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End#ri amental Health
Florida Health
?Miami-Dade County
OSTIDSAV ll Division
JIMA. Ski' 61h SUM•'Miami.F1,111115
31115 {�
Date
Address
:& - OSTOS
Signature
Scanned by CamScanner
Miami Shores VillagePlumbing Residential
Z S. 10050 N.E.2nd Avenue NW
Miami Shores,FL 33138-0000
Phone: (305)795-2204 _ 71' I'8t $, ` IR .;
i
Ex ration: 01/2512017
t12812t p
Project Address Parcel Number Applicant
155 NW 91 Street 1131010000220 JOHN&NICOLE KRINEY
Miami Shores, FL 33150- Block: Lot:
Owner Information Address Phone Cell
JOHN&NICOLE KRINEY 155 NW 91 Street
MIAMI SHORES FL 33150-
155 NW 91 Street
MIAMI SHORES FL 33150-
Contractor(s) Phone Cell Phone Valuation: $ 6,800.00
STATEWIDE SEPTIC CONNECTIONS (954)963-0082
_. _._ _..rc_.... _.. .. Total Scl Feet: 300
Type of Work:REPLACE SEPTIC TANK AND DRAINFIELD Available Inspections:
Type of Piping: Inspection Type:
Additional Info:
Bond Return: Top OutFinal
Classification:Residential Scanning: 1 Review Plumbing
Underground
Fees Due Amount Pay Date Pay Type Amt Paid Amt Due
Bond Type-Owners Bond $500.00 Invoice# PL-7-16-60755
CCF $4,20
DBPR Fee $4.50 07/29/2016 Check#:6128 $829.20 $0.00
DCA Fee $4.50 Bond#:3177
Education Surcharge $1.40
Permit Fee $300.00
Scanning Fee $9.00
Technology Fee $5.60
Total: $829.20
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: rtify that all the f egoing information is accurate and that all work will be done in compliance with all applicable laws regulating
construction and zo in Fu he re uth the above-named contractor to do the work stated.
1
July 29, 2016
Authorized Signature:Owner / Applicant / Contractor / Agent Date
Building Department Copy
July 29,2016 1
Miami Shores Village
2Buildin Department JOL20161
10050 N.E.2nd Avenue,Miami Shores,Florida 33138
Tel:(305)795-2204 Fax:(305)756-8972 yi
INSPECTION LINE PHONE NUMBER:(305)762-4949
FBC r20 1"1
BUILDING Master Permit No. �t-1 �P I 0
PERMIT APPLICATION Sub Permit No.
BUILDING F-] ELECTRIC 0 ROOFING Ej REVISION F-] EXTENS10 ❑RENEWAL
PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLA ION ❑ SHOP
ems- CONTRACTOR DRAWINGS
JOB ADDRESS:—f l4 V'j J
City: Miami Shores County Miami Dade Zion
Folio/Parcel#: I t 0 Is the Building Historically Designated:Yes NO 'C
Occupancy Type: Load: Construction Type: Flood Zone: BPE: FFE:
OWNER: Name(Fee Simple Titleholder): �n a W Co lli4a, -fir i neL( Phone#: I 3c)o
Address: 61; w-i q k '�*
City: m1® rv), State: -- 'Zip: 1
Tenant/Lessee Name: Phone#
Email:
CONTRACTOR:Company Name: e tx \ `'` '�,� �'f��f'CT.�y Phone#:
Address: 1 6 ® NW lei 4"f- 0 13
City: Li C` State Zip:
Qualifier Name: e"O'sPhone#:
State Certification or Registration#: ''"��®�1i,c��D� Certificate of Competency#:
DESIGNER:Architect/Engineer: Phone#:;
Address: / City: State: Zip:
Value of Work for this Permit:$ (0 Boo, Square/Linear Footage of Work: 3W
Type of Work: ❑ Addition ❑ Alteration ❑ New Repair/Replace 1 ❑ Demolition
Description of Work: IL . —Pk Ref
Specify color
Submittal Fee$ Permit Fee$ CCF$_1 co/cc$
Scanning Fee$�' � Radon Fee$_� w; tD IBPR$ ° �� N ��. �r�•%Si
Technology Fee$ Training/Education Fee$ `t Double ee$
Structural Reviews$ Bond$ '
TOTAL FEE NOW D E$ --3 ZO
(Revised02/24/2014) 2— 1
Bonding Company's Name(if applicable)
r
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 reinspection fee will be charged.
