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PL-03-0007Miami Shores Village Plumbing Permit 10050 NE 2nd Avenue Phone: 305-795-2204 Permit Number: PL2003 -7 13A #-d1 /15/2003 Page 1 of It Applicant: ANNETTE WATKINS Owner: WATKINS ANNETTE JOB ADDRESS: 1421 NE 102 ST Contractor MR C'S SEPTIC TANK Local Phone: 305 - 651-7859 Parcel # 1132050240190 Contractor's Address: P O BOX 693239 Legal Description: MIAMI SHORES BAY PK ESTS AMD PB 56 -86 LOT 23 Fees: Description Amount FEE2003 -266 Building Fee $80.00 Total Fees: $386.20 FEE2003 -267 Buildier's Bond $300 .00 Total Receipts: $0.00 FEE2003 -268 CCF $1.20 FEE2003 -269 Notary Fee $5.00 Total Fees: $386.20 Permit Status: APPROVED Permit Expiration: 7/1412003 Construction Value: $2,000.00 Work: TO REPLACE SEPTIC TANK AND DRAINFIELD MR. C'S SEPTIC & DRAIN, INC. OPERATING ACCOUNT P.O. BOX 693239 305 - 651 -7859 MIAMI, FL 33269 -0239 PAY A40,4441 TO THE ORDER OF FOR ®Washington Mutual W --4nfgm-n Mutual Bank, - Ml MV Nth Street Rnanolel Center 1719 178 NW. 199th Street 1- 800-79&7000 MWMI, FL 33169 24 bw C Servlae F eC.; "t 6332 DATE 83- 8413/2870 j% 3 �jn - DOLLARS B ✓�� MP 1150000006 3 3 Diu .,I: 2670134L30: 38 30 308 4 2011° :- inspection BLK 1 bon herefor in strict compliance with all ations that may have been submitted to lr if the plans are changed without isibility for a thorough knowledge of the at he assumes responsibility for work done s pertaining thereto and in strict conformity sponisibility for all work done by either I S%SR1lR'ICiN -tTR" F#tX3P�Y 8"BOTTOM, pp.. 3*t INSTRUCTIONS: s PERMIT NUMBER: Permit tracking number assigned by CPHU. CONSTRUCTION PERMIT FOR: Check type of permit, if "Other" specify type in blank. APPLICANT: Property owner's full name. TELEPHONE: Telephone number for applicant or agent AGENT: Property owner's legally authorized representative. MAILING ADDRESS: P.O. Box or street mailing address for applicant or agent. LOT, BLOCK, SUBDIVISION or PROPERTY ID #: 27 character id number for property. (CHD may require property appraiser ID # or section /township /range/parcei number) SYSTEM DESIGN AND SPECIFICATIONS: TANK: Minimum specifications from Chapter 64E-6, FAC. DRAINFIELD: Minimum specifications from Chapter 64E-6, FAC. OTHER: Other specifications, such as operating permit requirements, low- volume flush toilets, variance provisos. SPECIFICATIONS BY: Name of individual providing specifications. If designed by a registered engineer most be sealed. APPROVED BY: County Health Department (CHD) personnel reviewing and approving permit. DATE ISSUED: Date permit is issued by CHD EXPIRATION DATE: One year from date issued if the system has not been installed. Permits for system repairs become void 90 days from the date issued. STATE OF FLORIDA DEPARTMENT OF AALTH, ONSITE SEWAGE DISPOSAL SYSTEM SITE EVALUATION AND SYSTEM SPECIFICATIONS APPLICANT: /Color Texture Depth l,�i f ? LOT: -�,l BLOCK: SUBDIVISION: PERMIT -< .J AGENT a �411 I .� _ ✓ t ✓ l -� r-� j 1- PROPERTY ID ,a / o 5 [Section /Township /Range /Parcel No. or Tax ID Number] TO BE COMPLETED BY "ENGINEERy*-zHEALTH UNIT,EMPLOYEE, OR-`OTHER QUALIFIED PERSON. ENGINEER'S MUST PROVIDE REGISTRATION NUMBER AND SIGN AND SEAL EACH PAGE OF SUBMITTAL . MPOC�LETE ALL ITEMS. PROPERTY SIZE CONFORMS TO SITE PLAN: [1✓j YES [ ] NO NET USABLE AREA AVAILABLE: 6.7,1 0 AGES TOTAL ESTIMATED SEWAGE FLOW: 7�&Tz GALLONS PER DAY [RESIDENCES -TABLE 1 / OTHER- TAULE'_2] AUTHORIZED SEWAGE FLOW: 'it <e -3 GALLONS PER DAY [1500 GPD /ACRE OR 2500 GPD /ACRE] UNOBSTRUCTED AREA AVAILABLE: at;t De"y SQFT UNOBSTRUCTED AREA REQUIRED: _ - . r, _�SQFT BENCHMARK /REFERENCE POINT LOCATION: 0.1 J�',, .rA A111004Z.- ELEVATION OF PROPOSED SYSTEM SITE IS [INCHES /FT] [ABOVE /BELOW] BENCHMARK /REFERENCE POINT THE MINIMUM SETBACK WHICH CAN BE MAINTAINED FROM THE PROPOSED SYSTEM TO THE FOLLOWING FEATURES: SURFACE WATER: 14pp FT DITCHES /SWALES: i02as> FT NORMALLY WET? [ ] YES IVI NO WELLS: PUBLIC: �`�f� /. FT LIMITED USE: LO 1A FT PRIVATE: a FT NON - POTABLE: j„t 1,k . FT BUILDING FOUNDATIONS: FT PROPERTY LINES: ' POTABLE WATER LINES: qtr' FT SITE SUBJECT TO FREQUENT FLOODING: [ ] YES (,,ENO 10 YEAR FLOODING? [ ] YES [ui- NO 10 YEAR FLOOD ELEVATION FOR SITE: FT MSL /NGVD SITE ELEVATION: FT MSL /NGVD SOIL PROFILE INFORMATION SITE 1 SOIL PROFILE INFORMATION SITE 2 Munsell # /Color Texture Depth l,�i f ? � 1'� s'r to to to to t0 to to to to USDA SOIL SERIES: It_af(L401 , -.I unsell #Icolor Texture Depth to � 3 to to to to to to USDA SOIL SERIES: ez�! A f./ ,4 D OBSERVED WATER TABLE: Nf� INCHES [ABOVE / BELOW] EXISTING GRADE. TYPE: [PERCHED / APPARENT] ESTIMATED WET SEASON WATER TABLE ELEVATION: I q INCHES [ ABOVE.