PLUMBING PERMIT�� l•I
Passed
Insp : to Comm
- nts
Failed
Correction
Needed
Re- Inspection
Fee
($75)
No Additional Inspections can be scheduled
re- inspection fee is paid.
until
'Inspection Number: INSP 151
Inspection Date: 05/11/2006
Inspector: Levrack, James
Owner: GOMEZ, RODOLFO AND SUSANA
Job Address: 1156101 Street NE
Project: <NONE>
Miami Shores Village, FL 33138-
Contractor: A ARON SUPER ROOTER
Building Department Comments
Wednesday, May 10, 2006
Inspection Worksheet
Miariti Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Block:
Permit Number: "PL -4 -06 -986
Permit Type: Plumbing - Residential
Inspection Type: Landscaping
Work Classification: Drainfield
Phone Number (305)898 -8841
Parcel Number 1132050190250
Lot:
Phone: 305 - 944 -8886
Page 2 of 2
51///06
Passed
In • ec •
i
0.
mmen
Failed
Correction
Needed
Re- Inspection
Fee
($75)
No Additional Inspections can be scheduled
re- inspection fee is paid.
until
Inspection Number: ; INSP 151
Inspection Date: 05/11/2006
Inspector: Levrack, James
Owner: GOMEZ, RODOLFO AND SUSANA
Job Address: 1156101 Street NE
Miami Shores Village, FL 33138-
Project: <NONE>
Contractor: A ARON SUPER ROOTER
Building Department Comments
Wednesday, May 10, 2006
Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Block:
tpermiit--Number: PL -4 -06 -986
Permit Type: Plumbing - Residential
Inspection Type: Final
Work Classification: Drainfield
Phone Number (305)898 -8841
Parcel Number 1132050190250
Lot:
Phone: 305 -944 -8886
Page 2 of 2
Issue Date: 4/18/2006 Expires: 04/17/2007
Owner's Name: RODOLFO AND SUSANA GOMEZ
Permit Type: Plumbing - Residential
Work Classification: Drainfield
Job Address: 1156 101 Street NE
Comments:
INSTALL NEW DRAINFIELD
Additional Information
Miami Shores Village, FL 33138-
Miami Shores Village
10050 N.E. 2nd Avenue
Miami Shores, FL 33138 -0000
Phone: (305)795 -2204 Fax: (305)756 -8972
Permit
Contractor(s)
A ARON SUPER ROOTER
Phone
305 - 944 -8886
Primary Contractor
Yes
Type of Work: DRAINFIELD
Additional Info: 200 SQ FT
Classification: Residential
Type of Piping:
Bond Return :
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.
Fees Due
Bond Type - Contractors Bond
CCF
Education Surcharge
Permit Fee - Additions /Alterations
Scanning Fee
Technology Fee
Total:
Amount
$300.00
$2.40
$0.80
$175.00
$3.00
$4.40
$485.60
Building Department File Copy
Applicant Signature
Parcel #:
Block:
Section:
Permit Status: APPROVED
Permit Number: PL -4 -06 -986
Phone: (305)898 -8841
1132050190250
Lot:
PB:
Total Square Feet: 150
Total Valuation: $ 2,600.00
Required Inspections
Rough
Landscaping
Final
Invoice Number
PL - 4 - 06 - 24500
Total:
Amt Due
$485.60
Amt Paid
$485.60
$485.60
NOTICE: In addition to the requirements of this permit, there may be
additional restrictions applicable to this property that may be found in the
public records of this county.
AND THERE MAY BE ADDITIONAL PERMITS REQUIRED FROM OTHER
GOVERNMENTAL ENTITIES SUCH AS WATER MANAGEMENT
DISTRICTS, STATE AGENCIES, OR FEDERAL AGENCIES.
BUILDING
PERMIT APPLICATION
FBC 2004
Permit Type (circle): Building
Owner's Name (Fee Simple Titleholder)
Owner's Address 1\ % ( ye
City Glf 5 State
Tenant/Lessee Name
Csa,,,.a�
Job Address (where the work is being done)
City Miami Shores Village
Is Building Historically Designated YES
Contractor's Company Name
Contractor's Address 6'022
City M < fa i ai
Qualifier Name 3.6 Tv
State Certificate or Registration No.
Architect/Engineer's Name (if applicable) N A
Value of Work For this Permit $ 4' 3 60 —_
Type of Work: EAddition EAlteration
Describe Work:
Submittal Fee $ Permit Fee $
Notary $ Training/Education Fee $
Scanning $- C3 - Radon $
Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
BY: Electrical
FOLIO / PARCEL # ( - 3�Q 5 0 t -02So
1 I�� E 1 a treej
State L
NO V
p say.zn & '
S 2 Cf
******** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** F * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
CC)
Q, &c: .
DPBR $
mud $ c3. Code Enforcement $ Double Fee $
Structural Review. $
APR 1 2006
Master Permit No.
