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PL-01-21-132, 100 NE 101st StMiami Shores Village 10050 NE 2 Ave Miami Shores FL 33138 305-795-2204 ocation Address Contacts Issue date: 01/26/2021 Parcel Number nit Type: Plumbing- Residential Classiftcotion: Septic/orainfield Permit Status: Approved Expiration: 07/ 19/2021 BRYON THOMAS Owner 136 NE 101 ST, MIAMI SHORES, FL 331382321 A Super Septic & Drain Field Inc Contractor Bryan Zero 7701 W 18 LN, HIALEAH, FL 33014 Business: 3053640113 asuperseptic@gmail.com Description: INSTALLATION OF DRAINFIELD AND SEPTIK TANK Valuation: $ 8,500.00 Inspection Requests: 305.762 4949 TotalSq Feet: 150.00 1 1 7::] 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 Building Department Copy Payments Date Paid Amt Paid Total Fees $328.58 Credit Card 01/19/2021 $50.00 Credit Card 01/26/2021 $278.58 Amount Due: $0.00 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 reajdatino construction and zonirA9 Futhermore, I authorize the above named contractor to do the work stated. Adthored Signature: Own —A licant / Contractor / Agent Date Janualry 26, 2021 Page 2 of 2 I`3MNW9?AVSWlV2n �"`°RIU4331" Noun byrur rs .3nr. .im SUR ORS DITAWNlTY.•AL MG-1! ''77 .. ' • .. . . . • .. • ' •' .. . BOUNDARY SURVEY • • • • • • • • . • • . • I. • • GRAPHIC SCALE • * • : : -20 • 0 10 211 40 80 1UMv20FEET • • • • . • • • • • •• •• • • • • • • • • • • • •• • • • . • • • ... ..... • ... • ... 140 • T•RE•E NAIVE 1 DIAMETER (') HEIGHT (') SPREAD ( ) • 1 •OAK TREE ! 1.30 25.00 35.00 • • - �. � i 1.60 j 20.00 20.00 •3CUSTERT.AVELER8OA4 •• .. 1 0.1TD 35.00 20.00 4 ARECA PALM 0.30 ! 20.00 7.00 8 ARE PALM 0.30 I 20.00 7.00 H TMiEAOALDWMM PALM 0.40 I 10,00 6.00 11 TROWAD ALEXANDRA PALM 0.40 10.00 5.00 BIBW�BEALOUOmRAPALM 0.5D I MOD 5.00 BI °149�Ni0 0.60 10.00 8.00 10 BOX TAIL PALM I I 0.60 20.00 MOD 11 OAK TREE 3.00 i 40.00 35.00 ALM] 121TROIEADEXAUO)RA PAL 40.00 I 10.00 30.00 13�SMESEALoWmmPAW; 40.00 10.00 5.00 l4 OAK TREE I IA0 35.00 10.00 15 OAK THE I 1.00_ I 25.00 36.00 16OAK TREE 1.00 26.00 35.00 -- - .I.1-,.. s• 1 '! ♦ ! RIw In 14'/f•IT .� /0�9Io 1'/•6- -6 a to '•� IL or a Is( 19 rc �Tl iTT M_ _ '! I 13 N..101 ro 11 i .9 -4 4• t..Iw It 19 ' TO tl 1! 50 30�;�3 c 100 so: so 94'! Lilm 14. 1l'1[.n w ? X •L ti LEGAL DESCRIPTPDN: SURYEYOFLOr f3 s f4, BLOCK 14 OFALmIIOEDPLAT aFLB4IBSHOREB SgC7pNRp. I ACIQRRNp TO THEPLArTNEREDFAS REMMIN THEPLATBOOR 10, PAGE70. OFTNEPUHL/C RECOIPDSOFMALB.pq�+ppOpiy q,O�pq PROPERTYABORM., fw w f0f sr WAW S110RE.M FL 3313R suRYEYDRSLroTEs: 1xffSHR BEgRORi9AREREFERRED TOANASSULO=DAGR IAN, BYSAIDPLATW THE DESORPTION OF THE PROPERTY. IF NOT. THEN SEARWSS ARE REFERRED TO CCLW Y, TOWNSHIP YAPS. 2). NORM ARROWBASED ON MAT 9} Au ELEVATIONS SHOWNAREREFERR® TO H4710HAL GEODETIC VERTICAL DATUM OF 1929 DARE COLL'" BENCH A94M0 N-0B7. LOCATOR: ft 31M ELEVATIQVIa FEETOFMG.VA.0F(12M. 4). THE GLOSURELN D EBOLHWARYSLWAYISABOVE 1:75WFr. I HEREffYCERTIFr THAT THIS TOLUMARYWAVEYOF THEPROPERTYDESCRiBEp HERECX AS RE CENTLYSEIRVEYEDAND DRAWN UNOERYYsLL;,MM0N, CDVPL(ES WITH THE TEC1N1G1L STANLTAROSAS SET FDRTHBYIHEFLORIDA BOARD OF PROFESSIONAL LAND AMQWl SURVEYORS IN CHAPTER 61017-4 FLORIDAADIBAOSTRATTVE CODE pWMhAHT To41,027. FLORIDA SMITE& i� BY: -GEORGEaMRRA OFF/BD WORIQ PROFESM141. LAND SURVEYOR NO. 2S24 STATEOFFLORIDA STATE OF FLORIDA DEPARTMENT OF HEALTH ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM CONSTRUCTION PERMIT FOR: OSTDS Repair APPLICANT: Bryon John Thomas PROPERTY ADDRESS: 100 NE 101 St Miami, FL 33138 LOT: 13 14 BLOCK: 15 SUBDIVISION: PST #:13-SC-2219290 APPLICATION #: AP1611534 DATE PAID: FEE PAID: RECEIPT #: DocvMENT #: PR1497679 PROPERTY ID #: 11-3206-013-2020 [SECTION, TOWNSHIP, RANGE, PARCEL NUMBER] [OR TAX ID N0148ER] 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 [ 1,050 ] GALLONS / GPD Septic CAPACITY A [ 0 ] GALLONS / GPD CAPACITY N [ 0 ] GALLONS GREASE IN7ZRCEPTOR CAPACITY- [M CAPACITY SINGLE TANK:1250 GALLONS] K [ • 'f 'MwN3 .DoswG TANK CAPACITY [ ] GALLONS @ [ ] DOSES PER 24 =3 #Pumps I ] i! :Poo. 150 �? SOVARE F.W • Trench coniiauration drainfi SYSTEM R ,C 0 ] 'SQUARE'' F2'!.' •' SYSTEM it _TM SYS7'W-:', j*j jtANDARD [ ] FILLED [ ] MOUND I I T.'Ctt&IGURATYON:0 jal'ffENCH [ ] BED t ] .•••. . •••• $ RsocjrxoN OFF sENcAgg; : : , Front door F.F.E. 13.30' NGVD 7••NATION OF PROPOSTD:nTSTEN SITE [ 22.80] INCHES FT ][ABOVE/ BENCIDULRg/REFERENCE POINT E .BOTTOM OF bRAI1FIELb 78OVE [ 57.84 I t INCHEs FT I[ ABOVE /� BENCHMARK/REFERENCE POINT •••••• •••• • • L . • D 0 T H E R rJuLL R&W L U.UU j INCHES EXCAVATION REQUIRED: 50.00 INCHES "THIS PERMIT IS NOT FOR " ADDITION(s) ". Inspector to verify the broken septic tank is properly abandon. 'Invert elevation of drainfield to be no less than 8.98' NGVD. "Bottom of drainfield elevation to be no less than 8.48' NGVD. Install 12" of slightly limited soil under the bottom of drainfield. -Perimeter of excavation area shall be at least 2 ft. wider and longer than the proposed absorption bed or drain trench. The system is sized for 2 bedrooms with a maximum occupancy of 4 persons (2 per bedroom), for a total estimated flow of SPECIFICATIONS BY: A Super Septic TITLE: APPROVED BY: TITLE: Dade CED Carlos td zcaZa DATE ISSUED; 01 /11 /2021 EXPIRMION DATE: 04/11 /2021 DUE DR 4016, 08/09 (Obsoletes all previous editions which ma not used) 11S'gji _ Incorporated• 64E-6.003, FAC Ct11/k'. "-jav__ Page 1 of 3 STATE OF FLORIDA DEPARTMENT OF HEALTH APPLICATION FOR CONSTRUCTION PERMIT Permit Application Number, ---------------------------PART II-SITEPLAN--------------------------- ■ice■■■■■■■■■■■■�������������■ 7faf,itaf,f�f�fifsf,f�� 1■■■■■■■■■■■■■ ■■���■■r :, . ^ .■■■■ I OWNMENEM 11■■■■■■■1 ■' ` �MUD �■ 1■`=� 11 ■� 11 ■111 ■■■■1 ®_®■■■■■®I ■■■■■■■■■■■ I■■■■ 11 ■ 111 ■111 ■■■ I 11®■■■■Ilt�!!I �������� I��� I■■■■ �� ■ 1 �� i�l �� ■■■■ i WEEME■EI- �i�i i f�■■■■■■■ i l �■■�i INN■ ■ JI Notes: REPAIR, REPLACING EXISTING DILAPIDATED SYSTEM, REPLACING EXISTING 900 & 200 SY BED, WITH A 900 & 200 S.F W TRENCH CONFIGIJ ATION D.F. PROPERTY UNINHABITED FOR MORE THAN 9 FEARS NO WATER CONSUMPTION OBTAINABLE AT THIS TME. Site Plan submitted by: Plan Approved Approved CONTRACTOR Date 1-6-21 By County Health Department � n� ALL CHANGES MUST BE Af1�QroV.,�B W�r@EPARTMENT DH 4015, 08109 (Obsoletes previous editions which may not be used) Incorporated: 64E-6.001, FAC Page 2 of 4 (Stock Number: 5744-002-4015-6) IF -LE CF,TVEY3 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 Master Permit No. BX ---� P FBC 20 1 � Sub