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PL-05-1205‹, Building RE EVE D SEP 0 9 2005 Electrical Code Enforcement $ Structural Plan Review. $ Total Fee Now Due $ `IO'• .—+ Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 BUILDING PERMIT APPLICATIO FBC 2001 Permit Type (circle): Permit No. PLa5 t2©� .Master Permit No. 6 P0c (Plumbing �) Mechanical Roofing Owner's Name (Fee Simple Titleholder) C.0 C Chia Phone # j 1767 4q67) Owner's Address City Tenant/Lessee Name State -/ Zip Job Address (where the work is being done) 55/ /1/4//D..) City Miami Shores Village Is Building Historically Designated YES Contractor's Company Name Contractor's Address / <>9 City // Qualifier ��! //errri County Miami -Dade NO Phone # Phone # Zip a3/ State -F Zip a ) ,K) State Certificate or Registration No. Certificate of Competency No. Architect/Engineer's Name (if applicable) t„,4 411,1/ Phone # 3f,r 7e $ Value of Work For this Permit /j �z) Square Footage Of Work: Type of Work: Addition ■ Alteration New ❑ Repair/Replace ❑ emolition Describe Work: ****************************Fees**********lre ************** Submittal Fee $ Permit Fee 7i' *75 CCF $ - 2ED CO/CC Notary $— Training/Education Fee $ 0 , 4 . Technology Fee $ cS • Scanning $ Radon $ Zoning Bond $ 3/3 • °,f2_,_,, (Continued on opposite side) chc 05/13/03 Bonding Company's Name (if applicable) Bonding Company's Address City State Zip Mortgage Lender's Name (if applicable) Mortgage Lender's Address City State Zip Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRICAL WORK, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and AIR CONDITIONERS, ETC 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. "WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT 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." Notice to Applicant: As a condition to the issuance of a building permit with an estimated value exceeding $2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochur will be delivered to the person , whose property is subject to attachment. Also, a certified copy of the recorded notice of commence e t must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the a of such posted notice, the inspection will not be approved and a reinspection fee will be charged. Signature Signature Owner or Agent Contractor The foregoing instrument was acknowledged before me this The foregoing instrume t was acknowledged before me this day of , 20 , by , day of s;. , 2006; by , I I r^ who is personally known to me or who has produced who i : persona y nown o me or w o has produced As identification and who did take an oath. as identifi . and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC Si n: � �0 g Sign: Print: Print:.;. - -=--- My Commission Expires: My Commission Ex **********************************************************-******************* *************************************** MY COMMISSION # DD 428255 ;,�%"a •EXPIRES: May 11, 2009 * aF4 * * laaadv4>k porno ************************************************* APPLICATION APPROVED BY: �/ /7 -0 (-Plans Examiner Engineer Zoning "1"liTE = OF FLORIDA DERTMENT OF HEALTH ONS E 'SEWAGE'TREATMENT AND'DISPOSAL SYSTEM CONSTRUCTION PERMIT CONSTRUCTION PERMIT FOR New System [tt] Existing System Repair [/' ] �Abandonment ' ] APPLICANT: [] Holding Tank [I ] Temporary PERMIT NO. O S I' - Nict DATE PAID: Ci.. r- 2 (o FEE PAID: /G/ a RECEIPT #: SQSQ;2(-060 I. Z9 S7,�. [f)] Innovative [ ] t s �:, rJ L 1, 0 z a '. r- i 4' Pvt . r PROPERTY ADDRESS: T T + �'• 3 3 t 3 Q' LOT: Z G BLOCK: t 3 SUBDIVISIONe'/`!' [SECTION, TOWNSHIP, RANGE, PARCEL NUMBER] PROPERTY ID #: (1 ' 3 Z `O (o - 61.7 - 6 `l R C1 [OR TAX ID NUMBER] SYSTEM MUST BE CONSTRUCTED IN ACCORDANCE WITH SPECIFICATIONS AND STANDARDS OF SECTION 381.0065, F.S., AND CHAPTER 64E-6, F.A.C." DEPARTMENT APPROVAL OF SYSTEM DOES NOT GUARANTEE SAFTISFACTORY 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. ISSUANCE OF THIS PERMIT DOES NOT EXEMPT THE APPLICANT FROM COMPLIANCE WITH OTHER FEDERAL, STATE, OR LOCAL PERMITTING REQUIRED FOR DEVELOPMENT OF THIS PROPERTY. SYSTEM DESIGN AND SPECIFICATIONS T ['ZOO] A [ ] N [ — ] K [ —. ] GALLONS / GPD SEPTIC TANK/AEROBIC UNITCAPACITY MULTI-CHAMBERED/IN-SERIES LAI GALLONS / GPD CAPACITY MULTI-CHAMBERED/IN-SERIES [< ] GALLONS GREASE INTERCEPTOR CAPACITY,` [MAXIMUM' CAPACITY SINGLE TANK:'1250 GALLONS] GALLONS DOSING TANK CAPACITY [ ] GALLONS @ [ ] DOSES PER 24 HRS # PUMPS [ ] ] SQUARE FEET PRIMARY DRAINFIELD-SYSTEM R . [ ] SQUARE FEE . SYSTEM FILLED A TYPE SYSTEM: [ ] STANARD [ /] [ ] MOUND [ ] _ I CONFIGURATION: [ ] TRENCH [,/] BED [ ] tN F I E L D 0 T H E R LOCATION. -OF^ BENCHMARK: t `/ `T ` N ' Ci . J,.LJ . CYU W In O f r •I Z li ELEVATEON OF PROPOSED SYSTEM SITE :;[O�,j 51] [INCHES/FT] [ABOVE/BELOW] BENCHMARK/REFERENCE POINT BOTTOM OF DRAINFIELD TO BE [3,04] [INCHES/FT] [ABOVE/BELOW] BENCHMARK/REFERENCE POINT i - INCHES EXCAVATION REQUIRED: [ 72 ] INCHES FILL REQUIRED: -41347 ",a w L.1 0. --e SPECIFICATIONS BY: APPROVED BY: DATE ISSUED: INSTALL AZLOF SLIGH'THLY LIMITED SOIL UNDER BOTTOM Ur intt t1;si o it INVER1 EL?N 'BOTTOM OF DR N t PERIMETER OF EX" .� .V , t l 1 AT LEAST 2.0IEET W x,J.vi4 p 1 * E- 1f- L lty . PROPOSED .4.44g .:' ' T g'ti,Y1 TITLE: • j i1/41)G 0? t' Dade CHD EXPIRATION DATE: J 11 I f 6 DH 4016, 12/99 (Page 1) (Previous Editions May Be Used)_ Page 1 of 3 pt. 1: Health. Department pt:2: Applicant pt. 3: Installer/Contractor pt. 4: Building Department 7 "`STATE OF FLORIDA DERARTMENT OF HEALTH ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM CONSTRUCTION PERMIT PE MIT NO. 0 .. %'` / '1 DA .... PAID: - ; + :,- FE PAID:: RE,EIPT #: CONSTRUCTION PERMIT FORS i [X] New System [;] Existing System [t'] Holding Tank [ Innovative [3] Repair [ " l ] Abandonment [;'� ] Temporary [ APPLICANT: f t PROPERTY ADDRESS: LOT: _ ) BLOCK: ' = SUBDIVISION:. '1 ! { ; r' t r. , +r: 4 ,.. PROPERTY ID #: 1/- [SECTION, TOWNSHIP,4,RANGE, PARCEL NUMBER] [OR TAX ID NUMBER] SYSTEM MUST BE CONSTRUCTED IN ACCORDANCE WITH SPECIFICATIONS AND STANDA7 F.S., AND CHAPTER 64E-6, F.A.C. DEPARTMENT APPROVAL OF SYSTEM DOES NOT PERFORMANCE FOR ANY SPECIFIC PERIOD OF TIME. ANY CHANGE IN MATERIAL F BASIS FOR ISSUANCE OF THIS PERMIT, REQUIRE THE APPLICANT TO MODIFY ". S OF SECTION 381.0065, +7ARANTEE SAFTISFACTORY 'TS, WHICH SERVED AS A YE PERMIT APPLICATION. SUCH MODIFICATIONS MAY RESULT IN THIS PERMIT BEING MADE NULL AND VOID. 4SSUANCE OF THIS PERMIT DOES NOT EXEMPT THE APPLICANT FROM COMPLIANCE WITH OTHER FEDERAL, STAI , OR LOCAL PERMITTING REQUIRED FOR DEVELOPMENT OF THIS PROPERTY. SYSTEM DESIGN AND SPECIFICATIONS T ( ^'')U ] GALLONS / GPD_SEPTIC TANK/AEROBIC UNIT CAPACITY MULTI-C ERED IN -SERIES [)<] A [ ] GALLONS / GPD _.� CAPACITY' MULTI-C ERED/IN-SERIES [ ] N [ ] GALLONS GREASE INTERCEPTOR CAPACITY [MAXIMUM CAPACITY SIN LE TANK: 1250 GALLONS] K [ ] GALLONS DOSING TANK CAPACITY [ ]GALLONS @ [ ] DOSES PE 24 HRS # PUMPS [ ] D [ I ._.] SQUARE FEET PRIMARY DRAINFIELD SYSTEM R [ _.] SQUARE FEET SYSTEM A TYPE SYSTEM: [A STANARD [ ] FILLED [ ] MOUND [ ] I CONFIGURATION: [ ] TRENCH [.A BED [ ] N F LOCATION OF BENCHMARK:' I ELEVATION OF PROPOSED SYSTEM SITE E BOTTOM OF DRAINFIELD TO BE L D FILL REQUIRED: �!'r .._(' ] INCHES [INCHES/FT] [ABOVE/BELOW] BE HMARK/REFERENCE POINT ).] [INCHES/FT] [ABOVE/BELOW] BE HMARK/REFERENCE POINT EXCAVATION REQUIRED: [ / ,` ;T ] INCHES t 0 T t SOIL E SPECIFICATIONS BY: APPROVED BY: TITLE: DATE ISSUED: TITLE 5 EXPIRATION' DATE: I i DH 4016, 12/99, (Page 1) (Previous Editions May Be Used) pt. t: Helih Depai1 pt. 2: App!icaM ,,fit. 4: E3c:uC: u..Ci • Page 1 of 3 ADDENDUM TO BUILDING PERMIT APPLICATION (AN APPLICATION FOR BUILDING PERMIT MUST ACCOMPANY THIS ADDENDUM. IF A MASTER PERMIT HAS B. OBTAINED, THE OWNER'S NOTARIZED SIGNATURE NEED NOT BE PRESENT ON SUBSEQUENT APPLICATIONS.) PLUMBING ELECTRICAL MECHANICAL ITEM BATH 11,E UNIT FEE ITEM SWITCH OUTLETS UNIT FEE ITEM SPACE HEATERS UNIT FEE BIDET LIGHT OUTLETS CENTRAL HEATING DISHWASHER RECEPTACLES A/C (WIND) DISPOSAL SERVICE TEMPORARY A/C (CENTRAL) DRINKING FOUNTAIN SERVICE SIZE IN AMPS DUCT WORK FLOOR DRAIN SERVICE REPAIR/METER CHANGE REFRIGERATION GREASE TRAP APPLIANCE OUTLETS PROCESS AND PRESS PIPING INTERCEPTOR RANGE TOP UNDERGROUND TANKS LAVATORY OVEN ABOVE [ROUND TANKS LAUNDRY TRAY WATER HEATER U.F. PRESSURE VESSELS CLOTHES WASHER MOTORS 0- 1 HP STEAM BOILERS SHOWER MOTORS OVER 1- 3 HP HOT WATER BOILERS SINK, POT/3 COMP. MOTORS OVER 3- 5 If MECHANICAL VENTILATION SINK, RESIDENCE MOTORS OVER 5- 8 HP TRANSPORTING ASSEMBLIES SINK, SLOP MOTORS OVER 8- 10 HP ELEVATORS/ESCALATORS TEMPORARY WATER CLOSET MOTORS OVER 10- 25 If FIRE SPRINKLER SYSTEMS URINAL MOTORS OVER 25-100 HP COOLING TOWERS WATER CLOSET MOTORS OVER 100 FP VIOLATION INDIRECT WASTES A/C WINDOW REINSPECTION nn WATER SUPPLY TO: AIR CONDITIONERS tti rNlr� D A/C UNIT STRIP HEATER FIRE