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444 NE 102 St (8)Date Time Type Ins - Permit No. Name Address 3/ `- Company /4-1 1 Phone # For Inspector: Approved Correction Re-Insp'n Fee MIAMI SHORES VILLAGE BUILDING DEPARTMENT 305- 795 -2204 Building Inspection Request LOT: 6 [03] [04] [05] [06] [07] [08] CONSTRUCTION [ APPROVED FINAL SYSTEM [ APPROVED- STATE OF FLORIDA DEPARTMENT OF HEALTH ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM CONSTRUCTION INSPECTION AND FINAL APPROVAL APPLICANT: Mahoney, Robert AGENT: SR0921112, PROPERTY STREET ADDRESS:444 NE 102 St Miami Shores FL 33138 BLOCK: 91 PROPERTY ID #: 11- 3206 -017 -0580 TANK INSTALLATION [01] TANK SIZE [1] 900 [2] [02] TANK MATERIAL Fiberglass OUTLET DEVICE MULTI - CHAMBERS LEGEND N/A WATERTIGHT LEVEL DEPTH OF LID DRAINFIELD INSTALLATION [09] AREA [1] 0 [2] 0 [10] DISTRIBUTION BOX /HEADER [11] NUMBER OF DRAINLINES 0 [12] DRAINLINE SEPARATION [13] DRAINLINE SLOPE [14] DEPTH OF COVER [15] SYSTEM ELEVATION [16] SYSTEM LOCATION [17] DOSING PUMPS 0 [18] AGGREGATE SIZE [19] AGGREGATE SOURCE [20] AGGREGATE WASHED [21] AGGREGATE DEPTH FILL /EXCAVATION MATERIAL [22] FILL AMOUNT [23] FILL TEXTURE [24] EXCAVATION DEPTH [25] EXCAVATION AREA [26] REPLACEMENT MATERIAL DA 4016, 03/97 (Obsoletes previous editions which may not be used) (Stock Number: 5744- 002 - 4016 -4) [ostds_cins_4016 -2] • SUBDIVISION: Miami Shores Sec 4 [Section /Township /Range /Parcel No.] [OR TAX ID NUMBER] CHECKED [X] ITEMS ARE NOT IN COMPLIANCE WITH CHAPTER 64E -6, FLORIDA ADMINISTRATIVE CODE. 0.0 0 [ ] [ ] [ ] [29] [ ] [30] [ ] [31] [ ] [32] [ ] [33] [ ] [34] [ ] [35] SQFT 1 1 [ ] [ ] [ ] ] Cave, Ronald ] Cave, Ronald SETBACKS [27] SURFACE WATER [28] DITCHES PRIVATE WELLS PUBLIC WELLS IRRIGATION WELLS POTABLE WATER LINES BUILDING FOUNDATION PROPERTY LINES OTHER FILLED /MOUND SYSTEM [36] DRAINFIELD COVER [371 SHOULDERS [38] SLOPES [39] STABILIZATION MATERIAL ADDITIONAL INFORMATION [40] UNOBSTRUCTED AREA [41] STORMWATER RUNOFF [42] ALARMS [43] MAINTENANCE AGREEMENT [44] BUILDING AREA [45] PLUMBING FIXTURES [46] FINAL SITE GRADING [47] CONTRACTOR SR0921112 [48] OTHER Aggregate ABANDONMENT ] [49] TANK PUMPED 3/29/02 J [50] TANK CRUSHED AND FILLED 3/29/02 EXPLANATION OF VIOLATIONS: Dade CENTRAX #:13 -SG -12280 DATE PAID: FEE PAID : RECEIPT . OSTDSNBR :02- 0887 -R CHD Date: 3/29/02 Dade CHD Date: 3/29/02 Page 2 of 2 Date 3 -2. e Legal Description 1 Owner /Lessee/Tenet IN Owner's Address Contracting Co. Qualifier 3 L - • 1 a PERMIT APPLICATION FOR MIAMI SHORES VILLAGE 10050 N.E. 2nd Avenue • Miami Shores, Florida 33138 • 305-795-2204 0 Address 444 i E 1 02 S 'I Tax Folio () - 3 Q vi--0S L.-F G 61 `iv MS S-P_c 4 Historically Designated: Re, WA \' MoJi o v e4 say . State # Municipal # O k • /A .1 .l ` as to i wner d;,0 • • 49 President My Commission Exp res ;" APPROVED: Zoning Building Mechanical Plumbing 3 D SS# Master Permit # Phon Address Go 22, 5 3S C7 /"l Q- 'P'v ` Phone 33 S) 4 4--» Competency # IF THERE IS NO PERMIT PACKAGE ACCESSIBLE ON THE JOB SITE FOR INSPECTORS TO VERIFY, THERE WILL BE NO INSPECTION. RE- INSPECTION FEE IS $50.00 AND MUST BE PAID IN ADVANCE BEFORE CALLING FOR ANOTHER INSPECTION. Permit Type (circle one): BUILDING ELECTRICAL to Not My Co WORK DESCRIPTION: I ' r -L 1�0► 1N» 4- - e"T —Y' ' _ `� -. ` � . i //r � � / /l r 1 i • na „j�of owner an O Condo O resident � Date ,� 4— rn ssnn 7 -s3-50 ^ 0 �T Per -jl�. Yes No Ins. Co. PLUMBIN MECHANICAL ROOFING Square Ft. * r- Estimated Cost (value) 200®' o:. 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 ANY 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 all disciplines. OWNERS AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will b done in compliance with all applicable laws regulating construction and zoning. Furthermore, I authorize the above named contractor to do the work s Signature of Contractor FEES: PERMIT av RADON C.C.F I .A a NOTARY •1/ r Owner Builder Date J. S O LOMO N s T =' ��•�� MY C • • IUOION # CC 854808 EXPIRES: Jul 16, 2003 14063440wv Fla Nowt Borvio* • Bonding Co. D BOND t2 0 +� TOTAL DU3 3 4 - o� Date Electrical Structural Engineer Miami Shores Village 10050 NE 2nd Avenue X 0 —Phone: 305 - 795 -2204 Printed: 4/2/2002 (�O Applicant: ROBERT 0 Contractor A ARON SUPER ROOTER Local Phone: 305 - 944 -8886 Owner: Parcel # 1132060170580 Job Address: 444 NE 102 ST Fees: Description Amount FEE2002 -1868 Building Fee $80.00 FEE2002 -1869 CCF $1.20 FEE2002 -1870 Notary Fee $5.00 FEE2002 -1871 Buildier's Bond $300.00 Total Fees: $386.20 Permit Status: Approved Permit Expiration: 9/28/2002 Construction Value: $2,000.00 /y Work: ABANDON & REPLACE NEW SEPTIC TANK If there is no permit package accessible on the job -site for inspectors to verify, there will be no inspections. Re- inspection f ee is $50.00, which must be paid in advance before calling for another inspection. Teres J Solomon (954)962 -7919 4310 SW 25 Street Hollywood, FL 33023 -4412 BANK OF AMERICA MIAMI, FL 33169 Cam) 444 t tO2- Sr 63- 27/631 •:063L002771: 0037374832 _ 0303 Legal Description: 6 53 42 PB 15 - 14 AMD PL OF MIAMI SHORES SEC 4 W1/2 OF LOT 6 & 3 /27 90 02 Plumbing Permit Permit Number: PL2002 -83 MAHONEY Address: 6022 SW 35 CT Cellular: 0303 the equipment or device described in the application herefor in strict compliance with all with any plans, drawings, statements or specifications that may have been submitted to is not done in compliance with such ordinances or if the plans are changed without Ictor or builder named above assumes the responsibility for a thorough knowledge of the ings or in the statements or specifications and that he assumes responsibility for work done in compliance with all ordinances and regulations pertaining thereto and in strict conformity res Village. -In accepting this permit I assume responisibility for all work done by either BY: BY: Page 1 of 1 Total Fees: $386.20 Total Receipts: $0.00 UNIT TLB FEE ITEM UNIT SWITCH CURETS FEE • ITEM . - SPACE HEATERS'. UNIT FEE LIGHT OUTLETS