Loading...
150 NE 96 St (9)Nary/as to Owner Commission Expir( APPROVED: PERMIT APPLICATION FOR MIAMI SHORES VILLAGE -�� /,y - e /i . ,2P4 i' 61 18 Date G � Job Address � J Tax Folio Legal Description /7H / / ���. -/ Owner / Lessee / Tenant 40 4664;e Master Permit 4t 7iT Owner's Address 7.5`e 77 89/Fg Contracting Co. P /WW � � ,a, ► '� Qualifiers State # l' ✓.:. Munici # c, mpetency # Ins.Co. Architect /Engineer Address Bonding Company Address Mortgagor Address Permit Type(circle one): BUILDING ELECTRICA PLUMBIN MECHANICAL ROOFING PAVING FENCE SIGN WORK DESCRIPTION A < 6AV Square Ft. Estimated Cost(value) ,`��)t`�I)• 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 onstruction and zoning. Furthermore, I authorize the above -named contractor to do the work sta ed, J Signature, o ner and /or Condo Date: #77 91 President Zoning Mechanical SS A st :0C197545 Building Address ,;(,) 44 , J r o Phone (z) er Signatur f Contractor or Owner- Builder Phone Date: 9 aaeii tar as to Contractor or Owner- Builder My Commission Expires: * * * * * * * * * * * * * * * * ** FEES: PERMIT 3 6 ' /6.( ' RADON C . C . F . r NOTARY n a TOTAL DUE .. Fire Other Electrical � q p%y Plumbin� 1-- 3V kils " 1 l/Engineering APPLICANT: LOT: T [ A [ N [ K [ CONSTRUCTION PERMIT FOR: [ ] New System [ ] Existing System [ ] Holding Tank [ ] Temporary /Experimental [ ] Repair [ ] Abandonment [ ] Other(Specify) PROPERTY STREET ADDRESS: PROPERTY ID #: STATE OF FLORIDA DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PERMIT Authority: Chapter 381, FS & Chapter 10D -6, FAC BLOCK: SUBDIVISION: 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 ] [GALLONS / GPD] SEPTIC TANK /AEROBIC UNIT CAPACITY MULTI— CHAMBERED /IN SERIES:[ ] ] [GALLONS / GPD] CAPACITY MULTI— CHAMBERED /IN SERIES:[ ] ] GALLONS GREASE INTERCEPTOR CAPACITY [MAXIMUM CAPACITY SINGLE TANK: 1250 GALLONS] ] GALLONS PER DOSE DOSING TANK CAPACITY DOSE RATE [ ] PER 24 HRS NO. OF PUMPS: [ ] D [ ] 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 L D FILL REQUIRED: [ ] INCHES EXCAVATION REQUIRED: [ ] INCHES 0 T H E R SPECIFICATIONS BY: APPROVED BY: DATE ISSUED: AGENT: HRS -H Form 4016, Mar 92 (Obsoletes previous editions which may not be used) (Stock Number: 5744 - 001 - 4016 -0) [SECTION /TOWNSHIP /RANGE /PARCEL NUMBER] [OR TAX ID NUMBER] TITLE: TITLE: ' // EXPIRATION ii EXPIRATION DATE: PERMIT # DATE PAID FEE PAID $ RECEIPT # 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 qumber for property. (CPHU may require property appraiser ID tt or section/township /range /parcel number) SYSTEM DESIGN AND SPECIFICATIONS: TANK: Minimum specifications from Chapter 1OD -6, FAC. DRAINFIELD: Minimum specitcations from Chapter 10D-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. J I siume fim /tmaaammarni mmoman iumu merino sanam ■iunsann tn1:>• mmati iQmVtowanim tip/ t■■/•ltss!■!'/ tatss/■! t! q/ i////■/■/! 1•/ / / ■ / /!/ ■R /// / /! ■!//■■/ /■// // /■1311//■ / / / / / /// / / //// ! iumastssaa tmag � /!. / ■///■/■1//// /;!// / / /!�//■■I ■/////a/ / /■//////// �f/! i////■/■ Mi // / /N / ■ / / / //i���asa / ///■/■#/ ■1313/ '1313/ / t•t a!!/■■/■■!! / ■! ■ ■/■ //!Q /! / ■!!/■/!! / /! / ■// /N •//d• /■/■■1313 MO/!■i/■ p�� t////!■////!///!//////■/' ////// ///// ■Q/ / ■ / /■/!/ /,/mmunsi ■ !/■ nutamm!I//!N/N®/ i ■M••••••/!!!■/ H/// N/; •// / / / / ■! ■ / / ■//// ■! / / /■/ //! /! /■ / /■/!/■!/!O /r■• IHMMINt•/ /,/I •i • NEs tssU tua nna/// t! a!/ //!u/■/ //////!W_!i� /j!// ■/ !!/!/ !/! ■/■//*//■////■t.s a mas!//tt■t�■amat / mmtatati m■■ // ■it`■alln!//■ /!/t /t //t(/t/■!■!,// /t/////■ ////!// tt■/■! 1•■■ t ■/■ /■■/■t ////■t■//;!/////■/ ■t•• !// ■■/■■Ham 1•/■/ /tassa //t•tt// laaartmatataitatemaiit MN ■ •••••••t/t t//!/t■ /•t•■ ilUDOOMI ■t it /ass■/• •MINI•!■ •••)4)4! /t/•t •sr■ltta ,•a t tauattw■ t■sta S ttt4l4ttt■t• . =NM Mt■M /■/i! /tit■■■ /■iMtt/ t m wm an s�a s ■■ss■ /tttsn ssas sso _ N ■a�■t /Qtlal•Ra16 a••— IIMININ as �ittit !t t !! i! ! ea ma! [ ■ _ aaas!■■si /)stunt • t■ ■Ott /t t MOOR■ •NU!/!a/■■■a■t■aM u!!!! !!■■ ■tom ■!Molt ■.. M!!!ot!!!� - 5 !!!■!!•■ r!!!■■ !!! ! •l !l �1 � 1 N• i la! ■g■!s�!■■■!!a !a!!!! ■ •u•■■• warns !/t!t■M!•al/anaa•/tNl/ttt /■a /'•tlti!■■t■!■ !■!a••1!! lttft ■t/ ■t■■■ ■■ ■M•//s■■a ta!!!!!!!■ t /a/!!i!/ti!!!!■!!!a!Ulalaama 1!!•f;1l.!i■ t/! !■!aa!!u/ ■! ■!!■aa /■!•1!! a i /t/■a twin taaaa llatttlttta tlu Blta t // t /! SEES i!■tN III N t /Ei • • as"i■\ u/i■ - - litila /mama 0, V _, 1 i-44. `Y l f *-1-1 1 - _-- ._._•_ dit + !■tt4!■■ ■■■tilt; • Notes: 156 fl E 9 (o Sk `M .o 33/ 3� Site Plan Submitted by Plan Approved By �. Z STATE OF FLORIDA DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES - APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PERMIT Permit Application Number 7 3 /O 7 PART II - SITE PLAN ---- HRS -H Form 4015, Feb S5 (Obso!etes previous editions which may not be used) (Stock Number -5744- 902 - 4015 -R1 SIGNATURE Not Approved Illr" ALL CHANGES MUST BE APPROVED BY THE COUNTY PUBLIC HEALTH UNIT CIO 6-6 k. TITLE Date County Public Unit _Paaa 9 of '� 4 APPLICANT: LOT: PROPERTY ID #: STATE OF FLORIDA DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES ONSITE SEWAGE DISPOSAL SYSTEM SITE EVALUATION AND SYSTEM SPECIFICATIONS dal BLOCK: TO BE COMPLETED BY ENGINEER, HEALTH UNIT EMPLOYEE, OR OTHER QUALIFIED PERSON. ENGINEER'S MU: PROVIDE REGISTRATION NUMBER AND SIGN AND SEAL EACH PAGE OF SUBMITTAL. COMPLETE ALL ITEMS. PROPERTY SIZE CONFORMS TO SITE PLAN: [ ] YES j NO NET USABLE AREA AVAILABLE: ACRE TOTAL ESTIMATED SEWAGE FLOW: .CLSO GALLONS PER DAY [RESIDENCES -TABLE 1 / OTHER -TABLE 2 AUTHORIZED SEWAGE FLOW: GALLONS PER DAY [1500 GPD /ACRE OR 2500 GPD /ACRE] UNOBSTRUCTED AREA AVAILABLE: JO U d - I - SQFT UNOBSTRUCTED AREA REQUIRED: 5 � n SQF BENCHMARK /REFERENCE POINT LOCATION: ELEVATION OF PROPOSED SYSTEM SITE IS THE MINIMUM SETBACK WHICH CAN BE MAINTAINED FROM THE SURFACE WATER: WELLS: PUBLIC: BUILDING FOUNDATIONS: SITE SUBJECT TO FREQUENT FLOODING: 10 YEAR FLOOD ELEVATION FOR SITE: SOIL PROFILE INFORMATION SITE 1 SUBDIVISION: Mu sell Color Texture Depth `Vg . 6 tots to to to to to to to to USDA SOIL SERIES: SITE EVALUATED BY. NRS -H Form 4015, Mar 92 (Obsoletes previous editions which may not be ed) (Stock Number: 5744 -003- 4015 -1) PERM r 9,fg:fd 7O q AGENT: , Gp , n A [Section /Township /Range /Parcel No. or Tax ID Number [INCHES /FT] [ABOVE /BELOW] BENCHMARK /REFERENCE POIN PROPOSED SYSTEM TO THE FOLLOWING FEATURES: FT DITCHES /SWALES: FT NORMALLY WET? [ ] YES b4 N FT LIMITED USE: t\ \� FT PRIVATE: - 4 FT NON- POTABLE: �y FT PROPERTY LINES: S FT POTABLE WATER LINES: jO F [ ] YES NO 10 YEAR FLOODING? [ ] YES N FT MSL /NGVD SITE ELEVATION: FT MSL /NGV: SOIL PROFILE INFORMATION SITE 2 Munsell # /Color Texture Depth to to to to to to to to to USDA SOIL SERIES: OBSERVED WATER TABLE: INCHES [ABOVE / BELOW] EXISTING GRADE. TYPE: [PERCHED / APPARENT. ESTIMATED WET SEASON WATER TABLE ELEVATION: INCHES [ ABOVE / BELOW ] EXISTING GRADE HIGH WATER TABLE VEGETATION: [ ] YES [.NO MOTTLING: [ ] YES K NO DEPTH: INCHES SOIL TEXTURE /LOADING RATE FOR SYSTEM SIZING: DRAINFIELD CONFIGURATION: [ ] TRENCH [ ..BED [ ] OTHER (SPECIFY) REMARKS /ADDITIONAL CRITERIA: DEPTH OF EXCAVATION: INCHES DATE: 1 Page 3 of 3 APPLICATION FOR: [ ] New System ( ] Existing System ' 4 Repair [ ] . Abandonment APPLICANT: AGENT: MAILING ADDRESS: LOT: BLOCK: SUBDIVISION: PROPERTY ID #: PROPERTY SIZE: ACRES [Sqft/43560] PROPERTY STREET ADDRESS: DIRECTIONS TO PROPERTY: Unit Type of No. of No Establishment Bedrooms S �-� 2 3 4 STATE OF FLORIDA DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES ONSITE SEWAGE DISPOSAL SYSTEM APPLICATION FOR CONSTRUCTION PERMIT Authority: Chapter 381, FS & Chapter 1OD -6, FAC ' ] Garbage Grinders /Disposals ] Ultra -low Volume F ush Toilets '.ANT'S SIGNATURE: 3 C1,3)3,0 [ ] [ ] Holding Tank Other(Specify) dLi:L e•U AS)')QA �2C�oy�b 11cL.t,rct- - rte . , BUILDING INFORMATION ['] RESIDENTIAL 50 n E q 5*T . - 1 0,33) 3 PROPERTY WATER SUPPLY: [ ] PRIVATE [ a1 Building Area Sqft [ ] Spas /Hot Tuba 115, Mar 92 (Obsoletes previous editions which may not be used) • 5744 - 001 - 4015 -1) # Persons Served PERMIT I DATE PAID FEE PAID RECEIPT # TELEPHONE: - ] COMMERCIAL Yij2oz 70 $ J!4 - • • Ziff [ ] Temporary /Experimental 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] DATE OF SUBDIVISION. [Section /Township /Range /Parcel No.] ZONING: Business Activity For Commercial Only [ ] Floor /Equipment Drains [ ] Other (Specify) bATE: 1 1q Page 1' of 3 PERMIT APPLICATION FOR MIAMI SHORES VILLAGE Date / 2 ' 7 Job Address /SO /U C c lb > � � Tax Folio Legal Description i-0 " 7-e "5 - Lie 6 /c # `2..--/2 Historically Designated: Yes No Owner/Lessee / Tenant P Master Permit# ee Owner's Address / 52 Ai -- 9' /6 t Phone - Contracting Co. 4 hi %��2 A/ ©/ fi /Y 6 t / C /'rvc Address 2 0 Al A7 .2o .`� / �/_ Qualifier ice'/ - /-M N fr Y , 4 State # Municipal # Competency # O o 0 ?O276 / Ins. Co. o f A /u 9 Architect/Engineer Bonding Company Mortgagor Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN WORK DESCRIPTION p, l /v !' f2 -4l -/% LAY S Square Ft. Signature of owner : or Condo Pr • ident Date Notary as to Owner and/or Condo esid t' Date My Commission Expires: FEES: PERMIT s- RADON C.C.F. APPROVED: Zoning Building � Mechanical Plumbin: 111 l Address Address Address Estimated Cost (value 11i►I W SS# - P h o n e ;.> ; . )7 /0 O de , a 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. ignature o ' ontractor ••r Owner- Builder No ' •n • ctor or Owner - Builder My Commission Expires: � P PV a PERCIVAL R. TODD o ; COMMISSION # CC 425162 z EXPIRES JAN 15,1999 BONDEDTHFU 9 e 1 NOTARY 9 BOND Electrical ( a �p Datd /i / 7 Date Engineering APPLICANT: PROPERTY STREET ADDRESS: LOT: PROPERTY ID #: STATE OF FLORIDA DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION INSPECTION AND FINAL APPROVAL Authority: Chapter 381, FS & Chapter 10D -6, FAC FILL /EXCAVATION MATERIAL [22] FILL AMOUNT [23] FILL TEXTURE [24] EXCAVATION DEPTH [25] EXCAVATION AREA [26] REPLACEMENT MATERIAL EXPLANATION OF VIOLATIONS: BLOCK: SUBDIVISION: AGENT: [SECTION/TOWNSHIP/RANGE/PARCEL NUMBER] [OR TAX ID NUMBER] CHECKED [X ITEMS ARE NOT IN COMPLIANCE WITH CHAPTER 10D -6, 11,ORIDA ADMINISTRATIVE CODE. TANK INSTALLATION 01] TANK SIZE [ [2] [02] TANK MATERIAL [03] OUTLET DEVICE [04] MULTI- CHAMBERS' [05] LEGEND [06] WATERTIGHT [07] LEVEL [08] DEPTH OFIID DRAINFIELD INSTALLATION' [09] AREA [1] ' . „' [2] SQFT [101 DISTRIBUTION BOX /HEADER [11] NUMBER OF DRAINLINES [12] DRAINLINE SEPARATION [13] DRAINLINE SLOPE [14] DEPTH OF COVER t r; [15] SYSTEM ELEVATION [16] SYSTEM LOCATION [17] DOSING PUMPS [18] AGGREGATE SIZE [19] AGGREGATE SOURCE [20] AGGREGATE WASHED [21] AGGREGATE DEPTH :ONSTRUCTION,I APPROVED/ DISAPPROVED]: FINAL SYSTEM [APPROVED /DISAPPROVED]: [ [ HRS -H Form 4016, Mar 92 (Obsoletes previous editions which may not be used) (Stock Number: 5744 - 002 - 4016 -4) PERMIT # RECEIPT # FEE PAID DATE PAID SETBACKS [27] SURFACE WATER [28], DITCHES [29] PRIVATE WELLS. [30] PUBLIC WELLS . [31] IRRIGATION WELLS [32] POTABLE WATER LINES [33] BUILDING FOUNDATION [34] PROPERTY LINES [35] OTHER FILLED /MOUND SYSTEM [36] DRAINFIELD COVER [37] SHOULDERS [38] SLOPES [39] STABILIZATION MATERIAL ADDITIONAL INFORMATION [40] UNOBSTRUCTED AREA [41] STORMWATER RUNOFF [42] ALARMS [43] MAINTENANCE AGREEMENT [44] BUILDING AREA [45] PLUMBING FIXTURES [46] FINAL SITE GRADING [47] CONTRACTOR [48] OTHER ABANDONMENT [49] TANK PUMPED/ (50] TANK CRUSHED AND FILLED i CPHU DATE CPHU DATE: / / Page 2 of 2 ,h its :C. LI A DEPARTMENT OF °HEALTH • APPROVED 623-3500' • S6 W. E.