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400 NE 101 St (2)BUILDING PERMIT APPLICATION FBC 2004 Owner's Name (Fee Si ple Titleholder) Owner's Ad ress d C3 /U ( 0 / City/� SA/LS State 4i/A Tenant/Lessee Name Job Address (where the work is being done) Contractor's Company Name 9 i • C• 7-1 CST Contractor's Address City Qualifier Name s /A (L.. ) 1 /�' State Certificate or Registration No. c',2, q ca 1 h Architect/Engineer's Name (if applicable) Bond $ Structural Review. $ Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 Permit Type (circle): Building Electrica Plumbing Mechanical Roofing City Miami Shores Villa e County Miami - I . • FOLIO / PARCEL # �'' V 7 6 0 Is Building Historically Designated YES NO X State Type of Work: ['Addition ❑Alteration ['New Describe Work: 0 4165 o t S7 Phone # Code Enforcement $ Double Fee $ Master Permit No. Phone # Zip 3 :'j / 3 U v Phone # 3os 5 s /? Zip Phone # Zip Certificate of Competency No. P// Value of Work For this Permit $ a0 0(4 Square / Linear Footage Of Work: Phone # Total Fee Now Due $ ip©/EME la APR � 3 2006 BY: ._L!� r)dJ VA9-- Permit No \L 40C — q 5 1 , 7 4) S ee Reverse side -› (IS 4'4. % c ❑ Demolition Submittal Fee $ Permit Fee $ / l'• / CCF $ 1 , 20 _ CO /CC Notary $ Training/Education Fee $ Technology Fee $ Scanning $ Radon $ DPBR $ Zoning $ Bonding Company's Name (if applicable) Bonding Company's Address City Mortgage Lender's Name (if applicable) Mortgage Lender's Address City Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRICAL WORK, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and AIR CONDITIONERS, ETC OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. "WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT." Notice to Applicant: As a condition to the issuance of a building permit with an estimated value exceeding $2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first i ection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection •ill n.t be ... ved and a reinspection fee will be charged. Signat Sign Prin Owner or Agent The foregoing instrument was acknowledged before me this 1 3 day of4 1Z.I.C.., 20O y CA k L . 'F PA ay of k , 20(X2, by ►IObQtTj : a 1 11 who is personally known to me or who has produced who is personally known to me or who has produced Fi.9r'l ,lrj 11( • As identification and who did take an oath ?�p identification and who NOTARY PUBLIC: TARY PUBLIC-ST' • _ i, t Yo I e Akar t fx' illk al Tonded Thrut, :..e:. •.•g 0., My Com ission Expires: * * * * * * * * * * * * * * * * * * * * * * ** APPLICATION APPROVED BY: / _ (Revised 02/08/06) State State * * * * * * * * * * ** LORIDA andez / Alige I L �ntractor The foregoing instrumen . . acknowledge. before me this i3 Signature NOTARY PUBLIC: Zip My Commission Expires: Zip ************************ * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** lans Examiner Engineer Zoning 4 STATE OF FLORIDA DEPARTMENT OF HEALTH ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM CONSTRUCTION PERMIT CENTRAX #: 13 -SG -28565 DATE PAID: FEE PAID : $ RECEIPT . OSTDSNBR : 06 -1001- -R CONSTRUCTION PERMIT FOR: [ ]New System [ ]Existing System [ ]Holding Tank [ ] Innovative Other [ X ]Repair [ ]Abandonment [ ]Temporary [ NA ] APPLICANT: Paulsen, Carl AGENT: SR0921116, PARILLA ROBERT PROPERTY STREET ADDRESS: 400 NE 101 St Miami Shores FL 33138 LOT: 11 BLOCK: 90 PROPERTY ID #: 11- 3206 - 017 -0480 SUBDIVISION: Amd P1 of Miami Shor [Section /Township /Range /Parcel No.] [OR TAX ID NUMBER] SYSTEM MUST BE CONSTRUCTED IN ACCORDANCE WITH SPECIFICATIONS AND STANDARDS OF CHAPTER 64E -6,FAC DEPARTMENT APPROVAL OF SYSTEM DOES NOT GUARANTEE SATISFACTORY PERFORMANCE FOR ANY SPECIFIC TIME PERIOD. 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. ISSUANCE OF THIS PERMIT DOES NOT EXEMPT THE APPLICANT FROM COMPLIANCE WITH OTHER FEDERAL, STATE OR LOCAL PERMITTING REQUIRED FOR PROPERTY DEVELOPMENT. SYSTEM DESIGN AND SPECIFICATIONS T [ 750 ]Gallons SEPTIC TANK A [ 0 ]Gallons N [ 0 ]GALLONS GREASE INTERCEPTOR CAPACITY K [ 0 ]GALLONS DOSING TANK CAPACITY [ 0 ]GALLONS @ [0 D [ 200 ]SQUARE FEET PRIMARY DRAINFIELD SYSTEM R [ 0 ]SQUARE FEET SYSTEM A TYPE SYSTEM: [ ]STANDARD [ N ]FILLED I CONFIGURATION: [ N ]TRENCH [ ]BED N F LOCATION TO BENCHMARK: F.F.E.: 12.3' NGVD I ELEVATION OF PROPOSED SYSTEM SITE [ 2.4 ] [ FEET E BOTTOM "OF;DRAINFIELD TO BE [ 4.9 ] [ FEET L D FILL REQUIRED: [ 0.0 ]INCHES EXCAVATION REQUIRED: [ 30.0 ] INCHES THIS PERMIT IS NOT FOR "ADDITION(s) ". SPECIFICATIONS BY: OSPINA, PEDRO TITLE: APPROVED BY: Ospina, Pedro TITLE: DATE ISSUED: 4/5/06 DH 4016, 03/97 (Obsoletes previous editions which may not be used) (Stock Number: 5744- 001 - 4016 -0) [ostds_cons_4016 -11 MULTI - CHAMBERED /IN SERIES: [Y ] MULTI - CHAMBERED /IN SERIES: [Y ] ]DOSES PER 24 HRS # PUMPS[ 0 ] [ N ]MOUND [ N ] [ N ] ] [ BELOW BENCHMARK /REFERENCE POINT ] [ BELOW ] BENCHMARK/REFERENCE POINT OTHER REMARKS: THIS PERMIT IS FOR THE SOUTH SYSTEM OF THE PROPERTY 1.- Install 200 sf of drainfield in bed configuration. 2.- Existing 750 gal. septic tank, certified by "Bob's Septic & Drain Inc. on 04/04/2006" to remain. 3.- Invert elevation of drainfield to be no less than 7.90' NGVD. 4.- Bottom of drainfield elevation to be no less than 7.40' NGVD. Dade EXPIRATION DATE: 7/4/06 CHD Page 1 of 2 Scale: Each block represents 5 feet and 1 inch = 50 feet. 41, - garart• - • ,,x7y2 C) 0 . 45t 4"<1 V61 •, •■ ta. 1,14' - d 00 7)&2 eke 222.a 4 • • k`' - APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PEM,17 :.,, Permit Application Number r . _ • IL4' ': PART II SITE PLAN r;rp N Cb 1410114C 41 eLo ;.7-10.3 c STATE,QF FLORIDA DEPARTMENT OF HEALTH hey • I. DH 4015, 10/96 (Replaces HRS-H Form 4015 which may be used) (Stoci Nurricer: 5744.002-4015-6) /0/ ( •-£71 - •a■SE. • ••311- - a r - "'"r• 1 Site Plan submitted by: 6)4W7t—, Signature Title Plan Approved Not Approved Date By County Health Department ALL CHANGES MUST BE APPROVED BY THE COUNTY HEALTH DEPARTMENT Page 2 of 3 Issue Date: 4/14/2006 Owner's Name: CARL PAULSON Permit Type: Plumbing - Residential Work Classification: Drainfield Job Address: 400 101 Street NE Additional Information Miami Shores Village, FL 33138 Expires: 04/13/2007 Contractor(s) Phone BOBS SEPTIC & DRAIN INC 305 - 558 -5818 Primary Contractor Yes Comments: 200 SQ FT DRAINFIELD REPLACEMENT. OVERFLOWING Applicant Signature Miami' Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL 33138 -0000 Phone: (305)795 -2204 Fax: (305)756 -8972 Permit Type of Work: DRAINFIELD REPLACEMEN Type of Piping: Additional Info: 200 SQ FT Bond Return : Classification: Residential In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are required for ELECTRICAL, PLUMBING, MECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work. OWNERS 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. Futhermore, I authorize the above -named contractor to do the work stated. Fees Due Bond Type - Contractors Bond CCF Education Surcharge Notary Fee Permit Fee - Additions /Alterations Scanning Fee Technology Fee Total: Amount $300.00 $1.20 $0.40 $5.00 $175.00 $3.00 $4.40 $489.00 Building Department File Copy Parcel #: Block: Section: Total Square Feet: Total Valuation: Required Inspections Permit Status: APPROVED Permit Number: PL -4 -06 -957 Phone: 1132060170480 Lot: PB: 0 $ 2,000.00 Rough Landscaping Final Invoice Number PL - 4 - 06 - 24480 Total: APR 14 PAID Amt Due $489.00 Amt Paid Q ,Sq - OO d NOTICE: In addition to the requirements of this permit, there may be additional restrictions applicable to this property that may be found in the public records of this county. AND THERE MAY BE ADDITIONAL PERMITS REQUIRED FROM OTHER GOVERNMENTAL ENTITIES SUCH AS WATER MANAGEMENT DISTRICTS, STATE AGENCIES, OR FEDERAL AGENCIES. PERMIT APPLICATION FOR MIAMI SHORES VILLAGE Date 6/20/94 Job Address4ff N F. 101 Street Tax Folio Legal Description Owner / Lessee / Tenant Master Permit # Owner's Address DAVID CORA Phone 751 -1765 Contracting Co. North Dade Septic Tank Address8n0 N w 111 St., Miami, fla Qualifier SS# - - Phone State if Municipal # Competency # Ins.Co. Architect /Engineer Address Bonding Company Address Mortgagor Address Permit Type(circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN WORK DESCRIPTION �� � :� ituu� 1.e.�0• Square Ft. Estimated Cost(value) 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 co j ruction and zo _ 'ng. Furthermore, I authorize the above -named contractor to do the work stated l� P AAA c Signature of owner and /o Condo President Date: Not y :s to a an4/or Condo President My Commission E pires: rOTA Y &'U2t.(C; STATS 3 FflCsr;!n,-A AT ! A. ^,°'3 ** * * * *: ul:i ^ * * * APPROVED: Zoning Buildin Mechanical Plumbin S ure of Contractor or Owner- uilder Date: 1 ry FEES: PERMIT RADON C.C.F. I NOTARY s to Con.L`rdct!orlor Owner- Builder No My ommission Eres: pOTARV PLIEUUC; 5770 1 i°A('D_ A7 Lfa: ?GE EC:\DE4 * * * * :;* * * ik* Fire Other Electrical TOTAL DUE ,f Engineering CONSTRUCTION PERMIT ,FOR: [p) New System V ] Existing System [)V] Holding Tank [4f] Temporary /Experimental [y] Repair [Ai] Abandonment [� )] Other(Specify) AX F �' e t N APPLICANT: Ci 4 _ ® AGENT: )d • PROPERTY STREET ADDRESS: A 0 0 1 C 1 0 / _. LOT: PROPERTY ID #: 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. HRS 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 DE,.SIGN AND SPECIFICATIONS D [ R [" ] SQUARE FEET A TYPE SYSTEM: I CONFIGURATION: [ ] TRENCH N F LOCATION OF BENCHMARK: I ELEVATION OF PROPOSED SYSTEM SITE [ E BOTTOM OF DRAINFIELD TO BE L D FILL REQUIRED: [ 0 T H E R APPROVED BY: BLOCK: SPECIFICATIONS BY: ] [GALLONS / GPD] SEPTIC TANK /AEROBIC UNIT CAPACITY MULTI- CHAMBERED /IN SERIES:( ] ] [GALLONS / GPD] CAPACITY MULTI- CHAMBERED /IN SERIES:[ ] ] GALLONS GREASE INTERCEPTOR CAPACITY [MAXIMUM CAPACITY SINGLE TANK: 1250 GALLONS] ] GALLONS PER DOSE DOSING TANK CAPACITY DOSE RATE [ ] PER 24 HRS NO. OF PUMPS: [ ] 4 SQUARE FEET PRIMARY DRAINFIELD SYSTEM DATE ISSUED: 4, w U „ 7 �j7 STATE OF FLORIDA DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PERMIT Authority: Chapter 381, FS & Chapter 1OD - FAC [ ] STANDARD ] INCHES SUBDIVISION: HRS -H Form 4016, Mar 92 (Obsoletes previous editions which may not be used) (Stock Number: 5744- 001- 4016 -0) [SECTION /TOWNSHIP /RANGE /PARCEL NUMBER] [OR TAX ID NUMBER] SYSTEM [ FILLED [ ] MOUND [ ] [X BED [ ] ] [INCHES /FT] [ABOVE /BELOW] BENCHMARK /REFERENCE POINT ] [INCHES /FT] [ABOVE /BELOW] BENCHMARK /REFERENCE POINT EXCAVATION REQUIRED: [ ] INCHES TITLE: TITLE: APPLICANT PERMIT # DATE PAID FEE PAID $ RECEIPT # o CPHU EXPIRATION DATE: Page 1 of 2 APPLICATION FOR: [1] New System E. ] Repair APPLICANT: AGENT: MAILING ADDRESS: STATE OF FLORIDA DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES ONSITE SEWAGE DISPOSAL SYSTEM APPLICATION FOR CONSTRUCTION PERMIT Authority: Chapter 381, FS & Chapter 10D -6, FAC Existing System ( kl Holding Tank [6 Temporary /Experimental . Abandonment [ -k y) Other(Specify) MR, D4VID_CORA l Y Q Y rIi 15/1∎5 f` 7) PERMIT # DATE PAID C j .. 07</a FEE PAID $ -1.7 • r % ij RECEIPT # TELEPHONE :3 c . 2 . /: 3 TO BE COMPLETED BY APPLICANT OR APPLICANT'S AUTHORIZED AGENT. ATTACH BUILDING PLAN AND TO -SCALE SITE PLAN SHOWING PERTINENT FEATURES REQUIRED BY CHAPTER 10D -6, FLORIDA ADMINISTRATIVE CODE. PROPERTY INFORMATION [IF LOT IS NOT IN A RECORDED SUBDIVISION, ATTACH LEGAL DESCRIPTION OR DEED] LOT: PROPERTY ID #: PROPERTY SIZE: 1 2 3 4 BLOCK: PROPERTY STREET ADDRESS: DIRECTIONS TO PROPERTY: BUILDING INFORMATION [ ] Garbage Grinders /Disposala [ ] Ultra -low youme Flush Toilets APPLICANT'S SIGNATURE: Ann SUBDIVISION: Unit Type of No. of No Establishment Bedrooms ACRES [Sgft /43560] PROPERTY WATER SUPPLY: [ ] PRIVATE [ ] PUBLIC [ ] RESIDENTIAL [ ] COMMERCIAL 2 HRS -H Form 4015, Mar 92 (Obsoletes previous editions which may not be,ued (Stock Number: 5744 - 001-4015-1) 6 , DATE OF SUBDIVISION: . (Section /Township /Range /Parcel No.] ZONING: i(ll St 11 . ^.-g 51 -ir Building # Persons Area Soft Served ( ] Spas/Hot Tubs [ ] Other (Specify) 4 DATE: J,t Business Activity For Commercial Only [ ] Floor /Equipment Drains Page 1 of 3 APPLICANT: DAVFD COCA LOT: PROPERTY ID #: [Section /Township /Range /Parcel No. or Tax ID Number] 400 K.a7, 101 S� _ i�i3 Shnrrea TO BE COMPLETED BY ENGINEER, HEALTH UNIT EMPLOYEE, OR OTHER QUALIFIED PERSON. ENGINEER'S MUST PROVIDE REGISTRATION NUMBER AND SIGN AND SEAL EACH PAGE OF SUBMITTAL. COMPLETE ALL ITEMS. PROPERTY SIZE CONFORMS TO SITE PLAN: [ ] YES [ ] NO NET USABLE AREA AVAILABLE: ACRES TOTAL ESTIMATED SEWAGE FLOW: 3 Do GALLONS PER DAY [RESIDENCES -TABLE 1 / OTHER -TABLE 2] AUTHORIZED SEWAGE FLOW: GALLONS PER DAY [1500 GPD /ACRE OR 2500 GPD /ACRE] UNOBSTRUCTED AREA AVAILABLE: G a 0 SQFT UNOBSTRUCTED AREA REQUIRED: :,,�i � SQFT BENCHMARK /REFERENCE POINT LOCATION: ELEVATION OF PROPOSED SYSTEM SITE IS 5 .- - , (7 [INCHES /FT] [ABOVE /BELOW] BENCHMARK /REFERENCE POINT CAN BE MAINTAINED FROM THE PROPOSED SYSTEM TO THE FOLLOWING FEATURES: DITCHES /SWALES: FT NORMALLY WET? [71 YES [ ] NO LIMITED USE: FT PRIVATE: --- -= - -- FT NON -PO ABLE: FT /C;/ FT PROPERTY LINES: 2! FT POTABLE WATER LINES: Ce / FT SITE SUBJECT TO FREQUENT FLOODING: [ ] YES [ NO 10 YEAR FLOODING? t YES ] NO 10 YEAR FLOOD ELEVATION FOR SITE: S F MSL /NGVD SITE ELEVATION: �j,� FT MSINGVD THE MINIMUM SETBACK WHICH SURFACE WATER: - ' FT WELLS: PUBLIC: FT BUILDING FOUNDATIONS: BLOCK: SUBDIVISION: SOIL PROFILE INFORMATION SITE 1 STATE OF FLORIDA DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES ONSITE SEWAGE DISPOSAL SYSTEM SITE EVALUATION AND SYSTEM SPECIFICATIONS . Munsell # /Color USDA SOIL SERIES: Texture Srineky 0 Depth to 72 °° to to to to to to to to OBSERVED WATER TABLE: 7xl INCHES [ABOVE / =ELOW EXISTING GRADE. TYPE: [PERCHED / APPARENT] ESTIMATED WET SEASON WATER TABLE ELEVATION: INCHES [ ABOVE / BELOW ] EXISTING GRADE. HIGH WATER TABLE VEGETATION: [ ] YES [.] NO MOTTLING: [ ]"YES ( 'y NO DEPTH: INCHES SOIL TEXTURE /LOADING RATE FOR SYSTEM SIZIN : f : DEPTH OF EXCAVATION: 2 INCHES DRAINFIELD CONFIGURATION: [ ] TRENCH [ / BED [ ] OTHER (SPECIFY) REMARKS /ADDITIONAL CRITERIA: et J H RS -H Form 4015, Mar 92 (Obsoletes previous editions which may not be used) (Stock Number: 5744- 003-4015 -1) AGENT: PERMIT # 9 /go Korth Daft Sn WZaik SOIL PROFILE INFORMATION SITE 2 Munsell # /Color Texture ]3fOUN USDA SOIL SERIES: 0° Depth to 7 °° to to to to to to to to DATE: ©0 Page 3 of 3 Scale: Each block represents 5 feet and 1 inch = 50 feet. I Il Notes: Y^ t STATE OF FLORIDA DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PERMIT_ Permit Application Number /6 Site Plan submitted by: Plan Approved t7 By 1 1 I II II_' 1 I i _ __1 1. 