916 NE 96 St (9)Date
Legal Description
/ Tenant 0 6 S O ttC
Owner's Address { ifs' N ti 4 L Phone ,� / - �
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
C a Job Address et 1 Kos"
o 9 & S :t / Tax Folio
Contracting Co. i /
Qualifier J �.•�s yr-,7•A
State #
Architect/Engineer
Bonding Company
Mortgagor
Square Ft. i
OWNER'S AFF
laws regulating c
My Commission Expires:
FEES: PERMIT
der • s
Municipal #
No .'ras to Own - "r an or Condo President Date
APPROVED:
Zoning Building
Mechanical Plumbing
" /
Address
Address
Address
(// -0/4-3Ozo)
Historically Designated: Yes No
_ .
IMF
v
Master Permit #
q7
7 J7 - 68 6
ss# c 1 sIt — (' t 3 r 1
Competency # - I 4=>t..) q.,
Sa cy �
Permit Type (circle one): BUILDING ELECTRICA LUMBING ECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIPTION s V e (xi `m c. E-) 411, g (co- 5 S U cE)
Estimated Cost (value) 41 -e-e-- , " r c'
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 INTENT) 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 req • ed for ELECTRICAL, PLUMBING, SIGNS, POOLS, ROOFING and MECHANICAL WORK.
AVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable
nstruction and zoning. Furthermore, I authorize the above -named contractor to do the work stated.
(ROTARY PUBLIC - STATE OF FLORIDA
LUIS MONTERO
COMMISSION Y CC711335
EXPIRES 112712002
�? \ A
i a fore of Contract r Owner-Builder
Signature Builder
Ins. Co.
Notary as to Contractor or Owner - Builder
My Commission Expires:
* *My commission CCTZ/s9s
Expires Mach 24, 2002
C.C.F. 0 NOTARY
Electrical
2_e/ ft)
Date
c)58‘
ate
:BOND
TOTAL DUE • 6. p
Engineering
I. LOCATE AND PROTECT ALL UTILITIES IN AREA OF
CONS7RUCZTON. SUNSHINE /I -500-41Z-4770
2. RESTORE ALL AREAS ro PRIOR CONDITIONS
J. ALL CONSTRUCTION /O FOLLOW JURISDICTIONAL
GOVERMENT AND PCS STANDARDS.
NE_ 96 ST
-1 d.
#96
LOT 10
BLK 76
J
0_
W
/
\
(U
PROP 2' PREFAB RISER
S P/L
XIST " SP
PROP OPEN CUT WORK AREA
T /T, T /F, E/M
TIE
PROPOSED 1/2' PL GAS PIPE
916 NE 96 ST
MIAMI SHORES
,/O ; 1225
AFE• 010170000102
ATLAS: M -13
L01 10 BM* 76
SHEET 1 OF 1
SCALE NTS
DRAWN BY:
C. H. NESBITT
DAM: 05 -27 -98
N/
/
1. LOCATE AND PROTECT ALL UTILITIES IN AREA OF
CONSTRUC77ON. SUNSHINE /1- 800 -432 -4770
2. RESIORE ALL AREAS 70 PRIOR CONONfONS.
J. ALL CONSTRUCTION IV FOLLOW IURISO /C77ONAL
GOVERMENT AND PCS STANDARDS
\
N
NE 96 ST
#96
LOT 10
BLK 76
X S " SP
PROP 2' PREFAB RISER
0
� S P/L
PROP OPEN CUT WORK AREA
T /T, T /F, E/M
P HOPLas aas
J
d
W
PROPOSED 1/2' PL GAS PIPE
916 NE 96 ST
MIAMI SHORES
Jo ; 1225
AFE.• 010170000102
ATLAS: M -13
LOT: 10 BLK: 76
SHEET. 1 OF
SCALE: NTS
DRAWN BY:
C. H. NESBITT
DATE: 05 -27 -98
Permit No. __Q _____
APPLICATION FOR PLUMBING PERMIT
Owner's Name and Address
Registered Architect and /or Engineer
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
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 Divisior
of Miami Shores Village shall be complied with, whether herein specified or not. A copy of approved plans and specifications must be kept al
building during progress of work.
Employing Plumber's Name ' re\c• C...�2•"' _— !�l =" vo Street
1
Location and Legal Description Lot____________ ____________________ __ Block_____ ____ , , Subdivision
Street and Number where work is to be performed —No _1_LLL'_____ ..
State work to be performed and purpose of building (By Floors)
New Building Remodeling Addition Repairs No. of Stories
Size Septic Tank Type of Tank_ _ Capacity Gals.__
Feet of Drain Tile Dist. Feet of Tank or Drain Field from Well
Nature of Water Supply: 9.ty } Well . l • O. _O ____Size of Soakage Pit
Amount of Permit $ ,____ __ (Signed) _ _I
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 5966, 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 not' s as are
required by the Act. The undersigned agrees to employ only such sub- contractors, on work to be perp'rrfed under this p , as are
licensed by Miami Shores Village. `~ -
(Si
Date -i - 3
No Street
Street
Plumbing Inspector.
aster plumber.
