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499 NE 102 St (6)MIAMI SHORES VILLAGE BUILDING DEPARTMENT 305- 795 -2204 Building Inspection Request Dat Time Type Insp'n Permit No. . � o " -1 Name Address X 19 �,�e•. 1 0 a f Compan sL Phone # �S S2 1? For Inspector21 ' Approved Correction Re- Insp'n Fee Date o �/ Job Address l Q S Tax Folio j L 3 a O o Legal D scription L o l g3 -d` /5/ K q2 Historically Designated: Yes No 1� 7���- ooa��Ce Lessee/Tenet e1� TO m ��� e ermit # Owner's Address Phon 151 5 Contracting Co. Ob 5 c -1- lg44-) P '' address I o o uCJ , 130557 Nom(i R,F Qualifier b -- pit-6 L1 Pe— SS # Phone $1W State # J RO 5 11 1 b Permit Type (circle one): WORK DESCRIPTION: Square Ft. My Co PERMIT APPLICATION FOR MIAMI SHORES VILLAGE 10050 N.E. 2nd Avenue • Miami Shores, Florida 33138.305- 795 -2204 Municipal # 0 1) - Frle Dat Competency # 1 � ) ) Ins. Co. IF THERE IS NO PERMIT PACKAGE ACCESSIBLE ON THE JOB SITE FOR INSPECTORS TO VERIFY, THERE WILL BE NO INSPECTION. RE- INSPECTION FEE IS $50.00 AND MUST BE PAID IN ADVANCE BEFORE CALLING FOR ANOTHER INSPECTION. BUILDING • ELECTRICAL PLUMBING MECHANICAL ROOFING kfri Estimated Cost (value) �5 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 ANY 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 all disciplines. OWNERS 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. ignature of own an or Condo Pre dent D S 0 -5 1 ik on E i reANGELA M BECKER 2 CI COMMISSION NUMBER a 0 1'- Q CC786697 9�� r MY NOV. COMMISSION 2002 ES OFFS 33- D ate Sig flat/re Contra to or Owner Build .. 6' "1 as t ontracto a g„ ne,� % ufti •- + COMMISSION NUMBER 91' +'�` ' CC786697 7 1 , O' MY COMMISSION EXPIRES OF FL NOV. 15,2002 --- ary My Commission Expi / 3 o 6� ate Date FEES: PERMIT _ ' RADON C.C.F ) 2 a NOTARY ‹,-. 0 D BONDR 0 0' APPROVED: Zoning Building Electrical Mechanical Plumbing TOTAL DUE3'1 4 . 3 0 Structural Engineer CONSTRUCTION PERMIT FOR: [ ]New System [ ]Existing System [ ]Holding Tank [ ] Innovative Other [ X ]Repair [ ]Abandonment [ ]Temporary [ NA ] APPLICANT: Toomey, Patrick PROPERTY STREET ADDRESS: 499 NE 102 St Miami FL 33138 LOT: 23 -24 BLOCK: 92 [Section /Township /Range /Parcel No.] PROPERTY ID #: 11- 3206 - 017 -0850 [OR TAX ID NUMBER) SYSTEM DESIGN AND SPECIFICATIONS T [ 900 ]Gallons SEPTIC TANK A [ 0 ]Gallons N [ 0 ]GALLONS GREASE INTERCEPTOR CAPACITY K [ 0 ]GALLONS OTHER REMARKS: SPECIFICATIONS BY: Andre, APPROVED BY: Andre, Paul STATE IDA DEPARTMENT OF HEALTH ONSITE SEWAGE TREATMENT AND DISPOSAL.- S- Y CONSTRUCTION PERMIT ; 1 \ 0'61 Paul DATE ISSUED: 1/30/02 SUBDIVISION: Miami Shores DOSING TANK CAPACITY [ 0 L D FILL REQUIRED: [ 0.0 ]INCHES EXCAVATION REQUIRED: [ 30.0 ] INCHES Existing 900 Gallons Septic Tank to remain. Install 300 Square Feet drainfield. Invert Elevation of the D/F to be NLT 7.5' NGVD. Bottom Elevation of the D/F to be NLT 7.0' NGVD. This permit is not for addition. THE SEPTIC AGENT: SR0921116, PARILLA ROBERT TITLE: DH 4016, 03/97 (Obsoletes previous editions which may not be used) (Stock Number: 5744- 001 - 4016 -0) [ostds cons 4016 -1] CENTRAX #: 13 -SG -11664 DATE PAID: FEE PAID : $ RECEIPT OSTDSNBR : 02 -0271- -R Dade EXPIRATION DATE: 4/30/02 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 ] ] GALLONS @ [ 0 ] DOSES PER 24 HRS # PUMPS [ 0 ] D [ 300 ]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: Finish Floor of E /Residence