402 NE 93 St (2)ADDRESS
402 N.
. 93rd Street LEGAL; 11 & 12 W ?. 50 See. //2 RECORD GARBAGE TAX
'�
1�9�
PAID BY
�r7� )� / /�` �Nf3T'� T.� nllf;tiQI1
1 4 ' � 7,-
YEAR
ANNUAL TAX
/
0 - yF1
PERIOD USED
A sib k
AMOUNT PAID
- L ' G ,
DATE PAID
RECEIPT
NUMBER
%
�/%
ING
TRICAL
?MBING
)wner of
uilding
Architect
Contractor
or Builder
Legal
r)escription
Address of
Building
Lot
i/wiZ
-02 #0
permit is granted to the contractor r builder named abode to
herefor'"in strict compliance with all ordinanc pertaining thereto and with
drawings, statements or specifications that may have been submitted to an
:ime if the work is not done in compliance with such ordinances or if the
*ranted is the understanding that the contractor or builder named above
,ertaining to the work covered hereby whether shown on the plans or d
one by his agents, servants or employees.
CONTRACTOR OR BUILDER
MIAMI SHORES VILLAGE, FLORIDA- -
PERMIT N? 10921
W • to : p ed under this Permit_
S ibdi-
v: sion
DAT
Contra Etoi s
License No
IN
In consideration of the issuance to me of t ermit I agree to perform the work covered hereunder in complian
taining thereto and in strict conformity with the p ta ents or specifications submitted to the proper
acceptin permit I assume respoibility for all work done y either, myself, ny agent, servant or employee.
V( ��
ixt
Amt. of
# 4IP
Permit $
P; og%Nt�, x
ilding or install the equipment or device describ d i he applic3
anding that the work will be performed in compliance with any plans,
proper municipal authorities. This Permit may be revoked at 'lty
ithout authorization. A further condition upon which this permit is
sibility for a thorough knowledge of the ordinances and regulations
ate nts . e • xis and that he assumes r - sponsibility for work
all ordinan and regulations
uthorities of Mia Shores Village.
BY AUTHORITY
%..
r
THIS LICENSE MUST BE DISPLAYED IN A CONSPICUOUS PLACE
A Penalty is imposed for failure tokeeeptthis license exhibited at your establishment or place of business
=
6j 1 TRIP LICATE
VILLAGE LICENSE E;
N^ 5165
This License Expires Au 2 .:t951
In consideration of the sum of
Paid to Miami Shores Village, Dade County, St ate of Florida,
Aid F.. Dutton Address -S NA. 9$$k Sweet
is hereby licensed to engage in or operate the business of
Owaer - bui14 T at osw re awes call at 02 x.r. 93M Street
For the period beginning Feberary 241951 and ending Avast 2 1951
subject to the Provisions of all ordinances.
(SEAL)
Date Issued
Fab 11
TeentilivA end 40100 Dollars $ 250
MIAMI SHORES VILLAGE, FLORIDA
By
J.D.H. VILLAGE MANAGER
p . 1
•6 THIS LICENSE NOT TRANSFERABLE WITHOUT APPROVAL OF THE VILLAGE MANAGER
• MI l� a ttm�o, MII T u ! ' lMMi fit ! �, ...:
• •���ir• �r �r••... ��r •.....•ir•.....�lr••....�r�r• ..�n•....•ft••....�lr �r•....• ii�°.'�°.'ii••....•n
INSPECTIONS
DATE
BY
RE- INSPECT
BY
RE- INSPECT
BY
FOUNDATION
/
3- - / (
SPECIAL PERMITS
PERMfT NO.
DATE
FEE
TEMPORARY SERVICE
BEAMS & LINTELS �~"�'
i
42i IA
VC
$
FRAMING
4 -2.1•S/
$
SOLAR HEATER
$
6 -r. r/
/. b -
$
FINAL
+/+
- --c- ;
�
DATE
BY
RE- INSPECT
BY
CLEAN -UP
/
�,,,,�� 0 -.{r •
ni+
/ ../.../
CONTRACTOR ki
11/).4 ...,., r V
PHONE 7r
PERMIT NO. / /J( t
DATE 1 ' 10 - S ,
i f
FEES X �
NEW BLDG.
L
ALTERATION ADDITION
REPAIRS
SPECIAL PERMITS
PERMfT NO.
DATE
FEE
TEMPORARY SERVICE
$
SEPTIC TANK
$
SEWER
$
SOLAR HEATER
$
GAS
$
INSPECTIONS
DATE
BY
RE- INSPECT
BY
RE- INSPECT
BY
�,,,,�� 0 -.{r •
ni+
/ ../.../
GAS
SEWER
SEPTIC TANK
eq a 3 -s?
//
,_4 .
SOLAR HEATER
t
FIXTURES
•-' ° /%
f
� _r,�.
ELECTRICAL PERMITS & INSPECTIONS
CONTRACTOR
� � j
PHONE
FEE S /1. Q,,jj
PERMIT NO. � DATE '
NEW BLDG. ALTERATION
ADDITION
REPAIRS
SPECIAL PERMITS
PERMIT NO.
