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306 NE 102 St (10)Dat- Approved Correction Re- Insp'n Fee MIAMI SHORES VILLAGE BUILDING DEPARTME 305- 795 -2204 Bu lding Inspection Re hitm b 1413 1:71100. 7 1 FiCA Type Insp'n Permit No. Name Address ' M: 1% (( -3 ■N E (62 Company ll ))U � Oa- n V Phone # Inspection Date Type Insp'n Permit No. MIAMI SHORES VILLAGE BUILDING DEPARTM 305- 795 -2204 Building Inspection Reque P V Date 1p� Name Z:M -u Z�Yt i Address 6 6 it)e 10 Cr JI Company vL sl C, ✓Il%'• aQ 'cm: rO n n"∎. Phone # g(9* 7y5 - H C C3 � Inspection Date 4 6/67/ -N 0 i i Approved 47 \ , _, Correction ❑ Re- Insp'n Fee ❑ Type of Work: Describe Work: E[ ID) � �D) BUI ING PERMIT APPLICATION FBC 2001 Permit Type (circle): Building Electrical Plumbin Mechanical Roofing Owner's Name (Fee Simple Titleholder) M R X HIS Peter 4V Phone # t C , CD,W Owner's Address DC (P J - (Q ), D cit H (i4 -(l S i2eS State ` r /A Zip ? 1 "3 Tenant/Lessee Name I!a frt E Phone # S a Me Job Address (where the work is being done) 30(Q ti E. IC D ti S City Miami Shores Village Is Building Historically Designated YES NO ,)( Contractor's Company Name N tiNtA F N t) ((1O f,% He ai Phone # 7 gLe ,ZS ( _cc o 99 Contractor's Address 5g t. EQ u N t \ 1u Ble o(A,• BLU S ;1C F' City (µ\\ iLk f • State F I r Zip 3 317 2 Qualifier r-VQ, YaKT Architect/Engineer's Name (if applicable) $ Value of Work For this Permit . h GOO (Continued on opposite side) ❑Addition ❑Alteration r Total Fee Now Due $ -1P)5. • . �t )C .5 q c Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 Permit No. PI OLl — �, County Miami -Dade ❑New C Master Permit No. Zip 3 3 l 3 Phone # I. ' Square Footage Of Work: 4c0 14 Repair/Replace ❑ Demolition i\, 11 b2 I e Pie -1c' rt)A I Ce F /bc/1 q /4S; 7 a Arlo £lGoo (L At u r r c * * * * * * * * * * * * * * * * * * * * * * * * * * ** F ees * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** Submittal Fee $ Permit Fee $ 17 c CCF $ 2 • 4 0 CO /CC Notary $ Training/Education Fee $ c ,/ 0 Technology Fee $ 37 Scanning $ 3 -CC_' Radon $ Zoning Bond $ �` X i C ) t 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 a ccurate 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 PROPER'L'Y. 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 rtyth an estimated value exceeding $2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the joh site for the first inspection which occurs seven (7) days after the building peirmit is issued. In the absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. Signature Contractor The foregoing instrument was acknowledged before me this - The forego g instrument was acknowledged before me this 1 day of :y k 4 4 • �- , 20 t7 1, by t , day of , 20'C 6} , by .,) Cr r a Signature who is personally known to me or who has produced NOTARY PUBLIC: Sign : � � . .1 . Print: My Commission Expires: APPLICATION APPROVED BY: Chc 12/15/03 Owner or Agent TERESA J. SOLOMON .E tNY COMMISSION # DD250437 it0 EXPIRES: September 16, 2007 f 1-800 - 3-NOTARY FL Notary Discount Assoc. ('.oj who i$ personally known to me or who has produced • 1 . ■ i `) -As identification and who did take an oath. d , Y2, as identification and who did take an oath. NOTARY PUBLIC: ign: ft: u R Print: \k, Iy1y Comr>ys Expires: (Certificate of Competency, Holder) State Certificate or Registration No. - Certificatie of Competency No. ****************************************************$:************************ * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** Engineer Zoning Plans Examiner CONSTRUCTION PERMIT FOE: New System [ ] Repair . C., APPLICANT: PROPERTY ADDRESS: LOT: pLocxt PROPERTY ID #: 0 ;, STATE OF FLORIDA - DEPARTMENT OF HEALTH -ONSITE'SEWAGE TREATMENT AND DISPOSAL SYSTEM CONSTRUCTION PERMIT Existing System Abandonment 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 SAFTISFACTORI PERFORMANCE FOR ANY SPECIFIC PERIOD OF TIME. ANY CHANGE IN MATERIAL FACTS, WHICH SERVED AS 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 PEER= DOES NOT EXEMPT THE APPLICANT FROM COMPLIANCE WITH OTHER FEDERAL, STATE, OR LOCAL PERMITTING REQUIRED FOR DEVELOPMENT OF THIS PROPERTY. SYSTEM DESIGN AND SPECIFICATIONS T N [ K E 3 GALLONS / GPD SEPTIC TANK/AEROBIC UNIT CAPACITY MULTI-CHAMBERED/IN-SERIES [ i . - GALLONS / GPD CAPACITY MULTI-CHAMBERED/IN-SERIES [ 3 GALLONS GREASE INTERCEPTOR CAPACITY MAXIMUM CAPACITY SINGLE TANK: 1250 GALLONS] GALLONS DOSING TANK CAPACITY [ 1GALLONS 0 [ ] DOSES PER 24 HRS # PUMPS E 1 D [ ;,,_,] SQUARE FEET PRIMARY DRAINFIELD SYSTEM R [ ] SQUARE FEE SYSTEM A TYPE SYSTEM: [‘-'] STANARD [ z r FILLED [ ] MOUND 1 1 — I CONFIGURATION: [ ] TRENCH [] BED I 3 N F LOC.ATION OF BENCHMARK : ,' i • , ' I ' f4 vf , c', ,,, ,,,,, , 1. ,,,-:: 7 ,- 1 ELEVATION OF PROPOSED SYSTEM SITE [5 • [INCEES/FT] [ABOVE/BELOW] BENCHMARK/REFERENCE POINT __...„ 5 BOTTOM OF DRAINFIELD TO BE ( 3 . - ? 2 0 (INCHES/PT] [ABOVE/BELOW] BENCHMARX/REPERENCE POINT L D FILL REQUIRED: U% ; ',' ] INCHES EXCAVATION REQUIRED: 1 f' , ] INCHES 0 T R ) ,'.' •)„ ..,, i. ,' • .,. '' ( 1 ' '--; 1 0 1 z \ &.1.3 \ ..., i fl ... - . , . 6 , r , i t • ...-- SPECIFICATIONS BY - 44'1/e Jr/ '; TITLE: APPROVED BY: f. DATE ISSUED: Holding Tank (J Innovative Temporary [ ] '!) TITLE : I SUBDIVISION: . (SECTION, TOWNSHIP, RANGE, PARCEL NUMBER] [OR TAX ID NUMBER] PERMIT NO. 4 ' 4 DATE PAID: FEE PAIDi RECEIPT #:, , • EXPIRATION DATE: DE 4016, 12/99 (Page 1) (Previous Editions May Be Used) Page 1 of 3 AMM••■■■•■•■••191,.../ CHD STATE OF FLORIDA DEPARTMENT OF HEALTH APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PERMIT Permit Application Number Scale: Each block represents 5 feet and 1 inch = 50 feet. 3y r • A,. V • E N • V' • • / • v • k 'Ian Approved , •-•.? •( S").0P_ \ ,rr 3ite Plan submitted by?--; 4otes: ;;A : 3? N , 51 Mr cA tf-L PART II - SITE PLAN q i . i t 0 V - a, 4 ,.1.3:, ' I.: R t3 • , * '1 - 1 1 -...,..—• -•`-'`' ....--•--- gal-) ctons Signature Not Approved • • • • • • 6) 0 ^ - „. N ; i'1/4„Z r ALL CHANGES MUST BE APPROVED BY THE COUNTY HEALTH DEPARTMENT Title Date • .1 County Health Department ITEM BATH TUB UNIT FEE ITEM SWITCH OUTLETS UNIT FEE ITEM SPACE HEATERS UNIT FEE BIDET LIGHT OUTLETS CENTRAL HEATING DISHWASHER RECEPTACLES A/C (WILD) DISPOSAL SERVICE TEMPORARY A/C (CENTRAL) DRINKING FOUNTAIN SERVICE SIZE IN MPS DUCT WORK FLOOR DRAIN SERVICE REPAIR/METER CHANGE REFRIGERATION GREASE TRAP APPLIANCE OUTLETS PROCESS AND PRESS PIPING INTERCEPTOR RANGE TOP UNDERGROUND TANKS LAVATORY OVEN ABOVE GROUND TANKS LAUNDRY TRAY WATER HEATER U.F. PRESSURE VESSELS CLOTHES WASHER MOTORS 0- 1 HP STEAM BOILERS SHOWER MOTORS OVER 1- 3 HP HOT WATER BOILERS SINK, POT /3 COMP. MOTORS OVER 3- 5 HP MECHANICAL VENTILATION SINK, RESIDENCE MOTORS OVER 5- 8 HP TRANSPORTING ASSEMBLIES SINK, SLOP MOTORS OVER 8- 10 HP ELEVATORS/ESCALATORS TEMPORARY