PL-07-939Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Date: 07/13/2007
Inspector: Levrock, James
Owner: WILETS, JAMES DANIEL
Job Address: 1160 100 Street NE
Miami Shores Village, FL
Project: <NONE>
Contractor: ALL PRO - SEPTIC & SEWER INC
Permit Type: Plumbing - Residential
Inspection Type: Final
Work Classification: Septic
Phone Number (305)754 -4322
Parcel Number 1132050190410
At 16 MP
Block: Lot:
Phone: (305)635 -3002
Building Department Comments
REPLACE EXISTING TANK AND DRAINFIELD
Passed
Inspector Comments
drainfield ok
Failed
Correction
Needed
Re- Inspection
Fee
($75)
No Additional Inspections can be scheduled
re- inspection fee is paid.
until
Monday, July 16, 2007
Page 1 of 2
MIAMI SHORES VILLAGE
BUILDING DEPARTMENT
305 - 795 -2204
Building Inspection Request
Date 11 II 6
Type Insp'n ri 7)fEtt
Permit No. 1?t, - (ni
Name
Address
Company
Phone #
Urge
Inspection Date
Approved
Correction
Re- Insp'n Fee
Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
BUILDING ��I�`^
PERMIT APPLICATION \IC4C61
FBC 2004
Permit Type: Plumbing
MAY 0 8 2007
Permit No. P[ 07-415/
Master Permit No.
Owner's Name (Fee Simple Titleholder) �.F} -rn t5 Lj'J 1 LT5 Phone # 7 j2--ZJ
'
I «& s i3€_ 100+e. 5 n�i i a w,=t 5h(x- s) P--. 3 /3
City %((44h Slaves State rt.. Zip 3 313
Owner's Address
Tenant/Lessee Name S Act-•IL Phone #
E -MAIL:
1,u i 1.ef-s jQ is law, no ✓a. edu
Job Address (where the work is being done)
City Miami Shores Village County Miami -Dade
FOLIO / PARCEL# h 5 - O\°I -of Io
zip 3- 13$
L ®}— 5 81k. i')8'
Is Building Historically Designated YES
Contractor's Company Name
Contractor's Address g-90
City K'-
NO bL
- E–.1C- Phone #
tor-
State
3(35 -- G 3s -30
Zip 37 c{
Qualifier Name 16 A-0.4 ,-4_11 t Phone 9Z.) a i Lt - a. S
State Certificate or Regi ation No. 1A-01T (3 7 Certificate of Competency No.
E -MAIL: PAA.V1119 5S CO 5 t 1412-4–
Architect /Engineer's Name (if applicable) �}
Value of Work For this Permit $
Type of Work:
Describe Work:
loo .
Phone # L) /'\'
Square / Linear Footage Of Work:
Addition ❑Alteration ['New Repair /Replace ❑ Demolition
41:1c04_ iub 443
* * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
Submittal Fee $ Permit Fee $
Notary $ 5- Training /Education Fee $
Scanning $ 1'OO Radon $
Bond 5 Code Enforcement $
* * * ** Fees * * * * ** * * * * * * * * * * * * * *x * * *xwwwww w *xw www * * * **
3 5 `. CCF $ 4Q CO /CC
Technology Fee $ nO+
DPBR $ Zoning $
Double Fee $
Structural Review. $ Total Fee Now Due $ 5 10-40
See Reverse side
NAY 0
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 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.
Sign
Contractor
The foregoing instrument was acknowledged before me this 2 0 The foregoing instrument was ackno [edged before me this a
day of +t 20 by 3 w day of , 20a, by S[' ,1I4_
who is personally known to me or who has produced
�� 1.-)e As identification and who did take an oath.
NOTARY PUBLIC:
Sign.
Print: t,
4 °`P3 DMA TEIXEIRA
My Commission Expires: * �Y j * MYCOMMISSIO #DD241470 My Commission Expi
EXPIRES: A ust 13 2007
0,, ll'oi d'fi1iniEtf l ryter s*************************** * * * * * * * * * * * * * * * * * * * * * * * * ** * * * **
who is personally known to me or who has produced
r P%'N7✓)1k, as identification and who did take an oath.
