PL-04-85Miami Shores Village
10050 NE 2nd Avenue
Phone: 305 - 795 -2204
Printed: 3/10/2004
Applicant: ANNETTE
Owner: ATKINSON
JOB ADDRESS: 78
Contractor MR C'S SEPTIC TANK
Local Phone: 305 - 651 -7859
Parcel # 1121360050230
NW 106
Signed: (INSPECTOR)
Plumbing Permit
Permit Number: PL2004 -85
ATKINSON
ANNETTE
ST
Contractor's Address: P 0 BOX 693239
Legal Description: DUNNINGS MIAMI SHORES EXT NO 1
Permit Status: APPROVED Permit Expiration: 9/6/2004 Construction Value: $2,200.00
Work: DRAINFIELD REPLACE
Page 1 of 1
PB41 -51 LOT7
Fees: Description Amount
FEE2004 -2524 Building Fee $175.00
FEE2004 -2525 CCF $1.20
FEE2004 -2526 Notary Fee $5.00
FEE2004 -2527 Scanning Fee $3.00
FEE2004 -2528 Builders Bond $300.00
FEE2004 -2529 Training and Education Fee $0.60
FEE2004 -2530 Technology Fee $4.37
Total Fees: $489.17
Total Fees: $489.17
Total Receipts: $489.17
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:
BLK
Permit Type (circle): Building Electrical
/ _ e a► -
Phone #
la'
Owner's Address l r ti3 1 o L �! +
Type of Work:
Describe Work:
Job Address (where the work is being done)
City Miami Shores Village
Is Building Historically Designated
$ Value of Work For this Permit
Submittal Fee $ Permit Fee $
Notary $ S • C)O
Scanning $ 3.60 Radon $
Code Enforcement $
Total Fee Now Due $
(Continued on opposite side)
Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
❑Addition 0A1te on
fQp[a&- or
YE S NO
Zip
1;!-- Phone #
( ( &L ID S
County Miami -Dade Zip
Contractor's Company Name Alt c � / Its ` / ^ ° Phone #
Contractor's Addr A l (� . / .1
City
Qualifier
State
Architect/Engineer's Name (if applicable) Phone #
❑New
11 5.0 0
Training/Education Fee $ „- et) 0
Structural Plan Review. $
Permit No.1 M rY
Master Permit No.
Zip
Mechanical Roofing
73/3r.
s
Square Footage Of Work:
Repair/Rep1'a.ce ❑ Demolition
CCF $I .20 CO /CC
Technology Fee $ 4 .33-
Zoning Bond $ 3C0 00
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 REST LT 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 w no. be approved and a reinspection fee will be charged.
Signature
Owner or Agent
The forego instrument was acknowledged be
day of linaa200t1, by
who is personally known to me
LCD
NOTARY
Sign:
Print:
My Commission Expires:
Cho 12/15/03
LIC:
'ore me this Q
who has produced .
As identification and who did take an oath.
lVIabel Vargas
1 A �� ' 1i DD23 2007
g Co., Inc.
Contractor
The foregoing instrument was acknowledged before me this
day of ,20by
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:
(Certificate of Competency Holder)
State Certificate or Registration No. Certificate of Competency No.
* * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** .. * *."******************************** * * * * * * * * * ** * * * * * * * * * * * * * * * ** * **
APPLICATION APPROVED BY
/ f c f / 'r Plans Examiner
Engineer
Zoning
STATE OF FLORIDA
DEPARTMENT OF HEALTH
' ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM
CONSTRUCTION PERMIT
COP STRUCTION PERMIT FOR:
[
)New System ( ] Existing System
[ )Repair [ ]? andcnment
APPLICANT: Atkinson, Annette
SYSTEM DESIGN AND SPECIFICATIONS
T [ 900 ]Gallons SEPTIC TANK
A [ 0 ]Gallons
N [ 0 ]GALLONS GREASE INTERCEPTOR CAPACITY
K [ 0 ] GALLONS DOS :NG TANK CAPACITY [ 0 )GALLONS
D [ 300 ]SQUARE FEET PRIMARY DRAINFIELD SYSTEM
SYSTEM
( N PILLED
[ y1BED
SPECIFICATIONS EY :Andre, Paul
APPROVED BY: Andre, Paul
DATE ISSUED: 3/8/04
[
[
Di 4016, 33/9- (ObeeXete3 previous ed`tions which may not `•e used;
tf A.nw.. lh vwMe..� C7AA — flflT - R96...1. • a. �.�. AA.•.•
CENTRAX 4: 13 -90 -19901
DATE PAID:
FEE PAID :
RECEIPT :
OSTCSNHR : 04- 0871±
)Holding Tank [ ] Innovative Other
)Temporary [ NA 1
AGENT: SA0021074, Solomon Teresaa Ili/
PROPERTY STREETADDRESS: 78 NW 106 St Miami Shores FL 33150
LO' 7 BLOCK: 203 SUBDIVISION: Duzin M La i Shor
(Section To4mship Range /Parcel No.;
PROPERTY 1D #: 11 -2136- 005 -0230 _ (OR TAX ID 'UMBER]
SYSTEM MUST SE CONSTRUCTED IN ACCORDANCE WITH SPECIFICATIONS AND STANDARDS CF CHAPTER 64E -6,FAC
DE:ARTMENT APPROVAL OF SYSTEM DOES NOT GUARANTEE SATISFACTORY PERFORMANCE FOR ANY SPECIFIC TIME
PERIOD. AMY 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 THHIS
PERMIT BEING MADE NULL AND VOID. ISSUANCE OF THIS PERMIT DOES NOT EXEMPT THE APPLICANT E'RON
COAPLIANCE WITH OTHER. FEDERAL, STATE OR LOCAL PERMITTING REQUIRED ?OR PROPERTY DEVELOPMENT.
MULTI - CHAMBERED /IN :SERIES: [Y 1
MULTI - CHAMBERED /IN SERIES: IT ]
(0 ]DOSES PER 24 HRS if PUMPS( 0
R [ 0 ]SQUARE FEET
A TYPE SYSTEM: [ lic J STANDARD
I CONFIGURATION: ( )TRENCH
N
F LOCATION TO BENCHMARK: Finished Floor o£ xiatino Residpnce Elev. 12.3' NGV ,,
I ELEVATION OF PROPOSED SYSTEM SITE [ 1.6 1 ( FEET 1 ( BEL0W]EEMCHMARR /REFERENCE POINT
E BOTTOM OF DRAINF :ELD TO BE [ 4.1 ] [ FEET 1 ( BEI,CW 1 BENCHMARK/RKFERENCE POINT
L
D FILL REQUIRED:( 0.0 :INCHES EXCAVAT =ON REQUIRED: [ 30.0 ] INCHES
( N ]MOUND ( N 1
[ N ]
OTHER REMA:RXS:
]- Install 3'0 sq. ft of dxainfie3.d in bed configuration.
- Existing 900 gals. septic tank to remain.
1-The pump -out robeeipt shall be provided prior to the granting of the final approval.
4.- Invert elevation of drairsfield to be no less than 8.70' NAVD. .-Bottom elevation of
ctrairsfield to be no less than 0.20' NGVD.
•.'HIS PERMIT IS NOT FOR ADDITION
044_ 47
TITLE: nr'�
TITLE: Professional Engin
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0310912084 13:40
Notes:
STATE OF FLORIDA
DEPARTMENT OF HEALTH
'APPLICATION FOR,QNSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PERMIT ;
• • Permit Application Number t. .
let
3055133472
Site Flan SUbMithAy: ialv‘ZK
Plan Approved Not Approva__
By
ALL CH ES MUST BE APPROVED BY THE COUNTY HEALTH DEPARTMENT
D4 4015.10/95 (Replaces HRS-H Ram 4015 which may be used)
tack Mater: 744402-4015-6)
PART II - SITEPLAN
PAGE 02
Date.,
County Health Department
Page 20f4