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1021 NE 93 St (8)PERMIT APPLICATION FOR MIAMI SHORES VILLAGE Date / 6 Job Address / 0.2 / A/ E- 7 3 S t * Tax Folio ) 3 c ? tic 0) 5 o n T v Legal Description B P l y PIl Pr e, P k fgt, mpia., Historically Designated: Yes No Owner/Lessee / Tenant 1 n.J,k) VI 4 - Master Permit # 4 3 as Owner's Address /0 2/ N t , q3 r Phone - -or-' 7 5 7- 0 3 99 a. Contracting Co. gr. C t I 94_ ,Picc,aJ 7,71G Address 7q'/ 32 ,J G- ' 2 0L,t a Qualifier . ,/41J ' £nr laiki SS# Phone 305- 6$7-7A ry State # M unicipal # Competency # Ins. Co. Architect/Engineer Address Bonding Company Address Mortgagor Address Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN WORK DESCRIPTION r Q f C(� c /0( • Square Ft. 2Y0 Estimated Cost (value) I t/ fm 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 OF 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. O AVIT: I certify at all the foregoing m ormation is accurate and that all work will be done in compliance with all applicable laws regulating con truct`on and zoning. Furthenno , I authorize the : bove =named contractor to do the work stated. Signature of owner and/or Condo Presrden CSl • -26 -0/ Notary as to Owner and/or Condo President Date My Commission Expires: 4 5 NGELA M BECKER COMPASSION NUMBER a CC786697 F�O MY NOV. 200 tary as Contrac : r, or My Commission Expires: FEES: PERMIT RADON C.C.F. ' I a 0 NOTARY -S.0 () BOND O Q .VD APPROVED: Zoning Building Mechanical Plumbing Electrical Structural Engineer TOTAL DUE Date Date C. y APPLICANT: PROPERTY ADDRESS: LOT: T A N K D R A I N F I E L D 0 T H E R STRUCTION PERMIT FOR: ] New System Repair v.)] ( `L9 I- - BLOCK: SPECIFICATIONS BY: APPROVED BY: DATE ISSUED: 4P a O) DI STATE OF FLORIDA DEPARTMENT OF HEALTH ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM CONSTRUCTION PERMIT ■ Existing Systez» l j L '� e� J lding Tank Abandonment PROPERTY ID #: 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 THE PERMIT APPLICATION. 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 ANDLSPECIFICATIONS [ /00 ] GALLONS / GPD(SEPTIC TANKJ,EROBIC UN ] GALLONS / GPD ] GALLONS GREASE INTERCEPTOR CAPACITY ] GALLONS DOSING TANK CAPACITY [ SQUARE FEET PRIMARY DRAINFIELD SYSTEM FILL REQUIRED: [ 0 1 1 )] INCHES EXCAVATION REQUIRED: [ SUBDIVISION: c. ✓G ercn:. 'J /ice 6L [ ] SQUARE FEET SYSTEM / / TYPE SYSTEM: ['] STANARD [ q FILLED [ 6 r / MOUND I k, CONFIGURATION: (3] TRENCH [ BED [. 0.--. l 1 / LOCATION OF BENCHMARK: HiJiziti P10001, Z3 r e"' ELEVATION OF PROPOSED SYSTEM SITE [ [INC S/ T [ABOVE/ ELO ] BENCHMARK /REFERENCE POINT BOTTOM OF DRAINFIELD TO BE La ? ] [QNC /FT] [ABOVE /BELOW] BENCHMARK /REFERENCE POINT DH 4016, 12/99 (Page 1) (Prp, May,IBe�,Used) I Healtt Department !" pt. 2: Applicant' " -= pt. 3: Installer /Contractor pt. 4: Building Department [`.Jf Temporary TITLE: , ' .T"� �� . PERMIT NO. O/ R„ _ ®,g` 0/ DATE PAID: d _ p/ - © / FEE PAID: 7, , a j RECEIPT # :.5 0 f o O/ /3 sZ -0-7 7 / ©1' / [ Innovative I / [SECTION, TOWNSHIP, RANGE, PARCEL NUMBER] [OR TAX ID NUMBER] IT CAPACITY MULTI- CHAMBERED /IN- SERIES [ ] CAPACITY MULTI- CHAMBERED /IN- SERIES [ ] [MAXIMUM CAPACITY SINGLE TANK: 1250 GALLONS] ]GALLONS [ ] DOSES PER 24 HRS # PUMPS [ ] 5L C4 v ] INCHES OF LOAMY COAfS P n.' Li.P 6U1 GI= fib�.;:'; bUIim i EEN(,,HMhf3r , E3Lrcir 1 Ti-li3 PERV.!T !:, A;OT INVZITi ELRVP1 �-, TITLE: cim EXPIRATION DATE: 3 7 Page 1 INSTRUCTIONS: 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) SYSTEM DESIGN AND SPECIFICATIONS: 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 issued. _I_Ji LI LJ t_I - �' ur 1_I I 1_, _J�� J i I - - U CJ L - 1 �.1J I _ i I 4 Lo L _ _ I • J Cl i I I o _ C ! , 1 _ L in i C _ I _" 1 H1_i ! '3 U I_I�_ Ii I I I -1,-- rim � i - i�i t� (� ! i - i ": LCF .1 u_, - 1 1 1 I i 1 r 1 1_' J I I_I I I 1 1 1_i_ _J I` J.