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PL-07-668Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP -45136 Permit Number: - 8 Inspection Date: 08/06/2007 Inspector: Levrock, James Owner: PEREZ, FELIPE Job Address: 735 94 Street NE Miami Shores Village, FL Project: <NONE> Contractor: ALL PRO - SEPTIC & SEWER INC Block: Permit Type: Plumbing - Residential Inspection Type: Final Work Classification: Drainfield Phone Number (305)758 -6056 Parcel Number 1132060141990 Lot: Phone: (305)635 -3002 Building Department Comments EXCAVATE TO REPLACE EXISTING DRAINFIELD Passed Ins • , °, m tor o)nments Failed Correction Needed Re- Inspection Fee ($75) No Additional Inspections can be scheduled re- inspection fee is paid. until Friday, August 3, 2007 Page 2 of 2 SfiATE OF FLORIDA • • •••CE11TRjkX ,1„4 -SG -32573 DEPARTMENT OF HEALTH :•••: • D. T: 'p1�1t ; ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM: : 9* • • •••RtCtI'PT •: ••• CONSTRUCTION PERMIT CONSTRUCTION PERMIT FOR: [ ]New System [ ] Existinyv,st [ X ]Repair [ ] Abando t="" D © OSTDSNBR 07 -01108 -R • • • • • • • ••• • • • • • • • • • �" ©� 2007 • • ••• • • • ••• • • •• ••• • • • • • • • • • • • • [ ] Innovative Other [ NA ] •• • • • •• ••• •• APPLICANT: Perez, Felipe PROPERTY STREET ADDRESS: 735 NE 94 St LOT: 18 BLOCK: 67 • All•Hro.• • • •• • • • • •• • • 3 SUBDIVISI PROPERTY ID #: 11- 3206 - 014 -1990 hoes o Town ip /Range /Parcel No.] OR D NUM ER] • • • • 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, ��__ _o__�_ -_.�_, !�,:::� -�_ ! "� CATIONS MAY RESULT IN THIS PERMIT BEING MADE NULL AND VOID.`'' i, S'IS • XEMPT THE APPLICANT FROM COMPLIANCE WITH OTHER FEDERAL, —.- �4_:. , - c - „��. _ q'e... - R PROPERTY DEVELOPMENT. SYSTEM DESIGN AND SPECIFICATION,�PPROOED ZONING DEPT T [ 750 ]Gallons SEPTIC TANK ZONING A [ 0 ]Gallons N [ 0 ]GALLONS GREASE INT K [ 0 ]GALLONS DOSING TAN D [ 200 ]SQUARE R [ 0 ]SQUARE A TYPE SYSTEM: I CONFIGURATION: N F I E L D S UBJECT TO COMPUANC. ALL FEDERAL FEET FEET PRIMAR DRAINFIELD TE AND COU tl S AND REGULATi ®NS [ Y ]STANDARD [ N ]TRENCH LOCATION TO BENCHMARK: FFE: 11.0' NGVD [ N ]FILLED [ Y ]BED - CHAMBERED /IN SERIES: [Y ] - CHAMBERED /IN SERIES: [Y ] S PER 24 HRS # PUMPS[ 0 ] [ W TMOUND [ N ] [ N ELEVATION OF PROPOSED SYSTEM SITE [ 15.6 BOTTOM OF DRAINFIELD TO BE [ 53.6 ] [ INCHES ] [ ] [ INCHES ] [ FILL REQUIRED:[ 0.0 ]INCHES EXCAVATION OTHER REMARKS: REQUIRED: [ 38. BELOW] BENCHMARK /REFERENCE POINT BELOW] BENCHMARK /REFERENCE POINT 0 ] INCHES 1.- Install 200 sf of drainfield in bed configuration. 2.- Perimeter of excavation area shall be at least 2 ft. wider and longer than the proposed absorption bed. 3.- Existing 750 gal. septic tank certified by "A11 Pro Septic & Sewer, Inc. on 03/27/07" to remain. 4.- Invert elevation of drainfield to be no less than 7.03' NGVD. 5.