PL-11-540REPLACE DRAINFIELD ONLY
Passed
Inspector Comments
r' •
/
Failed
Correction
Needed
Re- Inspection
Fee
No Additional Inspections can be scheduled
re- inspection fee is paid.
until
inspection Number: INSP- 157694 Permit Number: PL -3 -11 -540 1
Inspection Date: April 06, 2011
Inspector: Hernandez, Rafael
Owner: SMITHERMAN, DAVID
Job Address: 570 NW 112 Street
Project: <NONE>
Miami Shores, FL 33138 -0000
Contractor: STATEWIDE SEPTIC CONNECTIONS
Building Department Comments
April 06, 2011
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: Addition /Alteration
Phone Number
Parcel Number 3021360210620
Phone: (954)963 -0082
Page 1 of 1
BUILDING
PERMIT APPLICATION
FBC 20
Permit Type: PLUMBING
Owner's Name (Fee Simple Titleholder) k P O ' t DO 4 d Phone #
Owner's Address __510 M v ) C
City f" `t Q Prj lS `'1O re State L
Tenant/Lessee Name Phone #
Email
Job Address (where the work is being done)
City Miami Shores Village
FOLIO / PARCEL # 6 — O 2 (— 0G2_ O
Is Building Historically Designated YES NO V
t
Contractor's Company Name S i u de, . -f r � ( Phone # ce- c.6 `3 3
Contractor's Address ,359 c 5- 5 26
City - \ fir 0 r
Qualifier Name ¶ €SSG .0 ( r, ,Yt �n
State Certificate or Registration No. 5 Me t 1 t a
Contact Phone
Architect /Engineer's Name (if applicable)
Value of Work For this Permit $
Type of Work: ❑Addition
Describe Work:
Notary $
Scanning $
Double Fee $
Radon $
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. 0
I1 --
2L.t-o o
State El
❑Alteration
Submittal Fee $ � 4 /'U) Permit Fee $
Training /Education Fee $
570 ( 112
County Miami -Dade
Master Permit No.
Zip '5316 8
Zip X31
Zip 33) G 3
Phone #
Certificate of Competency No.
E -mail
Phone #
Square / Linear Footage Of Work:
QNew .`� Repair /Replace
lore:, ( > 0 ' 2 % - icf () I t
Flood Zone
d -" i4. * * ** * * * * * ** *:F.......:F ...., * *.x * * . * *x * * * *:a *...:F :r ** *.... * * *. * * * * * **
DPBR $
CCF $
CO /CC $
Violation date:
Structural Review. $ Total Fee Now Due $ 4 15. 5 0
Technology Fee $
Bond $
See Reverse side —+
MAR 2 8 2011 Li-
BY: --..
3e 0
❑ Demolition
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.
Signature ,4
Owner or Agent
The foregoing instrument was acknowledged before me this 22
day of 1"04 r c 20 , by 'tit d ,
who is personally known to me or who has produce ✓ L K
As id entiMgainthittaarrIM Atioath.
NOTARY PUBLIC: 4.7; Comm# DD0733346
Expires 11/8/2011
o` Florida Notary Assn., Inc
Sign: Sign:
Print: Print:
(Revised 07 /10 /07)(Revised 06/10/2009)
Engineer
Signature
Contractor
The foreng ins rument was acknowledged befo e
day o 1 , 201 1 , by
w i,, i personally known to me or who has produced
as identification and who did take an oath.
