PL-17-73 Permit NO. PL-1-17-73
,S oafs h Miami Shores Village Permit Type: Plumbing-Residential
10050 N.E.2nd Avenue NE PerIm
work Classification:Dra nfield
Miami Shores,FL 33138-0000 Permit Status:APPROVED
ti— Phone: (305)795-2204
�LORIDp
Issue Date: 1/1212017 Expiration: 07/11/2017
Project Address Parcel Number Applicant
1239 NE 100 Street 1132050080050
Miami Shores, FL 33138-2603 Block: Lot: JOSIE&CARLOS FONSECA
Owner Information Address Phone Cell
JOSIE&CARLOS FONSECA 1239 NE 100 Street
MIAMI SHORES FL 33138-
1239 N E 100 Street
MIAMI SHORES FL 33138-
Contractor(s) Phone Cell Phone Valuation: $ 2,400.00
MR C'S PLUMBING&SEPTIC INC (305)651-7859
v._.... �_.._ .......�.__ 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
CCF $1.80
DBPR Fee Invoice# PL-1-17-62584
$2.25 01/12/2017 Credit Card $ 118.30 $50.00
DCA Fee $2.25
Education Surcharge $0.60 01/11/2017 Credit Card $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 ' strict conformity with the plans,drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In
accepting tVanin
' me responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are
required foUMBING,MECHANICAL,WINDOWS,DOORS,ROOFING and SWIMMING POOL work.
OWNERS ti€Srthat all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating
constructioermore, I authorize the above-named contractor to do the work stated.
January 12, 2017
Authorized Signature:Owner / Applicant / Contractor / Agent Date
Building Department Copy
January 12, 2017 1
Miami Shores Village '
Building Department JAN 1 1 2017
10050 N.E.2nd Avenue, Miami Shores, Florida 33138 BY�—c� ___
Tel:(305)795-2204 Fax:(305)756-8972
INSPECTION LINE PHONE NUMBER:(305)762-4949
FBC 20 !�
BUILDING Master Permit No. P 1 I
PERMIT APPLICATION Sub Permit No.
F-IBUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION EXTENSION ❑RENEWAL
PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
z CONTRACTOR DRAWINGS
JOB ADDRESS: 1,a1- ! ��
City: Miami Shores County: Miami Dade Zip: 3 3 j 9
/J '
Folio/Parcel#: /! —30?65N- " -- O 64;-6 Is the Building Historically Designated:Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: F(FLE:
OWNER: Name(Fee Simple Titleholder): C&V-161 4-JU�f0(q1"qe F� hone#: - �"�
Address: I 3 I Off i 00��' SF
City: tA I of a) " S kd (e-S State: Zip: 3 3 r 3
Tenant/Lessee Name: Phone#:
Email:_ �I OS I e r77 t eKe" C uo( h OD . L,&g
CONTRACTOR:Company Name: � 4k . C" rs / 1tt�4 'ts "`'Phone#:
Address:_ l elfJ� IVJ4J iOn bk-P—
City: AA-4 _State: -L
Qualifier Name: Phone#: l� S
State Certification or Registration#: Sey 6 l s Certificate of Competency#:
DESIGNER:Architect/Engineer: / Phone#:
Address: City: State: Zip:
Value of Work for this Permit:$ d� Square/Linear Footage of work: 3
Type of Work: ❑ Addition ❑ Alteration ❑ New Repair/Replace ❑ Demolition
Description of Work:
Specify color of color thru tile:
Submittal Fee$ Permit Fee$ /16-0
CCF$ CO/CC$
Scanning Fee$ Radon Fee$ DBPR$ Notary$
Technology Fee$ Training/Education Fee$ Double Fee$
Structural Reviews$ Bond$
TOTAL FEE NOW DUE$
(Revised02/24/2014)
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$2500, the applicant must
promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person
whose property is subject to attachment. Also,a certified copy of the recorded notice of commencement must be posted at the job site
for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the
inspection will not be approved and a reinspection fee will be charged.
1
Signature C� Signature
OWNER or AGENT CONTRACTOR
The foregoing instrument was acknowledged before me this The fgregoing instrument was acknowledged before me this
I 3 day of J�i�-N ,20 by 3 day of U 20 , by
VOSrv�Of�lirL� i�/�S�ZQ',who is personally known to _ ��i/r1�� � w o is personally known to
me or who has produced as mor who has produced as
identification and who did take an oath. identification and who did take an oath.
NOTARY PUBLIC: NOTARY PUBLIC:
Sign: Sign:
Print: MM*K Print:
* on a
My Comm. Expires Sep 19,2017 Seal: "-'9'��., SHERYL A MENDES
Seal: ' '- Ca
:N Y Y.t� 1r B•moi
Commission # FF 055732 :°r°, `�+ Notary Public-State of Florida
Bonded Through National Notary Assn. •* :•5 My Comm.Expires Oct 23,2018
Commission#FF 136597
************************************************************* **ks "foe'R$A Itliflub"MI)t"'11 . ***********
APPROVED BY — Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)
PERMIT #: 13-SC-1728947
yP„� STATE OF FLORIDA
DEPARTMENT OF HEALTH APPLICATION #: AP 1268760
ONSITE SEWAGE TREATMENT AND DISPOSAL DATE PAID:
SYSTEM FEE PAID:
CONSTRUCTION PERMIT RECEIPT #:
`Ou DOCUMENT #: PR1043489
CONSTRUCTION PERMIT FOR: OSTDS Repair
APPLICANT: ,Josie Fonseca
PROPERTY ADDRESS: 1239 NE 100 St Miami, FL 33138
LOT: 5 BLOCK: 1 SUBDIVISION:
PROPERTY ID #: 11-3205-008-0050 [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
0 00
99PERL T APPLICATION! • 9UCH MODIFICATIONS MAY RESULT IN THIS PERMIT BEING MADE NULL AND VOID.
• ISSUANCE •K!P••THIS •PERMIT DOES NOT EXEMPT THE APPLICANT FROM COMPLIANCE WITH OTHER FEDERAL,
0.000• • 0 •
STATE, OR LOCAL PER1:;%%W REQUIRED FOR DEVELOPMENT OF THIS PROPERTY.
•
0000•• • •• ••
•:;S;EM DE*S•iGV IND SDSCiSR %i ATIONS
• •
• 00*0
T•[ • 900•),•:GALLONS ` SPD Existinq Septic Tank to Remain CAPACITY
• • • • •• •
�•A•t: 001 GALLOFIj4•`•WPD CAPACITY
••i•j• 0 ] CI:LLON�,OMSE INTERCEPTOR CAPACITY [MAXIMUM CAPACITY SINGLE TANK:1250 GALLONS]
•;C [ 0:•]•*(;9LLONS DQ$ING TANK CAPACITY [ ]GALLONS @[ ]DOSES PER 24 HRS #Pumps [ ]
• • • •
0000•• 0000 • •
D [ 3da•]••dQUARE FEET New Bed Conf. Drainfield SYSTEM
R [ 0 ] SQUARE FEET SYSTEM
A TYPE SYSTEM: [x] STANDARD [ ] FILLED [ ] MOUND [ ]
I CONFIGURATION: [ ] TRENCH [x] BED [ ]
N
F LOCATION OF BENCHMARK: FFE: 10.6' NGVD
I ELEVATION OF PROPOSED SYSTEM SITE [ 36.00 ] [ INCHES FT ] [ ABOVE BELOW BENCHMARK/REFERENCE POINT
E BOTTOM OF DRAINFIELD TO BE [ 81.00 ] [ INCHES FT ] [ ABOVE BELOW BENCHMARK/REFERENCE POINT
L
D FILL REQUIRED: [ 0.00 ] INCHES EXCAVATION REQUIRED: [ 57.001 INCHES
0 EXISTING SEPTIC TANK TO REMAIN, REPLACE DRAINFIELD ONLY
T 1.-EXISTING 900 gal.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 4.-Perimeter of excavation area shall be at least 2 ft wider and longer than the proposed absorption bed or trench.
R (Comments Continued on Page 2.)
SPECIFICATIONS BY: Yvenel Clermont TITLE: ENGINEERING SPECIALIST I
APPROVED BY: TITLE: Engineer Supervisor III Dade CHD
Astrid V Edwards
DATE ISSUED: 12/29/2016 EXPIRATION DATE: 03/29/2017
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 AP1268760 SE1017828
STATE OF FLORIDA
DEPARTMENT OF HEALTH
APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PERMIT
Permit Application Number
---------------------------PART II-SITEPLAN---------------------------
Scale: Each block re resents 10 feet and 1 inch =40 feet.
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• . . • • •
• ••
• . • .
••••
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•• •
There are no pertinent features on adjacent properties and or across the street that may affect the New Septic system installation.
'Notes:
r
Site Plan submitted by:
Plan Approved Not Approved Date_LZ L;7,10
BY County Health Department
ALL CHANGES MUST BE APPROVED BY THE COUNTY HEALTH DEPARTMENT
DH 4015,10/98(Replaces HRS-H Form 4016 which may be used) Page 2 of 4
(Stock Number. 5744-002-4015.6)