PL-19-634Permit No.: PL-E 3-19-634
Miami Shores Village Permit Type: Plumbing -Residential
10050 E 2 Ave
Miami Shores FL 33138 1Npfk classification:: Dr81t1I"II31t
305-795-2204 { Permit Status: Approved
Issue Date:04/01/2019 1 Expiration: 09/23/2019
Location Address Parcel Number
53 NE 98TH ST, Miami Shores, FL 33138 1132060131140
Contacts
TANIA GALLONI GALLONI Owner A SUPER SEPTIC & DRAIN FIELD INC Contractor
BRYAN K ZERO
Mobile: 5617038657 7701 W 18 LN, HIALEAH, FL 33014
Other:3057261627
Description: SEPTIC DRAINFILED - RENEW / REPLACE PERMIT Valuation: $ 3,975.00 Inspection Requests:
PL-8-18-2139 762-4946
Total Sq Feet: 0.00
Fees
Amount
Application Fee - Other
$50.00
CCF
$2.40
DBPR Fee
$2.09
DCA Fee
$2.00
Education Surcharge
$0.80
Permit Fee
$89.13
Scanning Fee
$3.00
Technology Fee
$3.48
Total:
$152.90
Building Department Copy
Payments
Date Paid Amt Paid
Total Fees
$152.90
Check # 3971
03/25/2019 $50.00
Check# 2330
04/01/2019 $102.90
Amount Due:
$0.00
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 an zofing. Futhermore, I authorize the above named contractor to do the work stated.
Signature:
April 01, 2019
/ , Applicant / Contractor / Agent
Date
Page 2 of 2
Miami Shores Village
Building Department BY:
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795-2204 Fax: (305) 756-8972
INSPECTION LINE PHONE NUMBER: (30S) 762-4949
BUILDING
PERMIT APPLICATION
❑BUILDING ❑ ELECTRIC ❑ ROOFING
rM
2 2019
AYI,
FBC 20
Master Permit No. PL 3 ''q
Sub Permit No.
❑ REVISION ❑ EXTENSION *RENEWAL
❑■ PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: 53 NE 98th Street
City: Miami Shores County: Miami Dade Zip: ni3%
Folio/Parcel#:11-3206-013-1140 Is the Building Historically Designated: Yes NO X
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder):Tania Galloni Phone#:305-726-1627
Address:53 NE 98th Street
City: Miami Shores State: FL Zip: 33138
Tenant/Lessee Name:
Email:
Phone#:
CONTRACTOR: Company Name: A Super Septic & Drain Field Inc. Phone#: (305) 364-0113
Address: 7701 W 18TH LANE
City: Hialeah State: FL Zip: 33014
Qualifier Name: Phone#:
State Certification or Registration #:
DESIGNER: Architect/Engineer:
Certificate of Competency #:
hone#:
Address: City: State
Value of Work for this Permit: $ S Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration ElNew ❑■ Repair/Replace
Description of Work: Septic drainfield - Renew / replace Permit No. PL-8-18-2139
Specify color of color T
ru tile:
Submittal Fee $ Q1 Permit Fee $
Scanning Fee $ Radon Fee $
Technology Fee $ Training/Education Fee $
Structural Reviews $
CCF $_
DBPR $
Zip:
❑ Demolition
CO/CC $
Notary $
-�v
Double Fee $
Tz
Bond $
TOTAL FEE NOW DUE
'Pam
(Revised02/24/2014)
Bonding Company's Name (if applicable)
Bonding Company's Address
City
State
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address
City
State
Application is hereby made to obtain a permit to do the work and instal
commenced prior to the issuance of a permit and that all wor
construction in this jurisdiction. I understand that a separate
Zip
Zip
lations as indicated. I certify that no work or installation has
k will be performed to meet the standards of all laws regulating
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.
r
Signature
OW ER or AGENT
The foregoing instrument was acknowledged before me this
? s h day of /411ff-4C4 120 by
/A% yi t- �igLLcVv , who is personally known to
me or who has produced Ee N 6m gal 73 922-b as
identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
Signature -&14�
CO CTOR
The foregoing instrument was acknowledged before me this
ce day of �C� 20 C% by
AggqZ� Z2k who is personally known to
me or who has produced FLy1-Z600 "6�`� "fas
identification and who did take an oath.
NOTARY PUBLIC:I
Sign:
Print: VA- k � C '�"� •
Seal: Seal: -----
;s�%v; VANESSA RIVERA
VANES g MY COMMISSION # FF982970
MY COMMISSION # FF�§OVA +t. • • atE° EXPIRES May 02, 2020
*********** i,�•ai�,,•`^*** * **** *****^ ********************** *,Q �399�0153**** Ft a'I�t'r'�*;k�'�'�dh'I�**** *******
?PI2ES May 02, 2 20 1 )
(407) 398-0153 FW•d Notary,; ,ry - .com
APPROVED BY Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)