Plumbing for septicMiami Shores Village
10050 NE 2nd Avenue
Phone: 305 - 795 -2204 Permit Number: PL2004 -365
Printed: 12/27/2004
Applicant: CARLOS MOGOLLON
Owner: MOGOLLON CARLOS
JOB ADDRESS: 284 NE 96 ST
Parcel # 1132060133860
Plumbing Permit
Contractor A AARON SUPER ROOTER INC Contractor's Address: 6022 S. W. 35 CT.
Local Phone: 954- 967 -9933
Legal Description: MIAMI SHORES SEC 1 AMD PB 10 - 70 LOTS 1 & 2 & E1/2 OF LOT 3 BLK 29 LOT SIZE
Fees: Description Amount
FEE2004 -13139 Building Fee $175.00
FEE2004 -13142 Technology Fee $4.37
FEE2004 -13143 Scanning Fee $3.00
FEE2004 -13144 Builders Bond $300.00
FEE2004 -13145 Training and Education Fee $0.40
FEE2004 -13146 CCF $1.20
Total Fees: $483.97
Total Fees: $483.97
Total Receipts: $0.00
Permit Status: APPROVED Permit Expiration: 6/19/2005 Construction Value: $2,400.00
Work: INSTALL DRAINFIELD
Signed: (INSPECTOR)
Page 1 of 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 responisibility for all work
done by either myself, my agent, servants or employes.
Signed: (Contractor or Builder) BY:
City M 1'4[ S to 1—
Tenant/Lessee Name
(Sc i)
Job Address (where the work is being done`
City Miami Shores V
Is Building Historically Designa
Qualifier
(. Y`A �Tv
State Certificate or Registration No.
Miami Shores Village
Building-Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
BUILDING DEC 2 1
PERMIT APPLICAT ON _I
FBC 2001
ti
& croG •4�
x: (305) 756.8972
Permit No. P /V"[
off
Master Permit No.
Permit Type (circle): ( Building Electrical
Owner's Name (Fee Simple "itleho der) earl t t o S O , 5 b (' Phone #
Owner's Address 2g1-1- %c7 S--r
Zip 33 ( 3d
vi i9 1)6A , one #
_Zip 331 Se
Contractor's Company Name
Contractor's Address 6O'
City M ka, tea( i c Zip .3'3
Certificate of Competency No.
Architect/Engineer's Name (if applicable) N n Phone #
$ Value of Work For this Permit 124 0°' a°
Mechanical Roofing
Type of Work: ❑Addition El Alteration ❑New _p VRepair/Replace ❑ Demolition
Describe Work: hratr\ -
Submittal Fee $ 9 Permit Fee $ 11 s CCF $ 1 ■ �0 • CO /CC
Notary $ Training/Education Fee $ / LU Technology Fee s4 • 33
Scanning $ " ( ' _ Radon $ Zoning Bond $ "W
Code Enforcement $ Structural Plan Review. $
9 -E-a&
Square Footage Of Work: 300
* * * * * * * * * * * * * * * * * * * * * * * * * * ** F ees * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
Total Fee Now Due $ - C
(Continued on opposite side)
Bonding Company's Name (if applicable) N L
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. 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: 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 th 4.sence of such posted notice, the
inspection will not be approved and a reinspection fee will be charged.
Signature,
Owner or Agent
The foregoing instrument was acknowledged before me this 17 The foregoing instrument was acknowledged before me this 1 )
day of O a d , 20 ° 4 by ' M 5 Fe. IAN Ko3ol O,n , day of 9tC , 26 , by ; 7r u (..n T ,
who is personally known to me or who has produced 1) - L' t ein C e who is personally known to me or who has p roduced t--''c-en s.e
NOTARY PUBLIC:
Sign:
Print:
So
**
* * * **
c rmo
-MASSA a, StitAMON
tatoKt:,§' +roeh'iief ��i a
* **
**
My Conunission Expires:
* * * * * * * * * * * * * * * * * * * * * * * * * * **
* * * * * * * * * * * * * * * * * * * * * * * * * * * **
APPLICATION APPROVED BY:
Chc 05/13/03
Lb-t€
ve
As identification and who did take an oath.
Signature
NOTARY PUBLIC:
Sign:
Print:
* * * * * * * * * * * * * **
Contractor
as identification and who did take an oath.
My Commissio jF3 TERESA J. SOLOMON
tvIY .Y)MM1SSION ?Y 'DI '
** * * ** * ** * * ** * **
; I�XYliih'�' rF t. - . i6 <U(7
IP FL Notary (Account Assoc. Co.
*** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** * * * * * * * * * * * * * * * * * * * * * * **
Zoning
Plans Examiner
Engineer
* **
STATE OF FLORIDA
DEPARTMENT OF HEALTH
OfSITF SEWAGE TREATMENT AND DISPOSAL SYSTEM
CONSTRUCTION PERMIT
CONSTRUCTION PERMIT FOR:
[ ]New System [ ]Existing System [ ]Holding Tank [ ] Innovative Other
[, X ]Repair [ ]Abandonment [ ]Temporary [ NA ]
APPLICANT: Mogollon, Carlos AGENT: SR091112, Tuffy John
PROPERTY STREET ADDRESS: 284 NE 96 St Miami Shores FL 33138
LOT: 1 BLOCK: 29
PROPERTY ID #: 11 - 3206 - 013 - 3860
SYSTEM MUST BE CONSTRUCTED IN ACCORDANCE WITH SPECIFICATIONS AND STANDARDS OF CHAPTER 64E -6,FAC
DEPARTMENT APPROVAL OF SYSTEM DOES NOT GUARANTEE SATISFACTORY PERFORMANCE FOR ANY SPECIFIC TIME
PERIOD. 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 PROPERTY DEVELOPMENT.
SYSTEM DESIGN AND SPECIFICATIONS
T
A
N
K
1050 ]Gallons SEPTIC TANK
0 ]Gallons
0 ]GALLONS GREASE INTERCEPTOR CAPACITY
0 ]GALLONS DOSING TANK CAPACITY [ 0 ]GALLONS
D 300 ]SQUARE FEET PRIMARY DRAINFIELD SYSTEM
R 0 ]SQUARE FEET SYSTEM
A TYPE SYSTEM: [ N ]STANDARD [ N ]FILLED
I CONFIGURATION: [ N ]TRENCH ( N ]BED
N
F LOCATION TO BENCHMARK: Existing Finished Floor Elev.:
I . •ELEVATION OF PROPOSED SYSTEM SITE [ 0.0 ] 1 FEET
E ;BOTTOM OF DRAINFIELD TO BE [ 0.0 ] [ FEET
L
D ;FILL REQUIRED: [
OTHER REMARKS:
1. Existing 1050 gal. septic tank has to remain.
2. Drainfield to be Terralift 12" below existing system.
THIS PERMIT IS NOT FOR AN ADDITION.
SPECIFICATIONS BY: Icaza, Carlos
APPROVED BY: Icaza, Carlos
SUBDIVISION: Miami Shores Sec N 1
[Section /Township /Range /Parcel No.]
[OR TAX ID NUMBER]
0.0 ]INCHES EXCAVATION REQUIRED: [ 0.0 ] INCHES
,f k k
t
TITLE:
TITLE: Engineer I
CENTRAX #: 13 - - 23235
DATE PAID:
FEE PAID : $
RECEIPT .
OSTDSNBR : 04 - 4185 - -
MULTI- CHAMBERED /IN SERIES: [Y ]
MULTI- CHAMBERED /IN SERIES: [Y ]
@ [0 ]DOSES PER 24 HRS # PUMPS( 0 ]
[ N ]MOUND [ N ]
[ N ]
10.70 Ft NGVD
] [ BELOW] BENCHMARK /REFERENCE POINT
] [ ]BENCHMARK /REFERENCE POINT
Dade
DATE ISSUED: 12/16/04 EXPIRATION DATE: 3/16/05
CHD
Miami -Dade My Home Page 2 of 2
http: / /gi sims2.co. miami - dade.fl.us /myhome /propmap. asp ?app= none&bytool= ADDR&cm.... 12/17/2004
Scale: Each block represents 5 feet and 1 inch = 50 feet.
STATE OF FLORIDA
DEPARTMENT OF HEALTH
APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION P//E�FT IT n
Permit Application NumbbrJ' f'
PART II - SITE PLAN
1 '
Votes: 4 3olio n ° 2 8 2 1- - NE 1 al 33138
EWA St\ r--e S1 s" Ai-ex C ow In - f-f -
u
ck Y o t r c t Y elm P x 1: ■ r`s9 S1 ,C"f - e
)2/ 1 g Of
Signature Title
Not Approved Date
Site Plan submitted by:
'Ian Approved
3 y County Health Department
ALL CHANGES MUST BE APPROVED BY THE COUNTY HEALTH DEPARTMENT
APPLICANT: Mogollon, Carlos AGENT: SR091112,
PROPERTY STREET ADDRESS:284 NE 96 St Miami Shores FL 33138
LOT: 1
PROPERTY ID #: 11- 3206 -013 -3860
CHECKED [X] ITEMS ARE NOT IN COMPLIANCE WITH CHAPTER 64E -6, FLORIDA ADMINISTRATIVE CODE.
BLOCK: 29
TANK INSTALLATION
[01] TANK SIZE [1]1050 [2]
[02] TANK MATERIAL Concrete
[03] OUTLET DEVICE
[04] MULTI - CHAMBERS
[05] LEGEND N/A
[06] WATERTIGHT
(07) LEVEL
[08] DEPTH OF LID
DRAINFIELD INSTALLATION
[09] AREA [1] 345 [2] 0
[10] DISTRIBUTION BOX /HEADER
[11] NUMBER OF DRAINLINES 16
[12] DRAINLINE SEPARATION
[13] DRAINLINE SLOPE
[14]
[15]
[16]
[17]
[18]
[19]
[20]
[21)
DEPTH OF COVER
SYSTEM ELEVATION
SYSTEM LOCATION
DOSING PUMPS 0
AGGREGATE SIZE
AGGREGATE SOURCE
AGGREGATE WASHED
AGGREGATE DEPTH
FILL /EXCAVATION MATERIAL
[22] FILL AMOUNT
[23] FILL TEXTURE
[24] EXCAVATION DEPTH
[25] EXCAVATION AREA
[26] REPLACEMENT MATERIAL
EXPLANATION OF VIOLATIONS:
ADS
CONSTRUCTION [ APPROVED
FINAL SYSTEM [ APPROVED
c • v
STATE OF FLORIDA
DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM
CONSTRUCTION INSPL TION AND FINAL APPROVAL
SUBDIVISION: Miami Shores Sec N 1
[Section /Township /Range /Parcel No.]
[OR TAX ID NUMBER]
3.5
] Cave, Ronald
] Cave, Ronald
DH 4016, 03/97 (Obsoletes previous editions which may not be used)
(Stock Number: 5744- 002 - 4016 -4) [ostds_cins_4016 -21
CENTRAX #:13 -SG -23235
DATE PAID:
FEE PAID :
RECEIPT .
OSTDSNBR :04- 4185 -R
SETBACKS
[27] SURFACE WATER
[28] DITCHES
[29] PRIVATE WELLS
[30] PUBLIC WELLS
[31] IRRIGATION WELLS
[32] POTABLE WATER LINES
[33] BUILDING FOUNDATION
[34] PROPERTY LINES
[35) OTHER
FILLED /MOUND SYSTEM
[36] DRAINFIELD COVER
[37] SHOULDERS
[38] SLOPES
[39] STABILIZATION MATERIAL
ADDITIONAL INFORMATION
[40] UNOBSTRUCTED AREA
[41] STORMWATER RUNOFF
[42] ALARMS
[43] MAINTENANCE AGREEMENT
[44] BUILDING AREA
[45] PLUMBING FIXTURES
[46] FINAL SITE GRADING
[47] CONTRACTOR A Aaron Super Rooter
[48] OTHER
ABANDONMENT
[ ] [49] TANK PUMPED 1/5/05
[ ] [50] TANK CRUSHED AND FILLED
Dade
CHD Date: 1/5/05
Dade CHD Date: 1/5/05
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