541 NE 102 St (4)MIAMI SHORES VILLAGE
UILDING DEPARTMENT
305- 795 -2204 \‘,
Building Inspection Request
Date 3 / t ,, 2N
Type Insp'n J l (Y) 1 �� L�et l
Permit No P «oV4- i I q
Phone # ()S
Inspection Date=
Approved
Correction
Re- Insp'n Fee
Name C , II ) J ci n C
Address N L S `� � 167._ S4-
Company
•
• 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 Plumbing Mechanical Roofing
Owner's Name (Fee Simple Titleholder) t k e-Uv, Y Phone # 1( o - ' 2 l ` � 2- - $( -((23 - I (Q-
Owner's Address 55'4 ( /1/41 E 102' &k /-11C0
City \or esS State t Lor (I Zip 35138
Tenant/Lessee Name ti' / /ck Phone #
Job Address. (where the work is being done) y N C tJZ��
City Miami Shores Village County Miami -Dade Zip as t�
Is Building Historically Designated YES NO
Contractor's Company Name Cm 1'`�rvl�g" L o Phone #
Contractor's Address \ e26-ti Pt' e
City ' ■cat.vv\ \ e o1-0-S
Qualifier ' \ / b ert \ cL
Architect/Engineer's Name (if applicable) Phone #
$ Value of Work For this Permit
LAD eLi «-,
1 S
Type of Work: ['Addition ['Alteration ['New
Describe Work:
* * * * * * * * * * * * * * * * * * * **
* ** *Fee
Submittal Fee $ Permit Fee $ /4 O
Notary $ Training/Education Fee $ l . - 0
Scanning $ Radon $
Code Enforcement $
Total Fee Now Due $ lc( ?e 0
(Continued on opposite side)
Miami Shores Village
State c' (-or Zip 33 13
Structural Plan Review. $
Master Permit No.
Square Footage Of Work:
* * * * * * * * * * * * * * * * * * * * * * * * * * * * **
Permit No. ( 2C04 iq
00a offo
et-
5 -
CCF$3. O
Technology Fee $ . D 0
Bond $
APR 1 2004
0 Demolition
l��
ooding 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 o /such posted notice, the
inspection will not be approved and a reinspection fee will be charged.
Signature
Owner or Agent r
The foregoing instrument was acknowledged before me this/
day of ti / 2( , by A01,6 C/
who is personally known
j(WJ°J 7d 6-13S take an oath.
NOTARY PUBLIC:°
Sign:
Print:
My Commission Expires:
APPLICATION APPROVED B
Chc 10/14/03
Signature
Contractor
The foregoing instrument was acknowledged before me this
day of r i ` , 20 y by 4 .. €. r k �Da�
who is personally known to me or who has produced
as identification and wN A
NOTARY PUBLIC STATE OF FLORIDA
COMMISSION NO. DE/093674
MMISSION EXP. FEB. 19,2006
NOTARY PUBLIC:
Sign:
Print:
ykrC.-- Strom
My Commission Expires: 2 _1 ot 1
(Certificate of Competency Holder)
State Certificate or Registration No. ( o 5 1 Certificate of Competency No.
* * *G * ** * * ** * ** * * * * * * **
a ans Examiner
Engineer
Zoning .
Miami Shores Village
10050 NE 2nd Avenue
Phone: 305 - 795 -2204
Printed: 4/16/2004
Applicant: DAVID /MARYELLEN KELLY
Owner: KELLY DAVID /MARYELLEN
JOB ADDRESS: 541 NE 102 ST
Contractor EMPIRE PLUMBING COMPANY Contractor's Address: 1853 WEST AVE
Local Phone:
Parcel # 1132060170960
Signed: (INSPECTOR)
Plumbing Permit
Permit Number: PL2004 -119
Legal Description: MIAMI SHORES SEC 4 AMD PLAT
Permit Status: APPROVED Permit Expiration: 10/12/2004 Construction Value: $4,500.00
Work: REPIPE H &C WATER LINES AS PER EXISTING FIX. LAYOUT 2 LAV 2 WS 1 SINK 1 WATER SRV
Page 1 of 1
PB 15-14 LOT 16 & W1/2 LOT 17
Fees: Description Amount
FEE2004 -3997 Building Fee $160.00
FEE2004 -3998 CCF $3.00
FEE2004 -3999 Training and Education Fee $1.00
FEE2004 -4000 Technology Fee $4.00
Total Fees: $168.00
Total Fees: $168.00
Total Receipts: $0.00
APR 2 9 PAID
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:
Lot No.
I herewith submit the following application for a permit covering
the installation of a Septic Tank
Soakage Pit: : Relaying: Fg New:
Feet of drain tile:
Installe + .
(NEW: Old: , Story:
For a (Store:
MIAUII SHORES VILLAGE, FLA.
APPLICATION FOR SEPTIC TANK PERMIT
DIVISION OF PLUMBII INSPECTION
Garage:
(Res: Garage wash floor: taste water from a:
Building has: Stores; Offices; Apts; Hotel Rms;
Bedrums 3
Owner or Agent: 4, Address:
Block No.
No. of Plumbing Fixtures:
Additional information:
Address of work:
Ready for Inspection: Date: 7
Apt:
Date:
ddress:
i
Addition: Remodeled:
Hotel: Office Bldg.
SUBDIVISION
?f r(
Time:
Laundry Tubs: Floor Drains:
Nature of water supply: City: Well: Feet Distant from all
wells: Type of tank installed: Tank capacity in
gallons:
Size of Soakage Pit: Purpose of same:
ak
APPROVED BY: (14I('k CONDEMNED BY:
Remarks:
PERMIT NO. ///,
DATE
ISSUED TO
A '.7 4/1' ,7 141.
to install the following described plumbing, in accordancewith
the laws, statutes and psgaiations of Miami Shores Village,
Flor:Ida and the St3te of Flapida, governing plumbing and drain-
age work done in filami Shoes Village, Florida,
FOR A ' STORY .4. 7 .' -4' BUILDING
•NNO. MO g . L•■■ ..• . ,
AT tj 5*1 //, :., 1 ,f.• ';:,'' i t o ,,, ' , i
. .., 1 / r
i y
f ,t
. i:: : 1,, ? 2, ( ,. 1 c I,
f e 1 r rlfr $ .', f .f . t 4 . ' ,2,...ie L 4 , :i •
t,
,..
FIXTURES 0 '.1 .
• SEWER ' / ID / •# d .,... .. ,/„` •',
Payment Rec4ived ;-..,:' -4k
--- ,v
SEPTIC TANK By
,
4 ..7.
TOTAL 3
Village Plumbing Inspector
This permit issued subject to approval of County Plumbing Inspector
-`
'
MIAMI SHORES VILLAGE FLA.
PLUMBING PERMIT
FIXTUR
P•.
NO.
570
Permit # 513 I
Permission is hereby granted
Lo,,, /2./6
Fixtures
As Shown on attached approved plans.
FIXTURES ROUGHED IN $
FIXTURES SET $ 1 7
if $ /
SEWER
SEPTIC TANK
TOTAL';, j
llage Pm bin Ins ector
g P
MI...\ :[ Hr R.r,,_ VILLAQE
Plumbing Permit
Miami ho Village, Fla03
to install the following described plumbing, in accordance with th
laws, statutes and regulations of Miami Shores Village, Florida an;::
the State of Florida, governing plumbing and drainage work done in
Miami Shores Village, Florida. ,�+ ,,. oe
For a ;g ' ° At No , e • ff 40,z
Blocl.3 Subdivision
•
Payment Rpceived'
By
This permit issued subject to approval of County Plumbing inspcctox-
DATE
, ft
ISSUED TO
' imA
to install the fcllowing aescribed plumbing, in accordance
the laws, statute and regalations of Miami Shores Village,
Florlda and the State of Fln governing plumbing and drain-
age work done in Miami Shoes Village, Florida.
