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SEPTICDate Legal Description Owner/Lessee / Tenant Owner's Address 941 G q2 112Z f-_..F1 / M S `3 i �? Contracting Co. L.L.C)f 0— N(c.,Iri -Tr ;)AYE ep IC Qualifier °Tvt P 5. 1'1 k° SS# - Phone (50 State # -;; ` a — Municipal # Competency # d ;0 Ins. Co. Z" ilfA-' - j b) Architect/Engineer Address Bonding Company Address Mortgagor Address Permit Type (circle one): BUILDING ELECTRICAL PC---"V MECHANICAL ROOFING PAVING FENCE SIGN WORK DESCRIPTION cAn Square Ft j� Y•��/ Job Address (1 0 1 ,0 1 / 7 1 - ( Jat Tax Folio Q DO 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 zo ing. Furthermore, I auhorize the above -named contractor to do the work stated. 1 / /I �•ri - of other • and/ `Condo President D7 e / 0 '%T Notary as to 0 My Commission Expires: • LESTER E. CROCKS — My Comm Exp. 5/20/2001 Bonded By Service Ir,S No. CC649326 f 1 Personally Known f 10th; r 1.0 FEES: PERMIT RADON APPROVED: Zoning Mechanical PERMIT APPLICATION FOR MIAMI SHORES VILLAGE ?r- Building Date Plumb' SRI/ f Historically Designated: Yes No Address " 1 Estimated Cost (value) 44 4 0 ef Notary as to Contra Date My Commission Expires: LESTER E. CROCKE.51 My Comm Exp. 5/2O/2C'i Bonded By Service Ins No. CC649326 f 1 Personalty Knovm 1 1 0th-r I.D Master Permit # C.C.F. J % W NOTARY Phone 15S' q 3 !_;© Electrical BOND 5ce TOTAL DUE '3-7,f, Engineering CONSTRUCTION PERMIT FOR: J New System [ ] Existing System [ 4 Tank [ ] Temporary /Experimental [ ;] Repair [ ] Abandonment [ =] Other(Specify) APPLICANT: PROPERTY STREET ADDRESS: LOT: PROPERTY ID #: ; [ SECTION /TOWNSHIP /RANGE /PARCEL NUMBER] [OR TAX ID NUMBER] 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. HRS APPROVAL OF SYSTEM DOES NOT GUARANTEE SATISFACTORY 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. SUCH MODIFICATIONS MAY RESULT IN THIS PERMIT BEING MADE NULL AND VOID. SYSTEM DESIGN AND SPECIFICATIONS T [ A N [ K [ 0 T H E R D [ ] SQUARE FEET PRIMARY DRAINFIELD SYSTEM R [ ] SQUARE FEET SYSTEM A TYPE SYSTEM: [ ] STANDARD [ ] FILLED [ ] MOUND [ ] I CONFIGURATION: [ ] TRENCH [ ] BED [ N F LOCATION OF BENCHMARK: I ELEVATION OF PROPOSED SYSTEM SITE [ j 'IINCHESJFT] [ABOVE$ELOWJ_BENCHMARK/ .FERENCE POINT E BOTTOM OF DRAINFIELD TO BE [ ] [INCHES /FT] [ ABOVE /BELOW] BENCHMARK /,REFERENCE POINT L D FILL REQUIRED: [ ] INCHES EXCAVATION REQUIRED: [ ] INCHES SPECIFICATIONS BY: APPROVED BY: DATE ISSUED: STATE OF FLORIDA DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PERMIT Authority: Chapter 381, FS & Chapter 10D -6, FAC BLOCK: SUBDIVISION: ] [GALLONS / GPD] SEPTIC TANK /AEROBIC UNIT CAPACITY MULTI- CHAMBERED /IN SERIES:[ ] ] [GALLONS / GPD] CAPACITY MULTI- CHAMBERED /IN SERIES:[ ] ] GALLONS GREASE INTERCEPTOR CAPACITY [MAXIMUM CAPACITY SINGLE TANK: 1250 GALLONS] ] GALLONS PER DOSE DOSING TANK CAPACITY DOSE RATE [ ] PER 24 HRS NO. OF PUMPS: [ ] AGENT: TITLE: HRS -H Form 4016, Mar 92 (Obsoletes previous editions which may not be used) (Stock Number: 5744 - 001 - 4016 -0) PERMIT # DATE PAID FEE PAID $ RECEIPT # .. t TITLE: CPHU EXPIRATION DATE: Page 1 of 2 J. 7O`_Z: Cher.', ty na of permit, if 'Other' specify tyre in bleak. Property owner's full name. Telephone number for applicant or agent. ACENT: Property owner's legally authorized representative. iv :AILING ADDRESS: P.O. box or street. mailing address for applicant or agent. L.OT , !BLOCK, SUBDIVISION or PROPERTY ID#: 27 character id number for property. (CPHU may require property appraiser ID (1 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 Public Hzalth Unit (CPHU) personnel reviewing and approving permit. DATE ISSUED: Date permit is issued by CPHU. 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. Permit Application Number PART II - SITE PLAN Scale: Each block represents 5 feet and 1 inch = 50 feet. L_ Site Plan submitted by: Notes: HRS -H Form 4015, Feb 85 (Obsoletes p-evious editions which may not be used) (Stock Number. 5744-002-4015-6) STATE OF FLORIDA DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PERMIT m MEMMEMEMEMMEMMOMM INIMMEMMEMENUMMEME minimmummimmumm me MINIMMEMMEMMOMME 1111111111 11 SIGNATURE Plan Approved Not Approved Date By County Public Unit ALL CHANGES MUST BE APPROVED BY THE COUNTY PUBLIC HEALTH UNIT TITLE Page 2 of 3 PERMIT APPLICATION FOR MIAMI SHORES VILLAGE Date Job Address / y L 4 4 8 6 Ic 51 Tax Folio Legal Description J L Q-1 Historically Designated: Yes No Owner/Lessee / Tenant r1 � 1 ( (6._. Master Permit # ( ) " / 7 5 J/ Owner's Address ' Phone Contracting Co. Qualifier State # C PLO SS '7 Architect/Engineer Bonding Company Mortgagor Address Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN l WORK DESCRIPTION nl 5(, n nl C 2k 'I fe.C.b vl n Q Cam" 5 .) �) o1 5 f SC,-Q - f 3 A J Z hoc c Square Ft. Estimated 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 INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENI:ER 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. Furth - ore, I auth •. • e the above- ed co . ctor to do the wo stated. 