BUILDING PERMITPERMIT APPLICATION FOR MIAMI SHORES VILLAGE
ss
Date Job Address �2 ALE. - 7 1 7Tax Folio
Legal Description Historically Designated: Yes No
Owner/Lessee / Tenant
Ow1er's Address p, , g 1 57-
Contracting Co. 0 IZ /2 E Cr E L E e/ • Taw.. Address // /WW � 7 t ) , l •
) / 7
-
Qualifier - VY\K-) a. E 4, SS# Phone off, 5 — 5P-/
State # 6 Municipal # / /¢ /, j Competency # Ins. Co. /7"74z 0
Architect/Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type (circle one): BUILDING LECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIP'T'ION
Square Ft. Estimated Cost (value) '" A?QO
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 -named contractor to do the work stated.
Signature of owner and/or Condo President Date
Notary as to Owner and/or Condo President Date
My Commission Expires:
FEES: PERMIT/4 ' D® RADON
oz) / M a -sP, Co 0,
Signature of Contractor or Owner- Builder
Notary
My
Building
Master Permit #
Phone .S j d O oZ
NOTARY Pint.uc. STATE OF FLINIDA
s KATMLEt'V GiARY SCHNIDER
? COMMIS MN No: CC-3
E!Y CO MISSION E1FIRES
r..« •' MAR. 21, 1998
C.C.F. NOTARY TOTAL DUE '7<17: D 0
APPROVED:
Zoning
Mechanical Plumbing Engineering
Electric
Date
Date
/2./
MIAMI SHORES VILLAGE
BUILDING INSPECTION DEPARTMENT
APPLICATION FOR BUILDING PERMIT
Application is hereby mode for the approval of the detailed statement or 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 wish, whether herein specified or not. A copy of approved
plans and specifications must bc kept at building during progress of the work.
Street and Number where work is to be done 2 ie 'vie. 9/ �T
/L
Date...----.7 26
Owner's Name and Address . C C G� / .11! ,
' .`':g.� � ._. No..._ . ..... . Street_..._ . .. _... _..
Registered Architect and /or Engineer .....''Sr*t /� 1P4/Sre r
sera.-
1..1. 11....,..•,,...,,. ?T."! •ItT .....
`
-. _._. A/10 t/E4 149, i1
Name and address of licensed contractor
Location and legal description of lot to be built on: �� p
Lot / Block t3 Subdivision s 1 ""°S V!1/ E 'E turn'/
State work to be done and purpose of building (by floors). elA. . r fAVE .Q ex).
e / cos'
and for no other purpose.
New Bui!ding WA-) Remodeling Addition Repairs No. of Stories _
P..
To be constructed of .C. Kind of foundationC.Pr' um Roof vering. e 77 i22_
Estimated Total cost of improvements $ /PO 000 Amount of Perm{ii�tt,, $. ,/Z t'
Zone cubage required plan Cubage T
Distance .to next 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 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 obligations as an employer
of Labor under the Florida Workmen's Compensation Act, being Section 5066, Compiled General Laws of Florida, Permanent Sup element,
and has complied uitlr the provisions thereof, and will require similar compliance from all contractors or sub - contractors employed by hint
in the work to bc 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 weyk to be performed under this
permit. as are licensed by Miami Shores Village. `/,_�A-
... _
Remarks - -- -• -- (Signed )_11
STATE OF FLORIDA, i
COUNTY OF DADE. ss.
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally ap-
peared
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 stat am true.
Permit No .._... l .f.
Disapproved
(Signed)
Date 111
Date
Read, Sworn to and Subscribed before me.
Notary Public, State of Florida
Building Inspector My Commission Expires
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 approval
the I'lanniog 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 anti /or workmanship.
to me well known,
Date
has hero obtained limn
r
STATE OF FLORIDA
DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES
ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION AND INSTALLATION PERMIT
Authority: Chapter 381, FS
Chapter 10D -6, FAC
Applicant Permit Number
PART I - SYSTEM CONSTRUCTION SPECIFICATIONS AND CONSTRUCTION APPROVAL
Treatment Tank
Septic tank or Grease
aerobic unit gallons interceptor gallons
Septic tank or
aerobic unit gallons Dosing tank gallons
Graywater
tank gallons
Laundry
waste tank gallons
Other Requirements:
(f) Other:
HRS -H Form 4018. Feb 85 (Obsoletes previous editions which may not be used)
(Stock Nimber,5744 -001- 4016 -0)
Minimum Draintrench OR Minimum Absorption
Size Bed Size
Square Feet % Square Feet
Square Feet Square Feet
Square Feet Square Feet
Square Feet Square Feet
(a) Installation must be in accord with requirements of chapter 10D -6, FAC.