Elevation 11.8' NGVD I ELEVATION OF PROPOSED SYSTEM SITE [ 2.3 ] [ FEET ] [ BELOW BENCHMARK /REFERENCE POINT E BOTTOM OF DRAINFIELD TO BE [ 4.8 ] ( FEET ] [ BELOW BENCHMARK /REFERENCE POINT CHD Page 1 of 2 THE MINIMUM SETBIC SURFACE WATERIt WELLS: PUBLIC: BUILDING FOUNDATIQ S: USDA SOIL SERIES: SITE EVALUATED BY: STATE OF FLORIDA DEPARTMENT OF HEALTH ONSITE SEWAGE DISPOSAL SYSTEM SITE EVALUATION AND SYSTEM SPECIFICATIONS Prri a 6 ®0 eN AGENT 045 5 F k.. -C ) A.) BLOCK: 42 SUBDIVISION: fYLfr .) )0 5 Shy _+k)LJ 4 ye J p i 1x) G a Q 1 1 -456 (Section /Township /Range /Parcel No. or Tax ID Number) PROPERTY ID #: u 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: [ ] TOTAL ESTIMATED SEWAGE FLOW: 0 AUTHORIZED SEWAGE FLOW: UNOBSTRUCTED AREA AVAILABLE: • � BENCHMARK /REFERENCE POINT LOCATION: ELEVATION OF PROPOSED SYSTEM SITE IS SOIL PROFILE INFORMATION SITE 1 ICH CAN BE MAINTAINED FROM THE PRO FT DITCHES /S FT .i'1,IMITED USE: FT PROPER SITE SUBJECT TO FREQUENT FLOODING: [ ] YES'] NO 10 YEAR FLOOD ELEVATION FOR SITE:5 /Y 1 47- :& FT MSL /NGVD Munsell Color Texture Depth 0 ! 914104 if to g [e :� to to OBSERVED WATER TABLE: ) 1:! INCHES (ABOVE / ESTIMATED WET SEASON WA R TABLE ELEVATION: HIGH WATER TABLE VEGETA ION: [ ] YES 3 NO MOTTL SOIL TEXTURE /LOADING RATE FOR SYSTEM SIZING: A DRAINFIELD CONFIGURATION: [ ] TRENCH REMARKS /ADDITIONAL CRITERIA: 0 DH 4015, 10198 (Replaces HRS -H Form 4015 [Pape 3] which may be used) (Stock Number: 5744 -003 - 4015 -1) YES [ F�] GALLONS GALLONS SQFT [INCHES S: FT PRIV Y LINES: BELOW] EXISTING GRADE. TYPE: PE$E / APPARENT] INCHES ( ABO BELOWT) EXISTING GRADE. ) YES 0— DE5TH: INCHES BED ] [ABO SITE ELEVATION: o! - go' , OAJ I xspaA) 5 PERMIT # SOIL PROFILE INFORMATION SITE 2 DATE r. / NO NET USABLE AREA AVAILABLE: ACRES PER DAY [RESIDENCES -TABLE 1 / OTHER -TABLE 2) PER DAY [15OO OPD1ACRE UNOBSTRUCTED AREA REQUIRED: SQFT BENCHMARK /REFERENCE POINT SED SYSTEM TO THE FOLLOWING FEATURE _ FT FORMALLY WET? [ ) YES E. NO AA TE: / FT NON - POTABLE: FT FT POTABLE WATER LINES: FT 10 YEAR FLOODINj ?V) YES [ ] NO FT MSL /NGVD Munsell USDA SOIL SERIES: Color Texture Depth 0 to to 'o t• to to to If tor., /1yi DEPTH OF EXCAVATION: ,15o INCHES OTHER (SPECIFY) 0 0 / Page 3 of 3 INSTRUCTIONS: PERMIT NUMBER: Permit tracking number by County Health Department. APPLICANT: Property owner's full name. AGENT: Property owner's legally authorized representative. LOT, BLOCK, SUBDIVISION: Lot, block, and subdivision for lot. PROPERTY ID NUMBER: 27 character number for property (property appraiser ID number or section /township /range /parcel number). PROPERTY SIZE: Check if property at site conforms to submitted site plan. Record net usable area available - lot area exclusive of all paved areas and prepared road beds within public rights -of -way or easements and exclusive of streams, lakes, normally wet drainage ditches, marshes, or other such bodies of water. SEWAGE FLOW: UNOBSTRUCTED AREA: MINIMUM SETBACKS: FLOOD INFORMATION: SOIL PROFILE INFORMATION: WATER TABLE: SOIL TEXTURE: Record the estimated sewage flow for the establishment from Table 1 (residence) or Table 2 (non - residential), Chapter IOD -6, FAC. Record the authorized sewage flow for the lot based on net usable area and water supply (1500 gallons per day per acre for private water supplies and 2500 gpd per acre for public water supplies). If authorized sewage flow does not equal or exceed the estimated sewage flow, the application must be denied. Record the square feet of unobstructed area available and the amount required. Unobstructed area must be at least 2 times as large as the drainfield absorption area and at least 75 percent of the unobstructed area must meet minimum setbacks in Chapter 1OD -6, FAC. The unobstructed area must be contiguous to the drainfield. BENCHMARK INFORMATION: Record the location of the benchmark. if using a surveyor's benchmark record the actual elevation. Record the elevation of the proposed system site in relation (above or below) to the benchmark. Record minimum setbacks which can be meet to all listed features. Actual measurements must be recorded or "NA" for nonapplicable features. Features on site plan or within 75 feet of the applicant lot must be measured. The location of any public drinking well within 200 feet of the applicant's lot must also be verified. Record information on lot's subject to flooding. For lots subject to flooding record 10 year flood elevation for site and actual site elevation. Two soil profiles within the proposed absorption area to a minimum depth of 6 feet or refusal are required. Soil identification will use USDA Soil Classification methodology (Munsell colors and USDA soil textures). Refusals must be clearly documented. Provide USDA soil series if available, record "UNK" if the series cannot be determined. Record the depth of the observed water table at the time of the evaluation. Mark "perched" or "apparent" as appropriate. Record the estimated wet season water table elevation based on site evaluation, USDA soil maps, and historical information. Indicate if there is high water table vegetation present. Indicate if mottling is present and depth. Record soil texture or loading rate for system sizing. DEPTH OF EXCAVATION: If applicable record depth of excavation required. Record "NA" if not applicable. DRAINFIELD CONFIGURATION: Check drainfield configuration required. If other, specify type. ADDITIONAL CRITERIA: Record any additional remarks pertinent to site or installation. Ex. dosing required. SITE EVALUATED BY: Signature of evaluator, title, and date of evaluation. Professional engineers must seal all documents submitted. ELEVATION WORKSHEET ELEVATION OF BENCHMARK / REFERENCE POINT IS: BENCHMARK SITE 1 SITE 2 SITE 3 1+ ] SHOT H.I. H.I. H.I. H.I. [ - ] SHOT [ - ] SHOT [ - ] SHOT I STATE OF FLORIDA DEPARTMENT OF HEALTH APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PERMIT Permit Application Number !' ( 7 )( Scale: Each block represents 10 feet and 1 inch = 40 feet. Notes: J Site Plan submitted by: Plan Approved By /0 ALL CHANGE MUST BE APPROVED BY THE COUNTY HEALTH DEPARTMENT DH 4015, 10/96 (Replaces HRS -H Form 401 which may be used) (Stock Number: 5744 - 002 = 4015 -6) PART II - SITEPLAN Date County Health Department Page 2 of 4 ._ f • •LP APPLICANT: = AGENT: PROPERTY ADDRESS: I I I I I I l l l l l I 1 l TANK [01] [02] [03] [04] [05] [06] [07] [08] [09] STATE OF FLORIDA DEPARTMENT OF HEALTH ONSITE SEWAGE TREATMENT AND CONSTRUCTION INSPECTION AND LOT :,.• BLOCK: SUBDIVISION: INSTALLATION TANK SIZE [1] [2] TANK MATERIAL OUTLET DEVICE • MULTI- CHAMBERED [ Y / N ] OUTLET FILTER ;: LEGEND WATERTIGHT LEVEL DEPTH TO LID CHECKED (X] ITEMS ARE NOT IN COMPLIANCE WITH =_ == a s = m== === as= =ss = ===za DRAINFIELD INSTALLATION [10] AREA [1] L [2) SQFT [11] DISTRIBUTION BOX _ HEADER [12] NUMBER OF DRAINLINES [13] DRAINLINE SEPARATION [14] DRAINLINE SLOPE [15] DEPTH OF COVER [16] ELEVATION [ABOVE /BELOW] BM [17] SYSTEM LOCATION [18] DOSING PUMPS [19] AGGREGATE SIZE,— [20] AGGREGATE EXCESSIVE FINES (21) AGGREGATE DEPTH FILL [ [23] (24] [25] [26] / EXCAVATION MATERIAL FILL AMOUNT FILL TEXTURE EXCAVATION DEPTH AREA REPLACED REPLACEMENT MATERIAL EXPLANATION OF VIOLATIONS / REMARKS: CONSTRUCTION [APPROVED /DISAPPROVED]: FINAL SYSTEM [APPROVED /DISAPPROVED]/ DH 4016, 10/97 (Prwious i`ditions May Be Used) I I I I I I I BUILDING DEPARTMENT • . ... . • . ... .. .. • . . .. .. • . • . • . . . . . . P)[IT NO. DATE PAID: FEE PAID: .ZEC T #: . ....... DIPOSAL SYSTEM i; teat. AM UO IL • • • • • • • • • • • • • • • • • ' . • ... • • • ..0 l l l I I I l l I .. • • • .. ... .. • • • • .. • • • • • ... .. PROPERTY ID #: FILLED / MOUND SYSTEM [36] DRAINFIELD COVER [37] SHOULDERS [38] SLOPES [39) STABILIZATION ABANDONMENT [49] TANK PUMPED " / / [50] TANK CRUSHED & FILLED STATUTE OR RULE AND MUST BE CORRECTED. === = == = f 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 ADDITIONAL INFORMATION [40] UNOBSTRUCTED AREA [41] STORMWATER RUNOFF [42] ALARMS [43] MAINTENANCE AGREEMENT [44] BUILDING AREA [45] LOCATION CONFORMS WITH SITE PLAN [46] FINAL SITE GRADING [47] CONTRACTOR [48] OTHER CAD DATE: CHD DATE : /L Page 2 of 3 Permit No 1/1 e 1 Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the building or other structure herein described. This application is made in compliance and conformity with the Building Ordinance of Miami Shores Village, Florida, and all provisions of the Laws of the State of Florida, all ordinances of Miami Shores Village and all rules and regulations of the Building Division of, Miami Shores Village shall be complied 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 /1J�< G �O /LL7 No. -d elf 4./4 Street,/ Registered Architect and /or Engineer Employing Plumber's Name d 1 d' •557 7 Location and Legal Description Lot Street and Number where work is to be performed —No 4 7f /l GS /d Z Street _._.... State work to be performed and purpose of building (By Floors) _ —•_ -- -- •---- .__.__�...� New Building- - -..._ _ _.._..........._.. Remodeling__. __ _ -- Addition... - - -_ __..... Repairs No of Stories. ....... Size Septic Tank__ Type of Tank Feet of Drain Tile 7e0 Dist Feet of Tank or Drain Field from Weil.. _ Nature of Water Supply: City —Well. Size of Soakage Pit. Amount of Permit $ fitt 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 5988, Compiled General Laws of Florida Permanent Supplement, and II1T com- plied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors employed by him in the work to lx performed under this permit; and will post or cause to be posted' for inspection on the site of the ,.. k public notice or notices as are required by the Act. The undersigned agrees to employ only such sub - contractors, on ormed under this permit, as are licensed by Miami Shores Village. My Commission Expires MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT Block Subdivision 1 v Y)? (Signed) _ - - .._- ( Si Notary Public, State of Florida Master Plumber. STATE OF FLORIDA, ( µ COUNTY OF DADE. Before me, the undersigned authority, • 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 be 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. NOTE: A re- inspection fee of $1A0 will be roads when web rwlespeetde Y mods esompery by Improper Dodo{ for baspectbe. er faulty materials Sad /ar worl®aaship. CLOSETS BATH TUBS SHOWERS TORIES GIN" GLOP SINKS LAUNDRY Tuve URINALS CATCH S ASIN FLOOR DRAIN DRINKING FOUNT' NS r--- TOTAL FIXTURES CONTR. LIST CHECK _ — SEPTIC TANK SEWER Comm. DRAIN FIELD SOAKAGE PIT G TRAP SOLAR HEATER DEEP WELL SPRKLR. SYSTEM SW IN'G POOL C ONTR. CHICK X LIST ✓ ll Permit No 1/1 e 1 Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the building or other structure herein described. This application is made in compliance and conformity with the Building Ordinance of Miami Shores Village, Florida, and all provisions of the Laws of the State of Florida, all ordinances of Miami Shores Village and all rules and regulations of the Building Division of, Miami Shores Village shall be complied 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 /1J�< G �O /LL7 No. -d elf 4./4 Street,/ Registered Architect and /or Engineer Employing Plumber's Name d 1 d' •557 7 Location and Legal Description Lot Street and Number where work is to be performed —No 4 7f /l GS /d Z Street _._.... State work to be performed and purpose of building (By Floors) _ —•_ -- -- •---- .__.__�...� New Building- - -..._ _ _.._..........._.. Remodeling__. __ _ -- Addition... - - -_ __..... Repairs No of Stories. ....... Size Septic Tank__ Type of Tank Feet of Drain Tile 7e0 Dist Feet of Tank or Drain Field from Weil.. _ Nature of Water Supply: City —Well. Size of Soakage Pit. Amount of Permit $ fitt 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 5988, Compiled General Laws of Florida Permanent Supplement, and II1T com- plied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors employed by him in the work to lx performed under this permit; and will post or cause to be posted' for inspection on the site of the ,.. k public notice or notices as are required by the Act. The undersigned agrees to employ only such sub - contractors, on ormed under this permit, as are licensed by Miami Shores Village. My Commission Expires MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT Block Subdivision 1 v Y)? (Signed) _ - - .._- ( Si Notary Public, State of Florida Master Plumber. STATE OF FLORIDA, ( µ COUNTY OF DADE. Before me, the undersigned authority, • 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 be 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. NOTE: A re- inspection fee of $1A0 will be roads when web rwlespeetde Y mods esompery by Improper Dodo{ for baspectbe. er faulty materials Sad /ar worl®aaship. Permit No Date - - — - — - - — Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the building or other structure herein described. This application is made in compliance and conformity with the Building Ordinance of Miami Shores Village, Florida, and all provisions of the Laws of the State of Florida, all ordinances of Miami Shores Village and all rules and regulations of the Building Division of Miami Shores Village shall be complied 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 ............ a !_(_ `Y _------- _-- •-- - - -.__ No. d97' --. Stree ` °C r' Registered Architect and /or Engineer Employing Plumber's Name Location and Legal Description Lot. Street and Number where work is to be performed —No Size Septic Tank_._ - Feet of Drain Tile. Nature of Water Supply: City —Well. Amount of Permit $_ STATE OF FLORIDA, COUNTY OF DADE. MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT No..l ga !