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1263 NE 94 St (7)Permit No. Date - 2 , / Application is hereby nude 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 ordirances of Miami Shores Village and all rules and regulations of the Building Divisior of Miami Shores Village shall be complied with, whether herein specified or not. A copy of approved plans and specifications must be kept al building during progreu of work. Owner's Name and Addieu Registered Architect and/or Engineer- Employing Plumber's Name._../. co........z.zie...2 v , i - - Street_ l_d.:. S X Location and Legal Description Lot--............— —.-- Blocir Subdivision,/Y,4d-2 14 Street and Nuinber where work is to be performed-No 1) 13 /V ig 57 Sheet. State work to be performed and purpose of building (By Floors).---_—____ New Building .-- Remodeling — Addition- Repairs. No. of Stories C LOUT S BATS Tuns LAVA- TORIES SHOWERS SINKS SLOP SINKS LAUNDRY TUBS unism.. CATCH BASIN FLoon DRAIN ORiNKiNO FOUNT' NS CONTR. LIST CNRCK CONTR. LIST Ramie TANK SIMI* CONN. p ut/4- 1 , 1- • • • DRAIN FIELD SOAKAOL PIT MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT BRUME TRAP SOLAR HEATER COMIC Size Septic Tank Type of Tank---,... Feet of Drain Tile Feet of Tank or Drain Field from Well. Nature of Water Supply: City-Well. - Size of Soakage Pit Amount of Permit $ (signed) • 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 Worlanen's Compensation Act, being Section 5988, Compiled General Laws of Florida Permanent Supplement, and hus com- plied with the provisions thereof, and will require similar complianoe 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 Woos to =Ploy only such sub-oontracton, 7 to be performed under thi permit as a n ho Mi honied by ami Says Village. , ' (Signed).- t/t - Muter Plumber. STATE OF FLORIDA, se. COUNTY OF DADE. ! Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeare ■•■•••••••••••••■■■■•••y•••••••••■••••• OCR WILL No. L. 2VI Street Grimm STRUM Capacity Gals TOTAL FIXTURM Plumbing Inspector. to n10 and who, bola by me first duly sworn, upon oath deposes and says that he is the of the e described construm, that he has carefully read the foregoing application, and that he did sign the ssune, and that all fac t by him stated are true. My Conunission Expires Notary Public, State of Florida NOTE: A re-inspection fee of 81.00 will be made when such re-inspection is made neceuary by improper notice for inspection, or flail materials and/or workmanship. Permit No. 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 Divisior of Miami Shores Village shall be complied with, whether herein specified or not. A copy of approved plans and specifications must be kept ai building during progress of work. r Owner's Name and Address_ Registered Architect and /or Engineer_ Size Septic Tank Feet of Drain Tile Nature of Water Su Amount of Permit $ IP• \ My Commission Expires , MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT G " — (Signed) Date No. Street Employing Plumbers Name Location and Legal Description Lot g Block _L 2 2 `J Subdivision Street and Number where work is to be performed— No._12_4_3___ ____________ Street f 6,1 State work to be performed and purpose of building (By Floors) New Building �.e."" - -- Remodeling Addition__._ Repairs No. of Stories_. Type of Tank_ _ Capacity Gals.__. Dist. Feet of Tank or Drain Field from WeIL Size of Soakage Pit (� J Plumbing Inspector. 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, 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. eTh (Signed)._ 4 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 appeare 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 far therein by him stated are true. Notary Public, State of Florida NOTE: A re- inspection fee of $1.00 will be made when such re- inspection is made necessary by improper notice for inspection, or faul materials and /or workmanship. CLOSETS BATH TUBS SHOWERS LAVA- TORIES SINKS SLOP SINKS LAUNORY TUBS URINALS CATCH BASI FLOOR DRAIN DRINK NO FOUNT 'NS I. A TOTAL FIXTUREI - - LIST ) CHECK )D S ' . 6 r ^ d am' ` J / eE DRAIN FIELD SOAKAGE PIT GREASE TRAP SOLAR H EATER DEEP WELL SPRKLR. SYSTEM SWIM'G POOL /,' '.L f�, 44 LT„ 5{aI / II g s 0 SEPTIC TANK SEWER CONN. CONTR. LIST CHECK AA / v 0 ..-c) Permit No. 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 Divisior of Miami Shores Village shall be complied with, whether herein specified or not. A copy of approved plans and specifications must be kept ai building during progress of work. r Owner's Name and Address_ Registered Architect and /or Engineer_ Size Septic Tank Feet of Drain Tile Nature of Water Su Amount of Permit $ IP• \ My Commission Expires , MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT G " — (Signed) Date No. Street Employing Plumbers Name Location and Legal Description Lot g Block _L 2 2 `J Subdivision Street and Number where work is to be performed— No._12_4_3___ ____________ Street f 6,1 State work to be performed and purpose of building (By Floors) New Building �.e."" - -- Remodeling Addition__._ Repairs No. of Stories_. Type of Tank_ _ Capacity Gals.__. Dist. Feet of Tank or Drain Field from WeIL Size of Soakage Pit (� J Plumbing Inspector. 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, 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. eTh (Signed)._ 4 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 appeare 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 far therein by him stated are true. Notary Public, State of Florida NOTE: A re- inspection fee of $1.00 will be made when such re- inspection is made necessary by improper notice for inspection, or faul materials and /or workmanship. ..""" /2, z 0 _ 1,ki e. L A J / A v v V 74" - e-- MIAMI SHORES VILLAGE, FLORIDA BUILDING ❑ DATE E cTRICAI. I PERMIT IN? 13263 PLUMBING [17 ROOFING ❑ Work to be performed under this Permit Owner of Building -t. . a Architect Contractor or Builder Legal Lot Description Address of Building 1 CONTRACTOR OR BUILDER Bl. Signed: fs Subdi- vision Value of Project $ 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. BY 4. 4 Yuri. BY AUTHORITY 195 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. BUILDING ELECTRICAL PLUMBING ROOFING Owner of Building Architect Contractor or Builder Legal Description Address of Building Lot n I EZI CONTRACTOR OR BUILDER MIAMI SHORES VILLAGE. FLORIDA DATF. PERMIT N? 13346 f] Work to be performed under this Permit Bl. Value of Project $ BY 1 ' t Subdi- vision /' t Amt. of Permit $ t i- e� , r 195 Contractor's License No 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 byeit1er, myse){, my agent, servant or employee. / l i /I AUTHORITY BUILDING ELECTRICAL PLUMBING ROOFING Owner of Building Architect Contractor or Builder Legal Description Address of Building Lot MIAMI SHORES VILLAGE, FLORIDA n PERMIT N? 13039 n ❑ Work to be performed under this Permit Bl. Subdi- vision CONTRACTOR OR BUILDER r � _ BY Value of Project $ DATE 195 Contractor's License No Amt. of // Permit $ AUTHORITY 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. Permit No 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 confax;,iZy with the building Ordinance of Miami Shores Village, Florida, and all provisions of the Laws of the State of Florida, all ordinances of Miami 511 Village and all rules and regulations of the Building Division of Miami Shores Village shall be complied with, whether herein specifieA rr. A cop :' of approved plans and specifications must be kept at building during progress of work. Ownea'a Name and Address - ------- _ -_ - -m ef______ - -- No Registered Arcbd:ect and /or Engineer_._ Em __ _ to Plumber's Name_[ &",1 _ °S Employing _A. t -- New Building Remodeling — ,.___._ Addition.- ._.._.._ Repairs Size Septic Tank Feet of Drain Tile_ Nature of Water Supply: City —Well. Amount of Permit $ MIAMI SHORES VIA 4,AG2 PLUMBING INSPECTION DEPARTMEt :' APPLICATION FOR PLUMBING Date /g4._ ___ Street_ Type of Tank__ ___.----------------- .- - - - - -. Dist. Feet of Tank or Drain Field from Well — __ _-Size of Soakage Pit My Commission Expires Notary Public, State of Florida 1 e zz Street_ No. of Stories. Capacity Gals Location and Legal Description Lot__ Street and Number where work is to be performed —No ___1_24 Street State work to be performed and purpose of building (By Floors) _.. '. ��_. . , �. - -- . kJ!? CNl^t o ' l9r3) F ► b f� bing Itfspector. The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligation as an employer of labor under the Florida Workmen's Compensation Act, being Section 5988, Compiled General Laws of Florida Permanent 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 . lic notice or notices as are required by the Act The undersigned agrees to employ only such sub- contractors, owork to be p o ed ,under this permit, as are licensed by Miami Shores Village. STATE OF FLORIDA, COUNTY OF DADE. Before me, the undersigned authority, a notary public, duly authorized to administ 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 hire, 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 Tugs URINAL{ CATCH BASIN FLOOR DRAIN DRINKING FOUNT' NS TOTAL FIXTURES Cott? . LIST CHECK SEPTIC TANK SEWER CONN. DRAIN FIELD SOAKAGE PIT GREASE TRAP SOLAR HEATER DEEP WELL SPRKLR. SYSTEM SWIM'G P001. CONTR. LIST - CHECK Permit No 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 confax;,iZy with the building Ordinance of Miami Shores Village, Florida, and all provisions of the Laws of the State of Florida, all ordinances of Miami 511 Village and all rules and regulations of the Building Division of Miami Shores Village shall be complied with, whether herein specifieA rr. A cop :' of approved plans and specifications must be kept at building during progress of work. Ownea'a Name and Address - ------- _ -_ - -m ef______ - -- No Registered Arcbd:ect and /or Engineer_._ Em __ _ to Plumber's Name_[ &",1 _ °S Employing _A. t -- New Building Remodeling — ,.___._ Addition.- ._.._.._ Repairs Size Septic Tank Feet of Drain Tile_ Nature of Water Supply: City —Well. Amount of Permit $ MIAMI SHORES VIA 4,AG2 PLUMBING INSPECTION DEPARTMEt :' APPLICATION FOR PLUMBING Date /g4._ ___ Street_ Type of Tank__ ___.----------------- .- - - - - -. Dist. Feet of Tank or Drain Field from Well — __ _-Size of Soakage Pit My Commission Expires Notary Public, State of Florida 1 e zz Street_ No. of Stories. Capacity Gals Location and Legal Description Lot__ Street and Number where work is to be performed —No ___1_24 Street State work to be performed and purpose of building (By Floors) _.. '. ��_. . , �. - -- . kJ!? CNl^t o ' l9r3) F ► b f� bing Itfspector. The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligation as an employer of labor under the Florida Workmen's Compensation Act, being Section 5988, Compiled General Laws of Florida Permanent 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 . lic notice or notices as are required by the Act The undersigned agrees to employ only such sub- contractors, owork to be p o ed ,under this permit, as are licensed by Miami Shores Village. STATE OF FLORIDA, COUNTY OF DADE. Before me, the undersigned authority, a notary public, duly authorized to administ 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 hire, 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. Application is hereby n_ace for the approval of the detailed statement of the plans and specifications herewith submitted for the building or other stn. ;ctuee 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 he kept at building during progress of work. Owner's Name and Address _s Registered Architect and /or Engineer Employing Plumber's Name O. G. LLOYD SEPTIC SERVICE N°1942 Location and Legal Description Lot..___— ....._._ _... - - - -_ -- 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 MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT DateII/2_ ?_ /b2_ No. 1263 Street.NaEa__94,..th__St. Street._.N•W• Subdivision 86 th St. Street. Repairs No. of Stories_ Capacity Gals Size Septic Tank-_-- _.__._ __ - - -- Type of Tank Feet of Drain Tile. z rr_Pt. - -flitre _B Feet of Tank or Drain Field from Well Nature of Water Supply: City— Well.______ ______ __._Size of Soakage Pit - - --- -- - -- -- - --- - ,....0 -61--- -.- Amount of Permit � _ , / d - -= - - - -- -- — — —_ (Signed) - - Plumbing Inspector. The undersigned applicant for rhisIbuilding permit does hereby certify that he understands and accepts his obligation s an employer of labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Permanent Supp ement, and has com- plied with the provisions thereof, and wil(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 rfrr_,Ired 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. Master Plumber. STATE OF FLORIDA, 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. My Commission Expires Notary Public, State of Florida NOTE: A re- inspection fee of 81.00 will be made when such re- inspection is made 'necessary by improper notice for inspection, or faulty materials and/or workmanship. CLOSr' S BATH TUBS SHOWER. LAVA. TORIES SIN" SINKS LAUNDRY TUBE URINALS CATCH BASIN FLOOR DRAIN DRINKING FOUNT'NS TOTAL FIXTURES CONTR. LIST _ CHILES - _ SEPTIC TANK SEWER CONN. DRAIN FIELD SOAKAGE PIT GREASE' TRAP SOLAR HEATER DEEP WELL SPRKLR. SYSTEM SWIM•G POOL CONTR. LIST - CMECK Application is hereby n_ace for the approval of the detailed statement of the plans and specifications herewith submitted for the building or other stn. ;ctuee 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 he kept at building during progress of work. Owner's Name and Address _s Registered Architect and /or Engineer Employing Plumber's Name O. G. LLOYD SEPTIC SERVICE N°1942 Location and Legal Description Lot..___— ....._._ _... - - - -_ -- 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 MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT DateII/2_ ?_ /b2_ No. 1263 Street.NaEa__94,..th__St. Street._.N•W• Subdivision 86 th St. Street. Repairs No. of Stories_ Capacity Gals Size Septic Tank-_-- _.__._ __ - - -- Type of Tank Feet of Drain Tile. z rr_Pt. - -flitre _B Feet of Tank or Drain Field from Well Nature of Water Supply: City— Well.______ ______ __._Size of Soakage Pit - - --- -- - -- -- - --- - ,....0 -61--- -.- Amount of Permit � _ , / d - -= - - - -- -- — — —_ (Signed) - - Plumbing Inspector. The undersigned applicant for rhisIbuilding permit does hereby certify that he understands and accepts his obligation s an employer of labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Permanent Supp ement, and has com- plied with the provisions thereof, and wil(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 rfrr_,Ired 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. Master Plumber. STATE OF FLORIDA, 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. My Commission Expires Notary Public, State of Florida NOTE: A re- inspection fee of 81.00 will be made when such re- inspection is made 'necessary by improper notice for inspection, or faulty materials and/or workmanship. PERMIT APPLICATION FOR MIAMI SHORES VILLAGE - he ` � �-+ Date / O 2 / / Job Address / (O 3 /UZ 9`f ��C> / Tax Folio Legal Description Historically Designated: Yes 4--/opa7 Owner's Address /.4-d A/L= ci Ll-Tri 3-77 Phone /5315 Address d .7) //J 7/ i /i9J$/ ,' . Owner/Lessee / Tenant ■/ ( HA AAO 7 11 // 1-1 Contracting Co. L L YD " /1)0 /N aL Qualifier TER FSA F�L ER State # 5g -g Architect/Engineer Bonding Company Mortgagor Permit Type (circle one): BUILDING ELECTRICAL WORK DESCRIPTION tASS PCL- D -A -' O Square Ft. 0 0 Estimated Cost (value) Soo 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 zoning. Furthermore, I authorize the above -named contractor to do the work stated. j 4r - of owner dri'� • C d e sriie ,/ A te'. t dent Notary as My Commission Expires: / 0F x� LESTER E. CROCKETT /Q 9 My Comm Exp. 5/20/2001 - NOiAR n Bonded By Service Ins No. CC649326 f I Personally Known I I Other 1.0 Municipal # FEES: PIJRMI 3 RADON APPROVED: Zoning Building Mechanical Plumbing Date Date Master Permit # SS# Phone - 75 I -1 616 Competency # 0 a 4-2- Ins. co. es IF f Mr*-y 4 Address Address Address MECHANICAL ROOFING PAVING FENCE SIGN Notary as to Co r actor or Uwner- tiuilderl My Commission Expires: °�,� LESTER E. CROCK ,_:. „ () My C omm P 5 „l >. ,� 5 / 20 /2001 i Bonded By Service Ins s - - No. CC649326 O I I Personally Known I 1 Other I.D 2 C.C.F. 1 • NOTARY �— Electrical 1 OND No TOTAL DUE /o-3 - Q l Date /0 ,47 Date C� 3 2L1 Engineering j D R A I N F I E L D 0 T H E R APPLICANT: LOT: T [ A [ N [ K [ LOCATION OF BENCHMARK: FILL REQUIRED: [ 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 CONSTRUCTION PERMIT FOR: [' ] New System [ /' %]. Existing System [' Holding Tank [ ] Temporary /Experimental [ ] Repair [, `] Abandonment [' ] Other(Specify) PROPERTY STREET ADDRESS: BLOCK: �,;�' SUBDIVISION: SYSTEM DESIGN AND SPECIFICATIONS [ ]SQUARE FEET PRIMARY ( ] SQUARE FEET TYPE SYSTEM: CONFIGURATION: �..._ 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. ] [GALLONS / GPDI 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: [ ] DRAINFIELD SYSTEM SYSTEM [ ] STANDARD [ ] FILLED [ ] TRENCH [,. ) BED ELEVATION OF PROPOSED SYSTEM SITE ] CINCHES/FT] [ABOV) /BEL04�D] BENCHMARK/RFERENCE POINT BOTTOM OF DRAINFIELD TO BE [ ° j [INCHES /FT] [ABOVE /BELO%J BENCHMARK /REFERENCE POINT ] INCHES EXCAVATION REQUIRED: [` ] INCHES TITLE: TITLE:. . HRS -H Form 4016, Mar 92 (Obsoletes previous editions which may not be used) (Stock Number: 5744 - 001-4016 AGENT: j PERMIT # DATE PAID »' FEE PAID $ RECEIPT # [ ] MOUND [ ] [ ] EXPIRATION DATE: CPHU Page 1 of 2 PART II - SITE PLAN STATE OF FLORIDA • DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PERMIT Permit Application Number Scale: Each block represents 5 feet and 1 inch = 50 feet. ( t 1' 1 Notes: „4 - Site Plan submitted by: ; SIGNATURE % TITLE Plan Approved Not Approved Date By County Public Unit ALL CHANGES MUST BE APPROVED BY THE COUNTY PUBLIC HEALTH UNIT HRS -H Form 4015, Feb 85 (Obsoletes previous editions which may not be used) (Stock Number. 5744-002-4015-6) Page 2 of 3