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379 NE 94 St (11)1 APPLICANT: AGENT: PROPERTY ADDRESS: 3-7q A/ E I `7‘ Si . CONSTRUCTIO STATE OF FLORIDA DEPARTMENT OF HEALTH ONSITE SEWAGE TREATMENT AND CONSTRUCTION INSPECTION AND K•. k P 0( 11 Y'4 v14, e TANK INSTALLATION (01] TANK SIZE [1] ''OO (3] (02] TANK MATERIAL L.:ers c, (03] (04] 6sft LOT: � 'L BLOCK: , `/ S SUBDIVISION: 31 tat-^ CHECKED [X] ITEMS ARE NOT IN COMPLIANCE WITH STATUTE OR RULE AND MUST BE CORRECTED. .OUTLET DEVICE . ( I MULTI - CHAMBERED [ Y / N ) I l [05] OUTLET FILTER y? S [A ] [06] LEGEND /3 -6 �1`j 0- DC 5 I 3 [07] WATERTIGHT q 1 I ) (08] LEVEL 4 .t c s` !vv [ ] (09] DRAINFIELD INSTALLATION AREA [1111 [2] 32S SQFT DISTRIBUTION BOX _ HEADER ✓ NUMBER OF DRAINLINES DRAINLINE SEPARATION " 2 DRAINLINE SLOPE 3 DEPTH OF COVER ELEVATION [ABOVE /BELOW] BM SYSTEM LOCATION DOSING PUMPS [10] (11] (12] (13] (14] [15] [16] [ (18] [19] [ [ FILL [ [ [ [25] [26] pi 0 AGGREGATE SIZE AGGREGATE EXCESSIVE FINES AGGREGATE DEPTH / EXCAVATION MATERIAL FILL AMOUNT /2" FILL TEXTURE EXCAVATION DEPTH AREA REPLACED REPLACEMENT MATERIAL EXPLANATION OF .VIOLATIONS / REMARKS: [.. I l I I [ [APPRO': +/DISAPPROVED]: FINAL SYSTEM [APPROV /DISAPPROVED]: DH 4016, 10/97 (Previous Editions Na DIPOSAL SYSTEM FINAL APPROVAL DEPTH TO LID • [ ] PROPERTY ID #: //'3)06-0/34/30 SETBACKS [27] SURFACE.WATER [28] DITCHES (29) PRIVATE WELLS [30] PUBLIC WELLS [31] IRRIGATION WELLS /f) [32] POTABLE WATER LINES in [33.] BUILDING FOUNDATION gill [34] PROPERTY LINES .S [ OTHER FILLED / MOUND SYSTEM [36] DRAINFIELD COVER [37] . SHOULDERS (38] SLOPES [39] STABILIZATION ADDITIONAL INFORMATION (40] UNOBSTRUCTED AREA (41] STORMWATER RUNOFF lOo'i [42] ALARMS [43] MAINTENANCE . AGREEMENT (44] BUILDING AREA (45] LOCATION CONFORMS WITH SITE PLAN [46] FINAL SITS aitiwING • (47] CONTRACTOR r 0H ( v c. ( OTHER ABANDONMENT l [49] TANS PUMPED _ /_ / l [50] TANS CRUSHED & FILLED _/ PA C CND DATE: 17L CHD DATE: 2 -2 77 -d PT 1: Applicant PT 2: Installer /Contractor PT 3: Building Department PT 4: Health Department PERMIT NO. DATE PAID: FEE PAID: RECEIPT #: ,- 65 o5r- 5 12 FT FT FT FT FT FT FT FT FT Page 2 of 3 0 0 • PAY TO THE - ORDER OF Miami Shores Village 10050 NE 2nd Avenue Phone: 305 - 795 -2204 Printed: 2/24/2003 Applicant: Owner: ANNIS JOB ADDRESS: 379 Contractor WALLACE PONDER SEPTIC Local Phone: 305 - 620 -8320 Parcel # 1132060136130 Fees: FEE2003 -1152 FEE2003 -1153 Description Building Fee Notary Fee Total Fees: Amount $80.00 $5.00 $85.00 Total Fees: $85.00 Total Receipts: $0.00 , Permit Status: Approved Permit Expiration: 8/23/2003 —. Work: SEPTIC TANK ABANDONMENT (REPLACEMENT) nkofAmerica, ACH Rfr 083100277 MIAMI, FL 33169',`x - NE 94 12 -99 Permit Number: PL2003 -56 MARGARET ST Construction Value: nn the iob -site for inspectors to verify, there will be no inspections. Re- inspection oA3 A S e c u r i t y dn'h'a n'e a d ' d o e u.nt e n t . See b a r k f o r d e t a i l e. rf] ' WALLACE PONDER. . D /B /A, wp S EPTIC TANK CO. 305-620 -8320. 17235 N.W.• 12 CT: ;IL00 23 �6 1I' . . 1 :063 00 ,... 36656593 ' 5611 , Plumbing Permit Contractor's Address: 17235 NW 12 CT I -� Legal Description: MIAMI SHORES SEC 1 AMD PB 10 -70 LOTS 15 -16 -17 INC BLK 45 LOT SIZE $400.00 2306 • 63 FL 994 $ VS' ,60 DOLLARS 8 . Page 1 of 1 m herefor in strict compliance with all lions that may have been submitted to if the plans are changed without ;ibility for a thorough knowledge of the he assumes responsibility for work done . pertaining thereto and in strict conformity Nv 1 wor do by either iiiSi`uiiity for a wui n done by iu im ELECT ICAL TVI'1; Minimum Fee QTY. "'1'1'1? Dryer QTV. TYI'I? Outlet, Appliance QT1. 'I'VPE'. Service Repair QYI Y. A/C Central 1 -3 Ton Fan Outlet, Wall Service, Temporary A/C Central 4 -7 Ton Fire Pump Outlet, Switch Signs A/C Central 8 -15 Ton Fixture - Fluorescent Oven Space Heater (kw) A/C Central 16-20 Ton Fixture Light Parking Lot Lights Spas/Hot Tubs A/C Central 20+ Ton Flood Lights Plugmold/Strip Subfeeds, No. of Amps A/C Window FPL - Load Central Posts Swim Pool, Commercial Air Conditioners Garbage Disposal Range/Range Top Swim Pool, Residential Chiller Generators, etc. Receptacles Switchboards Clear Violations Heat Recovery Refrigerator, Comm. (p/PH) Temp Serv., Construction Compactor Low -volt, Burglar Refrigerator, Domestic Temp for Test - 30 days Deep Freezer Low -volt, Fire Renew - Temp Service Water Closet Demolition Low -volt, Intercom/Teleph. Repair Circuits Water Heater Dishwasher Low -volt, Television Service, Number of Amps Water Heater New i\'IECHA TICAL TYPE. Minimum Fee QTY. TYPE Condensate Drain QTY. TYPE Generator QTY. TYPE Refrigeration, Tons Q'I'V. A/C Central, Tons Cooling Tower Heating Strips, each Vent Hood, Cost A/C Wall/Van. Tons Dryer Vents, Number of Paint Booth Ventilation, Cost Air Handler, Tons Ductwork, Cost of Piping, Flammable Liquid Periodic Inspections Barbecue Fire Sprinkler System. Process/Pressure Piping Supply, AC Well Bath Fan - Vented, # Fireplaces, Number of Pressure Vessel Temporary Toilet PLUMBING TYPE A/C Condensate QTY. TYPE Drains, Roof Qi'Y. TYPE Miscellaneous Fixture QTY. 'I'VPI? Soakage Pit QTV. Bath Tub Drinking Fountain Miscellaneous Repairs Solar Water Heater Bidet Filter Replace Pool Piping Sprinkler Repair Cap - Fixture Fountain Pump and Abandon Sprinkler System Cap - Water Gas - Appliance Pump, Domestic Supply, AC Well Cap - Sewer Gas - Natural Pump, Fire Stand Temporary Toilet Catch Basin Gas - Propane Pump, Re- circulate Temporary Water Closet Clothes Washer Gas Piping Pump, Replace - Pool Urinal Dental Chair Grease Trap Pump, Sprinkler Utility - Sewer Discharge Well Ice Maker Pump, Sump Utility - Water Dishwasher Indirect Wastes Relay Repair Vacuum Pump Disposal Interceptor Roof Inlet Water Closet Domestic Well Laundry Tray Septic Connection Water Heater Drainfield, 4" Tile/Res. Lavatory Septic Tank Water Heater New Drains, Area Meter Set (Gas) Sewer Connection Water Re -pipe Drains, Floor Minimum Fee Shower Water Service Drains, French Miscellaneous Equipment Sink Well, Supply Page 3 a PERMIT APPLICATION INSTRUCTIONS: Please indicate the type of work being performed and quantity(ies) in the space provided below. RECEIVEI) AND REVIEWED BY: DATE: 1 11 Page 4 OFFICE USE ONLY CHECKLIST ❑ OWNER - BUILDER FORM (Attach) ❑ FIRE DEPARTMENT APPROVAL (Commercial / multi - family) ❑ CONCURRENCY (New Construction) ❑ OTHER (Specify & Attach) $3.00 per page (Scanning Fee) Miami Shores Village Bond Code Enforcement Fine Zoning Review Notary ❑ PROOF OF OWNERSHIP (Attach) ❑ HRS / DERM APPROVAL (Septic / Sewer) ❑ IMPACT FEE (New Construction) ❑ OTHER (Specify & Attach) PERMIT FEES $ Sb Metropolitan Dade County (C.C.F.) $ ( sq.ft. = x/1000 x 0.60) Inspector State Educational Fund $ (¢.005 /sq.ft.) State DCA (Radon) _ $ (0.01 / sq.ft.) $ 5. SECTION Zoning Electrical Mechanical Plumbing Fire Public Works Structural Building Official BY DATE PERMIT APPLICATION ❑ CONDO ASSOCIATION APPROVAL (Attach) ❑ BPR APPROVAL (Restaurants) ❑ CONTRACTOR REGISTRATION (On File) TOTAL $ ' (/CD ISSUING OFFICIAL REVIEWED AND PREPARED BY: DATE: CONDITION OF APPROVAL Revised July 2001 10050 N.E. 2ND AVE., MIAMI SHORES, FL o (305) 795 -2207 o FAX (305) 756 -8972 0 http:/ /www.miamishoresvillage.com Page 2 INIPORT NT NOTICES 1. DO NOT BEGIN ANY WORK WITHOUT HAVING RECEIVED YOUR VALIDATED PERMIT AND PERMIT CARD. Applying for a permit does not grant the right to begin construction. HOURS OF CONSTRUCTION are limited to: Monday through Friday from 7:30 a.m. to 6:00 p.m., and Saturday from 8:00 a.m. to 5:00 p.m. No inspections will be conducted on weekends or holidays. 2. All construction of demolition areas MUST BE MAINTAINED IN A CLEAN, NEAT AND SANITARY CONDITION free from construction debris. 3. STREETS AND NEIGHBORING PROPERTIES SHALL BE KEPT FREE FROM DIRT AND DEBRIS. 4. SWALE; MUST BE PROTECTED FROM BEING DAMAGED BY EQUIPMENT OR VEHICLES, AND MAY NOT BE USED FOR STORAGE. A bond is required for work in or near the street/sidewalk. 5. CONSTRUCTION TRAILERS ARE PROHIBITED ON SINGLE FAMILY RESIDENTIAL CONSTRUCTION SITES. Other construction may have a trailer which rewires a separate permit. 6. PORTABLE TOILETS for a construction site require a separate permit. 7. DO NOT DISCHARGE WATER INTO THE RIGHT OF WAY OR STORM DRAINS without approval from the Building, Planning and Zoning Department. 8. EQUIPMENT AND MATERIALS SHALL BE STORED at least 10 feet from the edge of pavement. 