DS-13-1408bg$, g556
BUILDING
Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
INSPECTION'S PHONE NUMBER: (305) 762.4949
PERMIT APPLICATION
JUN 21 2013
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F 1
Permit No. 3
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Master Permit No. o
Permit Type: BUILDING ROOFING
JOB ADDRESS:'7-
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#: /� J� ) 6 ` ()13.
Is the Building Historically Designated: Yes NO 2S Flood Zone:
I
OWNER: Name (Fee Simple Titleholder): AC!�?Q s L-rM If -C— Phone#:
Address: C, �-
City:
Tenant/Lessee Name:
Email:
State: Zip.
CONTRACTOR: Company Name: 11 raj ru 1 ' �— Phone#: `� t� C) �-
Address: _ ' qo) Ab AJ W ( C=T
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City: J�'< _ State fy Zip: °:JS t 6
Qualifier Name:
State Certification or Registration #: _CISL1L7 6 Cq Certificate of Competency #:
Contact Phone#:
DESIGNER: ArchitecWngineer:
Email Address:
V Phone# `k ` Z 7 j 3-)
Value of Work for this Permit: $ 066 Square/Linear Footage of Work: ® ��
Type of Work: ❑Addition ❑Alterationr �^❑New /❑ )a�r/R�eplace ❑Demolition
Description of Work: I .. �- % I/
O
Color thru tile:
Submittal Fee $ Permit Fee $
Scanning Fee $
Radon Fee $
Notary $ Training/Education Fee $
Double Fee $ Structural Review $
CCF $ CO/CC $
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 andpTpinspecfnfee will be charged.
SignatureSignature
Owner or Agent Contractor
The foregoing instrument was acknowledged Ibe�for me this 'sem The foregoing instrument was acknowled ed before me this
day of-�,vate_, 20 c2 , by Ve day of & 20 , by
who is personally known to me or who has produced who i onally knownto a or who has produced
l7N fi�`� As identification and who did take an oath. as identification and who did take an oath.
NOTARY PUBLIC• --- NOTARY PUBLIC:
Sign: Sign
Print Print:
My Commission Expires: lett Cot stoN # wx7 a A My Commission Expires -v RMWA H(, PASTUNA
.j;p�y07.2017
-�! Mtf (;ObIldISS10N A BH8T26?A
MOM.AMMAR F&jWy07.2017
APPROVED BY ' Plans Examiner Zoning
Structural Review Clerk
(Revised 3/12/2012)(Revised 07/10/07)(Revised 06/10/2009)(Revised 3/15/09)
PERMIT #:13 -SC -1413558
STATE OF FLORIDA APPLICATION 4, X('1.073888
DEPARTMENT OF HEALTH DATE PAID'
ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM FEE PAID:
CONSTRUCTION PERMIT RECEIPT:
DOCUMENT #: PR878915 i
CONSTRUCTION PERMIT FOR: OSTDS New
APPLICANT: Mary Morgan
PROPERTY ADDRESS: 307 NE 95 St Miami, FL 33138
LOT: 1011 BLOCK: 44 SUBDIVISION:
PROPERTY ID #: 11-3206013-6000 [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 OR 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 CAPACITY
A [ ] GALLONS / GPD CAPACITY
N [ ] GALLONS GREASE INTERCEPTOR CAPACITY [MAXIMUM CAPACITY SINGLE TANK:1250 GALLONS]
K [ ] GALLONS DOSING TANK CAPACITY [ ]GALLONS Q[ ]DOSES PER 24 HRS #Pumps [
D [ 834 ] SQUARE FEET SYSTEM
R [ l SQUARE FEET SYSTEM °
A TYPE SYSTEM: [x] STANDARD [ ] FILLED [ ] Momm [ ]
I CONFIGURATION: [ ] TRENCH [x] BED [ ]
N
F LOCATION OF BENCHMARK: C/L SW 3 Avenue/95 Street 10.04' NGVD.
I ELEVATION OF PROPOSED SYSTEM SITE [ 8.88 ][ INCHES FT ][ABOVE BELOW BENCB19A1tK/REFERENCE POINT
E BOTTOM OF DRAINFIELD TO BE [ 38.88 ] ElpEREsFT ] [ ABOVE BELOW BENCmaRK/REE`ERENCE POINT
L
D FILL REQUIRED: [ 0.00 ] INCHES - EXCAVATION REQUIRED: [ 72.001 INCHES
1—Install 1200 gal. septic tank equipped with an approved filter. 2 -The licensed contractor installing the system is
O responsible for installing the minimum category of tank in accordance with sec. 64E-6.013(3)(1). 3 -Install $34 sf of
T drainfield in bed configuration. 4 -Install 42° of slightly limited soil under the bottom of drainfield. 5 -Perimeter of
H excavation area shall be at least 2 ft wider and longer than the proposed absorption bed. 6 -Invert elevation of drainfield
to be no less than 7.3V NGVD. 7. Bottom of drainfield elevation to be no less than 7.89 NGVD. S. This permit includes
E the Abandonment of the existing septic tank.
R
SPECIFICATIONS BY -Be J Solomon TITLE: Master Septic Tank Contractor
APPROVED BY: Dade CHD
N ospina
DATE ISSUED: 06/27/2012 EXPIRATION DATE: 12/27/2013
DH 4016, 08/09 (Obsoletes all previous editions which may not be used) +
Incorporated: 64E-6.003, FAC Page 1 of 3
V 1.1.4 AP1073808 SES73468