% BELOW, EXISTING GRADE. HIGH WATER TABLE VEGETATION: ( ] YES 1 °/] NO MOTTLING: [' ] YES [},.t']f NO DEPTH: INCHES SOIL TEXTURE /LOADING RATE FOR SYSTEM SIZING:/' DRAINFIELD CONFIGURATION: ( ] TRENCH [(,/] BED ( ] OTHER REMARKS /ADDITIONAL CRITERIA: SITE EVALUATED BY: DH 4015, 10198 (Replaces HRS -H Form 4015 [Page 31 which may be used) (Stock Number: 5744 -003 - 4015 -1) DEPTH OF EXCAVATIONS + INCHES (SPECIFY) DATE: a >3 iage 3 of 3 Page 4 PERMIT APPLICATION OFFICE USE ONLY CHECKLIST ❑ OWNER - BUILDER FORM ❑ PROOF OF OWNERSHIP ❑ CONDO ASSOCIATION APPROVAL (Attach) (Attach) (Attach) ❑ FIRE DEPARTMENT APPROVAL (Commercial / multi- family) ❑ CONCURRENCY (New Construction) ❑ OTHER (Specify & Attach) PERMIT FEES $3.00 per page (Scanning Fee) Miami Shores Village Bond Metropolitan Dade County (C.C.F.) Inspector State Educational Fund State DCA (Radon) Code Enforcement Fine Zoning Review REVIEWED AND PREPARED BY: ❑ HRS / DERM APPROVAL (Septic / Sewer) ❑ IMPACT FEE (New Construction) ❑ OTHER (Specify & Attach) $ BY DATE Zoning Enclosure Mechanical Electrical ( sq.ft. = x/1000 Repair x ¢.60) $ (¢.005 /sq.ft.) $ (¢.01 /sq.ft.) Relocation of Structure Fire Shell Only Public Works SECTION BY DATE Zoning Enclosure Mechanical Electrical Plumbing Repair Mechanical Alteration Interior Roofing Plumbing Fence Relocation of Structure Fire Shell Only Public Works Add'1 Attachment Structural Other Building Official Other ❑ BPR APPROVAL (Restaurants) ❑ CONTRACTOR REGISTRATION (On File) TOTAL $' DATE: Revised July 2001 10050 N.E. 211D AVE., MIAMI SHORES, FL • (305) 795 -2207 • FAX (305) 756 -8972 • http : / /www.miamishoresvillage.com PERMIT APPLICATION Master Permit No. Subsidiary Permit No. INSTRUCTIONS - The following steps must be taken to obtain from Step 1. Complete the attached permit application which must be signed by the property owner and qualifier. Both signatures must be notarized. Please print or type to allow for a more accurate processing of your application. If roofing work will be done, a roofing application must be submitted along with this permit application. Step 2. Submit the completed application with all necessary documents to the Building, Planning and Zoning Department for processing. During the processing of your application, you may be asked to submit additional information. Job Address: . Folio Number Lot Address Apt. City State Block Subdivision PB Current Use of Property Proposed Use of Property Tenant Information PERMIT TYPE (✓ ) Building New Construction Electrical Enclosure Mechanical Alteration Exterior Plumbing Repair LPGX Alteration Interior Roofing Demolish Fence Relocation of Structure Other Shell Only ARCHITECT Name License No. Address Telephone Fax PROPERTY OWNER Napif Address Home Telephone Business Telephone Fax PG Description of Work L Q' et_ 414-. r 1 .1"c lellli, 3/V Zip Zoning Linear Feet Square Feet Units Floors Value of Work` °" 2 * 00 �� ' Bldg Value Tax Assessed/Appraised Value Flood Zone Base Floor Elev. PERMIT CHANGE (✓ ) Ch g. Contractor Renewal Revision Extension TYPE OF MANAGEMENT (./) New Construction Enclosure Address �_Q � � / ° �• Alteration Exterior Telephone 2 , 661 Repair Qualifier Name .3 FP/4 J Alteration Interior Demolish Relocation of Structure Shell Only Foundation Only Add'1 Attachment Other Add'I Detachment Other ENGINEER Name License No. Address Telephone Fax CONTRACTOR Name License No. Address �_Q � � / ° �• � / ,,y��` Telephone 2 , 661 Fax ,, f 7�'� �sJ! Qualifier Name .3 FP/4 J r M Page 2 PERMIT APPLICATION IMPORTANT NOTICES 1. DO NOT BEGIN ANY WORK WITHOUT HAVING RECEIVED YOUR VALIDATED PERMIT AND PERMIT CARD. Applying for a permit does not grant the right to begin construction. HOURS OF CONSTRUCTION are limited to: Monday through Friday from 7:30 a.m. to 6:00 p.m., and Saturday from 8:00 a.m. to 5:00 p.m. No inspections will be conducted on weekends or holidays. 2. All construction of demolition areas MUST BE MAINTAINED IN A CLEAN, NEAT AND SANITARY CONDITION free from construction debris. 3. STREETS AND NEIGHBORING PROPERTIES SHALL BE KEPT FREE FROM DIRT AND DEBRIS. 4. SWALES MUST BE PROTECTED FROM BEING DAMAGED BY EQUIPMENT OR VEHICLES, AND MAY NOT BE USED FOR STORAGE. A bond is required for work in or near the street/sidewalk. 5. CONSTRUCTION TRAILERS ARE PROHIBITED ON SINGLE FAMILY RESIDENTIAL CONSTRUCTION SITES. Other construction may have a trailer which requires a separate permit. 6. PORTABLE TOILETS for a construction site require a separate permit. 7. DO NOT DISCHARGE WATER INTO THE RIGHT OF WAY OR STORM DRAINS without approval from the Building, Planning and Zoning Department. 8. EQUIPMENT AND MATERIALS SHALL BE STORED at least 10 feet from the edge of pavement. 9. Department of Health and Rehabilitative Services (HRS) approval is required for applications involving septic tanks. Department of Environmental Resources Management (DERM) and/or Miami -Dade Water and Sewer Department (MDWASD) approval is required for applications involving sewers. Application is hereby made to obtain a permit to do work and installation as indicated. I, the OWNER of the property, 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 ELECTRICAL, PLUMBING, POOL, EXTERIOR DOOR, MECHANICAL, WINDOW, FENCE, DRIVEWAY, ROOFING and SIGNS and there may be additional permits required from other governmental agencies. I, the OWNER of the property, have disclosed all information related to any work at the property performed in the prior twelve months to the Building Official. Further, I am fully aware that if the cumulative cost of work to my home or business under this and any other permit equals or exceeds fifty percent (50 %) of the fair market value of the structure, the entire structure must meet the present federal flood criteria for finished floor elevation. I am also fully aware that if the total cost of work to my home or business under this and any other permit exceeds fifty percent (50 %) of the replacement cost of the structure, then the entire structure must conform to the current code requirements of the Building Code. WARNING TO OWNER: Your failure to record a NOTICE OF COMMENCEMENT may result in you paying twice for improvements to your property. If you are spending more than $2,500 or intend to obtain financing, you may wish to consult with your attorney or lender before recording your Notice of Commencement. The Notice of Commencement must be recorded at: 22 N.W. 1st Street, 1s' Floor, (305) 679 -1078. Once recorded, the Notice of Commencement must be POSTED AT THE JOB SITE in accordance with Section 713 -35 of Florida Statutes. Review the brochure at Village Hall on Construction Lien Law and Choosing contractor. FLORIDA, of Owner Print Name Sworn to and subscribed before me this day of Signature of Notary Public - State of Florida SEAL: � 1 Personally known OR, Produced Identification COUNTY OF MIAMI -DADE of Contractor/ Qualifier Print Name Swom to and subscribed before me this day» , Signature oyNotary Pubkc -'State of Florida SEAL: rn Angela M B80" � My Commission DDISM48 +dam xpires November 1S, 2009 Personally known OR, Produced Identification Type of Identification Produced: Type of Identification Produced: Page 3 PERMIT APPLICATION INSTRUCTIONS: Please indicate the type of work being performed and quantity(ies) in the space provided below. ' ELECTRICAL Minimum Fee Dryer QTY. TYPE Outlet, Appliance QTY. TYPE QTY. Service Repair A/C Central 1 -3 Ton Vent Hood, Cost Fan A/C Wall/Win. Tons Outlet, Wall Paint Booth Service, Temporary A/C Central 4 -7 Ton Ductwork, Cost of Fire Pump Periodic Inspections Outlet, Switch Barbecue Signs Process/Pressure Piping A/C Central 8 -15 Ton Fixture - Fluorescent Fireplaces, Number of Oven Space Heater (kw) A/C Central 16 -20 Ton Fixture Light Parking Lot Lights Spas/Hot Tubs A/C Central 20+ Ton Flood Lights Plugmold/Strip Subfeeds, No. of Amps A/C Window FPL - Load Central Posts Swim Pool, Commercial Air Conditioners Garbage Disposal Range/Range Top Swim Pool, Residential Chiller Generators, etc. Receptacles Switchboards Clear Violations Heat Recovery Refrigerator, Comm. (p/PH) Temp Serv., Construction Compactor Low -volt, Burglar Refrigerator, Domestic Temp for Test - 30 days Deep Freezer Low -volt, Fire Renew - Temp Service Water Closet Demolition Low -volt, Intercom/Teleph. Repair Circuits Water Heater Dishwasher Low -volt, Television Service, Number of Amps Water Heater New MECHANICAL TYPE Minimum Fee QTY. TYPE QTY. Condensate Drain TYPE