SEPTIC/DRAINFIELDBUILDING
PERMIT APPLICATION
FBC 2001
Permit Type (circle): Building Electrical
Owner's Name (Fee
Owner's Address
City / 2".,e , 444
Tenant/Lessee Name
City
Qualifier
Architect/Engineer's Name (if applicable)
Type of Work:
Describe Work:
Total Fee Now Due $
(Continued on opposite side)
Miami Shores Village
Build' ent
10050 N.E.2nd . v 'T _ '; , ' , 10 da 33138
Tel:: (305) 95.2 F ,c ;56.8' 72
Permit No.pLas. z
Master Permit No.
C klumbing Mechanical Roofing
6 4 S fir Phone # 3°5 ' ! ‘ % 4'13
2-t s' 1J(:.
c State 1 L Zip 7
Phone #
Simple Titleholder)
Job Address (where the work is being done) 7 NE. 9 S / 13/1f
City Miami Shores Village County Miami -Dade Zip 33/q,
Is Building Historically Designated YES NO
Contractor's Company Name
Contractor's , ,dress dress l 7 3 2- "hi. 2- .
$ Value of Work For this Permit '
['Addition Alteration ['New
(06-g 00 ,6,9*,
Phone #
Zip
Square Footage Of Work: 7 1
�
* * * * * * * * * * * * * * * * * * * * * * * * * * ** F ees * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
Submittal Fee $ Permit Fee $ + 75 + 1 r .
Notary $ Training/Education Fee $
Scanning $ Radon $ Zoning
Code Enforcement $ Structural Plan Review. $ .P ' 1 / o 3i
CCF $ I g Q CO /CC
Technology Fee $ g -7S
Bond $ �_
Phone #
3o;t;i7g5
epair/Replace
❑ Demolition
Open CJ'�cC
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 anti 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
Signature aple.4. 1l C/Y Z. �
er or Agent
The fore � g / ,�,ng instrument was acknowledged before ore me this
day of 4 `'�f , 20 o 5, by 644/ ,
who is per onally known to me or who has produced
As identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:6 - -7-
My Commission Expires:
APPLICATION APPROVED BY:
Chc 12/15/03
STEPHEN E. OOCIONG
MY COMMISSION t OD 438919
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 Y�UR 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.ocatrs 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
******************************* * * * * * * * * * * * * * * * * * * * * * * * * * *3 * * *. * **
Contractor
The fore_ instn.11l�ent was ackno3clE�dged before me th 1
day of L J, _ ..� - 20
who is perso -_.y to me or who has produced
dentification and who did take an oath.
ion 3,98
3
NOTARY PUBL
Si
Print:
My Ct mmission E
*************************************.******** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
(Certificate of Competency Holder)
State Certificate or Registration No. Certificate of Com etency No.
*** * * * * * * * * * * * * * * * * * * * * * * * * * * * : * **
Plans Examiner
Engineer
Zoning
* * * * * * * * * **
ONSTRUCTION PERMIT FOR:
]New System [ ]Existing System
X ]Repair [ ]Abandonment
PPLICANT: Leah Fakhuri J.C.D. Maria MoAGENT: SR0931119, COCKING MSTEPHEN
ROPERTY STREET ADDRESS: 265 NE 96 St Miami FL 33138
)T: 18 BLOCK: 30 SUBDIVISION: Miami Shores
[Section /Township /Range /Parcel No.]
lOPERTY ID #: 11- 3206 - 013 -4100 [OR TAX ID NUMBER]
(STEM MUST BE CONSTRUCTED IN ACCORDANCE WITH SPECIFICATIONS AND STANDARDS OF CHAPTER 64E -6,FAC
:PARTMENT APPROVAL OF SYSTEM DOES NOT GUARANTEE SATISFACTORY PERFORMANCE FOR ANY SPECIFIC TIME
:RIOD. •ANY CHANGE IN MATERIAL FACTS WHICH SERVED AS A BASIS FOR ISSUANCE OF THIS PERMIT,
:QUIRE THE APPLICANT TO MODIFY THE PERMIT APPLICATION. SUCH MODIFICATIONS MAY RESULT IN THIS
:RMIT BEING MADE NULL AND VOID. ISSUANCE OF THIS PERMIT DOES NOT EXEMPT THE APPLICANT FROM
)MPLIANCE WITH OTHER FEDERAL, STATE OR LOCAL PERMITTING REQUIRED FOR PROPERTY DEVELOPMENT.
'STEM DESIGN AND SPECIFICATIONS
V1 L'LVLS..Utt
DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM
CONSTRUCTION PERMIT ;
i
1050 ]Gallons SEPTIC TANK
0 ]Gallons
0 ]GALLONS GREASE INTERCEPTOR CAPACITY
0 ]GALLONS DOSING TANK CAPACITY [ 0 ]GALLONS
[ 400 ]SQUARE FEET PRIMARY DRAINFIELD SYSTEM
[ 0 ]SQUARE FEET SYSTEM
TYPE SYSTEM: [ \J ]STANDARD [ N ]FILLED
CONFIGURATION: [ ]TRENCH [ y ]BED
LOCATION TO BENCHMARK: FEE: 11.0' NGVD
ELEVATION OF PROPOSED SYSTEM SITE [ 0.8 ] [ FEET
BOTTOM OF DRAINFIELD TO BE [ 3.1 ] [ FEET
iER REMARKS:
CENTRAX #: 13 -SG -26032
DATE PAID:
FEE PAID :
RECEIPT .
