PL-17-2951 Inspection Worksheet
Miami Shores Village
10050 N.E.2nd Avenue Miami Shores,FL
Phone: (305)795.2204 Fax: (305)756-8972
Inspection Number: INSO-293974 Permit Number: PL-12-17-2951
Scheduled Inspection Date: February 14,2018 Permit Type: Plumbing -Residential
Inspector: Hernandez, Rafael Inspection Type: Final
Owner. CAMPBELL BORJA,KENDRA L. Work Classification: Draintield
Job Address:10361 NE 4 Avenue
Miami Shores,FL Phone Number
Parcel Number 1122310150120
Project <NONE>
Contractor: MR C'S PLUMBING&SEPTIC INC Phone:(305)651-7859
Building Department Comments
DRAINFIELD REPAIR nfractio Passed Comments....
INSPECTOR COMMENTS False
Inspector Comments
Passed Et HRS APPROVAL ON FILE
Failed
Correction
Needed
Re-Inspection F-1
Fee
No Additional Inspections can be scheduled until
reinspection fee is paid
February 13,2018 For Inspections please call:(305)762-4949
Page 2 of 16
Permit NO. PL-12-17-2951
�sO1s°,i Miami Shores Village Permit ye:Plumbing-Residential
10050 N.E.2nd Avenue NE PmLr
r � Work'Classifrcatian:Dr2tnfield
'•� Miami Shores,FL 33138-0000 P i
fes° ett»f Status:APPROVED
Phone: (305)795-2204
FCORLDA
Issue nate: 12120/2017 Expiration: 06/18/2018
Project Address Parcel Number Applicant
10361 NE 4 Avenue 1122310150120
Miami Shores, FL Block: Lot: KENDRA L. CAMPBELL BORJA
Owner Information Address Phone Cell
KENDRA L.CAMPBELL BORJA 10361 NE 4 Avenue
MIAMI SHORES FL 33138-
10361 NE 4 Avenue
MIAMI SHORES FL 33138-
Contractor(s) Phone Cell Phone Valuation: $ 2,400.00
MR'C'S PLUMBING &SEPTIC INC (305)651-7859
- -�- Total Sq Feet: 300
Type of Work:DRAINFIELD REPAIR Available Inspections:
Type of Piping:. Inspection Type:
Additional Info: HRS Approval
Bond Return: Final
Classification:Residential Scanning:3 Review Plumbing
r
Fees Due Amount Pay Date Pay Type Amt Paid Amt Due
Bond'Type-Owners Bond $500.00
CCF $� 60 Invoice# PL-1 2-17-65916
DBPR Fee $2.25 12/20/2017 Check#: 1418 $500.00 $ 168.05
DCA Fee $2.00 12/14/2017 Credit Card $50.00 $118.05
Education Surcharge $0.60 12/20/2017 Credit Card $ 118.05 $0.00 ;
Permit Fee $150.00 Bond#:3597
Scanning Fee $9.00
Technology Fee $2.40
Total: $668.05
In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations
pertaining thereto and in strict conformity with the plans,drawings,statements or specifications submitted to the proper authorities of Miami Shores Village. In
accepting this permit I assume responsibility for all wXe-
a by either myself, my agent, servants, or employes. I understand that separate permits are
required for ELECTRICAL,PLUMBING,MECHANICALOWS,DOORS,ROOFING and SWIMMING POOL work.
OWNERS AFFIDAVIT: I certify that all the fo goin intion is accurate and that all work will be done in compliance with all applicable laws regulating
construction and zoning. Futhermore, I autho ' acon ractor to do the work stated.
December 20, 2017
Authorized Signature:Owner / pplicant / Contractor / Agent Date
Building Department Copy
December 20, 2017 1
Z�
Miami Shores Village
Building Department
� g p
10050 N.E.2nd Avenue, Miami Shores, Florida 33138 JDE1427017
Tel:(305)795-2204 Fax:(305)756-8972
INSPECTION LINE PHONE NUMBER:(305)762-4949
FBC 20 �Q
BUILDING Master Permit No. 2c `I
PERMIT APPLICATION Sub Permit No.
❑BUILDING ❑ ELECTRIC .ROOFING ❑ REVISION ❑ EXTENSION RENEWAL
PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
/^��i- � I / CONTRACTOR DRAWINGS
'JOB ADDRESS:l la3w 6 – !1 V
City: Miami Shores / / Countv: Miami Dade Zip: 731
Folio/Parcel#: .:�22U ��( ��/ Is the Building Historically Designated:Yes NO L
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name(Fee Simple Titleholder): �,e oud c A r Phone#:
Address: IVE to
—
City: State: Zip:
Tenant/Lessee Name: Phone#:
Email: /,, 7
CONTRACTOR:C77
o pang NaF�r ne#: 365 _&S ``
�Y
Address:
City: S ate: ( Zip: /
Qualifier Name: Phone#: � roS/
State Certification or Registration#: i,
Q, Certificate of Competency#:
DESIGNER:Architect/Engineer: 1 Phone#:
Address: City: State: Zip:
Value of Work for this Permit:$ Square/Linear Footage of Work:
'Type of Work: ❑ Addition ❑ Alteration ❑ New [ Repair/Replace ❑ Demolition
Description of Work:
r
Specify color of color thru tile:
Submittal Fee$ W Permit Fee$ CCF$ CO/CC$
Scanning Fee$ Radon Fee$ DBPR$ Notary$
Technology Fee$ Training/Education Fee$ Double Fee$
Structural Reviews$ Bond$ c
TOTAL FEE NOW DUE$ I e 0`�
(Revised02/24/2014)
6O • ,�
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 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 be charged.
