117 NE 102 St (4)APPLICANT: //(-
AGENT z ("' 72/-7
PROPERTY ADDRESS:
1 i
c
LOT: .•' > BLOCK: /
l
l
l
l
TANK
[01]
[
[03]
[04]
[05]
(06]
[07]
[08]
[09]
STATE OF FLORIDA
DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATAENT AND DIPOSAL SYSTEM
CONSTRUCTION INSPECTION AND FINAL APPROVAL
_ (r
SUBDIVISIONS / <_( _i 1 rZ_E:.4 _.PROPERTY ID 1:. i'/— -f r 0 ," ; r i
a :sass: ::s=as=s== :asamms:mat
CHECKED (X] ITEMS ARE NOT IN COMPLIANCE WITH STATUTE OR
___- ---- --=a =a =ate = =s
INSTALLATION
TANK SIZE [W OO [2]
TANK MATERIAL v .,.: . .7.,,.,
OUTLET DEVICE
MULTI - CHAMBERED 6)/ N
OUTLET FILTER Z , "y ,
LEGEND - '" 00 j -! `i,-
WATERTIGHT - • 7 - . "
LEVEL
DEPTH TO LID
DRAINFIELD INSTALLATION
[10] AREA [1)'Z KR ' [2] S C/ SQFT
[11] DISTRIBUTION BOX _ HEADER
[12] NUMBER OF DRA/NLINES 1 f
[13] DRAINLINE SEPARATION ,_f :r,
[14] DRAINLINE SLOPE
[15] DEPTH OF COVER./r''
[16] ELEVATION (ABOVE/ g0) BM _
[17] SYSTEM LOCATION
[18] DOSING PUMPS ,A1 i F
[19] AGGREGATE SIZEtt4/ ei^9,
[20] AGGREGATE EXCESSIVE FINES
[21) AGGREGATE DEPTH) ,Z ' '
FILL / EXCAVATION MATERIAL
[22] FILL AMOUNT . `
[23] FILL TEXTURE
[24] EXCAVATION DEPTH
[25] AREA REPLACED
[26] REPLACEMENT MATERIAL
f ..
DE 4016, 10/97 (Previous Editions Nay Be Used)
[ ] [Z
[ ] [
[ ] [
[ ] [
[ ] r31]
]
[ [33]
[ ] [33]
[ ] [34]
[ ] [35]
rA
i
EXPLANATION OF VIOLATIONS / REMARKS: t
[ ]
[ ]
[
CONSTRUCTION [APPROVED /DISAPPROVES']: - °,
FINAL SYSTEM [APPROVED /DISAPPROVED]:
Installer / Contractor
PERMIT NO.
DATE PAID:
FEE PAID:
RECEIPT #:
RULE AND MUST BE
SETBACKS
SURFACE WATER It/ IA FT
DITCHES FT
PRIVATE WELLS i FT
PUBLIC WELLS ■,( i %! FT
I RRIGATION WELLS C.) FT
POTABLE WATER LINES..S C =r'.1 ART
BUILDING FOUNDATION •. FT
PROPERTY LINES ,,f ` FT
OTHER FT
FILLED / MOUND SYSTEM
[36] DRAINFIELD COVER
[37] SHOULDERS
[38] SLOPES
[39] STABILIZATION
ADDITIONAL INFORMATION
[40] UNOBSTRUCTED AREA
(41] STORMWATER RUNOFF
[42] ALARMS
[43] MAINTENANCE AGREEMENT
[44] BUILDING AREA
(45] LOCATION CONFORMS WITH SITE PLAN1— /
[46] FINAL SITE GRADING ,, �•�
[47) CONTRACTOR
(48] OTHER
ABANDONMENT
[49] TANK PUMPED _ / /
[50] TANK CRUSHED & FILLED _ / /
/1
s
''/ -
77,77 / -
..5 r - T C ' / r1 E. "'
CORRECTED.
