PL-15-2416 4' Miami Shores Village
10050 N.E.2nd Avenue NE
Miami Shores,FL 33138-0000 `
Phone: (305)795-2204
Expiration: 0 /30/2016
Project Address Parcell Number Applicant
10676 NE 11 Avenue 1122320280300
GILDA GREENE LAWRENCE
Miami Shores, FL 33138-2120 Block: Lot:
Owner Information Address Phone Celli
GILDA GREENE LAWRENCE 10675 NE 11 Avenue
MIAMI SHORES FL 33161-2120
Contractor(s) Phone Cell Phone Valuation: $ 8,500.00
MR C'S PLUMBING&SEPTIC INC (305)651-7859 Total Sq Feet: 400
Type of Work:SEPTIC TANK&DRAINFIELD INSTALLATI Available Inspections:
Type of Piping: Inspection Type:
Additional Info:
HRS Approval
Bond Return: Final
Classification:Residential Scanning:3 Review Plumbing
Fees Due Amount Pay Date Pay Type Amt Paid Amt Due
Bond Type-Owners Bond $500.00 Invoice# PL-9-15-57179
CCF $5.40 10/02/2015 Check#:1507 $500.00 $332.40
DBPR Fee $4.50
DCA Fee $4.50 10/02/2015 Check*3002 $168.30 $164.10
Education Surcharge $1.80 10/022015 Credit Card $164.10 $0.00
Permit Fee $300.00 Bond#:2857
Scanning Fee $9.00
Technology Fee $7.20
Total: $832.40
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.
October 02, 2015
Authorized Signature:Owner / Applicant / Contractor t Agent Date
Building Department Copy
October 02,2015 1
Miami Shores VillageFrc
' `
Building Department SEP 2 2015
10050 N.E.2nd Avenue,Miami Shores,Florida 33138 ----
Tel:(305)795-2204 Fax:(305)756-8972
INSPECTION LINE PHONE NUMBER:(30S)762-4949 _
FBC 201 (
BUILDING Master Permit No. Fu� -2•k4 )6
PERMIT APPLICATION Sub Permit No.
❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
PLUMBING ❑ MECHANICAL [:]PUBLICWORKS ❑ CHANGE OF ❑CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: 10675 NE 11 th Avenue d
City: Miami Shores County: Miami Dade Zip: 33(3 e
Folio/Parcel#: it as 5 I "yag 010 Is the Building Historically Designated:Yes NO X
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER:Name(Fee Simple Titleholder):Gilda G. Greene-Lawrence Phone#:305 333 7300
Address:10675 NE 11 th avenue
City: Miami Shores State: Florida Zip: 33138
Tenant/Lessee Name: Phone#:
Email: gilda.gl@hotmail.com
CONTRACTOR:Company Name: t 6" Phone#:
Address: 1%)2- Ivid ay
City: wj l,� State: �[, Zip:
33 t69
Qualifier Name:_ " C11R` k Phone#:
State Certification or Registration#: I"IS36 Certificate of Competency#:
DESIGNER:Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for this Permit:$ b Square/Linear Footage of Work: 6fWY
Type of Work: ❑ Addition ❑ Alteration ❑ New ['Repair/Replace ❑ Demolition
Description of Work: -t^ t& �altt
Specify color of color thru tile:
Submittal Fee$ Permit Fee$ CCF$ CO/CC$
Scanning Fee$ Radon Fee$ DBPR$ Notary$
Technology Fee$ Training/Education Fee$ Double Fee$ �'
Structural Reviews$ Bond$ ✓l
TOTAL FEE NOW DUE$ ^
(Revised02/24/2014) )` y 1 O
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 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.
