725 NE 96 St (5)Village of Miami Shores
JOB to.V
to
INSPECTOR DATE
N° 3943
ADDRESS 7
INSPECTION 1— -
TIME READY
REMARKS
;UILDING
='-FCTRICAL
'LUMBING
EOOFING
Eivm
)caner of
- uilding
rchitect
ontractor
r Builder
egal
'escription
ddress of
uilding
Lot
1 „ 7 " x ""
MIAMI SHORES VILLAGE. FLORIDA
fr `
0
❑ DATE _ / 195 C
p PERMIT N9 _ 3402 Contractor's
License No.
0
1,41
r. 1 C .
itV
'/ 2
CONTRACTOR OR BUILDER
Work to be performed under this Permit
Signed. k)
BY
Subdi-
vision
Value of
Project $
Amount of r
Permit l ,
This permit is granted to the contractor or builder named above to construc the building or to install the equipment or device described in the application
s!refor in strict compliance with all ordinances pertaining thereto and with the understanding that the work will be performed in compliance with any plans,
awings, statements or specifications that may have been submitted to and approved by the proper municipal authorities. This Permit may be revoked at any
. =e 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
tinted is the understanding that the contractor or builder named above assumes the responsibility for a thorough knowledge of the ordinances and regulations
rtaining to the work covered hereby whether shown on the plans or drawings or in the statements or specifi ons and that he assumes responsibility for work
•ne by his agents, servants or employees.
INSPECTOR
In consideration of the issuance to me of this permit I agree to perform the work cove hereunder in compliance with all ordinances and regulations
=rtaining thereto and in strict conformity with the plans, drawings, statements or specifications suubbmitted to the proper authorities of Miami Shores Village. In ac-
piing is permit I sume responsibility for all work done by either, myself, my agent, servant or employee.
AUTHORITY
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
10050 N.E. 2nd Avenue • Miami Shores, Florida 33138 • 305-795-2204
Date 0.2 Job Address 73Y A-' G - ' HHH Tax Folio /J '3-C)6; 1 `/ - - 36
Legal Description LIT 7 3L,G 69 ,V t- 3 Historically Designated: Yes No
Owner /Lessee/Tenet L 4,3 <9 f I'4 V /? P 4 l Master Permit # ?.2 " (-, 0 - ( t
Owner's Address V J A) L ('/ 1i TO 5
Phone — ciLi .7_3/ 7z li'
Contracting Co. L- L- v'`/D ICJ I; lZ 7 I )I 7)L JZP/ l L Address 7 S L) /v it- / r) y S
Qualifier L L 3 / L' - , C Li KG- 7
WORK DESCRIPTION:
Square Ft. 75
\ Signature of owner and/or Condo Preside
Notary as to Owrie
My Commission
FEES: PERMIT C
cc
D,
•
• sql
4P OF Fl oq- Bonded Thru Budget Nola-
RADON
KE!
EXPIRES: May 2C, 70
SS# ' ' hone ?7't- .1 / - W 7 4
State # C �E - "I S" Municipal # Competency # Ins. Co.
IF THERE IS NO PERMIT PACKAGE ACCESSIBLE ON THE JOB SITE FOR INSPECTORS TO VERIFY,
THERE WILL BE NO INSPECTION. RE- INSPECTION FEE IS $50.00 AND MUST BE PAID IN ADVANCE
BEFORE CALLING FOR ANOTHER INSPECTION.
Permit Type (circle one): BUILDING ELECTRICAL / PLUMBING MECHANICAL ROOFING
Estimated Cost (value) /() C )
WARNING TO OWNER: YOU MUST RECORD A NOTICE OF COMMENCEMENT AND YOUR FAILURE TO DO SO MAY RESULT IN
YOUR PAYING TWICE FOR LMPROVEMENTS TO YOUR PROPERTY (IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITII
YOUR LENDER OR ANY ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT.)
Application is hereby made to obtain a permit to do work and installation as indicated above, and on the attached addendum (if applicable). I certify that
all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that separate permits are required
for all disciplines.
OWNERS AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws
regulating construction and zoning. Furthermore, I authorize the above named contracto o do the work stated.
C.C.F 1
NOTARY
My Commission Expi T.
Date ofOofitrac gx Owner uilder Date
Date --- `Notary as K t ®. wn¢$ B�tdet!.. e To!, ‘ate
BOND S (�'.
