445 NE 96 St (4)BUILDING
ELECTRICAL
PLUMBING
ROOFING
Owner of
Building
Architect
Contractor
or Builder
PERMIT
f
F•
Legal Lot
Description
Address of ,� Value of 1 Amount of
Building 4 `' 1 ' = 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 ytith 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 ac-
cepting this permit I assume responsibility for ell work done by either, myself, my agent, servant or employee.
MIAMI SHORES VILLAGE, FLORIDA
N9 5280
Work to be performed under this Permit
DATE. 19
Contractor's ,
License No.
Subdi-
vision
BY AUTHORITY
ABBOT ••E' °'
F '
Permit No.___
Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the building or other
structure herein described. This application is made in compliance and conformity with the Building Ordinance of 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 work.
Owner's Name and Address
Registered Architect and /or Engineer___ —_ Employing Plumber's Name_.i_i''?.1f,jR
�`/ 4 C/t1r✓<No._
Location and Legal Description Lot B1
Street and Number where work is to be performed —No ��
State work to be performed and purpose of building (By Floors)_____RC_k �_`L__
�
New Building ___ Remodeling —___._ _.__ Addition___________________ Repairs Le."'"
No. of Stories
Size Septic Tank _____T_ -_- _- -_�_ _______ ______Type of Tank__
___
Feet of Drain Tile ______ _______Dist. Feet of Tank or Drain Field from Well
Nature of Water Supply: City— Well._—____ _ _ __ ��_ _____Size of Soakage Pit
The undersigned applicant for this building permit does hereby certify that he understands and accepts his obli
under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Penman
plied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors e
performed under this permit; and will post or cause to be posted' for inspection on the si : . e work
required by tlie Act. The undersigned agrees to employ only such sub- contractors, i n work to be
licensed by Miami Shores Village.
STATE OF FLORIDA, 1
COUNTY OF DADE. j
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
No.
4 4 6— Street. F 9
Date --- . 16. j
Street.__! 1.
Subdivision..._.
�G �,� -_
1 � Street � .
x.�dt�_�.,At. 1e .t 5 ` L5LocK
Capacity Gals.
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
Plumbing Inspector.
ns as an employer of labor
pplement, and has corn-
y him in the work to be
notice or notices as are
under this permit, as are
NOTE: A re- inspection fee of 81.00 will be made when such re- inspection is made necessary by improper notice for inspection, or faulty
materials and/or workmanship.
CLOSETS
BATH
TUBS
SHOWERS
LAVA.
TORIES
INKS
SINKS
SLOP
SINKS
LAUNDRY
TUBE
URINALS
CATCH
BASIN
FLOOR
DRAIN
DRINKING
FOUNT'NS
TOTAL
FIXTURES
CONTR.
LIST
CHECK
SEPTIC
TANK
SEWER
CONN.
DRAIN
FIELD
. SOAKAGE
PIT
GREASE
TRAP
SOLAR
HEATER
DEEP
WELL
SPRKLR.
SYSTEM
SWIM'G
POOL
CONTR.
LIST
CHECK
F '
Permit No.___
Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the building or other
structure herein described. This application is made in compliance and conformity with the Building Ordinance of 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 work.
Owner's Name and Address
Registered Architect and /or Engineer___ —_ Employing Plumber's Name_.i_i''?.1f,jR
�`/ 4 C/t1r✓<No._
Location and Legal Description Lot B1
Street and Number where work is to be performed —No ��
State work to be performed and purpose of building (By Floors)_____RC_k �_`L__
�
New Building ___ Remodeling —___._ _.__ Addition___________________ Repairs Le."'"
No. of Stories
Size Septic Tank _____T_ -_- _- -_�_ _______ ______Type of Tank__
___
Feet of Drain Tile ______ _______Dist. Feet of Tank or Drain Field from Well
Nature of Water Supply: City— Well._—____ _ _ __ ��_ _____Size of Soakage Pit
The undersigned applicant for this building permit does hereby certify that he understands and accepts his obli
under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Penman
plied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors e
performed under this permit; and will post or cause to be posted' for inspection on the si : . e work
required by tlie Act. The undersigned agrees to employ only such sub- contractors, i n work to be
licensed by Miami Shores Village.
STATE OF FLORIDA, 1
COUNTY OF DADE. j
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
No.
4 4 6— Street. F 9
Date --- . 16. j
Street.__! 1.
Subdivision..._.
�G �,� -_
1 � Street � .
x.�dt�_�.,At. 1e .t 5 ` L5LocK
Capacity Gals.
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
Plumbing Inspector.
ns as an employer of labor
pplement, and has corn-
y him in the work to be
notice or notices as are
under this permit, as are
NOTE: A re- inspection fee of 81.00 will be made when such re- inspection is made necessary by improper notice for inspection, or faulty
materials and/or workmanship.
114
.,
1 /6P.i.zwerm - •
Date 3 / -1`4 Job Address
Legal Description
Owner/Lessee / Tenant J o t -
Owner's Address
Contracting Co.