STATE OF FLORIDA,
COUNTY OF DADE. j
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeare
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 fac
therein by him stated are true.
My Commission Expires Notary Public, State of Florida
NOTE: A re- inspection fee of $1.00 will be made when such re- inspection is made necessary by improper notice for inspection, or faul
materials and /or workmanship.
CLOSETS
BATH
TUBS
SHOWERS
LAVA.
TORIES
SINKS
SLOP
SINKS
LAUNORY
TUBS
URINALS
CATCH
BASIN
FLOOR
DRAIN
DRINKING
FOI NT'NS
TOTAL
FI %TUREI
-
CONTR.
LIST
1
I
_
CHECK
I . '1
.--
-.;sue
i -,)
7
_
SEPTIC
TANK
SEWER
CONN.
DRAIN
FIELD
SOAKAGE
PIT
GREASE
TRAP
GL.Mt
HEATER
' DEEP
WELL
SPRKLR.
SYSTEM
SW IM 'G
POOL
CONTR.
LIST
CHECK
1
1
1 D0
s _
J 0
Permit No. __Q _____
APPLICATION FOR PLUMBING PERMIT
Owner's Name and Address
Registered Architect and /or Engineer
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
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 Divisior
of Miami Shores Village shall be complied with, whether herein specified or not. A copy of approved plans and specifications must be kept al
building during progress of work.
Employing Plumber's Name ' re\c• C...�2•"' _— !�l =" vo Street
1
Location and Legal Description Lot____________ ____________________ __ Block_____ ____ , , Subdivision
Street and Number where work is to be performed —No _1_LLL'_____ ..
State work to be performed and purpose of building (By Floors)
New Building Remodeling Addition Repairs No. of Stories
Size Septic Tank Type of Tank_ _ Capacity Gals.__
Feet of Drain Tile Dist. Feet of Tank or Drain Field from Well
Nature of Water Supply: 9.ty } Well . l • O. _O ____Size of Soakage Pit
Amount of Permit $ ,____ __ (Signed) _ _I
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 5966, 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 not' s as are
required by the Act. The undersigned agrees to employ only such sub- contractors, on work to be perp'rrfed under this p , as are
licensed by Miami Shores Village. `~ -
(Si
Date -i - 3
No Street
Street
Plumbing Inspector.
aster plumber.
STATE OF FLORIDA,
COUNTY OF DADE. j
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeare
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 fac
therein by him stated are true.
My Commission Expires Notary Public, State of Florida
NOTE: A re- inspection fee of $1.00 will be made when such re- inspection is made necessary by improper notice for inspection, or faul
materials and /or workmanship.
McCORMICK- BOYETT
Plumbing Contractors
9443 W. RAILROAD (RENUART MILL BLDG.)
MIAMI SHORES, FLORIDA
PHONE 7 -4793
MIAMI SHORES VILLAGE
BUILDING INSPECTION DEPARTMENT
APPLICATION FOR BUILDING PERMIT
Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the build-
ing 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 the work.
Date , 19 -
Owner's Name and Address • No.______.- - Street � .__- .!
Registered Architect and /or Engineer
Name and address of licensed contractor ,. . • • •
Location and legal description of lot to be built on:
Lot Block Subdivision
Street and Number where work is to be done ., _.: ___- ±._-;_t_—
State work to be done and purpose of building (by floors) _____________
Remarks (Signed)
and for no other purpose.
New Building Remodeling Addition Repairs No. of Stories
To be constructed of Kind of foundation Roo f Covering
Estimated Total cost of improvements $ Amount of Permit $
Zone cubage required _Plan Cubage
Distance to next nearest building Size of Building Lot
Maximum live load to be borne by each floor
I hereby submit all the plans and specifications for said building. All notices with reference to the building and its construction may
be sent to
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 5966, Compiled General Laws of Florida, Permanent Supplement,
and has complied with the provisions thereof, and will require similar compliance from all contractors or sub-cor tractors employed by him
in the work to be performed under this permit; and will post or cause to be posted for inspe Lion on the site of the work such public notice
or notices as are required by the Act. The undersigned agrees to employ only such subcon actors, on work to be performed under this
permit, as are licensed by Miami Shores Village. r. „ ' r%
f�" °°` cam
STATE OF FLORIDA,
COUNTY OF DADE. ss.
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally ap-
peared
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.
Permit No Date Read, Sworn to and Subscribed before me.
Disapproved Date
(Signed)
Notary Public, State of Florid,
Building Inspector My Commission Expires
PLANNING BOARD DATE
Chairman Member
Member Member
Member Member
Council Approved Date Disapproved Date
NOTE: A charge of $1.00 will be made for making corrections or changes to this application after approval has been obtained from
the Planning Board.
A re- inspection fee of $1.00 will be charged when such re- inspection is made necessary by improper notice for inspection or faulty
materials and /or workmanship.
