989 NE 95 St (2)PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Date 6) -Z 3-17 Job Address 9 8 q Ni -E I S t Tax Folio
Legal Description Historically Designated: Yes No
Owner/Lessee / Tenant {3; 1 he F. (he u...) d f &T . I AW CHEW Master Permit # 4 1/4 Vg
Owner's Address 9Fct M' e g9 Sk Phone 759 0Z 9 51
Contractin Co. Wa. qc e - S. . PorC \ate Address
Qualifier L) ca, P6�42p
State # Municipal # Competency # Ins. Co.
Architect/Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type (circle one): BUILDING ELECTRICAL MECHANICAL ROOFING PAVING FENCE SIGN
RI
WORK DESCPTION RK171✓ D
Square Ft. Estimated Cost (value)
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.
W G - Z3-f1�
Signature of owner and/or Condo President Date
otary as to Owner and/or Condo President Date
My Commission Expires: 3. - 92
•
SS# Phone (n )o -
g - 8
Signature of Contractor or Owner - Builder Date
otary as to Contractor or Owner - Builder Date
My Commission Expires: 7 - 97
F ®c. P5 27oj -(-101-331-0
FEES: PERMIT .3 • RADON C.C.F. • NOTARY . BOND )0 �,�
TOTAL DUE 37f.
°)
APPROVED:
Zoning Building Electrical
Mechanical Plumbing Engineering
STATE OF FLORIDA U I - L U Ll lJ ._ PERMIT #
DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES DATE PAID
ONSITE SEWAGE DISPOSAL SYSTEM • FEE PAID
CONSTRUCTION PERMIT RECEIPT #
Authority: Chapter 381, FS & Chapter 10D -6, FAC
CONSTRUCTION PERMIT FOR:
[1.1] New System [ !J ] Existing System [ GJ] Holding Tank , [jO] Temporary /Experimental
[ A Repair [IA Abandonment [ t„.J) Other(Specify)
APPLICANT: I I/f e . eh R.) AGENT: , I // c Q rp _eir
PROPERTY STREET ADDRESS: q
LOT: Q JB A BLOCK: / SUBDIVISION: Ai m
PROPERTY ID #:
SYSTEM MUST BE CONSTRUCTED IN ACCORDANCE WITH SPE AND STANDARDS OF CHAPTER 10D -6, FAC
REPAIR PERMITS AND HOLDING TANK PERMITS EXPIRE 90'D YS 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 DES GN AND SPECIFICATIONS
T [ goo [GALLONS / GPD] SEPTIC TANK /AEROBIC 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 [ o ] GALLONS PER DOSE DOSING TANK CAPACITY DOSE RATE [ ] PER 24 HRS NO. OF PUMPS: [ ]
0
T
H
E
R
SPECIFICATIONS BY:
APPROVED BY:
DATE ISSUED:
D (.300] SQUARE FEET PRIMARY DRAINFIELD SYSTEM
R [ -- ] SQUARE FEET SYSTEM
A TYPE SYSTEM: [/] STANDARD [ j FILLED [ ] MOUND [ ]
I CONFIGURATION: [ ] TRENCH [b] BED [ ]
N
F LOCATION OF BENCHMARK: 5. 5 0 ' s r • 5G 5V.
I ELEVATION OF PROPOSED SYSTEM SITE [44 ] [INCHES /FT] [ABOVE /BELOW] BENCHMARK /REFERENCE POINT
i /
E BOTTOM OF DRAINFIELD TO BE [ eJl ] [INCHES /FT] [ABOVE /BELOW] BENCHMARK /REFERENCE POINT
L
D FILL REQUIRED: [Aj Q ] INCHES EXCAVATION REQUIRED: [ 36 ] INCHES
2 (�
7
[SECTION /TOWNSHIP /RANGE /PARCEL NUMBER]
[OR TAX ID NUMBER]
TITLE:
TITLE:
HRS -H Form 4016, Mar 92 (Obsoletes previous editions which may not be used)
(Stock Number: 5744 - 001 - 4016 - 0)
q 7e - /C0/
$ ®•B (�
21,E 7i
1 NKIa M L 07o Dili, (C1:
bUiSM U ra6c .ie + 1o;
���9 d� R!90 wCW Y I
91N ELEVATION, _ • 6 Q
(RniTifni nF fiwwIFLn PVA'IfM 46 50'
EXPIRATION DATE: 9
QCCC� 2lsUl'03 dL _ L3 cam_ n Pi.S L P �^
. d lEGIICC3 G e70 CLa� 'LO: c J L.-3J
d CPHU
Page 1 of 2
kNi;"; NUNIFA
i.
