PL-17-677 Permit NO. PL-3-17-677
�shORs y� Miami Shores Village ■ Permit Type: Plumbing-Residential10050 N.E.2nd Avenue NE Work Classification:Drainfield
Miami Shores,FL 33138-0000 Pen
Permit Status:APPROVED
Phone: (305)795-2204
ORtDp`
Issue Date:3/17/2017 Expiration: 09/13/2017
Project Address Parcel Number Applicant
500 NE 102 Street 1132060171070
Miami Shores, FL 33138- Block: Lot: JOHN BUTLER
Owner Information Address Phone Cell
JOHN BUTLER 500 NE 102 Street
MIAMI SHORES FL 33138-2455
Contractor(s) Phone Cell Phone Valuation: $ 2,400.00
STATEWIDE SEPTIC CONNECTIONS (954)963-0082 Total Sq Feet: 300
Type of Work:REPLACE DRAINFIELD Available Inspections:
Type of Piping: Inspection Type:
Additional Info:REPLACE DRAINFIELD
HRS Approval
Bond Return: Final
Classification:Residential Scanning:3 Review Plumbing
Fees Due Amount Pay Date Pay Type Amt Paid Amt Due
Bond Type-Contractors Bond $500.00
Invoice# PL-3-17-63296
CCF $1.80 03/14/2017 Check#:5269 $50.00 $618.30
DBPR Fee $2.25
DCA Fee $2.25 03/17/2017 Check#: 1001 $618.30 $0.00
Education Surcharge $0.60 Bond#:3346
Permit Fee $150.00
Scanning Fee $9.00
Technology Fee $2.40
Total: $668.30
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 sponsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are
required for ELECTRICAL,P MBING, MECHANI ,WINDOWS,DOORS,ROOFING and SWIMMING POOL work.
OWNERS AFFIDAVIT: I certify that all t or mg information is accurate and that all work will be done in compliance with all applicable laws regulating
construction and zoning F thermore, or he above-named contractor to do the work stated.
March 17, 2017
Authorizedi Signature!Owner / Applicant / Contractor / Agent Date
Building Department Copy
March 17,2017 1
DIVISION OF
+�wEnvironmental Health
Florida Health
Miami-Dade County
OSTDS/Well Division �O
11805 SW 26th Street•Miami,FL 33175
..... Date '+ •/7.
4
Inspector
Address
Comments:
Signature
7
a
Miami Shores Village
Building Departmen LMAR2017
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 l
BUILDING Master Permit No.
PERMIT APPLICATION Sub Permit No.
❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION [—]RENEWAL
PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF CANCELLATION ❑ SHOP
OLE
DRAWINGS
JOB ADDRESS: 500 O LE 102
City: Miami Shores County: Miami Dade Zip: '33J
Folio/Parcel#: I 1_D - 0I-7' u O Is the Building Historically Designated:Yes NO
Occupancy Type: Load: Construction Typ`e.:�- Flood Zone: BFE: FFE:
OWNER:Name-(Fee Simple Titleholder): JAY-)� `I
�v I ( ems Phone#: 16 S96 ff' 'Y-
Address: ;7_ (021S_r
City: M 10 rn I SS!2�2nPS State: r Zip: g
Tenant/Lessee Name: Phone#:
Email: / � 1
CONTRACTOR:Company Name: 1 Cv, , 3(S Phone#: 661' 0�3�
Address: 26 yt C w t el' AA '#-to
City: (n Lccz& State: Zip: 330 91-i
Qualifier Name: D ^� / Phone#:
State Certification or Registration#: fAO� 1I C72 Certificate of Competency#:
DESIGNER:Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for this Permit:$ 2 WJib Square/Linear Footage of Work: 75DO
Type of Work: EJ
Addition ❑ Alteration ❑ New Repair/Replace ❑ Demolition
Description of Work: R( o e,ca ( ►-� ��
Specify color of for thru tile: `�"'�" ..�
Submittal Fee$ AQP Permit Fee$ CCF$ 1 ^7' CO/CC
Scanning Fee$1 Radon Fee$ Z 6 =— DBPR$7 ! C-S 'Notary$'i a
Technology Fee$ ` [ i. V Training/Education Fee$ Double Fee$
Structural Reviews$ Bond$
TOTAL FEE NOW DUE$
(Revised02/24/2014) (n
r '
Bonding Company's Name(if appl
Bonding Company's Address
City State Zip
Mortgage Lender's Name(if applicabl,1
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 on 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 I of be appro d and a reinspection fee will be charged.
