PLUMBINGPermit No._ 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 specifications must be kept at
building during progress of work.
Owner's Name and Address
Registered Architect and /or Engineer
STATE OF FLORIDA, t
COUNTY OF DADE.
ss.
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
Employing Plumber's Name . d ' / " No Street
Block Subdivision
No Street
Location and Legal Description Lot
Street and Number where work is to be performed —No 2 '.- 4 1___Z - Street r, ?t c
State work to be per m d and purpose of building (By Floors)
New Building Remodeling Addition Repairs No. of Stories
Capacity Gals
Size Septic Tank Type of Tank
Feet of Drain Tile Dist. Feet of Tank or Drain Field from Well
Nature of Water Supply: City —Well 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 6bligations as an employer of labor
under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida - Per n nent Supplement, and has com-
plied with the provisions thereof, and will require similar compliance from all contractors or sub- contract9rs emplo`yed„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 wot'k such public nogce or notices as are
required by the Act. The undersigned agrees to employ only such sub - contractors, on work to die performed under `is permit, as are
licensed by Miami Shores Village. ff
( Signed) '
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.
My Commission Expires 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
TUBS
URINALS
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
SW IM'G
POOL
CONTR.
LIST
CHECK
Permit No._ 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 specifications must be kept at
building during progress of work.
Owner's Name and Address
Registered Architect and /or Engineer
STATE OF FLORIDA, t
COUNTY OF DADE.
ss.
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
Employing Plumber's Name . d ' / " No Street
Block Subdivision
No Street
Location and Legal Description Lot
Street and Number where work is to be performed —No 2 '.- 4 1___Z - Street r, ?t c
State work to be per m d and purpose of building (By Floors)
New Building Remodeling Addition Repairs No. of Stories
Capacity Gals
Size Septic Tank Type of Tank
Feet of Drain Tile Dist. Feet of Tank or Drain Field from Well
Nature of Water Supply: City —Well 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 6bligations as an employer of labor
under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida - Per n nent Supplement, and has com-
plied with the provisions thereof, and will require similar compliance from all contractors or sub- contract9rs emplo`yed„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 wot'k such public nogce or notices as are
required by the Act. The undersigned agrees to employ only such sub - contractors, on work to die performed under `is permit, as are
licensed by Miami Shores Village. ff
( Signed) '
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.
My Commission Expires 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.
BUILDING
ELECTRICAL
PLUMBING
Owner of
Building
Architect
Contractor `7
or Builder - d
Legal • Lot
Description
Address of j,v,
Building ' d
PERMIT N? 7540
Work to be performed under this PermiL r /. s
6/,
CON 7hRACTOR R BUILDER
MIAMI SHORES VILLAGE, FLORIDA
Bl.
L3 -
•
Subdi-
vision
Value of
Project
DAT
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 appli-
cation 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 s or in the statements or specifications and that he assumes respon-
sibility for work done by his agents, servants or employees.
Signed �� iJr �: - l — By �t)
INSPECTOR
In consideration of the issuance to me of this permit I agree to performs th work covered hereunder in compliance with -all ordinances
pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Sh
In accepting this perm I assume responsibility for all work done by ither myself, my agent, servant or employee.
BY
ntractor's
icense No.
Amt. of
Permit
AUTHORITY
1 944
egu
fires
ons.
age.'
Permit No 7 :S 0
Owner's Name and Address
Amount of Permit $
STATE OF FLORIDA,
COUNTY OF DADE.
ss.
d -o
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.
No 6 4- - - Street ��L �'+ "• ty - -
Registered Architect and /or Engineer
Employing Plumber's Name V A " — No ;%.
1 - 4 Street--- -
Location and Legal Description Lot Block Subdivision
Street and Number where work is to be performed —No. Street
State work to be performed purpose of building (By Floors)
New Building ' Remodeling Addition Repairs No. of Stories
Size Septic Tank
Feet of Drain Tile Dist. Feet of Tank or Drain Field from Well
.
