785 NE 94 St (5)E UILDING
LECTRICAL
- 1 1 PLUMBIN
0
Buil ding
CONTRACTOR 0 ILDER
MIAMI SHORES VILLAGE, FLORIDA
DATE
PERMIT N? 6312
Work to be perforid -under this Peri
Signe
Subdi-
vision
BY
SP' •R
Contractor's
License No.
194&
Architect
Contractor
or Builder
Legal Lot
Description
Address of
Building
This p: it is granted to the contract gf or ilder named above to construct the building or to install the equipment or .evice described in the appli-
cation 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 respons'.il' y for a thorough knowledge f ordinances and '
regulations pertaining to the work covered hereby whether shown on the plans .r dr. d'ings o " in the : a - ments or speci cations and t h assumes respon-
sibility for work done by his agents, servants or employees.
By
In consideration of the issuance to me of this permit I agree to per '.rn\ 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 authority of Miami Shofts.V)llale.
In acceptijg th ermit I assume res..nsibility for all work done by either myself, my agent, servant or employee.
AUTHORITY
•
f
nspection Number: INSP-1805
Inspection Date: 05/16/2006
Inspector: Levrack, James
Owner: BRIGGS, WILLIAM
Job Address: 785 94 Street NE
Project: <NONE>
Contractor:
Building Department Comments
6�
Passed
\ d
‘n
Re -Ins
Fee`
($ 7 5 )
No Additional Inspections c ai,
I I
re inspection fee is
Paid.
' , .duled until
HondaY, May 15
2006
Miami Shores Village, FL 33138-
WP SEPTIC TANK CO INC
Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (30 )795 -2204 Fax: (305)756 -8972
Block:
rmit Number: , -1245 -1169
Permit Type: Plumbing - Residential
Inspection Type: Final
Work Classification: Drainfield
Phone Number
Parcel Number 1132060142030
Lot:
Phone: 305 - 620 -6320
Page 1 of 2
s /3
Passed
J
In pec r C . 'mnt is
7
Failed
Correction
Needed
Re- Inspection
Fee
($75)
No Additional Inspections can be scheduled
re- inspection fee is paid.
until
Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
#SAY.17 On
nspection Number: I NSP -1804
Inspection Date: 05/16/2006
Inspector: Levrack, James
Owner: BRIGGS, WILLIAM
Job Address: 785 94 Street NE
Project: <NONE>
Miami Shores Village, FL 33138-
Contractor: WP SEPTIC TANK CO INC
Building Department Comments
Monday, May 15, 2006
Block:
MI
l umber: $PL -12 -05 -1169
Permit Type: Plumbing - Residential
Inspection Type: Landscaping
Work Classification: Drainfield
Phony Number
Parcel Number 1132060142030
Lot:
Phone: 305 -620 -6320
Page 1 of 2
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: '.. �' . t 1 6.8972
BUILDING
PERMIT APPLICATION
FBC 2001
Permit Type (circle): Building Electrical Plumbing Mechanical Roofing
Owner's Name (Fee Simple Titleholder) ttJ ` ;12 wi i Phone #
Owner's Address r f 2c /V C: 9 if r— .J
Cit 11 uc A i s 5 O t-,?..G State
Tenant/Lessee Name SL'>{ Aw f
Job Address (where the work is being done)
City Miami Shores Village County Miami- Zip . _ f �' S
Is Building Historically Designated YES NO V
Contractor's Company Name A//' ,P sa /( /C �, �� Phone #
Zip 7 ,3 46 '
b-
City / 1 / /11, , LL ,, / State
Qualifier 4/4 //a< e 4.2ne n �,
State Certificate or Registration No. Certificate of Competency No.
Architect/Engineer's Name (if applicable)
$ Value of Work For this Permit
Type of Work: ['Addition
pescribe Work:
❑Alteration
* * * * * * * * * * * * * * * * * * * * * * * * * * ** F ees * * * * * * * * * * * * * * * * * * * * * * * * * * ** *
¶Fee $ Permit Fee $ / 2 r CCF $
Training/Education Fee $
Radon $ Zoning Bond $
lent $ Structural Plan Review. $
;
.$ V1 r OO
:ite side)
Miami Shores Village
1 zip 3 3
LlNew
aster Permit No.
Phone #
Square Footage Of Work:
Permit No. ! LQ6 " 1 1 69
Phone #
Technology Fee $
}�Repair/Replace ❑ Demolition
CO /CC
Bonding Company's Name (if applicable)
Bonding Company's Address
City State
Signature tu WM
i
Owner or A ent
My Commission Expires:
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address
City State Zip
Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has
commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulating
construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRICAL WORK, PLUMBING, SIGNS,
WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and AIR CONDITIONERS, ETC
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.
"WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT 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."
Notice to Applicant: As a condition to the issuance of a building permit with an estimated value exceeding $2500, the applicant must
promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person
whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site
for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the
inspection will not be approved and a reinspection fee will be charged.
Signature
j Contractor
The foregoing instrument was acknowledged before me this 9 The foregoing i trument was acknowledged before me this q
Q
day of�� ,t,#iiba , 20 S, by day of Dean/ , 20 by
who ersonally known to me . who has . oduced D L • who is pers known to me or who
ss on # DD268491
My Commission Expires:
APPLICATION APPROVED BY:
IM Ili
eye
Chc 05/13/03
Plans Examiner
Engineer
Zoning
•
FEE
ITEM
SPACE HEATERS
UNIT
FEE
iEM
TLS
UNIT
FEE
ITEM UNIT
SWITCH OUTLETS
ATH
IDET
LIGHT OUTLETS
CENTRAL HEATING
ISHWASHER 1
1
RECEPTACLES
A/C (WIND)
ISPOSAL 1
SERVICE TEMPORARY
A/C (CENTRAL)
RINKING FOUNTAIN 1
SERVICE SIZE IN A6PS
DUCT WORK
LOOK DRAIN
SERVICE REPAIRAETER CHANGE
REFRIGERATION
;REASE TRAP
APPL I ANCE OUTLETS
PROCESS AND PRESS P I P I Flu
HTERCEPTOR
1
RANGE TT
UNDERGROUND TANKS
ATCRY
OVEN
ABOVE GRDUNIID TANKS
.AV
TRAY
WATER HEATER
U.F. PRESSURE VESSELS
.AUFDRY
MDTCRS 0- 1 I-P
STEAM BOILERS
:LOTHES WASHER
MOWER
MOTORS OVER 1- 3 H'
HOT WATER BOILERS
MOTORS OVER 3- 5 I-P
MECHAN I CAL ENT I LAT I DN
3 INK POT /3 COW
, .
3 INK RESIDENCE
MOTORS OVER 5- 8 H°
TRANSPORT ASSEM3LIES I
,
3INK, SLOP
MOTCRS OVER 8- 10 H'
ELEVATORS/E CAL ATORS I
TE1rPORARY WATER CLOSET
MOTORS OVER 1C- 25 If
F IRE SPRINK ER SYSTEZ I
URINAL
MOTORS OVER 25-100 FP
COOLING TOWERS
HATER CLOSET
MJTORS OVER 100 FP
VIOLATION
INDIRECT WASTES
1
I A/C W I FDOW
I
RE I,NSP,ECT J0 �
WATER SUPPLY T0:
1
1 AIR CONDITIONERS
I
1
1
A/C UNIT
1
I STRIP HEATER
I
I
1
F IRE SPRINKLER
1
I GENERATORS TRANSFORMERS
1
1
I 1
HEATER -NEW INST.
1
GENERATORS TRANSFORMERS
1
1
HEATER - REPLACE
I
1
GENERATORS TRANSFORMERS
I
I
LAWN SPRINKLER -WELL
I
I SPECIAL P%RPOSE
1
J
I
SWIM1ING POOL
OUTLETS COMI4ERCIAL
I
1 I
WATER SERVICE
SIGN TU3ES
I -'
SEWER CONNECTIONS
-
• SIGN TRANSFORMERS
'
UTILJTY -SEER -
SIGN TIME CLOCK
I
UT I L I TY -WATER
F.l XTl,RES.
I
•
SEPTIC TAW
r
ANTENNA
RELAY
1 TELEVISION OUTLETS
DRAINFIELD, t- TILE/RES. Jox3
VIOLATION
PUMP & ABANDON SEPT IC TANK
RE HS?ECT ION
SOAKAGE PIT CU. FT.
CATCH BASIN
DISCHARGE WELL
TIDIEST IC WELL
1
1
1
AREA DRAI
I
I
ROOF INLET
SOLAR WATER HEATER
FIRE STANDPIPE !
POOL P I P I hi; 1 I
1
LAWN SPRINKLER SYSTE.. I 1
1
1 •
GAS RANtiE 1 1
hETER SET (GAS) I 1 I
I i
GAS PIPIN:
ADDENDUM TO BUILDING PERMIT APPLICATIDN
AN AEPLICATION FOR BUILDING PERMIT MUST ACCOMPANY THIS ADDENDUM. IF A ikSTER PERMIT HAS B.
OBTAINED, THE OV €R' S NOTARIZED SIGNATURE NEED NOT BE PRESENT ON SUBS APPLICATIONS.)
PLUMBING
ELECTRICAL
ME CHAN I CAL
CONSTRUCTION PERMIT FOR:
[ ]New System [ ]Existing System [
[ X ]Repair [ ]Abandonment
APPLICANT: Brigos, William AGENT: SR0890743, PONDER WALLACE
PROPERTY STREET ADDRESS: 785 NE 94 St Miami Shores FL 33138
LOT: 24 BLOCK: 67
PROPERTY ID #: 11- 3206 - 014 -2030
SYSTEM MUST BE CONSTRUCTED IN ACCORDANCE WITH SPECIFICATIONS AND STANLARDS OF CHAPTER 64E -6,FAC
DEPARTMENT APPROVAL OF SYSTEM DOES NOT GUARANTEE SATISFACTORY PERFORMANCE FOR ANY SPECIFIC TIME
PERIOD. 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 PROPERTY DEVELOPMENT.
SYSTEM DESIGN AND SPECIFICATIONS
T [ 900
A [ 0
N [ 0
K [ 0
STATE OF FLORIDA
DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM
CONSTRUCTION PERMIT
]Gallons SEPTIC TANK
]Gallons
]GALLONS GREASE INTERCEPTOR CAPACITY
]GALLONS DOSING TANK CAPACITY [ 0
D [ 300 ]SQUARE FEET PRIMARY DRAINFIELD SYSTEM
R [ 0 ]SQUARE FEET SYSTEM
A TYPE SYSTEM: [ N ]STANDARD [ N ]FILLED
I CONFIGURATION: [ N ]TRENCH [ N ]BED
N
F LOCATION TO BENCHMARK: Top of Bottom Floor EL: 12.4'. NGVD
I ELEVATION OF PROPOSED SYSTEM SITE [ 2.3 ] [ FEET ] [ BELOW BENCHMARK /REFERENCE POINT
E BOTTOM OF DRAINFIELD TO BE [ 5.0 ] [ FEET ] [ BELOW BENCHMARK /REFERENCE POINT
L
D FILL REQUIRED:[ 0.0 ]INCHES EXCAVATION REQUIRED: [ 32.0 ] INCHES
OTHER REMARKS:
1 - Existing 900 gal septic tank certified by "W & P Septic Tank" to 'emain.
2 - Install 300 sf of drainfield in bed configuration.
3 - Invert elevation of drainfield to be no less than 7.93' NGVD.
4 - Bottom of drainfield elevation to be no less than 7.43' NGVD.
This permit is NOT for Addition(s).
SPECIFICATIONS BY: Heybeck, Nicholas
APPROVED BY: Heyback, Nick
DATE ISSUED: 11/30/05
SUBDIVISION: Miami Shores Sec 3
[Section /Township /Range /Parc
[OR TAX ID NUMBER]
DH 4016, 03/97 (Obsoletes previous editions which may not be used)
(Stock Number: 5744- 001 - 4016 -0) [ostds_cons_4016 -1)
] Temporary [ NA ]
TITLE: 6.01 %
TITLE:
CEN RAX #: 13 -SG -27195
DAT PAID:
FEE PAID : $
REC IPT .
OSTDSNBR : 05 -3742- -R
)Holding Tank [ ] Innovative Other.
a
=1 No.]
MULTI -C AMBERED /IN SERIES: [Y ]
MULTI -C AMBERED /IN SERIES: [Y ]
DOSES ER 24 HRS #
PUMPS[ ]GALLONS @ [ 0 ] [ ]
[ N ]MOUND [ N ]
[ N J
Dade
EXPIRAI DATE: 2/28/06
CHD
Page 1 of 2
_n
Joti
APPLICANT:
BLOCK: 1 F 7
PROPERTY ID #: .i 1, ,4i1 'r - j c- 11 - ===================
___
_ _ - --- -g- --_- _s'° = S MUST
_ - - - - - -- - ~~�.� ZED PERSON./ ENGINEE R
YO-YO - --__HEAL== =UNIT = PLOY-- -- OTHER- QUALIF SO
•. ALI, ZTE
=======================================================
_ --- COMP-- -- -- ---- =- -- ER HEALTH_ EMPLOYEE, O _- COMPLETE
TO V E COMPLETED REGIS REGISTRATION NNNIMB SIGN AND SEpL'EACH PAGE OF SUBMITTAL.
