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PL-09-398BUILDING PERMIT APPLICATION FBC 20 Tenant/Lessee Name Q l J &✓L Email Job Address (where the work is being done) City Miami Shores Village FOLIO / PARCEL # Miami Shores Village Building Department 1ap50 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: 795.2204 Fax: (305 56.8972 County Miami -Dade Permit No. 91_0`1 311 aster Permit No Permit Type: PLUMBING Owner's Name (Fee Simple Titleh lder) �! �') } n.--Q kik Phone # Owner's Address 00 City in1 SM,S State r �_. Zip 3 5 r CO Phone # - 3 - 3)co Zip Is Building Historically Designated YES NO x, Flood Zone A/2.> Contractor's Company Name Contractor's Address' 6 cit U : �i !1 .Zip Qualifier Name L t ,� Phone # State Certificate or Registration No. 7 g )f )1, Certificate of Competency No. r . -'S Contact Phone � E -mail �~ Architect/Engineer's Name (if applicable) 04/ Value of Work For this Permit $ d� 0O Type of Work: Addition ■Alteration ['New escribe Work: ** * * * * *** * **** * * * * * * * * **** * ***** *** * **F ** *: x*** x:**** *** **** ***** * **** * *** * * **** * **** 1 Submittal Fee $ Permit Fee $ 11 Iwl CCF $ AD CO/CC Notary $ 5.03 Training/Education Fee $0.(0 Technology Fee $ 431 Scanning $ 3.00 y Radon $ DPPBR: $ Zoning $ Bond $ . -VV tt \1 Cod "� a .fin' `'. g ►1 Double Fee $ " pa Structural Review. $ 111 Total Fee Now Due $ _ 0 / . 77 See Reverse side -> MAUI 6 20 9 CK470y MIAMI SHORES ILLAGE -. • Phone # Square / Linear Footage Of Work: %Repair/Replace ® Demolition Bonding Company's Name (if applicable) ) Bonding Company's Address City State Mortgage Lender's Name (if applicable) ls'' <. Mortgage Lender's Address City State" s - x 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 OWNE.R'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 anda reinspection fee will be charged. SignaturX Owner .. Agent' The foregoing instrument was acknowledged before me this t i day of iviarch , 20 9, by Who is NOTA&Y PURIM: Signature ontracto • The foregoing instrument was acknow ged before me this day of • , 20 ; by to me or who has produced who is personally known to me or who has produced As identification and who did take an oath. as identification and who did take an oath. NOTARY l "UBLlCo . Zip Sig Sign: Print:t , I f 1 Ian I Va IT L Print: My Commission Expires: 40',.Z.,% LIWANALVAREZ My Commission Expires: � e � * - ,, * MY COMMISSION # DD 702082 � l� , II 1 0 : EXPIRES: June 1, 2012 . *tom Itau Nigel Natty Sentes (Revised 07 /10/07) • APPLICATION APPROVED B la► xaminer Engineer i * * ** **********> * * *** * * * * * * * * * *** ** * * * * * * * * * *** Zoning- Clerk checked pi v 9 -3�g CHECKED' - -['X] -STEMS ARE NOT `IN COMPLIANCE WITH :STATUTE 2 ,RULE . AND MUST BE •.CORRECT-ED. TANK INSTALLATION {.. ] 101]-, TANK SIZE [1] cd [2] [ ] [ TANK MATERIAL a ' ` ' [03] OUTLET DEVICE 4 1041' !MULTI- CHAMBERED [Y / N ] 1 [05] , OUTLET FILTER 1 106] LEGEND ° X ] [07] WATERTIGHT ] [08] LEVEL ] [091 DEPTH TO LID DRAINFIELD INSTALLATION [101 - AREA [1] [2] SOFT ,,a- [111 DISTRIBUTION BOX , HEADER [12] NUMBER OF DRAINLINES [13] - DRAINUNE SEPARATION. E7. [141 DRAINUNE SLOPE 0 + 'j [15] DEPTH OF COVER e f d el [161 ELEVATION [ABOVE/BELOW] BM ] 117] SYSTEM LOCATION ] [18] . DOSING PUMPS ttj ` s ] [19] AGGREGATE SIZE ] [20]' ' AGGREGATE EXCESSIVE FINES 1 [211 ' AGGREGATE DEPTH FILL / EXCAVATION MATERIAL [ ] [22] FILL AMOUNT (` 1 [23] FILL TEXTURE [ 1 [241 EXCAVATION DEPTH . [ ] [25] AREA REPLACED [ ] [26] REPLACEMENT MATERIAL- FINAL SYSTEM [ARO D/DISAPPROVED]: DH 4016 (Page 2), 10/97 (Previous - Editions May Be Used) Stock Number. 5744- 0024016 -4 BLOCK : SUBDIVISION d `s LZ..` li SETBACKS [ ] [27] SURFACE WATER ` 1. ] [28] DITCHES [ ] [291 PRIVATE WELLS [ 1 [30] PUBLIC-WELLS# [ ] [311 IRRIGATION WELLS [. ] [32] POTABLE WATER LINES FT ] [33] BUILDING FOUNDATION 0 Fr ] [34] PROPERTY LINES FT FILLED / MOUND SYSTEM . ] [36] DRAINFIELD COVER [' 1 [37] SHOULDERS J. [38] SLOPES 1 ` [39] STABILIZATION- ADDITIONAL INFORMATION [` I [ UNOBSTRUCTED AREA ] [41] STORMWATER RUNOFF- [ ] [42] ALARMS [ ] [ MAINTENANCE AGREEMENT 1 14 BUILDING AREA [45] LOCATION CONFORMS, WITH, SITE PLAN _ [46] FINAL SITEGRADING [47] CONTRACTOR OTHER [ EXPLANATION OF VIOLATIONS / REMARKS: ]. [ ,, ] . �. r4 CONSTRUCTION [ ROVED/DISAPPROVED]: [48]. PERMIT.NO DATE PAID- - -FEE 'PAID: RECEIPT PROPERTY ID!#- [35] OTHER ABANDONMENT, [49] - TANK PUMPED [50]. TANK CRUSHED &.FILLED. CHD , DATE CHD- DATE: PT 1: Applicant PT 2: Installer /Contractor PT 3: Building Department PT 4: Health Department ge2of3 APPLICANT f V k AGENT: '. PROPERTY_ ADDRESS. - t.OT: - STATE OF FLORIDA --DEPARTMENT OF HEALTH -. ONSITEE SEWAGETREATMENT` AND 'DISPOSAL: SYSTEM CONSTRUCTION INSPECTION AND' FINAL APPROVAL. 8 74Oi 4 t. pbK , SURD 1.4I tIte; OR_ R ANKSIZE ,11111 tPerleIttrecIdng nuseberesigneet by oepers,tull mere. . .„ Property owiler authQfted' �presentatVe - , Etoe-or sheet mailing addresefor,applioar4pr agent _ Lot Bock anittubOlv:islao for - or j 27 - Character number for property (property *welder tOirat PAO/E1 P (ti ' FORMATION IS COMPLETED BY CHD ON FOLLOWING_ ITEIVAS:' ‘. , , . ;,..-„t,'" ;-,',1,- -,., ry ilA' 47';•'.rj 1 .- , ff I ._. 4,I■1 03/12/2009 22•00 FAX CONSTRUCTION PERMIT FOR: APPLICANT: Vivian Brown PROPERTY ADDRESS! 29 NW 100 Ter Miami, FL 33150 LOT: 15 +16 PROPERTY ID b: as A 0 T R STATE OP FLORIDA DEPARTMENT or HEALTH ONSITE SEWAGE TREATMENT AND DI SYSTEM 1 BLOCK: 3 - 3101 - 018 - 0330 SYSTEM DESIGN AND SPECIFICATIONS $Y$TEm $tr9T RE CONSTRUCTED r$ ACCORDANCE WITH SP CIFICATIQAI9 AND STANDARDS or SECTION 381.0055, F.S., AND CHAPTER 646 - F.A.C. DEPARTMENT APPROVAL OF SYSTEM DOES NOT GUARANTEE SATISFACTORY PZRA08a10'ANCE FQR ANY SPECIFIC PERIOD OF TINE. ANY CHANGE TN MATERIAL FACTS, WHICH SERVED As A BASIS FOR ISSUANCE OF THI8 PERMIT, REQUIRE THE APPLICANT TO MODIFY THE PERMIT APPLICATION. BQCS MODIFICATIONS MAX RESULT EN THIS PERMIT SLING MADE NULL AND VOID. ISSUANCE OF THIS PERMIT DOES NOT EXEMPT THE APPLICANT FROM COMPLIANCE WITH OTHER FEDERAL, STATE, OR LOCAL PERHITTING REQUIRED !bR DEVELOPMENT Or THIS PROPERTY. T ( 900 ) GALLONS / GPO - SOOtla Tank CAPACITY A ( 0 1 GALLONS / GPO CAPACITY A7 i 0 ) GALLONS GREASE INTERCEPTOR CAPACITY [MAXIMUM CAPACITY angora TANK :1250 ezrLLCMS] R r l GALLONS DOSING TANK CAPACITY [ ]GALLONS @[ MOSES PER 24 RPS *Pumps ( ] [ 225 ] SWAM YSET Trench Cori nation SYSTEM ( 0 ] SQUARE FEET SYSTEM TYPE SYSTEM: (E] STAMAAD ( ] FILLED ( ] MOUND ( CONFIGURATION: Cx] TRENCH [ ] BED ( F LOCATION OF BENCHMARK: FFE........12.7' NGVd I ELEVATION OF PROPOSED SYSTEM SITE [ 24.001 MORES FT ] [ ABOVE frril SIENGFimsAEi/7t$&2RENCE POINT E BOTTOM OF DRAItNFIELD TO BE [ 42.00 ] (r J FT ] ( ABOVE HENCfiWRK /REFERENCE POINT D FILL REQUIRED: [ 0,0E ] INCHES EXCAVATION REQt72RLD: ( X00] YNCfE$ 1.- Existang 900 gay, septic tank to remain. 2.- Install 225 sf of draa■weld In TRENCH oonflguratlon. 3 - Invert elevation of crainfield to be no less than 8,70 ft NOVO. 6.- Bcrtom of drain1eld elevation to be no less than 80.20 ft h]GVD. THIS PERMIT IS NOT FOR "ADDITION(s) ". SPZCiFiCATIONs BY: Oora►rd L philia a TITLE: APPROVED BY: DATE IBULTED: DH 401G, 10/9? (Provioos Editions bay to Used) v 1.1.4 PF lIT a : 13- SC- 974015 APPLICATION R: AP914480 SUBDIVISION: Navarro 51:17 [ SECTION, TOWNSHIP. RANGE, PARCEL NUMBER] [OR TAX ID NUMMI() [it 001/00 .DATE PAID: PEE PAID: RECEIPT 1: tnoNT «: PR766905 APS:448C noOr $pavial;,st II algae CND EXPIRATION DATE: SE78215 06110/200G Page 1 of 3 ,•R STATE OF FLORIDA DEPARTMENT OF HEALTH f j APPLICATION. FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PERMI _ r1 r ci r Permit Application Number E !% L. C d.&' PART. l - SITE PLAN Scale: Each bock represents 5 feet and 1 inch ■ 50 feet. y • .., . ,. „ . • l ©7 _ - - Site Plan submitted by: Plan Approved to By TE 311210 ALL CHANGES MUST BE APPROVED SY THE COUNTY HEALTH DEPARTMENT ON 098, team 040404 MIg.M Rem an161010 rimy 4e p t2tae P*Jr Dd: 5 . Lcc• LJ0If)j Qnatwe Net Approved Title Date County Health Department . _ Page 2of 3. X i hA :cam 6O4ML /C0 Project Address 29 100 Terrace 1131010180330 Miami Shores, FL 33150- Block: Lot: Owner Information Address VIVIAN BROWN 29 NW 100 TERR (305)751 -6247 MIAMI SHORES FL 33150 -1207 Contractor(s) BOB'S SEPTIC & DRAIN INC Phone 305 - 558 - 5818 CeII Phone Type of Work: DRAINFIELD REPLACEMENT Type of Piping: Additional Info: Bond Return : Classification: Residential Fees Due Bond Type - Owners Bond CCF Education Surcharge Notary Fee Permit Fee - Additions/Alterations Scanning Fee Technology Fee Total: Amount $300.00 $1.80 $0.60 $5.00 $175.00 $3.00 $437 $489.77 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. Authorized Signature: Owner / Applicant / Contractor / Agent Building Department Copy March 16, 2009 Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL 33138-0000 Phone: (305)795 -2204 AVM Expiration: 09/12/2009 Parcel Number Invoice # PL -3 -09 -34248 PL -3-09 -34248 Check #: 4709 Total Amt Paid Amt Due $ 489.77 $ 189.77 $ 489.77 $ 489.77 $ 0.00 Bond #: 1830 Phone Cell .... ......... ......... ......... .... Valuation: Total Sq Feet: Applicant VIVIAN BROWN Date $ 3,000.00 0 Available Inspections: Inspection Type: Final Rough Landscaping 1 March 16, 2009 1