PL-15-28BUILDING
PERMIT APPLICATION
Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795-2204 Fax: (305) 756-8972
INSPECTION LINE PHONE NUMBER: (30S) 762-4949
❑ BUILDING ❑ ELECTRIC ❑ ROOFING
T? -]Fl C
JAN ® i X014
FBC 20 16
Master Permit No. P6 Z5-- 2
Sub Permit No.
❑ REVISION ❑ EXTENSION ❑ RENEWAL
[%PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
'CONTRACTOR DRAWINGS
JOB ADDRESS: 4 01 N c'::r 10 -3 5T
City: Miami Shores County: Miami Dade Zip: 331'9r
Folio/Parcel#:_ Is the Building Historically Designated: Yes NO i/
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder): COQ ij Phone#:
Address: I BS E is S
City: L�S;yp rts' State: fl- Zip:
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR: Company Name: A �FPhone#: 3�
Address: (0®2;- S; -as 'C_t
rrl� �0�3
City: � r�` ✓ „ State: �. Zip:
Qualifier Name:
�N -® s
iication or Registration #: `S"' o
Certificate of Competency #:
DESIGNER: Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for this Permit: $ 2 0 Square/Linear Footage of Work: 2-,3
Type of Work: ❑ Addition ❑ Alteration ❑ New Repair/Replace ❑ Demolition
Description of Work:
Specify color of color thru tile:
Submittal Fee $n!1�16 Permit Fee $ _�d • CCF $ CO/CC $
Scanning Fee $
Radon Fee $
Technology Fee $ Training/Education Fee $
Structural Reviews $
DBPR $
Notary $
Double Fee $
Bond $ p
TOTAL FEE NOW DUE $ 9 W � -
(RevisedO2/24/2014) G 6 ?j 30
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.1 he absence of such posted notice, the
inspection will not be approved and a reinspection fee will be charged.
Signature
W ER AGENT
The foregoing instrument was acknowledged before me this
day of ,) deC , 20 1 LIi' by
F &4�ii ji Nv, who is personally known to
me or who has produced F -L R- o tr%i/ b Ce,-zs as
identification and who did take an oath.
NOTARY PUBLIC:
Sign: r_ G
sap�
Print:
Seal:
APPROVED BY
(Revised02/24/2014)
TERESA J SOLOMON
MY COMMISSION # EE131935
Signature -Fl�
CONTRACTOR
The foregoing instrument was acknowledged before me this
day of 20 , by
!J if1'O1 T , who is personally known to
-01
me or who has produced as
identification and who did take an oath.
NOTARY PUBLIC:
r7)
Sign: e
Print:
1-6 Plans Examiner
Structural Review
TERESA J SOLOMON
=• *: MY COMMISSION # EE131935
' �CPIRE3 Noverttber 08, 2015
Zoning
Clerk
li18 DEP91T1010
STATE OF FLORIDA NA.P-41-0
DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM
CONSTRUCTION PERMIT
CONSTRUCTION PERMIT FOR:
APPLICANT: Jose Hurtado
OSTDS Repair
PROPERTY ADDRESS: 166 NW 110 St Miami, FL 33168
LOT: 14 BLOCK: 219 SUBDIVISION:
PROPERTY ID #: 11-2136-003-0140
PERMIT # :13 -SC -1577461
APPLICATION #: AP1170075
DATE PAID:
FEE PAID:
RECEIPT #:
DOCUMENT #: PR959336
[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 [ 0 ] GALLONS / GPD CAPACITY
N [ 0 ] GALLONS GREASE INTERCEPTOR CAPACITY [MAXIMUM CAPACITY SINGLE TANK:1250 GALLONS]
K [ ] GALLONS DOSING TANK CAPACITY [ ]GALLONS @[ ]DOSES PER 24 HRS #Pumps [ l
D [00 SQUARE FEET new trench confiq. drain -fie SYSTEM
R [ 0 SQUARE FEET SYSTEM
A T E TEM: [X] STANDARD [ J FILLED [ ] MOUND [ ]
I CONFIGURATION: [x] TRENCH [ ] BED [ ]
N
F LOCATION OF BENCHMARK: FFE 12.9' NGVD
I ELEVATION OF PROPOSED SYSTEM SITE [ 25.20][ INCHES FT ][ABOVE BELOW BENCHMARK/REFERENCE POINT
E BOTTOM OF DRAINFIELD TO BE [ 73.20][ INCHES FT I ABOVE BELOW BENCHMARK/REFERENCE POINT
L
D FILL REQUIRED: [ 0.00] INCHES EXCAVATION REQUIRED: [ 48.00] INCHES
1. -Existing 1050 gal. septic tank, certified by "A Aaron" on 12/23/2014 to remain.
O 2. -Install 300 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 or drain trench.
4. -Invert elevation of drainfield to be no less than 7.30' NGVD.
H 5. -Bottom cf drainfield elevation to be no less than 6.80' NGVD.
E The system is sized for 4 bedrooms with a maximum occupancy of 8 persons (2 per bedroom), for a total estimated flow
R of 400 gpd. THIS PERM T IS NOT FOR ANY ADDITIONS.
SPECIFICATIONS BY A,1 ,,?� Aaron S Rooter
APPROVED BY:
TITLE:
TITLE: Engineering Specialist II
DATE ISSUED: X12/30/2014
DH 4016, 08/09 (Obsoletes all previous editionswhichmay not be used)
Incorporated: 64E-6.003, FAC
v 1.1.4 AP1170075
Dade CHD
EXPIRATION DATE: 03/30/2015
SE946554
Page 1 of 3
r8TATE OF FLORIUA
DEPARTNIENT OF HEALTH
c�
APPLICATION FOR ONSITE SEWAGE VAGE DISPOSAL SYSTEM CONSTPI 101100 PE'Rklff
Permit Applicator NiIrt1ber
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Sca.e: Each block represents 5 feet and inch = 50 feet.
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Site Plah submitted by:
Plan'ADbroved "
Not Approves{ _
Date
County Health Departm-
ALL CHANGES MUST BE APPROVED BY TH•E COUNTY HEALT14 DEPARTMENT
014 40'S. f0/3f (Rtiyttacrr HRS -H Firm 4015 which rnaq bo urad)
(atueg turnbor:574.t.0 7.4015.6)
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