PL-12-20-2910, 55 NE 94th StMiami 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
BUILDING
PERMIT APPLICATION
❑BUILDING ❑ ELECTRIC ❑ ROOFING
QPLUMBING ❑ MECHANICAL ❑PUBLIC WORKS
JOB ADDRESS: 55 NE 94 Street
FBC 2011
Master Permit No.
Sub Permit No. �' I Z C1 I
❑ REVISION ❑ EXTENSION ❑RENEWAL
❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#:11-3206-013-0560 Is the Building Historically Designated: Yes NO X
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder): Joseph Sawyer Phone#: (989) 780-0638
Address:55 NE 94 Street
City: Miami Shores state: FL Zip: 33138
Tenant/Lessee Name:
Email
CONTRACTOR: Company Name: Mr. C's Plumbing & Septic, Inc. Phone#: 305-651-7859
Address: 19932 NW 2nd Avenue
City: Miami
State: FL
Qualifier Name: Kemble Ettrick
State Certification or Registration #: SR0061536
DESIGNER: Architect/Engineer: N/A
Zip: 33169
Phone#: 305-651-7859
Certificate of Competency #:
Phone#:
Address: City: State: Zip:
Value of Work for this Permit: $ (7- Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration ❑ New Repair/Replace ❑ Demolition
Description of Work: Install new septic tank.
Specify color of color thru tile:
Submittal Fee $�� —,-Permit Fee $
Scanning Fee $ Radon Fee $
Technology Fee $ Training/Education Fee $
Structural Reviews $ _
CCF $
DBPR $
CO/CC $
Notary $
Double Fee $
Bond $ /\
TOTAL FEE NOW DUE $ �o� U
(Revi sed02/24/2014)
Bonding Company's Name (if applicable) N/A
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
OWNER or AGENT
The foregoing instrument was acknowledged before me this
14 day of December , 20 20 by
Joseph Sawyer 'who is personally known to
me or who has produced ( n\ � b (-k S'c- as
identification and who did take an oath.
NOTARY PUBLIC:
Sign
Print:
Seal: a_ MY COMMISSION # GG102743
EXPIRES May 09, 2021
CONTRACTOR
The foregoing instrument was acknowledged before me this
14 day of December , Zo 20 , by
Kemble Ettrick who is personally known to
me or who has produced
identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print: _ t " I d /U -✓
�;;<Ya" DONALD MARTIN
Seal:` -
MY COMMISSION # GG102743
EXPIRES May 09, 2021
rM
************************************************************************************************************
APPROVED BY fj /1, Plans Examiner
Zoning
Structural Review
(Revised02/24/2014)
Clerk
STATE OF FLORIDA
DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT AND DISPOSAL
SYSTEM
CONSTRUCTION PERMIT FOR: OSTDS Repair
APPLICANT: (Josepth Sawyer)
PROPERTY ADDRESS: 55 NE 94 St Miami, FL 33135
LOT: 18 &19 BLOCK: 4 SUBDIVISION:
PERMIT # :13-SC-2214292
APPLICATION #:AP1607948
DATE PAID:
FEE PAID:
RECEIPT #:
DOCUMENT #: PR1494483
PROPERTY ID #: 11-3206-013-0560 [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 DESIOtN "D SPECIFICATIONS
900 ;• GALLONS• y 6D Seotic Tank TO BE REPLACED CAPACITY
A•Y.•• 0' 'aLLON•S / GgD CAPACITY
N•f 0 ]•GALLONS %U41E INTERCEPTOR CAPACITY [MAXIMUM CAPACITY SINGLE TANK:1250 GALLONS]
tK•j•'• I GALLONS DOSIAIG TANK CAPACITY [ ]GALLONS [ ]DOSES PER 24 HRS #Pumps [
• • • • •
••••• • •• ••••••
.... • J. S
D � 300 ARE MTO• Bed T(7REMAIN SYSTEM
+R• �• •: 0 ) SQ1JARE FttT* SYSTEM
TYPE SYSTEM: •r2.]"*ANDARD [ ] FILLED [ )
1• jCoNFIGURA; TONi •[ � RENCH [x] BED [ ]
• •
9000• • •
F LOCATION* W btNCHMARK: Crown of the road inline with the front door 11.2' NGVD
I ELEVATION OF PROPOSED SYSTEM SITE [ 110 ] [ INCHES ' FT ] [ AB011E BELOW BENCHMARK/REFERENCE POINT
MOUND [ ]
E BOTTOM OF DRAINFIELD TO BE [ 51.20 ] [ INCHES FT ] [ A-BOVE 41iLOW BENCHMARK/REFERENCE POINT
L
D F
0
T
H
E
R
'ILL REQUIRED: [ 0.00 ] INCHES EXCAVATION REQUIRED: [ *U.UU 1 is UM16s
1.-The existing 300 sf bed drainfield, certified by Mr. C's Septic on 12/16/2020 may remain if the system was previously
permitted and approved, and not currently in failure, and meets the setback requirements of Table V Ch 64E-6 FAC. The
four (4) corners of the drainfield shall be exposed so that the DOH inspector can verify the size as specified in DH 4015 Pg
4 - Existing System Evaluation.
2.-Install a 900 gal min. septic tank with an approved filter.
3.-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.
SPECIFICATIONS BY: KEMBLE ETTRICK TITLE:
APPROVED BY: TITLE: Engineeriirg'sj�ec5.61ist II Dade CHD
Danith A Davis
DATE ISSUED: 12117/2020 g1��L7r ���, � EXPIRATION DATE: 03117/2021
DH 4016, 08/09 (Obsoletes all previousAeditions which may not be used}
Incorporated: 64E--6.003, FAC Page 1 of 3
STATE OF FLORIDA
DEPARTMENT OF HEALTH
APPLICATION FORCONSTRUCTION PERMIT
Perm[( Application.Number
t� In
z
0 0
0 -1i VN
0 0 0
0 6:0 0 0
0:
•
0 0 0 0 0 0 •
There are no pertinent features on adjacent properties'and or across the street that may affect the New Septic Systern Installation
I -
Notes: A 4 G4 - �-ei r, rvL-i,
!�? 64 tip Pce,.4\
Site Plan submitted
Plan Api2roved. 'V
By
Not Approved
Dbt6
County Health Department
Page.2 nf 4.
Number, 5744-0412-4011-6)
STATE OF, FLORIDA
DEPARTMENT OF'HEALTH
Lipeuc&Tl
Permit, Application Number.
•
**+&so
I
LL
o ei,
4i 0
7,
There are no pertinent features, o ' madjacent properties and or across the street that rnay affect the Now Septic System Installation
s4 -
Site Plan submitted
I
2
Da te4LI70
County Health Department
ALL CHANGES MUST BE APPROVED BY THE COUNTY HEALTH DEPARTMENT
DH 4015t rx {GbsoiO-L s PrOVious odlttonF, vAI idn may net bo u,ed1 ticAx-ponai-nd; 64E-ff;) 1, ?-Ate:. Page 2 of 4
kSloc* Nmber. 5744-VU-4015-6)