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1099 NE 96 St (4)// .. MIAMI 'SHORES VILLAGE, FLA. I 7y ii,' % . JOB /,s a ADDRESS /0 N9 7218 INSPECTION TIME READY S REMARKS: ,% i Permit No Application is hereby made for the approval of the detailed statement of the plans and specifications h ewith s mitted for the building or other structure herein described. This application is made in compliance and conformity with the Building Or ' arc 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 building during progress of work. Owner's Name and Address 4_ #A1 No. _-__._1 0-17- Street • 6 9 )‘ Registered Architect Employing P1 Location and Le esc /or Engineer_...____ ption Lot_.__ Street and Number where work is to be performed —No.— State work to be performed and purpose of building (By Floors New Building _ Remodeling Size Septic Tank ______ Type of Tank Capacity Gals Feet of Drain Tile ____________Dist. Feet of Tank or Drain Field from Well Nature of Water Supply: City— Well.___ —__. _ , - .... ___ ....... -___--_--Size of Soakage Pit Amount of Permit $ MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING ^ NwMIT _,_ Block___ Addition _____ (Signed)_ Plumbing cpect . The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations as an employer of labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Permanent Supplement, and Ilas 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 .. rk / • be performed under this permit, as are licensed by Miami Shores Village. ( Signed)._ My Counmission Expires Notary Public, State of Florida .0r Repairs No. of Stories . . ..... Master Plumber. STATE OF FLORIDA, l as. COUNTY OF DADE. 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 $1.00 will be made when such re- inspection is made • necessary by improper notice for inspection, or faulty materials and /or workmanship. CLOSETS BATH TUBE SHOWERS LAVA- TORIES S INKS SLOP SINKS LAUNDRY Tuns URINALS CATCH BASIN FLOOR DRAIN DRINK NG FOUNT' NS TOTAL FIXTURES CONTR. LIST CHECK SEPTIC TANK SEWER CONN. DRAIN FIELD SOAKAGE PIT GREASE TRAP SOLAR HEATER DEEP WELL SPRKLR. SYSTEM SW IM'G POOL CONTR. LIST CHECK Permit No Application is hereby made for the approval of the detailed statement of the plans and specifications h ewith s mitted for the building or other structure herein described. This application is made in compliance and conformity with the Building Or ' arc 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 building during progress of work. Owner's Name and Address 4_ #A1 No. _-__._1 0-17- Street • 6 9 )‘ Registered Architect Employing P1 Location and Le esc /or Engineer_...____ ption Lot_.__ Street and Number where work is to be performed —No.— State work to be performed and purpose of building (By Floors New Building _ Remodeling Size Septic Tank ______ Type of Tank Capacity Gals Feet of Drain Tile ____________Dist. Feet of Tank or Drain Field from Well Nature of Water Supply: City— Well.___ —__. _ , - .... ___ ....... -___--_--Size of Soakage Pit Amount of Permit $ MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING ^ NwMIT _,_ Block___ Addition _____ (Signed)_ Plumbing cpect . The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations as an employer of labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Permanent Supplement, and Ilas 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 .. rk / • be performed under this permit, as are licensed by Miami Shores Village. ( Signed)._ My Counmission Expires Notary Public, State of Florida .0r Repairs No. of Stories . . ..... Master Plumber. STATE OF FLORIDA, l as. COUNTY OF DADE. 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 $1.00 will be made when such re- inspection is made • necessary by improper notice for inspection, or faulty materials and /or workmanship. BUILDING ❑ ELECTRICAL ❑ PLUMBING ❑ ROOFI. ❑ Owner of Building • Architect Contractor or Builder Legal Description Lot Address of tq 7 Building MIAMI SHORES VILLAGE. FLORIDA PERMIT N? 6644 Work to be X0,2 performed under this Permit - 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 9f dpecif a tions and that he assumes responsibility for work done by his agents, servants or employees. / J Signed 44 j( BY • INSPECTOR Value of Project DATE Contractor's License No. Amount of Permit $ 195 Subdi- vision 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 ac• cepfg this permit I assume responsibility for all work done by either, myself, my agent, servant or employee. __.. - t ie CONTRACTOR OR BUILDER J BY AUTHORITY 1 Date 1 " I I : Job Address l O q 1\ C T G S7 Tax Folio Legal Description 1 11 P - t l S O''' S WC ' O w n e r / L e s s e e / T e n a n t W E i S S S H � YZ L~i✓ E Owner's Address l O ° I N G l� e Contracting Co. S P co or45 (NC • Qualifier TERESPf a. SO LotA State # 5 .1 g"08 g Municipal # Competency # Ins. Co. N " 1-1 " 45 Architect/Engineer Address Bonding Company Address Mortgagor Address Permit Type (circle one): BUILDING ELECTRICAL,UMBING) MECHANICAL ROOFING PAVING FENCE SIGN WORK DESCRIPTION Square Ft. Estimated Cost (value) la of 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 L Signatt a of o _Condo President Notary as o Owner or C on 's '.. •aw�tvaw���N Co ssion E s: Tema I Fcldes Notary Public, 9iarc of Florio n Commission No. tX 001107 tarns Mv CommLfbsBspsaaro 3 % . NM, MOTU! - IP& s0!r_•a soft Co FEES: PERMIT PERMIT APPLICATION FOR MIAMI SHORES VILLAGE RADON 74a 4-/ C P C I to iedg APPROVED: Zoning Building Mechanical Plumbing C.C.F. NOTARY i1- 32.0 - 01'-1 ( Historically Designated: Yes No Master Permit # Phone Address 'f gO)( 3/c6 A-0 L( FL - Phone C3�� �� ' �� �3 Signature • • _1 er- Builder Date ys s' g 0 7/; -a .2°°54 / '-f Notary o Contractor o OwnerfaitiklbtL BIOTA1t : ate My ommission Expires: GLAJ I, GARY P IA STATE VILAR OF FLORIDA MY COMMESTON EXP. MA1 R. CO2 BOND TOTAL DUE Electrical Structural Engineer STATE OF FLORIDA DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PERMIT , thority: Chapter 381, FS & Chapter 10D -6, FAC CONSTRUCTION PERMIT FOR: [//) Nei./ System [ Al Existing System [ •)] Repair [,]' Abandonment APPLICANT: LOT: j * 2_ BLOCK: PROPERTY ID f # ]: L D FILL REQUIRED: [ 0 T H E R SPECIFICATIONS BY: APPROVED BY: DATE ISSUED: PROPERTY STREET ADDRESS: ° f [ " / Holding Tank [ '_ - Temporary /Experimental [ �'jt_. Other (Specify) ? SUBDIVISION: ,� -- t /tl� TITLE: HRS -H Form 4016, Mar 92 (Obsoletes previous editions which may not be used) (Stock Number: 5744- 001 - 4016 -0) AGENT: TITLE: PERMIT # DATE PAID FEE PAID $ RECEIPT # piE 1/ �� _ CJ [SECTION /TOWNSHIP /RANGE /PARCEL NUMBER] [OR TAX ID NUMBER] ] INCHES EXCAVATION REQUIRED: [ 5 6] INCHES ( J6 -7- / L /_ r;F 7 Z. ..&e, Z_ EXPIRATION DATE: r 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 T [1 "eJ [GALLONS / GPD] SEPTIC TANK /AEROBIC UNIT CAPACITY MULTI- CHAMBERED /IN SERIES:[ ] A ['loci!) ] [GALLONS / GPD] CAPACITY MULTI- CHAMBERED /IN SERIES:[ ] N [ ] GALLONS GREASE INTERCEPTOR CAPACITY [MAXIMUM CAPACITY SINGLE TANK: 1250 GALLONS] K [ ] GALLONS PEIl DOSE DOSING TANK CAPACITY DOSE RATE [ ] PER 24 HRS NO. OF PUMPS: [ ] h, ti a 1 s /!' .4' D [6 z....) ] SQUARE FEET PRIMARY DRAINFIELD SYSTEM R [ ] SQUARE FEET SYSTEM A TYPE SYSTEM: N [ ] STANDARD [ ] FILLED [ J MOUND I CONFIGURATION: FT [ ] TRENCH [ 'y BED [ ] / F LOCATION OF BENCHMARK: (21./ C ¢ / /( V!) -4 '.u1.L— fuo fi 4 ! - -' q,( , -J , ,�r .