Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
PLUMBING
I'enni; Nu. .W - t .. MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT 17 Date ..Jl.. `.. ..r_ ._.... __ .__. :Ipphc :liIon is hereby made for the approval of the detailed statement of the plans and specifications herewith subr tt' .1 for the building or other rtructurc herein described. This application is made in compliance and conformity with the Building Ordinance of Mix I Shores Village, Florida, a,1d all provisions of the Laws of the State of Florida, all ordinances of Miami Shores Village and all rules and regulatic- of the Building Division of Miami Shores Village shall be complied with, whether herein specified or not. A copy of approved plans and spec fications must be kept it 1>uilding during progress of work. A /�� {� ')wnei s Name and Address..__! -!�r —L.`. GG�_ —_. �-•- -..._. No /2.1 Street -._CF A' ,egist:red Architect and /or Engineer :mploy{ng Plumber's Name ..pv1t0it1_ SystLFAts .rofe.. 8treet..11.4Nit-it c� Block Street and Number where work is to be performed —No X122- Street. . .4 -6 -.• State work to be performed and purpose of building (By Floors)---- /.__.7.t/_:.C_•..._ ._L-1-__A / i .._S?11afr.f New Building ........... Remodeling_ — ..... Addition Repairs No of Stones Location and Legal Description Lot. Size Septic Tank..... - - - - - -. - .--- - - - - -- -Type of Tank___ _ Capacity ^ ,als.. _. Feet of Drain Tile._ -._ -_ __---- .- _,.-Dist. Feet of Tank or Drain Field from Well ... .• •-- . - - -. - - -_ - .. Nature of Water Supply: City — Well..____-- ._. - - -..- _ - - - - -- - .-- . - -_ -_ -. -Size of Soakage Pit Amount of Permit 8..t!46 The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations as an e n;)losei of labor under the Florida Workmen's Compensation Act, being Section 5988, Compiled General Laws of Florida Permanent rum lement, and lids eori- z.livd with the provisions thereof, and will require similar compliance from all contractors or sub- contractors employed 1 y him in • e GI ak i� b performed under this permit; and will post or cause to be posted' for inspection on the site of the work such pabl: notice n no icer +s a required by the Act. The undersigned agrees to employ only such sub - contractors, on work to be performed r.,s this rI sii ar . licensed by Miami Shores Village. STATE OF FLORIDA, COUNTY OF DADE. Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, periurr; ; opearw 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 tint all acts therein by him stated are true. My Commission Expires (Si -L. C! /. (Signed)._ - -- - " - -. /11`[7[i711"-' Ii Notary Public, State of Florida Plumbing Inspector 1 • ........... Mast 3s, Plumber. NOTE: A re- inspection fee of 81.00 will be made when such re-inspection L made by improper notice for inspection, tlr fruity materials and /or workmanship. CLO•CT• BATH TUB• SHOWIR• LAVA• y SINK• SLOP SINKS LAUNDRY Twos URINALS CATCH BASIN FLOOR DRINKING DRAIN FOUNT' N• .....,...........1 . TOT..L FIMTI Rcs - CONTR. LI T / CHICK SEPTIC TANK SEWER CONN. DRAIN FIELD SOAKAGE PIT G TRAP SOLAR HEATER DEEP WELL SPRKLR. SYSTEM SW IM'O POOL T cONTR, LIST i _ CHICK I -_ L■, - I'enni; Nu. .W - t .. MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT 17 Date ..Jl.. `.. ..r_ ._.... __ .