PL-08-1846 r
Y
Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FIL
Phone: (305)795-2204 Fax: (305)756-8972
Inspection Number: INSP-97886 Permit Number: PL-10-08-1846
Scheduled Inspection Date: July 02,2010 Permit Type: Plumbing - Residential
Inspector: Hernandez, Rafael
Inspection Type: Final
Owner: BUTLER, ROBERT Work Classification: Drainfield
Job Address: 123 NE 97 Street
Miami Shores, FL 33138-
Phone Number (786)556-2919
Parcel Number 1132060132440
Project: <NONE>
Contractor: STATEWIDE SEPTIC CONNECTIONS Phone: (954)584-1481
Building Department Comments
ABANDON EXISTING SEPTIC TANK TO INSTALL NEW
1050 TANK AND NEW 571 SQ FT DRAINFIELD
Inspector Comments
Passed HRS APPROVAL HRS
Failed
Correction a•
Needed
Re-Inspection ❑
Fee
No Additional Inspections can be scheduled until
re-inspection fee is paid.
July 01,2010 For Inspections please call: (305)762-4949 Page 14 of 14
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DIVISION OF PL 1 —®8-.164(o
Environmental Health O 6 - 1
O Florida Department of Health
Miami-Dam County Health Department
IRV
OSTDS/Well Division �`�►�
11805 SW 26 St:•Miami,FL 33175
-� Inspector v� ��-�, Date K,
Address /� 3 �' OSTDS# )4 2 37 7
Comments:
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Miami Shores Village
Building Department
10050 N.E.2nd Avenue,Miami Shores, Florida 33138
Tel:(305)795.2204 Fax:(305)756.8972
BUILDING Permit No. R 0K_I
PERMIT APPLICATION Master Permit No.R
FBC 2004
Permit Type: Plumbing
Owner's Name(Fee Simple Titlehdlder) Robert 0.,,^�W Phone#
Owner's Address 12-3
I Z3 ma cl-7 S-1 ree t-
City °t State Zip 3
Tenant/Lessee Name �S Phone#
E-MAIL:
Job Address(where the work is being done) Ci-I S
City Miami Shores Villa2e County Miami-Dade Zip
FOLIO/PARCEL# jj — L3- -440
Is Building Historically Designated YES NO
Contractor's Company Name Sh��t% de t- &. c Inc Phone# 3AnG f- (oG -3
Contractor's Address 3G90 .,T, St "
City M `yar.-\ V- State Zip
Qualifier Name Tdrelgk (90 I01-1 0 Phone#
State Certificate or Registration No. �S°1``5`'1-11Z C� —Certificate of Competency No.
E-MAIL:
Architect/Engineer's Name(if applicable) Phone#
Value of Work For this Permit$ 760
0 . Square/Linear Footage Of Work:
Type of Work: B?;(ddition ❑Alteration ❑New ❑ lace Re air/Re
p p ❑ Demolition
Describe Work: 6C,-x4o a Pr,, e q
In5+qI kl� a -ct -11C
N-e_� 9-7)
Submittal Fee$ Permit Fee$ UV CCF$ CO/CC
Notary$ Training/Education Fee$ Technology Fee$.
Scanning$ Radon$ DPBR$ Zoning$
Bond $ Code Enforcement$ Double Fee$
Structural Review.$ Total Fee Now Due$
See Reverse side-�
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 asindicated. 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. l understand that a separate permit must be secured for ELECTRICAL 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. FF 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
inspectio will not be approved and a reinspection fee will be charged.
Signature Signaturecs;�
Ow er or Agent i�ti'�✓ TiMCo kao� Contractor
The foregoing instrument was acknowledged before me this j _ The fore oin i strument was acknowledged before e t is/0
day of ,20 � by , `, day of 20�by
who is personally known to me or who hasroduced
_ FLA As identifictf p � v /�... o is personally known to a or who has produced
(.rCef'��
as identification and who did take1 ath.
NOTARY PUBLIC: a�''% Comm#DD0793948 NOTARY PUBLIC• 84�n; 1'�
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Sign: fle- 11 e • hep®Deuces/tl/H/Ni//iN�eeiB
Sign:
Print: U r Print:
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My Commission Expires: My Commission Expires:
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APPLICATION APPROVED BY: o G Plans Examiner
L:
Engineer
Zoning
(Revised 02/08/06)
10/16/2008 15:03 9549630085 STATEWIDE SEPTIC PAGE 01
10/16/2908 15:01 3055133472 OSTDS PAGE 01/01
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