920 NE 100 St (6)BUILDING
PERMIT APPLICATION
FBC 2001
Miami Shores Village
Building Department
Permit Type (circle): Building Electrica Y Plum Mechanical Roofing
Owner's Name (Fee Simple Titleholder) /1i /C 1 1/4E4- , / T LJAa Phone #
Owner's Address 9/0 /lf /13Z) 7,-f ..37
City /'Ll /WO / Ofit-VIS State FL.072 /DA Zip 3-3/31
Tenant/Lessee Name Phone #
Job Address (where the work is being done) Az- c'71EET
City Miami Shores Village County Miami -Dade Zip 33/31
Is Building Historically Designated YES NO
Contractor's Company Name / (( CitJ✓ /72OJf1CM)%HL A6g Phone # -7 F6 4099
Contractor's Address QQl /Oil /1 //U 51_11 540 b #
City m // TYI / State FL d9 /PA Zip 33/
Qualifier Jo 'E 5 -p[."10
Architect/Engineer's Name (if applicable) . Phone #
Architect/Engineer's Address
City
$ Value of Work For this Permit
State
f . 'AM
Zip
Number of: Bays Stories Families Bedrooms Baths
Type of Work: ['Addition ['Alteration DNew ['j ❑ Demolition
Describe Work: / 7M(J DOA-
Code Enforcement $
* * * * * * * * * * * * * * * * * * * * * * * * * * ** F ees * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
County Escrow Fee $ o (p (D Permit Fee $ i ) 5 - O U Notary $ FEB 1 8 PAID
Education/Training Fee $ , 2-0 Tech $ q • 3r7 . Scanning $ Radon $
Bond $ Struct. $
Minus Plans Check Fee $ Total Fee Now Due $ 1 50 i 3
' 2004
Square Footage Of Work: /U• /4 •
L — 10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
Permit No. 1 l a y — 00
Master Permit No. 10 y — Sit
(Continued on opposite side)
Bonding Company's Name (if applicable)
Bonding Company's Address
City State Zip
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address
City State Zip
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 inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the
inspection will not be approved and a reinspection fee will be charged.
NOTARY PUBLIC: NOTARY P
Sign: Sign:
Print: Print:
APPLICATION APPROVED BY:
Chc7r7 /03
Owner or Agent Contractor
The foregoing instrument was acknowledged before me this The foregoin_ instrument was acknowledged before me this /DTI -•
day of , 20 _, by , day of � c41k 20 o� b Jb 'BO/ -,' fOO
who is personally known to me or who has produced ho is personally known to n1e.6r who has produced
As identification and who did take an oath. as identification and who did take an oath.
Ills
bill __..
i �►: aY
My Commission Ex fires:
Y P My Commission Expires.
(Certificate of Competency Holder)
State Certificate or Registration No. 1 Certificate of Competency No.
****************************** * * ** * * ** ********************•************* * *s * * * * * * *s * * * * * * * * * * * * * * *s * * **
Plans Examiner
Engineer
Zoning
Miami Shores Village
10050 NE 2nd Avenue
Phone: 305 - 795 -2204 Permit Number: PL2004 -60
Printed: 2/25/2004
Applicant: KATHLEEN ROTUNDO
Owner: ROTUNDO KATHLEEN
JOB ADDRESS: 920 NE 100 ST
Contractor MIAMI DADE ENVIROMENTAL Contractor's Address: 9591 FOUNTAINE BLUE BLVD #208
Local Phone: 786 -251 -4099
Parcel # 1132060340210
Signed: (INSPECTOR)
Plumbing Permit
Page 1 of 1
Legal Description: MIAMI SHORES SEC 8 PB 14 -33 LOTS 8 & 9 BLK 170 LOT SIZE 100.000 X
Fees: Description Amount
FEE2004 -1955 Building Fee $175.00
FEE2004 -1956 CCF $0.60
FEE2004 -1957 Training and Education Fee $0.20
FEE2004 -1958 Technology Fee $4.37
Total Fees: $180.17
Total Fees: $180.17
Total Receipts: $180.17
Permit Status: APPROVED Permit Expiration: 8/16/2004 Construction Value: $100.00
Work: ABANDON TANK
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 responisibility for all work
done by either myself, my agent, servants or employes.
