383 NE 96 St (11)Date [2118 1 Job Address
Contracting Co.
Qualifier TEQ A FEC PEQ
Square Ft. 30
);(11,dAial
to Owner an
nunission Expire
FEES: PERMIT
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
383 N e- G IGO STQEeeirFolio 1 1 -3206 - 0i3 - 5gao
Legal Description Historically Designated: Yes No
Owner/ Lessee / Tenant CO R o e L I u SS � Nl Master Permit # ' -e-') 5T
Owner's Address 383 we q 6 cS- 'r ' Phone /59-2085
iUDR77 8� 77C- Address kV q) ///7
ss# 4:30S- 75 r 7(r7?
State ._ _' 025 n& Municipal # Competenc # W Ins. Co. es/Fir4 L-01
Architect/Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type (circle one): BUILDING ELECTRICAL ' LUMBIN'r MECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIPTION 1 S( PNLI,- D INF(
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.
CWNER'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.
t ul�I'li cl 6 ewJ4
/2_/57
Signature of owner and/or Con, o President Date
sident Date
Plumbing
iKSMVAVASiiO`tRttSSctliWStStWAVICRM •
P6.6, Teresa J. Felder
'' r� Notary Pubiic, of Florida
�d Commission No. CC 480807
of r%.° My Commission Expires 07/16/99 •
eeeeeeeetteeeeeteeeee eetweet eereef a Ctal a
RADON C.C.F.
Estimated Cost (value) 44
Notary as to C
My Commission Expires:
�- NOTARY
APPROVED:
Zoning Building Electrical
Mechanical
boo. 00
LESTER E. CROCKETT
My Con,m Exp. 5/20/2001
Bonded By Service Ins
No. CC649326
11 Personally Known 11 Other 1.0
Date
Engineering
APPLICANT:
STATE OF FLORIDA
DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES
ONSITE SEWAGE DISPOSAL SYSTEM
CONSTRUCTION PERMIT
Authority: Chapter 381, FS & Chapter 100-6, FAC
CONSTRUCTION PERMIT FOR:
f ] New System [ ) Existing System 1 Holding Tank 1 Temporary/Experimental
) Repair ( Abandonment ] Other(Specify)
PROPERTY STREET ADDRESS:
LOT: BLOCK:
,
)„,
SUBDIVISION:
PROPERTY ID #: [SECTION/TOWNSRIP/RANGE/PAROEL NUMBER]
j /
SYSTEM MUST BE CONSTRUCTED IN ACCORDANCE WITH SPECIFICATIONS AND STANDARDS OF CHAPTER 1CD-6, FAC
REPAIR PERMITS AND HOLDING TANK PERMITS EXPIRE 90 DAYS FRO :aF, DATE OF :SSUE. ALL OTHER PERM:TS
EXPIRE ONE YEAR FROM THE DATE OF ISSUE. HRS APPROVAL OF SYK2EM DOES NOT C',UARANTEE SATISFACTORY
PERFORMANCE FOR ANY SPECIFIC PERIOD OF TIME. ANY CHANGE N ATERIAL FAC:; WHICH SERVED AS A
BASIS FOR ISSUANCE OF THIS PERMIT, REQUIRE THE APPLICANT .7_C MODIFY THE PERMIT APPLICATION. SUCH
MODIFICATIONS MAY RESULT IN THIS PERMIT BEING MADE NULL AD VCD,
SYSTEM DESIGN AND SPECIFICATIONS
T ' ](GALLONS J GPD1 SEPTIC TANK/AEROBIC UNIT CAPAC:TY MULTI-C SERIES:[ ]
A : ] [GALLONS / GPD] CAPACITY MULTI-C SERIES:[ 1
GALLONS GREASE INTERCEPTOR CAPACITY [MAXIMO'S CAPACITY SIMILE TANK: 1250 GALLONS]
