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445 NE 93 St (6)PERMIT APPLICATION FOR MIAMI SHORES VILLAGE Date 12 .- Job Address 01/ /' 7 j .S Tax Folio Legal Description Historically Designated: Yes No I/ Owner/Lessee / Tenant fG k f c 7re ti Master Permit # Owner's Address Y+< IV( f 3 , 5 Phone Contracting Co. Mortgagor WORK DESCRIPTION Square Ft. 7v Signature I /owner and/or C •. LORRAINE J. ZERO d9/" 4/ / R /+c �r Qualifier fi G11/" (' d o h rr-f d /'V' SS# Phone State # / 700' Th3 2 Municipal # / 9 C 3f Competency # Architect/Engineer Address B Company Address Permit Type (circle one): BUILDING ELECTRICAL ' LUMBING ECHANICAL ROOFING PAVING FENCE SIGN Pi 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. President Notar lolatgt anther fitialitmoCEIfidgPresident My Cc9iPJQllo FEES: PERMIT 3.s RADON Date Date APPROVED: Zoning Building Mechanical Plumbing Address Estimated Cost (value) / 2- O a LARRAINF .1 7ERO Notary Fi1My t6IIan etwioniluilder My Cc:AMOS IBIJOUisscict 24, 1999 t4 fS505204 al 0 C.C.F. J- NOTARY Address 7 7 U / t4V 1 /et "—a— Signature of Contractor or r-Builder at e Electrical Ins. Co. C Date BOND 3 a O TOTAL DUE 5 �> ° � Engineering APPLICATION FOR: , [/1/] New System [/ ] Existing System [k] Holding Tank VA Temporary /Experimental (y] Repair [hi] Abandonment (//] Oth Specify) S J.PPLI CANT: ;4 y�4 L- <T�. 4, AGENT MAILING ADDRESS: TO BE COMPLETED BY APPLICANT OR APPLICANT'S AUTHORIZED AGENT. ATTACH BUILDING PLAN AND TO -SCA, SITE PLAN SHOWING PERTINENT FEATURES REQUIRED BY CHAPTER 10D -6, FLORIDA ADMINISTRATIVE CODE. PROPERTY INFORMATION (IF LOT IS NOT IN A RECORDED SUBDIVISION- ,- LEGAL DESCRIPTION.OR DEED LOT: BLOCK: PROPERTY ID #: PROPERTY SIZE: PROPERTY STREET ADDRESS: DIRECTIONS TO PROPERTY: BUILDING INFORMATION Unit Type of No Establishment 1 /) 2 3 4 STATE OF FLORIDA DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES ONSITE SEWAGE DISPOSAL SYSTEM APPLICATION FOR CONSTRUCTION PERMIT Authority: Chapter 381, FS & Chapter 10D -6, FAC 71 C% / v/ l i' /n //./ /•=7/-e' 4/ A-- [ ] Garbage Grinders /Disposals [ ] Ultra -low Volume Flush Toilets APPLICANT'S SIGNATURE: 1}0 E % 5 s7 7 c AO' y• v e- Bedrooms Area Sgft Served PERMIT # DATE PAID FEE PAID RECEIPT # TELEPHONE: 7 S) 2 9 l SUBDIVISION: /9-- / �, / DATE OF L\ V ? J SUBDIVISION: [Section /Tow /Ra l /Parcel No.] ZONING: ACRES [Sgft /43560] PROPERTY WATER SUPPLY: [ ] PRIVATE (L PURL: `t _S L" 3 st f r 33/ [4 RESIDENTIAL [ ] COMMERCIAL No. of Building # Persons Business Activity For Commercial Only [ ] Spas /Hot Tubs [ ] Floor /Equipment Drai, ( ] Other (Specify) DATE: / 7 ` z — HRS -N Form 4015, Mar 92 (Obsoletes previous editions which may not be used) Page 1 of (Stock Number: 5744-001-4015-1) D R A I N F I E L D 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 10D -6, FAC CONS,IrRUCTION PERMIT _F9 � [ jj New System [API xisting System [/�] olding Tank [7] Repair [/ [ ] Abandonment APPLICANT. 