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PL-07-1931Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Numl INSP -61402 Permit Number: PL -9-07 -1931 Inspection Date: 09/19/2007 Inspector: Levrock, James Owner: DOWSON, DAVID AND NANCY Job Address: 65 95 Street NE Miami Shores, FL 33138- Project: <NONE> Block: Contractor: MR C'S PLUMBING SEPTIC INC Permit Type: Plumbing - Residential Inspection Type: Final Work Classification: Drainfield Phone Number (305)754 -1685 Parcel Number 1132060130710 Lot: Phone: (305)651 -7859 Building Department Comments TO REPLACE DRAINFIELD /1 sEp 2 o EVs 40 &ASS Passed Insect ? C mments pp i .$ F2� „`; D C OKAY ti e Failed Correction Needed Re- Inspection Fee ($75) No Additional Inspections can be scheduled re- inspection fee is paid. until Tuesday, September 18, 2007 Page 1 of 2 Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 O BUILDING �'I�� PERMIT APPLICATION �I�"'P FBC 2004 Permit Type: Plumbing Owner's Name (Fee Simple Titleholder) Owner's Address City t sA J State TL..- Permit haZallig'M 1�1 SEP 12 1007 no.'FC6i—I93I Master Permit No. -- tv ) soy% N t✓ g S Sfi Phone# —7 g`G 0E f=- Zip Tenant/Lessee Name Phone # E -MAIL: Job Address (where the work is being done) cJ N e- 9 5 S1' City Miami Shores Village County Miami -Dade Zip 33 ( 30 FOLIO / PARCEL # U ( � o• - v) 3 — 0-1 (C� Is Building Historically Designated YES NO Contractor's Company Name " r r C'S 1 �� �� Phone # Contractor's Address 1,,61.g a- N W O� ••trV'e---* City aft) 1 State John \o hLL Phone# Qualifier Name 3c S &S► -1k Zip 33 i 61 • 3o - G51 1859 State Certificate or Registration No.C(....- ( Lill 4 7s Certificate of Competency No. E -MAIL: Architect/Engineer's Name (if applicable) Phone # Value of Work For this Permit $ abCo ' 00 Square / Linear Footage Of Work: Type of Work: ['Addition ['Alteration ❑New Describe Work: Repair /Replace ❑ Demolition 3® /421 kz.c,e 6-6-cIr,elek:-.4 co xxudrx****x* xxxxxxxxx iex4e****d:*nYirzaYa4xxxxx Fees*****x#' Y' Y' Y*' Y* xxxxxxxetaY ***.****at* xxxxxxxx*** Submittal Fee $ Permit Fee $ CCF $ / • 20 CO /CC Technology Fee $ 11 DPBR $ Zoning $ Notary $ Training /Education Fee $ 0 •O Scanning $ U' 0 Radon $ Bond Code Enforcement $ Double Fee $ Structural Review. $ Total Fee Now Due $ 491 •4O • 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 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: 1 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." 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 whi occurs seven (7) days after the building permit is issued In the absence of such posted notice, the inspection will not be a ed and a reinspeceon fee will be charged Owner or Agent The foregoing instrument was acknowledged before me this day of & 2.I,120 who is personally known to m)r who has produced As identification and who did take an oath. NOTARY PUBLIC Sign: Print: My Commission Ex >Yxx>ttxxxxx ******* C MYC_'1MMISSION #DD471903 Qp�pO EXPIRES: Sept. 14,2009 **14046108#186*** b telpftesig 01PUx* ntx APPLICATION APPROVED BY: (Revised 02/08/06) gnature Contractor The fore oin instrument was acknowledged before me this 1 )" day of IM�Y 20 ©4, by JO%Vl t� 4".