PL-08-1916Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795-2204 Fax: (305)756-8972
Inspection Date: 11/18/2008
Inspector: Levrock, James
Owner: DUFFY, PATRICK
Job Address: 1222 99 Street NE
0 2 0 2000
Miami Shores Village, FL
Project: <NONE>
Block:
Contractor: MR C'S PLUMBING SEPTIC INC
Permit Type: Plumbing - Residential
Inspection Type: Final
Work Classification: Drainfield
Phone Number
Parcel Number 1132050090190
Lot:
Phone: (305)651-7859
Building Department Comments
Monday, November 17, 2008
Page 2 of 2
Passed
or o ments
—V17
Failed
Correction
Needed
Re-Inspection
Fee
($75)
No Additional Inspections can be scheduled
re-inspection fee is paid.
until
Monday, November 17, 2008
Page 2 of 2
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
OCT MCMEWMI
3 208 Jill
BY:____ .. ...- --
Permit No. Os6I9kp
Master Permit No.
Permit Type: Plumbing
Owner's Name (Fee Simple Titleholder) e,i,,,,_, D,t Phone # &a 0 ib
Owner's Address ('a - ?-)- W.) a C
City k-�l la I State O
Zip J 1 aJ
Tenant/Lessee Name Phone #
E- MAIL:
Job Address (where the work is being done)
I p1 Ci q ot S--
City Miami Shores Village County Miami -Dade
FOLIO / PARCEL # 1 (" 3v2bS-009- -61 0
Zip
Is Building Historically Designated YES NO
Contractor's Company Name G S >�� 11(161 P\ +
Contractor's Address t' (... dikA)&--
City \ a it-4( State e-
Qualifier Name ''- - a. A. ke-4
State Certificate or Registration No.CT—C.■
E -MAIL:
Phone #
Zip
Phone #
Certificate of Competency No.
Architect /Engineer's Name (if applicable) Phone #
GO/ '7 k-S-G
Value of Work For this Permit $ 1 860 " 6)-O Square /Linear Footage Of Work:
aoc
Type of Work: ❑Addition ['Alteration ❑News Repair/Replace
❑Demolition
Describe Work:
pq ?ra. l'i-e_scQ •
xxxxr.******* xx xxwx*****a':xxxrrwwr.xrr.xr.r.x Fees *rrrrx .****x*r.xr.xxxxxxxxxxxrxxxr.x
Submittal Fee $ Permit Fee $ h<_5e— CCF $ CO /CC
Notary $ Training /Education Fee $ Technology Fee $
Scanning $ Radon $ DPBR $ Zoning $
Bond $
Code Enforcement $ Double Fee $
Structural Review. $ Total Fee Now Due $ 413
See Reverse side —>
Bonding Company's Name (if applicable)
Bonding Company's Address
City
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. 1 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 taws 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 a ` roved and a reinspection, fee will be charged.
Signature
t
Owner or Agent yy
The foregoing instrument was acknowledged before me his 5b
day of _ 200 by
Contractor 2
The foregoing instrument was acknowledged before e this 3D
day. of c , 20 Ore, by o k r '' a A.
who is personally known to me or who has produced who is personally known to me or who has produced
As identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
My Commissio
"'MISSION # DD471903
EXPIRES: Sept. 14, 2009
Florida Notary Service.com
%XXXY.XXXXY.XXXX %XXXXXX XX % %XXXXY.X%XXX%XXX%XXX
APPLICATION APPROVED BY
(Revised 02/08/06)
as identification and who did take an oath.
NOTARY PUBL
l
Sign: far-
Print:
4 • �Q # PD471903
My Com issiversokpires: E? i s: Sept. 14,2009
(407) 399-0137. rlaroa Notary Ser ice.com
:xx XX XXicXXXXXXXXXXX - " - •....veta.vvv"!
/04
D
Plans Examiner
Engineer
Zoning
STATE OF FLORIDA
DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT AND DISPOSAL
SYSTEM
CONSTRUCTION PERMIT FOR: OSTDS Repair
APPLICANT: Patrick Duffy
PERMIT #: 13-SG-958575
APPLICATION #: AP899482
DATE PAID: 10 /20/2008
FEE PAID: $55.00
RECEIPT #: 13-PID-1074877
DOCUMENT #: PR754249
PROPERTY ADDRESS: 1222 NE 99 St MIAMI, FL 33138
LOT: 7
BLOCK: 2 SUBDIVISION: Earleton Shores
PROPERTY ID #: 11- 3205 -009 -0190
[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 CAPACITY [MAXIMUM CAPACITY SINGLE TANK:1250 GALLONS]
K [ ] GALLONS DOSING TANK CAPACITY [ ]GALLONS @[ ]DOSES PER 24 BRS #Pumps [
D [ 200 ] SQUARE FEET Bed configuration SYSTEM
R [ 0 ] SQUARE FEET SYSTEM
A TYPE SYSTEM: [x] STANDARD [ ] FILLED [ ] MOUND [ ]
I CONFIGURATION: [ ] TRENCH [x] BED [ ]
N
F LOCATION OF BENCHMARK: FFE 9.90 "" NGVD
I ELEVATION OF PROPOSED SYSTEM SITE [ 14.40] [1 INCHES FT ][ABOVE 4 BELOWliBENCHMARK /REFERENCE POINT
E BOTTOM OF DRAINFIELD TO BE [ 30.40][`INCHES I FT ][ABOVE/ BELOW(IBENCHMARK /REFERENCE POINT
D FILL REQUIRED: [ 2.00] INCHES EXCAVATION REQUIRED: [ 28.00] INCHES
0
H
E
1.-Existing 900 gal. septic tank to remain.
2.-Install 200 sf of drainfield in bed configuration.
3.- Invert elevation of drainfield to be no Tess than 6.86 ft NGVD.
6.-Bottom of drainfield elevation to be no Tess than 6.36 ft NGVD.
THIS PERMIT IS NOT FOR "ADDITION(s) ".
REPA iHTt DEPARTMENT COUNTY
SPECIFICATIONS BY:
APPROVED BY:
DATE ISSUED:
r d L Phi - sire TITLE:
ITLE: Engineer Specialist II
Dade CHD
EXPIRATION DATE: 01/19/2009
DH 4016, 10/97 (Previous Editions May Be Used) Page 1 of 3
v 1.1.4
A1,899.482 6E770483
STATE OF FLORIDA
DEPARTMENT OF HEALTH
APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PERMIT
Permit Application Number
PART 11- SITEPLAN
Scale: Each block represents 10 feet and 1 inch = 40 feet.
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Notes:
t 1---k
tce irt 4 &:-.1j
Site Pan submitted by
Plan Approved
Not APfirOved
Date
By County Health Department'
ALL CHANGES MUST BE APPROVED BY THE COUNTY HEALTH DEPARTMENT
DH 4015,10/96 (Replaces HRS-H Form 4016 which may be used)
(Stock Number: 5744402-40154)
Page 2o14
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