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Multiplelb Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (3051756 -8972 Inspection Date: 08/23/2006 W&J Inspector: Perez, JanPierre Owner: HUMBLES, MARK Job Address: 390103 Street NE Miami Shores Village, FL 33138- Project: <NONE> Permit Type: Imported Permit Inspection Type: Final Work Classification: Mechanical Phone Number (305)754 -0042 Parcel Number 1132060134980 Block: Lot: Contractor: KOOL ZONE AIR CONDITIONING CONTRACTOR Phone: 305 -553 -9494 Buildina Denartment Comments Tuesday, August 22, 2006 Page 2 of 2 Passed Inspector Comments Failed Correction Needed Re- Inspection Fee ($75) No Additional Inspections can be scheduled until re- inspection fee is paid . Tuesday, August 22, 2006 Page 2 of 2 VILLAGE OF MIAMI SHORES OWNER BUILDER DISCLOSURE STATEMENT NAME: �� S DATE: ADDRESS: Do hereby tition the Village of Miami. Shores to act. as my own contractor pursuant to the laws 3Z Q X P. g . Of the State pf Florida, FS 489.103(7). And I have read and understood the following disclosure statement, which entitles me to work as my own contractor; I further understand that I as the owner must appear in person to complete all applications. State Law requires construction to be done by a licensed contractor. You have applied for a permit under an exception to the law. The exemption allows you, as the owner of your property, to act as your own contractor even though you do not have a license. You must supervise the construction yourself. You may build or improve a one - family or two-family residence. You may also build or improve a commercial` building at a cost of $25,000.00 or less. The building must be for your own. use and. occupancy. It may not be Built for sale or lease: If you sell or lease a building you have built yourself within one year after the construction is complete, the law will presume that you built for sale or lease, which is a violation of this exemption. You may not hire an unlicensed person as a contractor. It is your responsibility to make sure the people employed by you have licenses required by state law and by county or municipal licensing ordinances. Any .person working on your building who is not licensed must work under your supervision and must be employed by you, which means.thatyou must deduct F.I.Q.A and with - holdings tax and provide workers' compensation for that emploype,.all,as prescribed by law. Your construction must comply with all applicable laws, ordinances, buildings codes and zoning regulations. Please read and initial each paragraph. 1. I hold title to the above property and I am planning on doing this construction Initial 2. I understand that as an owner- builder I must abide by all zoning ordinances and building regulations in effect at the time of permit application Initial kA 3: .I have an understanding of the 2004 FBC & FRC an d understand that this department and its inspectors are there to help enforce and interpret the code. There is a copy of the code in this office for review. Initial 4. I , understand that the building official and inspectors ate not there to design, alter or. advice on how to meet code —. only if the structure meets the minimum code. Initial 5. I understand that as an owner - builder, that any contractor disputes with sub - contractor& and myself must be handled in a civil court with the advice of an attorney. The department will not mitigate'any contract disputes. Initial 6. I understand that if I compensate any person or company for work performed they are required to- have a business license in the county. If for any f eason they do not posies a business license I will be responsible and liable for any wrong doing from this unlicensed company-or person. Initial 7. T understand that if any person gets injured on my construction project—they are entitled to workmen's compensation. And if they do not posses a workmen's policy I could be held liable for all doctor and related cost which could include loss of wages during recovery from injury. Initial 8: I. understand that under state and focal laws I can not do any Electrical, Plumbing, Heating, Air & Roof work on my property with out first obtaining the proper permits by licensed contractors. Initial Was acknowledged before me this day of / LW" , 20 By- 1, K" �� who was personally known to or who has Produced there License or _x- J�� � .!!!:N - OWNER Gilda Pereda Commission # DD273065 Expires: DEC. 01, 2007 ,�'' .ono, , www.AARONNoTAny.com as identification. NOTARY SrUn Nr - ,all t! ,,, ,.,,, LGLYYLL Skore-6 L AFMA T The undersigned Affiant, �����V lY��o • , does hereby attest that the (property owner) attached survey, performed by eo^a� --es W (name of surveyor's company) performed on �-` O Lk is an accurate representation of the existing conditions and (date of survey) locations of all structures on the property as of this date. The purpose of this Affidavit is to induce Miami Shores Village to issue a building permit for the property without first providing a survey less than six (6) months old. The Affiant, as property owner, further agrees to remove or obtain permits for any structures which now may exist on the property which are not permitted -or which may violate zoning or building code regulations. The Affiant further understands that the existence of any such structures may affect final inspections as applicable to this or other permits.. Further, Affiant sayeth naught. Witness(sign and print) `• ,6, 1 L.--- Affiant/Property owner Wttness(sign and print) SWORN TO AND SUBSCRIBED before me t,;er— --2 flay r%f Affiant is personally known to me, _produced Gilda Pareda -r! :Commission #00213065 ';. =Expires: DEC. 07, 2007 www,AARONNOTARY.com NOTICE OF COMMENCEMENT A RECORDED COPY MUST BE POSTED ON THE JOB SITE AT TIME OF FIRST INSPECTION PERMIT N0 `' —17? ZTAX FOLIO NO. STATE OF FLORIDA: COUNTY OF MIAMI -DADE: THE UNDERSIGNED hereby gives notice that Improvements will be made to certain real property, and in accordance with Chapter 713, Florida Statutes, the following information is provided in this Notice of Commencement. 1. Legal tw fA %A - ti 2. Description of and street/address: cam- Wl Y M . CIFN 2D306iii:� X712340 OR l3k 24681 Es 2270; (Ips) RECORDED 06130/2006 10:24:46 HARVEY RUVIN? CLERK OF COURT MIAMI -GAGE COUNTYP FLORIDA `to LAST FAME 3. Owner(s) name and address: M I O - ' r < < N t % V - % Me S 3 q 6 d V 1 1 1 O 3 SA-- - Interest in property: re5 S i de+nC c I Name and address of fee simple titleholder- 4. Contractor's name and address: ClWo— .ii - 5. Surety: (Payment bond required by owner from contractor, if any) Name and address: Amount of bond $_.___ IL 3313 7. Persons within the state provided by Section 713.13 Name and address: e of Florida designated by Owner upon whom notices or other documents may be served as 0111(a)7.. Flodda►Statutes. O Y1fi.. LoS Sl-- S. In addition to himself, Owners designates the following person(s) to receive a copy of the-Lienor's Notice as provided in Section 713.13(1)(b), Florjda,etutes. ��� Name and address: �a & _ 9. Expiration date of this Notice of Commencement: (the expiration date is 1 year from the date of recording unless a different date is specified) Signature of Owner A Print Owner's Name to and of nwiary rum d Print Notary's Name My commission expires: .� �•``i�c ".`'� GUS re 123.01 -52 PAGE 4 $!02 i ,`£�iri ,; apkW, DEC 01, 2001 r'••;;°�FS}o`� ww/w,AARONNQTABYQQ ( t Prepared by Vim- 14k 20 I_& Address: "'" Y) �, 10 3 S-f- 1&%� < <rec, ? 3. Owner(s) name and address: Interest in property: fi CS i 6e%At C— I Name and address of fee simple titleholder: 4. Contractor's name and address: 5. Surety: (Payment bond required by owner from contractor, if any) Name and address: Amount of bond `3313 provided by Section 713.1 Name and address: Florida designated by Owner upon whom notices or other documents may be served as �1 ko 8. In addition to himself, Owners designates the following person(s) to receive a copy of the-Lienor's Notice as provided in Section 713.13(1)(b), Name and 9. Expiration date of this Notice of Commencement: (the expiration date is 1 year from the date of recording unless a different date is specified) Signature of Owner j Print Owner's Name �✓ 4 1M, 6''t Sworn to anrd subscri d r e this y of I Print Notary's Name " " My commission expires: . =b``r:�':��, pp o�,,ta re o 123.01 -52 PAGE 4 SM2 • i +y Vtit�itlili�►►q� Expkes, DEC 07, 2007 %.`,�, l"j1p` wwwAABONNOTAHYAW1 STATE OF FLORIDA, COUNTY OF DADE I HEREBY CERTIFY that this is a t of the original A .n this office on. day of Ao ao WITH y hand and Official Seat. HARv uv LERK, , wds 13y ®,C. Pre ared b �! ' 0-e- V— �l Yk. U P Y 20 f?4d �V Address: U Y i ✓ S4— &ICA,M k -3--L �31$� . �n O®UIYi J \4'P CtBBK moo¢ CRi 1 Inspection Date: 01/17/2007 Inspector: Grande, Claudio Owner: HUMBLES, MARK Job Address: 390 103 Street NE Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756.5972 Miami Shores Village, FL 33138- Project: <NONE> Contractor: HOME OWNER Buildino Denartment Cemmpnts Permit Type: Driveways /Sidewalks /Slabs Inspection Type: Final Work Classification: New Block: Phone Number (305)754 -0042 Parcel Number 1132060134980 Lot: Tuesday, January 16, 2007 Page 1 of 1 JAN 18 2001 Inspector Comments Passed Failed Correction Needed Re- Inspection Fee ($75) No Additional Inspections can be scheduled until re- inspection fee is paid . Tuesday, January 16, 2007 Page 1 of 1 A Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Date: 07/1812006 JUL 1 ?S UU Inspector: Grande, Claudio Owner: HUMBLES, MARK Job Address: 390103 Street NE Miami Shores Village, FL 33138- Project: <NONE> Contractor: HOME OWNER Buildina Deoartment CnmmP_ntS Permit Type: Driveways /Sidewalks /Slabs Inspection Type: Foundation Work Classification: New Phone Number (305)754 -0042 Parcel Number 1132060134980 Block: Lot: Monday, July 17, 2006 Page 1 of 2 Inspector Comments Passed Failed Correction Needed Re- Inspection Fee ($75) No Additional Inspections can be scheduled until re- inspection fee is paid. Monday, July 17, 2006 Page 1 of 2 .... . ...... . ... . ..... . y . . ... . . . *see . • .. . .. . . . . •• • • • •. ••• •• • ••• • • • • •• • •• • • • • • ••• •• cvvr� cue - �► �r,•Mit�.c -G(�\ Miami Shores Vill go APPROVED BY DATE ZONING DEPT 6 BLDG DEPT US. SUIiJEC1'TO1 YYFM�L STATE AM t.'MPM FUM IM RMAMIM SHEET I Of REPORT OF _L BOUNDARY SURVEY ' LANDS DESCRIBED IN • .0 PLATBOOK 10 ATPAGE 70. SURVEY NUMBER.:04 -12 -030 MIANU-DADE COUNTY, FLORIDA MAIL TO: PHONE (305) 221 -3416 9245 S.W. 44h ST. • • • • :00 • • FAX (305) 553 -9903 1, MIAMI, FL 33165 • • • • • • SURVEY NOTES 1. THE SURVEY HEREON REPRESENTS A PERIMETER BOUNDARY SURVEY WITH EXISTING ABOVE GROUND IMPROVEMENTS LOCATED. NO UNDERGROUND FOOTINGS WERE LOCATED UNLESS OTHERWISE SHOWN. MAP OF BOUNDARY SURVEY FOR: ` 2. NO ENCROACHMENTS WERE NOTED BY THIS SURVEY UNLESS SHOWN. SEE THE MAP OF BOUNDARY SURVEY, LANDS DESCRIBED IN PLAT BOOK 10 AT PAGE 70 MIAMI DADE COUNTY, FLORIDA. THIS SURVEY REPORT AND MAP IS NOT VALID WITHOUT THE SIGNATURE AND ORIGINAL RAISED SEAL OF THE FLORIDA LICENSED SURVEYOR AND MAPPER. 3. ANY NOTORIOUS EVIDENCE OF OCCUPATION AND /OR USE OF THE DESCRIBED PARCEL THE SIGNATURE AND SEAL CAN BE FOUND AT THE END OF THIS REPORT. THE MAP A21I1) REPORT ARE NOT COMPLETE WTTHOI;T THE OTHER. FOR' RIGHTS-OF -WAY, INGRESS OR EGRESS IS SHOWN ON THIS SURVEY DRAWING. HOWEVER THIS SURVEY DOES NOT PURPORT TO REFLECT ANY RECORDED LEGAL DESCRIPTION: INSTRUMENTS OR RIGHTS -OF WAY OTHER THAN SHOWN ON THE RECORDED PLAT OR STATED IN THE LEGAL DESCRIPTION AS IT APPEARS ON THIS DRAWING. THIS SURVEY DOES NOT CERTIFY THAT SUCH INSTRUMENTS DO EXIST AND LANDS SHOWN HEREON LOTS 1 AND 2 BLOCK 37, SUBDIVISION " AN AMENDED PLAT OF MIAMI SHORES SECTION NO. 1 ". ACCORD TO THE WERE NOT ABSTRACTED FOR EASEMENTS AND/OR RIGHTS OF WAY OF RECORD. PLAT THEREOF AS RECORDED PLAT BOOK 10 AT PAGE 70 OF THE PUBLIC RECORDS OF MIAMI DADS COUNTY, FLORIDA. 4. THIS SURVEYOR DID NOT RESEARCH THE PARTICULAR SETBACKS AS REQUIRED BY CERTIFIED TO: THE ZONING OF THE DESCRIBED PARCEL, NOR DOES THIS SURVEY CERTIFY THAT ANY OF THE IMPROVEMENTS SHOWN ARE IN COMPLIANCE WITH THESE ZONING REGULATIONS. MARK HUMBLES 5. THE NORTH ARROW AND BEARINGS AS SHOWN ARE DERIVED FROM THE ASSUMED PROPERTY ADDRESS: MERIDIAN ON THE RECORDED PLAT, THE LEGAL DESCRIPTION THEREON IF SAID 390 N.E. N. 103RD STREET 390 DESCRIPTION IS A METES AND BOUNDS AND /OR A FRACTIONAL DESCRIPTION THE SHORES, FLORIDA 33138 BEARINGS ARE DERIVED FROM COUNTY SECTION MAPS AND THE BASE LINES ARE SHOWN ON THE LOCATION SKETCH. DATE OF FIELD SURVEY: DECEMBER 307H. 2004. 6. THE FLORIDA INSURANCE RATE MAP PANEL 0093 i DATED 7-17-95. INDEX DATE 3- 2- 94,COMMUNITY No. 120652 NATIONAL FLOOD INSURANCE PROGRAM DELINEATES THE ACCURACY: HEREIN DESCRIBED LAND TO BE WTTHIN ZONE "X" . ELEVATION NIA FEET. THE EXPECTED USE OF THE LAND: AS CLASSIFIED IN THE MIlNDC'M TECHNICAL STANDARDS .(61G17 -6 FAQ. IS "SINGLE FAMILY RESIDENTIAL ". THE M[NtMUM THIS TYPE SURVEY IN 7500 FEET. THIS IS NOT A FLOOD HAZARD ZONE. RELATIVE DISTANCE ACCURACY FOR OF IS 1 FOOT THE ACCURACY OBTAINED BY MEASUREMENT WITH A SOKKIA THEODILITE AND A 7. ELEVATIONS ARE BASED UPON NATIONAL GEODETIC VERTICAL DATUM AND BENCH SOKKIA 200 FOOT STEEL TAPE AND CALCULATION OF A CLOSED GEOMETRIC FIGURE MARKS ARE CITY, COUNTY, STATE OR GEODETIC VERTICAL REFERENCE MONUMENTS. WAS FOUND TO EXCEED THIS REQUIREMENT. 8. THIS IS A LAND SURVEY AND WAS PREPARED IN ACCORDANCE WITH FLORIDA DATA SOURCES: 55�� 5� LEGAL WAS FURNISHED BY MARK A. CAMPBELL ARCHITECTS 373 D L� STATUTE 472 AND THIS SURVEY COMPLIES WITH THE M NRvIUM TECHNICAL STANDARDS BY THE FLORIDA STATE BOARD OF PROFESSIONAL LAND SURVEYORS THE DESCRIPTION V L� N.E. 92ND STREET M[AMI SHORES, FLORIDA 33138. ADOPTED PURSUANT TO CHAPTER61G17 -6 FLORIDA ADMINISTRATIVE CODE AND MEETS THE J 2006 REQUIREMENTS OF THE FLORI)A LAND TITLE ASSOCIATION. EASEMENTS: THE RECORD PLAT DOES NOT INDICATE ANY EASEMENTS ON SUBJECT PROPERTY. R Y� Miami Shores Vill go APPROVED BY DATE ZONING DEPT 6 BLDG DEPT US. SUIiJEC1'TO1 YYFM�L STATE AM t.'MPM FUM IM RMAMIM s z RN 0 so MAIL TO: • • . . . PHONE (305) 221 -3416 . . .. . • •• . • • •• 245 S.W. 44h St. • ' FAX (305) 553 -9903 .... . .. n4ML FLORIDA 33165 ...' . I 30 -5 In w 130 Z •• • • • •• •.• . . N. � ' _l 6�4Me •' STREET — — n M h• M 5 A - ARC LENGPH BAI - BENCH MARK R - RADIUS PWRTRAN - POWER TRANSFORMER T - TANGENT qR• - WATERVALVE C - CHORD WAI -WATER DIETER - DELTA(CENTRALANGLE) 50 5202 E12 11 10 9 8 7 6 5 4 3 "2 1�°0° 50 - RIGHT WAY BNI FPL - FLORIDA POWER &LIGHT M ARK BD! - BENCH M EL - ELEVATION BASED ON 1929 NGNT1 FIND 1P -FOUND IRON PIPE FND IR - FOUND IRON ROD I.R. - CLEAR CLR ENcRO - ENCROACHMENT C L F - CHAIN LINK IK FENCE 50 L5=j DH - DRILL HOLE N/A - NOTAPPLiCABLE NlD - NAa &DISC P'0. - POINT OF CTY MON - COUNTY MONUMENT COMMENCEMENT P.O.C. -POINT OF COAIMENCEMENT KG SP - PARKING SPACE PKG CM - CONCRETE MONUMENT - FIRE HYDRANT SARI SWR- SANITARY SEWER H C PKG - HANDICAP PARKING -WATER U E - tTl'IL1TY EASEMENT X, F FENCE lVF -WOOD I�@ICE 5C 52.14 � A - ARC LENGPH BAI - BENCH MARK R - RADIUS PWRTRAN - POWER TRANSFORMER T - TANGENT qR• - WATERVALVE C - CHORD WAI -WATER DIETER - DELTA(CENTRALANGLE) P &T - POWER& TELEPHONE LINES o 13 14 15 16 17 18 19 20 21 22 23 24 -� 50 - RIGHT WAY BNI FPL - FLORIDA POWER &LIGHT M ARK BD! - BENCH M EL - ELEVATION BASED ON 1929 NGNT1 FIND 1P -FOUND IRON PIPE FND IR - FOUND IRON ROD I.R. - CLEAR CLR ENcRO - ENCROACHMENT C L F - CHAIN LINK IK FENCE 50 L5=j vI N. E. 102ND STREET LEGEND & SYMBOLS A - ARC LENGPH BAI - BENCH MARK R - RADIUS PWRTRAN - POWER TRANSFORMER T - TANGENT qR• - WATERVALVE C - CHORD WAI -WATER DIETER - DELTA(CENTRALANGLE) P &T - POWER& TELEPHONE LINES ME.0 - MEASURED MH - MANHOLE LID CALC - CALCULATED � g _ CArCH a4SBJ PCP PORh�AYER ?CONTROL CO - CLEAN-0LTCOVER PO1hT CL - CENTERLINE PRIM - N EN ?REFERENCE CBS - CONCRETE BLOCK STRUCTURE DI O M M CLP - CONCRETE LTTE POLE PC - POINNT T O OF F CURVE CONC. - CONCRETE - RIGHT WAY BNI FPL - FLORIDA POWER &LIGHT M ARK BD! - BENCH M EL - ELEVATION BASED ON 1929 NGNT1 FIND 1P -FOUND IRON PIPE FND IR - FOUND IRON ROD I.R. - CLEAR CLR ENcRO - ENCROACHMENT C L F - CHAIN LINK IK FENCE WMF - WIRE MESH FENCE TYP - TYPICAL(FOR SEVERAL) DH - DRILL HOLE N/A - NOTAPPLiCABLE NlD - NAa &DISC P'0. - POINT OF CTY MON - COUNTY MONUMENT COMMENCEMENT P.O.C. -POINT OF COAIMENCEMENT KG SP - PARKING SPACE PKG CM - CONCRETE MONUMENT - FIRE HYDRANT SARI SWR- SANITARY SEWER H C PKG - HANDICAP PARKING -WATER U E - tTl'IL1TY EASEMENT X, F FENCE lVF -WOOD I�@ICE LOCATED IN: VILLAGE OF MIAMI SHORES, MIAMI —DADE COUNTY, FLORIDA . u vl i1*44�. s LOCATION SKETCH LOT DETAILS SCALE: 1 INCH = 100 FEET SCALE: 1 INCH = 20 FEET SEETHE REPORT OF BOUNDARY SURVEY. LANDS DESCRIBED IN PLAT BOOK IU AT PAGE 70 , MIAMI -DARE COUNTY, FLORIDA. THIS SURVEY MAP IS NOT VALID WITHOUT SHEET 2 OF 2 THE SIGNATURE AND ORIGINAL RAISED SEAL OF THE FLORIDA LICENSED SURVEYOR AND MAPPER. THE SIGNATURE AND SEAL CAN BE FOUND AT THE END OF REPORT. SURVEY NUMBER•04 -12 -030 THE MAP B' REPOF'_ RE NOT COMPLETE WITHOUT THE OTHER. N.E. 103RD _ STREET�� 75' g/W .- 22' ASPHALT PAVING � �O I�a 35 Z, — (� FrTD I OFF WA 0.30 -AC 204 d 35 I w I Z C13 WALL ONLINE , h I I CLR 030 \ FND 1/2" LP. — — 4 -ate ��►3 -° I- d G ®W/M v .� SIDEWALK ' v A a _ T 15.24 !ss 76.78 F1vD I IRON ROD zr E. 2 95 2495 �p �po �O I o° cLR 1. pq 030 F.B. a A13.90 b 3.0o v � A/c SLAB ONE STORY 1&67 CBS RES #390 5. _ wooD DECK 40 rn 3.. 3' CB WALL CLR. p62 spy PATIO I 01' 102.14 L6LMA FND 1/2" I.P. 35.00 9' ASPHALT PAVING 15' ALLEY,' f O/H POWER & TELEPHONE LINES I �I w � a �r = W r7: 9 F•+ I Apo. i I I Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL 33138 -0000 Phone: (305)795 -2204 Fax: (305)756 -8972 Permit Permit Status: APPROVED Issue Date: 612912006 Expires: 12 12612006 Permit Number: DS -6 -06 -1732 Owner's Name: MARK HUMBLES one: (305)754 -0042 Permit Type: Driveways /Sidewalks /Slabs Work Classification: New Job Address: 390 103 Street NE Miami Shores Village, FL 33138- Contractor(s) Phone Primary Contractor HOME OWNER Yes Comments: Additional Information Type of Work: BRICK DRTIVEWAY Additional Info: 1700 Bond Retum : Classification: Residential me of this permit, 1 agree to 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 responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are required for ELECTRICAL, PLUMBING, MECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work. 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. Futhermore, I authorize the above -named contractor to do the work stated. Fees Due Amount Bond Type - Owners Bond $300.00 CCF $3.00 Education Surcharge $1.00 Inspection Fee $75.00 Permit Fee $100.00 Scanning Fee $6.00 Technology Fee $3.50 Total: $488.50 Building Department File Copy Applicant Signature Total: Parcel #: 1132060134980 Block: Section: Lot PB: Total Square Feet 1700 Total Valuation: $ 4,200.00 'JUN 3 0 PAID NOTICE: In addition to the requirements of this permit, there may be additional restrictions applicable to this property that may be found in the public records of this county. AND THERE MAY BE ADDITIONAL PERMITS REQUIRED FROM OTHER GOVERNMENTAL ENTITIES SUCH AS WATER MANAGEMENT DISTRICTS, STATE AGENCIES, OR FEDERAL AGENCIES. 4 r�- -a Inspection Date: 0611312006 Inspector: Devaney, Michael Owner: HUMBLES, MARK Job Address: 390103 Street NE Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Miami Shores Village, FL Project: <NONE> Contractor. HOME OWNER Buildina Department Comments Permit Type: Electrical - Residential Inspection Type: Final Work Classification: Addition /Alteration Block: Phone Number (305)754-0042 Parcel Number 1132060134980 Lot: Monday, June 12, 2006 Page 2 of 2 Passed Inspector Comments -- a6 Failed Correction Needed Re- Inspection Fee ($75) No Additional Inspections can be scheduled until re- inspection fee is paid. Monday, June 12, 2006 Page 2 of 2 Issue Date: 2/8/2006 Owner's Name: MARK HUMBLES Permit Type: Electrical - Residential Work Classification: Addition /Alteration Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL 33138 -0000 Phone: (305)795 -2204 Fax: (305)756 -8972 Permit : 02/07/2007 Parcel #: Block: Job Address: 390 103 Street NE Section: Miami Shores Village, FL Contractor(s) Phone Primary Contractor HOME OWNER Yes ommen LOW VOLTAGE WIRE FOR TV CABLE Additional Information Type of Work: Additional Info: Classification: Residential 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 responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are required for ELECTRICAL, PLUMBING, MECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work. 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. Futhermore, I authorize the above -named contractor to do the work stated. Fees Due Amount CCF $0.60 Education Surcharge $0.20 Notary Fee $5.00 Permit Fee - Additions /Alterations $100.00 Scanning Fee $3.00 Technology Fee $2.50 Total: $111.30 Building Departirr e t File Copy X A I Applicant Signature Permit Status: APPROVED Permit Number: EL -2 -06 -321 rnone: (305)754 -0042 1132060134980 Lot: PB: Total Square Feet, I Total Valuation: $ 500.00 Alteration Underground Rough WW Service Change Meter Box Fire Alarm Relocation Final Invoice Number Amt Due Amt Paid EL -2 -06 -23788 $111.30 Total: 01- NOTICE: In addition to the requirements of this permit, there may be additional restrictions applicable to this property that may be found in the public records of this county. AND THERE MAY BE ADDITIONAL PERMITS REQUIRED FROM OTHER GOVERNMENTAL ENTITIES SUCH AS WATER MANAGEMENT DISTRICTS, STATE AGENCIES, OR FEDERAL AGENCIES. Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972, Inspection Date: 06/13/2006 Inspector: Devaney, Michael Owner: HUMBLES, MARK Job Address: 390103 Street NE Miami Shores Village, FL 33138- Project: <NONE> Block: Permit Type: Imported Permit Inspection Type: Final Work Classification: Addition Phone Number (305)754 -0042 Parcel Number 1132060134980 Lot: Contractor. CARLY ELECTRICAL SERVICE Phone: 305 - 970 -6345 Buildina Denartment Comments Monday, June 12, 2006 Page 2 of 2 Passed ET_ Inspector Comments ✓ ��� �,�' Failed El Correction Needed Re- Inspection Fee ($75) No Additional Inspections can be scheduled until re- inspection fee is paid. Monday, June 12, 2006 Page 2 of 2 NOTICE OF COMMENCEMENT A RECORDED COPY MUST BE POSTED ON THE JOB SITE AT TIME OF FIRST INSPECTION PERMIT NO. STATE OF FLORIDA: COUNTY OF DADE: TAX FOLIO NO. THE UNDERSIGNED hereby gives notice that improvements will be made to certain real property, and in accordance with Chapter 713, Florida Statutes, the following information is provided in this Notice of Commencement. 1. Legal description of property and street address: _'SIR A, 46� / D,3 S4'• ln QLzku, r V 2. Description of improvement: /% aoc- 3.Owner(s) name and address: /D T .C�. !/YUn y-1j ,, '-r �/ Interest in property: 14eavoe Name and address of fee simple titleholder: 4. Contractor's name. and address: — �,i!/r s a I �z 4 r•. 5. Surety:(Payment bond required by owner from contractor, if any) Name and address: i Amount of bond 6. Lender's name and address: 7. Persons within the State of Florida designated by Owner upon whom notices or other documents may be served as provided by Section 713.13(1)(a)7., Florida Statutes, Name and address: _ o % 8. In addition to himself, Owner designates the following person(s) to receive a copy of the Lienor's Notice as provided in Section 713.13(1)(b), Florida Statutes. Name and address: _ A 9. Expiration date of !his Notice of Commencement: (the expiration date is 1 year from the date of recording unless a different date is specified) ftnawre of Owner Print Owners Name Sworn to and Notary Public Print Notary's My Commiss STATE OF FLORIDA, COUNTY OF DADE I HEREBY CERTIFY fi,o' this is a tru py of the 0 13ino iced .n "s of ce on damof A 0. 19 w rNE4 y h od rnd Q `IciaYSeat. HA,iV i }Af Circuit and County Coarrs By (� O.C. Prepared by: \,�''�`� Address ®� '014, 0 all A m .Q 123.01 -52 2193 C4 C4 I M a %0 o► a, ., L� 0 IN Lo I� Ridge ventilation? MEAN HEIGHT Appendix "E" UNIFORM ROOFING PERMIT APPLICATION PROCESS No. SLOPED SYSTEM DESCRIPTION ment: X30 lbY Insulation• I- Fastener type & spa 4- tz^ HOOF SLOPL D E T A I L" 3 'a feet: I vff/ Roof Covering: ,Q 2 i°l0c-6 lv -ro,G Fuld 1C, es q, , ATTACHMENTS REQUIRED 1) Fire Directory Listing Page 2), Dade County Product Control Notice of Acceptance -Cover Sheet 'a) Specific System Description b) Specific System Limitation c) General Limitations d) Applicable Detail Drawings 3) Municipal Permit Application 4) Other Component Approvals TILE CALCULATIONS (Pmaxl; X X (Aerodynamic Multiplier): ) - Mg: = Mr1: PCA: (Pmax2: x (Aerodynamic Multiplier): Mg: = Mr2: PCA: (Pmax3: X X (Aerodynamic Multiplier): ) M j = Mr3: PCA: Page -2 Appendix "E" UNIFORM ROOFING PERMIT APPLICATION PROCESS No. Contractor's Name: rjO Q @. 6 Job Address: 3^f D i -, /& �ST ROOFCATEGORY ❑ (Low Slope Application) ❑ (Nail -On Tile) X (Mortar- Adhesive Set Tile) (Asphalt/Fiberglass Shingles) ❑ ( Metal Roofs \Wood Shingles & Shakes) ❑ (Other) ROOF TYPE ❑ New Roof 5ZRe- roofing ❑ Recovering ❑ Repair ❑ Maintenance Flat Roof Area (ft) Sloped Roof Area (ft )� Total (ft) Master Permit No. Exposure category (per ASCE 7 -88): Building lassification category (per ASCE 7 -88 table 1): Ft. Ft. ROOF HEIGHT AND SYSTEM DETAILS (Drava details as needed) ROOF PLAN 1 I ' ' r - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - ' 1 ' I I i 1 ' t Deck type: 1� I� � � r------------------- - - - - -- I 1 1 /jam r ----------------- , i,; I � I � I, Cam' I-- ---- - -- - - -- I I 1 I ATTACHMENT Fastener Type: •' I ' 1 ' 1 ' , ' I ' , ' , ' , ' , ' I i 1 , SPACING Field: Perimeter: b Corner: L9�1 gl5er,nZ,f , - - - -- --- - - - - -- -- I I , - - - - - -------- ----- DETAIL 1 & 2 - - -- -- 1 =01-72 9M Page -1 STATE OF FLORIDA CENTRAX #: 13 -SG -19400 DEPARTMENT OF HEALTH DATE PAID: ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM FEE PAID $ CONSTRUCTION PERMIT RECEIPT OSTDSNBR 04-0369--R J CONSTRUCTION PERMIT FOR: ear em [ ]Existing System [ ]Holding Tank [ ] Innovative Other g ]Abandonment [ ]Temporary [ NA ] APPLICANT: Humbler, Mark AGENT: SR0931119, COCKING MSTEPHEN PROPERTY STREET ADDRESS: 390 NE 103 St Miami FL 33138 LOT: 1 BLOCK: 37 SUBDIVISION: Miami Shores [Section /Township /Range /Parcel No.] PROPERTY ID #: 11- 3206 - 013 -4980 [OR TAX ID NUMBER] SYSTEM MUST BE CONSTRUCTED IN ACCORDANCE WITH SPECIFICATIONS AND STANDARDS OF CHAPTER 64E -61FAC 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 [ 900 ]Gallons SEPTIC TANK A [ 0 ] Gallons N [ 0 ]GALLONS GREASE INTERCEPTOR CAPACITY K L 0 ]GALLONS DOSING TANK CAPACITY [ 0 D R A I N F I E L D MULTI- CHAMBERED /IN SERIES: [Y ] MULTI- CHAMBERED /IN SERIES: [Y ] ] GALLONS @ T 0 ] DOSES PER 24 HRS # PUMPS [ 0 ] [ 400 ]SQUARE FEET PRIMARY DRAINFIELD SYSTEM [ 0 ]SQUARE FEET SYSTEM TYPE SYSTEM: [ Y ]STANDARD [ N ]FILLED CONFIGURATION: [ N ]TRENCH [ V ]BED [ N ]MOUND [ N ] [ N ] LOCATION TO BENCHMARK: Existing Finished Floor E1 :12 60 Ft Ngvd ELEVATION OF PROPOSED SYSTEM SITE [ 2.3 ] [ FEET ] [ BELOW] BENCHMARK/ REFERENCE POINT BOTTOM OF DRAINFIELD TO BE [ 4.7 ] [ FEET ] [ BELOW] BENCHMARK /REFERENCE POINT FILL REQUIRED:[ 0.0 ]INCHES EXCAVATION REQUIRED: [ 29.0 ] INCHES OTHER REMARKS: 1- Install 900 Gallons Septic Tank cat 1 w/ an approved outlet filter 2- Install 400 square feet of drainfield in bed configuration. 