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PLUMBING PERMIT;UILDING - LECTRICAL 'LUMBING ;OOFING ? wner of �ufiding ` Irchitect ontractor 3r Builder .egal )escription address of wilding Lot MIAMI SHORES VILLAGE. FLORIDA ❑ PERMIT N° 3855 0 Work to be performed under this Permit Bl. DATE Contractor's License No. 195' Subdi- vision Value of Amount of Project $ II 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 application ierefor in strict compliance with all ordinances pertaining thereto and with the understanding that the work will be performed in compliance with any plans, '.rawings, statements or specifications that may have been submitted to and approved by the proper municipal authorities. This Permit may be revoked at any ime 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 !ranted is the understanding that the contractor or builder named above assumes the responsibility for a thorough knowledge of the ordinances and regulations , ertaining to the work covered hereby whether shown on the plans or drawings or in the statements or specifications and that he assumes responsibility for work one by his agents, servants or employees. {✓ Signed - 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 3ertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In ac- opting this permit I assume responsibility for all work done by either, myself, my agent, servant or employee. CONTRACTOR OR BUILDER BY AUTHORITY e Pennit No.- - -- - =-- --- Size Septic Tank_._ - .d_a Feet of Drain Tile_ Nature of Water Supp y: Ci' —W Amount of Permit $_. �. MIAMI SHORES VIL AG PLUMBING INSPECTION DEPARTMEN APPLICATION FOR PLUMBING " ..•.'!`i (Signed) _ (Signed). Application is hereby made for the approval of the detailed statement of . plans and specifications herewith submitted for the building or other structure herein described. This application is made in compliance and confora..ty 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 oP no. A copy of approved plans and specifications must be kept at building during progress of work. Owner's Name and Address ........... Registered Archa and /or Engineer___ Employing Plumber's Name__ A- No.___ Street_ Street.. Location and Legal Description Lot__._.. ___________________._______ _ . _ Block Q A' - Subdivision Street and Number where work is to be performed— No. __� 6 ° "2" J ' - ' • Street State work to be performed and purpose of building (By Floors)_ New Building ✓ Remodeling____ ___ Addition Repairs No. of Stories. Type of Tank Capacity Gals. _`_bist. Feet of Tank or Drain Field from Well Size of Soakage Pit Plumbing Inspector. The undersigned applicant for this building permit does hereby certify that he understands and accepts hisOiligations 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 tie Act. The undersigned agrees to employ only such sub- contractors, on k to be performed und this permit, as are licensed by Miami Shores Village. Plumber. STATE OF FLORIDA, 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 hire stated are true. My Commission Expires Notary Public, State of Florida 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 TUB6 SHOWERS LAVA. TORIES SINKS SLOP SINKS LAUNDRY Tinos T S URINALS URI CATCH BASIN FLOOR DRAIN DRINKING FOUNT' NS 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. LIoT CHECK Pennit No.- - -- - =-- --- Size Septic Tank_._ - .d_a Feet of Drain Tile_ Nature of Water Supp y: Ci' —W Amount of Permit $_. �. MIAMI SHORES VIL AG PLUMBING INSPECTION DEPARTMEN APPLICATION FOR PLUMBING " ..•.'!`i (Signed) _ (Signed). Application is hereby made for the approval of the detailed statement of . plans and specifications herewith submitted for the building or other structure herein described. This application is made in compliance and confora..ty 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 oP no. A copy of approved plans and specifications must be kept at building during progress of work. Owner's Name and Address ........... Registered Archa and /or Engineer___ Employing Plumber's Name__ A- No.___ Street_ Street.. Location and Legal Description Lot__._.. ___________________._______ _ . _ Block Q A' - Subdivision Street and Number where work is to be performed— No. __� 6 ° "2" J ' - ' • Street State work to be performed and purpose of building (By Floors)_ New Building ✓ Remodeling____ ___ Addition Repairs No. of Stories. Type of Tank Capacity Gals. _`_bist. Feet of Tank or Drain Field from Well Size of Soakage Pit Plumbing Inspector. The undersigned applicant for this building permit does hereby certify that he understands and accepts hisOiligations 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 tie Act. The undersigned agrees to employ only such sub- contractors, on k to be performed und this permit, as are licensed by Miami Shores Village. Plumber. STATE OF FLORIDA, 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 hire stated are true. My Commission Expires Notary Public, State of Florida 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. PERMIT APPLICATION FOR MUNICIPALITIES OF DADE COUNTY (OWNE,j2 TO RETAIN COPY) Job Address /1O0 P g'7,-/>---> Tax Folio ' / ,A,S 1 L� , X06 4 � b Legal Description 9 / ` ,�yPt - e Master Pe it �G��S'�`. Owner / Lessee / Tenant `t W Kra r `J 1 O 1) /1' S q ./ i . phone 7 5- 6 /' - 06,0 5 ° "Q I') p4)Y /(J Address 70 /a t/ e % _5)i sS# phone Seca 7 i 0 I State# 9 Competency# OD0910 ! (‘pP a i Ins. Co. NI 6. ‹P f Citlutii-t d.-.., A /V4 dd Owner's Address Contracting Co. Qualifier ._�OWe vZjr - SOAff. Architect /Engineer Bonding Company Mortgagor Address Permit Type (circle one): BUILDING ELECTRICAL "PLUMBING MECHANICAL PAVING FENCE SIGN WORK DESCRIPTION 300 Square Ft. 300 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. 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 regul: g construction and zoning. Furthermore I authorize the ab•ve -named contractor to do .fie stated. Notary as to Owner and /or Condo President My Commi „ ExpitletiY :u9 s ,. . * * * MY CQy F6ia:;:::. *: * . .. .. " ,1( moNDeri PERMIT FEE: APPROVED: ba Zoning ndo President -n Fire Building Address Address � . ) /), / f .007 / /r / ) , Estimated Cost Signature of C• tractor or Owner- Builder Date : / G I f / Notary as to Contractor or Owner - Builder My Commission Exp i s * Other P Electrical 14� Mechanical Plumbing <1aLQ �� 0 gineering Authority: Chapter 381, FS Chapter 10D -6, FAC Date of Application Permit Application Number 94- 3 Name of Owner ()■)/) Mailing Address of Owner J C DO /1/F_ 90) S/, Owner's Agent < /AI 6 J Agent's Mailing Address goo Al hJ Sl Property Street Address / 00 NE 9 t77 sf Lot No. Block No Subdivision Date Subdivided NOTE: IF NOT IN A SUBDIVISION ATTACH A METES AND BOUNDS DESCRIPTION This Application is for: New System Repair Existing System STATE OF FLORIDA • DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PERMIT Type of Establishment AUDIT CONTROL / CON TROL NO N° 239519 4 HRS -H Form 4015, Feb 85 (Obsoletes previous editions which may not be used) (Stock Number. 5744.001- 4015 -1) PART I - APPLICATION TOTAL FLOW = Telephone Number Builder Telephone No Sewage Flow Sewage Flow (Gallons per day) Based On Type of No. Bedrooms Heated or Cooled Area No. Dwelling Sewage Flow Residential (each dwelling unit) (each dwelling unit) Units (Gallons per day) ?ig 3 00 ft2 ft Applicant's Signature Exact Directions to Property Page 1 of 3 Date Qf Job Address /, (0 'J 4/7-. / n,-° .S % Tax Folio Legal Description � `� S Lessee / Tenant 21q. �� � . l -P Master Permit # �? Owner's Address / 04F, 90 /� ® O e S Phone / ,f Contracting Co. e /}d2� �S 5 /6 �J��l// Address ! ©80/i? '�{: & / S, 1!