133 NE 102 St (7)Date
Type Insp'n
Permit No.
Name
Address 13 ()\ ^ • 0
Company
Phone #
Inspection Date
Approved
Correction
Re- Insp'n Fee
MIAMI SHORES VILLAGE
BUILDING DEPARTME,
305- 795 -2204
Building Inspection Request
7
MIAMI SHORES VILLAGE
BUILDING DEPARTME
305- 795 -2204
Building Inspection Request /41/0
Dat?
Approved
Correction
Re- Insp'n Fee
Type Insp
Permit No. P L / O LI _3
Name
Address )33 - F
Company
Phone #
Inspection Date
MIAMI SHORES VILLAGE
BUILDING DEPARTMEN T
305- 795 -2204
Building Inspection Request
Date O
I �
Type Insp' I_ 116. v . \♦
Z
Permit No.-P L 0 " l
Name ``
Address F )3
Compan ' iL.I
Pho e#
[nsp�ction Date
Approved
Correction
Re- Insp'n Fee
MIAMI SHORES VILLAGE
BUILDING DEPARTMENT
305- 795 -2204
Building Inspection Request
Date 11 c •
Type Insp'n fi 5( i 1C, iCrCI .
Permit No. T ' oy - 31
Name roc.Q rTh .
I SS tit E_ 105- al-
Address
Company \ 1C.-{ 1 t\-r---141 •
Phone #
Inspection Date
Approved
Correction
Re- Insp'n Fee
Miami Shores Village
10050 NE 2nd Avenue
Phone: 305- 795 -2204 Permit Number: PL2004 -31
Printed: 2/4/2004
Applicant: GREGORY BROWN
Owner: BROWN GREGORY
JOB ADDRESS: 133 NE 102 ST
Contractor LLOYD NORTH DADE SEPTIC TANK SERVIONdNttactor's Address: 750 NW 107 ST
Local Phone: 305 - 754 -3375
Parcel # 1132060131820
Signed: (INSPECTOR)
Plumbing Permit
Page 1 of 1
Legal Description: MIAMI SHORES SEC 1 AMD PB 10 -70 LOT 19 & E1/2 OF 18 BLK 13 LOT SIZE
Fees: Description Amount
FEE2004 -1000 Building Fee $175.00
FEE2004 -1001 CCF $0.60
FEE2004 -1002 Notary Fee $5.00
FEE2004 -1003 Technology Fee $4.37
FEE2004 -1004 Training and Education Fee $0.20
Total Fees: $185.17
Total Fees: $185.17
Total Receipts: $185.17
Permit Status: APPROVED Permit Expiration: 7/31/2004 Construction Value: $800.00
Work: PUMP ABANDON AND REPLACE SEPTIC TANK - REPLACE 350 GALLON TANK WITH 900 GALLON 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:
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
BUILDING
PERMIT APPLICATION
FBC 2001
Permit Type (circle): Building Electrical
Owner's Name (Fee Simple Titleholder) t ',e 0rz y
Owner's Address /33 AIL::
Cit M/.4m l 517tO State RiJ7=3
Job Address (where the work is being done)
City Miami Shores Village
Is Building Historically Designated YES
Qualifier L- C - Z 1 CoC L TT
$ Value of Work For this Permit
Miami Shores Village
Db
Permit No. pi.,,,ztti/-31
Master Permit No.
ng Mechanical Roofing
P h o n e #
Zip 5S/3,1
Tenant/Lessee Name Phone #
/53412_7--
County Miami -Dade Zip 5"-/ -/
NO
Contractor's Company Name LLOYD ATo2TH P ' - lC Phone # 3VS l - - * -
Contractor's Address -7S O AI. of- /0 f-f (-- /L CT
City 1) l R M / State FLO2 /DA Zip c3 /6 d
Square Footage Of Work:
Architect/Engineer's Name (if applicable) Phone #
Type of Work: Addition ❑ Alteration ❑New L_T Repair/Replace ['Demolition
!
