325 NE 97 St (7)BUILDING
ELECTRICAL
PLUMBRIG,
Owner of
Building
Architect
Contractor
or Builder,
,t-
Legal Lot
Description
Address of ,r
Building ." .� r ,/ ,t
This permit is granted to the contractor of builder named above to construct the building or to install the equipment or device 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 responsibility for a thorough knowledge of the ordinances and
ca tions pertaining to the work covered hereby whether shown on the plans or drawings or in the sytements or sp ifications and that he as es respon-
ty for work done by his agents, servants or employees. s
Signed• d f ! /d1 ; -�2,r By 4 %,
INSPECTO
In consideration of the issuance to me of this permit I agree to perfo the work covered hereunder in compliance with all ordinances and regulations
+ g thereto and in strict conformity with the plans, drawings, s : ; ents or specifications submitted to the proper authorities of Miami Shores Village.
prit I + e • nsibility for all work done by e yse my t, servant or employee.
l
Work to be performed under this Permit
CONTRACTOR OR BUILDER
MIAMI SHORES VILLAGE, FLORIDA
PERMIT N? 6036
Gtr
Bl.
Subdi-
vision
Value of
Project
BY
DATE
Contrator's
License No.
f
Amt. of
Permit
194
AUTHORITY
BUILDING
ELECTRICAL
PLUMB
Owner of '
Building , / 1(I
Architect
Contractor
or Bujde
Legal Lot
De4cription
MIAMI SHORES VILLAGE, FLORIDA
PERMIT N° 6036
Work to be performed under this Permit 21 ..L)
lair
CONTRACTOR OR BUILDER
Bl.
Signed•
Subdi-
vision
Address of ...� ) t` Value of Amt. of
Building_ J P roject Permit
This permit is granted to the contractor o b ilder named above to construct the building or to install the equipment or device described in the appli-
cation herefor in si rict compliance with all ordinances pertaining thereto and with the understanding that the work will be perfornied 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 it 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 responsibi • y 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 st ments spe ifications and t3 he.as umes respon-
sibility for work done by his agents, servants or employees. / Y ,
� INSPECTO d } //` By °r el
In consideration of the issuance to me of this permit I agree to perfo m the work covered hereunder in compliance with all ordinances and regulations
pertaining thereto and in strict conformity with the plans, drawings, st. : tents or specifications submitted to the proper authorities of Miami Shdres Village.
In acce•g this permit I ass me ,sjonsibility for a work done by e . �� ysel� my fit, servant or employee.
BY
DATE
Contractor's
License No.
AUTHORITY
C
19471
APPLICATION FOR:
[ New System [ ] Existing System [ ] Holding Tank [ ] Temporary /Experimental
[':] Repair [ ] Abandonment [ ] Other(Specify)
APPLICANT: ,' ./
AGENT:
LOT:
PROPERTY ID #:
PROPERTY SIZE:
F
BLOCK:
PROPERTY STREET ADDRESS:
DIRECTIONS TO PROPERTY:
BUILDING INFORMATION
Unit Type of
No Establishment
1
2
3
4
APPLICANT'S SIGNATURE: .
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
1,
MAILING ADDRESS: 9 `
TO BE COMPLETED BY APPLICANT OR APPLICANT'S AUTHORIZED AGENT. ATTACH BUILDING PLAN AND TO -SCALE
SITE PLAN SHOWING PERTINENT FEATURES REQUIRED BY CHAPTER 1OD -6, FLORIDA ADMINISTRATIVE CODE.
PROPERTY INFORMATION [IF LOT IS NOT IN A RECORDED SUBDIVISION, ATTACH LEGAL DESCRIPTION OR DEED]
SUBDIVISION:
ACRES [Sqft /43560] PROPERTY WATER SUPPLY: [ ] PRIVATE [ ] PUBLIC
•
[ ] RESIDENTIAL [ ] COMMERCIAL
No. of
Bedrooms
DATE OF
SUBDIVISION:
[Section /Township /Range /Parcel No.] ZONING:
Building # Persons Business Activity
Area Sqft Served
PERMIT #
DATE PAID
FEE PAID $
RECEIPT #
TELEPHONE:
For Commercial Only
[ ] Garbage Grinders /Disposals [ ] Spas /Hot Tubs [ ] Floor /Equipment Drains
[ ] Ultra -low Volume Flush T?ilets ,e[\ ] Other (Specify)
DATE: /
C
_d
HRS-H Form 4015, Mar 92 (Obsoletes previous editions which may not be used) Page 1 of 3
(Stock Number: 5744-001- 4015 -1)
Check type of permit, if °Other specify type in blank.
7: :?roperty owner's full name.
Telephone number for rpplicant or r.gent.
Af..31. :Property owner's legally cut.horizned rept•nrenIctive.
ADal:F,SS: ?.C boa 07 atreet, city, state and zip seen - t - rtil.inn: c fo: ant or agent.
S
Lot, block, and subdivision To: lot (reco:ded or ara'acordcr: cavn). ie no: !_n. a s coy lot
lep,e! description or deed must be attached.
Official date of subdivision meorded. cot ?:a.t books (monfe/e.ay/yen) "a..: nr.
lot into two or more parcel the ryttaoce coaveyi... ot7!nnzahip cball
21 character 7LIM.b07 0 mry .- p?:Tr.'' ntrabn7.
lv.nt - Asable area of pro2erty ir (rt fon:2:51 /...0 cunt-n cncItt of a:
o within nublic rig way D. r - CI L.. :g7
Zvcil bodies of wat.cT. C.:ontigaoun unn:ved ar . L‘ca.c; ar.d easern J.:fry abfl:ncton..
may be included in calculating lo: c
Check private or pub!lc.
712,01.):17C.7.! ADD:laSS Street address for property. 1: lots without En assigned at address, indicate street or roar cod locale in county.
Provide detailed instructicns to lot or r.tutch 00 area map thawing lot location.
EN:FOrtilfrATION: Check residential commarcial.
List type of establishment from fable Chapter !O:a-6, 7Af..."'. lF.unmples: •.7;f:/;) heme,
doctor's office.
Count . rooms clesil primarily or alncping and that,: 1. eapected to routinely nrovit: slaepirg r.ccommodationa for
occupyr.ts.
",fotr.i square footage of e0. gErage, crr?ol:, r c?en o; fully
screened patios or decks. '3Esccl ct cutzlrin ::toy of ct
Nurdter of persons residing,
assumed.
3USINI,Et'SS 7.or commercial EppHcctioit3 only. nambnr ernployaay., ....n.n,arnf!". by
ablc Chapter 1C 7AC.
each listed 'nature with mirr.1:: cr
clign.aiure of applicant or agent. Iatt:e application !,...tbm"ited to the
A 710n drawn lo cctle, bounr (:re! - dc7d,
onsite of
• LrcL : 4' '' ' : '
. , •
pnefl within ',I..;
:;.v• • •• • - ; • ."
Site Plan Submitted by:
STATE OF FLORIDA
DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES
APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PERMIT
Permit Application Number
•
-IRS-H Form 4015. Feb 35 (ObsoIetet, previous echtons which may not be used)
'Stock Number: 5744-002-4015-6)
PART II - SITE PLAN
,71
Notes: 4
Plan Approved Not Approved
13y
SIGNATURE TITLE
ALL CHANGES MUST BE APPROVED BY THE COUNTY PUBLIC HEALTH UNIT
Date " ' 1 V
County Public: Unit
Page 2 of 3 •
LOT:
PROPERTY ID #:
- ;''4( t
BLOCK:
TO BE COMPLETED BY ENGINEER, HEALTH UNIT EMPLOYEE, OR OTHER QUALIFIED PERSON. ENGINEER'S MUST
PROVIDE REGISTRATION NUMBER AND SIGN AND SEAL EACH PAGE OF SUBMITTAL. COMPLETE ALL ITEMS.
PROPERTY SIZE CONFORMS TO SITE PLAN:
TOTAL ESTIMATED SEWAGE FLOW:
SEWAGE FLOW:
UNOBSTRUCTED AREA AVAILABLE:
BENCHMARK /REFERENCE POINT LOCATION:
ELEVATION OF PROPOSED SYSTEM SITE IS .;_ [INCHES /FT] [ABOVE /BELOWBENCHMARK /REFERENCE POINT
THE MINIMUM SETBACK WHICH CAN BE MAINTAINED FROM THE PROPOSED SYSTEM TO THE FOLLOWING FEATURES:
SURFACE WATER: FT DITCHES /SWALES: FT NORMALLY WET? [ ] YES [,] NO
WELLS: PUBLIC: FT LIMITED USE: FT PRIVATE: FT NON — POTABLE: FT
BUILDING FOUNDATIONS: 1 FT PROPERTY LINES: __ _ FT POTABLE WATER LINES: FT
SITE SUBJECT TO FREQUENT FLOODING: [ ] YES [1 10 YEAR FLOODING? [ ] YES [ j NO
10 YEAR FLOOD ELEVATION FOR SITE: FT MSL/NGVD SITE ELEVATION: FT MSL /NGVD
SOIL PROFILE INFORMATION SITE 1
STATE OF FLORIDA
DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES
ONSITE SEWAGE DISPOSAL SYSTEM
SITE EVALUATION AND SYSTEM SPECIFICATIONS
SUBDIVISION:
Munsell # /Color Texture
USDA SOIL SERIES:
Depth
to
to
to
to
to
to
to
t o
AGENT:
PERMIT #
[Section /Township /Range /Parcel No. or Tax ID Number]
[ ;J' YES [ ] NO NET USABLE AREA AVAILABLE: r,, ACRES
GALLONS PER DAY [RESIDENCES —TABLE 1 / OTHER —TABLE 2]
GALLONS PER DAY [1500 GPD /ACRE OR 2500 GPD /ACRE]
SQFT UNOBSTRUCTED AREA REQUIRED: SQFT
SOIL PROFILE INFORMATION SITE 2
Munsell #jColor
USDA SOIL SERIES:
Texture
Depth
to
to
to
to
to
to
to
to
to
OBSERVED WATER TABLE: '; INCHES [ABOVE / BELOW] \EXISTING GRADE. TYPE: [PERCHED / APPARENT]
ESTIMATED WET SEASON WATER TABLE ELEVATION: INCHES [ ABOVE / BELOW j EXISTING GRADE.
HIGH WATER TABLE VEGETATION: [ ] YES [ JYNO MOTTLING: [ ] YES [ j -NO DEPTH: _ INCHES
SOIL TEXTURE /LOADING RATE FOR SYSTEM SIZING:
DRAINFIELD CONFIGURATION: [ ] TRENCH [ 4 BED
REMARKS /ADDITIQy1[iAL CRITERIA:
HRS -H Form 4015, Mar 92 (Obsoletes previous editiofs which may rot be used)
(Stock Number: 5744 - 003 - 4015 -1)
SITE EVALUATED BY:
DEPTH OF EXCAVATION: INCHES
] OTHER (SPECIFY)
DATE:
Page 3 of 3
INSTRUCTIONS:
PERMIT 11: Permit tracking number assigned by CPHU.
APPLICANT: Property owner's full name.
AGENT: Property owner's legally authorized reprecentative.
LOT, BLOCK, SUBDIVISION: Lot, block, and subdivision for lot.
PROPERTY ID#: 27 character number for property. (property appraiser ID 0 or section/township /range /parcel number)
PROPERTY SIZE: Check if property size at site conforms to submitted site plan. Record net, usable area available - lot area exclusive of
all paved areas and prepared road beds within public rights -of -way or easements and exclusive of atreama, lakes,
normally wet drainage ditches, marshes, or other such bodies of water.
SEWAGE FLOW:
UNOBSTRUCTED AREA:
Record the estimated sewage flow for the establishment from Table 1 (residences) or Table 2 (non - residential), Chapter
101) -6, FAC. Record the authorized sewage flow for the to based on net usable area and water supply (1500 gallons
per day per acre for private water supplies and 2500 gpd per acre for public water supplies). If authorized sewage flow
does not equal or exceed the estimated sewage flow, the application must be denied.
Record the square feet of unobstructed area available and the amount required. Unobstructed area must be of least 2
times as large as the drainfield absorption area and at least 75 percent of the unobstructed area must meet minimum
setbacks in Chapter 10D -6, FAC. The unobstructed area must be contiguous to the drainfield.
BENCHMARK INFORMATION: Record the location of the benchmark. If using a surveyor's benchmark record the actual elevation. Record the
elevation of the proposed system site in relation (above or below) to the benchmark.
MINIMUM SETBACKS:
Record minimum setbacks which can be meet to all listed features. Actual measurements must be recorded or 'NA"
for non applicable features. Features on site plan or within 75 feet of the applicant lot must be measured. The location
of any public drinking well within 200 feet of the applicant's lot must also be verified.
FLOOD INFORMATION: Record information on lot's subject to flooding. For lots subject to flooding record 10 year flood elevation for site and
actual site elevation.
SOIL PROFILE INFORMATION: Two soil profiles within the proposed absorption area to a minimum depth of 6 feet or refusal are required. Soil
identification will use USDA Soil Classification methodology (Munsell colors and IISDA soil textured). Refusals must
be clearly documented. Provide USDA soil series if available, record "UNK" if the series cannot be determined.
WATER TABLE: Record the depth of the observed water table at the time of the evaluation. Mark "perched" or "apparent" as
appropriate. Record the estimated wet season water table elevation based on site evaluation, USDA soil maps, and
historical information. Indicate if there is high water table vegetation present. Indicate if mottling is present and depth.
SOIL TEXTURE: Record soil texture or loading rate for system sizing.
DEPTH OF EXCAVATION: If applicable record depth of excavation required. Record "NA" if not applicable.
DRAINFIELD CONFIGURATION: Check drainfield confguiation required. If other, specify type.
ADDITIONAL CRITERIA: Record any additional remarks pertinent to site or installation. Ex. dosing required.
SITE EVALUATED BY: Signature of evaluator, title, and date of evaluation. Professional engineers must seal all documentation submitted.
ELEVATION WORKSHEET ELEVATION OF BENCHMARK / REFERENCE POINT IS:
BENCHMARK
[¢] SHOT:
H.I.
SITE 1
H.I.
[ -] SHOT
SITE 2
H.1.
[ -] SHOT
SITE 3
H.I.
[ -] SHOT
CONSTRUCTION PERMIT FOR:
[' + ] New System
V.-/) Repair
APPLICANT:
PROPERTY STREET ADDRESS:
LOT: r i d 00 BLOCK: SUBDIVISION:
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
T [r.pia ] [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 [ , t 1 7 : 7 0 ] SQUARE FEET PRIMARY DRAINFIELD SYSTEM
R [ ] SQUARE FEET SYSTEM
A TYPE SYSTEM: [' ] STANDARD VI] FILLED [" ) MOUND [ ]
I CONFIGURATION: [i., ] TRENCH [V:''] BED NJ]
N i
1-a
F LOCATION OF BENCHMARK: ' - > , , /.. y. c. /."'Q+`�� L-
I ELEVATION OF PROPOSED SYSTEM SITE [,. a'):]
E BOTTOM OF DRAINFIELD TO BE
L
D FILL REQUIRED: [ -r ] INCHES EXCAVATION REQUIRED: ['j ] INCHES
0
T
H
E
R
STATE OF FLORIDA
DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES
ONSITE SEWAGE DISPOSAL SYSTEM
CONSTRUCTION PERMIT
Authority: Chapter 381, FS & Chapter 10D -6, FAC
[ Existing System ] Holding Tank
[ !] Abandonment [iej Other(Specify)
AGENT:
[SECTION /TOWNSHIP /RANGE /PARCEL NUMBER]
[OR TAX ID NUMBER]
[INCHES /FT] [ABOVE /BELOW] BENCHMARK /REFERENCE POINT
[INCHES /FT] [ABOVE /BELOW] BENCHMARK /REFERENCE POINT
TITLE:
HRS -H Form 4016, Mar 92 (Obsoletes previous editions which may not be used)
(Stock Number: 5744 - 001 - 4016 -0)
PERMIT # , `?
DATE PAID / ",`
FEE PAID $ 1 { )
RECEIPT # j
] Temporary /Experimental
kit-7 4 a
SPECIFICATIONS BY:
APPROVED BY: TITLE: CPHU
DATE ISSUED:
i
EXPIRATION DATE:
4'1 f -)
Page 1 of 2
,_NS' ;.2UC fE0NS:
?i21v2 T NJMME'_3ER: Permit tracking number assigned by CP11U.
1-11 LICATEON FOR: Check type of permit, if "Other" specify type in blank.
Property owner's full name.
TELEPHONE: Telephone number for applicant or agent.
AGENT: Properiy owner's legally authorized representative.
MAILING A:OUZF �S: P.O. box or street niisilieg cdLress for applicant or agent.
3LOC:(., SU3DWV :.13ION
PROPERTY :D!/: 27 character id number for prDperty. (CPI -EU may require prope:2y appraiser /DC or. section /townshin/:r: ;ZSe /greet :!umber)
S`'ST117.b', DESIGN AND
5 0NS:
°ANK: Minimum specifications from Chapter I0D -6, FAC.
RAINiri�,;_D: Minimum specifications from Chapter 100 -6, FAC. .
OTHER: Other specifications, such as operating permit requirements, ion'- volume: flush toilets, variance provisos.
S ?ECIFICA t IONS 3Y: Name of individual providing, specifications. Lf designed by L registered engineer must be ceaie .
/ 3Y: County Public Health Unit (CPHU) personnel reviewing cnd approving permit.
i 7e3 - ASS UED: Date permit is issued by CP1-111.
'EXPIRATION DATE: One year from date issued if the system has not been installed. Permits for system repairs beccme void 90 days from the dete
issued.
Date 7-1 -/( Job Address 32.6 NE 97 S7 2
�' tzer Tax Folio
Legal Description Historically Designated: Yes No
Owner/Lessee / Tenant 3 ,25 /U 6 97 r
Owner's Address / he, /47 as et Pt in Tb
to A Mok-ric IruC_
Contracting Co.
Qualifier r, n a. ( d C . 6 ►'1 vl s ?iv)
)
Signature of owner and/or
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
ondo President
,mt yy j i f AL NOTARY SEAL'
2 ill 7 -- SANDRA IA MON'OEL
ic , ,, s:axae �s�I�N �du �w�ER
Q I:C4 Say
r /‘ (LS 111Y COMMIS,cICM .EXP
Date
FEES: PERMIT RADON C.C.F.
APPROVED:
Zoning
Mechanical Plumbing
Address
Master Pe► #
Phone
State # Municipal # /5 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 //1.4.5-7 A./e_ [.ej 'Dewi "" Pe a 300
Square Ft. Estimated Cost (value) / /6 Do L 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.
IDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable
onstruction and zonin:. emiore, I authorize the above -nam4 contractor to dp41 e work stated.
ature of Contrac y'or Owner- Builder
( ;
Notary as to ContractorQv et,- wilder
c ! `. C040'
a t (\
n ? �'
Building a t t Electrical
Engineering
3i/ :3
93s -
Date
Date
V NOTARY ) TOTAL DUE I '_ r`"