PL-10-121 o I N
s 6 Miami Shores Village
10050 N.E. 2nd Avenue
7 s
Miami Shores, FL 33138 -0000 - m N
Y f Y
`resx+g Phone: (305)795- 2204�r f
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2
Expiration: 0101299
Projec Address P arcel Number Applicant
790 96 Street 1132060142060
Miami Shores, FL 33138 Block: Lot: ANN RUSSOLI
Owner Information Address Phone Cell
ANN RUSSOLI 790 NE 96 ST
MIAMI SHORES FL 33138 -2520
Contractor(s) Phone Cell Phone
Valuation: $ 3,750.00
ALL PRO SEPTIC & SEWER INC / ALL
_.._.... (305)635-3002 (305)206 -4473
Total Sq Feet: 0
Type of Work: REPLACE DRAINFIELD For Inspections please call:
Type of Piping: (305)762 -4949
Additional Info: Available Inspections:
Bond Return : Inspection Type:
Classification: Residential HRS Approval
Abandonment
Final
Rough
Landscaping
Fees Due Amount Invoice # Total Amt Paid Amt Due
Bond Type - Contractors Bond $300.00 PL -1 -10 -36899 $ 440.65 $50.00
CCF $2.40 4,. --
Education Surcharge $0.80 PL -1 -10 -36899 $ 440.65 $ 440.65 $ 0.00
Permit Fee - Additions /Alterations $131.25 Check #: 7845 Bond #: 1922
Scanning Fee $3.00
Submittal Fee $50.00
Submittal Reversal Fee ($50.00)
TechnoloWFee $3.20
Total: $440.65
f ,h
In consider tion of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations
pertainingAbereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In
accepting%is permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are
required *ELECTRICAL, PLUMBING, MECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work.
OWNER$ i,' FFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating
constructf.'O and zoning. Futhermore, I authorize the above -named contractor to do the work stated.
February 01, 2010
Authorized Signature: Owner / Applicant ! Contractor / Agent Date
+,_,
Building Departme Copy
February 01, 2010 1
Miami Shores Villag F g RECEOVtOl
Building Department JAN 2 6 2016
10050 N.E.2nd Avenue, Miami Shores, Florida 33138 -� A I
Tel: (305) 795.2204 Fax: (305) 756.8972 --
BUILDING Permit No. FLI 1 0 Gki
PERMIT APPLICATION Master Permit No.
FBC 2004 �(
�O
Permit Type: Plumbing
Owner's Name (Fee Simple Titleholder)
Owner's Address �gQ X _5;t7_
City S/� State
., zi
Tenant/Lessee Name /� �f Phone #
E- MAIL:
Job Address (where the work is being done) . 6 9 6
City Miami Shores V ` County Miami -.Dade Zip
FOLIO / PARCEL # 11 " 2-Qlbb - 2_8
Is Building Historically Designated YES NO ® _
N ' m
Contractor's Company Name - S Phone #
Contractor's Address A ZAP ,,
City ��a t State rL Zip 531&5
Qualifier Name Z�� - 7P/Xe.41" Phone # 1 A0V 2,
State Certificate or istration N�� /' Ge Certificate of Competency No.
E : � `4,J � wl r
Architect/Engineer's Name (if applicable) �— ,; Phone #
Value of Work For this Permit $ y e _
S3Aq�fT Af Ps {! � �O�r vow =.
❑A�lcbt„ ❑Alteration epa [� Demol
�`�ub mittal Fee $ •� Permit Fee $
c� _ � 6 � CCF $ CO /CC
^' Notary $ Training /Education Fee $ Technology Fee $.
Scanning $ Radon $ DPBR $ Zoning $
Bond $ Code Enforcement $ Double Fee $
Structural Review. $ Total Fee Now Due $
See Reverse side -�
Bonding Company's Name (if applicable) f y
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 absence of such posted notice, the
inspection will not be approved and a reinspection fee will be charged.
Signature `
Signature _
Owner or Agent Contractor
The foregoing instrument was acknowledged fore me thin The foreg 'ng instrument was acknowledged before me this
day o 2010 , by �nA C3[ 1 day of , 20 b ��,•
who is personally known to me or who has produced who is personally known to me or who has produced
As identification and who did take a h. as identification and who did take an oath.
NOTARY PUBLIC: NOTARY PU C:
at
PAN 2L
Sign:
Sign: g�TIER�
Print:
Print: Not�Y �p
My Commission Expires. My Commission E
APPLICATION APPROVED BY: / 'Jl Plans Examiner
Engineer
Zoning
(Revised 02/08/06)
a
t
ADDENDUM TO BUILDING PERMIT APPLICATION
(AN APPLICATION FOR BUILDING PERMIT MUST ACCOMPANY THIS ADDENDUM. IF A MASTER PERMIT HAS B.
OBTAINED, THE OWNER'S NOTARIZED SIGNATURE NEED NOT BE PRESENT ON SUBSEQUENT APPLICATIONS.)
PLUMBING �1 ELECTRICAL MECHANICAL
ITEM UNIT FEE ITEM UNIT FEE ITEM UNIT FEE
BATH TUB SWITCH OUTLETS SPACE HEATERS
BIDET LIGHT OUTLETS CENTRAL HEATING
DISHWASHER RECEPTACLES A/C (WIND)
. DISPOSAL SERVICE TEMPORARY A/C (CENTRAL)
DRINKING FOUNTAIN SERVICE SIZE IN AMPS DUCT WORK
FLOOR DRAIN SERVICE REPAIR/METER DiAIGE REFRIGERATION
GREASE TRAP APPLIANCE OUTLETS PROCESS AND PRESS PIPING
INTERCEPTOR RANGE TOP UNDERGROUND TANKS
LAVATORY OVEN ABOVE GROUND TANKS
L9M TRAY WATER HEATER U.F. PRESSURE VESSELS
CLOTHES WASHER MOTORS 0- 1 HP STEAM BOILERS
SHOWER MOTORS OVER 1- 3 HP HDT WATER BOILERS
SINK, POT /3 COMA. MOTORS OVER 3- 5 HP MECHANICAL VENTILATION
SINK, RESIDENCE MOTORS OVER 5- 8 HP TRANSPORTING ASSEMBLIES
SINK, SLOP MOTORS OVER 8- 10 HP ELEVATORS/ESCALATORS
TEWORARY WATER CLOSET MOTORS OVER 10- 25 HP FIRE SPRINKLER SYSTEMS
URINAL MOTORS OVER 25 -100 If COOLING TOWERS
WATER CLOSET MOTORS OVER 100 HP VIOLATION
INDIRECT WASTES A/C WINDOW REINSPECTION
WATER SUPPLY TO: AIR CONDITIONERS
A/C UNIT STRIP HEATER
FIRE SPRINKLER GENERATORS TRANSFORMERS
HEATER -NEW INST. GENERATORS TRANSFORMERS
HEATER- REPLACE GENERATORS TRANSFORMERS
LAWN SPRIWLER -WELL SPECIAL PURPOSE
SWIMMING POOL OUTLETS CDA ERCIAL
WATER SERVICE SIGN TUBES
SEWER CONNECTIONS SIGN TRANSFORMERS
UTILITY -SEWER SIGN TIME CLOCK
UTILITY -WATER FIXTURES
SEPTIC TANK ANTENNA
RELAY TELEVISION OUTLETS
DRAINFIELD, 4' TILE/RES. i VIOLATION
PUMP & ABANDON SEPTIC TANK REINSPECTION
SOAKAGE PIT CU. FT.
