PL-10-2169Scheduled Inspection Date: January 21, 2011
Inspector: Hernandez, Rafael
Owner: LUC, MARCELLE
Job Address: 141 NW 100 Street
Miami Shores, FL
Project: <NONE>
Contractor: A AARON SUPER ROOTER
Building Department Comments
January 20, 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- 154101 Permit Number: PL -12 -10 -2169
For Inspections please call: (305)762 -4949
Permit Type: Plumbing - Residential
Inspection Type: Final
Work Classification: Septic
Phone Number
Parcel Number 1131010220330
Phone: 305 -944 -8886
REPLACE DRAIN FIELD
Passed
Failed
Correction
Needed
Re- Inspection
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
Inspector Comments
please pick up copy of HRS inspection at the job site
Page 7of15
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
E 9 2010
Q_SA
Permit No. PL 10 -21 ( 1
BUILDING
PERIVIIT APPLICATION Master Permit No.
FBC 20
Permit Type: PLUMBING
Owner's Name (Fee Simple Titleholder) Marcel Lu Phone # 7 SG 311 9
Owner's Address l 1+1 Khiv (00 S1
City M arrNi 51noreS State -' Zip 3 3 ( Go
Tenant/Lessee Name Phone #
Email
Job Address (where the work is being done)
) 1 -{- l (00 Si
City Miami Shores Villa e County Miami -Dade
FOLIO / PARCEL # I - 300 - 0'5•N)
Is Building Historically Designated YES NO l�
Contractor's Company Name ,,6.Q ro r1 S ( Phone # ,0 S Lf4 -$:FFP4
Contractor's Address GO 22 5''■,.5 - 3 S C-t
City NAtYG 2 State r Zip 33o
Qualifier Name K.". 7■ Phone #
State Certificate or Registration No. Certificate of Competency No.
Contact Phone E -mail
Architect/Engineer's Name (if applicable)
Value of Work For this Permit $
Type of Work: ❑Addition
Describe Work:
24 --
❑Alteration
Submittal Fee $ `- Permit Fee $
Square / Linear Footage Of Work: 1 Bo
:New Repair/Replace ❑ Demolition
Re_p kg cc_, Drc r,
Phone #
Zip X31 So
Flood Zone
* * * * * * * * * * * * * ** * * * * * * * * * * * * * * * ** Fees* * * * * * * * * * * * * * * * * * ** * * * * * * * * * * **
CCF $ CO /CC $
Notary $ Training/Education Fee $ Technology Fee $
Scanning $ Radon $ DPBR $ Bond $
Double Fee $ Violation date:
Structural Review. $ Total Fee Now Due $ L A („Q 2 ' $0
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 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 excee' ' g $2500, the applicant must
promise in good faith that a copy of the notice of commencement and construction lien law brochur ill be delivered to the person
whose property is subject to attachment. Also, a certified copy of the recorded notice of commence t must be posted at the job site
for the first inspection which occurs seven (7) days after the building permit is issued. In the .sence of such posted notice, the
inspection will not be approved and a reinspection fee will be charged.
Signature
Sign:
Print:
The foregoing instrument was acknowledged before me this 8
day of DeC ,20 Toby k arCel Luc
who is personally known to me or who has produced flv.
L.l Ce" As identification and who did take an oath.
NOTARY PUBLIC:
My Commission Expires:
Owner o ge
(Revised 07 /10 /07)(Revised 06/10/2009)
® ® ® ®, ® ° ® °e°eu. °eq ® ° ® ° ® ® ® ®..G.q My Commission Expires:
'TERESA J. SOLOMON atv�t9 eaz�p3 � fie �aSo� J ®qS ®1L ®� ®� eesaeeees
®•,pNtYaf i�s�� (',o9TIrY1fh DW73 aeYSV ® c� I'
t ee,a,r r
Com
�r, ��r�*�r*�r:�**,�*,�,��r�r**�r�r ��� �` �/���017��,�x�r•��r��r
Assn., kac Fih
' e /e q.m.:� 8 °8�•. e°°°!eN° °°B® q°pBA ®°q° ® rMN70 i I Inc g
Plans Examiner ° ° ° °° ®°a s®nes°u ° °ns Zoning
Engineer
Sign:
Print:
Zip
Signature
Contractor
The foregoing instrument was acknowledged before me this 3
day of t C , 20 l O, by (3 r Tu
who is personally known to me or who has produced art./.
