PLUMBINGPERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Date
/4 6 -9
Legal Description /i
. er Lessee / Tenant
Owner's Address
Contracting Co.
Job
Qualifier loos .0 awl
APPROVED:
6/495U
State #.406=Wqmve Municipal # ON 'i -C Competency # Q/v '— Ins.Co. oAI
** * *
ItU) q ,/67 9, sr
ECOND /20 7Z
�A 4
o r '% 4-1 7 r•.; " • :. .. ' • " ident
tleExp. Aug. 4, 19• 5
Commission # CC133062
Zoning
Mechanical
Address
16?6 ! N. 6 9j' sr Tax Folio /1 � 7�`' ' 'P evA
old
01144# Coo „-
Master Permit # X3 6
S
D
* * *
Building
Phone 75 — " ' ; 7
Address 8333 /W NISI / ffl
ssa # Phone S7 !f'O
Architect /Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type(circle one): BUILDING ELECTRICAL APR5DIPMECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIPTION DA g /iUF /e
Square Ft. 3 O �
Estimated Cost(value) / d ^
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 do in compl':nce with all applicable laws regulating construction and zoning. Furthermore, I
a Vii* a the above na,-d contractor to do the work stated
- Ji ✓ iI'!
as
, !`7 ,7 1 . orS#a!e
ommissi Tomb: 4V.
Commission #
or Owner- Builder
riigailder
, 1995
C133062
FEES: PERMIT .50 • RADON C.C.F. / 1 Do NOTARY TOTAL DUB-5.4
Fire Other
Electrical
gineering
PROPERTY ID #:
STATE OF FLORIDA
DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES
ONSITE SEWAGE DISPOSAL SYSTEM
CONSTRUCTION PERMIT
Authority: Chapter 381, FS & Chapter 10D -6, FAC
CONSTRUCTION PERMIT FOR:
[ ] New System [ ] Existing System [ ] Holding Tank [ ] Temporary /Experimental
0.0 Repair [ ] Abandonment [ ] Other(Specify)
0/6
APPLICANT: A41
f1 (L ,4
PROPERTY STREET ADDRESS:
LOT: BLOCK: SUBDIVISION:
SYSTEM MUST BE CONSTRUCTED IN ACCORDANCE WITH SPECIFICATIONS AND STANDARDS OF CHAPTER 10D -6, FAC
REPAIR PERMITS AND HOLDING TANK PERMITS EXPIRE 90 DAYS FROM THE DATE OF ISSUE. ALL OTHER PERMITS
EXPIRE ONE YEAR FROM THE DATE OF ISSUE. HRS APPROVAL OF SYSTEM DOES NOT GUARANTEE SATISFACTORY
PERFORMANCE FOR ANY SPECIFIC PERIOD OF TIME. 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.
SYSTEM DESIGN AND SPECIFICATIONS
T [ ] [GALLONS / GPD] SEPTIC TANK /AEROBIC UNIT CAPACITY MULTI— CHAMBERED /IN SERIES:[ ]
A [ ] [GALLONS / GPD] CAPACITY MULTI— CHAMBERED /IN SERIES:[ ]
N [ J GALLONS GREASE INTERCEPTOR CAPACITY [MAXIMUM CAPACITY SINGLE TANK: 1250 GALLONS]
K [ ] GALLONS PER DOSE DOSING TANK CAPACITY DOSE RATE [ ] PER 24 HRS NO. OF PUMPS: [ ]
D [ i e-J] SQUARE FEET PRIMARY DRAINFIELD SYSTEM
R [ ] SQUARE FEET
A TYPE SYSTEM: [ ] STANDARD
I CONFIGURATION: [ ] TRENCH
N
F LOCATION OF BENCHMARK:
I ELEVATION OF PROPOSED SYSTEM SITE [
E BOTTOM OF DRAINFIELD TO BE [
L
D FILL REQUIRED: [
O
T
H
E
R
SPECIFICATIONS BY:
DATE ISSUED:
] INCHES
APPROVED BY:
SYSTEM
/c FILLED
[ ] BED
HRS-H Form 4016, Mar 92 (Obsoletes previous editions which may not be used)
(Stock Number: 5744- 001 - 4016
AGENT: (r C4M49 77.10--1P
[SECTION /TOWNSHIP /RANGE /PARCEL NUMBER]
[OR TAX ID NUMBER]
] [INCHES /FT] [ABOVE /BELOW] BENCHMARK /REFERENCE POINT
] [INCHES /FT] [ABOVE /BELOW] BENCHMARK /REFERENCE POINT
EXCAVATION REQUIRED: [ ] INCHES
TITLE:
TITLE:
APPLICANT
PERMIT #
DATE PAID
FEE PAID $
RECEIPT #
] MOUND [ ]
]
CPHU
EXPIRATION DATE: /
Page 1 of 2
STATE OF FLORIDA
DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES
APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PERMIT
Permit Application Number 3 — 7? 0
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wilial _ ,e LV i c . c ) ) o I iiirliot NO ri/e2-6--
PARTTI - SITE PLAN
Site Plan Submitted by:
Plan Approved
By County Public Unit
ALL CHANGES MUST BE APPROVED BY THE COUNTY PUBLIC HEALTH UNIT
HRS-H Form 4015, Feb 85 (Obsoletes previous editions which may not be used)
SIGNATURE
Not Approved
TITLE
Date
Page 2 of 3
LOT:
APPLICANT: i71n//;, (dv
11
BLOCK:
PROPERTY ID #:
SURFACE WATER:
WELLS: PUBLIC:
BUILDING FOUNDATIONS:
STATE OF FLORIDA
DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES
ONSITE SEWAGE DISPOSAL SYSTEM
SITE EVALUATION AND SYSTEM SPECIFICATIONS
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: [ ]
TOTAL ESTIMATED SEWAGE FLOW: /fl)
AUTHORIZED SEWAGE FLOW:
UNOBSTRUCTED AREA AVAILABLE:
SOIL PROFILE INFORMATION SITE 1
SUBDIVISION:
YES [ ] NO NET USABLE AREA AVAILABLE: ACRES
GALLONS PER DAY [RESIDENCES -TABLE 1 / OTHER -TABLE 2)
GALLONS PER DAY [1500 GPO/ACRE OR 2500 GPD /ACRE]
SQFT UNOBSTRUCTED AREA REQUIRED: SQFT
AGENT: e d 07ve
PERMIT
[Section /Township /Range /Parcel No. or Tax ID Number]
BENCHMARK /REFERENCE POINT LOCATION:
ELEVATION OF PROPOSED SYSTEM SITE IS / V ' ' [INCHES /FT] (ABOVE /BELOW] BENCHMARK /REFERENCE POINT
THE MINIMUM SETBACK WHICH CAN BE MAINTAINED FROM THE PROPOSED SYSTEM TO THE FOLLOWING FEATURES:
SITE SUBJECT TO FREQUENT FLOODING: [ ] YES (R40 10 YEAR FLOODING? [ ] YES {
10 YEAR FLOOD ELEVATION FOR SITE: FT MSL /NGVD SITE ELEVATION: FT MSL /NGVD
Munsell # /Color Texture
USDA SOIL SERIES:
Depth
to
to
to
to
to
to
to
to
to
FT DITCHES /SWALES: FT NORMALLY WET? [ ] YES [ ] NO
gT LIMITED USE: FT PRIVATE: FT NON - POTABLE FT
7 FT PROPERTY LINES: �� FT POTABLE WATER LINES: /d FT
SITE EVALUATED BY:
NRS -H Form 4015, Mar 92 Obsoletes previous editions which may not be used)
(Stock Number: 5744- 003 - 4015-1)
SOIL PROFILE INFORMATION SITE 2
Munsell # /Color Texture
USDA SOIL SERIES:
Depth
to
to
to
to
to
to
to
to
to
OBSERVED WATER TABLE: \ >./rINCHES [ABOVE ulgRI / EL EXISTING GRADE. TYPE: PERCHED / PARE ]
ESTIMATED WET SEASON FfATER TABLE ELEVATION•". y? INCHES ( ABOVE 0 _ EXIS�1'i RADE.
HIGH WATER TABLE VEGETATION: [ ] YES [ 1,.1 "NO" MOTTLING: [ ] YES [ 0 DEPTH: INCHES
SOIL TEXTURE /LOADING RATE FOR SYSTEM SIZING: \ // DEPTH OF EXCAVATION : L INCHES
DRAINFIELD CONFIGURATION: [ ] TRENCH [ 4,] --BED [ ] OTHER (SPECIFY)
REMARKS /ADDITIONAL CRITERIA:
DATE: / -09-93
Page 3 of 3
STATE OF FLORIDA
DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES
ONSITE SEWAGE DISPOSAL SYSTEM
APPLICATION FOR CONSTRUCTION PERMIT
PERMIT 1
DATE PAID
FEE PAID
RECEIPT 1
$ A/ L c C)
/ //o
Authority: Chapter 381, FS & Chapter 1OD -6, FAC
APPLICATION FOR:
[ ] New System [ ] Existing System [ ] Holding Tank [ ] Temporary /Experimental
[ !.j Repair [ ] Abandonment [ ] Other(Specify) rr/
APPLICANT: / • � p dge.K TELEPHONE: �S - :P ld r ��
AGENT: -2 (- t-' /6 0 0 iW
MAILING ADDRESS: k- 33 A/ p / S
1 '
TO BE COMPLETED BY APPLICANT OR APPLICANT'S AUTHORIZED AGENT. ATTACH BUILDING PLAN AND TO -SCALE III
SITE PLAN SHOWING PERTINENT FEATURES REQUIRED BY CHAPTER 1OD -6, FLORIDA ADMINISTRATIVE CODE.
