PLUMBINGName
Address
Company
Phone #
. V4 l
MJ. MI SHORES VILLAGE
B' ILDING DEPARTMENT
305- 795 -2204
Building Inspection Request
Date 'AtLk05
Type Insp'n hwi\ C- OUYA I CII ?NI
Permit No. 11- ?as ` 161
Inspection Date
Approved
Correction
Re- Insp'n Fee
c91 ci 1 4O
141 PE q �T
s a4s
?s04 ?=.7
❑
JOB
Village of Miami Shores N? 3698
INSPECTION
ADDRESS /
TIME READY 2 2 '
REMARKS
INSPECTOR
DATE
A (f.
��
A /
C:ollud -
liphnn d YOL
77r r -y ("SyN
anLs _a -,u
•
Signed_
Bonding Company's Name (if applicable)
Bonding Company's Address
City State Zip
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address
City State Zip
Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has
commenced prior to the issuance of a permit and tha: all work will be performed to meet the standards of all laws rcgulating
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 , 5uilding 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.
Signature �► y;:1Lxai�i�'
Chc 12/15/03
Signature
cs
My CommissionE 4n s: .
Owner or Agent , Contractor
`
The foregoing instrument was acknowledged before me this 9 The foregoing instrument was acknowledged before me this t; r '
day of+ `J,L., RX 20lV , by r,' / j - /:k. " r kr L T day of / t ' e.,' " -k' 20 e'41 by 1 i '-.))/ ,4i-:-' ('°(!( t e``/ r,
(who is personally known to me Jr who has produced who is personally known to me Or who has produced
As identification and who did take an oath. as identification and who did take an lath.
NOTARY PUBLIC' i /1 ' NOTARY PUBLIC:
Si: gn a. t �. , ' z Sign:) . ,/,
Print: 2 t_ ,i> r t 1 (`� )f.s Alt:-
Print:
My Commission Expires: yiy). ;�. ma 4/ f
'**************** * *** ** *** * * * * ** * * * ** * * * ** ** * * ** * * * * * * * * * * * ** * * * * * ** * *** **** ”4 ** * * ** * * * * * ** ** *** * ** **
(Certificate of Competency Holder)
State Certificate or Registration No. Certificate of Competency No.
* * * * * * * * * * * * * * * * * * * * * * * * * ** * ** F. * * * ** *************************************** ** ** * * ** * * * * * * ** * * * * * * * * *. ; . * **
APPLICATION APPROVED BY: �,
Z' =� � ( �- � <� `� ' ,�` � Plans Examincr
Engineer
Zoning
Tenant/Lessee Name
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
BUILDING
PERMIT APPLICATION
FBC 2001
Miami Shores Village
Building Department
Permit Type (circle): Building Electrical
Owner's Name (Fee Simple
�I Titleholder) y
j-`� PLY l4%
' PL ll%
Owner's Address / / '7 - 1 A.
City `) / ) / 5,4-d L';et State /L ;T )Z) /
$ Value of Work For this Permit
(Continued on opposite side)
Total Fee Now Due $ l d ie 9 7 FEB 0 4 = PAID
Permit No.
Master Permit No. 74. a 9--37
Mechanical Roofing
Phone # `. J _ ie4
Zip 33/37
/37
Phone #
Job Address (where the work is being done) / 1 - - , 1 7 L , Q 1iii 5 /Z! L7
City Miami Shores Village County Miami -Dade Zip 33 /3V
Is Building Historically Designated YES NO
Contractor's Company Name L L (YID A ./ %r- : Phone # : 3 / - '7 C
Contractor's Address 7&
City in //l / State Ft- tile 473 11 Zip
Qualifier L.-L /L ' _L � G =C : 77
Architect/Engineer's Name (if applicable) Phone #
Square Footage Of Work:
Type of Work: ['Addition El Alteration ❑New ErRepair/Replace ❑ Demolition
Describe Work: C I' LI+-e • C t) 9//i . "'l:L%)
* * * * * * * * * * * * * * * * * * * * * * * * * * ** F ees * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
Submittal Fee $ Permit Fee $ 115'' CCF $ 1, 2 (.) CO /CC
Notary $ S ' Training/Education Fee $ , 1 10 Technology Fee $ Q ,3 c 7
Scanning $ 3 Radon $ Zoning Bond $ _h
Code Enforcement $ Structural Plan Review. $
Amount of Permit $. 1.'50
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
Permit No. �` Date. 11/7/56.
Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the building or othcl
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 work.
R. Erhardt 1147 NE 97t
Owner's Name and Address ___ _.._ __________ ____ • No eat
Registered Architect and /or Engineer
Employing Plumber's Name..__ or_t_hrte s t..__E.1hg,_._&._ .P►lm p La..
Location and Legal Description Lot Block -- _ __ _ _ _ _ _ Subdivision _ ________..________..
Street and Number where work is to be performed —No.
State work to be performed and purpose of building (By Floors)
New Building .. Remodeling Addition._
Street _._.
Repairs.
Size Septic Tank Type of Tank_ _ .. Capacity Gals.
Feet of Drain Tile Dist. Feet of Tank or Drain Field from WeIL__________
Nature of Water Supply: City —Well _ -_ Size of Soakage Pit.__
( Signed )
No. of Stories .. .... .. .
Plumbing Inspector.
The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations as . II employer of labor
under the Florida Workmen s Compensation Act, being Section 5988, Compiled General Laws of Florida Permanent Supplement, and h:,s �n-
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 an
licensed by Miami Shores Village.
........ .. Master Plumber.
STATE OF FLORIDA, ss.
COUNTY OF DADE.
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeare
to me well known, and who, being by me first duly sworn, upon oath deposes and says that he is the
of the above described construction, that he has carefully read the foregoing application, and that he did sign the same, and that all tau
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 f,.ul
materials and /or workmanship.
CLOSETS
BATH
TUBS
SHOWERS
LAVA.
TORIES
SINKS
I
SLOP
SINKS
LAUNDRY
Tulsa
U RINALS
CATCH
SA81N
FLOOR
DRAIN
DRINKING
FOUNT'NS
TOTAL
FIKTUREI
CONTR.
LIST
�
2"
CHICK
Supply
vE
11 for lam sprinklers.
_
SEPTIC
TANK
SEWER
CONN.
DRAIN
FIELD
SOAKAGE
PIT
GREASE
TRAP
SOLAR
HEATER
DEEP
WILL
SPRKLR.
SYSTEM
SWIM'O
POOL
CONTR.
LIST
CHECK
Amount of Permit $. 1.'50
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
Permit No. �` Date. 11/7/56.
Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the building or othcl
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 work.
R. Erhardt 1147 NE 97t
Owner's Name and Address ___ _.._ __________ ____ • No eat
Registered Architect and /or Engineer
Employing Plumber's Name..__ or_t_hrte s t..__E.1hg,_._&._ .P►lm p La..
Location and Legal Description Lot Block -- _ __ _ _ _ _ _ Subdivision _ ________..________..
Street and Number where work is to be performed —No.
State work to be performed and purpose of building (By Floors)
New Building .. Remodeling Addition._
Street _._.
Repairs.
Size Septic Tank Type of Tank_ _ .. Capacity Gals.
Feet of Drain Tile Dist. Feet of Tank or Drain Field from WeIL__________
Nature of Water Supply: City —Well _ -_ Size of Soakage Pit.__
( Signed )
No. of Stories .. .... .. .
Plumbing Inspector.
The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations as . II employer of labor
under the Florida Workmen s Compensation Act, being Section 5988, Compiled General Laws of Florida Permanent Supplement, and h:,s �n-
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 an
licensed by Miami Shores Village.
........ .. Master Plumber.
STATE OF FLORIDA, ss.
COUNTY OF DADE.
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeare
to me well known, and who, being by me first duly sworn, upon oath deposes and says that he is the
of the above described construction, that he has carefully read the foregoing application, and that he did sign the same, and that all tau
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 f,.ul
materials and /or workmanship.
BUILDING
ELECTRICAL
PLUMBING
ROOFING
Owner of
Building
Architect
Contractor
or Builder
Legal Lot
Description
Address of
Building
CONTRACTOR OR BUILDER
MIAMI SHORES VILLAGE. FLORIDA
PERMIT 3197
Bl.
