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DRAINFIELD/SEPTIC1 Permit No MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT Dace..._.._9- 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 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 Barton & Barton ConSt. No Street... Registered Architect and /or Engineer Employing Plumber's Name Rose epti 'tank Co. P.O. BiuC .. __.. 344 Hialeah �..... ........_...._. S treet.._........_...... Location and Legal Description Lot____._. Bloc] Subdivision Street and Number where work is to be performed —No. 479 N.E. 9 3 rc) .street Street ._.__._ _.._.. State work to be performed and purpose of building (By Floors)__. New Building .__..._.____.__ ...... ....._.. Remodeling _ Addition. _ Repairs_ __.._...-- • -- ._....._. No. of Stories. Size Septic Tank___ Type of Tank`_ Feet of Drain Tile _Dist F e e t of T a s k o r Drain F i e l d f r o m W e l l Nature of Water Supply: City —Well. Size of Soakage Pit.. _...__ Amount of Permit $ 4 a_Q1 (Signed)_ umbing Inspector.' - The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligati . as an employer of labor under the Florida Workmen's Compensation Act, being Section 5988, Compiled General Laws of Florida Permanent upplement, and hay 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. STATE OF FLORIDA, COUNTY OF DADE. My Commission Expires (Signed) .._Capacity Gals• -• - -- _.__.__.____._ - 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. Notary Public, State of Florida Master Plumber. mat� A w of $1.00 will be made when such re- inspection is made•neoessary by improper notice for inspection, or faulty CLOSETS BATH TUBS SHOWERS LAVA. SINKS SLOP SINKS LAUNDRY Tue. URI CATCH BASIN FLOOR DRAIN DRINKING FOUNT'N6 TOTAL FIXTURES COHTII. LIST CHECK SEPTIC SEWER TANK CONN. DRAIN FIELD SOAKAGE PIT GREASE TRAP SOLAR HEATER DEEP WELL SPRKLR. SWIM'G SYSTEM POOL CONTR. , 1 900W/75 CHECK 1 Permit No MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT Dace..._.._9- 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 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 Barton & Barton ConSt. No Street... Registered Architect and /or Engineer Employing Plumber's Name Rose epti 'tank Co. P.O. BiuC .. __.. 344 Hialeah �..... ........_...._. S treet.._........_...... Location and Legal Description Lot____._. Bloc] Subdivision Street and Number where work is to be performed —No. 479 N.E. 9 3 rc) .street Street ._.__._ _.._.. State work to be performed and purpose of building (By Floors)__. New Building .__..._.____.__ ...... ....._.. Remodeling _ Addition. _ Repairs_ __.._...-- • -- ._....._. No. of Stories. Size Septic Tank___ Type of Tank`_ Feet of Drain Tile _Dist F e e t of T a s k o r Drain F i e l d f r o m W e l l Nature of Water Supply: City —Well. Size of Soakage Pit.. _...__ Amount of Permit $ 4 a_Q1 (Signed)_ umbing Inspector.' - The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligati . as an employer of labor under the Florida Workmen's Compensation Act, being Section 5988, Compiled General Laws of Florida Permanent upplement, and hay 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. STATE OF FLORIDA, COUNTY OF DADE. My Commission Expires (Signed) .._Capacity Gals• -• - -- _.__.__.____._ - 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. Notary Public, State of Florida Master Plumber. mat� A w of $1.00 will be made when such re- inspection is made•neoessary by improper notice for inspection, or faulty STATE OF FLORIDA DEPARTMENT OF HEALTH CONSTRUCTION PERMIT FOR: [ ]New System [ ]Existing System [ [ X ]Repair [ ]Abandonment APPLICANT: Galpin, Jane E. PROPERTY STREET ADDRESS: 479 NE 93 St FL 33161 LOT: 22 SYSTEM DESIGN AND SPECIFICATIONS T [ 900 ]Gallons SEPTIC TANK A [ 0 ]Gallons N [ 0 ]GALLONS GREASE INTERCEPTOR CAPACITY K [ 0 ]GALLONS DOSING TUC SEPTIC TAM SHALL BE PUMPED AND A SOLID DEFG.ECTCOW DEFACE MULLED CH TILE OUTLET TED SPECIFICATIONS BY: R. Arrieta Eng.I APPROVED BY: Arrieta, Rolando REPAIR ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM CONSTRUCTION PERMIT ]Holding Tank ]Temporary BLOCK: 51 SUBDIVISION: Miami Shores DH 4016, 03/97 (Obsoletes previous editions which may not be used) (Stock Number: 5794- 001 - 4016 -0) (ostds_cons_4016 -1) AGENT: WALLACE P, Ponder Wallace [Section /Township /Range /Parcel No.] PROPERTY ID #: 11- 3206 - 014 -0411 [OR TAX ID NUMBER] TITLE: CENTRAX #: 13 -SG -10550 DATE PAID: FEE PAID : $ RECEIPT . OSTDSNBR : 01 -3135- -R ] Innovative Other 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. MULTI - CHAMBERED /IN SERIES: [Y ] MULTI - CHAMBERED /IN SERIES: [Y ] TANK CAPACITY [ 0 ]GALLONS @ [0 ]DOSES PER 24 HRS # PUMPS[ 0 ] D [ 300 ]SQUARE FEET PRIMARY DRAINFIELD SYSTEM R [ 0 ]SQUARE FEET SYSTEM A TYPE SYSTEM: [ N ]STANDARD [ N ]FILLED [ N ]MOUND [ N ] I CONFIGURATION: [ N ]TRENCH [ N ]BED [ N ] N F LOCATION TO BENCHMARK: 9.50'NGVD Cl NE 93 St & W P1 I ELEVATION OF PROPOSED SYSTEM SITE [ 0.3 ] [ FEET ] [ BELOW] BENCHMARK /REFERENCE POINT E BOTTOM OF DRAINFIELD TO BE [ 3.4 ] [ FEET ] [ BELOW] BENCHMARK /REFERENCE POINT L D FILL REQUIRED: [ 0.0 ]INCHES EXCAVATION REQUIRED: [ 36.0 ] INCHES OTHER REMARKS: Existing 900 gis. s/t to be pumped and a solid deflector installed on the outlet device. Install 300 sq.ft. or available area drainfield, but no less than 150 sq.ft. using undisturbed sand, previous confirmation of that condition in the complete area to 48" depth. Invert elev. of d/f no less than 6.65'NGVD Bottom of d/f elev. no less than 6.15'NGVD This permit is not for addition. THIS NERM!T IS NOT FOR ADWIti: Haan ELEVATOON. " 45 IA " SOTTO= OF ®R INFIELD ELEVATION G • /5 u6'° TITLE: Engineer I Dade DATE ISSUED: 10 /11 /01 EXPIRATION DATE: 1/9/02 CHD Page 1 of 2 Scale: Each block represents 10 feet and 1 inch = 40 feet. Notes: Site Plan submitted by: Plan Approved Jo :11 J/ By STATE OF FLORIDA DEPARTMENT OF HEALTH APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PERMIT Permit Application Number 0, • \ «J • DH 4015, 10/96 (Replaces HRS -H Form 4015 which may be used) (Stock Number: 5744 -002 - 4015 -6) PART II - SITEPLAN 7'9 5 G ('a SS Not Approved • ALL CHANGES MUST BE APPROVED BY THE COUNTY HEALTH DEPARTMENT 7 i Da t / O - ' - C o u n t y Health Departmen Page 2 of 4 �n� • Gook for: blue bat•kground on the front adds check, and the imageSafe® logo on back. If not present, do not cash. u i5 O • PAY TO THE ORDER OF FOR NationsBank NationsBank, N.A. ACH R/T 063100277 WALLACE PONDER D/B/A WP SEPTIC TANK CO. 305-620 -8320 17235 N.W. 12 CT. MIAMI, FL 33169 12 -99 DATE 11'00 L74011' ':063 L002771: 00366565935611' X 11 ♦& . - I► /1 ` _ I . .di 4 v77/4 �: _ 1 $ 73.13G Li DOLLARS 1740 63-27/631 FL 994 Doh. on badt 1 CONTRACTOR Name License No. Address Tens_ s4\1_110 Qualifier Name PROPERTY OWNER New Construction Nam e4ur - - - I—. Gf1 L1P/ /0 Enclosure L r NI . i ST — lfF r IA-tk i J ?eS, F&33/3i Home Telephone 3 V S - 7s .- ? _ 4, Z 6 Business Telephone 30 S g 9 3— / 3 0 1.k t - 11 Fax • Alteration Interior 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 be taken to obtain a permit from the Miami Shores Village: Step 1. 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. 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. A PPLICATION Job Address: h/ 7 q A e . ' 3 ` • 1 3 313? Address Apt. City State' Zip Folio Numbetl )o4 �� d escript i t 1 on of Wor / .