640 NE 101 St (5)APPLICANT:
• AGENT
PROPEKTi4iDbitiiitii
LOT
CHECKED [X] ITEMS ARE NOT III COMPLIAII CE WITH STATUTli OR RULE ,-
,s; )
• TANK INSTALLATION
] [01] TANK SIZE [ I]
] [02] TANK MATERIAL
] '1 OUTLET DEVICE'
] [04]
• (051 OUTLE4 FILTER
106] LEGEND A/ :).
[07] •WATERTIGHT
[08] LEVEL
[09] DEPTH
• ..
•-• ' •
STATE OF FLORIDA
DEPARTMENT OF HEALTH '
ONSITE SEWAGE TREATMENT ' AND DIPOSAL SYSTEM
CONSTRUCTION - INSPECTION AND 4INAL"APPRO*AL
RPor-TC: SUBDIVISION: ' • . .
• --7.•;;X;1'
• .
• • • • -
r'.
•
i� [2] 1 7 137 j SURFACE 'TATER /I/ 74- FT
' - '1 .128] DITCHES • "
' 1 1. it 251] PRIVATE
• ] 1,: 131) ,IKR;c!A2,I9 /e (,) ,FT
t301 pUBLIC
( 1z. [ lYptitilia '14 ;
• [ ] [33] BUILDING FOUNDATION FT
t 1 t 3 4 1
- . 1 - (35] . OTHER
J • .., " J 4,*
DRAIIIFIELD INSTALLATION ,_.. _ OP tILLED / MOUND, Tuns,' , „... •;.n..;;--';:#1:f7:,.7!..7.
I ] [10] AREA [ 2 -4 1i] a' r-stili :1 ::-) - 1341
E i [111 DISTRIBUTION BOX azAnisit.... .. • 1 ;j371' : SHOULDERS:, . _ .
[ ] [12] NUMBER OF DRAIN 1 .i 1 ,. ,,. 1381 .. 8 -ifi p ireg i
,
[ I 113] DRAINLINE SEPARATION . I- I _139] • STABILIXATION .
[ ] [14] . DRAINLINE SLOPE - ' ' •
% - DITIONAL . INFORN,AFXPF, -, • ' i r :•,- ; 't • -'
I I [15] DEPTH OF COVER( ' -
[ ] _1161 ELEVATION [AR° BELOW BM .- _.
: 1 .- 40] UNOBSTRIktEif'AIEA" ''''.: • - '7 '''' " -
[ ] [17] • SYSTEM LOCATION ..:_e7.__.,. ., ., [ . 1 ..,_ 41] ; 'PRIM. , - - -. ---- -
I [ (18) DOSING . piiies "1:1 . t.--,di r , ' :1- - t -1(42 7
''w 1..4 ""' "i"..° jill 414.. .2 '.:':.:
[ ] [19] _. AGGREGATE SIZE Ai i 4 .4 ; . . -.. 1 1 ,-.... i43] ' KniTENANgs .A04933mENT
- 4 ,_.- -, ° 4. `' '''' I t , • '"'"' 2. i . ...: IL' ,' -; - ;II! - .:: •• 7%; i...i.;°
i • ] . [201 Aoartiia.# EXCE8IFIVE FINES 1 A ' • (441 ' gumbilia AREi
[ I [21,1 AGGREGATE DEPTH A/ ) [ , ] „ (45] LOFILTIONi:CONFORIIS. -WITH SITE-RLAN
. : [ 3 (461 FINAL SITE GRADING
FILL / ...EXCAVATION.-scaTicatAL - 44 7 -
[ [22] AMOUNT i . 1 1 14111 , OTHER -
3233 FIL NEVA fr•Ti • '
I 1 I2 Oc1"..40I0i1 DEPTE . SBAIAkillmina
1 ARE*N
1 J [361 REPLAc�N 1 1 I TANK
.f
EXPLAIIATION„.0E- VI
44,
• INSTALLER / *TRACTOR
PROPERTY I� 1:
F. (i
PEBNIT 110.0/ ie • / / 7
DATE PAID:. /
FEE PAID: 7 _
RECEIPT #:
•
• _
•
•
; =•_.
