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95 NE 95 St (8)Permit No. Amount of Permit $ Dt? MI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT 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 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 work. Owners Name and Address -- � ---------- - -__ -- No. Street_ Registered Architect and /or Engineer__________ ___ —_____ _ -- Employing Plumber's Name f . � L __ 0 � ! / e - r d i a _ No._____— 1 -X3 Street -- Id f l -8. .__ Location and Legal Description Lot - - Block Subdivision.- __._ -- -------- ___ - _- Street and Number where work is to be performed -No Street__ 7f J" State work to be performed and purpose of building (By Floors)_. ___________ New Building -_ _ - - - - -- Remodeling— _--- - - - - -- _____ Addition_ Size Septic Tank ------ -- _-__ -- -- -_Type of Tank Feet of Drain Tile,Q - de!f -get. Feet of Tank or Drain Field from Well Nature of Water Supply: City - Well.__________________________ __._,_Size of Soakage Pit (Signed)- (Signed) Date -- -- 'S .s Repairs No. of Stories. Capacity Gals. The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligatdns 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. My Commission Expires Notary Public, State of Florida i tn t/ Plumbing Inspector STATE OF FLORIDA, 1 COUNTY OF DADE. j 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. NOTE: A re- inspection fee of 0.00 will be made when such re- inspection is made•necessary by improper notice for inspection, or faulty materials and /w workmanship. CLOSETS BATH TUBS SHOWERS LAVA. TORIES SINKS SLOP SINKS LAUNDRY TU88 U RINALS CATCH BASIN FLOOR DRAIN DRINKING FOUNT TOTAL FIXTURES CONTR. LIST - CHECK SEPTIC TANK SEWER CONN. DRAIN FIELD SOAKAGE PIT GREASE TRAP SOLAR HEATER DEEP WELL SPRKLR. SYSTEM SWIM'G POOL CONTR. LIGT CHECK Permit No. Amount of Permit $ Dt? MI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT 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 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 work. Owners Name and Address -- � ---------- - -__ -- No. Street_ Registered Architect and /or Engineer__________ ___ —_____ _ -- Employing Plumber's Name f . � L __ 0 � ! / e - r d i a _ No._____— 1 -X3 Street -- Id f l -8. .__ Location and Legal Description Lot - - Block Subdivision.- __._ -- -------- ___ - _- Street and Number where work is to be performed -No Street__ 7f J" State work to be performed and purpose of building (By Floors)_. ___________ New Building -_ _ - - - - -- Remodeling— _--- - - - - -- _____ Addition_ Size Septic Tank ------ -- _-__ -- -- -_Type of Tank Feet of Drain Tile,Q - de!f -get. Feet of Tank or Drain Field from Well Nature of Water Supply: City - Well.__________________________ __._,_Size of Soakage Pit (Signed)- (Signed) Date -- -- 'S .s Repairs No. of Stories. Capacity Gals. The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligatdns 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. My Commission Expires Notary Public, State of Florida i tn t/ Plumbing Inspector STATE OF FLORIDA, 1 COUNTY OF DADE. j 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. NOTE: A re- inspection fee of 0.00 will be made when such re- inspection is made•necessary by improper notice for inspection, or faulty materials and /w workmanship. IvMIAMI' SHORES VILLAGE, FLA. No JOB ADDRESS INSPECTION TIME READY REMARKS : w INSPECTOR_ DATE PERMIT APPLICATION FOR MIAMI SHORES VILLAGE Date L d i 17 Job Address . N C , J fit l Tax Folio Legal Description J Historically Designated: Yes No b�4..?fI /�, t/ Owner's Address ? 5-' q 5 S- 1- A - k Phone 7S9 - S L/ g / ,, �'� Address / 3 y.P » � /5 / a 2- Contracting Co. � ` C, � f OHO �. 4 s c Qualifier Si /f, G� j , ss# Phone 6S7*' 747 Owner/Lessee / Tenant State # unicipal # Competency # Ins. Co. Architect/Engineer Address Bonding Company Address Mortgagor Address Permit Type (circle one): BUILDING ELECTRIC PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN WORK DESCRIPTION S � �' "/elee Square Ft. ature o .weer or Cond Notary as to 0 My Commissio APPROVED: Zoning Mechanical an or Condo President es: ko DOUGLAS W ROMANlK *: ,k - E 24 1998 3055 Expires Aug. Bonded by HAI 440F ' 800-422-1555 FEES: PERMIT 3F. RADON Master Permit # Estimated Cost (value) 1,/Sas " 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 OBTA'I 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 law regulating construction and oning. Furthermore, I authorize the above -named contractor to do the work stated. te � /97 D Signature of ontractor or Owner - Builder Da N ary as to Contractor or Owner - Builder C.C.F. / ° NOTARY My Commission Expires: _ � ( 3 vp 0 ' 7` :�"5 ,i I • BOND TOTAL DUE �t / 2l y,• D Date /s -s„ CONSTRUCTION PERMIT FO ] New System [ , � • xisting System [ ] Olding Tank [ ArTe mporary /Experimental ] Repair [ Abandonment Other(Specify) STATE OF FLORIDA DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PERMIT Authority: Chapter 381, FS & Chapter 10D -6, FAC AGENT: 4 4p e cn( (7___ PROPERTY STREET ADDRESS: J APPLICANT: LOT: e3 V i LOCK: PROPERTY ID #: /(/ o � P� p ® ?