333 NE 102 St (3)PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Date 7 — / c4 Job Address 3:33 N.6' /oa Si Tax Folio
Legal Description
Owner's Address
Lessee / Tenant Pv4771/C //4 Qg 7 s
3 tip / 6? S 7
Contracting Co. i 7/)() S2 27 ?C Ci Address /MO AV) Z /9-0T ri/,4i
QualifierP� f S/ �I � SS# // Phone 3J3 AO 00 in
l
c� /y I N/ If State # b 7So2 9CMunicipal # ca 0(D 07S � Competency # `� /a .l3 Ins.Co /7?9m 9
Architect /Engineer /V Address
Bonding Company Address
Mortgagor 11/' Address
Permit Type(circle one): BUILDING ELECTRICAL P I MECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIPTION
Ditfiboat6, Ptc>Iiey
Square Ft. y)
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 i accurate and that all work will
be done compliance with all a•plicable laws regulating cons action and zoning. Furthermore, I
authori the above-na y d cy actor to do the work sta
Signature of owner
Dat • `? -0,, -I 4
UE�2l �7 orgi� P,res C. _
Notary as to Owner and /oar
My Commission Expires:
A
*
** * * *
APPROVED:
OFFIC SLAL
SAt4 J. BERMAN
My CommIs3ion Expires
Doc. 14, 1996
Comm. No. CC 245980
* * *
Fire
Zoning Buildin
Mechanical Plumbin
a
Estimated Cost(value) / .
Master Permit # 3 ' -> 3
Phone 3,7?
Signature of Contractor or Owner- Builder
Da 7 - /S 7 .� l� weseminz.Ly /CN3
otary as to C9igi aF orOW4V- 'ider
• , KENNETH J. BERMAN
My Commission Expires
My CommissionfE
Dec. 14, 1996
* *;?•0FF ° ** Comm. No. CC 245980
* * * * **►m* ** * * * **
FEES: PERMIT : 30.00 RADON C.C.P. 50 NOTARY TOTAL DU 'G'C
Other
Electrical
Engineering
7
Scale: ch block represents 5 feet and 1 inch = 50 feet.
1 i ,-r
-
By
Plan Approved
STATE OF FLORIDA
DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES
APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PERMIT
Permit Application Number �f7? 7
fii -_j _ 1
1 , �1T
Notes 36 v g
Site Plan submitted by:
;:t
PART II - SITE PLAN
i
SIGNATURE
Not Approved
■
,
G`zo/bt
ALL CHANGES MUST BE APPROVED BY THE COUNTY PUBLIC HEALTH UNIT
TITLE
Date
r
.x �'. 0 County Public Unit
LOT:
APPLICANT: ,Le/ ,// � �
BLOCK: SUBDIVISION:
PROPERTY ID #:
TO BE COMPLETED BY ENGINEER, HEALTH UNIT EMPLOYEE, OR OTHER QUALIFIED PERSON. ENGINEER'S MU:
PROVIDE REGISTRATION NUMBER AND SIGN AND SEAL EACH PAGE OF SUBMITTAL. COMPLETE ALL ITEMS.
