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DRAINFIELDBUILDING ELECTRICAL PLUMBING ROOFING Owner of - r r Building .A' • • d . � ► Architect Contractor or Builder Legal Lot Description II Bl Address of r A Building 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 applica- tion 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 time 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 granted is the understanding that the contractor or builder named above assumes the responsibility for a thorough knowledge of the ordinances and regulations pertaining to the work covered hereby whether shown on the plans or drawings or in the statements or specifications and that he assumes respon- sibility for work done by his agents, servants or employees. Signed. L.A. INSPECTOR In consideration of the issuance to me of this permit I agree to perform the work covered hereunder in compliance w all ordinan =. -• egulations pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In ac cepting this permit I assume responsibility for all work done by either, myself, my agent, servant or employee. ref 4 MIAMI SHORES VILLAGE, FLORIDA DATE 41) ° 19 ❑ PERMIT N9 6404 Contractor's License No. D CONTRACTOR OR BUILDER Work to be performed under this Permit ~•- t . .Ci Subdi- vision Value of Project $ Amount of Permit $ BY t `' AUTHORITY A Y DOT BUILDING ❑ ELECTRICAL El DATE 195' PLUMBING d PERMIT N? 8 3 51 Contractor's h License No r ROOFING ❑ ❑ Work to be performed under this Permit Owner of Building Architect Contractor or Builder Legal Description Address of Building Lot MIAMI SHORES VILLAGE. FLORIDA 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 time 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 granted is the understanding that the contractor or builder named above assumes the responsibility for a thorough knowledge of the ordinances and regulations pertaining 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 done 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 pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I 'assume responsibility for all work done by either, myself, my agent, servant or employee. Bl. Subdi- vision Sq. Ft Value of Project $ Amt. of Permit $ BY AUTHORITY • MIAMI SHORES VILLAGE, FLA. N? 5711 JOB JeR...W0 4e ADDRESS 3 3 INSPECTION =L-1 TIME READY REMARKS: 'PECTOR % -' =� DATE 7 MIAMI SHORES VILLAGE, FLA. INSPECTION r c_. p 'rx . JOB ?A ,J ill o S ADDRESS .3 3 - E N? 6231 _ TIME READY P - "-/ -s 7 • REMARKS: a+c ` DATE PERMIT APPLICATION FOR MIAMI SHORES VILLAGE D a t e 5-40-99 J o b A d d r e s s 3 3 f ) 9 3 I Tax Folio /J 2 d /3 63 Legal Description Z078 2' 9 auf /IJ Historically Designated: Yes 2 No Owner/Lessee / Tenant 74 T (J IL 7 Tl� �1// / Master Permit # 7 */ ✓' Owner's Address 33.6 /CJE Q RZ 8 Phone 3 961? - 4 Contracting Co. L L CYD- /iDRT/t7FW �J4 ric Address Q t/v MJ -W /l/ var' Qualifier J d 5-E SS# Phone — Rs — qq6-x • State # Municipal # Competency # Ins. Co. Architect/Engineer Address Bonding Company Address Mortgagor Address Permit Type (circle one): BUILDING LDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN N WORK DESCRIPTION / 5 414 " rA /AJF CV) Square Ft. Estimated Cost (value) 4/R2). 