Describe Work: L J OP, J J r j /lJ 1 �t L L'/ $P77 C ��/L-ti<
6111-1-emi 77-7Alk toi 774,,,y‹
il ***********ft******** * * * * * ** F ees * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
Submittal Fee $ Permit Fee $ J CCF $ , he CO /CC
Notary $'‹ Training/Education Fee $ g 0 Technology Fee $ 1/, 3
Scanning $ ilirr Radon $ Zoning Bond $
Code Enforcement $ Structural Plan Review. $
Total Fee Now Due $
(Continued on opposite side)
lei r7
Bonding Company's Name (if applicable)
Bonding Company's Address
Cit♦ 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."
No to Applicant: As a condition to the issuance of a building permit with an estimated value exceeding 82500, the applicant must
promise in good faith that a copy of the notice of commencement and construction lien law brochure will he delivered to the person
whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must he 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 1 `
Owner or Agent
The foregoing instrument was acknowledged before me this - 2 72r(.
day of , 20 0 , by &'Yt y B&W. A)
(ho is personally known m or who has produced
As identification and who did take an oath.
Signature
p
L
LESTER E. CROCKETI
e ■ 1) 1 4762
EXPIRES: May 20, 2005
wss
NOTARY P
Sign: \
Print:
My Commission Expires: "As-/ ~2 .
ARY PUBL
Sign:
The foregoing instrument was acknowledged before me tthisJ " L4.
day of✓Lif14t4, , 20C9, by L1 -D /Z Ca>`' l Tr
who is personally k known to ` m or who has produced
as identification and who did take an oath.
-let f
Contractor
A : ISEAL
Print:
My Cominissio+n E iyes`.
***************************************************************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
(Certificate of Competency Holder)
State Certificate or Registration No. , Certificate of Competency No.
* * * * * * * * * * * * * * * * * * * * * * * * * * * * **
******************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
r
r'
APPLICATION APPROVED BY(_ =� 2//A-6t--L- ( (3 Z z; ?` - 1 Plans Examiner
Engineer
Zoning
Chc 12/15/03
STATE OF FLORIDA
DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM
CONSTRUCTION PERMIT
CONSTRUCTION PERMIT FOR:
[ (J ] New System (J] Existing System [lJ] Holding Tank [JJ ] Innovative
[X1 Repair [0] Abandonment [j ] Temporary [ 1
APPLICANT: C)nQCi / b'y (3cvw1
PROPERTY ADDRESS: / 3 3 Ai' L. /6 Z S y, G ,-,,,<..
mac c> 4 or r s I- 1 , 3 3/ 3 ?
1 8` " / 3 /�-� /6 S ir o r e s S P c . 1
LOT: `! BLOCK: SUBDIVISION:
[ SECTION, TOWNSHIP, RANGE, PARCEL NUMBER]
PROPERTY ID #: / 1 - 3 Z 0 (a - O 13 - l 2 Z G [OR TAX ID NUMBER]
SYSTEM MUST BE CONSTRUCTED IN ACCORDANCE WITH SPECIFICATIONS AND STANDARDS OF SECTION 381.0065,
F.S., AND CHAPTER 64E -6, F.A.C. DEPARTMENT APPROVAL OF SYSTEM DOES NOT GUARANTEE SAFTISFACTORY
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. ISSUANCE OF THIS PERMIT
DOES NOT EXEMPT THE APPLICANT FROM COMPLIANCE WITH OTHER FEDERAL, STATE, OR LOCAL PERMITTING
REQUIRED FOR DEVELOPMENT OF THIS PROPERTY.
