PL-17-555 Permit NO. PL-3-17-555
y4 Miami Shores Village Permit Type:Plumbing-Residential
10050 N.E.2nd Avenue NW � ' Work Classification:Drainfield
Miami Shores,FL 33138-0000 Permit Status:APPROVED
Phone: (305)795-2204
fLORtDP
Issue Date:318/2017 Expiration: 09/04/2017
Project Address Parcel Number Applicant
469 NW 111 Terrace 1121360010470
Miami Shores, FL 33168- Block: Lot: EDWIN RIVERA
Owner Information Address Phone Cell
EDWIN RIVERA 469 NW 111 Terrace (305)298-3969
MIAMI SHORES FL 33168-
Contractor(s) Phone Cell Phone Valuation: $ 3,150.00
STATEWIDE SEPTIC CONNECTIONS (954)963-0082
_.......n _.. �__._, ... ..__ q Total SFeet:
150
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-3-17-63145
CCF $2.40
DBPR Fee $2.25 03/03/2017 Check#:5257 $50.00 $619.90
DCA Fee $2.25 03/08/2017 Check*5267 $619.90 $0.00
Education Surcharge $0.80 Bond#:3333
Permit Fee $150.00
Scanning Fee $9.00
Technology Fee $3.20
Total: $669.90
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.
OWNEAFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating
constr do and zoning. Futhermore, I uthorize the above-named contractor to do the work stated.
March 08, 2017
orized Signature:Owner / Applicant / Contractor / Agent ate
Builds g Department Copy
March 08, 2017 1
Miami Shores Village D
Building Department IG1Y2 '�
100SO N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305)795-2204 Fax:(30S) 756-8972
INSPECTION LINE PHONE NUMBER:(305)762-4949 J
FBC 201
BUILDING Master Permit No.
PERMIT APPLICATION Sub Permit No.
BUILDING ❑ ELECTRIC ROOFING REVISION ❑ EXTENSION ❑RENEWAL
[�PLUMBING ❑ MECHANICAL [:]PUBLICWORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: E�dy'j k() (Z!2,r'o` `'t—! NW R1 -Tey-
City: Miami Shores County: Miami Dade Zip: 33166
Folio/Parcel#: :2[36- 00�.'OLC--I O Is the Building Historically Designated:Yes NO ✓
Occupancy Type: Load: _Construction Type: Flood Zone: BFE: FFE:
QQ\
OWNER: Name(Fee Simple Titleholder): E dof(vn ``��era. Phone#:
Address: 4-69. Nyco m -Tey-
City: MA 0. rni State: �Z Zip: 33 1G '
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR:Company Name:_- -'� _ `GWI�e G l.� S ChC Phone#: 3 IGG (_66'63
Address: g W (9 Ave_ * k)
City: OtC^ Lec_KO State: 1�L Zip:
Qualifier Name: cS�6,,(,. o� Phone#:
y
State Certification or Registration#: r o 0?1(26 Z Certificate of Competency#:
DESIGNER:Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for this Permit:$ 3�SC7 A Square/Linear Footage of Work: f SO
Tyne of Work: ❑ Addition ❑ Alteratio(nn��_M ff ❑ New [�R1 Repair/Replace ❑ Demolition
Dr-scrirtinn of Work: f, 1qce- DYQ(n �-e Cj
40.x►-yL.___ .. v�.a1'�.eFkrrfSt ry' �,�� •5 ri.i:.
Specify liorof colon �P f','r� `<<. `15'x, _
31
Submittal Fee$• Permit'Fee$_ " d CCF$ A CO/CC$
Scarnirr Fns± $ Radon Fee$ DBPR$ _Notary$
Technology Fee$ Training/Education Fee$ Double Fee$
Structural Reviews$ Bond$
TOTAL FEE NOW DUE$
(Revised02/24/2014) � �� p _ _�•
6� l« Ce-y-
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 ORTAI.N- 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 the absence of such posted notice, the
inspFction will not be approved and a reinspection fee will be charged.