__. :Ipphc :liIon is hereby made for the approval of the detailed statement of the plans and specifications herewith subr tt' .1 for the building or other rtructurc herein described. This application is made in compliance and conformity with the Building Ordinance of Mix I Shores Village, Florida, a,1d all provisions of the Laws of the State of Florida, all ordinances of Miami Shores Village and all rules and regulatic- of the Building Division of Miami Shores Village shall be complied with, whether herein specified or not. A copy of approved plans and spec fications must be kept it 1>uilding during progress of work. A /�� {� ')wnei s Name and Address..__! -!�r —L.`. GG�_ —_. �-•- -..._. No /2.1 Street -._CF A' ,egist:red Architect and /or Engineer :mploy{ng Plumber's Name ..pv1t0it1_ SystLFAts .rofe.. 8treet..11.4Nit-it c� Block Street and Number where work is to be performed —No X122- Street. . .4 -6 -.• State work to be performed and purpose of building (By Floors)---- /.__.7.t/_:.C_•..._ ._L-1-__A / i .._S?11afr.f New Building ........... Remodeling_ — ..... Addition Repairs No of Stones Location and Legal Description Lot. Size Septic Tank..... - - - - - -. - .--- - - - - -- -Type of Tank___ _ Capacity ^ ,als.. _. Feet of Drain Tile._ -._ -_ __---- .- _,.-Dist. Feet of Tank or Drain Field from Well ... .• •-- . - - -. - - -_ - .. Nature of Water Supply: City — Well..____-- ._. - - -..- _ - - - - -- - .-- . - -_ -_ -. -Size of Soakage Pit Amount of Permit 8..t!46 The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations as an e n;)losei of labor under the Florida Workmen's Compensation Act, being Section 5988, Compiled General Laws of Florida Permanent rum lement, and lids eori- z.livd with the provisions thereof, and will require similar compliance from all contractors or sub- contractors employed 1 y him in • e GI ak i� b performed under this permit; and will post or cause to be posted' for inspection on the site of the work such pabl: notice n no icer +s a required by the Act. The undersigned agrees to employ only such sub - contractors, on work to be performed r.,s this rI sii ar . licensed by Miami Shores Village. STATE OF FLORIDA, COUNTY OF DADE. Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, periurr; ; opearw 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 tint all acts therein by him stated are true. My Commission Expires (Si -L. C! /. (Signed)._ - -- - " - -. /11`[7[i711"-' Ii Notary Public, State of Florida Plumbing Inspector 1 • ........... Mast 3s, Plumber. NOTE: A re- inspection fee of 81.00 will be made when such re-inspection L made by improper notice for inspection, tlr fruity materials and /or workmanship. PERMIT APPLICATION FOR MIAMI SHORES VILLAGE Date 3 - . - o o J o b A d d r e s s / a s N. F 9 P f Tre S-. Tax Folio I/ 3 a 0 S- o f cc, - 0 3 7 0 Legal Description Owner/Lessee /Tenant [3rA 61c 4- Owner's Address / N • e 9 P _Ire Contracting Co. a) M 4 s i e r, Qualifier �- ?- State # 0 0 SJ Square Ft. 3 7Sio Signature of o FEES: PERMIT j:. ..e,+ Architect/Engineer Bonding Company .41/4 . Mortgagor Ay Permit Type (circle one): BUILDING ELECTRICAL WORK DESCRIPTION otary as t .'Owner and/or Condo President My Commission Expires: S RADON Municipal # e p o s " r,f LA), ,C' ►, c A w . Master Permit # /- /. e. S. o o 42 - / I f-CEO' er and/or ondo Preside Date -0 Date ANNA QUINONES MY COMMISSION # CC 883662 EXPIRES: Odt 28.2003 1- eo0- 3-NOTARY Fle. NoUry SeN1016 londi^9 Co. APPROVED: Zoning Building Mechanical Plumbing Z..�, Address /.3 I. 9 w. U. 7 r �. 