CATCH BASIN
DISCHARGE WELL
DOMESTIC WELL
AREA DRAIN
ROOF INLET
SOLAR WATER HEATER
FIRE STANDPIPE
POOL PIPING
LAWN SPRINKLER SYSTEM
GAS RANGE
METER SET (GAS)
GAS PIPING
PERMIT # : 13 -SC- 1117743
STATE OF FLORIDA APPLICATION #: AP949519
DEPARTMENT OF HEALTH DATE PAID:
ONSITE SEWAGE TREATMENT AND DISPOSAL FEE PAID:
SYSTEM
4P
RECEIPT #:
DOCUMENT # : PR796600
CONSTRUCTION PERMIT FOR: OSTDS Repair
APPLICANT: Ann Russo
PROPERTY ADDRESS: 790 NE 96 St Miami, FL 33138
LOT: 1 + 2 BLOCK: 68 SUBDIVISION:
PROPERTY ID #: 11- 3206 -014 -2060 [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 [ 750 ] GALLONS / GPD Seotic 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 [ 300 ] SQUARE FEET Bed confiauration SYSTEM
R [ 0 ] SQUARE FEET SYSTEM
A TYPE SYSTEM: [X] STANDARD [ ] FILLED [ ] MOUND [ ]
I CONFIGURATION: [ ] TRENCH [X] BED [ ]
N
F LOCATION OF BENCHMARK: FFE .................10.60' NGVD
I ELEVATION OF PROPOSED SYSTEM SITE [ 18.00][ INCHES FT ][ ABOVE BELOW BENCHMARK /REFERENCE POINT
E BOTTOM OF DRAINFIELD TO BE [ 48.00][ INCHES FT ][ABOVE BELOW BENCHMARK /REFERENCE POINT
L
D FILL REQUIRED: [ 0.00] INCHES EXCAVATION REQUIRED: [ 42.00] INCHES
0 1.- Existing 750 gal. septic tank to remain.
2.- Install 300 sf of drainfield in BED configuration.
T 3.- Invert elevation of drainfield to be no less than 6.10 ft NGVD.
H 6. -Bottom of drainfield elevation to be no less than 5.60 ft NGVD.
E THIS PERMIT IS NOT FOR " ADDITION(s) ".
R
SPECIFICATIONS BY: Gerard L Philiz 'r TITLE:
APPROVED BY: neer Specialist II Dade CHD
J s Pive 7
DATE ISSUED: 01/ '/2 10 - EXPIRATION DATE: 04/22/2010
DH 4016, 10/97 (Prev us Editions May Be Used) Page 1 of 3
v 1.1.4 AP949519 SE805665
s d
STATE OF FLORIDA -qufl
DEPARTMENT OF HEALTH �.
APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUC iON PERMIT
Permit Application Num d`r t.`.1�t;
---- PARTII - SITEPLAN - - ---- 3
Scale: Each block represents 10 feet and 1 inch = 40 feet. 90 6 • t}IZE�S "l .
9
,...
i
Ary
V
�53
-e -00
j t
j
It- !
"..i
Notes: x�S "�
Site Plan submitted by: -
Signature i
Plan Approved Not Approved date
By County Health Department
ALL CHANGES MUST BE APPROVED BY THE COUNTY HEALTH DEPARTMENT
DH 4015,10/96 (Replaces HRS -H Form 4016 which may be used) Page 2 of 4
(Stock Number: 5744 -002- 4015 -6) r `'
A RECORDED COPY MUST BE POSTED ON THE JOB SITE AT TIME OF FIRST INSPECTION
PERMIT NO. TAX FOLIO NO. OR B €: 27155 Ps 2593; Qps )
RECORDED 01/21/2010 11:41:
STATE OF FLORIDA: HARVEY RUl1INP CLERK, OF c BURT'
COUNTY OF MIAMI -DADE: MIAMI -DADE COUNTY? ` FLORIDA
LA6T PAGE-
THE UNDERSIGNED hereby gives notice that improvements will be made to certain real
property, and in accordance with Chapter 713, Florida Statutes, the following information
is provided in this Notice of Commencement.
1. Legal description of property and street/address: �:!� 96 S f e
� - 5 /.
2. Description of improvement:
3. Owner (s) name and ess: .�..7 f 'M N E q(0 cS t yu qm ls
Interest in property:
Name and address of fee simple titleholder:
4. name and address: -� lf✓
-. .. �
5. Surety: (Payment bond required by owner from contractor, if an c inn
Name and address: �' FLORON, COUP DF p o the ,� s3
gY CE
_a � w
Amount of bond �M Ir1 egs Oflo o
6. Lender's name and address:
CCi ",its
vets, GI RK
7. Persons within the state of Florida designated by Ong es or other documents may be served as
provided by Section 713.13(1)(a)7., Florida Statutes,
Name and address: 4e-
8. In addition to himself, Owners designates the following person(s) to receive a copy of the Lienor's Notice as provided
in Section 713.13(1)(b) Florid Statutes.
Name and address :��' 1;
9. Expiration date of this Notice of Commencement: (the expiration date is 1 year from the date of recording unless a
diff ent date* specified)
Signature of Owner
Print Owner's Named Prepared by
�'�`
CArU
!�,
Sworn to and subscribed before me hi ay of , 20�
Address: <�
Notary Public cuT�EtBtEZ
Print Notary's e _ Pabxc . S tx
My commission expires:
�' 123.01 -52 PAGE 4.5/07
02/03/2010 07:58 FAX ALLPRO IaOO 1 /004
All Piro Plumbing Septic & Sewer, Inc.
All Pro Septic and Sewer, Inc
2700 NW 27 Ave Mi=4 Fl 33142
Ph: 305 - 5353002 Fax: 305 - 635-7473
Email: allpross@bensouth.net
FAX
Attention: Qk"\
�—
From:
PL o ��--� 0 - 12
Date:
Pa ( including cover page)
If you do not receive OR M" Please call (30516353002
r �
n
02/03/2010 07'.58 FAX ALLPRO 1a002/004
STATE OF FLORIDA PERMIT NO. ILL
DEPARTMENT OF HEALTH
DATE PAID:
ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM FEE PAID:
'. aw CONSTRUCTION INSPECTION AND FINAL APPROVAL RECEIPT #:
APPLICANT.'_
7 ..
AGENT:
PROPERTY ADDRESS: _jfe
LOT:z__L� BLOCK: - SUBDIVISION: PROPERTY ID #://-
CHECKED (XI ITEMS ARE NOT IN COMPLIANCE WITH STATUTE OR RULE AND MUST BE CORRECTED,
TANK INSTALLATION SETBACKS
I [Oil TANK SIZE Ell [2] 1 1 [271 SURFACE WATER FT
1 .(021 TANK MATERIAL ) 1281 DITCHES. Fr
1 1031 OUTLET DEVICE ] (29] PRIVATEELLS FT
1 104] MULTI-CHAMBERED ty / -
1 1051 OUTLET FILTER 1301 Pudb6_W _' FT
(311 IRRIGATION WELLS FT
[081 LEGEND 1321 POTABLE WATER LINES FT
1 [071 WATERTIGHT 1 [33] BUILDING FOUNDATION FT
1 1081 LEVEL -.2 e7 [343 PROPERTY LINES FT
1 [091 DEPTH TO LID [35] OTHER FT
DRAINFIELD INSTALLATION, FILLED /'MOUNUSY
1 1101 AREA Ell -/2X-2 �r I OFT 1 [36] DRAINIFIELD COVER
Ill] DISTRIBUTION BOX — HEADER 1 (371 SHOULDERS'
[12) NUMBER OF DRAINLINES -_ . A 1 (381 SLOPES'
[1 a] DRAINLINE SEPARATION [39) STABILlikTION
1 [14] DRAINLINE SLOPE
1 [15] DEPTH OF COVER ADDITIONAL INFORMATION
1 ELEVATION [ABOVIM�E� j3M 1 1 [401 UNOBSTRUCTED AREA
(17) SYSTEM LOCATION j (41] STORmWATER• RUNOFF
[is] DOSING PUMPS 1 [421 'ALARMS
1 [191 AGGREGATE SIZE 1 [431 MAINTENANCE- AGREEMENT
1 (201 AGGREGATE EXCESSIVE FINES 1 [44] BUILDING AREA
1 (211 AGGREGATE DEPTH IV 1 1451 LOCATION CONFORMS WITH SITE PLAN
1 (461 FINAL SITE GRADING
FILL EXCAVATION MATERIAL
1 1 [22] FILL AMOUNT 1 1471 CONTRACTOR--
1 (231 FILL TEXTURE 1 [481 OTHER
1 1241 EXCAVATION DEPTH ABANDONMENT,
1 [25] AREA REPLACED [491 .TANK PUMP'ED__1_/
1 [261 REPLACEMENT MATERIAL. 1 [601 TANK CR6 SHED -& - FILLED'—/ _
EXPLANATION OF VIOLATIONS / REMARKS:
CONSTRUCF9 DIDISAPPROVEDI!