- Bottom of drainfield elevation to be no less than 6.53' NGVD. ! ��g�0 * * * ** *THIS PERMIT IS NOT FOR ADDITION(s) * * * * ** SPECIFICATIONS BY:EDWARDS, ASTRID TITLE: � R It APPROVED BY: Edwards, Astrid Lo TITLE: DATE ISSUED: 4/4/07 DH 4016, 03/97 (Obsoletes previous editions which may not be used) (Stock Number: 5744- 001 - 4016 -0) [ostds_cons_4016 -1] Dade EXPIRATION DATE: 7/3/07 CHD Page 1 of 2 STATE OF FLORIDA • • ••• • •CENTBJ #: 13 -SG -32573 DEPARTMENT OF HEALTH : STATE OF FLORIDA • • •••CENTRAX # :•13-SG -32573 DEPARTMENT OF HEALTH :•••• • DST Ails: ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM: : : aLiID :: $ CONSTRUCTION PERMIT • • ••'R Ct1'PT •: ••. OSTDSNBR : 07-01108-R • • • • • ••• • • • • • • • • • • • ••• • • •0• • • • • CONSTRUCTION PERMIT FOR: • •• • ••• • �•• ; [ ]New System [ ]Existing System [ ]Holding Tank [ ] Innovative Other [ X ]Repair [ ]Abandonment [ ]Temporary [ NA ] • • • • •• •e• •• APPLICANT: Perez, Felipe • • AGENT: ALL PRO, All•Pre : • • ••• • •• • •• • • • • • ••• •• PROPERTY STREET ADDRESS: 735 NE 94 St Miami Shores FL 33138 LOT: 18 BLOCK: 67 SUBDIVISION: Miami Shores [Section /Township /Range /Parcel No.] PROPERTY ID #: 11- 3206 - 014 -1990 [OR TAX ID NUMBER] 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. SYSTEM DESIGN AND SPECIFICATIONS T [ 750 ]Gallons SEPTIC TANK A [ 0 ]Gallons N [ 0 ]GALLONS GREASE INTERCEPTOR CAPACITY K [ 0 ]GALLONS DOSING TANK CAPACITY [ 0 MULTI - CHAMBERED /IN SERIES: [Y ] MULTI - CHAMBERED /IN SERIES: [Y ] ]GALLONS @ [ 0 ]DOSES PER 24 HRS # PUMPS[ 0 ] D [ 200 ]SQUARE FEET PRIMARY DRAINFIELD SYSTEM R [ 0 ]SQUARE FEET SYSTEM A TYPE SYSTEM: [ Y ]STANDARD [ N ]FILLED I CONFIGURATION: [ N ]TRENCH [ Y ]BED N F LOCATION TO BENCHMARK: FFE: 11.0' NGVD [ N ]MOUND [ N ] [ N I ELEVATION OF PROPOSED SYSTEM SITE [ 15.6 ] [ INCHES ] [ BELOW]BENCHMARK /REFERENCE POINT E BOTTOM OF DRAINFIELD TO BE [ 53.6 ] [ INCHES ] [ BELOW]BENCHMARK /REFERENCE POINT L D FILL REQUIRED: [ 0.0 ]INCHES EXCAVATION REQUIRED: [ 38.0 ] INCHES OTHER REMARKS: 1.- Install 200 sf of drainfield in bed configuration. 2.- Perimeter of excavation area shall be at least 2 ft. wider and longer than the proposed absorption bed. 3.- Existing 750 gal. septic tank certified by "All Pro Septic & Sewer, Inc. on 03/27/07" to remain .� 4.- Invert elevation of drainfield to be no less than 7.03' NGVD.' 5.- Bottom of drainfield elevation to be no less than 6.53' NGVD. * * * ** *THIS PERMIT IS NOT FOR ADDITION(s) * * * * ** too ok SPECIFICATIONS BY:EDWARDS, ASTRID TITLE: 11PL O APPROVED BY: Edwards, Astrid !0'' / U. TITLE: DATE ISSUED: 4/4/07 DH 4016, 03/97 (Obsoletes previous editions which may not be used) (Stock Number: 5744- 001 - 4016 -0) [ostds_cons_4016 -17 Dade EXPIRATION DATE: 7 /3/07 CHD Page 1 of 2 STATE OF FLORIDA DEPARTMENT OF HEALTH ONSITE SEWAGE DISPOSAL SYSTEM SITE EVALUATION AND SYSTEM SPECIFICATIONS APPLICANT: Perez, Felipe • • ••• •• •• • • • • • • • • • • • • • ••• . •CENTRE #: 13 -SG -32573 MITSNJ3R 07- 01108 -R .•• • • • • • • • • • • • • ••• • • • • • • • • • • • • • • • • • • • AGENT: All Pro, All Pro • ••• • • • • • • • • • • • ALL PRO LOT: 18 BLOCK: 67 SUBDIVISION: Miami Shores ••' : • jD :;•j,1I 0 X014 -1990 • • • • • • • • • • • • •• • • • • • ••• .. TO BE COMPLETED BY ENGINEER, HEALTH DEPARTMENT EMPLOYEE, OR OTHER QUALIFIED PERSON. ENGINEER'S 'Z• _l- ;_ ;1 ). 