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PL-18-2054Miami Shores Village 10050 N.E. 2nd Avenue NE Miami Shores, FL 33138-0000 Phone: (305)795-2204 Project Address Permit Issue Permit NO. PL-8-18 205' 4 Permit Type: Plumbing - Residential Work Classification: Septic Permit Status: APPROVED ate: 8/15/201 Expiration: 02/11/2019 Parcel Number Applicant 15 NE 104 Street Miami Shores, FL 33138-2026 1121360120090 Block: Lot: ABDUL S MUKHTAR CAMILLE H Owner Information Address Phone CeII 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 CeII Phone STATEWIDE SEPTIC CONNECTIONS (954)963-0082 Type of Work: REPLACE SEPTIC TANK & 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 Total: Amount $0.00 $0.00 $0.00 $0.00 $300.00 $0.00 $0.00 $300.00 Pay Date Pay Type Invoice # PL-8-18-68405 08/01/2018 Check #: 5587 $ 50.00 $ 250.00 08/15/2018 Check #: 9006 $ 250.00 $ 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 abov -named contractor to do the work stated. August 15, 2018 Authorized Signaturdr Own / Applicant— / Contractor / Agent Building Departfient Copy Date August 15, 2018 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-309543 Permit Number: PL-8-18-2054 Scheduled Inspection Date: August 16, 2018 Inspector: Massanet, Maykel Owner: CAMILLE HARRIS, ABDUL S MUKHTAR Job Address: 15 NE 104 Street Miami Shores, FL 33138-2026 Project: <NONE> Contractor: STATEWIDE SEPTIC CONNECTIONS Permit Type: Plumbing - Residential Inspection Type: Firial: Work Classification: Septic Phone Number Parcel Number 1121360120090 Phone: (954)963-0082 Building Department Comments REPLACE SEPTIC TANK & DRAINFIELD TO RENEW EXPIRED PERMIT PL 15-2083 TO REPLACE PL16-789 1/13/2017 - BOUNCE CHECK. NO INSPECTIONS UNTIL TOTAL PAID. AMOUNT DUE IS $282.40 Infractio Passed Comments INSPECTOR COMMENTS False Passed l Failed Correction Needed Re -Inspection Fee No Additional Inspections can be scheduled until re -inspection fee is paid. Inspector Comments HRS. APPROVAL ON'FILE. - August 15, 2018 For Inspections please call: (305)762-4949 Page 20 of 42 BUILDING PERMIT APPLICATION ❑ BUILDING ❑ ELECTRIC 'tA 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 C` FJVED AUG 01 2018 BY: FBC20l Master Permit No. 3 Sub Permit No.VL 19 " 205lf ❑ ROOFING ❑ REVISION ❑ EXTENSION XRENEWAL ID PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS t 5 NI t 0Lt- s-r City: Miami Shores County: Miami Dade Zip: 3 Folio/Parcel#: = 2 3 (. 2 o 0 Is the Building Historically Designated: Yes • NO Occupancy Type:- Load: r' Construction T e: Flood Zone: BFE: FFE: CGI V o I((���PJ,�.j.rnGt s /� e ld OWNER: Name (Fee Simple Titlehoer): 1 \ bQ(o 1 U K r) Q r Phone#: Address: Sh-o i - rt." � I Q M � State: Tenant/Lessee Name: Phone#: Email: 6.6 CONTRACTOR: Company Name: S"+CI-(-P.t.J I de G G. iNe, l' ' Phone 3S� 4- V h i Address: 1.3C)80 Nyu 1 ! A-e-e, *to City: O FIG LOC.{ C P State: ft zip:33/ 38 Is NE- toy-}-ST Zip: 3 3 oS Qualifier Name: 1.-- U t- si`d /0 MG _ Phone#: State Certification or Registration #: S /`'VO C/ % 1 ? 6 °2, Certificate of Competency #: DESIGNER: Architect/Engineer: Phone#: Address: City: State: Zip: Ix' Value of Work for this Permit: $ y-000 Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration 0 New Repair/Replace 0 Demolition RepIacc. 3 p hC -fan K- Description of Work: G 3 Specify color o�f\color thru tile: "� . co { Submittal Fee $ • aD Permit Fee $ CCF $ CO/CC $, Scanning Fee $ Radon Fee $ DBPR $ Notary $ Technology Fee $ Training/Education Fee $ Double Fee $ Structural Reviews $ Bond $ TOTAL FEE NOW DUE$ `C% . 1S 250.00 (Revised02/24/2014) , - • ; 4 tf 4,4 .4; 14 Bonding Company's Name (if applicable) 1 I. Bonding Company's Address ' • ) 1 • ? City State - • . • , - Zip Mortgage Lender's Name (if applicable) 'WI • '(41;- (72“-) :ClIn't • UHq ,th c-21,4(rmi -••• Mortgage Lender's Address 4:4 City !State -$.; .1 Zip likirr.4:311:114.fik Application'is- tierebirilide to obtain a permit to do the work and installations as indicated. I certify that no work or installation has commenced prior tO:lhe issuaride'tof:a-lierniii and thafall ' '14i:irk:will be pelieriffed: for meet the ftariairig of_ all Igi•egillating 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 441•- ,J • e•••i • • 7 •1)1 ' I OWNER'S AFFIDAVIT: I certify that all the foregoinginformation is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. _ ?') 1;110A ROI, "WARNING TO- OWNER: --YOUR FAILURE 'TO RECORD-7A' NOTICE -OF-COMMENCEMENT- MAY RESULT IN. YOUR PAYING IWICE+ORIMPROVEMENTS -TO YOUR -PROPERTY. -IF-YOU:INTEND' TO OBTAIN FINANCING; CONSULT,WITH YOUR LENDER OR AN'ATTORNEY BEFORE RECORDING' YOUR NOTICE OF COMMENCEMENT." in • 1,!; 11.C- .1t1'4V1/0 Notice to Applicant: As a conditionto 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_byilding 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 -- The foTegoing instrument was -acknowledged before me this IOC/ 1 ,20 - by —WV/ •—HQ wco 'is jr3lerris°O)n‘ally"l1Criolw' n to me or who has pfaducid- FL4WrID L as identification and who diiftake an oath. — NOTARY PUBUC: •• Sign: Pri Seal: - - • ;.. Siinattie CONTRACTOR The foregoing instrument is acknowledged before me this „ , 20 10, , by • ,.:,) i• it: ," T.R.reS , who is personally known to 30 day of ci me or who has produced .. Lh-9- as identification and who did fake an oath.- _ _ •,- - : ' < ; -:'(•-: ,-;, ,--.-r es •-• f tL.i: .14 .1 if 1 ./i iti; / 'i TO ,,...,. ' NOTARY PUBUCi --.JERRICA L. ARMSTRONG— : Notaryyublic . State of Florida ii*iiim46101,4**Fipmigms** My Comm. Expires Feb 9, 2019 APPROVED BY-Lr '1 I ,b Sign: Pri -- Seal:- , !!!../,, ,,,,, :-. . •/' Or T.A.0, ,,, _ Plans Examiner _ JERRICA L ARMSTRONG) Notary Public - State of Florida CoartiloUttr.1.9Jai** My Gomm. Feb 9, Mfg -1 4-44 4 • ofr 441444:iiaare - • . Zoning • d.op,09 (Revised02/24/2014) Structural Review 4,.#11 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) PROPERTY ADDRESS: 15 NE 104 St Miami, FL 33138 LOT: 8,9 BLOCK: SUBDIVISION: Beverly Glen PROPERTY ID #: 11-2136-012-0090 PERMIT #: 13-SC-1518158 APPLICATION #: AP1133916 DATE PAID: FEE PAID: RECEIPT #: DOCUMENT #: PR928590 [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 [ 1,050 ] GALLONS / GPD Seofic CAPACITY A [ 0 ] GALLONS / GPD CAPACITY N [ 0 ] 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 [ 300 ] SQUARE FEET Trench confiauration drain SYSTEM [ 0 ] SQUARE FEET SYSTEM TYPE SYSTEM: [x] STANDARD [ ] FILLED [ ] MOUND [ ] CONFIGURATION: [X] TRENCH [ ] BED [ ] LOCATION OF BENCHMARK: FFE 12.77' NGVD ELEVATION OF PROPOSED SYSTEM SITE BOTTOM OF DRAINFIELD TO BE FILL REQUIRED: [ 0.00 ] INCHES [ 21.20 ] [ [ 60.24 ] [I INCHES INCHES / FT ] [ ABOVE A BELOW FT ] [ ABOVE / EXCAVATION REQUIRED: [ BELOW BENCHMARK/REFERENCE POINT BENCHMARK/REFERENCE POINT ] INCHES THIS PERMIT HAS BEEN RENEWED ON 7-20-2018. 