PL-15-3107BUILDING
PERMIT APPLICATION
❑ BUILDING ❑ ELECTRIC
?PLUMBING ❑ MECHANICAL
JOB ADDRESS:
City:
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
REC 17
DE 16 2015
BY:
FBC 20I-"
N9CU $ Permit NoTPLU b"-31 0.4
Sub Permit No.
❑ ROOFING ❑ REVISION ❑ EXTENSION ❑ RENEWAL
❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
lay) N6 3 s+
Miami Shores
County:
Miami Dade
Zip:
3313Y
Folio/Parcel#: 11 - Vb1 0a?- 01Mo
Occupancy Type: Load: Construction Type:
Is the Building Historically Designated: Yes NO
Flood Zone:
BFE: FFE:
OWNER: Name (Fee Simple Titleholder): Lt/ti&.ZG Phone#: /S% ✓. 7f 07.0
Address: 10137 Are 43 St
City: /44(444 /
State:
Zip: 3313E.
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR: Company Name: m/' c� s 40.4
/9f3,? ijw
Address:
Phone#: g,; Kg< ? 5
City: /14/4/k/ / State: TG
Qualifier Name: Ket..,/( h'L
State Certification or Registration #: .. SIQ.0(16-36
DESIGNER: Architect/Engineer: Phone#:
Address: City:
Value of Work for this Permit: $ 3000. 00 Square/Linear Footage of Work:
Zip: 33'1�5
Phone#: 365 6 S/ 7Kc F
Certificate of Competency #:
State: Zip:
Sao 544
Type of Work: ❑ Addition ❑ Alteration ❑ New
� LL
Description of Work:
Repair/Replace ❑ Demolition
901+9M . if
fn 9lF�d
Specify color ofd Ior thru tile:
1 cri,J
OM
Submittal Fee $-ay•„ .:;:-.Permit Fee '$
Scanning Fee $
Technology Fee $ Training/Education
Structural Reviews $
/SO, x�
Radon Fee $
(Revised02/24/2014)
CCF $ CO/CC $
DBPR $ Notary $
Fee $ Double Fee $
Bond $
TOTAL FEE NOW DUE $ 11 e .30
Bonding Company's Name (if applicable)
Bonding Company's Address
City State Zip
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address
,i� !"ti Zip
State fp
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.
4
"WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY
RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOURPROPERTY..IF YOU INTEND
TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING
YOUR NOTICE OF.COMMENCEMENT."
ti -
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 ab ce of such posted notice, the
inspection will not be approved and a reinspection fee will be charged.
s •.
Signature
OWNER or AGENT
3Ji33l73gnature•n . 40' '0
t
The foregoing instrument was acknowledged before me this
/‘'
day of
,20 % ,by
LI/Llu�t f/SCitPr , who is personally known to
me or who has produced as
identification and who did take an oath.
NOTARY PUBLIC: •
Sign:
Print:
Seal:
KEMBLE ETTRICK
Notary Public - State of Horida
My Comm. Expires Sep 19, 2017
Commission # FF 055732
oF
,, ,,' Bonded Through National Notary Assn.
CONTRACTOR'
9"1
The foregoing instrument was acknowledged before me this
/( day of �if:l�i�l�/1 , 20 /S , by
K�21NbI� 6itt1►CJt , who is person iLanown to
me or who has produced as
identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print: 4,5ki QUI... Al _—
SHERYL A MENDES
Seal: o'�"ay °°a''
°. �.`� : Notary Public - State of Florida 0
I My Comm. Expires Oct 23, 2018 `
ACommission # FF 136597
".RSBonded Throw NtttleatlM Assn.
* *********
**************************************************************Ye
APPROVED BY
(Revised02/24/2014)
x'
Plans Examiner Zoning
Structural Review Clerk
STATE OF FLORIDA
DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM
CONSTRUCTION PERMIT
PE1*IIT t:13 -SLC -1647264
APPLICATION fl: AP1215843
DATE PAID:
FEE PAID:
RECEIPT 1:
Sa
• r
,
,'rl`'�j�f DOCUMENT 1:PR997483
CQUi tit `�
CONSTRUCTION PERMIT FOR: OSTDS Repair
APPLICANT: Michael Fischer
PROPERTY ADDRESS: 1237 NE 93 St Miami, FL 33138
LOT: 6
BLOCK: 1 SUBDIVISION:
PROPERTY ID *: 11-3205-027-0060
[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
A [ 0 I GALLONS / GPD
N [ 0 ] GALLONS GREASE INTERCEPTOR CAPACITY [MAXIMUM CAPACITY SINGLE TANK:1250 GALLONS]
K [ 300 ] GALLONS DOSING TANK CAPACITY ( 1GALLONS 8( 6 IDOSES PER 24 HRS *Pumps [ 1 ]
FEET Bed Drainfield SYSTE
SQUARE M
R [ 0 ] SQUARE FEET SYSTEM
A TYPE SYSTEM: [x] STANDARD [ I FILLED '' [ I MOUND [ ]
I CONFIGURATION: [ ] TRENCH (x] BED [ ]
Septic (Existing)
CAPACITY
CAPACITY
N
F LOCATION OF BENCHMARK: FFE 7.6' NGVD
I ELEVATION OF PROPOSED SYSTEM SITE
E BOTTOM OF DRAINFIELD TO BE
L
D FILL REQUIRED: [ 0.00I INCHES
0
T
H
E
R
SPECIFICATIONS BY:
APPROVED BY:
[ 22.80 1 El INCHES J FT ] [ ABOVE A BELOW b BENCHMARK/REFERENCE POINT
148.80 1 (J INCHES 1 FT ] ( ABOVE d BELOW p BENCHMARK/REFERENCE POINT
EXCAVATION REQUIRED: ( 38.00] INCHES
"THIS PERMIT IS NOT FOR ADDITIONS"
*Existing 300 gal dosing tank certified on 12/7/15 by Mr. C's Plumbing and Septic to remain.
'Install 12" of slightly limited soil at the bottom of the drainfield.
`Perimeter of excavation area shall be at least 2 ft wider and longer than the proposed absorption bed.
'Invert elevation of drainfield to be no less than 4.03' NGVD.
'Bottom of drainfield elevation to be no less than 3.53' NGVD.
*Water line within 10 ft of septic sy to be Sch 40 PVC or sleeved in accordance with FAC Ch 64E -6.005(2)(b).
DATE ISSUED:
DH 4016, 08/09 (Obaoletes all previous editions which lay not be used)
TITLE:
Incorporated: 64E-6.003, FAC
v 1.1 .8 AP12158*
I. .
8E979366
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