PROPERTY SIZE CONFORMS TO SIT
TOTAL ESTIMATED SEWAGE FLOW:
AUTHORIZED SEWAGE FLOW:
UNOBSTRUCTED AREA AVAILABLE:
STATE OF FLORIDA
DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES
ONSITE SEWAGE DISPOSAL SYSTEM
SITE EVALUATION AND SYSTEM SPECIFICATIONS
E PLAN: ) ]
BENCHMARK /REFERENCE POINT LOCATION: ,
fl �7
ELEVATION OF PROPOSED SYSTEM SITE IS
THE MINIMUM SETBACK WHICH CAN BE MAINTAINED FROM THE
SURFACE WATER:f FT DITCHES /SWALES:
WELLS: PUBLIC: j FT LIMITED USE: ,i- FT
BUILDING FOUNDATIONS: FT PROPERTY LINES:
SITE SUBJECT TO FREQUENT FLOODING: [ ] YES [' NO
10 YEAR FLOOD ELEVATION FOR SITE: 'FT MSL /NGVD
AGENT: /_://72Ai
[Section /Township /Range /Parcel No. or Tax ID Numbez
YES [ ] NO NET USABLE AREA AVAILABLE• '/// ACRI
GALLONS PER DAY [RESIDENCES -TABLE 1 / OTHER -TABLE
GALLONS PER DAY (1500 GPD /ACRE OR 2500 GPD/ACRE]
SQFT UNOBSTRUCTED AREA REQUIRED: (/C-' SQ1
[INCHES /FT] [ABOVE /BELOW] BENCHMARK /REFERENCE POI1
PROPOSED SYSTEM TO THE FOLLOWING FEATURES
r' FT NORMALLY WET? [ ] YES [ " ] 1
PRIVATE: • FT NON- POTABLE: f',
FT POTABLE WATER LINES: %• 1
10 YEAR FLOODING? ( ] YES [• ] 'r
SITE ELEVATION: FT MSL /NGV;
SOIL PROFILE INFORMATION SITE 1 SOIL PROFILE INFORMATION SITE 2
Munsell 0/Color'
USDA SOIL SERIES:
Texture
�)
Depth
to
to
to
to
to
to
to
to
HRS -H Form 4015, Mar 92 ,(gbsoletes previous editions which may not be used)
(Stock Humber: 5744 - 003-4015 -1)
Munsell # /Color Texture
USDA SOIL SERIES:
PERMIT # / .
Depth
to
to
to
to
to
to
to
to
to
OBSERVED WATER TABLE:} y INCHES [ABOVE / E OL W]) EXISTING GRADE. TYPE: [PERCHED / PAREN:
ESTIMATED WET SEASON WATE( TABLE ELEVATION: <1, l `TRCHES [ ABOVE // LOW EXISTING GRADE
HIGH WATER TABLE VEGETATION: [ ] YES ] NO ' MOTTLING: [ ] YES y NO DEPTH: INCHE
SOIL TEXTURE /LOADING RATE FOR SYSTEM SIZI :, i1i'"1 DEPTH OF EXCAVATION:3 INCHE
DRAINFIELD CONFIGURATION: [ ] TRENCH [ ] BED [ ] OTHER (SPECIFY)
REMARKS /ADDITIONAL CRITERIA:
SITE EVALUATED EX: �' DATE:
Page 3 of
STATE OF FLORIDA
DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES
ONSITE SEWAGE DISPOSAL SYSTEM
APPLICATION FOR CONSTRUCTION PERMIT
Authority: Chapter 381, FS & Chapter 10D -6, FAC
APPLICATION FOR:
[/l/) New System DV) Existing System ['`/] Holding Tank [ ] Temporary /Experimental
[Y] Repair [/U ] Abandonment [/V] Other(Specify)
J TELEPHONE: 3 3. ( - 1 WO LI
APPLICANT:
AGENT: ,) i -
/`7 //r')/1) J N � 7/)( (4j'(,
MAILING ADDRESS: %/ (,///,', k/ Z c -
TO BE COMPLETED BY APPLICANT OR APPLICANT'S AUTHORIZED AGENT. ATTACH BUILDING PLAN AND TO -SCALI
SITE PLAN SHOWING PERTINENT FEATURES REQUIRED BY CHAPTER 1OD -6, FLORIDA ADMINISTRATIVE CODE.
PROPERTY INFORMATION [IF LOT NOT IN A RECORDED SUBDIVISION, ATTACH LEGAL DESCRIPTION OR DEED]
LOT:
PROPERTY ID #:
PROPERTY SIZE:
PROPERTY STREET ADDRESS:
DIRECTIONS TO PROPERTY:
2
3
4
BLOCK:
APPLICANT'S SIGNATURE:
SUBDIVISION:
ACRES [Sqft /43560]
[y
PROPERTY WATER SUPPLY: [fi PRIVATE
BUILDING INFORMATION] RESIDENTIAL
Unit Type of 1 No. of Building # Persons
No Establishment Bedrooms Area Sgft - __Served
[ c] Garbage Grinders /Disposals'
[t.)] Ultra -low Volume Flush Toilets
•
MRS -N Form 4015, Mar 92 (Obsoletes previous editions which may not be used)
(Stock Number: 5744- 001- 4015-1)
/ d --
DATE OF 1 j /L{ -
SUBDIVISION. / _
[Section /Township /Range /Parcel No.] ZONING: // 94
[AA COMMERCIAL
[ ff,Spas /Hot Tubs
[ 4 /Other (Specify)
•
PERMIT #
DATE PAID
FEE PAID
RECEIPT #
7 7/7 37 !
lit 3
1
Business Activity
For Commercial Only
PUBLIC
1 / f1 ) n
'] Floor /Equipment Drains
DATE: 7
Page 1 of 3
APPLICANT:
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 /
(rf New System [P] Existing System [• v ] Holding Tank [;•] Temporary /Experimental
( ] Repair [pi] Abandonment [Ai] Other(Specify)
1
PROPERTY STREET ADDRESS:
LOT: BLOCK:
PROPERTY ID #:
SYSTEM DESIGN AND SPECIFICATIONS
•%
T [ t /A
i
A ( / ]
N [
K (
[& ]
SUBDIVISION:
D
R [ ] SQUARE FEET
A TYPE SYSTEM: [ ] STANDARD
I CONFIGURATION: ( ) TRENCH
N
F LOCATION OF BENCHMARK:
I ELEVATION OF PROPOSED SYSTEM SITE
E BOTTOM OF DRAINFIELD TO BE
L
D FILL REQUIRED: [ ] INCHES
O /
T ! T u( .a s 11 101- tr 10/ 1%•L-11
H
/
E
R
SPECIFICATIONS BY:
DATE ISSUED: q
BETTER lUBWi FORMS
aer
M �
Tallahassee, FL —(804) 878 -5401
1201808
PERMIT #
DATE PAID
FEE PAID $
RECEIPT #
AGENT:
APPROVED BY: rfr./1ITLE:
[SECTION /TOWNSHIP /RANGE /PARCEL NUMBER]
(OR TAX ID NUMBER]
EXCAVATION REQUIRED: [ ] INCHES
c - -
TITLE:
q /4r 20
7 -- '
SYSTEM MUST BE CONSTRUCTED IN ACCORDANCE WITH SPECIFICATIONS AND STANDARDS OF CHAPTER 10D -6, FA(
REPAIR PERMITS AND HOLDING TANK PERMITS EXPIRE 90 DAYS FROM THE DATE OF ISSUE. ALL OTHER PERMIT_
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. SUC
MODIFICATIONS MAY RESULT IN THIS PERMIT BEING MADE NULL AND VOID.
(GALLONS / GPD] SEPTIC 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 PER DOSE DOSING TANK CAPACITY DOSE RATE [ ] PER 24 HRS NO. OF PUMPS: [
SQUARE FEET PRIMARY DRAINFIELD SYSTEM
SYSTEM
[: ] FILLED [ ] MOUND ( )
] BED [
] (INCHES /FT] [ABOVE /BELOW] BENCHMARK /REFERENCE POIN
] [INCHES /FT] [ABOVE /BELOW] BENCHMARK /REFERENCE POIN
` 1.^- knk-0., /1,JAAIJ
/
CPH
EXPIRATION DATE:/{) I c
HRS-H Form 4016, Mar 92 (Cbsoletes previous editions which may not be used) Page 1 of
(Stock Number: 5744- 001 - 4016 -0)
Permit No.
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 En
Employing Plumber's Name !�4�'`��.�- �d�'`�-- �� �� 8t�eet..
Location and Legal Description Lot. Block
Street and Number where work is to be performed —No 3 33 street. - Po 2- — —
State work to be performed and purpose of building (By Floors)_ .___ -. - --
New Building - Remodeling — __ — _..._._ Addition
Size Septic Tank_. � -
Feet of Drain Tile.
Amount of Permit $
/7 Z6 -`7
My Conunission Expires
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
• fi r` / Q '-4 No. 5 5 Street L_ • /
__-__-_Type of Tank__
. Feet of Tank or Drain Field from Well.
Nature of Water Supply: City— Well._----- ._._..__- _ _ - -___ — -- -Size of Soakage Pit
( Signed) _
( Signed )
Repairs No. of Stories.. .......
Capacity Gals.
umbing Inspector.