Signed: (Contractor or Builder) BY:
Miami Shores Village
10050 NE 2nd Avenue
Phone: 305 - 795 -2204 Permit Number: PL2004 -60
Printed: 2/25/2004
Applicant: KATHLEEN ROTUNDO
Owner: ROTUNDO KATHLEEN
JOB ADDRESS: 920 NE 100 ST
Contractor MIAMI DADE ENVIROMENTAL Contractor's Address: 9591 FOUNTAINE BLUE BLVD #208
Local Phone: 786 251 - 4099
Parcel # 1132060340210
Permit Status: APPROVED Permit Expiration: 8/16/2004 Construction Value: $100.00
Work: ABANDON TANK
l-
Fees: Description Amount
FEE2004 -1955 Building Fee $175.00
FEE2004 -1956 CCF $0.60
FEE2004 -1957 Training and Education Fee $0.20
FEE2004 -1958 Technology Fee $4.37
Total Fees: $180.17
Total Fees: $180.17
Total Receipts: $180.17
Signed: (INSPECTOR)
Plumbing Permit
Page 1 of 1
Legal Description: MIAMI SHORES SEC 8 PB 14 -33 LOTS 8 & 9 BLK 170 LOT SIZE 100.000 X
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 responisibility for all work
done by either myself, my agent, servants or employes.
Signed: (Contractor or Builder) BY:
BUILDING
PERMIT APPLICATION
FBC 2001
Permit Type (circle): Building Electrical
Miami Shores Village
Is Building Historically Designated YES NO
Architect/Engineer's Name (if applicable) P1 /A—
S Value of Work For this Permit 5 440t)
Total Fee Now Due $ 415 q • I / 461
(Continued on opposite side)
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
Job Address (where the work is being done) Q 20 J E . !OCJST
Master Permit No.
FEB� S 8014
Mechanical Roofing
Owner's Name (Fee Simple Titleholder) H1 r � . A t_l. NoTom Q Phone #
Owner's Address q ` �.0 p1J . I oo c r M f S lSo (tee
City 11 1 ta3K1 S t4Oli0 5 State / /1 Zip S3 1 S&
Tenant/Lessee Name Phone #
City Miami Shores Village County Miami -Dade Zip 3 424 RBI-
Phone # N /4—
Square Footage Of Work:
* * * * * * * * * * * * * * * * * * * * * * * * * * ** F ees * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
FEB 1 PAID
Submittal Fee $ Permit Fee $ n5-00 CCF $ 1 -6'.1.--)
Notary $ /% Training/Education Fee $ . (00 Technology Fee $ u . 3 7
Scanning $ - 00 Radon $ Bond $ vU - 00
Code Enforcement $ Structural Plan Review. $
1
L
Permit No. P 1 acoq -
Contractor's Company Name M l A at • C lV U ( R QIJ ta Phone <786 1 ,s/-40 q'q'
Contractor's Address 9 pC Foo (v'T r.) P Qtai B( V O g Ire
City M (1A.1t( State P1 14- Zip 3 3/7
Qualifier ,,OS' e_ 1 1 -5 • 10.16
200 Sa FT
Type of Work: ❑AAddition ['Alteration ['New Ri Repair/Replace ❑ Demolition
Describe Work: : / 4 N 1N ADD S6il
a r - (n).A\u I (d(.
Bonding Company's Name (if applicable) iv! /4,
Bonding Company's Address
City State Zip
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address
City State Zip
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 inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the
inspection will not • • • • •. �•• d a rei ctio ' e will be charged.
Age -wird-TA.
4,„,,
Signature
Contractor
The f', regoing instrument
was acknowledged before me this %rT/ The fore: • ing instrument was acknowledged before me this APR/
Uq,
day of F 20 b4 , by /n1 / Cl-t<1CL % URaD , day of tIARY , 20 tom, by J 0'5 3pZ."J0.5 ,
w rs ersonally k me o
nown to who has produced w o ispersonally known to me or who has produced
As identification and who did take an oath. as identification and who did take an oath.
My Commission Expires:
LESTER E. Gig' ': •
MV COMPISSIW' i May 20
k/ /
NOTARY PUB
Sign:
Print: 1-C —
E CROCKETT
ON#DD014762
20,200=
Budaet Notery r
My Commission Expires: ' " ! cb S
***************************************************************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
State Certificate or Registration No.
Chc 10/14/03
(Certificate of Competency Holder)
Certificate of Competency No.
* * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** * * * * * * ** * * * * * * * * * * * * * * * * * * * * * * * * ** ******** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
APPLICATION APPROVED BY: ) / f .1 3 t iPlans Examiner
Engineer
Zoning
Scale: Each block represents 5 feet and 1 inch = 50 feet.
11,1, li 1 17-]
LLT:E111
rpm
1
- 1
_ r
t ,
-t, t7 3 t-t
1 rJ
i ■ is ,a
F.
•
i ,
1
a ,
_ —■
� ..
_
-
irr
ei i
,- 4
1 1
{
, Y /a
, ; `
- ~ -,. , ,
• ,
•
■'�'
•I
;,
„ t
i
f
- 4
anito
— -1-
A
7
■■■
•■■■■■
WWII
i k, --
_ 1- -�
( t
L_ 1
'
■
�'
. ....
-* _.�..
_l
(
IN
roj, IS
WIN
111
■�:
1111111111111N1
I
i
■
i f
t p -- j 1 ,
��
). �
t ... -_
• 1 .._
1-1—'-1111
.e i i I- { 1
- -
(
i .. i. i i
r . ; f i
-)
,.
■■■■■
■i
1I
i �
., f i i
+
flII
[1 t11TtLtt
—�
—
■
—
.
■ i
t �1
f
r -i
— ` -
■■■■
■
■ ■■■■
■ -
■N
� -
` '
i j
■
i
' EL
r il 1 1
',..-.'..... ' -1
, ---i-+-- •-■
, ---4--i-- -.--
','--.4.--i-j
. T
Hi
[ --- 1
I
r4=9
-
nia
llllllll
ga■■■
� ��
•
LH
NM
.■
■■ ■ �
ii■■■
i n. 111
O� MUM
•
■
■�11■■
1,1111•1111
■■■■
1 ■■
■■
1111111111111
v ■■■
•
as
■ ■
a
■■
A
�._
�-
- t
� 1
I
t
t '
r +
�-
1
;
_
i
I
t i j 1 1
f
y
, s "��
}
MI
1 i t( f 1'
i
1 I
i i i f-+ !'
'
I
■■
i 0 r !
-:
i-�
11
i■ ■■I
■
■
a
■ ■■■ __.....
NNW
■■■
■■
us
rt
■
T
�..._ .......
f
1
J �
� �
n
r
t �
msu
n■■■
T
, ,
, � f
r
■�
1 i
r
■■a�i
■ ■w
■■re
1 ,
•
_L._c..
f
� �_
I
' t '
�■■■■■■■■a
r .
1 I
1
+ ,
■II■■■o■■
4, t r- i
r -- ; t 1
l i r
Site Plan submitted b
Plan Approved r.
By .
STATE OF FLORIDA
FIECEOVED DEPARTMENT OF HEALTH
1
11,6r51I�f���U11I11�� F�OR 1? NSITE SEWAGE DISPOSAL SYS ONS Number �
Permit Application be
pp CC�� )
PART II - SITE PLAN-
Notes: Mi01 s kiEM ko e-u te, _ Ci2n 1 100ST- MAP SNol e P/A- csys - --
9l DS i DUe11 nOurcLi
En_oreo UJ(l( 1, R Pore
DH 4015. 10196 (Replaces HRSH Form 4015 which may be used)
(Stock Number: 5744.002. 40154)
Signature
Not Approved
ALL CHANGES MUST BE APPROVED BY THE COUNTY HEALTH DEPARTMENT
Title
Date 47109' -
County Health Department
Page 2 of 3
CONSTRUCTION PERMIT FOR:
[ ]New System [
[ X ]Repair
APPLICANT: Rotundo,
LOT: 8
T [
A [
N [
K [
D [
R [
A
I
N
F
I
E
L
D
•
STATE OF
DEPARTME
ONSITE SE
CONSTRUCT
SYSTEM DESIGN AND SPECIFICATIONS
FILL REQUIRED: [ 0.0 ]INCHES
SPECIFICATIONS BY:Icaza, Carlos
APPROVED BY: Icaza, Carlos
DATE ISSUED: 2/17/04
RECEIVED
LORIDA 4 A, 2094
AGE TREATMENT AND 'ISPOSAL SYSTEM
ON..RERM•I T
This Permit is not for Addition (s)
]Existing System [ ]Holding Tank
]Abandonment [ ]Temporary
Michael & Kathleen AGENT: SA0021077,
PROPERTY STREET ADDRESS: 920 NE 100 St Miami Shores FL 33138
BLOCK: 170 SUBDIVISION: Miami Shores
[Section /Township /Range /Parcel No.]
PROPERTY ID #: 11- 3206 - 034 -0210 [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.
900 ]Gallons SEPTIC TANK
0 ]Gallons
0 ]GALLONS GREASE INTERCEPTOR CAPACITY
0 ]GALLONS DOSING TANK CAPACITY [ 0 ]GALLONS
200 ]SQUARE FEET PRIMARY DRAINFIELD SYSTEM
0 ]SQUARE FEET SYSTEM
TYPE SYSTEM: [V ]STANDARD [ N ]FILLED
N ]TRENCH [)C� ]BED
LOCATION TO BENCHMARK: Top of Bottom F1 or
, 14.00' NGVD.
ELEVATION OF PROPOSED SYSTEM SITE [ 2.2 ] [ FEET ]
BOTTOM OF DRAINFIELD TO BE [ 3.9 ] [ FEET ]
OTHER REMARKS:
This permit is not for additions.
*Replace existing broken septic tank by a new 900 gl.
outlet filter.
*Install 200 sq.ft. of drainfield.
*Invert elevation to be no less than 10.63' NGVD.
*Bottom elevation to be no less than 10.13' NGVD.
TITLE:
DH 4016, 03/97 (Obsoletes previous editions which may not be used)
(Stock Number: 5744- 001 - 4016 -0) [ostds cons 4016 -1)
[ ] Innovative Other
[ NA ]
Bolanos Jose
EXCAVATION REQUIRED: [ 20.0 ] INCHES
CENTRAX #: 13 -SG -19642
DATE PAID:
FEE PAID :
RECEIPT .