� [SECTION /TOWNSHIP /RANGE /PARCEL NUMBER] 0 [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. SYSTEM DESIGN A D SPE Ij'ICATIONS T [r ] G `/ AL LON1 � G PD ] E P _ TIC TANK EROBIC 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 PER DOSE DOSING TANK CAPACITY- DOSE RATE [ ] PER 24 HRS NO. OF PUMPS: [ ] D R A I N F I E L D 0 T H E R p ®&' [ ] S TYPE SYSTEM: CONFIGURATION: APPROVED BY: SPECIFICATIONS BY: SQUARE FEET E FEET DATE ISSUED: g 97 SUBDIVISION: IMARY DRAINFIELD SYSTEM SYSTEM [ ] STANDARD [ ] FILLED [ ] MOUND [ ] TRENCH [ED [ LOCATION OF BENCHMARK: s P � o.r4 0 G41 _ ELEVATION OF PROPOSED SYSTEM SITE [�7 [INCHES /FT] [ABOVE /BELOW] BENCHMARK /REFERENCE POINT BOTTOM OF DRAINFIELD TO BE [ [INCHES ] [ABO MMELW] ENCHMARK/ FERENCE POIN�2 =FILL ED:- °] INCHES /\ EXCAVATION REQUIRED: \ =' 3 Uri i!`®I` kf Sirs DAATINis t L OUGHATE IN18)P (C'Sl © I ) ?a V C; ic 11 Aor ASS 3 1 �1I�111(il�Z�1� �5� )33Jis 'MOM (o)V i �i:;'�/Ai„�T'�`�I[�r� ;3113VATCJI �1, U � -- ---_mo TITLE: HRS-H Form 4016, Mar 92 (Obsoletes previous editions which may not be used)` (Stock Number: 5744-001-4016 -0) " „- QppdOcm7 [ PERMIT # DATE PAID FEE PAID RECEIPT # [ ] INCHES T ?Row $ &oll << 4o P 7 , o CPHU EXPIRATION DATE: INSTRUCTIONS: PERMIT NUMBER: APPLICATION FOR: APPLICANT: TELEPHONE: AGENT: MAILING' ADDRESS: Permit tracking numb r assigned by CPHU. Check type of permit if °Other° specify type in blank. Property owner's full name. Telephone number f.r applicant or agent. Property owner's legFIly authorized representative. P.O. box or street m iling address for applicant or agent. LOT, BLOCK, SUBDIVISION or PROPERTY ID#: 27 character id num er for property. (CPHU may require property appraiser ID 11 or section/townshi;p /range /parcel number) SYSTEM DESIGN AND SPECIFICATIONS: TANK: DRAINFIELD: Minimum specificat ons from Chapter I0D-6, FAC. Minimum specificat ons from Chapter 1OD-6, FAC. OTHER: Other specification 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 Public Hee th Unit (CPHU) personnel reviewing and approving permit. DATE ISSUED: Date permit is issu d by CPHU. EXPIRATION DATE: One year from dat issued if the system has not been installed. Permits for system repairs become void 90 days from the date issued. Notes: a/4 /4 k 316, 0 ✓A' 1 _ I ! I ii1" ! II A w a■■ •m ■ ■ /■■■/m a ■ • ■ - 1O Site Plan Submitted by: Plan Approved 00 STATE OF FLORIDA DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PERMIT 7 Gl 0V (if Gin By < HRS -H Form 4015, Feb 85 (Obsoletes previous editions which may not be used) (Stock Number: 5744- 002 - 4015 -6) PART II - SITE PLAN SIGNATURE Not Approved Permit Application Number C Jd t .� ALL CHANGE UST BE APPROVED BY THE COUNTY PUBLIC HEALTH UNIT Date 9 County PI4 blic Unit Page 2 of 3 BUILDING ELECTRICAL PLUMBING ROOFING ❑ Work to be performed under this Permit Architect c 1 Contractor . or Builder _ 4 > . , " 1;. / ,_r Legal Lot Subdi- Description II B1 vision Address of � :r } �� d , Value of Amount of ' Building Project $ I Permit $ w...., 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 shown on the plans or drawings or in the statements or specifications and that he assumes respon- sibility for work done by his agents, servants or employees. Owner of Building • Signed „• -• - `. , INSPECTOR In consideration of the issuance to me of this permit I agree to perform the work covered hereunder in compH, ce with all ordinances sad regulations pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper. authorities of Miami Shores Village. In as cepting this permit I assume responsibility for all work done by either, myself, my agent, servant or employee. ❑ MIAMI SHORES VILLAGE, FLORIDA s ,,. . ,/ 4 DATE 194A PERMIT 5235 Contractor's � - License No. (a* C - 8 0 CONTRArOR OR BUILDER e BY e l • If AUTHORITY AYEOT •`4”"