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PLC-17-515Project Address Miami Shores Village 10050 N.E. 2nd Avenue NE Miami Shores, FL 33138-0000 Phone: (305)795-2204 Parcel Number ©ranfield`' APPROVE Expiration: 09/03/2017 Applicant 1179 NE 98 Street Miami Shores, FL 1132050180290 Block: Lot: AGCEMALA2 LLC Owner Information Address Phone Cell AGCEMALA2 LLC 1179 NE 98 Spur MIAMI SHORES FL 33138- (954)881-3591 1179 NE 98 Spur MIAMI SHORES FL 33138- Contractor(s) Phone MR CS PLUMBING & SEPTIC INC (305)651-7859 Cell Phone Valuation: Total Sq Feet: $ 2,400.00 300 Type of Work: DRAINFIELD REPAIR Type of Piping: Additional Info: DRAINFIELD REPAIR 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 # PLC -2-17-63095 03/07/2017 Check #: 3636 $ 500.00 $ 168.30 02/28/2017 Credit Card $ 50.00 $ 118.30 03/07/2017 Credit Card $ 118.30 $ 0.00 Bond #: 3331 Amt Paid Amt Due Available Inspections: Inspection Type: Final Rough 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 st conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this p •' ass me responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are required for EL;( - L, LUMBING, MECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work. OWNERS AFFID1�j ? 1 - rt that -ail -the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zo/jl g. t e ore, 1 authorize the above-named contractor to do the work stated. March 07, 2017 Authorized Signature: Owner / Applicant / Contractor / Agent Building Department Copy Date March 07, 2017 1 •{ BUILDING PERMIT APPLICATION ❑ BUILDING [PLUMBING 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 ❑ ELECTRIC ❑ ROOFING FBC 20 kg Master Permit No. PI U R -515 Sub Permit No. 0 REVISION ❑ EXTENSION 0RENEWAL ❑ MECHANICAL ElPUBLIC WORKS ❑ CHANGE OF CONT CTOR 11-7q lArer q; S CANCELLATION ❑ SHOP DRAWINGS Miami Shores County: Miami Dade Zip: ;01 -6C -'01t --WO Is the Building Historically Designated: Yes Load: OWNER: Name (Fee Simple Titleholder): Address: City: Construction Type: Flood Zone: l ? % qt S*tet )L64114.-1 State: Tenant/Lessee Name: Email: b BFE: 33/32 NO FFE: t Phone#: Phone#: Zip: 33( Pc - CONTRACTOR: Company Name: AM • -g ` m& �o en #: 36 6 s--/^ 7S -C7 Address: /9952-- 5?- /VA) d, eA K -t— City: Q IlsL)% %State• Zip: 3S16/ kQ��biii £r eta ,L Qualifier Name: State Certification or Registration #: DESIGNER: Architect/Engineer: Phone#:Cs'.6 sf - 7C-7 3R 6 6 ! S J!b Certificate of Competency #: Al/ Phone#: Address: City: State: Value of Work for this Permit: $ 6t Type of Work: ❑ Addition ❑ Alteration ❑ New Repair/Replace Description of Work: 1\) Square/Linear Footage of Work: Zip: ❑ Demolition Z -t NF/ Ez-D g2 E P 117 Specify color of color hru tile: a Submittal Fee 50 at d Permit Fee /563) CCF $ I . U0 CO/CC $ Sub $ �,• � $ Scanning Fee $ - " Radon Fee $ a • C -S DBPR $ 2 'IS Notary $ Technology Fee $ 2,4c Training/Education Fee $ .b0 Double Fee $ Structural Reviews $ Bond $ S 00 ? 'l TOTAL FEE NOW DUE$ 1 l8 .30 (Revised02/24/2014) blg, 30 Or 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 low 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. Sign Aocec.Aik* '• ' OWNER or AGENT Signature CONTRACTOR e foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this day of Rk)Y Ua IA , 20 t 1 , by 2 S day of ree%. ve, 20 j i , by OLU f who is personally known to Lf 4 Tl'1zIc, Oho is personally known to or who has produced as ntification and who did take an oath. TARY PUBLIC: n: t: c S fiU Sd YC ' `"' •. REBECCA BRISTOL SANCHE me or who has produced as identification and who did take an oath. NOTARY PUBLIC: Sign: /' f Print: al. Seal: MY COMMISSION #FF106752 !' E,„no? EXPIRES March 26. 2018 r : lii) 398018g33 ffOridaNOL[vCarvtro r rr: #!#########lrlr!!*#!A##in#a##!##!!!!!!###! APPROVED BY (Revised02/24/2014) Plans Examiner J .•s`M**PSHERYL A MENDES :'r° `1 `�= Notary Public - State of Florida Tt ,'�I Q My Comm. Expires Oct 23, 2018 i9F,� �P�` Commission # FF 13 ,A- ""INr rvuiary Assn. ”' Zoning Structural Review Clerk STATE OF FLORIDA DEPARTMENT OF HEALTH ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM CONSTRUCTION PERMIT FOR: OSTDS Repair APPLICANT: (AGCEMALA2 LLC) PERMIT #:13 -SM -1740928 APPLICATION 8: API276580 DATE PAID: FEE PAID: RECEIPT 8: DOCUMENT #: PR1050674 PROPERTY ADDRESS: 1179 NE 98 St Miami, FL 33138 LOT: 20 BLOCK: 179 SUBDIVISION: REV PL MIAMI SHORES SEC 8 PROPERTY ID 8: 1132050180290 [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 [ A [ N [ K [ 900 ] GALLONS / GPD E dstina Septic Tank to Remain CAPACITY 0 ] GALLONS / GPD CAPACITY 0 ] GALLONS GREASE INTERCEPTOR CAPACITY [MAXIMUM CAPACITY SINGLE TANK:1250 GALLONS] ] GALLONS DOSING TANK CAPACITY D [ 300 1 SQUARE FEET R [ 0 ] SQUARE FEET ]GALLONS @[ ]DOSES PER 24 HRS #Pumps [ New Bed Conf. Drainf. SYSTEM A TYPE SYSTEM: [X] STANDARD Y CONFIGURATION: [ ] TRENCH N F LOCATION OF BENCHMARK: SYSTEM [ ] FLED I] MOUND [x] BED [ ] FFE: 11.20' NGVD ] I ELEVATION OF PROPOSED SYSTEM SITE E BOTTOM OF DRAINFIELD TO BE L D FILL REQUIRED: [ 0.00] INCHES 0 T H E R [ 28.80 l [l INCHES It FT ] [ ABOVE [ 78.80 ] [l INCHES Y FT ] [ ABOVE EXCAVATION REQUIRED: [ 50. BELOWDBENCHMARK/REFERENCE POINT BENCHMARK/REFERENCE POINT BELOW EXISTING SEPTIC TANK TO REMAIN, REPLACE DRAINFIELD ONLY "t F k erfo a'® ern 1. -EXISTING 900 gal. septic tank with and approved filter TO REMAIN. 5 °r designee) is req°ired s a��e time of 2.- Install 300 sf. of drainfield in BED configuration. or The c°ntraee nc� drainfield exgavation inspector shat 3.- Install 12"of slightly limited soil at the bottom of the drainfield. ring ad�aeene i0 Flnal AppPov�l• the 'pOH !,o he results to the ori�.r �1 der and longer than tn@ �Qb�iin z or; �aeill h assessed (Comments Continued on Page 2.) ��itnes5 eh s�Rid' IP Pe` 21or.� r d ritn� n n r rP,�% 1 4.- Perimeter of excavation area shall be at least 2 ft wider SPECIFICATIONS BY: APPROVED BY: DATE ISSUED: DE 4016, 08/09 (Obsoletes all previous Incorporated: 64E-6.003, FAC v 1.1.4 die Nva TITLE:g@ie<Vler�E�?rt�Y n TITLE: ENGINEERING SPECIALIST I Dade CED editions which may AP127658O not be used) EXPIRATION DATE: 05/23/2017 8E1024104 Page 1 of 3 4 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 300 (40„;o'• etd ed. w etat fn a SW. gaat5.t se14:4- F FF 1(.2s ffw.ttA. g St Notes: tht '1/ 34? C©u. - '�r Date be repi4G � `1'�? 117q IOC Rt 5i' 'Caw: S'i404§ TL 33( Site Plan submitted by: Plan Approved By County Health Department Dati•ASe l -b k tefikctd. Not Approved ALL CHANGES MUST BE APPROVED BY THE COUNTY HEALTH DEPARTMENT DH 4015, 08109 (Obsoletes previous editions which may not be used) Incorporated: 64E-6.001, FAC Page 2 of 4 (Stock Number: 5744-002-4015-6)