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PLUMBING
BUILDING ❑ ELECTRICAL ❑ PLUMBING ROOFING ❑ Owner of Building Architect Contractor or Builder Legal Lot Description Address of Building CONTRACTOR OR BUILDER MIAMI SHORES VILLAGE. FLORIDA PERMIT N9 9071 Bl. Work to be performed under this Permit Subdi- vision Sq. Ft Value of Project DATE 195 Contractor's License No Amt. of Permit S 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 he 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 regulation, 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. BY AUTHORITY 17 BUILDING Li ELECTRICAL PLUMBING [ 1 ROOFING L [1 Owner of Building_ Architect Contactor or 131:11E0:- Legal h Desc: ::on Address of Bu1d n c CONTRACTOR OR BUILDER MIAMI SHORES VILLAGE. FLORIDA PERMIT N9 9090 BI. Work to be performed under this Permit__ _ Subdi- vision sq. Ft. Value of Project $ DATE _ 195 Contractor's License No 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 here.for 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 hi, 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 alI 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. 13Y AUTHORITY BUILDING ❑ ELECTRICAL E PERMIT N9 PLUMBING ❑ N H 8 8 4 2 ROOFING Owner of Building_ Architect Contractor or Builder ____ Legal Lot Descr.pticn Address of Building CONTRACTOR OR BUILDER MIAMI SHORES VILLAGE, 31. DATE Work to be performed under this Permit_____ Subdi- vision FLORIDA Contractor's License No. Sq. Ft Value of Project $ Amt. of Permit $ 195 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 re%oked 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 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. BY AUTHORITY BUILDING ELECTRICAL Ili PLUMBING Li ROOFING CJ [ � Owner of Building Architect Contractor or Builder Lecai Lot Description Address of Bui I±ng CONTRACTOR OR BUILDER MIAMI SHORES VILLAGE, FLORIDA PERRMIT N9 8857 Bl. Work to be performed under this Permit_ Subdi- vision DATE 195 Contractor's License No. Sq. Ft Value of Amt. of Project $ 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 hereior 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 re\oked 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 wort: done by his agents, senant3 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 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. BY AUTHORITY �+ CLOSETB BATH TUB S SHDWERe LAVA- TORIES SINKS INK SLOP SINKS LAUNDRY TUes URINALS CATCH BASI FLOOR DRAIN DRINKING FOUNT•NS TOTAL FIXTURES LIST - GEPTIC TAR X SEWER CORN. DRAIN FIELD SOAKAGE PIT GREASE TRAP SOLAR HEATER DEEP WELL SPRKLR. SYSTEM SWIM•O P001. .Y No ' 1 Apniicat.ion is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the building or other s - - ^-ure herein described. This application is made in compliance and conformity with the Building Ordinance of Miami Shores Village, Florida, cnc 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 Shores Village shall be complied with, whether herein specified or not. A copy of approved plans and specifications must be kept at s•b_? g during progress of work. • G'.HHAMI SHORES VIL %AGE PLUMBING INSPECTION DEPARTMEN ' APPLICATION FOR PLUMBING iu 4 on an Legal Description Lot.__ C vi 2:'a Nam: and Address l?e rsstered Arc;;.tect and /or Engineer Emil:0343g 21nmber's Name frf � Noda ' I Block Subdivision --------- ___. - -- _--- __ -_ -- � y S s and Number where work is to be performed —No /1 t 1- e / J j Street d'z s S o he performed and purpose of building (By Floors)- -___ -- °cc� Builaiug __ —. __ Remodeling____ -_ ___ Addition-- ___ -_. Repairs No. of Stories . . . ........... .. .. .. .. .,'• 2� { Tank_ -- — _ -_T e of Tank__-- Capacity Gals._ (/ ^I;cs of Drain ._ _ - =--: !� st. Feet of Tank or Drain Field from Well Wait: Supply: City — Well.__. - -- _ _- ___Size of Soakage Pit l d cf Remit $----- -...... - ° — -- — - - - - -- — - — — - -- (Signed) f ed)--- w Date ( Signed ).. - - - -7 My Commission Expires Notary Public, State of Florida Street_ T — Plumbing Inspector. Tito under signed applicant for this building permit does hereby certify that he understands and accepts his •• .ligations as an employer of labor az,.r",.s:r tic L larch Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida ` .rmanent Supplement, and has crnn- , 37fs6 city the provisions thereof, and will require similar compliance from all contractors or sub - contractors employed by him in the work to be per!'o n--: 1 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 rb;,. ?r 1 Mgr i.";:2. Act. The undersigned agrees to employ only such sub- contractors, on work to be performed under this permit, as are ri cil by ;:fl Shores Village. Master Plumber. STATE e IFLORIIDA, C " JNTY mF DADE. 3zfose na, tho undersigned authority, a notary public, duly authorized to administer oaths and take aclmowledgments, personally appeared .o rse Weil kno 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 ti- � n ISy hi_r. 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 n erials and /or workmanship. .‘: CLOSETS BATH Tuos SHOWERS LAVA- TORIES SINKS SLOP SINKS t ; / URINALS CATCH BASIN FLOOR DRAIN DRINK I NG FOU NT' TOTAL F I XTUR ES COMI . LIST -. ./- i - --- CXECX --- SEPTIC TANK SEWER CONN. DRAIN FIELD SOAKAGE PIT GREASE' TRAP IrIiii FriATER DEEP WELL SPR KLR. SYSTEM SW I M • 0 POOL ..........-..--- ,I7R. Cc::. LIST C: SCA m 1/4 / 2cs-m.c• No 4 9 ." MIAMI SHORES VII:LAGE PLUMBING INSPECTION DEPARTMEN';' APPLICATION FOR PLUMBING " , 3 4 Date Application is hereby made for the approval of the detailed statement of the plans and specifications herewith subm' ed for the building or other etructure 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 1tlittg during progress of work affnefa Name, and Address Re3isZered Architect and/or 7,mp'loying ?lumber's meer _ _ No. Street. Nn // Street_ 2./. // :-.."• ILicention and 'Legal Description Lot___.-2_1—_—_-- --_____ Block / .. sv.zt and Number where work is to be performed—No / / .3 / 27 Street Stc;e worts to be paiforxj2ed and purpose of building (By Floors)_ New Railing Remodeling Type of Tank Capacity Cals._ Fee of Drain Tile._ _Dist Feet of Tank or Drain Field from Well Nat_ze of We= Supply(Ciell. _Size of Soakage Pit Septic Tank ----- A0.-zeunt cf ?emit $ 7:17.7 OF FLOPJDA, i as. - 0:7 DADE. Addition Repairs (signed)._ No. of Stories .... ..... Plumbing Inspector. The undersigned applicant for this building permit does hereby certify that he understands and accepts hi is obligations as an employer of labor tLe Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida ennanent Supplement, and has corn- •-)Yht-1 ita the provisions thereof, and will require similar compliance from all contractors or sub-contractors employed by him in the work to be perfamazi nuclei this permit; and will post or cause to be posted' for inspection