319 NE 101 St (12)03/15/2083 11:55 3055133472
STATE OF FLORIDA
DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT
CONSTRUCTION PERMIT
CO?STRUCTION PERMIT FOR:
EN] New System Ex38tiag System
(x) Repair (
APPLICANT: tzT Q
Abandonment
PROPERTY ADDOESS:
LOT: I Ct t -1 BLOCK:
PROPERTY ID #: ( 6— 3Z - (J3-5
3 S
I F.
IFi]
SUBDIVISION:
SYSTEM MUST BE CONSTRUCTED IN ACCORDANCE 9XTH SPECIFICATIONS AND STANDARDS OF SECTION 381.0065,
F.9., AND C.t'IAPTER 64E -6, F.A.C. DEPARTMENT APPROVAL OF SYSTEM DOES NOT GUARANTEE SAFTXSBACTORY
PERFORMANCE FOR ANY SPECIFIC PERIOD OP TIME. ANY CHANGE IN MATERIAL FACTS, WHICH SERVED AS A,
BASIS POR ISSUANCE OP THIS PERMIT, REQUIRE TEE APPLICANT TO MODIFY THE PERMIT APPLICATION.
SUCK MODIFICATIONS MAY RESULT IN THIS PERMIT BEING MADE NULL AND VOID. ISSUANCE OF THIS PERMIT
DOES NOT EXEMPT THE APPLICANT FROM COMPLIANCE MITE OTHER FEDERAL, STATE, OR LOCAL PERMITTING
REQUIRED FOR DEVELOPMENT OF THIS PROPERTY.
i4
T (
SYSTEM DESIGN AND SPECIFICATIONS 1[
] GALLONS / PD S TIC T /AEROBIC UNIT CAPACITY MULTI - CHAMBERED /IN- SERIES [x]
A [ 1 GALLONS / GPD - CAPACITY MULTI - CHAMBERED /IN- SERIES [ ]
M I ] GALLONS GREASE INTERCEPTOR CAPACITY (MARIMGM CAPACITY SINGLE TANX: 1250 GALLONS]
K [ -- ] GALLONS DOSING TANK CAPACITY [ )GALLONS 0 [ ] DOSES PSR 24 ERS # PUMPS I 1
D CO 1 SQUARE
R [ 1 SQUARE
A TYPE SYSTEM:
I CONFIGURATION:
N
F
I
E
L
D
FILL REQUIRED: 4./04 ] INCHES
0
T
R 0
Qf iG't lari
SPECIFICATIONS BY:
APPROVED BY:
DATE ISSUED: / V 3
PEET PRIMARY DRAINFISLD SYSTEM
F / SYSTEM
I''1 STANARD [ /] FILLED I
[ ] TRENCH I ] BED [ 1
N
ITLE
DH 4016, 12/99 (Page 1) (Previous Sditiona May Be Used)
pt. 1: }[calth Dcpartmcnt
pt. 2: Applicant
pt. 3: ImtallcdCcntractnr
pL 4: Fluilaing Dep tnmcrtt
• • •.•
PAGE
.' •• •• •
• . • • • .
... • •
k 1Q(Ir •Era
DATE PAID:
AND DISPOSAL SYSTEM R t PAID:
... • • tsxPT•'}k
• •
• • • • • • .
• •
• • ...
02
Holding.7siik. *LAX. Wovative
Temporary:.: • [• 1• • •'
*• • • ••• •••
.• • • •
/pltI skcr4-1 sc -rc.. 1
[SECTION, TOWNSHIP, RANGE, PARCEL NUMBER]
(OR TAX ID NUMBER]
] MOUND 1 1
LOCATION OF BENCHMARK: 01 4 0 + N L C . V'. 6 . r , •F. (2-/04../.
ELEVATION OF PROPOSED SYSTEM SITE E7,cp IINCFS /811 (ABOVE /BELOW]
BOTTOM OF DRAINFIELD TO BE K601 LXNCIIBS /VT] MEOW
EXCAVATION REQUIRED: [ 4 ] INCHES
BENCHMARK/REFERENCE PPTw't'
BENCEMARK R ' .ERENCE POINT
7 1
EXPIRATION DATE:
Page 1 of 3
i cJL cap
0
APPLICANT
7lGENT i
STATE .OP .FLORIDA •
DEPARTMENT OP HEALTH • •.
ONSITE :'SEWAGE TREAT/MITT .AND DIPOSAL SYSTEM'
• CONSTRUCTION ...'INBPECTIODT")( ND. PINAL .APPROVAL
Fd 'r
p:h: /01
PRAPERTY ADDAZSS:
3� • • sUB DIVI - ,;
BLOC>L i P
SIGN 1 � �-- s -n—�± � P • . .. . ,: • �::
�� •. %i ••' .::: �.• .. .. ": +'. i ".' .'. ., , : '1.'•;��: 7.•4 ;• •!; "•,
• •r• COWhLIANGB STATUTE.
TAT OR R Aim .
=soma [Z] 'IT�IS�•ARE I.K WITS 03t RULE � ��,, % � d�&?rr" z• - . - .. . ,_��•:, ,
[29] 'PRIVATE .MALL..s ' :: r '''
[ ] [ 30 ] PUBLIC• MELL1; .•,,., .. ..._�: << °�
?L ^ " %r .
[ • ] [31] :IRRIGATIOJ(•• MILLS ' /S• "' %' "'
TANS INSTALLATION •
( ] (01Y TANK SIZE (1] 4 C r.
• (• }, [0,�,]: ' ;MATERIAL ,•
( ] - [03] ;OUTLET DEVICE
• [•: ] [0a]'' MULTI7CHAUSERSD• (./
:[ ]
(05] OUTLET FILTER N - 45
( 1 [06] LEGEND N /
•[ ] [0 7] WATERTIGHT
( ] . [d
• ( ] (09] D. TO LID
•
•
(.
[
.1 . 3
( �.
(.
( ] (18] - DOSING PUMPS
I' ] (19 ] AGGREGATE SIZE Ap, 0, 0.
( ] •(20] AGGREGATE EXCESSIVE FINES
[ . s ], [2l] AGGREGATE DEPTH
T ILL
( ?)
•(23]
(24]
(25)
(26)
aXPLAN7ITIOM, 9r' VIOLATIONS
( . ]-.
I. ']
( •;
• CONSTRUCTI• P A ,/ ISAPPROVED]
' FINAL STATEN
DH 4016, 10/97
• f,
I r •• r•
DRAXNFIELN ,XNS,aT.I.a} O� ..,
] (10] AREA [1]' [ ] 7 $¢
1 (11] DISTRX.EUTION BOX • SL"AD
], ( 12] • NU ER''OP "DP.AINLINES
(13) DRAINLINE• 9 ARATION; •= , rI' i
] (14) DRAXNLINE SLOPE
(15) DEPTH • 07,COVER
(16). ELEVATION. / BELOW] BM ,
(17] •SYSTEM LOCATION • . /�
/ EXCAVATION mATEltIAL
FILL AMOUNT 1'3
PILL TEXTURE
EXCAVATION DEPTH
AREA REPLACED .-. • � 1- YirL
REPLACEMENT MATERIAL 5
REMARKS:
ISAPP&OVED] :
U
(Previous Editions May Be Iliad)
[
3 ( • Pcr 4.13P, : N .yam; <' rg.
( ;]t/. `[33,] BUILDING FOLAWD1TIOor'is " A �:
(• l (34) . PROPS TTT.:LINES. 74 .' "�""``
' " PT:
[ ] (35) OTBER'
PILLED,./ NOPND.
EN I [36] :';' DRAIN ?ISJ�p :z.COVER
l (37] •,;•�OULDERP
(' .•u •• (39J TA8'ILIZA
ADDITIOKAL .In'0> Imo
* '' [. • l (4 0 ] `UN0487WCT� Ai1•E#`;
[ • ] (41];.•8' ► '' i9 ...
(• ] '(42] ALARMS
[
3 [43]' .MAX :4.r :('�► :)ui 1T
] [44] BUILDING .AREA :'7t ?;'
[45). LOCATION' CONFORNC_MI,T> ;SITE. PLAN'.:
[46] • FINAL HIT='. I ,�•� ...
[47] CONtZ.LCTOit
48 OTHER
]
3
]
[
[ ]
(J y
;1Uv p CG
.J p L r r1 PC. CHD
J
PT 1: Applicant
PT 2: tnataliar/Corgpector
. PT 3: Budding DapaMWnl
.PT Hoallh DepLnmint
• •
PUMIT • $$O,. •' •a
DmpS PAID i • • ."07:17;'•
*is PAID'. "•.•1•'.
1'S:•'
RZCZIPT "f i' ::S• o 1 •,J %
CND
yr• -�.�•
[49 ] TANZ PtRiPI D
[
501 TANK c mues3D • a mm um&
t •a-; ;sYrt�e;
Page 2 o
1. •'
•
DATSi 3 ?
t •
;.
Miami Shores Village Plumbing Permit
10050 NE 2nd Avenue
Phone: 305 - 795 -2204 Permit Number: PL2003 -83
Printed: 3/25/2003
Applicant: LISA
Owner: LACROSS
JOB ADDRESS: 319 NE 101
Contractor BOBS SEPTIC & DRAIN INC
1\1 Local Phone: 305 - 558 -5818
Parcel # 1132060135200
LACROSS
LISA
ST
Contractor's Address: 1020 NE 130 ST
Page 1 of 2
Legal Description: MIAMI SHORES SEC 1 AMD PB 10 -70 LOTS 16 & 17 BLK 38 LOT SIZE 100.000 X 115
Fees: Description Amount
FEE2003 -1748 Builder's Bond $300.00
FEE2003 -1749 Notary Fee $5.00
FEE2003 -1751 CCF $1.80
FEE2003 -1753 Building Fee $80.00
FEE2003 -1754 Building Fee $80.00
Total Fees: $466.80
Total Fees: $466.80
Total Receipts: $0.00
Permit Status: Approved Permit Expiration: 9/21/2003 Construction Value: $2,500.00
If there is no permit package accessible on the job -site for inspectors to verify, there will be no inspections. Re- inspection
fee is $50.00, which must be paid in advance before calling for another inspection.
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 unicipal 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 .. dition 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 r • /la pertaining to the work covered hereby whether shown on the plans or drawings or in the statements or specifications and that he assumes responsibility for work done
by his agents -ervemployees.
,
Signed: /�■ (INSPECTOR) BY:
In conside •' on 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:
Work: TANK & DRAINFIELD
T - - %w .- „L? na'Lim . w....,%} wCI,. iv,rir:uw.... ,�i.v^�'imx... "u,.
u•u..v.••.,, a— xi..uM = ST^v!L�:.:.i _ a - ru.. - ^ _ 4L:_ ---- c - - w vu M - j .x:.inux1„ wn_,
PAY
TO THE
ORDER
BOB'S SEPTIC & DRAIN, INC.
1020 NE 130TH ST. PH. 305- 558 -5818
NORTH MIAMI, FL 33161 -4211
ctiban
CITIBANK, F.S.B. BR. #37
2750 AVENTURA BOULEVARD
AVENTURA, FL 33100
FOR
10 00559811' .1 :266086554x: 216 27060
DATE
D
LABS 8
5598
637665527
2660
Doris En Sack
If there is no permit package accessible on the job -site for inspectors to verify, there will be no inspections. Re- inspection
fee is $50.00, which must be paid in advance before calling for another inspection.
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 ertaining to the work covered hereby whether shown on the plans or drawings or in the statements or specifications and that he assumes responsibility for work done
by his agents, servants or ployees.
Sign :i 14 (INSPECTOR) BY:
In consid : ' ." of e 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 1 assume responisibility for all work done by either
myself, my agent, servants or employes.
