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PL-17-71Project Address Miami Shores Village 10050 N.E. 2nd Avenue NE Miami Shores, FL 33138-0000 Phone: (305)795-2204 Permit Permit NO. PL -1-17-71 Permit Type: Plumbing - Residential Work Classification. Drainfield Permit Status: APPROVED Issue Date: 1/25/2017 Expiration: 07/24/2017 Parcel Number Applicant 1237 NE 93 Street Miami Shores, FL 33138- 1132050270060 Block: Lot: LUCIANA FISCHER Owner Information Address Phone Cell LUCIANA FISCHER 1237 NE 93 Street MIAMI SHORES FL 33138-2940 (954)734-3411 Contractor(s) Phone MR C'S PLUMBING & SEPTIC INC (305)651-7859 Cell Phone Valuation: Total Sq Feet: $ 3,000.00 300 Type of Work: INSTALLATION OF DRAIN FIELD Type of Piping: Additional Info: Bond Return : Classification: Residential Scanning: 3 Fees Due CCF DBPR Fee DCA Fee Education Surcharge Permit Fee Scanning Fee Technology Fee Total: Amount $1.80 $2.25 $2.25 $0.60 $150.00 $9.00 $2.40 $168.30 Pay Date Pay Type Invoice # PL -1-17-62582 01/11/2017 Check #: 146 01/25/2017 Credit Card Amt Paid Amt Due $ 50.00 $ 118.30 $ 118.30 $ 0.00 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 anin strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this j I assume re •onsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are required for ;,g"1 AL, P BING, MECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work. OWNERS construction ertify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating ermore, I authorize the above-named contractor to do the work stated. January 25, 2017 Authorized Signature: Owner / Applicant / Contractor / Agent Building Department Copy Date January 25, 2017 1 Miami Shores Village C; -rCr.-, ►\11> • Building Department JAN 1 1 2017 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 J Tel: (305) 795-2204 Fax: (305) 756-8972 BY : - - - INSPECTION LINE PHONE NUMBER: (305) 762-4949 V FBC 201LA BUILDING Master Permit No.'f 1 1 -T t PERMIT APPLICATION Sub Permit No. ❑BUILDING ❑,ELECTRIC D ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP 99 n CONTRACTOR _DRAWINGS JOB ADDRESS: (� -7 , nv,im^' `J J) e.t - / City: MifamiShores . County: Miami Dade Zip: . 33 S? Folio/Parcel#: 41 ` SOS - 6��- a 86 0 Is the Building Historically Designated: Yes NO Occupancy Type: Load: Construction Type: Flood Zone: • BFE:. FFE: _ AV—IA-NA ( OWNER: Name (Fee Simple Titleholder): AV—I A -N 111 -T one#: Address: 3 ] N p City: 1 a!-� �� V10`y4A State: a_Zip: SSI SO Tenant/Lessee Name: Phone#: Email:;� CONTRACTOR: Company Name: I �� ' G rS 1 gf � / EP 7 `Pgine#: 3dS - 7W -C7 Address: )16132• NK) off- 7 , V ENikC- City: I V`k � State: A-- Zip: 33� 6 Qualifier Name: k 6-cG 1C� Phone#: 6 &"--/ >•• State Certification or Registration #: S Certificate of Competency #: DESIGNER:Architect/Engineer: N Phone#: Address: 360 Q City: State: Zip: Value of Work for this Permit: $ "- Square/Linear Footage of Work: 6 erDSj Type of Work: ❑ Addition ❑ Alteration ❑ New IZ Repair/Replace ❑ Demolition Description of Work: _. z -A -c NR ( U e PAz C Fer-vv l 7Cmc P 1,e,c c� • ' - 'TO' f Op10CP porn it is- 3'0 - Specify color of color thru tile: Submittal Fee $ Permit Fee $ /5-.° ' CCF $ % • SO CO/CC $ Scanning Fee $ 9 Radon Fee $ `... Z. DBPR $ 2 Z- Notary $ '----------- Technology Fee $ . • L v Training/Education Fee $ e• (o 0 Double Fee $ -s Structural Reviews $ Bond $ TOTAL FEE NOW DUE $ 1 1 t 1 ZS (Revised02/24/2014) Bonding Company's Name (if applicable) Bonding Company's Address City State Zip I Ai II - 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. 