0U (.,. AGENT: 4 PROPERTY STREET ADDRESS: 44,4r-- e s /► LOT: �t / A BLOCK: A/ SUBDIVISION: , `'.' PROPERTY ID #: yv SYSTEM MUST BE CONSTRUCTED IN ACCORDANCE WITH SPECIFICATIONS AND STANDARDS OF CHAPTER 1OD -6, F.. REPAIR PERMITS AND HOLDING TANK PERMITS EXPIRE 90 DAYS FROM THE DATE OF ISSUE. ALL OTHER PERMIT EXPIRE ONE YEAR FROM THE DATE OF ISSUE. HRS APPROVAL OF SYSTEM DOES NOT GUARANTEE SATISFACTOR1 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. SUS' MODIFICATIONS MAY RESULT IN THIS'.PERMIT BEING MADE MULL AND VOID. SYSTEM DESIGN AND SP•CIFICATIONS GPDZIC TAN_Kf AEROBIC UNIT [ ,] [GALLONS / GPD] [ ] GALLONS GREASE INTERCEPTOR CAPACITY [ ] GALLONS PER I}OSE, ?DOSING TANK CAPACITY A Vor /(ct.�J 37] SQUARE FEET PRIMARY DRAINFIELD SYSTEM [ ] SQURE FEET [GALLONS SYSTEM TYPE SYSTEM[ [ ] STANDARD [ CONFIGURATION: [ ] TRENCH LOCATION op BENCHMARK: U.S 47;P ^..P ELEVATION; :OF PROPOSED SYSTEM SITE [/ O,� BOTTOM OF.I DRAINFIELD TO BE [ �� 6 • f t FILL.REQUIRED: SPECIFICATIONS BY: APPROVED BY: DATE ISSUED: [ / 2 - 3 .:CTTON 4J ] Other(Specify) [SECTION /TOWNSHIP /RANGE /PARCEL NUMBER] [OR TAX ID NUMBER] ] FILLED [ ] MOUND J BED [ ] [ NCHES /FT] BOVE BENCHMARK/REFERENCE-1;49441 [INCHE /FT] [ABOVrBEL W1, BENCH REFERENCE POIN'j ] INCHES EXCAVATION REQUIRED: [3 � L ] INCHES ._ : ri. i / • TITLE: TITLE: CAPACITY MULTI- CHAMBERED /IN SERIES:[ CAPACITY MULTI CHAMBERED /IN SERIES:[ [MAXIMUM CAPACITY SINGLE TANK: 1250 GALLONS DOSE RATE PER 24 HRS NO. OF PUMPS: [ [ ] [ ] cis tiTT? ,414 ! ; HRS -H Form 4016, Mar 92 (Obsoletes previous editions which may not be used) " " u "LE6 1.0 (Stock Number: 5744- 001- 4016-0) INSTALLER /CONTRACTOR • PERMIT # 2-20 DATE PAID FEE PAID $ •C!!) RECEIPT # (/r Temporary /Experimental 1 / CPHU EXPIRATION DATE • 3 �C Page 1 of 2 PROPERTY ID #: [SECTION /TOWNSHIP /RANGE /PARCEL NUMBER] [OR TAX ID NUMBER] CORUCTION PERMIT _ � [IV] New System [/VJ Existing System [/"] lding Tank [/A] Temporary /Experimental ' [ ] Repair [ ] Abandonment ] Other(Specify) APPLICANT: PROPERTY STREET ADDRESS: LA _ � - LOT: 4/ A BLOCK: pSUBDIVISION: /"-.,[ SYSTEM MUST BE CONSTRUCTED IN ACCORDANCE WITH SPECIFICATIONS AND STANDARDS OF CHAPTER 10D -6, 1'. REPAIR PERMITS AND HOLDING TANK PERMITS EXPIRE 90 DAYS FROM THE DATE OF ISSUE. ALL OTHER PERM1 EXPIRE ONE YEAR FROM THE DATE OF ISSUE. HRS APPROVAL OF SYSTEM DOES NOT GUARANTEE SATISFACTOR. 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. SUS MODIFICATIONS MAY RESULT IN THIS PERMIT BEING MADE NULL AND VOID. SYSTEM DESIGN AND T A N K D R A I N F I E L D 0 T H E R [792 ( GPD "r IC TANK`,AEROBIC UNIT [GALLONS / GPD] GALLONS GREASE INTERCEPTOR CAPACITY GALLONS PER SE DOSING TANK CAPACITY 3 07, vo. / ( f ] SQUARE FEET PRIMARY DRAINFIELD SYSTEM ( j SQUARE FEET TYPE SYSTEM; CONFIGURATION: ] LOCATION OF BENCHMARK: ELEVATION OF PROPOSED SYSTEM SITE [ 10,81 [ NCHES /FT] BOTTOM OF DRAINFIELD TO BE [ � (iINCHEs /FT) FILL REQUIRED: [ q1 (:1 il�.. t >I C'I'IO ir; �., L Su tvi: "i �i�Y (S) BOTTOM GEL - -:.1 __L• SPECIFICATIONS BY: APPROVED BY: STATE OF FLORIDA DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES ' ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PERMIT Authority: Chapter 381, FS & Chapter 10D -6, FAC AGENT: � O4 7 4s ,4 p�� 4 FCIFICATIONS [ [ ] STANDARD ] TRENCH ] INCHES EXCAVATION REQUIRED: r3 L ] INCHES aigwr SYSTEM [ ] FILLED [ ] BED TITLE: APPLICANT PERMIT # �(p DATE PAID / L -- .3' - 7 FEE PAID $ Ste' RECEIPT # 0' /17 /4 - Pc CAPACITY MULTI- CHAMBERED /IN SERIES:I CAPACITY MULTI- CHAMBERED /IN SERIES:[ [MAXIMUM CAPACITY SINGLE TANK: 1250 GALLONS DOSE RATE [ ] PER 24 HRS NO. OF PUMPS: [ [ ] MOUND [ ] [ BENCHMA [ABOIAZEELIOY BENCHMARg5EFERENCE POIf TITLE CPh DATE ISSUED: / r EXPIRATION DATE THE SEPTIC TANK SHALL BE PU,IIPED AHD A SOLID bEFLECTIO;if DEVICE INSTALLED ON THE OUTLET TEE HRS -H Form 4016, Mar 92 (Obsoletes previous editions which may not be used) (Stock Number: 5744- 001 - 4016-0) Page 1 of APPLICANT: LOT: THE MINIMUM SETBACK WHICH SURFACE WATER: , //,/ • J FT WELLS: PUBLI9�:� ' (V J FT BUILDING,.F�OyI�ATIONS : SOIL PROFILE INFORMATION SITE 1 SITE EVALUATED BY: STATE OF FLORIDA DEPARTMENT OF HEALTH AND R$HABILITATIVE SERVICES ONSITE SEWAGE DISPOSAL SYSTEM SITE EVALUATION AND SYSTEM SPECIFICATIONS BLOCK: SUBDIVISION: CAN BE MAINTAINED FROM THE DITCHES /SWALES :. 4 USE : PROPERTY LINES: SITE SUBJECT TO '/ FREQUE FI0,G : [ ] YES ( L- J i 0 10 YEAR FLOOD ELEVATI N F SITE: FT MSL /NGVD Munsell # /Color Texture USDA SOIL SERIES: Depth c to to to to to to to to to 7z (/ � �s^'i HRS-H Form 4015, Mar 92 (Obsoletes previous editions -which may not be used) (Stock Number: 5744 -003- 4015 -1) AGENT: PROPERTY ID #: s� 3 3/ 3 � [Section /Township /Range /Parcel No. or Tax ID Numb e "3 TO BE COMPLETED BY ENGINEER, HEALTH UNIT EMPLOYEE, OR OTHER QUALIFIED PERSON. ENGINEER'S h PROVIDE REGISTRATION NUMBER AND SIGN AND SEAL EACH PAGE OF SUBMITTAL. COMPLETE ALL ITEMS. PROPERTY SIZE CONFORMS TO SITE PLAN: (L4 YES [ ] NO NET USABLE AREA AVAILABLE: /yA. A� TOTAL ESTIMATED SEWAGE FLOW: '( , GALLONS PER DAY [RESIDENCES -TABLE 1 / OTHER - TABLE AUTHORIZED SEWAGE FLOW: .--- iv GALLONS PER DAY [1500 GPD /ACRE OR 2500 OPD /ACRE] fir_ fi_ SQFT UNOBSTRUCTED AREA REQU]RED: S' C o UNOBSTRUCTED AREA AVAILABLE: BENCHMARK /REFERENCE POINT LOCATION: ELEVATION OF PROPOSED SYSTEM SITE IS `j,) [INCHES /FT] [ABOVE ELOW] ENCHMARK /REFERENCE PO PROPOSED SYSTEM TO THE FOLLOWING FEATURE PERMIT # NORMALLY WET? [fij�IES "'7[ VVATE FT NON- POTABLE: i, u j2 POTABLE WATER LINES: cc. 10 YEAR FLOODING? [ ) YES (J SITE ELEVATION: 1/ J FT MSL /N SOIL PROFILE INFORMATION SITE 2 Munsell # /Color USDA SOIL SERIES: Texture Depth to to to to to to to to OBSERVED WATER TABLE: 7 INCHES [ABOVE // LES OW XISTING GRADE. TYPE: / APPARL ESTIMATED WET SEASON WATER TABLE ELEVATION : INCHES [ ABOVE / EXISTING GRA HIGH WATER TABLE VEGETATION: [ ] YES [ E NO MOTTLING: [ ] YES [NO — TJ TH: INc SOIL TEXTURE /LOADING RATE FOR SYSTEM SIZING: i.y,. //y DEPTH OF EXCAVATION: 3 - INL DRAINFIELD CONFIGURATION: ( ] TRENCH [ (/] [ ,] OTHER (SPECIFY) REMARKS /ADDITIONAL CRITERIA: DATE: /7- Page 3 0 Scale: Each block represents 5 feet and 1 inch = 50 feet. - i� iiiiiiiiiiiinihIii� i u1 iniiiiiiiiiiii� HHinniiiiiiiIIIIIIiiui� iii ■■ ■■■■ ■■■■ ■■■ ■■ ■■■ ■��■ ■ . ■ ■.■■ ■■■ ■■ u� ■■■■■■ ■ ■ ■ ■■ ■ ■ ■ ■ ■ ■ ■ ■�m■.■ .1 ...........s..�...1....:. . :. . . ■::'::::::: ::: :::.::::::: ":::.u■.•:M . 1 ■■ : ■.■■.■.1.■. ■ - 111111111111111111111111111111 ■■■■■■■■■■ 1� ■ ■■■■■. -- - "Eas -- - - -I- M M EIM M � •uuruu um uuu - -- C ■ - - - -- �1111■ ... ■. ■ ■�■ 111111111111 --- - 1111 ■ ■■■■■■■■■■ ■■lii■iIi i 1� ■v I _ i iii ©uiLI'iAiii ■ ■■ ■■ ■■ ■ ■■ 11 ■■■ ■■■■■■■■■■■■ ■ ■■. . . :.:.: . a u1u us: u � ' 11: ::::1111: ...1.10:1 ...11. �.1..1..1.�1 C.J .1 ■ ■ 1 ■■■■■ 1■ ■■ IIIII■I■■ C1 :■■■■■ ■ ■■■1�._ :'� :: " 1 ®1:::11 " �:I:.1: ....I.. 