PL-15-2881 (2) PL,4fil-1 6-28
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Miami Shores Village ` Jftt►! 'Ae Plumy ResiantiT-
10050 N.E.2nd Avenue NE �
�VOtl<f Cls ?� �� tltfield'
Miami Shores,FL 33138-0000 � � OVED
Fed Phone: (305)795-2204
/3 Expiration: 5/28/2016
Project Address Parcel Number Applicant
9929 NE 4 Avenue Road 1132060171280
Miami Shores, FL 33138- Block: Lot: MARVIN R LIST 8,MARIA T MAN
Owner Information Address Phone Cell
MARVIN R LIST&MARIA T MANERBA 9929 NE 4 AVE Road (305)858-0204
- - - -- - -- - --- --- MIAMI SHORES FL 33138-
9929 NE 4 AVE Road
MIAMI SHORES FL 33138-
Contractor(s) Phone Cell Phone Valuation: $ 2,400.00
MR C'S PLUMBING 8,SEPTIC INC (305)651-7859
Total Sq Feet: 300
F;
Type of Work:DRAIN FIELD INSTALL. 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
CCF Invoice# PL-11-15-57764
$1.80 11/30/2015 Check#:2424 $500.00 $168.30
DBPR Fee $2.25
DCA Fee $2.25 11/30/2015 Credit Card $ 118.30 $50.00
Education Surcharge $0.60 11/13/2015 Credit Card $50.00 $0.00
Permit Fee $150.00 Bond#:2912
Scanning Fee $9.00
Technology Fee $2.40
Total: $668.30
In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations
pertaining thereto and in strict conformity with the plans,drawings,statements or specifications submitted to the proper authorities of Miami Shores Village. In
accepting this permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are
required for ELECTRICAL,PLUMBING,MECHANICAL,WINDOWS,DOORS,ROOFING and SWIMMING POOL work.
OWNERS AFFIDAVIT: 1 certify that a e-f�Vng information is accurate and that all work will be done in compliance with all applicable laws regulating
construction and zoning. Full re on�i ize the a-named contractor to do the work stated.
November 30, 2015
A ed Signature:Owner / Applicant / Contractor / Agent Date
Building Department Copy
November 30,2015 1
Miami Shores Village
Building Department NOV � 3 2015
g p
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel:(305)795-2204 Fax:(305)756-8972 , I
INSPECTION LINE PHONE NUMBER:(305)762-4949
FBC201 J
BUILDING Master Permit No d—I ;_
2_( 1
PERMIT APPLICATION Sub Permit No.
❑BUILDING ❑ ELECTRIC ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
® p CONTRACTOR DRAWINGS
JOB ADDRESS: 1� 4TV r �i
City: Miami Shores County: Miami Dade Zip: S Z�s
Folio/Parcel#: (1 1-tot DO Is the Building Historically Designated:Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER:Name(Fee Simple Titlehol er): AACNin_LPhone#:
Address:
Jg"4
City: M ; State: Zip:
Tenant/Lessee Name: Phone#:
Email: P6U41k
/CONTRACTOR:Company Name: r Phone#: A61f 7
Address: L` 3� Al Ol.� h
City: State: Zip: 17-710
Qualifier Name: K&Jkt v _ Phone#:
i
State Certification or Registration#: ertificate of Competency#:
DESIGNER:Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for this Permit:$ A Square/Linear Footage of Work: ado 0
Type of Work: ❑ Addition ❑ teration ❑ New Repair/Replace ❑ Demolition
Description of Work.
�a
Specify lorSr48 ,dk1&u ti1e::
Submittal FeeM�$ ` Permit Fee'$ ��Ud yc CCF$ CO/CC$
Scanning Fee$ Radon Fee$ DBPR$ Notary$
Technology Fee$ Training/Education Fee$ Double Fee$
Structural Reviews$ Bond$
TOTAL FEE NOW DUE$
(Revised02/24/2014) ro I ��
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 inspection fee will be charged.
Signature Signature
OWNER or AGENT CONTRACTOR
The foregoing instrument was acknowledged before me this The fp irtlitrument was acknowledged before me this
10 day of AJU►fiM.IDrLe- ,20 ,clay of 01/ 20 { J� by
I
who is personally k�om�nAo-'�� LL who is personally known to
me or who has produced i o 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: `S i-itIL'Y
. KEMBLE ETTRICK
0.V AVe
Seal: Seal:
r°.
Not Public -State of Florida
�; =My Comm.Expires Sep 19,2017 ,�4r\ ,,,� SHERyL A MENGES
Poc Commission#FF 055732 Seo �4+%L Notary Public-State Ot Florida
°F Flo`' o ed Thr ion N Assn. = .A My Comm.Expires Oct 23,2018
**x x\******
•�qrF OF FIOp�� h Natia►aI No3arY Assn.
' •rlll\\\\ Bonded nq
APPROVED BY �f �3�S Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)
PERMIT #:13-SC-1637757
APPLICATION #:AP 1209348
STATE OF FLORIDA
�? DEPARTMENT OF HEALTH DATE PAID:
a ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM FEE PAID:
CONSTRUCTION PERMIT RECEIPT #:
`"'F Documw #:PR993622
CONSTRUCTION PERMIT FOR: OSTDS Repair
APPLICANT: Marvin List
PROPERTY ADDRESS: 9929 NE 4 Ave Miami, FL 33138
LOT: 11 &12 BLOCK: 96 SUBDIVISION: Miami Shores Sec 4
PROPERTY ID #: 11-3206-017-1280 [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 I GALLONS / GPD Exist.septic tank to remain CAPACITY
A [ 0 ] GALLONS / GPD CAPACITY
N [ 0 I GALLONS GREASE INTERCEPTOR CAPACITY [MAXIMUM CAPACITY SINGLE TANK:1250 GALLONS]
K [ ] GALLONS DOSING TANK CAPACITY [ ]GALLONS @[ ]DOSES PER 24 HRS #Pumps [ ]
D [ 300 I SQUARE FEET Bed configuration drainfiel SYSTEM
R [ 0 ] SQUARE FEET SYSTEM
A TYPE SYSTEM: [x] STANDARD Q• [ ] FILLED [ ] MOUND [ ]
I CONFIGURATION: [ ] TRENCH [x] BED [ ]
N
F LOCATION OF BENCHMARK: FFE: 11.7
I ELEVATION OF PROPOSED SYSTEM SITE [ 24.001I INCHES, FT ] [ABOVE BELOW BENCHMARK/REFERENCE POINT
E BOTTOM OF DRAINFIELD TO BE [ 74.04FT ] [ABOVE BELOW BENCHMARK/REFERENCE POINT
L
D FILL REQUIRED: [ 0.00I INCHES EXCAVATION REQUIRED: [ 62.001 INCHES
1.-Existing 900 gal.septic tank,certified by"Mr.C's Plumbing and Septic"on 10/21/2015 to remain.
0 2.-Install 300 sf of drainfield in bed 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.
5.- (Comments Continued on Page 2.)
R
SPECIFICATIONS BY: Mr CI 's TITLE:
APPROVED BY: TITLE: Engineering Specialist II Dade CHD
Betsy Lange-Olmino
DATE ISSUED: 11/06/2015 EXPIRATION DATE: 02/04/2016
DH 4016, 08/09 (Obsoletes all previous editions which may no,, .
63p ,
Incorporated: 64E-6.003, FAC Page of 3
v 1.1.4 AP1209348Tr2 C--
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