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DRAINFIELDCONTRACTOR Name ( ' Vt e"r ye, . ("lc_ 11 / / j License No. 3e �1\ 0 0 3Y Address Co `V S i �� l W1 /leamccK F/. 3 Telephone y g 7 7� Fax �sy_3;a 93 Qualifier Name ( ce // PROPERTY OWNER / /^ / /,, Name /e nn r ,he & c ;et , Address / / / d ,t)-- S ^ `c " p� �'Y1 I ` VA , ' 'tc)YS 1 T Home Telephone Business Telephone 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 I. o(r/ooLfr P- oi oL ' 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: 1 1 10 (lJ . 1 OOF - 2p --�� �p ,, // Apt. City 5/ Folio Number � 1- b S - 0 ' I - (' -t ('Q Description of Work Address Lot 10 �,�Block 1 Subdivision I 1 \matt �I1 61SB PG Zoning Linear Feet "--' Current Use of Property C'S (C f f'L-f 1 Square Feet — � Units r' Floors ''--- Proposed Use of Property (reSt Ole K1+T Cd. Value of Work�,Q t)( Bldg Value Tenant Information PERMIT TYPE (✓ ) Building Electrical Mechanical Plumbing LPGX Roofing Fence Other PERMIT CHANGE (✓ ) Chg. Contractor Renewal Revision Extension Supplement Reinspection ARCHITECT Address Name License No. Telephone Fax PERMIT APPLICATION Master Permit No. ),. 'J IV 1 Subsidiary Permit No. 5 e -a b M■aryN 1 Ara- Tax Assessed/Appraised Value PI State Zip Flood Zone Base Floor Elev. ENGINEER Address Name License No. 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 Choosing a Contractor. ST E OF FLORID , COUNTY OF MI a I -DADE ST TE Q FJ.,ORIDA, COUNTY OF MIAMI -DADE gnature of litary Public - •te of Florida ,t - o; VtctAi ttu +aRY SEAL C P '6' ANGELA M BECKLER * - �, COAtS�ISStON NuMSER a '4,', wY Q CC786697 MY CO�SWISS:ON EXPIRES � r O� NOV. 15,2072 Personally known '. "`. - OR, Produced Identification SEAL: Type of Identification Produced : Is U V Signature of Coq+f/ctor / Qualifier Swom to and subscribed , efore me this Il day of _Mat' Print Name 1 .Ill Stay. PERMIT APPLICATION ignature of Notary Pub SEAL: f Florida Personally known / OR, Produced Identification 11 71 Type of Identification Produced: - -•c = -rsw DEDO 14 Ml NKY MY COMMISSION M CC 967734 EXPIRES: Sep 13,2004 1.8004- NOTARY Ft. Notary Service & Bonding, Inc. PIONEER SEPTIC, INC. 6541 S.W. 22 STREET MIRAMAR, FLORIDA 33023 (954) 987-7223 PAY OR R.OF TO THE M CLAYUL, t 0(04 b1544dad • AAwd - FIRST UNION NATIONAL FOR iiscm L Su' CO 6 700 6 3 21: 2000008 11., L 2990 DATE 1675 63-643/670 bi.0 6 DOLLARS 8 IMP CONSTRUCTION PERMIT FOR. [ j New System [ J Existing System [ X ] Repair [ ]Abandanmer'tc. APPLICANT: De La Espriella, Alexandra AGENT: %SR0 001347, Henry Russell PROPERTY STREET ADDRESS: 1110 NE 100 St Miami €T, 3138 LOT: 10 BLOCK: 178 PROPERTY ID }[: 11- 3205 -019 -0460 SYSTEM MUST BE CONSTRUCTED IN ACCORDANCE WITH iPECIFI CATIONS AND STANDARDS OF CHAPTER 64E -6, FAC DEPARTMENT APPROVAL OF SYSTEM DOES NOT GUARANTtE SATISFACTORY PERFORMILNCE FOR ANY SPECIFIC TIME PERIOD. ANY CHANGE IN Lv1ATERIAL FACTS S WHICH SEICJED AS A (BASIS FOR ISSUANCE OF 'PHIS PERMIT, REQUIRE THE AeL'LICANT TO MODIi:'Y THE PERMIT ",PPY4CA'T1( SUCH MODIFICATIONS MAY RESULT IN THIS PERMIT BEING MADE NULL AND VOID. ISSUANCE O' THis 1'•E_;MIT DOES NOT EXEMPT THE APPLICANT FROM COMPLIANCE WITH OTHER FEDERAL, STATE OR LOCA.i. t'E RMITTING REQUIRED FON. PROPERTY DEVELOPMENT. SYSTEM DESIGN AND SPECIFICATIONS T A N K NOV-16-2001 04:08 r STATE OF FLORIDA DEPARTMENT OF HEALTH ONSITE SEWAGE TREATMENT AND L I'POSA!T. SY'J'EM CONSTRUCTION PERMIT 750 ]Gallons SEPTIC TANK 0 J Ca ] 1011S 0 ]GALLONS GREASE INTERCEPTOR C :A!'ACIT't 0 GALLONS DOSING TANK.CnPACITY [ Q D [ R [ A I N F I L D FILL REQUIRED :[ 0.0 'INCHES SPECIFICATIONS BY: C. I. APPROVED BY: Icaza, Carlos DATE ISSUED: 11/13/01 DH 4016, 03/97 (ot previous edi ions we,Lc :h r' y r 4 (Stock Number: 5'/44 -001- 4016 -0) [ 1 ! 1di:ig Tank [ ] Innovzr.ive Other ( ]T4;:(po4ary ( ] 4' SUBDIVISION: Miauta. Shores (5:=c_o)i/ own:;?? i fri Range /Parcel No.] (Of ":uAX 'l l:r N !MBEP.J 200 ]SQUARE FEET PRIMARY i)H ?INFIELD :;':S'1?EM 0 )SQUARE FEET SYST :M TYPE SYSTEM: [ Y J STAND. R i [ N JJ FII;LED CONFIGURATION: [ N 'TRENCH i if tlBEll LOCATION TO BENCHMARK: Finished Floor of E / *, 1O 90' NGVD ELEVATION Of' PROPOSED SYSTEM. SLTE [ 1.9 J (!FEET [ BOTTOM OF DRA.'(NEIELD• TO BE ' [ 4.4 'J L ;FEET 1 PaC :A.VAT :O. REQUIRED: OTHER REMARKS: j i This permit is not for addition (s). *Existing 750 gl. septic tank. *Install 200 sq. ft. of drainfield. ` *Invert elevation to be.no less than 7.00' NGVD. *Bottom elevation to be no less than 6.50' NG' D. "It is strongly recommended to increase the pyyEL high water consumption. TITLE: TITLE: Engineer I e uslc! 4LL•UNS ra L P.01 CEN'TRAX #: 13 -SG -10891 DATE PAID: FEE,' PAID : RECEIPT . OS'1'IUSNBR : 01 -3481- -R MULTI - CHAMBERED /IN SERIES: [Y ] MULTI-CHAMBERED/IN SERIES: (Y ]. DOSES PER 24 HRS # PUMPS[ 0 ] [ N 1MOUND [ N ] [ N EELOW J BENCHMARK /REFERENCE POINT BELOW J DENCIIMARK /REFERENCE POINT 1 3INSTALL T N 1 ' Ea LOAMY COARSE SAN UNDER D0TTDIVf DP ORA:W ELD Dade CHI); ¢f'JERT EZct:W J[1a,, b0 N6u� &O pp�� T .� a ��� 1 RR �nn A! � ] a ` c c� C��rr�ELErVAT Es 6.50 ►'s!? RTiErR DF ENCe� ATiS fAiw7 J Shia L �E AT LEAST 2.0 FEET v'IitEIR AND LUX THAN THE PROPOSED ADSORPTION BEISbR DRAIN TRENCH drainfield area to 300 sq.ft. due to ' EXPIRATION DATE: 2/11/02 J • • • • • Page 1 of 2 PPLICATION FOR: n ] ] Repair .PPLICAN : GENT: [AILING ADDRESS: GLti �( J 70 BE COMPLETED BY APPLICANT OR APPLICANT'S AU;x 3Y A PERSON LICENSED PURSUANT TO 489.105(3)(m); LPPLICANT'S RESPONSIBILITY TO PROVIDE DOCUi�N PLATTED (t, /DD /YY) IF REQUESTING CONSIDERATIO: PROPERTY INFORMATION COT: 10 BLOCK: PROPERTY ID tt : _ _ V) Q. eyz -k ( : )( 1 ZONING: PROPERTY SIZE: V•;3r) ACRES WATER SUPPLY: [ ) PRIVATE PUBLIC [‘,, 2000GPD IS SEWER AVAILABLE AS PER 381_0065, FS? ( Y / PROPERTY ADDRESS: BUILDING INFORMATION Unit Type of No Establishment 1 2 3 4 ( �] SIGNATURE: NOV 04:09 New System Floor /Equ STATE OF FLORIDA DEPARTMENT OF HEALTH ONSITE SEWAGE TREATMENT AND DI SYSTEM APPLICATION FOR CONSTRUCTION PERMIT I DH 4015, 10/97 (Previous Ed Existing System Abandonment SUBDIVISION: 1 ) kYE DIRECTIONS TO PROPERTY: - No. of 'Bedrooms ain . . [ /1] • ther ns May lie Uscd s Holding 'Tank Temporary TELEPHONE: I/M OR EQUIVAT,ENT: DISTANCE TO SEWER: DATE: P.02 PEE2MIT No_ DATE PAID: FEE PAID: REtEIPT.f#: `nC) ( ( Slic c: i ,y) ( /�1 Innovative HORZED AGENT. SYSTEMS MUST BE CONSTRUCTED OR ;489.552, FLORIDA STATUTES. IT IS THE TION OF THS DATE THE LOT WAS CREATED OR OF ISTATUTORY GRANDFATHER PROVISIONS. C.A PLATTED: �Q [ Y / N 1 ] >2000GPD FT ( i/ 1 RESIDENTIA7 j [ ] COMMERCIAL Avild ng Commercial /Institutional System Design Area Ogftl Table 1, Chaster 64E -6 FAC Page 1 or 4 'PLICANT: )T: SUBMITTED BY: NOV-16-2001 04:10 IQ IGNATURE OF LICENSED STATE OF FLORIDA DEPARTMENT 4OF HEALTH i ONSITE SEWAGE TREATMENT AND DISPOSAL YSTEM EXISTING SYSTEM AND SYSTEM REPAIRIEV ATION I )NTRACTOR / AGENT: 16 SUSDZV: J "%\ SLort:.S ID #: 11 - 3;ao5 7 - 0 )'ci — i CGl..tfo BE COMPLETED'BY FLORIDA REGISTERED ENGINEER,.tEPAFdTMENT EMPLOYEE, SEPTIC TANK CONTRACTOR OR HER CERTIFIED PERSON. SIGN AND. SEAL ALL SUBMI�D I Y)OCUMENTS. COMPLETE ALL APPLICABLE ITEMS. )MPLETE TANK CERTIFICATION BELOW OR ATTACH LETT FROM A PERMITTED SEPTAGE DISPOSAL SERVICE. • BLOCK: CISTING TANK INFORMATION: 4 ,11r6a GALLONS. SEPTIC TANK /.GPD ] GALLONS SEPTIC TANK/GPD:ATV ] GALLONS GREASE INTERCEPTOR 1 GALLONS DOSING TANK Se. e t J LEGEND: - ! f MATERIAL: (' horse I ∎ BAFFLED :0Y / LEGEND: MATERIAL: BAFFLED : (Y /"N] LEGEND: } MATERIAL: LEGEND: % ' MATERIAL: tl PUMPS:[ CERTIFY THAT THE ABOVE NOTED TANKS WERE PUMPED ION .. 1 . 01 . &14:10/, HAVE THE VOLUMES SPECIFIED, ARE PRU Y SO HAVE A [•SOLIDS. DF'LECTII DEVICE / OUTLET • FILTER DEVICE ] INSTALLED. XISTING DRAINFIELD INFORMATION 7 � 4:7) • ] SQUARE FEET PRIMARY DRAINFIELD SYSTEM NO. O F TRENCHES [ ] DIMENSIONS: O X /3 ] SQUARE FEET , SYSTEM NO. O{F TRENCHES [ ] DIMENSIONS: X p_ YPE OF SYSTEM:] STANDARD [ : ] FIT T•En [ ]a MO4i1) [ ] ONFIGURATION: [ ] TRENCH [Nn 8ED ( ]; j ESIGN: A001 HEADER C ] D -BOX L GRAVITY SYSTEM ( ] DOSED SYSTEM LEVATION OF BOTTOM OF DRAINFIELD IN RELATION TOLEXIS GRADE 3C) INCHES [ ABOVE I YSTEM FAILURE AND REPAIR,INFORMATION � CA ] SYSTEM INSTALLATION PATE f (79 ] GPD ESTIMATED SEWAGE FLOW BASED ON aIs DRAINAGE' STRUCTURES :ONDITIONS : f l] I] SLOPING PROPERTY IATURE OF [ ] HYDRAULIC OVERLOAD 'ALLURE: [ ] DRAINAGE / RUN OFF ,AILURE [ ] SEWAGE OW GROUND; SYMPTOM: [ ] PLUMBING BACKUP OR: BUSINESS • • 2EMARKS /ADDITIONAL CRITERIA - 1 TYPE S F W. TE - 1' ] PATIO / DECK [ ] SOILS; [U'] MAINTENANCE [ ] ROOTS; [ ] WATER TABLE [ I TANK [ E ] ] D BOX /HEADER DATE DOMEST ±C [ ] COMMERCIAL • ] TABLE .1, 64E-6, FAC [ () PARKING [ ] SYSTEM DAMAGE [ [ V] DRAINP XELD TIT$.E /LkCENSE 71 � DATE :// - °'( DH 4015, 10/96 (Previous Editions may be used) Page 4 of 4, NOV -16 -2001 04:10 LOT: to BLOCK: j--7 PROPERTY ID #: TO BE COMPLETED BY ENGINEER,:SEALTH UNIT PROVIDE REGISTRATION NUMBER AND SIGN AND STATE :OP FLORIDA DEPARTMENT OF :HEALTH ONSITt SEWAGE DISPOSAL SYSTEM SITE EVALUATION AND SYSTEM SPECI i PROPERTY SIZE CONFORMS TO SITE PLAN: e TOTAL ESTIMATED SEWAGE FLOW:. 00C) AUTHORIZED SEWAGE FLOW: ( UNOBSTRUCTED AREA AVAILABLE: BENCHMARK /REFERENCE POINT LOCATION: ELEVATION OF PROPOSED :SYSTEM !SITE IS THE MINIMUM SETBAC SURFACE WATER: WELLS: PUBLIC: BUILDING FOUNDATI• S: WHICH FT FT SUBDIVISIO vl g _0 1/0 a 4 Section /Township /Range /Parcel No. or Tax ID Numbei / i EMPOYEE, OR OTHER QUALIFIED PERSON. ENGINEER'S:MU; SE4 EA4.H PAGE OF SUBMITTAL. COMPLETE ALL ITEMS. • CAN BE MAINTAINED : ROM!THE PR POSED S DITCHES /S q: FT LIMITED 'USE: FT PR VATE: _ FT PROPER 4 LINES: /e2 FT SITE SUBJECT TO FREQUENT FLOODING: [ ] YES 10 YEAR FLOOD ELEVATION FOR SITE: !� S /NGVD SITE ELEVATION: SOIL PROFILE INFORMATION SITE Mu 1 olor Texture l45J/l, USDA SOIL SERIES: SITE EVALUATED BY: OH 4015, 10/96 (Replaaae HRS-H Form 4015 (Pepe 3J which ma (Stock Number, 3744- 003- 4015 -1) Depth to t o to to to 'to i ta OBSERVED WATER TABLE: (�L• 'INCHES ,[ABOVE /o] EXISTING GRADE. ; TYPE: (PERCHED / APPARENT; ESTIMATED WET SEASON WAT R TABLE ELEVATION: I '/ INCHES ( ABOVE / BELOW ] EXIST IN SST HIGH WATER TABLE VEGETATION: •[ ] YES (Sk NO MOTTLING: [ ] YES N TE: /2 CHE: LOADING RATE FOR SYSTEM SIZING: SOIL TEXTURE / � DEPTH, OF EXCAVATION: ��.J INCSE: DRAINFIELD CONFIGURATION: ( ] TRENCH be/I:BED( [ ] OTHER (SPECIFY) REMARKS /ADDITIONAL CRITERIA: • b • ICATIONS AGENT: F T D O ti as YES', [ j NO NET USABLE AREA AVAILABLE: 