- ° = == L I TEMS. °H=
PROVIDE REGISTRATION NUMBER AND - = == =____Vic' =========================================
_= = = = =H === === E =H =PM- ==== A CRE:
PROPERTY SIZE CONFORMS TO SITE PLAN: [ "L]r YES [ ] NO NET USABLE Z • O „,..5 TRE - a A C 2i
P 2 2. GALLONS PER DAY [RE-SIDEN ES- TABLE ) / � /
TOTAL ESTIMATED SEWAGE FLOW: .�„ GALLONS PER DAY [
1500 GPI /ACRE OR, 2500 GP JICRE]
SQF
•� • � UNOBSTRUCTED AREA QUIRED: 6/Y,... AUTHORIZED SEWAGE FLOW: � .,)t. SQFT
UNOBSTRUCTED AREA AVAILABLE: ._- r" - ( ; ) 6,1„,,I)
i d ' -�� �ENC /�FE�NCE POIN
BENCHMARK /REFERENCE POINT LOCATION: ti INCHES /AFT} [ABOVE /�ELO �' . �
ELEVATION OF PROPOSED SYSTEM SITE IS << — [
THE MINIMUM SETBA CK Y WET? [ 1 YES URE :
WHICH CAN BE MAINTAINED FROM THE PROPOSED SYSTE STE TO THE FOLLOWING FEATURES.:
�3 / r
DITCHES /SWA E g , #f t FT ri) NON- POTABLE.
WE UBLIC !t FT u .: FT �,_ P O TA LE WATER LINES: /C7 1
FT PRIVATE:
WELLS: PUBLIC: I L IMITE D USE: c71 FT PROPERTY LINES: .ate
BUILDING FOUNDATIONS: � [ ] YES [ly1
FT MSL /N
STATE OF FLORIDA
DEPARTMENT OF HEALTH
ONSITE SEWAGE DISPOSAL SYSTEM
SITE EVALUATION AND SYSTEM SPECIFICATIONS
SOIL PROFILE INFORMATION SITE 1
f'
EL NCHES [
OBSERVED WATER TABLE: V ! ; I ABOVE /
ESTIMATED WET SEASON WATER TABLE ELSVA[IONN
SQJL TEXTURE/LOADING HIGH WATER TABLE VEGETATION: [ ]
SYSTEM SIZING:
CH [ L
DRAINFIELD CONFIGURATION: [ ] TREK
REMARKS /ADDITIONAL CRITERIA:
SITE EVALUATED BY:
SUBDIVISION:
[Section /Township /Range /P reel No. or;,Tax ID Number
1.r,
. .F�
BUI
YES [` NO 10 YE •• FLOODING?
J.i
SITE E V 1 __
SITE SUBJECT TO FREQUENT FLOODING: [ J FT MSL /NGVD LEATION: i
10 YEAR FLOOD ELEVATION FOR SITE: J
SOIL PROFILE INFORMATION SITE 2
.......:..w ...ew he used)
BELOW) EXISTING GRAD
INCHES [
MOTTLING: [ ) YE
BED [ ] OTHER (S
USDA SOIL SERIES:
Texture
Munsell Color
`fix to
to
to
to
to
to
to
to
ito ,e
L.t
TYPE: [PERCHED / APPAR
• OVE /:, EB LOW ] EXISTING GR
NO = 1`' IN
[ V)� DEPTH: f ; Ir
TH OF EXCAVATION:
ECIFY)
De
tb
DATE:
Page '-
Scale: Each block represents 5 feet and 1 inch = 50 feet.
• . r . ..', ‘."./' f i. ! .■ ;
-!-.•#;---', - 3 -% - --
- . - - (-•■, ' -
_,.. :....;_ _..il..L.;.; • ' • 1 •
: -- 't.it t.:; .4. -.• . -I - i .--,..- f -4 ... - , • --: -. • , ., -...• • i- ,;- . • .„-•••,., .• :,- ttl t-;• - 1,...... „ . ...1:„. - .. : ••. " .. . . . ..