3- Invert elevation of the drainfield to be no less than 8.40 ft NGVD 4- Bottom elevation of the drainfield to be no less than 7.90 ft NGVD 5 -The licenced contractor installing the system is responsible for installing the minimum tank category in accordance with chapter 64E -6.013 (3) (f) Florida Administrative Code. SPECIFICATIONS BY: Andrg, Paul TITLE: APPROVED BY: Andre, Paul TITLE: Professional Engin Dade CHD THE SEPTIC TA SHRALI g- DATE ISSUED: 2/4/04 ���� E; PI RATION DATE: 5/4/04 K OUTLET TEE DH 4016, 03/97 (Obsoletes previous editions which may not be used) (Stock Number: 5744 - 001 - 4016 -0) [ostdo- cons - 4016 -1] Page 1 of 2 A. STATE OF FLORIDA PERMIT 036q DEPARTMENT OF HEALTH DATE PAONSITE SEWTAGE TREATMENT AND DISPOSAL FEE PAI� � sysTEM cEIPT m c11 APPLICATION FOR CONSTRUCTION PERMIT APPLICATION FOR= [ New System [ 7 Existing System [ ] Bolding Tank, I ] Innovative [ ] Repair [ I Abandonment [ ) Temporary [ ) APPLICANT: JNA ' ,�, „" TELEPHONE= MAILING ADDRESS t a aoaaa :a�aars aaaas�aaae¢ asaaa�aa�aaaaaeasxa��aaeaaaQesaaaaaasass�maamaaaaa =a aoasca�ms�aaaaaasasaeoaaa TO BE COMPLET3M BY APPLICANT OR APPLICANT'S AUTHORIZ3D AGENT - SYSTEMS MUST BE CONSTRUCTED BY A PERSON LICENSED PURSUANT TO 489.105(3)(a) OR 489.552, FLORIDA. STATUTES. IT IS TSE APPLICANT'S RESPONSIBILITY TO PROVIDE DOCUMENTATION OF THE DATE THE LOT WAS CREATED OR PLATTED (MM /DD /YY) IF REQUESTING CONSIDERATION OF STATUTORY GRANDFATSER PROVISIONS. aemmsaaQm�naaasaaom�°° �aaaa° aa�e+ a�paao= aacaaaa�aascaaaaaa�°° a�aaaaaaa�aaaaaa�aaamaa= aaaaaa�a PROPERTY INFORMATION LOT= BLOCBs SUBDIVISION: Ar'" /%_ i PROPERTY ID # s f/ -7 *A/ 3 - !We - ZONING s I/M OR EQUIVALENT 3 [ Y / N I PROPERTY SIZE= 0.274 ACRES WATER SUPPLY: [ I PRIVATE PUBLIC R ) <- 2000GPD [ 192000GPD IS SEWER AVAILABLE AS PER 381.0065, FS? I Y / N I DISTANCE TO SEATER: FT PROPERTY ADDRESS: 5.9a 11e. /,O> 1 -1 DIRECTIONS TO PROPERTY: f . r / ( /J. 't;o; f y BUILDING INFORMATION Unit Type of No Establishment 1 + f x. 2 3 4 [I/I RESIDENTIAL [ I COMMERCIAL No. of Building Commercial /institutional System Design Bedrooms Area Sgft Table 1, Chapter 643 -6, FAC CIA [ ) Floor /Equipm t Drains [ I Other (Specify) SIGNATUREa ` ! �4 `� DATE S DH 4015, 10/97 (Previous Editions May Be Used) PAQR 7 or 4 REORDER FROM APEX BUSINESS FORMS STATE OF FLORIDA DEPARTMENT OF HEALTH ONSITE SEWAGE DISPOSAL SYSTEM SITE EVALUATION AND SYSTEM SPECIFICATIONS PERMIT APPLICANT i �j►e //� �� a 1r' �� /� , n AGENT s LOT: BLOOCK: 77- S�UBD�IVISION: PROPERTY ID ,>s ����� ®��• [Section /Township /Range /Parcel No. or Tax ID Number] 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: [ ] YES [ ] NO NET USABLE AREA AVAILABLE: A0 774 TOTAL ESTIMATED SEWAGE FLOW: GALLONS PER DAY [RESIDENCES -TABLE 1 / OTHER -T J AUTHORIZED SEWAGE FLOW: GALLONS PER DAY 11500 GPD /ACRE OR 2500 GPD /ACRE] UNOBSTRUCTED AREA AVAILABLE: SQFT UNOBSTRUCTED AREA REQUIRED: �f� SQFT BENCHMARK /REFERENCE POINT LOCATIONS ELEVATION OF PROPOSED SYSTEM SITE IS [INCHES FT [ABOVE / /REFERENCE POINT THE MINIMUM SETBACK WHICH CAN BE MAINTAINED FROM THE PROPOSED SYSTEM TO THE FOLLOWING FEATURES SURFACE WATER: /&" FT DITCHES /SWALES: 1� FT NORMALLY WET? [ ] YES FEATURES WELLS: PUBLIC: FT LIMITED USE: .4/A FT PRIVATE: 04 FT NON - POTABLE: FT BUILDING FOUNDATIONS: FT PROPERTY LINES: If FT POTABLE WATER LINES: FT SITE SUBJECT TO FREQUENT FLOODING: [ ] YES f /NO 10 YEAR FLOODING? [ j YES [ eO 10 YEAR FLOOD ELEVATION FOR SITE: �j FT MSL /NGVD SITE ELEVATION: ®* ? FT MSL /NGVD SOIL PROFILE INFORMATION SITE 114-0.r. 1 ~4 SOIL PROFILE INFORMATION SITE 2 Munsell I olor Texture Depth A e en. —� -*to L,� to to to to to to to USDA SOIL SERIES: unsell Solor Texture Depth le to to= to to to to to to r to USDA SOIL SERIES #M'5 �. OBSERVED WATER TABLE :ri INCHES [ABOVE / BELOW] EXISTING GRADE. TYPE: [PERCHED / APPARENT] ESTIMATED WET SEASON WA ER TABLE ELEVATIO •& "' INCHESl ABOVE / BELOW ] EXISTING GRADE. HIGH WATER TABLE VEGETATION: [ ] YES 1-f NO MOTTLING: [4 YES [ j NO DEPTH: INCHES SOIL TEXTURE /LOADING RATE FOR SYSTEM SIZING: DEPTH OF EXCAVATION: CHE DRAINFIELD CONFIGURATION: [ ] TRENCH [ )"BED j OTHER (SPECIFY) REMARKS /ADDITIONAL CRITERIA: �4T� LRfs44YH TFTi �V• �� :1$'i''IEf:Y �® i � APPLICANT: STATE OF FLORIDA DEPARTMENT OF HEALTH ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM EXISTING SYSTEM AND SYSTEM REPAIR EVALUATION CONTRACTOR / AGENT: LOT: t 4L poAilk) " r� J YA ' f PERMIT M6-e BLOCK: —17 SUBDIV :, ,K� ID #�"��' ®�7 aaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaa aaaaaaaaaa aaaaaaaaaaaaaaaaaaaaaaaaaaaaaaa aaaaaaaaaaaaaaaaaa_ TO BE COMPLETED BY FLORIDA REGISTERED ENGINEER, DEPARTMENT EMPLOYEE, SEPTIC TANK CONTRACTOR OR OTHER CERTIFIED PERSON. SIGN AND SEAL ALL SUBMITTED DOCUMENTS. COMPLETE ALL APPLICABLE ITEMS. COMPLETE TANK CERTIFICATION BELOW OR ATTACH LETTER FROM A PERMITTED SEPTAGE DISPOSAL SERVICE. aaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaa� EXISTING TANK INFORMATION [ 100 ] GALLONS SEPTIC TANK /GPD ATU LEGEND: MATERIAL: �� �I�pys ' BAFFLED: [Y / N] [ ] GALLONS SEPTIC TANK /GPD ATU LEGEND: MATERIAL: BAFFLED: [Y / N] [ ] GALLONS GREASE INTERCEPTOR LEGEND: MATERIAL: [ ] GALLONS DOSING TANK LEGEND: MATERIAL: # PUMPS:[ ] aaaaaaaaaaaaa =asaaa as aaaaaaaaaaaaaaaa aaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaa - �--- I CERTIFY THAT THE ABOVE NOTED TANK J/ HAVE THE VOLUMES [ LTE CE ] OLID LE OUT Ir SIGNATURE OF LICENSED CONTRACTOR BUSINESS NAME DA • aacaaaaa aaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaa�aaaaaaaaaaaaaaaaa== aaaaaaaaaaaaaaaaaa _aaaaaaaaaaaaaaa EXIqT3 7 IRLD INFORMATION I ] SQUARE FEET PRIMARY DRAINFIELD SYSTEM NO. OF TRENCHES [ ] DIMENSIONS: 7,0 X %� [C/ ] SQUARE FEET SYSTEM NO. OF TRENCHES [ ] DIMENSIONS: X TYPE OF SYSTEM: [.,r—STANDARD [ FILLED [ I MOUND [ ] CONFIGURATION: [ ] TRENCH BED DESIGN: I ] HEADER I ] D -BOX Imo'"] GRAVITY SYSTEM I ] DOSED SYSTEM ELEVATION OF BOTTOM OF DRAINFIELD IN RELATION TO EXISTING GRADiff INCHES [ ABOVE / BELOW] a. SYSTEM FAILURE AND REPAIR INFORMATION I < g?te ] SYSTEM INSTALLATION DATE TYPE O!,,,VWTE [,.,/] DOMESTIC [ ] COMMERCIAL , [ ?-2-3 6P,4 GPD ESTIMATED SEWAGE FLOW BASED ON [ METERED WATER [ ] TABLE 1, 64E -6, FAC SITE [ ] DRAINAGE STRUCTURES [ ] POOL [ ] PATIO / DECK [/] PARKING CONDITIONS: [ ] SLOPING PROPERTY [ ] NATURE OF [ ] HYDRAULIC OVERLOAD [ ] SOILS FAILURE: [ ] DRAINAGE / RUN OFF I ] ROOTS FAILURE SEWAGE ON GROUND [ ] TANK SYMPTOM: [ ] PLUMBING BACKUP [ ] REMARKS/ADDITIONAL CRITERIA SUBMITTED [ MAINTENANCE [/] SYSTEM DAMAGE [ ] WATER TABLE [ ] [ ] D BOX /HEADER [ ] DRAINFIELD TITLE /LICENSE DATE: J" DH 4015, 10196 (Previous Editions may be used) Page 4 of 4 FEB-03-2004 TUE 01:03 PM FAX NO. P. 01 to Erie Ea yew -Qo Favorites jUse inquill 11 111tedace WE V!W!—xj I SMaWs Reads 0 all j gu Meta; 54 INCH WATEFj fAETEP / 910513M Register- CFW / format 4.0 / coast I I Read j nVmaitn e 4 ni R i.1 . . . Read Difference R � LA dl5 )mckb i:37PM- ju!!`r F211:21W- -W2W2W2 1 -4F5*k 0E/20/2001 12:QQ4h4 08/21/2000 72:f1Q4hA..,� ................... -.21 rli.0 Fad ....... . .. Mtf JD: 73283181 My* Flog ID: 7328318298' a4 Type M4 Re *—,, ........ ............ ........ . . -Viboo; - ----- . ....... .. . ........... ..... .............. . .......784..........s.._ . ....... . .. W.... ..... . ....... . ..... ...... _.._......643 ..... .. F 1 Mtf JD: 73283181 My* Flog ID: 7328318298' a4 Type M4 Re *—,, ........ ............ ........ . . ,,,,. a .... ........... . ....... ................. ..... .............. ....... . ....... ............. .... . ........ . ......... . ..... UmUUUUUUU;..,,. i ------------- - --- ............... . ... 24. ry CL ..... . ..... . ......... Regular . .......... r .. ........ ...... . . [L 1 m .0 ..... ...... ............... ............ ...................... # tart 2Irb0V-Micfmoft0utk-k mPK-v ] -v MWO&Je Wet.. Enter 4v t 9 W a -4F*:iv d 11:57ANI W, February 03, 2004 11:57--49 AM nft,i- UU-L—. - STATE OF FLORIDA DEPARTMENT OF HEALTH APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PERMIT Permit Application Number -------------------- - - - - -- -PART II - SITEPLAN --------------------- - - - - -- Scale: Each block represents 10 feet and 1 inch = 40 feet. ■■■■■■■■■■■■■URA ■■■■ENNEMENNE001 ■■■■ ■■E■■■■ ■N■■■ ■■■■■■■■■■■■■■■N ■■■■■■■{■■■O■■■■■ ■■■■ ■■ ■I ■■■■ ■■■■■ ■■■■■■■.■■■■■■■■■ ■■■■ ■■■ {M■■■■■■■■ ■■■■■■■■■■■■■■■■ ■■■■M■■■■■■■■■■■ ■■■■ ■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■ ■■■■MMMMMMMMMMM1 ■■■■■■■■■■■■N on ■■■■■■■■N■■■■■■■ f Site Plan Plan App By Not Approved !G C. Date a County Healt Department ALL CHANGES MUST -BE APPROVED BY THE COUNTY HEALTH DEPARTMENT DH 4015,10/96 (Replaces HRS -H Form 4016 which may be used) Page 2 of 4 (Stock Number. 5744-002- 4015 -6) ELEVATION CERTIFICATE Owners Name:( MARK HUMBLES . Property Address. 390 NE 103RD STREET MIAMI SHORES, FL. 33138 1 1 LEGAL DESCRIPTION: FOLIO #: 11- 3206 - 013 -4980 Lot 1 & 2, Block 37 of "MIAMI SHORES SEC 1 AMD" according to the plat thereof as recorded in Plat Book 10 at Page 70 of the Public Records of Dade County, Florida. SURVEYOR'S NOTES: 1) Not valid without the signature and the original raised seal of a Florida Licensed Surveyor and Mapper. 2) Additions or deletions to this certificate by other than the signing party or parties are prohibited without written consent of the signing party or parties. 3) This certificate elevation is for the purpose of septic and drains repair and /or construction. 4) This certificate elevation must not be use for the purpose of acquiring flood insurance 5) Elevations are based on the National Geodetic Vertical Datum of 1929. 6) Flood Zone: XXX Base Flood Elev.: XXX as per Dade County, Florida. FEMA Panel Number: 120652 - 0093 - J - MARCH 2,1994 TOP OF BOTTOM FLOOR: TOP OF NEXT HIGHER FLOOR: ATTACHED GARAGE (at the door): GRADE @ DRAINFIELD AREA CROWN OF THE ROAD: Field Date: 1/27/04 12.6' N/A 10.9' 10.3' 10.7' 440- Pablo J. Alfonso P.S.M. Professional Surveyor & Mapper State of Florida Reg. No.5880 o-- ®Y /�. LAND S U R V E Y O R S , I N C. 6175 NW 153rd STREET, SUITE 103, MIAMI LAKES, FLORIDA 33014 Phone: 305 - 822 -6062 ** 305- 698 -9468 ** Fax: 305 - 827 -9669 Jeb Bush Govemor James J. John O. Agwunobi, M.D., M.BA M.H.A., Director "WELL FORM" t , Chapter 64E- 6.004(3)(a), F.A.C". DO Cy0 )-D3(ol lk A plan or plat of the lot of total site ownership drawn to scale, showing boundaries with dimensions, locations or residences or building swimming pools, recorded easements, the on -site sewage disposal system location, the general slope of the property and any existing or proposed wells, drainage features, filled areas, obstructed areas, and surface waters such as lakes, ponds, streams or canals. The location of wells, on -site sewage disposal systems, surface waters and other pertinent facilities of features on contiguous or adjacent property, if the features are within 75 feet of the applicant lot, must also be shown but need not be drawn to scale. The location of any public potable water system well, as defined in Chapter 64E- 6.002(40)(b), within 200 feet, and the location of limited use non - community or other public wells, as defined in Chapter 64E- 6.002(40)(b), within 100 feet of the applicant lot must also be shown, or as defined in Chapter 64E- 6.002(4)(a), F.A.C., within 75 feet from a private potable water well (well used only by four or less non - rental residences). Chapter 4616.1(p) South Florida Building Code: Wells shall be located as to be free of contamination from unsafe water supply and shall be at least 100 feet from a septic tank, drainfield, soakage pit or discharge well.... Under Chapter 64E-6, F.A.C., underdrains connected to a drainage system are considered an extension of surface water. The minimum setback for lots platted prior to January 1, 1972 is 50 feet. The minimum setback for lots plotted on or after January 1, 1972 is 75 feet. Where solid pipe is used to connect underdrains to an existing stormwater system, the setbacks would be applicable only to the underdrains, not the solid pipe. I have read the above and to the best of my knowledge I have provided the Department with full information regarding pertinent facilities and features on all adjacent properties. Furthermore, I understand that any Septic Tank Construction Permit issued on the basis of said facilities and features as provided by me and found to be incorrect will be subject to revocation in accordance with the provisions of Chapter 120, Florida Statutes. Date:�`�"� Signs Samir Elmir, M.S., P.E. , Environmental Administrator Miami Dade County Health DeparW=VEnvironm=W Health 1725 N.W. 1671 Street, Miami, Florida 33056 TEL (305) 623-3500 • FAX (305) 623-3502 Email: samir eimir@dohstate.fl.us w Website: www.daddwWdi.org Property Information Map My Home Miami -Dade County, Florida wa"Wila%wo Property Information Map 0 � 112 ft This map was created on 1/27/2004 2 :41:02 PM for reference purposes only. Web Site © 2002 Miami -Dade County. All rights reserved. M Page 1 of 1 M A. a Summary Details: Folio No.: 11-3206-013-4980 Property: 90 NE 103 ST Melling MARK HUMBLES Address: FAMILY Beds/Baths: 90 NE 103 ST MIAMI Floors: SHORES FL Living Units: 133138-2433 Prooerty Information: Primary 1000 SINGLE FAMILY Zone: RESIDENCE LUC: 0001 RESIDENTIAL- SINGLE lue: FAMILY Beds/Baths: e: rHomestead Floors: 1 Living Units: 11 �ta 489 e. $25,000 Lot Size: 12,038 SO FT Year Built: 1952 1 $101,852 MIAMI SHORES SEC 1 AMD Legal P13 10 -70 LOTS 1 & 2 BLK 37 Descri ption: LOT SIZE 102.020 X 118 OR 17362 -4285 0796 1 Sale Information: le O/R 17362 -4285 Ile Date: !1996 le Amount 1$116,600 Assessment Information: http:// gisims2. co. miami- dade.fl.uslmyhomelprintmap. asp? mapurl= http:Hgisims2.co.miami... 1/27/2004 2003 2002 : $134,723 112,18 lue: $156,982 $97,751 e: rHomestead $291,705 $209,938 alue: $126,852 123,87 $25,000 $25,000 otaI Exemptions: 1 $25,000 $25,000 axable Value: 1 $101,852 $98,8791 http:// gisims2. co. miami- dade.fl.uslmyhomelprintmap. asp? mapurl= http:Hgisims2.co.miami... 1/27/2004 Miami -Dade Department of Health- -Reciept PAYMENT DATE: PAYMENT FORM: St2ck 7018 Februa 3, 2004 r Mark AMOUNT PAID: $75.00 RELIEVED FROM: Humble , PAYING ON: 13 -SG -19400 04- 0369 -R PROPERTY LOCATION: Lot: 1 Block: 37 Miami Shores Properly ID 11- 3206 - 013 -4980 RECEIVED BY: mY9 MR. C'S SEPTIC & DRAIN, INC. OPERATING ACCOUNT P.O. BOX 693239 305- 651 -7659 MIAMI, FL 33269-0239 PAY TO THE ORDER OF C ® Wasohnington Mutual l MMjmV the t Fei ciao Canter 1719 ,� 17,5 NW. 19W sum I-WO-7W700D Warn[, L 69 a Ih= CwCwnw SeMce F0g r"- L01-1 �✓ 1130000 70 1811' 1: 26 70134 13 0: AUDIT CONTROL NO. SO40203001 q act 466) 55 - l 38 30 308 It 2011' 7018 ti 63- 8413/2670 DATE °2 " $ DOLLARS LJ Miami Shores Village Plumbing Permit 10050 NE 2nd Avenue Phone: 305 - 795 -2204 Permit Number: PL2004 -49 Printed: 2/18 /2004 Page 1 of 1 Applicant: MARK HUMBLES Owner: HUMBLES MARK JOB ADDRESS: 390 NE 103 ST Contractor MR C'S SEPTIC TANK Contractor's Address: P O BOX 693239 Local Phone: 305 - 651 -7859 Parcel # 1132060134980 Legal Description: MIAMI SHORES SEC 1 AMD PB 10 -70 LOTS 1 & 2 BLK 37 LOT SIZE 102.020 Fees: Description Amount FEE2004 -1533 Building Fee $175.00 Total Fees: $766.15 FEE2004 -1534 Building Fee $175.00 FEE2004 -1535 CCF $1.80 Total Receipts: $766.15 FEE2004 -1536 Notary Fee $5.00 FEE2004 -1537 Training and Education Fee $0.60 FEE2004 -1538 Technology Fee $8,75 FEE2004 -1539 Code Enforcement Fine $100.00 FEE2004 -1540 Builders Bond $300.00 Total Fees: $766.15 Permit Status: APPROVED Permit Expiration: 8/11/2004 Construction Value: $2,200.00 Work: REPLACE DRAINFIELD Signed: (INSPECTOR) 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: ACCEPTANCE NO.: 90708.04_ APPROVED SEC 0 5 1995 EXPIRES . EC 0 5 1999 NOTICE OF ACC IRAN ,,E• STANDARD CONDITIONS 1. Renewal of this Acceptance (approval) shall be considered after a renewal application has been filed and the original submitted documents, including test supporting data, engineering documents, are no older than eight (8) years. 2. Any antfall- tpproved7oducts•shall •bepermanently labeled with -the manufacturer's name, city, state, and the following statement: "Dade County Product Control Approval', or as specifically stated in the specific conditions of this Acceptance. 3. Renewals of Acceptance will not be considered if a) There has been a change in the South Florida Building Code affecting the evaluation of this product and the product is not in compliance with the code changes; b) The product is no longer the same product (identica) as the one originally approved; c) If the Acceptance holder has not complied with all the requirements of this acceptance, including cite correct installation of the product; d) The engineer who originally prepared, signed and sealed the required documentation initially submitted, is no longer practiciog•the engineering profession. 4. Any revision or change in the materials, use, and/or manufacture of the product or process shall automatically be cause for termination of this Acceptance, unless prior written approval has been requested (through the flung of a revision application with appropriate fee) and granted by this office. 5. Any of the following shall also be grounds for removal of this Acceptance: a) Unsatisfactory performance of this product or process: b) Misuse of this Acceptance as an endorsement of any product, for sales, advertising or any other purposes. 6. The Notice of Acceptance number preceded by the words Dade County, Florida, and followed by the expiration date may be displayed in advertising literature. If any portion of the Notice of Acceptance is displayed, then it shall be done in its entirety. 7. A copy of this Acceptance as well as approved drawings and other documents, where it applies, shall be provided to the user by the manufacturer or its distributors and shall be available for inspection at the job site at all time. The copies need not be resealed by the engineer. S. Failure to comply with any section of this Acceptance shall be cause for termination and removal of Acceptance. 9. This Acceptance contains pages 1, 2,2(a) through 2(d) and this last page 3. Items 10. 11 & 12 listed below only apply to glazed products and doors 10. Unless specifically indicated in the Acceptance (approval), this unit is approved as a single unit installation. For multiple installation of this unit, a separate Acceptance for mullions is required from the Product Control Section. H. The spacing of fasteners at winnow sills shaft be as indicated in Section 4 of this Notice of Acceptance. The spacing of fasteners in all other parts of the frame, shall be as indicated in Section 4 of this Notice of Acceptance. but in no case shall exceed 24" on center. The first fastener shall be located at a maximum of 6" Rom each corner and mullion or stile. Fastener shall fully penetrate the buck, which shall be the same size as the one tested withAeuniL No wood or plastic shields or pins shall be used for anchoring. 12. Hardware foir all windows and doors shall conform to Security and Forced Entry Preveti ' 36 of the South Florida Building Code. P.E. - Plans Examiner 11 Product Control Division END OF THIS ACCEPTANCE -3- (1� jkr EMERALD MASONRY SP c is u s r IN C M ro ff Ma s o M r -y INCENSED/ INSURED CC #NBSOOM 0 4 .6 � s ILA 390 NE 103 Street, Miami Shores, FL 33158 305/238 - 80041751 -7863 SKETCH OF BOUNDARY SURVEY SCA. E: 174 f7� i � 20 �- yP�.��r pLl1/EI�•IEdi T .. . o - 2/ PA 1z K m r r Z ► v � �.�—. �. �IUEU�ISLK -" • 1 P� Z..� Zt' , � art, . z P "� s ©° = `4 ° 7 6 1� °Jo Z d 4 Z c�..6►�a 1, P.C��CS N N •i F 1 P o to •'� ,I M _o O LWE-7 Z ISO = : _ �Q LAZE ' o treys M ` Cgs �- F-5. me �o r :.. o Z O Z d P b t y GTjP! orb �0� 'go o;.,NE D.10 v r 4e, CL . 1ST 4LLEy_ �— /'9 'A fdt- T 1 C ZoNE Cobh. I Fv= X /Zo65 Z I 935 REVISIONS: 4 . 4 N SUFFIX METRO-DADE METROPOLITAN DADE COUNTY, FLORIDA - METRO -DADE FLAGLER BUILDING BUILDING CODE COMPLIANCE OFFIcE` SUITE 1603 METRO -DADE FLAGLER BUILDING 140 WEST FLAGLER STREET MIAMI, FLORIDA 33130.1563 PRODUCT CONTROL NOTICE OF ACCEPTANCE (W!� 375 -2901 FAX (305) 375 -2908 Pella Corporation 102 Main Street Pella, IA 50219 PRODUCT CONTROL SECTION (305) 375 -2902 FAX (305) 372.8339 Your application for Product Approval of: Aluminum Clad Wood Outswing CasemendFixed Window under Chapter 8 of the Metropolitan Dade County Code governing the use of Alternate Materials and Types of Construction, and completely described in the plans, specifications and calculations as submitted, by: Applicant, For listing see Section 8 of this Notice ofAcceptance. has been recommended for acceptance by the Building Code Compliance office to be used in Dade County, Florida under the specific conditions set forth on pages 2 et. seq. and the Standard Conditions on page 3. This approval shall not be valid after the expiration date stated below. The Office of Code Compliance reserves the right to secure this product or material at anytime from a jobsite or manufacturer's plant for quality control testing. If this product or material fails to perform in the approved manner, the Code Compliance Office may revoke, modify, or suspend the use of such product or material immediately. The applicant shall re- evaluate this product or material should any ammendments to the South Florida Building Code be enacted affecting this product or material. The Building Code Compliance Office reserves the the right to revoke this approval, if it is determined by the Building Code Compliance Office that this product or material fails to meet the requirements of the South Florida Building Code. The expense of such testing will be incurred by the manufacturer. Acceptance No.: 95-0914.06 Expires: 0 1/04/99 guez Product Control Supervisor THIS IS THE COVERSHEET, SEE ADDITIONAL PAGES FOR SPECIFIC AND GENERAL CONDITIONS BUILDING CODE COMMITTEE This application for Product Approval has been reviewed by the Metropolitan Dade County Building Code Compliance Department and approved by the Building Code Committee to be used in Dade County, Florida under the conditions set forth above. Unanes anger, . Director Building Code Compliance Dept. Approved: 01/04/96 -1- Metropolitan Dade County Pella Corporation ACCEPTANCE No.: 95- 0914.06 APPROVED : JAN 0 4 1996 . EXPIRES : JAN 0 4 1999 1. DESCRIPTION OF UNIT 1.1 This approves a wood outswing casement/fixed window designed to comply with the South Florida Building Code, 1994 Edition for Dade County, for the locations where the pressure requirements, as determined by ASCE 7 -88 "Minimum Design Loads for Building and Other Structures ", do not exceed the Design Pressure Rating values in Section 7 and within the limitations contained in Section 3. 1.2 Model Designation Aluminum Clad Wood Out - Swinging Casement/Fixed Window 13 Overall Size: 4' 10" wide by 6' 1" high by 5 114" deep 1.4 Configuration: OX 1.5 No. & Size of Panels: Both operable and fixed vent measure T 3" wide by 5' 11" high. 2. MATERIAL CHARACTERISTICS 2.1 Frame & Panel Material: Wood 2.2 Glazing: Three glazing options described as follows: 2.2.1 Designer Classic: Glazing Material: The panel uses a nominal 518" insulating glass unit fabricated from two nominal 1/8" tempered sheets and a desiccant -filled spacer system. . Glazing Method: Groove - glazed againgt a continuous back - bedding of butyl rubber. 2.2.2 Smart -Sash II Glazing Material: The panel utilizes a nominal 1/8" tempered glass with an independently glazed removable panel on the interior, also containing a nominal 1/8" tempered lite, with a resulting air space of 1- 5116 ". This air space is vented to the exterior through four breather holes located on the stiles, l -1/2" below the top rail and 1 -1/2" above the bottom rail. Glazing Method: The exterior prime lite is stop - glazed against a continuous bead of silicone. Eight PVC glazing locaters, two on each panel member, are used to secure the glazing. Each locater is locked under the pine glass stop and secured with silicone and wrapped around the exterior surface of the glazing. The removable panel is groove - glazed into a roll- formed aluminum frame against a continuous bead of polyurethane. Each comer of the aluminum frame is secured with a stamped galvanized steel comer lock and sealed with silicone. An extruded vinyl bulb gasket is used on the exterior surface of the aluminum frame. Each removable panel is installed into the door panel with fourteen stamped aluminum cam -type clips which are locked into slots into the wood panel kerf, five on each vertical member and two on each horizontal member. 2.23 Smart -Sash III Glazing Material: The panel utilizes a nominal 518" insulating glass fabricated from two nominal 1/8" tempered sheets and a dessicant -filled spacer system, an independently glazed removable panel containing a nominal 1/8" tempered sheet is used on the interior with a resulting air space of 13/16 ". This air space is vented to the exterior through four breather holes located on the stiles, 1-1/2" below the top rail and 1 -1/2" above the bottom rail. V4 9_1q.A Ma uel Perez, P.E. P Examiner II Product Control Division -2- 0 ACCEPTANCE No.: 95- 0914.06 y APPROVED EXPIRES JAN 0 4 1996 JAN 0 4 1999 Glazing Method: The exterior prime I.G. is stop - glazed against a continuous bead of silicone. Eight PVC glazing locaters, two on each panel member, are used to secure the glazing. Each locater is locked under the pine glass stop and secured with silicone and wrapped around the exterior surface of the glazing. The removable panel is groove - glazed into a roll- formed aluminum frame against a continuous bead of polyurethane. Each corner of the aluminum frame is secured with a stamped galvanized steel corner lock and sealed with silicone. An extruded vinyl bulb gasket is used on the exterior surface of the aluminum frame. Each removable panel is installed into the door panel with fourteen stamped aluminum cam -type clips which are locked into slots into the wood panel kerf, five on each vertical member and two on each horizontal member. 2.2.4. Daylight Opening: Single lite 18.781" wide x 58.75" high. 2.3 Frame Construction: 2.3.1 Type: The frame jambs and head are of 5 1/4" wide by 1" thick molded pine wood sections. 2.3.2 Material: Wood 2.3.3 Construction: The ends of jambs are coped and butted against the head and sill. Each head-to-jamb corners are attached with two #8 x 3" long FHWS sealed with silicone. Each sill-to-jamb corner is attached with three #8 x 3" long FHWS, two thru the aluminum threshold into the jamb and one thru the oak sill into the jamb and sealed with butyl rubber and polyurethane adhesive sealant. Extruded aluminum cladding is locked over the exterior of the heads and jambs, with each cladding corner mitered and fastened with a nylon comer lock w /two #8 x 17/32" long SMS, sealed with butyl rubber. Each cladding piece is secured to the wood frame member with a continuous bead of polyurethane adhesive sealant. 23.4 Door stop: A finger jointed clear pine headramb stop .594" face x 1.125" deep is located interior of the door panel. Each stop is secured to each jamb and head with eight per jamb, four at head, 4d x 1 -1/2" long nails spaced at 4" from corners with the rest equally spaced. Each stop is also sealed with a continuous bead of silicone. 