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550 NE 94 St (5)PERMIT APPLICATION FOR MIAMI SHORES VILLAGE Date 2 30 cri Job Address 55o NE -14- - Tax Folio j j — ° 6 ° 014 0 l St'12. 16-31 Historicall Desi Yes Legal Description O w n e r / L e s s e e / Tenant K O g - 1 - Si t NO S Master Permit # 4',O ' 7 S Owner's Address 550 r\\E q Ur (S1i2E E.f Phone 15 1 ° 1065 Contracting Co. 1...1.0p- NO f DI DE Pri G Address 800 MN 111 ! i tLititt4/ Qualifier D N M S V (L1 SS# h o n e 7 S — 7 6 6 state # 0258 4 '� Municipal # Competency # l2C�'f'a Ins. Co. 5( &' VE-EZ Architect/Engineer Bonding Company Mortgagor Permit Type (circle one): BUILDING ELECTRICA WORK DESCRIPTION I KE 1 H LL MAMA EW Square Ft. 30 0 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. OWNERS AFFIDAVIT: I certify that all the foregoing information is accurate laws regulating cons 'on and zoning. Furthermore, I authorize the above -n t�l 1 d/or Condo Q Notary ; s to O My C. ssio or ID Signature of own FEES: PERMIT APPROVED: Zoning Mechanical ate Q-i r Con President Date 0 . p pr a� 1breaaa J. Felder Notary Public, g ote et Florida s OF y i. g Commission tio. CC 48007 Op My Commission Expires 07 /16 � 1400.3- NOrAAY • t Navy S" @ Baenl Co. ILI lute+!!! @ ef!et te!ee!!!ere!lR efel!eet!!!eC!tA 7. 337 RADON C.C.F. Address Address Address MECHANICAL ROOFING PAVING FENCE SIGN Estimated Cost (value) /700 ork will be done in compliance with all applicable to d ork stated. ereaa J. Felder Notary Public, Fiate of Florida '3 r' o Commission No. CC 480807 ' My Commission Expires 07/161 99 1- 800.7•NOTARY - Na. Notary &grim $ Ton Co. (Mfa(eee((eeeemeeeee&e eee(((Kelll!!K ) ) NOTARY 1 No 1 Date D12 ate r BOND 3 O D, TOTAL DUE 3 36 , °Z ) Notes: APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PERMIT .- =a Permit' Application Number � �- 0 L < u ! DS STATE OF FLORIDA DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES Site Plan submitted by: Plan Approved HAS -I-1 Form 4015, Feb 85 (Obsoletes previous editions which may not be used) (Stock Number. 5744 - 002 - 4015 -6) PART II - SITE PLAN Scale: Each block represents 5 feet and 1 inch = 50 feet. ....iiiii�'iiiii�Aiini ai il�iWllllll - .. N n�Di191Qe ■lI�� —mane iii��Ni�ii�il�llllllllia �OIIIaIIIII��IYI� mommomommommummampassiummissammisimmisimummismismiummimmummommummummu immommommimmommilimmommommommommummimmommommmommummommimmomm mum (4, 'GI1 In c/ ... 7 ) ✓ u C 2 d � f 7 instarvau - /f TITLE Not Approved Date ; By —_- = � _, ' County Public Unit ALL CHANGES MUST BE APPROVED BY THE COUNTY PUBLIC HEALTH UNIT Page 2 of 3 STATE OF FLORIDA DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PERMIT Authority: Chapter 381, FS & Chapter 10D -6, FAC CONSTRUCTION PERMIT F9R: (i ] New ,System (i System [ V] Rep [ vAbandonment d' APPLICANT: PROPERTY STREET ADDRESS: LOT: // BLOCK: PROPERTY ID #: q� 0 c7 (SECTION /TOWNSHIP /RANGE /PARCEL NUMBER] [OR TAX ID NUMBER] SYSTEM MUST BE CONSTRUCTED IN ACCORDANCE WITH SPECIFICATIONS AND STANDARDS OF CHAPTER 10D -6, FAC REPAIR PERMITS AND HOLDING TANK PERMITS EXPIRE 90 DAYS FROM THE DATE OF ISSUE. ALL OTHER PERMITS EXPIRE ONE YEAR FROM THE DATE OF ISSUE. HRS APPROVAL OF SYSTEM DOES NOT GUARANTEE SATISFACTORY PERFORMANCE FOR ANY SPECIFIC PERIOD OF TIME. ANY CHANGE IN MATERIAL FACTS WHICH SERVED AS A BASIS FOR ISSUANCE OF THIS PERMIT, REQUIRE THE APPLICANT TO MODIFY THE PERMIT APPLICATION. SUCH MODIFICATIONS MAY RESULT IN THIS PERMIT BEING MADE NULL AND VOID. T A N K D R A I N F I E L D O T H E R SYSTEM DESIGN_AND SPECIFICATIONS , - GALLONS h GPD PTIC TANK /-AEROBIC UNIT [GALLONS / GPD] GALLONS GREASE INTERCEPTOR CAPACITY GALLONS PER