PLC-12-1067BUILDING
PERMIT APPLICATION
FBC 20 LO
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
Permit No.P-LI 2 — , c '
Master Permit No.
RECEIVED
JUN 122012
Permit Type: PLUMBING
OWNER: Name (Fee Simple Titleholder): o (S L� . L.- L Phone#: St' G I ( O
Address: ( l � ✓fL ' ✓ 1 ✓Q
City: Act A,(( c9 LI 0 -U2 S / I
State: � ( Zip: 3
Tenant/Lessee Name: Lit 0 ✓lS � l Gt e
Email:
Phone#:
JOB ADDRESS: 1,1 (5 N
City: Miami Shores
County: Miami Dade
Zip: .3 3 1 .
Folio/Parcel#:
Is the Building Historically Designated: Yes NO D Flood Zone:
CONTRACTOR: Company Name: /j/,4 1D4 ft LXE ROf,1rkeu7A.
Address: g7 c70 GL` K e t) A S 33(/
City: Y/f / N4. ik I State: (- ( 4
•Qualifier Name: pSo o \ 1/a Qv"t9t
Phone#: 7 ..2S (^ClO C(
Zip: B! &T
Phone#: 786 2 S 144OQ' t'
State Certification or Registration #: S O 7 (2 74 Certificate of Competency'#: .; l Opp% /6/ 7
Contact Phone#: 7& -Z�(--4{J9q //E//mailAddress: XIt-f((�dQ2�S,Ui//]�Ntg-eAr �e /'1-S/2t(OU,
DESIGNER: Architect/Engineer: N/L Phone#:
Value of Work for this Permit: $ (o,S Ot Square/Linear Footage of Work:
Type of Work: OAddress ❑Alteration EtNew
❑Repair/Replace ❑Demolition
Description of Work: l k.) 7 6A k A (0 SO 5 i4` (ON S Ce Q (t C TA o k v duo s t{ "t s dl. ( r-
***************************************Fees********************************************
Submittal Fee $
Scanning Fee $
Notary $
Double Fee $
Permit Fee $ 3C, 6__ CCF $ CO/CC $
Radon Fee $ DBPR $ Bond $
Training/Education Fee $ Technology Fee $
Structural Review $
TOTAL FEE NOW DUE $ L • 1,0
Bonding Company's Name (if applicable)
Bonding Company's Address
City State Zip
Mortgage Lender's Name (if applicable) •t . 't•
Mortgage Lender's Address
•
City "' State Zip
. � m
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,. HEATERS, 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 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 conmienceinent must be posted at'the job site
for the first inspe Lion which occurs even (7) days after the building permit is issued. In the absence of such posted notice, the
inspection wNl not 'e approved and a r�nspection fee will be charged.
Signature
Owner or Agent
Contractor
The foregoing instrument was acknowle ged'before this e foregoing instrument was acknowledged before me this CL
day of-t 1 tWk[ , 20 VI-, by v (C. day of , 201 �!by 6 O
who is personally known to me or who has produced who is p
As identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
My Commission E
me or who has produced "
as identification and who did take an oath.
NOTARY PUBLIC:
`��u►ul ut►u
Sign: L
F'•.
Print: � �n /-' 4-7;��,: `J'
My Commission Expires: �• o
/.../OA.'......•••'''
*******************************************************************************************t1* ******;n1ll�** `***
+nu
APPROVED BY l� 16' Z� Plans Examiner } Zoning
a s -I,
Structural Review Clerk
irsaulkt. LAURA FARLE
MY COMMISSION # EE53276
EXPIRES: March 16, 2015
I-800J-NOTARY Fl. Notary Discount Assoc. Co.
(Revised 07/10/07)(Revised 06/10/2009)(Revised 3/15/09)
itS44".