The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligatioris as an employer of labor
under the Florida Workmen's Compensation Act, being Section 5968, Compiled General Laws of Florida Permanent Supplement, and Isar com-
plied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors emplOed 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
licensed by Miami Shores Village.
k to be performed under this permit, as are
Date ..._
(V- 6
STATE OF FLORIDA, } ss.
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 d e p o s e s and says that he is t h e . .... _ ....._.._ _..
of the above described construction, that be has carefully read the foregoing application, and that he did sign the same, and that all facts
therein by hire stated are true.
Notary Public, State of Florida
NOTE: A re- inspection fee of $LOO will be made when such no- Inspection L made.neosssary by improper notice for inspection, or faulty
materials and /or workmanship.
CLOSETS
BATH
TUB•
SHOWERS
LAVA-
TORIES
SINKS
SLOP
SINKS
LAUNDRY
Tugs
URINALa
CATCH
BASIN
FLOOR
DRAIN
DRINKING
FOUNT' NS
TOTAL
FIETUR ES
—
CONTR.
LIST
CHECK
SEPTIC
TANK
SEWER
CONN.
DRAIN
FIELD
SOAKAGE
PIT
GREASE
TRAP
SOLAR
NEATER
DEEP
WELL
SPRKLR.
SYSTEM
SWIM'G
POOL
CONTR.
LI ST
CHECK
Permit No.
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 En
Employing Plumber's Name !�4�'`��.�- �d�'`�-- �� �� 8t�eet..
Location and Legal Description Lot. Block
Street and Number where work is to be performed —No 3 33 street. - Po 2- — —
State work to be performed and purpose of building (By Floors)_ .___ -. - --
New Building - Remodeling — __ — _..._._ Addition
Size Septic Tank_. � -
Feet of Drain Tile.
Amount of Permit $
/7 Z6 -`7
My Conunission Expires
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
• fi r` / Q '-4 No. 5 5 Street L_ • /
__-__-_Type of Tank__
. Feet of Tank or Drain Field from Well.
Nature of Water Supply: City— Well._----- ._._..__- _ _ - -___ — -- -Size of Soakage Pit
( Signed) _
( Signed )
Repairs No. of Stories.. .......
Capacity Gals.
umbing Inspector.
The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligatioris as an employer of labor
under the Florida Workmen's Compensation Act, being Section 5968, Compiled General Laws of Florida Permanent Supplement, and Isar com-
plied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors emplOed 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
licensed by Miami Shores Village.
k to be performed under this permit, as are
Date ..._
(V- 6
STATE OF FLORIDA, } ss.
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 d e p o s e s and says that he is t h e . .... _ ....._.._ _..
of the above described construction, that be has carefully read the foregoing application, and that he did sign the same, and that all facts
therein by hire stated are true.
Notary Public, State of Florida
NOTE: A re- inspection fee of $LOO will be made when such no- Inspection L made.neosssary by improper notice for inspection, or faulty
materials and /or workmanship.
Owner of
Building
Architect
Contractor
or Builder
Legal
Description
Address of
Building
Lot
CONTRACTOR OR BUILDER
MIAMI SHORES VILLAGE. FLORIDA
BUILDING ❑
ELECTRICAL ❑ PERMIT N? PLUMBING El PERMIT 9 9 6 0
ROOFING ❑
Work to be performed under this Permit
Signed•
? t
-1
Subdi-
vision
Sq. Ft
Value of
Project $
DATE 1
Contractor's
License No
Amt. of
Permit $
t )
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. f �
it
f ^ � " + • BY
INSPECTOR
In consideration of the issuance to me of this permit I agree to perform 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 agent, servant or employee.
BY AUTHORITY
i7
BUILDING
ELECTRICAL
PLUMBING
•
MIAMI SHORES VILLAGE, FLORIDA
DATE 194 —'
PERMIT N? 8890
Work to be performed under this Permit
Owner of
Building
Architect
Contractor
or Builder
Legal Lot Bi.
Description
Address of
Building
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 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.
•
INSPECTOR By s
In consideration of the issuance to me of this permit I agree to perform 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 agent, servant or employee.
E.
Subdi-
vision
Value of
Project
Signed: l f
CONTRACTOR OR BUILDER BY
Contractor's
License No.
Amt. of
Permit
r
/•awe �"� `�'
AUTHORITY