PL-11-69Inspection Number: INSP - 154915 Permit Number: PL- 1 -11 -69
Scheduled Inspection Date: February 18, 2011
Inspector: Hernandez, Rafael
Owner: DOS SANTOS, MALON
Job Address: 801 NE 91 Terrace
Miami Shores, FL 33138-
Project: <NONE>
Contractor: MR C'S PLUMBING SEPTIC INC
Building Department Comments
REPAIR DRAINFIELD
Passed
Failed
Correction
Needed
Re- Inspection
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
Inspector Comments
February 17, 2011
Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
For Inspections please call: (305)762 -4949
Permit Type: Plumbing - Residential
Inspection Type: Final
Work Classification: Septic
Phone Number
Parcel Number 1132060050220
Phone: (305)651 -7859
Page 5 of 7
DIVISION OF
Environmental Health
Florida Department of Health
ami -Dade County Health Department
OSTDS/Well Division
11$U SW 26 St: • Mltml, 81.33175
11--(0°1
l -� 1 tt -
BUILDING
PERMIT APPLICATION
FBC 2004
Permit Type (circle): Building Electrical
Owner's Name (Fee Simple Titleholder) MA (oh DC64644165 Phone # 3cC g-(b � 1
Owner's Address �t p C. Q ( TV('
City 1 1 tx.N,,
Tenant/Lessee Name
Job Address (where the work is being done)
City
iO 1 foe ct t fit;✓
Miami Shores Village County Miami -Dade
FOLIO / PARCEL # 3 - dbS — OaDs
Is Building Historically Designated
Architect/Engineer's Name (if applicable)
Value of Work For this Permit $ ?,CThO ,00
Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138 BY: __
Tel: (305) 795.2204 Fax: (305) 756.8972
State Ft- Zip 3 3 1 3
YES
NO
Contractor's Company Name /4 6. P /vn6t f S9 ?1
Contractor's Address /993 a it/G) Q
City Jfis,,,r" State fa
-
Qualifier Name 3 It
State Certificate or Registration No. GFG. J4.a ?S7
Plumbing
Permit No. ( PL 11 - (G
Master Permit No.
Phone #
Zip 33 43 `1
Mechanical Roofing
Phone # 3vc 6 67 .71(6
Zip 53161
Phone # 3(3s 6s 71a-el
Certificate of Competency No.
JAN 112010 J
Square / Linear Footage Of Work: oZt3O
epair /Replace ❑ Demolition
Type of Work: ['Addition ['Alteration ['New
Describe Work: i t &A
****** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** F * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
Submittal Fee $ Sl:� � � `-'
�, Permit Fee $ CCF $ CO /CC
Notary $ Training/Education Fee $ Technology Fee $
Scanning $ Radon $ DPBR $ Zoning $
Bond $ Code Enforcement $ Double Fee $
Structural Review. $ Total Fee Now Due $ W 1 0,
See Reverse side -*
Bonding Company's Name (if applicable)
Bonding Company's Address
City
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 en (7) days after the building permit is issued. In the absence of such posted notice, the
inspection will not be approved an ijinspection fee will be charged.
Signature
Sign:
Print:
APPLICATION APPROVED BY:
(Revised 02/08/06)
//g,,, /na
State 4111111W"- • Zip
Own ;' or Agent
The foregoing instrument was acknowledged before me this
day of . & ' , 20 k l , by CCACI b °7L%- 1\-F ,>
who is personally known to me or who has produced
As identification and who did take an oath.
NOTARY PUBLIC:
Signature
Contractor
The foregoing instrument was acknowledged before me this I
day of . ,20 Iij ,by 3Ok.t ° "', 14G tr e;n
who is personally known to me or who has produced
as identification and who did take an oath,
KEMBLE
OMISSION # DD 891340
September 14, 2013
and d Thru Notary public Underwriters
*
NOTARY PUBLI
Sign:
Print:
KEMBLE ETTRICK
MY COMMISSION # DD 89124"
-EXPIRES: September 14, 201 t
My Commission'1~i @s 1edThruNotaryPubticUndewnicrs I t M Co
Y
Plans Examiner
Engineer
Zoning
- r -.—�,w
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OPERATION ■ LOCATI ; YEKCLE : tLVSJCN DM) BY Eli
IETAENT: PEriAL PROM 1045
I
"
CERT1F1CA7'E wOLr P
_ ... - -
01/21/2011 14:02 3056515610
CERTIFICATE OF LIABILITY INSURANCE
combinmd underwriters of 1Iiam4
8Z40 [3,N, E2 TOzr Suite 408
Miami FL 33166'
phone:30S- 477 -0444 E`a? 30E -5 -2343
CoVERAGEEa
ACORD 25 (20UM}
Mx, C'S 932ibinv 4 $epti4 Mc,
P ok 5
Mlaml rt, 33259
MR C PLUMB SEPTIC
,r 544: —.R C•
OP ID SZ
MRCSs -9.