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. SPECIFICATIONS BY: APPROVED BY: DATE ISSUED: Teresa J Solomon Frank Agras 07/20/2018 TITLE: Master Septic Tank Contractor TITLE: Engineering Specialist II Dade CHD EXPIRATION DATE: 10/20/2018 DH 4016, 08/09 (Obsoletes all previous editions which may not be used) Incorporated: 64E-6.003, FAC v 1.1.4 A91133916 SE918560 Page 1 of 3 DOCUMENT # : PR928590 5.-Bottom of drainfield elevation to be no less than 7.75' NGVD. 6.-This permit includes the abandonment of the existing septic tank. The system is sized for 4 bedrooms with a maximum occupancy of 8 persons (2 per bedroom), for a total estimated flow of 400 gpd. THIS PERMIT IS NOT FOR ANY ADDITIONS. nspector ddress ION OF Environmental Health Florida Health Miami -Dade County OSTDS/Well Division 11805 SW 26th Street • Miami, 11., 33175 Comments: Sigrtat Me - RI& larOcr 1 141_4/ Date TDS # AP- ‘. Miami Shores Village �'1\1� Building Department • ""' `""'°``" "''Th41'" 111'''10043'0-k 2n" Avenue, Miami Shores, Florida33a.38 Tel: (31N 795-2204 Fax: (305) 756-8972%.P.,, 'INSPECTION SINE PHONE NUMBER: (305) 762 4949 .. Kria BUILDING - PERMIT APPLICATION DEC 2 3 2016 BY: Mag'ter`r''iiib701—kr 3(-1 Sub Permit No. BUILDING ❑ ELECTRIC 0 ROOFING El REVISION PLUMBING 0 MECHANICAL 0 PUBLIC WORKS CHANGE OF ❑ CANCELLATION CONTRACTOR JOB ADDRESS: 15 ` WSJ i 0 5 T City: Miami Shores �t county: Miami Dade Zip: Folio Parcel#: 1 1' 2 t �� Ol 2 _ Oo-1 / Is the Building Historically Designated: Yes Occupancy Type: Load: Construction Type: Flood Zone: BFE: OWNER: Name (Fee Simple Titleholder): bv`V NI vk Address: ' S l� E i O L.+ S-r City: ( `1Gk yen S' WYS State: rt.- Phone#: Tenant/Lessee Name: Phone#: Email: CONTRACTOR: Company Name +6J{ 1 1•G S one#: 16,4 '- 66 33 ❑ EXTENSION 0 RENEWAL ❑ SHOP DRAWINGS 33118 NO F F C40.00, tt erg Zip: 33138 Address: \VOSo rSV'3'\01 / e 1,'CD City: ©L.)0C��+ 1 State: Zip: s3D Qualifier Name: ICJ! w11 �1� SN1O°11126z State Certification or Registration #: DESIGNER: Architect/Engineer: Address: Value of Work for this Permit: $ Type of Work: E Addition 7 Alteration 0 New Repair/Replace, Dernol, Description of Work: 6ice sr 11)-ir 0- 0,14‘44 c4e19 kCICD POOriA C;\ t(0- . Phone#: Certificate of Competency #: Phone#: City: State: lip: Square/Linear Footage of Work: Specify color of color thru tile: Submittal Fee $ Permit Fee $ 3 ' --- CCF $ 5 • Q 0 Scanning Fee $ •^�4 �^�, Radon Fee $ LI • 60 DBPR $ �/Vq • 3� Technology Fee $ Rf • � tJ Training/Education Fee $ ' - S Double Fee $ '....... Structural Reviews $ CO/CC $ Notary $ Bond $ TOTAL FEE NOW DUE $ ‘itO' C_ + (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 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 Signature OWNER or AGENT `� CONTRACTOR The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this 22 day of ' eC . , 20 1 1.e , by 72. day of -eL , 20 1 Cn , by /�bdv I .�J�T1 t"'who is personally known to Teees C�(.or4a , who is personally known to me or who has produced �L—�- as me or who has produced 1 L Tt as identification and who did take an oath. identification and who did take an oath. NOTARY PUBLIC: Sign: Print: Seal: Seal: NOTARY PUBLIC: Sign: J�Ct- iC „ Print: rr t c.q. l i t•ik Tt[ 011C -----i! pNUp `/%• JERRICA'L. ARMSTRONG 1: , JERRICA L. ARMSTRONG-- ****** Notary Public - State of Florida M-: �•' F Notary Public - State of Florida ail ..:illeli t44 ; p°.• ! \l''a ;�• My Comm. Expires Feb 9, 2019 '4F OF F��d• My Comm. Expires Feb 9, 2019 �� �,,,,,,;�; , �... '�4npN� APPR Plans Examiner f Zoning �� , -?-7- ( 4, Structural Review Clerk (Revised02/24/2014) At