1077 NE 96 St (9)b `
Date 0 Job Address - �S� N`z- ( (co C
Legal Description Z' E "a
Owner / Lessee / Tenant MOCA0 Master Permit �.. - 21;%1___
Owner's Address ?Qt ,V )k ( 1(a Phone - 7 Sq . 4 2-4 1
Contracting Co. qZ0 V oLDAz, Address '/)07',2_ 5c.0 ;; cT rn e'r.yy01dL
Qualifier N \\CL•LQ_ ;NAL) _,0 SS# Phone Cl (e Cf`i
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 r- Da- 'A\'�scr zCc .
Square Ft. 70 0 C75
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.
Signature of owner and /or Condo President
Date:
Notary as to Owner and /or Condo President
My Commission Expires:
** * * * * * *
APPROVED:
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
g 9 --- iyg)f,a4
Estimated Cost(value) 1 .00
ALL& J 4
Notary as o Contractor or 0 er- Builder
Signatu
Date:
FEES: PERMIT 1S P.0 RADON C.C.F. ' t 0 O NOTARY
Tax Folio) /i0ZD' /3 OA
Contractor or
My Commission Expires:
* * * * * u( 'rrAxv
• PUBLIC
- Bui l
.5
LVW ICJ !el it.G ::.* **
BONDED ElY V COMMIX!! 3 -1 7 -96 wrJ
I AEC SERVICE ' / o 4
Fire Other
Zoning Building �q Electrical Mechanical Plumbin 11
CONSTRUCTION PERMIT FOR:
[, ] New System [ ] Existing System [ ] Holding Tank [ J Temporary /Experimental
(V] Repair [ ] Abandonment [ ] Other(Specify)
APPLICANT:
PROPERTY STREET ADDRESS: ; ( A
LOT:
PROPERTY ID #:
0
T
H
E
R
APPROVED BY: C
DATE ISSUED: /1— ( v
STATE OF FLORIDA
DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES
ONSITE SEWAGE DISPOSAL SYSTEM
CONSTRUCTION PERMIT
Authority: Chapter 381, FS & Chapter 10D -6, FAC
i t
.n.
BLOCK: SUBDIVISION:
L
D FILL REQUIRED: [ ] INCHES
111
r-
SPECIFICATIONS BY: TITLE:
AGENT:
HRS -H Form 4016, Mar 92 (Obsoletes previous editions which may not be used)
(Stock Number: 5744 - 001 - 4016 - 0)
i
,!
PERMIT # 1
DATE PAID
FEE PAID $ 4 7I r
RECEIPT # ' %
[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 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 SPECIFICATIONS
c
k1.4
T [':' ] [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 [ ] GALLONS PER DOSE DOSING TANK CAPACITY DOSE RATE [ ] PER 24 HRS NO. OF PUMPS: [ ]
D [ re-' /1
SQUARE FEET PRIMARY DRAINFIELD SYSTEM
R [ ] SQUARE FEET SYSTEM
A TYPE SYSTEM: [ ] STANDARD [ ,] FILLED [ ] MOUND [ ]
I CONFIGURATION: [ ] TRENCH [ <] BED [ ]
N
F LOCATION OF BENCHMARK:
I ELEVATION OF PROPOSED SYSTEM SITE [ ] [INCHES /FT] [ABOVE /BELOW] BENCHMARK /REFERENCE POINT
E BOTTOM OF DRAINFIELD TO BE [ ] [INCHES /FT] [ABOVE /BELOW] BENCHMARK /REFERENCE POINT
EXCAVATION REQUIRED: [ ] INCHES
TITLE:
INSTALLER /CONTRACTOR
1
EXPIRATION DATE:
CPHU
Page 1 of 2
INSTRUCTIONS:
PERMIT NUMBER: Permit tracking number assigned by CPHU.
APPLICATION 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 ID#: 27 character id number for property. (CPHU may require property appraiser ID # or section /township /range /parcel number)
SYSTEM DESIGN AND
SPECIFICATIONS:
TANK: Minimum specifications from Chapter 10D-6, FAC.
DRAINFIELD: Minimum specifications from Chapter IOD-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 Public Health Unit (CPHU) personnel reviewing and approving permit.
DATE ISSUED: Date permit is issued by CPHU.
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.
