PL-09-1264 F
j F
{iI F T 2^h
Miami Shores Village � � ' m
10050 N.E. 2nd Avenue
Miami Shores, FL 33138 -0000 y
Phone: (305)795 -22041
Expiration: 012512010
Project Addres ^ „ Pa rcel Number Applican
74 103 Street 1132060131580
Miami Shores, FL 33138 Block: Lot: CAV HOLDINGS, LLC
Owner Info rmation A ddress Phone C ell
801 UNIVERSITY Drive
CAV HOLDINGS, LLC ,
PLANTATION FL 33324- x=
r
Contractor(s) Phone Cell Phone $ 2,500.00
MR C'S PLUMBING SEPTIC INC (305)651 -7859 (305)651 -5652 Valuation:
_ Total Sq Feet: 300
Type of Work: PLUMBING For Inspections please call:
Type of Piping: SEPTIC & DRAINFIELD (305)762 -4949
Additional Info: Available Inspections:
Bond Return : Inspection Type:
Classification: Residential HRS Approval
Abandonment
Final
Rough
Landscaping
Fees Due Amount Invoice # Total Amt Paid Amt Due
Bond Type - Owners Bond $300.00 PL -7 -09 -35506 $ 667.15 $ 300.00
CCF $1.80
Education Surcharge $0.60 PL -7 -09 -35506 $ 667.15 $ 667.15 $ 0,00
Permit Fee - Additions /Alterations $350.00 Check #: 4135 Bond #: 1876
Scanning Fee $6.00
Technology Fee $8.75
Total: $667.15
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.
July 29, 2009
Authorized Signature: Owner / Applicant / Corrractor / Agent Date
Building Department Copy__ _ ___
Julv 29. 2009 __._._ _ _.. __
1
Miami Shores ''pillage
�
Building Department JUL 9 200 jj�
10050 N.E.2nd Avenue, Miami Shores, Florida 33138 ''~
Tel: (305) 795.2204 Fax: (305) 756.8972
BUILDING Permit No.
PERMIT APPLICATION Master Permit N o.
FBC 2004
Permit Type: Plumbing
Owner's Name (Fee Simple Titlehdlder) C (net Pets Phone # 9 C 7 - [ a-; ^ G 7 � L
Owner's Address
City State Zip
Tenant /Lessee Name Phone #
E -MAIL:
Job Address (where the work is being done) ' C) 2 --. W
City Miami Shores Village County Miami -Dade Zip
FOLIO / PARCEL # ' \ *' - �ES b'' O I
Is Building Historically Designated YES NO t�
Contractor's Company Namet ' 1 f C" ewv�"lyyq
Contractor's Address
City - State FZ. Zip �
Qualifier Name �6 � In zq lit, k_-" Phone #
State Certificate or Registration No GFc- I L}- C;k (.'IS I Certificate of Competency No. ,
E- MAIL:
Architect /Engineer's Name (if applicable) Phone #
Value of Work For this Permit $ Oo ' V` Square / Linear Footage Of Work:
Type of Work: ❑Addition ❑Alteration ❑New Repair/Replace
E] Demolition
Describ ork
Ry
Submittal Fee $ Permit Fee $ � n cc $ I • _ CO /CC
Notary Training /Education Fee Technology Fee $.
Scanning $ Radon $ DPBR $ Zoning $
Bond $ Code Enforcement $ Double Fee $
Structural Review. $ Total Fee Now Due $
See Reverse side -a
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 app
, r qved nd a reinspection fee wil be c r
Signat Sig ature
Owner or Agent Contractor
The foregoing instrument was acknowledged before me this c The foregoing instrument was acknowledged before me this
day of �( , 20 L CkQr -Q.Q,S V l '1 �' day of , 20 0C4 by 0 +4rak dl
who is M rsonally kno g mto me or who has produc �>
-I: P who is�rs= naii�� e.or who has produced
As identification and who did take an oath. as identificat a d who did take an oath.
NOTARY PUBLIC• NOTARY PUBLIC:
Sign:
Sign:
Print:
Print:
My Commission E MYC �'A -44 ioN .ona»� F
M �14MISSioN # DD471903
u 'f EXPJR : Se '14, x0
My C
# *� * *� * *�otxRk Ar* aY *a� 9r* +t•4t &kik & * *tk fr eF a4 * *+t *st+44c *t ti �k��ac 9r *ic at 3e��� �kl�r & #,�'it t fr t,r k,t aY,t is k yt
407) 998-0159 Radde Notary SwWcaoom
APPLICATION APPROVED BY: P2 Plans Examiner
Engineer
Zoning
(Revised 02/08/06)
PERMIT # : 13 -SC- 996352
STATE o FLORIDA
APPLICATION #: AP930135
DEPARTMENT OF HEALTH DATE PAID:
ONSITE SEWAGE TREATMENT AND DISPOSAL FEE Pte
SYSTEM
RECEIPT #:
DOCUMENT #: PR780060
CONSTRUCTION PENMIT FOR: OSTDS Repair
APPLICANT: (Emc Mortgage Corp / C/0 vita)
PROPERTY ADDRESS 74 NE 103 St Miami, FL 33138
LOT: 3-4 BLOCK: 12 SUBDIVISION: Miami Shores
PROPERTY ID i#: 11 - 3206-013 - 1580 [SECTION, TOWNSHIP, RANGE, PARCEL NUMBER]
[OR TAX ID NUMBER]
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 LOC PERMITTING REQUIRED FOR DEVELOPMENT OF THI PROPERTY.
SYSTEM DESIGN AND SPECIFICATIONS
T L 900 ] GALLONS / GPD Septic CAPACITY
A L O�.fi GALLONS / GPD CAPACITY
N I 0 I GALLONS GREASE INTERCEPTOR CAPACITY [mLxnm4 CAPACITY SINGLE TANK:1250 GALLONS]
K [ I GALLONS DOSING TANK CAPACITY [ GAALLONS ®C ]DOSES PER 24 HRS #Pumps I ]
D [ 200 I SNARE FEET SYSTEM
R [ 0 ] SQUARE FEET SYSTEM
A TYPE SYSTEM: [X1 STANDARD I I FILLED [ ] MOUND C ]
I CONFIGURATION: t ] TRENCH [X1 BED [ I
N
F LOCATION OF BENCHMARK: F.F.E.: 13.0' NGVD
I ELEVATION OF PROPOSED SYSTEM SITE [ 21.60I[ INCHES FT I I ABOVE BENCHMmWREFERENCB POINT
E BOTTOM OF DNAINFIELD TO BE [ 49.60] INCHE3 FT I[A13OVE BENCHMARK /REFERENCE POINT
L
D FILL REQUIRED: [ 0.00] INCHES EXCAVATION REQUIRED: [ 28.00 INCHES
O 1— Install 900 gal. category -3 septic tank equipped with an approved filter. 2 -The licensed contractor installing the system
is responsible for installing the minimum category of tank in accordance with sec. 64E- 6.013(3)(f). 3- Install 200 sf of
T drainfield in bed configuration.4- Perimeter of excavation area shall be at least 2 It wider and longer than the proposed
H absorption bed. 5 -Invert elevation of drainfield to be no less than 9.3T NGVD 6. Bottom of drainfield elevation to be no less
E than 8.87' NGVD.
R THIS PERMIT IS NOT FOR ADDff
SPECIFICATION8 BY PEDRO NOS TLE: - Legacy
APPROVED BY TITLE: ? Dade CHU
Pbdro N ospina
DATE ISSUED: 07122/2009 EXPIRATION DATE: 10/20/2009
DH 4016, 10/97 (Previous Editions May Be Used) Page 1 of 3
V 1.1.4 AP930135 SE792761
STATE OF FLORIDA
DEPARTMENT OF HEALTH
APPLICATION FOR ®NSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PERMIT
Permit Application Number
------------------ -- - - - - -- -PART It SITEPLAN ---------------------------
Scale: Each block re resen 10 feet and 1 inch = 40 feet.
1 ! I
! !
� � c
ti !
0
3 s
l
E �
E �
I } i
Notes;
Site Plan submitted by: L (-- �i --e ✓'�
Plan Approved - ®ate -1
BY County Health Department
ALL CHANGES MUST BE APPROVED BY THE COUNTY HEALTH DEPARTMENT
DH 4015, 10/96 (Replaces HRS-H Form 4016 which may be used) Page 2 of 4
(Stock dumber: 5744 - 002 - 4015 -6)
Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
I nspection Number: INSP - 135967 Permit Number: PL -7 -09 -1264
Inspection Date: February 19, 2010 Permit Type: Plumbing - Residential
Inspector: Hernandez, Rafael Inspection Type: Final
Owner: HOLDINGS, LLC, CAV Work Classification: Septic
Job Address: 74 NE 103 Street
Miami Shores, FL 33138- Phone Number
Parcel Number 113206013158
Project: <NONE>
Contractor: MR C'S PLUMBING SEPTIC INC Phone: (305)651 -7859
Building Department Comments
REPLACE 900 GALLONS SEPTIC TANK AND 300SQ
DRAINFIELD
Inspector Comments
Passed CREATED AS REINSPECTION FOR INSP- 120530. NEED HRS CARD
2/17/2010
Failed El
z
Correction
Needed
Re- Inspection ❑
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
For Inspections please call: (305)762 -4949
February 19, 2010 Page 1 of 1
Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection N INSP- 120530 Pe N PL -7 -09 -1264
Scheduled Inspection Date: February 17, 2010 Permit Type: Plumbing - Residential
Inspector: Hernandez, Rafael
Inspection Type: Final
Owner: HOLDINGS, LLC, CAV Work Classification: Septic
Job Address: 74 NE 103 Street
Miami Shores, FL 33138 -
Phone Number
Parcel Number 113206013158
Project: <NONE>
Contractor: MR C'S PLUMBING SEPTIC INC Phone: (305)651 -7859
Building Department Comments
REPLACE 900 GALLONS SEPTIC TANK AND 300SQ
DRAINFIELD
Inspector Comments
Passed El
Failed ?PT�`` -S
Correction
Needed
Re- Inspection ❑
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
February 16, 2010 For Inspections please call: (305)762 -4949 Page 1 of 28
Miami Shores Village
Building Department
- 10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax:. (305) 756.8972
BUILDING Permit N6 H
PERMIT APPLICATION Master Permit N o.
FBC 20
Permit Type: PLUMBING
Owner's Name (Fee Simple Titleholder) G �� a Phone #
Owner's Address
City State Zip
Tenant/Lessee Name Phone #
Email «
h 5�
Job Address (where the work is being done) — 7 MF:7- C>
City Miami Shores Villa a County _ Miami -Dade Zip
FOLIO /'PARCEL#
Is Building Historically Designated YES NO Flood Zone .
Contractor's Company Na ne • �' S h one #
Contractor's ddress -
City State 1_ Zip
Qualifier Name ®� ( Phone
State Certificate or Registration NPfir�t L.-' C - 1 s Certificate of Competency No. r-
Contact Phone E -mail
Architect/Engineer's Name (if applicable) Phone #
Value of Work For this Permit $ Square / Linear Footage Of Work:
Type of Work: ❑Addition ❑Alteration ❑New ❑ Repair/Replace ❑ Demolition
Describe Work:
Submittal Fee $ Permit Fee $ CCF $ CO�CC
Notary $ Training/Education Fee $ Technology Fee $
Scanning$ Radon $ DPBR $ Zoning $
Bond $ Code Enforcement $ Double Fee $
Structural'Review. $ Total Fee Now Due $
See Reverse side -
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 diter 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 Signature
Owner or Agent Contractor
The foregoing instrument was acknowledged before me this The foregoing instrument was acknow beforeine this
day of 20 —, by day of 20 L, by
who is personally known 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 PUBLIC: NOTARY PUBLIC:
Sign: Sign: ETTRICK
Print:: :+ Y COMMISSION # DD 8913411
Print: EXPIRES: Se ember 14, ^2013
'' I . I �r Bonded Thru Notary Public underwrim
My Commission Expires: My Commiss
APPLICATION APPROVED BY Plans Examiner Zoning
Engineer Clerk checked
(Revised 07 /10/07)
Feb 11 10 03:02p p•2
DIVISION OF - _-
Environmental Health
0% Florida Department of Health
Q ® Miami -Dade County Health Department
��* 1 OSTDS; Well Division
11805 S!N' 26 St: • 17ismi, F1.3.3375
-A �y Datc �'
Address OSTDS #
{�..9 t
I 4 �
Comments: r'
I
I
Signature / •!
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