DOSE DOSING TANK CAPACITY [ W- } SQUARE FEET - PRIMARY DRAINFIELD SYSTEM [ ] SQUARE FEET SYSTEM TYPE SYSTEM: CONFIGURATION: SPECIFICATIONS BY: APPROVED BY: DATE ISSUED: 7r' AdCE SUBDIVISION: [ G 9 ] HRS -H Form 4016, Mar 92 (Obsoletes previous editions which may not be used) (Stock Number: 5744 - 001 - 4016 -0) Holding Tank [ Temporary/Experimental Other(Specify) AGENT: TITLE: PERMIT #fil / \\ ` � DATE PAID % -- 4 ' - - -r 74 FEE PAID $ c_=;-) ` "'' RECEIPT # Z '// -, CAPACITY MULTI- CHAMBERED /IN SERIES:[ CAPACITY MULTI- CHAMBERED /IN SERIES:[ [MAXIMUM CAPACITY SINGLE TANK: 1250 GALLONS] DOSE RATE [ ] PER 24 HRS NO. OF PUMPS: [ ] [ ] STANDARD [ ] FILLED [ ] MOUND [ ] [ ] TRENCH [ Z]'' [ ] LOCATION OF BENCHMARK: 1 or 01c., . I 0 ) / �%,-7 ( � 2 ' I - S - _ ELEVATION OF PROPOSED SYSTEM SITE [ 6D [INCHE S FT] [ABOVE /BELOW] BENCHMARK /REFERENCE POINT BOTTOM OF DRAINFIELD TO BE [ , 7 ] S 'T] [ABOVE /BELOW) BENCHMARK(EFERENCE POINT FILL REQUIRED: [ ] INCHES EXCAVATION REQUIRED: [ ( 7] INCHES TITLE i EXPIRATION DATE: ter - CPHU Page 1 of 2 . �.: ONE: m_t :C;ri1 P. l: 1': ''or 8pp1 4!1; -. J" .O. uu:: u: vc•.c,t,::..: :fu.:C�p_s °:" o::: •.. 3.:OC.:K, SUlID:- '.'`_SIGN ur :Of /• 2,/ ci ;ir ct:, i : numiler for o :y. (C ?_ ._, :nab • or S°7S "EPJ_'DSICNAND S ? E^..:lclCAriCNS: "ANK: Minimum snecificction s from C;lapter 0:. 'PAC. Minimum ::Pccific :tions from C'ta.rt.:r :C: 5, SAC. Other specifications, such as operating cc; ou- a flush toilets, vr.r:Cnce provtroa. SPEC:I /CAT IONS dY: Name of individual - providing specifics :ium•. ::f do i .• engineer must be realer". APPROVED BY: County Public Health Unit (Cn %1U) personnel revicwia, :.r r- _approving permit. DATE ISSUED: sate permit is issued by C?-U. EXPIRATION DATE: One year from date issued if the system Aar, not been ..?errnits for system repairs become void 90 rays from the date issued. 5 SECTION BY DATE Zoning Electrical Mechanical Plumbing �`�; 2- 27 --4 Fire Public Works Structural Building Official Page 4 OFFICE USE ONLY f1ECKLIST ❑ OWNER - BUILDER FORM (Attach) ❑ FIRE DEPARTMENT APPROVAL (Commercial / multi- family) ❑ CONCURRENCY (New Construction) ❑ OTHER (Specify & Attach) $3.00 per page (Scanning Fee) Miami Shores Village Bond Metropolitan Dade County (C.C.F.) Inspector State Educational Fund State DCA (Radon) Code Enforcement Fine Zoning Review /4/076 1 .ZA , (, ❑ PROOF OF OWNERSHIP (Attach) ❑ HRS / DERM APPROVAL (Septic / Sewer) ❑ IMPACT FEE (New Construction) ❑ OTHER (Specify & Attach) $ (p b . 0 () $ -O 0 r Do $ 0 REVIEWED AND PREPARED BY: (sq.ft. = x/1000 x ¢.60) (¢.005 /sq.ft.) (¢.01 /sq.ft.) PERMIT APPLICATION ❑ CONDO ASSOCIATION APPROVAL (Attach) ❑ BPR APPROVAL (Restaurants) ❑ CONTRACTOR REGISTRATION (On File) PERMIT FEES TOTAL $ ISSUING OFFICIAL DATE: CONDITION OF APPROVAL Revised July 2001 10050 N.E. 2ND AVE., MIAMI SHORES, FL • (305) 795 -2207 • FAX (305) 756 -8972 • http : / /www.miamishoresvillage.com ELECTRICAL TYPE Minimum Fee QTY. TYPE Dryer QTY. TYPE: Outlet, Appliance QTY. TYPE Service Repair QTY. A/C Central 1 -3 Ton Fan Outlet, Wall Service, Temporary A/C Central 4 -7 Ton Fire Pump Outlet, Switch Signs A/C Central 8 -15 Ton Fixture - Fluorescent Oven Space Heater (kw) A/C Central 16-20 Ton Fixture Light Parking Lot Lights Spas/Hot Tubs A/C Central 20+ Ton Flood Lights Plugmold/Strip Subfeeds, No. of Amps A/C Window FPL - Load Central Posts Swim Pool, Commercial Air Conditioners Garbage Disposal Range/Range Top Swim Pool, Residential Chiller Generators, etc. Receptacles Switchboards Clear Violations Heat Recovery Refrigerator, Comm. (p/PH) Temp Serv., Construction Compactor Low -volt, Burglar Refrigerator, Domestic / Temp for Test - 30 days Deep Freezer Low -volt, Fire Renew - Temp Service Water Closet Demolition Low -volt, Intercom/Teleph. Repair Circuits Water Heater Dishwasher Low -volt, Television Service, Number of Amps 1 Water Heater New MECHANICAL TYPE Minimum Fee QTY. 'I'YI'F. Condensate Drain QTY. 'I'VI'E Generator QTY. TY'I'E Refrigeration, Tons QTY. A/C Central, Tons Cooling Tower Heating Strips, each Vent Hood, Cost A/C Wall/Win. Tons Dryer Vents, Number of Paint Booth Ventilation, Cost Air Handler, Tons Ductwork, Cost of Piping, Flammable Liquid Periodic Inspections Barbecue Fire Sprinkler System Process/Pressure Piping Supply, AC Well Bath Fan - Vented, # Fireplaces, Number of Pressure Vessel Temporary Toilet PLUMBING TYPE A/C Condensate QTY TYPE Drains, Roof Q'I'Y TYPE Miscellaneous Fixture QTY. TYPE Soakage Pit QTY Bath Tub Drinking Fountain Miscellaneous Repairs Solar Water Heater Bidet Filter Replace Pool Piping Sprinkler Repair Cap - Fixture Fountain Pump and Abandon Sprinkler System Cap - Water Gas - Appliance Pump, Domestic Supply, AC Well Cap - Sewer Gas - Natural Pump, Fire Stand Temporary Toilet Catch Basin Gas - Propane Pump, Re- circulate Temporary Water Closet Clothes Washer Gas Piping Pump, Replace - Pool Urinal Dental Chair Grease Trap Pump, Sprinkler Utility - Sewer Discharge Well Ice Maker Pump, Sump Utility - Water Dishwasher Indirect Wastes -- Reair / Vacuum Pump Disposal Interceptor Roof Inlet Water Closet Domestic Well Laundry Tray Septic Connection Water Heater Drainfield, 4" Tile/Res. Lavatory Septic Tank 1 Water Heater New Drains, Area Meter Set (Gas) Sewer Connection Water Re -pipe Drains, Floor Minimum Fee Shower Water Service Drains, French Miscellaneous Equipment Sink Well, Supply Page 3 PERMIT APPLICATION INSTRUCTIONS: Please indicate the type of work being performed and quantity(ies) in the space provided below. RECEIVED AND REVIEWED BY: DATE: SECTION BY DATE Zoning Electrical Mechanical Plumbing *� A 02-2 Fire Ail. Public Works Structural Building Official Page 4 OFFICE USE ONLY IEC'KL'f.T CI OWNER - BUILDER FORM (Attach) ® FIRE DEPARTMENT APPROVAL (Commercial / multi- family) • CONCURRENCY (New Construction) CI OTHER (Specify & Attach) $3.00 per page (Scanning Fee) Miami Shores Village Bond Metropolitan Dade County (C.C.F.) Inspector State Educational Fund $ State DCA (Radon) $ Code Enforcement Fine Zoning Review LI PROOF OF OWNERSHIP (Attach) ® HRS / DERM APPROVAL (Septic / Sewer) • IMPACT FEE (New Construction) C.1 OTHER (Specify & Attach) PERMIT FEES $ ( p 7 ( $ $OO r 00 $ / 0 ( sq.ft. = x/1000 x 0.60) $ (¢.005 / sq.ft.) (¢.01 /sq.ft.) LI CONDO ASSOCIATION APPROVAL (Attach) • BPR APPROVAL (Restaurants) • CONTRACTOR REGISTRATION (On File) ISSUING OFFICIAL REVIEWED AND PREPARED BY: PERMIT APPLICATION DATE: CONDITION OF APPROVAL Revised July 2001 10050 N.E. 2ND AVE., MIAMI SHORES, FL o (305) 795 -2207 o FAX (305) 756 -8972 0 http:/ /www.miamishoresvillage.com CONSTRUCTION PERMIT FOR: [ ]New System [ ]Existing System [ [ X ]Repair [ ]Abandonment APPLICANT: Singer, Deanna PROPERTY STREET ADDRESS: 550 NE 94 St Miami FL 33138 LOT: 6 K [ 0 ]GALLONS STATE OF FLORIDA DEPARTMENT OF HEALTH ONSITE SEWAGE TREATM CONSTRUCTION PERMIT BLOCK: 56 SUBDIVISION: Miami Shores [Section /Township /Range /Parcel No.] PROPERTY ID #: 11- 3206 - 014 -0940 [OR TAX ID NUMBER] SYSTEM DESIGN AND SPECIFICATIONS T [ 900 ]Gallons SEPTIC TANK A [ 0 ]Gallons N [ 0 ]GALLONS GREASE INTERCEPTOR CAPACITY D [ 300 ]SQUARE FEET PRIMARY DRAINFIELD SYSTEM R [ 0 ]SQUARE FEET SYSTEM A TYPE SYSTEM: [ N ]STANDARD [ N ]FILLED I CONFIGURATION: [ N ]TRENCH [ N ]BED N F LOCATION TO BENCHMARK: Finish Floor of Existing Res. Elev I ELEVATION OF PROPOSED SYSTEM SITE [ 1.8 ] [ FEET ] E BOTTOM OF DRAINFIELD TO BE [ 3.6 ] [ FEET ] L D FILL REQUIRED: [ 0.0 ]INCHES EXCAVATION REQUIRED: [ OTHER REMARKS: Install New 900 Gallons Septic. Install 300 Square feet Drainfield. Invert Elevation of the D/F to be NLT 4.97' NGVD Bottom Elevation of the D/F to be NLT 4.47' NGVD This permit is not for addition. SPECIFICATIONS BY: Andre, Paul APPROVED BY: DATE ISSUED: DH 4016, 03/97 �c� -....v C I A — (1n1 _An1 c_nt .