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210 NE 102 St (8)f ! Date i ature of own My PERMIT APPLICATION FOR MIAMI SHORES VILLAGE Job Address Z/0 /'J E , D� Tax Folio Legal Description Historically Designated: Yes No Owner/Lessee / Tenant NA IC / /M ,/ -QG�Lr• Master Permit # t , 76 / 0 Owner's Address � o e - C pA. J�+ Phone 30S "' 1,2-6 4780 4 Contracting Co. al ` S Se ( Q-rA) Address lr f 4 t , a �� // '' rr I / C / Qualifier ' I`,.c�.�+ G ' �L L /(� Lw SS# - - Phone 4 ` 78 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 DESCRIP'T'ION � I , S / c — G' / /�t e Square Ft. 3 ‘46 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 i d zoning. Furthermore, I authorize the above -named contractor to do the work stated. or Condo President Da e • �� L S • . CKII "',, ,a 't'! - r' dri sident . ..s c cssstao APPROVED: Zoning Building Mechanical Plumbing Estimated Cost (value) d L Il _ALA or • r„ PTA! oi GLADYS J VILLAR NOTARY PUBLIC STATE OF F1 OR1DA COMMISSION NO. CC714103 MY COMMISSION EXP. MAR 1 S gnature of Contractor or Owner- Builder Date Npt to Contractor ommission Expire 4 763-Ey'D FEES: PERMIT RADON C.C.F. ' NOTARY Electrical BOND,O 45- 0 Date TOTAL DUES Engineering CONSTRUCTION PERMIT FOR: New System [� [' Repair ((. APPLICANT: /1*" y PROPERTY ADDRESS: el?"j O N 6 / 0 .R I LOT: SYSTEM DESI A K D R A I N F I E L D 0 T H E R 4 STATE OF FLORIDA DEPARTMENT OF HEALTH ONSITE SEWAGE TR r TMENT CONSTRUCTION PERM ti [ al)] SQUARE [ .] SQUARE TYPE SYSTEM: CONFIGURATION: BLOCK: Existing System Aba donment �( IEMb LOCATION OF BENCHMARK: r 41l1 J 0 IO ELEVATION OF PROPOSED SYSTEM SITE [ I. O] [IMISHES / T BOTTOM OF DRAINF.IELD TO BE [CUSPS/FT] pt. 1: Health Department pt. 2: Applicant pt. 3: Instal ler /Contractor pt. 4: Building Department IiI POSAL SYSTEM Holding Tank Temporary SUBDIVISION: (d4N3 Li6 [SECTION, TOWNSHIP, RANGE, PARCEL NUMBER] PROPERTY ID #: j l - oQIQ [OR TAX ID NUMBER] 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. ANTD 4I I S e 444 LONS / GPD SEP C 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] GALLONS DOSING TANK CAPACITY [ , ]GALLONS @ [ . ] DOSES PER 24 HRS # PUMPS [ ] FEET PRIMARY DRAINFIELD SYSTEM FEET ���{{ SYSTEM (7 ' STANARD 11" ] FILLED ] MOUND [/4 _ [NI TRENCH BED ung FILL REQUIRED: [ A ] INCHES EXCAVATION REQUIRED: (.20 ] INCHES [ABOVE /B BENCHMARK /REFERENCE POINT [ABOVE /D ] BENCHMARK /REFERENCE POINT • Ir ATA%h SP OF LOAMY COAPE's: SAND UNDER COTTOM 0, P9 , wr SUtM T 56:4'!C ,t'J:r. IUD v THIS PEtiml i MOT 70f1 ADDITION(F3) SPECIFICATIONS BY: TITLE: APPROVED BY: M TITLE: N I r (1sG" cHD DATE ISSUED: ) A n -- EXPIRATION DATE: Ilk DH 4016, 12/99 (Page 1) (Previous Editions May Be Used) PERMIT NO.004 - 33 � Z DATE PAID: ot e <00 FEE PAID: ?S , 0 3. RECEIPT #: 4 : oCt [ Innovative [�T Page 1 of 3 INSTRUCTIONS: PERMIT NUMBER: Permit tracking number assigned by CPHU. CONSTRUCTION PERMIT 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. (CHD may require property appraiser ID # or section /township /range/parcel number) SYSTEM DESIGN AND SPECIFICATIONS: TANK: Minimum specifications from Chapter 64E-6, FAC. DRAINFIELD: 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 ISSUED: 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. 1 1 l I I-1 y I I _.... !I 4 0 : Li - - I I 1 I 11 i t 1 I I l_ 1 1 1 I I 11 ! 1 1 1 ' 1 I I - I _' ' I _I 1 i !1 1 I 11 ._ t I I - I L I i 1 11 ' i 1 1 ! I i 1_ I I 1 i 1 I. -- i _ i _ I � 1 l I ., t I 2_1_1 L!�y _`�- ' ( I = II - 111111 1 I ! tilt!' I _ � �I I I � I I I� I� I IJ I i � (� ( 1 I, rf a l l _ .1 1 1 �_- f I T= I� 1 _ I i� t 1 I ! 