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42 NE 97 St (8)BUILDING ❑ MIAMI SHORES VILLAGE, FLORIDA Date � �� 19. ELECTRICAL ❑ PLUMBING ❑ PERMIT 1T? 8909 Contractor's o License No ROOFING ❑ ❑ Work to be performed under this Per;;(' s ' Owner of r= Building Architect Contractor or Builder -- Legal Lat 1 Description � Bl Address of Building 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) BY 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 accepting this permit I assume responsibility for all work done by either, myself, my agent, servant or employee. CONTRACTOR or BUILDER Subdi- vision Sq. Ft. Value of I I Amount of Project $ 11 Permit $ BY AUTHORITY IP EIIMIIT AIPPILI(CAII'II®N FOR MIAMI[ SHORES VIIILILAGIE Date Job Address 01 Ai Q� Folio Legal Description � Historically Designated: Yes No Y O w n e r / L e s s e e / Tenant ? t O " r Master Permit # 4 9 9 Owner's Address A C • 67e7 a et+ Phone Contracting Co. (II C A ' C C - 5 ._( 1 '% c Address 19.7 3 A c ? Qualifier r yog& ( C / ss# CT -c - h. C $ / — ? J 9 � l State # Municipal # Architect/Engineer Bonding Company Mortgagor Address Pere nit Type (curepe one): W®118X DESCRIPTION IL MIMING ELECTRICAL PLUM Square Ft. Estimated Cost (value) WARNING TO OWNER: YOU MUST RECORD A NOTICE OF COMMENCEMENT AND YOUR FAILURE TO DO SO MAY RESULT 1[N YOUR PAYING TWICE ]FOR EMPROVEMENTS TO YOUR PROPERTY (IF YOU IINTIENIID 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. OWNERS 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. Notary as to Owner and/or Condo President My Commission Expires: / FEES: PERMIT V RADON APPROVED: Zoning Mechanical IL Competency # Address Address IING, MIECIHIANIICAL ROOMING PASO FENCE SIION , Il i r Contractor or or Owner: , m/� . / s :Wider _ OFFI OR' YS CLADYS 3 V1LLAR NOTARY PUBLIC STATE OF FLORIDA COMMISSION NO. CC714103 MY COMMISSION EXP. MAR.1 /5 Signatur Building Plumbing • N;'' as to Contract.; My Commission Expir C.C.F. / Zv NOTARY Electrical Ins. Co. BOND 3 a TOTAL DUE )6 O � Date Structural Engineer STATE OF FLORIDA ,p TMENT OF HEALTH APPLICATION gOieONSITESEWAGE DISPOSAL SYSTEM CONSTRUCTION PE IT Permit Application Number ( ', b AI A 7' v t7 1 mws Scale: Each block represents 10 feet and 1 inch = 40 feet. N Not Approved ALL CHANGES MUST BE APPROVED EASY THE COMITY 1IEALTIH D PARTHL (iv1T 01-14015, 10/96 (Replaces HRS -H Form 4015 which may be used) (Stock Number: 5744 -0024015 -6) Site Plan submittedfby - --- Plan Approved By PART II - SITEPLAN qi Date 4 County Healt epartment Page 2 of 4 CONSTRUCTION PERMIT FOR: (M) New System '" ] Repair APPLICANT: PROPERTY STREET ADDRESS: LOT: 7 BLOCK: PROPERTY ID #: SYSTEM DESIGN AND SPECIFICATIONS T A D R A X E L D 0 T [ p n ] SQUARE [ ] SQUARE TYPE SYSTEM: CONFIGURATION: FILL REQUIRED: [ &✓f %INCHES SPECI FICATIO7ff ---Bff : APPROVED BY: DATE ISSUED: STATE OF FLORIDA PERMIT {} 6.71 - ' DEPARTMENT OF HEALTH O U DATE PAID 6- g_5. nn ONSITE SEWAGE DISPOSAL SYS FEE PAID $ _ n CONSTRUCTION PERMIT RECEIPT . pl n 2, P S n'S Authority: Chapter 381, FS E Chapter 10D -6, FAC w [�I Existing System 141 Holding Tan Abandonment (] Other(Specify) SUBDIVISION: FEET PRIMARY DRAINFIELD SYSTEM FEET SYSTEM LOCATION OF BENCHMARK: F44 D Fr ,0/ ll fi' ) (A.. n Ir ELEVATION OF PROPOSED SYSTEM SITE [4 ] (INCHES /1 BOTTOM OF DRAINFIELD TO BE [ 6 , g ] [ S /FT] 0N— e c i7 ' (f ) STANDARD [4 FILLED (e_01 TRENCH (' ) BED /, e) AGENT: [ 6O] WOUND [ABOVE /B [ABOVE/ Tempo rh rcj/ E$p`e r mental (SECTION /TOWNSHIP /RANGE/:PARCEL NUMBE orb �� O p,' e [OR TAX ID NUMBER] r . EXCAVATION REQUIRED: (j36 ] INCHES O DC �O(�C OC MpED °!CAD ,4] SCIUD l DH 4078, (Replaces RS -H Form 4016 (page 11 which may be usod) ` ` (Stock Numbor: bor: 57444 - 00101 - 4016 -0) \ pplicant OCR 1UUL ©UTLEY YEE \ —' � 1 V i 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. DEPARTMENT OF HEALTH 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. [GALLONS / GPD) S PTIC T K /AEROBIC UNIT CAPACITY MULTI - CHAMBERED /IM SERIES:( ] [GALLONS / GPD) CAPACITY MULTI'- CHAMBERED /IN SERIES:( 1 GALLONS GREASE INTERCEPTOR CAPACITY [MAXIMUM CAPACITY SINGLE TANK: 1250 GALLONS] GALLONS PER DOSE DOSING TANK CAPACITY DOSE•RATE.[ ] PER 14 HRS NO. OF PUMPS: LNA : 4 •i c . OWO BENCHMARK /REFERENCE POINT B L0 J BENCHMARK /REFERENCE POINT CM 1 Og fLOa W "MM E' i i n: o St. f; m ^ A LO �cC15�fA " �7��( l/�1�[E $ �p E5 o n � .D pyflf�td'n[`I'7Ea/i(B �GJ `/ rl A�I1G'v�1VEM OF lG lbH'.1V O ��FJL�1 k1.7 lSL\ niruc L TITLE FOB[ D /MORROW EaB OGJ E. s TtU"°t.CGsO I TXTLE: i1� . s 7 2 * ‘ EXPXRa2Ium f DATES 1. 1 CHD Page "1 of 2 INSTRUCTIONS: PERMIT NUMBER: Permit tracking number by County Health Department. 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 number for property. (Health Department may require property appraiser ID# or section /township /range /parcel number.) SYSTEM DESIGN AND SPECIFICATIONS: TANK: Minimum specifications from Chapter IOD -6, FAC. DRAINFIELD: Minimum specifications 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 Health Department personnel reviewing and approving permit. DATE ISSUED: Date permit is issued by County Health Department. t} w 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.