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144 NE 101 St (6)• • • . • • • • • • • • • • • • • • • .. • • • • • • • • •••• • • ••• • • •••• • • • • • • •• • • • • • • • • • • • •• ••• ""1 Miami Shores Village 10050 NE 2nd Avenue Phone: 305 - 795 -2204 Printed:1 /10/2003 Applicant: MIAMI SHORES CHRISTIAN Owner: CHURCH JOB ADDRESS: 144 NE 101 Contractor MIAMI DADE ENVIROMENTAL Local Phone: 786 - 251 -4099 rcel # 1132060131990 • Fees: FEE2003 -210 FEE2003 -212 Description Building Fee Notary Fee Total Fees: Amount $80.00 $5.00 $85.00 Total Fees: $85.00 Total Receipts: $0.00 � I • Permit Status: APP(2OVED Permit Expiration: I Work: PUMP AND ABANDONMENT a • • PAY TO THE ORDER OF LL� FOR/ h o OCEAN e8 20 2601 S. DAYSMORE DR. COCONUT OROVE.FIORIDA 33133 Secur! nced d o c u m r It 1 - /Of- / - HAn,(i!i 0 ,\1 :0660:11 L39 21: MIAMI DADE ENVIRONMENTAL � SERVICE INC. 9591 o MIAMI, FL 33172 • - • i See to v ock C/-7 S5 20 200 .L 9 or d e f a I 15. 10 DATE fe,410) t, 9u'0 5 156 y7/ 63- 1139/660 20 DOLLARS 8 .2 ... Legal Description: MIAMI SHORES SEC 1 AMD PB 10 -70 LOT 9 Plumbing Permit Permit Number: PL2003 -4 7/9/2003 CHURCH MIAMI SHORES CHRISTIAN ST Contractor's Address: 9591 FOUNTAINE BLUE BLVD #208 Construction Value: $2,400.00 Page 1 of 1 Re- inspection BLK 15 LOT SIZE 50.000 X cation herefor in strict compliance with all fications that may have been submitted to or if the plans are changed without lonsibility for a thorough knowledge of the that he assumes responsibility for work done Is pertaining thereto and in strict conformity Isponisibility for all work done by either • • ••• • • • ••• •• •• • • • • • •• •• • • • • • • • • • • • • • • • • • • • • ••• • • • • • • • • • • • • • . ....... • ••• •• • • • • • •• • • • • • • • • • •• • • • • • • • • • • • • • • • • • ••• • • • • • • •• • • • • • • • • • • • • • • • • • ELECTRICAL TYPE Minimum Fee QTY. TYPE Dryer • Q • • 'IYPE _ t ut•tpAegliance• QTY. TYPE. Service Repair QTY. A/C Central 1 -3 Ton Fan Outlet, Wall Service, Temporary A/C Central 4 -7 Ton Fire Pump Outlet, Switch 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 MECHANICAL TYPE Minimum Fee QTY. TYPE Condensate Drain QTY. TYPE Generator QTY. TYPE Refrigeration, Tons QTY. 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 Supply, AC Well Bath Fan - Vented, # Fireplaces, Number of Pressure Vessel Temporary Toilet PLUMBING TYPE A/C Condensate QTY. TYPE Drains, Roof QTY. TYPE Miscellaneous Fixture QTY. TYPE Soakage Pit Q "1'1'. 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 work3eing perf3rdj►ed qua ttity(ies) in the space provided below. AA A. • 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 Inspector State Educational Fund State DCA (Radon) Code Enforcement Fine Zoning Review Notary • • • • • ••. • ••• • •• • ••• • , • • • • • • • • ••• • • • • • • .• • d PROOF OI'OWNERSII1r (Attach) •• ••• •• • • • •• . • • • • • • • , ❑ .IRS P00211[ PRVIAG' '.(Septic /'Sawerr' • : '.. ❑ IMPACT FEE (New Construction) Cl OTHER (Specify & Attach) PERMIT FEES ?Q 00 Metropolitan Dade County (C.C.F.) $ ��� + ( sq.ft. = x/1000 x (t.60) $ 8,00 • • •• •• • • • • (¢.005 /sq.ft.) (¢.01 /sq.ft.) PERMIT APPLICATION ❑ CONDO ASSOCIATION APPROVAL (Attach) ❑ BPR APPROVAL (Restaurants) ❑ CONTRACTOR REGISTRATION (On File) TOTAL $ FG f 0 v ISSUING OFFICIAL REVIEWED AND PREPARED BY: DATE: SECTION Zoning Electrical Mechanical Plumbing Fire Public Works Structural Building Official BY DATE 7 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 Page 2 IMPORTANT NOTICES DO NOT BEGIN ANY WORK WITHOUT HAYING RECEIVES YOUR VALIDCTED PERMIT AND PERMIT CARD. Applying for a permit does not grant the right to begin construction. HOURS OF CONSTRUC'T'ION are limited to: Mt!Sday 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 MAjIITAIa D IN.t.CL EAN NIA T AND SANITARY CONDITION free from construction debris. 3. STREETS AND NEIGHBORING PROPERTIES SHALL BE'KBPT•FREE•FROM DIR'PAND DEBRIS. 4. SWALES MUST BE PROTECTED FROM BEINO)DAMAGED BY BQI MPMENT∎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, P' 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 F FL , OUNTY OF MIAMI -DADE ignature of Owner M 14..CCAt/1, IN 64 o & Print Name Sworn to and subscribed before me this day of Signature of Notary Public - State of Florida SEAL: • • • • • • • • ••. • • • • • • • • • • • ••.. ••••••• • J 1 ! Agit i Att We e ature o Print Nam worn to and subscribed before me this azure of is - ta day `-. A • a■ r - STATE OF Si SEAL: i' otary Pu i' actor / Qualifier NTY OF MIAMI -DADE Personally known OR, Produced Identification Personally known OR, Produced Identification - aR_ 0 Type of Identification Produced: Type of Identification Produced: e of Flonda PERMIT APPLICATION CONTRACTOR Name m (1/04 t htt U NUl001./Hekin4 L License No. S 4 002 ) 1 Address c S ?1• I x -oV N(4 (IIV C I Occ, 0( U n S. ft 03- vki ( v-t i 1.ta. Telephone7e6 ._ cipc 7 Fax 3� -.0 q 07 .. c .... 4 3 Qualifier Name S e � vAW � t Repair PROPERTY OWNER Name A iCri N U.0 M AMP!) Address I Lk N a- 1 0(ST 11/14Kl i SNO rlA. Home Telephone 305, - 7 5 s - 6 4 i 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 Job Address: ! L,L - • 101-"r 04 (tA l (l 5 N eD R e SN ORe s INSTRUCTIONS - The following steps must be taken to obtain a permit from the Miami Shores Village: 011I■9104 CI Step 1. Complete the attached permit application which must l% signed bzz the pr..ert7ownrand qualifier. Both signatures must be notarized. Please print or type to allow for a more accurate processing of yamreppiica• tio•n. • • • if toeing work will be done, a roofing application must be submit- • • • • ted 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. A PPLICATION c1 PERMIT TYPE (✓ ) aBuilding Electrical Mechanical Plumbing LPGX Roofing Fence Other Address Apt. Lot Block PERMIT CHANGE (✓ ) Chg. Contractor Renewal Revision Extension Supplement Reinspection ARCHITECT Name License No. Address Telephone Fax • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • ••• • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • Master Permit No. • •• . Sutisidiar): rr • P4ntt N • • • • • • • • • • • • • ••• • • • City State PERMIT APPLICATION Folio Number 1 1 - 3206 -o 1 S -1990 ' \ Description of Work 1 O M P IQ 1\) 11) 19 BOI.7 0o M e t1/T' Se_ e �tA-N k Zip Subdivision Wilk( S 00 co) PB /t PG 76 Zoning Linear Feet Current Use of Property ,Square Feet , Units Floors Proposed Use of Property (/alue of Work 2 / /0O Bldg Value Tenant Information Tax Assessed/Appraised Value Flood Zone Base Floor Elev. ENGINEER Name License No. Address Telephone Fax Miami Shores Village 10050 NE 2nd Avenue Phone: 305 - 795 -2204 Printed: 1/13/2003 C Applicant: MIAMI SHORES CHRISTIAN CHURCH r Owner: CHURCH MIAMI SHORES CHRISTIAN Q JOB ADDRESS: 144 NE 101 ST ( Contractor MIAMI DADE ENVIROMENTAL Local Phone: 786 -251 -4099 Parcel # 1132060131990 Fees: FEE2003 -213 FEE2003 -214 FEE2003 -215 FEE2003 -216 Description Amount Buildier's Bond $300.00 CCF $1.80 Notary Fee $5.00 Building Fee $80.00 Total Fees: $386.80 Total Fees: $386.80 Total Receipts: $0.00 Permit Status: APPROVED Permit Expiration: 7/9/2003 Work: DRAINFIELD REPAIR If there is no permit package accessible on the lob -site for insnectors to varifv +horn will h.. • •. -1=anamaaranr.Tehaazara.emammtmlfri S e MIAMI DADE ENVIRONMENTAL SERVICE INC. _ 9591 FOUNTAINBLEAU BLVD STE 208 MIAMI, FL 33172 T THE '^ + , C m / ^ ORDER OF /4 (Y F(` J4 LeC u/(1A e c rL 1oLJ tten SA NG ©NQ- OCEAN BANK 20` 2601 S. BAYSHORE DR. COCONUT GROVE. FLORIDA 33133 FOR / �/ N - /o(- ' Plumbing Permit Permit Number: PL2003 -3 Legal Description: MIAMI SHORES SEC 1 AMD PB 10 -70 LOT 9 BLK 15 LOT SIZE 50.000 X e n h a n c e d d o c u m e n t . S e e b a c k f o r derails. E i7 - — — — — — v Contractor's Address: 9591 FOUNTAINE BLUE BLVD #208 Construction Value: $2,400.00 DATE /_'0 156 63- 1139/660 20 $ 7/ ( DOLLARS 8 Page 1 of 1 •' - -- inspection a z ition herefor in strict compliance with all ations that may have been submitted to )r if the plans are changed without nsibility for a thorough knowledge of the at he assumes responsibility for work done 1 pertaining thereto and in strict conformity ;ponisibility for all work done by either CONSTRUCTION PERMIT FOR: • • • New System [rv] Existing System [ X ] Repair APPLICANT: 0 0 T H E R PROPERTY STREET ADDRESS: D R A I N F I ELEVATION E BOTTOM OF L D FILL SPECIFICATIONS BY: APPROVED BY: DATE ISSUED: • . • •,• ,: • • ••• •r p .. •••• • L'• _, STATE OF FORM: • �� + y+ i t •' -• •' DEPARTMENT :OF SiEAiLT�: :• ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PERMIT • •'• ••• •• Authority: Qpapter 301 P4 CUpter ; 0'Q b, ( AbancignW4pt . •. REQUIRED: [ ] INCHES • • •. • • • • • • • f •• • •••••• f • ••• • • • LOT: BLOCK: , s CI 1 PROPERTY ID #: 1 f 32 o f - O] 3 1 q q O DH 4016, 10/96 (Replaces HRS -H Form 4016 (page 11 which may be used) (Stock Number: 5744- 001 - 4016 -0) i L `4 1 6T, 161 s+. S4lres /_ 3313x' SUBDIVISION: 0 , es 5 2C • • t r FAC PERMIT # 6 3 g - 6 0 2 DATE PAID I -6,w FEE PAID $ 7 S • Cro RECEIPT # 9 9 S /3 -sc�- JSlot [ 0] Hq]disg• Tattsk (J J Temporary /Experimental f 1J1.94244spe s ify) *: 1 • •• • • •.• • * J • t / . .. AGENT: e f , vt tl, S P1 .(SECTION /TOWNSHIP /RANGE /PARCEL• NUMBER] [OR.TAX ID NUMBER] SYSTEM MUST BE CONSTRUCTED IN ACCORDANCE WITH SPECIFICATIONS AND STANDARDS OF CHAPTER 1OD -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. DEPARTMENT OF HEALTH 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 [C100 ] ,[,GALL / GPD] SEPT IC TANK /AEROBIC UNIT CAPACITY MULTI- CHAMBERED /IN SERIES: 01 A [ ] [GALLONS / GPD] CAPACITY MULTI- CHAMBERED /IN SERIES:[ ] N [ ] GALLONS GREASE INTERCEPTOR CAPACITY [MAXIMUM CAPACITY SINGLE TANK: 1250 GALLONS] K [ l GALLONS PER DOSE .DOSING TANK CAPACITY DOSE•RATE [ ] PER 24 HRS NO. OF PUMPS: ( ] EXCAVATION REQUIRED: [ 2 ) INCHES TAKTAI1, 1 4 2 OF SIIGHTHLY LIMITED SOIL UNDER BOTTOM Ox DAm,'1 IEW ..,.. —r,,,. •, rTn rp - ,. :1,•.T ' trrk,7I ^1, L P �nI ME . t,,. f�.� Y:.iV.ltl1Y: Y EP. c r. y � +..�'A � � i. i t � /���.i.u�a Jd"7fi 1 •: L.,. ST 2.0 TETITLE:Ea Ai [ ( 1T' Applicant TITLE: Ec, , [2 Q Q ] SQUARE FEET PRIMARY DRAINFIELD SYSTEM [ --• ] SQUARE FEET SYSTEM TYPE SYSTEM: [ d ] STANDARD [ FILLED ( ) MOUND [ ] CONFIGURATION:. [ ] TRENCH [ ) BED [ •] LOCATION OF BENCHMARK: '2, 1 Z. N i C,^ V , I t ( L 1 Q' J • OF PROPOSED SYSTEM SITE [22( [INCHES FT] [ABOVE /BELOW) BENCHMARK /REFERENCE POINT DRAINFIELD TO BE ( �'rUt J (INCHES /FT] [ABOVE /B EELOW) BENCHMARK /REFERENCE POINT Q • CHD EXPIRATION DATE: `- t I 6/ 3 Page 1 of 2 INSTRUCTIONS: ••• • • • • • •• • • • • • • • • • ••• • • •. •• • • . • • • lb •• S. E IP• ••• • • • •w ••• •y ♦ • • •• •• • •• • •• • • • • • • • • ••• '• • •• • •• ••• • • • • ••• • • ••• • PERMIT NUMBER: Permit tracking number by.GounCy QeVth Dap� rtme ' nt. • • • • •'.• • • _ i • • • • ••• ••• • • • • • ••• • • • APPLICATION FOR: Check type of permit; if "Other" spec type. I NM. � � • • • • • • •• • .• • .•. APPLICANT: Property owner's full name. • • •. . • • • ••• •l. . • • TELEPHONE: Telephone number for applicant or agent. AGENT: Property owner's legally authorized representative. MAILING ADDRESS: P.O. box or street mailing address for applicant or agent. • • • •• 0 • V _. (•• • •'• •• • • • ••• •• • • • ••• • •• . • • • • • 111 • • • • • • • LOT, BLOCK, SUBDIVISION or . PROPERTY ID #: 27 character ID number for property. (Health Department may require property appraiser ID# or section /township /range /parcel number.) SYSTEM DESIGN AND SPECIFICATIONS: TANK: Minimum specifications from Chapter 10D -6, FAC. DRAINFIELD: Minimum specifications from Chapter 10D -6, FAC. OTHER: Other specifications, such as operating permit requirements, low - volume flush toilets, variance provisos. SPECIFICATIONS BY: Name of individual providing specifications. If designed by a registered engineer must be sealed. APPROVED BY: County Health Department personnel reviewing and approving permit. DATE ISSUED: Date permit is issued by County Health Department. EXPIRATION DATE: One year from date issued if the system has not been installed. Permits for system repairs become void 90 days from the date issued. Scale: Each block represents 10 ee a p,49' b 4 c114; k r /rya ,tL,i. Notes: 5'T5 r L 7'M /a /L UP,C By Om CAL. rMAxsiRE Z? /41 4 L) /,O / J1Y721i, /74 i 5Hi Zi FL,. 