SYSTEM DESIGN AND SPECIFICATIONS
fi ler
T [ I 0 0 ] GALLONS / GPD SEPTIC TANK /AEROBIC UNIT CAPACITY •MULTI- CHAMBERED /IN- SERIES PA]
A [ --- ] GALLONS / GPD CAPACITY MULTI- CHAMBERED /IN- SERIES [ ]
N [ _- ] GALLONS GREASE INTERCEPTOR CAPACITY [MAXIMUM CAPACITY SINGLE TANK: 1250 GALLONS]
K [ _ ] GALLONS DOSING TANK CAPACITY [ ] GALLONS @ [ ] DOSES PER 24 HRS # . PUMPS [ ]
D [ O U] SQUARE FEET PRIMARY DRAINFIELD SYSTEM
R [ — ] SQUARE FEET, SYSTEM
A TYPE SYSTEM: [ ] STANARD [ r } FILLED [ ] MOUND [ ]
I CONFIGURATION: [ ] TRENCH [ "1 BED [ ]
N \ _
F LOCATION OF BENCHMARK : / 2 . d ' u ' ✓ . ' • F • r • (._ / P ✓ •
I ELEVATION OF PROPOSED SYSTEM SITE [20,y61 [INCHES /FT] [ABOVE /BELOW] BENCHMARK /REFERENCE POINT
E BOTTOM OF DRAINFIELD TO BE [50,00] [INCHES /FT] [ABOVE /BELOW] BENCHMARK /REFERENCE POINT
L
D FILL REQUIRED: [i J .p ] INCHES
EXCAVATION REQUIRED: [ (i Z ] INCHES
11 STAT Y . Z i OF SLIGHTHLY LIMITED SOIL
UNDER BOTTOM OF DRAINFIELD
e n I/ -31
PERMIT NO . D r k' - 6 Z
DATE PAID: j - Z `' 0
FEE PAID: 7.1 CI
RECEIPT #: S O `f 0 1 2 9 n 0 /
I 6 - - / �(Y
T IIE PEPW!T Ic N JT Fn n n ^,rt • =~ ^. "1
IN V'T E7 ?;n.TTrtihr 111 • g U
BoTrnm rlFfRA T wri 11\.:,i.t•Vk.'1'3i pis: ._,,..$. 0'
/ / PEWETiI OF Fisk V. =i Ili' .. AR` 5,-, :
SPECIFICATIONS BY: c t 0 Y �� Q r- f \ r �I FAST FEEfr iZ Al 8-01N x x
n PROPOS ABSORPTION BED OR DRAIN TRENC`
APPROVED BY: l k V (/l/, c t.. T ITLE: E. vt..o . i �'i G /r.e Li
c ,I
DATE ISSUED: / 12 l 1 r 0 EXPIRATION DATE : `1 / Z q/ G q
0
T
H
E
R
DH 4016, 12/99 (Page 1) (Previous Editions May Be Used)
Part 1 - Health Department
Part 2 - Applicant
Part 3 - Installer /Contractor
Part 4 - Building Department
Page 1 of 3
STATE OF FLORIDA
DEPARTMENT OF HEALTH
ONSITE SEWAGE DISPOSAL SYSTEM
SITE EVALUATION AND SYSTEM SPECIFICATIONS
APPLICANT: Ge 6728 Y BR7) (mot) k AGENT : LLC' y2) &)o 7 -/ ?p.9L- . 3Z- 77C
LOT: /y, /9 BLOCK: / a- SUBDIVISION: 0) (///fl/ 5f. / iE /
PROPERTY ID # : //. j /_ -
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: • /9 ACRES
TOTAL ESTIMATED SEWAGE FLOW: _ GALLONS PER DAY [RESIDENCES -TABLE 1 / OTHER -TABLE 2]
AUTHORIZED SEWAGE FLOW: Li r GALLONS PER DAY [1500 GPD /ACRE OR 2500 GPD /ACRE]
UNOBSTRUCTED AREA AVAILABLE: 7 SQFT UNOBSTRUCTED AREA REQUIRED: T � i S
/ C, .U�
BENCHMARK /REFERENCE POINT LOCATION: /= //\ l/.�J/•lED �L�R 1� ,, � I (.1
ELEVATION OF PROPOSED SYSTEM SITE IS ;2041 CHES FT] [ABOVE /BELOW] BENCHMARK /REFERENCE POINT
THE MINIMUM SETBACK WHICH CAN BE MAINTAINED FROM THE
SURFACE WATER: /J Al. FT DITCHES /SWALES:
WELLS: PUBLIC: n)49 • FT LIMITED USE: /000. FT
BUILDING FOUNDATIONS:
SITE SUBJECT TO FREQUENT FLOODING: [ ] YES ]✓ NO
10 YEAR FLOOD ELEVATION FOR SITE:
t
56/14/7 - 3,70
SOIL PROFILE INFORMATION SITE 1 N SOIL PROFILE INFORMATION SITE 2
Munsell //Color Texture Depth
/0 j .r /d Z- DAn4`/ 0" to
r7 R151 . &to to /0"
/0 -./k 7/2 2'/-okil) /0'/ to
GkL'y•• ,4i' /eV,D to
/ 1 /( to
/I / to
•// /1 to
/It /1 to
/1 • /1 to -7c /I
J . "'
USDA SOIL SERIES: (J•.k AJLH' /X)
OBSERVED WATER TABLE: /0 INCHES [ABOVE / BELOW] EXISTING GRADE.
