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OCCUPANCY7 2 7 Er N° 1084 CERTIFICATE OF OCCUPANCY MIAMI SHORES VILLAGE, FLORIDA BUILDING DIVISION Miami Shores Village, Fla., Owner, Agent or Tenant of Building Lot t: "(' ' block / Subdivision Street Address Approved use by occupancy Remarks: / .."`"- This Certificate of Occupancy is issued to the above named for building at above named location only upon the express provision that the applicant will abide by and comply with all conditions of Ordinances Nos. 92, 93, 94 and 97, known as the Zoning, Electrical, Plumbing and Building Ordinances of Miami Shores Village pertaining to the erection, construction, alteration or remodeling of buildings or structures. Bt6ILDING DIvlpIQN C .0.2.13_51 PAID BY Dean Clausssen (o) YEAR ANNUAL TAX PERIOD USED AMOUNT PAID DATE PAID NUMEBEPT R ) 9!-I ' - ' /; 1 .,�� _,_ /_ - ,9/- /9J /a. /a --v- -, I j ADDRESS 5 25 N. E. 92nd Street 12 & 11 Block , #5? LEGAL If S 342 RECORD GARBAGE TAX OWNER'S NAME .Dean_ C1ausaen PRESENT ADDRESS LICENSE NO. PHONE NO. _� . JOB LOCATION (ST. OR AVE.) 325 N. E. 9 - et LOT 12 an E1? BLOCK 7 SUBDIVISION Sec 2 . GENERAL CONTRACTOR Dean R. Claussen , AD PHONE NO. LICENSE NO. Q BUILDING PERMIT NO. 954 DATE 9/140 PERMIT FEE $ 14 BUILDER'S BOND NO. DATE ZONE REQUIREMENTS 17,500 CU. FT. PLAN CUBE 19.298 CU. FT. EST. COST $ 10,000 Pete Gaeta DRAWINGS, SPECIFICATIONS. RESTRICTIONS AND CUBE CHECKED BY Pete Gaeta 9/1/50 NEW CONSTRUCTION TYPE STORIES ROOF CONSTRUCTION INTERIOR CONSTRUCTION _ _ __ REPAIRS DESCR IPTION ALTERATION DESCRIPTION ADDITION SUBMITTED TO PLANNING BOARD APPROVED REJECTED REFERRED TO COUNCIL REASONS RE-SUBMITTED TO PLANNING BOARD SUBMITTED TO VILLAGE COUNCIL REMARKS CERTIFICATE OF OCCUPANCY NO.00/94 ISSUED2`� /3 ti BY �,7p k T O A C i eoe ,� Bj BUILD PER AND INSPECTION RECORD- 1S4IAMI SHOES VILLAGE INSPECTIONS DATE BY RE- INSPECT BY RE- INSPECT BY FOUNDATION PERMIT NO. DATE FEE TEMPORARY SERVICE $ H. W. HEATER CONN. BEAMS & LINTELS /20/50 „J;;. RANGE CONN. $ SEWER S FRAI•ING 10/19/50 TJJH $ FIXTURES $ GAS $ $ $ INSPECTIONS $ FINAL 9 0? /p TP Pc RE- INSPECT BY RE- INSPECT BY CLEAN -UP CONTRACTOR F. Jones - 7th Avenue PHONE PERMIT NO. 9994 1 DATE 9/13/50 FEE $ 11.75 NEW BLDG. X 1 ALTERATION 1 ADDITION REPAIRS SPECIAL PERMITS PERMIT NO. DATE FEE TEMPORARY SERVICE $ H. W. HEATER CONN. $ SEPTIC TANK $ RANGE CONN. $ SEWER S MOTORS $ SOLAR HEATER $ FIXTURES $ GAS $ $ $ INSPECTIONS $ INSPECTIONS DATE BY RE- INSPECT BY RE- INSPECT BY ROUGHING e . is-5D I RC ROUGHING 10/19/50 GAS SEWER H. W. HEATER CONN SEPTIC TANK RANGE CONN. SOLAR HEATER FIXTURES l02 - /9_c o 1 G nn FIXTURES & FINAL 1�(- - /,�%'SG /`6 CONTRACTOR Jennings Electric Co. PHONE PERMIT NO. 10 DATE 10/17/50 FEES 11 REPAIRS NEW BLDG. X ALTERATION 1 ADDITION SPECIAL PERMITS PERMIT NO. DATE FEE TEMPORARY SERVICE $ H. W. HEATER CONN. $ RANGE CONN. S MOTORS $ FIXTURES $ $ INSPECTIONS DATE BY RE- INSPECT BY RE- INSPECT BY TEMP. SERVICE ROUGHING 10/19/50 .TLH H. W. HEATER CONN RANGE CONN. nn FIXTURES & FINAL 1�(- - /,�%'SG /`6 BUILDING INSPECTIONS PLUMBING PERMITS & INSPECTIONS ELECTRICAL PERMITS & INSPECTIONS APPROVAL TO POWER CO. FOR SERVICE DATE /2. - 45 -7 :1 . 0 BY ,/ � DATE: NAME OF PERSON REQUESTING FILE: PHONE #: ✓ J 3 6 3,- Y2YOUR ADDRESS: ADDRESS OF FILE REQUESTED: c-.-2/- A� 2 f V S r INFORMATION REQUESTED: I understand that all documents in this file are property of Miami Shores Village and that NO documents may be removed from this file. You may get 4 complementary copies (8x11) size, additional copies will be furnished at 0.15 cents per page, not including any blue prints. If blue prints are order please be aware that we are not responsible for the quality of the printed documents. Acknowledged by: FILE RETURNED TO: INITIAL Miami Shores Village Building Department 10050 NE 2 Ave, Miami Shores, Fl 33138 Tel: (305)795 -2204 - Fax; (305)756 -8972 PLEASE PRINT 0 TIME: r Date Type Insp'n Permit No. Name Address Company Phone # Inspection Date Approved Correction Re- Insp'n Fee MIAMI SHORES VILLAGE BUILDING DEPARTMENT 305- 795 -2204 Build' g Inspection Request - t (Rev. 04/24/03) Address Building Officials Approval: Miami Shores Village Building Department Certificate of Re- Occupancy s;‘ Ai qc. ki, Permit No. Date The following residence is issued a Certificate of Re- Occupancy 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795 -2204 Fax: (305) 756 -8972 City Miami Shores State Florida Zip e 3N This certificate verifies that the referenced property has been inspected by Miami Shores Village and has been determined to presently comply with the schedule of regulations of the Miami Shores Land and Development Code pertaining solely to the requirement that each one - family dwelling is used and intended to used for a one - family dwelling purpose only; however, this certificate does not constitute any representation or warranty as to the condition of the dwelling or other structures on the premises described herein, or any aspect of such condition, and interested persons are advised and encouraged to make their own inspection of the premises in order to determine the condition thereof. Rev. 10/02/03) • RE- OCCUPANCY APPLICATION Date -I -LA -Roos Miami Shores Village Building Department Contact Name ") e ` n1,loc W) Buyer Seller Realtor Property Address City Miami Shores Applicant Name Signature 5a5 /icu-e • 1J2Lum4 State Fl Zip 33\ I hereby certify that I understand that the zoning of the property is for single - family residential use and that it is unlawful for more than one family to reside therein. I also understand that any Certificate of Re- Occupancy that may be issued by Miami Shores Village certifies only that the referenced property is being used for single - family purposes and that such Certificate does not constitute any representation, warranty or certification as to the condition of the dwelling or other structures on the property. OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate. The foregoing instrument was acknowledged before me this �,` day of t -p d , 200S by jalc Who is personally known to me or who has produced as identification and who did take an oath. NOTARY PUBLIC: Sign: Print: A F-, L c6 $2, k. My Commission Expires: k - , Y TT i o . 9_ ') , yi. �li�� C .... Las E. uNDLEY *? iY i MY COMMISSION # DD 361851 itt `: SX IIRTMSND80BRI 8f 115,, 22008 Building Officials Approval: 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795 -2204 Fax: (305) 756 -8972 Permit No. 3O 9- LocID (0C4 35 Phone # - 3)5 ° II ,y — 5J3 pany Nam40.1 U\ti�llCims I Re -Occ. $60.00 Notary CCF Total $5.00 $0.60 —LZU 1/101 STATE OF FLORIDA DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION AND INSTALLATION PERMIT Applicant 15 - 6. - 4 l� Z, C $fib ,E; Per it Number 87 �� T � -7r92 -PART II - SYSTEM INSTALLA ION INSPECTION AND Fl AL NST IPROVAL 7 Tank Manufacturer /1/4 Proper tank legend: Yes No /IA Tank materialatiCie W Tank level: Yes No / .__CA Tankswatertight: Yes____ No Tank size• gallons gallons gallons Proper tank outlet device: Yes v No Manhole or marker to grade: Yes No 44 Dralnfield Trench Absorption Bed Q / 7) I`sth Width9tr Mtn Length �eet x feet =24___ 2 feet feet 1 feet feet Length feet x feet = ft feet feet i feet feet Proper No. drainlines: Yes ✓ No feet feet feet feet Proper pipe separation: Ye 2 v No Total = ft = Total // ft 2 Distribution box level: Yes No Systems located as permitted: Yes No d1 /,� Systems including plumbing stub -outs installed at proper elevation: Yes No d/A Installer Other findings. �i i Average depth to drainpipe invert from finished grade 2� in ches Maximum depth: 2 Inches Average depth of drainfield gravel: inches Minimum depth of gravel. 12" inches Proper gravel size: Yes. V No Gravel is suitable quality Yes No Backfill or fill material ajequired: (Quality) Yes _1i_ No P Inspected by: / H. -------------- - ---------_......•------------ -- ----- PART III - FINAL INSTALLATION APPROVAL HRS —H Form 4016, Jan 86 (Replaces Feb 85 edition which may be used) (Stock Number: 5744-002- 4016 -4) (Quantity) Yes No ?\, Date f- /3 -17 Date i / qpproved by: G 6d4' l /I& t/i ' L �$- COUNTY PUBLIC HEALTH UNIT AN APPROVED INSTAL TION ES NOT GUAR TEE PERFORMANCE Note: Completed copies of this form will be provided to the applicant, installer and the building department. Page 2 of 2