Signed: (Contractor or Builder) BY:
083 453757 .,
Egg, JEF
84:N
WOODBRI F .
oa 0- 1
Tan pg 8-2022 .
ODORS .
.s-
RESTR
,08-22-2003
CONTRACTOR
Name 6. /1 - 1/.141
License Nos JC nA) q 0 )I l
Address
Iva-0 A /Sv s r
Telephone S3 / d Fax 9 3 0 ,?__-7 b
Q
Qualifier Name 13 6 ��1 An
PROPERTY OWNER
New Construction
Name
r�
lJT
� � C l
Address
3q
/E /0 /s . 1
Home Telephone `
/�
V
Business
s Telephones
Fax
TYPE OF MANAGEMENT (1 )
New Construction
Enclosure
Alteration Exterior
Repair
Alteration Interior
Demolish
Relocation of Structure
Shell Only
Foundation Only
Add'I Attachment
Other
Add'I Detachment
Other
Step 1.
Job Address:
Current Use of Property
Proposed Use of Property
Tenant Information
PERMIT TYPE (✓ )
Building
Electrical
Mechanical
Plumbing
LPGX
Roofing
Fence
Other
5i4 /06 /0 sT
PERMIT CHANGE (✓ )
Chg. Contractor
Renewal
Revision
Extension
Supplement
Reinspection
ARCHITECT
Name
Address
P1P
License No.
Telephone
Fax
Master Permit 14o. •
Subsidiary Per pt No. :
JA,
City
Description of Work
• •••
• • • . • 4.114, . • • • •
•
.
• - • •
. • S' • • •
A l
Address / Apt.
Folio Number ber /( J aok� 0/ 3 - 5.9-o ()
Lot I(4- 1 7 Block 3
Subdivision "ICC j PB PG Zoning l ! -' . Linear Feet
State
PERMIT APPLICATION
• i/e)/ er gS
•
• ••
INSTRUCTIONS - The following steps must be taken to obtain a permit from the Miami Shores Village:
Complete the attached permit application which must be signed by the property owner aad q Iiot5 signat mutt • be notarized. Please
print or type to allow for a more accurate processing of your application. If roofing wort 411 be elide, 9 raofmgeppltcation 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.
APPLICATION
Zip
Square Feet nits Floors
Value of Work 01 Bldg Value
Tax Assessed/Appraised Value
Flood Zone Base Floor Elev.
ENGINEER
License No.
Name
Address
Telephone
Fax
Page 2
••. •
• • • • •.. •
1
. .
••. •
• • . - ••
• • • • •
• • • •.. • •
•
•
•
DO NOT BEGIN ANY WORK VeITHCRYF HA' WOG 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 througb Friday from 7:30 a.m. to 6:00 p.m., and Saturday from 8:00 a.m.
to 5:00 p.m. No iaspectiogs will bee conducted on weekends or holidays.
2. All construction of demoI n areas M T DEVAINTAINED IN A CLEAN, NEAT AND SANITARY CONDITION free from construction debris.
3. STREETS AND p' EIGHBORINaRbfZRIF SFOLL BE KEPT FREE FROM DIRT AND
4. SWALES MUST I PltOJEC37'Et) NOM•BI INl3 DAMAGED BY EQUIPMENT OR VEH "CLES, 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 pproval from the Building, Planning and Zoning Department.
8. EQUIPMENT AND MATERIALS SHALL BE STORED at least 10 feet from the edge of pavdment.
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) approva is required for applications involving sewers.
AFFIDAVIT - Please read carefully.
Application is hereby made to obtain a permit to do work and installation as in
work will be performed to meet the standards of all laws regulating construction
are required for ELECTRICAL, PLUMBING, POOL, EXTERIOR DOOR,
ROOFING and SIGNS and there may be additional permits required from other
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 cumulati a 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 away 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 CO NCEMENT may result in you paying twice for
improvements to your property. If you are spending more than $2,500 or int nd to obtain financing, you may wish to consult with
your attorney or lender before recording your Notice of Commencement. he Notice of Commencement must be recorded at:
22 N.W. 1st Street, 1" Floor, (305) 679 -1078. Once recorded, the Notice of C mmencement must be POSTED AT THE JOB SITE in
accordance with Section 713 -35 of Florida Statutes. Review the broch re at Village Hall on Construction Lien Law and
Ch. • sing a Contractor.
ST, TE ► i► FLORIDA OF MI
int Name
- born to and subscribed be
Signature o otar uL iic" Male of Florida
,ia Po Angela M Becker
• ir My Commission D0150048
Vor ' Expires November 15, 2006 /
Personally known OR, Produced Identification + , �
SEAL:
Type of Identification Produced.
i �f
'gnat
SEAL:
Person
icated. I, the OWNER of the property, certify that all
in this jurisdiction. I understand that separate permits
MECHANICAL, WINDOW, FENCE, DRIVEWAY,
governmental agencies.
ly known
PERMIT APPLICATION
ry ' : 'c - tate .f Florida
e0 . Angela M Becker
My Commission 00160048
fit sr iv d� E)i pires November 16, 3006
OR, Produced Identification
Type o Identification Produced:
ELECTRICAL
TYPE
Minimum Fee
QTY.
TYPE.
Dryer
QTY.
'I VPI
Outlet, Appliance . • • •
Q r\.
• '
TY"E
ervice Repair
Q.LY.
A/C Central 1 -3 Ton
Fan
Dryer Vents, Number of
Outlet, Wall
Ventilation, Cost
Service, Temporary
Air Handler, Tons
A/C Central 4 -7 Ton
Piping, Flammable Liquid
Fire Pump
Outlet, Switch
Fire Sprinkler System
Signs
A/C Central 8 -15 Ton
Bath Fan - Vented, #
Fixture - Fluorescent
Pressure Vessel
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
W ter Closet
Demolition
Low -volt, Intercom/Teleph.
Repair Circuits
ter Heater
Dishwasher
✓
Low -volt, Television
Service, Number of Amps
V
Water Heater New
MECHANICAL
TYPIi
Minimum Fee
QTY. TYPE
Condensate Drain
QTY. TYPE
Generator
QTY. TYPE
Refrigeration, Tons
Q'rY.
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
Solar Water Heater
Air Handler, Tons
Ductwork, Cost of
Piping, Flammable Liquid
Periodic Inspections
Barbecue
Fire Sprinkler System
Process/Pressure Piping
Cap - Fixture
Bath Fan - Vented, #
Fireplaces, Number of
Pressure Vessel
Pump and Abandon
PLUMBING
TYPE
A/C Condensate
QTY.
TYPE
Drains, Roof
QTY.
TYPE
Miscellaneous Fixture
QTY.
TYPE
Soakage Pit
Q'rY.
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
W ter Closet
Domestic Well
)sundry Tray
Septic Connection
ter Heater
Drainfield, 4" Tile/Res.
✓
Lavatory
Septic Tank
V
Water Heater New
Drains, Area
Meter Set (Gas)
Sewer Connection
Water Re -pipe
Drains, Floor
Minimum Fee
Shower
Water Service
rains, French
Miscellaneous Equipment
Sink
Well, Supply
Page 3
•
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• • • -
• • • • • • •••
PERMIT APPLICATION
• •••
• • • • • .
••• •••. • • •
• ••••• •
• • •• . . •
•
INSTRUCTIONS: Please indicate the type of work being performed and quajfty(ies) :n the spacE provided below.
•
•
TED AND REVIEWED BY: DATE:
SECTION
BY
DATE
Zoning
Electrical
Mechanical
Plumbing
% -11(
Fire
Public Works
Structural
Building Official
Page 4
• •
••• •
OFFICE USA; bAILY
('1IL('KLIS'I'
U OWNER - BUILDER FORM 0 PROOF OF OWNERSHIP
(Attach) • • 66 : . • • • • • • • (Attach)
• •• . . . . • • •
• • • •. • . • ••• •
LI FIRE DEPARTMEN�P • • • • . dal HRS / DERM APPROVAL
APPROVAL (Commercial / • (Septic / Sewer)
multi - family)
❑ CONCURRENCY
(New Construction)
••• •
• •• .• • •
•
(] OTHER
(Specify & Attach)
PERMIT FITS
$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
REVIEWED AND PREPARED BY:
••. •
. • •
• • •
• •
• • • •
•
•
•
•
•
•
❑ IMPACT FEE
(New Construction)
❑ OTHER
(Specify & Attach)
$% p ED
$) 7) O
$ ( sq.ft. = x/1
x ¢.60)
$ (¢.005 / sq.ft!)
(¢.01 /sq.ft.
PERMIT APPLICATION
❑ CONDO ASSOCIATION APPROVAL
(Attach)
❑ BPR APPROVAL (Restaurants)
❑ CONTRACTOR REGISTRATION
(On File)
TOTAL
ISSUING OFFICI:�I.
DATE:
CONDITION OF A PPROVAL
Revised July
10050 N.E. 2ND AVE., MIAMI SHORES, FL • (305) 795 -2207 • FAX (:05) 756 -8972 • http: / /www.miamishoresvillag
BUILDING
ELECTRICAL
PLUMBING
Owner of
Building
Architect
Contractor 1.../
or Builder
1' / .
Legal Lot
Description
Address of /� ) °�
Building � f
This permit is graif ted- to the contractor or builder named above to construct the building or to install the equipment or d •vice described in the appli-
cation herefor in strict compliance with all ordinances pertaining thereto and w th the understanding that the work will be performed in compliance with any
plans, drawings, statements or specifications that may liave 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 ass th re onsibihty for a thorough knowledge + • ordinances and
' r the statements prfpecifications an . a e assumes respon-
regulations pertaining to the work covered hereby whether shown on the plans or
sibility for work done by his agents, servants or employees.
In consideration of the issuance to me of this permit I agree to per)6rm the work covered hereunder in compliance with all, ordinances and. fegulatlons
perta. . g reto an. in trict onformity with the plans, drawings,' statements or specifications submitted to the proper authorities of Miami Shote§ Vilrage.
In tin 1 res onsibility for all work done by either myself, my agent, servant or employee.
CONTRACTOR 0 BUI DER
E R M I T N° 6855 '''\4 Contractor's
,�..,,License No
Work to be performed unde this Permit _. Brit 1 tjj
MIAMI SHORES VILLAGE, FLORIDA
DATE
(1
Subdi-
vision
Value of
Project
Signe
BY
INSPECTOR
Amt. of
Permit
AUTHORITY
194
BUILDING
ELECTRICAL
PLUMBING
Owner of
Building
Architect
Contractor
or Builder
Legal
Description
Lot
MIAMI SHORES VILLAGE, FLORIDA
PERMIT N9 3573
Work to be performed under this Permit :` ,1
Bl.
N;• �+ ; � '�: this .3ollsi,►u, ;ill may he
NKr Beard Gtilsri Lf'iarkaits u!r . 41
Vcn are cautioned to consult your Wu Proriaeaton
___Eloard—offict Lim Mg walk authorized to
Vie permit
Subdi-
vision
DATE 194_
Contractor's
License No.
Address of t Value of Amt. of
Building ) l 1 . 4,- . 1 (Z I Fy Project Permit -,/
, r
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 specifications and
that he assumes responsibility for work done by his agents, servants or employees.
Signed•
INSPECTO
In consideration of the issuance to me of this permit I agree to perform the work covered hereunder in compliance with all ordinances and regula-
tions pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper auth1ies of Miami lr 0
illage. In accepting this pg nij•I assume responsibility for all work done by either myself, my agent, servant or employee.
CONT R bR BUILDER
1 "'
BY AUTHORITY
?D
BUILDING
ELECTRICAL
PLUMBING
MIAMI SHORES VILLAGE, FLORIDA
PERMIT N9 3573 1�
Work to be performed under this Permit " - 1
Owner of // .r..
Building r i' 1 t
Architect
Contractor
or Builder
Legal Lot Bt.
