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PL-09-1668Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP- 126860 Scheduled Inspection Date: December 09, 2009 Inspector: Levrock, James Owner: CRUTCHFIELD, TIMOTHY Job Address: 69 NE 99 Street Miami Shores, FL 33138- Project: <NONE> Contractor: A AARON SUPER ROOTER Permit Number: PL -10 -09 -1668 Permit Type: Plumbing - Residential Inspection Type: Final Work Classification: Drainfield Phone Number Parcel Number 1132060131300 Phone: 305 - 944 -8886 Building Department Comments REPLACE DRAINFIELD &SEPTIC TANK TO REMAIN Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Comments ROVAL IN FILE December 08, 2009 For Inspections please call: (305)762 -4949 Page 6 of 18 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 QC[ C 10119 BY: ./<.--) Permit No. 1-1,CP-666 Master Permit No. Permit Type: Plumbing Owner's Name (Fee Simple Titleholder) ) (Y\0f t' &kJ *(;k acC9 # Owner's Address N E �� fit City PA k —.e S State FL. Tenant/Lessee Name E -MAIL: Job Address (where the work is being done) City Miami Shores Village Zip 3 "31'38 Phone # 6q NE 9 1(i FOLIO / PARCEL # County Miami -Dade zip 33138 Is Building Historically Designated YES NO L7 Contractor's Company Name ,,pt r‘) ee Phone # 3 q Contractor's Address LZ,, . cs1. J C �-^ City M! fQ� n'•Ci ✓ State T1, Zip 330 2- 3 Qualifier Name JQ I - Phone # State Certificate or Registration No. Certificate of Competency No. E -MAIL: Phone # Architect /Engineer's Name (if applicable) Value of Work For this Permit $ 2 JOo Square / Linear Footage Of Work: Type of Work: ❑Addition ['Alteration [New ..N• Repair /Replace ❑ Demolition Describe Work: XWXXY. *xxxr.x *xr.xr.x * * *xxxxxxxxxxxxxxxFees* ***** xxxx, cxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx Submittal Fee $ Permit Fee $ Notary $ "—' Training /Education Fee $ Scanning $ 300 Radon $ Bond $ OD4- Structural Review. $ I1S •00 CCF $ I .D 0' (oO Technology Fee $ CO /CC 4•s1 DPBR $ Zoning $ Code Enforcement $ Double Fee $ Total Fee Now Due $ See Reverse side '- NT O9PAID 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. 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." Zip 1 v Notice to Applicant: As a condition to the issuance of a building permit with an estimated value excee promise in good faith that a copy of the notice of commencement and construction lien law broch whose property is subject to attachment. Also, a certified copy of the recorded notice of commenc e for the first inspection which occurs seven (7) days after the building permit is issued. In the inspection will not be approved and a reinspection fee will be charged ur wi ent •b Signature wner or Agent The foregoing instrument was acknowledged before me thisl day of OC.t , 20'01 , by 1 r-o*kr C t�hr) -e who is personally known to me or who has produced DTA L. (Q/\.J( As identification and who did take an oath. NOTARY PUBLIC: ?MIS . •■••• ±•lgnaw.uan........osuu.0 I• i A J. SOLOMON Signature $2.500, the applicant must be delivered to the person must be posted at the job site nee of such posted notice, the Contractor The foregoing instrument was acknowledged before me this'`r day of C t- , 20 N'1, by 03'VA t (ll who is personally known to me or who has produced b v L. ''S'` as identification and who did take an oath. NOTARY PUBLIC:.,,,,.,,. °TERESA J ,. . a \ \ \ \I19?f,f, Pr My Commission Expires: " ...... ....., acarwxwarwx,etcictric*WwWWW*******il APPLICATION APPROVED B (Revised 02/08/06) xr. xxr. rxxrxxx # rxrx, r rxxr rMy Commission Expires: / 6T/ Plans Examiner Engineer Zoning DIVISION OP ronmental Health Florida Department of Health Miami -Dade County Health Department OSTDS/Well Division ling►26 St' = Wind, FL33175 Inspector? :^ a_ `r Date Addles s°� / mr'f ?',.� f OSIDS # iao% Comments;r'' CIVIS1011 or EnvIron t manlai Hi Florida Department of Heath Miami-Dade K =a Health Department OSTDS ptie Tank Division .4,:t 7769 NW 411° St Sole 175 Mai. FL 33166 Dare J -e PERMIT #: 13-SC-1004539 APPLICATION #:AP937983 STATE OF FLORIDA DEPARTMENT OF HEALTH DATE PAID: ONSITE SEWAGE TREATMENT AND DISPOSAL FEE PAID* SYSTEM RECEIPT #' DOCUMENT #: PR787132 9 4 CONSTRUCTION PERMIT FOR: OSTDS Repair APPLICANT: Tomothy Crutchfield PROPERTY ADDRESS: 69 NE 99 St Miami, FL 33138 LOT: 19 -21 BLOCK: 9 SUBDIVISION: PROPERTY ID #: 11- 3206 -013 -1300 [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 [ 900 ] GALLONS / GPD Septic Tank CAPACITY A [ 0 ] GALLONS / GPD CAPACITY N [ 0 ] GALLONS GREASE INTERCEPTOR CAPAC ?TY [MAXIMUM CAPACITY SINGLE TANK:1250 GALLONS] K [ ] GALLONS DOSING TANK CAPACITY [ ]GALLONS @[ ]DOSES PER 24 HRS #Pumps [ D [ 300 ] SQUARE FEET Trench confiauration SYSTEM R [ 0 ] SQUARE FEET SYSTEM A TYPE SYSTEM: [X] STANDARD [ ] FILLED [ ] MOUND [ ] I CONFIGURATION: [x] TRENCH [ ] BED [ 3 N F LOCATION OF BENCHMARK: ' FFE 13.13' NGVD I Ei._VATION OF PROPOSED SYSTEM SITE [ 27.90 ] [I INCHES I' FT ] [ ABOVE A BELOW U BENCHMARK /REFERENCE POINT E BOTTOM OF DRAINFIELD TO BE [ 51.90 ] [I INCHES I/ FT ] [ ABOVE /I BELOW Ii BENCHMARK /REFERENCE POINT L D FILL REQUIRED: [ 0.00 ] INCHES EXCAVATION REQUIRED: [ 36.00 ] INCHES O 1.- Existing 900 gal. septic tank to remain. 2.- Install 300 sf of drainfield in TRENCH configuration. T 3. -Invert elevation of drainfield to be no less than 7.80 ft NGVD. H 6. -Bottom of drainfield elevation to be no less than 7.30 ft NGVD. THIS PERMIT IS NOT FOR " ADDITION(s) ".INSPECTOR TO VERIFY MIN 2' SET BACK. E R SPECIFICATIONS BY: APPROVED BY: DATE ISSUED: Gerara L Phi ire TITLE: gineer Specialist II Dade CHn EXPIRATION DATE: 01/06/2010 DH 4016, 10/97 (Pr ions Editions May Be Used) Page 1 of 3 V 1. .4 • AP937983 8E798083 STATE OF FLORIDA DEPARTMENT OF HEALTH APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PERMIT etVok.Sc1441V6 Permit Application Number PART II- SITE PLAN Scale: Each block represents 5 feet and 1 inch = 50 feet. J.33J, f 71-*4 _rff 4 +-4-4 „,2 1` -t1-,TITT-17 • +- ' I ; MEN , 1---1--`- * ,` 4,0" I , ' ; • 1-1 1-''-': ' .. ..-,,,,,,4,-,-,■,-,,,,,t,-,,,,--1,-,,,---4-,,,,,,,,,,,,,,,,,,,,. , . , . , I j. - , .. • -'4.--- .Y. r -,,. 4-4.-1 i--T-1.--i ----4-1.---t- I " 1 , .. - . • ,• , : • . i , .., i • .,. : 3 ; . ,, sum ,;;;_..,!3_4_4„ 4__■...4.,4_4,4, MJNIMII i . . ''. i I MI -'-- i - i . ' 1 ) •-t. - - i-i- Site Plan submitted by: DIan Approved 3y 10 ce, 1,) 300 Signature Not Approved c_tn 1-.)100 12-1 Gh(cs fee. vo 01 Title Date County Health Department ALL CHANGES MUST BE APPROVED BY THE COUNTY HEALTH DEPARTMENT H 4015, 10/96 (Replaces HRS-H Fomi 4015 which may be used) tocit Number: 5744-0M-4015A Page 2 of 3