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PL-17-1329
Inspection Worksheet Miami Shores Village 10050 N.E.2nd Avenue Miami Shores,FL Phone:(305)795-2204 Fax: (305)756-8972 0 Inspection Number: INSP-302204 Permit Number. PL-5-17-1329 Scheduled Inspection Date:April 23,2018 Permit Type: Plumbing -Residential Inspector: Hernandez,Rafael - Inspection Type: Final Owner: SNOW,DAVID AND JANICE Work Classification: Drainfield Job Address:12 NE 101 Street Miami Shores,FL Phone Number Parcel Number 1132060131380 Project <NONE> Contractor: STATEWIDE SEPTIC CONNECTIONS Phone:(954)963-0082 Building Department Comment REPLACE SEPTIC TANK AND DRAINFIELD Infractio Passed Comments INSPECTOR COMMENTS False Inspector Comments Passed CREATED AS REINSPECTION FOR INSP-282644. HRS IN FILE missing sod and broken side walk Failed Correction Needed ❑ Re-Inspection ❑ Fee No Additional Inspections can be scheduled until re-inspection fee is paid. April 20,2018 For inspections please call:(305)762-4949 Page 17 of 22 DIVISI"0'N'0F -Environmental Health Florida Health ,, Miami-Dade County, ;r�"��` OSTDS/MrMOPhsion, ' 11805 SSV 26h'Strcet FL 3i175O - Inspector J/,✓Nwr•. ° Date J' 2�1"19 C17ik1iCC�•G�1t5:� "' drew- OSTDS r Zr,] 1 Permit No. PL-5-17-1°329 Miami Shores Village Permiffype:Plumbing-Residential g� 10050 N.E.2nd Avenue NE 2Perl '111"t Work Classification.Drainfield Miami Shores,FL 33138-0000 Permit Status:APPROVED Phone: (305)795-2204 fGORIDA Issue Date.511712017 Expiration: 11/13/2017 Project Address Parcel Number Applicant 12 NE 101 Street 1132060131380 Miami Shores, FL Block: Lot: DAVID AND JANICE SNOW Owner Information Address Phone Cell DAVID AND JANICE SNOW 12 NE 101 Street MIAMI SHORES FL 33138- 12 NE 101 Street MIAMI SHORES FL 33138- Contractor(s) Phone Cell Phone Valuation: $ 5,500.00 STATEWIDE SEPTIC CONNECTIONS (954)963-0082 Total Sci Feet: 300 Type of Work:REPLACE SEPTIC TANK AND DRAINFIELD Available Inspections: Type of Piping: Inspection Type: Additional Info:REPLACE SEPTIC TANK AND DRAINFIELD HRS Approval Bond Return: Final Classification:Residential Scanning:3 Review Plumbing Fees Due Amount Pay Date Pay Type Amt Paid Amt Due Bond Type-Contractors Bond $500.00 Invoice# PL-5-17-64019 CCF, $3.60 05/15/2017 Check#:6245 $50.00 $777.60 DBPR Fee $4.50 DCA Fee $4.50 05/17/2017 Check#:5313 $777.60 $0.00 Education Surcharge $1.20 Bond#:3405 Permit Fee $300.00 Scanning Fee $9.00 Technology Fee $4.80 Total: $827.60 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 certthat all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction nd zoning. Futh rmore, I authorize the above-named contractor to do the work stated. May 17, 2017 / utho ze inatur :Owner / Applicant / Contractor / Agent ate Budin Department g p Copy May 17, 2017 1 h i { r e � . X"A Miami Shores Village RECEIVED � BuildingDepartment MAY 15 2(111'p 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel:(305)795-2204 Fax:(305)756-8972 " INSPECTION LINE PHONE NUMBER:(305)762-4949 Sf FBC 20 (U n BUILDING Master Permit No. ,PERMIT APPLICATION Sub Permit No. BUILDING ❑ ELECTRIC ❑ ROOFING REVISION ❑ EXTENSION ❑RENEWAL PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP A, CONTRACTOR DRAWINGS q JOB ADDRESS: 1 Z N F, 1 0I SJ pp City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: J1 -3Q& -O(OJ"l?)80 Is the Building Historically Designated:Yes NO ✓ Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER:Name(Fee Simple Titleholder): �y)ck S(VtoyV Phone#: �0 23" 330-5� 3 Address: I2: N 10 1 S;r ' City: M "�� S 4�0 State: Zip: 33l Tenant/Lessee Name: Phone#: Email: CONTRACTOR:Company Name:" STA-TEMO E SCV I(G C,\T" �NC Phone#: �t�gyl C76�� Address: P)bPO NiN (a kVIE 4{16 City: © � n —State: - Zip: �5� Qualifier Name: �A LA0 iV Phone#: State Certification or Registration#: Sl�a l( Certificate of Competency#: DESIGNER:Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit:$ 5 JUCJ Square/Linear Footage of Work: '?�Op Type of Work: ❑ Addition ❑ Alteration ❑ New Repair/Replace ❑ Demolition Description of Work: S 12 a b,�G --t�r d- o y-fn 1 n�� . .: x'�d'�,5'.e.tt`�.e•.K:`,.1`�?-•uFli.e'Sa Specify color of color thru tile: Submittal Fee$ r 1 .Permit Fee i CCF$ CO/CC Scanning Fee$ �' Radon'Fee$°."z DBPR$ `' "` Notary$ 4" Technology Fee$ Training/Education Fee$ Double Fee$//11 Structural Reviews$ Bond$ V� TOTAL FEE NOW DUE$ Z1� 60 (Revised02/24/2014) 97�_ ' 60 r Bonding.Company's,Name(if applicable) \f:(i' i. 11411 ..� .. 