PL-09-1913 Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number: INSP- 129640 Permit Number: PL -11 -09 -1913
Scheduled Inspection Date: April 14, 2010 Permit Type: Plumbing - Residential
Inspector: Hernandez, Rafael Inspection Type: Final
Owner: PEAKS, FRANCES Work Classification: Drainfeld
Job Address: 9342 NE 9 Avenue
Miami Shores, FL
Phone Number
Parcel Number 1132060020050
Project: <NONE>
Contractor: A AMERICAN PLUMBING INC Phone: (305)866 -5600
Building Department Comments
INSTALL NEW DRAINFIELD 150 SQ
TANK TO REMAIN (900 GALLONS)
Inspector Comments
Passed HRS APPROVAL IN FILE
Failed
Correction ❑
Needed
Re- Inspection ❑
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
April 13, 2010 For Inspections please call: (305)762 -4949 Page 3 of 20
• STATE
OP FLORIDA
DEPARTMENT OF HEALTH PERMIT NO , Ap, 2 Z o Sk
ONSITE SEWAGE TREATMENT ACID DISPOSAL SYSTEM FATE PAID:
• CONSTRUCTION INSPECT, FINAL APPROVAL FEE PAID:
ws RECEIPT 4,
APPLICANT:
AGENT:
PROPERTY ADDRESS:
LOT: 5— BLOCK:
SUBDIVISION, Or i�°� ROPERTY ID bpsC
CHECKED [XI ITEMS ARE NOT IN`COMPU W ITH STAT TE OR RULE A `
o _ — D MUS'P BE CORRECTED,
TANKINST
[ I [ TA K S (1I O b ,! SETBACKS o
[ ] [021 TA K MATERIAL [ I [271 SURFACE. WATER FT
[ 1
1031 OU LET DEVICE DITCHES F •
[ 1 (04] MU
TI-CHAMBERED [Y N G ) [29] PRIVATE WELLS Pr
( ] [067 OUTLET FILTER [ I 1301 PUBLIC WELLS r .
[ 1 1061 LEGEND [ I [311 IRRIGATION WELLS FT
[ I 1071 WATERTIGHT [ I 1.321 POTABLE WATER LINES �` FT
I ) [08] LE ,.t �j [ ] (331 BUILDING FOUNDATIOIV
FT
[ I [081 D TH TO LID' Pe ' f I ) 1341 PROPERTY LINES
1O [ ] [351 • OTHER FT
tt-- c t� FT DRAINFIELL� INI§ tjMAfil�1I - P�
[ 1 (101 AEA 111 1 FILLED ! MOUND SYSTEM
( l [ UTION BOX HEADER 1 [ 1 [361 DRAINFIELD COVER
[ l [121 MBER OF DRAINLINES --P— • ( 7 [37] SHOULDERS
I I [t3] AINLINE SEPARATION 3 ,C SLOPES
[ l [ D AINLINE SLOPE [ l (391 STABILIZATION
[ ] [151 D PTH OF COVE [181 E VATION [ABO 8M ADDITIONAL INFORMATION
[17] S TEM LOCATI [ I 1 UNOBSTRUCTED AREA
[ 7 [181 DO NI�M [ I (411 ALA RMWATER RUNOFF
[ ]
1191 AGGtREGATC -� � I [ 1 [421 ALARMS
1 - GATE BXC S�J1VE FINES [ 1 1431 MAINTENANCE AGREEMENT
( 1 [ 4 ' 4 1 BUILDING AREA
[ 1 1
ATE DEPTH ,�� ] [45) LOCATION CONFORMS WITH SITE PLAN
-
FILL / EXCAVATION MATERIAL I [461 FINAL SITE GRADIrjQ
[ 1 1221 FILL AM OUNT • Z fi �� I [ CONTRACTOR "
I ] 123) FILL TEXTURE [ ) [481 OTHER
[ I ( EXCAVATION DEPTH ABANDONMENT
[ 1 1 AREA REPLACED I 9 1491 TANK PU
[ 1 12 61 REPLACEMENT MATERIAL I ] (501 TANK CRUSHED 8t FILLED_ /
EXPLANATION OF VIOLATIONS / REMARKS:
[ 1
( 1
I )
CONSTRUCT APPRO /DISAPPROVED];
CHO DATE: /
FINAL SYS D ISAPPROVED]. � _
�� 9
GHD DATE
DH 4014 (Page 200/97 (Previous Editions May Be Used)
Stock Number. 3744. 002- 4t)1S•4 Page 2 of 3
PT 1: Appucartl
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Miami Shores Village N OV ����
303 m' hIL Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138 BY... ® ° ®' ° ° "" " " ° ° ® ° ® ® ®m
Tel: (305) 795.2204 Fax: (305) 756.8972
BUILDING Permit No. Pt0 - � 10
PERMIT APPLICATION Master Permit No.
