PL-19-1097Miami Shores Village
10050 NE 2 Ave
Miami Shores FL 33138
305-795-2204
Issue
Location Address Parcel Number
64 NW 101ST ST, Miami Shores, FL 33150 1131010180270
:ontacts
Permit No.: PL -06-19-W97
Permit Type: Plumbing - Residential
Work classification: Septic
Permit Status: Approved
Expiration: 11/13/2019
MONICA CRUZ Owner STATEWIDE SEPTIC CONNECTIONS Contractor
64 NW 101 ST, MIAMI SHORES, FL 33150 TERESA SOLOMON
13680 NW 19 AVE BAY#10, OPALOCKA, FL 33054
Business: 9549630082
Description: REPLACE TANK & DRAINFIELD Valuation: $ 4,400.00 Inspection Requests:
305-762-4449
Total Sq Feet: 0.00 11 1
Fees
Amount
Application Fee - Other
$50.00
CCF
$3.00
DBPR Fee
$2.31
DCA Fee
$2.00
Education Surcharge
$1.00
Permit Fee
$104.00
Scanning Fee
$9.00
Technology Fee
$3.85
Total:
$175.16
Building Department Copy
Payments
Date Paid Amt Paid
Total Fees
$175.16
Check # 5000
05/15/2019 $50.00
Cash
05/17/2019 $125.16
Amount Due:
$0.00
In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations
pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores
Village. In accepting this permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate
permits are required for ELECTRICAL, PLUMBING, MECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work.
OWNERS AFFIDA IT: I certi that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws
regulating constru tion/and z ng. Futhermore, I authorize the above named contractor to do the work stated. /
/
Authorizedature w e� Applicant / Contractor / Agent
May 17,
Page 2 of 2
BUILDING
PERMIT APPLICATION
Miami Shores Village
YV5ZO
Building Department By.
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795-2204 Fax: (305) 756-8972
INSPECTION LINE PHONE NUMBER: (305) 762-4949li
FIBC 201`
Master Permit No. �l.-� 6S_vi -10U
Sub Permit No.
❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
PLUMBING ❑ MECHANICAL PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: ('0-T Nyi � c) k Sfi
City: Miami Shores County: Miami Dade Zip: 331 "i0
Folio/Parcel#: 11 `3 101 — Op ) a —()2-71 Is the Building Historically Designated: Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FIFE:
OWNER: Name (Fee Simple Titleholder): MID VI Ni Cq G'uZ Phone#:
Address: (OL' r,.JW kol ST
City: MNGtyyb Jar es State: 1Z- Zip: �' ;3(S0
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR: Company Name:
�..JIC44"$ f ►-)C phone#: 766 q 8 0
Address: �36a� 1 i01 ,-.re, *I0
City: State: I=t.- Zip:
Qualifier Name: �-Plms �1'� ►^-�a^ Phone#:
State Certification or Registration #: SMO�-J� Z.� 2 Certificate of Competency M
DESIGNER: Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for this Permit: $ #; 4O Square/Linear Footage of Work: 22S
Type of Work: ❑ Addition El Alteration ❑ New ❑ Repair/Replace ❑ Demolition
Description of Work: -"A-N� .f 'p YC.I �r-' "Rj C f d
., �.: :./�d?µ..• • v.,yY �^f�,4{�,f�i�IA•. tYAi�A rM... .., waAJ -.J '.. —_ J
Specifji color of dolor thru tile.;..
Submittai-Fee $ ,a C ^-4*°--Permit Fee $ CCF $ CO/CC $ - *_
Scanning Fee $ Radon Fee $ DBPR $ Notary $
Technology Fee $ Training/Education Fee $ Double Fee $
Structural Reviews $ Bond $ G o
TOTAL FEE NOW DUE $ 12— G - I/-'
(Revised02/24/2014)
62g ° (�
Bonding Company's Name (if applicable)
Bonding Company's Address
City
State
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address
City
State
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 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 pproved and a ection fee will be charged.