��/ Street.Li7 Subdivision Street Block (Signed) _ State work to be performed and purpose of building (By Floors)__ New Building __ ___ Remodeling_ __ — _______ Addition Repairs No. of Stories. . ..... .......... . Type of Tank Capacity Gals —Dist. Feet of Tank or Drain Field from Well .............__._______ ._Size of Soakage Pit Plumbing Inspector. The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations as an employer of labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Permanent Supplement, and bus 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 su • :. is notice or notices as are required by the Act. The undersigned agrees to employ only such sub- contractors, on work to this permit, as are licensed by Miami Shores Village. My Commission Expires Notary Public, State of Florida aster Plumber. Before me, the undersigned authority, a notary public, duly authorized to dminister 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, a t all facts therein by him stated are true. NOTE: A re- inspection fee of $1.00 will be made when such re- inspection is made necessary by improper notice for inspct'4 nn, or faulty materials and /or workmanship. CLOSETS BATH TUBS SHOWERS LAVA- TORIES SINKS SLOP SINKS LAUNDRY TUBS URINALS CATCH BASIN FLOOR DRAIN DRINKING FOUNT'NS TOTAL FIXTURES CONTR. LIST CHECK SEPTIC TANK SEWER CONN. DRAIN FIELD SOAKAGE PIT GREASE TRAP SOLAR HEATER DEEP WELL SPRKLR. SYSTEM SWIM'G POOL CONTR. LIST . -- CHECK Permit No Date - - — - — - - — Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the building or other structure herein described. This application is made in compliance and conformity with the Building Ordinance of Miami Shores Village, Florida, and all provisions of the Laws of the State of Florida, all ordinances of Miami Shores Village and all rules and regulations of the Building Division of Miami Shores Village shall be complied 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 ............ a !_(_ `Y _------- _-- •-- - - -.__ No. d97' --. Stree ` °C r' Registered Architect and /or Engineer Employing Plumber's Name Location and Legal Description Lot. Street and Number where work is to be performed —No Size Septic Tank_._ - Feet of Drain Tile. Nature of Water Supply: City —Well. Amount of Permit $_ STATE OF FLORIDA, COUNTY OF DADE. MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT No..l ga !��/ Street.Li7 Subdivision Street Block (Signed) _ State work to be performed and purpose of building (By Floors)__ New Building __ ___ Remodeling_ __ — _______ Addition Repairs No. of Stories. . ..... .......... . Type of Tank Capacity Gals —Dist. Feet of Tank or Drain Field from Well .............__._______ ._Size of Soakage Pit Plumbing Inspector. The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations as an employer of labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Permanent Supplement, and bus 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 su • :. is notice or notices as are required by the Act. The undersigned agrees to employ only such sub- contractors, on work to this permit, as are licensed by Miami Shores Village. My Commission Expires Notary Public, State of Florida aster Plumber. Before me, the