PL-09-249Protect Address
Miami Shores Village
10050 N.E. 2nd Avenue
Miami Shores, FL 33138 -0000
Phone: (305)795 -2204
11016 2 Avenue
Miami Shores, FL 33138-
1121360020250
Block: Lot:
NHS HOUSING DEVELOPMENT
Owner Information
NHS HOUSING DEVELOPMENT LLC
Contractor(s)
A SUPER SEPTIC TANK, INC.
Phone
(05)364-0113
Cell Phone
Type of Work: PLUMBING
Type of Piping: SEPTIC & DRAINFIELD
Additional Info: MODULAR HOME
Bond Retum :
Classification: Residential
Fees Due
Bond Type - Contractors Bond
CCF
Education Surcharge
Permit Fee - Additions/Alterations
Scanning Fee
Technology Fee
Total:
Amount
$300.00
$3.60
$1.20
$350.00
$6.00
$8.75
$669.55
Address
100 84 Street
MIAMI FL 33138-
Parcel Number
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 regulating
construction and zoning. Futhermore, I authorize the above -named contractor to do the work stated.
Authorized Signature: Owner, / Applicant / Contractor / Agent
Building Department Copy
Phone
Invoice #
PL -2 -09 -34023
Check #: 6337
Total Amt Paid Amt Due
$ 669.55 $ 669.55 $ 0.00
Bond #: 1821
Applicant
February 27, 2009
Date
Cell
Available Inspections:
Valuation:
Total Sq Feet:
$ 6,000.00
0
Inspection Type:
HRS Approval
Abandonment
Final
Rough
Landscaping
February 27, 2009 1
1-1 v
BUILDING
PERMIT APPLICATION
FBC 2004
Permit Type: Plumbing
Owner's Name (Fee Simple Titlehdlder) /'..J TT 0s1 )evel Phone # 3 as ` 7�
Owner's Address 100 A)a S4'
City M it1.44—:, State -F /..._ Zip 33 138
Tenant/Lessee Name WA- i Phone #
' C
E -MAIL: YAW\ 60 tr\VeS ,�'+Q..t 1, C.
Job Address (where the work is being done) 1 ( C) C 4 dthA)
City Miami Shores Village County Miami -Dade Zip
FOLIO / PARCEL # 217,6 ° 0 - 0 o
Is Building Historically Designated YES NO
Contractor's Company Name 5 /, . /' S9p/d4 l9 '4 704Phone #
Contractor's Address 7 7a 1 14/ / k / r FP- City /Sao' <' State ' 91,i - i h, Zip - 3 3 d 1
Qualifier Name /9//,,b e el. Z e--, G
State Certificate or Registration No. 6 ? ® 1 Certificate of Competency No.
E- MAIL:
Architect/Engineer's Name (if applicable)
Value of Work Far. this Permit $
Type of Work: ❑Addition
Describe Work:
Submittal Fee $ Permit Fee $ 17c-t 17
Notary $. Training /Education Fee $ 1•oCt,�
►•i
.00 CO
Scanning $
Bond $
Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
['Alteration
# Q/ f- -ze //
� s 0
Square / Linear Footage Of Work:
New
Permit No. pl('_ ten
Master Permit No. 0 g _ (Z60
Phone #
JoS 307'/
Phone# '3 G 5 S(, 01/
El Repair /Replace
/3
❑ Demolition
Radon $ DPBR $
Code Enforcement $ Double Fee $
FE0 19 2009
BY:
67--/ CCF $ 5.(60 CO /CC
Technology Fee I �. 6.6
Zoning $
Structural Review. $ Total Fee Now Due $ 8(c •0
See Reverse side -+
0
Bonding Company's Name (if applicable)
Bonding Company's Address
City
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address
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 ELECTRICAL WORK, PLUMBING, SIGNS,
WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and AIR CONDITIONERS, ETC
OWNER'S AFFIDAVIT: 1 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
The fore going,instrum�
day of
Owner o
who is personally know
n� a uois
As ide
NOTARY PUBLIC,:
*** *** ********************** ******
APPLICATION APPROVED BY:
(Revised 02/08/06)
r Agent
State
Zip
gne this
049
on and who did take an oath.
Signature
Sign:
Sign:
Print: Print:
My Commission Expires: My Commissi
ractor
The foregoing i strument was acknowled
day of r- , 20 ®9, by
who is personally known to
as iden
NOTARY PUBLIC:
and who did take an oath.