Permit No. 61 J 2 1 J i 3 ❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL [PLUMBING [:]MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: City: Miami Shores County Miami Dade Zip: Folio/Parcel#: 41- �J/- J f - [f ` -'�� ,_r ,�6�2 / Is the Building Historically Designated: Yes Occupancy Type: " <r Load: Construction Type: Flood Zone: BFE: _ OWNER: Name (Fee Simple Titlehold NO 1---- FFE: Address: = �' ° L (� y City: >>"- 'oz 1/ State: p: Tenant/Lessee Name: Email: 11 1 CONTRACTOR: Company Nametf %�� ���%( ��' / �1�,� //� Phone#:�_ Address: City „ , , State: Zip: Qualifier Name: _ 4 1 Phone#_-:�,:?,�, State Certification or Registration M- I/4 ( z" ;` '� Certificate ificate of Competency #-1 . DESIGNER: Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit: $ Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration ❑ New © Repair/Replace ❑ Demolition Description of Work - Specify color of color thru tile: timittal Fee $ �_ • n Permit Fee $ ing Fee $ Radon Fee $ ,gy Fee $ Training/Education Fee $ 'eviews $ CCF $ CO/CC $ DBPR $ Notary $ Double Fee $ Bond $ TOTAL FEE NOW DUE $ 798-98 S ,L014) Bonding Company's Name (if applicable) Bonding Company's Address City State Mortgage Lender's Name (if applicable) Mortgage Lender's Address Zip 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 be approved and a reinspection fee will be charged. Signature OWNE N The foregoing instrument was acknowledged before me this 1 day of w 20 Z-'� , by �GSA� 3dHgj5,-Y — , wh is personally known to me or who has produced �� ' 2 as Signature 50:,W RACTOR The foregoing instrument was acknowledged before me this �— day of 20 �, I by Ze%tt) , who is personally known to me or who has produced [1. 'T 17 as identification and who did take an oath. identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: Sign' Sign: —74A Print: ••""'•• Print: J'' O Seal:s �= f1'C0*A Seal: ;;�:;"� `; ANAOLGADIAZ EXP) GG0477 =� MY COMMISSION A GG 070327 ceded Z P?` EXPIRES: 20��21 c fe my Pu k Un m Bonded 71uu Notay ####################################### ################# ################ APPROVED BY �--�� i �� j57► Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) SUPER SEPTIC & DRAIN FIELD INC. CC: SR0161772 PHONE: 305-364-0113 ,ATE: I.11- X ATE CF FLORIDA :'AUNTY OF NIIAMI-DADS 7701 WEST 18 LANE HIALEAH, FLORIDA 33014 Licensed and Insured FAX: 305-364-0349 SEFORE ME THIS DAY PERSONALLY APPEARED. L�r'�ri► 2 I%IHO 3EING DULY SWORN, DEPOSES AND SAYS: THAT HE OR SHE WILL BE THE ONLY PERSON WORKING ON THE PROJECT AT: 120 m, t ( o t S fi- 7) 31 2 :ontractor Sisnature: SWORN TO (OR AFFIRMED) AND SUBSCRi6 TOME THIS It DAY OF Ahum r1 A BY: =ERSONALLY KNOWN 1� PRODUCED IDENTIFICATION -': ?E OF INFORMATION PRODUCED FL �� L. • ANAOLGADWZ • W COMMISSION / GG 070327 �. EXPIRES: FebmM 6. 2021 i iM�dedTMuNafalrP�1O = RINT. TYPE, OR STAMP NAME OF NOTAP..`r 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: I . 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 re State of Florida County of Miami -Dade The foregoing was acknowledge before me this �_ day of5.20 �. 75�VIOSNA —m—am who is personally known tome or has produced DZ as identification. Notary: SEL.ENA ARANDA SEAL: = My COMMISSION # GG 971705 _';, EXPIRES: March 22, 2024