1220 NE 94 St (5)PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Date Job Address 1071 /✓&- ' f s/ ' Tax Folio
Legal Description Historically Designated: Yes No
Owner/Lessee / Tenant e /aim 5C Master Permit # 145 �3
Phone 3c5'— 7S
/ Address l r / 32 A f ii • a
•
Qualifier C�. Q- � eA) �c-/� n SS# `/Phone
State # Municipal # Competency # Ins. Co.
Architect/Engineer Address
Bonding Company
Mortgagor Address
Permit Type (circle one): UILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIP'T'ION / LP / GQi Q/ /a1--
Owner's Address /D 7 I /✓. t V s
Contracting Co. NQ. C { z f J rn-.1r-' 7nL.
Square Ft. gai
WARNING TO OWNE r : YOU MUST RECORD A NOTICE OF COMMENCEMENT AND YOUR FAILURE TO DO SO MAY RESULT IN YOUR
PAYING TWICE FO IMPROVEMENTS TO YOUR PROPERTY (IF YOU INTEND TO OBTAIN FINANCING, CONSULT WIITH YOUR LENDER
OR AN ATTORNEY : EFORE 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 perfonned 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.
Ni : as to Owner and/or Condo President 1 : to
My Commissio vvvvvvvvvvvvvv
STEPHEN E COCKING
State of Florida
My Comm. Exp: 08/04/0'.
Comm#: CC889180
FEES: PERMIT C RADON C.C.F. / • "` o
3
APPROVED:
Zoning Building
Mechanical Plumbing
Address
Estimated Cost (value)
ntractor or Owner - Builder Votyilev
te
A-52.-76 hi X03 0
11
:
ply
Signature of
d P.
Notary as to Con
My Commission E
ires:
NOTARY BOND
Electrical
;' ' : � i ►i,�' " ARYSEAL
GLADES] VILLA t
NOTARY COMMISSION STATE NO. CC714103
la COMMISSION EXP. MAR. 1
Date
TOTAL DUE S fg
Structural Engineer
CONSTRUCTION PERMIT FOR:
[N9] New System [N] Existing System [q] Holding Tank
[ ] Repair [GA Abandonment ( ] Temporary
APPLICANT: at R O O
STATE OF FLORIDA
DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT
CONSTRUCTION PERMIT
PROPERTY ADDRESS: O 78 NI a i
LOT: BLOCK: /i SUBDIVISION: a , 49 f('
[SECTION, TOWNSHIP, RANGE, PARCEL NUMBER]
PROPERTY ID #: _g - 3 a Q) S - - ®0 76P [OR TAX ID NUMBER]
SYSTEM MUST BE CONSTRUCTED IN ACCORDANCE WITH SPECIFICATIONS AND STANDARDS OF SECTION 381.0065,
F.S., AND CHAPTER 64E -6, F.A.C. DEPARTMENT APPROVAL OF SYSTEM DOES NOT GUARANTEE SAFTISFACTORY
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. ISSUANCE OF THIS PERMIT
DOES NOT EXEMPT THE APPLICANT FROM COMPLIANCE WITH OTHER FEDERAL, STATE, OR LOCAL PERMITTING
REQUIRED FOR DEVELOPMENT OF THIS PROPERTY.
SYSTEM DE IGN AND,SPECIFICATIONS
� a4 Q.ki°i 4 q )
T (0O] GALLONS / GPD/AEROBIC 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 DOSING TANK CAPACITY [ ]GALLONS @ [ ] DOSES PER 24•HRS # PUMPS [ ]
D [] SQUARE FEET PRIMARY DRAINFIELD SYSTEM
SYSTEM
[AA FILLED [ MOUND
BED [M
R [ ] SQUARE FEET
A TYPE SYSTEM: [/] STANARD
I CONFIGURATION: W] TRENCH
N
F LOCATION OF BENCHMARK:
Fri ALELJ EZ ;
I ELEVATION OF PROPOSED SYSTEM SITE [ D • 3 ] [INCHES'./ [ABOVE/
E BOTTOM OF DRAINFIELD TO BE [ 3', CS] [ ES /FT] [ABOVE
D FILL REQUIRED: [Pia ] INCHES EXCAVATION REQUIRED: [
0
T
H
E
R
SPECIFICATIONS BY:
APPROVED BY:
DATE ISSUED: A , a9 - c
TITLE:
P
pt. I: Health Depilt -
pt. 2: Applicant {�
pt. 3: Installer/Co
pt: 4: Building Department
CT14 N
YSTEM
Cl R=2 2.0 Gal
PERMIT NO.® ®ice_ &D
DATE PAID: 3_ a -
FEE PAID: 7.5 . 4
RECEIPT #: o o 0 4, v S4 t 1
[ A4] Innovative
(,j
[c4
INCHES
MUM - C7 tqr_TJV
(=pp 1 L $112) P.) (iI
rare aim M 1 ' ,�i 411=6* . ,
BE /REFERENCE POINT
BENCHMARK /REFERENCE POINT
an) ac2
0c
EXPIRATION DATE : o a 9 — ® 4
DH 4016, 12/99 (Page 1) (Previous Editions May Be Used) -8: Page _l of,2kAR
INSTRUCTIONS:
PERMIT NUMBER:
CONSTRUCTION
PERMIT FOR:
SYSTEM DESIGN AND
SPECIFICATIONS:
Permit tracking number assi ned b CP Lf. •• ? I
t c44 •
Check type of permit, if " n or type in blank.
TANK: Minimum specifications from Chapter 64E-6, FAC.
DRAINFIELD: Minimum specifications from Chapter 64E-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 (CHD) personnel reviewing and approving permit.
DATE ISSUED: Date permit is issued by CHD
•
• .,
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. (CHD may require property appraiser ID # or section /township /range /parcel number)
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.
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- STATE OF FLORIDA -
DEPARTMENT OF HEALTH
APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PERMIT
Permit Application Number OA / -
PART II - SITEPLAN l 5 I 7'
• Ea >lock represents 10 feet and 1 inch = 40 feet. N a. 9 �y lJ
Notes: ft) 'CD g4LP 16, /i
-Der o
By
Site Plan submitted by — r�
Plan Approved
Not Approved
, , 4.,2 / / 0 G 11 ' Healt9D partment
� d? , 2
ALL CHANGES OUST BE APPROVED BY THE COUNTY HEALTH NY
DH 4015, 10/96 (Replaces HRS -H Form 401 which may be used) Page Yof 4
(Stock Number: 5744 - 002 - 4015 -6)
Date
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- STATE OF FLORIDA -
DEPARTMENT OF HEALTH
APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PERMIT
Permit Application Number OA / -
PART II - SITEPLAN l 5 I 7'
• Ea >lock represents 10 feet and 1 inch = 40 feet. N a. 9 �y lJ
Notes: ft) 'CD g4LP 16, /i
-Der o
By
Site Plan submitted by — r�
Plan Approved
Not Approved
, , 4.,2 / / 0 G 11 ' Healt9D partment
� d? , 2
ALL CHANGES OUST BE APPROVED BY THE COUNTY HEALTH NY
DH 4015, 10/96 (Replaces HRS -H Form 401 which may be used) Page Yof 4
(Stock Number: 5744 - 002 - 4015 -6)
Date