PL-05-306Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Date: 02/13/2007
Inspector: Levrack, James
Owner: WHITE, MARGUERITE
Job Address: 1240 97 Street NE
Miami Shores Village, FL
Project: <NONE>
Contractor: A AARON SUPER ROOTER
Block:
Permit Type: Imported Permit
Inspection Type: Final
Work Classification: <NONE>
Phone Number
Parcel Number 1132050090590
Lot:
Phone: 305 - 944 -8886
Building Department Comments
INSTALL NEW DRAINFIELD
a( eg7jS
FEB 1422T 0 r__
Passed
In> p :ct
r 'omments
Failed
Correction
Needed
Re- Inspection
Fee
($75)
No Additional Inspections can be scheduled
re- inspection fee is paid .
until
Monday, February 12, 2007
Page 1 of 1
STATE OY FLORIDA
DEPARTMEET OF HEALTH
ONSITE SEWAGE TREATMENT A31D
CONSTRUCTION INSPECTION AND
D POBAL SYSTEM[
INAL APPROVAL
APPLICANT:
AGENT:
PERMIT No. C) 3 3G%A\
DATE PAID: /Cs / r, . Q�
FEE PAID: /enct'. .
RECEIPT #:
FEB it 2 2007
D
PL.05.306
PROPERTY ADUIEss: /�z yJ'
LOTS &I _ BLOCK: / SUBDIVISION:
CHECKED [1] ITEMS ARE NOT XR COMPLIANCE WITS STATUTE OR RULE AND MUST BE CORRE .
T� IN�t I aTION
[01] TANK SIZE (1) (2)
[02] TAN[ MATERIAL
[03] OUTLET DEVICE »
[04] ;MULTI 1 T /�l
(05 ] 'OUTLET FILTER/jl
[06] /A
[07] WATERTIGHT
[08] LEVEL /S/)
[09] DEPTH TO LID "
DRAINFIELD INSTALLATION
[ 10 ] AREA (1) /2)(2 r [ 2] 30Dej SOFT
[11] DISTRIBUTION BOX _ READER
[12] NUMBER OF DRAINLINES 9
[13] DRAINLINE SEPARATION y 4'°
[ 14 ] DR7IINLDIE SLOPE
[15] DEPTH OF COVER /t "
[16] ELEVATION [ABOVE
[17] SYSTEM LOCATION`
[18] DoSING PUMPS
[ 19 ] AGGREGATE SIZE* 5" a O, %°
[20] AGGREGATE EXCESSIVE FINES
[21) AGGREGATE DEPTH i Z '7
FILL
[22]
[23]
[24]
[25]
[26]
/ EXCAVATION MATERIAL
FILL AMOUNT /,Z if
FILL TEXTURE
EXCAVATION DEPTE
AREA REPLACED
REPLACEMENT MATERIAL
OF VIOLATIONS / REMARKS:
1
t
1
[
l
1
1
1
l
1
l
]
1
l
SETBACKS
[27] SURFACE WATER
[28] DITCEES
[29] PRIVATE WELLS
[30]
[31]
[32)
[33]
[34]
[35]
FT
FT
PUBLIC WILLS FT
IRRIGATION WELLS 71i 7A FT
POTATTAX WISER Lads T
BUILDING FOUNDATION 5 FT
PROPERTY LINES .✓"
OTHER
FT
FT
FILLED / MOUND SYSTEM
[36] maxim= COVER
[37) SROULDERS
[38] SLOPES
[39] STABILISATION
ADDITIONAL rffrommanor
[40] UNOBSTRUCTED AREA
[41) STORMOATER RUFF
[42) ALARMS
[43] MAINTENANCE AGREEMENT
[44] BUILDING AREA
[45] LOCATION CONFORMS RITE SITE PLAN
[46] FINAL SATE G*ADING
[47] CONTRACTOR , °
148) OMR
=mom= ,/�`
[49] TANK PUMPED A /L _i
(501 TANK CROONED & rim= ___/
CO-1•-C, r CED DATE: AO -/ k-o r
CED I. _
Page 2 of 3
DE 4016, 10/97 (Previous Editions May Is Ussd)
8mctd a Pis
Miami Shqres Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
BUILDING
PERMIT APPLICATIO
FBC 2001
ECE VED
OCT
Permit No.
Master Permit No.
-30/0
Permit Type (circle): Building Electri
Mechanical Roofing
Owner's Name (Fee Simple Titleholder) M 0 r der \"N1 \"NINe.1 Phone #
Owner's Address Z J e
City M shores State
Tenant/Lessee Name
Zip 33a.
