747 NE 94 St (5)t
BUILDING
PERMIT APPLICATION
FBC 2001
Permit Type (circle): Building trica
Plumbin echanical Roofing •
ame (Fee Simple Titleholder) - l1/1=10 e 11 / � - 'hone #
Owner's A4dres 7 7 r1 £ q
City irli,haz State a Zip
Tenant/Lessee Name
Job Address (where the work is being done) 7 'It AlE QV' S
City Miami Shores Village County Miami -Dade Zip i'3 / 3
Is Building Historically Designated YES NO_ _
_ Phone # ,537
Contractor's ddress 0
City ! r, P '�' State / Zip
Qualifier A /
Contractor's Company Name
a
$ Value of Work For this Permit
Miami Shores Village
Building Department
State
Phone #
10050+1.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
Permit No. 1 X -2G 3
Master Permit No.
Architect/Engineer's Name (if applicable) • Phone #
Architect/Engineer's Address
City
Zip
Square Footage Of Work:
Number of: Bays Stories d Families / Bedrooms
Type of Work: ['Addition ['Alteration [New
Describe Work: _
/L /' 0 V ; i 4/ Ii . ' -/ / . If
-w
❑ Repair/Replace
* * * * * * * * * * * * * * * * * * * * * * * * * * ** F ees * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
;C6 TV
Baths
❑ Demolition
County Escrow Fee $ Q - O . Permit Fee $ 60 , 00 . Notary $ 5.00 •
Education/Training Fee $ Tech $ Scanning $ Radon $
Code Enforcement $ Bond $ ?DO. 00 • 2 Q Struct. $ 38(,
Minus Plans Check Fee $ Total Fee Now Due $ • 'O
C ontinued on opposite side)
ata et. 5$14s
Bonding Company's Name (if applicable)
Bonding Company's Address
City
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:
PAYING TWICE FOR
CONSULT WITH Y
COMMENCEMENT."
a
ich
rove
oc
ed an
Notice to Applicant: As a
promise in good faith tha
whose property is subj
for the first inspectio
inspection will not b
Signature
chc7I7/03
c
APPLICATION APPROVED BY
State
who is personally known to me or who has produced
Zip
YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR
0' ' OVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING,
LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF
ition to the issuance of a building permit with an estimated value exceeding $2500, the applicant must
• y of the notice of commencement and construction lien law brochure will be delivered to the person
hment. Also, a certified copy of the recorded notice of commencement must be posted at the job site
rs seven (7) days after the building permit is issued. In the absence of such posted notice, the
• a reinspection fee will be charged.
Owner or Agent
The foregoing instil= was ackn edged before me this 23
day of
20 C6, by S004 Sh''iQ
who is personally known to me or who has produced
As identificatiQ nand ` Pa$ l a 93� as identification and who did take an oath.
YP
4 • •`6': Commission #DD23I98e
pires: Jul 13, 2007
Bonded Thru
NOT : Y f'UBLI
Sign:
Print:
My Commission Expires: My Commission Expires:
(Certificate of Competency Holder)
State Certificate or Registration No. Certificate of Competency No.
» * » * * » » * * » » * »4 *M » * * * * * * * * * » *» * ************************************* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
•
Signature
Con !Ftor
The foregoing instrument was acknowledged before me this
day of , 20 , by
NOTARY PUBLIC:
Sign:
Print:
Plans Examiner
Engineer
Zoning
TEM
ATH TUB
UNIT
FEE
ITEM
SWITCH OUTLETS
UNIT
FEE
ITEM
SPACE HEATERS
UNIT
FEE
IDET
LIGHT OUTLETS
CENTRAL HEATING
'SMASHER
RECEPTACLES
A/C (WIND)
ISPOSAL
SERVICE TEMPORARY
A/C (CENTRAL)
KINKING FOUNTAIN
SERVICE SIZE IN AMPS
DUCT WORK
LOOR DRAIN
SERVICE REPAIR/METER CHANGE
REFRIGERATION
REASE TRAP
APPLIANCE OUTLETS
PROCESS AND PRESS PIPING
NTERCEPTOR
RANGE TOP
UNDERGROUND TANKS
.AVATORY
OVEN
ABOVE GROUND TANKS
.AINDRY TRAY
WATER HEATER
U.F. PRESSURE VESSELS
:LOTHES WASHER
MOTORS 0- 1 HP
STEAM BOILERS
;,SOWER
MOTORS OVER 1- 3 HP
HOT WATER BOILERS
;INK, POT /3 COMP.
