PL-15-2523 PLAO-45-2523,,
,�rancmR�;r's L�� Miami Shores VillagePe'7'm r ype Olumb14 .ROO n ial -
10050 N.E.2nd Avenue NErM
Work Gla fca #r�ttnf�eI
.,
Miami Shores,FL 33138-0000
Phone: X305)795 22oa .� .. Permit$tam:ARPR�' ELO
xivA ,'.
x tssuete / 2i Expiration: 04/03/2016
Project Address Parcel Number Applicant
141 NE 102 Street 1132060131830
MARGUERITE MERRILL
Miami Shores, FL 33138- Block: Lot:
Owner Information Address Phone Cell
MARGUERITE MERRILL 141 NE 102 Street (786)423-5653
MIAMI FL 33138-2324
Contractor(s) Phone Cell Phone Valuation: $ 3,800.00
STATEWIDE SEPTIC CONNECTIONS (954)963-0082
Total Sq Feet: 300
Type of Work:REPLACE DRAINFIELD Available Inspections:
Type of Piping: Inspection Type:
Additional Info:
Bond Return
HRS Approval
: Final
Classification:Residential Scanning:3 Review Plumbing
Fees Due Amount Pay Date Pay Type Amt Paid Amt Due
Bond Type-Contractors Bond $500.00 Invoice# PL-10-15-57315
CCF $2.40 10/06/2015 Check*4922 $619.90 $50.00
DBPR Fee $2.25
DCA Fee $2.25 10/05/2015 Check#:4917 $50.00 $0.00
Education Surcharge $0.80 Bond#:2865
Permit Fee $150.00
Scanning Fee $9.00
Technology Fee $3.20
Total: $669.90
In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations
pertaining thereto and in strict conformity with the plans,drawings,statements or specifications submitted to the proper authorities of Miami Shores Village. In
accepting this permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are
required for ELECTRICAL,PLUMBING,MECHANICAL,WINDOWS,DOORS,ROOFING and SWIMMING POOL work.
OWNERS 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 zon' Futhe ore, authorize the bove d contractor to do the work stated.
October 06, 2015
Authorized Signature:Owner 1 Applicant / Contractor / Agent ate
Building Department Copy
October 06,2015 1
Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795-2204 Fax: (305)756-8972
Inspection Number: INSP-244890 Permit Number: PL-10-15-2523
Scheduled Inspection Date: November 04,2015 Permit Type: Plumbing - Residential
Inspector: Diaz, Osvaldo Inspection Type: Final
Owner: MERRILL, MARGUERITE Work Classification: Drainfield
Job Address: 141 NE 102 Street
Miami Shores, FL 33138- Phone Number (786)423-5653
Parcel Number 1132060131830
Project: <NONE>
Contractor: STATEWIDE SEPTIC CONNECTIONS Phone: (954)963-0082
Building Department Comments
REPLACE DRAINFIELD Infractio Passed Comments
INSPECTOR COMMENTS False
Inspector Comments
Passed E�r HRS IN FILE
Failed
Je
Correction
Needed ❑
Re-Inspection
Fee
No Additional Inspections can be scheduled until
re-inspection fee is paid.
November 03,2015 For Inspections please call: (305)762-4949 Page 12 of 39
DIVISION OF
•� Environmental Health
Florida Health
Miami-Dade County
�Q OSTDS/Well Division
�► 11805S 2 Street-N iami FL 33175 �O
�f Inspector Y , Date
Address_ Lii nG wo S-f OSTDS# EP 1DQ&�� `
Comments:
Signature
Miami Shores Village - -
I
Building Department OCT ® 6 2015
10050 N.E.2nd Avenue,Miami Shores,Florida 33138
••Teh(305)795-2204 Fax:(305)756-8972 -
' INSPECTION LINE PHONE NUMBER:(305)7624949
FBC 2014
BUILDING' Master.Permit No. l:S' 252_3
PERMIT APPLICATION Sub Permit No.