� I - - I. Lot Block Subdivision fi\ S Se- '- PB CO PG 37 Zoning Linear Feet Current Use of Property Square Feet Units Floors Proposed Use of Propertyue of Work Bldg Value Tenant Information PERMIT TYPE (✓ ) Building Electrical Mechanical Plumbing LPGX Roofing Fence Other Tax Assessed/Appraised Value Flood Zone Base Floor Elev. PERMIT CHANGE (✓ ) Chg. Contractor Renewal Revision Extension Supplement Reinspection ARCHITECT Name License No. Address Telephone Fax Master Permit No. Subsidiary Permit No. O q PERMIT APPLICATION ENGINEER Name License No. Address Telephone Fax Page 2 INIPORTANT 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 (MDWASD) approval is required for applications involving sewers. AFFIDAVIT - 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 the 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, 1 " Floor, (305) 679 -1078. Once recorded, the Notice of Commencement must be POSTED AT THE JOB SITE in accordance with Section 713 -35 of Florida Statutes. Review the brochure at Village Hall on Construction Lien Law and Choosing a Contractor. STATE OF FLORIDA, COUNTY OF MIAMI -DADS STATE F FLORIDA, COUNT OF MIAMI-DADE SEAL: ure of Owner Print Name ) worn to and subscribed before me this / day 00 ature of tary Public Stag of Fl u.' G A- flit) Personally known L ' R, Produced Identification Signature of Contractor / Qualifier, Print Name w. to a d subscribed before me this5 day , gnature o SEAL: Personally known bli. agate .f . lorida , - PERMIT APPLICATION OR, Produced Identification Type of Identification Produced: Type of Identification Produced: Page 4 OFFICE USE ONLY CHECKLIST ❑ OWNER - BUILDER FORM (Attach) O FIRE DEPARTMENT APPROVAL (Commercial / multi - family) ❑ CONCURRENCY (New Construction) ❑ OTHER (Specify & Attach) PERMIT FEES $3.00 per page (Scanning Fee) Miami Shores Village Bond Metropolitan Dade County (C.C.F.) Inspector State Educational Fund State DCA (Radon) Code Enforcement Fine Zoning Review ❑ PROOF OF OWNERSHIP (Attach) S / DERM APPROVAL (Septic / Sewer) ❑ IMPACT FEE (New Construction) ❑ OTHER (Specify & Attach) (sq.ft. = x/1000 x ¢.60) $ (¢.005 /sq.ft.) $ (¢.01 /sq.ft.) S 1 D D SECTION Zoning Electrical Mechanical Plumbing Fire Public Works Structural Building Official BY DATE REVIEWED AND PREPARED BY: PERMIT APPLICATION ❑ CONDO ASSOCIATION APPROVAL (Attach) ❑ BPR APPROVAL (Restaurants) ❑ CONTRACTOR REGISTRATION (On File) TOTAL 13 1 lAtitA 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 ELECTRICAL TYPE Minimum Fee QTY. TYPE Dryer QTY. TYPE Outlet, Appliance QTV. 'TYPE Service Repair QTY. 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 Fixture - Fluorescent Oven Space Heater (kw) A/C Central 16-20 Ton Fixture Light Parking Lot Lights Spas/Hot Tubs A/C Central 20+ Ton Flood Lights Plugmold/Strip Subfeeds, No. of Amps A/C Window FPL - Load Central Posts Swim Pool, Commercial Air Conditioners Garbage Disposal Range/Range Top Swim Pool, Residential Chiller Generators, etc. Receptacles 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 Closet Demolition Low -volt, Intercom/Teleph. Repair Circuits Water Heater Dishwasher Low -volt, Television Service, Number of Amps Water Heater New MECHANICAL TYPE Minimum Fee QTY. TYPE Condensate Drain QTY. TYPE Generator QTY. TYPE Refrigeration, Tons QTY. A/C Central, Tons Cooling Tower Heating Strips, each Vent Hood, Cost A/C Wall/Win. Tons Dryer Vents, Number of Paint Booth Ventilation, Cost Air Handler, Tons Ductwork, Cost of Piping, Flammable Liquid Periodic Inspections Barbecue Fire Sprinkler System Process/Pressure Piping Supply, AC Well Bath Fan - Vented, # Fireplaces, Number of Pressure Vessel Temporary Toilet PLUNIBING TYPE. A/C Condensate QTY. TYPE Drains, Roof QTY. TYPE Miscellaneous Fixture QTY. TYPE Soakage Pit QTY. Bath Tub Drinking Fountain Miscellaneous Repairs Solar Water Heater Bidet Filter Replace Pool Piping Sprinkler Repair Cap - Fixture Fountain Pump and Abandon Sprinkler System 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 Discharge Well Ice Maker Pump, Sump Utility - Water Dishwasher Indirect Wastes Relay Repair Vacuum Pump Disposal Interceptor Roof Inlet Water Closet 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 Drains, Floor Minimum Fee Shower Water Service 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: