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30 NE 93 St (2)Date i Owner/Lessee / Tenant Qualifier Square Ft. � -� 7C/ C' Legal Description f0A- o eit4 , Owner's Address Ada Q3 57i- Contracting Co. 0 WO'", c DESCRiON ERMIT APPLICATION FOR MIAMI SHO Job Address 30 AIL; 93,E / Tax Folio • Signature - nf owner and/or Condo President i / I 1 Personalty Known 11 Other I FEES: PERMIT 3 RADON Notary as to Owner and/or Condo President / Date My Commission Exp: E. C ilL Comm Ego. 5/20/2001 F �u3 % �1 Bonded By Service Ins No. CC649326 Y m A) Dkil- Address APPROVED: Zoning Building Me it r cal Historically Designated: Yes No A l Date Signature b r OY Y , r1 PUBLIC Master Permit # Phone r ss# 1L2_- Lig - Phone 17 /T/ ` , ` r't°; .' State # Municipal # Competency # Ins. Co. Architect/Engineer Address Bonding Company Address Mortgagor Address Perm t Type (circle one): UILD N G ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIG:\ \M Q PAPr( (1_ Est_rnated Cost (value) ,/ WARNING T WNER: YOU MUST RECORD A NOTICE OF COMMENCEMENT AND YOUR A::L JRIE TO DO SO IY:A`Y' RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR P OPERTY (IT YOU INTEND TO OBTAIN FL IANCrNG, 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 t'.zis jurisdiction. I understand that separate permits are required for ELECTRICAL, PLUMBING, SIGNS, POOLS, ROOFING and MECHANICAL WORK. OWNERS AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in ccmpliance with all applicable laws regulating construction and zoning. Furthermore, I authorize the above -named contractor to do the work stated. Contractdr rGunner- Builder C.C.F. // n NOTARY ( Notary as to Contractor or Owner - Builder My Commission Expires: LESTER E. CROCKETT My Comm Exp. 5/20/2001 e, Bonded By Service Ins N!c. CC649326 I I Personally Known (1 Other I C Electrical ES VILLAGE qv z,Lpr BOND / Date Date TOTAL, DUE Plumbing 1 � 1 , � >_ _ Engineering CONSTRUCTION [ ] New Sys [ ] Repair APPLICANT: PROPERTY STREET ADDRESS: LOT: PROPERTY ID 0: SYSTEM DESIGN AND SPECIFICATIONS T [ A [ N [ K [ D R A I N F I E L D 0 T H E R LOCATION OF BENCHMARK: ELEVATION OF PROPOSED SYSTEM SITE [ BOTTOM OF DRAINFIELD TO BE [ FILL REQUIRED: [ ] INCHES SPECIFICATIONS BY: APPROVED BY: DATE ISSUED: STATE OF FLORIDA DEPARTMENT OF HEALTH ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PERMIT Authority: Chapter 381, FS & PERMIT FOR: tem. [ ] Existing System [ ] Abandonment DH 4018, 10!46 (Replaces HRS -H Form 4016 [papa 1) which may be used) (Stock Number: 5744 - 001 - 4016-0) I ] I BLOCK: SUBDIVISION: Chapter 100 -6, FAC Holding Tank [ ] Temporary /Xxperimenta Other(Specify) AGENT: [SECTION /TOWNSHIP /RANGE; /PARCEL NUMBER] [OR TAX ID NUMBER] ` — - SYSTEM MUST BE CONSTRUCTED IN ACCORDANCE WITH SPECIFICATIONS AND STANDARDS OF CHAPTER 10LD -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. DEPARTMENT OF HEALTH APPRCVAL OF SYSTEM DOES NOT GUARANTEE SATISFACTORY PERFORMANCE FOR ANY SPECIFIC PERIOD OF TIME. ANY CHANGE IN MATERIAL FACTS W3ICH 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. [GALLONS / GPD] SEPTIC TANK /AEROBIC UNIT CAPACITY HULTI-- CHAMI:M1ERED /IN SERIES: [ ] [GAT•7.ONS / GPD] CAPACITY YULTI- •CHAMFERED /IN SERIES: [ ] ] GALLONS GREASE INTERCEPTOR CAPACITY [MAXIMUM CAPACITY SINGLE TANK: 1250 GALLONS] GALLONS PER DOSE DOSING TANK CAPACITY DOSE •RATE [ ] FER 24 HRS NO, OF PUMPS: [ ] [ ] SQUARE FEET PRIMARY DRAINFIELD SYSTEM ] SQUARE FEET SYSTEM TYPE SYSTEM: [ ] STANDARD [ ] ;FILLED CONFIGURATION: [ ] TRENCH [ ] :$ED ] [INCHES /FT] [ABOVE /BELOW] BENCHMARK/REFERENCE POINT ] [INCHES /FT] [ABOVE /BELOW] BENCHMARK /REFERENCE POINT EXCAVATION REQUIRED: [ ] INCHES TITLE: TITLE: [ ] MOUND I PERMIT 0 DATE PAID FETE PAID $ RECEIPT 0 I EXPIRATION DATE: Page 1 of 2 INSTRUCTIONS: PERMIT NUMBER: Permit tracking number by County Health Department. 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. (Health Department may require property appraiser ID# or section /township /range /parcel number.) SYSTEM DESIGN AND SPECIFICATIONS: TANK: DRAINFIELD: OTHER: SPECIFICATIONS BY: APPROVED BY: DATE ISSUED: EXPIRATION DATE: Minimum specifications from Chapter IOD -6, FAC. Minimum specifications from Chapter IC13-6, FAC. Other specifications, such as operating permit requirements, low - volume flush toilets, variance provisos. Name of individual providing specifications. If designed by a registered engineer must be sealed. County Health Department personnel reviewing and approving permit. Date permit is issued by County Health Department. One year from date issued if the system has not been installed. Permits for system repairs become void 90 days from the date issued. APPLICATION FOR: [ ] New System [ ] Repair APPLICANT: AGENT8 MAILING ADDRESS: TO BE COMPLETED BY APPLICANT OR APPLICANT'S AUTEORIZED AGENT. ATTACH BUILDING PLAN AND TO-'CALE SITE PLAN SHOWING PERTINENT FEATURES REQUIRED BY CHAPTER 10D -6, FLORIDA ADMINISTRATIVE CODS: PROPERTY INFORMATION IF LOT IS NOT IN A RECORDED SUBDIVISION, ATTACH LEGAL DESCRIPTION OR DEED] LOT: PROPERTY?' ID #: PROPS! TY SIZE: PROPERTY STREET ADDRESS: DIRECTIONS TO PROPERTY: BUILDING INFORMATION l 2 3 4 STATE OF FLORIDA PERMIT # DEPARTMENT OF HEALTH DATE PAID ONSITE SEWAGE DISPOSAL SYSTEM FEE PAID $ APPLICATION FOR CONSTRUCTION PERMIT RECEIPT Authority: Chapter 381, FS & Chapter 10D -6, VAC Existing System DH 4015 10196 (Replaces HRS -H Form 4015 [Pbge 1] which may be used) (Stock Runber 5744- 001 - 4015 -1) Abandonment [ ➢ Other(Specify) 3 Holding Tank [ ] Temporary,' /Experiments:. TELEPHONE: BLOCK {: SUBDIVISION: DiTE OF SUBDIVISION: [Section /Township /Range /Parcel No.] ZONING: ACRES [Sgft /43560] PROPERTY WATER SUPPLY: [ [ ) RESIDENTIAL [ ] COMMERCIAL PRIVATE ; ittn3Lic Unit Type of No. of Building f tersons Business Activity No Establishment Bedrooms Area Sqft Sexved For Commercial Only [ ] F:.00r /Equipmennt :3. °runs [ Garbage Grinders /Disposals [ ) Spas /Hot Tubs [ Ultra --law Volume Flush Toilets [ - ' Other (Specify) APPLICANT'S SIGNATURE: DATE: a :. ©f 3 1,;pci. it "Cf fy typi.: :ENT: ... 010115 01:;'7.171. : 0:7 SailDIVITON: citit: on cc:J.7:ty 917.t 0.000; 0 - . 1 k1.4. 1 .0" - ' :',. .; 014000071; 7/1 1000:1 , @k1C.01"0: 0":1,11 :11.1bt...11. ;Cr.: .."; lot 27 pri.T Jrt■. :lay requite pi opci iipprLmicr .1) or six:mil:it miniher.; find. r.r. cic:cor It. '0:10000 -- Jrie12...: or or ....I:rime.: : :.!0■:::•;7. C7. 1u or latbiclo 111:10 chewing locztion. of C NO. 3F.:01100MS: Court: prim:trily for ::1000i117 e;t20cic.ci to 1 . o.utirAy 00 00 IS. J.1care fclutufte.- 1101:Zbi.r; :;:'0■:00:Iir7 unit, C., C .. 'tic;; 0, ottth!.(-: f01: ;:10::10 0;:43: 77 007:0 i?El.SONS: o ■• : or •..: c':u 71. Lii0cn,,ture cc. Ippi icm10. or 0.2...lit 1);:le application on dtn, submitted to I Department cOb ippropt mtachincriti:. di. 11!..L'.1 7:At:IT! C01 : !1:/1. • • • • ' CO 0' TOT. 7 rlsor ( . c ?bin tho 1.7C.•,".:^1;; . . r.ccess::i-y to compo5itioi:t r.L.:2,:-;.:1:y +' Spqi p-°.a STATE OF FLORIDA ;;`, -• DEPARTMENT OF HEALTH 1 APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PERMIT L Permit Application Number Scale: Each block represents 5 feet and 1 inch = 50 feet. Notes: Site Ran submitted by: Plan App °oved By OH 4015, 10193 (Feg!cocs HRS-H Farm 4015 a'h'"ch may be used) (Stadt Nutrber: 5744-002-4015-5) PART II - SITE PLAN - Signature Not Approved Date Courtly Health Department ALL CHANGES MUST BE APPROVED BY THE COUNTY HEALTH DEPARTMENT T tle Pago 2 of f M Owner's Name and Address PP 8C , INON FOR FiLEL.DiNG I.sIERMIT Application is hereby made for the approval of the detailed statement of 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 ,egulations 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 the work. Registered Architect and /or Engineer. Name and address of licensed contractor......