1 .t Historically Designated: Yes No Phone 3 0 s- 9 ro - L y Competency # Address 3 10) 6 OP , Q 0 • Estimated Cost (value) Phone ,305 - 7s/ - yL�� 0 01 j. Ins. Co. l '�.s Address Address ECHANICAL ROOFING PAVING FENCE SIGN 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. Signature of Contractor or Owner - Builder Notary as to Contractor or Owner - Builder My Commission Expires: C.C.F. (, 2 NOTARY Electrical 9 /.r: to o . 0 0 Ali :. 'JONES MY CON. 4e CC 883662 EXPIHL..' 28, 2003 ARY Flo. Not Service d Bonding Co. BOND 3 08 Date Date TOTAL DUES S/ - Engineering R SPECIFICATIONS BY: APPROVED BY: DATE ISSUED: 5\1 \CPO STATE OF FLORIDA - DEPARTMENT OF HEALTH ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM CONSTRUCTION PERMIT REPAIR CONSTRUCTION PERMIT FOR: �. ll toil New System Existing System [ Holding Tank [ Innovative .[J Repair Abandonment [ Temporary APPLICANT: S *$ A .4%. 1w A01.2 k:. � f t 2 c` PROPERTY ADDRESS: 11 t L i`+ � { - LOT: BLOCK: 1 t a SUBDIVISION: L Lp4p i + 11 .i 4 . [SECTION, TOWNSHIP, RANGE, PARCEL NUMBER] 1 PROPERTY ID #: 1 1 3 0 J - o t 8 0 3 [OR TAX ID NUMBER] SYSTEM MUST BE CONSTRUCTED IN ACCORDANCE WITH SPECIFICATIONS AND STANDARDS OF SECTION 381.0065, F.S., AND CHAPTER 64E -6, F.A.C. DEPARTMENT APPROVAL OF SYSTEM DOES NOT GUARANTEE SAFTISFACTORY 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. ISSUANCE OF THIS PERMIT DOES NOT EXEMPT THE APPLICANT FROM COMPLYANCE WITH OTHER FEDERAL, STATE, OR LOCAL PERMITTING REQUIRED FOR DEVELOPMENT OF THIS PROPERTY. SYSTEM DES UN AND .SPECIFICATIONS T [ ] GALLONS / GPD SEP EROBIC UNIT CAPACITY MULTI- CHAMBERED /IN- SERIES [ ] A [ ] GALLONS / GPD CAPACITY MULTI- CHAMBERED /IN- SERIES [ ] N [ ] GALLONS GREASE INTERCEPTOR CAPACITY [MAXIMUM CAPACITY SINGLE TANK: 1250 GALLONS] K [ ] GALLONS DOSING TANK CAPACITY [ ]GALLONS @ [ ] DOSES PER 24 HRS # PUMPS [ 1 D [.300] SQUARE FEET PRIMARY DRAINFIELD SYSTEM R [ ] SQUARE FEET SYSTEM ,�/ A TYPE SYSTEM: [ STANARD p ] FILLED JOY/MOUND I CONFIGURATION: [ TRENCH [ 1 [ 11.71%). .......... , F LOCATION OF BENCHMARK: / a 3 0 / , I ELEVATION OF PROPOSED SYSTEM SITE [la G ] [I r -/FT] [ABOVE/ E BOTTOM OF DRAINFIELD TO BE (4 ` ] [414a1,-/FT] [ABOVE/ BENCHMARK /REFERENCE POINT BENCHMARK /REFERENCE POINT , MC D FILL REQUIRED: [/.4 t INCHES EXCAVATION REQUIRED: [ 3 Q ] INCHES o rr _ INST of LOAMY COARSE SAND T H E 1 ` AIKA A TITLE: DH 4016, 12/99 (Page 1) (Prebious:Editions May Be Used) pt. 1: Health Departmen• ` • pt. 2: Applicant pt. 3: Instal ler /Contractor pt. 4: Building Department Uautn BOTTOM OF DRAT +irLI , f n 0 P VP INVERT ELEVATION 1db, V J PERIMETER OF E1 C `.'. iTION ARFA AT LEAST 2.0 FEET WIDER AND LCNCEI THAI' THE ED AI SOR¢ T Ira RED OR DRAIN TREFICN CHD EXPIRATION DATE: PERMIT NO. QQjt : /4 f 4 DATE PAID: 41-404. qp FEE PAID: _ RECEIPT #: 3 Page 1 of 3 INSTRUCTIONS: PERMIT NUMBER: Permit tracking number assigned by CPHU. CONSTRUCTION PERMIT FOR: Check type of permit, if "Other" specify type in blank. APPLICANT: Property owner's full name. SYSTEM DESIGN AND SPECIFICATIONS: TELEPHONE: Telephone number for applicant or agent AGENT: Property owner's legally authorized representative. MAILING ADDRESS: P.O. Bon or street mailing address for applicant or agent. LOT, BLOCK, SUBDIVISION or PROPERTY I® #: 27 character id number for property. (CHD may require property appraiser IID # or section/township/range/parcel nu. ::her) TANK: Minimum specifications from Chapter 64E-6, IFAC. DRAIN(FEELD: Minimum specifications from Chapter 64E-6, JFAC. OTHER: Other specifications, such as operating permit requirements, low - volume flush