35 NE 92 St (13)PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Date g g Job Address 35 % Q (9 ‘ % Tax Folio /1- - 3 ;06 ' 0/3 ag r
Legal Description
Owner/Lessee / Tenant
State # / C1� / //�
Owner's Address 7 ` /(/E 9
Contracting Co. (i 6 5 c
Qualifier B/ - Pfre,`)/fr
Square Ft. 3 C
. ,
Ii
FEES: PERMIT 3d • RADON
Municipal #
WORK DESCRIPTION n 4.A -I A) Fl E i3O <26 PA" ea-
�Qo�a���� -� c3 zlz31QG.
Signature of owner and/or Condo President Date
. - -60-d-
otary as to OwnWand/or Condo President pate / q
My Commissi �n, plr : OFFICIAL NOTARY SEAL' /A- J / 7 /
S MARGARITA MONTIEL YY
.. 1 ` ( COMMISSION NUMBER
.y L., a CC797277
7.1. 4- MY COM MISSION EXPIRES
OF OP EC. 17,2002
APPROVED:
Zoning
Mechanical Plumbing
Building
Historically Designated: Yes
Master Permit #
Phone
Address /0 t)6 /3,057 Ai 7/1;,9 .T3/6/
ss#
Competency # Ins. Co.
Architect/Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type (circle one): BUILDING ELECTRICAL PLUMBIN ECHANICAL ROOFING PAVING FENCE SIGN
Estimated Cost (value) 1,71_000.
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-name • contractor to do the or
Sign: ure of Con or Owner -Buil
No
Phor ms s) 3 $T ".- ?/(
Notary as to Contractor or Owner- Builder
My Co ission Expires:
ko b er t' F P ��/
C.C.F. /` NOTARY
Electrical
e
Date
BOND 3 04
TOTAL DUE -3 /t°
Engineering
APPLICATION FOR:
[/ / ] New System
(y) Repair
APPLICANT:
AGENT:
MAILING ADDRESS:
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:/5:0( BLOCK:
PROPERTY ID #: // '30106, . 7/ 3 , O `P'O
PROPERTY SIZE: `Cif, ACRES /43560] PROPERTY WATER SUPPLY: [ ] PRIVATE [►i] PUBLIC
3 .
PROPERTY STREET ADDRESS: _ Q./ I
DIRECTIONS TO PROPERTY: e /ij 1 n 4 q 5 ..- `
BUILDING INFORMATION [VI
Unit Type of
No Establishment
1
2
3
4
I
Garbage Grinders /Disposals [��- Spas /Hot Tubs
Ultra -low Volume Flush Toilets y# Other (Specify)
G '7 72
; -/, - te e..._ DATE:
[fr
APPLICANT'S SIGNATURE:
5/qD
STATE OF FLORIDA
DEPARTMENT OF HEALTH
ONSITE SEWAGE DISPOSAL SYSTEM
APPLICATION FOR CONSTRUCTION PERMIT
Authority: Chapter 381, FS & Chapter 10D -6, FAC
[/v ]
LA)]
Existing System ( Holding Tank [AA Temporary /Experimental
Abandonment (/4/J Other(Specify)
S o Lc +, S c og
1 ) 1 . 4 1 ( _ )
/coo 130 57 13/6/
5
SUBDIVISION:
No. of
.Bedrooms
3
DH 4015, 10/96 (Replaces HRS -H Form 4015 [Page 1] which may be used)
(Stock Number: 5744- 001 - 4015 -1) ]
] COMMERCIAL
PERMIT #
DATE PAID
FEE PAID $
RECEIPT #
9% O
TELEPHONE: 53
DATE OF
SUBDIVISION,.
[Section /Township /Range /Parcel No.] ZONING:
m-9
Building # Persons Business Activity
Area Sgft Served For Commercial. Only
04 -Floor /Equipment Drains
p/asiqg
Page 1 of 3
INSTRUCTIONS:
APPLICATION FOR: Check type of pennit, 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, city, state and zip code mailing address for applicant or agent.
LOT, BLOCK,
SUBDIVISION:
PROPERTY iDI:
PROPERTY SIZE:
Lot, block, and subdivision for lot (recorded or unrecorded subdivision). If lot is not in a recorded subdivision, a copy of the lot
legal description or deed must be attached.
DATE OF SUBDIVISION: Official date of subdivision recorded in county plat books (month /day /year) or date lot originally recorded. Dividing an approved
lot into two or more parcels for the purpose of conveying ownership shall be considered a subdivision of the lot.
27 character number for property. (Health Department may require property appraiser 1D4 or section /township/range /parcel number.)
Net usable area of property in acres (square footage divided by 43,560 equare feet) exclusive of all paved arena and Erepared road
beds within public rights -of way or easements and exclusive of streams, lakes, normally wet drainage ditches, mareheo, or other
such bodies of water. Contiguous unpaved and noncompected road rights -of -way and easements with no subsurface obstructions
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.