SPRINKLER GENERATORS TRANSFORMERS I 'HEATER -NEW INST. GENERATORS TRANSFORMERS HEATER -REPLACE GENERATORS TRANSFORMERS LAWN SPRINKLER -WELL SPECIAL PURPOSE _ SWIMMING POOL OUTLETS COMI4ERCIAL WATER SERVICE SIGN TUBES SEWER CONNECTIONS .SIGN TRANSFORMERS UTILITY -SEWER SIGN TIME CLOCK UTILITY -WATER FIXTURES SEPTIC TANK I ANTENNA RELAY TELEVISION OUTLETS DRAINFIELD, 4" TILE/RES. VIOLATION PUMP 8 ABANDON SEPTIC TANK REINSPECTION SOAKAGE PIT CU. FT. CATCH BASIN DISCHARGE WELL DOMESTIC WELL AREA DRAIN ROOF INLET SOLAR WATER HEATER FIRE STANDPIPE POOL PIPING LAWN SPRINKLER SYSTEM. E GAS RANGE 1 METER SET (GAS) GAS PIPING Issue Date: 12/13/2005 Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL 33138-0000 Phone: (305)795-2204 Fax: (305)756-8972 Permit Expires: 09/09/2006 Owner's Name: CORY GITTNER Permit Type: Plumbing - Residential Work Classification: Drainfield Job Address: 551 102 Street NE Miami Shores Village, FL 33138- Contractor(s) Phone Primary Contractor A LEAGUE CONTRACTORS, INC. 305-256-0306 Yes Additional Information Type of Work: SEPTIC TANK AND DRAINF Type of Piping: Additional Info: NEW INSTALLATION 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, servants, or employes. I understand that separate permits are required for ELECTRICAL, PLUMBING, MECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work. OWNERS 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. Futhermore, I authorize the above -named contractor to do the work stated. Fees Due Amount Bond Type - Owners Bond $300.00 CCF $1.20 Education Surcharge $0.40 Inspection Fee $75.00 Inspection Fee $75.00 Permit Fee - Additions/Alterations $100.00 Permit Fee - Additions/Alterations $100.00 Scanning Fee $3.00 Technology Fee $8.75 Total: $663.35 Parcel #: Block: Section: Permit Status: APPROVED Permit Number: PL-12-05-1205 Phone: 1132060170980 Lot: PB: Total Square Feet: 0 Total Valuation: $ 1,500.00 Required Inspections Rough Landscaping Final Invoice Number PL-12-05-23030 Total: DEC 13 PAID Amt Due $663.35 Amt Paid 0 Building Department File Copy NOTICE: In addition to the requirements of this permit, there may be additional restrictions applicable to this property that may be found in the public records of this county. AND THERE MAY BE ADDITIONAL PERMITS REQUIRED FROM OTHER GOVERNMENTAL ENTITIES SUCH AS WATER MANAGEMENT DISTRICTS, STATE AGENCIES, OR FEDERAL AGENCIES. INSTRUCTIONS: PERMIT NUMBER: Permit tracking number assigned by CPHU. CONSTRUCTION PERMIT 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. (CHD may require property appraiser ID # or section/township/range/parcel number) SYSTEM DESIGN AND SPECIFICATIONS: TANK: Minimum specifications from Chapter 64E-6, FAC. DRALNFIELD: Minimum specifications from Chapter 64E-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 (CHD) personnel reviewing and approving permit. DATE ISSUED: Date permit is issued by CHD 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.