HI5 'TlFICAT f S5 EDA AT ER C •R11AT •
QNLY AND CONFERS NO MIGHT$ UPON THE CERTrr1CATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, OXT END OR
ALTER THE COVERA 3E AFFORPEO BY THE PQLiC }ES BELOW,
1 INSUR ER5 AFPORPI 3 179 NAIL
I a,3LRaRA HERMITAC$ INSUP, NCE CO.
rt C 5
IN St„: C;
PAGE 02/02
GATE 0.1 ZD111'Y ; 1
01/ZM/3
@ 19138 -21109 ACORD CORPORATION. A!1 rt9rlts reserv6d.
The ACORD nVna rmd IQ90 ire re$1sr4red marks vt ACORD
Miami Shores • Village
10050 NE 2 Ave
MiarXTi Shores, FL 33138
At,rth3R.Vig n N ATa
s
3 i#2 1 - 1 1-0. ANY CF71 E Pi.3e7ve.DES'WP,la p POU eE CANCE6,KD 2 EFoRErrk E!{PRA icisJ
CAT- T' ,PEOF. 1N4y1R8R W.LL AtcpE a'rC T:1 MAIL 30 DArs 1vRITITEN
NOTtGS TCa ;rap CERTff1CA':E HOLDrR 'J »{EC Tv TKE LO B JT FAILVRF TA DO SO SI -141.
1 :4POS& NO Aug \nCSd OR 1.1ADtUTY OF Amr ititgt')POh THE a4SURER. 7 15 A:_ ORj
RFR tENTAT1411$,
STATE OF FLORIDA
DEPARTMENT OF HEALTH DATE PAID:
ONSITE SEWAGE TREATMENT AND DISPOSAL FEE PAID.
SYSTEM RECEIPT #'
CONSTRUCTION PERMIT FOR: OSTDS Repair
APPLICANT: Melon Dos Santos
PROPERTY ADDRESS: 801 NE 91 Ter Miami, FL 33138
LOT: 14
PROPERTY ID #: 11- 3206 - 005 -0220
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 [ 750 ] GALLONS / GPD Septic 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
R
A
I
N
F
I
E
L
D
0
T
H
E
R
[ 200 ] SQUARE FEET SYSTEM
[ 0 ] SQUARE FEET SYSTEM
TYPE SYSTEM: [x] STANDARD [ ] FILLED [ ] MOUND [ ]
CONFIGURATION: [ ] TRENCH [x] BED [ ]
LOCATION OF BENCHMARK: F.F.E.: 9.7' NGVD II
ELEVATION OF PROPOSED SYSTEM SITE [ 19.20 ] [I INCHES [' FT 1[ ABOVE A BELOWhBENCHMARK /REFERENCE POINT
BOTTOM OF DRAINFIELD TO BE [ 47.20 ] [I INCHES FT ] [ ABOVE /I BELOW 11 BENCHMARK /REFERENCE POINT
FILL REQUIRED:
[ 0.00 ] INCHES
1— Existing 750 gal. septjc tank certified by " Mr C's Plumbing & Septic " on 01/04/2011 to remain. 2- Install 200 sf of
drainfield in bed configuration. 3- Install 12" of slightly limited soil under the bottom of drainfield. 4- Perimeter of excavation
area shall be at least 2 ft wider and longer than the proposed absorption bed. 5 -Invert elevation of drainfield to be no less
than 6.26' NGVD. 6. Bottom of drainfield elevation to be no less than 5.76' NGVD.
THIS PERMIT IS NOT FOR ADDITION(s).
SPECIFICATIONS BY:
APPROVED B
BLOCK: 2 SUBDIVISION:
PEDRO N OSPINA
P'dro N •spina
DATE ISSUED: 01/10/2011
EXCAVATION REQUIRED: [ 40.00] INCHES
TI
DH 4016, 08/09 (Obsoletes all previous editions which may not be used)
Incorporated: 64E- 6.003, FAC
AP96,9.`.i07
[SECTION, TOWNSHIP, RANGE, PARCEL NUMBER]
[OR TAX ID NUMBER]
REPAIR
T 'M COUNTY HEALTH tEPAPTI ENT
EXPIRATION DATE:
srwt3s3ca:
PERMIT #: 13-SC-1294791
APPLICATION #: AP989507
DOCUMENT # : PR831222
Dade CHD
04/10/2011
Page 1 of 3