PL-07-1768Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number: INSP -59307 Permit Number: PL- 8-07 -1768
Inspection Date: 08/27/2007
Inspector: Levrock, James
Owner:
Job Address: 534 95 Street NE
OLP
Miami Shores Village, FL
Project: <NONE>
Block:
Contractor: BOBS SEPTIC & DRAIN INC
Permit Type: Plumbing - Residential
Inspection Type: Final
Work Classification: Drainfield
Phone Number
Parcel Number 1132060140820
Lot:
Phone: 305- 558 -5818
Building Department Comments
REPLACEMENT OF DRAINFIELD
628291
Passed
`
p ctor Comments
Failed
Correction
Needed
Re- Inspection
Fee
($75)
No Additional Inspections can be scheduled
re- inspection fee is paid.
until
Friday, August 24, 2007
Page 1 of 2
P 0 BOX 612333
NORTH MIAMI, FL a3261-2333
305 - 558 -5818 * 954 - 920 -5099
FAX 305 - 893 -0270
0 Urgent ❑ For Review 0 Please Comment 0 Please Reply O Please Recycle
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STATE OF FLORIDA
DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM
CONSTRUCTION-INSPECTION AND FINAL APPROVAL
APPLICANT:
AGENT:
PROPERTY ADDRESS:
LOT? .' BLOCI<:._'"t
PERMI i NO f S3
DATE PAID' —w
FEE PAID:
RECEIPT #:
SUBDIVISION: ` ;-r •N-�1 '' f�* Y PROPERTY ID #: Zr ^ ' 0
CHECKED [X] ITEMS ARE NOT IN COMPLIANCE WITH STATUTE OR RULE AND MUST BE CORRECTED.
TANK INSTALLATION
[01] TANK SIZE [1J2n c..
[02] TANK MATERIAL
[031 OUTLET DEVICE„.- -
(04) MULTI- CHAMBERED (s/ N ]
[05) OUTLET FILTER,�IL/ —
[08] LEGEND /iv / /).
(07) WATERTIGHT -« —•..
[081 LEVEL
[09] DEPTH'TO LID y 9
DRAINFIELD INSTALLATION
2]
t
(
(10) AREA [1 vex 2[21 -r') SQFT
[111 DISTRIBUTION BOX HEADER ✓ [
[12) NUMBER OF DRAINLINES /� ��•f7�,•,�:�,�[
[13) DRAINLINE SEPARATION ; [
[14] DRAINLINE SLOPE
(15] DEPTH OF COVER, � .
[16] ELEVATION [ABOVE/BELOW] BM
(17J SYSTEM LOCATION,• . an •_
[181 DOSING PUMPS '
(19) AGGREGATE SIZE / 14:4 _���
[20) AGGREGATE EXCE IVE S
[21) AGGREGATE DEPTH 74/ }�
FILL / EXCAVATION MATERIAL
[22) FILL AMOUNT • i/ /
[231 FILL TEXTURE
(24) EXCAVATION DEPTH
[25) AREA REPLACED
[26) REPLACEMENT MATERIAL
EXPLANATION OF VIOLATIONS / REMARKS:
1 1
1 1__
1
1
1 1
SETBACKS
[27) SURFACE WATER FT
(28] DITCHES FT
[29J PRIVATE WELLS FT
[301 PUHLIC WELLS FT
[31] IRRIGATION WELLS FT
[321 POTABLE WATER LINES ,, '� FT
(33) BUILDING FOUNDATION_, ? FT
[34] PROPERTY LINES - ____.FT
[35) OTHER FT
FILLED / MOUND SYSTEM
[361 DRAINFIELD COVER
[37) SHOULDERS
[38] SLOPES
(39) STABILIZATION
ADDITIONAL INFORMATION
[40] UNOBSTRUCTED AREA
[41] STORMWATER RUNOFF
[42) ALARMS
MAINTENANCE AGREEMENT
[44] BUILDING AREA
[45) •, LOCATION CONFORMS WITH 51TE PLAN .
