577 NE 96 St (6)10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
o v r., I r ti ��
I � � C c, � ( �� Permit No. PLO5 r 2/-5/
(, ( tJ Master Permit No.
0
BUILDING
PERMIT APPLICATION
FBC 2001
Miami Shores Village
Building Department
Permit Type (circle): Building Electrical Plumbing Mechanical QQ Roofing Owner's Name (Fee Simple Titleholder) HOLL. / /(riJ6L- Y Phone # : ? ` W "S , `
Owner's Address L 99 /i. C QL ixa ?6 ' 7
City / / ,Sig- /O • State FL. Zip .35/3te
Tenant/Lessee Name Phone #
Job Address (where the work is being done) 3 4Jr C;. Q G 1t-! Cz -
City Miami Shores Village County Miami -Dade Zip 3 3/ 3
Is Building Historically Designated YES NO
Contractor's Company Name L L Y D / /C'Phone # RV 7G 34
Contractor's Address 7L.S 10- /D` � WI T
City /4///474/ / State A L Zip 3 ,§/(
Qualifier LL 7 2 L • CPO Q2= 7 T
/343
Architect/Engineer's Name (if applicable) Phone #
$ Value of Work For this Permit ($ J/0730. Square Footage Of Work: 6 e5
Type of Work: ❑A ❑Alteration ❑New ErRepair/Replace ❑ Demolition
/'c
Describe Work: EPL/9C 7?/EV Air /�L16
Submittal Fee $ 118C4 • .D Permit Fee $ 115 CCF $ 1 • 20 .
Notary $ 5.00 . Training/Education Fee $ 0 . 40 Technology Fee $ 4. 40
Scanning $ 3 . 00 Radon $ Bond $ 3 00
Code Enforcement $ Structural Plan Review. $
Total Fee Now Due $ 48a • / -
(Continued on opposite side)
* * * * * * * * * * * * * * * * * * * * * * * * * * ** F ees * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
(12.53
AUG 11 PAID
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 i r.:'. In the absence of such posted notice, the
inspection will not be approved and - a reinspection fee will be charged.
i J�
d` y
Signaturq Signature 6e0;- •
Owner or Agent
The fore oing instrument was acknowledged before me this 1t
day of 0 , 2005 by f l®L L / k/AJ Y,
ersonall known to m • r who has produced
d who did take an oath.
My Commission Expires:
Chc 10/14/03
Contractor
The fore •'ng instrument was acknowledged before me this //at-
day of d 114. - 8L 20 a by C / /
r who has produced
as identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
(Certificate of Competency Holder)
My Commission Expires:
State Certificate or Registration No. certificate of Competency No.
********** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** * * * *** * ** * * * * * * * * * * * * * * * * * * ** ** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
APPLICATION APPROVED BY: J � � ' ✓ / 2 ` "Z) Plans Examiner
Engineer
Zoning
STATE OF FLORIDA
DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM
,CONSTRUCTION PERMIT
CONSTRUCTION PERMIT FOR:
[ ]New System [ ]Existing System [ ]Holding Tank [ ] Innovative Other
[ X ]Repair [ ]Abandonment [ ]Temporary [ NA ]
APPLICANT: Kingsbury, Neal & Holli AGENT: SR0931123, Bryant Roland
PROPERTY STREET ADDRESS: 577 NE 96 St Miami Shores FL 33138
LOT: 19 BLOCK: 99 SUBDIVISION: Miami Shores
[Section /Township /Range /Parcel No.]
PROPERTY ID #: 11 - 3206 - 017 - 1590 [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 [ 1350 ]Gallons SEPTIC TANK
A [ 0 ]Gallons
N [ 0 ]GALLONS GREASE INTERCEPTOR CAPACITY
K [ 0 ]GALLONS DOSING TANK CAPACITY [ 0 ]GALLONS @
D [ 600 ]SQUARE FEET PRIMARY DRAINFIELD SYSTEM
R [ 0 ]SQUARE FEET SYSTEM
A TYPE SYSTEM: [ )1STANDARD [ N ]FILLED [ N ]MOUND [ N ]
I CONFIGURATION: [ N ]TRENCH [ )I BED [ N ]
N
F LOCATION TO BENCHMARK: Crown of Road EL: 8.2'
I ELEVATION OF PROPOSED SYSTEM SITE [ 0.2 ] [ FEET ] [ ABOVE]BENCHMARK /REFERENCE POINT
E BOTTOM OF DRAINFIELD TO BE [ 2.3 ] [ FEET ] [ BELOW]BENCHMARK /REFERENCE POINT
L
D FILL REQUIRED:[ 0.0 ]INCHES EXCAVATION REQUIRED: [ 30.0 ] INCHES
OTHER REMARKS:
1 - Install 1350 gal. category -2 septic tank equipped with an approved filter.
