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PL-19-1121Miami Shores Village 10050 NE 2 Ave Miami Shores FL 33138 305-795-2204 Permit No.: PL -W1$-1121 Permit Type: Plumbing - Residential Work Classification: Drainfield ftm9 Permit status: Approved Issue Date: 05/17/2019 Expiration: 11/13/2019 Location Address Parcel Number 11028 NW 2ND AVE, Miami Shores, FL 33168 1121360020260 Contacts CORY A BROWN Owner A SUPER SEPTIC & DRAIN FIELD INC Contractor 11028 NW 2 AVE, MIAMI SHORES, FL 33168 BRYAN K ZERO Other: 9132691610 7701 W 18 LN, HIALEAH, FL 33014 asuperseptic@gmail.com Description: NEW DOSING AND NEW DRAINFIELD IN TRENCH Valuation: $ 8,500.00 Inspection 4 Requests: CONFIGURATION 305 762 4949 Total Sq Feet: 0.00 Fees Amount Application Fee - Other $50.00 CCF $5.40 DBPR Fee $4.46 DCA Fee $2.98 Education Surcharge $1.80 Permit Fee $247.50 Scanning Fee $9.00 Technology Fee $7.44 Total: $328.58 Payments Date Paid Amt Paid Total Fees $328.58 Credit Card 05/17/2019 $278.58 Credit Card 05/16/2019 $50.00 Amount Due: $0.00 Building Department Copy 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 above named contractor to do the work stated. / Applicant / Contractor / Agent May 17, 2019 Date Page 2 of 2 Miami Shores Village C I EIS Building Department MAY 6 2019 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 BY: 1 Tel: (305) 795-2204 Fax: (305) 756-8972 INSPECTION LINE PHONE NUMBER: (305) 762-4949 FBC 20P r�th BUILDING Master Permit No. —69AI ' 12 19 PERMIT APPLICATION Sub Permit No. ❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION EJRENEWAL QPLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: //6 a e h) t&) X In v City: Miami Shores County: Miami Dade zip: 33 16 Folio/Parcel#: / I / 3 b - 0 6a - U a G 0 Is the Building Historically Designated: Yes NO Occupancy Type• � g . Load: Construction Type: Flood Zone: BFE: FIFE: OWNER: Name (Fee Simple Titleholder): 0)2 2 n w nJ Phone#: Address: l ! U YLr fN v City: MT na—ry1 � State: , Zip: Tenant/Lessee Name: Email: �1 pQ CONTRACTOR: Comnanv Name: .tel t,/ P,c __3j.ref fla,-,/ 0 Zn/. Phone#: YoS' 3Gy-D/l 3 Address: gr/01 W /8 AA,-) e,— City: /, h' -/J'14 State: /- / Zip: -330111-1 Qualifier Name: �g /�)-,v �ze p 0 Phone#: 3 D-5 - 3( q- a /) 3 State Certification or kegistration #: -98 "j, /6 l "Na Certificate of Competency #: -9.4 0 / 6 / -_� DESIGNER: Architect/Engineer: Address: Value of Work for this Permit: $ Type of Work: ❑ Addition ❑ Alteration Description of Work: Specify color of color thru tile: Submittal Fee $f50 `_' 1 d Permit Fee $ Scanning Fee $ Technology Fee $ Structural Reviews $ (Revised02/24/2014) Radon Fee $ State: Zip: Square/Linear �Flootage of Work: 9 a� IDu New Repair/Replace ❑ Demolition _P . v-/ Training/Education Fee $ CCF $ CO/CC $ DBPR $ Notary $ Double Fee ,$ _ Bond $ " TOTAL FEE NOW DUE $ �Z P1 • Sh Z? 7:�8"SG , 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 