PL-17-74 Permit No. PL-1-17-74
`5ANt%F Dy Miami Shores Village Permit Type:Plumbing-Residential
10050 N.E.2nd Avenue NE r
Work Classification:Dt'ainfel+d
� �I� �
■ Miami Shores,FL 33138-0000 Permit Status:APPROVED
F «a` Phone: (305)795-2204
LORtDP
Issue Date: 1/1212017Expiration: 07/11/2017
Project Address Parcel Number Applicant
1298 NE 95 Street 1132060144030
Miami Shores, FL Block: Lot: EDITH DAYLE PECK
Owner Information Address Phone Cell
EDITH DAYLE PECK 1298 NE 95 ST
MIAMI SHORES FL 33138-2550
Contractor(s) Phone Cell Phone Valuation: $ 2,400.00
MR C'S PLUMBING 8,SEPTIC INC (305)651-7859
Total Sq Feet: 300
Type of Work:DRAINFIELD REPAIR Available Inspections:
Type of Piping: Inspection Type:
Additional Info:DRAINFIELD REPAIR HRS Approval
Bond Return: Final
Classification:Residential Scanning:3 Review Plumbing
Fees Due jAmn Pay Pay Type Amt Paid Amt Due—
CCF
Type Amt Paid Amt Due
CCF
DBPR Fee Invoice# PL-1-17-62585
01/12/2017 CreditCard $ 118.30 $50.00
DCA FeeEducation Surcharge 01/11/2017 CreditCard $50.00 $0.00
Permit Fee Scanning Fee Technology Fee Total:
In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations
pertaining thereto and in strict conformity with the plans,drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In
accepting this permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are
required for EL A PLUMBING,MECHANICAL,WINDOWS,DOORS,ROOFING and SWIMMING POOL work.
OWNERS AF D T. I at all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating
construction an n u rmore,I authorize the above-named contractor to do the work stated.
January 12, 2017
Auth ized Signature:Owner / Applicant / Contractor / Agent ate
Building Department Copy
January 12,2017 1
Miami Shores Village .:
Building Department JAN 11 2017
10050 N.E.2nd Avenue,Miami Shores,Florida 33138
Tel: (305)795.2204 Fax:(305)756.8972 BY: _ _ __ 5
INSPECTION'S PHONE NUMBER:(305)762.4949 r i
BUILDING Permit No. I
PERMIT APPLICATION Master Permit No.
FBC 20
Permit Type: PLUMBING
OWNER:Name(Fee Simple Titleholder): DZT�' r- Phone#: L a
Address: oZ C1 ? N --::7 Q k s
City: CA-,-,. .i �k-.0-y-e- s State: f L Zip: 73 7 3
Tenant/Ussee Name: Phone#: ~
Email: e (29
` G' Lr Vv�
JOB ADDRESS: I al 9 e/ULA g S }`- S�
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#: //- -5 0/q C,� 6 3 y /
Is the Building Historically Designated: Yes NO !/ Flood Zone:
CONTRACTOR:Company Name: �� ' S �` Phone#: 30S S l�W"
Address: -(`t IV-w
City: a-1'Va Stat : Zip: 2-� l b
Qualifier Name: Phone#: 3 G 9-9 5--/
State Certification or Registration#: 6 Certificate of Competency#:
Contact Phone#: Email Address:
DESIGNER: Architect/Engineer: Phone#:
Value of Work for this Permit:$ O`�' Square/Linear Footage of Work: 3�
Type of Work: ❑Address ❑Alteration ❑New *epair/Replace ❑Demolition
Description of Work:
Submittal Fee$ Permit Fee$ So CCF$ 1 - 460 CO/CC$
Scanning Fee$ Radon Fee$ DBPR$ Bond$
Notary$ Training/Education Fee$ Technology Fee$
Double Fee$ Structural Review$
TOTAL FEE NOW DUE$ I I •—
Bonding Comp4ay's Name(if applicable)
v
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 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 irfu—e2k In the absence of such posted notice, the
inspection will not be approved and a reinspection fee will be charged.
Signature Signature
er or Agent Q Contractor
The fo oing i strument was acknowledged efore me this � The foregoing instrument was acknowledged before me this
day o ,20 1,by 2i✓ day o 20 ,by 610&*'
who is rsonally known to me or who has produced who is personally kn to me or who has produced
r.
As identification and who did take an oath. as identification and who did take an oath.
