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PL-17-553Project Address Miami Shores Village 10050 N.E. 2nd Avenue NW Miami Shores, FL 33138-0000 Phone: (305)795-2204 Parcel Number Resider n: Draini PRO' Expiration: 09/09/2017 Applicant 173 NW 92 Street Miami Shores, FL 33150- 1131010330990 Block: Lot: WILLIAM ARANGO CARLOS PEI Owner Information Address 173 NW 92 Street MIAMI SHORES FL 33150- 173 NW 92 Street MIAMI SHORES FL 33150- Phone Cell Contractor(s) Phone STATEWIDE SEPTIC CONNECTIONS (954)963-0082 Cell Phone Valuation: Total Sq Feet: Type of Work: REPLACE DRAINFIELD Type of Piping: Additional Info: REPLACE DRAINFIELD Bond Return : Classification: Residential Scanning: 3 Fees Due Bond Type - Contractors Bond CCF DBPR Fee DCA Fee Education Surcharge Permit Fee Scanning Fee Technology Fee Total: Amount $500.00 $1.80 $2.25 $2.25 $0.60 $150.00 $9.00 $2.40 $668.30 Pay Date Pay Type Invoice # PL -3-17-63142 03/03/2017 Check #: 6230 03/13/2017 Check #: 1208 Bond #: 3339 Amt Paid Amt Due $ 50.00 $ 618.30 $ 618.30 $ 0.00 $ 3,000.00 0 Available Inspections: Inspection Type: HRS Approval Final Review Plumbing 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 ELECTRICAL, PLUMBING, MECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work. OWNERS AFFIDAVI construction and zo ce F, that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating hermore, I authorize the above-named contractor to do the work stated. March 13, 2017 Author' ed gnature: Owner / Applicant / Contractor / Agent Buildin • epartment Copy Date March 13, 2017 1 ronmenta` Health '-`- E altb Florida 104thn� Miami Da ellDi�sion173 s a, 0 meet • T�S� � � 11803 5w Z6tt►5 Date -5 34 IV AP /211 q 4' BUILDING PERMIT APPLICATION ❑BUILDING ❑ ELECTRIC EMBING ❑ MECHANICAL JOB ADDRESS: City: Folio/Parcel#: Occupancy Type Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795-2204 Fax: (305) 756-8972 INSPECTION LINE PHONE NUMBER: (305) 762-4949 F FBC 20 H Master Permit No. P 1 - 55 - Sub Permit No. ❑ ROOFING ❑ REVISION ❑ EXTENSION El RENEWAL ❑ PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP / 73 N L) al-S.7— Miami 2-S'T CONTRACTOR DRAWINGS Miami Shores (County: Miami Dade Zip: (0 1 — 0 3'3o 09 90 is the Building Historically Designated: Yes NO 33150 Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder): V" I �- �a�'1Qj d VIOS a �Z 1i, Ni q2 SV J Address: City: ,/1% 1 CA (Y\ 1 c hp r,S State: IZ Zip: e3-1 &Q' Tenant/Lessee Name: Phone#: Email: CONTRACTOR: Company Name: u l i de 1 C i �C Phone#: l �' I L) t' Nva 1q # to y City: ora Loc*-- -' State: zip: ''`�' `, Qualifier Name: ' e%U G 4 oM42t Phone#: State Certification or Registration #: 0 9 ( 2-62' Certificate of Competency #: DESIGNER: Architect/Engineer: Phone#: Address: City: State: Zip: Address: Value of Work for this Permit: $ 3, ®oO Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration ❑ New Description of Work: 01, Repair/Replace ❑ Demolition 9D(evCe Ova to e Specify color of color thru tile: Submittal Fee $ Permit Fee $ / b V " CCF $ CO/CC $ • Scanning Fee $ Rad"dni ee' $ DBPR $ Notary $ Technology Fee $ Training/Education Fee $ Double Fee $ Structural Reviews $ (Revised02/24/2014) Bond $ TOTAL FEE NOW DUE $ m- 'D09 Uon6 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. Signature ?J05 ?Pre 7 OWNER or AGENT The foregoing instrument was acknowledged before me this day of �'C , 20 n , by CCU, "S P -Q rrf 2- me or who has produced , who is personally known to identification and who did take an oath. NOTARY PUBLIC: Sign: l Print:() r r I C -G L: t-�rrn5 as Seal: JERRICA L. ARMSTRONG : ° = Notary Public - State of Florida ****** i t. - **Okimmirakm ip�Cii4441189.**s*r*rrs***************s*** •140,Rf���'� MyComm. Expires Feb 9, 2019 ''�a4b�;t��` P APP f U'v crE5r, — - - Signature CONTRACTOR The foregoing instrument�-wasgacknowledged before me this °7` day of ,-j`�'%° , 20 \- by ` S' V `Jl,ofsr ^who is personally known to me or who has produced PTA" (L) as identification and who did take an oath. NOTARY PUBLIC: Sign: Print Seal: (Revised02/24/2014) Plans Examiner Structural Review JERRICA L. ARMSTRONG Notary Public • State of Florida '4 Commission # FF 197589 $` *** My4gramtExpirtif;abl!'8;" 28147 Zoning Clerk STATE OF FLORIDA DEPARTMENT OF HEALTH ONSITE SEWAGE TREATMENT AND DISPOSAL S!S CONSTRUCTION PERMIT CONSTRUCTION PERMIT FOR: APPLICANT: OSTDS Repair WILLIAM AND CARLOS ARANGO-PEREZ JTRS PROPERTY ADDRESS: LOT: 1415 BLOCK: 134 PROPERTY ID #: 11-3101-003-0990 SUBDIVISION: PERMIT #:13 -SM -1733115 APPLICATION #:AP1271395 DATE PAID: FEE PAID: CEIPT #: ocUMENT #: PR1046520 Miami Shores Sec 6 [SECTION, TOWNSHIP, RANGE, PARCEL NUMBER] [OR TAX ID NUMBER] SYSTEM MUST BE CONSTRUCTED IN ACCORDANCE WITH SPECIFICATIONS AND STANDARDS OF SECTION 381.0065, F.S., AND CHAPTER 64E-6, F.A.C. DEPARTMENT APPROVAL OF SYSTEM DOES NOT GUARANTEE SATISFACTORY PERFORMANCE FOR ANY SPECIFIC PERIOD OF TIME. ANY CHANGE IN MATERIAL FACTS, WHICH SERVED AS A BASIS FOR ISSUANCE OF THIS PERMIT, REQUIRE THE APPLICANT TO MODIFY THE PERMIT APPLICATION. SUCH MODIFICATIONS MAY RESULT IN THIS PERMIT BEING MADE NULL AND VOID. ISSUANCE OF THIS PERMIT DOES NOT EXEMPT THE APPLICANT FROM COMPLIANCE WITH OTHER FEDERAL, STATE, OR LOCAL PERMITTING REQUIRED FOR DEVELOPMENT OF THIS PROPERTY. SYSTEM DES•GLi AND SPECIFICATIONS •T [ 750•.]• • •CIALLON3• % GAD Existing Septic Tank to Remain CAPACITY rn1 a ler • • 0 7• G3�,LLON� ( G �D CAPACITY gea�li�gd to P On at tr8 Ai [ 0 I GALLONS •Gi gIll INTERCEPTOR CAPACITY (MAXIMUM CAPACITY SINGLE TANK:1250 ©�t .]fti�td eX�a vat the ( _ p. • �• GA�LONS �C�1%1G TANK CAPACITY [ ]GALLONS @ [ ] DOSEirt C ii d he dCa {e0v{ Po o a r a i 1 SYSTEM ,s Oeckol ad1 etoa• Oe oft bor\n9 a� mate � �nsG the s n sobratted. 'r; ,,,, SYSTEM t v Cee t S Ne ofig nat site,s�at$ at the oohted. :softs to �� �fiee tre b� a' time. anthe obskte al at thP. 1 • •[.•. • • D [ 225• se' 52 • • New Trench Conf. Drainfie :R • P • 0 ]• SQUARE FEET A.INAP sYsTri. ii�.iiANDARD 2•CONFIGU4TiOy! Jx]•TRENCH • • • •••• • • F LOCATION prj'•$LNCHMARK: I ELEVATION OF PROPOSED SYSTEM SITE E BOTTOM OF DRAINFIELD TO BE L D FILL REQUIRED: 0 T H E R SPECIFICATIONS BY: APPROVED BY: 10.00 ] INCHES [ ] FILLED [ ] BED [ [ 24.00 ] (1 INCHES [ 70.00 ] INCHES / FT ][ ABOVEf BELOWiBENCHMARK/REFERENCE POINT FT ][ABOVE4 BELOW Ji BENCHMARK/REFERENCE POINT EXCAVATION REQUIRED: [ 58.00] INCHES EXISTING SEPTIC TANK TO REMAIN, REPLACING DRAINFIELD ONLY 1. -EXISTING 750 gal. septic tank with and approved filter TO REMAIN. 2.- Install 225 sf. of drainfield in bed configuration. 3.- Install 12" of slightly limited soil at the bottom of the drainfield. (Comments Continued on Page 2.) Clermont Astrid V Edwards DATE . ISSUED: 01/24/2017 TITLE• ENGINEERING SPECIALIST I TITLE: Engineer Supervisor III DH 4016, 08/09 (Obsoletes all previous editions which Incorporated: 64E-6.003, FAC v 1.1.4 may not be used) AP1271395 Dade cHD EXPIRATION DATE: SE1020444 04/24/2017 Page 1 of 3 4 • 1 NOTICE OF RIGHTS A party whose substantial interest is affected by this order may petition for an administrative hearing pursuant to sections 120.569 and 120.57, Florida Statutes. Such proceedings are governed by Rule 28-106, Florida Administrative Code. A petition for administrative hearing must be in writing and must be received by the Agency Clerk for the Department, within twenty-one (21) days from the receipt of this order. The address of the Agency Clerk is 4052 Bald Cypress Way, BIN A-02, Tallahassee, Florida 32399. The Agency Clerk's facsimile number is 850-413-8743. Mediation is not available as an altemative remedy. Your failure to submit a petition for hearing within 21 days from receipt of this order will constitute a waiver of your right to an administrative hearing, and this order shall become a 'final order'. Should this order become a final order, a party who is adversely affected by it is entitled to judicial review pursuant to Section 120.68, Florida Statutes. Review proceedings are govemed by the Florida Rules of Appellate Procedure. Such proceedings may be commenced by filing one copy of a Notice of Appeal with the Agency Clerk of the Department of Health and a second copy, accompanied by the filing fees required by law, with the Court of Appeal in the appropriate District Court. The notice must be filed within 30 days of rendition of the final order. •• •• •• • ••• • • • • • • • • • • • • • . • •• •• • • . • •• • • • •. • • • • .••• •..• • •••• •••• • • • • •• •• • • •• •• • • • . • • • • • •••• • • • DOCUMENT # : PR1046520 5.- Invert elevation of drainfield to be no less than 7.37' NGVD 6.- Bottom of drainfield elevation to be no less than 6.87' 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)(f), FAC. • • ••• • •• • • • • • • • • • • •• • •• •• • • • • .• •••• •••• • • •••• •••• • • • •• •• • • • •• •••• STATE OF FLORIDA DEPARTMENT OF HEALTH APPLICATION FOR CONSTRUCTION PERMIT Permit Application Number PART II - SITEPLAN Scale: Each block represents 10 feet and 1 inch = 40 feet. N Cm 4 r r aziIt) ect JO) -lock 1 • • " • • •• imaivemm" • • • . • • :=1414mmitams mom .tramtmem•ii `Ts1 Al 1 0 • •• ••• •• • • ••• ••• • • •• • ••• ••• •• • • ••• • ••• • • • • • /\ w c LST�- otes: N2p 60 - r �' N 1 2 ST 3 i so P Qp V,i Ce i0 Nree---P-(ow a►7 cid eq 1\1 e 22S -r-eCh DP Site Plan submitted b Plan Approve Vo By tl L Not Approved Date ! I $9 d 9 - County Health Department ALL CHANGES MUST BE APPROVED BY THE COUNTY HEALTH DEPARTMENT DH 4015, 08/09 (Obsoietes previous editions which may not be used) Incorporated: 64E-6.001, FAC (Stock Number: 5744-002-4015-6) Page 2 of 4