FBC 2004
Permit Type: Plumbing
Owner's Name (Fee Simple Titleholder) ��L� S & Phone #
Owner's Address �� 1 1��
City
Tenant/Lessee Name Phone #
E -MAIL:
Job Address (where the work is being done) 3 vZ �t ye
City Miami Shores Village County Miami -Dade Zip
FOLIO / PARCEL #
Is Building Historically Designated YES NO
/Contractor's Company Name 1 411G t / b, , Phone # - 3 0 SM Oc
Contractor's Address /a5 ' R, -, 5e4r, f— F( (�P . Gi - ? 0
City A/� State �C, Zip `t
��!
Qualifier Name `t 1- "h Phone # 9&
State Certificate or Registration No. CFe / L (-S f 0 . Certificate of Competency No.
E- MAIL:
Architect/Engineer's Name (if applicable) Phone #
Value of Work For this Permit $ g3 Q W. Square / Linear Footage Of Work:
Type of Work: []Addition ElAlteration Repair/Replace ❑ Demolition
Describe Work &P—W ea
Submittal Fee $ Permit Fee $ lJl ./ CCF $ [' ar CO /CC
Notary $ Training/Education Fee $ Technology Fee $ t •
Scanning $ L Radon $ DPBR $ Zoning $
Bond $ Code Enforcement $ Double Fee $
Structural Review. $ Total Fee Now Due $
See Reverse side -�
r
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 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. 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 abse posted notice, the
inspection will not be approved and a reinspection fee will be charged
Signature Signature Z
Owner or Agent Contractor
The foregoing instrument was acknowledged before me this j The foregoing instrument was - .Sc_oT
acknowledged before me this&
day of 20 � by Y,
s IA.-,1 Yf �,e day of �O®�o . 20 B by "la C(I —�:)I `J
who is personally known to me or who has produced who is personally known to me or who has produce 1NIIN 1
l/t ��� ��JI��
As identification and who did �� t as identification and who
' 6
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NOTARY PUBLIC: �;Q;•�M �ON410 9, Q��dOTARY PUBLIC: sk
;5U. ze ; �• : cog
Print: l < 8 ct' : - •• ••• Q:
My Commission Expires: °``: e ®��� • S * lc'AFi ���� Commission Expires: �d �� �5��
APPLICATION APPRO BY: ®/ Plans Examiner
i
Engineer
Zoning
(Rued ouosfos)
,, t
VP
Miami Shores Village
10050 N.E. 2nd Avenue
Miami Shores, FL 33138-0000
Phone: (305)795 -2204
y
j
Expiration: 05/17/201
Project Address Parcel Number Applicant
9342 9 Avenue 1132060020050
Miami Shores, FL Block: Lot: FRANCES PEAKE
Owner Information Address Phone Cell
FRANCES PEAKE 9342 NE 9 AVE
MIAMI SHORES FL 33138 -2904
Contractor(s) Phone Cell Phone Valuation: $ 2, 000.00
A AMERICAN PLUMBING INC (305)866-5600 (786)402 -1775
Total Sq Feet: 900
Type of Work: PLUMBING For Inspections please call:
Type of Piping: DRAINFIELD (305)762 -4949
Additional Info: Available Inspections:
Bond Return : Inspection Type:
Classification: Residential Final
Rough
Landscaping
Fees Due Amount Invoice # Total Amt Paid Amt Due
Bond Type - Contractors Bond $300.00
CCF $1 PL -11 -09 -36450 $ 481.20 $481.20 $ 0.00
.20
Education Surcharge $0.40 Check #: 1214 Bond #: 1902
Permit Fee - Additions/Alterations $175.00
Scanning Fee $3.00
Technology Fee $1.60
Total: $481.20
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
construction and zoning. Futhermore, I authorize the above -named contractor to do the work stated.