02,1 &Cas identification and who did take an oath.
NOTARY PUBLIC:
x r
-r"-es Ste' l o vy1 a-.
Clerk checked
APPLICANT: Marcel Luc Marcelle
LOT: 12 -11
E
L
D
O
T
H
E
FILL REQUIRED:
SPECIFICATIONS BY:
APPROVED BY:
DATE ISSUED:
STATE OF FLORIDA
DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT AND DISPOSAL
SYSTEM
CONSTRUCTION PERMIT FOR: OSTDS Repair
PROPERTY ADDRESS: 141 NW 100 St Miami, FL 33150
PROPERTY ID #: 11- 3101 -022 -0330
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
BLOCK: 4 SUBDIVISION: Gold Crest
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 [ 150 ] SQUARE FEET Trench confiauration SYSTEM
R [ 0 ] SQUARE FEET SYSTEM
A TYPE SYSTEM: [X] STANDARD [ ] FILLED [ ] MOUND [ ]
I CONFIGURATION: [x] TRENCH [ ] BED [ ]
N
F LOCATION OF BENCHMARK: FFE 12.6' NGVD
I ELEVATION OF PROPOSED SYSTEM SITE [ 21.60 ] 11 INCHES V FT ] [ ABOVE A BELOW 1I BENCHMARK /REFERENCE POINT
[ 51.60 ] INCHES V FT ] I ABOVE /) BELOW h BENCHMARK /REFERENCE POINT
BOTTOM OF DRAINFIELD TO BE
[ 0.00] INCHES EXCAVATION REQUIRED: [ 30.00. ] INCHES
1.- Existing 750 . septic tank to remain.
2.- Install 150 of drainfield in TRENCH configuration
3. -Invert elevation of drainfield to be no Tess than 8.80 ngvd
6. -Bottom of drainfield elevation to be no less than 8.30 ngvd
THIS PERMIT IS NOT FOR " ADDITION(s) ".
Ger P lizai e
- Astrid V Edwards
12/08/2010
TITLE: Engineer Specialist II
APPLICATION #: AP986617
TITLE:
DH 4016, 08/09 (Obsoletes all previous editions which may not be used)
Incorporated: 64E- 6.003, FAC
v 1.1.4 AP986617
[SECTION, TOWNSHIP, RANGE, PARCEL NUMBER]
[OR TAX ID NUMBER]
EXPIRATION DATE: 03/08/2011
SE830965
PERMIT #: 13-SC-1290726
DATE PAID:
FEE PAID:
RECEIPT #:
DOCUMENT #: PR828671
Dade CHD
Page 1 of 3
PART II - SITEPLAN
Scale: Each block repreSents 10 feet and 1 inch = 40 feet.
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NNE mmaimmin311151MEMSTRIE
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EMI 1111•011101101111411111111111101MMIL7, ._ c _
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Notes:
STATE OF FLORIDA
DEPARTMENT OF HEALTH
APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION P R
Permit Application Number
IL lommumpawnwiciims
k I Oasis
DH 4015, 10/96 (Replaces HRS-H Form 4016 which may be used)
(Stock Number: 5744-002-4015-)
ALL CHANGES MUST BE APPROVED BY THE COUNTY HEALTH DEPARTMENT
04
Site Plan submitted by:
Signature
Plan Approved Not Approved
By m County Health Department
ceahl (
Date
Page 2 of 4