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434 NE 102 St (11)Legal Description _ Historically Designated: Yes No eJ- /` 4 rril- A/7 Master Permit # NM- ' 4 1 t- 1 / (O 0 Owner's Address 9 4 , ni L / O 2- S — Phone 75 © 8 3 Contracting Co. AR F 5' Q p 11 c- Ti"' ie 6 Address XZ.Z3 C) J T 4 ""� / Qualifier /4b' /eS 1 o C,4 Cs RCS SS# _4 ; 3��7Pho 54 96Z 7 33o State # 5Q-C' C1OO 6c, Municipal # Competency # Ins. Co. Architect/Engineer ! , V Address A Bonding Company 71 Address Mortgagor A//9 Address Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN WORK DESCRIPTION Df'A - /ki pot S) C P 1`} ( 2 16 ext s / l'uG- p ST ,d V< Owner/Lessee / Tenant PERMIT A PPLICATION FOR MIAMI SHORES VILLAGE Job Address "� 3 ( �E / /1306 ST Tax Folio !� cre Square Ft. _S© 0 D ‘42.s...1 Estimated Cost (value) 0,0 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 compliance with all applicable laws regulating construction and zo �:..��ermore, I authorize the above- nam tractor to do th Signature of owner d/.' Condo Pres •P nt Date Notary as to Owner and/or Condo President Date My Commission Expires: F 64. F6Y - 3-5 - ' / / J'3 kc '- / s S,,4 A ,/A/ ,g4A 1 ?Z Q l FEES: PERMIT > J RADON APPROVED: Zoning Building Mechanical ork stated. o a o o� factor My Commission Exp C.C.F. • ( 0 NOTARY f Contractor or Owner- Builder C _�,; 3 3 - 4/5 . S es: Electrical BOND 3 TOTAL DUE D�e Date • Plumbin , j { ° .� � P�) r •*' Engineering ►'P 0 T H E R CONSTRUCTION PERMIT FOR: [ ] New System [ ,. ] Existing System [ ] Holding Tank [' ] Temporary /Experimental [ ;) Repair ( ] Abandonment . [7) Other(Specify) APPLICANT: PROPERTY STREET;ADDRESS: LOT: / j BLOCK: SYSTEM DESIGN AND SPECIFICATIONS SPECIFICATIONS BY: APPROVED BY: DATE ISSUED: STATE OF FLORIDA PERMIT DEPARTMENT OF HEALTH DATE PAID ONSITE SEWAGE DISPOSAL SYSTEM FEE PAID $ CONSTRUCTION PERMIT RECEIPT 0 Authority: Chapter 381, FS i Chapter 10D -6, FAC O F.. n ,- :� .7 .> d DH 4016, 10/96 (Replaces HRS -H Form 4016 (paps 1) which may be used) (Stock Number: 5744 -001 - 4016 -0) SUBDIVISION: [ ] TRENCH [ ] BED -6 AGENT: PROPERTY ID 0: ,.�' ,. r' �• [SECTION /TOWNSHIP /RANGE /PARCEL NUMBER) [OR TAX ID NUMBER] D [ ] SQUARE FEET PRIMARY DRAINFIELD SYSTEM R [ J SQUARE FEET SYSTEM A TYPE SYSTEM: [ ] STANDARD ( ] FILLED I CONFIGURATION: N F LOCATION OF BENCHMARK: TITLE: TITLE: [ ] MOUND [ ) EXPIRATION DATE: 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. DEPARTMENT OF HEALTH 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. T ( `- _'] +(GALLONS,P GPD] SEPTIC TANK /AEROBIC UNIT CAPACITY MULTI- CHAMBERED /IN SERIES:[ ] A [' J (GALLONS / GPD] CAPACITY MULTI- CHAMBERED /IN SERIES:( ) N [ ] GALLONS GREASE INTERCEPTOR CAPACITY [MAXIMUM CAPACITY SINGLE TANK: 1250 GALLONS] K [ ] GALLONS FER DPSE DOSING TANK CAPACITY DOSE•RATE [ ] PER 24 HRS NO. OF PUMPS: [ ] 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: [ J INCHES EXCAVATION REQUIRED: [. s +] INCHES Page 1 of 2 INSTRUCTIONS: PERMIT NUMBER: Permit tracking number by County Health Department. 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. (Health Department may require property appraiser ID# or section /township /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 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 personnel reviewing and approving permit. DATE ISSUED: Date permit is issued by County Health Department. C 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. CONSTRUCTION PERMIT OR: (G/] New System ra L/ Existing System [PI Abandonment () ] Repair APPLICANT: r- PROPERTY STREET ARESS: ( j r E / 6 f 11d /(> P " �- �� r DD L O T cr) ( SUBDIVISION: / � R PROPERTY ID #: p s, e.) 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. DEPARTMENT OF HEALTH' 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 T (F j( J GALLON ' GPD] Es Pa TIC' TANK/AE A [, ] [GALLONS / GPD] N [ ] GALLONS. GREASE INTERCEPTOR C K [ J GALLONS PER DOSE DOSING TANK CAPACITY , D R A I N F LOCATION OF BENCHMARK: I E L D FILL REQUIRED: ENSTV 0 T H E R 1:2/0> ] SQUARE FEET PRIMARY DRAINFIELD SYSTEM [ ] SQUARE FEET TYPE SYSTEM: CONFIGURATION: g L N 7. C c ( ELEVATION OF PROPOSED SYSTEM SITE [,/ BOTTOM OF DRAINFIELD TO BE [ t- SPECIFICATIONS BY: APPROVED BY: J30 71701V. •lith. l \T. "' SI.:,) DATE ISSUED:2- C ti/ y STATE OF FLORIDA DEPARTMENT OF HEALTH ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PERMIT Authority: Chapter 381, FS & Chapter 10D -6, FAC [ ] STANDARD [ ] TRENCH J EXCAVATION REQUIRED: S'u1:.DIVZZI 77-Es klf137.7 ;3: OH 4016, 10196 (Replaces HRS -H Form 4016 (pope 1) which may be used) (Stock Number: 5744 -001 - 4016 -0) SYSTEM [ ] FILLED [ ' j BED [ ] ( ] MOUND PERMIT 0 DATE PAID FEE PAID RECEIPT S [I') Holding Tank [A/3 Temporary /Experimental V---(Other(Specify) AGENT: .O -PAd (SECTION /TOWNSHIP /RANGE /PARCEL NUMBER] ' [OR TAX ID NUMBER] • e ' MULTI- CHAMBERED /IN SERIES:[ ROBIC UNIT CAPACITY CAPACITY , MULTI - CHAMBERED /IN SERIES:( APACITY [MAXIMUM CAPACITY SINGLE TANK: 1250 GALLONS] DOSE-RATE [ ] PER 24 HRS NO. OF PUMPS: (] ] [INCHES /FT] [ABOVE /BELOW] BENCHMARK /REFERENCE POINT INCHE §/FT] [ ABOVEJBELOW] >ENCHMARK]REFERENCE POI (] INCHES TITLE: TITLE: r"_ CHD EXPIRATION DATE: 1 of 2 si INSTRUCTIONS: PERMIT NUMBER: Permit tracking number by County Health Department. 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. (Health Department may require property appraiser ID# or section /township /range /parcel number.) SYSTEM DESIGN AND SPECIFICATIONS: TANK: Minimum specifications from Chapter 1OD -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 Health Department personnel reviewing and approving permit. DATE ISSUED: Date permit is issued by County Health Department. 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. STATE OF FLORIDA DEPARTMERJ OF HEALTH AND REHABILITATIVE SERVICES / AP,PLICATION /,` O.B ( O:NSITE SEWAGE/DISPOSAL SY #E_M OJV 'RUiCT QN eE /ItT Permit Application Number /C 65. I!iIIIIiIiiIIIII!i!iUIII APART 11 - TE PLAN it C,L. ,� f-�- r 3 A/ 1 ._ : /l /) (1 i fo Scale: Each bI 11m =prese is 5_feet . ,d 1 inch — 50 feet. ,..-- f r : ■■ ■��uuu■Iln�ar� gal.■ Pau ■ ■■ ■■■■ ■■■■�G ■1�1rJ■©■61■i1■�11 ■ ■■ 1�1■■..m■■■ �I��■■■■■u■■■ ■■■.■ ■■ ■■ ■■■■ __ ■ ■■■r��,r�c�vf»�- ■ ■■ 1 MP:REM IN Mill IG ] 71w•J�71■'��J■■L�►116rJw■�7.•!�■ urN/w�I.%r /. La-Mc. ■■■�i711■■��■! — INI BR aiE■ r ail ■r�IIIWAI IIMA1i■!! ll''�ll�CNEMI t�ti ®K!' ■■■ I1 ■ ■�� ■■■��■C ■1°I■ ■slI`J ■il ■■ ■■ ■■ ■ ■ ■li ____ fii■ ■r�►�" ''iii ■ ■■ 11 ■i�l� ■ ■® I■■■ ■Y■■�I•■ ■!9Sl9■ ■ ■ ■ ■��Ji'ill11l0 i ��1f1 ■■ 11/1 =7■[I iii®■: iia ■■■�� ■■f►Jell■■LiFf■MMcr7�■�■►/. � J4I81 ■•■ 11 i lilill __ ••' Ti •• iiiiiiiii i IiI iIIiIIIi ■:��■•iii■ IMMIII•■ �NEM■c■11Milliti� ■��I i��i�h1 ■ 1 ■■ \��11■■■■�mErara !I•�:iur 1L \ ■ ■ ■ ■\>7C:Ur /� ■ ® ■■�� I1 MIE11 :11 ► L:IIt`iii111111 I! 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MIIII■■1110�■�■ 11111E X14 ■!�■r�I1■ ■v" l =e ■�■■■ ■■v iuuN► !n ■■1:�■■■■■■■■ J Fa�IEMM li �l! ■1�� ■■MI■W■l.!P93A1.111��" UM ■■\ \■■■■VALIVAD1IEINII ■IM ■ ■1'��E'1 MEI li■■IMMEGI ■1�iMBEIN ■LEalIMIL■ ill ,■■■■ IN■i LME■�■■hi 1 11! 11111 1 ®111111101111: 111111 111111 11 I 111111 111 �■IIIIIIIIIII 11111 11 1111111 uiIIIIuIiIuu!HIIHIII - ___ _ .1 wcramp �awz iTr• 1 IMENEE !MMIIII■s - f �r1!1 �nwr� #arasae.��w.w�7wlnrar'�t: , I�nP=QyF�ts: �r . �wr� +i l�O!I ■ ■ ■ ��■ : ■■i FINNI IIIII■■INIIIIINIMEM■■w■■■M■N■M ■■■■■■■■■■ 1 • 1�) II 1' Notes: � '// -I-2%; f"- / // / i . 5t . /ads �`' ') /7a Site Plan submitted by: Plan Approved By ALL CHANGES MUST BE A PROVED"`BY ° t`t uUNTY PUBLIC HEALTH :UNIT HRS-H Form 4015, Feb 85 (Obsoletes previous editions which may not be used) (Stock Number. 5744-002-4015-6). Not Approved ' 4',;;16 Th'f & ®0 •r-Y ? 4, Page 2 of 3 TITLE Date 2-U ( ' 7 ? County Public Unit Lin N t LD BUILDING El MIAMI SHORES VILLAGE, FLORIDA Date 2_ LI 9 . �l ELECTRICAL ❑ N_ 44168 PLUMBING 14 PERMIT ROOFING ❑ ❑ Work to be performed under this Permit Owner of Building Architect Contractor or Builder Legal Description Address of Building 7V 1, s s ` - n- 7 .L) , o' 411 11BI. 9� CONTRACTOR or BUILDER Contractor's License No. - �'L1tt11'i : 3) . C i /�`ICL.v NO . Subd BO %1D: vision l 1 3J. 6-6,17-0590 3(v. PO Sq. Ft. Value of H Arnount (") Project $ / � 11 Permit $,2 � 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 applica- tion 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 here y 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, sery nts or mployees. // ��. Signed • A i i► �ti CClk (INSPECTOR) B7s' i) In consideration of the issuance � f t. is permit I agree to perform the work covered hereunder in compliance with all ordinances and regulation. pertaining thereto and in strict confor tyh the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I assume respons b sty for all work done by either, myself ,.my_ agent,.servant or employee. BY AUTHORITY BUILDING ELECTRICAL PLUMBING ROOFING 0 MIAMI SHORES VILLAGE, FLORIDA PERMIT Owner of Building t Architect Contractor or Builder Legal Lot Description 4. N? 4293 Work to be performed under this Permit e t t_t 11 B DATE ' �. 19 Contractor's License No. .7 1 , Subdi- vision Address of u ft- r ° Value of II Amount of Building • a ,f • Project II Permit $ This permit is granted to the contractor or builder name above to construct the building or to install the equipment or device described in the applica- tion 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. • .*' Signed. AUTHORITY wM 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 as cepting this permit I assume reyonsibility for all r w�ork done by either, myself, my agent, servant or employes. `' '�'dF� • .fi 'rF ` 4 ..