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1140 NE 91 Terr (5)MIAMI SHORES VILLAGE BUILDING DEPARTMENT 305- 795 -2204 Building Inspection Request Date 1 /0 - ®L Time Type Insp'n I4'4/?ii Permit No. N. ,2z' e 2,- 5 Name / / 1 /0 f/ 7-e Address Company Phone # , ' S 7S7 .7 6 For Inspector: / fy 0-2 N e & Da Approved Correction Re- Insp'n Fee ? ham e_ If/ 3a 937- ag Pfr PERMIT APPLICATION '1 FOR MIAMI SHORES VILLAGE a J� Date I — �'O 1 1ol�Address I 140 N t -1 1 s* r. Tax Folio //c3 vZ3 6 ' 00 1 ' 'S V Legal Description Historically Designated: Yes No Owner/Lessee / Tenant S Noas to Owner : .rn My Commission Wilett Owner's Address of e l [ r `t V v Architect/Engineer Address Bonding Company Address Mortgagor Address Date Date Phone NO. CC91 • OFF1.0 FEES: PE l ,rl t t t t 1, KADO N C.C.F. tat) NOTARY --- r7 BOND APPROVED: Zoning Building Mechanical Plumbing Master Permit # 4 ' c 0 5 Electrical 3 p CI s -CO 0) Contracting Co. - N e4.4 "it -Cil wyAse Address 0( 0 t J t # Qualifier ‘ 71)e,1 4 ri;s Uq` N ss# �l�o4 - O$ - /903 Phone 3J 15 t-2 -�* State # CEC. 0 I 1-O S Municipal # Competency # S l , a Ins. C Z ew'rl ., 2-ur■ C� Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN WORK DESCRIPTION te►o A \'\-0 I C,` d 4,0 l s‘...irttc, e Nre1` os& l J mo Silk Square Ft. Estimated Cost (value) (9 3 (9 WARNING TO OWNER: YOU MUST RECORD A NOTICE OF COMMENCEMENT AND YOUR FAILURE TO DO SO MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY (IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT.) Application is hereby made to obtain a permit to do work and installation as indicated above, and on the attached addendum (if applicable). I certify that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that separate permits are required for ELECTRICAL PLUMBING, SIGNS, POOLS, ROOFING and MECHANICAL WORK. OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. Furthermore, I authorize the above -named contractor to do the work stated. Date TOTAL DUE C )....5 " C Structural Engineer ITEM BATH TL8 UNIT FEE ITEM SWITCH CUTLETS UNIT FEE ITEM SPACE HEATERS UNIT FEE BIDET LIGHT CURETS CENTRAL HEATING DISHWASHER RECEPTACLES A/C (WIND) DISPOSAL SERVICE TEMPORARY A/C (CENTRAL) DRINKING FOUNTAIN SERVICE SIZE IN AMPS DUCT WORK FLOOR GRAIN SERVICE REPAIR/METER CHANGE REFRIGERATION GREASE TRAP _ APPLIANCE OUTLETS PROCESS AND PRESS PIPING INTERCEPTOR RANGE TOP UNDERGROUND TANKS LAVATORY OVEN ABOVE GROUtO TANKS LAUNDRY TRAY WATER HEATER U.F. PRESSURE VESSELS CLOTHES WASHER te11occ `„ +, 1 MOTORS 0- 1 HP STEAM BOILERS SHOWER link \ eo\' ADTCRS OVER 1- 3 HP HOT WATER BOILERS SINK. POT /3 COMP. - MOTORS OVER 3- 5 HP MECHANICAL VENTILATION SINK. RESIDENCE MOTORS OVER 5- 8 HP TRANSPORTING ASSEMBLIES SINK. NIP NO ' Y 2lo loiin ( MOTCftS OVER 8- 10 HP ELEVATORS/ESCALATORS TEMPORARY WATER CLOSET