******************************** * ***** ** ********** ** * **'***X'***
Plans Examiner
Engineer
Zoning
LOT: 22
I ELEVATION OF PROPOSED SYSTEM
E BOTTOM OF DRAINFIELD TO BE
L
D FILL REQUIRED:
0
T
H
E
R
SPECIFICATIONS BY:
APPROVED BY:
DATE ISSUED:
STATE OF FLORIDA
DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT AND DISPOSAL
SYSTEM
CONSTRUCTION PERMIT FOR: OSTDS New
APPLICANT: (NHS Housing Development LLC)
PROPERTY ADDRESS: 11016 NW 2 Ave Miami, FL 33168
PROPERTY ID #: 11- 2136- 002 -0250
SYSTEM DESIGN AND SPECIFICATIONS
BLOCK: SUBDIVISION: Shoreland Height
D [ 334 ] SQUARE FEET SYSTEM
R [ ] SQUARE FEET N/A SYSTEM
A TYPE SYSTEM: [X] STANDARD [ ] FILLED [ ] MOUND [ ]
I CONFIGURATION: [X] TRENCH [ ] BED [ ]
N
F LOCATION OF BENCHMARK: 10.83' NGVD C/L NW 2 Ave.
[ 0.00 ] INCHES
V Edwards
Astrid V Edwards
12/30/2008
DH 4016, 10/97 (Previous Editions May Be Used)
v 1.1.4
TITLE: Engineer Specialist II
AP902398
PERMIT It: 13-SG-961614
APPLICATION # : AP902398
DATE PAID: 11 /18/2008
FEE PAID: $55.00
RECEIPT #: 13-PI D-1080354
DOCUMENT #: P R759183
[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. ••••
EXCAVATION REQUIRED: [ 30.00] INCHES
• •
• • •
•• •
TITLE: Engineer Specialist II
8E775126
• •••
•• •
• • •
• ••
•0
T [ 1,050 • ] GALLONS / GPD SeDtIC CAPACITY • • • •
A [ ] GALLONS / GPD N/A CAPACITY 0 ' 00 . 0 •••••• • •
N [ ] GALLONS GREASE INTERCEPTOR CAPACITY [MAXIMUM CAPACITY SINGLE TANF:?250 GALLtHVSI • •
K [ ] GALLONS DOSING TANK CAPACITY
[ ]GALLONS @I POSES Hi• 2S HRS: • •'#jumps• / • • • ]
•• •• ••••
• • •
• • •
• 0 0000
• •
• • 0000 • •
• • •
00 • . ma • •
• • •
SITE [ 2.76 ] [I INCHES k FT ] [ ABOVE /) BELOW b BENCHMARK /REFERENCE POINT
[ 32.76 ] [I INCHES I' FT ] [ ABOVE BELOW 1 BENCHMARK /REFERENCE POINT
1.- Install a 1050 gal min. category-3 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 334 sf of drainfield in trench configuration.
4.-Invert elevation of drainfield to be no less than 8.60' NGVD.
5.-Bottom of drainfield elevation to be no less than 8.10' NGVD.
Dade CBD
EXPIRATION DATE: 06/30/2010
Page 1 of 3
NOTICE OF RIGHTS
A party whose substantial interest is affected by this order may petition for an
administrative hearing pursuant to sections 120.569 and 120.57, Florida Statues. Such
proceedings are govemed by Rule 28 -106, Florida Administrative Code. A petition for
administrative hearing must be in writing and must be received by the Agency Clerk for the
Department, within twenty -one (21) days from the receipt of this order. The address of the
Agency Clerk is 4052 Bald Cypress Way, BIN # A02, Tallahassee, Florida 32399 -1703. The
Agency Clerk's facsimile number is 850 - 410 -1448.
Mediation is not available as an altemative remedy.
Your failure to submit a petition for hearing within 21 days from receipt of this order will
constitute a waiver of your right to an administrative hearing, and this order shall become a 'final
order'.
Should this order become a final order, a party who is adversely affected by it is entitled
to judicial review pursuant to Section 120.68, Florida Statutes. Review proceedings are
governed by the Florida Rules of Appellate Procedure. Such proceedings may be commenced
by filing one copy of a Notice of Appeal with the Agency Clerk of the Department of Health and a
second copy, accompanied by the filing fees required by law, with the Court of Appeal in the
appropriate District Court. The notice must be filed within 30 days of rendition of the final order.
••. •
• •
• • • •.••
• • • •
•• • •• • •
• • •
• .•
•
• • •
•
. •••• • •
•••• ••••
• ••
• • • • •
•• •• ••••
• •
• • •
• • • •
• • •
• •
• • •••• • •
• • •
•• • • •• • •
• • •