PLUMBING24 Hour Service
Licensed & Insured
BOB
• SEPTIC 8 DRAIN, INC.
Septic Tanks • Grease Traps
CC SR09111 Drains • Sewer Jetting
P.O. Box 16 State Certified • Septic Tank Contractor
North Miami, FL 33261 -2333
DADE (305) 558.5818
BROW (954) 920 -5099
Bob Paril /a
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Date / Job Address /00 A.,'r 9 571 Tax Folio
Legal Description Historically Designated: Yes_ No
] )�
Owner/Lessee / Tenant
Owner's Address
Contracting Co.
Qualifier
State # S 9 o " Z 1 1� Co Municipal #
Architect/Engineer
Bonding Company
Mortgagor
I00 A(JE
612'
b h 1
Permit Type (circle one): BUILDING ELECTRICA
WORK DESCRIPTION I to 1 //Fr n L)
Square Ft.
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 d.
ignature of owner and/or Condo President Date
k /AM I / 4
FEES: PERMIT 3] RADON
APPROVED:
Zoning
Mechanical Plumbing
Building
PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
Master Permit #
Phone�-� e 7,5 -" Q - S
Address /00 /V C 3 0 ST k ` LI„
Phoiee3d9 ,S - P/
Competency # Ins. Co. 6 Z) f u ),AC
Address
Address
Address
or - 7,6qtk) -TIE 1
Estimated Cost (value)
C.C.F. ' ° NOTARY
'
1/4
•.: v NO'TARYSEAR.
V1LLAR
NOTARY PUBl1C STATE OF FLORIDA
COMMISRON NO. CC7I4103
MY COMMISSION EXP. MAR. fl
l bd D, =
BOND W
O
TOTAL DUE 3 ,3S '
CONSTRUCTION PERMIT FOR:
[0 New System [ 'tee] Existing System
] Repair [4 /] Abandonment
Y
APPLICANT: 0
(- L' B / / i
PROPERTY STREET ADDRESS:
LOT:
,
P11 tY/jI
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D
R
A
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F
I
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0
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TYPE SYSTEM:
CONFIGURATION:
BLOCK:
FILL REQUIRED:
APPROVED BY:
DATE ISSUED:
1
STATE OF FLORIDA
DEPARTMENT OF HEALTH
ONSITE SEWAGE DISPOSAL SYSTEM
CONSTRUCTION PERMIT
Authority: Chapter 381, FS &
/ !"
(
( ] GALLONS PER DOSE
(
(
] INCHES
SYSTEM DESIGN AND SPECIFICATIONS
ALL'ONS`q GPDrSEPTICLTAjK /AEROBIC UNIT
1 TGA7'1:ON"S / GPD�
] GALLONS GREASE INTERCEPTOR CAPACITY
DOSING TANK CAPACITY
[ IY
I:: SQUARE FEET DRAINF'TELD SYSTEM
[
SPECIFICATIONS BY: TITLE:
SUBDIVISION:
DH 4016, 10/96 (Replaces HRS -H Form 4016 [page 1) which may be used)
(Stock Number: 5744- 001 - 4016 -0)
] STANDARD [ ] FILLED
] TRENCH [ ] BED
M1
Chapter 10D -6, FAC
Holding Tank
Other(Specify)
Building Department
AGENT:
[
[
LOCATION OF BENCHMARK: fi
ELEVATION OF PROPOSED SY TEM SITE o] [ /FTt [ABOVE /BELOW]
BOTTOM OF DRAINFIELD TO BE ( pa a „[X . NCHES /FT] [ABOVE/BELOW]
EXCAVATION REQUIRED: ( ] INCHES
TITLE:
PERMIT #
DATE PAID
FEE PAID S' ' / /
RECEIPT AE /,,r • '(
[ ] Temporary /Experimental
JV
a
y / - f f -
[ SECTION /TOWNSHIP /RANGE /PARCEL NUMBER]
F• / _ ! .. 2 .E J OR TAX ID NUMBER]
CAPACITY MULTI- CHAMBERED /IN SERIES:( ]
CAPACITY MULTI- CHAMBERED /IN SERIES:[ ]
[MAXIMUM CAPACITY SINGLE TANK: 1250 GALLONS]
DOSE •RATE [ ] PER 24 HRS NO. OF PUMPS: [ ]
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.
] MOUND [ ]
]
BENCHMARK /REFERENCE POINT
BENCHMAR]t /REFERENCE `'POINT
EXPIRATION DATE:
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 10D -6, FAC.
DRAINFIELD: Minimum specifications from Chapter 1OD -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.
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.
BUILDING
ELECTRICAL
PLUMBING
ROOFING
Owner of
Building
Architect
Contractor
or Builder
Legal
Description
Lot
❑ PERMIT N? 3736
❑ Work to be performed under this Permit
o F
CONTRACTOR OR BUILDER
MIAMI SHORES VILLAGE, FLORIDA
B1
DATE. * ' 19
Contractors '-',;
License No. -'
Subdi-
vision
Address of
> /I ,,=-' Value of
Building ;`` y t Project $
This permit is granted to the contractor or bui 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 stateme is 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 with all ordinances and regulations
pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authdrities of Miami Shores Village. In ac•
cepting this permit I assume responsibility for all work done by either, myself, my agent, servant or employee.
r
Amount of
Permit $
BY AUTHORITY
ABBOT PRINT