BUILDING
ELECTRICAL
PLUMBING
ROOFING
Owner of
Building 1 1 �{ `t�•t+ 3
Architect
Contractor
or Builder •.ia'^"A'
Legal Lot II Bl.
Description
Address of �+ f -
Building �� l Ni A �'t,r • `'� r
CONTRACTOR OR BUILDER
MIAMI SHORES VILLAGE, FLORIDA
❑
PERMIT it 13722
❑ Work to be performed under this 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 applieadoe
herefor in strict compliance with all ordinances pertaining thereto and with the understanding that the work will be perfxmed in compliance wilfr p
drawings, statements or epeafications that may have been submitted to and approved by the proper mead authorities. This Permit may be at
time if the work is not done in compliance with such ordinances or if the plans are changed without autho . A further condition uppon width ttiit *graft
granted is the understanding that the contractor or builder named above assumes the responsibility for a R knowledge of the ordinanws im tMi
pertaining to the work covered hereby whether shown on the plans or drawings or in tile , statements' tE at he assumes reap ilk wail!
done by his agents, servants or employees.
Signed:
s�.
Subdi-
vision
Value of
Project $ 5 o
BY
DATE 1. &"C 3' 105__
Contructcx's
Liosn.e I
p to Amt. of
d
Permit $
By See ,i0.,tth.
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 plane, 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 tither, myself, my agent, servant or employee.
AUTHORITY
BUILDING ❑
ELECTRICAL. ❑ PERMIT IV? 13409
PLUMBING
ROOFING
Owner of
Building ) r �
Architect
Contractor
or Builder
Legal
Description
Address of
Building
Lot
MIAMI SHORES VILLAGE. FLORIDA
E
Work to be performed under this Pursuit
1 BL
Signed.
Subdi-
vision
Value of
Project $
torero
11 Amt of
Permit 9
This permit is granted to the contractor or builder named above to construct the building or to install the uipment or device described, in
herefor in strict compliance with all ordinance pertaining thereto Mold` with the understanding that the work will be performed in compliance
drawings, statements or specifications that have been submitted ' to'and approved by the proper municipal authorities. This Permit may
time if the work is not done in compliance with such ordinances or ,it he plans are changed without authorisation. A further condition u pps� wbi t
granted is the understanding that the contractor or builder above assumes the responsibility for a thorough knowledge of the ordiaaaop
pertaining to the work covered hereby whether shown on the p aanstatements
�s or drawings o the or specifications and teat he assumes woel
done by his agents, servants or employees.
AAtu BY 1
DEIBOCTOR
In consideration of the issuance to me of this permit I agree to perfo work covered hereunder in compliance: with all ordlnanc sod
pertaining thereto in strict conformity the ns, drawings, statements or specifications •miffed to proper nutborities of Miami Shona
In a • • pting 't I assume respon f . , r ' work by
CONTRACTOR OR BUILDER BY AUTHORITY
BUILDING
ELECTRICAL
PLUMBING
ROOFING
Owner of
Building
Architect
Contractor
or Builder_
❑ PERMIT IT? 13395
❑ Work to be performed under this Pannit
Bl.
Legal Lot
Description.
Address of
Building I tt., ( 1
MIAMI SHORES VILLAGE,: FLORIDA
Signed-
Subdi-
vision
Value of
Project $
BY
I .Amt. of
Permit $
DATE 1 ' ''"' 195—
Contractor's
Limns* No.
This permit is granted to the contractor or builder named above to construct the building or to install the equipment or device desafbed in the application
herefor in strict compliance with all ordinances pertaining thereto and with the understanding that the work will be performed in compliance with sxq plat,
drawings, statements or specifications that may have been submitted to and approved by the proper municipal authorities. This Permit may be rsvelned at se
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 wit 1
granted is the understanding that the contractor or builder named above assumes the responsibility for a thorough knowledge of the ordinances and
pertaining to the work covered hereby whether shown on the plans or drawings or in the statements or specifications and diet he assumes responsibility woxlt
done by his agents, servants or employees.
DRIPECIOR
In consideration of the issuance to me of this permit I agree to perform ,d►e work cowered hereunder in compliance with all ordinances and es
pertaining thereto and in strict conformity with the plans, drawings, statemer specifications submitted to the proper zuthorities of Miami Shores
In accepting this permit I assume responsibility for all work done by either, myself, my agent, servant or employee.
, 6 //
BY
AUTHORITY
Architect
Contractor
or Builder
Legal
Description.
Address of
Building
CONTRACTOR OR BUILDER
MIAMI SHORES VILLAGE.. FLORIDA
BUILDING ❑
ELECTRICAL ❑ PERMIT IT ' T? 13649
PLUMBING L ` .
ROOFING ❑ Work to be performed under this Permit
Owner of I)
Building
J
Lot I BI.
Subdi-
vision
Value of
Project $
BY
DATE
Amt. of
Permit
/
1
Contractor's
Ucs s No
$ � *^.'.,
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 OpdgAioa
herefor in strict compliance with all ordinances pertaining thereto and with the understanding that the work will be perfcemed in compliance with pimk
drawings, statements or specifications that may have been submitted to and approved by the proper municipal authorities. This Permit may be 'Irdy
time if the work is not done in compliance with such ordinances or if the plans are changed without authorization. A further condition uu}pwocn whisk tbM pe It
granted is the understanding that the contractor or builder named above assumes the responsibility for a thorough knowledge of the ordmaaeea " i t1rsY
pertaining to the work covered hereby whether shown on the plans or drawings jr in the statements or specifications and that he assumes respossbakr
done by Inc agents, servants or employees.
In consideration of the issuance to me of this permit I agree to perform a, e work covered hereunder in compliance with all ordinances and rspdadons
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.
BUILDING ❑
ELECTRICAL ❑
PLUMBING ❑
ROOT I NG ❑
/t.r. ❑
Owner of
Building <.•4 + r '4:
Architect
CONTRACTOR OR BUILDER
MIAMI SHORES VILLAGE, FLORIDA
DATE r ' . #
PERMIT
Contractor
or Builder t
Legal Lot
Description
ir a G
Work to be performed under this Permit
B1
N 9 7854 Contractor's
License No. c 1 1
P •
Subdi-
vision
Address of ,. Value of J Amount of ;
Building ;'�'`<° Project $ n II 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. 6
#._.w.
9_42+
INSPECTOR
In consideration of the issuance to me of this permit I agree to perform the work covered hereunder in com¢1>Eance with all ordinances cad 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 ell work done by either, myself, my agent, servant or employee.
BY AUTHORITY
U1OT
Date
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Job Address 9/ �� 7 6 A4 ' Tax Folio
Legal Description
Lessee / Tenant i(' �Dt P 4 f7 1/ /. S G /l
9/t:, ) /V/ 9/ s7,
(W z 'S _5/.77 _5 kz' oe ''Address
Phone 7 (3 C Y‘, t'
/� f�? /- a -Jo (4),S n, '(de(f
Qualifier L /¢ /Z &4'/ J/' //::w SS4� ��` - Phone ,e4 6 -/ /,/ ff
State # Municipal # Competency IPCO , 90
Architect /Engineer Address
Bonding Company Address
Owner's Address
Contracting Co.
Mortgagor Address
Permit Type(circle one): BUILDING ELECTRICAL PfMBIN MECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIPTION ,r/.2_5 , 2 00 St,' i- T, ,D
OWNER'S A
be done i
authorize
Signatu
Date:
APPROVED:
r,
0
Notary a •' Owner and /or Condo President
My Commni = ion Expires:
NOTARY PUBLIC, STATE OF FLORIDA.
M cor:r.1 ?ss;oN RXPIrz S: April 16, 1995.
bO;.DED Tan NOTARY PUaLIC UNDERWRITER$.
** * * * * *
FEES: PERMIT "6 RADON
Zoning
Mechanical
2
Master Permit # 3440
Square Ft. Estimated Cost(value) / f D
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 BEFO1RE 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 .re required for ELECTRICAL, PLUMBING, SIGNS, POOLS, ROOFING and MECHANICAL WORK.
FIDAVIT: I certify that all the foregoing information is accurate and that all work will
comp k nce with all applicable laws regulating construction and zoning. Furthermore, I
he above -named contractor to do the work stated.
of owner and /or Condo President Signature of Cont =ctor or Owner- Builder
Date:
Notar -= to Contractor r Owner- Builder
My Commission Expires:
NOTARY PUBLIC, STATE OF FLORIDA.
MY COMMISSION EXPIRES: April 16, 1995
BONDED TkIRU NOTARY PUBLIC UNDERWRITERS.
* * * * * * * * **
C.C.F. ' NOTARY TOTAL DUE 5/ 14r°
Fire Other
Buildin: Electrical
Plumbin_,_ t ^p ngineering
^• ^C� KE
APPLICANT:
BLOCK: SUBDIVISION:
LOT:
PROPERTY ID #:
STATE OF FLORIDA
DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES
ONSITE SEWAGE DISPOSAL SYSTEM
SITE EVALUATION AND SYSTEM SPECIFICATIONS
PROPERTY SIZE CONFORMS TO SITE PLAN: [/
TOTAL ESTIMATED SEWAGE FLOW:
AUTHORIZED SEWAGE FLOW: j
UNOBSTRUCTED AREA AVAILABLE:
SITE SUBJECT TO FREQUENT FLOODING:
10 YEAR FLOOD ELEVATION FOR SITE:
SOIL PROFILE INFORMATION SITE 1
Munsell #JColor
,�
USDA SOIL SERIES:
Textur
Depth
Otto c)/
to
to
to
to
to
to
to
to
SITE EVALUATED BY: r / i( _ �,�'
-H Form 4015, Mar 92 (Obsoletes previous editions which may not be used)
ck Number: 5744 - 003 - 4015 -1)
AGENT:
PERMIT #
1 4 •
[Section /Township /Range /Parcel. No. or Tax ID Number]
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.
YES [ ] NO NET USABLE AREA AVAILABLE: ACRES
GALLONS PER DAY [RESIDENCES -TABLE 1 / , HER -TABLE 2)
GALLONS PER DAY [1500 GPD /ACRE OR 2500 G /ACRE]
SQFT UNOBSTRUCTED AREA REQUIRED:
BENCHMARK /REFERENCE POINT LOCATION: 4/7 C'1 %;( ) 4/ C '/'
ELEVATION OF PROPOSED SYSTEM SITE IS , '" [INCHES /FTf[ABOVE/ I;LOWJ BENCHMARK/REFERENCE POINT
THE MINIMUM SETBAC WHICH CAN BE MAINTAINED FROM THE PROPOSED SYSTEM TO THE FOLLOWING FEATURES:
SURFACE WATER: d'ri FT DITCHES /SWALES: ///„ FT NORMALLY WET? [ ] YES NO
WELLS: PUBLIC: 4 /l7' FT LIMITED USE: L•�'rj FT ORIVATE: FT NON - POTABLE: FT
BUILDING FOUNDATIONS: FT PROPERTY LINES: '=; FT POTABLE WATER LINES: / FT
YES [A NO
FT`M$L /NGVD SITE ELEVATION: . .- FT MSL /NGVD
10 YEAR FLOODING? [ ) YES [,4 NO
SOIL PROFILE INFORMATION SITE 2
Munsell # /Color Texture
USDA SOIL SERIES:
! D ? SQFT
r,'
Depth
' to f�
to
to
to
to
to
to
to
to
OBSERVED WATER TABLE: 7 ') INCHES [ABOVE / BELOW,} EXISTING GRADE. TYPE: PERCHED / APPARENT
ESTIMATED WET SEASON WATER TABLE ELEVATION: ( INCHES [ ABOVE / B LOW) EXISTING GRADE.
HIGH WATER TABLE VEGETATION: [ ] YES ] NO MOTTLING: [ ] YES L>4 NO - DEPTH: __ -- INCHES
SOIL TEXTURE /LOADING RATE FOR SYSTEM SIZING: i',J, ` -Z' DEPTH OF EXCAVATION: < , INCHES
DRAINFIELD CONFIGURATION: [ ] TRENCH [ aj BED [ ] OTHER (SPECIFY)
REMARKS /ADDITIONAL CRITERIA:
DATE: /�` f�
Page 3 of 3
INSTRUCTIONS:
ipaTIM FE' 0: Perrnii tracking cumber cmigneel by CU.
APPLECANT: Property owner's full narn:,•.
AGENT: Property owna's icgally : mprectmtctive.
:I-07, 3LOGX, SULDNISION: Lot, block, and subdivision for EM.
I?:10PERTY :DC 27 character number for 2:rope:v. (property apprairtr 0 or mcticovirlabip/r.r..se/przco: rurr_bc
:?410?:ERTY E: Meek if property lac ct rite conams to (.,-..Lbrnittee, c! cvriIc - c.23
all pLIveri CaT,113 :,nt; pr,;:r„:,:c; :oaf, i4eCti wiftirt pub2c o:: ezr,:i2.C.vo of
1.7./st dry.1:17.3c 77;C::
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11-`1.11. SHG?
to
APPLICATION FOR:
[ ` - New System
[ ] Repair
APPLICANT: :/.✓
AGENT: .- „ f
MAILING ADDRESS:
LOT:
PROPERTY ID #:
PROPERTY SIZE:
PROPERTY STREET ADDRESS:
DIRECTIONS TO PROPERTY:
BUILDING INFORMATION
1
2
3
4
STATE OF FLORIDA
DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES
ONSITE SEWAGE DISPOSAL SYSTEM
APPLICATION FOR CONSTRUCTION PERMIT
Authority: Chapter 381, FS & Chapter 10D -6, FAC
BLOCK:
r f5
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.
PROPERTY INFORMATION [IF LOT IS NOT IN A RECORDED SUBDIVISION, ATTACH LEGAL DESCRIPTION OR DEED]
• ! ACRES [Sgft /43560] PROPERTY WATER SUPPLY: [ ] ]PRIVATE [ 4
Unit Type of No. of
No Establishment Bedrooms
[ ] Garbage Grinders /Disposals [ ] Spas /Hot Tubs [ ] Floor /Equipment Drains
[ ] Ultra -low Volume Flush Toilets
APPLICANT'S SIGNATURE:
[ `J Existing System [ -r Holding Tank [
[ d ]' [ A-Other(Specify)
rr
SUBDIVISION:
6
[ �� RESIDENTIAL
DATE OF
SUBDIVISION:
[Section /Township /Range /Parcel Na.] ZONING:
Building
Area Soft
[
] COMMERCIAL
PERMIT #
DATE PAID
FEE PAID $
RECEIPT 0
F Temporary /Experimental
TELEPHONE:
- r
# Persons Business Activity
Served For Commercial Only
[ ] Other (Specify)
/ /`
H Form 4015, Mar 92 (Obsoletes previous editions which may not be used)
k Number: 5744 - 001-4015 -1)
v
DATE: `
Page 1 of 3
ACA17.CN I: 0.1 Check type of permit, if apecify :ype in blank.