4: : '\e PROPERTY SIZE CONFORMS TO SITE PLAN:[X]YES [ INC NET USABLE AREA AVAILABLE: TOTAL ESTIMATED SEWAGE FLOW: 300 GALLONS PER DAY [64E -6, TABLE 1] AUTHORIZED SEWAGE FLOW: 725 GALLONS PER DAY [1500GPD /ACRE OR 2500GPD /ACRE] UNOBSTRUCTED AREA AVAILABLE: 1000 SQFT UNOBSTRUCTED AREA REQUIRED: 857 SQFT 0.29 ACRES BENCHMARK /REFERENCE POINT LOCATION: ttt: 11.0' NGVD ELEVATION OF PROPOSED SYSTEM SITE IS 15.60 [ INCHES ] [ BELOW ]BENCHMARK /REFERENCE POINT THE MINIMUM SETBACK WHICH CAN BE MAINTAINED FROM THE PROPOSED SYSTEM TO THE FOLLOWING FEATURES: SURFACE WATER: N/A FT DITCHES /SWALES: N/A FT NORMALLY WET? [ ]YES [ X ]NO WELLS: PUBLIC: N/A FT LIMITED USE: N/A FT PRIVATE: N/A FT NON - POTABLE: N/A FT BUILDING FOUNDATIONS: 5 FT PROPERTY LINES: 5 FT POTABLE WATER LINES: 10 FT SITE SUBJECT TO FREQUENT FLOODING: [ ]YES [ X ]NO 10 YEAR FLOOD ELEVATION FOR SITE: 0 FT NGVD SOIL PROFILE INFORMATION SITE 1 Mansell # /Color Texture 10YR- 1 /9 -V1l(S RN Sane] tfYR- 4 /1 -RN Sandy Tram USDA SOIL SERIES: 15 Urban land Depth 0 to 19 19 to 79 to to to to to to 10 YEAR FLOODING? [ ]YES [ X ]NO SITE ELEVATION: 10 FT NGVD SOIL PROFILE INFORMATION SITE 2 Mansell # /Color Texture 10YR- 1/9 -Vf(:: RN Sand 101/R- d /'3 -RN Sandy T.nam USDA SOIL SERIES: 15 Urban land Depth 0 to 19 19 to to to to to to to OBSERVED WATER TABLE68.00 INCHES [ BELOW ] EXISTING GRADE TYPE: [APPARENT ESTIMATED WET SEASON WATER TABLE ELEVATION:68.00 INCHES [ BELOW ] EXISTING GRADE. HIGH WATER TABLE VEGETATION: [ ]YES [X]NO MOTTLING: [ ]YES [X]NO DEPTH: 0.0 INCHES SOIL TEXTURE /LOADING RATE FOR SYSTEM SIZING Replacement /0.70 DEPTH OF EXCAVATION:38.0 INCHES DRAINFIELD CONFIGURATION: [ ]TRENCH [ X ]BED [ ]OTHER (SPECIFY) REMARKS /ADDITIONAL CRITERIA: SITE EVALUATED BY: BARRY TEIXEIRA DH 4015, 03/97 (Obsoletes previous editions which may not be used) (Stock Number: 5744- 003 - 4015 -1) [ostds eval 4015 -3] DATE: 3/27/07 Page 3 of 3 • APPLICATI S a Each block represents 5 f STATE OF FLORIDA:. .1, EPAF TMENT OF='HEAV -1 V FOR ONSI SEWAGE DISPOSAL SYS1sEM oddr peri App 440, et and 1 1 ch RT 11- SITE PLAI4 50 feet. • • • •• • • •• •• • �• • • • • • • • • COC`f1014 F fl MIT tion Number • .. r; • 7• j11 ■1111■■1..11111.1•lI •1i.1. ■1 i1.ul1■u11u,II iIlI.1I1111 I1r tx 1 rr rmisso11.umm . 1. •...11.11•■.■■■1■ ■s r.I1 ■.11S •• •N tnlrilitl i ■■ ■ i t ICS: fltI rifiti ■ ■l;■V■ V IEWIMI 11,,1■■■■■O■e ■1■ ■■ MMII ■■ EMSHil•a[e1 ■ 1 i 1MMISS mniu ■ unro A 14147 .1=1,6111c.. •■ ■■■( �i[wJI' ■U SUMMI11 11 r� ■M MM =` ■MU ri MINIMP t' PI ■■■■■ ■■Nrl IIV IMW 16M■ I IMI Lli t ■■ IR■ I11.■11■ •E-:fr r1i trill rAMIS1■. 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RMOESNAaa::.; aeaaaRaUSIMMI IMMIMMeaaa�n® aaaaNaa ®m.oaa eRaaa>iamae MMOMMlRaaee .asRasoifaaMiINIMaaaao■slim■a EM OM MmsssOMMINSe1>X111®MltsssM ®1 1i111sngunsasisli ummin tlosaaoai�i n omwa' Y. 1"0,iw simm w .. ,� �rw`rr rii�i.�illiriiitt irralifrriini ii,i is� riirrrr��r .� � .ir�a� ii�rww rror� IrirelrC. 1 imam Rae,>taasiabli miummi lib® aesasmliasmaeA� 'anz=sMisMimimmummmiles aMlsilRSAfeaaA names no maama■seaarT mmul miumm1 wommel a ossieNtrimm .m■ac_i.immum unim A ,,rise = =mmimma M immsmaamsRaaamimmuf asaMilIMOOSm nuns !*�" rimulasi mM insitaYmMlmmmamemmammsam asmmommlee; ilElRIYIl111114rmilJ�Iti��!•rr r...r.� �aeu�wEr wirlllrliliermalitommo maamplumm rlmssR MMM Ii# M ICm mummili mmossI Mm RRe Notes Site Plan submitted by: Plan Approved 2 .n Cou , R"ea Departm ALL CHANGES MUST Be APPROVED BY THE COUNTY.H1 ,ILTH DEPARTMENT DH 4015.- 14196 - (Replaces FIRS-Pi Fam 4015 vklcb may be us 'sill (Stock iduymb9r; 57 02- !401544 le STATE or DEP ONSITE S SITE EVAL APPLICANT kfit://1,e1 LOT: • • ••� ••- -•• • ••• • • • » • 0 • • .••• AL SYSTEM SYSTEM ,SPECIFICATIONS' • •••• ••••• AG: `s ► • • • •s• • • • • 00 • i•i •'ERilx% # 1• _0 • ;.• 0410. (1-7-01c69\ BLOCK: PROPERTY ID 'i == ===ar=ms= === ===== ={seas TO =COMPLETED BY.ENGI =n= PROPERTY SIZE CONFORMS TO TOTAL_RSTIMATED SEWAGE, FL :DIVISION :. • ••• [Section /TownahpX • •• • •• • •• • • •,•• • ?&I.C1al No "or 'Tax ID Numbe • •7••• •• . PROVIDEREGISTRATION-- AUTHORIZED - SEWAGE FLOW: 1 UNOBSTRUCTED'- AREA.AVAI HEALTH IT EMPLOYEE,- OR OTHER QUALM AND SIGN AND SEAL EACH PAGE OF'SUBM zs= == ===s ==mw I YES [ ] ' N0 NET USABLE GALLONS PER DAY [RESI # • NS PER DAY [ 1500'i ED PERSON. -' ENGINEER'S MUST . COMPLETE ALL ' ITEMS. AREA AVAILABLE: . /s ACRES- CES TABLE 1 / OTHER- TABLE 2) D /ACRE OR 2500 GPD /ACRE] REQUIRED: C?e? SQFT SITE PLAN: Pc r Ni BENCHMARK /REFERENCE POINT ELEVATION OF PROPOSED SYS LOCATION: 'EM SITE IS UNOBSTRUCTED Q F -Mr) tABOVE4 I THE MINIMUMS C WHICH- CAN."BE NAII HIKED FROM''THE P�` OpP��OS�ED SYSTEM TO THE FOLLOWING FEATURES: SURFACE WATER 1 FT 1 . TCHES /WALES: r' FT + IiiTORMALLY -WET ? = [ ' j YES [ t 4 N0 WELLS: 'PUBLIC: ! ".;FT LIMITED`$E:' Ok FT PRIVATE:' /�'" -FT 'NON-POTABLE: `Lj' FT BUILDING FOUNDATIONS: FT . ;PROPERTY LI-NES: FTOTABLE WATER LINES: - FT BENCBMARK/ EFE ENCE PPOIN DISO:" R SITE:'. 110 FT MSL /NGVD FLOODING? ) YES [ NO ATION: o FT MSL /NGVD PROFILE '1 RMATION' SITE '2. Munsell ,/'Color Textuxe Muria 1. t#6 1ar N5 USDA SOIL SERIES: USDA `SOIL SER OBSERVED WATER 'TABLE: 0 INCHE ESTIMATED WET SEASON'WATE TABLE HIGH WATER 'TABLE VEGETATIION: [ [ABOVE / BELOW1 EXISTING GRAD ATION: , INCHES [ 1141 140 MOTTLING: .[ ] YE SIZING: l SOIL TEXTURE /LOADING RATH FORSYST3 DRAINFIELD CONFIGURATION ) REMARK /ADDIIRTONA - CR/TYS _ -ti• _ .. TYPIG. +• CHED / =,APPARENT OVE "BELOW;> EBISTINN GRADE. [ ISO DEPTH: INCHES OF EXCAVATION: '.INCHES" CIFY] SITE EVALUATED. BY DH 4045. 10l95:(Replecsl HRS-H Petit 4045 (Stock Number: 5744-004015 -4) . 3j which. may INSTRUCTIONS: PERMIT NUMBER: ii APPLICANT: AGENT: ••• • • • ••• • • • •• .. •• • • • ■• •• . • • • • • • • • 1 • • •.. • ••• • • • • • • • • 'P°grniit eking nuariber by County Health Dee ••• • • • • • • • • • • • • • 0 • •. LOT, BLOCK, SUBDIVIS ON: -••� • • • •• PROPERTY ID ER: i •• ••• PROPERTY SIDE: cr SEWAGE FLOW: Pipe! / owner', fait game. • • • • • • • • • •011 • • -. • •t • • Frolics; owner's legally authorized rep nta 101pck,,,tagl Sp$ division for lot. •• • • • • • • • • • ••• ''•. :211 e • a iturithn for property (property appj' Check if property at site