QTY. Generator TYPE QTY. Refrigeration, Tons A/C Central, Tons Cooling Tower Heating Strips, each Vent Hood, Cost Drinking Fountain A/C Wall/Win. Tons Dryer Vents, Number of Paint Booth Ventilation, Cost Air Handler, Tons Ductwork, Cost of Piping, Flammable Liquid Periodic Inspections Pool Piping Barbecue Fire Sprinkler System Process/Pressure Piping Cap - Fixture Bath Fan - Vented, # Fireplaces, Number of Pressure Vessel Sprinkler System PLUMBING TYPE QTY. A/C Condensate TYPE Drains, Roof QTY. TYPE Miscellaneous Fixture QTY. TYPE QTY. Soakage Pit Bath Tub Drinking Fountain Miscellaneous Repairs Solar Water Heater Bidet Filter Replace Pool Piping Sprinkler Repair Cap - Fixture Fountain Pump and Abandon Sprinkler System Cap - Water Gas - Appliance Pump, Domestic Supply, AC Well Cap - Sewer Gas - Natural Pump, Fire Stand Temporary Toilet Catch Basin Gas - Propane Pump, Re- circulate Temporary Water Closet Clothes Washer Gas Piping Pump, Replace - Pool Urinal Dental Chair Grease Trap Pump, Sprinkler Utility - Sewer Discharge Well Ice Maker Pump, Sump Utility - Water Dishwasher Indirect Wastes Relay Repair Vacuum Pump Disposal Interceptor Roof Inlet Water Closet Domestic Well Laundry Tray Septic Connection Water Heater Drainfield, 4" Tile/Res. Lavatory Septic Tank Water Heater New Drains, Area Meter Set (Gas) Sewer Connection Water Re -pipe Drains, Floor Minimum Fee Shower Water Service Drains, French Miscellaneous Equipment Sink T Well, Supply RECEIVED AND REVIEWED BY: DATE: MIAMI SHORES VILLAGE BUILDING INSPECTION DEPARTMENT APPLICATION FOR BUILDING PERMIT Application is hereby made for the npproyal of the detailed statement or tne plans and specifications herewith submitted for the build - inq or other structure herein desciibcd. 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 ein ,speeffied or no. A copy of approved plans and specifications must be kept at building during progress of the work. Date 19 t Owner's Natne and Addrcsj: .. ......... ia. , . .............. . ... . . �� RoisteredArchitect and/or Engincer.... . : ...... .... o .. . ............ . ...................................... . ............ iv.;.Yy ....... ... Name and address of licensed controctor.A-4-InU Location and legal description of lot to be built on: Lot............. ............................... Block .................................. Subdivision ............ Street and Number where work is to be a A State work to be done and purpose of building (by floors) ....................... . ............ . .. . .................................. . . .. . ». .............»........._ ».. »... .__».» »._. »......and for no other purpose. New Building ............................. Remodeling ........................ Addition .......................... Repairs:.. . . No. of Stories ...... .. 1.11- ...... To be constructed of ......................... Kind of foundatiom ..... ..... .. ................................ ........... Roof Covering............. ........................_...... 'J;�—Op 6vp 2v. 0 e5� Estimated Total cost of improvements $.. ................ !4 ....... . . ..... . . . . ...... Amount of Permit $ .... . . .. . . ..._..._......».... ..._ » » ................ ....... Zonecubage required ...... ...................................... . ... ........ . ... ----....Plan Cubage .................... . . . . . . . ................. . ....................... - Distance-to next nearest building ........................................... ...... _..Size of Building Lot ....... . . ...... . . ..... . . . ...... . ...... . . ................ ... . .... . Maximumlive load to be borne by each floor ........................... . . .................................................... . . .. . . . ....... . ....... . ................... .................. .... I hereby submit all the plans and spectficAtions for said building, no ices . s with reference to the building and its construction may besent to.. .1e.. .... ......... ................ 7......... ............................... ............ 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, PerinAn•nt Sup dement, anti has complied vvith the provisions thereof, and will require similar compliance from all contractors or sub-contractors employed by him in the work to be performed tinder this permit; and will post or cause to be posted for inspection on the site of the work such public notice or notices as are required by the Act. The undersigned agrees to employ only such subcoitractors, on work to � formed under this permit, as are licensed by Miami Shores Village. Kr -1/10 7 4t d e4o-y_q A (Si V , t - Remarks 6-_1_T:14.6.13.: IC - gned)dA STATE OF FLORIDA, � ss. COUNTY OF DADE. Before me, the undersigned authority, a notar' public, duly authorized to administer oaths and take acknowledgments. personally 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 lie has carefully read the foregoing application, and that he did sign the "me, and that by him stated are true.. Permit Read, Sworn to and Subscribed before me. Disapproved Date.._ .. . ......... .. . . ........ .. ... Not ary Public, State of Florida (Signed) ................ -N .V ............... . ................ . .......... . .. Building Inspector My Commission Expires.._- PLANNING BOARD .. . .. .... ........ ............... . ;.-..-.-.-DATE Chairman...... .. ........ . .......... . ......... . . ...... . ..... . ... . .. . ..... Member ....... . .......... . .... . ... »_..... »__.. Member...................» ........... - -- - — ----------- ----- - ----- - - . ..... Member Member............. .......------- ».- .- ...- .. - - - - -- — ----- - -- Member ...._..».. .........,_.......... »._».._ ».. CouncilApproved ..... ...........:............. ............._..__........___ -- ..Date Disapproved ...... ........ . . . ....................................... .... ... ............ Date NO-TE: A -ch.irge of $1.00 will be made for making corrections or changes to this application after approval has been obtained froin the Plannin.- Board. A re•inspection fee of $1.00 will be charged when such re-inspection is made necessary by Improper notice for inspft-ticm or faulty materials and/or workmanship. �d MIAMI SHORES VI LLAG E BUILDING INSPECTION DEPARTMENT APPLICATION FOR BUILDING PERMIT Application is hereby made 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 Miama 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. Date_ --- - - - - -� 21� �6 - .,19 - Owner's Name and Address - - -- N-. - - Registered Architect and /or Engineer-- -__ -__ Qrj _Exte_rminat�n� Co ®Inc. 1960 N.W. 27 Ave.Miami - - - - Name and address of licensed contractor -- __ - - - - - -- --------------- - -- Location and legal description of lot to be built on: Lot_ ------ _ —_ - -- Block--- - - - - -- Subdivision—.------ ---------------------------------- Street and Number where work is to be done —_ -- State work to be done and purpose of building floors) —_ 1 2Z NEE. 102 St® Miami Shores® aatiora ®Acritet 24 hours 19 Gals. – - - - - 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 $ - -__ of Permit $ _ — -- — - Zone cubage required— _._ —__ - --------------- Distance to next nearest building -- _-- -Size of Building ---- - - - - - -- ------------------- ---- - - - --- 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 --- - - - - -- ------------- --- ------------------ - 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 59$8, Compiled General Laws of Florida, Permanent Supplement, and has complied with the provisions thereof, and will require similar compliance from all contractors or sub- contractors employed by him in the work to be performed under this permit; and will post or cause to be posted for inspection on the site of the work such public notice or notices as are required by the Act. The undersigned agrees to employ only such subcontractors, on work to be performed under this permit, as are licensed by Miami Shores Village, pp Remarks, ___ _-_____ (Signed)__ -- STATE OF FLORIDA, COUNTY OF DADE.. Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally ap- peared -- �___ .___ __ _ — .— _------------ - - - - -- - -- - __to me well known, and who, being by me first duly sworn, upon oath deposes and says that he is the __— __ -------------- __ -_ -- -_ - - -- —_ _ of the above described construction, that he has carefully read the foregoing application, and that he did sign the same, and that all facts therein by him stated are true. Permit No. —_a__$ --_ _ —_ Date-4---J-0--°(Q S Read, Sworn to and Subscribed before me. Disapproved �_— Date— _ ( Signed) Notary Public, State of Florida _ Building Inspector My Commission Expires -_ -------------------- - __ -------- —..... -- - _- -- y- PLANNING 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 