1310 NE 101 St (9)Date 3" 8- R 9 Job Address 1:MO WE" 101S1 Tax Folio
Legal Description Lor / ,SGOCIc / LJ�/% -5 6..3kej AtlEk STATE"✓
/ Lessee / Tenant a{Q ke5• 2.c &e.D0 QoUt11
Owner's Address , /9 J6l 5
Contracting Co. , P A� 414PritH @IZP • Address r71Z - fte.
Qualifier lkiaPE61 61 fr4F Phone (
State # Municipal # 131115 Competency # 12-409 Ins.Co. " 4TYMUTUN- o
Architect /Engineer GitUtseS atalaaeo Address
Bonding Company Address
Mortgagor Address
Permit Type(circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIPTION 1 200 &ot/- S&1 - 7C ' Z wk / P4 iv P-Pe
Square Ft. Estimated Cost(value) .
WARN.NG TO OWNER: YOU MIST 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, PLU BING, SIGNS, POOLS, ROOFING and MECHANICAL WORK.
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. Furthermore, I
authorize the above -named contractor to do the work stated.
ymond
tS
Public
Siggature of • r and /or Co
Date: Qb5/ I
4444.. A
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
* * *
** *
Notary as to Owner and /or Condo President
My Commission. Expires:
FEES: PERMIT A!./ RADON
APPROVED:
t 2 r l t OF FLORIDA Sign: -'of
My C BONDED
Date:
Notar; as V.
My C.' ission
Zoning
Mechanical
Buildin
C.C.F. /ADO
Fire
1/ ,2g Ole d
P1B 55 /
Master Permit 4/ rk
Phone
ractor or Owner- Builder
Contracto or Owner- Builder
• JORGE MONTEAGUDO
MY COMMISSION 0 CC 248619
D(PIFI£S: January 25,1997
; d n ,,, NOW Thu Nowry Public Un otters
lit
NOTARY TOTAL DUBAO
* *.
Other
Electrical
Engineering
LOT: BLOCK: /
PROPERTY ID #:
cesm®ommmncn
STATE OF FLORIDA PERMIT #
DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES- - RECEIPT #
ONSITE SEWAGE DISPOSAL SYSTEM FEE PAID
CONSTRUCTION INSPECTION AND FINAL APPROVAL DATE PAID
Authority: Chapter 381, FS & Chapter 10D -6, P'AC
APPLICANT: �{�,
✓� / ENTt
PROPERTY STREET ADDRESS: /2 ' y / ,
CHECKED (X) /TEI4S ARE PIU'1' IN COMPLIANCE
SUBDIVISION; f6,_. , /� ���• � -� • rr
f_1/4-
TANK INSTALLATION
[01) TANK SIZE (I) IPSO (2)_
(02J TANK MATERIAL C . /J C& to
(03) OUTLET DEVICE
[04) MULTI CttAMBE1+.5 ��-
(05) LEGEND ‘ f17-"/ 1 ? S 1
(06) WATERTIGHT
[07] LEVEL
(08] DEPTH OF LID
D1tAINFIELD INSTALLATION
AREA [ I) X ]?a'S C } SQFT
DISTRIBUTION 30XLUXIElt>
NUMBER OF DRAINLINES
DItAINLINt; SEPARATION
DRAINLINk SLOPE
DEPTH or COVER
SYSTEM ELEVATION
SYSTEM LOCATION
UUsING PUMPS
AGGREGATE SIZE
AGGREGATE SOURCE
AGGREGATE WASHED
AGGREGATE DEPT);
1=ILL /EXCAVATION MATERIAL
1/1 [22) FILL AMOUNT
(.� ) (23 ] FILL 'I'tsXTuRE
I d' [ 24 )
[ [25]
(26)
EXCAVATION DEPTIH
EXCAVATION AREA
REPLACEMENT MATERIAL
15..: LANATI UN OF VIOLATIONS:
t::.1: :TRUCT ION [APPROVEDISISAPPROVEU) :
FINAL SYSTEM APi.K3 ED /DI5)PP1t0VED) :
7
jl,a H Form 4016, Or VT- TOtisoletes preview editions which may not
* rock Number: 5744- 002.4016.4)
(SECTION/TOWNSHIP/RANGE/PARCEL NUMBER)
-- (OR TAX ID NUMBER)
c
WITH CHAPTER 10D -6, FLORIDA
AQCZ
[
SETBACKS
[27]
1
(29)
I1/T (
(r '%i (
(✓f (3 21
(. --1r, (33)
1 v ( )
( ) 1
FILLED /MOUND SYSTEM
( 1 [36] DR.AINFIELD COVE
1 1 (37) SHOULDERS
( 1 (38) SLOPES
( 1 (39] STABILIZATION MATERIAL /
ADDITIONAL INFORMATION (Lj _ [40)
1 1
t ) (42)
[43)
[L1 [
t'!1' (45)
) 1
147)
[48)
(
be used)
7?
SURFACE WATER
D1TCHES
PRIVATE WELLS
PUBLLC WELLS
IRRIGATION WELLS
POTABLE WATER LINES
BUILDING FOUNDATION
PROPERTY LINES
OTHER
UNOBSTRUCTED ARrA
STORt1WA1'LR RUNOFF
ALARMS
MAINTENANCE AGREEMENT
BUILDING AREA
PLUMI3LNG FIXTURES
FINAL SITE GRADING
CONTRACTOR
OTHER
ABANDONMENT
( 1 [49] TANK PUMPED `
[50] TANK CRUSHED AND FILLED
=n rr
ADMINISTRATIVE f'orE.
i
4z<4. yC tS/ (" :1 ti e4-1
1 _
ail J.q.
CNN' DATE : a` .',
cr'HU DATE: __.....
Pacer. 2 ut
BUILDING INSPECTION DEPARTMENT
APPLICATION FOR BUILDING P
Application is hereby umdc for the approval of the detailed statement ui cite plans and specifications herewith submitted for the build.
Inc 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 $hall be complied with, whether herein sPecified or not. A copy of approved
plans and specifications must be kept at building during prggress of the work.
Owner's Name and Address Marie Kennedy
MIAMI SHORES VILLAGE
Date
Registered Architect and /or Engineer..
MAYO ROOFING COMPANY
Name and address of licensed contractor...,
Disapproved
(Signed)
Building Inspector
9/25/80
_ N o 131Q
Notary Public, . e of Florid
Spreet,.....I�,.F,.......l,Q i...S'�....
Location and legal description of lot to be built on:
Lot Block Subdivision
IAI
Street and Number where work is to be done 1310 N.E. 101 $tSr „_ -:_ _ —
_ Replace white tile roof - 38 squares
State work to . be done and purpose of building (by floors) .,.._..�....,.
and for no other purpose.
New Building Remodeling Addition , Repairs No. of Stories
To be constructed of Kind of foundation Roof Covering White Cement Tile
Estimate Total cost of improvements $ 9 r 000.00 Amount of Permit S.I LQD
Zone cubage required .Plan Cubage
Distance to next nearest building.. Size of Building Lot
Maximum live load to be borne by each floor
I hereby submit all the plans and specifications for said building. All notices with reference to the building and its construction may
be sent to..
The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations as an f•mployer
of labor under the Florida Workmen's Compensation Act, being Section 596G, Compiled General Laws of Florida, Permanent Supplement,
and has complied 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 arc required by the Act. The undersigned agrees to employ only such subco . actors, on work to be performed under this
permit, as are licensed by Miami Shores Village.
Remarks — _._._._ (Signed)
STATE OF FLORIDA,
COUNTY OF DADE. ss '
Before mc, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally ap-
peared
and who, being by me first duly sworn, upon oath deposes and says that he is the.
the above described construction, that he has carefully read the foregoing applicati':f , and thalhe did sign the and f}s t all facts
therein by him stated e. /1 I a
Permit No � D ate ” 1 J l �� , _ Read, orn t . and � ,Subscri . �v • fore roe,
My Commission Expires..JAPTARY PUBLIC STATE OF FLORIDA AI- LARGE
MY COMMIVStON litI IOLT
PLANNING BOARD BONDED DELI W INS. UNDERWRITE
Chairman Member
DATE BO , .
Mcu,ber Member
Member .. .. ,. ,... r ....._......,...._._ ,.. Member
t - ......
Council Approved Date Disapproved Pate
NOTE: A charge of $1.00 will be made for making corrections or changes to this application after approval has been obtained from
the Planning Board.
A re,iu.pection fee of $1.00 will be charged when such re- inspection is made necessary by Improper notice for inspection out (betty
materials and /or workmanship.
to me well known.