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29 NE 102 St (4)PERMIT APPLICATION FOR MIAMI SHORES VILLAGE Date q [ & 1O Job Address) Q i NE 102 ST Tax Folio Legal Description Historically Designated: Yes No Owner/Lessee / Tenant >1 al e R > E3 1<O Master Permit # Owner's Address . ‘c)2. Ohre of 33 I 3 S' Contracting Co. V L1 O y d - 1.10 411 t d V g ddress bo r/ W f l l rQ-e - f -- - 1 ) Q 1 7'1; Qualifier Teke &c t Fe (d-Pir SS# --7 Phone [0 57Cri 6 State # sf ax i4 48' Municipal # Competency # Architect/Engineer Address Bonding Company Address Mortgagor Address Permit Type (circle one): BUILDING ELECTRICAL L M MECHANICAL ROOFING PAVING FENCE SIGN WORK DESCRIPTION '— �D(Z-►4-k NIP! E ` ( 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 construction and zoning. Furthermore, I authorize the above -named contractor to do the work stated. e of owner an or n• o • resi• ent do Pre FEES: PERMIT 3DO • Owner and/ ssion Expire ta %‘%%% cc c%%\\%accccccacacccm . Pie Teresa J. Felder • ./ Notary Public, State of Florida . '• a Commission No. CC 480807 of r o My Commission Expires 07/16/99 + • t • &ere atatutaaereeee atte,ere eee a atxutticry —...7 RADON APPROVED: Zoning Mechanical Plumbing / G/q dent Date C.C.F. Building 1 Phone 3 n -4 2 f 151 - 2615 Ins. Co. Estimated Cost (value) ' /J5 /• / / • itr., or or Owner- Builder ion Exp OFFICIAL NOTARY SEAL GLADYS J VILLAR II.IC NOTARY K STATE OF FLORIDA COMMISSION NO. CC714103 MY COMMISSION EXP. MAR. 1 r- Builder Date Mary as to C My Commission 1-� NOTARY Electrical Engineering V . BOND 3 0 TOTAL DUE Date N F I E L D 0 T H E R PERMIT # 0 DATE PAID FEE PAID $ _9 G RECEIPT # � cJ Authority: Chapter 381, FS & Chapter 1OD -6, FAC STATE OF FLORIDA DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION CONSTRUCTION PERMIT FOR: .�. ] New System [ ']/Existing System [ '] Holding Tank [A-'Temporary /Experimental [ >] Repair [ ��]] Al .] Abandonment [ Other(Specify) APPLICANT: ' / �-)R P / 7 -, c ) AGENT: 4.4CP) ` V ?,, 7) ) PROPERTY STREET ADDRESS: 22 / ) .- 4/ (� ��� r J LOT: /2, BLOCK: SUBDIVISION: PROPERTY ID #: // 32-0 - [SECTION /TOWNSHIP /RANGE /PARCEL NUMBER] SYSTEM MUST BE CONSTRUCTED IN ACCORDANCE WITH SPECIFICATIONS AND STANDARDS OF CHAPTER 1OD -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 DESIG AND S pECIFICATIONS T [ 0 ] GALLtLS - GP] 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 [ 6PC SQUARE FEET PRIMARY DRAINFIELD SYSTEM R [ ] SQUARE RE FEET SYSTEM A TYPE SYSTEM: [ ] STANDARD [ ] FILLED [ ] MOUND [ I CONFIGURATION: [ ] TRENCH [ (-] - [ [ LOCATION OF BENCHMARK: + :f7. E. /0, 7 AiSe_ C d >, C - c, i ) ELEVATION OF PROPOSED SYSTE SIT [/� ] T,hLr�F FT] [ABOVE -ELO BENCHMARK / R1FERENCE POIN BOTTOM OF DRAINFIELD TO BE [ tr, [INCHES /FT] [ABOVE /BELOW] BENCHMARK /REFERENCE POINT FILL REQUIRED: [ ] INCHES EXCAVATION REQUIRED: [3 6) ] INCHES " a SPECIFICATIONS BY: APPROVED BY: DATE ISSUED: ® q . [OR TAX ID NUMBER] 7 ;7 ? r_2. TITLE': TITLE: HRS -H Form 4016, Mar 92 (Obsotetes previous editions which may not be used) Page 1 of 2 (Stock Number: 5744 - 001 - 4016 -0) CPHU EXPIRATION DATE: C; 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, SUBDIV1SION or PROPERTY ID11: 27 character id number for property. (CPHU may require property appraiser ID ft or section/township /range /parcel nrtnber) SYSTEM DESIGN AND SPECIFICATIONS: TANK: Minimum specifications from Chapter 10D -6, FAC. DRAINFIELD: Minimum specifications from Chapter 1OD -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 system repairs become void 90 days from the date issued. 