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405 NE 101 StPERMIT APPLICATION FOR MIAMI SHORES VILLAGE Date Job Address T v S4' Folio Legal Description Historically Designated: Yes No .ru,5 ,- -ut;/e Owner's Address 4 OS ,J 6- /014A-12 D1 4A T 4 g S� �— 6k /4 C S Contractin Co. -e c. _ ,✓� s tiY J Owner/Lessee / Tenant Qualifier State # Mudcipal # Competency # Ins. Co. Architect/Engineer Address Bonding Company Address Mortgagor Address Permit Type (circle one): BUILDI PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN l WORK DESCRIPTION Id / /0 �- )rceek-.1 Square Ft. 10 MileagiadVallitAt Notary to Owner an NW* . ATE OF FttitiA AKASION NO. CC714103 V o,.,;y,'U. CN EXP. MA 1 My C .mmission Expir FEES: PERMIT 6b RADON APPROVED: Zoning Mechanical Plumbing Building Address / 99 g Z tJt) • i '���` SS # ?f - 22 - 070 Phone 3°> 6-0 -It fl /e Estimated Cost (val Notary as to •ntrac My Co Sion Ex C.C.F. /1 NOTARY Master Permit # v/ 73-1 Phone 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. Furth ore, I authorize the above -named contractor to do the work stated. ires: COMMISSION NO. CC714103 MY COMMISSION EXP. MAR. 1 00 ATE OF FLO f Signature of Contr ctor or Owner- Builder v i ,v . yf NOT RYSEA � ;..i14. X11 •y Electrical Is' 7 y is erg /213 BOND .30 / TOTAL DUE _ ./ ? ..,, te ep Date Structural Engineer CONSTRUCTION PERMIT F R: a (fJJ New System [A] Existing System (/ Holding 'Tank [ ] Repair (11 Abandonment APPLICANT: PROPERTY STREET ADDRESS: LOT:, PROPERTY ID #: 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 ti 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 DES G AND SPEGIF TI NS T [14 ] [GALLONS / GPD] serfr T /AEROBIC 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 PER DOSE DOSING TANK CAPACITY DOSE •RATE [ ] PER 24 HRS NO. OF PUMPS: ( D R A I N F I E L 0 •T H E R ® STATE OF FLORIDA DEPARTMENT OF HEALTH i ONSITE SEWAGE DISPOSAL SYSTEMI_,l_ CONSTRUCTION PERMIT Authority: Chapter 381, FS & Chapter BLOCK: 5) AGENT: 0 [0./00] SQUARE FEET PRIMARY DRAINFIELD SYSTEM [ ] SQUARE FEET SYSTEM TYPE SYSTEM: [J STANDARD [/J] FILLED CONFIGURATION: [ ] TRENCH [IA BED LOCATION OF BENCHMARK: )4 - - (0 0 lid SPECIFICATIONS BY: APPROVED BY: DATE ISSUED: D FILL REQUIRED: [ t4 INCHES 9 i g,' A® O H 4016, 10/96 (Replaces HRS -H Form 4016 (page 1] which may be used) (Stock Number: 5744- 001 - 4016 -0) PERMIT ,# '1 ed9g-_3c7Tg DATE PAID — FEE PAID $ 76-00 RECEIPT #4000 .' 90 10D -6, FAC . /3 - 1/4.V ce o - [ Temporary /Experimental [ Other(Specify) SUBDIVISION: A' tPg° _, [SECTION /TOWNSHIP /RANGE /PARCEL NUMBER] [OR TAX ID NUMBER] ELEVATION OF PROPOSED SYSTEM SITE [to7 ] [INC "/ [ABOVE/ BOTTOM OF DRAINFIELD TO BE [ 114 , , 4a.¢ ) [I r /FT] [ABOVE /B EXCAVATION REQUIRED: ( Applicant TITLE: TITLE: [J] MOUND .1 1 BENCHMARK /REFERENCE POINT BENCHMARK /REFERENCE POINT INCHES IQ.O INSTALL / 1 F LOA^iViv UNDh4 u 1 TC � ° O+ c IF ON SllliiVii 6Ei�CH .� Manr, _ OR bill IO C I INVERT F - . ON : RAM e. " c� 1 J BOTTOM OF DRAINFJ 9 EVATION ��s. 4 '. -••7 EXPIRATION DATE: ®2. :A Page 1 of 2 i• 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: DRAINFIELD: OTHER: SPECIFICATIONS BY: APPROVED BY: DATE ISSUED: EXPIRATION DATE: Minimum specifications from Chapter 10D -6, FAC. Minimum specifications from Chapter 10D -6, FAC. Other specifications, such as operating permit requirements, low - volume flush toilets, variance provisos. Name of individual providing specifications. If designed by a registered engineer must be sealed. County Health Department personnel reviewing and approving permit. Date permit is issued by County Health Department. One year from date issued if the system has not been installed. Permits for system repairs become void 90 days from the date issued. • Notes* At -J Site Plan Submitted by Plan Approved By STATE OF FLORIDA DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION. PE Permit Application Number 1 P ► ( !L at q 13 aj- `; : County Public Unit ALL CHA GES M ST BE APPROV� HE COUNTY PUBLIC HEALTH UNIT HRS-H Form 4015, Feb 85 (Obsoletes previous editions which may not be used) (Stock Number: 5744- 002 - 4015 -6) ' PART II - SITE PLAN SIGNATURE Not Ap roved T / TITLE Date 7 /d . Page 2 of 3 am •i, erIMM ;y ■• ■ �� RUI•••••••• ••••• ••• :: l•• 1 :::: ■ti : : :: ■ I i:::::a' : I : ::: :: :: �■• ONORM�■. ii. 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I_ � • _ • ■■ • m un rti■0 I . • : : ■`` I .i■ ••vE . .0 l • R i ■ R■ • .. ■ ■■ t� • R• ■ i is Om mom mum a il iii • mum L I I [_ { , • i 1 �l 1 *ma . . 1 : - ■ � r .■ ... ■. ■ _MORMONS I_ �_ _ 1 + P \ I i- j • �auf ■r•. 1 ■_ . t� •`�u� RIDA i , Elkil . mil I 1 -1 ■ ■R MO II �•� ■ri •111 •• • _•miAI•R fib 0 :011107m (. R.. ■•W •■• . ■■.■111.111: • )•I om0 � _ c . / n o -r90 Notes* At -J Site Plan Submitted by Plan Approved By STATE OF FLORIDA DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION. PE Permit Application Number 1 P ► ( !L at q 13 aj- `; : County Public Unit ALL CHA GES M ST BE APPROV� HE COUNTY PUBLIC HEALTH UNIT HRS-H Form 4015, Feb 85 (Obsoletes previous editions which may not be used) (Stock Number: 5744- 002 - 4015 -6) ' PART II - SITE PLAN SIGNATURE Not Ap roved T / TITLE Date 7 /d . Page 2 of 3 MIAMI SHORES VILLAGE, FLORIDA BUILDING 0 DATE - 19 ELECTRICAL PLUMBING 0 PERMIT N9 7269 Contractor's C-01 / License No. ROOFING Work to be performed under this Pennit Owner of Building 12. 0 s Architect Contractor I or Builder if * Legal Lot Description B1 Address of 4.71 is/ Building In consideration of the iseil to me pertaining thereto • •d in strict‘confotrnity with cepting this pertnIt res••nsibili for l(r ,CONTRACTOR OR BUILIrc /6) —4,„„ e": 4 *- ;e1 e Subdi- vision Value of I Amount of Project $ 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. ' - 1 4 Signed. " • tk IlkigkE of this permit I agree to perform the work covered hereunder in compliance with!all ordinances and regulations the plans, drawings, statements or specifications submitted to the proper authoritiesAof Mianil Shores Village. In ac . all work done by either, myself, my agent, servant or employee. BY AUTHORITY ABBOT 4e4.79-' Permit No MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT Date_tlAltiC ry -- Z 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. MARCiS 5� - -- A/ Owner's Name and Address _ No._�___ __ Street_ Registered Architect and /or Engineer /' Employing Plumber's Name_ 1__'__t!_/_rl'Nl_! P:rn_eeft.__ —_ .mI C N ) ic No._— ___— ___ ' 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__ __ __ _ —__ Addition__ Feet of Drain Tile Amount of Permit $_ STATE OF FLORIDA, } COUNTY OF DADE. My Commission Expires Block_ Can n Street____ m' t /O / sr Sr Size Septic Tank_ ..... of Tank__ Capacity Gals. Dist. Feet of Tank or Drain Field from Well Nature of Water Supply: ________ _____Size of Soakage Pit (Signed)_ Repairs.__' No. of Stories 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 corn - plied with the provisions thereof, and will require similar compliance from all contractors or sub- contractors - - .loyed 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 wor -uch public notice or notices as are required by the Act. The undersigned agrees to employ only such sub-contractors work to • - pe .rmed under this permit, as are licensed by Miami Shores Village. (Si Street-_ _� - _-- Subdivision 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. 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 worlananship. CLOSETS BATH TUBS SHOWERS LAVA TORIES SINKS SLOP SINKS LAUNDRY TUBS URINALS CATCH BASIN FLOOR DRAIN DRINKING FOUNT' NS TOTAL FIXTURES CONTR. L16T _ CHECK SEPTIC TANK SEWER CONN. DRAIN FIELD SOAKAGE PIT GREASE TRAP SOLAR HEATER DEEP WELL SPRKLR. SYSTEM SWIM'G POOL CONTR. LIST - CHECK Permit No MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT Date_tlAltiC ry -- Z 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. MARCiS 5� - -- A/ Owner's Name and Address _ No._�___ __ Street_ Registered Architect and /or Engineer /' Employing Plumber's Name_ 1__'__t!_/_rl'Nl_! P:rn_eeft.__ —_ .mI C N ) ic No._— ___— ___ ' 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__ __ __ _ —__ Addition__ Feet of Drain Tile Amount of Permit $_ STATE OF FLORIDA, } COUNTY OF DADE. My Commission Expires Block_ Can n Street____ m' t /O / sr Sr Size Septic Tank_ ..... of Tank__ Capacity Gals. Dist. Feet of Tank or Drain Field from Well Nature of Water Supply: ________ _____Size of Soakage Pit (Signed)_ Repairs.__' No. of Stories 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 corn - plied with the provisions thereof, and will require similar compliance from all contractors or sub- contractors - - .loyed 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 wor -uch public notice or notices as are required by the Act. The undersigned agrees to employ only such sub-contractors work to • - pe .rmed under this permit, as are licensed by Miami Shores Village. (Si Street-_ _� - _-- Subdivision 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. 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 worlananship.