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PL-06-90 it Miami Shores Village Building Department 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 Tel:(3052795.2204 Fax-.A305�756.8972 0 BUILDING ,��� Permit No.`�-]-�-D�'Q0 PERMIT APPLICATION JA6� 226TH FBC 2001 m aster Permit No. Permit Type(circle): Building Electric Plumbing Mechanical �q Roofing Owner's Name(Fee Simple Titleholder) Ale,i- lltJ� Phone# 10-5 Owner's Address l S & &,L, 9 -5-S City OLOZ4a-; k g/t eC State ::;7---1141 Zip 'f ? Tenant/Lessee Name C1 ,e 0t' Ot4mv 1-e Phone# Job Address(where the work is being done) City Miami Shores Villaee County Miami-Dade Zip 7i S G Is Building Historically Designated YES NO 1---- Contractor's Company Name J `l��e Jere Phone# Contractor's Address e7 f City .e a 4 State 41 Zip -�5 l/ Qualifier `-•� �i �'�i State Certificate or Registration No. F- O 7 Z Z Certificate of Competency No. Architect/Engineer's Name(if applicable) Phone# $Value of Work For this Permit Square Footage Of Work: `j O Type of Work: DAddition ElAlteration ONew Repair/ReplaceEl Demolition P Describe Work: r� y� Submittal Fee$ Permit Fee$ CCF$ CO/CC. Notary$s, Training/Education Fee$ 0 Technology Fee$ � Scanning CC) Radon$ Zoning Bond$ Code Enforcement$ Structural Plan Review.$ rah. Total Fee Now Due$ j . (Continued on opposite side) ',IAS 11 PAID 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 einspection a will be charged. Signature / Signature Owner or Agent actor The fore oing instrument was acknowledged before me this t j The for oing instrument was acknowledged before me this day ofJ A-1`( ,2 by� 1rr-T'. �.P�11� , day Of ''"t N4- ,20QgbyA Ze--PC; who is personally known to me or who has produced who is personally known to me or who has produced -) As identification and�,�o A �p �© Y hUbL� •� � as identification and who did take an oath. NOTARY PUBLIC: Yorleny Herriande , OTARY PUBL C: Nq LIGSWE OF A Sign: Commission#D 64s Sign: orlen and fidil Ir 17 9 Y Print: 'C Co.,in Print: 7 2009 C. My Commissi %Expi�re�s:­-- My Co scion Expires:$0 de ru Adanri on o• APPLICATION APPROVED BY: - j2 �{/ Plans Examiner Engineer chc 05!13/03 Zoning j . � * t i STATE OF FLORIDA CENTRAX l[: 13-SGr-27349 DEPARTMENT OF HEALTH DATE PAID: ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM FEE PAID : $ CONSTRUCTION PERMIT RECEIPT : OSTDSNBR : 05-3885- R CONSTRUCTION PERMIT FOR: [ ]New System [ ]Existing System [ ]Holding Tank [ ] Innovative Other [ % l Repair [ ]Abandonment j ]Temporary [ NA. ] APPLICANT: Ruby, Helen AGENT: SR089722, Zero Andrew PROPERTY STREET ADDRESS: 145 NK 95 St Miami Shores FL 33150 LOT: 14 BLOCK: 5 SUBDIVISION: Bonmar Park [Secti8n/Township/Range/Parcel No.] PROPERTY ID : 11-3101-024-0310 [OR TAX ID NUMBER] SYSTEM MUST BE CONSTRUCTED IN ACCORDANCE WITH SPECIFICATIONS AND STANDARDS OF CHAPTER 64E-6,FAC DEPARTMENT APPROVAL OF SYSTEM DOES NOT GUARANTEE SATISFACTORY PERFORMANCE FOR ANY SPECIFIC TIME PERIOD. 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 PROPERTY DEVELOPMENT. SYSTEM DESIGN AND SPECIFICATIONS T [ 900 ]Gallons SEPTIC TANK A [ 0 ]GMULTI-CHAMBERED/IN SERIES: [y N [ 0 ]GAALLLLOONNSS GREASE INTERCEPTOR CAPACITY ] MULTI-CHAMBERED/IN SERIES: jy l K [ 0 ]GALLONS DOSING TANK CAPACITY [ 0 ]GALLONS @ 10 ] DOSES PER 24 HRS # PUMPS[ 0 ] D [ 225 ]SQUARE FEET PRIMARY DRAINFIELD SYSTEM R [ 0 ]SQUARE FEET SYSTEM A TYPE SYSTEM: [ N ]STANDARD [ N ]FILLED I CONFIGURATION: [ N ]TRENCH [ N ]BED [ N ]MOUND [ N ] N [ N ] F LOCATION TO BENCHMARK: I ELEVATION OF PROPOSED SYSTEM SITE [ 0.0 ] [ FEET E BOTTOM OF DRAINFIELD TO BE ] [ ]BENCHMARK/REFERENT DINT L [ 0.0 ] [ } [ IBENCHMARK/REFERENCE POINT D FILL REQUIRED: [ 0.0 ]INCHES EXCAVATION REQUIRED: j 0.0 ] INCHES OTHER REMARKS: 1.-rnO12 225 8f o£ drainfteld in trench asonfi 2.-r.xisting 900 gaa. septic tank 9'aration. ..a,maLi, , certified by n A super Septic Tank on 12-05-2005.n to 3--pert elevation of �I 4.-Bottom of rainfield to be no less than 10.50' NGVD. drainfield elevation to be no less than 10.00' NMP. THIS PENT ISNOT FOR "AWITION(s) ,� It? SPECIFICATIONS BY: Andre, pa TITLE: APPROVED BY: Andre, TITLE: Professional 8n in Dade DATE ISSUED: 12/12/05 CHD EXPIRATION DATE: 3/12/06 DH 4416, 03/97 (Obsolete, previous editions wtu (Stock Number: 5744-001-4016-0) - �� not be used) [Dates cons soa6-1j , � Miami Shores Village ` ��, 10050 N.E. 2nd Avenue KOMI" Miami Shores, FL 33138-0000 kgoW� Phone: (305)795-2204 Fax: (305)756-8972 Permit Permit Status:APPROVED Issue Date: 1/12/2006 Expires: 01/11/2007 Permit Number: PL-1-06-90 Owner's Name: SUSAN KOMORNIK Phone: (305)364-0113 Permit Type: Plumbing - Residential Parcel#: 1131010240310 Work Classification: Drainfield Block: Lot: Job Address: 145 95 Street NW Section: PB: Miami Shores Village, FL Contractor(s) Phone Primary Contractor Total Square Feet: 300 A SUPER SEPTIC TANK, INC. 305-940-2828 Yes Total Valuation: $ 1,200.00 Comments-7Comments-7 Re uired Inspections DRAINFIELD REPAIR Rough Landscaping Final Additional Information Type of Work:DRAINFIELD Type of Piping: Additional Info:225 SQ FT Bond Return Classification:Residential 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 zoning. Futhermore, I authorize the above-named contractor to do the work stated. Fees Due Amount Invoice Number Amt Due Amt Paid Bond Type-Owners Bond $300.00 PL-1-06-23404 $489.00 $489.00 CCF $1.20 Total: $489.00 Education Surcharge $0.40 Miscellaneous Fee $75.00 Notary Fee $5.00 Permit Fee-Additions/Alterations $100.00 Scanning Fee $3.00 Technology Fee $4.40 Total: $489.00 Building Department File Copy NOTICE: In addition to the requirements of this permit, there may be additional restrictions applicable to this property that may be found in the public records of this county. AND THERE MAY BE ADDITIONAL PERMITS REQUIRED FROM OTHER GOVERNMENTAL ENTITIES SUCH AS WATER MANAGEMENT DISTRICTS,STATE AGENCIES,OR FEDERAL AGENCIES.