Property owner's full zme.
7:elepiionc number fo: applicant jccn o arjeni.
ilImperty ownerl.;
TV:1_7; `1.179 1\7:3: ?.C.7.)ox atme ' :"; c:
0:7 SJ:7.tlis. IV :7,73N: date a's' !!',' hce
lU t into two or rrori. larcel-. for th:, , :enveyin.3
2rivate o
. ).
:lescription deed :nut:: attr.r.:71er7.
chater 71?.", f.:,2".":11 L.7 CCr"
.‘.`i T") •
`off :c :,Tia;:727-of e.• .;
c' 'c _
may b.: M.A.:eat' caleolatir lot
P.,;D:af ESS: Sct address fcr propt:::y. For loti r.. assigned It ..:er •
: Provide detailed inatiuctone '.ct lot o: attach an area map sl'ow lc: :0er:ion.
131J7,1`...`31lNG KNI Check residentil/ or commercial.
N. 13F.D11001t1S: C'ount all room; designed primarily for sieepim; and 0::pected te :outire! p.
occupants.
r..1st type of ectrblichment from. Tr.ble FAC. 1-my, sirgle wiale
doctor's office.
A.12A ".fotal square fontage of enclotted 17r:bitch:a 17:c of dwellin3 unit, Ec:!::, c •
screened patios or decks. !heed on outside ;;leasummtat‘ta for ace?: o
2:371SONS: Number of oemon.s residinz, ttsint:., or wo:king in ert:.blichmert. Pe: .2., 2 Ter
I?iSi.Nr,riSS AC Ts?:
assumed.
For commercirl applicationa only. rn: of e-7,loyces, a C..2C7 H:0:1 y
Table Z1, Chapter 10D-5, FAC.
Mark each li:Ard fixtura with nurnhe: installed or "NA" if rot nopl.'mtbl';.
Signature 07 applicant or agent. le application on clay SIA:3771.1':': Ch V.;:ip77zZc, fern :
A site orr.wr 10 reale, rhowir-; 0003 witl" • 0:: :7i3,
el:a.ement.!;, or ite r. jra f:rte ce:7'10,!1C ..'7773:27C:27,', any er,intir■
featu:ca, filled areas, o..)structctl. rurface '71 F.'217" 7.31
pertinent facilities ea feature:, zr rC0722 pror?et if ?.: : ': - -c o t2:::; cpplicczt :et. i.
pub:ic well wiliir 2C1 fect of lot.
IFor reridence:, r plan (rd ce ; ^ .:'02
ioor plan • r•
featuras noces.:r.ry to r:o:= LI qu;':.
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.
Plan Approved '
I
—.3
1
Site Plan submitted by
orm 4015 Feb 85 (Obsoletes previous editions which may not be used)
mber: 5744-002-4015-6)
PART II - SITE PLAN
/SIGNATURE
iii c!
Notes: ' __4'
2
-
d a
Not Approved
TITLE
ALL CHANGES MUST BE APPRdVED BY THE COUNTY PUBLIC:HEALTH UNIT
Date (14
County Public Unit
Page 2 of 3
0
T
H
E
R
CONSTRUCTION PERMIT FOR:
{` ] New System [` ] Existing System
[t' ] Repair W) , ] Abandonment
APPLICANT:
PROPERTY STREET ADDRESS:
LOT:
PROPERTY ID #:
STATE OF FLORIDA
DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES
ONSITE SEWAGE DISPOSAL SYSTEM
CONSTRUCTION PERMIT
Authority: Chapter 381, FS & Chapter 10D -6, FAC
BLOCK: SUBDIVISION:
SYSTEM DESIGN AND SPECIFICATIONS
D [ ] SQUARE FEET PRIMARY DRAINFIELD SYSTEM
R [ ] SQUARE FEET SYSTEM
A TYPE SYSTEM: [ ] STANDARD [ ] FILLED
I CONFIGURATION: [ ] TRENCH ( ] BED
N
F LOCATION OF BENCHMARK:
I ELEVATION OF PROPOSED SYSTEM SITE [
E BOTTOM OF DRAINFIELD TO BE [
L
D FILL REQUIRED: [ ] INCHES
SPECIFICATIONS BY:
APPROVED BY:
DATE ISSUED:
- -H Form 4016, Mar 92 (Obsoletes previous editions which may not be used)
-ck Number: 5744- 001 - 4016 -0)
„] Holding Tank [
PERMIT #
DATE PAID
FEE PAID $ % 1+
RECEIPT #
Temporary /Experimental
1 Other(Specify)
AGENT:
[SECTION /TOWNSHIP /RANGE /PARCEL NUMBER]
[OR TAX ID NUMBER]
y '.. ' q
n �
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. 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.
