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45 NE 94 St (4)BUILDING ELECTRICAL PLUMBING ROOFING Owner of Building 11 Architect Contractor 4 r ' or Builder I ` ` r- 4 Legal Lot t'/' 4,4,,,/ jj } t Description f 14* MIAMI SHORES VILLAGE, FLORIDA PERMIT N? 13172 C�Y�» [1 Work to be performed under this Permit n � a 1 -r-+ BL Subdi- vision BY ".! 3. J xA. r`}< G. CONTRACTOR OR BUILDER DATE r Contractor's Liciense No Address of + I'. ►f Value of Building $ C, ,Project $ This permit is ranted to the contractor or builder amed above to con the building or to install the equipment or device described in the app ftastion herefor in strict compliance with all ordinances pertaining thereto and with t 'e understanding that the work will be performed in compliance with any plans, drawings, statements or specifications that may have been submitted to and approved by the prosier municipal authorities. This Permit may be revoked at any time if the work is not done in compliance with such ordinances or if the plans are changed without authorization. A further condition upon which this permit is granted is the understanding that the contractor or builder named above assumes the responsibility for a thorough knowledge of the ordinances and regulations pertaining to the work covered hereby whether shown on the plans or drawings or in thest'stements of specifications and that he assure s responsibility for work done by his agents, servants or employees. INSPECTOR � ,s r In consideration of the issuance to me of this permit I agree to perform the work covered hereunder iccj461pliance with all dinances and regulations pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to.ythe proper authorities 4f Miami Shores Village. In accepting this permit I assume responsibility for all work done by either, myself, my agent, servant or eployee. Amt. of Permit • ..;i..0 AUTHORITY Amount of Permit $ 25.00 therein by him stated are true. illotuv Mut, State of Florida Aillr Commission Expires June 29, 199 Borhir sSoMmikidtelnElifferig MO 'All Sal*RES V011,R,A.01 PLUMBING INSPECTION DEPARTMENT APPLY ATION 1702 PLUMBONO EMOT r 40 Permit No ft Application is hereby made for the approval of the detailal statement of the plans and opec1fications3 herewith submitted for the building or other structure herein described. This application in made in compliense and conformity with the Bundling Ordinance of Miami Shores Village, Florida, and all provisions of the Laws of the State of Florida, all ordinances of Miami Shares Village and all rules and regulations of the Building Division of Miami Shores Village shall be complied t7ith, whether herein sperified w net A copy of approved plans and specifications must be kept at building during progress of work. Owner's Name and Address Paul Date No. s..t/g1111 Registered Architect and/or Engineer Employln 7z bces 1,40,9 2 cl.,2 Otatet--122.0.., /1 d a on 887-5594 I 1.. woritz 1 Suildiviolon.2 don an g Street and Number where work is to be performed-No 45 N.E. 94 street State work to be performed and puziorrs° of building (By Moro ).__ New Building__ ___ RGanedeling — Addition. STATE OF FLORIDA, ea COUNTY OF DADE. Before me, the undersigned authority, a Dewy public, duly a Repairs x Size Septic Tank-. __Type of TPfflIjr 300 sq . ft. Feet of Drain Til® _Diet. Feat of Tank az Drain Field from Well Nature of Water Supply: City-Wall Size of Stilltafp Pit (Signed)- 4. ”' \?C-4(C-4CCIC Plumbing IngpectO;: The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations es an employer of labor under the Florida Workmen's Compensation Act, being Section 5866, Compiled General Laws of Florida Permanent Supplement, and liar com- plied with the provisions thereof, and will require similar compliance from all contractors or sub-contractors employed by him in the worlr 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 MICA sub -contractors, on work to be performed under this permit, as are licensed by Miami Shores Village. to me well known, and who, being me first duly swam upon oath depoom and says that he is the__ of the above described construction, that he has cwefunly sued this foment/1g agsplication, and that Street. No. of Stories .... Capacity Cals....______ / MUMS number. to administer oaths and take acknowledgments, personally appeared NOTE: A re-inspection fee of $L90 bo inaelka 'Aga mob mokagestiote ceette by torpmpor ratio. for Inspection, or beaky materials aod/or warlosausitip. cLosirta BATH Tuns SMOW[W® LAVA- To „,,,, ammo SLOP SINK® LAUNDRY Tinos „ R1p4ALs .... CATCH DAWN PLOOPI DRAIN DRINKING POUNT'NS TOTAL FmTuRSS corcra. L IST CHSCK ...■.. - ...■■■■■■ SEPTIC TANK amen CONN. DRAIN FIELD SOAKAGE PIT GRIIAOE TRAP SOLAR HEATER DEEP WELL SPRELP. eyanics OW two POOL . Ceara. UST CHECK 1-300 ,2-.ft. Amount of Permit $ 25.00 therein by him stated are true. illotuv Mut, State of Florida Aillr Commission Expires June 29, 199 Borhir sSoMmikidtelnElifferig MO 'All Sal*RES V011,R,A.01 PLUMBING INSPECTION DEPARTMENT APPLY ATION 1702 PLUMBONO EMOT r 40 Permit No ft Application is hereby made for the approval of the detailal statement of the plans and opec1fications3 herewith submitted for the building or other structure herein described. This application in made in compliense and conformity with the Bundling Ordinance of Miami Shores Village, Florida, and all provisions of the Laws of the State of Florida, all ordinances of Miami Shares Village and all rules and regulations of the Building Division of Miami Shores Village shall be complied t7ith, whether herein sperified w net A copy of approved plans and specifications must be kept at building during progress of work. Owner's Name and Address Paul Date No. s..t/g1111 Registered Architect and/or Engineer Employln 7z bces 1,40,9 2 cl.,2 Otatet--122.0.., /1 d a on 887-5594 I 1.. woritz 1 Suildiviolon.2 don an g Street and Number where work is to be performed-No 45 N.E. 94 street State work to be performed and puziorrs° of building (By Moro ).__ New Building__ ___ RGanedeling — Addition. STATE OF FLORIDA, ea COUNTY OF DADE. Before me, the undersigned authority, a Dewy public, duly a Repairs x Size Septic Tank-. __Type of TPfflIjr 300 sq . ft. Feet of Drain Til® _Diet. Feat of Tank az Drain Field from Well Nature of Water Supply: City-Wall Size of Stilltafp Pit (Signed)- 4. ”' \?C-4(C-4CCIC Plumbing IngpectO;: The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations es an employer of labor under the Florida Workmen's Compensation Act, being Section 5866, Compiled General Laws of Florida Permanent Supplement, and liar com- plied with the provisions thereof, and will require similar compliance from all contractors or sub-contractors employed by him in the worlr 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 MICA sub -contractors, on work to be performed under this permit, as are licensed by Miami Shores Village. to me well known, and who, being me first duly swam upon oath depoom and says that he is the__ of the above described construction, that he has cwefunly sued this foment/1g agsplication, and that Street. No. of Stories .... Capacity Cals....______ / MUMS number. to administer oaths and take acknowledgments, personally appeared NOTE: A re-inspection fee of $L90 bo inaelka 'Aga mob mokagestiote ceette by torpmpor ratio. for Inspection, or beaky materials aod/or warlosausitip. Owner's Name and Address_ Amount of Permit $ -• -- - STATE OF FLORIDA, I COUNTY OF DADE. Siam Septic Tank._ _ - -- -- -- - Feat of Drain - - Nature of Water Supply: City —Well. My Commission Expires a b V6 - No Application is 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 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 wor Registered Architect and /or En ine _ ..- j Employing Plumber's Name 12aLa ) 7 It% 0 SHORES VILLAGE PLUMING INSPECTION DEPARTMENT Qpnocan ©m FOR PLUMBING PERMIT No. ( Signed ) - -- __ Street Street. Date Location and Legal Description Lot -._--.______ ______._.._._....._ --..___ Block_ ._— .— Subdivision. Street and Number where work is to be performed— No.__..- -_____ ..____. _ — Street_ . State work to be performed and purpose of building (By Floors) - _ New Building ____. Remodeling.-_ -. -- --- -- -_ - Addition_--_ _ _ .__ ___.._ . Repairs. /40/24/2Y Street l! v 4.! No. of Stories _ T 0 of ` • 0 e e of ank o /Drain Field from Well.. _ _- _.Si.e of Soakage Pit - - (Shed )- - -- -- - - -- - - Capacity Gals. Pl..mbing In:pecto. 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 5986, Compiled General Laws of Florida Permanent Supplement, rnd 1 as com- plied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors em.loyed by hint in the work to be performed under this permit; and will post or cause to be posted' for inspection on the - of the work s p ' a ' notic: • no' ices as are required by the Act. The undersigned agrees to employ only such sub- contractors, on k to p rfo. , eJ`' nder i1. 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 acknowledgn.