REV-09-19-2240, 9518 N Miami Ave!kA 1�It�201I Miami Shores Village
(6(2A--) I)o Building Department SEP 25 2019
10050 N.E.2nd Avenue, Miami Shores, Florida 33138 e�
Tel: (305) 795-2204 Fax: (305) 756-8972
(1` PHONE NUMBER: (305) 762-4949 Ij
S 0 FBC 20 11
BUILDING _ Master Permit No. ' C�.
PERMIT APPLICATION y� "" - .��...� � (� ICi -22�
Sub Permit No.
f�QBUILDING ❑ ELECTRIC ❑ ROOFING REVISION ❑ EXTENSION ❑ RENEWAL
❑ PLUMBING ❑ MECHANICAL ❑ PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
C /, _ ` 1 CONTRACTOR DRAWINGS
JOB ADDRESS: J !) I/ /'� I�� �CI L) C 7
City: Miami Shores County: Miami Dade Zip: J -3
Folio/Parcel#: Is the Building Historically Designated: Yes NO
Occupancy Type: Load: ,Construction Type: Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder): Y"l G Q i� 4 /t:j 6 C, A Q &/((Phone#: _-3 0 _S D 1
Address: C -</6 iV 1q11i" L V &
City: 14 ( P7 ^ 57l/0 X&V State: Zip: 3 3 /S'o
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR: Company Name: Phone#:
Address:
City: State: Zip:
Qualifier Name:
State Certification or Registration #:
DESIGNER: Architect/Engineer:
Ad
Value of Work for this Permit:
Phone#:
Certificate of Competency #:
hone#:
City: State: T W ,5
Square/Linear Footage of Work: i ?
Type of Work: ❑ Addition ,0 Alteration ❑ New
❑ Repair/Replace ❑ Demolition
Description of Work:
Specify color of color thru tile:
Submittal Fee $ 5; Permit Fee $
Scanning Fee $
Technology Fee $
Structural Reviews $
Radon Fee $
Training/Education Fee $
CCF $ CO/CC $
DBPR $
Notary $
Double Fee $
Bond $
TOTAL FEE NOW DUE $ I (� = 3c)
(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 will not be approved and a reinspection fee will be charged.
Signature Signature
0 NER or AGENT CONTRACTOR
The foregoing instrument was acknowledged before me this
day of 20 19 by
ois personally known to
me or who has produced �2{��~� as
identification and who did take an oath.
NOTARY PUBLIC:
The foregoing instrument was acknowledged before me this
day of
me or who has produced
20 by
, who is personally known to
identification and who did take an oath.
NOTARY PUBLIC:
as
Sign:
,.
Sign:
Print:
-� :z _,, IS 0-CS
Print:
Seal:
u,t yo,P,�
Seal:
APPROVED BY
/
Plans Examiner / Zoning
Structural Review
Clerk
(Revised02/24/2014)
MAP OF BOUNDARY SU
P.B. 10 - PG. 39
9' ASPHALT PAVEMENT —
15'ALL]EY'
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ORTH MIAMI AVENUE
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2
**Arc Pg. Page ABBREVIATIONS & LEGEND �
—Chain Link Fence
qD Found R/W Right —of —Way @ Unknown Manhole Fire Hydrant -—Wood
F• :Jtility E;p9("dht Sewer Manhole
Fence
Metal
0 (� Center Line @ E Electric Box
or plastic
:so**:
•
• 1p "Iron Pipeeose y 0
- Monument Line (D Telephone Manhole �`!Lp Light Pole
Fence
—Overhead
06460
OR Iron Reiperoos, Temporary WM
TBM porary N Water Meter `Q, Utility Pole
Nail & Di* Benchmark
OUL
Utility line
•,ti4il],
4
4600*4 PWY Parkway wv Water Valve MCLP
050L.. :Column Concrete Light Pole
0•o W/P Water Pump M
+ Spot Elevation
•
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.,3 PLat 13� ke ENC Encroachment 11M Catch basin 0 Property Corner
see*
FormTech
Job # 19-06044
Date: 06-17-2019
Scale: 1 20'
Land Surveying, Inc.
State of Florida LB # 7980 0 10, 20'
40'
12209 S.W. 129th Court, Miami, Florida, 33186
Ph: (786)429-3034 (786)443-0285 (786)443-0678 GRAPHIC SCALE
www.formtechsurveyors.com email:info@formtechsurveyofs.com
Page 2 of 2
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Mission:
To protect, promote & improve the health
of all people in Florida through integrated
state, county & community efforts.
Vision: To be the Healthiest State in the Nation
October 11, 2019
Miguel Tembladera
9518 N Miami Avenue
Miami, FL 33150
RE: Contingency Letter
Application Document No: AP1435257
Centrax Permit Number: 13-SC-1993066
OSTDS Number:
9518 N Miami Ave
Miami, FL 33150
Lot:4 Block:131 Subdivision:
Ron DeSantis
Governor
Scott A. Rivkees, MD
State Surgeon General
Dear Applicant:
This will acknowledge receipt of an application dated 09/25/2019 for a permit to use an existing
onsite sewage treatment and disposal system located on the above referenced property.
NO OBJECTION DECK AROUND POOL
Review on 10/11/2019 by Frantz Toussaint
NO OBJECTION LETTER ISSUED FOR A NEW DECK AROUND POOL INSTALLATION:
NO IMPACT OVER THE SEPTIC SYSTEM INSTALLATION
From a review of your completed application, it has been determined that your existing system
appears to meet the minimum standards of F.A.C. 64E-6 for the proposed use. It is approved for
use with the plans submitted to this office. If this system should fail, causing an unsanitary
condition to exist, steps must be taken to bring the system into compliance immediately.
Department approval of the 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 approval
requires the applicant to modify the permit application. Such modification may result in this
approval being made null and void. Issuance of this approval does not exempt the applicant from
compliance with other Federal, State, or Local Permitting required for development of this
property.
If you have any questions on this matter, please call our office at (786) 315-2446.
Sincerely,
Frantz Toussaint, ENGINEERING SPECIALIST II
Florida Department of Health www.Florid&Health.gov
in DADE COUNTY TWITTER:HealthyFLA
1725 NW 167 St, Opa Locka, FL 33056 FACEBOOK:FLDepartmentofHealth
PHONE: (305) 623-3500 FAX: (305) 623-3645 1 YOUTUBE: fldoh
Miguel Tembladera
Page two
October 11, 2019
Enclosures
cc: