PL-10-2220Scheduled Inspection Date: February 16, 2011
Inspector: Hernandez, Rafael
Owner: KLEINMAN, LORETTA
Job Address: 655 NE 97 Street
Miami Shores, FL 33138 -2470
Project: <NONE>
Contractor: MR C'S PLUMBING SEPTIC INC
Building Department Comments
February 15, 2011
Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number: INSP- 154312 Permit Number: PL -12 -10 -2220
For Inspections please call: (305)762 -4949
Permit Type: Plumbing - Residential
Inspection Type: Final
Work Classification: Drainfield
Phone Number
Parcel Number 1132060171890
Phone: (305)651 -7859
NEW DRAINFIELD
Passed
1;?(
Failed
Correction
Needed
Re- Inspection
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
Inspector Comments
Page 6 of 21
4
BUILDING
PERMIT APPLICATION
FBC 20
Permit Type: PLUMBING
OWNER: Name (Fee Simple Titleholder): 1-ortfiVL K1e& Phone#: 3 c 14.5
Address: 17ST me 11 6 -r
City: t4 c41. 5
Tenant/Lessee Name: Phone#:
Email:
JOB ADDRESS: 65S Me / 7
City: Miami Shores
Folio/Parcel#: 30106 • fl1 -irto
CONTRACTOR: Company Name:
Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
INSPECTION'S PHONE NUMBER: (305) 762.4949
Permit No. j - 10,22 9 20
Master Permit No.
State: . V01`761k.
County: Miami Dade
M ci K.4, / Se
Address: OW a... au-t._
City: totiorhi State: FloridA.
Qualifier Name: iituar.
State Certification or Registration #: (
Contact Phone#: Email Address:
Square/Linear Footage of Work: 5.3c) fi
Value of Work for this Permit: $ g#0 • 0
Type of Work: CiAddress ClAheration
__
Description of Work: _1115 1 01(rtiA 'fi
e
Zip: SS l'Ag
Zip: g3I7Y
toe
Is the Building Historically Designated: Yes NO Flood Zone:
Phone#: i�(s 7S1T
zip: 13/6ei
Phone#: t 7irr
Certificate of Competency #:
DESIGNER: Architect/Engineer. Phone#:
depaidReplace LIDemolition
Submittal Fee $ 0 Permit Fee $ /6.71
Scanning Fee $ Radon Fee $
Notary $ Training/Education Fee $ Teehnolo Fee $
Double Fee $ Structural Review $
CCF $ co/cc$
DBPR $ Bond $
4'
TOTAL FEE NOW DUE $ 1 (00 :10
.♦
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
Application is hereby made to obtain a permit to do the work and installations as indicated. 1 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. 1 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: 1 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
Owner or gent
The foregoing instrument was acknowledged before me this 1 6
day of Ott. ,20 60 , by !/0 (e 4L )S 2 )J l nnCL`j ,
who is personally known to me or who has produced
As identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
My Commission E
*******4****************** * ffi ***d& **** *ash * **** * ***#*&,g *fit`** 3 t* . t,e * *a ro** *t d ***
APPROVED BY
Structural Review
(Revised 07 /1(U07(Revised 06/10t2004)(Revised 3/15/09)
a/20 Plans Examiner
Zip
Contractor
The foregoing instrument was acknowledged before me this
day of 3C■ ,20I ,by J �� �T th 6 ls'ti
who is personally known to me or who has produced
as identification and who did take an oath.
NOTARY PUBLIC'
Zoning
Clerk
12/15/2010 14:58 FAX
LOT: 19 & 19
T
A
R
R [
R
L
SPECIFICATIONS BY:
ADP/WWII)
Y - or) (95 -50i
STATE OF FLORIDA
DEPARTMENT OF HEALTH
ON3ITE SEWAGE TREATMENT AND DISPOSAL
SYSTEM
CONSTRUCTION NM= FUR: OSTDS Repair
APPLICANT: Dennis Kleinman
PROPERTY ADDRESS:
eROr RTY ID #: 11X06- 017 -1890
SYsTa DEBIGN AND BPRO/FICATXXN2
655 NE 97 St Mlaml, FL 33138
ELME: 101
SYSTEM MUST Ss CONSTRUCTED EN ACCORDANCE WIN SPECIFICATx0Ne AND OTANDARDS CV sZCTION
381.0065, F.S., AND CRAFTER 64E -6, B.A.C. DEPARTMENT APPROVAL OF SYSTEM DOES NOT GUARANTEE
SATISSAC ORI PERFORMANCE 8138 ANY SPECIFIC PERIOD OF TIM. AN! ORANGE IR RATER= BACT9,
WHICH SERVED AS A BASIS FOR ISSUAPCS OF THIS PERMIT, REQUIRE THE APPLICANT TO MODIFY TES
BERN APPLICATION. OUCH MCOIFICATIONS MAY PRSOLT 7Ii 'PHIS PERMIT HEIR MDR NOLL AND VDYD.
ISSUANCE OO TEIE PE82QT DOSS NOT EXioloT TEE APPLICANT PEON COMPLIANCE WITS OTHER FEDERAL,
STATE, OR LOCAL PERMITTING REQflT I D fOR DEIPELomewr of TRIB PR0T7.
900 1 Ou.T 5 / CPO in
0 ) GP . WRB / Orb
O ] GALLONS GREASE INTERCEPTOR CAPACITY
] GALLONS DOSING TANK CAPACITY [
300 ] BARE FIT SYSTEM
O ) SQUARE BUT STSIMM
TYPE SYSTEM; [ #] STANDARD [ ] FILLED [ 1 MOUND [ ]
cenrxeunnTxaN: [ 1 TRENCH (m) NED [ ]
VOCATION or 9SFCC:
ELEVATIONS or PROPOSED BYST !4 SIT&
SOTTOK OP DRAME.GD TO ER
THIS PERMIT IS NOT FOR ADDrTION(s).
vadrp [4pina
DATE ISSUED: 12,15/2010
F.F.E.: 10.0' NGVD.
[ 13.20 )
[ 41.20
serer rr$TON: Miami Shores Sec 4
FUEL REgEracio : [ 0.00) EA CMES
1- Exlagng 900 gel. septic tank certified by " Mr C's Plumbing & Septic " on12 5/2010 to remain. 2-Install 300 sf of
• drainfield in bed configuration. 3- Install 12" of slights limited soil under the bottom of drafrdlaid. 4- Perimeter of excavation
T area shall be at least 2 ft wider and longer than thS proposed abeorptlon bed. 5-Invert elevation of dralnfleld to be no less
than 7.06' NGVD. 6. Bottom of drainfiekl elevation to be no leas than 6.58' NGVD.
EXCAVATION
40.00
-"
'°41
DH 4016, 09/09 [t eeletes all previous editions wbtob may not be used)
Incorporated: 64E- 6.003, PAC
0 1. 1.
CAPACITY
CAPACITY
[1 CAPACITY SINGLE TAMR:1250 GRIMM
MALLOWS 9 [ MOSES PSR 24 HMS Dumps
A1
PERMIT 0 : 13 -SC- 1291314
AFpLICATION is AP987O82
DATE PAID:
MR PAID:
RECEIPT #:
DOCUMENT #: PR829333
MOTTOS, TOWNSHIP, RANGE, PARCEL NSA]
[OR TAR ID NUMBER]
FT ] [ ABOVE AZ21 RENCIDgemixessrmorca POINT
] [ ABOVE I_! ji ' BINC NARE/RIPEZAENCE POINT
=Cm/41
:aann4e5
001/004
EPAIR
•DADE COUNTY
Ems' TERTTC0 DATE: 03115/2011
Page 1 of 3
COD
12,15/2010 14:58 FAX a002/004
NOTICE OF RIGHTS
A party whose substantial interest is affected by this order may petition for an
administrative hearing pursuant to sections 120.668 and 120.57, Florida Statues. Such
proceedings are governed by Rule 28 -106, Florida Administrative Code. A petition for
administrative hearing must be in writing and must be received by the Agency Clerk for the
Department, within twenty -one (21) days from the receipt of this order. The address of the
Agency Clerk is 4052 Bald Cypress Way, BIN # A02, Tallahassee, Florida 32399 - 1703. The
Agency Clerk's facsimile number is 850410 -1448.
Mediation is not available as an alternative remedy.
Your failure to submit a petition for hearing within 21 days from receipt of this order will
constitute a waiver of your right to an administrative hearing, and this order shall become a'fnal
order'.
Should this order become a final order, a party who Is adversely affected by it is entitled
to judicial review pursuant to Section 120,68, Florida Statute& Review proceedings are
governed by the Florida Rules of Appellate Procedure. Such proceedings may be commenced
by filing one copy of a Notice of Appeal with the Agency Clerk of the Department of Health and a
second copy, accompanied by the fling fees required by law, with the Court of Appeal in the
appropriate District Court. The notice must be filed within 30 days of rendition of the final order.
•
Inspector
Address
Signature
DIVISION OP
Environmental Health
Florida Department of Health
Miami-Dade County Health Departme
OSTDS/Well Division
tins SW 26 St:0 Mari, PL 33175
If' Date 12
a L OSTDS # i
Comments: