PL-08-1086 :
Miami Shores Village
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.1 09ir2008
Project Address Parcel Number Applicant
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1015 NE 97 Street 1132050170120
Miami Shores, FL 33138 -2555 Block: Lot: ROBERT BAILEY
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ROBERT BAILEY 1015 NE 97 Street
MIAMI SHORES FL 33138 -2555
........................................................ ...............................
Contractor(s) Phone Cell Phone :Valuation: $ 3,000.00
BOBS SEPTIC & DRAIN INC 305 -558 -5818
Total Sq Feet: 0
Type of Work: SEPTIC & DRAINFIELD Available Inspections:
Type of Piping:
Inspection Type
Additional Info:
HRS Approval
Bond Return: Final
Classification: Residential Rough
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Q Landscaping
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MIAMI SHORES VILLAGE
Fees Due Amount Total Amt Paid Amt Due
Bond Type - Owners Bond $300.00 :.............................
CCF $1.80 $ 669.14 $ 669.14 $ 0.00
Education Surcharge $0.60 :.......:....._
Notary Fee $5.00 Payment Type: Check / Number: 823
Permit Fee - Additions/Alterations $175.00
Permit Fee - Additions/Alterations $175.00
Scanning Fee $3.00
Technology Fee $8.74
Total: $669.14
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 12, 2008
Authorized Signature: Owner / Applicant / Contractor / Agent Date
Building Department Copy
Thursday, June 12, 2008 1
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100$0 �1 ',L r�4i Avenue,; Mia 'i Shores '1`I�ort da 33138"
T61, (30) 795.2204 Fa x (305) 756.8972
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BUILD NG Permit N o.
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PERMIT APPLIC" . i 10 � ' !�� ���' Master'Permit No.
� FBC 2004
Permit Type: Plumbing
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Owner's Dame (Fee Simp Titlelolde) Phone # S /' U
Owner's Address _
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ITenantlLessee Name M ! � i i �� Rhone #
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„ Job Address where the +Mork is bc�rt� done)
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City Miami Shoes Villa e' j bunty Miami -Dade Zip )
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FOLIO/ PARCEL # T v
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Is Building Historically Designated YES
NO
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Contractor's Company ame
pany `�"' Phone
Cvntracto 's Address i
City Zip
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Qualifier Name
S
I . (hone #
S Certificate i tration N i f
State Ce Reg s
Certificate o CompetencyNo. (-.)k) � +1�
E -MAIL:
ArchitectlEngineer's Name (if apPilcabie) Phone #
Value of Work For this Permit $ Square ! Linear Footage Of Work:
Type of Work: []Ad []Altetipnl EINew Repair /Replace El Demolition
Describe Work
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t4�z�& sYY4toYaY �n &pit &4'Y tk 8reY4r�sYM 'Ardt�t 'wYdeaSide4e ro4�a'iStQa4iruak�oYYe 4e se4esa. 4extit3r. sY` x1e9e9tx $r3cdrxs4tks4xxYe4.xYxir'&&
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Submittal Fee $ . permit Fee : ' � `' f 175 .— 356 r ' CCF $ ^ t, Ou CO /CC
Notary $ ! Trainn/ducatiod Ied 0. 60 'f eehnology Fee $. ` • 7q-
Scanning $ I[ta 00 $ � � ; � DPBR $ Zoning $
Bond $ t`l1'L- C( Enforaem j t Double fee $.' dd
Structural Review. $ Total Fee Now Due C6 T
Reverse side
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Bonding Company's Nat" if applicable)
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Bonding CoToan..:y Addre s j
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Zip
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Mo tgage Lender's Address l
City II
State
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Application'l§ hereby made t obtain a ernit to do the P work and instal
a .
s indicated..) certify .. ify that no work of installation
enced nor t illation has
o the s
Comm
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n uance of
a permit p and that all work will be
performed d to
meet P t th
e
standard
dard
construction) s of all laws �egulatmgl
ip this dui isdict� n. l understand that a separate permit must be secured for ELECTRICAL WORK, PLUMBING, SIGNS
'WELLS, POOLS, FURNAC �S, BOILERS, HEATERS, TANKS and AIR CONDITIONERS, ETC.....
OWNER'S 'FFIDAVIT: certify that all the foregoing information g g is accurate and that all work will be done in compliance with all
I' applicable las regulating construction and zoning.
"WARNINGI TO OWNER' YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR I I'
PA' INC TIIVICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANC
CONSULT I' WITH YO 1R LENDER ING,
OR
AN TTORNEY
A
BEFOR
E RECORDING YOUR
COiVIMENC�MENT. j NOTICE OF �
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Notice to Applicant: As a condition to the issuance of a building
with
$ permit an estimated value exceeding $2500, the applicant must I, �
promise in good faith that acopy of the notice of commencement and construction lien law brochure'' will be delivered to the person
whose prope `r is subject to a 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 o
such posted
ins ection x i l not be f p notice, the
P � I, approu¢d and a reinspection fee will be charged
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Signatu
Signature
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Owner Agent
g Contr ct r
The foregoing oin Instrument was' r.
g ai actin
I $ acknowledged before me this The foregoing instrument was ackn [edged before me this
'day of Al2 I �� , 20a , b� �� 1 t[ � f day o � 7)M�
, 20 d$, by
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who is ersonah known to m or w ho has
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who is personally rsonall known to l P y e or who has produced
6Z As ide tifcation and who did take a
LtG 4300 as identification and who did take an oat
NOTARY P L
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My Commission Expires: ,
I My Commission xpires: .,,�; ....• c; r
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APPLICATION, APPROVED BY:
s Examiner
Engineer
Zoning
(kevised 02/08/06)
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STATE OF FLORIDA
DEPARTMENT OF HEALTH
APPLICATION FOWONSITE.SEWAGE DISPOSAL SYSTEM CONSTRUCTION PERM T
•� Permit Application Number
-- -- -- ,.— ,_.._.�...i.___ PART II -SITE PLAN-------.;
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Scale Each block represents -5 feet and 1 inch - 50 feet.
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Site Plan submitted b :
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Plan Approved V 11, Not Approved Date
By ,, f d . County Health Department
ALL CHANGES MUST BE AiPPA VED BY THE COUNTY HEALTH DEPARTMENT.
DH 4018 10196 (Replaces HR8-H Forth 4015 which maybe used)
(Stock Number 674a- M-4015 s) Page 2 of 3
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PLOZ
JUN 12 ZOO PERMIT #: 13 -SG- 942705
STATE OF FLORIDA APPLICATION #: AP884392
DEPARTMENT OF HEALTH DATE PAID: 06/10/2008
`1<S ONSITE SEWAGE TREATMENT AND DISPOSAL - FEE PAID: $55.00
SYSTEM RECEIPT #: 13 -PID- 1039942
+ <y
"'` ` DOCUMENT # : P R741497
CONSTRUCTION PERMIT FOR: OSTDS Repair
APPLICANT: Robert Bailey
PROPERTY ADDRESS: 1015 NE 97 St MIAMI, FL 33138
LOT: 12 BLOCK: 180 SUBDIVISION: Miami Shores Sec. 8
PROPERTY ID #: 11 - 3205 017 - 0120 [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 190DIF-ICATIONS 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 Seotic 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 [ 200 ] SQUARE FEET SYSTEM
R [ ] SQUARE FEET SYSTEM
A TYPE SYSTEM: [X] STANDARD [ ] FILLED [ ] MOUND [ ]
I CONFIGURATION: [ ] TRENCH [X] BED [ ]
N
F LOCATION OF BENCHMARK: FFE : 10.4 " NGVD
I ELEVATION OF PROPOSED SYSTEM SITE [ 14.40][ INCHES FT ][ABOVE BELOW BENCHMARK /REFERENCE POINT
E BOTTOM OF DRAINFIELD TO BE [ 44.40][ INCHES FT ][ABOVE BELOW BENCHMARK /REFERENCE POINT
L
D FILL REQUIRED: [ 0.00] INCHES EXCAVATION REQUIRED: [ 30.00] INCHES
O 1.Install 900 g septic tank.
2.Install 200 sq ft drainfield.
T 3.Perimeter of excavation area shall be at least 2 ft wider and longer than the proposed absorption bed.
H 4.Invert elevation of drainfield to be no less than 7.2' NGVD.
5.13ottom of drainfield elevation to be no less than 6.7' NGVD.
E The licensed contractor installing the system is responsible for installing the minimum category of tank in accordance
R
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SPECIFICATIONS BY: Robert -S SzPTIC TITLE: - Legacy
APPROVED BY: TLE: Engineer Specialist II Dade CHD
ep R or
DATE ISSUED: 6/11 EXPIRATION DATE: 09/09/2008
DH 4016, 10/97 (P evious Editions May Be Used) Page 1 of 3
SE758659
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Septic Tanks • Graa8�9 Trepb
8
0 & Drain Raft - Sewer ?
Jet CA"ning
CC#OW652 • State Certified a Septic Tank Contractor
t1 *` P.O. Box 612333 a North Miami. Florida 33261 -2333
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Phone: (306) 558-5818
3 °08 FACSIMILE TRANSMISSION
Date: a
Please deliver these documents immediately to
Of
Fax #
From: P A a2 - ) U
Dade (305) 558 -5818 * Brow (954) 920 -5099
Fax (305) 893 -0270
# Of Pages Including Cover Sheet -
MESSAGE:
0 a b - r - Cdzas rA 0,
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loss N. ST>
"24 Hour Serviol • LiCensed & insured"
EnvironmentaiH l
Florida Department vf$egt';
i -Dida Coun
.Nham 'p •'s•ti
Tank D'
s ... OSTDSJS c ivi�i
7769 NW 49* St. SUM 175
i*am . �1 33166 ., �. ; F: � I�. } r .. '.. 5 r r Ir ' .• .
Inspector
,.• ., •
•. - Address °.: � -'
Comments:
Signatur
STATE OF FLORIDA PERMIT NO. n
DEPARTMENT OF HEALTH DATE PAID: V
ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM FEE PAID;
CONSTRUCTION INSPECTION AND FINAL APPROVAL RECEIPT P.
APPLICANT:
AGENT:
PROPERTY ADDRESS: _/_,__._.
LOT. BL.00K-.Z9k:L, SU13DIVISION PROPERTY ID #:
CHECKED [XI ITEMS ARE NOT IN COMPLIANCE WITH STATUTE OR RULE AND MUST BE CORRECTED.
= = = t= = = =
TANK INSTALLATION SETBACKS = -m =
1 1 TANK SIZE I'll a,2
_ MZ:
1 (021 TANK MATERIA% 1 1 1271 SURFACE WATER FT
t 1 [03] OUTLET DEVICE J�� 1 (281 DITCHES FT
t041 MULTI• CHAMBERED (I?/ N 1 1 1291 PRIVATE WELLS FT
(051 OUTLET FILTER -,- Q Lk 1 1 PUBLIC WELLS FT
D-�2�- -em Iq 1 (311 IRRIGATION WELLS— FT
1061 LEGEN
1 [321 POTABLE WATER LINES
10 WATERTIGHT
1081 LEVEL 1 1331 BUILDING FOUNDATION. -f FT
1 DEPTH TO LID 1 [341 PROPERTY LINES -4-c— FT
1 13 OTHER FT
DRAINFIELD INSTALLATION FILLED MOUND SYSTEM
( AREA ( 4EX-41- SOFT 1 1: DRAINFIELD COVER
( DISTRIBUTION BOX — HEADER I t371 SHOULDERS
1121 NUMBER OF DRAINLINES -'r- t 1 ( SLOPES
1 [131 DRAINLINE SEPARATION 1 (39] STABILIZATION
1 1141 DRAINLINF- SLOPE
1 1 DEPTH OF COVERI;F ADDITIONAL INFORMATION
(1 6 ) ELEVATION (ABOVI!4ELO m 1401 UNOBSTRUCTED AREA
1171 SYSTEM LOCATION -
[41] STORMWATER RUNOFF
I [lei DOSING PUMPS 1 [421 ALARMS
0 AGGREGATE SIZE 1/y f 1 143] MAINTENANCE AGREEMENT
1201 AGGREGATE EXCESSIVE FINES 1 [441 BUILDING AREA
12 AGGREGATE DEPTH 1 (451 LOCATION CONFORMS WITH SITE PLAN
) (46] FINAL SITE GRAD G
FILL EXCAVATION MATERIAL 1 [471 CONTRACTOR
1 1 FILL AMOUNT.:? 1 [48] OTHER
1 [23] FILL TEXTURE
1 [24] EXCAVATION DEPTH ABANDONMENT
1 [25] AREA REPLACED f491 TANK PUMPED —
1 1 REPLACEMENT MATERIAL 1 [ TANK CRUSHED & FILLED -6-1,2::Qzt
EXPLANATION OF VIOLATIONS REMARKS:
lop
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CONSTRUC� ObLL,�F�tFiayED/6$APPFtOVED102*! a!! CHD DATE: =
FINAL SYS );APPR �OSAPPROVEDJI.v ' * CHO DATE:1 ;Z! - 41"'e
OH 4018 (Page 2), 10/97 (Previous Editions May Be Used) Page 2 of 3
Stook Number $744-002-4015.4 PT 1: A00"Al
PT 9: instaffermontractor
FT ZZ BUIldirig Depwbftra
PT 4: HgWth D90anment
Inspection Worksheet
0 mot
Miami Shores Village
*X4
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795-2204 Fax: (305)756-8972
........ -------
............ !:W
Inspection Date: 06/24/2008 Permit Type: Plumbing - Residential
Inspector: Levrock, James Inspection Type: Final
Owner: BAILEY, ROBERT Work Classification: Septic
Job Address: 1015 97 Street NE
Miami Shores, FL 33138-2565 Phone Number
U0 00000 . Parcel Number 1132050170120
Project: <NONE>
Block: Lot:
Contractor: BOBS SEPTIC & DRAIN INC Phone: 305-558-5818
Building Department Comments
REPLACEMENT OF SEPTIC AND DRAINFIELD
or Comments
Passed
or C
Failed El
Correction
Needed
Re-inspection
Fee
($75)
No Additional Inspections can be scheduled until
re-inspection fee is paid
Monday, June 23, 2008 Page 2 of 2