Signature Signature
OWNER or AGENT CONTRACTOR
The foregoing instrument was acknowledged before me this The foregoing instru nt was acknowledged before me this
day of 20 ' !D by ��day ofC ' 20 ) SLI by
,1\m t� L who is personally known to ��.r�"��, �10p-- who is personally known to
me or who has produced E L !)L as me or who has produced ��– —LN-_, as
identification and who did take an oath. identification and who did take an oath.
NOTARY PUBLIC: NOTARY PUBLIC:
Sign• Sign: d
Pri CPrint: ' '
AC
Seal: ) Seal.
.•`'o� %, JERRICA L.ARMSTRO*8 o`ro y'ry JERRICA L.ARMSD
kotai Pubis `aate of Fbridlt
Y Notary Public-State
'ommlSS1uo # F •
res�� * � *�►*r**�* * ** *VY Comm.Expires Feb 11,201! '•.'; g;.•`� MY Culllr�.Expires F
APPROVED BY Plans Examiner Zoning
Structural Review Clerk
jRevised02/24/2014)
PERMIT #:13-SC-1696563
APPLICATION #:AP1249065
STATE OF FLORIDA
DEPARTMENT OF HEALTH DATE PAID:
ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM FEE PAID:
CONSTRUCTION PERMIT FII RECEIPT #:
9
DOCUMENT #: PR1026875
CONSTRUCTION PERMIT FOR: OSTDS Repair
APPLICANT: John Kriney
PROPERTY ADDRESS: 155 NW 91 St Miami, FL 33150
LOT: na BLOCK: na SUBDIVISION:
PROPERTY ID #: 11-3101-000-0220 [SECTION, TOWNSHIP, RANGE, PARCEL NUMBER]
[OR TAX ID NUMBER] i
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 l GALLONS / GPD New septic tank CAPACITY
A [ 0 1 GALLONS / GPD CAPACITY
N [ 0 l GALLONS GREASE INTERCEPTOR CAPACITY [MAXIMUM CAPACITY SINGLE TANK:11250 GALLONS]
K [ ] GALLONS DOSING TANK CAPACITY [ ]GALLONS @[ ]DOSES PER 24 HRS #Pumps [ ]
D [ 300 l SQUARE FEET Trench confiquration drain SYSTEM
R [ 0 ] SQUARE FEET SYSTEM
A TYPE SYSTEM: [x] STANDARD [ ] FILLED [ ] MOUND [ ]
I CONFIGURATION: [x] TRENCH [ ] BED [ ]
N
F LOCATION OF BENCHMARK: F.F.E., 12.90'NGVD
I ELEVATION OF PROPOSED SYSTEM SITE [ 13.20 ] [ INCHES FT ABOVE=BENCHMARK/REFERENCE POINT
E BOTTOM OF DRAINFIELD TO BE L 61.201 [ INCHES FT ] [ABOVE BELOW BENCHMARK/REFERENCE POINT
L
D FILL REQUIRED: L 0.00] INCHES EXCAVATION REQUIRED: [ 48.001 INCHES
Inspector to verify the existing septic tank is properly abandoned before final approval.
0 *Invert elevation of drainfield to be no less than 8.30'NGVD.
T *Bottom of drainfield elevation to be no less than 7.80'NGVD.
H "THIS PERMIT IS NOT FOR"ADDITION(s)".
The system is sized for 4 bedrooms with a maximum occupancy of 8 persons(2 per bedroom),for a tgtal estimated flow
E of 400 gpd.
Required drainfield area based on rule 64E-6.015(6)(c)2.
R
SPECIFICATIONS BY: Teresa Jon TITLE:
,, Master Septic,T_ Contractor
APPROVED BY: TITLE: riot (�'i IC51QIi8P)IS IeQ'-'i%� , a,th n Dade CHD
raci�n
�-�•: . sic+��>t��
Carl M aza The CO LOi �' fe I e:cav '
DATE ISSUED: 07/25/1016 .0tT orM, ii ' ���II tt i 1bpi DATE:
10/23/2016
DH 4016 08/09 (Obsoletes all previous editi i} FWffiA(il�ma Apt� 31h��'t! gut title
Incorporated: 64E-6.003, FAC P 4iesults i'= Z'�e r i 1 �, r,.,e„i „e Crn tr' '�` 's i ✓
!t . Page 1 of 3
V 1.1.4 SE1002859
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STATE OF FLORIDA
DEPARTMENT OF HEALTH
•� APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUC�ION PERMIT
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Permit Application Number _,
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F' Signature Title
an Approved �, .j -�` Not Approved Date
County Health Department
ALL CHANGES MUST BE APPROVED BY THE COUNTY HEALTH DEPARTMENT
&015.10196(Replaces HRSH Forth 4015 which may be used)
:c Number:5744-00¢-4015-67 Paoe 2 of 3