2.3.5 Threshold: The sill assembly consists of a composite wood and aluminum 5.788" wide x 1 3/4" high bumper threshold. Consisting of a 11/2" wide x 1" high finger jointed pine base (primary) portion kerfed to accept the aluminum portion and weatherstrip; and a 1 -5/8" wide x 1" high red oak top bumper (secondary) portion kerfed to accept the bulb weatherstrip, applied to the primary threshold with a continuous bead of polyurethane adhesive sealant and secured with four #6 x 1" long FHWS located at 1" from each end and the other two equally spaced between. The 4.656" wide x.6875" high extruded aluminum portion threshold is sealed to the base portion with polyurethane adhesive sealant. This composite threshold, extending the whole width of the window, is attached to the floor slab as specified in Section 4.1.1.3 below. -2a- Manu Perez, P.E. Pla a iner II Product Control Division Pella Corporation ACCEPTANCE No.: 95 -0914.06 APPROVED : JAN 0 4 1996 EXPIRES : JAN 0 4 1999 2.3.4 Mullion: None 2.3.5 Reinforcements: None 2.3.6 Finish: Interior wood is varnished. Exterior cladding is painted white. Threshold is. covered with two coats of lacquer. 2.4 Panel Construction: 2.4.1 Door thickness: The panel or vent is 1.844" thick. 2.4.2 Face sheets: NIA 2.43 Core Design: N/A 2.4.4 Construction: Stile and Rail wood construction. Stiles: 2 -1/8" face x 1.844" thick; Top rails: 4-3/8" min. face x 1.844" thick. Bottom rails: 8 -1/2" min. face x 1.844" thick. Stiles and Rails are of molded pine panel construction. _ Cladding: Roll- formed aluminum cladding .0235" thick is locked over the exterior, and sealed to the panel members with a continuous bead of silicone. Comer construction: The end of each rail is coped and butted against each stile. Each top corner is fastened with two #10 x 3" long FHWS. Each Bottom comer is fastened with three 10 x 3" long FHWS. All comers are sealed with silicone and glued together with urethane adhesive. 149, ps.�Ere=, Manue rez, P.E. Plans@xaminer II Product Control Division -2b- Pella Corporation ACCEPTANCE No.: 95 -0914.06 APPROVED : JAN 0 4 1996 w EXPIRES JAN 0 4 19 9 9 NOTICE OF ACCEPTANCE: SPECIFIC CONDITIONS 2.5 Hardware: 2.5.1 Four (two Per vent) 2.5.2 One 2.5.3 Ten Champagne vinyl bulb gasket Pair 2.5.4 One 2.5.5 Four Black Santoprene bulb gasket (Two • per vent) 2.5.6 Two 0 Description 41/2" x 41/2" x.130" brass hinge assemblies, attached to jamb with three #12 x 3/4" FHWS plus one #12 x 2 -1/2" long FHWS thru jamb; and attached to door with four # 12 x 1 -1/4" long FHWS. Two -point lock assembly with removable handle, attached with fourteen #6 x 2" long FHWS Wind -load brace clip with threaded wind -load brace pins Roto operator Lock strike Steel attachment link 2.5.7 Two Metal threaded attaching pin • Q y, Description 2.6.1 1 row Gray dual durometer vinyl bulb 2.6.2 1 row Champagne vinyl bulb gasket 2.6.3 1 row Black dual durometer PVC leaf 2.6.4 1 row Black Santoprene bulb gasket -2c- Location Head and sill of hinge stile At lock jamb with locks located 16" from each end. Hinge jamb, 6" and 34" from each end and midspan Center of sill. Lock stile of vent located 16" from each end. Lock stile of fixed vent located 16" from each end One through each steel attachment link into the frame jamb of fixed vent. Location Frame perimeter with comers mitered and welded and sealed to the frame with butyl sealant. Perimeter of removable glazing panel Perimeter of vents Fixed vent frame perimeter, bulb is sealed to the frame with butyl sealant and the corners are butted and also sealed with butyl. Maitukftrez, P.E. Pl#xaminer II Product Control Division 0 0 Pe la oMoration ACCEPTANCE No.: 95- 0914.06 APPROVED ; JAN 0 4 1996 EXPIRES ; JAN 0 4 1999 NOTICE OF ACCEPTANCE: SPECIFIC CONDITIONS 2.7 ealant: The fiame intersections, ends of the threshold and all weatherstrip intersections must be sealed with silicone sealant during assembly. 3. LIMITATIONS: 3.1 This approval applies to single window unit, applications only, as shown in Section 10. 3.2 Units with dimensions equal to or smaller than those shown in Section 1.3 shall qualify under this approval. 3.3 Installation is limited by the Design Pressure Rating shown in Section 7 of this approval. 4. INSTALLATION: 4.1 Screws and Method of Attachment 4.1.1 Directly Anchored to Wall 4.1.1.1 Head: #8 x 3" CP FHWS at 4" from corners and max. 12" o.c. #10 x 2 1/2" CP FHWS, two (2) thru lock strike plate. (over active 10 1) #8 x 2" CP FHWS two (2) thru exterior bolt strike plate. (over inactive leaf) 4.1.1.2 Jambs: #8 x 3" CP FHWS at 4" from comers and max. 12" o.c. #9 x 21/2" CP FHWS, one (1) through each hinge. 4.1.1.3 Sill: Three #10 x 3 1/2" CP FHWS, one at 6" from each end and one at midspan. 4.1.2 Anchored using stamped galvanized steel clips: 17/8" wide x 8 1/8" long x.0516" thick 4.1.2.1 Head: One clip located at 6" from each comer with the rest at 18" o.c. Each clip is attached to the wood frame member with four #6 x 1" CP FHWS and then attached to the wood buck with four #6 x 2" CP FHWS. 4.1.2.2 Jambs: Same as the head. 4.1.23 Sill: Three #10 x 3 1/2" CP FHWS, one at 6" from each end and one at midspan. 4.1.3 Anchoring of Fixed Panel: Each screw passes through PVC shims located between the door panel and the frame members. A continuous bead of polyurethane sealant seals the fixed panel to the head and jambs. 4.13.1 Head: Not fastened to the top rail. Two PVC shims are located between the frame head and the fixed panel top rail. 4.1.3.2 Jambs: Four #10 x 3 1/4" CP FHWS, thru the jambs into the fixed panel stiles, at 8 -3/8 ", 34 ", 59 -9/16" and 85 -3/16" from top of the jamb. 4.133 Sill: Three #8 x 3" CP FHWS, thru the sill into the fixed panel bottom rail, one at 3 -1/2" from each end and one at midspan. 4.2 Attachments of sub -bucks shall be designed by the Architect or Engineer of Records and must be in compliance with the South Florida. Building Code. 43 Fasteners must have their own Notice of Acceptance and must be made of stainless steel or have adequate protection against corrosion, per DIN 50018. Aluminum contacting metals not considered compatible shall be properly protected -2d- Manu Perez, P.E. P140 Examiner II Product Control Division i Pella Corporation ACCEPTANCE No.: -95-0914.06 APPROVED JAN 0 4 1996 EXPIRES JAN 0 4 1999 S. IDENTIFICATION 5.1 Each window system shall bear a permanent label with the manufacturer's name or logo, city, state and following statement: "Dade County Product Control Approved ". It shall be located in a visible place inside the frame jamb. 6. USE 6.1 Application for building permit shall be accompanied by two copies of the following: 6.1.1 This Notice of Acceptance 6.1.2 Completely dimensioned drawing showing size and location, including height above grade of opening to receive window, mean roof height, length and width of building. 6.1.3 Manufacturer's installation instructions. 6.2 A copy of this approval as well as the manufacturer's installation instructions shall be provided to the permit applicant by the manufacturer or his distributors and shall be available for inspections at the jobsite at all time. • 63 The Building Official shall ensure the adequacy of window to meet the pressure requirement of the opening in which it is to be installed. 6.4 The installation of this unit will require a hurricane protective system. • Manu Perez, P.E. Examiner II n 6 .• .7 Pella Corporation ACCEPTANCE No.: _95-0914.06 APPROVED : JAN 0 4 1996 EXPIRES : JAN 0 4 i a a a 7. TEST PERFORMED TEST TEST LOAD DESIGN LOAD IR INFILTRATION @ 1.57 PSF 0.01 CFM/Fe FBC PA 202 -94 (<0.37 CFMtFT) - ATI- 16032 -N IR INFILTRATION @ 624 PSF 0.01 CFWFN FBC PA 202 -94 (<037 CFWFT) ATI - 16032 -N IFORM STATIC AIR PRESSURE @Design Load +67.0 PSF =67.0 PSF FBC PA 202 -94 POSITIVE ATI - 16032 -N ATI- 16032 -N UNIFORM STATIC AIR PRESSURE @Design Load -52.0 PSF -52.0 PSF FBC PA 202 -94 NEGATIVE ATI- 16032 -N ATI - 16032 -N WATER RESISTANCE (PSF) 10.05 PSF +67.0 PSF FBC PA 202 -94 ATI- 16032 -N ATI - 16032 -N IFORM STATIC AIR PRESSURE @Full Test Load +100.5 PSF -67.0 PSF FBC PA 202 -94 POSITIVE ATI - 16032 -N ATI -16032 N UNIFORM STATIC AIR PRESSURE @Full Test Load -78.0 PSF -52.0 PSF FBC PA 202 -94 NEGATIVE ATI- 16032 -N ATI- 16032 -N FORCED -ENTRY RESISTANCE (FER) SATISFACTORY FBC Section 3603.02 and SFBC PA 202 -94 ATI - 16032 -N Design Pressure Rating (Positive) +67.0 PSF Design Pressure Rating (Negative) -32.0 PSF 8. EVIDENCE SUBMITTED 8.1 Tests: 8.1.1 Test reports on 1) Air Infiltration Test, per PA 202 -94 2) Uniform Static Air Pressure Test, Loading per PA 202 -94 _ 3) Water Resistance Test, per PA 202 -94 4) Forced Entry Test, per SFBC 3603.2 (b) and PA 202 -94. along with installation diagram of a out-swinging casement/fixed window prepared by Fenestration Testing Laboratory, Inc. No. ATI - 16032 -N dated August 16, 1995, signed and sealed by Allen N. Reeves, P.E. 8.2 D.rwwing: 8.2.1 Manufacturer's parts and section drawings. -2f- Manu erez, P.E. P Examiner II Product Control Division Pella Cotpor2tion ACCEPTANCE No.: 22-0 14.06 APPROVED a# 6 4 1996 '� SIRES dAN 0 4 1999 N =F. OF ACCEPTANCE: SPECIFCC CbNDrEMS 9. COMPARATIVE ANALYSIS: Not part of this appovaL Needs to be submitted under a separate application for review and appmvaL 10. TYPICAL ELEVATION: li�\ ACCEPTANCE NO.: 9"91406 APPROVED : JAN 0 4 1996 0 EXPIRES : JAN 0 4 1H9 1. Renewal of this Acceptance (approval) shall be considered after a renewal application has been filed and the original submitted documentation, including test supporting data, engineering documents, are no older than eight (8) years. 2. Any and all approved products shall be permanently labeled with the manufacturer's name, city, state, and the following statement•. "Dade County Product Control Approved ", or as specifically stated in the specific conditions of this Acceptance. 3. Renewals of Acceptance will not be considered if. a) There has been a change in the South Florida Building Code affecting the evaluation of this product and the product is not in compliance with the code changes; b) The product is no longer the same product (identical) as the one originally approved; c) If the Acceptance holder has not complied with all the requirements of this acceptance, including the correct installation of the product; d) The engineer who originally prepared, signed and sealed the required documentation initially submitted, is no longer practicing the engineering profession. 4. Any revision or change in the materials, use, and/or manufacture of the product or process shall automatically be cause for termination of this Acceptance, unless prior written approval has been requested (through the filing of a revision application with appropriate fee) and granted by this office. 5. Any of the following shall also be grounds for removal of this Acceptance: a) Unsatisfactory performance of this product or process; b) Misuse of this Acceptance as an endorsement of any product, for sales, advertising or any other purposes. 6. The Notice of Acceptance number preceded by the words Dade County, Florida, and followed by the expiration date may be displayed in advertising literature. If any portion of the Notice of Acceptance is displayed, then it shall be done in its entirety. - 7. A copy of this Acceptance as well as approved drawings and other documents, where it applies, shall be provided to the user by the manufacturer or its distributors and shall be available for inspection at the job site at all times. The copies need not be resealed by the engineer. 8. Failure to comply with any section of this Acceptance shall be cause for termination and removal of Acceptance. • 9. This Acceptance contains pages 1, 2,2(a) through 2(g) and this last page 3. Items 10,11 & 12 listed below only alln y t0 glazed products 10. Unless specifically indicated in the Acceptance (approval), this unit is approved as a single unit installation. For multiple installation of this unit, a separate Acceptance for mullions is required from the Product Control Section. 11. The spacing of fasteners at window sills shall be as tested. The spacing of fasteners in all other parts of the frame, shall be as tested, but in no case shall exceed 24" on center. The first fastener shall be located at a maximum of 6" from each corner and mullion or stile. Fastener shall fully penetrate the buck, which shall be the same size as the one tested with the unit. No wood or plastic shields or pins shall be used for anchoring. See section four (4) of this approval for sizes of fasteners used in testing. 12. Hardware for all windows and doors shall conform to Security and Forced Entry Prevention, Chapter 36 of the South Florida Building Code. Ajev'f I" Manu erez, P.E.PIans finer II Product Control Division END OF THIS ACCEPTANCE ;_ -3- METRO-CADe METROPOLITAN DADE COUNTY, FLORIDA METRO -DADE FLAGLER BUILDING BUILDING CODE' COMPLIANCE OFFICE SUITE 1603 METRO DADE FLAGLER BUILDING 14o WEST FLAGLEA STREET PRODUCT CONTROL NOTICE OF ACCEPTANCE MIAMI, FLORIDA 33130 -1563 (305) 375 -2901 ClearshWd Manufacturing FAX (305) 375 -2906 INTERNEM md=01 ®shadow net 4900 Dyer Boulevard - . Riviera Beach FL 33407' PRODUCT CONTROL SECTION (305) 375 -2902 • FAX (305) 372 -6339 Your application for Product Approval of: Polycarbonate Clear and Polycarbonate Recycled Black Storm Panel Shutters under Chapter 8 of the Metropolitan Dade County Code governing the use of Alternate Materials and Types of Construction, and completely described in the plans, specifications and calculations as submitted by: Applicant, along with Drawing No. 96 -132, Sheets 1 thru 3 of 3. (For listing, see Section 8 of this Notice ofAcceptance) has been recommended for acceptance by the Building Code Compliance office to be used in Dade County, Florida under the specific conditions set forth on pages 2 et seq. and the Standard Conditions on page 3. This approval shall not be valid after the expiration date stated below. The Office of Code Compliance reserves the right to secure this product or material at anytime from ajobsite or manufacturer`s plant for quality control testing. If this product or material fails to perform in the approved manner, the Code Compliance Office may revoke, modify, or suspend the use of such product or material immediately. The applicant shall re- evaluate this product or material should any ammendments to the South Florida Building Code be enacted affecting this product or material. The Building Code Compliance Office reserves the the right to revoke this approval, if it is determined by the Building Code Compliance Office that this product or material fails to meet the requirements of the South Florida Building Code. The expense of such testing will be incurred by the mamufacturer. Acceptance No.: 96-0708.04 (Revises No.: 944531.05) Expire.s:0aR5/97 k�uguez Product Control Supervisor THIS IS THE COVERSHEET, SEE ADDITIONAL PAGES FOR SPECIFIC AND GENERAL CONDITIONS BUILDING CODE COMMITTEE This application for Product Approval has been reviewed by the Metropolitan Dade County Building Code Compliance Department and approved by the Building Code Committee to be used in made County, Florida under the conditions set forth above. (Wee, Cnarms 1 g�� Director Budding Code Compliance Dept Approved: 12/05/96 -1- MMetropolitan Dade County CJearSWS1d NanufactndU ACCEPTANCE NO.: 96- 0708.04 APPROVED : mC o 5 1996 EXPIRES ; DEC o S 1999 NOT-ICE OF A CEPTAN PEAjFLC GONDITION-S 1. DESCRIPTION 1.1 ''This -approves -a corrugated traasparent virgin; (iion- recycled), polycarbortate and a corrugated black recycled, (up to 100% recycled material), polycarbonate storm panels designed to comply with the South Florida Building Code, 1994 Edition for Dade County, for the locations where-the pressure requirements as determined by ASCE 7 -88 "Minimum Design Loads for Buildings and Other Structures ", do not exceed the Design Pressure Rating values in Section 7 and within the limitations contained in Section 3. 2. MATERIAL CHARACTERISTICS 2.1- The storm panels shall be constructed as follows; Transparent using virgin Makrolon 3103 polycarbonate manufactured by General Electric and/or Bayer, having an Average Ultimate Tensile Strength of 8290 PSI (f10%) in accordance with AST, D-638; Xon-Transarent FIlack Pals., using first generation recycled Makrolon and Lexan polycarbonate manufactured by General Electric and/or Bayer, (up to 100% recycled material used), having an Average Ultimate Tensile Strength of 8120 PSI (t10 %) in accordance with ASTM D -638. Both the transparent and recycled black panels shall be extruded with a minimum thickncss of .093". 2.2 Each panel shall be extruded into a final formed, which shall have a nominal width of 12" and a total full width of 13 ", forming 2" deep ribs as shown on Detail "I", Drawing No. 96 -132, Sheet 1 of 3 bearing the Dade County Product Control approval stamp. 23 The storm panels shall be installed as shown on "Typical Panel Overlap" Detail, Drawing No. 96-132, Sheet 1 of 3 bearing the Dade County Product Control approval stamp. 2.4 All aluminum components shall be of aluminum alloy 6063 -T6, unless otherwise noted on Drawing No. 96 -132; All studded anglerintermediate straps (Part No. 2), shall be galvanized steel (G60 Min.), ATSM A36, Fy= 36,000 psi. 2.5 Tested specimen: Dimensions: 5 panels 44" wide x 100" long overall, (max. 37" clear width.) - 1 specimen for windload 5 panels 44" wide x 100" long overall, (max. 37" clear width) - 3 specimens for impact and cyclic load 3. LIMITATIONS 3.1 The storm panel approval shall be limited for installation over openings with a maximum clear width of 37" and an unlimited height as shown on the "Typical Elevation Details ", Drawing No. 96 -132, Sheet I of 3 bearing the Dade County Product Control approval stamp. 3.2 Minimum sena_ration to exic►ing elm ro ll 2 -3/4" minimum from the storm panel m from the horizontal leg of the i emiedWe reinforcing stra{3 rt No. 2) as shown on aand6Bladco, P.E. - Plans Examiner II Product Control Division -2- ClearShield Manufactu kg ACCEPTANCE NO.: - 9&0709.04 APPROVED : OEC 0 8 1996 EXPI ;DEC 0.5 1999 NO-TICE OF ACCEPTANCE.--- SPECIFIC CONDITIONS 3.4 Somial $gguir ment: -Reinforcing studded- angle/intermediate strap,.consistin$_of one- 1 -1 /8" x 1 -1/8 "x.118 "...Gals. Steel studded angle (Part No. 2) attached with 1/4 " -20 x 518" long machine screws with wingnut assemblies spaced 6" o.c. , each strap shall be installed at a 33" maximum spacing as shown on Drawing No. 96 -132. Each strap shall be anchored at the ends with a minimum of two approved tension anchors as shown on Details - "Concrete or Hollow Block Attachment Plan & Elevation " and" Wood Framed Attachment Plan & Elevation "; and with a minimum' of one approved tension anchor spaced 6" o.c. as shown on Detail - "Plan View (Projected Mount) ", Sheet 2 of 3, Drawing No. 96 -132. 4. INSTALLATION 4.1 The panels shall be installed only in the following condition: 4.1.1 Flush Wall Mounts (Direct Mountl: (A) (CONCRETE /MASONRY): The panels are directly secured to the wall using approved tension anchors as shown on Section B- "Flush Mount Section - (Direct Mount)", as shown on Drawing No. 96 -132, Sheet 2 of 3 bearing the Dade County Product Control approval stamp. (B) (WOOD FRAMED): NOT APPLICABLE 4.1.2 Ceilinr4nside Mounts; (A) ( CONCRETE / MASONRY): The panels are secured to an 3 "x 2" x 1/8" Aluminum Studded Header/Sill Angle (Part 6) at the head and sill with drilled and tapped 1/4 " -20 x 518" stud machine screws spaced 6" o.c. with a.080" thick polycarbonate washer (Part No. 4) and Wingnut (Part No. 5), both the header and sill angle are anchored to the wall, using approved tension anchors as shown on Section A - "Inset Mount Section ", Drawing No. 96 -132. Sheet.2 of 3, bearing the Dade County Product Control approval stamp. (B) (WOOD FRAMED): The panels are secured to an 3 "x 2" x 1/8" Aluminum Studded Header /Sill Angle (Part 6) at the head and sill with drilled and tapped 1/4 " -20 x 518" stud machine screws spaced 6" o.c. with a.080" thick polycarbonate washer (Part No. 4) and Wuput (Part No. 5), both the header and sill angle are anchored to the wall, using approved tension anchors as shown on Section D - "Wood Inset Mount Section ", Drawing No. 96 -132, Sheet 3 of 3, bearing the Dade County Product Control approval stamp. - Plans Examiner U Product Control Division -2a- IsarShield MAnufac udng ACCEPTANCE NO.: 6-0708.04 APPROVED : DEC 0 5 1996 EXPIRES :DEC 0 5 1999 MOTWE OF ACGEPTAN P CIEUC CONULTOINS 4.13 ftiection Mo nt• -•- -.(A) •(CONCRETE./MASONRY): The.panels.are Sccured.to an. 2 "x 3 ". x2" x.050" thick'Z' bar (Part No. 3) at the head, sill and jambs with drilled i/4 " -20 x 5/8" stud machine screws spaced 6" o.c. and a .080" thick polycarbonate washer (Part No. 4) and Wimput (Part No. 5), the'Z' Bar build outs are then anchored to the wall, using approved tension anchors as shown on Section C - "Projected Mount Section ", Drawing No. 96 -132, Sheet 2 of 3, bearing the Dade County Product Control approval stamp. (B) (WOOD FRAMED): The panels are secured to an 2 "x 3" x 2" x .050" thick'Z' bar (Part No. 3) at the head, sill and jambs with drilled 1/4 " -20 x 518" stud machine screws spaced 6" o.c. and a.080" thick polycarbonate washer (Part No. 4) and Wingnut (Part No. 5), the'Z' Bar build oats are then anchored to the wall, using approved tension anchors as shown on Section C - "Projected Mount Section ", Sheet 2 of 3; or the panels are secured at the head and sill to an 3"x 2" x 1/8" Aluminum Studded Header /Sill Angle (Part 6) with drilled and tapped 1/4 " -20 x 518" stud machine screws spaced 6" o.c. with a . 080" thick polycarbonate washer (Part No. 4) and Wingnut (Part No. 5), both the header and sill angle are then secured to a continuous 2 x4 or 2 x 6 PT wood ledger plate with 1/4" x 1 -3/4" S.S. wood lag screws spaced 12" o.c. with min. 1 -1/2" penetration into wood ledger plate, the wood ledger plate is then attached to the wall with (2)1/4" x 4-1/2" long lag screws spaced 24" o.c. as shown on Section E - "Wall Mount Section (Bottom) ", Sheet 3 of 3 , Drawing No. 96 -132, bearing the Dade County Product Control approval stamp. 4.1.4 Anv combination of the- 4.2 Anchorage of the shutters shall be to concrete, masonry and/or wood fuming and shall consist of only the anchors specified on drawing No. 96 -132, Sheets I thru 3 of 3. Substitution of anchor type or indicated embedment is unacceptable. 4.3 Fasteners must have their own Notice of Acceptance and must be made of stainless steel or have adequate protection against corrosion, per DN 50018. Aluminum contacting metals not considered compatible shall be properly protected. 4.4 Pennancnt set fastener components, embedded anchor bolts, threaded cones or metal shields, not in use, must be protected against corrosion, contamination and damage at all time. 5. IDENTIFICATION 5.1 Each unit shall bear a permanent label with the manufacturer's name or logo, city, state and following statement: "Dade County Product Control Approved ". 5.2 Also a Earn 'ng Note shall be permanently placed at each opening were panels are to be installed advising the home owner or tenant that the storm panels will not offer hurricane protection unless all real l reinfor in.g bolts are properly installed. That the shutter panels be installed only for the duration of a hurricane warning period and are not intended for r permanent installations with prolonged exposure to weathering conditions. That the is are be stored in areas with direct exposure to the weathering conditions. Palo_ /j Orlando BTanco, P.E. - Plans Examiner .1-1 Product Control Division -2b- ClearShield Manufacturing ACCEPTANCE NO.: 96- 0708.04 APPROVED : OR 0 5 1996 EXPIRES AC 0 5 1999 NOTICE OF ACCEPTANCE: SPECIFIC CONDITIONS 6. USE 6.1 Application -for building•pennit shall.be accompanied by two copies of the.following: 6.1.1 This Notice of Acceptance. 6.1.2 Completely dimensioned drawing showing size and location, including height above grade, of openings to receive shutters; mean roof height, length and width of building. 6.13 Duplicate prints of approved drawings No. 96 -132, Sheets 1 thru 3 of 3, bearing the approval stamp, Notice of Acceptance number and date by Dade County Product Control Section, clearly marked to show the components selected for the proposed installation. 6.2 The Building Official shall ensure the adequacy of shutter to meet the pressure requirement of the opening in which it is to be installed "7. TESTS PERFORMED TESTS: RESULTS: TEST TEST LOAD DESIGN LOAD Deflection RGE MISSILE IMPACT TEST SATISFACTORY Max. FBC PA 201 -94 CTC- 96.034 24A" CLIC WIND PRESSURE TEST +71.5 PSF +55.0 PSF F C PA 203 -94 POSITIVE (100- Span) CTC -964)34 CTC- 96-034 CYCLIC WIND PRESSURE TEST -975 PSF -75.0 PSF FBC PA 203 -94 NEGATIVE (100" Span) CTC -96-034 CTC- 96-034 UNIFORM STATIC AIR PRESSURE TEST +832 PSF +55.0 PSF Design FBC PA 202-94 POSITIVE (100- Span) CTC -96-034 CTC- 96.034 .125" IFORM STATIC AIR PRESSURE TEST' -119.0 PSF -79.0 PSF FBC PA 202 -94 NEGATIVE (100" Span) CTC -96-034 CTC- 96-034 MAXIMUM DESIGN PRESSURE RATING: + 55.0 PSF - 75.0 PSF Orlando Blanco, P.E. - Plans Examiner 11 Product Control Division -2c- CleurSbie[d Manufacturing ACCEPTANCE NO.: 96-0708.04 APPROVED : DEC 0 5 1996 EXPIRES :DEC 0 5 1999 NOT F A t'Ep'i'Aty F• SPECIFIC NDMONS S. EVIDENCE SUBMITTED &I Tabs: 8.2 8.3 8.4 8.5 8.1.1 Test report on: Uniform Static Air Pressure Test Impact Test Cyclic Wind Load Test prepared by Construction Testing Corporation, Report No. CTC -96 -034, dated June 28, 1996, signed and sealed by Christopher G. Tyson, P.E. Drawing: 8.2.1 Drawing No. 96 -132, ClearShield Manufacturing Polycarbonate Storm Panel , Sheets 1 thru 3 of 3 prepared by Knezevich & Associates Inc., dated 07117/96, Revision No. 2, dated 09/12196, signed and sealed by VJ. Knezevich, P.E. Material certification: 83.1 Fire Testing Laboratory Report, conducted by Center for Applied Engineering, Inc., MTS Job No. 257741 B, Rate of Bunning Characteristics of Clear Panel, ASTM D635, dated August 6, 1996. 8.3.2 Fire Testing Laboratory Report, conducted by Center for Applied Engineering, Inc., MTS Job No. 257741A, Ignition Properties of Clear Panel, ASTM D1929, dated August 6, 1996. 833 Fire Testing Laboratory Report, conducted by Center for Applied Engineering, Inc., MTS Job No. 257706B, Rate of Burning Characteristics of Black Panel, ASTM D635, dated July 23, 1996. 83.4 Fire Testing Laboratory Report, conducted by Center for Applied Engineering, Inc., MTS Job No. 257706A, Ignition Properties of Black Panel, ASTM D1929, dated July 23, 1996. 8.3.S Fire Testing Laboratory Report, conducted by Center for Applied Engineering, Inc., MTS Job No. 2577060, Surface Buming Characteristics of Black Panel, AS & T%4 E84 -95a, dated July 23, 1996. FLAME SPREAD INDEX - 0, SMOKE INDEX = 21. 83.6 Ccrtified Tensile Test Report issued by Certified Testing Laboratories, CTL No. 6808, dated A. gust 15, 1996, signed and sealed by Ramesh Patel, P.E. Calculations: 8.4.1 Comparative analysis and anchor calculations, dated 07103/96, pages t thru 12 of 12 and . dated 08/14196, pages I thru 4 of 4, prepared by Knezevich & Associates Inc., signed and sealed by V.J. Knezevich, P.E. Quality Control Program:. 85.1 ClearShield Manufacturing Corp. - "Polices and Procedures for Quality Control and Assurance for the Manufacture of ClearShield Hurricane/Security Panels and Mounting Systems" , pages 1 thru 4 f 4, revision date 10/09196, P &P No. %- 8000.I.D., prepared by ClearShield -2d- urn t3lanco, P.E. - Plans Examiner It Product Control Division ACCEPTANCE NO.: 96-0708.04 APPROVED :DEC 0 5 1996 EXPIRES AEC 5 1999 NOTICE OF ACCEPTANCE• .STANDARD CONDITIONS 1. Renewal of this Acceptance (approval) shall be considered after a renewal application has been filed and the original submitted documents, including test supporting data, engineering documents. are no older than eight (8) years. 2. Any andallapproved -products -dmUi epemtmmtly labeled with-the manufactumes name, city, state, and the following statement: °Dade County Product Control Approval ", or as specifically stated in the specific conditions of this Acceptance. 