�1_'_ �a l 1 !- I I ! 1J j L1 r- I D J (l II 1 - I (! _ ! _ 1 0 Il r { I I - � U__ , �' J J - -- 1 [ 1 ! 11 I 11 1 I -T rl 1 _I! : I. T) r `t r I_ _ LI - I_ I_I I 1_I I J 1 I I I I- I '_I_1_1_ _I I - - 1_1_!_1__1_1_ 1 II1 1 �1 I{ I I I I I _! 1 I !_1 1_ I I_1 _I_ ( II II 1 11_1 1 __ 1 _ 1 I [ - 1 - 1 --- . -- 1 - 1 --,-- n -- 1 - 1 . 71 -- I _ _ , I 1 - 1 I I I I _ : I I I I �r ' 1 1 - -- LI i I r i! 1 1 I�f .,�,, ;fi I 1 I I 'l l 1 -_J I -1- 1 1 _I 1i_I�, Il 1CII1JI L I I IJ I_I 1 I! I I I_1 I 1 1, C I I L 1_ !1 I v I 11 1 - I $1�/ _ti I I I JLII 11 0 C! r -1 Ell i'I 1 '_11 � _ _ _ I1'i_1 -Ci 1 CI - - 1 ( I - ! I_I_I I !_I i I l I_ _ X1 i 1 1 - I I 1__1_1 _ I! 11i I J 1 i_L 1,_ r17 1-1JcO t C _f - I i I - _ 1_1_1_1 i- 1 -� 1 1 1 J !- (^- l -'-1 J I Notes' 1 Site Plan Submitted by:� Plan Approved By STATE OF FLORIDA DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES APPLICATION FOR ONSITE SEWAGE DISPOSAL SYMTEf1 tNSTRUCTiON PERMIT • Permit Application Number Or/ LIJ I 110 1 _ _I J I i - 1 11 -J __ } •• /•• - J0 I 1 11•Y•r• • ! - 1 I I 1 - _ 'Hi i_ 1 1 1 I "1 I I - 1 J h1 _ i_i i _JJ_i_� 1 i , I t _ I -i I I I , I I I - I I 1 - 1 - ,1l 1 I I_( i • 11 1 1' 1_ ( _ ! t i -L 1 ` r s _ J J I I 1 1 11 1 I IJ I • 1 11111 1 1 1 I !_I 1 LI--I 1-1 1 L I -- - - _ 0 E I If ti__( I > f _ ! t I'I HI 1 I I I _J_ �I I C IJ 1- IJ ! 1 1 I _ I FIRS-H Form 4015, Feb 85 (Obsoletes previous editions which may not be used) (Stock Number: 5744- 002 - 4015 -6) PART II - SITE PLAN I I i I i 1 - II l 1 1 11 __ 1 I 11 k ! I _ ( _ L l 1 1 _(1I ! I 1 L. • I! _l._) 1 _ _a 1 _. _I L _ I I 1 I I I !J L I 1I ! 1 ' i 1 , I- 1 1 1 1 1 1 i II i I I II I i i II I III 11 II 1 1 II - 1 1 I_ I 1_ I _I 1 1 1 '1 1 1 i 1 J ' II_ 1 1 : 1 1 r 1111 1 ' I (J. 1 1 ill I! E I 1111111 I I 1 I 1 I_I J 1 I 11 1 1 1 11 .! I - J l I 1_1 !_ 1 I 1 1_4_1 1-. _I_ III II J 1 1 C i11 1 I'', 1 I 1 I 11E111E11 1 Ili 1, 1 11 ; I 1 11 I 1 i J J 1 1 1 1 1 1 I i I I I i 1111 lli i iil 1 1 1 1 1 I I . 1 I - _J_ - 1 I I h 1 I ' I ! - I ! 11 I_" , I_ 1 " _ 1 I_ -I I I L' _ i �J 1_ ∎f'} I LL I ! J ..._c_-,:-.___1_, I I' I! -! _I - 1 i . J J _ I'I I 111. 1 _ 11 1 _. 1 1 1 1 ! - -- 1 1 -. LI__1_I_I q . __I_I _DJ_I_ 1 I__ _ 1_1 1 1, 1 1 1 - 1r 1 1 1 1 1 1 1 i I! 11 1 it 11I 'I 1 lI i1 I I !I 11' I' I I_1 I ! Ci - 1 -� ALL CHANGES M - - - - -- L_ -1 - 1 i 1 l- I i 1 , I I_ ! I ' ! ! I - 1� J l_ I1 1i.I 1 ,. 11. J , 1 I C4-10 jp /lam SIGNATURE 1 II,I I _ ' _ 11 1 1__11 I � I X71 ', 1 ST BE APPROVE 1 �C°1_ _Ilii o Not Approved !_� ' co - -- [A i _ � J ! i _ _ 1 I Cl C ' D LTI 1 Cl� I I I I_I • I_I _f� _J__l 1_ 1_'- 1I -- JI - I _ I 1 1_ 11 1 ' 1 __ _ 1 _. I I _ € H ' i"'1 1 1 iJ 11_ _I_1_I_ - II !I !I 1 1 1 1 1,111 111E! 1 1 1 1 11 �� 11 1 1 I 1 I Li I ( 1 u I ( _l .I _ i I 1 -1 11 CJ" 1 Ll 1 I! I 11 L I! 1 - _II I J_! ! I'I I I I 1 1111(,, I it 1 I �®i ® y I �cs ®`» " G� s / � f � ; ;- o 1( . f f ` u h f ) .. O " i 111 I lI 1_ ! 11 1 1_ 1 _1_1 -e? 1 _ ; I I_ I l i I I I i 1 1' ___ 1_ I I 1 1 I ! I 1 I I 1 ( ( !^I_ _1 -1 -1-1-1-1" I 1 ! 1 Il 1 I 1 1 111 II E 11, 1 I 1 _. 1_1_1__ 1 IJ IJ 11 - - 1 1 ! C 1 1 I 1i I I ! I_ 111. TITLE Date az) ,e/ / / County Public Unit BY THE COUNTY PUBLIC HEALTH UNIT Page 2 of 3 Permit No Q7 9�j Stu Septic Tank.._ -Type of Tangy Feet o f Drain T i l e 200 sq. f t . Dist_ Feet of Tank or Drain Field from Well.. -_ --._ Nature of Water Supply: City —Wells Size of Soakage Pit Amount of Permit 8 25.00 MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT (Signed)_ (Sipped) Date..._ d 42...