PL-07-2381tiok iiic(di'
tAius altsa ittta�"t
lIt1tiOr
Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
BUILDING
PERMIT APPLICATION
FBC 2004
NOV2 72007 JIJI
8Y: ...
Permit Nov OT-2� 1
Master Permit No.
Permit Type: Plumbing
Owner's Name (Fee Simple Titleholder) Chr ° 54-t KI L Phone #
Owner's Address 12 N E 99 ST
City N‘ St'1 QN State R. Zip 33% 3 C3
Tenant/Lessee Name Phone #
E -MAIL:
Job Address (where the work is being done)
City Miami Shores Village
FOLIO /PARCEL# - -3 LC) E;
129 NE- `9Sr
County Miami -Dade
c 3-- 2.2 "o
Zip 33J 3E'
Is Building Historically Designated YES
�
NO '
Contractor's Company Name StciAtwict2, d C ( i 1 s Phone # t -6633
Contractor's Address 3S9 C> S. S°f' 1 1 $
City ora.,n q
Tear( S (..I Orr O .
Qualifier Name
State Pt-
State Certificate or Registration No. ss M 09 It Z6 2
E -MAIL:
Zip 3302.3
Phone #
Certificate of Competency No.
Architect /Engineer's Name (if applicable) Phone #
Value of Work For this Permit $ 2J4..50 Square / Linear Footage Of Work:
Type of Work: EAddition ❑Alteration ❑New NI Repair /Replace
1)1 e► r rl id 1b q+--,c(c -,
Describe Work:
❑ Demolition
******** * * * ***** * ** ** * * * * * * ****** * ***** Fees* * * * ** **** ** * * * * * ** * * * * ***** ** * * **** *****
Submittal Fee $
Notary $
Scanning $
Bond $
Permit Fee $
Training /Education Fee $
Radon $
DPBR $
CCF $ /- cV CO /CC
Technology Fee $ g-15
Zoning $
07-Code Enforcement $ Double Fee $
Total Fee Now Due $ 6 (04 • 13
See Reverse side -a
Structural Review. $
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 approved and a reinspection, fee will be charged.
Signature;.
Owner or Agent
The foregoing instrument was acknowledged before me this 1
day of NJV ,2001, by Chi tSt',Ink R cc,
who is personally known to me or who has produced D*` -kV s
Z.ew► As identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
SQ-Q,Q,Y■‹.
Tut'
t a r►i
My Commission Expires:
******************-
l.........
APPLICATION APPROVED
k;Et:A J. SOLOMON
Comm# DD0733346
(Revised 02/08/06)
* *0
/8117/7/
NcY'
**
Signature
Contractor
The foregoing instrument was acknowledged before me this Z7
day of NO J , 2007 , by TeCeSG Solo \
who is personally known to me or who has produced Ote v,
U L"0n44- as identification and who did take an oath.
NOTARY PUBLI ti :
MatkAcA, -3-4
My Commission Expires:
Ltl
C 1012.0
Pi(tPf MARIA JULIA GALLI
Vigto MY TOMMISSION # DD 54
OF'
1- 800.9- NQTAAY FL Notary Discount Assoc. Co.
Examiner
eer
Zoning
1
Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Date: 02/22/2008
Inspector: Levrock, James
Owner: RICCI, CHRISTINA
Job Address: 128 99 Street NE
Miami Shores, FL 33138-
Project: <NONE>
Contractor: STATEWIDE SEPTIC CONNECTIONS
u.,
Block:
Permit Type: Plumbing - Residential
Inspection Type: Final
Work Classification: Septic
Phone Number
Parcel Number 1132060132270
Lot:
Phone: 305 - 6614633
Building Department Comments
INSTALL NEW TANK AND NEW DRAINFIELD - ABANDON
EXISTING BROKEN TANK
Passed
,• •c'orC•
r
ments
Failed
Correction
Needed
Re- Inspection
Fee
($75)
No Additional Inspections can be scheduled
re- inspection fee is paid.
until
Thursday, February 21, 2008
Page 1 of 2
STATE OF FLORIDA
DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT AND DISPOSAL
SYSTEM
CONSTRUCTION PERMIT FOR:
APPLICANT: Christina Ricci
PROPERTY ADDRESS: 128 NE 99 St MIAMI, FL 33138
OSTDS Repair
PERMIT #: 13- SG- 573253
APPLICATION 8: AP530163
DATE PAID: 11/14/2007
FEE PAID: $200.00
RECEIPT #: 13 -PID- 554346
DOCUMENT 8: PR444220
LOT: 108,12 BLOCK: 17 SUBDIVISION: Miami Shores Sec 1 Amd
PROPERTY ID 8: 11- 3206 - 013 -2270
[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 MAX 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
New seotic tank
CAPACITY
CAPACITY
[MAXIMUM CAPACITY SINGLE TANK:1250 GALLONS]
JGALLONS #[ ]DOSES PER 24 HRS #Pumps [ ]
D ( 300 ] SQUARE FEET bed confiauration drainfiield SYSTEM
R [ 0 ] SQUARE FEET SYSTEM
A TYPE SYSTEM: [ ] STANDARD
I CONFIGURATION: [ ] TRENCH
N
F LOCATION OF BENCHMARK: F.F.E. 12.60" NGVD.
[ ] FILLED [X] MOB [ ]
[x] BED [ ]
I ELEVATION OF PROPOSED SYSTEM SITE [ 2.10 ][INCHES [ABOVE F LOW BENCHMARK /REFERENCE POINT
E BOTTOM OF DRAINFIELD TO BE [ 4.60 1[INCHES [ABOVE�wbBENC /REFERENCE POINT
L
D FILL REQUIRED: 1 0.00 ] INCHES
8
0
T
H
E
R
EXCAVATION REQUIRED: [ 30.00] INCHES
Inspector to verify 3 bedroom house.
*Invert elevation of drainfield to be no less than 8.50 ft. NGVD.
*Bottom of drainfield elevation to be no less than 8.00 ft. NGVD.
The licensed contractor installing the system is responsible for installing the minimum category of tank in accordance with
s. 64E- 6.013(3)(f), FAC. Required drainfield area based on rule 64E- 6.015(6)(0)2.
Install a new drainfield to achieve i.. infield size requirement.
SPECIFICATIONS BY:
APPROVED BY:
za TITLE:
Mica=
DATE ISSUED: 11''1 . '7
TITLE:
Dade CHD
EXPIRATION DATE: 02/19/2008
DH 4016, 10/97 (Previous Editions May Be Used) Page 1 of 3
AP530163 SE456388
v 1.1.4
STATE OF FLORIDA
DEPARTMENT OF HEALTH
APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PEW, )
Permit Application Number
PART iI - SITE PLAN - -- — -- -- *-'--
Sca�: Each block represents 5 feet and 1 inch = 50 feet.
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Notes:
Site Plan submitted by:
Swmwm Title
Plan Approved Not Approved Date
Sy_ County Health Department
ALL CHANGES MUST BE APPROVED BY THE COUNTY HEALTH DEPARTMENT
011 4015. 10116 tnopl.00. IH Famn 451s,nh mn► be
duck Nembet 5744-00540154
Page 2 of 3