Qualifier
State #
Architect/Engineer
Bonding Company
Mortgagor
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
(4- s ,.rte 96 c Q„
4 //�� tt —
!} er .1 S (10(— I rvG [ 4 _,
hob-
N 1/4
�ff
Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIPTION
Square Ft. Lf- Off.
\ce y
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-names con, ac ',Ito do the work stated.
SignAkg Date
� " fo "�> SACCv'"
�; �' °Slott of lot u %
,Kj, J:;: t ti `..1 C . -; Err C! ) »it;o . 7 _ 3 / -, G
•
Notar ;4s' 4(gr, Yor}doe,Wde rt Date
My Commission Expires: �) 54� 61.A.,
/ob. 0
FEES: PERMIT 70. OE) RADON
APPROVED:
Zoning Building
Mechanical Plumbing
Tax Folio
Historically Designated: Yes
SS#
Municipal # Competency # Ins. Co.
Address
Address
Address
Address
Estimated Cost (value) / S O O
Master Permit #
Ay/4-
4/1/4-
Electrical
No
void
Phone '7J ) .2_11(
C4 2 S 35 r T f44!'rQ �.. a •-
Phone C / 4 / 4 / -
of Contractor or Owner - Builder Date
Notary as to Contractor or Owner- Builder' Date
My Commissioi 12 pes: ` " `
C.C.F. /. O c' NOTARY TOTAL DUE / 7/. O 0
Engineering
CONSTRUCTION PERMIT F9R:
[/V] New System [�/ Existing System [ 01ding Tank
[ ] Repair [1] Abandonment [Other(Specify)
APPLICANT:
Te • d e. AGENT: t 4 41 , G s .
PROPERTY STREET ADDRESS:
LOT: / 1_ ) BLOCK: U SUBDIVISION:
PROPERTY ID #:
SPECIFICATIONS BY:
APPROVED BY:
DATE ISSUED:
7 -ate FC
STATE OF FLORIDA PERMIT #
DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES
ONSITE SEWAGE DISPOSAL SYSTEM
CONSTRUCTION PERMIT
Authority: Chapter 381, FS & Chapter 1OD -6, FAC
SYSTEM DESIGN AND SPECIFICATIONS
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. SUCH
MODIFICATIONS MAY RESULT IN THIS PERMIT BEING MADE NULL AND VOID.
T [ ] [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:`'125O GALLONS]
K [ ] GALLONS PEJt DOS DOSING TANK CAPACITY DOSE RATE [ ] PER 24 HRS NO. OF PUMPS: [ ]
,pp eta 4
D [C 2,] SQUARE FEET PRIMARY DRAINFIELD SYSTEM
SYSTEM
[ ] STANDARD [ ] FILLED
[ ] TRENCH [1/4_4—BED
R [ ] SQUARE FEET
A TYPE SYSTEM:
I CONFIGURATION:
N
F LOCATION OF BENCHMARK:
I ELEVATION OF PROPOSED SYSTEM SITE [
E BOTTOM OF DRAINFIELD TO BE [
G'
[SECTION /TOWNSHIP /RANGE /PARCEL NUMBER]
[OR TAX ID NUMBER]
L
D .FILL ?U � n Sj�T .G,HF$p C; g ( O REQUIRED:
T <Y r i, I,I..... t C = L - ^S
TITLE:
[ ] MOUND [ ]
[ ]
] [ABOVE /BELOW] BENCHMARK FERENCE POI
T] [ABOVE BELOW BENCHMARK EFERENCE POINT
DATE PAID
FEE PAID
RECEIPT #
Temporary /Experimental
] INCHES
k-m))7
CPHU
EXPIRATION DATE:
ag o ` a ` ;f1r i ec, rt r:� �,
HRS -H Form 4016, Mar 92 (Obsoletes previous editions which may not be used) Page 1 of 2
(Stock Number: 5744 - 001- 4016 -0)
)`' iv\ 1t
p
1i;1) i ...
i
APPLICATION FOR:
[OA New System [rn] Existing System [6z] Holding Tank f ] Temporary /Experimental
[/ j Repair [?c ] Abandonment [ue ] Other(Specify)
APPLICANT:
t° ✓v✓n
AGENT:
1
MAILING ADDRESS:
c
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.
PROPERT INFORMATION [IF LOT IS NOT IN A RECQRDED SUBDIVISION, ATTACH LEGAL DESCRIPTION OR DEED]
LOT: `�� BLOCK: G SUBDIVISION:
PROPERTY ID #:
PROPERTY SIZE:
PROPERTY STREET
DIRECTIONS TO PROPERTY:
BUILDING INFORMATION
Unit Typ; of
No Establishment
1
2
3
4
6
- c
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
T
ACRESo /43560] PROPERTY WATER SUPPLY:
ADDRESS:
C / L1 5 wcL
■
[ LJ RESIDENTIAL +e [ ] COMMERCIAL
- No. of ' Building # Persons Business Activity
Bedrooms Area Sqft Served For Commercial Onlv
[u ] Garbage Grinders /Disposals [l2 ° ] Spas /Hot Tubs (] Floor /Equipment Drains
[,,] Ultra -low Volume Flush Toilets Vu) - Qther (Specify)
APPLICANT'S SIGNATURE:
7
, 7 7/
/v
DATE OF f
-
SUBDIVISION:
[Section /Township /Range /Parcel No.] ZONING:
3 (f__
isoo
PERMIT #
DATE PAID
FEE PAID $
RECEIPT #
s
TELEPHONE:
PRIVATE [e1> PUBLIC
DATE: 7
HRS-H Form 4015, Mar 92 (Obsoletes previous editions which may not be used) Page 1 of 3
(Stock Number: 5744 - 001 - 4015 -1)
STATE OF FLORIDA
_DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES
ONSITE SEWAGE DISPOSAL SYSTEM
SITE EVALUATION AND SYSTEM SPECIFICATIONS
Cpl a�•cav�,.