1 • ■ ■ I r 1 ■ 1 r I_ _I _I iI_.1_ I ■ ■ ! I I ■ I I I I I I I 1 1 1 �I 1 I I, II IJJ I I 1 1 . _ 1 i tl ,' l 1 1 f L_I I IN `�. 11 I- I_ _ L I I �I I I I I I ( PL I I ' I_ I I ' II ! f 1 I I III i I _ II i I _ [ I_ . _ I I; I_I I T __ I _ I _I� 1 1 1 1 I 1 I 11 I _ -_ 1 1 _1_ _I 1 1 - hi - I I I 11 I 1 1 1 14_ 1 _ 41 1 - 1 I 1 I 1 I -. L ._ 1_I_ 1�_1 __ I_1 I I 1 I I_ I_ _ I I_ J_I I (I I I 1_I I1 I I _ 1 I 1 I I I _. 1 I I I I I L �1 ._ _ i 11_ - _ - I I I I 1 I r 4 1 �I 1 I 1 _L I I_ I. I_ 1 I . j 1 ( 1 _ 1 11 I 111 I I_. I I I I I -I I 1 II i t L - J_ 1.1. _ f y I h I._I T 1 1 I J 1 - I I _ WI I1 Jj 1 h. 1 1� II 1 I l L i i I I I I ( ! I ! i _ I I I_ 1 1 -- - -� V I I I. 1 j I _ I i — I 11 i l lil;1 ii {i 1 l 1 i, r_h l _1 I _ -1 ■ l I- 1 Ft 11 �1 1 DAVID CORA, 400 N. 2.101. St., d az': Shores, F] OLD SYSTEM OVER LOWIi' "O IGNATURE PART II - SITE PLAN Not Approved __c a.,_,,,,.„,....._ ' 41 it It I_ t ; 1 I _I !_ 1 _1 I 1 i) TITLE Date £ 7O q 4 /Th ft � r�"` "� � I .4 County Public Unit ALL CHANGES MUST BE APPROVED BY TH COUNTY PUBLIC HEALTH UNIT HRS -H Form 4015, Feb 85 (Obsoletes previous editions which may not be used) (Stock Number. 5744-002-4015-6) Page 2 of 3 'Inspection Number: INSP-14874 Inspection Date: 05/19/2006 Inspector: Levrack, James Owner: PAULSON, CARL Job Address: 400 101 Street NE Project: <NONE> Thursday, May 18, 2006 Miami Shores Village, FL 33138- Contractor: BOBS SEPTIC & DRAIN INC Building Deaartment Comments Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Block: Permit Number: PL -4-06 -957 Permit Type: Plumbing - Residential Inspection Type: Landscaping Work Classification: Drainfield Phone Number (305)754 -9370 Parcel Number 1132060170480 Lot: Phone: 305 - 558 -5818 Page 2 of 2 Passed v- Inspector Comments . • Failed Correction Needed Re- Inspection Fee ($75) No Additional Inspections can be scheduled re- inspection fee is paid. until 'Inspection Number: INSP-14874 Inspection Date: 05/19/2006 Inspector: Levrack, James Owner: PAULSON, CARL Job Address: 400 101 Street NE Project: <NONE> Thursday, May 18, 2006 Miami Shores Village, FL 33138- Contractor: BOBS SEPTIC & DRAIN INC Building Deaartment Comments Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Block: Permit Number: PL -4-06 -957 Permit Type: Plumbing - Residential Inspection Type: Landscaping Work Classification: Drainfield Phone Number (305)754 -9370 Parcel Number 1132060170480 Lot: Phone: 305 - 558 -5818 Page 2 of 2 I) LI r/W Aill! Passed I spe for o A l ments Failed Correction Needed Re- Inspection Fee ($75) No Additional Inspections can be scheduled re- inspection fee is paid. until nspection Number: INSP -14875 Inspection Date: 04/28/2006 Inspector: Levrack, James Owner: PAULSON, CARL Job Address: 400 101 Street NE Project: <NONE> Contractor: BOBS SEPTIC & DRAIN INC Building Department Comments Thursday, April 27, 2006 Miami Shores Village, FL 33138- Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone ' 5)795 -2204 Fax: (305)756 -8972 Block: Permit Number: PL -4-06 -957 Permit Type: Plumbing - Residential Inspection Type: Final Work Classification: Drainfield Phone Number Parcel Number 1132060170480 Lot: Phone: 305 - 558 -5818 Page 1 of 2 if- 6 if i 1 Passed l nsp • r 9 omments r 0 Failed Correction Needed Re- Inspection Fee ($75) No Additional Inspections can be scheduled re- inspection fee is paid. until uv s 'Inspection Number: INSP -14873 Inspection Date: 04/18/2006 Inspector: Levrack, James Owner: PAULSON, CARL Job Address: 400 101 Street NE Project: <NONE> Contractor: BOBS SEPTIC & DRAIN INC Building Department Comments Monday, April 17, 2006 Miami Shores Village, FL 33138- Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Block: • Permit Number: PL -4-06 -957 Permit Type: Plumbing - Residential Inspection Type: Rough Work Classification: Drainfield Phone Number Parcel Number 1132060170480 Lot: Phone: 305 - 558 -5818 Page 1 of 2 MIAMI SHORES VIL AGE PLUMBING INSPECTION DEPARTMEI -: APPLICATION FOR PLUMBING " . a,A1rr Permit No. T O Date E. „czz. Application is hereby made for the approval of the detailed statement of the plans and specifications here ifll .ubmitted f the building or other structure herein described. This application is made in compliance and conformity with the Building Ordin. • • 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 • ' • with, whether herein specified or not. A copy of approved plans and specifications must be kept at building during progress of work. Owner's Name and Address-_ Registered Architect and /or Employing Plumber's N Location and Legal Des Size Septic Tank Feet of Drain Tile Nature of Water Supply y —Well Amount of Permit $ 1 _4 s� <� Street_.., Subdivision_______ ( • LC/ Street No. (Signed)____ r. (Signed Street. Street and Number where work is to be performed —No State work to be performed and purpose of building (By Floors)_ New Building Remodeling _ _.._ Addition__.______._ Repairs No. of Stories Type of Tank__ Capacity Gals Dist. Feet of Tank or Drain Field from Well _ ___- S'i f 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 wo to be performed under this permit, as are licensed by Miami Shores Village. Master Plumber. STATE OF FLORIDA, COUNTY OF DADE. j 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. My Commission Expires Notary Public, State of Florida NOTE: A re- inspection fee of $1.00 will be made when such re- inspection is made•necessary by improper notice for inspection, or faulty materials and /or workmanship. CLOSETS BATH TUBS SHOWERS LAVA- TORIES SINKS SLOP SINKS LAUNDRY Tues 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 SW IM'G P001. CONTR. LIST - CHECK MIAMI SHORES VIL AGE PLUMBING INSPECTION DEPARTMEI -: APPLICATION FOR PLUMBING " . a,A1rr Permit No. T O Date E. „czz. Application is hereby made for the approval of the detailed statement of the plans and specifications here ifll .ubmitted f the building or other structure herein described. This application is made in compliance and conformity with the Building Ordin. • • 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 • ' • with, whether herein specified or not. A copy of approved plans and specifications must be kept at building during progress of work. Owner's Name and Address-_ Registered Architect and /or Employing Plumber's N Location and Legal Des Size Septic Tank Feet of Drain Tile Nature of Water Supply y —Well Amount of Permit $ 1 _4 s� <� Street_.., Subdivision_______ ( • LC/ Street No. (Signed)____ r. (Signed Street. Street and Number where work is to be performed —No State work to be performed and purpose of building (By Floors)_ New Building Remodeling _ _.._ Addition__.