PL-12-20-2912, 241 NW 91st StR Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795-2204 Fax: (30S) 756-8972
INSPECTION LINE PHONE NUMBER: (305) 762-4949
FBC 2®CI
BUILDING Master Permit No. � C—( f
PERMIT APPLICATION Sub Permit No.PL I Z1,10 Lq I
❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS
JOB ADDRESS: 241 NW 91 Street
❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
City: Miami Shores County: Miami Dade Zip: 33138
Folio/Parcel#:11-3101-033-1340 Is the Building Historically Designated: Yes NO X
Occupancy Type: Load: Construction Type:
OWNER: Name (Fee Simple Titleholder): Lori Brandt
Address:241 NW 91 Street
City: Miami Shores State: FL
Tenant/Lessee Name:
Email
Flood Zone: BFE: FFE:
one#: (786) 553-1962
Phone#:
33138
CONTRACTOR: Company Name: Mr- C's Plumbing & Septic, Inc. Phone#: 305-651-7859
Address: 19932 NW 2nd Avenue
City: Miami State: FL Zip: 33169
Qualifier Name: Kemble Ettrick Phone#: 305-651-7859
State Certification or Registration #: S R0061536 Certificate of Competency #:
DESIGNER: Architect/Engineer: N/A 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: Install new septic tank.
Specify color of color throe tile:
Submittal Fee $ !Hz) v Q Permit Fee $
Scanning Fee $ Radon Fee $
Technology Fee $
Training/Education Fee $
CCF $
DBPR $
CO/CC $
Notary $
Double Fee $ _
Structural Reviews $
(Revised02/24/2014)
Bond $
TOTAL FEE NOW DUE $ `J P, -
a
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
Im
Zip
0
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 2O by
Lori Brandt who is personally known to
me or who ha� ducecl �YI V e"5 G c"Se,
identification and who did take an oath.
Signature ��—
CONTRACTOR
The foregoing instrument was acknowledged before me this
14 day of December 2p 2O by
Kemble Ettrick 'who is personally known to
me or who has produced
identification and who did take an oath.
NOTARY PUBLIC: NOTARY PUBLIC:
as
Sign: Sign: i V"
Print: Print:
••:o3yYPbp_ DONALD MARTIN
Seal: Seal: `•DONALD MARTIN
MY COMMISSION # GG102743 ;=o,• `4¢.:
EXPIRES May 09, 2021 _ MY COMMISSION # GG102743
'? EXPIRES May 09, 2021
********************************************************************** ********** ******
APPROVED BY -~ I%'/`r �G Plans Examiner
Zoning
Structural Review
(Revised02/24/2014)
Clerk
STATE OF FLORIDA
DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT AND DISPOSAL
SfSTEM
CONSTRUCTION PERMIT FOR: OSTDS Repair
APPLICANT: (Lori Brandt)
PROPERTY ADDRESS: 241 NW 91 St Miami, FL 33150
LOT: 19 & 20 BLOCK: 136 SUBDIVISION:
PST #: 13-SC-2214293
APPLICATION- if : AP1607949
DATE PAID:
FEE PAID:
RECEIPT #:
DOCENT #: PR149"89
PROPERTY ID #: {SECTION, TOWNSHIP; RANGE, PARCEL NUMBER]
[OR TAX ID NUMBER]
v
s
SYSTEM MUST BE CONSTRUCTED IN ACCORDANCE WITH SPECIFICATIONS AND STANDARDS OF SECTION
381.OQ65, 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 ttIS PERMIT DOES NOT EXEMPT THE APPLICANT FROM COMPLIANCE WITH FEDERAL,
STATE, OR LOCAL'RERNITTING REQUIRED FOR DEVELOPMENT OF THIS PROPERTY.
SYSTEM DESIGN AND SPECIFICATIONS -
T { 900 ] GALLONS / GPD Seotic Tank TO BE REPLACED CAPACITY
A j 0 ] GALLONS / GPD CAPACITY
N [ 0 ] GALLONS GREASE INTERCEPTOR CAPACITY (MAXIMUM CAPACITY SINGLE TANK:12 0 N;]
K { *}*GALLONS DOSING TANK CAPACITY { ]GALLONS @[ ]DOSES PER 24 1 nn #Pumps [
• • • .: 0000 • • • I
'D [ • 20Q • ? .SQUARE �L•EET O Bed TO REMAIN SYSTEM
l • t e s 0-1 S¢UARE ;FEET ; SYSTEM *r��
A*TYPE SYSTEM: *jkj'§TANDARD [ ] FILLED [] MOUND [ ] l
i CONFIGUURABIOIS: • [ a TRENCH [x] BED j ]
••.. • •• ••••••
•
F•LOCATIoffi;Q13' �icHMA:, • Crown of the road iniine with front door 11.6' NGVD
• I ELEVATION OOF PROPOeec WSTEM SITE [ 3.60 7 INCHES FT ] { ABOVE
BOTTOM Gf 09R1:INFIiW W BE [ 43.60 ] IDTCHSS FT ] [ ABOVE
• .. . ••
D E
0
T
H
E
R
POINT
BENCHMARK/REFERENCE POINT
'ILL REQ 1 ( 0.00 ] INCHES EXCAVATION _ REQUIRED: [ 40.001 INCHES
I. -The existing 300 sf bed drainfieid, certified by Mr. C's Septic on 12/17/2020 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) comers 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. -
24n, stall 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-s,(\KEMBLE ETTRICK TITLE:
APPROVED BY: TITLE: Engineering Specialist II Dade CHD
pith A Davis
DATE ISSUEb: 12/1 020 EXPIRATION DATE: 03/17/2021
DH 4016, 08/09 (Obsoletes all previous editions which may not be used)
Incorporated: 64E-6.003, FAC Page 1 of 3
v 3..1..4 AP1€07949 azi452a82
STATE OF FLORIDA
DEPARTMENT OF HEALTH
APPLICATION FOR CONSTRUCTION PERMIT
Pea tit Application Number
There are fo{�J*tCnent felure; on adjacent properties and or across the street that may affect the New Septic System Installartorl
Notes: q-
C-e
Site Plan submitted
Plan Approved "'V
Not Approved
1 ,N
Date l `mac
County Health Department
ALL CHANGES MUST BE APPROVED BY THE COUNTY HEALTH DEPARTMENT
DH 4015, W09 (ObS011,el0sk WC--vious 86itions which MAy flot be U*oa) FAC Page 2 of 4
(Stock Numbv: 5:?44-002-4015-6)
STATE OF FLORIDA
DEPARTMENT OF HEALTH
APPLICATION FOP, CONSTRUCTION PERMIT
Permit Application Number
There are Anent features on adjacent,properties and or across the streetAhat may affect the New � Septid, System Instailation f wi
--�41 LZ
Notes: N
Site Plan submitted% IA�- `
Plan �ppLovad;:?- � Not Approved
By
Date
County Health Department
0H 4015, W'09 (Obsolplet- prp-Ociis Editions whivirgay nol, be useel, McortwrAtorj: 64L-6-001, FAC, of 4
(S*-A:w* Nufnbw� 67144-002-4015-6)