� • * s ,1 g 4 'CONTRACTOR OR BUILDER BY INSPECTOR . BOT ° �` ' 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, wh er 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 Deu,le___. _ Registered Architect and /or Engineer_____ ��— Employing Plumber's Name Location and Legal Description Lot______— ______ ________ 'VS Street and Number where work is to be performed—No. 'TS ` State work to be performed and purpose of building (By Floors) Amount of Permit $ f_(. STATE OF FLORIDA, 1 COUNTY OF DADE. } MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT Type of Tank -r = - - - - -- — — -- — - -- (Signed)._ ( Signed - - - & - Date...-- - -- - - / f..--/� Street Street Subdivision _.._..-.- -- _.--- -- -- --.— New Building _ Remodeling ... Addition________ _.__________ Repairs No. of Stories Size Septic Tank e g 7 - Feet of Drain Tile Nature of Water Supply: City — Well._____._._ ______________........... __ __ of Soakage Pit Capacity Gals. Dist. Feet of Tank or Drain Field from Well P1 bang Inspector. The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations as a employer of labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Permanent Supplement, and bas 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 undersigned agrees to employ only such sub - contractors, on work to be performed under this permit, as are licensed by Miami Shores Village. 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 swum, 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. i My Commission Expires Notary Public, State of Florida Master Plumber. 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 TUBE UR CATCH BASIN FLOOR DRAIN DRINKING DRINK FOUNT' NS TOTAL FIXTURES CONTR. LIST CHECK SEPTIC TANK SEWER CONN. DRAIN FIELD SOAKAGE PIT GREASE TRAP OLA EAT DEEP WELL SPRKLR. SYSTEM SW IM'G POOL CONTR. LIFT - - - -- 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, wh er 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 Deu,le___. _ Registered Architect and /or Engineer_____ ��— Employing Plumber's Name Location and Legal Description Lot______— ______ ________ 'VS Street and Number where work is to be performed—No. 'TS ` State work to be performed and purpose of building (By Floors) Amount of Permit $ f_(. STATE OF FLORIDA, 1 COUNTY OF DADE. } MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT Type of Tank -r = - - - - -- — — -- — - -- (Signed)._ ( Signed - - - & - Date...-- - -- - - / f..--/� Street Street Subdivision _.._..-.- -- _.--- -- -- --.— New Building _ Remodeling ... Addition________ _.__________ Repairs No. of Stories Size Septic Tank e g 7 - Feet of Drain Tile Nature of Water Supply: City — Well._____._._ ______________........... __ __ of Soakage Pit Capacity Gals. Dist. Feet of Tank or Drain Field from Well P1 bang Inspector. The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations as a employer of labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Permanent Supplement, and bas 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 undersigned agrees to employ only such sub - contractors, on work to be performed under this permit, as are licensed by Miami Shores Village. 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 swum, 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. i My Commission Expires Notary Public, State of Florida Master Plumber. 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.