PL-13-814k
Miami Shores Village
o� 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
BUILDING
PERMIT APPLICATION
FBC 20
Permit Type: PLUMBING
OWNER: Name (Fee Simple Titleholder): n
Permit No.
Master Permit No.'FL )``L
2"
Address: _ Of Al
City: _ A ; OR. State: IL Zip: 311 3 Q
Tenant/Lessee Name: Phone#:
Email:
JOB ADDRESS:
City: Miami Shores County: Miami Dade zip: 3 3Y
Folio/Parcel#: I1, '2452L - 0 3 2 0 06D
Is the Building Historically Designated: Yes NO i- Flood Zone:
CONTRACTOR: Company Name:
Addri
City:
Quali
_3667CO/ 7XS"0_
State Certification or Registration #: SA. 04/536 Certificate of Competency #:
Contact Phone#: Email Address:
DESIGNER: Architect/Engineer: Phone#:
Value of Work for this Permit: $ q 3 oQ { -o Square/Linear Footage of Work: 300 Y
Type of Work: ❑Address ❑Alteration ❑New ORenair/ReDlace ❑Demolition
Description of Work: _
Submittal Fee $ Permit Fee $ CCF $ CO/CC $
Scanning Fee $ Radon Fee $ DBPR $ Bond $
Notary $ Training/Education Fee $ Technology Fee $
Double Fee $ Structural Review $
TOTAL FEE NOW DUE $ LCJV'U�
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 commencezV%nd construction lien law brochure will be delivered to the person
whose property is subject to attachment. Also, a certified cop —recorded notice of commencement must be posted at the job site
for the first inspection which occurs seven (7) days after the g permit is issued. In the absence of such posted notice, the
inspection will not be approved and a reinspection fee will be ch
Signature 'L'VL,1 / / ature_
07
Owner or Agent Contractor
The foregoing instrument was acknowledged before me this Wregoing instrument was acknowledged before me this—W,
day of .*4L- , 20 -LS, by _ G'AeA Mn Ve r— day of �t��, 20 M, by t�Yiil9.ti1 tf T`/�iP1f/'�
who is personally known to me or who has produced who is personally known to or who has produced
As identification and who did take an oath.
NOTARY PUBLI
Sign:
Print:
My Commission Expires tirY COMMISSION q DD 97340
EXPIRES Th. September 14, 2C13
Bonded Thru Mary Public Untlenvriters
APPROVED BY 4 2 —t,3Plans Examiner
Structural Review
(Revised 07/10/07)(Revised 06/10/2009)(Revised 3/15/09)
identification and who did take an oath.
NOTARY PUBLIC:
Sign:
My Commission
,rte � tll�t� P1Ai(11R Sib IAt
i� She A Wd t
MtYGMnn�ir►EElt13f
..JJ.
Zoning
Clerk
STATE OF FLORIDA
DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM
CONSTRUCTION PERMIT
PERMIT #:13 -SC -1466440
APPLICATION #:AP1104163
DATE PAID:
FEE PAID:
RECEIPT #:
DOCUMENT #: PR903678
CONSTRUCTION PERMIT FOR: OSTDS Repair
APPLICANT: Ernesto Marquez
PROPERTY ADDRESS: 1421 NE 104 St Miami, FL 33138
LOT: 6 BLOCK: 3 SUBDIVISION: River Bay Park
[SECTION, TOWNSHIP, RANGE, PARCEL NUMBER]
PROPERTY ID 11-223? ?�0 .': _ [OR TAX ID NUMBER]
SYSTEM nJS'T 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 LPPLICATICN. SUCH L40DIFICATIONS 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 LOC,,%L PERMITTING REQUIRED FOR DEVELOPMENT OF THIS PROPERTY.
SYSTEM DESIGN AND SPECIFICATIONS
T [ ^0 ] GALLONS / GPD Existinq septic tank to remain.CAPACITY
A [ 0 GALLONS % GPD Y CAPACITY
N [ 0 ] GALLONS CREASE 71 t1,TFRCEPTOR CAPACITY [ttt .iPdL^1 CAP,.CITY SINGLE TANK:1250 GALLONS]
K ( ' C71,7,LONS DOSINC "A:"`K CAPACITY [ ]C, L',. Ns @ [ !DOSES PER 24 HRS #Pumps [ ]
D [ 300 ] SQUARE FEET SYSTi_'24
R [ 0 ) SQUARE FEET S*'Ysirl
A TYPE SYSTEM: [x] _STANDARD [ ] FILLED [ ] DOUND [ ]
I CONFIGURA'11�_'N: r ] TREP?CH r BED [ ]
N
F LOCATION Cr F.F.f ., 7.40 NGVD
I ELEVATION OF PROPOSED S?SI J. SITE ( 33.6U ] if I� _ 5 j 2 l [ ABOVE ENCHMARK/REF
E BOTTOM OF DRAINFIELD TO BE [ 46.60)[ INC'iF.S F1 ] [ABOVE BE CHMARK/REF
L
D FILL I' CHFS EXCAVATION REQr;IRrT': r 13.00 ) INCHE�,
Invert E c -n,)' wainfield to r _ .ss than 4..60 idv`J'i
O *Bottr,,I; of , elev�',r,t t:, r, I�.s'han 3 50 NGVD.
T The is sized for 3bedrec,ns with a maximum occupancy of 6 persons (2 per bedroom), for a total estimated
H sewn -d o ; 300 gpd:
"THIS PCRMiT L:S3 f10TFOR " ADDiTION(s)
E
R
POINT
POINT
SPECIFICATICNS BY: Kembie t` ick _ITL-:
APPROVED ?:Y:TITLE: Dade CHD
Car z M.. .tea.
DATE ISSUED: 04/13/20',3 EXPIRATION DATE: 07/17/2013
DH 4016,
10_bscicteas zTile, Cb,rr,jbrq,.d4�yyr, e Ts re'y"[7fredt0'perfd7ma'r: ti -.u)
Incorpc,•: :.' F 6 . 3, toif boring aoja(,e„t to the dralnfield excavation at the
time of final inspection. Prior tj Rrial"Approval, the DOH
inspector shall witness the soil boring and compare the
results to the original site evaluation submitted. A
reinspection fee will be assessed if the contractor is not
at the jobsite at the arraged time.
Page 1 of 3
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