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PL-15-2083Miami Shores Village 10050 N.E. 2nd Avenue NE Miami Shores, FL 33138-0000 Phone: (305)795-2204 Project Address Permit Permit NO. PL-8-1 52083 Permit Type: Plumbing - Residential Work Classification: Septic Permit Status: APPROVED Issue Date: 8/18/2015 Expiration: 02/14/2016 Parcel Number Applicant 15 NE 104 Street Miami Shores, FL 33138-2026 1121360120090 Block: Lot: ABDUL S MUKHTAR CAMILLE F Owner Information Address ABDUL S MUKHTAR CAMILLE HARRIS 15 NE 104 Street MIAMI SHORES FL 33138-2026 15 NE 104 Street MIAMI SHORES FL 33138-2026 Contractor(s) Phone STATEWIDE SEPTIC CONNECTIONS (954)963-0082 Cell Phone Phone Cell Valuation: Total Sq Feet: $ 8,500.00 0 Type of Work: INSTALL NEW SEPTIC TANK AND DRAINFI 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 Total: Amount $5.40 $4.50 $4.50 $1.80 $300.00 $9.00 $7.20 $332.40 Pay Date Invoice # 08/18/2015 08/17/2015 Pay Type PL-8-15-56746 Check #: 4862 $ 282.40 $ 50.00 Check #: 4856 $ 50.00 $ 0.00 Amt Paid Amt Due 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 and zoning. Futhermore, I authorize the above -named contractor to do the work stated. Authorized Signature: Owner / Applicant / factor / Agent August 18, 2015 Date Building Department Copy August 18, 2015 1 BUILDING PERMIT APPLICATION ❑BUILDING ❑ ELECTRIC PLUMBING ❑ MECHANICAL JOB ADDRESS: 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 Master Permit No. Sub Permit No. ❑ ROOFING ❑ REVISION ▪ PUBLIC WORKS ❑ CHANGE OF CONTRACTOR Sf FRE.c ivrn MAR 2 5 2016 BY: G--541 FBC 200'-4 pLIG-789 ❑ EXTENSION ❑RENEWAL ❑ CANCELLATION ❑ SHOP DRAWINGS Occupancy Type: . Load: Construction Type: ' Flood Zone: OWNER: Name (Fee Simple Titleholder): 61UL /l/lUK. l -(2-- City: Miami Shores County: Miami Dade Zip: 33 1 ,w9,n, 2 Folio/Parcel#: 11 _ 2 1. 9)G ,-- 0 f 2 - 009 a ,. Is the Building Historically Designated: Yes NO (%d'„., 4 'Is —1867(8-10 Address: i L4 City: ' 10 YZS State: h- BFE: Phone#: FFE: Zip: `).-2' I ?l3 Tenant/Lessee Name: Phone#: Email: CONTRACTOR: Company Name: .GH Q+r C4.j C C C \ Iris ( Phone#: VI ' I61 -Cv 33 68NW 1_ City: LOCI Ci State: I) / Zip:m�QJI�S 'JL S `i" ) Qualifier Nae: � � /�^'��1 Phone#: �''��' � . State Certification or Registration #: Certificate of Competency #: ''a ` ' 9 DESIGNER: Architect/Engineer: Phone#:.'. Address: .Y.' ,at .:' City: State: Zip:, Value of Work for this•Permiti $, g S CX) Square/Linear Footage of Work: /0° Address: Type of Work: E. Addition. t Alteration ❑ New ❑ Repair/Replace ❑ Demolition Description of Work: f 0401, Specify color of color thru tile: f(Ze p 1 kc2-,K- \rdCIO*" Us-2-C63 Submittal Fee $ Permit Fee $ Jl7O CCF $ • CO/CC $ Scanning Fee $ Radon Fee $ DBPR $ Notary $ Technology Fee $ Training/Education Fee $ Double Fee $ Structural Reviews $ (Revised02/24/2014) Bond $17LILk (2-0LI TOTAL FEE NOW DUE $ c�3� Bonding Company's Name (if applicable) Bonding Company's Address City State Zip Mortgage Lender's Name (if applicable) Mortgage Lender'siAddress City State , Zip Application is hereby made to -obtain a permit to do the work atnstallations 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. I r "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 $2506the 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-thejob-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 instru ent wass acknowledged�before me this a day ofA�—'mot(' Abr.20 (2 , by whd i§ e s Wally known to' me or who has produced t l-�J�'Z. L��1�a�' identification and who did take an oath. NOTARY P LIC: Sign: Print: Seal: N1(Q -aij Q c *************************** APPROVED BY CONTRACTOR 3 The foregoing instrument was acknowledged before me this RS day of 1 Y t� , 201 Tc) by S w ioit pe S`o�nall?kno)n to me or who has produced \���g1111111111/ll// identification and who did tkle @� ',.••• ii/i,,i' :��?•• MYc• 99, .' T, toy.% NOTARY PUBLIC: Sign: Print: ��ysY Pue Notary Public State of FloridaSea Sindia Alvarez if My Commission FF 156750#' Expires 09/03/2018 Plans Examiner *********************************************** c�• as Zoning (Revised02/24/2014) Structural Review Clerk 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 BUILDING PERMIT APPLICATION BUILDING OPLUMBING ❑ MECHANICAL ❑PUBLIC WORKS JOB ADDRESS: ❑ ELECTRIC 0 ROOFING MAR 2.4 201 5Pt FBC 2014 Master Permit No. {PL 16- q Sub Permit No. ❑ REVISION ❑ EXTENSION RENEWAL ❑ CHANGE OF 0 CANCELLATION 0 SHOP CONTRACTOR DRAWINGS Att City: Miami Shores ,County: Miami Dade Zip: GCS Folio/Parcel#: (I - 2i (33i - aka- Go p1 0 Is the Building Historically Designated: Yes 42%N0,\, Occupancy Type: Load: Construction Type: Flood Zone: BFE: OWNER: Name (Fee Simple Titleholder): f\-(J V L I" 1 VK(-} ` A-R_ Phone#: ? 8G I A 8 o 44-t4— Address: , . _.S _NE 10 " S1 City: ASODReS State: Tenant/Lessee Name: Phone#: Email: Zip: 3 CONTRACTOR: Company Name: (51 e.: )1Ok ,C, (17Y) S 1 h C Phone#: 3IG,G I- 633 Address: (3(eo—ls V,•> >\ lip 10 r City: 0t �.C�CK-C) State: Zip: 0 Qualifier Name: T I' S zz' Mif inPhone#: State Certification or Registration #: SMo°11( Z..q,2 Certificate of Competency #: DESIGNER: Architect/Engineer: Phone#: Address: Value of Work for'this Permit: $ Type of Work: - ,.❑ "Addition "I /1' Alteration Soo Description of Work: Square/Linear Footage of Work: ❑ New Re.P ace✓ 4-- O( City: State: Zip: 300 ❑ Repair/Replace ❑ Demolition catzth L&'"9 . MLT .FL t S- 208 3 Specify color of color thru tile: Submittal Fee $ 1CJ Permit Fee $ _ 300 ✓ Scanning Fee $ Radon Fee $ ` 50 Technology Fee $ 2-0 Structural Reviews $ (Revised02/24/2014) CCF $ s: Co/CC $ 9 DBPR $ SV Notary $ 5 • 03 Training/Education Fee $ i '80 Double Fee $ Q� Bond $?L[-H20q TOTAL FEE NOW DUE $.3 TQ Bonding Company's Name (if applicable) Bonding Company's Address City State Mortgage Lender's Name (if applicable) Mortgage Lender's Address Zip 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 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. OWNER or AGENT Signature . CONTRACTOR The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this �_ day of _ M 0 rde, , 20 __ , by O\ l day of �a-4-4- , 20 , 4" , by Pr( '- AWY1}' iR , who is personally known to T as 5t1L-1"--1'.3, who is personally known to me or who has produced RA- 1 D identification and who did take an oath. NOTARY PUBLIC: as Sign: Print: Seal: APPROVED BY Threi V it. • Y• .6"c TERES J. SOLOMON * MY COMMISSION # FF928161 di. n! l ,. EXPIRES: November 8, 2019 me.or who has produced — \11111111111/ ����� identification and who did take an VP,bdlON NOTARY PUBLIC: 4 ` t ••°• /�% Sign: Print: Seal: Plans Examiner 3. a. 0. .4, 6% \* as Zoning (Revised02/24/2014) Structural Review Clerk 0\0. 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 1 2015 BY: FBC 20 tL Master Permit No. 71. - I - 26(L3 Sub Permit No. 5j El BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL [ ] PLUMBING ❑ MECHANICAL LJ I'UBLIC WORKS j j alANGE OF CONTRACTOR JOB ADDRESS: S N v (©4 ST City: Miami Shores County: Folio/Parcel#: t I ---2-(6'6 - 0( 2 03 c10 Occupancy Type: Load: Address: Miami Dade ❑ (-Awn' AMIN I J SHOP Zip: Is the Building Historically Designated: Yes Construction Type: Flood Zone: BFE: OWNER: Name (Fee Simple Titleholder): PeDU L U 1= 1-4 5 IJE (off--ST • r` Phone#: City: 4� (I ( &11eS State: Zip: 3 Tenant/Lessee Name: Phone#: Email: CONTRACTOR: Company Name: STAlt1A1t 1,L 1 C CNTN C ( C Address: (rU4 t`l W (a A&Q_ ( S ti % Phone#: 3I c6 (` 66 City: ©pCt LO (X.