3. Renewals of Acceptance will not be considered if a) There has been a change in the South Florida Building Code affecting the evaluation of this product and the product is not in compliance with the code changes; b) The product is no longer the same product (identical) as the one originally approved; c) If the Acceptance holder has not compiled with all the requirements of this acceptance, including the correct installation of the product; d) The engineer who originally prepared, signed and sealed the required documentation initially submitted, is no longer practicing the engineering profession. 4. Any revision or change in the materials, use, and/or manufacture of the product or process shall automatically be cause for termination of this Acceptance, unless prior written approval has been requested (through filing of a revision application with appropriate fee) and granted by this office. 5. Any of the following shall also be grounds for removal of this Acceptance: a) Unsatisfactory performance of this product or process; b) Misuse of this Acceptance as an endowment of any product. for sales, advertising or any other purposes. 6. The Notice of Acceptance number preceded by the words Dade County. Florida, and followed by the expiration date may be displayed in advertising literature. if any portion of the Notice of Acceptance is displayed, then it shall be done in its entirety. 7. A copy of this Acceptance as well as approved drawings and other documents, where it applim shall be provided to the user by the manufacturer or its distributors and shall be available for inspection at the job site at all time. The copies need not be resealed by the engineer. 8. Failure to comply with any section of this Acceptance shall be cause for termination and removal of Acceptance. 9. This Acceptance contains pages 1, 2,2(a) through 2(d) and this last page 3. Items 10. 11 & 12 IidW below only apply to gimmd produMs and doors 10. Unless specifically indcated in the Acceptance (approval), this unit is approved as a single unit installation. For multiple installation of this unit, a separate Acceptance for mullions is required from the Product Control Section. 11. The spacing of fasteners at window sills shall be as indicated in Section 4 of this Notice of Acceptance. The spacing of fastener in all other parts of the frame, shall be as indicated in Section 4 of this Notice of Acceptance. but in no case shall exceed 24" an caner. The first fastener shall be located at a maximum of 6" from each corner and mullion or stile. Fastener shall fully penetrate the buck. which stall be the same size as the on;47 nit. No wood or plastic shields or pins shall be used for anchoring. 12. Hardware for all windows and doors shall conform to Security and Forced Entry P 36 of the South Florida Building Code. Orianjdlfhuw , P.E - Phu Examiner II Product Control Division END OF THIS ACCEPTANCE -3- age 6 MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PWMBING PERMIT i Permit No. ___,.____._ Date ------- - Application is hereby mad 'for the approval of the detailed statement of the plans and specifications herewith submitted for the building or other structure herein described. 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 Divisior of Miami Shores Village shall be complied with, whether herein specified or not. A copy of approved plans, and specifications must be kept al building during progress of work. Owner's Name and Address.--- - - - - -- =_ - No. Yo Registered Architect and /or Engineer —._ :_ ........... - — Employing Plumbei s Name__ °_ __ No. 2=6ci Street -_ 7 Location and Legal Description Lot-_ _..__T_ Block . __. Subdivision —__ Street and Number where work is to be performed —No. Stmt.._..__...__ -- - -_ -- State work to be performed and purpose of building (By Fkbrs) —r._ -- -__--__._— ---------- ----_ _ ------ - _--------------- • —___ -- New Building-- - - - -.. - - - -- --------- .. Remodeling —_,_ _ Addition .._.-__._ Repairs ---- - --- ._. - -_ ------- No. of Stories-- _J ------ — ----- - -- Size Septic of Tank . _--- - - - - -_ Capadty Cols. ..-.---------------_w ---------- Feet of Drain Tile - -_ -- --- _ -_ -_. . -- _ 1 _Dist. Feet'of Tank or Drain Field irom Nature of Water S Amount of Permit $___ -_Jf Of Soakage Pit - -- - -_--- Plumbing Inspector. The undersigned applicant for this building permit does hereby certify that he understan "d accepts his obligations as an employer of labor under the Florida Workmen's Compensation Act, being Section 5988, Compiled Cenral 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 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 sub- contractors, on work to be performed under this permit, as are licensed by Miami Shores Village. (wed) aster Plumber. STATE OF FLORIDA, 1 COUNTY OF DADE. j Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appear, to me well known, and who, being by me first duly sworn, upon oath oses and says that he is the ----------------_---w.___----------_--------.--___-.- of the above described construction, that he has carefully read the foregoing --- regoing application, and that he. did sign the same, and that all fac 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 such re-inspection is made necessary by improper notice for inspection, or foul materials and /or workmanship. BATH (,,SHOWERS LAY ^ - SINKS SLOP LAUNDRY .�JRINALS CATCH FLOOR DRINKINGpy, TOTAL CLOSETS TUBS TORIES SINKS TUBS BASIN DRAIN FOUNT'NS FIXTUkIn CLIST { LIST v _� o CHECK s r SEPTIC SEWER DRAIN SOAKAGE GREASE- DEEP SPRKLR. SWIM -G TANK CONN. FIELD PIT TRAP - HEATER WELL SYSTEM POOL CoNTR. LIST w CHECK Size Septic of Tank . _--- - - - - -_ Capadty Cols. ..-.---------------_w ---------- Feet of Drain Tile - -_ -- --- _ -_ -_. . -- _ 1 _Dist. Feet'of Tank or Drain Field irom Nature of Water S Amount of Permit $___ -_Jf Of Soakage Pit - -- - -_--- Plumbing Inspector. The undersigned applicant for this building permit does hereby certify that he understan "d accepts his obligations as an employer of labor under the Florida Workmen's Compensation Act, being Section 5988, Compiled Cenral 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 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 sub- contractors, on work to be performed under this permit, as are licensed by Miami Shores Village. (wed) aster Plumber. STATE OF FLORIDA, 1 COUNTY OF DADE. j Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appear, to me well known, and who, being by me first duly sworn, upon oath oses and says that he is the ----------------_---w.___----------_--------.--___-.- of the above described construction, that he has carefully read the foregoing --- regoing application, and that he. did sign the same, and that all fac 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 such re-inspection is made necessary by improper notice for inspection, or foul materials and /or workmanship. MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT Permit No. ___1_ 2 --- r -- - - - -- Application is hereby made �or 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 Divisior 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 work. owners Name and Address - --- No. _ . _ -- - - Street.- - — - -' - Registered Architect and /or Engineer —_._ __t -- _ _ .. _. ___ __._. _::-- ::;---- ...�._. Employing Plumber's Name_ o. _._..__..----_- - -•- Location and Legal Description Lot .____ - -- Block Subdivision..__... Street and Number where work is to be performed —No.__ =t e°l - J ®�_. Street.— ...__.___.______ _ _____-----_---- State work to be performed and purpose of building (By Floors)—_- _______ - - -_ --- -_ - - -- . _ _------ _---------- _----- . - -_ -_. New Building -- ----- _- _ - - - -- ;---- - - - - -- Remodeling - -___ _ Addition_M.._.___ —_ -_ Repairs------------------ - - - - -- No. of Stories - ---------- _ ------ _ -_ Size Septic Tank- - - - - -- - ----------- - - - - -- TrPe of Tank _ _ __ -- - -_ - -- Capacity Gals, _--- - - - - -- _ �--- _ -._ -- Feet of Drain Tile.-------..-.----- - - - -__ Dist. Feet of Tank or Drain Field from WelL.___._ Nature of Water Supply: City— Well._ -__ ____ __ _Size of Soakage Amount of Permit $ ----- - -- 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'$ Compensation Act, being Section 6988, Compiled General Laws of Florida Permanent Supplement, and has Com- plied with the provisions thereof, and will require similar compliance from all con tractors 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 sub - contractors, on work to be performed under this permit, as are licensed by Miami Shores Village. Master Plumber. STATE OF FLORIDA, l �. COUNTY OF DADE. j Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments , personally appeare tome well known, and who, being by me first duly sworn, upon oath d oses and says that he is the____-._-----------_---- __- _-------- _-------- -_ - -_- _ ep of the above described construction, that he has carefully read the foregoing application, and that he, did sign the same, and that all fac 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 such re- inspection is made necessa>y by improper notice for inspection, or faui materials and /or workmanship. BATH LAVA SLOP LAUNDRY CATCH FLOOR DRINKING TOTAL CLOSETS TUBS SHOWBRB TORIES SINKS SINKS Tuee URINALS BASIN DRAIN FOUNT'NS FIXTURRI CONTR. LIST— CHECK SEPTIC SEWER DRAIN SOAKAGE GREASE SOLAR- DEEP SPRKLR. SWIM•G TANK CONN. FIELD PIT TRAP NEATER WELL SYSTEM POOL CONTR. LIST r CHECK,,, -7X Yx Size Septic Tank- - - - - -- - ----------- - - - - -- TrPe of Tank _ _ __ -- - -_ - -- Capacity Gals, _--- - - - - -- _ �--- _ -._ -- Feet of Drain Tile.-------..-.----- - - - -__ Dist. Feet of Tank or Drain Field from WelL.___._ Nature of Water Supply: City— Well._ -__ ____ __ _Size of Soakage Amount of Permit $ ----- - -- 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'$ Compensation Act, being Section 6988, Compiled General Laws of Florida Permanent Supplement, and has Com- plied with the provisions thereof, and will require similar compliance from all con tractors 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 sub - contractors, on work to be performed under this permit, as are licensed by Miami Shores Village. Master Plumber. STATE OF FLORIDA, l �. COUNTY OF DADE. j Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments , personally appeare tome well known, and who, being by me first duly sworn, upon oath d oses and says that he is the____-._-----------_---- __- _-------- _-------- -_ - -_- _ ep of the above described construction, that he has carefully read the foregoing application, and that he, did sign the same, and that all fac 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 such re- inspection is made necessa>y by improper notice for inspection, or faui materials and /or workmanship. ca, FW sT�• �� W�L L I Per. ti jet 1 r , tV T NA�� II � t- C w AuA To �3u` " �PA-I AITE'4 �IITN SQL �� f, AINE a . y f7 _ A4 L E% �' — Zo MIAMI.SHORES VILLAGE ELECTRICAL INSPECTION DEPARTMENT APPLICATION FOR ELECTRICAL PERMIT Permit No... »tl �r .. ...... Date............. 9_ ... . e... $.r�... 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 Registered Architect xy ` „ =3 Em to y in g Electrician's Name.... ............. Street .................:.: . . .. Location and Legal Description Lot.: ................................... ............................... Block........ ..................................Subdivision................................. ............. :. Street and Number where work is to be performed— No........... ................ ......................... ...... Statework to be performed and purpose. of building (By Fl oors) .......................... _ ............... ...... ............................................ ........ . ... »........................... NewBuilding ...... » .... . .................. Remodeling ...... . ........................ Addition .... .......................... Repairs. ............................ .: ....... No. of Stories.................... Service Ove head d Size Feeders .................... Conduit ................ Main Sw ............ . .Amps ..........................Main Fuses ...... ....... : ...Amps Typeof Installation— Conduit ........................ Tubing ........................ B.X.L ......................... Metal Moulding ............ ... ................. .. ......... .......................... Amount of Permit (signed) ..... .................... ..................6............ .............I...... Electrical 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 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 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 sub - contractors, on work to be performed under this permit, as are licensed by Miami Shores Village. ( Signed ) ......................... »... .................... ......... Master Electrician. STATE. OF FLORIDA, COUNTY OF DADE. Be. 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, and he has carefully read the foregoing application, and that he did sign the same, and that all facts therein by him stated are true. .......... ............................... ..::...: - ............... ....................... »....... »......................................................................... ............................... My Commission Expires Notary Public, State of Florida V GTE: A reinspection fee of $1.00 will be made when such re• inspection is made necessary by improper notice for inspection, or faulty mat 'als and /or workmanship. SWITCH -LIGHT PLUG FIXTURES REFRIG.- IRON - RANGE RANGE WATER W. HEAT. SPACE STRIP TOTAL OUTLETS OUTLETS' RECE'P•T's NO. LAMPS OUTLET - OUTLET OUTLET CONN: HEATER CONN. HEATER HEATER CONTR. LIST - CHECK - ENT. DIST. SERVICE SERVICE MOTORS MOTORS NEON RADIO TOTAL SW. CAB. TEMP. PERM. 0.1 HP 1.5 HP TRANS. CONTR. LIST CHECK Service Ove head d Size Feeders .................... Conduit ................ Main Sw ............ . .Amps ..........................Main Fuses ...... ....... : ...Amps Typeof Installation— Conduit ........................ Tubing ........................ B.X.L ......................... Metal Moulding ............ ... ................. .. ......... .......................... Amount of Permit (signed) ..... .................... ..................6............ .............I...... Electrical 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 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 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 sub - contractors, on work to be performed under this permit, as are licensed by Miami Shores Village. ( Signed ) ......................... »... .................... ......... Master Electrician. STATE. OF FLORIDA, COUNTY OF DADE. Be. 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, and he has carefully read the foregoing application, and that he did sign the same, and that all facts therein by him stated are true. .......... ............................... ..::...: - ............... ....................... »....... »......................................................................... ............................... My Commission Expires Notary Public, State of Florida V GTE: A reinspection fee of $1.00 will be made when such re• inspection is made necessary by improper notice for inspection, or faulty mat 'als and /or workmanship. MIAMI SHORES VILLAGE ELECTRICAL INSPECTION DEPARTMENT _APPLICATI ®N FOR ELECTRICAL PERMIT 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 th, wheth�r herein ape ified or not. A copy of approved plans and specifications must be kept at building during progress of work. /% � ®/ 2s Owners Name and Registered Architect and /or En ne Employing Electricians Name..... Location and Legal Description Lot ................................. ............................... Street and Number where work is to be performed— No...._.._.... �- -. �Zqj I � State work to be performed and purpose. of building (By Floors ) .......................... _................................................. ............. ............................... NewBuilding ........... ... .................. Remodeling ................................ Addition .... .. .......................... Repairs. ..................................... No. of Stories.................... 9 OP - Service Overhead, `�- Size Feeders. ... „....Am ........................ Main Fuses. [�._.. ...Am s Underground ..... ..... ...Conduit. �,.��....Main Sw......._ ....wt�..: ps... ............. _, p Typeof Installation — Conduit ........................ Tubing........................ B.X1 ......................... Metal Moulding......................................... ............................... Amount of Permit, (Signed) -- �'- ----- Electrical Inspector. The undersigned applicant for this building permit does hereby certify that he understands d accepts his obligations as an employer of labor under the Florida Workmen's Compensation Act, being Sedipn 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 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 sub•contra on rk to be performed under this permit, as are licensed by Miami Shores Village. ( Signed STATE OF FLORIDA, ff Electrician. . COUNTY OF DADE. ss. 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 constriction, and he has carefully read the foregoing application, and* that he did sign the same, and that all fads therein by him stated are true. .... ............ ..... ............... __ .......... .. ... _ ..... .. ... ... ..... .. .................. ............. .....................................I............ .. ...................---;............................... My Commission Expires Notary Public, State of Florida NO T#r AA re inspection fee of $1.00 will be made when such re-inspection is made necessary by improper notice for. inspection, or faulty materials' d /or workmanship. SWITCH OUTLETS LIGHT OUTLETS' PLUG R CE'P -T -S FIXTURES NO. LAMPS REFRIG. OUTLET IRON OUTLET - RANGE OUTLET RANGE CONN, WATER HEATER W. HEAT. CONN. ' SPACE HEATER STRIP HEATER TOTAL CONTR. LIST CHECK S _. r 6 �'_ p 0.. - ENT. SW. DIST. CAS. SERVICE TEMP. SERVICE PERM. MOTORS 0.1 HP MOTORS 1•8 HP NEON TRANS. RADIO TOTAL LIST CLIST / p q CHECK . 9 OP - Service Overhead, `�- Size Feeders. ... „....Am ........................ Main Fuses. [�._.. ...Am s Underground ..... ..... ...Conduit. �,.��....Main Sw......._ ....wt�..: ps... ............. _, p Typeof Installation — Conduit ........................ Tubing........................ B.X1 ......................... Metal Moulding......................................... ............................... Amount of Permit, (Signed) -- �'- ----- Electrical Inspector. The undersigned applicant for this building permit does hereby certify that he understands d accepts his obligations as an employer of labor under the Florida Workmen's Compensation Act, being Sedipn 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 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 sub•contra on rk to be performed under this permit, as are licensed by Miami Shores Village. ( Signed STATE OF FLORIDA, ff Electrician. . COUNTY OF DADE. ss. 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 constriction, and he has carefully read the foregoing application, and* that he did sign the same, and that all fads therein by him stated are true. .... ............ ..... ............... __ .......... .. ... _ ..... .. ... ... ..... .. .................. ............. .....................................I............ .. ...................---;............................... My Commission Expires Notary Public, State of Florida NO T#r AA re inspection fee of $1.00 will be made when such re-inspection is made necessary by improper notice for. inspection, or faulty materials' d /or workmanship. MIAMI SHORES VILLAGE 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 confonmity 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 the work. V' Owner's Name and Re ' ered Architect and/(orr`Vngineer___. Name and address of licensed contractor Location and legal description of lot to kii Lot treet and Number where work is to be on: vfate work to be done and purpose of building (by ,sl o.; _, f/,7 A -- ----------- - - - - -- —_ -- .17 - -- _-- _____— __. —_ - -- -and for no other purpose. Vr�New Building____ Remodeling ---- -- ------- - -__ -- Addition - - -__ -- ___ -- Repairs-------- ____ - - - - -- No. of Stone . --_____---------------- To be constructed of— -- Kind of oundatinon _ _ -- — — -- - — — Roof Covering_-_--- - ------ - - - - -- vfitimated Total cost of improvements $__— � — Amount of Permit $___ —_ —________—_- --- -______________________________ Zone cubage required Flan Cubage - - - - -_ __—____-------__- ------ - ---- -- ..--- ----- -_ ________ __ _ _ _ _ __ Distance to neat 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 to_____— _--- _ -___ -- - -_- 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 complied with the provisions thereof, and will require similar compliance from ntractors or sub- contractors employed by him in the work to be performed under this permit; and will post or cause to be posted for ' e 'on. on the sit of the work such public notice or notices as are required by the Act. The undersigned agrees to employ only such su actors, on w k to performed under this permit, as are licensed by Miami Shores Village. Remarks — 1//,(("Signed)- STATE OF FLORIDA, COUNTY OF DADE. ss' 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 hire sta ed are trne. Permit No. _ _ __ Date /) W_ f _ 1�� °� Read, Sworn to and Subscribed before me. Disapproved - -- — __ Data - -- -- - - - - -- -------------------------- - - - - -- Notary Public, State of Florida ( Signed) uil ' Q`g Inspector My Commission Expires ----------- — ___.____— __� —__ PLANNING BOARD—._- .— .__- ..- ________.___.-- _.-. -_ -DATE Chairman — _ - -__Y -! Member Member . Member Council Member Member 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 le Planning Board. A re- inspection feel of $1.00 will be charged when such -re- inspection is made necessary by improper notice for inspection or faulty materials and /or workmanship. __ . ^+ ', /� �.. c � � � "V i 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 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 the work. l - Date_ • j� ,19 --- - --- Owner's Name and Address_ —___ me No ---- — __----- - - - - -- Street ---------- - _-- ------ -_ -- - Registered Architect and /or Engine - ---- - - - - -- -- ------------------------------_----_--__---------------------------------------- Name and address of licensed contractor��— rh"— - - -• -- -- - — -- — Location and legal description of lot to be built on: Block —___22_T____ Subdivision____ — Street and Number where work is to be done__— ____ —_ 2,4 Ac_j ------ _____1-L 3_4_�L _ -_____ State work to be done and purpose of building (by floors)_ and for no other purpose. New Building __ ----- _--__ -- Remodeling --- M-------------------- Addition----- ____ ------------- Repairs----- -- ------------ - - - - -- No. of Stories --------- __.._______ - - - - -- To be constructed of______�-- Kind of foundation -- _ -- _ ------- __-------- ____ -- Roof Covering --_- ----- ---- ------------- --------- ------- Estimated Total cost of improvements $_ 70 Amount of Permit $ ----- _ - 2 _____-_ ------ ___-_- _-- _•__ -------------- __- ------ _ Zone cubage required -------- - - - -_— - -_ - plan Cubage-- ---- — ----- -- --- --------_-------- ------- -- --- ---------- _------- - - - - -- Distance to nest 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 to 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 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 ublic notice or notices as are required by the Act. The undersigned agrees to employ only such subcontrac , on work to be perform as under this permit, as are licensed by Miami Shores Village. Remarks_._._ ' - -____ (Si e STATE OF FLORIDA, COUNTY OF DADE. ss 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 arp'true. Permit No.___ Date Read, Sworn to and Subscribed before me. Disapproved_____ _ __ to _____ - -_ -------------- ------- -------------------- ----- ----- ----------- ,- ---- -_ Notary Public, State of Florida (Signed) -- - - - -- -- - -- � ----------------- Building Inspector My Commission Expires — ------------- _--- -------------- ___---- -- - -____ _ -- PLANNING BOARD 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. MIAMI SHORES VILLAGE -�-� 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 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 the work. Date_._December 16,___---------- Owner's Name and Address- - - -_J. H. McGeary, Sr. — -- No._390---- ____ -- street-- N,— E'-- 103rd St, --- -•-- - - - - -- Registered Architect and /or Engineer - -- — -- — — - - - - - - -- - -- — - - -- - - Name and address of licensed contractor_ Certified York Corp____ Q N. _ E. -79th St. _ Miami,,. Location and legal description of lot to be built on-' Lot— -- __ Block-------- - - - - -- Subdivision- Street and Number where work is to be done —_39a _N. E. 10 rd Street_ _ _— Miami Shores, Florida - State work to be done and purpose of building (by floors)- Air conditioning installation. — — 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 $ s075, 00 _mount of Permit $___— _— __6•C� ___ ____ —_ __ — ---- - -- - - - - --- Zone cubage required--, Distance to neat nearest building-- - - - -__ - Size of Building Lot_-_--_-____-------- ---------- -- ---------------- ----------- Maximum live load to be borne by each I hereby submit all the plans and specifications for said building. All notices with reference to the building and its construction may be sent to_—-- - - -___ -- 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 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. Remarks —___ — (Signed) a� STATE OF FLORIDA, t COUNTY OF DADE. ( ss Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally ap- peared— _ �— --- -------- __ —__W_ — ___ __ _--------- - - - - -_ ---- ______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._.______ Date____ _I_��° S _ Read, Sworn to and Subscribed before me. Disapproved — Dat ___— — — - --- - — -- — — - - - - -- - - -- - Notary Public, State of Florida (signed) -- - -- - --- -_ —___ B g pector My Commission Expires - -- - - - -- 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. X teriA re- inspection fee of $1.00 will be charged when such re- inspection is made necessary, by improper notice for inspection or faulty als and /or workmanship. December 17, 1952 Miami Shores Village Building !' Inspection Dept. 10050 N, jE. 2nd Ave. Miami Shores, Florida Attention: Cdr. Hansen Subject: Installation of air conditioning for Mr. J. H. McCeary, Sr. new constrac- tion located at 390 N. E. 103rd St.s, Miami Shores, Florida. Dear Sirs: This is to acknowledge that on the above named installation we, the air conditioning contractor lmoun. as Certified York Corporation, do hereby accept responsibility for any zl&ise problem involved with any adjoining neigh- bors. Respectfully submitted this 17th day of December, 1952. Sincerely, CERTIFIED YORK CORP. Ri hard F Hollis Vice President RFH /st MIAMI SHORES VILLAGE 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 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 the work. Date _..., IQ 7 Owners Name and Address ................. mm �Po-. �„�,,,_ NO.—.12M.— 111mt..,.cU.1 03 n Registered Architect and /or Engineer...­.... - --- -- - -- -� P �°�r'- -- ..._._ - _ -- ..,_...___,.____.__.. -._ -- _..... . 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_____.