PL-19-1449Miami Shores Village
10050 NE 2 Ave
Miami Shores FL 33138
305-795-2204
issue Date: 06/26/2019
Location Address Parcel Number
1361 NE 104TH ST, Miami Shores, FL 33138 1122320320020
Contacts
Permit NO.: PL -06-19-1449
Permit Type: Mumbling - Residential
Work Ciassifrcvtfon., Septic/Draitifield
Permit Status: AprovetV
Expiration: 12/23/2019
ERIC ZETKA Owner A SUPER SEPTIC & DRAIN FIELD INC Contractor
260 NE 99 ST, MIAMI SHORES, FL 33138 BRYAN K ZERO
7701 W 18 LN, HIALEAH, FL 33014
asuperseptic@gmail.com
Description: DRAINFIELD AND SEPTIC Valuation: $ 300.00 Inspection Requests:
Total Sq Feet: 0.00
Fees
Amount
Application Fee - Other
$50.00
CCF
$0.60
DBPR Fee
$2.00
DCA Fee
$2.00
Education Surcharge
$0.20
Permit Fee
$50.00
Scanning Fee
$9.00
Technology Fee
$2.50
Total:
$116.30
Payments
Date Paid Amt Paid
Total Fees
$116.30
Credit Card
06/24/2019 $50.00
Credit Card
06/26/2019 $66.30
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.
nature: OtV / Applicant / Contractor / Agent Date
June 26, 2019 Page 2 of 2
0
BUILDING
PERMIT APPLICATION
Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795-2204 Fax: (305) 756-8972
INSPECTION LINE PHONE NUMBER: (305) 762-4949
BUILDING ❑ ELECTRIC ❑ ROOFING
EdPLUMBING ❑ MECHANICAL PUBLIC WORKS
Master Permit No
Sub Permit No.
RSC"
Fc
JON 1-94;
FBC 20 (1
?L -C6 -":�--iyyCi
❑ REVISION ❑ EXTENSION EJRENEWAL
CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS:
b ✓ U /D
�Y �� P �T
City:
Miami Shores
County: Miami Dade Zip:
�J
'=3 / D'
Folio/Parcel#:
// -,;�2 � j - 0 . &�2 -Ij
d�2 0 Is the Building Historically Designated: Yes
J NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder):( <:-R,v 0 n N 1 �I 0, n /2whone#:
Address:
City: & v State: Zip: c1"
Tenant/Lessee Name: Phone#:
Email
CONTRACTOR: Company Name:` 4(,Y�ZOW "T' 4D4p j,. r,e (� or, Phone#: ,;� 6� - 36
Address: n2 �%.6? ,fin
City: «i /00 State: -r-11 Zip: 2 q / 'z,/
Qualifier Name;
State Certification o 4R gistration #: ��(� �/ Certificate of Competency
DESIGNER: Architect/Engineer:
Phone#:
Address: / City: State: Zip:
Value of Work for this Permit: $,//�i r(� Square/Linearr Footage of Work: _30 d
Type of Work: ❑ Adclitlon ❑ Alteration ❑ New u Repair/Replace ❑ Demolition
Description of Work:
Specify color of color thru tile:
Submittal Fee $ cz6-- Permit Fee $
Scanning Fee $
Technology Fee $
Structural Reviews $
(Revised02/24/2014)
Radon Fee $
Training/Education Fee $
CCF $ CO/CC $
DBPR $
Notary $
Double Fee $
Bond $ E_W.
TOTAL FEE NOW DUE $ (Q& •'SO
• 30
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 approved and a reinspection fee will be charged.
Signature Signature g g
OXER or AGENT TRACTOR
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
day of :7U N -F[ 20 �� by
7—FL.TL� who is personally known to
me or who has produced 4�-- po\j-rv-? as
identification and who did take an oath.
day of 20, by
'5p=e (- --2F—V-,p , who is personally known to
me or who has produced :FL ill 'tom 9::�
identification and who did take an oath.
NOTARY PUBLIC: 4
NOTARY LIC:
,\`\`\t 11111111
Sign: P��•• IS 61eSign:
Print: ?`ch 6, 2oF�S Pri
4;
Seal: • m Cn : * _ Seal: �_"'�.. $INDIA ALVAREZ
• •_ MY COMMtSSIGN # GG 23•.273
oa"e5 • • a� r a EXP RES: September 3, 2022
•"��OQ� Bonded Thru Notary Public Undefvhers j
APPROVED BY �' / Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)
A SUPER SEPTIC & DRAIN FIELD INC.
CC: SR0161772
PHONE: 305-364-0113
DATE: G _ / f
STATE OF FLORIDA
COUNTY OF MIAMI-DADE
7701 WEST 18 LANE
HIALEAH, FLORIDA 33014
Licensed and Insured
E-MAIL: ASUPERSEPTiC GfViAIL.COM
WWU`tt.ASUPERSEPTIC.COPvl
FAX: 305-364-0349
BEFORE ME THIS DAY PERSONALLY APPEARED, WHO
BEING DULY SWORN, DEPOSES AND SAYS:
THAT HE OR SHE WILL BE THE ONLY PERSON WORKING ON THE PROJECT AT:
3G 1 p,, re, co k �.S'r1ee 7e -
Contractor Signature:
SWORN TO (OR AFFIRMED) AND SUBSCRIBED TO ME THIS a DAY OF
0 k' r-- 2019, BY: RC---`r'-ffq � tZC�
PERSONALLY KNOWN
OR PRODUCED IDENTIFICATION
TYPE OF INFORMATION PRODUCED T �-
$INDIA ALVAREZ 7
MY COMMISSION # GG 236273
o EXPIRES: September 3, 2022 E
Bonded TAru Notary Public Underwriters 1
PRINT, TYPE, OR STAMP NAME OF NOTARY
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 BELOW YOU ACKNOWLEDGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS
CONTENTS.
Signature:
Ow
State of Florida
County of Miami -Dade pC,
The foregoing was acknowledge before me this day of , 20 l 1
By "� �r 1 '�-'- ` who is personally known to me or has produced
00jaqVication.
�11S SILVE
Notary:
SEAL: = o 9N ;
CW
?2: #FF 954760_ Joh
'C, •S[ N1
thrI111%
PERMIT #: 13 -SC -1966846
STATE OF FLORIDA sNPAPPLICATION # : AP 1418912
DEPARTMENT OF HEALTH`,K DATE PAID:
ONSITE SEWAGE TREATMENT AND FEE PAID:
SYSTEM $RECEIPT #:
R 1
DOCUMENT # : P R1241131
CONSTRUCTION PERMIT FOR: OSTDS Repair
APPLICANT: Gregory Richards Palmer ✓��i _ `iC�,.
T [ 900 ] GALLONS / GPD NEW Seobc Tank CAPACITY
A [ 0 ] GALIANS / GPD CAPACITY
N [ 0 ] GALLONS GREASE INTERCEPTOR CAPACITY [MMU4UM CAPACITY SINGLE TANK:1250 GALLONS)
K [ I GALLONS DOSING TANK CAPACITY [ IGALLONS � @[ ]DOSES PER 24 HRS #Pumps [
D ( 225 ] SQUARE FEET NEW Drain Field in TRENC SYSTEM
R [ 0 ] SQUARE FEET SYSTEM ' E-
A TYPE SYSTEM: [ ] STANDARD I ] FILLED [Y) MOUND []
I CONFIGURATION: [X] TRENCH [ ] BED [ ] FLORNIUA Or-A:Li tip r11 A1V!1°-U/kt iV
F LOCATION OF BENCHMARK: FFE 10.1'
I ELEVATION OF PROPOSED SYSTEM SITE [ 43.20] INCHES FTI[ABOVE HELOW BENCHMARK/REFERENCE POINT
E BOTTOM OF DRAINFIELD TO BE [ 73.20] INCHES FT ](ABOVE)BELOW BENCHMARK/REFERENCE POINT
L
D FILL REQUIRED: [18.00] INCHES EXCAVATION REQUIRED: [ 30.001 INCHES
1.- Invert elevation and Bottom of drain field to be no less than 4.5' & 4.0' NGVD respectively.
O 2.- Install a NEW 900 gal. septic tank with an approved filter
T 3.- Install a NEW 225 sf. of drain field in .... TRENCH... configuration.
H 4.- The licensed contractor installing the system is responsible for installing the minimum category of tank in accordance
with s. 64E -6.013(3)(f)
E 5.- THIS PERMIT IS NOT FOR ANY ADD NS.
R 6.- Perimeter of excavation area sho eqder and longer than the proposed absorption trench.
SPECIFICATIONS BY:
TITLE:
APPROVED BY: ' TITLE: ENGINEERING SPECIALIST II Dade CHD
aintpow
DATE ISSUED: 19/ 19 EXP RATION TATE: 09/17/2019
DH 4016, 08/09 (Obsoletes all previous editions which may not be used) �r
Incorporated: 64E-6.003, FAC UMBING PLANS
PL �a //�j1 of 3
v 1 1.4 "1410912 ' 04 Date /
Approved Date_^____—
nisapproved
PROPERTY ADDRESS: 1361 NE 104 St Miami, FL 33138
LOT: 2 BLOCK: 3 SUBDIVISION: River Bay Park
[SECTION, TOWNSHIP, RANGE, PARCEL ryHypsj ••••••
•
PROPERTY ID #: 11-2232-032-0020
• : .
[OR TAX ID NUMBER]
.. *a:** • • • •
. •
SYSTEM MUST BE CONSTRUCTED IN ACCORDANCE
WITH SPECIFICATIONS
AND •.%WMARDS•• &F SEC'JWa •i
381.0065, F.S., AND CHAPTER 64E-6, F.A.C.
