PL-17-425�`,ggoaEs t'
...
4�0
Ff ORIDP
Miami Shores Village
10050 N.E. 2nd Avenue
Miami Shores, FL 33138-0000
Phone: (305)795-2204
Permit ivO. PL-2-17-425,
■ Permit Type: Plumbing - Residential
e t r Work Classification: Septic,
Permit Status: APPROVED
issue ;Date: 2/2412017 1 Expiration:08/23/2017
Project Address Parcel Number Annlicant
515 GRAND CONCOURSE 1132060171340
Miami Shores, FL Block: Lot: GREGORY PALMER
Owner Information Address Phone Cell
GREGORY PALMER 515 GRAND CONCOUSR (305)220-7663
FL
Contractor(s) Phone Cell Phone
MIAMI DADE ENVIROMENTAL 786-251-4099
Type of Work: INSTALL A NEW 1200 GALLONS SEPTIC S
Type of Piping:
Additional Info: INSTALL A NEW 1200 GALLONS SEPTIC S
Bond Return :
Classification: Residential Scanning: 3
Fees Due
Amount
CCF
$6.00
DBPR Fee
$4.50
DCA Fee
$4.50
Education Surcharge
$2.00
Permit Fee
$300.00
Scanning Fee
$9.00
Technology Fee
$8.00
Total:
$334.00
Valuation: $ 9,500.00
Total Sq Feet: 0
Pay Date Pay Type Amt Paid Amt Due
Invoice # PL-2-17-62991
02/17/2017 Credit Card $ 50.00 $ 284.00
02/24/2017 Credit Card $ 284.00 $ 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 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 accurate and that all work will be done in compliance with all applicable laws regulating
construction and zoning. Futhermg;e, I authorize the above -named contractor to do the work stated.
February 24, 2017
Authoriz tt : Ov ner / Applicant / Contractor / Agent
Buil g Department Copy
February 24, 2017 1
Miami Shores Village
Building Department
°'�
10050 N.E.2nd Avenue, Miami Shores, Florida 33138 FEB 17 2317
Tel: (305) 795-2204 Fax: (305) 756-8972
INSPECTION LINE PHONE NUMBER: (305) 762-4949 @y•
FBC 20
BUILDING Master Permit No. - C 1h-2 �
PERMIT APPLICATION Sub Permit No.
❑ BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION [:]RENEWAL
[PLUMBING ❑ MECHANICAL [:]PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: Z_� 1 -�, CA R A ti Usk CO N rO U R Se B 10- .
City: Miami Shores County: Miami Dade Zip• ) < 8—
Folio/Parcel#: 20(o -O 12 - t(O Is the Building Historically Designated: Yes NO
Occupancy Type: �_ Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder): s RC Qp (L � PA 1 li e R Phone#:
Address: SI S,qk ary LIS (rpk)COC)(I( c& -C%(UD
City: M (r4" 1 en- o O fl e s State: 1'(A- Zip:
Tenant/Lessee Name: e^� _ � � Phone#:�
Email:
CONTRACTOR: Company Name: t" sjw1 C k)He k)—i AJ- (3 Phone#: %CS6 -25 /- ((O9 �f
Address:: /82CC) LXKe L (\ S �`_5L(— L
�-! City: (o k ( I State: ef- Zip:
Qualifier Name:
ZIN
Phone#: 796^2 7/- L/n 9/C'y.
State Certification or Registration #: SR L 71 2 7(a Certificate of Competency #: S' '�g OOc(% /
DESIGNER: Architect/Engineer:
hone#:
Address: City: State: Zip:
Value of Work for this Permit: $ Square/Linear Footage of Work: J % ` --
Type of Work: ❑ Addition ❑ Alteration 14 New ❑ Repair/Replace ❑ Demolition
Description of Work: 1 N S L hk1 (A tjecy l 200 OSA(b /_ s T A W4 A b n
Specify color of -color thru die: ='� _5 ;• '
Submittal Fee $ Permit Fee $ 00 CCF $ CO/CC $ _
Scanning Fee $ Radon Fee $ U 5 DBPR $ - 4-4 • 5 C Notary $ �—
Technology Fee $ Training/Education Fee $ Double'Fee $
Structural Reviews $ Bond $
TOTAL FEE NOW DUE $ - ?-AS (I
(Revised02/24/2014)
Bonding Company's Name (if applicable)
Bonding Company's Address
City State
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address
City State
Zip
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 $2506, 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.
A.
&, —,
Signature Signature
OWNER or AGENT
The foregoing instrum t was acknowledged before me this
day of 20 — I � by
l
v_.�' 71, t, I who is personally known to
me or who has produced as
identification and who did take an oath.
NOTARY
Sign:l✓y'u
Print: L/� �,/ V(x J—(n
a�;W,.•••"A LAU FARLEY
Seal: * * MY COMMISSION t FF IBM
EXPIRES: March 16, 2019
'r o�
�'Fov Ftoe� Bonded Thru Budget Notary Services
CONTRACTOR
The oregoing instrument was acknowledged before me this
t Tdi2y of -i-6t,. 20 1 by
S � CAh who is personally known to
me or who a lc as
identification and who did take an oath.
NOT
Sign
Prin-
Seal
* MI VVinmwv.v.. • • • •----•
EXPIRES: March 16.2019
Bonded Thru Budget Notary Services
************************************************************************************************************
APPROVED BY /<-2Plans Examiner
N
Zoning
Structural Review
(Revised02/24/2014)
Clerk
STATE OF FLORIDA
DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM
CONSTRUCTION PERMIT
CONSTRUCTION PERMIT FOR: OSTDS New
APPLICANT: GREGORY PALMER
PROPERTY ADDRESS: 515 GRAND CONCOURSE Blvd Miami, FL 33138
LOT: BLOCK: 96 SUBDIVISION: Miami Shores
PERMIT #:13-SM-1719968
APPLICATION #: AP1263135
DATE PAID:
FEE PAID:
RECEIPT #:
DOCUMENT #: PR1043349 ,
PROPERTY ID #: 11-3206-017-1340 [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 New Septic Tank CAPACITY
A I ] GALLONS / GPD N/A CAPACITY Mae
N [ ] GALLONS GREASE INTERCEPTOR CAPACITY [MAXIMUM CAPACITY SINGLE TANK:1250 s�dtoPo�att� ON
K I ] GALLONS DOSING TANK CAPACITY [ ]GALLONS @[ ]DOSES PER °aya 1,the�the
°c d��acna al o�ace ]
D [ 575 ] SQUARE FEET Trench Conf. Drainfield SYSTEM (fie°n� �� ab�a�e�'41 �n Pce 5�,� `fig`e Ito{ �`'°t
N/A SYSTEM so'� t° \ \�5' • ess `� ova<��n C'0rtca
R [ ] SQUARE FEET e Gt t'�na,�at1 �t:�tn 5�te e`12 � �t the
A TYPE SYSTEM: Ix] STANDARD ti'mroct s O1A...", as esse e [ I FILLED [ l MOUND [ ] °` the be
I CONFIGURATION: [XI TRENCH [ ] BED��
N ces cUQr the aYc
F LOCATION OF BENCHMARK: 9.4T NGVD: CL Of Grand Concourse
I ELEVATION OF PROPOSED SYSTEM SITE [ 13.60 ] INCHES FT ] [ BELOW ] BENCHMARK/REFERENCE POINT
E BOTTOM OF DRAINFIELD TO BE 116.40] INCHES FT I[ABOVE BELOW BENCHMARK/REFERENCE POINT
L
E
O
T
H
E
R
.LLa. xMWU.LXau: L U.UU J INCHES EXCAVATION REQUIRED: [ 72.001 INCHES
1.- Install a 1200 gal. septic tank with an approved filter
2.- The licensed contractor installing the system is responsible for installing the minimum category of tank in accordance
with s. 64E-6.013(3)(0 FAC.
3 - Install 575 sf. of drainfield in TRENCH configuration.
4.- Install 47' 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 or trench.
(Comments Continued on Page 2.)
SPECIFICATIONS BY: Yin rmont TITLE: ENGINEERING SPECIALIST I
APPROVED BY: ~ d' TITLE: Engineer Supervisor III Dade CHD
DATE ISSUED
id V Edwards
12/28/2016
EXPIRATION DATE. 06/28/2018
DIVISION OF
EnVironmental Health ��
Florida Health /0�0
Miami -Dade County
�Q OSTDSfWell Division
Q 5 gW 2bth Street • Miami, FL 33175
_Q 1180_
/ Date ,
Inspector b%v� OSTDS#
Address
Comments:
Signature
L-
♦i1
i'Dade
ty
11805 W�DS t�'1 Div )Vision
Ad J /iK N rect ��aml Fj 3'175
d
QQ�
Inspector
DIVISION OF
lorida Environmental Health
INiam • Health
Tess
Colninents:
Signature
q�
Date
�7 i7
OSTDS #
0�6/'3 83-