PL-09-601Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel; (305) 795.2204 Fax: (305) 756.8972
Permit No. 109— ll/O
Master Permit No
BUILDING
PERMIT APPLICATION
FBC 20
Permit Type: PLUMBING
Owner's Name (Fee Simpleh • Dolder
Owner' dress
City " /•).�
6/
Nzemgvma � 13zo�
oy -4-i1G
Phone # —"
Staten
Tenant/Lessee Name a%l%L f
Email
Zip
Job Address (where the work is being done)
City Miami Shores Villa e
3
FOLIO / PARCEL #
Phone #
Count VJ• Miami-Dade
OS— 6 J 1 30
Is Building Historically Designated YES NO X.
Contractor's Company Nam
Cantractor's d6lress
City ) State . Zip 3 31 L i
Qualifier Name c� kg-) //A A Phone # • .. t I
State Certificate or Registration No. O q c�. 1 C. Certificate of Competency No. 0 N ?-• tS
hone #
Flood Zone /11/4/ 9--
'1P
Contact Phone / ► ■
E -mail
Architect/Engineer's Name (if applicable) /v . . Phone #
Value of Work For this i "erinit $ - c®7I
Type of Work: DAddition
[IA iteration
S uare / Linear Foo:. ge Of Work:
❑New Repair "replace ❑ Demolition
II escribe Work:
•
11 r41MO ���7 P1 �e 4 h/
** * * *>x:x:x:x*********** = *** **:x:x:x:z:x**:x*:x*** Fees * * ** x ****a:***** ** ** x **** **** x * * * * ****:x:x *: ***
CCF $ CO /CC
Submittal Fee $ Permit Fee $
Notary $ 5 Training/Education Fee $ Technology Fee $ 4.3
Scannin: $ �' ; • Radon $
Bond $ ® S `3 Code Enforcement $. Double Fee $
DPBR $
.Structural Review: $
fkitiCt
•
Zoning $
Total Fee Now Due $ '9 •
See Reverse side -4
Bonding Company's Name (if applicable) )
Bonding Company's Address
City State
4,/
Zip
Mortgage Lenderts,Narnfe (if applicable)
Mortgage`Jender'is Address Al 4r
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 inform ation is accurate and that all work will be done in compliance with all
applicable laws regulating construction and zoning.
"WARNING TO OWNER: YOUR FAILURE T() 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'buildng 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 i - n the absence of such osted notice, the
inspection will not be approved and a eins ection feelvill be charged. .
Owner or Agent -
The forego instrument was Ac o 1 ged . - this l - The fore •
day of `6 . 20c , by __ l ! day of
who is pers najly known to me or who has produced �' ; who s personally kno
-. signature
tr
hnsfrurpegrt was ackno ledge
, 2001, by
\c(. —As identification.and who did take an oath.
NOTA
Sign:
Print:
My Commission Expi
`z�'t 0:: MY COMMISSION # DD�649624
t • s P5
AYf„ eon EXPIRES:
Notary umic 5, 20:11
* * * * * * * * * * * * * * * * * * * * * * * **
APPLICATION APPRO
Revised 07/10/07)
5 fore me this 1
L
o me or who has produced
as identification and who did take an oath. .
Y NJ RAC:
, ti1a
off'. 1°t ti
<0 ° lti 'b4`t 6.
/
Sign: k�I�ti .� 4®
Print: C4gv.,. Cee ;*
si
My Commission Expires: y.o�
'°ammo
�O
*** * ******** * ** * * * ** * ****: x*********rx**** **** **** **** :****:xx: *rx:x*** * ** •
P ans xardner Zoning
Engineer
Clerk. checked
Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number: INSP- 111209
Per
Number: PL -4 -09-6
Scheduled Inspection Date: May 18, 2009
Inspector: Levrock, James
Owner: O'HARE, FRANK
Job Address: 1158 NE 99 Street
Miami Shores, FL 33138-
Project: <NONE>
Contractor: BOB'S SEPTIC & DRAIN INC
Permit Type: Plumbing - Residential
Inspection Type: Final
Work Classification: Drainfield
Phone Number
Parcel Number 1132050180130
Phone: 305 - 558 -5818
Building Department Comments
Passed
Failed
2, 0 so
Comments
OVAL IN FILE
Correction
Needed
■
Re- Inspection
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
A... A A .t "Al
\ / -.. •! HIl/lf
O1YI3IOM QF
Environmental Health
Florida Department of Heath •
Miami - Dade County Health Department
OSTDS /Septic Tank Division
7769 NW 4.11s SL Suita 175
Miami, FL 33166
tnspectorT=S ' �� r + ( •
Address 11 S' �. 14) E • �
Comments:
Signature
Date kI►k /27
! S ,'1 ; osi s a % 3- se- 71?
RT 1182.51
STATE OF FLORIDA
DEPARTMENT OF HEALTH
`°' ONSITE •SEWAGE:T9EATMENT AID DISPOSALSYSTEM..
CONSTRUCTION IN ECTION• AND FINAL APPROVAL
F
APPLICANT: z'` l' (' - H
AGENT: �y
PROPERTY ADDRESS: i 1,
1 r
PERMIT NO, -' C L WS
DATE PAID:
FEE PAID:
RECEIPT #: •
LOT: BLOCK:, (79 SUBDIVISION'
CHECKED [X] ITEMS ARE NOT
TANK INSTA
[01] TANK f [1 ]
TANK MATERIAL
OUTLET DEVICE
MULTI•CHAMBERED
OUTLET FILTER
' -L 3►3
PROPERTY ID 32.0,7M-rill d
IN COMPLIANCE WITH STA
RU14:•AND ,41A615'F4 ,BE, -CORRECTED., •
SETBACKS • -.
"." ] SURFACE WATER FT
t [' 1" •[28] DITCHES'" • • •• • FT
[ ] [29] PRIVATE WELLS FT
[ 1 [30]' PU'BL:IC WELLS 'FT
[ ] [3'11... 1 IIGATX*1 wg1,Ls ,, ,FT
I 1 [321 POTABLE WATER LINESS,Ve FT
[ l [33] : ®U1[,DING,F,OUND4di'ION • ' .• Z.$;; • FT
[ 1 [34] PROPERTY LINES 2-7, FT
• [ ] [35] OTHER 'Fr
[021
[03]
[g]
[05]
[06]
[07]
[08]
[081
[Y /N]
LEGEND`x S`
WATERTIGHT
LEVEL
DEPTH TO LID
DRAINFIELD INSTALLATION IS' X IS A r _ 14 •c" F 4L.ED / MOUND•SysTEM '•
[101 AREA [1] a i [2] SQFT ( ] [36] DRAINFIEL.D COVER
[11] DISTRIBUTION BOX HEADER_ J [ J [37] SHOULDE ' • '
[12] NUMBER OF [MAINLINES _ 2/ [ ] [38] SLOPE$
I 1 [391 STABILIZATiOIV' ''
[13]
[14]
[15]
[16]
[171
[18]
[19]
I201
[21]
DRAINLINE SEPARATION [
DRAINLINE SLOPE kw ✓ e 1 cb
DEPTH OF COVER
ELEVATION [ABOV LO BM .A �• _ �+
SYSTEM LOCATION
DOSING PUMPS
AGGREGATE SIZE
AGGREGATE EXCESSIVE FINES
AGGREGATE DEPTH
itg
FILL / EXCAVATION MATERIAL
[22] FILL AMOUNT
[23] FILL. TEXTURE �
RAI EXCAVATION DEPTH . 4ec •• r
[25] ARE*f EPI ACED
[26] REPLACEMENT MATERIAL
EXPLANATION OF VIOLATIONS / REMARK• .
[ 1
[ 1
I
[ 3
L
[ 1
ADBITIOIsiAL INFORMATION
[40] t.: & NOBSTfly TED AREA •
[41] STORMWATER RUNOFF
[42] ALARMS • ; • •
[43] MAINTENANCE AGREEMENT
[44] BUILONG AITIEA
[45] LOCATION CONFORMS WITH SITE PLAN;
[48] FINAL SITE GRAl?�NG • .�
[47). ... CONTRACTOR ,To s' t'
[48] OTHER
E491., . TANIt• MPgP .. /1 / �..
[50] TANK CRUSHED & F11..i.ED _/
CONSTRUC110141 /DISAPPROVED)!
FINAL SYSTEM LAP ISAPP.ROVED]:
DH 4012 (Page 2). 10/97 (Previews Editions May 8e •Uead)
Stock Number: 5744-0024010-4 •
PT 1: App2I
PT 2; at8lallerRCont aaor
PT 3: Building Damormart
Pr 4; Health osbartmsnt
STATS OF FLORIDA
DEPARTMENT OF HEALTH
ONSITE =WAGE TREATMENT AND DY3POnAL
SYSTEM
CONSTRUCTION PERMIT FOR:
APPLICANT: Franck) Ohre
PROPERTY ADDRESS;
OSTDS Rgpair
Pie o :13 -9C- 877575
AFPLICATZON 0: Mil 8251
DAIS 8ATD
FEE PAID:
RECEIPT
DOCULIna'r #: PR770194
1198 NE
99 St Miami, R. 33138
LOT: 4 BLOCK: 179 troserriaZCH:
PROPER'T'Y ID 0: 11- 3205-018.01130
[SECTION, TC1T1111IP, RANGE, PARCEL tft1103RLi.]
[OR TAX ID IR R]
mime MOST Ba CON8TRJ5CTaD IN ACCORDANCE WITH 0011CIi'ICA1'IiAQe At7D STANDARDS or SECTION
391.0065, P.8., AND CHAPTER 64E -6, LP.A.0. DERARTM NT APPROVAL OF SISTER DOES NOT GUARANTEE
**TI8FACTORy PER1ORNINCL FOR AtQY EPECIPTC PERIOD OF TIME. A83Y CRANr:i$ IN mom= SALTS,
ERIC8 SERVED AS A BASIS FOR ISSUANCE OF THIS PERMIT, REQO'ZRE TBtf APPLICANT TO MODIFY THE
3E1/I1xT ABPLICi►P 1Q]T, arICS MODIFICATItIit$ MAX =MT TN TETS PV3IIT P!ItG MADE NMI. AND FOID.
ISSUANCE OF THIS PST DOES NOT EXEMPT TEE APPLICANT FROM COMPLIANCE (SITE OTHER FEDERAL,
STATE, OA LOCAL PERMITTING REQUIRED FOR DEVE7rMENT or THIS PROPERTY.
STETEN DESIGN AND SPECIFICATIONS
T [
• [
N C
R
760 ] GALLONS / GOD
0 ] GALLONS / GPD
0 3 GALLONS GREASE DXTIRCEPTQR CAPAC :TY
7 GALLONS DOSING TANN CAPACITY
Seodc
CAPACITY
CAPACITY
(MAXENDM CAPACITY SINGLE TANR11230 Gi1LLcN9]
]GALLONS SI ]DOSES PER 24 ERR *Pumps [ I
D [ 300 ] SQUARE FEET SYSTEM
R [ C ] 3QVA14C BEET SYSTEM
A TYPE SYSTEM: [s] STANDARD [ ] TILLED ] ] MOTit i
x C0UT t&RATTON: [x] !32x403 [ 3 RED [ 3
F Y.0CATZQN OF E CEMABX: FFE: 9.9' NOVO
I ELEVATION OF PROPOSED SYSTEM SITE
✓ BOTTOM OF Mum= TO SE
D SILL REQUIRED: [ 0.00 ] muss
T
•
[ 22.601 + GT ] [ AsovE esseasteRIVaarniatcs POINT
62.80 ] Gail' FT ] ( A80vE swow SENCt af9[t /REFFASNCR POINT
EXCAVATION asgtrISSD: C 30,00 ] mass
1.fnetan 225 fig ft drainfleld in tenon configuration.
2.invert elevation of grainfield to be no lase than 6.0' NC3VD.
3.13ottom of dralnfield elevation to ba no less than 5.50' NOVO.
4.l_xisting 750 9 septic tank to remain.
SPECIFICATIONS BY; Robert BOB, SEPTIC
APPROVED RI:
DATE ISSUED:
DE 4018, 10/S1 (P,' us editions May 8e Used)
v 1.1.4
100 /i00 L
TITLE: -Lima
E mews oaiailaS I: Dade QED
EXPIRATION DUE: 07109/008
A791 ®251
al764a9®
Page 1 of 3
Mid ze:ZZ 8007 /80/170
STATE OF FLORIDA
DEPARTMENT OF HEALTH
APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION P RMIT
Permit Application Number nr 1 B251
PART II - SITEPLAN
Scale: Each block re ' resents 10 feet and 1 inch = 40 feet.
" r . �.- , _. .... ,.
Site Plan submitted by;
can
Plan Approved Sign ure 'Ftle
PP Not Approved Date
By L 0 County Health Department
ALL CHANGES MUST BE APPROVED BY THE COUNTY HEALTH DEPARTMENT
OH 4015, 10195 (Replaces MRS-H Form 4015 which may bo used)
(Stock Number: 5744 -D02 -4015.9)
300110021
Pegs 2 of 4
XJ L13:(73 6003140,'4+0