Loading...
1280 NE 102 St (6)PERMIT APPLICATION FOR MIAMI SHORES VILLAGE Date/0 Job Addre s 440 d A 2 /4 Tax Folio / e, 5 °`O6 e2,7 $SC Owner / Lessee / Tenant is tO d' Master Permit Q Legal Description Owner's Address /? b d Phone 9VD Contracting Co. , / e, ev— Address Qualifier ( /2 l yt V (Phone 97e1 Got / Square Ft. - ' O State # Municipal # Competency # Ins.Co. Architect /Engineer Address Bonding Company Address Mortgagor Address Permit Type(circle one): BUILDING ELECTRICAL MECHANICAL ROOFING PAVING FENCE SIGN WORK DESCRIPTION ( V I N - c 4 / h 4 7 ` • e - E s t i m a t e d 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 construction and zoning. Furthermore, I authorize the above -named contractor to do the work stated. Signature of owner and /or Condo President Date: Notary as to Owner and /or Condo President My Commission Expires: Signatur o retractor o Owner- Builder Date: P® / « / r., / / ,/ /L //, ;�EPHINECHURCN tar /as to C. 4�� •,r;p cc! , • y Commission J No. CC1 97545 ** * * * * * * * * * * * * PEES: PERMIT d f° RADON C.C.F. l f o ° NOTARY 5 ` TOTAL DUE "I5G ,, ' APPROVED: Fire Other Zoning Building tq Electrical Mechanical Plumbin 1i ) l Engineering � g I �3 g R Ex ** CONSTRUCTION PERMIT FOR: [ ] view System [ ] Existing System [ ] Holding Tank [ ] Temporary /Experimental [Repair [ ] Abandonment [ ] Other(Specify) APPLICANT: PROPERTY STREET ADDRESS: /Z g o , e . J oz s 1 . LOT: PROPERTY ID #: STATE OF FLORIDA PERMIT # 932-36 DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES DATE PAID ONSITE SEWAGE DISPOSAL SYSTEM FEE PAID $ CONSTRUCTION PERMIT RECEIPT # Authority: Chapter 381, FS & Chapter 10D -6, FAC Arlo BLOCK: SUBDIVISION: 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 AND SPECIFICATIONS T [ ] [GALLONS / GPD] SEPTIC TANK /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 [ 3 00] SQUARE FEET PRIMARY DRAINFIELD SYSTEM R [ — ] SQUARE FEET SYSTEM A TYPE SYSTEM: [L— [ ] FILLED [ ] MOUND [ ] I CONFIGURATION: [ ] TRENCH [u/(BED [ N ,1 F LOCATION OF .BENCHMARK: /.) /d4 I ELEVATION OF PROPOSED SYSTE SITE [AJ)4 ]'[INCHES /FT] [ABOVE /BELOW] BENCHMARK /REFERENCE POINT E BOTTOM OF DRAINFIELD TO BE [ �f � // ] [INCHES /FT] [ABOVE /BELOW] BENCHMARK /REFERENCE POINT �t D FILL REQUIRED: [frJ /A ] INCHES EXCAVATION REQUIRED: [/A ,4. ] INCHES 12 SG'w4 viJ'r bra/i4 4rea. H E R SPECIFICATIONS BY: APPROVED BY: DATE ISSUED: /0 L HRS -H Form 4016, Mar 92 (Obsoletes previous editions which may not be used) (Stock Number: 5744 - 001 - 4016 - 0) AGENT: fr 0 _ Poo 4.Q r 3273 [SECTION /TOWNSHIP /RANGE /PARCEL NUMBER] [OR TAX ID NUMBER] TITLE: vicJ. %p 'c. r TITLE: ef.oa. 5 F'C• ' 1)6eL APPLICANT EXPIRATION DATE:, CPHU Page 1 of 2 INSTRUCTIONS: PERMIT NUMBER: Permit tracking number assigned by CPHU. 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. (CPHU 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. 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. US * • - -- -- , ,.. 