PL-09-492Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795,2204 fax: (305) 756.8972
Permit No. PI
BUILDING
PERMIT APPLICATION
FBC 20
Permit Type: PLUMBING " ,a
Owner's Name (Fee Simple Titleholder) S ±G►'1 ��^��
i)t-\'1 Phone #
Owner's Address r_ IV CO NE '7 S1
City j1/44 WS State R. Zip 331 6(3
Tenant/Lessee Name Phone #
Email
MMCIEgVIE
la MAR 2 71009
BY: 1/<--)
Master Permit No,
Job Address (where the work is being done) G4-C) ) Ol Sfi
City Miami Shores Village County Miami -Dade
FOLIO / PARCEL # I 1 _ 3 z ®6 -- 0 14--- 27' o
Is Building Historically Designated YES NO
Contractor's Company Name A A ror P-004-0---
Contractor's Address GOZZ '.Sul 3 S Cl "
City r1 VTA rrrrQ✓ State Zip 33023
Qualifier. Name 3o he. Tv 01 Phone# (SO ) 94'4 --Ree6
Zip 33J'
Flood Zone
Phone #
State Certificate or Registration No. Certificate of Competency No.
Contact Phone E -mail
Architect/Engineer's Name (if applicable). ' Phone #
Value of Work For this Permit $ Zia'
Type of Work: (Addition nAlterat ion
Describe Work:
Square / Linear Footage Of Work:. 2 2S
ENew Repair/Replace
Ike f Ialce n( Y0,;nf --P1d
n Demolition
********** * * * * * * * * * * * * * * * * * * * * * * * * * * * * *Fe
Submittal Fee $
Notary $
Scanning $
Bond $
s************* * * * * * * * * * * * * ** * * * * * * * * * *** * ** **
Permit Fee $ 115' V V CCF $ CO /CC
Technology Fee $ 4
Zoning $
Training/Education Fee $ 040
Radon $
Code Enforcement $
DPBR $
Double Fee $ XX
Structural Review. $ " Total Fee Now Due $ fl
See Reverse side —>
Bonding Company's Name (if applicable)
Bonding Conililny's Address
City State
Zip
Mortgage Lender's Name (it 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 bro ure will be delivered to the person
whose property is subject to attachment. Also, a certified copy of the recorded notice of comm ement must be posted at the job site
for the first inspection which occurs seven (7) days after the building permit is issued. In " e absence of such posted notice, the
inspection will not be appr ed and a reinspection fe, will be charged.
Signature c- rc r Signature
Owner or Agent
The foregoing instrument was acknowledged before me this 23
day of . M°✓ 20 sal , by \\AA CiCr
who is personally known to me or who has produced alto/`
,-`
en se . As identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
Te* A L Q
My Commission Expires:
'TERESA J. SOLOMON
,NSUt
,a? r p eq " Comm# DD0733346
s<s Expi s.11 /8/2011
* * * * * * * * * * * * * * * * * **
APPLICATION APPRO
(Revised 07/10/07)
Notary Assn., Inc
4
ans Ex miner
Contractor
The foregoing instrument was acknowledged before me this �3
day of 1 M C 1 , 2008, by J3 h"
who is personally known to me or who has produced
as identification and who did take an oath:
NOTARY PUBLIC:
My Commissirr4
-ThlItSA J. SOLOMON
��, {�y p ti Comm# DD0733346
Expires 11/8/2011
4„g tv Florida Notary Assn., Inc
Engineer
Zoning
Clerk checked
STATE OF FLORIDA
DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT AND DISPOSAL FEE PAID:
SYSTEM RECEIPT #:
PERMIT #: 13-SC-976183
APPLICATION #: AP916614
DATE PAID:
CONSTRUCTION PERMIT FOR: OSTDS Repair
APPLICANT:
Silvia Stanforth
DOCUMENT #: PR768587
PROPERTY ADDRESS: 846 NE 97 St
LOT: 9
Miami, FL 33138
BLOCK: 74 SUBDIVISION:
PROPERTY ID #: 11- 3206 -014 -2730
[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 LOCAL PERMITTING REQUIRED FOR DEVELOPMENT OF THIS PROPERTY.
SYSTEM DESIGN AND SPECIFICATIONS
T [
A (
N [
K [
900 ] GALLONS / GPD
0 ] GALLONS / GPD
0 ] GALLONS GREASE INTERCEPTOR CAPACITY
] GALLONS DOSING TANK CAPACITY
Septic Tank
CAPACITY
CAPACITY
[MAXIMUM CAPACITY SINGLE TANK:1250 GALLONS]
]GALLONS @( ]DOSES PER 24 HRS #Pumps [ ]
D [ 225 ] SQUARE FEET Trench confiauration SYSTEM
R [ 0 ] SQUARE FEET SYSTEM
A TYPE SYSTEM: [X] STANDARD [ ] FILLED [] MOUND [ ]
I CONFIGURATION: [X] TRENCH [ ] BED [ ]
N
F LOCATION OF BENCHMARK: FFE 11.10' NGVD
I ELEVATION OF PROPOSED SYSTEM SITE
E BOTTOM OF DRAINFIELD TO BE
L
D FILL REQUIRED:
0
T
H
R
SPECIFICATIONS BY:
APPROVED BY:
DATE ISSUED:
[ 0.00 ] INCHES
[ 24.00 ] [I INCHES 1 FT ] [ ABOVE a BELOW U BENCHMARK /REFERENCE POINT
[ 42.00 ] [I INCHES I/ FT ] [ABOVE 4 BELOW b BENCHMARK /REFERENCE POINT
EXCAVATION REQUIRED: [ 30.00] INCHES
1.- Existing 900 gal. septic tank to remain.
2.- Install 225 sf of drainfield in TRENCH configuration.
3. -Invert elevation of drainfield to be no less than 7.10 ft NGVD.
6. -Bottom of drainfield elevation to be no less than 6.60 ft NGVD.
THIS PERMIT IS NOT FOR " ADDITION(s) ".
Gerard f3, Phili . ire
r
DH 4016, 10/97 (Pr -lious Editions May Be Used)
v 1 ,1.1
TITLE:
linear Specialist II
Dade
EXPIRATION DATE: 06/24/2009
FY916614 SE783523
CHD
Page 1 of 3
STATE OF FLORIDA
DEPARTMENT OF HEALTH
APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PERMIT ° S
Permit Application Number
PART II - SITE PLAN
Scale: Each block represents 5 feet and 1 inch = 50 feet.
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Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Psi'
Scheduled Inspection Date: April 07, 2009
Inspector: Levrock, James
Owner: CLARKE, SILVIA MARIA
Job Address: 846 NE 97 Street
Miami Shores, FL 33138-
Project: <NONE>
Contractor: A AARON SUPER ROOTER
Permit Type: Plumbing - Residential
Inspection Type: Final
Work Classification: Drainfield
Phone Number
Parcel Number 1132060142730
Phone: 305 - 944 -8886
Building Department Comments
Passed
Failed
Correction
Needed
Re- Inspection
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
April 06, 2009
Page 8 of 21