2 -The licensed contractor installing the system is responsible for installing the minimum
category of tank in accordance with sec. 64E- 6.013(3)(f), FAC.
3 - Install 600 sf of drainfield.
4 - Perimeter of excavation area shall be at least 2 ft. wider and longer than the proposed
absortion bed.
5 - Invert elevation of drainfield to be no less than 6.4' NGVD.
6 - Bottom of drainfield elevation to be no less than 5.9' NGVD.
This permit is not for addition(s).
SPECIFICATIONS BY: Millan, Jorge
APPROVED BY: Milian, Jorge
DATE ISSUED: 8/9/05
DH 4016, 03/97 (Obsoletes previous editions which may not be used)
(Stock Number: 5744- 001 - 4016 -0) [ostds cons 4016 -1)
TITLE:
TITLE: Engineer I
CENTRAX #: 13 - - 26080
DATE PAID:
FEE PAID : $
RECEIPT .
OSTDSNBR : 05 - 2649 - -R
MULTI - CHAMBERED /IN SERIES: [Y ]
MULTI - CHAMBERED /IN SERIES: [Y ]
[0 ]DOSES PER 24 HRS # PUMPS[ 0 ]
Dade CHD
EXPIRATION DATE: 11/7/05
Page 1 of 2
STATE OF FLORIDA
DEPARTMENT OF HEALTH
ONSITE SEWAGE DISPOSAL SYSTEM
SITE EVALUATION AND SYSTEM SPECIFICATIONS
APPLICANT: '1_1 \A Eu:\ �V1), � AGENT: 9 \�\�� r \1 Cll U
�t t c + ^J
LOT: 1 („1 �O )-\ BLOCK: S CA SUBDIVISION: 5 ‘... , s s , A L\ (/\ c p ` 5 _ `L`
PROPERTY ID #: I „ 3 O ( . U ,- _ 15 ci U [Section /Township /Range /Parcel. No. or Tax ID Number]
TO BE COMPLETED BY ENGINEER, HEALTH UNIT EMPLOYEE, OR OTHER QUALIFIED PERSON. ENGINEER'S MUST
PROVIDE REGISTRATION NUMBER AND SIGN AND SEAL EACH PAGE OF SUBMITTAL. COMPLETE ALL ITEMS.
PROPERTY SIZE CONFORMS TO SITE PLAN: [/] YES [ ] NO NET USABLE AREA AVAILABLE: J„o
TOTAL ESTIMATED SEWAGE FLOW: ACRES
Q U G ALLONS PER DAY [RESIDENCES -TABLE 1 / OTHER -TABLE 2] )
AUTHORIZED SEWAGE FLOW: �,, U () GALLONS PER DAY [1500 GPD /ACRE OR 2500 GPD /ACRE]
UNOBSTRUCTED AREA AVAILABLE: I '4.C) v SQFT UNOBSTRUCTED AREA REQUIRED: 11. 0 U SQFT
BENCHMARK /REFERENCE POINT LOCATION: ?, ;).,' ( ('U W h O E A U1 E (JC,
ELEVATION OF PROPOSED SYSTEM SITE IS [INCHES /FT] [ABOVE/BELOW] BENCHMARK /REFEREI!LCE POINT
THE MINIMUM SETBACK WHICH CAN BE MAINTAINED FROM THE PROPOSED SYSTEM TO THE FOLLOWING FEATURES:
SURFACE WATER: \ \th//, FT DITCHES /SWALES: \'A 14. FT NORMALLY WET? [ ] YES NI NO
WELLS: PUBLIC: N IA FT LIMITED USE: kA I14 FT PRIVATE: 1 . k l yv FT NON - POTABLE: W / /4. FT
BUILDING FOUNDATIONS: Lj FT PROPERTY LINES: 1 0 FT POTABLE WATER LINES: 16(' FT
SITE SUBJECT TO FREQUENT FLOODING: [ ] YES [fit] NO
10 YEAR FLOOD ELEVATION FOR SITE: — FT MSL /NGVD SITE ELEVATION:M FT MSL /NGVD
SOIL PROFILE INFORMATION SITE 1 W-- LI. 0
Munsell # /Color Texture
r p y c 1 ni't(G,ty S G VI
c\ 1 ] L_4 G,cy 5Ltt
lo y f fl tj - Wh►+C. 'SLAkA
USDA SOIL SERIES:
Depth
1 to
71' to
to
to
Vi
to
to
to
OBSERVED WATER TABLE: {' Q INCHES [ABOVE / BELOW] EXISTING GRADE. TYPE: [PERCHED / APPARENT]
ESTIMATED WET SEASON WATER TABLE ELEVATION: (, ( INCHES [ ABOVE / BELOW ) EXISTING GRADE.
HIGH WATER TABLE VEGETATION: [ ) YES [-?( NO MOTTLING: ( ) YES [>1 NO DEPTH: COI G INCHES
SOIL TEXTURE /LOADING RATE FOR SYSTEM SIZING:0 W) /(-4,1 DEPTH OF EXCAVATION: ,lL( INCHES
DRAINFIELD CONFIGURATION: [ ] TRENCH [-}BED \ [ 'O-OTHER (SPECIFY)
REMARKS/ADDITIONAL/CRITERIA:
SITE EVALUATED BY: �q\q ti(A n
DH 4015, 10/96 (Replaces HRS -H Form 4015 [Page 31 which may be used)
(Stock Number: 5744- 003 - 4015 -1)
SOIL PROFILE INFORMATION SITE 2 LA) T LI. 0
Munsell /Color Texture Depth
I bIt -ZI / t Org.0/ Ssvi U (t to
hIi r-7(1 t y $ct1A 5y1; 1, to c,
tr,ir- 9L w11t x Sg a to7)
to
to
to
to
to
to
USDA SOIL SERIES:
t)Clnc.r L_Gbtid
10 YEAR FLOODING? [ ] YES [ ,4] NO
DATE: y l oE.5
Page 3 of 3
/INSTRUCTIONS:
PERMIT NUMBER: Permit tracking number by County Health Department.
APPLICANT: Property owner's full name.
AGENT: Property owner's legally authorized representative.
LOT, BLOCK, SUBDIVISION: Lot, block, and subdivision for lot.
PROPERTY ID NUMBER: 27 character number for property (property appraiser ID number or section /township /range /parcel number).
PROPERTY SIZE: Check if property at site conforms to submitted site plan. Record net usable area available - lot area exclusive of
all paved areas and prepared road beds within public rights -of -way or easements and exclusive of streams, lakes,
normally wet drainage ditches, marshes, or other such bodies of water.
SEWAGE FLOW:
UNOBSTRUCTED AREA:
BENCHMARK INFORMATION: Record the location of the benchmark. If using a surveyor's benchmark record the actual elevation. Record the
elevation of the proposed system site in relation (above or below) to the benchmark.
MINIMUM SETBACKS:
Record the estimated sewage flow for the establishment from Table 1 (residence) or Table 2 (non - residential),
Chapter 10D-6, FAC. Record the authorized sewage flow for the lot based on net usable area and water supply
(1500 gallons per day per acre for private water supplies and 2500 gpd per acre for public water supplies). If
authorized sewage flow does not equal or exceed the estimated sewage flow, the application must be denied.
Record the square feet of unobstructed area available and the amount required. Unobstructed area must be at
least 2 times as large as the drainfield absorption area and at least 75 percent of the unobstructed area must meet
minimum setbacks in Chapter 10D -6, FAC. The unobstructed area must be contiguous to the drainfield.
Record minimum setbacks which can be meet to all listed features. Actual measurements must be recorded or
"NA" for nonapplicable features. Features on site plan or within 75 feet of the applicant lot must be measured.
The location of any public drinking well within 200 feet of the applicant's lot must also be verified.
FLOOD INFORMATION: Record information on lot's subject to flooding. For lots subject to flooding record 10 year flood elevation for
site and actual site elevation.
SOIL PROFILE INFORMATION: Two soil profiles within the proposed absorption area to a minimum depth of 6 feet or refusal are required. Soil
identification will use USDA Soil Classification methodology (Munsell colors and USDA soil textures). Refusals
must be clearly documented. Provide USDA soil series if available, record "UNK" if the series cannot be
determined.
WATER TABLE: Record the depth of the observed water table at the time of the evaluation. Mark "perched" or "apparent" as
appropriate. Record the estimated wet season water table elevation based on site evaluation, USDA soil maps,
and historical information. Indicate if there is high water table vegetation present. Indicate if mottling is present
and depth.
SOIL. TEXTURE: Record soil texture or loading rate for system sizing.
DEPTH OF EXCAVATION: If applicable record depth of excavation required. Record "NA" if not applicable.
DRAINFIELD CONFIGURATION: Check drainfield configuration required. If other, specify type.
ADDITIONAL CRITERIA: Record any additional remarks pertinent to site or installation. Ex. dosing required.
SITE EVALUATED BY: Signature of evaluator, title, and date of evaluation. Professional engineers must seal all documents submitted.
ELEVATION WORKSHEET ELEVATION OF BENCHMARK / REFERENCE POINT IS:
BENCHMARK SITE 1 SITE 2 SITE 3
[ + ] SHOT H.I. H.I. H.I.
H.I. [ - ] SHOT [ - ] SHOT [ - 1 SHOT
STATE OF FLORIDA
DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM
,CONSTRUCTION PERMIT
CONSTRUCTION PERMIT FOR:
[ ]New System [ ]Existing System [ ]Holding Tank [ ] Innovative Other
[ X ]Repair [ ]Abandonment [ ]Temporary [ NA ]
APPLICANT: Kingsbury, Neal & Holli AGENT: SR0931123, Bryant Roland
PROPERTY STREET ADDRESS: 577 NE 96 St Miami Shores FL 33138
LOT: 19
BLOCK: 99 SUBDIVISION: Miami Shores
[Section /Township /Range /Parcel No.]
PROPERTY ID #: 11 - 3206 - 017 - 1590 [OR TAX ID NUMBER]
SYSTEM DESIGN AND SPECIFICATIONS
D [ 600 ]SQUARE FEET PRIMARY DRAINFIELD SYSTEM
R [ 0 ]SQUARE FEET SYSTEM
A TYPE SYSTEM: [ )STANDARD ( N ]FILLED
I CONFIGURATION: [ N ]TRENCH [ '' *] BED
N
F LOCATION TO BENCHMARK: Crown of Road EL: 8.2'
OTHER REMARKS:
SPECIFICATIONS BY:Millan, Jorg TITLE: C ^�
APPROVED BY: Milian, Jorge � TITLE: Engineer I
DATE ISSUED: 8/9/05
DH 4016, 03/97 (Obsoletes previous editions which may not be used)
(Stock Number: 5744- 001 - 4016 -0) (ostds_cons_4016 -1)
CENTRAX #: 13 - - 26080
DATE PAID:
FEE PAID : $
RECEIPT .
OSTDSNBR : 05 - 2649 - -
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.
T [ 1350 ]Gallons SEPTIC TANK
A [ 0 ]Gallons MULTI - CHAMBERED /IN SERIES: [Y ]
N [ 0 ]GALLONS GREASE INTERCEPTOR CAPACITY
K [ 0 ]GALLONS DOSING TANK CAPACITY [ 0 ]GALLONS @ [0 ]DOSES PER 24 HRS # PUMPS[ 0 ]
MULTI - CHAMBERED /IN SERIES: [Y ]
[ N ]MOUND [ N ]
[ N ]
I ELEVATION OF PROPOSED SYSTEM SITE [ 0.2 ] [ FEET ] [ ABOVE]BENCHMARK /REFERENCE POINT
E BOTTOM OF DRAINFIELD TO BE [ 2.3 ] [ FEET ] [ BELOW BENCHMARK /REFERENCE POINT
L
D FILL REQUIRED: [ 0.0 ]INCHES EXCAVATION REQUIRED: [ 30.0 ] INCHES
1 - Install 1350 gal. category -2 septic tank equipped with an approved filter.
2 -The licensed contractor installing the system is responsible for installing the minimum
category of tank in accordance with sec. 64E- 6.013(3)(f), FAC.
3 - Install 600 sf of drainfield.
4 - Perimeter of excavation area shall be at least 2 ft. wider and longer than the proposed
absortion bed.
5 - Invert elevation of drainfield to be no less than 6.4' NGVD.
6 - Bottom of drainfield elevation to be no less than 5.9' NGVD.
This permit is not for addition(s).
Dade CHD
EXPIRATION DATE: 11/7/05
Page 1 of 2
„cafe: Each block represents 5 feet and 1 inch = 50 feet.
, . ,3_
_..._, i Lot Size 4,699 Sir
•
t f 7
1 -1--
, I! a
otes:
4- • i.._t_..t...r
7 - t •
to Plan submitted by
an Approved
1015. 10 (Replaces HRS-H Forth 4015 which may be used)
*Number: 5744. 002 - 4015.6)
STATE OF FLORIDA
DEPARTMENT OF HEALTH
APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PE 15
Permit Application Number ` � � 17
t 1 . 1 - - ' -
f
1
+
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! t
4- l_—
} i
•
Roland Bryant
ALL CHANGES MUS
.�.. f—i t t- i i •+
PART II - SITE PLAN-
} ! .. ,
. -+ f - "" 4- P
,11 j 1I +- 1• - -,4 4
{ o J.t L_ r .. t
P opos 60 j
Dia'nfiel� L--., --. i.-_
1
.
,existing 60..0sq.
�iainfield
t
\J
S 4i gnature
Not Approved
1 tL> 6a
ater tine
Contractor
BE APPROVED BY THE COUNTY HEALTH DEPARTMENT
•
Y 1 t •
{ t 1 -f- : -
t - t f _i._ -- {- 1
t - t l j . i .
4 4 - t j } t - 4 I
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1 11 1• e - 1 11 e - 1
Title
Date $ t\U4 C 0S
County Health Department
' Panp 9 of '�
Miami Shores Village
10050 NE 2nd Avenue
Phone: 305 - 795 -2204
Printed: 8/16/2005
Applicant: NEIL
Owner: KINGSBURY
JOB ADDRESS: 577 NE 96
Parcel # 1132060171590
Plumbing Permit
Permit Number: PL2005 -252
KINGSBURY
NEIL
ST
Contractor LLOYD NORTH DADE SEPTIC TANK SERVIOEdNttactor's Address: 750 NW 107 ST
Local Phone: 305 - 754 -3375
Legal Description: MIAMI SHORES SEC 4 AMD PB 15 -14 LOTS 19 TO 21 INC BLK 99 LOT SIZE
Fees:
FEE2005 -11252
FEE2005 -11253
FEE2005 -11255
FEE2005 -11256
FEE2005 -11257
FEE2005 -11258
FEE2005 -11259
Description
Building Fee
Builders Bond
CCF
Notary Fee
Training and Education Fee
Technology Fee
Scanning Fee
Total Fees:
Amount
$175.00
$300.00
$1.20
$5.00
$0.40
$4.40
$3.00
$489.00
Total Fees: $489.00
Total Receipts: $0.00
Permit Status: APPROVED Permit Expiration: 2/7/2006 Construction Value: $2,100.00
Work: REPLACE DRAINFIELD
Signed:
(INSPECTOR)
Signed: (Contractor or Builder)
BY:
Page 1 of 1
5: ID
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.
Inspection Number: INSP-5392
Inspection Date: 01/09/2006
Inspector: Levrack, James
Owner: KINGSBURY, NEIL
Job Address: 577 96 Street NE
Project: <NONE>
Contractor:
Miami Shores Village, FL
Building Deaartment Comments
Friday, January 6, 2006
Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Block:
Permit Number: PL2005 -252
Permit Type: Plumbing - Residential
Inspection Type: Final
• Work Classification: Septic
Phone Number
Parcel Number 1132060171590
Lot:
Page 1 of 2
Passed
- i ec or Comments
i
Failed
Correction
Needed
Re- Inspection
Fee
($75)
No Additional Inspections can be scheduled
re- inspection fee is paid.
until
Inspection Number: INSP-5392
Inspection Date: 01/09/2006
Inspector: Levrack, James
Owner: KINGSBURY, NEIL
Job Address: 577 96 Street NE
Project: <NONE>
Contractor:
Miami Shores Village, FL
Building Deaartment Comments
Friday, January 6, 2006
Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Block:
Permit Number: PL2005 -252
Permit Type: Plumbing - Residential
Inspection Type: Final
• Work Classification: Septic
Phone Number
Parcel Number 1132060171590
Lot:
Page 1 of 2
Inspection Number: INSP -5392
Permit Number: PL2005 -252
Inspection Date: 01/09/2006
Inspector: Levrack, James
Owner: KINGSBURY, NEIL
Job Address: 577 96 Street NE
Project: <NONE>
Contractor:
Building Department Comments
Friday, January 6, 2006
Miami Shores Village, FL
Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Block:
Permit Type: Plumbing - Residential
Inspection Type: Final
Work Classification: Septic
Phone Number
Parcel Number 1132060171590
Lot:
Page 2 of 2
Passed
Insp
\ctor Comments
Failed
Correction
Needed
Re- Inspection
Fee
($75)
No Additional Inspections can be scheduled
re- inspection fee is paid.
until
Inspection Number: INSP -5392
Permit Number: PL2005 -252
Inspection Date: 01/09/2006
Inspector: Levrack, James
Owner: KINGSBURY, NEIL
Job Address: 577 96 Street NE
Project: <NONE>
Contractor:
Building Department Comments
Friday, January 6, 2006
Miami Shores Village, FL
Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Block:
Permit Type: Plumbing - Residential
Inspection Type: Final
Work Classification: Septic
Phone Number
Parcel Number 1132060171590
Lot:
Page 2 of 2
i nspection Number: INSP-5390
Inspection Date: 01/09/2006
Inspector: Levrack, James
Owner: KINGSBURY, NEIL
Job Address: 577 96 Street NE
Project: <NONE>
Contractor:
Friday, January 6, 2006
Miami Shores Village, FL
Building Department Comments
Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Block:
Permit Number: PL2005 -252
Permit Type: Plumbing - Residential
Inspection Type: Landscaping
Work Classification: Septic
Phone Number
Parcel Number 1132060171590
Lot:
Page 2 of 2
Passed
Inspector Comments
- A-
Failed
Correction
Needed
Re- Inspection
Fee
($75)
No Additional Inspections can be scheduled
re- inspection fee is paid.
until
i nspection Number: INSP-5390
Inspection Date: 01/09/2006
Inspector: Levrack, James
Owner: KINGSBURY, NEIL
Job Address: 577 96 Street NE
Project: <NONE>
Contractor:
Friday, January 6, 2006
Miami Shores Village, FL
Building Department Comments
Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Block:
Permit Number: PL2005 -252
Permit Type: Plumbing - Residential
Inspection Type: Landscaping
Work Classification: Septic
Phone Number
Parcel Number 1132060171590
Lot:
Page 2 of 2
Inspection Number: INSP -5390
Permit Number: PL2005 -252
Inspection Date: 01/09/2006
Inspector: Levrack, James
Owner: KINGSBURY, NEIL
Job Address: 577 96 Street NE
Project: <NONE>
Contractor:
Building Department Comments
Friday, January 6, 2006
Miami Shores Village, FL
Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Block:
Permit Type: Plumbing - Residential
Inspection Type: Landscaping
Work Classification: Septic
Phone Number
Parcel Number 1132060171590
Lot:
Page 1 of 2
Passed
Inspector
I '
Comments
h'
1
Failed
✓
Correction
Needed
Re- Inspection
Fee
($75)
No Additional Inspections can be scheduled
re- inspection fee is paid.
until
Inspection Number: INSP -5390
Permit Number: PL2005 -252
Inspection Date: 01/09/2006
Inspector: Levrack, James
Owner: KINGSBURY, NEIL
Job Address: 577 96 Street NE
Project: <NONE>
Contractor:
Building Department Comments
Friday, January 6, 2006
Miami Shores Village, FL
Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Block:
Permit Type: Plumbing - Residential
Inspection Type: Landscaping
Work Classification: Septic
Phone Number
Parcel Number 1132060171590
Lot:
Page 1 of 2
BUILDING At
ELECTRICAL
PLUMBIN
Owner of
Building
Architect
Contractor
or Builder
Legal
Description
Lot
ri PERMIT N? 5135
Work to be performed under this Permit ;`ta
`
'CONTRACTOR OR BUILDER
MIAMI SHORES VILLAGE, FLORIDA
DATE
Bl.