4
Inspector
Address
Comments:
n
Signature
DIVISION OF
Environmental Health
Florida Department of Health �
Miami -Dade County Health Department dk OSTDS/Well Division
11805 SW 26 St. • Miami, Fl, 33175
[' [01]
[ [02]
[ ,3, [03]
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[ ] [05]
[ [06]
[ '] [07]
[ [08]
[ ./J [09]
Date
i A L _,,� �� �� '�)STDS #
TANK SIZE [1]
TANK MATERIAL
OUTLET DEVICE}
oS?i2] [ ]
e.�t .z� [ ]
[
MULTI -CHAMBERED [/. N ] p� [ ]
OUTLET FILTER /cr L. _ two J [ ]
LEGEND /3'-C 2 0 S`• C, 3 [ 1
WATERTIGHT C `�2 _ .2_[y [
LEVEL
DEPTH TO LID [ ]
DRAINFIELD INSTALLATION
AREA [1.VV 7[2] .S.5-S SQFT
DISTRIBUTION BOX HEADER 4-7
NUMBER OF DRAINLINES /1Z 41 '
DRAINLINE SEPARATION/,Z 9
DRAINLINE SLOPE
DEPTH OF COVER /2. "
ELEVATION [ABOVE BM
SYSTEM LOCATION
DOSING PUMPS v"S/ t-4^
[10]
[11]
[12]
[13]
[14]
[15]
[16]
[17]
[18]
[19]
[20]
[21]
AGGREGATE SIZE n/
AGGREGATE EXCESSIVE FINES
AGGREGATE DEPTH /"Y
FILL / EXCAVATION MATERIAL
[22] FILL AMOUNT lalai 1 /
[23] FILL TEXTURE
[24] EXCAVATION DEPTH
[25] AREA REPLACED
[26] REPLACEMENT MATERIAL
EXPLANATION
[ ]
[
[ 1
[ ]
OF VIOLATIONS / REMARKS:
SETBACKS
[27] SURFACE WATER
[28] DITCHES
1
NO. fiif/6)
ID:
D:
[29] PRIVATE WELLS
[30] PUBLIC WELLS
[31] IRRIGATION WELLS
[32] POTABLE WATER LINES
[33] BUILDING FOUNDATION
[34] PROPERTY LINES
[35] OTHER
i/
62012
FT
FT
FT
FT
FT
•
S FT
FILLED / MOUND SYSTEM
[36] DRAINFIELD COVER
[37] SHOULDERS
[38] SLOPES
[39] STABILIZATION
FT
FT
ADDITIONAL INFORMATION
[40] UNOBSTRUCTED AREA
[41] STORMWATER RUNOFF - -
[ 4 2 ] ALARMS
[43] MAINTENANCE AGREEMENT
[44] BUILDING AREA
[45] LOCATION CONFORMS WITH SITE PLAN
[47] CINTL CITR GRADING ,/i '
[47] CONTRACTOR c
27,7
[48] OTHER
ABANDONMENT
�'1/i/ [49] TANK PUMPED
Vi, [50] TANK CRUSHED
Ai /
v is GE /ZxD// 2.
FILLED
CONSTRUCTION :PPROVEr DISAPPROVED] : "eAA `p-- �C3-4P CHD DATE:6 ^,z
FINAL SYSTEM APPROVEDISAPPROVED]:/ 41d /)
DH 4016, 08/09 (Obsoletes all previous editions
Incorporated: 64E-6.003, FAC
C ,? e11.4 �O" , CHD DATE : b .r 2
which may not be used)
Page 2 of 3
STATE OF FLORIDA
DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT AND
CONSTRUCTION IN ?ECTCQN AND
DIPOSAL SYSTEM
FINAL APPROVAL
APPLICANT: CyZ4:74:2'9C.�
PERMIT NO. %i) 4%(J'5'z4
DATE PAID: J �'
FEE PAID:
RECEIPT #s
AGENT: 'i? .fir.— �p Q /zs��t,�rtl:�-+•�✓��J rr ,2tic.t-�
PROPERTY ADDRESS: < �7 15- /✓E^ , 2
LOT:
BLOCK: SUBDIVISION:
PROPERTY ID #:
CHECKED [X] ITEMS AtZEI NOT IN COMPLIANCE WITH STATUTE OR RULE AND MUST BE CORRECTED.
TANK
[' [01]
[ ,]' [02]
[ [03]
[ [04]
[ [05]
[ -11 [06]
[ 1 [07]
[ 4. [08]
[ /] [09]
INSTALLATION
TANK SIZE [1] /IJ [2]
TANK MATERIAL
[
[ ]
OUTLET DEVICE per— [ ]
MULTI -CHAMBERED [/ N,�] [ ]
OUTLET FILTER /cr �EA-�� IV ) [
LEGEND /3 C76'f0 # 2 C. [
WATERTIGHT
LEVEL
DEPTH TO LID [ ]
DRAINFIELD INSTALLATIQN
[10] AREA (1]Ji[2] 57$$ QFT
[11] DISTRIBUTION OX _ HEADER [
[12] NUMBER OF DRAINLINES /.2 [
[13] DRAINLINE SEPARATION /2 9
[14] DRAINLINE SLOPE
[15] DEPTH OF COVER /-Z.
[16] ELEVATION [ABOVE' :ELO BM
[17] SYSTEM LOCATION
[18] DOSING PUMPS .rS✓ J�4
[19] AGGREGATE SIZE ,1/
[20] AGGREGATE EXCESSIVE FINES
[21] AGGREGATE DEPTH /'V / •
FILL.
[22]
[23]
[24]
[25]
[26]
/ EXCAVATION MATERIAL
FILL AMOUNT s �/ 1
FILL TEXTURE
EXCAVATION DEPTH
AREA REPLACED
REPLACEMENT MATERIAL
EXPLANATION OF VIOLATIONS / REMARKS:
[ ]
[ ]
[
[ ]
SETBACKS
[27] SURFACE WATER
[28] DITCHES
FT
FT
[29] PRIVATE WELLS
[30] PUBLIC WELLS
[31] IRRIGATION WELLS
FT
FT
FT
[32] POTABLE WATER LINES
[33] BUILDING FOUNDATION
[34] PROPERTY LINES
[35] OTHER
FT
/sue FT
FILLED / MOUND SYSTEM
[36] DRAINFIELD COVER
[37] SHOULDERS
[38] SLOPES
[39] STABILIZATION
N/
FT
ADDITIONAL INFORMATION
[40] UNOBSTRUCTED AREA
[41] STORMWATER RUNOFF
[42] ALARMS
[43] MAINTENANCE AGREEMENT
[44] BUILDING AREA
[45] LOCATION CONFORMS WITH SITE PLAN
[46] FINAL SITE GRADING ,
[47] CONTRACTOR i i.+y e 9
[48] OTHER
ABANDONMENT
401 . [4 9 ] TANK PUMPED 6 / •ZC/ /Z
® [50] TANK CRUSHED & FILLED 6/<j/i 2.
Al/ 77
CONSTRUCTION : PPROVE DISAPPROVED] : CC ESL 2) Q.I9J4 CHD DATE:6 �' 2 6 -�Z
FINAL SYST APPROVE. DISAPPROVED] :/C *i / ( c i._k.. ) �pjC� CHD DATE:4, '2 t
DH 40
16, 08/09 (Obsoletes all previous editions which may not be used)
Incorporated: 64E-6.003, FAC Page 2 of 3
STATE OF FLORIDA
DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM
CONSTRUCTION PERMIT
CONSTRUCTION PERMIT FOR: OSTDS New
APPLICANT: (Odamise, LLC)
PERMIT #:13-SC-1378540
APPLICATION #: AP1052670
DATE PAID:
FEE PAID:
RECEIPT #:
DOCUMENT #:PR860145
PROPERTY ADDRESS: 9713-15 NE 2 Ave Miami, FL 33168
LOT: 12
BLOCK: 31 SUBDIVISION: Miami Shores
PROPERTY ID #: 11-3206-013-4220
[SECTION, TOWNSHIP, RANGE, PARCEL NUMBER]
[OR TAX ID NUMBER]
SYSTEM MUST BE CONSTRUCTED IN ACCORDANCE s 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 [ 1,050 ] GALLONS / GPD Septic CAPACITY
A [ ] GALLONS / GPD CAPACITY
N [ ] GALLONS GREASE INTERCEPTOR CAPACITY [MAXIMUM CAPACITY SINGLE TANK:1250 GALLONS]
K [ ] GALLONS DOSING TANK CAPACITY [ ]GALLONS @[ ]DOSES PER 24 HRS #Pumps [ ]
D
R
A
I
N
F
I
E
L
D
0
T
H
E
R
SPECIFICATIONS BY:
APPROVED BY:
[ 542 ] SQUARE FEET bed configuration drainfile SYSTEM
[ ] SQUARE FEET SYSTEM
TYPE SYSTEM: [x] STANDARD [ ] FILLED [ ] MOUND [ ]
CONFIGURATION: [ ] TRENCH [x] BED [ ]
LOCATION OF BENCHMARK: CL NE 2 ave., 9.22' NGVD.
ELEVATION OF PROPOSED SYSTEM SITE
BOTTOM OF DRAINFIELD TO BE
FILL
REQUIRED:
[ 0.00 ] INCHES
[ 0.96 ][
[ 29.04][
INCHES
/ FT ] [
FT ] [ ABOVE /
INCHES
ABOVE
/BELOW]BENCHMARK/REFERENCE POINT
BELOW
BENCHMARK/REFERENCE POINT
EXCAVATION REQUIRED: [ 72.00] INCHES
Inspector to verify the existing septic tank is properly abandon before final approval.
*Potable water line within 5 ft. of drainfield shall not be located at an elevation lower than the drainfield absorption
surface.
*Invert elevation of drainfield to be no less than 7.30 ft. NGVD.
*Bottom of drainfield elevation to be no less than 6.80 ft. NGVD.
*Install 42" of slightly limited soil under the bottom of the drainfield.
-Perimeter of excavation area shall be at least 2 ft wider and longer than the proposed absorption bed or drain trench.
DATE ISSUED:
Carlos. Ica a
Ca caza
11/30/2111
TITLE:
TITLE:
DH 4016, 08/09 (Obsoletes all previous editions which may not be used)
Incorporated: 64E-6.003, FAC
Dade CHD
EXPIRATION DATE: 05/30/2013
Page 1 of 3
DOCUMENT #: PR860145
-The licensed contractor installing the system is responsible for installing the minimum category of tank in accordance with
sec. 64E-6.013(3)(f). F.A.C.
STATE OF FLORIDA
DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM
SITE EVALUATION AND SYSTEM SPECIFICATION
(
APPLICANT: Odamise, LLC
APPLICATION # AP1052670
PERMIT # 13-SC-1378540
DOCUMENT # SE857062
CONTRACTOR / AGENT: ALC Excavators
LOT: 12 BLOCK: 31
SUBDIVISION: Miami Shores
ID# : 11-3206-013-4220
TO BE COMPLETED BY ENGINEER, HEALTH DEPARTMENT EMPLOYEE, OR OTHER QUALIFIED PERSON. ENGINEERS MUST
PROVIDE REGISTRATION NUMBER AND SIGN AND SEAL EACH PAGE OF SUBMITTAL. COMPLETE ALL ITEMS.
PROPERTY SIZE CONFORMS TO SITE PLAN: [X]YES [ ]NO
TOTAL ESTIMATED SEWAGE FLOW: 325 GALLONS PER DAY [
AUTHORIZED SEWAGE FLOW: 375.00 GALLONS PER DAY [
UNOBSTRUCTED AREA AVAILABLE: 813.00 SQFT UNOBSTRUCTED AREA REQUIRED:
BENCHMARK/REFERENCE POINT LOCATION: CL NE 2 ave., 9.22' NGVD.
NET USABLE AREA AVAILABLE: 0.15 ACRES
RESIDENCES-TABLE1
1500 GPD/ACRE OR
/ OTHER -TABLE 2 ]
SQFT
2500 GPD/ACRE
813.00
ELEVATION OF PROPOSED SYSTEM SITE 0.96 [
INCHES
/ FT ] [
ABOVE
/ BELOW ] BENCHMARK/REFERENCE POINT
THE MINIMUM SETBACK WHICH CAN BE MAINTAINED FROM THE PROPOSED SYSTEM TO THE FOLLOWING FEATURES
SURFACE WATER: FT DITCHES/SWALES: FT NORMALLY WET: [ ]YES [ ]NO
WELLS: PUBLIC: FT LIMITED USE: FT PRIVATE: FT NON -POTABLE: FT
POTABLE WATER LINES: 4 FT
BUILDING FOUNDATIONS:
5 FT PROPERTY LINES: 5 FT
SITE SUBJECT TO FREQUENT FLOODING?
10 YEAR FLOOD ELEVATION FOR SITE:
SOIL PROFILE INFORMATION SITE 1
[ ]YES [X]NO 10 YEAR FLOODING? [ ]YES [X]NO]
FT[ MSL / NGVD ] SITE ELEVATION: 9.30 FT [ MSL /
USDA SOIL SERIES:
Munsell #/Color
Urban land
Texture
Depth
10YR 3/3
Sand
0 To 8
10YR 5/2
Gravel
8 To 72
OBSERVED WATER TABLE:
ESTIMATED WET SEASON WATER TABLE
HIGH WATER TABLE VEGETATION:
INCHES
ELEVATION:
SOIL PROFILE INFORMATION SITE 2
NGVD
USDA SOIL SERIES:
Munsell #/Color
Urban land
Texture
Depth
10YR 8/3
Oolitic Limestone
0 To 7
10YR 5/2
Gravel
7 To 72
[ ABOVE / BELOW ] EXISTING GRADE TYPE:
63 INCHES [ ABOVE /
[ ]YES [X]NO MOTTLING: [ ]YES [X]NO
BELOW
SOIL TEXTURE/LOADING RATE FOR SYSTEM SIZING:
PERCHED
/ APPARENT ]
EXISTING GRADE
DEPTH: INCHES
Replacement 4-FS/0.60 DEPTH OF EXCAVATION: 72 INCHES
DRAINFIELD CONFIGURATION: [ ] TRENCH [X ] BED [ ] OTHER (SPECIFY)
f
REMARKS/ADDITIONAL CRITERIA
SITE EVALUATED BY:
DATE: 11/10/2011
SUAREZ„ GUILLERMO (Title: ) (G. SUAREZ SEPTIC TANK)
DH 4015, 08/09 (Obsoletes previous editions which may not be used) Incorporated: 64E-6.001, FAC Page 3 of 4
AP1052670 E01378540 v 1.0.2