295 NE 94 St (2),c2
(7-
APPLICANT:
AGENT:
PROPERTY ADDRESS:
LOT: �d
/,3 BLOCK: ?c" SUBDIVISION: Ili SA 5 57 ' �
=s = —as _____ as
CHECKED (X] ITEMS ARE NOT IN COMPLIANCE WITH
____- = ====s= ===== ===wa=s:=
TANK INSTALLATION
[01] TANK SI8E [1] 900 [2]
[02] TANK MATERIAL l= G^C -r°Ye
[03] OUTLET DEVICE ¢
[04] MULTI- CHAMBERED [ Y / ]
,[05] OUTLET FILTER
'106] LEGEND /11
[07] WATERTIGHT
[08] LEVEL / n 1 !
'[09•) DEPTH TO LID - - r J' / (
•
1
1
1
l
1
1
1
1
1
[115]
[16]
CONSTRUCT
FINAL
r 1'
STATE OF FLORIDA
DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATXHNT AND DIPOSAL SYSTEM[
CONSTRUCTION INSPECTION AND FINAL 'APPROVAL
L1 J�
se
FILL / EXCAVATION MATERIAL
[22] FILL AMOUNT
(23] FILL TEXTURE
[24] EXCAVATION DEPTH
(25] AREA REPLACED.
[26) REPLACEMENT MQ►TERIAL
[APPRO
29 P(I qI 97
EXPLANATION OF VIOLATIONS / REMARKS:
(APPROVED/DISAPPROVED]:
VED /DISAPPROVED]:
2�^
DRAINFIELD INSTALLATION 3e36
[10] AREA [1]/Or/ SQFT
[11] DISTRIBUTION BOX _ HEADER
[12] NUMBER OF DRAINLINES. t
(13] DRAINLINE SEPARATION
(14] DRAINLINE SLOPE
DEPTH OF COVER
ELEVATION.[ABOVE /BELOW] BM
[17] SYSTEM LOCATION
[18] DOSING PUMPS ti14
[19] AGGREGATE
[20) AGGREGATE EXCESSIVE FINES
(21] AGGREGATE DEPTH
STATUTE OR RULE AND MUST BE CORRECTED.
DH 4016, 10/97 (Previous, Editions May Be Used)
/DISAPPROVED] : •J f
]unstalller / Contractor
PROPERTY ID 1 :J/ 3206 74
SETBACKS
(27] SURFACE WATER
[28] DITCHES
(29] PRIVATE 'WELLS
(30] PUBLIC WELLS
[31 ] IRRIGATION WELLS 7s •
[32) POTABLE WATER LINES ,$()
[33] BUILDING FOUNDATION /0
[34] PROPERTY LINES /9 - FT
[35] OTHER FT
FILLED / MOUND SYSTEM
[36] DRAINFIELD COVER
[37] SHOULDERS
(38] SLOPES
(39] STABILIZATION
ADDITIONAL INFORMATION
[40] UNOBSTRUCTED AREA
[41] STORMWATER RUNOFF
[42] ALARMS
[43] MAINTENANCE AGREEMENT
[44] BUILDING AREA
[45] LOCATION CONFORMS WITH SITE PLAN
[46]. FINAL SITE.GRADING //
[47] CONTRACTOR P, /5
( 0T
ABANDONMENT
] (49] TANK PUMPED _,/_ /
] (50] TANK CRUSHED i FILLED _ /_/
Mt)
PERMIT NO.
DATE PAID*
FEE PAID:
RECEIPT #t
4'�- 3Ss8/L
l - /7—aa
c-
•
FT
FT
FT
FT
PT
FT
FT
CHD DATE: /,7 26-01_
CND DATE : 17- 1 17 -
Page 2 of 3
PERMIT NUMBER: Permit tracking number assigned by CHD.
APPLICANT: Property owners fun name.
AGENT: Property owners legally authorized representative.
MAILING ADDRESS: P.O. box or street mailing address for applicant or agent.
LOT, BLOCK, SUBDIVISION Lot, Block and Subdivision for lot or
PROPERTY ID#: 27 character number for property. (property appraiser ID* or GIS location)
COUNTY HEALTH DEPARTMENT CHECKS [X] ITEMS NOT IN COMPLIANCE WITH CONSTRUCTION PERMIT AND
STATUTE OR RULE. INFORMATION IS COMPLETED BY CHD ON FOLLOWING ITEMS:
TANK SIZE (gallons)
TANK MATERIAL (concrete, fiberglass, etc)
OUTLET FILTER (manufacturer, make, model)
LEGEND (manufacturer code)
DRAINFIELD AREA (square, feet)
DISTRIBUTION BOX / HEADER (check box)
NUMBER OF DRAINLINES (number installed)
SYSTEM ELEVATION (in relation to BM)
DOSING PUMPS (number installed)
SETBACKS (record actual setbacks in ft)
SETBACKS OTHER (as required)
STABILIZATION (date stabilized)
CONTRACTOR (contractor installing system)
ADDITIONAL INFORMATION (as required)
ABANDONMENT TANK PUMPED (date)
TANK CRUSHED AND FILLED (date)
EXPLANATION OF VIOLATIONS: Record item number, explanation of vitiation, and required
CONSTRUCTION APPROVAL: Circle approved or disapproved, CHD signature and date.
