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PLUMBING
Date/0 fl G / Job Address 3 S /v £ q 51 Tax Folio I I 0 t 0 13 ( )D / 0 Legal l ption c-4 [P . O w n e r / L e s s e e / T e n a n t s r i4 be V l fD A• l tie-rek Contracting Co. . l 1 C-- Qualifier State # (k_05-20-05-- _ 0 20- O j Owner's Address No My Architect/Engineer P PERMIT APPLICATION FOR MIAMI SHORES VILLAGE law - _11 ating •nstruction and zoning. Furthermore, I authorize the above- of owne or Condo President Date ,/ ,a`s �� tondo President Date to i n . nest ot irr`�,;;�' N otary Public, State of Florida My comm. exp. May 24, 2003 Com No. CC3l97p5 FEES: PERMIT ` lJ RADON APPROVED: Zoning Building Mechanical Plum Historically Designated: Yes Permit No � Master Peit # ( t/ 3 tk- ) _So a 7 V 3b s-- 7 s 7- 2 72 Phone Address 1 ' t) P £ / s' i St) NI 0 I II-IL ss# . ( Phone 3DSq Municipal # Competency # Ins. Co. et ruM Address 9 S -7 / 19-`)E: Bonding Company Address Mortgagor Address Permit Type (circle one): BUILDING ELECTRICA ' LUMBING MECHANICAL ROOFING PAVING FENCE SIGN WORK DESCRIPTION ?00 L P C F t n S Square Ft. Estimated Cost (value) 0 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�: f .t all ork will be done in compliance with all applicable to do the work stated. or Owner- Builder a i• Con or O er wn Ys � ! /HSN Date My ' omm Expir My C0� � ub��C $l �'� Cn fi 1n. G�X" ' Y 24 FIOr1 a Pdo CC$1 C0 NOTARY Electrical Engineering BOND L 1 TOTAL DUE STAI.LORIDA DEPAFf �MENT OF HEAtTH • ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM CONSTRUCTION PERMIT PROPERTY ADDRESS: eN r ry PROPERTY ID #: J T3 '6 4 9 t93 4 0 T H E R F LOCATION OF BENCHMARK: CONSTRUCTION PERMIT FOR: [V] New System [M Existing System [ y ] Repair [0] [b ] Abandonment APPLICANT: IS f-s-h 4 e d 6 Ye Va --e#,_ r 0, Holding Tank [&] Temporary 1 LOT: i5T 16 BLOCK: SUBDIVISION: [SECTION TOWNSHIP RANGE PARCEL NUMBER] [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 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.. 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 (7b] GALLONS / GPD: :ROBIC UNIT CAPACITY MULTI- CHAMBERED /IN SERIES [ ] A [ ] GALLONS / GPD CAPACITY - MULTI- CHAMBERED /IN- SERIES [ ] N [ ] GALLONS GREASE INTERCEPTOR CAPACITY [MAXIMUM CAPACITY. SINGLE TANK: 1250 GALLONS] K [ ] GALLONS DOSING TANK CAPACITY' [ ]GALLONS @ [ ] DOSES PER 24 HRS # PUMPS [ ] D [gelDtq . SQUARE FEET PRIMARY DRAINFIELD SYSTEM R 1 ] SQUARE FEET SYSTEM 11 A TYPE SYSTEM: [ STANARD [„r FILLED • (/ MOUND [ �/ I CONFIGURATION: [ TRENCH [ d] BED]' N _ r-lt I ELEVATION OF PROPOSED SYSTEM SITE [ [INS =: =S /g211 [ABOVE/ :`3 ,• " BENCHMARK /REFERENCE POINT E BOTTOM OF DRAINFIELD TO BE [111 ' ,-] [I D FILL REQUIRED: J 2 INCHES EXCAVATION REQUIRED: /FT] [ABOVE /B PERMIT NO. 0, 'igd g DATE PAID: _ 5 _ 0 FEE PAID: ,ezoc RECEIPT #:3,6 ca L A3--St go ,34,G [A/] Innovative Elk / tI BENCHMARK /REFERENCE POINT IRIST ':��4.; ," LOAMY COARSE'SAND u •' :OTTOM O. DnAurI_LD SUBMIT DENC1:MARK BEFORE UISRECTIM THIS PERMIT 45 NOT FOP Aflr)ITION S) i • ;,t ,. • ItUFiELD 417 • SPECIFICATIONS BY: TITLE: APPROVED BY: TITLE: c .DATE ISSUED: /i 4 B EXPI T N DATE: DH 4016, 12/99 (Page 1) (Previ� s 'Edit ions. Ma., B + U ed °) ME OUTLET TEE pt. I: Health Department pt. 2: Applicant pt. 3: Installer /Contractor pt. 4: Building Department Page 1 of 3 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. SYSTEM DESIGN AND SPECIFICATIONS: - 41 0 ' LOT, BLOCK, SUBDIVISION or ,n PROPERTY ID #: 27 character id number for property. (CHD may require property appraiser ➢D # or section /township /range/parcel number) TANK: Minimum specifications from Chapter 64E-6, FAC. DRAINFIELD: 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. A)dlv 0°i211 Site Plan submitt by: Plan Approved By DEPARTMENT OF HEALTH r t APPLICION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PERMIT 1 Permit Application Number ��./ ) ') d.t (Y ) ) (0 Scale: Each block represents, 10 feet and 1 inch = 40 feet. STATE OF FLORIDA r q( PART II - SITEPLAN DH 4015, 10/96 (Replaces HRS -H Form • 015 which may be used) (Stock Number: 5744-0024015 -6) Not Approved 7 108 7 A) ALL CHAN c ES MUST = E APPROVED BY THE COUNTY HEALTH DEPARTMENT 4 .County Health Department Page 2 of 4 c:?