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C ■ ■ ■. ■1CI�C�1 :119..1 .. ■.. ■..� :ii' ::i :■•1Oe■ 1111 �■■0 C C':CC::'i■ ::i:oi■�i:: :l� :� i ':m::: :: :G :f' :1i :�: : : : :�1 : :G :: E �O■ M II C::: ■■■■■ :1 C� : EM M ■■ EG:IC:CD:II:::C: :1 : � 1 .= .... . ■....�..I,s,sm.m�.......ti1 •:iiil::ii: i:: ■1■ i �: e - - ■■f�1c:l���'■■ ■■■■ 11.'11■ 1' 1111 :"'1°"" "' :■ C 1 1 1 • • :' ECCC 11:C:1 ii_. :::�::A ■� ■ ■s.■- ���11 ■■�� 1111. • ■ ■■■.■■■ 11111//1 -■■■■■ ■ 1m■■■■■1I1 1 I:i:: IIIIIM ■IIII 1111111111111117:71117111.1111111111111111 1® ■: ■ ■.. ■•• : - - .. ■...■ / ` j J ) Notes: Site Plan submitted by: Plan Approved By STATE OF FLORIDA ' DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES APPLICATION FOR ONSITE SEWAGE DI POSAL SYSTEM CONSTRUCTION PERMIT Permit Application Number `/, /2 p PART I1 - SITE PLAN -? HRS-H Form 4015, Feb 85 (Obsoletes previous editions which may not be used) • • (Stock Number. 5744-002.4015-6) • Not Approved 4,; 3 t(J / J - U f) r toT— 0S' //,_ / ��3 l SIGNATURE TITLE ALL CH y MUST BE APPROVED BY THE COUNTY PUBLIC HEALTH UNIT Date / County Public Unit Page 2 of 3 Scale: Each block represents 5 feet and 1 inch = 50 teet - - WOOL il pip i - ' "II linrej illi i 1 iits I Raman ii di 1 ki i 1 _ 1 Flu i P Itti 1 1111 • ii 1 II_ hi i _ pili II a pi ei ill _ •thi ii _ — ,_ .____ -/-q ----------- ,.:___--: 1 _ , , 1 In 1 _ I Ili 1 - -- - / --,-, - d . IL. II lir . .-::::" , 1 - - -I - I 1 - I Ili 1(1;- 11111 .1 11 NPR aril =4:-= ---- LI %La I : - 1 eq.. 4 _ ___ 1 1 IhE I .. ilir - 19.1 - Hu • II I r um. - ..1 gm L, 1 II lid- --luirm h 1 11_ mom ii • i ni,,,F1-1 IV 11 111110h110 LErihmindi I 1 111111111111 1 111 1\ EN - -- rilikainsi .. _ Notes: STATE OF FLORIDA DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES APPLICATION FOR ONSITE SEWAGE DIVOSAL SYSTEM CONSTRUCTION PERMIT Permit Application Number ` a `7 S /z- HRS•H Form 4015. Feb 85 (Obsoletes previous editions which may not be used) PART 1I - SITE PLAN- 7/ D SIgNAT RE Not Approved Site Plan submitted by Plan Approved By ice County Public Ui � ALL CHA MUST BE APPROVED BY THE COUNTY PUBLIC HEALTH UNIT TITLE Date /2 • Page 2 or • . ,\ ,N 4 , /- Permit No. _ Date<_= _______. Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the building 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 regulations 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 work. Owner's Name and •Address___ / Registered Architect and /or Engineer Employing Plumber's Name_ 1�� G,J<? / > No Street Location and Legal Description Lot i Block Subdivision Oe y, Street and Number where work is to be performed—No- _ _ � �� ° ,- =___:? _ Street State work to be performed and purpose of building (By Floors) New Building ___ Remodeling Addition Repairs No. of Stories • Amount of Permit $ STATE OF FLORIDA, t COUNTY OF DADE. ss MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT Street Size Septic Tank Type of Tank Capacity Cals. Feet of Drain Tile Dist. Feet of Tank or Drain Field from Well Nature of Water Supply: City —Well __Size of Soakage Pit (Signed) Plumbing Inspector. 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 com- plied 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 inspection on the site of the work such public notice or notices as are required by the Act. The undersigned agrees to employ only such sub - contractors, on work to be performed under this permit, as are licensed by Miami Shores Village. , / /. ✓ \\ (Signed �, �_� .�_2� .,..._., ...,...,-... _ Master Plumber. G I Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeared 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 foregoing application, and that he did sign the same, and that all facts 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. 0 CLOSETS BATH TUBS SHOWERS LAVA- T ORIES SINKS SLOP SINKS LAUNDRY TUBS URINALS CATCH BASIN FLOOR DRAIN DRINKING FOUNT' NS //' L� ,/ p TOTAL FIXTURES CONTR. LIST Iy / / /j CHECK - SEPTIC TANK SEWER CONN. DRAIN FIELD SOAKAGE PIT GREASE TRAP SOLAR HEATER DEEP WELL SPRKLR. SYSTEM SWIM'G POOL CONTR. LIST a. CHECK I • . ,\ ,N 4 , /- Permit No. _ Date<_= _______. Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the building 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 regulations 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 work. Owner's Name and •Address___ / Registered Architect and /or Engineer Employing Plumber's Name_ 1�� G,J<? / > No Street Location and Legal Description Lot i Block Subdivision Oe y, Street and Number where work is to be performed—No- _ _ � �� ° ,- =___:? _ Street State work to be performed and purpose of building (By Floors) New Building ___ Remodeling Addition Repairs No. of Stories • Amount of Permit $ STATE OF FLORIDA, t COUNTY OF DADE. ss MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT Street Size Septic Tank Type of Tank Capacity Cals. Feet of Drain Tile Dist. Feet of Tank or Drain Field from Well Nature of Water Supply: City —Well __Size of Soakage Pit (Signed) Plumbing Inspector. 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 com- plied 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 inspection on the site of the work such public notice or notices as are required by the Act. The undersigned agrees to employ only such sub - contractors, on work to be performed under this permit, as are licensed by Miami Shores Village. , / /. ✓ \\ (Signed �, �_� .�_2� .,..._., ...,...,-... _ Master Plumber. G I Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeared 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 foregoing application, and that he did sign the same, and that all facts 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. 0 t ,. BUILDING ELECTRICAL PLUMBING s tf Owner of Building �" 1? _ .a Architect Contractor ) or Builder Legal Lot Description PERMIT N? 8228 Work to be performed under this Permit CONTRACTOR 0 BUILDER MIAMI SHORES VILLAGE, FLORIDA DATE r !- Contractor's License No Ji ) 4,f _- , Subdi- vision Address of ,9�• i- '; Value of Amt. of '' Building �r c ) l ... .-- - �-- Project Permit This permit is granted to the contractor or builder named above to construct the building or to install the equipment or device describe cation herefor in strict compliance with all ordinances pertaining thereto and with the understanding that the work will be performed in oomph plans, drawings, statements or specifications that may have been submitted to and approved by the proper municipal authorities. This Permit m 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 ur permit is granted is the