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353 NE 94 St (8)Type Insp'n Address MIAMI SHORES VILLAGE BUILDING DEPARTMENT 305- 795 -2204 BBui ding Inspection Request Date 8 .94 Time T {n P(orn3. Permit No. P 1 aP Name `'" VO.V10/ 353 Nt(,. q`A1 - , Compan • Donf ppableP Phone # For Inspector: Approved Correction ❑ Re -Insp' n Fee Date Type Insp'n Permit No. t" n Company Phone # For Inspector: 10 Approved Correction Re- Insp'n Fee MIAMI SHORES VILLAGE BUILDING DEPARTME 305- 795 -2204 Building Inspection Reque 3 -213 Name PeleAnn Address S E> q "� v Date Legal Qualifier State # Owner/Lessee / Tenant Owner's Address Contracting Co. FEES: PERMIT APPROVED: Zoning Mechanical PERMIT APPLICATION FOR MIAMI SHORES VILLAGE Address `" ' V 9V 5 axFolio //3 e2 O t!, — 013 Z-0 // / n Historically Designated: Yes No -TJ24/ Master Permit # � n �! Phone '044 5 2,o52011., otary as o Own ek an d/d My Co ssion Expires: Municipal # / / ) / Competency # Address Address Architect/Engineer Bonding Company Mortgagor Address Permit Type (circle one): BUILDING ELECTRICA ' LUMBING ECHANICAL ROOFING PAVING FENCE SIGN WORK DESCRIPTION Square Ft. Estimated Cost (value) 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 Condo President ate -341- D P GCSr 0 IcIAIMOT RV�c 0 r 6 ANGELA M sE CKER )Cr.1 cOMWSSION NUMBER • 90'-9 Q CC 786697 MY COMPASSION EXPIRES �� O m F FAO NOV. 15,2002 RADON Building Plumbing C.C.F. QD Address / d ' C'3�hg .� U / Ins. Co. / / l / 00 , e /f)e._ ;I. • 1 1 e 1; "lK " p it. i .� I VILIAR NOTAFN PUBLIC SPATE OF FIARIDA COMMISSION NO. CC71410S Y COMMISSIOIs1 EXP. MAR. ..= a ■ L1) uilder ontractor or Sign Notary My Co NOTARY to Contractor o ssion Expires: Electrical ate Structural Engineer MIAMI SHORES VILLAGE BUILDING DEPARTMENT 305- 795 -2204 Building Inspection Requ Dat Type Insp'n _.J\. - 7 Permit No. Name Address Company Phone # Inspection Date Approved Correction Re- Insp'n Fee MIAMI SHORES VILLAGE BUILDING DEPARTMENT 305- 795 -2204 Building Inspection Request Date 13 Type Insp'n T' V Permit No. P1 c&3 - Li Address 3S3 f J E ""I `'l J4" Company ILO 0 Phone # 0S 51 3 4- Name Inspection Date Approved Correction Re- Insp'n Fee - 1.- - - -f: _11.1rI_II__ .... '_____. •• _ . 'TT _TI, ....47.- . 4 ' '`.-' • 4 ' • , . , ' - . I I : : I Ins all • r‘illn 1 Imm- _____ - _ -4- 4 ' !Wk._ , • 1 4 - ,- - 't t ■ 4,_, 1-. , ....:— T, 1 ' ' --' , / , -al --t.-4 - I • . • t 1 4, • Nino - - _ - 4:4— ■ i _ ..., , -. -.1 .., - ---t FT •-■ . -, , .• , . ... I al II Mae # - ,, I ! ; ' '. -, ; ',. 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Ak-45 aulessaas niii ••• 4 maul VI • liati /Kid twirroliinspausirmamosimmeror. frin- tie 4a pir 1_4131 • . • _IIIIIL , 4 i ;, 4 , L. . , .._, +I.., . _ I C -1---+ .. , . / , T .--r--- . -1--, --_ 4._-..,- -,-- -." , ._ ti- i•t 111111111 ..... 11111.11111111 11•••11111•11111 1111111111011111 1111111111111.1. IIIIMIIIM 1 IVIAIMIS r " . ,, i,.... IMMO 11•1211111118 I 10111•110011•• MERE il ■ . f +. -- - _ .. A ,AA A 4 4 - , - 4, - 4 II : ar , - - .1111161inutini• - 4 .. i , f - i , NM t , logionnummilmmumf 4 ' _ 4 1 . - -4- •••11601i •• Mike • nunironnommiggin ILI 1 UWE iirm 111 g n P ni III .., „ -/ _ ' 11121111111 tir 4. i -± •;•• • 4-- L I ; , r i --4- .. . i - :-. -i- -)--- ' t 4- i i I r 1 ' ' ■ i ' -- f 1 - - STATE OF FLORIDA DEPARTMENT OF HEALTH APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PERMIT Permit Application Number Scale: Each block represents 5 feet and 1 inch = 50 feet. Notes: floinE tb9 5cpric - rigiul.S ) ee sq/ £ OA) Exi5 soD gc th p6,_ Cro-T CM A Pi 6r Site Plan submitted by: Plan Approved 014 4015, 10I96 (Replaces HRS41 Ferns 4015 which may be tssed) (Slack Number 5744-002-4015-6) 6 •F PART II - SITiE PLAN Not Approved e- 4 zzt E 4ft (4' in Atleta 5/2--0 '9"///6, g/0 Sigrture Title Date By County Health Department ALL CHANGES MUST BE APPROVED BY THE COUNTY HEALTH DEPARTMENT Page 2 of 3 CONSTRUCTION PERMIT FQR: [] New System [ Existing System Repair [lei] Abandonment APPLICANT: & 0 O g ' AGENT: 74;14 0 I M P � 1 PROPERTY TREET ADDRESS: q A p LOT: G e BLOCK: SUBDIVISION: PROPERTY ID 7DF: nn 4 Q p [OR TAX ID NUMBER] SYSTEM MUST BE CONSTRUCTED IN ACCORDANCE WITH SPECIFICATIONS AND STANDARDS OF CHAPTER 10D -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. Pl i k , ) SYSTEM DESIGN AND SPECIFICATIONS N ) , V F LOCATION OF BENCHMARK: - 4) 1 !(A ;S" LO ON 61 1 V'*,- ' N. 1 a 17 I ELEVATION OF PROPOSED.- SYSTEM SITE [4- T] ] [INCHES/ [ABOVE /BEL BENCHMARK /REFERENCE E OTTO 9F,,,DRAI'NFIELD TO p E' [ 'W ] [INCHES /FT] [ABOVE /BELOW] BENCHMARK /REFERENCE I1_ ` FI .L, REQUIRED:' [: , , 1 0 j 'v p 1 t i v T K [ D [ 4 ®0] SQUARE FEET PRIMARY DRAINFIELD SYSTEM R [ ] SQUARE FEET SYSTEM A TYPE SYSTEM: [] STANDARD ] FILLED [ Ai ` MOUND I CONFIGURATION: ( kJ] TRENCH [ ] BED [4\]A / L H E R SPECIFICATIONS BY: APPROVED BY: [GALLONS [GALLONS GALLONS GALLONS STATE OF FLORIDA DEPARTMENT OF HEALTH • ONSITE SEWAGE DISPOSAL YSTEM CONSTRUCTION PERMIT 0 Authority: Chapter 381, 1 j / GPD] E IC TA K /AEROBIC. UNIT CAPACITY MULTI- CHAMBERED /IN SERIES:I / GPD] F ( GREASE INTERCEPTOR CAPACITY [MAXIMUM CAPACITY SINGLE TANK: 1250 GALLONS] INCHES! ( F .} 1 � CAPACITY MULTI- CHAMBERED /IN SERIES:( ) PER DOSE DOSING. TANK CAPACITY DOSE KATE [ ] PER 24 HRS PERMIT # "A -Ye./ DATE PAID Oat —O V °B PCB FEE PAID $ 9 • O Q RECEIPT #g0eA rd-- 9 CA(, 1t }OD -6, FAC 43. c, q_.7 i3 L i? / d' f � `/ /1 Holding Tank [ ] Temporary /Experimental [ A]/Other(Specify) 4a44 P-x3 [SECTION /TOWNSHIP /RANGE /PARCEL NUMBER] EXCAVATION REQUIRED: [301 w4 INCHES IS NOI INVEFIT E L - a OTTON OF CRAINFE` LD r:iEVAVIC. TITLE: V� , r EXPIRATION THE SIE,'F��1 .ilf A Fi( IE E, Par E r° a MLID r V E „��,, rc� � � t� ? L U 62;} 3 1 ! LIT TEE DH 4016, 10196 (Replaces HRS -H Form 4016 [page 1] which may be used) (Stock Number: 5744- 001 - 4016 -0) DATE 'ISSUED: 0• -nl a Applicant s NO. OF PUMPS: [ POINT POINT DATE: o Page 1 of 2 CHD INSTRUCTIONS: PERMIT NUMBER: Permit tracking number by County Health Department. APPLICATION FOR: Check type of permit; if "Other" specify type in blank. APPLICANT: Property owner's full name. TELEPHONE: Telephone number for applicant or agent. AGENT: Property owner's legally authorized representative. MAILING ADDRESS: P.O. box or street mailing address for applicant or agent. LOT, BLOCK, SUBDIVISION or PROPERTY ID #: 27 character ID number for property. (Health Department may require property appraiser ID# or section /township /range /parcel number.) SYSTEM DESIGN AND SPECIFICATIONS: TANK: Minimum specifications from Chapter 10D -6, FAC. DRAINFIELD: Minimum specifications from Chapter 10D -6, FAC. OTHER: Other specifications, such as operating permit requirements, low- volume flush toilets, variance provisos. SPECIFICATIONS BY: Name of individual providing specifications. If designed by a registered engineer must be sealed. APPROVED BY: County Health Department personnel reviewing and approving permit. DATE ISSUED: Date permit is issued by County Health Department. EXPIRATION DATE: One year from date issued if the system has not been installed. Permits for system repairs become void 90 days from the date issued. 4 PAY TO THE ORDER OF Miami Shores Village 10050 NE 2nd Avenue Phone: 305 - 795 -2204 Printed: 1 /29/2003 Applicant: KEVIN Owner: TROIKE JOB ADDRESS: 353 NE 94 Contractor Local Phone: 305 - 558 -5818 Parcel # 1132060136110 Fees: Description Amount FEE2003 -551 Building Fee $80.00 FEE2003 -552 Buildier's Bond $300.00 FEE2003 -553 CCF $1.20 Total Fees: $381.20 Total Fees: $381.20 Total Receipts: $0.00 • Permit Status: Work: 200 DRAIN FIELD BOBS SEPTIC & DRAIN INC APPROVED Permit Expiration: BOB'S SEPTIC & DRAIN, INC. 1020 NE 130TH ST. PH. 305- 558 -5818 NORTH MIAMI, FL 331 61 -421 1 Legal Description: MIAMI SHORES SEC 1 AMD PB 10 -70 LOT 12 & W2OFT OF LOT 13 BLK 45 LOT SIZE 7/28/2003 is - -- :- .... .... . ... :+ . ,er 4 �nn arroeeihlp on the iob -site for inspectors to verify, there will be no inspections. Re- inspection _4 tumr -r�r,;mus - . :;ufinennunF -a�rrc�a-'— �� r�:�rau - 63- 865537 4 C2-65. DATE 2660 6 4 fe -ge // r! `- DOLLARS U citibank® CITIBANK, F.S.B. BR. 037 2750 AVENTURA BOULEVARD AVENTURA, FL 33180 FOR Plumbing Permit Permit Number: PL2003 -30 TROIKE KEVIN ST Contractor's Address: 1020 NE 130 ST Construction Value: 0005 5 2011' I: 266086 5 54u: 2 LO 2 706069u $2,000.00 5520 Page 1 of 1 n herefor in strict compliance with all ions that may have been submitted to f the plans are changed without ibility for a thorough knowledge of the he assumes responsibility for work done )ertaining thereto and in strict conformity lonisibility for all work done by either • • • • • • • • •• • •• • •... • • •• sacia �� ee " `" State • JO T40IKE •,� • • KEVIN HN ST 38_OOQO • 353 I 99 0 &ES mow` 331 to, 10-08-1992 10_01-60 401.0-07-.199 1620_510_60-361-0 ^ \I4; 08 :1,gq 810 • • • • .• • • • • . � . .•• • • • •• • •• •• • • ..•• • • • • • •• •• r A N K 01/23/2603 13:04 =055133472 CONSTRUCTION PERMIT [ JNew System [ X JR.enair APPLICANT: Troike, Kevin STATE OF FLORIDA DEPARTMENT OF HEALTH ONSITE SEWAGE TREATMENT AND CONSTRUCTION PERMIT FOR: }Existing System }Abandonment PROPERTY STREET ADDRESS: 353 NE 94 8t Miami Shores FL 33138 LOT: 12 BLOCK: 45 SUB.DIVISICN: Miami Shores No. 1 [Section /Tonne 11 ip%Range; Parcel No.) [OR TAX ID NUMBER] P,=.:CPERTY IO #: 11-3206-013-6110 [ CSTOS: • ••• • • • • .. • • • •• •. • • • • • • • • • • • • ••• • • • • . • • • • • DISPCSstt'sIs tR • • • • • • • C- •• ••� Holding Tank l+?Lemporary .. SYSTEM DESIGN AND SPECIFICATIONS 750 0 0 [ 0 J Ga 11ons SEPTIC TAM. ] Gallons }GALLONS GREASE INTERCEPTOR CAPACITY ]GALLONS DOSING TANK CAPACITY [ 0 ]GALLONS [0 [ 200 ]SQUARE FEET PRIMARY DRAINFIELD SYSTEM [ 0 ]SQUARE FEET SYSTEM TYPE SYSTEM: • [ }STANDARD CONFIGURATION: N }TRENCH OTTER REMARKS. dN,: 'Cif( ^M:1a; ZF. POr•P9 ? P.N9 f ;;R:." DEFI.FG3[Ct■ JE.11117, t< BFtSVI Q:F(LiV arc SPECIFICATIONS BY: Icasa, Carlos APPROVED 2Y: Icasa, Carlos DATE ISSUED: 1/23/03 [ N (FILLED [./ ' ] BED 1 E L D FILL REQUIRED:[ 0.0 }INCHES EXCAVATION REQUIRED: ( This permit is not for addition(s). *Existing 750 gl.septic tank to remain. •Install 200 aq.ft. of drainfield. *Invert elevation to be no leas than 5.20' NGVD. *Bottom elevation to be no lees than 4.70' NGVD. TITLE: t'H 4016, •3/91 :Onsole•ces previous editions which may nfit 'oe used) (4rr. -k !: urrtae. S' :. -V01- 0016 -01 .n- i.a.,_cone_i)1G •' -1 TITLE: Engineer S CENTRAX #: 13 -SG -15257 DATE PAID: ••• FEE .PAIC RECEIPT . • •• aSTDSNBR 03 -0173- -R • • • • • [ ] Innovative ..I.N,•1 AGENT dR4911 :11%P�rZILLAAROBERT •• • ♦ • • • ••• •• r. ` FAGE 01 Other SYSTEM MUST BE CONSTRUCTED IN ACCORDANCE WITH SPECIFICATIONS AND STANDARDS OF CHAPTER 64E -6 , FAC DEPARTMENT APPROVAL OF SYSTEM DOES NOT GUARANTEE SATISFACTORY PERFORMANCE FOR ANY SPECIFIC TIME PERIOD. ANY CHANCE 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. ISSUANCE OF THIS PERMIT DOES NOT EXEMPT THE APPLICANT FROM CCtdPLIANCE WITH OTHER FEDERAL, STATE OR LOCAL PERMITTING REQUIRED FOR PROPERTY DEVELOPMENT. MULTI - CHAMBERED /IN SERIES: [Y ] MULTI - CHAMBERED /IN SERIES: (Y ] ]DOSES PER 24 HRS # PUMPS[ 0 } D Fi A [ N ]MOUND ( N ] I [ N ] F' LOCATION TO BENCHMARK: TO of Botto�t Y10Or, 10.10' NGVD. ELEVATION OF PROPOSED SYSTEM SITE ( 2.9 ] [ FEET ] [ BELOW ] BENCHMARK /REFERENCE POINT BOTTOM OF DR.AINFIELD TO BE [ 5.4 ) [ FEET ] [ BELOW ] BENCHMARK/REFERENCE PCI.NT 30.0 ; INCHES iiiRS PER `7i'T':S ;4(7 F:II 4 1DDITI9N(S) 1N 1 .1 . 3.. .v 7Q! _5-2.c, DorraNi OF DRAT. 1'.2i_LI• Dade CHD EXPIRATION DATE: 4/23/03 Page 1 cf 2 s AP I CANT: AGENT PROPERTY ADDRESS: LOT sssssress>r sssssss sasacs CHECKED [X] ITEMS ARE NOT IN CONPLIBBEE WITH sla. . =ss.asacswam.....sssssssssss TANK INSTALLATION (01) TAW $ISi [1) 7 n [2] (02] TANK MATERIAL }� (03] ,OUTLET DEVICE 1J k. -f Lo'. , [04] MULTI - CHAMBERED [ / ] [05] OUTLET FILTER Npr�,rt [06] LEGEND psi /1 WATERTIGHT LEVEL DEPTH TO LID I,:] ( 7 ] ( ] [08] ( I 1 1 l 1 l 1 l STATE OE FLORIDA DEPARTMENT 07 HEALTH ONBITE SEWAGE TREATMENT AND DIPOSAL SYSTEM CONSTRUCTION INSPECTION AND FINAL APPROVAL hc/) Fro,,- BLOCK: ` ( Th SUBDIVISION: mr • 51' y PROP ID 1# l / 6 - DRAINFIILD INS IO11N )3Q (10 ) AREA [ 1 ] 1 d L [ 2 ] /C.') SQFT . ✓ [11] DISTRIBUTION SOX spsi (12] NUMBER OF DRAINLINES _ (13) DRAINLINE SEPARATION 3L (14) DRAIHLINE SLOPE (15) DEPTH OF COVER [16] ELEVATION [ABOVE /BELOW] BM (17] SYSTEM LOCATION [18] DOSING PUMPS 0 k (19 ] AGGREGATE SIZE Al0 . ' r)• 1, l (20) AGGREGATE EXCESSIVE FINES [21] AGGREGATE DEPTH FILL / EXCAVATION MATERNAL [22] FILL AMOUNT [23] FILL TEXTURE 1 [24) EXCAVATION DEPTH [25] AREA REPLZ.CED [26] REPLACEMENT MATERIAL STATUTE OR Rmi AND MT/IOU 0 (28] [29] (30] (31] [32] [ (34) (35] TILLED / MOOED SYSTEM (36) 'DR/a: WIELD COVER 07 ] SHOULDERS [38] SLOPES (39] STABILIZATION ADDITIONAL INFORMATION PERMIT MO. G DATE PAID: FIE PAID: RECEIPT 0: MN)RT BE CORRECTED. FINAL SYSTEM , [APPaOVRD /DI><APPROVED] : c In ^^ CHID DATE DE 4016, 10/97 (Previous. Editions Kay Be Used) PT 1: Applloenl PT 2: Installer /Contractor P7 3: Building Department PT d: Health Department SURFACE MATER DITCHES PRIVATE WELLS PUBLIC MILLS IRRIGATION MLLE POTABLE WATER LZlas SUILDIIW FOU>INDATION PROPERTY LIMES $ OTHER MULTM:MMIEZMILIC 111ssss : : s: FT FT FT FT FT FT FT FT FT [40] UNOBSTRUCTED AREA (41] 1TORMATER R(JNorF [42] ALARMS (13] MAINTENAiC1 AQREE14DNT (44 ] BUILDING AREA [45] LOCATION CO3IFORM$ •WITH SITE PLAN (46] FINAL RITE [ 4 7) COXTR&C TOR u % 7 (4 S ] OTHER ] [49] TANK PUMPED / / ] (50] TANK CRUSHED NG FILLED — / / — EXPLANATION OF VIOLATIONS / REMARKa' [ l [ ( 1 [ l � CONSTRUCTION, "'[ APPROVEDOI SAPPROVED ] 1 � ` ? �^ v� p C CUD DATE Page 2 of 3 >2- ELECTRICAL T1'PE Minimum Fee QTV. TYPE Dryer QTV. : ; '� VP E Outlet ittidialice QTY. TYPE: Service Repair 1"I'V. A/C Central 1 -3 Ton Fan . • • OutICt, Wan "' •• Ventilation, Cost Service, Temporary Air Handler, Tons A/C Central 4 -7 Ton Piping, Flammable Liquid Fire Pump Outlet, Switch Fire Sprinkler System Signs A/C Central 8 -15 Ton Bath Fan - Vented, # Fixture - Fluorescent Pressure Vessel Oven Space Heater (kw) A/C Central 16 -20 Ton Fixture Light Parking Lot Lights Spas/Hot Tubs A/C Central 20+ Ton Flood Lights Plugmold/Strip Subfeeds, No. of Amps A/C Window FPL - Load Central Posts Swim Pool, Commercial Air Conditioners Garbage Disposal Range/Range Top Swim Pool, Residential Chiller Generators, etc. Receptacles Switchboards Clear Violations Heat Recovery Refrigerator, Comm. (p/PH) Temp Serv., Construction Compactor Low -volt, Burglar Refrigerator, Domestic Temp for Test - 30 days Deep Freezer Low -volt, Fire Renew - Temp Service Water Closet Demolition Low -volt, Intercom/Teleph. Repair Circuits Water Heater Dishwasher X) Low -volt, Television Service, Number of Amps Water Heater New MECHANICAL TYPE Minimum Fee QTY. TYPE Condensate Drain QTY. TYPIi. Generator QTY. TYPE Refrigeration, Tons QTY. A/C Central, Tons Cooling Tower Heating Strips, each Vent Hood, Cost A/C Wall/Win. Tons Dryer Vents, Number of Paint Booth Ventilation, Cost Solar Water Heater Air Handler, Tons Ductwork, Cost of Piping, Flammable Liquid Periodic Inspections Barbecue Fire Sprinkler System Process/Pressure Piping Cap - Fixture Bath Fan - Vented, # Fireplaces, Number of Pressure Vessel Pump and Abandon PLUMBING TYPE A/C Condensate QTY. TYPE Drains, Roof QTY. TYPE, Miscellaneous Fixture QTY. TYPE Soakage Pit QT1'. Bath Tub Drinking Fountain Miscellaneous Repairs Solar Water Heater Bidet Filter Replace Pool Piping Sprinkler Repair Cap - Fixture Fountain Pump and Abandon Sprinkler System Cap - Water Gas - Appliance Pump, Domestic Supply, AC Well Cap - Sewer Gas - Natural Pump, Fire Stand Temporary Toilet Catch Basin Gas - Propane Pump, Re- circulate Temporary Water Closet Clothes Washer Gas Piping Pump, Replace - Pool Urinal Dental Chair Grease Trap Pump, Sprinkler Utility - Sewer Discharge Well Ice Maker Pump, Sump Utility - Water Dishwasher Indirect Wastes Relay Repair Vacuum Pump Disposal Interceptor Roof Inlet Water Closet Domestic Well / Laundry Tray Septic Connection Water Heater Drainfield, 4" Tile/Res. X) Lavatory Septic Tank Water Heater New Drains, Area Meter Set (Gas) Sewer Connection Water Re -pipe Drains, Floor Minimum Fee Shower Water Service Drains, French Miscellaneous Equipment Sink Well, Supply Page 3 • • • • • •• • • • • • • • • • • • • • • • ••• • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • ••• ••• PERMIT APPLICATION •• INSTRUCTIONS: Please indicate the type of work being perform ei and clluait tity4ies) in the space provided below. IP IV • RECEIVED AND REVIEWED BY: DATE: Page 4 OFFICE USE ONLY ❑ OWNER - BUILDER FORM (Attach) ❑ FIRE DEPARTMENT APPROVAL (Commercial / multi- family) ❑ CONCURRENCY (New Construction) ❑ OTHER (Specify & Attach) $3.00 per page (Scanning Fee) Miami Shores Village Bond Metropolitan Dade County (C.C.F.) Inspector State Educational Fund State DCA (Radon) Code Enforcement Fine Zoning Review Notary • • • •• • • • • • • • • • • ••• • • ••• • • • • • • ••• • • • • • • • ••• • • CIIECKLIST • • • d •PROOP OP AVNL43HIP (Attach) •• ••• •• • • • •• Zt mat /:DtCR2VIek1sA) OW • ( �' 9ewer3 • • •• . . • • . • .• ❑ IMPACT FEE (New Construction) •• •• • • • • • • • • • ❑ OTHER (Specify & Attach) (0-4• gv, oc) $ (30o $ /e a0 ( sq.ft. = x/1000 x0.60) $ (0.005 /sq.ft.) $ (0.0I /sq.ft.) $ '0O SECTION Zoning Electrical Mechanical Plumbing Fire Public Works Structural Building Official BY DATE PERMIT APPLICATION ❑ CONDO ASSOCIATION APPROVAL (Attach) ❑ BPR APPROVAL (Restaurants) ❑ CONTRACTOR REGISTRATION (On File) PERMIT FEES TOTAL $ 3 a ' o! 0 ISSUING OFFICIAL REVIEWED AND PREPARED BY: DATE: CONDITION OF APPROVAL Revised July 2001 10050 N.E. 2ND AVE., MIAMI SHORES, FL • (305) 795 -2207 • FAX (305) 756 -8972 • http : / /www.miamishoresvillage.com III Page 2 IMPORTANT NOTICES 1. DO NOT BEGIN ANY WORK WITHOUT 19A,yI19G }2ECEIV1 D YlN,JR VAI. PERMIT AND PERMIT CARD. Applying for a permit does not grant the right to begin construction. HOURS OF CONSTRUCTION arefifrfted to Monday through Friday from 7:30 a.m. to 6:00 p.m., and Saturday from 8:00 a.m. to 5:00 p.m. No inspections will be conducted on weekends or holidays. 2. All construction of demolition areas MUST BE MAINTAINED IN A CLEAN, NEAT AND SANITARY CONDITION free from construction debris. 3. STREETS AND NEIGHBORING PROPERTIES tklALLl3F.IZb DIRT AND DEBRIS. 4. SWALES MUST BE PROTECTED FROM BEIM DAMAG613 BS' elQtI1T L1EN OR VEHICLES, AND MAY NOT BE USED FOR STORAGE. A bond is required for work in or near the street/sidewalk. • •• ••• • • • • • •• 5. CONSTRUCTION TRAILERS ARE PROHIBITED ON SINGLE FAMILY RESIDENTIAL CONSTRUCTION SITES. Other construction may have a trailer which requires a separate permit. 6. PORTABLE TOILETS for a construction site require a separate permit. 7. DO NOT DISCHARGE WATER INTO THE RIGHT OF WAY OR STORM DRAINS without approval from the Building, Planning and Zoning Department. 8. EQUIPMENT AND MATERIALS SHALL BE STORED at least 10 feet from the edge of pavement. 9. Department of Health and Rehabilitative Services (HRS) approval is required for applications involving septic tanks. Department of Environmental Resources Management (DERM) and/or Miami -Dade Water and Sewer Department (MDWASD) approval is required for applications involving sewers. AFFIDAVIT - Please read carefully. Application is hereby made to obtain a permit to do work and installation as indicated. I, the OWNER of the property, 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, POOL, EXTERIOR DOOR, MECHANICAL, WINDOW, FENCE, DRIVEWAY, ROOFING and SIGNS and there may be additional permits required from other governmental agencies. I, the OWNER of the property, have disclosed all information related to any work at the property performed in the prior twelve months to the Building Official. Further, I am fully aware that if the cumulative cost of work to my home or business under this and any other permit equals or exceeds fifty percent (50 %) of the fair market value of the structure, the entire structure must meet the present federal flood criteria for finished floor elevation. I am also fully aware that if the total cost of work to my home or business under this and any other permit exceeds fifty percent (50 %) of the replacement cost of the structure, then the entire structure must conform to the current code requirements of the Building Code. WARNING TO OWNER: Your failure to record a NOTICE OF COMMENCEMENT may result in you paying twice for improvements to your property. If you are spending more than $2,500 or intend to obtain financing, you may wish to consult with your attorney or lender before recording your Notice of Commencement. The Notice of Commencement must be recorded at: 22 N.W. 1st Street, 1°' Floor, (305) 679 -1078. Once recorded, the Notice of Commencement must be POSTED AT THE JOB SITE in accordance with Section 713 -35 of Florida Statutes. Review the brochure at Village Hall on Construction Lien Law and Choosing a Contractor. ature of Owner STATE OF ' ORIDA OUNTY OF IAMI -DADE S int Name Sworn to nd ubscribed before me this a day o Signature of N i . s . c N4d • on i • My Commission DD150048 1, ; - 0 ,,, 0 Expires November 15, 2006 SEAL: Personally known • •• •• • • • • • • • • • • • • • • • • ••• • • • • • • • • • • • • • • • • •••. • ••••••• • STATE 0 " • RIDA C h'tJNT Signat Print ame Sworn to and subscribed before me this �O day o Sig . ure of N SEAL: h• • PERMIT APPLICATION Florida 04"avia4c Angela M Becker My Commission DD150048 Expires November 15, 2006 OR, Produced Identification Personally known � OR, Produced Identification 0 S ,-/. U Type of Identification Produced: ' �� J .? I0 - 6O.36-TType of Identification Produced: PROPE T WNER New Construction Name � E y} ` / 0 } V �`/ � �V C - '- Address 3 &v . q ST■ Home Telephone A . in/ift , Business Telephone clq 3 o a'70 Fax Demolish CONTRACTOR { Name New Construction 13 , 6 S r � J7M " �1 7 � _ 1. License No.5 L q r 1 / "I Alteration Exterior Address f- [ oa.o OE 13x 3Z-41 A . in/ift , Telephon — ) S , Q Fax / clq 3 o a'70 Qualifier Name FR Demolish TYPE OF MANAGEMENT (✓ ) New Construction Enclosure Alteration Exterior Repair Alteration Interior Demolish Relocation of Structure Shell Only Foundation Only Add'I Attachment Other Add'I Detachment Other Step I. ted along with this permit application. PERMIT TYPE (✓ ) Building Electrical Mechanical Plumbing LPGX Roofing Fence Other PERMIT CHANGE (✓ ) Chg. Contractor Renewal Revision Extension Supplement Reinspection ARCHITECT Name License No. Address Telephone Fax . ••• •• •• • • • •• •• • • • • • • • • • PERMIT APPLICATION • • • • • • • • Master Permit No. / ' 1 0 1 _ 7 3 0 • �St.rb7s; dial: Parr�lit 1 . • • • • • •. •.•• INSTRUCTIONS - The following steps must be taken to obtain a permit from the Miami Shores Village: Complete the attached permit application which must be sigmedbylhe rope ovJ 4and cwalifier. Both signatures must be notarized. Please print or type to allow for a more accurate processing of ;ow Ii rctfiig wofl will be done, a roofing application must be submit- • • • • • •• • • • • • • • • • • ••• • • Step 2. ,Submit the completed application with all necessary documents to the Building, Planning and Zoning Department for processing. During the processing of your application, you may be asked to submit additional information. APPL1CA'I'1ON Job Address: 35 / t f/ I S' 5 ) 3 3 State Zip City Address /� Apt. Folio Number / / - 3 D.OX — 0 t3 6i ) /0 Description of Work ?do '-` J -- 3m4-, ) ,I) -71e-714 Lot /3_ Block Subdivisiorn SI QS O PB PG Zoning Current Use of Property Square Feet Sjnits Floors 1 Proposed Use of Property Value of Work 0 00. G Q Bldg Value Tenant Information Tax Assessed/Appraised Value Linear Feet Flood Zone Base Floor Elev. ENGINEER Name License No. Address Telephone Fax