PELICATION FOR , pccify 1 in blank.
okvr‘..n fo7..
ii ?IONE! ! or age ;:t.
Pioperty owner's iI iy:!1 .).r representative.
NtAiLiN(; iddre,:: for :pplieant or ag
LOT, BLOCK. SC l;DIVISIt )N or
EPOPE.PTY fc,t proFerty. ..:201iU may ret.,.;:re piopeLly applaisc,. H3 # i .c.cti;in/loc.. it /1 c.g.:/o..trc el
DESIGN AND
SPECIEICATICINS:
"TANK: Minimum specifications from Chapter 10D-6, FAC.
DRAINFIELD: Min1. sp riun flotn Chaptel FAC.
OTHER: O.hr .51.,ecifleations, such as operating permit requirements, low-volume flush toilets. variat pt
SPEC'll ICATIONS BY': Name oi'itidiviLIwil intIviding socciaations. if designed by a registered engineer must be sealed.
APPROVED BY: County Puldle Ii iITt Unit '0:7PITC) personnel reviewing and appiovinp. permit.
DATE ISSUED: Date permit is i.-sued by CPBU.
EXPIRATION DATE: One year from date issued ii the system has not been installed. Permits for system tepiirs become void 90 days from the date
issued.
t '
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:
0] New System [ / .J] Existing System
[ (.] Repair [p2] Abandonment
APPLICANT: 6? A F /
Jl- 6J ( r !l i
PROPERTY STREET ADDRESS:
LOT: y � BLOC
PROPERTY ID #:
SUBDIVISION:
[AD] Holding Tank ] Temporary /Experimental
[Jj] Other(Specify)
AGENT: ,
Lit
4 :-L1 [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- 9O,pAYS 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. f - -e>
SYSTEM DESIGN AND SPECIFICATIONS �, / /jJ /c_-): _
T [e?,),,u ] [GALLONS /,. GPD] SEPTIC S TANK /AEROBIC UNIT CAPACITY _ MULTI- CHAMBERED /IN SERIES:[ ]
A [ T , ] [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 [ 1'3 ] SQUARE FEET PRIMARY DRAINFIELD SYSTEM
R [ m ] SQUARE FEET SYSTEM
A TYPE SYSTEM: [ .1] STANDARD [ ] FILLED [ ] MOUND [ ]
I CONFIGURATION: [ ] TRENCH [/] BED [
_
F LOCATION OF BENCHMARK: cd e <j (^ °) r • ' S _
I ELEVATION OF PROPOSED SYSTEM SITE p/, ] [INCHEES /FT] [ABOVE /BELOW] ;BENCHMARK /REFERENCE POINT
E BOTTOM OF DRAINFIELD TO BE [ ] [INC E / V BEL W /t 1; HMARK /REFERENCE POINT
D FILL REQUIRED: ] INCHES EXCAVATION REQUIRED: [3& ] INCHES
0
T
H
E
R
SPECIFICATIONS BY:
APPROVED BY:
DATE ISSUED:
TITLE:
I }
C '
TITLE:
HRS -H Form 4016, Mar 92 (Obsoletes previous editions whichiiriay t be used)
(Stock Number: 5744 -001- 4016-0) c t� �. -
r' •
1
PERMIT # q /4?../f,70/
DATE PAID c2 ?2 - 17
FEE PAID $ a O•t9 U1
RECEIPT # 2 e iP /
„y
EXPIRATION DATE:9
r rTin
d` •
CPHU
Page 1 of 2
:N! 1( )NS.
1
. , • . 11..)
