457 NE 95 St (10)MIAMI SHORES VILLAGE, FLA.
N? 6291
JOB J� A S
ADDRESS 4 AJ- �. �� 6
INSPECTION - r► -
TIME READY 41 "x"- - 7 .-
REMARKS•
J
INSPECTOR
DATE 7 - -
MIAMI SHORES VILLAGE
BUILDING DEPARTMENT
305- 795 -2204
Building Inspection Request
Dat
Type lnsp'n Q�
Permit No. L 01N 11 ICJ
Name 2:/.1A
Address y S l 1\ ' C -,
"— , )? c �
Company �
Phone #
Inspection Date 2
Approved
Correction
Re- Insp'n Fee
MIAMI SHOR /LLAGE
BUILDING DEPARTS E
305- 795 -2204
Building Inspection Reque
Date eln
Type Insp'n Pax t 1 C ,e
1 - 001 - 17
Name PcJfla
Permit No.
Address 451 1 vE c1154
Company
Phone #
Inspection Date
Approved
Correction
Re-Insp'n Fee
IC, -
Address
Company
MIAMI SHORE//VILLAGE
BUILDING DEPARTMENT
305- 795 -2204
Building Inspection R- • est
Date
Type Insp'n � () /� f I
Permit No. r 1 0 q -1
Name KC31 (*V)
(45 1 K*__ qs54-
66 b Sep -1r .
Phone #
Inspection Date
Approved
Correction
Re -Insp' n Fee
BUILDING
PERMIT APPLICATION
FBC 2001
Permit Type (circle): Building
Owner's Name (Fee Simple Titleholder)
Owner's Address I S , ,� IQ
City j l ,s V l.O\C_ S State
Tenant/Lessee Name
Job Address (where the work is being done)
City Miami Shores Village
Is Building Historically Designated YES
City
Qualifier 13 b PR-12_;11_4.-
Architect/Engineer's Name (if applicable)
$ Value of Work For this Permit
Type of Work: ❑Addition
Describe Work:
Submittal Fee $ Permit Fee $
Training/Education Fee $
Radon $
Notary $ S 00
Scanning $ ', 06
Code Enforcement $
(Continued on opposite side)
r
Miami Shores Village
Department
.E.2nd Avenue, Miami Shores, Florida 33138
Xl� T (305) 795.2204 Fax: (305) 756.8972
Electrical
VI VI - Ve'r
Plumbing
State
['Alteration
q67 NI- 95 St
County Miami -Dade
NO X
Contractor's Company Name I Vjii lone #
Contractor's Address / 0 4.), � ! 1 2S
Mr's
VA4
['New
b 7124 - b
Structural Plan Review. $
Total Fee Now Due $ L \ 5 ' ` e-u 0 (o 193
Permit No. QLD-00 _ /?.
Master Permit No.
Mechanical
Phone # 305 - - 7S 7
S
Phone #
Zip
Phone #
Zip 3313
�OS
33i
Square Footage Of Work: 1)/4-
Repair/Replace
* * * * * * * * * * * * * * * * * * * * * * * * * * ** F * * * * * * * * * * * * * * * * * * * * * * * * * * * **
Roofing
❑ Demolition
Co 2
d,A
CCF $ - _ • I , CO /CC
Technology Fee $ "1 , 31
Zoning Bond $ '00
Bonding Company's Name (if applicable) N
Bonding Company's Address Al
/i) ( 3
City State Zip
Mortgage Lender's Name (if applicable) y
Mortgage Lender's Address
City State Zip
Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has
commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulating
construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRICAL WORK, PLUMBING, SIGNS,
WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and AIR CONDITIONERS, ETC
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.
"WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT 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."
Notice to Applicant: As a condition to the issuance of a building permit with an estimated value exceeding $2500, the applicant must
promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person
whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site
for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the
inspection will not be approved and a reinspection fee will be charged.
l
Signatur
Chc 12/15/03
i Owner or Agent ' Contract
The f egoing ilfstr unent was cknowledged before me this // The foregoing instrument was acknowledged before me this 1
f1/0 day o 204, b A\ * / at 1 A ,vLT ` day of > , 20 Oy by who is personally known to me or who has produced �), U L who is personally own to me or who has produced
Qs 3S "/ ` 0 - -- /)As identification and who did take an oath.
NOTARY PUB IC:
Skgn:
Pnn.
My Commission Expires:
NOTARY P
/I\ Sign:
Print:
∎Anu
e .
ondul
in
asi ti
My Commission Expires.
***************************************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
h . � elY ' an oath.
ommli's9
1 13, 2007
u
* * * * * * * * * * * * * * **
(Certificate of Competency Holder)
State Certificate or Registration No. Certificate of Competency No.