Address of _ ;, Value of Amt. o
Building u ' Project Permit ,
This permit is granted to the contractor o builder named above to construct the building or to install the equipment or 1 evice : escribed in the appli-
cation herefor in strict compliance with all ordinances pertaining thereto and with the understanding that the work will be performe 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 the plans arechanged 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 ordrawings or in the statements or specifications and that he assumes respon-
sibility for work done by his agents, servants or employees. /.,
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
p ertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities o Miami Shores Village.
In accepting this permit I assume responsibility for all work done by either myself, my agent, servant or employee.
y. n
Subdi-
vision
Signed. . By
BY
INSPECTOR
Contractor's
License No.
AUTHORITY
194-
,,
Permit No _ _.7 " .
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__ kg:______ ? ° P
New Building
Size Septic Tank _- -- -- --
Feet of Drain Tile
Nature of Water Supply: City
A,
Amount of Permit $
STATE OF FLORIDA, 1
j Bs'
COUNTY OF DADE.
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
Registered Architect and /or Engineer .....
___.___________
Employing Plumber's Name_a. aW- L1 4
Location and Legal Description Lot__ ___________ —
Street and Number where work is to be performed No
State work to be performed and purpose of building (By Floors)_
No.
Block_.
Remodeling_______.________ Addition..______._ Repairs No. of Stories.
Type of Tank
Dist. Feet of Tank or Drain Field from Well
Size of Soakage PP'
(Signed)_
Capacity Gals
Date
Street 7A/
Street___?6. 1N
Subdivision__
(Signed)._
My Commission Expires Notary Public, State of Florida
Street
Plumbing Inspector.
The undersigSued applicant for this building permit does hereby certify that he understands and accepts his 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.
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
TUBS
SHOWERS
LAVA
TORIES
SINKS
SLOP
SINKS
LAUNDRY
TUBS
URINALS
CATCH
BASIN
FLOOR
DRAIN
DRINKING
FOUNT' NS
TOTAL
FIXTURES
CONTR.
LIST
CHECK
SEPTIC
TANK
SEWER
CONN.
DRAIN
FIELD
SOAKAGE
PIT
GREASE
TRAP
SOLAR
HEATER
DEEP
WELL
SPRKLR.
SYSTEM
SW IM'G
POOL
CONTR.
L. 1ST
CHECK
Permit No _ _.7 " .
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__ kg:______ ? ° P
New Building
Size Septic Tank _- -- -- --
Feet of Drain Tile
Nature of Water Supply: City
A,
Amount of Permit $
STATE OF FLORIDA, 1
j Bs'
COUNTY OF DADE.
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
Registered Architect and /or Engineer .....
___.___________
Employing Plumber's Name_a. aW- L1 4
Location and Legal Description Lot__ ___________ —
Street and Number where work is to be performed No
State work to be performed and purpose of building (By Floors)_
No.
Block_.
Remodeling_______.________ Addition..______._ Repairs No. of Stories.
Type of Tank
Dist. Feet of Tank or Drain Field from Well
Size of Soakage PP'
(Signed)_
Capacity Gals
Date
Street 7A/
Street___?6. 1N
Subdivision__
(Signed)._
My Commission Expires Notary Public, State of Florida
Street
Plumbing Inspector.
The undersigSued applicant for this building permit does hereby certify that he understands and accepts his 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.
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
ELECTRICAL
PLUMBING
Architect
Contractor
or Builder
Legal
Description
Lot
CONTRACTOR OR BUILDER
MIAMI SHORES VILLAGE, FLORIDA
PERMIT N? 5135
Work to be performed under this Permit • '; <'s.
Owner of
Building
Bl.
Subdi-
vision
Address of jx' Value of Amt. of
Building _ i , ' Project Permit
This permit is granted to the contractor or builder named above to construct the building or to install the equipment or vice
cation herefor in strict compliance with all ordinances pertaining thereto and w th the understanding that the work will be performed j( 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 the 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 res onsibility for a thorough knowledge of the ordinances and
regulations pertaining to the work covered hereby whether shown on the plans or drawings or in the stifenittitrsr recifications and that he assumes respon-
sibility 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 relations
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 responsibility for all work done by either myself, my agent, servant or employee.
DATE . y °" . —, 194_7
Contractor's
License No.
BY AUTHORITY
e
scribern the appli-