on the site of the work such public notic or notices as are by die Act. The undersigned agrees to employ only such sub-contractors, on work to be performed under this permit, as are Y!ca-rsod by zai Shores Village. • (Signed) ,faster Plumber. . iefoTe. MT, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeared to ma well tulawu, and who, being by me first duly sworn, upon oath deposes and says that he is the t:te above described construction, that he has carefully read the foregoing application, and that he did sign the same, and that all, facts 7 ly him stated are true. My Commission Expires Notary Public, State of Florida NOTE: A re-iuspection fee of $1.00 will be made when such re-inspection is made•necessary by improper notice for inspection, or faulty trctesials and/or worlonanghip. V 1 Y ® CL ®o[?c OATH 'Nos ,. .N /D LAVA. YORIE° SINK° SLOP SINK° LAUNDRY TUDG URINAL° CATCH IIACIN FLOOR DRAIN DRINKING FOUNT' NO [.�tiA 0 - -% !,dt�1Yf_y1_ Vr Ea;r '.- ; "-a, TOTAL F'IJSS CONTD. LIG4 ii ... �- cO4zsn Sap= YAWS Caw= Comm. DRAIN PIELD SOAKAGE PIT GREA °E TRAP SOLAR H EATER DEEP WELL SPRKLR. SYSTEM SWVIM•G POOL a'- P —� C«a. LhOG1T —_ ..... execs - - - - - — — Permit No._ State work to be p formed and purpose of building (c:,y Floors)----_ Amnunt of ?emit 0 STATE Off' FLORIDA, COUN717 07 DADIDE. r c�. smonEs PLUM ©UISPECT ON DEPART ENT aFFR LCQ4i0k1 VOL2 pdMBINO pC RE g4 .J 1 v 3 's - `k (Signed)- ( Sign Application is hereby made for the approval of the detniL l atm¢ement of the plans and specifications herewith submitted for the building or ether structure lie rein described. This application is made in compliance end conformity with the Building Ordinance of Miami Shores Village, Ficrida, and all provisions of the Laws of the State of Florida, all ordinances of Miami Shares Village and all rules and regulations of the Building H ivisiom of Miami Shores Village shall be complied with, whether herein specified or not. A copy of approved plan and specifications must be kept et building during progress of work. O ¢ c Name and Address I -__ - -- --- -- - Registered Arc test and /or --------__--._ Employing Plumber's Name ?..:e r 23:3 ��. � Mc. -1_ (, "� Street -1N;. k L 1133% oTxd Legal Description Lot. Blo _ - - -- Stuet and Nunaitur where work is to be performed--No S est New ........ -_ -- Reraecdeling ______..__________._ Addition -__ Repairs Sim Septic Tam — - - -- -- - ------ - --- -- -Type of Tank —_ - Feet cf Drain 71' ilo------- -------- ------- _moist. Feet of Tank or Drain Field from Well Mature of Water Supply: City— We91.------------ - - -_ -- _ Size of Soakage Pit Capacity Gals.__._ No. of S t o r i e s . . . . - Pk bing IIn ,,eector. The und=igned applicant for this building permit does hereby certify that he understands and accepts his obligations as inployea of lab under the Florida Workmen's Compensation Act, being Section 5968, Compiled General Laws of Florida Permanent Supp ant, and hiss c •- plied with the proerfs =ons thereof, and will require similar compliance from all contractors or sub - contractors employed by i in the work Co be perform ''. under this permit; and will post or cause to be posted for inspection on the site of the work such public notice ar notices as are required by die Act. The undersigned agrees to employ only such sub- contractors, on work to be performed under this permit, as are licensed by PA/r Shams Vi➢Pnge. /. Before me, the undersigned authority, a notary pubh!c, daily antharized to administer oaths and take acknowledgments, personally appearil to me well !mown, and who, being by me first duly sworn, upon oath deposes and says that he is the- ____ -._ -- - -• -. - -- - .