PL-16-3462 Permit NO. PL-12-16-3462
�s*'ORFs q Miami Shores Village Permit Type:Plumbing-Residential
10050 N.E.2nd Avenue NE Work Classirrcation:Drainfield
• Miami Shores,FL 33138-0000 Per ''
tieO
Permit Status:APPROVED
fioi iPhone: (305)795-2204
s>p`
Issue Date: 12/2912016 Expiration: 06/27/2017
Project Address Parcel Number Applicant
1199 NE 102 Street 1132050190010
Miami Shores, FL 33138-2649 Block: Lot: IRIS GOMEZ
Owner Information Address Phone Cell
[ IRIS GOMEZ 1199 NE 102 Street
MIAMI SHORES FL 33138-
Contractor(s) Phone Cell Phone Valuation: $ 2,400.00
A AARON SUPER ROOTER 305-944-8886
Total Scl Feet: 300
Type of Work:REPLACE DRAINFIELD Available Inspections:
Type of Piping: Inspection Type:
Additional Info:
Final
Bond Return: HRS Approval
Classification:Residential Scanning:3 Review Plumbing
Fees Due Amount Pay Date Pay Type Amt Paid Amt Due
CCF $1.80
DBPR Fee Invoice# PL-12-16-62460
$2.25 12/29/2016 Check#:6211 $ 118.30 $50.00
DCA Fee $2.25
Education Surcharge $0.60 12/23/2016 Check#:6208 $50.00 $0.00
Permit Fee $150.00
Scanning Fee $9.00
Technology Fee $2.40
Total: $168.30
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 an zoning. Futhermore, I authorize th bove-named contractor to do the work stated.
December 29, 2016
Authorized Signature:Owner / Applicant / Contractor / Agent Date
Building Department Copy
December 29, 2016 1
`� Miami Shores Village RECFTA7F
Building Department DEC 23 2 16
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
(L CY Tel:(305)795-2204 Fax:(305)756-8972 BY:
INSPECTION LINE PHONE NUMBER:(305)762-4949 �k
�F-�yBC 2r 0��
BUILDING Master Permit No. 2-
PERMIT APPLICATION sub Permit No.
❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
PLUMBING ❑ MECHANICAL F-1 PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
/� ^( r CONTRACTOR DRAWINGS
JOB ADDRESS: , 'TCJ ry C I D 2 9t
�7Z,
City: Miami Shores County: Miami Dade Zip: �� os
Folio/Parcel#: '1 ' 32c�5 "Q -C)0 ( o Is the Building Historically Designated:Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name(Fee Simple Titleholder). V-'l Go r'le Phone#:
�� g
Address: 1 I N t__- I')2
City: M�rf1 iy' � State: Zip: 1331 c7C3
Tenant/Lessee Name: Phone#:
Email: 2 q r I
CONTRACTOR:Company Name: n (20 ty Phone# ( t�`"F' ffkK
Address: 0022
S-W 2;,� C �-1
City: ! '\1rQ State: Zip: 330
Qualifier Name: V Phone#:
State Certification or Registration M Certificate of Competency M
DESIGNER:Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for this Permit:$ cx__) Square/Linear Footage of Work:- _ 1300
Type of Work: ❑ Addition ❑ Alteration ❑ New !" Repair/Replace ❑ Demolition
Description of Work:
cc r
l' [ rx:"�nw+�• ,'!'!c-,!`,ir.'...-,Z..:,r;,s .+fw.et:`w.�:...Law,e.ss'
Specify color of color thru tile:
Submittal Fee$ 0MX - Permit Fee$ �� CCF$
Scanning Fee$ Radon Fee$ G. DBPR$ `x r Nota`
IL
ry$ �.
TechnologyFee$ (�' ��j��/^^�� �W 41Y ``�• � •,
Training/Education Fee$ a `4013ouble Fee$
Structural Reviews$ Bond$
TOTAL FEE NOW DUE$
(Revised02/24/2014)
• s ,
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 t e absence of such posted notice, the
inspection will not be approved a d a rein pection fee will be charged.
Signature r Signature
OWNER or AGENT ONTRACTOR
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged befor me this
day of D t.U 120 by r�day of pC9G 201 by
�f1 S GO wL2 Z who is personally known to 0 who is personally known to
me or who has produced l l 112 as me or who has produced F—Lp 0 as
identification and who did take an oath. identification and who did take an oath.
