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EL-13-2191Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-222959 Scheduled Inspection Date: February 06, 2015 Inspector: Devaney, Michael Owner: YZQUIERDO, JOSE Job Address: 1351 NE 101 Street Miami Shores, FL 33138 - Project: <NONE> Permit Number: EL -9-13-2191 Permit Type: Electrical - Residential Inspection Type: Final Work Classification: Alarm Phone Number Parcel Number 1132050230080 Contractor: YORK ELECTRIC CORP Phone: (786)287-7380 dunaing uepartment comments BURGLAR ALARM INSPECTOR COMMENTS False Inspector Comments Passed ❑ CREATED AS REINSPECTION FOR INSP-222909. Replace the receptacle that the transformer is connected to to the old style with a screw termonal in the center. Failed Correction Needed Lo/_e gao js Re -Inspection ❑ Fee No Additional Inspections can be scheduled until re -inspection fee is paid. February 05, 2015 For Inspections please call: (305)762-4949 Page 6 of 32 Miami Shores Village Building Department 10050 N,E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 INSPECTION'S PHONE NUMBER: (305) 762.4949 �, % �3 - -T3� 6 - BUILDING PERMIT APPLICATION Permit Type: Electrical _ -SEP ,8 7 j6j3 FBC 201 `- Permit No. Master Permit No. U-3 d)lq JOB ADDRESS: /3-51 )JE 16/ 54 City: Miami Shores County. Miami'Dade Zip:. 3 3 ( - Foho/Parcel#• Is the Building Historically Designated: Yes NO Flood Zone: OWNER: Name (Fee Simple Titleholder): Address: 13!5/-- 14�Z„ t0 l 34 I S'A -SZ,5 e— City: - - Id"j i " � r State: - Zip: 3 T 3 Tenant/Lessee Name: Phone#: Email: CONTRACTOR: Company Name: �� Ul�� -- r p _ _ Phone#• _ -'30-5 (o Q'Z" ?3Zd -7 Address: City: 1 Qualifier Name: 33)L5 State Certification or Registration #: GL -13 00J,-1 61 Certificate of Competency # Contact Phone#: '' &4 Z " ?-U --j Email Address: DESIGNER: Architect/Engineer.. aCw�� Value of Work for this Permit: $ `-Square/Linear Footage of Work: Type of Work: OAddress \ DAlteration hKqew ❑Repair/Replace Memolition Description of Work: Submittal Fee $ Permit Fee $ /� P c� CCF $ CO/CC $ . Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ • 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 Z. 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 reinspection feill be charged. Signature, y9awrorA991 The foregoing iin—strum t was owledg before me this 25day of ``" 20 L3 , by who is personally known to me or who has produced As identification and who did take an oath. NOTARY PUBLIC: Sign: _ Print: 41 My Commission Expires: NOTARY PLBLIC-STATE OF FLORIDA Zeida Andreu Signature Contractor The foregoing instrument was acknowledgedefore a this 0.5 day of � ,2013 by7��� who is Personally known to e o P Y m r who ;lip produced ------------ as identification and who did take an oath. NOTARY PUBLIC: Sign: Print: Expires: MAY O5, 2015 e:20ij APPROVED DED THRU ATLANTIC BONWRiG CO., INC. Plans Examiner SWj,' Structural Review (Revised 3/12/2012)(ReAsed 07/10/07XRevised 06/10/2009XRevised 3/15/09) L My Commissi&-(tires: NOTARY PUBLIC -STATE OF FLORIDA Zeida Andreu BONDED THRU ATIA ILC BONDUiG CO., INC. Zoning Clerk Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-185279 Scheduled Inspection Date: February 06, 2015 Inspector: Devaney, Michael Owner: YZQUIERDO, JOSE Job Address: 1351 NE 101 Street Miami Shores, FL 33138 - Project: <NONE> Permit Number: EL -2-13-226 Permit Type: Electrical - Residential Inspection Type: Final Work Classification: Alteration Phone Number Parcel Number 1132050230080 Contractor: YORK ELECTRIC CORP Phone: (786)287-7380 rsuuaing uepartment comments NEW ELECTRICAL INCLUDING PANEL, Circuits AND Infractio Passed Comments OUTLETS. I INSPECTOR COMMENTS False Inspector Comments Passed Dr Failed t�� C10 Correction Needed Re -Inspection ❑ Fee No Additional Inspections can be scheduled until re -inspection fee is paid. February 05, 2015 For Inspections please call: (305)762-4949 Page 1 of 32 YORKELE-01 NVALETON s+-iCVRL� CERTIFICATE OF LIABILITY INSURA14CE[___DATE (MM/DD/YYYY) 8/5/2013 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER BenTrust AIB, LLC 701 Waterford Way Suite 300 Miami, FL 33126-4682 CONTACT NAME: PHONE (305 444-8350 AX No : 305 444-8501 A/c No EXt : ) ( ) E-MAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # INSURERA:The Travelers Indemnity Company 25658 7/16/2014 INSURED INSURER B: Normandy Harbor Insurance Company 13012 York Electrical Contractor Corp 10871 SW 188 Street Unit 25 INSURER C: INSURER D Miami, FL 33157 INSURER E: INSURER F: $ COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE ADDL R U R POLICY NUMBER POLICY EFF MM/DD/YYYY POLICY EXP MM/DD/YYYY LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE 1XI OCCUR 6604D446486 7/16/2013 7/16/2014 EACH OCCURRENCE $ 1,000,00 DAEMMA ISES S ( Ea RENTED $ 300,000 PRoccurrence MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: X POLICY r PRO LOC PRODUCTS - COMP/OP AGG $ 2,000,00 $ AUTOMOBILE LIABILITY ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS NON -OWNED HIRED AUTOS AUTOS COMBINED SINGLE LIMIT Ea accident $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE $ Per accident F� UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED RETENTION $ $ B WORKERS COMPENSATION AND EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE YIN OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N / A NHFL131544 7/22/2013 7/22/2014 WC STATU- OTH- TORY LIMITS ER E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE $ 1,000,00 E.L, DISEASE - POLICY LIMIT I $ 1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Miami Shores Village Building Department 10050 NE 2nd Avenue Miami Shores, FL 33138 ACORD 25 (2010/05) SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED © 1988-2010 The ACORD name and logo are registered marks of ACORD TION. All rights reserved. Miami Shores Village Building Department FEB 0 5 2013 90050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 INSPECTION'S PHONE NUMBER: (305) 762.4949 BUILDING PERMIT APPLICATION Permit Type: Electrical FBC 20 ((D Permit No. Master Permit No. JOB ADDRESS: 1-�) -:5 1 1 u l -A City: Miami Shores County: Miami Dade Zip: 3313 Folio/Parcel#: 1 1- 3 - d 0 0 6 Is the Building Historically Designated: Yes NO Flood Zone: OWNER: Name (Fee Simple Titleholder)C>� Phone#: Address:R City: P\- k awl Tenant/Lessee Name: Email: State: Zip: > 1 7?> CONTRACTOR: Company Name:_1 �UPhone#: Address: ,a`� 1 -1-5t4-) % � ) �{- City: N\A- &A'kit Qualifier Name: V_&2 h7 Phone#: State Certification or Registration #: Certificate of Competency #: Contact Phone#: 615 4 - S1,61 Email Address: DESIGNER: Architect/Engineer: Phone#: 3 ' �8 —7 Value of Work for this Permit: $ Square/Linear Footage of Work: Type of Work: ❑Address, j ❑Alteration ❑New Ptepair/Replace ❑Demolition Description of Work: F� uD c_._ 1 % 2 C c� Fees �G�Q� Submittal Fee $.5'3 - dD Permit Fee $ 3,V"P CCF $ CO/CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ TOTAL FEE NOW DUE 914. ic- 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 $2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection whi5h Rccurs seven (7) days after the building permit is issued In the absence of such posted notice, the inspection will not be ap oved a reinspection fee will be charged. Signature Signature mer Agent - Contractor 4-L The foregoing instrume acknowledged befo a me this The foregoing instrument was acknowled`ged,, be ore m 'sO— day of , 20 VS, by 0 G day of who is personally known to me or who has produced who is`all�known to me or who has produced identification and who did take an oath. NOTARY �* Q t tate of Florida Sign: d gene -S 1111FMy Commission E043995 Print: �iras.i?lnsnat� My Commis " NOTARY Sign: Print: My as and who did take an oath. Florida Commission EE043995 *sss**s$**sss*sss*******ss*ssss*s***s*s*s***sssss**ss****s***ss**ss*s*sss*sss**ss***s***ss***ss**sss*******s APPROVED B4 �A -� �% Plans Examiner Zoning Structural Review (Revised 3/12/2012)(Revised 07/10/07)(Revised 06/10/2009)(Revised 3/15/09) Clerk Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-190693 Permit Number: PL -5-13-950 Scheduled Inspection Date: March 12, 2015 Permit Type: Plumbing - Residential Inspector: Diaz, Osvaldo Inspection Type: Final Owner: YZQUIERDO, JOSE Work Classification: Septic Job Address: 1351 NE 101 Street Miami Shores, FL 33138 - Phone Number Parcel Number 1132050230080 Project: <NONE> Contractor: SOUTHERN SEPTIC CONTRACTORS INC Phone: (305)598-8266 Building Department Comments SEPTIC TANK AND DRAINFIELD INSTALLATION - ___-- -- - INSPECTOR COMMENTS False Inspector Comments Passed HRS ON FILE Failed Correction,,-�o� Needed Re -inspection Fee No Additional Inspections can be scheduled until S WXZ re -inspection fee is paid. y March 11, 2015 For Inspections please call: (305)762-4949 Page 1 of 32 Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 INSPECTION'S PHONE NUMBER: (305) 762.4949 BUILDING PERMIT APPLICATION FBC 20 Permit T - PLUMBING YPe� ETrX±R Permit No. VI � PO Master Permit No. OWNER: Name (Fee Simple Titleholder): S0Sc 2 Civ ` eao o Phone#: Address: 1 N t t 0 t S City: S)r- ort 5 State:Zip: l_ 37:-' 3 8 Tenant/Lessee Name: — ;4 fa Phone#: Email: tJ I JOB ADDRESS: 3 5 ►J L� 1 0 1 5i City: Miami Shores County: Miami Dade Zip: '5"313 Folio/Parcel#: I I - 3 Z 06 . t� Z'!j ., -3 $ Is the Building Historically Designated: Yes NO A Flood Zone: CONTRACTOR: Company Name: Phone#: 33 -SC `�2b e `r�''^ LY�^ Address: _s`" City: State: L Zip: Y3 ! Cl L� Qualifier Name: 'Y).P , o 1 0 % ,, Z Phone#: SS 261, State Certification or -Registration #: 0 2I Certificate of Competency #: Contact Phone#: Email Address:✓��f�k; LootPIC ��; �, �y Yom; Cpvr DESIGNER: Architect/Engineer:. Phone#: Value of Work for this Permit: $ 2 o o a . D 0 Square/Linear Footage of Work: mak. Type of Work: ❑Address ❑Alteration❑New I Repair/Replace ❑Demolition Description of Work: _ !_„@ k � L. k a N k_ --N Cz��(aLL Submittal Fee $ Permit Fee $ -� CCF $ CO/CC $ Scanning Fee $ Notary $ Radon Fee $ DBPR $ Bond $. Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ �W TOTAL FEE NOW DUE $ aL LU Bonding Company's Name (if applicable) Bonding Company's Address City State Zip Mortgage Lender's Name (if applicable) Mortgage Lender's Address City StatC 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 app rd and a reinspection fee will be charged. Signature \ /, \ ) wta7c Agent �� \o ractor The forego .ng instrum tknowledged beforeme this The foregoin instrument was ackno of re me t i day of 20 ) by c vi % , day of , 20 I!:; -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. as identification and who did take an oath. NOTARY PUBLIC: Sign: Print: M Commission E Y PUBLIC -STATE OF FLORIDA My ' 7,,ida Andreu Commissim # EE091055 Expires: MAY 05, 2015 BQN* EN**0x1NC'�w�w*�x*�:�x�:**��*gym APPROVED BY 3cu f/ Plans Examiner Structural Review (Revised 07/10/07)(Revised 06/10/2009)(Revised 3/15/09) NOTARY PUBLIC: Sign: vi Print: My Com f ��.STAT"F,km=A' Zeida Andreti Commission # EE091055 Zoning Clerk P 2 STATE OF FLORIDA DEPARTMENT OF HEALTH ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM CONSTRUCTION PERMIT CONSTRUCTION PERMIT FOR: OSTDS Repair APPLICANT: Jose Izquierdo PERMIT # :13 -SC -1465351 APPLICATION # : AP 1103485 DATE PAID: FEE PAID: RECEIPT #: DOCUMENT #: PR902869 PROPERTY ADDRESS: 1351 NE 101 St Miami, FL 33138 LOT: 3 BLOCK: 2 SUBDIVISION: PROPERTY ID #: 11-3205-023-0080 [SECTION, TOWNSHIP, RANGE, PARCEL NUMBER] [OR TAX ID NUMBER] SYSTEM MUST BE CONSTRUCTED IN ACCORDANCE WITH SPECIFICATIONS AND STANDARDS OF SECTION 381.0065, F.S., AND CHAPTER 64E-6, F.A.C. DEPARTMENT 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 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 DEVELOPMENT OF THIS PROPERTY. SYSTEM DESIGN AND SPECIFICATIONS T [ 1,050 ] GALLONS / GPD Septic CAPACITY A [ 0 ] GALLONS / GPD CAPACITY N [ 0 ] GALLONS GREASE INTERCEPTOR CAPACITY [MAXIMUM CAPACITY SINGLE TANK:1250 GALLONS] K [ ] GALLONS DOSING TANK CAPACITY [ ]GALLONS @[ ]DOSES PER 24 HRS #Pumps [ ] D [ 300 ] SQUARE FEET SYSTEM R [ 0 ] SQUARE FEET SYSTEM A TYPE SYSTEM: [x] STANDARD [ ] FILLED [ ] MOUND I CONFIGURATION: [ ] TRENCH [x] BED [ ] N F LOCATION OF BENCHMARK: FFE: 8.44'ngyd I ELEVATION OF PROPOSED SYSTEM SITE [ 33.10][ INCHES FT ][ABOVE BELOW BENCHMARK/REFERENCE POINT E BOTTOM OF DRAINFIELD TO BE [ 59.12][ INCHES FT ][ABOVE BELOW BENCHMARK/REFERENCE POINT L D FILL REQUIRED: [ 0.00] INCHES EXCAVATION REQUIRED: - Install 1050 g septic tank. 0 - Install 300 sq ft drainfield. T - Install 12" of slightly limited soil under bottom of drainfield. - Elevation of bottom of drainfield to be no less than 3.51` NGVD. H - The system is sized for 3 bedrooms with a maximum occupancy of 6 persons, E for a total estimated sewage flow of 400 g/d. - Not for additions R 38.001 INCHES The contractor (^rt+e ne:�) is regcirn to CerfcFrm soil t.r"}rin4' I ? t t t0b , rt f a 6Xc'j Vfjtion at ti time efflni inspector sha i witp 3 c fc" )0tsn:+ u7Ji] compare result -8 t4to Vf�rlll"7£; z ,en -, bi7jitfed. A relnspectlo {er , ilii ne , sFieaseo if the contractor is at the jobsite at the arrangea time. SPECIFICATIONS BY: Robe Rodriguelz TITLE: APPROVED BY: " TITLE: Engineer Specialist II Dade CHD os »h R Pavvr5er ` DATE ISSUED: otf 043 EXPIRATION DATE: DH 4016, 08/09 (ffbsoletes all previous editions which may not be used) Incorporated: 64E-6.003, FAC , 1.1.4 AP1103485 SE895338 07/09/2013 Page 1 of 3 STATE OF FLORIDA .DEPARTMENT OF HEALTH TION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PERMIT Permit Application Number -------------------------- PARTII- SITEPLAN--------------------------- block represents In fc-Apt anti 9 inrh = an fast Notes: THERE ARE NO PERTINENT FEATURES ON ADJACENT PROPERTIES AND OR ACROSS THE STREET THAT MAY AFFECT THE NEW SYSTEM INSTALLATION. Site Plan submitted Plan Approved BY. S�no2ty2i Date County Health Department ALL CHANGES MUST BE APPROVED BY