Signatur Signature 6
OWNER or AGENT CONTRACTOR
The for going instrument was acknowledged before me this The foregoing instrumtent was acknowledged before me this
day of "'`yC�� 20 by 2g day of , rv,5� 20 k'?, by
�iVy Qho is personally known to 1Q y ,D�� who is personally known to
me or who has produced `li� ()L— as me or who has produced �r) as
identification and who did take an oath. identification and who did take an oath.
NOTARY PUBLIC: NOTARY PUBLIC:
Sign. Sign:
Print: f�rrr5 Print:
JERRIC •��" �'•
Seal• '`PS�' No E A L.ARMSTRONG rl Seal: =s•� JERRICA L.ARMSTRONG
Y Public-State Notary Public-State of Flortda
CommlaSlon#FF of Florida
*********MY COmssion#FF 197589
m.EXpi*e***b ?01 ********************* ', ?'o'un�**My CortlRli E* i '1*4t 20#S
APPROVED BY 3-6- Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)
STATE OF FLORIDA PERMIT #: 13-SC-1742350
DEPARTMENT OF HEALTH APPLICATION #: AP1277534
m' ONSITE SEWAGE TREATMENT AND DISPOSAL DATE PAID:
SYSTEM
CONSTRUCTION PERMIT FEE PAID:
RECEIPT #:
Wilk DOCUMENT #: PR1051188
CONSTRUCTION PERMIT FOR: OSTDS Repair
APPLICANT: Edwin Riviera
PROPERTY ADDRESS: 469 NW 111 Ter Miami, FL 33168
LOT: 31 BLOCK: 2 SUBDIVISION:
PROPERTY ID #: 11-2136-001-0470 [SECTION, TOWNSHIP, RANGE, PARCEL NUMBER]
[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 [ 650 ] GALLONS / GPD Existing SeDtIC tank for remain. CAPACITY
A [ 0 ] GALLONS / GPD CAPACITY
N [ 0 j GALLONS GREASE INTERCEPTOR CAPACITY [MAXIMUM CAPACITY SINGLE TANK:1250 GALLONS]
K [ ] GALLONS DOSING TANK CAPACITY [ ]GALLONS @[ ]DOSES PER 24 HRS #Pumps [ ]
D [ 150 j SQUARE FEET Trench configuration drainfi SYSTEM
R [ 0 ] SQUARE FEET SYSTEM
A TYPE SYSTEM: [xj STANDARD [ ] FILLED [ ] MOUND [ ]
I CONFIGURATION: [XI TRENCH [ j BED [ ]
N
F LOCATION OF BENCHMARK: F.F.E., 12.60'NGVD
I ELEVATION OF PROPOSED SYSTEM SITE [ 10.80 ] [ INCHES FT ] [ ABOVE BELOW BENCHMARK/REFERENCE POINT
E BOTTOM OF DRAINFIELD TO BE [ 58.80 ] [ INCHES FT ] [ ABOVE BELOW BENCHMARK/REFERENCE POINT
L
D FILL REQUIRED: [ 0.001 INCHES EXCAVATION REQUIRED: [ 48.00 ] INCHES
0 'Invert elevation of drainfield to be no less than 8.20' NGVD.
`Bottom of drainfield elevation to be no less than 7.70' NGVD.
T "THIS PERMIT IS NOT FOR"ADDITION(s)".
H The system is sized for 2 bedrooms with a maximum occupancy of 4 persons(2 per bedroom),for a total estimated flow of r
E 300 gpd.
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 Solomon TITLE: Master Septic Tank Contractor
APPROVED BY: TITLE: Dade CHD
Carlos M Icaza
DATE ISSUED: 02/27/2017 EXPIRATION DATE: 05/28/2017
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 AP1277534 aE1024558
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0 DIVISI0N, 0
Environmental Health
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Florida Health
Q� M�iatrli-t?ade fount 'd
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nQSTDS/WeYI Division
11.805 SSV 36th Street•bliaml,FL 33175
f �► Opector + ,
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Signatur
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