understanding that the contractor or builder named above assumes the responsibility for a thorough knowledge of the o regulations pertaining to the work covered hereby whether shown on the plans or drawings or in the statements or specifications and that he as sibility for work done by his agents, servants or employees. y{ "y // 1 -< Signed: z, - INSPECTOR ✓Y u .. In consideration of the issuance to me of this permit I agree to perform th work covered hereunder in compliance with all,Ardinances ai pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authoriti' of Miami In accepting this permit I assume responsibility for a work done by ei myself, my agent, servant or emp ee. AUTHORITY MIAMI SHORES VILLAGE Permit No X 1 ! Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the building 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 rules and regulations 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 se building during progress of work. 0 Owners Name and Address Ted arc No Registered Architect and /or Engineer l:atplo ltttn 's N P. 4) . ' - = 2 - Ntl<P..�. 3©e o�1 ® i ..F 1 3 1,3 _ i e � s'i on ® and Legal p on Lot. � �.� � Blom • snbdivW n..2 ,,�. �� Street and Number where work is to be performed -No 4 / 1- FS - Street... .._ _l._ ....- S�f - -• -- State work to be performed and purpose N2c^.: Frain F i e (c 4 - rk,� 4e%t/ 5 v/ t,� - /"..9 f;Cl/ of building (By Fk�oas) _ -•_ -- _ - -_ -- _ .......... __ -- New Building.. -__._ _ Remodeling —_ __ -- Addition.. -__ -._ __ Repair ' No. of Stories Amount of Permit $ X c r sa. Size Septic Tank_.. Type of Tank._, Feet of Drain Tile __Dirt. Feet of Tank or Drain Field from Well.. Nature of Water Supply: City -WeIL Size of Soakage Pit PLUM0� INSPECTION I a �TMEIdT APPLICATION FOR PLUMBING PERMIT (si A 1(`4 Street _.. £ /KQ /q Plumbing inspector. 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 5989, Compiled General Laws of Florida Permanent Supplement, and liar com- plied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors employed by him in the wori•• o be performed under this permit; and will post or cause to be posted' for inspection on the e of the work su . ubl enotice or notices as air required by the Act. The undersigned agrees to employ only such sub-contractor, work to be fr ni Village. ,.•.:., permit. Res are licensed by Miami Shores ( (Signed) �I ' 1 * �' Master Plumber. STATE OF FLORIDA, I COUNTY OF DADE. Before me, the undersigned authority, a notary public, duly autiscAzed to adn4pister oaths and take acknowledgments, personally appeared 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 foregoing application, and that be did atin tho same, and that all fact therein by him stated are true. N p e, State of Florida ,'_ ICI a a �� Ores Oct 7, 1 =t: Bonded t fir � NOTE: A re- inspection fee of $1.00 wW be made wham moth re•hrspaotfos V seade Gary by kapseper notion ilea inspection, as faulty materials and /or workmanship. - CLOSETS BATH TUBS BHOW[Ra LAVA- TORI[S SINKS SLOP as". LAUNDR TUBS URINALS CATCH a ASIN FLOOR D RAIN DRINKING FOUNT•NS TOTAL PISTUq[S CONTR. LIST CHICK - SEPTIC TANK Smug CONN. DRAIN FIELD BOAKAO[ PIT G TRAP SOLAR HATER DEEP w[LL BPRKLR. SYSTEM 8N'IM'0 POOL CONTS. LIST - CHECK MIAMI SHORES VILLAGE Permit No X 1 ! Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the building 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 rules and regulations 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 se building during progress of work. 0 Owners Name and Address Ted arc No Registered Architect and /or Engineer l:atplo ltttn 's N P. 4) . ' - = 2 - Ntl<P..�. 3©e o�1 ® i ..F 1 3 1,3 _ i e � s'i on ® and Legal p on Lot. � �.� � Blom • snbdivW n..2 ,,�. �� Street and Number where work is to be performed -No 4 / 1- FS - Street... .._ _l._ ....- S�f - -• -- State work to be performed and purpose N2c^.: Frain F i e (c 4 - rk,� 4e%t/ 5 v/ t,� - /"..9 f;Cl/ of building (By Fk�oas) _ -•_ -- _ - -_ -- _ .......... __ -- New Building.. -__._ _ Remodeling —_ __ -- Addition.. -__ -._ __ Repair ' No. of Stories Amount of Permit $ X c r sa. Size Septic Tank_.. Type of Tank._, Feet of Drain Tile __Dirt. Feet of Tank or Drain Field from Well.. Nature of Water Supply: City -WeIL Size of Soakage Pit PLUM0� INSPECTION I a �TMEIdT APPLICATION FOR PLUMBING PERMIT (si A 1(`4 Street _.. £ /KQ /q Plumbing inspector. 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 5989, Compiled General Laws of Florida Permanent Supplement, and liar com- plied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors employed by him in the wori•• o be performed under this permit; and will post or cause to be posted' for inspection on the e of the work su . ubl enotice or notices as air required by the Act. The undersigned agrees to employ only such sub-contractor, work to be fr ni Village. ,.•.:., permit. Res are licensed by Miami Shores ( (Signed) �I ' 1 * �' Master Plumber. STATE OF FLORIDA, I COUNTY OF DADE. Before me, the undersigned authority, a notary public, duly autiscAzed to adn4pister oaths and take acknowledgments, personally appeared 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 foregoing application, and that be did atin tho same, and that all fact therein by him stated are true. N p e, State of Florida ,'_ ICI a a �� Ores Oct 7, 1 =t: Bonded t fir � NOTE: A re- inspection fee of $1.00 wW be made wham moth re•hrspaotfos V seade Gary by kapseper notion ilea inspection, as faulty materials and /or workmanship. - • STATE OF FLORIDA • - .,,: DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PERMIT Authority: Chapter 381, FS Chapter 10D-6, FAC Date of Application /j ,k Permit Application Number In PART I — APPLICATION Telephone Number Name of Owner Mailing Address of Owner `> y Owner's Agent G �a ;� -� , • ��., • r G� c -, r/ 1) Z r /r i r Agent's Mailing Address Property Street Address Lot No. Block No Subdivision Date Subdivided NOTE: IF NOT IN A SUBDIVISION ATTACH A METES AND BOUNDS DESCRIPTION This Application is for: New System Repair Existing System ft ft Exact Directions to Property AUDIT CONTROL NO 117955 Applicant's Signature (v 1e r u ' ,- Type of Establishment Type of No. Bedrooms Heated or Cooled Area No. Dwelling Residential (each dwelling unit) (each dwelling unit) Units /` -Z HRS+I Form 4015, Fe 85 (Obsoietes prey editions which may not be used) (Stock Number: 5744-001-4015 -1) r2j TOTAL FLOW = Builder Telephone No 7 S �% /c /t. ,F a.6G( (j F/. Sewage Flow Sewage Flow (Gallons per day) Based On Sewage Flow (Gallons per day) Page 1 of 3