THE COUNTY HEALTH DEPARTMENT DH 4015,10196 (Replaces HRS -H Form 4016 which may be used) Page 2 of 4 (Stock Number: 57444)02-4015.6} Fj-P trr No CAP N89V93rE S'NF FJP1Tr MO CAP } QBEP p - Z&VI it E 3��► p \ A,EA m 2SAr c`X. d Baa - 1 0 ; g STEPS Ic ib■■ 4 2075' OW STORY A�•g� w n RES. � 135f w a1 oo a w to qo O O m LOT -3 ti 8LOCK-2 2it10' X082' 7D' Pic F -fp l 2' ' o 4) d v 4 0 law m C.P_ CL&W � 13.9' 6?' NOCAP cfi aarr O- CL ASPHALTORNE Fa.P ur i P.G., ?1 WPM FAEPULI NOCAP o * �� T43' O o CIL o 1011h STREFET Notes: THERE ARE NO PERTINENT FEATURES ON ADJACENT PROPERTIES AND OR ACROSS THE STREET THAT MAY AFFECT THE NEW SYSTEM INSTALLATION. Site Plan submitted Plan Approved BY. S�no2ty2i Date County Health Department ALL CHANGES MUST BE APPROVED BY THE COUNTY HEALTH DEPARTMENT DH 4015,10196 (Replaces HRS -H Form 4016 which may be used) Page 2 of 4 (Stock Number: 57444)02-4015.6} BUILDING Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795-2204 Fax: (305) 756-8972 INSPECTION LINE PHONE NUMBER: (305) 762-4949 FEB 2 0 2015 FBC 20 10 Master Permit No.P 6 Z `) —9= PERMIT APPLICATION Sub Permit No.- -F -]BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION L&RENEWAL PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: j'!>5N"C 1 O 1 tit City: Miami Shores County: Miami Dade Zip: 3313$ Folio/Parcel#: 11 _32.050%S001%0 Is the Building Historically Designated: Yes NO X_ Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder): 006t V 2cayL & W Phone#: Address: S) N C 1 -0 1 City: Ms a+"w Swo•c sS State: `r 1,- zip: 3?713 Tenant/Lessee Name: C4 ).cw Phone#: Email: CONTRACTOR: Company Name: 5 0 j NVtj n f>691` Phone#: 10S' 0.6.06 d o Address: 1 � Z"• � '�� 1 �� �q'fl'�• City: .1 tom=- State: �` Zip: 1 Qualifier Name: 1'Z,��'1 '..� IR44,' ,•rZ • Phone#: °1 sit _SU b State Certification or Registration #: S Roo 22.1a Z- j Certificate of Competency #: DESIGNER: Architect/Engineer: hone#: Address:_ eJ � City: State: Zip: Value of Work for this Permit: $ 20 0 O . Square/Linear Footage of Work: ' 00 S f Type of Work: ❑ Addition ❑ Alteration ❑ New M Repair/Replace ❑ Demolition r Q �% N 9 � d\Description of Work: -SQ0 * . Specify color of color thru tile: Submittal Fee $ P'ermit Fee $ y CCF $ CO/CC $ Scanning Fee $ " Radon Fee $ DBPR�$ �� Notary $ Technology Fee $ Training/Education Fee $ C) T c () Double Fee $ Structural Reviews $ (Revised02/24/2014) Bond $ TOTAL FEE NOW DUE $ Bonding Company's Name (if applicable) Bonding Company's Address City State Mortgage Lender's Name (if applicable) Mortgage Lender's Address City ri 4 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 ELECTRIC, PLUMBING, SIGNS, POOLS, FURNACES, BOILERS, HEATERS, TANKS, AIR CONDITIONERS, ETC..... OWNER'S AFFIDAVIT: 1 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. Signatu The foregoing instrument was acltnew edgi d before me this ��n daqzi�;ho 20 �J by c 1C1u. is personally known to me or who has produced identification and who did take an oath. NOTARY PUBLIC: Sign: ' c Print: nda Seal: ; �y ('olG Yic .,x:751 a Q " ow as The foregoing instrument was a*kQWedged before me this (� day of 20 (rJ by }-, who is personally known to me or who has produced C -pal km L (Lay6s identification and who did take an oath. NOTARY PUBLIC: Sig . Print: ,'+ Notary Public tate or a Seal:' Sindia Alvarez I 1� My Commission FF 156750 '�1q qcr' Expires 08/03/2018 APPROVED BY L'�%S Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) REGISTERED SEPTIC TANK CONTRACTOR