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PL-09-1414Project Address Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL 33138-0000 Phone: (305)795 -2204 Per S Parcel Number 29 98 Street Miami Shores, FL 33138- 1132060131120 Block: Lot: BEVERLY MCCORQUODALE Owner Information BEVERLY MCCORQUODALE Contractor(s) MR CS PLUMBING SEPTIC INC Phone Cell Phone (305)651 -7859 (305)651 -5652 Fees Due Bond Type - Owners Bond CCF Education Surcharge Permit Fee - Additions/Alterations Scanning Fee Technology Fee Total: Amount $300.00 $1.80 $0.60 $350.00 $3.00 $8.75 $664.15 Authorized Signature: Owner / Applicant / Building Department Copy August 24, 2009 Address 29 98 Street FL Type of Work: SEPTIC & DRAINFIELD Type of Piping: REPLACEMENT Additional Info: Bond Retum : Classification: Residential Invoice # PL -8-09 -35711 PL -8-09 -35711 Check #: 4215 Total Amt Paid Amt Due $664.15 $30000 IVO $ 664.15 $ 664.15 $ 0.00 Bond #: 1884 In consideration of the issuance to me of this permit. ! agree to per-fowl 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. Contractor Agent Phone Applicant Valuation: Total Sq Feet: Date Expiration: 02/20/2010 CeII $ 2,200.00 300 For Inspections please call: (305)762 -4949 Available Inspections: August 24, 2009 414 ROVED Inspection Type: HRS Approval Abandonment Final Rough Landscaping 1 Permit Type: Plumbing BUILDING PERMIT APPLICATION FBC 2000 City F-4 t C- t' 6 r State cL.. Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tenant/Lessee Name E -MAIL: nn © Job Address (where the work is being done] Ac-3 �& O City Miami Shores Village County Miami -Dade FOLIO / PARCEL # t 2■ 0 13 - 11 20 Is Building Historically Designated YES NO I� a 11 pp�C•__ r ` �j la AUG 24 2009 NI BYE'' Tel: (305) 795.2204 Fax: (305) 756.8972 Permit No. '' 1414 Master Permit No. ry G Owner's Name (Fee Simple Titlehdlderfkl�VJ .1 " � ���� e # & CDS - 75a° 5-7 g J Owner's Address Crl G fa tqS Zip Phone # Zip .3- / oe 3o Gs 1 - ,451 Contractor's Company Names` r- C one # Contractor's Address t J2 NO r- 'J €- Cit IN-ALRIS 1 State W... Zip 33 C CoC Qualifier Name a)k In Ha, Y1 1 'ell Phone # 30C 65/ .- 72 State Certificate or Registration No. G (i oZ (al S 1 Certificate of Competency No. E -MAIL: Architect/Engineer's Name (if applicable) Phone # Value of Work For this Permit $ Submittal Fee $ eXt Square / Linear Footage Of Work: Notary $ — Training /Education Fee $ Scanning $ 3'00 Radon $ Bond $ • Code Enforcement $ - Double Fee $ Structural Review. $ Total Fee Now Due $ ( 0 Type of Work: ['Addition ['Alteration ['New Repair /Replace ❑ Demolition Describe Work: p �pk 'ep-1 vy s-$enn va. i vl r--7 cf - w*9i*** * &x &x******x** xx * *wwwwwwwwxxxww&F e „ w ww*wx�YZ&xx�exx&u x xxxx****x *w x9:**xxxx *x* Permit Fee $ 3 { CCF $I 1• CO /CCU Technology Fee $. D.PBR $ Zoning $ See Reverse side -a Bonding Company's Name (if applicable) Bonding Company's Address City Signature (Revised 02/08/06) Mortgage Lender's Name (if applicable) Mortgage Lender's Address City ./it 11.10) I.�L /Ode ir Owner or Agent The foregoing instrument was acknowledged before me this�t f day of►'nley.tS'f 20 j, byP V rc ,,od' who is personally known to me or who has produced As identification and who did take an oath. NOTARY PUBLIC: Sign: Print: My Commission Expires: * *xx *x *xx * * *x * *x *xx * * * * ** APPLICATION APPROV State 1 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: [ 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. Print: Zip Contractor The foregoing instrument was acknowledged before me this 2 da) of &b4 54- , 2009 , by \-bkh Pt who is personally known to me or who has produced as identification and who did take an oath. NOTARY PUBLIC• lax * * *** * ** * My Commission Expires: ************************************ **** * ** *** ** * * * ** * ** * ** * * ** S Plans Examiner Engineer Zoning T 3 STATE OF FLORTDE ORPARTMIDIT car HEALTH ONSXTE SEA= TRAAMMENT AND DZOPOSA.L STSTSM COraraucrsot MUM I i gems Repok aP!rTCAle: Donald Male MARTI AIMISSI 29 NE 96 St tEarni, F1. 33136 L6: 16+10 BLOC& 6 80@DIvISICK: YMEMMTE m fl: 1i 5209.0 13.7.120 nem etraT SU OONalsoom TLQ aroma= Ezra arderrimArollille MCI eratemsea or 38L.000, !.D., A11D =AMU 601 Y.I.C. camsedomer AP!*OVAL or 9Y0 3N D080 NOT ToupatIM 8A?IawACTOSY PPRIPONNAm Ma art emir= PDAIOD O! Tom, Ab1I Owed MASTaxsr. awn, 1Q*2OH NEMO AN a MS=S !'OA rat 01' me SST, NNOVM TUT APPLICANT TO lioDTIY T101 Mon aNuracklOON. OTA`9 arrOrrxemors mar RUM 2* T®tO MP= Hem UM LWXL ANO VOID. ZUW CP '!*T8 mum D400 Now MAIPT TNN APPLTCANT FM COMMON MN OT . Ma. OR LQBAL Pummus lagumen roe ozvasommarr OP Irma smornarc. OYSTB!! 0ESIOR AND 9PECYEiCa'IIONS T t 9001 T $ / sew Sens Tj nk CAPACYTTY a t 0 1 c .L000B / COO CAPACITY u t 0 1 ciaLLOVe MAPS =mom CAPAGTTt MUM SIN= RAVA22250 TALtom It t 1 OM= DDMO ZNION CAP CITIG t MALLOW 54 'D OM P2* 24 1148 Pawl t ] D t 300 3 9009PE OPME Bed ,OTBEIN E t 0 ] acMaille Pan WPM a TTP* ME ; tx] Mom= t 1 riztaD t 3 =ND I : t ] PRA= tall alto t 3 0 O LOO Ttofs OD . E. 12.60, NOW T ICLWAT2a* for V toPONTD MUM NM C 10.16 ] trilo FT ] t ABOVE aiiiiiteuicteLtoutfaaasteaci Epp' a HOTTON Or oRATNTZER TO n t 34.00 3Ilisauf FT 1 t non 01,Zili twarciatesaiumweetos vow L D !i32. ammutat A APEOLT ICasICAS SY: Al VM 0 ; DAIS Z@ISGAD: DE 4016, 30/97 { 100 /100 II t 2.00 ] 20*009 pia = , 13-SC- 908754 UMW= #: AR932478 antra t0T0: VMS MED' M*02p= s: .,.,e =mom 9; PR702705 aiewormanew tom. PORMSAPP, BMA, Phi MEM LORI EAR TB =MOM tI_ asssilligraMooltivmsse Oftoroso DaDaveerom s t 2100 men 1. tnstell 800. ta* equipped w l9 an approved filter, 2. The Oosnued corer N INtiponsMe for Installing the Wilknum category of lark Net 04E4 013(3)(f). 3.- Install 300 of of drojnfleld In bed configuration. 4.- Invert 9bvatlon of dratrdtetd to be no lees than 928 ft NOVO. 0. - Sots om of dratnfiotd elsva ion to b9 no less than f1.76 ft NOVO. THIS PERMIT IS NOT FOR ° ADu mON(s)'. EXPZT0N DMZ: Osd9 CND nations My S. U.sd) i.9. L e! 8 v 1.4,4 A8932478 m94a$4 TVA CZ:LO 6002 /LZ /60 STATE OF FLORIDA DEPARTMENT OF HEALTH APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PERMIT Permit Application Number Scale: Each block represents 10 feet and 1 inch = 40 feet. A IIIMINIMMEMMININCAMMEMMINIMMEMMEMEM EEEEEEE MINI iiEEEEEIEEEEEEEEEMME EEEEEEEEEEEMMEEEEE MEE EEMEEMM- MMEMMEMOMMUMMMIMMINFENEMSEEM EEEmmirmam isms mEEE oEEeEmens EE mmunftmsmommommemminammummummm ■ ■EEEEEEEEMBEEEl E3 EMBI 'EEEEEEEEE EEEEEEEEEE IMM EEEEMMEMEEEEEEEMME E.EEuI�IEEEEEEEEEE I ■EEEEEE milmmanimmEE IEEEE ilmmE ■EEEElEumumEEEEEE„EEEEEEmmum Notes: -Qt N&' 9 8 S ( 14-H 1 2 o) aR L'e ' k S c. � 4CZ, AAL' d e Cs rF . a C. 1r e -X S . . t �.ic 13 use LQp )ac e • Site Plan submitted by: Plan Approved By County Health Depiirtment ALL CHANGES MUST BE APPROVED BY THE COUNTY HEALTH DEPARTMENT DH 4015,10196 (Replaces HRS -H Form 4016 which may be used) (Stock Number. 5744-002- 4015 -6) PART 11- StTEPLAN Not Approved Date Page 2 of 4