DATE
Work to be performed under this Permit_
Subdi-
vision
Value of
Project $
195
Contractor's
License No.
Amount of
Permit $
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
herefor in strict compliance with all ordinances pertaining thereto and with the 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 proper municipal authorities. This Permit may be revoked at any
time if the work is not done in compliance with such ordinances or if tho 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 cr in the statements or specifications and that he assumes responsibility for work
done by his agents, servants or employees.
Signed. BY
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 ac-
cepting this permit I assume responsibility for all work done by either, myself, my agent, servant or employee.
BY AUTHORITY a
"‹.
<
r,
e
Permit No
Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the building or other
structure herein described. This application is made in compliance and conformity with the Building Ordinance of Miami Shores Village, Florida,
and all provisions of the Laws of the State of Florida, all ordinances of Miami Shores Village and all rules and regulations of the Building Division
of Miami Shores Village shall be complied with, whether herein specified or not. A copy of approved plans and specifications must be kept at
building during progress of work.
Owner's Name and Address
Registered Architect and/or Engineer_ . ,..— —
. , , , '
Employing Plumber's Name __ _ , ' ,,, , , ,, z., , - _ No. Street.
Location and Legal Description Lot____1____________1_ Block / ,'.."' Subdivision -
,
,. -,
Street and Number where work is to be performed—No— / / ti 1. 4 .: : (:'. c'' ' i '''''' Street
State work to be performea and purpose of building (By Floors) . _
New Building l ''' Remodeling_ . Addition. Repairs
Size Septic Tank
Feet of Drain Tile. Z
Nature of Water Supply
Amount of Permit $
STATE OF FLORIDA, }
ss.
COUNTY OF DADE.
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
No
Date • /
(Signed).
Street.
Type of Tank. Gals
__Dist. Feet of Tank or Drain Field from Well
Size of Soakage Pit
The undersigned applicant for this building permit does hereby certify that he understands and accepts is 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 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 are
Licensed by Miami Shores Village.
No. of Stories.
— _ ..... ...........
Plumbing Inspector.
My Commission Expires Notary Public, State of Florida
Master Plumber.
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally 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 facts
therein by him stated are true.
NOTE: A re-inspection fee of $1.00 will be made when such re-inspection is made•necessary by improper notice for inspection, or faulty
materials and/or workmanship.
CLOSETS
BATH
TusS
SHOWERS
LAVA-
TORIES
SINKS
SLOP
SINKS
LAUNDRY
Tuss
URINALS
CATCH
BASIN
FLOOR
DRAIN
DRINKING
FOUNT'NS
TOTAL
FIXTURES
CONTR.
LIST
f
•
.
,
/
CHICK
_
SEPTIC
TANK
SEWER
Conn.
DRAIN
FIELD
SOAKAGE
PIT
GREASE
TRAP
SOLAR
HEATER
DEEP
WELL
SPRKLR.
SYSTEM
SWIM'G
POOL
, -
,. '
CONTR.
LisT
CHECK
/
1
/
/
--_
Permit No
Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the building or other
structure herein described. This application is made in compliance and conformity with the Building Ordinance of Miami Shores Village, Florida,
and all provisions of the Laws of the State of Florida, all ordinances of Miami Shores Village and all rules and regulations of the Building Division
of Miami Shores Village shall be complied with, whether herein specified or not. A copy of approved plans and specifications must be kept at
building during progress of work.
Owner's Name and Address
Registered Architect and/or Engineer_ . ,..— —
. , , , '
Employing Plumber's Name __ _ , ' ,,, , , ,, z., , - _ No. Street.
Location and Legal Description Lot____1____________1_ Block / ,'.."' Subdivision -
,
,. -,
Street and Number where work is to be performed—No— / / ti 1. 4 .: : (:'. c'' ' i '''''' Street
State work to be performea and purpose of building (By Floors) . _
New Building l ''' Remodeling_ . Addition. Repairs
Size Septic Tank
Feet of Drain Tile. Z
Nature of Water Supply
Amount of Permit $
STATE OF FLORIDA, }
ss.
COUNTY OF DADE.
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
No
Date • /
(Signed).
Street.
Type of Tank. Gals
__Dist. Feet of Tank or Drain Field from Well
Size of Soakage Pit
The undersigned applicant for this building permit does hereby certify that he understands and accepts is 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 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 are
Licensed by Miami Shores Village.
