PL-14-1358Y r • �
Miami Shores Village
4
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795-2204 Fax: (305) 756-8972
INSPECTION LINE PHONE NUMBER: (305) 762-4949
FBC 20jo
BUILDING Master Permit No.R/ _L3.
PERMIT APPLICATION Sub Permit No.
❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
PLUMBING [:]MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
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OFF
DRAWINGS
JOB ADDRESS: '36 OFF ) R S1"ree+
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#: 11-2-156-004-00" Is the Building Historically Designated: Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder): Com" d, Gy-eai Yw i Phone#:
Address: 3G �� (1lr S
�
City: M) c% A0 -lei State: Ft_ Zip: ,33/191
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR: Company Name:y 14 1'_kA)i d'e,' G G"<� I#1c Phone#: aLG (5 (__6 &53
Address: 156" NW lcA Xyc 4 115
City: Lo0� State: FL Zip: 330 S4 -
Qualifier Name:
one#:
State Certification or Registration #: 6ROct 1 i2_62, Certificate of Competency #:
DESIGNER: Architect/Engineer: Phone#: _
Address: City: State: Zip:
Value of Work for this Permit: $ 3000 ®` Square/Linear Footage of Work: 2_00
Type of Work: ❑ Addition ❑ Alteration ❑ New �Kepair/Replace ❑ Demolition
Description of Work:
Specify color of color thru tile:
Submittal Fee $ Permit Fee $!,f d► ';Zr CCF $ CO/CC $
ff
Scanning Fee $
Technology Fee
Structural Reviews $,
(Revised02/24/2014)
Radon Fee $
Training/Education Fee $
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
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 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.
OWNER or AGENT
The foregq{pd instrument was acknowledged before me this
21day of (TQ vv- y
. 20 ILF by
who is personally known to
me or who has produced RPIpawelT as
identification and who did take an oath.
NOTARY PUBLIC:
Sign:
cvd-'O�
Qua
Seak
APPROVED BY
(Revised02/24/2014)
TERESA J SOLOMON
MY COMMISSION # EE 131935
EXPRES November 08, 2015
Signature
CONTRACTOR
The foregoing instrument was acknowledged before me this
day of �ula , 20 by
1!e=X Cn, , who rsonally knoto
me or who has produced as
identification and who did take an oath.
NOTARY PUBLIC:
2 T-YYPlans Examiner Zoning
Structural Review Clerk
d t4
G Jfl�1r^s9i-i lr hJClm'C U HEA..'Ci L4-PAA'G{ Wr,,
STATE OF FLORIDA
DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM
CONSTRUCTION PERMIT
CONSTRUCTION PERMIT FOR: OSTDS Repair
APPLICANT: Jude Greenwell
PROPERTY ADDRESS: 36 NE 111 St Miami, FL 33161
LOT: 4 BLOCK: 1 SUBDIVISION:
PROPERTY ID #: 11-2136-0040040
PERMIT #:13 -SC -1545216
APPLICATION # : AP 1150957
DATE PAID:
FEE PAM:
RECEIPT #:
DOCUMENT #: PR943273
College Heights
[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 [ 650 ] GALLONS / GPD Existinq septic tank 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 [ 200 ] SQUARE FEET
R [ 0 ] SQUARE FEET
A TYPE SYSTEM: [x]
I CONFIGURATION: [ ]
N
Bed confiquration drainfiel SYSTEM
SYSTEM
STANDARD [ ] FIT.1a [ ] MOUND [
TRENCH [x] BED [ ]
F LOCATION OF BENCHMARK: FFE 13.3' NGVD
I ELEVATION OF PROPOSED SYSTEM SITE [ 28.80][ INCHE3 FT ][ABOVE BELOW BENCHMARK/REFERENCE POINT
E BOTTOM OF DRAINFIELD TO BE [ 66.84][ INCHES FT ][ABOVE BELOW BENCHMARK/REFERENCE POINT
L
D F
0
T
H
E
R
1LL A&WU.LKffU: L U.UU J 1NUfts`f 1.Au&vAA'lU14 Aswul L .lt5.UU J -Munab
1. -Existing 650 gal. septic tank, certified by "Statewide Septic Connections nc." on 6/15/2014 to remain.
2. -Install 200 sf of drainfield in bed configuration.
5. -Invert elevation of drainfield to be no less than 8.23' NGVD.
6: Bottom of drainfield elevation to be no less than 7.73' 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 PERMIT IS NOT FOR ANY ADDITIONS.
SPECIFICATI Teresa J Solomon TITLE: Master Septic Tank Contractor
APPROVED BY: ITLE: Engineering Specialist II Dade CHD
tey o
DATE ISSUED: 06/24/2014 EXPIRATION DATE: 09/22/2014
.. ..... ...
�Y+N,797 "7 r
"UT,,\TE OF FLORIDA
D-EPARTMENT OF HEALTH
APPLICATION FOR ONSITE: SCVVAGE DISPOSAL SYSTEM CONSTFUG
T101 1 PRM"
Permit Applical or 111(jr! Utji
Pr,"NRT* 11 SITE: PLAIN -
ScF:--: Each block represents 5 feet arid inch - 50 feet.
SitE Plan submitted by:.
Plan Approved
A
C
Signature
Not Approved __
Da-
C-ouniy Health D-epaftnm:
ALL CHANGES MUST BE APPROVED BY THE COUNTY HEALTH DEPARTMENT
01' ( 40-5_ !M; , (Rep fqe; HRS4 1 �,Qfm 4015 whir, h , aay bq w;wj)
009-4015-6)
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