- . 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. Owners Name and Address 3 d r 1 q 11 P 7 No 1021 N. E . Street._ 93rd St Registered Architect and /or Engineer £ loy Z LL l a_ ,v. bors Natn North Da d e S e p t i c .. 1 Lbdd t_1 l �J Bbek Subdivision. 4 - Street and Number where work is to be performed —No 10 21 N N. E E . 9 3rd S t Street__ _..___._...__.._._ State work to be performed and purpose of building (By Floors ) __._._ New Building.._.._ _.•- •-- ....._ -•_ -. Remodeling Addition. Repairs..._XXX No. of Stories ........... 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 lids com- plied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors employed by him in the wor`Ir to be performed under this permit; and will post or cause to be posted' for inspection on the site of the work notice u notices as err required by the Act. The undersigned agrees to employ only such sub - contractors, on work to be permit, as are licensed by Miami Shores Village. STATE OF FLORIDA, COUNTY OF DADE. Before me, the undersigned authority, • 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 dgn the same, and that all facts therein by him stated are true. My Commission Expires Notary Public, State of Florida Master Plumber. NOTE: A re- inspection fee of 81.00 will be made wbin smolt se.ispeotfoa Y soade•aeoaseary by improper notice far 6rpection, or faulty materials and /or wod®anahup. CLOSETS BATH TU•• SHOWER; LAVA- TORIES 161"11 SLOP SINKS LAUNDRY Tuns U RINAL; CATCH BASIN FLOOR DRAIN DRINKING FOUNT'NS TOTAL FIXTURES CONTR. LIST CHECK SEPTIC TANK SEWER CONN. DRAIN FIELD PIT G TRAP SOLAR HEATER DEEP WELL 8 . S M SWIMrG POOL Comm. LIST .-- J CHECK Permit No Q7 9�j Stu Septic Tank.._ -Type of Tangy Feet o f Drain T i l e 200 sq. f t . Dist_ Feet of Tank or Drain Field from Well.. -_ --._ Nature of Water Supply: City —Wells Size of Soakage Pit Amount of Permit 8 25.00 MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT (Signed)_ (Sipped) Date..._ d 42...- . 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. Owners Name and Address 3 d r 1 q 11 P 7 No 1021 N. E . Street._ 93rd St Registered Architect and /or Engineer £ loy Z LL l a_ ,v. bors Natn North Da d e S e p t i c .. 1 Lbdd t_1 l �J Bbek Subdivision. 4 - Street and Number where work is to be performed —No 10 21 N N. E E . 9 3rd S t Street__ _..___._...__.._._ State work to be performed and purpose of building (By Floors ) __._._ New Building.._.._ _.•- •-- ....._ -•_ -. Remodeling Addition. Repairs..._XXX No. of Stories ........... 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 lids com- plied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors employed by him in the wor`Ir to be performed under this permit; and will post or cause to be posted' for inspection on the site of the work notice u notices as err required by the Act. The undersigned agrees to employ only such sub - contractors, on work to be permit, as are licensed by Miami Shores Village. STATE OF FLORIDA, COUNTY OF DADE. Before me, the undersigned authority, • 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 dgn the same, and that all facts therein by him stated are true. My Commission Expires Notary Public, State of Florida Master Plumber. NOTE: A re- inspection fee of 81.00 will be made wbin smolt se.ispeotfoa Y soade•aeoaseary by improper notice far 6rpection, or faulty materials and /or wod®anahup.