAKAGE PIT CRGAOE TRAP SOLAR HEATER DEEP WELL SPRKLR. SYSTEN SWIM'0 POOL - Cogre. LIST CHECK ( � . MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT /L < c? 3 Permit No Date--- -. -_ -- -. Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the building or other structure herein described. This application is made in compliance and conformity with the Building Ordinance of Miami Shores Village, Florida, and all provisions of the Laws of the State of Florida, all ordinances of Miami Shores Village and all rules and regulations of the Building Division of Miami Shores Village shall be complied with, whether herein specified or not. A copy of approved plans and specifications must be kept at building during progress of work. Owner's Name and Address r ' S Registered Architect and /or Engineer Employing Plumber's Name .. /v 0 Ora Da Sq2rI . rf€ IK co Block Location and Legal Desctiption Lot. 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 Tangy —.— - — — — - - -- _...Type of Tank__ Feet of Drain Tile.____ — - ---Die. Feet of Tank or brain Field from Well Nature of Water Supply: City — Well. --- .____ -- ...Sias of Soakage Pit Amount of Permit $ umbing Inspector. The undersigned applicant for this building permit does horeby certify that he understands and accepts his obligati es an employer of labor under the Florida Workmen's Compensation Act, being Section 5 , Compiled General Laws of Florida Permanent pplement, and has com- plied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors employed by him in the work to be performed under this permit; and will post or cause to be posted' for inspection on the site of the work such public notice or notices as are required by the Act. The undersigned agrees to employ only such sub - contractors, on wrh to be performed under this permit, as are Deemed by Miami Shores Village. No. -2 3 / /..-- Street (Signed) __ -- �! Capacity Gels. Street My Commission Expos Notary Public, State of l 'ios -da STATE OF FLORIDA, t COUNTY OF DADE. Before me, the undersigned authority, a notary p b1ic, duly authorized to administer oaths and take acknowledgments, personally appeared to me well known, and who, being by me first duly worn, elirz oath deposes and says that he is the._._--- -.. -.- •- - --.. _.. of the above described construction, that he has carefully toad She regoing application, and that he did sign the gees, and that all facts therein by him stated are true. NOTE: A re- inspection fee of *1.00 will b nrado To1i to-atapectittm to enade'neoasaso-ry by tmprop% notice for inspection, or faulty materials and /or workmanship.