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PL-13-768�, Miami Shores Village AO Building Department artment 1 as 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 APR �l Tel: (305) 795.2204 Fax: (305) 756.8972 INSPECTION'S PHONE NUMBER: (305) 762.4949 FBC 20 Q (2� BUILDING Permit No. ° PERMIT APPLICATION Master Permit No. Permit Type: PLUMBING JOB ADDRESS: 3+ LF (;;-r City: Miami Shores County: Miami Dade Folio/Parcel#: (- 37.®lo 0`(2_,_-> Is the Building Historically Designated: Yes NO '✓ Flood Zone: OWNER: Name (Fee Simple Titleholder): tn V1 C Phone#: Address: 44r. Inn V) City: State: Tenant/Lessee Name: Phone#: Email: CONTRACTOR: Company Name: �� fn P{-�c J j' Cad Phone#: ��66 l- (063-:5 Address: G0 3Z SS w 2 �) 1+q 0 City: +rCAVN-N� State: J= -L- Zip: 7!)6l0 .d Qualifier Name: e1�S dQ Phone#: State Certification or Registration #: `S" a cl 11 Z -G Z Certificate of Competency #: Contact Phone#: Email Address: DESIGNER: Architect/Engineer. Phone#: Value of Work for this Permit: $ '2 ` 0 O � Square/Linear Footage of Work: 2_25 Type of Work:. DAddress ❑Alteration ONewtepair/Replace ODemolition Description of Work: R p � 4 (. e J-) r 1,-, [) -e (of Submittal Fee $ Permit Fee $ i 5-0 CCF DBPR $ Bond $ C) • (00 Scanning Fee $ Radon Fee $ CO/CC $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ _ Structural Review $ TOTAL FEE NOW DUE $ til I C) ri< 1* Bonding Company's Name (if applicable) Bonding Company's Address City State Mortgage Lender's Name (if applicable) Mortgage Lender's Address zip 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 s inspection will not be approved and a reinspection fee will be charged. a 149 A$1gnatureJSignature CW 1#� Owner or Agent Contractor The foregoing instrument was acknowledged before me this le day of dl , 20 a, by (Am l Aran <16n who is personally known to me or who has produced Drtv' L (Qn k( As identification and who did take an oath. My COMMISSION # EE131935 EXPIRES November 08, 2015 The foregoing instrument was acknowledged before me this E) day of 1k - , 20 0, by - who isersonally mwn a or who has produced as identification and who did take an oath. My Commission Expires: APPROVED BY ) V—r — 13 Plans Examiner Zoning Structural Review (ReAsed3/12/2012)(Revised 07/10/07XRevised 06/10/2009XRMsed 3/15/09) Clerk y STATE OF FLORIDA DEPARTMENT OF HEALTH ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM CONSTRUCTION PERMIT B, I F", CONSTRUCTION PERMIT FOR: OSTDS Rep APPLICANT: Leslie & Carol Ann Klew PROPERTY ADDRESS: 534 NE 94 St Miami, FL 33138 LOT: B BLOCK: 56 SUBDIVISION: Miami Shores Sec 2 PROPERTY ID #: 11-3206-014-0920 PERMIT #:13 -SC -1466228 APPLICATION #: AN 104041 DATE PAID: FEE PAID: RECEIPT #: DOCUMENT #: PR903131 [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 T [ 750 ] GALLONS / GPD Existinq septic tank to remain. 