9. Department of Health and Rehabilitative Services (HRS) approval is required for applications involving septic tanks. Department of Environmental Resources Managernent (DERM) and/or Miami -Dade Water and Sewer Department (MDWASD) approval is required for applications involving sewers. AFFIDA 'IT - Please read carefully. Application is hereby made to obtain a permit to do work and installation as indicated. I, the OWNER of the property, certify that all work will to performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that separate permits are required for ELECTRICAL, PLUMBING, POOL, EXTERIOR DOOR, MECHANICAL, WINDOW, FENCE, DRIVEWAY, ROOFING and SIGNS and there may be additional permits required from other governmental agencies. I, the OWNER of the property, have disclosed all information related to any work at the property performed in the prior twelve months to the Building Official. Further, I am fully aware that if the cumulative cost of work to my home or business under this and any other permit equals or exceeds fifty percent (50 %) of the fair market value of the structure, the entire structure must meet the present federal flood criteria for finished floor elevation. I am also fully aware that if the total cost of work to my home or business under this and any other permit exceeds fifty percent (50 %) of the replacement cost of the structure, then the entire structure must conform to the current code requirements of the Building Code. WARNING TO OWNER: Your failure to record a NOTICE OF COMMENCEMENT may result in you paying twice for improvements to your property. If you are spending more than $2,500 or intend to obtain financing, you may wish to consult with your attorney or lender before recording your Notice of Commencement. The Notice of Commencement must be recorded at: 22 N.W. 1st Street, 1°' Floor, (305) 679 -1078. Once recorded, the Notice of Commencement must be POSTED AT THE JOB SITE in accordance with Section 713 -35 of Florida Statutes. Review the brochure at Village Hall on Construction Lien Law and Choosing a. Contractor. SEAL: STATE OF FLOR i�Y OF MIAMI -DADE Si ure of Owner Signature of Notary Public - State of Florida Signature of Contractor / Qualifier cdo- e Print Name Print Name ))) Sworn to and subscribed before me this day of Sworn to and subscribed before me this day of STATE OF FLORID A, COUNTY qF MIAMI -DADE Signature of Notary Public - State of Florida SEAL: PERMIT APPLICATION Personally known OR, Produced Identification Personally known OR, Produced Identification Type of Identification Produced: Type of Identification Produced: CONTRACTOR Name (7_ ,.� l•l/�"�� P C� License No. -a Address 32 lb w 1 a 6_ . Telephong50f . (o r si!axo `? Qualifier Name e PROPERTY OWNER New Construction .. , g 0 Name CZLI Addres 3 -- ?a Nit t Home Telephone Business Telephone Fax TYPE OF MANAGEMENT (✓ ) New Construction Enclosure Alteration Exterior Repair Alteration Interior Demolish Relocation of Structure Shell Only Foundation Only Add'I Attachment Other Add'I Detachment Other I r; INSTRUCTIONS - The following steps must be taken tolotitain a permit from the Miami Shores Village: Step 1. Step 2. Submit the completed application with all necessary documents to the Building, Planning and Zoning Department for processing. During the processing of your application, you may be asked to submit additional information. Complete the attached permit application which must be signed by the property owner and qualifier. Both signatures must be notarized. Please print or type to allow for a more accurate processing of your application. If roofing work will be done, a roofing application must be submit- ted along with this permit application. Folio Number Lot Block Subdivision PB PG Current Use of Property Proposed Use of Property Tenant Information PERMIT TYPE (✓ ) Building Electrical Mechanical Plumbing LPGX Roofing Fence Other PERMIT CHANGE (✓ ) Chg. Contractor Renewal Revision Extension Supplement Reinspection ARCHITECT Name License No. Address Telephone Fax Master Permit No. PERMIT APPLICATION Subsidiary Permit No. > • Description of Work Zoning Square Feet Tax Assessed/Appraised Value Flood Zone Base Floor Elev. Linear Feet aOtlfb Units Floors Value of Work Value ENGINEER Name License No. Address Telephone Fax Job Compa y Address Inspection Time Ready Date Ready RECAUESit FOR INSPECTION r ) e Date Signature o PERMIT APPLICATION FOR MIAMI SHORES VILLAGE ? 37q n( t • q `f s Tax Folio Legal Descripticn /J/j Owner/Lessee /'Tenant Ic. / (� S 31q . ', Contracting Co. NIN. l S a= d (;`' -� Qualifier me,,) State # Municipal # Owner's Address Architect/Engineer Bonding Company Mortgagor Permit Type (circle one): BUILDING ELECTRICAL PLUMBING / MECHANICAL ROOFING PAVING FENCE SIGN WORK DESCRIPTION j Q G - - �.�.,. �c't% 2 I � J Square Ft. 6 Estimated Cost (value) WARNING 10 OWNER: YOU MUST RECORD A NOTICE OF COMMENCEMENT AND YOUR FAILURE TO DO SO 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.) Application is hereby made to obtain a permit to do work and installation as indicated above, and on the attached addendum (if applicable). I certify that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that separate permits are required for ELECTRICAL, PLUMBING, SIGNS, POOLS, ROOFING and MECHANICAL WORK. OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable la regulating construction and z g. Furthermore, I authorize the above -named contractor to do the work stated. Condo President 7 Z Z �,7�" Notary as to Owner and/or Condo President 1 ate My Commission Expires: l FEES: PERMIT 3 RADON APPROVED: Zoning Building Mechanical 7 Historically Designated: Yes No (W.- Address SS# , / - Competency # Address Address Address Signa a of Contracto 4 • er- u Dae - - 7� .- d /_ /a3 a / 1-, PAP. %Notar as t• on tr• t. • .caner- 3u{lti pate My Commission E ires:'�OCARY PUbLI STAB � oFn,DRifI/ j. y COMMISSION NO. CCi t i ":+t1 MY COMSS E;(P. AfiAt�. t: Lf? C.C.F. / • cZ 0 NOTARY Master Permit # Phone ( g g32A). �.� P h o n e j C5 / - 71 7 • Ins. Co. Electrical 30e .oa TOTAL D 2 BOND Plumbing . t\ 1/ / Engineering CON ( ] New System ry Repair STATE OF FLORIDA DEPARTMENT OF HEALTH ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PERMIT Authority: Chapter 381, FS & Chapter 10D -6, RUCTION PERMIT F9R: ( ] Existing System (P] Abandonment APPLICANT: 'L AGENT: 9 PROPERTY STREET ADDRESS: LOT: 14A BLOCK: PROPERTY ID #: (SECTION/ TOWNSHIP /RANGE /PARCEL NUMBER] [OR TAX ID NUMBER] SYSTEM DESIGN AND SP,ECITICATIONS SPECIFICATIONS BY: APPROVED BY: DATE ISSUED: SYSTEM MUST BE CONSTRUCTED IN ACCORDANCE WITH SPECIFICATIONS AND STANDARDS OF CHAPTER 10D -6, FAC. REPA]:R PERMITS AND HOLDING TANK PERMITS EXPIRE 90 DAYS FROM THE DATE OF ISSUE. ALL OTHER PERMITS EXPIRE ONE YEAR FROM THE DATE OF ISSUE. DEPARTMENT OF HEALTH 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. 4 SUBDIVISION: 4 ) T [ C1QGALLONI/ GPD] SEPTIC TANK /A UNIT CAPACITY MULTI- CHAMBERED /IN SERIES :[ ") A ( ] [GALLONS / GPD] CAPACITY MULTI- CHAMBERED /IN 'SERIES:[.] N' .( • ] GALLONS GREASE INTERCEPTOR CAPACITY (MAXIMUM CAPACITY SINGLE TANK: 1250 .GALLONS] K' ( ] GALLONS PER DOSE DOSING TANK CAPACITY DOSE -RATE [ ) PER 24 HRS NO. OF PUMPS: [ ] [ ( O ] UARE_FgEa- PRIMARY DRAINFIELD SYSTEM D R [ ] SQUARE FEET SYSTEM A TYPE SYSTEM: ( ] STANDARD ( ) FILLED [ ) MOUND ( ) I CONFIGURATION: ( ) TRENCH ( q) -BED ( ] F LOCATION OF BENCHMARK: 5 ' s <,o,, 4 � , � P - c `rf�'' O .-4 1 ELEVATION OF PROPOSED SYSTEM SITE W47) (INCHES /FT) [ABOVE /BELOW) BENCHMARK /REFERENCE - POINT E BOTTOM OF DRAINFIELD TO BE [ ] [ NCHES 'FT] [ABOVE B EL0W BENCHMARK REFERENCE POINT) L D FILL REQUIRED: ( ] INCHES EXCAVATION REQUIRED: ' ] INCHES :AZT 7 7 ^ � e'< a (r n n.Z ,A,' \R % \Y ; ' - , ; i � � T =6'D, 7, . , 4/ :- :',.. :AU •i. ;:: ,. fl Ltk! O H 4016, 10/96 (Replaces HRS -H Form 4016 (page 11 which may be used) (Stock Number: 5744- 001 - 4016 -0) FAC [A Holding Tank [ ('1 Other(Specify) TITLE: TITLE: JL]. Temporary /Experimental PERMIT # 9 DATE PAID - 7 - a - 3 - 5> 'FEE PAID $ - 7 a `. = RECEIPT # 2` �� • r-7';23)- . CHD EXPIRATION DATE: ifir)i` . Page 1 of 2 cr INSTRUCTIONS: PERMIT NUMBER: Permit tracking number by County Health Department. • APPLICATION FOR: Check type of permit; if "Other" specify type in blank. APPLICANT: Property owner's full name. TELEPHONE: Telephone number for applicant or agent. AGENT: Property owner's legally authorized representative. MAILING ADDRESS: P.O. box or street mailing address for applicant or agent. LOT, BLOCK, SUBDIVISION or PROPERTY ID #: 27 character ID number for property. (Health Department may require property appraiser ID# or section /township /range /parcel number.) SYSTEM DESIGN AND SPECIFICATIONS: TANK: Minimum specifications from Chapter 10D -6, FAC. DRAINFIELD: Minimum specifications from Chapter 1OD -6, FAC. OTHER: Other specifications, such as operating permit requirements, low - volume flush toilets, variance provisos. SPECIFICATIONS BY: Name of individual providing specifications. If designed by a registered engineer must be sealed. APPROVED BY: County Health Department personnel reviewing and approving permit. DATE ISSUED: Date permit is issued by County Health Department. EXPIRATION DATE: One year from date issued if the system has not been installed. Permits for system repairs become void 90 days from the date issued. STATE OF FLORIDA DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PERMIT Permit Application Number 9 T /9 Scale: Each block represents 5 feet and 1 inch = 50 feet. Notes: geed le d e p� 2 ) ) orminiiL 1 f ) Site Plan submitted by: Plan Approved By A TILAP (1-'? 71/0/0 /V 0 . PART II - SITE PLAN SIGNATURE Not Approved 3z4,y/ TITLE Date - 7 — 2 .3'- " County Public Unit ALL CHANGES:MUST BE- APPIRdVEI THE COUNTY PUBLIC HEALTH UNIT HRS -H Form 4015, Feb 85 (Obsoletes previous editions which may not be used),_ - Page 2 of 3 (Stock Number. 5744. 002. 4015.6) 9 PAY TO THE ORDER OF FOR Miami Shores Village 10050 NE 2nd Avenue Phone: 305 - 795 -2204 Printed: 2/24/2003 Applicant: MARGARET Owner: ANNIS JOB ADDRESS: 379 NE 94 Contractor WALLACE PONDER SEPTIC Local Phone: 305 - 620 -8320 Parcel # 1132060136130 Fees: Description FEE2003 -1154 Building Fee FEE2003 -1155 Buildier's Bond FEE2003 -1156 CCF Total Fees: Amount $80.00 $300.00 $1.80 $381.80 Total Fees: $381.80 Total Receipts: $0.00 Permit Status: Work: INSTALLED 200 SQ FOT OF NEW DRAINFIELD INSTALL 900 GAL SEPTIC TANK ANNIS MARGARET ST APPROVED Permit Expiration: 8/23/2003 Construction Value: $2,400.00 Ft; uu n_rn t r a_ a !Tr /ur detail s_ WALLACE PONDER 12 -99 D /BSA WP SEPTIC TANK CO. 305-620 -8320 17235 N.W.12 CT. MIAMI, FL 33169 e Plumbing Permit Permit Number: PL2003 -57 Contractor's Address: 17235 NW 12 CT I ..1 Legal Description: MIAMI SHORES SEC 1 AMD PB 10 -70 LOTS 15 -16 -17 INC BLK 45. LOT SIZE DATE I $ ,6D nkofAmerica. ACH R/r 08311IO27'i ��. 2,117002'311061 .1:06 3 LOO 2?'?1: 003665 2306 63-27/631 FL 994 DOLLARS 8 Page 1 of 1 ;e- inspection ration herefor in strict compliance with all cations that may have been submitted to or if the plans are changed without '')nsibility for a thorough knowledge of the tat he assumes responsibility for work done s pertaining thereto and in strict conformity sponisibility for a!: work do..e by either ?PLICANT: )T: ZO `O 3 - +]64 :OPERTY ID, #: STATE OF FLORIDA DEPARTMENT OF HEALTH ONSITE SEWAGE DISPOSAL SYSTEM' SITE EVALUATION AND SYSTEM SPECIFICATIONS 1 n BE COMPLETED BY ENGINEER, HEALTH UNIT EMPLOYEE, OR OTHER QUALIFIED PERSON. OVIDE REGISTRATION NUMBER AND SIGN AND SEAL EACH PAGE OF SUBMITTAL, ENGINEER'S •MUST COMPLETE ALL �i'J�g,'`- ..:i.� !i� rm. ESTIMATED SEWAGE FLOW: /00 DPERTY SIZE CONFORMS TO SITE PLAN; [ ] YES [ ] NO NET USABLE AREA AVAILABLE: Lila__ [HORIZED SEWAGE FLOW: GALLONS PER DAY [ -TABLE 1 OTHER -TABLE / 2] )BSTRUCTED AREA AVAILABLE: � GALLONS PER DAY / O PD /ACRE] 2] Z SQFT [1500 GPD/ACRE D: 2500 GPD /ACRE] _ Q UNOBSTRUCTED AREA REQUIRED: 2r'� SQFT (CHMARK /REFERENCEPOINT LOCATION: .NATION OF PROPOSED SYSTEM SITE IS 2.2, [INCHES/ MINIMUM SETBACK RICH FACE WATER: / V FT LS: PUBL/C : - =-Z.— FT LDING FOUNDATIONS: CAN BE MAINTAINED FROM THE PRO>OSED SYSTEM TO THE FOLLOWING FEATURES: D ITCHES /SWALES: %2 FT LIMITED USE: . 2 1 1a . FT PRIVATE: _Li_ OILY WET? [ ] YES [ NO FT PROPERTY LINES: --5 FT POTABLE WATER LINES: (2 FT /S FT SUBJECT TO FREQUENT FLOODING: [ ] YES [40 (EAR FLOOD ELEVATION FOR SITE: FT MSL /NGVD PROFILE INFORMATION SITE 1 .sel Color SOIL SERIES: VALUATED BY: Texture a th to - to — � to to 0 /96 (Replaces HRS -H Form 4015 [Page 3J which may be used) Der: 5744- 003 - 4015 -1) to to to re+ DIVISION: 0 W i IS AGENT: /`4 ( t ca f / [ABOVE SOIL PROFILE INFORMATION SITE 2 PERMIT # • `/ [Section /Township /Range /Parcel No. or BENCHMARK/ EFERENCE P 1 10 YEAR FLOODING? YES [ SITE ELEVATION: C. FT MSL /NGVD VD VEL WATER TABLE: WA INCHES [ABOVE / BE ATED WET SEASON WATER TABLE ELEVATIO EXI STING GRADE. TYPE• RCHED / WATER TABLE VEGETATION: INCHES [ ABOVE / EL [ ] YES [ NO MOTTLING: [ ] YES ] EXIST v GRADE". [ NO DEPTH: INCHES rEXTURE /LOADING RATE FOR SYSTEM SIZING: ?IELD CONFIGURATION: [ ] TRENCH [ CS /ADDITIONAL CRITERIA: DEPTH OF EXCAVATION INCHES HER (SPECIFY) DATE : '- 1 /' 03 Page . 3 of 3 )tes: 4 MN. 1 ;_ _._,... _I _f_ i_ i_ 1..1. 1 1 t ''. -'. . - . -7-- •i• ' - i -'• • ii ._- 7 - 11_, - i - r • -- r ,• T .. - 1 - . - 1 - t - ? -- t --- ; r i e Plan tri Approved • • • • • - r. • • • • • ,r•unT•••••-•.. "•,•‘: STATt OF FLORIDA DEPARTMENT OF HEALTH APPLICATION FOR ONSITE SEWAGE 'DISPOSAL SYSTEM CONSTRUCTION PERMIT PART II SITE PLAN Sc Each block represents 5 feet and 1 inch = 50 feet. Permit Application Number ALL CH NGES MUST BE APPROVED BY THE COUNTY HEALTH DEPARTMENT 15. INS (Replaces HRS-H Form 4015 which may be used) Neater: 6744-002-4M MI) -1 0 3 OS of) R - 3 -Dsaik ; } --: r •-- - ' , , T 1 --- 1 - 4 -- i - f -- • ---- 'T r -. ; ri" - I - , , • . , • , '- --- '. • . , •- C " - -, • 1 - 1 - 1 ' • 1 1, i i -- i IT , - -. - 7 . : , ! - :---;- i i• • .' • -- . ;1 -- ------ ---------- i ..• . -•-•••••-', ; i -4 --Lc I - —7--r- 1 -- 1 , , , r • r --1-- . ■ . , ' ! .L j :. '-' ! + .4, - .,- : ' ...: , . . , ; i • -.+.--, ..- ...... .i....f. .... . 1 ! ...f . r . : ... - . . . -1. ... 1 I- - . ' 1 • • ' 1 i ' t . . . I ■ . , -r , . • :., 1 -4. ...,... • I .4- I i 1 ri i i . .. .,... H.I..._ --1---f -4 - , '.i • f • T " - • 1 1 •'•f -... 1 - • • .4.- .-.• ;- - - ••1 .. -"---i - I. - , 1 T I 1 f /-• ' f 4 T I ! 4 - -4 : '-- 7 --i---.-`-, . i - ri 7 , "t -4---- 1 -. ' ' • - 7 .. 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( 900 ] A [ ] N [ --- ] K [ ] GALLONS / GPD SEPTIC TANK /AEROBIC UNIT CAPACITY MULTI CHAMBERED /IN- SERIES [X] GALLONS / GPD CAPACITY MULTI CHAMBERED /IN- SERIES [ ] GALLONS GREASE INTERCEPTOR CAPACITY (MAXIMUM CAPACITY SINGLE TANK: 1250 GALLONS] GALLONS DOSING TANK CAPACITY [ ]GALLONS @ [ ] DOSES PER 24 HRS # PUMPS [ D [2 O Q ] SQUARE FEET PRIMARY DRAINFIELD SYSTEM R [ — ] SQUARE FEET SYSTEM A TYPE SYSTEM: [4 STANARD [ ] FILLED [ ] MOUND [ ] I CONFIGURATION: [ ] TRENCH [ -1 BED [ ] N q F LOCATION OF BENCHMARK: / c , i0 (r 0. 6 . ✓ , b T 1 ,, (--' / ei , I ELEVATION OF PROPOSED SYSTEM SITE [2 2] E BOTTOM OF DRAINFIELD TO BE [sq.° L COFSTRUCTION PERMIT FOR: [ti] New System [kJ] Existing System [(] Repair. [iJ ] t Abandonment APPLICANT: t" ([ c J/ 1 /`' / i -r y a y e f 170011 PROPERTY ADDRESS: SYSTEM DESIGN AND SPECIFICATIONS 0 r a 2 iPECIFICATIONS BY: IPPROVED BY: )ATE ISSUED:: STATE OF FLORIDA DEPARTMENT OF HEALTH ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM CONSTRUCTION PERMIT )H 4016 (Page 1) 3- A), E . •9 •s7 LOT: I /c BLOCK: ` `r SUBDIVISION: PROPERTY I]) # : 1 - 3 2 0 (o - °I 3 — (p 1 30 SYSTEM MUST BE CONSTRUCTED IN ACaRDANCE WITH SPECIFICATIONS AND STANDARDS OF SECTION 381:0065, F.S.; AND CHAPTER 64E -6, F.A.C. . DEPARTMENT APPROVAL OF SYSTEM DOES NOT GUARANTEE SAFTISFACTORY 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. • D FILL REQUIRED: [J ((l&r ] INCHES EXCAVATION REQUIRED: [ 1 ] INCHES INSTALL / 2 OF SLIGHTHLY LIMITED SOIL (Previous C' C e Q REPAIR Editions May Be Used) pt. 1: Health Department pt. 2: Applicant pt. 3: Installer /Contractor pt. 4: Building Department W Holding Tank [N] Temporary J - /. 3 3 ) j (`I i Giritn.li CJNDt.K EO 1 IIIIMM (Jr DKAl1Qr1LLU THIS PERMIT IS NOT FOR ADDITION(S) Ii IVERT ELEVATION x(171 t BOTTOM OF DRAINF ELD ELEVATION _ ER METER OF EXCAVATION AREA sipALL b« 4T4F,Agrg,VEET WIDE NGr L Pl FLJ AI3SORPIIVN QR� 1) A1N TITLE: PERMIT NO. Q3 -DS 0 9'2 DATE PAID: 2 e 3 FEE PAID: 7 dl1 RECEIPT #: SO 21 3- SC�_t [ I ] Innovative [ 1 [SECTION, TOWNSHIP, RANGE, PARCEL NUMBER] [OR TAX ID NUMBER] [INCHES /FT] [ABOVE /BELOIi[] BENCHMARK /REFERENCE [INCHES /FT] [ABOVE /BELOW] BENCHMARK /REFERENCE POINT POINT i EXPIRATION DATE: S /( Si/ u �. Page 1 of 3 ELECTRI CAL 'I'VPI Minimum Fee (fry. '1'YI'E Dryer QT y. TYPE: Outlet, Appliance QTY. 1'11'1{ Service Repair (,TV. A/C Central 1 -3 Ton Fan Outlet, Wall Service, Temporary A/C Central 4 -7 Ton Fire Pump Outlet, Switch Signs A/C Central 8 -15 Ton Fixture - Fluorescent Oven Space Heater (kw) A/C Central 16-20 Ton Fixture Light Parking Lot Lights Spas/Hot Tubs A/C Central 20+ Ton Flood Lights Plugmold/Strip Subfeeds, No. of Amps A/C Window FPL - Load Central Posts Swim Pool, Commercial Air Conditi oners Garbage Disposal Range/Range Top Swim Pool, Residential Chiller Generators, etc. Receptacles Switchboards Clear Violations Heat Recovery Refrigerator, Comm. (p/PH) Temp Serv., Construction Compactor Low -volt, Burglar Refrigerator, Domestic Temp for Test - 30 days Deep Freezer Low -volt, Fire Renew - Temp Service Water Closet Demolition Low -volt, Intercom/Teleph. Repair Circuits Water Heater Dishwasher Low -volt, Television Service, Number of Amps it Water Heater New MECHA 'ICAL TYI'F. Minimum Fee QTY. TYPE Condensate Drain QTY. TYI'I: Generator Q1'1'. 