BUILDING
ELECTRICAL
PLUMBING
ROOFING
Owner of -
Building k? w,
MIAMI SHORES VILLAGE. FLORIDA
❑ DA 195 '.. "195..f,igh
❑ PERMIT N° _ 3726
Architect
Contractor
or Builder re. f- - •
Legal Lot
Description
Address of _
Building 1 0 f a 1
t i II t � ,I
Work to be performed under this Permit
B1
t
Contractor's
License No
Value of Amount of
Project $ • < ,, Permit $
�i 0
Subdi-
vision
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 or in the statements or specifications and that he assumes responsibility for work
done by his agents, servants or employees. ♦ i `, `�,,
Signed. Id
INSPECTOR
In consideration of the issuance to me of this permit I agree to perform the work covere• ' in compllance 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 ac-
cepting this permit I assume responsibility for all work done by either, myself, my agent, servant or employee. •
L CONTRACTOI 'OR BUILDER BY At<C
I
n v 0
Site Plan Submitted by
Plan Approved
By
STATE OF FLORIDA
DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES
APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PERMIT
Permit Application Number ~ 1 7R 3. `'
_J._
2
PART II - SITE PLAN - --
SIGNATURE
ALL CHANGES MUST BE APPROVED B�Y�TH C
-IRS -H Form 4015, Feb 85 (Obsoletes previous editions which may not be used) `,,JJ
(Stock Number: 5744-002-4015-6)
s t t. ' -
Notes
9 8 (( P ;, S Y
TITLE
Not Approved Date
I -1
County Public Unit
PIUBI5,HEpLTH UNIT
Page 2 of 3
Contracting Co. (1/t�i�.K. ald.D /f/ 5 r��Tl s? 5� P 3 d/& Address l 903 plc) (9 7 /9/(r S/,F= �/3(o - G
Qualifier d IIt'I acid D/ Phone go? 6 ` /dt /F
State lfr Municipal # Competency # boo Q /oo3..:2Ans.Co.
Architect /Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type(circle one): BUILDING ELECTRICAL i MECHANICAL ROOFING PAVING FENCE SIGN
• d PERMIT APPLICATION FOR MUNICIPALITIES OF DADE COUNTY
(OWNER TO RETAIN COPY)
Date s 'S 902 Job Address /e977 C 96 S. Tax Folio /1 !Ad /7 Id& 1
Legal Description 7 .ef g , i q fee4
Owner / Lessee / Tenant A. , et/D,Qe - ,4f!
Owner's Address (177 4)e.7. 9 t Sr
fl -
Nota' as to Owner and / r Condo President
My Commission Expires NOTARY PUBLIC, STATE OF FLORIDA.
MY COMMISSION EXPIRES: April 16, 1995.
BONDED THRU NOTARY PUBLIC UNDERWRITERS,
WORK DESCRIPTION if fi f/ .4, 4 c /fj,D -140
Square Pt. Estimated Cost(value) /100' d
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 abov -named contractor to do the work stated.
/ 6( iv
Signature of owner and /or Condo President ignature of tra ctor or Owner- Builder
Dates 3- 5 -q2r Da • 3 - 5-92 _ t
, 'vex: 9.2 oJoo
Master Permit #3.7..,..9Z(7
Phone 7.1 9 7,7
as to Contract r or OWaer -Builder
Not
My Commission Expir 'ARY PUBLIC, STATE OF FLORIDA.
MY COMMISSION EXPIRES: April 16, 1995.
BONDED TIL4li NOTARY PLBLIC UNDERWRITERS.
** * * * * * * * * * * * * * * * **
FEES: PERMIT 01 @ 0 RADON C.C.F. 0 NOTARY TOTAL DUE 0'0
APPROVED: Fire Other
Zoning Building ) Electrical
Mechanical Plumbing � ^L" ' /n
ITEM
BATH TUB
UNIT
FEE
ITEM
SWITCH OUTLETS
UNIT
FEE
ITEM
SPACE HEATERS
UNIT
FEE
BIDET
LIGHT OUTLETS
CENTRAL HEATING
DISHWASHER
RECEPTACLES
A/C (WIND)
DISPOSAL
SERVICE TEMPORARY
A/C (CENTRAL)
DRINKING FOUNTAIN
SERVICE SIZE IN AMPS
DUCT WORK
FLOOR DRAIN
SERVICE REPAIR/METER CHANGE
REFRIGERATION
GREASE TRAP
APPLIANCE OUTLETS
PROCESS AND PRESS PIPING
INTERCEPTOR
RANGE TOP
UNDERGROUND TANKS
LAVATORY
OVEN
ABOVE GROUND TANKS
LAUNDRY TRAY
WATER HEATER
U.F. PRESSURE VESSELS
CLOTHES WASHER
MOTORS 0- 1 HP
STEAM BOILERS
SHOWER
MOTORS OVER 1- 3 HP
HOT WATER BOILERS
SINK, POT /3 COMP.
