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PL-19-2567Miami Shores Village 10050 NE 2 Ave Miami Shores FL 33138 305-795-2204 r� If IfiPJUU Issue Date:11/01/2019 Location Address Parcel Number 10603 NE 10TH CT, Miami Shores, FL 33138 1122320280800 f nntartc Permit No.: PL-10-19-2567 Permit Type: Plumbing - Residential Work classification: Septic/Drainfield Permit Status: Approved Expiration: 04/27/2020 MICKAEL LAN RI Owner 10603 10 CT, MIAMI SHORES, FL 33138 Other: 7862463456 A Super Septic & Drain Field Inc Contractor Bryan Zero 7701 W 18 LN, HIALEAH, FL 33014 Business: 3053640113 asuperseptic@gmail.com Ins ect Description: INSTALLATION OF SEPTIC TANK DOSING SYSTEM Valuation: $ 10,000.00 quests: Inspe 2 4 ion Requests: AND NEW DRAINFILED IN TRENCH CONFIGURATION. Total Sq Feet: 0.00 Fees Amount Application Fee - Other $50.00 CCF $6.00 DBPR Fee $5.25 DCA Fee $3.50 Education Surcharge $2.00 Permit Fee $300.00 Scanning Fee $9.00 Technology Fee $8.75 Total: $384.50 Payments Date Paid Amt Paid Total Fees $384.50 Credit Card 11/01/2019 $334.50 Check # 271 10/28/2019 $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 AFFID VIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction an4zoning. Futhermore, I authorize the above named contractor to do the work stated. Authorized Signature:'dwner— / Applicant / Contractor / Agent Date November 01, 2019 Page 2 of 2 BUILDING Miami Shores Village =- LED \\� Building Department oC 2 S 019 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 BY., Tel: (305) 795-2204 Fax: (305) 756-8972 — INSPECTION LINE PHONE NUMBER: (305) 762-4949 FBC+ nq2-0 . — `V� I 1 Master Permit No—2s 6 PERMIT APPLICATION BUILDING ❑ ELECTRIC ❑ ROOFING Sub Permit No. ❑ REVISION ❑ EXTENSION ❑RENEWAL PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS [—]CHANGE OF ❑ CANCELLATION ❑ SHOP (/ CONTRACTOR DRAWINGS JOB ADDRESS: 106013 clz � 1 \ �� ry(?-T— Citv: Miami Shores County: Miami Dade Zip: Folio/Parcel#: Is the Building Historically Designated: Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholde Address:IF J U V C)O2T' o city: �j ra mi �� i•S State: Tenant/Lessee Name: Email CONTRACTOR: Company Name: Address: City: Qualifier Name: State Certification or Re istratio DESIGNER: Architect/Engineer: Ad Phone#: hone#: I E Phone#:,14h " -fos 4 l ' /-©.vim State: Zip: 2T C1 r Phone#;.26 6-- --�i�//3 #: �(as,� %� Certificate of Competency #: Yie/el yZ o2-- State: Zip: Value of Work for this Permit: $�A01) e S Square/Linear Footage of Work: o%�/�? 56,✓. T Type of Work: ❑ Addition ❑ Alteration ❑ Never E Repair lace ❑ Dem v Description of Wor : �/ a �� 4 C S Specify color of color thru tile: Submittal Fee $ Sd Permit Fee $ Scanning Fee $ Radon Fee $ Technology Fee $ Training/Education Fee $ Structural Reviews $ _ (Revised02/24/2014) CCF $ CO/CC $ DBPR $ Notary $ Double Fee $ Bond $ 56 6 • G� TOTAL FEE NOW DUE $ 3 3 9• C 0 934• `3) 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 Zi 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 OWNER or AGENT The foregoing instrument was acknowledged before me this h day ofCT , 20 1 6 by Signature V /CONTRACTOR The foregoing instrument was acknowledged beforemethis �`j L day of , 20 / by 4, on Z0-0 who is personally known to me or who has produced DL as 1�lentif atio nd o did\ake an oath�-,§1'' Y P�"'�//�� A INN 1 OTA SS. i�i ` SNEta�•. Y PUBL j •Gp� pH Sign: cl S Print: l a i •••l a 4ded 11+ �.