PL-13-1386/
Miami Shores Village -
Q'N
Building Department
90050 N.E.2nd Avenue,Miami Shores,Florida 33138 `
Tel: (305)795.2204 Fax:(305)756.8972
INSPECTION'S PHONE NUMBER:(305)762.4949
FBC 201®
BUILDING Permit No. 1FL'V 3_ 1`3
PERMIT APPLICATION Master Permit No.
Permit Type: PLUMBING
JOB ADDRESS:.43 2 N,) i 1 1 TP—C, f"I 10 ryl►
City: Miami Shores County: Miami Dade Zip: �, 6(9
Folio/Parcel#: 11 - T_( ?,G , cot - ® S(
Is the Building Historically Designated:Yes NO —Flood Zone:
OWNER:Name(Fee Simple Titleholder): A hone#: �Q 5" 6 '52---7 10c)
Address:
City: State: Zip:
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR:Company Name: S b,+e"e ae' & f Phone#: 3oS–'6'61-°E'.6"33
Address: 6 0 '-3G 'SW Z'3 S-t
City: (-A 1'Cci rr10 r State: IZ Zi P•.3'3 OZ 3
Qualifier Name: Few u-- ��-01®c^�-®� Phone#:
State Certification or Registration#: 001'7)2-6-2- Certificate of Competency#:
Contact Phone#: Email Address: S'+Ci -e U3 i Ode SC p-}►C 'C' n o 1, (o rn
DESIGNER:Architect/Engineer: Phone#:
Value of Work for this Permit:$ x.400 03 Square/Linear Footage of Work: 'LZ 5
Type of Work: ❑Address ❑Alterationnn ❑New Repair/Replace ❑Demolition
Description of Work: fl e o,C, D Y0 I B-P f CY
Submittal Fee$ •�J Permit Fee$ ��� �- CCF$ CO/CC$
4109 lq�
P14-31-V W-01
Scanning Fee$ Radon Fee$ DBPR$ Bond$
Notary$ Training/Education Fee$ Technology Fee$
Double Fee$ Structural Review$
TOTAL FEE NOW DUE$ � d
ti
Bonding Company's Name(if applicable)
Bonding Company's Address
City State 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 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$2500, the applicant must
promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person
whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site
for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the
inspection will not be approved and a reinspection fee will be charged.
Signature Signature
Offer or Agent t "' Contractor
The foregoing instrument was acknowledged before me this ® The foregoing instrument was ackmwV ed before me this-LI
day of - "�r1e. ,20`2,by 1 C-+o n fJ retd3�)4 vy day of ,24Q—,by ,
who is personally known tome or who has produced ELL Priv. who is rsonall kn me or who has produced
°C�b-3-c As identification and who did take an oath. as identification p&"81 d/ e an oath.
NOTARY PUBLIC: NOTARY PUBLIC• >�'a�n""° •.
Sign: Sign: a �;
Print: _ �� M rte- Print:
< a TERESA J SOLOMON My Commission Expires ""
My Commission Expires: `
MY COMMISSION#EE981935
EXPIRES November 08,2095
sksk�ksk�k�k�h+k��ksk�Iasksk�ksk�k�k�ksk�ksk�k�k�sknIssksk�k�k�k�k�k�h�kak � awotsrySerolee•co"' �k�k�hhsksk�ksk�ksk�k,k��kaIssk�ksk,k�k�k�ksk�k�kk�k�k�k�ksk�skskak�h�kdsskskHask�k�k�k�#sk�#�S
APPROVED BY � s 6 Plans Examiner Zoning
Structural Review Clerk
(Revised3/12/2012)(Revised 07/10/07)(Revised 06/10/2009)(Revised 3/15/09)
13 1��
REPAIR _
PERMIT #: 13-$C-1478802
M(A"ADE COUlir W—fty"DWARTMEII PLICATION #:AP 1110859
STATE OF FLORIDA DATE PAID:
DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM FEE PAID:
CONSTRUCTION PERMIT RECEIPT #:
40 DOCUMENT #: PR909445
CONSTRUCTION PERMIT FOR: OSTDS Repair
APPLICANT: Elston&Ruby Bradshaw
PROPERTY ADDRESS: 432 NW 111 Ter Miami, FL 33168
LOT: 3 BLOCK: 3 sUBDIvxsION: New Miami Shores Estates
PROPERTY ID #: 11-2136-001-0510 [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 [ 750 ] GALLONS / GPD existing septic tank CAPACITY
A [ ] GALLONS / GPD CAPACITY
N [ ] GALLONS GREASE INTERCEPTOR CAPACITY [MAXIMUM CAPACITY SINGLE TANK:1250 GALLONS]
K [ ] GALLONS DOSING TANK CAPACITY [ ]GALLONS @[ ]DOSES PER 24 HRS #Pumps [ ]
D [ 225 ] SQUARE FEET trench confiquration drainf SYSTEM
R [ ] SQUARE FEET SYSTEM
A TYPE SYSTEM: [x] STANDARD [ ] FILLED [ ] MOUND [ ]
I CONFIGURATION: [x] TRENCH [ ] BED [ ]
N
F LOCATION OF BENCHMARK: FFE 12.2'NGVD
I ELEVATION OF PROPOSED SYSTEM SITE [ 8.40 ] [ INCHES FT ] [ ABOVE BELOW BENCHMARK/REFERENCE POINT
E BOTTOM OF DRAINFIELD TO BE [ 48.40 ] [ INCHES FT ] [ ABOVE BELOW BENCHMARK/REFERENCE POINT
L
D FILL REQUIRED: [ ] INCHES EXCAVATION REQUIRED: [ 40.001 INCHES
1.-Existing 750 gal.septic tank,certified by Statewide Septic Connections Inc on 06/10/2013 to remain.
O 2.-Install 225 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.
H 4.-Invert elevation of drainfield to be no less than 8.67'NGVD.
5.-Bottom of drainfield elevation to be no less than 8.17'NGVD.
E The system is sized for 3 bedrooms with a maximum occupancy of 6 persons(2 per bedroom),for a total estimated flow
of 300 gpd.
R
SPECIFICATIONS BY: Teresa J Solomon TITLE:
�i Master Septic Tank Contractor
APPROVED BY: / /' � (/f� TITLE: Engineering Specialist II Dade CHD
Erlande Oaaiaca
DATE ISSUED: 06/18/2013 EXPIRATION DATE: 09/16/2013
DH 4016, 08/09 (Obsoletes all previous editions which may not be use-�e contrzct-Df(or docigripE) :S fE{Ig 'etol¢�25'0ft3 a
Incorporated: 64E-6.003, EAC SC:f
v 1.1.4 AP111.OS59 t,r E$0�36f "1 n
..Pvt. '%'FTATE Or- FLORIDA
-)386-
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DEPARTMENT OF HEALTEf
APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTBil CONSTI-JCT-ION P&IMiT
Per-mit A licai or; NTu;rt)f)r
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PART 11 - SITE PLAN
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Sca:e. Each block represents 5 feet and 1 inch = 50 feet.
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ALL CHANGES MUST BE APPROVED BY THE COUNTY HEALT-1 DEPARTMENT
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