DATE
FEE
TEMPORARY SERVICE
$
H. W. HEATER CONN.
$
RANGE CONN.
$
MOTORS
$
FIXTURES
$
$
INSPECTIONS
DATE
BY
RE- INSPECT
BY
RE- INSPECT
BY
TEMP. SERVICE
)- /0_ if /
''y
7
ROUGHING
I 6 -G -s/
> '
d
H. W. HEATER CONN
RANGE CONN.
FIXTURES & FINAL
rte
q-"' `' ;
_I \
,,. t .!
BUILDING INSPECTIONI 7 A 47
PLUMBING PERMITS & INSPECTIONS
i f
APPROVAL TO POWER CO. FOR SERVICE DATE
BY
EARLE L. DUTTON
402 N. E. 93rd Street
OWNER- BUILDER
BUILDING PERMIT NO
ZONE
X
REPAIRS
JOB LOCATION (ST. OR AVE.)
NEW CONSTRUCTION
ALTERATION
ADDITION
OWNER'S NAME
GENERAL CONTRACTOR
10921
REQUIREMENTS 20,000
SUBMITTED TO PLANNING BOARD
'RE- SUBMITTED TO PLANNING BOARD
SUBMITTED TO VILLAGE COUNCIL
DATE 2 -24 -51
APPROVED
CU. FT.
CBS 1 Tile
•
PRESENT ADDRESS
574 N. E.95th Street
LOT
#11 & 12
ADDRESS
REJECTED
BLOCK
5
402 N. E. 93rd Street
PERMIT FEE S 19
PLAN CUBE 24105
DRAWINGS, SPECIFICATIONS, RESTRICTIONS AND CUBE CHECKED BY:
TYPE STORIES ROOF CONSTRUCTION
JDH
DESCR IPTIO N
REFERRED TO COUNCIL
Sect. #2
CU. FT.
REMARKS
LICENSE NO.
SUBDIVISION
PHONE NO.
EST. COST $
CERTIFICATE OF OCCUPANCY NO. A I ISSUED I T' BY - 61 TO
BUILDING PERMIT AND INSPECTION RECORD -MIAMI SHORES VILLAGE
15,000
INTERIOR CONSTRUCTION
REASONS
PHONE NO.
LICENSE NO.
15
BUILDER•S BOND
NO. 8 DATE 2 -24-51
DATE
2.24 51
Ter. Floors- Plas.Wal is & Cell
Lia Rm- Din Rm- Jal Par - Kit - 2 car Att Gar 2 RPdrnOmS • 2 batlw
DESCRIPTION
N9 1299
CERTIFICATE OF OCCUPANCY
MIAMI SHORES VILLAGE, FLORIDA
BUILDING D VISION
Owner, Agent or Tenant of Building
Approved use by occupancy '
Miami Shores 'Tillage, Fla , F 1
Lot Block Subdivision
Street Address
Remarks.
This Certificate of Occupancy is issued to the ab 3 v named
for building at above named location only upon the express provision that the applicant will
abide by and comply with all conditions of Ordit ances Nos. 92, 93, 94 and 97, known as the
Zoning, Electrical, Plumbing and Building Ordina ices of Miami Shores Village pertaining to
the-erectisn, construction, alteration or remodeling of buildings or structures.
�ar�t�'C >ti o fv
BUILDING
ELECTRICAL
PLUMBING
Owner of
Building
Architect
Contractor
or Builder
l
MIAMI SHORES VILLAGE, FLORIDA
DATE , l ' ��_ 194—
PERMIT N° 4286
Work to be performed under this Permit_
Contractor's
License No.
Legal Lot ' Bl. f
Description «'
Address of
Building , , r
This permit i granted to the contractor or builder named above to construct i he building or to install the equipment or device described in the .pli-
cation herefor in strict compliance with all ordinances pertaining thereto and with th< understanding that the work will be performed in compliance w + any
plans, drawings, statements or specifications that may have been submitted to and ap,>roved by the proper municipal authorities. This Permit may be r - oked
at any time if the work is not done in compliance with such ordinances or if the plan; are changed without authorization. A further condition upon wh h this
permit is granted is the understanding that the contractor or builder named above as sumes the responsibility for a thorough knowledge the o , i es and
regulations pertaining to the work covered hereby whether shown on the plans or drawings or in the statements or specifications and th h: as u >'� respon-
sibility for work done by his agents, servants or employees.
CONTRACTOR OR BUILDER
Sul di-
visi m
Val ie of
Pro ect
Signed•
INSPECTOR
Amt. of
Permit
By
In cons . eratio •f the issuance to me of this permit I agree to perform the w +rk covered hereunder 4n compliance with all ordinances . regulations
pertaining the eto an in strict conformity with the plans, drawings, statements or s ?ecifications submitted to the proper authorities of Mia S +res Village.
In acceptin 1 is it I assume spo b 1 for all work done by either myself, n y agent, servant or employee.
AUTHORITY
n
� «*
l 1 74 !s iott o:4i
putt stA 46 :.azt *or* in iota
**tilt es't 81:1, rsgni en1 ;s ant _regn2,*tt*sis a
t Ad i t*tr tt
.i��
.
