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45 NE 94 St (14)BUILDING ELECTRICAL PLUMBING ROOFING r ❑ Work to be perlormed under t Owner of Building Architect contractor jam, or Builder Legal Description MIAMI SHORES VILLAGE, FLORIDA 1 ❑ PERMIT IT? 13172 DA BL Address of ,J 7 ' Building low : 4 This permit is ranted to the contractor or builder�amed above to co herefor in strict compliance with all ordinances pertaining thereto and with drawings, statements or specifications that may have been submitted to and time if the work is not done in compliance with such ordinances or if the pia granted is the understanding that the contractor or builder named above ass pertaining to the work covered hereby whether shown on the plans or dra done by his agents, servants or employees. In consideration of the issuance to me of this permit I agree t pertaining thereto and in strict conformity with the plans, drawings, s In accepting this permit I assume responsibility for all work done CONTRACTOR Olt BUILDER Signe Permit Value of oject $ e building t' understanding roved by the pro are changed wit es the respons• gs or in the BY TR Co *ractoi s nse No. Amt. of Permit AUTHORITY 195 ECTOR o . erform the work covered hereunder tements or specifications submitted t either, myself, my agent, ssynt or • i pliance with all e proper authorities ployee. to install the equipment or device descnfied in the app t at the work will be performed in compliance with any plane er municipal authorities. This Permit may be revoked at any t authorization. A further condition upon which this permit is ty for a thorough knowledge of the ordinances and regulations ements . specifications and that he ass s responsibility for work dinances and regulations Miami Shores Village. Owner's Name and Address Paul Date MIAMI SHORES VBLLAOE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT Permit No .__.._ 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 Dopy of approved plans and specifications must be kept at building during progress of work. Registered Architect and /or Engineer E l' )ti N �� . 9. :L ��s SepI r Tank .�a� - 23 - S�Ab, - . - .33 Nd4reet a .�.,.. i c�y� -.... // lS °Z t1Q ea gaf luau tf 0. 887 -5594 Bioo ____ Subdivlalon.��J_5 14 Street and Number where work is to be performed —No 45 N.E. 94 street Street. State work to be performed and purpose of building (By Floors )___ — — - — New Building._ -. Remod ®ling____. _._._ _ Addition Repairs X No. of Stories .... Size Septic Tank_._ Type of T °=k -- 300 sq. ft . Dist_ Feet of Tank or Drain Field from We11...____.� - - -._ .. — Feet of Drain Tile -. -- __...._ ..�_,�.__.....__._ Nature of Water Supply: City —Well. Size of Soakage Pit. Amount of Permit $ 25.00 No 4L,5 Streel =l r� �� (Si Plumbing Inspector. The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations as an employer of labor under the Florida Workmen's Compensation Act, being Section 5888, Compiled General Laws of Florida Permanent Supplement, and hd% com- piied with the provisions thereof, and will require similar compliance from all contractors or sub-contractors employed by him in the worm to he 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 art required by the Act. The undersigned agrees to employ only such orb- contractors, on work to be performed under this permit, as are licensed by Miami Shores Village. (Signed 4 G�rs19 7* / � Master number. STATE OF FLORIDA, at. COUNTY OF DADE. Before me, the undersigned authority, a notary public, duly a administer oaths and take acknowledgments, personally appeared to me well known, and who, being r me first duly sworn, upon oath dep0aes and sari that he is the._._ of the above described construction, that he bas carefully read the ffooregaing applicatlon, and that and that all facts therein hY hirn staMI are n \otLry Pfit. 3dade of l °oria$a .My Cammission Finites June 29, 14C97 B oalty Rodusaibaketvilic. Notary Public, State of NOTE: A re- inspection fee of $1.00 will be made wham mob re-inapaotfos is eadenaosrsary by improper notice for lsasprction, or faulty materials and /or workmanship. CLOSETS BATH Tun[ SHOWERS LAVA• TORIES SINKS SLOP SINKS LAUNDRY Tuns U RINALS CATCH B ASIN FLOOR DRAIN DRINKING FOUNT' Ns TOTAL ',Etyma* CONTR. LIST CHECK + SEPTIC TANK SEWER CONN. DRAIN FIELD SOAKAGE PIT GR[ASI TRAP SOLAR HEATER DEEP WELL SPRKLR. SYSTEM SW 114•0 POOL comm. 7 -300 sq.ft. I � CHICK Owner's Name and Address Paul Date MIAMI SHORES VBLLAOE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT Permit No .__.._ 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 Dopy of approved plans and specifications must be kept at building during progress of work. Registered Architect and /or Engineer E l' )ti N �� . 9. :L ��s SepI r Tank .�a� - 23 - S�Ab, - . - .33 Nd4reet a .�.,.. i c�y� -.... // lS °Z t1Q ea gaf luau tf 0. 887 -5594 Bioo ____ Subdivlalon.��J_5 14 Street and Number where work is to be performed —No 45 N.E. 94 street Street. State work to be performed and purpose of building (By Floors )___ — — - — New Building._ -. Remod ®ling____. _._._ _ Addition Repairs X No. of Stories .... Size Septic Tank_._ Type of T °=k -- 300 sq. ft . Dist_ Feet of Tank or Drain Field from We11...____.� - - -._ .. — Feet of Drain Tile -. -- __...._ ..�_,�.__.....__._ Nature of Water Supply: City —Well. Size of Soakage Pit. Amount of Permit $ 25.00 No 4L,5 Streel =l r� �� (Si Plumbing Inspector. The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations as an employer of labor under the Florida Workmen's Compensation Act, being Section 5888, Compiled General Laws of Florida Permanent Supplement, and hd% com- piied with the provisions thereof, and will require similar compliance from all contractors or sub-contractors employed by him in the worm to he 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 art required by the Act. The undersigned agrees to employ only such orb- contractors, on work to be performed under this permit, as are licensed by Miami Shores Village. (Signed 4 G�rs19 7* / � Master number. STATE OF FLORIDA, at. COUNTY OF DADE. Before me, the undersigned authority, a notary public, duly a administer oaths and take acknowledgments, personally appeared to me well known, and who, being r me first duly sworn, upon oath dep0aes and sari that he is the._._ of the above described construction, that he bas carefully read the ffooregaing applicatlon, and that and that all facts therein hY hirn staMI are n \otLry Pfit. 3dade of l °oria$a .My Cammission Finites June 29, 14C97 B oalty Rodusaibaketvilic. Notary Public, State of NOTE: A re- inspection fee of $1.00 will be made wham mob re-inapaotfos is eadenaosrsary by improper notice for lsasprction, or faulty materials and /or workmanship. - Z7 Permit No _ -- (_ _ 2 Registered Architect and /or En i neer aal d - Employing Plumbers Name - Nature of Water Supply. City—Well. Amount of Permit $ _- - - STATE OF FLORIDA, COUNTY OF DADE. MIAMI SHORES VILLAGE PLUMING INSPECTION DEPARTMENT APPL@C TION FOR PLUMBING PERMIT Location and Legal Description Lot.__ —_-___ __— ___ —._.f_ — -- Block_ Street and Number where work is to be performed —No State work to be performed and purpose of building (By Floors). _ New Building ....... - - _____ -- _ - - -- --- Remodeling____- -__ _ -- -- _ -- _ Addition___- _ _ --_ -_ -- -- . Repairs. Size Septic Tank__ _ __ -- -- - -- T of�[a _ Capacity Gals. Feet of Drain �__ � . _ . e of'f`ank Drain Field from Well._ Sig -e of Soakage Pit No._ (Signed) - '- -- -- - - -- (Signed)__ Date 0 Application i- hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the build ng 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 th Building Dig' sion 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 wor Owners Name and Address_ __ R, ____2 P No._— ___ ___ Street Street // t/ = ! Subdivision_ _.- No. of Stories _ . 9 Ph.mb In:pecto. The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations as an e nployer of labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Permanent SuppLment, :'n1 1 as ran plied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors em.loyed by hin in the woik to be performed under this permit; and will post or cause to be posted' for inspection on the of the work s notic: • no ices as are required by the Act. The undersigned agrees to employ only such sub- contractors, on . k to er nit, as are licensed by Miami Shores Village. Plumber. Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledge ents, personal) 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 .acts therein by him stated are true. My Commission Expires Notary Publi State of Florida — - NOTE: A re- inspection fee of $1.00 will be ma •. when such re- inspection is made necessary by improper notice for inspection, or faulty materials and /or workmanship. CLOSaYB B ATH TUBS SHOWERS LAVA- TORIES SINKS SLOP SINKS LAUNDRY TUBS URINALS CATCH BASIN FLOOR DRAIN DRINKING FOUNT' NS TOTAL F XTUREB CONTR. LIST CMECK _� SEPTIC TANK SEWER CONN. DRAIN FIELD SOAKAGE PIT GREASE TRAP SOLAR HEATER DEEP WELL SPRKLR. SYSTEM SWIM'G POOL CONTR. LIST CHECK - Z7 Permit No _ -- (_ _ 2 Registered Architect and /or En i neer aal d - Employing Plumbers Name - Nature of Water Supply. City—Well. Amount of Permit $ _- - - STATE OF FLORIDA, COUNTY OF DADE. MIAMI SHORES VILLAGE PLUMING INSPECTION DEPARTMENT APPL@C TION FOR PLUMBING PERMIT Location and Legal Description Lot.__ —_-___ __— ___ —._.f_ — -- Block_ Street and Number where work is to be performed —No State work to be performed and purpose of building (By Floors). _ New Building ....... - - _____ -- _ - - -- --- Remodeling____- -__ _ -- -- _ -- _ Addition___- _ _ --_ -_ -- -- . Repairs. Size Septic Tank__ _ __ -- -- - -- T of�[a _ Capacity Gals. Feet of Drain �__ � . _ . e of'f`ank Drain Field from Well._ Sig -e of Soakage Pit No._ (Signed) - '- -- -- - - -- (Signed)__ Date 0 Application i- hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the build ng 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 th Building Dig' sion 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 wor Owners Name and Address_ __ R, ____2 P No._— ___ ___ Street Street // t/ = ! Subdivision_ _.- No. of Stories _ . 9 Ph.mb In:pecto. The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations as an e nployer of labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Permanent SuppLment, :'n1 1 as ran plied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors em.loyed by hin in the woik to be performed under this permit; and will post or cause to be posted' for inspection on the of the work s notic: • no ices as are required by the Act. The undersigned agrees to employ only such sub- contractors, on . k to er nit, as are licensed by Miami Shores Village. Plumber. Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledge ents, personal) 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 .acts therein by him stated are true. My Commission Expires Notary Publi State of Florida — - NOTE: A re- inspection fee of $1.00 will be ma •. when such re- inspection is made necessary by improper notice for inspection, or faulty materials and /or workmanship. Permit No 0 7" Owner's Name and Address. Size Septic Tank__ _ __ -- .- - -- Feet of Drain Tie _ � e Nature of Water Supply. City —Well. Amount of Permit i} -- - STATE OF FLORIDA, COUNTY OF DADE. j MIAMI SHORES VFLEn, E PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBIN© pL f M iT _Dist. Feet of Tank or Drain Field from Well.. __ _ . Si- :e of Soakage Pit _ (Signed). - - ( Signed)_ Date Application i- hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the build ng 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 th Building Di•' lion 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. _____ Street _ 9 Registered Architect and /or Engineer _ • _-- __--- T______ Employing Plumber's Name __JSl-:_N_ -� S� ri - . _ No._ : lYi Location and Legal Description Lot_ -____- -__._. _ ._._..