] [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: [ ]
TITLE:
[ ] MOUND
[
] [INCHES /FT] [ABOVE /BELOW] BENCHMARK /REFERENCE POINT
] [INCHES /FT] [ABOVE /BELOW] BENCHMARK /REFERENCE POINT
EXCAVATION REQUIRED: [ ] INCHES
EXPIRATION DATE:
TITLE: CPHU
Page 1 of 2
:?rop■:rty
. ...Q1.0 . ■J ' 1101"!■: •
autn(Hzcd :Tvc.
!;o7: - • ' f.o:. o...
. . .
:
ps:,:elli....ations. such E:. -
Name of individial providing speeificatio'w. ..i by r. ssr:
3 .? County Public Fealth Unit 2eramnel
•ATTE :SSUED: Date permit is issued by Cf
D One year from Cate issued if the system been installed. fo: renr.i...i 11.7.0 Mile void Cl dr.r.;
issued.
4
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Date 7" ,fi 7 7P Job Address 9/6 N4( 96 - r'4'l ' Tax Folio
Legal Description ��' / % .z b,1
/
Owner / Lessee / Tenant �' / / O f ;/0.to f Master Permit # g. Ve Y
Owner's Address 9/ / 6 r7'ee / Phone
Contracting Co. Al/i r /4/34At ✓ 2 Address A9/5 / 2/e!' 4 M/eve'
Qualifier CGWu rd J G'h /Iev SS# .f:?or G.r.' .7O .T/
State # CA5aVi /9, Municipal # Competency # Ins.Co. X re t,'G i
Architect /Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type(circle one): BUILDING ELECTRICAL LUMBIN MECHANICAL / ROOFING PAVING / FENCE SIGN
WORK DESCRIPTION f y Gild de/' 1 _r`to1.✓e-✓r / L✓ - C'f e ✓ j / G( •
Square Ft. Estimated Cost(value) / 4,Jw do
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 -named contractor to do the work stated. .
** *
FEES: PERMIT
Signature of owner and /or Condo President
Date:
Notary as to Owner and /or Condo President
My Commission Expires:
APPROVED:
* *
Zoning
* * * * *
RADON C.C.F.
Buildin
Mechanical Plumbi
Signature of Contactor or Owner- Builder
Date: ' 7 2 7- 'et o oR , % Ines Montero
* *My Commission CC882422
Expires September 22, 200
N. ary as to Contractor or Owner- Builder
y Commission Expires:
Fire Other
NOTARY TOTAL DUE
Electrical
Engineering
ITEN
BAT}i its
BIDET
UNIT
FEE
1TE1
SNITCH WILETS
LIGHT OJTLETs
IKNIT
FEE
ITEM
SPACE HEATERS
UNIT
FEE
CF tE A TING
eistoAS R
RECEPTACLES
Alt (1110)
o I SP0SAL
SERVICE TtWORARY
A/C (CENTRAL t
ORDOCDG FOIMTAIN
SERVICE SIZE IN AMPS
OICT RORK
fLOOR DRAIN
SERVICE REPAIR/1ETER Ma
REFRIGERATION
GREASE TRAP
APPLIANCE CUTLETS
PIKES AND PRESS PIPING
INTERCEPTOR
RANGE TOP
UN CER01OU IC TANKS
LAVATORY
OVEN
AADVE GRIM MSS
wart TRAY
RATER HEATER
U.F. PRESSUM VESSELS
CLOVES RASHER
1aTORS 0 1 HP
STEAM BOILERS
SNORER
10TORS OVER 1- 3 HP
TOT MAO BOILERS
SINK. POT/3 cm.
IOTORS OVER 3- S NP
MEXIA IICAL VENTILATION
SINX. RES1' 6
IOTOtS DYER S a HP
TRANSPCSTING ASSUMES
SINK. SLOP
NOTDRS OVER 11- 10 HP
ELEVATOtS/ESCALATM>IO;
TEA M/RY RATER CLOSET
113TERS OVER 10- 25 HP
F IRE SPIT IMO.ER MIDIS
URINAL
I TMS OVER 25 HP
=MG 1DRERS
RATER CLOSET
TOT= OVER 100 1P
VIOLATION
1,0 IRECT DUES
A M
RE Il6PECf 1011
MATER SUPPLY TO:
O PCOM t
A/C UNIT
STRIP HEATER
F IRE SPAIN LER
OtTERATERS TRANSFORMERS
HEATER-AN 116T.
GENERATORS 1R011SFOORRS
II
?SEATS-REPLACE
GENERA= AS TRAHI PERIERS
LAN SPRINCLER -RELL
SIIIWRG POOL
RATER SERVICE
SPECIAL APPOSE
WR.ETS COIREN:IAI
SIGN TUBES
1111111
SEVER KHNECTURS
SIGN TRANSFONERS
UTILITY -SET
SION TIME CLOCK
UT iL HTI- HATTER
F IXTLAES
SEPTIC TAROK
AHREHNA
RELAY
TELEVISION URLETS
GRAINFIELD. A' TILE/RES.
VIOLATION
PU1P 1 ABANDON SEPTIC TAN(
REINSPECTtON
SOAKAGE PIT W FT.
CATCH BASIN
'
OISt71ARGE WELL
=WIC WELL
AREA DRAIN
ROOF ULET
SOLAR RATER HEATER
FIRE STANDPIPE
POOL PKPIAG
_
LANK SPRINKLER SYSTEM
GAS RAKE
NETER SET GAS)
GAS PIPUT.
.
1
Jul -27 -98 02:37A MARLIN PLUMBING OF MIAMI 305 -652 -3135 P.02
ADDENDUM TO BUILDING PERMIT APPLICATION
(AN APELICATION FOR BUILDING P='m IT MUST ACCOMPANY THIS ADDENDUM. IT A MASTER PERMIT HAS B,
OBTAINED, THE OVNER•S NOTARIZED SIGNATU NUM NOt BE PRESENT ON SUBSEQUENT APPLICATIONS.)
9/6 e �� S " /? r %n PlOon
PLUMBING ELECTRICAL
MECHANICAL
„,, c -
Date f t? Job Address `7 li/ / (- C
Legal Description Historically Designated: Yes No
Owner/Lessee / Tenant db E L i S C1
Owner's Address
Contracting
Qualifier
OWNER'S
laws regula
Si
Notary as to
0
My Commissi
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
,14("0%•,-// it 2
Architect/Engineer
Bonding Company ter' Address
Mortgagor i��” 1 �
Permit Type (circle one): BUILDING ELECTRICA
WORK DESCRIPTION of A
er and/o6c0o President Date
PUBLIC - STATE OF FLORIDA
LUIS MONTERO
COMMISSION N CC711335 !20
EXPIRES 1/2702
D THRU ASA 1 388- NOTARYI
S101,-/' ndo President Date
•n
(:).„
Tax Folio
Master Permit # - 3 3 ? V
51 ( ( S ktE s Phone 757, gc9
Address
Address 6 _ Gzd /,ice
SS# g 6 ,
State # 4 C4 Z/ «S 3 Municipal # f4 . Competency # $ J C. Ins. Co. /44.4,54/ 29
Address - 44
ECHANICAL ROOFING PAVING FENCE SIGN
-feczo /< '10 (0IJ) c
rC���
Square Ft. Estimated Cost (value) �. 00
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 al work will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that separate
permits are re ' ' ed for ELECTRICAL, PLUMBING, SIGNS, POOLS, ROOFING and MECHANICAL WORK.
IDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable
nstruction and zoning. Furthermore, I authorize the above -named contractor to do the work stated.
Signa - of Contractor or Owner- Builder Date
otary as to Contractor or Owner- Builder • Date
My Commission Expires
FEES: PERMIT S (,' RADON ' C.C.F NOTARY BOND
TOTAL DUE
APPROVED:
Zoning Building Electrical
Mechanical Plumbing
.j■) a \ Engineering
' 4?c , 9eta,t,
9.5"'
M-Pa.
DATE:
SHEET : 1 OF I SCALE: NTS
Drawn by:
Cust Sign:
E
1
9
l
1
O
(
4o
TECO: PEOPLES GAS
(ZAka-.
THE PROPOSED SERVICE LINE:
FORA TOTAL FOOTAGE OF
I N S E W
ENTERS THE ❑ ❑ ❑ ❑ P!L (ft) FROM THE MAIN
THROUGH
R
Q °cog (t1)
NS E W .. 6 ' os
- ❑ 0 ❑ ❑ _ _ ❑ n ❑ ❑ ❑ 0 0 n
❑❑❑❑__❑rr ❑ ❑0❑ ❑
0000 ❑. 0 0 0 0❑ n
• ❑ ❑ ❑ ❑ _ _ 0 n 0 ❑ ❑ ❑ ❑ n
00 ❑❑_•_.0n 00 0001
❑ ❑ ❑ 0 _ _ 0 n ❑ ❑ 0 ❑ ❑ n
❑❑❑❑__ ❑n ❑❑❑❑ ❑n
0 ❑0o__ ❑n 00❑❑0n
MAIN
size
11
JO:
AFE:
ATLAS:
BLOCK: LOT:
THE RISER IS TO EIE LOCATED:
N S E W
ON THE ❑❑[]❑
❑❑❑❑
(ft) 4 EW
0 ❑ 0 ❑
❑ ❑ ❑ ❑
❑ 0 0 0
1 i
type ❑ steel _
0 plastic
400 O?rz7
P14 flj,vl
° W/e{//
6c) up
0`a Od
side of ❑ n
0 1
side of ❑ n
on
❑ n
1
RAN SIZE
PERMIT RECTO