1248 NE 98 StMiami Shores Village
10050 NE 2nd Avenue
rzy
PAY
TO THE
RD R OF
FOR
Phone: 305 - 795 -2204
Printed: 3/12/2002
Applicant: JOHN
Owner:
Contractor MR C'S SEPTIC TANK
Local Phone: 305 - 651 -7859
Parcel # 1132050090330
Job Address: 1248 NE 98 ST
M Fees:
FEE2002 -1474
FEE2002 -1475
.\-- FEE2002 -1476
FEE2002 -1477
r n
41, 17 1 ---
Work: TO REPLACE DRAINFIELD _ ,. --
If there is no permit r+�• -.-- - "� `. 513
?Mt.
11 ` n tIlII 111
L � ,
11h�1t�111 t\u, l�
Ir I ). ItI 1A nll L 1tJaYUy U•r1y
MIAMI,
la MA
Washington Mutual
Washington Mutual Bank. FA t Boo ,a8 7000
Mwmd199th Street Financial Center 71 49uur 7mnl•, Semcc
Mram WFL 33169
Cellular:
Legal Description: EARLETON SHORES PB 43 - 80 LOT 6 BLK 3 LOT SIZE 75.000 X 109 OR 18779 - 3323
Description Amount
Buildier's Bond $300.00
CCF $1.20
Notary Fee $5.00
Building Permit Application Fe$60.00
Total Fees: $366.20
Permit Status: Approved Pormit Expiration: 9/8/2002
61-
tour
is 267084 L3 L�:383hh10 3084 208100
u 005 13 70 - ,.� _u
Plumbing Permit
Permit Number: PL2002 -73
PERIKLES
Address: P 0 BOX 693239
Construction Value: $2,000.00
$ 1 - 1 .54 , ,
DOLLARS
Total Fees: $366.20
Total Receipts: $0.00
Page 1 of 1
Re- inspection
dl, •,11,, • 1 ••.,..1 -„ 1. -.1,b 1 - ,,,,,,,IP,r,r -. ,oil, .,11
'111' 01rr11''. 111M Ihrty 11'1'rr' IX r'11 - edrilltllf r11r,
ma 1,1 If Ilro Opole pro r 11pn1Jor1 Willi n l
$A..:. L•' ty r t. 4 4 '.` . ..y ''t•,...C t. "T.0
that he assumes responslbthty for ,r.c'x ticre
is pertaining thereto and in strict conformity
sponisibility for all work done by either
4
STATE OF FLORIDA
DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM
CONSTRUCTION PERMIT
REIN
CONSTRUCTION PERMIT FOR:
[ ]New System [ ]Existing System [ ]Holding Tank [ ] Innovative Other
[ X ]Repair [ ]Abandonment [ ]Temporary [ NA ]
APPLICANT: Perikles, John & Marie
PROPERTY STREET ADDRESS: 1248 NE 98 St Miami FL 33138
LOT: 4 BLOCK: 3
PROPERTY ID #: 11- 3205 - 009 -0330
SYSTEM DESIGN AND SPECIFICATIONS
SUBDIVISION: Earleton Shores
[Section /Township /Range /Parcel No.]
[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.
T [ 900 ]Gallons SEPTIC TANK
A [ 0 ]Gallons
N ( 0 ]GALLONS GREASE INTERCEPTOR CAPACITY
K [ 0 ]GALLONS DOSING TANK CAPACITY [ 0 ]GALLONS @ [0
D [ 300 ]SQUARE FEET PRIMARY DRAINFIELD SYSTEM
R [ 0 ]SQUARE FEET SYSTEM
A TYPE SYSTEM: [ N ]STANDARD [ N ]FILLED
I CONFIGURATION: ( N ]TRENCH [ N ]BED
N
F
I
E
L
D FILL REQUIRED: [ 0.0 ]INCHES
LOCATION TO BENCHMARK: Finished Floor of E /R, 8.40' NGVD.
ELEVATION OF PROPOSED SYSTEM SITE [ 1.5 ] [ FEET
BOTTOM OF DRAINFIELD TO BE [ 3.9 ] [ FEET
OTHER REMARKS:
This permit is not for addition (s).
*Install a new 900 gl. septic tank with its approved outlet filter.
*Install 300 sq. ft. of drainfield.
*Invert elevation to be no less than 4.98' NGVD.
*Bottom elevation to be no less than 4.48' NGVD.
NEWLY INSTALLED SINGLE C TANK
SHALL BE MUL
AND EDUIP O UTI.E I FILTER -
APPROVED
Carlos
SPECIFICATIONS BY: Icaza, Carlos
APPROVED BY: Icaza,
DATE ISSUED: 3/7/02
AGENT: SR0931119, COCKING MSTEPHEN
EXCAVATION REQUIRED: [ 29.0 ] INCHES
TITLE:
DH 4016, 03/97 (Obsoletes previous editions which may not be used)
(Stock Number: 5744- 001 - 4016 -0) [ostds_cons_4016 -1)
TITLE: Engineer I
CENTRAX #: 13 -SG -12046
DATE PAID: 3-6 -o't-
FEE PAID : $ 7 ,:
RECEIPT
OSTDSNBR : 02 -0653- -R
MULTI- CHAMBERED /IN SERIES: [Y ]
MULTI- CHAMBERED /IN SERIES: [Y ]
]DOSES PER 24 HRS # PUMPS[ 0 ]
[ N ]MOUND [ N ]
[ N ]
] [ BELOW 1 BENCHMARK/REFERENCE POINT
] [ BELOW ] BENCHMARK/REFERENCE POINT
THIS PERMR !S NOT FOR ADO H S)
INVERT ELEVATION `I q �NG
r nti►r.r i t 3 1 r II. p 'l )
Dade CHD
EXPIRATION DATE: 6/5/02
Page 1 of 2
STATE OF FLORII?A
DEPARTMENT OF HEALTH
ONSITE SEWAGE DISPOSAL SYSTEM
SITE EVALUATION AND SYSTEM SPECIFICATIONS
APPLICANT:
BLOCK:
' ROPERTY ID N,#: / 2 �y 6
'0 BE COMPLETED BY ENGINEER, HEALTH UNIT EMPLOYEE, OR OTHER QUALIFIED PERSON. ENGINEER'S MUST
'ROVIDE REGISTRATION NUMBER AND SIGN AND SEAL EACH PAGE OF SUBMITTAL. COMPLETE ALL ITEMS.
'ROPERTY SIZE CONFORMS TO SITE PLAN: ( ] YES [ J NO NET USABLE AREA AVAILABLE: 0./6.5
TOTAL ESTIMATED SEWAGE FLOW: �I L1 GALLONS PER DAY [RESIDENCES -TABLE 1 / OTHER -TABS 2]
IUTHORIZED SEWAGE FLOW: GALLONS PER DAY [1500 GPD /ACRE OR 2 ��0 �GPD /ACRE]
TNOBSTRUCTED AREA AVAILABLE: 65 SQFT UNOBSTRUCTED AREA REQUIRED: �+r SQFT
/ /- n
BENCHMARK /REFERENCE POINT LOCATION: - g . '1 h -,s 4 2
[INCHES[ABOVE LO BENCHMARK /REFERENCE POINT
SURFACE WATER:
BELLS: PUBLIC:p
WILDING FOUNDATIONS:
10 YEAR FLOOD ELEVATION FOR SITE:
sLEVATION OF PROPOSED SYSTEM SITE IS ''
CHE MINIMUM SETBACK WHICH CAN BE MAINTAINED FROM THE PROPOSED SYSTEM TO THE FOLLOWING FEATURE
FT I . {{ DITCHES/WALES: /� FT NORMALLY WET? [ J YES /�
DITCHES [ NO
FT LIMITED USE: r � A FT PRIVATE: /f 1A FT NON- POTABLE: ( FT
FT PROPERTY LINES: /0 FT POTABLE WATER LINES: ZS FT
3ITE SUBJECT TO FREQUENT FLOODING: [ ] YES [ NO 10 YEAR FLOODING} ] YES (/r NO
FT MSL /NGVD SITE ELEVATION: (2 t FT MSL /NGVD
1 4(1/1/.1, 30IL PROFILE INFORMATION SITE 4(1/1/.1, 3• D
Munsell Color Texture Depth
A- S to
1w
, t
USDA SOIL SERIES:
6 " to7Z
to
to
to
to
to
to'
to
(% (6A L
.
rI 4Q r
)BSERVEII WATER TABLE: /
SITE EVALUATED BY:
SUBDIVISION: 4 ft. ETon� Sk°R�
Munsell /Color
(//// etar
(1 7L 5 1 i
INCHES [ABOVE / BELOW] E ISTING GRADE. TYPE* PERCHED / APPARENT]
ESTIMATED WET SEASON WATER TABLE ELEVATIO 4" j) CH S [ ABOVE BELO�J EXISTING GRADE.