MOTORS OVER 10- 25 HP FIRE SPRINKLER SYSTEMS . IAINAL MOTORS OVER 25-100 HP COOLING TOWERS WATER CLOSET )OTC S OVER 100 HP ` VIOLATION INDIRECT WASTES A/C WINDOW REINSPECTION WATER SUPPLY TO: AIR CONDITIONERS • A/C UNIT STRIP HEATER FIRE SPRINKLER GENERATORS TRANSFORMERS • HEATER -NEW INST. GENERATORS TRANSFORMERS HEATER - REPLACE GENERATORS TRANSFORMERS LAWN SPRINKLER -WELL SPECIAL PURPOSE SWIMING POOL OUTLETS COIERCIAL WATER SERVICE SIGN TUBES SEWER CONNECTIONS SIGN TRANSFORMERS UTILITY -SEWER . SIGN TIME CLOCK UTILITY -WATER • FIXTURES SEPTIC TANK ANTENNA ' RELAY TELEVISION CURETS GRAINFIELD, 4' TILE/RES. VIOLATION PUMP & ABANDON SEPTIC TAN( REINSPECTION SOAKAGE PIT CU. FT. CATCH BASIN DISCHARGE WELL DOMESTIC WELL AREA CRAIN _ ROOF INLET SOLAR WATER HEATER FIRE STANDPIPE _ POOL PIPING LAWN SPRINKLER SYSTEM GAS RAKE METER SET (GAS) SAS PIPING (AN APPLICATION FOR BUILDING PERMIT MUST ACCOMPANY THIS ADDENDUM. IF A MASTER PERMIT HAS BEEN OBTAINED, THE OWNER'S NOTARIZED SIGNATURE NEED NOT BE PRESENT ON SUBSEQUENT APPLICATIONS.) PLUMBING ADDENDUM TO BUILDING PERMIT APPLICATION ELECTRICAL MECHANICAL Village of Miami Shores 10050 NE 2nd Avenue Miami Shores, FL 33138 Phone: 305 - 795 -2204 Printed: 1/7/2002 authorization. A furthe ordinances and regulati by his agents, is Signed: If there is no permit pack. fee is $50.00, which must lac This Permit is granted to the contr ordinances pertaining thereto and wii and approved by the pr per municipi condition upt ns pertainint employee: A In consideration•, he suance to with the plans, drawings, statements myself, my agent, servants or emplo PAY TO THE ORDER OF Signed: Plumbing Permit Permit Number: PL2002 -5 Applicant: WILLIAM LEE WALSH Owner: WALSH WILLIAM LEE Contractor THE NEW MIAMI SHORES PLUMBIRadress: 900 NW 144 ST Local Phone: 305 - 751 - 2446 Cellular: Parcel # 1132050010430 Legal Description: WATERSEDGE Job Address: 1140 NE 91 TERR Permit Status: Approved Permit Expiration: 7/6/2002 Construction Value: Work: RELOCATING HOT /COLD LINES TO WASHING MACHINE, RELOCATING MOP SINK - S r i 1 4 e n n n r r it d o. rt a rf 1. S e. THE NEW MIAMI SHORES PLUMBING, INC. BLUE ACCOUNT 900 N.W. 144TH ST. MIAMI, FL 33168 COLONIAL BANK PB 9 -141 LOT 18 & E1/2 OF LOT 17 Nai4 Total Fees: Total Receipts: ) or Miami Beach, Florida 33140 1 24 Hi. Banking call 1- 800 -897 -6935 FOR -111 V. 1 II`t0 Na' 9 1 erVr) 0 L1360 1:06700 LS LBO: 80 2 786 30 2911 - - fir. 1t.m'.n'bt1 #::.t11.,xr,r 4a.■ . 1t (Contractor or Builder) BY: Page 1 of 1 DATE 10 diva- 1102. $0.00 $0.00 d e l n i l s. V� un_�t -.:,c. rrr.r_smec.- e_.a.