• Sea I: STAM ��i,,o�l'C .... • •oI�,\\�� /i.._ _.A t**s***•t*�*****��*:ss*****************#*rrs*ss*****#****r**s*s*s*s**s*ss*:*is*sr**rrssr**srs*srr*****:***** APPROVED BY 319 lans Examiner Zoning Structural Review Clerk (Revised02/24/2014) IM STATE OF FLORIDA DEPARTMENT OF HEALTH ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM CONSTRUCTION PERMIT CONSTRUCTION PERMIT FOR: APPLICANT: IUlirhnPl r I anrri OSTDS Repair PROPERTY ADDRESS: 10603 NE 10 Ct Miami, FL 33138 LOT: BLOCK: SUBDIVISION: PROPERTY ID #: 11-2232-028-0800 PERMIT #: 13-SC-2009035 APPLICATION #: AP1448664 DATE PAID. FEE PAID: RECEIPT #: DOCUMENT # : PR1267"5 [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 New SeDtic Tank CAPACITY A [ 0 ] GALLONS / GPD CAPACITY N [ 0 ] GALLONS GREASE INTERCEPTOR CAPACITY [MAXIMUM CAPACITY SINGLE TANK:1250 GALLONS] K [ 225 ] GALLONS DOSING TANK CAPACITY [ ]GALLONS @[ ]DOSES PER 24 HRS #Pumps [ 1 ] D- ( 248 ] SQUARE FEET New Drainfield Trench conf SYSTEM R [ 0 ] SQUARE FEET SYSTEM A TYPE SYSTEM: [ ] STANDARD [ ] FILLED [x] MOUND [ ] I CONFIGURATION: [x] TRENCH [ ] BED [ ] N F LOCATION OF BENCHMARK: ERE: 5.00' I ELEVATION OF PROPOSED SYSTEM SITE [ 12.00][ INCHES FT ][ABOVE BELOW BENCHMARK/REFERENCE POINT E BOTTOM OF DRAINFIELD TO BE [ 12.00][ INCHES FT ][ ABOVE BELOW BENCHMARK/REFERENCE POINT L D FILL REQUIRED: [18.001 INCHES EXCAVATION REQUIRED: [ 12.00] INCHES 0 T H E R 1- Invert elevation and Bottom of drainfield to be no less than 4.59 & 4.00' NGVD respectively. 2- Install a 900 gal. septic tank with an approved filter. 3 - Install 248 sf. of drainfield TRENCH configuration. 4.- Existing SAND at the bottom of the drainfield to remain. Any spoil material UNDERNEATH THE DRAIN FIELD within 24' vertically that has visible signs of effluent shall be removed as part of the repair. THIS PERMIT IS NOT FOR ANY ADDITIONS. (Comments Continued on Page 2.) SPECIFICATIONS BY: Yliana Serra TITLE: Engineering Specialist II APPROVED BY: TITLE: Dade CHD PLUMBING PLANS DATE ISSUED: 10/21/2019 EXPIRATION DATE: 01/19/2020 Approved DH 4016, 08/09 (Obsoletes all previous editions which may not bh used) Incorporated: 64E-6.003, FAC Disapproved Daige 1 of 3 1.1.4 AP1448664 SE1216434 N STATE OF FLORIDA DEPARTMENT OF HEALTH ONSITE SEWAGE TREATMENT SYSTEM CONSTRUCTION PERMIT CONSTRUCTION PERMIT FOR: OSTDS Repair PERMIT #: 13-SC-2009035 APPLICATION # : AP 1448664 AND DISPOSAL DATE PAID: APPLICANT: Michael C Lancri PROPERTY ADDRESS: 10603 NE 10 Ct Miami, FL 33138 LOT BLOCK: SUBDIVISION: PROPERTY ID #: 11-2232-028-0800 FEE PAID: RECEIPT #: DOCUMENT #: PR1267445 [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 New Septic Tank CAPACITY A [ 0 ] GALLONS / GPD CAPACITY N [ 0 ] GALLONS GREASE INTERCEPTOR CAPACITY [MAXIMUM CAPACITY SINGLE TANK:1250 GALLONS] K [ 225 ] GALLONS DOSING TANK CAPACITY [ ]GALLONS 8[ ]DOSES PER 24 HRS #Pumps [ 1 ] D [ 248 ] SQUARE FEET R [ 0 ] SQUARE FEET A TYPE SYSTEM: [ ] I CONFIGURATION: [X] N F LOCATION OF BENCHMARK: F.F.E: 5.00' I ELEVATION OF PROPOSED SYSTEM SITE [ 12.00][ INCHES FT ][ ABOVE BELOW BENCHMARK/REFERENCE POINT E BOTTOM OF DRAINFIELD TO BE [ 12.003[ INCHES FT ]( ABOVE BELOW BENCHMARK/REFERENCE POINT New Drainfield Trench conf SYSTEM SYSTEM STANDARD [ ] FILLED [x] MOUND TRENCH [ ] BED ( ] L D FILL REQUIRED: [18.00] INCHES EXCAVATION REQUIRED: [ 12.001 INCHES 0 T H E R 1.- Invert elevation and Bottom of drainfield to be no less than 4.50' & 4.00' NGVD respectively. 2.- Install a 900 gal. septic tank with an approved filter. 3.- Install 248 sf. of drainfield TRENCH configuration. 4.