MOTORS OVER 3- 5 IP
MECHANICAL VENTILATION
;INK, RESIDENCE
MOTORS OVER 5- 8 HP
TRANSPORTING ASSEMBLIES
;INK, SLOP
MOTORS OVER 8- 10 HP
ELEVATORS/ESCALATORS
TEMPORARY WATER CLOSET
MOTORS OVER 10- 25 HP
FIRE SPRINKLER SYSTEMS
RIVAL
MOTORS OVER 25-100 HP
COOLING TOWERS
;ATER CLOSET
MOTORS OVER 1O0 HP
VIOLATION
IhOIRECT -WASTES
A/C WINDOW
REINSPECTION
iATER SIPPLY TO:
AIR CONDITIONERS
A/C UNIT
STRIP HEATER
FIRE SPRINKLER
GENERATORS TRANSFORMERS
•
HEATER -NEW INST.
GENERATORS TRANSFORMERS ..
I
HEATER - REPLACE
GENERATORS TRANSFORMERS
LAWN SPRINKLER -WELL
SPECIAL PURPOSE
SWIMMING POOL
OUTLETS COMMERCIAL
WATER SERVICE
SIGN TUBES
;EWER'CONNECTIONS
SIGN TRANSFORMERS
TTILITY -SEWER
SIGN TIME CLOCK
1TILITY -WATER
FIXTLRES
;EPTIC TANK
li
ANTENNA
1ELAY
•
TELEVISION OUTLETS
IRAINFIELO, 4' TILE/RES.
'-/
VIOLATION
'UMP E ABANDON SEPTIC TANK
REINSPECTION
OAKAGE PIT CU. FT.
;ATCH BASIN
)ISCHARGE WELL
)OMESTIC WELL
AREA DRAIN
100F .INLET g
30LAR WATER HEATER 1
:IRE STANDPIPE
'COL PIPING
•
AWN SPRINKLER SYSTEM
AS RANGE
AFTER SET (GAS)
AS PIPING
' 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
CONSTRUCTION PERMIT FOR:
[P] New System [k Existing System
[S Repair (J] Abandonment
APPLICANT: 71 C a . - H . :P J U Q
PROPERTY ADDRESS: 7 `r / - `4 SI". 1-PI G SLye S 1. 331 3 k
LOT: 2 1 `7 2 Z BLOCK:
PROPERTY ID #: / 1-' 2 6 6- 6 1 - 2 0 1 0
SYSTEM MUST BE CONSTRUCTED IN ACCORDANCE WITH SPECIFICATIONS AND STANDARDS OF SECTION 381.0065,
F.S., AND CHAPTER 64E -6, F.A.C. DEPARTMENT APPROVAL OF SYSTEM DOES NOT GUARANTEE SAFTISFACTORY
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. ISSUANCE OF THIS PERMIT
DOES NOT EXEMPT THE APPLICANT FROM COMPLIANCE WITH OTHER FEDERAL, STATE, OR LOCAL PERMITTING
REQUIRED FOR DEVELOPMENT OF THIS PROPERTY.
SYSTEM DESIGN AND SPECIFICATIONS
T (?()O ] GALLONS / GPD SEPTIC TANK /AEROBIC UNIT CAPACITY MULTI- CHAMBEREDJIN- SERIES [R]
A [ ] GALLONS / GPD CAPACITY MULTI- CHAMBERED /IN- SERIES [ ]
N [ ] GALLONS GREASE INTERCEPTOR CAPACITY [MAXIMUM' CAPACITY SINGLE TANK: 1250 GALLONS]
K [ ] GALLONS DOSING TANK CAPACITY [ ]GALLONS CO [ ] DOSES PER 24 HRS # PUMPS [ ]
D [ zoo] SQUARE FEET PRIMARY DRAINFIELD SYSTEM
R [ ] SQUARE FEET SYSTEM
A TYPE SYSTEM: [ 4 STANARD [ , /] FILLED [ ] MOUND
I CONFIGURATION: [ ] TRENCH [ .j BED [ ]
F LOCATION OF BENCHMARK: I O.? 0' tJ' G • ■/, b • F. r 6
I ELEVATION OF PROPOSED SYSTEM SITE [I k, 0 ] [I /FT]
E BOTTOM OF DRAINFIELD TO BE ['f g, d ] [INCHES /FT]
L
D FILL REQUIRED: [4 INCHES
0
T
H
E
R
SPECIFICATIONS
APPROVED BY:
DATE ISSUED:
DH 4016, 12/99 (Page 1) (Previous Editions May Be Used)
STATE OF FLORIDA
DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM
CONSTRUCTION PERMIT
v
3/22/a.3 d
,oF
[P] Holding Tank (/‘)] Innovative
(] Temporary [ ]
7 SUBDIVISION:. r 6-‘444., l t £ .p c. a
[SECTION, TOWNSHIP, RANGE, PARCEL NUMBER]
[OR TAX ID NUMBER]
[ABOVE /BELOW] BENCHMARK /REFERENCE POINT,