CENTRAL FEATING I .SrER. RECEPTACLES A/C (WIND) . SAL SERVICE TEMFCRARY A/C (CENTRAL) ;ING FOUNTAIN SERVICE SIZE IN APS DUCT 1CCRX 1 CRAIN SERVICE REPAIRMTE C REFRIGERATION ;E TRAP )(Mika CURETS PROCESS A'0 PRESS PIPING ,CEPTCR RAW4E TCP UNDERGROUt•0 TANKS TORY OVEN ABOVE GROUNO TANKS NY TRAY WATER NEATER U.F. PRESSURE VESSELS S WASHER MOTOTLS 0- 1 FP - l STEAM BOILERS • • .R MOTORS OVER 1- 3 FP HOT WATER BOILERS .. . POT /3 COMP MNTCRS OVER 3- .5 FP MECHANICAL VENTILATION • . RESIDENCE MOTORS OVER 5- 8 FP TRANSPORTING ASS- BLIES :. SLOP MOTORS OVER 8- 10 FP ELEVATORS/ESCALATCRS CRARY WATER CLOSET NATCRS OVER 10- 25 FP • FIRE SPRINKLER SYSTEMS UN_ MOTORS OVER 25-100 FP COOLING TOWERS :R CLOSET MOTCRS OVER 100 FP VIOLATION IRECT WASTES A/C WINDOW REIMSPECTION 'R SUPPLY TO: [ AIR CONDITIONERS iC UNIT 1 STRIP NEATER IRE SPRINKLER GENERATORS TRANSFCRIERS I EATER -NEW INST. GENERATORS TRANSFCR.I.S II EATER - REPLACE GENERATORS TRAXSFCRLVFRS I I *CS SPRINKLER-WELL SPECIAL PURPOSE 4 1 MM I NG POOL OUTLETS CCMMZRC I AL - I ATER SERVICE SIGN TUBES ER CONVECTIONS SIGH TR4'SFOFARS I _ I TY -SE7 a SIGN T I)E CL00( :ITT-WATER FIXTURES TIC TANG( 1 AY TELEY{SION CUTLETS INFIELD, 4' TILE/RES. '- VfOlATION ? & ABANDON SEPTIC TANK :CAGE PIT CU. FT. _ 1 RE I NSPECT ION CH BASIN LARGE WELL EST IC WELL A CRAIN -_ �■ IF INLET .AR ?ATER HEATER - tE STANDPIPE :L PIPItiG IN SPRINKLER SYSTEM 3 RANGE DER SET (GAS) 3 PIPING APPLII CATION FOR BUILDING PER.'!IT MUST ACCOMPANT THIS ADDENDUM. IF A MASTER PERMIT HAS 3. 'AINED, THE OPTh ER' S NOTARIZED SIGNATURE NEED NOT BE PRESENT ON SUBSEQUENT APPLICATIONS.) PLUMBING ELECTRICAL MECHANICAL SYSTEM DESIGN AND SPECIFICATIONS T [ 900 ]Gallons SEPTIC TANK A [ 0 ]Gallons N [ 0 ]GALLONS GREASE INTERCEPTOR CAPACITY THE SEPIK; Mdtt ;;Hill.L BE POOPED AHD A MOO UEFLECTION DEVICE INSTALS) ON THE OUTLET TEE SPECIFICATIONS BY: RAM, APPROVED BY: Arrieta, Rolando -- 1 DATE ISSUED: 3/25/02 STATE OF FLORIDA DEPARTMENT OF HEALTH ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM CONSTRUCTION PERMIT CONSTRUCTION PERMIT FOR: [ ]New System [ ]Existing System [ ]Holding Tank [ ] Innovative Other [ X ]Repair [ ]Abandonment [ ]Temporary [ NA ] APPLICANT: Mahoney, Robert AGENT: SR0921112, Tuffy John PROPERTY STREET ADDRESS: 444 NE 102 St Miami Shores FL 33138 LOT: 6 BLOCK: 91 SUBDIVISION: Miami Shores Sec 4 [Section /Township /Range /Parcel No.] PROPERTY ID #: 11- 3206 - 017 -0580 [OR TAX ID NUMBER] SYSTEM MUST BE CONSTRUCTED IN ACCORDANCE WITH SPECIFICATIONS AND STANDARDS OF CHAPTER 64E -6,FAC DEPARTMENT APPROVAL OF SYSTEM DOES NOT GUARANTEE SATISFACTORY PERFORMANCE FOR ANY SPECIFIC TIME PERIOD. 