CHD DATE:
CHD• DATE:
Page 2 of 3
Contractor's Address
BUILDING
PERMIT APPLICATION
FBC 2001
Permit Type (circle): Building Electrical
Owner's Name (Fee Simple Titleholder) F (no nd o TO ro
Owner's Address t t' Z S -ceQJ\
City I Q M i S ko reC State FL-
Tenant/Lessee Name
Job Address (where the work is being done)
City Miami Shores Village
Is Building Historically Designated
Contractor's Company Name Uoyc( - o (4 Dade, ' ei) c
City WI Q r.1 State ¥t.
Qualifier . E C • CA, c11e. 4
Architect/Engineer's Name (if applicable)
Architect/Engineer's Address
City ..
"1 N) v•-) 1 o vkfe€"
State
S Value of Work For this Permit '* Goo wr
Miami Shores Village
Building Department
County Miami -Dade
YES NO V
Number of: Bays Stories
Type of Work: ❑Addition ❑Alteration ❑New
Describe Work: ft) 4 - F A Gn crl fxI
2 i6J r) s c h e
i
Permit No.
Master Permit No.
Mechanical Roofing
Phone #
Zip 3313
Phone #
St �-
Zip 33130
Phone# (3oS) - 1 SI'-6
Zip 3'
Phone #
Zip
Square Footage Of Work:
Families Bedrooms
X I Repair/Replace
* * * * * * * * * * * * * * * * * * * * * * * * * * ** F ees * * * * * * ** ** * * * * * * * * * * * * * * * * * * **
/
Permit Fee $ f 1 -
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
Baths
Notary $ b D 0
County Escrow Fee $ L CO
Education/Training Fee $ . o b Tech $ . 131 Scanning $
Code Enforcement $ Bond $ Struct. $
Minus Plans Check Fee $ Total Fee Now Due $ [ l
❑ Demolition
Radon $
(Continued on opposite side)
Bonding Company's Name (if applicable) N `2s
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.
Signature afl/Y
Owner or Agent
The foregoing instrument was acknowledged before me this aly
day of /)Rkji. , 20 OIL, by &;2",U4/t.'
t who is personally known to me b r who has produced
State Certificate or Registration No.
APPLICATION APPROVED BY:
chc7nro3
As ideptification and who did take an oath.
NO ARY P y�
Sign: 14-
Print: L- r .57 £. 7GPVeleE TT
Signature
The foregoing instrument was acknowledged before me this .
day of ,/- /L. , 2027d, by
is personally known to me)Dr who has produced
NOTARY P
Si
P
Contractor
as identifi. tion and
ho did take an oath.
My Commission Expires: f3 it y / ? p j j, � - My Commission Expires:
(Certificate of Competency Holder)
Certificate of Competency No.
* * * * * * * * * * * * * * * * * * * * * * * * * * * * ** * * * ** * **** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
3 -14 r Plans Examiner
Engineer
Zoning
Miami Shores Village
10050 NE 2nd Avenue
Phone: 305- 795 -2204 Permit Number: PL2004 -134
Printed: 5/10/2004
Applicant: EDUARDO
Owner: NODAL
JOB ADDRESS: 117 NE 102 ST
Contractor LLOYD NORTH DADE SEPTIC TANK SERVIOXdtftTactor's Address: 750 NW 107 ST
Local Phone: 305 - 754 -3375
Parcel # 1132060131810
Plumbing Permit
NODAL
EDUARDO
Legal Description: MIAMI SHORES SEC 1 AMD PB 10 -70 LOT 17 & LOT 18 LESS E1/2 BLK 13 LOT SIZE
Fees: Description Amount
FEE2004 -4375 Building Fee $175.00
FEE2004 -4376 CCF $0.60
FEE2004 -4377 Notary Fee $5.00
FEE2004 -4378 Training and Education Fee $0.20
FEE2004 -4379 Technology Fee $4.37
Total Fees: $185.17
Total Fees: $185.17
Total Receipts: $185.17
Permit Status: APPROVED Permit Expiration: 10/27/2004 Construction Value: $600.00
Work: ABANDON SEPTIC TANK
Signed: (INSPECTOR)
Page 1 of 1
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
BUILDING DEPART
305- 795 -2204
Building Inspection Request
� Dat a
Type Insp' n ' /
Permit No. PL
L O `
51'1
Name
Address r1 - C.
Company
Phone #
Inspection Date
Approved
Correction
Re- Insp'n Fee
4
JAMI SHORES VILLAGE
J BUILDING DEPARTMENT
305 -2204 )
Building Inspection Request y
(-)
Dates/ / ) \
Type Insp' n
Permit No. Pi ( : L - 1 3
Nar/ 'A it .,
Address /( w .,
Company U
Phone #
Inspection Date 5 / 1 j
Approved
Correction
Re- Insp'n Fee
'i
IU
j,
Miami Shores Village
Buildin g Department
artment
cwt.
BUILDING
PERMIT APPLICATION
FBC 2001
Permit Type (circle): Building Electrical
Job Address (where the work is being done) 111 I ` E \ OZ. Sk{ et+
City Miami Shores Village County Miami -Dade
Is Building Historically Designated YES NO ✓
Contractor's Company Name L.1 #oy d- J0r4-h Dade--
Contractor's Address '1 0 W 101 St ream
City I• 1 Q M 1 State 1'L
Qualifier Le u+Zr !< - CYo ck eit
Minus Plans Check Fee $
Permit No.
Master Permit NoPi O 4 -' 2
Mechanical Roofing
Owner's Name (Fee Simple Titleholder) EeXYI 01,1(40 To r0 Phone #
Owner's Address N11 14 \02
City N11 QMi D' CS State ft- Zip 1 38
Tenant/Lessee Name Phone #
Zip
G Phone # (305 191-161
zip 3316
3313
$ Value of Work For this Permit 4 GOO ' 224 Square Footage Of Work: 200
* * * * * * * * * * * * * * * * * * * * * * * * * * ** F ees * * * * * * * * ** * * * * * * * * * * * * * * * * * * **
County Escrow Fee $ 1 — b Permit Fee $ 1 1.--C
Education/Training Fee $ L D Tech $ l 3 Scanning $ Radon $
Code Enforcement $ Bond $ 3 D, Struct. $
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
Architect/Engineer's Name (if applicable) N ity - Phone #
Architect/Engineer's Address
City -. State Zip
Number of: Bays Stories Families Bedrooms Baths
Type of Work: DAddition ['Alteration [New ,E3 Repair/Replace ❑ Demolition
Describe Work: \ h 5V'q I l t l..ev) "v -G - Tcc n K
•* In s-\ - a 11 sl ew 0 i q \n e 101
Notary $ o
Total Fee Now Due $ JJ (Continued on opposite side)
Bonding Company's Name (if applicable) IJ Ps
Bonding Company's Address
City State Zip
6 ho is personally known to meer who has produced
* * * * * * * * * * * * *** * * * * * * * * * * * **
APPLICATION APPROVED BY:
chc7//ro3
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.
Signature
%.*-- v �`
Owner or Agent
The foregoing instrument was acknowledged before me this may`
day of /4-A IL , 20 0` , by Freil krA9 lozo
As identification and who did take an oath.
o .44.
NOTAR
NOT
Sign:
Print t 2 J L C C- i' CAL
Signature
riot:
Contractor
The foregoing instrument was acknowledged before me this
day of 1 /L- , 20 G , by - LEY/254" L- c,2 cA2E 7
rho is personally known to meor who has produced
as identification and who did take an oath.
My Commission Expires: J /7'> Cor jv),S My Commission Expi s: '\.
************************************************ * * * ** * * * * * * * ** * ** ** * ** * * * ** * *** * , $* **** *** #*Op * ** r ****
(Certificate of Competency Holder)
State Certificate or Registration No. Certificate of Competency No.
