PL-17-1078 Permit o PL-4-17-' 178
Miami Shores Village � fl Type:F`�Ut 11}�1t - ittential
10050 N.E.2nd Avenue NW
W,6rk ClaM§Xoat6t n Orainfield
Miami Shores,FL 33138-0000 P e,,
P@rte 5talrS:AP ED
Phone: (305)795 2204
o ioA Expiration: 10/31/2017
Issue Date.5/4/2017 p�
Project Address Parcel Number Applicant
94 NW 95 Street 1131010340090 _w '
Miami Shores, FL 33150- Block: Lot: NOEL MOLINA
Owner Information Address PhoneCell
I NOEL MOLINA 94 NW 95 Street
MIAMI SHORES FL 33138-
Contractor(s) Phone Cell Phone Valuation: $ 4,350.00
STATEWIDE SEPTIC CONNECTIONS (954)963-0082 Total Sq Feet: 225
Type of Work:REPLACE TANK AND 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-4-17-63737
CCF $3.00 05/04/2017 Check#: 1222 $776.00 $50.00
DBPR Fee $4.50
DCA Fee $4.50 04/18/2017 Check#:5288 $50.00 $0.00
Education Surcharge $1.00 Bond#:3396
Permit Fee $300.00
Scanning Fee $9.00
Technology Fee $4.00
Total: $826.00
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 thisermit sume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are
required for E CT C ,PLUMBING,MECHANICAL,WINDOWS,DOORS,ROOFING and SWIMMING POOL work.
OWNERSVazon'
Ice 'fy that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating
constru oR th rmore,I authonz Bove-named contractor to do the work stated.
May 04,2017
zed Sign Owner / Applicant / Contractor / Agent Date
Building Department Copy
May 04,2017 1
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Miami Shores a Villa ''�' -- 0 - t
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` Building Department
10050 N.E.2nd Avenue,Miami Shores,Florida 33138 ► I
Tel:(305)795-2204 Fax:(305)756-8972 ►-fit
INSPECTION LINE PHONE NUMBER:(30S)762-4949
FBC 20
BUILDING Master Permit NoT��' V
PERMIT APPLICATION Sub Permit No.
❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
�
o CONTRACTOR DRAWINGS
rn
JOB ADDRESS: `14 N w C� G St
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#: l k 30 - N _Wq-0 Is the Building Historically Designated:Yes NO L--"
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER:Name(Fee Simple Titleholder): M®f i n Q S N dQl Phone#:
Address: I�t NV\1 C1 G �5 1
City: NA 1 Cly-n1 state: Zip: '331 5o
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR:Company Name: 33
� Ol-1rl �31. 1 i G S I h Phone#: k6 Address: )36130i W AxR, *140
City: State: Zip: _
Qualifier Name: I Terat, E'er Phone#:
State Certification or Registration#: SM®9-7126 2- Certificate of Competency#:
DESIGNER:Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for this Permit:$ 0 Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration ❑ New IN Repair/Replace ❑ Demolition
Description of Work: Ir-t-
Specify color
of color thru tile:
Submittal Fee$ ZJ)u Permit Fee$ CCF$ CO/CC$
Scanning Fee$ Radon Fee$ "'T DBPR$ Nota'ry$
(vy
Technology Fee$ '�` `` ra ducafion Fee$ Double Fee$
Structural Reviews$ Bond
TOTAL FEE NOW DUE$ co
(Revised02/24/2014) �] ( co
1�`U• W
Bonding Company's Name(if applicable)
Bonding Company's Address s
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 t nt. Also,a certified copy of the recorded notice of commencement must be posted at the job site
for the first inspection c seven (7) days after the building permit is issued. In the absence of such posted notice, the
inspection will not be a an reinspection fee will be charged.
Signat Signature
OWNER or AGENT CONTRACTOR
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
day of I 20 by day of �^ L 20 .by
Noel lit Jh e-- who is personally known to TAXI-5 X1'0�1`'l�^�who is personally known to
me or who has produced D as me or who has produced f as
identification and who did take an oath. identification and who did take an oath.
NOTARY PUBLIC: NOTARY PUBLIC:
Sign *(1
4Sign• A
Print r r Prin t'
Seal: Seal:
RRICA L.ARMSTRONG JERRICA l "MSTN l
"' °"-�°�''
a� N Public-State of Florida V^ = Notary Public State of Florida
**low ff410 **
''•;;F,q� �qYnm.Expires Feb 9 .. ,ley ggmm.Ex�p(o;�;Feb 9,2019
y fir` Plans Examiner Zoning
7r 77 7--r-
Structural Review Clerk
(Revised02/24/2014)
PERMIT#: 13-SM-1751599
STATE OF FLORIDA APPLICATION #:AP 1283685
DEPARTMENT OF HEALTH DATE PAID:
ONSITE SEWAGE TREATMENT AND DISPOSAL FEE PAID:
SYSTEM
RECEIPT #:
"W"' DOCUMENT #: PR1067112
CONSTRUCTION PERMIT FOR: OSTDS Repair
APPLICANT: NOEL MOLINA
PROPERTY ADDRESS: 94 NW 95 St Miami,FL 33150
LOT: 13-14 BLOCK: 167 SUBDIVISION: Miami Shores Section 6
PROPERTY ID #: 11-3101-034-0090 [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 ] GALLONS / GPD NEW SEPTIC TANK TO INSTALL CAPACITY
A [ 0 ] GALLONS / GPD CAPACITY C
N [ 0 ] GALLONS GREASE INTERCEPTOR CAPACITY [MAXIMUM CAPACITY SINGLE TANK:1250 5],;,.
K [ ] GALLONS DOSING TANK CAPACITY [ ]GALLONS @[ ]DOSES PER i ^€ice,, #,1Fhmps [' 'j,?�0
D [ 225 ] SQUARE FEET NEW DF IN TRENCH CON SYSTEM "
R [ 0 ] SQUARE FEET SYSTEM
A TYPE SYSTEM: [x] STANDARD [ ] FILLED [ ] MOUND [ ]
I CONFIGURATION: [X] TRENCH [ ] BED [ ] Q .;
N
F LOCATION OF BENCHMARK: FFE.........12.60'NGVD 81"FJ
I ELEVATION OF PROPOSED SYSTEM SITE [ 28.80 ] [ INCHES FT ] [ABOVE BELOW BENCHMARK/REFERENCE POINT
E BOTTOM OF DRAINFIELD TO BE [ 76.80 ] [ INCHES FT ] [ABOVE BELOW BENCHMARK/REFERENCE POINT
L
D FILL REQUIRED: [ 0.00] INCHES EXCAVATION REQUIRED: [ 60.00 ] INCHES
1.-Install a 900 gal.septic tank with an approved filter p@r`
O 2.-The licensed contractor installing the system is responsible for installing the minimum category of to
T with s.64E-6.013(3)(f)FAC. + '
H 3.-Install 225 sf. of drainfield in ....TRENCH... configuration.
4.-Install "SAND"of slightly limited soil at the bottom of the drainfield.
E 5.-Perimeter of excavation area shall be at least 2 ft wider and longer than the proposed absorptio ed or trench.
R (Comments Continued on Page 2.)
SPECIFICATIONS BY: Ger4 Philizair TITLE
Engineering Specialist II
APPROVED BY: TITLE: Engineer Supervisor III Dade CHD
4d V Edwards
DATE ISSUED: 04/10/2017 EXPIRATION DATE: 07/09/2017
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 AP1283685 SE1029977
STATE OF FLORIDA
DEPARTMENT OF HEALTH
APPLICATION FOR CONSTRUCTION PERMIT
Grf ' Permit Application Number
------ - ------------ - P T 1 ITEPLAN ---------------------------
Scale: Each block r resents 10 feet And 1 inch =40 feet.
dw I M-7 lip
Al 10
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Notes: G S dt 16,1-�;-o
C� DF..,
Site Plan submitted y:
Plan Approved Not Ap roved Date b
By County Health Department
ALL CHANGES MUST BE APPROVED BY THE COUNTY HEALTH DEPARTMENT
DH 4015,08/09(Obsoletes previous editions which may not be used) Incorporated: 64E-6.001,FAC Page 2 of 4
(Stock Number: 5744-002-4015-6)