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489 NE 101 St (8)Date -1' -2/" % y Job Address 4 79 AJC /o/r7 Tax Folio Legal Description LOT -14 Ims• 44743 Historically Designated: Yes No C9/ �/ Owner/Lessee / Tenant 4/1 f LA �/ igZe✓ /a Master Permit # L t5 (5— 0 L Owner's Address T P9 /)L- /0/ 7 , 1 a 0/P Phone ' � / 7 - 99 71• Contracting Co. L L C7yb /(JD�]iy "PT /C Address (J 6) /1/. t4/• ///7 U /. Qualifier Job O SS# // < - Phone ' 9J7- 76 76 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 WORK DESCRIPTION J " 7 2z/NJ /jL✓D 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 con . ctmon . • oning. Furthermore, I authorize the above -named contractor to do the work stated. Notary My Commissio _ Expires: FEES: PERMIT PERMIT APPLICATION FOR MIAMI SHORES VILLAGE LESTER E. CROCKETT My Comm Exp. 5/20/2001 Bonded By Service Ins No. CC649326 I I Pers ally Known I I Other I.D RADON Notary as to Con My Commissi C.C.F. NOTARY Estimated Cost (value) 1 ° 0 0 0/- Ctp90 eT.ESTER E. CROCKETT My Comm Exp. 5/20/2001 Bonded By Service Ins No. CC649326 11 Personally Known 1 1 Other I.D BOND 7Y9 Date 7-21-99 Date APPROVED: TOTAL DUE Zoning Building Electrical Mechanical Plumbing Structural Engineer CONSTRUCTION PERMIT OR: 04/] New System ;Existin System [//) Holding Tank [7] Repair [ Abandonment [/"-] Other(Specify) APPLICANT -i, AGENT: PROPERTY STREET ADDRESS: 4.. J� / 0 I a L LOT: Z3 5'24 BLOCK: cT SUBDIVISION: �/44/7-, ! '/G ?e. 13 SYSTEM DESIGN AND SP�IFICATIONS 13St L D FILL REQUIRED: [ 0 T H E R SQUAR SPECIFICATIONS BY: APPROVED BY: DATE ISSUED• 7 STATE OF FLORIDA DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PERMIT Authority: Chapter 381, FS & Chapter 10D -6, FAC ] INCHES PERMIT # 4 DATE PAID FEE PAID $ RECEIPT # PROPERTY ID #: / [SECTION /TOWNSHIP /RANGE /PARCEL NUMBER] II - 320. G, / "7 ~G ? [OR TAX ID NUMBER] /5 ] Temporary /Experimental r 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. HRS 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. T ["'G v ](GALLgiS - / GPD SEPTIC TANA /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: [ ] INFIELD S [ ] SQUARE FEET SYSTEM TYPE SYSTEM: [ ] STANDARD [ ] FILLED [ ] MOUND CONFIGURATION: [ ] TRENCH [ ] BED [ D R A I F LOCATION OF BENCHMARK: /0 ( 2 NOW/) ( kr),..thy F C. / i /'2v /�GU /L/? PIS s 5-7/) I ELEVATION OF PROPOSED SYSTEM SITE f 5 7 tI /FT] [A OV /REFERENCE POINT E BOTTOM OF DRAINFIELD TO BE [ 3k., g ] [INCHES /FT] [ABOVE /BELOW] BENCHMARK /REFERENCE POINT TITLE: TITLE: HRS-H Form 4016, Mar 92 (Obsoletes previous editions which may not be used) (Stock Number: 5744 - 001 - 4016 -0) BUILDING DEPARTMENT EXCAVATION REQUIRED: [ 3 0 ] INCHES EXPIRATION DATE• / G- 2 7- CPHU Page 1 of 2 INSTRUC EQNS: PT. Permit tracking number assigned by CPE-IU. A PPLICAn ION FOR: Check type of permit, if °Oter' specify ty : ?e in blank. APPLICANT: Property owner's full name. TELEHONE: Telephone number for applicant or agent. AGENT: Property owner's legally authorized representative. MAILING ADDRESS: P.O. beet or street mailing address for applicant or agent. S`'!S' 3M DESIGN AND S EC'IFICAT1ONS: LOT, BLOCK, SUBDIVISION or PACPa..1TY ID1,': 27 character id number for property. (CPHU U may require property appraiser ID L or eection/towvehip /range /parcel number) TANK: Minimum specifications from Chapter 10D -6, PAC. D AINF1ELD: Minimum specifications from Chapter 10D -6, PAC. OTHER: Other specifications, such as operating permit requirements, !ow- volume flush toilets, variance provisos. SPECIFICATIONS BY: Name of individual providing specifications. If designed by a registered engineer must be scaled. A?PROVED BY: County Public Health Unit (CPHU) personnel reviewing and approving permit. DATE ISSUED: Date permit is issued by CPHU. EXPIRATION DATE: One year from date issued if the system has not been installed. Permits for system repairs become void 90 days f:om the date issued. STATE OF FLORIDA DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PERMIT Permit Application Number PART II - SITE PLAN Scale: Each block represents 5 feet and 1 inch = 50 feet. I I f I I I I I I I I r " -I t AJ _�IA e \ G tc,. Nr. /O(-S %- ` it.J r SAMOCP Notes: oven F/ou, N� Site Plan submitted by: Plan Approved By if - HRS-H Form 4015, Feb 85 (Obsoletes previous editions which may not be used) (Stock Number. 5744- 002 - 4015-6) SIGNATURE P1,n / % /S,e,ri7 u- 7 - 2-7-7 TITLE E Not Approved Date 2 -2 7-99 County Public Unit ALL CHANGE UST BE APPROVED BY THE COUNTY•PUBLIC HEALTH UNIT Page 2 of 3 PERMIT APPLICATION FOR MIAMI SHORES VILLAGE Date pU Job Address 4 8 y /✓t - /D! Tax Folio Legal Description 1- Iistorically Designated: Yes No Owner/Lessee / Tenant Owner's Address Contracting Co. 4 c / 64_ Qualifier - 9/e"./ 2% a4 4� 7 /1 C, i0/ Ff Competency # Ins. Co. Architect/Engineer Address Bonding Company Address Mortgagor Address State # unicipal # Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN WORK DESCRIPTION -� 41 .) c i 'fN % —41 Square Ft. Estimated Cost (value) X./07P- 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 egulating construction and zoning. Furthermore, I authorize the above -named contractor to do the work stated. otary as to Owner and/or Condo President/ D My Commission Expires: "OZ s- -- .4 FEES: PERMIT a J , RADON APPROVED: Zoning Mechanical • tom Building Plumbing(NA^ Master Permit # 4 I 'O Phone Address /. 'j' / ' a 4--t_ Phone 305 65/ " •P13 ignature of Contractor or Owner- Builder Notary as to Contractor or Owner - Builder My Commission Expires - • Electrical L D: e ate C.C.F. 1. NOTARY SI BOND ..30 C) TOTAL DUE 3 c °L Engineering CONVTRUCTION PERMIT FO [Al New System isting System [ H ding Tank [ \1] Repair [dr.../ [ Other(Specify) APPLICANT: , J G J C ye , AGENT: c ' Sp p I:: G PROPERTY STREET ADDRESS: /e C /01 LOT: BLOCK: q SUBDIVISION: 4 PROPERTY ID #: [SECTION /TOWNSHIP /RANGE /PARCEL NUMBER] �'^ 3 o� -01:7 4:0 [OR TAX ID NUMBER] 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. HRS 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._ANND, PECIFICATIONS T [ 71D ] ALLON / GPD] Criiiiiiii7REROBIC 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 [ 2' UARE FE IMARY DRAINFIELD SYSTEM R [ ] SQUARE FEET SYSTEM A TYPE SYSTEM: [ ] STANDARD [ ] FILLED [ ] MOUND I CONFIGURATION: [ ] TRENCH [ (JIBED [ ] N Q /� F LOCATION OF BENCHMARK: U '''� ✓4 1 . - mo - {c .Q./J.1 -'--" - r I ELEVATION OF PROPOSED SYSTEM SITE [ 4 CA INCHES /FT] [ABOVE /BELOW] BENCHMARK /REFFE jE P T E BOTTOM OF DRAINFIELD TO BE [ ( INCHES„ET] [ABOV LOW] 4NCHMARK L D FILL REQUIRED: ( ] INCHES EXCAVATION REQUIRED: [ INCHES 0 T H E R SPECIFICATIONS BY: APPROVED BY: STATE OF FLORIDA DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PERMIT Authority: Chapter 381, FS & Chapter 10D -6, FAC DATE ISSUED: 41, Z��2 ti 5 w , TITLE: TITLE: HRS-H Form 4016, Mar 92 (Obsoletes previous editions which may not be used) (Stock Number: 5744-001-4016-0) ►.,, �' LLEK/C.s.".11ACTOR PERMIT # DATE PAID FEE PAID $ RECEIPT # 2 emporaiy /Experimental [ EXPIRATION DATE: CPHU Page 1 of 2 !\?: ?1- 7CAN7: :?rop; rty owner's full name. Tr_1.e -hone 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. (CPHU may require property appraiser ID 0 or section/township /range /parcel number) SYSTEM DESIGN AND SPECIFICATIONS: :y; In TANK: Minimum specifications from Chapter 1OD -6, FAC. DRAINFIELD: Minimum specifications from Chapter IOD -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 Public Health Unit (CPHU) personnel reviewing and approving permit. DATE ISSUED: Date permit is issued by CPHU. 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. By (LtI Jam+ ! C et, 7 1, i 1 I i - I I t -I - - a d,4e4,101 Notes' APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PERMIT Permit Application Number 1 ' ` • o I Site Plan Submitted Plan Approved L/ STATE OF FLORIDA DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES 1.1 rtmi I _ _ 1 J _1 I 1 1 , . 1_ L ; 1 .._ 1 JJ I ! III I 1 i I _ _I_I i I I I i I t I 1 ' I I( 1 - 1 - - I I I ' zoo ( J - I ; �, ,_1_I !_I_I r L___ I. �_l1 --I 1 1 1 - L __I .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 . f: i I 1 1 I _ I I _ I _ J I I. i- . .