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. Notary Public, State of Florida NOTE: A re- inspection fee of $1.00 will be made when such re-inspection is made necessary by improper notice for inspection, or faulty materials and /or workmanship. CLODOTG BATH TUBS SHOWERS LAVA- TORIES SINKS SLOP SINKS LAUNDRY TUBE URINALS CATCH BASIN FLOOR DRAIN DRINKING FOUNT' NS TOTAL F XTURES CONTR. LIUT CHOCK SEPTIC TANK SEWER CONN. DRAIN FIELD SOAKAGE PIT GREASE TRAP SOLAR HEATER DEEP WELL SPRKLR. SYSTEM SWIM'G POOL CONTR. LIST CHOCK - _ Owner's Name and Address_ Amount of Permit $ -• -- - STATE OF FLORIDA, I COUNTY OF DADE. Siam Septic Tank._ _ - -- -- -- - Feat of Drain - - Nature of Water Supply: City —Well. My Commission Expires a b V6 - No Application is 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 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 wor Registered Architect and /or En ine _ ..- j Employing Plumber's Name 12aLa ) 7 It% 0 SHORES VILLAGE PLUMING INSPECTION DEPARTMENT Qpnocan ©m FOR PLUMBING PERMIT No. ( Signed ) - -- __ Street Street. Date Location and Legal Description Lot -._--.______ ______._.._._....._ --..___ Block_ ._— .— Subdivision. Street and Number where work is to be performed— No.__..- -_____ ..____. _ — Street_ . State work to be performed and purpose of building (By Floors) - _ New Building ____. Remodeling.-_ -. -- --- -- -_ - Addition_--_ _ _ .__ ___.._ . Repairs. /40/24/2Y Street l! v 4.! No. of Stories _ T 0 of ` • 0 e e of ank o /Drain Field from Well.. _ _- _.Si.e of Soakage Pit - - (Shed )- - -- -- - - -- - - Capacity Gals. Pl..mbing In:pecto. 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 5986, Compiled General Laws of Florida Permanent Supplement, rnd 1 as com- plied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors em.loyed by hint in the work to be performed under this permit; and will post or cause to be posted' for inspection on the - of the work s p ' a ' notic: • no' ices as are required by the Act. The undersigned agrees to employ only such sub- contractors, on k to p rfo. , eJ`' nder i1. 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 acknowledgn.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. Notary Public, State of Florida NOTE: A re- inspection fee of $1.00 will be made when such re-inspection is made necessary by improper notice for inspection, or faulty materials and /or workmanship. Permit No. Application is 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 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 work. Owner's Name and Address_ /_ _.! ©_ C No. _QS - •-- ____ -_ Street _9 `' T Registered Architect and /or Engineer Employing Plumber's Name - :_lA_ D S'4 ( i l Ii < _ _ No._ _ - ' - _ -- - street._ _ 9 Location and Legal Description Lot________ ..... __— __.____.___________._._ Block__ -- _ Subdivision. Street and Number where work is to be performed —No 4 Street_ . _ -9 / --. - - S t a t e w o r k to be performed and purpose of building (By F l o o r s ) . _ New Building Remodeling_____ -- Addition_--- _ _ ___ _.__ .- . Repairs_ Size Septic Tank_ -_ _ _ -- -- -- _ -- - -- t Feat of Drain Tile___ Z - Nature of Water Supply: City —Well. Amount of Permit $ STATE OF FLORIDA, I COUNTY OF DADE. MIAMI SHORES VH,En,ZE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLLP':`,BONG PC RMOT -Dist. Feet of Tank or Drain Field from Well _ . Size of Soakage Pit - (Signed). -- ( Signed) __ Date Capacity Gals. 7 - - - - fir No. of Stories . Plumbing Fn pea(); The undersigned applicant for this building permit does hereby certify that he understands and accepts his obli moons as an employer of labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Perin. nt Supplement, and 1. as 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 no'ices as are required by the Act. The undersigned agrees to employ only such sub- contractors, on w. k to be perfo; wed under this per nit, as are licensed by Miami Shores Village. My Commission Expires Notary Public, State of Florida Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take aclnowledgnlents, 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. NOTE: A re- inspection fee of $1.00 will be made when such re- inspection is made•neeessary by improper notice for inspection, or faulty materials and /or workmanship. CL06QTG BATH Tuss SHOWERS LAVA.. TORIES INKS SLOP SLOP SINKS LAUNDRY TUBE U URINALS CATCH BASIN FLOOR DRAIN DRINKING FOUNT' Ns TOTAL F XTUREB Comm LIST CHECK SEPTIC TANK SEWER CONN. DRAIN FIELD SOAKAGE PIT GREASE TRAP SOLAR H EATER DEEP WELL SPRKLR. SYSTEM SWIM'S POOL Comm LIBT -- CHOCK Permit No. Application is 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 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 work. Owner's Name and Address_ /_ _.! ©_ C No. _QS - •-- ____ -_ Street _9 `' T Registered Architect and /or Engineer Employing Plumber's Name - :_lA_ D S'4 ( i l Ii < _ _ No._ _ - ' - _ -- - street._ _ 9 Location and Legal Description Lot________ ..... __— __.