PL-16-3104 Permit No. PL-11-16-3104
, 11"% 1Z Miami Shores Village -anPermit Type:Plumbing-Residential
10050 N.E.2nd Avenue NE r
Perill 'it Worts Classification:Drainfield
Miami Shores,FL 33138-0000 Permit Status:APPROVED
Phone: (305)795-2204
FLORIDA
Issue Date: 1/6/2017 Expiration: 07/05/2017
Project Address Parcel Number Applicant
1460 NE 103 Street 1132050310060
Miami Shores, FL Block: Lot: MONICA SAVITS
Owner Information Address Phone Cell
MONICA SAVITS 1360 N. E. 103 ST.
Contractor(s) Phone Cell Phone Valuation: $ 8,500.00
MR C'S PLUMBING 8,SEPTIC INC (305)651-7859
Total Sq Feet: 400
Type of Work:DRAINFIELD Available Inspections:
Type of Piping: Inspection Type:
Additional Info:
HRS Approval
Bond Return: Final
Classification:Residential Scanning:3 Review Plumbing
Fees Due Amount Pay Date Pay Type Amt Paid Amt Due
Bond Type-Owners Bond $500.00
Invoice# PL-11-16-62051
CCF $5.40 11/14/2016 Check#:1195 $50.00 $782.40
DBPR Fee $4.50
DCA Fee $4.50 01/06/2017 Check#:97 $500.00 $282.40
Education Surcharge $1.80 01/06/2017 Credit Card $282.40 $0.00
Permit Fee $300.00 Bond#:3296
Scanning Fee $9.00
Technology Fee $7.20
Total: $832.40
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 stns conformity with the plans,drawings,statements or specifications submitted to the proper authorities of Miami Shores Village. In
acceptingVn ?n
a responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are
required fUMBING,MECHANICAL,WINDOWS,DOORS,ROOFING and SWIMMING POOL work.
OWNERat alth I the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating
constructrmore,I authorize the above-named contractor to do the work stated.
January 06, 2017
Authorized Signature:Owner / Applicant / Contractor / Agent Date
Building Department Copy
January 06,2017 1
Miami Shores Village RECEIVED
QV 14 2016
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel:(305)795-2204 Fax:(305)756-8972Tl(-�C
INSPECTION LINE PHONE NUMBER:(305)762-4949
FBC 201 q
BUILDING Master Permit No-P(-1 1 Vy
PERMIT APPLICATION Sub Permit No.
❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: 1 4 627 L2 Ica`—I <-f-r��—
City: Miami Shores County: Miami Dade zip:
Folio/Parcel#: Is the Building Historically Designated:Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FIFE:
OWNER:Name(Fee Simple Titleholder): c h+ c a�1 �� Phone#:
Address: 14 6 D3"f
City: �f I a.t tA&-, xr
, <U.rr a StateZip: 3 313
Tenant/Lessee Name: ' N ZZ-0 62 11 Phone#:
Email: '5L-V1 Con V-c} Gt.o ('n,fit_,
CONTRACTOR:Company Name: o's RwaU�4 'V, -J-mc, Phone#:
Address: L.V
City: v+o AA State: Zip: 34.
Qualifier Name: Jam. ten.-Q�-�e� --H-r.+ ctk_� Phone#:"---T8 6- 5 86- 2±4}-3
State Certification or Registration#: Certificate of Competency#: 10 14
DESIGNER:Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for this Permit:$ ')IOD Square/Linear Footage of Work: yLCR1
Type of Work: ❑ Addition ❑ Alteration ❑ New F► Repair/Replace ❑ Demolition
Description of Work: (
Specify color of coloor�thru tile:
j
Submittal Fee$ `'� Permit Fee$ 3 f $
CO/CC CCF$ 1 �� •^���+3
( CO/CC
Scanning Fee$ •W Radon Fee$ �. SV DBPR$ ' R) +Notary$
Technology Fee$ 2y Training/Education Fee$T�� Double Fee$
Structural Reviews$ Bond$ •w
TOTAL FEE NOW DUE$ ���_
(Revised02/24/2014) Q I C
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 must be posted at the job site
for the first inspection which occurs seven (7) days after the building permit is issued. In e a ence of such posted notice, the
inspection will not be approved and a reinspection fee will be charged.
X •
Signature Signature
OWNER or AGENT . , CONTRACTOR
The foregoing instru�Aee�nt-�was
nacknowledged before me this The foregoing instrument was acknowledged before
me this
�'�'1 day of VIJI V►J-L r 20 by _� day of AXASEZIMAyylD` '20 J , by
Nhoi LIDO I)f who is personally known to t�FZM/DL����who is personally known to
------------------
me or who has produced as me or who has produced as
identification and who did take an oath. identification and who did take an oath.
NOTARY PUBLIC: NOTARY PUBLIC:
Sign: y��� Sign:
Print: ,p Ut I I` i-t Mew Print:
Irl
Seal: Seal: ,,.�aY'P� SHERYL A MENDES
Notary Public State of Florida
s •s el fir ? ** •= My Comm.Expires Oct 23,2018
Commission#FF 136597
wwaMioiNovNnr o0M %'rF opo' o al Notary Assn.