__ h1 i I ,_ I _ 1 I ._ I I Not Approved I, , , - 1 , , , , „ 1 I I. Ii i ? I11=. 1 11 i _I1 1 1 1 , 1 1 , I I L1= -i I LJJ I ! t_t _ 1: 11 1 I • 1 I l i i �� I I I - i1 I , -- r -- 4 o* GES MUST BE APPROVED BY THE COUNTY PUBLIC HEALTH UNIT ' I I r II I I IIl - iII I I i i I County Public Unit ' ,-o D --� 07/V 0 44_ 2_ � 7 '��� TITLE Date C- r 77 Page 2 of 3 BUILDING ELECTRICAL PLUMBING ROOFING Owner of Building \\\J Description. Address of Building Lot n ■ ERMIT 1ST? 13383 i MIAMI SHORES VILLAGE, FLORIDA ❑ Work to be performed under this Permit I I� ■x.. . Architect Contractor il r Builder - or Buder Bl. Value of I Amt. of 14. c <a, �,r t Project $ Permit $ i 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 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. Signed. . °•..: � tj ••-,. a3. �„,�Q ��, BY 1,, '- INSPECTOR In consideration of the issu to me of this permit I agree t per form 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 agept, servant or employee. k 3,e .... ,k. CONTRACTOR OR BUILDER BY AUTHORITY Subdi- vision DATE. 7- /- 195 Contractor's License No BUILDING ELECTRICAL PLUMBING ROOFING ❑ Owner of - Building .. Work to be performed under this Permit J . Architect Contractor or Builder i '~ �►�"' "s Legal Lot I I BL Description MIAMI SHORES VILLAGE, FLORIDA DATE y _ j S.... 195 ERMIT 1■° 13621 Address of �{ ,, * t__ Value of Amt. of e v, Building 1 -/ f / ( ` c s / Project $ Permit $ / This permit is granted to t to contractor or builder named above to construct the building or to install the equipment or device described in the application herefor in strict compliancelwith all. ordinances pertaining thereto and with the understanding that the work will be performed in compliance with any plans, drawings, statements or spec tficatio t} att 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 tie statements or specifications and that a assumes responsibility for work done by his agents, servants' or employees. `J >�..., :,.�j� -� +•M'_ BY INSPECTOR In consideration of the issuance to me of this permit I agree to p■rfcirm 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 age servant or employee. (T4e.t CONTRACTOR OR B ILDER Signed: Subdi- vision 1 Contractor's License No BY AUTHORITY .BUILDING 'ELECTRICAL PLEIMBiNG ROOFING Owner of Building Architect Contractor or Builds Legal Description. Address of Building Lot, E MIAMI SHORES 'VILLAGE FLORIDA DATE ,) Contractor's License No Work to be performed under this Permit PERMIT N9 14952 11 Bl. Subdi- vision vision Vctltut of / €! "" l' ' P e r t. of r Am } Project $ PerntBt $ ,,/ i This permit' is granted to the constractor or builder named above to construct the building or to install' the equipment or device described in the application herefor in.. trict compliance wig all ordinances' pertaining ,thereto and with the understanding that: the work will be. perforreed in compliance witch any plants, drawings, statements or ?pecifications'that. may have been.. s bn tted ao and approved by the proper the authorities. This Permit may be r "yoked at any `thhe if the work is not d ' e in compliance with such orb} y a o s o of the plans are changed without aiuthoriaaa oa. A further condition upon v hid this permit is gransed is the understan ag that the contractor .or bnff er "named alcove assumes the responsibility for a thorough knowledge of the ordinances and regulations pertaining to the work coed hereby whether a own on the plans or drawings .6r in the statements or specifications and that he assumes responsiblity for work done by leis agents servants or employees., I 1 I Li considera 'rs, of t pertaining to d in in accept toil:'- rtn'iC,•1 Signed SP2CTOTt agree to- ,?arkrm the work catered' hereunder in compliance with all ordinances and regulations -wings statements or specifications submitted to the proper authorities of Miami Shores Village. work done by either, myself, my agent, servant or employee. Work done by Address of work Owner Septic Tank Vi Drainfield When ready Plumbing - Final e ,— Received by Date Time PLUM3ING - LISPECTION ‘..uwer C s Rough To_2_ out PM