November 18, 2009
Authorized Signature: Owner / Applicant / Contractor / Agent Date
Building Department Copy
November 18, 2009 1
PERMIT # : 13 -SC- 1006833
APPLICATION #: AP940098
STATE OF FLORIDA
DEPARTMENT OF HEALTH DATE PAID:
ONSITE SEWAGE TREATMENT AND DISPOSAL FEE PAID:
e, SYSTEM RECEIPT #:
DocuMENT #: PR788495
CONSTRUCTION PERMIT FOR: OSTDS Repair
APPLICANT: Francis Peake
PROPERTY ADDRESS: 9342 NE 9 Ave Miami, FL 33138
LOT: 5 BLOCK: SUBDIVISION: Marilyn Heights
PROPERTY ID #: 11- 3206 -002 -0050 [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 [ 900 ] GALLONS / GPD Existing Septic Tank 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 [ 150 ] SQUARE FEET in trench configuration SYSTEM
R [ 0 ] SQUARE FEET SYSTEM
A TYPE SYSTEM: [X] STANDARD [ ] FILLED [ ] MOUND [ I
I CONFIGURATION: [X] TRENCH [ I BED [ I
N
F LOCATION OF BENCHMARK: FFE : 13.0' NGVD
I ELEVATION OF PROPOSED SYSTEM SITE [ 20.40][ INCHES FT ][ABOVE BELOW BENCHMARK /REFERENCE POINT
E BOTTOM OF DRA61MIELD TO BE [ 39.40 ] [ INC g FT ] [ ABOVE BELOW BENCHMARK /REFERENCE POINT
L
D FILL REQUIRED: [ 0.00] INCHES EXCAVATION REQUIRED: [ 19.00] INCHES
0 1. Existing 900 g septic tank to remain.
2.lnstall 150 sq ft drainfield in trench configuration.
T 3. Invert elevation of drainfield to be no less than 10.20' NGVD.
H 4.13ottom of drainfield elevation to be no less than 9.70' NGVD.
E
R
SPECIFICATIONS BY: William Wo TITLE:
APPROVED BY: T ineer Specialist II Dade CHD
n 12 " 009 DATE ISSUED: 12 009 EXPIRATION DATE: 01/20/2010
DH 4016, 10/97 (P a ious Editions - Be Used) Page 1 of 3
a 1.1.4 AP940096 SE799455
o�
._ STATE OF FLORIDA PERMIT NO.
g ` °DEPARTMENT OF HEALTH DATE PAID: `t
ONSITE SEWAGE TREATMENT AND DISPOSAL: SYSTEM FEE PAID:
CONSTRUCTION INSPECTION -AND FINAL APPROVAL RECEIPT #:
wa
�
APPLICANT: / - %�s :.e- r-• -� �'7 JZ.
'
AGENT:
c 1
PROPERTY ADDRESS:
LOT: BLOCK:_,_;: SUBDIVISION: ROPERTY ID #: k— 3� ri °{� POro
CHECKED ' [)q ITEMS ARE NO IN COMPLIANCE WITH -STAT: E OR RULE AND MUST BE CORRECTED.-
TANKINST SETBACKS
1 l 1011 T K SIZE [1] 1, �°°' I 1 [ SURFACE WATER FT
[ 1 [021 TA K TMA ERIAL_ 1 1 [281 DITCHES FT
[ ] [031 OU ET DEVICE, 4 � � [. j [29] PRIVATE WELLS FT
[ 1 [041 MU TI- CHAMBERED [Y N 1 1 [301 PUBLIC WELLS FT
( 1 [051 OUTLET FILTER [ ] 1311 IRRIGATION WELLS FT
1 1 [061 LEGEND `i `> [ 1 [321 POTABLE WATER LINES C Q FT
( 1 (071 WATERTIGHT : � [ ] [33]' BUILDING FOUNDATION FT
( ] 108] LE 'C,.� ' . [ l '[34] PROPERTY LINES f ^ FT
( 1 1091 DE TO LID f " �� [ 1 [351 OTHER FT
r . #
DRAINFIEL IN FILLED / MOUND SYSTEM
[ 1 1101 A EA [11 (2 I ( 1 . - - -[36] DRAINFIELD COVER
[ J [111 UTION BOX HEADER [ 1 1371 SHOULDERS
[ 1 [121 • MEER OF DRAINLINES L [ 1 [381 SLOPES
[ 1 [ D AINLINE SEPARATION .3 G ri [ 1 [39] STABILIZATION
[ 1 [14] D INLINE SLOPE
[ ]
11 D PTH OF COVER ADDITIONAL INFORMATION
[ 1 [161 EL VATION [ABO ELO BM [ 1 [401 UNOBSTRUCTED AREA
[ 1 [171 S EM LOCATION_ ( 1 [411 STORMWATER RUNOFF
[ 1 [18] DO I�PUMP ' "� ( 1 [421 ALARMS
[ ]. [191 AGGREG ~ ~' ( 1 [431 MAINTENANCE AGREEMENT
[ I._ F2#i [ -^• EXC S .. VE FINES [ 1 (441 BUILDING AREA
[ 1 GATE DEPTH ,) ! /, ] (45] LOCATION CONFORMS WITH SITE PLAN
1 [46 FINAL SITE GRADI G ✓
FILL / EXCAVATION MATERIAL ] [47] CONTRACTOR _9 1
( 1 [221 FILL AMOUNT Z! �!r r �+ [ 1 (48] OTHER
( 1 [23 FILL TEXTURE
