PL-18-2996 (2)Miami Shores Village
10050 NE 2 Ave
Miami Shores FL 33138
305-795-2204
Location Address
Issue Date:10/16/2018
Parcel Number
Permit NO.: PL-10-18-2996
Permit Type: Plumbing - Residential
Work Classification: Septic
Permit Status: Approved
Expiration: 04/01/2019
Project
77 NE 105 ST, Miami Shores, FL 1121360060150 <NONE>
Contacts
JESSICA SCHILLING Owner EZEQUIEL ZYLBERBERG Owner
77 NE 105 ST, MIAMI SHORES, FL 33138 77 NE 105 ST, MIAMI SHORES, FL 33138
Other: 9546293012 Mobile: 5617032510 SCHILLINGESI@GMAIL.COM
JESSICA SCHILLING Applicant MR C'S PLUMBING & SEPTIC INC Contractor
77 NE 105 ST, MIAMI SHORES, FL 33138 KEMBLE ETTRICK
Other:9546293012
Business: 3056517859
Description: INSTALL DRAINFIELD AND SEPTIC TANK Valuation: $ 4,000.00 Inspection Requests:
305-762-4949
Total Scl Feet: 230.00
Fees
Amount
Application Fee - Other
$50.00
CCF
$2.40
DBPR Fee
$2.10
DCA Fee
$2.00
Education Surcharge
$0.80
Permit Fee
$90.00
Scanning Fee
$3.00
Technology Fee
$3.50
Total:
$153.80
Building Department Copy
Payments
Date Paid Amt Paid
Total Fees
$153.80
Credit Card
10/16/2018 $153.80
Amount Due:
$0.00
In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations
pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores
Village. In accepting this permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate
permits are required for ELECTRICAL, PLUMBING, MECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work.
OWNERS AFFIDAVIT: I certify that all the foregoing informat' accurate and that all work will be done in compliance with all applicable laws
regulating construction and zoning..,Futhermore, I authoriz a above named contractor to do the work stated.
'/-Z'!�fq'j< Zf Br013'C'fz c
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Authorized Signature: Owner / Applicanft t/ Contractor / Agent Date
October 16, 2018 Page 2 of 2
e
Miami Shores Village 1 V E D
Building Department ^of"T of 2018
10050 N.E.2nd Avenue, Miami Shores, Florida 33138 �(
Tel: (305) 795-2204 Fax: (305) 756-8972
INSPECTION LINE PHONE NUMBER: (305) 762-4949
BC 20
BUILDING Master Permit No.�
PERMIT APPLICATION Sub Permit No. 1 - L(40
❑ BUILDING ❑ ELECTRIC ROOFING REVISION ❑ EXTENSION ❑ RENEWAL
❑PLUMBING ❑ MECHANICAL PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS:
City: Miami Shores County: Miami Dade Zia: -?31 k
Folio/Parcel#: Is the Building Historically Designated: Yes NO
Occupancy Type: Sf Load: Construction Type: C G Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder): T$- ��� Phone#:
Address: �� At /0 j 14 -< 2r
City: k (j'a"K t Ao r� State: T L Zip: J` s 45
(
Tenant/Lessee Name: A Phone#: 7 �i4 — �, `9
-7_ l-� �Z-
Email: > L/rt L/_L /!✓te> l (�? L, fKAIL
CONTRACTOR: Company Name: hit, • e,
Address: 1 �_ 13Z- kw � e-1
City: M t awrl i Stz
Phone#: � S-4 S 1 ^ /�" 1
��
� Zip: �J t1
0
Qualifier Name: b�Qt E1 Ck— Phone#:
State Certification or Registration #: Sao Certificate of Competency #: _
DESIGNER: Architect/Engineer: N Phone#:
Address: City: State: Zip:
Value of Work for this Permit: $ 600 Square/Linear Footage of Work: 7-7>7 S
Type of Work: ❑ Addition ❑ Alteration EVNew ❑ Repair/Replace ❑ Demolition
Description of Work:
1.
Specify color of color thru tile:
Submittal, Fee $ Permit Fee $ q0 • W CCF $ __ _.. CO/CC $
Scanning Fee $
Radon Fee $
Technology Fee $ Training/Education Fee $
Structural Reviews $
DBPR $
Notary
Double Fee $
Bond
TOTAL FEE NOW DUE $
(Revised02/24/2014)
J _ V
Bonding Company's Name (if applicable)
Bonding Company's Address
City
State
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address
City
State
AlA-
Zip
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 on 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 aDDrovidl nd a r ns ction fee will be charged.