AS BUILT INSTALLATION SKETCH
FINAL APPROVAL: Circle approved or disapproved. CHD signature and date of approval.
Final approval shall not be granted unit the CHD has confirmed thatbuilding construction and lot grading are in substantial
compliance with plans and specifications submitted withth'e permit application.
ELEVATION WORKSHEET ELEVATION OF BENCHMARK OR REFERENCE POINT:
EXISTING GROUND TOP OF AGGREGATE
[+1 SHOT H.I. H.I. H.I.
H.I. [ -] SHOT [ SHOT [ ] SHOT
ELEVATION
'
STATE OF FLORIDA
DEPARTMENT OF HEALTH AND REHABILITATIVE.SERVICES
ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION AND INSTALLATION PERMIT
Applicant (ZJ, y , l e �li� /oc / y�l Permit Number g7 M INSTAL TI
PART II - SYSTEbN I NSPECTION AND FINAL INSTALLATION APP -
Installer /J 0/I/2 9/7 Tank Manufacturer �/
Proper tank legend: Yes /V�l Tank material Tank level: Yes 47
Tanks watertight: Yes /il� Tank size• ons gallons — gallons
Proper tank outlet device: Yes No !/ Manhole or marker to grade: Yes _ZP)*(c>
Dralnfield Trench Absorption Bed
Length Width Leigth Width Length - - - S feetx CM'S feet= 2)6
feet feet feet feet Length '_... feet x feet ft
feet feet feet feet Proper No. drainlines: Yes v No
/
feet feet feet feet Proper pipe separation: Yes N oo
Total = ft Total = ft Distribution box level: Yes ___F,106. ,fQ�
Systems located as permitted: Yes " No
Systems including plumbing stub -outs installed at proper elevation:
Average depth to drainpipe invert from finished grade: 2 inches
Average depth of drainfield gravel I ` inches Minimum depth of gravel inches
Proper gravel size: Yes V" No Gravel is suitable quality: Yes v No
Backfill or fill material as required: (Quality) Yes
Other findings• i< -ice f9/
„U
�_- - : �
/-,4- 57 0-14
Inspected by: C.)
Date / - a :Approved by:
AN APPROVED INSTALLATION DOES NOT GUARANTEE PERFORMANCE
!e: Completed copies of this form will be provided to the applicant, installer and the building department.
Form 4016, Jan 86 (Replaces Feb 85 edition which may be used)
/ oau mbar: 5744-002-4016-4)
Yes /v x(0
Maximum depth C`' Inches
L - No (Quantity) Y-s t/-
PART III - FINAL INSTALLATION APPROVAL
f�
Date /— ?_ $�
UNTY PUBLIC HEALTH UNIT
Page 2 of 2
And further this Deponent says not.
AFB' I1
SUBSCRIBED AND SWORN TO BEFORE ME THIS DAY of
2.
1. Signature of Applicant.
2. Signature of Officer administering oath.
//,es, / e. "44D/F,P
A. D., 19
STATE OF FLORIDA) SS
COUNTY OF DADE '/
4 S' a ,,,,deg of the Village of Mani Shores, County of Dade and
State of Florida, being duly sworn, doth depose and say that under the provisions
of Section B -368, Sub - section (d), of the Building Code of Miami Shores Village
he desires to build 4L -4N /I ' , 5 /E/yC4 on Lot 22-/-03
Block ; of ,*(45: F� . subdivision; that he is the owner of said
property, and will do the work personally, and that he will, at such times as are
required by the Zoning and Building Director: -
1. File plans and specifications and obtain approval ,f Village Planning Board
and of the Building Inspector.
2. Apply for and secure a permit.
3. Pay the required fees for license and for permit.
4. Execute the work in accordance with the provisions of the Zoning, Building,
and Electrical Codes of Miami Shores Village.
5. Apply for inspections. •
•
6. File with the Building Inspector certificates that provision has been made
to carry the necessary Workmants Compensation, Public Liability and Rroperty
Damage Insuranco.
7. File with the Building Inspector as the job progresses certificates showing
the payment required by the Federal Social Security Act to the State of
Florida or the United Spates of America.
8. Assume the responsibility of not employing contractors or sub - contractors
other than those properly licensed by Miami Shores Village or any part or
portion of tho work including, but not limited to, general contracting,
plumbing, heating, electrical, septic tank, solar system, lathing, tile,
torrazo, painting, roofing and shoot metal work or installation.
9. Not sot himself up as a "Contractor ".
10. Execute Builder's Bond.
NICKOLAS C. BERRY
YELVA MONTES
295 N.E. 91st Street
Miami Shores, Florida 33138 -3127
Phone: (305) 754 -5783
Building and Zoning Department
Miami Shores Village
10050 N.E. 2nd Avenue
Miami Shores, Florida 33138
Dear Sirs:
Re: 295 N.E. 91st Street
On September 1, 1994, Bennet Electric Co. secured a
permit from you in order to upgrade the electrical system of
our house. The permit did not specify that the house was re-
wired, pulling all the cloth wires and replacing them with
copper conductors.
On October 4, 1994, Mr. Mike Devaine, from your office,
inspected the entire job and approved it. After the
inspection, Mr. Devaini amended a copy of the permit,
specifying that the job also included the rewiring of the
house.
Enclosed please find copy of the permit No. 36779, as
amended by your inspector. We would appreciate if you make
this amended permit part of the file that you have on our
house, so that it accurately shows the job that was done.
Thank you very much for your attention to this matter.
Sincerely yours,
BUILDING ❑
E CTRICAL - PERMIT
PLUMBING
h ROOFING - ❑
Owner of Y)
Building
t)
Architect
Contractor i J
or Builder ` L L
Legal Lot II
Description � 11 B1
Address of c %S NE 7/
Building
MIAMI SHORES VILLAGE, FLORIDA
/ !ii
Date 19
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 applica-
tion 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 i:i 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 s ecififations and that he assumes respon-
sibility for work done by his agents, servants or employees.
Signed • +' (INSPECTOR) BY
In consideration of the issuance to me of this4ermit 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 1 assume responsibility for all work done by either, myself, my agent, servant or employee.
CONTRACTOR or BUILDER BY
N° 36779
Work to be performed under this Permit
( C .S6V / L /3 3
Subdi-
vision
Sq. Ft.
Value of ..r. 11 Amount of
Project �� 11 Permit $
/..7 SG'/ r tic/ C
y �c7 � sAV
Contractor's
License No
S
AUTHORITY
eij
NOTICE OF COMMENCEMENT a :16493110669
A RECORDED COPY MUST BE POSTED ON THE JOB SITE AT TIME OF FIRST INSPECTION
PERMIT NO. TAX FOLIO NO.
STATE OF FLORIDA:
COUNTY OF DADE:
THE UNDERSIGNED hereby gives notice that improvements will be made to certain real property, and in accordance with
Chapter 713, Florida Statutes, the following information is provided in this Notice of Co encement.
1. Legal description of property and street address: a t N 0 1 ,
2. Description of improvement:
3. Owner(s) name and address:
Interest in property: ; jbtr
Name and address of fee simple titleholder:
Lo°► a t 1'C . Wtaet re) uel,.
5. Surety:(Payment bond required by owner from contractor, if any)
4. Contractor's name and address:
Name and address:
Amount of bond $
6. Lender's name and address:
6N 4 II A3 21A.AA0 • N1 o41
K( A
M/A
7. Persons within the State of Florida designated by Owner upon whom notices or other documents may be served as provided
by Section 713.13(1)(a)7., Florida Statutes,
Name and address:
,Va
8. In addition to himself, Owner designates the following person(s) to receive a copy of the Lienor's Notice as provided in
Section 713.13(1)(b), Florida Statutes.
Name and address:
N
K
9. Expiration date of this Notice of Commencement: (the expiration date is 1 year from the date of recording unless a
different date is specified)
RECORDED IN OFFICIAL RECORDS 8001
Q0-0/ - c Ee&t.rr, FLORIDA.
RECORD VERIFIED
HARVEY R11VIN,
Cleft of Circuit & Cnuqgy
Courts
Signature of Owner _ 4 „
•°
Print Owners Name : ` � �� S
Sworn lo and subscribe ti bjore + i 3 clay of fit/9 (1S.1 , 19 1 1 y
°
Notary Publ V _ • ° ' ,�
Print Notary's Name t--'•
My Commission Expires: my co
9484 1285n foot p114 2°15=53
S
Prepared ANP 1r1 r
Address: MCC Of LI t d
12301 -52 2/93