MOTORS OVER 3- 5 HP
MECHANICAL VENTILATION
SINK, RESIDENCE
MOTORS OVER 5- 8 HP
TRANSPORTING ASSEMBLIES
SINK, SLOP
MOTORS OVER 8- 10 HP
ELEVATORS/ESCALATORS
TEMPORARY WATER CLOSET
MOTORS OVER 10- 25 HP
FIRE SPRINKLER SYSTEMS
URINAL
MOTORS OVER 25-100 HP
COOLING TOWERS
WATER CLOSET
MOTORS OVER 100 If
VIOLATION
INDIRECT WASTES
A/C WINDOW
REINSPECTION
WATER SUPPLY TO:
AIR CONDITIONERS
A/C UNIT
STRIP HEATER
FIRE SPRINKLER
GENERATORS TRANSFORMERS
HEATER -NEW INST.
GENERATORS TRANSFORMERS
HEATER - REPLACE
GENERATORS TRANSFORMERS
LAWN SPRINKLER -WELL
SPECIAL PURPOSE
SWIMMING POOL
OUTLETS COMMERCIAL
WATER SERVICE
SIGN TUBES
SEWER CONNECTIONS
SIGN TRANSFORMERS
UTILITY -SEWER
SIGN TIME CLOCK
_
UTILITY -WATER
FIXTURES
SEPTIC TANK
ANTENNA
RELAY jo ' 0
/
TELEVISION OUTLETS
DRAINFIELD, 4' TILE/RES.
VIOLATION
PUMP & ABANDON SEPTIC TANK
REINSPECTION
SOAKAGE PIT CU. FT.
CATCH BASIN
DISCHARGE WELL
DOMESTIC WELL
AREA DRAIN
ROOF INLET
SOLAR WATER HEATER
FIRE STANDPIPE
POOL PIPING
LAWN SPRINKLER SYSTEM
GAS RANGE
METER SET (GAS)
GAS PIPING
ADDENDUM TO BUILDING PERMIT APPLICATION
(AN APPLICATION FOR BUILDING PERMIT MUST ACCOMPANY THIS ADDENDUM. IF A MASTER PERMIT HAS BEEN
OBTAINED, THE OWNER'S NOTARIZED SIGNATURE NEED NOT BE PRESENT ON SUBSEQUENT APPLICATIONS.)
PLUMBING
ELECTRICAL
MECHANICAL
1-
Agent's Mailing Address
Property Street Address
STATE OF FLORIDA
DEP • VENT OF HEALTH AND REHABILITATIVE SERVICES
APPLIC ON FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PERMIT
Authority: Chapter 381, FS
Chapter 100-6, FAC
s - .s - - 9-Z 0 2 _ 000
Date of Application Permit Application Number
AUDIT CONTROL NO. 302422
/077 414'. 9G 5
jj 19 1 '
HRS-H Form 4015. Feb 85 (Obsoletes previous editions which may not be used)
(Stock Number: 5744-001 - 4015-1)
PART 1— APPLICATION
/3903 ,Gtr..! (7 , L/
TOTAL FLOW
Applicant's Signature
Name of Owner Zia...°'e.c"A v Telephone Number 7 S — V - 9
Mailing Address of Owner /077 WC 9( <7
Owners Agent � �� ` ��- S4. Z 't Builder
Telephone No .rJ ,' - 2 o t/
Lot No Block No Subdivision Date Subdivided
NOTE: IF NOT IN A SUBDIVISION ATTACH A METES AND BOU DS DESCRIPTION
This Application is for: New System Repair Existing System
Type of Sewage Flow Sewage Flow
Establishment (Gallons per day) Based On
Type of No. Bedrooms Heated or Cooled Area No. Dwelling Sewage Flow
Residential (each dwelling unit) (each dwelling unit) Units (Gallons per day)
A-.c. ft2
ft
Exact Directions to Property
Page 1 of 3