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 4q approved and a reinspection fee will be charged. EMWL Signature "O Signature 19,41o� Z6� OWNER or AGENT CO ACTOR The foregoi i stru t was acknowledged before me this The foregoing instrume t as acknowledged before me this w �� of 20 by day of wV 20 by GLA rdW h who is personally known to •has y1 BYO who is known to me or wh pr ed y', ,Ii (t iw h as personally me or ho has pro dT)6Mf 1 c QKS'J� as identific tion n who 'd take an oatkOW1111"tim i entifica ion a ho di take an oath.//y/ \\y�pDY P/�j�t7/i Ov NOTAR PUBLI O i� aS TARY UBLIC ``��� i ` , �P* O 4 ?.• ?•� � . c`� 1 r rtj: _S R . Sign. 7f �. = Sign: L 0 • Print: dl►1A `y 2 Print: a ! '•��° t`•' Seal: ���4 "Wrc Node •'•��`��� �j%b11111111N���� Seal: ��/STATED*�o� /ryJN111111111���� A��``�`; APPROVED BY lG� Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) A SUPER SEPTIC & DRAIN FIELD INC. CC: SR0161772 PHONE: 305-354-0113 DATE: f Gy 4 STATE OF FLORIDA COUNTY OF MIAMI-DADE 7701 WEST 18 LANE HIALEAH, FLORIDA 33014 Licensed and Insured t.-. t. = 5., 'PER "E --p F `P=RSi iC.ccz07,, PAX: 305-354-0349 BEFORE ME THIS DAY PERSONALLY APPEARED, /212Y/ -f -I Z�-f2v WHO BEING DULY SWORN, DEPOSES AND SAYS: THAT HE OR SHE WILL BE THE ONLY PERSON WORKING ON THE PROJECT AT: ►o Contractor Signature: SWORN TO (OR AFFIRMED) AND SUBSCRIBED TOME THIS W" Wh DAY OF . 2019, BY: &af\ Z-( Y 0 PERSONALLY KNOWN / OR PRODUCED IDENTIFICATION TYPE OF INFORMATION PRODUCED J VO -O' IIC BGG2a726d PRINT, TYPE, OR STAMP NAME OF N Notice to Owner — Workers' Com Miami Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 nsation Insurance Exemption Florida Law requires Workers' Compensation insurance coverage under Chapter 440 of the Florida Statutes. Fla. Stat. § 440.05 allows corporate officers in the construction industry to exempt themselves from this requirement for any construction project prior to obtaining a building permit. Pursuant to the Florida Division of Workers' Compensation Employer Facts Brochure: An employer in the construction industry who employs one or more part-time or full-time employees, including the owner, must obtain workers' compensation coverage. Corporate officers or members of a limited liability company (LLC) in the construction industry may elect to be exempt if 1. The officer owns at least 10 percent of the stock of the corporation, or in the case of an LLC, a statement attesting to the minimum 10 percent ownership; 2. The officer is listed as an officer of the corporation in the records of the Florida Department of State, Division of Corporations; and 3. The corporation is registered and listed as active with the Florida Department of State, Division of Corporations. No more than three corporate officers per corporation or limited liability company members are allowed to be exempt. Construction exemptions are valid for a period of two years or until a voluntary revocation is filed or the exemption is revoked by the Division. Your contractor is requesting a permit under this workers' compensation exemption and has acknowledge that he or she will not use day labor, part-time employees or subcontractors for your project. The contractor has provided an affidavit stating that he or she will be the only person allowed to work on your project. In these circumstances, Miami Shores Village does not require verification of workers' compensation insurance coverage from the contractor's company for day labor, part-time employees or subcontractors. BY SIGNING $JOW YOU ACKNOWLEDGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS CONTENTS. / A ri Signatur State of County of Miami -Dade The foregoing was acknowledge before me this b day of ' " �Q _,20 . who is perso�►`"_j me or has produced �p p ��i ication. �Y P *V'z 25 lQjFrO 2 • 60267266 1 d N 0 lvC.B.W V � 6 cn O LOT - 22 1 0.15'CL — 11028 NW 2nd AVENUE, MIAMI SHORES, FL 33168 MIAMI SHORES 5ECTION 7 (P.13 35-PG.24) c Z LIMIT OF PLAT r (N.A.P.) r 65.64' = O � g � J 3 w • 0000 0000•0 4' C.B.W. t .. • . ... 0 ,� r (� • ryONC. ; • ; • �� •:POOP•: DECK v �4 POOL VERHEAI RE t� D FILTER GONG. BOX :WATER PUMP v A.0 Vf STEPS 0.20' CL 4' 6.62' �� 0.23' CL ONE STORY LOT - 23 RES. # 11028 W C.L.F. CL L � o W 0000 5. I = O � g � J 3 w • 0000 0000•0 t .. • . ... 0 ,� 6'W!P•Wt L F. 00 0 ••.••. 000 0 po ..•.•. n 0 S < z, F.I.P. 1%21'•.. ENCROACHMENT NOTES: ••••. NOC9P..... T 0.•• ....e 0 ON PL •. .. .,. 0000.. _M z • 0000.. n N Lu . . •.•.•. 0000.. W, C Q . 0 0 0 • . 4'C.B.W'• 0 : . • RIGHT OF WAY OF NW 2nd AW UE. •000 z I 0000 0 0 Q FILTER GONG. BOX :WATER PUMP v A.0 Vf STEPS 0.20' CL 4' 6.62' �� 0.23' CL ONE STORY LOT - 23 RES. # 11028 W C.L.F. CL L � o W Q 5. I = O � g � J 3 w ;> t O c� ,� _ po n 0 S < z, ENCROACHMENT NOTES: T r9 f� 'w. A. EAST SIDE OF THE SUBJECT PROPERTY, z _M z n N Lu CONCRETE RETURN IS ENCROACHING INTO THE W, C Q 7 IW RIGHT OF WAY OF NW 2nd AW UE. z I U 0 0 Q [r z (!)L w V I II c� LF C)-1 c Q Q O F.I.P. I/2' IPC /2' NO CAP Q ".I c ci LEGAL DESCR/PT/ON.•. Nr,N _, OS IBe - DRAWN BY 5. I T ,� po 0 S < z, ENCROACHMENT NOTES: r9 f� 'w. A. EAST SIDE OF THE SUBJECT PROPERTY, n N CONCRETE RETURN IS ENCROACHING INTO THE :> ;.; RIGHT OF WAY OF NW 2nd AW UE. IV F.I.P. 1/2' Q F.I.P. I/2' IPC /2' NO CAP NO CAP NO AP 5' COKC-. 5WK - : 65:?.4' -w.M, ZFW • :69:90'(M). W.M. - 70.00 R: =�QNC : 4"A5 PVMT c 4 ;g 10 MEDIAN GRA55 (� LIMIT OF PLAT(N.A.P.) o 'MIAMI 5HORE5 E=N510N i 3' A5Pt1ALT PVMT. (P ' -b 43 PG 40),; NW 2nd::AVENUE Q. rA 75' TOTAL RIGHT -0F -WAY____._ - 1y Q; Q LEGAL DESCR/PT/ON.•. Nr,N _, OS IBe - DRAWN BY STATE OF FLORIDA DEPARTMENT OF HEALTH ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM CONSTRUCTION PERMIT FOR: OSTDS Repair PERMIT #: 13 -SC -4 948186 ARM13392DA7 APPL3:dTIQi1 •t]: •• • now • •0 • • • FLL•p�D: RE1j1 -0: ...... DOclA!lElt4 •II : PR1226879 .....' .... .. . ...... ••...