( ] [241 EXCAVATION DEPTH ABANDONMENT
[ 1 (251 AREA REPLACED [ ] ''` - 1491 TANK PUMPED__
[ ] [26] REPLACEMENT MATERIAL [ 1 [50 TANK CRUSHED & FILLED_
EXPLANATION OF VIOLATIONS / REMARKS:
[ 1
d I
[ 1
CONSTRUCT APPRO /D ISAPPROVED]: !^-- / CHD DATE: 7
FINAL SYS D ISAPPROVED]: . -- CHD. DATEf j /}
OH 4016 (Page 2), 10!97 {Previous Editions May Be Used)
Page 2 of 3
Stock Number 5744 -002. 40164 PT 1: Appfimt
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STATE OF FLORIDA
DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION
CONSTRUCTION INDUSTRY LICENSING BOARD (850) 487 -1395
•ate TALLAHASSEE MONROE 3TRFLT32399 -0783
CHAMBER KENNETH SCOTT
A AMERICAN PLUMBING NC
1255 BISCAYNE BLVD #970
FL 33181
_.. .. _ ...«___....._......_... .. ..... __.w.. � ..___ ._....- ._.....� .......__._
ratulationsl With this license y ou of
g y become one the nearly one million
••.•��••''': N ,
Floridians licensed by the Department of Business and Profession Regulation. .'`b' `0.
Con INBSS
yacht bro
Our professionals and businesses range from architects t kersfrom
box "" US A]D
LOFSt"01�
ers to barbs , and keep Florida's
que restaurants they k p economy strong. _ �, .... < . • • :.'r ::: :' `.:,
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'��• : < >;:�F'C?��"1.0 : -=, ' >tS� %2�9�{0�.9� ;0:8::00 =1.74
Every day we work to improve the way we do business In order to serve you better. _'a
For information about our services, please log onto www.myflorldaticense.com. P* ' „
There you can find more Information about our divisions an the regulations that ° ":r L :OIl? '
,.. "G > p,
Impact you,
Imps Y , to department newsletters and Isom more about th :'�'� * a. •
Department's initiatives. e r '`d:'.C'i4N' ' LDI�ING
strive De is: Licen Efficientiy, Regulate Fairly. We
constantly
by to serve you better so that can se
you se your customers
Our mission at the D . :,:, : :'• .:::..:. s -' b
Thank you for doing business in Florida, and congratulations on your new license!
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A p Z Lock i imCATE F ur Y INSURANCE Nu: 1993 1413
PRODttCER THIS CERTIFICA'I'I3 IS ISSUED AS A MATTER OF INFORMATION
INFINITY INSURANCE SOLUTIONS ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT Am m, EXTEND OR
6412 N Univdrsity Drive Stec 132 TER THE COVERAGE AFFORDED BY THE POLICIES SELOW.
Tamaraa, FL 3332
—0 5411318- 24IJ9 INSURERS AFFORDING COVERAGE NAIL#
MURW A AMERICAN P?LT MXNG, =c. INSURER A MT. FIRE rwa Co.
12555 BISCAYNZ BOULBVARD, #970 INWRER e: T AL
NORTH MIAMI, FLORIDA 33181 INGURERC.
305 -8 66 5600- oB`FICE INSIRI;R Lx
- INauR6R
COVERAGES
THE PO LICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POUCY PERIOD INDICATED. NO7WITt18TANDM TERM OR �W URANCE APFOROEL] BY THE FOUCI DE�SCRIBEQ HE(iEIN ( DOC U MENT
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CERTIFICATE CANCELLATION
CITY OF NORTH MIAMI BEACH IRHOULD ANY OF THE AMR DE8CRM POLICIES B8 CANCEM BEFORE THS ENMRA
170.80 N. S . 19TH AVE DATE THEREOF, THE I88W4 INSURER WILL. ENDEAVOR TO MNL 30 DAYS WRITTEN
HURTS MIAMI BEACH, FLORIDA 33162 NOTICE TO TW CIN HOLDER NAMED TO THE LEFT; BIT FAa.URE To DO 8O 81141.1.
IMIPOSE NO 08"TION OR LIA111LITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
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