!lbolvissgs f'lemPts 61 1 be PrO
eabinsts t ttabi laa in $ti
rs a• s!+. +�d
less Boards shall bit ov te&.
. $ '11111.1 be • prvit '
- rlsari t bA of '1 *t 6 � . S* . , It tdmme4 rr <
g�fsih floors 1 b ,
s of 111.14612 itod .
Uvula shall bit :t•'$ `. Xr5 . t, s d
i litritsieti . ibiill bit et X. $ R ll • o ft
htags Roos shall b i - ►ith
Root braes sbea o: - , Oa
Wr -
•
' i oaf, ira11s -ex id ogi' mg i *hall b+ p .ae ter+ two eeit
'die +iii be ' teatare as rte leeted 4 t
erivilOvi and ped*ich wet 4e 03141: be gi vearl two ` t
ettd I*t*reot• ¶hnll 1, 41 of *Pit of e
•
a.r
'sy"
'47;
Page 2
IMPORTANT NOTICES
1, DO NOT BEGIN ANY WORK WITHOUT HAVING RECEIVED YOUR VALIDATED PERMIT AND PERMIT CARD. Applying for a permit does not grant
the right to begin construction. HOURS OF CONSTRUCTION are limited to Monday through Friday from 7:30 a.m. to 6:00 p.m., and Saturday from 8:00 a.m.
to 5:00 p.m. No inspections will be conducted on weekends or holidays.
2. All construction of demolition areas MUST BE MAINTAINED IN A CLEAN, NEAT AND SANITARY CONDITION free from construction debris.
3. STREETS AND NEIGHBORING PROPERTIES SHALL BE KEPT FREE FROM DIRT AND DEBRIS.
4. SWALES MUST BE PROTECTED FROM BEING DAMAGED BY EQUIPMENT OR VEHICLES, AND MAY NOT BE USED FOR STORAGE. A bond is
required for work in or near the street/sidewalk.
5. CONSTRUCTION TRAILERS ARE PROHIBITED ON SINGLE FAMILY RESIDENTIAL CONSTRUCTION SITES. Other construction may have a trailer
which requires a separate permit.
6. PORTABLE TOILETS for a construction site require a separate permit.
7. DO NOT DISCHARGE WATER INTO THE RIGHT OF WAY OR STORM DRAINS without approval from the Building, Planning and Zoning Department.
8. EQUIPMENT AND MATERIALS SHALL BE STORED at least 10 feet from the edge of pavement.
9. Department of Health and Rehabilitative Services (HRS) approval is required for applications involving septic tanks. Department of Environmental Resources
Management (DERM) and/or Miami -Dade Water and Sewer Department (MDW:VASD) approval is required for applications involving sewers.
A FFIDAVIT - Please read carefully.
Application is hereby made to obtain a permit to do work and installation as indicated. I, the OWNER of the property, 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, POOL, EXTERIOR DOOR, MECHANICAL, WINDOW, FENCE, DRIVEWAY,
ROOFING and SIGNS and there may be additional permits required from other governmental agencies.
I, the OWNER of the property, have disclosed all information related to any work at the property performed in the prior twelve
months to the Building Official. Further, I am fully aware that if thr: cumulative cost of work to my home or business under this and
any other permit equals or exceeds fifty percent (50 %) of the fair market value of the structure, the entire structure must meet the
present federal flood criteria for finished floor elevation. I am also fully aware that if the total cost of work to my home or business
under this and any other permit exceeds fifty percent (50 %) of the replacement cost of the structure, then the entire structure must
conform to the current code requirements of the Building Code.
WARNING TO OWNER: Your failure to record a NOTICE OF COMMENCEMENT may result in you paying twice for
improvements to your property. If you are spending more than $2,500 or intend to obtain financing, you may wish to consult with
your attorney or lender before recording your Notice of Commencement. The Notice of Commencement must be recorded at:
22 N.W. 1st Street, P' Floor, (305) 679 -1078. Once recorded, the Nctice of Commencement must be POSTED AT THE JOB SITE in
accordance with Section 713 -35 of Florida Statutes. Review tle brochure at Village Hall on Construction Lien Law and
Choosing a Contractor.
ST • : % 7 E FLORID COJJNTY OF MI I -DADE
r
Signature of Owner
C'zAJ�P�"TT-
subscribed be me this 134 day of 2 °:'" lA 3V�
Personally known 1 ' OR, Produced Identification
Type of Identification Produced:
ignatureief-Contctor/ Qdalifier
gn e of 1 stary 'ubli % $1.31e of Flo
o �
,i•
r .
N
SEAL:
PERMIT APPLICATION
Y F MIAMI -DADE
Print Name ,,,,
S . om to and subscribed before me this
Personally known OR, Produced Identification
Type of Identification Produced:
CONTRACTOR
New Construction
�2�>y�� /��j/
74 �, '�
�7
License No. !!//
License Jam
2iiiletez 44.........
Address � . /
Address
5-6
Home Telephone 3z6"---
K s
Telephone Fax
o c
�
Qualifier Name
Shell Only
PROPERTY OW
New Construction
� N � E � R
Name / �J Q��,� /.e,
/ j ,
2iiiletez 44.........