� r, � ��'� s I ELEVATION OF PROPOSED SYSTEM SITE [ f • ] [INCHES ABOVE BELOW BEN H E BOTTOM OF DRAINFIELD TO BE [ .5_:[ C ](',&I ES /FT] [ABOVE .1�ELOWJ. BENCHMARK REF POI [ 9 '7 CPHU /(! —lu — Page 1 of 2 .: e9lo -7 -:: .t bci °71 cp:)11v.17.1 OW•:ez _ e_rally ':utao_-iizer: r pr;:..antctiv :. .. .... hot: or :true; ':'!.aLir a.l :drer. ^. for applicant or agent. A ?.! --1:::ber raper.y. (C''::: _. ay mp,uire property cpD--aice' f: or rection /toeintlip /ranwe /patcei s :cificr.tionc from Chrpte. ?C:)-6,;FAC. '.'i�licren scccificrtiens from Chapter iFAC. o n i m s flush variance is :i ll C:7 as ODe-at!n� !).. Tla :'eC!1E <ireTe_ 1s, low- VQ i _LS,. _;. >Ilf: toilets, da__a_ Cd prOd..As. _. of ,- ovidim; specifications. :f designed by a rePic.xtea', engineer muss be :,ea.e . Cuunt; ?un'.ic Hesith Jnit (CL ?HU; personnel reviewing and approving permit. =SS ..ute n::mii is issued by CP} U. One yea: from date issued if the system sap not been installed. ?emits for system repairs becorne void 90 days from the d_te �vsucd. • 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: [1') New System [ f 1 Existing System WI' -j' Holding Tank [ j Temporary /Experimental [ ] Repair [ � ' j ' Abandonment [ # ] . Other(Specify) APPLICANT: f °' 1 C PROPERTY STREET ADDRESS: LOT: 7 P- BLOCK: PROPERTY ID #: 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 a: T [V ] [GALLONS / GPD] SEPTIC TANK /AEROBIC UNIT A [,- , ` ] [GALLONS / GPD ] N [ ] GALLONS GREASE INTERCEPTOR CAPACITY K [ ] GALLONS PER DOSE DOSING TANK CAPACITY ,r' . D [LS.. ] SQUARE FEET PRIMARY DRAINFIELD SYSTEM 0 T 11 E R R [ ] SQUARE FEET A TYPE SYSTEM: I CONFIGURATION: N F LOCATION OF BENCHMARK: (,2'.(7 ( 7 1 / ) I ELEVATION OF PROPOSED SYSTEM SITE [/ E BOTTOM OF DRAINFIELD TO BE [ ra; L D FILL REQUIRED: [ ] INCHES SPECIFICATIQN�,S-) �x APPROVED B DATE ISSUED: SUBDIVISION: SYSTEM [ ] STANDARD [ ] FILLED [ ] MOUND [ ] TRENCH [ .] BED [ ] HRS-H Form 4016, Mar 92 (Obsoletes previous editions which may not be used) (Stock Number: 5744-001-4016-0) +EL /1/ INCHE FT , ABOVBELOW BENCHMARK FERENCH POINT ]C`[INCHES /FT] [ABOVEM L ' , 13EFICHMA'RK /kEFE NitE `PO T EXCAVATION REQUIRED: [ ? j l7 RES f. , /— AGENT: 6/, < TITLE: TITLE: PERMIT # DATE PAID FEE PAID $ ; > RECEIPT # -- J ( a [SECTION /TOWNSHIP /RANGE /PARCEL NUMBER] [OR TAX ID NUMBER] F CAPACITY MULTI— CHAMBERED /IN SERIES:[ ] CAPACITY MULTI— CHAMBERED /IN SERIES:[ ] [MAXIMUM CAPACITY SINGLE TANK: 1250 GALLONS] DOSE RATE [ ] PER 24 HRS NO. OF PUMPS: [ ] EXPIRATION DATE: , �J(f CPHU Page 1 of 2 rr, 1:NS7 3UC•1'".CNS: : :J:,':= 7?e :=?it t:ac:ciT3 number assigned by CPhi;ZJ. Ciiecit type o` permit, if ° Ottier° specify type : ?roperty owner's full name. 'Telephone number for applicant or went. .= :-3.erty owr.::r's legally authorizes representative. ,._. _ '.... ao :_ o,• 2re3: cQdre.°.:{ for applicant or agent. C..C.f,. S:..11 :TV::S:ON or -. --._•_... i.� �-:. :y" property 1 "'T ra ce r nhi ! 2.7 Cf:;r7!:..- D .la ,'• �• _W wry: propr.:. cnpr4.irrr .,. 0 or c.io_hoe�._s._i /reige/ arse_ unbar AND Aiti >: imu r seecific-.tiors from Chapter 1OD-6, :FAC. IVIiniraun specifications from Chapter IOD -6, FAC. es operrtu ^^ p: a.it requirements, !ow- volume flush toilets, variance provisos. 3 Ts": r'ame of `:, i s duel n -ov :ding+ soecifeaticas. :f designed by a regis_e; ad engineer must be sealed. - i`_'. County ?colic health Unit (C° U) personnel reviewing and approving permit. Date permit i5 issued by CPHU. at; ye...r from !,. _ issi:od 113' - :s net :leer installed. Pe-:i?s for system repairs become void 90 days from Li^.e date issued. STATE OF FLORIDA DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES APPLICTION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION P ERMIT , t, Permit Application Number PART II - SITE PLAN Scale: Each block represents 5 feet and 1 inch = 50 feet. 44-.4-411144P.4 ;11.1.414sy-aq 1 f ,21 1 ,- w4.+ •410 '41)• 1 ) Notes: s; Site Plan submitted by: Plan Approved ■ HRS -H Form 4015, Feb 85 (Obsoletes previous editions which may not be used) (Stock Number. 5744-002-4015-6) SIGt5717Unt r TITLE Not Approved Date By �` - / � County Public Unit ALL CHANGES MUST BE APPROVED BY THE COUNTY PUBLIC HEALTH UNIT Page 2 of 3