Signatu Signature rq� Z-
OWNER or AGENT CONTRACTOR
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
Ub day of 00 r-(J'l 20 I 7 by i ?�) p,,
day of �"L Q L-QJ�) 20 )_7 by
U�n►'� �V"�"' eY who is personally known to ,.* n r 1_�� who is personally known to
me or who has produced as me or who has produced �'7 as
identification and who did take an oath. identification and who did take an oath.
NOTARY PUBLIC: NOTARY PUBLIC:
Sign: Sign:
Print. J Crrf CQ (» 4rnrr, Print. Y
Seal: Seal:
E
:JERRICA L.ARMSTRONG e'• JERRICA L.ARMSTRONG
Notary Public-State of Florida s Notary Public-State of Florida
"Vff*I*AS �**ob 1� My Comm.Expires Feb 9,2019 °'� My Comm.Expires Feb 9,2019
A Plans Examiner Zoning
/Z 3-/Y-
Structural Review Clerk
(Revised02/24/2014)
PERMIT #: 13-SC-1743325
STATE OF FLORIDA
APPLICATION #:AP1278176
DEPARTMENT OF HEALTH DATE PAID:
ONSITE SEWAGE TREATMENT AND DISPOSAL FEE PAID:
SYSTEM
RECEIPT #:
.� W"'A A DOCUMENT #: PRI 051805
CONSTRUCTION PERMIT FOR: OSTDS Repair
APPLICANT: John Butter
PROPERTY ADDRESS: 500 NE 102 St Miami, FL 33138
LOT: 1112 BLOCK: 94 SUBDIVISION:
[SECTION, TOWNSHIP, RANGE, PARCEL NUMBER]
PROPERTY ID #: 11-3206-017-1070 [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 [ 900 ] GALLONS / GPD Existing Septic tank to remain 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 Trench configuration drainfi SYSTEM
R [ 0 ] SQUARE FEET SYSTEM
A TYPE SYSTEM: [X] STANDARD [ ] FILLED [ ] MOUND [ ]
I CONFIGURATION: [X] TRENCH [ ] BED [ ]
N
F LOCATION OF BENCHMARK: F.F.E., 11.50'NGVD
I ELEVATION OF PROPOSED SYSTEM SITE [ 14.40 ] [ INCHES FT ] [ ABOVE BELOW BENCHMARK/REFERENCE POINT
E BOTTOM OF DRAINFIELD TO BE [ 62.40 ] [ INCHES FT ] [ ABOVE BELOW BENCHMARK/REFERENCE POINT
L
D FILL REQUIRED: [ 0.00] INCHES EXCAVATION REQUIRED: [ 48.001 INCHES
"Invert elevation of drainfield to be no less than 6.80' NGVD.
O "Bottom of drainfield elevation to be no less than 6.30'NGVD.
T "THIS PERMIT IS NOT FOR"ADDITION(s)".
H The system is sized for 4 bedrooms with a maximum occupancy of 8 persons(2 per bedroom),for a total estimated flow.of
400 gpd.
E Required drainfield area based on rule 64E-6.015(6)(c)2.
R Install a new drainfield to achieve Drainfield size requirement.
SPECIFICATIONS BY: Teresa J om TITLE:
Master Septic Tank Contractor
APPROVED BY: LE: Dade CHD
Ca os M caza
DATE ISSUED: 03/!t/2017 EXPIRATION DATE: -.05/31/2017
DH 4016, 08/09 (Obsoletes all previous editions which may not be used)
Incorporated: 64E-6.003, FAC ° Page 1 of 3
The contractor(or designee)is required to perform a
V 1 ' ° soil boring abWt lffthe drainfield excavallb'r AtAhe
time of final inspection.Prior to Final Approval,the DOH
inspector shall witness the soil boring and compare the
results to the original site evaluation submitted.A
reinspection fee will be assessed if the contractor is not
at the jobsite at the arranged time,