PL-19-2736BUILDING
PERMIT APPLICATION
Miami Shores Village - �`" 1 1
Building Department NOV 1 5• ZOi9
BY: i
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795-2204 Fax: (305) 756-8972
INSPECTION LINE PHONE NUMBER: (305) 762-4949 pt --1 — ) 4-1-70
ABC 20
Master Permit No. — 1-- I I — , V
Sub Permit No.
❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION EXRENEWAL
PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF [:]CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: 117 NW 103 Street
City: Miami Shores County: Miami Dade Zip: 50
Folio/Parcel#: 11-2136-013-157033 Is the Building Historically Designated: Yes NO X
Occupancy Type: Vacant Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder): Vincent R. LeVros Phone#:
Address: 750 i..G +en
City: crgylston State: PIT- Zip: 02-9Z_1
Tenant/Lessee Name:
Email:
Phone#:
n �• � O ,, SOS
A p
CONTRACTOR: Company Name: A ri ^''�`-'� Phone#:
Address: (a 0 Z2 �'S a 3S CA
City: M 1"'(-annar State: MZ Zip: e'-7) 30 2.3
Qualifier Name: t_ O hn L)Cj� Phone#:
State Certification or Registration #: Certificate of Competency #:
DESIGNER: Arch itect/Enginee r:1 Phone#:
Address: City: State: Zip:
Baa
Value of Work for this Permit: $ 'JDOO Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration ❑ New [� Repair/Replace ❑ Demolition
Description of Work:
Specify color of color thru tile:
Submittal Fee $ Permit Fee $ CCF $ CO/CC $
Scanning Fee $ Radon Fee $ DBPR $ Notary $
Technology Fee $ Training/Education Fee $
Structural Reviews $
(Revised02/24/2014)
Double Fee $
Bond $
TOTAL FEE NOW DUE $ �� Q
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. A
1
Signature A�� A.- 4--V Signature
G'
OWNER or AGENT
The foregoing instrument was acknowledged before me this
% day of NO' 20 19 , by
ut ce,.i+ L QYV5 , who is personally known to
me or who has produced F,g ( n as
identification and who did take an oath.
NOTARY PUBLIC:
Sign: ^�
Print:
CONTRACTOR
The foregoing instrument was acknowledged before me this
day of p� t%K>-4 20 1' by
CSbhn who is personally known to
me or who has produced t''"A lb as
identification and who did take an oath.
NOTARY PUBLIC:
Sig
Print: �Q-rPS �Ao
Seal: TERES J. SOLOMON Seal: ,
* * MY COMMISSION It FF 928141 7 FRES J. 30i.06(pA►
EXPIRES: November 8, 2019 w * My COMMISSION B FF 928141
Bonded Thru BWpt Notary Sorka a,� `O� EXPIRES: November 8, 2019
APPROVED BY _ U//��g Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)
14
STATE OF FLORIDA
DEPARTMIM OF HEALTH
ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM
CONSTRUCTION PERMIT
CONSTRUCTION PERMIT FOR: OSTDS Repair
APPLICANT: Adette & Vincent Levros
PROPERTY ADDRESS: 117 NW 103 St Miami, FL 33150
LOT: 21, 22 BLOCK: 127 SUBDIVISION: Miami Shores Sec 5
PROPERTY ID #: 11-2136-013-1570
PERMIIT #:13 -SC -1514084
APPLICATION #:AP1131350
DATE PAID:
FEE PAID:
RECEIPT #:
DOCUMENT #TR926624
[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
T [ 650 ] GALLONS / GPD existing septic tank CAPACITY
A [ ] GALLONS / GPD CAPACITY
N [ ] GALLONS GREASE INTERCEPTOR CAPACITY (160MfUM CAPACITY SINGLE TANK:1250 GALLONS]
K ( ] GALLONS DOSING TANK CAPACITY [ ]GALLONS ®( ]DOSES PER 24 HRS #Pumps [
D ( 150 ] SQUAME FEET
R ( ] SQUARE FEET
A TYPE SYSTEM: (x]
I CONFIGURATION: (x]
N
F LOCATION OF BENCHMARK:
trench configuration drainf SYSTEM
SYSTEM
STANDARD I ] FILLED [ ] MOUND
TRENCH [ ] BED ( ]
FFE 12.9 NGVD
I ELEVATION OF PROPOSED SYSTEM SITE
E BOTTOM OF DRAINFIELD TO BE
L
D F
[ 30.00 ] INCHES FT ] [ ABOVE BENCHMARK/REFERENCE POINT
[ 68.00 ] (IINCHES FT ] ( ABOVE �� BENCHMARK/REFERENCE POINT
ILL REQUIRED: ( ] nwms EXCAVATION REQUMMU: _L_ j5-UU J -LJN a
I. -Existing 650 gal. septic tank, certified by A Aaron Super Rooter on 01/07/2014, to remain.
2. -Install 150 sf of drainfield in trench configuration.
3. -Perimeter of excavation area shall beat least 2 ft wider and longer than the proposed absorption bed or drain trench.
4. -Invert elevation of drainfield to be no less than 7.73' NGVD.
5. -Bottom of drainfield elevation to be no less than 7.23' NGVD. i
(Comments Continued on Page 2.)
SPECIFICATIONS BY: Teresa J Solomon TITLE: Master Septic Tank Contractor
APPROVED BY: ��,_ TITLE: Engineering Specialist II Dade CHD
8rlaade Cmisca
DATE ISSUED: 01/10/2014 mcpIERTioN DATE: 04/102014
DH 4016, 08/09 (Obsoletes all previous editions which maY not beTh! con(Or designee) is required �l�Q� $soil
Incorporated: 64E-6.003, FAC
AP1131350 boring adjaqjgj;%tfle dreUfield excavation at the time of final
Inspection. Prior to Final Approval, the FDON inspector shall
witness the soli boring and compare the results to the original
site evaluation submitted. A reinspectlon fee will be assessed
if the contractor Is not at the jobslte at the arranged time.
`^'+a"eS=.1 a -rr -a gr �C �p�r,�e„ ) M- iy< ,S.:.aF .�,•v?t, 1m�.'S C F ✓..,�'{:-
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FLORIDA
s . _ . ' DEPARTMENT OF HEALTFI
APP ICATION'POR ONSITE SEWAGE DISPOSAL" SYSTEM CONSTRJCT(OfV PERMIT
t Permit Applical;on Nuns l� - --
PART II SITE PLAN
Scale: Each.block repres nts 5 feet and 1 inch - 50 feet."SO A
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Signature rt €
Not Approved Date
_
.Count/ Health.Departmer
HANGES.MPPT.BE.APPROVED BY THE COUNTY HEALTH DEPARTMENT
1
164ACh may ba aced)