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 [ 225 ] SQUARE FEET Trench confiquration drain SYSTEM R [ 0 ] SQUARE FEET SYSTEM A TYPE SYSTEM: [x] STANDARD [ ] FILLED [ ] MOUND [ ] I CONFIGURATION: [x] TRENCH [ ] BED [ ] N F LOCATION OF BENCHMARK: F.F.E., 11.40' NGVD I ELEVATION OF PROPOSED SYSTEM SITE [ 27.60][ INCHE3 FT ][ABOVE BELOW BENCHMARK/REFERENCE POINT E BOTTOM OF DRAINFIELD TO BE [ 65.60][ INCHES FT ][ABOVE BELOW BENCHMARK/REFERENCE POINT L D FILL REQUIRED: [ 0.00] INCHES EXCAVATION REQUIRED: [ 38.001 INCHES *Invert elevation of drainfield to be no less than 6.43' NGVD. 0 'Bottom of drainfield elevation to be no less than 5.93' NGVD. T -The system is sized for 3 bedrooms with a maximum occupancy of 6 persons (2 per bedroom), for a total estimated H sewage flow of 300 gpd. 'THIS PERMIT IS NOT FOR " ADDITION(s) ". E R BY: Carlos APPROVED BY: TITLE: TITLE: DATE ISSUED: 04/12/2013 ,�r1 erform a need) DH 4016, 08/09 (Obsoletes all p e W�, i@f]i�71be Incorporated: 64E-6.003, fOVal, the DOH so�►j on adjac ecti n{Pro 1°fF 1pv time °ting fnsp ss the soil bonng aiid�ompare the inspector shall witne results to the original site evaluation submitted• reinspection fee will be assessed it the contractor is not at the :obsite at the arranged time. Dade CHD EXPIRATION DATE: 07/11/2013 SES9560D Page 1 of 3 ATE FWRIDA DEFYA ENT OF H ALTFt - AP L(CkTION FOR- ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PERMIT WS Permit Application Numbs r ; —--------�---- — -- PART 11 SITE PLAN -------- —_%: Scale Each block represents 5 feet and 1 inch = 50 feet '�g.--- `J1, L. E^ i S t j s _} ,_ e s (' #� -;yt t' i + _t.. # _ u. _:t • l� # 3 v _1 -r- y i g € {I � 33 _.� ~` a € 3 Ey i!_ ._i_.,` .i # F +y3 i #' f � -y' •-•- 2 €'-1 D € t t-5...;_` s. •._ � i_s� t t # s i_( ` _ '~ivf a t t If �, p_t._ t _ # s _:_ I-...•� #� ` # ' ._e�i_• - i t i_f v t `,, _p _ 'µ. 1#, •-.€-.F... # i ...'. .�I..' a 3 € _[# E + i { ' , 1 ! # _, � a !. t..; t -i.;. 4 E w!....° �.'... �. _ •. € s + t . rt -€.-. �_.:W t s. + .1 a ,..��-t 4• _( t # �_( +( +7'J_ �s 4-1J .. •..«s #p # +, ��+ , # 3 a' `t 3 t 3 t - ( y # `_4_�i 3# v a E—b th—.-•._:r' +' i 3-: 3^t. i: t€ t t I. L F,. t i ,�• i_'t_"i—€ `.• -j— + fr-mo -E Ki, V -F r - • ' E .�>ili�T':� ',■*�R�.6��..i>:i'��i'�i4#F1S'�o�i.•�i�� � )�!� 1i'6� ate; >wRR �n [�p4 ��-.� -,�.�� ��.`z �.!`-`t--§ �_ € ; ^ j -i--i 1 -•i+ -Y t 1_'�� p ^� t( ` _ � { # ��p Vs.,_ t _ t - ! t...it F �,.._a �-�-f--•t"i--.s--�._.;y_..� {{ �$$ ��"�qY_'_—�—+ i ' f .i$� j i €� ` # ' i } f _ �I E E 1 t 3_€ E._•.._:_1 _,..[ .:{I +_ I • # # 8 { t .. •a-t--ry(+_ a�� ! €��. s.. i- �..--.'sF-t^ {'�. __��, t--:1--.._.�.�.�'�� � t _ €.._:-• a t + , �'.^1i-- ' 1� i }.. J �....-{-F? ... •{-, 'j it 1 ice€ i i t t# -r 1. i-� i i -i t 7 {. 7: p pIi .S 1 r-'}. i_•t'i ! .ft i— 3't i € # C_ ( i i_C # ! #d# 1 b'$..E - i i .- .1 Notes:' 1 q ON, c.� 1,5: S. Site Plan submitted Y �� � 4Y c Plan Approv d Signature Title %L Not Approved Date BY County Health Departmr .a0. CHANGES.MUST B-E.APPROVED BY*T-1 E COUNTY -HEALTH DEPARTMENT 014 4015, 10/EJ6 (Replaces HRS -H J Form (Stec Nust,Xr: 5744-0024 is-� SS which may 6e ttse4) Page 2 o STATE OF FLORIDA PERMIT NO. f9 J DEPARTMENT OF HEALTH DAT$ PAID: / ONSITE SEWAGE TREATMENT AND DIPOSAL SXSTEM FEE PAID: CONSTRUCTION INSPECTION AND FINAL APPROVAL RECEIPT #: APPLICANT: AGENT: _,4 PROPERTY A LOT: 46 c,+..)-� CHECKED [X] ITEMS ARE NOT IN COMPLIANCE WITH STATUTE -OR RIIX,$ AND MUST •BE,OORR$CT=. TAMC INSTALLATION [oil TANK SIZE [11�1 ' O (2l [021 TANK MATERIAL 1031 OUTLET DEVICE [041 MULTI-CHAMBERED [ Y /,(J [05] OUTLET FILTER [06] LEGEND [.07] WATERTIGHT [08] LEVEL [091 DEPTH TO LID DRAINFIELD INSTAU ATIpN ,r^ 1101 AREA [1yM&r[21a2f SQFT L ] [111 bISTRIBUTION BOX HEADER � [ ] [121 _ NUMBER OF DRAINLINEB 3 ] [131 DRAINLINE $NPX ATION_Z y ] [14] DRAIN1,41ft SLOPE [15] DEPTH OF COVER/k4o!, � [16] ELEVATION [ABOV�ZM 4-: 1 [17] SYSTEM LOCATION'.-� I ] [181 DOSING PUMPS [191 AGGREGATE SIZE [201 AGGREGATE EXCESSIVE FINES [ ] [211 AGGREGATE DEPTH FILL / EXCAVATION MATERIAL I ] [221 FILL AMOUNT � `/ [231 FILL TEXTURE [241 =CAVATION DEPTH. [251 AREA, REPLACED [26] REPLACEMENT MATERIAZ, EXPLANATION I 7 [ 1 OF VIOLATIONS /REMARKS: SETBACKS [27] SWACE WATER FT 1281 DITCHES FT [291 PRIVATE WELLS FT 1301 PVBi XC WEZ,LS FT [31] IRRXQATION WELLS FT E 32 POTABI;R WATER BINES FT [33] BVXI)DIN¢ FOUNDATION 0 FT [34] PROPERTY LINES „ 2 ©FT [35) OTHER SFT FILLED / MOUND SYSTEM [36] DRAMIELA COVER 1371 SHOULDERS /A [38] SLOPES _ [391 STABILIZATION ADDITIONAL IN 6MmTION [40] UNQBSTRUCTED AREA 1411 PTORMKATER RUffb 142.1 ALARMS 1431. MAINTMO47CE AGPEMENT [441 BUILDING 'ARNA [45] LOCATION QONVOR14S WITH SITE ;,?W [461 FINAL SITE 1471 CONTRACTOR [481 OTHER ABANDONMENT' yQ . I f (491 . TANK PU10ED / L 1 *150.1 TANK CRUSHED & FILi�ED I ] . CONSTRUCTIO [APPROVED ISAPPROVED]:,� y ^^�. 4\ CED. DATZY Aey,� `INAL SYSTE PRO /DISAPPROVED] : C.�...�1 CSD DATE: _-- '' `16, 08/09 (Obsoletes all previous editions which may not be used) gated• 648-6.003, FAC- I Page 2 of 3 DIVISION OF Environmental Health 10 Florida Department of Health 0 Miami-Dade County Health Department 1 �v OSTDS/Well Division `I�►o 11805 SW 26 St. • Miand, FL 13175 pecto I Date'"��' 3 dress -5'3 Y A/. C 1 y ,SIDS # fQOL--/l6 Comments: Signature Ij 76 