PL-17-676 �WrmXNQ PL
� gt�t Miami Shores Village Mfr
eRillTfy[p@,j (IMIygj}q��� terl/t��(
<y 10050 N.E.2nd Avenue NW
Miami Shores,FL 33138-0000
h� e1�t Stetus.APP 'ED "
Phone: (305)795-2204 ;
W47
121 Expiration: /13/2 17
Project Address Parcel Number Applicant
175 NW 100 Street 1131010230320
CHRISTIAN LANSER
Miami Shores, FL 33138- Block: Lot:
Owner Information Address Phone Cell
CHRISTIAN LANSER 175 NW 100 Street (305)772-4313
MIAMI SHORES FL 33150-
175 NW 100 Street
MIAMI SHORES FL 33150-
Contractor(s) Phone Cell Phone Valuation: $ 2,400.00
STATEWIDE SEPTIC CONNECTIONS (954)963-0082
., ..... m _....... Total Sq Feet: 150
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 Invoice# PL-3-17-63295
CCF $1.80 03/14/2017 Check#:5269 $50.00 $618.30
DBPR Fee $2.25
DCA Fee $2.25 03/17/2017 Check#: 1001 $618.30 $0.00
Education Surcharge $0.60 Bond#:3345
Permit Fee $150.00
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 permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are
required for ELECT AL,PLUMBING,MECHANICAL,WINDOWS,DOORS,ROOFING and SWIMMING POOL work.
OWNERS AFFI T: ify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating
construction a�n z n' hermore,I authorize the above-named contractor to do the work stated.
W March 17,2017
Auth rize gna ure:Owner / Applicant / Contractor / Agent Date
Build. g Department Copy
March 17, 2017 1
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Miami Shores Village
L9-�
-
Building De
CSS- Department
artment
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 20t_/�_
BUILDING Master Permit No.
PERMIT APPLICATION Sub Permit No.
❑BUILDING ❑ ELECTRIC ❑ ROOFING REVISION ❑ EXTENSION EJRENEWAL
PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
,} CONTRACTOR DRAWINGS
JOB ADDRESS: �-I s � w 100 I
City: Miami Shores County: Miami Dade Zip: S�
Folio/Parcel#: 11--51C1 - Q 2-3-032-0 Is the Building Historically Designated:Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER:Name(Fee Simple Titleholder): CV1 1 S-tl oy-j I o tiger- Phone#: -765S�e6 8)�r)'
Address: 1.15 N)w 100 &-f rG,
City: State: Zip: 35 1 S®
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR:Company Name: r4z i G TMS Phone#:
Address: Ib G 1502 NW 19 A--G c�
City: L° c+ State: 2 Zip: so
Qualifier Name: V e yy , o Phone#:
State Certification or Registration#: (q��� Certificate of Competency#:
DESIGNER:Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for this Permit:$ .Z:� Square/Linear Footage of Work: ISO
Type of Work: ❑ Addition ❑ Alteration ❑ New [K Repair/Replace ❑ Demolition
Description of Work: �( fi l�C� nr-% d
Specify colgpof colorru its e: a- 9
Submittal Fee 'Dpermit Fee°$ CCF$ 1 C) CO/CC$
CA n
Scanning Fee$ Radon Fee$; DBPR$, ° �� Notary$
Technology Fee r `y1 v TrainingJBdn Fee$ ° Double Fee$
Structural Reviews$ Bond$ 000
t
TOTAL FEE NOW DUE$ 1 .
(Revised02/24/2014) „r•,
4 ti
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.
e
Signature Signature
OWN or GENT CONTRACTOR
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
day of 20 F) by t�!--) day of I-)�Ct f c h 20 11 by
c -'J-vi on, Lonwjz-vho is personally known to �� �.n---hk�r who is personally known to
me or who has produced T L A L as me or who has produced Piz as
identification and who did take an oath. identification and who did take an oath.
NOTARY PUBLIC: NOTARY PUBLIC:
Sign: G Sign:
Print. rr n r,, Print: A Q i o. o P rir)f+t'
Seal: Seal:
g+%s'�; JERRICA L.ARMSTRONG JERRICA L e NIA TPOMJV1 Notary Public-State of Florida a`` ;', �J6RRI6�Ar
Fl„ARMt:�l�gfpG
My Comm.Expires Feb 9.2019 Commisslon,#F
My
aFOF ����� Comm..Ex fres Fe
APPR Plans Examiner Zoning
Structural Review Clerk
(ReAsed02/24/2014)
t
PERMIT #:13-SC-1743320
. .
STATE OF FLORIDA APPLICATION #:AP1278174
DEPARTMENT OF HEALTH DATE PAID:
ONSITE SEWAGE TREATMENT AND DISPOSAL FEE PAID:
SYSTEM
RECEIPT #:
DOCUMENT #TR1052109
CONSTRUCTION PERMIT FOR: OSTDS Repair
APPLICANT: Christian Lancer
PROPERTY ADDRESS: 175 NW 100 St Miami,FL 33150
LOT: 16 BLOCK: 4 SUBDIVISION:
PROPERTY ID #: 11-3101-023-0320 [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 [ 750 ] 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 [ 150 ] 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:
I ELEVATION OF PROPOSED SYSTEM SITE [ 30.00 ] [ INCHES FT ] [ABOVE BELOW BENCHMARK/REFERENCE POINT
E BOTTOM OF DRAINFIELD TO BE [ 76.00 ] [ INCHES FT ] [ABOVE BELOW BENCHMARK/REFERENCE POINT
L
D FILL REQUIRED: [ 0.00] INCHES EXCAVATION REQUIRED: [ 58.001 INCHES
EXISTING SEPTIC TANK TO REMAIN,REPLACE DRAINFIELD ONLY
O rIlEA1T OF HATH
T 1.-EXISTING 750 gal.septic tank with and approved filter TO REMAIN. COUNTY
H 2.- Install 150 sf.of drainfield in TRENCH configuration. IN as A �®
3.-Install 12"of slightly limited soil at the bottom of the drainfield. ehojo eoE� ®\
E 4.-Perimeter of excavation area shall be at least 2 ft wider and longer than the proposed absorption bed or trench. �o P t.\ ts
R (Comments Continued on Page 2.) �teQ����o�ZttrrSPe
SPECIFICATIONS BY: Te lomon TITLE: Master SeptiZ902igOTAn � �\ � p ksc,��\\�
APPROVED BY: TITLE: ENGINEERING SPECIAL;gI `I n< �6 ��ap Pd01� � CHD
ei cunt IAN` 90 6r a, ��0
DATE ISSUED: 03/03/2017 bot��Q�e``Mt �,09 06/04/2017
z 40
DH 4016, 08/09 (Obsoletes all previous editions which may not be use s`'a��t\®�
Incorporated: 64E-6.003, FAC `TlS\`e@V ��� Page 1 of 3
v 1.1.4 AP1278174 slot 2�saso
t
STATE OF FLORIDA
DEPARTMENT OF HEALTH !°
APPLICATION FOR CONSTRUCTION PERMIT ���� ��
Permit Application Number
--------------------------- PART II - SITEPLAN ---------------------------
Scale: Each block re resents 10 feet and 1 inch =40 feet.
1
ef
S
Notes: ITS NW 100 -t 2 31 5'0
se,� N-e vJ 1S� Jy r G,
Site Plan submitted 2 + -?► Z6 2-
Plan
Plan App Not Approved Date
By o County Health Department
i
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: 5744-0024015-6)
DOCUMENT #: PR1052109
5.-Invert elevation of drainfield to be no less than 7.77'NGVD
6.-Bottom of drainfield elevation to be no less than 7.27'NGVD
THIS PERMIT IS NOT FOR ANY ADDITIONS.
The system is sized for 2 bedrooms with a maximum occupancy of 4 persons(2 per bedroom),for a total estimated flow of 300
gpd.
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.Required drainfield area based on rule 64E-6.015(6)(c)2.
Install a new drainfield to achieve Drainfield size requirement.