____ C?_ _ N ( 'wr•r,�$t��g w,o k to be done-,and purpose of 4uilding,, (by floors) L- Z3 7 -- = --- - - - - -- -- ------------- - - - - -. _ - - - - -- - - \ - -_and 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 $ ...... ® !_ ®� - Amount of Permit Zone cubage required- _ ------- - ------------- - ----------- _ _ plan Cubage_________.- __ -- Distance to next nearest building ------- - -------- ---- ------ -_ ----Size of Building Lot._.. __--- _--- -- _- •• -___ -- •- _ -____ Maximum live load to be home 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 to------ - - - - -- -- -- _ - - -_ 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 complied with the provisions thereof, and will require similar compliance fro jctorsFon n or sub -con ors employed by him in the work to be performed under this permit; and will post or cause to be posted f the site of e w k such ublic notice or notices as are required by the Act. The undersigned agrees to employ only such work rf under this �e*mit' as are licensed by Miami Shores Village. (Signed) —_ STATE OF FLORIDA, COUNTY OF DADE. I ss. Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally ap- peared--- r- - - -- - ------------------------ - - - - -- - -- ----- - - - - -- - - - - - -- 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 ve. Permit No. t � VC:- _____ Date- r__ _ _ Read, Sworn to and Subscribed before me. Disapprove ( Signed ) - - - ---------- ------ -- ----------- - ---- -- Notary Public, State of Florida My Commission Expires_._._.._ .- .-- ..._.._.. PLANNING BOARD ._. _--- --------- ------------- -- ._DATE Chairman ___.---------- ----- - - -_.w _ _ —__ _ _ Member Member------ •- _----- .-- .._____— .---- - - -_ -- - .._.___ - - -_ _ Member _ ___.. _ _ _._..._._..____.._.__-....----___----_-- Member -• --------- -- --- --- ----- ----- --- - - - - -- _— _ _ — Member Council Approved ----- — _ ---- _ ------- ---- Date Disapproval ---- --- __.__._..__. —_.—. _____..-......._ ---- _ ----------------------- __.._....- ............. - -- .....Date NOTE::A ch4ge 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 BUILDING INSPECTION DEPARTMENT APPLICATION FOR BUILDING PERMIT Application is hereby made for the approyal 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 anage andall 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 the work. Date 19 _ — Owner's Name and Address .......... j9IM-H KC _!11_­-._--_— No--aK­­ Street NE_ 10_3L�Cj fteg*ercd Archit@0 and/or Engineor ------ - Nme and address of H@N§@d contract" ...... J.9_41LF,&_&fir&rY ..... Location and legal description of lot to be built on: ---- - - -• -- Biock-37 ............ . . ......... s ubdivision. - M-IAMIL _5EDRE5L -Ane-ad 0A . .. . ..... 5:treat- Street and Number where work is to be done-3 90 NE 10.1 State work to be done and purpose of building (by floors) --Additi on _t ... g_ n r idence. g- r . ...... for no other purpose. New Building -- — - - - - -----------_- Remodeling---------- •--- ...• --._ Addition ------- _X ............. Repairs .............. . ....... No. of Stories....1--__ To be constructed of--..jqD-q ......... . .. Kind of foundation--C.b-O-q-r-C:tg---]Fqgtlt;LZ194-- Roof CoveringLjPM_'_T 'P- _--- - - - -_. Estimated Total cost of improvements $ ---- 7.,._4Q9_&_Q_______Amount of,Permit Zone cubage required . ....... Cubge .......... 1!E1_2___ 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 to--contracto.r .....•....... — ------ — -----­--- --------- - ---------------- - 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 Sup lenient, "A has complied with the provisions thereof, and will require similar compliance from all contractors or sub-contractors employe 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 "bcontractors, on­ work o be performed under this permit, as are licensed by Miami Shores Village. Remarks---- (Signed)--- ------- STATE OF FLORIDA, COUNTY OF DADE. ss. I Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, persollany, ap- peared ---------- --,to me wey, Imown, and who, being by me first duly sworn, upon oath deposes and says that he is the..._ . C011tX_a.C_'L4?r ------­----- 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.— Date- Read, Sworn to and bed mew Date Disapproved Date— - ------------- ............ . NdW Pillil -fee, WW6 of ffirida at Large. (Signed) ---- -- ------ ----- — - ------- - - - - -- Building ailding Ins*vector My Commission Epire^.LftMMiSSiaaBj iei-.AuglUaL9 PLANN BOARD -.._._.__- .._____.- .______ -____ _..DATE Chairman - - --------------- - ------ - -- - Member ------ MemberMember _. -. __. ____ ____ _.__.-----___--_-.._----- Member.. ...... . - ---- - ----- - - ------- - - . ...... Member - — - ----- - --- - ------- _ Council 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. 040 J-1 —7 a7. , k.k,— I I J j 7.17 MIAMI SHORES VILLAGE 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 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 the work. Jean P. Weary., 1II 3 90 --- E_103 --- ftl— Owners Name and AOOress ......_ .............. ... �L�ii`4@ft?� ,�citlt�t 9tit�IBf �,ti�iHNBi' :.;: a oa, : ,: J�fi�'] a�i��arjaua��a�sam�i�a�:' raeai�ttt :�� :carflnaa�f�aAt�eta�a lea : :sasaaesaataaa• Name and address of licensed contractor......... Locatio3 ai legal description of lot to lY,3'puilt on: MIAMI SNORES SECTION 1, Amended Lot_.-_- .. - Block ._ ............... _ - - 0►vi.- t.3a�' Street and Number where work is to be done..._.. -_ -... Addition--to ,, e i a ,ing roe rl.,�r,,,ca State work to be done and purpose of building (by floors)_. .•,. ,,,, ___ ......_....._.... _,.. ,_......._.....,_....... _and for no other purpose. New Building Remodeling...__ ... . . .. ....... C ®n n- .. :....... ......... - .... . Repairs __..........._._..... No. of Stoles»».. To be constructed of_ ......... _... ... ..._-_ Kind of foundation.._ cret -a Footings Roof Coverirr C �" • Tile __...�... ___.. ». _— g_ ............._........ Estimated Total cost of improvements $..2 x.4Q ®• Q ­---Amount of Permit Zone cubage required- .... ..... ..... _ _._ » - - - -- plan Cubage._.... _ Distance to next nearest building­­ .. ......._ - _ - 10 2 t X 11$ t .—Size of Building Lot....... » 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 to....- .ggntractor r-•---- .1...... _ . - --.. .. . • . -• .. --.... -- . .. -..... . ................ __. _......•. ...... —. 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 complied 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 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 e — permit, as are licensed by Miami Shores. Village. �J Remarks_ _.._.- ------ (Signed) _ •'r °` STATE OF FLORIDA, COUNTY OF DADE. ss. Before me, the undersigned authority„a notary public, duly authorized to administer oaths and take acknowledgments, gmenta Personally ap- peared John N . qGe� a Jr . to me well known. and who, being by me first duly sworn, upon oath deposes and says that he is the..._.� _ ti of the above described construction, that he has carefully read the foregoing application, and that he did ri theme -d --h- a therein by him stated are true. l;A same. mad that aii facts Permit No ��� • _____.. Date_..... ..._._ Read, Sworn to �n 'bed _ Disapproved ... _ ... Date_ (Signed) _ - -_ -- - -• _ . _.. _- � Notar"Public, Staff swe Cf �.. Building Inspector �..'�..._ -� lvty Commission Expires -• �!rf![�a laf g;. . PLANNING BOARD- _,__............... .. •,� ,,- ___ _,,,DATE Chairman _ . _ -- _._... _�.__._._.._......_....___ Member .... Member .. ______..._. _ _._ .._. - - Member Member ..... Council Approved—­-­... Member .. - .»Date Disapproved .._.._....._. _......_...._ ». »......._. Date NOTE: A charge of $1.00 will be made for making corrections or changes to this application after apprmal has becn ed ,obtain 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 laqwetion at fmdW ' materials and /or workmanship. Y ® UTICA MUTUAL INSURANCE COMPANY ❑ GRAPHIC ARTS MUTUAL INSURANCE COMPANY UTICA, NEW YORK NEW YORK, N. Y. CERTIFICATE OF INSURANCE THIS IS TO CERTIFY that the policies designated below have been issued by the company checked above and are in -force on the date borne by this Certificate. This Certificate of Insurance neither affirmatively nor negatively amends, extends or alters the coverage afforded. 1. Name and address of person to whom this Certificate is issued. Name City Of Miami Shores Address 10050 N. E. 2nd Avenue, Miami Shores, Florida 2. Name and address of insured for whom this Certificate is issued. Name of insured John H. McGeary, Jr. Address 8340 N. E. 2nd Avenue, Miami, Florida 3. Location of operations of insured 8340 N. E. 2nd Avenue, Miami, Florida 4. Kinds of insurance afforded the insured. KINDS OF INSURANCE ' X Policy Number Effective Date Expiration Date Limits of Liability (a) Workmen's Compensation and Employers' Liability X W115191 7 -25 -72 7 -25 -73 As provided by law (b) General Liability Bodily Injury Premises - Operations Independent Contractors Completed Operations and Products Contractual $ 250,000 Each Person $ 500,000 Each Occurrence $ Aggregate - Products X 1101164LC 7-25-7Z 7-25-73 X rr t1 �t Property Damage Premises- Operations Independent Contractors Completed Operations and Products Contractual $ 25,000 Each Occurrence $ 25,000 Aggregate -Prem. Oper. $ 25, 000 Aggregate- Protective $ Aggregate- Products $ Aggregate - Contractual X 101164E 6 -25 -72 7 -25 -73 X BB tt BB (c) Automobile Liability Bodily Injury Owned Automobiles Hired Automobiles Non -owned Automobiles $ Each Person $ Each Occurrence Property Damage Owned Automobiles Hired Automobiles Non -owned Automobiles $ Each Occurrence (d) 'INSURANCE AFFORDED ONLY FOR HAZARDS INDICATED BY X 5. If any of the above policies are cancelled or changed during their term in such manner as to affect this certificate .....1.0......... days prior notice will be given to the persons indicated in Item 1 above. Notice by mail so addressed shall be sufficient compliance with this provision. The company does not assume any liability in the event of failure to give such notice, or for any error. UTICA MUTUAL INSURANCE COMPANY GRAPHIC ARTS MUTUAL INSURANCE COMPANY �C_ - 0 A,— Secretary a Secretary Countersigned at Date By y� Miami, Florida 10 -4 -72 /-)i � i ed Representative Agency V Number Elliott & McKiever I G2006 FORM 8 -C 125 Ed. 12 -71 AFF IDAV I'T STATE OF FLORIDA) W COUNTY OF DATE ) of the,` Village of'Miam!! *horess County of Dade. and State of Florida* being,'duly sworn, doth depose 4d say, that under the. provisions of Ordinance Now 185,, dated June 1:5, 1948* amendo. ing Paragraph (d) of Section B -368 of Ordihance Nn. 97 of the Building Code of Miami Shores Village, he desires to build a on Lot Block Of Subdivision,. that he is the owner of said p perty da iiiila be the owner of said - that he , vi. 11! do the work personally, and that. he wills at such times as are required by the Zoning and Building D�rectcr s- 1. File plans and specifications and obtain approval of the Planning.Board and the Building Inspector. 26 Apply for and secure a Permit. 3. Pay the required fees. 4& Execute the work in accordance with the provisions of this Code. 5• Apply for inspections. 6 File with the Building Inspector certificates that provis3vx has been made to carry the necessary Workmen's Compensation, Public Liability and Property Damage Instr ante. 7. File with the Building Inspector as the job progresses certi- f ieates showing the payment { required by the Federal Social Security Act to the State of'Florida or the United States of America. 80 Assume the responsibility of: not employing other than properly licensed contractors by Miami Shores Village for any part or Portion of the work. 9. Not set himself up as a "contractor ". 10. Sign an affidavit before commencing work to the effect that he has read this Article and will do the work personally and observe all of the requiremelnts of the Buildings Electrical,. Plumbing and Zoning Codes of` Miami Shores Village. Such affidavit to be properly notarized upon blanks to be supplied by the Building Inspector. ll. In order to. prevent abuses and subterfuge the right of such owner - builder as herein provideds ' is limited to but one Owner- builder pe=lt each 2 years* and where an owner- buiJ.dP-r- has once exercized the privi'',lege herein conferred no second app&ication for owner- builder permit shall be granted -in le:csr thm..2 years, unless the applicant is qualified as a licensed General Contractor under the applicable Ordinances of said Village. And Further this Deponent Gaye not% SUBSCRIBM AND -SWMM -TO. RTEORE .ME 19 this day of A.. D., NOTARY PUBLIC. MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT Permit No._ Date-_------__- - -- Application is hereby ma te o r 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. Owner's Name and Address_ __ -- � R No.__S3_L -___-- Street_ 4 Registered Architect and /or Engineer Employing Plumber's Name-A LA A io Location and Legal Description Lot Bk _ Street and Number where work is to be performed —No. /0 , State work to be performed and purpose of building (By Floors)__ _ C y /Fated"" `N el L 1__ _ -- ------ L! New Building - -.___ Remodeling Addition _ _ -_ Repairs— �._.-_. No. of Stories.._ Size Septic Tank —_— Type of Tank ______— ____ —___- --_Capacity Feet of Drain Tile __ -__ - -- Feet of Tank or Drain Field from Well _ ------ —_ _ —__. -- Nature of Water Supply: City Well, -- -Size of Soakage Pit_— _ - -__— ___ _ - - -__ ---- - -._ -- i r Amount of Permit � ._._._.� (S��) --- — - Z - ----..._....... ------ ----- Plumbspector. 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 a ye 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 at Ac pub notice or notices as are required by the Act. The undersigned agrees to employ only such sub - contractors, ° w �k to beo�perf0 under this permit, as are lid by Miami Shorn Village. r / STATE OF FLORIDA, i a. 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 dep ores 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. My Commission Expires Notary Public, State of Florida NOTE: A re- inspection fee of $1.00 will be made when such re- inspection is made-necessary by improper notice for inspection, or faulty materials and /or worlananship. BATH LAVA- SLOP LAUNDRY CATCH FLOOR DRINKING TOTAL CLOSETS TUBS SHOWERS TORIES SINKS SINKS TUBS URINALS BASIN DRAIN FOUNT'Ns FIXTURES CONTR. LIST CHECK SEPTIC SEWER DRAIN SOAKAGE GREASE SOLAR DEEP SPRKLR. 01WIM'G TANK CONN. FIELD PIT TRAP HEATER WELL- SYSTEM POOL CONTR. LIST CHECK Size Septic Tank —_— Type of Tank ______— ____ —___- --_Capacity Feet of Drain Tile __ -__ - -- Feet of Tank or Drain Field from Well _ ------ —_ _ —__. -- Nature of Water Supply: City Well, -- -Size of Soakage Pit_— _ - -__— ___ _ - - -__ ---- - -._ -- i r Amount of Permit � ._._._.� (S��) --- — - Z - ----..._....... ------ ----- Plumbspector. 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 a ye 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 at Ac pub notice or notices as are required by the Act. The undersigned agrees to employ only such sub - contractors, ° w �k to beo�perf0 under this permit, as are lid by Miami Shorn Village. r / STATE OF FLORIDA, i a. 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 dep ores 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. My Commission Expires Notary Public, State of Florida NOTE: A re- inspection fee of $1.00 will be made when such re- inspection is made-necessary by improper notice for inspection, or faulty materials and /or worlananship. 3056515610 02/18/2004 14:18 3056515610 MR C SEPTIC DRAIN CO FLORIDA DEPARTMENT OF HEALTH APPROVED 7 ,Fm► Ab, � a — - - PAGE 01 0 :Nl MIAMI SH13RES VILLAGE 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 Build' Ordinance of Miami Shores Village, Florida, and all provisions of the Laws of the State of Florida all ordinances of Miami Shores Vmiflag� 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 the work. Owner's Name and Address- No.3Rrlt Stt Registered Architect and/or Engineer - - -: - GIAXA)Up - --- - - --------- -- ------ - - - - -- Name and address of licensed contractor_ Wwx _WL fr IF ii�? -- - --- — - - ------------- - --------- — ----------- Location and legal description of lot to be built on: LAI 14 2 Block§- I Street and Number where work is to, 1 State work to be done and purpose of building (by floors _------------------ __ - - - - -- -and for no other purpose. New Building ---- )(F5____ ------- - -- Remodeling---------- - - - - -_ Addition—____ No. of Stories -------------------------- To be constructed of_d� - - ------------ Kind of foundation--- - -- ------ Roof Covering-_f E -------------------------------- Estimated Total cost of improvements ---------Amount of Permit ----------------- Zone cbage required.J2r0jo _______ Plan Cubage- — - — - - --- - - - - ------------- - -- - ----------------------------- Distance to next nearest) building- FT Size of Building LotJ0_%r__1t."2__________ - -__ - -------------------- Maximum live load to be home 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 t._jM��,Y Pix j. AJ wr 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 complied with the provisions thereof, and will require similar compliance from all contractors or sub-contractors employe by him wl 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 ublic notice or notices as are required' by the Act. The undersigned agrees to employ only such subcontr tors, on work -perfo n under this permit, as are licensed by Miami Shores Village. (Signed) �71Z tors, on STATE OF FLORIDA, COUNTY 'OF DADE. ss. Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally ap- peared me well known, and who, being by me fiIst duly sworn, upon oath I 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. Date Read, Sworn to and Subscribed before me. Disapproved Date- — ----- — - --------- - - VA Notary . Public, State of Florida (signed) B ` din'' ector My Commission PLANNING BOARD_ --.------------ ---DATE Chairman Member Member Member Member Member Council APPr0ved---------_______Date Disapproved 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 $1.00 will be charged when such re-inspection is made necessary by improper notice for inspection or faulty materials and/or workmanship. MIAMI SHORES VILLAGE ELECTRICAL INSPECTION DEPARTMENT APPLICATION FOR ELECTRICAL PERMIT Permit No......'.:....:: , . / :................ Date.........® / .�L ...... ............_........ Application is hereby made for the approval of the detailed statement of the plans and specifications herewith. submitt for the building or other structure herein described. This application is made in compliance and conformity with the Building Ordinance of Miami Shores Village, Florida, and all provisions of the Laws of the State of Florida, all ordinances of Miami Shores Village and all rules and regulations of the Building Division of Miami Shores Village shall be complied with. whether herein specified or not. A copy of approved plans and specifications must be kept at building during progress of work. Owners Name and Address...... Registered Architect and /or Engineer .................... ............................... Employing Electrician's Name_,; ... I... .............. I el. . Location and Legal Description Lot. ...... _ .............. ............................................. Block .......................................... Subdivision .................................. ......... Street and Number where work is to be State work to be performed and purpose New Building ............. .. .. Remodeling .......................... ..Addition................ , ........Repairs• :........ ..- ....No. of Stories.................... Overhead w .... .....................Amps... ..................... Main Service Site Feeders ...... .....Conduit................ Mafia S Underground ...,:... ...... ... Typeof Installation— Conduit ........................ Tubing :............... . ....... B.$. L ......................... Metal Moulding ........,............... _ ....... --------- _- •---- - - - - -- ---- • - - - -- --- - - - -•- - -- - - - - - -- - -- Amountof Permit $ .............r(.: / i.. ar..®......................... ............................... ......... ..... ...................... 9 _ .:. _ ...... The undersigned applicant for this building permit does hereby certify that he understands and accepts his ob igations as an employer of labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida /Permanent Supplement, and has complied with the provisions thereof, and will require similar compliance from all contractors or sub•contra�etop 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. (Signed) .......... .» ........................ .... ......... Master• 1?lectridan. STATE OF FLORIDA.. COUNTY OF DADE. ss' Before me, the undersigned authority, a notary public,. duly authorized to administer oaths and take acknowledgments, personally appeared.......................... . . ............................... . a.... ... .I........................... ...... .......... ...» ... .. ............ ..... .............. ................ ..... .............................. 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, and he has carefully read the foresoing application, and that he did sign the same, and that all facts therein by him stated are true. .. . . ............................. . ....... _ ........... ... . ... . ............ ........... My Commission .spires Notar.. Public State of Florida NOTE: A re inspection fee of $1.00 will be made when such re-inspection is made necessarq. by improper notice for inspection, or faulty materials and /or workmanship. $WITCH LIGHT- PLUG FIXTUR98 R6IRla, IRON RANGE RANGE WATER W. HEAT. g�ACE STRIP - TOTAL OUTLETS OUTLETS Rlc,E *10'1.15 NO• LAMPS OUTLET OUTLET OUTLET CONN. HEATER CONN. He7ATER HEATER CONTR. - LIST - - CHECK ENT. DIST. epeRvIcit $aRVICE MOTORS MOTORS NEON RADIO TOTAL $W. CAS. TEMP. PERM. O./ HP 1.8 HP TRANS. LIST 3 xv CHECK Overhead w .... .....................Amps... ..................... Main Service Site Feeders ...... .....Conduit................ Mafia S Underground ...,:... ...... ... Typeof Installation— Conduit ........................ Tubing :............... . ....... B.$. L ......................... Metal Moulding ........,............... _ ....... --------- _- •---- - - - - -- ---- • - - - -- --- - - - -•- - -- - - - - - -- - -- Amountof Permit $ .............r(.: / i.. ar..®......................... ............................... ......... ..... ...................... 9 _ .:. _ ...... The undersigned applicant for this building permit does hereby certify that he understands and accepts his ob igations as an employer of labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida /Permanent Supplement, and has complied with the provisions thereof, and will require similar compliance from all contractors or sub•contra�etop 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. (Signed) .......... .» ........................ .... ......... Master• 1?lectridan. STATE OF FLORIDA.. COUNTY OF DADE. ss' Before me, the undersigned authority, a notary public,. duly authorized to administer oaths and take acknowledgments, personally appeared.......................... . . ............................... . a.... ... .I........................... ...... .......... ...» ... .. ............ ..... .............. ................ ..... .............................. 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, and he has carefully read the foresoing application, and that he did sign the same, and that all facts therein by him stated are true. .. . . ............................. . ....... _ ........... ... . ... . ............ ........... My Commission .spires Notar.. Public State of Florida NOTE: A re inspection fee of $1.00 will be made when such re-inspection is made necessarq. by improper notice for inspection, or faulty materials and /or workmanship. 0 ' MIAMI SHORES VILLAGE 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 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 the work. c Date.. _ o� f:� - -''- - - j- � ........... _ ........... 19.- - - - - -- Owner's Name and Address. _. . c. . .__....---.-_....---•--- w�_ ��.__.. _..- •-- •---- •- •---------- ----_. No.-------- �=- �- •�-- - - - -.. Streetw..�L'....�_ .----- ��` = - - - -- Registered Architect and /or Engineer �3 <� Name and address of licensed contractor .. -:a_._ L.-. a- f- ••-- •.- •- •---=- 4_:!s_:.�:1. nd- -_�__� Location and legal description of lot to he built on: Lot - - - -- - ..--- ._...------ ••-- •-- -• -... Block .- ............................... Subdivision. ----------------- - --- - ------- - ---------------------•-----•----------- Street and Number where work is to be done ................. ._-_....... _ ----- __ - _-- _--- ..._--- ... -- -_- ............ --------- _.. State work to be done and p ose of building (by floors)_ - ._._.._..-----_ ............................... ___- __- .-------- _._._�_ ..__---..._ ... - ........... _.. - - - - L 4 7 _.).__...- ___ __ ............. _ ... _ ..................... -- - _ - -- _-.._...--_-_- ...... .. ............... _..- .... _..- __- ..._-....... - _-- -------- - ----------------- _-_•.- .-_........and for no other purpose. New ........ Remodeling _ ........................ Addition ....... _ -------- _....... Repairs ......................... No. of Stories .......................... To be constructed of_ .......... _ ......... -.... Kind of foundation----------- ... ....... ----------- --------- _..z .......... Roof Covering ................................................ Estimated Total cost of improvements $ ......... _ ::_......_.._...____._._.. .Amount of Permit $ ...... e_.®__._ ...... - ........................................... _........ Zone cubage required—­ Cubage .................. ____ ...... .......................... Distance to nest nearest building ------- -- _._...__Size of Building Lot ------ --_ ----- _•-___ ------- -_- -------------------------------------- Maximum live load to be home 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 to - -_- 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 complied 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 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. Remarks- ..._.. -.._ (Signed)_Y__12i.?_`!'J�.� __ --- 'Z Z`. -- STATE OF COUNTY OF Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally ap- peared- - - - .._.. _ ___ .._ -__ - ..... ..... --- --------------- ---- - - - - -- .._ __ .,._.------- - - --- - - ------.---•------ _. _.___. -.•.......... ---------- - --- - -_ me well known, and who, bein 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 foregoing application, and that he did sign the same, and that all facts therein by him stated are true. Permit No' �' - �___...._. Date._ __ Read, Sworn to and Subscribed before me. Disapproved _ _,_..- ------- - ------- Date_ Notary Public, State of Florida (Signed) ------ __ _.- ---------------------------------------- --_----------------_--------------- Building Inspector My Commission Expires -_--------•__---.------_ - -------------- _ ----- - ---- _---- -• PLANNING Chairman ._- _._...__._.__. - - -- _ _ ___. __ -. - - -- ._ ___ __.__ Member --- --- - ---------- - _........ Member ------ -. _- -_ - -__ Member Member ............ - _ - - - -- - - _____ __ Member - - - -- -- CouncilApproved_.. ---.- __- --_------ _--- _-- - - -___ _.._._._._,.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. MIAMI SHORES VILLAGE BUILDING INSPECTION DEPARTMENT APPLICATION FOR BUILDING PERMIT Application is hereby made for the approyal 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 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 piggress of the work. Date Ov Owner's Name and Address........ .1 . ...... .............. . ...... . . Registered Architect and/or Engineer...... . .................... ....... 1 ........ ............................. Name and address of licensed contractor... .................... »»». Location and legal description of lot to be built on: Lot. ...... . . . .................... ......... Bl ock.. ..................._...... - --.. Subdivision ._................ . . ........... . .. . .. Street and Number where work is to be done .... .......... State work to be done and purpose of building (by floors) 7ZE, . . . . ................... . . .... ............................ ..... .... -• ................ . ... . .... . ..... . ..................................... ... . . ............. . .. . ..... for no other purpose. New Building ............................. . Remodeling ......................... Addition... ................... Repairs ....... No. of Stories ...... f ........ . ...... To be constructed of............ ................ Kind of foundation. ..........................•.•................. Roof Covering ............... ....... ........... ... Estimated Total cost of improvements ...... Amount of Permit & ....... ............ . ...... . . . .............. . Zone cubage required ...... ........... . . ........ . ........... —_._-------Plan Cubage ............ — - - — --------- - --- — — - — ----------------------- - Distance to next nearest building.. ................................. ___.-_—_.Size of Building Lot ........ . . ..... . — - --- — - - ------ - ------ --_--------_---- - - - - - - - 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 besent to ................ __ ............................................................................... .................. __ ----------------------------------------------------------- ...... ........ . .......... - The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations as in employer of labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida, Pennanent 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 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 subconlract k t be performed under this permit, as are licensed by Miami Shores Village. 4, Remarks --- - ------- - --------- - - - -------- - — (Signed) STATE OF FLORIDA, COUNTY OF DADE . ss Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, persoyfally 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 tr e Permit No. Date ... 7 Read, Sworn to and Subscribed before me. DisapprovedDat ...... ................................................................... . . Notary Public, State of Florida (Signed) .. . ... . ............. ..... ...... ...... ........... -------- - ----- ............. Building Inspec 'r My Commission Expires._—__..___. F LANNING 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 h"n obtained from the Plannin.- 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. Y VILLAGE OF MIAMI SORES OWNER BUILDER DISCLOSURE ,STATEMENT NAME: DATE: b 1 AD•DRESS:3n Do hereby petition the Villa0e of Miami Shores to act as myown contractor pursuant to the laws 33 \' of the State of Florida, RS 489.103(7). And I have read and understood the following disclosure statement, which entitles me to work as my own contractor; I further understand that I as the owner must appear in person to complete all applications. State Law requires construction to -be done by a licensed contractor. You have applied for a permit under an exceptiop to the law. The exemption allows you, as the owner of your property, to act as your own contractor even though you do not have a license. You must supervise the construction youraolf. You may build or improve a one- family or two- family redidbnce. You may also build or improve a commercial building at a cost of $25,000.00 or less. The building must be for your own use and occupancy. It may not be built for sale-or lease. If you sell or lease a building you have built yourself within one year after the construction is complete, the law will presume that you built fot sale or lease, which is a violation bf this exemptiola. You Bray not hire an unlicensed person as a contractor. It is your responsibility to make sure the people employed by you helve licenses. rdquired by state law.and by county or municipal licensing ordinances. Any person working on your building who is not licensed mast work under your supervision and must be employed by you, which means that you must deduct F.LC.A and with- holdings tax and provide workers' Fompensation for that employee, all as prescribed by law. Your construction must comply with all applicable laws, ordinances, -buildings codes and zoning regulations. Please road and initial each paragraph. 1. I hold. title to the above property and I am planning on doing this construction Myself. Initial 2. I understand that as an owner- builder I must abide by all zoning ordinances and building regulations in effect at the time of permit application. •Inactive permits for a period of over 180 days will become null and void (expired) and a new permit will be required. to be issued for reinstatement of the p ermit, Initial 3. I have an understanding of the 2004 FBC & FRC and understand that this department and its inspectors are there to help enforce and interpret the code. There is a copy of the code in this office for review. Initial 4. I, understand that the building official and inspectors *are not there to design, alter or give advice on how to meet code — only if the structure meets the minimum code. M 1 91 MM�il 11 S. 1 understand that as an owner - builder, that any contractor disputes with sub- contractors and myself must be handled in a civil court with the advice of w attorney. The department will not mitigate any contract* disputes. Initial 6. I understand that if I compensate any person or company for work performed they are requited to hiave a business license in the county. If for any reason they do not posses a business license I will be responsible and liable for any wrong doing from this unlicensed company or person. Initial 7. I understatio• that if any person ,gets injured on my construction projcct –fhey are entitled to workmen's compensation. • Anil Ilk they do not posses a workmen's policy I could be held liable for all doctor and related cost which could include loss of wages during recovery from injury. Initial 8. 1 understand . that under state and local laws 'I can not do . any Electrical, Plumbing, Heating, Air & Roof work on my 'property with out first obtaining the proper permits by licensed contractors. Initial — Was acknowledged before me this CD day of 2W , 20 �j�AWII i BA=M-- who was personally known to me or who has Produced there License or as identification. OWNER dAft( IA-11 NOTARYa 5TA'�OF� c��11os ,QU�ATam �csp�Aaaco „� '�oz� f, - MIAMI SHORES VILLAGE BUILDING DEPARTMEN 305 - 795 -2204 Building Inspection Request Dat� Type Insp'n Permit No. L-. Na Address ' r Com ny l� � Phone # Inspectior Approved Correction u Re- Insp'n Fee ❑ BOUNDARY SURVEY. LANDS DESCRIBED IN PLAT BOOK 10 AT ADE COUNTY. FLORIDA. THIS SURVEY MAP IS NOT VALID WITHOUT SHEET 2 OF —2 0 ORIGINAL RAISED SEAL OF THE FLORIDA LICENSED SURVEYOR SIGNATURE AND SEAL CAN BE FOUND AT THE END OF REPORT. SURVEY NUMBER: 04-12-030 )RT ARE NOT COMPLETE Wn HOT TT TRF 0THFR N.E. 103RD STREET PAVING 75' R/W - 22' .ASPIL4LT I I Aga I �I �I I I I I I 5 5iDF,WALK ° d o ' ° P_25.24 a ° 35.00 — Ftvr� . — p I IRON ROD N ALK T S 2 2493 t �/ L=' ZJ93 ♦J. 9���Q�4� I n H 34 4 15.11 15.40 kL,L E �� 71.02 Z I \ ` 0. 21.50 N CLR. c7 W Q F.B. gSO N 3 w ° 0.30 > Q a 13.90 b `♦�' �•, ° ♦ y t� STOOP ,a`., ONE STORY e4 .� 8.67 CBS RES #390 4.0 ,a 3 1.5 9.35 f io N \ I . 4 27.10 54.1 iL CLR. gQ 6 0. 7.8 41. FIND lit" LP. I FND 3'CB WALL 102.1• PWR \Cjx a ClILZ �PWR -o POLE 030 0.30 POLE 9' ASPHALT PAVING 15' ALLEY O/H POWER & TELEPHONE LINES MIAMI SHORES BUILDING DEPARI'Mh i 305 - 795 -2204 Building Inspection Request 0y _ 'n Type Insp'n Permit No. 13 Addresa3 I I � ®� Q� Phone #S Inspection Date ` S Approved Correction Re -Insp' n Fee JLL 1 rte ncr W. �� PAGE 70, M THE SIGNA•TI 1p � 76AND OURS 9 = 2 RO & AND MAPPEI MAIL TO: PHONE (305) 221 -3416 TBE MAP AN 245 S.W. 44b St MIAMI, FLORIDA 33165 x,,'03 RD STREET _ W I 50 ? 50 52.02 I W �• / z, 30 eau �a 35 W 12 11 r1,0 9 IS 8 7 6 5 4 3 2 1 �00 LZIL • W 1 30 zI I d' 35 I W IZ N. E. 102ND STREET LEGEND & S"IROLS - ARC LENGTH Bhf -• BENCH MARI: R - RA PWRTRAN - POWER TRANSFORMER T - TANGGEE NT W\' .- WATER VALVE C -- CHORD AW - WATER METER D- ANGLE ? o cn- hIH - MANHOLE LID CALC - CALCULATED CB -CATCH BASIL. PCP PERMANEN7CUNII;CL CO - CLEAN- OUTC0VVF PO IN7 CL - CEA"TERUNI: PRh1 -• PER�INI ENT REFERENCE CBS - CONCRETE BLOC , STRUCIURI.. MONUMEP7 o0 13 14 15 16 17 18 19 20 21 22 23 24 -- 50 DH •• DRILL HOLE NOTALIFORSEVERALi N A - NOTAPPLICABLE N•'D - NAILS DISC P.O.B - POIN70F BEGM7NG y' MON - CO171JT5' h40NtJh1ENT CTY P O.0 -POINT OF COMMENaiiEN7 PKG SP - PARI:ING SPACE C M - CONCRETE hIONU�IENT 1 1 50 5227 I d' 35 I W IZ N. E. 102ND STREET LEGEND & S"IROLS - ARC LENGTH Bhf -• BENCH MARI: R - RA PWRTRAN - POWER TRANSFORMER T - TANGGEE NT W\' .- WATER VALVE C -- CHORD AW - WATER METER D- ANGLE P kT -- POWER d TELEPHONE LINES MEASURED ME -AS - h1EASURED hIH - MANHOLE LID CALC - CALCULATED CB -CATCH BASIL. PCP PERMANEN7CUNII;CL CO - CLEAN- OUTC0VVF PO IN7 CL - CEA"TERUNI: PRh1 -• PER�INI ENT REFERENCE CBS - CONCRETE BLOC , STRUCIURI.. MONUMEP7 CLP - CONCRETE LITE Poll, PC •- PO1NT OF CURVE CONIC - CONCRETE KM - RIGHT OF WAY FPL - FLORIDA POWER & LlQHl BM - BENCH MARK EL _ ELEVATION BASED ON 19:1) NGVl. FND IP - FOUND IRON PIPE p IR -FOUND IRON ROD CLR - CLEAR ENCRO - ENCROACHMENT C L F - CHAIN LINK FENCE WMF -- U IRE MESH FENCE TIT - DH •• DRILL HOLE NOTALIFORSEVERALi N A - NOTAPPLICABLE N•'D - NAILS DISC P.O.B - POIN70F BEGM7NG y' MON - CO171JT5' h40NtJh1ENT CTY P O.0 -POINT OF COMMENaiiEN7 PKG SP - PARI:ING SPACE C M - CONCRETE hIONU�IENT -- FIRE HYDRANT SAN SWR - SANITARY SEWEF H C PICG -• HANDICAP PARKING R%M - WATER MAIN 13 E - LTILTTY EASEMENT R'F - WOOD FENCE LOCATED IN: VILLAGE OF MIAMI SHORES, MIAMI -DADE COUNTY. FLORIDA . LOCATION SKETCH SCALE: 1 INCH = 100 FEET d, W 4 4kk, ,T Miami Shares nPPPOVED BY DATE 7()�,ITNIG DEPT f7EPT I _Zoov�c- E,_ T TO COMPLIANCE WITH All- FEDERAL O NTY PULES AND P.EGUTATIONS L�' I�t I - SCALE: 1 INCH = 20 FEET j MIAMI SHORES VILLAGE BUILDING DEPAR 305 - 795 -2204 Building Inspection Reque t Date % Type Insp'n Permit No. -P 7 (`f — L Name Address �a O h Company Phone # Inspection Date 'O Approved ❑ Correction ❑ Re- Insp'n Fee ❑ X&sti! y� �* Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL 33138 -0000 ��9RiDP' Phone: (305)795 -2204 Project Address 390 103 Street Miami Shores, FL 33138- Parcel Number 1132060134980 Block: Lot: MARK HUMBLES owner mrormanon Address Phone cell F MARK HUMBLES 390 103 Street (305)754 -0042 MIAMI SHORES FL 33138 -2433 Contractor(s) Phone Cell Phone OWNER Approved: Denied: of Construction: oification: Residential Fees Due Amount CCF $0.60 Education Surcharge $0.20 Permit Fee - Concrete & Masonry $100.00 Technology Fee $5.02 Total: _ $105.82 Additional Info: Repair Masonry Wall Valuation: $ 580.00 Total Sq Feet: 30 For Inspections please call: (305)762.4949 Invoice # Total Amt Paid Amt Due FW -8-09 -35558 $ 105.82 $ 105.82 $ 0.00 Check #: 107 Avaraore Cells Columns 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 responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are required for ELECTRICAL, PLUMBING, MECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work. 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. Futhermore, I authorize the above -named contractor to do the work stated August 06, 2009 Authorized Signature: Owner / Applicant / Contractor / Agent Date Building Department Copy August 06, 2009 1 MMI SHORES VILLAGE BUILDING DEPARTMENT 305- 795 -2204 Building Inspection Request Date Type Insp'n Permit Not Name Address Company Phone # Inspection Date Approved ❑ Correction Re -Insp' n Fee ❑ ' Inspection Worksheet Miami Shores Village 10060 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP- 121235 Permit Number: FW -8 -09 -1306 Scheduled Inspection Date: August 26, 2009 Permit Type: FenceMall Inspector: Bruhn, Norman Inspection Type: Final Owner: HUMBLES, MARK Work Classification: Masonry Job Address: 390 NE 103 Street Miami Shores, FL 33138- Phone Number (305)754 -0042 Project: <NONE> Parcel Number 1132060134980 Contractor: OWNER Comments Repair 10' of masonry wall Inspector Comments � Passed C Failed Correction Needed Re- Inspection ❑ Fee No Additional Inspections can be scheduled until re- inspection fee is paid. August 25, 2009 For Inspections please call: (305)762 -4949 Page 14 of 32 I M MI SHORES VILLAGE BUILDING DEPARTMENT 305- 795 -2204 Building Inspection Request Date 1 �..` TypeInsp'n 5v ITi ail 1(+kSG Permit No. �l" Name \V`� _l_ Address u tit t S1 Company ®(a, ( ho"tu (, t A Phone # -®5 S A6 ° 0A Inspection Date` Approved Correction Re -Insp' n Fee M �C MIAMI SHORES VILLAGE ELECTRICAL INSPECTION DEPARTMENT APPLICATION FOR ELECTRICAL PERMIT 7z( Permit No.......... ® ...... Date............ „( :. ..A X......... 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, Fiunda, 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. Owner's Name and Address... c. .! ........ . ...................No.......... '................Street. — 44K Af�.. z �.. �..�a'...... RegisteredArchitect and /or Engineer.... ................ ........................................ ....... ......................... ........................................ ................... ...................... Employing Electriciah's Name ... �.&. —Z. ... .............No...... rid. 1... ..................Street.sod.4 ...0 .... .t ....t...V,... Location and Legal Description Lot .................. .................... .............................. Block ................................ _ ........ Subdivision ...... ............................... :......... Street and Number where work is to be performed— No ........................cs�. ...................... ............Street.....✓.:s�... � :......�..f ..�._- d.............. State work to be performed and purpose of building (By Floors) ....................................................................................................... ............................... . New Building ................................ Remodeling ................................ Addition .............................. Repairs ...................................... No. of Stories................... Service Overhead '� Size Feeders .................... Conduit ................ Main Sw . .............................. Amps ........................... Main Fuses...................... Amps Underground Typeof Installation—Conduit ..... ......... .... ..... Tubing ..... .................. B.X.L ......................... Metal Moulding........................................ ............................... .......................................................... ............................... .............................................................................................. ................. »............. ..... » .......................... ............................... ...... ��1/ • ... ` !' .................... .... Amount of Permit $ .............................. ( Signed).... ............................... �... :. Electrical Inspector. The undersigned applicant for this building permit does hereby certify that he understands and accepts his ob lions as an employer of labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida ermanent 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 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. or ( Signed) ....... .................. ............................... ..... ............................... Master Electrician. STATE OF FLORIDA, COUNTY OF DARE. as. 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, and he has carefully read the foregoing application, and that he 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 such re-inspection is made necessary by improper notice for inspection, or faulty materials and /or workmanship. SWITCH LIGHT PLUG FIXTURES REFRIG. IRON RANGE RANGE WATER W. He". SPACE STRIP TOTAL OUTLETS OUTLETS REcF,P•T•s NO. LAMPs OUTLET OUTLET OUTLET CONN. HEATER CONN. HEATER HEATER CONTR. LIST LIST / �J p A ® � CHECK ENT. DIST. SERVICE SERVICE MOTORS MOTORS NEON RADIO TOTAL SW. CAS. TEMP. PERM. 0.1 HP 1.8 HP TRANS. J CHECK Service Overhead '� Size Feeders .................... Conduit ................ Main Sw . .............................. Amps ........................... Main Fuses...................... Amps Underground Typeof Installation—Conduit ..... ......... .... ..... Tubing ..... .................. B.X.L ......................... Metal Moulding........................................ ............................... .......................................................... ............................... .............................................................................................. ................. »............. ..... » .......................... ............................... ...... ��1/ • ... ` !' .................... .... Amount of Permit $ .............................. ( Signed).... ............................... �... :. Electrical Inspector. The undersigned applicant for this building permit does hereby certify that he understands and accepts his ob lions as an employer of labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida ermanent 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 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. or ( Signed) ....... .................. ............................... ..... ............................... Master Electrician. STATE OF FLORIDA, COUNTY OF DARE. as. 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, and he has carefully read the foregoing application, and that he 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 such re-inspection is made necessary by improper notice for inspection, or faulty materials and /or workmanship. a I I 1 1 ► ► 1 1 �1 1 ► I 1 ► I 1 I I ► 1 1 I 1 1 ► I I 1 ► 1 1 1 I I 1 1 ► 1 t N° CERTIFICATE OF OCCUPANCY MIAMI SHORES VILLAGE, FLORIDA BUILDING DIVISION 1703 Miami Shoresm Village, Fla.,e Owner, Agent or Tenant of Building Lo* I — *2 Block 31 Street A Approved use by Remarks: This Certificate of Occupancy is issued to the above named for building at. above named location only upon the express provision that the applicant will abide by and comply with all conditions of Ordinances Nos. 92, 93, 94 and 97, known as the Zoning, Electrical, Plumbing and Building Ordinances of Miami Shores Village pertaining to the erection, construction, alteration or remodeling of buildings or structures. BOIL ING DIVISION MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT Permit No ----------- _ - - .. 0. 10 i d /6 7 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 spedfied or not. A copy of approved plans and specifications must be kept at building during progress of work. 3. I�� �%- Owner's Name and Address ......... No.__'_`.. —%� — StfeeE -- � - -.. _.. - -• - -. .. _. Registered Architect and /or Er Employing Plumber's Name __ -- •-• --•- ........ .......... ..._w....... Location and Legal Description Lot ___ _ .._._ _ _._ rBllock _ ----- _ -__ -- Subdivision-____- . Street and Number where work is to be performed -No. 1 _ Street - . -. - -. ra.- .....t _.... - --------- — __..___. State work to be performed and purpose of building (By Floors)_.-..--- --- __ ----- - --- ------------- -- --- •- ------- --- --- - - - - -- -.--- . -- --- -.- - .-- • - -_ - -- New Building------- •-------- -- -- - --- -- - - - -- Remodeling--- ------------ - -- - -- Addition.-----•_- ............. Repairs ------- _................ No. of Stories.... _ ..... . BATH GLOf[Tf TUBS SHOWERS LAVA- TORIES SINKf SLOT SINKS LAUNDRY TUff URINALf CATCH BASIN FLOOR DRAIN DRINKING FOUNT'Nf TOTAL RIKTURtf UfT CHICK SWIM•G POOL SEPTIC TANK SEWER CONN• DRAIN FIELD SOAKAGE PIT GREASE TRAP SOLAR HEATER DEEP WELL SPRKLR. SYSTEM CONTR. LIST CHECK _ r- Size Septic Tank_ — -- - - — -- - - - -- - Type Of Tank------------------------------------- - - - - -- --- - - - - -- Capacity Gals...- Feet of Drain Tile .- _-- _ --------------- --- - -- -Dist. Feet of Tank or Drain Field from Well --- - -------- _.. - Nature of Water Supply: City - Well. -_ -_ _ ------- •- - - - - -- - . - -- - -- .__..Size of Soakage Pit ................... Amount of Permit (Signed) Plumbing Inspector. The undersigned applicant for this building permit does hereby certify that he understands and accepts his 0%figations as an employer of labor under the Florida Workmen's Compensation Act, being Section 5988, 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 permit; and will post or cause to be posted for inspection on the site of the work such public notice or notices are required by the Act. The undersigned agrees to employ only such sub - con tractors. on work to be performed under this permit, as are licensed by Miami Shores Village. _77:r� STATE OF FLORIDA, 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 he did sign the same, and that all facts therein by him stated are true. My Commissjon moires Notary Public, State of Florida NOTE: A re- inspection fee of $1.00 will be made when M& rs4nVOetion is made- neoessary by improper notice for insPoc"14 or faulty materials and /or workmanship. CERTIFICATE OF OCCUPANCY Nn 1703 MIAMI SHORES VILLAGE, FLORIDA BUILDING DIVISION Miami Shores Village, Fla., Owner, Agent or Tenant of Building `" Block Subdivisi Street Address Approved use by occupancy This Certificate of Occupancy is issued to the above named for building at above named location only upon the express provision that the applicant will abide by and comply with all conditions of Ordinances Nos. 92, 93, 94 and 97, known 4s the Zoning, Electrical, Plumbing and Building Ordinances of Miami Shores Village pertaining to the erection, construction, alteration or remodeling of buildings or structures. +y BUILDING DIVISION J X00 ,O d) t�l. E_ 1(37:;o `�.° ST Ln . r Q99�3 g99-I 3 � oG IZ l Iv 9 8 1 S 4,O' Dic), r hr i 0 Li Z I � i 1¢ 15 IC; 1� I$ 19 20 ZI ZZ 2.3 Z11 r '7 X995 , 4 -D 5116 r ,n r (:Z,d Sca 1e ►.. _ CD SKETCH OF SURVEY I and 2, Block 37, AN AMENDED PLAT OF MIAMI SHORES, SECTION NO. it �^c�rciSng to the plat thereof recorded in Plat Book 10, at Page 70, of the Public Records of Dade County, Florida. For John H. Mc Geary, Sr., BISCAYNE ENGINEERING COMPANY Order ## 26808 Civil Engineers August 9th, 1952• # 977 -33 Miami Florida Scales Shown 'WE HEREBY IERTIFY That the' attached "SKETCH OF SURVEY" or the above described property is true and correct to the beat of our knowledge and belief as recently surveyed and platted under our direction; also that there are no encroachments unless shown thereon. BISCAYNE ENGINEERING COMPANY By See I Y. J. Bennett RegiJ41 stered Engineer # 145 Registered Surveyor # 46 STATE OF FLORIDA. 0 CP 4&! Drill HOic-- o.o¢ in wall COI I C. \VG PI F,�- 2 =Z5 i - C J °O jl1 C d V� i , � � PiP� Drill 1101 U oG +r� walk BUILDING ELECTRICAL. ❑ PLUMBING ❑ ROOFING ❑ Owner of Building Architect - ontractor or Builder- Legal. Lot Address of Building MIAMI SHORES VILLAGE, FLORIDA DATE #• I95 PERMIT N° 13 810 Contractor's License No Work to be performed under this 131. Subdi- vision Value of Project $ 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, }n the statements or specifications and that he assumes responsibility for work done by his agents, servants or employees. Signed: —" BY SPECTOR 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 responsibility for all work done by either, myself, my agent, servant or employee. CONTRACTOR OR BUILDER BY AUTHORITY MIAMI SHORES VILLAGE, FLORIDA BUILDING ❑ DATE 195 ELECTRICAL. ❑ PERMIT 1N° 13859 Contractors PLUMBING ❑ License No ROOFING ❑ Work to be performed under this Permit Owner i Buildinc Architec ontrac or Build Legal Descripi Address Buildin Df r :t for er Lot I II Bl. S Subdi- ion. v vision of V Value of A Amt. of --- 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. µ Signed: BY INSPECTOR 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 responsibility for all work done by either, myself, my agent, servant or employee. CONTRACTOR OR BUILDER BY AUTHORITY BUILDING ELECTRICAL PLUMING ROOFING Owner of Building Architect , ontractor or Builder Legal Lot MIAMI SHORES VILLAGE, FLORIDA ❑ DATE ❑ PERMIT N° 13979 Contractor's ❑ License No— ❑ Work to be performed under this Permit Bl. Subdi- vision 195 Address of " °`• F II Value of �: II Amt, of $ #t �,,. Building 4 0\4 Project $ 4 •: 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. Signed: .- BY INSPECTOR 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 responsibility for all work done by either, myself, my agent, servant or employee. of Awe COMACTOR M BUILDER BY AUTHORITY BUILDING ❑ ELECTRICAL ❑ PLUMBING ❑ ROOFING ID Owner of Building Architect - ontractor or Builder Legal Lot MIAMI SHORES VILLAGE, FLORIDA PERMIT 1X? 13988 Work to be performed under this Bl. Subdi- vision DATE. I ;L- f -. r- 2'ff 195 Contractors License No- Address of Value of Amt. of Building Project $ 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. , a°a Signed: '"V`°> "%. r BY- INSPECTOR 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 responsibility for all work done by either, myself, my agent, servant or employee. CO OR BUILDER t'j BY ice+ AUTHORITY I I An BUILDING ELECTRICAL PLUMBING MIAMI SHORES VILLAGE, FLORIDA ❑ DATE ❑ PERMIT ? 14767 Contractor's ❑ License No._ ROOFING ❑ Work to be performed under this Permit Owner of I) Building _ Architect - ontractor or Builder Legal Lot II Bl. Descrinti on Subdi- vision Address of II Value of Amt. of Building Project $ Permit $ 95__ 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. Signed: BY INSPECTOR 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 responsibility for all work done by either, myself, my agent, servant or employee. CONTRACTOR OR BUILDER BY AUTHORITY BUILDING ELECTRICAL PLUMBING ROOFING Owner Buildin Archite Contrac or Build Legal Descrip Address Buildin ❑ DATE ❑ PERMIT ? 14005 Contractor's ❑ License No._ ❑ Work to be performed under this Permit 95 of Ct for „ er - - -- - — Lot II BL Subdi- tion. vision of Value of Amt, of Building Project $ 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. Signed: — BY INSPECTOR 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 responsibility for all work done by either, myself, my agent, servant or employee. CONTRACTOR OR BUILDER BY AUTHORITY 0 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. Signed: — BY INSPECTOR 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 responsibility for all work done by either, myself, my agent, servant or employee. CONTRACTOR OR BUILDER BY AUTHORITY 0 BUILDING ELECTRICAL PLUMBING ROOFING Owner Buildin Archite -ontra or Buil� Legal Descrix Addres Buildin MIAMI SHORES VILLAGE, FLORIDA ❑ DATE'' 195 ❑ PERMIT N° 14 018 Contractor's License No. F-1 Work to be performed under this Permit — of g ct :tor ler Lot II Bl. Subdi- tion. vision 3 of X Value of Project $ 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. Signed: BY INSPECTOR 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 responsibility for all work done by either, myself, my agent, servant or employee. CONTRACTOR OR BUILDER BY AUTHORITY MIAMI SHORES VILLAGE, FLORIDA BUILDING ❑ DATE ELECTRICAL ❑ PERMIT N? 14074 Contractor's PLUMBING ❑ License No. ROOFING ❑ Work to be performed under this Permit ----- - Owner of II Building _ Architect Contractor or Builder__ Legal Lot II B1. Subdi- vision 95 Address of Value of Amt. of Building 11 Project $ 11 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. Signed: BY INSPECTOR 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. 