DES!' N
1: ,L
I AN. hapir t•, FACT.
iliLD FAC
lit i< OIL I i Himit rr■vi,os
SIPEF.C ,N.S BY: de,igr,„ .1 by
APPR )V ED EV. li.hit anti apk.1
DATE ISSUED: i:$,.!t tilt is issucu by CPIIU
i\Ij! nil ' Lmj . k; - • ."
1,,,1
LOT:
STATE OF FLORIDA
DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES
ONSITE SEWAGE DISPOSAL SYSTEM
SITE EVALUATION AND SYSTEM SPECIFICATIONS
C A. ) AGENT: 9, l joee a i 5
BLOCK: 2�� 4 SUBDIVISION:
[Section /Township /Range /Parcel No. or Tax ID Number]
PROPERTY ID 14f:
r
4 �.
TO BE COMPLETED BY ENGINEER HEALTH UNIT EMPLOYEE, OR OTHER QUALIFIED PERSON.; ENGINDER'S MUST
PROVIDE' REGISTRATION NUMBER AND SIGN AND SEAL EACH PAGE OF SUBMITTAL'. COMPLETE ALL ITEMS.
PROPERTY SIZE CONFORMS TO SITE P
TOTAL ESTIMATED SEWAGE FLOW:
AUTHORIZED SEWAGE FLOW:
UNOBSTRUCTED AREA AVAILABLE:
BENCHMARK /REFERENCE POINT LOCATION:
ELEVATION OF PROPOSED SYSTEM SITE IS [INCHES /FT] [ABOVE /BELOW] BENCHMARK /REFERENCE POINT
THE MINIMUM SETBACK .ICH CAN BE MAIgTAINED FROM THE PRO <
SURFACE WATER: ,. FT DITCHES /SW ES: �✓� FT Y ±WET? [ ] YES � NO
WELLS: PUBLIC: At FT IMITED USE: FT °PRI E: F NON- POTABLE: WSJ FT
BUILDING FOUNDATIONS: FT PROPER LINES: FT POTABLE WATER LINES: FT
YES [ ] NO NET USABLE AREA AVAILABLE: (/ 17 ,- Y ACRES
GALLONS PER DAY [RESIDENCES -TABLE 1 / OTHER -TABLE 2]
GALLONS PER DAY [1500 GPD /ACRE OR 250 /B PD /ACRE]
SQFT UNOBSTRUCTED AREA REQUIRED: /CYO SQFT
SED SYSTEM TO THE FOLLOWING FEATURE :
SITE SUBJECT TO F'REQ{TENT FLOODING: ( ] Y [ j NO. ,t 1 10�E D; t G?
10 YEAR FLOOD ELEVATION FOR SITE: FT MSL /NGVD r SITE ELEVATION: _
SOIL PROFILE INFORMATION SITE 1 W.r -- q o' SOIL PROFILE INFORMATION SITE 2
Munsell Color Textate Depth
(a to
to
to
USDA SOIL SERIES:
to
to
to
to
to
to
SITE EVALUATED BY: '`-J
HRS-H Form 4015, Mar 92 (Obsoletes previous editions which ' th t be used)
(Stock Number: 5744 - 003 - 4015 -1) • ,�
Munsell I/ /Color Te re Depth
-�� . _
USDA SOIL SERIES:
PERMIT # 9-1 8 if
DATE:
YE[ NO
FT MSL /NGVD
to
to
to
to
to
to
to
to
OBSERVED WATER TABLE: INCHES [ABOVE / BEL EXISTING GRADE. TYPE: [PERCHED / APPARENT]
ESTIMATED WET SEASON WATER TABLE ELEVATION: /�/ INCHES [ ABOVE)-BELOW ] EXISTING GRADE.
