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SEPTICLegal Description Square Ft. PERMIT APPLICATION FOR MUNICIPALITIES OF (OWNER TO RETAIN COPY) Date 0 / d. Job Address /OS '6 / f- kti/fr / Lessee / Tenant /21-,e 16 i • 4100 9stAti Signature of owner and /or Condo President Date: DADE COUNTY 9S S T Tax Folio 1 7 ago 020 7'6V ,V Al Master Permit # Owner's Address JP ,5 A/6 Phone 7 7 - l 9,P 7 Contracting Co. Address Qualifier ( i4 heeZ SS# a - - Phone f/4 7 State 1i Municipal # Competency # Ins.Co. Architect /Engineer Address Bonding Company Address Mortgagor Address Permit Type(circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN WORK DESCRIPTION ' RAJ - alb bQ aJ 6-1/) Estimated Cost(value) - /,.2lo WARNING TO OWNER: YOU MUST RECORb 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. ) Awl( %/ ,.cd Signat r'e of Owner- Builder e : 4,1 3 /9 SJ— - f'J2- r/�tic.a— Notary as to Owner and /or Condo President Notary as to Own er - My Commission Expires: My Corona ssion Expires NOTARY PUBLIC STATE Bu OF ilder FLORIDR MY COMMISSION EXPIRES 5/09/94 * Bonded thru Stembler-.dams & feet * * * * * ** * * * * * * * * FEES: PERMIT a RADON C.C.P. Ob NOTARY 5 TOTAL DUE 21 bk APPROVED: Fire Other Zoning Building , �Y �?/ i/ Mechanical Plumbing Engineering STATE OF FLORIDA - DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM- CONSTRUCTION PERMIT Authority: Chapter 381, F.S. & Chapter 10D -6, F.A.C. Application Is For: New System [ ] Repair [ ] Existing System [ ] Experimental System (Temporary) [ ] Tank Abandonment [ ] Holding Tank [ ] Other (Specify) NOTE: PERMITS EXPIRE ONE YEAR FROM DATE OF ISSUANCE AND ARE NOT RENEWABLE. REPAIR PERMITS AND HOLDING TANK PERMITS EXPIRE 90 DAYS FROM DATE OF ISSUANCE. APPROVAL OF A SYSTEM DOES NOT GUARANTEE SATISFACTORY PERFORMANCE FOR A SPECIFIC PERIOD OF TIME. TO BE COMPLETED BY APPLICANT: Owner: A r?! E F. - 7 , -/E ✓E >./ Owner's Mailing Address:/045 Aj,(2. 15 ST City:/f//?A-l/ State: FL zip: 33 / 36 . i;wryzr;s Agent: ;!-t!.: Telephone (W) (H) ) Agent's Mailing Address: City: State: 'r v rc . Zip: a erty Street Address: /p,5 AI. E �' 5 STizzET ~� '' r .eons to Property: 't - ,. i . ..:)cc # Subdivision I r : ,� e,' . `� T'o4rnship: )opert'y Size: r ater Supply: Private [ ] Unit Date Subdivided Range: Parcel #: Zoning Designation: • Square Feet /Acres Public [1/1 Limited Use [ ] 'Is Sanitary Sewer Available: Yes [ ] No V No, approximate the Is Public Water Available: line closest to your property: Yes [ ✓] No [ ] If No, approximate the distance line closest to your property: Type of Establishment Commercial / (circle one) Y Cesidentiai) # of Units Building Area (sq ft) & # of Bedrooms Applicant'S Signature: 24,41:41P BUILDING INFORMATION Plumbing Fixtures: Garbage Grinders /Disposals Spas /Hot Tubs _ Floor /Equip. Drains Ultra -low Volume Flush Toilets Other BUILDING PLANS MUST BE ATTACHED SHOWING OFFICES, BEDROOMS, TOTAL PERTINENT FEATURES REQUIRED BY CHAPTER 10D -6, F.A.C. IN SITE AND SURVEY, DRAWN TO SCALE, MUST BE ATTACHED SHOWING PROPERTY DIMENSIONS, BUILDING LOCATIONS, AND PERTINENT FEATURES REQUIRED TO BE SUBMITTED PER CHAPTER 1 0D - 6.046 F.A.C. / J l 2 Building Permit #: Application /Permit Number: Date Application Received: 0y _ 7 2 Fee. Amount Paid: Receipt #: Telephone: (Work) [J (Home) 76,- /98 # of Persons # of Scats Hours of Operation Date: / cel • distance to the sewer to the sewer. 1 1 f r. ; a By STATE OF FLORIDA DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION AND INSTALLATION PERM Permit Application Number 2— PART II - SITE PLAN Scale: Each block represents 5 feet and 1 inch , 50 feet. 4 _ Of M E S,! i r t -- - f f._ r (t 1' , 1 1 .•ri t i r ry Site Plan submitted by: "i f �: ' Plan Approved sIOHAT une TITLE :;,. ..�,• Not Approved + qt ` "''• D a te g „; County :R. ALL CHANGES MUST BE APPROVED BY THE COUNTY PUBLIC HEALTH UNIT .If �I �... ..' • •�� i . • ry (,rT:( •'; I)' A- A'r .."7':�.! . ” :1'.t_';_ ^, f(.;.....,;•'.!4••I•it5 DADE COUNTY DEPARTMENT OF PUBLIC HEALTH 7 ------5 -'--- U • Septic Tank Receipt • - RECEIVED LOCATIO FO R 3 N? 19347 100 his receipt not valid unless dated, filled in and signed by authorized emnlovee of depa ent. _ RS BUILDING ELECTRICAL PLUMBING ROOFING ❑ PERMIT N? 6882 MIAMI SHORES VILLAGE. FLORIDA Owner of Building Architect Contractor or Builder Legal Lot Description Bl. Address of Building CONTRACTOR OR BUILDER Value of Project $ DATE - r 195 Contractor's License No. ' Work to be performed under this Permit Subdi- vision Amount 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 ac- cepting this permit I assume responsibility for all work done by either, myself, my agent, servant or employee. BY AUTHORITY 6 Application is hereby mode for the approval of the detailed state;irre•ne u► the plans and specifications herewith submitted for the build inc 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 the work. Owner's Name and Address Registered Architect and /or Engineer Name and address of licensed contractor Location and legal description of lot to be built on: 67s" Lot Block Street and Number where work is to be done State rk qt Al © A o be done and urpose of building (by floors)..... .., a/ k STATE OF FLORIDA, COUNTY OF DADE. ss• MIAMI SHORES VILLAGE BUILDING INSPECTION DEPARTMENT APPLICATION FOR BUILDING PERMIT Date Building Inspector Sevrt- J 1 - 0 .4" 2` EZlp / A�,�' ( ' l ... . Subdivision t O/ a `0 8 .. 00 .72 -B-Z 3 __ ...._.__..... . ,19.. ......._ _. No.. Street.ta , , v4 2 It •Itt o 4 0e/ /ct Read, Sworn to and Subscribed before me. Notary Public, State of Florida and for no other purpose. New Building Remodeling Addition Repairi Ar No. of Stories To be constructed of Kind of foundation Roof Covering Estimate Total cost of improvements $ (FS 'd 0 Amount of Permit &. ! . L e Zone cubage required .Plan Cubage Distance .to next nearest building Size of Building Lot Maximum live load to be borne by each floor I hereby submit all the plans an pecifications for said building. All notices with reference to the building and its construction may • be sent to �e '' od ( isvG� r9-v/7.) / w Cr - 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, anti has complied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors employed by hips 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 arc required by the Act. The undersigned agrees to employ only such subcontract rs, o work to ormed nder this pennit, as are licensed by Miami Shores Village. Remarks .Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally ap- peared 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.. Permit No y $ Disapproved. ... _ Date (Signed) to me well known, MyCommission Expires _ ................. ..� _._.. PLANNING BOARD DATE Chainnan Member Member Member Member ..... _....._......_..._. ....._ Member Council Approved Date Disapproved Date NOTE: A charge of 51.00 will be made for making corrections or changes to this application after approval has been obtained from the l l.rnnir,g Board. A re-inspection fee of 51.00 will be charged when such re- inspection is made necessary by improper notice for inspection or faulty materials anti /or workmanship. i)i/i In pe• or C;�m is Passed v Failed Correction Needed Re- Inspection Fee ($75) No Additional Inspections can be scheduled until re- inspection fee is paid. Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 'Inspection Number INSP- 17277 Y 1 7 Permit Number. PL2005 -317 Inspection Date: 05/16/2006 Inspector: Inspector, Default Owner: DESPAIGNE, CECILIA Job Address: 105 95 Street NE Miami Shores Village, FL 33138- Project: <NONE> Contractor: WP SEPTIC TANK CO INC Building Department Comments Monday, May 15, 2006 Block: Permit Type: Plumbing - Residential Inspection Type: Landscaping Work Classification: Drainfield Phone Number Parcel Number 1132060132720 Lot: Phone: 305 - 620 -6320 Page 1 of 2 Miami Shores Village Building Department BUILDING PERMIT APPLICATION FBC 2001 Permit Type (circle): Building Electrical 1 ' lumbing Mechanical Roofing Owner's Name (Fee Simple Titleholder) t 1; AD-es f}-( fie- Phone # 30 [1 1 3 (Q Owner's Address 1 0 ✓ f E GIG iRed " V Cit m i ;coil i 5hes State i= L. Zip Tenant/Lessee Name ) \I /ICI Job Address (where the work is being done) 1 0 6— N E J JI Cit Miami Shores Village County Miami -Dade Zip ,53 j 52 Is Building Historically Designated YES NO X t f �_ ,,��'' �� .. `rte , J �a Contractor's Company Name v U *t y. ; " y;';� 6 1) y y Phone # S( 6. Contractor's Address - 1, A i �/ j ' l (,, City a 4, f ,✓ � �, ,, .. State `(✓� Zip � c'}; Qualifier ✓'� ,, � \LL - „ v .. ill State Certificate or Registration No. Certificate of Competency No. / ' Phone # Square Footage Of Work: Architect/Engineer's Name (if applicable) $ Value of Work For this Permit Type of Work: ❑Addition Describe Work: Total Fee Now Due $ (Continued on opposite side) air 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 Scanning $ 3 • CO Radon $ Zoning Code Enforcement $ Structural Plan Review. $ ['Alteration ; t 7 /(k - Notary $ Training/Education Fee $ 0. 40 . GG3 .3S Permit No. Master Permit No. Phone # ❑New aair/Replace ❑ Demolition 42K. . r; ' d �:�i (C a * * * * * * * * * * * * * * * * * * * * * * * * * ** F ees * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** Submittal Fee $ Permit Fee $ 1 7 17/7 CCF $ 1 . Z•O Co/cc Technology Fee $ .6„ 75 Bond $ 3 00 . 00 1 3d1 69 , Bonding Company's Name (if applicable) Bonding Company's Address City State Mortgage Lender's Name (if applicable) Mortgage Lender's Address City Signata NOTARY PUB Si Print: My Commission Expires: MARIA LTERRAZAS i r NOTARY PUBLIC STATE OF FLORIDA * * * * * * * * * * * * * * * * * * * * * ** �*** OM ISS1ONf'JCI. * * *, L COMMISSION EXP. , J * * * * * * * * * * * * * * * * * * * * * * * * * * * ** APPLICATION APPROVED BY: Chc 05/13/03 State who is ers 4 NOTARY ' U Pr' My Commission * * * * * * * * * * * * * * * * * * * * ** Zip Zip Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRICAL WORK, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and AIR CONDITIONERS, ETC 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. "WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT 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." Notice to Applicant: As a condition to the issuance of a building permit with an estimated value exceeding $2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. Signature Owner or Agent The foregoing instrument was acknowledged before me this The foregoin instrument was acknowledged before me this, day of me 20 (j6 by C..e.CA ■CA BPS jC 0-0 , day of , 20C, by who is personally known to me or who has produced As identification and who did take an oath. e or 1 ••,,,, CARMEN A. RIVERA • ', Notary Public - State of Florida E. or ' Y���1 %: n d'' AL' Commisslon # DD26849 . Bonded By Notional NotaryAssn. � - as produced as identif - . r, , .1 . ho did take an oath. A!4 .44/ tr�'�1�,�?! *** * * * * * * * * * * ** * * * * * * * * * * * * * * * * Contractor Plans Examiner , Engineer Zoning Owner's Name and Address MIAMI SHORES VILLAGE BUILDING INSPECTION DEPARTMENT APPLICATION FOR + ` ERMIT Application is hereby umdc for the approval of the detailed statement in me plans and specifications herewith submitted for the build in¢ or other structure herein described. This application is made in compliance and conformity with the ) 3uildingg 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 the work. Date No 1 oS street. Registered Architect and /or Engineer . ...................<.,,...,,.,. Name and adclress of licensed contractor t r1 0 d - 1 - 4 ' _ cc - 1 - ■ C — 1/ 1 - 4 +C_ _ 17 ° Location and legal description of lot to be built on: Lot Block Subdivision Street and Number where work is to be done _ State work to be done and purpose of building (by floors) b 2 (" P', L6 L- and for no other purpose. New Building Remodeling Addition Repairs No. of Stories ...Q N _ To be constructed of Kind of foundation l Rg eCovering g Estimated Total cost of improvements $ ��© Amount of Permit $ k? _ Zone cubage required plan Cubage Distance to next nearest building Size of Building Lot Maximum live load to be borne by each floor I hereby submit all the plans and specifications for said building. All notices with reference to the building and its construction may be sent to.. The umlersigncd 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 Snp clement, and has complied s.itlr 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 ;uch public notice or notices as arc required by the Act, The undersigned agrees to employ only such subcontractgrs, on work be • formed under this permit, as are licensed by Miami Shores Village. _ o Remarks __._..__ (Signed). STATE OF FLORIDA, COUNTY OF DADE. Ss. Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally ap- peared 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 scat dAare 11 Permit No...... .�. 1 Date.. .� Read, Sworn to and Subscribed before me. Disapproved .... Date d ._ ( ....... \ \ .. ` „�.. � , (Signed) l`� e� .l'!�b C3� '' `'}. . 1s r Building Inspector Notary Public, State of Florida My Commission Expires 1 1 , PLANNING BOARD DATE Chairman Member Mcrnber Member Member .. .. Member- - Council Approved Date Disapproved Date NOTE: A charge of $1.00 will be made for making corrections or changes to this application after approval has been obtained from the P1.tnnir Board. A re itiNpectiun fee of $1.00 will be charged when Nell re- inspection is made necessary by Improper notice for inspection or faulty materials and /or workmanship. 6,. ,./ t,)f .. Passed I spec or o ( en J Failed Correction Needed Re- Inspection Fee ($75) No Additional Inspections can be scheduled re- inspection fee is paid. until Inspection Date: 05/16/2006 Inspector: Levrack, James Owner: DESPAIGNE, CECILIA Job Address: 105 95 Street NE Miami Shores Village, FL 33138- Project: <NONE> Contractor: WP SEPTIC TANK CO INC Building Department Comments Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Block: Permit Type: Plumbing - Residential Inspection Type: Final Work Classification: Drainfield Phone Number Parcel Number 1132060132720 Lot: Phone: 305 -620 -6320 Monday, May 15, 2006 Page 1 of 2 ITEM BATH TLB UNIT FEE ITEM SWITCH OUTLETS UNIT FEE ITEM SPACE HEATERS UNIT FEE BIDET LIGHT OUTLETS CENTRAL HEATING DISHWASHER RECEPTACLES A/C (WIND) DIAL SERVICE TEMPORARY A/C (CENTRAL) DRINKING FOUNTAIN SERVICE SIZE IN AMPS DUCT WORK FLOOR DRAIN SERVICE REPAIR/METER CHANGE REFRIGERATION GREASE TRAP APPLIANCE OUTLETS PROCESS AND PRESS PIPING INTERCEPTOR RANGE TOP UNDERGROUND TANKS LAVATORY OVEN ABOVE GROUND TANKS LAUNDRY TRAY WATER HEATER U.F. PRESSURE VESSELS CLOTHES WASHER MOTORS 0- 1 HP STEAM BOILERS SHOWER MIJTCRS OVER 1- 3 hP HOT WATER BOILERS SINK, POT /3 COMP. MOTORS OVER 3- 5 If MECHANICAL VENTILATION SINK, RESIDENCE MOTORS OVER 5- 8 HP TRANSPORTING ASSEMBLIES SINK, SLOP MOTORS OVER 8- 10 HP ELEVATORS/ESCALATORS TEMPORARY WATER CLOSET MOTORS OVER 10- 25 HP FIRE SPRINKLER SYSTEMS URINAL MJTCRS OVER 25-100 FP COOLING TOWERS WATER CLOSET MOTORS OVER 100 HP VIOLATION INDIRECT WASTES A/C WINDOW REINSPECTION WATER SUPPLY TO: AIR CONDITIONERS A/C UNIT STRIP HEATER FIRE SPRINKLER GENERATORS TRANSFORMERS i 'HEATER -NEW INST. GENERATORS TRANSFORMERS 1 HEATER - REPLACE GENERATORS TRANSFORMERS 1 LAWN SPRINKLER -WELL SPECIAL PURPOSE SW !WING POOL OUTLETS COWERCIAL WATER SERVICE SIGN TUBES SEWER CONNECTIONS SIGN TRANSFORMERS UTILITY -SEWER SIGN TIME CLOCK UTILITY -WATER FIXTURES r SEPTIC TANK i)(,) ANTEN?1A RELAY d TELEVISION OUTLETS DRAINFIELD, 4" TILE/RES. VIOLATION PUMP & ABANDON.SEPTIC TANK REINSPECTION . SOAKAGE PIT CU. FT. CATCH BASIN DISCHARGE WELL DOMESTIC WELL AREA DRAIN ROOF INLET SOLAR WATER HEATER FIRE STANDPIPE POOL PIPING LAWN SPRINKLER SYSTEM GAS RANGE METER SET (GAS) GAS PIPIN ,ADDENDUM TO BUILDING PERMIT APPLICATION (AN e£PLICATION FOR BUILDING PERMIT MUST ACCOMPANY THIS ADDENDUM. IF A MASTER PERMIT HAS B. OBTAINED, THE OWNER'S NOTARIZED SIGNATURE NEED NOT BE PRESENT ON SUBSEQUENT APPLICATIONS.) PLUMBING ELECTRICAL MECHANICAL LOT: 16 APPROVED BY: Andre, Paul DATE ISSUED: 10/13/05 STATE OF FLORIDA DEPARTMENT OF HEALTH ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM CONSTRUCTION PERMIT CONSTRUCTION PERMIT FOR: [ ]New System [ ]Existing System [ [ X ]Repair [ ]Abandonment APPLICANT: Despaigne, Cecilia M. PROPERTY STREET ADDRESS: 105 NE 95 St Miami Shores FL 33138 BLOCK: 20 SUBDIVISION: Miami Shores [Section /Township /Range /Parcel No.] PROPERTY ID #: 11- 3206 - 013 -2720 [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 A [ 0 )Gallons 9 [ 0 ]GALLONS GREASE INTERCEPTOR CAPACITY K [ 0 ]GALLONS DOSING TANK CAPACITY [ 0 AGENT: WALLACE P, Ponder Wallace [ 300 ]SQUARE FEET PRIMARY DRAINFIELD SYSTEM [ 0 ]SQUARE FEET SYSTEM TYPE SYSTEM: [ N ]STANDARD [ N ]FILLED CONFIGURATION: [ N ]TRENCH [ N ]BED ' LOCATION TO BENCHMARK: [ ELEVATION OF PROPOSED SYSTEM SITE [ 0.0 ] [ FEET ] [ ? BOTTOM OF DRAINFIELD TO BE [ 0.0 ] [ FEET ] [ L D FILL REQUIRED:[ 0.0 ]INCHES OTHER REMARKS: l.-Install 900 gal. category -3 septic tank 2 . - Install 300 sf of drainfield IN BED CONF 3 . - Invert elevation of drainfield to be no 4 . - Bottom of drainfield elevation to be no THIS PERMIT IS NOT FOR " ADDITION ". [CP] The licensed contractor installing the minimum category of tank in accordance with SPECIFICATIONS BY:Andre, Paul DH 4016, 03/97 (Obsoletes previous editions which may not be used) (Stock Number:, 57 44 - 001 - 4016 -0) [ostds cons 4016 -11 CENTRAX #: 13 -SG -26780 DATE PAID: FEE PAID : $ RECEIPT . OSTDSNBR : 05- 3351 - -R ]Holding Tank [ ] Innovative Other ]Temporary [ NA ] MULTI - CHAMBERED /IN SERIES: [Y ] MULTI - CHAMBERED /IN SERIES: [Y ] ]GALLONS @ [ 0 ]DOSES PER 24 HRS # PUMPS[ 0 ] EXCAVATION REQUIRED: [ 0.0 ] INCHES equipped with an approved filter. IGURATION. less than 8.50' NGVD. less than 8.00' NGVD. • TITLE: TITLE: Professional Engin [ N ]MOUND [ N ] [ N ] ]BENCHMARK /REFERENCE POINT ]BENCHMARK /REFERENCE POINT REPS system is responsible for installing the sec. 64E- 6.013(3)(f), FAC. Dade EXPIRATION DATE: 1/11/06 CHD A;Ro 1 of 7 STATE OF FLORIDA DEPARTMENT OF HEALTH ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM CONSTRUCTION PERMIT CONSTRUCTION PERMIT FOR: [ ]New System [ ]Existing System [ [ X ]Repair [ ]Abandonment APPLICANT: Despaigne, Cecilia M. PROPERTY STREET ADDRESS: 105 NE 95 St Miami Shores FL 33138 LOT: 16 BLOCK: 20 SUBDIVISION: Miami Shores [Section /Township /Range /Parcel No.] PROPERTY ID #: 11- 3206 - 013 -2720 [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 A [ 0 ]Gallons MULTI - CHAMBERED /IN SERIES: [Y ] N [ 0 ]GALLONS GREASE INTERCEPTOR CAPACITY K [ 0 ]GALLONS DOSING 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 I CONFIGURATION: [ N ]TRENCH [ N ]BED N F LOCATION TO BENCHMARK: AGENT: WALLACE P, Ponder Wallace I ELEVATION OF PROPOSED SYSTEM SITE [ 0.0 ] [ FEET ] [ E BOTTOM OF DRAINFIELD TO BE [ 0.0 ] [ FEET ] [ L D FILL REQUIRED: [ 0.0 ]INCHES OTHER REMARKS: 1.- Install 900 gal. category -3 septic tank 2.- Install 300 sf of drainfield IN BED CON 3.- Invert elevation of drainfield to be no 4.- Bottom of drainfield elevation to be no EXCAVATION REQUIRED: [ 0.0 ] INCHES THIS PERMIT IS NOT FOR " ADDITION ". [CP] The licensed contractor installing the system is responsible for installing the minimum category of tank in accordance with sec. 64E- 6.013(3)(f), FAC. SPECIFICATIONS BY: Andre, Paul APPROVED BY: Andre, Paul DATE ISSUED: 10/13/05 AA _nni_nniF_n% r < «a< em a_11 ]Holding Tank [ ] Innovative Other ] Temporary [ NA ] equipped with an approved filter. FIGURATION. less than 8.50' NGVD. less than 8.00' NGVD. TITLE: DH 4016, 03/97 (Obsoletes previous editions which may not be used) TITLE: Professional Engin CENTRAX #: 13 -SG -26780 DATE PAID: FEE PAID : $ RECEIPT . OSTDSNBR : 05- 3351 - -R MULTI - CHAMBERED /IN SERIES: [Y ] [ N ]MOUND [ N ] [ N ]BENCHMARK /REFERENCE POINT ]BENCHMARK /REFERENCE POINT Dade EXPIRATION DATE: 1/11/06 CHD Page 1 of 2 Scale: Each block represents 5 feet and 1 inch = 50 feet._ , • • • • • • • • . Site Plan submitted by Plan Approved By STATE OF FLORIDA DEPARTMENT OF HEALTH APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PERMIT Permit Application Number PART II - SITE PLAN- ' . • ''9 '4.44• ' • itc;'11 • ''. . •'..‘ ; ; • • --! - '"." t ! - i . ' ' 44;4 , k r-.„) • • ., - , - , i , -•: - -; : - : :,• ..„..,- -:.• ••, ; : ..... ;: :.*7:::. ...'.'• ‘ ' . ' . ' ..ti ' ..j, 4..lraq ■• ' .. ■ - . ' 1 tq , ., , ,,k ,- 4.:, ' , , --.,,,,,...,.: : • • - -, “ 4 :', , :4 • ,, - i - t ..V1 .. 1‘, ,,,i .; , ,.. ., . • • ."--" - • i - 1 • t--;. - 1 7 ."7; I a , 4 I • , I . . 5 •• ,•• • • ; •,• • • r • - • • 4 . - ; • • 4 4 - 41- - - - - ,-41 ••-• - • - • . ••• e " 4.1 ) •.!? Notes: ..;-!K- „, ••i• , 1-4 • • • , ,•••••••;.,-; - 1 :,; 4 • ■tk) , ,,••• ••• • Signature Not Approved ,•"'N ',••• •,•• \\, 1 ALL CHANG S ST BE APPROVED BY THE COUNTY HEALTH DEPARTMENT ; Title Date County Health Department Miami Shores Village 10050 NE 2nd Avenue Phone: 305 - 795 -2204 Printed: 11/1/2005 Applicant: CECILIA Owner: DESPAIGNE JOB ADDRESS: 105 NE 95 Contractor W P SEPTIC TANK CO INC Local Phone: 305 - 620 - 6320 Parcel # 1132060132720 Signed: (INSPECTOR) Signed: (Contractor or Builder) Permit Number: PL20O5 317 DESPAIGNE CECILIA ST Permit Status: APPROVED Permit Expiration: 4/29/2006 Construction Value: $1,100.00 Work: INSTALL NEW 300 SQ FT DRAINFIELD AND SEPTIC TANK BY: Contractor's Address: 17235 NW 12 CT Page 1 of 1 Legal Description: 1 53 41 1 53 42 MIAMI SHORES SEC 1 AMD PB 10 -70 LOT 16 & W1/2 LOT 17 BLK Fees: FEE2005 -13964 FEE2005 -13965 FEE2005 -13966 FEE2005 -13967 FEE2005 -13968 FEE2005 -13969 Description Building Fee CCF Training and Education Fee Technology Fee Scanning Fee Builders Bond Total Fees: Amount $350.00 $1.20 $0.40 $8.75 $3.00 $300.00 $663.35 Total Fees: $663.35 Total Receipts: $0.00 NOV 29 PAID H- 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 responisibility for all work done by either myself, my agent, servants or employes.