AP-15-7589 Miami Shores Village � ��6 2016Building Department
AlAU 2 6 2096
10050 N.E.2nd Avenue,Miami Shores,Florida 33138 BY:
Tel:(305)795-2204 Fax:(305)756-8972
INSPECTION LINE PHONE NUMBER:(305)7624949 Tt+
FBC 20 ( q b —
BUILDING Master Permit No.-T�_ (r-23 9B
PERMIT APPLICATION Sub Permit No. AP 11,
❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION [—]RENEWAL
[PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: �'Si•� /?J //�. �'?.ri f'
a
City: Miami Shores County: Miami Dade Zia:
Folio/Parcel#: 019 D 'y QCT Is the Building Historically Designated:Yes NO
Occupancy Type: ES Load: Construction Type: Flood Zone: BFE: FFE:
OWNER:Name(Fee Simple Titleholder): �47`,LA ir)Q i Au /S Phone#:
Address: 23/6 lv i:" 4,16-
City: Mi'ii rHi' Spr?�,�, State: �� . Zip: .% _*3 /.3 SO
Tenant/Lessee Name: Phone#:
Email:
s
CONTRACTOR:Company Name: ✓ -P� �' � � 1 hone#: C7•
Address: `�JIJ/ )A/
City: /bra 6< t17 State: /. zip: ._23d/K
Qualifier Name: Phone#: JOS-3 Ml-o// v
State Certification or R ration#:.912.6 112 /7/_'? Certificate of Competency#: A &D i/o! !d Q__
DESIGNER:Architect/Engineer: Phone#:
Address: �� City: a/' Stater' Zip,-_---
Value
ips
Value of Work for this Permit:$cz _1;w)• Square/Linear Footag of Work: r,7r-V
Type of Work: ❑ Addition ❑ Alteration ElNew Repair/Replace ❑ Demolition
Description of Work: /_ 9r'�1ln,�i ecj �Z/Ward �.�'2z
--rO t-t,, cx FlE7zm ,TIL F�- i `#- 6--?n--4
Specify color of color thru tile:
Submittal Fee$ tC)" 0�3 Permit Fee$ ® CCF$ 1 . CK-) CO/CC$
Scanning Fee$ � Radon Fee$ DBPR$ 27' Notary
f $
Technology Fee$ 4 Training/Education Fee$ Double Fee$
Structural Reviews$ Bond$
TOTAL FEE NOW DUE$
(Revised02/24/2014)
Bonding Company's Name(if applicable)
Bonding Company's Address
City State Zip
Mortgage Lender's Name(if applicable)
Mortgage Lender's Address /
City I,--- State /- Zip
Application is hereby made to obtain a permit to do the work and installations as indicated. 1 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 b roved and a reinspection fee will be charged.
SignatureSignature
OWNER M AGENT CONT OR
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
26 day of^ y� 20 ( 6 ,by �day of tJ O U 20 Ka by
®VJ "
r'1 c`J .who is personally known to 9-&t-4 A,-__ 2,m PO ,who is personally known to
me or who has produced as me or who has produced FV(k Q9 as
identification and who did take an oath. identification and who did take an oath.
NOTARY PUBLIC: NOTARY PUBLIC:
rs�� &'�Q� (% 0
Sign: Sign:
Print: e@ s1 S® ®mp y\ Print:
*otr �?ue�c TERES J.SOLOMON Seal: „a�
Seal: * MY COMMISSION#FF
* 928161 e°�0a'•;ei�o TERES J.SOLpMON
mf ' EXPIRES:November 8,2019 » * MY COMMISSION#I F 928161
9j4FF0' Ban*ThrUSUO tNotaryU ®j v� EXPIRES:November 8,2019
******a*ax**xs** w+exaxxw*****rasaax+�xs*esrr:*►rasa**sssa***sxse**ssa*' ` a* on ugap 5* x**ss**s**a** ***
APPROVED BYPlans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)
c
This instrument prepared by:
CHRISTOPHER P. KELLEY, Esquire
11098 Biscayne Boulevard, Suite 205
Miami, FL 33161
POWER OF ATTORNEY
Know All Men By These Presents
That I, AIMEE DEMIDUKE, have made, constituted and appointed and by these presents
do make, constitute and appoint NANCY DOWSON my true and lawful attorney for me and in my
name, place and stead, giving and granting unto said attorney full power and authority TO
REPRESENT ME and handle all matters concerning the property located at 246 NE 105 Street,
Miami Shores, FL 33138,
specifically concerning the following three (3) open permits:
1. Open Permit No. FW-9-14-2124 (Replace existing chain link and wood fence)
2. Expired Permit No. DS-10-14-2174 (Replace driveway with stamp concrete)
3. Expired Permit No. PI-9-14-1907 (Install trench drain field)
TO REPRESENT ME at any hearings or government proceeds in regard to these
matters, and to sign any and all documents required by Village of Miami Shores
against the property owned by AIMEE DEMIDUKE;
and all documents necessary to accomplish the same, in and about the premises as fully, to all
intents and purposes,as I might or could do if personally present,with full power of substitution and
revocation, hereby ratifying and confirming all that my said attorney or his substitute shall lawfully
do or cause to be done by virtue hereof.
IN WITNESS WHEREOF, I have hereunto set my hand and seal this Iq day of August,
2016.
Sea d d delivered in the presence of:
it ss R,�nature / AIMEE DEMIDUKE
Print na e -
Witness i turey � O
Print name
STATE OF FLORIDA
COUNTY OF7� }
THE FOREGOING INSTRUMENT was acknowledged before me this day of August,
2016, by AIMEE DEMIDUKE, who produced —L-/)L' as identification.
NOTARY PUBLIC, fWte of FLORIDA at Large
My commission expires: 44-4''�t41r
=O�pAY PV Sherry Rao
State of Florida
* *MY COMMISSION#FF 110092
IPA
�oP�17 Expires:April 6,2018
Bonded through Florida
D1Y[E[OR OF
' Envivonilmentdt Htdth
O Florida Health
Miami-Dade County �j0
Q� OSTDS/Well Didion
90
11805 SW 26th Street-Miami,FL 33175 O
0 Inspector r Date
Address�r
E: OSTDS#
a
Comments:
Signature
904
STATE OF FLORIDA PEST #: 13-SC-1556389
DEPARTMENT OF HEALTH APPLICATION #:AP1157589
ONSITE SEWAGE TREATMENT AND DISPOSAL DATE PAID:
SYSTEM FEE PAID
CONSTRUCTION PERMIT _ s
�.
Lgp
-�'�`�p/�� RECEIPT #:
DOCUMENT #: PR948815
� Z���CONSTRUCTION PERMIT FOR: OSTDS Repair
APPLICANT: Rober Demiduke
PROPERTY ADDRESS: 246 NE 105 St Miami,FL 33138
LOT: 7-8 BLOCK: 120 SUBDIVISION: Miami Shores
PROPERTY ID #: 11-2136-013-0490 [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 [ 900 ] GALLONS j GPD Exist.septic tank to remain CAPACITY
A [ 0 1 GALLONS / GPD CAPACITY
N L 0 l GALLONS GREASE INTERCEPTOR CAPACITY [MAXIMUM CAPACITY SINGLE TANK:1250 GALLONS]
K [ 1 GALLONS DOSING TANK CAPACITY I ]GALLONS @[ ]DOSES PER 24 HRS #Pumps [ 7
D [ 225 1 SQUARE FEET Trench configuration drain SYSTEM
R [ 0 ] SQUARE FEET SYSTEM
A TYPE SYSTEM: [x] STANDARD [ ] FILLED [ ] MDUND [ ]
I CONFIGURATION: [xl TRENCH [ 1 BED [ 1
N
F LOCATION OF BENCHMARK: FFE 12.0'NGVD
I ELEVATION OF PROPOSED SYSTEM SITE [ 21.601 [ INCHES FT ] [ABOVE BELOW BENCM-1ARK/REFERENCE POINT
E BOTTOM OF DRAINFIELD TO BE [ 61.56 ] [ INCHES FT ] [ABOVE BELOW BENCHMARK/REFERENCE POINT
L
D FILL REQUIRED: [ 0.001 INCHES EXCAVATION REQUIRED: [ 52.001 INCHES
O 1.-Existing 900 gal.septic tank,certified by"Drain Master"on 8/20/2014 to remain.'
2.-Install 225 sf of drainfield in trench configuration.
T 3.-Install 12"of slightly limited soil at the bottom of the drainfield.
H 4.-Perimeter of excavation area shall be at least 2 ft wider and longer than the proposed absorption bed or drain trench.
E (Comments Continued on Page 2.)
R
SPECIFICATIONS BY: Yudeisy Martin TITLE:
APPROVED BY: TITLE: Engineering Specialist II Dade CED
Betsy no
DATE ISSUED: 08/26/2014 EXPIRATION DATE: 11/24/2014
DH 4016, 08/09 (Obsoletes all previous editions which may not be used)
Incorporated:. 64E-6.003, FAC Page 1 of 3
v 1.1.4 AP1157589 SE936900
t
NOTICE OF RIGHTS
A party whose substantial interest is affected by this order may petition for an
administrative hearing pursuant to sections 120.569 and 120.57, Florida Statutes. Such
proceedings are governed by Rule 28-106, Florida Administrative Code. A petition for
administrative hearing must be in writing and must be received by the Agency Clerk for the
Department,within twenty-one(21) days from the receipt of this order. The address of the
Agency Clerk is 4052 Bald Cypress Way, BIN#A02, Tallahassee, Florida 32399-1703. The
Agency Clerk's facsimile number is 850-410-1448.
Mediation is not available as an aftemative remedy.
Your failure to submit a petition for hearing within 21 days from receipt of this order
will constitute a waiver of your right to an administrative hearing, and this order shall become
a'final order.
Should this order become a final order, a party who is adversely affected by it is
entitled to judicial review pursuant to Section 120.68, Florida Statutes. Review proceedings
are governed by the Florida Rules of Appellate Procedure. Such proceedings may be
commenced by filing one copy of a Notice of Appeal with the Agency Clerk of the
Department of Health and a second copy, accompanied by the filing fees required by law,
with the Court of Appeal in the appropriate District Court. The notice must be filed within 30
days of rendition of the final order.
• DOCUMENT #: PR948815
5.-Invert elevation of drainfield to be no less than 7.37'NGVD.
6.-Bottom of drainfield elevation to be no less than 6.87'NGVD.
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.
THIS PERMIT IS NOT FOR ANY ADDITIONS.