PL-06-1090Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795-2204 Fax: (305)756-8972
JAN 1 2 2007
Inspection Date: 01/10/2007
Inspector: Levrack, James
Owner: ROSEN, NEIL & ELIZABETH
Job Address: 444 96 Street NE
Miami Shores Village, FL 33138-
Project: <NONE>
Block:
Contractor: STATEWIDE SEPTIC CONNECTIONS
Permit Type: Plumbing - Residential
Inspection Type: Final Building
Work Classification: Septic
Phone Number 305-576-5900
Parcel Number 1132060140580
Lot:
Phone: 305-661-6633
Building Department Comments
INSTALL NEW 1350 TANK AND
INSTALL NEW643 DRAINFIELD
DRAINFIELD
ABANDON SEPTIC TANKS 2
225 TANK
AND NEW200
31
q i46 g
0 i
e
Passed
In - •e i; ■
Comments
Failed
Correction
Needed
Re-Inspection
Fee
($75)
No Additional Inspections can be scheduled
re-inspection fee is paid .
until
Wednesday, January 10, 2007
Page 1 of 1
id4 7; `.t .: 1 t't}i'wa`Y"P: £� 611: }:3.1 t ... �.;'�. i. {.zt ".. P3'C3W T'
STATE OF FLORIDA ' PERMIT NO.E'i =°~ /,
DEPARTMENT OF HEALTH v.x5 14, DATE PAID- T �.._..
ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM. FEE PAID
CONSTRUCTIONIMP'EffiCl ' AI1i 'I I` `E 'APPROVAL,''' ''' RECEIPt
APPLICANT: .Yrr!`.!
AGENT
PROPERTY•ADDRESS:
LOTS Y BLOCKS 3 SU]l]_t to
•
CHECKED [X] ITEMS . ARE
NOT IN COMPLIANCE WITH
PERTY
STATUTE OR RULE AND MUST BE COR -;: •
RECTED
TANK INSTALLATION
[01] TANK SIZE [1]/ 3 SO [2]
[02] TANK MATERIAL
lr�
[03] OUTLET DEVICE
[04] MULTI- OHAItABERED 1'N ]
[05] OUTLET FILTER
[06] LEGEND
[07] WATERTIGHT
[08] LEVEL - - >
[09] DEPTH TO LID f' 4
DRAINFIELD INSTALLATION /
[' ] [10] AREA [1] [2] 5 SOFT
[ 1 [11] DISTRIBUTION BOX HEADER
[ 1 [12] NUMBER OF DRAINLINES
i ] [13] DRAINLINE SEPARATIONJ''.
[ 1 [14] DRAINLINE SLOPE
[ ` ] [15] DEPTH OF COVER /
I l [16] ELEVATION [APO
[ ; ] [17] . SYSTEM LOCATION
[ ] [18] DOSING PUMPS
[ ] [19] AGGREGATE SIZE'-a7 C/
[ ] [20r AGGREGATEEXO SSIVt't-INhS'
[ 1 [21] AGGREGATE DEPTH, ',
ftii I � .`�'�cail
FILL / EXCAVATION MATERIAL
[ ] • [22] FILL AMOU bf i
[ ] [23] FILL TEXTURE
' X24 ICY E�H1t:'.�tiq:ae
F;t i sa�c,� 5 �t� -tk`a �k5'i - n '4��r`:z'sa 4t.t t`° -f
l[ ] [26] REPLACEMENT MATERIAL
EXPLANATION OP VIOLATIONS: /: REMAIjIf
[
[ l
[ l'
[ ]
opo
[ 1
[ 1
is / .at 6 y tr Frey E
SETBACKS
[27] SURFACE WATER
[28] DITCI-IE a s .:.
[29] PRIVATE WELLS FT
3RUBLIO'E11 L5'
[31] IRRIGATION WELLS
[32] ,r'1nPoIABI EWA'I'i
[33] „6UI ,DIN.Ca FOLI(IDA..
[34] PROPERTY LINES
[35] OTHER:
FILLEQ• pup 13YST11A $, :;-
[36] DRAINFIELD COVER
[37] SHOU.L[ 2 a ,)
[38] SLOPES
[39] STABiI [A91 lip! •
ADDITI6NALI*614nA tiX `''3;
[40] UNOBSTRUGTERABJ
[41] I{%M� AI'ti 13UNFF
1421 Yc { 4SxJ i >44A 3b Yom,r ti?Si.
[43] MAINTENANCE AGREEMENT
[44] B[aIt3J,Ne ..E MIA t t f-; M'1,'
[45] LOCATION CONFORMS WITH SITE PLAN
446I9 FINAL• I Eg GI AC 7'i
[47] CONTRACTOR
OTHER
/DISAPPROVED].
DH 4016 (Page 2), 10/97 (Previous Editions May Be Used)
Stock Number. 5744- 002 - 4016 -4
PT 1: Applicant
PT 2: iiistalter /Contractor
PT 3:, Building Department
PT 4: Health Department
Miami Shores Village
s e Building Department
10050 N.E.2nd Avenue, Mi
4_ 10(0 3:.s5 ens Tel: (305) 795.2204
ami Shores, Florida 33138
Fag: (305) 756.8972
BUILDING I MC�TOVM
PERMIT APPLICATION app 2 7 TOO
FBC 2001
Permit No. i.Q
aster Permit No.
BYa���'
Permit Type (circle): Building Electrical
Mechanical ,Roofing
Owner's Name (Fee Simple Titleholder) NEIL & ELIZABETH ROSEN Phone # 305 - 776- 1414/305- 576 -5900
Owner's Address 4554 NAUTILUS DR
City MIAMI BEACH State FL Zip 33140
Tenant/Lessee Name Phone #
Job Address (where the work is being done) 444 N .E 96 STREET
City Miami Shores Village
Is Building Historically Designated YES
_ County Miami -Dade
NO o/
roc•
Contractor's Company Name STa4't ev4 tDe. S Pik r�.1,45,3'(1 Phone #
Contractor's Address 5540 S„ ; Ito AN
Zip 33138
(acs) Get- 66 33
City M q a.�Qrtdi Aft,
Qualifier
State
Zip3 °Z
State Certificate or Registration No. 5Pk091 Certificate of Competency No.
Architect/Engineer's Name (if applicable) t4A Phone #
$ Value of Work For this Permit ' `20—
Type of Work: ['Addition
Describe Work:
Square Footage Of Work: Sej ► eIQ NAII
['Alteration ['New 2/Repair/Replace
hitAj 1S0 n k. t 2Z S fin x,
[' Demalitgn
kek 1.1k 14-6.4 (o 4--5 foyyfle a d N,e%n► 2.00 d {q) i-e4
********************* * * * ** **Fees** ** * * *** * * * * ** * **
Submittal Fee $ Permit Fee $ °
Notary $ - C Training/Education Fee $ CD
Scanning $ —O Radon $ Zoning
Code Enforcement $ Structural Plan Review. $
Total Fee Now Due $ - t 6
(Continued on opposite side)
* * * * * **
CCF $ i O CO /CC.
Technology Fee $
Bond $ CC)
APR 2 7 PA,D
-IL
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 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 certed copy of the recorded notice of commencement must be posted at the job site
for the first inspection ;hich oc _ . rs even -) days after the building permit is issued In the absence of such posted notice, the
inspection will no pr. ved %nd re:: ~ ection fee will be charged.
Owner or Agent
The foregoing instrument was acknowledged before me this 0
day ofocteP, ,20(25_,by Ne/ L e'OSew
who is(personally known to mor who has produced
NOTARY PUBLIC:
As identifi ation and who did take an oath.
Signature
4 c)Q.C14'.0..
Contractor
The foregoing instrument was acknowledged before me this 2:7
day of t , 2006 , by Teresa SoN So/ e
who is personally known to me or who has produced
as identification and who did take an oath.
DT.I?UC -STATE OF (iRIDA
rimy H dez
NOTARY P
Sign
Prin
My
My Commission Expires:
T • • • @Oa` nded Thru
6 ' ' "��3 A�nyc Bonding Co., Inc.
**** * * * * * * * * * * * * ***** ** ** * * * * ** * * * * * * ** * * * * * *** * **
APPLICATION APPROVED BY:
chc 05/13/03
*, * * * * * * * * * * **
ssion Expire
******* * * * * * * *9 * * * * * * * * * * * * * * * * * * * * * **
* * * * * * * * * * * * * * * * * * * * * ** * * * * * ,4 * * * * * * * * * * * * * * * * * * * * * * **
Plans Examiner
Engineer
Zoning
Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Date: 06/19/2006
Inspector: Levrack, James
Owner: ROSEN, NEIL & ELIZABETH
Job Address: 444 96 Street NE
Miami Shores Village, FL 33138-
Project: <NONE>
Block:
Contractor: STATEWIDE SEPTIC CONNECTIONS
Permit Type: Plumbing - Residential
Inspection Type: Final
Work Classification: Septic
Phone Number 305 - 576 -5900
Parcel Number 1132060140580
Lot:
Phone: 305 -661 -6633
Building Department Comments
6de. i 136
Passed
nspector Comments
(IV-I
i
Failed
Correction
Needed
Re- Inspection
Fee
($75)
No Additional Inspections can be scheduled
re- inspection fee is paid .
until
Friday, June 16, 2006
Page 1 of 2
STATE OF FLORIDA
DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM
CONSTRUCTION PERMIT
CENTRAX #: 13 -SG -27312
DATE PAID:
FEE PAID : $
RECEIPT .
OSTDSNBR : 05 -3849- -N
CONSTRUCTION PERMIT FOR:
[ X ]New System [ ]Existing System [ ]Holding Tank [ ] Innovative Other
[ ]Repair [ ]Abandonment [ ]Temporary [ NA ]
APPLICANT: 444 Ne 96 St Llc AGENT: SA0021074, Solomon Teresa
PROPERTY STREET ADDRESS: 444 NE 96 St Miami Shores FL 33138
LOT: 4 BLOCK: 53 SUBDIVISION: Miami Shores Sec 2
[Section /Township /Range /Parcel No.]
PROPERTY ID #: 11- 3206 - 014 -0580 [OR TAX ID NUMBER]
SYSTEM MUST BE CONSTRUCTED IN ACCORDANCE WITH SPECIFICATIONS AND STANDARDS OF CHAPTER 64E -6,FAC
DEPARTMENT APPROVAL OF SYSTEM DOES NOT GUARANTEE SATISFACTORY PERFORMANCE FOR ANY SPECIFIC TIME
PERIOD. 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 PROPERTY DEVELOPMENT.
SYSTEM DESIGN AND SPECIFICATIONS
T [ 1350 1 Gallons SEPTIC TANK
A [ 225 ] Gallons LAUNDRY CAPACITY MULTI- CHAMBERED /IN SERIES: [Y ]
N [ 0 ]GALLONS GREASE INTERCEPTOR CAPACITY
K [ 0 ]GALLONS DOSING TANK CAPACITY [ 0 ]GALLONS Q [0 ]DOSES PER 24 HRS # PUMPS[ 0 ]
MULTI- CHAMBERED /IN SERIES: [Y ]
D [ 643 ]SQUARE FEET PRIMARY DRAINFIELD SYSTEM
R [ 200 ]SQUARE FEET LAUNDRY CAPACITY SYSTEM
A TYPE SYSTEM: [ Y ]STANDARD [ N ]FILLED [ N ]MOUND [ N ]
I CONFIGURATION: [ N ]TRENCH [ Y ]BED [ N ]
N
F LOCATION TO BENCHMARK: Top of Bottom Floor EL: 10.78' NGVD
I ELEVATION OF PROPOSED SYSTEM SITE [ 22.2 ] [ INCHES ] [ BELOW] BENCHMARK /REFERENCE POINT
E BOTTOM OF DRAINFIELD TO BE [ 52.2 ] [ INCHES ] [ BELOW]BENCHMARK /REFERENCE POINT
L
D FILL REQUIRED: [ 0.0 ]INCHES EXCAVATION REQUIRED: [ 72.0 ] INCHES
OTHER REMARKS:
1 - Install 1350 gal. category -3 septic tank equipped with an approved filter.
2 -The licensed contractor installing the system is responsible for installing the minimum
category of tank in accordance with sec. 64E- 6.013(3)(f), FAC.
3 - Install 643 sf of drainfield in bed configuration.
4 - Install 42n of slightly limited soil under the bottom of drainfield.
5 - Perimeter of excavation area shall be at least 2 ft. wider and longer than the proposed
absortion bed.
6 - Invert elevation of drainfield to be no less than 6.93' NGVD.
7 - Bottom of drainfield elevation to be no less than 6.43' NGVD.
8 - Install 225 gal laundry waste interceptor and 200 sf of drainfield in bed configuration.
9 - Concrete shall not be over system.
SPECIFICATIONS BY: Heybeck, N cholas TITLE:
APPROVED BY: Heyback, Nick -�// TITLE: Engineer I Dade CHD
DATE ISSUED: 3/27/06 EXPIRATION DATE: 9/27/07
DH 4016, 03/97 (Obsoletes previous editions which may not be used)
(Stock Number: 5744- 001 - 4016 -0) [ostds_cons_4016 -17
Page 1 of 2
TO: City of Miami Shores
DATE: May 10, 2006
RE: Sidewalk and curb damage at 444 NE 96 Street
To Whom It May Concern:
Attached are photos showing long standing sidewalk and curb damage existing in front of
444 NE 96 Street. We will be installing a new septic tank this week and are providing
this documentation to show this damage as pre - existing to our project.
By
For a s e City of Miami Shores
By
For William Peacock Design LLC
L( 9Cc
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