PL-09-271I
Afork.3. heel;
hfkEimd Shores Vldage
10(50 kl.E, vai ie War li 'Shores, FL
Ph ,)51e; 1J(P796-220, Fax i',(X.i..751-8972
Scheduled r:ection Date: March 13, 200!)
James
Owner. i2LEY, JAMES
Job Adcir,.::::_,-:•:110 NE 99 Street
!',Harni Shores, F.
Projec: ,-.NONE>
Contractor: A AARON SUPER ROOT:ER
Permit Type: PILurnitinci Fwsidentlai
ins,-pecfion Type: Final
Septic
Pi or
Parcel unber 13.20 ;J0180150
ue; 31:i5-j44-6386
11■7971.1ammtmMla ■ty m a It.m.s.mm‘mr.,,Tar ,ssam=mm.mmm..r,m,==mmm ..r-mmi=== II13.11=1,32E12.
Building -ii:ment Comments
Fa W;-.(
Cer: c F,)1
Cf,..1,Tr■iffits
rth€
No 4. can be scheduled until
paid
March -12 1.-(i 2
age 3 of '19
Pl o9- a�,
Miami Shores Village pcmgv2E1
Building Department FEB 2 5 2009
10050 N.E.2nd Avenue, Miami Shores, Florida 33138 BY• '' \
Tel: (305) 795.2204 Fax: (305) 756.8972
BUILDING
PERMIT APPLICATION
FBC 2004
Permit No.PL
Master Permit No.
09-n
Permit Type: Plumbing t3 a Y
Owner's Name (Fee Simple Titleholder) `Ja ►e .) rMei Aj t- L°► S rj Phone # (3°;)) �' S- -
Owner's Address \ t 00 Qe. 1)'1 `-
City Ilk S k, FC. State t✓ Zip - ;1ti a
Tenant/Lessee Name
E -MAIL:
Job Address (where the work is being done) \ I '0® 1'
Phone #
City Miami Shores Village County Miami -Dade
FOLIO / PARCEL # Oi —OI50
Is Building Historically Designated YES NO
Contractor's Company Name A
Contractor's Address b® 2Z s CI-
City CCIr/lG1 ('
Qualifier Name �� 1 ,
State Certificate or Registration No.
E -MAIL:
State
Zip 33(3
Phone# (30s) '1 it-4- &6
Zip 3,3o 2
Phone #
Certificate of Competency No.
Architect/Engineer's Name (if applicable) Phone #
Value of Work For this Permit $ "2''5 GO —
Square / Linear Footage Of Work:
Type of Work: ❑Addition ❑Alteration ❑New Repair/Replace
El Demolition
Describe Work:
Ref n Serhc K-
********* * * * * * * *xxxxxx * * * * * * *. * * * * * * * * ** Fees****** r. xxxxxxx** * * ** ** * *r.* * *r. * * * *r. *xxxxxxxxx
Submittal Fee $ Permit Fee $ 'CrO CCF $ .tip CO /CC
Notary $ Training /Education Fee $ N'0 Technology Fee $ 4.3'
Scanning $ Radon $ DPBR $ Zoning $
Bond $...0-010 ) g Code Enforcement $ Double Fee $
Structural Review. $
Total Fee Now Due $
See Reverse side -4.
FEB 2 5 PAID
191 R
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
p 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 commende,j ent must be posted at the job site
for the first inspection which occurs seven (7) days after the building permit is issued. /n,, the absence of such posted notice, the
inspection will not be proved and a reinspection fee will be charged
Signature kL. ritit Signature
Contractor
The foregoing instrument was acknowledged before me this l The foregoing instrument was acknowledged before me this 19
day of e b , 20 09, by l Li SGI ('j r 0 g 1 , day of Ni , 20 Oat by J'..`or7 i� -) ,
who is personally known toaame rr.�y' k 111.I�f161�e who is personally known to me or who has produced b r iv ,
L As irie ' r :0,,,'i a
n �
ttthr# X48 *lath.
NOTARY PUBLIC:
R ' H Expires 11/8/2011
��_-_;. �,
Sign:
Print:
eaeaecFlorida N tarysn nml
a cfeeZn-°I.C1--
My Commission Expires:
• W Y. xxxx*x xx xxxx xx x x,t**** xxxr.
APPLICATION APPROVED BY:
(Revised 02/08/06)
xxxxxx xxx WIC xx
l.r c St- as identification and who did take an oath.
NOTARY PUBLIC: TERESA J. SOLOMON C
°, 6' Comm# DD0733348
Expires 11/8/2011•
ride-NotaryAssn„ Inc
Sign:
Print:
111 .111/ .1/ Ml.t.l
drei `,./ 43 .9 dot
My Commission Expires:
* x* x xxr. xx
• x r.****,;xxxa *****xzx
(/Plans Examiner
4
Engineer
Zoning
STATE OF FLORIDA
DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT AND DISPOSAL
SYSTEM
CONSTRUCTION PERMIT FOR: OSTDS Repair
APPLICANT:
James, Mary & Lisa Bailey
PERMIT # :13 -SC- 971314
APPLICATION #: AP911868
DATE PAID:
FEE PAID:
RECEIPT #:
DOCUMENT #: PR764756
PROPERTY ADDRESS: 1100 NE 99 St Miami, FL 33138
LOT: 6
BLOCK: 179 SUBDIVISION: Miami Shores
PROPERTY ID #: 11- 3205-018 -0150
[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
WHICH SERVED AS A BASIS FOR ISSUANCE OF THIS PERMIT, REQUIRE THE APPLICANT
PERMIT APPLICATION. SUCH MODIFICATIONS MAY RESULT IN THIS PERMIT BEING MADE
ISSUANCE OF THIS PERMIT DOES NOT EXEMPT THE APPLICANT FROM COMPLIANCE WITH
STATE, OR LOCAL PERMITTING REQUIRED FOR DEVELOPMENT OF THIS PROPERTY.
MATERIAL FACTS,
TO MODIFY THE
NULL AND VOID.
OTHER FEDERAL,
SYSTEM DESIGN AND SPECIFICATIONS
T [
A[
N [
K [
900 ] GALLONS / GPD Septic
0 ] GALLONS / GPD
0 ] GALLONS GREASE INTERCEPTOR CAPACITY
] GALLONS DOSING TANK CAPACITY [
CAPACITY
CAPACITY
[MAXIMUM CAPACITY SINGLE TANK:1250 GALLONS]
]GALLONS @[ ]DOSES PER 24 HRS #Pumps
D [ 100 ] SQUARE FEET Existina - Bed Confiauratio SYSTEM
R [ 0 ] SQUARE FEET
A TYPE SYSTEM:
I CONFIGURATION:
N
F LOCATION OF BENCHMARK: FFE: 10.6 NGVD
SYSTEM
[x] STANDARD [ ] FILLED [ ] MOUND
[ ] TRENCH [x] BED [
[ 3
I ELEVATION OF PROPOSED SYSTEM SITE
E BOTTOM OF DRAINFIELD TO BE
L
D
0
T
H
E
R
SPECIFICATIONS BY:
APPROVED BY:
FILL REQUIRED:
[ 0.00] INCHES
[ 28.80 1 [1 INCHES fr FT j [ ABOVE A BELOW U BENCHMARK /REFERENCE POINT
[ 58.80 ] ['INCHES I FT ] I ABOVE BELOW I BENCHMARK /REFERENCE POINT
EXCAVATION REQUIRED: [ 0.00 } INCHES
1.-Install a 900 gal min. category-3 septic tank with an approved filter.
2. 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.
® tOetfj4:°
s,A 4‘‘r®
TITLE: Engineer Specialist II
3.-Existing 100 sf drainfield, certified by "A Aaron Super Rooter on 02/18/09" to remain.
• "° "•''*'"°"*THIS PERMIT IS NOT FOR ADDITION(s)*********************
DATE ISSUED:
V Edwar•s
Astrid V Edwards
02/20/2009
TITLE: Engineer Specialist II
Dade
CHD
EXPIRATION DATE: 05/21/2009
DE 4016, 10/97 (Previous Editions May Be Used)
v 1.1.4 AP911868 8E780237
Page 1 of 3
- m. -
STATE OF FLORIDA
DEPARTMENT OF HEALTH
APPLICATI ON FOR ONSITE SEWAGE DISPOSAL. SYSTEM CONSTRUCTION PERMIT
Permit Application Number
- - PART II • SITE PLAN- —
Scale: Each block represents 5 feet and 1 Inch a 50 feet.
Notes:
Site Plan submitted by*
Signature Tele
Plan Approved Not Approved Date
By
County Health Department
ALL CHANGES MUST SE APPROVED BY THE COUNTY HEALTH DEPARTMENT
Dk1 WIS. 10 14/11144 F 4015 which may bused)
pock 5744002.401540
Page 2 of 3
-F1 00P\A
STATE OF FLORIDA
DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT AND DISPOSAL
SYSTEM
CONSTRUCTION PERMIT FOR: OSTDS Abandonment
APPLICANT: James Bailey
PERMIT # :13 -SC 971310
APPLICATION #: AP911864
DATE PAID:
FEE PAID:
RECEIPT #:
DOCUMENT #: PR764751
PROPERTY ADDRESS: 1100 NE 99 St Miami, FL 33138
LOT: 6
BLOCK: 179
PROPERTY ID #: 11- 3205 - 018-0150
SUBDIVISION:
[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 [ ] GALLONS / GPD CAPACITY
A [ ] GALLONS / GPD CAPACITY
N [ ] GALLONS GREASE INTERCEPTOR CAPACITY [MAXIMUM CAPACITY SINGLE TANK:1250 GALLONS]
K ( ] GALLONS DOSING TANK CAPACITY [ ]GALLONS of ]DOSES PER 24 HRS ()Pumps [
D
R
A
I
N
F
I
E
L
D
0
T
H
E
R
[ ] SQUARE FEET SYSTEM
[ ] SQUARE FEET SYSTEM
TYPE SYSTEM: [ ] STANDARD [ ] FILLED [ ] MOUND [ ]
CONFIGURATION: [ ] TRENCH [ ] BED [ ]
LOCATION OF BENCHMARK:
ELEVATION OF PROPOSED SYSTEM SITE
BOTTOM OF DRAINFIELD TO BE
FILL REQUIRED: [ 0.00] INCHES
/ ] [ ABOVE / BELOW ] BENCHMARK/REFERENCE POINT
/ I [ABOVE/ BELOW] BENCHMARK /REFERENCE POINT
EXCAVATION REQUIRED: [ ] 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.
SPECIFICATIONS
APPROVED B
DATE ISSUED:
02/20/2009
Dade CHD
EXPIRATION DATE: 05/21/2009
DH 4016, 10/97 (Previous Editions May Be Used) Page 1 of 3
v 1.1.4
AP911864 SE -1
STATE OF FLORIDA
DEPARTMENT OF HEALTH
APPL'CATION FOR 'ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PERMIT
Penn* Application Number
AMMO COMM -- • IMMO ._.- . -_ --
Scale: Each block represents 5 feet and I u�kt
PART 11 SITE PLAN. — — _. —
50 feet
Notes:
Site Plan submitted by:
Plan ApProbtd
By
Signature
Not Approved
Date
County Health Department
ALL CHANG MUST BE APPROVED BY THE COU$TY HEAL'T'H DEPARTMENT
DH 4015. Itiffia Iltopiaces HR Fenn 4416wNeh ray b#6 used) ,
a
— Paselot3.