501 NE 102 St (10)Date 1/10/95
Owner's Address
Qualifier DENNIS NEVILLE
Square Ft.
**
APPROVED:
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Job Address 501 NE 102 STREET
Legal Description
Owner / Lessee / Tenant JENNY OWENS Master Permit # 3 ?c ?3
501 NE 102 STREET, MIAMI SHORES, 33138
Contracting Co. NORTH DADE SEPTIC TANK
Tax Folio //- 30'204:7 -cal 7 09'10
Phone 756 -1612
Address 800 NW 111 STREET
SS# Phone 754 -3375
State # 025836 -8 Municipal # Competency # 12842 Ins.Co.TRAVELERS /ESIF
Architect /Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type(circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING PENCE SIGN
WORK DESCRIPTION INSTALLL DRAINFIELD
200 SQ FT Estimated Cost(value) $1400.00
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
be done in compliance with all applicable laws regulating const
authorize the above -named contractor to do the work stated.
Signature of owner and /or Condo President Signa
Date: , Date:
N Lary , s to OwnQ ( and /or Condo President
My Commission xpYresi �pR
NOThItY Milt; SiATS of FLORIDA AT
c- I'VE 11, 1475
EONDE* THRU HUCiii.C3ERnw
Ch MM 5Stt7N Ef j ASiOC
flcY l &TcS
* L� *
FEES: 'PERMIT . RADON C.C.F.
Zoning
Mechanical
Buildin
Plumbin
as to C ractor or o per- Buildet
fission x•irc�s:
NOT ltiSUIIC; STATE OF FLORIDA 9 ; LARGE
MY CO .S510N £XPIRci ZU:�E 19.
* * * * DONDED*THRU HU SE` LF3ERRY & ASSOCIATES .
* *. **
NOTARY TOTAL DUE I D
Fire Other
curate and that all work will
and zoning. Furthermore, I
f Cont actor or Owner- Builder
Electrical
e ngineering
1
2
3
4
AGENT:
APPLICATION FOR:
(N) New System [ N] Existing System [ A Holding Tank [ N] Temporary /Experimental
[y] Repair [ Ni Abandonment ,[ N Other(Specify)
APPLICANT: OWEN S
MAILING ADDRESS:
TO BE COMPLETED BY APPLICANT OR APPLICANT'S AUTHORIZED AGENT. ATTACH BUILDING PLAN AND TO -SCALE
SITE PLAN SHOWING PERTINENT FEATURES REQUIRED BY CHAPTER 10D -6, FLORIDA ADMINISTRATIVE CODE.
�i;,bPERTY { NFORMATION [IF LOT IS NOT IN A RECORDED SUBDIVISION,.ATTACH LEGAL DESCRIPTION - OR DEED]
LOT: BLOCK:
PROPERTY ID #:
....PROPERTY. SIZE: ACRES [Sgft /43560] PROPERTY WATER SUPPLY: [ ] PRIVATE [ X] PUBLIC
STREET ADDRESS: Sa` 6770g S:4- PROPERTY
`� 501 NE STREET, 33138
pIRECTIONS TO PROPERTY:
BUILDING INFORMATION
Unit Type of
No Establishment
SFR
[ N] Garbage Grinders /Disposals
[ N] Ultra -low Volume Flush Toilets
APPLICANT'S SIGNATURE
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
NORTH DADE SEPTIC TANK
800 NW 111 STRE'T, MIAMI 33168
SUBDIVISION:
,cad /de: / -Y/1
(X)J RESIDENTIAL
No. of Building # Persons
Bedrooms Area Sgft Served
2 BEDROOMS
[ N) Spas /Hot Tubs
P
HRS-H Form 4015, Mar 92 (Obsoletes previous editions which may not be used)
(Stock Number: 5744- 001 - 4015 -1)
[ ] COMMERCIAL
PERMIT #
DATE PAID
FEE PAID $
RECEIPT #
TELEPHONE: 756-1612
754 -3375
DATE: 1/105
