PL-16-791 �c Miami Shores Village MAR 24 201
Building Department BY:
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 20(`f
BUILDING Master Permit No.� 1. .
PERMIT APPLICATION Sub Permit No.
❑BUILDING ❑ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ' RENEWAL '
[PLUMBING ❑ MECHANICAL []PUBLICWORKS ❑ CHANGE OF ❑CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: 88 NW (t �.1 l y-e e+
City: Miami Shores County Miami Dade• Zio• 33 6 f?
Follo/Parcel#: "I _2 i 6"'�O — p�� Is the'Suilding Historically Dirsignated:Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
-TY-` sttrCioy� �OWNER:Name(Fee Simple Titleholder):
Phone#: S�. �� 3-7
Address: �✓ W( Z-0 -f
City: C-ry"'� State: h, Zip: 3 139
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR:Company Name: GA+Y)Q j v1c-phone#: w .b 6
Address: ''-56 S® Nva
City: 00& .Q -State: Zip: 330 S y"
Qualifier Name: e, c^ Phone#:
State Certification or Registration#: �`M 09'1( ��Z Certificate of Competency#:
DESIGNER:Architect/Engineer: Phone#:
Address: //� c� City: State Zip:
Value of Work for this Permit:$ (Oct�O Square/Linear Footage of Work:
Type of Work: Pq Addition ❑ Alteration ❑ New ❑ Repair/Replace ❑ Demolition
Description of Work: CL'i GZ
• i
Specify color of color thru tile:
Submittal Fee$ 30 Permit Fee$ CCF$_Lf- CO/CC$
Scanning Fee$ •(Jr.)/� ,�,,\\ Radon Fee$ �° ��® DBPR$�. �� Notary$ � -co
Technology Fee$ 6 V Training/Education Fee$ ® Double Fee$ CD
Structural Reviews$ Bond$ f3
TOTAL FEE NOW DU �-
2-0S
(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 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 toachment. Also,a certified copy of the recorded notice of commencement must be posted at the job site
for the first Inspection wh' h ccurs s n (7) days after the building permit is issued. In the absence of such posted notice, the
inspection will not be app Ove and rei pection fee will be charged.
Signature Signature
OWNER or AGENT CONTRACTOR
The fore oing Instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
day of 1"10�Y(' 20 ,by4 day of .20_ by
Ado M COO f� �whho is personally known to N � who is personally known to
l
me or who has produced wt n? as me or who has produced ] as
identification and who did take an oath. identification and who did take an oath. q�►►►INi1�ll1/
II VJCW *iij
NOTARY PUBLIC: NOTARY PUBLIC: v rye•. ••••.• y�/i
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Sign: 17"r— Sign: = •
Print: ��-I r SZc> tv� Print: _ 4 'a�•��
Seal: r�•• o*
MyCOCitISSION Seal: �i�,�� •:••••• e��'��`
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EXPIRES:November e,2o19
'''so,�o�`O fDnup�y
*************************** ********************************************************************************
APPROVED BY 2 Cie' Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)
Miami Shores Village MAR 2 6 2016
Building Department
10050 N.E.2nd Avenue,Miami Shores,Florida 33138
- Tel.(305)795-2204 Fax:(305)756-8972
4NSPECn LINE-PHONE NUMBER*(305)762-4949
FBC 20N
BUILD(N Master Permit No.
'--1"1 .
PERMIT APPLICATION Sub Permit No.
BUILDING ELECTRIC [j ROOFING ❑ REVISION EXTENSION RENEWAL
PLUMBING ❑ MECHANICAL F-1 PUBLIC WORKS [—] CHANGE OF CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: 88 NW 111 ST
City: Miami Shores County: Miami Dade zip:
Folio/Parcel#:11-2136-003-0400 Is the Building Historically Designated:Yes_NO xx
Occupancy Type: Load: Construction Type: Flood Zone:—BFE: FFE:
OWNER:Name(Fee Simple Titleholder):TRIFECTA CAPITAL LLC Phone#:
Address: 1504 BAY RD#1204
City: MIAMI BEACH State: FL Zip: 33139
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR:Company Name: STATEWIDE SEPTIC CONNECTIONS INC Phone#: 305-661-6633
Address: 13680 NW 19 AVE#10
City: OPALOCKA State: FL Zip: 33054
Qualifier Name: TERESA SOLOMON Phone#:
State Certification or Registration#: SM0971262 Certificate of Competency#:
DESIGNER:Architect/Engineer: Phone#:
Address: City: State:_Zip:
Value of Work for this Permit:$6,500.00 Square/Linear Footage of Work: 667
Type of Work: A Addition EAlteration ❑ New ❑FRepair/Replace ❑ Demolition
Description of Work: REPLACE SEPTIC TANK& DRAINFIELD
Specify color of color thru tile:
Submittal Fee$ Permit Fee$ CCF$ CO/CC$
Scanning Fee$ Radon Fee$ DBPR$ Notary
Technology Fee$ Training/Education Fee$ Double Fee$
Structural Reviews$ Bond2L
TOTAL FEE NOW DUE$ 3"1 -
(Revised02/24/2014)
i
1
Bonding Company's Name(if applicable) NA
Bonding Company's Address
city State Zi
P
Mortgage Lender's Name(if applicable) NA
Mortgage Lender's Address
City State Zi
JP
Application is hereby made to obtain a permit to do the work and Installations as indicated. I certify that n work or installation has
commenced prior to the issuance of a permit and that all work will be performed to meet the standar s of all laws regulating
construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRIC, PL MBING, 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 don In compliance with all
applicable laws regulating construction and zoning.
"WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMM NCEMENT MAY
RESULT IN YOL R PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND
TO OBTAIN FIN kNCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEF RE RECORDING
YOUR NOTICE C IFCOMMENCEMENT."
Notice to Applicant: a condition to the issuance of a building permit with an estimated value exceeding$2 , the applicant must
promise in good faith that a copy of the notice of commencement and construction lien law brochure will be ellvered to the person
whose property is subs ect to attachment Also,a certified copy of the recorded notice of commencement must b posted at the Job site
for the first inspection which occurs seven (7) days after the building permit Is issued. In the absence of s ch posted notice, the
inspection will not he ve d a reins fon fee will be charged.
Signatu Signature G
i OWNER or AGENT CONTRACTOR
he foregoing inst, i1nent was acknowledged before me this The foregoing instrument was acknowledg before me this
_ day of- , KApA nl eel.` 20 I �e •by _day of �� 20by
LAO �� c .who is omnally known to —At LC2 � own to
me or who has prod cep I as me or who has produced as
iden,ification and who did take an oath. identification and who did take an oath.
1401 ARY PUBLIC: NOTARY PUBLIC:
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Sig,':- Sign: ��•'
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Print: x •�_
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Seal Seal:
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001111"b"g FF 1132481
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AP, ROVED BY Plans Examiner Zoning
Structural Review Clerk
(Revised02;A/2014)
PERMIT #: 13-SC-1609367
STATE OF FLORIDA
DEPARTMENT OF HEALTH APPLICATION #:AP 1190755
ONSITE SENAGE TREATMENT AND DISPOSAL DATE PAID:
SYSTEM
CONSTRIICTION PERMIT FEE PAID:
RECEIPT #•
DOCUMENT #: PR978076
CONSTRUCTION PERMIT FOR: OSTDS New
APPLICANT: Adam Cook
PROPERTY ADDRESS: 88 NW 111 St Miami,FL 33168
LOT: 8 BLOCK: 220 SUBDIVISION:
PROPERTY ID #: 11-2136-003-0400 [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 1 GALLONS / GPD Septic CAPACITY
A I I GALLONS / GPD N/A CAPACITY
N I ] GALLONS GREASE INTERCEPTOR CAPACITY [MAXIMUM CAPACITY SINGLE TANK:1250 GALLONS]
K [ I GALLONS DOSING TANK CAPACITY [ ]GALLONS @[ ]DOSES PER 24 HRS #Pumps [ ]
D [ 667 1 SQUARE FEET bed confiquration drainfiel SYSTEM
R [ ] SQUARE FEET N/A SYSTEM
A TYPE SYSTEM: [x] STANDARD [ ] FILLED [ 7 MOUND [ I
I CONFIGURATION: [ ] TRENCH [x] BED [ I
N
F LOCATION OF BENCHMARK: CL NW 111 St., 11.40'NGVD
I ELEVATION OF PROPOSED SYSTEM SITE [ 6.12 11 INCHE3 FT ] [ABOVE jBELOW BENCHNwx/REFERENCE POINT
E BOTTOM OF DRAINFIELD TO BE [ 36.1231 INCHE3 FT I [ABOVE BELOW BENCHMARK/REFERENCE POINT
L
D FILL REQUIRED: [ 0.001 INCHES EXCAVATION REQUIRED: [ 72.001 INCHES
o Inspector to verify the existing septic tank is properly abandoned before final approval.
*Invert elevation of drainfield to be no less than 8.89'NGVD.
T *Bottom of drainfield elevation to be no less than 8.39'NGVD.
H *Install 42'of slightly limited soil under the bottom of drainfield.
-Perimeter of excavation area shall be at least 2 ft.wider and longer than the proposed absorption bed or drain trench
E The system is sized for 4 bedrooms with a maximum occupancy of 8 persons(2 per bedroom),for a total estimated flow
R of 400 gpd.
The licensed contractor installing the system is responsible for installing the minimum category of tank in accordance
SPECIFICATIONS BY: Teresa J Solomon TITLE: Master Septic Tank Contractor
APPROVED BY: TITLE: Dade CHD
Uwlos X icaza
DATE ISSUED: 06/16/2015 EXPIRATION DATE: 12/16/2016
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 AP1190755 SE963507
Miami Shores Village
10050 N.E.2nd Avenue NW _ -
�K
Miami Shores,FL 33138-0000 "
Phone: (305)795-2204
Project Address Parcel Number Applicant
88 NW 111 Street 1121360030400
Miami Shores, FL 33138- Block: Lot: Trifecta 1 Capital LLC
Owner Information Address Phone Cell
Trifecta 1 Capital LLC 1504 BAY Road (954)465-3753
MIAMI BEACH FL 33139-
1504 BAY Road
MIAMI BEACH FL 33139-
Contractor(s) Phone Cell Phone Valuation: $ 6,600.00
STATEWIDE SEPTIC CONNECTIONS (954)963-0082 Total Sq Feet: 0
Type of Work:REPLACE SEPTIC TANK&DRAINFIELD 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
CCF $4•20 Invoice# PL-3-16-59146
DBPR Fee $4.50 03/25/2016 Check#:5053 $334.20 $0.00
DCA Fee $4.50
Education Surcharge $1.40
Notary Fee $5.00
Permit Fee $300.00
Scanning Fee $9.00
Technology Fee $5.60
Total: $334.20
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: 1 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. FiAheynore,l authorize a abov amed contractor to do the work stated.
t March 26,2016
Authorized Sig :Owner / Applicant / Contractor / Agent Date
Building Department Copy
March 25,2016 1
ilkDate
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