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334 NE 102 StDate 3 Job Address 33 / (Jk /045? .5 r Tax Folio // ee J 4 5 Z c Legal Description T P & �� er / Lessee / Tenant /Hi, t/ 0 Master Permit # 33, 6 Owner's Address 2 3 y ,e, E, /0 A Phone 7,5-3- c, e5 13 Contracting Co. 'S .S T, ' :�,��� e ,CJ��gAddress %o foi - ,7 A)90 /� /,die � j Qualifier 6 9% 9/( 's( // /- SS# Phone S ' Gd -/ 4 / f State # Municipal # Competency # 646 '5 7 Ins.Co. Architect /Engineer Address Bonding Company Address Mortgagor Address Permit Type(circle one): BUILDING ELECTRICAL E MECHANICAL ROOFING PAVING PENCE SIGN WORK DESCRIPTION 0 () ED, /�Tp f ET:- // Square Ft. Estimated 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 t ove -named contractor to do the work stated. Signature, Date Notar to Owner and / • Condo President My Co y` ission Expire.' 71=7 7Up.7^, ? CFFLORTM..,)A. • T “.V C1J,'LTY.tS °'Ca 77, 7' 2ES• Anr3 16, 1995. EULL7.7 TETtU NO7:11 PUBLIC UNDERWRITER& /� /1 _ PUBLIC STATE OF FLORIDA i/� /2.o n i c ,A._ A- , NOTARY PUBLIC U :+ 1 l ** * * * * * * * Pr*nr type o scamp nal4tc of Not�Cry Public* MY C iti ii $J;f�t” r:;l . l ":."•••• / Q./ , . i l ** Pcrfonally known SR Produced I.D.❑ Bonded thru Si6ri,Uie Hsu SW FEES: PERMIT ...20/ RADON C . C T e a n Maer of Iib Aced: .....61.2 TOTAL DUE `��� APPROVED: PERMIT APPLICATION FOR MIAMI SHORES VILLAGE owner and /or Condo President 3- itc-`13 F Zoning Buildin Mechanical Plumbin 41.E St-7-)-/#0(0., DID take an oath, or Signatyre of ,Cont Notary as to Contractor or My Commission Expires: tor or Owner- Builder / A... Owner- Builder Other Electrical ngineering "l. . at APPLICANT: LOT: CONSTRUCTION PERMIT FOR: [ ] New System [ ] Existing System [ ] Holding Tank [ ] Temporary /Experimental [x ] Repair [ ] Abandonment [ ] Other(Specify) f PROPERTY STREET ADDRESS: PROPERTY ID #: STATE OF FLORIDA DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PERMIT Authority: Chapter 381, FS & Chapter 10D -6, FAC 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 AGENT: 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 [ 'i] SQUARE FEET PRIMARY DRAINFIELD SYSTEM R [ ] SQUARE FEET SYSTEM A TYPE SYSTEM: [ ] STANDARD [ ] FILLED [ ] MOUND [ ] I CONFIGURATION: [ ] TRENCH L v ] BED [ ] N F LOCATION OF BENCHMARK: I ELEVATION OF PROPOSED SYSTEM SITE [ ] [INCHES /FT] [ABOVE /BELOW] BENCHMARK /REFERENCE POINT E BOTTOM OF DRAINFIELD TO BE [ ] [INCHES /FT] [ABOVE /BELOW] BENCHMARK /REFERENCE POINT L D FILL REQUIRED: [ ] INCHES EXCAVATION REQUIRED: [ ] INCHES 0 T H E R SPECIFICATIONS BY: APPROVED BY: DATE ISSUED: TITLE: HRS -H Form 4016, Mar 92 (Obsoletes previous editions which may not be used) (Stock Number: 5744 - 001 - 4016 - 0) PERMIT # DATE PAID FEE PAID $ RECEIPT # [SECTION /TOWNSHIP /RANGE /PARCEL NUMBER] [OR TAX ID NUMBER] BUILDING DEPARTMENT .7_ , ,1 TITLE: . ✓_ 7CPHU EXPIRATION DATE: Page 1 of 2 INSTRUCTIONS: PERMIT NUMBER: Permit tracking number assigned by CPHU. APPLICATION FOR: Cluck 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 TIM: 27 character id number for property. (CPHU may require property appraiser ID 11 or section /tow3.ship /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 t.s operating permit requirements, low - volume flush toilets, variance provisos. SPECIFICATIONS BY: Name of individual providi.ag 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 ii the system has not been installed. Permits for system repairs become void 90 days from the date issued. --' CLOSETe BATH TUBS SHOWERS LAVA. TORIES SINKS SLOP SINKS LAUNDRY Tuee U RINALS CATCH BASIN FLOOR DRAIN DRINKING FOUNT•NS TOTAL FIXTURES CONTR. LIST CHECK SEPTIC TANK SEWER CONN. DRAIN FIELD SOAKAGE PIT GREASE TRAP SOLAR HEATER DEEP WELL SPRKLR. SYSTEM SWIM'G POOL CONTR. LIMY CHECK Pern►it 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. ya �. _ / 1. I .. Owner's Name and Address. _ ./ _- „- _ r-- r__ I Registered Architect and /or Eimer_ New Building _ -- Remodeling - -_- __ -- Addition Size Septic Tank G Feet of Drain Tile LG Nature of Water Supply: City - Well -. Amount of Permit $ MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT' APPLICATION FOR PLUMBING r';r,A1T No. No._ ___---- -___ -- Employing Plumber's Names Location and Legal Description Lot ______— __-__.__-_- ...... ___ __.___ Block Street and Number where work is to be performed- No.___ 2'-'' ` j _ / �_� Street EtE.:e work to be performed and purpose of building (By Floors )_ . _.-._ - -- - -- - - - - -- ( Signed )- - - -- -• - - Date / "' . /T Street___________ Repairs No. of Stories My Commission Expires Notary Public, State of Florida Street Capacity Gals. D' . F e of Tan` Field from Well - ------------------- ____ __ ___-____ -Size of Soakage Pit PI bing Inspector. The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations an employer of labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Permanent S .plement, and has com- plied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors employe y 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 py is 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) -fF J Master Plumber. STATE OF FLORIDA, I COUNTY OF DADE. x efore 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 himr stated are true. 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.