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. ISSUANCE OF THIS PERMIT DOES NOT EXEMPT THE APPLICANT FROM COMPLIANCE WITH OTHER FEDERAL, STATE OR LOCAL PERMITTING REQUIRED FOR PROPERTY DEVELOPMENT. K [ 0 ]GALLONS DOSING TANK CAPACITY [ 0 ]GALLONS @ [0 ]DOSES PER 24 HRS # PUMPS[ 0 ] D [ 0 ]SQUARE FEET PRIMARY DRAINFIELD SYSTEM R [ 0 ]SQUARE FEET SYSTEM A TYPE SYSTEM: [ N ]STANDARD [ N ]FILLED [ N ]MOUND I CONFIGURATION: [ N ]TRENCH [ N ]BED [ N ] N F LOCATION TO BENCHMARK: 10.80'NGVD FF E/R I ELEVATION OF PROPOSED SYSTEM SITE [ 0.7 ] [ FEET ] [ BELOW] BENCHMARK /REFERENCE POINT E BOTTOM OF DRAINFIELD TO BE [ 3.2 ] [ FEET ] [ BELOW] BENCHMARK /REFERENCE POINT L D FILL REQUIRED: [ 0.0 ]INCHES EXCAVATION REQUIRED: [ 30.0 ] INCHES OTHER REMARKS: Install 900 gls. new, multi - chambered s/t equipped w/ an approved filter. Existing 300 sq. ft. d/f to remain as it is, Apply pressure cleaner into d/f pipes using jetting system only. This permit is not for addition. TITLE: DH 4016, 03/97 (Obsoletes previous editions which may not be used) (Stock Number: 5744- 001 - 4016 -0) [ostds cons _4016 -1) GC :] Cis' E 4k:%'si 2-3 6 ELEt"fat ill 7 .4. 11 , == 24,1L,, TITLE: Engineer I CENTRAX #: 13 -SG -12280 DATE PAID: FEE PAID : $ RECEIPT . OSTDSNBR : 02 -0887- -R MULTI - CHAMBERED /IN SERIES: [Y ] MULTI - CHAMBERED /IN SERIES: [Y ] Dade CHD EXPIRATION DATE: 6/23/02 Page 1 of 2 STATE OF FLORIDA PERMIT )]f DEPARTMENT OF HEALTH ONSITE SEWAGE DISPOSAL SYSTEM SITE EVALUATION AND SYSTEM SPECIFICATIONS APPLICANT: /�� �� � A ., .. AGENT: A'il v'O p1 S � 6 f� LOT: (,, 7 BLOCK: ISION:' ' PROPERTY ID I I _320 OS8-b [Section /Township /Range /Parcel No. or Tax ID Number] � O 44- Li- NE 102 .S : ■■.4 Shows 3313 ' TO BE COMPLETED BY ENGINEER, HEALTH UNIT EMPLOYEE, OR OTHER QUALIFIED PERSON. ENGINEER'S MUST PROVIDE REGISTRATION NUMBER AND SIGN AND SEAL EACH PAGE OF SUBMITTAL. COMPLETE ALL ITEMS. PROPERTY SIZE CONFORMS TO SITE PLAN: [ A YES [ ] NO NET USABLE AREA AVAILABLE: - (7 ACRES TOTAL ESTIMATED-- SEWAGE FLOW: 30D GALLONS PER DAY [RESIDENCES -TABLE 1 / OTHER -TABLE 2] AUTHORIZED SEWAGE FLOW: 4.2.1 GALLONS PER DAY [1500 GPD /ACRE OR 2500 GPD /ACRE] UNOBSTRUCTED AREA AVAILABLE: 00 O SQFT UNOBSTRUCTED AREA REQUIRED: GOO SQFT BENCHMARK /REFERENCE POINT LOCATION: I 102 ELEVATION OF PROPOSED SYSTEM SITE IS % / [INCHES f] [ABOVE SITE SUBJECT TO FREQUENT FLOODING: [ ] YES [ ] NO Munsell PColor Texture Depth IOyQ I` GRID c t"to 72- to to to to to to to r , to (W( USDA SOIL SERIES: P' e`a OBSERVED WATER TABLE: AIe INCHES [ABOVE / ESTIMATED WET SEASON WATER TABLE ELEVATION: HIGH WATER TABLE VEGETATION: [ ] YES [19 NO SITE EVALUATED BY: DH 4015, 10/96 (Replaces HRS -H For 4015 [Pape 3] which may be used) (Stock Number: 5744- 003 - 4015 -1) • SOIL PROFILE INFORMATION SITE 2 J rBENCHMARK/RCEEONCE POINT THE MINIMUM SETBACK WHICH CAN BE MAINTAINED FROM THE PROPOSED SYSTEM TO 'THE FOLLOWING FEATURES: SURFACE WATER: N A FT DITCHES /SWALES: rIk FT NORMALLY WET? [ ] YES NO WELLS: PUBLIC: P A- FT 5 /07.k FT PRIVATE: FT NON- POTABLE: FT BUILDING FOUNDATIONS: V FT PROPERTY LINES: a FT POTABLE WATER LINES:fO FT 10 YEAR FLOODING? [ ] YES [ ] NO 10 YEAR FLOOD ELEVATION FOR SITE: FT MSL /NGVD SITE ELEVATION: la1 FT MSL /NGVD w'T 3,5' SOIL PROFILE INFORMATION SITE 1 Munsell # /Color oft Depth loy SI1 Gaj `� / oft to12�' 1 to to to to to to to /� to USDA SOIL