PL-16-2275Project Address
Miami Shores Village
10050 N.E. 2nd Avenue NW
Miami Shores, FL 33138-0000
Phone: (305)795-2204
Permit
Permit NO. PL -8-16-2275
Permit Type: Plumbing - Residential
Work Classification: Septic
Permit Status: APPROVED
Issue Date: 8118/2016
Expiration: 02/1412017
Parcel Number
Applicant
195 NW 96 Street
Miami Shores, FL 33150-
1131010250160
Block: Lot:
RAFAEL ARANGO
Owner Information
Address
195 NW 96 Street
MIAMI SHORES FL 33150-
195 NW 96 Street
MIAMI SHORES FL 33150-
Phone
Cell
Contractor(s)
MR C'S PLUMBING & SEPTIC INC
Phone
(305)651-7859
Cell Phone
Valuation:
$ 10,700.00
Total Sq Feet: 300
Type of Work: NEW SEPTIC SYSTEM
Type of Piping:
Additional Info:
Bond Return :
Classification: Residential
Scanning: 3
Fees Due
Bond Type - Owners Bond
CCF
DBPR Fee
DCA Fee
Education Surcharge
Permit Fee
Scanning Fee
Technology Fee
Total:
Amount
$500.00
$6.60
$4.50
$4.50
$2.20
$300.00
$9.00
$8.80
$835.60
Pay Date Pay Type
Invoice # PL -8-16-60966
08/12/2016 Credit Card $ 50.00 $ 785.60
08/18/2016 Credit Card $ 500.00 $ 285.60
08/18/2016 Credit Card $ 285.60 $ 0.00
Bond #: 3197
Amt Paid Amt Due
Available Inspections:
Inspection Type:
HRS Approval
Final
Review Plumbing
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 accura •and that all work will be done in compliance with all applicable laws regulating
construction and zoning. Futhermore, I authorize the above-named contr or to do the work stated.
Authorized Signature: Owner / Applicant / ' ntractor / Agent
Building Department Copy
August 18, 2016
Date
August 18, 2016 1
e\A‘'
Yo'
BUILDING
PERMIT APPLICATION
0BUILDING ❑ ELECTRIC
PLUMBING ❑ MECHANICAL
Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795-2204 Fax: (305) 756-8972
INSPECTION LINE PHONE NUMBER: (305) 762-4949
❑ ROOFING
❑PUBLIC WORKS
JOB ADDRESS: 'ck 5 Nm
City:
-re L.'
FBC 20 '`t
Master Permit No L-1 C 22'1 J
Sub Permit No.
• REVISION EXTENSION 0RENEWAL
❑ CHANGE OF ❑ CANCELLATION SHOP
CONTRACTOR DRAWINGS
Miami Shores County:
Folio/Parcel#: 1\ Ol 02s tv \coo
Occupancy Type: `79P/W. Load:
Miami Dade Zip: 3J� So
Is the Building Historically Designated: Yes NO
Construction Type: p Flood Zone:
BFE: FFE:
OWNER: Name (Fee Simple Titleholder): Rte' -` 01305'0 Phone#: \S4 q - -1" .moi M2. coact}- fre v
Address: 31/44
City: NA.
State:
Zip: '3313
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR: Company Name: ' \ S u 1 bi c\ COC *A3 C Phone#: 3o (05t 9"g Scl
cek 32 IJP 7pa tee.
Address:
City: V -A..1 G.\A.A: State: '- Zip: 33\ (o 9
Qualifier Name: 1110"/00‘ e - }+(`l_ .! :. Phone#: O5 65-- -p.»
State Certification or Registration #: S62:45(01 S 3 Co Certificate of Competency #:
DESIGNER: Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for this Permit: $ kQ , O'O Square/Linear Footage of Work:
Type of Work: ❑ Addition
121 Alteration ❑ New
Description of Work: Se_p+ c S._ jo -
❑ Repair/Replace
❑ Demolition
Specify color of color thru tile:
Submittal Fee $4 tiv
Scanning Fee $ 9`
CkTh
Technology Fee $ ° `QC)
Structural Reviews $
(Revised02/24/2014)
0
Permit Fee $
Radon Fee $
CnnI r.
0 0----- ccfiNtc "t
0 DBPR $ `T ° 93 Notary $ 0
Training/Education Fee $ 2 • 20 Double Fee $ P
Bond $ DO ' CO
TOTAL FEE NOW DUE $ 29 5 - GS
RES• co
lenVI
cO/cc $
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 $2500, the applicant must
promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person
whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site
for the first inspection which occurs seven (7) days after the building permit is issued.bsence of such posted notice, the
inspection will not be approved and a reinspection fee will be charged.
Signature
OWNER or AGENT
Thegoing instru ent was acknowledged before me this
day of(i'. ,20 \lO ,by
me or who has produced
v . a! who is personally jknown to
Or c •DrilC cevlfas
identification and who did take an oath.
NOTARY PUBLIC:
Notary Puma
MYaOMMISSION S 1F 16
*******************************#tt## M **************
Signature
CONTRACTOR
The foregoing instrument was acknowledged before me this
day of icl-Rau.S"r ,20 frr ,by
K '$ 6L.P ���' � �,C.�� , who is personally known to
me oor who has produced
identification and who did take an oath.
NOTARY PUBLIC:
as
Sign:
Print:
Seal:
APPROVED BY
(Revised02/24/2014)
Plans Examiner
,�tig"" a`o SHERYL A MENDES
"r°r° ` �: Notary + _ Public - State of Florida
My Comm. Expires Oct 23, 2018
Commission # FF 136597
Zoning
Structural Review Clerk
STATE OF FLORIDA
DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM
CONSTRUCTION PERMIT
CONSTRUCTION PERMIT FOR:
APPLICANT: Alvaro Valerian
OSTDS Repair
PERMIT # :13 -SC -1699854
APPLICATION # : i4P 1251016
DATE PAID:
FEE PAID:
RECEIPT #•
DOCUMENT #: PR1028282
PROPERTY ADDRESS:
LOT: 16
195 NW 96 St Miami, FL 33150
BLOCK: 3 SUBDIVISION:
PROPERTY ID #: 113101-025-0160
[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
A
N
900
0
0
GALLONS / GPD
GALLONS / GPD
GALLONS GREASE INTERCEPTOR CAPACITY [MAX/MUM CAPACITY
GALLONS DOSING TANK CAPACITY [ ]GALLONS N[
NEW Septic TANK
CAPACITY
CAPACITY
D [ 300 1 SQUARE FEET DF BED CONFIGURATIO SYSTEM
R [ 0 ] SQUARE FEET SYSTEM
A TYPE SYSTEM: [z] STANDARD [ ] FILLED [] MOUND
I CONFIGURATION: [ ] TRENCH
N
F LOCATION OF BENCHMARK: FFE 12.0'NGVD
[8] BED [ ]
[ ]
a
do o
SINGLE TANK:1250 G LrtpNk c 11>cr6\ 4C)C 4 o�
]DOSES PER 24 AI: \S.`�\ti2�1 �3G J •A . t�
n�crk, \V.; 6i��St£SedJdcc�
`Ye �hot��K �� t�S° \Ccte
u��e ays� �
��fi2��cOts'ss— bNt�t� y_
..tfa
I ELEVATION OF PROPOSED SYSTEM SITE
E BOTTOM OF DRAINFIELD TO BE
L
D
O
T
H
E
R
FILL REQUIRED:
[ 12.00 ] (I INCHES'' FT ] [ ABOVE
leis Q�p��\``L
.Irf7W BENCHMARK/REFERENCE POINT
62.00 ] l INCHES FT ] [ ABOVE 4 BELOW p BENCFIZARIC/REFERENCE POINT
[ 0.00] INCHES EXCAVATION REQUIRED: [ 62.00] INCHES
1.- Install a NEW 900 gal. septic tank with an approved filter
2.- The licensed contractor installingthe system is responsibleinstalling category ua ' \\
Y for the minimum cat o of tank in accor ance° '�
with s. 64E -6.013(3)(f) FAC. \\Tt`3.- Install 300 sf. of drainfield in bed configuration.\
4.- Install 12" of slightly limited soil at the bottom of the drainfield.
5.- Perimeter of excavation area shall be at least 2 ft wider and longer than the proposed absorption bed -trench.
(Comments Continued on Page 2.)
SPECIFICATIONS BY:
APPROVED BY:
Philizaire
%'�dwarda
DATE ISSUED: X8/05/2016
l..
TITLE: Engineering Specialist II
TITLE: Engineer Supervisor III
Dade CHD
EXPIRATION DATE:
DE 4016, 08/09 (Obsoletes all previous editions which may not be used)
Incorporated: 64E-6.003, FAC
v 1.1.4 AP1251016 SE1004125
11/03/2016
Page 1 of 3
STATE OF FLORIDA
DEPARTMENT OF HEALTH
APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION IT r \O'U—R
Permit Application Number 1" �J
PART II - SITEPLAN
• =
es:
.*/11/17 -
196- Nw fi St-
h' 2 d
Site Plan submitted b�+:
Pian Approve• V
By
At -
Goy.: (4 C -d(
Not Approved Date
County Health Department
ALL CHANGES MUST BE APPROVED BY THE COUNTY HEALTH DEPARTMENT
DH 4015, 10/96 (Replaces HRS -H Form 4016 which may be used)
(Stock Number: 5744-002-4015-6)
Page 2 of 4
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There are no pertinent features on adjacent properties and or across the street that may affect the New Septic system installation.
es:
.*/11/17 -
196- Nw fi St-
h' 2 d
Site Plan submitted b�+:
Pian Approve• V
By
At -
Goy.: (4 C -d(
Not Approved Date
County Health Department
ALL CHANGES MUST BE APPROVED BY THE COUNTY HEALTH DEPARTMENT
DH 4015, 10/96 (Replaces HRS -H Form 4016 which may be used)
(Stock Number: 5744-002-4015-6)
Page 2 of 4