Board. A re- inspection fee of $1.00 will be charged when such re- inspection is made necessary by improper notice for inspection or faulty materials and /or workmanship. I 1 11111 � Application is hereby made for the approl al of the detailed statement of the plans and specifications herewith submitted for the build- ing in compliance and conformity with the Building Ordinance of Miami State of Florida, all d of Miami Shores Village and all rules and Shores be complied with, - regulations th, whether rein specified or not. A copy of approved plans and specifications must be kept at building Burin gress of the work. a, n Owner's Name and. Addresr.�f__ n Registered Architect and/or Engineer_____ Name and address of licensed contractor Location and legal description of lot to be 071� --- - --------- Block------- - Street and Number where work is to be No/0K7.3_.!L._ State work to be done and purpose of building (by floors) - - - ------ - ---- - - -------- - ---- - ------- for no other purpose. New Building----- ------ -----•---- - - - - -_ Remodeling ----------------_------- Addition--------------- _- - - - - -- Repairs_-- - - - - -- ------ - ------- No. of Stories - - - - -- •........... ...... To be constructed of----- _--------------- - - - - -- Kind of foundation - - -- --- - - - ------------- -------------------------------- R CANering ----_----- - -- ........... ---------------• - - -- Estimated Total cost of improvements $ of Permit $ ---------- Zone cubage required --- - ---- - - - - ---------- - ---- Cubage -- - ------- - -------- — -- - -- - _---_------ ----- - - - - -- - Distance to next nearest building -------------- - - -- - ------ - ---- - - ------.Size of Building Lot-__---_ — - - --------- - ------------_-------- ........... . Maximum live load to be home by each floor-------- .____-- -_ - -._ __.w----- - - - - -- I hereby s t all the plans and sp cations for said Vding. All notices with reference " the building and its construction may C__;';_�/ --- - --- be sent 21 1 — ----------- - - ---- The undersigned applicant or - .................................... 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 5960, Compiled neral Laws of Florida, Permanent Supplement, and has complied with the provisions thereof, and will require similar compliance fro all contractors or su con ac employed by him • in the work to be performed under this permit; and will post or cause to be posted r in ection on the site of t w such public notice or notices as are required by the Act. The undersigned agrees to employ only su su ntractors, on w k t rformed under this permit, as are licensed by Miami Shores Village. Remarks_----- Man Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally ap- peared— -- - ---- — — — --------------- - ------------ -------- --- — ----- - ----_Jo me well known, and who, being by me first duly sworn, upon oath deposes and says that he is the - ---------- ------ ------------ - -----_----__-- - ------- - - - ----- ...... of the above escribed construction, that he has carefully read the therein by him stated are true. Pregoing application, and that he did sign the same, and that all facts Permit Read, Sworn to and Subscribed before me. Disapproved (Signed) __ Notary Public, State of Florida My Commission Expires- - - - - -- -------- - -------- - ------------ - ------- ____- PLANNING Chairman ------------------- - _- - --- Member ------------- _---------------- - - -_ -- Member-- - -- - -- - ------ Member - - -------- - ---- - -------- - - -- - ------ - -- - ------ - ------------ - - ---- - - ------------- - Member --------- Member Council Approved.___------ --- -- ---- -- ----- -- - - --. - 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 Board. A re-inspection fee of $1.00 will be charged when such re- inspection is made necessary by improper notice for inspection or faulty materials and/or workmanship. MIAMI SHORES VILLAGE ELECTRICAL INSPECTION DEPARTMENT APPLICATION FOR ELECTRICAL PERMIT Permit No............:....... Date...........: �. L .............................. ...... 