PL-13-1962Miami Shores Village _
Building Department
AUG iJ i3
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
INSPECTION'S PHONE NUMBER: (3057 762.4949
FBC 20 l
BUILDING Permit No. F) cL3 (pa
PERMIT APPLICATION Master Permit No.
Permit Type: PLUMBING
JOB ADDRESS: 12.ZE N6 -(Z Y -f
City: Miami Shores County: `� Miami Dade Zip: 3 3131?
Folio/Parcel#: 11 - --52-OS e 02-1 " 0 3 00
Is the Building Historically Designated: Yes NO V Flood Zone:
P"2d r ct
OWNER: Name (Fee Simple Titleholder): Kcir^Prt 61Qt - A S'PAYv 2 i G Phone#:
Address: 12 -ZS NE Cj?_ St
f `
City: s • Ko res State: FL Zip: 331 3B
Tenant/Ussee Name:
Email:
CONTRACTOR: Company Name: S#+e-a C�, C (;Ifirt r I h G Phone#: `3aaS'- CC I -66 33
Address: Co -o52— " 23 S-"
City: M, fv-sAo- State: r—L Zip: 3 3 02 '3
QualifierName: Tea' e&c Soo ryxx>5 Phone#:
State Certification or Registration #: cSM0911 ZG 2 Certificate of Competency #:
Contact Phone#: 3C5, ra (,f - 6 (3 3 Email Address:50+e- W ) de c 83401, GoY»
DESIGNER: Architect/Engineer: Phone#:
e
Value of Work for. this Permit: $ �3rJ0 Square/Linear Footage of Work: 3 0 0
Type of Work: DAddress UAlteration ONew �SRepair/Replace ODemolition
Description of Work: I a Ce Q rot f» 13It d- l r S4 %% Dos) I tl
+ nlC v-) (avrn p 'IL's �- a 1 a ror�
Submittal Fee $ Permit Fee $ CCF $ CO/CC $
Scanning Fee $
Radon Fee $
Notary $ Training/Education Fee $
Double Fee $ Structural Review $
DBPR $ Bond $
Technology Fee $
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
State
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.
r
Signature116�
Signature
Owner or Agent
The foregoing instrument was acknowledged before me this ZG
day of Pq4
, 201f �, by Pl—e-d �q cS t4 -C e` ' G
who is personally known to me or who has produced FtO Gill/
L, (epi �C,
As id WM6N
NOTARY PUBLIC:*- My COMMISSION # EE131935
EXPIRES November 08, 2015
407 3%••1153 FWwallow ca.aom
Sign: C
Print: --r8*e-&C C (rel'a Mon
My Commission Expires:
Contractor
The fore oing ' trument was s ackn wled ed bef m thi
ag
day of 2011,
V , by
�&�
wh is ersonall to me or who has produced
APPROVED BY / .�J �'Plans Examiner
Structural Review
(Reviseifi3/12/2012)(Rt"ed 07/10/07XRvAsed 06/10/2009)(Revised 3/15/09)
NO
Sig,
Prin
My
as identification and who did take an oath.
Zoning
Clerk
C1
R4EPAIR _
.r'AAi'-DADS COUNTY HFALTH DEPARiAlIFN1'P'
STATE OF FLORIDA
DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM
CONSTRUCTION PERMIT
CONSTRUCTION PERMIT FOR: OSTDS Repair
APPLICANT: Karen Blair
PROPERTY ADDRESS: 1225 NE 92 St Miami, FL 33138
c
LOT: 18,19 BLOCK: 2
PROPERTY ID #: 11-3205-027-0300
SUBDIVISION:
PERMIT #:13 -SC -1489934
APPLICATION #: AP1117427
DATE PAID:
FEE PAID:
RECEIPT #:
DOCUMENT #: PR914683
Bay Lure PB
[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 existing septic tank CAPACITY
A [ ] GALLONS / GPD CAPACITY
N [ ] GALLONS GREASE INTERCEPTOR CAPACITY [MAXIMUM CAPACITY SINGLE TANK:1250 GALLONS]
K [ 300 ] GALLONS DOSING TANK CAPACITY 167.00 ]GALLONS @[ 6 ]DOSES PER 24 HRS #Pumps [ 1 ]
D [ 300 ] SQUARE FEET
R [ ] SQUARE FEET
A TYPE SYSTEM: [X]
I CONFIGURATION: [X]
N
trench configuration drainf SYSTEM
SYSTEM
STANDARD [ ] FILLED [ ] MOUND
TRENCH [ ] BED [ ]
F LOCATION OF BENCHMARK: FFE 5.5' NGVD
I ELEVATION OF PROPOSED SYSTEM.SITE [ 1.20 ][ INCHE3 FT ][ABOVE BELOW BENCHMARK/REFERENCE POINT
E BOTTOM OF DRAINFIELD TO BE [ 24.00][ INCHES FT ][ABOVE BELOW BENCHMARK/REFERENCE POINT
L
DE
O
T
H
E
R
.L" liLWU.LXW: L J iNC:Hzs "UAVATIU14 MWU11UW: L LL.CU J 1M;t1Az
** Performing Lift Dosing.
Pumps must be certified as suitable for distributing sewage effluent.
1. -Existing 1200 gal. septic tank, certified by Statewide Septic Connections Inc on 08/15/2013, to remain.
2. -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.
3. -Install 300 sf of drainfield in trench configuration.
4. -Perimeter of excavation area shall be at least 2 ft wider and longer than the proposed absorption bed or drain trench.
SPECIFICATIONS BY: TeresaaJ Solomon TITLE: Master Septic Tank Contractor
APPROVED BY: ,00mr , TITLE: Engineering Specialist II Dade CHD
Erlande Omisca
DATE ISSUED: 08/19/2013 EXPIRATION DATE: 11/17/2013
DH 4016, 08/09 (Obsoletes all previous editions which may not be used) The contractor (or designee) isi �(rat tgperorrn a
Incorporated: 64E-6.003, FAC soil boring adjacent to the dra.infiePd excavation at the
v 1.1.4 AP1117427 Sfifr�fiba linai inspection. Prior io Final Approval, the DOH
inspector shalt witness the soil boring and compare the
resiAs to the original site dvaivalion �ubmillcd. A
reinspection fee will be assess„ o it the contractor is not
at the ;obstte at tile arranged tirrre
Ift
DOCUMENT #: PR914683
5. -Invert elevation of drainfield to be no less than 4.00' NGVD.
6. -Bottom of drainfield elevation to be no less than 3.50' NGVD.
The system is sized for 4 bedrooms with a maximum occupancy of 8 persons (2 per bedroom), for a total estimated flow of
400 gpd.
whoUm I N I
1 11 1 � . .11" W11 WT.7w4ww"
17,
DEPARTMENT: -OF -HEALTH
E SE*W'AG D `.,
;APPLI.CATION. FOR ONSITE E ISPOSAL SYSTEM CONS
i
�i
Pficatiori..Nunb
X;
-RT,
-1 iTE KAN
I. -S A
8�h ockseptesipits 5 feet an 1 hich - 5b Leet r
7,
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7:
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ine, 2,
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Fite Plan submitted TJ
,'mitted by:
b t, lsl�
Signature
Title
Not Approved Date
r.
'D6pqnom--,�
B
count ialth
.4
T
ALL,:C HANG ES �UT-B'E' AP
PROVED BY j4j�60UNTY HE H bEPA+ RTMENT
d, w +1
fl, 14
tock lurrbm-
TANK
['] [01]
[ ] [021
[ 1 [031
I 1 [041
[ 1 [051
I I [061
[ 1 [071
[ ] [081
OUTLET DEVICE ,,7- "• [
MULTI-CHAMBERED [ V/ N ] I
OUTLET FILTER • /74 [
LEGEND 70 --,/oP-y 3 &C 3 [
WATERTIGHT -C-LC, .2 y [
LEVEL
DEPTH TO LID"''-'`^'L� [
[ 1 [211 AGGREGATE DEPTH^/ /,t I ]
DRAINFIELD INSTALLATIQN
[ ]
I 1
[10]
AREA [11IS` W 30-0 SQFT
I ]
[ 1
1111
DISTRIBUTION BOX HEADER ✓
[ ]
[ ]
[121
NUMBER OF DRAINLINES _�$~� G /�
I ]
[131
DRAINLINE SEPARATION
[ ]
[ ].
[141
DRAINLINE SLOPE
PROPERTY LINES $-
[ ]
[151
DEPTH OF COVER
[ ]
{161
ELEVATION (ABOVE EI, BM
[ ]
[ ]
[171
SYSTEM LOCATION
[ ]
C ]
11
,81 DOSING PUMPS �
[ I
C 1
[ ]
1191
1201
AGGREGATE SIZEIV
}FINES
[ ]
AGGREGATE EXCESSIVE
[ ]
[ 1 [211 AGGREGATE DEPTH^/ /,t I ]
EXPLANATION OF VIOLATIONS / REMARKS:
[ ]
[ l
[]
128]
129]
I3 01
[31]
[321
[33]
[341
[351
x
FILL / EXCAVATION MATERIAL
[ ]
I221
FILL AMOUigT,� y • • . .
[ ]
[23]
FILL TEXTURE
[ ]
[241
EXCAVATION -DEPTH
[ ]
[251
AREA REPLACED
[ ]
[261
REPLACEMENT MATERIAI,
EXPLANATION OF VIOLATIONS / REMARKS:
[ ]
[ l
[]
128]
129]
I3 01
[31]
[321
[33]
[341
[351
x
iat � r
k �
J �
DITCHES
FT
PRIVATE WELLS
FT
PVBI,IC WELLS
FT
IRRIQATION. WELL'S
FT
POTABLE WATER LINES �_
FT
BUILDING FOUNDATION i t
FT
PROPERTY LINES $-
FT
OTHER
FT
FILLED / MOUND SYSTEM
1361 DRAINFIELD COVEk /
[371 SHOULDERS
[381 SLOPES
1391 STABILIZATION
ADDITIONAL INFORATION
[401 UNQBSTRUCTED AREA
[411 STORMWATER*RT.
NOF
ak•[4[421 ALARMS 471k—
[431
31 MAINTENANCE AGREEMENT
[441 BUILDING AREA
[451 LOCATION CONFORMS WITH SITE PLAN
[461 FINAL SITE G
[471 CONTRACTOR
[481 OTHER
'ABANDONMENT
[ ] 1497 TANK PUMPED
[ ] -[50.] TANK CRUSHED . & FILT•rn
CONSTRUCTIO [APPRODATE:- VED ISAPPROVEDI s-�3���'---�-�"
FINAL SYST i,PPROVED DISAPP120VEDj s�/�C..iR"`''""C' 4/�R_� CED DATE.J"' 77� �3
DH .4016, W09 - (Obsoletes all previous editions which may not be used)
Incorporated: 64E-6.003, FAC Page 2 of 3