PL-09-967Project Address
Miami Shores Village
10050 N.E. 2nd Avenue
Miami Shores, FL 33138 -0000
Phone: (305)795 -2204
120 91 Street
Miami Shores, FL
Owner Information
Address
Parcel Number
1131010190020
Block: Lot:
Phone
MICHAEL MORRIS
120 NE 91 ST
MIAMI SHORES FL 33138 -2810
Valuation:
Total Sq Feet:
$ 4,500.00
0
Contractor(s)
MIAMI DADE ENVIROMENTAL
Phone
786 - 251 -4099
Cell Phone
Type of Work: PLUMBING
Type of Piping: DRAINFIELD
Additional Info:
Bond Retum :
Classification: Residential
Fees Due
Bond Type - Contractors Bond
CCF
Education Surcharge
Notary Fee
Permit Fee - Additions/Alterations
Scanning Fee
Technology Fee
Total:
Amount
$300.00
$3.00
$1.00
$5.00
$175.00
$3.00
$4.38
$491.38
Authorized Signature: Owner / Applicant /
Building Department Copy
Invoice #
PL -6-09 -$5056
Check #: 2184
Total Amt Paid Amt Due
$ 491.38 $ 491.38 $ 0.00
Bond #: 1857
Contractor
Agent
June 10, 2009
Expiration: 12/0712009
Applicant
MICHAEL MORRIS
Date
Cell
For Inspections please call:
(305)762 -4949
Available Inspections:
Inspection Type:
Final
Rough
Landscaping
1
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.
June 10, 2009 1
BUILDING Permit No. PI : RC%i
PERMIT APPLICATION Master Permit No.
FBC 200
Permit Type: Plumbing
Owner's Name (Fee Simple Titleholder) t ��e . 1 N'Llr) kill S Phone # - 7S c2 - l 6, 7®
Owner's Address /0 _Cj[ r-'
City l ( 05 State pet_ Zip 13 3j 3�
Tenant/Lessee Name Phone #
E -MAIL:
Job Address (where the work is being done) tom. !J ( I2 3r
City Miami Shores Village County Miami -Dade Zip j D)f `3
FOLIO / PARCEL #
Is Building Historically Designated YES NO
Contractor's Company Name R(j(ZIilt O t f1o/1 P J 4 Phone # 786 `1 -4091
Contractor's Address. B2901 ikK Q Qa R, S 4 3?1((
City 1 State FO4 Zip((9c
Qualifier Name j c Phone # 786, .2 Si -Ci oc
Certificate of Competency No. dq Oc 2 ( 07
State Certificate or Registration No.gQkQg7 tY 7 (�,
E -MAIL:
Architect/Engineer's Name (if applicable)
Type of Work: ['Addition ['Alteration
Describe Work: \ e C ) PC & n ? n
Submittal Fee $
Notary$ s•
Scanning $
Bond $
Structural Review. $
Permit Fee $
Training /Education Fee $
Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
r(A
['New
1 • 90
Radon $ DPBR $
Phone #
Value of Work For this Permit $ L � SOO Square / Linear Footage Of Work: ,DO
Repair /Replace ❑ Demolition
4exx**** **xxxx*xxx?ca4*** *xxxxx*xuxxx Fees*****www ******xxxx x aYa4xxxxxxxx xxxx*xxxxir****
CCF$ 3-
Technology Fee $
CO /cc
43s(
Zoning $
Code Enforcement $ Double Fee $
Total Fee Now Due $ 49) -3&
►iUN 10 PAID
a)Tr
See Reverse side
agmETEEN
JUN 1 u 2009 �Uf
BY:— ......
Bonding Company's Name (if applicable)
Bonding Company's Address
City State Zip
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. 1 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: 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 wil l not be approved and a reii oection fee will be charged.
Signature
Owner or Agent
The foregoing instrument was acknowledged before me this q The
day of 1) O ( , 20 1, by kP tAA tt 4A0f.11(5 , da
who is personally known to me or who has produced
p,N As identification and who did take an oath.
NOTARY PUBLIC:
Sign.
Prind
,to My Znission Expires;'
.aa
1'
xXxxx9e* -.
$O
Sign:
Print:
M Commission Expires:
'•,,.o* Expi
�. res: 0
BONDED THRUATLANTIC B
**************************
APPLICATION APPROVED
(Revised 02/08/06)
NOTARY PUBLIC -STATE OF FLORIDA
Jose Bo
xx r. " Yx '
Signature
anos
v /r,4.,
h
. 08, 2010
NDING CO., INC.
xxxx$rxxxxxzxxxxxxxxxxxxx a Yaea :x,4xa:**tew
Contractor
fo oing instrument was ackno - dged before me this
by
me or who has produced
as identification and who did take an oath.