•sMr -c 1186 BLK 2 LOT 63- 151/670 DOLLARS el 01 ELECTRICAL TYPE Minimum Fee TY. TYPE Dryer QTY. TYPE. Outlet, Appliance QTY. TYPE Service Repair QTY. A/C Central 1 -3 Ton Fan Outlet, Wall Service, Temporary A/C Central 4 -7 Ton Fire Pump Outlet, Switch Signs A/C Central 8 -15 Ton Fixture - Fluorescent Oven Space Heater (kw) A/C Central 16 -20 Ton 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 Air Conditioners Garbage Disposal Range/Range Top Swim Pool, Residential Chiller Generators, etc. Receptacles Switchboards Clear Violations Heat Recovery Refrigerator, Comm. (p/PH) Temp Serv., Construction Compactor Low -volt, Burglar Refrigerator, Domestic Temp for Test - 30 days Deep Freezer Low -volt, Fire Renew - Temp Service Water Closet Demolition Low -volt, Intercom/Teleph. Repair Circuits Water Heater Dishwasher #,avatory Low -volt, Television Service, Number of Amps Water Heater New MECHANICAL TYPE Minimum Fee QTY. TYPE Condensate Drain QTY. TYPE Generator QTY. TYPE Refrigeration, Tons QTY. 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 Handler, Tons Ductwork, Cost of Piping, Flammable Liquid Periodic Inspections Barbecue Fire Sprinkler System Process/Pressure Piping Supply, AC Well Bath Fan - Vented, # Fireplaces, Number of Pressure Vessel Temporary Toilet PLUMBING TYPE A/C Condensate QTY. TYPE Drains, Roof QTY. TYPI: Miscellaneous Fixture QTY. TYPE Soakage Pit QTY. Bath Tub Drinking Fountain Miscellaneous Repairs Solar Water Heater Bidet Filter Replace Pool Piping Sprinkler Repair Cap - Fixture Fountain Pump and Abandon Sprinkler System Cap - Water Gas - Appliance Pump, Domestic Supply, AC Well Cap - Sewer Gas - Natural Pump, Fire Stand Temporary Toilet Catch Basin Gas - Propane Pump, Re- circulate Temporary Water Closet Clothes Washer Gas Piping Pump, Replace - Pool Urinal Dental Chair Grease Trap Pump, Sprinkler Utility - Sewer Discharge Well Ice Maker Pump, Sump Utility - Water Dishwasher Indirect Wastes Relay Repair Vacuum Pump Disposal Interceptor Roof Inlet Water Closet Domestic Well aundry Tray Septic Connection Water Heater Drainfield, 4" Tile/Res. #,avatory Septic Tank Water Heater New Drains, Area Meter Set (Gas) Sewer Connection Water Re -pipe Drains, Floor Minimum Fee Shower Water Service Drains, French Miscellaneous Equipment Sink Well, Supply Page 2 IMPORTANT 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 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, POOL, EXTERIOR DOOR, MECHANICAL, WINDOW, FENCE, DRIVEWAY, ROOFING and SIGNS and there may be additional permits required from other governmental 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 JOB SITE in accordance with Section 713 -35 of Florida Statutes. Review the brochure at Village Hall on Construction Lien Law and Choosing a Contractor. F ; • RIDA, . i r' Y OF MIAMI -DADE :_4111111,■—_ 4111 Signature of Owner Print Name Sworn to and Subscribed before me this;"? " day d4 III Signature of o i • f ic o f r` .s • SEAL: Type of Identification Produced: porpI WARY SEAL ■ ECKER - : NUMBER a. = TARES .:002 o2 Personally known OR, Produced Identification STA o ' ORI Sign Print e Sworn to and subscribed before me this'( day o SEAL: ure of No PERMIT APPLICATION AMI -DADE Sta_ .f' fli Witq M BECtEFa ' * COI.:US.