Signature Signature
OWNER or AGENT CONTRACTOR
The foregoing instrument was acknowledged before me this
—0— day of 20 1 by
�UIU��AR�Ii QQ•!J� {nw�ho is personally known to
me or who has produced C�— mil �X—Q- Sr— as
identification and who did take an oath.
NOTARY PUBLIC:
The foregoing instrumentwasacknowledged before me this
�
\ day of z " \ 20J by
-Fiye� Q .OwY4�ho is personally known to
me or who has produced ��� as
identification and who did take an oath.
NOTARY PUBLIC:
`_i I—
Print: k A LQ.lr Pr
���e;"•
Seal: SINDIA ALVARE2 Seal:
MY COMMISSION # GG 238273
'•; P; EXPIRES: September 3, 2022
Bonded Thru Notary Pubk llndery niters
******** ************************
APPROVED BY �' ' �/9Plans Examiner
Structural Review
(Revised02/24/2014)
-A-0 6#k Notary Public State of FlorWa
Teyana Solomon
My Cornmrsswn GG 2218641
ar Expires 1011712022
Zoning
Clerk
:4
0
t
STATE OF FLORIDA
DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT AND DISPOSAL
t SYSTEM
I
PERMIT FOR
Monica Cruz
dSTDS Repair
ADDRESS: _ 64 NW 101 St
Fl. 33150 '
PERMIT #:13 -SC -193611
APPLICATION #:AP1405571
DATE PAID:
FEE PAID:
RECEIPT #:
DOCUMENT #: PR1213947
% i +
6 7 BLOCK: 3 SUBDIVISION:
i 0000
[SECTION, TOWISH jam• RANGL a jyLRCEL NUMBER]
PERTY ID #: 11-3101-018-0270• • • • •
[OR TAX ID NUI -231R) • • •••
000`0•• �� •
.0000•
TEM. MUST HE CONSTRUCTED IN ACCORDANCE WITH SPECIFICATIOIR0j.0AND 3TAADARD3 :00��006E
0065, F.S., AND CHAPTER 64E-6, F.A.C. DEPARTMENT APPROVAL'• OF •SYST]M..US NOT GUAR
•
'ISFACTORY PERFORMANCE FOR ANY SPECIFIC PERIOD 01:: TIME. M..CHANG& IN MATER 171b . F,t,��,,
CH SERVED A8 A BASI9 FOR ISSUANCE OF THIS PERMIT, REQUIPA-' THE APPfI`•AV �a
TO••IFY
MIT APPLICATION. SUCH MODIFICATIONS MAY RESULT IN THIS pff
Ti••BEING 0NAD1! NUffis•iS1TD
DANCE OF THIS PERMIT DOES NOT EXEMPT THE APPLICANT;'FROM: COMPILIANCE •KITH OTHER• FEE
' • • • • • • •
ME, OR LOCAL PERMITTING REQUIRED FOR DEVELOPMENT OF THIS PROPERTY. 0000••
• • •
DESIGN AND SPECIFICATIONS 0000
T � [ 900 l GALLONS /GPD New Septic Tank
CAPACITY
A C 0 ] GALLONS / GPD CAPACITY
[MA
N [ 0 I GALLONS GREASE INTERCEPTOR CAPACITY XIMUM CAPACITY SINGLE TANK:1250 GALLONS]
K L ] GALLONS DOSING TANK CAPACITY •[ ]GALLONS @[ ]DOSES PER 24 HRS #Pumps [
ARER % r fie *
D ( 225 ] SQUARE FEET New Drainfield Trench conf SYSTEM I H( ; r
SYSTEM FLORIDA .�
R [ 0 ] SQUARE FEET
A TYPE SYSTEM: [X] .STANDARD C ] FILLED (] MOUND
I CONFIGURATION: [x] TRENCH [ l BED ( ]
N
F LOCATION OF BENCHMARK: FFE 13.14' NGVD.
