455 NE 93 St (4),/,2/
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, who er herein specified or not. A copy of approved plans and specifications must be kept at
building during progress of work. a F
Owner's Name and Address , F �___ _ No—
Registered Architect and /or Engineer______
Employing Plumber's Name _ _
0 7__C_ - _._._ Street_
!_s_�_ -- - ' ___ __ (� .____� — ____
Amount of Permit $__
My Commission Expires
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING ' " ;w,MIT
State work to be performed and purpose of building (By Floors)__.__._._._.__
New Building --_.__- Remodeling —__ - -_ Addition_
Date i .2 -- - - - - -
Street
Location and Legal Description Bl Subdivisi
* Street and Number where work is to be performed —No `$ Street
Repairs No. of Stories.
Size Septic Tank_-_ —1 r -- -- - - -- -- ---
Feet of Drain Tile_ /L C ^2� st. Feet of Tank or Drain Field from Well
Nature of Water Supply. City — Well._________ ____________________________________Size of Soakage Pit
Type of Tank____ Capacity Gals
(Signed) _
(Signed)._
Plumbing Inspector.
The undersigned applicant for this building permit does hereby certify that he understands and accepts his ob :: tions as an employer of labor
under the Florida Workmen's Compensation Act, being Section 5968, Compiled General Laws of Florida Perin. put Supplement, and has com-
plied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors e ployed 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 su .y 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.
-)7
Master Plumber.
STATE OF FLORIDA, }
COUNTY OF DADE.
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeared
tc 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.
Notary Public, State of Florida
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
Tues
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
H EATER
DEEP
WELL
SPRKLR.
SYSTEM
SWIM'G
POOL
I __
CONTR.
LIST
CHICK
44
,/,2/
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, who er herein specified or not. A copy of approved plans and specifications must be kept at
building during progress of work. a F
Owner's Name and Address , F �___ _ No—
Registered Architect and /or Engineer______
Employing Plumber's Name _ _
0 7__C_ - _._._ Street_
!_s_�_ -- - ' ___ __ (� .____� — ____
Amount of Permit $__
My Commission Expires
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING ' " ;w,MIT
State work to be performed and purpose of building (By Floors)__.__._._._.__
New Building --_.__- Remodeling —__ - -_ Addition_
Date i .2 -- - - - - -
Street
Location and Legal Description Bl Subdivisi
* Street and Number where work is to be performed —No `$ Street
Repairs No. of Stories.
Size Septic Tank_-_ —1 r -- -- - - -- -- ---
Feet of Drain Tile_ /L C ^2� st. Feet of Tank or Drain Field from Well
Nature of Water Supply. City — Well._________ ____________________________________Size of Soakage Pit
Type of Tank____ Capacity Gals
(Signed) _
(Signed)._
Plumbing Inspector.
The undersigned applicant for this building permit does hereby certify that he understands and accepts his ob :: tions as an employer of labor
under the Florida Workmen's Compensation Act, being Section 5968, Compiled General Laws of Florida Perin. put Supplement, and has com-
plied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors e ployed 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 su .y 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.
-)7
Master Plumber.
STATE OF FLORIDA, }
COUNTY OF DADE.
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeared
tc 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.
Notary Public, State of Florida
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.
0 . Phone: 305 -795 -2204
Printed: 9/17/2002
Applicant: JOHN
Owner: DILLON
° JOB ADDRESS: 455 NE 93
f Contractor
Local Phone:
Parcel # 1132060140391
Fees: Description
FEE2002 -5205 CCF
FEE2002 -5206 Building Fee
FEE2002 -5207 Buildier's Bond
FEE2002 -5208 Notary Fee
Total Fees:
f ns‘ It G can
Miami Shores Village
10050 NE 2nd Avenue
STATEWIDE SEPTIC SOLUTIONS, INC
18800 N.W. 2ND AVE SUTIE 223
MIAMI, FL 33169
PAY
TO THE
pgpFA OF
��
ACH R/T 083100277
Plgmbing Permit
Permit Number: PL2002 -248
Legal Description: 6 53 42 MIAMI SHORES SEC 2 PB 10 -37 LOT 18 & W25FT LOT 19 BLK 51 LOT
• Amount
$1.20
$80.00
$300.00
$5.00
$386.20
Total Fees: $386.20
Total Receipts: $0.00
Permit §tatus:
Work: i DRAINFIELD
If there is no permit package accessible on the inh -cifa f ^- 2 -- •- - - -•
Srrurity_r nhanr =J uo,u Sr _ - J 1:• -
Bank of America.
APPROVED Permit Expiration:
3/16/2003
DA
DILLON
JOHN
ST
Contractor's Address:
Construction Value: '$1,300.00
qoi 0
63-4/630 FL
2. 799
384.4
DOLT/1RS•
FOR 4 E ST
0000 ?OH' 1 :06300004 01: 0034 .9 63 1611
.sus *302 ;.- ..skra :�:gral
Page 1 of 1
Re- inspection
)Iication herefor in strict compliance with all
.cifications that may have been submitted to
es or if the plans are changed without
sponsibility for a thorough knowledge of the
that he assumes responsibility for work done
ms pertaining thereto and in strict conformity'
responisibility for all work done by either
STATE OF FLORIDA
DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM
CONSTRUCTION PERMIT
ff fl,�fl
10j
APPLICANT: Dillon, John AGENT: SA0021074, Solomon Teresa
PROPERTY STREET ADDRESS: 455 NE 93 St Miami Shores FL 33138
LOT: 18 BLOCK: 51
PROPERTY ID #: 11- 3206 - 014 -0391
SYSTEM DESIGN AND SPECIFICATIONS
T [ 900 ]Gallons SEPTIC TANK
A [ 0 ]Gallons
N [ 0 ]GALLONS GREASE INTERCEPTOR CAPACITY
K [ 0 ]GALLONS DOSING TANK CAPACITY [ 0 ]GALLONS
OTHER REMARKS:
This permit is not for addition(s).
*Existing 900 gl. septic tank to remain.
*Install 400 sq.ft. of drainfield.
*Invert elevation to be no less than 4.50' NGVD.
*Bottom elevation to be no less than 4.00' NGVD.
SPECIFICATIONS BY: Icaza, Carlos
APPROVED BY: Icaza, Carlos
DATE ISSUED: 9/13/02
•
DH 4016, 03/97 (Obsoletes previous editions which may not be used)
(Stock Number: 5744- 001 - 4016 -0) [ostde cons_4016 -1]
SUBDIVISION: Miami Shores Section
[Section /Township /Range /Parcel No.]
[OR TAX ID NUMBER]
TITLE:
W-E
gJ'Mb
TITLE: Engineer I
CENTRAX #: 13 -SG -14091
DATE PAID:
FEE PAID : $
RECEIPT
OSTDSNBR : 02 -2702- -R
CONSTRUCTION PERMIT FOR:
[ ]New System [ ]Existing System [ ]Holding Tank [ ] Innovative Other
[ X ]Repair [ JAbandonment [ ]Temporary [ NA ]
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.
MULTI- CHAMBERED /IN SERIES: [Y ]
MULTI- CHAMBERED /IN SERIES: [Y ]
@ [0 ]DOSES PER 24 HRS # PUMPS[ 0 ]
D [ 400 ]SQUARE FEET PRIMARY DRAINFIELD SYSTEM
R [ 0 ]SQUARE FEET SYSTEM
A TYPE SYSTEM: [y' ' ]STANDARD [ N ]FILLED [ N ]MOUND [ N ]
I CONFIGURATION: �/ N ]TRENCH ]BED [ N ]
N /
F LOCATION TO BENCHMARK: Top of Bottom Floor, 7.70' NGVD.