NOTARY PUBLIC:
* * * * * * * * * * * * * * * * * * * * * * * **
0
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
CONSTRUCTION PERMIT FOR:
[ ]New System [ ]Existing System [
[ X ]Repair [ ]Abandonment
CENTRAX #: 13 -SG -32919
DATE PAID:
FEE PAID : $
RECEIPT
OSTDSNBR : 07 -01452 -R
]Holding Tank [ ] Innovative Other
]Temporary [ NA ]
APPLICANT: Wilets, James Daniel AGENT: ALL PRO S, TEIXEIRA BARRY
PROPERTY STREET ADDRESS: 1160 NE 100 St Miami Shores FL 33138
LOT: 5
BLOCK: 178 SUBDIVISION: Miami Shores Sec
[Section /Township /Range /Parcel No.]
PROPERTY ID #: 11- 3205 - 019 -0410 [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 [ 1050 ]Gallons SEPTIC TANK MULTI - CHAMBERED /IN SERIES: [Y ]
A [ 0 ]Gallons MULTI - CHAMBERED /IN SERIES: [Y ]
N [ 0 ]GALLONS GREASE INTERCEPTOR CAPACITY
K [ 0 ]GALLONS DOSING TANK CAPACITY [ 0 ]GALLONS @ [0 ]DOSES PER 24 HRS # PUMPS[ 0 ]
D [ 300 ]SQUARE FEET PRIMARY DRAINFIELD SYSTEM
R [ 0 ]SQUARE FEET SYSTEM
A TYPE SYSTEM: [ Y ]STANDARD [ N ]FILLED
I CONFIGURATION: [ N ]TRENCH [ Y ]BED
N
F LOCATION TO BENCHMARK: FFE: 9.7' NGVD
[ N ]MOUND [ N ]
[ N
I ELEVATION OF PROPOSED SYSTEM SITE [
E BOTTOM OF DRAINFIELD TO BE
L
25.2 ] [ INCHES
55.2 ] [ INCHES
D FILL REQUIRED: [ 0.0 ]INCHES EXCAVATION REQUIRED:
OTHER REMARKS:
] [ BELOW] BENCHMARK /REFERENCE POINT
] [ BELOW BENCHMARK /REFERENCE POINT
[ 50.0 ] INCHES
1.- Install 1050 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 300 sf of drainfield in bed configuration.
4.- Install 12" of slightly limited soil at the bottom of drainfield.
5.- Perimeter of excavation area shall be at least 2 ft. wider and longer than the proposed
absorption bed.
6- Invert elevation of drainfield to be no less than 4.93' NGVD.
7.- Bottom of drainfield elevation to be no less than 4.43' NGVD. DEpAZO
weg C
SPECIFICATIONS BY:EDWARDS, ASTRID
TITLE: - g. 1
APPROVED BY: Edwards, Astrid m (v TITLE: Dade CHD
DATE ISSUED: 5/7/07 EXPIRATION DATE: 8/5/07
DH 4016, 03/97 (Obsoletes previous editions which may not be used)
(Stock Number: 5744 - 001 - 4016 -0) [ostds_ cons _4016 -1]
Page 1 of 2
Scale:
STATE OF FLORIDA
DEPARTMENT OF HEALTH
APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PERM
Permit Application Nurnber U
PART II SITE PLAN
Each block represents 5 feet and 'I inch = 50 feet. ILO 00 514t7teC' Fl- 8'
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Notes:
Site Plan submitted by:
Plan Approved
ett,0
L
By
Signature
Not Approved
Title
Date -
County Health Department
ALL CHANGES MUST BE APPROVED BY THE COUNTY HEALTH DEPARTMENT
DH 4015. 10196 (Replaces HRS-H Form 4015 which may be used)
(Stock Number: 5744-002-4015-5)
Page 2 of 3