SERIES: U LA'•O ] EXISTING GRADE. TYPE: [PERCHED / A�PAR NT] 11.2 INCHES [ ABOVE / j ] EXISTING GRADE. MOTTLING: [ ] YES [ � ] NO DEPTH: /" INCHES SOIL TEXTURE /LOADING RATE FOR SYSTEM SIZING: V DEPTH OF EXCAVATION: 30 INCHES DRAINFIELD CONFIGURATION: [ ] TRENCH [/\] BED j ] OTHER (SPECIFY) REMARKS /ADDITIONAL CRITE I�d'1}: DATE: Ice Page 3 of 3 INSTRUCTIONS: PERMIT NUMBER: Permit tracking number by County Health Department. • APPLICANT: Property owner's full name. AGENT: Property owner's legally authorized representative. LOT, BLOCK, SUBDIVISION: Lot, block, and subdivision for lot. PROPERTY ID NUMBER: 27 character number for property (property appraiser ID number or section /township /range /parcel number). PROPERTY SIZE: Check if property at site conforms to submitted site plan. Record net usable area available - lot area exclusive of all paved areas and prepared road beds within public rights -of -way or easements and exclusive of streams, lakes, normally wet drainage ditches, marshes, or other such bodies of water. SEWAGE FLOW: UNOBSTRUCTED AREA: MINIMUM SETBACKS: Record the estimated sewage flow for the establishment from Table 1 (residence) or Table 2 (non - residential), Chapter 10D -6, FAC. Record the authorized sewage flow for the lot based on net usable area and water supply (1500 gallons per day per acre for private water supplies and 2500 gpd per acre for public water supplies). If authorized sewage flow does not equal or exceed the estimated sewage flow, the application must be denied. Record the square feet of unobstructed area available and the amount required. Unobstructed area must be at least 2 times as large as the drainfield absorption area and at least 75 percent of the unobstructed area must meet minimum setbacks in Chapter IOD -6, FAC. The unobstructed area must be contiguous to the drainfield. BENCHMARK INFORMATION: Record the location of the benchmark. If using a surveyor's benchmark record the actual elevation. Record the elevation of the proposed system site in relation (above or below) to the benchmark. Record minimum setbacks which can be meet to all listed features. Actual measurements must be recorded or "NA" for nonapplicable features. Features on site plan or within 75 feet of the applicant lot must be measured. The location of any public drinking well within 200 feet of the applicant's lot must also be verified. FLOOD INFORMATION: Record information on lot's subject to flooding. For lots subject to flooding record 10 year flood elevation for site and actual site elevation. SOIL PROFILE INFORMATION: Two soil profiles within the proposed absorption area to a minimum depth of 6 feet or refusal are required. Soil identification will use USDA Soil Classification methodology (Munsell colors and USDA soil textures). Refusals must be clearly documented. Provide USDA soil series if available, record "UNK" if the series cannot be determined. WATER TABLE: Record the depth of the observed water table at the time of the evaluation. Mark "perched" or "apparent" as appropriate. Record the estimated wet season water table elevation based on site evaluation, USDA soil maps, and historical information. Indicate if there is high water table vegetation present. Indicate if mottling is present and depth. SOIL TEXTURE: Record soil texture or loading rate for system sizing. DEPTH OF EXCAVATION: If applicable record depth of excavation required. Record "NA" if not applicable. DRAINFIELD CONFIGURATION: Check drainfield configuration required. If other, specify type. ADDITIONAL CRITERIA: Record any additional remarks pertinent to site or installation. Ex. dosing required. SITE EVALUATED BY: Signature of evaluator, title, and date of evaluation. Professional engineers must seal all documents submitted. ELEVATION WORKSHEET ELEVATION OF BENCHMARK / REFERENCE POINT IS: BENCHMARK SITE 1 SITE 2 SITE 3 [ + ] SHOT H.I. H.I. H.I. H.I. [ - J SHOT [ - ] SHOT [ - ] SHOT STATE OF FLORIDA DEPARTMENT OF HEALTH APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PERMIT / � , Permit Application Number ( Scale: Each block represents 5 feet and 1 inch = 50 feet. 10 Notes: icAki- 4t -° 4-A-4 N 5 102 Ski MSkore4 33i 3 010 eti y -1 - (-effaced Site Plan submitted by: Plan Approved 0 312 S J t By Signature Not Approved d r9 " - PLArni) b of an Rx) )"3 PART II - SITE PLAN- ALL CHAN MUST BE APPI�O4D THE COUNTY HEALTH DEPARTMENT DH 4015. 10/96 (Replaces HRS-H Form 4015 whIc y be used) `` 1 (Stock Number: 5744.002 4015.6) N� TM 4.- JUNG DO-14-1 NFIe Title Date 3 12.1 (o2. County Health Department Page 2 of 3 0 PERMIT APPLICATION FOR MUNICIPALITIES OF DADE COUNTY (OWNER TO RETAIN COPY) Date S- Ar. 9.. Job Address `// /9 N / °L 1Z Tax Folio // 2d6 /7 Uf7 Legal Description Owner / Lessee / Tenant Owner's Address Phone Contracting Co. aff,i apti.e s&--1/61,...- Qualifier WORK DESCRIPTION APPROVED: w/a ,454 f / 64v ,L i ds• 1'cc-. q /�• Sre-Aw4'N ArNoNe V . Master Permit fir` Address /3903idof 4 7/11f #3 /0 - e (!'it/D/1- SS# ' - Phone / State # Municipal # Architect /Engineer Address Bonding Company Address Mortgagor Address Permit Type(circle one): BUILDING ELECTRICA UMBING MECHANICAL ROOFING PAVING FENCE SIGs Zoning Competenc # too° ?004„7 Square Pt. Estimated Cost(value) /000 WARNING TO OWNER: YOU MUST RECORD A NOTICE OF COMMENCEMENT AND YOUR FAILURE TO DC SO MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY (IF YOU INTENL TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUF NOTICE OF COMMENCEMENT). Application is hereby made to obtain a permit to do work and installation as indicated above, an on the attached addendum (if applicable). I certify that all work will be performed to meet th. 