I ELEVATION OF PROPOSED SYSTEM SITE ( 22.30][ INCHES FT ][ABOVE HELOW BENCHMARK/REFERENCE POINT
E!BOTTOM OF DRAINFIELD TO BE [ 70.30](INCHES FT ][ABOVE BELOW BENCHMARK/REFERENCE POINT
L�
D; FILL REQUIRED: ( 0.00 INCHES EXCAVATION REQUIRED: E..48.001 INCHES
1: Install a 900 gal. septic tank with an approved filter
° 2.- The licensed contractor installing the system is responsible for installing the minimum category of tank in accordance
T with s. 64E -6.013(3)(f FAC.
H 3.- Install 225 sf. of drainfield in TRENCH configuration.
4: Invert elevation and Bottom of drainfield to be no less than 7.78'& 7.28NGVD respectively
4 THIS PERMIT IS NOT FOR ANY ADDITIONS.
I
R
SPECIFICATIONS %Aftilizaire
Te-reSolomon ._ TITLE' Master Septic Tank Contractor
i
.— - TITLE: Environmental Manager j Dade
PROVED BY:
EXPIRATION DATE: 07/25/2011
DATE ISSUED: 04/262019
I
DH 4016, 08/09 (Obsoletes all previous editions which may not be used) Page 1 of
Incorporated: 64E-6.003, FAC
V 1.1.4 "1405571 SE1163542
STATE OF FLORIDA
DEPARTMENT OF HEALTH
APPLICATION FOR CONSTRUCTION PERMIT
PermitApplication Number-
------------------------- _
PART - SITEPLAN rR
Scale: FaCh hlnrk ronrcconf- 1n i t 4 P\, , O --j, i
N
N
G.-) L
7t- 2 "� .d
Site Plan submitted by: I'26 Z
Plan Approved Not Approved Date
By
County Health
ALL CHANGES MUST BE APPROVED BY THE COUNTY HEALTH DEPARTMENT
DH 4015, 08/09 (Obsoletes previous editions which may not be used) Incorporated: 64E-6.001, FAC
(Stock Number: 5744-002-4015-6)
i
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7t- 2 "� .d
Site Plan submitted by: I'26 Z
Plan Approved Not Approved Date
By
County Health
ALL CHANGES MUST BE APPROVED BY THE COUNTY HEALTH DEPARTMENT
DH 4015, 08/09 (Obsoletes previous editions which may not be used) Incorporated: 64E-6.001, FAC
(Stock Number: 5744-002-4015-6)
i
Phone/Fax: (3 V 223-6060
L 11UV LD)HL„1lf�tr�0 L1�. @ U (J &
E-mail: rvizcaya.13@gmail.com 13217 S.W. 46th Ln.
L.B. 8000 Miami, Florida 33175
r PROPERTY ADDRESS: 64 NW 1 01 ST ST. MIAMI SHORES, L. 33 1 50
LEGAL DESCRIPTION: THE WEST 35 FEET OF LOT 6 AND THE EAST 30 FEET OF LOT 7, BLOCK 3,
OF NAVARRO, ACCORDING TO THE PLAT THEREOF AS RECORDED IN PLAT BOOK 1 2, AT PAGE 59, OF
THE PUBLIC RECORDS OF MIAMI DADE COUNTY, FLORIDA.
SKETCH OF SURVEY
(BOUNDARY SEIRVEY)
SCALE 1" = 20'
+, w
Al f
T 750 Total, R/W } ' r ..y
x
!'
16.7 PDrkwoy
F0. Q ••••
we
KAsphalt DrivewaB.C.eLot S _.s1e;"T:.-ba3w D.• •
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••••••
`tom :n •••• ••••••
Tk 00
stij •tRl VOL* Is � •1 •
zRes.# 64 •' • • • •
F.F.Elev.:13.14' y ••�ti ••••••
_. _ 1295 5.50 y • • • • •
Is
Remainder of M I !z' • y M Remainder of
LOT- 7 0 12.00,• 0.76 9.7s 1s68 G LOT- 6
J
BLOCK -3 r Ca1c.A N< BLOCK -3
MOD 6.10 r
12.0• •; $ I <aD•
1
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n '0
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On PA
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0.50 L
6'W F
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M,ami ShcIes Village I/Y.LP. 6i .00' FD.
