PL-17-2149Project Address
Miami Shores Village
10050 N.E. 2nd Avenue NE
Miami Shores, FL 33138-0000
Phone: (305)795-2204
9819 NE 4 Avenue Road
Miami Shores, FL 33138-
Owner Information
Permit
Permit IVO. PL -8-17-2149
Permit Type: Plumbing - Residential
Work Classification: Septic
PermitStatus: APPROVED
Issue Date: 8125/2017
Expiration: 02/21/2018
Parcel Number
Applicant
Address
1132060170210
Block: Lot:
MELIDA MATOS
Phone
Cell
MELIDA MATOS
9819 NE 4 Avenue Road
MIAMI SHORES FL 33168-
Contractor(s) Phone CeII Phone
MR C'S PLUMBING & SEPTIC INC (305)651-7859
Valuation:
Total Sq Feet:
$ 3,500.00
200
Type of Work: NEW TANK AND DRAINFIELD
Type of Piping:
Additional Info:
Bond Return :
Classification: Residential
Scanning: 1
Fees Due
Bond Type - Owners Bond
CCF
DBPR Fee
DCA Fee
Education Surcharge
Permit Fee
Scanning Fee
Technology Fee
Amount
$500.00
$2.40
$4.50
$4.50
$0.80
$300.00
$3.00
$3.20
Total: $818.40
Pay Date Pay Type
Invoice # PL -8-17-64985
08/25/2017 Credit Card
08/25/2017 Credit Card
08/24/2017 Check #: 328
Bond #: 3499
Amt Paid Amt Due
$ 268.40 $ 550.00
$ 500.00 $ 50.00
$ 50.00 $ 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 ELECL, PL BING, MECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work.
OWNERS AFFID
construction and zo
oregoing information is accurate and that all work will be done in compliance with all applicable laws regulating
e, I authorize the above-named contractor to do the work stated.
Author .. Signature: Owner Applicant / Contractor / Agent
Building Department Copy
August 25, 2017
Date
August 25, 2017 1
Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795-2204 Fax: (305)756-8972
Inspection Number: INSP-288505 Permit Number: PL -8-17-2149
Scheduled Inspection Date: December 20, 2017
Inspector: Hernandez, Rafael
Owner: MATOS, MELIDA
Job Address: 9819 NE 4 Avenue Road
Miami Shores, FL 33138 -
Project: <NONE>
Contractor: MR C'S PLUMBING & SEPTIC INC
Permit Type: Plumbing - Residential
Inspection Type: Final
Work Classification: Septic
Phone Number
Parcel Number 1132060170210
Phone: (305)651-7859
Building Department Comments
NEW TANK AND DRAINFIELD
Infractio Passed Comments
INSPECTOR COMMENTS
False
Passed
Failed
Correction
Needed
Re -Inspection
Fee
No Additional Inspections can be scheduled until
re -inspection fee is paid.
Inspector Comments
hrs approval on file
in the left side of the house there is a gate to get access to property . permit
will be on mail box
December 19, 2017
For Inspections please call: (305)762-4949
Page 14 of 41
•
Anspector
•
•
0111111 DIVISION OF
Environmental Health
,Arida Health
•
A...A6i-Dade County
)STDS/Well Division
f Sv",26th Street • Miami, FL 33175
.„ Address 7g1
comilivdts:
ture
Date
OSTDS #
A I' /.7 aJ
BUILDING
PERMIT APPLICATION
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
RECEIVED
AUG 2 4 2017
FBC 2014
Master Permit No.CP Li i.._-. 2 L °�
Sub Permit No.
El BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION 0RENEWAL
LUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
� CONTRACTOR
J�
JOB ADDRESS: 1219 / V 4 heft k-.. kpf
City: Miami Shores County: Miami Dade Zip: 53/5g
Folio/Parcel#: 11 -34q -r 0/7-- 02-10 Is the Building Historically Designated: Yes NO (/
DRAWINGS
Occupancy Type: Load: Construction Type:
Flood Zone:
BFE:
OWNER: Name (Fee Simple Titleholder): i f Phone#:
fM161 Alt
Address: �I 1 /I_" 4' e�'lkQ Q
City: Qi3f/t. L ���� State: ^ Zip: 33/30
Tenant/Lessee Name: /V/"� Phone#:
FFE:
Email:
CONTRACTOR: Company Namq:
f
Address: ( <VW d €4µ'e-'
City: f 4144*�vyc_ te:
State Certification or Registration #: .44/c '3h Certificate of Competency #:
DESIGNER: Architect/Engineer: Aif Phone#:
Address: City: State: Zip:
Qualifier Name:
Phone#: ,os -Cs --/-78S7
Zip: 33/.47
Phone#: 6s/ -?g 7
Value of Work for this Permit:$
Square/Linear Footage of Work: aQ o
Type of Work: ❑ Addition ❑ Alteration ❑ New epair/Replace ❑ Demolition
Description of Work:
D2 -A1 I fCD r—
keAk) •-e,t)(6,G /vk_
Specify color of color thru tile:
Submittal Fee $ Permit Fee $nr CCF $ CO/CC $
Scanning Fee $ Radon Fee $ �� Ck� DBPR $ Notary $
Technology Fee $ Training/Education Fee $ Double Fee $
Structural Reviews $ Bond $ S-00 . v�
TOTAL FEE NOW DUE$ \'
3• go
(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. 1 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 npt be approved and a reinspection fee will be charged.
