1270 NE 94 St (3)PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Date Job Address Jai 7t J A( . X 54 _ Tax Folio
Legal Description Historically Designated: Yes No
Owner/Lessee / Tenant 0 L Z.L .�Zl^ ?Agee - O 0 . Master Permit # `7` // 933 (
Owners Address /�7 N 6 e ?,1 l4 - Phone 7' 7 Sq -- 6 6 9 3
Contracting Co. // f k i G S Jpp �� f / &
/ � Address
Qualifier a 4/ 4 ■ C.o tr,, k%1 g
V
State # 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 L ° 4c-e, th4
Square Ft. 3 021 Estimated Cost (value) / .eat-
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, Lthorize the above -named contractor to do the work stated.
r-v1,_coal
i gnature of owner and/or Condo Presi
Notary as to Ownet.and/o ondo•President =Y• pate
My Commission Aire :
FEES: PERMIT
APPROVED:
Zoning
Mechanical
STEPHEN E COCKING ;
State of Florida >
My Comm. Exp: 08/0410': • c
e ± mm #: CC889180
RADON
Building
Plumbing
ss# 7Phone ?o s't 7 - 7 f
•
r...rsar
r or fa r .
fires: G 0 VILIAR
NOTARY CMMISSION NO. CC71410
MY COMMISSION EXP. MAR.1
it er
otary as to Contra
My Commission Ex
f Contractor or caner -B
a °
C.C.F. / NOTARY
Electrical
/g13Z c2
BOND 5oO
TOTAL DUE
6 - o/
Date
Date
Structural Engineer
O
T
H
E
R
CO STRUCTION PERMIT FOR:
] New System
Repair
APPLICANT:
PROPERTY ADDRESS:
LOT:
SPECIFICATIONS BY:
APPROVED BY:
DATE ISSUED:
DE 4016, 12/99
STATE 'OF FLORIDA
DEPARTMENT OF HEALTH
ONSITE SEM _
CONSTRUCTIO
SYSTEM DESIGN SPERICA,TIONS
T [ 9"] �J1�jj
A [
N [ : ]
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6 61
(Page 1)
Existing System
Abandonment
#.1,70 /Je
S 10411 I
( &iseZ-V7Ter
BLOCK: SUBDIVISION: M t kiN.A . \ 1� Rio 4\-11A) [SECTION, TOWNSHIP, RANGE, P ' CELL NUMBER]
[OR TAX ID NUMBER]
PROPERTY ID #: V 3 2. os 0/0 431
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.
HAND DISPOSAL SYSTEM
GALLONS / GPD AEROBIC UNIT CAPACITY MIILTI- CHAMBERED /IN- SERIES [
GALLONp EA DCAPACITY MULTI- CHAMBERED /IN- SERIES [ ]
GALL Si E INTERCEPTOR CAPACITY [MAXIMUM CAPACITY SINGLE TANK: 1250 GALLONS]
GALLONS DOSING TANK CAPACITY [ ] GALLONS @ [ ] DOSES PER 24 HRS # PUMPS ( " ]
D .[ - ] SQUARE FEET PRIMARY DRAINFIELD SYSTEM
R [ ] SQUARE FEET/ SYSTEM
A TYPE SYSTEM: (Y STANARD [ FILLED
I CONFIGURATION: [ ] RENCH [ -] BED
N
F LOCATION OF BENCHMARK:
I ELEVATION OF PROPOSED SYSTEM SITE
E BOTTOM OF DRAINFIELD TO BE
D FILL REQUIRED: [�� ] INCHES EXCAVATION REQUIRED:
I ,Q�] Holding Tank ( Innovative
( Gam' Temporary (A
MOUND
TITLE:
TITLE: 9
M1�LS � �� n mnnn k �.• _
(P r e ( � 1fo r U Fiai�tiihAcMg fBe { __
G6lPI� :V DE } 4ir ye2 d 5
pt. 3: Installer Contractor
pt. 4: Building Department
EXPIRATION DATE:
PERMIT NO. 4k,_____
DATE PAID: A. .p _ , j
FEE PAID: 0 J
RECEIPT i 8 0 L.Z.C. .o v 1
0 - — 37 �
ment
[ABOVE/:42M] +=ENCHMARK /REFERENCE POINT
[ABOVE /BELOW] BENCHMARK /REFERENCE POINT
[ ] INCHES
oNSTAI ° OF LOAMY COARSE SAND
UNDER BOTTOM OF UHikiNI - iELD
SUBMIT BENCHMAHm tsitFCRE INSPCCTIt�
D w , y ,
Page 1 of 3
IINSTRUCTIIONS:
PERMIT NUMBER: Permit tracking number assigned by CPHU.
CONSTRUCTION
PERMIT 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 DDD #: 27 character id number for property. (CHD may require property appraiser DD # or section/township /range/parcel number)
SYSTEM DESIGN AND
SPECIFICATIONS:
TANK: Minimum specifications from Chapter 64E-6, FAC.
DDLADNFIIELD: 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
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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Notes:
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1
Site Plan Submitted y:
Plan Approved
By
r
STATE OF FLORIDA
DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES
APPLICATION FOR ONSITE SEWAGE-DISPOSAL SYSTEM-CONSTRUCTION PERMIT
Permit Application Number
ALL CHANGES MUST BE'
r �
HRS -H Form 4015, Feb 85 (Obsoletes previous editions which my.,not be used)
:(Stock Number: 5744- 002 - 4015 -6)
PART II - SITE PLAN
- 71) „MI ro L(C> `7fi /-2
SIGNA ' RE
Not Approved
OVED BY THE COUNTY PUBLIC HEALTH UNIT
Date
County Public Unit
Page 2 of 3
BUILDING D MIAMI SHORES .VILLAGE, FLORIDA
4
ELECTRICAL D
PLUMBING Date_1
PERMIT .1■19 8170 Contractor's
ROOFING 0
Work to be performed under this Permit
Z l n d e i r ng ° f eL,
Architect
Contractor
or Builder .1; '11` T 4_1 4,6
Legal Lot
Description
Address of
Building r1 o
CONTRACTOR or BUILDER
BI
Z AP2 .0 . 0
*
License No.
Loto Vh
BY AUTHORITY
19 (A,
Subdi-
vision
Sq Ft. et,
Value of
II Amount of 3 -
Project $ ---
11 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 applica-
tion 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 sh wn on the plans or drawings or in the statements or specifications and that he assumes respon-
1 •
sibility for work done by his agents, servants or employees., r
‘
Signed • C. .- t,...- -)1.-t4," SPECTOR) BY
.44
In consideration of the issuance to me of this permit I agree to perform the work covered hereunder in compliance with all ordinances aid regulations
pertaining thereto and in strict conformity with the plans, drawings, i st fesients or specifications submitted to the proper authorities of Miami Shores Village.
--' c
In accepting this permit I assume responsibility for all work done by ejtfier, as.. myself,--my agent, servant or employee.