PL-14-1159BUILDING
PERMIT APPLICATION
Miami Shores Village 7-_jL_4L_
Building Department N 04 2014
10050 N.E.2nd Avenue, Miami Shores, Florida 33138Tel: (305) 795-2204 Fax: (305) 756-8972
INSPECTION LINE PHONE NUMBER: (305) 762-4949
FBC 20b�-
Master Permit No.
Sub Permit NoTL'l (I, I l S 1
❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: 802- WE. yoo
Com: Miami Shores County: Miami Dade Zip:
Folio/Parcel#: I � _ 5 2_10G -, 0 3 4 " ®® 8 0 Is the Building Historically Designated: Yesio
�B�
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder): Fv-OZ X16 S + A -C 6a COl t*� Phone#:
Address: q0z NE l o o
City: &pyes State: Zip: 3-3138
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR: Company Name: Std tI&J i de �I'fir �C Phone#: 316'f4,63-3
Address: �s 640K) v\j (C) AV --e- -* Is
City: !�ba I:p State: Zip: 33_0Sq-
Qualifier Name:% = �^® Phone#: ISur 2--oY 36 44
State Certification or Registration #: 011 2 2- Certificate of Competency #:
DESIGNER: Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for this Permit: $ 2-�00' Square/Linear Footage of Work: I SO
Type of Work: ❑ Addition ❑ Alteration ❑ New URepair/Replace ❑ Demolition
Description of Work:
Specify color of color thru tile:
CzC
Submittal Fee $ Permit Fee $ ._ IrCA -r CCF
Scanning Fee $
Technology Fee $
Structural Reviews
(Revised02/24/2014)
Radon Fee $
Training/Education Fee $
CO/CC $
DBPR $ Notary $
Double Fee $
Bond $
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
0 t
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 ELECTRIC, PLUMBING, SIGNS, POOLS,
FURNACES, BOILERS, HEATERS, TANKS, 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.
ASignature_a-
OWNER or AGENT
The foregoing instrument was acknowledged before me this
?- day of -d u n� .2014- by
A 1bcl G c' rA- a-(- . who is personally known to
me or who has produced FIA OrN, tom, W S-< as
identification and who did take an oath.
NOTARY PUBLIC:
Print:
Signature
CONTRACTOR
The
foregoing instrument was acknowledged before me this
l day of , 20 )''l , by
& . 96Xu-n-who is personally known to
me or who has produced
identification and who did take an oath.
NOTARY
Print:
= MY CVPnnn���,..
Seal: =* g November 06.2015 Seal:
EXPIRE --�
IDL
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as
APPROVED BY'� / Y Plans Examiner Zoning
Structural Review
(Revised02/24/2014)
Clerk
PflI !f—DADE COUNTY HEALTH DEPA�4TME`Pt9"
STATE OF FLORIDA
DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM
CONSTRUCTION PERMIT
CONSTRUCTION PERMIT FOR: OSTDS Repair
APPLICANT: Francis Carter
PROPERTY ADDRESS: 802 NE 100 St Miami, FL 33138
LOT: 11 BLOCK: 169 SUBDIVISION:
PROPERTY ID #: 11-3206-034-0080
CI1424
PERMIT #:13 -SC -1541156
APPLICATION #:AP1148428
DATE PAID:
FEE PAID:
RECEIPT #:
DOCUMENT #: PR941013
Miami Shores Sec 8 Rev
[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 I 750 ] GALLONS / GPD existinq septic tank CAPACITY
A [ ] GALLONS / GPD CAPACITY
N [ ] GALLONS GREASE INTERCEPTOR CAPACITY [1O,XIMUM CAPACITY SINGLE TANK: 1250 GALLONS]
K [ ] GALLONS DOSING TANK CAPACITY [ ]GALLONS @[ ]DOSES PER 24 HRS #Pumps
D [ 150 ] SQUARE FEET trench configuration drainf SYSTEM
R [ ] SQUARE FEET SYSTEM
A TYPE SYSTEM: [xl STANDARD [ ] FILLED I l MOUND
I CONFIGURATION: [xl TRENCH [ ] BED [ ]
N
F LOCATION OF BENCHMARK: FFE 13.4' NGVD
I ELEVATION OF PROPOSED SYSTEM SITE
E BOTTOM OF DRAINFIELD TO BE
L
D E
O
T
H
E
R
I
134.80][ INCHES k FT ][ABOVE kjj4ON b BENCHMARK/REFERENCE POINT
170.80 l I INCHES FT ] [ ABOVE AiEHIIBENCHMARK/REFERENCE POINT
ILL REQUIRED: [ ] INCHES EXCAVATION REQUIRED: L 3b.UUJ 114uUmb
1. -Existing 900 gal. septic tank, certified by "A American Septic on 09/13/07" to remain.
2. -Install 150 sf of drainfield in trench configuration.
3. -Perimeter of excavation area shall be at least 2 ft wider and longer than the proposed absorption bed or drain trench.
4. -Invert elevation of drainfield to be no less than 8.00' NGVD.
5. -Bottom of drainfield elevation to be no less than 7.50' NGVD.
The system is sized for 2 bedrooms with a maximum occupancy of 4 persons (2 per bedroom), for a total estimated flow
of 300 gpd. ""THIS REPAIR PERMIT IS NOT FOR ANY ADDITIONS`*
APPROVED BY:
DATE ISSUED:
DH 4016, 08/09
Incorporated:
BY: Teresa J Solomon TITLE: Master Septic Tank Contractor
TITLE: Engineering Specialist II
Erl—1 Omisca
05/30/2014 EXPIRATION DATE
(Obsoletes all previous editions which may not be used)
Dade CHD
08/28/2014
64E-6.003, FAC Page 1 of 3
e 1.1.4 A21148428 l"he c :?RMr (or designee) is required to perform a soil
boring adjacent to the drainfield excavation at the time of final
inspection, F:ior to Final Approval, the FDOH inspector shall
witness tie soil boring and compare the results to the original
site evaluation submitted. A reinspection fee will be assessed
i' the contractor is not at the jobsite at the arranged time.
's "�: _
f SATE 4F FLORIDA
DEPARTMENT OF HEALTH
PERM!APLSEWAGE DISPOSAL SYSTEM COVSTR ;CiICATION POR iTf
Permit Applicaton I`1untf�='r _� -----
—--- ----- PAiTii-SIT.EPLArtl------------_--
Sca:e: Each block represents 5 feet and t inch = 50 feet.
No
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------
Signature _ Ttfe
Pfai I Approved Not Approves! _ Date
ay- - ---- ---- ucunty Health Departm-
ALL CHANGES MUST BE APPROVED BY THE COUNTY HEALTH DEPARTMENT
GR 40'5, W1'6 (1Rc ilaA5 HRS -H Farm 401$ which ;reit bo Ural) r1 n 1
Pturk WCTA X: 5744 02.4015-6{
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