Address � . /
Repair
5-6
Home Telephone 3z6"---
K s
7 ss
o c
�
Business Telephones
Shell Only
Fax
Add'I Attachment
TYPE OF MANAGEMENT (✓ )
New Construction
Enclosure
Alteration Exterior
Repair
Alteration Interior
Demolish
Relocation of Structure
Shell Only
Foundation Only
Add'I Attachment
Other
Add'I Detachment
Other
INSTRUCTIONS - The following steps must he taken to obtain a permit from the Miami Shores Village:
Step 1.
Step 2. Submit the completed application with all necessary documents to the Building, Planning and Zoning Department for processing. During the
processing of your application, you may be asked to submit additional information.
APPLICATION
Job Address:
Complete the attached permit application which must be signed by the property owner and qualifier. Both signatures must be notarized. Please
print or type to allow for a more accurate processing of your application. If roofing work will be done, a roofing application must be submitted
along with this permit application.
Address Apt.
Folio Number 1 / . s O14 - OJLfr W..tD Description of Work
Lot 1/ / Block 3
Subdivision /i �f/'B PG Zoning Linear Feet
Current Use of Property - /Z 5AJ�_L' Square Feet Units Floors
Proposed Use of Property 5 /NC/1. Value of Work /0 69 0 • 00 Bldg Value
Tenant Information Tax Assessed/Appraised Value
Flood Zone Base Floor Elev.
PERMIT TYPE (✓ )
Building
Electrical
Mechanical
Plumbing
LPGX
Roofing
Fence
Other
PERMIT CHANGE (✓ )
Chg. Contractor
Renewal
Revision
Extension
Supplement
Reinspection
ARCHITECT
Name
License No.
Address
Telephone
Fax
Master Permit No.
PERMIT APPLICATION
3)
Subsidiary Permit No. :§30 ¥3
,5
City
33/ �g
State
Zip
c
ENGINEER
Name
License No.
Address
Telephone
Fax
210'
PAY
TO THE
ORDER OF
FOR
LLOYD NORTH DADE SEPTIC
750 NW 107TH ST.
MIAMI, Fl 33168
Washington Mutual
Washington Mutual Bank, FA
North Miami/7th Avenue Financial Center 1746
12600 NW. 7 Avenue 1
North Miami, FL pk68 24 hoyr Custornm Service
14 0.9 4). 1.? Y3A2 91-
DATE -o/ 63-8413/267
11'00 2 LO4v 1: 267084 L 3 LI: L9 3111 2009 2 So'
■!`,77.--StBM ,
DOLLARS IS
Does
/)
(Ck A,7/0 dc
APPLICANT:
AGENT:
/ � 1
PROPERTY ADDRESS: 1 .7X may 1 � �- • 7 _� �. '� n
LOT :• -
=======================-w-----
CHECKED [X] ITEMS ARE NOT IN COMPLIANCE
==.=======
TANK
[01]
[02]
[03]
[04]
[05]
[06]
[07]
[08]
[09]
DRAINFIELD INSTALLATION f
[10] AREA [1],f.< X C 5 - ' .. SQFT
[11] DISTRIBUTION BOX _ HEADER !f
[12] NUMBER OF DRAINLINES
[13] DRAINLINE SEPARATION
[14] DRAINLINE SLOPE
(15] DEPTH OF COVER &. y �
[16] ELEVATION [ABOVE /BELOWp BM -
[17] SYSTEM LOCATION -T
[18] DOSING PUMPS
[19] AGGREGATE SIZED-
[20] AGGREGATE EXCESSIVE FINES
[21] AGGREGATE DEPTH , i -
FILL
[22]
[23]
[
[25]
[26]
STATE OF FLORIDA
'DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT AND DIPOSAL SYSTEM
CONSTRUCTION INSPECTION AND FINAL•APPROVAL
BLOCK:
SUBDIVISION:
i
INSTALLATION
TANK SIZE [1j. /C` C) [2]
TANK MATERIAL
OUTLET DEVICE
MULTI - CHAMBERED [ Y / N ]
OUTLET FILTER
LEGEND : `' 1; _ •) :
x,i
WATERTIGHT z ,
LEVEL
DEPTH TO
-/ EXCAVATION MATERIAL
FILL AMOUNT" l/ r'
FILL TEXTURE
EXCAVATION DEPTH
AREA REPLACED .
REPLACEMENT MATERIAL
EXPLANATION OF VIOLATIONS / REMARKS:
u .>
•
4 1
CONSTRUCTIO APPRO�V D/DISAPPROVED] 7 7 /yn 7 r> -
FINAL SYSTEM APPROVVENDISAPPROVED] �,...e 0` _ F
/ %
-
WITH STATUTE OR RULE. AND MUST 'BE CORRECTED.