I I
PROPERTY INFORMATION [IF LOT IS NOT IN A RECORDED SUBDIVISION, ATTACH LEGAL DESCRIPTION OR DEED]
LOT: BLOCK: SUBDIVISION: DATE OF
SUBDIVISION:
PROPERTY ID 11 k: [Section /Township /Range /Parcel No.] ZONING:
PROPERTY SIZE: //"7/ ACRES[ -Sgft /43560] PROPERTY WATER SUPPLY: [ ] PRIVATE
PROPERTY STREET ADDRESS: 06 9 ,c 9 22-vi
DIRECTIONS TO PROPERTY:
BUILDING INFORMATION
Unit Type of
No Establishment
1 / //c - (-wig y 3
2
3
4
[ RESIDENTIAL
[ ] COMMERCIAL
No. of Building i Persons Business Activity
Bedrooms Area Soft Served
/ So
For Commercial Only •
[ ] Garbage Grinders /Disposals, [ ] Spas /Hot Tubs [ ] Floor /Equipment Drains
[ ] Ultra -low Volume Flush T•i'lets [ ] Other (Specify)
DATE: 1 24)-9 3
UBLIC
APPLICANT'S SIGNATURE:
HRS -H Form 4015, Mar 92 (Obsoletes previous editions which may not be used) Page 1 of 3
(Stock Number: 5744 - 001-4015-1)
Permit No 119 b
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 No.
Registered Architect and /or Engineer
Employing Plumber's Name .%% /ll-
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 Fly)- . -
New Building _._ ._------ ---- - ---_._ Remodeling X _ - Addition
Size Septic Tank._ _ 0 Q
Feet of Drain Tile 042_44
p C'
Amount of Permit $
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
Type of T
._Dist. Feet of Tank or Drain Field from Well
Nature of Water Supply: City- Well.- _- ____- ___ -___ -- - - - -- .._Size of Soakage Pit
No,— Street- ., .. ....1��'`�..
B1ocSt
Street.
(Signed) - --
Repair No. of Stories.. /......
Date Z.72/
Capacity Cali . /O O
The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligat
under the Florida Workmen's Compensation Act, being Section 5988, Compiled General Laws of Florida Pennanen
plied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors emplo
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 pennit, as are
licensed by Miami Shores Village.
s as an employer of labor
Supplement, and bus corn-
ed by him in the work to be
STATE OF FLORIDA, t ss.
COUNTY OF DADE.
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 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 Commission Expires Notary Public, State of Florida
NOTE: A re- inspection fee of $1.00 will be made when such re-inspection 1. made•neoersary by improper notice for inspection, or faulty
materials and /or workmanship.
TOTAL
FIETun[S
CLOSETS
BATH
Tun[
SHOW[Rn
LAVA-
TORIES
SINKS
SLOP
11NK•
LAUNDRY
Tun.
URINAL/
CATCH
BASIN
FLOOR
DRAIN
DRINKING
FOUNT•NS
CONTR.
LIST
CHECK
SEPTIC
TANK
SEWER
CONN.
DRAIN
FIELD
SOAKAGE
PIT
G
TRAP
SOLAR
HATER
DEEP
WELL
SPRKLR.
S
$W114'43
POOL
Corm'.
—
LIST
CHUCK
1
Permit No 119 b
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 No.
Registered Architect and /or Engineer
Employing Plumber's Name .%% /ll-
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 Fly)- . -
New Building _._ ._------ ---- - ---_._ Remodeling X _ - Addition
Size Septic Tank._ _ 0 Q
Feet of Drain Tile 042_44
p C'
Amount of Permit $
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
Type of T
._Dist. Feet of Tank or Drain Field from Well
Nature of Water Supply: City- Well.- _- ____- ___ -___ -- - - - -- .._Size of Soakage Pit
No,— Street- ., .. ....1��'`�..
B1ocSt
Street.
(Signed) - --
Repair No. of Stories.. /......
Date Z.72/
Capacity Cali . /O O
The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligat
under the Florida Workmen's Compensation Act, being Section 5988, Compiled General Laws of Florida Pennanen
plied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors emplo
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 pennit, as are
licensed by Miami Shores Village.
s as an employer of labor
Supplement, and bus corn-
ed by him in the work to be
STATE OF FLORIDA, t ss.
COUNTY OF DADE.
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 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 Commission Expires Notary Public, State of Florida
NOTE: A re- inspection fee of $1.00 will be made when such re-inspection 1. made•neoersary by improper notice for inspection, or faulty
materials and /or workmanship.
l °/ 0 ,4 1 16 34f
12
Permit No......... - T
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
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
�tc
3 ' No
Registered Architect and /or Engineer
Employing Plumber's Name. �SuMS/A/G• . NO.,... + (C :..2.. 5.5,,— 8!i<eet.3.Z,L. ���C.(-.....- .
Location and Legal Description Lot_ J_� Block 2 SubdivWon. 6C�?! „SA-are 3
Street and Number where work is to be performed —No Street
State work to be performed and purpose of building (By Floozy) _ eft i_. Th _ -14 4) P -
New Building -- •-- .-- • - - -.. - . -.__. Remodeling___ __ - -- Addition._.___ -___ Repairs No. of Stories... /MC . ...
Size Septic Tnnk -------- - - - - -- — - - -- _._Type of Tank_._
Feet of Drain Tile._ -__.- ____ ___ —Dist. Feet of Tank or Drain Field from Well
Capacity Gals
Nature of Water Supply: City —Well. Size of Soakage Pit
Amount of Permit $
(Signed) - - --
Date ..._ � 0./__4 ....__..._
Street.
g Ins
The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations a employer of labor
under the Florida Workmen's Compensation Act, being Section 5988, Compiled General Laws of Florida Permanent Su • .1 ment, 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 per ed under this permit, as are
licensed by Miami Shores Village.
Muter Plumber.
STATE OF FLORIDA, i
COUNTY OF DADE.
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 Fbrida
NOTE: A re-inspection fee of 11.00 will be made when such no-inspection is mada'neoessary by improper notice for inspection, or faulty
materials and /ar workmanship.
TOTAL
FIXTURE{
CLOSET{
BATH
TUBS
SHOWER{
LAVA-
TORIES
SINK{
SLOP
SINKS
LAUNDRY
Tuns
URINAL{
CATCH
BASIN
FLOOR
DRAIN
DRINKING
FOUNT'NS
CONTR.
LIST
CHECK
SEPTIC
TANK
SEWER
CONN.
DRAIN
FIELD
SOAKAGE
PIT
G
TRAP
SOLAR
H
DEEP
WELL
$PRKLR.
SYSTEM
8WIM•G
POOL
CoNTn.
/ t_
-
LIST
CHECK
l °/ 0 ,4 1 16 34f
12
Permit No......... - T
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
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
�tc
3 ' No
Registered Architect and /or Engineer
Employing Plumber's Name. �SuMS/A/G• . NO.,... + (C :..2.. 5.5,,— 8!i<eet.3.Z,L. ���C.(-.....- .
Location and Legal Description Lot_ J_� Block 2 SubdivWon. 6C�?! „SA-are 3
Street and Number where work is to be performed —No Street
State work to be performed and purpose of building (By Floozy) _ eft i_. Th _ -14 4) P -
New Building -- •-- .-- • - - -.. - . -.__. Remodeling___ __ - -- Addition._.___ -___ Repairs No. of Stories... /MC . ...
Size Septic Tnnk -------- - - - - -- — - - -- _._Type of Tank_._
Feet of Drain Tile._ -__.- ____ ___ —Dist. Feet of Tank or Drain Field from Well
Capacity Gals
Nature of Water Supply: City —Well. Size of Soakage Pit
Amount of Permit $
(Signed) - - --
Date ..._ � 0./__4 ....__..._
Street.
g Ins
The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations a employer of labor
under the Florida Workmen's Compensation Act, being Section 5988, Compiled General Laws of Florida Permanent Su • .1 ment, 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 per ed under this permit, as are
licensed by Miami Shores Village.
Muter Plumber.
STATE OF FLORIDA, i
COUNTY OF DADE.
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 Fbrida
NOTE: A re-inspection fee of 11.00 will be made when such no-inspection is mada'neoessary by improper notice for inspection, or faulty
materials and /ar workmanship.
