PL-12-196Miami 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
""
FEB O 2
BUILDING Permit No. Y
PERMIT APPLICATION
FBC 20
Master Permit No.
Permit Type: PLUMBING
OWNER: Name Q�Q,0 R ko 4
(Fee Simple Titleholder): Phone #:
Address: (sue )
City: State: Zip:
Tenant/Lessee Name: Phone #:
Email:
JOB ADDRESS:
City:
Miami Shores County: Miami Dade Zip: 33 t GO
Folio/Parcel #: - (01- Q2-1-1--008c
Is the Building Historically Designated: Yes
NO Flood Zone:
CONTRACTOR: Company Name: 91-61kev.) ide Stv,,c C 1 k L Phone#: 3 I 1- 6633
Address: ?O ej ca )C 386S L
City: l( ul State: ` L 9 Zip: (33 0
Qualifier Name: [ Q-e5e+ rSQdO;1oel Phone #:
State Certification or Registration #: '' el l l i✓G t° Certificate of Competency #:
Contact Phone#: Email Address:
DESIGNER: Architect/Engineer: Phone #:
Value of Work for this Permit: $ "2. Square/Linear Footage of Work: 2.2 99
Type of Work: DAddress DAlteration DNew J Repair/Replace ODemolition
I)rptilth- of Work:,
,
r , Pp.;.
kip t4c broom. V c -1 -e v
**** ***+x******* * ** + + **************** Fees+ x***+ x+ x*********+ x* *****+ xx ::*+x ***a:********:x****
Submittal Fee $ Permit Fee $ J® 0 CCF $ CO /CC $
Scanning Fee $ Radon Fee $ DBPR $ Bond $
Notary $ Training/Education Fee $ Technology Fee $
Double Fee $ Structural Review $
TOTAL FEE NOW DUE $
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 $2500, the applicant must
promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person
whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site
for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the
inspection will not be approved and a reinspection fee will be charged.
fli -
Owner or Agent
The foregoing instrument was acknowledged before me this 01 The fo e . i r • in trument was ackn., led ed , efor
day of fcb , 20 1,2 , by She elvo dimes , day of �i�.11 , ,' 20 �I-_, by 4-4
who is personally. known to me or who has produced !° who is personall kn
As identification and who did take an oath.
NOTARY PUBLIC:
Signature
Contractor
Sign:
Print:
3Q),-Loc
My Commission Expires:
* * * * * * * * * * * * ** * * * ** * ** * **
APPROVED BY
4.4k,;"'%, . TERESA
:.g _ M 141
J SOLOMO Y COMMISSION #
( 7 3 EXP►RES November 08131935
02-6° 1 4— Plans Examiner
(Revised 07 /10 /07)(Revised 06 /10/2009)(Revised 3/15/09)
as
to e or who has produced
dentification and who did take an oath.
•
NOTARY PUBLIC: •
Sign:
Print:
My Commissi
CLAUDIA V. CUBILLOS
4$ s Notar l i'�1 t
pi res Sep 23, 2015
• _ My Comm. Ex
Co # EE 128810
?• ? "'. �=
Commission Assn.
„�„tid; Bonded Through National Notary
* ** * * * * * ** *** *.. ** * * * * * ** * ** * * * *** * * * * * * * **
Structural Review
Zoning
Clerk
1
1
Project Address
Miami Shores Village
10050 N.E. 2nd Avenue NW
Miami Shores, FL 33138 -0000
Phone: (305)795 -2204
Parcel Number
Applicant
9802 NW 1 Avenue
Miami Shores, FL
1131010240080
Block: Lot:
STEVEN RHODES
Owner Information
Address
Phone
CeII
STEVEN RHODES
9802 NW 1 Avenue
MIAMI SHORES FL 33139-
(305)799 -1407
9802 NW 1 Avenue
MIAMI SHORES FL 33150
Contractor(s) Phone Cell Phone
STATEWIDE SEPTIC CONNECTIONS (954)963 -0082
Valuation:
Total Sq Feet:
$ 2,450.00
225
Type of Work: TANK & DRAINFIELD
Type of Piping: PLUMBING
Additional Info:
Bond Retum :
Classification: Residential
Scanning: 1
Fees Due
Bond Type - Owners Bond
CCF
DBPR Fee
DCA Fee
Education Surcharge
Permit Fee
Scanning Fee
Technology Fee
Amount
$500.00
$1.80
$2.25
$2.25
$0.60
$150.00
$3.00
$2.40
Total: $662.30
Pay Date Pay Type
Invoice # PL-2-12-43294
02/02/2012 Check #: 5561 $ 662.30 $ 0.00
Bond #: 2102
Amt Paid Amt Due
Available Inspections:
Inspection Type:
HRS Approval
Final
In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations
pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In
accepting this permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are
required for ELECTRICAL, PLUMBING, MECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work.
OWNERS 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. Futhermore, I authorize the above -named contractor to do the work stated.
February 02, 2012
Authorized Signature: Owner / Applicant / Contractor / Agent
Building Department Copy
Date
February 02, 2012 1
'ALTH
ATMENT AND DISPOSAL SYSTEM
'ECTION ?AND FINAL APPROVAL
PERMIT NOr' la/0 ocs3G J
DATE PAID*
FEE PAID'
RECEIPT #•
ON:
PROPERTY ID ft-
LIANCE WITH STATUTE OR RULE AND MUST BE CORRECTED.
SOFT t
ER4".--i
[17] SYS ' 4/1-1.1 OC
[18] DOSIN PUM
[19] AGGREGATE S
[20] AGGREGATE E
[211 AGGREGATED •" M» ... --
FILL / EXCAVATION MATERIAL
[22] FILL AMOUNT / , ' 1
[23] FILL TEXTURE
[24] EXCAVATION DEPTH
[25] AREA REPLACED
[26] REPLACEMENT MATERIAL
EXPLANATION OF VIOLATIONS / REMARKS:
[
[ ) 1'
[ ]
( ]
SETBACKS
[ J [27] SURFACE WATER FT
[ ] [28] DITCHES FT
[ 1 [29] .. PRIVATE WELLS FT
[ ] [30] PUBLIC WELLS FT
[ ) [31] IRRIGATION WELLS FT
[ °y ] [32] POTABLE WATER LINES / C� FT
[ " ] [33] BUILDING FOUNDATION FT
[ [34] PROPERTY LINES ,f • FT
[ I [35] OTHER FT
FILLED / MOUND SYSTEM
[ .1
[
[361 I DRAIN;FIELD COVER
[37] 4 SHOULDERS
[38] SLOPES'
[39] `STABILIZATION
ADDITIONAL INFORMATION
[40] UNOBSTRUCTED AREA
[41] S- TORMWATER RUNOFF
[42] ALARMS
[43] MAINTENANCE AGREEMENT
[44] - BUILDING AREA �I
[45] ' LOCATION CONFORMS WITH SITE PLAN
[46] FINAL S. GRADI
[47] ` *CONTRA s s R
[48] - OTHER
ABANDONMENT _
� [49] ' TANK PUMPED/ LL �
CPA.] [50] TANK CRUSHED & FILLED -2,1 71/
1'-6
FINAL SYST [APPROV /DISAPPROVED)* .,4/
DF] 4016 (Page 2). 10/97 (Previous Editions May Be Used)
Stock Number. 5744 - 002 -40164
+ �d C- - -(1- & CHD DATE- 2 r ✓- / 2
CHD DATE- °
Page 2' of 3
PT 1: Applicant
ftiT 2: Installer /Contractor
PT 3: Building Department
PT 4 Health Department
1
STATE OF FLORIDA
DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM
CONSTRUCTION PERMIT
CONSTRUCTION PERMIT FOR:
APPLICANT: Steven Rhodes
PERMIT 8:13-SC-1390066
APPLICATION 8: API 060001
DATE PAID:
FEE PAID :,
RECEIPT 8:
DOCUMENT 8: PR865347
PROPERTY ADDRESS: 9802 NW 1 Ave Miami, FL 33150
LOT: 1819
BLOCK: 1
PROPERTY ID 8: 11- 3101 - 024-0080
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 [
A [
N [
K [
900 ] GALLONS / GPD
0 ] GALLONS / GPD
0 ] GALLONS GREASE INTERCEPTOR CAPACITY
] GALLONS DOSING TANK CAPACITY [
New Septic Tank
D [ 225 ] SQUARE FEET
R [ 0 ] SQUARE FEET
A TYPE SYSTEM:
I CONFIGURATION:
N
F LOCATION OF BENCHMARK: F.F.E., 12.70' NGVD
CAPACITY
CAPACITY
[MAXIMUM CAPACITY SINGLE TANK:1250 GALLONS]
]GALLONS 9[ ]DOSES PER 24 HRS ()Pumps [
Trench configuration drain SYSTEM
SYSTEM
[ ] FILLED [ ] MOUND
[]BED []
[x] STANDARD
[x] TRENCH
]
Y ELEVATION OF PROPOSED SYSTEM SITE 1 25201[
E BOTTOM OF DRAINFIELD TO BE
L
D FILL REQUIRED:
0
T
H
E
R
INCHES
FT ][ABOVE BELOW BENCHMARK /REFERENCE POINT
[ 55.20 rums FT ][ABOVE 4 BELOW BENCHMARK /REFERENCE POINT
[ 0.(X)] INCHES EXCAVATION REQUIRED: [ 30.00] INCHES
Inspector to verify the existing septic tank is properly abandon before final approval.
*Invert elevation of drainfield to be no lass than 8.60 ft. NGVD.
*Bottom of drainfield elevation to be no less than 8.10 ft. NGVD.
-The licensed contractor installing the system is responsible for installing the minimum category of tank in accordance
with sec. 64E- 6.013(3)(f). F.A.C.
"THIS PERMIT IS NOT FOR "ADDITION(s) ".
SPECIFICATIONS BY:
APPROVED BY:
DATE ISSUED:
DH 4016, 08/09
Incorporated:
Carlos M TITLE:
ITLE:
Carlos M 1
01/31/2012
(Obsoletes all previous editions which
r dot be
64E -6.0 The nip is required p. �t *
The coring act (or e t to the designee) ex t Qn" at the
soil borinQYa�ia ��1;`(hs DON
NOT to Final Apnd compare the
inspector c or final inspection. ll witnthe soil boring
inspector sheh witness
results to the original site evaluation submitted.
reinspection tee wilt beaassessed
time the contractor is not
at the jobsite at
used)
Dade
EXPIRATION DATE: 04/30/2012
8E861529
CHD
Page 1 of 3
UTMt'.Si r�L.'t/ •y..
3: 'r
DEPARTMENT OF HEALTH
APPLICATION FOR oNSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PERM T
Permit Application Numb
sire. ...re *mom own. ammo. _ a... _. Iowa. ram.
PART IISITE PLAN-- ---- -- --
Scale: Each block represents 5 feet and 1 inch = 50 feet.
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Notes:
o
krki c
0
s-
Site Plan submitted by
Plan Approve
By
tot S'
gnature
Not Approved
So
tt
N
n`
ride
Date C, 6 �
County Health Department'.
CHANGES MUST BE APPROVED BY THE COUNTY HEALTH DEPARTMENT
U04015 096 (Replaces HRS-H Fa =401& tdch may be used)
(Stodc Plumber: 5744002-40154)
Page 2 of 3