(46)
[47] CONTRACTOR ( „� -✓�.,, 1 -' ' t_
(48] OTHER
1 3)
FINAL SITE GRAD G• , -
'ABANDONMENT r
[49] TANK PUMPED a".".. /IJ
[50) TANK CRUSHED & FILLED /
CONSTRUC PPROVED/ SAPPROVED]7S =� «� °�r-�- •',
FINAL S'STEM [APPROVED/DISPROVED): ✓I( •'•� r'•
DH 4019 (Pape 2). 10/97 (Previous Editions Witty Be Used)
Stock Number: 5744402 - 40164
CHD DATE. r
►' 1 /_ ^' `. CHD DATE: " ti' =
Page 2 of 3
PT 1; ApplioaM
PT 2; Inslallu 'Gomm ctar
PT 3• ButdMN) Department
PT 4: Haahh Deparfness
r=414 ` ro�
Miami Shores Village t.luki/`
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
BUILDING
PERMIT APPLICATIO
FBC 2004
Permit Type: Plumbing
Owner's Name (Fee Simple Titleholder) 1 it ..J65 (4)41;r5j1) Phone #
Owner's Address
REC
AUG 2 12007
. 0
BY..
Permit No. PL 1 1
Master Permit No.
City
Tenant/Lessee Name� y0
E -MAIL:
/
Job Address (where the work is being done)
E 73
Zip
L
Phone #
City Miami Sher 's Villa e County , Miami -Dade Zip
FOLIO / PARCEL # " ,e O/t
Is Building Historically Designated YES NO X
Contractor's Company Name a
Contractor's Address
City
Qualifier Name
S%
State 1,
)/11- Phone #
State Certificate r Registration No.. / /j (10-41/1 Certificate of Competency No. ( LJ
E -MAIL:
3 A �
Ro-c
Zip
Architect/Engineer's Name (if applicable)
Value of Work For this Permit $
Type of Work: ❑Addition
Describe Work:
1/4
['Alteration
Phone #
Square / Linear Footage Of Work: IV
['New
Repair/Replace
['Demolition
******** * * * * * * * * * * * * * * * ** *** * ** * ** * ** ** Fees************* * * * ** *** * ** * * *x * *xxxxxx *xrxxxxx
Submittal Fee $
.7
Permit Fee $ � 1 � •Or)
Notary $
Training /Education Fee $ t 40
CCF $ , 70 CO /CC
Technology Fee $. ,_yq
Scanning $ U) Radon $ DPBR $ Zoning $
Bond $ Code Enforcement $
Structural Review. $
Double Fee $
o25I2, foi
Total Fee Now Due $
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 1 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. l 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. fF YOU INTEND TO OBTAIN FINANCING,
CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF
COMMENCEMENT."
Zip
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
Owner or Agent
The foregoing instrument was acknowledged before me this _
day of 61.71.1 , 20 , by affislieS LuTRA
who is (personally known to me or who has produced 0-S ittbriily
Ct • (.04y) As identification and who did take an oath.
NOTARY PUBLIC:
Sign: ��pp
Print: l"16otleer G.''
My Commission Expires:
0- a, o �00‘a�s
*************************** ********xxxxxxxxx*, *,teat**
APPLICATION APPROVED BY:
(Revised 02/08/06)
Signature
ontractor
The foregoing instrument was acknowledged before me this t(
day of td" , 2,0O { , by
who is ersonally known to me or who has rte 9 ; �t "�
300 as identification
NOTARY PUBLIC:
Sign:
Print:
My Commission Expires:
x, Y, ti'x 9:, 6, Yxx xxxxxx, t, Yx, Y****, Yx, 4, Yxxx, t, 49ex ,t,4,Y,Yx,Y,t,Y,Px,'e,Y*******
Plans Examiner
Engineer
4oning
• • ••• •
•.• .• • • •
• • • • • • • • •
• • • •.•
SW& 4 a
• •••
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• • •
•
• •
•
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• •••
DSPAIRTMEI1 OP MALTS
OATS ITE • SF IAilir/3 BLVD
PERMIT #: 13- SG- 367116
APPLICATION #: AP334676
DATE PAID: OS/15/2007
Di a� r_: PAID: $200.00
�r - ---- -- - - --
• • • • • • • • • • • ECE IpE D sixtEi r # 13-PID- 302528
• • • • • • • • •
• • • • • • • • .
