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DRAINFIELDPermit No- -- ----- ------ - - • - -- — — New Building Nature of Water Supply: City —Well. Amount of Permit $__ _ ss. My Commission Expires MIAMI SHORES VILLAGE PLUMBING INSPEC "ION DEPARTMENT APPLICATION FOR PLUMBING PERMIT 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 col fonnity with the Building Ordinance of Miami Shores Village, Florida, and all provisions of the Laws of the State of Florida, all ordinances of Mi imi Shores Village and all rules and regulations of the Building Division of Miami Shores Village shall be complied with, whether herein specifies or not. A copy of approved plans and specifications must be kept at building during progress of work. Owner's Name and Address �.. AA No. _ f..__ __ __ _ Street __ J%5 r Registered Architect and /or Engineer Employing Plumber's Name 1. _ ' f lY!'_2 {'' No. Location and Legal Description Lot Block Street and Number where work is to be performed —No. Street __ _._.. _ _ `� State work to be performed and purpose of building (By Floors) - ___ A 11AL1 / {_lfI . _ Repairs ✓ No. of Stories - Remodeling Addition _ r Size Septic Tank - - -Type of Tank Feet of Drain Tile _ s. � Dist. Feet of Tank or Drair Field from Well Capacity Gals. S ze of Soakage Pit - - -- -- - - - - -- — -- -- ( Signed) Date I6 .99 Street /:',4 6.6 `'' Subdivision 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. j /J i Signed f'' ` _ 4 aster Plumber. STATE OF FLORIDA, 1 COUNTY OF DADE. Before me, the undersigned authority, a notary public, duly authorizes: to administer oaths and take acknowledgments, personally appeared to me well known, and who, being by me first duly sworn, upon oath depos3s and says that he is the of the above described construction, that he has carefully read the fore;oing application, and that he did sign the same, and that all facts therein by him stated are true. 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 Tuns SHOWERS LAVA- TORIES SINKS SLOP SINKS LAUNCRY TUB'i URINALS CATCH BASIN FLOOR DRAIN DRINKING FOUNT•NS I I TOTAL FIXTURES CONTR. LIST CHECK SEPTIC TANK SEWER CONN. DRAIN FIE LD Y LD SOAKAGE PIT GREASE TRAP SOLAR HEATER DEE' WEL.. SPRKLR. SYSTEM SWIM'G POOL CONTR. LIST — CHECK Permit No- -- ----- ------ - - • - -- — — New Building Nature of Water Supply: City —Well. Amount of Permit $__ _ ss. My Commission Expires MIAMI SHORES VILLAGE PLUMBING INSPEC "ION DEPARTMENT APPLICATION FOR PLUMBING PERMIT 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 col fonnity with the Building Ordinance of Miami Shores Village, Florida, and all provisions of the Laws of the State of Florida, all ordinances of Mi imi Shores Village and all rules and regulations of the Building Division of Miami Shores Village shall be complied with, whether herein specifies or not. A copy of approved plans and specifications must be kept at building during progress of work. Owner's Name and Address �.. AA No. _ f..__ __ __ _ Street __ J%5 r Registered Architect and /or Engineer Employing Plumber's Name 1. _ ' f lY!'_2 {'' No. Location and Legal Description Lot Block Street and Number where work is to be performed —No. Street __ _._.. _ _ `� State work to be performed and purpose of building (By Floors) - ___ A 11AL1 / {_lfI . _ Repairs ✓ No. of Stories - Remodeling Addition _ r Size Septic Tank - - -Type of Tank Feet of Drain Tile _ s. � Dist. Feet of Tank or Drair Field from Well Capacity Gals. S ze of Soakage Pit - - -- -- - - - - -- — -- -- ( Signed) Date I6 .99 Street /:',4 6.6 `'' Subdivision 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. j /J i Signed f'' ` _ 4 aster Plumber. STATE OF FLORIDA, 1 COUNTY OF DADE. Before me, the undersigned authority, a notary public, duly authorizes: to administer oaths and take acknowledgments, personally appeared to me well known, and who, being by me first duly sworn, upon oath depos3s and says that he is the of the above described construction, that he has carefully read the fore;oing application, and that he did sign the same, and that all facts therein by him stated are true. 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 MIAMI SHORES VILLAGE /5 07, Al E . - (3 6 1 - 14-4 Tax Folio Date Job Address Legal Description His'orically Designated: Yes No Owner/Lessee / Tenant Vi / 141- 1 20 0P ' Master Permit # Owner's Address i' a 'h . I U - 1.pad i Phone , c6.