PL-10-1512BUILDING
PERMIT APPLICATION
FBC 20
Permit Type: PLUMBING
OWNER: Name (Fee Simple Titleholder): P Jm LI LU..sS l Phone#:
Address: � ,1 "I
City: 1 1 1, cs2Th5 A/Y State: PL.
Tenant/Lessee Name: Phone#:
Email:
JOB ADDRESS: Pr) 1 I4 6 t
City: Miami Shores
Folio/Parcel #: - Bo
Is the Building Historically Designated: Yes
CONTRACTOR: Company Name: r C) s l t Phone#: c - 1 -fl)
City: -1/Vl.t State
Qualifier N a m e : \ \k
State Certification or Registration #: 1 4 2,. to I Certificate of Competency #:
C o n t a c t P h o n e # : ' ( 1 f 6 6 1 Emil A d d r e s s : vy\C C - t c 1 � 4,1 ) c Or ht
DESIGNER: Architect/Engineer: Phone#:
Address:
Value of Work for this Permit: $ 1 i C I DD ° ® 0 Square/Linear Footage of Work:
u \ P e =
Type of Work: DAddress D D
Alteration New eplace DDemolition
Description of Work:
Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
INSPECTION'S PHONE NUMBER (305) 762.4949 BY:
County: Miami Dade
****+b** **YA*+B********* ******** **** tiR** Fees *** * ***bA+******B*+C** ************* *** ***B***
Permit Fee $ /5.
Radon Fee $ «lll
Training/Education Fee $
Structural Review $
Submittal Fee $. 6-
Scanning Fee $
Notary $
Double Fee $
Zip: S_ LS
Permit No. 1 PLIO '1512—
Master Permit No.
NO Flood Zone:
Zip: I (p9
Phone#: �DS _ — Lc i 1
CCF $ CO /CC $
DBPR $ Bond $ • C
pia.cC.)
Tec Fee $
TOTAL FEE NOW DUE $
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. 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 the absence of such posted notice, the
inspection will not be approved and a reinspection fee will be charged
Signatur
Owner or Agent
The foregoing instrument was ac • • wledged before me this
day of 51 rOb "� � w � ?
who is personally know -6 ' 'who aas u '
Contractor
The foregoing instrument was acknowledged before me this
d a y o f . 2010 , by r (k)"\ � � li+ e L
yy ho has produced
As i':'ntifi 'on and who did take an oath. as i.; and who did take an oath.
�h-
iRl
Sign:
Print:
MY COMM '* I ' #
My Commissi t"` •= EXPIRES: September 14, 2013
oer. Bonded That Notary Public Underwriters
APPROVED BY
(Revised 07 /10/07)(Revised O6/10/2OO9)(Revised 3/15/09)
■
who is personally known to
/ •e> •PlansExaminer
Structural Review
Sign:
Print:
�' SSION # DD 891340
• My Comm. bni PIR SE : September 14, 2013
7� Y' » q',.•' Bonded Thru Notary Public Underwriters
****+h* AFAR +***►d *L+****** **sI:**** soD+ ***** ' *** r- ; >8***** BBL: P**** *B ***** **k*+ M**aA+ R*** **+ R******* ******** *** *****+R*:M ****
Zoning
Clerk
REPLACE DRAINFIELD
Passed
Inspector Comments
HRS APPROVAL
'
Failed
Correction
Needed
Re- Inspection
Fee
No Additional Inspections can be scheduled
re- inspection fee is paid.
until
R
nspection Number: INSP - 150344
Permit Number: PL -8 -10 -1512
Inspection Date: September 27, 2010
Inspector: Bi N i01-
Owner: LOUISIAS, MARIE
Job Address: 801 NE 96 Street
Miami Shores, FL 33138-
Project: <NONE>
Contractor: MR C'S PLUMBING SEPTIC INC
Building Department Comments
September 27, 2010
Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
For Inspections please call: (305)762 -4949
Permit Type: Plumbing - Residential
Inspection Type: Final
Work Classification: Drainfield
Phone Number
Parcel Number 1132060142780
Phone: (305)651 -7859
Page 1 of 1
STATE OF FLORIDA
DEPARTMENT OF HEALTH
APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PERMIT
Permit Application Number
MN= NMI
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Scale: Each block represents 10 feet and 1 inch = 40 feet.
Notes: g ( tOC 9 N tet),.,,1 I .
3 to. cQ `ti, 6e )42 g A ac,,ecp . Sep4tc_- --- -In t-Q Ata ),, .