Description
Address of ,./
Building ? ,1 '
Value of
Project
Subdi-
vision
DATE
r • q
194
Contractor's
License No.
A4; this i,onstrtrcbOn nlyl be in VOL ,
:f 3
rau an uW+onN N consult tow Wor Proeuc i n
-- flowl — office — bsisnrsimi s
pot
Amt. of
Permit
4
BY AUTHORITY
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 specifications and
that he assumes responsibility for work done by his agents, servants or employees.
Signed• By
INSPECTOR'
In consideration of the issuance to me of this permit I agree to perform the work covereed hereunder in compliance with all ordinances and regula-
tions 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 . i assume responsibility for all work done by either myself, my agent, servant or employee.
Permit No -
building during progress of wor
Owner's Name and Address, '
STATE OF FLORIDA, 1
COUNTY OF DADE.
ss.
Registered Architect and /or Engineer
Employing Plumber's Name- _-- i__;:'_____
Amount of Pennit `
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
Application is hereby made for the approval of the detailed statement of the plans and specifications herewith 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
No. ' ' Street_
4
(Signed)
w + No `Street.. --
Location and Legal Description Lot B19�k_ 1 Subdivision
Street and Number where work is to be performed —No L,.:�_�_ I e ; y, Street
State work to be performed and purpose of building (By Floors)
New Building Remodeling Addition Repairs __'`____.. -
(Signed) -
No. of Stories_
My Commission Expires Notary Public, State of Florida
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 Inspector.
The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations as an employer of labor
under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Permanent 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 the Act. The undersigned agrees to employ only such sub - contractors, on work to be performed under this permit, as are
licensed by Miami Shores Village.
Master Plumber.
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.
CLOSETS
BATH
TUBS
SHOWERS
LAVA
TORIES
SINKS
SLOP
SINKS
LAUNDRY
TUBS
URINALS
CATCH
BASIN
FLOOR
DRAIN
DRINKING
FOUNT'NS
TOTAL
FIXTURES
CONTR.
LIST
—
CHECK
SEPTIC
TANK
SEWER
CONN.
DRAIN
FIELD
k''
SOAKAGE
PIT
GREASE
TRAP
SOLAR
HEATER
DEEP
WELL
SPRKLR.
SYSTEM
SWIM'G
POOL
CONTR.
LIST
CHECK
Permit No -
building during progress of wor
Owner's Name and Address, '
STATE OF FLORIDA, 1
COUNTY OF DADE.
ss.
Registered Architect and /or Engineer
Employing Plumber's Name- _-- i__;:'_____
Amount of Pennit `
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
Application is hereby made for the approval of the detailed statement of the plans and specifications herewith 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
No. ' ' Street_
4
(Signed)
w + No `Street.. --
Location and Legal Description Lot B19�k_ 1 Subdivision
Street and Number where work is to be performed —No L,.:�_�_ I e ; y, Street
State work to be performed and purpose of building (By Floors)
New Building Remodeling Addition Repairs __'`____.. -
(Signed) -
No. of Stories_
My Commission Expires Notary Public, State of Florida
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 Inspector.
The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations as an employer of labor
under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Permanent 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 the Act. The undersigned agrees to employ only such sub - contractors, on work to be performed under this permit, as are
licensed by Miami Shores Village.
Master Plumber.
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.
_ pvt,e/42..Lezt_:-
( 12. a-) .
-ell-A4/1"'
Permit No .- d
Amount of Permit $
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the building or other
structure herein described. This application is made in compliance and conformity with the Building Ordinance of Miami Shores Village, Florida,
and all provisions of the Laws of the State of Florida, all ordinances of Miami Shores Village and all rules and regulations of the Building Division
of Miami Shores Village shall be complied with, whether herein specified or not. A copy of approved plans and specifications must be kept at
building during progress of work.
_a 4._ No
Owner's Name and Address ___ ./� --+
Registered Architect and /or Engineer ________ _ -- � _- - -__�_
Employing Plumber's Name —_ ` _ No. 7 .i 1 _- Kl Street -Z.-_ L .t__ __--_-
Location and Legal Description Lot_-_-_ ______Block —__ Subdivision__— ...... ______—__,----__---
Street and Number where work is to be performed —No _ ______ Street ________ _____- ___--- _______— ________
State work to be performed and purpose of building (By Floors)
New Building____— _____ Remodeling Addition Repairs No. of Stories
Size Septic Type of Tank _Capacity
Feet of Drain Tile _____ ___— _________— ___________ Dist. Feet of Tank or Drain Field from Well
Nature of Water Supply: City — Well. ____— — Size of Soakage Pit
The undersigned applicant for this building permit does hereby ce
under the Florida Workmen's Compensation Act, being Section 5966,
plied with the provisions thereof, and will require similar compliance
performed under this permit; and will post or cause to be posted for
required by the Act. The under signed agrees to employ only such
licensed by Miami Shores Village.
STATE OF FLORIDA,
COUNTY OF DADE.
Before me, the undersigned authority, a notary public, duly authorized
My Commission Expires
Date
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
therein by him stated are true.
Notary Public. State of Florida
31 Street - - -" ] __–___ - --
(Signed) - - - - -- – - -- – -- — - -- — – —_ - -_— —_
Plumbing Inspector.
rtify that he understands and accepts his obligations as an employer of labor
Compiled General Laws of Florida Permanent Supplement, and has com-
from all contractors or sub - contractors employed by him in the work to be
inspection on the site of the work such public notice or notices as are
sub - contractors, on work to be performed under this permit, as are
to administer oaths and take acknowledgments, personally
the same, and that all facts
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
TUBS
URINALS
CATCH
BASIN
FLOOR
DRAIN
DRINKING
FOUNT'NS
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 .- d
Amount of Permit $
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the building or other
structure herein described. This application is made in compliance and conformity with the Building Ordinance of Miami Shores Village, Florida,
and all provisions of the Laws of the State of Florida, all ordinances of Miami Shores Village and all rules and regulations of the Building Division
of Miami Shores Village shall be complied with, whether herein specified or not. A copy of approved plans and specifications must be kept at
building during progress of work.
_a 4._ No
Owner's Name and Address ___ ./� --+
Registered Architect and /or Engineer ________ _ -- � _- - -__�_
Employing Plumber's Name —_ ` _ No. 7 .i 1 _- Kl Street -Z.-_ L .t__ __--_-
Location and Legal Description Lot_-_-_ ______Block —__ Subdivision__— ...... ______—__,----__---
Street and Number where work is to be performed —No _ ______ Street ________ _____- ___--- _______— ________
State work to be performed and purpose of building (By Floors)
New Building____— _____ Remodeling Addition Repairs No. of Stories
Size Septic Type of Tank _Capacity
Feet of Drain Tile _____ ___— _________— ___________ Dist. Feet of Tank or Drain Field from Well
Nature of Water Supply: City — Well. ____— — Size of Soakage Pit
The undersigned applicant for this building permit does hereby ce
under the Florida Workmen's Compensation Act, being Section 5966,
plied with the provisions thereof, and will require similar compliance
performed under this permit; and will post or cause to be posted for
required by the Act. The under signed agrees to employ only such
licensed by Miami Shores Village.
STATE OF FLORIDA,
COUNTY OF DADE.
Before me, the undersigned authority, a notary public, duly authorized
My Commission Expires
Date
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
therein by him stated are true.
Notary Public. State of Florida
31 Street - - -" ] __–___ - --
(Signed) - - - - -- – - -- – -- — - -- — – —_ - -_— —_
Plumbing Inspector.
rtify that he understands and accepts his obligations as an employer of labor
Compiled General Laws of Florida Permanent Supplement, and has com-
from all contractors or sub - contractors employed by him in the work to be
inspection on the site of the work such public notice or notices as are
sub - contractors, on work to be performed under this permit, as are
to administer oaths and take acknowledgments, personally
the same, and that all facts
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.