V/
MIAMI SHORES VILLAGE
BUILDING DEPARTMENT
305- 795 -2204
B iding Inspection Request
Inspection Date
Approved
Correction ❑
Re- Insp'n Fee ❑
Date �
Type Insp'n ~ 1l , / 10 I
Permit No. 2L__03-
Name 1 Co(/ V l
Address ' 2 CA G I mu u P U 5+
Company [C/' / /'' 30o-us P
Phone # 3OrS — )S ' LJ"I 6
BUILDING
PERMIT APPLICATION
FBC 2001
Permit Type (circle): Building
Owner's Name (Fee Simple Titleholder)
Owner's Aciclress 12(o4 Ni E'
city i Q+ 51 State
f'enani/Lessee Naine
Joh Address (where the work is being done)
City Miami Shores Village
Is Building Historically Designated YES
City I M
Qualifier 1,1114 RCCD
Architect/Engineer's Name (if applicable)
$ Value of Work For this Permit
Type of Work: (]Addition
Describe Work:
`X
Total Fee Now Due $
(Continued on opposite side)
1
JL t Ji.Y 4+1411..1..E1
Building Department
1 0050 N.E,2ad Avenue, Miami S .w ,. loricla 33138
Te1:13 .8972
❑Alteration
Electrical
arneS CaRRol
' See+
�L-
12oq S- },tee+
Comity Miami-Dade Zip 33 ) 3
State
NO
Pern it No OS ' 113
stet Permmii: No.
Mechanical Roofing
Phone# 335 - - 329 5
Zip 33 )3?
Phone
Contractor's Company Name /4 AfR)rriable Jel Q-I- n i WIC. Phone 305- (081, C32,.2
Contractor's Address 1 C j Ni1i\! 189 +-
Zrlr
3 31( 3
State Certificate or Registration No. —" Certificate of Cotrtpetency No. 91.6roco?) 9
eu
Square Footage Of 'Work:
Phone
0 Demo ition
Submittal It $ dQJ Permit Fee $ ' CCF' $ r• r CO /CC
Notary � Traiuin / &tlorcatiott Pee $ [ Tec1wolegy Fee $
Scanning $ Radon $ Zoning Wad'
Code Enforcement $ Strife ta raj' Plan Review. $
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. 1 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: 1 certify that all the foregoing information is accurate and that all work will be done in compliance wiih 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 10 the issuance of a building permit with an estimated value exceeding $2500, the applicant must
promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person
whose property is subject to attachn►ent. Also, a certified copy of the recorded notice of commencement must be posted al the job sue
for the first inspection which occurs seven (7) days after the building permit is issued In the absence of such posted notice, the
inspection will not be approved and a reinspection fe will be charged.
- v
Owner or Agent
The foregoing instrument was acknowledged before me this
day of Ap ✓t / , 20 DS, by „/,2/274-5 Cpl /l
'vL►o is personahlyknown .&me or who has produced
As identification and who did take an oath.
My Commission Expires:
* * * * * * * * * * * * * * * * * * * * * * * * **
* * * * * * * * * * * * * * * * * * * * * **
APPLICATION APPROVED BY:
Chc 05 /13/03
Oatassometio
MARCU r(U$AS
5 p 1 Pr Comm/ DD0238481
1
t * * * * * * * * * * * * **
_' Bonded ewe (800)432 -4254
° ,aos cr Florida Notani Assn., Inc
**
NOTARY PUBLIC:
Signatur
Co (tractor
The foregoing instrument was acknowledged before Inc this
day of A101 1 , 20 _S, by gGo 1?-, !
� lae- .s.personall y knowOo me or who has produced__
as id and who did take an oath.
Sign:
Print:
My C
o ff! .. vk '.— T9l@t4
3 4.. ..,e). commission # DD348926
Sv, . Eipires AUG 22, 2008
,
ir
. I ** * ** d f * * **r:
. ,,oF,Fw,.� Atlantic Bonding Co„ Inc.
* *** ****************************: ** *** *** *** ****4*a:*:l.:k ***
Plans Examiner
Engineer
Zoning
ci
wok
-4
Y.
9E, d e ce
ja.r Ci o /
42 S7u
Cl 41" 47
CC# 96P000219
Affordable Irrigation, Inc.
198 NW 139 Street
Miami, FL 33168
1/ /l/ /64 - - I t D
? 0 t 0 g-7 .s� f'
• 20 e l /»J // CL( Z° e
_ c,, , • wt 1/
/ ,,v s en,c ti
3o‘ pip)
Y
9
MIAMI SHORES VILLAGE
BUILDING DEPARTMENT
305- 795 -2204 X 10
Buildin Inspection Request -
PI 05 1/3
Date
Type Insp'n
Permit No.