ESTIMATED WET SEASON WATER TABLE ELEVATION:
HIGH WATER TABLE VEGETATION: [ ] YES [/) NO MOTTLING: [ ] YES [
SOIL TEXTURE /LOADING RATE FOR SYSTEM SIZING: /•0 DEPTH OF EXCAVATION:_, INCHES
DRAINFIELD CONFIGURATION: [ ] TRENCH [s`] BED [ ] OTHER (SPECIFY)
REMARKS ADDITIONAL CRITERIA: O (6s /ILJAL 3Sb (7,11 LLD/& z5LP 7c. 7/1/VK
/q 7c e) f4 L L ; - 07e [- /,577A)77 (lot= t VL T�/= 1/Ln,k1 3F5 Z5 V i i 7
Cal LLMN
SITE EVALUATED BY: 4P7. L 3Z
011 4015. 10/96 (Replaces HRS -H Form 4015 (Page 31 which may be used)
(Stock Number: 5744- 003 - 4015 -1)
FT PROPERTY LINES:
[Section /Township /Range /Parcel No. or Tax ID Number]
PROPOSED SYSTEM TO THE FOLLOWING FEATURES:
A)./7 • FT NORMALLY WET? [ ] YE S /I.I9 [ ] NO
PRIVATE: 4/.-FT NON-POTABLE: JA1) FT
FT POTABLE WATER LINES: /0 FT
10 YEAR FLOODING? [ ] YES [-1
NGVD SITE ELEVATION: /(4>s n NGVD
Munsell # /Color Texture Depth
to
to /ly/
/ma
G kL-Y
/ n Y,P 3 .2
11
/1
//
//
USDA SOIL SERIES:
)PeJL_P412)
to
to
to
to
to
to
to ,7
PERCHED / APPARENT]
EXISTING GRADE.
NO DEPTH: /04 . INCHES
DATE: / 2q`
Page 3 of 3
STATE OF FLORIDA
‘-
DEPARTMENT OF HEALTH ,
APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PEI,D.V ty")
Permit Application Number -- 1 1 1•"'
PART II - SITE PLAN
7S i
. '''1 ' ""...'''',"''''...? "Ji , , '---• i J 4 . -,..... " ......, ......... , : , , ' J 4 -- ..... --■--...-4.-{.-- -
.4-
: J,. - 1' - ' , --r--•-- -44-i -;--t--1 ; ..r.- os ; ,., il i 3 i .._;. 1 3 1 L., _ 1.1
3 _. _ -4 • J. -• 4• ,- , } i H _ r _ 1 . 1 t
. ..41:1,4 - 7 4 _ - 1.1. - _1_11... i,.1 . _ .L.I. 1 I 1
ing
.
tt. - 1-4 4 711- 11
-,-+-- i 1 4 --!- 4-- -' -4 -'-- ' - ' 4-4-4 . - ' ' f--r- ; - t 4 L 4
. . , 4
- ,- - - IrV/4115-R-4 -' - ''.-
.4.4... - ---
_.4_4,.._,..._-; t1 0et„L.44 Alk, 1 , 1
I
i -- H ' ' .--- '
. --' 7 .
R V ) i4'
- 7 --' --, -, _,
, ÷ 0 _ , .., - ■
*-->
, 4• - 1--! , , -* ••-• •-- : - ':'
Scale: Each block represents 5 feet and 1 inch -7. 50 feet.
- 4 . 4.
4 1. .
. . ■ _ . ' _.L___1
:;L
; . 1
1 .$_ 4....:2'-' 11. --
1- - 4. -+ - - ...1 - - L_4.
1-- .1- , 1--- -1-- f---
-..--- ; .
- -3-,.. . .,43-3 '
---3, ---3-,---3---,--
• ., 2. .3. _-..3.-.3._._j.
1 ' I J J i;
;,.-- - -t - . i t , . 4 - - ..-....%
-f-. t---r--, :4-4.
-
- 1 ....
r .,.
, + - • - 1 -4--- rt
r r
By
Notes:
.,
- f '
4. -44-- 4
4 f
° 6/44 -.
gsr)„
ue
0114015. 10/98 (Replaces HRS-H Form 4015 which may be used)
(Sled( Number: 5744-002-40154)
•
y , • r -3 " -
I
f 1 T t
r r r
; -ir- ; 1 t t r
• t r •
•
T
'
I I , -;" - 4 j
• 1 ,‘
3 j . ht
f
4- • r
; -t
' -f -4-+-. -
ae107/1.
tCl gag's14. 1 (ii(thetfl.
- 0.. 0-6,1 /2. 3 3/3
/
Site Plan submitted by: iteA
;Recekt-77Signature
Plan Approved v Not Approved
. " •
,
GerZe.„ ) 3
( •- : f / • 1- e County Health Department
ALL CHANCES MUST BE APPROVED BY THE COUNTY HEALTH DEPARTMENT
1 • ;
t -3- -
-
I if?
4.- -
, • • - 1 t •••
,
1 "I 4- e" t r
• -44 -; 4 • • :
•
•ELTPre- al/OVACTOR
Title
Date I - Zi--o I
Page 2 of 3
BUILDING
PERMIT APPLICATION
FBC 2001
Permit Type (circle): Building Electrical
Owner's Name (Fee Simple Titleholder) G�cera.Y zpo GS Phone # 7S7 - Die)/
Owner's Address /33 JV'- E • / Q LAJ7)
City rYl / /1111 / cS- / - 1L991 State ri-O /7 19 Zip 3.31 3- r
Tenant/Lessee Name Phone #
Job Address (where the work is being done)
City Miami Shores Village
Is Building Historically Designated YES
Contractors Address -7,570 A) 1.4i • "7T.� -/
City /'1 rn / State Le'Z IDA
Qualifier C -ie
$ Value of Work For this Permit / FPV •
Type of Work:
Describe Work:
Total Fee Now Due $
(Continued on opposite side)
❑Addition ❑Alteration
RL'P,/Z
1 %'
Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
mbin
Permit No.
Master Permit No.
Mechanical
/ 4 /lj'L- /C„UiD
Zip 5/3 S
County Miami -Dade
NO
,z,' V -32-
Roofing
Contractor's Company Name L A � /4 hone # cJ�L.) - / " 7
❑New
Zip 33/6/
Square Footage Of Work: 3V2
Architect/Engineer's Name (if applicable) Phone #
Rpair/Replace ❑ Demolition
0 .........ft.. * * * * ** * * * * * * * ** F ees * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
Submittal Fee 43 Permit Fee $ v CCF $ I o- C CO /CC
Notary $ Training/Education Fee $ : i t d Technology Fee $ 4 . ,3 9
Scanning $. f Radon $ Zoning Bond $ 30 0 f
Code Enforcement $ Structural Plan Review. $
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
fir the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the
7
i is' '
%1.4 kelt
Contractor
inspection will not be approved and a reinspection fee will be charged.
Signature )= 1 i rj
Owner or Agent
The foregoing instrument was acknowledged before me this_
day of 32414441 , 20 0 by &ZECt.ty D y J
(jho is personally known to moor who has produced
As identification and who did take an oath.
.7 May 2), 2005 !4
NOT4CRY P
Sign:
Print: L C -
My Commission Expires: Mkt
Signature
The foregoing instrument was acknowledged before me this j
day of G✓1%f , 20 /Ai, by Lt� 5T[Q L- trY,?L�'
who ispeisuna nocvj,tame -Dr who has produced
as identification and who did take an oath.
,,,NOTARY PUBLI
Sign:
Print:
F 0F
My Commission Expire s: __
) IAiYSEAL
p•6 VILi1J'
L' 'HIcSI Nil NI IAL -pK-
00091094
i;MMISSON FXPIRPS
1 AR ' 2006
State Certificate or Registration No.
**** * * * * * * * * * * * * * * * * * * * * * * * * * * * *4*
APPLICATION APPROVED BY: L
Chr 12/15/03
(Certi cate of Competency Holder)
Certificate of Competency No.
********************************* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
tY 1
L —‘2 (7
Plans Examiner
Engineer
Zoning
•
42O(OPC'7 01/0 u
Plumbing Permit
Miami Shores Village
10050 NE 2nd Avenue
Phone: 305 - 795 -2204 Permit Number: PL2004 -32
Printed: 2/4/2004
Applicant: GREGORY
Owner: BROWN
JOB ADDRESS: 133 NE 102
BROWN
GREGORY
ST
Contractor LLOYD NORTH DADE SEPTIC TANK SERVIORdNtractor's Address: 750 NW 107 ST
Local Phone: 305 - 754 -3375
Parcel # 1132060131820
Signed:
Page 1 of 1
Legal Description: MIAMI SHORES SEC 1 AMD PB 10 -70 LOT 19 & E1/2 OF 18 BLK 13 LOT SIZE
Fees: Description Amount
FEE2004 -993 .� Builders Bond $300.00
FEE2004 -994 Building Fee $175.00
FEE2004 -995 CCF $1.20
FEE2004 -996 Notary Fee $5.00
FEE2004 -997 Scanning Fee $3.00
FEE2004 -998 Technology Fee $4.37
FEE2004 -999 Training and Education Fee $0.40
Total Fees: $488.97
Total Fees: $488.97
Total Receipts: $488.97
Permit Status: APPROVED Permit Expiration: 7/31/2004 Construction Value: $1,800.00
Work: REPAIR DRAINFIELD
(INSPECTOR)
FEB 04 PA1p
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:
wner of
ailchng
II ' rchitect
ontractor
Builder
egal
escription
1dress of
Aiding
Lot
P
A
Al
. 41Ct r ik 11161 ' 114 4111Wf 411
.. .
All=r
.1
r
Signed:
th
b'
to install the equipment or de e des
that the work will be performed in com
roper municipal authorities. This Permit ma
ithout authorization. A further conditiw up
nsib' ' •r a thorough knowledge of the or
. r .ec _ th• su
tandi
by the
e changed
es the r
Ara
Work to be pe
o rk • +e
Subdi-
vision
•
my
0
Amt. of
Permit
y
d
INSPECTOR
ork covered hereunder in compliance with all ordinances and re
r specifi ins submi to t. I. �. Pi Shor- •
ant or +ploy
IMP
'fl y'
JILDING
LECTRICAL
LUMBING
In • .nsi. lion
;rtainin = + er:. and
acce
A OR OR BULL
e to me
` ity
ER
MIAMI 'SHORES VILLAGE, FLORIDA
DATE
IT N? 7125
under this rmi
Value of
Proje t
This permit 's _ ant • the contr or or builder name: above o struct
tion herefor in strict compliance with all ordinances pertaining thereto with the
ans, drawings, statements or specifications that may have been submitte and ap
any time if the work is not done in compliance with such ordinances or e plan ti
;rmit is granted is the understanding that the contractor or builder named above as
gulations pertaining to the work covered hereby whether shown on the plans or
)ility for work done by his agents, servants or employees.
this pe • • ee to pe -
+ e •is .r.. ings, statem
Contract
icense
194'
in the appli-
+ ce with any
revoked
on - this
ons
age.