OSTDSNBR : 04 -0612- -R
MULTI- CHAMBERED /IN SERIES: [Y ]
MULTI - CHAMBERED /IN SERIES: [Y ]
[0 ]DOSES PER 24 HRS # PUMPS[ 0 ]
[ N ]MOUND [ N ]
[ N ]
[
BELOW] BENCHMARK /REFERENCE POINT
BELOW] BENCHMARK /REFERENCE POINT
C -1 septic tank with its approved
NEM ?' INSTALLED LI ED d=•? IF. SEPTIC TANK
SHALL BE klULTi-CHAMERED
AND EQUIPPED
APPROVED OUTLET FILTER
TITLE: Engineer I Dade
CHD
EXPIRATION DATE: 5/17/04
Page 1 of 2
Miami Shores Village
10050 NE 2nd Avenue
Printed: 2/25/2004
Applicant: KATHLEEN ROTUNDO
Owner: ROTUNDO KATHLEEN
JOB ADDRESS: 920 NE 100 ST
Parcel # 1132060340210
Signed:
Plumbing Permit
Phone: 305- 795 -2204 Permit Number: PL2004 -59
Page 1 of 1
Contractor MIAMI DADE ENVIROMENTAL Contractor's Address: 9591 FOUNTAINE BLUE BLVD #208
Local Phone: 786 -251 -4099
Legal Description: MIAMI SHORES SEC 8 PB 14 - 33 LOTS 8 & 9 BLK 170 LOT SIZE 100.000 X
Fees: Description Amount
FEE2004 -1949 Building Fee $175.00
FEE2004 -1950 CCF $1.80
FEE2004 -1951 Training and Education Fee $0.60
FEE2004 -1952 Technology Fee $4.37
FEE2004 -1953 Scanning Fee $3.00
FEE2004 -1954 Builders Bond $300.00
Total Fees: $484.77
Total Fees: $484.77
Total Receipts: $484.77
Permit Status: APPROVED Permit Expiration: 8/16/2004 Construction Value: $2,400.00
Work: REPLACE SEPTIC TANK AND 200 SQFT OF DRAINFIELD
(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 responisibility for all work
done by either myself, my agent, servants or employes.
Signed: (Contractor or Builder) BY:
AA ,
ATM
yI $
•••••••:".
;AZ
AREA 1117X3 [2] sQvit
DISTRIBUTION BOIL
NUMBER OF DRAINLINES [
DEAINLINN SEPARATION : [
DRAINLINE otOOS
riziita or coiiii
1
1
1
1
1
1101
(11)
[12 )
[13)
. E141
I
(16)
[17)
[18]
[19]
(20]
(21)
FILL
/
[23)
•
ELEVATION Bag - -
SYSTEM f
DoSitni PUMPS
AGGREGATE SIBE'l* 0 [
AGGREGATE SEUESSIUE '
[22] ExcAVATzoitiv-
7 6(o ( 0 q C
ST
. •
PAID: 7-0(4
T NO. 01 06i)
'r; PAID:
Z f7r) )
fl DisosAv
AND PIW1.
•
gRA? MATER
- 1 titbit* , : FT
I .
_
[ 3.30t FT
1 (4 4111144AT10.4041*r, , FT
011 POTABLE ATER * PT
133) FT
t I 101 PROPERTY Limn FT
I 0
FILLED / MOUND"SYSTEM
-- `
1 1 FILL .**Oiii100 J ,
FILL mvRE
•
[ ) [24] . . .„ . .guipopoprz
•••••••- :
I (25) AREA 9414A0ID rpliw,flomm PUMPED a Li ; c1
t y (i
I I [26) catigue a FILLED
=41.
linithitOiON '
..... • :1.
..fl 4016, 10/97-(Pr4ifinisAiditions E61604e-biaE)---. -
Installer / Contractor
'Owsr*ELD. cow,*
•-.) •I17I
1 0$j ELOPES
1 [39)
ADDITIONAL untioa0tOit
:iitiOnOttoopkb, AREA
t 4 8TORWTgR 'RUNOFF
101 4040
:,•-, • r ' •• •
j : Lot adittsioorr
• 1 (41 iiti#0# UEA .
053 LOAT X0 c�NFORMS virtu - Bits - kit;
1 1 -1 FINAL gTE
• ',ir;Wei
Arl
CONSTRUCatiltp gasAppRovnori
- -
. 4 - . . ,
FINAL SYSTEM -WPROFED ISAPPROVEDI
- - .
(47] C0ETRAUTOR
xD 1
I
IBM
CED DUNA - 40 L.
