PL-08-1658BUILDING
PERMIT APPLICATIO
FBC 2004
Permit Type: Plumbing
Tenant/Lessee Name
FOLIO / PARCEL #
Is Building Historically Designated YES NOS(
Structural Review. $
4.914 3 lgt l
Value of Work For this Permit $ ,3 Y
Miami Shores Village
g
Budding Department
10050 I\11E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
Permit No. PL 0 0"
Owner's Name (Fee Simple Titleholder) S IW 8 n Phone #
Owner's Address 81S NE, t&Ss4
City f�1'1 tD �t�wl State' (
E -MAIL:
Job Address (where the work is being done) 5 ('g 1 M'S
City Miami Shores Village County Miami -Dade Zip 3313 g
Contractor's Company Name 0.31rogYL S p1tC1 &) e
Contractor's Address c �
City nk ( .O M, State p( Zip L3 a
Qualifier Name Phone # vh /6 6
State Certificate or Registration No. M- ® e9 I •llb2 ertificate of Competency No. 1 to 4441.°1 t 2d 44'1
E -MAIL: 5rieCI1-7/
Architect/Engineer's Name (if applicable)
Square / Linear Footage Of Work: , Cja2eO
OC 1 2008
MIA
MI SHORES VILLAGE
Master Permit No.
Zip 53 )3&
Phone #
Phone # Si O ls'R € (
Phone #
Type of Work: ❑Addition ❑Alteration New
� . - [Y]Repair/Replace � ❑Demolition
Describe. Work: /`� , %I- P il; { i , c - i ��' �I'lC�i
1 w6, 4-ai I 01 960 ga/ , ` JO& (Ira, le\ Dike s
******* If * ****** *** * * * * ** * **t * ** * * * * * ** F * **,* #**** ***** * ** **x **xx. *wwww. * * **** ****
y to
Submittal Fee $ Permit Fee $ / �5 7 * ' tOO CCF $ 1. ?0 CO /CC
Notary $ ,E 1 Training /Edu!cation Fee $ o t�CJ Technology Fee $. /7.
Scanning $ 3�OD , Radon $ _ I ' BR $ Zoning $
Bond $ e^ 174'6
Code Enforceme t . .� o i i Fee $
ee Now Due $ I, �'f �b
See Reverse side —4
Bonding Company's Name (if applicable)
Bonding Company's Address
City
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address
City
State
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. l 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. fF 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
f whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site
or 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.
Signature
C
0 rorAgent
The foregoin instrument was acknowledged before me this g /IQ
day of '..71 f `A 204 , by get2 5kaui,I.
'
who is personally known to me or who has produced
As identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
My Commission
(Revised 02/08/06)
sr�i a. I�UII
1LA;c Commbsfon # DD 441
E iPe ao Bonded By National Nota
**x*** ***xicx*��** , r**xxxxxxx***xx,rx
1 44/ /A , (4tA
fr il 11' dr"
APPLICATION APPROVE
Zip
Signature ghji4
Contractor
The foregoing instrument was acknowledged before me this
day of � , 20a , by G
who is persona known to me or who has produced
as identification and who did take an oath.
NOTARY PUBLIC:
1.14 Mffri
Sign:
Print:
My Commis Commission # DD 441287
es:
'''' %'' ■ Bonded By National Notary Assn.
xxxx4:xx&Scx xxx ,Y,Yxxx x xx xx,Y,Y VC x xx .� xIIIPxWe xWx,lk Witt! WW2.* Oir% Ian A
67
Plans Examiner
Engineer
Zoning
Protect Address
318 NE 105 Street 1121360130060
Miami Shores Village, FL 33138- Block: Lot:
Owner Information
JANET OETTING
Miami Shores Village
10050 N.E. 2nd Avenue
Miami Shores , FL 33138 -0000
Phone: (305)795 -2204
Contractor(s) Phone
CHAPMAN SEPTIC SERVICE, INC. (305)815 -9901
CeII Phone
Type of Work: SEPTIC AND DRAINFIELD
Type of Piping:
Additional Info: ABANDON TWO SEPTICS
Bond Return :
Classification: Residential
Fees Due
Bond Type - Contractors Bond
CCF
Education Surcharge
Permit Fee - Additions/Alterations
Permit Fee - Additions /Alterations
Permit Fee - Additions/Alterations
Permit Fee - Additions/Alterations
Scanning Fee
Technology Fee
Total:
Amount
$300.00
$1.80
$0.60
$175.00
$175.00
$175.00
$175.00
$3.00
$17.50
$1,022.90
Building Department Copy
Address
atm
Expiration: 03110/2009
Parcel Number
318 NE 105 ST
MIAMI SHORES FL 33138 -2022
Total
$ 0.00 $ 0.00
Payment Type :
Amt Paid Amt Due
$ 0.00
Authorized Signature : Owner / Applicant / Contractor / Agent
OCT 0 8
0.
MIAMI SHORES VILLA( F
Phone
Applicant
Valuation:
Total Sq Feet:
WILLIAM OETTING
September 11, 2008
Date
CeII
$ 3,000.00
0
Available Inspections:
Inspection Type :
Final
HRS Approval
Landscaping
Rough
Abandonment
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 .
Thursday, September 11, 2008 1
CONSTRUCTION PERMIT FOR: OSTDS Repair
APPLICANT:
PROPERTY ADDRESS: 315 NE 105 St MIAMI, FL 33138
LoT: 10 & 9
PROPERTY ID #: 11- 2136- 013 -0060
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.
SYSTEM DESIGN AND SPECIFICATIONS
T [
A [
N [
K [
I ELEVATION OF PROPOSED SYSTEM SITE
E BOTTOM OF DRAINFIELD TO BE
L
D FILL REQUIRED: [ 0.00] INCHES
0
T
H
E
R
SPECIFICATIONS BY: Gerard L P
APPROVED BY:
DATE ISSUED:
STATE OF FLORIDA
DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT AND DISPOSAL
SYSTEM
William Oetting ((New owner Lisa Sharom))
BLOCK: 117 SUBDIVISION: Miami Shores Sec 5
900 ] GALLONS / GPD
0 ] GALLONS / GPD
0 ] GALLONS GREASE INTERCEPTOR CAPACITY
] GALLONS DOSING TANK CAPACITY
v 1.1.4
Septic Tank
D [ 200 ] SQUARE FEET Bed configuration SYSTEM
R [ 0 ] SQUARE FEET SYSTEM
A TYPE SYSTEM: [X] STANDARD [ ] FILLED [ ] MOUND [ ]
I CONFIGURATION: [ ] TRENCH [X] BED [ 1
N
F LOCATION OF BENCHMARK: FFE 12.00 "" NGVD
[ 24.00 ] [I INCHES I FT ] [ ABOVE /) BELOW li BENCHMARK /REFERENCE POINT
[ 52.00 ] [I INCHES 1 FT ] [ ABOVE A BELOW 1' BENCHMARK /REFERENCE POINT
EXCAVATION REQUIRED: [ 40.00] INCHES
1.- Install 900 gal. category-3 septic tank equipped with an approved filter.
2. -The Iic enced contractor is responsible for installing the minimum category of tank sec. 64E- 6.013(3)(f).
3.-Install 200 sf of drainfield in bed configuration.
4.- Install 12" of slightly limited soil at the bottom of the drainfield.
5.- Perimiter of excavation area shall be at least 2 ft wider and longer than the proposed absorption bed.MIAMI-DADE COUNTY HEALTH
6. -Invert elevation of drainfield to be no Tess than 8.16 ft NGVD.
7. -Bottom of drainfield elevation to be no Tess tha 66 ft NGVD.THIS PERMIT IS NOT FOR "ADDITION(s) ".
zaire-' TITLE:
CAPACITY
CAPACITY
[MAXIMUM CAPACITY SINGLE TANK:1250 GALLONS]
]GALLONS @[ ]DOSES PER 24 HRS #Pumps [ ]
TITLE: Engineer Specialist II
AP894384 8E766455
PERMIT #: 13 -SG- 953214
APPLICATION #: AP894384
DATE PAID: 09/03/2008
FEE PAID: $55.00
RECEIPT #: 13 -PID -10605
DOCUMENT #: PR749824
[SECTION, TOWNSHIP, RANGE, PARCEL NUMBER]
[OR TAX ID NUMBER]
REPAIR
Dade CHD
EXPIRATION DATE: 12/03/2008
DH 4016, 10/97 (Previous Editions May Be Used) Page 1 of 3
DEPARTMEI
CONSTRUCTION PERMIT FOR: OSTDS Repair
APPLICANT: William Oetting ((New Owner Lisa Sharom))
PROPERTY ADDRESS: 318 NE 105 St MIAMI, FL 33138
LOT: 10 &9
PROPERTY ID #: 11- 2136- 013-0060
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.
SYSTEM DESIGN AND SPECIFICATIONS
T [ 900 ] GALLONS / GPD Septic Tank CAPACITY
A [ ] GALLONS / GPD CAPACITY
N [ ] GALLONS GREASE INTERCEPTOR CAPACITY [MAXIMUM CAPACITY SINGLE TANK:1250 GALLONS]
K [ ] GALLONS DOSING TANK CAPACITY [ ]GALLONS @[ ]DOSES PER 24 HRS #Pumps [ ]
D [ 200 ] SQUARE FEET Bed configuration SYSTEM
R [ ] SQUARE FEET SYSTEM
A TYPE SYSTEM: [X] STANDARD [ ] FILLED [ ] MOUND [ ]
I CONFIGURATION: [ ] TRENCH [x] BED [ ]
N
F LOCATION OF BENCHMARK: FFE 12.00 "" NGVD
I ELEVATION OF PROPOSED SYSTEM SITE [ 24.00] [I INCHES FT ][ABOVE A BELOW I] BENCHMARK/REFERENCE POINT
E BOTTOM OF DRAINFIELD TO BE [ 54.00][J INCHES I FT ][ ABOVE 4 BELOWbBENCHMARK /REFERENCE POINT
L
D FILL REQUIRED: [ 0.00] INCHES
0
T
H
E
R
1.-Install 900 gal. category-3 septic tank equipped with an approved filter.
2.-The licenced contractor is responsible for installing the minimum category of tank sec. 64E- 6.013(3)(f).
3- Install 200 sf of drainfield in bed configuration. `
4.- Install 12" of slightly limited soil at the bottom of the drainfield. � I T1 )EP /ai�� i i�Eil= a
5.- Perimiter of excavation area shall be at least 2 ft wider and longer than the proposed ab 'rpti fi C ° ' - .11\
6. -Invert elevation of drainfield to be no Tess than 8.00 ft NGVD.
7. -Bottom of drainfield elevation to be no less than 7.50 ft NGVD.THIS PERMIT IS NOT FOR "ADDITION(s) ". E»
SPECIFICATIONS BY: Gerard Lire TITLE:
APPROVED BY: TITLE: Engineer Specialist II
I1 ..
DH 4016, 10/97 ('evious Editions May Be Used) Page 1 of 3
DATE ISSUED:
STATE OF FLORIDA
DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT AND DISPOSAL
SYSTEM
BLOCK: 117 SUBDIVISION: Miami Shores Sec 5
v 1.1.4
AP894382
PERMIT 41: 13 -SG- 953212
APPLICATION #: AP894382
DATE PAID: 09/03/2008
FEE PAID: $55.00
RECEIPT #: 13 -PID -10605
DOCUMENT #: PR749814
[SECTION, TOWNSHIP, RANGE, PARCEL NUMBER]
[OR TAX ID NUMBER]
EXCAVATION REQUIRED: [ 42.00] INCHES
EXPIRATION DATE: 12/03/2008
SE766446
Dade CHD
CONSTRUCTION PERMIT FOR: OSTDS Abandonment
APPLICANT: William Oetting ((New Owner Lisa Sharom))
PROPERTY ADDRESS: 318 NE 105 St MIAMI, FL 33138
LOT: 10 &9
PROPERTY ID #: 11 - 2136 013 - 0060
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.
SYSTEM DESIGN AND SPECIFICATIONS
T [ ] GALLONS / GPD CAPACITY
A [ ] GALLONS / GPD CAPACITY
N [ ] GALLONS GREASE INTERCEPTOR CAPACITY [MAXIMUM CAPACITY SINGLE TANK:1250 GALLONS]
K [ ] GALLONS DOSING TANK CAPACITY [ ]GALLONS @[ ]DOSES PER 24 BRS #Pumps [ ]
D [ ] SQUARE FEET SYSTEM
R [ ] SQUARE FEET SYSTEM
A TYPE SYSTEM: [ ] STANDARD [ ] FILLED [ ] MOUND [ ]
I CONFIGURATION: [ ] TRENCH [ ] BED [ ]
N
F LOCATION OF BENCHMARK:
I ELEVATION OF PROPOSED SYSTEM SITE [ if / ] [ABOVE/BELOW ]BENCBMARK/REFERENCE POINT
[ ] [ / ][ABOVE/ BELOW] BENCHMARK /REFERENCE POINT
E BOTTOM OF DRAINFIELD TO BE
L
D FILL REQUIRED:
0
T
H
E
Have the tank abandoned in accordance with the following procedures:(a) The tank shall be pumped out.(b) The bottom of
the tank shall be opened or ruptured, or the entire tank collapsed so as to prevent the tank from retaining water, and(c) The
tank shall be filled with clean sand or other suitable material, and completely covered with soil.Have the system inspected
by the health department after it has been pumped and ruptured but before it is filled with sand and covered.