NOTARY ' UBLIC:
xxx xxxac xx xxx xx
Plans Examiner
Engineer
Zoning
'
CONSTRUCTION PERMIT FOR: OSTDS Repair
APPLICANT: Michael Moms
PROPERTY ADDRESS: 120 NE 91 St
LOT: 2
PROPERTY ID #: 11- 3101 - 019-0020
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 [ 900 ] GALLONS / GPD Septic CAPACITY
A [ 0 ] GALLONS / GPD CAPACITY
N [ 0 ] GALLONS GREASE INTERCEPTOR CAPACITY [MAXIMUM CAPACITY SINGLE TANK:1250 GALLONS]
K [ ] GALLONS DOSING TANK CAPACITY [ ]GALLONS 8( ]DOSES PER 24 HRS #Pumps [ ]
D [ 225 ] SQUARE FEET SYSTEM
R [ 0 ] SQUARE FEET SYSTEM
A TYPE SYSTEM: [x] STANDARD [ ] FILLED [ ] MOUND [ ]
I CONFIGURATION: [x] TRENCH [ ] BED 1 1
N
F LOCATION OF BENCHMARK: F.F.E.: 11.6' NGVD
I ELEVATION OF PROPOSED SYSTEM SITE
E BOTTOM OF DRAINFIELD TO BE
L
D FILL REQUIRED: [ 0.00] INCHES
0
T
H
5
R
1— Existing 900 gal. tank certified by "Miami Dade Environmental S. on 6/5/2009 to remain.2- Install 225 sf of drainfield in
bed configuration. 3- Perimeter of excavation area shall be at least 2 ft wider n Io r n pry • ; _ • absorption
trench.. 4 -Invert elevation of drainfield to be no less than 8.88' NGVD 7. Bo i viii be no less than
8.83' NGVD
MIANII.DADE COMY MATH DEPT
THIS PERMIT IS NOT FOR ADDITION*
SPECIFICATIONS BY . ,,.. °PEDR
APPROVED BY" __.._._.__. TITLE �j
i
2., Pedro N Oepina
DATE ISSUED: 06 /08/2009
STATE OF FLORIDA
DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT AND DISPOSAL
SYSTEM
BLOCK: 7 SUBDIVISION:
DH 4016, 10/97 (Previous Editions May Be Used) Page 1 of 3
v 1.1.4
Miami, FL 33138
[ 13.20 ] [
[ 33.20 ] [
INCHES
INCHES
TITLE: - Legacy
EXCAVATION REQUIRED: [ 20.00] INCHES
AP925205 5s7B94O7
PERMIT # : 13 -SC- 984786
APPLICATION #: AP925205
DATE PAID:
FEE PAID:
RECEIPT #:
DOCUMENT #: PR775885
[SECTION, .TOWNSHIP, RANGE, PARCEL NUMBER]
[OR TAX ID NUMBER]
FT ][ABOVE BELOW1BENCHMARK /REFERENCE POINT
FT ][ ABOVE4BELOWhBENCHMARK /REFERENCE POINT
Dade CHD
EXPIRATION DATE: 09/06/2009
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Scale: Each blodc represents 5 feet and 1 Inch 50 feet.
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Notes: u.4 s ,44
Site Plan submitted
Plan Approved
By
STATE OF FLORIDA
DEPARTMENT OF HEALTH
APPLICATION FOR ONSITE SEVVAGE DISPOSAL SYSTEM CONSTRUCTIOrsi PERMIT
Permit Application Number 4 Vf
• PART II - SITE PLAN-
014 4016. wee ouptae.. i Form 4016 which maybe ttued)
(Stock Number: 6744-002-4015-6)
Signature
;Not Approved
- -
ALL CHANGES MUST BE APPROVED BY THE COUNTY HEALTH DEPARTMENT
•
Title
Date cr-4.:
County Health Department
Page 2 of 3
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Scale: Each blodc represents 5 feet and 1 Inch 50 feet.