______._ Repairs No. of Stories Type of Tank__ Capacity Gals Dist. Feet of Tank or Drain Field from Well _ ___- S'i f 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 wo to be performed under this permit, as are licensed by Miami Shores Village. Master Plumber. STATE OF FLORIDA, COUNTY OF DADE. j 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. My Commission Expires Notary Public, State of Florida NOTE: A re- inspection fee of $1.00 will be made when such re- inspection is made•necessary by improper notice for inspection, or faulty materials and /or workmanship. BUILDING ELECTRICAL PLUMBING ROOFING PERMIT N° 4028 MIAMI SHORES VILLAGE. FLORIDA Owner of Building DATF 195 Contractor's License No. Work to be performed under this Permit Architect Contractor or Builder Legal Lot i l Subdi- Description ! B1 vision Address of !, Value of Building Project $ This permit is granted to the contractor or builder named above to construc 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. Amount of Permit $ BY INSPECTOR In consideration of the issuance to me of this permit I agree to perform the work covered Jereunder in compliance with all ordinances and regulations pertaining thereto and in strict conformity with the plans, drawings, statements or specificatio sub fitted to the proper authorities of Miami Shores Village. In ac- ceptRig this permit I assume responsibility for all work done by either, myself, myetgent t or employee. c CONTRACTOR OR BUILDER B Y AUTHORITY a . MIAMI SHORES VILLAGE, FLORIDA BUILDING ( DATE 195 ELECTRICAL f PERMIT IT? 11956 Contractor's PLUMBING License No ROOFING n Work to be performed under this Permit Owner of II Building Architect Contractor or Builder zip c .•.�_.. �_ CONTRACTOR OR BUILDER. r stoo- 1 1 Leggy Lot Description / j '-t Z 1 Address of ` Building ,_ ~ 1 L l Z ■ Signed Subdi- vision Value of Project $ 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. INSPECTOR In consideration of the issuance to me of this permit I agree to perform the work covered hereunder in compliance with all ordinances and regulations pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I assume responsibility for all ork donelly either, my agen servant or employee. BY T Amt. of �. Permit $ AUTHOR= IT7 Date f%/7 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. Owner's Name and Address. No ' 4..__ Street__ J .✓ r" _ ___ Permit No._ / .k.-45_.L"' Registered Architect and /or Eng' eer -0 yL -et 1 E c r c � ;lee 4,4_ e No l :∎ Street f Employing Plumber's Names: Block Subdivision____ Street and Number where work is to be performed —No. /// C -\///, e . / �'f . Location and Legal Description Lbt State work to be performe I- nd purpose of building (By Floors) New Building Size Septic Tank © .0 Type of Tank Feet of Drain Tile_ Nature of Water Supply: City —Well. Amount of Permit $ ss. MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT Remodeling Addition Repairs /1-""-° Dist. Feet of Tank or Drain Field from Well (Signed ) 3 7`- o 1 es Street Capacity Gals r e No. of Stories Size of Soakage Pit (Signed) 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. y STATE OF FLORIDA, 1 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 fo regoing application, and that he did sign the same, and that all facts therein by him stated are true. My Commission Expires Notary Public, State of Florida NOTE: A re- inspection fee of $1.00 will be made when such re- inspection is made necessary by improper notice for inspection, or faulty materials and /or workmanship. CLOSETS BATH TUBS SHOWERS LAVA- TORIES SINKS SLOP SINKS LAUNDRY 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 SW IM'G POOL CONTR. LIST CHECK Date f%/7 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. Owner's Name and Address. No ' 4..__ Street__ J .✓ r" _ ___ Permit No._ / .k.-45_.L"' Registered Architect and /or Eng' eer -0 yL -et 1 E c r c � ;lee 4,4_ e No l :∎ Street f Employing Plumber's Names: Block Subdivision____ Street and Number where work is to be performed —No. /// C -\///, e . / �'f . Location and Legal Description Lbt State work to be performe I- nd purpose of building (By Floors) New Building Size Septic Tank © .0 Type of Tank Feet of Drain Tile_ Nature of Water Supply: City —Well. Amount of Permit $ ss. MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT Remodeling Addition Repairs /1-""-° Dist. Feet of Tank or Drain Field from Well (Signed ) 3 7`- o 1 es Street Capacity Gals r e No. of Stories Size of Soakage Pit (Signed) 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. y STATE OF FLORIDA, 1 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 fo regoing application, and that he did sign the same, and that all facts therein by him stated are true. My Commission Expires Notary Public, State of Florida NOTE: A re- inspection fee of $1.00 will be made when such re- inspection is made necessary by improper notice for inspection, or faulty materials and /or workmanship. Permit No 1 (s ss. MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT Amount of Permit $ / (Signed) Date 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. Owner's Name and Address_ C NoD Street__ ��� Registered Architect and /or E neer __ Employing Plumber's Nam : _ -- ' __ � ,114 ___ _/ No , ' Street Location and Legal Description Lot 1.I ' /)-- Block t __...) Subdivision c` 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 Capacity Gals l c Size Septic Tank -4 - - 49 a Type of Tank Feet of Drain Tile l__# 0 Dist. Feet of Tank of 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. (Signe • y- yr e".409-7.^----- er. STATE OF FLORIDA, t 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. My Commission Expires Notary Public, State of Florida NOTE: A re- inspection fee of $1.00 will be made when such re- inspection is made necessary by improper notice for inspection, or faulty materials and /9r 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 SEWER TANK CONN. DRAIN FIELD SOAKAGE PIT GREASE TRAP SOLAR H EATER DEEP WELL SPRKLR. SYSTEM SWIM'G POOL CONTR. LIST / , / fff /// CHECK Permit No 1 (s ss. MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT Amount of Permit $ / (Signed) Date 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. Owner's Name and Address_ C NoD Street__ ��� Registered Architect and /or E neer __ Employing Plumber's Nam : _ -- ' __ � ,114 ___ _/ No , ' Street Location and Legal Description Lot 1.I ' /)-- Block t __...) Subdivision c` 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 Capacity Gals l c Size Septic Tank -4 - - 49 a Type of Tank Feet of Drain Tile l__# 0 Dist. Feet of Tank of 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. (Signe • y- yr e".409-7.^----- er. STATE OF FLORIDA, t 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. My Commission Expires Notary Public, State of Florida NOTE: A re- inspection fee of $1.00 will be made when such re- inspection is made necessary by improper notice for inspection, or faulty materials and /9r workmanship.