I ELEVATION OF PROPOSED SYSTEM SITE [ 1.2 ] [ FEET ] [ BELOW BENCHMARK /REFERENCE POINT
E BOTTOM OF DRAINFIELD TO BE [ 3.7 ] [ FEET ] [ BELOW BENCHMARK /REFERENCE POINT
L
D FILL REQUIRED: [ 0.0 ]INCHES EXCAVATION REQUIRED: [ 30.0 ] INCHES
% - S�z `� 1
OO �NG -�
Dade
EXPIRATION DATE: 12/12/02
CHD
Page 1 of 2
Notes:
Scale: Each block represents 5 feet and 1 inch = 50 feet.
rT -T r i
t I
f t
' (
f r I 1 -
-r -' 7'"t 1 / r r ' '1 r
1 ._1
i-+
1 1 1. I
1 , L - , i t -
T A +r1 ( , J t
t 1 _ i I ® ori°
- 1 I 1 ! _
j f' t -
I ,
t
J „
1 i 'T 1 i
t --- 444 1 t r r i t
■ } 1 I _ -
' --- - om' ° I �.
4
77 YY
I I - -- I Y '- I 1 J ! 11
1 i
-ti- i Jr-frill ' , 1 1 l T I 1 ,. t I / 7 -I r _ i f
I r I 1 _ I 7 1 p f�
i i I I ; ` 1
1
D \LloNI — 4-SS tE q,. Sl SS 331 38
bLO S'CV (Wo rt.0 t 6 RePL P iakrkINi F^ � GP.4 Li.
Site Plan submitted by:
Plan Approved �
By \-\\
DH 4015. 10/96 (Replaces HRS•H Form 4015 which may be used)
(Stock Number: 5744 - 0024015 A
STATE OF FLORIDA • .
DEPARTMENT OF HEALTH . .
APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PERM/ -
Permit Application Number
PART II - SITE PLAN
S� /r-4
Signature
Not Approved
ALL CHANGES MUST BE APPROVED BY THE COUNTY HEALTH DEPARTMENT
Tale
Date I $`
County Health Department
Page 2 of 3
APPLICANT:
LOT:
PROPERTY
STATE OF FLORIDA <s
DEPARTMENT OF HEALTH
ONSITE SEWAGE DISPOSAL SYSTEM
SITE EVALUATION AND SYSTEM SPECIFICATIONS
3CMAr.1 9116104
BLOCK: 5 SUBDIVISION:
ID #: 11-3 0G-C)14 -0 11
TO BE COMPLETED BY ENGINEER, HEALTH UNIT EMPLOYEE, OR OTHER QUALIFIED PERSON. ENGINEER'S MUST
PROVIDE REGISTRATION NUMBER AND SIGN AND SEAL EACH PAGE OF SUBMITTAL. COMPLETE ALL ITEMS.
PROPERTY SIZE CONFORMS TO SITE PLAN: [)6] YES
TOTAL ESTIMATED SEWAGE FLOW: 400
AUTHORIZED SEWAGE FLOW: 5(3
UNOBSTRUCTED AREA AVAILABLE: 4 40o
BENCHMARK /REFERENCE POINT LOCATION:
ELEVATION OF PROPOSED SYSTEM SITE IS
THE MINIMUM SETBACK WHICH
SURFACE WATER: N R FT
WELLS: PUBLIC: NO, FT
BUILDING FOUNDATIONS:
CAN BE MAINTAINED FROM THE
DITCHES /SWALES:
LIMITED USE: n1 ta FT
5 FT PROPERTY LINES:
SITE SUBJECT TO FREQUENT FLOODING: [ ] YES [X] NO
10 YEAR FLOOD ELEVATION FOR SITE:
1.4 .7. 3.5'
SOIL PROFILE INFORMATION SITE 1
Munsell # /Colo Texture Depth
\® \ict 5 % ( (LE 0 to `lz'`
to
to
to
to
to
to
to
to
USDA SOIL SERIES: U(1.DPc1• PrOO
OBSERVED WATER TABLE: 12-1 INCHES [ABOVE /
ESTIMATED WET SEASON WATER TABLE ELEVATION:
HIGH WATER TABLE VEGETATION: [ ] YES V] NO
SOIL TEXTURE /LOADING RATE FOR SYSTEM SIZING:
DRAINFIELD CONFIGURATION: [ ] TRENCH l( ]
REMARKS /ADDITIONAL CRITERIA:
SITE EVALUATED BY:
DH 4015, 10/96 (Replaces HRS -H Form 4015 [Page 3) which may be used)
(Stock Number: 5744 - 003 - 4015 -1)
[ ] NO
AGENT:
M S■oYed
5-e c Z
[ Section /Township /Range /Parcel No. or
4 NE 93 Sr JkS
NET USABLE AREA AVAILABLE: 22 ACRES
GALLONS PER DAY
GALLONS PER DAY
SQFT UNOBSTRUCTED AREA REQUIRED:
1
FrE 1. °1
142. [INCHES /0 [ABOV
FT MSL /NGVD
1$
BED
4,
STATE w I E PIG Co rJNE7C-- aofv
[RESIDENCES -TABLE 1 / OTHER -TABLE 2)
[1500 GPD /ACRE OR 2500 GPD /ACRE]
$00 SQFT
yI
PROPOSED SYSTEM TO THE FOLLOWING FEATURES:
NA FT NORMALLY WET? [ ] YES [X ] NO
PRIVATE: N YI FT NON - POTABLE: N A FT
FT POTABLE WATER LINES: FT
10 YEAR FLOODING j ] YES [X] NO
SITE ELEVATION: FT MSL /NGVD
SOIL PROFILE INFORMATION SITE 2
PERMIT # 0)' " r , 7) 3
Tax ID Number)
] BENCHMARK /R( R POINT
Munsell # /Color Texture Depth
Gd' \s 41i to'l Z-
to
to
to
to
to
to
to
i, to
USDA SOIL SERIES: U (t At.t Lf Jt
EXISTING GRADE. TYPE: PERCHED /
INCHES [ ABOVE / • LO. ] EXISTING
MOTTLING: [ ] YES [)(] NO DEPTH: ►v A
ARE )
E.
INCHES
DEPTH OF EXCAVATION: 3 0 INCHES
] OTHER (SPECIFY)
DATE: 13102..
Page 3 of 3
INSTRUCTIONS:
PERMIT NUMBER: Permit tracking number by County Health Department.
APPLICANT: Property owner's full name.
AGENT: Property owner's legally authorized representative.
LOT, BLOCK, SUBDIVISION: Lot, block, and subdivision for lot.
PROPERTY ID NUMBER: 27 character number for property (property appraiser ID number or section /township /range /parcel number).
PROPERTY SIZE: Check if property at site conforms to submitted site plan. Record net usable area available - lot area exclusive of
all paved areas and prepared road beds within public rights -of -way or easements and exclusive of streams, lakes,
normally wet drainage ditches, marshes, or other such bodies of water.
SEWAGE FLOW:
UNOBSTRUCTED AREA:
Record the estimated sewage flow for the establishment from Table 1 (residence) or Table 2 (non - residential),
Chapter 10D-6, FAC. Record the authorized sewage flow for the lot based on net usable area and water supply
(1500 gallons per day per acre for private water supplies and 2500 gpd per acre for public water supplies). If
authorized sewage flow does not equal or exceed the estimated sewage flow, the application must be denied.
Record the square feet of unobstructed area available and the amount required. Unobstructed area must be at
least 2 times as large as the drainfield absorption area and at least 75 percent of the unobstructed area must meet
minimum setbacks in Chapter 10D -6, FAC. The unobstructed area must be contiguous to the drainfield.
BENCHMARK INFORMATION: Record the location of the benchmark. If using a surveyor's benchmark record the actual elevation. Record the
elevation of the proposed system site in relation (above or below) to the benchmark.
MINIMUM SETBACKS:
Record minimum setbacks which can be meet to all listed features. Actual measurements must be recorded or
"NA" for nonapplicable features. Features on site plan or within 75 feet of the applicant lot must be measured.
The location of any public drinking well within 200 feet of the applicant's lot must also be verified.