____ /_!__ ___.._ Block_ Street and Number where work is to be performed —No °9" S rni State work to be performed and purpose of building (By Floors)_ _ - - _ _. _ __ -- ...... _ - - New Building —_ -- -- - - -- - -- - Remodeling____ -_ _ -- _ _ Addition.-_- Capacity Gals. treet.. _ 9 t2y 57(.c. Subdivisiion_ -- -_ -. -- Street - _. _ Y/ _-_ -. Repairs_ _ _ _ ___ No. of Stories _ Pkmb ng n :pecto. The undersigned applicant for this building permit does hereby certify that he understands and accepts his obl'.'ons as an employer of labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Perin. nt Supplement, ant I as min- plied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors employed by hin- in the wo!k 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 no ices as are required by the Act. The undersigned agrees to employ only such sub- contractors, on w. k to be perfo..•ed under this per nit, as are licensed by Miami Shores Village. Master Plumber. Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgn ents, personall 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 •acts therein by him stated are true. M C Expires Notary Public, State of Florida NOTE: A re- inspection fee of $1.00 will be made when such re- inspection is inade by improper notice for inspection, or faulty materials and /or workmanship. CLO86TE3 BATH TUBS SHOWERS LAVA. TORIES SINKS SLOP SINKS LAUNDRY TUBE U RI CATCH BASIN FLOOR DRAIN DRINKING FOUNT' NS TOTAL F %TURES CONTR. LIST CHRCIC SEPTIC TANK SEWER CONN. DRAIN FIELD SOAKAGE PIT GREASE TRAP SOLAR HEATER DEEP WELL SPRKLR. SYSTEM SW IM•G POOL COMM. LIST ` CHOCK Permit No 0 7" Owner's Name and Address. Size Septic Tank__ _ __ -- .- - -- Feet of Drain Tie _ � e Nature of Water Supply. City —Well. Amount of Permit i} -- - STATE OF FLORIDA, COUNTY OF DADE. j MIAMI SHORES VFLEn, E PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBIN© pL f M iT _Dist. Feet of Tank or Drain Field from Well.. __ _ . Si- :e of Soakage Pit _ (Signed). - - ( Signed)_ Date Application i- hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the build ng 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 th Building Di•' lion 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. _____ Street _ 9 Registered Architect and /or Engineer _ • _-- __--- T______ Employing Plumber's Name __JSl-:_N_ -� S� ri - . _ No._ : lYi Location and Legal Description Lot_ -____- -__._. _ ._._..____ /_!__ ___.._ Block_ Street and Number where work is to be performed —No °9" S rni State work to be performed and purpose of building (By Floors)_ _ - - _ _. _ __ -- ...... _ - - New Building —_ -- -- - - -- - -- - Remodeling____ -_ _ -- _ _ Addition.-_- Capacity Gals. treet.. _ 9 t2y 57(.c. Subdivisiion_ -- -_ -. -- Street - _. _ Y/ _-_ -. Repairs_ _ _ _ ___ No. of Stories _ Pkmb ng n :pecto. The undersigned applicant for this building permit does hereby certify that he understands and accepts his obl'.'ons as an employer of labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Perin. nt Supplement, ant I as min- plied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors employed by hin- in the wo!k 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 no ices as are required by the Act. The undersigned agrees to employ only such sub- contractors, on w. k to be perfo..•ed under this per nit, as are licensed by Miami Shores Village. Master Plumber. Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgn ents, personall 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 •acts therein by him stated are true. M C Expires Notary Public, State of Florida NOTE: A re- inspection fee of $1.00 will be made when such re- inspection is inade by improper notice for inspection, or faulty materials and /or workmanship. PERMIT APPLICATION FOR MIAMI SHORES VILLAGE Date Job Address 2-45 N 1= 4 Tax Folio Legal Description Historically Designated: Yes r j No Owner / Tenant t a v) I , a 2 h - DA h L Master Permit # )? ,S Owner L_ s Address 5 1) 1 L S4 7 R Phonc(3 ) '' 59 — L 6 5 I Contracting Co. A w r)) ?to f l fwg tj CL. l k (* , Address f 6 115 c W, ; S+ Qualifiern Lea W c i) SS# „(., Phone (' GS ) 4-') - State # 90 +21 d G. Municipal # Yl 1Aci1 i oS Ins. Co. Architect/Engineer Bonding Company Mortgagor Permit Type (circle one): BUILDING ELECTRIC L PLUMBING Square Ft. , �c Notary as to Owner My Commission E FEES: PERMIT 3 J — ' RADON Y —l6- 7 Signature of owner and/or Condo President Date Ill d/oi @ wf tP ENS Date C NARY PUBLIC STATE OF FLORIDA COMMISSION NO. CC542901 MY COMMISSION EXP. APR. 7,2000 APPROVED: Zoning Building Mechanical Plumbing Competency # GC /4 /5 Address Address Address WORK DESCRIPTION � tM U141 - C I - 3- MECHANICAL ROOFING PAVING FENCE SIGN Estimated Cost (value) (z 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 ab• - - : • ed contractor to do the work s d. 4 „, , ,......„ ,, ature of Contracto - 1 4601 A AA t Notary as to Contractor or 0 Nier- Builder n D . to My Commission Expires: ( -t C t �t YItAt � k r) 0 OFFICIAL NOTARY SEAL LETICIA ANGUIANO NOTARY PUBLIC STATE OF FLORIDA COMMISSION NO. CC501748 OMMISSION EXP. OCT. 31,1999 L C.C.F. s! d NOTARY BOND f) 0 36 .sto 3 er- Builder TOTAL DUE 2 9°7 Date ICo q`7 , METROPOLITAN DADE COUNTY, FLORIDA ' F METRODADE Mr. and Mrs. Date 45 N.E. 94 Street Miami Shores, Florida 33138 Re: March 19, 1997 ENVIRONMENTAL RESOURCES MANAGEMENT POLLUTION PREVENTION DIVISION SUITE 800 33 S.W. 2nd AVENUE MIAMI, FLORIDA 33130-1540 (305) 372.6817 CERTIFIED MAIL NO. Z428 468 121 RETURN RECEIPT REQUESTED Tank Removal Plans submitted by Bagwell Equipment Co., Inc. (received March 10, 1997) for the Date Residence, UT- 5400 /DERM 15512, located at, near, or in the vicinity of 45 N.E. 94 Street, Miami Shores, Dade County, Florida. Dear Mr. and Mrs. Date: The Waste Cleanup Section of the Department of Environmental Resources Management (DERM) has reviewed the above - referenced plans and approved said plans subject to the plan approval conditions attached to them. Be advised that: 1. If a UST is subject to the requirements of Chapter 62 -761, Florida Administrative Code (FAC), and no evidence of contamination is detected, a Tank Closure Assessment Report (TCAR) prepared in accordance with the Florida Department of Environmental Protection's "Pollutant Storage Tank Closure Assessment Requirements" must be submitted to the DERM PRS within sixty days of the UST closure. 