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PL-10-925Scheduled Inspection Date: July 02, 2010 Inspector: Hernandez, Rafael Owner: ZIBELLI, HEATHER Job Address: 1480 NE 102 Street Miami Shores, FL 33138- Project: <NONE> Contractor: STATEWIDE SEPTIC CONNECTIONS Building Department Comments July 01, 2010 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP - 144196 Permit Number: PL -5 -10 -925 For Inspections please call: (305)762 -4949 Permit Type: Plumbing - Residential Inspection Type: Final Work Classification: Septic Phone Number Parcel Number 1132050240260 Phone: (954)584 -1481 REPLACE BROKEN SEPTIC TANK 1050 GAL & DRAINFIELD 300 SQ Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments / 24' Page 8 of 14 aAe -- Tt5 1480 NE 102 Street Miami Shores, FL 33138- 1132050240260 Block: Lot: HEATHER ZIBELLI Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL 33138 -0000 Phone: (305)795 -2204 HEATHER ZIBELLI 1480 NE 102 Street MIAMI SHORES FL 33138 -2622 Contractor(s) Phone STATEWIDE SEPTIC CONNECTIONS (954)584 -1481 CeII Phone Type of Work: SEPTIC & DRAINFIELD Type of Piping: PLUMBING Additional Info: Bond Retum : Classification: Residential Fees Due Bond Type - Owners Bond CCF Education Surcharge Permit Fee - Additions/Alterations Scanning Fee Technology Fee Total: Amount $300.00 $4.20 $1.40 $300.00 $3.00 $5.60 $614.20 r. 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 pertainir7g 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. Authorized Signature: Owner / Applicant / Contractor / Agent Building Department Copy Pay Date Pay Type Invoice # PL -5-10 -37976 05/26/2010 Check #: 1097 Bond #: 1969 Amt Paid Amt Due $ 614.20 $ 0.00 Valuation: Total Sq Feet: $ 6,200.00 300 1 Available Inspections: Inspection Type: HRS Approval Abandonment Final Rough Landscaping May 26, 2010 Date May 26, 2010 1 BUILDING PERMIT APPLICATION FBC 20 Permit Type: PLUMBING Owner's Name (Fee Simple Titleholder) 2t,(_( Owner's Address �"" "" t t A h.11:. 2 City �,t,�tW'.t State . Tenant/Les ee Name (� Email 4 t f 41, &A. t.'- �J Ica • Co City i t/e rrkGr Sta Qualifier Name ez ( Architect/Engineer's Name (if applicable) Submittal Fee $ S 0.00 Notary $ Scanning $ Radon $ Double Fee $ Structural Review. $ PAO 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 Pi Permit Fee $ ®� Training/Education Fee $ Violation date: DPBR $ Zip Contractor's Company Name S eL, d c - Contractor's Addres 0 S- # 2.0 n C Phone # Master Permit Nb. Phone# JOE' � S - �2i7 ssise Phone # Job Address (where the work is being done) (LW) tie (02.• ,1 City Miami Shores Village County Miami -Dade Zip 3?,1 3 FOLIO / PARCEL # I - ? - b'j - O2 GO Is Building Historically Designated YES NO Zip 33 2 Phone # State Certificate or Registration No. S P 4 1 1, 2 - G ° Certificate of Competency No. Contact Phone E -mail Phone # Total Fee Now Due $ Flood Zone °D.,(6 66 3 X0 Value of Work For this Permit $ 020 (-) r Square / Linear Footage Of Work: ®® Type of Work: Addition ❑Alteration ❑New Re air/Re lace [� p p ❑ Demolition Describe Work: R.€pfe4Ce Ii rokc- . SCp I .K 4. prof * * * * * * * * * * * * * * * * *** * * * * * *, * * * * * * * * * * ** Fees * * * * * * *** *** * ** * * * * * * * * * * * * * * * * * * * * * * * * **** CCF $ CO /CC $ Technology Fee $ Bond $ 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 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. c <5� Contractor The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this 2 4 day of i\A Ct , 20 1 by � eresz 1 �� h who is personall own to me or who has produced Signature 1,C2 day of "1.O , 201 Q by}� r i 7H�,�. 2l 3 r L , who is personally known to me or who has produced CA—LO 2,14 0 -331746100 As identification and who did take an oath. NOTARY PUBLIC: Sign: C2 ISZ 1..... `` h. Print: -�� �M.ssr�rr e`ii4"" '�1'® 1 My Commission Expires: APPROVED BY Owner or Agent (Revised 07 /10 /07)(Revised 06/10/2009) Engineer as identification and who did take an oath. NOTAR PUBLIC: Sign: � i . � . L a /i�/ I�[ i� f cio, Print: <,f m ®P�n moo. s N re d, ti9 �,�j? . Gc v , My Commission Expire Im CO ta 11:kael 1 10 Tans Examiner Zoning Clerk checked CONSTRUCTION PERMIT FOR: OSTDS Repair APPLICANT: Aurora Loan PROPERTY ADDRESS: 1480 NE 102 St Miami, FL 33138 LOT: 9 STATE OF FLORIDA APPLICATION #: AP965868 DEPARTMENT OF