Zip
Permit No.
r - 0 0 g Mechanical Roofing
do Ifs * 5USC i, n #
3 3136'
Phone # (r � � i D`-'o4
County Miami -Dade Zip 'D - 58 '
Phone #
Zip 3•:
Phone #
Certificate of Competency No.
Phone #
Square / Linear Footage Of Work:
['New F Repair/Replace 11 Demolition
1' 44 < < ��Mi S�rGl 1e fi(2-4
Total Fee Now Due $ —ED
See Reverse side -
CCF$ Z .
Technology Fee $ 4
PLp
a1 4-4 8 8 6
(s3
CO /CC
.
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 absen of such posted notice, the
inspection will not be approved and a reinspection fee will be charged.
(Revised 02/08/06)
t r r ' t
The foregoing instrument was acknowledged before me this )1 K
day of P T O I , 20 0 , by 5%) S i rick e s , day of , 20 dti, by To Tv
who is personally known to me or who hasprpduced. 1 v • who's personally known to me or who has produced
Li' -' ✓! l �Q MON t ficationvand sw.hlaaNA€ ath.
an .
A s id en t ificati n i dea otb�e'z37 L �!'�
a • 'JD25O437 IS
NOTARY PUBLIC: ;, Q, t :PEtt `�,:entttriG..ig7 NOTARY ' „ t ; 14,2007 •
�Of N D iscount Assoc. i '
FL Co.
FL Notary Discount Assoc. Co. OF ��
1 BOa3 NOTARY 13- NOTARY
Sign:
Print:
My Commission : es:
APPLICATION APPROVED BY:
1 e-'SG Sc) ken Of
4 cS Q..P-0Elim-
Signature
Contractor
The foregoing instrument was acknowledged before me this ( 7
Sign: Tefe5
Print:
My Co k mi ion Expires:
***************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** *********************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
17- Plans Examiner
Engineer
Zoning
CONSTRUCTION PERMIT FOR:
[ ]New System [ ]Existing System [ ]Holding Tank [ ] Innovative Other
[ X ]Repair [ ]Abandonment [ )Temporary [ NA ]
APPLICANT: Gomez, Rodolfo & Susana AGENT: SR0921112, Tuffy John
PROPERTY STREET ADDRESS: 1156 NE 101 St Miami Shores FL 33138
LOT: 2 BLOCK: 177
PROPERTY ID #: 11 3205 - 019 -0250
SYSTEM DESIGN AND SPECIFICATIONS
T [ 750
A [ 0
N [ 0
K [ 0
OTHER REMARKS:
SPECIFICATIONS
APPROVED BY: Ospina
DATE ISSUED: 4/17%06
STATE OF FLORIDA
DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM
CONSTRUCTION PERMIT
DH 4016, 03/97 (Obsoletes previous editions which may not be used)
(Stock Number: 5744- 001 - 4016 -0) [ostds_cons- 4016 -1)
SUBDIVISION: Miami Shores Sec 8 R
[Section /Township /Range /Parcel No.]
[OR TAX ID NUMBER]
F LOCATION TO BENCHMARK: F.F.E.: 8.9' NGVD
I ELEVATION OF PROPOSED SYSTEM SITE [ 1.2 ] [ FEET
E BOTTOM OF DRAINFIELD TO BE [ 3.7 ] [ FEET
L
D FILL REQUIRED:[ 0.0 ]INCHES
CENTRAX #: 13 -SG -28684
DATE PAID:
FEE PAID : $
RECEIPT .
OSTDSNBR : 06 -1116- -R
SYSTEM MUST BE CONSTRUCTED IN ACCORDANCE WITH SPECIFICATIONS AND STANDARDS OF CHAPTER 64E -6,FAC
DEPARTMENT APPROVAL OF SYSTEM DOES NOT GUARANTEE SATISFACTORY PERFORMANCE FOR ANY SPECIFIC TIME
PERIOD. 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 PROPERTY DEVELOPMENT.
]Gallons SEPTIC TANK MULTI - CHAMBERED /IN SERIES: [Y ]
)Gallons MULTI - CHAMBERED /IN SERIES: [Y ]
]GALLONS GREASE INTERCEPTOR CAPACITY
]GALLONS DOSING TANK CAPACITY [ 0 ]GALLONS @ [0 ]DOSES PER 24 HRS # PUMPS[ 0 ]
D [ 150 ]SQUARE FEET PRIMARY DRAINFIELD SYSTEM
R [ 0 ]SQUARE FEET SYSTEM
A TYPE SYSTEM: [ " ]STANDARD [ N ]FILLED [ N ]MOUND [ N ]
I CONFIGURATION: [ ]TRENCH [ N ]BED [ N ]
N
] [ BELOW BENCHMARK /REFERENCE POINT
] [ BELOW BENCHMARK /REFERENCE POINT
EXCAVATION REQUIRED: [ 30.0 ] INCHES
l.- Install 571 sf of drainfield in trench configuration.
2. Existing 750 gal. septic tank, certified by._ "A Aaron Super Rooter on 04/06/2006" to
remain.