IP c 1/2'LP.
c)ATE LOT- 10 0 I LOT -11
APF R, 0"JF BY --BL CK- 3 I BLOCK- 3
ZONING DE FIT
BI- DG DEP T PLUMBING PLANS /q
SJBJ CT I' :aaTE: UANCE ii r1ri ALL FEDERAL DATE OFRrOVC 17
AMOVE GROUND ENCROACHMENT p,$� NOTED: N/A RENSEO pp ease
ELEVATIOLLN,q t.p.RE.REFE:RREISj ''d�Rl'IANiI 'aADE COUNTY
j -i -+T:- Alli 8�.1 nVL56i71`ELEv.=1 1,0.54�OF^N:G:V.D ODF 1929 IbnN.a deMdpyB I�wl.�s, Mortgage,lnaat@,/AT�
—F— •^+•°^•dw h M.,.,wn.R.eMw RqTTUTIMFCOmnnitment
LEGAL NOTES AlncSo,,, AM .MR RRdI OR 1bY,unTWr•y SWdM!•.. w 1
TMS SURVEY DOES NOT REJECTOR DETER MINEDVMD13111P.EXAMINA7gNOFTNEABSTRACTOF '�'"�btlr Fl•M•B•W dPnIwdNW Sumryn.nd MpP•nb
TRLE HALL HAVE TO BE MADE TO GET
ERMWE RECORDED WSTRUMENIB, If ANY. AFFECTING THE F.S.
epbrlM.17.OSOBw SF17.OR FAG pRMWtb Mdlen �72A77
PROPERTY. THIS SURVEY L4 BUBJECTTO DEpIUTpF UMaATgNS, gISTRICTgN3, RES
ERVAT10N3
OR EASEMENTS OF OR
LEGAL DESCRIPTION PgOVN1E0 BY CLIENT.7NE llAB1UTY OFTHIS
SURVEY IS LIMBED TO THE COST OF THE SUgVEY. UNOEROROUND ENCROACHMENTS•KANY, ME��
NOT SHOWN. THIS FIRM HAS NOT ATTEMPTED TO LOCATE NORMO ANDDTi Fd1ND1TpN8 ANDRM
UNDERGROUND IMPROVEMENTS OF Amy NATURE. IF SHOWFNBEARINWAgE RFFEi1gEG TO AN ARTURO R.TOIRAC P.S.M. 3102
BOUNDARYASSUMED SUR IAN. IF SHOWN ELEVATIONS ARE REFERRED TO N.G. V.D. OF jMTHE CLOSURE W THE Nd •JA nV-4h Will""( RlgkW.RbR•rNWd•
BOUNDARY SURVEY IS ABOVE 1:18000
FYrW Ila•rr.e 8uw7a•nA M•MN,.
LEGEND AND ABBREVIATIONS JOB No. 1 7-1
A=ARC DISTANCE CONC=CONCRETE O.H.'OVERHEAOUTIUTIES
RMl '01AC AIR CONDITIONED UNIT D.M.E.- DRAINAGE MAINT, EASEMENT P,C.P.= PERMANENT CONTROL POINT TVP,= TYPICAL -WAY a' - ELEVATION
B. BLOCK CORNER -CATCH BASIN
ENC.' ENCROACHMENT P.O.B.= POINTO OF BEGINNING U. E= UTILITY EASEMENT
C. B.= CATCH BASIN FD,= FOUND P.O.C.' POINT OF COMMENCE WF: WOOD FENCE ®=WATER METER ®=SANITARY SEWER
CLtc�CALCULATED I.F? IRON FENCE R'= 'RADIUS W.M.' WATER METER �7' POWER POLE
CL:=NCLEAR . (Mi= MEASl1RED IR)= RECORD I>Q = WATER VALVE
C.LF.= CHAIN LINK FENCE MA.= MONUMENT LINE RES: RESIDENCE ORD = LIGHT POLE ® =TV BOX
=CENTER UNE