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. CLA/1_41- / KAANI pik 3/t) -99 Si afar of owner and/or Condo President Date Notary as to 0 Date My Commission Expires: o'F P4 My Comm Exp. 5/20/2001 Bonded By Service Ins No. CC649326 11 Personally Known 1 Other 1.0 FEES: PERMIT / ✓ RADON APPROVED: Zoning Building Mechanical Plumbing 5-v49 . �� ontracto • orl go .:2_._: or' ._ Notary as to Contr My Commission Expires: wner- Builder Date ct• • • ___ ' ...uu LESTER E. CROCKETT My Comm Exp. 5/20/2001 Bonded By Service Ins No. CC649326 11 Personally Known 1 1 Other 1 r) Date C.C.F. /* ( NOTARY BOND Electrical TOTAL DUE Engineering Notes: Site Plan submitted by: Plan Approved DH 4015, 10/96 (Replaces HRS-H Forth 4015 which may be used) (Stock Number: 5744 -0012- 4015.6) STATE OF FLORIDA DEPARTMENT OF HEALTH APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PERT Permit Application Number ( 9Ge .0/ S PART II - SITE PLAN Scale: Each block,,represents 5 feet and 1 inch = 50 feet l e 7 3 -L �•�r 4.t I r d _ _ u `� h - 1 -, 1 r1 , I ! T I ti j IJ 11+ � . � I I E — 01 N 006A- rl orori • Signature Not Approved • t' Ci By �' County Health Department ALL CHANGES MUST BE APPROVED BY THE COUNTY HEALTH DEPARTMENT Title Date - /o -9i Page 2 of 3 p F I 0 T H E R DATE ISSUED: STATE OF FLORIDA PERMIT # `P .01,'' DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES DATE PAID:- F� ONSITE SEWAGE DISPOSAL SYSTEM FEE PAID $+ , J°` CONSTRUCTION PERMIT RECEIPT # `q Authority: Chapter 381, FS & Chapter 1OD -6, FAC 0 CONSTRUCTION PERM * T y R: [L New System ,' fisting System [ ] Repair ),/[ L] Abandonment `� v� , APPLICANT: ' ,J � 1 1 AGENT: PROPERTY STREET ADDRESS: cl. LOT: ti p 7 K o(J BLOCK: SUBDIVISION: PROPERTY ID #: U �� _ s5 , [SECTION /TOWNSHIP /RANGE /PARCEL NUMBER] A �/ [OR TAX ID NUMBER] SYSTEM MUST BE CONSTRUCTED IN ACCORDANCE WITH SPECIFICATIONS AND STANDARDS OF CHAPTER 1OD -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 GPD] SE PTI C TA /AjaROBIC 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 [ ^• GALL PER DOSE DOSING TANK CAPACITY DOSE RATE [ ] PER 24 HRS NO. OF PUMPS: [ ] D ] SQUARE FEET PRIMARY DRAIN R [ ] SQUARE FEET A TYPE SYSTEM: I CONFIGURATION: N 3- SYSTEM • [ ] STANDARD [ ] FILLED [ ] MOUND [ [ ' ] TRENCH [ YED. [ ] LOCATION OF BENCHMARK: »i 4 !/P.0 y / 7 ELEVATION OF PROPOSED SYSTEM SITE [ ] CHES FT] BOTTOM OF DRAINFIELD TO BE 3 ] INCHES ] E L D FILL REQUIRED: [ ] INCHES LD EXCAVATION REQUIRED: [ 3 3') INCHES Ho -ding Tank ['emporary /Experimental Other(Specify) [ABOV BELO ENCHMARK /REFERENCE [ABOV BELOW] ENCHMARK ERENCE POI SPECIFICATIONS BY: APPROVED BY: 2 ; TITLE: EXPIRATION DATE: ,/' �,� HRS -H Form 4016, Mar 92 (0bsoletes previous editions which may notjbe used) (Stock Number: 5744- 001 - 4016 -0) TITLE: PPLICANT CPHU Page 1 of 2 'INSTRUCTIONS: PEzEMrr NUMBER: r Permit tracking number assigned by CP }iU. 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: Properly owner's legally authorized representative. MAILING, ADDRESS: P.O. box or street mailing address for applicant or agent. LOT, BLOCK, SUBDIVISION or PROPERTY IDN: 27 character id number for property. (CPHU may require property appraiser ID it or section /township /range /parcel number) SYSTEM DESIGN AND SPECIFICATIONS: TANK: Minimum specifications from Chapter IOD -6, FAC. DRAINFIELD: Minimum specifications from Chapter IOD -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 Public Health Unit (CPHU) personnel reviewing and 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 void 90 days from the date issued.