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 wil: be done in compliance with all applicable. laws regulating construction and zoning. Furthermore, authorize the above -named contractor to do the work stated. Signature of owner and /or Condo President Date: 5- /5- 92 i Notary : 7to 'Jwner' site; /or ('Condo President My Commis si.on Expires : N(hARY PUBLIC, STATE OF FLORIDA. . - Mt COMMISSION EXPIRES: April 16, 1991 , -MINDED 'MU NOTARY. PUBLIC UNDERWRITERS. ** * * * . ;,, *-` * * * * * * FEES: PERMIT "e RADON C.C.F. Fire Mechanical Plumbing �4 Signature of Cony actor or Owner-Builder Date: , 5 -15 -9 Notary My Co to Contractor or Owner-Builder ssion Expires: NOTARY PUBLIC, STATE OF'FLORIDA. MY COMMISSION EXPIRES: April 16, 1995. BONDED TIIRU NOTARY PUBLIC UNDERWRITER& * * * * * ** NOTARY TOTAL DUE 3 Other Building //0/ Electrical Engineering STATE OF FLORIDA - DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEi CONSTRUCTION PERMIT Authority: Chapter 381, F.S. Building Permit #: & Chapter 10D -6, F.A.C. Application /Permit Number: Date Application Received: `1 5 - Application Is For: New System [ ] Repair [✓I ,/ Fee Amount Paid: o P,� Receipt #:(""C0):74) Existing System [rI r:xperimental System [ ] (Temporary) [ ] Tank Abandonment [ ] Holding Tank [ ] Other (Specify) NOTE: PERMITS EXPIRE ONE YEAR FROM DATE OF ISSUANCE AND ARE NOT RENEWABLE. REPAIR PERMITS AND HOLDING TANK PERMITS EXPIRE 90 DAYS FROM DATE OF ISSUANCE. APPROVAL OF A SYSTEM DOES NOT GUARANTEE SATISFACTORY PERFORMANCE FOR A SPECIFIC PERIOD OF TIME. TO BE COMPLETED BY APPLICANT: Owner: /?: A , -y' Telephone: : Work P ( ) (Home) 70'.1/7.f7 Owner's Mailing Address: Y'9 � (Jca- ' ST City: dp f „ State: " Zip: Owner's Agent: /���� J;?7z Telephone (W) .53 (H) Agent's Mailing Address: ... 0 /1Qdl ,Uw e7Ave City: ,lid State: f<- Zip: o,y P� .I.T Property Street Address: 'S A/e ST, Exact Directions to Property: Lot it Block # Subdivision Unit Date Subdivided Section: Township: Range: Parcel #: Zoning Designation: Property Size: Square Feet /Acres Water Supply: Private [ ] Public [ ] Limited Use [ ] Is Sanitary Sewer Available: Yes [ ] No [ ] If No, approximate the distance to the sewer Is Public Water Available: Yes line closest to your property: [ ] No [ ] If No, approximate the distance to the water line closest to your property: Type of BUILDING INFORMATION Establishment- # of Units Building if of Persons # of Seats Hours of Commercial Residentia Area (sq ft) (circle & # of Bedrooms Operation Plumbing Fixtures: Garbage Grinders /Disposals Spas /Hot Tubs Floor /Equip. Drains Ultra -low Volume Flush Toilets — Other BUILDING PLANS MUST BE ATTACHED SHOWING OFFICES, BEDROOMS, TOTAL BUILDING AREA, AND ANY PERTINENT FEATURES REQUIRED BY CHAPTER 10D -6, F.A.C. IN ADDITION, A DETAILED SITE PLAN AND /OR SURVEY, DRAWN TO SCALE, MUST BE ATTACHED SHOWING PROPERTY DIMENSIONS, BUILDING LOCATIONS, AND PERTINENT FEATURES REQUIRED TO BE SUBMITTED PER CHAPTER 10D -6.046 F.A.C. Applicant's Signature: Date: Scale: Each block represents 5 feet and 1 Inch — 50 feet. Notes: i k..e. , .ez./4 lam Site Plan submitted by Plan Approved By STATE OF FLORIDA DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION AND INSTALLATION PERMIT r, Permit Application Number 9' ? �d' yy ,e.