[ABOVE /B E LOW] BENCHMARK /REFERENCE POINT
EXCAVATION REQUIRED: [ 4 /2 ]INCHES
INSTALL 1 ZK OF SLIGHTI LY LIMTED SOIL
UNDER BOTTOM OF DRAIN 7ELD
P,ER- a ti8ER J Ei," t , T i 3 V 1 �'S1 1 SEAL
r
BY : ¢ C ` � / (...) A'I \ �V fTZ.TL'E TAI$ Al ? 3E
PROPOSED ABSORPTION.B D OR. DRAW Ti
TITLE: e
pt. 1: Health Department
pt. 2: Applicant
pt. 3: Installer /Contractor
pt. 4: Building Department
PERMIT NO. 0 3 /?- 2 ! 0
DATE PAID: g'. Zl - 0
FEE PAID: 7
RECEIPT #: S0 5 097200 0
/ 3 . sC- _ 1 8000,
i 1
ft. -4,.% 8 G' ctip CND
EXPIRATION DATE: / 2/2 Z/ 0 3
Page 1 of 3
INSTRUCTIONS:
PERMIT NUMBER: Permit tracking number assigned by CPHU.
CONSTRUCTION
PERMIT FOR: Check type of permit, if "Other" specify type in blank.
APPLICANT: Property owner's full name.
TELEPHONE: Telephone number for applicant or agent
AGENT: Property owner's legally authorized representative.
MAILING ADDRESS: P.O. Box or street mailing address for applicant or agent.
LOT, BLOCK, SUBDIVISION or
PROPERTY ID #: 27 character id number for property. (CHD may require property appraiser ID # or section /township /range/parcel number)
SYSTEM DESIGN AND
SPECIFICATIONS:
TANK: Minimum specifications from Chapter 64E-6, FAC.
DRAIN FIELD: Minimum specifications from Chapter 64E-6, FAC.
OTHER: Other specifications, such as operating permit requirements, low - volume flush toilets, variance provisos.
SPECIFICATIONS BY: Name of individual providing specifications. If designed by a registered engineer must be sealed.
APPROVED BY: County Health Department (CHD) personnel reviewing and approving permit.
DATE ISSUED: Date permit is issued by CHD
EXPIRATION DATE: One year from date issued if the system h s not been installed. Permits for system repairs become void 90 days from the date
issued.
Scale: Each block represents 10 feet and 1 inch = 40 feet.
ICJ
By
Notes:
STATE OF FLORIDA c '��
DEPARTMENT OF HEALTH ;
APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PERMIT /- '
Permit Application Number b 9 % i ®/
DH 4015, 10/96 (Replaces HRS -H Form 4015 which may be used)
(Stock Number: 5744 - 002 - 4015 -6)
PART II - SITEPLAN
Not Approved
e
1 ' 4
ts,i ttJf �C�,A)��
got) (qt. CAT.
6/6 - pa l i Att. woi
Site Plan submitted y: fi j TA fl L L /I 60 "d-
Plan Approved Approved
CHANGES MUST BE APPROVED BY THE COUNTY HEALTH DEPARTMENT
I , 1
�a,lR
9
C- 15 -n ` a�i� �'� 1 I
Date
/ CL .4AA a de County Health Department
Page 2 of 4
APPLICANT,
AGENT:
STATE 07 YLORIDA
DEPARTMENT 07 REALM
ONSITE SEVACIEz TREATMENT AND DIPOSAL SYSTEM
CONSTRUCTION INSPECTION /MD FINAL APPROVAL
ccc_64( (.44
73
PROPERTY ADDRXXX:
A j
LOT 2 I aLOCil 6- 7 111311Nviimpitu, aa.„„ SIA,P 5‘.
CEEiiiiD [X] ITEMS ARE NOT IN COMPLIANCE WIT! MAIM= OR ROLM AED MUST Ai CORRECTED.
TAME INSTALLATION 700
[01] TANK ME [1]
(02] TAXI MATERIAL
[03) ouTpET DEVICE
(04] MULTI-CHAMBERED
(05] OUTLET FILM!
[06] LEGEND
CM WATERTIGHT
(OBI LEVEL
[OW DEPTH TO LID
_.DRAINFEILD INS IC11 - }x5
. /ale
(10) .,AREA 1] [2] 01/4) SOFT [ ]
[11] 112$TRIEUTION BOX IMADER y)
[12] DIUDWER OF DRAINLINEO
[13] DRAINLINE SEPARATION 2!" I p )
(14) MAINLINE ELOPE
[15] DEPTH OF COVER
[16] ELEVATION [ABOVE
(17] SYSTEM LOCATION
(18] DOSING PUMPS
(19) AGGREGATE SIZE 14 D.
[20] AGGREGATE EXCESSIVE FINIS
(21) AGGREGATE DEPTH
RN' .7;
C
TILL / EXCAVATION MATERIAL
(22] FILL AMOUNT )
(23) TILL TEXTS/RH
(24) EXCAVATION DEPTH
(25) AREA REPLACED " / —, [
(26] REPLACEMENT MATERIAL6vs-4: _ti [ •
=PLANATION or wax= :ow, / stionstis
( I
• . ;,;!:;‘.
•",„t.j"4
CONSTRUCTION(4APP__ /DISAPPROVEDp- 0
FINAL sum= (11PPRDVED/jX&APPROVICD3
DE 4016, 10/97 (Provious 144. ' 'Mai Eo Vsipd)
I
(41)
(42]
(43]
(44)
[45]
[46]
[47)
[41]
. TnAtallpr I C.nntractor
smicxs
(27] sur.raci WATER
[28] DITCEMS
(29]
[30)
r311
(12)
[33]
(34]
[35]
• PILIND"A/44010'
(36) DRAINFIELD COVER
[37] SHOULDERS'
[38] SLOPES
[39] STABILISATION
PERMIT NO.
DATE PAID,
YIN PAID,
RECEIPT #:
morn= Iv 3 60 -c(2
PRIVATE WILLSA.
PUBLIC WELLS
IRRIGATION WELLS •
POTABLE MATER LIMES
EUILDING'POUNDATION
PROPERTY Lusa
Sd 3 6
•
ADDITIONAL mffrolsomow
(40) UNOBSTRUCTED AREA
kSTORMWATEK4UNOli Wartk
ALARM
ABANDONMENT •
(49) TAME PUMPED
(501 TANK CRUSHED A FILLED
a-
PT
rr
PT
• PT
PT
PT
FT
PT •
MAINTENANCE aoakiK6iih -. •
BUILDIUG
Locastoor COJIPORMI WITH BITE PLAN
FINAL SITE Guam . 1 •
CONTRAATION* '7its • Sertrc
•
C- • CAD DATA:
•
CND DATE:7 'f•Y")
Page 2 of 3
/
/
Of
From:
f
BOB' •
SEPTIC & DRAIN INC
Septic Tanks • Grease Traps
• & Drain Fields • Sewer
Jet Cleaning
CC#000652 • State Certified • Septic Tank Contractor
P.O. Sox 612333 • North Miami, Florida 33261 -2333
Phone: (305) 558 -5818
FACSIMILE TRANSMISSION
Date: 9 9 o3
Please . eliv.: these • ocuments immediately to
To:
1 A )
Fax #
A t,8,,
de (305) 558 -5818 * Brow (954) 920 -5099 *
Fax (305) 893 -0270
# Of Pages Including Cover Sheet
MESSAGE:
I &A LL
...� x) c'
(J 6vJ 7
j i'n G 2b -f'U goo.
40(A.)
"24 Hour Service • Licensed & Insured"
3899
MIAMI SHORES VILLAGE
BUILDING DEPARTMENT
305- 795 -2204
Building Inspection Request
Date Time
Type Insp'n
Permit No. ►? I CDC_
Name
Address -i E V 4-
Company Me. eb n e) ve
Phone # 305 - S
For Inspector:
Approved
Correction
Re-Insp'n Fee
Date
Type Insp'n
Permit No. J)
MIAMI SHORES VILLAGE
BUILDING DEPARTME
305- 795 -2204
Building Inspection Request
Name \
Address
Company
Phone # /
For Inspector: b
l )
Approved
Correction
Re- Insp'n Fee
o
MISCELLANEOUS INSPECTIONS
PERMIT NO. ACME SEPTIC TANK CO, WILL GET
P, O. BOX 1000
INSTALLED BY HIALEAH_ FLORIDA DATE C
OWNER'S NAME �I C% , ,'may ADDRESS fi l ; , /
ljx
LOT
BLOCK
SUBDIVISION
INSPECTION A. M. p. M.
RELAY DRAINFIELD ` r „ ::' WELLS
J
GAS APPLIANCES WATER PIPING
SOLAR MISCELLANEOUS
APPROVED BY: CONDEMNED BY:
REMARKS