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PL-16-3495
DIVISION OF Environmental Health O�```Q Florida Health lt` Miami -Dade County \ OSTDS/Well Division Q` //cb?' 11805 SW 26th Street • Miami, FL 33175 /� Inspector A/YDate /sress 7 3 y 40 f7 .5)c OSTDS # /7 .7)elp Comm nts: Project Address Miami Shores Village 10050 N.E. 2nd Avenue NW Miami Shores, FL 33138-0000 Phone: (305)795-2204 Permit Permit NO. PL -12-16-3495 Permit Type: Plumbing - Residential Work Classification: Drainfield Permit Status: APPROVED Issue Date: 1/3/2017 Expiration: 07/02/2017 Parcel Number Applicant 93 NW 97 Street Miami Shores, FL 33150- 1131010330250 Block: Lot: BARBARA DELGADO Owner Information Address Phone Cell BARBARA DELGADO 93 NW 97 Street MIAMI SHORES FL 33150- (786)499-7389 93 NW 97 Street MIAMI SHORES FL 33150- Contractor(s) Phone STATEWIDE SEPTIC CONNECTIONS (954)963-0082 CeII Phone Valuation: Total Sq Feet: $ 2,300.00 150 Type of Work: REPLACE DRAINFIELD. Type of Piping: Additional Info: Bond Return : Classification: Residential Scanning: 3 Fees Due CCF DBPR Fee DCA Fee Education Surcharge Permit Fee Scanning Fee Technology Fee Amount $1.80 $2.25 $2.25 $0.60 $150.00 $9.00 $2.40 Total: $168.30 Pay Date Pay Type Invoice # PL -12-16-62502 12/30/2016 Check #: 6217 01/03/2017 Check* 6219 Amt Paid Amt Due $ 50.00 $ 118.30 $ 118.30 $ 0.00 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 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 aning. Futher e, I authorize the above-named contractor to do the work stated. Aignature: Owner / Applicant / Contractor / Agent Building Department Copy January 03, 2017 Date January 03, 2017 1 BUILDING PERMIT APPLICATION ❑BUILDING ❑ ELECTRIC ❑ ROOFING REVISION Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 95-2204 Fax: (305) 756-8972 INSPECTION LINE PHONE NUMBER: (305) 762-4949 Master Permit No. PLUMBING E] MECHANICAL El PUBLIC WORKS JOB ADDRESS: CI 3 NDN City; Miami Shores County: Folio/Parcel#: j r- 3(01- 033_ 0 2 So Occupancy Type: Load: DEC 30 2016 BY: et—f 4-1 5'Cv— FBC 20ty P ( too - 3Ug5 Sub Permit No. 0 EXTENSION RENEWAL ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS Miami Dade zip: 33 iso Is the Building Historically Designated: Yes NO Construction Type: Flood Zone: OWNER: Name (Fee Simple Titleholder): �ar-bo T0% De loci d o 61:3 N v.1 0(1 -1— City: "I C( re -1% S ht0 r S State: Address: BFE: FFE: Phone#: 3/ei S_ 19zz Zip: 33 t 0 Tenant/Lessee Name: Phone#: Email: CONTRACTOR: Company Name: ♦ct6+ftO (ote-- ` G C'h Wocne#: 51421 00 33 t* BoN,, v\J l �`1 `rv-� ' i O City: ©F LONA ( State: f Z Zip: 330 Gq- Qualifier Name: \ ' ✓ f 0 Phone#: Address: State Certification or Registration #: Z7'&O c 1 t Z6 DESIGNER: Architect/Engineer: Address: Value of Work for this Permit: $ Type of Work: ❑ Addition ❑ Alteration Description of Work: Certificate of Competency #: Phone#: City: State: Zip: Square/Linear Footage of Work: _ 15D ❑ New psiRepair/Replace ❑ Demolition Ree (a Ce--. OYa t 'Pe( d O ICP \QUI 1 �/ ! Specify color of color thru tile: Submittal fee $ • b •.•:a tPermit Feel /.J `� CCF $ Scanning Fee $ 't Radon Fe $ DBPR $ �- Technology Fee $ Structural Reviews $ (Revised02/24/2014) Training/Education Fee $ .' CO/CC $ • Nota $ Double Fee $ Bond $ TOTAL FEE NOW DUE $ % C� • 3c) 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 J 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. 1 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 OWNER or AGENT The foregoing instrument was acknowledged before me this C day of b-ec , 20 1.6 , by P)0r119C-' D}C(O�`;VV is personally known to me or who has produced BUJ 10 . as identification and who did take an oath. NOTARY PUBLIC: Sign: Ii'Ot 012 Print: ,�Q t C' (-1 1 . 01 I ' r--- t -TO Seal: ****** ,00 ''. JERRICA L. ARMSTRONG i Notary Public - State of Florida � **Gaeafife Ol9** osN.0 My Comm. Expires Feb 9, 2019 an.0 APP O'E• (Revised02/24/2014) Signature CONTRACTOR The foregoing instrument was acknowledged before me this day of Dec,, 20 16 . by T SG I SO VI P\Or— , who is personally known to me or who has produced r�-ice (h identification and who did take an oath. NOTARY PUBLIC: Sign: Print: Seal: ******************** 91 Plans Examiner Structural Review • Ofw•-crrio-k 12(21 Ccs L. e -1r OtArcrCS RAPA JERRICA L. ARMSTRONG Notary Public - State of Florida My Comm. Expires Feb 9, 2019 as ************ Zoning Clerk Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 INSPECTION'S PHONE NUMBER: (305) 762.4949 BUILDING PERMIT APPLICATION FBC 20 RECEIVED M R`25 2016 Permit No. `� Master Permit No70.. t — I Permit Type: PLUMBING QQ�� y� - OWNER: Name (Fee Simple Titleholder): �X, rbo r4 Oc, f . Q C[ o Address: ct. (�J City: /01G( r1i Shoves State: h. aA n�a Tenant/Lessee Name: Email: LEP: Phone#: -86 L G lc( -4-8 � ci JOB ADDRESS: 9 VV City: Folio/Parcel#: Miami Shores County: Miami Dade Zip: 3 3143 �I -3(DI-- 03-02GO Is the Building Historically Designated: Yes NO Flood Zone: CONTRACTOR: Company Name: G CVIr1Y1S ('icPhone#: (66 I66, 33 Address: t'6 $O NQJ ( A-i/e_ w co � 11'114.1M City: O L.--1NN_q f State: f x .,4 ,ylr, .._ i° 1 t4 0 Zip: 3 S Qualifier Name: Te1eJ'6 Ec(,--�.3 t'v ' Phone#: State Certification or Registration #: &J,MO C(i ( LC Z Certificate of Competency #: Contact Phone#: DESIGNER: Architect/Engineer: Phone#: Email Address: Value of Work for this Permit: $ .'OO Square/Linear Footage of Work: 1 SO Type of Work: Address Cl Alteration :New Ktepair/Replace ❑Demolition Description of Work: ptCe, 6-e(d Submittal Fee $ 6) " C Permit Fee $ / 1) CCF $ (. BO coicc $ /� Scanning Fee 0 ' 00 Radon Fee $ c' • DBPR $ a • PS Bond $ rW a) Notary $ 5 •03 Training/Education Fee $ 0 " GO Technology Fee $ 0 - .I 0 Double Fee $ Structural Review $ TOTAL FEE NOW DUE $ � 3• $1,.) 603. Bonding Company's Name (if applicable) Bonding Company's Address h4 4-- City State Zip Mortgage Lender's Name (if applicable) tV r 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 ELECTRICAL WORK, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEA RS, TANKS and 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 con`struction:and zoning. "WARNING TO OWNER: YOU "IL RECORD A NOTICE OFPAYING TWICE FOR ii/ COMMENCEMENT MAY RES 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 p`rmitiis?its ed. In the absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged.t, Jt #t uSignature Signatu Owner or Agent The foregoing instrument was acknowledged before me this 25 day of MOv6,201G,by who is personally known to me or who has produced As identifica and who did take an oath. NOTARY PUBLIC: Sign: Print: My Commissi . YOHENDRY DEL RIO MY COMMISSION #FF198880 EXPIRES: FEB 12, 2019 Bonded through 1st State Insurance ************.x* ****-******************** APPROVED BY atAN RNakt-4•,. Contractor The foregoing instrument was acknowledged before me this2 day of 1,../VP-0..1-1- , 20 tb, by-TU2 QUDMO� who is personally known to me or who has produced tL `Q - L( (VSA as identification and who did take an oath. NOTARY PUBLIC: Sign: Print: #� ss:f "(Av. Notary Public :'ate of riorla, My Commission EEpites4 Sindia Alvarez r < My Cor ^'"•'qnr FF 156750 � o 9j�c�o4 Expires ;•; (13!2018 nF ******************************************************************** 3,mg-/ts (Revised 07/10/07)(Revised 06/10/2009)(Revised 3/15/09) Plans Examiner Structural Review Zoning Clerk STATE OF :FLORIDA DEPARTMENT OF HEALTH ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM CONSTRUCTION PERMIT CONSTRUCTION PERMIT FOR: APPLICANT: Barbara Delgado OSTDS Repair PERMIT #: 13 -SC -1656097 APPLICATION #: AP1221566 COPY Florida Health Mlaml-bade County 0,S,1 .S & W _ U Pro; ram _'_�3a316 DATE PAID: FEE PAID: RECEIPT #: DOCUMENT #: PR1002479 PROPERTY ADDRESS: 93 NW 97 St Miami, FL 33150 LOT: 14 BLOCK: 129 SUBDIVISION: PROPERTY ID #: 11-3101-033-0250 [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 I 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. i I SYSTEM DESIGN AND SPECIFICATIONS I T [ 750 1 GALLONS / GPb Exist. septic tank to remain CAIACITY A [ 0 ] GALLONS / GPD1CAPACITY N [ 0 ] GALLONS GREASE INTERCEPTOR CAPACITY [MAXIMUM CAPACITY SINGLE TANK:1250 GALLONS] K [ ] GALLONS DOSING TANK CAPACITY [ ]GALLONS 1@[ ]DOSES PER 24 HRS #Pumps [ ] D [ 150 ] SQUARE FEET , Trench configuration drain SYSTEM R [ 0 ] SQUARE FEET j SYSTEM [ ] MOUND 1 A TYPE SYSTEM: [X] STANDARD [ ] FILLED! 1 [ ] I CONFIGURATION: [x] TRENCH [ ] BED [ ] N F LOCATION OF BENCHMARK: FFE: 13.54' NGVD I ELEVATION OF PROPOSED SYSTEM SITE E BOTTOM OF DRAINFIELD TO BE L D FILL REQUIRED: 0 T H E R [ 0.00 ] INCHES [ 29.70 ] [) INCHES FT ] [IABOVE 4 BELOW b BENCHMARK/REFERENCE POINT [ 71.76 ] [I INCHES FT ] [ ABOVE 4 BELOW b BENCHMARK/REFERENCE POINT EXCAVATION REQUIRED: j[ 54.00] INCHES 1. -Existing 750 gal. septic tank certified by "Day & Night" on 1/8/2016 to remain. 2. -Install 150 sf of drainfield in trench configuration. 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 drain trench. 5.- (Comments Continued on Page 2.) SPECIFICATIONS BY: APPROVED BY: DATE ISSUED: Betsy Lange-Olmino 01/27/2016 DH 4016, 08/09 (Obsoletes all previous Incorporated: 64E-6.003, FAC v 1.1.9 TITLE: I TITLE: Engineering Specialist II editions which may not be used) Dade CHD EXPIRATION DATE: 04/26/2016 AP1221566 1 SE983275 Page 1 of 3 DOCUMENT # : PRI002479 Invert elevation of drainfield to be nO less than 8.06' NGVD. 6. -Bottom of drainfield elevation to be no less than 7.56' NGVD. The system is sized for 2 bedrooms',with a maximum occupancy of 4 persons (2 per bedroom), for a total estimated flow of 200 gpd. THIS PERMIT IS NOT FOR ANY ADDITIONS. Scale: STATE OF FLORID DEPARTMENT OF HEALTH APPLICATION FOR CONSTRUCTION PERMIT Permit Application Num ber PART II - SITEPLAN - Each block represents 10 feet and 1 inch = Site Plan submitted by: Plan Approved By 61--ficeso– kiuu Not Approved t-2'4-- Date I — County Health Department ALL CHANGES MUST BE APPROVED BY THE COUNTY HEALTH DEPARTMENT DH 4015, 08/09 (Obsotetes previous editions which may not be used) Incorporated: 64E-6.001, FAC (Stock Number 5744-002-4015-6) Page 2 of 4 FROI mms t°mi■■=mum■■ NE lig ing FAN IREVFM mememo A ' 111 %■■ IHIUi I.•III.11 IN 111111 1 ! ERNI 1111" 1 itwoontm II II1II!UIIIIiIIiIijj ■■■■IN m Ill■■[i�lE■11■ ■■■■■I■■"11►'d1/�I MAW ■■ " ■■`ii iliiilisi I NEM MI IIIIIEIFIRIWUIII II 1112.11 I NE UM MROWIEibleMM UMW ! lotes: 0 rdt 2 c 1' Z S17 4-, pI. f L, V/ L r Site Plan submitted by: Plan Approved By 61--ficeso– kiuu Not Approved t-2'4-- Date I — County Health Department ALL CHANGES MUST BE APPROVED BY THE COUNTY HEALTH DEPARTMENT DH 4015, 08/09 (Obsotetes previous editions which may not be used) Incorporated: 64E-6.001, FAC (Stock Number 5744-002-4015-6) Page 2 of 4