Nature of Water Suppl : City 'Well Size of Soakage Pit
Type of Tank Capacity Gals
Date
( Signed) ? = — r —
Plumbing Inspector.
The undersigned applicant for this building permit does hereby certify that he understands and accept 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 ( s e performed under this permit, as are
licensed by Miami Shores Village.
(Signed)
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 $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
FOUNT' NS
TOTAL
FIXTURES
CONTR.
LIST
, a
0
�.)
CHECK
/ . , _
/ ''
2
77 'yam
SEPTIC
TANK
SEWER
CONN.
DRAIN
FIELD
SOAKAGE
PIT
GREASE
• TRAP
SOLAR
HEATER
D EEP
WELL
SPRKLR.
SYSTEM
SWIM'G
POOL
/n>�
I
�, - i
CONTR.
LIST
/
/
•
/-"-
7%
a�
CHECK
Permit No 7 :S 0
Owner's Name and Address
Amount of Permit $
STATE OF FLORIDA,
COUNTY OF DADE.
ss.
d -o
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.
No 6 4- - - Street ��L �'+ "• ty - -
Registered Architect and /or Engineer
Employing Plumber's Name V A " — No ;%.
1 - 4 Street--- -
Location and Legal Description Lot Block Subdivision
Street and Number where work is to be performed —No. Street
State work to be performed purpose of building (By Floors)
New Building ' Remodeling Addition Repairs No. of Stories
Size Septic Tank
Feet of Drain Tile Dist. Feet of Tank or Drain Field from Well
.
Nature of Water Suppl : City 'Well Size of Soakage Pit
Type of Tank Capacity Gals
Date
( Signed) ? = — r —
Plumbing Inspector.
The undersigned applicant for this building permit does hereby certify that he understands and accept 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 ( s e performed under this permit, as are
licensed by Miami Shores Village.
(Signed)
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 $1.00 will be made when such re- inspection is made necessary by improper notice for inspection, or faulty
materials and /or workmanship.
Date
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
c 9r Job Address ( S12 7 &rTax Folio I (° 32o to — Or '�"
Legal Description Historically Designated: Yes No
Owner/Lessee / Tenant /2/IVK ° Il Le- 2;i5Z°771, 1 X ic 772 41 Master Permit #
Owner's Address (+ .R9 y P3-PD Phone —J
Contractin Co. LtJ10" ) OO7H � ? Y_/ i L' Address q l/CJ AU J / //W �.
Qualifier 76121L-- (I. ��b lL) SS# Phone 151
State # 5EP30(9 c - C - 1 8'
FEES: PERMIT
Municipal #
Square Ft. 0-
$ /VV19 «
Signature of owner and/or Condo Preside Date
LESTER E. CROC
My Comm Exp.
Bonded By Se
No. CC6493
Notary as to Own d/o1•
My Commission Expires:
RADON
APPROVED:
Zoning Building
Mechanical Plumbing
Competency #
Address
Address
Electrical
Ins. Co.
Architect/Engineer
Bonding Company
Mortgagor Address
Permit Type (circle one): BUILDING ELECTRICAL LUMB MECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIPTION ( sl A`LL D 'f N et.,0
Estimated Cost (value) t r3O0. 0 O
WARNING TO OWNER: YOU MUST RECORD A NOTICE OF COMMENCEMENT AND YOUR FAILURE TO DO SO MAY
RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY (IF YOU INTEND TO OBTAIN FINANCING,
CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT.)
Application is hereby made to obtain a permit to do work and installation as indicated above, and on the attached addendum (if applicable). I
certify that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that separate
permits are required for ELECTRICAL, PLUMBING, SIGNS, POOLS, ROOFING and MECHANICAL WORK.
OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable
laws regulating construction and zoning. Furthermore, I authorize the above -named contractor to do the work stated.
wner- : uilder
TER E. "OCK
My Com P. 5/20
Bonded By Service I
No. CC64932F
Notary as to Co ' . or 8tOwnerNBuildevtner i.o
My Commission Expires:
C.C.F. / . 23 NOTARY
BOND .3 co,
TOTAL DUE - 3 ;4
Engineering
0
T
H
E
R
CON TRUCTION PERMIT FSJR:
[ ] New System [f ] isting System [ Holding Tank
[ \2] Repair Abandonment [ ] Other(Specify)
N
D FILL REQUIRED: [ ]. INCHES
SPECIFICATIONS BY:
APPROVED BY:
DATE ISSUED: Oca,..c,) ,q----
D [ Z — ] SQUARE FEET
R ( ] SQUARE FEET
A TYPE SYSTEM:
I CONFIGURATION:
LOCATION OF BENCHMARK: % TUB <777'1
ELEVATION OF PROPOSED SYSTEM SITE [ 0 ®]
BOTTOM OF DRAINFIELD TO BE [
STATE OF FLORIDA PERMIT #
DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES DATE PAID
ONSITE SEWAGE DISPOSAL SYSTEM FEE PAID $
CONSTRUCTION PERMIT RECEIPT #
Authority: Chapter 381, FS & Chapter 1OD -6, FAC
APPLICANT: KT 3 , AGENT: L
PROPERTY STREET ADDRESS: (760 9V q3 d 5 4
�
LOT: A BLOCK: . SUBDIVISION:
go3:
'U4 Cs� d
Temporary /Experimental
orTH D &,p E
PROPERTY ID #: BOQ 3 2 0c _ U / pj2,y_) [ SECTION /TOWNSHIP /RANGE /PARCEL NUMBER]
[OR TAX ID NUMBER]
SYSTEM MUST BE CONSTRUCTED IN ACCORDANCE WITH SPECIFICATIONS AND STANDARDS OF CHAPTER 1OD -6, FAC
REPAIR PERMITS AND HOLDING TANK PERMITS EXPIRE 90 DAYS FROM THE DATE OF ISSUE. ALL OTHER PERMITS
EXPIRE ONE YEAR FROM THE DATE OF ISSUE. HRS APPROVAL OF SYSTEM DOES NOT GUARANTEE SATISFACTORY
PERFORMANCE FOR ANY SPECIFIC PERIOD OF TIME. ANY CHANGE IN MATERIAL FACTS WHICH SERVED AS A
BASIS FOR ISSUANCE OF THIS PERMIT, REQUIRE THE APPLICANT TO MODIFY THE PERMIT APPLICATION. SUCH
MODIFICATIONS MAY RESULT IN THIS PERMIT BEING MADE NULL AND VOID.
L_
SYSTEM DESI A }�]D IFICATIONS
T [ 7 ] GALLON / GP TI_C TANK /AEROBIC UNIT CAPACITY MULTI- CHAMBERED /IN SERIES:[ ]
A [ ] S / GPD] CAPACITY MULTI- CHAMBERED /IN SERIES:[ ]
N [ ] GALLONS GREASE INTERCEPTOR CAPACITY [MAXIMUM CAPACITY SINGLE TANK: 1250 GALLONS]
K [ ] GALLONS PER DOSE DOSING TANK CAPACITY DOSE RATE [ ] PER 24 HRS NO. OF PUMPS: [ ]
RIMARY DRAINFIELD SYSTEM
SYSTEM
[ ] STANDARD [ ] FILLED [ ] MOUND
[
[ ] TRENCH [ 4-BED [ ]
LOW
Y FT] [ABOVE/ E BENCHM K /AFERENC
] INCHES/ T] [ABOVFOW]JENCHMARK EFERENCE POI
EXCAVATION REQUIRED: C:3 ] INCHES
G .7_
HRS -H Form 4016, Mar 92 (Obsoletes previous editions which may not be used)
(Stock Number: 5744 - 001 - 4016 - 0)
TITLE:
TITLE: E
EXPIRATION DATE: oS clr1
Page 1 of 2
eoo WE T
...............
APPLICANT:
LOT: �� /,�, BLOCK: I
PROPERTY ID #: p 3 q ( 500 [Section /Township /Range Parcel No. or Tax ID Number]
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: [ ]
TOTAL ESTIMATED SEWAGE FLOW:
AUTHORIZED SEWAGE FLOW:
UNOBSTRUCTED AREA AVAILABLE:
BENCHMARK /REFERENCE POINT LOCATION:
ELEVATION OF PROPOSED SYSTEM SITE IS 6 .0 /FT] [ABO , B BENCHMARK/REt!!!!53 POINT
THE MINIMUM SETBACK WHICH CAN BE MAINTAINED FROM THE PROPOSED SYSTEM TO THE FOLLOWING FEATURES:
SURFACE WATER: Q FT DITCHES /SrALES:,',MA' FT NORMALLY WET? [ ] YES ] NO
n
WELLS: PUBLIC: Q3 FT LIMITED USE: U A FT PRIVATE: N,,A FT NON- POTABLE: FT
BUILDING FOUNDATIONS: 5 FT PROPERTY LINES: FT POTABLE WATER LINES: Q FT
SITE SUBJECT TO FREQUENT FLOODING: ] YES
10 YEAR FLOOD ELEVATION FOR SITE: N.T 3.0
SOIL PROFILE INFORMATION SITE 1
Mun ell # /Color Texture Depth e B
1ARC ZAIN‘ (SM 0 toi 7
to
to
to
to
to
to
to
to
USDA SOIL SERIES:
SITE EVALUATED Y:
HRS -H Form 4015, Mar 92 Obsole s previou
(Stock Number: 5744 - 003 -4b 151)
STATE OF FLORIDA
DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES
ONSITE SEWAGE DISPOSAL SYSTEM
SITE EVALUATION AND SYSTEM SPECIFICATIONS
SUBDIVISION: hqN
0
0
OBSERVED WATER TABLE: INCHES [ABOVE /
ESTIMATED WET SEASON WATER TABLE ELEVATION:
HIGH WATER TABLE VEGETATION: [ ] YES [A] NO
SOIL TEXTURE/LOADING RATE FOR SYSTEM SIZING:
DRAINFIELD CONMGURK [ ] TRENCH
REMARKS /ADDI,.h�' dNAL CRITERIA:
i ,/ ) .
YES [' ] NO NET USABLE AREA AVAILABLE: 0li1Z ACRES
GALLONS PER DAY [RESIDENCES -TABLE 1 / OTHER -TABLE 2]
GALLONS PER DAY [1500 GPD /ACRE OR 2500 ,, G�PD /ACRE]
`
SQFT UNOBSTRUCTED AREA REQUIRED: 4106 SQFT
not be used)
AGENT fl (r� [� m1f�'�� ( D
l�� � tit '`U'
SOIL PROFILE INFORMATION SITE 2
Mun -ell r Color Texture
MOTTLING:
b r
USDA SOIL SERIES:
r
BED [ ] OTHER (SPECIFY)
7a
PERMIT C # 6 ifie036.G
10 YEAR FLOODING? [ ] YES ] NO
NGVD SITE ELEVATION:
Depth
to` P2, 9
to
to
to
to
to
to
to
to
/NGVD
EXISTING GRADE. TYPE; PERCHED / Atii4NT]
Q./S INCHES [ ABOVE / EL ] EXISTING GRADE.
[ ] YES [, ] NO DEPTH: PA INCHES
DEPTH OF EXCAVATION: ='' INCHES
DATE: is 4-19a
Page 3 of 3
.'.i: u!r:
[l. U. 1lit
:1
•
:
I.
C.
11 - •
PART II - SITE PLAN
Scale: Each block represents 5 feet and 1 inch = 50 feet.
Site Plan submitted
Plan Approved
By
STATE OF FLORIDA
DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES
APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCT PERMIT
Permit Application.Number 6 R® %6
HRS -H Form 4015, Feb 85 (Obsoletes previous editions which may not be used)
(Stock Number. 5744 - 002 - 4015-6)
Not Approved
ALL CHANGES MUST BE APPROVED BY THE COUNTY PUBLIC HEALTH UNIT
ROT
MIN
i
■
I II1
I .Iil
o `� — 3� 3,
Notes: � � . � ''`� � - 4 Q - - -- - -_-
Sy,t (71 /Ld
AL/ ooto -Cos /9
4
TITLE
Date
County Public Unit
Page2of3
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Date 5 -20 -02 Job Address 680 N.E. 93rd Street Tax Folio
Legal Description Historically Designated: Yes No
Owner/Lessee / Tenant F rank Kr i ston Master Permit # P" , di) ®a ' 1-
Owner's Address 680. N.E. 93rd Street, Miami, Fl 33138 Phone 305- 751 -5379
contracting co. Coastal Plumbing Co. of Miami
Qualifier Robert E. Br i ncef i e l d ss# Phone 305- 651 -4429
State # CFCO -19042 Municipal # 6264 Competency # 6264 Ins. Co. Collinsworth, et al.
Architect/Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIPTION Replace existing electric water heater
Square Ft. Estimated Cost (value) $200.00
A 5
'Signature of owner d/or Condo President Date
Notary as to Owner and,/ . .
Ex
My Commission Expir
FEES: PERMIT
5 -20 -02
ndo President. - ricia Stover Date
th ; I MY COMMISSION # CC839914 EXPIRES
`' June 28, 2003
", ......Q,• BONDED THRU TROY FAIN INSURANCE, INC
/v RADON C.C.F.
Address
APPROVED:
Zoning Building
Mechanical Plumbing
X 'al.e,12 Als h
Signature of Contractor or Owner -B jf. er
285 N.E. 185th Street, Miami, F1 33179
WARNING TO OWNER: YOU MUST RECORD A NOTICE OF COMMENCEMENT AND YOUR FAILURE TO DO SO MAY RESULT IN YOUR
PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY (IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER
OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT.)
Application is hereby made to obtain a permit to do work and installation as indicated above, and on the attached addendum (if applicable). I certify that all work
will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that separate permits are required for ELECTRICAL
PLUMBING, SIGNS, POOLS, ROOFING and MECHANICAL WORK.
OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating
construction and zoning. Furthermore, I authorize the above -named contractor to do the work stated.
•
5 -20 -02
Date
5 -20 -02
Owner- Builder Date
' z Patricia Stover
.\ MY COMMISSION # CC839914 EXPIRES
June 28, 2003
BONDED THRU TROY FAIN INSURANCE, INC
Notary as to Contractor
My Commission Expir
k� ' NOTARY BOND
Electrical
Structural Engineer
TOTAL DUE
INSURED
Coastal Plumbing Co. of Miami
285 N. E. 185th Street
Miami FL 33179
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
CO
,TR
A
A
B
TYPE OF INSURANCE
GENERAL LIABILITY
x COMM. GENERAL LIABILITY
CLAIMS MADE I x IOCC.
OWNER'S & CONTRACT'S PROT
AUTOMOBILE LIABILITY
x ANY AUTO
ALL OWNED AUTOS
SCHEDULED AUTOS
x HIRED AUTOS
X NON -OWNED AUTOS
GARAGE LIABILITY
Collinsworth, Alter, Nielson,
Fowler & Dowling,Inc.(CJN/LRF)
5979 NW 151 Street, Suite 105
Miami Lakes, FL 33014
EXCESS LIABILITY
UMBRELLA FORM
OTHER THAN UMBRELLA FORM
WORKERS' COMPENSATION
AND
EMPLOYER'S LIABILITY
OTHER
I URA
POLICY NUMBER
CAU10012322
CAU10012322
00038261
Miami Shores Village
10050 N.E. 2nd Avenue
Miami, FL 33138
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND
CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE
DOES NOT AMEND. EXTEND OR ALTER THE COVERAGE AFFORDED BY THE
POLICIES BELOW
COMPANIES AFFORDING COVERAGE
COMPANY
LETTER A National Trust Ins. Co.
