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1040 NE 96 St (6)BUILDING PERMIT APPLICATION FBC 2001 Permit Type (circle): Building Electrical Owner's Name (Fee Simple Titleholder) �-� . , � � %� °� Phone # ° Owner's Address City PV IC ;r'trk §tae FE, Tenant/Lessee Name Phone # Job Address (where the work is being done) City Miami Shores Village Is Building Historically Designated YES Contractor's Company Name r.:3'; Contractor's Address ?,39O S ,Y .� City Qualifier Submittal Fee $ Notary $ 5. QC ) Scanning $ Code Enforcement $ k d Cr`tkyk T State Permit Fee $ Architect/Engineer's Name (if applicable) Phone # S Value of Work For this Permit Type of Work: ❑Addition ['Alteration ❑New ["Repair/Replace ❑ Demolition Describe Work: � r:4 a n Y q * * * * * * * * * * * * * * * * * * * * * * * * * * ** F ees * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** Training/Education Fee $ Total Fee Now Due $ 16 ` - 37 _045h (Continued on opposite side) Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 S . County Miami -Dade NO 0 X15.0) .40 Radon $ Permit No. Pi o4- 1 s 2 Master Permit No. 4 lumbing) Mechanical De Phone # Zip `� L Zip - ' `s Square Footage Of Work: .P -X, CCF$ 0 Technology Fee $ 4.37 Bond $ zoo. cc) Structural Plan Review. $ • Roofing Bonding Company's Name (if applicable) Bonding Company's Address City State Zip Mortgage Lender's Name (if applicable) 1 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 reinspection fee will be charged. Owner or Agent The foregoing instrument was acknowledged before me this 2-9 day of 3t. , 2004 -, by 'D\4 Q Dvw who is personally known to me or who has produced I)Y \J • U c et„ e NOTARY PUBLIC: Sign: Print: N.A i $ fication and who did take an s TERESA J. SOLOMON MY COMMISSION # DD250437 I • ember 16, 2007 W . J P"wrr `ra !"~f th. ntractor The foregoing instrument was acknowledged before me this 30 day of to na , 2004 by 1 l ?3 5 l t!')I rr(-J who is V'ersonally known to me or who has produced rte[. Z NOTARY PUBL Sign: Print: My Commission Expires: q 11(0)01 My Commission Expires: ;` :• •. ************************************************************ * * * * ** * ** * ** * * * * * ** * * * * * * * *4ih (Certificate of Competency Holder) State Certificate or Registration No. Certificate of Competency No. as identification and who did take an oath. Sion #DD23198 es. u onded Thru c Bonding Co., Inc * * * * * * * * ** # # ## ._sS3 * ** ' **** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** ** * * * * * * * * * * * * * * * * * * * * * * ** * * * * * * * * * * * * * * * * * * * * * * * * ** APPLICATION APPROVED �_' aI Plans Examiner O Engineer CONSTRUCTION PERMIT FOR: [ ]New System [ ]Existing System [ X ]Repair [ ]Abandonment APPLICANT: Durban, Scott D. &/W Diane AGENT: SA0021074, Solomon Teresa PROPERTY STREET ADDRESS: 1040 NE 96 St Miami Shores FL 33138 LOT: 11 BLOCK: 81 PROPERTY ID ##: 11- 3206 -014 -3540 SYSTEM MUST B. 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 A: ?PLICANT TO MODIFY THE PERMIT APPLICATION. SUCH MODIFICATIONS MAY RESULT IN THIS PERMIT BEING IRADE NULL AND VOID. ISSUANCE OF THIS PERMIT DOES NOT EXEMPT THE APPLICANT FROM COMPLIANCE WI'CH OTHER FEDERAL, STATE OR LOCAL PERMITTING REQUIRED FOR PROPERTY DEVELOPMENT. SYSTEM DESIGN AND SPECIFICATIONS T [ A [ N [ K [ D R A I N F I E L D 900 ]Gallons SEPTIC TANK 0 'Gallons 0 ]GALLONS GREASE INTERCEPTOR CAPACITY 0 ]GALLONS DOSING TANK CAPACITY [ 0 [ :300 ]SQUARE [ 0 ] SQUARE TYPE SYSTEM: CONFIGURATION: OTHER REMARKS: LOCATION TO BENCHMARK: 11.40'NGVD FF ELEVATION OF PROPOSED SYSTEM SITE [ BOTTOM OF DRAINFIELD TO BE DATE ISSUED: 6/30/04 STATE OF FLORIDA ; ;" DEPARTMENT OF HEALTH ` N [ ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM CONSTRUCTION PERMIT t. SUBDIVISION: Miami Shores Sec 3 [Section /Township /Range /Parcel No.] [OR TAX ID NUMBER] FEET PRIMARY DRAINFIELD SYSTEM FEET SYSTEM [ N ]STANDARD [ N ]FILLED [ N ]TRENCH [ N ]BED E/R 2.0 ] 5.0 ] FILL REQUIRED:[ 0.0 ]INCHES EXCAVATION REQUIRED: SPECIFICATIONS BY: RAM, Arrieta, Rolan TITLE: )H 4016, 03/97 (Obsoletes previous editions which may not be used) (Stock Number: 5744 -001- 4016 -0) fostds cons 4oi6 - CENTRAX #:' 13 - - 21363 DATE PAID: FEE PAID : RECEIPT OSTDSNBR : 04 -2313- -R ]Holding Tank [ ] Innovative Other ]Temporary [ NA ] MULTI - CHAMBERED /IN SERIES: [Y ] MULTI - CHAMBERED /IN SERIES: [Y ] ]GALLONS @ [0 ]DOSES PER 24 HRS # PUMPS[ 0 ] [ N ]MOUND [ N ] [ N ] [ FEET ] [ BELOW 1 BENCHMARK/REFERENCE POINT [ FEET ] [ BELOW ] BENCHMARK/REFERENCE POINT [ 42.0 ] INCHES This repair permit is for a unique blackwater, standard, gravity and single -bed system to remain serving the existing single - family residence, it is NOT FOR ADDITION. Existing 900 gals. septic tank to be inspected for an appropriate pump -out and a solid vertical deflector installed on the outlet device. The pump -out receipt shall be provided prior to the granting of the final approval. Install nc less than 300 sf drainfield, replacing the unsuitable soil in the site with 12" of slightly limited sand at the bottom, extended 12" wide as a barrier all around the perimeter of the required area. Invert elevation of drainfield to be no less than 6.90' NGVD. Bottom of drainfield elevation to be no less than 6.40' NGVD. APPROVED BY: Arrieta, Rolando �, " TITLE: Engineer I Dade 1 EXPIRATION DATE: 9/28/04 CHD A.7(TP 1 of ') DH 4015, 10196 (Replaces HRS-H Form 4015 which may be used) (Stock Number: 5744-002-4015-6) STATE OF FLORIDA DEPARTMENT OF HEALTH APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PERMIT Permit Application Number Scale: Each block represents 5 feet and 1 inch = 50 feet. - • r 1 . • Site Plan submitted / by: \ , \ Plan Approved • PART II SITE PLAN ; I " ‘.10■7 j i I 1 1 'i _ i . 1rr .111.,1 __A - .., . i i \ 1 ___--- ' ..;-,;‘,;;Is),7,1):,:;i,:::_.:::.,■11— - - - ..... --_, ..._... ), 3\10 ..--- _..... . ), 11 ;. k 1. Notes: C:) 11 -;) 0 - 040 Nr- qb ST ?) - _ , T)t ovei fit 0 \i ■ • • - 6 2 °zi Signature Not Approved Date ALL CHANGES MUST BE APPROVED BY THE COUNTY HEALTH DEPARTMENT Title ae" 1 v , r) : Ye C. ( rs By County Health Department Page 2 of 3 Miami Shores Village 10050 NE 2nd Avenue Phone: 305 - 795-2204 Printed: 7/6/2004 Applicant: DIANE DURBAN Owner: DURBAN DIANE JOB ADDRESS: 1040 NE 96 ST Parcel # 1132060143540 Fees: Description Amount FEE2004 -6696 Building Fee $175.00 FEE2004 -6697 CCF $1.20 FEE2004 -6698 Notary Fee $5.00 FEE2004 -6699 Training and Education Fee $0.40 FEE2004 -6700 Technology Fee $4.37 FEE2004 -6702 Scanning Fee $3.00 FEE2004 -6703 Builders Bond $300.00 Total Fees: $488.97 Work: DRAINFIELD Plumbing hermit Permit Number: PL2004 -188 Permit Status: APPLIED Permit Expiration: 12/29/2004 Construction Value: $1,800.00 Page 1 of 1 Contractor STATEWIDE SEPTIC CONNECTIONS Contractor's Address: 3590 SOUTH STATE ROAD 7, SUITE 26 Local Phone: 305 - 661 -6633 1 Z 0 1119N Legal Description: MIAMI SHORES SEC 3 PB 10 -37 LOTS 11 & 12 BLK 81 LOT SIZE Total Fees: $488.97 Total Receipts: $488.97 Signed: (INSPECTOR) 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. Signed: (Contractor or Builder) BY: Miami Shores Village 10050 NE 2nd Avenue Phone: 305 - 795 -2204 Parcel # 1132060143540 Signed: (INSPECTOR) Plumbing Permit Permit Number: PL2004 -188 Printed: 7 /6/2004 Page 1 of 1 Applicant: DIANE DURBAN Owner: DURBAN DIANE JOB ADDRESS: 1040 NE 96 ST Contractor STATEWIDE SEPTIC CONNECTIONS Contractor's Address: 3590 SOUTH STATE ROAD 7, SUITE 26 Local Phone: 305 - 661 -6633 Legal Description: MIAMI SHORES SEC 3 PB 10 -37 LOTS 11 & 12 BLK 81 LOT SIZE Fees: Description Amount FEE2004 -6696 Building Fee $175.00 FEE2004 -6697 CCF $1.20 FEE2004 -6698 Notary Fee $5.00 FEE2004 -6699 Training and Education Fee $0.40 FEE2004 -6700 Technology Fee $4.37 FEE2004 -6702 Scanning Fee $3.00 FEE2004 -6703 Builders Bond $300.00 Total Fees: $488.97 Permit Status: APPLIED Permit Expiration: 12/29/2004 Construction Value: $1,800.00 Work: DRAINFIELD Total Fees: $488.97 Total Receipts: $488.97 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. Signed: (Contractor or Builder) BY: Miami Shores Village 10050 NE 2nd Avenue Phone: 305 - 795 -2204 Permit Number: PL2004 -188 Printed: 7 /6/2004 Page 1 of 1 Applicant: DIANE DURBAN Owner: DURBAN DIANE JOB ADDRESS: 1040 NE 96 ST Contractor STATEWIDE SEPTIC CONNECTIONS Contractor's Address: 3590 SOUTH STATE ROAD 7, SUITE 26 Local Phone: 305 - 661 -6633 Parcel # 1132060143540 Legal Description: MIAMI SHORES SEC 3 PB 10 - 37 LOTS 11 & 12 BLK 81 LOT SIZE Fees: Description Amount FEE2004 -6696 Building Fee $175.00 FEE2004 -6697 CCF $1.20 FEE2004 -6698 Notary Fee $5.00 FEE2004 -6699 Training and Education Fee $0.40 FEE2004 -6700 Technology Fee $4.37 FEE2004 -6702 Scanning Fee $3.00 FEE2004 -6703 Builders Bond $300.00 Total Fees: $488.97 Plumbing Permit Permit Status: APPLIED Permit Expiration: 12/29/2004 Construction Value: $1,800. Work: DRAINFIELD Signed: (INSPECTOR) Total Fees: $488.97 Total Receipts: $488.97 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. Signed: (Contractor or Builder) BY: Miami Shores Village 10050 NE 2nd Avenue Plumbing Permit Phone: 305- 795 -2204 Permit Number: PL2004 -188 Printed: 7 /6/2004 Page 1 of 1 Applicant: DIANE DURBAN Owner: DURBAN DIANE JOB ADDRESS: 1040 NE 96 ST Contractor STATEWIDE SEPTIC CONNECTIONS Contractor's Address: 3590 SOUTH STATE ROAD 7, SUITE 26 Local Phone: 305 - 661 -6633 Parcel # 1132060143540 Legal Description: MIAMI SHORES SEC 3 PB 10 -37 LOTS 11 & 12 BLK 81 LOT SIZE Fees: Description Amount FEE2004 -6696 Building Fee $175.00 FEE2004 -6697 CCF $1.20 FEE2004 -6698 Notary Fee $5.00 FEE2004 -6699 Training and Education Fee $0.40 FEE2004 -6700 Technology Fee $4.37 FEE2004 -6702 Scanning Fee $3.00 FEE2004 -6703 Builders Bond $300.00 Total Fees: $488.97 Permit Status: APPLIED Permit Expiration: 12/29/2004 Construction Value: $1,800.00 Work: DRAINFIELD Signed: (INSPECTOR) Total Fees: $488.97 Total Receipts: $488.97 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. Signed: (Contractor or Builder) BY: WHEN CLEARED AND REPAIRED BY THE VILLAGE: Amount of Bond: $ Cost of clearing and repairs done by Village: $ Balance due Builder: $ Final: Miami Shores Village, Florida BUILDER'S BOND KNOW ALL MEN BY THESE PRESENTS, that I, STATEWIDE SEPTIC 3590 SOUTH STATE MIRAMAR FL of STATEWIDE SEPTIC CONNECTIONS in consideration of the issuance to me by Miami Shores Village, Florida, of a permit or permits to construct or repair a building or buildings at the following address: 1040 NE 96 ST do hereby deposit with Miami Shores Village, Florida, the sum of: $300.00 and I agree with said Village that, when such construction shall have been completed by me within the meaning of the ordinances of said Village, I will clear all premises and repair any Village property damaged by me, used for the deposit of material or equipment in the construction or repair and that, if I do not so clear and repair such premises immediately upon the completion of such construction withing the meaning of such ordinances, the Village may clear and repair the same and pay the cost of such clearance and repairs out of the aforesaid Builder's Bond, and return the remainder to me; and that, if I shall clear and repair said property immediately, as aforesaid, then