` ion . �7 J — ado 45 ,e4. PART II - SITE PLAN 3IONAMUAE TITLE Not Approved Date A CHANGES MUST BE APPROVED BY THE COUNTY PUBLIC HEALTH UNIT FIRS - H FORM 4015 -A January 1992 (Obsolote, M Prev1ou• Editions) County Publi FOR OPTIONAL USE AS AN ATTACIIMENT TO HRS -H FORM 40 Permit No. ._L. 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 _-- ___ No.. Registered Architect and /or z ineer __ Employing Plumber's Name __ / :. ' Location and Legal Description Lot....._.___..— .__________.._ Street and Number where work is to be performed —No 40.1.4 . /Ag State work to be performed and purpose of building (By Floors) New Building Remodeling_______._.___ .____.______ Addition Size Septic Tank. Feet of Drain Nature of Water Supply: ity— ell.- __.__...... _ .......... of Soakage Pit Amount of Permit $ es. MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT Type of Tank t. eet of Tank or Drain Field from Well. ............ ______.� ( Signed Date 7/.5 . / Street Street.. Subdivision. Street Repairs No. of Stories Capacity Gals Plelmbing 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 5968, 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 tlie Act. The undersigned agrees to employ only such sub- contractors, on work to be perform under this permit, as are licensed by Miami Shores Village. Master Plumber. STATE OF FLORIDA, t 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 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 inspection, or faulty materials and /or workmanship. CLOSETS TUBS TUBS W SHOWERS LAVA- TORIES I SINKS SLOP SINKS LAUNDRY TUBE I NALS URINALS CATCH BASIN FLOOR DRAIN DRINKING FO FOUNT'NB TOTAL FIXTURES T CONTR. LIST CHICK SEPTIC TANK SEWER CONN. DRAIN FIELD SOAKAGE PIT GREASE TRAP SOLAR HEATER DEEP WELL SPRKLR. SYSTEM SWIM'O POOL CONTR. Liar CHECK - -.- Permit No. ._L. 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 _-- ___ No.. Registered Architect and /or z ineer __ Employing Plumber's Name __ / :. ' Location and Legal Description Lot....._.___..— .__________.._ Street and Number where work is to be performed —No 40.1.4 . /Ag State work to be performed and purpose of building (By Floors) New Building Remodeling_______._.___ .____.______ Addition Size Septic Tank. Feet of Drain Nature of Water Supply: ity— ell.- __.__...... _ .......... of Soakage Pit Amount of Permit $ es. MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT Type of Tank t. eet of Tank or Drain Field from Well. ............ ______.� ( Signed Date 7/.5 . / Street Street.. Subdivision. Street Repairs No. of Stories Capacity Gals Plelmbing 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 5968, 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 tlie Act. The undersigned agrees to employ only such sub- contractors, on work to be perform under this permit, as are licensed by Miami Shores Village. Master Plumber. STATE OF FLORIDA, t 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 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 inspection, or faulty materials and /or workmanship.