PL-14-1227Miami Shores Village PE�r-�_-
l� Building Department JUN 12 2014
I
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: 305 795-2204 Fax: 305 756-8972
INSPECTION LINE PHONE NUMBER: (30S) 762-4949
FBC 201C)
BUILDING Master Permit No. / y - S
PERMIT APPLICATION sub Permit No.1PL
❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
PLPLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF [:]CANCELLATION ❑ SHOP
CONTRACTOR
JOB ADDRESS: 37'1 U C
City: Miami Shores County: Miami Dade Zip: 3S 1 SIR-
Folio/Parcel#: //- 3 206 —D ( — X206 j Is the Building Historically Designated: Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder): "R it jani i 1 Phone#:
Address: �-2 q • 6 j r . 7'
City: M A W State: Zip: 3/
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR: Company Name: A811 0 A -Dg (-t— ALl l(I11 PoP-LeDUi-At Phone#: 7W n2-51 'L1, 02
Address: S29'0 /a 1t 2 C 6 ri`;-11y
City: H( 14 jP% ( State: if/g- Zip:
Qualifier Name: nsr 0 t lA (v255 Phone#:
State Certification or Registration #:s'��g ] f 2 7� Certificate of Competency #:54
DESIGNER: Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for this Permit: $(Q Soo --2— Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration
Description of Work: (PST/di
4 S&rT(0Ir 6nr�( �
0
❑ New Wj Repair/Replace ❑ Demolition
1-1/0�(-s PTic 1-4vk KtirP43
Specify color of color thru tile:
Submittal Fee $� Permit Fee $
Scanning Fee $ Radon Fee $
Technology Fee
Structural Reviews $
(Revised02/24/2014)
Training/Education Fee $
CCF $ 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
Zi
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 approveq arldg reinspection fee will be charged.
Signature Signature
OWNER or AGENT
The foregoing instrument was acknowledged before me this
el -
day of ',.� 1l -e . 20 It/ , by
6042C/,
tMP t iZ, is personal known to
me or who has produced
identification and who did take an oath.
NOTARY
Seal:
MY COMWSSt0N # EE53276
E-WMM: March 16, 2015
/ CONTRACTOR
Thforegoing instruTL1
t was acknowledged before,me this
day of 16AP—_, 20t � by
who is personally known to
as me or who has produced
identification and who did take an oath.
NOTARY
Sign: l U fit C&
Print: L—GC. U -CA
Seal: GN
APPROVED BY Plans Examiner
Structural Review
(Revised02/24/2014)
LAURA FARLEY -
MY COM OS91ON # EE53276
EXPIRES: Mardi 16.2015
as
Zoning
Clerk
0
STATE OF FLORIDA
DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT AND DISPOSAL
SYSTEM
CONSTRUCTION PERMIT
CONSTRUCTION PERMIT FOR:
APPLICANT: Marc Adier
OSTDS New
PROPERTY ADDRESS: 374 NE 95 St Miami, FL 33138
LOT: 2 BLOCK: 3 SUBDIVISION:
PROPERTY ID #: 11-3206-013-6060
PERMIT #: 13 -SC -1524696
APPLICATION #: AP1138060
DATE PAID:
FEE PAID:
RECEIPT #•
DOCUMENT #: PR938686
[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 l GALLONS / GPD Septic 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 [ 667 1 SQUARE FEET bed conflquration drainfiel SYSTEM
R [ ] SQUARE FEET N/A SYSTEM
A TYPE SYSTEM: [x] STANDARD [ 1 FILLED [ ] MOUND [ ]
I CONFIGURATION: [ ] TRENCH [x] BED [ J
N
F LOCATION OF BENCHMARK: CL NE 95 st., NGVD. 9.95' NGVD
I ELEVATION OF PROPOSED SYSTEM SITE [ 1.56 ][INCHES FT ][ABOVE BELOW BENCHMARK/REFERENCE POINT
E BOTTOM OF DRAINFIELD TO BE [ 31.561[ INCHES FT ][ABOVE BELOW BENCHMARK/REFERENCE POINT
L
D FILL REQUIRED: [ 0.001 INCHES EXCAVATION REQUIRED: [ 72.001 INCHES
O
T
H
E
R
Inspector to verify the existing septic tank is properly abandoned before final approval.
*Invert elevation of drainfield to be no less than 7.82' NGVD.
*Bottom of drainfield elevation to be no less than 7.32' NGVD.
Install 42" of slightly limited soil under the bottom of drainfield.
-Perimeter of excavation area shall be at least 2 ft. wider and longer than the proposed absorption bed or drain trench.
The system is sized for 3 bedrooms with a maximum occupancy of 6 persons (2 per bedroom), for a total estimated flow
of 400 gpd.
The licensed contractor installing the system is responsible for installing the minimum category of tank in accordance
'SPECIFICATIONS BY: Teresa J Solomon
APPROVED BY: TITLE:
Carlos M loaza
TITLE: Master Septic Tank Contractor
DATE ISSUED: 05/06/201,.4
DH 4016, 08/09 (Obsoletes all previous editions which may not be used)
Incorporated: 64E-6.003, FAC Floc
V 1.1.4 AP1138060
Dade CHD
11/06/2015
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