[
DE 4016, 10/97 (Previous Editions Be Used)
INSTALLER / CONTRACTOR
PERMIT NO•, ! -
DATE PAID: / -
FEE PAID:
RECEIPT ft
PROPERTY ID #:
SETBACKS
[27] SURFACE WATER
[28] DITCHES /.1 1 '� .t -` -
(29] PRIVATE WELLS F/ i y=am
[303 PUBLIC WELLS ; +y '..: FT
[31] IRRIGATION WELLS FT
(32) - POTABLE WATER LINES . 1C'? FT
[33] BUILDING FOUNDATION FT
[34] PROPERTY LINES' J FT
[35] OTHER FT
FT
FT
FT
FILLED / MoUND
[36] DRAINFIELD:OOVER
[37] SHOULDERS_
[38] SLOP88
[39] STABILIZATION
ADDITIONAL-INFORMATION -
[40] UNOBSTRUCTED AREA
(413 STORMWATER RUNOFF _ •
[42] .: ALARMS
[43] MAINTENANCE AGREEMENT
[44] BUILDING AREA
[45) LOCATION -- CONFORMS WITH SITE PLAN-7_,
[46] FINAL 8/T8 - y
[47] CONTRACTOR . A / .. ; `.t
(48] OTHER ,E,-• �,. -
1-
ABANDONMENT
[491. TANK PUMPED 4L/LL/(2;
(50] TANK CRUSHED i FILLED j_% / L
< J --�
} -1
/
CHD DATE t I -< / / Q /•
CHD DATE" 1 ^ /' c
Page 2 of 3
CONSTRDCTIO;
FINAL SYS P )tGiV 4D >p>itbVEDj _
DH 4016; .(PrOv : ld tioiis itay Be Used)
[27) 'SURFACE' fay ,
[28) 'DITCHES
1;91 PRivATS •WELLS
[ 31) I tA IOATICIT
33 - POTA$L } `HATER LThES" /C'
[331
*00149
i34) AOPERTY LI>ls88 :
r{ ;
IL i[OU SY STEM
air %1
1NFII Wg0VER
APPLICANT:
AOIRNT$ r� -r ".J 2 4 t
LOT 41- k BLOCK: % SUBDIVISIONs IDf1
CHECKED (X ] ITEMS ARE -NOT lit :COMPLIANCE WITH STATUTE OR RULE
TANK INSTALLATION
] [ .TANK SIZE [ljfo. [?) �.
] [02 ] . TANK N#ITERIAL
l [03]:OUTLET p$VICS •
] [04] • NuLTI ;C�BSRED [ Y / N
[05 ] - . OUTLET i!YLT R Z
]
y[05] ' LEGEHD,, '
rR ��,
] [07] M TER_TIG� 4 .
1091: DEP TH ' LIDr
DRAINFIFI4, ]<NS'+ATZON
I l [ it ) A
[ 1
1111 :EISTRXBU40 : 0X ...
[ ] - [ 1Z) `NUMBER DP' :DRAI
[ 1
I l
I ]
•
I
[ 1.
[ ] [ 18)
I T . I19) ; Aet RBOAT8 ,8I8> . .S: A
[ ] _ [20) •AGO Ef TIi'$ZCLSSIV$
I 1; �A4GREC AT'S • DEPTS,./ =Z '.
STATE 07 FLORIDA
DEPARTMENT . .OF HEALTH .
ONBITE :SEWAGE .TREATMENT AND
CONSTRUCTION INSPECTION' AND
[
ill' ' `'DRAINLII .'S ARATIOK
[ 14) " ..DRAII L 1!iS: sOr $ •
[ 15 ] ',DEPT. - OF .COVER j
[16) ' ". ELEVATION {ABO�
[. SYSTI r+
] 22 j : • t.
] . . 123). ,.,
} 24 ) . DECA Yd11
] . [ 25 ] .••, AREA 'RBPLAcB
) [26) REPLACEMENT
EXPLANATION Or 7 V1QLATION8.
[ 1
I ]
[ 1
I
I
1
BUILDING DEPARTIAENT
J
PE8NIT NO - 3 t - r
DAT! PAID*. / _
DIPOSAL BYSTEJI ` Pap=
:1111:111i PPBOVAL
•
J • _f ' / r
am _DATES I
- c
t ::
�: �. Page 2 of • 3
CONSTRUCTION PERMIT FOR:
[ ]New System [ ]Existing System [ ]Holding Tank
[ X ]Repair [ ]Abandonment [ ]Temporary
APPLICANT: Generette, William
STATE OF FLORIDA
DEPARTMFNT OF HEALTH
ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM
CONSTRUCTION PERMIT
PROPERTY STREET ADDRESS: 402 NE 93 St Miami Shores FL 33138
LOT: 11 -12 BLOCK: 50 SUBDIVISION: Miami Shores
( ] Innovative Other
[ IN ] Infiltrator
AGENT: SR0001343, Crockett Lester
[Section /Township /Range /Parcel No.]
PROPERTY ID #: 11- 3206 - 014 -0220 [OR TAX ID NUMBER]
SYSTEM MUST BE CONSTRUCTED IN ACCORDANCE WITH SPECIFICATIONS AND STANDARDS OF CHAPTER 64E -6,FAC
• DEPARTMENT APPROVAL OF SYSTEM DOES NOT GUARANTEE SATISFACTORY PERFORMANCE FOR ANY SPECIFIC TIME
PERIOD. 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. ISSUANCE OF THIS PERMIT DOES NOT EXEMPT THE APPLICANT FROM
COMPLIANCE WITH OTHER FEDERAL, STATE OR LOCAL PERMITTING REQUIRED FOR PROPERTY DEVELOPMENT.