%ON n Uu8E:i I ' 0. ? h Q CC7886o7 Personally known OR, Produced Identification 2 y of Identification Produced: Page 3 PERMIT APPLICATION INSTRUCTIONS: Please indicate the type of work being performed and quantity(ies) in the space provided below. RECEIVED AND REVIEWED BY: DATE: CONTRACTOR Name n ^ ' , 1 & k Scpr1 c D A�/�' / AJ -_, License No. 5 [ c 11 I �• ( � Address tam kIE • l oST kJ % rim -.` 1.33141 Telephone � / Q Fax gj�3 0 7 0 v - Name 736 / l) Qualifier L; L *- PROPERTY OWNER it Name HE � /'/ � �� /// Address 1/ 60 E1 el/y-4 Home Telephone Business Telephone Fax TYPE OF MANAGEMENT (✓ ) New Construction Enclosure Alteration Exterior Repair Alteration Interior Demolish Relocation of Structure Shell Only Foundation Only Add'l Attachment Other Add'l Detachment Other D.J -�1 r /d, C# J74// 3 V T om'/ ` Page 4 OFFICE USE ONLY CHECKLIST ❑ OWNER - BUILDER FORM (Attach) ❑ FIRE DEPARTMENT APPROVAL (Commercial / multi- family) ❑ CONCURRENCY (New Construction) ❑ OTHER (Specify & Attach) ❑ PROOF OF OWNERSHIP (Attach) ❑ HRS / DERM APPROVAL (Septic / Sewer) ❑ IMPACT FEE (New Construction) ❑ OTHER (Specify & Attach) PERNIIT FEES $3.00 per page (Scanning Fee) $ Miami Shores Village Bond / Metropolitan Dade County (C.C.F.) $ ! 5 d� Inspector State Educational Fund $ State DCA (Radon) $ Code Enforcement Fine Zoning Review $ 50 $ .3a0 /1 ISSUING OFFICIAL 0 REVIEWED AND PREPARED BY: SECTION Zoning Electrical Mechanical Plumbing Fire Public Works Structural Building Official BY DATE • (sq.ft. = x/1000 x ¢.60) (¢.005 /sq.ft.) (¢.01 /sq.ft.) PERMIT APPLICATION ❑ CONDO ASSOCIATION APPROVAL (Attach) ❑ BPR APPROVAL (Restaurants) ❑ CONTRACTOR REGISTRATION (On File) TOTAL $ :381p. DATE: CONDITION OF APPROVAL Revised July 2001 10050 N.E. 2ND AVE., MIAMI SHORES, FL • (305) 795 -2207 • FAX (305) 756 -8972 • http : / /www.miamishoresvillage.com INSTRUCTIONS - The following steps must be taken to obtain a permit from the Miami Shores Village: Step 1. 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. APPLICATION Job Address: Complete the attached permit application which mu t be si ned b the •ro • ert owner and • ualifier. Both i natures 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. 160 wr q/ 7 /2; >1 S6? s; 33/3e Folio Number / -3aosoO j" tDSO Lot 0-1 Block 4 Subdivisio4Jt'ti5 C PB PG Current Use of Property t S 116.11/71 -L. Proposed Use of Property Tenant Information PERMIT TYPE (✓ ) Building Electrical Mechanical Plumbing LPGX Roofing Fence Other Address Apt. Cit y State Zip Zonin PERMIT CHANGE ( )i Chg. Contractor Renewal Revision Extension Supplement Reinspection ARCHITECT Name License No. Address Telephone Fax PERMIT APPLICATION Master Permit No. . Subsidiary Permit No. ,1 -m -' /6, �.Q Description of Work 300 nD�44).