conforms to submitted ent. ve. se r ID number or section/townshipi e/parcel number) site plan. Record net usable area available ,7 tot area etpiusive of all paved areas and prepared road beds within public rights-of-way or easements and exclusive ofstrea pas, lakes, l normidly wet age ditches, marshes, or other such bodies of water. UNOBSTRUCTED AREA: Record the estimated sewage flow for the estab ishment from Table 1 (residence) or Table 2 (non -resi tial), , Chapter 1OD-6, FAC. Record the authorized seurage flow for the lot based on net usable area and wate 'supply (1500 gallons per day per acre' for private ware supplies and 2500,gpd per acre for public water supplies). If authorized sewage flow does not equal or ex the estimated sewage Cow, the application must be d f filled. Record the square feet of unobstructed area aysiilable and the. amount required'; Unobstructed must be at least 2 times as as the drainfield absorption area and at least 75 percent of the unobstructed must meek p unobstructed u must be coati ::'.ulw mini setbacks in Chapter l Ola-6, FAC. i h contiguous to the drainfield. BENCHMARK INFORMATION: Record the location of the benchmark. If using elevation of theiproposed system site in relatio. MINIMUM SETBACKS: FLOOD INFORMATION: SOIL PROFILE! INFORMATION: WATER TABLE: SOIL RE: DEPTH OF EXCAVATION: DRAINFIELD CONFIGURATION: ADDITIONAL CRITERIA: SITE EVALUATED BY: ELEVATION �'WORKSiEET BENCHMARK [ +]SHOT H.1. a surveyor's benchmark record the actual elevation. Record the (above or below) to the benchmark. Record minimum setbacks which can be meet all listed features. Actual measurements Must be recorded or. "NA" for nonapplicable features. Features on pte plan or within 75 feet oldie applicant lot must be measured.,;_ The location of any public drinking well withi 200 feet of the applicant's lot must also be verified. Record information on lot's subject to floodlit . For lots subject to flooding record 10 year flood elevtion for site and actual Site elevation. �In area to a minimum depth of 6 feet or refusal are required. Soil methodology (Munseli colon end USDA soil textures). fltsa* i1 series if available; record "UNK * if the series cannotiue Two soil profiles within the proposed absocpti identification will use USDA Soil Classiflcatic must be clearly,', documented. Provide USDA s determined. Record the depth of the observed water table a appropriate. Record the estimated wet season and historical infortation. Indicate if there is and depth. IC' the time of the evaluation. Mark "perched" or "appareiir as rater table elevation based on site evaluation, USDA soil maps, sigh water table vegetation present. Indicate if mottling is prase-at Record soil texture or loading late for system tag. If applicable record depth of excavation required. Record "NA" if not applicable. Check drainfield configuration required. Ifot$er,!specify Record any additional remarks pertinent to Si - or installation. Ex. dosing required. Signature of evaluator, title, and date of evalu ELEVATION OF BENCH /REFEREN CE FOINT IS: don. Professional engi must seal all documents submitted..