PL-16-2390 Permit NO. PL-8-16-2390
5HO1is i, Miami Shores Village Permit Type:Plumbing-Residential
10050 N.E.2nd Avenue N
�' ��� ' Work Classification:Drainfield
" Miami Shores,FL 33138-0000
Permit Status:APPROVED
Phone: (305)795-2204
17
Issue Date:9130/2016 Ex piration: 03/29/20
Project Address Parcel Number Applicant
9301 N BAYSHORE Drive 1132050270560
GUY&SELIN KURLANDSKI
Miami Shores, FL Block: Lot:
Owner Information Address Phone Cell
GUY&SELIN KURLANDSKI 9301 N BAYSHORE Drive
MIAMI SHORES FL 33138-
15811 COLLINS Avenue
SUNNY ISLES FL 33160-
Contractor(s) Phone Cell Phone Valuation: =10,850.00STATEWIDE SEPTIC CONNECTIONS (954)963-0082Total Sq Fee
Type of Work:INSTALL NEW 1200 TANK 378 GAL DOSIN 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
CCF $6.60 Invoice# PL-8-16-61118
DBPR Fee $4.50
DCA Fee $4.50 09!30/2016 Check#:5156 $290.60 $50.00
Education Surcharge $P.40 08/25/2016 Check#:6155 $50.00 $0.00
Notary Fee $5.00
Permit Fee $300.00
Scanning Fee $9.00
Technology Fee $8.80
Total: $340.60
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 AFFIDA T: rtify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating
construction and z in u herrWe, orize the above-named contractor to do the work stated.
September 30, 2016
AutWrizea Mignature:Owner / Applicant / Contractor / Agent Date
Building Department Copy
September 30,2016 1
f \� Miami Shores Village
4BY*
2 5X016
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
FBC 200
BUILDING Master Permit NO.FL�6— 2-39
PERMIT APPLICATION Sub Permit No.I S 3 12 '1—
BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION RENEWAL
PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
Ct 30
(,,,CONTRACTOR DRAWINGS
JOB ADDRESS: ( 6,9, S� of c, y-
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#: 2oG- o2"7- O S 6-o Is the Building Historically Designated:Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name(Fee Simple Titleholder): Gv �' Se t Ir) I Phone#:
Address: C1 30 N • P,A S rG �-^
City: t-AI Gt �rI State: rZ Zip: 3 3 i 38
Tenant/Lessee Name: Phone#:
Email: Ott L r / //
CONTRACTOR:Company Name:!- - --�1 Ott �+ C � -S 1� �' Phone#:� 6 - GfbX)
Address: k 3 6 s c) N va 1 ?'\ ' t* 10
City: �a Cocxgq (f State: �C. Zip: 33oSI-�1-
Qualifier Name: \ P�r{�Q U� MAn Phone#:
State Certification or Registration#: S m 0 q-7 k-2-6'Z Certificate of Competency#:
DESIGNER:Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for this Permit:$x\_l 10
, cojSd Square/Linear Footage of Work: 5-75
Type of Work: ❑ Addition ❑ Alteration ® New ❑ Repair/Replace ❑ Demolition
Description of Work:
375 1975
Specify color of color thru tile:
Submittal Fee$ SO- 0-'-Z) Permit Fee$ 300 — _CCF$ CO/CC$
Scanning Fee$ Radon Fee$ ' SbDBPPR11$ 4 Sp Notary$ �T�
Technology Fee$ C�JI� Training/Education Fee$ ��J Double Fee$ �!!
Structural Reviews$ Bond$ 2-90 .
yQ� (�
TOTAL FEE NOW DUE$ L l O • GO
(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 reinspection fee will be charged.
Signaturer74fJ��6 Signature'*�—)
WNER or AGENT CONTRACTOR
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
day of 20 1 (e_, by 2-L-; day of�--o g20 J by
(N 01 W,who is personally known to E:. E, �I Q 4-(NS*�y�� personally known to
me or who has produced 1::1- 'D624 VIM- as me or who has produced . L-��N as
identification and who did take an oath. identification and who did take an oath.
NOTARY PUBLIC: NOTARY U LIC:
\\\111111
Sign: Sig
Print: = :; 'a� �0�9�� Print:
NV
Seal: '; +,N ! ti Seal: pv�W°oe, Notary>'ut)!ic State of Florida
Sindia Alvarez
U S:t J ,;♦� **' �: Po My C,orrmission FF 1567500'�.`.. Expires09`03,'20 ?
*****************************�RM�?R1� .k?F,*9d,*'##***************************************�'dc �+•/!"��rr'�k*`>k'�R*'sk�lr'tR,+L',k�r.
APPROVED BY � ���' Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)
y
f PERMIT #: 13-SC-1655501
STATE OF FLORIDA
APPLICATION #: AP 1221168
DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT AND DISPOSAL DATE PAID:
SYSTEM FEE PAID:
CONSTRUCTION PERMIT
RECEIPT #:
• DOCUMENT #: PR1012685
CONSTRUCTION PERMIT FOR: OSTDS New
APPLICANT: Guy Kurdlandsk
PROPERTY ADDRESS: 9301 N Bayshore Dr Miami, FL 33138
LOT: 3 BLOCK: 4 SUBDIVISION: Bay Lure
PROPERTY ID #: 11-3205-027-0560 [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 [ 1,200 ] GALLONS / GPD Septic CAPACITY
A [ ] GALLONS /.GPD N/A CAPACITY
N [ ] GALLONS GREASE INTERCEPTOR CAPACITY [MAXIMUM CAPACITY SINGLE TANK:1250 GALLONS]
K [ 375 ] GALLONS DOSING TANK CAPACITY [ 77.00 ]GALLONS @[ 6 ]DOSES PER 24 HRS #Pumps ( 1 ]
D [ 575 ] SQUARE FEET Trench confiquration drain SYSTEM
R [ ] SQUARE FEET N/A SYSTEM
A TYPE SYSTEM: [ ] STANDARD [x] FILLED [ ] MOUND ( ]
I CONFIGURATION: [x] TRENCH [ ] BED [ ]
N
F LOCATION OF BENCHMARK: CL N. Bayshore dr.,3.98'NGVD
I ELEVATION OF PROPOSED SYSTEM SITE [ 15.80 ] [ INCHES FT ] [ ABOVE BELOW]BENCHMARK/REFERENCE POINT
E BOTTOM OF DRAINFIELD TO BE [ 12.80 ] [ INCHES FT ] [ ABOVE BELOW]BENCHMARK/REFERENCE POINT
L
D FILL REQUIRED: [ 15.00] INCHES EXCAVATION REQUIRED: [ 45.60 ] INCHES
0 *Invert elevation of drainfield to be no less than 5.50'NGVD.
'Bottom of drainfield elevation to be no less than 5.00'NGVD.
T 'Install 42"of slightly limited soil under the bottom of drainfield.
H -Perimeter of excavation area shall be at least 2 ft.wider and longer than the proposed absorption bed or drain trench.
The system is sized for 4 bedrooms with a maximum occupancy of 8 persons(2 per bedroom),for a total estimated flow
E of 460 gpd.
R The licensed contractor installing the system is responsible for installing the minimum category of tank in accordance'�a
with s.64E-6.013(3)(f), FAC. Performing Lift Dosing. JZ`
SPECIFICATIONS BY: Jorge M Millan TITLE:
a
.O �o
APPROVED BY: TITLE: �Q I We CHD
Carlos m icaza
DATE ISSUED: 04/06/2016 EXPIRA E: 0/06/2017
DH 4016, 08/09 (Obsoletes all previous editions which may not be used) a��'�'
Incorporated: 64E-6.003, FAC 3� ()• Page 1 of 3
v 1.1.4 AP1221168 SE94I�8'
9/28=16 Report Viewer
it I i tt00% i
t JEFF ATWATER STATE OF FLORIDA
CHIEF FINANCIAL OFFICER
9III DEPARTMENT OF FINANCIAL SERVICES
DIVISION OF WORKERS'COMPENSATION
"CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS'COMPENSATION LAW"
1 CONSTRUCTION INDUSTRY EXEMPTION
3
This certifies that the individual listed below has elected to be exempt from Florida Workers'Compensation law.
EFFECTIVE DATE: 8/26/2016
EXPIRATION DATE: $/26/2018
PERSON: SWEAT ANTHONY
' FEIN: 450475464
i
BUSINESS NAME AND ADDRESS:
STATEWIDE SEPTIC CONNECTIONS INC
13680 NW 19 AVE BAY 10
OPALOCKA FL 33054
SCOPES OF BUSINESS OR TRADE:
B; PLUMBING NOC AND
i DRIVERS
r PlnLwt tD ChWW 440.05(14),FS,an oscer are ca vusilm who elects eicarnpdmham ris dww M RiM ecer"com d dedim viler Ws maw
ZZ-n6—
yy
not reader bandifa ar oompavatim oder ha dagar.plrsusnt b Chapter 440.05(12),F.S,Cr44calea d dectim b be a wnpL..q)oy arty
ZZ-n a,e scape.d the business or tads Naha m menoaso d deacn b is oxempL P,rsuaa to chepler 440.05(13),F.S.Ndices d decem b be
ae,ampt ad urtiRealee ddacbon b be aaampt"l be sub)edb nwoodon U,st"vme mbw ft 511rg d the notce orthe lsae ce dihe cwt8cew
the person ranad m tb nor�or cerNllcale ro Iv,gs meet tl,e requiremenffi d1Ns seL4m far IativaCe daartl6cata The deperbnea shell revoke a
DFS-F2-0WG252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 08-13 QUESTIONS?(850)413-1608
1
i
E
I
I
I
)
,
1
i
I
i
i
1
1
t
hftps•J/apps8.fldts.com/crreparrtviewerheportViewer.aspx? kdvpgirc9D7Q3gH6TER6eP1KMZ°/o2fSz5bXKYfBxkrekeESoPVylv4NPOPN42XeirDRGXVWI... 1/2
�O• DIVISION OF
nvronmental Health
�@10 FlHealth
�QQ FloridaMiami-Dade County qi�p
:., �' 11800 wTDh tre ell Division
f Street•Miami,FL 33175 Off►
Inspector GO
,• ,
Address Date
,. p)
Comments: OSTDS#_•��f1��11�Y
Signature
C,
P� 1 (� -2- 3 1