PL-07-2434_�
Inspection Number: INSP -69177 Permit Number: PL -12 -07 -2434
Scheduled Inspection Date: February 26, 2010
Inspector: Hernandez, Rafael
Owner: PALMATIER, LOUISE
Job Address: 540 NE 103 Street
Miami Shores, FL 33138 -2458
Project: <NONE>
Contractor: A AARON SUPER ROOTER
Building Department Comments
REPLACEMENT OF DRAINFIELD
Passed
X
Failed
Correction
Needed
Re- Inspection
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
Inspector Comments
di ;1 2419
February 25, 2010
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: Drainfield
Phone Number (305)754 -0838
Parcel Number 1132060170900
Phone: 305 - 944 -8886
Page 10 of 11
Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
BUILDING Permit No. �� 1-
PERMIT APPLICATIO Master Permit No.
FBC 2004
RECEIVED
N
DEC (1 5 2007
BY: 014.9"
Permit Type: Plumbing
Owner's Name (Fee Titleholder) RCOq o * Lo 4 rriaffKine #
Owner's Address '5 40 rSF (0
City Sk°'l®reri State
Tenant/Lessee Name Phone #
E -MAIL:
Job Address (where the work is being done)
540 NE t03 Streef
City Miami Shores Village County Miami -Dade Zip 33138
FOLIO /PARCEL# 1t - ' —01 '7
Is Building Historically Designated YES NO IV
Contractor's Company Name A Act r i Jai i 1 O P +hone # 4L(-t-i` —& 't
Contractor's Address SW 3S Ck
City iv1 t(7. v-i ck V State Zip 330
Qualifier Name 30 i
State Certificate or Registration No. ScechooG 4-8 Certificate of Competency No.
E -MAIL:
.Architect/Engineer's Name (if applicable) Phone #
Value of Work For this Permit $ Square / Linear Footage Of Work: 3V 0
Type of. Work: ['Addition ['Alteration ['New 17/Repair /Replace ❑ Demolition
Describe Work:
Submittal Fee $ 0
Notary $
O?
Scanning $a
Bond $ 3(0 ititoT
Structural Review. $
********* * ***** * ***** * *•* * * * *** ******* ** F *** * * * *** * *xx * • xxxxxx xxxxxx *** **
Permit Fee $ I1S ' CCF $ I. 10 CO /CC
Training /Education Fee $ 0.60
Radon $
Code E ., me
DEC 0 5 2007
at tit
MIAMI SHORES VILLAGE
DPBR $
Phone #
P�ep(a prg i.� �eld
Double Fee $
Technology Fee $ 4:37
Zoning $
Total Fee Now Due $ 474.17
See Reverse side -+
Bonding Company's Name (if applicable)
Bonding Company's Address
City
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address
City
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. 1 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 ee ng $2500, the applicant must
promise in good faith that a copy of the notice of commencement and construction lien law bro "ure ill be delivered to the person
whose property is subject to attachment. Also, a certified copy of the recorded notice of comme cem nt must be posted at the job site
for the first inspection which occurs seven (7) days after the building permit is issued In he hence of such posted notice, the
inspection will not be approved and a reinspection fee will be charged.
—
Q 'i eerr or Agent
The foregoing instrument was acknowledged before me this 3
day of Dec, , 20 Cr) by
who is personally known to me or who as roduced D .
Sre As id
s entification p ""
. �A�lath.
NOTARY PUBLIC: R z�
5
& fa- & to , P
Sign:
Print:
My Commission Expires:
APPLICATION APPROVED B
(Revised 02/08/06)
State
State
..W
Comm# DD0733346
Expires 11/8/2011
Florldeda blow/Assn, Inc
�Slfiiu. .fHN.N..
Signature
Contractor
The foregoing instrument was acknowledged before me this 3
clay of t 'G , 26 by 3
who is personally known to me or who has produced l V,
C2r . as i4pntificAtiAlialidailaa.alltake.au .oath.
NOTARY PUBd TERESA J. SOLOMON
$ 4 '" � Coma DD073334e
Expires 11/8/2011
Sign: \
Print:
My Commission Expires:
Zip
TereA
* ** *********** **** **** ee.***x ,0,e,4KxoY*.***..*x*** ** *,ta *.* * * **.,k,i**** tA, At / .4 i 4' -a 7
Plans Examiner
Engineer
Zoning
Protect Address
Owner Information
Miami Shores Village
10050 N.E. 2nd Avenue
Miami Shores, FL 33138 -0000
Phone: (305)795 -2204
Contractor(s)
A AARON SUPER ROOTER
Phone
305 - 944 -8886
CeII Phone
Type of Work: DRAINFIELD REPLACEMENT
Type of Piping:
Additional Info:
Bond Retum :
Classification: Residential
DEC 9 5 2U07
CKGA11
MIAMI SHORFS APP
Fees Due
Bond Type - Contractors Bond
CCF
Education Surcharge
Permit Fee - Additions/Alterations
Scanning Fee
Technology Fee
Total:
lbo%
Amount
$300.00
$1.80
$0.60
$175.00
$3.00
$4.37
$484.77
Authorized Signature: Owner / Applicant / Contractor / Agent
Building Department Copy
Address
Parcel Number
Phone
Total I Amt Paid I Amt Due
$ 484.77 $ 484.77
Payment Type: Check / Number: 6476
$ 0.0
December 05, 2007
Date
i"Ctassifieat Drain
Permit Status: APPROVED
Expiration: 06/02/2008
Applicant
CeII
Valuation:
Total Sq Feet
$ 3,000.00
300
1
Available Inspections:
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.