NOTARY PUBLIC: NOTARY PUBLIC:
Sign: • Sign:
Print: r r i G Print:
Seal: Seal:
�"Ay:; � TERES J.SOLOMON
•.,," MY COMMISSION#FF 928161
JIAtIRICAL ARMSTRONG
Notary P*k_She of Florioo a, o* EXPIRES:November 8,2019
k4q%tartSeryices
� ����.: My Comm.Ex Ires Feb 9,2019
APPR Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)
1 r
w
DIVISION OF
44> • Environmental Health
Florida Health
Miami-Dade County ' �O
OSTDS/Well Division �+V
t
11805S 6th Street•Miami,FL 33175
i
Inspectolv NllDate �' ��'� �•D ��
i':�""�`a' �i�l� -
Address 1� a a �`� �OyST OSTDS#
Comments: I
Signature ��
ti fr��
PERMIT #: 13-SC-1602810
ri�+tl +t
APPLICATION #:AP1186412
STATE OF FLORIDA
DATE PAID:
DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM FEE PAID:
CONSTRUCTION PERMIT RECEIPT #:
a y DOCUMENT #: PR973835
CONSTRUCTION PERMIT FOR: OSTDS Repair
APPLICANT: Iris Gomez
PROPERTY ADDRESS: 1199 NE 102 St Miami, FL 33138
IAT: 1 BLOCK: 175 SUBDIVISION:
[SECTION, TOWNSHIP, RANGE, PARCEL NUMBER]
PROPERTY ID #: 11-3205-019-0010 [OR TAX ID NUMBER]
SYSTEM MUST BE CONSTRUCTED IN ACCORDANCE WITH SPECIFICATIONS AND STANDARDS OF SECTION
64E-6, T.A.C. DEPARTMENT APPROVAL, OF SYSTEM DOES NOT GUARANTEE
381.0065, F.S. , AND CHAPTER
SATISFACTORY PERFORMANCE FOR ANY SPECIFIC PERIOD OF TIME ANY CHANGE IN MATERIAL FACTS,
WHICH SERVED AS A BASIS FOR ISSUANCE OF THIS PERMIT, .2EQUIRE THE APPLICANT TO MODIFY THE
AND VID.
PERMIT APPLICATION. SUCH MODIFICATIONS STY TRESUITHE PLICANTTHIS
7FROM PERMIT
COMPLIPNCE rWITH OTRNULL FEDEORAL,
ISSUANCE OF THIS PERMIT DOES
NOT IRED FOR DEVELOPMENT OF THIS PROPERTY.
STATE, OR LOCAL PERMITTING REQU
SYSTEM DESIGN AND SPECIFICATIONS
t, Septic
CAPACITY
T [ 900 ] GALLONS / GPD CAPACITY
A [ 0 l GALLONS / GPD
N [ 0 ] GALLONS GREASE INTERCEPTOR CAPACITY [MAXI]GALLONS
LON MUM CAPACITY
CL[Y SI ]DOSES PER 24 HRS GALLONS]
[ 7
K [ ] GALLONS DOSING TANK CAPACITY L
SQUFEET Trench confiquration drain SYSTEM
D [ 300 ARE SYSTEM
R [ 0 ] SQUARE FEET LLEDMOUND [ l
A TYPE SYSTEM: [x] STANDARD I ]BED [ ] []
I CONFIGURATION-. [x] TRENCH [ ]
N FFE: 11.5'NGVD
F LOCATION OF BENCHMARK:
FT ] [ A130VE BELOW BENCHMARK/REFERENCE POINT
Z ELEVATION OF PROPOSED SYSTEM SITE [ 25.20 ] [ INCHES FT ] [ BOVE BELOW BE
POINT
73.20 ] [ IVCOES
E BOTTOM OF DRAINFIELD TO BE
[
L EXCAVATION REQUIRED: 48.00 ] INCHES
D FILL REQUIRED: [ 0.001 INCHES
1.-Existing 900 gal.septic by"A Aaron"on 4/20/2015 to remain.
Ptic tank,certified ,
0 2.-Install 300 sf of drainfield in trench configuration.
T 5.-Invert elevation of drainfield to be no less than 5.9' NGVD.
6.-Bottom of drainfield elevation to be no less tancy of 8 pan ersons(2 per D. lb bedroom),for a total tal a timat d flow of4NS
00gpd.
