1254 NE 100 St (5)1
" ?(10
DES � ,.
BUILDING
PERMIT APPLICATION
FBC 2001
Permit Type (circle): Building Electrical
Owner's Name (Fee Simple Titleholder)
Owner's Address 1254- pl E 100
City M k v ."'; S h Oc . State
Tenant/Lessee Name 'IQ A
Contractor's Company Name '` ce G
Contractor's Address Pc w x 38
City x,11 ,✓C cv cl State FL-
Qualifier Ter @:3a J. Sao , ..e•
Total Fee Now Due S L i . 0 1 T
(Continued on opposite side)
Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
( ' +(o Phone #
Permit No.
Master Permit No.
O'eSvS Do CC.,ss / 6 r ba fa Phone #
Sire�� Mc
FL Zip 33138
Phone #
Mechanical Roofing
Job Address (where the work is being done) 12 F f 14E 1 c'tI' 5{ --
City Miami Shores Village County Miami -Dade Zip 3313 b
Is Building Historically Designated YES NO tr
Zip 35013 3
Architect/Engineer's Name (if applicable) NIA Phone #
$ Value of Work For this Permit � 2CC O" Square Footage Of Work: 3c o St e+
Type of Work: DAddition ❑Alteration ❑New Repair/Replace ❑ Demolition
Describe Work: (n 5.1 - Pit 1•1e, Dro rl P td
* * * * * * * * * * * * * * * * * * * * * * * * * * ** F ees * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
Submittal Fee $ Permit Fee $ 1 I S.00 " CCF $ i : LO ' t t -�
Notary $ 5 . CO Training/Education Fee $ 140 Technology Fee e $ 4 J !
Scanning $ 3 . co Radon $ Bond $ ^->. - C�J
Code Enforcement $ Structural Plan Review. $
Bonding Company's Name (if applicable) N Pc
Bonding Company's Address
City State Zip
Mortgage Lender's Name (if applicable) N
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." r F 1 , ',
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 Signature
er or Agent
ntractor
The foregoing instlment was acknowledged before me this Ei The foregoing instrument was acknowledged before me this
day of , 20 by
who is personally known to me or who has produced Vt. t P'' v , who is personally known to me or who has produced
as identification and who did take an oath.
day of Dec, , 2(P.3 , by , S v S iD v c sS
Chc 10/14/03
Li c <nsfr
NOTARY PUBLIC:
Sign:
Print:
My Commission E
As identification and who did take an oath.
1
� MON
.. : _ }.
NOTARY PUBLIC:
Sign:
Print:
VT` J . h.,
II Of I� r �. co.
* * * * * * * * * * * * * * ** *�pp�l6QI
A,� Fl NdW ,. ******************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
(Certificate of Competency Holder)
My Commission Expires:
State Certificate or Registration No. Certificate of Competency No.
*** * * * * * * * * * * * * * * * * * * * * * * * * * **1* ** *************************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
APPLICATION APPROVED BY: 44.--< J r " t j 1 ' t-1 J Plans Examiner
Engineer
Zoning
1030201
NOT A ORNFR LICENSE
The Sunshine State
IDENDRIZMICt4 NUMBER
S455-810-67-712-0
TEFtES JOHNSON SOLOMON
4310 SW 26114 ST1REET
HOLLYWOOD, R. 330234412
OATE SEK HGT.
06-1247 F 6-03
1.•:"
ISSUED EXPIRES DUPIJCATE
11-0348 064243 maw
RESIDENT: YES
IMNTIRCATION IINIRPCXSFS OM V
1L/ lt7/ zon.1 tali: 4Y J11bb1.13472
STATE OF FLORIDA -
DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM
CONSTRUCTION PERMIT
PPLICANT: Duaoesi, Jesus AGENT: 3A0021074, Solomon Teresa
'ROPERTY STREET ADDRESS: 1254 NE 100 Bt Miami shores FL 33138
SOT: 4 BLOCK: 1 SUBDIVISION: Earleton Shores
[Section /Township Range /Parcel No.)
ROPERTY ID #: 11- 3205 - 009-0040 [OR TAX ID NUMBER)
YSTEM DESIGN AND SPECIFICATIONS
. [
[
[ 150 ,] SQUARE FEET PRIMARY DRAINFIELD SYSTEM
[ 0 ]SQUARE FEET SYSTEM
TYPE SYSTEM: [ y )STANDARD [ N )FILLED
CONFIGURATION: ( N )TRENCH ( Y ]BED
FILL REQUIRED:[ 0.0 )INCHES EXCAVATION REQUIRED: [ 42.0 ] INCHES
THER REMARKS:
THIS PERMIT IS NOT FOR ADDITION
PECIFICATIONS BY Andrd, P
PPROVED BY: Andre, Paul
ATE ISSUED: 12/9/03
OSTDS
b.>l, EEFUMPED
VICE INSTALLED
TITLE; Profesaioxxal Enq�n
PAGE 01
CENTRAX #: 13 -SG -10809
DATE PAID:
FEE PAID : $
RECEIPT :
OSTDSNBR : 03 -3722- ■R
'ONSTRUCTION PERMIT FOR:
)New System ( )Existing System ( l Holdirng Tank ( ] Innovative Other
X ]Repair" ( ]Abandonment ( )Temporary ( NA )
YSTEM MUST BE CONSTRUCTED IN ACCORDANCE WITH SPECIFICATIQNS AND STANDARDS OF CHAPTER 64E -6,FAC
MPARTMENT APPROVAL OF SYSTEM DOES NOT GUARANTEE SATISFACTORY PERFORMANCE FOR ANY SPECIFIC TIME
ERIOD. ANY CHANGE IN MATERIAL FACTS WHICH SERVED AS A BASIS FOR ISSUANCE OF THIS PERMIT,
:EQUIRE THE APPLICANT TO MODIFY THE PERMIT APPLICATION. SUCH MODIFICATIONS MAY RESULT IN THIS
'hRMIT BEING MADE NULL AND VOID, ISSUANCE OF THIS PERMIT DOES NOT EXEMPT THE APPLICANT FROM
'OMPLIANCE WITH OTHER PEDERAL, STATE OR LOCAL PERMITTING REQUIRED FOR PROPERTY DEVELOPMENT.
MULTI - CHAMBERED /IN SERIES: [Y J
MULTI- CHAMBERED /IN SERIES: [Y ]
900 ) Gallons SEPTIC TANK
0 ]Gallons
0 ]GALLONS GREASE INTERCEPTOR CAPACITY
0 ]GALLONS DOSING TANK CAPACITY [ 0 )GALLONS ® [0 ]DOSES PER 24 HRS # PUMPS[ 0 ]
[ N ]MOUND [ N ]
[ N J
LOCATION TO BENCHMARK: Satiating Finished Flour Elej,, :9.60 Ft Navel,
ELEVATION OF PROPOSED SYSTEM SITE ( 2.2 ) [ FEET 3 [ BELOW )BENCHMARK /REFERENCE POINT
BOTTOM OF DRAINFIELD TO BE [ 4.7 ] [ FEET ] [ BELOWJBENCHMARK /REFERENCE POINT
1• Existing 900 gallons peptic tank to remain.
2.-Install 150 square feet drainfield in bed configuration.
3.- Invert elevation of the drainfield to be no less than 5.40' NGVD.
4.- Bottom elevation of the drain£ie14 to be no Lees than 4.90 NGVD.
5. Perimeter of excavation shall be 2 ft wider and longer than the proposed abaortion bed.
Dade CHD
EXPIRATION PATE: 3/8/04
12/10/2003 08:42 3055133472
PART II - SITE PLAN- -
•
Icale: Each block represents 5 feet and 1 inch 50 feet.
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lite Plan submitted
Plan Approved
OSTDS
STATE OF FLORIDA
DEPARTMENT OF HEALTH
APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PE
Permit Applicatton Number
IT I • "
40 AI 1.1 1_1
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Signature
Not Approved
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PAGE 02
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6,4(cc-hpe
County Health Department
Miami Shores Village
10050 NE 2nd Avenue
Phone: 305 - 795 -2204 Permit Number: PL2003 -339
Printed: 12 /15/2003
Applicant: BARBARA
Owner: MESSICK
JOB ADDRESS: 1254 NE 100
Parcel # 1132050090040
Signed: (INSPECTOR)
Plumbing Permit
MESSICK
BARBARA
ST
Contractor STATEWIDE SEPTIC CONNECTIONS Contractor's Address: 18800 N. W. 2nd Ave #223
Local Phone: 305 - 661 -6633
Permit Status: APPROVED Permit Expiration: 6/8/2004 Construction Value: $2,000.00
Work: INSTALL NEW DRAINFIELD
Page 1 of 1
Legal Description: EARLETON SHORES PB 43 -80 LOT 4 BLK 1 LOT SIZE 75.000 X 109
Fees: Description Amount
FEE2003 -8202 Builders Bond $300.00
FEE2003 -8203 Building Fee $175.00
FEE2003 -8204 CCF $1.20
FEE2003 -8205 Notary Fee $5.00
FEE2003 -8206 Training and Education Fee $0.40
FEE2003 -8207 Scanning Fee $3.00
FEE2003 -8208 Technology Fee $4.37
Total Fees: $488.97
Total Fees: $488.97
Total Receipts: $488.97
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:
BUILDING
ELECTRICAL
PLUMBING
ROOFING
4.j
Owner of "--
Building /
Architect
Contractor
or Builder 4 e:
❑
0
Legal Lot
Description —
Address of
Building ' ?
MIAMI SHORES VILLAGE. FLORIDA
DATP L i 195 _
PERMIT 11T° 3771
/
Work to be performed under this Permit
B1
i
Si
Subdi-
vision
Value of
Project $
Contractor's
License No /
Amount of ,•/' ;
Permit $
This permit is granted to the contractor or builder named above to construct the building or to install the equipment or device described in the application
herefor in strict compliance with all ordinances pertaining thereto and with the understanding that the work will be performed in compliance with any plans,
drawings, statements or specifications that may have been submitted to and approved by the proper municipal authorities. This Permit may be revoked at any
time if the work is not done in compliance with such ordinances or if the plans are changed without authorization. A further condition upon which this permit is
granted is the understanding that the contractor or builder named above assumes the responsibility for a thorough knowledge of the ordinances and regulations
pertaining to the work covered hereby whether shown on the plans or drawings or in the statements or syeeifications and that he assumes responsibility for work
done by his agents, servants or employees. J r
Signed � `�BY
INSPECTOR
In consideration of the issuance to me of this permit I agree to perform the work co d hereunder in compliance with all ordinances and regulations
pertaining thereto and in strict conformity with the plans, drawings, statements or specification§§ submitted to the proper authorities of Miami Shores Village. In ac-
cepting this permit I assume responsibility for all wofk done by either, myself, my agent, servant or employee.
r _;r
CONTRACTOR OR BUILDER
c
BY
AUTHORITY e
Permit No 3 2 7(
MIAMI SHORES VIL:',AGk
PLUMBING INSPECTION DEPARTME':
APPLICATION FOR PLUMBING
No
Account of Permit $---- - - - - -- - ------ - - - - -- (Signed)---- -�--•
Date
Repairs
( Signed) -•- j-
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 conf:,u ,,ity 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 shell be complied with, whether herein specified OT rot. A copy of approved plans and specifications must be kept at
building during progress of work.
Street__ 1. —. ; ' a
Subdivision- .--- :_..._.- ___. - - - -•
StreeLW . -
r
Owner's Name and Address__.
Registered Architect and /or Engineer _
. t� � � � 7 - 7 — t �' C c I �j
� _ _ �_ -: o . ._____.__._.___._ _ S ? ��� / A Employing Plumber's Name
Location and Legal Description Lot_ Block_
Street and Number where work is to be performed —No /' T
State work to be performed and purpose of building (By Floors)_ P V.i? t
New Building ____ -- _ -- Remodeling------------------- _ -.___ Addition
<� -gi
No. of Stories.._
Size Septic Tank. Type of Tank Capacity Gals.
Feet of Drain Tile. Dist. Feet of Tank or Drain Field from Well
Nature of Water Supply: City —Well
..Size of Soakage Pit
Plumbing nspector.
The undersigned applicant for this building permit does hereby certify that he understands and accepts his ob 'gations 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 die Act. The undersigned agrees to employ only such sub- contractors, on work to be performed under this •ermit, as are
licensed by Miami Shores Village.
STATE OF FLORIDA,
COUNTY OF DADE.
Eefore 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 workmanship.
CLOSETS
BATH
TUBS
SHOWERS
LAVA.
TORIES
SINKS
SLOP
SINKS
LAUNDRY
rues
U RINALS
CATCH
BASIN
FLOOR
DRAIN
DRINKING
FOUNT'NB
TOTAL
FIXTURES
CONTR.
LIST
CHECK
SEPTIC
TANK
SEWER
CONN.
DRAIN
FIELD
SOAKAGE
PIT
GREASE
TRAP
SOLAR
HEATER
DEEP
WELL
SPRKLR.
SYSTEM
SWIM'G
POOL
CONTR.
LIST
CHECK
Permit No 3 2 7(
MIAMI SHORES VIL:',AGk
PLUMBING INSPECTION DEPARTME':
APPLICATION FOR PLUMBING
No
Account of Permit $---- - - - - -- - ------ - - - - -- (Signed)---- -�--•
Date
Repairs
( Signed) -•- j-
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 conf:,u ,,ity 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 shell be complied with, whether herein specified OT rot. A copy of approved plans and specifications must be kept at
building during progress of work.
Street__ 1. —. ; ' a
Subdivision- .--- :_..._.- ___. - - - -•
StreeLW . -
r
Owner's Name and Address__.
Registered Architect and /or Engineer _
. t� � � � 7 - 7 — t �' C c I �j
� _ _ �_ -: o . ._____.__._.___._ _ S ? ��� / A Employing Plumber's Name
Location and Legal Description Lot_ Block_
Street and Number where work is to be performed —No /' T
State work to be performed and purpose of building (By Floors)_ P V.i? t
New Building ____ -- _ -- Remodeling------------------- _ -.___ Addition
<� -gi
No. of Stories.._
Size Septic Tank. Type of Tank Capacity Gals.
Feet of Drain Tile. Dist. Feet of Tank or Drain Field from Well
Nature of Water Supply: City —Well
..Size of Soakage Pit
Plumbing nspector.
The undersigned applicant for this building permit does hereby certify that he understands and accepts his ob 'gations 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 die Act. The undersigned agrees to employ only such sub- contractors, on work to be performed under this •ermit, as are
licensed by Miami Shores Village.
STATE OF FLORIDA,
COUNTY OF DADE.
Eefore 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 workmanship.