(b) A system construction permit is valid for a period of one calendar year from date of issue.
(c) Final installation inspection and approval is required before the system is covered.
(d) Invert of stub -out for to be " benchmark.
Invert of stub -out for to be benchmark.
Invert of stub -out for to be benchmark.
Invert of stub -out for to be benchmark.
(e) Fill quality and quantity:
• - -• ,r, •
System design and specifications by: Title -
Construction authorized by: _ Date
County Public Health Unit
Note: Completed copies of this form will be provided to the applicant, installer and the building department.
AUDIT CONTROL NO
Page 1 of 2
Date of Application
STATE OF FLORIDA
DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES
APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PERMIT
/ .
Name of Owner Telephone Number
Mailing Address of Owner
This Application is for: New System '
Type of
Residential
AUDIT CONTROL NO
No. Bedrooms
(each dwelling unit)
HRS-H Form 4015, Feb 85 (Obsoletes previous editions which may not be used)
(Stock Number: 5744-001-4015-1)
Authority: Chapter 381, FS
Chapter 10D-6, FAC
PART I APPLICATION
•
Owner's Agent Builder 7 •.
Agent's Mailing Address Telephone No
--• • /
„ . ;
Property Street Address "
Lot No. Block No. ' Subdivision Date Subdivided
NOTE: IF NOT IN A SUBDIVISION ATTACH A METES AND BOUNDS DESCRIPTION
Type of Sewage Flow Sewage Flow
Establishment (Gallons per day) Based On
..'
TOTAL FLOW =
Permit Application Number
/
Repair Existing System
Heated or Cooled Area No. Dwelling Sewage Flow
(each dwelling unit) Units (Gallons per day)
r*7/1
ft2
ft2
/ - •
Exact Directions to Property
Applicant's Signature
•
Page 1 of 3
COLOR
TEXTURE
DEPTH
- /
0 " to
"
" to "
II t0
"
" to
/I
" to 11
" to
"
I tO lI
II to .
c. . II
. • f
" tO
11
,COLOR
TEXTURE
DEPTH
0" to_"
" to "
" to "
lI to I '
" to 11
I tO lI
STATE OF FLORIDA
DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES
APPLICA' EON FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PERMIT
Applicant, ` ' �r�_ � � � ( "° Permit Application Number
Lot size appears to be as indicated on site plan: Yes
7. Is lot subject to frequent flooding? Yes
SOIL PROFILE - SAMPLE SITE 1
Water table at time of evaluation
inches below /above existing grade
Type water table:
Perched Apparent
Are vegetative species indicative
of high water table? Yes No
Date of Site Evaluation
5 -1 Fora 4015, Feb 85 (Obsoletes previous editions which may not be used)
Numbar. 5744-003-4015-1)
PART III - SITE EVALUATION INFORMATION
USDA Soil Series Name (if Known)
No
2. Anticipated sewage flow from Part I GPD
3. Benchmark location
4. Existing elevation (at time of site evaluation) of the proposed system site in relation to the benchmark
is inches above /below the benchmark '
5. Proposed system distance to: Surface water "feet
wells , feet feet feet; Community public wells
Other public wells feet feet; Non - potable wells
6. Unobstructed area available for system installations- ft
If subject to a 10 year flood indicate: (a) the 10 year flood elevation in the area
(b) property elevation at proposed system location ` feet MSL.
/:;e _e 7 .
USDA Soil texture classification on which drainfield size should be based
Authorized sewage flow GPD
feet feet; Private potable
feet feet;
feet feet;
ft ft
No , 10 year flood? Yes No
feet MSL
OIL PROFILE - SAMPLE SITE 2
USDA Soil Series Name (if Known)
•
Estimated wet season water table
below /above existing grade
inches
Is mottling found in the soil? Yes No
At what depth? Inches Inches
For property with contiguous ditches:
Depth of ditches >', 'inches
Depth of water in ditches inches
inches
inches
Other findings
Evaluator's Signature
(Include seal if performed by P.E.)
