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301 NE 101 St (7)Date d Job Address 3c/ 4.26, /0/ Tax Folio Legal • ription f 7z- A , 5k5 Lla Owner/Lessee / Tenant /144 ,(1 Owner's Address / ( �l Contracting Co. Qualifier SS# State # Sl?,0 9 ?iJ Municipal # (11) Ye competency # /) Jl Ins. Co. Architect/Engineer Bonding Company Mortgagor i Permit Type (circle one): BUILDING LECTRIC PLUMBING CHANICAL ROOFING PAVING FENCE SIGN WORK DESCRIPTION D 7 k,- / /L/ 37 011 Square Ft. 4 Estimated Cost (va1u C::?"Z.c2c 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 pennit 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 construction and zoning. Furthermore, I authorize the above -named contractor to do • d/or C . .,' .. OF FLOR G . e MY COMM •... AR COMMISSION COMMISSION CC714103 002 ' .'I ArApil4E er r and/or ondo President N om. ' . ;r Signature of Notary as t My Commission Ex APPROVED: Zoning Mechanical PERMIT APPLICATION FOR MIAMI SHORES VILLAGE RADON Historically Designated: Yes No Address Address Address /a -y -0a D: to Signa /0 -4a Notary My Co Phon ed. ntractor or ssion Expires: C.C.F. ( . l� NOTARY // 3-2 -0/ l $7 ?O Master Permit # sEi8 Address /690 /VL 43O5T Electrical be done in compl all applicable laws regulating / Q DYS l VILLAR D : to NOTARY PUBLIC STATE OF FLORIDA COMMISSION NO. CC714103 MY COMMISSION EXP . MAR. 1 002 BOND �+ a TOTAL DUE 34 Structural Engineer oo CO NSTRUCTION PERMIT FOR: [ tV1 c APPLICANT: PROPERTY STREET ADDRESS: LOT: 7, G 4 4,BLOCK: a> , PROPERTY ID #: T A N K [ D R A I N F I E L D 0 T H E R New System Repair � d a FILL REQUIRED: [1 /' ) INCHES SPECIFICATIONS BY: APPROVED BY: DATE ISSUED: STATE OF FLORIDA DEPARTMENT OF HEALTH ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PERMIT Authority: Chapter 381, r �i_d ts •SadJ��� [M] Existing System (A' [&i Abandonment [6� SUBDIVISION: Holding Tank Other(Specify) [ AGENT: '' ( TAX ID ] SECNTOWNSHIPRANGE /PARCEL NUMBER) f ' 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. SYSTEM DESIGN AND SPEC FJ CATIONS t ' ":p [GALLONS / GPD] S), TIC 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] J GALLONS PER DOSE DOSING TANK CAPACITY DOSE .RATE [ ) PER 24 HRS NO. OF PUMPS: [ ) 2 , � �Wo4 1' [v:'• J SQUARE FEET PRIMARY DRAINFIELD SYSTEM [ ] SQUARE FEET SYSTEM TYPE SYSTEM: [[ j FILLED CONFIGURATION: [-,) BED [y .) STANDARD [,r,1) TRENCH LOCATION OF BENCHMARK: of `‘Ji _ d a!� s ELEVATION OF PROPOSED SYSTEM SITE [r;.® ] [INCHES/ BOTTOM OF DRAINFIELD TO BE ( t A [INCHES /FT] TITLE: Installer /Contractor EXCAVATION REQUIRED: [J INCHES TITLE; I 9 , roc r ' r DH 4016, 10/96 (Replaces HRS -H Form 4016 (page 1] which may be used) (Stock Number: 5744- 001- 4016 -0) PERMIT` � a DATE PAID "0- FEE PAID $ 75. ' RECEIPT # Temporary /Experimental di MOUND [ G'4/ [ABOVE /B OW BENCHMARK /REFERENCE POINT [ABOVE /BELOW) BENCHMARK /REFERENCE POINT INSTAll1 c 1 f)A.MY COARSE SAND iiNnER1FOTTOM OF DRAINFIELD SUBMIT BENCHMARK BEFORE INSPkc i ]UN THIS PERMIT IS NOT FOK Auu1TIoN(S) INVERT tLtVATIOI tk� Bo; ;OM OF 1' RAINFIELD CLC IP1°1* EXPIRATION DATE: f `ZJ 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 10D -6, FAC. APPROVED BY: County Health Department personnel reviewing and approving permit. DATE ISSUED: Date permit is issued by County Health Department. 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. 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. • Scale: Each block represents 5 feet and 1 inch = 50 feet. ..�-, dpi y d" y Notes: Site Plan su b v` Plan Approved By 4 `0 K DH 4015. 10/96 (Replaces HRS-H Forrn 4015 which may be used) (Shod( Number: 5744 -002- 4015.6) STATE OF FLORIDA DEPARTMENT OF HEALTH APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PERMIT Permit Application Number a ., PART II - SITE PLAN Signahre Not Approved /0/ V 9 l _ XD's'= 'c=- sr- � ✓�p L L b • 1 ALL CHANGES MUST BE APPROV BY THE COUNTY HEALTH DEPARTMENT 1- '7 {�7 Date County Health Department Page 2 of 3 BUILDING ❑ ELECTRICAL PLUMBING ' ROOFING Owner of Building MIAMI SHORES VILLAGE, FLORIDA ❑ PERMIT N° 14119 ❑ Work to be performed under this Permit Architect *" Contractor or Builder Legal Lot II' BI Subdi- Description. . vision Address of Value of Building Project $ 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 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 responsibility for,work done by his agents, servants or employees. • tti • • CONTRACTOR OR BUILDER Signed: INSPECTOR BY DATE Contractor's License No. BY Amt. of Permit $ _/ AUTHORITY 195 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 authorities of Miami Shores Village. In accepting this permit I assume responsibility for all work done by either, myself, my agent, servant or employee. Permit No..- _,�._7 Application is hereby in for the approval of the detailed statement of the plans and specifications herewlilt submitted for the building or otlual 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 at building during progress of work. Owner's Name and Address - Registered Architect and /or Engi eer Plumber's Name No.._ Location and Legal Description Lot _______. ................ __ - .... ___ _ _-_ Block__ _. _ . _ Su Street and Number where work is to be performed— No.--- f If 6 161 _ _ Street_ b .� State work to be performed and purpose of building (By Floors)_ New Building Remodeling Addition__ Size Septic Tank_ Feet of Drain Tile_ Nature of Water Supply: City —Well . it ' mL • Amount o Permit $ ______ STATE OF FLORIDA, I COUNTY OF DADE. My Commission Expires MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT Type of Tank__ Capacity Cals. Dist. Feet Tank qF Drain Field from Well Size of Soakage Pit No.3 .6I 14 21 1" Street (Signed) ( Signed) Repairs n s ° 3 Date - Street__ Notary Public, State of Florida No. of Stories Plumbing nspector. The undersigned applicant for this building permit does hereby certify that he understklSds 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 coin - 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 p - :''• under this permit, as are licensed by Miami Shores Village. Plumber. Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally ilppeare 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 hie therein by him stated are true. NOTE: A re- inspection fee of $1.00 will be made when such re- inspection is made necessary by improper notice for inspection, or fatll materials and /or workmanship. CLOSETS BATH T UBS S SHOWERS LAVA. TORIES SINKS SLOP SINKS LAUNDRY TU88 IA URINALS CATCH BASIN FLOOR DRAIN DRINKING FOUNT'NS TOTAL FIRTUR[I CONTR. LIST CHECK SEPTIC TANK SEWER CONN. DRAIN FIELD SOAKAGE PIT GREASE TRAP SOLAR W ATER DEEP WELL SPRKLR. SYSTEM SWIM'O POOL CONTR. LIST CHECK Permit No..- _,�._7 Application is hereby in for the approval of the detailed statement of the plans and specifications herewlilt submitted for the building or otlual 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 at building during progress of work. Owner's Name and Address - Registered Architect and /or Engi eer Plumber's Name No.._ Location and Legal Description Lot _______. ................ __ - .... ___ _ _-_ Block__ _. _ . _ Su Street and Number where work is to be performed— No.--- f If 6 161 _ _ Street_ b .� State work to be performed and purpose of building (By Floors)_ New Building Remodeling Addition__ Size Septic Tank_ Feet of Drain Tile_ Nature of Water Supply: City —Well . it ' mL • Amount o Permit $ ______ STATE OF FLORIDA, I COUNTY OF DADE. My Commission Expires MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT Type of Tank__ Capacity Cals. Dist. Feet Tank qF Drain Field from Well Size of Soakage Pit No.3 .6I 14 21 1" Street (Signed) ( Signed) Repairs n s ° 3 Date - Street__ Notary Public, State of Florida No. of Stories Plumbing nspector. The undersigned applicant for this building permit does hereby certify that he understklSds 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 coin - 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 p - :''• under this permit, as are licensed by Miami Shores Village. Plumber. Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally ilppeare 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 hie therein by him stated are true. NOTE: A re- inspection fee of $1.00 will be made when such re- inspection is made necessary by improper notice for inspection, or fatll materials and /or workmanship. Registered Architect and /or Engineer MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT Permit No Date I ' ° '- 'a` 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 No. Street / ? Employing Plumber's Name " No.__,: Street; ' Streit ' i Location and Legal Description Lot / ° s__ Block____— Subdivision l ^ , e' P Street and Number where work is to be performed —No - e/ Street // ° s i ii z.. '% 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: City —Well. Size of Soakage Pit ( Signed i t 2_2 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 5968, 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 undersigned agrees to employ only such sub - contractors, on work to be performed under this permit, as are licensed by Miami Shores Village. Amount of Permit $___ eta STATE OF FLORIDA, ,1 ss. COUNTY OF DADE. ( Signed) My Commission Expires Notary Public, State of Florida Master Plumber. 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. NOTE: A re- inspection fee of 0.00 will be made when such re- inspection is made necessary by improper notice for inspection, or faulty materials and /or workmanship. - 2 CLOSETS BATH TUBS SHOWERS LAVA- TORIES SINKS 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 CHECK Registered Architect and /or Engineer MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT Permit No Date I ' ° '- 'a` 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 No. Street / ? Employing Plumber's Name " No.__,: Street; ' Streit ' i Location and Legal Description Lot / ° s__ Block____— Subdivision l ^ , e' P Street and Number where work is to be performed —No - e/ Street // ° s i ii z.. '% 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: City —Well. Size of Soakage Pit ( Signed i t 2_2 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 5968, 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 undersigned agrees to employ only such sub - contractors, on work to be performed under this permit, as are licensed by Miami Shores Village. Amount of Permit $___ eta STATE OF FLORIDA, ,1 ss. COUNTY OF DADE. ( Signed) My Commission Expires Notary Public, State of Florida Master Plumber. 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. NOTE: A re- inspection fee of 0.00 will be made when such re- inspection is made necessary by improper notice for inspection, or faulty materials and /or workmanship. - 2 JILDING ECTRICAL UMBING .vner of iilding l CONTRACTOR OR BUILDER MIAMI SHORES VILLAGE, FLORIDA DATE ' 194_4 Contractor's License No PERMIT N? 8654 Work to be performed under this Permit chitect ,retractor Builder gal Lot Bl. Subdi- :scription vision !dress of / / , Value of Amt. of ilding ! �!. Project Permit Z 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 appli- ion herefor in strict compliance with all ordinances pertaining thereto and w th the understanding that the work will be performed in compliance with any ns, drawings, statements or specifications that may have been submitted to and approved by the proper municipal authorities. This Permit may be revoked 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 mit is granted is the understanding that the contractor or builder named above assumes the responsibility for a thorough knowledge of the ordinances and ulations pertaining to the work covered hereby whether shown on the plans or drawings or in the statements or specifications and that he assumes respon- ility for work done by his agents, servants or employees. 7 f / 4' ' • Signed. / (_ By /A INSPECTOR f In consideration of the issuance to me of this permit I agree to perform the work covered hereunder in compliance with all ordinaances and regulations taining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. accepting this permit I assume responsibility /or all work done by either myself, my agent, servant or employee. / % BY AUTHORITY s