NOTARY PUBLIC:
My Commission Expires: My Commission Expires:
•
* * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** *********************** * * * * * * ** ** * * * * ** * * * ** * * ** * * * ***
APPROVED BY � V Plans Examiner
SaW\-.
t
Zoning
Clerk checked
CONSTRUCTION PERMIT FOR:
APPLICANT: Lisa Bailey
PROPERTY ADDRESS:
LOT: 3
T
A [
N [
• [
D
R
A
I
N
F
I
E
L
D
O
T
H
R
FILL REQUIRED:
STATE OF FLORIDA
DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT AND DISPOSAL FEE PAID:
SYSTEM RECEIPT #
PROPERTY ID #: 11 - 2136 021 - 0620
SYSTEM DESIGN AND SPECIFICATIONS
OSTDS Repair
570 NW 112 St Miami, FL 33168
900 ] GALLONS / GPD Septic
O ] GALLONS / GPD
O ] GALLONS GREASE INTERCEPTOR CAPACITY
) GALLONS DOSING TANK CAPACITY [
LOCATION OF BENCHMARK: F.F.E.: 12.5' NGVD.
ELEVATION OF PROPOSED SYSTEM SITE
BOTTOM OF DRAINFIELD TO BE
THIS PERMIT IS NOT FOR ADDITION(s).
SPECIFICATIONS BY
APPRO - BY:
DATE ISSUED:
BLOCK: 4 SUBDIVISION:
[ 0.00] INCHES EXCAVATION REQUIRED: [ 36.00] INCHES
_FDRO N OSPINA
o N ()spina
, 03/28/2011
DH 4016, 08/09 (Obsoletes all previous editions which may not be used)
Incorporated: 64E- 6.003, FAC
v 1 14
AP999186
PERMIT #: 13-SC-1309124
APPLICATION #: AP999186
DATE PAID:
DOCUMENT #: PR839724
[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.
CAPACITY
CAPACITY
[MAXIMUM CAPACITY SINGLE TANK:1250 GALLONS]
]GALLONS @[ ]DOSES PER 24 HRS #Pumps
[ 300 ] SQUARE FEET SYSTEM
[ 0 ] SQUARE FEET SYSTEM
TYPE SYSTEM: (X] STANDARD [ ] FILLED ( ] MOUND [ ]
CONFIGURATION: [x] TRENCH [ ] BED [ ]
[ 13.20 ] [I INCHES f FT J [ ABOVE /1 BELOW II BENCHMARK /REFERENCE POINT
[ 49.20 ] (1 INCHES Y FT ] [ ABOVE 4 BELOW b BENCHMARK /REFERENCE POINT
1— Existing 900 gal. septic tank certified by " Statewide Septic Connections Inc. " on 03/23/2011 to remain. 2- Install 300 sf
of drainfield in trench configuration. 3- Perimeter of excavation area shall be at least 2 ft wider and longer than the proposed
absorption trench. 4 -Invert elevation of drainfield to be no less than 8.90' NGVD. 5. Bottom of drainfield elevation to be no
Tess than 8.40' NGVD.
The contractor (or designee) Is requir E , riR 1
sdth� ' g adjacent to the drainfield 4604104bisihttotArtv ? ►i :04 C
time of ' • I inspection. Prior to Final Approval, the DOH
r tiginal site evaluation submitted. A
wft be assessed it the contractor W not
: c . the arranged time.
EXPIRATION DATE:
14
Dade
06/26/2011
Page 1 of 3
CHD
Notes:
Site Plan submitted by:
Plan Approved t/
STATE OF FLORIDA
DEPARTMENT OF HEALTH
APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PERMIT
Permit Application Number ? tl
Scale: Each block represents 5 feet and 1 inch = 50 feet.
By `
1\
JH 4015, 10/96 (Replaces HRS -H Form 4015 which may be used)
Stock Number: 5744- 002 - 4015.6)
c :9
59
PART II - SITE PLAN
3Z
Signature
Not Approved
,lc im -- 5 0 Nv‘1 112 Sd A S'f rf'.
c re v.-No t r '. ms's
CiG-°Sl A- Le S ree J 0011)C, c
c i !, - 4
S \� 3"
Si 0
3i? •! i ) )
X2
Sol I Gal iv�
( I. )
3316
Date
ALL CHANGES MUST BE APPROVED BY THE COUNTY HEALTH DEPARTMENT
- 3,rc( t'
Title
County Health Department
Page 2 of 3