PL-17-569 Permit NO. PL-3-17-569
,g00RES�� Miami Shores Village Permit Type: Plumbing-Residential
10050 N.E.2nd Avenue NW ' Work Classification:Dra nfield
Miami Shores,FL 33138-0000 PenPermit Status:APPROVED
`rye- 3 Phone: (305)795-2204
ELOR1Dp`
issue Date:3/7/2017 Expiration: 09/03/2017
Project Address Parcel Number Applicant
163 NW 102 Street 1131010230060
Miami Shores, FL Block: Lot: MARTA FERNANDEZ
Owner Information Address Phone Cell
MARTA FERNANDEZ 163 NW 102 ST
MIAMI SHORES FL 33150-1231
Contractor(s) Phone Cell Phone Valuation: $ 2,400.00
MR C'S PLUMBING&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 Amount Pay Date Pay Type Amt Paid Amt Due
Bond Type-Owners Bond $500.00
CCF Invoice# PL-3-17-63178
$1.80 03/07/2017 Credit Card $500.00 $ 168.30
DBPR Fee $2.25
DCA Fee $2.25 03/07/2017 Credit Card $ 118.30 $50.00
Education Surcharge $0.60 03/03/2017 Credit Card $50.00 $0.00
Permit Fee $150.00 Bond#:3330
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 theret a d i strict conformity with the plans,drawings,statements or specifications submitted to the proper authorities of Miami Shores Village. In
accepting this rm t I ssume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are
required for EL IG L,PLUMBING, MECHANICAL,WINDOWS,DOORS,ROOFING and SWIMMING POOL work.
OWNERS A ID I ' I rtify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating
construction nd i g. ermore,I authorize the above-named contractor to do the work stated.
March 07, 2017
Authorized Signature:Owner / Applicant / Contractor / Agent Date
Building Department Copy
March 07, 2017 1
,xN\ Miami Shores Village
OBuilding Department artment ! MAR 32017.
10050 N.E.2nd Avenue,Miami Shores,Florida 33138 ••+✓
Tel:(305)795-2204 Fax:(305)756-8972
INSPECTION LINE PHONE NUMBER:(305)762-4949
FBC 20(Y
BUILDING Master Permit No. P
PERMIT APPLICATION Sub Permit No.
❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION EXTENSION ❑RENEWAL
PLUMBING F-1MECHANICAL [:]PUBLIC WORKS [:] CHANGE OF ❑CANCELLATION EDSHOP
/ /]� (� CONTRACTOR DRAWINGS
/�
JOB ADDRESS: l A "'"
City: Miami Shores County: Miami Dade Zip: >.3 C
Folio/Parcel#: Is the Building Historically Designated:Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER:Name(Fee Simple Titleholder): Q f- /", Phone#:
Address: 13 lvw loot S
City: State: Zip: 7�'
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR:Company Name: !' ( (Gt A#PW.ne#: 3,63 --gT-1 7�s
Address: I ( 3�L AAJ
`
City: 1 ./LL-tSt te: Zip: J
Qualifier Name: /, � Phone#: 7'6
VIs-316
J
State Certification or Registration#: IS / Certificate of Competency#:
DESIGNER:Architect/Engineer: �/ Phone#:
Address: City: State: -Zii\p:
Value of Work for this Permit:$ Square/Linear Footage of Work: 3- v
Type of Work: ❑ Addition Q Alteration ❑ New Repair/Replace Q Demolition
Description of Work: _ /
Specify color of color thru tile: r
Submittal Fee$ Permit Fee$ �V O' CCF$ CO/CC$
Scanning Fee$ Radon Fee$ DBPR$ Notary$
Technology Fee$ Training/Education Fee$ Double Fee$
Structural Reviews$ Bond$
TOTAL FEE NOW DUE$ L
(Revised02/24/2014) S'®0
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 the absence of such posted notice, the
inspection will not be a ved and a reinspection fee will be charged. qW
Signature Signature
OWNER or AGENT CONTRACTOR
The fegoing instrumen was acknowledged before me this The foregoing instrume t was acknowledged before me this
day of hrct� ,20 (- by 2 day of r C-' `- 20 , / by
F"Z-'CKCC-vctt7-who is personally known to (1 ho is personally known to
me or who has produced as me or who has produced-DL'
' as
identification and who did take an oath. identification and who did take an oath.
_NOTARY PUBLIC: NOTARY PU C:
Sign: Sign:
•
Print: NotaryPublic-State of Florida Print:
My Comm. Expires Sep 19,2017 " "�e•,, NAYDA S.ARAGON
Seal: Pte' p�= Commission# FF 055732 Seal: �;�: Not
Public -State of Florida
Bonded Through National Notary Assn. - Commission # GG 022703
My Comm Expires Aug 18.2020
�************************** * ** * * * ***********
APPROVED BY �' fes' Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)
IN!� cl-t>
PERMIT :13-SM-9 742275
` APP�cI� =AP 1277483
STATS OF FLORIDA
I DWAR9HIN'T OF HEALTH DATE PAM:
ONSITE SEWAGE TREATMENT AND DISPOSAL FEE PAID:
t�. SYSTEM
BECEIBT $:
DocabaIT i#:PRI 051637
NSTRUCTION PERMIT FOR: OSTDS Repair
APPLICANT: MARTA FERNANDE
PROPERTr ADDRESS: 163 NW 102 St Miami.FL 331&-
AT: 14 BLOCK: 1 SUBDIVISION: Sonmar Park
3ECTION, TOWNSHIP, RADE, PARCEL NUMMM)
ID 4: 11-3101-023-0060 fOR TAX ID NtA4sMI
SYSTEM MUST BE CONSTRUCTED IN ACCORDANCE WITH SPECIFICATIONS AND STANDARDS OF SECTION
381.0065, F.S., AND CHAPTER 64E-6, F.A.C. DEPARTMENT APPROVAL OF SYSTEM DOES NOT GUARANTEE
SATISFACTORY PERFORMANCE FOR ANY SPECIFIC PERIOD OF TIME. ANY CHANGE IN M4r1TSRIAL FACTS.
