PL-13-2560I
Miami Shores Village
• �' Building Department
10050 N.E1nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
INSPECTION'S PHONE NUMBER: (305) 762.4949'
BUILDING
PERMIT APPLICATION
Permit Type: PLUMBING
ce.
NGV 1 � d13
FBC 20 VO
Permit No.
Master Permit No.
JOB ADDRESS: A Ale V ff -
City. Miami Shores County: Miatpi Dade Zip: 33/3 '"
Folio/Parcel* u05` y-61a -0/,267
Is the Building Historically Designated: Yes NO Flood Zone:
OWNER: Name (Fee Simple Titleholder) Se Phone #: ZA
Address:
City: �%r State•- gip: 3
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR: Company Name: X� L& Phon0: _4_�-,,4, er,.-;VJ
Address: /W rid
City: l¢►r- State: �� Zip: Y3f-j�G/
Qualifier Name: r C�?
7f �
State Certification or Registration #: -59 � 0 ` / �.� Certificate of Competency �6S(.!"/
mpetency #: r _
Contact Phone#• Email Address:
1
DESIGNER: Architect/Engineer: Phone#:
Value of Work for this Permit: $ I ' (�
Square/Linear Footage of Work:
Type of Work: 13,k ° fess - OAlteratioa ONew *epak/RgAace ODemolition
Description of Work: " "
Mkie, k�Yda, kktkk4rtY, kiakaYskirhk, k�k�t�1r+ Y, L�YF�, r* �rk4rtk*, kia*, k4rdrt��YtitTrA�k,&+ k�ra�aY *�kIrlr,kt�r�nk�rina��Yda*
Submittal Fee $ Permit Fee $ S��9b o CCF $ CO /CC $
Scanning Fee $ Radon Fee $ DBPR $ Bond $-5-00
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
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address
City
Zip
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 `�����i'� =�. Signature f f Yom— "'
Owner or Agent Contractor
The foregoing instrument was acknowledged before me this f3 The foregoing instrument was acknowledged before me this If
day of °1Y- °'� 20 LZ, by 61& A tow day of f 20 17, by &4 �e_ 014 hek ,
who is personally known to me or who has produced
I,e::::,. As identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print
My C.
ommissi towiLe�rP A u �Mte s rSwbete a
dFler[Aa
who is personally known to me or who ha% produced t/
as identification and who did take an oath.
NOTARY PUBLIC:
Sign: lei
Print: ,rJ po'kw Notaly pubft stde of t
MwrO A Mertes
My Co MWW0n EE617619
or n4 10/214
�'�'lY1TC' Ilia' A' 11t'itA'TiC11C'liNY7Y9TCC1♦C *1� �l' �C�i6�' �l' fif7ti' �CdP' il' �' l!' �9T[ �t�111t 1T[*' �' 7Y�" iPiiPt�C�t�t �P1Tf��i�i" XTiI�C�tiil7i1�t1' �f�t�Pt�t�i ' *�' *1k�C�`��Ptti'1TC11C94�f �Hk' �l' x'! �C' 1P11t�HA 'Qf�t�i�P1Tl'x'Qf7Tl1�'� *�'A'
APPROVED BY f/ �3-/ Plans Examiner
Structural Review
(RwisW3 /12i2012)(Rrdsed 07 /10 /07XRv&W 06110/2009)(Revised 3/15/09)
Zoning
Clerk
DIVISION OF Environmental Health
Florida Department of Health
Q� Miami -Dade County Health Department
Q� OSTDS/Well Division
t No. PL -11-13 -2560
ype: Plumbing - Residential
Work Classification: Septic
�IQ Permit Status: APPROVED
805 SW 26 St. Miami, FL 33175
Expiration: 05/17 /2014
Inspector l GO ��thAbS Da a L(' 2'L 2013
0/_ 1' y. kpplicant
Address 1 N 4 S 1 OSTDS #
°_LLEN SEPE
Comments:
Coll
Signature
MIAMI SHORES FL 33138-
Contractor(s) Phone Cell Phone
MR C'S PLUMBING & SEPTIC INC (305)651 -7859
of Work: DRAINFIELD INSTALL
of Piping:
ional Info:
Return :
Valuation: $ 1,800.00
1
Total Sq Feet: 500
Fees Due Amount% Date'- ' Y Amt Paid Amt Due
Bond Type - Owners Bond
CCF
$500. 0
InO1C' VC
L 9762
DBPR Fee
$1.20
$2.25
11/21
heck #: 8443 $ 116.70 $ 550.00
DCA Fee
$2.25
11113/2013
Cash $ 50.00 $ 500.00
Educ&AW Surcharge
$0.40
11/21/2013
Check #: 1009 $ 500.00 $ 0.00
Permi'Fee
$150.00
Bond #: 2291
Scan rii[t Fee
$ a.00
Technology Fee
$1.60
Totals
$666.70
Available Inspections:
Inspection Type:
HRS Approval
Final
Review Plumbing
*iicant copy
For Inspections, Call (305) 762 -4949 or Log on at https: // bldg .miamishoresvillage.com /cap /.
Requests must be received by 3 pm for following day inspections.
NOTICE: In addition to the requirements of this permit, there may be AND THERE MAY BE ADDITIONAL PERMITS REQUIRED FROM OTHER
additional restrictions applicable to this property that may be found In GOVERNMENTAL ENTITIES SUCH AS WATER MANAGEMENT
the public records of this county. DISTRICTS, STATE AGENCIES, OR FEDERAL AGENCIES.
November 22, 2013 2
REPAIR
STATE OF FLORIDA
DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM
CONSTRUCTION PERMIT
CONSTRUCTION PERMIT FOR: OSTDS Repair
APPLICANT: Ellen Sepe
PROPERTY ADDRESS: 1066 NE 94 St Miami, FL 33138
LOT:
r i} 7,44 �
PROPERTY ID #: 11- 3205-012 -0120
SUBDIVISION:
PERMIT #:13- SC- 1504456
APPLICATION #: AP1125667
DATE PAID:
FEE PAID:
RECEIPT #:
DOCUMENT #T R921689
Kirbys Add to Miami Shores
[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 [ 1,200 ] 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 [ 500 ] SQUARE FEET Bed configuration drainfiel SYSTEM
R [ 0 ] SQUARE FEET SYSTEM
A TYPE SYSTEM: [x] STANDARD [ ] FILLED [ ] MOUND [ ]
I CONFIGURATION: [ ] TRENCH [x] BED [ I
N
F LOCATION OF BENCHMARK: FFE 6.9' NGVD
I ELEVATION OF PROPOSED SYSTEM SITE [ 4.80 ][ INCHE3 FT ] [ ABOVE BELOW BENCHMARK /REFERENCE POINT
E BOTTOM OF DRAINFIELD TO BE [ 39.84][ INCHES FT ][ABOVE BELOW BENCHMARK /REFERENCE POINT
L
D B
O
T
H
E
R
ILL REQUIRED: L U.UU J INUtiss rau:AV"X.LVA AZWU- Lttau: L 4f.UU J .LIMUnZIN
1.- Existing 1200 gal. septic tank, certified by "Mr. C's Plumbing and Septic" on 11/4/2013 to remain.
2.- Install 500 sf of drainfield in bed configuration.
3.- Install 12" of slightly limited soil at the bottom of the drainfield.
4.- Perimeter of excavation area shall be at least 2 ft wider and longer than the proposed absorption bed or drain trench.
(Comments Continued on Page 2.)
SPECIFICATIONS BY: Kemble Ettrick - TITLE:
APPROVED BY:
DATE ISSUED:
DH 4016, 08/09
Incorporated:
t<- U�""� TITLE: Engineering Specialist II Dade CHD
Betsy Lange
11/08/2013 EXPIRATION DATE: 02/06/2014
(Obsoletes all previous editions which may not be used)
64E- 6.003, FAC
V 1.1.4 AR1125667 The cont designee) is required Page erfo m a soil
boring adjacent to the drainfield excavation at the time of final
inspection. Prior to Final Approval, the FDOH inspector shall
witness the soil 4oring and compare the results to the original
site evacuation submitted. A reinspection fee will be assessed
if the contractor is not at the jobsite at the arranged time.
nMUMNT #: PR921689
Invert elevation of drainfield to be no less than 4.08' NGVD.
6. -Bottom of drainfield elevation to be no less than 3.58' NGVD.
Thesystem is sized for 5 bedrooms with a maximum occupancy of 10 persons (2 per bedroom), for a total estimated flow of
520 gpd.
THIS PERMIT IS NOT FOR ANY ADDITIONS.
NOTICE OF RIGHTS
A party whose substantial interest is affected by this order may petition for an
administrative hearing pursuant to sections 120.569 and 120.57, Florida Statutes. Such
proceedings are govemed'by Rule 28 -106, Florida Administrative Code. A petition for
administrative hearing must be in writing and must be received by the Agency Clerk for the
Department, within twenty -one (21) days from the receipt of this order. The address of the
Agency Clerk is 4052 Bald Cypress Way, BIN # A02, Tallahassee, Florida 32399 -1703. The
Agency Clerk's facsimile number is 850 -410 -1448.
Mediation is not available as an alternative remedy.
Your failure to submit a petition for hearing within 21 days from receipt of this order
will constitute a waiver of your right to an administrative hearing, and this order shall become
a 'final order'.
Should this order become a final order, a party who is adversely affected by it is
entitled to judicial review pursuant to Section 120.68, Florida Statutes. Review proceedings
are governed by the Florida Rules of Appellate Procedure. Such proceedings may be
commenced by filing one copy of a Notice of Appeal with the Agency Clerk of the
Department of Health and a second copy, accompanied by the filing fees required by law,
with the Court of Appeal in the appropriate District Court. The notice must be filed within 30
days of rendition of the final order.
STATE OF FLORIDA APPLICATION # AP1125667
DEPARTMENT OF HEALTH PERMIT # 13SC- 1504456
ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM DOCUMENT # SE912384
SITE EVALUATION AND SYSTEM SPECIFICATION
APPLICANT: Ellen Sepe
CONTRACTOR / AGENT: MrC
LOT: BLOCK:
SUBDIVISION: Kirbys Add to Miami Shores ID #: 11- 3205 -012 -0120
TO BE COMPLETED BY ENGINEER, HEALTH DEPARTMENT EMPLOYEE, OR OTHER QUALIFIED PERSON. ENGINEERS MUSS
PROVIDE REGISTRATION NUMBER AND SIGN AND SEAL EACH PAGE OF SUBMITTAL. COMPLETE ALL ITEMS.
PROPERTY SIZE CONFORMS TO SITE PLAN: [X ]YES [ ]NO NET USABLE AREA AVAILABLE: 0.69 ACRES
TOTAL ESTIMATED SEWAGE FLOW: 520 GALLONS PER DAY [ ESIDENCES-TABLEI / OTHER -TABLE 2 ]
AUTHORIZED SEWAGE FLOW: 1724.98 GALLONS PER DAY [ 1500 GPD /ACRE OR x2500 GPD /ACRE ]
UNOBSTRUCTED AREA AVAILABLE: 750.00 SQFT UNOBSTRUCTED AREA REQUIRED: 750.00 SQFT
BENCHMARK /REFERENCE POINT LOCATION: FFE 6.9' NGVD
ELEVATION OF PROPOSED SYSTEM SITE 4.80 [ INCHES / FT ] [ ABOVE / FzLOW ] BENCMUM /REFERENCE POINT
THE MINIMUM SETBACK WHICH CAN BE MAINTAINED FROM THE PROPOSED SYSTEM TO THE FOLLOWING FEATURES
SURFACE WATER: FT DITCHES /SWALES: FT NORMALLY WET: [ ]YES [ ]NO
WELLS: PUBLIC: FT LIMITED USE: FT PRIVATE: FT NON- POTABLE: 78 FT
BUILDING FOUNDATIONS: 5 FT PROPERTY LINES: 8 FT POTABLE WATER LINES: 95 FT
SITE SUBJECT TO FREQUENT FLOODING? [ ]YES [X]NO 10 YEAR FLOODING? [ ]YES [X]NO)
10 YEAR FLOOD ELEVATION FOR SITE: FT [ MSL /NGVD ] SITE ELEVATION: 6.50 FT [ MSL / NGVD
SOIL PROFILE INFORMATION SITE 1 SOIL PROFILE INFORMATION SITE 2
USDA SOIL SERIES: Urban land
Munsell # /Color Texture
Depth
1 OYR 3/1
Sand
0 To 6
10YR 5/4
Sand
6 To 24
10YR 5/4
Oolitic Limestone
24 To 72
USDA SOIL SERIES: Urban land
Munsell #/Color Texture
Depth
10YR 311
Sand
0 To 6
10YR 5/4
Sand
6 To 24
10YR 514
Oolitic Limestone
24 To 72
OBSERVED WATER TABLE: INCHES [ ABOVE / BELOW ] EXISTING GRADE TYPE: [ PERCHED / APPARENT
ESTIMATED NET SEASON WATER TABLE ELEVATION: 42 INCHES [ ABOVE / rBE LOW I EXISTING GRADE
HIGH WATER TABLE VEGETATION: [ ]YES [X]NO MOTTLING: [ ]YES [X]NO DEPTH: INCHES
SOIL TEXTURE /LOADING RATE FOR SYSTEM SIZING: Replacement 4 -FS /0.60 DEPTH OF EXCAVATION: 47 INCHES
DRAINFIELD CONFIGURATION: [ ] TRENCH [X1 BED [ ] OTHER (SPECIFY)
r- REMARKS /ADDITIONAL CRITERIA
SITE EVALUATED BY: DATE: 11/04/2013
Ettrick, Kemble (Title:) (Mr. Max Septic Servi)
DH 4015, 08/09 (Obsoletes previous editions which may not be used) Incorporated: 64E- 6.001, PAC Page 3 of 4
AP1126687 EID1604456 v 1.02