Signatu
NEII or AGENT
The foregoing instrument was acknowledged before me this
h► day of
6"Ae, ✓ 20 f �0 by
,1 !SS► '"1jG�! ��� g� who is personally known to
me or who has produced ?oriole 0S [;CAN SC as
identification and who did take an oath.
NOTARY PUBLIC:
Sign: 2v"vv`� ,
Print: it 4,f. &Yv.1
Seal: ,`�y;; DONALD MARTIN
� MY COMMISSION # GG102743
awV- 11 EXPIRES May 09, 2021
*************** *********
Signature
CONTRACTO
The foregoing instrument was acknowledged before me this
Sfpp day oof�f���� !,f/�s ✓ 20 �� by
Ph1b/L 6Y')� who is personally known to
me or who has produced as
identification and who did take an oath.
NOTARY PUBLIC:
Sign: /
Print: f in.fit e%
Seal: `.'%.: DONALD MARTIN
MY COMMISSION # GG102743
'.' EXPIRES May 09, 2021
APPROVED BY (C—d— // Plans Examiner
Structural Review
Zoning
Clerk
(Revised02/24/2014)
STATE OF FLORIDA
DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT AND DISPOSAL
SYSTEM
CONSTRUCTION PERMIT FOR: OSTDS New
APPLICANT: JESSICA SCHILLING
PROPERTY ADDRESS: 77 NE 105 St Miami, FL 33138
LOT: 15 BLOCK: 202
PROPERTY ID #: 11-2136-006-0150
SUBDIVISION:
PERMIT #:13-SM-1842341
APPLICATION # : AP 1341297
DATE PAID:
FEE PAID:
RECEIPT #:
DOCUMENT #: PR1116467
[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 ( 900 ] GALLONS / GPD Seotic CAPACITY
A [ ] GALLONS / GPD N/A CAPACITY
N [ ] GALLONS GREASE INTERCEPTOR CAPACITY [MAXIMUM CAPACITY SINGLE TANK:1250 GALLONS]
K ( ] GALLONS DOSING TANK CAPACITY ( ]GALLONS @[ ]DOSES PER 24 HRS #Pumps [ ]
D [ 375 ] SQUARE FEET Trench configuration drainfi SYSTEM
R [ ] SQUARE FEET N/A SYSTEM
A TYPE SYSTEM: [x] STANDARD ( ] FILLED [ ] MOUND [ ]
I CONFIGURATION: [XI TRENCH [ ] BED ( ]
N
F LOCATION OF BENCHMARK: CL NE 105 St., 9.91' NGVD.
I ELEVATION OF PROPOSED SYSTEM SITE [ 2.28 ][ INCHES FT ]( ABOVE FBELOW1 BENCHMARK/REFERENCE POINT
E BOTTOM OF DRAINFIELD TO BE [ 32.28][ INCHES FT ]( ABOVE BELOW BENCHMARK/REFERENCE POINT
L
D E
O
T
H
E
R
'ILL HY:jlulmlJ: ( U.VU J INUMES NXUAVATIUN MQUIMD: t /L.UU J 1NUMY:S
This permit was amended on 7/25/18 to increase the wooden deck size at back yard.
Inspector to verify the existing septic tank is properly abandoned before final approval.
*Invert elevation of drainfield to be no less than 7.72' NGVD.
*Bottom of drainfield elevation to be no less than 7.22' NGVD.
*Install 42" of slightly limited soil under the bottom of drainfield.
-Perimeter of excavation area shall be at least 2 ft. wider and longer than the proposed absorption bed or drain trench.
The system is sized for 2 bedrooms with a maximum occupancy of 4 persons (2 per bedroom), for a total estimated flow of
SPECIFICATIONS BY: ! TITLE:
APPROVED BY: TITLE:
C4r3.08M Icaza
DATE I S SUED : 05400/2dUl
DH 4016, 08/09 (Obsoletes all previous editions which may'not be used)
Incorporated: 64E-6.003, FAC
Dade CHD
EXPIRATION DATE: 11/10/2019
v 1.1.4 M-1341297 SE1076791
Page 1 of 3
DIVISION OF ! e
Environmental Health ry
Florida Health
Miami -Dade County
OSTDS/We;"'
11805 SW 26th ]Division]Division,•
treet • hlyami, FL 33175 O�
,..� inspector / Sr e�,
Address Dates/
.Comments:..
Signature
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T L � 116 - 7 (119 G