9: r:e - OP/
DATE OF
SUBDIVISIO
[Section /Township /Range /Parcel No.] ZONING:
•
Business Activity
For Commercial Only
[N ] Floor/Equipment Drains
Page 1 of 3
[ N] Other (Specify)
LOT:
1 .2,71.a.,:" o - ;
APPLICANT:
PROPERTY ID #:
MIMS
STATE OF FLORIDA
DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES
ONSITE SEWAGE DISPOSAL SYSTEM
SITE`EVALUATION AND SYSTEM SPECIFICATIONS
BLOCK: SUBDIVISION:
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: [
TOTAL ESTIMATED SEWAGE FLOW:
AUTHORIZED SEWAGE FLOW:
UNOBSTRUCTED AREA AVAILABLE: 400
BENCHMARK /REFERENCE POINT LOCATION:
ELEVATION OF PROPOSED SYSTEM SITE IS
THE MINIMUM SETBACK WHICH
SURFACE WATER: a 7 FT
WELLS: PUBLIC: 100 FT
BUILDING FOUNDATIONS:
300
CAN BE MAINTAINED FROM THE PROPOSED SYSTEM TO THE FOLLOWING FEATURES:
DITCHES /SWALES: - -- FT NORMALLY,WET? [ ] YES [ ] NO
E: -" FT NON-POTABLE: -° m FT
5 FT PROPERTY LINES: 5
LIMITED USE: s" FT PRIVAT
SITE SUBJECT TO FREQUENT FLOODING: [ ] VS [X] NO
FT MSL /NGVD
10 YEAR FLOOD ELEVATION FOR SITE:
SOIL PROFILE INFORMATION SITE 1
Munsell # /Color
brown
USDA SOIL SERIES:
Texture
sandy
Depth
0`° 72"
to
to
to
to
to
to
to
to
to
SITE EVALUATED BY:
AGENT 1ORTH DADE
PERMIT
PTIC TANK
[Section /Township /Range /Parcel No. or Tax ID Number]
ACRES
GALLONS PER DAY [RESIDENCES -TABLE 1 / OTHER- TABLE,2]
GALLONS PER DAY [1500 GPD /ACRE OR 2500 GPD /ACRE]
SQFT UNOBSTRUCTED AREA REQUIRED: 400 SQFT
YES [ ] NO NET USABLE AREA AVAILABLE:
(INCHES /FTJ [ABOVE /BELOW] BENCHMARK /REFERENCE POINT
SOIL PROFILE INFORMATION SITE 2
Munsell # /Color Texture Depth
brown sandy 0" t 72"
$ to
to
to
to
to
to
to
USDA SOIL SERIES:
OBSERVED WATER TABLE: INCHES [ABOVE / BELOW ] EXISTING GRADE. TYPE: [PERCHED / APPARENT]
ESTIMATED WET SEASON WATER TABLE ELEVATION: 108 INCHES [ ABOVE / BELOW ] EXISTING GRADE.
HIGH WATER TABLE VEGETATION: [ ] YES [X] NO MOTTLING: [ ] YES [X] NO DEPTH: 24 INCHES
SOIL TEXTURE /LOADING RATE FOR SYSTEM SIZING: 1.2 5 DEPTH OF EXCAVATION: 24 INCHES
DRAINFIELD CONFIGURATION: [ ] TRENCH [ X] BED [ ] OTHER (SPECIFY)
REMARKS /ADDITIONAL CRITERIA:
FT POTABLE WATER LINES: FT
10 YEAR FLOODING? 7° Z ] YES p(] NO
SITE ELEVATION: FT MSL /NGVD
/et DATE: 1/10/95
HRS-H Form 4015, Mar 92 (Obsoletes previous editions which may not be used) Page 3 of 3
(Stock Number: 5744- 003-4015 -1)
-
CONSTRUCTION PERMIT TR:
] New System [ATExisting System [V ],Holding Tank [ %J Temporary /Experimental
] Repair [A] Abandonment ['i Other(Specify)
APPLICANT:
STATE OF FLORIDA
DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES
ONSITE SEWAGE DISPOSAL SYSTEM
CONSTRUCTION PERMIT
Authority: Chapter 381, FS & Chapter 1OD -6, FAC
0 LL) ) e $ AGENT: d/ [ ei)i¢
PROPERTY STREET ADDRESS: 5415 p /0 2,
LOT:
BLOCK: SUBDIVISION:
PROPERTY ID #: [SECTION /TOWNSHIP /RANGE /PARCEL NUMBER]
dl� [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.
T
A
N
K
D
R
A
I
N
F
I
E
L
D
0
T
H
E
R
SYSTEM DESIGND SF�EC• FICATIONS
[7S ( GALLO , / GP / D
[
SEPTIC TANK /A ROBIC UNIT CAPACITY MULTI- CHAMBERED /IN SERIES:[ ]
CAPACITY MULTI- CHAMBERED /IN SERIES:[ ]
[MAXIMUM CAPACITY SINGLE TANK: 1250 GALLONS]
DOSE RATE [ ] PER 24 HRS NO. OF PUMPS:
] [GALLONS / GPD]
[ ] GALLONS GREASE INTERCEPTOR CAPACITY
[ ] GALLONS PER DOSE DOSING TANK CAPACITY
[2 ?] SQUARE FEET PRIMARY DRAINFIELD SYSTEM
[ ] SQUARE FEET SYSTEM
TYPE SYSTEM: [ ] STANDARD [ ] FILLED
CONFIGURATION: [ ] TRENCH [ ] BED
LOCATION OF BENCHMARK:
ELEVATION OF PROPOSED SYSTEM SITE
BOTTOM OF DRAINFIELD TO BE [
FILL REQUIRED: [
SPECIFICATIONS BY:
DATE ISSUED:
APPROVED BY:
] INCHES
6� /7— 7 5 "
[INCHES /FT]
[INCHES /FT]
EXCAVATION REQUIRED: [
7 Coq r
TITLE:
TITLE: /''-
APPLICANT
PERMIT # 95 R02/
DATE PAID
FEE PAID $
RECEIPT #
[ ] MOUND [ ]
[
[ABOVE /BELOW]
[ABOVE /BELOW]
BENCHMARK /REFERENCE POINT
BENCHMARK /REFERENCE POINT
] INCHES
�J' ' Jvi, lies i . �?:o
.. `i C n 0
HRS-H Form 4016, Mar 92 (Obsoletes previous editions which may not be used)
(Stock Number: 5744- 001 - 4016 - 0)
afde-V4L-
[]
CPHU
EXPIRATION DATE:
1 of 2
ENSTRUCTEONS:
PSRR/MLT NUMBER: Permit tracking number assigned by CPHU.
APPLECATIGN FOR: Check type of permit, if °Other° specify type in blank.
APPLECANT: 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 IDi/: 27 character id number for property. (CPHU may require property appraiser ID f1 or section/township /range /parcel number)
SYSTEM DESIGN AND
SPECIFICATIONS:
TANK: Minimum specifications from Chapter 10D -6, FAC.
DRAINFIELD: Minimum specifications from Chapter IOD-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.
Scale: Each block represents 5 feet and 1 inch = 50 feet.
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Notes:
By
STATE OF FLORIDA
DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES
APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION-PERMIT �� f �
Permit Application Number S (�
n .
ovens: 501 NE 102 Street, Miami Shores 33138
Old system overflowing.
Site Plan submitted by:
Plan Approved
HRS -H Form 4015, Feb 85 (Obsoletes previous editions which may not be used)
(Stock Number. 5744-002-4015-6) t
PART II • SITE PLAN
SIGN;- RE
Not Approved
ALL CHANGES MUST BE APPROVED BY THE COUNTY PUBLIC HEALTH UNIT
TITLE
Date / -"/,- t7.1
County Public Unit
Page 2 of 3
BUILDING
ELECTRICAL
PLUMBING
ROOFING
Owner of
Building
Architect
Contractor
or Builder
Legal
Description
Address of
Building
Lot
° PERMIT N9 8278
`g7
rot
i
4 l
CONTRACTOR OR BUILDER
MIAMI SHORES VILLAGE. FLORIDA
Bl.
Work to be performed under this Permit
Sq. Ft
Value of ` a
Project $ 10 cro•
Subdi-
vision
BY
4
DATE
Contractor's
License No
Amt. of
Permit $
AUTHORITY
1
195 ' fi
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 thorou h knowledge of the ordinances and regulations
pertaining to the work covered hereby whether shown on the plans or drawings or in the statements or specifjclon nd that he assumes responsibility for work
done by his agents, servants or employees.
Signed • °"•' iP.,. a�fr.! i2 BY
INSPE OR
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.
17
BUILDING
ELECTRICAL
PLUMBING
r
{
Owner of 4
Building
Architect
Contractor
or Builder
Legal Lot ` t , _ I� BI.
Description
Address of
Building
r J
C()1GTRO6Q'OR CfR BITILD
MIAMI SHORES VILLAGE, FLORIDA
DATE / 194 L
PERMIT N9 1841 Contractor's
License No.
Work to be performed under this Permit
Subdi-
vision
Value of
Project
Amt. of
Permit
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.
•
Signed• 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 regula-
,, tions pertai 1 reto ajA in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores
Villa fn ac ng thd's perolt I assume telponsibility for all work done by either myself, my agent, servant or employee.
BY AUTHORITY
JOB:
BUILDING
PLU}.IBING
7 . 1 .(C4/"...cr.,v;
•
•
•
•
ELECTRICAL •
Inspector's Report:
: WORK
: DONE BY:
: REQUESTED
•' /
The following is ready for Inspection:
AD: /)? /0 2-
•
•
•
•
•
•
•
•
. WILL BE READY
Permit No. 1 7 L
Size Septic Tank_____ ____ _________ .______ -_____ Type of Tank
Feet of Drain Tile_________ ..
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
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.
/ 1F
.
Owner's Name and Address —C� L L '
Registered Architect and /or En neer
No
Employing Plumber's Name ' f� -__ �) )1 i''' Street
�� - ' No t_
Location and Legal Description Lot_- ________/ ` ? " Block ,' "' — ______________ Subdivision_______, ____.�_____�
Street and Number where work is to be performed —No ° ' Street — '__�_____ —_____
State work to be performed and purpose of building (By Floors)
New Building — Remodeling Addition Repairs No. of Stories
N
Dist. Feet of Tank or Drain Field from Well
Capacity Gals
Nature of Water Supply: City 'Well. Size of Soakage Pit
Amount of Permit $_ (Signed) --
Plumbing Inspector.
The undersigned applicant or this building permit does hereby certify that h nderstands 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; 1 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.
STATE OF FLORIDA,
COUNTY OF DADE.
(Signed)''
r� Street
t
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
Maker 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
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
-
Permit No. 1 7 L
Size Septic Tank_____ ____ _________ .______ -_____ Type of Tank
Feet of Drain Tile_________ ..
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
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.
/ 1F
.
Owner's Name and Address —C� L L '
Registered Architect and /or En neer
No
Employing Plumber's Name ' f� -__ �) )1 i''' Street
�� - ' No t_
Location and Legal Description Lot_- ________/ ` ? " Block ,' "' — ______________ Subdivision_______, ____.�_____�
Street and Number where work is to be performed —No ° ' Street — '__�_____ —_____
State work to be performed and purpose of building (By Floors)
New Building — Remodeling Addition Repairs No. of Stories
N
Dist. Feet of Tank or Drain Field from Well
Capacity Gals
Nature of Water Supply: City 'Well. Size of Soakage Pit
Amount of Permit $_ (Signed) --
Plumbing Inspector.
The undersigned applicant or this building permit does hereby certify that h nderstands 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; 1 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.
STATE OF FLORIDA,
COUNTY OF DADE.
(Signed)''
r� Street
t
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
Maker 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.