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. , F "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." G Notice to Applicant: As a condition to the issuance of a building permit with an estimated value exceeding$2500, the applicant must promise in good faith that a copy of the notice of commencement and,construction lien law brochure will be delivered to the person whose property is sutiject to attachment. Also,a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be approved and a reinspection fee will be c rged. Signatu __ Signature OWNER or AGENT CONTRACTOR 1 r The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this day of (Y—)CIL 1 20 n by S day,o(�f 4 20 (� by Da vicf Snow who is personally known to -t-0U;fs t O M who is personally known to me or who has produced as me or who has produced as identification and who did take an oath. identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: a Sign: Sign: Print:oCkk JC0 r Print: r� Seal: ; Seal: 0. e �e JERRICA L.ARMSTR]rlda �aN'YP�e��., JERRICA L.ARMSTRONG Notary Public-State o :°� Notary Public-State of Florida 7k`�8g"YMy Gomm. Expires Feb � 5' My Comm.Expires Feb 9,2019 AP Plans Examiner Zoning ( r ��Strt�ctural Review Clerk (Revised02/24/2014) REPAIR u 3-$C-1760655 STATE OF FLORIDA AOAM11`-DADE COUNTY HEALTH DSPARTMENT APPLICA I ION y#: AP1289189 DEPARTMENT OF HEALTH DATE PAID: ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM FEE PAID• F • RECEIPT #: 'fit►qct DOCU NT #:PR1060893 CONSTRUCTION PERMIT FOR: OSTDS Repair APPLICANT: David Snow PROPERTY ADDRESS-. 12 NE 101 St Miami, FL 33138 I LOT: 10, 11 BLOCK: 10 SUBDIVISION: Miami Shores Sec 1 Amd i PROPERTY ID #: 11-3206-013-1380 [SECTION, TOWNSHIP, RANGE, PARCEL NUMBER] [OR TAX ID NUMBER] I I 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 [ 1,050 ] GALLONS / GPD septic tank CAPACITY A [ ] GALLONS / GPD CAPACITY N I ] GALLONS GREASE INTERCEPTOR CAPACITY [MAXIMUM CAPACITY SINGLE TANK:12II50 GALLONS] K [ l GALLONS DOSING TANK CAPACITY [ ]GALLONS @[ ]DOSES PER 24 HRS #Pumps [ ] D l 200 ] SQUARE FEET Bed confiauration drainfield SYSTEM R [ ] SQUARE FEET SYSTEM A TYPE SYSTEM: [X] STANDARD [ ] FILLED [ ] MOUND [ ] I CONFIGURATION: [ j TRENCH [x] BED [ ] N F LOCATION OF BENCHMARK: FFE 12.7'NGVD I ELEVATION OF PROPOSED SYSTEM SITE [ 24.00 ] [ INCHES FT ] [ABOVE =BENCHMARK/REFERENCE POINT E BOTTOM OF DRAINFIELD TO BE [ 70.00 ] [ INCHES FT ] [ABOVE BELOW BENC"RK/REFERENCE POINT L D FILL REQUIRED: [ ] INCHES EXCAVATION REQUIRED: [ 46.00 ] INCHES **THIS REPAIR PERMIT IS NOT FOR ANY ADDITIONS** � 1.-Install a 1050 gal min.septic tank with an approved filter. T 2.-The licensed contractor installing the system is responsible for installing the minimum category of tank in accordance H with s.64E-6.013(3)(0, FAC. 3.-Install 200 sf of drainfield in bed configuration. E 4.-Perimeter of excavation area shall be at least 2 It wider and longer than the proposed absorption bed or drain trench. R (Comments Continued on Page 2.) SPECIFICATIONS BY: Teresa J Solomon TITLE: Master Septic Tank Contractor APPROVED BY: 22TITLE: Engineering Specialist II Dade CHD Erlande Oiaieca DATE ISSUED: 05/08/2017 EXPIRATION DATE: 08/06/2017 DH 4016, 08/09 (Obsoletes all previous editions which may not be used) I i R R Incorporated: 64E-6.003, FAC CONTRACTOR... SILRORING v 1.1.4 AP1289189 ThetPfo�(or designee)is required to perform a soil boring adiacen! tc t drairir-•eld excavat on at the time of firal inspection. Poor to Final Approval, the FDOH inspector shall witness ti•e so:! beringland compare the results to the original site evaluation submit ed. A reinspection fee will be assessed if the rxmtraranr is not at the iobshe at the arranged time. .s. STATE OF FLORIDA , - DEPARTMENT OF HEALTH - M Q'e (2`*�"�' ntAPPLICATION FOR CONSTRUCTION PERMIT A� 4 /0,,,,r, S� r Permit Application Number -------"' PART II-SITEPLAN- _-_-----_ Scale:-Each block re resents 10 feet and 1 inch=40 feet. 1 Ilk - f t ` r i t c Notes: vJ 12, O1 S T 53 y 3 � \ C Y,'O a t7. Site Plan submitted by: Sf"l -'7 j Plan Approved Not Approved Date k BY County Health Department ALL CHANGES MUST BE APPROVED BY THE COUNTY HEALTH DEPARTMENT bH 4015,08/09(Obsoletes previous editions which may not be used) Incorporated: 64E-6:001,FAC (Stock Number: 5744-002.4015-6) Page 2 of 4 Scanned by CamScanner I DOCUMENT #: '' PR1060893 5Anvert elevation of drainfield to be no less than 7.37'NGVD. 6--Bottom of drainfield elevation to be no less than 6.87'NGVD. 7.-This permit includes the abandonment of the existing septic tank. The system is sized for 2 bedrooms with a maximum occupancy of 4 persons(2 per bedroom),for a total estimated flow of 400 gpd. I � i 3 � I � I I I i i I f i i I i 1 I i 1 I i I I