No. of Stories.
— _ ..... ...........
Plumbing Inspector.
My Commission Expires Notary Public, State of Florida
Master Plumber.
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally 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 facts
therein by him stated are true.
NOTE: A re-inspection fee of $1.00 will be made when such re-inspection is made•necessary by improper notice for inspection, or faulty
materials and/or workmanship.
BUILDING
PERMIT APPLICATION
FBC 2001
Permit Type (circle): Building
Owner's Name (Fee Simple Titleholder)
Owner's Address /1 7 /1i'
City /? i dfrti , $ 4 ' v f State
Tenant/Lessee Name
Job Address (where the work is being done)
City Miami Shores Village
Is Building Historically Designated YES NO
Contractor's Company Name d - 5 /
Contractor's Address /CoU 5 s#1/70 i'e JP/v.,"
City A"d.4,0 &l O .ege',.G 4 State
Qualifier /f ore, a e/ /C 5 - 7 1 ,,o rr--!<d 71-
State Certificate or Registration No./ r Z .s 55 47 •w Certificate of Competency No. ,0 2, ' 9 2 -if/ c
Architect/Engineer's Name (if applicable)
$ Value of Work For this Permit
Type of Work: ❑Addition ❑lAlteration
Describe Work: /we / ;fr, '
Submittal Fee S z o •( Y
Notary S
Scanning S Radon $
Code Enforcement $
Total Fee Now Due S
(Continued on opposite side)
Training /Education Fee $
Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
Electrical .
c ay /e- Phone # ?05
Zip
1/47 /r/E 9 7 Sree/
County Miami -Dade
* ** * * ** * * * * * * * * * * * * * * ** * *:r ** * * * * * * * * * * * * * * * * * *
F * * * * * * * * * * **
ees �
Permit Fee $ CCF $ %- CO /CC
Zoning
Structural Plan Review. $
Master Permit No. fa PC - `-) u f
Phone #
Phone #
Permit No. 1% ) I (
ii /Tr
Phone #
Mechanical
Zip
❑New Reppiplace
=;ebb
Technology Fee $
Bond $
Roofing
.r G - 6 717
9Sci z//. 2J'
Square Footage Of Work:
❑ Demolition
Bonding Company's Name (if applicable)
Bonding Company's Address
City State Zip
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address
City State Zip
Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has
commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulating
construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRICAL WORK, PLUMBING, SIGNS,
WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and AIR CONDITIONERS, ETC
OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all
applicable laws regulating construction and zoning.
"WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR
PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING,
CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF
COMMENCEMENT."
Notice to Applicant: As a condition to the issuance of a building permit with an estimated value exceeding $2500, the applicant 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.
Contractor
The foregoing instrument was acknowledged before me this L The foregoing instrument was acknowledged before me this 4-1
day of /01,,,,,41 , 2O b c v 4,01 o , day of fle— 4 , 20 by / p /Je:rjr v.--orv` ,
who is personally known to me or who has produced 40P/4 who is personally known to me or who has produced
As identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
My Commission Expires:
* * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** * *
APPLICATION APPROVED BY:
chc 05/13/03
/' e KlLGO •••••••••
ended 1b.Ash
Flodda Notary Assn.. I .i
NOTARY PUBLIC:
as identification and who did take an oath.
Sign:
Print: oF
" MD- 4321254) Florida Notary Assn., tnc
My Commission Expit6s1 ,, ” ......... u.0 us
* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * *
* * ** ******************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
P lans Examiner
Engineer
Zoning
•
Vi age of Miami Shores N° 3744
JOB 1
ADDRESS
INSPECTION
TIME READY
REMARKS
INSPECTOR DATE
LOT: 4
OTHER REMARKS:
STATE OF FLORIDA
DEPARTMENT OF HEALTH
OMITE SEWAGE TREATMENT AND DISPOSAL SYSTEM
CONSTRUCTION PERMIT
CONSTRUCTION PERMIT FOR:
[ ]New System [ ]Existing System [
[ X ]Repair [ ]Abandonment
APPLICANT: Pumo, Mark AGENT: SR0001343, Crockett Lester
PROPERTY STREET ADDRESS: 1147 NE 97 St Miami FL 33138
BLOCK: 180 SUBDIVISION: Miami Shores
]Holding Tank [ ] Innovative Other
] Temporary [ NA ]
[Section /Township /Range /Parcel No.]