R
SPECIFICATIONS BY:
APPROVED BY: j
DATE ISSUED:
STATE OF FLORIDA
DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT AND DISPOSAL
SYSTEM
BLoCK: 117 SUBDIVISION: Miami Shores Sec 5
[ 0.00 ] INCHES
Astrid V Edwards
09/04/2008
v 1.1.4
EXCAVATION REQUIRED: [
TITLE: Engineer Specialist II
EVJEOPBSIUMMUE
DH 4016, 10/97 (Previous Editions M l " - )CO 'N 4 V HEALTH DEPARTMENT
PEST #: 13 -SG- 953215
APPLICATION #: AP894385
DATE PAID:
FEE PAID:
RECEIPT #:
DOCUMENT #: PR749777
[SECTION, TOWNSHIP, RANGE, PARCEL NUMBER]
[OR TAX ID NUMBER]
] INCHES
TITLE: Engineer Specialist II
Dade CHD
✓z.,F R' _, ii FRom EXPIRATION DATE: 12/03/2008
A2894385 SE -1
Page 1 of 3
CONSTRUCTION PERMIT FOR: OSTDS Abandonment
APPLICANT: William Oetting ((New owner Lisa Sharom))
PROPERTY ADDRESS: 318 NE 105 St MIAMI, FL 33138
LOT: 10, 9
PROPERTY ID #: 11 -2136- 013 -0060
STATE OF FLORIDA
DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT AND DISPOSAL
SYSTEM
SYSTEM DESIGN AND SPECIFICATIONS
T [
A [
N [
K [
0
T
H
E
FILL REQUIRED:
BLOCK: 117 SUBDIVISION: Miami Shores Sec 5
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.
] GALLONS / GPD CAPACITY
] GALLONS / GPD CAPACITY
] GALLONS GREASE INTERCEPTOR CAPACITY [MAXIMUM CAPACITY SINGLE TANK:1250 GALLONS]
] GALLONS DOSING TANK CAPACITY [ ]GALLONS @[ ]DOSES PER 24 HRS #Pumps [
D [ ] SQUARE FEET SYSTEM
R [ ] SQUARE FEET SYSTEM
A TYPE SYSTEM: [ ] STANDARD [ ] FILLED [ ] MOUND [ ]
I CONFIGURATION: [ ] TRENCH [ ] BED [ ]
N
F LOCATION OF BENCHMARK:
I ELEVATION OF PROPOSED SYSTEM SITE
E BOTTOM OF DRAINFIELD TO BE
L
D
[ 0.00 ] INCHES
Have the tank abandoned in accordance with the following procedures:(a) The tank shall be pumped out.(b) The bottom of
the tank shall be opened or ruptured, or the entire tank collapsed so as to prevent the tank from retaining water, and(c) The
tank shall be filled with clean sand or other suitable material, and completely covered with soil.Have the system inspected
by the health department after it has been pumped and ruptured but before it is filled with sand and covered.
R
SPECIFICATIONS BY:
APPROVED BY: .44Ad TITLE Engineer Specialist II
_ Astrid V Edwards Ati'JC', D ',;J A 'u
DATE ISSUED: 09/04/2008 E XPR VAYS FRom EXPIRATION DATE: 12/03/2008
id V Edwards
EXCAVATION REQUIRED: [
DH 4016, 10/97 (Previous Editions Miti 'Reai`dpOUNTY HEALTH DEPARTMENT
v 1.1.4 A1.894388 SE -1
PERMIT # : 13-SG- 953218
APPLICATION #: AP894388
DATE PAID:
FEE PAID:
RECEIPT #:
DoCUMENT #: PR749774
[SECTION, TOWNSHIP, RANGE, PARCEL NUMBER]
[OR TAX ID NUMBER]
/ ][ABOVE/BELOW 1BENCEMARIVREFERENCE POINT
/ 1 [ABOVE/ BELOW1 BENCHMARK /REFERENCE POINT
] INCHES
TITLE: Engineer Specialist II
Dade CHD
Page 1 of 3
ABANDON TWO EXISTING SEPTICS AND INSTALL
900 GAL SEPTIC AND 2 200 DRAINFIELD
A
2
Passed
Ins!)> to'
c
'
mments
\ 0 OA_
\ \\k` ��
T
Failed
Correction
Needed
Re- Inspection
Fee
($75)
No Additional Inspections can be scheduled
re- inspection fee is paid.
until
Inspection Date: 10/10/2008
Inspector: Levrock, James
Owner: OETTING, JANET
Job Address: 318 105 Street NE
Project: <NONE>
Miami Shores Village, FL 33138-
Contractor: CHAPMAN SEPTIC SERVICE, INC.
Building,De artment Comments
Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Block:
Permit Type: Plumbing - Residential
Inspection Type: Final
Work Classification: Septic
Phone Number
Parcel Number 1121360130060
Lot:
Phone: (305)815 -9901
Thursday, October 9, 2008
Page 1 of 2