Signature
The foregoing inst
day of
e�
OWNER or AGENT
was acknowleged before me this
20 }e-4—, by
, who is personally known to
me or who has produced as
identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
Seal:
************
:►):`'•' ' DONALD MARTIN
MY COMMISSION # GG102743
"-vo,�, �,.�` EXPIRES May 09, 2021
APPROVED BY
(Revised02/24/2014)
Signature
The foegoing instrum
16
day of
CONTRACTOR
was ackpowledged beforememe this
20 /7 , by
, who is personally known to
me or who has produced as
identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
Seal:
ofieibt /144'("t
V ':': DONALD MARTIN
MY COMMISSION # GG102743
EXPIRES May 09, 2021
***********************
Plans Examiner
**************************************
Zoning
Structural Review Clerk
STATE OF FLORIDA
EPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT AND DISPOSAL
SYSTEM
CONSTRUCTION PERMIT
CONSTRUCTION PERMIT FOR: OSTDS Repair
APPLICANT: Melida Matos
PERMIT #:13 -SC -1783570
APPLICATION #: AP 1303525
DATE PAID:
FEE PAID:
RECEIPT #:
DOCUMENT #: PR1072918
PROPERTY ADDRESS: 9819 NE 4 Ave Miami, FL 33138
LOT: 56
BLOCK: 87 SUBDIVISION:
PROPERTY ID #: 11-3206-017-0210
[SECTION, TOWNSHIP, RANGE, PARCEL NUMBER]
[(Na 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 [ 900 1 GALLONS / GPD NEW Seotic TANK CAPACITY
A [ 0 ] GALLONS / GPD CAPACITY
N [ 0 ] GALLONS GREASE INTERCEPTOR CAPACITY [MAXIMUM CAPACITY SINGLE TANK:1250 GALLONS]
K [ ] GALLONS DOSING TANK CAPACITY [ ]GALLONS 8[ ]DOSES PER 24 HRS #Pumps [ ]
D [ 200 ] SQUARE FEET NEW DF IN BED CONFIG SYSTEM
R [ 0 ] SQUARE FEET SYSTEM
A TYPE SYSTEM: [x] STANDARD [ ] FILLED [] MOUND [ ]
I CONFIGURATION: [ ] TRENCH [x] BED [ ]
N
F LOCATION OF BENCHMARK: FFE 12.T
I ELEVATION OF PROPOSED SYSTEM SITE
E BOTTOM OF DRAINFIELD TO BE
L
D FILL REQUIRED:
0
T
H
E
R
[ 0.00 ] INCHES
[ 32.40 ] [J INCHES It FT ] [ ABOVE A BELOW P BENCHMARK/REFERENCE POINT
[ 82.40 1 INCHES If FT ] 1 ABOVE 4 BELOW b BENCHMARK/REFERENCE POINT
EXCAVATION REQUIRED: [ 62.00] INCHES
1.- Install a 900 gal. septic tank with an approved filter
2.- 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.
3.- Install 200 sf. of drainfield in ...BED....configuration.
4.- Install 12" of slightly limited soil at the bottom of the drainfield.
5.- 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:
APPROVED BY:
DATE ISSUED:
Mr C's Pib Sept
Loans X Gonzalez
08/17/2017
TITLE:
TITLE: Engineering Specialist II
DH 4016, 08/09 (Obsoletes all previous editions which may not be used)
Incorporated: 64E-6.003, FAC
L-,1303525
Dade CHD
EXPIRATION DATE: 11/15/2017
Ss.1044599
Page 1 of 3
STATE OF FLORIDA
DEPARTMENT OF HEALTH
APPLICATION FOR CONSTRUCTION PERMIT
Permit Application Number
PART 11- SITEPLAN
Scale: Each block represents 10 feet and 1 inch = 40 feet.
There are no pertinent features on adjacent properties and or across the street that
may affect the New Septic System Installation
Notes:
ra-I1,0-1 6( -t- • T eft) (oe i$ ret=.1qc--ed
Site Plan submitted by:
Pian Approved
By County Health Department
Not Approved
Date 01 ` ' i
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: 5744-002-40156)
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63
1
LOCATION SKETCH
NOT TO SCALE
LEGAL. DESCRIPTION:
LOT 5AND 6. BLOCK 87, AMENDED PLAT OF MIAMI SNORES SECTIONAUA'ACCORDING TO THE PUT
THEREOF AS RECORDED IN PLAT 800X18 PAGE 14. OF THE PUBLIC RECORDS OFNIAMI-040E
COUNTY. FLORIDA
SURVEYOR'S NOTES:
1) NOT VAUO UNLESS SIGNATURE IS EMBOSSED MTH T EREGIS7EREO LINO SURVEYORS SEW
2) LEGAL DESCRIPTION FRONDED BY OTHERS.
3) PROPERTIES SHOWN HEREON WERE NOT ABSTRACTED FOR EASEMENTS OR OTHER RECORDED
ENCUMBRANCES NOT SHOWN oN THE PROPERTY PUT OF RECORD
4) MEASUREMENTS TO WOOD FENCES ARE TO OU7SI0B OF WOOD.
6) UNDERGROUND UJILRLES, FOLNDARONS, OR OTHER IMPROVEMENTS, IP ANY, WERE NOT
LOCATED
6) ELEVATIONS. IF. SHOWN ARE BASED ON NATIONAL GEODETIC VHiRCAL OATI811929.
7) FENCE OWERSHIP NOT DE7ERMINED 0
SS
8) MEASUREMENTS pTS 7WIREFENCES ARE TO OTHERWISE
04728 OF MARE.
9) WALL MEASUREMENTS ARE 7'OPROM FACE 07 WALL
10) DRA WNG DISTANCE BETWEEN WALLS AND/OR FENCES AND PROPERTY ONES MAYBE
EXAGGERATED FOR CLARITY.
11) FLOOD ZONE INFORMATION WASDERIVED FROM FEDERAL EMERGENCY MANAGEMENT AGENCY
FLOOD INFORMATION RATE MAPS
12) BPARIN)3 111 ANY SHOWN ARE BASED ON PUT MERIDIAN AT:
CERTIFIED TO:
RAPID 1111E SERVICES COMPANY; COMMOMYEALTH LAND TITLE INSURANCE COMPANY•' PHILIP
LA VASSER AND -DA RLENE LA VASSER
LEGEND
lD1CA7E$COMOTEIH
9DIATEs
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N 1546049011611704
S N04ATEB50UTH
• NOCATEE OENiEf EN
la123E7EI D,CATESCONCRETE
019244 NL11C.M7EsoNFROPFRTYNNB
0.M R16C41Sa149144M19
FLOOD ZONE: X
MAP & PANEL= 12025C0093
COMMUNITYNo.: 120652
SUFFDC J
DATE OF FIRM: 7-17-95
BASE ELEV. ■ N/A
PROPERTY OF: PHILIP LAVASSER AND
DARLENE LAVASSER
•
9819 NORTHEAST 4th AVENUE ROAD'
MIAMI SHORES, FLORIDA 33138
NOT VALID WTHOUT THE S1GN$TUAEANDTHE
ORIGINAL RAISE 07A FE04 L.'CENSED
• A BOUNDARY -SURVEY
:HEREBY CERTIFY THAT THE SURVEY
REPRESENTED HEREONMEE7S THEM/MMM
720132 CAL sTANDAROS SET FORTH BY TME
FLORIO4 BOARD OF LAND SURVEYORS IN
CHAPTER 81G17-6, FLORE14 ALMEMSTRI1IVE
UDE PURSUANT TO SECTION 472-027. FLORI114
STATUTES. THERE ARE NO ENCROACHMENTS.
OVERUM, EASEMENTS APPEARING ON TTE
PUT, OTHER TH4NAS sNO141/HE7ETO.
PROFESSIONAL SURVEYING AND MAPPING
LANNES & GARCIA, INC.
LB # 2098
FRANCISCO F. FAJARDO PSM # 4767
359 ALCAZAR AVENUE, CORAL GABLES, FLORIDA 33134
PH (305) 868-7909 FAX (305) 559.3002
FLORIDA PROFESSIONAL SURVEYOR AND;,.: _ 1FID DATE:G6-03-2008I. :...'1'=Sp •( gVYNAY: M. PIO WII. Nb.:.212QM.
MAPPER REG. N47H•� �..5_ •.... �' .. Q