-- "- ---- .n,c 11 DOSING TANK CAPACITY [ 0 SYSTEM AGENT: SR0931119, COCKING MSTEPHEN . 8.1' NGVD TITLE: / CENTRAX #: 13 -SG -11936 DATE PAID: FEE PAID : $ RECEIPT . OSTDSNBR : 02 -0543- -R ]Holding Tank [ ] Innovative Other ]Temporary [ NA ] SYSTEM MUST BE CONSTRUCTED IN ACCORDANCE WITH SPECIFICATIONS AND STANDARDS OF CHAPTER 64E -6,FAC DEPARTMENT APPROVAL OF SYSTEM DOES NOT GUARANTEE SATISFACTORY PERFORMANCE FOR ANY SPECIFIC TIME PERIOD. ANY CHANGE IN MATERIAL FACTS WHICH SERVED AS A BASIS FOR ISSUANCE OF THIS PERMIT, REQUIRE THE APPLICANT TO MODIFY THE PERMIT APPLICATION. SUCH MODIFICATIONS MAY RESULT IN THIS PERMIT BEING MADE NULL AND VOID. ISSUANCE OF THIS PERMIT DOES NOT EXEMPT THE APPLICANT FROM COMPLIANCE WITH OTHER FEDERAL, STATE OR LOCAL PERMITTING REQUIRED FOR PROPERTY DEVELOPMENT. MULTI - CHAMBERED /IN SERIES: [Y ] MULTI - CHAMBERED /IN SERIES: [Y ] ]GALLONS @ [0 ]DOSES PER 24 HRS # PUMPS[ 0 ] [ N ]MOUND [ N ] [ N ] [ BELOW BENCHMARK /REFERENCE POINT [ BELOW BENCHMARK /REFERENCE POINT 22.0 ] INCHES 7 M Wr Gs N ra c6;,1 '004:71161"..," �? g .,1^7 -± �! L n pi', P� ��; ��'1D •. 'f� • (-,� �-• t ,,, �•:� �• - y7 bJ� d� ' Andre, Paul :E Engin Dade 2/22/02�� !CiEJ ��p�� ® � �� CO E DATE: 5/23/02 (Obsoletes previous editions may not be used) CHD Dn.,. 1 ,f ') • IMO 116 e' 'iv VaiP' MIMI 1111111 • mos MIMI r; NE :ILA= -- - --'--- -1-4-- --- --- • i 1 ail NM 4 um ■� ■ moo , ■ um MEM ■ .f . ---+ -4 -,. ■■-,...-- __.,. ____4 � u - � ■1I1 1:► �,e 1 1 h - .� __ - - - _ ■..■.■ ■I1ME I = / , - --1--;- m — ._ Notes: By / S17 • STATE OF'FLORIDA DEPARTMENT OF HEALTH APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PERMIT Permit Application Number " ( 6, Scale: Each block represents 10 feet and 1 inch = 40 feet. a. C� PART II - SITEPLAN 1 r 4 k 4'1 ?b-9 rfi- ye Site Plan submittedcctby: =emu'°% Plan Approved N/ Not Approved ALL CHAN 1 ES MUST BE APPROVED BY THE COUNTY HEALTH DEPARTMENT DH 4015, 10/96 (Replaces HRS -H Form 4015 which may be used) (Stock Number: 5744 -002 -4015 -6) chi f.. Date I County Health Department Page 2 of 4 7.:;7=cW ∎::,7 nr.. = taMt ta'.n:.. „+su.,....x.,a., i;017/L7rtGt1 ��avrta�xmuc•. -_;?1 ,r=w}... _a17111 .amuv:, ∎... uu.. ..,xm..:c�:, r¢mr42S2s,∎ _mtarretst _:" L.,:u rsusw.e:,.NI■ 5078 63- 8413/2670 3830308420 I, MR. C'S SEPTIC & DRAIN, INC. OPERATING ACCOUNT P.O. BOX 693239 MIAMI, FL 33269 -0239 PAY TO THE ORDER OF I i W • shingto Mutual Washington Mutual Bank. FA Miami/199th Street Financial Center 1719 175 NW. 199th Street 1.800.7887000 Miami. Ft. 33169 24 hour Customer Scmce . FOR a) II'00 SO 7811' 1: 26 7081113 1I: 38 3"O 3084 2 DATE o / 2 / ' ,a .. - ^ uT �= �r�._ �nr� _�m�^+'.r�r4- �.a= u�:.•�"r�t� _gym .:'��z.�7T — ..:t:��^v. .sc;,"^_�7� .