Page 3 of 2
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Date S 2,3 e 4 Job Address 2YE NE 9 i STre T Tax Folio
Legal Description /075 / 0)/1 0 2 — 2 /06e 3 Historically Designated: Yes No
Owner/ Lessee / Tenant / g P \.. l G 11 f 9 /L /t f Master Permit # 3'' 3
Owner's Address v2 98 N e^ ft S f►r r Phone 757 0 6. 1r
Contracting Co. tSS I y P C,, Address 'boo 1 E / (/ S I
Qualifier D / - ' / C L t S S i 5 SS# Phone c/ f ' 000
State # CPC 0( z So! Municipal # Competency # Ins. Co. ii gl/a w n
Architect/Engineer En # # 00 4 1 a /� #1 £nS t /lee,/ Address 5 Awe,/ //, ,Q d
Bonding Company J / Address
Mortgagor Address
Permit Type (circle one ) ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIPTION Ae(Ai ' Mac , /? 5 7b0 dA deck_ V6/ 0K
1 s i:») d
Square Ft. Estimated Cost (value) -A 17,000
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 -name . . tractor/C . . e work stated.
'' � SaiL �)/f
Signature/f owner and/or Condo esident
ary as to and/or Condo President
My Commission Expires:
l'>S: PERMIT RADON
as to Conlr: • or or Owner - Builder
My Commission Expires:
C.C.F. 6 'O NOTARY
l�38_ S
TOTAL DUE
APPROVED: f 1Y4 S / - y / 6
Zoning Building / Electrical
Mechanical Plumbing Engineering
NOTICE OF COMMENCEMENT
A RECORDED COP( MUST BE POSTED ON THE JOB SITE AT TIME OF FIRST INSPECTION
PERMIT NO. TAX FOLIO NO.
STATE OF FLORIDA:
COUNTY OF DADE:
THE UNDERSIGNED hereby gives notice that improvements will be made to certain real property, and in accordance with
Chapter 713, Florida Statutes, the following information is provided in this Notice of Commencement.
1. Legal description of property and street address:. 0198 N( 91 s/pt•eT
2. Description of improvement: POOL 0?4 pa — tic) 9✓e r K
3. Owner(s) name and address: e P/d✓ /.J #v'? t- eV
?9• me" 1/ sr Mtet•M, skor -s
Interest in property: it/ / 14-
Name and address of fee simple titleholder: A% /IQ
4. Contractor's name and address:
5. Surety:(Payment bond required by owner from contractor, if any)
Name and address: JL/ /4
Amount of bond $ /v /b9
41/4-
Al 4
6. Lender's name and address:
7. Persons within the State of Florida designated by Owner upon whom notices or other documents may be served as provided
by Section 713.13(1)(a)7., Florida Statutes,
Name and address:
different date is specified)
Signature of Owner ,[;, ��
Print Owners Name / ' ' I+ ' `
Sworn to and subscribed before me this
Notary Public
Print Notary's Na
My Commissio
ESSi 404.1 _ .ci ,
/Boo NE /.r/ sr j 'UM 1 33/6
STATE OF FLORIDA, COUNTY OF DADE
1 HERESY CERHIFV Mal this is a • copy of As
0 r %led in this office on
• • A, D. 19
W r r!' h •nd and Ofllclol Seal.
fin . Ve Ii!' IN ERK, of Circuit ond County Cootie
kJ) 0,
?go ," S 48 eee
8. In addition to himself, Owner designates the following person(s) to receive a copy of the Lienor's Notice as provided in
Section 713.13(1)(b), Florida Statutes.
Name and address:
A/p4
9. Expiration date of this Notice of Commencement: (the expiration date is 1 year from the date of recording unless a
day of /HA( 199,4 .
G
4'g - •
NOTARY PUBLIC, STATE OF FLORIDA
1
467719
xpires.
of
9 58470318 1995 NOV 16 09:58
Prepared by: IW O
/f300 /4" /11 cT
Address: Nf1 j /4/
_3.3/L Z
12301.52 2183
l=-