--- -• -. -- -- -- • -_ _ -- of the above clearribed construction, that he has carefully read the foregoing application, and that he did sign the rams, and ¢feat a] facts thane n by him stmt...; are true. li,Jy Commission E pi(r Cdr. Notary Public, State af Florida NOTE: Are- fms-oection fee off 011.00 will be mach V,71M =eh re-inspection is s ade'neessary by improper notic.' for ins& n, as fa;sLty Materials =UV V msaTicahnil¢. ELECTRICAL TYPE Minimum Fee QTY. 'TYPE Dryer QTY. I P1 Outlet, Appliance Q'Tl'. 'I'YPG. QTY. Service Repair A/C Cenral 1 -3 To A/C Wall/Win. Tons Fan - Paint Booth Outlet, Wall Air Han .i i er, Tons Service, Temporary - Piping, Flammable Liquid A/C Central 4 -7 To Barbecue Fire Pump - Process/Pressure Piping Outlet, Switch 1 ath Fan-Vented, # Signs Pressure Vessel A/C Central 3-I5 Ton Fixture - Fluorescent Oven Space Heater (kw) A/C Central 16-20 To Fixture Light Parking Lot Lights Spas/Hot Tubs A/C Central 20+ Ton Flood Lights Plugmold/Strip Subfeeds, No. of Amps A/C Window FPL - Load Central Posts Swim Pool, Commercial Clothes WasGner Air Conditioners Gas Piping Garbage Disposal Pump, Replace - 9 "col Range/Range Top Urinal Swim Pool, Residential Chiller Generators, etc. Receptacles Discharge We Switchboards lice Maker Clear Violations Pump, Sump Heat Recovery Utility - Water Refrigerator, Comm. (p/PH) Temp Serv., Construction Compactor Low -volt, Burglar Disposal Refrigerator, Domestic lInterceptor Temp for Test - 30 days eof Ia lllet Deep Freezer Water CCosea Low -volt, Fire Renew - Temp Service Septic Connection Demolition IIDrairelield, 4" 'll'ile/ll es. Low -volt, Intercom/I'eleph. Lavatory Repair Circuits Septic Tank Water Heater New Dishwasher Low -volt, Television Service, Number of Amps Water Re -pipe Drains, Floor MECHANICAL TYPE QTY. Minimum Fee TYPE Condensate Dram QTY. TYPE Generator QTY. TYPE QTY. Refrigeration, Tons A/C Central, Tons Cooling Tower Heating Strips, each Vent Hood, Cost A/C Wall/Win. Tons Dryer Vents, Number of - Paint Booth Ventilation, Cost Air Han .i i er, Tons Ductwork, Cost of - Piping, Flammable Liquid Periodic Inspections Barbecue Fire Sprinkler System - Process/Pressure Piping 1 ath Fan-Vented, # Fireplaces, Number of Pressure Vessel Cap - Flint :re PLUMBING TYPE A/C Condensate QTY. 'TYPE Drains, Roof Q'I'Y. 'Ti'l'l: Miscellaneous Fixture QTY. TYPE QTY. Soakage Pit I3ath Tub Drinking Fountain Miscellaneous Repairs Solar Water Heater IMialet Filter Replace Pool Piping Sprinkler Repair Cap - Flint :re Fountain Pump and Abandon Sprinkler System Cap - Water Gas - Appliance Pump, Domestic Supply, AC Weli Cap - Sewer Gas - Natural Pump, Fire Stand Temporary Toilet Catch 1.asin Gas - Propane Pump, Re- circulate Temporary Water Clcset Clothes WasGner Gas Piping Pump, Replace - 9 "col Urinal Dental Clair Grease Trap Pump, Sprinkler UtiGity - Sewer Discharge We lice Maker Pump, Sump Utility - Water Dis'hwas'her llndirest Wastes Relay epair Vacuum Pump Disposal 1 lInterceptor eof Ia lllet Water CCosea ll kmnestlle Well Laundry Tray Septic Connection Water Heater IIDrairelield, 4" 'll'ile/ll es. 1 Lavatory Septic Tank Water Heater New Drains, Area Meter Set (Gas) Sewer Connection Water Re -pipe Drains, Floor Minimum Fee Shower Water Service Drains, IFrenctn Miscelllanneous (Equipment Sink Weel, Supply Page 3 PERMIT APPLI[CAT ON l i INSTRUC EONS: Please indicate the type of work being performed and quantity(ies) in the space provided below. RECEIVED AND REVIEWED BY: DATE: Page 4 OFFICE USE ONLY CKTIST • OWNER - BUILDER FORM (Attach) • FIRE DEPARTMENT APPROVAL (Commercial / multi - family) • CONCURRENCY (New Construction) Ul OTHER (Specify & Attach) $3.00 per page (Scanning Fee) Miami Shores Village Bond Metropolitan Dade County (C.C.F.) Inspector State Educational Fund $ State DCA (Radon) $ Code Enforcement Fine Zoning Review LI PROOF OF OWNERSHIP (Attach) HRS / DERM APPROVAL (Septic / Sewer) LI IMPACT FEE (New Construction) ® OTHER (Specify & Attach) $ SECTION Zoning Electrical Mechanical Plumbing Fire Public Works Structural Building Official BY DATE (sq.ft. = x/1000 x 0.60) (¢.005 /sq.ft.) (¢.01 /sq.ft.) PERMIT APPLICATION B CONDO ASSOCIATION APPROVAL (Attach) • BPR APPROVAL (Restaurants) 12 CONTRACTOR REGISTRATION (On File) RMIT FEES TOTAL $ ISSUING OFFICIAL REVIEWED AND PREPARED BY: DATE: Revised July 2001 10050 N.E. 2ND AVE., MIAMI SHORES, FL • (305) 795 -2207 • FAX (305) 756 -8972 • http : / /www.miamishoresvillage.com Page 2 IT\!IPORTANT NOTICES 1. DO NOT BEGIN ANY WORK WITHOUT HAVING RECEIVED YOUR VALIDATED PERMIT AND PERMIT CARD. Applying for a permit does not grant the right to begin construction. HOURS OF CONSTRUCTION are limited to: Monday through Friday from 7:30 a.m. to 6:00 p.m., and Saturday from 8:00 a.m. to 5:00 p.m. No inspections will be conducted on weekends or holidays. 2. All construction of demolition areas MUST BE MAINTAINED IN A CLEAN, NEAT AND SANITARY CONDITION free from construction debris. 3. STREETS AND NEIGHBORING PROPERTIES SHALL BE KEPT FREE FROM DIRT AND DEBRIS. 4. SWALES MUST BE PROTECTED FROM BEING DAMAGED BY EQUIPMENT OR VEHICLES, AND MAY NOT BE USED FOR STORAGE. A bond is required for work in or near the street/sidewalk. 5. CONSTRUCTION TRAILERS ARE PROHIBITED ON SINGLE FAMILY RESIDENTIAL CONSTRUCTION SITES. Other construction may have a trailer which requires a separate permit. 6. PORTABLE TOILETS for a construction site require a separate permit. 7. DO NOT DISCHARGE WATER INTO THE RIGHT OF WAY OR STORM DRAINS without approval from the Building, Planning and Zoning Department. 8. EQUIPMENT AND MATERIALS SHALL BE STORED at least 10 feet from the edge of pavement. 9. Department of Health and Rehabilitative Services (HRS) approval is required for applications involving septic tanks. Department of Environmental Resources Management (DERM) and/or Miami -Dade Water and Sewer Department (MDWASD) approval is required for applications involving sewers. AFFIDAVIT - Please read carefully. Application is hereby made to obtain a permit to do work and installation as indicated. I, the OWNER of the property, certify that ail 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, POOL, EXTERIOR DOOR, MECHANICAL, WINDOW, FENCE, DRIVEWAY, ROOFING and SIGNS and there may be additional permits required from other govemmental agencies. I, the OWNER of the property, have disclosed all information related to any work at the property performed in the prior twelve months to the Building Official. Further, I am fully aware that if the cumulative cost of work to my home or business under this and any other permit