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710 NE 93 St (4)Work done biT Oryner Se-tic Tank _ _ Drain2: Plurn.bing - 7 2inal Jhei roady Received by Date Time j • PLUBIG - '-..d0.re2s of work / • Oi Ga n Routh q o ut 0 Permit No. ##;° building during progress of work. Size Septic Tank APPLICATION FOR PLUMBING PERMIT Application is hereby made for the approval of the detailed statement of the plans and specifi :ations 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 a td all rules and regulations of the Building Division of Miami Shores Village shall be complied with, whether herein specified or not. A copy c f approved plans and specifications must be kept at Owner's Name and Address Registered Architect and/or Engineer Employing Plumber's Name CaCT. No Location and Legal Description Lot N• Block a Street and Number where work is to be performed—No. / State work to be performed and purpose of building (By Floors) New Building Remodeling Addition My Commission Expires MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT 2ij %. (7 No. b.) Street Dist. Feet of Tank or Drain Field from Well employ only such sub-contractor (Signed) Date ie t45 9-7 B Street 4214/ 6 Subdivision_ Street /1 t 1 Repairs No. of Stories / Type of Tank /_ #1 4 kt, Capacity Gals. o on work to be performed under this permit, • Notary Public, State of Florida Feel of Drain Tile Nature of Water Supply . City—Well 7_ .Size of Soakag Pit. Ainount of Permit $- Lt. (Signed) 1 / -.- Plumbing Inspector. The undersigned applicant for this building permit does hereby certify that he un lerstands and accepts his obligations as an employer of labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled Gene al Laws of Florida Permanent Supplement, and has com- plied with the provisions thereof, and will require similar compliance from all contr, ctors 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 under signed agrees to licensed by Miami Shores Village. as are STATE OF FLORIDA, ss. COUNTY OF DADE. Before me, the undersigned authority, a notary public, duly authorized • o 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 a )plication, and that he did sign the same, and that all facts therein by him stated are true. NOTE: A re-inspection fee of $1.00 will be made when such re- inspectio is made necessary by improper notice for inspection, or faulty materials and/or workmanship. CLOSETS BATH TUBS SHOWERS LAVA- TORIES SINKS SLOP SINKS LAUNDRY "rues URINALS :ATCH 3ASIN FLOOR DRAIN DRINKING FOUNT' NS TOTAL FIXTURES CONTR. LIST CHECK SEPTIC TANK SEWER CONN. DRAIN FIELD SOAKAGE PIT GREASE TRAP SOLAR HEATER DEEP WELL SPRKLR. SYSTEM SWI M •G POOL CONTR. Lis? / CHECK Permit No. ##;° building during progress of work. Size Septic Tank APPLICATION FOR PLUMBING PERMIT Application is hereby made for the approval of the detailed statement of the plans and specifi :ations 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 a td all rules and regulations of the Building Division of Miami Shores Village shall be complied with, whether herein specified or not. A copy c f approved plans and specifications must be kept at Owner's Name and Address Registered Architect and/or Engineer Employing Plumber's Name CaCT. No Location and Legal Description Lot N• Block a Street and Number where work is to be performed—No. / State work to be performed and purpose of building (By Floors) New Building Remodeling Addition My Commission Expires MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT 2ij %. (7 No. b.) Street Dist. Feet of Tank or Drain Field from Well employ only such sub-contractor (Signed) Date ie t45 9-7 B Street 4214/ 6 Subdivision_ Street /1 t 1 Repairs No. of Stories / Type of Tank /_ #1 4 kt, Capacity Gals. o on work to be performed under this permit, • Notary Public, State of Florida Feel of Drain Tile Nature of Water Supply . City—Well 7_ .Size of Soakag Pit. Ainount of Permit $- Lt. (Signed) 1 / -.- Plumbing Inspector. The undersigned applicant for this building permit does hereby certify that he un lerstands and accepts his obligations as an employer of labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled Gene al Laws of Florida Permanent Supplement, and has com- plied with the provisions thereof, and will require similar compliance from all contr, ctors 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 under signed agrees to licensed by Miami Shores Village. as are STATE OF FLORIDA, ss. COUNTY OF DADE. Before me, the undersigned authority, a notary public, duly authorized • o 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 a )plication, and that he did sign the same, and that all facts therein by him stated are true. NOTE: A re-inspection fee of $1.00 will be made when such re- inspectio is made necessary by improper notice for inspection, or faulty materials and/or workmanship. Date l e Job Address --N `kk`� c ' S \ Legal Description -6` (Owner / Lessee / Tenant Owner's Address Contracting Co. r"a Qualifier State 1 Architect /Engineer Address Bonding Company Permit Type(circle one): BUILDING ELECTRICAL WORK DESCRIPTION . cii( MC:1r jig-) /1'st Square Pt. WARNING TO OWNER: YOU MUST RECORD A NOTICE OF COMMENCEMENT AND YOUR FAILURE TO DO YOUR MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO UR 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 thet all work will be performed to meet the standards of all laws regulating construction in this ;,urisdiction. 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 in compliance with all applicable laws regulating construct and zoning. Furthermore, I he a••ve -named contractor to do the work be done auk-? Signature Date t ** * * FEES: PERMIT APPROVED: PERMIT APPLICATION FOR MIAMI SHORES VILLAGE Municipal # Mortgagor Address PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN y Addre::s of owner and /or Condo*0 J,10 Notary as to Owner and /or My Commission Expires: Zoning Mechanical , 6' f l/ .— �� - Address � � C " Phone C 17.x)— 677-9- c cam.Cz2.. c Condo President RADON C.C.F. ;- `5' NOTARY Competency # Ins.Co. Poe; ©� 77/)64/- I Estimated Cost(value) stat.e� Signat Date: Notary a to Contractor or Owner- Builder Icy Commission Expires: Fire Buildin 1 binR Tax Folid // neG' 0( i S'n'( )6. Master Permit # 4_5 Phone e of Contractor or Owner- Builder Crn '57l £Z) Z - :-\ .:2 .Z\ TOTAL DUE 6 $t Other Electrical Engineering_ • . • • 70 ro Gate of Florida 'County of Dade THE UNDERSIGNED hereby gives notice that Improvement will be made to real property, and In accordance with Chapter 713, Florida Statutes, following information is provided In this Notice of Commencement. 1. Description of property :(legal description of the property, and street address If a va 1 1 ab I e) is'' /9I 63 . 164 4 , ' iy , J a Z 11-0 e t el; 2. ISenera I description of Improvement: g u t s ± ' Ns ) 4 : 4 5 3. Owner information: / / a. Name and Address : ?/ ;4 i Si44 c 7/0 we ?g S -f- b. Interest In property: /012'70 c. Name and address of fee 'simple titleholder (If other than 4. Contractor: (name and address) 5. Surety: a. Name and Address b. Amount of bond $ 7. Persons with the State or other documents may Florida Statutes:(Name '...1 \ • . s in5 ' Slr l l . . r : > JS" le ieVYV NOT I Q.E OF COMMENCEMENT 6 i> AI c &) J 1'T4i p F/ 3, 4 6 8' ClerkCirdui Cdurt 6 . Lender: (Name and address i9 x a .?Se? 9. Expiration date of notice of commencement (the expl year from the date of recording unl • f fere / S gnat're of Sworn to l and subscribed before me t h i s /6j day of : Notary y Pub C I c iZtVtARE.Z • STATE OP FLORIDA COUNTY OF DADE :+ • lit CERTIFY that this b a twpefft nrigu' oi nc l iii this olfice p pee WITNESS niy hand id Official r A , � 62 4442 /w owner): of Florida designated by Owner upon whom notices be served as provided by Section 713.13(1)(a)7., and address) 8. In addition to himself, Owner designates to receive a copy of the Lienor's Notice as provided In Section 7.13.13(1)(b), Florida Statutes. ration date Is 1 date Is specified) of �V? c4 • certa1nQ the r, ce 0s Own "r , fi e c gaze . / � ,�, 1 ( 9 � 9 $ NIJl1�iiF Pl.»t.IC 5AW O Tn 117 Ct1111SSICN EXP.JAN. I,I'd.M3, • May Commission Expires BONDED f lGEttPAL INS.L D. PERMIT APPLICATION FOR MIAMI SHORES VILLAGE Date 7 c Job Address 71° C- 9 3 S/ ", ax Folio Legal Description Historically Designated: Yes No Owner/Lessee / Tenant �� �` e4J JIS' �f Master Permit # ?�� Owner's Address 7 0 ' . g 1 Phone 7 8q— c3 q 1- C o n t r a c t i n g Co. * • C � � f I1 C., t Address / a i Qualifier d ° /f �Q. o� SS# � _ Phone 1)s1' 2Rs State # Municipal # Ccmpetency # Ins. Co. Architect/Engineer Address Bonding Company Address Mortgagor Address Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN WORK DESCRIPTION / O fAe 1/ Square Ft. Estitr_ated Cost (value) 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 1R'TEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMESCEMENT.) Application is hereby made to obtain a permit to do work and installation as indicated zbove, 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. OWNERS AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating ccnstruction and zoning. Furthermore, I authorize the above -named contractor to do the work stated. Signature of owner d/ . ' endo President Date . 7/Ya as to Owner and/or Condo D ate Notary My Commissi ' STEPHEN F Stet® o' tat etwilm .Mary u STEPHEN E COCKING State of Florida My Comm. Exp: 08/04/0' Commit: CC889180 FEES: PERMIT 50 RADON C.C.F. ctor or Own -Buil Signature of Co Notary • Con My Cozssion E APPROVED: Zoning Building Mechanical Plumbing tor or '";?fE��' Date d.`�.RY PUBLIC S;'A't'F OF FW ZiDA j .b C: c NOTARY ,S BOND Electrical GJ " 6?) Date Structural Engineer CONSTRUCTION PERMIT FOR: [ ] New System [_.,] Existing System [ ) Holding Tank [ J Temporary /Experimental [ ') Repair ( ] Abandonment ( ) Other(Specify) APPLICANT: . AGENT: PROPERTY STREET ADDRESS: LOT: PROPERTY ID #: SYSTEM MUST BE CONSTRUCTED IN ACCORDANCE WITH SPECIFICATIONS AND STANDARDS OF CHAPTER 10D -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. DEPARTMENT OF HEALTH APPROVAL OF SYSTEM DOES NOT GUARANTEE SATISFACTORY PERFORMANCE FOR ANY SP2CIFIC 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 RESUL'..' IN THIS PERMIT BEING MADE NULL AND VOID. SYSTEM DESIGN AND SPECIFICATIONS T [ ],(GALLONS / GPD] SEPTIC 'TANK / 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 [ ] SQUARE FEET PRIMARY DRAINFIELD SYSTEM R [ ] SQUARE FEET SYSTEM A TYPE SYSTEM: [ /] STANDARD [ ] FILED [ ] MOUND [ ] I CONFIGURATION: [ ) TRENCH [ ) BED [ ] N F LOCATION OF BENCHMARK: I ELEVATION OF PROPOSED SYSTEM SITE [' ;',] 4INCH3S /FTJ [ABOVE /BELOWJ, BENCHMARK /REFERENCE: POINT E BOTTOM OF DRAINFIELD TO BE [ ] [INCHES /FT] [ABOVE/BELOW) BENCHMARK /REFERENCE POINT L D FILL REQUIRED: [ ] INCHES EXCAVATION REQUIRED: [ J INCHES 0 T H SPECIFICATIONS BY: APPROVED BY: DATE ISSUED: STATE OF FLORIDA PERMIT # DEPARTMENT OF HEALTH DATE PAID ONSITE SEWAGE DISPOSAL SYSTEM FEE PAID $ CONSTRUCTION PERMIT RECEIPT 0 ` Authority: Chapter 381, FS & Chapter 10D -6, FAC BLOCK: SUBDIVISION: DH 4016, 10/96 (Replaces HRS -H Form 4016 (page 1] which may be used) (Stock Number: 5744- 001- 4016 -0) [ SECTION /TOWNSHIP /RANGE /PARCEL NUMBER] [OR TAX ID NUMBER] Applfca t TITLE: TITLE: EXPIRATION DATE: Page 1 of 2 CHD INSTRUCTIONS: PERMIT NUMBER: Permit tracking number by County Health Department. APPLICATION FOR: Check type of permit; 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 mailing address for applicant or agent. LOT, BLOCK, SUBDIVISION or PROPERTY ID #: 27 character ID number for property. (Health Department may require property appraiser ID# or section /township /range /parcel number.) SYSTEM DESIGN AND SPECIFICATIONS: TANK: Minimum specifications from Chapter 10D -6, FAC. DRAINFIELD: Minimum specifications from Chapter 10D -6, FAC. OTHER: Other specifications, such as operating permit requirements, low- volume flush toilets, variance provisos. SPECIFICATIONS BY: Name of individual providing specifications. If designed by a registered engineer must be sealed. APPROVED BY: County Health Department personnel reviewing and approving permit. DATE ISSUED: Date permit is issued by County Health Department. EXPIRATION DATE: One year from date issued if the system has not been installed. Permits for system repairs become void 90 days from the date issued. STATE OF FLORIDA DEPARTMENT OF HEALTH APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PERMIT PART II - SITEPLAN Scale: Each block represents 10 feet and 1 inch = 40 feet. Notes: Site Plan submitted by Plan Approved By County Health Department DH 4015, 10/96 (Replaces HRS -H Form 4015 which may be used) (Stock Number: 5744 -002 -4015 -6) Not Approves Permit Application Number . Date ALL CHANGES MUST BE APPROVED BY THE COUNTY HEALTH DEPARTMENT Page 2 of 4