PL-15-273/" 021 aq[iS
012.
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
FBC 20
Permit Type: PLUMBING
Permit No. ?L ( 5 —:Z--13
Master Permit No.
OWNER: Name (Fee Simple Titleholder): 50* 6- UW14cc Phone#: 1W TOS'c�d%
Address: od 5r'
City: AL624 State:
Tenant/Ussee Name: Phone#:
Email:
JOB ADDRESS: Si X A16 10e k
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#: / E — aa3/ - o/q •- 02//
Is the Building Historically Designated: Yes
NO s Flood Zone:
CONTRACTOR: Company Name: 91P L,f / dyt I" Phone#: 3466 1 &Zl [ 9r
Address: / f`f Erol 4�% '� ._43
City: A6.1, State: &
Qualifier Name: 9&-& Phone#:
State Certification or Registration #: A4 0 C 3 e Certificate of Competency #:
Contact Phone#: Email Address:
DESIGNER: Architect/Engineer: Phone#:
X6110. J
Value of Work for this Permit: $ Square/Linear Footage of Work:
Type of Work: ❑Address ❑Alteration ❑New pRepair/Replace ❑Demolition
Description of Work: V .
Submittal Fee $ Permit Fee $ �� ` CCF $ CO/CC $
Scanning Fee $
Radon Fee $
Notary $ Training/Education Fee $
Double Fee $ Structural Review $
DBPR $ Bond $500-M
Technology Fee $
TOTAL FEE NOW DUE $ 12-11 50
21- SO
Bonding Company's Name (if applicable)
Bonding Company's Address
City
State
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address
City
State F
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 and a reinspection fee will be charged.
Signature Signature
Owner or Agent Contractor
The forego' instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
day of _j& , 20L, byWOo � day of A 20 �, by
who is personally known to me or who has produced who is personally kno to me or who has produced.
As identification and who did take an oath. as identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
KEMBLE ETTRICK
My Commission Y P b',' Nita:,y Public -State of Florida
My comm. Expires Sep 19, 2017
ql po;; commission # FF 055732
Rnnded Throuah National Notary Assn.
APPROVED BY s 1 _1 S Plans Examiner
Structural Review
(Revised 07/10/07)(Revised 06/10/2009)(Revised 3/15/09)
NOTARY PUBLIC:
Sign:
Print:
QI
- 081F]
Oct 23.
Oft # FF -13351
Zoning
Clerk
STATE OF FLORIDA
Dp,pARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM
CONSTRUCTION PERMIT
CONSTRUCTION PERMIT FOR:
OSTDS Existing Modification
APPLICANT: John Wallace
PROPERTY ADDRESS: 518 NE 106 St Miami, FL 33138
LOT: 10,11 BLOCK: 110 SUBDIVISION
PROPERTY ID #: 11-2231-014-0211
PERMIT #: 13 -SC -1 574575
APPLICATION #: AP 1 68306
DATE PAID:
FEE PAID
RECEIPT #
Documm #.. PR961756
amd pl miami shores
[SECTION, TOWNSHIP, RANGE, PARCEL ]
[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 [ 900 ] GALLONS / GPD Exist septic tank to remain CAPACITY
A [ I GALLONS / GPD N/A CAPACITY
N [ I GALLONS GREASE INTERCEPTOR CAPACITY [MAXIMUM CAPACITY SINGLE TANK:1250 GALLONS]
K [ l GALLONS DOSING TANK CAPACITY [ ]GALLONS @I ]DOSES PER 24 HRS #Pumps [ ]
D [ 500 I SQUARE FEET
R [ I SQUARE FEET
A TYPE SYSTEM: [XI
I CONFIGURATION: [XI
N
F LOCATION OF BENCHMARK:
Trench configuration drain SYSTEM
N/A SYSTEM
STANDARD [ ] FILLED [ I MOUND [ 7
TRENCH [ I BED [ I
FFE 10.95' NGVD
I ELEVATION OF PROPOSED SYSTEM SITE
E BOTTOM OF DRAINFIELD TO BE
L
D I
0
T
H
E
R
[ 6.24 IEFI-N-C-HE-S-V FT I [ ABOVE
[ 36.24 ] [ ITCHES FT ] [ ABOVE
BENCHMARK/REFERENCE POINT
BENCHMARK/REFERENCE POINT
'ILL REQUIRED: [ 0.001 INCHES EXCAVATION REQUIRED: L IL.UU J tiv-:e zO
1. -Existing 900 gat. septic tank, certified by " Mr. C's Plumbing and Septic" on 1218%2014 to remain.
2. -Install 500 sf of drainfield in trench configuration.
3. -Install 42" of slightly limited soil at the bottom of the drainfield.
4. -Perimeter of excavation area shall be at least 2 ft wider and longer than the proposed absorption bed or drain trench.
(Comments Continued on Page 2.)
SPECIFICATIONS BY': Kemble Ettrick
TITLE:
APPROVED BY:
TLE: Engineering Specialist YI
Dade CHD
Het
DATE ISSUED:
_ 01123/2015
EXPIRATION DATE: 07/23/2016
DH 4016, 08/09
(Obsoletes all previous editions which may not be used)
Page 1 of
Incorporated:
64E-6.003, FAC
v 5.1.4
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a sol! baring.
time of final
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