1 MARIE J. PASCAL MY COMMISSION # CC 729534 • 2 PIRES: March 30, 2002 Thru Notary Public Underwriters and/or Condo President No tary as My Commr FEES: PERMIT APPROVED: Zoning Mechanical T ro r"fd p)oth RADON Municipal # / 1 Date Address / /3 i 4 -1 ) ss# ����5 ?�'° C Competency # Ins. Co. ai2,f.&e Address Address Ngt6iy as to Contrac My Commission E C.C.F. r t0 0 NOTARY 5 Building Electrical Plumbing Structural Engineer es: CLAMS l VELLAR AyrAi N ?J C. E`SAIT OF FLO3ISA COMMcf..SION NO. CCP."11 g ay CO lM SSION EXP. MA1.1. 92')2 BOND TOTAL DUE S) BUILDING ELECTRICAL PERMIT N? 12494 PLUMBING Architect Contractor or Builder Legal Description Address of Building Lot ROOFING I Work to be performed under this Permit Owner of \,k) /A ( ' Building � �.._. 7 , i MIAMI SHORES VILLAGE, FLORIDA Bl. Y) 20 7 2, ,4,4 Subdi- vision Value of Project $ DATE J - / / - .. / 195 Contractor's License No Amt. of J�$' Permit $ /o fa A This permit is granted to the contractor or builder named above to construct the building or to install the equipment or device described in the application herefor in strict compliance with all ordinances pertaining thereto and with the understanding that the work will be performed in compliance with any plans, drawings, statements or specifications that may have been submitted to and approved by the proper municipal authorities. This Permit may be revoked 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 upon which this permit is granted is the understanding that the contractor or builder named above assumes the responsibility for a thorough knowledge of the ordinances and regulations pertaining to the work covered hereby whether shown on the plans or drawings or in the statements or specifications and that he assumes responsibility for work done by his agents, servants or employees. ".4 Signed: - 71.-..-1 ,., -� i 1 . ;,..4r BY J INSPECTOR In consideration of the issuance to me of this permit I agree tb.4erform the work covered hereunder in compliance with all ordinances and regulations pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I assume responsibility for all work done by either, m f,, my agent, servant or employee. CONTRACTOR O IBLS LRL !� ri BY BUILDING ELECTRICAL PLUMBING ROOFING Owner of Building Architect Contractor or Builder Legal Description. Address of Building Lot l '! .mod MIAMI SHORES VILLAGE, FLORIDA PERMIT N? 12441 ' cik to be performed under this Permit f • BI. N • Sipper In consideration of the issuance to me of this permit I ag pertaining thereto and in strict conformity with the plans, drawings, In accepting this permit I assume responsibility for all work done b r / / jrr ,e: a l 1 'r J l �/� 'Ik C' .yf c, NTRACTOR OR BUILDER either, myself, r Subdi- vision Value of Project $ This permit is granted to the contractor or builder named above to construct the building or to install the equipment, or device described in the application herefor in strict compliance with all ordinances pertaining thereto and with the understanding that the work will be performed in compliance with any plan drawings, statements or specifications that may have been submitted to and approved by the proper municipal authorities. This Permit may be revoked at time if the work is not done in compliance with such ordinances or if the plans are changed without authorization. A further condition upon which this permit granted is the understanding that the contractor or builder named above assumes the responsibility for a thorough knowledge he ordinances and regulati pertaining to the work covered hereby whether shown on the plans or drawings or,dn th sta menu or specifications and that a sumes res sibili done by his agents, servants or employees. f, i i, p i bili I t. ''"$Y INSPECTOR orm the work covered hereunder in compliance with all ordinances and regulations ments or spec "cations submitted to the proper authorities of Miami Shores Village. agent,, se7alit or employee. BY 1 DATE �'. Contractor's License No Amt. of Permit $ i AUTHORITY .7 195 1� 1 BUILDING ELECTRICAL PLUMBING ROOFING Owner of Building Architect Contractor or Builder Legal Description Address of Building Lot 1] CONTRACTOR OR BUILDER MIAMI SHORES VILLAGE, FLORIDA PERMIT IT? 13040 Work to be performed under this Permit Bl. Subdi- vision Value of Project $ DATF 195 Contractor's License No Amt. of Permit $ This permit is granted to the contractor or builder named above to construct the building or to install the equipment or device described in the application herefor in strict compliance with all ordinances pertaining thereto and with the understanding that the work will be performed in compliance with any plans, drawings, statements or specifications that may have been submitted to and approved by the proper municipal authorities. This Permit may be revoked 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 upon which this permit is granted is the understanding that the contractor or builder named above assumes the responsibility for a thorough knowledge of the ordinances and regulations pertaining to the work covered hereby whether shown on the plans or drawings or in the statements or specifications and that he assumes responsibility for work done by his agents, servants or employees. Signed: , BY INSPECTOR In consideration of the issuance to me of this permit I agree to perform the work covered hereunder in compliance with all ordinances and regulations pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I assume responsibility for all work done by either, myself, my agent, servant or employee. BY AUTHORITY )7 Permit No. __ i y 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 _r' ( 1 Registered Architect and /or Engineer_____ Employing Plumbers Name » ' _. =_ No.__ '__ -' l _ Street f " ' Location and Legal Description Lot / z w t~ .__ .v Block 1 subdivision —.1 • • Street and Number where work is to be performed —No '' .V - M ` Street___ ss. MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT Date • No Street State work to be performed and purpose of building (By Floors) New Building Y Remodeling Addition Repairs No. of Stories Size Septic Tank Type of Tank Capacity Gals. Feet of Drain Tile Dist. Feet of Tank or Drain Field from Well Nature of Water Supply: City —WS M. Size of Soakage Pit Amount of Permit $ / - (Si Plumbing Inspector. • The undersigned applicant for this building permit does hereby certify that he understands and accepts hi; obligations as an employer of labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Peimanent 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) ,r' My Commission Expires Notary Public, State of Florida Master Plumber. STATE OF FLORIDA, 1 COUNTY OF DADE. 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. 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. CLOSETS BATH TUBS SHOWERS LAVA- TORIES SINKS SLOP SINKS LAUNDRY TUBS URINALS CATCH BASIN FLOOR DRAIN DRINK ING FOU NT' NS W ' b\ TOTAL FIXTURES CONTR. L 1ST / / f J �" / -- CHECK �j / 1 � 7 ! L 3 `1 ? ''� 7 '� 7 ..S SEPTIC TANK SEWER CONN. DRAIN FIELD SOAKAGE PIT GREASE TRAP SOLAR HEATER DEEP WELL SPRKLR. SYSTEM SW IM'G POOL `•r W • CONTR. LIST / / C t , / / C•'; CHECK Permit No. __ i y 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 _r' ( 1 Registered Architect and /or Engineer_____ Employing Plumbers Name » ' _. =_ No.__ '__ -' l _ Street f " ' Location and Legal Description Lot / z w t~ .__ .v Block 1 subdivision —.1 • • Street and Number where work is to be performed —No '' .V - M ` Street___ ss. MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT Date • No Street State work to be performed and purpose of building (By Floors) New Building Y Remodeling Addition Repairs No. of Stories Size Septic Tank Type of Tank Capacity Gals. Feet of Drain Tile Dist. Feet of Tank or Drain Field from Well Nature of Water Supply: City —WS M. Size of Soakage Pit Amount of Permit $ / - (Si Plumbing Inspector. • The undersigned applicant for this building permit does hereby certify that he understands and accepts hi; obligations as an employer of labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Peimanent 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) ,r' My Commission Expires Notary Public, State of Florida Master Plumber. STATE OF FLORIDA, 1 COUNTY OF DADE. 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. 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. Estimated Quantity Actual Quantity Size - -- - - - - -- Description Retirement Disposition Pipe 1hhdicate Trpe) Cbcks Lube Fittings JOB ORDER SHEET �� / w/DP i sG% Nb0 Locations ?" 9�� "( 5 nC"' X000 1Poo� t f -C Description • IN SPECTOR o S REPORT: Status Of Bbildings Municipal Permits PGS - EC 7 0 of Risers Type Of Service A.B.E. Nb. )) /Q--.77- Residence Date Issued �ea: 11b. Of Apt, Units '"-*-` Commercial Tax District /45.6 c Date Estimated Installation Dates Remarks: -- Inspector Date Reinspected Remarks: By Approved By: Shpt. Date Job Completed /