PL-12-2198Miami 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 \Q
Permit Type: PLUMBING
OWNER: Name (Fee Simple Titleholder): E. c° c(-4' Con A, 'fi e S °`-'1 Phone#: 3C;.--TC9 ^36� 9
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Permit No. 2 ` ) Z� 98
Master Permit No.
Address: 3Q3 I NE
City: QY1 State:
FL
Te
Email: ( c + tn
Phone #:
tot Snt/`--rx *
JOB ADDRESS: 3C,1 ME_ /60
County:
City: Miami Shores p�
Folio/Parcel #: `I 328& "rp 'SOD
Is the Building Historically Designated: Yes NO
zip: 33138
Miami Dade
(/
zip: 3313e
CONTRACTOR: Company Name: 2
Address: 6�01i., OM
City: Pttttcta)
Qualifier Name:
State Certification or Registration #:
Contact Phone #: Email Address:
Flood Zone:
Phone #:
State: n
Zip: r 7/-$
'Phone #: �� Sig tel
Certificate of Competency #:
DESIGNER: Architect/Engineer:
one#:
sP �P a
Value of Work for this Permit: $ f ISO Square/Linear Foo of Work:
Type of Work: ❑AddresssLL OAlteration epair/Replace ODemoltUon
Description of Work: /globs
ONew
aidR lace ODemoli'on
'�'rs�l(.�.ec5l�at� 4B9 9a( Acyrd iex-iktmi �L0
a *** ***** *** * * * * * * * **** x*+ x*+ x*********** Fees******** *** * ****** * * * **** *** * *•x ****** *** * ***
Submittal Fee $ Permit Fee $ l 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.
Signature
Owner or AgeCnt v1 rz'; e- de r-06,-,
The foregoing instrument was acknowledged before me this / if The foregoing instrument was acknowledged before we -this i9
day of /V07► , 20 Id,, by f'`At1IP,444� m. 9i.1 , day of Ail , 20 Ai, by
who is personallyknown to nfe or who has produced
As identification and who did take an oath.
NOTARY PUBLIC:
Sign: '74�� yy� 4� tali /��� __ j/,,:�%
Print: ' ettl ,&i 1 c21J4'h4 -i
My Contnilboift MAX
6 ,,SPaY peso, VANESA CANTRELL
_.r* - .� *��; Notary Public - State of Florida
My Comm. Expires Jun 15, 2013
* * * ** ,U; ; **604014404#444394W**
**
1 iR is`° Bonded Through National Notary Assn.
APPROEE15 fry--
'WV -,r. r
who is personally known to me or who has produced
as identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
Plans Examiner
(Revised 07 /10 /07)(Revised 06 /10/2009)(Revised 3/15/09)
Structural Review
aission :CANTRELL
Notary ubtic - State of Florida
• My Comm. Expires Jun 15, 2013
Commission # DD 897782
*( +i4 ***9diFilAdiffl gt fena61tloteepAesec 3 **** ********
ci.
de Nair
Zoning
Clerk
STATE OF FLORIDA
DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM
CONSTRUCTION PERMIT
CONSTRUCTION PERMIT FOR: OSTDS Repair
APPLICANT: Conie Benson
PERMIT #:13 -SC- 1439193
APPLICATION # : AP 1088127
DATE PAID:
FEE PAID:
RECEIPT #:
DOCUMENT #:PR889277
PROPERTY ADDRESS: 361 NE 102 St Miami, FL 33138
LOT: na
BLOCK: na SUBDIVISION:
PROPERTY ID #: 11- 3206 - 016 -5090
[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 [ 900 ] 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 51 ]DOSES PER 24 HRS #Pumps [ ]
[
R
A
I
N
F
I
L
D
0
R
[ 300 ] SQUARE FEET
[ 0 ] SQUARE FEET
TYPE SYSTEM: [x] STANDARD
CONFIGURATION: [ ] TRENCH
existing SYSTEM
SYSTEM
[ ] FIT.T.FD [ ] MOUND [ ]
[x] BED [ ]
LOCATION OF BENCHMARK: FFE: 10.45'NGVD
ELEVATION OF PROPOSED SYSTEM SITE
BOTTOM OF DRAINFIELD TO BE
FILL REQUIRED:
11.40111 INCHES 1 FT ] [ABOVE 1 BENCHMARK/REFERENCE POINT
[ 41.40 ] [I INCHES If FT ] [ ABOVE /) BELOW N BENCHMARK /REFERENCE POINT
BELOW
[ 0.00] INCHES EXCAVATION REQUIRED: [ 42.00] INCHES
- Install 900 g septic tank.
- Existing 300 sq ft drainfield to remain.
- The system is sized for 3 bedrooms with a maximum occupancy of 6 persons,
for a total estimated sewage flow of 300 g /d.
- Not for additions
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.
SPECIFICATIONS BY:
APPROVED BY:
Charles J Chapm
Jo = =•h
DATE ISSUED: 11/0:,:61
TITLE: Master Septic Tank Contractor
TITLE: -- : "ineer Specialist II
DH 4016, 08/09 (Obsole,,�all previous editions which may not be used)
Incorporated: 64E - 6.01`, FAC
v 1.1.4
AP1088127
Dade CHD
EXPIRATION DATE: 02/06/2013
SE882739
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