DIRECTIONS: Provide detailed instructions to lot or attach an area map showing lot location.
BUILDING INFORMATION: Check residential or commercial.
TYPE ESTABLISHMENT: List type of establishment from Table i1, Chapter 10D-6, FAC. Examples: single family, single wide mobile home, restaurant,
doctor's office.
NO. BEDROOMS: Count all rooms designed primarily for sleeping and those areas expected to routinely provide sleeping accommodations for
occupants.
BUILDING AREA: Total square footage of enclosed habitable area of dwelling unit, excluding garage, carport, exterior storage shed, or open or fully
screened patios or decks. Based on outside measurements for each story of structure.
# PERSONS: Number of persons residing, using, or working in establishment. For residential establishment, 2 persons per bedroom are
assumed.
BUSINESS ACTIVITY: For commercial applications only. List number of employees, shifts, and hours of operation, or other information required by
Table II, Chapter 10D -6. FAC.
FIXTURES: Mark each listed fixture with number installed or "NA" if not applicable.
SIGNATURE: Signature of applicant or agent. Date application on day submitted to Health Department with appropriate tees and attachments.
ATTACHMENTS: A site plan drawn to scale, showing boundaries with dimensions, locations of residences or buildings, swimming pools, recorded
easements, onsite sewage disposal system components end location, slope of prv_rty, any existing or proposed wells, drainage
features, filled areas, obstructed areas, and surface water. Location of wells, onsite eewage disposal systems, surface waters, and
other pertinent facilities or features on adjacent properly, if the features are with 75 feet of the applicant lot. Location of any
public well within 200 feet of lot.
For residences, a floor plan (residences) showing number of bedrooms and building area of each unit. For nonresidential
establishments, a floor plan showing the square footage of the establishment, all plumbing drains and fixture types, and other
features necessary to detennine composition and quantity of wastewater.
Scale: Each block represents 5 feet and 1 inch = 50 f
r Y
Site Plan submitted by:
Plan Approved
By
STATE OF FLORIDA
DEPARTMENT OF HEALTH
APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PERMIT
Permit Application Number / /l? - 0 i S e
A
r .
Notes: - 171)) 4 porn n p c)1 c? l Q q
4
11 �r7 BA Ck 5 - r0 � � M ru
ALL CHAN('J�j',�`S MUS ? BE APPROVED BY THE COUNTY HEALTH DEPARTMENT
S-H Form 4015 which ins
C be
used)
4015. 10/96 (Replaces HR y )
(S1odc Number: 5744 -002- 4015.6)
SIP
kd
PART 1I - SITE PLAN-
gnature
Not Approved
72.4..eat
me
Date
County Health Department
Page 2 of 3
APPLICANT:
LOT:
PROPERTY ID #: /1 ,1,96,x,„ ,O/3 -O,. ( 1 0
TO BE COMPLETED BY ENGINEER, HEALTH UNIT
PROVIDE REGISTRATION NUMBER AND SIGN AND
PROPERTY. SIZE CONFORMS TO SITE P
TOTAL ESTIMATED SEWAGE FLOW:
AUTHORIZED SEWAGE FLOW:
UNOBSTRUCTED AREA AVAILABLE:
BENCHMARK /REFERENCE POINT LOCATION:' /
ELEVATION OF PROPOSED SYSTEM SITE IS
THE.MINIMUM SETBAC
SURFACE WATER: Al
WELLS: PUBLIC:
BUILDING FOUNDATI
USDA SOIL SERIES:
SITE EVALUATED BY:
STATE OF FLORIDA
DEPARTMENT OF HEALTH
' ONS3TE SEWAGE DISPOSAL SYSTEM
SITE EVALUATION AND SYSTEM SPECIFICATIONS
BLOCK:
L��rG
1HICH CAN
FT
FT LIMITED
FT
SITE SUBJECT TO FREQUENT FLOODING: [ ] YES
10 YEAR FLOOD ELEVATION FOR SITE:
1 SOIL PROFILE INFORMATION SITE 1
Munsell # /Color " *,.Texture
5A A/6
OBSERVED WATER TABLE: 6 IN2
ESTIMATED WET SEASON WATER TABLE
HIGH WATER TABLE VEGETATION: [ ]
•
SUBDIVISION:
DITCHES /S ALES: -
USE: Ai FT
PROPS TY LINES:
Depth
to
to
to
to
to
to
to
to
H-E S .[ P BD YE
ELEVATION:
YES [aril
DH 4015. 10/96 (Replaces HRS -H Form 4015 (Page 31 which may be used)
(Stock Number: 5744- 003 - 4015 -1)
tw
wr >r{s•
CHES i T
ABO
SOIL PROFILE INFORMATION SITE 2
'F,d 74;//-
Jot
t
PERMIT # g_00 5
[Section /Township /Range /Parcel No. or Tax ID Number]
EMPLOYEE, OR OTHER QUALIFIED PERSON. ENGINEER'S MUST
SEAL EACH PAGE OF SUBMITTAL. COMPLETE ALL ITEMS.
YES [ ] NO NET USABLE AREA AVAILABLE: , 34 ACRES
GALLONS PER DAY (RESIDENCES -TABLE 1 / OTHER -TABLE 2)
GALLONS PER DAY [1500 GPD /ACRE OR 2500 GPD ACRE]
SQFT UNOBSTRUCTED AREA REQUIRED: SQFT
CHMARK /REFERENCE POINT
BE MAINTAINED FROM THE PROPOSED SYSTEM TO THE FOLLOWING,- FEATURES:
FT NQRMALLY WET? [ YES (, ] NO
RIVATE: /Vir FT NON - POTABLE: �- FT
FT POTABLE,WATER LINES: 10 FT
[Le,NO 10 YEAR FLOODING? [ ] YES [ NO
FT MSL /NGVD SITE ELEVATION: �.) FT MSL /NGVD
Munsell # /Color Texture
USDA SOIL SERIES:
Depth
to
to
to
to
to
to
to
to
to r
BELOW XISTING GRADE. TYPE: [PERCHED / APPARENT]
INCHES (_ABOVE / BELOW ] EXISTING GRADE.
MOTTLING( [/ j - YESG• 4(-. 1 0 R9EP(TH:/ `3 ts, INCHES
, ' .;`-; /`,fi' , J / � / �� / / ��t..J
/� O bEPTH OF EXC AVATION :3 INCHES
SOIL TEXTURE /LOADING RATE FOR SYSTEM SIZING:
DRAINFIELD CONFIGURATION: [ ] [BED [ ] OTHER (SPECIFY)
/fir
REMARKS /ADDITIONAL CRITERIA: /1 9ermdzs. ""7 ' (gc I'n r - Aiii P 71 p 1� / v14
DATE: d`
Page 3 of
INSTRUCTIONS:
PERMIT NUMBER: Permit tracking number by County Health Department.
APPLICANT: Property owner's full name.
AGENT: Property owner's legally authorized representative.
LOT, BLOCK, SUBDIVISION: Lot, block, and subdivision for lot.
PROPERTY ID NUMBER: 27 character number for property (property appraiser ID number or section /township /range /parcel number).
PROPERTY SIZE: Check if property at site conforms to submitted site plan. Record net usable area available - lot area exclusive of
all paved areas and prepared road beds within public rights -of -way or easements and exclusive of streams, lakes,
normally wet drainage ditches, marshes. or other such bodies of water.
SEWAGE FLOW:
UNOBSTRUCTED AREA:
Record the estimated sewage flow for the establishment from Table 1 (residence) or Table 2 (non - residential),
Chapter 10D -6, FAC. Record the authorized sewage flow for the lot based on net usable area and water supply
(1500 gallons per day per acre for private water supplies and 2500 gpd per acre for public water supplies). If
authorized sewage flow does not equal or exceed the estimated sewage flow, the application must be denied.
Record the square feet of unobstructed area available and the amount required. Unobstructed area must be at
least 2 times as large as the drainfield absorption area and at least 75 percent of the unobstructed area must meet
minimum setbacks in Chapter 1OD -6, FAC. The unobstructed area must be contiguous to the drainfield.
BENCHMARK INFORMATION: Record the location of the benchmark. If using a surveyor's benchmark record the actual elevation. Record the
elevation of the proposed system site in relation (above or below) to the benchmark.
MINIMUM SETBACKS:
Record minimum setbacks which can be meet to all listed features. Actual measurements must be recorded or
"NA" for nonapplicable features. Features on site plan or within 75 feet of the applicant lot must be measured.
The location of any public drinking well within 200 feet of the applicant's lot must also be verified.
FLOOD INFORMATION: Record information on lot's subject to flooding. For lots subject to flooding record 10 year flood elevation for
site and actual site elevation.
SOIL PROFILE INFORMATION: Two soil profiles within the proposed absorption area to a minimum depth of 6 feet or refusal are required. Soil
identification will use USDA Soil Classification methodology (Munsell colors and USDA soil textures). Refusals
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" as
appropriate. Record the estimated wet season water table elevation based on site evaluation, USDA soil maps,
and historical information. Indicate if there is high water table vegetation present. Indicate if mottling is present
and depth.
SOIL TEXTURE: Record soil texture or loading rate for system sizing.
DEPTH OF EXCAVATION: If applicable record depth of excavation required. Record "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 seal all documents submitted.
ELEVATION WORKSHEET ELEVATION OF BENCHMARK / REFERENCE POINT IS:
BENCHMARK SITE 1 SITE 2 SITE 3
[ + ] SHOT H.I. H.I. H.I.
H.I. [ - ] SHOT [ - ] SHOT [ - ] SHOT