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Miami Shores Village
10050 N.E.2nd Avenue NW
n �
Miami Shores,FL 33138-0000
Phone: (305)795-2204
s} Expiration: 11/23/2016
Project Address Parcel Number Applicant
11004 NW 2 Avenue 1121360020240
Miami Shores, FL 33168- Block: Lot: LSP HOMES LLC
Owner Information Address Phone Cell
ELSPMES LLC 455 NE 210 Circle Terrace (305)527-3643
MIAMI FL 33179-
455 NE 210 Circle Terrace
MIAMI FL 33179-
Contractor(s) Phone Cell Phone Valuation: $ 6,500.00
STATEWIDE SEPTIC CONNECTIONS (954)963-0082 Total Sq Feet: 500
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
CCF $4.20 Invoice# PL-5-16-59931
DBPR Fee $4.50 05/27!2016 Check#:6105 $279.20 $50.00
DCA Fee $4.50
Education Surcharge $1.40 05/25/2016 Check#:5079 $50.00 $0.00
Permit Fee $300.00
Scanning Fee $9.00
Technology Fee $5.60
Total: $329.20
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: 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 autho' e the ove-named contractor to do the work stated.
C� YQ� May 27,2016
Authorkeg Snature:Owner / Applicant / Contra or / Agent Date
Building Department Copy
May 27,2016 1
Miami Shores Villaga
MAY 2'5 tote
Building Department
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.20
BUILDING Master Permit No.az a 1 Z/y�
PERMIT APPLICATION Sub Permit No.
[--]BUILDING ❑ ELECTRIC ROOFING F-1 REVISION f-1 EXTENSION RENEWAL
71 PLUMBING ❑ MECHANICAL [:]PUBLICWORKS F-1 CHANGE OF ❑ CANCELLATION ❑ SHOP
/�
CONTRACTOR DRAWINGS
JOB ADDRESS: 1100 4' r�N W ,G. P'V Cp i !�• p
City: Miami Shores County Miami Dade Ziw Cp
Folio/Parcel#: I I- 7- [-5 6, 00 2-O2 qO is the Building Historically Designated:Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: r FFE: //�/p
OWNER: Name(Fee Simple Titleholder): LSP HoMes LLCi Phone#: � S21 " 3 64-3
Address: 1(004- I\)vJ 2 017�
City: Mi iM) Shore-,S State: if Zip: 3_'>l
Tenant/Lessee Name: Phone#:
Email: (� ,, t 2 P
CONTRACTOR:Company Name: S i A_+_e .A ��(°�'�'i �i `•''`�n S I-. Phone#:_ 7 66 35 ,
Address: 11)(0ASO p4 w 1!9 heal . k
City: `�.(<r-01 State: ��• Zip: 3 30S
,°-0
Qualifier Name: �• A 'O Lovnd Phone#:
State Certification or Registration#: o�7 Certificate of Competency M
DESIGNER:Architect/Engineer: Phone#:
Address: City: State Zip:
Value of Work for this Permit:$ Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration New ❑ Repair/Replace ❑ Demolition
Description of Work: �n�{- ��2+� '4 S6 t Q✓)
Specify color of color t4ru tile:__
Submittal Fee$T��'d Aeriiiit'Fde$" (0® � CCF$ �'' CO/CC
Scanning Fee$ `g 62® ° Radon Fee$ DBPR$ . Notary$
Technology Fee$ s`r,61_Training/Education Fee$ la 'YL1 Double Fee$
Structural Reviews$ Bond$ &81 _24094..
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 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 whic ccurs seven (7) days after the building permit is issued. In the absence of such posted notice, the
inspection will not be a Prov and a r rasp ion fee will be charged.
Signature Signature
OWNJR or AGENT CONTRACTOR
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
V✓ day of � 20 Ib ,by day of 4 l
20 r 6 ,by
enny &LVU ,who is personally known to To.,-,r461 who is personally known to
me or who has produced (h as me or who has produced �7—� I D as
identification and who did take an oath. identification and who did take an oath.