1 '_U 1 1 1_l 1 1 I l r 1 1 i I t ! l I 1 1 1 1 1 1 ! I_ I t ;i I CI [ 1 I I I L1 I I - T - I l I 1 Ili T - 1_! De ! - ( 1 f 1 1 t I 1 I 1 I I P � j { i 1 -1 i _ 1 (: 11 1 1- ___1 -i - - i -=- 1 ' LI_ I I I - I. I_ I__L' i_ 1 • -- t 1 t i_ =t I 1 1 1 1 ! - I I I _ �I I - 1 - I 1 . r- I I 1 I -; i. �_ 1 I ` I 'II 1 1 _I I I_ 1 i 1 1 - _IJ 1 ' I I - 1 - 1 I I I I _ _, 1 1 , _I I 1 1 ' _1 1= - -' 1: I I 1 t_I 1' I I 1 1 -:- I 1 I 1 _I _ 1 I1 _ . I I I_!� 1 I I 11 _ I - L -1 I U-- 1 ' i - 1 1 I I 111 i 1 I :.. 11 1I 1I Ili 1 I 1 _ ) _ 1 1 ! : I 1 L: I11 II _J '_I I_IL I I I_ I I _ 1 1 1 1• 1 1 1 1_ _ I I .._1!j- 1 _ I IJ 1 u_._ 1 1 1 f"Th, 1 1 I_ I i I r , I ' 11 (1' L ii I ` 1 ; r _ i! ) 11 I I I By Notes: 1 (1 i;I_I 4 1 1 , _ _I L I I I _ 1 1_, 1 Site Plan Submitte Plan Approved j ♦y STATE OF FLORIDA DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PERMIT � . Permit Application Number �(.) -� 'c3-- I r, 4 3 / 1,744,--e-- (-41-, ' i!_ IAI I I I _ j — I -, ( I _. _ I 1 ! 1 1 • !) i Ii 1 1I I 11 1 1 1 U 1 1 1 i_ I 1 I 1 - 1 - I I , I _ 1 1 1 LI I _1_I_ 1 . . 1 11 --- 11 1 '-- 1 ---- 1 - - - 1 U HRS -H Form 4015, Feb 85 (Obsoletes previous editions which may not be used) (Stock Number: 5744- 002 - 4015 -6) L PART II - SITE PLAN SIGNATURE ALL HANGES ST BE APP30(E Not Approved -iL i.11 � 1 I 1 I • I _ -, I �,I _) • ' f LI 1 I I 1 ,' 1 i11I1i :11 _ t ` -I III _. I 1 I I I :111 1 I I: LI L I 1 I 1 I I 1 1 L1 1`•!_ i 1 I l 1 1 .! , • Y. THE COUNTY PUBLIC HEALTH UNIT I L : Il 1 1 - 1 `' 1 1 I I _11 '_! I ` I .-1-Ti-T-1--- i_I._I rl , 1 i 11 , 1 TITLE Date County Public Unit Page 2 of 3 DATE: S e ADDRESS OF FILE REQUESTED: INFORMATION REQUESTED: Acknowledged by: FILE RETURNED TO: INITIAL Miami Shores Village Building Department 10050 NE 2 Ave, Miami Shores, Fl 33138 Tel: (305)795 -2204 - Fax; (305)756 -8972 PLEASE PRINT 6 TIME: NAME OF PERSON REQUESTING FILE: c l , Cvou 71 (0 & C2- 2_ to N- (,02") PHONE #: YOUR ADDRESS: \in: ace-L-1 F[_ot,; � 33 13 ( C I understand that all documents in this file are property of Miami Shores Village and that NO documents may be removed from this file. You may get 4 complementary copies (8x11) size, additional copies will be furnished at 0.15 cents per page, not including any blue prints. If blue prints are order please be aware that we are not responsible for the quality of the printed documents. Permit Na 99ya Registered Architect and /or Engineer 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 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 the progress of work. Owner's Name and Address t J .� r � fif Pi�1(1 Q Na 7-4 / 2 2 Street 0 G• •/iol 1l to ing Ph mb Dame 445 /ne. -1 Location and Legal Description Lot / Block / Subdivision Street and Number where work is to be performed — Na alO by /01 6 Street State work to be performed and purpose of building (By Floors) New Building Remodeling Addition Size Septic Tank Type of Tank Capacity Gals. Dist. Feet of Tank or Drain Field from Well Nature of Water Supply: City - Well Size of Soakage Pit Feet of Drain Tile Ao Amount of Permit $ No. ‘0 Street Repairs geA No. of Stories (Signed) t/•' 0 ` 9c4 ?sy ss. Date '`!O� /V 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 complied 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. (Signed) ,17 ��° 0 $9D ,��� Master Plumber. STATE OF FLORIDA, 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 $25.00 will be made when such re- inspection is made necessary by improper notice for inspection, or faulty materials and/or workmanship. BATH LAVA • SLOP LAUNDRY CATCH FLOOR DRINKING CLOSETS TUBS SHOWERS TORIES SINKS SINKS TUBS URINALS BASIN DRAIN FOUNTAINS -- TOTAL FIXTURES CONTR. LIST ------�_----- CHECK ------------- SEPTIC SEWER TANK CONN. FIELD FIELD SOAKAGE PIT GREASE TRAP TRAP HEATER HEATER DEEP WELL SYSTE. SYSTEM M ---- S . POOL POOL CONTR. LIST ------------- CHECK ------------- Permit Na 99ya Registered Architect and /or Engineer 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 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 the progress of work. Owner's Name and Address t J .� r � fif Pi�1(1 Q Na 7-4 / 2 2 Street 0 G• •/iol 1l to ing Ph mb Dame 445 /ne. -1 Location and Legal Description Lot / Block / Subdivision Street and Number where work is to be performed — Na alO by /01 6 Street State work to be performed and purpose of building (By Floors) New Building Remodeling Addition Size Septic Tank Type of Tank Capacity Gals. Dist. Feet of Tank or Drain Field from Well Nature of Water Supply: City - Well Size of Soakage Pit Feet of Drain Tile Ao Amount of Permit $ No. ‘0 Street Repairs geA No. of Stories (Signed) t/•' 0 ` 9c4 ?sy ss. Date '`!O� /V 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 complied 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. (Signed) ,17 ��° 0 $9D ,��� Master Plumber. STATE OF FLORIDA, 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 $25.00 will be made when such re- inspection is made necessary by improper notice for inspection, or faulty materials and/or workmanship. Date of Application Name of Owner N $ S /M' 1 /.4JZTelephone Number '7 3 . cv- f 87 Mailing Address of Owner a I 4), � , Owner's Agent 4-)%1M4 s 7 4'uilder Agent's Mailing Address Property Street Address / /if- ; /8 V- th Lot No NOTE: IF NOT IN. A SUBDIVISION ATTACH A METES AND WUNDS DESCRIPTION This Application is for: New System Repair Existing System -# 19 0 Type of Residential No. Bedrooms Heated or Cooled Area Sewage Flow (each dwelling unit) (each dwelling unit) U (Gallons per day) ft ft Exact Directions to Property STATE OF FLORIDA DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PERMIT 1447 --?0 Block No Subdivision Date Subdivided Type of Establishment 3 AUDIT CONTROL NO. l V ''_:P_ � /3 / G' HRS-H Form 4016, Feb 85 (Obsoletes pre editions which may not be used) (Stock Number:'5744 -001-4015 -1) Authority: Chapter 381, FS Chapter 10D-6, FAC PART I - APPLICATION Permit Application Number Sewage Flow (Gallons per day) TOTAL FLOW = Applicant's Signature Telephone No bay- 93 No. Dwelling Units c? Sewage Flow Based On Page 1 of 3 ..P °2/769 1 No.... �. r1 Application is Hereby made for the approval of the detailed statement of the plans and specifications herewith subr.i '...il for the bu(!ding ar other ,'tructure herein described. This application is made in compliance and conformity with the Building Ordinance of Mi..: •-! Shores Village, Florida, a „d all provisions of the Laws of the State of Florida, all ordinances of Miami Shores Village and all rules and regulati- of the Building Division of Miami Shores Village shall be complied with, whether herein specified or not. A copy of approved plans and spec. ficatlons must be kept it '�uilding during progress of work. `,Nvner's Narne and Address ........ ....____. .cgist Architect and /or Engineer :mploying Plumber's Name Feet of Drain Tile.. 00 Amount of Permit $ STATE OF FLORIDA, } COUNTY OF DADE. MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT 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 Repairs No of Stones Size Septic Tank__.-'I • — -__.- _..Type of Tank__ `✓ ' Bloch __Dist. Feet of Tank or Drain Field from Well . (Signed)_ No.- / 2 / . ' .:,, .,. Street... Capacity .Sts._._ / • - -.._. Nature of Water Supply: City — Well..--- .-- .--•_-- •-_ -..... .--- ..