.. . .
-- ,...i.....,„:7-4...;,....,;,....4.... .....1,..i.......4.4_,;,..i......„..„.............:,.......,.....;-.4......i...i....i....;....„.,...-;_....„!..„'`,,.......,;....;.,C....,. , ,,,...,o.. ;... •;.!
' -: 4 ••-•;• . • . . . .
4 , •
--1....i.-.).• ; ,...„ . .: : :,......,.. 1, ...,...;..4.... t.'1. '' ; t., . •
• -...- ,s" : % , ' . :
1 ' • 1 ••••i• - . t • •• . ' ••••;,'" +,--- ; - :i -°-. :. :' ■-; ' - -.:---,::: .... - ••; . : - , ,i.. 4....; j......; .,:. ..- ..; • .k...,..
,-; . , i f• •; ,,, -1,•••••• -', -- 4- ..,. • ;,-... ...•;. , -, -...:.- i....; ...i......,....,......,.. - ...4...:. ,. .„ . ; . if..1. .i.....; ..:.. 4.....;,...t, ., . . .4. .., ,.....:
- .. , - • '; ,.--. . ';. .t -AL--;• i -.: i. ,- 1-.!... !_.-.1, i, .,. ! .;...i ...II:. :.............4i..,...,...., .; $. :. , : , , F. ,, , ' , .
II • , • ,;:■-•;;'!! ; .-'. • • - , ' ' I ; ; c ' • • ; • . . 1' ; • , • 1 • , .. . .
'-. - .+ 1 - '-. t ---.' r. -'. i ' -. 1 ,--, -. ''.. ' - ':- 1 "'' 4 , ': ' . • 1 -- . -
•., , , 1 : , • 1 ' , ! , 4 4 " : '' '' . , ft ' - . ''.- .' 7 -- I' - ' r ' : ' , , .
, ' I i I ; ; ' ! ; :.! ; ' T
.k._ ,.._.:._ 1444
, o r r 3 • - k - -,-- - -- - I ' ' . i - io
4 o-r O O k- 1 ooro ; ::r.-
;- •, -1,
', ' --; 'i• 1 1 —i; : L ..: j.,--, -,-: 1 , : t : , ,
i - • - ^ c •" - • ; l- 4- - 1 - --• -.- -',- ' ' •: -- ( ---4 , ; - --;—; •-- 1 4 1 i i 4 ' r i r ', - I
...,.._ .., '.. , _L.; ,_ _i_.__4 .. .-; . -;--- 1 ' i ,54 i .-,--,, ; , --i-1-4-•-,- ;- ..? ) ; ; - -i.- ' , , :, ,,,, r . : ,'. „ ■ .. '•
' . ; . ! ; • t „
. . .
1 r ' ; , 1-
-,..-- - - -.- ,. •-. ; 4-,--- : : , ; ,i; = '..' ..: ....; : , !,..4...„..._; t ;
t. • ,...1.,..... ! , i . • , ; : - - ---1-- , -.--' -- o r-cti-.) - 4 .: „I ...
, .
• t
4
- •
- *---"• - ' ' ' : i ; : ' ,-,'. , ' • i ; ier ---- ;; -- - i -- -- , --• - . - ---
: : . ' ; ' r I ' - 1". " : "; , I ' ! -i ) -- 1 ^ ,` • ' • ; i : -- 1 4 4
: , , I ' , ; I o . 1 , : .;; i ,:, Air '-` ;-- - t . ' '- ' t' 1 4-1 -4 , -4 -, or - o, oror • - - ! ' - o o — -
• o i ,,,, ..,,, -
' '' . .. ' — o — , 7 ; ; –, .-- l''' '''' -'-' – L 't ' ' ' , "i' . ' • , "
• I
'+" –•• "7.– .4 — - 4/ : ; ' ''.,'' ' ' ' 1 '
. . ,
} – "; •■■ , ^ . ; ' . : 4 f - f jc T I ; . l'• 1 i ,
4 - -, --, 4 t -; :t• ,.- 4- - -:.-- ' - t- i - 41 - i- .---!--- - -• , .- - .
i_ _ - , ,;-., __, i__., i_ , ■ ,
L ., .:._, .L... ..d 1 , : ; J ; .1 i -
, , , . 1 - '. , - - t ' ; - --irt :- ; --:. ; , - - • , • !.
.,,,,...,-., . i 1 ,...,il I, v . ,
, . ■ • : i
,--)i,rt•--1;•--7-.--------i.-,1----;----'.- - 75,-- -
..............,_,.._1,-.i..--;.--....-,......,..........i... ',.......,..,-.....te....6 .-- =f ..;---1--).---3-- ---1---1--4--i44
-: : ‘---;', 4----;- 1 • i -1 -; - ; ; --t--- 4 -i i- i -- ' i- '' ! ' : , • - : - • . -'-'!'• --- ) , ; i ' , : • ' ■ : - ; I,C,'. k;
, • ., , .........., , I. . t , I . •
.!
..., Si.:
.,,,,,,,, ..,...,....1–,:t. ^...... •. 11., ' 1,,,,,,L, –; 1 4-.....,--,1, .....:.-- ' ......t„,
1- i -----4----i--;-- 1.- -i----; -I-- { 1 1 i - ; 1
.:-.... ..t 1 .... . ■ . , .. ;....! - . i - ' 4 ' ' ; t ; 4. LI .1 - - ---!.:-- , .i„,•; , - ,. i - i
I .". 1 ...,. 1 i A-- : ; , ,,, i ; 1 , • 1 ; ', , i , -; - '" - - --- „ • 4„.._.,....,. . , t
; 1 T ,- rl --; -, ; I — - -4-4,----- 1 -1 +, - , ' ---:---,.. , . --, . . - •et. - - - 4 - 1
Notes:
Site Plan submitted by:
Plan Approved
By
ALL CHANGI
444015, 10/96 (Replaces HRS-H Form 4015 which may 1:s
hock Number: 5744-002.4M 5.41
STATE OF FLORIDA
DEPARTMENT OF HEALTH
APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PERMIT — r
Permit Application Number
PART II - SITE PLAN
9tti:
•
• •
.•
.........,!..,.4......ii_.s---,:i
,.....--,; - - —' -• . - 0
v„'
., .
3 , • , i3
._, , , ,_ ____. • : . , .. _, ..1. .t . ... ?..(7 ,,..„. : .
, ,,4 .-- ! ' •
,re
,( Approved
• , • i ■:'; • • •
•
,E APPROVED BY THE COUNTY HEALTH D PARTMENT
Li
Date
County Health Department
Issue Date: 12/12/2005
Owner's Name: WILLIAM BRIGGS
Permit Type: Plumbing - Residential
Work Classification: Drainfield
Job Address: 785 94 Street NE
Additional Information
Miami Shores Village, FL 33138-
Building Department File Copy
Applicant Signature
Miami Shores Village
10050 N.E. 2nd Avenue
Miami Shores, FL 33138 -0000
Phone: (305)795 -2204 Fax: (305)756 -8972
Permit
Expires: 12/09/2006
Contractor(s)
W P SEPTIC TANK CO INC
Phone
305 - 620 -6320
Primary Contractor
Yes
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, servants, or
employes. I understand that separate permits are required for ELECTRICAL,
PLUMBING, MECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING
POOL work.
OWNERS 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. Futhermore, I authorize the above -named contractor to do the work
stated.
Parcel #:
Block:
Section:
Permit Status: APPLIED
Permit Number: PL -12 -05 -1169
Phone:
1132060142030
Lot:
PB:
Total Square Feet: 300
ToIjai Valuation: $ 1,500.00
Required Inspections
Type of Work: INSTALL 300 SQ FT DRAINF Type of Piping:
Additional Info:
Fees Due Amount
Bond Type - Contractors Bond $300.00
CCF $1.20
Education Surcharge $0.40
Miscellaneous Fee $75.00
Permit Fee - Additions /Alterations $100.00
Scanning Fee $3.00
Technology Fee $4.40
Total: $484.00
Invoice Number
PL - 12 - 05 - 23005
Total:
Rough
Landscaping
Final
Amt Due
$484.00
MAf 15 PAID
Amt Paid
NOTICE: In addition to the requirenients of this permit, there may be
additional restrictions applicable to thi property that may be found in the
public records of this county.
AND THERE MAY BE ADDITIONAL ERMITS REQUIRED FROM OTHER
GOVERNMENTAL ENTITIES SUCH AS WATER MANAGEMENT
DISTRICTS, STATE AGENCIES, OR FEDERAL AGENCIES.