3 .616 Site Plan submitted Plan Approved By „ if ,. . .CRIDA e *.: 4�' ' `f . ;T F11HIEALTH . _ , , .. APPLICATION F JR 4N4 , giltAG IiiSPOSAL SYSTEM CONSTRUCTION P IT;;s, 1.1 , !' ,P' lnit Application Number U 31 2 -0o 'ARt *§FTEPLAN DH 4015, 10/96 (Replaces HRS -H Form 4015 which may be used) (Stock Number: 5744 - 002 - 4015 -6) 111111 • • • Tor- o HY A ih-Jc a LoAD . No t Approved 14 el....4 .4 • / i � it Date / t \ C J D S County Health Department ALL C ANGES MUST BE APPROVED BY THE COUNTY HEALTH DEPARTMENT,' Page 2 of 4 INSURANCE DATR(MMOD/YY r) 12/30/2002 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE • • HOLDER CERTIFICATE Does NOT AMEND, EXTEND OR ALT" 1HECb The VERAQE AFFORDED SY S POLICIES BELOW. • $500,000 • • • . • • • - ' i AFFORDING COVERAGE NAIC# IMO EXP (Any eat omen) • uuUMtEMiA; Commercial Casualty PERSONAL & ADVINJURY - " wsunnt .. IYADa/crs COMP/OP ,m COMBINED Si ROLE UNIT Ma e•IMwq • rouRetc: • T BODILY INJURY (Per plum) BODILY INJURY IPu .c r ) • • MSUow11 D: • • AUTO ONO' .EAACCIDENT I • •• Nowlin . OTHER THAN fAACC • DtCATED. NOTWITHSTANDING TIFICATI' MAY BE I88UED OR IS AND CONDIT10N8 OF SUCH LIME EACH OCCURRENCE $500,000 DAMAOE'(O'I7ENTE6 PREMISES (E& ace kgen YI 00,000----- IMO EXP (Any eat omen) .1, 000 PERSONAL & ADVINJURY $500,000 — ,i 3 O00,000 - EJ - 00, 0 00 GENIRAL AGGREGATE IYADa/crs COMP/OP ,m COMBINED Si ROLE UNIT Ma e•IMwq $ BODILY INJURY (Per plum) BODILY INJURY IPu .c r ) • PROPERTY DAMAGE (IYTactldNNJ • AUTO ONO' .EAACCIDENT • OTHER THAN fAACC • AUTOCNLY: AGO i EACH OCCURRENcE $ AGGREGATE f 1 1TORY tTE I I ER E.L. EACH AccI MT 5 El. DISEASE - EA BIPLO EE f E.L. muse- F000Y LIMIT • COVERAGES ,., ••••c•• • • ••• • • • • ••• JW Insrance Services, Inc 2145 D14vie Blvd *105 • Ft Lauderdale, F]. 3331f .;• • . 954 -58:° -7213 • • •• • • • • • I!liami Dade Envirjnental S • THI E POLfC1ei1 �F INSURANCE LISTED BELOW NAVE BEEN ISSUED rp THE INSURED NAMED ABOVE FOR THE POCKY PERIOD ANY REOUIRI!: RENT, TERM OR CONDITION OP ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CER MAY PERTAMA . TNE. INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN 13 SUEJECT TO ALL THE TERMS, EXCLUS1 POLICIES. AO ii RELATE LIMITS SHOWN MAY HAVE DUN REbuCEDEIY PAID CLAIMS. N•Y A • •• • , • • • • • ••• T N—T —• -� �w • • • ACOFI'D ,, CERTIFICArg (F4.1i 1C,111c; • . • % • X TYPE OF1xRUlNe�. POLIOV NU$IPM i .uil.. EFFECTIVE LJTY O x NI .I AL LWSLRY 1 CAOER LtA CuI GENERAL F_ ,,_J cLA$AS"MADE occww X 591 Fountain - Blue Blue Blvd,,. #.20.8 • !Iliami, FL 33172,•• . • � •�• � � {�•�. 1 1786) 251 -4704 •. :•• • • •i• ; •$ • •s .01_ • caw. WGREOATE UNIT APPUES PRA: DLICY n JIECT I I LOC AUTDh OSIELIAIMLITY YAUTO .LOWNEDAUTOS li :MEDIAE° AUTOS RED AUTOS 4 701•01AAEDAUTOS DAM lI I NAMUtY . . 1 , IYAUTO EXICEI.I NMMILLA LWSLDY , &:CUR CLAISISWIDE 1:.:oucTi$LE 1ENTION VPONiER•oOI. PRNMTIONNELI EMPLOYERS' I. ABWY MY IMPRIEN.I MT•[R, xsaniE OFROUYNMEN ,K, ugD, Uyu, •Iwllh• a ,br EPECIAI FIYC a &ONE mow OTSM IMMsio 10N OF DPi II ATONE/ WOMEN!! / mean/ EXCLUSION/ loom SYEMDDRS5MINT /SPECIAL P•IMENONS CERTIFICATE I'1 OLDER ACORD 25 (2001,1! 8) GL2002282 M Shores Village 10050 NE 2nd Ave M :.arni Shores, F1 33138 AI.tn: Property Manager 7/22/02 7/22/03 CANCELLATION NITMOa18e POUCYEX•IMTION 511010.0 NW OF Ti1E ABOVR DESCRIBED POLICES OE CANCELED SSIOnE TIE EYPIRATIOR OILTE TROMP, *NE mWN0 RIMER FALL Elg1CAVOR TO MAX. DAY! YEMEN NOTICE TO TN/ CYITFICAT5 /(OLDER NANED TO MI LEFT, BUT FAT.URI To 00 So &HALL IMPOSE NO OmWATION DR L OP ANY RIND UAW ?NE (SEWER, 375 AOENTE OR RIPAEBENTATIYI&, 1 . ACORD CORPORATION 1888 HAVING MET THE R£GISTRAlION REQUIREMENTS OF MIAMI-DA0E COUNTY IS REGISTERED AS A STATE CONTRACTOR IN THE FULLUWlYwO CATEGOR,(S): STATE CONTRACTOW"S UNrARY REGISTRATION WI �DA ° °°°°°° ° ° °°°°°°°°°°°* °° THIS lS TO CERTIFY _l ° ° � ° � SEF�VlCE INC „I NT: ° ° p ` �DNhENTA CONTRACTOR CERTIFICATE NO SEP021077 TRADE: PLUMBING REGISTRATION EXPIRATION DATE: 08/ 0006 SEPTIC TANK INST ° ° .°°° °�° • • • • � • • °° ° • ° : °° • • • °�� ~ • • • �~ : : : :I tAri �-���/� cuun., B[]lLDING GONE CnMP `' OFFICE 140 W AGLER°��' t602 ' .� • 7~��Y�/: �V • • • • • • °° ° • • WITH ALL WORK TO BE DONE UNDER THE 6UPEUVI61ON, DIRECTION AND CONTROL OF QUALIFYING AGENT 8OLANOS JOSE S.S.N. 112-58-4332 ALTERATION, REPPODULT1ON OR TRANGFER OF [1-1 CERTIFICATE lS PROHIBITED. MIAMI DADE ENVIRONMENTAL SERVICE INC FOUmTAINE 8LEAU #20e MIAMI FL 33172 FRANC]GCO J. (]UlNTANA" H.A. SECRETARY, CONSTRUCTION TRADES QUALIFYING BOARD • 1 . :0 •• • • • • • •••• e s . •• °S s el • • •: • • • • • • • • • • ••• • • • • • • • • • • • 00 Il• • •11, 1"! • • • • • • • • • • • • so • ••• • • • • • • • • 0 • et: • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • : • •• * ** •* 0 • S • • • • • • 0 • ••• 0000 •• • • • • • ••• so • • • • • • • LEGAL DESCR1P7ION: 6LU Pe 0,47E OF CU ISSUANCE: 8/ THIS CERTIFICATE M U THIS CERTIFICATE OF SEWN PROVIDE° THERE. OHNERSHIP. ALSO, THEE THE APPROVED USE, Ai4:C0-, NEW cERTIFICATE. Pr .:USE SFC: $4 tgAr 'FoL/0/ 30.5054014001 MAI r me AivRios Corr 407 F NIAN1 0 ENVIROMO 9591 FONTAINEBLEAU' NIANI FL - BUSINESS USE: HOME USE SPECIFICS: MOO CONOITIONS: NO SIGNS/ NNUALLY , , • THIS CERTZTiOrg At 2' 7/Pr 140f :t"i0 A4,1 N0010 Otif". 41 p ' L EV: at• INSINSIONI:;100, •18111:1001 0UP 3104 • • • •• •• • • • • • • • • ;'... • • •• •. • • ••• • •• • �• ...:. ; • •I • . •... •. . . ... •.•• • • • • • • •••• . ••• • • • • • • . • s• • • se • • • • •• • • 1 • •••• •i •.. •_ . . • ♦.• • • • . . . • • • • ••• • . . •. • • • t: ' ' •• • • • •.. . • •.o•• •1� • ... .. • • • • . • • • • • • .. • • • • • ••• •• ISM OCCUPATIONAL LJOINtt TAX MU MA1110AOS COUNTY • OTATI 0P FLORIDA MUI? UNION OIM'L YI D Al PLAACA SUMO NNMIMNT TO COUNTY COO! CMAPTI 1* • ART. 0.10 PIN$T-CLAUII Y.O. OTAOt PtRM0T 931 488257 -4 •. NOME OFFICE * NEW I DA D E ENV IRONMENTAL SERVICE C C SEP021077 3 Tai C 208 "� .I« POE ENVIRONMENTAL SVS INC PECIALTY PLUMBING CONTRACTOR WORKERS I 0‘ * 1; 711 116;114118 E E VIRO E A L SERVICE BLVD 1208 wpm TAN , Ofigr nlluulil � lll � ll �lillltl�llrull�lli��l�l�l����llJ Mt OTi�ll NM .. t : -�•'�" �, "i.ti . - la3-aC R6 Cwt 07 � .... • • •••. •;•... • .::L #. • .,• • .... The Florida Department of Health hereby certifies the business or entity named :. :•: t • • below has satisfied the requirements of Part III, Chapter 489, Florida Statutes, .•..• for septic tank contracting and has been duly authorized by the department to • : • • : • : provide septic tank contracting services under the name of : • SEPTIC TANK CONTRACTING MIAMI DADE ENVIRONMENTAL SERVICE, INC. SA0021077 Authorization Number Date Issued Jeb Bush, Governor DOH 4079,1,1997 r., T nmrr^ HEAL \ 4 T,yygga�'ylD:.. ,,,>�1w•1+'n l_•`!).!n�.vn ,yCG_'/?R)6�Q ),t>til FLORIDA DEPARTMENT OF CERTIFICATE OF AUTHORIZATION 4e. September 01, 2002 March 31, 2003 • • •• • Expiration Date John 0. Agwunobi, M.D., M.B.A. Secretary 1X% trirffM1,01(41Wrr • • •••• •# • • ? • . •••• • • •••• •• ••1* •• •• • ••• • •S• • • • 1-. � t 1 � . ,. '• r r .. w - "Rv... '._w r� ._. �..,��._'� �.:•. ^iY'„rX1.. +c�ti�j.�;e ..::.r) u., •:rm•V+ .:gym },. •.a .,. r(: n.,..vn vr....a;xrA •• • • • • ••• • Ss iWisuite, rai nS - •i .o.ouS: +.bY�.� r'. tiYi& i' u" N` ai:.. uaosttu�+. .c/�n5'BUnsul"Rx2+autS'k@ifYCu+ » u Ci[L'+"'"?tvn '• • ""` iliar.MriniCLuZaretti:6: tiX su .,.. '&41'n •• ae a4Mt8i: •'efassai F.c The Florida Department of Health hereby certifies the individual named below has satisfied the requirements of Part III, Chapter 489, Florida Statutes, for registration as a septic tank contractor and has been duly registered by the department to provide contracted septic tank services. • • •••• • ;. %• • •••• ' ♦• •• • •• i •• •• • •••.•# • • • • •; • •I. I.• •••• • • • • • ••••: • • •• • • • ••• • • • •• • •• •• ••••.• • • • • • • • • • ▪ • • • •• • • • STATE OF FLORIDA DEPARTMENT OF INSURANCE DIVISION OF WORKERS' COMPENSATION CERTIFICATE OF EXEMPTION FROM FLORIDA WORKERS COMPENSATION LAW CONSTRUCTION INDUSTRY EXEMPTION This certifies that the individual listed below has elected to be exempt from Florida Workers' Compensation Law . • • . • • • • • • • • : • • FECTJV'E' • . •..•.. •••• • •PERSON • • .. ••• • • • 08/22/2002 EXPIRATION DATE 08/21/2004 •••••• • ••• ••• O •.66NN• • .• ••:••:. 112 - 58 - 4332 ._ •••• • .... • . • • • . •.... •• •• .820553271 .. ».. •••••• • • • • . •••••••• ;...$J 'NE� • •• ::• : .MIAMI -DADE ENVIRONMENTAL SVC, INC • ••••• 7 • • • •' •�: . %.9591 FOUNTAINBLEAU BLVD #208 •••• MIAMI FL 33172 • • •••■••• • • • • • • •••• • • • • • • •• • • • • • • BOLANOS JOSE NOTE Pursuant to Chapter 440.10(1),181, 2 ,F . S . , a sole proprietor , partner, or an officer of a corporation who elects exemption from the Ronda worker Compensation Law may not recover benefits or compensation under Chapter 440. 08 -21 -2002 Page 4 OFFICE USE ONLY ❑ OWNER - BUILDER FORM (Attach) ❑ FIRE DEPARTMENT APPROVAL (Commercial / multi - family) ❑ CONCURRENCY (New Construction) ❑ OTHER (Specify & Attach) $3.00 per page (Scanning Fee) Miami Shores Village Bond Metropolitan Dade County (C.C.F.) Inspector State Educational Fund State DCA (Radon) Code Enforcement Fine Zoning Review Notary • .• • • • •••• • • • • • •• •• • • • • •• ' . t • • • • • • • • • • • • •• • •• Z • • • • • • • • • • • • •••• ••••••• • ••• • • .• • • • • • • • • • • •• ❑ PROOF OF OWNERSHIP • •(elttaci • • • • • • • • •• • • i•% • %%• •• • • • •• ❑ i / I ReAI$Ita ;: :: APP (Restaurants) (Septic / Sewer) • • • • •. ••• . .' . • . •• ❑ IMPACT FEE (New Construction) ••• • • ❑ OTHER (Specify & Attach) $ o , O0 $ � - C� (sq.ft. = x/1000 x ¢.60) $ (¢.005 / sq.ft.) $ (¢.01 /sq.ft.) DO SECTION Zoning Electrical Mechanical Plumbing Fire Public Works Structural Building Official BY DATE PERMIT APPLICATION ❑ CONDO ASSOCIATION APPROVAL (Attach) ❑ CONTRACTOR REGISTRATION (On File) PERMIT FEES TOTAL $ 3 ' v 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 ELECTRICAL TYI'f: Minimum Fee Q'1'1'. '1'YPI? Dryei S s ; • QTY. • ; 7"i :'F: Ontl>'t, Appliance QT1'. '1'1 Service Repair Q " ry• A/C Central 1 -3 Ton Dryer Vents, Number of FA • • • • • • • • • • 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 R Water Heater New. MECHANICAL TYPE QTY. Minimum Fee TYPE QTY. Condensate Drain 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/Re. . Lavatory Septic Tank R Water Heater New. Drains, Area . . Meter Set (Gas) Sewer Connection ., Re -pipe :..:; Drains, Floor . . • Minimum Fee : . Shower . Water Service .; ;. ' -. Drains, French 'Miscellaneous Equipment Sink Well, Supply • " Page 3 •': • ••• • ••• •• •• • • • • • •• •.•• • • • • • • • ' • ••• • • • • • • • ••• • • •.•• • • • ••• • • • • • • • • • • • • • • • • • • • • • • • ••• • • • • • • • • • • PERMIT APPLICATION • • • • INSTRUCTIONS: Please indicate<he t e of • beiol aio rrmeci tincl uantit ies in the space YP .�"9 . g. • Y� ) provided below. P P RECEIVED AND REVIEWED BY: DATE: Page 2 STATE OF FLORIDA, COUNTY OF MIAMI -DADE MaJLtirYt. Signature of Owner / wr,� 7AJ rDezd,V1 n1OA)D Print Name /. nd subscribed before me this / T rL day of .//VU/gRY Signature u. • •• - 3PdTZ' of Hon ntification ••• • • • • • ••• • ••• • • • • Type of Identification Produced: • • ••• • • • • • • • • • • • • t• • • ... • • • .• • • • • • ••. • • • .• . • . • ••••••• • PERMIT APPLICATION IMPORTANT NOTICES • 1: DO NOT BEGIN ANY WORK WITHOUT HAVING RECEIVED YOIlt 14AI':D'ATBI) E &MIT AND PERMIT CARD. Applying for a permit does not grant the right to begin construction. HOURS OF CONSTRUCTION are limited to: Monday thtbugh Friday frdrf 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 ll'days. 2. All construction of demolition areas MUST BE MAINTAj1�}ED UMAC L.£AAI' E�T Nf •SANITARY CONDITION free from construction debris. 3. STREETS AND NEIGHBORING PROPERTIES SHAD. BE KEPT FADE MG TAD DEBRI6. • • 4. SWALES MUST BE PROTECTED FROM BEING DAMAGED:134EOUOPPEIte R• Fl- 114L4S,A 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. STATE OF FLLOID� • ► Y OF MIAMI -DADE __ Signature of C(717" ct `r / Q : Iifier Print Name Sworn to and s bscribed before me this Personally known ntification Type of Identification Produced: CONTRACTOR Name ,t m(AN 1� L/v OW/u/nCii•• License No. t 00 2 /O q 7 Address q t:Q y w i ( J t vi . #_2 J n1 // v,, / 1-. 3.5/7- Telephone 9 - f , t 1 / ax 5 2...) -_ . 2 07 Qualifier Name D s, PROPERTY OWNER Name MAtcTiN Dkuµmowt Address !Yi -NE - lo 1-ST. M(xµi Gt4orie5 FI l4• Home Telephone SO .. .. 75 , 8 __, ) , (9 ,,,_ 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 Step 1. Step 2. Address • • Complete the attached permit application wkich print or type to allow for a mope acatrate processing ted along with this permit applicaticiit. • . • �:• •• • • • • • Folio Number /1 —' c tO(Q -O (S -• 4 `tO Lot L Block /5 Subdivision M (A 4.1(s' JQ?gc PBIt2 PG 7r Current Use of Property Proposed Use of Property Tenant Information PERMIT TYPE (✓ ) Building Electrical Mechanical Plumbing LPGX Roofing Fence Other •• •• • •• •• •.• • • • • • • • • • • • • • • • • • • • • • ••.•• • g••• • • • • • •• • •• . • • • • • • • • • • • • • PERMIT CHANGE (✓ ) Chg. Contractor Renewal Revision Extension Supplement Reinspection ARCHITECT Name License No. Address Telephone Fax • • • • • • • •.• • • 'Master j No. • •- • • Ss• • • • • INSTRUCTIONS - The following steps mu be t to obtain a permit from the Miami Shores Village: ••. •• 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:) / L / — N E MI lA-M I g 14-0 R e ,. r:14. • • • • • Asst b itnIcligy the p ro r erty ostler and qualifier. Both signatures must be notarized. Please fQurilicp[t �n. �I� roofing work will be done, a roofing application must be submit- I • Apt. City State escription of Work B K INA v r l eA R e PA R PERMIT APPLICATION Zip Zoning Linear Feet Square Feet di Units Floors ') alue of WoriC aO Bldg Value Tax Assessed/Appraised Value Flood Zone Base Floor Elev. ENGINEER Name License No. Address Telephone Fax - -^ CLOSETS BATH TUBS SHOWERS LAVA. TORIES SINKS SLOP SINKS LAUNDRY TUBS URINALS CATCH BASIN FLOOR DRAIN DRINKI NG FOUNT' NS TOTAL FIXTURES C am . T LIST CHECK SEPTIC TANK SEWER CONN. DRAIN FIELD SOAKAGE PIT GREASE TRAP SOLAR HEATER DEEP WELL SPRKLR. SYSTEM SW IM'G P001. CONTR. LIST CHECK � - _- MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT ,...,tai :ic N. Date 0 tr. V j 9W/ 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. / of ` / Owner's Name and Address __ ' _ 00 1 24- !_ No.__ .�, Street A/ A (7 Registered Architect and /or Engineer . ,p _. p Employing Plumber's NameAl I...l. tt L ___!a _ _ .5r • __ No.- __.._.- _ -_ Street. ! e 6 Sr Location and Legal Description Lot___-_---_- ____._______._. _Block Subdivision Street and Number where work is to be performed —No / Str S Suu d 1. / _ ‘57,e7 7 I-0 State work to be performed and purpose of building (By Floors)_-_.-_-_ �_� - ____d !_._ ,VA/ ) C) -- C1 f - Size Septic Tank Feet of Drain Tile Amount of Permit $ (Signed) My Commission Expires Notary Public, State of Florida New Building Remodeling__ ________ Addition Repairs No. of Stories '`, ..._. ...... ........ Type of Tank_ , Capacity Gals Dist.' 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 Iii tobligations as an employer of labor under the Florida Workmen's Compensation Act, being Section 5988, Compiled General Laws of Florida P lnanent Supplement, and has com- plied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors emplo -d 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 s • publi notice or notices as are required by the Act. The undersigned agrees to employ only such sub - contractors, work to be •erforme• under this permit, as are licensed by Miami Shores Village. (Signed)_____ / 4aster Plumber. STATE OF FLORIDA, I EE. 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. 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. i / • -\ VT 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 ' ether herein specified or not. A copy of approved plans and specifications mum be kept at building during progress of work. No- __ Street 4 Owner's Name and Address Registered Architect and /or Engineer______ Employing Plumber's Namei _;4.61 1_ Location and Legal Description Street and Number where work is to be performed —No State work to be performed and purpose of building (By Floors)____ New Building _- _.. Remodeling_.._____ Amount of Permit L. cmg MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT _____ Block ( Signed) _ Date 4 /" -- Street. _ -1 e- -.ri_r lift . �,�✓�l- te. 4!1 - . Addition_________ — Repairs No. of Stories Size Septic Tank _ -__ -_ Type of Tank_ Feet of Drain Tile Dist. Feet of Tank or Drain Field from Well Nature of Water Supply: City — Well.____ _ _____._Size of Soakage Pit Capacity Gals The undersigned applicant for this building permit does hereby certify that he understands and accepts his obli under the Florida Workmen's Compensation Act, being Section 5986, Compiled General Laws of Florida P plied with the provisions thereof, and will require similar compliance from all contract, or sub - contra performed under this permit; and will post or cause to be posted' for inspection on a site •f the w required by the Act. The undersigned agrees to employ only such sub- contracto•:, on • k to •: per licensed by Miami Shores Village. My Commission Expires Notary Public, State of Florida Z3 Plumbing Inspector. as an employer of labor upplement, and has corn- ed by him in the work to be blic notice or notices as are dr s permit, as are STATE OF FLORIDA, COUNTY OF DADE. J Before me, the undersigned authority, a notary public, duly authorized to administ 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. 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. CLOeETB TABS TUBS SHOWERS LAVA- Tome SINKS SINKS SLOP LAUNDRY TUBS U RINALS CATCH BASIN FLOOR DRAIN DRINKING FOUNT' HS 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 - 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 ' ether herein specified or not. A copy of approved plans and specifications mum be kept at building during progress of work. No- __ Street 4 Owner's Name and Address Registered Architect and /or Engineer______ Employing Plumber's Namei _;4.61 1_ Location and Legal Description Street and Number where work is to be performed —No State work to be performed and purpose of building (By Floors)____ New Building _- _.. Remodeling_.._____ Amount of Permit L. cmg MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT _____ Block ( Signed) _ Date 4 /" -- Street. _ -1 e- -.ri_r lift . �,�✓�l- te. 4!1 - . Addition_________ — Repairs No. of Stories Size Septic Tank _ -__ -_ Type of Tank_ Feet of Drain Tile Dist. Feet of Tank or Drain Field from Well Nature of Water Supply: City — Well.____ _ _____._Size of Soakage Pit Capacity Gals The undersigned applicant for this building permit does hereby certify that he understands and accepts his obli under the Florida Workmen's Compensation Act, being Section 5986, Compiled General Laws of Florida P plied with the provisions thereof, and will require similar compliance from all contract, or sub - contra performed under this permit; and will post or cause to be posted' for inspection on a site •f the w required by the Act. The undersigned agrees to employ only such sub- contracto•:, on • k to •: per licensed by Miami Shores Village. My Commission Expires Notary Public, State of Florida Z3 Plumbing Inspector. as an employer of labor upplement, and has corn- ed by him in the work to be blic notice or notices as are dr s permit, as are STATE OF FLORIDA, COUNTY OF DADE. J Before me, the undersigned authority, a notary public, duly authorized to administ 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. 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.