equals or exceeds fifty percent (50 %) of the fair market value of the structure, the entire structure must meet the present federal flood criteria for finished floor elevation. I am also fully aware that if the total cost of work to my home or business under this and any other permit exceeds fifty percent (50 %) of the replacement cost of the structure, then the entire structure must conform to the current code requirements of the Building Code. WARNING TO OWNER: Your failure to record a NOTICE OF COMMENCEMENT may result in you paying twice for improvements to your property. If you are spending more than $2,500 or intend to obtain financing, you may wish to consult with your attorney or lender before recording your Notice of Commencement. The Notice of Commencement must be recorded at: 22 N.W. 1st Street, 1" Floor, (305) 679-1078. Once recorded, the Notice of Commencement must be POSTED AT THE .VOA. S'j= iz accordance with Section 713 -35 of Florida Statutes. Review the brochure at Village Hall on Construction Lien Law a ^d Choosing a Contractor. STATE Q FLORIDA, COUNTY OF MIAMI -DADE Signature of Owner • •i N rr. • 10474 EXPIRES T FO G�� ADVANTAGE KOTAR ©0 '�:D Print Name Sworn to and subs Signature of o ry Public - State of Florida SEAL: 2. actor / Qu 'li orA STA OF FLORIDA, Signature of - d t6 9-oarr o , 46q._ . Print Name Sworn 0 t � , t + y � } . X20 06 "'` EXPIRES 1 2006 / gON AR � DVANTA NO .... Signat of No !' Public - State of Florida SEAL: PERMIT APPL:CA i HON TY OF MIAMI -DADE Personally known OR, Produced Identification Personally known OR, Produced Identification Type of Identification Produced: Type of Identification Produced: CONTRACTOR Name 1ZZ T . ) ( i L ` p 6 U E L 5€ P 4 - 1 L, License No. s fp cr 2 iS q,'3)' Address I �0 std 1 l i 7 � c _ Pk■ AC L 131$1, Telephon( g zwq 2 21c, - Fax Qualifier Name v 4 0 a 9 d 5f.. z, PROPERTY OWNER New Construction Name Enclosure Address 1. t- 1 N e CI 1 i e' ) Alteration Exterior Home Telephone el)coS 1 75.1_ ,'-� . Business Telephone Alteration Interior Fax Demolish TYPE CIF MANAGEMENT (✓ ) New Construction Enclosure Alteration Exterior Repair Alteration Interior Demolish Relocation of Structure Shell Only Foundantionn Only Add'] Attachment Other Add'] Detachment Other RUCTIONS - The following st ps must be taken to obtain a permit frgoi he bores Village: Step 1. Master Permit No. Subsidiary Permit No. PERMIT APPLICATION Complete the attached permit application which must be _i ned b the .ro.ert owner and .ualifi-r. Both si nature must be notarized. Please print or type to allow for a more accurate processing of your application. If roofing work will be done, a roofing application must be submitted along with this permit application. Step 2. Submit the completed application with all necessary documents to the Building, Planning and Zoning Department for processing. During the processing of your application, you may be asked to submit additional information. AI CATION Job Address: �,� �� ITC a. Address Apt. Folio Number l° -2 7a05 ° O 0 I ° 1 6 0 Lot k Block �Q Subdivision \•)0a Q S PB GII PG f q Current Use of Property Proposed Use of Property Tenant Information PERMIT TYPE (✓ ) Building Electrical Mechanical Plumbing ILPGX llcfing Fence Other Chg. Contractor Renewal Revision Extension Supplement Reix spection PERMIT CHANGE (✓ ) A CHITECT Name License No. Address Telephone Fax City Description of Work State