PL-17-1131 Permit
Miami Shores Village M Pem Type Plumbing-Resentia�N
10050 N.E.2nd Avenue NE
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Miami Shores,FL 33138-0000
r
ire Phone: (305)795-2204 '
POM*Status.'A �'#�C���
fCORID�' ;t -- ,
Issue uat+. 20IT, Expiration: 1 /25 2017
Project Address Parcel Number Applicant
[�54 NE 99 Street 1132060131070 CORDON MOYER
Miami Shores, FL Block: Lot:
Owner Information Address Phone Cell
CORDON MOYER 54 NE 99 Street (305)758-4893
MIAMI FL 33138-2339
Contractor(s) Phone Cell Phone Valuation: $ 2,400.00
MR C'S PLUMBING&SEPTIC INC (305)651-7859
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
Bond Type-Owners Bond $500.00
Invoice# PL-4-17-63798
CCF $1.80 04/28/2017 Credit Card $272.80 $550.00
DBPR Fee $4.50
DCA Fee $4.50 04/28/2017 Check#:7397 $500.00 $50.00
Education Surcharge $0.60 04/25/2017 Credit Card $50.00 $0.00
Permit Fee $300.00 Bond#:3387
Scanning Fee $9.00
Technology Fee $2.40
Total: $822.80
In consideration of issu nce to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations
pertaining thereto stri conformity with the plans,drawings,statements or specifications submitted to the proper authorities of Miami Shores Village. In
accepting this a it s e responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are
required for E T C LUM PQP I tdf€CHANICAL,WINDOWS,DOORS,ROOFING and SWIMMING POOL work.
OWNERS AF T:-I rti t t all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating
construction and on th rmor authorize the above-named contractor to do the work stated.
April 28, 2017
Authorized Signature:Owner / Applicant / Contractor / Agent Date
Building Department Copy
April 28,2017 1
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�ISION OF
ental Health
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Miami Shores Village
RECEIVED
Building Department PR 25 2017
10050 N.E.2nd Avenue,Miami Shores,Florida 33138
Tel:(305)795-2204 Fax:(305)756-8972
INSPECTION LINE PHONE NUMBER:(305)762-4949 S�
FBC 20 I�
BUILDING Master Permit No.L)I I d 1
PERMIT APPLICATION Sub Permit No.
r_jBUILDING ❑ ELECTRIC ROOFING ❑ REVISION ❑ EXTENSION [:]RENEWAL
O PLUMBING ❑ MECHANICAL PUBLIC WORKS ❑ CHANGE OF CANCELLATION ❑ SHOP
r
CONTRACTOR DRAWINGS
JOB ADDRESS: b `-l' C.1��--
City: Miami Shores�dJ// County: Miami Dade Zip: �-
Folio/Parcel#: l b — D l� l 0 9D Is the Building Historically Designated:Yes NO XOccupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER:Name(Fee Simple Titleholder): d an /410- V- Phone#:
Address: N a 01� S
City: Ar�w JA State: PC— Zip: lssl m
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR:Company Name: Mr C's Plumbing and Septic Phone#: 305 651 7859
Address: 19932 NW 2 Ave
City: Miami State: FL Zip: 33169
Qualifier Name: Kemble Ettrick Phone#: 305 651 7859
State Certification or Registration#: SR061536 r1 Certificate of Competency#:
DESIGNER:Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for this Permit:$ Square/Linear Footage of Work: SC-0
Type of Work: ❑ Addition ❑ Alteration ❑ New K Repair/Replace ❑ Demolition
Description of Work:
'DeAiAc-iC;LD jcEpm4 -
Specify color of color thru tile:
Submittal Fee$ Permit Fee$ CCF$ CO/CC$
Scanning Fee$ Radon Fee$ DBPR$ Notary$
Technology Fee$ Training/Education Fee$ Double Fee$
Structural Reviews$ Bond$ ° nM (�
TOTAL FEE NOW DUE$ 2� L• 0
(Revised02/24/2014) 80
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 imthis 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 Qoa��
OWNER or AGENT CONTRACTOR
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
day of `Tl [ °1� C— ,20 �� by _day of Aq /, '20.1 by
(a^ Nlavl�✓' ,Who'IS nPrcnnally k t� 6J,!_ E-rT,rick,who is personally known to
=cir who has produced as me or who has produced F,�[i, P L__ as
identification and who did take an oath. identification and who did take an oath.
NOTARY PUBLIC: NO A PUBLIC:
0IIIFu,
MARIE FIGUEROA
e Notary Public -State of Florida
Sign: Sign:
3 commission #GG 045807
�•, r���.. y Comm.Expires Mar 3,2021
Print: ,� '"" Print:
Seal' Nllt3l,Public- state of Florida Seal:
4-'- h4y Comm. Expires Sep 19,2017
Commission #FF 055732
Bonded Through National Notary Assn,
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APPROVED BY Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)
PERMIT #: 13-SC-1756180
STATE OF FLORIDA
DEPARTMENT OF HEALTH APPLIcATIoN #:AP 1286592
ONSITE SEWAGE TREATMENT AND DISPOSAL DATE PAID:
SYSTEM FEE PAID
CONSTRUCTION PERMIT RECEIPT #:
DOCUMENT #: PR1058629
CONSTRUCTION PERMIT FOR: OSTDS Repair
APPLICANT: Gordon Moyer
PROPERTY ADDRESS: 54 NE 99 St Miami, FL 33138
LOT: 67 BLOCK: 8 SUBDIVISION:
PROPERTY ID #: 11-3206-013-1070 [SECTION, TOWNSHIP, RANGE, PARCEL NUMBER]
[OR TAIL ID NUMBER]
SYSTEM MIDST 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
N [ 0 ] GALLONS GREASE INTERCEPTOR CAPACITY [MAXIMUM CAPACITY SINGLE TANK:1250 GALLONS]
K [ ] GALLONS DOSING TANK CAPACITY [ ]GALLONS @[ ]DOSES PER 24 HRS #Pumps [ ]
D [ 300 ] SQUARE FEET NEW DF IN BED CONFIG SYSTEM
R [ 0 ] SQUARE FEET SYSTEM
A TYPE SYSTEM: [R] STANDARD I I FILLED I I MOUND [ l
I CONFIGURATION: [ 1 TRENCH Ig] BED I ]
N
F LOCATION OF BENCHMARK: FFE......12.WNGVD
I ELEVATION OF PROPOSED SYSTEM SITE [ 26.40 ] INCHES FT ] [ABOVE BELOW BENCHMARK/REFERENCE POINT
E BOTTOM OF DRAINFIELD TO BE [ 76.40 ] INCHgg FT ] [ABOVE I�BENCHMARK/REFERENCE DINT
L
D FILL REQUIRED: [ 0.001 INCHES EXCAVATION REQUIRED: [ 62.001 INCHES
0 1:Install a 900 gal.septic tank with an approved filter
2:The licensed contractor installing the system is responsible for installing the minimum category of tank in accordance
T with s.64E-6.013(3)(f)FAC.
H 3:Install 300 sf.of drainfield in...BED.......configuration.
E 4:Install 12"of slightly limited soil at the bottom of the drainfield.
5: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: Gerard L Philizaire TITLE: Engineering Specialist II
APPROVED BY: TITLE: Professional Engineer I Dade CHU
Riebard N Pojas
DATE ISSUED: 04/20/2017 EXPIRATION DATE: 07/19/2017
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 AP1286592 S&1031350
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