(e, who is- personally known to .9or who has produced DD as identification and who did take an oath. NOTARY PUB Sign: Print: My Comm KEMBLE G ETTRICK MY COPY' ' A 3SION # DD47I903 —,.. res. ,r 4L, ;, ALS: Sept 14, 2009 >e>4>r>eic***tar4x>4x,txor>i** x>U( **W 9 ** ****** Plans Examiner Engineer Zoning 09/14/2007 15:12 3056515610 MR C PLUMBING & SEPT PAGE 01 P1 (c131 STAVE OF FLORIDA DEPARTMENT OF HEALTH ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM CONSTRUCTION PERMIT E'oa: OSIDS Repair APPLICANT: Nancy Dowson PROPERTY ADDRESS: 65 NE 95 St MIAMI, FL 33138 LOT: 20,19,21 PERMIT #: 13- SG- 409624 APPLICATION #: AP376998 DATE PAID: 09 /11/2007 FEE PAID: $200.00 RECEIPT #: 13- PID- 329050 DOCUMENT #:PR279897 BLOCK: 5 sysDlvISION: Miami Shores PROPERTY ID #! 11 -3206- 013 -0710 [SECTION, TOWNSHIP, RANGE, PARCEL NUMBER] [OR TAX ID NUMBER] SYSTEM MUST HE 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 MODIP'XCATIONS MAY RESULT IN THIS PERMIT BEING MADE NULL AND VOID. ISSUANCE OF THIS PERMIT DOES NOT EST Tar APPLICANT FROM COMPLIANCE WITH OTHER FEDERAL, STATE, OR LOCAL PERMITTING REQUIRED FOR DEVELOPMENT OF THIS PROPERTY. SYSTEM DESIGN AND SPECIFICATIONS T [ 900 ] GALLONS / GPD Septic CAPACITY A [ 0 ] GALLONS / GPD CAPACITY N [ 0 ] GALLONS GREASE INTERCEPTOR CAPACITY [MAXIMUM CAPACITY SINGLE TANK:1250 GALLONS] K [ ] GALLONS DOSING TANK CAPACITY [ IGALLONS @[ ]DOSES PER 24 HRS #Pumps [ ] D [ 300 ] SQUARE FEET Bed con1auratlon SYSTEM R 1 0 ] SQUARE FEET SYSTEM A TYPE SYSTEM; [x] STANDARD [ ] FIL *.ED 1 1 MOUND [ ] I CONFIGURATION: [ ] TRENCH [X] BED 1 ] N ✓ LOCATION of BENCHMARK: FFE 10.6" NGVD I ELEVATION OF PROPOSED SYSTEM SITE t 2.40 ][lINCHESY FT 1 ABOVE BELOW BENCEIMARK /REFERENCE POINT E BOTTOM OF DEAINFIELD TO BE [ 25.68 ] [I INCHES 1/ FT 11 ABOVE 4 BELow ',BENCHMARK/REFERENCE POINT L D FILL REQUIRED: [ 2.00] INCHES EXCAVATION REQUIRED: [ 28.00] INCHES 0 T H zr R Existing tank OK for use, Required drainfield area based on rule 64E- 6.015(6)(c)2. Install a new 300 sf of drainfield to achieve Drainfleld size requirement. Invert elevation of drainfield to be no less than 8,96 ft NGVD. Bottom of drainfield elevation to be no less than 8.46 ft NGVD. THIS PERMIT IS NOT FOR ANY " ADDITION(s) ". REPAIR MAW-DADE COUNTY HEALTH DFPAPTImP1T SPECIFICATIONS BE: Joseph R Pivorger TITLE: Engineer specialist iI APPROVED BY: 7:01-00$1, r TITLE: Dade CHD DATE ISSUED: 109/12/2007 �� EXPIRATION DATE: 12/11/2007 DH 4016, 10/97 (Previous Editi•r May Be Used) Page 1 of '3 09/14/2007 15:12 3056515610 MR C PLUMBING & SEPT PAGE 02 STATE OF FLORIDA DEPARTMENT OF HEALTH APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PERMIT Permit Application Number Scale: Each block re PART II - SITEPLAN resents 10 feet and 1 inch = 40 feet. fi11111 111r1111r11111111111■.1��'�!■ M■■I■r ■r■ ■rrrr11■r1 ■■r■■MEMO rininumummumpummaimomm immumuniummenrans m ■■■ ■ro■■i■r■■ro■�■t■ ■o■ ■■■m # ■■r■■r■��r■r�■ramosrm zmu.i �■1111r11=111161I1i1 ■ ■ ■ ■�■t1�r __ ■r■■ .�• ■r ■ ■■r ■ ■I 1111Iir ■r■ ■■ ■ ■■ __MOM ■Ir■■rIII■ ■01•r11■■■1■ ■l■ LASIII MEN17l■• \■■111 M■ ■■■ r MUNI MIME mom ■ rww1•rwwwwr��w*w� ■� • • r■ mum itimmEmmommessonsmormanmii ■ ■fir ■mp1gs�!'�i, i ■ ■r■ ■�■r■ir■f1i� ■■ ■ ■ ■ ■ ■ ■ ■ ■■111■■ ■ ■ ■ ■r Notes: ,p5 NG- 9 IIN 1© Site Plan submitted by: Plan Approved By County Health Department Not Approved, Date ALL CHANGES MUST BE APPROVED BY THE COUNTY HEALTH DEPARTMENT DH 4015,10196 (Replaces HRS-H Form 4016 which may be used) (Stock Number: 5744- 002 - 4015 -8) Page 2 of 4 DIVISION OF Environmental Health Florida Department of Heath Miami Dade County Health Department OS S /Septic Tank Division 7769 NW 48th St. Suite 175 Inspector tX7 Ce. Miami, FL 33166 Date 7:— / / osms # /q(,.3 % '. 5' ?cY' ttatin