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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. ------------ 1- . , . , : 5_ : ri ; . _ ' • ' • • • 5 •• c --t---4--- --; - -; • - - ; +„„--1., - 4.- 5-- -4 ;! ; •-: t • 5 ; 5 ; , 5 ; • 17,44, ; • r __ -t, 5_4_5.. t._ ; j , , ' 5 I I . EEE E' ••• --k-1 ' .54. 5. 5 ; ; ; • . ; - 5 ' - . -':. a ' 17- :' . 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