2. If a UST is subject to the requirements of Chapter 62 -761, FAC, a FDEP Underground Storage Tank Installation and Removal Form for Certified Contractors #62- 761.900(5) must be completed and submitted directly to the FDEP within thirty days after the UST removal. 3 A TCAR is not required if a UST is not subject to the requirements of 62 -761, FAC (i.e., residential, on -site consumptive use heating oil, or hydraulic lift),..or is in a contaminated area for which a Chapter 62 -770, FAC, contamination assessment or remedial action is being conducted. However, for UST removals: a) Soil and /or groundwater samples from a minimum of one soil boring and /or monitoring well may be required if groundwater is not made accessible at the time of the scheduled inspection, if the lengths of any underground product piping abandoned in place is greater than twenty five feet, or if new evidence of contamination is detected. Mr. and Mrs. Date UT- 5400 /DERM 15512 Page -2- and for UST abandonment in place: b) Soil and /or_ groundwater samples must be collected from the soil boring(s) and /or monitoring well(s) shown on the approved plans and analyzed for the appropriate analytical group (as defined by Chapter 62 -770, FAC). The following must be submitted to the DERM WCS within sixty days of the UST closure: receipts and manifests documenting the proper disposal of all liquid and /or solid wastes (including any applicable UST components), all soil screening and groundwater sample results, and if no contamination was detected, a proposal for abandonment of any remaining monitoring wells. If you have any questions concerning the above, please contact Tomas Fonte of the Waste Cleanup Section at (305) 372 -6700. Sincerely, Wilbur Mayorga, P.E., Chief Waste Cleanup Section TF /vx pc: Bagwell Equipment Co., Inc. w /Approved Plans. METROPOLITAN DADE COUNTY. FLO goawrf d MAR 10 . v� 1991 E 'h` DERIA ENVIRONMENTALRESOURCES MANAGEMENT WASTE CLEANUP POLLUTION PREVENTION DIVISION. r ID WASTE CLEA6EC ION - SUITE 800 N C 33 S.W. 2nd AVENUE 0 CONSTRUCTION PLAN REVIEW. APPLICATION MIAMI, FLORIDA 33130 -1540 (305) 3:26817 FACILITY NAME: P0.,U 1 q P,�- y �� � ' K4s I (ATM C UT #JrO 0 FACILITY ADDRESS : __ ' DERM FILE# 15512 CONTRACTOR /CONSULTANT NAME: ?7Gt3 I UJ (D„ C j . Lei `J CONTACT PERSON PHONE# : ( 5 ] 3 g,C) PLAN TYPE (check appropriate box) FEE TOTAL [] TANK INSTALLATION (up to 10 tanks, includes wells & Stage II) [] COMPLIANCE MONITORING WELL INSTALLATION ONLY 4 WELLS OR LESS 5 WELLS OR MORE [] MODIFICATION [] AS -BUILT [] INSTALLATION OF STAGE II ONLY V TANK OR OIL /WATER SEPARATOR CLOSURE (requires Closure Application) [1 RENEWAL OF PREVIOUSLY APPROVED PLANS (50% of original fee) [] 1ST RESUBMITTAL [] 2ND RESUBMITTAL (50% of original fee, $50 minimum) [] AFTER THE - FACT PLANS (100% of the original fee, plus applicable administrative costs to be assessed by the plan reviewer.) PLAN REVIEWER $600 $ 55 $110 $200 PAID WITH CHECK# / 1 `- /3 31V 36 TOTAL FEE RECEIPT NO . # 2 / `f 3 $275 N/A FOR DERM USE ONLY FEE ADJUSTMENT O DATE c>>,IHt5,7 (Fee Due or Credit Due) AC 10/1/96 (Form /fees subject to change without notice. Fees to be verified prior to submittal.) x'1 METROPOLITAN DADE COUNTY, FLORIDA METROOADE ENVIRONMENTAL RESOURCES MANAGEMENT POLLUTION PREVENTION OMSION PETROLEUM REMEDIATION SECTION BITE 900 33 S.W. 2n d AVENUE MIAMI, FLORIDA 33130.1540 APPLICATION FOR POLLUTANT STORAGE SYSTEM CLOSURE (305) 372-0817 TYPE OF POLLUTANT STORAGE SYSTEM CLOSURE (CHECK ONE PER APPLICATION): UNDERGROUND 'STORAGE TANK SYSTEM: (,, REMOVAL ABANDONMENT IN PLACE UNDERGROUND HYDRANT LINE SYSTEM: _ REMOVAL _ ABANDONMENT IN PLACE UNDERGROUND OIL /WATER SEPARATOR SYSTEM: _ REMOVAL ABANDONMENT IN PLACE FACILITY NAME: pool >j (.44y )) + �F ; ►�� Nc �' FACILITY ADDRESS: 4) [\I Ji . ')141) `sI2 , I' ciTy0Thm,6 :2 3 0 ; FOLIO # (IF AVAILABLE): PROPERTY OWNER: Pau ( q Rd! 1)Afk TITLE (IF APPLICABLE) : COMPANY NAME (IF APPLICABLE): NI/ n ADDRESS: CITY: STATE: ZIP: POLLUTANT STORAGE SYSTEM SPEC CONTRACTOR (PSSSC) NAME: rC�NAkI j.. Bc1CILU I 1 / COMPANY NAME: B rWCr I I C��u ► I ) PHONE: (3v ) 2-J' - 3 v ?C7 FDPR PSSSC #: C. C c(10 -1 J I ADDRESS: 1U715 ;w Z7( Si . CITY: �orr, ;I'skc` COUNTY: WE ZIP: >>(1 PLEASE NOTIFY: Ka p Pi U ( u.,'F I 1 PHONE: ( 505 ) 3 �F �. - U°) ) WHEN READY ADDRESS: Val 1 j S.W. 2_70 S � . CITY :)-Iw„3Cka STATE: nort n ZIP: 3 3 5 1. Staple to this application a check for $250 made out tot 2. Attach two copies (minimum) of an 8 -1/2' x 11' site diagram c early s ow ng the: (1) property address, (2) property boundaries, (3) adjacent streets, (4) on -site buildings, (5) ALL on -site pollutant storage systems and (6) monitoring wells. 3. Attach two copies (minimum) of an 8 -1/2' x 11' schematic detail of the pollutant etoragg system to be closed, clearly showing for each component the: (1) age, (2) composition, (3) size, (4) substance stored, and (5) method of closure. 4. If proposing abandonment in place, clearly show the locations of the proposed soil borings and monitoring wells on a scaled site diagram and schematic detail and attach two copies (minimum) of an 8 -1/2' x 11' monitoring well detail. 5. The attachments do need to be signed and sealed by a professional engineer. 