- 2.e.... c iFLORIDA DEPARTMENT OF HEALTH APPROVED (305) 623-3555 c„- , APPLICANT AGENT: TANK [01) [02] [03] [ [05] [06] [07] [08] [09] STATE OF FLORIDA DEPARTMENT OF HEALTH ONSITE SEWAGE TREATMENT AND DIPOSAL SYSTEM CONSTRUCTION INSPECTION AND FINAL APPROVAL '2 r / PROPERTY ADDRESS: Ai :.? LOT: ,` BLOCK /1'11 ,../C SUBDIVISION: : •',/1'11,../C • - :, 1 •_; PROPERTY ID 1: s s= == == sa=s====- = =s= =ssssmsss =ssss CHECKED [X] ITEMS ARE NOT IN COMPLIANCE WITH STATUTE OR RULE. AND MUST IS CORRECTED. INSTALLATION TANK SIZE [11.2. C% [2] TANK MATERIAL OUTLET DEVICE - -- _ - MULTI- CHAMBERED [ Y / Ii'] OUTLET FILTER i LEGEND r WATERTIGHT LEVEL., . DEPTH TO DRAINFIELD INSTALLATION [10] AREA [11] DISTRIBUTION BOX [12] NUMBER OF DRAINLINES [13] DRAINLINE SEPARATION [14] DRAINLINE SLOPE [15] DEPTH OF COVER [16] ELEVATION [ABOVE/BELOW ] BN [17] SYSTEM LOCATION [18] DOSING PUMPS • [19] AGGREGATE SIZE4 ,+. [20] AGGREGATE EXCESSIVE FIs [21] AGGREGATE DEPTH FILL / EXCAVATION MATERIAL [22] FILL AMOUNT ;? [23] FILL TEXTURE [24] EXCAVATION DEPTH [25] AREA REPLACED [26] REPLACEMENT MATERIAL EXPLANATION OF VIOLATIONS / REMARKS: 1 _SQFT HEADER ° f' l l 1 1 1 1 • I CONSTRUCTION.,, [APPROVED /DISAPPROVED] : . r' . : FINAL SYSTEM [APPROVED /DISAPPROVED] : >,., - :�' (, -� .. f DH 4016, 10/97(Previous Editions May Be Used) PERMIT NO. DATE PAID* -. FEE PAID: 'J - RECEIPT ,#` :. . SETBACKS [27] SURFACE WATER /1 FT [28] DITCHES 11: • y FT [29] PRIVATE WELLS 1V 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 (36) DRAINFIELD COVER [37] SHOULDERS • [38] SLOPES [39] STABILIZATION ADDITIONAL INFORMATION 140] UNOBSTRUCTED AREA [41] STORMWATER RUNOFF [42] ALARMS ' ABANDONMENT (49) TANK PUMPED �_ /_4 [50] TANK CRUSHED &.FILLED _/, • [43) . [44] [45] [46] [ [ 48] OTHER MAINTENANCE AGREEMENT BUILDING AREA LOCATION CONFORMS ,WITH FINAL SITE GRADING CONTRACTOR CHD DATE: SITE PLAN r CID DATE :, Page 2 of 3 CSL rs KT.mumL : AL' AGENT: EtrLAEL]MG ADDRESS: LO c', BLOCK, SU < DEVUSG@N PROPERTY Cam.): C:,iNTY HE T:I: C DEPARTMENT CHECKS C KS ',Kj [ITEMS NOT EN w:' r ©ONS`U'G3UC'11C v A_A:E; S ATUU` E OR RULE. CN;'GC C ,A`U'G®N CO OL TC D DY © L.Lt_n'3:'w 06STR6BMTC®M • TANK S (g,EGCons) TANK TEMAC, (=emits, s, t5( mOass, etc) FCLLTER (mEnmffeolvaP, mnem, medal]) LEGEND (m anuffaMurs7 cols) DRACNFELD AREA (slum knit) X / HEADER (check Cox) NUMBER OF DMNUNES (nRothssr hs$ai68 ) SYSTEM ELM/ATOM QBn Pe a' i®R 10 BM) DOSCLZO PUMPS (nuntrar uws4e ) SETBACKS (m Pd aclusC se5 dts in ti) SETBACKS OTHER ER (Es PrgatGP ) STABBLC iTC GAG (data VIEtdBized) CONTC ACCToR (contredor 6nsQEEng system) GAP© : f ©wno < fu fit:'.`: y. Prot' .nlj ©C9" [NOJ'<> Cog 1C: P.O. Cnz © P t: ©� C ACC =C : 0t t - 7 titi:: ©' cgont Lo% n: ©ca end at o 0o tik5 t,D, r t V tht,' lckeP J nn o ^P a; °% `,`f, �r ; :) s� t: -- we!oov CO 0 c7 :c©: ) AS L3 JTX Pa TAWA CON 8M ON ADDGMONALL CMFORMATOOE (as PequBPaad) ABANDONMENT' 'TAN PUMPED DD Ot s) TANK CRUSHED AND POLLED ( Tca) C P' G :ATEOM C V/EO / `nON9S: R ss clamp mlE.M P, or rt' ff.'LL' aq v : " E, c,rL� Pogu7PCtl CONrS'd,° O :O X APPROVAL: Urdo opF3'o J o ^s :;Sae., On' ;Cg n.F; rr EMI cla). P r t7..v7cvEr ...:1 IPM :1 L,a usP,rs 4utio ©ter,' m'r.T v' J C.:;:' -(1' . !c7] Cr sTu..:RE L ccr :;1 :'Lm a ms J spodT Tons o u C o r o t i & J- 4 r g o r H ". ; V G A L ' ' r , O „ ' I M R G x 'f ; � ' OF ' YI. ur CJ „ .. ,'[ -.3 ',Na , ?)OJ �_\ . I 8NOT N.G. G .G. .G. .G. H SHOT ` �°� SG;.C;`'c O oOT LL VAl CO ELECTRICAL TYPE Minimum Fee QTY. TYPE Dryer QTY. TYPE Outlet, Appliance QTY. TYPE Service Repair QTY. A/C Central 1 -3 Ton Heating Strips, each Fan Outlet, Wall Service, Temporary Paint Booth A/C Central 4 -7 Ton Fire Pump Outlet, Switch Piping, Flammable Liquid Signs A/C Central 8 -15 Ton Fixture - Fluorescent Process/Pressure Piping Oven Space Heater (kw) A/C Central 16 -20 Ton Pressure Vessel 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 Ice Maker Demolition Low -volt, Intercom/Teleph. Repair Circuits Dishwasher Low -volt, Television Service, Number of Amps Disposal MECHANICAL 'Tl'PE Minimum Fee QTY. TYPE Condensate Drain Q'I'Y. TYPE Generator QTY. TYPE Refrigeration, Tons QTY. A/C Central, Tons Q'I'1'. 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 Sprinkler Repair Bath Fan - Vented, # Fireplaces, Number of Pressure Vessel Fountain PLUMBING TYPE A/C Condensate QTY. 