PL-16-571 l � _ •r-*
Miami Shores Village MAR 082016
Building Department :
10050 N.E.2nd Avenue,Miami Shores,Florida 33138
Tel:(305)795-2204 Fax:(305)756-8972
INSPECTION LINE PHONE NUMBER:(305)762-4949
FBC 201L1
BUILDING Master Permit No:�! 1 1 b '
PERMIT APPLICATION Sub Permit No.
❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
&I-PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: I N W O S-�Y'kx-C
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#: 11 klS Olo Oc " Is the Building Historically Designated:Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
2r
OWNER:Name(Fee Simple Titleholder): Ala-'w
yamez Phone#: 2305-57-2`ciff
Address: V-j l(3-11'-3
City: i A yen e S State: Zip: 33 4 to8
Tenant/Lessee Name: 11 Phone#:
Email:
A ,,
CONTRACTOR:Company Name: t��Y. lS eW9,nM1/�6i n 4 S� e,-Tr. 30S-•6S 1-•7SJ59�-54,52
Address: /9932 AJ� 2-40( VP-2r4� ll'• O. Coq�jZ 3�
City: State: Zip:
Qualifier Name: KFiijdo -- -C�hi(L Phone#:
State Certification or Registration#: -5K 061536 Certificate of Competency M
DESIGNER:Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for this Permit:$ „e ao Square/Linear Footage of Work: Z d0 /2
Type of Work: ❑ Addition ❑ Alteration ❑ New Repair/Replace ❑ Demolition
Description of Work: IY-J cl,'L -i. 'b'l, W&
Specify color of color thr tile:
Submittal Fee$ �� Permit Fee$ ��rr� CCF$_j
rr CO/CC$
Scanning Fee$ S� - 6) Radon Fee$.2=, W DBPR$ '01 Notary$
Technology Fee$ a�� Training/Education Fee$ `[�� Double Fee$
Structural Reviews$ Bond$
TOTAL FEE NOW DUE$ (R
(Rev1sed02/24/2014)
or '"b
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 on estimated value exceeding$2500,the applicant must
promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person
whose property is subject to attachment. Also,a certified copy of the recorded notice of commencement must be posted at the job site
for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the
inspection will not be approved an in pection fee will be charged.
Signatur Signature
OWNER or AGENT CONTRACTOR
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
day of IVI�l,,1-(,h ,20 1(. .by :_day of A&C(� '20 16 by
_4kA"d j 64 AleZ- ,who is personally known to rplakP L who is person known to
me or who has produced AD as me or who has produced as
identification and who did take an oath. identification and who did take an oath.
NOTARY PUBLIC- NOTARY PUBLIC:
Sign: Sign:
Print: Print:
.�� r n••. YL A MENDES
Seal: '°` Notary Public State of Florida s..$o� �e••,
a Seal: 's
Notary Public-State of Florida
r'k My Comm.Expires Sep 19,2017 Y
Commission#FF 055732 '=MY Comm.Expires Oct 23,2018
OF F, Borated jpt�Notarypp�......�Coommission#FF 138597
I11111t1. /1/1 NVIRIOY 11�0�Natior�
APPROVED BY 3-3-A, Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)
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Inspection Worksheet
Miami Shores Village
10050 N.E.2nd Avenue Miami Shores,FL
Phone: (305)795-2204 Fax:(306)758-8872
Inspection Number: INSP-253920 Permit Number. PL-3-16-571
Scheduled Inspection Date:August 30,2016 Permit Type: Plumbing -Residential
Inspector Hernandez,Rafael
Inspection Type: Final
Owner. GOMEZ,ALEXANDER&KARLA Work Classification: Dmingeld
Job Address:186 NW 109 Street
Miami Shores,FL 33138-4317 Phone Number
Parcel Number 1121360100240
Project <NONE>
Contractor. MR C'S PLUMBING&SEPTIC INC Phone:(305)651.7859
Building Department Comments
omm
DRAIN FIELD INSPECTOR COMMENTS False
Inspector Comments
Passed GREEN TAG IN FILE
Failed
Correction a
Needed
Re-Inspection
Fee
No Additional Inspections can be scheduled until
re-inspection fee is pald.
NNW
£
Miami Shores Village ,
10050 N.E.2nd Avenue NW
z
Miami Shores,FL 33138-0000y`
Phone: (305)795-2204
E
Expiration: 0910412016
Project Address Parcel Number Applicant
186 NW 109 Street 1121360100240
Miami Shores, FL 33138-4317 Block: Lot: ALEXANDER&KARLA GOMEZ
Owner Information Address Phone Cell
ALEXANDER&KARLA GOMEZ 186 NW 109 Street
MIAMI SHORES FL 33168-4317
186 NW 109 Street
MIAMI SHORES FL 33168-4317
Contractor(s) Phone Cell Phone Valuation: $ 3,000.00
MR C'S PLUMBING&SEPTIC INC (305)651-7859
__�---�- -- � --_ ---. Total Sq Feet: 200
Type of Work: Available Inspections:
Type of Piping: Inspection Type:
Additional Info: HRS Approval
Bond Retum: Final
Classification:Residential Scanning:3 Review Plumbing
Fees Due Amount Pay Date Pay Type Amt Paid Amt Due
Bond Type-Owners Bond $500.00
CCF Invoice# PL-3-16.58883
$1.80 03/08/2016 Credit Card $67.80 $550.00
DBPR Fee $2.00
DCA Fee $2,pp 03/03/2016 Credit Card $50.00 $500.00
Education Surcharge $0.80 03/08/2016 Credit Card $500.00 $0.00
Permit Fee $100.00 Bond#:3006
Scanning Fee $9.00
Technology Fee $2.40
Total: $617.80
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 f�pgoing information is accurate and that all work will be done in compliance with all applicable laws regulating
construction and zoning. Futhermoree above-named contractor to do the work stated.
March 08,2016
Authorized Sig re:Owner / Applicant / Contractor / Agent Date
Building Department Copy
March 08,2016 1
nmaT #:13-SC-1663015
APPLICATION #:AP1226455
STATE OF FLORIDA DATE PAID:
DEPARTNEW OF HEALTH
ONSITE SEWAGE TEdU01 ENT AND DISPOSAL SYSTEM FEE PAM:
CONSTRIICTION PERMIT RECEIPT #:
PRI 006626
CO3iSTRUCTICN PERMIT FOR: OSTDS Repair +'
i
APPLICANT: Karla Gomez
PROPERTY ADDRESS: 1S6Nw 109 St Miami Shores,FL 33168
LOT: 8
BLOCK: 213 on MSION: Dunnings Miami Shores
j [SECTION, TOWNSHIP, RANGE, PARCEL NU1IDERI
PROPERTY ID #: 11-2136-010-0240 [OR TAX M NUMMI
SYSTEM MUST BE CONST IN ACCORDANCE WITH SPECIFICATIONS AND STANDARDS OF SECTION
381.0065, F.S., AND CHAPTER 64E-6, F.A.C. DEPARTHM APPROVAL OF SYSTEM DOES NOT GUARANTEE
SATISFACTORY PERFORMAyCE FOR, ANY SPECIFIC PERF OF TIME. ANY CHANGE IN MATERIAL FACTS,
WHICH SERVED AS A BASIS FOR ISSUANCE OF THIS IT, REQUIRE THE APPLICANT TO MODIFY THE
PERMIT APPLICATION. SUCH MODIFICATIC" 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 PERMITTxyG REQUIRED FOR DEVELOPMENT OF THIS PROPERTY.
'I m
SYSTEM DESIGN AND SPECIFICATIONS
T [ 750 I GALLONS / GPD Septic(EXistinAI CAPACITY
A [ 0 ] GALLONS 1 G9D CAPACITY
N [ 0 I GAS CREASE INTERCEPTOR CAPACITY [mumM CAPACITY SINGLE TANK:1250 GALLONS]
K [ I GALLcros Dosn;G TANK CAPACITY [ ]GALLONS #[ IDOSES PER 24 HRS #Pumps I I
D I 200 I SQUARE FEET Bed Drainfield SYS'T'EM
R [ 0 I SQUARE FEET SYSTEM
A TYPE SYSTEM: [x] STANCARD [ I FILLED [ ] >!K [ ]
I CONFIGURATICN: [ i TRENCH Ixl RED [ l
N
F LOCATION OF ARK: FFE 12.8'NGVD
I ELEVATICK OF PROPOSED SYSTEM SITE 1 22.801&MMSI FT I[ABOVE BEraW BE10CHMAXW2EFERENCB POINT
E BOTTOM OF DRAINFIELD TO HE [ 62.80 I INCHES I I ABOVE'1-..�J'B�C POINT
L
D FILL REQUIRED: [ 0.001 INCHES EXCAVATICN REQUIRED: [ 52.001 INCHES
i *'THIS PERMIT IS NOT FOR ADDITIONS"
O -Install 12"of slightly Isnited soli at the bottom of the drainfleld.
T *Perimeter of excavation area shall be at least 2 ft wider and longer than the Proposed absorption bed.
H 'Invert elevation of draftfteld to be no less than 8.0T NGVD.
j *Bottom of drainfa:id elevation to be no less than 7.5T NGVD.
E The system is siZed for 2 bedrooms with a maximum occupancy of 4 persons(2 per bedroom),for a total estimated flow
of 300 gpd.
R
({ SPECIFICATICKS BY: g TITLE:
APPROVED BY: UVVTITLE: Engineering Specialist II Dade coo
i
DATE I$$UM: 6 EXPIRATION DATE: 05/26(2016
DH 4016, 08/09 (Obsoletes all previous edition* which may not be used)
Incorporated: 64E-6.003, FAC Page 1 of 3
V 2.1.4 AP1226455 SE986642