PL-14-1204 Miami Shores Village
BuildingDepartment p ° r�T �
_
10050 N.E.2nd Avenue,Miami Shores,Florida 33138 JIJN 1 0 2014
Tel: (305)795.2204 Fax: (305)756.8972 ^
INSPECTION'S PHONE NUMBER:(305)762.4949 ;2
FBC 20
BUILDING Permit No.
PERMIT APPLICATION Master Permit Noiez
Permit Type: PLUMBING
JOB ADDRESS: is tO !± St
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#:
Is the Building Historically Designated:Yes NO Flood Zone:
OWNER:Name(Fee Simple Titleholder): A b c-o Phone#:
Address: 6 Ne 104-S+
City: rvs Ir_f' to re's State: Zip: 3 31 36
TenanVUssee Name: Phone#:
Email:
CONTRACTOR: Company Name: S+s:bes- 'de - Phone#: '31 33
Address: lun4o N v\j m Asre *- �.
r
City: Stater Zip:
Qualifier Name: Tares, ' Phone#:
State Certification or Registration#: ®Ct 2- Certificate oeCompetency#:
Contact Phone#: Email Address:
DESIGNER: Architect/Engineer: Phone#:
Value of Work for this Permit:$450® Square/Linear Footage of Work: -300
Type of Work: ❑Address ❑Alteration ❑New �Repair/Replace ❑Demolition
Description of Work: Mo :KV)K 1- 300
fin•. Ck D fek�n `E=e V
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Submittal Fee$ Permit Fee$ 1. -Z/ CCF$ CO/CC$
Scanning Fee$ Radon Fee$ DBPR$ Bond$
Notary$ Training/Education Fee$ Technology Fee$
Double Fee$ Structural Review$
TOTAL FEE NOW DUE$
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
Owner or Agent Contractor
The foregoing instrument was acknowledged before me this 2. The fore oing instrument was acknowledged before me this
day of e J ,201 ,by d%j1�0+011! day of U/1 ,20� .,bye' aS
/el1wr"-
who is personally known to me or who has produced v' who is ersonally known to a or who has produced
As identification and who did take an oath. as identification and who did take an oath.
NOTARY PUBLIC: NOTARY PUBLIC:
Sign: c Si
Print: C � �� SO��M P
My Commission Expires: y Co 1 :00110 St8te of Flodde
TERESA J SOLOMON �p`�"`r °<t� ,loanna M F®Ildano
• e My COMMlasion FF 082753
-•; •"_ MY COMMISSION#EE131936 g,,,1,S otliyj20i8
(407)3@8-01537) �•,` FW W8N0WryS6rVi--eom
APPROVED BY �,�O/(y Plans Examiner a Zoning
Structural Review Clerk
(Revised3/12/2012)(Revised 07/10/07XRevised 06/10/2009)(Revised 3/15/09)
FLORIDA
` DEPARTMENT OF HEALTH
It�. ,I APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTPUCTION PERMIT
Permit Applicai-on Number.�, ,•__•_
PART 11 SITE PLAN----
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Scale: Each block represents 5 feet and I inch= 50 feet.
or 'ad
JUN.1 2914
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Not)s: .CA 1 4-n r 19 , NE 10 S-r 33136 _
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Sitt+ Plant submitted by: 1 2 1 � e' al--
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Signature Title
Plat Approved Not Approved Date
By — County/ Health Departm:;
ALL CHANGES MUST BE APPROVED BY THE COUNTY HEALTH DEPARTMENT
ON 40-5,10%(Reptaw-.HFISM F=401 6 vth9rh mal be U.'ed) P7-• '?
f%mk Iumba:5Z44.Cttt•40i5&k
PERMIT #: 13-SC-1518158
APPLICATION #:AP 1133916
STATE OF FLORIDA
-Q1?'iP4"2x=T OF HEALTH DATE PAID:
ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM FEE PAID:
CONSTRUCTION PERMIT RECEIPT #:
41D DOCUMENT #: PR928690
CONSTRUCTION PERMIT FOR: OSTDS Repair
APPLICANT: (Calvin Harris&Abdul Mukhtar)
PROPERTY ADDRESS: 15 NE 104 St Miami, FL 33138
LOT: 8,9 BLOCK: suBDIVIsioN: Beverly Glen
PROPERTY ID #: 11-2136-01240090 [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 I GALLONS / GPE, Septic CAPACITY
A [ 0 I 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 #Pt2 ]
D [ 300 ] SQUARE FEET Trench configuration drain SYSTEM
A TYPE SYSTEM SQUARE XI STANDARD [ I FILLED EET SYSTEM MOUND �0\ 0
I CONFIGURATION: [x] TRENCH [ ] BED [ ] C° �a �C 6`!'�%W�a\1�6
F LOCATION OF BENCHMARK: FFE 12.77'NGVD vo' C�O'S sot\® \\\'0V. � ®d
I ELEVATION OF PROPOSED SYSTEM SITE [ 21.20 ] [ INCHES FT ] ABOVE RfC/REFERENCE POINT
E BOTTOM OF DRAINFIELD TO BE [ 60.24 ] [ INCHES FT ] [ABOVEB ENCHMARK/REFERENCE POINT
L
D FILL REQUIRED: [ 0.001 INCHES EXCAVATION REQUIRED: [ ] INCHES
THIS PERMIT HAS BEEN EXTENDED FOR 90 DAYS TO EXPIRE ON 7/30/2014.Original permit approved by Betsy
Lange. "Ore
T 1-Install a 1050 gal min.septic tank with an approved filter. V W"
H 2-The licensed contractor installing the system is responsible for installing the minimum category of%aWktoo with s.64E-6.013(3)(f),FAC.
E 3.-Install 300 sf of drainfield in trench configuration.
4-Invert elevation of drainfield to be no less than 8.25'NGVD.
R
SPECIFICATIONS BY: Teresa J Solomon TIS: Master Septic Tank Contractor
APPROVED BY: TITLE: Engineer Supervisor III Dade CHD
Astrid V Edwards
DATE ISSUED: 01/31/2014 EXPIRATION DATE: 05/01/2014
DH 4016, 08/09 (Obsoletes all previous editions which may not be used.)
Page 1 of 3
Incorporated: 64E-6.003, FAC
V 1.1.4 AP1133916 SE918560
a
DOCUMNT #: PR928590
6.-This permit includes the abandonment of the existing septic tank.
The system is sized for 4 bedrooms with a maximum occupancy of 8 persons(2 per bedroom),for a total estimated flow of
400 gpd.
THIS PERMIT IS NOT FOR ANY ADDITIONS.