/K=/� •�1 , Qualifier C,4 e WA'J - Phone s'oC Co -/ if State # Municipal # Competency # b - 47Ins.Co. Architect /Engineer Address Bonding Company Address Mortgagor Address Permit Type(circle one): BUILDING ELECTRICAL GUMBI MECHANICAL ROOFING PAVING FENCE SIGN WORK DESCRIPTION _TA) s 9.& h ..3 00 S a f=/ eh # Square Ft. Estimated Cost(value) 1/30 2 d 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. 42,4j(!---e4 S gnature of owner and /or Condo President Dat _� Not My PERMIT APPLICATION FOR MIAMI SHORES VILLAGE p ,-o President epono YWAY SEAL 4c OOMiL :SSION itiZ.i t.6ED 'ss" ( CC401201 ** NIY*OOk?PAIS*iON EE XP. *� * * * (<' OF AjG. 97 'MO FEES: PERMIT �`a ' RADON C.C.F. APPROVED: Fire Zoning Buildin Mechanical Plumbin Signature of Contra �' or Owner- Builder Dat otaryas to _Contractor or O wner- Builder M . P(Ratactliocridixt34KAPAAv SEAL O <. SANDRA 1.1 liON'TEL 77 Q coMa lss!asv Num m ; .oft A 3�?J " .EXP. " k * ** TOTAL DUE Other Electrical Engineering 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 FOR: [ New System [,'' System 1 Holding Tank [ /] Temporary /Experimental [ ] Repair [ f Abandonment [ 9)'"Other(Specify) APPLICANT: PROPERTY STREET ADDRESS: LOT: PROPERTY ID #: 0 T H E R BLOCK: SUBDIVISION: 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 / GPD] 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: [ ] STANDARD [ ] FILLED [ ] MOUND [ ] I CONFIGURATION: [ ] TRENCH [ ']'BED [ N F LOCATION OF BENCHMARK: I ELEVATION OF PROPOSED SYSTEM SITE - E BOTTOM OF DRAINFIELD TO BE [ L D FILL REQUIRED: [ ] INCHES SPECIFICATIONS BY: APPROVED BY: DATE ISSUED: AGENT: [SECTION /TOWNSHIP /RANGE /PARCEL NUMBER] [OR TAX ID NUMBER] ] [INCHES /FT] [ABOVE /BELOW] BENCHMARK /REFERENCE POINT ] [INCHES /FT] [ABOVE /BELOW] BENCHMARK /REFERENCE POINT EXCAVATION REQUIRED: [ ] INCHES 54 7 TITLE: TITLE: HRS -H Form 4016, Mar 92 (Obsoletes previous editions which may not be used) (Stock Number: 5744- 001 - 4016 -0) PERMIT # DATE PAID FEE PAID $ RECEIPT # EXPIRATION DATE: CPHU Page 1 of 2 INSTRUCTIONS: ?Elm IT 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, BLOC:(, SUBDIVISION or PROPERTY ID //: 27 character id number for property. (CPHU may require property appraiser D (i or section /towns : /range /pereel number) SYSTEM DESIGN AND SPECIFICATIONS: TANK: iVlinimum 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 provir.oa. SPECIFICATIONS BY: Name of individual providing specifications. If designed by a registered engineer must he scaled. APPROVED BY: County Public Health Unit (CPHU) personnel reviewing end 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 veki 90 days from the date issued. LOT: PROPERTY ID #: STATE OF FLORIDA DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES ONSITE SEWAGE DISPOSAL SYSTEM SITE EVALUATION AND SYSTEM SPECIFICATIONS . �` %%aal �_, �fj:�P ,;iii `r �j � i d��'� BLOCK: SUBDIVISION: 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 PLAN: (,c] YES [ ] NO NE ,3 6 0 GALLONS PER DAY e_1 ) GALLONS PER DAY t9 SQFT UNOBSTRUCTED AREA REQUIRED: / 7- TOTAL ESTIMATED SEWAGE FLOW: AUTHORIZED SEWAGE FLOW: UNOBSTRUCTED AREA AVAILABLE: BENCHMARK /REFERENCE POINT LOCATION: / 1 7//7 / / 6 - V y d ' i L -&0 y ELEVATION OF PROPOSED SYSTEM SITE IS u , /FT] [ABOVE / >;L0W1 BENCHMARK)REFERENCE POINT THE MINIMUM SETBACK/WHICH CAN BE MAINTAINED FROM THE SURFACE WATER: t/ FT DITCHES /S ALES: WELLS: PUBLIC: FT LIMITED USE: l' / FT FT PROPERTY LINES: BUILDING FOUNDATIONS: SOIL PROFILE INFORMATION SITE 1 SITE SUBJECT TO FREQUENT FLOODING: [ ] YES [( NO 10 YEAR FLOOD ELEVATION FOR SITE: FT MSL /NGVD SITE ELEVATION: FT MSL /NGVD Munsell # /9olor USDA SOIL SERIES: Texture Depth t,2 "to te to to to to to to to to OBSERVED WATER TABLE: � INCHES [ABOVE / ESTIMATED WET SEASON WATER TABLE ELEVATION:,. HIGH WATER TABLE VEGETATION: [ ] YES [4 NO SOIL TEXTURE /LOADING RATE FOR SYSTEM SIZING: DRAINFIELD CONFIGURATION: [ ] TRENCH REMARKS /ADDITIONAL CRITERIA: SITE EVALUATED BY: HRS-H Form 4015, Mar 92 (Obsoletes previous editions which may not be used) (Stock Number: 5744- 003 - 4015 -1) AGENT: (),,/4/ I< PERMIT ,#` (Section /Township /Range /Parcel No. or Tax ID Number) PR POSED SYSTEM TO THE FOLLOWING FEATURES:, -' A FT ,,1,1 RMALLY WET? [ ] YES [/1'240 PRIVATE: _4 FT NON- POTABLE: i__ FT 0 FT POTABLE WATER LINES: / FT T USABLE AREA AVAILABLE: ��` ACRES [RESIDENCES -TABLE 1 / OTHER -TABLE 2] [1500 GPD /ACRE OR 2500 GPD /ACRE] SQFT 10 YEAR FLOODING? [ ] YES [,>]' NO SOIL PROFILE INFORMATION SITE 2 DATE: Munsell Texture Depth f USDA SOIL SERIES: to to to to to to to to ] EXISTING GRADE. TYP�E /,APPARENT] 1W7 INCHES [ ABOVE /(BEL9 ] EXISTING GRADE. MOTTLING: [ ] YES [4-NO DEPTH: INCHES So 4P („.;;; , DEPTH OF EXCAVATION: _. INCHES 0 BED [ ] OTHER (SPECIFY) Page 3 of 3 INSTRUCTIONS: P E.RM T 0: Permit tracking number assigned by CL U. APPL''CANU': Property owner'o full name. fv^c° iY"3: ?eepetgy owner'o legally authorized rep:.everitative. S"JBDEv7,S :ON: ,Lot, block, and subdivision for Fos. ^� =':'i ""• :j ,'1: 27 character number for property. (property :.a2A11. :.r 13 0 o: xc).cn /to J:_ .r, ;1li+f:.2 t Site COP :'ira t uunral.y wet drain f;:,., ditches rT!r: .. .1 Ci -.... C D: 7ai:::. :!ay 7. ^,L .0 fc: �.'VC. tk: 11 :' :7J .. _... �(.�. ` L..r. f:C". _.,.. .. cord the sea.: o. uno:J. ..ctcr. - _, ..., . ' _ • .. .••.... t!mcs as a_-gc as t;3c c__�.? etd absor; " !� _ "..., r.��. __ ' _ .;...,_' /5 __ ..,_ .. setbacks En En Chapter 10.D-6, PAC. Tae cont ra su: iLe i cord the lccation of the benchmark. 'f _.sin; ; .:�. w;yor'c :Je.-:. :�� ,'s record: the e :;'.:v: _'u::. .._csc..r. fee elevation_ of the proposed sy =.tem site in elctior. (o.'Jove or below) to the benchm eft. iU2INIMUM SETBACKS: Record minimum setbacks which can be meet to a!i listed features. Actuci . -, ;:: !3t bd taco :der: for non applicable features. Features on site plan or within 75 feet of the applicant lo, :. co arsacL red. itc iacatit of any public drinking well within 2C0 feet of the applicant'3 lot must also be verified. : INFORMATION: Record information on lot's subject to flooding. For lo1II subject to flooding record i0 year flood e:evation for cite and actual site elevation. SOIL PROFILE INFORMATION: Two soil profiles within the proposed absorption area to a minimum depth of 6 feet or ;,—e 3r,.1 are required. Soil identification will use USDA Soil Classification methodology (Monsell colors and USDA coil textures). 14efusalo must be clearly documented. Provide USDA soil series if available, record °UNK" if the series cannot be determined. WATER TABLE: Record the depth of the observed water table at the time of the evaluation. Mark "perched" or "apparent° 03 appropriate. Record the estimated wet season water table elevation based on site evaluation, USDA snit rnopo, and historical information. Indicate if there is high water table vegetation present. :ndicate if rnoziling in present and fepth. SOIL TEXTURE: Record soil texture Cr loading rate for system sizing. DEPTH OF EXCAVATION: If applicable record depth of excavation equiree.. accord "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 sea! all decu: tentation submitted. ELEVATION WORKSHEET ELEVATION OF BENCHMARK / REFERENCE DINT !IS: BENCHMARK SITE I SITE 2 SITE 3 [-t-] SHOT: H.I. H.I. HI H.I. [ -] SHOT [ -] SHOT [ -] SHOT APPLICATION FOR: [ ) New System [ ] Existing System [ ] Holding Tank [ ] Temporary /Experimental (W) Repair [ ] Abandonment [ ] Other(Specify) APPLICANT: �J S Z) / TELEPHONE: /i / AGENT: ��, / /�� /� / l / a MAILING ADDRESS: / ; ;? 0, / 0 1,/h /.. 1 , 3" , TO BE COMPLETED BY APPLICANT OR APPLICANT'S AUTHORIZED AGENT. ATTACH BUILDING PLAN AND TO -SCALE SITE PLAN SHOWING PERTINENT FEATURES REQUIRED BY CHAPTER 10D -6, FLORIDA ADMINISTRATIVE CODE. PROPERTY INFORMATION [IF LOT IS NOT IN A RECORDED SUBDIVISION, ATTACH LEGAL DESCRIPTION OR DEED] LOT: PROPERTY ID #: DIRECTIONS TO PROPERTY: STATE OF FLORIDA DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES ONSITE SEWAGE DISPOSAL SYSTEM APPLICATION FOR CONSTRUCTION PERMIT Authority: Chapter 381, FS & Chapter 10D -6, FAC BLOCK: SUBDIVISION PROPERTY SIZE: / ACRES [Sgft /43560] PROPERTY WATER SUPPLY: [ ] PRIVATE [ 4 PUBLIC PROPERTY STREET ADDRESS: BUILDING INFORMATION [^] RESIDENTIAL Unit Type of No. of No Establishment Bedrooms 1 2 3 4 r [ ] Garbage Grinders /Disposals [ ] Ultra -low Volume Flush Toilets APPLICANT'S SIGNATURE: DATE OF d 2 SUBDIVISION: [Section /Township /Range /Parcel No.] ZONING: / ot9 A/ r .5/7 / #( / HRS -H Form 4015, Mar 92 (Obsoletes previous editions which may not be used) (Stock Number: 5744 - 001 - 4015-1) [ ] COMMERCIAL PERMIT # / ? .d / ; ' DATE PAID /.i0/ . FEE PAID $ Jc,. RECEIPT # C�/ %/: (` i� a Building # Persons Business Activity Area Sgft Served For Commercial Only [ ] Spas /Hot Tubs [ ] Floor /Equipment Drains [ ] Other (Specify) DATE: /) / , ms s ' Page 1 of 3 INS RU flONS: APPL:CA2 iON ;r"O`2: Check type of permit, if °Other° specify type in blan %. APPLICANT: Property owner's full name. TEL`3Piiu`ONE: Telephone number for applicant or agent. AGENT: Property owner's legally authorizes representative. MA.'L :.NC ADDRESS: P.O. boa or street, city, state End zip code ernil!ng address for cppliccnt or agent. �0 f, I8 CCX, SJ3DF.VHSHON: Lot, block, and subdivision for lot (recorded o, unrecorded subdivision). tf lot is not in a recorder; subdivision, o copy of the !at legal description or deed must be attached. DATE OF S'U3:odvlSION: Official date of subdivision recorded in county plat boolta (_,-oath /city /yea:) or date lo. originally :- ;co::ded. E', oven lot into two or more parcels for the purpose of conveying ownership stall be considered c subdiv':s!c of the lot. 'KzW:PEir:7Y D(/: 77 character number for property. (CP; iU ray require pipes •, raprciser 2D !1 cr section✓toeva :'ip /::gage /pc:cel cumber. P_iOPEZ':'`! SP: Net usable area of prcaei y in ccre:a (squer -e fac'c c divided cy' 3,560 e uc: feet) cuc!uaive of : p^ved c -:c' :: -z: -s e ._r d secs: beds within public rights-of wny or ensementa and mtel.!sive; of r' a, !c!tec, normally wet d cl :- s c :icti : ;c, : acrahe;;, or other such bodies of water. Contiguous unpaved and noncornpacted rani, rights-of-way and cacorlentc wits rLo au eacts may be included in calculating lot area. WATER SUPPLY: Check private or public. PROPERTY ADDRESS: Street address for property. For lots without an assigned street address, indicate street or road and locale in county. DLRECT3ONS: Provide detailed instructions to lot or attach an area map showing lot location. 3UILDHNC !NFORNMAT!ON: Check residential or commercial. if ESTA3° ESHMENT: "_ist type of establishn'tent from Table HH, Chapter !OD-6, PAC. IEac:nptea: aing!e family, single snits mobilc hors, restcurcnt, doctor's office. NO. D` 00iV!S: Count all rooms designed primarily for sleeping and those areas enpected to routinely provide sleepi accommodations for occupants. . JL :)tNc AREA: Total square footage of enclosed habitable area of dwelling unit, cacluding garage, carport, exterior r " c shed, or ape_' c: fully screened patios or decks. Based on outside tneasuretrento for each atop+ of structure. 0 ?3RSONS: Number of persons residilg, using, or working in c:;tcbli:A ens. :?o: residential cstc !ia_tr._cnt, 2 ° :c_t,; per bedroom_ cr assumed. ?:JSENPSS AC':.'NI t f: For commercial applications only. List ,umber of employees, :sifts, and hours of operation_, or ctizc_ i :o_:rcl.a- .-:t. by Table i!, Chapter 1OD -6 FAC. :'7£' 711 :?S: Mark each listed fixture with number installed or °NA° if not applicable. SZ TAI URE: A': ":"A.-1\Z`rNTS: Signature of applicant or agent. Date application one day submitted to t h e O P H U with apart, rinse fee : :: A site plan_ ti zwn to scale, Lilowing boundaries with din .° D'e!'t Tae ..iic7 ""9 of :::cc , or JL'.: CC:i :'f ;:,, 1 . ;CD fI, :'?cC_ :i ;c 229. marts, onlitc : :wEgc f: system co<-!por.: n_^ cnr. 7c7,*; o`p'cp ^ ^y , ... c - rise:', , pl +'. r t obstructed rrecs, Err' curfcce ; °...... . afv .. qq, o ^ti ry •,...' c ;: ether pe :amen: Zac ttet: a. features Or criJ ant •J�'op ^y, :r , r"' O' /5 ae � . � ti �• ` -�` ubiic well within 200 .ecC of' lo:. -c- <,sue c(:;;, l: `1 ^0° plat. ( ^lee ^acs) :; cu +>z; ?L.__3 . p° .. .. . .......... ._ '?'1", ..... C:7".. (.... .�_ ..__ _.. -.. � ^ t co^'_ .,`c -.,... C'U.' .'fir of kf ^t Site Plan Submitted 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 Notes��. I (' / Fl 1 SIGNATURE TITLE Plan Approved Not Approved Date By County Public Unix 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) Page 2 of 2 BUILDING ELECTRICAL PLUMBING ROOFING ❑ ❑ DATE PERMIT N° 3864 Contractor's License No. Owner of Building �, 1 ,! Architect Contractor or Builder t. Legal Lot Description Address of �ui1ding ' ' MIAMI SHORES VILLAGE. FLORIDA 195_ Work to be performed under this Permit 1/ B1 Subdi- vision Value of Project $ Amount of 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 application 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 lime 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 anted is the understanding that the contractor or builder named above assumes the responsibility for a thorough knowledge of the ordinances and regulations 'ertaining to the work covered hereby whether shown on the plans or drawings or in the statements or specifications and that he assumes responsibility for work lone by his agents, servants or employees. Signed. 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 uertalning thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In ac- epting this permit I assume responsibility for all work done by either, myself, my agent, servant or employee. CONTRACTOR OR BUILDER BY AUTHORITY e4/ER¢ Permit No - �d Owner's Name and Address MIAMI SHORES VV. PLUMBING INSPECTION DEPARTMLi■F' APPLICATION FOR PLUMBING ' f "' Registered Architect and /or Engineer __ 4 Employing Plumber's Name _ _ _ �! � s' _�:_� — No Date 6- Application is hereby made for the approval of the detailed statement of t.4 plans and specifications herewith submitted for the building or other structure herein described. This application is made in compliance and cos" �a s• . ✓ with the ': rilding Ordinance of Miami Shores Village, Florida, mi ;' and all provisions of the Laws of the State of Florida, all ordinances of Mia,.ores Village and all rules and regulations of the Building Division Miami Mii Shores Village shall be complied with, whether herein specified ^ ter'. A cop :' it approved plans and specifications must be kept at building during progress of work. c — - - - -- NIo -- ----- — Street — ----- ._-- -. - -- __ --... Street. Location and Legal Description Lot___________ ..- . —�:_ — r �._ Blocky Subdivision Street and Number where work is to be performed—No. � l � v� �� � Street ` . 4 State work to be performed and purpose of building (By Floors)_-_. New Building � Remodeling_____ —_ Addition.._____ Repairs No. of Stories. . ..... ... ........ Size Septic Tank Feet of Drain Tile Type of Tank_____ Capacity Gals ..... Dist. Feet of Tank or Drain Field from Well Nature of Water Supply: City —Well ____Size of Soakage Pit Amount of Permit $ Plumbing Inspector. The undersigned applicant for this building permit does hereby certify that he understands and accepts his ob 'gations as an employer of labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Pennanent 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 rewired 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. STATE OF FLORIDA, } ss. 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. My Conunission Expires Notary Public, State of Florida 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. Tomes SINKS SLOP SINKS LAUNDRY TUBS U RINALS CATCH BASIN FLOOR DRAIN DRINKING FOUNT'N6 TOTAL FIXTURES CONTn. LIST I 1 1-.. O -- CHECK SEPTIC TANK SEWER CONN. DRAIN FIELD SOAKAGE PIT GREASE TRAP SOLAR HEATER Zr_ ✓J Gam DEEP WELL SPRKLR. SYSTEM SWIM•G POOL Ej ^�,- " -- , . ° CONTR. LIST p fl CHECK Permit No - �d Owner's Name and Address MIAMI SHORES VV. PLUMBING INSPECTION DEPARTMLi■F' APPLICATION FOR PLUMBING ' f "' Registered Architect and /or Engineer __ 4 Employing Plumber's Name _ _ _ �! � s' _�:_� — No Date 6- Application is hereby made for the approval of the detailed statement of t.4 plans and specifications herewith submitted for the building or other structure herein described. This application is made in compliance and cos" �a s• . ✓ with the ': rilding Ordinance of Miami Shores Village, Florida, mi ;' and all provisions of the Laws of the State of Florida, all ordinances of Mia,.ores Village and all rules and regulations of the Building Division Miami Mii Shores Village shall be complied with, whether herein specified ^ ter'. A cop :' it approved plans and specifications must be kept at building during progress of work. c — - - - -- NIo -- ----- — Street — ----- ._-- -. - -- __ --... Street. Location and Legal Description Lot___________ ..- . —�:_ — r �._ Blocky Subdivision Street and Number where work is to be performed—No. � l � v� �� � Street ` . 4 State work to be performed and purpose of building (By Floors)_-_. New Building � Remodeling_____ —_ Addition.._____ Repairs No. of Stories. . ..... ... ........ Size Septic Tank Feet of Drain Tile Type of Tank_____ Capacity Gals ..... Dist. Feet of Tank or Drain Field from Well Nature of Water Supply: City —Well ____Size of Soakage Pit Amount of Permit $ Plumbing Inspector. The undersigned applicant for this building permit does hereby certify that he understands and accepts his ob 'gations as an employer of labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Pennanent 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 rewired 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. STATE OF FLORIDA, } ss. 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. My Conunission Expires Notary Public, State of Florida 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. illa of Miami Shores JOBS C.L. ADDRESS a ° ' A.; - 2 N° 4651 INSPECTION al. a- # e} i I TIME READY t - - s REMARKS INSPECTOR DATE e )- 1 - f • `\5 g e o liami Shores n � JOB e LC ADDRESS 12 � 4) Z INSPECTION I V 1 '> TIME READ{ REMARKS fN 'SPECTOR N9 4658 DATE — / -57 17