********************************* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
Aru;aln M n'ckPr
� . J Plans Examiner
Engineer
Zoning
APPLICANT: Toro, Fernando
LOT: 17 BLOCK: 13
APPROVED BY: Andre, Paul
STATE OF FLORIDA
DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM
CONSTRUCTION PERMIT
CONSTRUCTION PERMIT FOR:
[ ]New System [ ]Existing System [
[ X ]Repair [ ]Abandonment
PROPERTY ID #: 11- 3206 -013 -1810
SYSTEM DESIGN AND SPECIFICATIONS
DH 4016, 03/97 (Obsoletes previous editions which may not be used)
(Stock Number: 5744- 001 - 4016 -0) [ostds_cone 4016 -1]
]Holding Tank [ ] Innovative Other
] Temporary [ NA ]
AGENT: SR0001343, Crockett Lester
PROPERTY STREET ADDRESS: 117 NE 102 St Miami Shores FL 33138
SUBDIVISION: Miami Shores
[Section /Township /Range /Parcel No.]
[OR TAX ID NUMBER]
T [ 900 ]Gallons SEPTIC TANK
A [ 0 ]Gallons
N [ 0 ]GALLONS GREASE INTERCEPTOR CAPACITY
K [ 0 ]GALLONS DOSING TANK CAPACITY [ 0 ]GALLONS [ 0
L
D FILL REQUIRED: [ 0.0 ]INCHES EXCAVATION REQUIRED: [ 30.0 ] INCHES
CENTRAX #: 13 -SG -20627
DATE PAID:
FEE PAID : $
RECEIPT .
OSTDSNBR : 04 -1576- -R
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.
MULTI - CHAMBERED /IN SERIES: [Y ]
MULTI- CHAMBERED /IN SERIES: [Y ]
]DOSES PER 24 HRS # PUMPS[ 0 ]
D [ 200 ]SQUARE FEET PRIMARY DRAINFIELD SYSTEM
R [ 0 ]SQUARE FEET SYSTEM
A TYPE SYSTEM: [ N ]STANDARD [ N ]FILLED [ N ]MOUND [ N ]
I CONFIGURATION: [ N ]TRENCH [ N ]BED [ N ]
N
F LOCATION TO BENCHMARK: 12.7' NGVD/ FF of Residence
I ELEVATION OF PROPOSED SYSTEM SITE [ 1.3 ] [ FEET ] [ BELOW BENCHMARK /REFERENCE POINT
E BOTTOM OF DRAINFIELD TO BE [ 3.8 ] [ FEET ] [ BELOW BENCHMARK /REFERENCE POINT
OTHER REMARKS:
1- Install 900 gals. category -3 septic tank equipped with an approved filter.
2- The licensed contractor installing the system is responsible for installing the minimum
category of tank in accordance with sec. 64E- 6.013(3)(f), FAC.
3- Install 200 sq. ft. of drainfield in bed configuration.
4- Existing 350 gals. septic tank and 150 sq. ft. drainfield, certified by Lloyd North
Dade Septic are to be properly abandoned.
5- Invert elevation of drainfield to be no less than 9.40' NGVD.
6- Bottom of drainfield elevation to be no less than 8.90' NGVD.
7- This permit is not for additions.
SPECIFICATIONS BY:Andre, Paul TITLE:
TITLE: Professional Engin Dade CHD
DATE ISSUED: 4/27/04 EXPIRATION DATE: 7/26/04
Page 1 of 2
Scale: Each block represents 5 feet and 1 inch = 50 feet.
--�
Notes: � ; '
Site Plan submitted b, :
Plan Approved
By
STATE OF FLORIDA
DEPARTMENT OF HEALTH
APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PERMIT
Permit Application Number
f 6> l
e. .:; a
,A.a
0H 4015, 10/98 (Replaces HRS.H Form 4015 vhich rttay be used)
(Stock Nurrbr: 5744 - 0024015.8)
PART II - SITE PLAN -
s y, /
° u f,1,/ (. 'M' r? )//'
Signature
Not Approved
ALL CHANGES MUST BE APPROVED BY THE COUNTY HEALTH DEPARTMENT
r
Title
Date
County Health Department
Page 2 of 3
APPLICANT:
STATE OF FLORIDA
DEPARTMENT OF HEALTH
ONSITE SEWAGE DISPOSAL SYSTEM
SITE EVALUATION AND SYSTEM SPECIFICATIONS
r ' , J z) � 0
LOT: f 4 BLOCK: / SUBDIVISION: MA/I/ ,-5/../C)6 54z /
PROPERTY ID #: /•• �'� CMG O/ 3 • /
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
TOTAL ESTIMATED SEWAGE FLOW:
AUTHORIZED SEWAGE FLOW:
UNOBSTRUCTED AREA AVAILABLE:
BENCHMARK /REFERENCE POINT LOCATION: Lis
ELEVATION OF PROPOSED SYSTEM SITE IS / .4, • NCHEo/FT] [ABOV BELOWP BENCHMARK /REFERENCE POINT
THE MINIMUM SETBACK WHICH
SURFACE WATER: /OA- • FT
WELLS: PUBLIC: /V -/ FT
BUILDING FOUNDATIONS:
SITE SUBJECT TO FREQUENT FLOODING: [ ] YES [4NO
10 YEAR FLOOD ELEVATION FOR SITE: :3 ( MSI*NGVD
� / -!Gt)7'
SOIL PROFILE INFORMATION SITE 1
Munsell # /Color Texture Depth
/t)' /k s/ / L on 01-1 0"
G72 C Y 5AN2)
/ `/q 7/-2 -5/1/1J /L)
'r
/1
r
USDA SOIL SERIES: (A /1/Li LA/J-D
i
1'
to
to
t o
to
to
to
to
to
to 7r7"
SITE EVALUATED BY:
PLAN: [4 YES [ ]
200 GALLONS
L I47 5— GALLONS
SO SQFT
CAN BE MAINTAINED FROM THE
DITCHES /SWALES:
LIMITED USE: Af /7• FT
FT PROPERTY LINES:
(---i� v. itirrt1zo v
LL 5 7 L -. CP &Cf&-
DH 4015, 10196 (Replaces HRS -H Form 4015 (Page 31 which may be used)
AGENT: L L l� /T 4 J2t /L L 52 Z T/C
[Section /Township /Range /Parcel No. or Tax ID Number]
NO NET USABLE AREA AVAILABLE: . /7 ACRES
PER DAY [RESIDENCES -TABLE 1 / OTHER -TABLE 2]
PER DAY [1500 GPD /ACRE OR 2500 GPD /ACRE]
UNOBSTRUCTED AREA REQUIRED: Li Ln SQFT
PROPOSED SYSTEM TO THE FOLLOWING FEATURES:
/1)./q FT NORMALLY WET? [ ] YES AA ] NO
PRIVATE : /L FT NON-POTABLE: _r0 FT
FT POTABLE WATER LINES: /0 FT
10 YEAR FLOODING? [ ] YES []NO
SITE ELEVATION: //.4/' F MS NGVD
SOIL PROFILE INFORMATION SITE 2
Munsell # /Color
/ D' /'
RL
'D 742
/1
/ r
If
11
11
1/
11
USDA SOIL SERIES : o f h/wLA /Li)
Depth
0'' to
to
/D" to
to
to
to
to
to
to
/D "
1
PERMIT #
OBSERVED WATER TABLE: / INCHES [ABOVE / BE %ISTING GRAD
ESTIMATED WET SEASON WATER TABLE ELEVATION ' y 4/•d `INCHE
HIGH WATER TABLE VEGETATION: [ ] YES [✓NO MOTTLIN
SOIL TEXTURE /LOADING RATE FOR SYSTEM SIZING: f /
DRAINFIELD CONFIGURATION: [ ] TRENCH [ ✓] BED [ ] OTHER (SPECIFY)
REMARKS /ADDITIONAL CRITERIA: OR.6 3S7) 67gLw4) 729,t 'k' 7,1;:q)271,70/_z....
"T6 5z 1 7 )L M
PERCHED / APPARENT]
BELOW UE %ISTING GRADE.
NO DEPTH: 4)4' INCHES
YPE:
DEPTH OF EXCAVATION: 50
INCHES
DATE: /'f- - D t
Page 3 of 3
Miami Shores Village
10050 NE 2nd Avenue
Phone: 305 - 795 -2204 Permit Number: PL2004 -133
Printed: 5/10/2004
Applicant: EDUARDO NODAL
Owner: NODAL EDUARDO
JOB ADDRESS: 117 NE 102 ST
Contractor LLOYD NORTH DADE SEPTIC TANK SERVIONdNftactor's Address: 750 NW 107 ST
Local Phone: 305 - 754 -3375
Parcel # 1132060131810
Signed:
(INSPECTOR)
Plumbing Permit
Permit Status: APPROVED Permit Expiration: 10/27/2004 Construction Value: $1,600.00
Work: INSTALL NEW SEPTIC TANK AND DRAINFIELD
Page 1 of 1
Legal Description: MIAMI SHORES SEC 1 AMD PB 10 -70 LOT 17 & LOT 18 LESS E1/2 BLK 13 LOT SIZE
Fees: Description Amount
FEE2004 -4369 Building Fee $175.00
FEE2004 -4370 CCF $1.20
FEE2004 -4371 Notary Fee $5.00
FEE2004 -4372 Training and Education Fee $0.40
FEE2004 -4373 Technology Fee $4.37
FEE2004 -4374 Builders Bond $300.00
Total Fees: $485.97
Total Fees: $485.97
Total Receipts: $485.97
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:
Z � APPLICATION FOR PLUMBING PERMIT -
Permit No ..........
Application is hereby made for the approval of the detalled 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..,
Owners Name and Address ...._.4r. 21!_
Registered Architect and /or En b ..
Employing Plumber's Name...
Location and Legal Description Lot.
Street and Number where work is to be performed —No /17
State work to be performed and purpose of building (By Floors)_
New Building Remodeling Addition..
Size Septic Tank__ — ______- - - - --
Feet of Drain Tile. - ___k 2
Nature of Water Supply: City —Well.
Amount of Permit $
STATE OF FLORIDA, ss.
COUNTY OF DADE.
My Commission Expires
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
__..Type of Tank —__
(Signed)-
( Signed)
No._,_,J/ 1 Streets ... .fldoz
No.," Street.
Capacity Gals.
t. Feet of Tank or Drain Field from Well. ._...-- •• - - -._ _.__......._.___
of Soakage Pit
Sir
Notary Public, State of Florida
Bl SubdivWon.__... L __--- .______.
oc1k� , 3-° , Street /6 f
Repairs No. of Stories
Plum ..'g Inspect°
The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations as 'employer of labor
under the Florida Workmen's Compensation Act, being Section 5968, Compiled General Laws of Florida Permanent Supp ent, and Ilan com-
plied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors employed by him in the work to be
performed under this permit; and will post or cause to be posted' for inspection on the site of the work such public notice or notices as are
required by the Act. The undersigned agrees to employ only such sub - contractors, on work to be performed under this permit, as are
licensed by Miami Shores Village.
Master Plumber.
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeared
to me well known, and who, being by me first duly sworn, upon oath dep oses 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 fads
therein by hire stated are true.
NOTE: A re- inspection fee of $1.00 will be made when such re- inspection it mede by Improper notice for Inspection, or faulty
materials and /or workmanship.
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URINALS
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DRAIN
DRINKING
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TOTAL
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LIST
CHECK
•
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TANK
SEWER
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DRAIN
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SOAKAGE
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GREASE
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WILL
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Z � APPLICATION FOR PLUMBING PERMIT -
Permit No ..........
Application is hereby made for the approval of the detalled 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..,
Owners Name and Address ...._.4r. 21!_
Registered Architect and /or En b ..
Employing Plumber's Name...
Location and Legal Description Lot.
Street and Number where work is to be performed —No /17
State work to be performed and purpose of building (By Floors)_
New Building Remodeling Addition..
Size Septic Tank__ — ______- - - - --
Feet of Drain Tile. - ___k 2
Nature of Water Supply: City —Well.
Amount of Permit $
STATE OF FLORIDA, ss.
COUNTY OF DADE.
My Commission Expires
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
__..Type of Tank —__
(Signed)-
( Signed)
No._,_,J/ 1 Streets ... .fldoz
No.," Street.
Capacity Gals.
t. Feet of Tank or Drain Field from Well. ._...-- •• - - -._ _.__......._.___
of Soakage Pit
Sir
Notary Public, State of Florida
Bl SubdivWon.__... L __--- .______.
oc1k� , 3-° , Street /6 f
Repairs No. of Stories
Plum ..'g Inspect°
The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations as 'employer of labor
under the Florida Workmen's Compensation Act, being Section 5968, Compiled General Laws of Florida Permanent Supp ent, and Ilan com-
plied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors employed by him in the work to be
performed under this permit; and will post or cause to be posted' for inspection on the site of the work such public notice or notices as are
required by the Act. The undersigned agrees to employ only such sub - contractors, on work to be performed under this permit, as are
licensed by Miami Shores Village.
Master Plumber.
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeared
to me well known, and who, being by me first duly sworn, upon oath dep oses 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 fads
therein by hire stated are true.
NOTE: A re- inspection fee of $1.00 will be made when such re- inspection it mede by Improper notice for Inspection, or faulty
materials and /or workmanship.
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.
t Date_ er...,Zs 3 ,
Owner's Name and Address. f &. _ r. AO No. ..I _ 1... 7 Street .GP. LO . e2 �}�4:
Registered Architect and /or Engineer D�
Name and address of licensed contractor--- ✓ -- ./�al<._._.'� / ... ><� 1_?!e
Location and legal description of lot to be built on:
Lot / 7 Block / 3 Subdivision. - - - -• —16/7
Street and Number where work is to be done.. /. /_._ E • �� f�-- .(r___ ae
State wor to .be dor a. . purpose of b
New Building Remodeling
To be constructed of Kind of foundation Roof Covering
Estimated Total cost of improvements $ Amount of Permit $ . _
Zone cubage required Plan Cubage
Distance to next nearest building Size of Building Lot
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 pe formed under this
permit, as are licensed by Miami Shores Village.
Remarks (Signed). .. w-
Disapproved
(Signed)
Date
Dat
Building
Addition Repairs
Read, Sworn to and Subscribed before me.
No. of Stories
and for no otheI urpose.
STATE OF FLORIDA,
COUNTY OF DADE. 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
Notary Public, State of Florida
My Commission Expires
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 $1.00 will be charged when such re- inspection is made necessary by improper notice for inspection or faulty
materials and /or workmanship.
BUILDING
ELECTRICAL
PLUMBIOIG
Owner of
Building i
Architect
Contractor
or Builder - .-/
Legal Lot
Description
o actor's
L ense No
Work to be performed under this Permit
MIAMI SHORES VILLAGE, FLORIDA
DATE 194
RMIT N9 6593
1.
Subdi-
vision
Address of o r .�
Building
This permit is gr •ted to the . n. actor or .0 der named a e . construct the building or to install the equipment car device described in the appli-
cation herefor in strict .mpliance 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,,.00f the ordinances and
regulations pertaining to the work covered hereby whether shown on the plans or drawings or in the statements or specifications andthat hejssumks respon-
sibility for work done by his agents, servants or employees. ,, Y ,.�
Value of
Project
In consideration of the issuance to me of this permit I agree to perform the work covered hereunder in compliance with l ordinances anvil regul lions
pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authonties of Miami SW fey Village.
In acceptin this permit I assume respor3siility for all work done I by either myselfy agent, servant or employee.
Ao't..4444),?„ ., ,
ei 74 i Itt t)( r, _ CONTRACTOR OR BUILDER •` tY AUTHORITY
Amt. of
Permi
Signed J } INSPECoR ' BY r