3.- Invert elevation of drainfield to be no less than 5.70' NGVD.
4.- Bottom of drainfield elevation to be no less than 5.20' NGVD.
THIS PERMIT IS NOT FOR "ADDITION(s) ".
PEDRO TITLE:
_ _,.._T.I_T_LE :. Engineer I
Dade
EXPIRATION DATE: 7/16/06
CHD
Page 1 of 2
. _
'
ale: Each block represents 5 feet and 1 inch = 50 feet.
3ite Plan submitted b
STATE OF FLORIDA
-DEPARTMENT OF HEALTH
APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PERMIT
Permit Application Number -
• .'
. . . •
• •
. . .
T ... , .. • • .•
' A1
, I
PART II - SITE PLAN
LAitt
N ■
4otes: z - mS(n<Dr-e 753i 02
Signature
,
k e
o r('
(1's c),) • .0 to
-e(d 0 A
IP 3 4cv -e-s
-6 )c 112
Title
Date
Plan Apptoved Not Approved
By
61,y J.:. e',.16V;VC County Health Departmen
'
ALL CHANGES MUST BE APPROVED BY THE COUNTY HEALTH DEPARTMENT
c
APPLICANT
k!
AGENT
PROPERTY ADDRESS' if
LOT•
[ ]
[ l
STATE OF FLORIDA .. PERMIT No�< --
DEPARTMENT OF HEALTH _y DATE PAID -
ONSITE SEWAGE TREATMENT AND DISPOSAL. SYSTEM ,,,:., EE AID
CONSTRUCTION INSPECTION AND FINAL APPROVAL RECEIPT #*
I
BLOCK:i f
TANK INSTALLATION
[01] TANK SIZE [1] f' [2]
[02] TANK .MATERIAL
[03] OUTLET DEVICE; ;:
[04] MULTI - CHAMBERED [Y;! N.]
[05] OUTLET FILTER -
[06] LEGEND,
[07] WATERTIGHT ? __
[08] LEVEL
[09] DEPTH TO LID
DRAINFIELD INSTALLATION {
[10] AREA 111'X' 1 &`[2] / /' SQFT
[11] DISTRIBUTION BOX - HEQDER -
[12] NUMBER OF DRAINLINES " '''"
[13) DRAINLINE SEPARATION _7/
[14] DRAINLINE SLOPE
[15] DEPTH OF. COVER I f
[16] ELEVATION [ABOVE-BELb 1'BM
[17] SYSTEM LOCATION
[18] DOSING PUMPS
[19] AGGREGATE SIZES
[20] AGGREGATE'EXCESSIVE FINES
[21] AGGREGATE DEPTH Af .,I
FILL / EXCAVATION MATER IAL
[22] FILL AMOUNT 2 1 ;t 1
[23] FILL TEXTURE
[24] EXCAVATION DEPTH
[25] AR F,t ACED
[26] REPLACEMENT MATERIAL
`D14`4011fi_{Page 2), 10/97 (Previous Editions May'Be Used)
Stock Number: 5744- 002 - 4016 -4
SUBDIVISION: '- •w' f ��
CHECKED [X] ITEMS ARE NOT IN COMPLIANCE WITH STATUTE OR RULE
1 ]
[ 1
[ .]
CONSTRUCTION [APPROVED/DISAPPROVED].
FINAL SYSTEM _[ APPROVD /DISAPPROVED]:1C_. 4
PROPERTY ID #:
AND MUST BE CORRECTED.
SETBACKS
[27] SURFACE WATER
[28]. '- DITCHES
] [29] PRIVATE WELLS
[ ] " [30] . PUBLIC WELLS
[ ] [31] IRRIGATION WELLS
[ ] [32] POTABLE WATER LINES
[33] BUILDING FOUNDATION
[34] PROPERTY LINES
[ r .....OTHER: ,. .
FILLED / MOUND SYSTEM
[36] DRAINFIELD COVER r
[37] SHOULDERS
[38] SLOPES
[39] STABILIZATION "
-'CHD , : DATE: /
L
` - CHD ' DATE*
. PT 1: Applicant
PT 2: Installer /Contractor
PT 3: Building Department
PT 4: Health Department
FT
FT
FT
FT
FT
FT
FT
FT
FT
ADDITIONAL INFORMATION
[40] - . UNOBSTRUCTED AREA
[41] . STORMWATER RUNOFF
[42] . ALARMS
[43] ' MAINTENANCE AGREEMENT
[44] BUILDING AREA
[45] LOCATION CONFORMS WITH SITE PLAN
[46] • FINAL GRADING
] 147] • CONTRACTOR L` -� '�` `!''� i .._
] [ OTHER
ABANDONMENT r
•
] [49] TANK PUMPED ?'f . , <3.1`—`
[50] TANK CRUSHED & FILLED /.J
EXPLANATION OF VIOLATIONS / REMARKS:
1 T.
[ ]
[ 1
[
Page 2 of 3