Phone #
Job Address (where the work is being done)
City Miami Shores Village County Miami- ade Zip 331--5=5
Is Building Historically Designated YES NO
124-0 N °, ST
Contractor's Company Name j\ yon (S 4Phone #
Contractor's Address Go 2-7, ,St -6 S (
City N+ i rC t vvy, State 15--
Qualifier C 1V j
(3c )q 4 -cS e 6
Zip 3 0 23
State Certificate or Registration No. 3e--10000648 Certificate of Competency No.
Architect/Engineer's Name (if applicable) n1 Pt Phone #
$ Value of Work For this Permit WOO--
Square Footage Of Work: 2 5
Type of Work: ❑Addition DAlteration ❑New g Re air/Replace ❑ Demolition
\in s -'6 ±►��. 0 (Q\f,-%eid
Describe Work:
* * * * * * * *, * * ** * * *, * * # ** *, *, Fees * * *, ** * ** * * * * ** ** * * * * * ** ** * * **
Submittal Fee $ Permit Fee $ 1 ,S CCF $ 1 • c• CO /CC
Notary $ Training/Education Fee $ U. - 7 Technology Fee $ 4 .40
Scanning $ 3.0D Radon $ Zoning Bond $ t )• 00
Structural Plan Review. $ C.--
Code Enforcement $
OCT 12 PAID
Total Fee Now Due $ 46,4_ .
(Continued on opposite side) C-%a 84
X3-1 1
10 -13 -05 A11 :22 IN
Bonding Company's Name (if applicable)
Bonding Company's Address
City State Zip
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. 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 REECORDING YOUR NOTICE OF
COMMENCEMENT."
Notice to Applicant: As a condition to the issuance of a building permit with an estimated value
promise in good faith that a copy of the notice of commencement and construction lien law bro
whose property is subject to attachment. Also, a certified copy of the recorded notice of comme
for the first i action which occurs seven (7) days after the building permit is issued. In t
inspection will no be approved and a reinspection fee will be charged.
e ; ".eding $2500, the applicant must
e will be delivered to the person
ent must be posted at the job site
absence of such posted notice, the
The foregoing instrument was acknowledged before me this B 0
day of e7c--4° , 20 by P5d
who is personally known to me or who has produced
D ti CeinAs identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
My Commission Expir
* * * ** *0-F * * * * * * * * * * **
Contractor
The foregoing instru ent was acknowledged before me this 10
day of 0C+ , 20 , by (Tt®iewo 71..) ,
who is personally known to me or who has produced
U C.ZIn as identification and who did take an oath.
NOTARY PUBLIC:
c
I _GSA J. SOLOMON
,A .t a: MMISSION # Dt 04 .17
1. 800 -3- NOTARY FL Notary Discount Anson, Co,
Si
Pr
M
* *** * * ** * ** *
pqY P;
tri,1
1'
RIESA J. -' • MtN c{ l
MY COMMISSI i1 t
•
SicifiXERffirEisy.tember 16, 2007
1.800-3 - NOTARY FL Notary Discount Assoc. Co.
7
* * * * * * * * * **
********************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
APPLICATION APPROVED BY:
chc 05/13/03
/ ' Plans Examiner
Engineer
Zoning
STATE OFFLORIDA
DEPARTMENT OF HEALT3.
ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM
CONSTRUCTION PERMIT •
ONSTRUCTION PERMIT FOR:
]New. System [ ]Existing System
X ]Repair [ ]Abandonment
PPLICANT: White, Marguerite
CENTRAX #: 13 -SG -26738
DATE PAID:
FEE PAID : 0
RECEIPT :
OSTDSNBR : 05 -3309- -R
[ ]Holding Tank [ ] Innovative Other
[ 'Temporary [ NA ]
AGENT: SR091112, Tuffy John
ROPERTY STREET ADDRESS: 1240 NE 97 St Miami Shores FL 33138
OT: 16 BLOCK: 4
SUBDIVISION: Farieton Shores
[Section /Township /Range /Parcel No.]
[OR TAX ID NUMBER]
ROPERTY ID #: 11 -3205- 009 -0590
YSTEM MUST BE CONSTRUCTED IN ACCORDANCE WITH SPECIFICATIONS AND STANDARDS OF CHAPTER 64E -6,FAC
) EPARTMENT APPROVAL OF SYSTEM DOES NOT GUARANTEE SATISFACTORY PERFORMANCE FOR ANY SPECIFIC TIME
'ERIOD. ANY CHANGE IN MATERIAL FACTS WHICH SERVED AS A BASIS FOR ISSUANCE OF THIS PERMIT,
;SQUIRE THE APPLICANT TO MODIFY THE PERMIT APPLICATION. SUCH MODIFICATIONS MAY RESULT IN THIS
'ERMIT BEING MADE NULL AND VOID. ISSUANCE OF THIS PERMIT DOES NOT EXEMPT THE APPLICANT FROM
:OMPLIANCE WITH OTHER FEDERAL, STATE OR LOCAL PERMITTING REQUIRED FOR PROPERTY DEVELOPMENT.
;YSTEM DESIGN AND SPECIFICATIONS
900 ] Gallons SEPTIC TANK MULTI- -CHAMBERED /IN SERIES: [ Y ]
0 ]Gallons MULTI- CHAMBERED /IN SERIES: [Y ]
0 ]GALLONS GREASE INTERCEPTOR CAPACITY
0 ]GALLONS DOSING TANK CAPACITY [ 0 ]GALLONS @ [0 ]DOSES PER 24 HRS # PUMPS[ 0
[ 225 ]SQUARE FEET PRIMARY DRAINFIELD SYSTEM
i [ 0 ]SQUARE FEET SYSTEM
k TYPE SYSTEM: [ N ]STANDARD [ N ]FILLED [ N ]MOUND [ N ]
CONFIGURATION: [ N ]TRENCH [ N ]BED [ N ]
LOCATION TO BENCHMARK:
C ELEVATION OF PROPOSED SYSTEM SITE [ 2.2 ] [ FEET ] [ BELOW1 BENCHMARK /REFERENCE POINT
BOTTOM OF DRAINFIELD TO BE [ 4.5 ] [ FEET ] [ below ]BENCHMARK /REFERENCE POINT
) FILL REQUIRED: [ 0.0 ]INCHES EXCAVATION REQUIRED: [ 30.0 ] INCHES
)THER REMARKS:
1.- Install 225 sf of drainfield in trench configuration.
2.- Existing 900 gal. septic tank , certified by " A Aaron Super Rooter ." to remain.
3.- Invert elevation of drainfield to be no less than 5.16' NGVD.
4.- Bottom of drainfield elevation to be no less than 4.66' NGVD.
THIS PERMIT IS NOT FOR " ADDITION".`
SPECIFICATIONS BY: Andre, Paul
APPROVED BY: Andre, Pau].
DATE ISSUED: 10/10/05
TITLE:
TITLE: Professional Engin Dade CHD
EXPIRATION DATE: 1/8/06
STATE OF FLORIDA P'
• ,DEPARTMENT OF HEALTH
APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PE M F-
Perml Application Numbs '
PART II - SITE PLAN
ale: Each -block represents 5 feet and 1 inch = 50 feet.
Al ke-dij-)
6
cotes:
ite. Plan submitted by: - 1« c,e ,r\ .G C...-4;'...-r-
Signature title
Ian roved J Not Approved Date
R
y.E County Health Department
ALL GES MUST BE APPROVED BY THE COUNTY HEALTH DEPARTMENT
Miami Shores Village
10050 NE 2nd Avenue
Phone: 305 - 795 -2204
Printed: 10 /17/2005
Plumbing Permit
Permit Number: PL2005 -306
Page 1 of 1
Applicant: MARGUERITE
Owner: WHITE
JOB ADDRESS: 1240 NE 97
Contractor A ARON SUPER ROOTER
Local Phone: 305 - 944 -8886
Parcel # 1132050090590
WHITE
MARGUERITE
ST
Contractor's Address: 6022 S.W. 35 CT.
Legal Description: 5 53 42 FARLETON SHORES PB 43 -80 W1/2 LOT 16 & LOT 17 BLK 4 LOT SIZE
Fees: Description Amount
FEE2005 -13566 Building Fee $175.00
FEE2005 -13567 CCF $1.80
FEE2005 -13568 Training and Education Fee $0.60
FEE2005 -13569 Technology Fee $4.40
FEE2005 -13570 Scanning Fee $3.00
FEE2005 -13571 Builders Bond $300.00
Total Fees: $484.80
Total Fees: $484.80
Total Receipts: $484.80
Permit Status: APPROVED Permit Expiration: 4/11/2006 Construction Value: $2,400.00
Work: INSTALL NEW DRAINFIELD
Signed:
(INSPECTOR)
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 responisibility for all work
done by either myself, my agent, servants or employes.
Signed: (Contractor or Builder) BY: