REV-17-62BUILDING
PERMIT APPLICATION
0BUILDING 0 ELECTRIC ❑ ROOFING`tom' REVISION
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
t[1-1(..i&LOM s
FBC 201
Master Permit No. Pt (b - "'15
Sub Permit No. V (R- - C% Z
0 EXTENSION (RENEWAL +=
[PLUMBING ❑ MECHANICAL 0PUBLIC WORKS TreHANGE OF ❑ CANCELLATION I I SHOP
,• CONTRACTOR DRAWINGS
JOB ADDRESS: 93 NW G` '1 5-i-
City: Miami Shores County: , Miami Dade Zip: 33 1, 5 0 '"
Folio/Parcel#: ii_ 3101- 0 3 2r 0 7 Go Is the Building Historically Designated: Yes NO V
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder): V�i -C6Cr ra
Address:
C Qal
c 3 NI q
1.
Phonett: oS-8 I e22
City: NA) rel
State:
Zip: 331 50
Tenant/Lessee Name: Phone#:
Email: (�
�A'i"Q � l G GI S Phone#: 3/6' 61- 66'33
CONTRACTOR: Company Name: S
Address:
City: tOpQ Lp(1<ok State: FL. Zip: 350 S -
Qualifier Name: T.C.ItcSG a (c)rn.0-,--) Phone#:
9-
QualifierState Certification or Registration #: SN,'Oq 1 ( 26 2_ Certificate of Competency #:
DESIGNER: Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for this Permit: $ 50,00 e
13CoSd N vJ lq /-J6 0
Type o or Additio r .001111K
ration
Description of Work: to its
"lmma3 tet';,
Square/Linear Footage of Work: 3-75
New
Ali,,
L epair/Replace Demolition
t)4( -t Cr) td
t:` V -S ?-6-r1;‘' 61 ase t" h' c(1..O { . 'CrP w o (K -Q'n
Specsl f colortu tile: , ,�
,;r=L�a ; t, aH �n+�ti .t a;, t �
�. , t yea �)s9c�it auilst? fo WI? sit,,1 ' •,•- ,Ii r. "�j
Submittal ee $ Permit Fee $ CCF $ !! ;e ?? / Csr$
: gse' t n0 C.
e'' ���... c: iia ,e dal englif� .t1 mQ �' "e u••;,:'•
Scanning � S ,Q +� Radoh. Fee _
nnpp
P < E In i o "'
.417
Technology Fee Training/Education Fee $ Double Fee $
Structural Reviews $ Bond $
TOTAL FEE NOW DUE $
(Revised02/24/2014)
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 zonirig.
"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 buildin-7 nermit ;s issued. In the absence of such posted notice, the
inspection will not be ap.roved and a reinspection fee will be charged.
Signature
OWNER oAGENT
The foregoing instrument was acknowledged before me this
5 day of 0–
q
,,��,�,, ,20F1 ,by
a-r6Grzx Delga`,'`4`JFio is personally known to
me or who has produced �1 �. 1!) as
identification and who did take an oath.
NOTARY PUBLIC:
Seal:'K- — — — W Seal:
APIA*,,,. JERRICA L. ARMSTRONG
I:NS i
� Notary Public -State of Florida
k*** is `3i.,`_ .1 - Notary
***********************
4 .; My Comm. Expires Feb 9, 2019
APPR DTY��——Plans Examiner
%-!O'/ /
Signature
CONTRACTOR
The foregoing instrument was acknowledged before me this
T> day of , 20'7 , by
Terw;:Y''6a is personally known to
me or who has produced
identification and who did take an oath.
NOTARY PUBLIC:
Print
A11116 -
ICA . ",RONiG
II
as
(Revised02/24/2014)
Structural Review
JERRICA L. ARMSTRONG
alj• c Notary Plait - State of Florisa*
***_r'
` �***'E`tfitihill'>0 *i '�` %ii
,' ;'•° My Comm. Ex91tw Fib 9, 2019
Zoning
Clerk
*
4'
STATE OF FLORIDA
DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT AND DISPOSAL
SYSTEM
I CONSTRUCTION PERMIT
CONSTRUCTION PERMIT FOR: OSTDS Existing New
APPLICANT:
Barbara Delgado
PERMIT 1: 13 -SC -1714883
APPLICATION #: AP1260118
DATE PAID:
FEE PAID:
RECEIPT #:
DOCUMENT 1: PR1041229
PROPERTY ADDRESS: 93 NW 97 St Miami, FL 33161
LOT: 1415
BLOCK: 129 SUBDIVISION:
PROPERTY ID 1: 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 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 [ 1,090 I GALLONS / GPD Existing Septic Tank to Remain CAPACITY
A [ ] GALLONS / GPD N/A CAPACITY
N [ l GALLONS GREASE INTERCEPTOR CAPACITY [MAXIMUM CAPACITY SINGLE TANK:1250 GALLONS]
K [ ] GALLONS DOSING TANK CAPACITY [ ]GALLONS 8( IDOSES PER 24 HRS #Pumps [ ]
D [ 375 ] SQUARE FEET New Trench conf. Drainfie SYSTEM
R [ I SQUARE FEET N/A SYSTEM
A TYPE SYSTEM: [x] STANDARD [ ] FILLED [ ] MOUND [ ]
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
[ 29.80 I d INCHES {' FT ] [ ABOVE 4 BELOW 11 BENCHMARK/REFERENCE POINT
[ 59.80 I (1 INCHES f FT I [ ABOVE 4 BELOW i BENCHMARK/REFERENCE POINT
EXCAVATION REQUIRED: [ 72.00] INCHES
ADDING A NEW MASTER BEDROOM
1. -EXISTING 1090 gal. septic tank with and approved filter TO REMAIN.
2.- Install 375 sf. of drainfield in TRENCH configuration.
3.- Install 42" 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.
(Comments Continued on Page 2.)
SPECIFICATIONS BY: Yvenel Clermont
APPROVED BY:
Astrid V Zdwards
DATE ISSUED: 12/08/2016
TITLE: ENGINEERING SPECIALIST I
TITLE: Engineer Supervisor III
Dade CHD
EXPIRATION DATE: 06/08/2018
DE 4016, 08/09 (Obsoletes all previous editions which may not be used)
Incorporated: 64E-6.003, FAC
v 1.1.4 AP1260118 SE1015822
Page 1 of 3
1
IF
DOCUMENT # :
PR1041229
5.- Invert elevation of drainfield to be no less than 9.00' NGVD
6.- Bottom of drainfield elevation to be no Tess than 8.50' NGVD
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.
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.