PL-16-1985Miami Shores Village
10050 N.E. 2nd Avenue NE
Miami Shores, FL 33138-0000
Phone: (305)795 2204
Permit NO. PL-7-16-1985
Permit Type: Plumbing - Residential
enimt n Work Classification: Septic
Permit Status: APPROVED
Issue Date: 7/21/2016 1 Expiration: 01/17/2017
Project Address Parcel Number Applicant
17 NE 105 Street 1121360060100
OLIVER &ANDREE STEPHANIE
Miami Shores, FL 33138- Block: Lot:
Owner Information Address Phone cell
OLIVER & ANDREE STEPHANIE 17 NE 105 Street
--- - - -- MIAMI SHORES FL 33138-
nwwn�www
17 NE 105 Street
MIAMI SHORES FL 33138-
Contractor(s) Phone Cell Phone
STATEWIDE SEPTIC CONNECTIONS (954)963-0082
Type of Work: NEW 1050 GALLON SEPTIC TANK AND NEW
Type of Piping:
Additional Info:
Bond Return :
Classification: Residential Scanning: 3
Fees Due
Amount
Bond Type - Contractors Bond
$500.00
CC F
$4.80
DBPR Fee
$4.50
DCA Fee
$4.50
Education Surcharge
$1.60
Notary Fee
$5.00
Permit Fee
$300.00
Scanning Fee
$9.00
Technology Fee
$6.40
Total:
$835.80
Valuation:=7,500.00Total Sq Fee
Pay Date Pay Type Amt Paid Amt Due
Invoice # PL-7-16-60617
07/21/2016 Credit Card $ 785.80 $ 50.00
07/18/2016 Check #: 613 $ 50.00 $ 0.00
Bond #: 3154
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. Futlf6(mgre(,\I EWthorize the above -named contractor to do the work stated.
July 21, 2016
Authorized
Applicant / Contractor / Agent
Building Department Copy
July 21, 2016
BUILDING
PERMIT APPLICATION
Miami Shores Village RECETVF�
Building Department J L 18 2016
10050 N.E.2nd Avenue, Miami Shores, Florida 33138 BY:
An -
Tel: (305) 795-2204 Fax: (305) 756-8972
INSPECTION LINE PHONE NUMBER: (305) 762-4949
FBC 201q'
Master Permit No-pu6-1,985
Sub Permit No.
❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
FJ PLUMBING ❑ MECHANICAL [—]PUBLIC WORKS [:]CHANGE OF ❑ CANCELLATION ❑ SHOP
�t CONTRACTOR DRAWINGS
JOB ADDRESS: „' Iris Sf
Folio/Parcel#: (1 - 24 3 (o - 000- 0100 Is the Building Historically Designated: Yes NO q
Occupancy Type: � Load: 1J/A Construction Type: 01A- Flood Zone: 01A BFE: PIA FFE: 17' Z t "
OWNER: Name (Fee Simple Titleholder): �1l�jwx So ryal Phone#: 30� u g (0- 6 `b'
Address:_ (� NE l 0 s ST
City: m' 9AWtS State: . Zip: 33139
Tenant/Lessee Name: P/ A Phone#:
Email
NA
CONTRACTOR: Company Name:
Address:
Lif,IN•tde c
3( Vo Nvq I q
'f10
140-35q-uq so
City: 010 Lo64-& State: FL Zip;
Qualifier Name: I at'sA 6010wgL& Phone#: _
State Certification or Registration #:
Certificate of Competency #:
DESIGNER: Architect/Engineer: N / R Phone#:
054
I alp 3 54 tt4 YO
Address: n City: State: �? Zip: � I � �
Value of Work for this Permit: $ `,'�0 • Square/Linear Footage of Work:425
Type of Work: ❑ Addition ❑ Alteration E� New Q Repair/Replace ❑ Demolition
Description of Work:
loin JCD-6& +*('K_
P" Ube - So. 4 ' f ir`the Ld JA bed wt f, d. ra�hor•
Specify color of color thru tile:
Submittal Fee $ i O�) Permit Fee $ :30 O CCF $ CO/CC $ 0
Scanning Fee $ W Radon Fee $ DBPR $ Notary $ 5.
l)
Technology Fee $ �(1` Training/Education Fee $ 1 GO Double Fee $ 1`�•'
(
Structural Reviews $ Bond $ W - W _
TOTAL FEE NOW DUE $�%� J�
(Revised02/24/2014)
Bonding Company's Name (if applicable)
Bonding Company's Address
City State
w � Zip
Mortgage Lender's Name (if applicable) _ 1 `� i
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 toning.
"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 S2500, the applicant must
Promise in good faith that a copy of the notice of comraence..rent ord construction lien low brochure will be delivered to the person
whose props +s t to attachment. Also, o certified copy of the reco•ded notice ojrommencement must be posted of the job site
for the f ll spection w ' h occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the
inspection wit and o rtinspection fee will be charged.
r'
Signature
or AGENT CONTRACTOR
The foregoing instrument was acknowledged before me this
day of .20 V1 —, by
! ..- w(�h,o, Is personally kno'"po
me or who has produced lO r l CAw3 85
Identification and who did take an oath.
The foregoing instrument was acknowledged before me this
Is _day of 20_1r. by
r�RKS J DRN �W� `-'Jwhoss p sonaity known to
me or who has produced t l- D21wX u.cxNg�as
identification and who did take an oath.
NOTARY PUBLIC `
NOTARY PUBLIC
Sign:
Slgn--�.l
Print*
Print
Seal: ••� *� SiLVIA LARRONt 0
.'e
Seal
o,�,RY P(,!-
Notary Public State of Florida
4 ^" C v` art . •+•'
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Sindia Alvarez
c
PAy Commission , F 156750
+,� A° EJCPIRES
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Expires09/03 1�8�
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APPROVED BY Vvr�"
Plans Examiner
Zoning
Structural Review
Clerk
(R«+seeowAl/mal
STATE OF FLORIDA
DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT AND DISPOSAL
SYSTEM
CONSTRUCTION PERMIT
CONSTRUCTION PERMIT FOR: OSTDS New
APPLICANT: Olivier Servat
PROPERTY ADDRESS
LOT: 10
17 NE 105 St Miami, FL 33138
BLOCK: 202 SUBDIVISION:
PROPERTY ID #: 11-2136-006-0100
PERMIT # :13-SC-1678139
APPLICATION #: AP1236842
DATE PAID:
FEE PAID:
RECEIPT #:
DOCUMENT # : PR1024086
Dunnings, Miami Shores EA #2
[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 septic tank 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 [ 667 ] SQUARE FEET bed confiquration drainfiel SYSTEM
R [ ] SQUARE FEET SYSTEM
A TYPE SYSTEM: [x] STANDARD [ ] FILLED [] MOUND [ ]
I CONFIGURATION: [ ] TRENCH [x] BED [I
N
F LOCATION OF BENCHMARK: FFE 12.29' NGVD
I ELEVATION OF PROPOSED SYSTEM SITE [ 22.601 INCHES FT ][ABOVE BELOW BENCHMARK/REFERENCE POINT
E BOTTOM OF DRAINFIELD TO BE [ 52.681 INCHES FT ][ABOVE BELOW BENCHMARK/REFERENCE POINT
L
D FILL REQUIRED: [ ] INCHES EXCAVATION REQUIRED: [ 30.001 INCHES
O
T
H
E
R
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)(0, FAC.
3.-Install 667 sf of drainfield in bed configuration.
4.-Perimeter of excavation area shall be at least 2 ft wider and longer than the proposed absorption bed or drain trench.
(Comments Continued on Page 2.)
APPROVED BY:
BY: Teresa J Solomon
TITLE: Master Septic Tank Contractor
TITLE: Engineering Specialist II
r an a sca
DATE ISSUED: 06/29/2016
Dade CHD
EXPIRATION DATE: 12/29/2017
DH 4016, 08/09 (Obsoletes all previous editions which may not be used)
Incorporated: 64E-6.003, FAC
v 1.1.4 AP1236842 SE1000362
Page 1 of 3
j- DOCUMENT #: PR1024086
-Invert elevation of drainfield to be no less than 8.40' NGVD.
-Bottom of drainfield elevation to be no less than 7.90' NGVD.
-This permit includes the abandonment of the existing septic tank.
ie system is sized for 4 bedrooms with a maximum occupancy of 8 persons (2 per bedroom), for a total estimated flow of
)0 gpd.
0i DIVISION OF
Environmental Health
Florida Health
�0Q
Miami -Dade County
e01 OSTDS/Well Division Q
11805 SW 26th Street • Miami, FL 33175
Inspector_
�o� fro Date
Address % Z -v `_ S OSTDS # -1 Zj; 3
Comments:
Signature