�.. • DOLLARS Page 4 OFFICE USE ONLY IC1`IE,CKLIST ❑ OWNER - BUILDER FORM (Attach) ❑ FIRE DEPARTMENT APPROVAL (Commercial / multi- family) ❑ CONCURRENCY (New Construction) ❑ OTHER (Specify & Attach) ❑ PROOF OF OWNERSHIP (Attach) ❑ HRS / DERM APPROVAL (Septic / Sewer) ❑ IMPACT FEE (New Construction) ❑ OTHER (Specify & Attach) PERMIT FEES $3.00 per page (Scanning Fee) $ Miami Shores Village Bond $ Metropolitan Dade County (C.C.F.) Inspector State Educational Fund $ State DCA (Radon) $ Code Enforcement Fine $ Zoning Review $ 1 SECTION Zoning Electrical Mechanical Plumbing Fire Public Works Structural Building Official BY DATE (sq.ft. = x/1000 x0.60) (¢.005 /sq.ft.) (¢.01 /sq.ft.) REVIEWED AND PREPARED BY: PERMIT APPLICATION ❑ CONDO ASSOCIATION APPROVAL (Attach) ❑ BPR APPROVAL (Restaurants) ❑ CONTRACTOR REGISTRATION (On File) TOTAL $ ISSUING OFFICIAL DATE: CONDITION OF APPROVAL Revised July 2001 10050 N.E. 2ND AVE., MIAMI SHORES, FL • (305) 795 -2207 • FAX (305) 756 -8972 • http : / /www.miamishoresvillage.com ELECTRICAL TYPE Minimum Fee QT\'. TYPE Dryer QTY. TYPE Outlet, Appliance QTY. TYPi Service Repair QTY A/C Central 1 -3 Ton Fan Outlet, Wall Service, Temporary A/C Central 4 -7 Ton Fire Pump Outlet, Switch Signs A/C Central 8-15 Ton Fixture - Fluorescent Oven Space Heater (kw) A/C Central 16-20 Ton Fixture Light Parking Lot Lights Spas/Hot Tubs A/C Central 20+ Ton Flood Lights Plugmold/Strip Subfeeds, No. of Amps AJC Window FPL - Load Central Posts Swim Pool, Commercial Air Conditioners Garbage Disposal Range/Range Top Swim Pool, Residential Chiller Generators, etc. Receptacles Switchboards Clear Violations Heat Recovery Refrigerator, Comm. (p/PH) Temp Serv., Construction Compactor Low -volt, Burglar Refrigerator, Domestic Temp for Test - 30 days Deep Freezer Low -volt, Fire Renew - Temp Service Water Closet Demolition Low -volt, Intercom/Teleph. Repair Circuits Water Heater Dishwasher Low -volt, Television Service, Number of Amps Water Heater New MECHANICAL TYPE Minimum Fee QTY. TYPE Condensate Drain QTY 'TYPE Generator QTY. TYPE Refrigeration, Tons QTY. A/C Central, Tons Cooling Tower Heating Strips, each Vent Hood, Cost AJC Wall/Win. Tons Dryer Vents, Number of Paint Booth Ventilation, Cost Air Handler, Tons Ductwork, Cost of Piping, Flammable Liquid Periodic Inspections Barbecue Fire Sprinkler System Process/Pressure Piping Supply, AC Well Bath Fan - Vented, # Fireplaces, Number of Pressure Vessel Temporary Toilet PLUMBING TYPE. A/C Condensate QTY. TYPE Drains, Roof QTY. TYPE Miscellaneous Fixture QTY. TYPE Soakage Pit QTY. Bath Tub Drinking Fountain Miscellaneous Repairs Solar Water Heater Bidet Filter Replace Pool Piping Sprinkler Repair Cap - Fixture Fountain Pump and Abandon Sprinkler System Cap - Water Gas - Appliance Pump, Domestic Supply, AC Well Cap - Sewer Gas - Natural Pump, Fire Stand Temporary Toilet Catch Basin Gas - Propane Pump, Re- circulate Temporary Water Closet Clothes Washer Gas Piping Pump, Replace - Pool Urinal Dental Chair Grease Trap Pump, Sprinkler Utility - Sewer Discharge Well. Ice Maker Pump, Sump Utility - Water Dishwasher Indirect Wastes Relay Repair Vacuum Pump Disposal Interceptor Roof Inlet Water Closet Domestic Well Laundry Tray Septic Connection Water Heater Drainfield, 4" Tile/Res. Lavatory Septic Tank Water Heater New Drains, Area Meter Set (Gas) Sewer Connection Water Re -pipe Drains, Floor Minimum Fee Shower Water Service Drains, French Miscellaneous Equipment Sink Well, Supply Page 3 PERMIT APPLICATION INSTRUCTIONS: Please indicate the type of work being performed and quantity(ies) in the space provided below. RECEIVED AND REVIEWED BY: DATE: Page 2 IMPORTANT NOTICES DO NOT BEGIN ANY WORK WITHOUT HAVING RECEIVED YOUR VALIDATED PERMIT AND PERMIT CARD. Applying for a permit does not grant the right to begin construction. HOURS OF CONSTRUCTION are limited to: Monday through Friday from 7:30 a.m. to 6:00 p.m., and Saturday from 8:00 a.m. to 5:00 p.m. No inspections will be conducted on weekends or holidays. 2. All construction of demolition areas MUST BE MAINTAINED IN A CLEAN, NEAT AND SANITARY CONDITION free from construction debris. 3. STREETS AND NEIGHBORING PROPERTIES SHALL BE KEPT FREE FROM DIRT AND DEBRIS. 4. SWALES MUST BE PROTECTED FROM BEING DAMAGED BY EQUIPMENT OR VEHICLES, AND MAY NOT BE USED FOR STORAGE. A bond is required for work in or near the street/sidewalk. 5. CONSTRUCTION TRAILERS ARE PROHIBITED ON SINGLE FAMILY RESIDENTIAL CONSTRUCTION SITES. Other construction may have a trailer which requires a separate permit. 6. PORTABLE TOILETS for a construction site require a separate permit. 7. DO NOT DISCHARGE WATER INTO THE RIGHT OF WAY OR STORM DRAINS without approval from the Building, Planning and Zoning Department. 8. EQUIPMENT AND MATERIALS SHALL BE STORED at least 10 feet from the edge of pavement. 9. Department of Health and Rehabilitative Services (HRS) approval is required for applications involving septic tanks. Department of Environmental Resources Management (DERM) and/or Miami -Dade Water and Sewer Department (MDWASD) approval is required for applications involving sewers. 1. AFFIDAVIT - Please read carefully. Application is hereby made to obtain a permit to do work and installation as indicated. I, the OWNER of the property, certify that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that separate permits are required for ELECTRICAL, PLUMBING, POOL, EXTERIOR DOOR, MECHANICAL, WINDOW, FENCE, DRIVEWAY, ROOFING and SIGNS and there may be additional permits required from other governmental agencies. I, the OWNER of the property, have disclosed all information related to any work at the property performed in the prior twelve months to the Building Official. Further, I am fully aware that if the cumulative cost of work to my home or business under this and any other permit equals or exceeds fifty percent (50 %) of the fair market value of the structure, the entire structure must meet the present federal flood criteria for finished floor elevation. I am also fully aware that if the total cost of work to my home or business under this and any other permit exceeds fifty percent (50 %) of the replacement cost of the structure, then the entire structure must conform to the current code requirements of the Building Code. WARNING TO OWNER: Your failure to record a NOTICE OF COMMENCEMENT may result in you paying twice for improvements to your property. If you are spending more than $2,500 or intend to obtain financing, you may wish to consult with your attorney or lender before recording your Notice of Commencement. The Notice of Commencement must be recorded at: 22 N.W. 1st Street, 1" Floor, (305) 679 -1078. Once recorded, the Notice of Commencement must be POSTED AT THE JOB SITE in accordance with Section 713 -35 of Florida Statutes. Review the brochure at Village Hall on Construction Lien Law and Choosing a Contractor. STATE OF FLORIDA, COUNTY OF MIAMI -DADE STATE OF FLO Wo Signature of Owner Print Name Sworn to and subscribed before me this Signature of Notary Public - State of Florida s SEAL: SEAL: PERMIT APPLICATION COUNTY OF MI Signature of Contractor / Qualifier 0 PriiirName day of Ow and subscribed before me thig: day of Signature of Notary Public - State of Florida Personally known OR, Produced Identification Personally known OR, Produced Identification Type of Identification Produced: Type of Identification Produced: CONTRACTOR New Construction Name ALA , / ► C 1� 46-16e-1. 