-as State: I c� Qualifier Name: TEES A So LO M3 r') State Certification or Registration #: FOCI ) ( 26 2- DESIGNER: Architect/Engineer: Phone#: Address: Value=of:Work for this'P_ermitr$ •E3C0 Square/Linear Footage of Work: Phone#: Type of Work: ❑ Addition ❑ Alteration Description of Work: n New S'cAz. i, Certificate of Competency #: City: State: Zip: ❑ Repair/Replace n Demolition Jai L=w T( c T tt-N IC ajg•-f N Pi E; U3 T O Specify color of color;tliru,itile: f::r. Submittal Fee'$ `= '-'- 0 � "',0 'Permit Fee $' Scanning Fee $ Radon Fee $ Technology Fee $ Structural Reviews $ %JAY CCF $ . r�/ r,-. ny„?.+ '''CO/CC $ DBPR $ • Notary $ Training/Education Fee $ _ Double Fee $ Bond $ PL t ` - t-CM (Revised02/24/2014) TOTAL FEE NOW DUE $ -[0 Bonding Company's Name (if applicable) 1 it 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 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.) ddys` 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 .‘harged. Signature OWNER or AGENT Signature U a: CONTRACTOR The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this 11—. day of 6ttS f - , 2u i s-,r. . - 2-- uay of t�i11 U' 20• 1S ur PrSDU: M 0 K ►-11Alt , who is personally known to ' 1 - &(.d M, 1, who is personally known to me or who has produced r' ( as me or who has produced FA"'. ro as identification and who did take an oath. NOTARY PUBLIC: Sign: - Print Seal: ******** identification and who did take an oath. NOTARY PUBLIC: Print: Seal: . ******** ************* APPROVED BY Plzns Examiner Zoning (Revised02/24/2014) Structural Review Jul Clerk STATE OF FLORIDA DEPARTMENT OF HEALTH ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM CONSTRUCTION PERMIT CONSTRUCTION PERMIT FOR: OSTDS Repair APPLICANT (Calvin Harris & Abdul Mukhtar) PERMIT #: 13-SC-1518158 APPLICATION #: AP1133916 DATE PAID: FEE PAID: RECEIPT #: DOCUMENT #: PR928590 PROPERTY ADDRESS: 15 NE 104 St Miami, FL 33138 LOT: 8,9 .BLOCK: SUBDIVISION: Beverly Glen PROPERTY ID #: 11-2136-012-0090 [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-1ESIGAI AND SPECIFICATIONS T [ 105 GALLONS / GPD Septic CAPACITY A [ 0 ] GALLONS / GPD CAPACITY N [ 0 ] GALLONS GREASE INTERCEPTOR CAPACITY [MAXIMUM CAPACITY SINGLE TANK:1250 GALLONS] K [ .-- ] GALLONS DOSING TANK CAPACITY [ ]GALLONS @[ JDOSES PER 24 HRS #Pumps [ ] D [ ] SQUARE FEET Trench configuration drain SYSTEM SYSTEM A TYPE SYSTEM: [x] STANDARD [ ] FILLED [ ] MOUND [ ] I CONFIGURATION: [x] TRENCH [ ] BED [ J R [ 0 ] SQUARE FEET N F LOCATION OF BENCHMARK: FFE 12.77' 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 [ 21.20 ] [ 60.24 ] [ INCHES / FT ] [ ABOVE / FT ] [ ABOVE / INCHES EXCAVATION REQUIRED: [ BELOW BELOW ]BENCHMARK/REFERENCE POINT ]BENCHMARK/REFERENCE POINT FINCHES INCHES THIS PERMIT HAS BEEN EXTENDED FOR 90 DAYS TO EXPIRE ON 7/30/2014. Original permit approved by Betsy Lange. 1.-Install a 1050 gal min. 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 300 sf of drainfield in trench configuration. 4.-Invert elevation of drainfield to be no less than 8.25' NGVD. 5.-Bottom of drainfield elevation to be no less than 7.75' NGVD. SPECIFICATIONS BY: APPROVED BY: DATE ISSUED: Teresa J Solomon 0 Astrid V Edwards 01/31/2014 TITLE: Master Septic Tank Contractor TITLE: Engineer Supervisor III DH 4016, 08/09 (Obsoletes all previous editions which may not be used) • Incorporated: 64E-6.003, FAC Florida Healt v 1. 1..4 A21133916 SE'iF,�i.S� "0 .T.D Dade EXPIRAT ;% y X !/ 05/01/2014 CHD aag°.not 3 ram