•
••• •• ,
T; •
I - 1 - :' :- '----'* . . -
• I 1 -,-..,, .•,..- t.I.,4,..--4.z , -
. . . . . .
... - „-. • . ----- • i • .
CONSTRUCTION -- (APPROVED/Dxs4pivysK . -aw DATE:1_2.a , /
.1-,
a a, - . . . , • .! IN. , ! am 7 g.,F, ta... I> ^ e 4...4. ^. 0 -
.. , 2+ ' . - ' • . ' - . . -
4 . .
PuAL SisTEWIAppRonsp/pxgAmItOVOT . 0 . 4L-X,- - ---- r --- M6 ---- tuaiji •-• ''' ‘44,*).•'.•-
• VI .
. . • -s:
RR - 4016 ; : 10 • (privious .iditioni - *I. 141 110 - . -- -, • .- • . ' 7 --'''''-'• '------71Pago q
ELECTRICAL
TYPF.
Minimum Fee
QT1'.
TYPF,
Dryer
QTY.
TYPE
Outlet, Appliance
QTY.
TYPE:
Service Repair
QTY.
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
Water Closet
Demolition
A
Low -volt, Intercom/Teleph.
Repair Circuits
Water Heater
Dishwasher
Low -volt, Television
Service, Number of Amps
Water Heater New
MECHANICAL
TYPE
Minimum Fee
QTY. 'TYPF.
Condensate Drain
QTY. 'TYPE
Generator
QTY. 'Tl'l'E
Refrigeration, Tons
QTY.
A/C Central, Tons
Cooling Tower
Heating Strips, each
Vent Hood, Cost
A/C Wall/Win. Tons
Dryer Vents, Number of
- Paint Booth
Ventilation, Cost
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
'TYPF,
A/C Condensate
QTY.
TYPE.
Drains, Roof
QTY.
TYPE
Miscellaneous Fixture
QTY.
'Tl'1'E:
Soakage Pit
QTY.
Bath Tub
Drinking Fountain
Miscellaneous Repairs
Solar Water Heater
Bidet
Filter Replace
Pool Piping
Sprinkler Repair
Cap - Fixture
Fountain
Pump and Abandon
Sprinkler System
Cap - Water
Gas - Appliance
Pump, Domestic
Supply, AC Well
Cap - Sewer
Gas - Natural
Pump, Fire Stand
Temporary Toilet
Catch Basin
Gas - Propane
Pump, Re- circulate
Temporary Water Closet
Clothes Washer
Gas Piping
Pump, Replace - Pool
Urinal
Dental Chair
Grease Trap
Pump, Sprinkler
Utility - Sewer
Discharge Well
Ice Maker
Pump, Sump
Utility - Water
Dishwasher
Indirect Wastes
Relay Repair
Vacuum Pump
Disposal
Interceptor
Roof Inlet
Water Closet
Domestic Well
A
Laundry Tray
Septic Connection
Water Heater
Drainfield, 4" Tile/Res. add
Lavatory
Septic Tank
Water Heater New
Drains, Area
Meter Set (Gas)
Sewer Connection
Water Re -pipe
Drains, Floor
Minimum Fee
Shower
Water Service
Drains, French
Miscellaneous Equipment
Sink
Well, Supply
3
PERMIT APPLICATION
INSTRUCTIONS: Please indicate the type of work being performed and quantity(ies) in the space provided below.
RECEIVED AND REVIEWED BY: DATE:
SECTION
BY
DATE
Zoning
Electrical
Mechanical
Plumbing
r
1? v9 -d )
Fire
v
I
Public Works .
Structural
Building Official
Page 4
OFFICE USE ONLY
CHECKLIST
LI OWNER - BUILDER FORM
(Attach)
❑ FIRE DEPARTMENT
APPROVAL (Commercial /
multi - family)
❑ CONCURRENCY
(New Construction)
❑ OTHER
(Specify & Attach)
$3.00 per page (Scanning Fee)
Miami Shores Village
Bond
Metropolitan Dade County (C.C.F.)
Inspector State Educational Fund
State DCA (Radon)
Code Enforcement Fine
Zoning Review
❑ PROOF OF OWNERSHIP
(Attach)
❑ HRS / DERM APPROVAL
(Septic / Sewer)
❑ IMPACT FEE
(New Construction)
❑ OTHER
(Specify & Attach)
PERMIT FEES
$ (¢.005 /sq.ft.)
$ (¢.01 /sq.ft.)
ISSUING OFFICIAL
•
$ GO , bc�
$ 3 9o. O
$ / d 8 ( sq.ft. = x/1000
x ¢.60)
REVIEWED AND PREPARED BY:
PERMIT APPLICATI(
❑ CONDO ASSOCIATION APPRCVAL
(Attach)
❑ BPR APPROVAL (Restaurants)
❑ CONTRACTOR REGISTRATION
(On File)
TOTAL $ / F (")
DATE:
CONDITION OF APPROVAL
Revised July 2001
10050 N.E. 2ND AVE., MIAMI SHORES, FL • (305) 795 -2207 • FAX (305) 756 -8972 • http : / /www.miamishoresvillage.com
Notes:
STATE OF FLORIDA
DEPARTMENT OF HEALTH
APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PERMIT
Permit Application Number /
Scale: Each block represents 10 feet and 1 inch = 40 feet.
1 4
+ .
+
1
r
PART II - SITEPLAN
r „y
t
Site Plan submitted by:
Plan Approved Not Approved
,!
t
ALL CHANGES MUST BE APPROVED BY THE COUNTY HEALTH DEPARTMENT
{
Y
Date
By County Health Department
DH 4015, 10/96 (Replaces HRS -H Form 4015 which may be used) Page 2 of 4
(Stock Number: 5744 -002 - 4015 -6)
STATE OF FLORIDA
DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM
CONSTRUCTION PERMIT
: ONSTRUCTION PERMIT FOR:
[ ]New System [ ]Existing System [ 'Holding ank
g [ ] Innovative Other
[ X ]Repair [ ]Abandonment
[ ]Temporary [ IN ] Infiltrator
APPLICANT: Grundhauser, John AGENT: SR0921116, PARILLA ROBERT
PROPERTY STREET ADDRESS: 640 NE 101 St Miami FL 33138
LOT: 3
BLOCK: 103 SUBDIVISION: Miami Shores
[Section /Township /Range /Parcel No.]
PROPERTY ID #: 11- 3206 - 017 -2090 [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 [ 1050 ]Gallons SEPTIC TANK MULTI - CHAMBERED /IN SERIES: [Y ]
A [ 0 ]Gallons MULTI - CHAMBERED /IN SERIES: [Y ]
N [ 0 ]GALLONS GREASE INTERCEPTOR CAPACITY
K [ 0 ]GALLONS DOSING TANK CAPACITY [ 0 ]GALLONS @ [0 'DOSES PER 24 HRS # PUMPS[ 0 ]
D [ 300 ]SQUARE FEET PRIMARY DRAINFIELD SYSTEM
R [ 0 ]SQUARE FEET SYSTEM
A TYPE SYSTEM: [ ]STANDARD [ N ]FILLED [ N ]MOUND [ N ]
I CONFIGURATION: [ ]TRENCH [ W]BED [ N ]
E LOCATION TO BENCHMARK: Finish Floor Of Ex. Residence Elev. 14.6' NGVD.
I ELEVATION OF PROPOSED SYSTEM SITE [ 5.0 ] [ FEET ] [ BELOW]BENCHMARK /REFERENCE POINT
BOTTOM OF DRAINFIELD TO BE [ 7.0 ] [ FEET ] [ BELOWJBENCHMARK /REFERENCE POINT
•
) FILL REQUIRED: [ 0.0 ]INCHES EXCAVATION REQUIRED: [ 24.0 ] INCHES
ETHER REMARKS:
Existing 1050 Gallons Septic Tank.
Install 300 Square Feet Drainfield.
Invert Elevation of the Drainfield to be no less than 8.1' NGVD.
Bottom Elevation of the Drainfield to be no less than 7.6' NGVD.
This permit is not for addition.
SPECIFICATIONS BY: Andre, Paul
A PPROVED BY: Andre, Paul
)ATE ISSUED: 12/10/01
H 4016, 03/97 (Obsoletes previous editions which may not be used)
Stock Number: 5744- 001 - 4016 -0) (ostds_cons_4o16 -1]
Em's ��..•-- -
TITLE: tl
TITLE: EH Supervisor
CENTRAX #: 13 -SG -11172
DATE PAID:
FEE PAID : $
RECEIPT .
OSTDSNBR : 01 -3742- -R
Dade CHD
'EXgIFrATION DATE: 3/10/02
Page 1 of 2
:... i,14.4:^`...�11..::- r...:,,,7i5 1P. — . �— r:..., 1/I.u•.Sm,. `-r .. ••...:n. ti: .. -..r .lS:::.'..r.l. .-r'. iIf..'r.. -,.- �r
{�± PAY
TO THE . 71j .5 Z/1u, 124,11, Q
ORDER OF
FOR
BOB'S SEPTIC & DRAIN, INC.
1020 NE 130TH ST. PH. 305 -558 -5818
NORTH MIAMI, FL 33161 -4211
6
c tibank®
CITIBANK, F.5.0. 0R. #37
2750 AVENTURA BOULEVARD
AVEN,U FL33180
( & , i 4- &A)4
le (-Ca
00049 701 h: 2660E36 S St o: 2 10 2 '0606
iit�"3lll�F:. �r:..ulIG9.'9,T41�..;Y � 'I@3�m1ti ' i✓Jtl�lti - 's'^ -` - ..�... - v 'I� ` iY�YLi6a�6_:...
DAT /
4970
• 63- 865537
2660 PO
a,
_�/ 1 DOLLARS
61 _.,. icTw lri , ` m.: mnn =.,,.m._;... P.- !..-.ui v,.. m:= ami z = • vim? n .r ',. ....mL rte_ i1 im.^imiie _: •• nc :zmn9...sa ., ,_ _"Z WM-:
Page 2 Page
PERMIT,APPLICATION
IMPORTANT NOTICES
DO NOT BEGIN ANY WORK WITHOUT HAVING 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 through Friday from 7:30 a.m. to 6:00 p.m., and Saturday from 8:00 a.m.
to 5:00 p.m. No inspections will be conducted on weekends or holidays.
2. All construction of demolition areas MUST BE MAINTAINED IN A CLEAN, NEAT AND SANITARY CONDITION free from construction debris.
3. STREETS AND NEIGHBORING PROPERTIES SHALL BE KEPT FREE FROM DIRT AND DEBRIS.
4. SWALES MUST BE PROTECTED FROM BEING DAMAGED BY EQUIPMENT OR VEHICLES, AND MAY NOT BE USED FOR STORAGE. A bond is
required for work in or near the street/sidewalk.
5. CONSTRUCTION TRAILERS ARE PROHIBITED ON SINGLE FAMILY RESIDENTIAL CONSTRUCTION SITES. Other construction may have a trailer
which requires a separate permit.
6. PORTABLE TOILETS for a construction site require a separate permit.
7. DO NOT DISCHARGE WATER INTO THE RIGHT OF WAY OR STORM DRAINS without approval from the Building, Planning and Zoning Department.
8. EQUIPMENT AND MATERIALS SHALL BE STORED at least 10 feet from the edge of pavement.
9. Department of Health and Rehabilitative Services (HRS) approval is required for applications involving septic tanks. Department of Environmental Resources
Management (DERM) and/or Miami -Dade Water and Sewer Department (MDWASD) approval is required for applications involving sewers.
1.
AFFIDAVIT - Please read carefully.
Application is hereby made to obtain a permit to do work and installation as indicated. I, the OWNER of the property, certify that all
work will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that separate permits
are required for ELECTRICAL, PLUMBING, POOL, EXTERIOR DOOR, MECHANICAL, WINDOW, FENCE, DRIVEWAY,
ROOFING and SIGNS and there may be additional permits required from other governmental agencies.