r-HD DATE: .2 /0
FINAL SYSTgZ� ��PPRoy /DISAPPROVED]: c,�
CHO DATE: l o
DH 401 (Page 2), 10 /07 (Proyloug Ed Uona May Be Used) Page 2 of 3
Stock Number: 5744-002-4016-4
PT 1: Appffe*nt
PT 2'
PT 3: BLAdng Depantnem
PT a: Heath Depenmeni
i
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i Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
nspection Number: INSP-135084 Permit Number: PL -1 -10 -121
Inspection Date: February 09, 2010 Permit Type: Plumbing - Residential
Inspector: Hernandez, Rafael
Inspection Type: Final
Owner: RUSSOLI, ANN Work Classification: Septic
Job Address: 790 NE 96 Street
Miami Shores, FL 33138- Phone Number
Parcel Number 113206014206
Project: <NONE>
Contractor: ALL PRO SEPTIC & SEWER INC / AL L PRO PLUMBING SEP' Phone: (305)635 -3002
Building Department Comments
REPLACE EXISTING DRAINFIELD 300 SQFT
Inspector Comments
Passed AS PER NB SIDEWALKS OK.
Failed El
Correction
Needed
Re- Inspection ❑
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
For !m7pe .tions please call: (305)762 -4949
February 08, 2010 Page 1 of 1
. . . .......... .
Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FIL
Phone: (305)795-2204 Fax: (305)756-8972
------ -- — ------ -- ----
1) 11 4
Inspection Number: INSP-1 34218 Permit Number'. P /_1 0 A 26
Scheduled Inspection Date: February 03, 2010 Permit Type: Plu ng - Residential
Inspector. Hernandez, Rafael
I pection Type: Final
Owner: RUSSOLI, ANN W k Type:
Septic
Job Address: 790 NE 96 Street
Miami Shores, FL 33138- Phone Number
Parcel Number 1132060142060
Project: <NONE>
Contractor'. ALL PRO SEPTIC & SEWER INC i ALL PRO PLUMBING SEP Phone: (305)635-3002
Building Department Comments
REPLACE EXISTING DRAINFIELD 300 SQFT
Inspector Comments
Passed ok hrs approval in file
C
Failed I V I
Correction cn-
Needed ov
Re-inspection ❑
Fee
No Additional Inspections can be scheduled until
re-inspection fee is paid.
February 02, 2010 For Inspections please call: (305)762-4949 Page 12 of 22
RTO/LOOZ SHMAHEIS (11HId NVOS VJV(l HSL 999 008 T YVA T9:60 OTOZ/CO/ZO
Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
i nspection Number: INSP - 134810 Permit Number: PL -1 -10 -121
Inspection Date: February 05, 2010 Permit Type: Plumbing - Residential
Inspector: Hernandez, Rafael Inspection Type: Final
Owner: RUSSOLI, ANN Work Classification: Septic
Job Address: 790 NE 96 Street
Miami Shores, FL 33138- Phone Number
Parcel Number 113206014206
Project: <NONE>
Contractor: ALL PRO SEPTIC & SEWER INC / AL L PRO PLUMBING SEP' Phone: (305)635 -3002
Building Department Comments
REPLACE EXISTING DRAINFIELD 300 SOFT
Inspector Comments
Passed ❑ HRS APPROVAL IN FILE
Failed
Correction
✓� %�'�-
Needed f
Re- Inspection
Fee,
No Additional Inspections can be scheduled until
re- inspection fee is paid.
For Inspections please call: (305)762 -4949
February 05, 2010 Page 1 of 1