PROPERTY ID #:
USDA SOIL SERIES:
V �JC�v✓+ i=
APPLICANT.(•
LOT: BLOCK: ,,, /SUBDIVISION:
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 " AN:
TOTAL ESTIMATED SEWAGE FLOW; L 9c)
AUTHORIZED SEWAGE FLOW:
UNOBSTRUCTED AREA AVAILABLE:
BENCHMARK /REFERENCE POINT LOCATION: i 6 Re Act d / 6 ,
ELEVATION Op PROPOSED SYSTEM SITE IS e;, e) [INCHES /FT] [ABOVE /BELOW] BENCHMARK /REFERENCE POINT
THE MINIMUM SETBACK WHICH CAN BE MAINTAINED FROM THE PRO �OSED SYSTEM TO THE FOLLOWING FEATURES:
2URFACE WATER: A FT DITCHES /SWALES: / / /-d FT NORMALLY WET? [ ] YES [A] NO
WELLS: PUBLIC: _ FT LIMITED USE: FT PRIVATE: FT NON - POTABLE: 4/4 FT
BUILDING FOUNDATIONS: /0/- FT PROPERTY LINES: (U?. POTABLE WATER LINES: 'Oh- FT
SITE SUBJECT TO FREQUENT FLOODING: [ ] YES y1\1410
10 YEAR FLOOD ELEVATION FOR SITE: #,4 FT MSL /NGVD
SOIL PROFILE INFORMATION SITE 1 V� L IP SOIL PROFILE INFORMATION SITE 2
Munsell # /Color Texture\
Depth
to
to (,
to
+ f to 6
� \ to
to
3t
t
ti
OBSERVED WATER TABLE: INCHES [ABOVE /
ESTIMATED WET SEASON WATER TABLE ELEVATI'ONr
HIGH WATER TABLE VEGETATION: [ ] [(] NO
a
SOIL TEXTURE /LOADING RATE FOR SYSTEM SLING: i V
DRAINFIELD CONFIGURATION: [ ] TRENCH BED
REMARKS /ADDITIONAL CRITERIA:
SITE EVALUATED BY:
AGENT: //J
PERMIT 1
P t_. ✓
[Section /Township /Range /darcel No. or Tax ID Number]
YES [ ] NO NET USABLE AREA AVAILABLE: `)a( (y ACRES
GALLONS PER DAY [RESIDENCES -TABLE 1 / OTHER -TABLE 2]
GALLONS PER DAY [1500 GPD /ACRE OR 25.0 GPD /ACRE]
SQFT UNOBSTRUCTED AREA REQUIRED: " FS SQFT
10 YEAR FLOODING? [ ] YES NO
SITE ELEVATION: FT MSL /NGVD
Munsell # /Color Texture Depth
to
to
to
to
to
to
to
to
USDA SOIL SERIES:
XISTING GRADE. TYPE: [PERCHED / APPARENT]
INCHES [ ABOVE / BELOW ] EBI:pG GRADE.
ING: [ ] YES [S) NO DEPTH: INCHES
bEPTH OF EXCAVATION: 754a INCHES
[ ] OTHER (SPECIF
DATE: ,2
HRS-H Form 4015, Mar 92 Qb olet s previous /editions which may not be used) Page 3 of 3
(Stock Number: 5744 -00 - 4015 -15
Li J _ - ■ ■■ � 1 r ■ ■■ J 1 I �l�
1 1 ! - �-_ 1 I- I -- I ■ ■ Dal 1 1 ( I 1 I ILLLL L-
- - - - � - L1 J 1
Notes:
•
STATE OF FLORIDA
DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES
APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTIONAERMIT
Permit Application Number (/ i9'°
Each block represents 5 feet and 1 inch = 50 feet.
Site Plan submitted by:
Plan Approved
PART II - SITE PLAN
SIGNATURE
40 fit..) r
Not Approved
r'
TITLE
r
Date j-
By �� -� County Public Unit
ALL CHANGES MU 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)
Page 2 of 3
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Notes:
•
STATE OF FLORIDA
DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES
APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTIONAERMIT
Permit Application Number (/ i9'°
Each block represents 5 feet and 1 inch = 50 feet.
Site Plan submitted by:
Plan Approved
PART II - SITE PLAN
SIGNATURE
40 fit..) r
Not Approved
r'
TITLE
r
Date j-
By �� -� County Public Unit
ALL CHANGES MU 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)
Page 2 of 3