*********** ********r******•*********'************ *****r** **ka9fvbs**�eor�de1111li1&k ************
MY`
•
APPROVED BY K Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)
STATE OF FLORIDA11-0 CC31.3t, 'q
-4 DEPARTMENT OF HEALTH DATE PAID:
ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM FEE PAID:
CONSTRUCTION PERMIT RECEIPT #:
I'M
RIO
""` DOCUMENT #:PR1037519
CONSTRUCTION PERMIT FOR: OSTDS Repair
APPLICANT: Monica Saylts
PROPERTY ADDRESS: 1460 NE 103 St Miami,FL 33138
SOT: 15 BLOCK: 5 SUBDIVISION: RE PLAT OF TR C MIAMI SHORES
PROPERTY ID #: 11-3205-031-0060 [SECTION, TOWNSHIP, RANGE, PARCEL NUMBERI
[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 FRCM COMPLIANCE WITH OTHER FEDERAL,
STATE, OR LOCAL PERMITTING REQUIRED FOR DEVELOPMENT OF THIS PROPERTY.
SYSTEM DESIGN AND SPECIFICATIONS
T [ 1,050 ] GALLONS / GPD septic tank CAPACITY
A [ ] GALLONS / GPD CAPACITY
N [ ] GALLONS GREASE INTERCEPTOR CAPACITY [1+A=4UM CAPACITY SINGLE TANK:1250 GALLONS]
K [ 300 ] GAZaAMS DOSING TANK CAPACITY [67.00 ]GALLONS 8 6 ]DOSES PER 24 HRS #Pumps [ 1 1
D [ 400 ] SQUARE FEET Bed configuration drainfiel SYSTEM
R [ ] SQUARE FEET SYSTEM
A TYPE SYSTEM: [x] STANDARD [ ] FILLED [ ] MOUND I I
I CONFIGURATION: I ] TRENCH Ix] BED I ]
N
F LOCATION OF BENCHMARK: FFE 8.4'NGVD
I ELEVATION OF PROPOSED SYSTEM SITE [ 28.80] INCHES FT ][ABOVE BELOW BENCHMARK/REFERENCE POINT
E BOTTOM OF DRAINFIELD TO BE 158.801 d 33;cHEsT FT ][ABOVE BELOW BENCMDaWREFERENCE POINT
L
D FILL REQUIRED: [ ] INCHES EXCAVATION REQUIRED: 142.00] INCHES
"Performing Lift Dosing.
O "Pumps must be certified as suitable for distributing sewage effluent
T 1.Install a 1050 gal min.septic tank with an approved filter.
H 2.-The licensed contractor installing the system is responsible for installing the minimum category of tank in accordance
with s.64E-6.013(3)(f),FAC.
E 3.-Install 400 sf of drainfield in bed configuration.
(Comments Continued on Page 2.)
R
SPECIFICATIONS BY: KEMBLE ETTRICK TITLE:
APPROVED BY: ��� TITLE: Engineering Specialist II Dade CHD
Erlande O=Sca
DATE ISSUED: 11/02/2016 EXPIRATION DATE: 01/31/2017
DH 4016, 08/09 (Obsoletes all previous editions which may not be used)
Incorporated: 64E-6.003, FAC AP1261379TT ... T1I �
The con:rcto'(or^�saqn.,e;is re%qui.ad'to pericrn a soli V07"(
c,.•-Cc'!' eY.c�3'Val..cn a° VPc 'Ljme Cf c^ai
Y ?3 -:nai "iD.^✓,rovai, tUhe f DOH. ?i15�)8i x s'`iH1l
noa':d C'J:ilpa:'a ?^c rf~S:.;IS `0 2^e O^y.'a�
A ic--ns.noc!i-r. 'Be l4;if JE assessc-J
:s ro". at me at tt:e alrar o ti r.e.
STATE OF FLORIDA
DEPARTMENT OF HEALTH
APPUCATION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PERMIT
Permit Application Number
Scale: Each
�ool
fEws, •t nn 1 cs;o �
iE? ICct;�yt w 300
-� fit'G S '`t•t
. 1
. fro
0
4eCuaa� r
fib � C 5b:o �
Thereare no pertinent features on adjacent pmpefts and or across the street that may affect the New Septic system insWilation.
es:
��_� c vti �Jr�)ti ke id .�- f-t c, fiC�wL< E;n g 4-�i ►1 ng incc- ( ACH-
�c�st
Site Plan submitted by: CcC.' Y
Plan Approved_ - - Not Approved Date l a 1
By County Health Department
ALL CHANGES MUST BE APPROVED BY THE COUNTY HEALTH DEPARTMENT
DH 4015,90186(Replaces MRS-1i Form 4016 which may be used) Page 2 of d
(Stock Number: 5744-002-4015-6)