toilets, variance provisos. SPECIFICATIONS BY: Name of individual providing specifications. llf designed by a registered engineer must be sealed. APPROVED BY: County Health Department (CIED) personnel reviewing and approving per ±. DATE ISSUED: Date permit is issued by CHD EXPIRATION DATE: One year from date issued if the system has not been installed. Permits for system repairs become void 99 days from ti :e date issued. t APPLICATION FOR: [V] New System (4/) Existing System [A] Holding Tank [Ail Temporary /Experimental [y] Repair [ ] Abandonment (A/) Other(Specify) APPLICANT: n n II /"jr1Ahl Q *)r' �C/( AGENT: MAILING ADDRESS: / 3 6, 1),G- 7 Y l Y 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] LOT: BLOCK: SUBDIVISION: DATE OF a0 iRD 2 PV, /0l. 1'414 HI sy ei SUBDIVISION. 19Y 7 PROPERTY ID #: [Section /Township /Range /Parcel No.] ZONING: /,yo n /fr- (37' PROPERTY SIZE: ACRES [Sgft /43560] PROPERTY WATER SUPPLY: [ y] PRIVATE [ ] PUBLIC 0. ). 07 / PROPERTY STREET ADDRESS: - T -95 k ys J DIRECTIONS TO PROPERTY: D r' A -11 ',4 S 2ti� BUILDING INFORMATION ['/] RESIDENTIAL Unit Type of No. of No Establishment Bedrooms 1 2 3 4 v..• Garbage Grinders /Disposals ] Ultra -low V.prml Flush Toilets APPLICANT'S SIGNATURE DH 4015, 10/96 (Replaces HRS -H Form 4015 (Page 11 which may be used) (Stock Number: 5744- 001 - 4015 -1) STATE OF FLORIDA DEPARTMENT OF HEALTH ONSITE SEWAGE DISPOSAL SYSTEM APPLICATION FOR CONSTRUCTION PERMIT Authority: Chapter 381, FS & Chapter 10D -6, FAC /V .- j4 / h4,144'1 c Building Area Sgft ( ( 4 Spats Tubs [,A/] Othe 'l ( Specify) ] COMMERCIAL PERMIT # DATE PAID FEE PAID $ RECEIPT 1 3' TELEPHONE: 9 Yo- # Persons Business Activity Served For Commercial Only Floor /Equit 5 DATE: , j - / - © J INSTRUCTIONS: 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, city, state and zip code mailing address for applicant or agent. LOT, BLOCK, SUBDIVISION: PROPERTY SIZE: Lot, block, and subdivision for lot (recorded or unrecorded subdivision). If lot is not in a recorded subdivision, a copy of the lot legal description or deed must be attached. DATE OF SUBDIVISION: Official date of subdivision recorded in county plat hooka (month /day /year) or date lot originally recorded. Dividing an approved lot into two or more parcels for the purpose of conveying ownership shall be considered a subdivision of the lot. PROPERTY ID#: 27 character number for property. (Health Department may require property appraiser ID# or section /township /range /parcel number.) Net usable area of property in acres (square footage divided by 43,560 square feet) 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. Contiguous unpaved and noncompacted road rights -of -way and easements with no subsurface obstructions may be included in calculating lot area. WATER SUPPLY: Check private or public. PROPERTY ADDRESS: Street address for property. For lots without an assigned street address, indicate street or road and locale in county. DIRECTIONS: Provide detailed instructions to lot or attach an area map showing lot location. BUILDING INFORMATION: Check residential or commercial. TYPE ESTABLISHMENT: List type of establishment from Table II, Chapter IOD-6, FAC. Examples: single family, single wide mobile home, restaurant, doctor's office. NO. BEDROOMS: Count all rooms designed primarily for sleeping and those areas expected to routinely provide sleeping accommodations for occupants. BUILDING AREA: Total square footage of enclosed habitable area of