- 77, e, - 5 g -y a S Contracting Co. A ` ( fe- ere4 l i 1 ./ ,Address I'M ,5 .7/1 /`J ✓`/ • 2 -s2. &' WORK DESCRIPTION Qualifier State # Municipal # Competency # Ins. Co. Architect/Engineer Address Bonding Company Address Mortgagor Address Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN Notary as to • er and/or Condo President My Commission Expires: ofkie,A, , Square Ft. g f3' 01 Estimated Cost (value) / a Ca 0 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 COMK:ENCEMENT.) 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 juisdiction. I understand that separate permits are required for ELECTRICAL PLUMBING, SIGNS, POOLS, ROOFING and MECHANICAL WORK. OWNER'S AFFIDAVIT: I certify that all the foregoin: ' ation is accurate and that all work will be done in compliance with all applicable laws regulating construction . ; zoning. Furth • • e, I autho • . • i e above -named contractor to do the work stated. wV :1 % a;� 5 e� +,., ST FP 6'ds 4 s n i'tS4e4e of Fly ��. pp h l" _ FEES: PERMIT r RADON C.C.F. APPROVED: Zoning Mechanical Building Plumbing S6# Phone , '°'76 ' V Si nature o o tractor or Owner-Builder Date 3-27-® Date :.r Notary My Co (• 2 I NOTARY o Contractot`or Ow' `r 111H'i6C ='4.;. '' ssion Expires: P.'5'2Ai.aX:��1 Electrical Structural Engineer BOND O O / TOTAL DUE 3 (p (0 ' APPLICANT: STATE OF FLORIDA DEPARTMENT OF HEALTH ONSITE SEWAGE TREATMENT -AND DISPOSAL- SYSTEM CONSTRUCTION PERMIT CONSTRUCTION PERMIT FOR:, j] New System [] Existing System (*0 Repair [i ] Abandonment (M Holding Tank (6 4 Temporary PERMIT NO.47A} F, 4! DATE PAID: FEE PAID: ? RECEIPT #: [ Innovative PROPERTY ADDRESS: i cc. N 2 0 , . LOT: BLOCK: SUBDIVISION: ' kk I -' ' � ` re r"j [SECTION, TOWNSHIP, RANGE, PARCEL NUMBER] PROPERTY ID #: 00- — Chi 9 - c'; — [OR TAX ID NUMBER] 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 TIE APPLICANT TO MODIFY THE PERMIT APPLICATION. SUCH MODIFICATIONS MAY RESULT IN THIS PERMIT BE::NG MADE NULL AND VOID. ISSUANCE OF THIS PERMIT DOES NOT EXEMPT THE APPLICANT FROM COMPLIANCE WITH OTHER FEDERAL, STATE, OR LOCAL PERMITTING REQUIRED FOR DEVELOPMENT OF THIS PROPERTY. SYSTEM DESIGN AND SPECIFICATIONS T [ N:) " ] A [ N [ K [ D [,*eta ] R [ ] 0 T H E R GALLONS / GPD T AEROBIC UNIT CAPACITY MULTI- CHAMBERED /IN- SERIES [ ] GALLONS / GPD CAPACITY MULTI- CHAMBERED /IN- SERIES [ ] GALLONS GREASE INTERCEPTOR CAPACITY [MAXIMUM CAPACITY SINGLE TANK: 1250 GALLONS] GALLONS DOSING TANK CAPACITY [ ]GALLONS @ [ ] DOSES PER 24 HRS # PUMPS [ ] SQUARE FEET PRIMARY SQUARE FEET A TYPE SYSTEM: [1 STANARD I CONFIGURATION: [] TRENCH N F LOCATION OF BENCHMARK: I ELEVATION OF PROPOSED SYSTEM E BOTTOM OF DRAINFIELD TO BE L D FILL REQUIRED: [ /-] INCHES DRAINFIELD SYSTEM SYSTEM [1A FILLED MOUND [ [•;,0] BED [ /3 ` .' SITE [ e „s ] [INC? ESQ [ABOVE [ �✓. ' [ SIFT] [ABOVE /B ^ r EXCAVATION REQUIRED: SPECIFICATIONS BY: TITLE: APPROVED BY: DATE ISSUED: TITLE: DH 4016, 12/99 (Page 1) (Previous Editions May Ba Used) 1 INCH'ES C ' l r 1 . � ,° 4 ' /t) BENCHMARK /REFERENCE POINT BENCHMARK /REFERENCE POINT EXPIRATION DATE: pt. 1: Health Dapzrtmant Qoafipnnt...., Page 1 of 3 CH1 INSTRUCTIONS: 4 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. .1 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. re II I I_ I I 1 11 1 II 1 Site Plan Submitted by STATE OF :=LORIDA DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PERMIT Permit Application Number FART II - SITE PLAN 1 I 1 1 I 11 1 i 1 II' 1I II I 1 - I - 1H - I ' I I_1 _I_ 1 — I - 11 I -1 I I I 1. 1.I I I I 11 I 1 1 II1I 1 1 II 1 I I 1 1 I I 11 1 - 11 I11. 1 _ 1, _ 11, _ ': _ 1 _ 1 1 l I II I 11 1 11 111!1 1 II 1 1•il 11 11'1 1 I I 111 l ill I l i HRS -H Form 4015, Feb 85 (Obsoletes previous editions which may not be used) (Stock Number: 5744- 002 - 4015 -6) I_I 11,I I , II —L I 1! 1 litl 1 l 1 1 I 1 F' i 1 1 1 11 II 1 1 1 !, t I • 11 LI I I 11 Not Approved 111 II Il I( III' II I II ,__ 1_ 11 I I - 1 1 1 i11 -1 — 1 '' I— — — 1 1 1 1 I — 1 � II � I t 1 I1_I 1 i I 11 l 11 1 I I i _. 1 _. 1 1 1 1 1 1 _ 1 • ALL CHANGES MUST BE APPROVED BY THE COUNTY PUBLIC HEALTH UNIT TITLE Notes . SIGNATURE Ran Approved By County Public Unit Date Page 2 of 3