PROPERTY ID #: 11- 3205 - 017 -0040 [OR TAX ID NUMBER]
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.
SYSTEM DESIGN AND SPECIFICATIONS
T [ 900 ] Gallons SEPTIC TANK
A [ 0 ]Gallons
N [ 0 ]GALLONS GREASE INTERCEPTOR CAPACITY
K [ 0 ]GALLONS DOSING TANK CAPACITY [ 0 ]GALLONS
D [ 300 ]SQUARE FEET PRIMARY DRAINFIELD SYSTEM
R [ 0 ]SQUARE FEET SYSTEM
A TYPE SYSTEM: [ Y ]STANDARD [ N ]FILLED
I CONFIGURATION: [ N ]TRENCH [ '1 ]BED
N
F LOCATION TO BENCHMARK: Existing Finished Floor El.:11.70 Ft Ngvd
I ELEVATION OF PROPOSED SYSTEM SITE [ 2.0 ] [ FEET ] [ BELOW BENCHMARK /REFERENCE
E BOTTOM OF DRAINFIELD TO BE [ 4.5 ] [ FEET ] [ BELOW BENCHMARK /REFERENCE
L
D FILL REQUIRED: [ 0.0 ]INCHES EXCAVATION REQUIRED: [ 30.0 ] INCHES
1- Existing 750 Gallons Septic Tank to remain.
2- Install 300 square feet of drainfield in bed configuration.
3- Invert elevation of the drainfield to be no less than 7.70 ft NGVD
4- Bottom elevation of the drainfield to be no less than 7.20 ft NGVD
THIS PERMIT IS NOT FOR ADDITION.
SPECIFICATIONS BY: Andre, Paul
APPROVED BY: Andre, Paul
DATE ISSUED: 2/2/04
TITLE:
DH 4016, 03/97 (Obsoletes previous editions which tray not be used)
(Stock Number: 5744 -001- 4016 -0) [ostde cons_4016 -11
MULTI- CHAMBERED /IN SERIES: [Y ]
MULTI- CHAMBERED /IN SERIES: [Y ]
TITLE: Professional Engin
CENTRAX #: 13 -SG -19373
DATE PAID:
FEE PAID : $
RECEIPT .
OSTDSNBR : 04 -0342- -R
Q [0 ]DOSES PER 24 HRS # PUMPS[ 0 ]
[ N ]MOUND [ N ]
[ N ]
Dade
EXPIRATION DATE: 5/2/04
POINT
POINT
CHD
Page 1 of 2
Notes:
Scale: Each block represents 5 feet and 1 inch = 50 feet.
Site Plan submitted by:
DH 4015, 10195 (Replaces HRS•H Form 4015 which may be used)
(Stodc Number: 5744.002.40158)
STATE OF FLORIDA
DEPARTMENT OF HEALTH
APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PERMIT
Permit Application Number
PART II - SITE PLAN
Signature Tale
Plan Approved Not Approved D ate
B County Health Department
ALL CHANGES MUST BE APPROVED BY THE COUNTY HEALTH DEPARTMENT
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Miami Shores Village
10050 NE 2nd Avenue
Phone: 305- 795 -2204 Permit Number: PL2004 -34
Printed: 2/9/2004 Page 1 of 1
Applicant: GAYLE PUMO
Owner: PUMO GAYLE
JOB ADDRESS: 1147 NE 97 ST
Fees: Description Amount
FEE2004 -1098 Building Fee $175.00
FEE2004 -1099 CCF $1.20
FEE2004 -1100 Notary Fee $5.00
FEE2004 -1101 Training and Education Fee $0.40
FFF2004 -1102 Technology Fee $4.37
FEE2004 -1103 Builders Bond $300.00
FEE2004 -1104 Scanning Fee $3.00
Total Fees: $488.97
Signed: (INSPECTOR)
:um in Perm:
Contractor LLOYD NORTH DADE SEPTIC TANK SERVIQdNttactor's Address: 750 NW 107 ST
Local Phone: 305 - 754 - 3375
Parcel # 1132050170040 Legal Description: REV PL MIAMI SHORES SEC 8
Permit Status: APPROVED Permit Expiration: 8/2/2004 Construction Value: $1,500.00
Work: REPLACE DRAINFIELD
PB 43 -51 LOT 4 BLK 180 LOT
Total Fees: $488.97
Total Receipts: $488.97
PA L -n)\
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:
APPLICANT:
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1
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1
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[101
(11)
[12)
(131
[14]
[15)
[161
[17]
[181
[19)
[20)
(21)
STATE OP FLORIDA
DEPARTMENT OF HEALTH
ONSITE SEWAGE TREAT/MT AND DIPOSAL SYSTEM
CONSTRUCTION INSPECTION AND FINAL APPROVAL.