HIGH WATER TABLE VEGETATION: [ ] YES [J4 NO MOTTLING: [ J YES [ NO DEPTH: INCHES
SOIL TEXTURE /LOADING RATE FOR SYSTEM SIZING: / DEPTH OF EXCAVATION:
D CONFIGURATION: [ ] TRENCH [ BED [ ] OTHER (SPECIFY)
QEMARKS/�AIlDITIONAL CRITERIA:
OH 4015, 10/96 (Replaces HRS -H Form 4015 [Page 31 which may be used)
(Stock Number: 5744- 003 - 4015 -1)
AGENT: /``/,� (
A. . S
PERMIT #
[Section /Township /Range /Parcel No.
SOIL PROFILE INFORMATION SITE 2
Texture
Gtr ; - -00 5 3
or Tax ID Number]
Depth
to
- to7 2 ..
to
/ to
t •
0
to
USDA SOIL SERIES: ti _g_64,,./
2q
DATE: 3
Page 3 of 3
STATE.OF FLORIDA
%. DEPARTMENT OF HEALTH
APPLICATIbN FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PERMIT
Permit Application Number (j)/\
-
Scale: Each block represents 10 feet and 1 inch = 40 feet.
^I'
13
Notes:
PART II - SITEPLAN
q s
.PA
77 d / / - , al WS)
Not Approved
ALL CHANGES MUST BE APPROVED BY THE COUNTY HEALTH DEPARTMENT
Site Plan submitted •y
Plan prod
By County Department X
oun H e art
ment
DH 4015, 10/96 (Replaces HRS -H Form 4015 which may be used) Page 2 of 4
(Stock Number. 5744-002 -4015 -6)
CONTRACTOR
New Construction
Name e, la.....,10_,
Enclosure
License No. Sc. .r 66 $ i
Alteration Exterior
Address / 9t 3 Z /� , t Z a4 _
Repair
� rJ 33/61
Telephone 7o 45./ 71S9 Fax 3 .. �s� /1 "
/ I O
I
Qualifier Na ' 0
�.oc�c.r4 f \
TYPE OF MANAGEMENT (✓ )
New Construction
Enclosure
Alteration Exterior
Repair
Alteration Interior
Demolish
Relocation of Structure
Shell Only
Foundation Only
Add'l Attachment
Other
Add'l Detachment
Other
INSTRUCTIONS - The following steps must be taken to obtain a permit from the Miami Shores Village:
Step 1.
Step 2. Submit the completed application with all necessary documents to the Building, Planning and Zoning Department for processing. During the
processing of your application, you may be asked to submit additional information.
Job Address:
Complete the attached permit application which must be signed by the property owner and qualifier. Both signatures must be notarized. Please
print or type to allow for a more accurate processing of your application. If roofing work will be done, a roofing application must be submitted
along with this permit application.
Address Apt.
Folio Number City tate Zip
I-- 3 ' Q fl� -- �3 D escriptio o
Lot �' Bloc ( k
6Q,�+ IC 70
Subdivision QL ked ^1 J PG Zoning Linear Feet
Current Use of Property Square Feet Units Floors
Proposed Use of Property Value of Work 24ov Bldg Value
Tenant Information Tax Assessed/Appraised Value
Flood Zone Base Floor Elev.
PERMIT CHANGE (✓ )
PERMIT TYPE (✓ )
Building
Electrical
Roofing
Fence
Other
Mechanical
Plumbing
LPGX
Chg. Contractor
Renewal
Revision
Extension
Supplement
Reinspection
ARCHITECT
Name
License No.
Address
Telephone
Fax
PROPERTY OWNER
Name
Address
Home Telephone
Business Telephone
Fax
Master Permit No.
Subsidiary Permit No.
PERMIT APPLICATION
PAWN
ENGINEER
Name
License No.
Address
Telephone
Fax
Page 2
IMPORTANT NOTICES
1. DO NOT BEGIN ANY WORK WITHOUT HAVING RECEIVED YOUR VALIDATED PERMIT AND PERMIT CARD. Applying for a permit does not grant
the right to begin construction. HOURS OF CONSTRUCTION are limited to: Monday through Friday from 7:30 a.m. to 6:00 p.m., and Saturday from 8:00 a.m.
to 5:00 p.m. No inspections will be conducted on weekends or holidays.
2. All construction of demolition areas MUST BE MAINTAINED IN A CLEAN, NEAT AND SANITARY CONDITION free from construction debris.
3. STREETS AND NEIGHBORING PROPERTIES SHALL BE KEPT FREE FROM DIRT AND DEBRIS.
4. SWALES MUST BE PROTECTED FROM BEING DAMAGED BY EQUIPMENT OR VEHICLES, AND MAY NOT BE USED FOR STORAGE. A bond is
required for work in or near the street/sidewalk.
5. CONSTRUCTION TRAILERS ARE PROHIBITED ON SINGLE FAMILY RESIDENTIAL CONSTRUCTION SITES. Other construction may have a trailer
which requires a separate permit.
6. PORTABLE TOILETS for a construction site require a separate permit.
7. DO NOT DISCHARGE WATER INTO THE RIGHT OF WAY OR STORM DRAINS without approval from the Building, Planning and Zoning Department.
8. EQUIPMENT AND MATERIALS SHALL BE STORED at least 10 feet from the edge of pavement.
9. Department of Health and Rehabilitative Services (HRS) approval is required for applications involving septic tanks. Department of Environmental Resources
Management (DERM) and/or Miami -Dade Water and Sewer Department (MDWASD) approval is required for applications involving sewers.
AFFIDAVIT - Please read carefully.
Application is hereby made to obtain a permit to do work and installation as indicated. I, the OWNER of the property, 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, POOL, EXTERIOR DOOR, MECHANICAL, WINDOW, FENCE, DRIVEWAY,
ROOFING and SIGNS and there may be additional permits required from other governmental agencies.
I, the OWNER of the property, have disclosed all information related to any work at the property performed in the prior twelve
months to the Building Official. Further, I am fully aware that if the cumulative cost of work to my home or business under this and
any other permit equals or exceeds fifty percent (50 %) of the fair market value of the structure, the entire structure must meet the
present federal flood criteria for finished floor elevation. I am also fully aware that if the total cost of work to my home or business
under this and any other permit exceeds fifty percent (50 %) of the replacement cost of the structure, then the entire structure must
conform to the current code requirements of the Building Code.
WARNING TO OWNER: Your failure to record a NOTICE OF COMMENCEMENT may result in you paying twice for
improvements to your property. If you are spending more than $2,500 or intend to obtain financing, you may wish to consult with
your attorney or lender before recording your Notice of Commencement. The Notice of Commencement must be recorded at:
22 N.W. 1st Street, 1" Floor, (305) 679 -1078. Once recorded, the Notice of Commencement must be POSTED AT THE JOB SITE in
accordance with Section 713 -35 of Florida Statutes. Review the brochure at Village Hall on Construction Lien Law and
Ch...:' . -. actor.