-rlald asrA#A --7 j t(/ Linear Feet Square Feet Units .. Floors 1 Value of Work OO1 2 Bldg Value Tax Assessed/Appraised Value Flood Zone Base Floor Elev. 6.0p". ENGINEER Name License No. Address Telephone Fax cr--Miami Shores Village 10050 NE 2nd Avenue PAY 0' TO THE ORDER .F FOR • Phone: 305 -795 -2204 Permit Number: PL2002 -163 Printed: 6/24/2002 Applicant: MIKE • Owner: XANTHOPOULOU • JOB ADDRESS: 1160 NE 91 Contractor BOBS SEPTIC & DRAIN INC �-- 4 Local Phone: 305 - 558 - 5818 Parcel # 1132050010450 Fees: FEE2002 -3548 FEE2002 -3549 FEE2002 -3550 FEE2002 -3551 BOB2 & INC. a NC NORTH MIAMI, FL 33161 -4211 Description Building Fee Buildier's Bond Notary Fee CCF Total Fees: Plumbing Permit INMAN PAULA TERR Contractor's Address: 1020 NE 130 ST Legal Description: WATERSEDGE PB 9 - 141 ELY3OFT OF LOT 20 & ALL LOT 21 & WLY5FT LOT Amount $80.00 $300.00 $5.00 $1.80 $386.80 Permit Status: Approved Permit Expiration: 12/21/2002 Construction Value: $2,500.00 Work: 300 SQUARE FT DRAINFIEL INSTALLATION _ _— If thArp is nn . - -- :a -. 5 248 r -- - - � ICI �I DATE CITIBANK, F.S.B. BR. 437 2750 A NTUR 3 OULEVARD AVE,NT � .1 11'005 2481 I: 2660865541: 2 /0 2? 606 9I - ���.. -ems^: 3Yd?d DOLLARS 8 }*°i /t/^ 63- 666637 2660 Page 1 of 1 Total Fees: $386.80 Total Receipts: $0.00 Re- inspection • ication herefor in strict compliance with all ifications that may have been submitted to s or if the plans are changed without - )onsibility forr a thorough knowledge of the that he assumes responsibility for work done Is pertaining thereto and in strict conformity ?sponisibility for all work done by either ••••• The Sunshine State •••-• ocs osto sso 15 50-1 13-61446.0 oAtuol uctud3.0014 iiss 0 76114 SI sonvose so tot Rest WO° ii010 ,0.101106116 ussolva_ 0,0046,48ass 04.001 01401 tit 6A1 zsvui SOS 06°154 test Teckuiced tri • STATE OF FLORIDA DEPARTMENT OF HEALTH ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM CONSTRUCTION PERMIT REP p CONSTRUCTION PERMIT FOR: [ ]New System [ ]Existing System [ ]Holding Tank [ X ]Repair [ ]Abandonment [ ]Temporary SYSTEM DESIGN AND SPECIFICATIONS T [ 900 A [ N [ K [ D [ 300 ]SQUARE FEET PRIMARY DRAINFIELD SYSTEM R [ 0 ] SQUARE FEET A TYPE SYSTEM: [ N ]STANDARD [ N ]FILLED I CONFIGURATION: [ N ]TRENCH [ N ]BED N F LOCATION TO BENCHMARK: Top of Bottom I ELEVATION OF PROPOSED SYSTEM SITE [ E BOTTOM OF DRAINFIELD TO BE L D FILL REQUIRED: [ 4.0 ]INCHES Yid SEPTIC TANK SHALL DE PUMPED 0;,[1 P SOLID DCFIACTION DEVICE INSTALLED GA THE OUTLET TEE Floor, 0.9 2.1 6.00' NGVD ] [ FEET ] [ FEET OTHER REMARKS: THIS PERMIT IS NOT FOR ADDITIONS(S). *Existing 900 gl. septic tank to remain. *Install 300 sq.ft. of