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960 NE 97 St (11)APPLICANT: AGENT: PROPERTY ADDRESS: LOT: BLOCK: TANK [01] [02] [03] [04] [05] [06] [07] [08] [09] [10] [11] [12] [13] [14] [15] [16] [ [18] [19] [20] [21] CONSTRUCTIO [AFB STATE OF FLORIDA DEPARTMENT OF HEALTH ONSITE SEWAGE TREATMENT AND DIPOSAL SYSTEM CONSTRUCTION INSPECTION AND FINAL APPROVAL LEGEND g e-Q.J;.e / ! WATERTIGHT LEVEL DEPTH TO LID if x === = ===m1m== asp en = ==mumma= CHECKED [X] ITEMS ARE NOT DR COMPLIANCE = = ==== INSTALLATION TANK SIZE [1] tOU [2] TANK,MATERIAL".-¢ OUTLET DEVICE ,p c MULTI- CBARBERED [ / � ] OUTLET FILTER 404. SUBDIVISION: irI 1 a o S J +'f r d C PROPERTY ID #s / 3.%1.1 (1 ()PI 3/' a6k 7 55 DRAINFIELD INSTALLATION , AREA [11/6 x 4 . 5 1 [21 SQFT DISTRIBUTION BOX _ HEADER NUMBER OF DRAINLINES 4 DRAINLINE SEPARATION 30 DRAINLINE SLOPE DEPTH OF COVER ELEVATION [ABOVE /BELOW] BM SYSTEM LOCATIOx w' DOSING PUMPS . , V f AGGREGATE SIZE y 0,0.; AGGREGATE EXCESSIVE FINES AGGREGATE DEPTH FILL / EXCAVATION MATERIAL [22] FILL AMOUNT 11 [23] FILL TEXTURE [24] EXCAVATION DEPTH [25] AREA REPLACED [26] REPLACEMENT MATERIAL ZPLANATION OF VIOLATIONS / REMARKS: ] WITH 3a (1 _. r ISAPPROVED]: DE 4016, 10/97 (Previous Editions May Be Used) STATUTE OR RULE AND MUST BE ?LS + FINAL SYSTEM [APPROVED ISAPPROVED]$ p- SETBACKS SURFACE WATER DITCHES PRIVATE WELLS [Z [ [29] [30] [31] [ [33] [34] [35] FILLED / MOUND SYSTEM [36] DRAINFIELD COVER [37] SHOULDERS [38] SLOPES [39] STABILIZATION ADDITIONAL INFORMATION [40] [41] [42] [43] [44] [45] [46] [ [48] PERMIT x0. DATE PAID: FEE PAID: RECEIPT 1: CORRECTED. Li .„7 - 41 17 PUBLIC WELLS FT IRRIGATION WELLS FT POTABLE WATER LINES FT BUILDING FOUNDATION .1 FT PROPERTY LINES S FT OTHER FT UNOBSTRUCTED AREA STORMWATER RUNOFF ALARMS MAINTENANCE AGREEMENT BUILDING AREA LOCATION CONFORMS WITH SITE PLAN FINAL SITE ING r r ' CONTRACTOR o `-T % , _ t OTHER ABANDONMENT ] [49] TANK PUMPED _ / / ] [50) TANK CRUSHED & FILLED _ / 'WPC- CND DATE f {, CHD DATE:;;.- •'/r : PT 1: Applicant PT 2: Installer /Contractor PT 3: Buildng Department PT 4: Health Department FT FT FT Page 2 of 3 PERMIT NUMBER: Permit tracking number assigned by CHD. APPLICANT: Property owners full name. AGENT: Property owners legally authorized representative. MAILING ADDRESS: P.O. box or street mailing address for applicant or agent. LOT, BLOCK, SUBDIVISION Lot, Block and Subdivision for lot or PROPERTY ID#: 27 character number for property. (property appraiser ID* or GIS location) COUNTY HEALTH DEPARTMENT CHECKS [X] ITEMS NOT IN COMPLIANCE WITH CONSTRUCTION PERMIT AND STATUTE OR RULE. INFORMATION IS COMPLETED BY CHD ON FOLLOWING ITEMS: TANK SIZE (gallons) TANK MATERIAL (concrete, fiberglass, etc) OUTLET FILTER (manufacturer, make, model) LEGEND (manufacturer code) DRAINFIELD AREA (square feet) DISTRIBUTION BOX / HEADER (check box) NUMBER OF DRAINLINES (number installed) SYSTEM ELEVATION (in relation to BM) DOSING PUMPS (number installed) SETBACKS (record actual setbacks in ft) SETBACKS OTHER (as required) STABILIZATION (date stabilized) CONTRACTOR (contractor installing system) ADDITIONAL INFORMATION (as required) ABANDONMENT TANK PUMPED (date) TANK CRUSHED AND FILLED (date) EXPLANATION OF VIOLATIONS: Record item number, explanation of violation, and required CONSTRUCTION APPROVAL: Circle approved or disapproved, CHD signature and date. AS BUILT INSTALLATION SKETCH FINAL APPROVAL: Circle approved or disapproved. CHD signature and date of approval. Final approval shall not be granted unit the CHD has confirmed that building construction and lot grading are in substantial compliance with plans and specifications submitted with the permit application. ELEVATION WORKSHEET ELEVATION OF BENCHMARK OR REFERENCE POINT: EXISTING GROUND TOP OF AGGREGATE [ +] SHOT H.I. H.I. H.I. H.I. [ -] SHOT 1-1 SHOT [ -] SHOT ELEVATION 0 e / 9 n G o m . Ss fr Type Insp'n Permit No. Name MIAMI SHORES VILLAGE BUILDING DEPARTMENT 305- 795 -2204 Building Inspection Reques Date (1_,Qek / For Inspector) ( 4. / 0 5 ?N. & Date Approved Lam' Correction ❑ Re- Insp'n Fee ❑ Address () Y\ ' fff Company Phone # s'S ? _s ? 8 MIAMI SHORES VILLAGE BUILDING DEPARTMENT 305- 795 -2204 Building Inspection Request Dat 1 Ni ) D \ Time Name Address Company Phone # For Inspector: 2/13 Approved Correction Re- Insp'n Fee o o ADDRESS 960 N. E.. 97th street LEGAL3 & 4 77 Nos #3 RECORD GARBAGE TAX rr��8 [ PAID BY 5 -9 -51 C arro ll YEA ANNUAL TAX PERIOD USED AMOUNT PAID DATE PAID RECEIPT NUMBER \ 11478 Pr OWNER'S NAME J . S, CARROLL PRESENT ADDRESS 971 N. E.. 103 Street, LICENSE NO. PHONE NO. JOB LOCATION (ST. OR AVE.) 960 N. E. 97th Street LOT #3 & #4 BLOCK ?7 SUBDIVISION Miami Shores Section #3 GENERAL CONTRACTOR T S, Carroll ADDRESS PHONE NO. LICENSE NO. BUILDING PERMIT NO. 11438 C DATE 5-9 51 PERMIT FEE S 20 BUILDER'S B C ?ansfferr NO. 9 DATE 5 -10-51 ZONE REQUIREMENTS 20,000 CU. FT. PLAN CUBE 222 CU. FT. EST. COST S 21I 15 DRAWINGS. SPECIFICATIONS. RESTRICTIONS AND CUBE CHECKED BY: P. G. DATE 5 -9-51 XI TYPE M NEW CONSTRUCTION CBS STORIES ROOF CONSTRUCTION T Tile INTERIOR CONSTRUCTION Oak Floors.,Plas« walls & cell, REPAIRS DESCR IPTION :Ili ' • • . .-• •vu• •1 • . - ALTERATION _ DESCRIPTION ADDITION SUBMITTED TO PLANNING BOARD APPROVED REJECTED REFERRED TO COUNCIL REASONS RE- SUBMITTED TO PLANNING BOARD SUBMITTED TO VILLAGE COUNCIL REMARKS CERTIFICATE OF OCCUPANCY NO. / �' " = ISSUED/ V' // '1' BY . - 1- -) I TO _. BUILDING PERMIT AND INSPECTION RECORD -MIAMI SHORES VILLAGE ed INSPECTf6NS ' DATE BY RE- INSPECT BY RE- INSPECT BY FOUNDATION (r-g" 5/ P q $ $ SEPTIC TANK ° ° ° ° ° °______ ______ '''"'������ "```` BEAMS & LINTELS - / ,f'�` / f .. z ak. s1 SEWER IIIIII ! $ SOLAR HEATER FRAMING $ 6'/„3'�r / 0♦ � l�. $ $ $ INSPECTIONS DATE RE- INSPECT RE- INSPECT BY FINAL BY ROUGHING 6 - */'s/ //// V CLEAN -UP GAS � Y'f` ,•� H. W. HEATER CONN CONTRACTOR ,7". ig .107.47, L�fiN' PHONE PERMIT NO. / /�O r DATE 6-/- / V r FEE $ NEW BLDG. I ALTERATION ADDITION REPAIRS SPECIAL PERMITS PERMIT NO. DATE FEE TEMPORARY SERVICE $ $ SEPTIC TANK ° ° ° ° ° °______ ______ '''"'������ "```` / /�/ 3 - / ,f'�` / $ /-"--- SEWER IIIIII ! $ SOLAR HEATER $ $ GAS $ $ $ INSPECTIONS DATE RE- INSPECT RE- INSPECT BY RE- INSPECT BY ROUGHING 6 - */'s/ //// V ROUGHING GAS � Y'f` H. W. HEATER CONN SEWER RANGE CONN. SEPTIC TANK 1 { j A t3 $' 1' c SOLAR HEATER FIXTURES & FINAL FIXTURES - f ' CONTRACTOR J PHONE ' a ' PERMIT NO. //. X27 I DATE G y FEE S / /,3 NEW BLDG. 1 ALTERATION I ADDITION REPAIRS SPECIAL PERMITS PERMIT NO. DATE FEE TEMPORARY SERVICE $ H. W. HEATER CONN. $ RANGE CONN. $ MOTORS $ FIXTURES $ INSPECTIONS DATE BY RE- INSPECT BY RE- INSPECT BY TEMP. SERVICE ROUGHING J - 6/3 � Y'f` H. W. HEATER CONN RANGE CONN. FIXTURES & FINAL 9. ! - - .._ (P U LLDINGINSPECTIONS PLUMBIN�a PERMITS & INSPECTIONS "ELECTRICAL PERMITS & INSPECTIONS APPROVAL TO POWER CO. FOR SERVICE DATE 9- - _ J PERMIT APPLICATION FOR MIAMI SHORES VILLAGE Square Ft. Estimated Cost (value) $ / 0© Date 7 zoev Job Address 9v) N 9 7 St. Tax Folio Legal \ Description Historically Designated: Yes No GC1ekessee / Tenant 51b R S E - Master Permit # 1 3 W Owner's Address 9&10 /UE q7 Sr- Phone 3a 5 75 - 4- 3a 3 Contracting Co. /E le Address Qualifier SS# Phone State # Municipal # Competency # Ins. Co. Architect/Engineer Address Bonding Company Address Mortgagor Address Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN WORK DESCRIPTION Pn O t 0 e 14. - rc n c r e t e WARNING TO OWNER: YOU MUST RECORD A NOTICE OF COMMENCEMENT AND YOUR FAILURE TO DO SO 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.) Application is hereby made to obtain a permit to do work and installation as indicated above, and on the attached addendum (if applicable). I certify that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that separate permits are required for ELECTRICAL PLUMBING, SIGNS, POOLS, ROOFING and MECHANICAL WORK. 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. Furthermore, I authorize the above -named contractor to do the work stated. Sign and/or Condo President Notary as to Owner and/or Condo President Date My Commission Expires: 7.6' 2.009 Date otary as My Commi 4 FEES: PERMIT 5 0 RADON C.C.F. NOTARY Signature of Contr or or Owner - Builder Date �pp 0f1-1C O EAL St1XS: 9 MARGARITA MONTIEL z S "' 1.1S: � CO & S90N NUMBER �fJ CC797277 'Y )1 � ..'i c- oMrfIZSION EXPIRES f ` c OF F� � `. 17,2002 7. 4, • Z000 BOND 3O2 Date APPROVED: TOTAL DUE 7 /7/ Zoning Building / ( 0 Electrical /6Z 71/43* Mechanical Plumbing Structural Engineer /2) Comments: Sr 4' hereby apply for a certificate to re- occupy the single family residence known as: (address) 9•6" /<-(-- 77 .S774= t" , Miami Shores, Florida_ Legal description: Lot: 3 ¢ f' ,Block: 7 7 ,PB&PG: I hereby certify that I understand that the zoning of the property is for single -family residential use and that it is unlawful for more than one family to reside therein. I also understand that any Certificate of Re- Occupancy that may be issued by Nliami Shores Village, Florida, certifies only that the referenced property is being used for single- family purposes and that such Certificate does not constitute any representation, warranty or certification as to the condition of the dwelling or other strucrures on such property. Applicant: APPLICATION FOR CER'I1FICATE OF RE- OCCUPANCY /(02--J-e_ Print Name: Sr /= S F Date: �O 2`7 -e7 `757 I303 Contact Name: 3 �1 /a' /_ ESE Telephone: — ' . Buyer �/ Seller. Realtor. Company Name: — Y Application Fee (SS0) Paid: Cash: /Check Number: For the purposes of conducting the inspection required by Section 902 of the yfiami Shores Development and Zoning Code, contact: Inspection: By:/ji Approved: rDenied:_Date: pW . CERTIFICATE OF RE- OCCUPANCY On behalf of Miiami Shores Village, Florida, the undersigned certifies that the property described in the application has been inspected for the purposes of re- occupancy pursuant to Sections 901 and 902 of the Mani Shores Land Development and Zoning Code and that such property may be re- occupied by the applicant for single - family residential purposes. MIAMI SHORES VILLAGE, FLORIDA By Daze of Certification :a' THIS CER1 Li ■ICATE VERIFIES THAT THE REFERENCED PROPERTY HAS BEEN INSPECTED BY MIAMI SHORES VILLAGE AND HAS BEEN DETERMINED TO PRESENTLY COMPLY WITH THE SCHEDULE OF REGULATIONS OF rHE MIAMI SHORES LAND AND DEVELOPMENT CODE PERT_UNNG SOLELY TO IHE REQUIREMENT THAT EACH ONE- FAMILY DWELLING IS USED AND INTENDED TO BE USED FOR A ONE-FAMILY DWELLING PURPOSE ONLY; HOWEVER, THIS CER'Tih KATE DOES NOT CONSTITUTE ANY REPRESENTATION OR WARRANTY AS TO THE CONDITION OF THE DWELLING OR OTHER STRUCTURES ON THE PREMISES DESCRIBED HERELN, OR ANY ASPECT OF SUCH CONDITION, AND INTERESTED PARTIES ARE ADVISED AND ENCOURAGED TO MAKE THEIR OWN INSPECTION OF THE PREMISES IN ORDER TO DETERMINE THE CONDITION THEREOF.