I, the OWNER of the property, have disclosed all information related to any work at the property performed in the prior twelve
months to the Building Official. Further, I am fully aware that if the cumulative cost of work to my home or business under this and
any other permit equals or exceeds fifty percent (50 %) of the fair market value of the structure, the entire structure must meet the
present federal flood criteria for finished floor elevation. I am also fully aware that if the total cost of work to my home or business
under this and any other permit exceeds fifty percent (50 %) of the replacement cost of the structure, then the entire structure must
conform to the current code requirements of the Building Code.
WARNING TO OWNER: Your failure to record a NOTICE OF COMMENCEMENT may result in you paying twice for
improvements to your property. If you are spending more than $2,500 or intend to obtain financing, you may wish to consult with
your attorney or lender before recording your Notice of Commencement. The Notice of Commencement must be recorded at:
22 N.W. 1st Street, 1" Floor, (305) 679 -1078. Once recorded, the Notice of Commencement must be POSTED AT THE JOB SITE in
accordance with Section 713 -35 of Florida Statutes. Review the brochure at Village Hall on Construction Lien Law and
Choosing a Contractor.
T A _OF
4 .
Signature of Owner
4 s W e. l 5 04 a. c
Print Name
S :m to • d subscribed before me this / day of e�
<' . .t
Personally known OR, Produced Idegtificati
Type of Identification Produced:F/4
IDA, COUNTY OF MIAMI -DADE
SSS
S
Sign
• • OR-5I • j•F MIAMI -DADE
' N O
ual
Print Name
and subscribed before me this
/ � � l a
ature"ot rry Publie� :c
VVVVVV � -, c t.b
Personally known OR, Produced Identification
-SR- a7 pe of Identification Produced: Tip ip I Prow) (06 J 1 130 ,0
ARCHITECT
New Construction
Name
6 . ' i �N
i 1I iW
License No.
Repair
Address
��0
Y//ti �
)
t /0 / sr
Teleph e
Relocation of Structure
Fax
Foundation Only
TYPE OF MANAGEMENT (✓ )
New Construction
Enclosure
Alteration Exterior
Repair
Alteration Interior
Demolish
Relocation of Structure
Shell Only
Foundation Only
Add'I Attachment
Other
Add'l Detachment
Other
)N
INSTRUCTIONS - The following steps must be taken to ob
Step 1.
Job Address:
Folio Number
Address
1, 0 1 , /0 I CP
Apt.
Block
Subdivision 5er, ' PB
Current Use of Property
Proposed Use of Property
Tenant Information
Lot
PERMIT TYPE (✓ )
Building
Electrical
Mechanical
Plumbing
LPGX
Roofing
Fence
Other
PG Zoning_
PERMIT CHANGE (✓ )
Chg. Contractor
Renewal
Revision
Extension
Supplement
Reinspection
PROPERTY OWNER
Name
Address
Home Telephone
Business Telephone
Fax
444,
PERMIT APPLICATION
Master Permit No.
Subsidiary Permit No.
ain a permit from the Miami Shores Village:
Complete the attached permit application which must be signed by the property owner and qualifier. Both signatures must be notarized. Please
print or type to allow for a more accurate processing of your application. If roofing work will be done, a roofing application must be submitted
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.
6 Description of Work
City — State
CONTRACTOR
Name
F /
3'd
Telephone
Qualifier Ndne
Zip
Linear Feet
Square Feet ,f .r'Jnits Floors /
Value of Work ( 9-500. -- Bldg Value
Tax Assessed/Appraised Value
Flood Zone Base Floor Elev.
ENGINEER
Name
License No.
Address
Telephone
Fax
License No. c5 �' � 1
Address
O 'iF Fax
(ID ,/)Ateil.k.„,
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Date `f Job Address 6yD Avc /o/ „ 5 T Tax Folio
Afi+9 fitsi�.rt .
Legal Description ✓ 1 Y .29 . / Ct3 /4/ 3ns-t
Owner/Lessee / Tenant , LOX/ 5 W e l S IM 2 w +"l Q Master Permit # 4/s a yvZ
Owner's Address 6 K O 4:4 /pl S%
Contracting Co.. 5//7T 3 CO /t/c" Address /p 3, S %eye 66' yam'
Qualifier t%9#5 VS/77 S SS# � Phone e s 2e, - S 7 4 7
State # Municipal # F 'C'C? Competency # Z ct=>O Ins. Co. Ff 2 Z 78 v o
Architect/Engineer Address
Bonding Company Address r
Mortgagor Address
Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIPTION //V_5T:9 . /S " a eN {' 3IS " 1.3
Square Ft. /249 o X
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.
Si '.: a of owner d/or Condo President Da
Wys --333 -3g - S/3 --
Notary as Odm and/or Condo President
My Commission friqiii O7P21""k "
'�x ° Y S
J
FEES: PERMIT RADON
APPROVED: ' 5
Zoning
Mechanical
e tas
1'n r3A
NO (".:f •r3
tom r C
No
My Commission E
C.C.F. 7+ 90 NOTARY S� '
Historically Designated: Yes No
Phone 7 5,' 8'0
Estimated Cost (value) 3 e
tractor or Owner- Builder
0 c2 -Se -- oe
Electrical
BOND _ t) v `'
7 `J
TOTAL DUE 3 03
Structural Engineer
te .ell «U
id
stn
Date
fires:
Nyi t±alJ
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NOTICE OF COMMENCEMENT
A RECORDED COPY MUST BE POSTED ON THE JOB SITE AT TIME OF FIRST INSPECTION
PERMIT NO. TAX FOLIO NO. 1 3,40 7 C4 0 9 b
STATE OF FLORIDA:
COUNTY OF DADE: 99R 196288 1999 APR 16 09:55
THE UNDERSIGNED hereby gives notice that improvements will be made to certain real property, and in accordance with
Chapter 713, Florida Statutes, the following information is provided in this Notice of Commencement.
1. Legal description of property and street address: b di 0 ''4 r / 0 /
At-in P 1 ^ `'fi ,- s
3 -- 4- G /d 5 ) ./9 -eox it 03
2. Description of improvement: . � ( Cj ■ ►�
t Owner(s) name and address: I.tjP 1S rM ✓l f ( € S
(. 'I-0 AI t • %o 4/1(A04, 5 ., R. 33'33
Interest in property:
Name and address of fee simple titleholder:
P J�P G• 7 fi�'�y '�1(',' IL' V ^t J: y. /VV .�'V" ? J �'.i - .�ai q t ..
Contractor's name and address: (VI S rir �'r '':0 9 P i T i C KT; l/O_ lv� i
-Yn e 1 FL- e 3
$'1-ATE OF FLOR'DP; COUNTY OF DP`
5. Sure : Pa ment bond required by owner from contractor�,�If:,
tY ( Y 4 Y '+bcear► v PI iii ,: c P.uo
mri ?inal / n in P; is/A cn f 7 I ,:..
Name and address:
Amount of bond $
6. Lender's name and address:
Signature of Owner
Print Owners Name G-P)/ S W eiSMa'1 7
Sworn to and subscribed before me this
Notary Public
Print Notary's Name
My Commission Expires:
7. Persons within the State of Florida designated by Cwne .notices, or, other doc,urrents. may be served as provided
by Section 713.13(1)(a)7., Florida Statutes,
Name and address:
8. In addition to himself, Owner designates the following person(s) to receive a copy of the Uenor's Notice as provided in
Section 713.13(1)(b), Florida Statutes.
Name and address:
9. Expiration date of this Notice of Commencement: (the expiration date is 1 year from the date of recording unless a
different date is specified)
Prepared by: 1-0 iS 1vrs wow I- ip
Address: (o t10 /OE 10f S 7
0 1 rcC t.vf, S 4or.2c , FF 3 3i38'
12301 -52 2.93
CLOSETS
BATH
TUBE
SHOWERS
LAVA-
TORIES
SINKS
SLOP
SINKS
LAUNDRY
TUBS
URINALS
U
CATCH
BASIN
FLOOR
DRAIN
DRINKING
FOUNT•NB
TOTAL
FIXTURES
LIST
CHECK
1_�.
_
SEPTIC
TANK
SEWER
CONN.
DRAIN
FIELD
SOAKAGE
PIT
GREASE
TRAP
SOLAR
H EATER
DEEP
WELL
SPRKLR.
SYSTEM
SWIM'G
POOL
CONYR•
LIST
CHECK
iE hereby awe for the approval of the detailed statement of the plans and specifications herewith submitted for the building or other
stza:.tat• herein described. This application is made in compliance and conformity with the Building Ordinance of Miami Shores Village, Florida,
rain 911, provisions of the Laws of the State of Florida, all ordinances of Miami Shores Village and all rules and regulations of the Building Division
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.
Ownes Name and Address �' • �� Ate? ______ ___ ___.____..--- -.__ -- No _640 . _ Street_ ......
-- PI.i'�...1O1 . .t •
Registered Architect and /or Engineer .....
---- . —. Employing Plumber's Plumber's Name Rose :'. t• rd �1ve ., Hiaie
Street___ -.�._- - -_ -_ -- �
Location and' Legal Description Lot_._
Street and Number where work is to be performed —No 640
State work to be performed and purpose of building (By Floors) ___
New Building ------ ^_---- --- - -- -- --__ Remodeling
Size Septic Tank Type of Tank
Feet of Drain Feet of Tank or Drain Field from Well
Nature of Water Supply: City — Well. - - -- _ ----- -_-- _.-- _ -- --- __ -. - Size of Soakage Pit
Amount of Permit $ 4-
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
red zi-ed by the Act. The undersigned agrees to employ only such sub - contractors, on work to be performed under this permit, as are
Ilcersed by Miami Shores Village.
( Signed _ l< �_L � r>!
{ Master Plumber.
STATE OF FLORIDA, ( u.
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
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
Addition
(Signed )
Street
Date 2/24/61
Block Subdivision... _.._..._.._...__..._.._.____.__
N. E. 101st St.
Repairs No. of Stories .. . .... . ... ......_.__
_Capacity Gals
Notary Public, State of Florida
Inspector.
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.
JOB
ll ie of Miami Shores
r WC
ADDRESS
INSPECTION � P
TIME READY � 0 0 C
REMARKS
N? 3802
'RECTOR DATE e " 7- .
State work to be done and purpose of building (by floors)
W. NG..._ SHUT TE.H.._ IP
MIAMI SHORES VILLAGE
BUILDING INSPECTION DEPARTMENT
APPLICATION FOR BUILDING PERMIT
Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the build-
ing 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 the work.
Date LAY 2 1957 , 19
Owner's Name and Address... G • A TEN No 6110 Street N....._E.. 101 S T
Registered Architect and /or Engineer RAQ _.E NG •
Name and address of licensed contractor S.EH i NG C 0 • 030 N • \`X • 29TH S T
CONGRESS BLDG.
Location and legal, description of lot to be 11163:
II (�,1
Lot _ & ' & 0 F 5 Block ll '• Subdivision._._._.�L1.I.A11L1 SH ORE SEC . i
Street and Number where work is to be done �.[�. Q...J.. E.. 101ST S T •
and for no other purpose.
New Building Remodeling Addition .X Repairs No. of Stories
To be constructed of__.. fi E..T.A.L Kind of foundation Roof Covering ....P .L.0 M 1 NU iv'
Estimated Total cost of improvements $ 735..�� Amount of Permit $
Zone cubage required _Plan Cubage
Distance to next nearest building t 1.2c' t
g._.. Size of Building L � x.
Maximum live load to be borne by each floor
I hereby submit all the plans and specifications for said building. All notices with reference to the building and its construction may
be sent to
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 complied 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 subcontractors, on work to be performed under this
permit, as are licensed by Miami Shores Village. r
Remarks (Signed)L.tr' '� �� ----�
STATE OF FLORIDA,
COUNTY OF DADE. J ss
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally ap-
peared
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.
Permit No 4 ''') Date._ �° � Read, Sworn to and Subscribed before me.
Disapproved °z Date
(Signed)
`Building Inspector My Commission Expires
Notary Public, State of Florida
PLANNING BOARD DATE
Chairman Member
Member Member
Member Member
Council Approved Date Disapproved Date
NOTE: A charge of $1.00 will be made for making corrections or changes to this application after approval has been obtained from
the Planning Board.
A re- inspection fee of 81.00 will be charged when such re- inspection is made necessary by improper notice for inspection or faulty
materials and /or workmanship.