PL-16-3103 G �I
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Miami Shores Village _ PG17�Tylllti>Klb�#� eieni
10050 N.E.2nd Avenue NE
Wt rhk 16A 10 aIt 0,d
Miami Shores,FL 33138-0000e�,rrit
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ivA Phone: (305)795-2204
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i«1f01t Expiration: 0582712017
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Project Address Parcel Number Applicant
384 NE 94 Street 1132060136140
Miami Shores, FL Block: Lot: MICHELLE CANERO
Owner Information Address Phone Cell
PENN DAVIS 384 NE 94 Street
MIAMI SHORES FL 33138-2832
Contractor(s) Phone Cell Phone Valuation: $ 2,500.00
MR C'S PLUMBING 8,SEPTIC INC (305)651-7859
_. Total Sq Feet: 300
Type of Work:DRAINFIELD Available Inspections:
Type of Piping:
Inspection Type:
Additional Info: 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 Invoice# PL-11-16-62060
CCF $1.80 11/14/2016 Check#:1195 $50.00 $772.80
DBPR Fee $4.50
DCA Fee $4.50 11/23/2016 Check#:3139 $500.00 $272.80
Education Surcharge $0.60 11/28/2016 Check*1211 $272.80 $0.00
Permit Fee $300.00 Bond#:3264
Scanning Fee $9.00
Technology Fee $2.40
Total: $822.80
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 nformity with the plans,drawings,statements or specifications submitted to the proper authorities of Miami Shores Village. In
accepting this I assu responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are
required fol LEC AL, MBING,MECHANICAL,WINDOWS,DOORS,ROOFING and SWIMMING POOL work.
OWNER ID I.' ify th the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating
construction an /Fu h ore,I authorize the above-named contractor to do the work stated.
November 28,2016
Authorized Signature:Owner / Applicant / Contractor / Agent Date
Building Department Copy
November 28,2016 1
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RECEIVED
Miami Shores Village NOV 14 2016
Building Department
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
BUILDING Master Permit No.�vi— cj 310 3
PERMIT APPLICATION Sub Permit No.
❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION [-]RENEWAL
PLUMBING ❑ MECHANICAL [:]PUBLICWORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
( G� CONTRACTOR DRAWINGS
JOB ADDRESS: l !T e C�
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#: Is the Building Historically Designated:Yes NO X
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER:Name(Fee Simple Titleholder): !V�Ctte L.0 C-- (-:A-"
�"�7E 1'-0 Phone#:
Address: p� gg ->
V"l t�) S�e C Et )
City: 'I State: (- `� Zip: ��1 � Z1
Tenant/Lessee Name: / Phone#:
Email: ,�� -7 c
CONTRACTOR:Company Name: �� ' CISH ""'Phone#:
Address: (� Nw 3— e A1,, '
City: `-vl Q l L IState: f:�(✓ Zip:
Qualifier Name: Phone#: �p�'
State Certification or Registration#: Certificate of Competency#:
DESIGNER:Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for this Permit:$ ��� Square/Linear Footage of Work: 310-0
Type of Work: ❑ Addition ❑ Alteration ❑ New Repair/Replace ❑ Demolition
Description of Work: I e-A-1 N N 04-V3 /
Specify color of color thru tile:
Submittal Fee$Jy• 00 Permit Fee$ ?00 CCF$ (� CO/CC$
Scanning Fee$ <2:3 /
• W Radon Fee$ '�I. —03 DBPR//$�� • �v Notary$
Technology Fee$ Q. V Training/Educatlon Fee$ �• �V Double Fee$
Structural Reviews$ 0 Bond$ 900" 0v
TOTAL FEE NOW DUE$o27�a • 90
(Revised02/24/2014)
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Bonding Company's Name(if applicable)
Bonding Company's Address
City . __ State Zip
Mortgage Lender's Name(if applicable)
Mortgage Lenders 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.