COMPANY
LEIR $ The FCCI Mutual
COMPANY
LETTER
COMPANY T
LETTER D
COMPANY E
LETTER
POLICY EFF.
DATE ( MM/DD/YY)
5/05/02
5/05/02
5/05/02
POLICY EXP.
DATE (MM/DD/YY)
5/05/03
5/05/03
5/05/03
LIMITS
GENERAL AGGREGATE
PROD-COMP /OP AGG.
PERS. & ADV. INJURY
EACH OCCURRENCE
FIRE DAMAGE(One Fire)
MED. EXP. (One Per)
COMBINED SINGLE
LIMIT
BODILY INJURY
(Per person)
BODILY INJURY
(Per accident)
PROPERTY DAMAGE
EACH OCCURRENCE
AGGREGATE
'STATUTORY LIMITS
EACH ACCIDENT
DISEASE - POLICY LIMIT
DISEASE -EACH EMP.
ISSUE DATE ( MM/DD/YY)
0 5/07/02
2000000
2000000
2000000
1000000
1000Q0
5000
1000000
100000
500000
100000
DESCRIPTION OF OPERATIONS /LOCATIONS/VEHICLES /SPECIAL ITEMS
................... ...............................
CERTIFICATE HOLDER
..... ...............................
CANCELLAT101
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO
MAIL 1(() DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE
LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR
LIABILITY OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES.
AUTHORIZED NTATI
A �
ORD2
,S:090
1.
Miami Shores Village
10050 NE 2nd Avenue
Phone: 305 - 795 -2204
Printed: 5/29/2002
Applicant: DOROTHY
Owner: KRISTON
JOB ADDRESS: 680 NE 93
Contractor COASTAL PLUMBING COMPANY OF MIAMI Contractor's Address: 285 NE 185 ST
Local Phone:
Parcel # 1132060141500
Fees:
FEE2002 -3045
FEE2002 -3046
If there is no permit packE
fee is $50.00, which must be
This Permit is granted to the contra
ordinances pertaining thereto and wit
and approved by the proper municipa 2
authorization. A further condition up( ;
ordinances and regulations pertaininc
by his agents, servants or employees s
Signed:
In consideration of the issuance to
with the plans, drawings, statements
myself, my agent, servants or emplo
I
PAY
TO THE
ORDER OF
Description
Building Fee
CCF
Total Fees:
Permit Status: Approved Permit Expiration: 11/20/2002
Work: REPLACE EXISTING ELECTRIC WATER HEATER
WACHOVIA
Signed:
Legal Description:
Wachovia Bank, NA.
North Miami Beach, FL 33162
FOR Plumbing Permit
Plumbing Permit
Permit Number: PL2002 -129
KRISTON
DOROTHY
ST
MIAMI SHORES VILLAGE
MIAMI SHORES SEC 3 PB 10 -37 LOT 10 & W1/2 OF LOT 9 BLK 63 LOT SIZE
Amount
$65.00
$0.60
$65.60
Construction Value:
COASTAL PLUMBING COMPANY 03 -82
OF MIAMI
CC NO. 6264
285 NE 185TH STREET
MIAMI, FL 33179
1000 7 7 2 20 1 :0670L3S641:
$200.00
I.) s to i, i:. i►'. i..1 1 ; jOiS it ri
Page 1 of 1
15
Total Fees: $65.60
Total Receipts: $0.00
L4 2 LO 84911'
DATE May 29, 2002
63- 1356/670
BRANCH 04055
I $ 65.60
DOLLARS