'I'YI'1E. Refrigeration, Tons QTY. A/C Central, Tons Cooling Tower Heating Strips, each Vent Hood, Cost A/C Wall/Win. Tons Dryer Vents, Number of Paint Booth Ventilation, Cost Air Handler, Tons Ductwork, Cost of Piping, Flammable Liquid Periodic Inspections Barbecue Fire Sprinkler System Process/Pressure Piping Supply, AC Well Bath Fan-Vented, # Fireplaces, Number of Pressure Vessel Temporary Toilet PLUMB NG TYPE A/C Condensate QTY. TYPE. Drains, Roof QTY. TYPE Miscellaneous Fixture QTY. 'I I'li Soakage Pit QTY. Bath Tub Drinking Fountain Miscellaneous Repairs Solar Water Heater Bidet Filter Replace Pool Piping Sprinkler Repair Cap - Fixture Fountain Pump and Abandon Sprinkler System Cap - Water Gas - Appliance Pump, Domestic Supply, AC Well Cap - Sewer Gas - Natural Pump, Fire Stand Temporary Toilet Catch Basin Gas - Propane Pump, Re- circulate Temporary Water Closet Clothes Washer Gas Piping Pump, Replace - Pool Urinal Dental Chair Grease Trap Pump, Sprinkler Utility - Sewer Discharge 'Well Ice Maker Pump, Sump Utility - Water Dishwasher Indirect Wastes Relay Repair Vacuum Pump Disposal Interceptor Roof Inlet Water Closet Domestic Well Laundry Tray Septic Connection Water Heater Drainfield, 4" Tile/Res. Lavatory Septic Tank 9 ) G it Water Heater New Drains, Area /e, A(28 421.�Ieter Set (Gas) Sewer Connection Water Re -pipe Drains, Floor Minimum Fee Shower Water Service Drains, French Miscellaneous Equipment Sink Well, Supply Page 3 R PERMIT APPLICATION INSTRUCTIONS: Please indicate the type of work being performed and quantity(ies) in the space provided below. RECEIVED AND REVIEWED BY: DATE: Page 4 OFFICE USE ONLY CHECKLIST ❑ OWNER - BUILDER FORM (Attach) ❑ FIRE DEPARTMENT APPROVAL (Commercial / multi - family) ❑ CONCURRENCY (New Construction) D OTHER (Specify & Attach) $3.00 per page (Scanning Fee) Miami Shores Village Bond Metropolitan Dade County (C.C.F.) Inspector State Educational Fund State DCA (Radon) Code Enforcement Fine Zoning Review Notary ❑ PROOF OF OWNERSHIP (Attach) ❑ HRS / DERM APPROVAL (Septic / Sewer) ❑ IMPACT FEE (New Construction) ❑ OTHER (Specify & Attach) $ 00 $ 3 ( 0 0 $ 1 , v t (sq.ft. = x/1000 x ¢.60) $ (¢.005 /sq.ft.) $ (¢.01 /sq.ft.) $ REVIEWED AND PREPARED BY: SECTION Zoning Electrical Mechanical Plumbing Fire Public Works Structural Building Official BY DATE PERMIT APPLICATION ❑ CONDO ASSOCIATION APPROVAL (Attach) ❑ BPR APPROVAL (Restaurants) ❑ CONTRACTOR REGISTRATION (On File) PERMIT FEES TOTAL $ 1 ISSUING OFFICIAL DATE: CONDITION OFAPPROVAL Revised July 2001 10050 N.E. 2ND AVE., MIAMI SHORES, FL o (305) 795 -2207 0 FAX (305) 756 -8972 http : / /www.miamishoresvillage.com Page 2 I'IPORTAN AFFIDA\'I NOTICES 1. DO NOT BEGIN ANY WORK WITHOUT HAVING RECEIVED YOUR VALIDATED PERMIT AND PERMIT CARD. Applying for a permit does not grant the right to begin construction. HOURS OF CONSTRUCTION are limited to: Monday through Friday from 7:30 a.m. to 6:00 p.m., and Saturday from 8:00 a.m. to 5:00 p.m. No inspections will be conducted on weekends or holidays. 2. All construction of demolition areas MUST BE MAINTAINED IN A CLEAN, NEAT AND SANITARY CONDITION free from construction debris. 3. STREETS AND NEIGHBORING PROPERTIES SHALL BE KEPT FREE FROM DIRT AND DEBRIS. 4. SWALES M1JST BE PROTECTED FROM BEING DAMAGED BY EQUIPMENT OR VEHICLES, AND MAY NOT BE USED FOR STORAGE. A bond is required for work in or near the street/sidewalk. 5. CONSTRUCTION TRAILERS ARE PROHIBITED ON SINGLE FAMILY RESIDENTIAL CONSTRUCTION SITES. Other construction may have a trailer which requires a separate permit. 6. PORTABLE TOILETS for a construction site require a separate permit. 7. DO NOT DISCHARGE WATER INTO THE RIGHT OF WAY OR STORM DRAINS without approval from the Building, Planning and Zoning Department. 8. EQUIPMENT AND MATERIALS SHALL BE STORED at least 10 feet from the edge of pavement. 9. Department of Health and Rehabilitative Services (HRS) approval is required for applications involving septic tanks. Department of Environmental Resources Management (DERM) and/or Miami -Dade Water and Sewer Department (MDWASD) approval is required for applications involving sewers. - Please read carefully. Application is hereby made to obtain a permit to do work and installation as indicated. I, the OWNER of the property, certify that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that separate permits are required for ELECTRICAL, PLUMBING, POOL, EXTERIOR DOOR, MECHANICAL, WINDOW, FENCE, DRIVEWAY, ROOFING and SIGNS and there may be additional permits required from other governmental agencies. I, the OWNER of the property, have disclosed all information related to any work at the property performed in the prior twelve months to the Building Official. Further, I am fully aware that if the cumulative cost of work to my home or business under this and any other permit equals or exceeds fifty percent (50 %) of the fair market value of the structure, the entire structure must meet the present federal flood criteria for finished floor elevation. I am also fully aware that if the total cost of work to my home or business under this and any other permit exceeds fifty percent (50 %) of the replacement cost of the structure, then the entire structure must conform to the current code requirements of the Building Code. WARNING TO OWNER: Your failure to record a NOTICE OF COMMENCEMENT may result in you paying twice for improvements to your property. If you are spending more than $2,500 or intend to obtain financing, you may wish to consult with your attorney or lender before recording your Notice of Commencement. The Notice of Commencement must be recorded at: 22 N.W. 1st Street, 1" Floor, (305) 679 -1078. Once recorded, the Notice of Commencement must be POSTED AT THE JOB SITE in accordance with Section 713 -35 of Florida Statutes. Review the brochure at Village Hall on Construction Lien Law and Choosing a Contractor. STATE OF :FLORIDA, C Y OF DADE Signature of Owner Print Name 1 Signature SEAL: 4 OF Personally known OR, Produced Identification STATE OF FLORIDA, COUNTY OF `v ADE Signature of Contractor / Qualifier Print Name Signature SEAL: Personally known PERMIT APPLICATION Iv • • NO.CC918427 ? • S ••, B LAG %.0�: tyybil _qv , Type of Identification Produced: Type of Identification Produced: CONTRACTOR Q Name 1 - y , 1 f 4Ce Po cO_/ t License No. Address d 7 I1 NW ) la c - I C r/ zg6 / Telephone 4m _ / tca326 Qualifier Name , r� a n � nA �� PROPERTY OWNER A tt4 i:' 1,,, ,ye= ! Name /' , /thy' Address 3 79, Nt 9y f lil'4m 1'l R3/ 3 g Home Telephone � Name Business Telephone Fax License No. ARCHITECT New Construction Enclosure Name Alteration Exterior Repair License No. Alteration Interior Demolish Address Relocation of Structure Shell Only Telephone Foundation Only i. � ^A AA Fax � � ,, TYPE OF MANAGEMENT (✓ ) New Construction Enclosure Alteration Exterior Repair G• Alteration Interior Demolish Relocation of Structure Shell Only Foundation Only Add'I Attachment Other Add'I Detachment Other i Step I. Job Address: ?79 v G HS 7 Address Apt. Folio Number i / 1 - ) /S - O& " ' 4'43'.n. Description of Work Lot j i/4/ i - Block r _s PERMIT TYPE (✓ ) Building Electrical Mechanical Plumbing LPGX Roofing Fence Other PERMIT CHANGE (✓ ) Chg. Contractor Renewal Revision Extension Supplement Reinspection Master Permit No. V Via'. City Tax Assessed/Appraised Value State PERMIT APPLICATION .a3 Subsidiary Permit No. INSTRUCTIONS - The following steps must be taken to obtain a permit from the Miami Shores Village: Complete the attached permit application which must be signed by the property owner and qualifier. Both signatures must be notarized. Please print or type to allow for a more accurate processing of your application. If roofing work will be done, a roofing application must be submit- ted along with this permit application. Step 2. Submit the completed application with all necessary documents to the Building, Planning and Zoning Department for processing. During the processing of your application, you may be asked to submit additional information. APPLICATION Zip Subdivision PB PG ning Linear Feet Current Use of Property Square Feet i ..../- Units Floors Proposed Use of Property Value of Work � 1o 0 Bldg Value Tenant Information Flood Zone Base Floor Elev. ENGINEER Name License No. Address Telephone Fax