0.97 AGRI GA.I:ON$ PER DAY (RESIDENCES -TABLE 1 / OTHER -TABLE 2 GA'LONS PER DAY (1500 GPD /ACRE OR 2500 GPD /ACRE] SOFT UNOBSTRUCTED AREA:REQUIRED: ( Llfl?) SQE tt s.c, -J ( Ffar'S/FT] [D.D0' E /BELOW] R POIN YSTEM TO THE FOLLOWING FEATURES: NQRMALLY WET? ( ) YES FT NON- POTABLE: f) POTABLE WATER LINES: USDA SOIL SERIES:: 10 YEAR FLOODI PERMIT # ()I .),(7/9/ .f Texture = SOIL PROFILE INFORMATION SITE 2 DATE: P.04 [ ] YES (X) N FT MSL /NGV Depth t to to to to to to to Page 3 of NOV-16-2001 04:11 STATE OF.FLPRIDA .DEPARTMEN OF HEALTH APPLICATION FOR ONSITE SEWAGE DISPOS4 SYSTEM CONSTRUCTION PERMIT Permit Application Number / 3 PART II ;ITE LAN Scale: Each block represents 10 feet and 1 indh = 46 fee Site Plan submitte Plan Appro e By • DH 4015, 10/96 (Replaces HRS-H Feint 4015 which may be used) (Stock Number. 5744-002-4015-6) ALL CHANGES MUST BE APPROVED; BY tHE COUNTY HEALTH DEPARTMENT P. 05 A ;W. APYA 12 Not Approv % Date a ! County Health Department Page 2 of 4 NOV -16 -2001 04:11 P.06 Owners Name: (,U ILL(AN - Co L .- -cs Property Address: 111 Nc loo - r- Ffi LEGAL DESCRIPTION OR FOLIO # : 1/ - 3,205 - o l 9 - (246 Lot I 0 , Block • 17$ of 7' 5kDre` . , �e'- according to the plat thereof as recorded in plat Book 43 at Page 67 of the Public Records of Dade County, Florida. SURVEYOR'S NOTES: 1) Not valid. without the sign a the .o nal taised seal of a Florida Licensed Surveyor and Mapper. i 2) Additions or deletions to this certificate by ether than the signing party or parties are prohibited without written consent of the signing party :ar parties. 3) This certificate elevation is .for the purpose of sep and drains repair and /or construction. 4) This certificate elevation must not be use forithe Ourpose of acquiring flood insurance 5) Elevations are based on the National Geodetic Vrtical Datum of 1929. 6) Flood Zone: 44 Base ;Flood Elev.: g.O r ?s ppr Dade County, Florida. FEMA Panel Number: 12065a - 0013 J - MARCH 2, 1994 TOP OF BOTTOM FLOOR: TOP OF NEXT HIGHER FLOOR :' ATTACHED GARAGE (at the ddor GRADE © DRAINF'1ELD AREA • f CROWN OF THE ROAD: Field Date: ELEVATION CERTIFICATE Pa ; k • = :ons Professionaol Surveyor& Mapper State of Florida-Reg. No.5880 TOP GUN GROUP, INC "291 E. 38 STREET, HIALEAH, FLORIDA 33013 Phone 305 -822 -6062 * Fax: 305- 827 * Cellular; 305 - 345 -4764 E -mail: To GuhLSrv(a�AOL.cotn NOV-16-2001 04:12 MIAMI-DAM COUNTY PROPERTY APPRAISER1PUBLIC ACCESS ADDRESS: 1010 NE 100 ST Use scroll bar to view com4te information. • • , . FOLIO NUMBER: 11-3205-019-0480 ADDRESS: 1110NE 100ST MAILING ADDRESS: IMLIJ AM COLIAZOS &W ALEXANDRA 11110 NE 100 ST , MIAMI SHORES FL, 33138-M2 CLUC: 0001; FiESIDENMAL- SINGLE FAMILY PRIMARY ZONE: 1100 SINGLE PAM/1Y RESIDEl4E , I 13E0ROOIVIS: 2 . . .; BATIO: 2 . „ FLOORS: 1 • ' LIVING UNCTS: 1 ,. . ACIJ SQUARE FOOTAGE: ' ZS! LOT SIZE: item SO FT YEAR BUILT: 1958 LEGAL DESCRIPTION: MIA41ISHORES SEC 8 REV PB 43-87 COT 10 BU( 178 LOT SIZE 98050 X 119 OR 17041-4825 1295 1 SALE OR: 17041-4825 SALE MONTH: '12 SAL4 YEAR 1995 SALE AMOUNT: $ 117,500 ASSESSMENT YEAR: 2001: ASSESSED VALUE: $ 158,237 LAND VALUE $ 85282 HOMESTEAD EXEMPTION: $ 25,000 BUILDING VALUE 5143,509 WDOW EXEMPTION: $ 0 MARKET VALUE: $ 228,771 i TOTAL EXEMPTIONS: $ 25,000 TAX4SLE VALUE: $ 133,237 I ASSESSMENT YEAR: 2000 :.. ASS4SSED vaLue $ 153,828 LAND VALUE $ 73884 '.) HONIEMAD EXEMPTION: $ 25,000 BUILDING VALUE: 8 128,825 i WDOW DtEMI:rnON: $ 0 MARKET VALUE: $ 202,519 ' TOT/L E<BVIPTIONS: $ 25,000 TAXABLE VALUE: $ 128,90 ■ Owner Search Address Sarcii Folio Number Search HOOle. P. 07 http://gisims.co.miami-dade.flxs/scripts/esrimap.411?Narne—PublicAccess&Cmc1=SearchA.. 11/13/2001 NOU -16 -2001 04:12 Page: 1 Document Name: MS G HOWARD /LSTU 10:09 AM 11 -13 -2001 021803 yUNIT= 1 METER #1 DOS W CCF PROJECTED 33 10 /01 86 33 10 /01 ADJ 7/01 92 7/01 ADJ 4/01 90 34 4/01 ADO' 1 /01 88 94 10/00 93 44 7/00 92 102 4/00 91 68 z /00 94 39 10/99 91 35 7/99 91 53 4/99 88 56 1/99 95 51 P/N Date: 11/13/ 1;Time: 10:06:05 AM 600 bA mSSaQ 'NE 100 ST 1110 MO S METER #2 METER#3 METER #4 METER4#5 INTER 46 RATES ?;1c 51Ylid l 34 • ---> 2 4-62 'k RAD # R A D R A D R A D R A D R A D RA D R A D R R A -D R A - D R A -8 A200 SF00 5 SPECIAL ONLY MBE.. P.08 TVA 6z:TT TO /£T /TT NOV -16 -2001 04:12 Jeb Bush Governor Chapter 64E- 6.004(3)(a), F.A.C.: Robert G. Brooks, M.D. i Secretary James J. James, M.D., Dr, P.H.,M.H.A., Director "WELT; FORM" DOH# A plan or plat of the lot of total site ownership drawn to scale, showing boundaries with dimensions, locations or residences or build ngs, Iswinmming pools, recorded easements, the on -site sewage disposal sy tem location, the geneial slope of the property and any existing or proposed wells; drainage features, filled areas, Obstructed areas, and surface waters such as lakes, ponds, streams or canals. The location of wells, on -site sewage disposal systems, surface waters and other pertinent facilities of feadtures on contiguous or adjacent property, if the features are within75 feet of the applicant lot, must also be shown but need not be drawn to scale. The location of any public pbtabl water system well, as defined in Chapter 64E- 6.002(40)(b), within 200 feet, and the location of limited use non- community or other public wells, as defined in Chapter 64E- 6:0112(40)(b), within 100 feet of the applicant lot must also be shown, or as defined in Chapter 60- 6.002(4)(a), F.A.C., within 75 feet from a private potable water well (well used only byfouror less non - rental residences). Chapter 4616.1(p) South Florida Building Code: Wells shall be located as to be free of contamination from unsafe water supply and shall be at least 100 feet frpm a septic tank, drainfield, soa age: pit or discharge well.... Under Chapter 64E -6, F.A.C., underdrains connected to a drainage system arc considered an extension of surface water. The minimuu se for lots platted prior to January 1, 1972 is 50 feet. The minimum setback for lots plattted on or after .January 1, 1972 is 75 feet. Where solid pipe is used to connect underdrains to an existing stormwater system, the setbacks would be applicable only to the underdrains, not the solid pipe; I have read the above and to the best of my knowledge I have provided the Department with full information regarding pertinent facilities and features on all adjacent properties. Furthermore, I understand that any Septic Tank Construction Permit issued on the basis of said facilities and features as provided by sne aid found to be incorrect will be subject to • • • P. 09 0 (- 5 i TOTAL P.09 ELECTRICAL TYPE Minimum Fee QTY. TYPE 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 � avatory Low -volt, Television Service, Number of Amps Water Heater New MECHANICAL TYPE QTY. Minimum Fee TYPE Condensate Drain QTY. TYPE Generator QTY. TYPE QTY. 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 TYPE A/C Condensate QTY. TYPE Drains, Roof QTY. TYPE Miscellaneous Fixture QTY. TYPE 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. � avatory 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. RECEIVED AND REVIEWED BY: DATE: Page 4 OFFICE USE ONLY CHECKLIST ❑ OWNER - BUILDER FORM (Attach) ❑ FIRE DEPARTMENT APPROVAL (Commercial / multi- family) ❑ CONCURRENCY (New Construction) ❑ OTHER (Specify & Attach) ❑ PROOF OF OWNERSHIP (Attach) ❑ HRS / DERM APPROVAL (Septic / Sewer) LI IMPACT FEE (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 $ o s o c� $ 3b e., $ ' ° C\ 0 (sq.ft. = x/1000 it x 0.60) $ 5 'o o SECTION Zoning Electrical Mechanical Plumbing Fire Public Works Structural Building Official BY DATE (¢.005 / sq.ft.) (¢.01 /sq.ft.) REVIEWED AND PREPARED BY: PERMIT APPLICATION ❑ CONDO ASSOCIATION APPROVAL (Attach) ❑ BPR APPROVAL (Restaurants) ❑ CONTRACTOR REGISTRATION (On File) 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