Try \d■ci Rep6ii r . Zoning Linear Feet \f iv Bldg Value Square Feet frA Units Value of Work 13 ,=10 SO, Tax Assessed/Appraised Value Flood Zone `\CitA Base Floor Elev. Floors *f, 4 33(3 8 . Zip ENGIINEEIR Name License No. Address Telephone Fax Miami Shores Village 10050 NE 2nd Avenue O Phone: 305 - 795 -2204 Permit Number: PL2002 -326 Printed: 12 /3/2002 q 0 N Applicant: MANUEL Owner: MANUEL JOB ADDRESS: 1131 NE 91 TERR Contractor RODRIGUEZ SEPTIC SERVICE INC Contractor's Address: 7370 NW 36 ST 105G Local Phone: Parcel # 1132050010160 Fees: Description Amount FEE2002 -6853 Buildier's Bond $300.00 FEE2002 -6854 Building Fee $80.00 FEE2002 -6855 CCF $1.20 Total Fees: $381.20 Total Fees: $381.20 Total Receipts: $0.00 Permit Status: Approved Permit Expiration: 6/1/2003 Work: DRAINFIELD REPAIR Plumbing Permit Legal Description: 5 53 42 WATERSEDGE PB 9 -141 LOT 18 Construction Value: $2,050.00 Page 1 of 1 If there is no permit package accessible on the job -site for inspectors to verify, there will be no inspections. Re- inspection fee is $50.00, which must be paid in advance before calling for another inspection. BLK 1 LOT SIZE 50.000 X 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 regulat:.ns 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, se an or employees. Sign - I L �_��. ' (INSPECTOR) BY: In considerati , •'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, : rawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I assume responisibility for all work done by either myself, my agent, servants or employes. Signed: (Contractor or Builder) BY: PAY TO THE ORDER OF ODRIGUEZ SEPTIC TANK SERVICES, INC. 2 0 0 2 PH 305-264 -6318 12040 SW 118TH STREET MIAMI, FL 33186 First Union National Bank firstunion.com 8• ao Or 003 R/T 067006432 FOR 113 G s k rte° 11 ■00 200 211' 1:06 70064 3 21: 20000 L 7 9811' 63- 6431870 BRANCH 130 DATE g �` DOLLARS L=J Ci1SIOM BUSINESS BANKING Pay to the Order (rf MANUEL F. FERNANDEZ MARIA C. FERNANDEZ 1131 - 91ST NE MIAMI, FL 3313 ClTIBAN(O' CITIBANK, F.S.B. 69 64 CRANDON BOULEVARD KEY BISCAYNE, FL 3314f .Crti j 2 'Z4 / l- /F /,_>) lrleiliU �, 63- 865569 �tz — • 2 , 2 CC 2 _. 2660 /hit, 0: 2660865540: 290756584611' 0 LO6 CLF? /ct.) I)u!Iar., 106 CONSTRUCTION PERMIT FOR: [ ]New System [ ]Existing System [ X ]Repair [ ]Abandonment APPLICANT: Fernandez, Manuel LOT: 18 SYSTEM DESIGN AND SPECIFICATIONS T ( A [ N K [ D R A I N F I E L D BLOCK: 1 SUBDIVISION: Watersedge STATE OF FLORIDA DEPARTMENT OF HEALTH ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM CONSTRUCTION PERMIT LOCATION TO BENCHMARK: Top of Bottom ELEVATION OF PROPOSED SYSTEM SITE [ BOTTOM OF DRAINFIELD TO BE [ OTHER REMARKS: This permit is not for addition(s). *Existing 750 gl. septic tank to remain. *Install 200 sq.ft. of drainfield. *Invert elevation to be no less than 5.10' NGVD. *Bottom elevation to be no less than 4.60' NGVD. OEFLECTIGO iiIST LLED ON 1882 CoJ16m7 TEE SPECIFICATIONS BY:Icaza, Carlos APPROVED BY: Icaza, Carlos DATE ISSUED: 11/21/02 DH 4016, 03/97 (Obsoletes previous editions which may not be used) (Stock Number: 5744- 001 - 4016 -0) [ostds_cons_4016 -1] ]Holding Tank [ ] Innovative Other [ ]Temporary [ NA ] AGENT: SR0890223, RODRIGUEZ JULIO PROPERTY STREET ADDRESS: 1131 NE 91 Ter Miami Shores FL 33138 [Section /Township /Range /Parcel No.] PROPERTY ID #: 11- *3205 - 001 -0160 [OR TAX ID NUMBER] CENTRAX #: 13 -SG -14743 DATE PAID: FEE PAID : RECEIPT . OSTDSNBR : 02 -3353- qt 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. 