Loading...
PL-04-144Miami Shores Village 10050 NE 2nd Avenue Phone: 305 - 795 -2204 Printed: 5/17/2004 Applicant: LIONEL CASEY Owner: CASEY LIONEL JOB ADDRESS: 10610 NE 11 AVE Contractor A SEPTIC MAN Local Phone: Parcel # 1122320280620 Fees: Description Amount FEE2004 -4972 Building Fee $175.00 FEE2004 -4973 CCF $0.60 FEE2004 -4974 Training and Education Fee $0.20 FEE2004 -4975 Technology Fee $4.37 Total Fees: $180.17 Total Fees: $180.17 Total Receipts: $180.17 Permit Status: APPLIED Permit Expiration: 11/8/2004 Construction Value: $500.00 Work: ABANDON TANK Signed: (INSPECTOR) Plumbing Permit Permit Number: PL2004 -144 Page 1 of 1 Contractor's Address: 11050 S. W. 170 TERRACE Legal Description: MIAMI SHORES ESTATES PB 47 -58 LOT 12 BLK 4 LOT SIZE 75.000 X 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 responisibility for all work done by either myself, my agent, servants or employes. Signed: (Contractor or Builder) BY: AGENT: I. I C [ ] ] I APPLICANTS PROPERTY ADDRESS: CHECKED [X] ITEMS [03] [04] [05] [06] [ 10 [09] STATE OP FLORIDA DEPARTMENT OF HEALTH ONSITE SEWAGE TREATMENT AND'DIPOBAI. SYSTEM CONSTRUCTION INSPECTION AND FINAL APPROVAL It : / BLOCK: 4 4 _ SUBDIVISION: ARE NOT IN COMPLIANCE WITH STATUTE OR RULE AND MUST BE CORRECTED. TANK INSTALLATION CATION [01] TANK SIZE [1] [2] [02] TANK MATERIAL OUTLET DEVICE MULTI- CHAMBERED [;Y) OUTLET FILTER LEGEND / ;ro f; ,t ^ : , r)(2 - WATERTIGHT LEVEL DEPTH TO LID DRAINFIELD INSTTALLATION (10) AREA [ 1 ] a , d [2) SQFT [11] DISTRIBUTION MOX HEADER NUMBER OF•DRAINLINES DRAINLINE SEPARATION y DRAINLINE SLOPEHJe ADC DEPTH OF COVER ELEVATION [ABOVE /BELOW] BW fS. 7 SYSTEM LOCATION .. _- DOSING PUMPS AGGREGATE SIZE AGGREGATE EXCESSIVE FINES AGGREGATE DEPTH FILL-/ EXCAVATION MATERIAL [22] FILL AMOUNT ,k [23] FILL TEXTURE [24] EXCAVATION: DEPTH [25] :_AREA'REPLACED [261 REPLACD ENT 1ATERIAL .v 'EXPLANATION OF VIOLATIONSr, /: RENARES: ° PROPERTY ID #://'T Its I/ I [' ] PERMIT NO DATE PAID: PAID: RECEIPT #: [29] PRIVATE WELLS FT [30] PUBLIC WELLS FT [31] IRRIGATION WELLS FT [32] POTABLE WATER LINES FT [33] BUILDING FOUNDATION FT [34] PROPERTY LINES �" FT [35] OTHER FT FILLED / MOUND SYSTEM [36j DRAINFIELD COVER [37] SHOULDERS [38] SLOPES [39] STABILIZATION CONSTRUCTION [APPROVED /DISAPPROVED]: , t! FINAL SYSTEM [APPROVED /DISAPPROVED] i CUD DH 4016, 10 /97_(Pr.v ous Editions Map Be Used) Building Department ADDITIONAL INFORMATION [40] UNOBSTRUCTED AREA [41] STORMWATER RUNOFF [4 ALARMS [43] MAINTENANCE AGREES - [ 44 ] BUILDING AREA [45] LOCATION CONFORMS WITH SITE PLAN [46] FINAL SITE GRADING [47] CONTRACTOR [ 01 ABANDONMENT [89] TANN'PUM (503 TANK CRUSHED i FILLEQ //' / — COD DATE: - .- '; - ii DATE: Page 2 of 3 PERMIT NUMBER: Permit tracking number assigned by CHD. APPLICANT:. Property owner's fuf name. AGENT: Property owner's legally authorized representative. MAILING ADDRESS: P.O. box or street mailing address for applicant or agent. LOT, BLOCK, SUBDIVISION Lot, Block and Subdivision for lot or PROPERTY ID#: 27 character number for property. (property appraiser ID* or GIS location) COUNTY HEALTH DEPARTMENT CHECKS [X] ITEMS NOT IN COMPLIANCE WITH CONSTRUCTION PERMIT AND STATUTE OR RULE. INFORMATION IS COMPLETED BY CHD ON FOLLOWING ITEMS: TANK SIZE (gallons) TANK MATERIAL (concrete, fiberglass, etc) OUTLET FILTER (manufacturer, make, model) LEGEND (manufacturer code) DRAINFIELD AREA (square feet) DISTRIBUTION BOX / HEADER (check box) NUMBER OF DRAINLINES (number installed) SYSTEM ELEVATION On relation to BM) DOSING PUMPS (number installed) SETBACKS (record actual setbacks in ft) SETBACKS OTHER (as required) STABILIZATION (date stabilized) CONTRACTOR (contractor installing system) ADDITIONAL INFORMATION (as required) ABANDONMENT TANK PUMPED (date) TANK CRUSHED AND FILLED (date) EXPLANATION OF VIOLATIONS: Record item number, explanation of violation, and required CONSTRUCTION APPROVAL Circle approved or disapproved, CHD signature and date. AS BUILT INSTALLATION SKETCH FINAL APPROVAL: Circle approved or disapproved. CHD signature and date of approval. Final approval shall not be granted unit the CHD has confirmed that'building construction and lot grading are in substantial compliance with plans and specifications submitted with the permit application. ELEVATION WORKSHEET ELEVATION OF BENCHMARK OR REFERENCE POINT: EXISTING GROUND TOP OF AGGREGATE [ +] SHOT H.I. H.I. H.I. H.I. 1-1 SHOT []SHOT []SHOT ELEVATION 0 BUILDING PERMIT APPLICATION FBC 2001 Permit Type (circle): Building Electrical Owner's Name (Fee Simple Titleholder) U® NIEL CAS, Owner's Address JOG 10 N 1 A" City M Sho r State PL Tenant/Lessee Name Phone # Job Address (where the work is being done) City Miami Shores Village Is Building Historically Designated YES Contractor's Company Name A S 2flC M ekV Contractor's Address e 050 S VJ 11 City State j Qualifier t-1 Ion ct ' M vt b'k/ $ Value of Work For this Permit Type of Work: Describe Work: Submittal Fee $ Notary $ Scanning $ Code Enforcement $ Total Fee Now Due $ (Continued on opposite side) Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 fP 500 ��- Cann. 10610 NC /Y Are County Miami -Dade NO t� Zip RECEOVED mAY`' 2 ®04 Permit No. Pi 200 Master Permit No p I Z V t Ll - 103 Mechanical Roofing Phone # R 1 , f69 Zip 33 I3 Zip 3308 Phone # (305 28 - i 3©s.- g1is`alu Architect/Engineer's Name (if applicable) ` " ' Phone # Square Footage Of Work: AI ❑Addition ❑Alteration ['New U"Repair/Replace 0 Demolition e,v o 1 C ****************************F Permit Fee $ 1 ° 0 0 CCF $ o rO 0 CO /CC Training/Education Fee $ b 2.0 Technology Fee $ 4 .37- Radon $ Zoning Bond $ Structural Plan Review. $ Signature D. uceils< My Commission Expires: iu Owner or Agent The foregoing instrument was acknowledge' . fore me this /o day of l 20 +, by LIED a-t CQ h nab who is perso ly known to me or who has produced As identification and who did take an.oath. NOTARY P .'; IC: ,� Sign: , .: , 0 �_—� -- Print: Sign Print: My C * * *, , * * *, * *, * *, *, **** * * * * * * * ** * * * ** * ** * ** * ** * * * ** * * * * * * * * * * *** * *** (Certificate of Competency Holder) ***** * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** **** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * APPLICATION APPROVED B Chc 12/15/03 6 L Bonding Company's Name (if applicable) Bonding Company's Address City State Zip N (J 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 brochure will be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is .issued In the absence of such posted notice, the inspection will not be approved an a reinspection fee will be charged. Signatuse Contractor The foregoing instrument was acknowledged before me this g° day of C. 29 '14-by A ( Car / f 1. who is personally idown to me or who has produced D a Li CefilSeas identification and who did take an oath. NOTARY P ** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * State Certificate or Registration No. Certificate of Competency No. * * * * * * * * * * * * * * * * * * * * * * * * * ** Plans Examiner Engineer Zoning