PL-16-1781 (2) 4.►0 DIVISION OF
Environmental Health
Florida Health .�
RIO Miami-Dade County j
�QQ OSTDS/Well Division
►� /� 11805 SW 26th Street-Miami,FL 3317.5 O
In Spector cam! ✓ �� �!o Date
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Address- ?� Al 1 s t OSTDS# �3e'J
Comments:
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�sK ay Miami Shores Village' )! ) � R� E�rit �
y.� 10050 N.E.2nd Avenue NE M W � � (rift d1,01
Miami Shores,FL 33138-0000 ��
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arP— , Phone: (305)795-2204 P 0
305)795 2204PPRty
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F`OR`D , , $ }I2016 Expiration: 1 27/2016
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Project Address Parcel Number Applicant
777 NE 98 Street 1132060142380
Miami Shores, FL Block: Lot: ANA PENARANDA
Owner Information Address Phone Cell
ANA PENARANDA 777 NE 98 ST
MIAMI SHORES FL 33138-2530
Contractor(s) Phone Cell Phone Valuation: $ 1,500.00
MR C'S PLUMBING&SEPTIC INC (305)651-7859
_..._ ... ....__ .,, Total Sq Feet: 300
Type of Work:DRAINFIELD INSTALLATION. 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 Invoice# PL-6-16-60348
CCF $1.20 06/30/2016 Check*1115 $ 116.70 $550.00
DBPR Fee $2.25
DCA Fee $2.25 06/30/2016 Check*824 $500.00 $50.00
Education Surcharge $0.40 06/27/2016 Cash $50.00 $0.00
Permit Fee $150.00 Bond*3130
Scanning Fee $9.00
Technology Fee $1.60
Total: $666.70
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 worl-
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 authorize the above-named contrio ffo do the work stated.
June 30, 2016
Authorized Signature:Owner / Applicant ontractor / Agent Date
Building Department Copy
June 30,2016 1
(V`q�\ Miami Shores Village
4 211 LOIr
�e Building Department
10050 N.E.2nd Avenue,Miami Shores,Florida 33138 BY.
Tel:(305)795-2204 Fax:(305)756-8972
INSPECTION LINE PHONE NUMBER:(305)762-4949
FBC 20 N
BUILDING Master Permit No.-Fu G— '��s�
PERMIT APPLICATION Sub Permit No.
❑B/UILDING F-] ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION [:]RENEWAL
PLUMBING F-] MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION [—] SHOP
7� CONTRACTOR DRAWINGS
JOB ADDRESS: —1—T1 1591'\0 c�rN \A t i T
City: Miami Shores County: Miami Dade Zip: '?>"?) 112
Folio/Parcel#: Q - $20 6 0 ILA —,Z l?0 Is the Building Historically Designated:Yes NO
Occupancy Type: ('e-S Load: -Construction Type: Flood Zone: BiFE: FFE:
OWNER:Name(Fee Simple Titleholder): -t 'Alva Phone#:
Address: cl\ '1C S-r ti e e
City: 1"A�tike Sal tZ�� State: T'"`s, ms t)A Zip: 7 3 I?) Lt
Tenant/Lessee Name: Phone#,
Email: G
CONTRACTOR:Company Name: r I VEL�`' SPhone#i, AM
j�` 7-V
Address: /7/3� w C;�� Ann c,
City: N,-A, II f/State: � Zip: 47r?`e
Qualifier Name: k�b� e_#/7�L Phone#:
State Certification or Registration M 54- 6 bli, 3I Certificate of Competency M
DESIGNER:Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for this Permit:$ �Sf�. Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration ❑ New Repair/Replace ❑ Demolition
Description of Work: u
Specify color of color thru tile:
Submittal Fee$ SO - Permit Fee$ CCF$ ° CO/CC$
Scanning Fee$®$ - Radon Fee$ S DBPR$ Notary$
Technology Fee$ i Training/Education Fee$ (0 - 40 Double'Fee$
Structural Reviews$ Bond$ 9 �V
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 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 r ' spe tion fee will be charged.
NSignature Signature
OWkl4R or AGENT CONTRACTOR
The foregoing instru t was acknowledged before me this The foregoing instrument was acknowledged before me this
SF
l day of 20 by day of 11 Alt— 20 by
Pen who is personally known to who is personally known to
me or who has produced 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: �./,��. /�. '�w�•l��-�
Print: "" a Print:
Seal: omaPCOPAMiSSION#EE2a0343 Seal: 2°`�rPue`'�'- Notary Public-State of Florida
IRES:September 19 2016 •�.E M Comm.Expires Oct 23,2018
4.�.•' Banded Thru Notary Public undemriters Y
�'4%°�� °P°�, Bow Commission
National Nary Assn.
APPROVED BY / Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)
PERMIT #: 13-SC-1 687862
APPLICATION #:AP1243374
STATE OF FLORIDA DATE PAID:
DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM FEE PAID:
CONSTRUCTION PERMIT RECEIPT #:
DOCUMENT #:PR1021722
CONSTRUCTION PERMIT FOR: OSTDS Repair
APPLICANT: Jose Penaranda
PROPERTY ADDRESS: 777 NE 98 St Miami,FL 33138
LOT: 2 3 BLOCK: 71 SUBDIVISION:
PROPERTY ID #: 11-3206-014-2380 [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 / GPD Septic CAPACITY
A [ 0 ] GALLONS / GPD CAPACITY
N [ 0 ] GALLONS GREASE INTERCEPTOR CAPACITY [MAXIMUM CAPACITY SINGLE TANK:1250 GALLONS]
K [ ] GALLONS DOSING TANK CAPACITY [ ]GALLONS @[ ]DOSES PER 24 HRS #Pumps [ ]
D [ 300 ] SQUARE FEET Bed Configuration SYSTEM
R [ 0 ] SQUARE FEET SYSTEM
A TYPE SYSTEM: [x] STANDARD [ ] FILLED I MOUND [ ]
I CONFIGURATION: [ ] TRENCH [x] BED [ ]
N
F LOCATION OF BENCHMARK: FFE ................10.80'NGVD
I ELEVATION OF PROPOSED SYSTEM SITE [ 9.60 ] [ INCHES FT ] [ ABOVE BELOW BENCHMARK/REFERENCE POINT
E BOTTOM OF DRAINFIELD TO BE [ 44.60 ] [ INCHES FT ] [ABOVEBELOW BENCHMARK/REFERENCE POINT
L
D FILL REQUIRED: [ 0.00] INCHES EXCAVATION REQUIRED: [ 47.001 INCHES
1.-EXISTING 900 gal.septic tank with and approved filter 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.
4.-Perimeter of excavation area shall be at least 2 ft wider and longer than the proposed absorption bed or trench.
H (Comments Continued on Page 2.)
E
R
SPECIFICATIONS BY: and L Philizaire TITLE: Engineering Specialist II
APPROVED BY: / TITLE: Professional Engineer I Dade CED
Richarki M Roja,
DATE ISSUED: 06/10/2016 EXPIRATION DATE: 09/08/2016
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 AP1243374 SE998481
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