- Existing SAND at the bottom of the drainfield to remain. Any spoil material UNDERNEATH THE DRAIN FIELD within 24" vertically that has visible signs of effluent shall be removed as part of the repair. THIS PERMIT IS NOT FOR ANY ADDITIONS. (Comments Continued on Page 2.) SPECIFICATIONS BY: Yliana Serra APPROVED BY: TITLE DATE ISSUED: 10/21/2019 TITLE: Engineering Specialist II jq jTMBING PLANS Dade CHD Date. /p: 'EXPIRATION DATE"P- t'-01149/2020 DH 4016, 08/09 (Obsoletes all previous editions which may not be used) Incorporated: 64E-6.003, FAC v 1.1.4 AP1448664 SE1216434 Page 1 of 3 DOCUMENT # : PR 1267445 -The licensed contractor installing the system is responsible for installing the minimum category of tank in accordance with s. 64E-6.013(3)(f) FAC. -The system is sized for 3 bedrooms with a maximum occupancy of 6 persons (2 per bedroom), for a total estimated flow of 300 gpd. -Install a new drainfield to achieve Drainfield size requirement. Thing Lift Dosing. > must be certified as suitable for distributing sewage effluent. ed drainfield area based on rule 64E-6.015(6)(c)2. r ED Zb OCT 8 2 19 3002 N.W. S SUITE 202 SURVEY No. c = MMW FLO A 3126 y * r g TELEPHONE. (305) 22"171 V u 1 Za ru a rs ,�I r • M* 1308) 26I-02" +� DRA*w ay. 44r LAND SURVEYORS SHEET' No. �-otr G BOUNDARY SURVEY! A�F�nb_J BY DATE P T Sl.3JECT 10 CGNIPUAN 'EgTy_Adl. FEDERAL =?V---*P, GULATIONS w rp — ie, ; Y T U teane • pL �� 1(�9 �. �. W STATE OF FLORIDA DEPARTMENT OF HEALTH APPLICATION FOR CONSTRUCTION PEERMIIT�TFLU �� ` Perr�tit AppficBaIloYi`N�rs pp oved a ---------------------------PART II-SITEPLAt�ispprgved___ --- - -.- -Dare- Scale: Each block represents 10 feet and 1 inch = 40 feet. III■11■■■■��i■��■■��■■■■■� 1■■■■■■ I I I Iy,■■■■■�._..._II.■■■■■■■■11■■■■■■ 11 13 Iw i•••••■■■■■■■■■■■■■■:Ill■■■■■■ I � 1■�� '■�■■■■■■■■■■■■■■■■■III■■■■■■ i � li■ 11�!� ■■■■■■■�.��c��®■■■■III■■■■■■ • � �■ i� r;i®��■■��■■■■III■■■■■■a � �■� �� ■■■■■■■■■, . , ��■■�■■■■■III■■■■■� , . ! 1 Notes: �■� ■� ■■■■■■■■■�l��■■■■■■■■■III■■■■■■1 11■11■ ■■■■■■■■■■■■■■■■■■■■III■■■■■■ 11■Lr7 ■■■■■■■■■■■■■■■■■■■■III■■■■■■ !� �■■■ ■■C�'■■■■■ ■■■E��mc��■� car■■■■■1 REPAIR, EXISTING SYSTEM DILAPIDATED. INSTALLING ANEW 900 GALLON, A 225 GA CLON tSOSINto.QMA MOl1NDl:D 225 S.F D.F IN TRENCH CONFIGURATION. • • _ • • • : • • • •: Site Plan submitted by: Plan Approved By of Approved CONTRACTOR Date 10-16-19 _ County Health Department 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) Page 2 of 4 Miami shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 Notice to Owner - Workers' Compensation 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: 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; The officer is listed as an officer of the corporation in the records of the Florida Department of State, Division of Corporations; and 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: caner State of Florida County of Miami -Dade The foregoing was acknowledge before me this CA+h day of , 20(1. By KC, � C AI �• Ln 0 6 who is pers9,Wg1tVy jj,1e or has produced yw '�SSION' ti NGG 287263 o� T - onded�b�° �i�/. jD�6/ic Undec�•• v� \�. A SUPER SEPTIC & DRAIN FIELD INC. CC: SR0161772 PHONE: 305-364-0113 DATE: /0-, Q-t I STATE OF FLORIDA COUNTY OF MIAMI-DARE 7701 WEST 18 LANE HIALEAH, FLORIDA 33014 Licensed and Insured FAX: 305-364-0349 BEFORE ME THIS DAY PERSONALLY APPEARED, /�� j-�I �- Z r= ✓� WHO BEING DULY SWORN, DEPOSES AND SAYS. THAT HE OR SHE WILL BE THE ONLY PERSON WORKING ON THE PROJECT AT: �06 tir iy e�v V-f Contractor Signature: SWORN TO (OR AFFIRMED) AND SUBSVIED TO ME THIS 28t" DAY OF 2019, BY;an�1'Q PERSONALLY KNOWN OR PRODUCED IDENTIFICATION TYPE OF INFORMATION PRODUCED �L Y'�y��/ Z : y NGG 287269 S o. OAD/iC Un6O Z/C STATE PRINT, TYPE, OR STAMP NAME OF NOl9ft0i11111H1\\��\