said Builders Bond shall be returned to me. WITNESS MY HAND and Seal at Miami Shores Village, Florida this date: 7/6/2004 Signature INSTRUCTIONS TO BUILDER: When above mentioned construction is completed and the premises are cleared and repaired, take this bond to the Village Building Inspector and obtain his approval, after which Miami Shores Village will refund your money in accordance with the above agreement. VILLAGE BUILDING INSPECTOR'S APPROVAL I hereby certify that the construction contemplated under this Bond, has been completed and that the builder thereof has caused the surrounding premises to be cleared and repaired in as good condition as they were before commencing said construction Bond refund payable to applicant only. ($10.00 CHARGE IF BOND IS LOST OR DAMAGED) Cancelled: By: Issued: 7/6/2004 Amount: $300.00 Bond #: FEE2004 -6703 Permit #: PL2004 -188 Village Building Inspector, Miami Shores (Date) 9° 6 vc'coa spvena CDn 8 EgUCp (o°( 8 0 IIaraSI 87 8 aCEa2 algU 7 Cad gmuscE i 80 QE 211gMalOTIE ARM* EME NOD E DEM NO a QnD (ILO NO QflpD NO Qgs1 amen NO WEMELECCV I O o r o , e,; , MgCMD CM TU2Ed z.s FgoC? s m MMMEETEOUga EGO 0111010220M0 [(LTD F'I a= Cgi gatEellMa7UE Q9th2 1=g0.110 OMno.,n D /COMO Qsg➢ OEMaT amascaucca Ent OEMET U� ETEU0,0q2 aggD a ©KZMI WME NED umEm aamd QogD Ica arguamm Q agl Oaa QED MOM QaU&o QED D yvr ..a . .. : :: a. : - : . u . w . q EU &OEM Ca? EMU (. a , Q Q a D D D ft-ooga 0 0 d pi WM. oMogoo& &g/©t , D7N. 3 MOM MEOOV MOEgMstn Maa2Z0 maoa as MgcTSC MOEgUaMMO =TEEM] DEMaTMsMIa do MEEMM MOO QED 7 ; QED Ma? 8 gaIMOZaclaMECiana(tUolal taIZMO MIME 8 Qasaondoaa0 ©o gogr geomanzazomo, S Y 2SVIGI QgD D zs. 8 mgoyasamo E : E : / omoyac oaa ao memummoN CEOUTWE mgam comss T?EMEOM mougmiloz D x� M ' E M ct©o NEKBAIWcIEU INEEMTE o QX,W &Q ©rx O5y, MOM QaoJ maam aeoD moaalmm. QLOD *Nom f END MgT1M Leo NO =AEC gETga10 Qg0➢ ° IIrtalla nom QgoD ai] ssao Emm aiol aaagMEMa& :ELb Eim In cal( OKEZE Q z D am3 aan �n Eaaa a ss aaLSacs2 (/ FLORIDA DEPARTMENT OF HEALTH APPROVED (305) 513 -3459 BUILDING ELECTRICAL PLUMBING _.O■FING Li MIAMI SHORES VILLAGE. FLORIDA PERMIT N° 6308 Owner of Kuilding Architect - 2ontractor )r Builder .egal Lot )escription Bi. 'zddress ofd% 3uilding CONTRACTOR OR BUILDER Work to be performed under this Permit Signed. DATE 195 Contractor's ' License No. Subdi- vision Value of Project $ This permit is granted to the contractor or builder named above to construct the building or to install the equipment or device described in the application terefor in strict compliance with all ordinances pertaining thereto and with the understanding that the work will be performed in compliance with any plans Irawings, statements or specifications that may have been submitted to and approved by the proper municipal authorities. This Permit may be revoked at any ime 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 ;ranted is the understanding that the contractor or builder named above assumes the responsibility for a thorough knowledge of the ordinances and regulations Dertaining to the work covered hereby whether shown on the plans or drawings ,,,or in Cae siatgrnents or specification nd that he assumes responsibility for work lone by his agents, servants or employees. J� 'rte BY Amount of Permit $ INSPECTOR In considera(on of the issuance to, me of this permit I agree to perform the work covered hereunder in compliance wit I I c`ii egulations ertainin wig) r thereto a" in strict conformity 1 T or g � y the .plans;, drawmq�, statements or submrtted tq the props r audhor� ' 4f Miami Shores Village. mete °�-^• epting this permit I assume responsibility for a' W 0T` dole by %' efther, myself, my agent, servant "or loy . . ,_ " „ r �.r. . sue! /' @.. BY AUTHORITY i11