OSTDSNBR : 05 -2601- -R
]Holding Tank [ ] Innovative Other
]Temporary [ NA ]
FILL REQUIRED: [ 0.0 ]INCHES EXCAVATION REQUIRED: [ 28.0•] INCHES
MULTI - CHAMBERED /IN SERIES: [Y
MULTI - CHAMBERED /IN SERIES: [Y
@ [ 0 ]DOSES PER 24 HRS # PUMPS[ 0
[ N ]MOUND [ N ]
[ N
[ BELOW]BENCHMARK /REFERENCE POINT
[ BELOW] BENCHMARK /REFERENCE POINT
. Install 1050 gal. category -1 septic tank equipped with an approved filter.
. The licensed contractor installing the system is responsible for installing the minimum
ategory of tank in accordance with sec. 64E- 6.013(3)(f), FAC.
Install 400 sf of drainfield in bed configuration.
. Existing 1050 gal. septic tank to be inspected for an appropriate pump -out and properly
)andoned.
. Invert elevation of drainfi= . to be no less than 8.37' NGVD.
. Bottom of drainfield eleva 'on •• be no less than 7.87' NGVD.
,CIFICATIONS BY: Andre, Paul
ROVED BY: Andre, Paul
E ISSUED: 8/5/05
016, 03/97 (Obsoletes previous editio hich may not be.used)
qlk Number! 5744 -M1 _ant 4_M
TITLE: P 6
TITLE: Professional Engin Dade CHD
EXPIRATION DATE: 11/3/05
BUILDING ❑ MIAMI SHORES VILLAGE, FLORIDA S , +
ELECTRICAL Date 19
°
PLUMBING PERMIT N? 8777 Contractor's �/
License No. Poe /96
ROOFING ❑
❑ Work to be performed under this Permit
Owner of ,O i 1 1 t/ 1
Building 7 r7IL -t'
CONTRACTOR or BUILDER
Architect
Contractor
or Builder �`'' -` / Subdi-
vision
Legal Lot
Sq Ft
Building Project S y ' Q/ Value � I Amount
; of $ II of n „
Buildi [� '�" (� ((I - �G� 7 / oj Permit
This permit is granted to the contractor or builder named above to construct the building or to install the equipment or device described in the applica-
tion herefor in strict compliance with all ordinances pertaining thereto and with the understanding that the work will be performed in compliance with any
plans, drawings, statements or specifications that may have been submitted to and approved by the proper municipal authorities. This Permit may be revoked
at any time if the work is not done in compliance with such ordinances or if the plans are changed without authorization. A further condition upon which this
permit is granted is the understanding that the contractor or builder named above assumes the responsibility for a thorough knowledge of the ordinances and
regulations pertaining to the work covered hereby whether shown on th plans or drawings or in the statements or specifications and that he assumes respon-
sibility for work done by his agents, servants or employee '
Signed• t i i i (INSPECTOR) BY
In consideration of the issuance to me of this permit I ee to perform the work covered hereunder in compliance with all ordinances and regulations
pertaining thereto and in strict conformity with the plans, dr ngs, 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, myssf, my agent, servant or employee.
BY AUTHORITY
BUILDING ❑ MIAMI SHORES VILLAGE, FLORIDA �. , Z
Date 19_ e d
ELECTRICAL ❑
PLUMBING ❑ PERMIT N° 8768 Contractor's eea `E. 'V (3
ROOFING ❑ License No.
Owner of
Building '" i "t • is _
❑ Work to be performed under this Permit
Architect
Contractor 1 *4.
or Builder +� . r c T t 4 R..
Legal Lat
Description 1 Bl
Address of 14 L C.„ j
Building • ' f j
CONTRACTOR BUILDER
(.?rer
BY
��p'4 , V
1
Subdi-
vision
Sq Ft f�
Value of II Amount of
Project $ II Permit $ ■
This permit is granted to the contractor or builder named above to construct the building or to install the equipment or device described in the applica-
tion herefor in strict compliance with all ordinances pertaining thereto and with the understanding that the work will be performed in compliance with any
plans, drawings, statements or specifications that may have been submitted•to and approved by the proper municipal authorities. This Permit may be revoked
at any time if the work is not done in compliance with such ordinances or if the plans are changed without authorization. A further condition upon which this
permit is granted is the understanding that the contractor or builder namedftbove assumes the responsibility for a thorough knowledge of the ordinances and
regulations pertaining to the work covered hereby whether shown on the p ns or drawings or in the statements or specifications and that he assumes respon-
sibility for work done by his agents, servants or emp es. t '
Signed 16 1!.4 v" ' ''' "�, (INSPECTOR) BY
In consideration of the issuance to me of this permit I r to perform the work covered hereunder in compliance with all ordinances and regulations
pertaining thereto and in strict conformity with the plans, dra i , statements or specifications submitted to the proper authorities of Miami Shores Village.
In accepting this permit I assume responsibility for all ork a by either, myse f)y a nt, servant or employee.
7:4-C44
AUTHORITY