PLC-19-66744>0 •. DIVISION OF L� PLC
IEnvironmental Health l_ 1
Florida Health
Miami -Dade County
eQ� OSTDS/Well Division
Q` 11805 SW 2611, Street • Miami, FL 33175 �O
Inspector. Rl�n� �� �M` Date{.-.lC
iI Address d� OSTDS #
ij
f Comments:
Signature
RECEIVED
Miami Shores Village MI 2 8 2019
Building Department sY:
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795-2204 Fax: (305) 756-8972
INSPECTION LINE PHONE NUMBER: (305) 762-4949
BUILDING
PERMIT APPLICATION
❑ BUILDING ❑ ELECTRIC ❑ ROOFING
FBC 201 _j
—PLC Cx21
Master Permit NO. -$ �� - ,
Sub Permit No.�-�-
❑ REVISION ❑ EXTENSION ❑RENEWAL
LUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
/� �"jCONTRACTOR DRAWINGS
JOB ADDRESS: v v
City: Miami Shores County: Miami Dade Zip: 3U t 5�
Folio/Parcel#: 1 — 37,o6 o2{P-' oZYo Is the Building Historically Designated: Yes NO 4--�
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FIFE:
OWNER: Name
((Fee Simple Titleholder): ,J �%�'i `/ Phone#:
Address: v -� KF6 ` jejv
City: /qlmI State: Zip:
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR: Company Name: r'41CII� ��y [ ��"1'�-�[y+�iJ Phone#:
Address: _T__7 01 SLJ 2E
City:
L
Qualifier Name: / AAA ���^s,,, ^ 4_^A Phone#: -
State Certification or Registration #: C l%S-66 Z V Certificate of Competency #: _
DESIGNER: Architect/Engineer: Phone#: -
Address: City: State
Value of Work for this Permit: $ 3 r "5-e Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace
Description of Work:
'Specify color of color thrujtile:
.�,•"W'VMt:.et'-'h..P ry..y...y..,-,.p r sy. .. �
Submittal Fee $ Permit Fee $
Scanning Fee $ Radon Fee $
Technology Fee $ Training/Education Fee $
Structural Reviews $ _
p: 73e7.?
Zip:
❑ Demolition
FYI P_ILP,( r+
� N.MUC V!STy�aNvk+.Clt'j'*\�r� �•
'' CCU � CS/CSC
_ DBPR $ Notary $
Double Fee $
Bond $
TOTAL FEE NOW DUE $ (� 0
(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
Zip
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 4g.cberged.
Signature Signature / "
NER or AGENT NTRACTOR
The foregoing instrument was acknowledged before me this
day tof I' I Q(�(r� 20 1011 by
)bVIA M k \ 1,fiCu'10L who i onalr5� kn to
me or who has produced
identification and who did take an oath.
NOTARY PUBLIC:
Sign: l
Print:
.•�
Seal: Notary Public - Slate of Florida
s • •) Commissior 0 GG 179596
My Comm. Expires May 21.2022
"•OFP.�.' Sonded:hroigh%a,crallowvAssn
The foregoing instrument was acknowledged before me this
day of M w 61 120 l q by
MAC4Ih K1Wt,H who i per ovally known
as me or who has produced
identification and who did take an oath.
NOTARY PUBLIC:
as
Sign: C� MA, .
Print: SUS Co\
Seal: �: a '�:� 146is�y—�lemll
I0/ Cgyt m Ex*es Imlay 21. 2022
jp..dWA �mrjjr. Micro Noary Asm.
APPROVED BY �-/ Plans Examiner
Structural Review
Zoning
Clerk
(Revised02/24/2014)
STATE OF FLORIDA
DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT AND DISPOSAL
SYSTEM
CONSTRUCTION PERMIT FOR: OSTDS Abandonment
APPLICANT: ,John Militana
PROPERTY ADDRESS: 8801 Biscayne Blvd Miami, FL 33138
LOT: 24
BLOCK: 2 SUBDIVISION: North Shore Crest
PERMIT #: 13-SC-1 936135
APPLICATION #: AP1405584
DATE PAID:
FEE PAID:
RECEIPT #:
DOCUMENT # : PR1209229
PROPERTY ID #: 11-3206-028-0240 [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 [
A [
N [
K [
] GALLONS / GPD
] GALLONS / GPD
] GALLONS GREASE INTERCEPTOR CAPACITY
] GALLONS DOSING TANK CAPACITY [
D [ ] SQUARE FEET
R [ ] SQUARE FEET
A TYPE SYSTEM: [ ] STANDARD
I CONFIGURATION: [ ) TRENCH
N
F LOCATION OF BENCHMARK:
I ELEVATION OF PROPOSED SYSTEM SITE
E BOTTOM OF DRAINFIELD TO BE
L
D F
O
T
H
E
R
CAPACITY
CAPACITY
[MAXIMUM CAPACITY SINGLE TANK:1250 GALLONS]
]GALLONS @[ ]DOSES PER 24 HRS #Pumps [
SYSTEM
SYSTEM
[ ] FILLED [ ] MOUND
[ ] BED [ ]
][ABOVE/BELOW] BENCHMARK/REFERENCE POINT
][ABOVE/BELOW] BENCHMARK/REFERENCE POINT
ILL REQUIRED: [ U.UUJ INCHES EXCAVATION REQUIRED: L j lNCHEs
Have the tank abandoned in accordance with the following procedures: (a) The tank shall be pumped out. (b) The bottom of
the tank shall be opened or ruptured, or the entire tank collapsed so as to prevent the tank from retaining water, and (c) The
tank shall be filled with clean sand or other suitable material, and completely covered with soil. Have the system inspected
by the health department after it has been pumped, ruptured and filled with sand and covered.
SPECIFICATIONS BY: TITLE:
APPROVED BY: TITLE: Engineering Specialist II
Erlande Omisca
DATE ISSUED: 03/27/2019 EXPIRATION DATE:
DH 4016, 08/09 (Obsoletes all previous editions which may not be used)
Incorporated: 64E-6.003, FAC
v 1.1.4 AP1405584 SE-1
Dade CHD
06/25/2019
Page 1 of 3
NOTICE OF RIGHTS
A party whose substantial interest is affected by this order may petition for an
administrative hearing pursuant to sections 120.569 and 120.57, Florida Statutes. Such
proceedings are governed by Rule 28-106, Florida Administrative Code. A petition for
administrative hearing must be in writing and must be received by the Agency Clerk for the
Department, within twenty-one (21) days from the receipt of this order. The address of the
Agency Clerk is 4052 Bald Cypress Way, BIN A-02, Tallahassee, Florida 32399. The Agency
Clerk's facsimile number is 850-413-8743.
Mediation is not available as an alternative remedy.
Your failure to submit a petition for hearing within 21 days from receipt of this order will
constitute a waiver of your right to an administrative hearing, and this order shall become a 'final
order'.
Should this order become a final order, a party who is adversely affected by it is entitled
to judicial review pursuant to Section 120.68, Florida Statutes. Review proceedings are
governed by the Florida Rules of Appellate Procedure. Such proceedings may be commenced
by filing one copy of a Notice of Appeal with the Agency Clerk of the Department of Health and a
second copy, accompanied by the filing fees required by law, with the Court of Appeal in the
appropriate District Court. The notice must be filed within 30 days of rendition of the final order.
Miami Shores Village
10050 NE 2 Ave
Miami Shores FL 33138
305-795-2204
Location Address
8801 BISCAYNE BLVD, Miami Shores, FL 33138
Contacts
Issue Date: 04/08/2019
Parcel Number
1132060280240
Permit NO.: PLC-03-19-667
Permit Type: Plumbing - Commercial
Work Classification: Septic/Drainfield
Permit Status: Approved
Expiration: 09/24/2019
JOHN MILITANA Owner
JOHN MILITANA
8801 BISCAYNE BLVD, MIAMI, FL 331383381
Other: 3057586691
KARCH ENERGY CONSTRACTORS INC Contractor
MARTIN KARCH
5741 SW 25 ST, WEST PARK, FL 33023
Business: 9542142517
Description: ABANDON SEPTIK TANK AND DRAIN FIELD Valuation: $ 3,500.00 Requests:
Inspection 305-4949
Total Sq Feet: 0.00
Fees
Amount
Application Fee - Other
$50.00
CCF
$2.40
DBPR Fee
$2.00
DCA Fee
$2.00
Education Surcharge
$0.80
Permit Fee (Manual)
$250.00
Scanning Fee
$3.00
Technology Fee (Manual)
$7.50
Total:
$317.70
Payments
Date Paid Amt Paid
Total Fees
$317.70
Credit Card
04/08/2019 $317.70
Amount Due:
$0.00
Building Department Copy
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 copstruction oning. Futhermore, I authorize the above named contractor to do the work stated.
Authorized Signature: Owner / Ap—p iiZant / Contractor / Agent
Date
April 08, 2019 Page 2 of 2