4- / // /�� License No. Address JO) ' Telephon�3e)5) / ' /]FR?c 5 C � - Qualifier Name Demolish PROPERTY OWNER New Construction Name /a ce.,,,, �'i"""(A Address 350 / 9s-.6 Home Telephone Repair Business Telephone Alteration Interior Fax Demolish TYPE OF MANAGEMENT (/ ) New Construction Enclosure Alteration Exterior Repair Alteration Interior Demolish Relocation of Structure Shell Only Foundation Only Add'l Attachment Other Add'l Detachment Other _ ______r�., ZUCT, - The follo he taken to obtain a permit from the Miami Shores Village: Step 1. Complete the attached permit application which must be signed by the property owner and qualifier. Both signatures must be notarized. Please print or type to allow for a more accurate processing of your application. If roofing work will be done, a roofing application must be submitted along with this permit application. Step 2. Submit the completed application with all necessary documents to the Building, Planning and Zoning Department for processing. During the processing of your application, you may be asked to submit additional information. APPLICATION Job Address: /� T Zip Folio Number /1 3�01g ' 01 ! / l • 0 / !� 9-V < Description of Work � Lot Block r&Q/Yl 4 Q.()2 a to zi, L Subdivision PB PG Zoning Linear Feet Current Use of Property Square Feet Units Proposed Use of Property Value of Work l ? 0(9 I 00 Bldg Value Tenant Information Address PERMIT TYPE ( ) Building Electrical Mechanical Plumbing LPGX Roofing Fence Other Apt. Chg. Contractor Renewal Revision Extension Supplement Reinspection A CHITECT Name License No. Address Telephone Fax Master Permit No. Subsidiary Permit No. City PERMIT APPLICATION Floors Tax Assessed/Appraised Value Flood Zone Base Floor Elev. PERMIT CHANGE ( ) ENGIINEE Name License No. Address Telephone Fax Page 2 IMPORTANT NOTICES DO NOT BEGIN ANY WORK WITHOUT HAVING RECEIVED YOUR VALIDATED PERMIT AND PERMIT CARD. Applying for a permit does not grant the right to begin construction. HOURS OF CONSTRUCTION are limited to: Monday through Friday from 7:30 a.m. to 6:00 p.m., and Saturday from 8:00 a.m. to 5:00 p.m. No inspections will be conducted on weekends or holidays. 2. All construction of demolition areas MUST BE MAINTAINED IN A CLEAN, NEAT AND SANITARY CONDITION free from construction debris. 3. STREETS AND NEIGHBORING PROPERTIES SHALL BE KEPT FREE FROM DIRT AND DEBRIS. 4. SWALES MUST BE PROTECTED FROM BEING DAMAGED BY EQUIPMENT OR VEHICLES, AND MAY NOT BE USED FOR STORAGE. A bond is required for work in or near the street/sidewalk. 5. CONSTRUCTION TRAILERS ARE PROHIBITED ON SINGLE FAMILY RESIDENTIAL CONSTRUCTION SITES. Other construction may have a trailer which requires a separate permit. 6. PORTABLE TOILETS for a construction site require a separate permit. 7. DO NOT DISCHARGE WATER INTO THE RIGHT OF WAY OR STORM DRAINS without approval from the Building, Planning and Zoning Department. 8. EQUIPMENT AND MATERIALS SHALL BE STORED at least 10 feet from the edge of pavement. 9. Department of Health and Rehabilitative Services (HRS) approval is required for applications involving septic tanks. Department of Environmental Resources Management (DERM) and/or Miami -Dade Water and Sewer Department (MDWASD) approval is required for applications involving sewers. AFFIDAVIT - Please read carefully. Application is hereby made to obtain a permit to do work and installation as indicated. I, the OWNER of the property, certify that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that separate permits are required for ELECTRICAL, PLUMBING, POOL, EXTERIOR DOOR, MECHANICAL, WINDOW, FENCE, DRIVEWAY, ROOFING and SIGNS and there may be additional permits required from other governmental agencies. I, the OWNER of the property, have disclosed all information related to any work at the property performed in the prior twelve months to the Building Official. Further, I