PL-17-554 f
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Miami Shores Village - n 7 t) »}
10050 N.E.2nd Avenue NW
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Miami Shores,FL 33138-0000
Phone: (305)795-2204
P600 Status APPROVED'
Ex iration: 09/04/2017
tsusDate 201
Project Address Parcel Number Applicant
11121 NW 6 Avenue 1121360210600
Miami Shores, FL 33168-3311 Block: Lot: PATRICK 8 LAREMISE LUBIN
Owner Information Address Phone Cell
PATRICK&LAREMISE LUBIN 400 NW 101 Terrace
PEMBROKE PINES FL 33026-
400 NW 101 Terrace
PEMBROKE PINES FL 33026-
Contractor(s) Phone Cell Phone Valuation: $ 3,800.00
STATEWIDE SEPTIC CONNECTIONS (954)963-0082
_.. _ Total Sq Feet: 225
Type of Work:REPLACE DRAINFIELD Available Inspections:
Type of Piping: Inspection Type:
Additional Info:REPLACE DRAINFIELD 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
CCF Invoice# PL-3-17-63143
$2.40 03/03/2017 Check#:5257 $50.00 $619.90
DBPR Fee $2.25
DCA Fee $2.25 03/08/2017 Check#:5267 $619.90 $0.00
Education Surcharge $0.80 Bond#:3332
Permit Fee $150.00
Scanning Fee $9.00
Technology Fee $3.20
Total: $669.90
In consideration of the issuance to me of this permit, 1 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 accurate and that all work will be done in compliance with all applicable laws regulating
const u 'on and zoning. Futherm re,I a thorize the above-named contractor to do the work stated.
March 08, 2017
thorized Signature:O ner / Applicant / Contractor / Agent ate
Buil gDartment
Copy
March 08,2017 1
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Miami Shores Village y
Building Department MAR 1 ,(' ' 1�
10050 N.E.2nd Avenue,Miami Shores,Florida 33138 '_ V—
Tel:(305)795-2204 Fax:(305)756-8972
INSPECTION LINE PHONE NUMBER:(305)762-4949 J�
FBC 20k�-A _
BUILDING Master Permit No. I _ j,5y
PERMIT APPLICATION sub Permit No.
BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑EXTENSION ❑RENEWAL
]PLUMBING ❑ MECHANICAL E]PUBLIC WORKS ❑ CHANGE OF ❑CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: l ial NL,NI G Ay'Q.
City: Miami Shores County: Miami Dade zip: 331 (0
Folio/Parcel#: 1' 2 )3 -o 21-O 6 p Is the Building Historically Designated:Yes NO V
Occupancy Type: Load: ` Construction Type: Flood zone: BFE: FFE:
OWNER:Name(Fee Simple Titleholder): L U 6 i n La r-e ry'1!&C, Phone#: S& 1 `,2 k
Address: 11121 W1W ( kilts
City:_^ 4 �r�r State: 01 Zip: 33 16(5
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR:Company Name: 13+A+ew i ote� EV--VC y``+YNS fv'G Phone#: 3 661 b)I�3�
Address: 13 6$0 NW iq Ave * i o
City: Ooc' LoCkA State: FL Zip: 3305 9
Qualifier Name: 1'e�SG ��� �1�+'� Phone#:
State Certification or Registration#:'MO 9 7( 26 Z Certificate of Competency#:
DESIGNER:Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for this Permit:$ 00 Square/Linear Footage of Work: 2 2
Type of Work: ❑ Addition ❑ Alteration ❑ NewP
�] Repair/Replace El Demolition
Description of Work: R.P) 14 t e, D Ya t r, J e t of
Specify color of color thru tile: C
Submittal Fee$ Permit Fee$ CCF$ CO/CC$
Scanning Fee$ Radon Fee$ DBPR$ Notary$
Technology Fee$ Training/Education Fee$ Double Fee$
Structural Reviews$ Bond$
TOTAL FEE NOW DUE$
(Revised02/24/2014) , C) 9,-c no
53
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 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$2500, the applicant must
promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person
whose property is subject to attachment. Also,a certified copy of the recorded notice of commencement must be posted at the job site
for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the
inspection will not be approved and a reinspection fee will be charged.
Signatur Signature_,/-r"6
OWNER or AGENT CONTRACTOR
The foregoing Instrument„ p�was acknowledged before me this The foregoing instrument was acknowledged before me this
7-6 day of 1" � .20 �� ,by 20 day of .20 7 ,by
W r e mig ��r1 ,who is personally known to rte. f-d0 rYl .who is personally known to
me or who has produced^ FLW I� as me or who has produced E49- r� as
identification and who did take an oath. identification and who did take an oath.
NOTARY PUBLIC: NOTARY PUBLIC:
Sign: � LA�_ � ! h���i Sign
Print: 14r,r,6-V' Print: r( 1 LCA
Seal: Seal:
JERRICA L.ARMSTRONG ( •o<I”""�°'',, JERRICA L.ARMSTRONG
Notary Public-State of Florida i �? Notary Public-State of Florida
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My Comm.Expires Feb 9,2019 ., %',Fo� �°�qMy Comm.Expires Feb 9,2019
nrnu..
APPR Plans Examiner �.� �, ` Zoning
Structural Review Clerk
(Revised02/24/2014)
STATE OF FLORIDA PERMIT #: 13-$C-1742349
DEPARTMENT OF HEALTH APPLICATION #: AP 1277533
ONSITE SEWAGE TREATMENT AND DISPOSAL
' DATE PAID:
SYSTEM
CONSTRUCTION PERMIT FEE PAID:
RECEIPT #:
DOCUMENT #: PR1051211
CONSTRUCTION PERMIT FOR: OSTDS Repair '
APPLICANT: � '{ U
Lubin Laremise U ��
PROPERTY ADDRESS: 11121 NW 6 Ave Miami, FL 33168 ' sr rJ ':
LOT: 1 BLOCK: 4 SUBDIVISION:
PROPERTY ID #: 11-2136-021-0600 [SECTION, TOWNSHIP, MANGE, 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 Existina Seotic Tank to Remain 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 [ 225 ] SQUARE FEET New Trench Conf. Drainf. SYSTEM
R [ 0 ] SQUARE FEET SYSTEM
A TYPE SYSTEM: [X] STANDARD [ ] FILLED [ ] MOUND [ ]
I CONFIGURATION: [X] TRENCH [ ] BED [ ]
N
F LOCATION OF BENCHMARK: FFE: 13.0'NGVD
I ELEVATION OF PROPOSED SYSTEM SITE [ 13.20 ] [ INCHES FT ] [ ABOVE BELOW BENCHMARK/REFERENCE POINT
E BOTTOM OF DRAINFIELD TO BE [ 61.20 ] [ INCHES FT ] [ ABOVE BELOW BENCHMARK/REFERENCE POINT
L
D FILL REQUIRED: [ 0.00] INCHES EXCAVATION REQUIRED: [ 48.001 INCHES
O EXISTING SEPTIC TANK TO REMAIN, REPLACE DRAINFIELD ONLY
T 1.-EXISTING 900 gal.septic tank with and approved filter TO REMAIN.
H 2.- Install 225 sf.of drainfield in TRENCH configuration.
E 3.-Install 12"of slightly limited soil at the bottom of the drainfield.
4.-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: Teresa J Solomon TITLE: Master Septic Tank Contractor
APPROVED BY: TITLE: ENGINEERING SPECIALIST I Dade CHD
Yvene C ermont
DATE ISSUED: 02/27/2017 EXPIRATION DATE: 05/28/2017
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 AP1277533 SE1024584
f- . 66
DOCUMENT #: PR1051211
5.-Invert elevation of drainfield to be no less than 8.40'NGVD
6.-Bottom of drainfield elevation to be no less than 7.90'NGVD
THIS PERMIT IS NOT FOR ANY ADDITIONS.
The system is sized for 3 bedrooms with a maximum occupancy of 6 persons(2 per bedroom),for a total estimated flow of 300
gpd.
Required drainfield area based on rule 64E-6.015(6)(c)2.
Install a new drainfield to achieve Drainfield size requirement.
The licensed contractor installing the system is responsible for installing the minimum category of tank in accordance with s.
64E-6.013(3)(0, FAC.