5 NE 102 St (14)Dat
Type Insp'n
Permit No.
Name
Address
Compan
Phone #
Inspection Date
Approved
Correction
Re- Insp'n Fee
MIAMI SI[ORES VILLAGE •
BUILDING DEPARTMENT
305- 795 -2204
Building Inspection Reques
oy
Type Insp'n
Permit No.
Name
Address
C• pany
( —CI
Inspection Date k
1 0
Phone #
Dat Mo
Approved
Correction
Re- Insp'n Fee
MIAMI SHORES VILLAGE
BUILDING DEPARTMEN
305- 795 -2204
Building Inspection Request
LPL A. • i __• 1 .
c)7
MIAMI SHORES VILLAGE
BUILDING DEPARTMENT
305- 795 -2204
Building Inspection R
Dat2_4(
Type Insp'n
Permit No.�) D ll
Name
Address _ 0
Company / C 1 P I —
Phone # 'LC 1,
Inspection Date 2 J C / 0 '1
Approved
Correction
Re-Insp'n Fee
Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
BUILDING Permit No.
PERMIT APPLICATION
FBC 2001
Permit Type (circle): Building Electrical
Owner's Name (Fee Simple Titleholder) / $ / f ' Phone #
Owner's Address S /v . 1V 2 5, 'Li
City i G'4 r;40vo State
Tenant/Lessee Name A Sit// r
Contractor's Company Name
State Certificate or Registration No.
$ Value of Work For this Permit ' .S a 'a
Total Fee Now Due $
(Continued on opposite side)
a
Master Permit No.
Job Address (where the work is being done) 5 Alt ' /p 2—S
City Miami Shores Village County Miami -Dade Zip
Is Building Historically Designated YES NO
"Ift , n je 1
Phone #
Contractor's Address I7 7 3 /�!.✓. i� �
Cit /i✓ Alegi'
State Zip 334j
Qualifier c L - A
Zip 3 3r 3 g
Phone #
Certificate of Competency No.
Architect/Engineer's Name (if applicable) Phone #
Square Footage Of Work:
Mechanical Roofing
Type of Work: ❑Addition ❑AI e ration � ❑New epa /Replace ❑ Demolition
Describe Work: ; //11.f#
9 e—z> /<,.
* * * * * * * * * * * * * * * * * * * * * * * * * * ** F ees * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
Submittal Fee $ Permit Fee $ f 7S • CCF $ /, o 0 CO /CC
Notary $ .S, 0 0 Training/Education Fee $ T 0 Technology Fee.$ l i� 7
Scanning $ Radon $ Zoning Bond $
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
for the first inspection which occurs seven (7) days after the building permit is issued. In y absence of such posted notice, the
inspection will not be approved and a reinspection fee will be charged.
My Commission Expires:
* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
APPLICATION APPROVED BY:
Chc 05/13/03
NOTARY PUBLIC: NOTARY P
Sign: Sign: ,A.A.` .
Print: Print: t , ► ro
My Commission Expires:
Signature Signature
Owner or Agent Contractor
The foregoing instrument was acknowledged before me this The f regoing instrument was acknowledged before me this
day of , 20 _, by day of , 2®.., b
who is personally known to me or who has produced who is personally known to me or who has produced
As identification and who did take an oath.
as identification and who did take an oath.
l3LIC:
Ettgires Nc iember 16. )006
***************************************************************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
PExaminer
Engineer
Zoning
Miami Shores Village
10050 NE 2nd Avenue
Plumbing Permit
Phone: 305 - 795 -2204 Permit Number: PL2004 -185
Printed: 6/29/2004
Applicant:
Owner: SAKZ
JOB ADDRESS: 5
Contractor MR C'S SEPTIC TANK
Local Phone: 305 - 651 - 7859
Parcel # 1132060131640
Signed:
NE 102
(INSPECTOR)
ROBERT
ST
Contractor's Address: P 0 BOX 693239
Permit Status: APPROVED Permit Expiration: 12/26/2004 Construction Value: $1,500.00
Work: INSTALL 900 GAL. SEPTIC TANK
Page 1 of 1
Legal Description: MIAMI SHORES SEC 1 AMD PB 10 -70 LOTS 13 & 14 LOT SIZE IRREGULAR OR
Fees: Description Amount
FEE2004 -6490 Building Fee $175.00
FEE2004 -6491 CCF $1.20
FEE2004 -6492 Notary Fee $5.00
FEE2004 -6493 Training and Education Fee $0.40
FEE2004 -6494 Technology Fee $4.37
Total Fees: $185.97
Total Fees: $185.97
Total Receipts: $185.97
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 1 assume responisibility for all work
done by either myself, my agent, servants or employes.
Signed: (Contractor or Builder) BY:
- - --
CLOSE TS
BATH
Tue.
SHOWER•
LAVA•
TORIES
SINKS
SLOP
SINK[
LAUNDRY
Tuns
URINALS
CATCH
BASIN
FLOOR
DRAIN
DRINKING
FOUNT'N•
TOTAL
FI*TUR[[
CONTR.
LIST
CHECK
_
SEPTIC
TANK
SEWER
CONN.
DRAIN
FIELD
SOAKAGE
PIT
GREASE
TRAP -
SOLAR
HEATER
DEEP
WILL
SPRKLR.
6
SWIM'O
POOL
CONTR.
LIST
CHECK
Permit No Q 3
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
Application is hereby made for the approval of the detailed statement of the plans and specifications herewith subn(itted 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 f k
g uring progress o work.
Owner's Name and Address 7 ZW1 No.
Registered Architect and /or Engineer
Employing Plumber's MUSIC ./.14 O ibrigL .-
8treeLIV .. s
Block Subdivision______ .
Location and Legal Desctiption Lot. ['�
Street and Number where work is to be performed —No `�' Street N _ / Q 2- -
State work to be performed and purpose of building (By Floors)_-______ .. .c...L.A4_._ 7 - " - -5 .1.4?: 4:-. ...._ ... - ... I.N.
New Building __ Remodeling —_ - - -_ -- Addition...- ...__. Repairs No. of Stories..
Size Septic Tank_-.- -_------ -_• - -- — - - -- _.:.Type of- Tank —
Feet of Drain Tile___ _ ____ _____Dist. Feet of Tank or Drain Field from Well.
Nature of Water Supply: City—Well. — ___._ —._ -Size of Soakage Pit
- -•Q
C/
Amount of Permit $ L (Signed ) -
(Signed)
Capacity gala.._ _
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 Permanent Supplement, and Isar com-
plied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors employ - • him in the work to be
performed under this permit; and will post or cause to be posted' for inspection on the site o ork such otice or notices as are
required by the Act The undersigned agrees to employ only such sub - contractors, on • k to . Per nd this permit, as are
licensed by Miami Shores Village.
aster Plumber.
STATE OF FLORIDA, i
COUNTY OF DADE.
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeared
to me well known, and who, being by me first duly sworn, upon oath deposes and says that he is the
of the above described construction, that he has carefully read the foregoing application, and that be did sign the same, and that all facts
therein 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 mob ore inspection L made•neceasary by improper notice for inspection, or faulty
materials and /ce workmanship.