1 understand that a separate permit must be secured for ELECTRIC, PLUMBING, SIGNS, P0013, 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 absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. Signature OWNER or AGENT Signature CONTRACTOR The fore oing instrument was acknowledged before me this OC day of J - l)1pr1', 20 / 7 , by tF 1 LE &'�� 1 � Kwh is personally known to The foregoing instrument was acknowledged before me this Com * day of C ()Ale-- , 20 17 , by I u G i Pt ZA-M i rH- N( b4Fio is ps onaliv known to m a or who has produced as identification and who die .. ke an oath. �1► 71 NOTARY PUBUC: Sign: Print: Seal: KEMBLE ETTRICK • Y` My Comm. Expires Sep 19, 2017 :9.. °n Commission # FF 055732 Bonded Through National Notary Assn. APPROVED BY (Revised02/24/2014) me or who has produced identification and who did take an oath. 5 � r NOTARY PUBLIC: Sign: Print: Seal: Plans Examiner i` �e o'; Notary Public - State of Florida 'My Comm. Expires Oct 23, 2018 9art - Q.a.� Commission # FF 136597 '��'e ,1 ,,, Bonded Through National Notary Fssn. as ************ Zoning Structural Review Clerk STATE OF FLORIDA DEPARTMENT OF HEALTH ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM CONSTRUCTION INSPECTION AND FINAL APPROVAL APPLICANT: Michael Fischer APPLICATION # :AP1215843 PERMIT # :13 -SC -1647264 DOCUMENT # : F11037102 DATE PAID:O1/27/2016 FEE PAID:100.00 RECEIPT #:13 -PI D-2883606 AGENT: Mr C"s Plumbing PROPERTY ADDRESS: 1237 NE 93 St Miami, FL 33138 LOT: 6 SUBDIVISION: BLOCK: 1 ID#: 11-3205-027-0060 CHECKED [X] ITEMS ARE NOT IN COMPLIANCE WITH STATUTE OR RULE AND MUST BE CORRECTED. TANK [01] [02] [03] [04] [05] [06] [07] [08] [09] INSTALLATION TANK SIZE [1] TANK MATERIAL OUTLET DEVICE MULTI-CHAMBERED OUTLET FILTER LEGEND 1. WATERTIGHT LEVEL DEPTH TO LID 900.00 [2] 300.00 [ ] [ [ [ [ [ [ [ [ [ Y / N DRAINFIELD INSTALLATION [10] [11] [12] [13] [14] [15] [16] [17] [18] [19] [20] [21] FILL [22] [23] [24] [25] [26] Comments: AREA [1] 300 DISTRIBUTION BOX NUMBER OF DRAINLINES DRAINLINE SEPARATION DRAINLINE SLOPE DEPTH OF COVER ELEVATION [ ABOVE / SYSTEM LOCATION DOSING PUMPS AGGREGATE AGGREGATE AGGREGATE [2] 2. 01-011-93SC4 SQFT HEADER X 1. 5.00 2. BELOW IBM 42.24 SIZE EXCESSIVE FINES DEPTH / EXCAVATION MATERIAL FILL AMOUNT FILL TEXTURE EXCAVATION DEPTH AREA REPLACED REPLACEMENT MATERIAL Comments are on page 2. SETBACKS [27] [28] [29] [30] [31] [32] [33] [34] [35] SURFACE WATER DITCHES PRIVATE WELLS PUBLIC WELLS IRRIGATION WELLS POTABLE WATER FT FT FT FT FT 3 (sleeved 40 PVC) FT BUILDING FOUNDATIONS PROPERTY LINES OTHER FILLED / MOUND SYSTEM [36] [37] [38] [39] 5 FT 5.5 FT DRAINFIELD COVER SHOULDERS SLOPES STABILIZATION ADDITIONAL INFORMATION [40] [41] [42] [43] [44] [45] [46] [47] [48] UNOBSTRUCTED AREA STORMWATER RUNOFF ALARMS MAINTENANCE AGREEMENT BUILDING AREA LOCATION CONFORMS WITH SITE PLAN FINAL SITE GRADING CONTRACTOR (Mr C"s) FT OTHER PTI MPRDS (9 pipes - 2 tier) ABANDONMENT [49] TANK PUMPED [50] TANK CRUSHED & FILLED CONSTRUCTION [ APPROVED / Dade CHD DATE: DISAPPROVED ] Environmental Specialist II Heber Montero (Department of Health in Dade C FINAL SYSTEM [ APPROVED / DISAPPROVED ]: (Explanation of Violations on following page) 01/28/2016 Dade CHD DATE: 01/28/2016 Environmental Specialist 1I Heber Montero (Department of Health in Dade DH 4016, 08/09 (Obsoletes all previous editions Incorporated: 64E-6.003, FAC EH Database v101 which may not be used) AP1215843 E1D1647264 Page 2 of 3 STATE OF FLORIDA DEPARTMENT OF HEALTH ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM CONSTRUCTION INSPECTION AND FINAL APPROVAL APPLICATION # : API 132263 PERMIT #: 13 -SC -1515588 DOCUMENT #:FI947640 DATE PAID : 01 / 15/2014 FEE PAID :200.00 RECEIPT #:13 -PID -2338990 Violation Number Comment Comments The system is sized for 3 bedrooms with a maximum occupancy of 6 persons (2 per bedroom), for a total estimated flow of 300 gpd. DH 4016, 08/09 (Obsoletes all previous editions which may not be used) Incorporated: 64E-6.003, FAC EH Database v 1.0.1 AP1132263 EID1515588 Page 2 of 3