___ -- .._Size of Soakage Pit Street '. My Commission Expires Notary Public, State of Florida • Plumbing Inspector The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations as an a n;rloyet of litho under the Florida Workmen's Compensation Act, being Section 5969, Compiled General Laws of Florida Permanent : up► lement, and lids 0017• t.lied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors employ . 1 y him In ' le •.I rk v b� performed under this permit; and will post or cause to be posted for inspection on the site of the work such p 31. notice r no leer is ar required by the Act. The undersigned agrees to employ only such sub - contractors, on work . • . perfo - ed is a rl.ril :u . licensed by Miami Shores Village. ( Signed Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, per,or,,et ; . ppearec, 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 acts therein by him stated are true. NOTE: A re- inspection fee of $1.00 will be made when such re-inspection la mede•neoessary by improper notice for inspert!on, ttr omit) materials and /or workmanship. CLesrrs BATH TUB• SHOWERS LAVA- TORIES SINK• SLOP SINKS LAUNDRY Twos URINALS CATCH BASIN FLOOR DRINKING DRAIN FOUNT'Ne TOT..L FIETIT ES CONTR. LIT CHECK • SEPTI TAN SEWER CONN. DRAIN FIELD SOAKAGE PIT GREASE TRAP SOLAR M DEEP WELL SPRKLR. S SWI14'0 POOL CONTR. LIST CHECK i ..P °2/769 1 No.... �. r1 Application is Hereby made for the approval of the detailed statement of the plans and specifications herewith subr.i '...il for the bu(!ding ar other ,'tructure herein described. This application is made in compliance and conformity with the Building Ordinance of Mi..: •-! Shores Village, Florida, a „d all provisions of the Laws of the State of Florida, all ordinances of Miami Shores Village and all rules and regulati- of the Building Division of Miami Shores Village shall be complied with, whether herein specified or not. A copy of approved plans and spec. ficatlons must be kept it '�uilding during progress of work. `,Nvner's Narne and Address ........ ....____. .cgist Architect and /or Engineer :mploying Plumber's Name Feet of Drain Tile.. 00 Amount of Permit $ STATE OF FLORIDA, } COUNTY OF DADE. MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT 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 Repairs No of Stones Size Septic Tank__.-'I • — -__.- _..Type of Tank__ `✓ ' Bloch __Dist. Feet of Tank or Drain Field from Well . (Signed)_ No.- / 2 / . ' .:,, .,. Street... Capacity .Sts._._ / • - -.._. Nature of Water Supply: City — Well..--- .-- .--•_-- •-_ -..... .--- ..___ -- .._Size of Soakage Pit Street '. My Commission Expires Notary Public, State of Florida • Plumbing Inspector The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations as an a n;rloyet of litho under the Florida Workmen's Compensation Act, being Section 5969, Compiled General Laws of Florida Permanent : up► lement, and lids 0017• t.lied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors employ . 1 y him In ' le •.I rk v b� performed under this permit; and will post or cause to be posted for inspection on the site of the work such p 31. notice r no leer is ar required by the Act. The undersigned agrees to employ only such sub - contractors, on work . • . perfo - ed is a rl.ril :u . licensed by Miami Shores Village. ( Signed Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, per,or,,et ; . ppearec, 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 acts therein by him stated are true. NOTE: A re- inspection fee of $1.00 will be made when such re-inspection la mede•neoessary by improper notice for inspert!on, ttr omit) materials and /or workmanship.