Name E • k C
Address I D 69 k) f. C ( S &I-
Company
Phone #
3c - 6 k1 - b3�
Inspection Date /c2�f
Approved
Correction
Re- Insp'n Fee ❑
, 51
n I,��
Miami Shores Village
10050 NE 2nd Avenue
Phone: 305 - 795 -2204
Printed: 4/12/2005
Applicant: ERICA RICHTER
Owner: RICHTER ERICA
JOB ADDRESS: 1269 NE 98 ST
Parcel # 1132050090260
Signed:
(INSPECTOR)
Plumbing Permit
Permit Number: PL2005 -113
Contractor AFFORDABLE IRRIGATION INC Contractor's Address: 198 NW 139 ST
Local Phone: 305 - 681 - 6322
Permit Status: APPROVED Permit Expiration: 10/4/2005 Construction Value: $1,600.00
Work: LAWN SPRINKLERS INSTALLATION
Page 1 of 1
APR 14 PAID
Legal Description: EARLETON SHORES PB 43 -80 LOT 15 BLK 2 LOT SIZE 75.000 X 109
Fees: Description Amount
FEE2005 -4774 Building Fee $160.00
FEE2005 -4775 CCF $1.20
FEE2005 -4776 Training and Education Fee $0.40
FEE2005 -4777 Scanning Fee $3.00
FEE2005 -4778 Technology Fee $4.00
FEE2005 -4779 Submittal Fee ($50.00)
Total Fees: $118.60
Total Fees: $118.60
.6/ Total Receipts: $0.00
ck'\i
In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations pertaining thereto and in strict
conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I assume responisibility for all work
done by either myself, my agent, servants or employes.
Signed: (Contractor or Builder) BY:
2703 qv
MIAMI SHORES VILLAGE
BUILDING DEPARTMENT
305- 795 -2204
Building Inspection Request
Date a) /Z9 /05
Type Insp'n-Tl r I L03 5eyv1 cc
Lucile,/ 5-)pplNi
Permit No. PLo5
Name JOrne5 CCJrr° J I
Address 12-6C4 kkE c8 ST,
Company Th'e ? kw Mi Shorts P1.
Phone # (105) 35 — 2.44
Inspection Date 06 /
Approved �
Correction ❑
Re- Insp'n Fee ❑
Tenant/Lessee Name
BUILDING
PERMIT APPLICATION
FBC 2001
Permit Type (circle): Building
Mechanical Roofing
Owner's Name (Fee Simple Titleholder) ...is; Phone # 4o$ 9
Owner's Address 1 a- i ! ME
City //` t Arai Silva -6° State c
Contractor's Company Name
Contractors Address
City a OM
Qualit'ier3 j)f5
State Certificate or Registration Noeg i0
Architect/Engineer's Name (if applicable)
$ Value of Work For this Permit 24
.,. :,n
Type of Work: DAdltio'tt i` r �, D ratiop
Describe Work:
Code Enforcement $
Total Fee Now Due $ 1Y0 e t,
(Continued on opposite side)
Miami Shores Village
Building Department
10050 I■lihmi. Shores, Florida 33138
Tel: 305) 795.2204 Fax: (305) 756.8972
Plumbing
Electrical
Zip
r./69 1llarg8
,fob Address (where the work is being done)
City Miami Shores Village
is Building Historically Designated YES
A .313
Phone #
County Miami-Dade Zip 33/ 3
Structural Plan Review. $
Certificate of Competency No.
Phote #
Permit PLQ '- cd
er Permit No.
Footage Of Work:
Submittal Fee $ Permit Fee $ Q CCF $ 1 - • CWCC
Notary $ Training/Educations Fee $ 2Q ) Technology Fee S " -
Scanning $ 3 • W Radon r.: Zoning Bond S
Bonding Company's Name (if applicable)
Bonding Company's Address
City State Zip
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address
City State Zip
Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has
commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulating
construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRICAL WORK, PLUMBING, SIGNS,
WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and AIR CONDITIONERS, ETC
OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all
applicable laws regulating construction and zoning.
"WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR
PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING,
CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF
COMMENCEMENT."
Notice to Applicant: As a condition to the issuance of a building permit with an estimated value exceeding $2500, the applicant must
promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person
whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site
for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the
inspection will not be approved and a reinspection fee will be charged.
Signature
Owner or Agent [ ,/
The fore oing instrument was was acknowledged before me this / �
day of , 2(66, by
who is personally known to me or who has produced PI-
N
s
entif c
1
"►e I4
PPM r aAW
Print:
My Co
Chc 05/13/03
(D-
APPLICATION APPROVED BY:
ion and who did take an oath.
•
Signature
Contractor
The foregoing instrument was acknowledged before me this
day of (lair , 20
who is 'ers
NOTARY
S
P
- 7p - a
by
My Commissio
me or who h. _ oduced
as identific. ,i•.,fTiL ho did take an oath.
