825 NE 100 St (3)\ 0
Po2L; Nk {Nkra
— 7 `is -2:1�
82-S
Date
Legal Description
Owner/Lessee / Tenant in .74 A-1 S4 $5
Owner's Address C i 7 ~ ) r v P /7); aM
Contracting Co. c 71, 1 ' A /Qd
Qualifier £c ,u / i /iR () n -✓ /,'N
My Commission Expires:
FEES: PERMIT
( L5:6 D 4
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Job A Iv O 0 / Tax Folio
Historically Designated: Yes
Square Ft. Estimated Cost (value)
Notary as to Owner and/or Condo President Date
RADON
C o c./ I di/
1/45Ao/1CS
C.C.F. '7 / NOTARY
-
No
C /u I7 Master Permit #
Phone
Address 73 U.5 Gu / y / n c % A4 F �
SS # Phone(30) '-c/90
State # fC -c A S6 7a C. Municipal # Competency # Ins. Co.
Architect/Engineer 41 e.' i g Alt t., ! A Address 4, 3 S ci n> w 9s i /77:/).•)-,* j/ 33 /� L
Bonding Company Address
Mortgagor Address
Permit Type (circl ne): BUILDING ELECTRICAL PLUMBING
MECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIPTION s % 1/ 44 Q • p Anl p .J .v La / 10- yd N d t R —t
oo
WARNING TO OWNER: YOU MUST 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
PLUMBING, 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.
Signature of owner and/or Condo President Date Signature of of : ctor or • • ' er- Builder Date
as to Contracto
for Owner - Builder
My Commission Expires: ,r �6 '•" ate
+ -
ii� COMMISSION # CC6I8044
4 „, EXPIRES MAR 22.2001
d3, ^`. BONDED THROUGH
fi � ATLANTIC BONDING CO., INC.
BOND
TOTAL DUE ” 1'
APPROVED:
Zoning Building Electrical
Mechanical
1/ ✓, j Plumbing Structural Engineer
S gin iF .�■ rrwAcr " 'FE 10 1999 L
o ��n�rcroF e�ot�ru�ou�
DERM
POLLUTION REMEDIATION SEE410e
CONSTRUCTION PLAN REVIEW APPLICA ?I
Op- a�G
FACILITY NAME: i"
Lf > o po FACILITY ADDRESS: ? -2lJ A.//- /to s File# '9go5
CONTRACTOR/CONSULTANT NAME: 6, P • S
CONTACT PERSON: ern QA PHONE# 8 P 6 7 R - 7. z 5
Is this site in a COI? Y / N If yes, which one?
FEE
PLAN TYPE (check appropriate box)
O UST Installation (up to 10 tanks, includes wells & Stage II) $600
O AGT Installation (up to 10 tanks, includes wells & Stage II) $325
1,000 gallons or less $475
1,001 - 2,000 gallons $575
2,001 - 4,000 gallons $675
4,001 - 8,000 gallons $775
8,001 - 20,000 gallons $ 775
20,001 - 50,000 gallons $ $9 00
50,001 - 125,000 gallons 4 wells or less $ 55
O Compliance Monitoring Well Installation Only 5 wells or more $1
titi UST Modification [J AST Modification
._UST As -Built 0 AST As -Built �....
UST or Oil/Water Separator Closure- requires ClosureApplication . $275/excavation
0 Contaminated' Site Drainage Plans $160
$160
Remedial Action Construction Plans (petroleum and non - petroluem) 160
O Remedial Action As -Built Plans (petroleum and non - petroleum) 50% of original fee
O Renewal of Previously Approved Plans N/A
O 1st Resubmittal
O 2nd Resubmittal 50% of original fee, $50 minimum
O After -the -Fact Plans Double the original fee, plus appli-
cable administrative costs to be assessed by the plan reviewer.
PAID WITH CHECK # /3
el/ FEE PAID $ _2A_L___
RECEIPT NO. ).-i---7 4 (Copy of receipt must be attached.)
0
FOR DERM USE ONLY
Plan Reviewer = Fee A4jastmeat C7
-Me ---0 .- ,.C,1.. t n (Fee Due or. Refund Issued)
ATC 6/15198 (Formlfeea su1 Ject to change without nods. Fees to be verified prior to submittal.)
DO NOT REMOVE
ER/1A
OEPARTS4ENT OFOWI K RESOURCES 1.4M4ACOVIVIT
Miami- -Dade County
PZ4211.1V SECTION
111 N.W. 1st Street Suite 1010
Miami, Florida 33128
Building Permit Application: Sec: Twn: Rge:
Project Name: M) ' 1 S R OL i 4 c.,6O AfTRA4 CL U 5
Project Address: g30 0 N• E 100 .S± • Municipality:
Project Description:
PLEASE OBTAIN APPROVAL FROM THE FOLLOWING SECTION(S): (Checked Items Only)
Fi AIR SECTION (Stage II) APPROVAL REQUIRED:
33 S.W. 2nd Avenue, 9th Floor, (305)372 -6925
PERMIT NUMBER: APS2- FEES COLLECTED:
Approved:
Reviewer.
STORAGE TANK SECTION APPROVAL REQUIRED:
33 S.W. 2nd Avenue, 7th Floor, (305)372 -6700
PERMIT NUMBER: UT- 1 m oo
Approved:
Reveiwer:
PLAN REVIEW SECTION: ' 9
DISAPPROVED: 1� -4
Reviewer: � v14 -4tAthe, Reviewer:
TANKSREVSHT.DOC 12/97
Date:
■ 111
_ L
DERM Number: 58 7 c � 79
STORAGE TANK REVIEW SHEET
Date:
FEES COLLECTED: a.00. °O
APPROVED:
UT/File .T I s
Pollution Remediation Section
UST SYTEM CONSTRUCTION
PLAN APPROVAL CONDITIONS
May 28, 1998
AC -02
TEC7:11NZCB.L GrTJTDALINICE
The following conditions are hereby incorporated as part of the construction plan approval granted by
the Pollution Remediation Section (PRS) and shall supersede the scope of work proposed in the
approved plans if discrepancies exist. Additional approval may be required from other DERM sections
and other governmental agencies having jurisdiction over the facility.
1. This approval shall be valid for one year from the approval date; however, compliance with all
regulatory timeframes stipulated elsewhere is required.
2. An inspection must be scheduled with the DERM Storage Tank Section (STS) Inspection
Coordinator at (305) 372 -6716 two business days in advance of the initial inspection of any
UST to be installed or backfilling any UST related excavation. At the time of the scheduled
inspection all applicable components must be properly installed, lines /tanks pressurized and
readily accessible for the inspection. All piping sumps and dispenser sumps must be able to
hold water for the inspection.
3. An original set of the most recently approved UST construction plans must be maintained on-
site for inspection throughout the construction procedures.
4. All work, including all applicable safety requirements, must be performed by a Pollutant
Storage System Specialty Contractor possessing a valid license from the Florida Department of
Professional Regulation and in accordance with the approved plans, all manufacturer's
specifications, applicable requirements of Chapter 24 of the Miami -Dade County Code,
Chapter 62,761 of the Florida Administrative Code, American Petroleum Institute
Recommended Practice #1615, Petroleum Equipment Institute Recommended Practice #100,
National Fire Prevention Association Standard #30 and any requirements imposed by the fire
department or any other governmental agency having jurisdiction over the facility.
5. Metallic piping in direct contact with soil must be cathodically protected, and all piping te13t
boots must be pushed back after pressure testing is completed.
6. If a major change in the piping layout from that shown on the construction plans occurs,
modification plans showing the actual location must be submitted and be approved by the PRS
prior to the DERM inspection., Minor changes in piping layout may be subject to as-built
submittal, based on the inspector's request. Approval for the inspection will not be granted
prior to the approval of the as -built plans.
MIAMI -DADS couNri DERM
POLLUTION CONTROL DIVISION
POLLUTION REMEDIATION SECTION
ENVIRONMENTAL REVIEW APPROVAL s
UST System Construction
Plan Approval Conditions
May 28, 1998
ATC•AC- 02 *5 -28 -98
8. If undocumented soil or groundwater contamination is encountered during construction, a
Discharge Report Form (Form 62- 761.900 (1) FAC) must be submitted within 24 hours of
discovery.
7. The DERM recommends that free floating product and/or other liquid waste exposed in an
excavation be recovered and disposed of properly. The DERM recommends that all the
excavated contaminated soil (as defined by Chapter 62 -770, FAC, effective date September 23,
1997) not be returned to the excavation and be disposed of properly if the removal will
significantly impact the restoration requirement of the site.
9. All liquid wastes must be disposed of by a DERM Permitted Liquid Waste Transporter within
ninety days of recovery, All applicable solid waste materials must be disposed of in accordance
with an approved DERM Solid Waste Disposal Plan within ninety days of excavation. Contact
the DERM Liquid Waste Transporter or Solid Waste Program Manager at (305) 372 -6804 for
more information.
10. A DERM Dewatering Permit must be obtained prior to dewatering any excavation. Contact the
DERM Water Control Section at 372 -6681. For sites with contaminated groundwater, a
pretreatment system will be required. Contact the Pollution Remediation Section at 372 -6700
for additional information.
11. Within sixty days of the proper disposal of any free floating product and excessively
contaminated soils, submit to the DERM PRS all analyticals, receipts and manifests in an Initial
Remedial Action (IRA) Report in accordance with Chapter 62 -770, FAC.