Site Plan submitted by:
Plan Approved V Not Approved Date 51 t ca
By County Health Department
PART II - SITEPLAN
ALL CHANGES MUST BE APPROVED BY THE COUNTY HEALTH DEPARTMENT
DH 4015, 10196 (Replaces HRS -H Form 4016 which may be used)
(Stock Number: 5744002- 4015 -6)
Page 2 of 4
CONSTRUCTION PERMIT FOR: OSTDS Repair
APPLICANT: Joseph Louisias
PROPERTY ADDRESS: 801 NE 96 St
PROPERTY ID #: 11-3206-014-2780
SYSTEM DESIGN AND SPECIFICATIONS
I ELEVATION OF PROPOSED SYSTEM SITE
E BOTTOM OF DRAINFIELD TO BE
L
D FILL REQUIRED: [ 0.00 ] INCHES
0
T
H
E
R
APPLICATION #: AP975810
STATE OF FLORIDA
DEPARTMENT OF HEALTH DATE PAID:
ONSITE SEWAGE TREATMENT AND DISPOSAL FEE PAID.
SYSTEM
RECEIPT #:
DOCUMENT #:PR819532
THIS PERMIT IS NOT FOR ADDITION(s).
SPECIFICATIONS BY:
APPROVED BY
DATE ISSUED:
08/17/2010
ar/e ,3 (151
Miami, FL 33138
LOT: 16 +17 BLOCK: 74 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 SeDtiC 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 [ 300 ] SQUARE FEET SYSTEM
R [ 0 ] SQUARE FEET SYSTEM
A TYPE SYSTEM: [X] STANDARD [ ] FILLED [ ] MOUND [ ]
I CONFIGURATION: [ ] TRENCH [S] BED [ ]
N
F LOCATION OF BENCHMARK: F.F.E.: 10.9' NGVD
1- Existing 900 gal. septic tank certified by " Mr C's Plumbing & Septic " on 08/03/2010 to remain. 2- Install 300 sf of
drainfield in bed configuration. 3- Install 12" of slightly limited soil under the bottom of drainfield. 4- Perimeter of excavation
area shall be at (east 2 ft wider and longer than the proposed absorption bed. 5 -Invert elevation of drainfio be no less
NGVD. ixt,„„,"osposolistv
than 7.46' NGVD. 6. Bottom of drainfield elevation to be no less than 6.96'
tAiN
[ 19.20 ] [I INCHES V FT ] [ ABOVE a BELOW b BENCHMARK /REFERENCE POINT
[ 47.20 ] (1 INCHES I FT 3 [ ABOVE /) BELOW h BENCHMARK /REFERENCE POINT
EXCAVATION REQUIRED: [ 40.001 INCHES
TITI;E: /
[SECTION, TOWNSHIP, RANGE, PARCEL NUMBER]
[OR TAX ID NUMBER]
TITLE:
DH 4016, 08/09 (Obsoletes all previous editions which may not be used)
Incorporated: 64E- 6.003, FAC
v 1.1,4 AP975810 8E823886
PERMIT # -SC- 1273376
Dade CHD
EXPIRATION DATE: 11/15/2010
Page 1 of 3
NOTICE OF RIGHTS
A party whose substantial interest is affected by this order may petition for an
administrative hearing pursuant to sections 120.569 and 120.57, Florida Statues. Such
proceedings are govemed by Rule 28 -106, Florida Administrative Code. A petition for
administrative hearing must be in writing and must be received by the Agency Clerk for the
Department, within twenty-one (21) days from the receipt of this order. The address of the
Agency Clerk is 4052 Bald Cypress Way, BIN # A02, Tallahassee, Florida 32399 -1703. The
Agency Clerk's facsimile number is 850 -410 -1448.
Mediation is not available as an altemative remedy.
Your failure to submit a petition for hearing within 21 days from receipt of this order will
constitute a waiver of your right to an administrative hearing, and this order shall become a 'final
order'.
Should this order become a final order, a party who is adversely affected by it is entitled
to judicial review pursuant to Section 120.68, Florida Statutes. Review proceedings are
govemed by the Florida Rules of Appellate Procedure. Such proceedings may be commenced
by filing one copy of a Notice of Appeal with the Agency Clerk of the Department of Health and a
second copy, accompanied by the filing fees required by law, with the Court of Appeal in the
appropriate District Court. The notice must be filed within 30 days of rendition of the final order.