750 ]Gallons SEPTIC TANK 0 ]Gallons 0 ]GALLONS GREASE INTERCEPTOR CAPACITY 0 ]GALLONS DOSING TANK CAPACITY [ 0 ]GALLONS MULTI- CHAMBERED /IN SERIES: [Y ] MULTI- CHAMBERED /IN SERIES: [Y ] [0 ]DOSES PER 24 HRS # PUMPS( 0 ] 200 ]SQUARE FEET PRIMARY DRAINFIELD SYSTEM 0 ]SQUARE FEET SYSTEM TYPE SYSTEM: ( N ]STANDARD [ N ]FILLED [ N ]MOUND [ N ] CONFIGURATION: ( N ]TRENCH [ N ]BED [ N ] Floor, 7.10' NGVD. 1.0 ] [ FEET ] [ BELOW BENCHMARK /REFERENCE POINT 2.5 ] [ FEET ] [ BELOW BENCHMARK /REFERENCE POINT FILL REQUIRED:[ 0.0 ]INCHES EXCAVATION REQUIRED: [ 18.0 ] INCHES TITLE: TITLE: Engineer I THIS PERMIT IS NOT FOR -� I ,$) �� i`� INVERT r r B Dade CHD EXPIRATION DATE: 2/19/03 Page 1 of 2 APPLICANT: Z BLOCK: PROPERTY ID #: ( - A.3 C? Q l v ,c 0 BENCHMARK /REFERENCE POINT LOCATION: ELEVATION OF- PROPOSED "S SITE IS ---------------- TO BEyCOMPLETED BY ENGINEER, HEALTH UNIT EMPLOYEE, OR OVER QUALIFIED PERSON.! ENGINEER'S MUST PROVIDE REGISTRATION NUMBER AND SIGN AND SEAL EACH PAGE OF SUBMITTAL: - " - COMPLETE ALL ITEMS. ============ SIZE CONFORMS TO SITE PLAN: [ ] YES [ ] - NO NET _ USABLE AREA AVAILABLE: f ,jl. _ - -_ - PROPERTY ACRES TOTAL ESTIMATED SEWAGE FLOW: _ GALLONS PER DAY [RESIDENCES -TABLE 1 / OTHER -TABLE 2] AUTHORIZED SEWAGE FLOW: 3`.3 0 GALLONS PER DAY [1500 GPD /ACRE OR 2500 GPD/ACRE] UNOBSTRUCTED AREA AVAILABLE:______ i'() SQFT UNOBSTRUCTED AREA REQUIRED: C9. 4 SQFT THE MINIMUM SETBACK WHICH CAN SURFACE WATER: 1- F WELLS PUBLIC: FT LI BUILDING FOUNDATIONS: SITE SUBJECT TO FREQUENT FLOODING: [ J YES (:(] NO 10 YEAR FLOOD ELEVATION FOR SITE:\ \.;A > FT MSL /NGVD SITE ELEVATION: -L _ FT MSL /NGVD SOIL PROFILE INFORMATION SITE 1 Munsell #JColor Texture USA)\ 40IL SERIES: to to to to to % j ' Depth ,to to to Ii,4li00 °1a WATER TABLE: Ni <.. INCHES [ABOVE / BELOW] EXISTING GRADE. TYPE_L PERCHED / APPARENT] In lit WET SEASON WATER TABLE ELEVATION: 7 • �.. INCHES [ ABOVE t BELOW ] ") EXISTING GRADE. [J p OA TABLE VEGETATION: [ ] YES (A) NO MOTTLING: [ ] YES [t] NO INCHEE if . RATE FOR SYSTEM TEMCSIZING: BED / OTHER DEPTH PECIFY)EXCAVATION:� INCHES IRE /LOADING 0 1 ! � [ CONFIGURATION: [ ] [ �(] [ ] CONFIGURATION: CRITERIA: 1 'ED BY: STATE OF FLORIDA DEPARTMENT OF HEALTH ONSITE SEWAGE DISPOSAL SYSTEM SITE EVALUATION AND SYSTEM SPECIFICATIONS i SUBDIVISION: ` j` l [Section /Township /Range /Parcel BE MAINTAINED FROM THE ) PROPOSED SYSTEM TO THE FOLLOWING FEATURES: DITCHES /SWALES: rJ /r- FT NORMALLY WET? [ ] YES p‘] NO MITED USE: Alf. FT PRIVATE: A// ..z FT NON- POTABLE: N/ FT FT PROPERINES: S' FT ( POTABLE WATER LINES: /Q FT nr�s HRS-H Form 4015 [Pape 3J which may be used) ' 1- 4015 -1) I` • (CINCHES/FT] NCHES /FT] (ABOVEZBEL911 BENCHMARK /REFERENCE,'POINT r -- PERMIT # - • J � AGENT: 9 0 i7 [ 6 U E L S or Tax ID Number] 10 YEAR FLOODING? [ ] YES [A; NO SOYL PROFILE INFORMATION SITE 2 Texture Depth DATE: / /'AC-n a- Page 3 of PART II SITEPLAN Scale: Each block represents 10 feet and 1 inch = 40 feet. e, Notes: Site Plan submitted ,by: Plan Approved By STATE OF FLORIDA DEPARTMENT OF HEALTH APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PERMIT Permit Application Number 1' DH 4095, 10/96 (Replaces HRS-H Form 4015 which may be used) (Stock Number 5744-002-4015-6) '1 1 Not Approved „ Date % ALL CHANGES MUST BE APPROVED BY THE COUNTY HEALTH DEPARTMENT County Health Department Page 2 of 4