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383 NE 97 St (9)Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 BUILDING Permit No. , 2 PERMIT APPLICATION SEP 7 X 1105 Pf1aster Permit No. FBC 2001 1 Permit Type (circle): Building Electrical Owner's Name (Fee Simple Titleholder) K eyNy,2 t Owner's Address l !• 1 7 `r' City M a 5 State F(, Tenant/Lessee Name Contractor's Company Name `5. +CwNC P, Contractor's Address Z 7 City v l State PI Qualifier T -t•S State Certificate or Registration No. $ Value of Work For this Permit Z2)UXJ Notary $ Training /Education Fee $ b • f - Total Fee Now Due $ 40 4 -cssc) (Continued on opposite side) Miami Shores Village umbin f � Job Address (where the work is being done) 1Q? ,K3 E ( 1 St City Miami Shores Village Is Building Historically Designated YES County Miami -Dade NO ✓ Zip "3 Phone # ,), 3 v r�Q c Phone # 4 2 1 Vtetoct 7 f 2 Certificate of Competency No. Architect /Engineer's Name (if applicable) Phone # Square Footage Of Work: Type of Work: ❑Addition ❑Alteration ❑New [ " R air /Replace El Demolition Describe Work: New Drq, -e/ Cd Mechanical Roofing N.711 l one # Zip ?, ";1 (36 (��,►�� — ( 6 i3 Zip t.) **** * * * * * * * * * * * * * * * * * * * * * * ** Fees * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** Submittal Fee $ 8 Permit Fee $ 1 7S - CCF $ 1 CO /CC Technology Fee $ 4. • 40 Scanning $ 3 . CO Radon $ Zoning Bond S a30 - CO Code Enforcement $ Structural Plan Review. $ C� —> 1zg14 � A.5 13 CEP 2 7 PAID S1- 1 "1-131-1-K_ 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. Signature Signature (.. Owner or Agent Contractor The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this day of Sy , 20 a 5, by 4a n,-N. S r-- .-4-1 day of , 20 , by who is personally known to me or who has produced U''NN,' who is personally known to me or who has produced 0 fir. As identification and who did take an.oath. as identification and who did take an oath. NOTARY PUBLIC: pp Sign: Q.(1 LD .Uv Print: My Commission Expires: * * * * * * * * ** APPLICATION APPROVED BY: Chc 05/13/03 * * * * * * * * * * * * * * * * * * * * * * * ** * ** * * * * ** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** * ** * * * * * * * * * * * * * * * * * * ** Plans Examiner Engineer Zoning NOTARY PUBLIC: Sign: Print: My Commission Expires: STATE OF FLORIDA DEPARTMENT OF HEALTH ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM CONSTRUCTION PERMIT CONSTRUCTION PERMIT FOR: ]New System [ ]Existing System [ X ;Repair [ ]Abandonment APPLICANT: Smith, Kenneth & Ballinger, AGENT: SA0021074, Solomon Teresa PROPERTY STREET ADDRESS: 361 NE 97 St Miami Shores FL 33138 LOT: 19 BLOCK: 42 SUBDIVISION: Miami Shores [Section /Township /Range /Parcel No.] PROPERTY ID #: 11 - 3206 - 013 - 5760 [OR TAX ID NUMBER] SYSTEM MUST BE CONSTRUCTED IN ACCORDANCE WITH SPECIFICATIONS AND STANDARDS OF CHAPTER 64E- 6,;'AC DEPARTMENT APPROVAL OF SYSTEM DOES NOT GUARANTEE SATISFACTORY PERFORMANCE FOR ANY SPECIFIC T : :1:E 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 TH: 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 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: N ]STANDARD [ N ]FILLED I CONFIGURATION: [ N ]TRENCH [f ]BED x F LOCATION TO BENCHMARK: FFE 12.0' NGVD ,. ELEVATION OF PROPOSED SYSTEM SITE [ 1.6 ] [ FEET ] [ BELOW]BENCHMARK /REFERENCE POINT E BOTTOM OF DRAINFIELD TO BE [ 4.1 ] [ FEET ] [ BELOW]BENCHMARK /REFERENCE POINT D FILL REQUIRED: [ 0.0 ]INCHES EXCAVATION REQUIRED: [ 30.0 ] INCHES OTHER REMARKS: 1. Install 300 sf of drainfield in the bed configuration. 