Signature Signature
04N ER or AGENT CONTRACTOR
The for loing instrumewas ack owled ed before me this The foregoinginstru t g was acknowledged before me this
It day of 5-(EGa 1— g 20 14 , by / day of Zef"; e lk' 20 IX by
0,q,li" TA who is personally known toTN��M►9(fC f i(�1i1'In who is personallv_knowg to
me or who has produced as me or who has produced as
identification and who did take an oath. identification and who did take an oath.
NOTARY PUBLIC: NOTARY PUBLIC:
Sign: Sign: I
Print: ���a��T a►� r� Print: d�lA �f ,r'1
Seal: �►Y' DONALD Seal: ; +!'" DONALD MARTIN
`4i. MARTIN MY COMMISSION#GG102743
MY COMMISSION#GG102743EXPIRES May 09,2021
a ,,•` EXPIRES May 09,2021
APPROVED BY �1 1— Plans Examiner Zoning
Structural Review Clerk
(Revised 02/24/2014)
PERbUT #: 13-SM-1806206
`�`.. APPLICATION #:AP1317587
STATE OF FLORIDA
DEPARTMENT OF HEALTH. DATE PAID
ONSITE SEWAGE TREATMENT.AND:DISPOSAL FEE PAID:
SYSTEM
s RECEIPT #:
•�`°°WMI , fi: , ,�k 3 DOCUMENT #:PRI 084684
,
t
CONSTRUCTION PERMIT FOR: OSTDS Repair
APPLICANT: KENDRA BORJA
PROPERTY ADDRESS: 10361 NE 4 Ave Miami, FL 33138
LOT: 12 BLOCK: SUBDIVISION:
PROPERTY ID #: 11-2231-015-0120 [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.
- t
SYSTEM DESIGN AND SPECIFICATIONS
T [ 900 ) GALLONS / GPD Existin0 Septic Tank to remain CAPACITY
A ( 0 ] GALLONS / GPD CAPACITY
N [ 0 ] GALLONS GREASE INTERCEPTOR CAPACITY [MAXIMUM CAPACITY SINGLE TANK:1250 GALLONS]
K ( ] GALLONS DOSING TANK CAPACITY [ ]GALLONS @[ ]DOSES PER 24 HRS #Pumps [ )
D [ 300 ] SQUARE FEET NEW DF IN BED CONFIG SYSTEM
R [ 0 ] SQUARE FEET SYSTEM
A TYPE SYSTEM: Ix] STANDARD I ] FILLED I l MOUND [ ]
I CONFIGURATION: [ ) TRENCH [Xl BED I l
N
F LOCATION OF DENCHI4ARK: FFE...........13.2'NGVD
I ELEVATION OF.PROPOSED SYSTEM SITE [ 27.60] [ INCHES FT ] [ABOVE BELOW BENCHMARK/REFERENCE POINT
E BOTTOM OF DRAINFIELD TO BE [ 77.60.1 [ INCHES FT ] [ABOVE BELOW BENCHMARK/REFERENCE POINT
a
L
D FILL REQUIRED: [ 0.00] INCHES EXCAVATION REQUIRED: I ] INCHES
1.-EXISTING 900 gal.septic tank with and approved filter TO REMAIN.
° 2: Install 300 sf.of drainfield in... BED.......configuration.
T 3.-Install 12"of slightly limited soil at the bottom of the drainfield.
H
4.-Invert elevation and Bottom of drainfield to be no less than 7.23' & 6.73 NGVD respectively
5.-Perimeter of excavation area shall be at least 2 ft wider and longer than the proposed absorption bed
E THIS PERMIT IS NOT FOR ANY ADDITIONS.
R The system is sized for 3 bedrooms with a maximum occupancy of 6 persons(2 per bedroom),for a total estimated flow of
SPECIFICATIONS BY: KEMB ETTRICK TITLE:
APPROVED BY: TITLE: Engineering Specialist II Dade cHD
Ger lizaire
DATE ISSUED: 12/06/2,017 EXPIRATION DATE:, 03/06/2018
DH 4016, 08/09 (Obsoletes all previous editions which may not be used) r
Incorporated: 64E-6.003, FAC Page 1 of 3
V 1.1.4 AP1317581 SE1055964
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STATE OF FLORIDA
DEPARTMENT--0F'- :.HEALTH
APPLICATION FOR CONSTRUCTION
PERMIT
'Per'mit Application Number
--------------------------- PART II -SITEPLAN----------------------
Scale: Each block re resents 10 feet and 1 inch =40 feet.
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VIC
-77
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There are no pertinent features on adjacent properties and or across the street that
may affect the New Septic System Installation
Notes: A-v)e k4
T- r-e em.-,I I'\
Site Plan submitted by: � �.
Plan Approved Not Approved Date— td 30 ,
BY T
County Health Department
ALL CHANGES MUST BE APPROVED BY THE COUNTY HEALTH DEPARTMENT
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10361 N.E.a Avenue
Miami Shares.FLORIDA 33138
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AptArt�cn sig a Suite 3110 `
SIGNED ; ` FOR THE HRN Miami,FL 33157 ME LAND
EFRAIa Lop ;;a, + Phone:(305)740-3319 �' rf
STATE OF FL \� " P.E SL No.ti7l7 Fa>L(305)6&9 3190
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