DS-15-700 Miami Shores Village
10050 N.E.2nd Avenue NW
Miami Shores,FL 33138-0000
'"•k*�e.off Phone: (305)795-2204
FCOrtkDA
` Expiration: 10/2812015
Project Address Parcel Number Applicant
117 NW 100 Terrace 1131010220230
Miami Shores, FL Block: Lot: NANCY JONES VAN HOOSEAR
Owner Information Address Phone Cell
NANCY JONES VAN HOOSEAR 117 NW 100 TERR 3057573185
MIAMI SHORES
Contractor(s) Phone Cell Phone
Valuation: $ 6,400.00
CHAMPION CONCRETE
(305)252-8055 (786)402-4802
Total Sq Feet:
720
Approved:In Review Available Inspections:
Comments: Inspection Type:
Date Approved: :In Review Final
Date Denied: Foundation
Type of Work:OLD CHICAGO BRICK Additional Info: Review Planning
Bond Return: Classification:Residential Review Building
Scanning:3
Fees Due Amount Pay Date Pay Type Amt Paid Amt Due
Bond Type-Owners Bond $500.00 Invoice# DS-3-15-54967
CCF $4.20 03/27/2015 Check#:2477 $50.00 $604.20
DBPR Fee $2.00
DCA Fee $2.00 05/01/2015 Credit Card $604.20 $0.00
Education Surcharge $1.40 Bond#:2698
Notary Fee $5.00
Permit Fee $125.00
Scanning Fee $9.00
Technology Fee $5.60
Total: $654.20
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 t foreg ing information is accurate and that all work will be done in compliance with all applicable laws regulating
construction an zoning. uthermore,I thonz he above-named to do the work stated.
May 01, 2015
AuIt riz gn tures Owner / Applicant / Contractor / Agent Date
Building partment Copy
May 01, 2015 1
�W
Miami Shores Village
Lt1 Building Department MAIC 27 2015
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
V• Tel: (305)795-2204 Fax:(305)756-8972
INSPECTION LINE PHONE NUMBER:(305)762-4949 r`"--
FBC 20 /D
BUILDING Master Permit No. 0—s /6= ZC2:2
PERMIT APPLICATION Sub Permit No.
•` BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
PLUMBING MECHANICAL PUBLIC WORKS CHANGE OF CANCELLATION SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: id0 '7TVt1-
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#: Is the Building Historically Designated:Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name(Fee Simple Titleholder): f���/� `� �'�r - %)4-1V'r104 `t Phone#: 93S a;) I GO( C
Address: `i
City: i ► i�l State: �. Zip:
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR:Company Name: C Phone#: 3 ��
Address: ae& vv � - '►"'� 7
City: L _ f State: Zip:
Qualifier Name: 'M—e-- 64>1940 Phone#:
State Certification or Registration#: Certificate of Competency#: i� 0
DESIGNER:Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for this Permit:$ a Square/Linear Footage of Work: 77 40
Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace ❑ Demolition
Description of Work: Jt GT /
Specify color of color thru tile:
Submittal Fee$ Permit Fee$ t2�' w CCF$ CO/CC$
Scanning Fee$ Radon Fee$ DBPR$ Notary$
Technology Fee$ Training/Education Fee$ Double Fee$
Structural Reviews$ Bond$ Goo • Q:)
TOTAL FEE NOW DUE$ C
(Revised02/24/2014)
boy• �
Bonding Company's Name(if applicable)
Bonding Company's Address
City State Zip
Mortgage Lender's Name(if applicable)
Mortgage Lender's Address
City State Zip
Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has
commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulating
construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRIC, PLUMBING, SIGNS, POOLS,
FURNACES, BOILERS, HEATERS,TANKS,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 mu t be posted at the job site
for the first inspection which occurs seven (7) days after the building permit is issued. In the absence' f such posted notice, the
inspection will not be approved and a reinspection fee will be charged.
Signatured,�,��ignature `
NER or AGENT CONTRACTOR
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
day ofM/ ?,/n 20 /�S`'_ , by day ofi224t _,dn 20,-'-5— by
f! fx1/�;who is personally known to �/a
V %�L- -_�,�I S, /i�� �1v c s personally kno to
me or who has produced a)L 5-A( -6736)`#YI r-AV19 me or who has produced has
identification and who did take an oath. identification and who did take an oath.
NOTARY PUBLIC: NOTARY PUBLIC:
Print:
Seal: �oam9:f ar,3 r Notary Public State of Florida Seal:
Joanna M FeliUiano
My cornmission FF 082753 z°�PaY pusG Notary Public State of Florida
� Expires ott�zi2ots Joanna M Feliciano
PAy commission FF 082753
I �
APPROVED BY [ c Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)
Mission: Rick Scott
+
Governor
To protect,promote&improve the health
all people in Florida through integrated
state,
'I John H.Armstrong, MD, FACS
state,county&community efforts. HEALTH State Surgeon General&Secretary
Vision:To be the Healthiest State in the Nation
April 09, 2015
Nancy Jones Van Hoosear
117 NW 100 Terrace
Miami, FL 33150
RE: Modification to a Single Family Residence - No Bedroom Addition
Application Document Number: AP1182602
Centrax Permit Number: 13-SC-1596802
117 NW 100 Terrace
Miami, FL 33150
Lot: 8 Block: 3 Subdivision: Gold Crest
Dear Applicant,
This will acknowledge receipt of a floor plan and site plan on 03/30/2015 for the use of the existing
onsite sewage treatment and disposal system located on the above referenced property. No
Objection: addition of patio. Issued by E. Omisca on 04/09/2015.
This office has reviewed and verified the floor plan and site plan you submitted, for the proposed
remodeling addition or modification to your single-family home. Based on the information you provided,
the Health Department concludes that the proposed remodeling addition or modification is not adding a
bedroom and that it does not appear to cover any part of the existing system or encroach on the
required setback or unobstructed area. No existing system inspection or evaluation and assessment,
or modification, replacement, or upgrade authorization is required.
Because an inspection or evaluation of the existing septic system was not conducted, the Department
cannot attest to the existing system's current condition, size, or adequacy to serve the proposed use.
You may request a voluntary inspection and assessment of your system from a licensed septic tank
contractor or plumber, or a person certified under section 331.0101, Florida Statutes.
If you have any questions, please call our office at (305) 623-3500.
Sincerely,
Erlande Omisca
Engineering Specialist II
Department of Health in Dade County
Florida Department of Health www.floridahealth.gov
in Dade County• •,Florida TWITTER:HealthyFLA
PHONE: (305)623-3500 FACEBOOK:FLDepartmentofHealth
YOUTUBE:fldoh
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