H System sized for 4 bed with a maximum P
E
R '
w i TITLE:
SPECIFICATIONS BY: A Aaron S Rooter s Dade CHD
~' TITLE: Engineering Spe+=ialist II
APPROVED BY: �. EXPIRATION DATE: 08/05/2015
i
Betsy ange-ono
05/07/2015
DATE ISSUED: not be used) page 1 of 3
08/09 (Obsoletes all previous editions which may .,
DH 4016,
FAC RIP
Incorporated: 64E-6.003, z slleeal2 � �TR P V ,
v 1.1.4
The contractor(j
edjacent to
inspection Pco
witness the soil tK"'
sa_vt3luation submrre 1. i c
� i ig,�,t]1�? ;rAniYSftfjr iS r�.t ?'. t^r
TATE OF FLORIDA
D'E�ARTMENT OF HEALTH
APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM'CONSTRUCTION PERITL.',,
Edo Permit Application Number
------------— PART 11 -SITE PLAN------------
represents feet a
scale: Each block hd 1 i9ch 50 feet.
C)l
A
..... .... ...
... ...... .... .....
w
lip
A :
r AV`
A
I.
A
A
tx-
--- ........
w
.............
7.
............ . .....
-L. ..... L
Notes: L, s$
E12
-Al
Site Plan submitted by:� Signature
ptoNot Approved Date
Plan A� �ed V
County Health Department
By
LIST BE APpROVED BY THE COUNTY M
HEALTH DEPARTMENT
�-.'-.OALLCHANGESM Page 2
DH 4015.10196(Replaces HRS-H Form4015 which MY be used)
--
(Stock Number:5744.002-4015-6)
Miami Shores Village nF
Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138Tel:(305)795-2204 Fax:(305)756-8972
INSPECTION LINE PHONE NUMBER:(305)762-4949
FBC 20 0)
BUILDING V Master Permit No.-?— (S;- 1303
PERMIT APPLICATION '�� Sub Permit No.
❑BUILDING ❑ ELECTRIC ❑� G ❑ RE I ['X�ENSION ❑RENEWAL
PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF 0 CANCELLATION ❑ SHOP
�
} CONTRACTOR DRAWINGS
JOB ADDRESS: I�'1 N OZ J 1 �p
City: Miami Shores County Miami Dade Zig 33 130
Folio/Parcel#: I t—3 Z0 5--0�9 — oO I(D Is the Building Historically Designated:Yes NO�_
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER:Name(Fee Simple Titleholder):_I KI S GO Mf�Z Phone#: 3�3S— 3 J 2-
Address:_(I()q NE 102 S'
City: WA-141, CQ02a4��S State: Zip: 33� 8
Tenant/Lessee Name: Phone#:
Email: ����
CONTRACTOR:
^^Company Name: A Aft//��Pb(V c�IPM- '�-n �
.yC L
Address: `0 Z 2 ,SLS " $ GT phone#:
City: 4w-F"c''`NU State: Zip:
Qualifier Name: 00TVr( Phone#:
State Certification or Registration#:_ Certificate of Competency#:
DESIGNER:Architect/Engineer: Phone#:
Address: / City: State: Zip:
Value of Work for this Permit:$_":1q001U Square/Linear Footage of Work: '32C
Type of Work: ❑ Addition ❑ Alteration ❑ New
Repair/Replace ❑ Demolition
Description of Work:
2.6 ace �Y7JIl+n -2 d
Specify color of color thru tile:
Submittal Fee • Permit Fee$ SSG �`y' CCF$ CO/CC$
Scanning Fee$ Radon Fee$ DBPR$ Notary$
Technology Fee$ Training/Education Fee$ Double Fee$
Structural Reviews$ Bond$ sm • Q
TOTAL FEE NOW DUE$ ( I U
(Revised02/24/2014)
619 . 30
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 installation i Cate-d. I certify that no work or installation has
commenced prior to the issuance of a perrViJtik -,all work will be perfor meet the standards of all laws regulating
construction in this jurisdiction. I understand that (tate 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 commen. men must be posted at the-job site
for the first inspection which occurs seven (7) days after the building permit is issued. In t bsence 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
dayof- A 20 by day of M 20 S by
who is personally known to who is personally known to
me or who has producedZ- as me or who has produced F_ Pt- as
identification and who did take an oath. identification and who did take an oath.
NOTARY PUBLIC: NOTARY PUBLIC:
Sign: Z Sign: ?.
Print: "Y:' ' T pee A eIiui�NPrint: Q-
'= MY COMMISSION#EE131935 Seal: a°' % TERESq SOLOMON MON
$or EXPIRES November 08,2015 • MY COMMISSION
(J@7)398-0153 FWkIalloia #EE1
ryservice.com °!n; ' EXPIRES November31935
( 117)398-p153 08,2u^15
APPROVED BY ��. /� /3 Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)