HIGH WATER TABLE VEGETATION: [ ] YES [terNO MOTTLING: [ ] YES NO. DEPTH: 0' INCHES
SOIL TERTURE /LOADING RATE FOR SYSTEM SIZING: , 0 DEPTH OF EXCAVATION: INCHES
DRAINFIELD CONFIGURATION: [ ] TRENCH [�J BED,? [ ] OTHER (SPECIFY),t
REMARKS /ADDITIONAL CRITERIA: -
Page 3 of 3
■. fu
.is
APPLICATION FOR:
] New System [4)] Existing System
Repair [�] Abandonment
]
APPLICANT:
MAILING ADDRESS:
-
AGENT ,:
TO BE COMPLETED BY APPLICANT OR APPLICANT'S AUTHORIZED AGENT. ATTACH BUILDING PLAN AND TO -SCALE
SITE PLAN SHOWING PERTINENT FEATURES REQUIRED BY CHAPTER 10D -6, FLORIDA ADMINISTRATIVE CODE.
PROPERTY INFORMATION [IF LOT IS NOT IN A RECORDED SUBDIVISION, ATTACH LEGAL DESCRIPTION OR DEED]
LOT: BLOCK: [/ SUBDIVISION:
PROPERTY ID
PROPERTY SIZE:
PROPERTY STREET ADDRESS:
DIRECTIONS TO PROPERTY:
BUILDING INFORMATION
Unit Type of
No Establishment
1
2
3
4
cU.,)
STATE OF FLORIDA
DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES
ONSITE SEWAGE DISPOSAL SYSTEM
APPLICATION FOR CONSTRUCTION PERMIT
Authority: Chapter 381, FS & Chapter 10D -6, FAC
ACRES (Sqft /43560]
No. of
Bedrooms
Garbage Grinders /Disposals
Ultra -low Volume Flush Toilets
] RESIDENTIAL
DATE OF
/1) S UBDYVISION:MU
[Section /Township /Range /Parcel No.] ZONING:
PROPERTY WATER SUPPLY: [ ] PRIVATE p-11 PUBLIC
Holding Tank ('] Temporary /Experimental
Other(Specify)
HRS -H Form 4015, Mar 92 (Obsoletes previous editions which may not be used)
(Stock Number: 5744 - 001 - 4015 -1)
TELEPHONE:
( ] COMMERCIAL
APPLICANT'S SIGNATURE :A /�+ DATE:
PERMIT #
DATE PAID °�"%
FEE PAID $
RECEIPT #
Building # Persons Business Activity
Area Sqft Served ti For Commercial Only
W] Spas /Hot Tubs (/ y Floor /Equipment Drains
[ Other (Specify)
Page 1 of 3
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Scale: Each block represents 5 feet and 1 inch = 50 feet.
Notes:
Site Plan submitted by:
By
STATE OF FLORIDA
DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES
APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTIO APE VII
Permit Application Number q71
4 r A)
.-�
Plan Approved
({4
HRS -H Form 4015, Feb 85 (Obsoletes previous editions which may not be used)
(Stock Number. 5744-002-4015-6)
PART II - SITE PLAN
Not Approved
i =1,1=0
o
TITLE
rs
Date a
County Public Unit
ALL CHAT GES MUST BE APPROVED BY THE COUNTY PUBLIC HEALTH UNIT
Page 2 of 3
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Notes:
'="
_it 5
Scale: Each feet and 1 inch =
gE)
Site Plan submitted by: l`/L
Plan Approved
By
STATE OF FLORIDA / 2
DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES
APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION. PERMIT
Permit Application Number g" /' ' 15
PART II - SITE PLAN
(pi/c&zi
SIGNATURE
Not Approved
•
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)
TITLE
Date
is 4P, County Public Unit
Page 2 of 3
BUILDING
ELECTRICAL
PLUMBING
ROOFING
0
CONTRACTOR OR BUILDER
MIAMI SHORES VILLAGE, FLORIDA
PERMIT
Owner of ;
Building
Architect
Contractor
or Builder
Legal Lot
Description BI
Address of
Building
N° 5016
DATE 19 "
Contractor's
License No.
Work to be performed under this Permit —.
Subdi-
vision
Value of
Project $
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.
Signed. INSPECTOR
In consideration of the issuance to me of this permit I agree to perform the work covered hereunder in complionce 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 as
cepting this permit I assume responsibility for all work done by either, myself, my agent, servant or employee.
BY AUTHORITY
Amount of
Permit $