- SITE 1 H.I. {' -1 SHOT -41 SITE 2 H.I. [ -1S OT SITE 3 H.I. [•1 SHOT BUILDING PERMIT APPLICATIO FBC 2004 Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 Permit Type: Plumbing Permit No. Cit 144 Ca Master Permit No. Owner's Name (Fee Simple Titleholder) 4 I Phone # Owner's 's Address t' 1)E *ST I��1� City SI. Tenant/Lessee Name Of A Phone # E -MAIL: Job Address (where the work is being done) 3Q me 4Vob City Miami Shores Village County Miami -Dade Zip FOLIO / PARCEL # State %, Zip Is Building Historically Designated YES NO Contractor's Company Name ALL 'Pj6' n 2 ) W Phone # 3/635 - Z Contractor's Address /Ion IJuu Vi ;� City Kl`k State CL Zip `3'51 Qualifier Name 11 isty X (4 Yrik Phone # State Certificate or Registration No. % b ct ¶t (231 Certificate of Competency No. E -MAIL: Architect/Engineer's Name (if applicable) Phone # Value of Work For this Permit $ 3/001:11013 Square / Linear Footage Of Work: ZOD 34'j Type of Work: ['Addition ['Alteration [New � Repair/Replace Demolition Describe Work: 1 I A It&. 6fr C+K flea() **************************************Fees**** a}' *** ********************W******.****** Submittal Fee $ Notary $ Scanning $ Bond $ 0- Permit Fee $ Training /Education Fee $ f 5•U0 CCF $ /. C CC Technology Fee $. '• O r DPBR $ Zoning $ Double Fee $ e7 vet Total Fee Now Due $ `TOE 1 1 4- b I Code Enforcement $ Structural Review. $ See Reverse side -+ 0 ` Bonding Company's Name (if applicable) Bonding Company's Address City State Mortgage Lender's Name (if applicable) Mokgage LerldeS-Address City State Zip Zip Application is hereby made to obtain a permit to do the work an installatiCns as indicated. 1 certify that no work or installation has commenced prior to the issuance of a permit and that all wOrl# 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, SIGN% 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 PROPERtV. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OP" 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 peilmit is issued. In the absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. Signature Signature Owner or Agent Contractor The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this day of , 20 , by , day of, , 20 , by 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. NOTARY PUBLIC: NOTARY PUBLIC: Sign: ign: Print: Print: My Commission Expires: My Commission Expires: II ij Plans Examiner as identification and who did take an oath. APPLICATION APPROVED BY: (Revised 02/08/06) Engineer Zoning Miami Shores Village 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 Electrica RECEIVED APR 0 4 2007 BY: it19' Permit No. Master Permit No. Mechanical Roofing Owner's Name (Fee Simple Titleholder) / Phone # Owner's Address 7. q 5 7 ty/ + State Tenant/Lessee Name Aye Job Address (where the work is being done) 735° f 991-57-- Zip % 3 Phone # City Miami Shores Village Is Building Historically Designated YES Contractor's Company Name County Miami -Dade NO A.,"' f, c Contractor's Address 7OO fa) °7 City ®VfP11 ® State Qualifier 7,efe( State Certificate or Registration N Zip 35/ Phone # 2/4.25- .. f eoz- ,'. Zip Architect/Engineer's Name (if applicable) $ Value of Work For this Permit OM? Certificate of Competency No. Type of Work: ['Addition ['Alteration ['New Describe Work: tue tip// c e Phone # Square Footage Of Work: co 50 Fr i t Repair/Replace [' Demolition 16 e 'a'e li ****************************Fees****************************** *** Fees, * * * * * ** ** ** * * ** * * * ** * * * * * *** Submittal Fee $ Permit Fee $ I15, - CCF $ 1.D CO /CC. Notary $ Training/Education Fee $ 01 60 Technology Fee $ Scanning $ a (P Radon $ Zoning Bond $ Structural Plan Review. $ Code Enforcement $ Total Fee Now Due $ 414 .3 (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 Contractor The foregoing instrument was acknowledged before me this71 The foregoing instrument was acknowledged before meetthis2 day of \i 2, by p� �'@� , day of'\1 `L1 , 2Q by gsaf tiC1 who is personally known to me or who has producedO t Q ,who is a to me or who has produced " cation and who did e i ,= th. as iden and who did take an oath. NOTARY PUBLIC- NOTARY PUBLIC. Sign: Print: My Commission Exp ******** * * * * * * * * * * * * * * * * * * * * * * * * * * * _* * ** APPLICATION APPROVED BY: chc 45!13!03 Sign: Print: My Co Bonded By National Notary Assn. fires: *************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** Plans Examiner Engineer Zoning ADDENDUM TO BUILDING PERMIT APPLICATION ;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.) PLUMB IN ELECTRICAL MECHANICAL GAS PIPU .755 PE Ws' /1--ficifp,?' Shiro 3-3/5 !TEM 3ATH TU3 UNIT FEE ITEM SWITCH CUTLETS UNIT FEE ITEM SPACE HEATERS UNIT FEE 310ET LIGHT OUTLETS CENTRAL HEATING 31SHWAS{ER RECEPTACLES A/C (WIND) DISPOSAL SERVICE TEMPORARY A/C (CENTRAL) DRINKING FOUNTAIN SERVICE SIZE IN AMPS DUCT WORK FLOOR [MAIN SERVICE REPAIR/METER (MANGE REFRIGERATION GREASE TRAP APPLIANCE OUTLETS PROCESS AND PRESS PIPING INTERCEPTOR RANGE TCP UNDERGtOU1D TANKS LAVATORY OVEN ABOVE (ROUND TANKS LAUNDRY TRAY WATER HEATER U.F. PRESSURE VESSELS CLOTHES WASHER MOTCRS 0- 1 HP STEAM BOILERS SHOWER MOTCRS OVER 1- 3 If HOT WATER BOILERS SINK, POT /3 COMP. MOTCRS OVER 3- 5 hP MTECHAN I CAL VENTILATION SINK, RESIDENCE MOTCRS OVER 5- 8 HP TRANSPORTING ASSEMBLIES SINK, SLOP MOTORS OVER 8- 10 HP ELEVATORS/ESCALATORS TEMPORARY WATER CLOSET MOTCRS OVER 10- 25 HP FIRE SPRINKLER SYSTEMS _ URINAL MOTCRS OVER 25-100 HP COOLING TOWERS WATER CLOSET MOTCRS OVER 100 HP VIOLATION INDIRECT WASTES WATER SUPPLY TO: A/C WINDOW REIFISPECT ON AIR CONDITIONERS A/C UNIT STRIP HEATER FIRE SPRINKLER GENERATORS TRANSFORMERS HEATER -NEW INST. GENERATORS-TRANSFORMERS I HEATER - REPLACE GENERATORS TRANSFORMERS LAWN SPRINKLER -WELL SPECIAL PURPOSE _ SWIMfi1ING POOL OUTLETS COMMERCIAL WATER SERVICE SIGN TUBES SEWER CONNECTIONS ,' SIGN TRANSFORMERS UTILITY -SEWER SIGN TIME CLOCK UTILITY -WATER FIXTURES SEPTIC TANK ANTENNA -t RELAY TELEVISION OUTLETS DRAINFIELD, 4" TILE/RES. VIOLATION PUMP 8 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 I METER SET (GAS) I 1____ -, GAS PIPU .755 PE Ws' /1--ficifp,?' Shiro 3-3/5