PL-11-1949\1'4\ ozIvi
Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
INSPECTION'S PHONE NUMBER: (305) 762.4949
BUILDING
PERMIT APPLICATION
FBC 20
Permit Type: PLUMBING
OWNER: Name (Fee Simple Titleholder): e R1 e fi roc
Address: 3 Lt- IQ E bs Sf
Ii
I 1- .-.011
Permit No.
Master Permit No.
Phone#:.5()5 7c7
City: 1t c i S h yes State: „ft.,-
l- Zip: 33 13 i2
Tenant/Lessee Name: Phone #:
Email:
JOB ADDRESS: 3y- NE- I o5 s'+
City:
Folio/Parcel #:
Miami Shores County:
II - CCU- 13 —00c-c,
Is the Building Historically Designated: Yes
Miami Dade
331,E
000d Zone:
CONTRACTOR: Company Name: 6r es f v Phone#: 3 0065- 17 V5-9
Address: I cel 3 MW a 04C-
City:
Qualifier Name:
State Certification or Registration #:
State:
'To kw. L.�1ey
b e t t - .-2's 1
Contact Phone#:
tC le
zip: 33161
Phone #: 3G (S1 ? /69
Certificate of Competency #:
Email Address:
DESIGNER: Architect/Engineer: Phone #:
Value of Work for this Permit: $ / tZ2.c34 Square/Linear Footage of Work: CJ
❑New I Repair/Replace LIDemolition
Type of Work: ❑Address ❑Alterationn
Description of Work: - pct ;S . rkiv t t
** *** **** ** **** * * * ***$ * * *s *** ** * ** *ir **Fees * * * ** ***�***** ** *** * * ***** *m * * *$ ** *** * ****
Submittal Fee $ 50 "k_4-7 f
Permit Fee $ [ re° -— CCF $ CO/CC $
Scanning Fee $ Radon Fee $ DBPR $ Bond $
Notary $ Training/Education Fee $ Technology Fee $
Double Fee $ Structural Review $
TOTAL FEE NOW DUE $ \ 5 •�v
•
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, BOIL FRS, HEATERS, TANKS and AIR CONDITIONERS, ETC
OWNER'S Al('FIDAVIT: 1 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 ) days after the building permit is issued. In the absence of such posted notice, the
inspection will not be approved and a re 'e ion fee will be charged.
/111
__tee i`".
Signature
Owner or Agent Contractor
The foregoing instrument was acknowledged before me this 4 The foregoing instrument was acknowledged before me this
day of _, 201. , by , day of F 6i u&rrg0 .L, by
who is personally known to me or who has produced who is personally known to me or who has produced
As identification , ' ., who did take an oath. as identification and who did take an oath.
NOTARY PUBLIC:
NOTARY PUBLIC:
Sign:
Print:
My Commission Ex
tie
Sign:
Print:
My Commas'
APPROVED BY '4 2-'741 Plans Examiner Zoning
Structural Review Clerk
(Revised 07 /10/07)(Revised 06/10/2009)(Revised 3/15/09)
D
/1/E CAS.
STATE OF FLORIDA
DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT AND DISPOSAL
SYSTEM
CONSTRUCTION PERMIT FOR: OSTDS Repair
APPLICANT: George Frix
PROPERTY ADDRESS: 334 NE 105 St Miami, FL 33138
LOT: 8-9
PERMIT # :13 -SC- 1298143
APPLICATION #: AP991824
DATE PAID:
FEE PAID:
RECEIPT #:
DOCUMENT #: PR833215
BLOCK: 117 SUBDIVISION: MiamiShores
PROPERTY ID #: 11- 2136 - 013 -0050
[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 [ 750 ] GALLONS / GPD Septic CAPACITY
A [ 0 ] GALLONS / GPD CAPACITY
N [ 0 ] GALLONS GREASE INTERCEPTOR CAPACITY [MAXIMUM CAPACITY SINGLE TANK:1250 GALLONS]
K [ ] GALLONS DOSING TANK CAPACITY [ ]GALLONS @[ ]DOSES PER 24 HRS #Pumps [ ]
D [ 200 ] SQUARE FEET SYSTEM
R [ 0 ] SQUARE FEET SYSTEM
A TYPE SYSTEM: [x] STANDARD [ ] FILLED [ ] MOUND [ ]
I CONFIGURATION: [ ] TRENCH [x] BED [ ]
N
F LOCATION OF BENCHMARK: F.F.E.: 12.50' NGVD
I ELEVATION OF PROPOSED SYSTEM SITE [ 26.40 (1 INCHES FT ][ABOVEA BELOW11BENCHMARK /REFERENCE POINT
E BOTTOM OF DRAINFIELD TO BE [ 54.40 INCHES I/ FT ]( ABOVE /I BELOW bBENCHMARK/REFERENCE POINT
D FILL REQUIRED: [ 0.00] INCHES EXCAVATION REQUIRED: [ 28.00 INCHES
O
T
H
E
R
1— Existing 750 gal. septic tank certified by " MrC's Plumbing & Septic" on 01/15/2010 to remain. 2- Install 200 sf of
drainfield in bed configuration. 3- Perimeter of excavation area shall be at least 2 ft wider and longer than the proposed
absorption bed. 4 -Invert elevation of drainfield to be no Tess than 8.46' NGVD. 5. Bottom of drainfield elevation to be no
Tess than 7.96' NGVD.
THIS PERMIT IS NOT FOR ADDITION(s).
SPECIFICATIONS
PEDRO N OSPINA
REPAIR
�Ab�,ltia-
o}a,
APPROVED -Y: TITLE: Dade CHD
DATE ISSUED:
P . o N Ospiva
0 31/2011 EXPIRATION DATE: 05/01/2011
DH 4016, 08/09 (Obsoletes all previous editions which may not be used)
Incorporated: 64E- 6.003, FAC
v 1.1.4
AB991824
8E834801
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