FLOOD INFORMATION: Record information on lot's subject to flooding. For lots subject to flooding record 10 year flood elevation for
site and actual site elevation.
SOIL PROFILE INFORMATION: Two soil profiles within the proposed absorption area to a minimum depth of 6 feet or refusal are required. Soil
identification will use USDA Soil Classification methodology (Munsell colors and USDA soil textures). Refusals
must be clearly documented. Provide USDA soil series if available, record "UNK" if the series cannot be
determined.
WATER TABLE: Record the depth of the observed water table at the time of the evaluation. Mark "perched" or "apparent" as
appropriate. Record the estimated wet season water table elevation based on site evaluation, USDA soil maps,
and historical information. Indicate if there is high water table vegetation present. Indicate if mottling is present
and depth.
SOIL. TEXTURE: Record soil texture or loading rate for system sizing.
DEPTH OF EXCAVATION: If applicable record depth of excavation required. Record "NA" if not applicable.
DRAINFIELD CONFIGURATION: Check drainfield configuration required. If other, specify type.
ADDITIONAL CRITERIA: Record any additional remarks pertinent to site or installation. Ex. dosing required.
SITE EVALUATED BY: Signature of evaluator, title, and date of evaluation. Professional engineers must seal all documents submitted.
ELEVATION WORKSHEET ELEVATION OF BENCHMARK / REFERENCE POINT IS:
BENCHMARK SITE 1 SITE 2 SITE 3
[ + ] SHOT H.I. H.1. H.I.
H.I. [ - ] SHOT [ - ] SHOT
[ - ]SHOT
WE OR
8110105220131
Operation or s rector vehicle constitutes consent to any sobriety test required by law.
•
•-•
The Sunshine State
MODE MAWR
. D450-406-33-172-0
JOHN F DILLON •
270 GRAND CONCOURSE
MIAMI SHORES, FL 331380000
SIM DATE SEX MT. REST. ENDORSE:
05-1243 M • 540 •
*sum EXPIRES UCATE
06-22-01' - 054247 00.00.00
•
ELECTRICAL
TYI,I.
Minimum Fee
()Ty.
TYPI,;
Dryer
Q.LV
.LV,I,I,,
Outlet, Appliance
QTY.
TvI
Service Repair
Q . LV ..
A/C Central 1 -3 Ton
Dryer Vents, Number of
Fan
Ventilation, Cost
Outlet, Wall
Ductwork, Cost of
Service, Temporary
Periodic Inspections
A/C Central 4 -7 Ton
Fire Sprinkler System
Fire Pump
Outlet, Switch
Fireplaces, Number of
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
1
Low -volt, Television
Service, Number of Amps
Water Heater New
MECHANICAL
TYPE
Minimum Fee
QTY. TYPE QTY.
Condensate Drain
'I'V'PE
Generator
QTY. TYPE Q'I'Y.
Refrigeration, Tons
A/C Central, Tons
Cooling Tower
Heating Strips, each
Vent Hood, Cost
A/C Wall/Win. Tons
Dryer Vents, Number of
Paint Booth
Ventilation, Cost
Air Handler, Tons
Ductwork, Cost of
Piping, Flanunable Liquid
Periodic Inspections
Barbecue
Fire Sprinkler System
Process/Pressure Piping
Bath Fan - Vented, #
Fireplaces, Number of
Pressure Vessel
PLUMBING
TYPE;
A/C Condensate
QTY.
TV'PE
Drains, Roof
QTY.
TYPE:
Miscellaneous Fixture
Q'T'Y.
TY
Soakage Pit
Q"fV'.
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, 4" Tile/Res.
1
Lavatory
Septic Tank
Water Heater New
Drains, Area
Meter Set (Gas)
Sewer Connection
Water Re -pipe
Drains, Floor
Minimum Fee
Shower
Water Service
Drains, French
Miscellaneous Equipment
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
CHECKLIST
❑ OWNER - BUILDER FORM
(Attach)
❑ FIRE DEPARTMENT
APPROVAL (Commercial /
multi- family)
❑ CONCURRENCY
(New Construction)
❑ OTHER
(Specify & Attach)
Notary
❑ PROOF OF OWNERSHIP
(Attach)
❑ HRS / DERM APPROVAL
(Septic / Sewer)
❑ IMPACT NEE
(New Construction)
❑ OTHER
(Specify & Attach)
$3.00 per page (Scanning Fee) $
Miami Shores Village $ ,) 0
Bond $ 3 D
Metropolitan Dade County (C.C.F.) $ 1 1 4 > () (sq_tt. = x/1000
x4.60)
Inspector State Educational Fund $ 6t.005/sq -ft)
State DCA (Radon) $ (4.01/sq.11)
Code Enforcement Fine $
Zoning Review
SECTION
Zoning
Electrical
Mechanical
Plumbing
Fire
Public Works
Structural
Building Official
BY
DATE
PERMIT APPLICATION
LI CONDO ASSOCIATION APPROVAL
(Attach)
❑ BPR APPROVAL (Restaurants)
❑ CONTRACTOR REGISTRATION
(On File)
PER\IIT FEES
TOTAL $ �74 1
ISSUING OFFICIAL
REVIEWED AND PREPARED BY: 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
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, P° 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 ORID O Y 0 AMI -DADE
'gnat of Owner
(gr of Notary Public - Sute of Florida
SEAL:
Personally
43o03t4OTARV Fla ee A
••■
1) Name
Sytpn►_t 2nd subscribed before me this day of
■JO
TERESA J. SOLOMON
MY 00MMISSION # Op 1
!XPI E : Jut 9®, ION
STATE OF FLORID
O�I�TI � I -DADE
k.00 J '
ature of Co tractor / uali !ier
6 'J Sol tom,
Si
Print Name
S om to nd subscribed before me this
b emu .,
~ : �gn e�df :11.1.
, Pyblie Sta of
r,
TC
C ;1,3:j G.97
r' FAO f ca .
Personally known
PERMIT APPLICATION
day of
OR, Produced Identification
Type of Identification Produced: D14-5 3 3I — 72O Type of Identification Produced:
CONTRACTOR
Name 41 4* �� lYsilE i➢ IVF,SePfic
f
License No.
Address - 16800 14v.I 2. NE 4 - 2, 2.3
Mil t L 331 G9
Telephone( ( _ (o G 3.3 Fax
Qualifier Name el
PROPERTY WNER
Nam
Address U
i /SS /ti f 9_sfr
Home Telephone 3 o S - 7) _ – l 9 cP S
Business Telephone3 O S 7 5 — Y G ,
i
Fax J
TYPE OF MANAGEMENT ( )
New Construction
Enclosure
Alteration Exterior
Repair
i/
Alteration Interior
Demolish
Relocation of Structure
Shell Only
Foundation Only
Add'I Attachment
Other
Add'I Detachment
Other
Step 1.
( Job Address:
Master Permit No.
Subsidiary Permit No.
PERMIT APPLICATION
INSTRUCTIONS - The following steps must be taken to obtain a permit from the Miami Shores Village:
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 submit-
ted along with this permit application.
Step 2. Submit the completed application with all necessary documents to the Building, Planning and Zoning Department for processing. During the
processing of your application, you may be asked to submit additional information.
APPLIC kTION
Folio Number 11 b206 ` 01 Q' - 05q I
Lot 1 Z Block 51
Subdivision N` ise ZPB PG
Current Use of Property S PO-
Proposed Use of Property 5
Tenant Information Tax Assessed/Appraised Value
Flood Zone Base Floor Elev.
PERMIT TYPE (✓ )
Building
Electrical
Mechanical
Plumbing
LPGX
Rooting
Fence
Other
yss L 9_3 57"
Address Apt.
PERMIT CHANGE (✓ )
Chg. Contractor
Renewal
Revision
Extension
Supplement
Reinspection
ARCHITECT
Name
License No.
Address
NPs
Telephone
Fax
escription of Work
Zoning
h er - L. 0 _
Linear Feet
City State
7 ic,k%C. -tC_
Square Feet � 00 Units Floors
X Value of Work"' � 3 d 6) Bldg Value
33/3F
Zip
ENGINEER
Name
License No.
P
Address
Telephone
Fax
MIAMI SHORES VILLAGE. FLORIDA
BUILDING ❑
ELECTRICAL ❑ DATE 2 '
PLUMBING V PERMIT N? 9623
ROOFING ❑
Owner of
Building .tom..) i- • rs t t t \ 1 _ t V ie' -
Architect
Contractor
or Builder IAA
Legal Lot
Description
Address of
Building
•
ONTRACTOR OR t)CIILDER
Bl.
7
Work to be performed under this Permit
This permit is granted to the contractor or builder named above to construct the building or to install the equipment or device described in the application
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. i i 7
i .
Signed: { �{ /.." - W l3X`
INSPECTOR
In consideration of the issuance to me of this permit I agree to perform the work covered hereunder in compliance with all ordinances and regulations
pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village.
In accepting this permit I assume responsibility for all work done by either, yself, my agent, servant or employee.
Subdi-
vision j L .
Sq. Ft
Value of
Project $
BY
Contractor's
License No
Amt. of
Permit
t
$2g
AUTHORITY
195
- -'
CLOSETS
BATH
TuSS
SNOW[RR
LAVA.
TOR IES
SI NKS
SLOP
SINKS
LAUNDRY
Tune
URINALS
BASIN
FLOOR
DRAIN
DRINKING
FOUNT'NS
TOTAL
FIXTURES
CONTR.
LIST
CHECK
SEPTIC
TANK
SEWER
CONN.
DRAIN
PI LO
SOAKAGE
PIT
GREASE
TRAP
SOLAR
HEATER
DEEP
WELL
SPRKLR.
SYSTEM
SW IM'O
POOL
CONTR.
LIST
CHICK
I
-
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
Permit No (q Z 7 Date..._.. !_ /1 /"` �i 7
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 Nand 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 Name and Address c 4 No 5 / Street.. 9 3 5-7-
Registered Architect and /or Engineer
Employing Plumber's Name I iO(2 T 4 I+) A� S � c I A(UK .�o a,�.. -., e...e.._.4,._...,... $ SSL �._.,....._..... n ....�_..._
Location and Legal Uesalption Lot Block
Street and Number where work is to be performed -No 4-(CS
State work to be performed and purpose of building (By Floors) _
New Building.
Size Septic Tank_._
Feet of Drain Tile
Nature of Water Supply: City -Well.
Amount of Permit $
Remodeling Addition._ -__ _. _.... Repairs_
Type of Tank
Dist Feet of Tank or Drain Field from Well
Size of Soakage
(Signed) -- l •_ -_-
(slimed)
Q Subdivision
Street... 3 5 /
No. of Stories........._....
The undersigned applicant for this building permit does hereby certify that he understands and accepts his ob t Lions as an employer of labor
under the Florida Workmen's Compensation Act, being Section 8988, Compiled General Laws of Florida Penn ent 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 nab- contractors, work to be performed under thb permit, as are
licensed by Miami Shores Village.
h >-‘
Plumber.
STATE OF FLORIDA, I u
COUNTY OF DADE.
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 Comndssion Expires Notary Public, State of Florida
NOTE: A re inspection fee of $1.00 will be nada whoa once solaapsolfora Y mstio. mammy by Improper notice for Impaction. er fault'
material and /or wrocl®aaship.
PermitNo
2 b
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 regulation of the Building Division
of Miami Shores Village shall be complied with, whether herein specified or not. A copy of approved plans and speclications must be kept at
building during progress of work
Owner's Name and Address b 1--b65
..tegistered Architect and/or Engineer
tMCVA- VIVA-17E9A-4/ s treet.. 9 Avs-
Zrnplo Plumber's Name
Location and Legal Description Lot_
Block_
ubdivision..
Street and Number where work is to be performed—No Street ct
_
State work to be performed and purpose of building (By Floon) ‘PRI ma-I a yerri:g
New Building Remodeling Addition.
Date...
No. 1 fi T
......
Repairs No. of Stories
Size Septic Tank__ of Tank____
Feet of Drain Tile. Dist. Feet of Tank or Drain Field from Well
Nature of Water Supply: City—Well.— of Soakage Pit
Amount of Permit $
STATE OF FLORIDA, }
ss.
COUNTY OF DADE.
(Signed)1
Capacity Gals.
a RscR_
( Signed ) k
My Commission Expires Notary Public, State of Florida
Plumb1n3 Inspector
The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations as an e nployer of labor
under the Florida Workmen's Compensation Act, being Section 5988, Compiled General Laws of Florida Permanent rupi.lement, and Ilan con-
plied with the provisions thereof, and will require similar compliance from all contractors or sub-contractors employed 1 y him in tce wcrk
performed under this permit; and will post or cause to be posted for inspection on the site of the work such publ notice no'icer as
required by the Act. The undersigned agrees to employ only such sub-contractors, on work to be performed • • .ica this wriaii, as ,
licensed by Miami Shores Village.
Mouton Plumber.
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personarr cppearec".
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 be did sign the same, and that all :acts
therein by him stated are true.
NOTE: A re-inspection fee of $1.00 will be made when such re-biped:km is made.neoessary by hnproper notice for inspection, or faulty
materials and/or workmanship.
CLOSETS
BATH
T
SHOWERS
LAVA.
TORIES
SINKS
SLOP
SINKS
LAUNDRY
TUBS
URINALS
CATCH
SAWN
FLOOR
DRAIN
DRINKING
FOUNT'N•
1
1
TOTAL
FIXTL RE•
CONTR.
LIOT
CHECK
---
--..■
SEPTIC
TANK
SEWER
CONN.
DRAIN
FIELD
SOAKAGE
PIT
G
TRAP
SOLAR
11
DEEP
WELL
SPRKLR.
S
SW11140
Pool.
Coperpt.
LIST
CHECK
PermitNo
2 b
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 regulation of the Building Division
of Miami Shores Village shall be complied with, whether herein specified or not. A copy of approved plans and speclications must be kept at
building during progress of work
Owner's Name and Address b 1--b65
..tegistered Architect and/or Engineer
tMCVA- VIVA-17E9A-4/ s treet.. 9 Avs-
Zrnplo Plumber's Name
Location and Legal Description Lot_
Block_
ubdivision..
Street and Number where work is to be performed—No Street ct
_
State work to be performed and purpose of building (By Floon) ‘PRI ma-I a yerri:g
New Building Remodeling Addition.
Date...
No. 1 fi T
......
Repairs No. of Stories
Size Septic Tank__ of Tank____
Feet of Drain Tile. Dist. Feet of Tank or Drain Field from Well
Nature of Water Supply: City—Well.— of Soakage Pit
Amount of Permit $
STATE OF FLORIDA, }
ss.
COUNTY OF DADE.
(Signed)1
Capacity Gals.
a RscR_
( Signed ) k
My Commission Expires Notary Public, State of Florida
Plumb1n3 Inspector
The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations as an e nployer of labor
under the Florida Workmen's Compensation Act, being Section 5988, Compiled General Laws of Florida Permanent rupi.lement, and Ilan con-
plied with the provisions thereof, and will require similar compliance from all contractors or sub-contractors employed 1 y him in tce wcrk
performed under this permit; and will post or cause to be posted for inspection on the site of the work such publ notice no'icer as
required by the Act. The undersigned agrees to employ only such sub-contractors, on work to be performed • • .ica this wriaii, as ,
licensed by Miami Shores Village.
Mouton Plumber.
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personarr cppearec".
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 be did sign the same, and that all :acts
therein by him stated are true.
NOTE: A re-inspection fee of $1.00 will be made when such re-biped:km is made.neoessary by hnproper notice for inspection, or faulty
materials and/or workmanship.