RC-13-1170 (2)Miami Shores Village
ry JUN 1:7101
Building Department BY:
1 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 20 CDBUILDING Master Permit No.9,C) 3 — 1110
PERMIT APPLICATION Sub Permit No.pLl —1--- r y
❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
�p r CONTRACTOR DRAWINGS
JOB ADDRESS: 0 I,/f®( r
City: Miami Shores County: Miami Dade zip:
Folio/Parcel#:_ j/ ®1— 0 ) � — () gL► 0 Is the Building Historically Designated: Yes NO
Occupancy Type: `:0461-oad: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder): i'O'+< LF n�f pOO�(/ Phone#:
Address:
City: -/L- t r e L? C State: t—G'/' 4 Zip: �/ " S' c7
Tenant/Lessee Name: Phone#:
Email:
i r
CONTRACTOR: Company Name:
Address: C
City:
Qualifier Name:
State Certification or RegiWation #: �( �`'f 2 -1�— Certificate of Competency #:
DESIGNER: Architect/Engineer: Phone#:
Zip:
/�/ ��✓%
%r- (®
Address: City: State: Zip:
Value of Work for this Permit: $ 13 lf�i� Square/Linear Footage of Work: /5,0
Type of Work: ❑ Addition M Alteration ❑ New ❑ Repair/Replace ❑ Demolition
Description of Work:
/V Or q
Specify color of color thru tile:
Submittal Fee $ Permit Fee $ -. W CCF $ CO/CC $
r
Scanning Fee $
Radon Fee $
Technology Fee $ Training/Education Fee $
Structural Reviews $
(Revised02/24/2014)
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.
Signature
q7L---
OWNER or AGENT
The foregoing instrument was acknowledged before me this
—& day of i r�0� , 20 f '-/, by
&n� i OS✓I-l,reT�'ho is personally known to
me or who has produced®�°°°®�r���i,,_ as
a®® a1
identification and who did take an oap °Qa�,oe oy�o• o�2y
NOTARY PUBLIC: A A / I
Sign
Prini
Seal
Signature ��— J
4N, TRACTOR
The foregoing instrument was acknowledged before me this
_/ day of 20 _ f 4 , by
Ai,� 612�j iPlt , who is personally known to
me or who has produced _.�®���"°1��rsir,_ as
identification and who did an Og,':
NOTARY PUBLIC: n
9.� 00 Wiz:
i per` °'jy_ VS•A0'` '" �10I
•ea
Sign:
Print: s,��r'' pA• ``�0`°°°
Seal:
APPROVED BY Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)
C'J
STATE OF FLORIDA PERMIT #: 13 -SC -1504492
DEPARTMENT OF HEALTH APPLICATION #: AP1125689
ONSITE SEWAGE TREATMENT AND DISPOSAL DATE PAID:
SYSTEM
FEE PAID:
CONSTRUCTION PERMIT
RECEIPT #:
DOCUMENT #: PR926623
CONSTRUCTION PERMIT FOR: OSTDS Existing Modification
APPLICANT: (Fotios & Jessica Andreopoulos)
PROPERTY ADDRESS: 118 NW 101 St Miami, FL 33150
LOT: 4 BLOCK: 3 SUBDIVISION:
PROPERTY ID #: 11-3101-022-0200
[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 [ 1,050 ] GALLONS / GPD Existinq Septic Tank (to remain) CAPACITY
A [ ] GALLONS / GPD N/A CAPACITY
N [ ] GALLONS GREASE INTERCEPTOR CAPACITY [MAXIMUM CAPACITY SINGLE TANK:1250 GALLONS]
K [ ] GALLONS DOSING TANK CAPACITY [ ]GALLONS @[ ]DOSES PER 24 HRS #Pumps [
D [ 375 ] SQUARE FEET
R [ ] SQUARE FEET
A TYPE SYSTEM: [X] STANDARD
I CONFIGURATION: [X] TRENCH
N
N/A
[ ] FILLED
] BED
SYSTEM
SYSTEM
[ ] MOUND [ ]
F LOCATION OF BENCHMARK: F.F.E. 13.4
I ELEVATION OF PROPOSED SYSTEM SITE [ 28.80][ INCHES FT ][ABOVE BELOW BENCHMARK/REFERENCE POINT
E BOTTOM OF DRAINFIELD TO BE [ 58.80][ INCHES FT ][ABOVE BELOW BENCHMARK/REFERENCE POINT
L
D FILL REQUIRED: [ 0.00] INCHES EXCAVATION REQUIRED: [ 30.00] INCHES
0 1. -Existing 1050 gal. septic tank, certified by "Day & Night on 11/1/13" to remain.
2. -Install 375 sf of drainfield in trench configuration.
T 3. -Perimeter of excavation area shall be at least 2 ft wider and longer than the proposed absorption bed.
H 4. -Invert elevation of drainfield to be no less than 9.00' NGVD.
E 5. -Bottom of drainfield elevation to be no less than 8.50' NGVD.
6. -Water line within 10 ft of septic system to be Sch 40 PVC or sleeved in accordance with FA Ch 64E-6. (2)( . CIO
R (Comments Continued on Page 2.) ae®
SPECIFICATIONS BY: TITLE: `/ V" 0"
,re
APPROVED BY: TITLE: Engineering Specialist I as �, ade CHD
Nicole P GUMS
DATE ISSUED: 01/10/2014 EXPIRA D}'E� 07/10/2015
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 AP1125689 SE9S6781
DOCUMENT #: PR926623
system is sized for 3 bedrooms with a maximum occupancy of 6 persons (2 per bedroom), for a total estimated flow of
gpd.
NOTICE OF RIGHTS
A party whose substantial interest is affected by this order may petition for an
administrative hearing pursuant to sections 120.569 and 120.57, Florida Statutes. Such
proceedings are governed by Rule 28-106, Florida Administrative Code. A petition for
administrative hearing must be in writing and must be received by the Agency Clerk for the
Department, within twenty-one (21) days from the receipt of this order. The address of the
Agency Clerk is 4052 Bald Cypress Way, BIN # A02, Tallahassee, Florida 32399-1703. The
Agency Clerk's facsimile number is 850410-1448.
Mediation is not available as an alternative remedy.
Your failure to submit a petition for hearing within 21 days from receipt of this order
will constitute a waiver of your right to an administrative hearing, and this order shall become
a'final order.
Should this order become a final order, a party who is adversely affected by it is
entitled to judicial review pursuant to Section 120.68, Florida Statutes. Review proceedings
are governed by the Florida Rules of Appellate Procedure. Such proceedings may be
commenced by filing one copy of a Notice of Appeal with the Agency Clerk of the
Department of Health and a second copy, accompanied by the filing fees required by law,
with the Court of Appeal in the appropriate District Court. The notice must be filed within 30
days of rendition of the final order.