undersigned authority, a notary public, duly authorized to dminister 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, a t all facts therein by him stated are true. NOTE: A re- inspection fee of $1.00 will be made when such re- inspection is made necessary by improper notice for inspct'4 nn, or faulty materials and /or workmanship. INSPECTIONS Inspector's Name DATE COMMENTS FOUNDATION FNDN. WALL CAP GRADE BEAM FLOOR SLAB LINTEL COLUMNS TIE BEAMS FRAMING LATHING CAP OR RAKE ROOF - TIN CAPS ROOF - FINISH OFFST. PARKING FINAL C. 0. ISSUED OWNER Mr. Ted Koper AD E R s 499 N.E. 102 nd St. CONTRACTOR Yale Ogron Mfg. Co. Inc. CONTRACTOR'S 671 West 18th St .Hia ADDRESS ARCHITECT OR ENGINEER ARCHITECT'S OR ENGINEER'S ADDRESS BUILDING USE one family residence DESCRIPTION Replace 19 jals. with OF WORK awning type windows CONSTRUCTION: C. B. S. O FRAME 0 OTHER ❑ NO. OF STORIES NO. OF UNITS PLUMBING NOS O ELECTRICAL YES O I understand that this application is subject to the Building Ordin- ance and all other Ordinances of the City of Miami. Laws of the State of Florida and Rules and Regulations of the Building Division applic- able thereto. A copy of approved plans and specifications must be kept at building site during progress of the work. All employers of labor are subject toiWte iwviyApptq(-t.he gllpgioda WicKli :enIa Act. APPLICANT'S SIGNATURE BY President PERMIT NUMBER DATE ISSUED BY TOTAL FEE $ APPROVALS ZONING RESOLUTION FIRE ZONE BUILDING GROUP BUILDING TYPE STRUCTURAL ELECTRICAL PLUMBING SEWER LINE GRADE FIRE PREVENTION • MECHANICAL STATE HOTEL PERMIT It STATE ItEALTH DEPARTMENT DATE GdiRiftx6)ExiiititithibbocEchdigallaA 4PLIC &TION FOR BUILDING PERMIT Village of Miami Shores Applicant shall complete the following: ( LAND USE REVIEW NEW BUILDING ADDITION REMODELING Replace 19 jals REPAIRS SLAB SQ. FT. SWIMMING FOOL GALLONAGE LOT SIZE X NUMBER OF PARKING SPACES REQUIRED APPROVED SQ. FT. SQ. FT. COST $ No structural chang This space represents the lot: Indicate the building in space showing the dis- tance from lot lines and other buildings. INSPECTOR'S COPY s AREA COST $ COST $ COST$ 575 .00 COST $ COST $ FEE $ FEE 5 FEE 5 FEE 5 FEE $ 9.5 FEE $ FEE 5 FOR OFFICE USE ONLY 4 r 0 w 0 t7 10M 2/89 REQ.32439 FORM 8100 REV. ro BUILDING n ELECTRICAL PERMIT N? 12576 I PLUMBING ROOFING ❑ Work to be performed under this Permit Owner of Building Architect Contractor or Builder Legal Description, Address of Building Lot CONTRACTOR OR BUILDER MIAMI SHORES VILLAGE, FLORIDA mo t : Bl. Signed• Subdi- vision Value of Project $ DATE • J A 195 Contractor's License No Amt. of Permit This permit is granted to the contractor or builder named above to construct the building or to install the equipment or device described in the application herefor in strict compliance 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 of the ordinances and regulations pertaining to the work covered hereby whether shown on the plans or drawings or in the statements or specifications and that he assumes responsibility for work done by his agents, servants or employees. i > • t ._ .. ---- -••W+w BY INSPECTOR ✓ y 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 . pr specifications•submitted to the proper authorities of Miami Shores Village. In accepting this permit I assume responsibility for all work done byefier „self„ my, aunt, servant or employee. BY 0. AUTHORITY