5 UR - F4 1 II ma* ■ .._ i ' iN 11 au N !viii KF! s I9 ! 21111 1 -i1 Ri M ■$$$U •' • I ■ = MN ass , a as'��. -. ■ ON NON _ - 1 • *T IEt' h ,, ais ma 1 iii,,L, i I VPI. n 1_ -1 11 I - J I I_ I--1 ! IJ___0 -- __I �1 I I 1 I ■ 1 1 _ I n_T1 1 I _ j I I__ I`J CI 1 ; J T J_C'C _I J L I' J J / h I i ( ■ ( 1- I I -1_t I I I I I_ !J k L I _ L _ _ _ 1 _ L1 - 1 . -l- - JJ [ J'i 1 1 1 HJ�1 J 1 _ 1 o I __! J 1J __ - I I 1 1 - . I 1 ' 1 . i -I_LJl n If ( J !I 1:ITlI rt_f_ 1 _L _i_ I II I I f i 1 _'JAI - I I _! - 1 I ! !_ f r '_ 1L._ J I i - 1 LL; I 1 ! I -t -. 1 I I 1 1 1 1 : _ I I I 1 . 1 �! IJ !_I.1 1 L - ITC_ I I - - II. # � • Llll Iii U�1_IU '1 - l_I l _,1. Id 1 i j_ i I 1 1 L! - ( I -1 I 1 (lJ r 1 t1 - I U - T 1 J -� L d _I_r _1 i I , 1 I J ! 1 r I 11 - I I I J_J I 1 I_L I _ I i _I I LTI JE I =, -I I I -- J I [MI i l l (J ! {�1 ilf f 1 1 ! l�r i 1I - _ ! _ ! _ - 1 [i _ j I _ I I - 1_1 ! ! _ l_ I _ - 1 I x"7 1 t " - T - 1 (+ 1_I 1 t_ - - 1 -1 1 CI J i -! 11_I I - j ���I_I D i I I ! DE IJ J r , _ ' !_ 1 I C -- ' I 1 ,_, _,_IJ I F L: J ^ .. - 1 J ( I JJ 1 E 1 J I 1 -1! U 1_ 1 Lf 1 ! I ! _1 -1-1-1 (E [I_I L I_ („_l ' �O . 1 1 —� — r ' ' ! I I _ I _ I LI _ I_I _ I _ _ ( L _ I I I I I I • 1. 1 11 I - r - 1 -,---- j;, n :_IJ - 1 _ 1 - ! - j I - - 1 Li I i E1_1_ _I_I i I_I I_ I I __(��T _I _, I_ _U COD _,J 1_ _ 1 I _i 1� J 1 I ;1 (_ L I J_3 1 r 1 -1 r- l 1 I I I _ - I J 1l I 1 l E I _�- C I D DTI t I LL 1 ,FTI I I I_ LL 1 E LC_I - [o I __ MI-I CO 1 _ 1 J- f I - 1 _ J J - i i i ID i U C i _U_C0_ J _L IIInf11E n in 1 i_II L -_ 11 — ' - C _ 1 '' I L [-I_I J III • n _ _ ! J_ J 1 LL _ 1 - LI 1 ■ 1 1 1 - 1 1 1 1 1 1 I_1 I I L ! i I 1 1I� _3_� _ �_� Limn! !7 1 - -u L �J_I 1 11 1 1 1� LI J 1_1 -- 1 nul .1 .1 1 i (LLi_i_ ,,,L1- I__ 1 I_ 1 --- � I I 1 "1 rl_E 1 1 — I • ! Q 1 1 II - r I 1 1 1 - f � - n_ i_ I_ _ V� T _ � JJ I � _ L L _ I i �l LE 11 . • i 1 - I 1 1 3 1 _ I - I I I r 1 ! � ~ 1 ._ I L'J I ■ � I ■ n 1 I 1_I � ( i I t { I IT J -- J I ! I • j 3 1 I _ _ I 7 iJ 1 f I _ " �_ l� l ! �; 1 1 I 1 I 1 1 1 1 I 1( I f � 1 ( 1v'1 I! I l 1 1 I I I I I . . _ f I! 1 ri - (iI I -j 1 I J 1 1 1 1 1 ' : _ 1I r7_( OD! 11 _ � 1 I I_ J 1 ! • i t i 1 t !! I _ . - 1_ I I _ .._ _ I 1 0 (-1 I I_ _1_.!_J i 1 ( I 12 _ 1_I Ef !II f . 1_! LI_ - 1_ III I I 1 - 1 � _ , r _ ___ _ 1 _ 1 i � I - L, __ ( - � _ 1 l - _____L„ 1 - - 1 Il f 1 1 U I! i I 1 I U rtra�rrl>• a I I R a ■ , H E I L - I __ i _ -! I I- 1J !( 1 FO: LL _J. 1 J I I ■ ■ __f I_ 1i I ,� } it - k I 1_ J , I i- `t 1, 1 - _J 1 i �I 7 1_1_1 11 1 - 1 1 1 r i' 1 1 1! - 1 . 1 ■ 1 ■ J ■ I R ■ I 1" ■ m own ii U 1_4 1 L! 1 Notes STATE OF FLORIDA DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION ^E" "•'T Permit Application PART II - SITE PLAN /,'D 1"O ,ut /o 2 Site Plan Submitted by: SIGNATURE Plan Approved By Not Appr' E.-4(4 jp Pc. I. A L GRANGES MUST BE APPROVED BY :IRS -H Form 4015, Feb 85 (Obsoletes previous editions which may not be used) (Stock Number: 5744 - 002 - 4015 -6) TVAJ UNIT / TITLE Date JO County Public Unit Page 2 of 3 fri MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT Permit No / Date__ 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 Registered Architect and /or Engin r__ __ _ __ Employing Plumber's Name - ��� %G �� ! - - -- Street_. Location and Legal Description Lot______ ________.____. / _____ Block_ Subdivision _ Street and Number where work is to be performed —No ' k Street_ Street State work to be performed and purpose of building (By Floors) _______ _ _________ --- __._______ - - - _ New Building _ Remodeling_________ _______ Addition____ Repairs No. of Stories. Size Septic Tank z Feet of Drain Tile__ ' Nature of Water Supply: City—Well Amount of Permit $ Type of *auk_ _ Capacity Gals. t. Feet of Tank or Drain Field from Well Size of Soakage Pit (Signed)._ ( Signed Plumbing Inspector. The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligat ns as an employer of labor under the Florida Workmen's Compensation Act, being Section 5988, Compiled General Laws of Florida Perine Supplement, and has rm- plied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors employed by him in the work t9 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. aster Plumber. STATE OF FLORIDA, I is. COUNTY OF DADE. 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. CLOSETS BATH TUBS SHOWERS LAVA. TORIES SINKS SLOP SINKS LAUNDRY TUBS URINALS CATCH BASIN FLOOR DRAIN DRINKING FOUNT' NS TOTAL FIXTURES CONTR. LIST CHICK SEPTIC TANK SEWER CONN. DRAIN FIELD SOAKAGE PIT GREASE TRAP SOLAR HEATER DEEP WELL SPRKLR. SYSTEM SW IM'0 POOL CONTR. LIST CHICK fri MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT Permit No / Date__ 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 Registered Architect and /or Engin r__ __ _ __ Employing Plumber's Name - ��� %G �� ! - - -- Street_. Location and Legal Description Lot______ ________.____. / _____ Block_ Subdivision _ Street and Number where work is to be performed —No ' k Street_ Street State work to be performed and purpose of building (By Floors) _______ _ _________ --- __._______ - - - _ New Building _ Remodeling_________ _______ Addition____ Repairs No. of Stories. Size Septic Tank z Feet of Drain Tile__ ' Nature of Water Supply: City—Well Amount of Permit $ Type of *auk_ _ Capacity Gals. t. Feet of Tank or Drain Field from Well Size of Soakage Pit (Signed)._ ( Signed Plumbing Inspector. The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligat ns as an employer of labor under the Florida Workmen's Compensation Act, being Section 5988, Compiled General Laws of Florida Perine Supplement, and has rm- plied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors employed by him in the work t9 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. aster Plumber. STATE OF FLORIDA, I is. COUNTY OF DADE. 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.