6. Separate applications are required for storage systems separated by more than 200' or for closures requiring more than one of the same type of inspection. 7. All applicable tanks must be registered with FDEP 30 days prior to closure. Attach a copy of the FDEP Storage Tank Registration placard or a copy of the FDEP Form 62- 761.900(2) clearly showing the date it was sent to FDEP. 8. If this application is approved, the approval will be for the environmental aspects only and will be subject to requirements which must be met as a condition of approval. The requirements will be attached to the approved plans. 9. Allow approximately 14 days for the plan review process and do tga commence any plan related activities until you have received a copy of the approved plans. File #:\c512... UT M: 5400 IW( )0: ATC 10/3/95 (Subject to change without notice) HW 0: FDEP N: 9 10 11 12 13 ' '14 ' e 15 16 ' 17 18' ' ' k'. 19' , , , • , • u •NUirld •' _ �" IOW .t'1. Florida Department of Environmental Regulation T In lbwere omee Bldg. • 2600 13121r Stone Road 41I'ThII1 useee. Florida 32399 -2400 ' 1 ' 11•: •t 5. Facility Name: Tank(s) Address' City/State/Zip. Contact Person: l t 1)c F 6. Financial Responsibility Type: WI r)t 8. location (optional) Latitude: °. 20. 11Irit i tP. t \ Certified ,C ontta CO, MC For new tank installation or tank removal To the best of my knowledge and belief all informatio •n A A S. - R,a uJ' I I Print rtpme & title of owner pe _ thorized. rson newt.. Dora Na+»..Ono 1eo oel ennw er Covar T O = 1Mq. Ms 0 SOO P isu . Rondo 70e01.sn4 Renee 32007 1044760000 1044164200 IAc1 Longihlde: ° Cover. Dim • um meow" sea NO CD 04enda nmtll 3200237.' a7 ew.7s13 lalewt ChM 411eo40 wsa. spree ReIld. linotsel Storage Tank ,! gglstration Form . p Please Print. or lype - Review Instructions Before Completing Form II 1. DER Facility ID Number: 2. Facility Type. 3. New Registration Lam.! New Owner Data ❑ Facility Revision ❑ Tank(s) Revision ❑ 4. County and Code of tank(s) location. Complete 9. 16 for tans IA use; 9 • 19 for tanks out of use t,., •••111,„i Telephone ( ) 7 5 .1 r " cocoa Complete One Line For Each lank At This Facility (Use Codes - See Instructions) . ti d Soo* 21101 000 Pm msg. fiends 33101 Me 113 -331 0370 7a. Tank(s) Owner. EA lYl F. 3 o V Owner Mailing Address: City/State/Zip Contact Person: Telephone' • • 7b. New Owner Signature/Change Date: / • I I_ 1r 111 f A Section_ Township' Rarlpe i . t' r ()PRO j1 — Cv Sc-)1 Department of Professional Regulation Ucerme Number' , ,v • 'ilA/ 0 • � , It .i . tted on t his form. is,true, acc u rate and c omplete. s A 1 0 .. , .. °•!► ale I P 3 / . Ski . , ,. • ',P 1 'M? 2.r • • 1 Da046,41 r e JO saute.. tlrea Wm Purl Nock Porde *1401 see•403-21e0 1: 3. /,f , pp ma �QQ b, D4 METROPOLITAN DADE COUNTY, FLORIDA METROOADE PETROLEUM REMEDIATION SECTION UST SYSTEM REMOVAL PLAN APPROVAL CONDITIONS An 8. All UST contents (including liquid wastes decontamination E4E ENVIRONMENTAL RESOURCES MANAGEMENT POLLUTION PREVENTION DIVISION SUITE 800 33 S.W. 2nd AVENUE MIAMI, FLORIDA 33130-1540 (305) 372 -6817 The following conditions are hereby incorporated as part of the UST System Removal Plan Approval granted by the Petroleum Remediation Section (PRS) and unless otherwise stipulated, shall supersede the scope of work proposed in the approved plans if discrepancies exist. Additional approval may be required from other DERM sections, the local fire department and other governmental agencies having jurisdiction over the facility and /or activities to be conducted. 1. This approval shall be valid for one year from the approval date, however; compliance with all regulatory timeframes stipulated elsewhere is required. 2. An inspection must be scheduled with the DERM Storage Tank Permitting Section (STPS) Inspection coordinator at (305) 372 -6716, two days prior to commencing any UST excavation activities. At the time of the scheduled inspection all ignition sources must be extinguished. A site representative possessing a properly calibrated monitoring device (i.e., Combustible Gas Indicator) must meet the DERM insspector outside the vapor hazard area. Each UST must be inert, securely blocked on a level surface, and made readily accessible to the inspector. Groundwater must be -, •�_ed in each excavation and made readily accessible to the inspector . riginal set of the most recently approved UST removal plans must be tained on -site for inspection throughout the removal activities. 1 work, including all applicable safety requirements, must be performed by a ollutant Storage System Specialty Contractor (PSSSC) possessing a valid license om the Florida Department of Professional Regulation and in accordance with the approved plans, applicable requirements of Chapter 24 of the Metropolitan Dade County Code, Chapter 62 -761 of the Florida Administrative Code (FAC), United States Occupational Safety and Health Administration. American Petroleum Institute (API) Recommended Practice #1604, National Fire. Prevention Association (NFPA) Standard #30, and the requirements imposed by any other governmental agency having jurisdiction over the facility and /or activities. 6. Equipment to contain accidental discharges (e.g., absorbent pads) must be on site during all UST removal activities. 