NOTARY PUBLIC: NOTARY PUBLIC:
Signe Sign: � , &A.4 GL Ae--'
Print: Iq Print: rictnG L l S
Seal: PON Nagy Public Stott of Florida Seal: Notary P„wlo Stato at Florida
Trencella Lows Trencoa Lewis
� MY COMMI Swo FF 146:107 My COMMMion FF 198307
Expires()2/0512019 w Exphea 02ArS12Ute
############ # # # # # # # # # # # ###################### # ## # # # # # ##########
APPROVED BY �" �' Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)
i
PERMIT #: 13-SC-1573085
f STATE OF FLORIDA APPLICATION #:API 167408
DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT AND DISPOSAL DATE PAID:
SYSTEM FEE PAID:
CONSTRUCTION PERMIT
RECEIPT #•
DOCUMENT #: PR963629
CONSTRUCTION PERMIT FOR: OSTDS New
APPLICANT: (LSP Homes LLc)
PROPERTY ADDRESS: 11004 NW 2 Ave Miami,FL 33168
LOT: 20 21 BLOCK: na SUBDIVISION:
PROPERTY ID #: 11-2136-002-0240 [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 L 1,050 ] GALLONS / GPD Septic CAPACITY
A [ ] GALLONS / GPD N/A CAPACITY
N [ ] GALLONS GREASE INTERCEPTOR CAPACITY [MAXIMUM CAPACITY SINGLE TANK:1250 GALLONS]
K [ ] GALLONS DOSING TANK CAPACITY [ ]GALLONS @[ ]DOSES PER 24 HRS #Pumps [ ]
D [ 500 ] SQUARE FEET Trench conflquration drain SYSTEM
R [ ] SQUARE FEET N/A SYSTEM
A TYPE SYSTEM: [x] STANDARD [ ] FILLED [ l MOUND L I
I CONFIGURATION: [x] TRENCH [ ] BED [ ]
N
F LOCATION OF BENCHMARK: CL NW 2 AVE: 10.75'NGVD
I ELEVATION OF PROPOSED SYSTEM SITE [ 6.60 ] [ INCHES FT ][ ABOVE BELOW]BENCHMARK/REFERENCE POINT
E BOTTOM OF DRAINFIELD TO BE [ 23.40] [ INCHE3 FT ] [ABOVE BELOW BENCHMARK/REFERENCE POINT
L
D FILL REQUIRED: L 0.00] INCHES EXCAVATION REQUIRED: [ 72.001 INCHES
O Amended by B.Olmino on 9/30/2015 to change from 3 bedrooms to 4 bedrooms.
1.-Install a 1050 gal min.septic tank with an approved filter.
T 2.-The licensed contractor installing the system is responsible for installing the minimum category of tank in accordance
H with s.64E-6.013(3)ft FAC.
3.-Install 500 sf of drainfield in trench configuration.
E 4.-Install 42"of slightly limited soil at the bottom of the drainfield.
R 5.-Perimeter of excavation area shall be at least 2 ft wider and longer than the proposed absorption bed or drain trench.
(Comments Continued on Page 2.)
SPECIFICATIONS BY: Teresa J Solomon TITLE: Master Septic Tank Contractor
APPROVED BY: TITLE.: Engineering Specialist II Dad@1116 CHD
Betsy 9e- uo C01-
aae ,,,,,,��(�
.DATE ISSUED: 02/10/2015 EXPI �� (Q8/10/2016
DH 4016, 08/09 (Obsoletes all previous editions which may not be used) ea\'fir �\
Incorporated: 64E-6.003, FAC a�x.05- e 1 of 3
a 1.1.4 AP1167408 3'C
DOCUMENT #; PR963629
6.-Invert elevation of drainfield to be no less than 9.30'NGVD.
7.-Bottom of drainfield elevation to be no less than 8.80'NGVD
The system is sized for 3 bedrooms with a maximum occupancy of 6 persons(2 per bedroom),for a total estimated flow of
400 gpd.