1167 NE 99 St (12)BUILDING
PERMIT APPLICATION
FBC 2001
Permit Type (circle): Building Electrical
t1G 1 NF 9q Week
City kgAo eS State FL,,
Owner's Address
Tenant/Lessee Name
$ Value of Work For this Permit
Type of Work: ❑Addition
Describe Work: r
Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
Owner's Name (Fee Simple Titleholder) 0oe1 ?exeZ Phone # C30 - 5) '758 — Nip}
Job Address (where the work is being done) ` I �p� NIP &tr'ee r
City Miami Shores Village County . Mi 1 -L ►de Zip 3313
Is Building Historically Designated YES NO
,, ��� 6
{�e
Contractor's Company Name & u 1 rte, 1 1 � Ci CClnll[�. Oe # Co) 6 61 66 33 .
Contractor's Address 3S9 o S • St 1
City i•MrQr r a r State ,-(-- Zip 3023
Qualifier 7RJ( e&II &■Ot mOx.
State Certificate or Registration No. 5002101 I Certificate of Compecy No.
Architect/Engineer's Name (if applicable) -�� Phone
4 !Dos° 23-
❑Alteration
1 • , -� . - no op . de
* * * * * * * * * * * * * * * * * * * * * * * * * * ** F ees * * *x * * * * * * * * * * * * * * * * * * * * ** * * **
Submittal Fee $ Permit Fee $ 1 - 75. �..�J CCF $ I • 60 CO /CC
Notary `�� Training/Education Fee $ • (00 Technology Pee $ 4-57
Scanning $ 3.00 Radon $ Zoning Bond $ CO
Code Enforcement $ Stru ctural Plan Review. $
Total Fee Now Due $ _4 I
(Continued on opposite side)
❑New
Zip 331 38'
Phone 0
Square Footage Of Work: 42-9
Master Pernik No.
Permit No. Pion -
Mechanical Roofing
Repaiepiace
i. 1
❑ °WWI
, r!�6?pr} $489,7
4_ .J'.. t 5 �l:
•
Bonding Company's Name (if applicable)
Bonding Company's Address A
City State Zip
Mortgage Lender's Name (if applicable)
iu
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 nzust
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 size
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
Own or Agent
The foregoing instrument as acknowledged ore me this 20
day of tic r , 2005, by =Toe 1 Perez
who is personally known to me or who has produced FLA
D L k:engre As identification and who did take an oath.
Signature
day of
who is
NOTARY PUBLIC: NOTARY PUBL Ii
Sign: Sign:
Print: ` aA TERESA J. SOLOMON Print:
My Commission Expires: �` �ii re EXPIRES: September 16.2001 My Com
1- 800- 3•NOTARY FL Notary Discount Assoo. Co.
* * * * * * * * * * * * * * * * * * * * **
***** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
APPLICATION APPROVED BY:
Chc 05/13/03
Sotcale\--
The foregoing instrument was acknowledged before me thi 200_5 2" by IJ' ` L t L O kQ C�
rsonally kno . n to me or who has produced
ii
Contractor
ission E
entification ami wh9 did tak a
'ov,i `:or 23M4
2A7
„ K r' .i
* * * * * * * * * * * * * * * * * * * * * * * * * * * ** * * * * * * * * * * * * * * * * * * * * **
************************* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
7 5 Plans Examiner
Engineer
Zoning
D
A
I
F
I
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.L
D
01/21/2005
CONSTRUC' fl:L
I )New ,3
[ ' ] Re❑ai.
APPLICADr:'.
SYSTEM MUST
DEPARTMENT
PERIOD. NC
REWIRE I:II:3
PERMIT BEEN{
COMPLIAN:.'Ii;
SYSTEM 171:1(
T `(' 90(r
A .j; 0
N [
K
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)
]
42S I
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TYPE : W.
CONF If I IE;,)
LOCAT:: r :::Di
ELEVAT, I:DF
BOTTOM 01
FILL I'.li:l!t RED.:
OTHER REM1!.RK
[CP] Exic ti
vertical de
prior to th
elevation •
be no less
SPECIFICA'.' I :UF
3055133472
16:20 3055133472 OSTDS
I' ATE OF FLORIDA
PARTMENT OF HEALTH
OA SITE SEWAGE TREATMENT AND DISPOSAL SYSTEM
C: ASTIZUCTIODT PERMXT
T FOR:
t,trr
r ]Existing System
[ ]Abandonment
Irr Ds Joel AGENT: SA0021074, Solomon Teresa
PROPERTY S7 air :'- DRESS: 1167 NE 99 St Miami PL 33138
LOT: 19 1.78 SUBDIVISION: Miami Shores
[Section Towzlship/Range /Parcel No_)
PROPERTY ID I:: ,1 „3205 -018 -0080 [OR TAX ID NUMBER]
:E: C'.i:) 13TRUCTED IN ACCORDANCE WITH SPECIFICATIONS AND STANDARDS OF CHAPTER 64E -6,FAC
:F03Y;r.., OF SYSTEM DOES NOT GUARANTEE SATISFACTORY PERFORMANCE FOR ANY SPECIFIC TIME
C;iLklqIE IN MATERIAL FACTS WHICH SERVED AS A BASIS FOR ISSUANCE OF THIS PERMIT,
IPl':L:I ANT TO MODIFY THE PERMIT APPLICATION. SUCH MODIFICATIONS MAY RESULT IN THIS
NUDE: DULL AND VOID. ISSUANCE OF THIS PERMIT DOES NOT EXEMPT THE APPLICANT FROM
TT: ;:(.'(ER FEDERAL, STATE OR LOCAL PERMITTING REQUIRED FOR PROPERTY DEVELOPMENT.
SPECIFICATIONS
I SEPTIC TANK MULTI - CHAMBERED /IN SERIES: [ Y ]
3 ' 1 1 `' r3 ' r
MULTI SERIES: [ Y ]
,A:t L0 l i GREASE INTERCEPTOR CAPACITY
.aa,LO(I I DOSING TANK CAPACITY [ 0 ] GALLONS @ [ 0 ]DOSES PER 24 HRS # PUMPS[ 0 )
q,ii :d:;.[ FEET PRIMARY DRAINFIELD SYSTEM
TJ 1W FEET
K: [ N ]STANDARD
t':::'r7: ( N )TRENCH
�) i3E1 I:ITMARK:
1Y)) );'f { HPOSED SYSTEM SITE
I)fl i "s::[ h YIELD TO BE
[
[
]Holding Tank [ ] Innovative Other
]Temporary ( MO ] Modified
SYSTEM
[ N )FILLED
[ N J BED
[ N ]MOUND [ N )
( N )
0.0 ] [ FEET ] [ BELOW)BENCHMARK /REFERENCE POINT
0.0 ] [ FEET ) [ ]BENCHMARK /REFERENCE POINT
0.0 ]INCHES EXCAVATION REQUIRED: [ 0.0 ] INCHES
i'Cf) gal. septic tank to be inspected for an appropriate pump-out and a solid
le,:t,a;, installed on the outlet device. The pump-out receipt shall be provided
g1a.ra; ing of the final approval. Instal]. 429 sq. ft. drainfield, Invert
dl :;ai.ifield to be no lees than 5.50' NGVD. Bottom of drainfield elevation to
:air. ;:I . DO' NGVD.
:Y: I AM, Arrieta, Roland TITLE:
DH 4016, 03/97 ( p ::;,n_ : previoU6 editions which may not be used)
(Stock Number. '44 -CC 4016 -0) roabdo_cona_4ot6-ij
CENTRAX #: 13 -SG -23322
DATE PAID:
FEE PAID : $
RECEIPT .
OSTDSNBR : 04 -4272- -M
APPROVED 117: ant : _, TITLE: EH Specialist I Dade CHD
DATE ISSUED: L 21 , 14
EXPIRATION DATE:
PAGE 01
Paqe 1 of 2
Miami Shores Village
10050 NE 2nd Avenue
Phone: 305 - 795 -2204
Printed: 1 /25/2005
Applicant: JOEL
Owner: PEREZ
JOB ADDRESS: 1167 NE 99
Contractor STATEWIDE SEPTIC CONNECTIONS
Local Phone: 305 - 661 -6633
Parcel # 1132050180080
Plumbing Permit
Permit Number: PL2005 -31
PEREZ
JOEL
ST
Contractor's Address: 3590 SOUTH STATE ROAD 7, SUITE 26
Legal Description: REV PL MIAMI SHORES SEC 8
Permit Status: APPROVED Permit Expiration: 7/20/2005 Construction Value: $2,350.00
Work: INSTALL NEW 429 SQFT DRAINFIELD
Page 1 of 1
PB 43-69 LOT 19
Fees:
FEE2005 -1087
FEE2005 -1088
FEE2005 -1089
FEE2005 -1090
FEE2005 -1091
FEE2005 -1092
FEE2005 -1093
Description
Building Fee
CCF
Notary Fee
Training and Education Fee
Technology Fee
Scanning Fee
Builders Bond
Total Fees:
Amount
$175.00
$1.80
$5.00
$0.60
$4.37
$3.00
$300.00
$489.77
Total Fees: $489.77
Total Receipts: $489.77
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:
BLK 178 LOT
Permit No 0(
Registered Architect and /or Engineer
Employing Plumber's Name%- L/1111.1._ e ett
Location and Legal Description Lot.
Street and Number where work is to be performed —No
STATE OF FLORIDA, } ss.
COUNTY OF DADE.
Amount of Permit $
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
uc .- a!
State work to be performed and purpose of building (By Floors )-- _- _--- •.---------- a L-R ___ - -- -
New Building Remodeling— —..__ Addition--- _ - -.-- Repairs
Size Septic Tank_.— _._--____--___. _ -----Type of Tank__
Feet of Drain Tile._.— Y.— -- _Dist. Feet of Tank or Drain Field from Well.
Nature of Water Supply: City — Well.— _.— __-- .. -. - - -- ---- -- ...Size of Soakage Pit
(Signed)-
Capacity Gals
7 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 ____/ LTC k1 E LL.
No.__.. //6 7 Street. ._1_ ` ?L
f
Block Subdivision
wc Lpc ^ : ....___.
No. of Stories
Plumbing Inspector.
The u ► undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations as an employer of labor
anent Supplement, and has com-
under the Florida Workmen's Compensation Act, being Section 5988, Compiled General Laws of Florida
plied with the provisions thereof, and will require similar compliance from all contractor or sub -contr or mployed by him in the work to be
performed under this permit; and will post or cause to be posted' for inspection on . e sit - of the ork ch public notke or notices as are
required by the Act. The undersigned agrees to employ only such sub- contract rb on work o • . fo 1 ; d this permit, as are
licensed by Miami Shores Village.
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowl • gments, 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 be has carefully read the foregoing application, and that he did sign the same, and that all facts
therein by him stated are true.
My Comnusslon Expo Notary Public, State of Florida
NOTE: A re- inspection fee of $1.00 will be made when suck re - inspection is made. necessary by improper notke for inspection, or faulty
materials and /or workmanship.
LAVA-
Tom"
SINKS
SLOP
SINKS
LAUNDRY
Tu••
URINALS
CATCH
BASIN
FLOOR
DRAIN
DRINKING
FOUNT•NS
TOTAL
FIXTURE[
CLOSETS
BATH
TUB[
SHOWERS
CONTR.
LIST
CHICK
SEPTIC
TANK
SEWER
CONN.
DRAIN
FIELD
SOAKAGE
PIT
G
TRAP
SOLAR
H
Dip
WELL
SPRKLR.
S
SWIM'O
POOL
CONrw.
LIST
CHECK
Permit No 0(
Registered Architect and /or Engineer
Employing Plumber's Name%- L/1111.1._ e ett
Location and Legal Description Lot.
Street and Number where work is to be performed —No
STATE OF FLORIDA, } ss.
COUNTY OF DADE.
Amount of Permit $
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
uc .- a!
State work to be performed and purpose of building (By Floors )-- _- _--- •.---------- a L-R ___ - -- -
New Building Remodeling— —..__ Addition--- _ - -.-- Repairs
Size Septic Tank_.— _._--____--___. _ -----Type of Tank__
Feet of Drain Tile._.— Y.— -- _Dist. Feet of Tank or Drain Field from Well.
Nature of Water Supply: City — Well.— _.— __-- .. -. - - -- ---- -- ...Size of Soakage Pit
(Signed)-
Capacity Gals
7 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 ____/ LTC k1 E LL.
No.__.. //6 7 Street. ._1_ ` ?L
f
Block Subdivision
wc Lpc ^ : ....___.
No. of Stories
Plumbing Inspector.
The u ► undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations as an employer of labor
anent Supplement, and has com-
under the Florida Workmen's Compensation Act, being Section 5988, Compiled General Laws of Florida
plied with the provisions thereof, and will require similar compliance from all contractor or sub -contr or mployed by him in the work to be
performed under this permit; and will post or cause to be posted' for inspection on . e sit - of the ork ch public notke or notices as are
required by the Act. The undersigned agrees to employ only such sub- contract rb on work o • . fo 1 ; d this permit, as are
licensed by Miami Shores Village.
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowl • gments, 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 be has carefully read the foregoing application, and that he did sign the same, and that all facts
therein by him stated are true.
My Comnusslon Expo Notary Public, State of Florida
NOTE: A re- inspection fee of $1.00 will be made when suck re - inspection is made. necessary by improper notke for inspection, or faulty
materials and /or workmanship.
OwBofs Name :.e x 'A
Registered tlrchhteot an
Employg Pk+mb
Lotatie•and L -_: Des ,t on
Street aid Nz3..'.as a • ,1
. State work to bepea' rm
New lila
Size Septic T ai3 Ta
Feet of Drain Th.—
Nate
The lmz j'; y aa(:d
raider the Florida IVO
pried wide the pr
performed under
required, 117 dm A
licensed tor Miami Store
Defoe me, the
33412 "'..,.