THICK SERVED AS A BASIS FOR ISSUANCE OF THIS PERMIT, REQUIRE THE APPVICANV TO q D'A7 THE
PERMIT APPLICATION. SUCH MODIFICATIONS MAY RESULT IN 'THIS PERMIT BEING PADS: NULL •kfe VOIDI••0••
ISSUANCE OF THIS PERMIT DOES NOT EXIT THE APPLICANT FROM COMPLIANC80.11319$ OTHE6L •PtMMAL, 0•
STATS. OR LOCAL P2211ITTING REOUIRED FOR DEVELOPMENT OF THIS PROPERTY. 004•0 •0 00 •000 •
• 0000 0
SYSTEM DESIGN AND SPECIFICATIONS 00000 •••••
0000•• • •
•00•
T f 900 l CALLOW / GPD _- Eidbtln0 Seutic Tank to Remain CAPACITY ••0 0 0• •• • • •0 i 0••
A f 0 I GALLCM / GPD CAPACITY 000.0 0 •• •
N r 0 I GALLO" GREASE INTERC8PT0R C1MCITY tMlDCI m capwITY SINGLE TANK:925CP gMLONS] • 00 0
R ( I CALLOW DOSING TANK CAPACITY [ I CALLOW 0 f I DOSES PEA 24 PS iv."vps f 0 0 i •
D f 300 } SQUARE FEET - NeW Bed Con,Drainf. SYSTEM •••• ••.•:
R t 0 1 SQUAMt?EE2 SYSTEM ••
A TYPE SYSTEM: fx3 STANDARD f I FILLED f l "Oum f
I CONFIGURATION: f I TRENCH fxI BED ( ]
;x
F LOCATION OF BENCHMARK: FFE-.12.50'NGVD
I ELEVATION OF PROPOSED SYSTEM SITS t 2280} INC888 FT I[ABOV mwCm4ARK/REFBRQNCE POINT
3 BOTTOM OF DRAINFIELD TO BE ( 72.80 I INCHES FT I t A80VF)�BEITCHMARK/REFERENCE POINT
D FILL BEQUIRM: [ 0.001 ngCBE8 ExCAvATION REQUIRED: ( 62001 INCHES_
EXISTING SETPIC TANK TO REMAIN.REPLACE DRAINFIELD ONLY . t r4f.
O
T i.-EXISTING 900 98L Septic tank with and approved Nor TO REMAIN.
s 2.- Install 300 St.of dratrrrretd in bed corfturBGon. �
3.-Install 12"of slightly limited soil at the bottom of the drainW.
' $ .-Perimeter of excavation area shall be at least 2 It wider and WW than the propnqpdabsorptil
R (Corm Continued on Page 2)
SPECIFICATIONS BY:
tr1Ck `T;
APPROVED BY: . TITLE. �7GZNEERIIjGl' rA>;I�S' I.,a s<, ..,:.- Dade CHD
1 ri-tet
DATE ISSUED: 03(01=7 EXPIRATIOIT DATE: 05/302017
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 AP1277483 SE102498.
STATE OF FLORIDA
DEPARTMENT OF HEALTH
APPLICATION FOR CONSTRUCTION PERMIT
Permit Application Number
------- ---- --- --- -- - - -- -- -- II - SITEPLAN -- --- - ------- -------- --- -- -
Scale: Each block re resents 10 feet and 1 inch = 40 feet.
' S
ee — —
t6
t I o0
n
T �
•• •• •• • ••••••
•
• • !�•••
•
• • • I. 1 4100"
There are no pertinent features on adjacent properties and or across the street that may affect the New Septi
System,Installation
Notes:
6 2 5T (tel Ct42
F
Site Plan submitte by: L�UY
Plan Approved Not Approved Date t
gy County Health Department
ALL CHANGES MUST BE APPROVED BY THE COUNTY HEALTH DEPARTMENT
DH 4015,08/09(Obsofetes previous editions which may not be used) Incorporated: 64E-6.001, FAC Page 2 of 4
(Stock Number: 5744-002-4015-6)
DIVISION OF
Environmental Health ,
Florida Health
�
O� Miami-Dade County
QQ OSTDS/Well Division
11505 SW 26th Street•Miami,FL 33175 �O
_'D Inspector-y Date Y-1017 `
Address /C 3 4/m. l'0 zJ y
OSTDS# O/2 77 y�
Comments:
Signature