FOR A / STORY •
FIXTURES
SEWER
?!,
. .
4 J' • if .4.• •••
SEPTIC TANK
MIAMI SHORES VILLAGE FLA.
TOTAL
PLUMBING PERMIT
•-•,1
AT
•
• - ,
FIXTURES
.‘,#1 ! •
,
z • f / •
/l!
NO.
Payment Received
By
PI 570
BUILDING
_ 5
• ir • /
4
,
1
Village Piuinbing Inspector
This permit issued subject to approval of County Plumbing Inspector
Al
/ ')
r /ve
P.
A 4
Ltwesty tie7- A
_ _ -J u(
1
/ /L
< *)-
"
(
CLOSETS
BATH
TUBS
SHOWERS
LAVA-
TORIES
SINKS
SLOP
SINKS
LAUNDRY
TUBS
URINALS
CATCH
BASIN
FLOOR
DRAIN
DRINKING
FOUNTAINS
TOTAL
FIXTURES
A
/
/
as
/
7
A -244 5 -35, 5M
I herewith submit the following plan of plumbing for approval:
Employing Plumber
New i
For a
Dwelling ❑ Store
Owner or Agent
Builder or Contractor is
/1217
Lot N .' /% Block No.
Address
/ h /D2
Sewer Connections At center of St. ❑
A charge of $1.00 will be made for correcting any inaccuracies in the foregoing information.
DO NOT WRITE IN SPACE BELOW. THIS IS FOR THE USE OF THE DIVISION OF PLUMBING INSPECTION ONLY.
@44 1 O
e..4,
Plan No
Date �- i; !,
REMARKS
6 B�
DIVISION OF PLUMBING INSPECTION
DEPARTMENT OF PUBLIC SERVICE
MIAMI, FLORIDA
ROUGH -IN INSPECTION
Ground Rough -In Rain Leader
A M P M.
Approved -by t ( i` ' j 6
Condemned by
Imo
6' 7 D
Old ❑
❑ Garage ❑
9 Subdivision
At curb ❑
Date_
SEWER INSPECTION
A M P M
Approved by
Condemned by
REMARKS
Work executed by
Story
Apartment ❑
Address
Address
At property line ❑ Existing in alley ❑ Existing bldg. sewer ❑
To septic tank L� Existing bldg. drain ❑ To dry well ❑
Sewer Permit No
Addition ❑
Hotel ❑
FINAL INSPECTION
19
Remodeled ❑
Office Bldg. ❑
Date
AM PM.
Approved by
Condemned by
REMARKS
THIS SPACE FOk ELEVATION SKETCH
In alterations to existing work show the old work in red' ink and the new in black ink. Letter each stack to
correspond with the opening shown in floor Plan or ground plan on opposite page.
%
A PERSCTIVE SKETCH
PR VIDEi { { THE WORK CA
1, i 'L.,
Sketch position of building and lot lines in square (which represents an entire city block), showing on which
street the building and lot faces; also show exact location of "Y" in street and position of lateral or septic
tank. Show sewer and any change in direction same may make. The purpose of this plan is to have an accurkte
layout of all underground pipes for future references.
WEST
NORTH
A
EAST
Remarks :
NORTH
SOUTH
T7
En
WILL BE SUFFIEIENT
.N BE CLEARLY
HOWN
THIS SPACE FOR PLAN SKETCH
Show location of stacks and horizontal drains inside building, lettering each opening to correspond with the
stock connections as shown on the elevation sketch on opposite page. Where ground work is concealed, draw
floor plan of building showing location of walls, partitions, columns, etc., and the location of all horizontal
soil and waste pipes, in reference to same.