X : ] GALLONS PER DOSE DOSING TANK CAPACITY DOSE RATE : ] PER 24 LRS NO. OF PUMPS: [ ]
D 1 SQUARE FEET PRIMARY DRAINFIELD SYSTEM
R SQUARE FEET SYSTEM
A TYPE SYSTEM: [ ] STANDARD [ ] FILLED f MOUND
1 CONFIGURATION: [ ] TRENCH ] BED
7 LOCATION OF BENCHMARK; '
ELEVATION OF PRO?OSED SYSTEM SITE [ 2 1 [INCHES/FT]
E BOTTOM OF DRAINFIELD TO BE [ ,/ J [INCHES/FT]
L
D FILL REQUIRED: [ ] INCHES
0
T
SPECIFICATIONS BY:
APPROVED BY:
DATE ISSUED;
AGENT:
3
MRS-H Form 4016, Mar 92 (Obsoletes previous editions which may not be used)
(Stock Number: 5744-001-4016-0)
[OR TAX ID NUMBER]
EXCAVATION REQUIRED: [ ] INCHES
TITLE:
TITLE: CPHU
[A3OVE/BELOW)
[ABOVE/BELOW]
PERM = #
DATE PAID
FEE 1 $
RECE1 #
BENC,MARK/REFERENCE POINT
BENCEMARK/REFERENCE POINT
EXPIRATION DATE:,,
Page 1 of 2
APPLICANT:
LOT
PRC?ERTY ID #:
20:; i= QTY SIZE CONFORMS
, ESTIMATED SEWAGE
BRXZED SEWAGE LOW:
STRUCT..1.3 AREA AVAILABLE:
1 /R.EFERENCE POINT LOCATION:
SUld.;'ACE WATER: . FT
PUBL,C: FT
BU=NG 'O ;XDATIONS
PROFILE : NFORMATION SITE 1
M ;easell # /Ca Lor
TJS: A SOIL SERIES: \`-
EVALUATED BY:
STATE OF FLORIDA
DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES
ONSITE SEWAGE DISPOSAL SYSTEM
SITE EVALUATIOIJ AND SYSTEM SPECIFICATIONS
BLOCK:
UV • `d
Texture
HRS-:7 Form 4015, afar 9a, (Obsoletes
(Stock Number: 5744 -0 - 4fl15"-1)
ii .tea
SUBDIVISION:
TD COMPLETED BY ENGINEER, HEALTH UNIT
m'3:3'XDE REGISTRATION NUMBER AND SIGN AND
[ S ion / hip /Range /Parpe1 No or , Tax ID Number
TO SITE PLAN: [ ] YES Q
FLOW: l ;) GALLONS
GALLONS
SQFT
PROPOSED SYSTEM SITE IS : s,
DITCHES /SWALES:
Depth
to'
to
to
to
to
to
to
to
to
$3':, TEXTURE/LOADING RATE FOR SYSTEM SIZING:
DRAINFIELD CONFIGURATION: [ ] TRENCH [ ] BED
I- rIVARKS /ADDS' ZONAL CRITERIA:
y � �� AGENT:
EMPLOYEE, OR OTHER QUALIFIED PERSON. ENGINEER'S MUST
SEAL EACH PAGE OF SUBMITTAL. COMPLETE ALL ITEMS.
NO NET USABLE AREA AVAILABLE ACRES
PER DAY [RESIDENCES-TABLE 1 / OTHER -TABLE 2'
PER DAY [150J GPD /?:RE OR 2500 GPD /ACRES
UNOBSTRUCTED AREA REQUIRED: SQFT
PERMIT 1
[INCHES/FT] [ABOVE/1ELOWI BENCHMARX /REFERENCE POINT
=tIMun SETLACI KHICH CAN BE MAINTAINED FROM THE PROPOSED SYE> ,EM `':O T FOL�,:UWING FEATURES:
FT NORMALLY WET? I ] YES [ NO
LIMITED USE: n, FT PRIVATE: FT NON-POTABLE: FT
PROPERTY LINES: FT POTABLE WATER LINES: FT
10 YEAR FLOODING? [ ] YES [_ ] NO
5I1 SUBJECT 20 FREQUENT FLOODING: [ ] YES [A NO
10 ?EAR FLOOD ELEVATION FOR SITE: 5 FT I4SL /NGVD SITE ELEVATION: FTyMSL /NGVO
SOIL PROFILE INFORMATION SITE 2
Munsell # /Color Texture
USDA SOIL SERIES:
Depth
to
to
to
to
to
to
to
to
to
3E .=:RVED WATER TABLE: INCHES [ABOVE / BE ±OW]EXISTING GRADE. TYPE: [PERCHED / APPARENT]
FMS °°MATED WET SEASON WATER TABLE ELEVATION: !' INCHES I ABOVE / BELOW ] EXISTING GRADE.
BIC' ] ; WATER TABLE VEGETATION: [ ] YES [ ,�1 NO MOTTLING: [ ] YES [ NO DEPTH: ice. INCHES
[
previous editi;uns which may not be used)
DEPTH OF EXCAVATION:
] OTHER SPECIFY)
DATE:
INCHES
Page 3 of 3
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KNEW
STATE OF FLORIDA
DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES
APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PERMIT
Notes: -
Site Plan submitted by:
Plan Approved
ALL CHANGES MUST BE APPROVED BY THE COUNTY PUBLIC HEALTH UNIT
HRS -H Form 4015, Feb 85 (Obsoletes previous editions which may not be used)
(Stock Number. 5744- 002 - 4015-6)
PART 1I SITE PLAN
SIGNATURE
Permit Application Number
Not Approved
TITLE
Date
County County Public Unit
Page 2 of 3
MIAMI SHORES VILLAGE, FLA.
JOB
ADDRESS
INSPECTION
TIME READY
REMARKS :
N9 5945
L s'
INSPECTOR 1 DATE
Permit
Size Septic Tank.
Feet of Drain Tile.
Nature of Water upply: City —Well.
STATE OF FLORIDA, I
COUNTY OF DADE.
Amount of Permit $
G it M! SHORES VILLA S
PLUMBING INSPECTION DEPARTMENT
apnoc . TOON FOR PLUMBBNG PER IT
(Sign
Date.
Application is hereby made for the approval of the detailed statement of the plans and specifications herewith su •v itted for the building or other
structure herein described. This application is made in compliance and conformity with the Building Ordinance o 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 at
building during progress of w )
Ownez's Name and AddreetZAZ_i_i_
----r••//c
� �L/ ' / 6
No. - - -- _ '-- _____ -- Street _ Employing Plumber's
Registered Architect and/ Engineer _______
Location and Legal Descripti Lod_-- _-------- -_ --�-
Street and Numb where work is to be performed —No
State work to be performed and purpose of building (By Floors) - _---- ---_ --
Nv Building________----- _________ Remodeling - -_ . -- Addition - .
Repairs
No. of Stories
Type of Tank Capacity Gals
__Dist. Feet of Tank or Drain Field from Well
--- ---- ---_ -_ - -- - Size of Soakage Pit
bing ]Inspector.
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 5988, Compiled General Laws of Florida Permanent Supplement, and has 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, work to be performed under this permit, as are
Licensed by Miami Shares Village.
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.
My Commission Expires Notary Public, State of Florida
Mester Plumber.
NOTE: A re- inspection fee of $1.0 will be made when such re- inspection is made•necessary by improper notice for inspection, or faulty
matsaials and /ca workmanship.
CLOOCITD
BATH
TUeB
SH WERO
LAVA.
TORIES
SINKS
SLOP
SINKS
LAUNDRY
TU88
U RINALS
CATCH
BASIN
FLOOR
DRAIN
DRINK NG
FOUNT' NS
TOTAL
FIXTURES
COIN=.
LIST
Ct• t ct
SEPTIC
YANK
SLOWER
CONN.
DRAIN
FIELD
SOAKAGE
PIT
GREASE
TRAP
SOLAR
HEATER
DEEP
WELL
SPRKLR.
SYSTEM
SW IM•G
POOL.
LIDS
CHEcit
Permit
Size Septic Tank.
Feet of Drain Tile.
Nature of Water upply: City —Well.
STATE OF FLORIDA, I
COUNTY OF DADE.
Amount of Permit $
G it M! SHORES VILLA S
PLUMBING INSPECTION DEPARTMENT
apnoc . TOON FOR PLUMBBNG PER IT
(Sign
Date.
Application is hereby made for the approval of the detailed statement of the plans and specifications herewith su •v itted for the building or other
structure herein described. This application is made in compliance and conformity with the Building Ordinance o 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 at
building during progress of w )
Ownez's Name and AddreetZAZ_i_i_
----r••//c
� �L/ ' / 6
No. - - -- _ '-- _____ -- Street _ Employing Plumber's
Registered Architect and/ Engineer _______
Location and Legal Descripti Lod_-- _-------- -_ --�-
Street and Numb where work is to be performed —No
State work to be performed and purpose of building (By Floors) - _---- ---_ --
Nv Building________----- _________ Remodeling - -_ . -- Addition - .
Repairs
No. of Stories
Type of Tank Capacity Gals
__Dist. Feet of Tank or Drain Field from Well
--- ---- ---_ -_ - -- - Size of Soakage Pit
bing ]Inspector.
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 5988, Compiled General Laws of Florida Permanent Supplement, and has 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, work to be performed under this permit, as are
Licensed by Miami Shares Village.
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.
My Commission Expires Notary Public, State of Florida
Mester Plumber.
NOTE: A re- inspection fee of $1.0 will be made when such re- inspection is made•necessary by improper notice for inspection, or faulty
matsaials and /ca workmanship.