1In accepting this permit I assume responsibility for all work done by either, myself, my agent, servant or employee. CONTRACTOR OR BUILDER BY AUTHORITY / 1) � MIAMI SHORES VILLAGE, FLORIDA BUILDING ❑ E. DAT 195_ ELECTRICAL ❑ PERMIT NO 13851 Contractor's PLUMBING ❑ License No. ROOFING ❑ Work to be performed under this Permit Owner of t i Building "°t` `�--�' `" i ASP Architect k' - ontractor or Builder Legal Lot II Bl. Subdi- Description. vision Address of r''' Value of I Amt. of Building. ' x `•...� Project $ 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. - - Signed: i` BY INSPE 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 responsibility for all work done by either, myself, my agent, servant or employee. CONTRACTOR OR BUILDER BY AUTHORITY THIS LICENSE MUST BE DISPLAYED IN A CONSPICUOUS PLACE A Penalty is imposed for failure to keep this license exhibited at your establishment or place of business TRIPLICATE W 11111a�e�a��I1�Wffiti�'�i� This License Expires r.11 3,953 N° 6562 In consideration of the sum of yet` ivy !/�0 3�.» ..»........,w««.a.. ►.. , �. �......,..004ft,,,....M, Dollars $ - Paid to Miami 'Shores Village, Dade County, State of Florida, Total :I• rtr Address L-02 1I#3+ U ! is hereby licensed to engage in or operate the business of_ 0rM0 •.bU11 .V 2.1oowa **izos SIX mwrAw f..vm tiew of 196uwev For the period beginning and ending 4=11 Ali, 125' subject to the Provisions of all ordinances. (SEAL) Date Issued' 1 MIAMI SHORES VILLAGE, FLORIDA VILLAGE MANAGER THIS LICENSE NOT TRANSFERABLE WITHOUT APPROVAL OF THE VILLAGE MANAGER OWNER'S NAME PRESENT ADDRESS LICENSE NO. PHONE NO. john f . ?kIcG'cary gr 8635 ^Dixie TipIj . 6562 JOB LOCATION (ST. OR AVE.) LOT BLOCK SUBDIVISION 10 N.21. 100rs St. 1 -2 3? T?S GENERAL CONTRACTOR ADDRESS PHONE NO. LICENSE NO. inner- builder I I I p �- - -- BUILDER'S BOND 1?810 DATE 10 -15 -�2 ����� I1,A6 BUILDING PERMIT NO. PERMIT FEE S NO. DATE 21,275 10, 000 ZONE REQUIREMENTS CU. FT. PLAN CUBE CU. FT. EST. COST $ DATE DRAWINGS, SPECIFICATIONS, RESTRICTIONS AND CUBE CHECKED BY: TYPE STORIES ROOF CONSTRUCTION INTERIOR CONSTRUCTION x I CEO I 1 I ti l- I o,-.k floors, plaster walls and NEW CONSTRUCTION e ­14- DESCR IPTION t''q 12 bd=...-2 baths - living room - jalousie - dining room - kitchen - utility REPAIRS_ porch and 2 car garage APPROVED SUBMITTED TO PLANNING BOARD RE- SUBMITTED TO PLANNING BOAR CERTIFICATE OF OCCUPANCY NO. �� I ISSUED -V-J I B BUILDING PERMIT AND INSPECTION R DESCR,PTIOM RRED TO COUNCIL REMARKS iC�V /i I TO RD -MIAMI SHORES VILLAGE REASONS BUILDING INSPECTIONS INSPECTIONS DATE B/Y RE- INSPECT BY RE- INSPECT BY FOUNDATION /4' -j PERMIT NO. DATE FEE TEMPORARY SERVICE °,„.,, BEAMS & LINTELS / - / ai ^I^a' �k SEPTIC TANK - FRAMING- SEWER $ MOTORS g SOLAR HEATER FIXTURES g GAS FINAL g DATE BY RE- INSPECT BY g CLEAN -UP DATE Y RE- INSPECT BY RE- INSPECT BY PLUMBING PERMITS & INSPECTIONS CONTRACTOR PHONE r -g PERMIT NO. I a DATE �� 7�'- Sr �"�� FEE $ J Q � NEW BLDG. I ALT RATION ADDITION REPAIRS SPECIAL PERMITS PERMIT NO. DATE FEE TEMPORARY SERVICE °,„.,, Q'I• °i.,.a_ $ %� $ SEPTIC TANK - $ SEWER $ MOTORS g SOLAR HEATER FIXTURES g GAS g DATE BY RE- INSPECT BY g INSPECTIONS DATE Y RE- INSPECT BY RE- INSPECT BY ROUGHING ROUGHING o- Y GAS H. W. HEATER CONN SEWER RANGE CONN. SEPTIC TANK SOLAR HEATER FIXTURES & FINAL FIXTURES i ELECTRICAL PERMITS & INSPECTIONS CONTRACTOR - W PHONE PERMIT NC I d- L FEES / 6 NEW BLDG. ALTERATION ADDITION REPAIRS SPECIAL PERMITS PERMIT NO DATE FEE TEMPORARY SERVICE °,„.,, Q'I• °i.,.a_ $ %� H. W. HEATER CONN. O' RANGE CONN. $ MOTORS $ FIXTURES $ INSPECTIONS DATE BY RE- INSPECT BY RE- INSPECT BY TEMP. SERVICE ROUGHING o- Y H. W. HEATER CONN RANGE CONN. FIXTURES & FINAL APPROVAL TO POWER CO. FOR SERVICE DATE" 1 ,Lv�,. Architect Contractor or Builder Legal Lot I /Subdi- Description I Bl. vision — Address of Value of Amount of Building Project " ° 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 tatements or specifications and that he assumes responsibility for work done by his agents, servants or employees. Signed. - ..�, -s_,_. ..... 11 INSPECTOR 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 ac- cepting this permit I assume responsibility for all work done by either, myself, my agent, servant or employee. CONTRACTOR OR BUILDER N A I f d BY AUTHORITY MIAMI SHORES VILLAGE, FLORIDA BUILDING El ELECTRICAL ❑ DATE `' ° -- 195 PLUMBING ❑❑ PERMIT N° 5302 Contractor's License No. ROOFING ❑ ❑ Work to be performed under this Permit Owner of - Building Architect Contractor or Builder Legal Lot I /Subdi- Description I Bl. vision — Address of Value of Amount of Building Project " ° 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 tatements or specifications and that he assumes responsibility for work done by his agents, servants or employees. Signed. - ..�, -s_,_. ..... 11 INSPECTOR 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 ac- cepting this permit I assume responsibility for all work done by either, myself, my agent, servant or employee. CONTRACTOR OR BUILDER N A I f d BY AUTHORITY MIAMI SHORES VILLAGE. FLORIDA BUILDING ❑ ELECTRICAL ❑ DATE /c, r � � 195 PLUMBING ❑ PERMIT X 6240 Contractor's License No. ROOFING ❑ ❑ Work to be performed under this Permit — Owner of {r° + Building Architect _ Contractor f. - or Builder Legal Lot Description I Bl. I? Subdi- vision i.:r. Address of Value of Amount of Building Project " ` £ ' i` _ Project $ 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 andAat he assumes responsibility for work done by his agents, servants or employees. Signed: `` �/ _ . –_ ' BY: — - - - -- — INSPECTOR 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 ac- cepting this permit I assume responsibility for all work done by either, myself, my agent, servant or employee. CONTRACTOR OR BUILDER ,s4 BY AUTHORITY BUILDING ❑ ELECTRICAL ❑ PLUMBING ❑ ROOFING ❑ -_ EJ Owner of Building Architect Contractor or Builder MIAMI SHORES VILLAGE, FLORIDA Date—_.. PERMIT N? 9089 Contractor's License No. Work to be performed under this Perm Legal Lat Subdi- i X Description Bl, vision Sq. Ft. _ Address of Value of Amount of Building _ Project $ 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 applica- tion 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 respon- sibility for work done by his agents, servants or employees. Signed: — (INSPECTOR) BY —_ 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 h. assume responsibility for all work done by either, myself, my agent, servant or employee. CONTRA C,TA o BUILDER BY AUTHORITY BUILDING Miami Shores Village (,IZG(c Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 i 6 2006 Permit No. PERMIT APPLICATION N Master Permit No. FBC 2004 BY _ - - - - -- Permit Type (circle): Building Electrical Plumbing Mechanical Roofing Owner's Name (Fee Simple Titleholder) V1 ANR _V'_ Phone # 73 Ca'� Owner's Address - 3°10 'N •V. \ Q,S S`'�R�', City 9NkkvP � Sti%oR.C�State Wit_ Zip '3`d 13Fr- Tenant/Lessee Name Phone # 30-5 _1S\ — "1" 1 X03 Job Address (where the work is being done) City Miami Shores Village County Miami -Dade Zip FOLIO / PARCEL Is Building Historically Designated YES NO 7�: Contractor's Company Name Phone # Contractor's Address City Qualifier Name State Certificate or Registration No. Architect/Engineer's Name (if applicable) State _Zip_ Phone # Certificate of Competency No. Phone # Value of Work For this Permit $ t{' _o kD Square/ Linear Footage Of Work: \-lap - tr�,1,.v Type of Work: ❑Addition ❑Alteration ❑New Repair/Replace ❑ Demolition Describe Work: e-W �C��L%- O{2�VQsJ�\c•� * * * *** ** Fees***** * *� * *� *,� * * * *��� *� * * *�� *�� *� * ** Submittal Fee $ Permit Fee $ J Z 1� CCF $ CO /CC Notary $ Training/Education Fee $ Scanning $ I Radon Bond $ Structural Review. $ Code Enforcement $ DPBR $ Technology Fee $ _ Zoning $ Double Fee $ _- - - - -- Total Fee Now Due $ See Reverse side -+ Bonding Company's Name (if applicable) Bonding Company's Address City State Mortgage Lender's Name (if applicable) Mortgage Lender's Address City State Zip 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 $2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged Signature Owner or Agent The forego' g instrument was w,as acknowledged before me this J(.0 day of lA'V1G' 20(�, by _ ` !G� v- )c kit, 4,j,( who is personally known to me or who has produced As identifion and who did take an oath. NOTARY PUBLIC /^ f# Sign: lJ'yL� i Signature_ Contractor The foregoing instrument was acknowledged before me this day of .20 ;, by who is personally known to me or who has produced as identification and who did take an oath. NOTARY PUBLIC: Sign: Print: , ",,, Gilria P r �"`•'�$°i,� 2 C(i0 Print: My Commission Ex q. _Commission #00273065 P My Commission Expires: +;.....: Expire�sy: DEC. 07, 2,1007 WW . bA(4 lUtYcom APPLICATION APPROVED BY (Revised 02/08106) `-e 1A10 (A Plans Examiner Engineer Zoning 4 oft T Ito DADE wow Altusa Tile Alfareria del Turbio, S.A. Barquisimeto, Venezuela IIIETROPOLITAN DAUE COUNTY. FLORIDA METRO -DADE FLAGLER BUILDING 2C:_-.•-.� COr.E COMPLIANCE DEPARTMENT SUITE 1603 METRO -DADE Fl GLEA BUILDING 140 WEST FLAGLER STREET MIAMI. FLORIDA 73170.1569 (705) 375 -2901 FAx (3os) ws-290a t 1 I N 1► t 1 ► 1 1 J Your application for Product Approval of A Itusik TI ti ^ Ihortr or Adhesive cwt Clav "Altusa S" Bootle[ jilts under Chapter 8 of the Metropolitan Dade County Code governing the use of Alternate Materials and Types of Construction, and completely described in the plans, specifications and calculations as submitted by Rediaad Technologies, The Center for Applied Engineering. Inc., and Testwell Craig Laboratories used in Dade County. INC- has been recommended for acceptance by the Building Code Compliance Department to Florida under the specific and standard conditions set Conti herein. The approval shall be valid for a period of three years. The Building Code Compliance Department reserves the right to secure a product or material at any time for a jobsite or manufacturer plant for quality control testing. If product or material fail to perform in the approved manner, the Code Compliance Department may �ent. modiify or suspend the use of such product or material immediately. The Building Code Compliance Dep the right to require testing of this product or material should any amendments to the South Florida Building Code be enacted affecting this product or material. The expense of such testing will be incurred by the Manufacturer. �/ 0 PRODUCT NO.: Raul Rodriguez ACCEPTANCE NO.: $i�2L1.114- 9914.01 Produc_ Co—ml Division EXPTR ^:S: FEB 1 q 1997 Supervisor PLEASE NOTE - THIS IS THE COVERSHEET. SEE ADDITIONAL PAGES . FOR SPECIFIC AND GENERAL BUILDING CODE COMMITTEE This application for Product Approval has been reviewed by the Metropolitan Dade County Building Code C impliance Department and approved by the Building Code Committee to be used in Dade Count ,Florida under 1110 conditions set forth above. n FEB 7 1) 1995 APPROVED: Charles Danger, P.E., Director Building Code Compliance Department Metropolitan Dade County PRODUCT CONTROL NOTICE OF ACCEPTANCE ROO7!ING SYSTEM APPROVAL Applicant: Altusa Tile Alfareria del Turbio. S.A. Barquisimeto, Venezuela cat==: Prepared Roofing $ub- - atntorv: Tile Nail- on/Monar Set/Adhesive Set $yb Tvee: Clay Product Control No.: _94- 0914.01 Approval Date: Expiration Date: FEB 2 2 199 � FEB 1 4 1997 Alfareria de) Turbio, S.A. (Altusa), located in BarquisimeW. Venez:te!a, manufacturers c-a•- -of tile for nail -on, mortar set or adhesive set applications. All tile is manufactured from natural Venez- :Plan "Altusa S" the profile. @sFer to arloronriate clays. This P a t t l Aonrtival relate4 to Altusa! Product Control ADnrovak for other the orofles. The "Altusa S" tile profile is available in a variety of natural clay colors ana has matching trim pieces used for rake hip, ridge hip, and valley terminations. These accassones are manufactured for all " profiles and form a part of this Product Control Approval. Optional rubber or clay eave closures are also available. Altusa roof tiles have been tested in compliance with the South Florida Building Code requirements for clay, nail -on, mortar set or adhesive set tile applications. The minimum roof slope for the "Altusa S" nail -or, tiles shall be 2 ":12 ". See the "Profile Drawing" section in this approval for the "Altusa S" profile drawing. The "Altusa S" profile has been tested for loth wind characteristics and static uplift performance, therefore. any consideration for installation shall be done as a 'Moment Based Svstem'. Data for attachment calculations is noted in Tables I through 4 of this Approval. Almar (USA), Inc- located in Miami, Florida, is the sole approved importer under contract for selling and distributing Altusa products in the South Florida jurisdiction. Contact: Carlos J. Fernandez General Manager Altusa Tile, Aimar (USA), Inc. 6645 Northwest 77th Avenue Miami, FL 33166 (305) 471 -5830 Raul Rodriguez Product Control No.: 240914.01 SYSTEM LIMITATIONS (CONTINUED) 8 All tiles shall bear the imprint or identifiable marking of the manufacturers name or logo for identification in the Feld. 9. The Altusa "Altusa S" the profile has been tested for both wind characteristics and static uplift performance. therefore, attachment calculations for installation in compliance with Dade County Protocol PA 115 or PA 127 shall be done as a'Moment Based System = 10. Applications for roofing permits shall include a completed Section 11 of the Uniform Building Permit. a copy of Ahusa Tile's current specifications and details, a copy of this Product Control Approval and a copy of the Product Control Approval of any Roofing Component used in the proposed the application. Reference shall be made to appropriate data for the required fire rating. I i. The applicant shall retain the services of a Dade County certified testing laboratory to maintain quality control in compliance with the South Florida Building Code and related protocols. 12. Any amendments to these provisions shall be in compliance with Sections 203 and 204 of the South Florida Building Code. .I, t Product Control No. 2-n41 .1 DATA FOR ATTACIIIUENT CALCULATIONS Table 1: Aerodynamic Multiplier - a (ft') from PA 108 Testing Tile x (ft') ]. (ft') Profile Batten Application Direct Deck Application Itusa 'S' Tile - 0.29 0.31 Table 2: Restoring Moments due to Gravity - Mo (ft4bf) from PA 102 Testing Tile 3 "Ar 4 ":12" 5 ":12" 6 ":12" 7 ":12" or Profile or less 1 nail 2 nails 1 greater Battens Direct Battens Direct Battens Direct Battens Direct Battens Dir Deck 6.20 Deck 28.70 31.80 21.20 Deck 7634. Deck De Altura IT Tile 4.47 5.35 4.40 5.27 4.31 5.16 ' 4.20 5A3 4.08 N/ Table 3: Attachment Resistance Expressed as a Moment - M, {tt -Ibf) from PA 102 and PA 1021A1 Testina Tile Profile TILE APPLICATION APPROVED NAILS APPROVED SCREWS APPROVED FIELD CLIP WITH: APPROVE EAVES CLI WITH: 1 nad 2 nails 1 screw 2 screws 1 nail 2 nails 1 2 nAttu sa'S'Tile Battens N/A N/A N/A 26.80' N/A, N/A jnad NNDirect Deck 6.20 8.40 28.70 31.80 21.20 25.30 7634. — rw use n—atwuon over uanens snan ue *a it zn: King, corrosion resistant, Utuk- Drive screws install in two manufactured holes located 131.7 and t' /; from the head of the tile. Table 4: Attachment Resistance Expressed as a Moment - M, (ft -lbf) from PA 101 Testing Tile Profit* Tile Application Attachment Resistance Altusa 'S' Tile `Mortar Set . 24 50 Adhesive Set 66 50 I - /11� I '- H..dricue, _._ __._ R.wl Test Arencv Redland Technologies Redland Technologies T Ire Center for Applied f neineering. Inc. The Center for Applied Eneinecring.Inc. The Center for Applied Engineering. Inc. Redland Technologies Product Control No.. q4-0914 01 TEST REPORTS SYSTEMS Test Identifier 7161 -03 Test Name/Report Static uplift Testing Appendix 111 PA 102 7161 -03 Static Uplift Testing Appendix III PA 102(A) 25- 7200 -1 Static Uplift Testing 94 -084 94 -083 7161 -03 Appendix 11 Redland Technoloeies Letter Dated Aug. 1, 1994 Redland Technologies Redland Technoloeies The Center for Applied E ngineering. Inc lesmell Craig laboratories Consultants- Inc. P0647 -01 P0402 Project No. 307025 Test NNIDC -78 Lab aAAP -2 Tech: A. Porcello PA 102 (Quik -Drive Screws, Battens) Static Uplift Testing PA 101 (Mortar Set) Static Uplift Testing PA 101 (Adhesive Set) Wind Tunnel Testing PA 108 (Nail -On) Wind Tunnel Testing PA 108 (Nail -On) Wind Tunnel Testing PA 108 (Mortar Sc:) Withdrawal Resistance Testing of screw vs. sm nth shank nails Wind Driven Rain PA 100 Physical Propenie• ASTM C 1167 It.u�l Ko.ln.�n: Data Dec. 1991 Dec. 1991 Feb. 1995 May 1994 April 1994 Dec. 1991 Aug. 1994 Aug. 1994 Sept. 1993 Oct. 1994 Oct. 1994 Product Control No.: _94.04 .Lnl_ s SYSTEMS Deck Type: Wood, Non - insulated Deck Description: New Construction or greater plywood or wood plank. SYSTEM A: Counter -Batten Application Slope Range: 2 ":12" to 7 ":12" Note: Counter- Battens, as noted below, are required for slope range 2 ":12" to less than 4 ":12" and are optional for slopes of 4 ":12" to 7 ":12 ". For slopes exceeding 7 ":12 ", refer to System C. Underlayment: Install choice of approved underlayment system, noted on Page 1 or 2 of (lade County Protocol PA 118, in compliance with Section 3.02 of PA 118. Vertical Battens: Install vertical battens of pressure treated or decay resistant lumber having minimum dimensions of nominal 1" x 2 ". Vertical Battens shall be set in a continuous bed of flashing cement ' /r" thick and secured not greater than 24" o.c. into the sheathing with approved, corrosion resistant fasteners. Vertical battens shall be positioned over the top chord of the roof trusses. (See PA 118.) Horizontal Battens: Install horizontal battens of pressure treated or decay resistant lumber having minimum dimensions of nominal I" x 4 ". Horizontal battens shall be installed over vertical battens at a spacing to provide a tile overlap not less than 3" and secured through the vertical batten and sheathing with approved, corrosion resistant fasteners. (See PA 118.) Roofing Tile: Install the in compliance with PA 118 using one of the approved methods of attachment for batten applications noted in Table 3, attached. The method of attachment utilized shall provide sufficient attachment resistance expressed as a moment to meet or exceed the required moment of resistance determined in compliance with PA I IS or PA 127. Comments: 1. For re-roof applications, "/„" plywood is an acceptable substrate. 2. Clips are required on all cave tile. s Product Asphalt Primer Roofing Nails Tin Caps Food Battens bile Nails rile Screws Roof Tile Mortar ("I ilellter" ") Root I tic Adhesive t "I'oI, pia M� AI1160 ") pjmc s*on N/A min. 12 ga. with head min. 32 ga. min. 1' /r" o.d. max. 2" o.d. vertical min. I" x 4" h4tJI.MW min. I" x 4" for use with vertical barrens or min. I" x 2" for use alone min. 8d x 2' /a" or min. iOd x 3" min. 118 x 21/," or min. 410 x 2" NIA N/A Product Control No.: 93-0914.01 Test e111MAISAUR s Product Description Manufacturer ASTM D 41 Cut back, asphalt generic Test based coating used to Product facilitate bonding of ypciftcations PA 114 dissimilar materials. generic PA 114 Annular ring shank, generic Appendix E hot dipped, electro or min. '/1" width PA 123 mechanically galv.: Bermuda Roof roofing nails for use Company. Inc. stainless steel, in underlayment PCA $194- 0614.01 attachment. galvanized steel or PA 114 Corrosion resistant generic Appendix E circular disc for use in Inc. underlavment PCA #94- 0401.01 clips for supplemental attachment Wood Preservers Salt pressure treated generic Institute LP - 2 or decay resistant lumber battens PA 114 Corrosion resistant, generic Appendix E screw, smooth or Test annular ring shank Product nails. ypciftcations PA 114 Corrosion resistant, generic Appendix E coated. coarse thread Corrosion resistant generic wood screws. min. '/1" width PA 123 Prepared mortar mix Bermuda Roof designed for mortar Company. Inc. stainless steel, set roof the PCA $194- 0614.01 applications. galvanized steel or See PCA Two component Polyfoam Products. polyurethane adhesive Inc. designed for adhesive PCA #94- 0401.01 clips for supplemental set roof tile applications. the attachment. Clips are installed with It.ud N.•.In.,wv Product Control No.: 94 -0914 01_. Test Product Product Dimensions ypciftcations Description ManufMWUE Flurricane Clip & clips PA 114 Corrosion resistant generic Fasteners min. '/1" width Appendix E bronze, aluminum, min. 0.060" thick stainless steel, galvanized steel or Slip Fasteners plastic attachment min. 8d x I'''A" clips for supplemental the attachment. Clips are installed with corrosion resistant roofing nails compatible with the clip. A hurricane clip is required on all eave tiles. Valley Flashing min. 26 ga. ASTM A 525 Galvanized steel generic min. 16" width valley flashing Drip Edge min. 26 ga. PA I I I Galvanized steel drip generic min. 2" face flange edee min. 2" deck flange Decl. Type: ltcck Description: SN'STEht B: Slopc Range: underlayment: Roofing Tile: Comments: Product Control NO: 94.0914 01 SYSTEMS (CONTINUED) Wood. Non- insulated New construction " / „” or greater plywood or wood plank. Direct Deck Application 4 ":12" to 7 ":12" only Note- System refer to Systems Ale tFor slopes in excess of 7` :12", refer to , System C. install choice of approved underlayment system, noted on Page I or 2 of Dade County Protocol PA 118, in compliance with Section 3.02 of PA 1 l8. Install tile in compliance with PA I18 using one of the approved methods of attachment for direct deck applications noted in Table 3, attached. The method of attachment utilized shall provide sufficient attachment resistance expressed as a moment to meet or exceed the required moment of resistance determined in compliance with PA 115 or PA 127. 1. For re -roof applications, " /r: plywood is an acceptable substrate. 2. Clips are required on all cave tile. It.1111 Itodt raic: Product i.ontrul No.: SYSTEMS (CONTINUED) t� f Ii :uJ Itodn =net - -- - --- _ - Wes, Non - insulated Deck Type: " /„" or greater plywood or wood plank. Deck Description. New construction SYSTEM C: Horizontal Batten Application Slope Range: 4 ":12" or greater for slopes in excess Note: Horizontal battens, as noted below, are required 4 ":12" to 7 ":12 ". For slopes of 7 ":12" and are optional for slopes pes of less than 4 ":12 ", refer to Sy A. Instal{ choice of approved underlayment system, noted on Page I or 2 of Dade Section 3.02 of PA 119. Underlayment: County Protocol PA 119, in compliance with having battens of 2 treated install horizontal 4 feet long allo n$ for min mum Horizontal Battens: minimum ors nominal 1" x x between each 4 foot length. Horizontal battens shall be installed over less than 3" an /z" gap the underlayment system spaced to provide a tile overlap not than 24" o.c. with approved, secured through the sheathing not greater fasteners. (See PA 119.) corrosion resistant Install the in compliance with PA 119 using one of the approved methods of ' in Table 3, attache d. The method of Roofing Tile: applications noted attachment for batten app utilized shall provide sufficient attachment resistance expressed as determined in attachment oorlexceed the moment of resistance a moment to meet compliance with PA PA 1. For re-roof applications, " /,x" plywood is an acceptable substrate: Comments: 2. Clips are required for all cave tile. t� f Ii :uJ Itodn =net - -- - --- _ - Product Control No.: 94- 0914.01 SYSTEMS (CONTINUED) Deck Type: Wood, Non - insulated Heck Description: New construction 1%," or greater plywood or )wood plank. SYSTEM D: Slope Range: Underlayment: Mortar or Adhesive Set Application 2 ":12" to 7 ":12" Note: System D is only acceptable in this slope range. Install choice of approved underlayment system, noted on Page I of Dade County Protocol PA 120, in compliance with Section 3.02 of PA 120. See System Limitation V. flooring Tile: Install the in compliance with PA 120 using one of the approved mortars or adhesives noted in this approval. Mortar or adhesive shall be applied in compliance with the mortar or adhesive manufacturer's Roofing Component Product Control Approval. The mortar or adhesive attachment shall provide sufficient attachment resistance expressed as a moment to meet or exceed the required moment of resistance determined in compliance with PA 115 or PA 127. The mortar and adhesive attachment data is noted in Table 4, attached. Comments: 1. For re -roof applications, " /,)" plywood is an acceptable substrate. 2. For mortar set applications, the first three courses of tile shall be nailed with not less than one nail per tile. As an alternate, the first three courses of tile shall be applied in mortar over a single layer of minimum 12 ga. wire mesh with square openings of not less than'/," which is mechanically attached to the deck with not less than one roofing nail every I ft'. For roof pitches from 6 ":12" to 7 ":12 ", every third tile of every fifth course, beginning at the eighth course, shall be nailed with not less than one nail per tile. 10 Rjut Product Control No.: ' 94- 0914.01_ SYSTEM LIMITATIONS I. The standard minimum roof pitch for "Altura S ", nail -on, mortar or adhesive set the applications is 2" rise in 12" run (2 ":12 "). The maximum roof pitch for mortar or adhesive set the applications is 7" rise in 12" run (7 ":12 "). 2 All nail -on tile applications having a roof pitch less than 4 ":12" shall be installed over both vertical and horizontal battens ( "Counter- Battens "), as noted in System A. All nail -on the applications having a roof pitch in excess of 7 ":12" shall be installed over horizontal battens as noted in System C. 3. For nail -on applications, brass or stainless steel screws for mechanical attachment of tiles shall have a head diameter larger than that of the preformed holes in the tile. 4. System installation shall be in compliance with the system specifications outlined in this Product Control Approval. Nail-on tile shall be attached using one of the methods of attachment noted in Table 3 of this Approval. Mortar or adhesive set tile shall be attached using an approved mortar or adhesive noted in this Approval, the data of which is noted in Table 4 of this Approval. The method of attachment utilized shall provide sufficient attachment resistance expressed as a moment to meet or exceed the required moment of resistance determined in compliance will) Dade County It Protocol PA I l5 or PA 127. 5. For nail -on the applications, an eave clip is required on all eave tile. For mortar set applications. the first three courses of the shall be nailed with not less than one nail per tile. As an alternate, the first three courses of the shall be applied in mortar over a single layer of minimum 12 ga. wire mesh with square openings of not less than' /," which is mechanically attached to the deck will) not less than one roofing nail every 1 W. For roof pitches from 6 ":12" to 7 ":12 ", every third tile of every fifth course, beginning at the eighth course, shall be nailed with not less than one nail per tile. 6. For mortar or adhesive set tile applications, a field static uplift test by a Dade County accredited testing agency. in compliance with Dade County Protocol PA 106, shall be required not less than 30 days after application to confirm the adhesion. The results of this testing shall be reported to the Building Official and the installer stating that the application has passed or failed PA 106 testing. If the application fails PA 106 testing, the report shall state which portion of the test was failed: Category I (examination for loose tile) or Category 2 (uplift testing of tile). Subsequent to testing. the installer may repair not more than 5% of field area tiles and 10% of perimeter area (i.e. ridge /rake) tile with approved tile adhesive. The installer shall place an identifiable marking on each repaired the for future reference. Any PA 106 re -test shall not include any marked tile. 7. For mortar or adhesive set tile applications. 30/90 hot mopped underlayment applications may be installed perpendicular to the roof pitch prior to June 1, 1995 unless stated otherwise by the material manufacturer. Thereafter, 30/90 underlayment systems shall be installed parallel to the roof pitch in compliance with Appendix"A` of Dade County Protocol PA 120. haul Rodrieua Product Control No.: 24- 0214AI PROFILE DRAWING 1 t� r; I c ISA !._ DOVI: TAIL LOCKS ALTUSA'S' TILE Rxrl atr,Jrrutt 1 r' IF METnODA EE 1- z. 1. i. S. 6, 7 IAETnOVOLIIAN DADE COUNTY, F.LOIIID Mr.1110-UADE FLAGLEFI DUILORI '_ _ --- — nuILDING CODE COMPLIANCE OESUITE IC ME1nU -UADE FLAGLEn 13tJ11 Uu 140 WEST FIAGLER 61 RE MIAMI, FLORIDA 33130 -L' 13051 375 Z'. FAX (3051 7752` may be considered after a new application has been filed and the supporter Eatenstons of Acceptance been re data, lest reports no older than Ica (10) Years, have evaluated. All reports of rc- testing shall bear the seal, signature and date of an engineer registered in the State Florida. Any revision or change is the materW use. or manufaeatrc of the product or process shall automatics be cause for termination, unless prior approval is granted for revisions or change. Any unsatisfactory performance of this product or process or a change in Code provisions shall be grout for re-evaluation. shall not used as an endorsement of any product for asks or advertising purposes. This acceptance County, Florida. and followed by The Notice of Acceptance number preceded by The words Dade expiration date may be displayed in advertising literature. if any portion of the Notice of Acceptano displayed, then it shall be done in its entirety. product approval drawings, where required for permit applications shall be provided c. the sprints � the manufacturer or his distributors unless otherwise noted to the Notice of Acceptance. The prints r not be re- sealcJ by an engineer. onditions shall because for termination of the Approval. failure-to comply with the Standard C r' Y Raul Rodri=uez Product Control Division Supervisor This spprovsl supersedes s0 peevloas spprovals- Last App...al Plumber 94-0106.18 PERMIT APPLICATION FOR MIAMI SHORES VILLAGE Date 6 Job Address{!d Tax Folio Legal Description Historically Designated: Yes No �� Owner/Lessee / Tenant. Master Permit # Owner's Address ,394�1 /2-1 4 l�LS� PhOne 2 c. V= Contracting Co. Adddress2 Qualffier SS# J?S & 61 Municipal # Competency ## Ins. Co. ArchitectlEnginwr Address Bonding Compaq Address Mortgagor Address Permft Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAYING FENCE SIGN WORK DESCRIPTION Square Ft Estimated Cast (value) WARNING TO OWNER: YOU MUST RECORD A NOTICE OF COMMENCEMENT AND YOUR FAILURE TO 110 so MAY RESULT IN YOUR PAYIlOG TWICE FOR IMPROVEMENTS TO YOUR PROPERTY (IF YOU INTEND TO OBTAIN Ai %KNCI NG, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCRNWNT Application is hereby made to obtain a permit to do work and installation as indicated above, and on the attached addendum (if AWfiftblq). I certify that all work will belPerformed to meet the standards of all laws regulating construction in this jurisdietwn. I an :. to r permits are required for ELECTRICAL, PLUMBING, SIGNS, POOLS, ROOFING and MECHANICAL WORK. OWNER'S AFFIDAVIT: I l certify that all the foregoing information is accurate and that work will be done in compliance with all applicable laws regulating construction and zoning. Furthermore, I authorize the above -named to do the work statecL Signature of owner and/or undo sident Date Sign of trac Buuilder t 13�Q Notary as to A D to Nota6 as to EDA M Commis _ : * COMMISSION NUMBER My Commis COMMISSION NtM1EEl4 y ., Q CC331710 AC C031'710 4 %' Q4 MY CokwIssiou EXP. �.* FoF F NOV. �Q? MY COMMISSION EXP. OF F1, NOV. 2121997 of � FEES: PERMIT _ RADON C.C.F. JT' `Q NOTARY BOND c a a TOTAL DUE — APPROVED: Zming Building Electrical Mechanical Plumbing Engineering Miami Shores Village w' Z A r� Building Department fi � � �� � ®� , g p 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 BUILDING PERMIT APPLICATION 7k- Permit ZO06 FBC 2001 APPLICATION, NoIE7L `.z-1 Permit No. Permit Type (circle): Building AF!t'! I - Tu'>PI'tltiing Mechanical Roofing Owner's Name (Fee Simple Titleholder) t tW.b1 -C S Phone # 30 J—__� Sq —0504 Z Owner's Address 3 o V-) �L- �0 3 City mow. State �r — Zip Tenant /Lessee Name Phone # Job Address (where the work is being done) '3'0 n �__ l0 3 &�r Ge_4_ City Miami Shores Village County Miami -Dade Zip Is Building Historically Designated YES NO�_ Contractor's Company Name ��-'� -���� Phone # �0 S�-l"" c� Contractor's Address �ty State Zi , p ualifier State Certificate or Registration No. Architect /Engineer's Name (if applicable) $ Value of Work For this Permit I sCO • W Certificate of Competency No. Phone # Square Footage Of Work: Type of Work: ❑Addition ❑Alteration ❑New ❑ Repair /Replace ❑ Demolition Describe Work: Cooke Submittal Fee $ Permit Fee $ fOPGl ° G° CCF $ Q • bO CO /CC Notary $S - Training /Education Fee $ Q 2-0 Technology Fee $ Scanning $ C& Radon $ Zoning Bond $ Code Enforcement $ Structural Plan Review. $ • Total Fee Now Due $ (Continued on opposite side) Bonding Company's Name (if applicable) Bonding Company's Address City State Mortgage Lender's Name (if applicable) Mortgage Lender's Address City State Zip Zip a . 5 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 mast 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_ Signature Owner or Agent Contractor The foregoing instrument was acknowledged before me this � The foregoing instrument was acknowledged before me this day of—t b , 2006, by 1 " 111 l(-� 4w ]1 D a day of 20 _> by who is personally known to me or who has produced ID As identification and who did take an oath NOT Sign: Print: My Commilsi who is personally known to me or who has produced NO PUBLIC - STATE; OF FLORIDA Yorleny NOTARY PUBLIC: H+� Sign: as identification and who did take an oath. Print: My Commission Expires: APPLICATION APPROVED BY: chc 05/13/03 Plans Examiner Engineer Zoning PERMIT APPLICATION FOR MIAMI SHORES VILLAGE Date 2/22/96 Job Address 390 NE 93 STREET Tax Folio Legal Description Historically Designated: Yes No Owners / Tenant SULLIVAN Master Permit Owner's Address _ 390 NE 03 STREET, MIAMI SHORES 33138 Phone 758 -.1808 Contracting Co. NORTH D{ADE SEPTIC TANK Address 800 NW 111 STREET, MIAMI M j6 Qualifier DENNIS NEVILLE SS #' Ply 7 54-337 State # 025836 -5 Municipal # Competency # 12842 Ins. Co. TRAY ArchitectiEngineer Address Bonding Company Address Mortgagor Address Permit Type (circle one): INN&MXHUMU IL PLUMBING 1%MUXM XXi1k 6X Wn;+Y X WORK DESCRIPTION INSTALL DRAINFEILD Square Ft. 300 Estimated Cost (value) $1000.00 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 AN 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 ELECTRICAL, PLUMBING, SIGNS, POOLS, ROOFING and MECHANICAL WORK. OWNER'S AFFIDAVIT: I certify that all the foregoing, information is accurate peVat all work will be done in compliance with all applicable laws regulating construction and zoning. Furthermore, I authorize the above-na#fel actor a work stated. Sign of 5&ner and/or Condo President Date Si a of tractor er- Builder D to Notary as to Owner o Cd' President Date otary to Contrac r - Builder Date rnunissio n E it ommission E t��tSttS« ttKS�CSSSKttS� `SSS�tSSt`S'��tISSS�� � y A �' �tStSSSSStV4SSStStS4V�54iSStt� 'it4 � �` a Teresa J. Felder < Notary Public, State of Florida ; Teresa L Felder ; < � Notary Public, State of Florida � Commission No CC 480807 < r o Commissraa.No. CC 480807 ; f of a My Casomison My Commission Expires 07/16/99 , Bxpuvs 07 /16/99 , > Ni- 3= IJA!l - R C+. � E t�ld dll lldddd6 ldddlddldKCltftdEdd�i7lltdt d1- ttlfCdi dY l d d dPKled lbddtlrly l d�vlu K ddl dB l llClddCldod. d v eFEES: PERMIT .` RADON C.C.F. NOTARY TOTAL DiiE APPROVED: Zaring Building Electrical Mechanical Plumbing Engineering — 'A STATE OF FLORIDA PERMIT # 'Cc7`r% DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES DATE PAID ONSITE SEWAGE DISPOSAL SYSTEM FEE PAID $ .ice APPLICATION FOR CONSTRUCTION PERMIT RECEIPT 7I� Authority:- Chapter 381, FS & Chapter 10D -6, FAC WE APPLICATION FOR: [ N] New System [ N] Existing System [;r N] Holding Tank Temporary /Experimental [ Y] Repair [ N] Abandonment I� N] Other(Specify) APPLICANT: SULLIVAN TELEPHONE: 758-1808 AGENT: NORTH DADE SEPTIC TANK 754 -3375 c *AILING ADDRESS: 800 NW 111 STREET, MINK 33168 TO BE COMPLETED BY APPLICANT OR APPLebANT'S AUTHORIZED AGENT. ATTACH BUILDING _PLAN AND TO-SCALE SITE PLAN SHOWING PERTINENT FEATURES REQUIRED BY CHAPTER 1OD -6 -, FLORIDA ADMINISTRATIVE CODE. PROPERTY INFORMATION [IF LOT IS NOT IN A RECORDED SUBDIVISION, ATTACH LEGAL DESCRIPTION OR DEED) ra, a LOT: BLOCK: SUBDIVISIONe DATE OF BEFORE 72 SUBDIVISION: PROPERTY ID #: [Section /Township /Range /Parcel No.] ZONING: PROPERTY SIZE: ACRES [Sgft /43560] PROPERTY WATER SUPPLY,: [ ] PRIVATE [ XX PUBL'ic PROPERTY STREET ADDRESS: 390 NE 93 STREET, 33138 DIRECTIONS TO PROPERTY: BUILDING INFORMATION [ X3 RESIDENTIAL [ ] COMMERCIAL i Unit Type of No. of Building # Persons Business Activity No Establishment Bedrooms Area.Saft Served For Ca mmercal Only i SFR 3 BEDROOMS 2 3 4 [ N] Garbage Grinders /Disposal [ N] Spas /Hot Tubs [ N) Floor /Equipment Drains [ N f ] Ultra -low Volume Flush oets [ N] Other (Specify) APPLICANT'S SIGNATURE:' --- DATE:_ 2/22/96 j 1 NRS -N Form 4015, Mar 92 (Obsoletes previous editi' s which may not be used) Page 1 of 3 (Stock Number: 5744 -001- 4015 -1) tt"S,nk UC -11,03"'i IS 1 AEPLIC"AT10N RJR: Chnk ype s4enw. W Wn qQj toe in h6ok, .APPLiCANT-. prop�rty OWMIN MH nartus- TELEP-HONF�i Tdqhmo nomber Ir appli"M of agot, AGEN0 fzoferty leg4ly jrthonve,� nniv-.?ZnWteve MWILING f.0, box or clrce�, Q' ay, amw j.'r,"Zip cod t nutding address for applicant I:- agen", LUL BLOCK biot;k� and fs�Abdivision Aw A Mo=d w Unrecorded aoibdh,vdon), If !at is not in a recorded iubdrvhdon� a Copy off-tire lo, SUBDR71SIt))N or d iwau be alwhs - DATE OF SUBDARMON GRO it dam of bTv Ron ns,"M in evinty pla lunks ,:-nonlhlday( (year) or dAle lot (niggiradly m-carded, Divi ding an approve e It Wo two or trusc Pamela RX the Purpose of somcYing owneraiip ahail be considin-c- da ;wbdivi%Ia of the test, PROOERTVID,V� 27 chuMCWr stualur far pRWeny. (CPHU fray reqWn: pmVerty appraiser I dZ nornber. MWOMSME! Net vsaW� atoa of prperty in a ma (square fxxage MVWW by 43,560 square feet) eNclwaive of all paved arcaN and pospanul mad Roo wahin pubik dighw-of way or camown"r and exciufsoof of Streams, lakes, normally wet drainag-, ditcheg, marchea, or other such Win ofwhwr. cktraguwua uppa-ved and noloompactcd road rights,of way and easements with no ttubsurfimo obstru loans .r,,,iy be istc, iubcd� m "ad" Weling �o-' aro WA1'FR SCIPPLY: Cho�;% private �)r pabii�2, P R 0 PE R "I" y A D D n F, S.S i Wo am— Ir rm-on, Re Its Man an anjud savem a0mass, •trac, cr Y--,3aJ and icfcaje in eouftiy. DIRECTI(INS' Pfo%idi� &MM WMAws w W w WMA an-sma mW Mwing SM KMAn, E-TUILIDING INIFf')RAIATIN -the ck or PIT ESTABLWIAIFIN'1, �--fg of esawHAnwiv from Too H, Chapter MM F Exi sass, arse -4olgi fairix�y, single wine al'ohdle hcooc, rt*woran;, N,,,,. BEDP,4)01%1,'z3. C'- nit zj rMMS Wyned p6mSy ra< a and ad o5e am;,x rxpazzed w, rou6nely po-,i& tdccph-,jg accownvu-ni-azions fox ML $Z, BUMDING ARM Toml ,c 3 -' fooza,,,. hAnsul amn of dweilky; uuh, enjudiog aazP-,)-t-- cxle6af bo: nage shed, or open or,fally vacmd pwas w SAx Band oa taosltu owasurennents dn- as--1i "cary of &,oschxc, !,-Rc, tj N S Narthn o4nsom reMMy, cr workinb, at ectalaishafc,,4� Foc ro:adjoid�al tsialodshm x - 2 cfaens fn em, p p - boom can aft anuand- BUSINEW', AC11VITY! Fix W, Lin numimr of empl"ces, WA, am; kt�,,-,ur3 Gf openatkrjt,� co- ouhcr inforantfion by ,, bbt Jff- — F,L% T U Wks z Mark coch Rsted Mmm iestallcu 'NA iC a-, SMAITRE s"Mae f,,f applsaol o" agaui,. 'Dunc apphc-96",o., ono day susdued to to CPHI-fe'd1h zppropfiaw feev--,,,od "Imbawmv ATTACHMENTS! to 6Y phn drawn to scam. shawmg bougurks MA Imenmom" i of o,- hui-- ,has gs, swintiang poon, eawassm, onommmt; ujis'pt'NI-0 S"i CauTunzws mad hX0600, Wops C&P,olway, any CATI M pro"vied --iN, dratnage w, "'L4,Xtaian a WAq Ulm nwne diaposal wrfatams, aa, fact afamo, an Wity; ordslares nn rFTc fealures are-with 'TS fe-to ofthe app"kanthas, ueafic'nofany pub& weR Min 2Nj W! of h,,' For reMnon, a EMU* Pon "K&MQ swon'd flumber of bedroLums and Wildis, am of WA no. For nonmWen Sat a, f1C,:a& flat, .fimvua tho aquare "ranage, of ere eatatdml-uneta� th" pbv iabiog amins and frelum typ-;ao and other Coitart's xa, 9uzrT, it-, deatri-nn-ot composi6on and quatsky of wam4water, ck STATE OF FLORIDA PERMIT -- DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES DATE PAID . ONSITE SEWAGE DISPOSAL SYSTEM FEE PAID CONSTRUCTION PERMIT RECEIPT`" . WF Authority: Chapter 381, FS & Chapter IOD -6, PAC CONSTRUCTION PERMIT FOR: [ NJ New System ( NJ Existing System IN ] Holding Tank IN } Temporary /Experimental: 'YJ Repair. [ NJ Abandonment IN J Other(Specify) APPLICANT: SULLIVAN AGENT, NORTH DADE SEPTIC TANK PROPERTY STREET ADDRESS: NN 390 NE 93 STREET, 33198 k LOT: na BLOCK: na SUBDIVISION: na PROPERTY ID - #: na [ SECTION /TOWNSHIP /RANGE /PARCEL NUMBER -} [OR TAX ID NUMBER] - - -- - - -- _ -- -- -- - _=--- _ ^=— ___=-- _=_— =___ —_ = _— _____ ___ SYSTEM - MUST 'BE CONSTRUCTED IN ACCORDANCE WITH SPECIFICATIONS AND STANDARDS OF CHAPTLR 100 --6, FAC REPAIR PERMITS AND HOLDING TANK PERMITS EXPIRE 90 DAYS FROM THE DATE OF ISSUE, ALL OTHER PERMITS %"IRE'ONE YEAR FROM THE DATE OF ISSUE. HRS APPROVAL OF SYSTEM DOES NOT GUARANTEE SATISFACTORY PERFORMANCE FOR ANY SPECIFIC PERIOD OF TIME. ANY CHANGE IN MATERIAL; FACTS WHICH SERVED AS A BASIS FOR ISSUANCE OF'THIS•PERMIT, REQUIRE THE APPLICANT TO MODIFY TKE PERMIT APPLICATION. SUCH" MODIFICATIONS MAY RESULT IN THIS PERMIT BEING MADE NULL AND VOID. SYSTEM DESIGN AND SPECIFICATIONS ` �x� wff T [�&40] [GALLONS /.GP9j PTIC T /AEROBIC UNIT CAPACITY MULTI - CHAMBE f1N:SERIES :[: ] s A_: [ ] [GALLONS / GPD] CAPACITY MULTI- CHAMSE�DfIN SERIES:[ ] GALLONS GREASE•INTERCEPTOR CAPACITY [MAXIMUM CAPACITY--' SINGLE -TANK: 1Z -50F6ALLONS] K [ ] GALLONS PER DOSE DOSING 'TANK CAPACITY DOSE RATE.[ ] PER 24 HRS :NO. OF PUMPS., [ ] D" [ -TOO J SQUARE FEET PRIMARY DRAINFIELD SYSTEM R` [ ] SQUARE FEET SYSTEM A` TYPE SYSTEM: [ ] STANDARD ( FILLED (MOUND [ J I CONFIGURATION: TRENCH; A-fBED [ ] N �� GJ G F LOCATION OF BENCHMARK: . ` tl I ELEVATION OF PROPOSED SYSTEM SITE [ ] [INCHES /FTj [ABOVE /BELOW] BENCHMARK /REFERENCE POINT E BOTTOM OF DRAINFIELD TO BE [ ] [INCHES /FT] [ABOVE /BELOW] BENCHMARK /REFERENCE POINT L D FILL REQJIRED: [ ] INCHES EXCAVATION REQUIRED: [ s ,may ] INCHES 0 INSTALL 12" OF LOAMY COARSE SAND UNDER BOTTOM T OF DRAINFIELD SUBMIT BENCHMARK BEFORE INSPECTION H THIS PEST IS NOT FOR ADDITIONS E INVERT ELEVATION (MINIMUM) • At L' .% 5 -a 1= R BOTTOM OF DRAINFIELD ELEVATION NIMI SPECIFICATIONS BY: TITLE: APPROVED BY: '!i TITLE:f j A CPHU DATE ISSUED: EXPIRATION DATE: 2131% YHE SEP'T'IC TANK SHALL BE PUMPED AND A SOLID DEFLECTION DEVICE INSTALLED ON THE OUTLET TEE. HRS.H Form 4016, Mar 92;(Obsoletes previous editions which may not be used) Page 1 of 2 (Stock Number: 5744 -001- 4016 -0) APPLICANT INSTRUCTIONS: PERMIT NUMBER: Permit tracking number assigned by CPHU. APPLICATION 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. (CPHU may require property appraiser ID # or section /township /range /parcel number) SYSTEM DESIGN AND SPECIFICATIONS: TANK: Minimum specifications from Chapter IOD-6, FAC. DRAINFIELD: Minimum specifications from Chapter IOD-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 must be sealed. APPROVED BY: County Public Health Unit (CPHU) personnel reviewing and approving permit. DATE ISSUED: Date permit is issued by CPHU. 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 HEALTH AND REHABILITATIVE SERVICES ONSITE SEWAGE DISPOSAL SYSTEM SITE EVALUATION AND SYSTEM SPECIFICATIONS PERMIT # APPLICANT: SULLIVAN AGENT: NORTH DADE SEk.,16 NX LOT: NA BLOCK: NA SUBDIVISION: NA PROPERTY ID : NA [Section/ Township /Range /Parcel No. or Tax ID Nomber] 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: [ YES [ ] NO NET USABLE AREA AVAILABLE: ' ACRES TOTAL ESTIMATED SEWAGE FLOW: ?a o GALLONS PER DAY [ RESIDENCES -TABLE 1 / OTHER -TABLE 2 ] AUTHORIZED SEWAGE FLOW: GALLONS PER DAY [1500 GPD /ACRE OR 2500 GPD /ACRE] UNOBSTRUCTED AREA AVAILABLE: < Q 0 SQF^'T UNOBSTRUCTED AREA REQUIRED: ® SQFT BENCHMARK /REFERENCE POINT LOCATION: J.a�Jr ✓ t { ,EVATION OF PROPOSED SYSTEM SITE IS f.S Z [ NCH /FT] [ABOVE/ O BENCHMARK /REFERENCE POINT THE MINIMUM SETBACK WHICH CAN BE MAINTAINED FROM THE PROPOSED SYSTEM TO THE FOLLOWING FEATURES: SURFACE WATER: 100+ FT DITCHES /SWALES: FT NORMALLY WET? [ ] YES - fXj NO 'WELLS: PUBLIC: 100+ FT LIMITED USE: --- FT PRIVATE: FT NON - POTABLE: FT BUILDING FOUNDATIONS: 5 FT PROPERTY LINES: 5 FT POTABLE WATER LINES: 5 FT SITE SUBJECT TO FREQUENT FLOODING: [ YES [X] NO 10 YEAR FLOODING? ] YES- NO 10 YEAR FLOOD ELEVATION FOR SITE:W.T. .Om FT (MS /NGVD SITE ELEVATION : FT S NGVD SOIL PROFILE INFORMATION SITE 1 SOIL PROFILE INFORMATION SITE `2 Munsell # /Color Texture Depth a; BROWN: SANDY 0" to 72' to to to to to to to to USDA SOIL SERIES: SANDY unsel Color Texture De nth BRO ANDY r' to to to to to to to to to USDA SOIL SERIES: OBSERVED WATER TABLE: 60 INCHES [ABOVE / ____ EXISTING GRADE. TYPE: digi / APPARENT] O8 q - ESTIMATED WET SEASON WATER TABLE ELEVATION. INCHES [ XMnX/ BELOW ] EXISTING GRADE. HIGH WATER TABLE VEGETATION: [ ] YES YX] NO MOTTLING: [ ] YES JX] NO DEPTH: INCHES SOIL TEXTURE /LOADING RATE FOR SYSTEM SIZING: 1.25 DEPTH OF EXCAVATION: 30 INCHES - DRAINFIELD CONFIGURATION: [ ] TRENCH [X,] BED [ ] OTHER (SPECIFY) «- . REMARKS /ADDITIONAL CRITE�'4. I SITE EVALUATED BY: DATE: 2/22/96 HRS-N Form 4015, Mar 92 (obsoletes previous editio which may not be used) Page 3 of 3 (Stock Number: 5744- 003 - 4015 -1) INST?g:.CTIO; S: PEWiI #; APPLIt:;: N"'-: LOT �-- 0' t pr �ti 1 'tSF )~t vxt,.f I , SOIL TFXT!'RE! Pvrrni�t trr.eking nuntber assigned by CPHU. Prcopc: ^,y owner's Ball name. I',�t. , etc* owrcr`s legally au4horiyed reprasentative. x.': ,ck, and sublivision for lot. p.apenp appraiser -.D x .:,.r number" altc r,4:,— RGCOrd rirc�s Available -.lot eras exclusive of r'- z,,. __. ...rare•' :rata be.d :vri1+'f public 6ghts-,-t w �y or easPntants -Tad exel,bstve of streams, Imes, V t 1,.. ?r bite -i >;s, - narshes, !,r whler such bodies M water. z, ,..N fGr the es b , '. ..at f. r 4'Tal1;e 1 (.estd nccsi or Toot, � (non- residsn >ia!?, Chapter s_thc i <.e,3 swa •- !, ,. tr,` u� t,). b.;s, o o; . ne: .`, ";c area and, eater supple t; saf3 gallons . 3,e :�,., : iL s and � cp , .. d rr f,A public v�af -r supplies} If au harrzcd zev,�4ge flow sewage �0 e .Canon must he dapied- . 7'. _ F s t• tS. . Ur �r Tr.ust m ! i ,6 tv en;!!!, t v1; t } a t 'ice +4ei t ,.,r,s. ,• '.era. S� t� ^_c {�. ,. �ext3r�. -n ..� r.. to . " l; x0uU+ v revue r,enta mat to reeorde -1 or "t,A" a;u-7i, ^ant lot musi be measured. 31he lox ation ..,...r ._rr , psi a v=: ._ a ... a:at also verifiew. t l,a-d;p- ' r.r l.',t r.a jcot 'o odi n„ -,7cord 10 Far flood elevr,,on for site and e �n" ^sad r a Fait .at. zi 9.o c rs is: l :ie . depth F` v feet or F ,f zc ,i 2re require) Lo: t s ,tv u..elt c�'t.r.� Ana ITS A soil text res). Refusays nest F° vi 6v !.,!S^ x 4 1 se •i:.s ;f a -s.. cfd "UN17," if the series cannot be determined. n h `r,etf water table a, t, time of the evaluation. ?dark "pepc}hed" or apparent" as Tcc� ord 'he estimated wet season water table :,vation hayed on `site -valuation, USDA soil maps, and WJicate if there is high -,eater table vegett,tion p:ese,v'. Indicate if mottling is present and depth. Record soil textu,e or loading ratio for system sizing. DEPTH OF EXCAVATION: If -jppli +.able record depth c. excavation required. Record "NA" if not applicable. DRAINFIELD CONFIGURATION: Check drainitteld 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 documentation submined. ELEVATION WORKSHEET ELEVATION OF BENCHMARK / REFERENCE POINT IS: BENCHMARK SITE 1 SITE 2 SITE 3 [ +] SHOT: H.I. H.I. H.I. H.I. 1 [ -] SHOT [ -] SHOT [ ] SHOT PERMIT APPLICATION FOR MIAMI SHORES VILLAGE r Date — ` — C1* Job A&hm aFi0 (\'er \Q3 %V Tax Folio s Legal Description Historically Designated: Yes No - Owner/Lessee / Tenant , �riV � Master Permit # Owner's Address ` ` � 1 Sal \UUv.�.� 13 phone c� °l 51 't C�: Contracting Co. Address Qualifier SS# - Phone State # Municipal # Competency # Ins. Co. - Architect/Engineer Address Bonding Company Address Mortgagor Address Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN WORK DESCRIPTION Square Ft Estimated Cost (value 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.ILENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF CONOkIENCEMENT.) 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 ' i 'on. I understand that separate permits are required for ELECTRICAL, PLUMBING, SIGNS, POOLS, ROOFING and MECHANIC Arl ORK. 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. Furthermore, I authorize the above -named contractor to do the work stated. Signature of owner and/or Condo President Date Simiature of Contra Bul Date IeL lb Notary as to Owner and/or Condo President Date o Owner- Builder Date My Commission Expires: my C NOTARyP[ Comm cohAms Nd. Cc"7t4 oa ` Bb7UN P. MAR 1,2002 FEES: PERMIT 90 RADON C.C.F. ' NOTARY BOND 60 TOTAL DUE APPROVED: l Zoning Building �' Electrical Mechanical Plumbing Engineering 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. PL o q •- PERMIT APPLICATION Master Permit No. FBC 2001 Permit Type (circle): Building f Electrical umbing Mechanical Roofing Owner's Name (Fee Simple Titleholder) 1 "le Phone # Owner's Address City _ A a,'ui .`<„ State O�' Zip Tenant/Lessee Name Phone # Job Address (where the work is being done) City Miami Shores Village County Miami -Dade Zip s J/ Is Building Historically Designated YES NO ��, SJ� Contractors Company Name w< (� Rik- �'�* Phone # Contractor's Address / � /� � uQ City /O" 12�t Qualifier_ ? State ly Zip 3 3IC; Architect/Engineer's Name (if applicable) $ Value of Work For this Permit Type of Work: diti L�teratibn Describe Work: Phone # Square Footage Of Work: 0 Q/Repair/Replace ❑ Demolition Submittal Fee $ Permit Fee i� h CCF $ CO /CC Notary $, :5'- Q Training/Education Fee $_ Technology Fee $ Scanning $ Radon $ Zoning Bond $3y 0 Code Enforcement $ 0 0 Structural Plan Review. $ Total Fee Now Due $ � O (Continued on opposite side) Bonding Company's Name (if applicable) Bonding Company's Address City State Mortgage Lender's Name (if applicable) Mortgage Lender's Address City State Zip 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. Sign Signature Owner or Agent Contractor The foreg g instrument was ac ledged be e _ f_ The foregoin instrument was acknowledged before me this day of 20, by _ /��11�� >/ day o ' 0 4 0 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 e an oath. as ide ' ication and who did take an oath. NOTARY PUBLIC: _ 41� NOTARY UBLI �.' Sign: � Print: p My Commission MY COMMISSION # DD 031747 M Comnfs ; missim Dr!50048 EXPIRES: June 20, 2005 y State Certificate or Registration No. APPLICATION APPROVED BY: of Competency Holder) Certificate of Competency L ° 1410' --�J Y Plans Examiner Engineer cho 12/15/03 Zoning PERMIT APPLICATION FOR MIAMI SHORES VILLAGE Date Job Address 3� 0 '�% 103S I �y �� Tax Folio Legal Description Historically Designated: Yes No v� Owner/Lessee / Tenant QQ\<— iy ��t !: S Master Permit # -� Owner's Address 2 ,t C) (1�C 1y3S� v�lc� � Phone l lc( L3 Contracting Co. 4k [ C Address 33 Y 3 oq,r t1 Qualifier M CZ � �1 S SS# ��� - = `Phone :1 j 1 — 2'1 �_3 State # Architect/Engineer- Bonding Company Mortgagor Permit Type (circle o k , Municipal # Competency # Bt ILDING, Address Address Address PLUMBING MECHANICAL Ins. Co. ROOFING PAVING FENCE SIGN Square Ft. 260 - Estimated Cost (value q 7'� WARNING TO OWNER: YOU MUST RECORD A NOTICE OF COMMENCEMENT AND YOUR FAILURE TO DO 80 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 COMMENC19N ,) Application is hereby made to obtain a permit to do work and installation as indicated above, and on the attached addendum (if le). I certify that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. I undersftd did sepwate permits are required for ELECTRICAL, PLUMBING, SIGNS, POOLS, ROOFING and MECHANICAL WORK. 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. Furthermore, I authorize the above -named contractor to do the work stated. Signature of o er an or Condo President Date Signature of Contractor or Owner- Builder Doe Notary as to Owner and/or Condo President Date My Commission Expires: (tY P& OrFICJAL' NOTARY SEAL 0 elm GILOA ®EREDA Z t * COMMISSION NUMBER < CC33171 • 3 MY COMMISSION Exp. Notary as to Contractor or Owner - Builder Data My Commission Expires: eOF fyl:� L, NOV. 2111227 iw�wwr� FEES: —RADON C.C.F.r NOTARY BOND TOTAL DUE APPROVED: Zoning Building b Electrical Mechanical Plumbing Engineering 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 FBA W Permit Type (circle): Building Roofing Owner's Name (Fee Simple Titleholder) Owner's Address City State Tenant/Lessee Name Permit No. /'v" o—( Master Permit No. Phone # Zip Phone # Job Address (where the work is being done) City Miami Shores Village County Miami -Dade Zip FOLIO / PARCEL # 4 Is Building Historically Designated YES NO Contractor's Company Name Contractor's Address Citv Qualifier Name State Certificate or Registration N S Phone # Certificate of Competency Architect/Engineer's Name (if applicable) Phone # Value of Work For this Permit % 0 Square / Linear Footage Of Work: Type of Work: ❑Addition ❑Alteration ❑New El Repair/Replace ❑ Demolition Describe Work: Submittal Fee $� Permit Fee $ /00006 CCF $ OQ CO /CC Notary $ Training/Education Fee $ • .2 y Technology Fee $ Sraj Scanning $ Radon $ DPBR $ Zoning $ Bond $ Code Enforcement $ Double Fee $ Structural Review. $ Total Fee Now Due $_&XSz zri) See Reverse side -+ 4 Bonding Company's Name (if applicable) Bonding Company's Address City State 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 workx 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 offer 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 Signature Owner or Agent Contractor The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this day of q I , 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: Sign: identification and who did take an oath. NOTARY PUBLIC: Sign: Print: Print;_ �Yp�dG •�iilda Pereda My Commission Expires: . o, a,"•.e= My Commission Expires: _- �COMMISSION#DD734956 V. .... s, ., A;RO NOOTARYY APPLICATION APPROVED BY: (Revised 07/10/07) Plans Examiner Engineer Zoning I'- Pi- L -20 CIS" 2. C. Aq, 150 .9w OISO jo) - //O,o 07, Ci so i