SEPTICBUILDING
ELECTRICAL
PLUMBING
ROOFING
0
0
0
0
Owner d
Building
Contractor
or Builder ' ..' ji
Legal lot
Description —
Address of
Building
CONTRACTOR OR BUILDER
MIAMI SHORES VILLAGE. FLORIDA
PERMIT
7
Architect
B
p
s
N? 5864
Value of
Project $
T R TT ,v • 195Y
Contractor's
License No.
✓ 6�
Work to be performed under this Permit - .0„,,,,,,, �r �'' ` ` -«�
"7'
Amount of
Permit $
Subdi-
vision
i
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 f r in the statements oyspecifipstions and that he assumes responsibility for work
done by his agents, servants or employees. ` .,
,
r
I t
Signed ( �� .P.,
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 s
ce hng this permit I assume responsibility for all work done by either, myself, my age
BIB - *`
BY
mitted to the proper authorities of Miami Shores Village. In ac•
t or employee.
AUTHORITY
e/(J‘
MIAMI SHORES VILLAGE, FLA.
JOB
ADDRESS
INSPECTION
TIME READY
REMARKS
INSPECTOR
N9 6461
DATE
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Date -, Job Address 4/ 2 '� 94 S• Tax Folio ^ 520 — Q i � O (O
Legal Description Historically Designated: Yes No
Owner/Lessee / Tenant m / i e • """O2 G L / CS Master Permit # e Q
Owner's Address q '2O N 27 4g-30 S M �R M / AL 33/72 Phone 30 <- S3 - 3 a
Contracting Co. L L 0 > ,6 N 0 2714 671 2 S ET /L T// -A), Address d' /v W 1/1ST" /4/4-0// ,G 33/68
Qualifier A reee5 A J. , Phone 7s1 C07G
State # Z Municipal # Competency # 12e4 Z Ins. Co. 1SI F /F4 /LI 4T CAS
Architect/Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIPTION
Square Ft. ,SOO Estimated Cost (value) di IC-400
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.
S e of owner an _ Condo President Date
Notary as to Own . and/ • Condo Presi• ent Date
My Commission Expires:
LESTER E. CROCKETT
My Comm Exp. 5/20/2001
Bonded By Service Ins
No. CC649326
I I Personally Known 1 /Other I.D
FEES: PERMIT RADON
1 1=26-9-7
Date
C.C.F.
Notary as to
My Commission Expires:
LESTER E. CROCKETT
My Comm Exp. 5/20/2001
Bonded By Service Ins
No. CC649326
I I Personally Known 11 Other I.D
NOTARY BOND
TOTAL DUE
APPROVED:
Zoning Building Electrical
Mechanical Plumbing / l (,d` / Engineering
CONSTRUCTION PERMIT FOR:
[/:,- New System [ V ] xisting System [ ] olding Tank
4 [
] Repair [!� Abandonment [ - Other(Specify)
APPLICANT: IT h� - 7 a .
A P
_ AGENT: 4//o ! ) 2) e7
PROPERTY STREET ADDRESS: CLi a
LOT:
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[ .30(1]
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TYPE SYSTEM:
CONFIGURATION:
FILL REQUIRED:
\ n
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
i/ q
BLOCK: AAN, SUBDIVISION:
UARE FEE:; IMARY DRAINFIELD SYSTEM
RE'FEET SYSTEM
[ ] STANDARD [ ] FILLED
[ ] TRENCH [ 4BED
LOCATION OF BENCHMARK: 7 F> F. 0 Ov7
ELEVATION OF PROPOSED SYSTEM SITE [ ■ [ABOVE
BOTTOM OF DRAINFIELD TO BE [j 4 � [INCHES /FT] [ABOV
] INCHES EXCAVATION REQUIRED:
i q,\ �! \u! /fan t\ ..,7a a J 1,1
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 #
Temporary /Experimental
PROPERTY ID #: a 2 e) .� v 0 2 [SEC /TOWNSHIP /RANGE /PARCEL NUMBER]
[OR TAX ID NUMBER]
2
SYSTEM MUST BE CONSTRUCTED IN ACCORDANCE WITH SPECIFICATIONS AND STANDARDS OF CHA,P,TER 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 SPEC FIQATIONS
_ NK /
OC) ]
T [ [GALLONS - GPD L�SEPTIC TA EROBIC UNIT CAPACITY
MULTI- CHAMBERED /IN SERIES:[ ]
] [GAT•T. S / 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: [ ]
[ ] MOUND [ ]
[ ]
ELOWj, BENCHMARK / iiERENCE PaUD
BELOW J BENCHMARK1 FERENCE POINT)
[ 34] INCHES
TITLE• CPHU
EXPIRATION DATE:
Page 1 of 2
STATE OF FLORIDA.
DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES
APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCT,I I
Permit Application Number / fl p `7
Scale: Each block represents 5 feet and 1 inch = 50 feet.
1111111111111111111111111111111111111111111111111111111111111111111 I
11 111111 1 1111111111111111Il1011111111l11ll11lllli
Notes: �;
oLo
Site Plan submitted by: \ 0 .
( Sf(�N ' TU
Plan Approved ��: _ / Not Approved
By � � � �� ' / County Public Unit
ALL CHANGES MUST BE APPROV‘D 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)
PART II - SITE PLAN
r
Fitc-i1 4/2,/c
2 - 77
TITLE
Date 43?. ®3.- ` 2
Page 2 of 3