330 NE 97 St (7)r
Date r 01 1 T Job Address
Owner / Lessee / Tenant
State #
Signature of owner and /or
Date:
60.E
Notary as to Owner an
My Commission Expires
** * * *
APPROVED:
Zoning
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Legal Description
Owner ° s Address 330 NJ 9 S T
Contracting Co. C- 0QO Q0047._2
Qualifier McAnrill Mt.) e
Condo President
t - ro 1 S
or Condo Pres ident
�paY P(/ OFFICIAL NOTARY SEAL
�,<i . BARBARA ANN FUOAZZI
l�S * COMMISSION NUMBER
Q * CC36Qi91
Of FA PAY 291998
8 P.
FEES: PERMIT 30. RADON C.C.P.
Mechanical Plumbin
, 6 T7/ Tax Folio
SS# Phone
Municipal # Competency # Ins.Co.
Buildin
*
0
*
NOTARY
* *
Fire
Master Permit # / �y
Phone
Address .oO ZZ S A4 WilyniK
o-j-3
Architect /Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type(circle one): BUILDING ELECTRICAL sIGIBIZ MECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIPTION - 1 - .)(2-4- t-W\ 9- `c,X4A ■
Square Ft. Estimated Cost(value) / 5 0 0 ' c 7 - 0
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,g-named contractor to do the work; d.
Si_ ature of Contractor or Owner - Builder
Date.
7 74/
Nota as to Contractor or Owner-RuiLder
My mmission Expires.1.
zit Raida at t
MY Ou!nn E t* ;
tuber e '
* * *
TOTAL DUE
0
Other
Electrical
Engineering
AP?L I CANT :
LOT:
PROPERTY ID #:
T
A
N
K [
0
T
H
E
R
SPECIFICATIONS BY:
APPROVED BY:
DATE ISSUED:
STATE OF FLORIDA
DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES
ONSITE SEWAGE DISPOSAL SYSTEM
CONSTRUCTION PERMIT
Authority: Chapter 381, FS & Chapter 1OD -6, FAC
CCNSTRUCTION PERMIT FOR:
[ : New System [,J.] Existing System [; ] Holding Tank ] Temporary /Experimental
[ I Repair [. ] Abandonment C, Other(Specify)
PROPERTY STREET ADDRESS:
BLOCK: SUBDIVISION:
SYSTEM DESIGN AND SPECIFICATIONS
[SECTION /TOWNSHIP /RANGE /PARCEL NUMBER]
[OR TAX ID NUMBER]
SYSTEM MUST BE CONSTRUCTED IN ACCORDANCE WITH SPECIFICATIONS AND STANDARDS OF CHAPTER 1OD -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. SUC
MODIFICATIONS MAY RESULT IN THIS PERMIT BEING MADE NULL AND VOID.
] ?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
I CONFIGURATION: [ ] TRENCH
N
F LOCATION OF BENCHMARK:
a ELEVATION OF PROPOSED SYSTEM
E 3OTTOM OF DRAINFIELD TO BE [
L
D FILL REQUIRED: [ ] INCHES
[
[
]
]
AGENT:
FILLED
BED
HRS -H Form 4016, Mar 92 (Obsoletes previous editions which may not be used)
(Stock Number: 5744- 001- 4016-0)
[ ] MOUND [
[
SITE [ ] [INCHES /FT] [ABOVE /BELOW] BENCHMARK /REFERENCE POINT
] [INCHES /FT] [ABOVE /BELOW] BENCHMARK /REFERENCE POINT
EXCAVATION REQUIRED: [ ] INCHES
TITLE:
PERMIT #
DATE PAID
FEE PAID $
RECEIPT #
TITLE: CPHU
EXPIRATION DATE:
Page 1 of 2
LNSTRUC'C'IONS:
: ?: 'V2 N 1ic:.B:' : ?ern trrc cinG is _r:.be_• cosigned. uy
yeti ' , i'' `Ot.` specify type in blcr.S.
opzrty cwnz.., __._ acme.
...._E'_':;:Oiz' =: rueiJC_ for rnpliccn: o. cgen:.
IV:A:.:.ING box or street ri iling c.dress for cnpliccnt o- agent.
,.O?', 13I.0CIL, SUBDIVISION or
?2Q ?E TY ;;DC: 27 charcater id nur_ be: for property. (C?: a racy require p:cpet.y cpo_Ur : f !i o- Section /towns'+_io/rcrtge /pereel number)
SYSTEM DESIGN AND
SPECIFICATIONS:
A11t t: Minimum specifications from Chanter I0D-6, PAC.
:7aAINFUELD: Minimum specifications from Citcpte_ IOD-6, I=AC.
Cr ER: Other specifications, such cs operating permit recluirements, /ow- volume f`us_h'.oileta, vc icnce crovicos.
SPECIFICATIONS BY: Name of individual providing specifications. If designed by c registered enginaer must be c:clec
APPROVED BY: County Public Health Unit (CPHU) personnel reviewing cnd approving permit.
DATE ISSUED: Date permit is issued by CPHU.
EXPIRATION DATE: One year from date issued if the system Iles not been instclled. Permits for system repcirs ::_coma void 90 clays from the date
issued.
STATE OF FLORIDA
DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES
APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PERMIT
Permit Application Number
Scale: Each block represents 5 feet and 1 inch = 50 feet.
Site Plan submitted by:
PART II - SITE PLAN
�s.
HRS -H Form 4015, Feb 85 (Obsoletes previous editions which may not be used)
(Stock NLmber. 5744-002-4015-6)
SIGNATURE
C
Notes: * ,
j _.
ALL CHANGES MUST BE APPROVED BY THE COUNTY PUBLIC HEALTH UNIT
TITLE
Plan Approved Not Approved �_.. Date
By
County Public Unit
Page 2 of 3
BUILDING
ELECTRICAL
PLUMBING
ROOFING
MIAMI SHORES VILLAGE, FLORIDA
PERMIT
Owner of
Building
Architect
Contractor
or Builder
Legal Lot
Description
B1
N9 6303
Work to be performed under this Permit
DATE 1 • 19__—
Contractor's
License No.
Subdi-
vision
Address of Value of I! Amount cf ,..,, --
Building Project $— 1! 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 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 compliance with all ordinthieee -sad regulations
pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In ao•
cepting this permit I assume responsibility for all work done by either, myself, my agent, servant or employee.
CONTRACTOR OR BUILDER BY
AUTHORITY
.1YROT