* * * * * * * * * * * * * * * * * * * * * * * * * ** * * * ** ************************************ * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
APPLICATION APPROVED /16��G - / 5 ' 5 Plans Examiner
Engineer
Zoning
• PROPERTY ID #:
1 t
SYSTEM DESIGN AND SPECIFICATIONS
T
E
R
DH 4018, 10/98 (Replaces HRS -H Form 4018 (page 11 which may be used)
(Stock Number: 5744- 001 - 4018 - 0)
Applicant
P
STATE OF FLORIDA lit Oki 14 �t, (f 4 L? u
DEPARTMENT OF HEALTH
ONSITE SEWAGE DISPOSAL SYSTEM
CONSTRUCTION PERMIT
Authority: Chapter 381, FS & Chapter 10D -6, FAC
O �. r'�,. `2\/ L
PERMIT # " �t
DATE PAID (a -) 1 - o '.
FEE PAID $ /6 0 0 v
RECEIPT AE a ,j 0 {v 1 16
1 1 - 2 I[ -/
CONSTRUCTION PERMIT FOR:
[P )0 System (! -) Existing System (N-] Holding Tank [ ] Temporary /Experimental
( ] 1 ( N�) Abandonment (0) Other(Specify)
APPLICANT : ? (1.) N 1 (- . J i w .GENT: 1� G. 4:� S Q � ? I C ( i-4 w. .L
PROPERTY STREET ADDRESS: 4
� — G�'� r C e�t4 ) L \ ; J 3 2 7 j i G ... •
LOT: 1 r )1 , ? z BLOCK: J 3 SUBDIVISION: r ///
! 7
2 06 0 ' l - U J ECI O ID NOWNSHIPJRANGE /PARCEL NUMBER]
(OR T
SYSTEM MUST BE CONSTRUCTED IN ACCORDANCE WITH SPECIFICATIONS. AND 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. DEPARTMENT OF HEALTH 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.
1 ,- • I I
c f- r
T [C-/ () 0) [G,ALLQ�(S / GPD) SEPTIC TANK/AEROBIC UNIT CAPACITY M CHAMBERED IN SERIES:(/)
A [ / r j (GALLONS / GPI)] CAPACITY MULTI- CHAMBERED /IN SERIES:( )
N [ 1 GALLONS GREASE INTERCEPTOR CAPACITY [MAXIMUM CAPACITY SINGLE TANK: 1250 GALLONS]
K [ j GALLONS PER DOSE DOSING TANK CAPACITY DOSE•RATE [•'] PER 24 HRS NO. OF PUMPS: [ j
D [ a j J] SQUARE FEET PRIMARY DRAINFIELD SYSTEM
R ( ) SQUARE FEET / SYSTEM
A TYPE SYSTEM: (!) STANDARD [ J FILLED [ ) MOUND [ ]
I CONFIGURATION: ( ) TRENCH [ •1 BED [ )
N /i c-S kJ , C — j.Jt t, r ` 1 Q✓'
F .LOCATION OF BENCHMARK:
I ELEVATION OF PROPOSED SYSTEM SITE [►q,2] [INCHES /FT] [ABOVE BELOW BENCHMARK /REFERENCE POINT
E BOTTOM OF DRAINFIELD TO BE ( - 1 , Z C) ] [INCHES FT] (ABOVE /BELOW BENCHMARK /REFERENCE POINT__
L
D FILL REQUIRED: (N "'f) INCHES EXCAVATION REQUIRED: [ 3 r)) INCHES
/ + !
SPECIFICATIONS BY ) I TITLEi.• ;•'„ ( � ii •. C. • �1:V
' (� �' TITLE: cl_A CHD
APPROVED BY: My (�� t•t / / %;�v
!
DATE ISSUED: lam( 1 !!' , ,4 EXPIRATION DATE: ?� (t;
111
Page 1 of 2
STATE.OF FLORIDA
DEPARTMENT OF HEALTH
APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PER
Permit Application Number � G J
(. i / c /
PART 1I - SITE PLAN
Scale: Each block represents 5 feet and 1 inch = 50 feet. / aZ / 6AcS M6&
• i
•5E
''i'7.4!4: EA
-t-4
t
•
By
' l its'et 11)
DH 4015. 1098 (Replaces HRS•H Form 4015 which may be used)
(Stock Number: 5744- 002 - 40154)
ir-
i )
+i I - 4- r, . I. t � l
l j t + - • T
7 1 1 ; ; • •t • '
r i i i u
Notes: Els L e \ SE Er , � , k I A . LaY.-,1 -lii , FY 14 )I-1 --- 91 2 -R;e F 4"A;IJk, \,
�p lfIC \ ti 1,u1 A,a:uo qoo g-A, L CAS q '. .k d. In u 11') 0ChA m b6 (A 0) I kpp/col/oi obTu-i-
-\!, c,t "L V U 1Y AA Uf /1 -- J { C t I.) A - 3 cn 6) L/ r l VIL-r1 1 1 o k,_
A Il / St ' ;TgAc.)LS u'
b6 Pl'.
Site Plan submitted by: �; _ 1-// w Signature
Plan Approved ✓ Not Approved
ALL CHANGES MUST BE APPROVED BY THE COUNTY HEALTH DEPARTMENT
ir
> i 3
/.u e'LL
4e
4-
Title 1
Date co/
County Health Department
Page 2 of 3
Miami Shores Village
10050 NE 2nd Avenue
Phone: 305 - 795 -2204
Printed: 6/15/2004
Applicant: ALBERT QUINTON
Owner: QUINTON ALBERT
JOB ADDRESS: 457 NE 95 ST
Contractor BOBS SEPTIC & DRAIN INC
Local Phone: 305 - 558 -5818
Parcel # 1132060140630
Plumbing Permit
Permit Number: PL2004 -176
Contractor's Address: 1020 NE 130 ST
Legal Description: MIAMI SHORES SEC 2 PB 10 -37 LOTS 20 & E1/2 LOT 19 & LOT 21 & 22
Fees: Description Amount
FEE2004 -6125 Building Fee $175.00
FEE2004 -6126 CCF $1.80
FEE2004 -6127 Notary Fee $5.00
FEE2004 -6128 Training and Education Fee $0.60
FEE2004 -6129 Technology Fee $4.37
FEE2004 -6130 Scanning Fee $3.00
FEE2004 -6131 Builders Bond $300.00
Total Fees: $489.77
Total Fees: $489.77
Total Receipts: $489.77
Permit Status: APPROVED Permit Expiration: 12/11/2004 Construction Value: $2,500.00
Work: REPLACE SEPTIC TANK AND REPLACE DRAINFIELD
Page 1 of 1
Signed: (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 responisibility for all work
done by either myself, my agent, servants or employes.
Signed: (Contractor or Builder) BY:
APPLICANT
PROPERTY ADDRESS!
1
TANK INSTALLATION
[01] TANK SHE
[ 02 ] TAP= MATERIAL
[ 03 ]
[ 04 ]
[ 05 ]
[ 06 ]
[ 07 ]
[ 0 ]
[ 09 I
FILL
[ 11) [22J
[ [22.j
[ (24]
[ [251.
[ '] [261
, •
OUTLET XlEvr=
MULTI-CAMBERED
OUTLET F
LEGEND
WATERTIGHT Ci
LEVEL
DEPTH TO LID
DRA IELD INSTALLATION
(10] MA 1 1/CXA: 6 13] SQFT
[ 11] DIsTRimpriati $OX "IlirrADEA
[12] NUMBER OF MAINLINES
[ 13 ] PRA 1111, INN EMANATION
[ 14] muumuu: taLopis
[ 15 I DEPTH OF COVER 0 Cb 9"
) =MATZOS! (ABOVE/WILOW] EN
[ 17 ) SYSTEM LOCATION
[ 16 ] DOS IND PUS P
[ 19] AGGREGATE SIZE
0 el
201 AGGREGATE EXCESSIVE PINES 0
[21] AGO/MATS DIP= / 261
ItzeavAnou kumazaz
rzu. mptuer Zs
FILL TEXTURE
EXCAVATION WPM
ONS.TRUCTXON
1rATE OF FLORIDA
DEPARTMENT OF HEALTH
ONSITE ANNAGNi4NEATNENr AND
CONSTRUCTION INSFBCT/ON AND
[ 2]
ZAW "
XSASPROVEDI
INAL SYSTEM [APPROVED 41 SASPROVEDP
E 4016, 10/97 Pr-wrious Edition* Way Rag
7
PERMIT WO.
DATE PAID:
DIPOSAV- SUITEN g:Figirtitiii
FINAL AppRovAr., RECEIPT 1:
LOT a l ELOCEC s
e`" EgraMISIQN1.,//e( 9f,
•
PROPERTY ID # a
=========mmummam===========
aims= [1] ITEMS ARE NOT IN COMPLIANCE WITH STATUTE OR :-RuL. 11101 BE CORRECTED
,• , • .• -
===============m= . . ... •
/ SETBACKS
[ 1 [ 27] SURFACE WATER •-
• ), [28] DITCHES
f (29] PRIVATE WELLS'
[ 6, ', [30] PUBLIC WELLS /
l L/ r31 1 raItztattioN-maLLS - :5''' - 'FT
/2c4 4 (32 1 POTABLE WATER LINES P,: FT
I I( 1„ [ 33] ''' BUILDING' FOUNDATION . 72/ FT
( el [ ;4] PROPERTY LINES i'ir FT
[ ] [ 35 ] OTEER' ' ' ' --- - ' - ' ' , ''' ' FT
FILLED / MOUND SYSTEM
[ 1 [ 36 ] DRAINFIELD COVER
E ] [37] SMOULDERS
(38] SWIMS
3 ,( 391 STABILIZATION
. t
PC
••••••••--- = =
VT
pT
FT'
FT
ADDITIONAL INFOIUDIIION
140) Am ,.,
(/1 [ ] SwommaaTut - RUNOFF
I A ( 42 I ALARMS
] [431 satiNTENANcE AGREEMENT
1 ( 44] auzzpING.ARaa
t 1 (451 LocaTioN cxyaroinu; WITH SITS PLAN
[ 1.461 raNAL giamie
(47) CONTRACTOR
OTHER
AREA HEMMEN I "7 •
a
r mu* pump=
REPLACEMENT NATERV4 - 34 ' 449. , 1. 7.:1-,,tacti TAN =MED a PuzD771/0/
apioaNavcas OF VIOLET IONS REMUS
f /7
CND DATE
CE• DATE
/7
Page 2 of 3
00/
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