Wednesday, December 5, 2007 1
540 NE 103 Street
Miami Shores Village, FL
1132060170900
Block: Lot
ROGER PALMATIER
1
ROGER PALMATIER
540 NE 103 ST
MIAMI SHORES FL 33138 -2458
1
Inspection Type:
Final
Rough
Landscaping
CONSTRUCTION PERMIT FOR:
APPLICANT: Roger & Louise Palmatier
PROPERTY ADDRESS: 540 NE 103 St MIAMI, FL 33138
LOT: 7 -8
PROPERTY ID #: 11- 3206 - 017 -0900
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
MATERIAL FACTS,
TO MODIFY THE
NULL AND VOID.
OTHER FEDERAL,
SATISFACTORY PERFORMANCE FOR ANY SPECIFIC PERIOD OF TIME. ANY CHANGE IN
WHICH SERVED AS A BASIS FOR ISSUANCE OF THIS PERMIT, REQUIRE THE APPLICANT
PERMIT APPLICATION. SUCH MODIFICATIONS MAY RESULT IN THIS PERMIT BEING MADE
ISSUANCE OF THIS PERMIT DOES NOT EXEMPT THE APPLICANT FROM COMPLIANCE WITH
STATE, OR LOCAL PERMITTING REQUIRED FOR DEVELOPMENT OF THIS PROPERTY.
SYSTEM DESIGN AND SPECIFICATIONS
T [
A [
N [
K [
D [ 300 ] SQUARE FEET Trench configuration SYSTEM
R [ 0 ] SQUARE FEET SYSTEM
A TYPE SYSTEM: [X] STANDARD [ ] FILLED [] MOUND [ ]
I CONFIGURATION: [X] TRENCH [ ] BED [ ]
N
F LOCATION OF BENCHMARK: F.F.E, 11.50" NGVD.
0
H
E
900 ] GALLONS / GPD Seotic
0 ] GALLONS / GPD
0 ] GALLONS GREASE INTERCEPTOR CAPACITY
] GALLONS DOSING TANK CAPACITY
I ELEVATION OF PROPOSED SYSTEM SITE
E BOTTOM OF DRAINFIELD TO BE
L
D FILL REQUIRED:
*Invert elevation of drainfield to be no Tess than 7.40 ft. NGVD.
*Bottom of drainfield elevation to be no less than 6.90 ft. NGVD.
*Install 42" of slightly limited soil under the bottom of the drainfield.
- Perimeter of excavation area shall be at least 2 ft wider and longer than the proposed absorption bed or drain trench.
-The licensed contractor installing the system is responsible for installing the minimum- category of tank in accordance with
77- 77,517 fm, [17T r �7 n ^5:1 Vin.
1 ' (° �� e. �s cue ^ F c r�r��� 7573L IA
o t �_.ti" � P -2do c, .. a" c. 6 . s .ca ;. � ��t.�
Pi?.I G u itla r1 FlI �'r'iV f. i 'r 67 .nY • L li `i J .: Err' .
sec. 64E- 6.013(3)(f). F.A.C.
R
SPECIFICATIONS BY:
APPROVED BY:
DATE ISSUED:
STATE OF FLORIDA
DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT AND DISPOSAL
SYSTEM
[ 16.00] INCHES
OSTDS Repair
BLOCK: 93 SUBDIVISION: Miami Shores, Section 4
[ 1.60 ] [ INCHES 4 FT b [ ABOVE /LBELOW b BENCHMARK /REFERENCE POINT
[ 4.60 ] [ INCHES [ ABOVE /) BELOW b BENCHMARK /REFERENCE POINT
EXCAVATION REQUIRED: [ 36.00] INCHES
TITLE:
DH 4016, 10/97 (Previous Editions May Be Used)
v 1.1. AP611612 6E525334
PERMIT #: 13- SG- 661456
APPLICATION #: AP611612
DATE PAM: 11/30/2007
FEE PAID: $200.00
RECEIPT #: 13- PID- 668408
DOCUMENT #: PR512652
[SECTION, TOWNSHIP, RANGE, PARCEL NUMBER]
[OR TAX ID NUMBER]
CAPACITY
CAPACITY
[MAXIMUM CAPACITY SINGLE TANK:1250 GALLONS]
]GALLONS @[ ]DOSES PER 24 HRS #Pumps [ ]
Dade CHD
EXPIRATION DATE: 03/02/2008
Page 1 of 3
Site Plan submitted by:
Plan Approved
By
.e •
OH 4015. 10105 (lep laces HRS-11 FOIM 4015 which may be used)
1 Sint* Mather 57444102-4015411
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.
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Notes: be-0-
A
, „
PART II - SITE PLAN-
Signature
Not Approved
ALL CHANGES MUST BE APPROVED BY THE COUNTY HEALTH DEPARTMENT
; • • • , 5 ; f
Tale
Date
County Health Departmen
:54) t---; -1
Page 2 of: