PL-12-1491ILI --4/410)
PERMIT APPLICATION
FBC 20
Miami Shores Village
�'����
g Au f 0 6 2012
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
INSPECTION'S PHONE NUMBER: (305) 762.4949
Permit No.P1 )�` 14911
Master Permit No.
Permit Type: PLUMBING
OWNER: Name (Fee Simple Titleholder): t l Fitt / Phone #:
Address: as ?4-)
`3Q yliL�
City: t &t ( State: ft
Tenant/Lessee Name: Phone #:
Email:
Zip: 3313
JOB ADDRESS: R sr% IgSaty AS. 61061
City: Miami Shores County: Miami Dade
Folio/Parcel #: j 1— 'jJ .2216 - 014 - O
Is the Building Historically Designated: Yes NO
Zip: '� 3138
CONTRACTOR: Company Name: Oik1rQ/Y i1 t-t � JCI 1120.
Address: 1' 3 bal-- (3 (Cl l (
City: PICA 1J444) State: r
Qualifier Name: 3%V ,%A!r.. 61,01,1
State Certification or Registration #: $(V1& - g `1' 14,6.7 Certificate of Compe
Contact Phone #: 3es(8 GS- Wei Email Address:
DESIGNER: Architect/Engineer:
Flood Zone:
Phone #: 'V' /$i'S-� Gtr
Zip: A3.243
Phone #: i6 4 g6S` 4 %i t
ency #: � now os tri'
Phone #:
Value of Work for this Permit: $ci g6-0 Square/Linear Foo a of Work: S80
Type of Work: DAddress DAlteration [>
Description of Work: //b
ONew er/Replace DDemolition
/M qD& qa, a 84.01 3000 d (
************* * *** * ****it ** ******+x******* Fees* *********** ********** *** * ** *wax **** ***,x*****
Submittal Fee $ Permit Fee $-- CCF $ CO /CC $
Scanning Fee $ Radon Fee $ DBPR $ Bond $
Notary $ Training/Education Fee $ Technology Fee $
Double Fee $ Structural Review $
TOTAL FEE NOW DUE $ 3 t
5cso'
i .-°
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 FT FRCTRICAL WORK, PLUMBING, SIGNS,
WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and 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 $2500, the applicant must
promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person
whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site
for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the
inspection will not e approved and a reinspection fee will be charged.
Signature
Owner or Agent
The foregoing instrument was acknowledged before emme"this %
day of , 20 , byi�'�wC., Tvrv�� day of
who is personally known to me or who has produced who is personally known to me or who has produced
As identification and who did take an oath. as identification and who did take an oath.
NOTARY PUBLIC: NOTARY PUBLIC:
Contractor
The foregoing instrument was acknowledged be fo e me this G
, 20,a , by
Sign:
Print:
My Co
' n Naar ublic - State of Florida
�9Q cr$. sCommission # DD 897782
bonded Through National Notary Assn.
* * * * * * * * * * * * * * * * * * **
APPROVED BY
* **
Signq ANESA CANTRELL
i. , No -ry P Iic - State of Florida
Fxpir c Jun 1 rt, 201
Commission # DD 897782
grigThrough National Notary Assn.
1 d..,.....,.
Print
My
.m- - e'
**************************************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
Plans Examiner Zoning
Structural Review Clerk
(Revised 07 /10 /07)(Revised 06 /10/2009)(Revised 3/15/09)
STATE OF FLORIDA
DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM
CONSTRUCTION PERMIT
CONSTRUCTION PERMIT FOR: OSTDS Repair
APPLICANT:
Crethel Ferig
PERMIT #:13 -SC- 1409094
APPLICATION #:AP1071569
DATE PAID:
FEE PAID:
RECEIPT #:.
DOCUMENT #: PR875283
PROPERTY ADDRESS: 9520 Biscayne Blvd Miami, FL 33138
LOT: 3
BLOCK: 75 SUBDIVISION:
PROPERTY ID #: 11- 3206 - 014 -2870
[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 [
R
A
I
N
F
I
L
D
0
T
H
E
R
900 ] GALLONS / GPD Septic
0 ] GALLONS / GPD
0 ] GALLONS GREASE INTERCEPTOR CAPACITY
] GALLONS DOSING TANK CAPACITY
300 l SQUARE FEET
[ 0 l SQUARE FEET
TYPE SYSTEM: [x] STANDARD
CONFIGURATION: [ ] TRENCH
CAPACITY
CAPACITY
[MAXIMUM CAPACITY SINGLE TANK:1250 GALLONS]
]GALLONS @[ ]DOSES PER 24 HRS #Pumps [
SYSTEM
SYSTEM
[ ] FILLED [ ] MOUND
[x] BED [ ]
LOCATION OF BENCHMARK: FFE : 11.40' NGVD
ELEVATION OF PROPOSED SYSTEM SITE
BOTTOM OF DRAINFIELD TO BE
FILL REQUIRED:
[ 0.00] INCHES
[ 12.00 ] [
[ 42.00 ]
INCHES I FT ][ABOVE 4 BELOW I] BENCHMARK /REFERENCE POINT
INCHES FT ][ ABOVE 4 BELOW I] BENCHMARK /REFERENCE POINT
EXCAVATION REQUIRED: [ 54.00] INCHES
- Install 900 g septic tank.
- Install 300 sq ft drainfield.
- Install 24" of slightly limited soil under bottom of drainfield.
- Elevation of bottom of drainfield to be no less than 7.90' NGVD.
- Not for additions
The licensed contractor installing the system is responsible for installing
the minimum category of tank in accordance with s. 64E- 6.013(3)(f), FAC.
The contractor (or designee) is required to pe; tarry,
soil boring adjacent to the drainfield excavation ar rreE
time of final inspection. Prior to Final Approval, the
inspector shall witness the soil boring and con-:;are the
results to the original site Evaluation submitte7. A
reinspection fee will be assessed if the contractor is spat
at the jobsite at the arranged time.
SPECIFICATIONS BY:
APPROVED BY:
DATE ISSUED:
Charles J, - -pman
DH 4016, 08/09 (Obs
Incorporated: 64E
TITLE: Master Septic Tank Contractor
. g TITLE: Engineer Specialist II Dade cep
0/2012
es all previous editions
003, FAC
v 1.1.4
which may not be used)
AP1071569
EXPIRATION DATE: 08/08/2012
S5870228
Page 1 of 3
STATE ; /'FLORIDA
DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT
CONSTRUCTION INSPECTION
PERMIT NO. ,/°j0 7l. s--6' (j
DATE PAID* /
AND DIPOSAT?? SXSTEM FEE PATE
AND FINAL APPROVAL RECEIPT #1
APPLICANT a
AGENT*
. PROPERTY ADDRESS: - i /.� i.rt.._ •
LOT: 3 ALOCKS / 5 SVBDIVISIQNa4 __ ` PROPERTY ID #* 1`�S (-111Y-41-0
CHECKED [X] ITEMS ARE NOT IN COMPLIANCE WITH STAN:O143 OR RULE AND';NUST BE CORRECTED .
rte• . . _ .
TANK INSTALLATION
101] TANK SIZE [1]' /O, 1121
[02] TANK MATERIAL,
[031 =MET DEVICE .� .
104] MILT' -CHAMBERED
[051 OUTLET FILTER ir
106] LEGEND dC'S- ;,
[07] W)TERTTGUT
[08] LEVEL
[09] DEPTH TO LID
SETBACKS..
t 1 [27] SURFACE WATER
C 1 [28] DITCHES VT
[ 1 [29] PRIVATE WELLS FT
3 I30] Pt7BLIC WELLS FT
1 131] IRRIGATION WELLS FT
[32] POTABLE WATER EMS a FT
[ - 133] BUILDINQ FOUNDATION 7 FT
,FT
[ ] [35] olai
134] PROPERTY LINES
DRAINFIELD INST ION
1 [10] AREA 11] [2]; 1/3:243QFT /' [
t 1 111] DISTRIBUTION BOX HEADER'!/ [ 1
[ 1 112 ] NUMBER OF r 1 AINLINES" 6 [ ]
[ 3 [13] DRAIN/aN pEP.RATI0N 6 ri 1 1
E 1 114] DRAINLINE SLOPE �'�,,� - I
I 1 [15] DEPTH OF COVE1 6 / L%
t 1 [16] ELEVATION" 1ABOVE BM t✓]
E 1 [171 SYSTEM LOCATION I'1
[ 3 [i8] DOSING PUMPS ` [ 11
I 3 [19] AGGREGATE SIZE oy /44 1 1
t ] 1201 AGGREGATE EXCESSIVE FINES Is..1.''
I ] [21] AGGREGATE . DEPTH N i-�Q t
I --3'
FILL / EXCAVATION∎MATER 1 1.Y
I 3 122] FILL AMOUNT /..Z, r.• t 1
t ] [23] FILL ' SATOx,E'
t 1 [24] EXCAVATION;DEPTE
[ ] [25] AREA REPLACED
I 1 1261 REPLACEMENT' MATERIAL
EXPLANATION OF VIOLAT;QNS / REMARKS
{ ]
I ]
I 3
[ ]
CONSTRUCT,
FINAL -, SYSTi
DH 4016, -O8/
incoxp3V ed.e';
PILLED / NOI)= SYSTEM!
(36] DRAINFIELP COVER
1371 SHOULDERS
[38] SLOPES
[3 ] STAB /LIBATION
ADDITIONAL INFORMATION
140] UNOBSTRUCTED AREA
[41] STORMWATER RUNOFF
[42] ALARMS
[43] MAINTENANCE AGREEMENT
144] BUILDING 'AREA
[45] LOCATION CONFORMS WITH SITE PLAN
148] FINAL SITE GRAD ~ G
[4 1 CONTRACTOR �„
14 OTHifit
y° ABANDONMENT p
[491 TANK PUMPED !] /4/ Z
( [50] TANK CRUSHED & Data= 9// // ..
DATE; 7'',
(Obsoetes all
64E- 6.003, FAC
evious editionswhic] may . not be u
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