(11
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AGENT.
:-
PROPERTY A 1 -) DDRESS: Al ,)I 42;
LOT: BLOCK: 1 SUBDIVISION: PROPERTY ID ft il - - - •
mostrammenummumemerigmassrmnammamansmenussummumummusimmasammensisamm================
CHECKED [X] ITEMS ARE NOT IN C.OMPLIANCE WITH
================================mn
TANK INSTALLATION , 1
(01) TA/fit SIZE [1) Y./ [2)
[02] TANK MATERIAL r
[ 03) OUTLET DEVICE
( 04] MULTI -CENSER= [ Y / QS) )
[OS] OUTLET FILTfit fj 17 -
[06] LEGEND
[07] WATERTIGHT
[081 T=
(09] DEPTH TO LID
7.
0' • . e." 1 ')• ' .
DRAINFIELD INSTALLATION -
AREA [1]/ / 4.1 V(2J _____ O SQPT
DISTRIBUTION BOX HEADER
NUMBER OF DRAINLINES
DRAINLINE SEPARATION 7/
DRAINLINE SLOPE
DEPTH OF COVER , 7, ')
ELEVATION (ABOVE/B0) RH
SYSTEM LOCATION
DOSING PUMPS
AGGREGATE SIZE, .
AGGREGATE EXCESSIVE FXNE
AGGREGATE DEPTE
FILL / EXCAVATION MATERIAL
[22] FILL AMOUNT /
[23] FILL TEXTURE
[24] EXCAVATION DEPTE
[251 AREA REPLACED
[26] REPLACEMENT MATERIAL
EXPLANATION OF VIOLATIONS / REMARKS:
1 ... CS
PM ;
Id ILI 1,..
e cp
-cc will 0:
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k (1- C6
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CO 4 6 waft
Ca INC
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STATUTE OR RULE AND MUST BE CORRECTED.
histaliller / Contractor
FILLED / MOUND SYSTEM
(36) DRAINFIELD COVER
[37] SHOULDERS
[38] SLOPES
[39) STABILIZATION
PERMIT
DATE PAID: -)
FEE PAID:
RECEIPT 1:.-
).•
========================
SETBACKS
[27] SURFACE WATER All FT
[28] DITCHES FT
[29] PRIVATE WELLS FT
[30] PUBLIC WELLS FT
U31) IRRIGATION WELLS ' , y 6t) EFT
[32] POTABLE WATER LINES 1 00 EFT
[33] BUILDING FOUNDATION
[34] PROPERTY LINES FT
[351 OTHER FT
•
ADDITIONAL INFORMATION
[40] UNOBSTRUCTED AREA
[41) STORMWATER RUNOFF
(42) ALARMS
[43] MAINTENANCE AGREEMENT
(44) BUILDING AREA
[45] LOCATION CONFORMS WITH SITE PLAN
[46] FINAL SITE GRADING
[47] CONTRACTOR
[48] OTHER
ABANDONMENT
1 [49] TANK PUMPED
1 (50) TANK CRUSHED & FILLED
I 1
1
1 ]
CONSTRUCTIONJAppROViD/DISAPPROVED) o- cf- ( ) ) C. 1 cED
— ‘
FINAL SYSTEM 1APPROVED/DISAPPROVED]:
DH 4016, 10/97 (Previous Editions May Be Used)
DATE: •
; t
DATE:”-
1
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