____.___________._._ Block__ -- _ Subdivision. Street and Number where work is to be performed —No 4 Street_ . _ -9 / --. - - S t a t e w o r k to be performed and purpose of building (By F l o o r s ) . _ New Building Remodeling_____ -- Addition_--- _ _ ___ _.__ .- . Repairs_ Size Septic Tank_ -_ _ _ -- -- -- _ -- - -- t Feat of Drain Tile___ Z - Nature of Water Supply: City —Well. Amount of Permit $ STATE OF FLORIDA, I COUNTY OF DADE. MIAMI SHORES VH,En,ZE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLLP':`,BONG PC RMOT -Dist. Feet of Tank or Drain Field from Well _ . Size of Soakage Pit - (Signed). -- ( Signed) __ Date Capacity Gals. 7 - - - - fir No. of Stories . Plumbing Fn pea(); The undersigned applicant for this building permit does hereby certify that he understands and accepts his obli moons as an employer of labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Perin. nt Supplement, and 1. as 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 no'ices as are required by the Act. The undersigned agrees to employ only such sub- contractors, on w. k to be perfo; wed under this per nit, as are licensed by Miami Shores Village. My Commission Expires Notary Public, State of Florida Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take aclnowledgnlents, 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. NOTE: A re- inspection fee of $1.00 will be made when such re- inspection is made•neeessary by improper notice for inspection, or faulty materials and /or workmanship. Date 4I 1 9( Job Address 1- 4 s N c_ Legal Description Owner/Lessee / Tenant Architect/Engineer Bonding Company Mortgagor Square Ft. C Notary as to Owner My Commission Ex PERMIT APPLICATION FOR MIAMI SHORES VILLAGE U Owner's Address L) S I `t 54-e€- 7 e Contracting Co. Cn W ?to t i qN/ rj CCp erPa)) Q�fi State # Fit) 21 d c. Municipal # (�vY1 I q S Permit Type (circle one): BUILDING ELECTRIC L PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN WORK DESCRIPTION ?g_vn c k)A 1 c, 1 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 ., f. Stet■ 01%, - L i C- 14-- 77 Signature of own er and/or Condo President Date � d/ot N f ARY PUBLIC STATE OF FLORIDA COMMISSION NO. MY COMMISSION EXP. APR. 7,2000 p c• ' ENSDate • Nt FEES: PERMIT 3 r . RADON APPROVED: Zoning Building Mechanical Plumbing Tax Folio Historically Designated: Yes No Master Permit # ( "1 l a 5 Phon43c5) °7 ScD) - 6 5 Address P 6/ 15 S W_ 5+ SS# (, -30_- 1 945 Phone ( oS ) - Competency # / S Ins. Co. Address Address Address Estimated Cost (value) ature of Contracto er- Builder yi( Date ri fit _ : 4__ • /Lt-. /& Notary as to Contractor or 0 � ► V er- Builder My Commission Expires: Le_ C.1 OFFICIAL NOTARY SEAL LEtICIA ANGUIANO NOTARY PUBLIC STATE OF FLORIDA COMMISSION N NO. CC501748 MY • MMISSION EXP. OCT. 31,1999 Electrical 4 4 Ka Q °7 D•te Y1�utc�Y \ gg O C.C.F. L U P NOTARY BOND O O 3 6. TOTAL DUE AD Engineering , METROPOLITAN DADE COUNTY, FLORIDA ' Mr. and Mrs. Date 45 N.E. 94 Street Miami Shores, Florida 33138 Re: 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: ita.L ( h J. 9 , a. 99 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 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 w.i i.h i n sixty days of the UST closure: receipts and manifests documenting t he 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 POLLUTION PREVENTION DIVISION. 1 WASTE CLEASECTIONION SUITE Boo N r, 33 S.W. 2nd AVENUE CONSTRUCTION PLAN REVIEW APPLICATION MIAMI. FLORIDA 33130 -1540 (305) 3 :3.6817 FACILITY NAME: Pox( Y 4 7) 45 10\5M C E UT #J / V 0 FACILITY ADDRESS: 4 � . - 1 ', S] -, DERM FILE# 1 5512. CONTRACTOR /CONSULTANT NAME: i CONTACT PERSON PHONE# : 065) c , 1 49 3 VD.o / 3w2 - C G ' S 1 Y j0 6r)¢. FEE TOTAL [] TANK INSTALLATION $600 PLAN TYPE (check appropriate box) Fw 0 (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 `A TANK OR OIL /WATER SEPARATOR CLOSURE (requires Closure Application) [] 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 Lo be assessed by the plan reviewer.) DER/A ENVIRONMENTAL RESOURCES MANAGEMENT WASTE CLEANUP PAID WITH CHECK# � (- 31 g4 36 TOTAL FEE RECEIPT NO . # 2 PLAN REVIEWER MA R 101991 ERM $ 55 $110 $200 $275 N/A FOR DERM USE ONLY FEE ADJUSTMENT O DATE c,iHkv,7 (Fee Due or Credit Due) AC 10/1/96 (Form /fees subject to change without notice. Fees to be verified prior to submittal.) METROPOLITAN DADE COUNTY, FLORIDA METROOADE ENVIRONMENTAL RESOURCES MANAGEMENT POLLUTION PREVENTION DIVISION PETROLEUM REMEDIATION SECTION SUITE 800 33 S.W. 2nd AVENUE MIAMI, FLORIDA 331301540 APPLICATION FOR POLLUTANT STORAGE SYSTEM CLOSURE 1► 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: Paul > i P*-4 On t {�-;►�J, • FACILITY ADDRESS: / l) NI .1_ . , ► `lRf : I' CITY: Mlonn I v�rtZIP: 3 - 3V - 3( FOLIO 0 (IF AVAILABLE): PROPERTY OWNER: 0,01 8 r I4' 1) 1 TITLE (IF APPLICABLE) : COMPANY NAME (IF APPLICABLE): I/ n ADDRESS: CITY: STATE: ZIP: POLLUTANT STORAGE SYSTEM SPECIALTY CONTRACTOR (PSSSC) NAME: • ?U N A K4 J, 3c c c.0 F_ I I / COMPANY NAME: ( t-o4 I I CCC(ju 1 PHONE: ( 3 - I ) 2L-I9 - 3 8 -2 FDPR PSSSC N : �C. C L c:'I Q,Ll 1 ADDRESS: IUJ) ; ' W. Z7(, ► SI.. CITY: to�rw, c1'S \d COUNTYt 0 ZIP: > jC1 PLEASE NOTIFY : ?v (.: I"i L� � u ;di PHONE : ( l ) 3 L) - V°1 C, r WHEN READY ADDRESS: (.3'11 SW.27c s . CITY :��poll c+ STATE : no 2.4 -, ZIP . 36 3 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 ear y sho 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 storage 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 WE 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 UQI commence any plan related activities until you have received a copy of the approved plans. File M:\G512 UT 0: 5400 IW( )0: ATC 10/3/95 (Subject to change without notice) NW M: FDEP 0: BIM 9 10 11 12 13 ' '14 - kni - "15 16 17 18 . '-'• 19' - 7 LI k 0 ,. 110/4F 1 63 1 • , le f ini$1 . • , $. ii r ; • 8. Location (optional) Latitude: —° 20. r : 2 A3. 1 1 P.1 V c.e (1 1 10 C0.• - k1 c . Certified Contractor 'For new tank installation or tank removal To the best of my knowledge and beet all informati W9H Print name & title of owner r llthorized.person 1400.09 Demi Ito 0049100010 Cup. P.1e95e14 race 32001 5794 904-4344300 No191..a orua nme s. Iwr• ems 200 1Ifw 1b1°. 3210, 0047/0.4200 UA d F L ° ._ 1 7, c..s o1+a • 3311 0 45 0 .49 514 kis rs2 0 519. 32103-3/52 b ON ,313 Saawleatiana MO On r9► 1111. Arms 9154517 3310043.0 Florida Department of Environmental Regulation "nvin lbwero Office Bldg. • 2600 Bblr Stone Road •''tiil Florida 32399 -2400 • Storage Tan..R ' s k} ation Form Section 11 Tank(s) Revision / I Complete 9 • 16 for tanks lh use; 9 • 19 for tanks out of use 1 :il t,'' ; 1 • oen W..... 17 - 1 11 , 0 1 92) 0-,.. Soma* 11201 maim f1+. *samba toe ; 1111 ,11 1'1i' , 0311 4 r0c4501 IN 0r0a. br 0U Please Print. or Type - Review Instructions Before Completing Form 1. DER Facility ID Number: 2. Facility Type qc �i IrF �1 3. New RegistratIon L�1J New Owner Data ❑ Facility Revision ❑ 4. County and Code of tank(s) location .1': 5. Facility Name: PLO Of BF F ify I )A � �. � 4 '1, 1+J e lc� Tank(s) Address: ,�' . r c- 14 rh �� 1 - - 3 -3 (j City/State/Zip I' I l A )•VII - Vl o �Qq ; l NO O l 41 Contact Person: — P a t ) 1'D c F a Financial Responsibility type: Ni ()t Telephone (.._ '75 - ` 4oG5 n 7a. Tank(s) Owner IjA M C . (k`�) (\ P' 0 Owner Mailing Address: City/State/Zip Contact Person. Telephone ) • .4 • 7b. New Owner Signature/Change Date: Township Complete One Line For Each Illnk At This Facility (Use Codes - See Instructions) .1( Department of Professional Regulation License Number' fitted on thls form is.true, accurate and complete. awe. 0000 :ter ea a 10.1 1 .44.1 Fiend. 33901 2990 03133 39 .11 410 l3l ! 11 rot I 44, i, • .7 'Date „l 301119440 043911 1 3003 Crp14•9 940 004 114401, Pans 33101 00-4134010 3. , .x(4 7 ij 6 /O t: �`' 5' 4 ma T Fv Roy D to co METROPOLITAN DADE COUNTY, FLORIDA METROOADE PETROLEUM REMEDIATION SECTION UST SYSTEM REMOVAL PLAN APPROVAL CONDITIONS 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 inspector the vapor hazard area. Each UST must be inert, securely blocked .. •9Fi� F surfa y accessible to the inspector. and made readily %r,) / � ,���� !A n in each excavation and made readily accessible to ed ENVIRONMENTAL RESOURCES MANAGEMENT POLLUTION PREVENTION DIVISION SUITE 800 33 S . 2nd AVENUE MIAMI, FLORIDA 331301540 (305) 372.6817 outside on a level Groundwater must be the inspector. riginal set of the most recently approved UST removal plans must be tained on -site for inspection throughout the removal activities. • yst, 1 work, including all applicable safety requirements, must be performed by a d, 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 .(OSHA), American Petroleum Institute (API) Recommended Practice N1604, 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 must be properly cleaned, marked, and disposed of in accordance with API #1604 and NFPA 430. 8. All UST contents (including liquid wastes, decontamiriation wastewater and sludges) must be properly recovered prior to commencing any UST excavation UT #:54O0 Approval Date: 4:111L+7 Page 1/2 LEGEND PIL = PROPERTY LINE Sys = SOL SAMPLE UST REMOVAL SITE PLAN ALLEY EXISTING RESIDENCE N.E. 94th Street FR POLE 6 LINE WATER METER & LAZE P 111 - 1 SUCTION & RETURN ONES 1 -275 Gel. UST (fuel NMI, steel) 0 -.ma Viso. Jjelf - 4:011 ... ENLARGEMENT 300% FILL 109 • VENT (f SCALE 10 20 30 40 1 g W N 0. c. 50 t: B Ba e11 ment Co., Inc. L�J PROPOSED UST REMOVAL PLAN O SITE NAME: Date Residence SITE ADDRESS: 45 N.E. 94th Street b g 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: AB work to be completed in accordance with FDEP 62 -761, API 1604, PEI, and NFPA #30 guidelines. • APPLICATION FOR BUILDING PERMIT Application is hereby made for the approyal 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 May 31, 1 955 19 Owner's Name and Address MacDonald & Aufford No 45 N0E 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 45 N.E. 94th St. State work to be done and purpose of building (by floors) Sprinkler System No WELL-- 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 tile building it nst i Monarch Pump & Equipment Co., 1532 N.W. 2 n d S t n and li , '� 8T'x u a be sent to BUILDING INSPECTION DEPARTMENT The undersigned applicant for this building pennit 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, Permanent 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 insp tion on the lily) the work such public notice or notices as are required by the Act. The undersigned agrees to employ only such s• . .n.: tors, on ork t• be _ . rfo ed under this permit, as are licensed by Miami Shores Village. / / Remarks (Signed)- ._.l.,l Building Inspector MIAMI SHORES VILLAGE STATE OF FLORIDA, COUNTY OF DADE. j 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 carefull read the foregoing application, and that he did sign the same, and that all facts therein by him stated are tie. S � Permit No � te a. r ,, , --- —.•.,.) Read, Sworn to and Subscribed before me. Disapproved Date Notary Public, State of Florida (Signed) My Commission Expires ee 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 51.00 will be charged when such re- inspection is made necessary by improper notice for inspection or faulty materials and /or workmanship. Permit No. 1 6 7L Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the building or othei 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 al building during progress of wok. Owner's Name and Address. � Z ��� ��______ No. Street .:/ „..,.4.4„,._ � a __ -- Registered Architect and /or in ine, s{- Employing Plumber's Name n _,L - �� �: _7 '! �� \ —No . Street____ � , _ _Block _/ Subdivision -1 %L_.. __ �' ) Location and Legal Description Lot. Street and Number where work is to be performed—No �`? _1/ State work to be performed rid purpose of building (By Floors) __. New Building Remodeling Addition _________ ___ ____________ Repairs No. of Stories Amount of Permit $ Nature of Water Supply: City —Well MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT Size Septic Tank Type of Tonle Capacity Gals. Feet of Drain Tile � _Dist. Feet of Tank or Drain Field from WeIL Size of Soakage Pit (Signed) __/ �� A--g 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 Perinanent 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 permit, as art licensed by Miami Shores Village. (Signed). Date Plumbing Inspector. Master Plumber. STATE OF FLORIDA, 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 fac therein by him stated are true. My Commission Expires Notary Public, State of Florida 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 ce0?9° materials and /or workmanship. ��D CLOSETS BATH TUBS SHOWERS LAVA- TORIES SINKS SLOP SINKS LAUNDRY Tuas URINALS CATCH BASIN FLOOR DRAIN DRINKING FOUNT' NS TOTAL FIXTUREt -- CONTR. LIST CHECK SEPTIC TANK SEWER CONN. DRAIN FIELD SOAKAGE PIT GREASE TRAP SOLAR HEATER DEEP WELL SPRKLR. SYSTEM SWIM'G POOL CONTR. LIOT CHECK 1 )) Permit No. 1 6 7L Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the building or othei 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 al building during progress of wok. Owner's Name and Address. � Z ��� ��______ No. Street .:/ „..,.4.4„,._ � a __ -- Registered Architect and /or in ine, s{- Employing Plumber's Name n _,L - �� �: _7 '! �� \ —No . Street____ � , _ _Block _/ Subdivision -1 %L_.. __ �' ) Location and Legal Description Lot. Street and Number where work is to be performed—No �`? _1/ State work to be performed rid purpose of building (By Floors) __. New Building Remodeling Addition _________ ___ ____________ Repairs No. of Stories Amount of Permit $ Nature of Water Supply: City —Well MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT Size Septic Tank Type of Tonle Capacity Gals. Feet of Drain Tile � _Dist. Feet of Tank or Drain Field from WeIL Size of Soakage Pit (Signed) __/ �� A--g 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 Perinanent 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 permit, as art licensed by Miami Shores Village. (Signed). Date Plumbing Inspector. Master Plumber. STATE OF FLORIDA, 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 fac therein by him stated are true. My Commission Expires Notary Public, State of Florida 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 ce0?9° materials and /or workmanship. ��D Permit No. d a e Owner's Name and Address Amount of Permit $ l ✓ ad. My Commission Expires MiIA' B SHORES MACE 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 Miaini 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 al building during progress of work. 1 2 (Signed) No Street Registered Architect and /or Engineer r Employing Plumber's Name � tt?ita s0- =- No. -1 /-62- -1-E . Street__ 7 Ode_ Location and Legal Description Lot 11.7 _ __6I_r _____ Block__ _____7 Subdivision la_ ea 12 "'___ _ Street and Number where work is to be performed —No _2.Z S treet State work to be performed and purpose of building (By Floors) ,62.&11.3 € 2 New Building Remodeling Addition , Repairs No. of Stories / Date Size Septic Tank Type of Tank_ Capacity Gals. Feet of Drain Tile Dist. Feet of Tank or Drain Field from Well I Nature of Water Supp R�) ell 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 e► I�nver of labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Permanent Sup emen and hp com- plied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors employed b him i 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 o notieis as are required by the Act. The undersigned agrees to employ only such sub -contra t , on,'work t performed under t is permit, hs an licensed by Miami Shores Village. - ),�. (Si r o g r r IX 5 l / G'o�. � �--- - -f--- ham rite Plumber. STATE OF FLORIDA, t 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. Notary Public, State of Florida �IQOTE: 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 TUBS URINALS CATCH BASIN FLOOR DRAIN DRINKING FOUNT'NS tgML'�49 n��,/j ) G� TOTAL FIXTUREI - 6 / • � /y �° / /d cj) v J<V 77-- CONTR. ST LIST CHECK 17 SEPTIC TANK SEWER CONN. DRAIN FIELD SOAKAGE PIT GREASE TRAP SOLAR H EATER DEEP WELL SPRKLR. SYSTEM SWIM•G POOL ( W e �Q � � �JI a f, c S. COS u,a ¢Ln CL IET LIST CHECK ,' p i g ) C.l _ � s m Permit No. d a e Owner's Name and Address Amount of Permit $ l ✓ ad. My Commission Expires MiIA' B SHORES MACE 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 Miaini 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 al building during progress of work. 1 2 (Signed) No Street Registered Architect and /or Engineer r Employing Plumber's Name � tt?ita s0- =- No. -1 /-62- -1-E . Street__ 7 Ode_ Location and Legal Description Lot 11.7 _ __6I_r _____ Block__ _____7 Subdivision la_ ea 12 "'___ _ Street and Number where work is to be performed —No _2.Z S treet State work to be performed and purpose of building (By Floors) ,62.&11.3 € 2 New Building Remodeling Addition , Repairs No. of Stories / Date Size Septic Tank Type of Tank_ Capacity Gals. Feet of Drain Tile Dist. Feet of Tank or Drain Field from Well I Nature of Water Supp R�) ell 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 e► I�nver of labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Permanent Sup emen and hp com- plied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors employed b him i 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 o notieis as are required by the Act. The undersigned agrees to employ only such sub -contra t , on,'work t performed under t is permit, hs an licensed by Miami Shores Village. - ),�. (Si r o g r r IX 5 l / G'o�. � �--- - -f--- ham rite Plumber. STATE OF FLORIDA, t 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. Notary Public, State of Florida �IQOTE: 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. 1 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax:05) 756.8972 BUILDING � �,r� Permit No. P1 QS-- PERMIT APPLICATION 2001 Permit Type (circle): Building Ele rica 7 Plumbing Mechanical Roofing Owner's Name (Fee Simple Titleholder) / f .e � 9 , i7 03 Phone # ( ,3 0 s) 2/5 /.