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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