am fully aware that if the cumulative cost of work to my home or business under this and any other permit equals or exceeds fifty percent (50 %) of the fair market value of the structure, the entire structure must meet the present federal flood criteria for finished floor elevation. I am also fully aware that if the total cost of work to my home or business under this and any other permit exceeds fifty percent (50 %) of the replacement cost of the structure, then the entire structure must conform to the current code requirements of the Building Code. WARNING TO OWNER: Your failure to record a NOTICE OF COMMENCEMENT may result in you paying twice for improvements to your property. If you are spending more than $2,500 or intend to obtain financing, you may wish to consult with your attorney or lender before recording your Notice of Commencement. The Notice of Commencement must be recorded at: 22 N.W. 1st Street, 1°' Floor, (305) 679 -1078. Once recorded, the Notice of Commencement must be POSTED AT THE JOB SITE in accordance with Section 713 -35 of Florida Statutes. Review the brochure at Village Hall on Construction Lien Law and Choosing a Contractor. STATE OF FLORIDA, COUNTY OF MIAMI -DADE Signature of Owner Signature of Contractor / Qualifier Print Name Sworn to and subscribed before me this day of Signature of Notary Public - State of Florida SEAL: SEAL: STATE OF FL R PA OUNTY OF MIAMI -DADE C7EPI/E E. Print Name PERMIT APPLICATION Sworn to and subscribed before me this day of Signature of Notary Public - State of Florida Personally known OR, Produced Identification Personally known OR, Produced Identification Type of Identification Produced: Type of Identification Produced: CONTRACTOR - q' Name MR. e g en e t/ jj�� ( A X- License No. sp c . (� colo • Y_... l s Address /?r,7 $ 7., NAJ . z-- Telephone `,6 $°_ t Si - �1 Fax Qualifier Name 5/4 e I e j el,s PROPERTY OWNER New Construction Name 3 ,. ph4 p <7� / s ex Addresss Repair Home Telephone Demolish Business Telephone Relocation of Structure Fax Foundation Only TYPE OF MANAGEMENT (✓ ) New Construction Enclosure Alteration Exterior Repair Alteration Interior Demolish Relocation of Structure Shell Only Foundation Only Add'l Attachment Other Add'I Detachment Other OORlcg Oa o � m L®ei111 INSTRUCTIONS - The following steps must he taken to obtain aperntit from the Miami Shores Village: Step 1. Complete the attached permit application which must be signed by the property owner and qualifier. Both signatures must be notarized. Please print or type to allow for a more accurate processing of your application. If roofing work will be done, a roofing application must be submitted along with this permit application. Step 2. Submit the completed application with all necessary documents to the Building, Planning and Zoning Department for processing. During the processing of your application, you may be asked to submit additional information. APPLICATION Job Address: Tenant Information Address Apt. Folio Number (1 1 1 — 04/1) 1) Lot Block Subdivision PB PG Zoning Linear Feet Current Use of Property �.,k 1C% , / y Square Feet Units Floors Proposed Use of Property ce/MA"' Value of Work 0 9 - B ldg Value PERMIT TYPE (✓ ) Building Electrical Mechanical Plumbing LPGX oofing Fence Other v PERMIT CHANGE (✓ ) Chg. Contractor Renewal Revision Extension Supplement Reinspection ARCHITECT Name License No. Address Telephone Fax PERMIT APPLICATION Master Permit No. ® 2 - Os - Subsidiary Permit No. A Ali City State Description of Work oc...2 D se let Aar Zip Tax Assessed/Appraised Value Flood Zone Base Floor Elev: ENGINEER Name License No. Address Telephone Fax