PL-09-230Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Scheduled Inspection Date: March 19, 2009
Inspector: Levrock, James
Owner: RAMIREZ, DIANE
Job Address: 760 NE 96 Street
Miami Shores, FL 33138-
Project: <NONE>
Contractor: LUIS QUALITY PLUMBING
Permit Type: Plumbing - Residential
Inspection Type: Final
Work Classification: Septic
Phone Number
arcel Number 1132060142080
Phone: 305 -553 -7155
Building Department Comments
Passed
Failed
`,A 2 0 *0
Ins =:cto om nts
Correction
Needed
Re- Inspection
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
March 18, 2009
Page 21 of 29
CTATi- ` i.if�.
DEPARTMENTOF i dE'A1 H
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LOT:
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TAIT< INSTAL, "7-1C)T9
[O ; - - -- - -
[02] TANK MATERIAL _
[33] OUTLET DEY10E
RA] • MULTI -CHAMBEREL?F•r l /..N.] •
[Q5] UTLET. ILTF
1071 WAT.ERTIGI T
[081 LEVEL
[09] ` DEPTH' T_ LTD •
DRAINFIEt_fr INSTALL Al ON
[141 . • AREA. [11.
[111'
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DIST U3UTIG1N B(; X H ADE
f�iUP EJ OF U3 AI141�Ii�1 5. `.. .
D13AI.N UNE>'SEPARATION . •
[141 ORAiNLU IE: SLOPE
', [151. DEPTH OF COVER
[1.6] . ELEVATION fAf3O E'BELOW]..M
[171. . • SYSTEM LOCATION
18) OOSi 10:PUtPS
[191 ArCFECnAi :SI E
[201 •Pr'r1 ELATE EXCESSIVE FILM=S
x211 ?{` C:P,EG T _DEF H,
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Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
BUILDING
PERMIT APPLICATION
FBC 2004
Permit Type: Plumbing
Owner's Name (Fee Simple Titleholder) 1 O�
Owner's Address —1L00 PE ' Lo tS
City 9- XI CQrfl i sh0'(C State
MLECEEIVILTI
F31,2C9
BY-
Permit No .P1 09 C
Master Permit No.
V, 3 --c.t h #3O5 - -0vIssq
Tenant /Lessee Name
E- MAIL:
Job Address (where the work is being done
Zip 3313
Phone #
City Miami SI ares Village Count iami -Dade Zip 33138
FOLIO / PARCEL # / _ --
Is Building Historically Designated
YES NO V
Contractor's Company Name L j \ 1 �I U1"/"601?
Contractor's Address 3 Ng.) (p-1 S
City 1 a ✓/-1 t' State . -1-- Zip
Qualifier Name ),,0‘ , - l/J'1 Ct-CL, Phone # 305 — (-13to -1(d.0
Phone # 305 - S58
---),55
33I (.Q Co
State Certificate or Registration No. Certificate of Competency No.
E -MAIL:
Architect /Engineer's Name (if applicable) Phone #
Value of Work For this Permit $ , qod
Type of Work: ❑Addition,:.
Describe Work:eR%kir
��k iD T
Square / Linear Footage Of Work:
Alteration ❑New Repair /Replace
±3e-ed 02 )2,7 900 q/5 S
O r c J cow . -e c-, rl -,
-A( r_
0 Demolition
********* * * * * ** * * * * * * * * * * * * * * * * * * * * * * * *F
Submittal Fee $ Permit Fee $
Notary $ Training /Education Fee $
57
Scanning $ j `CO
Bond $
Structural Review. $
************* * * * * * * ** * * * * * * * * * * * * * * * * * * * ** **
Radon $ DPBR $
CC F $ CO /CC
Technology Fee $ 01-51
Zoning $
Code Enforcement $ Double Fee $
Total Fee Now Due $
S°t4 5`l
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
Zip
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 ab nee of such posted notice, the
inspection will not be approved and a reinspection fee will be charged.
Signat
Owner or Agent
The foregoing instrument was acknowledged before me this
day of -Vet . , 20 , by ) ICII'l— , ��
who is p sonally known to imeor who has produced
As identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print.
Signatur
ntract
The foregoing instrument was acknowledged beftlre me this 17)
, day of -C , 206\ by
who is personally known tch nee or who has produced
as identification and who did take an oath.
NOT
Sig
Prin
My Commission Expires:
* * * * * * * * * * * * * * * * * * * * * **
My Commission Expires:
• x** ** xr *x *xx* *xx* x* *xxx ** x* xx*** * *** *, ,
APPLICATION APPROVED B
(Revised 02/08/06)
Plans Examiner
Engineer
Zoning
STATE OF FLORIDA
DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT AND DISPOSAL
SYSTEM
CONSTRUCTION PERMIT FOR: OSTDS Repair
APPLICANT: Diane Stewart
PERMIT # :13 -SC- 969887
APPLICATION # : AP910486
DATE PAID:
FEE PAID'
RECEIPT #•
DOCUMENT #: PR763910
PROPERTY ADDRESS:
LOT: 5
760 NE 96 St Miami, FL 33138
BLOCK: 68 SUBDIVISION: Miami Shores Sec 3
PROPERTY ID #: 11- 3206 - 014 -2080
[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 I,
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.
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 [ ]GALLONS @[ ]DOSES PER 24 HRS #Pumps [ ]
D
R
A
I
N
F
I
E
L
D
O
T
H
E
R
[ 200 ] SQUARE FEET SYSTEM
0 ] SQUARE FEET SYSTEM
TYPE SYSTEM: [ ] STANDARD [x] FILLED [ ] MOUND [ ]
CONFIGURATION: [ ] TRENCH [x] BED [ ]
LOCATION OF BENCHMARK: FFE: 10.4' NGVD
ELEVATION OF PROPOSED SYSTEM SITE
BOTTOM OF DRAINFIELD TO BE
FILL REQUIRED:
[ 12.00] INCHES
[ 12.00 ] [I INCHES / FT ] [ ABOVE / BELOW ] BENCHMARK /REFERENCE . POINT
[ 30.00 ] [I INCHES / FT ] [ ABOVE A BELOW ] BENCHMARK /REFERENCE POINT
EXCAVATION REQUIRED: [ 18.00] INCHES
1.-Install a 900 gal min. category-3 septic tank with an approved filter.
2.-The licensed contractor installing the system is responsible for installing the minimum category of tank in accordance
with s. 64E- 6.013(3)(f), FAC.
3.- Install 200 sf of drainfield in bed configuration.
4. -Invert elevation of drainfield to be no less than 8.40' NGVD. W.14:0 D6Q
5. -Bottom of drainfield elevation to be no less than 7.90' NGVD. GO
* * * * * * * * **`* ***THIS PERMIT IS NOT FOR ADDITION(s) * * * * * ******* * * * *** M�,gJ1t.D
SPECIFICATIONS BY:
APPROVED BY:
DATE ISSUED:
TITLE: Engineer Specialist II
TITLE: Engineer Specialist II
DH 4016, 10/97 (Previous Editions May Be Used)
v 1.1.4
AP910486
Dade CHD
EXPIRATION DATE: 05/13/2009
8E779470
Page 1 of 3
STATE OF FLORIDA
DEPARTMENT OF HEALTH DATE PAID:
ONSITE SEWAGE TREATMENT AND DISPOSAL FEE PAID:
SYSTEM RECEIPT #:
DOCUMENT #: PR763426
PERMIT if: 13-SC-969883
APPLICATION #: AP910481
CONSTRUCTION PERMIT FOR: OSTDS Abandonment
APPLICANT: Diane Stewart
PROPERTY ADDRESS: 760 NE 96 St Miami, FL 33138
LOT: 5
BLOCK: 68 SUBDIVISION: Miami Shores Sec 3
PROPERTY ID #: 11- 3206- 014-2080
[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.
SYSTEM DESIGN AND SPECIFICATIONS
T [ ] GALLONS / GPD CAPACITY
A [ ] GALLONS / GPD CAPACITY
N [ ] GALLONS GREASE INTERCEPTOR CAPACITY [MAXIMUM CAPACITY SINGLE TANK:1250 GALLONS]
K [ ] GALLONS DOSING TANK CAPACITY [ ]GALLONS @[ ]DOSES PER 24 HRS #Pumps [ ]
D [ ] SQUARE FEET SYSTEM
R [ ] SQUARE FEET SYSTEM
A TYPE SYSTEM: [ ] STANDARD [ ] FILLED [] MOUND [ ]
I CONFIGURATION: [ ] TRENCH [ 3 BED [ 3
N
F LOCATION OF BENCHMARK:
I ELEVATION OF PROPOSED SYSTEM SITE [ ]( / ][ABOVE/ BELOW3BENCHMARK /REFERENCE POINT
E BOTTOM OF DRAINFIELD TO BE [ ][ / I [ABOVE/ BELOW] BENCHMARK /REFERENCE POINT
L
D FILL REQUIRED: [ 0.00] INCHES EXCAVATION REQUIRED: [ ] INCHES
0
T
H
E
Have the tank abandoned in accordance with the following procedures:(a) The tank shall be pumped out.(b) The bottom of
the tank shall be opened or ruptured, or the entire tank collapsed so as to prevent the tank from retaining water, and(c) The
tank shall be filled with clean sand or other suitable material, and completely covered with soll.Have the system Inspected
by the health department after It has been pumped and ruptured but before it is filled with sand and covered.
R
SPECIFICATIONS BY:
APPROVED BY:
DATE ISSUED:
os = •h R Piv sr
TITLE: Engineer Specialist II
TI gineer Specialist II Dade CHD
02/09 — EXPIRATION DATE: 05/10/2009
DH 4016, 10/97 ,previous Editions May Be Used)
v 1.1.4 AS910481 SE -1
Page 1 of 3