WATER CLOSET MOTORS OVER 10- 25 FP FIRE SPRINKLER SYSTEMS URINAL MOTORS OVER 25-100 HP COOLING TOWERS WATER CLOSET MOTORS OVER 100 HP VIOLATION INDIRECT WASTES - A/C WINDOW REINSPECTION WATER SUPPLY TO: AIR CONDITIONERS A/C UNIT STRIP HEATER . FIRE SPRINKLER GENERATORS TRANSFORMERS HEATER -NEW INST. GENERATORS TRANSFORMERS HEATER - REPLACE GENERATORS TRANSFORMERS LAWN SPRINKLER -WELL SPECIAL PURPOSE SWIMMING POOL OUTLETS COMMERCIAL WATER SERVICE SIGN TUBES SEWER CONNECTIONS SIGN TRANSFORMERS UTILITY -SEWER SIGN TIME CLOCK UTILITY -WATER FIXTLRES SEPTIC TANK ANTENNA RELAY TELEVISION OUTLETS DRAINFIELD, 4" TILE/RES. j VIOLATION PUMP & ABANDON SEPTIC TANK ,( REINSPECTION SOAKAGE PIT CU. FT. CATCH BASIN DISCHARGE WELL DOMESTIC WELL AREA DRAIN ROOF INLET SOLAR WATER HEATER FIRE STANDPIPE POOL PIPING LAWN SPRINKLER SYSTEM GAS RANGE METER SET (GAS) GAS PIPING (AN APPLICATION FOR BUILDING PERMIT MUST ACCOMPANY THIS ADDENDUM. IF A MASTER PERMIT HAS B. OBTAINED, THE OWNER'S NOTARIZED SIGNATURE NEED NOT BE PRESENT ON SUBSEQUENT APPLICATIONS.) PLUMBING ADDENDUM TO BUILDING PERMIT APPLICATION ELECTRICAL MECHANICAL Miami Shores Village 10050 NE 2nd Avenue Phone: 305 - 795 -2204 Printed: 8/12/2004 Applicant: ELIZABETH Owner: TREACY JOB ADDRESS: 306 NE 102 Parcel # 1132060135170 Signed: (INSPECTOR) Plumbing Permit Permit Number: PL2004 -230 TREACY ELIZABETH ST 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 1 AMD PB 10 -70 LOTS 11 & 12 Permit Status: APPLIED Permit Expiration: 2/5/2005 Construction Value: $500.00 Work: ABANDONMENT TANK BLK 38 LOT SIZE Fees: FEE2004 -8068 FEE2004 -8193 FEE2004 -8194 FEE2004 -8195 FEE2004 -8196 Description Building Fee CCF Notary Fee Training and Education Fee Technology Fee Total Fees: Amount $175.00 $0.60 $5.00 $0.20 $4.37 $185.17 Total Fees: $185.17 Total Receipts: $185.17 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 Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138. Tel: (305) 795.2204 Fax: (305) 756.8972 Permit Type (circle): Building Electrical ( Plumbing Mechanical Roofing Owner's Name (Fee Simple Titleholder) P(''Ilj Phon e # 3C...5- - 7/O -.;26 2L � Owner's Address Pk, R % Q''{ (S f' 4- Citi f (IUa V-At S I.O(Zes State l� l o. Zip 3 ) J 3 Tenant/Lessee Name (--; 1.4 Q. Phone # Job Address (where the work is being done) .JC)( L1 cE • 102 c am' 1 City Miami Shores Village County Miami -Dade Is Building Historically Designated YES NO Contractor's Company Name f" t 1 c4 ILU 0 0 c tk)(J( tuf(eou Phone # 7)(9 - 9 5) L 9 Contractor's Address q 5 ' W (-vC,1J 1 A \J t ele (a(,ri Et() f c1-' 2c City H( L/l \ State Zip 1 ) 2 Qualifier_�{r> State Certificate or Registration No. Certificate of Competency No. Architect/Engineer's Name (if applicable) $ Value of Work For this Permiti_ , C( 1 Square Footage Of Work: / (a Type of Work: ❑ f, ❑Alter4tion ❑New Describe Work: A ex 1. bir/ ' - t" ( Phone # -I Permit No. no t) Master Permit No. Zip 3'3/ 3 8 * * * * * * * * * * * * * * * * * * * * * * * * * * ** F ees * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** Repair/Replace ❑ Demolition Submittal Fee $ Permit Fee $ i, ,C'C' CCF $ r (c> C> CO /CC Notary $ 5 00 Training/Education Fee $ : 7 0' Technology Fee $ 4.3 'I Scanning $ Radon $ Zoning Bond $ Code Enforcement $ Structural Plan Review. $ Total Fee Now Due $ I' 1 • t1 ( -. DV/ (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. Signature Owner or