Print Name
Sworn to and subscribed before me this
Signature of Notary Public - State of Florida
SEAL:
PERMIT APPLICATION
STATE OF FLOR1YMCOUNTY OF MIAMI -DADE
" ti
Signature of ontractor / Qualifier
Print Name Q
Swo'. o a nd subscribed before me this 1 [J day of
SEAL:
855E1£h &E ' ER
) • 0 comIS.E:O 1 WU5ABER
r ct. 9v CO=tSSSOO t XP'iRES
`'Or r\P ' !OV. 55,2002
Personally known OR, Produced Identification Personally known .J OR, Produced Identification
Type of Identification Produced: Type of Identification Produced:
ELECTRICAL
TYPE
Minimum Fee
QTY.
TYPF.
Dryer
QTY.
TYPE
Outlet, Appliance
QTY.
TYPE
Service Repair
QTY.
A/C Central 1 -3 Ton
Dryer Vents, Number of
Fan
Ventilation, Cost
Outlet, Wall
Ductwork, Cost of
Service, Temporary
Periodic Inspections
A/C Central 4 -7 Ton
Fire Sprinkler System
Fire Pump
Outlet, Switch
Fireplaces, Number of
Signs
A/C Central 8-15 Ton
Fixture - Fluorescent
Oven
Space Heater (kw)
A/C Central 16-20 Ton
Fixture Light
Parking Lot Lights
Spas/Hot Tubs
A/C Central 20+ Ton
Flood Lights
Plugmold/Strip
Subfeeds, No. of Amps
A/C Window
FPL - Load Central
Posts
Swim Pool, Commercial
Air Conditioners
Garbage Disposal
Range/Range Top
Swim Pool, Residential
Chiller
Generators, etc.
Receptacles
Switchboards
Clear Violations
Heat Recovery
Refrigerator, Comm. (p/PH)
Temp Serv., Construction
Compactor
Low -volt, Burglar
Refrigerator, Domestic
Temp for Test - 30 days
Deep Freezer
Low -volt, Fire
Renew - Temp Service
Water Closet
Demolition
Low -volt, Intercom/Teleph.
Repair Circuits
Water Heater
Dishwasher
Low -volt, Television
Service, Number of Amps
Water Heater New
NIECHANICAL
TYPE QTY.
Minimum Fee
TYPE;
Condensate Drain
QTY. TVI'I
Generator
QTY. TYPE Q . Q . Y .
Refrigeration, Tons
A/C Central, Tons
Cooling Tower
Heating Strips, each
Vent Hood, Cost
A/C Wall/Win. Tons
Dryer Vents, Number of
Paint Booth
Ventilation, Cost
Air Handler, Tons
Ductwork, Cost of
Piping, Flammable Liquid
Periodic Inspections
Barbecue
Fire Sprinkler System
Process/Pressure Piping
Bath Fan - Vented, #
Fireplaces, Number of
Pressure Vessel
PLUMBING
'I'VPF.
A/C Condensate
QTY.
TVPI:
Drains, Roof
Q'I'V.
TYPE
Miscellaneous Fixture
QTV.
TYPE.
Soakage Pit
'I'V.
Bath Tub
Drinking Fountain
Miscellaneous Repairs
Solar Water Heater
Bidet
Filter Replace
Pool Piping
Sprinkler Repair
Cap - Fixture
Fountain
Pump and Abandon
Sprinkler System
Cap - Water
Gas - Appliance
Pump, Domestic
Supply, AC Well
Cap - Sewer
Gas - Natural
Pump, Fire Stand
Temporary Toilet
Catch Basin
Gas - Propane
Pump, Re- circulate
Temporary Water Closet
Clothes Washer
Gas Piping
Pump, Replace - Pool
Urinal
Dental Chair
Grease Trap
Pump, Sprinkler
Utility - Sewer
Discharge Well
Ice Maker
Pump, Sump
Utility - Water
Dishwasher
Indirect Wastes
Relay Repair
Vacuum Pump
Disposal
Interceptor
Roof Inlet
Water Closet
Domestic Well
Laundry Tray
Septic Connection
Water Heater
Drainfield, 4" Tile/Res.
Lavatory
Septic Tank
Water Heater New
Drains, Area
Meter Set (Gas)
Sewer Connection
Water Re -pipe
Drains, Floor
Minimum Fee
Shower
Water Service
Drains, French
Miscellaneous Equipment
Sink
Well, Supply
Page 3
PERMIT APPLICATION
INSTRUCTIONS: Please indicate the type of work being performed and quantity(ies) in the space provided below. 1
RECEIVED AND REVIEWED BY: DATE:
Page 4
OFFICE USE ONLY
PERMIT APPLICATION
CHECKLIST
❑ OWNER - BUILDER FORM
(Attach)
❑ FIRE DEPARTMENT
APPROVAL (Commercial /
multi- family)
❑ CONCURRENCY
(New Construction)
❑ OTHER
(Specify & Attach)
PERMIT FEES
$3.00 per page (Scanning Fee)
Miami Shores Village
Bond
Metropolitan Dade County (C.C.F.)
Inspector State Educational Fund
State DCA (Radon)
Code Enforcement Fine
Zoning Review
ISSUING OFFICIAL
0 PROOF OF OWNERSHIP
(Attach)
❑ HRS / DERM APPROVAL
(Septic / Sewer)
❑ IMPACT FEE
(New Construction)
❑ OTHER
(Specify & Attach)
$ 60-
$� DO,
$ , a a (sq.ft. = x/1000
x ¢.60)
$ (¢.005 /sq.ft.)
$ (¢.01 /sq.ft.)
REVIEWED AND PREPARED BY:
SECTION
Zoning
Electrical
Mechanical
BY
DATE
Plumbing
Fire
Public Works
Structural
Building Official
❑ CONDO ASSOCIATION APPROVAL
(Attach)
❑ BPR APPROVAL (Restaurants)
❑ CONTRACTOR REGISTRATION
(On File)
TOTAL
DATE:
CONDITION OF' APPROVAL
Revised July 2001
10050 N.E. 2ND AVE., MIAMI SHORES, FL • (305) 795 -2207 • FAX (305) 756 -8972 • http : / /www.miamishoresvillage.com
CONTRACTOR.g /tom
Name C , , cal °1 ,aG t
License No. / C 0 „13 ,e ,,,,.- -
Address 6 L,3 s I� 1 3 v re. v°
Telephone 3,,,c ,,L. 6 1.4 \ r Fax
Qualifier Namep (40 k c./.44., (Q.4
PROPERTY OWNER
Name r —r O It ,j All ee f 1 lc. 1 G f
Address
I 1L? •k- cla S�
/
,- 77 ? a
Home Telephone 3 .J y ., S iY"'
Business Telephone
Fax
TYPE OF MANAGEMENT (✓ )
New Construction
Enclosure
Alteration Exterior
Repair
Alteration Interior
Demolish
Relocation of Structure
Shell Only
Foundation Only
Add'l Attachment
Other
Add'I Detachment
Other
Master Permit No.
Subsidiary Permit No.
INSTRUCTIONS - The following steps must be taken to obtain a permit from the Aliami Shores Village:
Step 1.
Complete the attached permit application which must be signed by the property owner and qualifier. Both signatures must be notarized. Please
print or type to allow for a more accurate processing of your application. If roofing work will be done, a roofing application must be submit-
ted along with this permit application.
Step 2. Submit the completed apolication with all necessary documents to the Building, Planning and Zoning Department for processing. During the
processing of your application, you may be asked to submit additional information.
APPLICATION
Job Address: / 2.(1? ( Z' 18 ST
Address Apt.
PERMIT TYPE (✓ )
Building
Electrical
Mechanical
Plumbing
LPGX
Roofing
Fence
Other
Chg. Contractor
Renewal
Revision
Extension
Supplement
Reinspection
ARCHITECT
Name
License No.
Address
Telephone
Fax
Ott 14,1A f 1-F oftfc
City
State
PERMIT APPLICATION
G.
Folio Number /1 -- -3)- 3 ` .5 ° 0 Description of Work D -SlN / 1 4-C .f "f Te -,4 ( (TL.
Lot Block
Subdivision PB PG Zoning Linear Feet
Current Use of Property .51/4..;) I e_ Fib Em -1 l (.t,,.,. 1. Square Feet Units Floors
Proposed Use of Property Value of Work t-(L 1 , Bldg Value
Tenant Information Tax Assessed/Appraised Value
Flood Zone Base Floor Elev.
PERMIT CHANGE (✓ )
Zip
ENGINEER
Name
License No.
Address
Telephone
Fax
Page 2
INIPORTANT NOTICES
1. DO NOT BEGIN ANY WORK WITHOUT HAVING RECEIVED YOUR VALIDATED PERMIT AND PERMIT CARD. Applying for a permit does not grant
the right to begin construction. HOURS OF CONSTRUCTION are limited to: Monday through Friday from 7:30 a.m. to 6:00 p.m., and Saturday from 8:00 a.m.
to 5:00 p.m. No inspections will be conducted on weekends or holidays.
2. All construction of demolition areas MUST BE MAINTAINED IN A CLEAN, NEAT AND SANITARY CONDITION free from construction debris.
3. STREETS AND NEIGHBORING PROPERTIES SHALL BE KEPT FREE FROM DIRT AND DEBRIS.
4. SWALES MUST BE PROTECTED FROM BEING DAMAGED BY EQUIPMENT OR VEHICLES, AND MAY NOT BE USED FOR STORAGE. A bond is
required for work in or near the street/sidewalk.
5. CONSTRUCTION TRAILERS ARE PROHIBITED ON SINGLE FAMILY RESIDENTIAL CONSTRUCTION SITES. Other construction may have a trailer
which requires a separate permit.
6. PORTABLE TOILETS for a construction site require a separate permit.
7. DO NOT DISCHARGE WATER INTO THE RIGHT OF WAY OR STORM DRAINS without approval from the Building, Planning and Zoning Department.
8. EQUIPMENT AND MATERIALS SHALL 13E STORED at least 10 feet from the edge of pavement.
9. Department of Health and Rehabilitative Services (HRS) approval is required for applications involving septic tanks. Department of Environmental Resources
Management (DERM) and/or Miami -Dade Water and Sewer Department (MDWASD) approval is required for applications involving sewers.
AFFIDAVIT - Please read carefully.
Application is hereby made to obtain a permit to do work and installation as indicated. I, the OWNER of the property, 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, POOL, EXTERIOR DOOR, MECHANICAL, WINDOW, FENCE, DRIVEWAY,
ROOFING and SIGNS and there may be additional permits required from other governmental agencies.
I, the OWNER of the property, have disclosed all information related to any work at the property performed in the prior twelve
months to the Building Official. Further, I am fully aware that if the cumulative cost of work to my home or business under this and
any other permit equals or exceeds fifty percent (50 %) of the fair market value of the structure, the entire structure must meet the
present federal flood criteria for finished floor elevation. I am also fully aware that if the total cost of work to my home or business
under this and any other permit exceeds fifty percent (50 %) of the replacement cost of the structure, then the entire structure must
conform to the current code requirements of the Building Code.
WARNING TO OWNER: Your failure to record a NOTICE OF COMMENCEMENT may result in you paying twice for
improvements to your property. If you are spending more than $2,500 or intend to obtain financing, you may wish to consult with
your attorney or lender before recording your Notice of Commencement. The Notice of Commencement must be recorded at:
22 N.W. 1st Street, 1" Floor, (305) 679 -1078. Once recorded, the Notice of Commencement must be POSTED AT THE JOB SITE in
accordance with Section 713 -35 of Florida Statutes. Review the brochure at Village Hall on Construction Lien Law and
Choosing a Contractor.
OF FLORID UNTY OF MIAMI -DADE STATE OF RIDA, COY OF MIAMI -DADE
Signatire of Owner l Signatur of Contractor / Qualifier
t+,..? Pei/ lcl e.S'
Print Name
Sworn to and subscribed before me this `5 day of
L>O
0 C.v.
Signature o Notary Public - State o Florida III
W. Keith Phillips,
SEAL: . . • ,LCommission # CC 829610
, ,
Expires Boned Thru 003
;;; e ` Atlantic Bondidg Co., Inc.
Personally known OR, Produced Identification
Type of Identification Produced:
6 4.4c (7/ / e
Print Name
Sworn to and subscribed before me this S
Signature of Notary Public - State
PERMIT APPLICATION
Florida
day of
W. Keith Phillips, IT
',,° s.Commission # CC 8296)
A? Expires June 14, 200.1
Bonded Thru
Personally known
'a%' OR, rdctilifiedtion
SEAL:
Type of Identification Produced:
ELECTRICAL
TYPE:
Minimum Fee
QTY.
TYI'P.
Dryer
QTY.
TYPE:
Outlet, Appliance
Q'I'V.
1 l'1'I.:
Service Repair
Q'I1.
A/C Central 1 -3 Ton
Heating Strips, each
Fan
Outlet, Wall
Dryer Vents, Number of
Service, Temporary
Paint Booth
A/C Central 4 -7 Ton
0
Fire Pump
Ductwork, Cost of
Outlet, Switch
Piping, Flammable Liquid
Signs
A/C Central 8 -15 Ton
Fire Sprinkler System
Fixture - Fluorescent
Process/Pressure Piping
Oven
Space Heater (kw)
Fireplaces, Number of
A/C Central 16-20 Ton
Pressure Vessel
Fixture Light
Parking Lot Lights
Spas/Hot Tubs
A/C Central 20+ Ton
Flood Lights
Plugmold/Strip
Subfeeds, No. of Amps
A/C Window
FPL - Load Central
Posts
Swim Pool, Conunercial
Air Conditioners
Garbage Disposal
Range/Range Top
Swim Pool, Residential
Chiller
Generators, etc.
Receptacles
Switchboards
Clear Violations
Heat Recovery
Refrigerator, Comm. (p/PH)
Temp Serv., Construction
Compactor
Low -volt, Burglar
Refrigerator, Domestic
Temp for Test - 30 days
Deep Freezer
Low -volt, Fire
Renew - Temp Service
Water Closet
Demolition
Low -volt, Intercom/Teleph.
Repair Circuits
Water Heater
Dishwasher
Low -volt, Television
Service, Number of Amps
Water Heater New
MECHANICAL
TYI'F.
Minimum Fee
QTY. TYPE:
Condensate Drain
Q'I'Y.
(
TYPE:
Generator
QTY. TN IT
Refrigeration, Tons
Q'I V.
A/C Central, Tons
li Cooling Tower
Bath Tub
Heating Strips, each
FR Vent Hood, Cost
A/C Wall/Win. Tons
Dryer Vents, Number of
Solar Water Heater
Paint Booth
Ventilation, Cost
Air Handler, Tons
Ductwork, Cost of
Pool Piping
Piping, Flammable Liquid
Periodic Inspections
Barbecue
Fire Sprinkler System
Fountain
Process/Pressure Piping
Pump and Abandon
Bath Fan - Vented, #
Fireplaces, Number of
Cap - Water
Pressure Vessel
Gas - Appliance
PLUMBING
TYPt
A/C Condensate
QTY.
"1'YI'I
Drains, Roof
QTY.
TYI'li
Miscellaneous Fixture
QT1'.
TvII{
Soakage Pit
Q'I V.
Bath Tub
Drinking Fountain
Miscellaneous Repairs
Solar Water Heater
Bidet
Filter Replace
Pool Piping
Sprinkler Repair
Cap - Fixture
Fountain
Pump and Abandon
Sprinkler System
Cap - Water
Gas - Appliance
Pump, Domestic
Supply, AC Well
Cap - Sewer
Gas - Natural
Pump, Fire Stand
Temporary Toilet
Catch Basin
Gas - Propane
Pump, Re- circulate
Temporary Water Closet
Clothes Washer
Gas Piping
Pump, Replace - Pool
Urinal
Dental Chair
Grease Trap
Pump, Sprinkler
Utility - Sewer
Discharge Well
Ice Maker
Pump, Sump
Utility - Water
Dishwasher
Indirect Wastes
Relay Repair
Vacuum Pump
Disposal
Interceptor
Roof Inlet
Water Closet
Domestic Well
Laundry Tray
Septic Connection
Water Heater
Drainfield, 4" Tile/Res.
Lavatory
Septic Tank
Water Heater New
Drains, Area
Meter,Set (Gas)
Sewer Connection
Water Re -pipe
Drains, Floor
Minimum Fee
Shower
Water Service
Drains, French
Miscellaneous Equipment
Sink
Well, Supply
Page 3
PERMIT APPLICATION
INSTRUCTIONS: Please indicate the type of work being performed and quantity(ies) in the space provided below. I
RECEIVED AND REVIEWED BY: DATE:
SECTION
BY
DATE
Zoning
Electrical
Mechanical
. {j — >
/.. Or. O
Plumbing
Fire
Public Works
Structural
Building Official
Page 4
OFFICE USE ONLY
CHECKLIST
Cl OWNER - BUILDER FORM
(Attach)
❑ FIRE DEPARTMENT
APPROVAL (Commercial /
multi- family)
❑ CONCURRENCY
(New Construction)
❑ OTHER
(Specify & Attach)
$3.00 per page (Scanning Fee)
Miami Shores Village
Bond
Inspector State Educational Fund $
State DCA (Radon)
Code Enforcement Fine
Zoning Review
Notary
❑ PROOF OF OWNERSHIP
(Attach)
❑ HRS / DERM APPROVAL
(Septic / Sewer)
❑ IMPACT FEE
(New Construction)
Cl OTHER
(Specify & Attach)
PERMIT FEES
$
Metropolitan Dade County (C.C.F.) $ 3 d o
( x .60 x/1000
)
(¢.005 /sq.ft.)
(¢.01 /sq.ft.)
PERMIT APPLICATION
❑ CONDO ASSOCIATION APPROVAL
(Attach)
❑ BPR APPROVAL (Restaurants)
❑ CONTRACTOR REGISTRATION
(On File)
TOTAL $ ? , b D
ISSUING OFFICIAL
REVIEWED AND PREPARED BY: DATE:
CONDITION OF APPROVAL
Revised July 2001
10050 N.E. 2ND AVE., MIAMI SHORES, FL • (305) 795 -2207 • FAX (305) 756 -8972 • http : / /www.miamishoresvillage.com
PROPERTY OWNER
,/
Name 1"t f�21- t0e re t K ( S
Address
)2 1t 4 /7 ST
m iA m,' S hoe F i- " �5 3 13 e
Home Telephone -i c/ _ 11 1 5
Business Telephone 3o S `/ 3 _ 3 2 30
J
Fax
TYPE OF MANAGEMENT (✓ )
New Construction
Enclosure
Alteration Exterior
Repair
Alteration Interior
Demolish
Relocation of Structure
Shell Only
Foundation Only
Add'I Attachment
Other
Add'I Detachment
Other
INSTRUCTIONS - The following steps must be taken to obtain a permit from the Miami Shores Village:
Step 1.
Complete the attached permit application which must be signed by the property owner and qualifier. Both signatures must be notarized. Please
print or type to allow for a more accurate processing of your application. If roofing work will be done, a roofing application must be submitted
along with this permit application.
Step 2. Submit the completed application with all necessary documents to the Building, Planning and Zoning Department for processing. During the
processing of your application, you may be asked to submit additional information.
APPLICATION
Job Address: Va4% NE 98 Sr.
Apt.
Folio Number X Description of Work
Lot Block
Subdivision PB
Address
Current Use of Property
Proposed Use of Property
Tenant Information
PERMIT TYPE (✓ )
Building
Electrical
Mechanical
Plumbing
LPGX
Roofing
Fence
Other
Value of Work
PERMIT CHANGE (✓ )
Chg. Contractor
Renewal
Revision
Extension
Supplement
Reinspection
ARCHITECT
Name
License No.
Address
Telephone
Fax
Square Feet
Master Permit No.
Subsidiary Permit
1 1 1 9 ✓YI I ShoRP,
City
PG Zoning
State
PERMIT APPLICATION
33/3 '
Zip •
WOO i FExidd
4570
Linear Feet
Units Floors
I SU vo Bldg Value
Tax Assessed/Appraised Value
Flood Zone Base Floor Elev.
ENGINEER
Name
License No.
Address
Telephone
Fax
CONTRACTOR
Name
License No.
Address
Telephone
Fax
Qualifier Name
Page 2
IMPORTANT NOTICES
1. DO NOT BEGIN ANY WORK WITHOUT HAVING RECEIVED YOUR VALIDATED PERMIT AND PERMIT CARD. Applying for a permit does not grant
the right to begin construction. HOURS OF CONSTRUCTION are limited to: Monday through Friday from 7:30 a.m. to 6:00 p.m., and Saturday from 8:00 a.m.
to 5:00 p.m. No inspections will be conducted on weekends or holidays.
2. All construction of demolition areas MUST BE MAINTAINED IN A CLEAN, NEAT AND SANITARY CONDITION free from construction debris.
3. STREETS AND NEIGHBORING PROPERTIES SHALL BE KEPT FREE FROM DIRT AND DEBRIS.
4. SWALES MUST BE PROTECTED FROM BEING DAMAGED BY EQUIPMENT OR VEHICLES, AND MAY NOT BE USED FOR STORAGE. A bond is
required for work in or near the street/sidewalk.
5. CONSTRUCTION TRAILERS ARE PROHIBITED ON SINGLE FAMILY RESIDENTIAL CONSTRUCTION SITES. Other construction may have a trailer
which requires a separate permit.
6. PORTABLE TOILETS for a construction site require a separate permit.
7. DO NOT DISCHARGE WATER INTO THE RIGHT OF WAY OR STORM DRAINS without approval from the Building, Planning and Zoning Department.
8. EQUIPMENT AND MATERIALS SHALL BE STORED at least 10 feet from the edge of pavement.
9. Department of Health and Rehabilitative Services (HRS) approval is required for applications involving septic tanks. Department of Environmental Resources
Management (DERM) and/or Miami -Dade Water and Sewer Department (MDWASD) approval is required for applications involving sewers.
AFFIDAVIT - Please read carefully.
Application is hereby made to obtain a permit to do work and installation as indicated. I, the OWNER of the property, 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, POOL, EXTERIOR DOOR, MECHANICAL, WINDOW, FENCE, DRIVEWAY,
ROOFING and SIGNS and there may be additional permits required from other governmental agencies.
I, the OWNER of the property, have disclosed all information related to any work at the property performed in the prior twelve
months to the Building Official. Further, I am fully aware that if the cumulative cost of work to my home or business under this and
any other permit equals or exceeds fifty percent (50 %) of the fair market value of the structure, the entire structure must meet the
present federal flood criteria for finished floor elevation. I am also fully aware that if the total cost of work to my home or business
under this and any other permit exceeds fifty percent (50 %) of the replacement cost of the structure, then the entire structure must
conform to the current code requirements of the Building Code.
WARNING TO OWNER: Your failure to record a NOTICE OF COMMENCEMENT may result in you paying twice for
improvements to your property. If you are spending more than $2,500 or intend to obtain financing, you may wish to consult with
your attorney or lender before recording your Notice of Commencement. The Notice of Commencement must be recorded at:
22 N.W. 1st Street, 1°' Floor, (305) 679 -1078. Once recorded, the Notice of Commencement must be POSTED AT THE JOB SITE in
accordance with Section 713 -35 of Florida Statutes. Review the brochure at Village Hall on Construction Lien Law and
Choosing a Contractor.
ST41TE OF FLORIDA, COUNTY OF MIAMI -DADE STATE OF FLORIDA, COUNTY OF MIAMI -DADE
(t t,ti Lest,
Signature of Owner Signature of Contractor / Qualifier
2 C--- n: (C a»,?,(K.(
Print Name / Print Name
Sw and subscribed before me this l — day of , Sworn to and subscribed before me this day of
GELA M BECKER
Co,n SnOH NUMBER
CC786697 SEAL:
raY COkIIVIISSJON EXPIRES
NOV. 15,200
Signature of Notary Public - State of Florida
PERMIT APPLICATION
Personally known OR, Produced Identification Personally known OR, Produced Identification
Type of Identification Produced: F). pL PCB / a 9 St) g- 4.39y- Oype of Identification Produced:
ELECTRICAL
TYPE
Minimum Fee
QTY.
TYPE
Dryer
QTY.
TVPE.
Outlet, Appliance
QTY.
TVn:
Service Repair
QTY.
A/C Central 1 -3 Ton
Heating Strips, each
Fan
Outlet, Wall
Service, Temporary
Paint Booth
A/C Central 4 -7 Ton
Fire Pump
Outlet, Switch
Piping, Flammable Liquid
Signs
A/C Central 8 -15 Ton
Fixture - Fluorescent
Process/Pressure Piping
Oven
Space Heater (kw)
A/C Central 16-20 Ton
Pressure Vessel
Fixture Light
Parking Lot Lights
Spas/Hot Tubs
A/C Central 20+ Ton
Flood Lights
Plugmold/Strip
Subfeeds, No. of Amps
A/C Window
FPL - Load Central
Posts
Swim Pool, Commercial
Air Conditioners
Garbage Disposal
Range/Range Top
Swim Pool, Residential
Chiller
Generators, etc.
Receptacles
Switchboards
Clear Violations
Heat Recovery
Refrigerator, Comm. (p/PH)
Temp Serv., Construction
Compactor
Low -volt, Burglar
Refrigerator, Domestic
Temp for Test - 30 days
Deep Freezer
Low -volt, Fire
Renew - Temp Service
Water Closet
Demolition
Low -volt, Intercom/Teleph.
Repair Circuits
Water Heater
Dishwasher
Low -volt, Television
Service, Number of Amps
Water Heater New
I\IECHANICAL
TYPE.
Minimum Fee
QTY.
TYPE.
Condensate Drain
QTY. TYPE
Generator
()Ty. "1'YPI :
Refrigeration, Tons
QTY.
A/C Central, Tons
QTy.
Cooling Tower
Heating Strips, each
Vent Hood, Cost
A/C Wall/Win. Tons
Dryer Vents, Number of
Paint Booth
Ventilation, Cost
Air Handler, Tons
Ductwork, Cost of
Piping, Flammable Liquid
Periodic Inspections
Barbecue
Fire Sprinkler System
Process/Pressure Piping
Pump and Abandon
Bath Fan - Vented, #
Fireplaces, Number of
Pressure Vessel
Gas - Appliance
PLUMBING
TYPE
A/C Condensate
QTY.
TYPE
Drains, Roof
QTY.
TYPE
Miscellaneous Fixture
QTY.
.
Soakage Pit
QTy.
Bath Tub
Drinking Fountain
Miscellaneous Repairs. ,
Solar Water Heater
Bidet
Filter Replace
Pool Piping
Sprinkler Repair
Cap - Fixture
Fountain
Pump and Abandon
Sprinkler System
Cap - Water
Gas - Appliance
Pump, Domestic
Supply, AC Well
Cap - Sewer
Gas - Natural
Pump, Fire Stand
Temporary Toilet
Catch Basin
Gas - Propane
Pump, Re- circulate
Temporary Water Closet
Clothes Washer
Gas Piping
Pump, Replace - Pool
Urinal
Dental Chair
Grease Trap
Pump, Sprinkler
Utility - Sewer
Discharge Well
Ice Maker
Pump, Sump
Utility - Water
Dishwasher
Indirect Wastes
Relay Repair
Vacuum Pump
Disposal
Interceptor
Roof Inlet
Water Closet
Domestic Well
Laundry Tray
Septic Connection
Water Heater
Drainfield, 4" Tile/Res.
Lavatory
Septic Tank
Water Heater New
Drains, Area
Meter Set (Gas)
Sewer Connection
Water Re -pipe
Drains, Floor
Minimum Fee
Shower
Water Service
Drains, French
Miscellaneous Equipment
Sink
Well, Supply
Page 3
PERMIT APPLICATION
INSTRUCTIONS: Please indicate the type of work being performed and quantity(ies) in the space provided below. 1
RECEIVED AND REVIEWED BY: DATE:
SECTION
BY
DATE
Zoning
&_o
Electrical
Mechanical
Plumbing
Fire
Public Works
Structural
Building Official
[
Z /�
Page 4
OFFICE USE ONLY
CHECKLIST
❑ OWNER - BUILDER FORM
(Attach)
❑ FIRE DEPARTMENT
APPROVAL (Commercial /
multi- family)
❑ CONCURRENCY
(New Construction)
❑ OTHER
(Specify & Attach)
$3.00 per page (Scanning Fee) $
Miami Shores Village
Bond
Metropolitan Dade County (C.C.F.) $ a La- 0
Inspector State Educational Fund $
State DCA (Radon)
Code Enforcement Fine
Zoning Review
❑ PROOF OF OWNERSHIP
(Attach)
❑ HRS / DERM APPROVAL
(Septic / Sewer)
❑ IMPACT FEE
(New Construction)
❑ OTHER
(Specify & Attach)
PERMIT FEES
0
(sq.ft. = x/1000
x0.60)
(¢.005 /sq.ft.)
(0.01 /sq.ft.)
REVIEWED AND PREPARED BY:
PERMIT APPLICATION
❑ CONDO ASSOCIATION APPROVAL
(Attach)
❑ BPR APPROVAL (Restaurants)
❑ CONTRACTOR REGISTRATION
(On File)
TOTAL $ Q6 0
ISSUING OFFICIAL
DATE:
CONDITION OF APPROVAL
Revised July 2001
10050 N.E. 2ND AVE., MIAMI SHORES, FL • (305) 795 -2207 • FAX (305) 756 -8972 • http : / /www.miamishoresvillage.com
Miami Shores Village
10050 NE 2nd Avenue
Plumbing Permit
Phone: 305 - 795 -2204 Permit Number: PL2002 -72
Printed: 3/12/2002
Applicant: JOHN
Owner:
PERIKLES
Contractor MR C'S SEPTIC TANK Address: P 0 BOX 693239
Local Phone: 305 - 651 -7859 Cellular:
Page 1 of 1
C — �
M Parcel # 1132050090330 Legal Description: EARLETON SHORES PB 43 -80 LOT 6 BLK 3 LOT SIZE 75.000 X 109 OR 18779 -3323
t n Job Address: 1248 NE 98 ST
Fees: Description Amount
FEE2002 -1473 Building Fee $90.00
Total Fees: $90.00 Total Fees: $90.00
Total Receipts: $0.00
Permit Status: Approved Permit Expiration: 9/8/2002 Construction Value: $1,500.00
Work: TO REPLACE TANK
Cam'
If there is no permit package accessible on the job -site for inspectors to verify, there will be no inspections. Re- inspection
PAY
TO THE
RD R OF
MR. C'S SEPTIC & DRAIN, INC.
. OPERATING ACCOUNT
P.O. BOX 693239 305 -651 -7859
MIAMI, FL 33269 -0239
N
/1/1;40A f'L {III
Washington Mutual
Wasmnggtton Mutual Bank, FA
Miare 199th Street Financial Center 1719
175 NW. 199th Street 1. 800.788.7000
Miami, FL 33169 24 hour Customer Sec
FOR
0 00 5 L 3 70 1: 26 708 LI: 38 3»0 308 2»00
DOLLARS 'L'u
/ � , 63 8413/2670
DATE
$ ' - 1St,. o
ration herefor in strict compliance with all
fications that may have been submitted to
s or if the plans are changed without
)onsibility for a thorough knowledge of the
that he assumes responsibility for work done
'ns pertaining thereto and in strict conformity
responisibility for all work done by either
CONTRACTOR
Name �/') C r v`
1 /
Name 66 rIPJ
p , p 4 , y .�
License No. fi g
' ,p (Z440
` •
Address f C i .5 • 4w„_�
Telephone 5.cto,.i 65 / . 7‘57 Fax 3aS _ 0 5 . fd
b
Qualifier Name aE e. NE (2 ` l
PROPERTY OWNER
New Construction
Name 66 rIPJ
Enclosure
' ,p (Z440
` •
Address 1 Zy$ "1c,
8
Home Telephone
S —
7 S 4 6. — 7 '77
Business Telephone
Demolish
Fax
Shell Only
TYPE OF MANAGEMENT (✓ )
New Construction
Enclosure
Alteration Exterior
Repair
Alteration Interior
Demolish
Relocation of Structure
Shell Only
Foundation Only
Add'I Attachment
Other
Add'I Detachment
Other
INSTRUCTIONS - The following steps must be taken to obtain a permit from the Nliami Shores Village:
Step 1.
Complete the attached permit application which must be signed by the property owner and qualifier. Both signatures must be notarized. Please
print or type to allow for a more accurate processing of your application. If roofing work will be done, a roofing application must be submitted
along with this permit application.
Step 2. Submit the completed application with all necessary documents to the Building, Planning and Zoning Department for processing. During the
processing of your application, you may be asked to submit additional information.
APPLICATION
vi Y \ - Job Address:
12_ 4 6 9 f'`e"
Address Apt.
. dog.- 033-c)..
Folio Number
Lot Block
Subdivision PB PG
Current Use of Property
Proposed Use of Property
Tenant Information
PERMIT TYPE (✓ )
Building
Electrical
Mechanical
Roofing
Fence
Other
Plumbing
LPGX
PERMIT CHANGE (✓ )
Chg. Contractor
Renewal
Revision
Extension
Supplement
Reinspection
ARCHITECT
Name
License No.
Address
Telephone
Fax
t 71 /34S
Description of Work l D J7 /4 CA- I &_-
Zoning
Square Feet
Master Permit No.
Subsidiary Permit No. pi-
City
State
PERMIT APPLICATION
Zip
Linear Feet
Units Floors
/ Ci Bldg Value
Value of Work
Tax Assessed/Appraised Value
Flood Zone Base Floor Elev.
ENGINEER
Name
License No.
Address
Telephone
Fax
Page 2
INIPORTANT NOTICES
DO NOT BEGIN ANY WORK WITHOUT HAVING RECEIVED YOUR VALIDATED PERMIT AND PERMIT CARD. Applying for a permit does not grant
the right to begin construction. HOURS OF CONSTRUCTION are limited to: Monday through Friday from 7:30 a.m. to 6:00 p.m., and Saturday from 8:00 a.m.
to 5:00 p.m. No inspections will be conducted on weekends or holidays.
2. All construction of demolition areas MUST BE MAINTAINED IN A CLEAN, NEAT AND SANITARY CONDITION free from construction debris.
3. STREETS AND NEIGHBORING PROPERTIES SHALL BE KEPT FREE FROM DIRT AND DEBRIS.
4. SWALES MUST BE PROTECTED FROM BEING DAMAGED BY EQUIPMENT OR VEHICLES, AND MAY NOT BE USED FOR STORAGE. A bond is
required for work in or near the street/sidewalk.
5. CONSTRUCTION TRAILERS ARE PROHIBITED ON SINGLE FAMILY RESIDENTIAL CONSTRUCTION SITES. Other construction may have a trailer
which requires a separate permit.
6. PORTABLE TOILETS for a construction site require a separate permit.
7. DO NOT DISCHARGE WATER INTO THE RIGHT OF WAY OR STORM DRAINS without approval from the Building, Planning and Zoning Department.
8. EQUIPMENT AND MATERIALS SHALL BE STORED at least 1.0 feet from the edge of pavement.
9. Department of Health and Rehabilitative Services (HRS) approval is required for applications involving septic tanks. Department of Environmental Resources
Management (DERM) and/or Miami -Dade Water and Sewer Department (MDWASD) approval is required for applications involving sewers.
1.
AFFIDAVIT - Please read carefully.
Application is hereby made to obtain a permit to do work and installation as indicated. I, the OWNER of the property, 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, POOL, EXTERIOR DOOR, MECHANICAL, WINDOW, FENCE, DRIVEWAY,
ROOFING and SIGNS and there may be additional permits required from other governmental agencies.
I, the OWNER of the property, have disclosed all information related to any work at the property performed in the prior twelve
months to the Building Official. Further, I am fully aware that if the cumulative cost of work to my home or business under this and
any other permit equals or exceeds fifty percent (50 %) of the fair market value of the structure, the entire structure must meet the
present federal flood criteria for finished floor elevation. I am also fully aware that if the total cost of work to my home or business
under this and any other permit exceeds fifty percent (50 %) of the replacement cost of the structure, then the entire structure must
conform to the current code requirements of the Building Code.
WARNING TO OWNER: Your failure to record a NOTICE OF COMMENCEMENT may result in you paying twice for
improvements to your property. If you are spending more than $2,500 or intend to obtain financing, you may wish to consult with
your attorney or lender before recording your Notice of Commencement. The Notice of Commencement must be recorded at:
22 N.W. 1st Street, 1° Floor, (305) 679 -1078. Once recorded, the Notice of Commencement must be POSTED AT THE JOB SITE in
accordance with Section 713 -35 of Florida Statutes. Review the brochure at Village Hall on Construction Lien Law and
Choosing a Contractor.
STATE OF FLORI A,.COUNTY OF MIAMI -DADE
Signa e of Owner
Print Name
Sworn to and subscribed before me this day of
Signature of Notary Public - State of Florida
SEAL:
Personally known OR, Produced Identification
Type of Identification Produced:
PERMIT APPLICATION
STATE OF FL I,' IDA, COUNTY OF MIAMI -DADE
Signature of Contractor / Qua i ter
Print Name
Swsm to and subscribed before me thi
AVIL
ignattugi of �R 1'u t - S id •131orj u
�I o � Al ALA �7 B L, it4
SEAL: f wx. czo: rut �_a
,71 e CC' 36C97
1L' e 1;7R
Personally known OR, Produced Identification
Type of Identification Produced:
ELECTRICAL
TYPE
Minimum Fee
QTY.
TvPE
Dryer
QTy.
Tyi,i;
Outlet, Appliance
QTY.
'I'\'PE
Service Repair
QTR.
A/C Central 1 -3 Ton
Dryer Vents, Number of
Fan
Ventilation, Cost
Outlet, Wall
Ductwork, Cost of
Service, Temporary
Periodic Inspections
A/C Central 4 -7 Ton
Fire Sprinkler System
Fire Pump
Outlet, Switch
Fireplaces, Number of
Signs
A/C Central 8 -15 Ton
Fixture - Fluorescent
Oven
Space Heater (kw)
A/C Central 16 -20 Ton
Fixture Light
Parking Lot Lights
Spas/Hot tubs
A/C Central 20+ Ton
Flood Lights
Plugmold/Strip
Subfeeds, No. of Amps
A/C Window
FPL - Load Central
Posts
Swim Pool, Commercial
Air Conditioners
Garbage Disposal
Range/Range Top
Swim Pool, Residential
Chiller
Generators, etc.
Receptacles
Switchboards
Clear Violations
Heat Recovery
Refrigerator, Comm. (p/PH)
Temp Serv., Construction
Compactor
Low -volt, Burglar
Refrigerator, Domestic
Temp for Test - 30 days
Deep Freezer
Low -volt, Fire
Renew - Temp Service
Water Closet
Demolition
Low -volt, Intercom/Teleph.
Repair Circuits
Water Heater
Dishwasher
Low -volt, Television
Service, Number of Amps
Water Heater New
f' 1ECHANICAL
Typ
Minimum Fee
( ) T y . TyrE
Condensate Drain
Q . i . N . Tyi Q.i.y.
Generator
Tyi,F: (.1.Y
Refrigeration, Tons
A/C Central, Tons
Cooling Tower
- Heating Strips, each
Vent Hood, Cost
A/C Wallin. Tons
Dryer Vents, Number of
Paint Booth
Ventilation, Cost
Air Handler, Tons
Ductwork, Cost of
- Piping, Flammable Liquid
Periodic Inspections
Barbecue
Fire Sprinkler System
- Process/Pressure Piping
Bath Fan - Vented, #
Fireplaces, Number of
- Pressure Vessel
PLUMBING
Ti'pE
A/C Condensate
()Ty.
TYPE
Drains, Roof
QTR'.
'nil:
Miscellaneous Fixture
QTY.
'FYTI:
Soakage Pit
'FY.
Bath Tub
Drinking Fountain
Miscellaneous Repairs
Solar Water Heater
Bidet
Filter Replace
Pool Piping
Sprinkler Repair
Cap - Fixture
Fountain
Pump and Abandon
Sprinkler System
Cap - Water
Gas - Appliance
Pump, Domestic
Supply, AC Well
Cap - Sewer
Gas - Natural
Pump, Fire Stand
Temporary Toilet
Catch Basin
Gas - Propane
Pump, Re- circulate
Temporary Water Closet
Clothes Washer
Gas Piping
Pump, Replace - Pool
Urinal
Dental Chair
Grease Trap
Pump, Sprinkler
Utility - Sewer
Discharge Well
Ice Maker
Pump, Sump
Utility - Water
Dishwasher
Indirect Wastes
Relay Repair
Vacuum Pump
Disposal
Interceptor
Roof Inlet
Water Closet
Domestic Well
Laundry Tray
Septic Connection
Water Heater
Drainfield, 4" Tile/Res.
Lavatory
Septic Tank
Water Heater New
Drains, Area
Meter Set (Gas)
Sewer Connection
Water Re -pipe
Drains, Floor
Minimum Fee
Shower
Water Service
Drains, French
Miscellaneous Equipment
Sink
We11, Supply
Page 3
PERMIT APPLICATION
INSTRUCTIONS: Please indicate the type of work being performed and quantity(ies) in the space provided below.
RECEIVED AND REVIEWED BY: DATE:
Page 4
OFFICE USE ONLY
❑ OWNER - BUILDER FORM
(Attach)
❑ FIRE DEPARTMENT
APPROVAL (Commercial /
multi- family)
❑ CONCURRENCY
(New Construction)
❑ OTHER
(Specify & Attach)
$3.00 per page (Scanning Fee)
Miami Shores Village
Bond
Metropolitan Dade County (C.C.F.) $
Inspector State Educational Fund $
State DCA (Radon) $
Code Enforcement Fine
Zoning Review
❑ IMPACT FEE
(New Construction)
$
$
SECTION
Zoning
Electrical
Mechanical
Plumbing
Fire
Public Works
Structural
Building Official
BY
DATE
CHECKLIST
❑ PROOF OF OWNERSHIP
(Attach)
❑ HRS / DERM APPROVAL
(Septic / Sewer)
❑ OTHER
(Specify & Attach)
(sq.ft. = x/I000
x ¢.60)
(¢.005 / sq.ft.)
(¢.01 /sq.ft.)
REVIEWED AND PREPARED BY:
PERMIT APPLICATION
❑ CONDO ASSOCIATION APPROVAL
(Attach)
❑ BPR APPROVAL (Restaurants)
❑ CONTRACTOR REGISTRATION
(On File)
PERMIT FEES
TOTAL $
ISSUING OFFICIAL
DATE:
CONDITION OF APPROVAL
Revised July 2001
10050 N.E. 2ND AVE., MIAMI SHORES, FL • (305) 795 -2207 • FAX (305) 756 -8972 • http : / /www.miamishoresvillage.com
SHORES VILLAGE FL
0
nation of the issuance to me of Ms
and in strict coot with dia p I
permit ;; , suine resp nsiility for al
be pe
BUILDING
ELECTRICAL
F�LOI�lSII3i3
Rt?8P1NG
0wnef of
Architect
Contractor
or Builder
Legal t:t
Description
Address of
Building
This permit is grants
herefor in strict compliance with
drawings, statements or specificatio
time if the work is not done in
granted is the rtnderst g that t
pertaining to the work covered bomb
done by his agents, servants or saw
In cons
pertaining there
in accepting this
CONTRA
5
Date
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.
Permit No
Registered Architect and /or Engine
Employing Plumber's Name
Owner's Name and Address...
Location and Legal Description
Street and Number where work is to be performed —No
Size Septic Tank
i
Feet of Drain Tile__�a1
Nature of Water Supply: City —Well.
Amount of Permit $ .444- --
STATE OF FLORIDA,
COUNTY OF DADE. 1
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING
New Building ___ Remodeling_ Addition.
No._
Street
Street
Block Subdivision
State work to be performed and purpose of building (By Floors) ___ ..... __....
_____
Street
Repairs No. of Stories_ -
Type of Tank_
'st. Feet of Tank or Drain Field from Well
_Size of Soakage Pit
(Signed )
Plumbing Inspector.
The undersigned applicant for this building permit does hereby certify that he understands and accepts .,'obligations as an employer of labor
under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Pennanent 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.
(Signed).
Capacity Gals
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.
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 faulty
materials and /or worlcmanship.
CLOSETS
BATH
TUBS
SHOWERS
LAVA-
TORIES
SINKS
SLOP
SINKS
LAUNDRY
Tuns
URINALS
CATCH
BASIN
FLOOR
DRAIN
DRINKING
FOUNT'NS
TOTAL
FIXTURES
CONTR.
LIST
CHICK
—
SEPTIC
TANK
SEWER
CONN.
DRAIN
FIELD
SOAKAGE
PIT
GREASE
TRAP
SOLAR
HEATER
DEEP
WELL
SPRKLR.
SYSTEM
SWIM'G
POOL
CONTR.
LIST
- - - --
CHECK
Date
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.
Permit No
Registered Architect and /or Engine
Employing Plumber's Name
Owner's Name and Address...
Location and Legal Description
Street and Number where work is to be performed —No
Size Septic Tank
i
Feet of Drain Tile__�a1
Nature of Water Supply: City —Well.
Amount of Permit $ .444- --
STATE OF FLORIDA,
COUNTY OF DADE. 1
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING
New Building ___ Remodeling_ Addition.
No._
Street
Street
Block Subdivision
State work to be performed and purpose of building (By Floors) ___ ..... __....
_____
Street
Repairs No. of Stories_ -
Type of Tank_
'st. Feet of Tank or Drain Field from Well
_Size of Soakage Pit
(Signed )
Plumbing Inspector.
The undersigned applicant for this building permit does hereby certify that he understands and accepts .,'obligations as an employer of labor
under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Pennanent 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.
(Signed).
Capacity Gals
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.
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 faulty
materials and /or worlcmanship.