7. All applicable underground piping must be capped, removed, or filled with concrete, and all vent risers must be removed unless they also serve another UST left in place. Any UST components removed roust be properly cleaned, marked, and disposed of in accordance with API #1604 and NFPA #30. sludges) must be properly recovered on wastewater and 1Y1# S4O0 Approval Date: o Page 1/2 LEGEND PIL = PROPERTY LINE SIS = SOIL SAMPLE UST REMOVAL SITE PLAN i1111e®■111111I ■1111t=311/l111■1•111 N.E. 94th Street ENLARGEMENT 300% SCALE 10 20 30 40 50 a ell ! i went Co. nc. PROPOSED UST REMOVAL PLAN (L' ► M1 SITE NAME: Date Residerice W g; SITE ADDRESS: 45 N.E. 94th Street ( 2;11 Miami Shores, Florida 33138 SITE OWNER: Paul & Betty Date OWNER ADDRESS: Same as above. TANK SIZE: 275 Gallon CONSTRUCTION MATERIAL: Steel LAST CONTAINED: Fuel Oil ASSOCIATED PIPING: To be removed during - project. TANK AGE: Unknown TANK CONTENTS: To be removed by a DERM approved Liquid Waste Hauler. REMOVAL & DISPOSAL CONTRACTOR: Bagwell Equipment Co., Inc. 16715 S.W. 276th Street Homestead, Florida 33031 PSSSC Lic. #: PC CO50784 Signature of NOTE: All work to be completed in accordance with FDEP 62 -761, API 1604, PEI, and NFPA #30 guidelines. Disapproved Date (Signed) MIAMI SHORES VILLAGE BUILDING INSPECTION DEPARTMENT APPLICATION FOR BUILDING PERMIT Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the build- ing 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 the work. Date , Owner's Name and Address.- MacDonald & L�LL`d'$'Ord N i- ; - 5 N • E Street 94th 'St. Registered Architect and /or Engineer Name and address of licensed contractor Location and legal description of lot to be built on: Lot Block Subdivision Street and Number where work is to be done 4 5 N.E. 94th St. State work to be done and purpose of building (by floors) Sprinkler System No WE and for no other purpose. New Building Remodeling Addition Repairs No. of Stories To be constructed of Kind of foundation Roof Covering Estimated Total cost of improvements $ Amount of Permit $ Zone cubage required -Plan Cubage Distance to next nearest building Size of Building Lot Maximum live load to be borne by each floor I hereby submit all the plans and specifications for said building. All notices with referen o the building its nst i r be sent to Monarch Pump & Equipment Co., 1532 N.W. b2nd S t, Alar '/ T ?'a The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations as an employer of labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida, Pennanent Supplement, and has complied 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 ite. of.the work such public notice or notices as are required by the Act. The undersigned agrees to employ only such s an tors, on work per / to be ,performed under this permit, as are licensed by Miami Shores Village. ,( Remarks (Signed)._ !f % J - ,1 :;-✓_ -- Notary Public, State of Florida May 31 1955 19 STATE OF FLORIDA, COUNTY OF DADE. ss• Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally ap- peared — — — 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 e. j Permit No Date.. < �� �> Read, Sworn to and Subscribed before me. Building Inspector My Commission Expires PLANNING BOARD DATE Chairman Member Member Member Member Member Council Approved Date Disapproved Date NOTE: A charge of $1.00 will be made for making corrections or changes to this application after approval has been obtained from the Planning Board. A re- inspection fee of $1.00 will be charged when such re- inspection is made necessary by improper notice for inspection or faulty materials and /or workmanship. Permit No.. / 31 / Size Septic Tank Type of Tank_ Feet of Drain Tile Dist. Feet of Tank or Drain Field from Well Amount of Permit $ My Commission Expires MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT (Signed)_ (Signed). Date Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the building or othe, 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 Divisior 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 ....'„2„; , '. / �._ _ l� s.' No. Street Registered Architect and /or Engineer — _ Employing Plumber's Name , !.; - _ _ ___. No s Street Location and Legal Description Lot___ i 7/ >_ Block �4- Subdivision- ,_ _ - __�__ l F =; (' -, / ( /i Street and Number where work is to be performed —No _- ,L-________1 --..c.. -' t/ _ Street State work to be performed and purpose of building (By Floors):. New Building Remodeling Addition Repairs No. of Stories Capacity Gals Nature of Water Supply; City —Well — Size of Soakage Pit Plumbing Inspector. The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations as an employer of labor under the Florida Workmen's Compensation Act, being Section 5988, 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 be performed under this perniit, as are licensed by Miami Shores Village. Notary Public, State of Florida Master Plumber. STATE OF FLORIDA, ss. COUNTY OF DADE. Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeare 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 fat. 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 faul Caj 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 - //2 Permit No.. / 31 / Size Septic Tank Type of Tank_ Feet of Drain Tile Dist. Feet of Tank or Drain Field from Well Amount of Permit $ My Commission Expires MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT (Signed)_ (Signed). Date Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the building or othe, 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 Divisior 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 ....'„2„; , '. / �._ _ l� s.' No. Street Registered Architect and /or Engineer — _ Employing Plumber's Name , !.; - _ _ ___. No s Street Location and Legal Description Lot___ i 7/ >_ Block �4- Subdivision- ,_ _ - __�__ l F =; (' -, / ( /i Street and Number where work is to be performed —No _- ,L-________1 --..c.. -' t/ _ Street State work to be performed and purpose of building (By Floors):. New Building Remodeling Addition Repairs No. of Stories Capacity Gals Nature of Water Supply; City —Well — Size of Soakage Pit Plumbing Inspector. The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations as an employer of labor under the Florida Workmen's Compensation Act, being Section 5988, 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 be performed under this perniit, as are licensed by Miami Shores Village. Notary Public, State of Florida Master Plumber. STATE OF FLORIDA, ss. COUNTY OF DADE. Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeare 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 fat. 