NOTARY PUBLIC: NOTARY PUBLIC:
Sign: Sign: k, �
Print: Print:
H.BARBARA MEMAN .SPav n�.
My Commission Expires: * MV COMMISSION i EE 860789 My C hpiWsiary Public-State of Florida
s� r EXPIRES:February 15,2017 + ►�; My Comm.Expires Oct 23,2018
BorWThruUptNciarySemces .;rFOFF` °� Commission#FF 136597
Bonded Through National Notary Assn.
APPROVED BY ` - /z,—/--7 Plans Examiner Zoning
Structural Review Clerk
(Revised 07/10/07)(Revised 06/10/2009)(Revised 3/15/09)
STATE OF FLORIDA PERMIT #: 13-SM-1730140
DEPARTMENT OF HEALTH APPLICATION #:AP 1269465
ONSITE SEWAGE TREATMENT AND DISPOSAL DATE PAID:
SYSTEM
FEE PAID:
CONSTRUCTION PERMIT
RECEIPT #:
w` DOCUMENT #: PR1044380
CONSTRUCTION PERMIT FOR: OSTDS Repair
APPLICANT: DAYLE PECK
PROPERTY ADDRESS: 1298 NE 95 St Miami,FL 33138
82 •• W.• 85 SUBDIVISION: Miami Shores Sec 3
••••" ' [SECTION, TOWNSHIP, RANGE, PARCEL NUMBER]
•
PROPERTY ID 0.: 1132660144)30 [OR TAX ID NUMBER]
••••..
• T .a-sT—
Avm MUST .BE Cp14TRUCTED IN ACCORDANCE WITH SPECIFICATIONS AND STANDARDS OF SECTION
:351 1QO65, IVY: AN6..VVAPTER 64E-6, F.A.C. DEPARTMENT APPROVAL OF SYSTEM DOES NOT GUARANTEE
'SATISFACTORY• PERFOR ff, FOR ANY SPECIFIC PERIOD OF TIME. ANY CHANGE IN MATERIAL FACTS,
619tC8 SERVED••AS 1,..'�VS FOR ISSUANCE OF THIS PERMIT, REQUIRE THE APPLICANT TO MODIFY THE
i�ARMIT APPPLIC WION.• .$UCH MODIFICATIONS MAY RESULT IN THIS PERMIT BEING MADE NULL AND VOID.
•IS%bANCE .O8••THIS •PARM=T DOES NOT EXEMPT THE APPLICANT FROM COMPLIANCE WITH OTHER FEDERAL,
STATE, OR WCX PERMITTING REQUIRED FOR DEVELOPMENT OF THIS PROPERTY.
SYSTEM DESIGN AND SPECIFICATIONS
T I 1,050 ] GALLONS / GPD Existtno SeDtiC 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 I 300 1 SQUARE FEET Bed Cont Drainfield SYSTEM
R [ 0 ] SQUARE FEET SYSTEM
A TYPE SYSTEM: [X] STANDARD [ ] FILLED [ ] MOUND I ]
I CONFIGURATION: [ ] TRENCH [X] BED [ ]
N
F LOCATION OF BENCHM9IRK: FFE:8.T NGVD
I ELEVATION OF PROPOSED SYSTEM SITE 126.40 ]iff INCHES FT ][ABOVE BELOW BENCHMARK/REFERENCE POINT
E BOTTOM OF DRAINFIELD TO BE [ 56.40] Cn—x—m--sT FT ][ABOVE BELOW BENCHMARK/REFERENCE POINT
L
D FILL REQUIRED: [ 0.00] INCHES EXCAVATION REQUIRED: 142.00 ] INCHES
0 EXISTING TANK TO REMAIN,REPLACE DRAINFIELD ONLY
T I.-EXISTING 1050al.
g septic tank with and approved filter TO REMAIN.
H 2: Install 300 sf.of drainfield in bed configuration.
3:Install 12"of slightly limited soil at the bottom of the drainfield.
E (Comments Continued on Page 2.)
R
SPECIFICATIONS BY: Yvenel Cle=ont TITLE: ENGINEERING SPECIALIST I
APPROVED BY: TITLE: Engineer Supezvisor III Dade CHD
Astrld V Edwards
DATE ISSUED: 01/06/2017 EXPIRATION DATE: 04/06/2017
DH 4016, 08/09 (Obsoletes all previous editions which may not be used)
Incorporated: 64E-6.003, FAC Page 1 of 3
v 1.1.4 AP1269465 SE1018580
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