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Signature Signature
OWNER or AGENT CONTRACTOR
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
�l day of .��fwE`1 �1-= 20 by day of&)OL)IF N/S" 20J,6 by
f E- L'i�-v who is personally known to who is personally known to
me or who has produced as me or who has produced as
identification and who did take an oath. identification and who did take an oath.
NOTARY PUBLIC: NOTARY PUBLIC:
Sign: Sign:
.�.".' C N fll
Print: tr Print:
;!QmY UUMMISSION#FF022530
" ° Seal: "gay" SHERYL A MENDES
Seal: 'spfoQ EXPIRES June 17,2017 e�,,
(407)398-0153 FloridallotarySemce.com k° Notary Public-State of Florida
* .•=My Comm.Expires Oct 23,2018
*Q:
Commission#FF 13659
arY Awn.
APPROVED BY � C���'I Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)
PERMIT #:113-SM-1714979
STATE OF FLORIDAAPPLICATION #.AP1260171
DEPARTMENT OF HEALTH DATE PAM:
ONSITE SZWVM TREATMENT AND DISPOSAL SYSTEM FEE PAM:
CONSTRUCTION PERMIT RECEIPT #,
Igo DOCMQM #:PR1036221
CONSTRUCTION PERMIT FOR: OSTDS Repair
REPAIR
APPLICANT: PENN DAVIS
PROPERTY ADDRESS: 384 NE 94 St Miami,Fl.33138
LOT: 1-4 BLOCK: 46 SUBDIVISION: Miami Shores Sec 1 Amd
PROPERTY ID #: 11-3206-013-6140 [SECTION. TOWNSHIP, RANGE, PARCEL NUMBER]
[OR TAX M 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 EX@IlsT 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 Septic tank(H-10 traffic rated) CAPACITY
A [ 0 ] GALLONS / GPD CAPACITY
N [ 0 ] GALLONS GREASE INTERCEPTOR CAPACITY Dffl XIMUM CAPACITY SINGLE TANK:1250 GALLONS]
K [ I GALLONS DOSING TANK CAPACITY [ ]GALLONS 8[ IDOSES PER 24 SRS #Bumps I ]
D t 300 ] SQUARE FEST Bed configuration drainfiel SYSTEM
R [ 0 l SQUARE FEET SYSTEM
A TYPE SYSTEM: [X] STANDARD [ ] FILLED [ ] FOUND [ ]
I CONFIGURATION: t ] TRENCH [xl BED [ ]
N
F LOCATION OF SENCHMARK: F.F.E.,10.1V NGVD
I ELEVATION OF PROPOSED SYSTEM SITE [ 3.60 l INCHES >•T ]I ABOVE j�sENCHMARK/REEBRENCE pons
E BOTTOM OF DRAINFIELD TO BE t 53.64]d INCHES FT IIABOVE�BENCHMARK/REFERENCE POINT
L
D FILL REQUIRED: t 0.00] INCHES EXCAVATICK REQUIRED: t 50.001 INCHES
Spill system(south)rear.
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Inspector to verify the existing septic tank is properly abandoned before final approval.
T `Invert elevation of drainfceld to be no less than 6.I T NGVD.
H 'Bottom of drainfield elevation to be no less than 5.63'NGVD.
Install 42°of slightly limited soil under the bottom of drainfield.
E -Perimeter of excavation area shall be at least 2 ft,ander and longer than the proposed absorption bed or drain trench.
R The systems are sized for 5 bedrooms with a maximum occupancy of 10 persons(2 per bedroom),for a total estimated
SPECIFICATIONS BY: Kemble ick TITLE:
APPROVED BY: TITLE: Dada CBD
1 I
DATE ISSUED: e 1 EXPIRATION DATE: 01/19/2017
DH 4016, Q8/09 (Obsoletes all previous editions which may not be used)
Incorporated: 64E-6.003, FAC TN, `:t;;, .eF�� �?•;c � : Page 1 of 3
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