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PL-17-425 (2)�`,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-