'I'1'PE Drains, Roof ()Ty. 'TYPE Miscellaneous Fixture Q'I'1'. 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 Laundry Tray Septic Connection Water Heater Drainfield, 44 Lavatory 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 F,quipment Sink Well, Supply 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: Page 4 OFFICE USE ONLY I'I ' IST ❑ OWNER - BUILDER FORM (Attach) ❑ FIRE DEPARTMENT APPROVAL (Commercial / multi- family) ❑ CONCURRENCY (New Construction) ❑ OTHER (Specify & Attach) PERMIT FEES $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 ❑ PROOF OF OWNERSHIP (Attach) - )1 HRS / DERM APPROVAL (Septic / Sewer) ❑ IMPACT FEE (New Construction) ❑ OTHER (Specify & Attach) $ l 6 $ l 1 4?-0 ( sq.ft. = x/1000 x 0.60) $ (¢.005 /sq.ft.) $ (4.01 /sq.ft.) ISSUING OFFICIAL REVIEWED AND PREPARED BY: SECTION Zoning Electrical Mechanical Plumbing Fire Public Works Structural Building Official BY DATE *27- PERMIT APPLICATION ❑ CONDO ASSOCIATION APPROVAL (Attach) ❑ BPR APPROVAL (Restaurants) ❑ CONTRACTOR REGISTRATION (On File) TOTAL $3 b (O 0 DATE: CONDITION OF APPROVAL Revised July 2001 10050 N.E. 2" AVE., MIAMI SHORES, FL • (305) 795 -2207 • FAX (305) 756 -8972 • http : / /www.miamishoresvillage.com CONTRACTOR ( OWNER Name j »/ V A :1ir �f T /� /� � ) Name ) b � 0. r r � ' ) ,91 /L License No. ei� / ) Address /O?O U /3os r, Telephone 5 / E Fax U 3 03 Qualifier Name 0 h ; )_ / t J PROPERTY ( OWNER Name j »/ V A :1ir �f T Address 35 A) c q0- s`j 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'I Attachment Other Add'I Detachment Other T;I;NSTRucTI "ONS - The following steps must be taken to obtain a permit froni 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 Complete the attached permit application which must be signed by the property owner and qualifier. Both signatures 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. PERMIT TYPE (✓ ) Building Electrical Mechanical Plumbing LPGX Roofing Fence Other Folio Numbe I ���/ ' �' Lot 511-' ( 9{ Block g Subdivisiot j f9/1 5 ' PB PG Current Use of Property Proposed Use of Property Tenant Information PERMIT CHANGE (✓ ) Chg. Contractor Renewal Revision Extension Supplement Reinspection ARCHITECT Name License No. Address Telephone Fax Master Permit No. Subsidiary Permit No. �` 1 Description of Work 7).414 PERMIT APPLICATION Linear Feet Zoning Square Feet c ' Units Floors „c Value of Work ; Bldg Value Tax Assessed/Appraised Value Flood Zone Base Floor Elev. ENGINEER Name License No. Address Telephone Fax Page 2 IMPORTANT NOTICES 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. 1. 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. STATE OF t ORIDA, TY F -DADE Signature o o • er ; Print Name worn t and subscribed before me this u day of i . n -� Signature o Not ry,�P�frH & Stat d#t BECXER IZ 'S \lr � CO�1k7SSOW :luuaER � -4:, o CC766697 e NAY COMMISSION 'XpiRES SEAL: OFF 9 NOV. 15,2002 Personally known OR, Produced Identification ,/ Type of Identification STAT '. ORI ! CO ��`T OF i p -DADE Print Name Sworn to .nd subscribed before me this Q day of 00 Personally known PERMIT APPLICATION !r - .. )o _ ;i lY,; C SEAL: N 4 , ` OF f\ /7 OR, Produced Identification Type of Identification Produced: MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT Permit No v" 7\11 / 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 spedfiationi must be kept it building during progress of work. �1. Owner's Name and Address Registered Architect ypol /or Engin 14N4 0i0 Employing Plumbor's Neime - •- °•)"'/ " \ ± don 2d Delption S N were or 1s Yo be performed —No State work to be performed and purpose of building (By Floors)_ New Building. -_ -- _ --- •- - - -••- - - - - -.. Remodeling —__ ___ -.__ Addition.. _ - -_ __ Repairs Size Septic Tank_._ Feet of Drain Tile. — Nature of Water Supply: City —Wells w d ir Amount of Permit $ No. 3 S Street Type of Tank--. __—._Dist. Feet of Tank or Drain Field from Well ...___ - Size of Soakage Pit Subdiviilon.g • .• ( / street-. - AL. - '- . total (Si IP& f (Signed) - ---f - -- Z_W_ K. No. of Stories Ss7 My Commission Expires Notary Public, State of Florida Master Plumber. Plumbing Inspector. The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations as an employer of labor under the Florida Workmen's Compensation Act, being Section 5989, 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 worl robe performed 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 required by tie Act. The undersigned agrees to employ only such sub - contractors, . , k to licensed by Miami Shores Vi ormed under this permit, as are Village. STATE OF FLORIDA, µ COUNTY OF DADE. Before me, the undersigned authority, a notary public, duly authorized to administer oatlu 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 be has carefully read the foregoing application, and that he did sign the same, and that all facts therein by him stated are true. NOTE: A re inspection fee of $1.00 wdl be made wises war mimeo** 1a made•neomeary by 'romper notice for inspection, or faulty materials and /or worloaanalup. CLOSET• BATH TuB• SHOWER• LAVA• TORIES SIN" SLOP SINKS LAUNDRY Tu.S URINALS CATCH BASIN FLOOR DRAIN DRINKING FOUNT N• TOTAL FIXTURES CONTR. LIST CHECK •_ SEPTIC TANK SEWER CONN. DRAIN FIELD SOAKAGE PIT G TRAP SO LAR NEATER DEEP WELL SPRKLR. 5 SW IM•G POOL CONTR. LIST CHECK MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT Permit No v" 7\11 / 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 spedfiationi must be kept it building during progress of work. �1. Owner's Name and Address Registered Architect ypol /or Engin 14N4 0i0 Employing Plumbor's Neime - •- °•)"'/ " \ ± don 2d Delption S N were or 1s Yo be performed —No State work to be performed and purpose of building (By Floors)_ New Building. -_ -- _ --- •- - - -••- - - - - -.. Remodeling —__ ___ -.__ Addition.. _ - -_ __ Repairs Size Septic Tank_._ Feet of Drain Tile. — Nature of Water Supply: City —Wells w d ir Amount of Permit $ No. 3 S Street Type of Tank--. __—._Dist. Feet of Tank or Drain Field from Well ...___ - Size of Soakage Pit Subdiviilon.g • .• ( / street-. - AL. - '- . total (Si IP& f (Signed) - ---f - -- Z_W_ K. No. of Stories Ss7 My Commission Expires Notary Public, State of Florida Master Plumber. Plumbing Inspector. The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations as an employer of labor under the Florida Workmen's Compensation Act, being Section 5989, 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 worl robe performed 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 required by tie Act. The undersigned agrees to employ only such sub - contractors, . , k to licensed by Miami Shores Vi ormed under this permit, as are Village. STATE OF FLORIDA, µ COUNTY OF DADE. Before me, the undersigned authority, a notary public, duly authorized to administer oatlu 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 be has carefully read the foregoing application, and that he did sign the same, and that all facts therein by him stated are true. NOTE: A re inspection fee of $1.00 wdl be made wises war mimeo** 1a made•neomeary by 'romper notice for inspection, or faulty materials and /or worloaanalup. Permit No._ 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. a A/ Owner's Name and Address_1 / V Registered Architect and /or Engineer__._ Employing Plumber's Name No Location and Legal Description Lot Block J Street and Number where work is to be performed —No Amount of Permit $ r MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT (Signed) No 6 - /)-/ L Street Street Date / Street V Subdivision My Commission Expires Notary Public, State of Florida State work to be performe ,and purpose of building (By Floors) New Building Remodeling Addition Repairs No. of Stories ,9' Size Septic . Tank Type of Tank Capacity Gals Feet of Drain Tile Dist. Feet of Tank or Drain Field from Well Nature of Water Supply: City Well.___L___� Size of Soakage Pit (Signed) j ' — — =— 7 % Plumbing Inspector. / The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations as an a ployer of labor _ , under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Permanent Supplement, and has corn- - 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; and 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 undersigned agrees to employ only such sub - contractors, on work to be performed under this permit, as are licensed by Miami Shores Village. 13---'f----- ) , �' / ���� �j o '4 r A TE OF FLORIDA, } ss. COUNTY OF DADE. Master Plumber. 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. NOTE: A re- inspection fee of $1.00 will be made when such re- inspection is made necessary by improper °notice for inspectio materials and /or workmanship. CLOSETS BATH TUBS SHOWERS LAVA. TORIES SINKS SLOP LAUNDRY SINKS TUBS URINALS CATCH BASIN FLOOR DRAIN DRINKI FOUNT' NS ) /� / TOTAL FIXTURES LIST CHECK / i ei _ G S AI / - SEPTIC TANK SEWER CON DRAIN FIELD SOAKAGE PIT GREASE TRAP .4 i.R1 HEATER DEEP WELL. SPRKLR. SYSTEM SW IM'G POOL .� CONTR. LIST % N. // C ((( // CHECK 'i Permit No._ 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. a A/ Owner's Name and Address_1 / V Registered Architect and /or Engineer__._ Employing Plumber's Name No Location and Legal Description Lot Block J Street and Number where work is to be performed —No Amount of Permit $ r MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT (Signed) No 6 - /)-/ L Street Street Date / Street V Subdivision My Commission Expires Notary Public, State of Florida State work to be performe ,and purpose of building (By Floors) New Building Remodeling Addition Repairs No. of Stories ,9' Size Septic . Tank Type of Tank Capacity Gals Feet of Drain Tile Dist. Feet of Tank or Drain Field from Well Nature of Water Supply: City Well.___L___� Size of Soakage Pit (Signed) j ' — — =— 7 % Plumbing Inspector. / The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations as an a ployer of labor _ , under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Permanent Supplement, and has corn- - 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; and 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 undersigned agrees to employ only such sub - contractors, on work to be performed under this permit, as are licensed by Miami Shores Village. 13---'f----- ) , �' / ���� �j o '4 r A TE OF FLORIDA, } ss. COUNTY OF DADE. Master Plumber. 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. NOTE: A re- inspection fee of $1.00 will be made when such re- inspection is made necessary by improper °notice for inspectio materials and /or workmanship. Permit No Amount of Permit $ STATE OF FLORIDA, COUNTY OF DADE. MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT 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. Owner's �y Name and Address______________ - -�_ ------- ____ -- No.__ 3 Street Registered Architect and /or Engineer ..... ____— ___________ ------ - - - - -- Employing Plumber's Name No.___ ® Street_gL_eei` d_e _��'U ° Location and Legal Description Lot ---______.... Block__ Street and Number where work is to be performed —No . State work to be performed and purpose of building (By New Building Remodeling —__ ___ ___ Addition__ Size Septic Tank ----- _-- _-_ -__ Type of Tank Capa ,ty Gals Feet of Drain Tile__ —Dist. Feet of Tank or Drain Field from Well ■1 ___ Nature of Water Supply: City — Well.______— —____ Size of Soakage Pit (Signed) Plumbing Inspector. - The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations as an employer of labor under the Florida Workmen's Compensation Act, being Section 5986, Compiled General Laws of Florida Pennanent 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; and will post or cause to be posted' for inspection on the site of the work such public notice or noties as are required by the Act. The undersigned agrees to employ only such sub - contra s, on work to be performed under this permit, as are licensed by Miami Shores Village. � / S � ubdivision Street.6 epaus No. of Stories Date o o UZ My Commission Expires Notary Public, State of Florida Master Plumber. 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. NOTE: A re- inspection fee of 0.00 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 S LAVA- TORIES SINKS SLOP SINKS LAUNDRY TUBS U RINALS 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 Amount of Permit $ STATE OF FLORIDA, COUNTY OF DADE. MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT 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. Owner's �y Name and Address______________ - -�_ ------- ____ -- No.__ 3 Street Registered Architect and /or Engineer ..... ____— ___________ ------ - - - - -- Employing Plumber's Name No.___ ® Street_gL_eei` d_e _��'U ° Location and Legal Description Lot ---______.... Block__ Street and Number where work is to be performed —No . State work to be performed and purpose of building (By New Building Remodeling —__ ___ ___ Addition__ Size Septic Tank ----- _-- _-_ -__ Type of Tank Capa ,ty Gals Feet of Drain Tile__ —Dist. Feet of Tank or Drain Field from Well ■1 ___ Nature of Water Supply: City — Well.______— —____ Size of Soakage Pit (Signed) Plumbing Inspector. - The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations as an employer of labor under the Florida Workmen's Compensation Act, being Section 5986, Compiled General Laws of Florida Pennanent 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; and will post or cause to be posted' for inspection on the site of the work such public notice or noties as are required by the Act. The undersigned agrees to employ only such sub - contra s, on work to be performed under this permit, as are licensed by Miami Shores Village. � / S � ubdivision Street.6 epaus No. of Stories Date o o UZ My Commission Expires Notary Public, State of Florida Master Plumber. 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. NOTE: A re- inspection fee of 0.00 will be made when such re-inspection is made necessary by improper notice for inspection, or faulty materials and /or workmanship. • MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT 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. 0 � Owner's Name and Address 1� Gt' i n ( No Registered Architect and /or Engineer Employing Plumber's Name t 144 1 VA _ _ _ / /!/�?� a - No I / ` d ; / r 6 1 / ,.� . n l I street__ /Z_ _ Location and Legal. Description Lot i_ __� 4 r Block L_ j_' L Subdivision__)2 "^ ' 2 ;, : ' 0 &. Street and Number where work is to be performed —No. -65 7/__ Street , • .__ __ State work to be performed and purpose of building (By Floors) New Building Remodeling Addition Repairs No. of Stories Street / __ - j Size Septic Tank _ - -0 Type of Tank �� � ..�� Capacity Gals Feet of Drain Tile /__ a Dist. Feet of Tank or Drain Field from Well " ✓ Nature of Water Supply: City —Well - L___ Size of Soakage Pit Amount of Permit $ ( Signed) Plumbing Inspector. The undersigned applicant for this building permit does hereby certify that he understands 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; and 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 undersigned agrees to employ only such sub - contractors, on work to be performed y ider this permit, as are licensed by Miami Shores Village. ' STATE OF FLORIDA, COUNTY OF DADE. ss. ( Signed ) ? 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 Masted' 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 FOU NT' NS TOTAL FIXTURES CONTR. LIST CHECK SEPTIC TANK SEWER CONN. DRAIN FIELD SOAKAGE PIT - GREASE TRAP SOLAR H EATER DEEP WELL SPRKLR. SYSTEM SWIM'G POOL CONTR. LIST CHECK • MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT 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. 0 � Owner's Name and Address 1� Gt' i n ( No Registered Architect and /or Engineer Employing Plumber's Name t 144 1 VA _ _ _ / /!/�?� a - No I / ` d ; / r 6 1 / ,.� . n l I street__ /Z_ _ Location and Legal. Description Lot i_ __� 4 r Block L_ j_' L Subdivision__)2 "^ ' 2 ;, : ' 0 &. Street and Number where work is to be performed —No. -65 7/__ Street , • .__ __ State work to be performed and purpose of building (By Floors) New Building Remodeling Addition Repairs No. of Stories Street / __ - j Size Septic Tank _ - -0 Type of Tank �� � ..�� Capacity Gals Feet of Drain Tile /__ a Dist. Feet of Tank or Drain Field from Well " ✓ Nature of Water Supply: City —Well - L___ Size of Soakage Pit Amount of Permit $ ( Signed) Plumbing Inspector. The undersigned applicant for this building permit does hereby certify that he understands 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; and 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 undersigned agrees to employ only such sub - contractors, on work to be performed y ider this permit, as are licensed by Miami Shores Village. ' STATE OF FLORIDA, COUNTY OF DADE. ss. ( Signed ) ? 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 Masted' 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. BUILDING ELECTRICAL PLUMBING Owner of Building 1111 Architect Contractor - or Builder Legal Description. Fl PERMIT - N? 10705 r -Work to be pe ;t rmed under this Permit ... .� MIAMI SHORES VILLAGE, FLORIDA Address of Building This permit is granted to the contractor or buil r named above to co truct the building or to install the equipment or device descibed in the ap Lion herefor in strict compliance with all ordinances perta Ing thereto and with he understanding that the work will be performed in compliance with any p drawings, statements or specifications that may have een submitted to and pproved 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 pl s are changed without authorization. A further condition upon which this permit is granted is the understanding that the contractor or builder named above a umes 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. w,, x. Y me, CONTRACTOR OR BUILDER Signed- Subdi- vision Value of Project $ DATE 195 Contractor's License No Amt. of Permit $ - IIOSPE In consideration of the issuance to me of this permit I agree to perform the work covered hereunder in compliance with all ordinances aid regulations pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authority "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 3 BUILDING ELECTRICAL PLUMBING Owner of Building Architect Contractor or Builder Legal Lot Description. Address of `r�A Building CONTRACTOR OR BUILDER MIAMI SHORES VILLAGE, FLORIDA DATE PERMIT N? 10413 Work to be performed under this Permit Subdi- vision Value of Project $ 195 - Contractor's License No Amt. of Permit $ This permit is granted to tfle 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 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 :e¢ponsibility for all work done by either, myself, my agent, servant or employee. BY AUTHORITY fk BUILDING PERMIT APPLICATION FBC 2004 Permit Type (circle): Building Electrical Plumbing Mechanical Roofing Owner's Name (Fee Simple Titleholder) Owner's Address \ E City \f- N,),(-'. 3 State Tenant/Lessee Name FOLIO / PARCEL # Contractor's Company Name Contractor's Address Value of Work For this Permit $ Structural Review. $ Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 eP� Zip 3?)1 ' Phone # Job Address (where the work is being done) BS N) 6 ci a r c-4 City Miami Shores Villa e County . Miami -Dade Zip . Is Building Historically Designated YES NO Phone # City State Zip Qualifier Name Phone # State Certificate or Registration No. Certificate of Competency No. Architect/Engineer's Name (if applicable) Phone # Permit No. Master Permit No. R. cg, Phone # -w6 306 qi ''9 Square / Linear Footage Of Work: 10 Type of Work: ['Addition ['Alteration ['New Repair/Replace 1=1 Demolition Describe Work: {-\-(� 0C1 T a) m j (� *********** * * * * * * * * * * * * * * * * * * * *:* * * * * * * *********** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** Submittal Fee $ Permit Fee $ % / 6) 9 CCF $ ( ) . c J CO /CC Notary $ S. Training/Education Fee $ 0 • 2-CD Technology Fee $ 4 - CO Scanning - , Radon $ DPBR $ Zoning $ Bond $ Code Enforcement $ Double Fee $ Total Fee Now Due $ 1 - 7 2... 30 See Reverse side --› cia 2 '_ 2 Bonding Company's Name (if applicable) Bonding Company's Address City State Zip Mortgage Lender's Name (if applicable) � C n UCi ( �N 1 TI f Mortgage Lender's Address 4 B 0 2( 10 1 �? City P� 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 and a reinspection fee will be charged. Signature l.L.C,CJ,k Y ` - Signature Own or Agent Contractor The foregoing instrument was acknowledged before me this Z,`� The foregoing instrument was acknowledged before me this day of tic , 20(L , by �J Ci1[- � 5`�Lt . , day of , 20 _ , by who is personally known to me or who has produced Ff )f i Y24'i) Li j, who is personally known to me or who has produced .', As identification and who did take an as identification and who did take an oath. O WiS NOTARY PUBLIC: �pVSS pp 463 NOTARY PUBLIC: { --,� ea��j° Sign: Sign: �'�'- � ., .: Print: N ;?i'.& (I ` „ /' � ' Print: My Commission Expires: My Commission Expires: APPLICATION APPROVED BY: (Revised 02/08/06) • f / Plans Examiner // / Engineer Zoning ITEM PATH TUB UNIT FEE ITEM SWITCH OUTLETS UNIT FEE ITEM SPACE HEATERS UNIT FEE 3IDET LIGHT OUTLETS CENTRAL HEATING )ISNWASHER RECEPTACLES A/C (WIND) )ISPOGAL SERVICE TEMPORARY A/C (CENTRAL) DRINKING FOUNTAIN SERVICE SIZE IN AMPS DUCT WORK FLOOR DRAIN SERVICE REPAIR/I TER D REFRIGERATION GREASE TRAP APPLIANCE OUTLETS PROCESS AND 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 FP STEAD BOILERS SHOWER MOTORS OVER 1- 3 FP HOT WATER BOILERS I SINK, POT /3 COMP. MOTORS OVER 3- 5 Mfr' MECHANICAL VENTILATION SINK, RESIDENCE MOTORS OVER 5- 8 HP TRANSPORTING ASSEMBLIES SINK, SLOP MOTORS OVER 8- 10 I-P ELEVATORS/ESCALATORS TEMPORARY WATER CLOSET MOTORS OVER 10- 25 -P FIRE SPRINKLER SYSTEMS URINAL MOTORS OVER 25-100 FP COOLING TOWERS WATER CLOSET MOTORS OVER 100 FP VIOLATION INDIRECT WASTES A/C WINDOW REINSPECT-JON WATER SUPPLY T0: AIR CONDITIONERS A/C UNIT STRIP HEATER FIRE SPRINKLER - GENERATORS TRANSFORMERS HEATER -HEW INST. I GENERATORS' TRANSFORMERS HEATER - REPLACE 1 GENERATORS TRANSFORMERS LAWN SPRINKLER -WELL ' SPECIAL PURPOSE SWIMMING POOL OUTLETS COt,4 RC I AL MATER SERVICE SIGN TUBES SEWER CONNECTIONS ,'SIGN TRANSFORMERS UTILITY -SEWER 1 SIGN TUE CLOCK UTILITY -WATER ! F I XTLR ES SEPTIC TANK 1 ANTENNA RELAY I TELEVISION OUTLETS GRAINFIELD, 4' TILE/RES. 1 VIOLATION PUMP L ABANDON SEPTIC TANK REINSPECT ION SOAKAGE PIT CU. FT. CATCH BASIN DISCHARGE WELL DOMESTIC WELL AREA DRAIN 0JF INLET 'AN APPLICATION FOR BUILDING PERMIT MUST ACCOMPANT THIS ADDENDUM. IF A MASTER PERMIT HAS E. OBTAINS),., .T.Ha OWNER'S NOTARIZED SIGNATURE NEED NOT BE PRESENT ON SUBSEQUENT APPLICATIONS.) ;GEAR WATER HEATER IRE STANDPIPE POOL PIPING AWN SPRINKLER SYSTEW AS RAN CE TER SET (GAS) �c PIPIN. PLUMBING ELECTRICAL MECHANICAL Issue Date: 4/3/2006 Owner's Name: ALAIN AND NICOLE SUISSA Permit Type: Plumbing - Residential Work Classification: Addition /Alteration Job Address: 35 92 Street NE Additional Information Miami Shores Village, FL 33138- Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL 33138 -0000 Phone: (305)795 -2204 Fax: (305)756 -8972 Permit Expires: 03/28/2007 Contractor(s) Phone Primary Contractor HOME OWNER Yes Comments: PLUMBING WORK FOR BATHROOM REPLACEMENT Type of Work: BATHROOM RENOVATION Type of Piping: Additional Info: Bond Return : Classification: Residential 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 CCF Education Surcharge Notary Fee Permit Fee - Additions /Alterations Scanning Fee Technology Fee Total: Amount $0.60 $0.20 $5.00 $160.00 $3.00 $4.00 $172.80 Building Department File Copy Applicant Signature Parcel #: Block: Section: Permit Status: APPROVED Permit Number: PL -3 -06 -787 Phone: (305)975 -0400 1132060130240 Lot: PB: Total Square Feet: 104 Total Valuation: $ 800.00 Required Inspections Underground Rough Water Main Top Out Main Drain Lavatory Water Service Re Pipe Heater Final Invoice Number PL-4-06-24347 Total: APR 0 4 PAID Amt Due $172.80 Amt Paid 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. 0 r Passed I n p = • � o nts V Failed Correction Needed Re- Inspection Fee ($75) No Additional Inspections can be scheduled re- inspection fee is paid . until Inspection Date: 08/08/2006 Inspector: Levrack, James Owner: SUISSA, ALAIN AND NICOLE Job Address: 35 92 Street NE Miami Shores Village, FL 33138- Project: <NONE> Contractor: HOME OWNER Building Department Comments Monday, August 7, 2006 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 AUG 0 9 RECD 0 Permit Type: Plumbing - Residential Inspection Type: Final Work Classification: Addition /Alteration Block: Phone Number (305)975 - 0400 Parcel Number 1132060130240 Lot: Page 2 of 2 V Passed /nsrjns Failed Correction Needed Re- Inspection Fee ($75) No Additional Inspections can be scheduled re- inspection fee is paid. until i nspection Number: INSP- , 13324 Inspection Date: 04/25/2006 Inspector: Levrack, James Owner: SUISSA, ALAIN AND NICOLE Job Address: 35 92 Street NE Miami Shores Village, FL 33138- Project: <NONE> Contractor: HOME OWNER Building Department Comment Monday, April 24, 2006 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Permit Number: PL -3 -06 -787 Permit Type: Plumbing - Residential Inspection Type: Underground Rough Work Classification: Addition /Alteration Block: Lot: Phone Number (305)975 -0400 Parcel Number 1132060130240 Page 1 of 2