Agent The foregoing instrument was acknowledged before me this day of , 20 , by who is personally known to me or who has produced As identification and who did take an oath. NOTARY PUBLIC: Sign: Print: My Commission Expires: APPLICATION APPROVED BY: Chc 05/13/03 Sign time CT - Contractor The for oi instrument was acknowledged before ,2c1' , day of who is person ) ly know to me or wh - has produced NOTARY PUBLIC: Sign: Print: My Commission Expirirsu entification and who did take an oath. **************** **** *** ****** ********** **** * * ** k****************************** * *,k******** ********** * *** *** ** this - 3 nc ************* * * ** * * * * * ** * * ** * * ** ** * *** * * * * ** tit******************************** *** * * * *** * * * ** * * * * * * * * ** * * * *,,* Plans Examiner Engineer Zoning sr APPLICANT : AGENT: TANK [ ] [01] [ ] [02] [ J [03] [ ] [04] [ ] [05] [ ] [06] [ ] [071 [ 3 [08] [ ] [09] [10] [11] [12] [13] [14] [15] [16] [17 ] [18] [19] [20] [21] FILL [22 ] [23 ] [24] [25] [26 ] STATE. OF FLORIDA ]Y PAR OF HEALTH ONSITE SEWAGE TREATMENT CONSTRUCTION INSPECTION WATERTIGH1 LEVEL DEPTH TO LID % f�`_ PROPERTY ADDRESS: ._� . 1,4 , JO i LOT: 1 ''''. BLOCK: _; ��° SUBDIVISION: C -- �`' �� PROPERTY ID $fir: CHECKED [X] ITEMS ARE NOT IN COMPLIANCE WITH STATUTE OR RULE AND MUST BE CORRECTED. INSTALLATION %( TANK SIZE [1F C [2] ,. TANK MATERIAL OUTLET DEVICE MULTI CHAMBERED [ Y / N ] OUTLET FILTER LEGEND ' . _ 2"- f G//& is..A .27 1 DRAINFIELD INSTALLATI.,.� . �, , AREA [11; = J.? - v. [ 2 ] •-' , . SQFT DISTRIBUTION BOX HEADER NUMBER OF DRAINLINES DRAINLINE SEPARATION `y! DRAINLINE SLOPE DEPTH OF COVER." • ELEVATION LABovElpttaVoLpm SYSTEM LOCATION DOSING PUMPS AGGREGATE SIZE '%-'! AGGREGATE EXCESSIVE FINES AGGREGATE DEPTH , '"T / EXCAVATION MATERIAL FILL AMOUNT % FILL TEXTURE EXCAVATION DEPTH AREA REPLACED REPLACEMENT MATERIAL EXPLANATION OF VIOLATIONS,/ REMARKS: T • 1 -. C1.. 1. AND DISPOSAL SYSTEM FEE PAID: rf AND FINAL APPROVAL RECEIPT #: !r% / PERMIT NO. DATE PAID: SETBACKS [27] SURFACE WATER FT [28] DITCHES FT [29] PRIVATE WELLS FT [30] PUBLIC WELLS FT [31] IRRIGATION WELLS FT [32] POTABLE WATER LINES FT [33] BUILDING FOUNDATION FT [34] PROPERTY LINES FT [35] 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 SIZE PLAN [46] FINAL SIZE GRADING [47 ] CONTRACTOR '! � C [48] OTHER ABANDONMENT ] [49] TANK PUMPED f:' //�` / �' ] (50] TANK CRUSHED & FILLED /J ?T 1: Aro;■cant PT 2: I.:; °..a;ier/CarGrector CONSTRUCTION' > [APPROVEDDISAPPROVED] (��. / �� `� '� //�� r , `.J i CHD DATE: FINAL SYSTFVr [APPROVEDDISAPPROVED] : ;f _.� -:• _�; t �,)' A- CHD DATE: DH 4016, 10/97 (Previous Editions May Be Used) Page 2 of 3 • N.- LJ APPLICANT: AGENT: TANK [ ] [01] [ ] [02 [ ] [03] [ ] [04] [ ] (05] [ ] [06] [ ] [07] [ ] [08] [ ] [09] DEPTH TO LID c A /5 27 _ . "- STATE OF FLORIDA DEPARTMENT OF HEALTH ONSITE SEWAGE TREATMENT CONSTRUCTION INSPECTION AN 4INAL APPROVAL - PROPERTY ADDRESS : _ r" `%: . '! —7 / LOT: -' _'?BLOCK: SUBDIVISION: �� "`� �; cr�.� PROPERTY ID #: CHECKED [X] ITEMS ARE NOT IN COMPLIANCE WITH STATUTE OR RULE AND MUST BE CORRECTED. INSTALLATION TANK SIZE [1] [ TANK MATERIAL ' " ' OUTLET DEVICE MULTI CHAMBERED [ Y / N ] OUTLET FILTER LEGEND WATERTIGHT • LEVEL DRAINFIELD INSTALLATION `� (10] AREA [ 11 73 [ 2 ] - i SQFT [11] DISTRIBUTION BOX HEADER [12] NUMBER OF DRAINLINES [13] DRAINLINE SEPARATION `/, ' [14] DRAINLINE SLOPE [15] DEPTH OF COVER;':? [16] ELEVATION (ABOVE/BEL [17] SYSTEM LOCATION [18] DOSING PUMPS [19 ] AGGREGATE SIZE;- [20] AGGREGATE EXCESSIVE FINES (21] AGGREGATE DEPTH 7 FILL / EXCAVATION MATERIAL [22] FILL AMOUNT,. 