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Notes: u.4 s ,44
Site Plan submitted
Plan Approved
By
STATE OF FLORIDA
DEPARTMENT OF HEALTH
APPLICATION FOR ONSITE SEVVAGE DISPOSAL SYSTEM CONSTRUCTIOrsi PERMIT
Permit Application Number 4 Vf
• PART II - SITE PLAN-
014 4016. wee ouptae.. i Form 4016 which maybe ttued)
(Stock Number: 6744-002-4015-6)
Signature
;Not Approved
- -
ALL CHANGES MUST BE APPROVED BY THE COUNTY HEALTH DEPARTMENT
•
Title
Date cr-4.:
County Health Department
Page 2 of 3
STATE OF FLORIDA
DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT AND DISPOSAL
SYSTEM
CONSTRUCTION PERMIT FOR: OSTDS Repair
APPLICANT: Michael Moms
PROPERTY ADDRESS: 120 NE 91 St
LOT: 2
PROPERTY ID #: 11- 3101 - 019 -0020
SYSTEM DESIGN AND SPECIFICATIONS
L
D FILL REQUIRED: [ 0.00] INCHES
0
H
E
R
THIS PERMIT IS NOT FOR ADDITION..
SPECIFICATIONS BY:
v 1.1.4
Miami, FL 33138
BLOCK: 7 SUBDIVISION:
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.
T [ 900 ] GALLONS / GPD SeptC CAPACITY
A [ 0 ] GALLONS / GPD CAPACITY
N [ 0 ] GALLONS GREASE INTERCEPTOR CAPACITY [MAXIMUM CAPACITY SINGLE TANK:1250 GALLONS]
K [ ] GALLONS DOSING TANK CAPACITY [ ]GALLONS @[ ]DOSES PER 24 HRS #Pumps [ ]
D [ 225 ] SQUARE FEET SYSTEM
R [ 0 ] SQUARE FEET SYSTEM
[SECTION, TOWNSHIP, RANGE, PARCEL NUMBER]
[OR TAX ID NUMBER]
A TYPE SYSTEM: (X] STANDARD [ ] FILLED [ ] MOUND [ ]
I CONFIGURATION: [X] TRENCH [ ] BED [ ]
N
F LOCATION OF BENCHMARK: F.F.E.: 11.6' NGVD
I ELEVATION OF PROPOSED SYSTEM SITE [ 13.20 1 (1 INCHES I/ FT ] [ ABOVE 4 BELOW l BENCHMARK /REFERENCE POINT
E BOTTOM OF DRAINFIELD TO BE [ 33.20 ] [) INCHES I FT ] [ ABOVE A BE LOW h BENCHMARK /REFERENCE POINT
EXCAVATION REQUIRED: [ 20.001 INCHES
1— Existing 900 gal. tank certified by "Miami Dade Environmental S. on 6/5/2009 to remain.2- Install 225 sf of drainfield in
bed configuration. 3- Perimeter of excavation area shall be at least 2 ft wider n4 lo r n prppp absorption
trench.. 4 -Invert elevation of drainfield to be no less than 8.88' NGVD 7. Botorai Idvio be no less than
8.83' NGVD
MIAMI -DADE COUNTY HEALTH DEPARTMENT
EDR•.N OSPINA TITLE: - Legacy
APPROVED BY ` ` TITLE: /� )- Dade CHD
Pedro N Ospina rte"
DATE ISSUED: 06/08/2009 EXPIRATION DATE: 09/06/2009
DH 4016, 10/97 (Previous Editions May Be Used) Page 1 of 3
AP925205 5E789407
PERMIT #: 13 -SC- 984786
APPLICATION #: AP925205
DATE PAID:
FEE PAID:
RECEIPT #:
DOCUMENT #: PR775885
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STATE OF FLORIDA
DEPARTMENT OF HEALTH
APPLICATION FOR ERMIT
Permit Application Number
ale: Each block represents 5 feet.
PART II SITE PLAN
y n .
Notes: . a 0
Site Plan submitted
Signature
Plan Approved Approved
By /
B Gs+ a F
ALL CHANGES MUST BE APPROVED BY THE COUNTY HEALTH DEPARTMENT
DH 4015,10195 (Replaces HRS-H Form 4015 which may be used)
(Stock Number: 5744052- 4015 -6)
f „P it � ,a firo t+r 7 /
Title
Date
County Health Department
Scheduled Inspection Date: June 15, 2009
Inspector. Levrock, James
Owner: MORRIS, MICHAEL
Job Address: 120 NE 91 Street
Project: <NONE>
Miami Shores, FL
Contractor: MIAMI DADE ENVIROMENTAL
Building Department Comments
June 12, 2009
Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Permit Type: Plumbing - Residential
Inspection Type: Rough
Work Classification: Drainfield
Phone Number
Parcel Number 1131010190020
Phone: 786-251-4099
Passed
Failed
Correction
Needed
Re- Inspection
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
Page 13 of 22
DIVISION OF
Environmental Health
Florida Department of Health
Miamit Health Department
OSTDS /Well Division
11805 SW 26 St. • Miami, FL 33175
O
117459"
. J .100. 0;
PER
3i
clgtoP