PL-10-741Inspection Number: INSP - 141918 Permit Number: PL -4 -10 -741
Scheduled Inspection Date: December 20, 2010
Inspector: Hernandez, Rafael
Owner: GLUECK, MARKUS & JENNIFER
Job Address: 94 NW 97 Street
Project: <NONE>
Contractor: A AARON SUPER ROOTER
Building Department Comments
SEPTIC AND DRAINFIELD
Passed
Failed
Correction
Needed
Re- Inspection
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
Inspector Comments
December 17, 2010
Miami Shores, FL 33150-
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 1131010330370
Phone: 305 - 944 -8886
Page 4 of 28
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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
BUILDING
PERMIT APPLICATION Master Permit No.
FBC 20
Permit Type: PLUMBING 6 l v e" -=_.
Owner's Name (Fee Simple Titleholder) p Cif IKU S Phone #
Owner's Address C i 4 KW c t - 7 ST
City i s Rio 5 State f Zip 3) 53
Tenant/Lessee Name
Email
Job Address (where the work is being done)
City Miami Shores Village County Miami -Dade
FOLIO / PARCEL # (t -j(0( 'LO 7j- -03-70
Describe Work:
E -mail
Phone #
°(iJ- 1 s-r
Is Building Historically Designated YES NO, Flood Zone
Contractor's Company Name V S. J f ' + ' phone #
Contractor's Address 60 2.2 Sw 3G C1- 22
City 1 �auc State r2 Zip J 3Q Z 3
Qualifier Name act, t, to Phone #
State Certificate or Registration No. Certificate of Competency No.
Contact Phone
Architect /Engineer's Name (if applicable) Phone #
Zip 3 [SCE
2. _.
t.ui
Permit No. L.- 4 -t 0-1 LEI Ct-T rcri)
Value of. Work For this Permit $ '2 3 o n Square / Linear Footage Of Work: 150
Type of Work: ❑Addition ❑Alteration New J Repair /Replace 11 Demolition
kci (mow Kc -...m 5-TA-1 C. of
************* * * * * * * * * * * * * ** * * * * * *� * ** ** * ** F * * * * * * * * * *:r * * * * * * * * * * * * * * * * * **
L ='�-�
Submittal Fee $ Permit Fee $ . CCF $ CO /CC $
Notary $ Training /Education Fee $ Technology Fee $
Scanning $ Radon $ DPBR $ Bond $
Double Fee $ Violation date:
Structural Review. $ Total Fee Now Due $
See Reverse side -->
Bonding Company's Name (if applicable)
Bonding Company's Address
City State
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address
City
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 br, hure will be delivered to the person
whose property is subject to attachment. Also, a certified copy of the recorded notice of comm cement must be posted at the job site
for the first inspection which occurs seven (7) days after the building permit is issued. - In absence of such posted notice, the
inspection will not be approved and a reinspection fee will be charged.
x�
i)wn �or Agen
The foregoing instrument was acknowledged before me this 4
day of t)-X,C , 20 1 ° , by 'e t1 ,
who is personally known to me or who has produced 9nv
1 ,2121/1V- As identification and who did take an oath.
NOTARY PUBLIC:
S\ tu
r
Sign:
Print:
My Commission Expires:
,Itta 9aae4.MN•9 *
APPROVED BY
(Revised 07 /10 /07)(Revised 06/10/2009)
<y „ «s6yl�.nr a nuu••u•••rrr•rrrrrrl
'TERE J. SOLOMON
"1 % Comm# DD0733346
�G
Expires 111812011
State
Plans Examiner
Engineer
Signature
NOTARY PUBLIC:
Sign:
Print:
* * * * * * * * * * * * * * * **
Zip
Zip
Contractor
The foregoing instrument was acknowledged before me tt 1�
day of ‘)e- , 2� , by j T`r�
who is personally known to me or who has produced O•'1\A•
t C-Cfr l r as identification and who did take an oath.
My Commission Expizes. M �.��•••••••M
'TERESA J. 8C OMON C
Comm# DUO
trs Notary Assn., Inc
raaaasau••••rP••••■
Zoning
Clerk checked
CONSTRUCTION PERMIT FOR: OSTDS Repair
APPLICANT: Morkus & Jennifer Glueck
PROPERTY ADDRESS: 94 NW 97 St Miami, FL 33150
LOT: 13 -14
PROPERTY ID #: 11- 3101 - 033 -0370
SYSTEM MUST BE CONSTRUCTED IN ACCORDANCE WITH SPECIFICATIONS AND STANDARDS OF SECTION
381.0065, F.S., AND CHAPTER 64E -6, F.A.C.