SYSTEM DESIGN AND SPECIFICATIONS
T [ 900 ]Gallons SEPTIC TANK ILI r MULTI- CHAMBERED /IN SERIES: [Y ]
A [ 0 ]Gallons MULTI - CHAMBERED /IN SERIES: [Y ]
V [ 0 ]GALLONS GREASE INTERCEPTOR CAPACITY
C [ 0 ]GALLONS DOSING TANK CAPACITY [ 0 ]GALLONS @ [0 ]DOSES PER 24 HRS # PUMPS[ 0 ]
[ 200 ]SQUARE FEET PRIMARY DRAINFIELD SYSTEM
[ 0 ]SQUARE FEET SYSTEM
1 , TYPE SYSTEM: [sit ]STANDARD [ N ]FILLED [ N ]MOUND ( N ]
I CONFIGURATION: [ JTRENCH [ [DS/] BED [ N ]
LOCATION TO BENCHMARK: Finish Floor of Exis inc Res. Elev. 11.4' NGVD
ELEVATION OF PROPOSED SYSTEM SITE [ 2.4 [ FEET ] [ BELOW BENCHMARK /REFERENCE POINT
BOTTOM OF DRAINFIELD TO BE [ 4.9 ] [ FEET ] [ ]BENCHMARK /REFERENCE POINT
) FILL REQUIRED: [ 0.0 ]INCHES EXCAVATION REQUIRED: [ 30.0 ] INCHES
)THER REMARKS:
Install New 900 Gallons Septic Tank.
Install 300 Square feet Drainfield.
Invert Elevation of the Drainfield to be no less than 7.0' NGVD.
Bottom Elevation OF the Drainfield to be no less than 6.5' NGVD.
This permit is not for addition.
> PECIFICATIONS BY: Andre, Paul
PPROVED BY: Andre, Paul
)ATE ISSUED: 12/13/01
TITLE: : j
TITLE: EH Supervisor
CENTRAX #: 13 -SG -11221
DATE PAID:
FEE PAID : $
RECEIPT .
OSTDSNBR : 01 -3792- -R
•
Dade CHD
EXPIRATION DATE: 3/13/02
H 4016, 03/97 (Obsoletes previous editions which may not be used)
Stock Number: 5794 - 001 - 9016 -0) (ostds_cons_4016 -1( Page 1 of 2
PAYMENT FORM: Check 2103
1725 North West 167 Street, Miami,
RECIEVED FROM: Generette, William AMOUNT PAID: $75.00
PAYING ON: 13 -SG -11221 01- 3792 -R
PAYMENT DATE: December 13, 2001
PROPERTY LOCATION:
Lot: 11 -12 Block: 50 Miami Shores
Property ID 11- 3206 - 014 -0220
EXPLANATION or DESCRIPTION: PERFORMANCE -BASED SYSTEM FEE
Application for permitting of an onsite sewage treatment and disposal
system, which includes application and plan review $ 25.00
Site evaluation for a new system which includes an evaluation of criteria
specified in rule 64E- 6.004(3)
Site evaluation for a system repair which includes an evaluation of criteria
specified in rule 64E- 6.015(1)
Site re- evaluation, new or repair
Permit for new system, including standard subsurface, filled or mounded
system $ 0.00
New system installation inspection $ 0.00
Research fee to be collected in addition to and concurrent with the
permit for a new system installation fee $ 5.00
Repair permit issuance, which includes inspection $ 45.00
Inspection of a system previously in use $ 0.00
Reinspection fee per visit for site inspections after system construction approval $ 0.00
or Installation reinspection for non - compliant system per each visit $ 0.00
System abandonment permit, includes permit issuance and inspection $ 0.00
Variance application for a single - family residence per each lot or building site $ 0.00
Variance application for a multi - family residence or commercial building per each
building site
RECEIVED BY: dm AUDIT CONTROL NO. S011213001
APPLICANT:
LOT: / ; ; ,•,
STATE OF FLORIDA
DEPARTMENT OF HEALTH
ONSITE SEWAGE DISPOSAL SYSTEM
SITE EVALUATION AND SYSTEM SPECIFICATIONS
;,
L[.; 17r ;,
BLOCK:
PROPERTY ID #: i j 6�
TO BE COMPLETED BY ENGINEER, HEALTH UNIT EMPLOYEE, OR OTHER QUALIFIED PERSON. ENGINEER'S MUST
PROVIDE REGISTRATION NUMBER AND SIGN AND SEAL EACH PAGE OF SUBMITTAL. COMPLETE ALL ITEMS.
PROPERTY SIZE CONFORMS TO SITE
TOTAL ESTIMATED SEWAGE FLOW:
AUTHORIZED SEWAGE FLOW:
UNOBSTRUCTED AREA AVAILABLE:
BENCHMARK /REFERENCE POINT LOCATION: r I • /l.., _ / . J � j OZ�: /,1 /
ELEVATION OF PROPOSED SYSTEM SITE IS _. (INCEIES /FT] [ABOVE;(BELOWJ ^,BENCHMARK /REFERENCE POINT
THE MINIMUM SETBACK WHICH
SURFACE WATER: A : AY/ - FT
WELLS: PUBLIC: ?•_J FT
BUILDING FOUNDATIONS:
SITE SUBJECT TO FREQUENT FLOODING: [ ] YES (4 NO
10 YEAR FLOOD ELEVATION FOR SITE: L FT MSI, /NGVD
SOIL PROFILE INFORMATION SITE 1
Munsell # /Color
6 . 'C
i
USDA SOIL SERIES:
Texture Depth
j_ x/94 /) to
?r
/!
t / f)
" to
to
to
to
to
to
to ;12
OBSERVED WATER TABLE: i i INCHES (ABOVE / BELOW] 13XIS ING. GRADE. TYPE:..[PERCHED / APPARENT]
ESTIMATED WET SEASON WATER TABLE ELEVATION(" / NCHES`[ ABOVE<BELOW) EXISTING GRADE.
HIGH WATER TABLE VEGETATION: [ ] YES ('1 NO M07,7LING: -[' ] YES [ - -] NO DEPTH: 4/ ./1. INCHES
SOIL TEXTURE /LOADING RATE FOR SYSTEM SIZING: /•12 DEPTH OF EXCAVATION: ,.%i_/ INCHES
DRAINFIELD CONFIGURATION: [ ] TRENCH [r BED [ ] OTHER (SPECIFY)
REMARKS /ADDITIONAL CRITERIA:
SITE EVALUATED BY: \-. - '..,J<7 1,/21 L• " :%!.4°r /rf
DH 4015. 10/98 (Replaces HRS-H Form 4015 (Page 3] which may be used)
(Stock Number: 5744 -003 - 4015 -1)
SUBDIVISION: ,,
�.j
CAN BE MAINTAINED FROM THE
DITCHES /SWALES:
LIMITED USE: FT
FT PROPERTY LINES:
AGENT: if./ n N.,/.7,1
[Secion /Township /Range /Parcel No. or
PLAN: [ .T/YES ( ] NO NET USABLE AREA AVAILABLE: ' -;-/ ACRE:
GALLONS PER DAY [RESIDENCES -TABLE 1 / OTHER -TABLE 2]
-/.2) GALLONS PER DAY [1500 GPD /ACRE OR 2500 GPD /ACRE]
"1 L. SQFT UNOBSTRUCTED AREA REQUIRED: ,> SQF1
PROPOSED SYSTEM TO THE FOLLOWING FEATURES:
4 /:9 • FT NORMALLY WET? [ ] YES -A ( ] NC
PRIVATE: ' t% /:: FT NON-POTABLE: _' .KO F7
a� FT POTABLE WATER LINES: JO F7
S:)LL, PROFILE INFORMATION SITE 2
Munsell # /Color Texture
(;r fv
i-
r
USDA SOIL SERIES:
PERMIT #
10 YEAR FLOODING? [ ] YES _ _ [ ' ] NO
SITE ELEVATION: Li. (FT MSLJNGVI)
r•.
,5= /, i I
Tax ID Number]
Depth
to
to /[i''
to
to
to
to
to
to
to
DATE: , / � � , � 7 - r
Page 3 of 3
Scale: Each block represents 10 feet and 1 inch = 40 feet. o>
- - -- -
STATE OF FLORIDA
DEPARTMENT OF HEALTH
APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PERMIT
Permit Application Number
Site Plan submitted by:
Plan Approved -
By
C > ti e, n�
i
(
PART II - SITEPLAN
v •
0
Notes:
Not Approved
4 -"
i/
G /.,`/
ALL CHANGES MUST BE APPROVED BY THE COUNTY HEALTH DEPARTMENT
Date
County Health Department
DH 4015, 10/96 (Replaces HRS-H Form 4015 which may be used) Page 2 of 4
(Stock Number. 5744-002 - 4015 -6)
ELECTRICAL
TYPE QTY. TYPE
QTY. 'I'VPE
QTV.
TYPE. QTY.
Minimum Fee
QT\
Dryer
Q . I . y
Outlet, Appliance
Service Repair
A/C Central 1 -3 Ton
Fan
Outlet, Wall
Service, Temporary
A/C Central 4 -7 Ton
Fire Pump
Outlet, Switch
Signs
A/C Central 8 -15 Ton
Cap - Water
Fixture - Fluorescent
Gas - Appliance
Oven
Pump, Domestic
Space Heater (kw)
Supply, AC Well
A/C Central 16-20 Ton
Cap - Sewer
Fixture Light
Gas - Natural
Parking Lot Lights
Pump, Fire Stand
Spas/Hot Tubs
Temporary Toilet
A/C Central 20+ Ton
Catch Basin
Flood Lights
Gas - Propane
Plugmold/Strip
Pump, Re- circulate
Subfeeds, No. of Amps
Temporary Water Closet
A/C Window
Clothes Washer
FPL - Load Central
Gas Piping
: ?osts
Pump, Replace - Pool
Swim Pool, Commercial
Urinal
Air Conditioners
Dental Chair
Garbage Disposal
Grease Trap
Range/Range Top
Pump,, Sprinkler
Swim Pool, Residential
Utility - Sewer
Utility - Water
Chiller
Discharge Well
Generators, etc.