Pogo 2 of 3
APPLICANT:
AGENT: y ",
STATE OF FLORIDA
DEPA tTMENT of EEALTE
ONBITE SEIM= TREATMENT
CONSTRUCTION INSPECTION
PROPERTY ADDRESS, , () f )/, L _ , /eU
LOTS 7 • BLOCKS 7() SUBDIVISIONS �??L`a... -� .0 y �... PROP ID #s 1 .� 3 -2.<-) `C) r `/
CHECKED [X] ITEMS ARE NOT INCOMPLIANCI WITH STATUTE OR RULE AND j MUST EE
TAB INSTALLATION
[01) TANK SIZE [1] Jc 1 c- [2)
[02) TANK 1o1TERIAL
[03) OUTLET DEVICE
(04) MULTI - CHAMBERED (`.Y)/ N ]
(OS) OUTLET PI1jTE2 - h 1..
(06) IEOEND ("5 -
[07] "WATERT
[08) LEVEL
[09) DEPTH TO LID /
DRAINFIELD INSTALLATION
( A3131 1 ( SCUM
[11] DISTRIBUTION NOZ HEADER
[12) NUMBER OF DRAINI.INES 3
(13) DRAIMU.INE SEPARATION •3 '
[14) DRAINLINE SLOPE
(15) DEPTH Or COVER 4
[16] ELEVATION [AB0VE BM
[ 17) SYSTEM LOCATION - a-� --
[ 18] DOSING PUMPS .
(19) AGGREGATE SIZE . ; ' 00, r'? -•
(10) AGGREGATE EXCESSIVE FINES
(21) AGGREGATE . DEPTH /4
FILL / EXCAVATION MATERIAL
[22) FILL AMOUNT
(33] FILL MIXTURE
[24) EXCAVATION DEPTH [ZS] AREA REPLACED
[26] REPLACEMENT MATERIAL
CONSTRUCTION
FINAL SYS „.APPROVED
DE 4016, 10/97 (Previous Editions May Be Used)
AND DIPOBAL 8Y8TEM
AND FINAL APPROVAL
/ DISAPPROVED]
f
ISAPPROVED] s tI -' '
PERMIT NO.
DATI PAID:
FEE PAID:
RECEIPT #s
STORMNATER RUNOFF
n 0 /2
/ 7 -G'V
r-1
S•:7") V /,i17c /.I
CORRECTED.
SETBACKS
[27] SURFACE MATER
(28] DITCHES
(29) PRIVATE WELLS
[30] PUBLIC MSLLS
(311 :IRRIGATION WELLS N /
[32] POTa8L3 MATER LINES d
[33) EVILDI1if r0UNDATION • . 5" •
[34] PROPERTY LINES
[ OTENR
I
FT
FT
FT
FT
FT
FT
FT
FT
rILLED /MOUND SYSTEM
(36] DRAINFIELD COVER
(37] SMOULDERS • 1
[38] SLOPES t.
[39] STABILIZATION
ADDITIONAL INFORMATION
[40] UNOBSTRUCTED AREA
(41)
(42] ALARMS
[43] MAINTENANCE AGREEMENT
[44) BUU.DINO AREA
(45) LOCATION CONFORMS MITE
[46) FINAL SITE GRADING
(47) CONTRACTOR
[48] OTHER
SITE PLAN -
AMIAMEMINKENT
(49 ) TANK PUMPED �-'� v/ c/
(50] TANK CRUSESD ai FILLED 0
EXPLANATION OF VIOLATIONS / REMARKS: : ";
t ]
[
t
/ C8D DATES-. _ 2-0 '0 '
7)) • D . C. imp DATE- ' '
Pagsl;,_2 of +3
APPLICATION FOR PLUMBING PERMIT
Permit No IP / Date... �_. l _ .. / ___ ..._ .- _. - -'
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 whether herein specified or not. A copy of approved pI ns and specifications must be kept at
building during progress of work.
Owner's Name and Address
Registered Architect and /or Engineer
Employing Plumber's Name
Location and Legal Description Lot.
Street and Numbgr where work is to be performed —No 9
State work to be performed and purpose of building (By
New Building .. - - -._ _ ---- ........... -__ Remodeling —__ _. -._ __ Addition.
Size Septic Tank_. -.
Feet of Drain Tile
Nature of Water Supply: City—We1L
-Type of Tank
Dist. Feet of Tank or Drain Field from Well. _ _ __ ___ -- _ -- - -• - -_ __
Size of Soakage Pit.
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
CE
( Signed) .
(Si
No. __H20 Street-'vr2Lt'.Ls'. �..
Block Subdivision
A
Street . ...A 4_/ O
Repain No. of Stories.
Capacity Cals..._..__.__.
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 Pennanent Supplement, and hes 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' foe inspection on the site of the work �suc . blic notice or notices as are
required by the Act. The undersigned agrees to employ only such Bub - contractors, on to be psi► A under this permit, as are
licensed by Miami Shores Village.
Plumber.
STATE OF FLORIDA, µ
COUNTY OF DADE. j
Before me, the undersigned authority, a notary public, duly authorised to administer oaths and take acknowledgments, personally appeared
to me well known, and who, being by me first duly sworn, upon oath dep oses and says that be is the __--- '-- _.- _..-- • -_ - -. - - -•- _ - -- _
of the above described construction, that be has carefully read the forsgaing application, and that be 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 nob twbospeotdon is mode•neosseery by improper notice for inspection, or faulty
materials and /ar workmanship.
CLOUTS
BATH
T
eMOW[A•
LAVA•
Toas[O
SINKS
SLOP
SINK!
LAUNDRY
TUD•
URINALS
CATCH
SAO IN
FLOOR
DRAIN
ORINKIN.
FOUNT'N.
TOTAL
FI
CONTR.
LIST
CHICK
SEPTIC
TANK
SEWER
CONN.
DRAIN
FIELD
SOAKAO[
PIT
GREASE
TRAP
SOLAR
H EATER
Da6P
WILL
SPRKLR.
°TOTEM
SWIM'O
POOL
•
Cowne.
LIST
•—�
CHECK
APPLICATION FOR PLUMBING PERMIT
Permit No IP / Date... �_. l _ .. / ___ ..._ .- _. - -'
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 whether herein specified or not. A copy of approved pI ns and specifications must be kept at
building during progress of work.
Owner's Name and Address
Registered Architect and /or Engineer
Employing Plumber's Name
Location and Legal Description Lot.
Street and Numbgr where work is to be performed —No 9
State work to be performed and purpose of building (By
New Building .. - - -._ _ ---- ........... -__ Remodeling —__ _. -._ __ Addition.
Size Septic Tank_. -.
Feet of Drain Tile
Nature of Water Supply: City—We1L
-Type of Tank
Dist. Feet of Tank or Drain Field from Well. _ _ __ ___ -- _ -- - -• - -_ __
Size of Soakage Pit.
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
CE
( Signed) .
(Si
No. __H20 Street-'vr2Lt'.Ls'. �..
Block Subdivision
A
Street . ...A 4_/ O
Repain No. of Stories.
Capacity Cals..._..__.__.
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 Pennanent Supplement, and hes 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' foe inspection on the site of the work �suc . blic notice or notices as are
required by the Act. The undersigned agrees to employ only such Bub - contractors, on to be psi► A under this permit, as are
licensed by Miami Shores Village.
Plumber.
STATE OF FLORIDA, µ
COUNTY OF DADE. j
Before me, the undersigned authority, a notary public, duly authorised to administer oaths and take acknowledgments, personally appeared
to me well known, and who, being by me first duly sworn, upon oath dep oses and says that be is the __--- '-- _.- _..-- • -_ - -. - - -•- _ - -- _
of the above described construction, that be has carefully read the forsgaing application, and that be 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 nob twbospeotdon is mode•neosseery by improper notice for inspection, or faulty
materials and /ar workmanship.
u&
Permit - - - - - -
Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the bidding 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 � ' , I c
Registered Architect and /or Engineer____ _ __--_
Employing Plumber's Name_ /klififl4.121eele .5_ C`<!' _ 'V Ir No. -� Street_
Size Septic Tank
Feet of Drain Tile._
Nature of Water Supply: City —Well.