F-IBUILDING F-1 ELECTRIC ❑ ROOFING ❑ REVISION F] EXTENSION ❑RENEWAL
I
PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
pp yy�� CONTRACTOR DRAWINGS
JOB ADDRESS: 1'T I 0 2-
City: Miami Shores County: Miami Dade Zip: 531
V
Folio/Parcel#: ) I '�)2_0 6 _®( 3- r 8 3 f Is the Building Historically Designated:Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER:Name(Fee Simple Titleholder): _tt Me-Tr; I l Phone#: 7.5 C a 4 2- • !� S
6
Address: 141 12- 5--
City: I-A i prfl i S I ►v aES State: � Zip: 3 3/'_3 6
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR:Company Name: '`int J't( C C CNTN-C C Phone#: 3166 /' 6633
Address: 13C40 N\Ai
City: QPA-(_�lam-A State: 1 6' Zip:
Qualifier Name: (Orp-S- jc o m o N Phone#:
State Certification or Registration#: 71 2.6 Certificate of Competency#:
DESIGNER:Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for this Permit:$ 33 0C) Square/Linear Footage of Work: 30L
Type of Work: ❑ Addition ❑ Alteration ❑ New Repair/Replace ❑ Demolition
Description of Work:
Specify color of color thru tile:
Submittal Fee$ Permit Fee$ �Cfa d` CCF$ CO/CC$
Scanning Fee$ Radon Fee$ DBPR$ Notary$
Technology Fee$_ Training/Education Fee$-- Double Fee$
Structural Reviews$ Bond$ SM (j
TOTAL FEE NOW DUE$i R 9 , 1� 6
(RevisedO2/24/2014)
Bonding Company's Name(if applicable)
Bonding Company's Address
City State Z Zip
Mortgage Lender's Name(if applicable)
Mortgage Lender's Address
City State 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$2500, the applicant must
promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person
whose property is subject to attachment. Also,a certified copy of the recorded notice of commencement must be posted at the job site
for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the
inspection will not be approved and a reinspection fee will be charged.
Si '
SignatureAl Signature
OWNER or AGENT CONTRACTOR
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
A day of O C f ,20 15 by day of pp 6 I- 20 1S by
who is personally known towho is personally known to
me or who has produced �'y tib as me or who has produced (` ` )� as
identification and who did take an oath. identification and who did take an oath.
NOTARY PUBLIC: NOTARY PUBLIC:
Sign: Sig
Print: �C�1 �(� o -� Print: � -� Ila C
Seal: Seal:
Notary Pubft SUM of Florida
WBY
trr Pulft$loe of Florida Tne=Da Lewis
307
FF 198767 � � E roermills Lewis My es ods on 19198APPROE J /5 Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)
1 .&
PERMIT #: 13-SC-1633276
STATE OF FLORIDA APPLICATION #:AP1206347
DEPARTMENT OF HEALTH
_ DATE PAID:
ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM
w
CONSTRUCTION PERMIT ey�pn FEE PAID:`yy f� �}
,zr Grp s� t9 ��k
.ti. _WCEIPT #:
DOCUMENT D #: PR989436
C r•.(l,.)'i�i � et-
P�u
CONSTRUCTION PERMIT FOR: OSTDS Repair
APPLICANT: Marguerite Merril
PROPERTY ADDRESS: 141 NE 102 St Miami, FL 33138
LOT: 20 21 BLOCK: 3 SUBDIVISION:
PROPERTY ID #: 11-3206-013-1830 [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.
WHICH SERVED AS A BASIS FOR ISSUANCE OF THIS PERMIT, REQUIRE THE
THE APPLICANT CHANGE IN rTOERMOIALDIFY ACTS,
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 [ 750 ] GALLONS / GPD Septic(Existing) CAPACITY
A [ 0 ] GALLONS / GPD CAPACITY
N [ 0 ] GALLONS GREASE INTERCEPTOR CAPACITY [MAXIMUM CA .11 CITY SINGLE TANK:1250 GALLONS]
K [ GALLONS DOSING TANK CAPACITY [ ]GALL S @[ ]DOSES PER 24 HRS #Pumps
D [ (3:00 ] UARE FEET Bed Drainfield SYSTE
R [ SQUARE FEET SYSTEM
A TYPE SYSTEM: [X] STANDARD [ ] FILLED [ ] MOUND [ ]
I CONFIGURATION: [ ] TRENCH [X] BED [ ]
N
F LOCATION OF BENCHMARK: FFE 12.5'NGVD
I ELEVATION OF PROPOSED SYSTEM SITE [ 20.40 ] [ INCHES FT ] [ABOVE BELOW BENCHMARK/REFERENCE POINT
E BOTTOM OF DRAINFIELD TO BE [ 65.40 ] [ INCHES FT ] [ABOVEBELOW BENCHMARK/REFERENCE POINT
L
D FILL REQUIRED: [ 0.00] INCHES EXCAVATION REQUIRED: [ 45.001 INCHES
..THIS PERMIT IS NOT FOR ADDITIONS-
0 *Perimeter of excavation area shall be at least 2 ft wider and longer than the proposed absorption bed.
T *Invert elevation of drainfield to be no less than 7.55'NGVD.
H *Bottom of drainfield elevation to be no less than 7.05'NGVD.
*The system is sized for 3 bedrooms with a maximum occupancy of 6 persons(2 per bedroom),for a total estimated flow
E of 300 gpd.
R Required drainfield area based on I E-6.015(6)(c)2.
SPECIFICATIONS BY: Ter s S 1 m n TITLE:
Master Septic Tank Contractor
APPROVED BY: TI \: Engineering Specialist II Dade CHD
Ni e
DATE ISSUED: 10/ /2015 EXPIRATION DATE: 12/30/2015
DH 4016, 08/09 (Obsoletes all previous editions wh.ich.may not be used).
Incorporated: 64E-6.003, FAC Page 1 of 3
AP1206347 - - SE972938
STATE OF FLORIDA
DEPARTMENT OF HEALTH
APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PERMIT,`
RB t�
Permit A 4
pplication Number ` .
------- ---. PART 11 , SITE PLAN---
Scale: Each block represents 5 fleet and 1 inch 50 feet. T�—
>.. �, I
at' _
i
•
:
2
: t t
i y t
{ t
1
vo. -
# � . . There are no Oe'rtFnent fea..tures.aeross.
- ;
_ thestrlwt of Adjacent to the property
t
_ h�ttnay'affectsepticsgskem,
!
dotes: ���,.L_()�� �_ �• - t.4 � � .� � '.: _ _.__._-- -' ..------- ---------•-- .-'_-_`___�.._:._ .�..__ `
33 t3 d
CT��."7 '4. E:a. �.�` �'''��'-�' a,�•'1'•% i'' 1�✓Y �� ��. �� !t T �f� '"'a+ A-`+B't��✓M1,,.,®� L.k�.�° 4...:�'0�
site Plan submitted by: : �. P,,3
Signature
Ian Approved Title
F i dot Approved Date 11„ I I C
r'
County Health Department
ALL CHANGES MUST BE APPROVED BY THE COUNTY HEALTH DEPARTMENT
4015,10/96(Replaces HRS-H Forth 4015 which may be used)
ck Number;5744-002-4015-6)
Local Business Tax Ra s
Marr Dade County, State Of Florida
-THIS IS NOT A BILL-DO NOT PAY
4ON330
BUStNMS NAMEILOCATION RECEIPT NO. EXPIRE
STATE DE SEPTIC RENEWAL SEPTEMBER 3 , 2016
CONNECTION INC 5100094
OPERATING IN DAME COUNTY Must be displayed at placo of ,j„i
Pursuant to County code
MIAMI, FIR. 33999 ChaPter&A.-AM 9&1
SEC.TYRE OF BUSINESS PAYMENTQ[tlIl�,"
3 .
STA CIE SEPTIC NNECTION , 196 SPEGiALTY PLtJMBiNGY "
JNC CONTRACTOR 02.50 10 fS
( ) SEP021074 3-1 33
This Locals Taxkc*Daly co payma�c ue Local BusTSL is *N
ori . '; caation W folder's q w.Io business,Holder t c 0
V uow dal regu " tt th apply to the boxinx13.
$ a
I. I : o all" rcial vo t .
Scanned by CamScanner
ft
9/a,�
/
N � f F
iJ
/
`..�' , -. a� OR PRIM
_ �
// 's f
Ya t9 PRI
/
Pp
W
f
r - .
as E
Scanned by CarnScanner