dwelling unit, excluding garage, carport, exterior storage shed, or open or fully screened patios or decks. Based on outside measurements for each story of structure. # PERSONS: Number of persons residing, using, or working in establishment. For residential establishment, 2 persons per bedroom are assumed. BUSINESS ACTIVITY: For commercial applications only. List number of employees, shifts, and hours of operation, or other information required by Table II, Chapter 1OD -6, FAC. FIXTURES: Mark each listed fixture with number installed or °NA" if not applicable. SIGNATURE: Signature of applicant or agent. Date application on day submitted to Health Department with appropriate fees and attachments. ATTACHMENTS: A site plan drawn to scale, showing boundaries with dimensions, locations of residences or buildings, swimming pools, recorded easements, onsite sewage disposal system components and location, slope of property, any existing or proposed wells, drainage features, filled areas, obstructed areas, and surface water. Location of wells, onsite sewage disposal systems, surface waters, and other pertinent facilities or features on adjacent property, if the features are with 75 feet of the applicant lot. Location of any public well within 200 feet of lot. For residences, a floor plan (residences) showing number of bedrooms and building area of each unit. For nonresidential establishments, a floor plan showing the square footage of the establishment, all plumbing drains and fixture types, and other features necessary to determine composition and quantity of wastewater. Notes: By Site Plan submitted by: Plan Approved ✓ STATE OF FLORIDA DEPARTMENT OF HEALTH APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PER Permit Application Number A:44 a"P Scale: Each block represents 5 feet and 1 inch = 50 feet. re PART II - SITE PLAN- Signature Not Approved filth 4 7 .-/ .1.2(13-7/ a7 S.i r P. ) • Ttle Date 1 : County Health epartment ALL CHANGES MUST BE A BY THE COUNTY HEALTH DEPARTMENT DH 4015, 10/96 (Replaces HRS-H Form 4015 which may be used) (Stoc( Number: 5744 -002. 4015.6) APPLICANT: 13rigN OAP /, ir PROPERTY ID #: STATE OF FLORIDA DEPARTMENT OF HEALTH ONSITE SEWAGE DISPOSAL SYSTEM SITE EVALUATION AND SYSTEM SPECIFICATIONS / /• ,)3 SUBDIVISION: PROPERTY SIZE CONFORMS TO SITE PLAN: (.,.4 ES [ ] TOTAL ESTIMATED SEWAGE FLOW: 3 p o GALLONS AUTHORIZED SEWAGE FLOW: 5I9 GALLONS UNOBSTRUCTED AREA AVAILABLE: G p-0 SQFT SITE SUBJECT TO FREQUENT FLOODING: [ ] YES [ ] NO 10 YEAR FLOOD ELEVATION FOR SITE: FT MSL /NGVD SOIL PROFILE INFORMATION SITE 1 SHar 3, Munsell # /Color Texture 1 0 7 r Y /3, SALyi Q rn „rti. SA..s- USDA SOIL SERIES: U r Depth n y to to to to to to "1'• . SOIL TEXTURE /LOADING RATE FOR SYSTEM SIZING: Q DRAINFIELD CONFIGURATION: [ ] TRENCH [ '9] BED [ ] REMARKS /ADDITIONAL CRITERIA: )-•I )n,1l( 1, t-) .€rLowao) SITE EVALUATED BY: DH 4015, 10/96 (Replaces HRS -H Form 4015 [Page 3] which may be used) (Stock Number: 5744 - 003 - 4015 -1) .�- .,,.: -,• .tea.: - AGENT: - ,: - pqmr , ...” . c. ram PERMIT # 00 LIL Or/ fioid Ad t 7A LOT: "e) BLOCR: /8v M ],aM S'No.Pl [Section /Township /Rang No. or Tax ID Number] iLate TO BE COMPLETED BY ENGINEER, HEALTH UNIT EMPLOYEE, OR OTHER QUALIFIED PERSON. PROVIDE REGISTRATION NUMBER AND SIGN AND SEAL EACH PAGE OF SUBMITTAL. COMPLETE ALL ITEMS. ENGINEER'S MUST NO NET USABLE AREA AVAILABLE: n,107 ACRES PER DAY [RESIDENCES -TABLE 1 / OTHER -TABLE 2] PER DAY [1500 GPD /ACRE OR 2500 GPD /ACRE] UNOBSTRUCTED AREA REQUIRED: ,Gp J • SQFT BENCHMARK /REFERENCE POINT LOCATION: 1 0 L I1070' - f(,,,, /),0 , ELEVATION OF PROPOSED SYSTEM SITE IS 3 [INCH FT] [ABOVE te W BENCHMARK /REFERENCE POINT THE MINIMUM SETBACK WHICH CAN BE MAINTAINED FROM THE PROPOSED SYSTEM TO THE FOLLOWING FEATURES: SURFACE WATER: 0 ) , 4 1 . FT DITCHES /SWALES: 1)!N . FT NORMALLY WET? [ ] YES d NO WELLS: PUBLIC: l ]v. FT LIMITED USE: ) ON 1 FT PRIVATE: AT ,FT NON- POTABLE: SO FT BUILDING FOUNDATIONS: S 7, FT PROPERTY LINES: T FT OTABLE WATER LINES: 10 FT 10 YEAR FLOODING? [ ] YES [ ] NO SITE ELEVATION: g.0 FT MSL /NGVD O 44te. SOIL PROFILE INFORMATION SITE 2 Munsell # /Color Texture /lye Sy') _S n v 0) /777/_ .ei>. /,w,,c ar• USDA SOIL SERIES: Depth 0 to to frF • y,f to to to to to to to ' U r •- CA nJo 1 • t OBSERVED WATER TABLE: ? INCHES [ABOVE / BELOW] EXISTING GRADE. TYPE: [PERCHED / APPARENT] ESTIMATED WET SEASON EfTABLE ELEVATION: 5'f' [ ABOVE / �� ;yt:y J EXISTING GRADE. H IGH WATER TABLE VEG TATION: [ ] YES [ ] NO MOTTLIN [ ] YES [ ] NO DEPTH: INCHES DEPTH OF EXCAVATION: - 3p INCHES OTHER (SPECIFY) DATE: S- - / - 0 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: Record the estimated sewage flow for the establishment from Table 1 (residence) or Table 2 (non - residential), Chapter I0D -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. FLOOD INFORMATION: Record information on lot's subject to flooding. For lots subject to flooding record 10 year flood elevation for site and actual site elevation. SOIL PROFILE INFORMATION: 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. WATER TABLE: 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. SOIL TEXTURE: 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 [ + ] SHOT H.I. H.I. H.I. H.I. [ - ] SHOT [ - ] SHOT [ - ] SHOT - -+ CLOSETS BATH Tues SHOWERS LAVA. TORIES SINKS SLOP SINKS LAUNDRY Tues URINALS CATCH BASIN FLOOR DRAIN DRINKING FOUNT'NS TOTAL FIXTURES ' CONTII. LIST CHECK SEPTIC TANK SEWER CONN. DRAIN FIELD SOAKAGE PIT GREASE TRAP SOLAR HEATER DEEP WELL SPRKLR. SYSTEM SWIM'G POOL CONTR. LIST CHECK ,?l Pamt,it r3o.____ / 7 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 Size Septic Tank Registered Architect and /or Engine Employing Plumber's Name Nature of Water Supply: City —Well. Amount of Permit $ MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT __!'",mil - -- - -- No._ Location and Legal Description Lot---_--___ .__________.._._.__.___L.—_._._ Block__ ,.�.____ Subdivision Street and Number where work is tO be performed—No __// a. .... Street State work to be performed and purpose of buikling (By Floors) Feet of Drain Tile-_- - - -�`^ ee o • or Drain Field from Well Date Street Street___ Capacity Gals Size of Soakage Pit (Signed)_ Plumbing , spector. The undersigned applicant for this building permit does hereby certify that he understands and accepts his %•ligation, as an employer of labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Pe nanent 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 notices as are required by the Act. The undersigned agrees to employ only such sub- contractors, on work to be performed under this permit, as are licensed by Miami Shores Village. (Signed)____ Master Plumber. STATE OF FLORIDA, 1 COUNTY OF DADE. I 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 NOTE: A re- inspection fee of $1.00 will be made when such re- inspection is made .necessary by improper notice for inspection, or faulty materials and /or workmanship.