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PL-09-577Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 (Inspection Number: INSP - 110911 Permit Number: PL -4 -09 -577 Scheduled Inspection Date: April 16, 2009 Inspector: Levrock, James Owner: O'HARE, FRANK Job Address: 1158 NE 99 Street Miami Shores, FL 33138- Project: <NONE> Contractor: LASSETER PLUMBING CO INC Permit Type: Plumbing - Residential Inspection Type: Final Work Classification: Addition /Alteration Phone Number Upossio. Parcel Number 1132050180130 Phone: 305 -893 -7180 Building Department Comments Passed Failed Ins `• =for Comments gre- tag in file Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. ..ISIS.. Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 BUILDING PERMIT APPLICATIatECENED FBC 2004 Permit Type: Plumbing Owner's Name (Fee Simple Titleholder Owner's Address //ST 2 E. City '/yl /04 %flf' S )/2t"J State Tenant/Lessee Name F04/4 0///9 99 Permit No. FL9,11 Master Permit No. Phone # 737— Zip _3 /3 of Phone # E- MAIL: --- > c Job Address (where the work is being done) it -S7 22. e. • ` -7T City Miami Shores Village County Miami -Dade Zip 33/3? FOLIO / PARCEL # Is Building Historically Designated YES NO Contractor's Company Name .1.—/-453 CT2/t- P/_ UI 2' /`t" 6 Contractor's Address �‘,S.— `i /L - ,/ 3) ' .. Phone # 36,3-493-7/2 City 2/. ,1 //9J) /L/ / t ,, J State FL - Zip 33/6 / Qualifier Name J J / /22, , %j�� L//6n, L 7 ,J( r!� Phone # ���.� 'J / 3' 7/J State Certificate or Registration No. -/ t C) Certificate of Competency No. E -MAIL: Architect/Engineer's Name (if applicable) Value of Work For this Permit $ Phone # 4' 760" i Square / Linear Footage Of Work: 4r€ Type of Work: DAddition ❑Alteration ❑New E--Repair/Replace ❑ Demolition Describe Work: 4 2 �if 'e't2 i 2-- [ �^ �r1'?2 -C'-�- o; c / 1� Z OO x�Yxxx kaYx�r oYxxxxxxxx ********:*.**.******Fee Submittal Fee $ .A Permit Fee $ Notary $ Scanning $ Bond $ Training /Education Fee $ Radon $ Structural Review. $ xxx xxxxxxx xxxxxxxxxxxxxrxx xxxxxxxxxxxxxxxrx CCF $ ©•(Qo CO /CC Technology Fee $ 4 Y3 Zoning $ DPBR $ Code Enforcement $ Double Fee $ Total Fee Now Due $ 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 willv_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 properly 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 absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. F Owner or Agent The foregoing instrument was acknowledged before me this day of ( t ,204yby zL� 0 o who is rsonally kno to me or who has produced Contractor The foregoing instrument was acknowledged before me this , day of ! 1... , 20 G'/, bySiZi`t/t) p, L J47- As identification and who did take an oath. NOTARY PUBLIC: Sign: C #k My Commission Expires: who is . to me or who has produced ersonally know as identification and who did take an oath. NOTARY PUBLIC: CHRISTINA PORRAS DD 391258 EXPIRES: May 30, 2009 nded Thru Notary Public Underwriters x xxxxxxwww*****xxxxxxxxxxxxxxxxx APPLICATION APPROVED (Revised 02/08/06) Commission Ex xrxxxxxxxxxxxxx xxxxxxxxxxxxxxrxx Plans Examiner Engineer Zoning DIVISION OF Environmental .Health Florida Department of Heath Miami -Dade County Health Department OSTDS /Septic Tank Division 7769 NW 48th St. Suite 175 Miami FL 33166 InspectorT Se i\ 1 1 Vre r� 2 t% Date 4/14/09 Address F I -S C- 7 I I 8 N E �t S /' J� � � � osTDS # 3 �i 7g' 75- ire 92S t Comments: STATE OF FLORIDA PERMIT NO DEPARTMENT OF HEALTH DATE PAID. ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM FEE PAID CONSTRUCTION INSPECTION AND FINAL APPROVAL RECEIPT #: APPLICANT: AGENT: PROPERTY ADDRESS: LOT: BLOCK SUBDIVISION: PROPERTY ID #: CHECKED [X] ITEMS ARE NOT IN COMPLIANCE WITH STATUTE OR RULE AND MUST BE CORRECTED. TANK INSTALLATION SETBACKS [01] TANK SIZE [1] - [2] [02] TANK MATERIAL [03] OUTLET DEVICE [04] MULTI - CHAMBERED [Y / N 1 [05] OUTLET FILTER [06] LEGEND [07] WATERTIGHT [08] LEVEL [09] DEPTH TO LID DRAINFIELD INSTALLATION [10] AREA [1] [2] SQFT [11] DISTRIBUTION BOX HEADER [12] NUMBER OF DRAINLINES [13] DRAINLINE SEPARATION [14] DRAINLINE SLOPE [15] DEPTH OF COVER [16] ELEVATION [ABOVE /BELOW] BM [17] SYSTEM LOCATION [18] DOSING PUMPS [19] AGGREGATE SIZE [20] AGGREGATE EXCESSIVE FINES [21] AGGREGATE DEPTH FILL / EXCAVATION MATERIAL [22] FILL AMOUNT [23] FILL TEXTURE [24] EXCAVATION DEPTH [25] AREA REPLACED [26] REPLACEMENT MATERIAL EXPLANATION OF VIOLATIONS / REMARKS: [27] SURFACE WATER FT [28] DITCHES FT [29] PRIVATE WELLS FT [30] PUBLIC WELLS FT [31] IRRIGATION WELLS FT [32] POTABLE WATER LINES - FT [33] BUILDING FOUNDATION FT [34] PROPERTY LINES FT [35] OTHER FT FILLED / MOUND SYSTEM [36] DRAINFIELD COVER [37] SHOULDERS [38] SLOPES [39] STABILIZATION ADDITIONAL INFORMATION [40] UNOBSTRUCTED AREA [41] STORMWATER RUNOFF [42] ALARMS [43] MAINTENANCE AGREEMENT [44] BUILDING AREA [45] LOCATION CONFORMS WITH SITE PLAN [46] FINAL SITE GRADING [47] CONTRACTOR [48] OTHER ABANDONMENT [49] TANK PUMPED [50] TANK CRUSHED & FILLED CONSTRUCTION [APPROVED /DISAPPROVED• FINAL SYSTEM [APPROVED/DISAPPROVED]. DH 4016 (Page 2), 10/97 (Previous Editions May Be Used) Stock Number: 5744 - 002 - 4016 -4 CHD DATE: CHD DATE: PT 1: Applicant PT 2: Installer /Contractor PT 3: Building Department PT 4: Health Department Page 2 of 3 PERMIT NUMBER: Permit tracking number assigned by CHD. APPLICANT: Property owners full name. AGENT: Property owner's legally authorized representative. MAILING ADDRESS: P.O. box or street mailing address for applicant or agent. LOT, BLOCK, SUBDIVISION Lot, Block and Subdivision for lot or PROPERTY ID #: 27 character number for property. (property appraiser ID # or GIS location) COUNTY HEALTH DEPARTMENT CHECKS [X] ITEMS NOT IN COMPLIANCE WITH CONSTRUCTION PERMIT AND STATUTE OR RULE. INFORMATION IS COMPLETED BY CHD ON FOLLOWING ITEMS: TANK SIZE (gallons) AS BUILT INSTALLATION SKETCH TANK MATERIAL (concrete, fiberglass, etc) OUTLET FILTER (manufacturer, make, model) LEGEND (manufacturer code) DRAINFIELD AREA (square feet) DISTRIBUTION BOX / HEADER (check box) NUMBER OF DRAINLINES (number installed) SYSTEM ELEVATION (in relation to BM) DOSING PUMPS (number installed) SETBACKS (record actual setbacks in ft) SETBACKS OTHER (as required) STABILIZATION (date stabilized) CONTRACTOR (contractor installing system) ADDITIONAL INFORMATION (as required) ABANDONMENT TANK PUMPED (date) TANK CRUSHED AND FILLED (date) EXPLANATION OF VIOLATIONS: Record item number, explanation of violation, and required CONSTRUCTION APPROVAL: Circle approved or disapproved, CHD signature and date. FINAL APPROVAL: Circle approved or disapproved. CHD signature and date of approval. Final approval shall not be granted until the CHD has confirmed that building construction and lot grading are in substantial compliance with plans and specifications submitted with the permit application. ELEVATION WORKSHEET ELEVATION OF BENCHMARK OR REFERENCE POINT: EXISTING GROUND TOP OF AGGREGATE [ +] SHOT H.I. H.I. _ H.I. H.I. [ -] SHOT [ -] SHOT [ -] SHOT ELEVATION 0