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358 NE 100 St (5)PERMIT APPLICATION FOR MIAMI SHORES VILLAGE Date Job Address 3 6S 4 6 '' I kJ Tax Folio \t I / a. y — Legal Description /� I j -NO Historically Designated: Yes No Owner/Lessee / Tenant I "/�' ,f < . CA& ' " /� Z "% Master Permit # Y.1 01 (0 C1 4 + Phone Contracting Co. /It ' � ' S ,,.� 1 : 44 - Address 99 N �"� ' z Owner's Address 3 S 0 14 I/ 3 q0,4 3 Qualifier ffEP4 . C cX-ic t %�� V State # Municipal # Competency # Ins. Co. Architect/Engineer Address Bonding Company Address Mortgagor Address Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN SS# - 305 trio 7 t WORK DESCRIPTION / e k 1/ ,9)2_, Square Ft. 09en Estimated Cost (value) 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 constructiop and zoning. Furthermore, I authorize the above -named contractor to do the work stated. - .-- =. i I L1 � • a e o o a an d/or C President Date c if*/ ate Notary as to Owner and/or Condo President My Commission Expires: 7 c / afore of Contractor or • � '�� , er- Builder ." —/" J Li • lb . N • .: as to' ontrac` ., •;, - : ' ., P , • • � C IAL tJOTARY SEAL My Commission Expir sp ANG n9 BECKER * • � 501,4% CO M MS9Q buQ9an lii'-4 Q CC786697 u r i c cs MY COMMISSION EXPIRES OF FL NOV ^5 7r ,? FEES: PERMIT 6 0 RADON C.C.F. ) , ,?P NOTARY S _ O () BOND J? p Electrical TOTAL DUE Date APPROVED: Zoning Building Mechanical Plumbing Structural Engineer Notes STATE OF FLORIDA " DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PERMIT Permit Application Number PART II - SITE PLAN 1 i I ■ I I ' _1111_11_111,_1_. It II I 1 1 , i i i 1 ■ 1 1 . 1 1 - 1 1 : ; I I 1 1 I ; 1 I 1 II. I : 1 1 11 1 I I ; - ' I t ; cs! r ,..,.. , 4. 1 ria- ' e .,_jr .' 8, Li -,, 7 f 1 ' il 7 e HRS-H Form 4015, Feb 85 (Obsoletes previous editions which may not be used) (Stock Number: 5744-002-4015-6) ; I I ; I I , • I ; , , I I 1 1 1 I 1 I I 1 1 - — I _ _ - - CI , ' - . 4.44. .44. 4 4 -4 . - 1' I I I I , , I . I 1 1 1 1 1 1 , „..1 ■ 1 1 i , 1 1 i r , t..„, ,.,,,, t 1 } 1 1,4 T. - I 1 i 1 1 1 i 1 i a l 1 1 111 I i i I ! j, ' - ) f tl.i - FA, 3 ,, , , ,—) • ;,, ..,,,-......-3. - I e.: (> . ,. i; ° 7 /!' , L; Site Plan Submitted by SIGNATURE JfrLE Plan Approved J Not Approved Date.”, fi By , • County Public Unit ALL CHANGES MUST BE APPROVED BY THE COUNTY PUBLIC HEALTH UNIT - -- 4 1 ■ I I ., I --r,. 5 , Page 2 of 3 CO 0 STRUCTION PERMIT FOR: ] New System [Ad] Existing System ((/] Repair [^+1 Abandonment I APPLICANT: .R C ci I u 7. PROPERTY ADDRESS: .- 8 /1 t_ LOT: .5 BLOCK: 4- 0 / pp p [SECTION, TOWNSHIP, RANGE, PARCEL NUMBER] PROPERTY ID #: L ° mC Dip - (31.3 - '.3 0 [OR TAX ID NUMBER] D (c4 SQUARE R [ ] SQUARE A TYPE SYSTEM: I CONFIGURATION: N F LOCATION OF BENCHMARK: I E L D FILL 0 T H E R SPECIFICATIONS BY: APPROVED BY: DATE ISSUED: DH 4016, 12/99 STATE OF FLORIDA DEPARTMENT OF HEALTH ONSITE SEWAGE TREATMEN'T' AND,,fISPOSAL SYSTEM CONSTRUCTION PERMIT ; 1 FEET PRIMARY FEET STANARD ] TRENCH (Page 1) - g REQUIRED: [b ] INCHES SUBDIVISION: EXCAVATION REQUIRED: Holding Tank [ Temporary 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 COMPLIANCE WITH OTHER FEDERAL, STATE, OR LOCAL PERMITTING REQUIRED FOR DEVELOPMENT OF THIS PROPERTY. SYSTEM DESIG AND PECIFICATIONS :f1 T 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 # [ 76 Q ] GALLONS / GPD GPTIC TA /AEROBIC UNIT CAPACITY DRAINFIELD SYSTEM r SYSTEM [ 4, `m] FILLED 1 [� MOUND [7] BED [0J] 111 Ed - o fL SITE [ � • � (CVO [ABOVE ELEVATION OF PROPOSED SYSTEM BOTTOM OF DRAINFIEL TO BE [3-14-1 [ CHE /FT] [ABOVE /BE r PERMIT NO.0/_0 DATE PAID: _ o/- of FEE PAID: 75 ,. e RECEIPT #: �ol ®�o o/$ 77l [ n► Innovative [A.) g . PUMPS [ ] [ Ot 3 ] INCHES BENCHMARK /REFERENCE POINT BENCHMARK /REFERENCE POINT i O'") TITLE: TITLE: rL - EXPIRATION DATE: (PTVESEITIreiT L DE rpm k 0� DEF DEVIC I�f TAla. ➢uiJ� � `'Eft M pt. 1: Health Department pt. 2: Applicant pt. 3: Instal ler /Contractor pt. 4: Building Department Page of 3 CHD INSTRUCTIONS: PERMIT NUMBER: Permit tracking number assigned by CPHIJ. CONSTRUCTION PERMIT FOR: ('heck type of permit, if "Other" specify type in blank. APPLICANT: Property owner's full name. SYSTEM DESIGN AND SPE('IE'1('ATIO \S: T ♦ \K: Minimum specifications from Chapter64E -6, FAC. TELEPHONE: E: Telephone number for applicant or agent ACE: \T': Property owner's legally authorized representative. MAILING ADDRESS: P.O. Box or street mailing address for applicant or agent. 1.07', BLOCK, SUBDIVISION or PROPERTY ID #: 27 character id number for property. (CHD may require property appraiser ID # or section /township /range/parcel number) DRAIN EIELD: Minimum specifications from Chapter 64E-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 (CHD) personnel reviewing and approving permit. DATE; 1551 :I): 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 90 days from the date issued. 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. 3 �( /��/� c 7 3 4 _624 E 7° 7 No. J `S " Street._ 1 t/'v Owner's Name and Address Registered Architect and /or Engineer Employing Plumber's Name..M.l'1! Location and Legal Description Lot Street and Number where work is to be performed —No State work to be performed and purpose of building (By Floors) New Building -- ••-- •----- •- • .. ............... Remodeling MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT Block Size Septic Tank _.---- .- ..- - - - - -- _ - -- �'p° of Tank__ Feet of Drain Tile._._ _ ___- _— _Dist. Feet of Tank or Drain Field from Well. Nature of Water Supply: City— We1L__— _---- - - - - -. — - - -- __.Size of Soakage Pit Amount of Permit $ (Signed)- STATE OF FLORIDA, I µ COUNTY OF DADE. 3 .. ge 4 44-- _ 31 - ' [.0 kU 4e.)!..N..:...._._. . Addition.- _..._ Repairs . No. of Stories ........ (Si Capacity Gals..._.... ....... •- -- •..... . .....__... The undersigned a pplicant for this building permit does hereby certify that he understands and accepts his obligation / s an employer of labor Compensation Act, being Section 5968, Compiled General Laws of Florida Permanent S pplernent, and has com- under the Florida Worlanen's plied with the provisions thereof, and will require similar compliance from all contractors or sub- contractors employ by im in the work to be performed under this permit; and will post or cause to be posted for inspection on the site • I e work suc • p • litxdtice or notices as are required by the Act. The undersigned agrees to employ only such sub - contractors, on work to be o nder this permit, as are licensed by Miami Shores Village. � J 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 be did sign the same, and that all facts therein by him stated are true. My Commission Expires Notary Publics, State of Florida y- ` P)Cimbing Inspector. Master Plumber. NOTE: A re- inspection fee of $LOO will be made when such re•inspeetion is mads'neoessary by improper notice for inspection, or faulty materials and/cm workmanship. CLOSETS BATH TUB[ SHOWERS LAVA- TORIES SINK{ SLOP SINKS LAUNDRY Tuns URINAL{ CATCH BASI FLOOR DRAIN DRINKING FOUNT'N• TOTAL FIXTURES CONTR. LIST CHICK SEPTIC TANK SEWER CONN. DRAIN FIELD SOAKAGE PIT GREASE TRAP SOLAR H DEB WILL SPRKLR. SYSTEM SW IM'O POOL CONTR. LIST CHECK 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. 3 �( /��/� c 7 3 4 _624 E 7° 7 No. J `S " Street._ 1 t/'v Owner's Name and Address Registered Architect and /or Engineer Employing Plumber's Name..M.l'1! Location and Legal Description Lot Street and Number where work is to be performed —No State work to be performed and purpose of building (By Floors) New Building -- ••-- •----- •- • .. ............... Remodeling MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT Block Size Septic Tank _.---- .- ..- - - - - -- _ - -- �'p° of Tank__ Feet of Drain Tile._._ _ ___- _— _Dist. Feet of Tank or Drain Field from Well. Nature of Water Supply: City— We1L__— _---- - - - - -. — - - -- __.Size of Soakage Pit Amount of Permit $ (Signed)- STATE OF FLORIDA, I µ COUNTY OF DADE. 3 .. ge 4 44-- _ 31 - ' [.0 kU 4e.)!..N..:...._._. . Addition.- _..._ Repairs . No. of Stories ........ (Si Capacity Gals..._.... ....... •- -- •..... . .....__... The undersigned a pplicant for this building permit does hereby certify that he understands and accepts his obligation / s an employer of labor Compensation Act, being Section 5968, Compiled General Laws of Florida Permanent S pplernent, and has com- under the Florida Worlanen's plied with the provisions thereof, and will require similar compliance from all contractors or sub- contractors employ by im in the work to be performed under this permit; and will post or cause to be posted for inspection on the site • I e work suc • p • litxdtice or notices as are required by the Act. The undersigned agrees to employ only such sub - contractors, on work to be o nder this permit, as are licensed by Miami Shores Village. � J 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 be did sign the same, and that all facts therein by him stated are true. My Commission Expires Notary Publics, State of Florida y- ` P)Cimbing Inspector. Master Plumber. NOTE: A re- inspection fee of $LOO will be made when such re•inspeetion is mads'neoessary by improper notice for inspection, or faulty materials and/cm workmanship. BUILDING ❑ ELECTRICAL ❑ PLUMBING E ROOFING ❑ Contractor or Builder o1 / Owner of C ; Building /Y MIAMI SHORES VILLAGE. FLORIDA PERMIT N? 7201 Architect Legal Lot 1 Description Bl Address of >" Building & - /PO O .� Work to be performed under this Permit Subdi- vision l Value of Project $ 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 application 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 v- is not done in compliance with such ordinances or ff the plans are changed without authorization. A further condition upon which this permit is granted i^ 'erstanding that the contractor or builder named above assumes the responsibility for a thorough knowledge of the ordinances and regulations pertain` rk covered hereby whether shown on the plans or drawings or in Oat statements or specifications and that he assumes responsibility for work dons ervants or employees. Signed x, INSPECTOR :suance to me of this permit I agree to perform the work covered hereunder in compliance with all ordinances and regulations 'nformity with the plans, drawings, statements or specifications pubmj) ed to the proper authorities of Miami Shores Village. In ac- nsibility for all work done by either, myself, my agent, ser4ant r employee. wt r BY 14?3 kit S DATE /// /t! Contractor's License No 2i/ r c Amount of Permit $ AUTHORITY 195 6,wf:;i" L,r• Permit No z_ Owner's Name and Address STATE OF FLORIDA, 1 COUNTY OF DADE. ss. MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the building or othei 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. Registered Architect and /or Engineer i' L' "__ 6 11 t+ ,`' j Employing Plumber's Name ( '.} I- r L No. Street Location and Legal Description Lot s, ,y" 1' ` Block Subdivision At i,' Street and Number where work is to be performed —No �� ) � ` Street At f F / � i. State work to be performed and purpose of building (By Floors) _icr My Commission Expires Type of Tank t� No. I~ = n" Date 1 Street___L_1 J f ": - New Building k`__ Remodeling Addition Repairs No. of Stories Size Septic Tank Feet of Drain Tile :4- Dist. Feet of Tank or Drain Field from Well Nature of Water Supply: City —Well t r Size of Soakage Pit. (Signed) 6/ Capacity Gals.____ ' NOTE: A re- inspection fee of $1.00 will be made when such re- inspection is made necessary by improper n materials and /or workmanship. Amount of Permit $_ / (Signed)�'�____ Plumbing Inspector. 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 notices as are required by the Act. The under signed agrees to employ only such sub - contractors, on work to be performed under this permit, as are licensed by Miami Shores Village. 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 therein by him stated are true. Notary Public, State of FI' Master 1. CLOSETS BATH TUBS SHOWERS LAVA- TORIES $INKS SLOP SINKS LAUNDRY TUBS 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 SW IM'G POOL CONTR. LIST r CHECK Lfil( /i. ,,' A ', L,r• Permit No z_ Owner's Name and Address STATE OF FLORIDA, 1 COUNTY OF DADE. ss. MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the building or othei 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. Registered Architect and /or Engineer i' L' "__ 6 11 t+ ,`' j Employing Plumber's Name ( '.} I- r L No. Street Location and Legal Description Lot s, ,y" 1' ` Block Subdivision At i,' Street and Number where work is to be performed —No �� ) � ` Street At f F / � i. State work to be performed and purpose of building (By Floors) _icr My Commission Expires Type of Tank t� No. I~ = n" Date 1 Street___L_1 J f ": - New Building k`__ Remodeling Addition Repairs No. of Stories Size Septic Tank Feet of Drain Tile :4- Dist. Feet of Tank or Drain Field from Well Nature of Water Supply: City —Well t r Size of Soakage Pit. (Signed) 6/ Capacity Gals.____ ' NOTE: A re- inspection fee of $1.00 will be made when such re- inspection is made necessary by improper n materials and /or workmanship. Amount of Permit $_ / (Signed)�'�____ Plumbing Inspector. 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 notices as are required by the Act. The under signed agrees to employ only such sub - contractors, on work to be performed under this permit, as are licensed by Miami Shores Village. 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 therein by him stated are true. Notary Public, State of FI' Master 1.