DEPARTMENT APPROVAL OF
•
SYSt'W•DOES *M
SATISFACTORY PERFORMANCE FOR ANY SPECIFIC
PERIOD OF TIME. ANY
06UARAATEE
CHAWA ••7ji MATERIAL FAC ••
WHICH SERVED AS A BASIS FOR ISSUANCE OF
THIS PERMIT, REQUIRE THE AP?L;ir M TO :MODIFY eme
PERMIT APPLICATION. SUCH MODIFICATIONS MAY
RESULT IN THIS PERMIT
•••• ••••••
BEIt4•ME NULL AND VOID.,
ISSUANCE OF THIS PERMIT DOES NOT EXEMPT
•
THE APPLICANT FROM CCMPLIANtE •W;TH 9THER FEDERAL::
STATE, OR LOCAL PERMITTING REQUIRED FOR DEVELOPMENT OF THIS PROPERTY.
• ••••••
SYSTEM DESIGN AND SPECIFICATIONS
••i•••
T [ 900 ] GALLONS / GPD NEW Seobc Tank CAPACITY
A [ 0 ] GALIANS / GPD CAPACITY
N [ 0 ] GALLONS GREASE INTERCEPTOR CAPACITY [MMU4UM CAPACITY SINGLE TANK:1250 GALLONS)
K [ I GALLONS DOSING TANK CAPACITY [ IGALLONS � @[ ]DOSES PER 24 HRS #Pumps [
D ( 225 ] SQUARE FEET NEW Drain Field in TRENC SYSTEM
R [ 0 ] SQUARE FEET SYSTEM ' E-
A TYPE SYSTEM: [ ] STANDARD I ] FILLED [Y) MOUND []
I CONFIGURATION: [X] TRENCH [ ] BED [ ] FLORNIUA Or-A:Li tip r11 A1V!1°-U/kt iV
F LOCATION OF BENCHMARK: FFE 10.1'
I ELEVATION OF PROPOSED SYSTEM SITE [ 43.20] INCHES FTI[ABOVE HELOW BENCHMARK/REFERENCE POINT
E BOTTOM OF DRAINFIELD TO BE [ 73.20] INCHES FT ](ABOVE)BELOW BENCHMARK/REFERENCE POINT
L
D FILL REQUIRED: [18.00] INCHES EXCAVATION REQUIRED: [ 30.001 INCHES
1.- Invert elevation and Bottom of drain field to be no less than 4.5' & 4.0' NGVD respectively.
O 2.- Install a NEW 900 gal. septic tank with an approved filter
T 3.- Install a NEW 225 sf. of drain field in .... TRENCH... configuration.
H 4.- The licensed contractor installing the system is responsible for installing the minimum category of tank in accordance
with s. 64E -6.013(3)(f)
E 5.- THIS PERMIT IS NOT FOR ANY ADD NS.
R 6.- Perimeter of excavation area sho eqder and longer than the proposed absorption trench.
SPECIFICATIONS BY:
TITLE:
APPROVED BY: ' TITLE: ENGINEERING SPECIALIST II Dade CHD
aintpow
DATE ISSUED: 19/ 19 EXP RATION TATE: 09/17/2019
DH 4016, 08/09 (Obsoletes all previous editions which may not be used) �r
Incorporated: 64E-6.003, FAC UMBING PLANS
PL �a //�j1 of 3
v 1 1.4 "1410912 ' 04 Date /
Approved Date_^____—
nisapproved
. r
STATE OF FLORIDA
DEPARTMENT OF HEALTH
APPLICATION FOR CONSTRUCTION PERMIT
Permit Application Number
---------------------------PART II-SITEPLAN---------------------------
Scale: Each block re resents 10 feet and 1 inch = 40 feet.
75.0 101
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submitted • • • •
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)
CORNER
IN WATER
F.NAIL
BISCAYNE DRAINAGE CANAL
75.00 EDOE OF WATER CORNER
• 1.30' SEA WA IN WATER
6.50' W6bDbECK- � -
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Property Address: Notes: WOOD DECK ENCROACHES QVER NORTH LOT
1361 N.E. 104 Street LINE. FENCES ENCROACH OVER WEST'LOT LINE.
Miami Shores,;FLORIDA 33138
SURVEYOR:CATM:;HERBY THATBOUNDARYBURVEYI8ATRUEAND M.E. Land Surveying,Inc.
CORRECT OF MEDN.DERMYDIRECTION. THISCOMPLEB si - x.tiWRTiTHEMMIMUMTECHIM OMBYTHEMTEOFFLORIDABOARDOF 10665 SW 180th Street
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Accepted By:
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0000•
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Property Address: Notes: WOOD DECK ENCROACHES QVER NORTH LOT
1361 N.E. 104 Street LINE. FENCES ENCROACH OVER WEST'LOT LINE.
Miami Shores,;FLORIDA 33138
SURVEYOR:CATM:;HERBY THATBOUNDARYBURVEYI8ATRUEAND M.E. Land Surveying,Inc.
CORRECT OF MEDN.DERMYDIRECTION. THISCOMPLEB si - x.tiWRTiTHEMMIMUMTECHIM OMBYTHEMTEOFFLORIDABOARDOF 10665 SW 180th Street
PROFESSOHALtANDsu THRouoHsf]-n-atA�FwROA Suite 3110�`�ADMINISTRATIVE CODEPU ,TUES