PL-17-1091 Pomit. ,,PL4:�17�1 X91
�e�*OMmV , Miami Shores VillagePermit Type.Plumbing'Residential
�� 10050 N.E.2nd Avenue NE Wotkaess�Cation:Drairl'l 61d
n
°' "' Miami Shores,FL 33138-0000 '
Phone: (305)795 2204 Permit Status.aPf�RG1YED
FLORIDA
Isl, taat� ,4�27t17' Expiration: 10/24/2017
Project Address Parcel Number Applicant
534 NE 94 Street 1132060140950
CAROL ANN KLEIN r
Miami Shores, FL Block: Lot:
Owner Information Address Phone Cell
LESLIE KLEIN 534 NE 94 ST (305)876-7514
MIAMI SHORES FL 33138-2848
Contractor(s) Phone Cell Phone $ 2,200.00
='
Valuation:
MR C'S PLUMBING&SEPTIC INC (305)651-7859 Total Sq Feet: 200
Type of Work:DRAIN FIELD REPAIR. 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# PL4-17-63751
CCF $1.80 04/26/2017 Check#:1204 $500.00 $ 168.30
DBPR Fee $2.25
DCA Fee $2.25 04/19/2017 Credit Card $50.00 $ 118.30
Education Surcharge $0.60 04/27/2017 Credit Card $ 118.30 $0.00
Permit Fee $150.00 Bond#:3385
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 thereto and in strict conformity with the plans,drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In
accepting this_permitA assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are
required for T AL,PLUMBING,MECHANICAL,WINDOWS,DOORS,ROOFING and SWIMMING POOL work.
�—
OWNERS F IDA T. certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating
constructi a o in thermore,I authorize the above-named contractor to do the work stated.
April 27, 2017
AuttVized Signature:Owner / Applicant / Contractor / Agent Date
Building Department Copy
April 27,2017 1
►.► DIVISION OF loci I
Environmental Health
Florida Health 99i�
e�O Miami-Dade County V%4
OSTDS/Well Division
11805 SW 26th Street•Miami,FL 33175
Inspector liwutti. S Date 2/•17
Address S3`FyL 9 qj OSTDS# P J2 F 5730
Comments:
Signature
3o S'- ��Z -ISI
J
Miami Shores Village
Building Departmentx -
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 I q
BUILDING Master Permit NOT U 1091
PERMIT APPLICATION Sub Permit No.
F-1 BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
�LUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑CANCELLATION ❑ SHOP
2 J J �1 CONTRACTOR DRAWINGS
JOB ADDRESS: V ! -1
City: Miami Shores County: Miami Dade Zip: a 3 12 � --)-I L/8
Folio/Parcel#: Is the Building Historically Designated:Yes NO Y
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER:Name(Fee Simple Titleholder): LiEs L i r. (a . J CW-.),a L AN rQ1 k LQ : a N-7- PS-1 - q 46Z
Address: � � S-r
City: -!-t l &'H-0 RY-S- State: ,_ Zip: 3 A I- Z 4/,
Tenant/Lessee Name: Phone#:
Email: —0 . iU C T—
/
CONTRACTOR:Company Name: C PS e�` � l Phone#:
Address: I LQ eJ'LK-' q
City: ,State: � 4
Zip: I
Qualifier Name: K C!1te1l'ta-- Phone#:
State Certification or Registration#: SK 6 61 Certificate of Competency#:
DESIGNER:Architect/Engineer: Phone#:
Address: �i City: State: Zip:
Value of Work for this Permit:$ Square/Linear Foo a of Work: c2d-2 �1 '
Type of Work: El Addition El Alteration El New Repair/Replace ❑ Demolition
Description of Work:
Specify color of color thru tile:
Submittal Fee$ ' Q Permit Fee$ 4iF6 ' CCF$ CO/CC$
Scanning Fee$ Radon Fee$ DBPR$ Notary$_�Q�
Technology Fee$ Training/Education Fee$ Double Fee$
Structural Reviews$ Bond$ sM` no
TOTAL FEE NOW DUE$
(Revised02/24/2014)
Bonding Company's Name(if applicable) Aj I-A- -
Bonding Oompanyrs Address
City State Zip
Mortgage Lender's Name(if applicable) Attl ja=
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.
Signature Signature
OWNER or AGENT CONTRACTOR
The foregoing instrument was acknowledged before me this The foregoing instrument
was acknowledged before me this
tK day of Hoe- 20 by day of 1••f lr�� 20 by
®� AA >4<1ZI ,who is personally known to Ki F4 in,4� F-�/�:QXwho 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 PUBILIC:
Sign: Sign:
Print -e— K Print
U y u ,�o �� ES
Seal: _ : My Comm. Expires Sep 19,2017 Seal ,°a Notary Public-State of Florida
Commission# FF 055732y9 "rte;My Comm.Expires Oct 23,2018
o-
°L Bonded Through National Notary Assn. •,;��F,o?;°` Commission#FF 136597
Borxled
1f►rargh National N� Assn
��*�*x�r����***����a�***"u�*�*a�"x�x�**x�""���*�x*+"**�"�s•����*�xrs«�s�*+�"*�x�aw�x�*x�*" x�w � *x��x�*+�
APPROVED BY y Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)
CIS
PERMIT #:13-SM-1754760
APPLICATION #:AP1285730
STATE OF FLORIDA
DEPARTMENT OF HEALTH DATE PAID:
ONSITE SEWAGE TREATMENT AND DISPOSAL FEE Pte;
SYSTEM
RECEIPT #:
DOCUMENT #:PRI068000
CONSTRUCTION PERMIT FOR: OSTDS Repair
APPLICANT: CAROLANN KLEIN
PROPERTY ADDRESS: 534 NE 94 St Miami,FL 33138
LOT: 7-8 BLOCK: 56 SUBDIVISION: Miami Shores Sec
PROPERTY ID #• 11-3206-014-0950 [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 FM24PT THE APPLICANT FROM COMPLIANCE WITH OTHER FEDERAL,
STATE, OR LOCAL PERMITTING REQUIRED FOR DEVELOPMENT OF THIS PROPERTY.
SYSTEM DESIGN AND SPECIFICATIONS
T [ 750 ] GALLONS / GPD EXISTING Septic Tank TO REMAIN CAPACITY
A [ 0 l GALLONS / GPD CAPACITY
N [ 0 ] GALLONS GREASE INTERCEPTOR CAPACITY [ ! CAPACITY SINGLE TANK:1250 GALLONS]
K [ ] GALLONS DOSING TANK CAPACITY I IGALLONS @[ ]DOSES PER 24 HRS #Pumps [ ]
D [ 200 ] SQUARE FEET NEW DF IN BED CONFIG SYSTEM
R [ 0 ] SQUARE FEET SYSTEM
A TYPE SYSTEM: [X] STANDARD [ I FILLED [ l MOUND [ ]
I CONFIGURATION: [ ] TRENCH [X] BED [ I
N
F LOCATION OF BENCHMARK: FFE............11.4UNGVD
I ELEVATION OF PROPOSED SYSTEM SITE [ 27.60] INCHES FT I[ABOVE BELOW BENCHMAN K/REFERENCE POINT
E BOTTOM OF DRAINFIELD TO BE [ 77.60] INCHES FT I[ABOVE'L BENCHMARK/REFERENCE POINT
L
D FILL REQUIRED: [ 0.00 1 INCHES EXCAVATION REQUIRED: [ 62001 INCHES
1-EXISTING 750 gal.septic tank with and approved filter TO REMAIN.
° 2- Install 200 sf.of drainfield in... BED.......configuration.
T 3.-Install 12"of slightly limited soil at the bottom of the drainfield.
H 4-Perimeter of excavation area shall be at least 2 It wider and longer than the proposed absorption bed or trench.
(Comments Continued on Page 2.)
E
R
SPECIFICATIONS BY: Gerard L Philizaire TITLE:
Engineering Specialist II
APPROVED BY: TITLE: Professional Engineer I Dade CHD
Ri M Rojah
DATE ISSUED: 04/17/2017 TEXPIRATION DATE: 07/16/2017
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 AP1285730 SE1030781
STATE OF FLORIDA
DEPARTMENT OF HEALTH
APPLICATION FOR CONSTRUCTION PERMIT
9 `f =
eA,q: o
3�
���� { � � t✓!«STS�� ��
fit' / fGv� �s'�t ss s 1-elaA -iv (ce c�'
ere are no pertinent features on adjacent properties and or across the street that may affect the New Septic-H
ystem Installation
Notes: 5 3 N� 9 1 '
1
S
Site Plan submitted y:
Plan ove Not Approved Date__4::_4 l
By NK— 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)