APPROVED: TOTAL DUE
Zoning Building Electrical
Mechanical Plumbing _ _ Structural Engineer
CONSTRUCTION PERMIT FOR:
[ ]New System [ ]Existing System [ ]Holding Tank [ ] Innovative Other
[ X ]Repair [ ]Abandonment [ ]Temporary [ NA ]
APPLICANT: Murray, Wanda
PROPERTY STREET ADDRESS: 725 NE 96 St Miami FL 33138
LOT: 7 BLOCK: 69
PROPERTY ID #: 11- 3206 - 014 -2230
SYSTEM MUST BE CONSTRUCTED IN ACCORDANCE WITH SPECIFICATIONS AND STANDARDS OF CHAPTER 64E -6,FAC
DEPARTMENT APPROVAL OF SYSTEM DOES NOT GUARANTEE SATISFACTORY PERFORMANCE FOR ANY SPECIFIC TIME
PERIOD. 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. ISSUANCE OF THIS PERMIT DOES NOT EXEMPT THE APPLICANT FROM
COMPLIANCE WITH OTHER FEDERAL, STATE OR LOCAL PERMITTING REQUIRED FOR PROPERTY DEVELOPMENT.
SYSTEM DESIGN AND SPECIFICATIONS
T [ 750 ]Gallons SEPTIC TANK
A [ 0 ]Gallons
N [ 0 ]GALLONS GREASE INTERCEPTOR CAPACITY
K [ 0 ]GALLONS DOSING TANK CAPACITY [ 0 ]GALLONS
D [ 300 ]SQUARE FEET PRIMARY DRAINFIELD SYSTEM
R [ 0 ]SQUARE FEET SYSTEM
A TYPE SYSTEM: [ N ]STANDARD [ N ]FILLED
I CONFIGURATION: [ N ]TRENCH [ N ]BED
N
F
I
E
L
D
STATE OF FLORIDA
DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT AND DISPOSAL - SYSTEM
CONSTRUCTION PERMIT
SUBDIVISION: Miami Shores
LOCATION TO BENCHMARK: Finished Floor of E/R
ELEVATION OF PROPOSED SYSTEM SITE [ 2.6 ]
BOTTOM OF DRAINFIELD TO BE [ 5.1 ]
FILL REQUIRED:[ 0.0 ]INCHES EXCAVATION
OTHER REMARKS:
Existing 750 Gallons Septic tank to remain.
Install 300 Square feet Drainfield.
Invert Elevation of the D/F to be NLT 6.53' NGVD.
Bottom elevation of the D/F to be NLT 6.03' NGVD.
This permit is not for addition.
AGENT: SR0001343, Crockett Lester
[Section /Township /Range /Parcel No.]
[OR TAX ID NUMBER]
Elev. 11.10' NGVD
REQUIRED: [ 30.0 ] INCHES
TITLE:
SPECIFICATIONS BY: Andre, Paul
APPROVED BY: Andre, Paul
DATE ISSUED: 3/5/02
DH 9016, 03/97 (Obsoletes previous editions which may not be used)
c� nn_nn1_nnic_n1 ,.
CENTRAX #: 13 -SG -12026
DATE PAID:
FEE PAID : $
RECEIPT .
OSTDSNBR : 02 -0633- -R
MULTI - CHAMBERED /IN SERIES: [Y ]
MULTI - CHAMBERED /IN SERIES: [Y ]
@ [0 ]DOSES PER 24 HRS # PUMPS[ 0 ]
[ N ]MOUND [ N ]
[ N ]
[ FEET ] [ BELOW BENCHMARK /REFERENCE POINT
[ FEET ] [ BELOW BENCHMARK /REFERENCE POINT
TITLE: Professional Engin Dade
G•S
1
4 -43 ,,A4
''ZKURATWN DATE: 6/3/02
CHD
Dm,. 1 r.f `)
APPLICANT:
LOT:
PROPERTY ID #:
BLOCK:
THE MINIMUM SETBACK
SURFACE WATER:
WELLS: PUBLIC:
BUILDING FOUNDATIONS:
STATE OF FLORIDA
DEPARTMENT OF HEALTH
ONSITE SEWAGE DISPOSAL SYSTEM
SITE EVALUATION AND SYSTEM SPECIFICATIONS
WHICH
FT
FT
SOIL PROFILE INFORMATION SITE 1
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.
r
PROPERTY SIZE CONFORMS TO SITE PLAN: [ ] YES ( ) NO NET USABLE AREA AVAILABLE: ACRES
TOTAL ESTIMATED SEWAGE FLOW:
GALLONS PER DAY [RESIDENCES -TABLE 1 / OTHER -TABLE 2)
AUTHORIZED SEWAGE FLOW: GALLONS PER DAY [1500 GPD /ACRE OR 2500 GPD /ACRE]
UNOBSTRUCTED AREA AVAILABLE: SQFT UNOBSTRUCTED AREA REQUIRED: .'.`� SQFT
• F '
BENCHMARK /REFERENCE POINT LOCATION:
ELEVATION OF PROPOSED SYSTEM SITE IS " [INCHES /FT] [ABOVE /BELOW] BENCHMARK/REFERENCE POINT
SITE SUBJECT TO FREQUENT FLOODING: [ ] YES ( ] NO
10 YEAR FLOOD ELEVATION FOR SITE: FT MSL /NGVD
Munsell # /Color Texture
■
USDA SOIL SERIES:
Depth
to
to
to
to
to
to
to
to
T
to ,
SOIL TEXTURE /LOADING RATE FOR SYSTEM SIZING:
DRAINFIELD CONFIGURATION: [ ] TRENCH [ ] BED
REMARKS /ADDITIONAL CRITERIA:
SITE EVALUATED BY:
DH 4015, 10196 (Replaces HRS-H Form 4015 (Page 3] which may be used)
(Stock Number: 5744 -003 - 4015 -1)
AGENT:
PERMIT #
[Section /Township /Range /Parcel No. or Tax ID Number]
CAN BE MAINTAINED FROM THE PROPOSED SYSTEM TO THE FOLLOWING FEATURES:
DITCHES /SWALES: s FT NORMALLY WET? [ ] YES [ ] NO
LIMITED USE: ,'•> FT PRIVATE: FT NON- POTABLE: FT
FT PROPERTY LINES: FT POTABLE WATER LINES: FT
10 YEAR FLOODING? [ ] YES [ ] NO
SITE ELEVATION: FT MSL /NGVD
SOIL PROFXLE INFORMATION SITE 2
Munsell # /Color Texture
USDA SOIL SERIES:
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: ■ t INCHES [ ABOVE / BELOW ) EXISTING GRADE.
HIGH WATER TABLE VEGETATION: [ ] YES [ ] NO MOTTLING: j j YES [•) NO DEPTH: INCHES
DEPTH OF EXCAVATION: INCHES
[ ] OTHER (SPECIFY)
DATE:
Page 3 of 3
INSTRUCTIONS:
PERMIT NUMBER: Permit tracking number by County Health Department.
APPLICANT: Property owner's full name.
AGENT: Property owner's legally authorized representative.
LOT, BLOCK, SUBDIVISION: Lot, block, and subdivision for lot.
PROPERTY ID NUMBER: 27 character number for property (property appraiser ID number or section /township /range /parcel number).
PROPERTY SIZE: Check if property 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 streams, lakes,
normally wet drainage ditches, marshes, or other such bodies of water.
SEWAGE FLOW:
UNOBSTRUCTED AREA:
MINIMUM SETBACKS:
FLOOD INFORMATION:
SOIL PROFILE INFORMATION:
WATER TABLE:
SOIL TEXTURE:
Record the estimated sewage flow for the establishment from Table 1 (residence) or Table 2 (non - residential),
Chapter 10D -6, FAC. Record the authorized sewage flow for the lot 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 at
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.
Record minimum setbacks which can be meet to all listed features. Actual measurements must be recorded or
"NA" for nonapplicable 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.
Record information on lot's subject to flooding. For lots subject to flooding record 10 year flood elevation for
site and actual site elevation.
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 USDA soil textures). Refusals
must be clearly documented. Provide USDA soil series if available, record "UNK" if the series cannot be
determined.
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.
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 configuration 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 documents submitted.
ELEVATION WORKSHEET ELEVATION OF BENCHMARK / REFERENCE POINT IS:
BENCHMARK SITE 1 SITE 2 SITE 3
[ + 1 SHOT H.I. H.I. H.1.
H.I. [ - 'SHOT [ - )SHOT 1 -1 SHOT
Scale: Each block represents 10 feet and 1 inch = 40 feet.
STATE OF FLORIDA
DEPARTMENT OF HEALTH
APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PERMIT
Permit Application Number
r
g r
Notes:
• _a.. 7 . 4 -
Ari/ , .1 •
By
N 0 •L.
s r 4 7- "
7.2
i !
•
ir 6
Di?./4/ e7,- 1
PART II SITEPLAN
Site Plan submittecLby: r
t C.C.ei
Plan Approved 4 / Not Approved
• F
1-
—
Date ,
1
. County Health Department
ALL CHANGES MUSD BE APPROVED BY THE COUNTY HEALTH DEPARTMENT
-
DH 4015, 10/96 (Replaces HRS-H Form 4015 which may be used) Page 2 of 4
(Stock Number: 5744-002-4015-6)
MIAMI SHORES VILLAGE
BUILDING DEPARTMENT
305- 795 -2204
B uilding Inspection Request
DaR / J Y l) . Time
Type Insp'n
Permit No. 00 b f
Name
Address
Company
Phone #
For Inspecto
Approved
Correction
Re- Insp'n Fee ❑