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
(Signed)-
( Signed) __
Ci No.____...... Q ___.__ _ Street
Location and Legal Description Lot_.__.._______ _ .____ Block_
Street and Number where work is to be performed —No.__ A 9 z-0 treet
State work to be performed and purpose of building (By Floors)_______.___.�4C&L
Type of Tank
_Dist: Feet of Task or‘Drain Field from Well
__Size of Soakage Pit
The undersigned applicant for this building permit does hereby certify that he understands and accepts h
under the Florida Workmen's Compensation Act, being Section 5988, Compiled General Laws of Florida P
plied with the provisions thereof, and will require similar compliance from all contractors or sub - contracto
performed under this permit; and will post or cause to be posted' for inspection on the si
required by the Act. The undersigned agrees to employ only such sub - contractors, o
licensed by Miami Shores Village.
the work su
to be pe
Date /94C/
6 /
A/47 i oos l
Subdivision ----- .,---------- .._.---- -•__ --
ch
r f
My Commission Expires Notary Public, State of Florida
T
Oa 4S' t` - "
New Building Remodeling__:__.__..._ ______ Addition Repairs No. of Stories
Capacity Gals
Plumbing Inspector.
bligations as an employer of labor
inanent Supplement, and has coin-
employ -: y 'm in the work to be
or notices as are
this permit, as are
mber.
STATE OF FLORIDA, I
COUNTY OF DADE.
Before me, the undersigned authority, a notary public, duly authorized to administer oa s 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_
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.
CLOBrTS
BATH
TU BE
SHOWERS
LAVA-
TORIES
SINKS
SLOP
SINKS
LAUNDRY
TUBE
URINALS
CATCH
BASIN
FLOOR
DRAIN
DRINK! NG
FOUNT' NS
TOTAL
FI %TORES
CONTR.
LIST
CHECK
.Z..�
SEPTIC
TANK
SEWER
CONN.
DRAIN
FIELD
SOAKAGE
PIT
GREASE
TRAP
SOLAR
H EATER
DEEP
WELL
SPRKLR.
SYSTEM
SW IM'G
POOL
CoNTR.
LIST
CHECK
u&
Permit - - - - - -
Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the bidding 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 � ' , I c
Registered Architect and /or Engineer____ _ __--_
Employing Plumber's Name_ /klififl4.121eele .5_ C`<!' _ 'V Ir No. -� Street_
Size Septic Tank
Feet of Drain Tile._
Nature of Water Supply: City —Well.
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
(Signed)-
( Signed) __
Ci No.____...... Q ___.__ _ Street
Location and Legal Description Lot_.__.._______ _ .____ Block_
Street and Number where work is to be performed —No.__ A 9 z-0 treet
State work to be performed and purpose of building (By Floors)_______.___.�4C&L
Type of Tank
_Dist: Feet of Task or‘Drain Field from Well
__Size of Soakage Pit
The undersigned applicant for this building permit does hereby certify that he understands and accepts h
under the Florida Workmen's Compensation Act, being Section 5988, Compiled General Laws of Florida P
plied with the provisions thereof, and will require similar compliance from all contractors or sub - contracto
performed under this permit; and will post or cause to be posted' for inspection on the si
required by the Act. The undersigned agrees to employ only such sub - contractors, o
licensed by Miami Shores Village.
the work su
to be pe
Date /94C/
6 /
A/47 i oos l
Subdivision ----- .,---------- .._.---- -•__ --
ch
r f
My Commission Expires Notary Public, State of Florida
T
Oa 4S' t` - "
New Building Remodeling__:__.__..._ ______ Addition Repairs No. of Stories
Capacity Gals
Plumbing Inspector.
bligations as an employer of labor
inanent Supplement, and has coin-
employ -: y 'm in the work to be
or notices as are
this permit, as are
mber.
STATE OF FLORIDA, I
COUNTY OF DADE.
Before me, the undersigned authority, a notary public, duly authorized to administer oa s 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_
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.