4�� 1 - 644--'0- -
Signature Signature
OWNER or AGENT CONTRACTOR
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
_-1-1 day of by day of "Pr- 20 IS .by
who is personally known to .who is personally known to
me or who has produced 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: Sign: 41
s
AV
Print: Print: M04 UA
�1P�Y PV6 �
Seal: z°, .`�-: Notary Public-State of Florida Seal: Notary Public-State of FhWwW
My Comm.Expires Sep 19.2017 My Comm.Expires Oct 23.2018
Commission#FF 055732 Commission#FF 136887
" ,
5onded Through National Notary Assn•
**** ****************** *********************************************
APPROVED BY �% %`� Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)
PERMIT #: 13-SC-1628843
STATE OF FLORIDA _ APPLICATION #:AP1203474
DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT AND DISPOSAL DATE PAID:
SYSTEM FEE PAID:
CONSTRUCTION PERMIT
RECEIPT #•
01P DocuxwT #: PR986972
CONSTRUCTION PERMIT FOR: OSTDS Repair
APPLICANT: Robert Lawrence
PROPERTY ADDRESS: 10675 NE 11 Ave Miami,FL 33138
LOT: 2 BLOCK: 3 SUBDIVISION:
PROPERTY ID #: 11-2232-028-0300 [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 EXIT 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 Septic CAPACITY
A [ 0 ] GALLONS / GPD CAPACITY
N [ 0 ] GALLONS GREASE INTERCEPTOR CAPACITY [MAXIMUM CAPACITY SINGLE TANK:1250 GALLONS]
K [ I GALLONS DOSING TANK CAPACITY [ NS @[ ]DOSES PER 24 HRS #Pumps [oe
I
D [ 400 ] SQUARE FEET Bed configuration drainfiel YsTEM
R [ 0 I SQUARE FEET SYSTEM
A TYPE SYSTEM: [x] STANDARD [ ] FILLED [ ] MOUND [ ]
I CONFIGURATION: [ ] TRENCH [xl BED [ ]
N
F LOCATION OF BENCHMARK: FFE:9.7'NGVD
I ELEVATION OF PROPOSED SYSTEM SITE [ 10.80 ][ INCHES FT ][ABOVE BELOW BENCHMARK/REFERENCE POINT
E BOTTOM OF DRAINF IELD TO BE [ 60.84][ INCHES FT ][ABOVE BELOW BENCHMARK/REFERENCE POINT
L
D FILL REQUIRED: [ 0.00] INCHES EXCAVATION REQUIRED: [ 62.001 INCHES
0 I.-Install a 1050 gal min.septic tank with an approved filter.
2.-The licensed contractor installing the system is responsible for installing the minimum category of tank in accordance
T with s.64E-6.013(3)(f),FAC.
H 3.-Install 400 sf of drainfield in bed configuration.
4.-Install 12"of slightly limited soil at the bottom of the drainfield.
E 5.-Perimeter of excavation area shall be at least 2 ft wider and longer than the proposed absorption bed or drain trench.
R (Comments Continued on Page 2.)
SPECIFICATIONS BY: Kemble Ettrick TITLE:
Engineering Specialist II Da
APPROVED BY: TITLE. g g SPe de CHD
Betsy Lange-olmno
DATE ISSUED: 09/09/2015 EXPIRATION
DATE: 12/08/2015
DH 4016, 08/09 (Obsoletes all previous editions which may not be used)
Incorporated: 64E-6.003, EAC Page 1 of 3
v 1.1.4 AP1203474 SE970850
1
.�F.� k '� '��";" '�'"= � �-aa3�r�. ' mak:•..
ar AL3 5�•- F �, / pS H�"
T
._ ,;rr'" „� 'i ':'� >, - -a;. ..:.t.
�'
zr
y
or OVNM-�
17,
_-.
r
rr �
r� o
i,
•,r
� �," � � ark w �� ,�,�'.. -'-9 a �' �� •�' �� �
—
�
< d
R.
s
�,^ ,, � r ,N %� 3 x '_ � '` 'ire•�9 �y9 �fi �,`&��� r
,� i k 3 ,� .a•-x 1 �''.ate, ,a� � � / `a{ Z�'�
;y
.. ..,� r "' ;: n�� / w /i,f,i� ',. � � ,,a ��b _a s� �.J•-U`� �' 3 �
"��' ����,�,e-. - ;� a'� ,aj:, Z�. ,��y� -� y- �.r � � x / � s�/,l/ r. ��� y��r ��' ✓ �.�� ��x, �:-
,., ar „3 �',, ,^. �, '� ;,, � x ,.,�c$ k ,.,.; � (/:� _ ._ .. •; k / � ,y 3,:�kr r' �E :��1.. L ,,. '.
y
,
3
.a
a
r
1
:... .y„x',:, � ,, a `t� •' v a.n. ,% � :x: „a§;,aa/�k d ddb'^.i �!� �.',:' "''az�y s �, r
•a }, 8�fd:. £ .v�' � � �/',,,ice/ xs'k i//fi/�ii t I ,•�
—
tz
9 a yy, t � % f i' `` � __ � ,€, u kms• ,.Sxsa �,i"@ 3� IaS� � ,.
r.
� ".•�' � ,�,:,, � fan r -,k Y ,� � ,�
i I rIIM,lrl��lwtlsl I I
r
�� � €e.>' �`• ill. ! ''.�' .,t'. .ia
y �
I