_ . __� <��,?� C..0 Location and legal description of lot to be built on: Lot Block Subdivision AMC SHLN S VRLLAGE L.JILDDRIG VNSPECTION DEPARTMENT No 30 'Remarks (Signed 2 Street and Number where work is to be done 0 p✓ ! l State work to be done and purpose/ buil ing (by floors) / -- - / , > , -. -4 C... /2j � (2.-- and for no other purpose. New Building Remodeling Addition.__ Repairs No. of Stories To be constructed of Kind of foundation _._. Roof Covering (./.‘=-0 e<'; Estimated Total cost of improvements $ __Amount of Permit $ Zone cubage required Plan Cubage 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 5966, Compiled General Laws of Florida, Permanent Supplement, and has complied 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 inspectio on the site of the work such public notice or notices as are required by the Act. The undersigned agrees to employ only such subcontr s, on work to bp, erformed under this permit, as are licensed by Miami Shores Village. STATE OF FLORIDA, COUNTY OF DADE. ss. Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally ap- peared 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 fcregoing application, and that he did sign the same, and that all facts therein by him stated are true. Permit No Date Read, Sworn to and Subscribed before me. Disapproved Date (Signed) Building Inspector My Commission Expires Notary Public, State of Florida. Street / / (")., %f" PUNNING BOARD DATE / Chairman Member %.iember Member Member . _.. Member Council Approved Date Disapproved Date NOTE: A charge of $1.00 will be made for making corrections or changes to this application after approval has been obtained from 4,:•e Planning Board. A rc- inspection fee of $1.00 will be charged when such re- inspection is made necessary by improper notice for inspection or frailty materials and /or workmanship. BUILDING ELECTRICAL PLUMBING ROOFING Owner of Bui Architect Contract 07 or Ih.ilder Legal Lot Description Address of Buildin:r. CONTRACTOR OR BUILDER MIAMI SHORES VILLAGE. PERMIT NY 9021 131. Work to be performed under this Fermit_ _ Subdi- vision SQ. Ft. Value of Project C. FLORIDA DATE Contrac tor's License No.__ Amt, of I Permit This permit is granted to the contractor or builder named above :o co.astruct the building or to ins:all the equipmeit or device described in t le application herefor in strict compliance with all ordinances pertaining thereto and with the understanding that tie work will be pi rimmed in comp'ianc ' th any plan. drawings, statements or specifications that may have been submitted to and approved by the prcper municipal authoritie This Permit may be 7-I:\ o'Ked at any time if the work is not done in compliance with such ordinances or if the plans are changed without autho:ization. A furt ler condition upon whicl this permit s granted 's tile understanding that the contractor or builder named above assumes the responsibility for a thorougo knowledge of the ordinances ST Ti regulatiors pertaining to the work covered hereby whether shown on the plans or erawings or in the statements or specifications and that he assumes responsibility for work done by his agents, servants or employees. Signed E31' INSPECTOR In considerat'on of the issuance to me of this permit I agree to perform the work covered hereunder in compl'aree with all ordinance a rd regulations pertaining thereto and in strict conformity with the plans, drawings, statements or specifications subraitte to the prope:• a ,ithe rities of Miami h 01 es \ 'iflapc. In accepting this permit I assume responsibility for all work done by either, myself, my agent, servant or employee. BY AUTHORITY