HEALTH DATE PAID: ONSITE SEWAGE TREATMENT AND DISPOSAL FEE PAID* SYSTEM RECEIPT #• PROPERTY ID #: 11- 3205 - 024 -0260 BLOCK: 3 SUBDIVISION: 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 [ 1,050 ] GALLONS / GPD Seotic 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 R A I N F I E L D 0 T H E R [ 300 ] SQUARE FEET SYSTEM [ 0 ] SQUARE FEET SYSTEM TYPE SYSTEM: [x] STANDARD [ ] FILLED [ ] MOUND [ ] CONFIGURATION: [X] TRENCH [ ] BED [ ] LOCATION OF BENCHMARK: F.F.E.: 9.00' NGVD ELEVATION OF PROPOSED SYSTEM SITE BOTTOM OF DRAINFIELD TO BE FILL REQUIRED: THIS PERMIT IS NOT FOR ADDITION 44--- ---- SPECIFICATIONS B PEDRO N pSPINA APPROVED BY:' DATE ISSUED: [ 0.00] INCHES EXCAVATION REQUIRED: [ 40.00] INCHES 1— Install 1050 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 300 sf of drainfield in trench configuration. 4- Install 12" of slightly limited soil under the bottom of drainfield. 5- Perimeter of excavation area shall be at least 2 ft wider and longer than the proposed absorption trench. 6 -Invert elevation of drainfield to be no less than 4.07' NGVD. 7. Bottom of drainfield elevation to be no less than 3.57' NGVD. - -�edro Ni Oepina 05/18/2010 DH 4016, 08/09 (Obsoletes all previous editions which may not be used) Incorporated: 64E- 6.003, FAC [ 37.00) [1 INCHES I FT ] [ ABOVE /$ BELOW ] BENCHMARK /REFERENCE POINT [ 65.00 ] [I INCHES I FT ] [ ABOVE 4 BELOW b BENCHMARK /REFERENCE POINT TITLE: [SECTION, TOWNSHIP, RANGE, PARCEL NUMBER] [OR TAX ID NUMBER] TITLE: Page 1 of 3 v 1.. 1 . 4 A1 MiA441 # (rl6'10 > �I� fFOAr; i,rtarli EXPIRATION DATE: 08/16/2010 PERMIT # DOCUMENT # : PR810744 Dade CHD 0 T H E STATE OF FLORIDA DEPARTMENT OF HEALTH ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM CONSTRUCTION PERMIT FOR: OSTDS Abandonment APPLICANT: (Aurora Loan Serv) PROPERTY ADDRESS: 1480 NE 102 St Miami, FL 33138 LOT: 9 BLOCK: 3 SUBDIVISION: Miami Shores Bay Park Estates PROPERTY ID #: 11- 3205 -024 -0260 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 [ ] SQUARE FEET SYSTEM R [ ] SQUARE FEET SYSTEM A TYPE SYSTEM: [ ] STANDARD [ ] FILLED [ ] MOUND [ ] I CONFIGURATION: [ ] TRENCH [ ] BED [ ] N F LOCATION OF BENCHMARK: I ELEVATION OF PROPOSED SYSTEM SITE [ ] [ E BOTTOM OF DRAINFIELD TO BE L D FILL REQUIRED: [ 0.00] INCHES ][ PERMIT #: 13 -SC- 1144202 APPLICATION #: AP965870 DATE PAID: FEE PAID RECEIPT #• DOCUMENT # : PR810738 [SECTION, TOWNSHIP, RANGE, PARCEL NUMBER] [OR TAX ID NUMBER] / / ][ABOVE/ BELOW3BENCHMARK /REFERENCE POINT EXCAVATION REQUIRED: [ ] INCHES ] [ ABOVE / BELOW ] BENCHMARK/REFERENCE POINT 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. R SPECIFICATIONS APPROVED TITL Pe • o N Ospina DATE ISSUED: 05/18/2010 DH 4016, 08/09 (Obsoletes all previous editions which may not be used) Incorporated: 64E- 6.003, FAC v 1..1.4 AP965870 SE -1 EXPIRATION DATE: 08/16/2010 Page 1 of 3 iM. aOa ■■■ ■ ■ r _ . ■ �■■■ iii■ ` n 111 I lin essommonsniammomssammEonmEmmosso SomonsomMommossomMomnimmummum ME MM M . s ■+ I ■ ■ � i iia .�I !■ ■ ■ _ . 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OH 4015, 10/91) (Replaces HRS-H Forth 4015 width maybe used) (Stock Number: 5744402.40154 Q Signatu Not Approv� ALL CHANGES MUST BE APPROVED BY THE COUNTY HEALTH DEPARTMENT Aft Title �\ Date County Health Department Page 2 of 3 Scale: Each block represents 5 feat and 1 inch = 50 feet. STATE OF FLORIDA DEPARTMENT OF HEALTH APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PERMIT Permit Application Number PART II - SITE PLAN ; a Pa MffiiT #:vi i it) - 4t$' Miami Shores Village BY APPROVED DATE ZONING DEPT BLDG DEPT SUBJECT 10 CCMPLIANCE WITH ALL FEDERAL STATE AND rY MULES AND REGULATIONS Scale: Each block represents 5 fee and 1 inch = 50 feet. 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Mafia■/ � uN/ a/. a■ i. a..■. uuaa ■.i ■i ■.aaa•i■/.i#uuua.a. /..•uu s u•auu• • %i•mt . %naum At�� irmo� �s//�� % LNsitsu. a ai� Amain ores 33 d 3,4 IC -} 4e11 i i • NvA3 10SO J(o-,, OD ii ilrfilr 1-1, ct et? I `el "Kg O PART II - SITE PLAN �= ..3'.: % rtatur Not Apprpved ALL CHANGES MUST BE APPROVED BY THE COUNTY HEALTH DEPARTMENT Title Date County Health Department Page 2 of 3 PERMIT #: ft. 10 - itS Shores Village BY DATE Miami APPROVED ZONING DEPT BLDG DEPT SUBJECT i0 CCMPI.IANCE WITH ALL FEDERAL STATE AND eC UN N MULES AND REGULATIONS