365 NE 93 St (10)e ^ T
Date 'V Job Address %5 NE 9 ° ST Tax Folio -0 a 3043
Legal Description Historically Designated: Yes No
Owner/Lessee / Tenant 4 &Z k• 4' JLL)1N Master Permit # / 1 9 6
Owner's Address d"Cpj /kJ Q.33D 4'1 //v/ eJHo,& Phone 16C' 1 4 - 'O
Contracting Co. L L CV//- iticerq Address ,POD A) 4t) 17/f sr 4/4/1/
Qualifier
TEg s/ ) FOLD SS# Phone " 75/ / 7&76'
State # Q 2 5E3 (6 8 Municipal # Competency # /.24?"4 Ins. Co. W ®/5S I F
Architect/Engineer
Bonding Company
Mortgagor
Permit Type (circle one): BUILDING ELECTRICA PLUMB 1 ' G MECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIPTION / iJ ��"-C ✓ 1k eLp
S Ft , %�Qo ,5-Q P1
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.
Si of owner or - ondo Presi • ent Date
Notary as to i _: :: _ - -i Date
My Commission Expires:
LESTER E. CROCKETT
My Comm Exp. 5/20/2001
Bonded. By Service Ins
No. CC649326
I I Personaily Known I I Other 1.0
APPROVED:
a r r i t d 9-/(0_0-
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
FEES: PERMIT ' 35 ': RADON C.C.F.
Address
Address
Address
Estimated Cost (value)
Notary as
My Commission Expires:
LESTER E. CROCKETT
MY Comm Exp. 5/20/2001
Bonded By Service Ins
No. CC649326
I 1 Personally Known 110tr:3 I.D
I5oo es
NOTARY BOND
TOTAL DUE 3 3 , - z �
CONSTRUCTION PERMIT FOR:
(/).] New System [,J] Existing System
(;] Repair [j ] Abandonment
APPLICANT:
PROPERTY STREET ADDRESS:
LOT: f,j BLOCK:
PROPERTY ID #:
0
T
H
E
R
STATE OF FLORIDA
DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES
ONSITE SEWAGE DISPOSAL SYSTEM
CONSTRUCTION PERMIT
Authority: Chapter 381, FS & Chapter 1OD -6, FAC
SPECIFICATIONS BY:
APPROVED BY:
DATE ISSUED:
SYSTEM DESIGN AND SPECIFICATIONS
..; J . •
[ :`)]
SUBDIVISION:
a - )0
ro
]
Holding Tank [,) ] Temporary /Experimental
Other(Specify)
AGENT:
" ^
/UM.
TITLE:
HRS-H Form 4016, Mar 92 (Obsole:es previous editions which may not be used)
(Stock Number: 5744 - 001 - 4016 -0)
INSTALLER /CCN7
PERMIT #
DATE PAID
FEE PAID $
RECEIPT #
[SECTION /TOWNSHIP /RANGE /PARCEL NUMBER]
[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.
1. °
T [ ; j ] "[GALLON / GPD] ,SEPTIC TAN 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 [ 1 ] SQUARE FEET PRIMARY DRAINFIELD SYSTEM
R [ ] SQUARE FEET
A TYPE SYSTEM:
I CONFIGURATION:
N
F LOCATION OF BENCHMARK: .
I ELEVATION OF PROPOSED SYSTEM SITE [�:' ] [INCHES /FT] [ABOVE /BELOW] BENCHMARK /REFERENCE POINT
E BOTTOM OF DRAINFIELD TO BE [ �q ]' /FT] [ABOVE /BELOW) BENCHMARK /REFERENCE POINT
L
D FILL REQUIRED: [ ~ °,. ] INCHES EXCAVATION REQUIRED: [ ) ] INCHES
SYSTEM
[.d'] STANDARD [ ] FILLED [ ] MOUND [ ]
[ ] TRENCH V] BED [
.,
ea
.v.
TITLE: CPHU
EXPIRATION DATE:
Page 1 of 2
. :J.: 0:
: :c:
- i irr i ti !I i sir, c r n
.`�;:Lh: t]�1Rl1VU�tr1 i7 ". "Ol .1. _. ..; dCi `CL'!O:'�. ,,.(
'.':C..l ".f. 1'C" 511'_•. - ,Y. £CL_�:'..
/,. 3i It:)E :;i CCUilly Public _^.da1.i1 'Unit (171 J) DCr::O ?A+:l
DATE ISSUED: D tc permit is is.sue:I is y C':•1:?.
:te .. t. - . ., l . J G J
., :,, year !r. �- .......:,.:� ,:a �" . ...LII1 c- - �,-� .�. ; :' `! :[r.r - cr^: v ..
F
N.
STATE OF FLORIDA
DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES
APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTIONPERMIT
Permit Application Number , � /
Scale: Each block represents 5 feet and 1 inch = 50 feet.
1
1
'01(
c . '
1
Notes
Plan Approved
is
Site Plan submittedby: �.
By County Public Unit
ALL CHANGES MUST BE APPROVED BY THE COUNTY PUBLIC HEALTH UNIT
HRS-H Form 4015, Feb 85 (Obsoletes previous edit ons which may not be used)
(StockNumber. 5744.002.4015.6)
PART II - SITE PLAN
r, r,e
%/SIGNATURE
Not Approved
TITLE
Date
Page 2 of 3
Permit No __ ___ ?_ `2—
Application i 1:ereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the build ng or other
structure herein described This application is made in compliance and conformity with the Budding 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 th Building Di ' sion
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.
Owner's Name and Address_ ___
Registered Architect and/or Engineer _
Employing Plumber's Name
Size Septic Tank__ _
Feet of Drain Tile_
Nature of Water Supply. City —Well.
Amount of Permit $ _
STATE OF FLORIDA,
COUNTY OF DADE. j
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
Date
/4/A.5
-- ---- ....... No._---- - -_ - -. _ _ _. _ Street_ ....... .
/4-‘14
No._ Street . ._-
Locatjon and Legal Description Lot______ -__ _ —___ ____._ w B ock Subdivision—
Street
Street and Number where work is to be performed —No 3 I
State work to be performed and purpose of building (By Floors)- _
New Building -____- - -___ -- - - - -- - -- --- Remodeling___ _ -- _- _ _ _ Addition__--
_Dist. Feet of Tank or Drain Field from Well -.
__ _ Si , of Soakage Pit
Capacity Gas.
_. No. of Stories _ _..._ .
'---7
(Signed)___.. _J i �
The undersigned applicant for this building permit does hereby certify that he understands and acc. : ,Its hiss obhga'ions an e nployer of labor
under the Florida Workmen's Compensatio,i Act, being Section 5966, Compiled General Laws of Florida Peananent S plement, 'n'l I a' om
plied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors employe d by hin in the woe k 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 no ices as are
required by the Act. The undersigned agrees to employ only such sub contractors, on work to be perfo. ed under this per nit, as are
licensed by Miami Shores Village.
ast
Before me, the undersigned authority, a notary public, d 11y authorized to administer oaths and take acknowledgn ents, personall appeared
to me well known, and who, being by me first dily sworn u oath deposes and says that he is the
of the above described construction, that he has carefully d the foregoing application, and that he did sign the same, and that all acts
therein by him 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.
CLOSITB
BATH
Tues
SHOWERS
LAVA-
TORIES
SINKS
SLOP
SINKS
LAUNDRY
TUBS
R INALS
URINALS
CATCH
BASIN
FLOOR
DRAM
DRINKING
FOU 'T' NS
TOTAL
F %TURES
CONTR.
LIST
CHICK
SEPTIC
TANK
SEWER
CONN.
DRAIN
FIELD
SOAKAGE
PIT
GREASE
TRAP
SOLAR
H EATER
DEEP
WEAL
SPRKLR.
SYSTEM
SW IM•G
POOL
CONTR.
LIST
—�--
CHECK
_
-
Permit No __ ___ ?_ `2—
Application i 1:ereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the build ng or other
structure herein described This application is made in compliance and conformity with the Budding 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 th Building Di ' sion
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.
Owner's Name and Address_ ___
Registered Architect and/or Engineer _
Employing Plumber's Name
Size Septic Tank__ _
Feet of Drain Tile_
Nature of Water Supply. City —Well.
Amount of Permit $ _
STATE OF FLORIDA,
COUNTY OF DADE. j
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
Date
/4/A.5
-- ---- ....... No._---- - -_ - -. _ _ _. _ Street_ ....... .
/4-‘14
No._ Street . ._-
Locatjon and Legal Description Lot______ -__ _ —___ ____._ w B ock Subdivision—
Street
Street and Number where work is to be performed —No 3 I
State work to be performed and purpose of building (By Floors)- _
New Building -____- - -___ -- - - - -- - -- --- Remodeling___ _ -- _- _ _ _ Addition__--
_Dist. Feet of Tank or Drain Field from Well -.
__ _ Si , of Soakage Pit
Capacity Gas.
_. No. of Stories _ _..._ .
'---7
(Signed)___.. _J i �
The undersigned applicant for this building permit does hereby certify that he understands and acc. : ,Its hiss obhga'ions an e nployer of labor
under the Florida Workmen's Compensatio,i Act, being Section 5966, Compiled General Laws of Florida Peananent S plement, 'n'l I a' om
plied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors employe d by hin in the woe k 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 no ices as are
required by the Act. The undersigned agrees to employ only such sub contractors, on work to be perfo. ed under this per nit, as are
licensed by Miami Shores Village.
ast
Before me, the undersigned authority, a notary public, d 11y authorized to administer oaths and take acknowledgn ents, personall appeared
to me well known, and who, being by me first dily sworn u oath deposes and says that he is the
of the above described construction, that he has carefully d the foregoing application, and that he did sign the same, and that all acts
therein by him 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.
MIAMI SHORES VILLAGE, FLORIDA
Date
i PERMIT
BUILDING
ELECTRICAL
PLUMBING
ROOFING ❑
0
Owner of
Building
Architect
Contractor
or Builder
Legal
Description
Address of � "' .�
Building •?
Lox
1 BI
N° 9186
Contractor's
License No.
� � 1967
//5 .2/
Work to be performed under this Permit
Subdi-
vision
Sq Ft
Value of Amount of 2 � !
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 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 ore ploy es.
Signed / (INSPECTOR) BY
In consideration of the issuance to me of this permit gree to perform the work covered hereunder in compliance with all ordinances and regulationb
pertaining thereto and in strict conformity with the plans, d trigs, statements or specifications submitted to the proper authorities of Miami Shores Village.
In acceptin - his permit I:assume sponsi ility for all work done by either, myself, my agent, servant or employee.
/l L \ .-g►.J� t s r� u
s.
N.
r
CONTRACTOR or BUILD4R- BY AUTHORITY