PL-3-17-755 CanceledMiami Shores Village
.� g
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
UL 1 9�2015
FBC 20 14
�T�t
BUILDING CANCELLED Master Permit No.-P U« — 2-0( G
PERMIT APPLICATION Sub Permit No.
❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
dLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS:
City:
Miami Shores
Countv
Miami Dade zip:.
Folio/Parcel#:
- (D' —C�
-{ �
Is the Building Historically Designated: Yes NO
Occupancy Type:
Load:
Construction Type:
Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder): 1_��-r�a1 (� 1(^� l Phon'e#:' 11;('
Address: o c 1 0
City: Cy_N\Q State: ` Zip: `� 1
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR: Companyo)
Name: rpr��k��C' ( lL Phone#:
Address: 14-) QC_1 k %
City: CC �G State: Zip:
Qualifier Name:
State Certificatic
DESIGNER: Architect/Engineer:
Phone#:
mcy #:
Phone#:
Address: City: State: Zip:
Value of Work for this Permit: $�(`� . �� Square/Linear Footage of Work: Q-1",_
Type of Work: ❑ Addition ❑ Alteration ❑ New _ 2epair/Replace ❑ Demolition
Description of Work: �_ ( \ V--
1 at_'e.ck .6 N PC --a -I-) - Iss
Specify color of color thru tile:
Submittal Fee $ Permit Fee $ � CCF $ CO/CC $
Scanning Fee $ Radon Fee $ c . DBPR $ vas Notary $ _
Technology Fee $ 2 : �40 �y
Training/Education Fee $ (s. G Double Fee $
Structural Reviews $ Bond $ 1�03 .
TOTAL FEE NOW DUE $
(Revised02/24/2014)
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 4OWNE
2!f7
d.
SignatureSignature 2 "ice
CONTRAC
The foregoing instrument was acknowledged before me this
day of �,L 20 l `p by
s CW1 C�100, who is personally known to
me or who has produced V I— � L as
identification and who did take an oath.
NOTARY PUBLIC:
Sign
Prin
Seal: W
JERRICA L. ARMSTRONB
N"YPU �IC-StOofFbft
s CQI�tNtibe I FF JVW
APPROVED BY
R
The foregoing instrument was acknowledged before me this
1-4 day of 0 1 L 201(e _, by
7
►�Y1t who is personally known to
me or who has produced as
identification and who did take an oath.
NnTARV PI IRI I!'•
Sl ..
JERRICA L. ARMSTRONB
;. NotMp'ubllC • Stets of FW"Ws
**$011111NHibRFfkfl9** ***********
'��;,qC„��.•� My Comm. Expires Feb 9, 2019
Plans Examiner Zoning
(Revised02/24/2014)
Structural Review
Clerk
il,}�->AiR.r{�+.at'.`t;e_.;lt+a.wu�s� �`.adliewa�. 46wallik..
2fA r
l7Y1C1i�14i4i�i'S ''v!Rfe�t � ° ;,stti;•
' h
ONOto �f6�� rii.,�'t � ''� !i
$.S�'•r6? � � � �Er S'+R\ea1PPMt14f :. 1 .
C l ►��`%Cvrs1'�'c�cTc�'
REPAIK
A�lr�MI.DA DF COt1NTY HFAI. D 1+�
STATE OF FLORIDA
DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM
CONSTRUCTION PERMIT
PERMIT #:13-SC-1691387
APPLICATION # : AP 1245695
DATE PAID:
FEE PAID:
RECEIPT #:
DOCUMENT #: PR1025453
CONSTRUCTION PERMIT FOR: OSTDS Repair
APPLICANT: Brandon Simon
PROPERTY ADDRESS: 162 NE 106 St Miami, FL 33138
LOT: 3 BLOCK: 201 SUBDIVISION: Dunnings Miami SHores Ext No 1
PROPERTY ID #: 11-2136-005-0030 [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 J GALLONS / GPD
septic tank
CAPACITY
A [ ] GALLONS / GPD
CAPACITY
N [ ] GALLONS GREASE
INTERCEPTOR CAPACITY
[MAXIMUM CAPACITY SINGLE TANK:1250 GALLONS]
K [ J GALLONS DOSING
TANK CAPACITY [
]GALLONS @[ ]DOSES PER 24 HRS #Pumps
D [ 200 ] SQUARE FEET
R [ ] SQUARE FEET
A TYPE SYSTEM: [X]
I CONFIGURATION: [ ]
N
Bed configuration drainfiel SYSTEM
SYSTEM
STANDARD [ ] FILLED [ ] MOUND [ ]
TRENCH [X] BED [ ]
F LOCATION OF BENCHMARK: center line of NE 106 St. 10.16' NGVD
I ELEVATION OF PROPOSED SYSTEM SITE [ 3.12 ][ INCHES FT ][ABOVE BELOW BENCHMARK/REFERENCE POINT
E BOTTOM OF DRAINFIELD TO BE [ 51.121[ INCHES FT ][ABOVE BELOW BENCHMARK/REFERENCE POINT
L
D E
0
T
H
E
R
ILL F'EQu.LxB:IJ: t 1 1NUHZ5 EAUAVATIUN XNgUTAZU: t hU.UU 1 1NUHN6
1.-Install a 900 gal min. septic tank with an approved filter.
2.-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.
3.-Install 200 sf of drainfield in bed configuration.
4.-Install 12" of slightly limited soil at the bottom of the drainfield.
5.-Perimeter of excavation area shall be at least 2 ft wider and longer than the proposed absorption bed or drain trench.
(Comments Continued on Page 2.)
SPECIFICATIONS BY: Teresa J Solomon TITLE: Master Septic Tank Contractor
APPROVED BY: TITLE: Engineering Specialist II Dade CHD
Erlande Omisca
DATE ISSUED: 07/12/2016 EXPIRATION DATE: 10/10/2016
DH 4016, 08/09 (Obsoletes all previous editions which may not be used)
Incorporated: 64E-6.003, FAC co?.4 I flACTOil, s o 8 fl it FOR ING
v 1.1.4 AP1245695 SE1001556 6•
The gnee) is required to pErfoml a Soil borne
„"�.. .. EX Va.Ofi at tl�:. ti.^e OT i'^
Approval, the FDOH inslectcr shal
w;tr,�ss the so ng and compare the resjts to ,�e orgira
s :• evaluaticn submitted. A reinspection [ee v0(l be assessec
the contracts; is not at the jobs .e at the prr2oGe•+ ?:m2