SATISFACTORY PERFORMANCE FOR ANY SPECIFIC
WHICH SERVED AS A BASIS FOR ISSUANCE OF
PERMIT APPLICATION. SUCH MODIFICATIONS MAY
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 [
A [
N [
K [
D
R
A
I
N
F
I
E
L
D
0
T
H
E
R
900 ] GALLONS / GPD Seotic
0 ] GALLONS / GPD
0 ] GALLONS GREASE INTERCEPTOR CAPACITY
] GALLONS DOSING TANK CAPACITY
[ 150 ] SQUARE FEET SYSTEM
[ 0 ] SQUARE FEET SYSTEM
TYPE SYSTEM: [X] STANDARD [ ] FILLED [ ] MOUND [ ]
CONFIGURATION: [X] TRENCH [ ] BED [ ]
LOCATION OF BENCHMARK: F.F.E.: 13.6' NGVD
ELEVATION OF PROPOSED SYSTEM SITE
BOTTOM OF DRAINFIELD TO BE
FILL REQUIRED:
SPECIFICATIONS
APPROVED BL Y:
STATE OF FLORIDA
DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT AND DISPOSAL
SYSTEM
THIS PERMIT IS NOT FOR ADDITIO
[ 0.00 ] INCHES
dro N Ospina
DATE ISSUED: 04/29/2010
BLOCK: 130 SUBDIVISION: MiamiShores
DH 4016, 10/97 (Previous Editions May Be Used)
v `. 1 .4
[SECTION, TOWNSHIP, RANGE, PARCEL NUMBER]
[OR TAX ID NUMBER]
DEPARTMENT APPROVAL OF SYSTEM DOES NOT GUARANTEE
PERIOD OF TIME. ANY CHANGE IN MATERIAL FACTS,
THIS PERMIT, REQUIRE THE APPLICANT TO MODIFY THE
RESULT IN THIS PERMIT BEING MADE NULL AND VOID.
CAPACITY
CAPACITY
[MAXIMUM CAPACITY SINGLE TANK:1250 GALLONS]
]GALLONS @[ ]DOSES PER 24 HRS #Pumps [ ]
[ 28.80 ] [I INCHES y FT ] [ ABOVE A BELOW Il BENCHMARK /REFERENCE POINT
[ 56.80 ] [I INCHES c FT ] [ ABOVE A BELOW h BENCHMARK /REFERENCE POINT
EXCAVATION REQUIRED: [ 28.00] INCHES
AP9132 9 9
PAIR
PERMIT #: 13-SC-1133742
APPLICATION #:AP963299
DATE PAID:
FEE PAID:
RECEIPT #'
DOCUMENT #: PR808576
1- Install 900 gal. category-3 septic tank equipped with an approved filter. 2 -The licensed contractor installing the system
is responsible for installing the minimum category of tank in accordance with sec. 64E- 6.013(3)(f). 3- Install 150 sf of
drainfield in trench configuration. 4- Perimeter of excavation area shall be at least 2 ft wider and longer than the proposed
absorption trench. 5 -Invert elevation of drainfield to be no less than 9.36' NGVD 6. Bottom of drainfield elevation to be no
less than 8.86' NGVD.
EXPIRATION DATE: 07/28/2010
Page 1 of 3
CHD
BUILDING
PERMIT APPLICATION
FBC 20
Permit Type: PLUMBING
Owner's Name (Fee Simple Titleholder)itAa.v1 Nl S a.t et/1 ✓t W # 0 ? � 3l (�
Owner's Address t Mr1A) a 3'`n 5+-
Cit vn Ciktrto—
Tenant/Lessee Name
Email 5'l dc e bL /Y1
Job Address (where the work is being done) S a o__
City Miami Shores Village County Miami -Dade Zip
FOLIO / PARCEL #
Is Building Historically Designated YES NO2,
Contractor's Company Name
Contractor's Address ( ,a SkJ
City M l va fil
Qualifier Name
Contact Phone
Architect /Engineer's Name (if applicable)
Value of Work For this Permit $
Type of Work: ❑Addition
Describe Work:
Structural Review. $
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
State
3Sw f
State
❑Alteration
r ;
Phone #
E -mail
Violation date:
a
Zip 33 t 513
Phone #
J
Zip 3Ua 3
Phone #
Phone #
CCF $
Total Fee Now Due $
ul
BY: - --
Permit NoPL I 0 1'
Master Permit No.
Flood Zone
�-'
Ar 2010
State Certificate or Registration No. Certificate of Competency No.
Square / Linear Footage,,,9f Work:
❑New [Repair /Replace ❑ Demolition
******** * ** * * * * * * * * * * * * * * * * * * * * * * * * * * ** F * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
Submittal Fee $ Permit Fee $ „�l"G?
CO /CC $
Notary $ Training /Education Fee $ ('5 Technology Fee $
Scanning $ V �; Radon $ DPBR $ Bond $ 6 J' r )- -
Double Fee $
( 1.`tC
See Reverse side -*
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. 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 exce's ng $2500, the applicant must
promise in good faith that a copy of the notice of commencement and construction lien law broch e ill be delivered to the person
whose property is subject to attachment. Also, a certified copy of the recorded notice of commenc %me t must be posted at the job site
for the first inspection which occurs seven (7) days after the building permit is issued. In th . ab ence of such posted notice, the
inspection will not be approved and a reinspection fee will be charged.
Owner or Agent
The foregoing instrument was acknowledged before me this 2_
day of f' ,! , 20 ,by 1 �
who is personally known to me or who has produced 0 YiV
' As identification and who did take an oath.
NOTARY PUBLIC:
'TERESA SOLOMON
Comm8 000r,e
Expires 11/8/2011
Florida Notary Man, Ina
•
Sign: : r\--4-473
Print:
My Commission Expires:
APPROVED BY
(Revised 07 /10 /07)(Revised 06/t0/2009)
—30 — I I Plans Examiner
Engineer
Signature
Contractor
The foregoing instrument was acknowledged before me this -2
day of A i" , 20 ( , by
wl is personally known to me or who has produced : `+
NOTARY PUBLIC:
su NN1!!y
Sign:
Tint:
My Commission Expires:
Zip
as identification and who did take an oath.
A 4, SOLOMON
348
11
� Notary Assn., Inc 4
Zoning
Clerk checked
Notes:
STATE OF FLORIDA
DEPARTMENT OF HEALTH
APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PERMIT
Permit Application Number
Scale: Each block represents 5 feet and 1 inch = 50 feet.
,..-: 333 3
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Title
Site Plan submitted by:
Plan Approved ,_»- _-44't Approved
By
Cy
ALL CHANGES MUST BE APPROVED BY THE COUNTY HEALTH DEPARTMENT
DH 4015, 10/98 (Replaces HRS-H Form 4015 which may be used)
(SW& Number: 5744-002-4015-8)
PART II - SITE PLAN-
c s+ 3J
Date
County Health Department
Page 2 of 3
STATE OF FLORIDA
DEPARTMENT OF HEALTH
APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PERMIT
Permit Application Number
Scale: Each block represents 5 feet and 1 inch = 50 feet.
-c by
Site Plan submitted by:
Plan Approved
By
DH 4015. 10/96 (Replaces HRS-H Form 4015 which may be used)
(Stock Number: 5744.002- 1015.6)
PART II - SITE PLAN
A cio RT 1GCPd.
Signature
— ..p---NatAppTOV d
4
CP 1 \ °"'
Title
ALL CHANGES MUST BE APPROVED BY THE COUNTY HEALTH DEPARTMENT
Date
County Health Department
Page 2 of 3
STATE OF FLORIDA
DEPARTMENT OF HEALTH DATE PAID:
ONSITE SEWAGE TREATMENT AND DISPOSAL FEE PAID.
SYSTEM RECEIPT #
CONSTRUCTION PERMIT FOR: OSTDS Abandonment
APPLICANT: Morkus & Jennifer Gluek
PROPERTY ADDRESS: 94 NW 97 St Miami, FL 33150
LOT: 13 -14 BLOCK: 130 SUBDIVISION: Miami Gardens
PROPERTY ID #: 11- 3101- 033 -0370
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 [ ] GALLONS / GPD CAPACITY
A [ ] GALLONS / GPD CAPACITY
N [ ] 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
[ ] SQUARE FEET SYSTEM
[ ] SQUARE FEET SYSTEM
TYPE SYSTEM: [ ] STANDARD [ ] FILLED [] MOUND [ ]
CONFIGURATION: [ ] TRENCH [ ] BED 1 1
LOCATION OF BENCHMARK:
ELEVATION OF PROPOSED SYSTEM SITE
BOTTOM OF DRAINFIELD TO BE
FILL REQUIRED: [ 0.00] INCHES
Have the tank abandoned in accordance with the following procedures:(a) The tank shall be pumped out.(b) The bottom of
the tank shall be opened or ruptured, or the entire tank collapsed so as to prevent the tank from retaining water, and(c) The
tank shall be filled with clean sand or other suitable material, and completely covered with soil.Have the system inspected
by the health department after it has been pumped and ruptured but before it is filled with sand and covered.
SPECIFICATIONS B PEDRO N OSPINA TI
APPRO D BY:
DATE ISSUED:
F -• o N Ospina
04/28/2010
v 1..1.4
EXCAVATION REQUIRED: [ ] INCHES
TITLE:
AP953292
SE -1
PERMIT #: 13-SC-1133735
APPLICATION #:AP963292
DOCUMENT #: PR808548
[SECTION, TOWNSHIP, RANGE, PARCEL NUMBER]
[OR TAX ID NUMBER]
[ ] [ / ] [ ABOVE/ BELOW 1BENCHMARK/REFERENCE POINT
[ 1( / ] [ ABOVE/ BELOW 1BENCHMARK /REFERENCE POINT
Dade CHD
EXPIRATION DATE: 07/27/2010
DH 4016, 10/97 (Previous Editions May Be Used) Page 1 of 3