Ice Maker
Receptacles
Pump, Sump
Switchboards
Clear Violations
Heat Recovery
Refrigerator, Comm. (p/PH)
Temp Serv., Construction
Compactor
Low -volt, Burglar
refrigerator, Domestic
Temp for Test - 30 days
Deep Freezer
Low -volt, Fire
renew - Temp Service
..
Water Heater New
Demolition
Low -volt, Intercom/1'eleph.
Repair Circuits
Water Re -pipe
Water Service
Dishwasher
Low -volt, Television
S, ^rvice, Number of Amps
Drains, French
Miscellaneous Equipment
I\1ECI-IA NICAL
.
Minimum Fee
Q . I . V .
TYPE
Condensate Drain
Q . I . Y .
T}
Generator
QT\
' rypi ,
Refrigeration, Tons
Q . I . y
A/C Central, Tons
Cooling Tower
Heating Strips, each
Vent Hood, Cost
A/C Wall/Win. Tons
Dryer Vents, Number of
Pant Booth
Ventilation, Cost
Air Handler, Tons
Ductwork, Cost of
Piping, Flammable Liquid
Cap - Water
Periodic Inspections
Gas - Appliance
Barbecue
Pump, Domestic
Fire Sprinkler System
Supply, AC Well
Prccess/Pressure Piping
Cap - Sewer
Gas - Natural
Bath Fan - Vented, #
Pump, Fire Stand
Fireplaces, Number of
Temporary Toilet
Pressure Vessel
Catch Basin
Gas - Propane
PLUI\1BING
TYPI.:
A/C Condensate
QTY.
TYPE
Drains, Roof
Q'I'Y.
TYPE
Miscellaneous Fixture
()Ty.
'IY'PI..
Soakage Pit
)TV.
Bath Tub
Drinking Fountain
Miscellaneous Repairs
Solar Water Heater
Bidet
Filter Replace
Pool Ding
Sprinkler Repair
Sprinkler System
Cap - Fixture
Fountain
Pum;,i and Abandon
Cap - Water
Gas - Appliance
Pump, Domestic
Supply, AC Well
Cap - Sewer
Gas - Natural
Pump, Fire Stand
Temporary Toilet
Catch Basin
Gas - Propane
Pump, Re- circulate
Temporary Water Closet
Clothes Washer
Gas Piping
Pump, Replace - Pool
Urinal
Dental Chair
Grease Trap
Pump,, Sprinkler
Utility - Sewer
Utility - Water
Discharge Well
Ice Maker
Pump, Sump
Dishwasher
Indirect Wastes
Interceptor
Relay fair
Roof I:ilet
Vacuum Pump
Water Closet
Disposal
Domestic Well
Laundry Tray
Septic Connection
Water Heater
Drainfield, 4" Tile/Res.
Lavatory
Septic Tank
..
Water Heater New
Drains, Area
Meter Set (Gas)
Sewer Connection
Water Re -pipe
Water Service
Drains, Floor
Minimum Fee
Shower
Drains, French
Miscellaneous Equipment
Sink
Well, Supply
Page 3
PERMIT APPLICATION
INSTRUCTIONS: Please indicate the type of work being performed and quantity(ies) in the space provided below.
RECEIVED AND REVIEWED BY: DATE:
Page 4
OFFICE USE ONLY
CHECKLIST
❑ OWNER - BUILDER FORM
(Attach)
❑ FIRE DEPARTMENT
APPROVAL (Commercial /
multi- family)
❑ CONCURRENCY
(New Construction)
❑ OTHER
(Specify & Attach)
❑ PROOF OF OWNERSHIP
(Attach)
❑ HRS / DERM APPROVAL
(Septic / Sewer)
❑ IMPACT FEE
(New Construction)
❑ OTHER
(Specify & Attach)
PERMIT FEES
$3.00 per page (Scanning Fee) $
Miami Shores Village
Bond
Metropolitan Dade County (C.C.F.) $ (sq.ft. = x/1000
x 0.60)
(¢.005 /sq.ft.)
Inspector State Educational Fund $
State DCA (Radon)
Code Enforcement Fine
Zoning Review
$ (4.01 /sq.ft.)
$
REVIEWED AND PREPARED BY:
SECTION
Zoning
Electrical
Mechanical
Plumbing
Fire
Public Works
Structural
Building Official
BY
DATE
PERMIT APPLICATION
❑ CONDO ASSOCIATION APPROVAL
(Attach)
❑ BPR APPROVAL (Restaurants)
❑ CONTRACTOR REGISTRATION
(On File)
TOTAL $
ISSUING OFFICIAL
DATE:
CONDITION OF APPROVAL
Revised July 2001
10050 N.E. 2ND AVE., MIAMI SHORES, FL • (305) 795 -2207 • FAX (305) 756 -8972 • http : / /www.miamishoresvillage.com