drainfield or 12 infiltrator *Invert elevation to be no less than 4.43' NGVD. *Bottom elevation to be no less than 3.93' NGVD. DATE ISSUED: 6/18/02 DH 4016, 03/97 (Obsoletes previous editions which may not be used) fostds cons 4016 -1) • CENTRAX #: 13 -SG -13225 DATE PAID: FEE PAID : $ RECEIPT . OSTDSNBR : [ ] Innovative Other [ IN ] APPLICANT: Inman, Mike AGENT: SR0921116, PARILLA ROBERT PROPERTY STREET ADDRESS: 1160 NE 91 Ter Miami Shores FL 33138 LOT: 21 BLOCK: 2 SUBDIVISION [Section / /Range /Parcel No.] PROPERTY ID #: 11- 3205 -001 -0450 [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. EXCAVATION REQUIRED: [ 14.0 ] INCHES 02 -1834- -R MULTI - CHAMBERED /IN SERIES: [Y ] ]Gallons SEPTIC TANK MULTI-CHAMBERED/IN SERIES: [Y ] ]Gallons ]GALLONS GREASE INTERCEPTOR CAPACITY ]GALLONS DOSING TANK CAPACITY [ 0 ]GALLONS Q [0 ]DOSES PER 24 HRS # PUMPS[ 0 ] [ N ]MOUND [ N [ N ] [ BELOW BENCHMARK /REFERENCE POINT [ BELOW BENCHMARK /REFERENCE POINT chambers of EQ -36. THIS PERMIT IS EU ?TiTt fiD73' j S4 0) BOTTOM OF J`9f:;" ......� ' :r1li i:j �. 5 .. ' N SPECIFICATIONS BY: Icaza, Carlos I TITLE: APPROVED BY: Icaza, Carlos ` TITLE: Engineer I Dade CHD EXPIRATION DATE: 9/16/02 Page 1 of 2 v-C Scale: Each block represents 10 feet and 1 inch = 40 feet. 4 - SA TE OF FLORIDA DEPARTMENT OF HEALTH APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION P MITE ` ' ��jj Permit Application Number � J Q 1 -\()11.1 _ % J \ 7 Site Plan submitt by: Plan A proved kl By 7 PbSS . m t>, IJ Notes: ai DH 4015, 10/96 (Replaces HRS -H Form 4015 which may be used) (Stock Number: 5744 - 002 - 4015 -6) PART II - SITEPLAN II 3 &t,71, Res-, o'!/e 5 ro, / CA10 Not Approved � 7 5 - 3O tft C;' t' / 7 Naa SoARe f • .r �. . • I / 'i 6 gio Dat ALL CHANGES MUST BE APPROVED BY THE COUNTY HEALTH DEPARTMENT County Health Department Page 2 of 4 PERMIT APPLICATION FOR MIAMI SHORES VILLAGE Date 10' 26 Job Address , HC / I "" q "(04/Me, Tax Folio Legal Description Historically Designated: Yes No Owner/Lessee / Tenant t `I i WI t Lki tt' VAXA Master Permit # , T / 36 Owner's Address 1 HO W;- 1 �' Ter1't Z(P Phone (72 65 ) 75q 6 % 2 Contractin Co. `i', r? 6/.,e/ ._, Address /Plc ,2J / e Qualifier ‘ ,4-1//&'—. SS# , .. Phone �4-9- `y. —4lJ.ei: 1 State # el , Municipal # Competency # Ins. Co. Architect/Engineer Address Bonding Company Address Mortgagor Address Permit Type (circle one): BUILDING ELECTRIICA PLUMBING�MECHANICAL ROOFING PAVING FENCE SIGN WORK DESCRIPTION c) 77 / . .-u�� Square Ft ?6.g WARNING TO OWNER: YOU MUST RECORD A NOTICE OF COMMENCEMENT AND YOUR FAILURE TO DO SO MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY (IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT.) Application is hereby made to obtain a permit to do work and installation as indicated above, and on the attached addendum (if applicable). I certify that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that separate permits are required for ELECTRICAL, PLUMBING, SIGNS, POOLS, ROOFING and MECHANICAL WORK. OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. Furthermore, I authorize the above- named dontractor to do the work stated. Signature of owner and/or Condo President Date Amin fit: • !ii t sso00! - U AmiA AM: ` • t lt1f�l � FEES: PERMIT v RADON APPROVED: Zoning Building Mechanical Plumbing C.C.F. / Estimated Cost (va1u€) ',5 Signature of Contractor or Owner - Builder Notary as to on ac My Commissiorj A jdali Date My Caren '. Sabi al aurvir NOTARY Electrical Date BOND 3 2 TOTAL DUE 1 Engineering STATE OF FLORIDA PERMIT # DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES DATE PAID ONSITE SEWAGE DISPOSAL SYSTEM FEE PAID CONSTRUCTION PERMIT RECEIPT # Authority: Chapter 381, FS & Chapter 1OD -6, FAC CONSTRUCTION PERMIT FOR: [ /y) New System [ ] Existing System [`y] Repair [1/1 Abandonment APPLICANT: vl r [ ^•' PROPERTY STREET ADDRESS: SUBDIVISION: LOT: BLOCK: PROPERTY ID #: L D FILL REQUIRED: [ 0 T H E R SPECIFICATIONS BY: APPROVED BY: DATE ISSUED: HRS -H Form 4016, Mar 92 (Obsoletes previous editions which may not be used) (Stock Number: 5744 - 001- 4016 -0) 7 c f� .)cf `> $ . (` • <_ Holding Tank [4A Temporary /Experimental [,r--1 Other(Specify) AGENT: [SECTION /TOWNSHIP /RANGE /PARCEL NUMBER] [OR TAX ID NUMBER] SYSTEM MUST BE CONSTRUCTED IN ACCORDANCE WITH SPECIFICATIONS AND STANDARDS OF CHAPTER 1OD -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. SYSTEM DESIGN AND S ,PECIFICATIONS T rit -- [GALLO�NS �/ GPD SEPTIC TANK /AEROBIC UN CAPACI Y MULTI- CHAMBERED /IN SERIES:[ ] A [ ] [ ALLOTS/ GPD] CAPACITY MULTI- CHAMBERED /IN SERIES:[ ] N [ ] GALLONS GREASE INTERCEPTOR CAPACITY [MAXIMUM CAPACITY SINGLE TANK: 1250 GALLONS] K [ ] GALLONS PER DOSE DOSING TANK CAPACITY DOSE RATE [ ] PER 24 HRS NO. OF PUMPS: [ ] D SQ UARE FEET PRIMARY DRAINFIELD SYSTE1« R [ ] SQUARE FEET SYSTEM A TYPE SYSTEM: [ ] STANDARD [ ] FILLED [ ] MOUND [ ] I CONFIGURATION: [ ] TRENCH [•'] BED [ F LOCATION OF BENCHMARK: 3 (. r 0 ° � '. , r 2 E BOTTOM OF DRAINFIELD TO BE [ I ELEVATION OF PROPOSED SYSTEM SITE [ ] [INCHES /FT] [ABOVE /BELOW] BENCHMARK/ REFERENCE POINT ( ]`[INCHES /FT] [ABOV BELOW] BENCHMAR )iEFERENCE POINT ] INCHES EXCAVATION REQUIRED: [3 ] ] INCHES TITLE: TITLE: CPHU E" ▪ a "'NUT EXPIRATION DATE: J. -2 J - cq7 Page 1 of 2 LI! Date 10 -2 Q — C{ 0 Job Address 1140 c ? ieffaCe Tax Folio Legal Description Historically Designated: Yes No Owner/Lessee / Tenant �( I Yom/ q 1 er z i Master Pe 't # 436 g milt* � /9� � �,(Q� Phone 1 ly �J Owner's Address G '� "O"l Contracting Co. `U�/ V !/1/l � Address 9e6 ' `'vv 1 44 I Qualifier .� - � `�'.. �/► _ / �4 AL (� 5 � g4(0 State # OR, op 2.0q Municipal 01 Competency # OK, 6 ( 6 72 0 5ns. Co. cow % �� ignature of owner • d/or Condo President Date Notary as o My Commis FEES: PERMIT PERMIT APPLICATION FOR MIAMI SHORES VILLAGE APPROVED: Zoning Mechanical Plumbing Architect/Engineer Bonding Company Mortgagor Permit Type (circle one): BUILDING ELECTRI WORK DESCRIPTION S¢ w (xi i1 eel t Ot 7 • Date PLUMBING © &M o tos Zia CCS40089 w...er • tl DWI Ir RADON C.C.F. Address Address Address Square Ft Estimated Cost (value) WARNING TO OWNER: YOU MUST RECORD A NOTICE OF COMMENCEMENT AND YOUR FAILURE TO DO SO MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY (IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT.) Application is hereby made to obtain a permit to do work and installation as indicated above, and on the attached addendum (if applicable). I certify that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that separate permits are required for ELECTRICAL, PLUMBING, SIGNS, POOLS, ROOFING and MECHANICAL WORK. OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. Furthermore, I authorize the above -named contractor to do the work stated. Signature o Contractor or Owner- Builder Date .r:rjKSi AO Ad Notary as to Contractor My Commission Expire Building NOTAR CHANICAL ROOFING PAVING FENCE SIGN For eirct (,1 Fl el c/ Electrical 1 �� /0-26- Date A T UMAR My COMM ECp. 3114/00 flooded By Service fns We. 0CS40089 f.srr, % wn t t omw t r. BOND TOTAL DUE O Engineering ITEM BATH TL8 UNIT FEE ITEM SWITCH OUTLETS UNIT FEE ITEM SPACE HEATERS UNIT FEE BIDET LIGHT OUTLETS CENTRAL HEATING DISHWASHER RECEPTACLES A/C (WINO) DISPOSAL SERVICE TEMPORARY A/C (CENTRAL) DRINKING FOUNTAIN SERVICE SIZE IN AMPS DUCT WORK FLOOR DRAIN SERVICE REPAIR/AETER CHANGE REFRIGERATION GREASE TRAP APPLIANCE OUTLETS PROCESS ANO PRESS PIPING INTERCEPTOR RANGE TOP UNDERGROUND TANKS LAVATORY OVEN ABOVE GROUND 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. RESIOENCE MOTORS OVER 5- 8 HP TRANSPORTING ASSEMBLIES SINK. SLOP MOTORS OVER 8- 10 HP ELEVATORS/ESCALATORS TEMPORARY WATER CLOSET MOTORS OVER 10- 25 HP FIRE SPRINKLER SYSTEMS URINAL MOTORS OVER 25-100 HP COOLING TOWERS WATER CLOSET MOTORS OVER 100 HP VIOLATION INDIRECT WASTES A/C WINDOW REINSPECTION WATER SUPPLY TO: AIR CONDITIONERS • A/C UNIT STRIP HEATER FIRE SPRINKLER GENERATORS TRANSFORMERS • HEATER -NEW INST. _ GENERATORS TRANSFORMERS HEATER - REPLACE GENERATORS TRANSFORMERS LAWN SPRINKLER -WELL SPECIAL PURPOSE SWIMMING POOL OUTLETS COMMERCIAL . WATER SERVICE . SIGN TLBES SEWER CONNECTIONS / SIGN TRANSFORMERS UTILITY -SEWER SIGN TIME CLOCK UTILITY -WATER FIXTLRES SEPTIC TANK ANTENNA . RELAY TELEVISION OUTLETS ORAINFIELO, 4' TILE/RES. VIOLATION PUMP & 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 GAS RANGE METER SET (GAS) _ GAS PIPING 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