PL-16-3493 Nim&NO PL-1-2 "I � 493
Miami Shores Village r8/t�7Ii!lt3i[tIIl1'
10050 N.E.2nd Avenue NE
WorkClassrficatibi Draiinfleld
Miami Shores,FL 33138-0000 {
`rye OVE
Phone: (305)795-2204
�OR t "1
Perntltstef6s"'�APP
ts�u t�;9�2t117, Expiration: 07/02/2017
Project Address Parcel Number Applicant
574 NE 102 Street 1132060171030
Miami Shores, FL Block: Lot: CARLOS GONCALVES
Owner Information Address Phone Cell
CARLOS GONCALVES 574 NE 102 ST 305/754-5840
MIAMI SHORES FL 33138
80 MEADOW Street
GARDEN CITY NY 11530-
Contractor(s) Phone Cell Phone Valuation: $ 2,450.00
STATEWIDE SEPTIC CONNECTIONS (954)963-0082
_._. .. _._..._
...... _ Total Sq Feet: 225
Type of Work:REPLACE 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
CCF $1.80
DBPR Fee $2 25 Invoice# PL-12-16-62500
DCA Fee $2.25 01/03/2017 Check#:6219 $ 118.30 $50.00
Education Surcharge $0.60 12/30/2016 Check#:6217 $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 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.
OWNERS AFFIDAVIT: I certify that all th foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating
construction and zoni g. thermore,I au h rize t1le above-named contractor to do the work stated.
t{ January 03, 2017
Authorizedign re:Owner / Applicant / Contractor / Agent Date
Building Department Copy
January 03,2017 1
Miami Shores Village ����a���� t
BUlldi g Department DEC 2016
\ 10050 N.E.2nd A !nue,Miami Shores,Florida 33138 BY.
Tei:(305) 5-2204 Fax:(305)756-8972
• INSPECTION UN PHONE NUMBER:(30S)762-4949 S�
FBC 20Nt
BUILDING Master Permit No. P x Aw
PERMIT APPLICATION Sub Permit No.
❑BUILDING ELECTRIC ® ROOFING ® REVISION ❑ EXTENSION 06RENEWAL
PLUMBING ❑ MECHANICAL ❑PUBLIC WO IKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
,� 1 CONTRACTOR DRAWINGS
JOB ADDRESS: 5-7NE 102 e 4
C' Miami Shores u Miami Dade Z12:
Folio/Parcel#: 11 - 21Z-0-6 - 0171- 1030 . Is the Building Historically Designated:Yes NO
Occupancy Type: Load: Constructio Type: Flood Zone: BFE: FFE:
OWNER:Name(Fee Simple Titleholder): ���' GOPhone#:
Address: 5-1C t 0 2- &—t-
City: 1 1 S r l 0 f-S State: rL. Zip: 3 3 38
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR:Company Name: a i l C.4>1'1'Y1.� /r-)C Phone#: .30S- 661- 6633
Address !�11 S® � * t
City: 0(Y, l.c. ckcc State Zip: 3;1 0rJ Lf-
Qualifier Name: Phone#:
State Certification or Registration#: s m® Certificate of Competency#:
DESIGNER:Architect/Engineer: Phone#:
Address: City: State Zip:
Value of Work for this Permit:$ lzz s Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration ❑ New CR Repair/Replace ❑ Demolition
Description of Work.• [[��
P�ep llgcez D
t a
Specify cokor Ci rr�dr thAl tifee:
Submittal Fee$ Permit Fee " CCF$ CO/CC$
Scanning Fee$, Radon Fe; DSPR$ Notary$
Technology Fee$.... , ,..:... ,:: .
Training/Education Fee$ Double Fee$
Structural Reviews$ Bond$
TOTAL FEE NOW DUE$ 1 I".
(Revisedo2/24/2014)
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 tha 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 CONDITIONE ,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 udding permit with an estimated value exceeding$2500, the applicant must
promise in good faith that a copy of the notice of comm ncement and construction lien law brochure will be delivered to the person
whose property is subject to attachment. Also,a certified copy of the recorded notice of commencement must be posted at the job site
for the first inspection which occurs seven (7) days aft r the building permit is Issued. In the absence of such posted notice, the
inspection will not be approved�gnd a reinspection fee wil be charged.
Signature Signature
-' OWNER or AGENT CONTRACTOR
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
2_9 day of D-C C, 20 by 2P day of De—C, .20 , G by
C Girl®S G®n CG Int o is personally known to ares &I O r-Na;+who is personally known to
me or who has produced as me or who has produced 04— (h as
Identification and who did take an oath. identification and who did take an oath.
NOTARY PUBLIC: NOTARY PUBLIC:
I
P
Sign Sign: '\A_CA_
Print 1 Off'"_ Print: r 0
Seal: Seal:
0 W-V�'��
' JERRICA L.ARMSTRONG ' "r4 L AR
i° e`4+= �;�,� . JERRICA L.AP4
z Notary Public-State of Florida = Notar Public-Stat°
dfshw!=ts1� 9�g«« ««« «««« «$««««««««« «« ���ublic-ita
F��; My Comm.Expires Feb 9,2019
My Comm.Expires Feb 9,201!#'
APPRO Plans Examiner `�� Zoning
Structural Review Clerk
(Revised02/24/2014)
Miami Shores Village 1 erm ;hype plu xllbinj -Re entl t
I
10050 N.E.2nd Avenue NE " Vl�l t rf€cifi6rt Drathfiold
Miami Shores,FL 33138-0000VED
t Tett5'tatus`API�
Phone: (305)795-2204MW
: �
Issue`"' 319201 Expiration: 09/25/2016
Project Address Parcel Number Applicant
574 NE 102 Street 1132060171030
CARLOS GONCALVES
Miami Shores, FL Block: Lot:
Owner Information Address Phone Cell
CARLOS GONCALVES 574 NE 102 ST 305/754-5840
MIAMI SHORES FL 33138 1
80 MEADOW Street
GARDEN CITY NY 11530-
Contractor(s) Phone Cell Phone Valuation: $ 2,450.00
STATEWIDE SEPTIC CONNECTIONS (954)963-0082 Total Sq Feet: 225
Type of Work:REPLACE 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-Contractors Bond $500.00 Invoice# PL-3-16-59171
CCF $1.80 03/29/2016 Credit Card $623.30 $50.00
DBPR Fee $2.25
DCA Fee $2.25 03/25/2016 Check#:6050 $50.00 $0.00
Education Surcharge $0.60 Bond#:3036
Notary Fee $5.00
Permit Fee $150.00
Scanning Fee $9.00
Technology Fee $2.40
Total: $673.30
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 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.
OWNERS AFFIDAVIT: I certify that all the foregoing information is cur a and that all work will be done in compliance with all applicable laws regulating
construction and zoning. Futhermore,I authorize the above-named r or to do the work stated.
March 29, 2016
Authorized Signature:Owner / Applicant / Co�tractbr / Agent Date
Building Department Copy
March 29,2016 1
Miami Shores VillageCEl'' ,�
Building Department artment M 016
,.
10050 N.E.2nd Avenue,Miami Shores,Florida 33138 BY:
Tel: (305)795.2204 Fax:(305)756.8972
INSPECTION'S PHONE NUMBER:(305)762.4949
BUILDING Permit No.
PERMIT APPLICATION Master Permit No.
FBC 20
Permit Type: PLUMBING
OWNER: Name(Fee Simple Titleholder): G/ �03 ('tNC $ ° Phone#: -7E;6 Z'Z6 6(07 6
Address: S-T
City: 1 PMAl oleS State: Zip: 331 36
Tenant/Lessee Name: Phone#:
Email: r-
JOB ADDRESS: S1 L- 6�E I<D-2 & 1
City: Miami Shores County: Miami Dade Zip: 3 3 k 15e
Folio/Parcel#:
Is the Building Historically Designated:Yes NO®\ Flood Zone:
CONTRACTOR:Company Name:--_ I"4c Phone#:
Address:b() N V-j (q t�-Vr
City: Flo C CL 1� State: Zip:
Qualifier Name: T el'eSAS�®mor4 Phone#:
State Certification or Registration#: ;i k i 4 Certificate of Competency#:
Contact Phone#: Email Address:
DESIGNER:Architect/Engineer: Phone#:
Value of Work for this Permit:$ y'i ® � Square/Linear Footage of Work: �2
Type of Work: ❑Address ❑Alteration ❑New Repair/Replace ❑Demolition
Description of Work:
Submittal Fee$ 0 Permit Fee$ CCF$ CO/CC$
Scanning Fee$ Radon Fee DBPR$ Bond$
Notary$ - , Training/Education Fee$ 0 4�J Technology Fee$
Double Fee$ r/1 Structural Review$
TOTAL FEE NOW DUE$
��� e '-30
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 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 issued. In the absence of such posted notice, the
inspection will not be approved and a reinspection fee will be charged.
C &V-eQVt--1
Signature' Signature
Owner or Agent Contractor
The foregoing instrument was acknowledged before me this-2-5 The foregoing instrument was acknowledged before me this c;t-`5
day of N�04LO ,20 I by C—kP 0S 60' T!S day of ,20 ,byT
who is personally known to me or who has produced flfy who is personally known to me or who has produced PVJ �K2
�9 Cide * ion and who did take an oath. d1��Q�� as identification and who did take an oath.
NOTARY PUBLICNOTARY PUBLIC:
Sign: Sign:
Print: Print: -��
My Commission pir My Commission ELd Notary Public State of Florida
YO ENDRY DEL RIO Sindia Alvarez
=oaN r P4eG� MY COMMISSION#FF198880 Dlly Commission FF 156750
EXPIRES:FEB 12,2019 Expires 09/03/2018
APPROVED BY Plans Examiner Zoning
Structural Review Clerk
(Revised 07/10/07)(Revised 06/10/2009)(Revised 3/15/09)
'r PERMIT #:13-SC-1660306
APPLICATION #:AP1224610
STATE OF FLORIDA
_ DATE PAID:
DEPARTMENT OF HEALTH
x ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM FEE PAID:
E.• CONSTRUCTION PERMIT RECEIPT #:
w�ygcDOCUMENT #TR1
CONSTRUCTION PERMIT FOR: OSTDS Repair
APPLICANT: Carlos A. Goncalves
PROPERTY ADDRESS: 574 NE 102 St Miami, FL 33138
LOT: 3 BLOCK: 94 SUBDIVISION: Miami Shores
PROPERTY ID #: 11-3206-017-1030 [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 [ 900 l GALLONS / GPD Septic(Existinq) CAPACITY
A [ 0 l 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 [ 225 l SQUARE FEET Trench Drainfield SYSTEM
R [ 0 1 SQUARE FEET SYSTEM
A TYPE SYSTEM: [xl STANDARD [ ] FILLED [ l MOUND [ ]
I CONFIGURATION: [x] TRENCH [ ] BED [ ]
N
F LOCATION OF BENCHMARK: CROWN OF ROAD:9.91'NGVD
I ELEVATION OF PROPOSED SYSTEM SITE [ 3.96 l [ INCHES FT ] [ABOVE BELOW BENCHMARK/REFERENCE POINT
E BOTTOM OF DRAINFIELD TO BE [ 45.96 ] [ INCHES FT ] [ABOVE BELOW BENCHMARK/REFERENCE POINT
L
D FILL REQUIRED: [ 0.001 INCHES EXCAVATION REQUIRED: [ 42.001 INCHES
**THIS PERMIT IS NOT FOR ADDITIONS-
0 *Perimeter of excavation area shall be at least 2 ft wider and longer than the proposed absorption bed.
T *Invert elevation of drainfield to be no less than 7.24'NGVD.
*Bottom of drainfield elevation to be no less than 6.74' NGVD.
H The system is sized for 3 bedrooms with a maximum occupancy of 6 persons(2 per bedroom),for a total estimated flow
E of 300 gpd.
R
SPECIFICATIONS BY: TITLE:
APPROVED BY; VkVAX ITLE: Engineering Specialist II Dade CHD
P Gumba
DATE ISSUED: 02/15/2016 EXPIRATION DATE: 05/15/2016
DH 4016, 08/09 (Obsoletes all previous editions which may not be used)
Incorporated: 64E-6.003, EAC Page 1 of 3
V 1.1.4 AP1224610 SE985356
d� l
STATE OF FLORIDA
F DEPARTMENT OF HEALTH
APPLICATION FOR CONSTRUCTION PERMIT V)D n�( nrD
PerrrjlitApplication Number
I lYJ
- - - - -- --- ---- ---- --- ------- PART II - SITEPLAN
Scale: Each block re resents 10 feet and 1 inch ='40 feet.
ll�
I kA 11
S
I
P
� L
r
I
Notes:
Pq
yC '
Site Plan submitted by:
Plan Approved Not Approved . I /
By Date--2, -►� `��
County Health Department
ALL CHANGES MUST BE APPROVED BY THE COUNT Y HEALTH DEPARTMENT
DH 4015,08/09(Obsoletes previous editions which may not be used) Incorporated: 64E-6.001,FACT
(Stock Number: 5744-002-4015-6) Page 2 of 4
� f
�'F-'kris.,-k., � .'-}{�:>�'� } '` g -, i� �``,�` w ,r�i �` c� y•t,*'�` ?*�.���', � �`
K
101
i
�';E�d# Mfr�r •< fi.
• 'u�i' ,: _ he Fx x. �-rsr +t�s 'z� r Y ' , ` �s"rah
g
kr w—
NEED
pur
y •:'�. � � _: ,,� Y.'s .},;yin �r r _ c�. - �'f- "€''� ,��' �e lx r�, ���`F
3�
s