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... !!! o...A...... J... ... .. ....... :.........N.......1.... ... / .............Street... ArIOF ... Za RegisteredArchitect and /or Engineer .......................... ............................... `........................................................................................... ............................... Employing Electrician's Name....... v.. %9. ....... � ° .. ...............No....... ` ................. Street..................... ..... Location and Legal Description Lot ....... _ ........................................................... Block .......................................... Subdivision ...... ....... ..... , .. ... Street and Number where work is to be performed— No .............. °�` State work to be performed and purpose of building (By Floors) .............................................................. ............................... New Building . ............................... Remodeling ................................ Addition .............................. Repairs ...................................... No. of Stories.................... Service Underground Size Fceders ....................Conduit _.........I ... Main Sw ............_................. Amps ........... . ........... ,...Main Fuses...... »...................Amps Type of Installation --- •Conduit ..................... Tubing............ iC ...... ..B.X.L........................ Metal Moulding ............. Amount of Permit $....... . i ..., ........................... `.................... (Signed).......... . The undersigned applicant for this building permit doeil hereby certify that he understands and accepts his obligations as an employer of labor under the Florida Workmen's Compensation Act, being Sectipn 5966, Compiled General Laws of Florida Permanent Supplement, and has complied with the provisions thereof, and will require' similar compliance from all contractors or subcontractors employed by him in the work to be performed under this permit; and will post or 'tiuse to be posted for inspection on the site of the work such public notice or notices as are required by the Act. The undersigned agrees to ear oy only such subcontractors, on work to be performs der this permit, as are licensed by Miami Shores Village. STATE OF FLORIDA, COUNTY OF DADE. as' Before me, the undersigned authority, a notary itlic, duly authorized to administer oaths and take acknowledgments, personally to me well known, and who, being by me first duly of the above described construction, and he has ca' therein by him stated are true. My Commission Expires NOTE: A re-inspection fee of $1.00 will be made materials and /or workmanship. ioath deposes and says that he is the ........................................... ............................... the foregoing application, and that he did sigh the same, and that all facts ....................... .. .............. I ............... . ..... _.............................................. Notary Public, State of Florida such re•inspection is made necessary by improper notice for inspection, or faulty SWITCH LIGHT PLUS FIXTURES REFRIG. IRON RANGE RANGE WATER W. HEAT. 8� ACB STRIP TOTAL OUTLETS OUTLETS RECE,P'T'S NO. LAMPS OUTLET OUTLET OUTLET CONN. HEATER CONN. HATER HEATER CONTR. - LIST CHECK ENT. DIST. SERVICE SERVICE MOTORS MOTORS NEON �IaT.� RADIO TOTAL ow. CAS. TEMP. PERM. « 0.1 HP 1•5 HP TRANS. - CONTR. LIST CHECK- - Service Underground Size Fceders ....................Conduit _.........I ... Main Sw ............_................. Amps ........... . ........... ,...Main Fuses...... »...................Amps Type of Installation --- •Conduit ..................... Tubing............ iC ...... ..B.X.L........................ Metal Moulding ............. Amount of Permit $....... . i ..., ........................... `.................... (Signed).......... . The undersigned applicant for this building permit doeil hereby certify that he understands and accepts his obligations as an employer of labor under the Florida Workmen's Compensation Act, being Sectipn 5966, Compiled General Laws of Florida Permanent Supplement, and has complied with the provisions thereof, and will require' similar compliance from all contractors or subcontractors employed by him in the work to be performed under this permit; and will post or 'tiuse to be posted for inspection on the site of the work such public notice or notices as are required by the Act. The undersigned agrees to ear oy only such subcontractors, on work to be performs der this permit, as are licensed by Miami Shores Village. STATE OF FLORIDA, COUNTY OF DADE. as' Before me, the undersigned authority, a notary itlic, duly authorized to administer oaths and take acknowledgments, personally to me well known, and who, being by me first duly of the above described construction, and he has ca' therein by him stated are true. My Commission Expires NOTE: A re-inspection fee of $1.00 will be made materials and /or workmanship. ioath deposes and says that he is the ........................................... ............................... the foregoing application, and that he did sigh the same, and that all facts ....................... .. .............. I ............... . ..... _.............................................. Notary Public, State of Florida such re•inspection is made necessary by improper notice for inspection, or faulty MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPUCATION R' PLUMBING P& IT Permit No.— Application is hereby made for the approval of the detailed statement of the plans and specifications herewith subuSitttted 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 Mian-A Shores Village and all rules and regulations of the Building Division of Miami Shores shall complied with, whether herein specified or not. A copy of approved plans and � specifications must be kept at of building during pr= of wor Owner's Name and Addr No. _L�L Str Registered Architect and/or Ex kg Employing Plumber's Street ✓ Location and Legal Description Lot subdivision— Street and Number where work Is to be performed—No, State work to be performed and purpose of building (By Floors)— New.BuJld1ng_____,______ Remodeling Addition..----..- Repairs__________:___ -_ -__- No. of Stories___ ...... ... . .... Sim septic Tank_-- _- _--- -_._ -_ _ of Tauk----- . ______.Capacity Cab .. . ... — ------ — -- --- --- -------- Fed of Drain Feet of Tank or Drain Field from Well-- of Water of Soakage ------- 9-009 Amount of Permit $ (Signed 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 has 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 pern-dt; and will post or cause to be posted for inspection on the site of the work such public notice or notices as are required by tlie Act. The undersigned agrees to employ only such sub - contractor e vor performed I vm" p t as are licensed by Miaml-Shores Village. ( Signed) - Master plumber. 0 lil V 31 ' •11 , - .1"'11111 V 31 ' a : 1• � a V ,III IIN1,61 4 J. - 9 - 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, deposes and - says that he is the-. _._...___.__------- _---- _ -._..- carefully y read foregoing application, and that he of the above described construction, that he has id sign the same, and that all facts therein by him stated are true. My Commission Expires Notary Public, State of Florida NOTE: A re-hopection fee of $1.00 will be made when such re-inspection is made•necessary by improper notice for Inspection, or faulty materials and/or Workmanship. CLOSETS BATH TUBS SHOWERS LAVA• TORIES SINKS SLOP SINKS LAUNDRY Tuns URINALS CATCH BASIN FLOOR MAIN DRINKING FoUNT'NS TOTAL FIXTURES CONTR. LIST CHECK SEPTIC TANK SEWER CONN. DRAIN FIELD SOAKAGE PIT GREASE' TRAP SOLAR HEATER DEEP SPRKLR, WELL SYSTEM SWIM'G POOL CONTR. LIST CHECK Sim septic Tank_-- _- _--- -_._ -_ _ of Tauk----- . ______.Capacity Cab .. . ... — ------ — -- --- --- -------- Fed of Drain Feet of Tank or Drain Field from Well-- of Water of Soakage ------- 9-009 Amount of Permit $ (Signed 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 has 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 pern-dt; and will post or cause to be posted for inspection on the site of the work such public notice or notices as are required by tlie Act. The undersigned agrees to employ only such sub - contractor e vor performed I vm" p t as are licensed by Miaml-Shores Village. ( Signed) - Master plumber. 0 lil V 31 ' •11 , - .1"'11111 V 31 ' a : 1• � a V ,III IIN1,61 4 J. - 9 - 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, deposes and - says that he is the-. _._...___.__------- _---- _ -._..- carefully y read foregoing application, and that he of the above described construction, that he has id sign the same, and that all facts therein by him stated are true. My Commission Expires Notary Public, State of Florida NOTE: A re-hopection fee of $1.00 will be made when such re-inspection is made•necessary by improper notice for Inspection, or faulty materials and/or Workmanship.