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E•D- Y THE COUNTY PUBLIC HEALTH UNIT HRS -I-1 Form 4015, Feb 85 (Obsoletes previous editions which may not be•usetl) f� Page 2 of 3 (Stock Number. 5744 - 002 - 4015 -6) STATE OF FLORIDA DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PERMIT Authority: Chapter 381, FS & Chapter 10D -6, FAC CONSTRUCTION PERMIT FOR: [1V] New System [ A System [Al Holding Tank 01-Temporary/Experimental [ >] Repair [ #] Abandonment [Al Other(Specify) APPLICANT: �` / j, P / E T \G PROPERTY STREET ADDRESS: 2' .vz / LOT: BLOCK: SUBDIVISION: PROPERTY ID #: i! 3 2-0 / „ 0 /3 _ s [SECTION /TOWNSHIP /RANGE /PARCEL NUMBER] b [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_AND SPACIFICATIONS T [ / A [ N [ K [ GAL -/ GP SEPTjTANK /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 PER DOSE DOSING TANK CAPACITY DOSE RATE [ ] PER 24 HRS NO. OF PUMPS: [ ] D [ 3 DARE FEE Tj PRIMARY DRAINFIELD SYSTEM R [ ] SQUARE FEET SYSTEM A TYPE SYSTEM: [ ] STANDARD [ ] FILLED [ ] MOUND [ ] I CONFIGURATION: [ ] TRENCH [ 44.-BED -BED [ ] ' F LOCATION OF BENCHMARK: . ' /0. / "'� 'liS! C 0 -7,. C 4 - f 1)% ^ - - I ELEVATION OF PROPOSED SYSTEM SITE [ /, ] CHEO FT] [ABOVEOELOWI; BENCHMARK / RtFERENCE POINT, E BOTTOM OF DRAINFIELD TO BE [ £..'fi [INCHES /FT] [ABOVE /BELOW] BENCHMARK /REFERENCE POINT D FILL REQUIRED:- r� 0 T H E R ] INCHES SPECIFICATIONS BY: APPROVED BY: DATE ISSUED: 6 AGENT: G i,,, r - EXCAVATION REQUIRED: [ 3 d, INCHES TITLE: TITLE: HRS -H Form 4016, Mar 92 (Obsotetes previous editions which may not be used) (Stock Number: 5744-001- 4016 -0) PERMIT # 84//.1r DATE PAID 6 - FEE PAID $ RECEIPT # � ' tic .41 'y CPHU EXPIRATION DATE: 9 ,09 , ? 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 11 or section/township /range /parcel number) SYSTEM DESIGN AND SPECIFICATIONS: TANK: Minimum specifications from Chapter 10D-6, FAC. DRAINFIELD: Minimum specifications from Chapter I0D-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. Permit No Size Septic Tank_.___... Feet of Drain Tile-- Amount of Permit $_ STATE OF FLORIDA, } COUNTY OF DADE. 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 progress of worrk.�' Owner's Name and Address ..... --11144/144114.-.- _— No._ __ - _/Y_i treet..___0 - Registered Architect and /or Eng' r- ____ ___ —` r._ _ Employing Plumber's Name_- -- _ -- // !/ i /.i ___ No._ _ 54 ��- Street_ Location and Legal Description Lot-_-------------- __ -_ -- Bloch Subdivision. _------- ____ -________ Street and Number where work is to be performed —No Street. State work to be performed and purpose of building (By Floors)_ New Building _ -- Remodeling —_ _______ Addition.---- _--- •------ ____ -. Repairs No. of Stories . . ..... .... .... .. . .... Type of Tank Capacity Gals _ _Dist. Feet of Tank or Drain Field from Well Nature of Water Supply: City — Well.____—_ ...... _-_ ... _______ ..... ___— ____Size of Soakage Pi Plu . . mg Inspector. The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations as : employer of labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Permanent Supp,' ent, and has com- plied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors employed by im 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 w., k to be per : - ed der this per; licensed by Miami Shores Village. ( Signed Date._ 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. 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 insp - -:'qn, or faulty materials and /or worlmanship. CLOSETS BATH TUB6 S LAVA. TORIES S INKS SLOP SINKS LAUNDRY TUBS U RINALS CATCH BASIN FLOOR DRAIN DRINKING FOUNT' NS TOTAL FIXTURES CONTR. LIST CHECK SEPTIC TANK SEWER CONN. DRAIN Fri ELM SOAKAGE PIT GREASE TRAP SOLAR HEATER DEEP WELL SPRKLR. SYSTEM $W IM'G POOL CONTR. LIST - - -_ CHECK Permit No Size Septic Tank_.___... Feet of Drain Tile-- Amount of Permit $_ STATE OF FLORIDA, } COUNTY OF DADE. 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 progress of worrk.�' Owner's Name and Address ..... --11144/144114.-.- _— No._ __ - _/Y_i treet..___0 - Registered Architect and /or Eng' r- ____ ___ —` r._ _ Employing Plumber's Name_- -- _ -- // !/ i /.i ___ No._ _ 54 ��- Street_ Location and Legal Description Lot-_-------------- __ -_ -- Bloch Subdivision. _------- ____ -________ Street and Number where work is to be performed —No Street. State work to be performed and purpose of building (By Floors)_ New Building _ -- Remodeling —_ _______ Addition.---- _--- •------ ____ -. Repairs No. of Stories . . ..... .... .... .. . .... Type of Tank Capacity Gals _ _Dist. Feet of Tank or Drain Field from Well Nature of Water Supply: City — Well.____—_ ...... _-_ ... _______ ..... ___— ____Size of Soakage Pi Plu . . mg Inspector. The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations as : employer of labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Permanent Supp,' ent, and has com- plied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors employed by im 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 w., k to be per : - ed der this per; licensed by Miami Shores Village. ( Signed Date._ 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. 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 insp - -:'qn, or faulty materials and /or worlmanship. BUILDING ELECTRICAL PLUMBING Owner of Building CONTRACTOR OR BUILDER MIAMI SHORES VILLAGE, FLORIDA DATE 7,I ( .� � 194 Contractor's License No. PERMIT N? 7713 Work to be performed under this Permit Architect Contractor /7" ' c . a ,�� �r'� r . ,,� ° z > or Builder { ' Legal Lot Description Address of / - - '� Value of Building , , ;� - At :ti , Project This pendi is granted to the contractor or builder na above to construct the building or to install the equipment or device described in the appli- cation 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. Bl. Sube vision Signed: ' •_ ; •� „,1 F 1.-. . ; ( By �.� INSPECTOR In consideration of the issuance to me of this permit I agree to perform the work covered hereunder in compliance with all : races and re 1a ('l pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities . 'Miami Shores itM ge' .15 In accepting this permit I assume responsibility for all work done by either myself, my agent, s rvantsSi employe BY Amt. t of t Permi t.) AUTHORITY