• • . • • • . 0000 . APPLICANT: Cory A Brown • • • •••••• PROPERTY ADDRESS: 11028 NW 2 Ave Miami, FL 33168 • • • • LOT: 23 BLOCK: 1 SUBDIVISION: Shoreland Height PROPERTY ID #: 11-2136-002-0260 [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 3 GALLONS / GPD EXISTING SeDtic tank CAPACITY A [ 225 3 GALLONS / GPD NEW Dosina tank CAPACITY N I 0 ] GALLONS GREASE INTERCEPTOR CAPACITY [MAXIMUM CAPACITY SINGLE TANK:1250 GALLONS] K 1 l GALLONS DOSING TANK CAPACITY [ ]GALLONS @[ ]DOSES PER 24 HRS #Pumps [ 7 D [ 225 ] SQUARE FEET NEW Drain Field in TRENC SYSTEM _j �] `�`� R[ 0] SQUARE FEET SYSTEM R r PA I R �"" L Y. ` 1 6 i<w A TYPE SYSTEM: [X] STANDARD [ ] FILLS [ 7 MOUND I CONFIGURATION: [x] TRENCH [ l BED F LOCATION OF BENCHMARK: FFE 12.8' . A U t V-A f . $ ,.4 I ,+� . . e . + r U a.+ I ELEVATION OF PROPOSED SYSTEM SITE [ 24.001 INCHE3 FT ][ABOVE BELOW BENCHMARK/REFERENCE POINT E BOTTOM OF DRAINFIELD TO BE [ 59.04] INCHES Fr II ABOVE BELOW BENCHMARK/REFERENCE POINT L D FILL REQUIRED: [ 0.00] INCHES EXCAVATION REQUIRED: [ 35.003 INCHES 1.- Invert elevation and Bottom of drain field to be no less than 8.38'& 7.88' NGVD respectively. O 2.- Install a NEW 225 gal. DOSING tank. T 3- Install a NEW 225 sf. of drain field in ....TRENCH... figuration. H 4- The licensed contractor installing the system is ponsible for installing the minimum category of tank in accordance with s. 64E -6.013(3)(f) /' E 5.- THIS PERMIT IS NOT FOR A (Com ents Continued on_P,2g6 2.) SPECIFICATIONS BY: A APPROVED BY: Frantz T DATE ISSUED: 05/10 ` DH 4016, 08/09 (Obsoll es all Incorporated: 64E-5.003, FAC TITLE: : ENGINEERING SPECIALIST II Dade CHD editions which may not be used) AP1413392 EXPIRATION DATE: 08/08/2019 SE1175412 Page 1 of 3 DOCUMM It : • PR12258T� 00 _ 0 _ 0 _ • • • • • • • NY ADDITIONS.• • • • • • • • • • • • • B. Perimeter be at least 2 ft wider and longer than the absorption trench : of excavation area shall proposed 0000 . 00000 0 .0000. 0000 0000 The system is sized for 3 bedrooms with a maximum occupancy of 6 persons (2 per bedroom), for a total e4VWed flow of•W • • • 0 . 9Pd• .. .. .. 0000 . 0000.. Required drainfield area based on rule 64E -6.015(6)(c)2. 0000.. • • • • • Install a new drainfield to achieve Drainfield size requirement I k, • 11■ i®��'i■� �/!■■■ilii■■■■11■■■■■■■■■■■ 11■ ■■■■■Oil■\�\�������■■■■■■■■■■■ 111■■ii»■ i7�illi .■ II ■■■■■■■1 ■■■\■■■ Ell IM 1 IBJ■11 ■I 1 I■ 11■ II /i�� II �■�..���1 t■■■\�■ ■■■ IIN;���...'■11 ■I 1 I■ 11■ 11 /IC�� �i ■■■■■■■I ■■■■■\� ■■■ !� �I \�.■11 ■I i I■ 11■ 1.■■■ II ■■■■■■■� ■■iIi7■■\■■ \7F:■11 ■I 1 I■ 11� 11 ■■■■ II ■■■■■■■� ■■■■■■■ ■\L ■fir■11 ■I 1 I■ 1 SII 11 ■■■■ II ■■■■■■■1 ■■■■■■■ ■\■ 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 Page 2 of 4 (Stock Number: 5744-002-4015-6) C 118©5 w. Inspector rnilv Address i /si r ?s? Comments:' rl ; CA , �l 0 r Aq .�,1 � y 11 l