2. Perimeter of excavation area shall be at least 2 ft. wider and longar than the proposed absortion bed. 3. Existing 900 gal. septic tankd, certified by "Statewide Septic Connections Inc." as structurally sound and having a solids deflection device. 4. Invert elevation of drainfield to be no less than 8.40' NGVD. 5. Bottom of drainfield elevation to be no less than 7.90' NGVD. 6. This permit is not for "additions ". SPECIFICATIONS BY: Klug, Geoffrey TITLE: APPROVED BY: Klu•, Geoffre /Efs! TITLE: Sanitation & Safot MI 4016, 03/97 (Obsoletes previous editions which may not be used) Stock Number: 5749- 001 - 4016 -0) [ostds_cons_4016 - 1] CEN "RAX #: 13 - - 26575 DATE PAID: FEE PAID : $ RECEIPT . OST_)SNBR : 05 - 3145 - - ]Holding Tank [ ] Innovative Other [ ] Temporary [ NA ] MULTI - CHAMBERED /IN SERIES: [Y MULTI - CHAMBERED /IN SERIES: [Y @ [ 0 ]DOSES PER 24 HRS # PUMPS[ C [ N ]MOUND [ N ] [ N ] Dade ;ATE ISSUED: 9/26/05 EXPIRATION DATE: 12/25/05 CHC Page 1 of 2 STATE OF FLORIDA DEPARTMENT OF HEALTH • 4 4 , APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PERMIT 1 ale: Each block represents 5 feet and 1 inch = 50 feet. rtes: le Plan submitted by: Signature Title An Approved Not Approved Date County Health Department ALL CHANGES MUST BE APPROVED BY THE COUNTY HEALTH DEPARTMENT 4015, MI5 (Replaces HRS-H Foes 4015 which may be used) ia x.: 5744-002.4015-4 PART 11 - SITE PLAN Permit Application Number Page 2 of 3 4LI 7005 C j . MLAMI SHORES VILLAGt BUILDING DEPARTMENT 305- 795 -2204 Building Inspection Request Date 01\05 Type Insp'n WML\ 'Dc al 1AcI M Permit No. 005 Name 1 6.)tA ' WOW Address `, �3 14t co S 1 Company SA • � S S��1L Phone # a6 I I �51 -1g5 Inspection Date 114105 Approved Correction Re- Insp'n Fee Miami Shores Village 10050 NE 2nd Avenue Phone: 305 - 795 -2204 Printed: 9/28/2005 Applicant: HOWARD BALLINGER Owner: BALLINGER HOWARD JOB ADDRESS: 383 NE 97 ST Parcel # 1132060135760 Signed: Plumbing Permit Permit Number: PL2005 -295 Page 1 of 1 Contractor STATEWIDE SEPTIC CONNECTIONS Contractor's Address: 3590 SOUTH STATE ROAD 7, SUITE 26 Local Phone: 305 - 661 -6633 Legal Description: 1 53 41 6 53 42 MIAMI SHORES SEC 1 AMD PB 10 -70 LOT 19 & 20 BLK 42 Fees: Description Amount FEE2005 -12909 Building Fee $175.00 FEE2005 -12910 CCF $1.80 FEE2005 -12911 Training and Education Fee $0.60 FEE2005 -12912 Technology Fee $4.40 FEE2005 -12913 Scanning Fee $3.00 FEE2005 -12914 Builders Bond $300.00 Total Fees: $484.80 Total Fees: $484.80 Total Receipts: $0.00 Permit Status: APPROVED Permit Expiration: 3/26/2006 Construction Value: $2,300.00 Work: INSTALL NEW DRAINFIELD (INSPECTOR) p t. _14_ 5/39 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 Printed: 9/28/2005 Applicant: HOWARD BALLINGER Owner: BALLINGER HOWARD JOB ADDRESS: 383 NE 97 ST Parcel # 1132060135760 Signed: (INSPECTOR) Plumbing Permit Permit Number: PL2005 -295 Permit Status: APPROVED Permit Expiration: 3/26/2006 Construction Value: $2,300.00 Work: INSTALL NEW DRAINFIELD Page 1 of 1 Contractor STATEWIDE SEPTIC CONNECTIONS Contractor's Address: 3590 SOUTH STATE ROAD 7, SUITE 26 Local Phone: 305 - 661 -6633 Legal Description: 1 53 41 6 53 42 MIAMI SHORES SEC 1 AMD PB 10 - 70 LOT 19 & 20 BLK 42 Fees: Description Amount FEE2005 -12909 Building Fee $175.00 FEE2005 -12910 CCF $1.80 FEE2005 -12911 Training and Education Fee $0.60 FEE2005 -12912 Technology Fee $4.40 FEE2005 -12913 Scanning Fee $3.00 FEE2005 -12914 Builders Bond $300.00 Total Fees: $484.80 Total Fees: $484.80 Total Receipts: $0.00 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: M (MI SHORES VILLAGE, FLA. JOB 1■T° 5819 , ADDRESS "'-& A - INSPECTION ' 0 /1,1 1 k TIME READY REMARKS: INSPECTOR DATE