AEG 2 1 2007
C ogan=TrOri mom yote:t i i (2392/ Rpp it • _ • • JBY: iV22
APPIAC11A]T: Chad @5 • • • • • • • • • • . • •
WAtsG�'� •
PROPERTY ADDRESS: : 534 iJE '15 $i £ $I Mr' L A'1138
=: 889
swag: Se
PROPERTY ID S: 11-3208-014,9320
SIDEDIVIEt0N: Miami Shares
[ SECTION, TOWNSHIP, AM OS, PAST, NUMBER]
[OR T7;X ID NUMEERI
3Y3TEX tORT SE CC04817kUL ED Zvi AcCoRDANC.E WITH STMCIPMATICOVS AND STANDARDS OF SECTION
381.0065, F.6 -, AND CHARTER 64E -6, F.A.C. DEPARTMENT APPROVAL OP SYSTEM LAS NOT GUARANTEE
SATISFACTORY PERFORMANCE FOR ANY SPECIFIC exam= OF TIME. Pan CHANt E IN MATERIAL FACTS,
REICH SERVED As A EASIH . FOR MOAN= OF THIS PERMIT, RRQT IRE TEE APPLICAET TO MODXY2 THM
AEPHTET AP'P&.'[CATIOtt. MOE MODIFTCATioNS MAY RESULT IN MS PERMIT BETEL 200E NULL AND V0ID.
ISSUgNCE OF THIS PERMIT DOTS HOT EXEMPT TXE APPLICANT FRLRq tompLyANcE WITS OTTHRR Ti ,
STAMM, OR LOCAL PERNITTING REQUIRED FOR DENEIAPMENT OP THIS PROS'ERry.
Ice
STBTeEm DEEM; AND SPECIPI ATICNS
T t 900 ] GALLON* / cWC• Seatic CAPACITY
1. [ 0 ] GALLONS / 6$L• CAPACITY
N [ 0 ] CAS GREASE INTBRC.t+IPTnRd CAPACITY [mAximA�i CAPACITY SINGLE TANS :].250 GALLONS]
E [ ] GALION'S DOSING TAN'R CAPACITY t J0AI.t0 S et ]POSES PsR 24 HMS *amps i ]
O t 160 ] soma FaET CPL T sssTrm • • [ 0 ] SQUARE FEET SYSTEM
A `rim SYSTEM_ [E] $T14.IM= [ ] mum t I MIME t
1 ZGUPJ.TZON: [x] TRENCH [,I END t I
N
• Meta or estaefatel.aa! FFE: 10.7e NOVO
I ELEVATION OF 1n40POsED SYSTIRd SITE
E BOTTOM OF DRAINFIELD TC SE
P FILL. REQUIRED:
t 0.00 ] ,INCHES
t 19.20 ]
[ 49.20 ]
ET 31 ,SOWS
P"t ] [ ABOVE
ERNORKARE/REPERENCE PO /NT
EXCAVATION REQUilED : [ $1001 INCHES
1.-Existing 900 gal, septic tank 4 rlified by Sob "" a Septic & Orin on 8115/07" OK for use.
2.- Required drainfleld area based on rule 64.E- 6.015(ego)2.
3. Install a new 181E SF dr-ainfield n trench conflguratlon to 2ch(eve Drainfleld size requirement, Isoe 4.- Inert elevation of 017/10field to !7@ no less than 7.10'"' NGVD. " ,���'
S.-Bottom of draindefd elevation 1;o be no less than 8.60 m NGVD. S irj4."
1044141'w
«` 1 D� 1:01 tr0
.11E /REVERENCE POINT
*St k* " ""THIS PERMIT IS NOT OR ADDITI01 1 ;.s **I a�- 44R4**
SPECIFIMTION9 Et: Astrid N. Edwards _ 6f/ ,,
CIVINNMI
APPROVED EY:
LATE ISSUED;
08/16/200i'
Mill A, ffiSOirioar Specialist Ir
or-
oialisl;. II Dade co
Miami Shores Viii %Y$7�M 4rYT �i�'- 1 11/16/2007
OH 4016, :10/97 (Previous Edi1:ions May $a D - - ROVED
ZONING DEPT
BLDG DEPT •
DATE
SUBJECT TO COMPUANCENTH ALL FEDERAL
STATE AND COUN1Y RULES AND REGULATIONS
Page 1 of 3
• • .•. • •
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Notes:
Site Plan submitted
Plan Approved
By
artrnen
ALL CHANGES BAUBT L
OK 401k WU ( Replaces HRS-H form-+0t5 ► may be used)
Bieck Nu naer.5744- OO24016e4
OVED BY
Page 2 of 3