'j [23] FILL TEXTURE [24] EXCAVATION DEPTH [25] AREA REPLACED [26] REPLACEMENT MATERIAL EXPLANATION OF VIOLATIONS / REMARKS: ,; r y . ,/ _ , [ ] _ r'- ,- ,/ . -.C.-s',.., 'Q � d .. r, i G1 i,:,- •,:• - : , ,, .r -, i ,: e ( ] [ l CONSTRUCTION APPROVED /DISAPPROVED] : yd, FINAL SYSTEM (APPROVED)DISAPPROVED]: - a ,,�.: DH 4016, 10/97 (Previous Editions May Be Used) ABANDONMENT ] (49] TANK PUMPED / A `" /C; ' ] [50] TANK CRUSHED & FILLED RECEIPT PT 1: Appliccn? FT 2: !n L-- -iizr /Corircr?c• Pi 3: Ce IcZ nr, Dcp= r¢mcnl PT 4: t3 4iI1 D.. partn Vn: PERMIT NO. �'` % - DATE PAID: r? > ' AND DISPOSAL SYSTEM FEE PAID: 9'f SETBACKS [27] SURFACE WATER 1/ • FT [28] DITCHES FT [29] PRIVATE WELLS / FT [30] PUBLIC WELLS FT [31] IRRIGATION WELLS j FT [32] POTABLE WATER LINES d' FT [33] BUILDING FOUNDATION > FT [34] PROPERTY LINES FT [35] 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 SIZE PLAN [46] FINAL SIZE GRADING [47 ] CONTRACTOR IT), . [48] OTHER CHD DATE: CHD DATE: Page 2 of 3 Registered Architect and /or Engineer.. Name and address of licensed contactor Location and legal description of lot to be built on: Lot Block Subdivision Disapproved, r (Signed) MIAMI SHORES VILLAGE B uil d ing Inspector BUILDING INSPECTION DEPARTMENT APPLICATION FOR BUILDING PERMIT Application is hereby wade 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. Owner's Name and Address ... V R)g.TtkeirEYS1 - . Via No.3Q. - - Street...M .. S.SSSSS =•t Street and Number where work is to be done State work to be done and purpose of building (by floors)..._.. A to..D1 7 1 U►IIP .. «.� ) ts) _ . � �-�. °) › . 2. 1 \n4. TIgitto .... E. 1.1ST _W..12 1 ° $MwCtVwfi■ civr C-As IIM " 1" and for no other purpose. ' New Building Remodeling Addition Repairs No. of Stories To be constructed of Kind of foundation Roof Covering Estimated Total cost of improvements $...I -QO MA 5.113.4.W.. Amount of Permit S. 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 of l,rbor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of and has complied with the provisions thereof, and will require similar compliance froinal ntract rs or s in the work to be performed under this permit; and will post or cause to be pos d'for inspec n on the si or notices as are required by the Act. The undersigned agrees to employ only chtsubcontract rs n wo pennit, as are licensed by Miami Shores Village. Remarks ( Signed)...-- obligations as an employer a, Permanent Supplement, tractors employed by him work su s public notice perform d under this STATE OF FLORIDA, COUNTY OF DADE. ss. Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, pen.onally 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 foregoing application, and that he did sign the same, and that all facts therein by him stated are true. Permit No.. Date A te. -... `i' Read, Sworn to and Subscribed before me. Notary Public, State of Florida My Commission Expires PLANNI 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 hoard. A re fee of 31.00 will be charged when such re- inspection is made necessary by improper notice for inspection or faulty materials and /or workmanship. SEPTIC SEWER DRAIN SOAKAGE GREASE SOLAR DEEP SPRKLR. SWIM'G TANK CONN. FIELD PIT TRAP HEATER WELL SYSTEM POOL CONTR. !1ST CHECK Appiic_:L,on is hereby mad for the approval of the detailed statement of the plans and specifications herewith submitted for the building or other structta,t, h■:..ein dosiribed. This application is made in compliance and conformity with the Building Ordinance of Miami Shores Village, Florida, and al' 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 S'••Ioies Village shall be complied with, whether herein specified or not. A copy of approved plans and specifications must be kept at louild'mg among progress of work. ° , � i'C,CE' i G!-lt _ 3 C- .I i > - /02 Owner's Neme and Address._ -- AIL -- _ -_ -__ —__ - _ -- -. No.___ - _ _ Street _ - !� Registe:ed Architect and /or En sneer-- _- _----- .�---------- - - - -__ — Employing Plumbers Name .__ � � t►i N . 91 Street. Location and Legal Description Lot•._ Street and Number where work is to be performed —No State wcrk to be performed and purpose of building (By Floors) New Building _ -- _- _ - - - -- -- -- - - --- - -- Remodeling Addition-------- .--- .---- _ - - - -• Repairs No. of Stories Size Septic Tank_ _ Feet of Drain Nature of Water Supply: City —Well Amcunt of Permit $_ 1__ -- STATE OF FLORIDA, } COUNTY OF DADE. My Commission Expires MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT Block Date... __ _ Subdivision ....... ______..... ___________ Street Ty/p°ee of T { 4 Capacity Gals.__ - �. Fee Tank or Drain Field from Well Size of Soakage Pit l< y (Signed) - -- l - - -- Plumbing Inspector. The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations as.an essployer 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 ' • the performa under this permit; and will post or cause to be posted for inspection on the site of e . such public Mice o roc:tared by the Act. The undersigned agrees to employ only such sub - contractors, on w.' o be performed u licensed by Miami Shores Village. 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. Notary Public, State of Florida NOTE: A re inspection fee of $1.00 will be made when such re inspection is made•necessary by improper notice for inspection, or faulty materials and /oar workmanship. CLOSETS B BATH L SHOWERS S LAVA- S SINKS I SLOP L LAUNDRY U URINALS C CATCH F FLOOR D DRINKING T TOTAL CONTR. — — .— CNECK Appiic_:L,on is hereby mad for the approval of the detailed statement of the plans and specifications herewith submitted for the building or other structta,t, h■:..ein dosiribed. This application is made in compliance and conformity with the Building Ordinance of Miami Shores Village, Florida, and al' 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 S'••Ioies Village shall be complied with, whether herein specified or not. A copy of approved plans and specifications must be kept at louild'mg among progress of work. ° , � i'C,CE' i G!-lt _ 3 C- .I i > - /02 Owner's Neme and Address._ -- AIL -- _ -_ -__ —__ - _ -- -. No.___ - _ _ Street _ - !� Registe:ed Architect and /or En sneer-- _- _----- .�---------- - - - -__ — Employing Plumbers Name .__ � � t►i N . 91 Street. Location and Legal Description Lot•._ Street and Number where work is to be performed —No State wcrk to be performed and purpose of building (By Floors) New Building _ -- _- _ - - - -- -- -- - - --- - -- Remodeling Addition-------- .--- .---- _ - - - -• Repairs No. of Stories Size Septic Tank_ _ Feet of Drain Nature of Water Supply: City —Well Amcunt of Permit $_ 1__ -- STATE OF FLORIDA, } COUNTY OF DADE. My Commission Expires MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT Block Date... __ _ Subdivision ....... ______..... ___________ Street Ty/p°ee of T { 4 Capacity Gals.__ - �. Fee Tank or Drain Field from Well Size of Soakage Pit l< y (Signed) - -- l - - -- Plumbing Inspector. The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations as.an essployer 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 ' • the performa under this permit; and will post or cause to be posted for inspection on the site of e . such public Mice o roc:tared by the Act. The undersigned agrees to employ only such sub - contractors, on w.' o be performed u licensed by Miami Shores Village. 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. Notary Public, State of Florida NOTE: A re inspection fee of $1.00 will be made when such re inspection is made•necessary by improper notice for inspection, or faulty materials and /oar workmanship. CoNTrt. Ci aCK. - CLUSETS ',.TH cuss SHOWERS LAVA- TORIES SINKS SLOP SINKS LAUNDRY Tuns URINALS CATCH BASIN FLOOR DRAIN DRINKING FOUNT' NS TOTAL FIXTURES SEPTIC TANK S.WER CONN. DRAIN FIELD SOAKAGE PIT GREASE TRAP SOLAR HEATER DEEP WELL SPRKLR. SYSTEM SWIM'G POOL I -- -- COM R. LIST CHECK Amount of Permit $ STA'T'E OF FLORIDA, } COUNTY OF DADE. MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT Date._ __ __ (16. Applicaiion is bei. by made for the approval of the detailed statement of the plans and specifications herewith submitted for the building or other ab:I ure h'cein 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 cf Mia:.ni Shores Village shall be complied with, whether herein specified or not. A copy of approved plans and specifications must be kept at butt:ling during progress of work. a:,er's Name and Address 1'Lh•--- - -( - ' 1 ( ._ ; .k_ ! L-"'�! Cr -�) No._ ._: f &' Street r` /c2 q Registered Architect and /or En in r - - -_ __ -__ �__ a y Employing Plumber's Name __ _ J�l_� � Y ► .7C ZM4o. Locs lion and Legal Description L o t . Street and Number where work is to be performed -No S..-te work to be performed and purpose of building (By Floors)_ New Building_ -..... - __ __... ______ ________ Remodeling_ __ Addition Block Size Septic Tank (1 - - - - - -- -- T T - or Drain d from Capacity Gals. - Feet of Dirmrri4le-_- " }` et of Tani i W 1 Nature of Water Supply: City - Well .____.______________._.__ — ____ Size of Soakage Pit ( Signed) - - - - - - - F Street_tAc ! L ' • ./ Subdivision Street Repairs No. of Stories ...................... 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 5968, Compiled General Laws of Florida Pennanent Supplement, and has c plied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors employed by hi ' ' the wo performed under this permit; and will post or cause to be posted' for inspection on the site of ouch public required by the Act. The undersigned agrees to employ only such sub- contractors, on wo . d . be . erformed licensed by Miami Shores Village. 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 therm by him stated are true. My Commission Expires Notary Public, State of Florida NOTE: A re- inspection fee of $1.00 will be made when such re- inspection is made•neoessary by improper notice for inspection, or faulty materials and /or workmanship. F