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361 NE 102 St (4)Date Legal Description PERMIT APPLICATION FOR MIAMI SHORES VILLAGE Job Address •3 GS t 6 ` /0A5-1-- Tax Folio Historically Designated: Yes No L Ri c �7 Al s ,t Contracting Co. (2, S D /� <0+ `, Address Qualifier C- ( , O lA/' SS# 3 o� J O S — 7 8 6? State # Municipal # Competency # Ins. Co. Architect/Engineer Address Bonding Company Address Mortgagor Address Owner/Lessee / Tenant Owner's Address Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANI AL ROOFING PAVING FENCE SIGN C'l <r ` -- a'`"4 r� l / WORK DESCRIPTION f t> Square Ft. Estimated Cost (value) ature of owner and/or Condo President Date Notary as to Owner and/or Condo Presi • cttt D a e My Commission Expires: FEES: PERMIT 3S • RADON APPROVED: Zoning Building Mechanical Plumbing Master Permit # Phone /4932 • Notary as to Contractor or 0 My Commission E ' ires: O �PRY P, 2 t _.i n OF F\• Electrical 7P1-73 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 t, do the work stated. c , Signature of Contractor or Owner- Builder OFRCIAL NOTARY SEAL 8 MARGARITA MONTIEL COMMSEI0N NUMBER CC797277 MY COMMISSION EXPIRES DEC. 17,2002. C.C.F. / . oZ a NOTARY • BOND s ©C7 TOTAL DUP . CIW Engineering M f TRUCTION PERMIT F9R: • New System pt:Uxisting S [ ] Repair [ andonmen APPLICANT: STATE OF FLORIDA DEPARTMENT OF HE, ONSITE SEWAGE DI CONSTRUCTION PERT Authority: Chapi PROPERTY STREET ADDRESS: ?Cy / ) LOT : 20,/ 2 ( BLOCK: 3 � St PROPERTY ID #: a ^ . .32c.„4„ e5 /. -; en - [SECTION /TOWNSHIP /RANGE /PARCEL NUMBER] [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 SP IFICATIONS T [ 7 q0 GALLONS"/ SEPTIC TAI /AEROBIC UNIT CAPACITY MULTI- CHAMBERED /IN SERIES:[ ] A [ ] [G NS 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: [ ] FEET PRIMARY DRAINFIELD SYSTE D [ 3? ea? 1 R [ ] SQUARE FEE A TYPE SYSTEM: I CONFIGURATION: N ' F LOCATION OF BENCHMARK: /0, / 4G . v P U5' 08## ; F/cr I ELEVATION OF PROPOSED SYSTEM SITE [ 1 ] . CHES E BOTTOM OF DRAINFIELD TO BE [ 3 r. s D,� `FILL -REQUI E ]-- I- NGHES - EXCAVATION REQUIRED: [3 INCHES fir+ QV _ ♦ u .. .... _ O H E R SPECIFICATIO *'S BY: APP.D' v 0, fa cc SYSTEM [ ] STANDARD [ ] FILLED [ ] MOUND [ ] TRENCH [ ], BED [ TITLE: oletes previous editions which may not be used) -0) [ ] ] [ABOVE /- LOW] BENCH RK EFERENC ] [ABOV y LOW]`:ENCHMARK ERENCE POIN TITLE: APPLICANT rE PAID 9' -g -7 I P PAID $ EIPT # .5,70 yeig 7 porary/Experimental sAtP7-7 7 /29r .7-f _ . O f's,1 SaSe AI CPHU EXPIRATION DATE: Z .-O 77 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 IDN; 27 character id number for property. (CPHU may require property appraiser ID /) or section/township /range /parcel nu: ber) 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. cale: Each block represents 5 feet and 1 inch = 50 feet. I 74° 1 S v By Plan Approved= G� t STATE OF FLORIDA DEPARTMENT OF HEALTH AND- REHABILITATIVE SERVICES APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PERMIT Permit Application Number, PART II - SITE PLAN Site Plan submitted. by: SIGNATURE Not Approved k?, "(3 `if` TITL • :Date. a rc County Public Unit . . ..ALL CHANGES MUST BE'APPRO :EP /BY THE-COUNTY PUBLIC HEALTH UNIT HRS-H Form 4015, Feb 85 (Obsoletes previous editions which - may, non be used) (Stock Number. 5744-002-4015-6) t t'= __`_ ___ ___ __ Page 2 of ' Date Jyze 1 . .._... .1.. 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. Permit No Owner's Name and Address New Building___ - -_ _-- __ .... ..... ......... .. .. Remodeling Size Septic Tank Feet of Drain Tile_____ Nature of Water Supply: City—Well lG 39 Amount of Permit $ MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT No. 36/ Registered Architect and /or Engineer____._ Employing Plumbei s Name____6:1... /_i !t i.L ii?l.4. Location and Legal Description Lot___- . —._._ ______.____ — Block_ Street and Number where work is to be performed —No J4I State work to be performed and purpose of building (By Ripe/ C X vi C No.. -- - - - 6- ._.. Street._._ E S 7 Subdivision Street_ - Ai 4770,2 `S7 k1.`0 /9 514c Street /V F i a 2 Addition________.___________._.. Repairs L.— No. of Stories Type of Tank__ Capacity Gals _Dist. Feet of Tank or Drain Field from Well _Size of Soakage Pit The undersigned applicant for this building permit does hereby certify that he understands and accepts under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida plied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors performed under this permit; and will post or cause to be posted' for inspection • • the site of the wor required by die Act. The undersigned agrees to employ only such sub -contra •. s, on work to licensed by Miami Shores Village. My Commission Expires Notary Public, State of Florida Plumbing Inspector. legations as an employer of labor nanent Supplement, and has com- ployed by him in the work to be ublic notice or notices as are rmed under this permit, as are Master Plumber. STATE OF FLORIDA, f COUNTY OF DADE. Before me, the undersigned authority, a notary public, duly authorized to a ster 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. 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 worlm►anship. CLOSETS BATH TUBS SHOWERS LAVA. TOES RI SINKS SI SLOP SINKB LAUNDRY TUBS URINALS 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. LIST CHICK Date Jyze 1 . .._... .1.. 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. Permit No Owner's Name and Address New Building___ - -_ _-- __ .... ..... ......... .. .. Remodeling Size Septic Tank Feet of Drain Tile_____ Nature of Water Supply: City—Well lG 39 Amount of Permit $ MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT No. 36/ Registered Architect and /or Engineer____._ Employing Plumbei s Name____6:1... /_i !t i.L ii?l.4. Location and Legal Description Lot___- . —._._ ______.____ — Block_ Street and Number where work is to be performed —No J4I State work to be performed and purpose of building (By Ripe/ C X vi C No.. -- - - - 6- ._.. Street._._ E S 7 Subdivision Street_ - Ai 4770,2 `S7 k1.`0 /9 514c Street /V F i a 2 Addition________.___________._.. Repairs L.— No. of Stories Type of Tank__ Capacity Gals _Dist. Feet of Tank or Drain Field from Well _Size of Soakage Pit The undersigned applicant for this building permit does hereby certify that he understands and accepts under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida plied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors performed under this permit; and will post or cause to be posted' for inspection • • the site of the wor required by die Act. The undersigned agrees to employ only such sub -contra •. s, on work to licensed by Miami Shores Village. My Commission Expires Notary Public, State of Florida Plumbing Inspector. legations as an employer of labor nanent Supplement, and has com- ployed by him in the work to be ublic notice or notices as are rmed under this permit, as are Master Plumber. STATE OF FLORIDA, f COUNTY OF DADE. Before me, the undersigned authority, a notary public, duly authorized to a ster 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. 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 worlm►anship. STATE OF FLORIDA, COUNTY OF DADE. Amount of Permit $____ b 0 My Commission Expires MIAMI SHORES VI LLAG E 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. R �+ Owners Name and Address _______� No - - Street___ Registered Architect and /or Engineer Employing Plumber's Name ___Cia 'v ‘1_t_4_ m No /2. ' Street ' _ _. Location and Legal Description Lot _Block__ Subdivision__�___________�__ Street2_2_L2 ,'_2 _ Street and Number where work is to be performed —No ∎- 1 P1 State work to be performed and purpose of building (By Floors) New Building Remodeling Addition Repairs No. of Stories Size Septic Tank �_______ Type. of Tank . Capacity Gals.________________ ®� Feet of Drain Tile__________ _�___ Dist. Feet of Tank or Drain Field from Well �� Nature of Water Supply: City-We/1 Size of Soakage Pit _(Signed) (Signed) -- LL_ _____ ___ 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 com- plied 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 under signed agrees to employ only such sub - contractors, on work to be performed under this permit, as are licensed by Miami Shores Village. Notary Public. State of Florida 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. 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 CHECK SEPTIC TANK SEWER CONN. DRAIN FIELD SOAKAGE PIT GREASE TRAP SOLAR HEATER DEEP WELL SPRKLR. SYSTEM SWIM'G POOL CONTR. LIST CHECK STATE OF FLORIDA, COUNTY OF DADE. Amount of Permit $____ b 0 My Commission Expires MIAMI SHORES VI LLAG E 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. R �+ Owners Name and Address _______� No - - Street___ Registered Architect and /or Engineer Employing Plumber's Name ___Cia 'v ‘1_t_4_ m No /2. ' Street ' _ _. Location and Legal Description Lot _Block__ Subdivision__�___________�__ Street2_2_L2 ,'_2 _ Street and Number where work is to be performed —No ∎- 1 P1 State work to be performed and purpose of building (By Floors) New Building Remodeling Addition Repairs No. of Stories Size Septic Tank �_______ Type. of Tank . Capacity Gals.________________ ®� Feet of Drain Tile__________ _�___ Dist. Feet of Tank or Drain Field from Well �� Nature of Water Supply: City-We/1 Size of Soakage Pit _(Signed) (Signed) -- LL_ _____ ___ 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 com- plied 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 under signed agrees to employ only such sub - contractors, on work to be performed under this permit, as are licensed by Miami Shores Village. Notary Public. State of Florida 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. 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. 3d,4sc0 y , y f 5 c F/►9 iQ" '/ p " //w Flex ur! /nky 50 CFwt ze Flex a)5 CF/1 /0" x 10" /w 8" Flex I < r'tc !,« Kam, 6Af4 k Fist / a5 CFi4 �., 1/w 6 " Flex p , n/ /'n/ / /a5 C FM g " y Sr •. a/w & Y Alt 3 `' ,' /i 4(- / Su c t Q" 'tie' 6/44rN f-o / d a 5o CFm /o" x /0 •, i/w g "F/ex Bolt-ti G uest LAZ 50 CF14 i/w y „ F/ex a C Ff /0 " /0" //w " Fie x L . 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E 'd 4S/e /•s-, S fig f ..� lc► ic7 l� . t 7 g-5 ,, E S r� 14 vim• / r ,.v.si i - f < . 3 .3,/b,7) DRAWING NUMBER 2 - 7/-7/ A/7/ D a T 2 .24 /a_30 / '4y Act H Sc/C f / cgs c a S t04 -teW • A IC eoNS.0.7, 36/ .✓.F- /o? d S7 /v),' Ave..? 5:A0 /o s . Ft. . 33 /35 SCALE: 3/;;i4 A &n7 e) 75 7 —5 Cg • T DRAWN BY