*********** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** * * *( 4 ** *********************** * * * * * * * * * * * * * * * * * * * * * * * *:* * * * **
Plans Examiner
Engineer
Zoning
fitA
ADDENDUM TO BUILDING PERMIT APPLICATION
(AN APPLICATIOK FOR BUILDING PERMIT MUST ACCOMPANY THIS ADDENDUM. IF A MASTER PERMIT HAS B.
OBTAINED, THE OWNER'S NOTARIZED SIGNATURE NEED NOT BE PRESENT ON SUBSEQUENT APPLICATIONS.)
PLUMBING
ELECTRICAL
MECHANICAL
ITEM
BATH TUB
UNIT
FEE
ITEM
SWITCH OUTLETS
UNIT
FEE
ITEM
SPACE HEATERS
UNIT
FEE
BIDET
LIGHT OUTLETS
CENTRAL HEATING
DISHWASHER
RECEPTACLES
A/C (WIND)
DISPOSAL
SERVICE TEMPORARY
A/C (CENTRAL)
DRINKING FOUNTAIN
SERVICE SIZE IN AMPS
DUCT WORK
FLOOR DRAIN
SERVICE REPAIR/METER CHANGE
REFRIGERATION
GREASE TRAP
APPLIANCE OUTLETS
PROCESS AND PRESS PIPING
INTERCEPTOR
RANGE TOP
UNDERGROUND TANKS
LAVATORY
OVEN
ABOVE GROUND TANKS
LAUNDRY TRAY
WATER HEATER
U.F. PRESSURE VESSELS
CLOTHES WASHER
MOTORS 0— 1 HP
STEAM BOILERS
SHOWER
MOTCRS QVER 1— 3 HP
HOT WATER BOILERS
SINK, POT /3 COMP.
MOTORS OVER 3— 5 hP
MECHANICAL VENTILATION
SINK, RESIDENCE
MOTORS OVER 5— 8 HP
TRANSPORTING ASSEMBLIES
SINK, SLOP
MOTCRS OVER 8— 10 HP
ELEVATORS/ESCALATORS
TEMPORARY WATER CLOSET
MOTORS OVER 10— 25 HP
FIRE SPRINKLER SYSTEMS
URINAL •
MOTORS OVER 25-100 HP
COOLING TOWERS
WATER CLOSET
MOTORS OVER 100 If
VIOLATION
INDIRECT WASTES-
A/C WINDOW
REINSPECTION
_
WATER SUPPLY TO: .
•
AIR CONDITIONERS
A/C UNIT
STRIP HEATER
FIRE SPRINKLER
GENERATORS TRANSFORMERS
HEATER —NEW INST.
GENERATORS TRANSFORMERS
HEATER — REPLACE ,-
GENERATORS TRANSFORMERS
LAWN SPRINKLER —WELL
SPECIAL PURPOSE
SWIMMING POOL
OUTLETS COMf,IERCIAL
WATER SERVICE
a
SIGN TUBES
SEWER CONNECTIONS
SIGN TRANSFORMERS
UTILITY —SEWER
SIGN TIME CLOCK
UTILITY —WATER
FIXTURES
SEPTIC TANK
ANTENNA
RELAY
TELEVISION OUTLETS
DRAINFIELD, 4' TILE/RES.
VIOLATION
PUMP & ABANDON SEPTIC TANK
REINSPECTION
SOAKAGE PIT CU. FT.
CATCH BASIN
DISCHARGE WELL
DOMESTIC WELL
AREA DRAIN
ROOF INLET
SOLAR WATER HEATER
FIRE STANDPIPE
POOL PIPING
LAWN SPRINKLER SYSTEM
GAS RANGE
METER SET (GAS)
GAS PIPIPC
ADDENDUM TO BUILDING PERMIT APPLICATION
(AN APPLICATIOK FOR BUILDING PERMIT MUST ACCOMPANY THIS ADDENDUM. IF A MASTER PERMIT HAS B.
OBTAINED, THE OWNER'S NOTARIZED SIGNATURE NEED NOT BE PRESENT ON SUBSEQUENT APPLICATIONS.)
PLUMBING
ELECTRICAL
MECHANICAL
Plumbing Permit
Miami Shores Village
10050 NE 2nd Avenue
Phone: 305- 795 -2204 Permit Number: PL2005 -202
Printed: 6/27/2005
Applicant: JAMES CARROLL
Owner: CARROLL JAMES
JOB ADDRESS: 1269 NE 98 ST
Contractor THE NEW MIAMI SHORES PLUMBING Contractor's Address: 900 NW 144 ST
Local Phone: 786- 553 -5424
Parcel # 1132050090260
Legal Description: EARLETON SHORES PB 43 -80 LOT 15 BLK 2 LOT SIZE 75.000 X 109
Fees: Description Amount
FEE2005 -8821 Building Fee $160.00
FEE2005 -8822 CCF $1.80
FEE2005 -8823 Training and Education Fee $0.60
FEE2005 -8824 Technology Fee $4.00
FEE2005 -8825 Scanning Fee $3.00
Total Fees: $169.40
Total Fees: $169.40
Total Receipts: $0.00
Permit Status: APPROVED Permit Expiration: 12/19/2005 Construction Value: $2,400.00
Work: REPLACE WATER SERVICE AND WATER SUPPLY
Page 1 of 1
JUN 2 8 PAID
Signed: (INSPECTOR)
In consideration of the issuance to me of this permit, 1 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:
IaT r�
CN[CK
Owners Name and Addreu
1 o &n 4n J F1 bc' � // ci Leg Lot
Street and Number where work is to be performed —No 11
State work to be performed and purpose of building (By Floors)__.
We
Amount of Permit $ ;.4
My Commission Expires
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
Permit No
2/1
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 specification must be kept st
building during progress of work.
Registered Architect and /or Engineer -' 'EN`r GIAsTEaraLiklirrel
No 1 2 /4
mtS
.
S bdi vl�doJG1l/
Street_
(Signed) _ _L%'
5 S ? G �S -Sz -bogs'
CA{
.st
Notary Public, State of Florida
rJQ..
±.L..t ............ _ -.... _.
New Building -__ -- _ — _.._.........._.. Remodeling.—_. ___.__ Addition...- . -_ —.._ Repairs No. of Stories ..
Size Septic T _Type of Tank---
Feet of Drain Tile_. Feet of Tank or Drain Field from Well. .._.__ ._._.___.__.. _ --
Nature of Water Supply: City—Well Size of Soakage Pit
Plumbing Inspector.
The undersigned 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 5988, Compiled General Laws of Florida Permanent Supplement, and hgt com-
plied with the provisions thereof, and will require similar compliance from all contractors or subcontractors employed by him in the worm to he
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 PIP
required by the Act. The undersigned agrees to employ only such sub-contractors, on work to be performed under this permit, Ks are
Loomed by Miami Shores Village.
STATE OF FLORIDA, t k
COUNTY OF DADE.
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take aclmowledgnments, personally appeared
to me well known, and who, being by me first duly sworn, upon oath deposes and says that be 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.
NOTE: A re- inspection fee of $1.00 will be made whoa sari ariiaspeotfoa it made•asaswacr by Improper satine for laspection, ar faulty
materials aad /cr worlananahip.
CLOSETS T
BATH a
a[Ka L
LAVA s
sINKa S
SLOP L
LAUNDRY U
URINALS C
CATCH /
/LOOK D
DKINKINO T
TO-AL
CONTn.
Liar —
—
SWIM'e O
O �e.Qyl�°+
SEPTIC S
SSWIR O
ORAIN S
SOKKAO[ G
G S
SOLAR M
MCP S
SPKKLR. S
CL I U
UT
L
Owners Name and Addreu
1 o &n 4n J F1 bc' � // ci Leg Lot
Street and Number where work is to be performed —No 11
State work to be performed and purpose of building (By Floors)__.
We
Amount of Permit $ ;.4
My Commission Expires
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
Permit No
2/1
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 specification must be kept st
building during progress of work.
Registered Architect and /or Engineer -' 'EN`r GIAsTEaraLiklirrel
No 1 2 /4
mtS
.
S bdi vl�doJG1l/
Street_
(Signed) _ _L%'
5 S ? G �S -Sz -bogs'
CA{
.st
Notary Public, State of Florida
rJQ..
±.L..t ............ _ -.... _.
New Building -__ -- _ — _.._.........._.. Remodeling.—_. ___.__ Addition...- . -_ —.._ Repairs No. of Stories ..
Size Septic T _Type of Tank---
Feet of Drain Tile_. Feet of Tank or Drain Field from Well. .._.__ ._._.___.__.. _ --
Nature of Water Supply: City—Well Size of Soakage Pit
Plumbing Inspector.
The undersigned 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 5988, Compiled General Laws of Florida Permanent Supplement, and hgt com-
plied with the provisions thereof, and will require similar compliance from all contractors or subcontractors employed by him in the worm to he
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 PIP
required by the Act. The undersigned agrees to employ only such sub-contractors, on work to be performed under this permit, Ks are
Loomed by Miami Shores Village.
STATE OF FLORIDA, t k
COUNTY OF DADE.
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take aclmowledgnments, personally appeared
to me well known, and who, being by me first duly sworn, upon oath deposes and says that be 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.
NOTE: A re- inspection fee of $1.00 will be made whoa sari ariiaspeotfoa it made•asaswacr by Improper satine for laspection, ar faulty
materials aad /cr worlananahip.