`13 9 /' Owner's Address 4/5 °E 4 .5 City • S A c /2 e S State �• Tenant/Lessee Name Phone # Job Address (where the work is being done) 2 % /c/ City Miami Shores Village County Miami -Dade Is Building Historically Designated YES NO Contractor's Company Nance O ? L h_ S t4 I tiA f3l y . Phone # 3 OS - 25s 775 Contractor's Address O - X z- 7 4 City 't�'�e 5 { a� Slate Qualifier 6 ✓q e_ Q �. C—. State Certificate or Registration No.0 -L.-5 D Certificate of Competency No. Architect/Enweer's Name (if applicable) $ Value of Work For this Permit Type of Work: ❑Addition ❑Alterati Describe Work: Total Fee Now Due $ (Continued on opposite side) F)(,? Miami Shores Village Building D epartment ? New Structural Plan Review. $ aster Permit No. gP 05-1(0 7 Zip 3 2 /3 V ° 91 . Zip .3‘ 3/3 Zip X3 12-- Rhone # '() Square Footage Of Work: ` Repair/Replace ❑ Demolition CC * * * ** * * * * ** *F * * * * * * * * * * * * * * ** * * * * * * * * * * * ** /Lc) 4 Submittal Fee $ ' Permit Fee $ 'ry a2`�� CCF $ Q ' �G �O /CC Notary $ Training/Education Fee $ 30 Technology Fee $ • _ -® Scanning $ Radon $ Zoning Bond $ Code Enforcement $ Bonding Company's Name (if applicable) Bonding Company's Address City State Zip IP 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 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 reinspeon fee will be charged. Signature Owner or Agent The foregoing instrument was acknowledged before me this day of — 0m A who is peril, NOTARY Sign: Print: My Commission Expires: * * * * * * * * * * * * * * * * * * * ** Chc 05/13/03 • FE tIX P. VELIS • MyCommission Expres 9, 2008 g AsddootiilSataeitirD Yftfl4lia take an oath. _'' t• " Bonded By National Notary Assn. — • ********* * * * * * * * * * * * * * * * * * * * * * * * * * * * + * ** * APPLICATION APPROVED BY: 7 -9720-7' Zoo * * Signatur The foregoing day of who is pers NOTARY P Sign: Print: ;P: wi • ....... Bon instrument was acknowledged before me this _ • Ftllx a VtuS filtdarimPobtielidiute pteriade4 • I NVCommigion ExpipsfvJar 9 2 li en(it N< tury Assn. My Commission Expires: ' Cft-- Z * * * * * * * * * * * * * * * * * * * * * * * * *< ***************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** ***************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** Plans Examiner Engineer Zoning e an oath. 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 OVER 1- 3 HP HOT WATER BOILERS SINK, POT /3 COMP. MOTDRS OVER 3- 5 HP MECHANICAL VENTILATION SINK, RESIDENCE 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 HP 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 SWIWING POOL OUTLETS CCNNERCIAL WATER SERVICE SIGN TUBES SEWER CONNECTIONS SIGN TRANSFORMERS UTILITY -SEWER SIGN TIME CLOCK UTILITY -WATER FIXTLRES SEPTIC TANK ANTENNA RELAY TELEVISION OUTLETS DRAINFIELD, 4' TILE/RES. VIOLATION PUMP & ABANDON SEPTIC TANK REINSPECTION SOAKAGE PIT CU. FT. Fr) D-4 - er .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 PIPIP ADDENDUM TO BUILDING PERMIT APPLICATION (AN APPLICATION 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 1 RECEPTACLES A/C (WIND) DISPOSAL SERVICE TEMPORARY A/C (CENTRAL) DRINKING FOUNTAIN SERVICE SIZE IN AMPS DUCT WORK FLOOR DRAIN SERVICE REPAIR/IETER CHANGE REFRIGERATION GREASE TRAP APPLIANCE OUTLETS PROCESS AND PRESS PIPING INTERCEPTOR RANGE TOP UNDERGROUND TANKS LAVATORY OVEN ABOVE GROUND TANKS LAUIORY 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 DOW. MOTCRS OVER 3- 5 I•P MECHANICAL VENTILATION SINK, RESIDENCE 9 MOTORS OVER 5- 8 HP TRANSPORTING ASSEMBLIES SINK, SLOP MOTCRS OVER 8- 10 FP ELEVATORS/ESCALATORS TEWORARY WATER CLOSET MOTORS OVER 10- 25 HP FIRE SPRINKLER SYSTEMS FINAL MOTORS OVER 25-100 HP COOLING TOWERS WATER CLOSET MOTORS OVER 100 FP 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 FIXTLRES SEPTIC TANK ANTENNA RELAY TELEVISION OUTLETS DRAINFIELD, 4 TILE/RES. VIOLATION PUMP & ABANDON SEPTIC TANK REINSPECTION 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 APPLkATION 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 Parcel # 1132060134290 Signed: (INSPECTOR) Signed: (Contractor or Builder) Plumbing Permit Permit Number: PL2005 -46 BOLTON ST Contractor ROYAL FLUSH PLUMBING & SUPPLY INC Contractor's Address: 14481 SW 296 ST Local Phone: 305 - 255 -7755 Legal Description: MIAMI SHORES SEC 1 AMD PB 10 -70 LOT 23 Permit Status: APPROVED Permit Expiration: 8/2/2005 Construction Value: $500.00 Work: KITCHEN REMODELING PLUMBING - MASTER BP2005 -167 BY: 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 iti c, 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.