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 faul Caj materials and /or workmanship. Permit No. Amount of Permit $ building during progress of work. Owner's Name and Address / / v ___ - My Commission Expires MI MI 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 Divisior of Miami Shores Village shall be complied with, whether herein specified or not. A copy of approved plans and specifications must be kept at Date c _ No. Street Registered Architect and /or Engineer_ t ,,- f Employing Plumbers Name _ �! 9� �- ._f _�-- u ��- -- No. - - - t� Street- - �( 9 Location and Legal Description Lot_-__..... - / T.../.4 - - Block_- - _ --- -- -_- -_ --_ Subdivision - - - -_ .��. __p Street and Number where work is to be performed —No TI ' ____/h�___) Street State work to be performed and purpose of building (By Floors) 'd I f1_2 1'.a "3 New Building l Remodeling Addition Repairs No. of Stories _ _ (Signed) �.' %< • F (Sim Capacity Gals Size Septic Tank Type of Tank_ _ Feet of Drain Tile Dist. Feet of Tank or Drain Field from WeIL � Nature of Water Supp Ctt Yell 4 • ei ________Size of Soakage Pit Plumbing Inspector. The undersigned applicant for this building permit does hereby certify that he understands an accepts his obligations as an employer of labor under the Florida Workmen's Compensation Act, being Section 5988, Compiled General Laws of Florida Pennanent Sup lement, and has com- plied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors employed b 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 noti or notices as are required by the Act. The undersigned agrees to employ only such sub -contra to, on work to' be performed under t is permit, as are licensed by Miami Shores Village. 7 Master Plumber. STATE OF FLORIDA, COUNTY OF DADE. j Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeare 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 file therein by him stated are true. Notary Public, State of Florida .'NO A re- inspection fee of $1.00 will be made when such re- inspection is made necessary by improper notice for inspection, or faul aterials and /or workmanship. CLOSETS BATH TUBS SHOWERS LAVA- TORIES SINKS SLOP SINKS LAUNDRY TueS URINALS CATCH BASIN FLOOR DRAIN DRINKING FOUNT 'NS C " - � TOTAL FIXTURE! CONTR. LIST] v hi <� CHECK / F •,) � � �`� " 'ii ) 6 .f SEPTIC TANK SEWER CONN. DRAIN FIELD SOAKAGE PIT GREASE TRAP SOLAR HEATER DEEP WELL SPRKLR. SYSTEM SWIM'G POOL ' i `,( Cie c I ,red fl .. , CONTR. LIST _ r i�!L ) , /-� . -- fF -- .._ c e 7 cS� / A �'' CHECK Permit No. Amount of Permit $ building during progress of work. Owner's Name and Address / / v ___ - My Commission Expires MI MI 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 Divisior of Miami Shores Village shall be complied with, whether herein specified or not. A copy of approved plans and specifications must be kept at Date c _ No. Street Registered Architect and /or Engineer_ t ,,- f Employing Plumbers Name _ �! 9� �- ._f _�-- u ��- -- No. - - - t� Street- - �( 9 Location and Legal Description Lot_-__..... - / T.../.4 - - Block_- - _ --- -- -_- -_ --_ Subdivision - - - -_ .��. __p Street and Number where work is to be performed —No TI ' ____/h�___) Street State work to be performed and purpose of building (By Floors) 'd I f1_2 1'.a "3 New Building l Remodeling Addition Repairs No. of Stories _ _ (Signed) �.' %< • F (Sim Capacity Gals Size Septic Tank Type of Tank_ _ Feet of Drain Tile Dist. Feet of Tank or Drain Field from WeIL � Nature of Water Supp Ctt Yell 4 • ei ________Size of Soakage Pit Plumbing Inspector. The undersigned applicant for this building permit does hereby certify that he understands an accepts his obligations as an employer of labor under the Florida Workmen's Compensation Act, being Section 5988, Compiled General Laws of Florida Pennanent Sup lement, and has com- plied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors employed b 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 noti or notices as are required by the Act. The undersigned agrees to employ only such sub -contra to, on work to' be performed under t is permit, as are licensed by Miami Shores Village. 7 Master Plumber. STATE OF FLORIDA, COUNTY OF DADE. j Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeare 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 file therein by him stated are true. Notary Public, State of Florida .'NO A re- inspection fee of $1.00 will be made when such re- inspection is made necessary by improper notice for inspection, or faul aterials and /or workmanship. Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 BUILDING Permit No. pi Os-- PERMIT APPLICATION Master Permit No. a° 05-1407 FBC 2001 Permit Type (circle): Building Electrical / Plumbing Mechanical Roofing Owner's Name (Fee Simple Titleholder) / AI .e4' , , 7 0 $ Phone # ,� !� s) 2/6 $ Value of Work For this Permit Total Fee Now Due $ (Continued on opposite side) Owner's Address 7/5 IV -E ' 94 5 Cit (• ', ) cP /2 e 5 State F /. Zip .3 /3 V Tenant/Lessee Name Phone # Job Address (where the work is being done) 2 9 9 /Ci C • 9 s / • City Miami Shores Village County Miami -Dade is Building Historically Designated YES NO Contractor's Company Name °`r A 7D l l Yy1 11, Contractor's Address - - X '' Z 44( City `t't'° e s." a4 State -- Zip 3 3c ) Qualifier �� e- % \e4,t el 0 --- State Certificate or Registration No.C-- 14.2.5 5 0 Certificate of Competency No. Architect/Engineer's Name (if applicable) Phone # Zip - 3/..a Phone # 3 O' — 2c -7755 Square Footage Of Work: Describe Work: CC . * * * * * ** * * * * **** ** *F * * * * * * * * * * *,� * * ** * * * * * * * * * * * ** lie + Ie ., e2t�� - Submittal Fee , 5 5—® ******* e ammo Permit Fee $ . W '� . CO /CC Notary $ -,,' Training/Education Fee $ ,/ < 13 +,, Technology Fee $ . - Scanning $ Radon $ Zoning Bond $ Code Enforcement $ ['New � ft€ 6647 G/ Structural Plan Review. $ CCF $ Repair/Replace ['Demolition Bonding Company's Name (if applicable) Bonding Company's Address City State Zip Mortgage Lender's Name (if applicable) 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 ntusl 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. Signature Signatur Owner or Agent The foregoing instrument was acknowledged before me this day of • — vclis • " IMit, FE who is per f% ,,��` `� : gtswiltioiwi 4ts ! J •Em 9,2008 �" Ase4x+mti�1Qi � cd4Aa d `' .......... Bonder! By National Notary Assn. My Commission Expires: c lf' ZooF **************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** ** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** ** APPLICATION APPROVED BY: Chc 05/13/03 take an oath. NOTARY P Sign. Print: My Commission Expires: Contractor The foregoing instrument was acknowledged before me this day of — — b — — — — �. FE K VtLIS who is pers. Ki trl slgcPobtisslicsilvhs praticicit � idee tile916 g S1 take an oath. o c. ,.�`' _. -,���„ Bon tiPncjl Notary ASsn. % ilk 9 ZOo f ***************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ******************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** — O Plans Examiner Engineer Zoning ITEM BATH TUB UNIT FEE ITEM SWITCH OUTLETS UNIT FEE ITEM SPACE HEATERS UNIT FEE BIDET LIGHT OUTLETS CENTRAL HEATING DISHWASHER RECEPTACLES j A/C (WIND) DISPOSAL SERVICE TEMPORARY A/C (CENTRAL) DRINKING FOUNTAIN SERVICE SIZE IN AMPS DUCT WORK FLOOR DRAIN SERVICE REPAIR/METER CHANGE REFRIGERATION GREASE TRAP APPLIANCE OUTLETS PROCESS AND PRESS PIPING INTERCEPTOR RANGE TOP UNDERGROUND TANKS LAVATORY OVEN ABOVE GROUND TANKS LAUNDRY TRAY WATER HEATER U.F. PRESSURE VESSELS CLOTHES WASHER MOTORS 0- 1 HP STEAM BOILERS SHOWER MOTORS QVER 1- 3 HP HOT WATER BOILERS SINK, POT /3 COMP. MOTORS OVER 3- 5 If MECHANICAL VENTILATION SINK, RESIDENCE MOTORS OVER 5- 8 HP TRANSPORTING ASSEMBLIES SINK, SLOP MOTORS OVER 8- 10 If ELEVATORS/ESCALATORS I TEMPORARY WATER CLOSET MOTORS OVER 10- 25 EP FIRE SPRINKLER SYSTEMS URINAL MOTORS OVER 25-100 HP COOLING TOWERS WATER CLOSET MOTORS OVER 100 HP VIOLATION INOIRECT WASTES -` A/C WINDOW REINSPECTION WATER SUPPLY TO: AIR CONDITIONERS A/C UNIT STRIP HEATER FIRE SPRINKLER GENERATORS TRANSFORMERS 'HEATER -NEW INST. GENERATORS TRANSFORMERS HEATER - REPLACE GENERATORS TRANSFORMERS LAWN SPRINKLER -WELL SPECIAL PURPOSE SWIMMING POOL OUTLETS COMMERCIAL WATER SERVICE SIGN TUBES SEWER CONNECTIONS .SIGN TRANSFORMERS UTILITY -SEWER SIGN TIME CLOCK UTILITY -WATER FIXTURES SEPTIC TANK ANTENNA RELAY TELEVISION OUTLETS DRAINFIELO, 4' TILE/RES. VIOLATION PUMP & ABANDON SEPTIC TANK REINSPECTION SOAKAGE PIT CU. FT. D-P c4-- e.r 3 . CATCH BASIN DISCHARGE WELL DOMESTIC WELL • AREA DRAIN ROOF INLET SOLAR WATER HEATER FIRE STANDPIPE POOL PIPING LAWN SPRINKLER SYSTEM GAS RANGE METER SET (GAS) GAS PIPING ADDENDUM TO BUILDING PERMIT APPLICATION (AN APPLICATIOri FOR BUILDING PERMIT MUST ACCOMPANY THIS ADDENDUM. IF A MASTER PERMIT HAS B. OBTAINED, THE OWNER'S NOTARIZED SIGNATURE NEED NOT BE PRESENT ON SUBSEQUENT APPLICATIONS.) PLUMBING ELECTRICAL MECHANICAL ITEM BATH TUB UNIT FEE ITEM SWITCH OUTLETS UNIT FEE ITEM SPACE HEATERS UNIT FEE BIDET LIGHT OUTLETS CENTRAL HEATING DISHWASHER ti RECEPTACLES A/C (WARD) DISPOSAL SERVICE TEMPORARY A/C (CENTRAL) DRINKING FOUNTAIN SERVICE SIZE IN AMPS DUCT WORK FLOOR DRAIN SERVICE REPAIR/METER CHANGE REFRIGERATION GREASE TRAP APPLIANCE OUTLETS PROCESS AND PRESS PIPING INTERCEPTOR RANGE TOP UNDERGROUND TANKS LAVATORY OVEN ABOVE (ROUND TANKS LAUNDRY TRAY WATER HEATER U.F. PRESSURE VESSELS CLOTHES WASHER MOTORS 0- 1 HP STEAM BOILERS SHOWER MOTORS OVER 1- 3 HP HOT WATER BOILERS SINK, POT /3 COMP. MOTCRS OVER 3- 5 HP MECHANICAL VENTILATION SINK, RESIDENCE 1 MOTORS OVER 5- 8 HP TRANSPORTING ASSEMBLIES SINK, SLOP MOTORS OVER 8- 10 HP ELEVATORS/ESCALATORS TEMPORARY WATER CLOSET MOTORS OVER 10- 25 HP FIRE SPRINKLER SYSTEMS URINAL MOTORS OVER 25-100 HP COOLING TOWERS WATER CLOSET MOTORS OVER 100 IP ' VIOLATION INDIRECT WASTES - A/C WINDOW REINSPECTION WATER SUPPLY TO: AIR CONDITIONERS A/C UNIT STRIP HEATER FIRE SPRINKLER GENERATORS TRANSFORMERS HEATER -NEW INST. GENERATORS TRANSFORMERS HEATER - REPLACE GENERATORS TRANSFORMERS LAWN SPRINKLER -WELL SPECIAL PURPOSE SWIMMING POOL OUTLETS COMMERCIAL WATER SERVICE ,• SIGN TUBES SEWER CONNECTIONS .SIGN TRANSFORMERS UTILITY -SEWER SIGN TIME CLOCK UTILITY -WATER FIXTURES SEPTIC TANK ANTENNA RELAY TELEVISION OUTLETS DRAINFIELD, 4' TILE/RES. VIOLATION PUMP & ABANDON SEPTIC TANK RE INSPECTION SOAKAGE PIT CU. FT. CATCH BASIN DISCHARGE WELL DOMESTIC WELL AREA DRAIN ROOF INLET SOLAR WATER HEATER FIRE STANDPIPE POOL PIPING LAWN SPRINKLER SYSTEM GAS RANGE METER SET (GAS) GAS PIPING ADDENDUM TO BUILDING PERMIT APPLICATION (AN APPL .ATION FOR BUILDING PERMIT MUST ACCOMPANY THIS ADDENDUM. IF A MASTER PERMIT HAS B. OBTAINED, '"HE OWNER'S NOTARIZED SIGNATURE NEED NOT BE PRESENT ON SUBSEQUENT APPLICATIONS.) PLUMBING ELECTRICAL MECHANICAL • Miami Shores Village 10050 NE 2nd Avenue Phone: 305 - 795 -2204 Printed: 2/16/2005 Applicant: JENNIFER Owner: JOB ADDRESS: 297 NE 97 Contractor ROYAL FLUSH PLUMBING & SUPPLY INC Local Phone: 305 - 255 -7755 Parcel # 1132060134290 Signed: (INSPECTOR) Signed: (Contractor or Builder) Plumbing Permit Permit Number: PL2005 -46 BOLTON ST Contractor's Address: 14481 SW 296 ST Legal Description: MIAMI SHORES SEC 1 AMD PB 10 -70 LOT 23 Page 1 of 1 BLK 31 LOT SIZE 53.810 X Fees: FEE2005 -2075 FEE2005 -2076 FEE2005 -2077 FEE2005 -2078 FEE2005 -2079 Description Building Double Fine Fee CCF Training and Education Fee Technology Fee Submittal Fee Total Fees: Amount $240.00 $0.60 $0.20 $6.00 ($50.00) $196.80 Total Fees: $196.80 Total Receipts: $0.00 Permit Status: APPROVED Permit Expiration: 8/2/2005 Construction Value: $500.00 Work: KITCHEN REMODELING PLUMBING - MASTER BP2005 -167 c, a 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. BY: