PL-08-1974nspaction Worksheet
Miami Sh• res Village
10050 N.F. 2nd Avenue Miami Shores, FL
Phole: (305)795-2204 Fax: (305)756-8972
Inspection Date: December 19, 2008
Inspector: Levrock, James
Owner: PERRY, ROXANNE
Job Address: 868 100 Street NE
Miami Shores Viilage, FL
Project: <NONE>
Contractor:
SOUTHERN SEPTIC CONTRACTORS INC
Building Department Commen ts
emit Type: Plumbing - Residential
Inspection Type: Final
Work Classification: Drainfield
Bock:
Phone Number
Parcel Number 1132060340020
Lot
Phone: (305)598-8266
Passed
Failed
rto
Inso
CC
omm nts
Correction
Needed
Re-Inspection
Fee
No Additorial Inspections can be scheduled urtil
re-inspection fee is paid.
EN CAD IN FILE
Thursday, December 18, 2008
Page 1 of 1
Dec 18 08 09:28a Roberto Rodriguez
3055988858 p.2
OIVISICIM OF
Environmental Health
Florida Department of Heath
Muni-Dade County Health Department
OSTDS/Septie Tank Division
TI69 42. St Suite 175
inspectolAe "RID4 FL 33166
/ Date -Z — 1
•
Address g -c /00,t7C OS1DS# 7c, sz 2 y
Commons:
Signature .1(.ft,-6,-:%4Wre„,.as.„
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
Permit Type: Plumbing
Owner's Name (Fee Simple Titleholder) -Roxex nwn -e,m P (=if
(-gi6's (QC too s-1
Owner's Address
City N.J (,q
Tenant /Lessee Name
E -MAIL:
Permit No.
Master Permit No.
Phone #
NOV 1 0 2008
BY: �-
D6-1T)4_
.50s7s1-41S1
State �-- Zip '1)117
Phone #
Job Address (where the work is being done) 4 & `g to 1' 1 O -
City Miami Shores Village County Miami -Dade Zip
t t —6006 01A 0 0 ?■0
FOLIO / PARCEL #
Is Building Historically Designated YES NO x
Contractor's Company Name SO J`, ke(A. Se pt V
Contractor's Address
& vii t 1 g s
City r■.^ State IL_
Qualifier Name ‘..2,:k13
J �
State Certificate or Registration No. 6 cj a. 11/44 a. Certificate of Competency No.
E -MAIL:
-
Phone # 4 '- )1 b
Zip
Phone #
39
Architect /Engineer's Name (if applicable)
Value of Work For this Permit $ IS 0 J
Phone #
Square / Linear Footage Of Work:
Type of Work: ❑Addition ❑Alteration ❑New
Describe Work:
❑ Repair /Replace
7"-)r(' gLik 127301 e tv _
❑ Demolition
******************************* * * *xxxxxEes * * * * * * * * * * * *xxxxxxxx
Submittal Fee $ Permit Fee $ 1 �(
Notary $ 5' Training /Education Fee $ 0 tin
Scanning $ 3 r I Radon $ DPBR $
Bond $ Code Enforcement $
Structural Review. $
*xrxx *xxxx xxx x * **
CCF Si- AO C0) CC
Technology Fee $
Zoning $
Double Fee $
Total Fee Now Due $
See Reverse side -+
Bonding Company's Name (if applicable)
Bonding Company's Address
City
State
I 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: 1 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 issue . h ce o f such posted notice, the
inspection will not be approved and a reinspection fee will be charged
Signature k
a/xm
or Agent
f
The foregoing in rumens ac y owledged before
day of rNII�N�'CnJ,VAVI, 0 , by 0 / j lk° d
who i pe sonall known to me or who has produced
NO
this
identification and who did t an oath.
.
Sign: _
,49G� e
Print:
My Commission Expires:
*** * ** *x xxxxx *** * *x *x******* * * ***
APPLICATION APPROVED BY:
(Revised 02/08/06)
Signature
The fore
day of
who is
oing in
rume
ntracto
t was ackno
20
rsonally known to
�►ii'i
by
meorw
,eage.1,efore 40thi
who has produce
ntification and who did take and@ g
i ' • � -.
, ��9�ti4 r�UCO.,
OTARY UBLIC:
Sign:
Print:
My Commission Expires:
x************************* xxxxxxxie,cxx *, **** **** *** ********
/— a - O/ Plans Examiner
Engineer
Zoning
STATE OF FLORIDA
DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT AND DISPOSAL
SYSTEM
CONSTRUCTION PERMIT FOR: OSTDS Repair
APPLICANT: Roxanne Perry
PERMIT #: 13-SG-960434
APPLICATION #: AP901279
DATE PAID: 11/06/2008
FEE PAID: $55.00
RECEIPT #: 13-PID-1078440
noctMENT #: PR755823
PROPERTY ADDRESS: 868 NE 100 St Miami, FL 33138
LOT: 4
BLOCK: 169 SUBDIVISION: Miami Shores
PROPERTY ID #: 11- 3206 -034 -0020
[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
MATERIAL FACTS,
TO MODIFY THE
NULL AND VOID.
OTHER FEDERAL,
SATISFACTORY PERFORMANCE FOR ANY SPECIFIC PERIOD OF TIME. ANY CHANGE IN
WHICH SERVED AS A BASIS FOR ISSUANCE OF THIS PERMIT, REQUIRE THE APPLICANT
PERMIT APPLICATION. SUCH MODIFICATIONS MAY RESULT IN THIS PERMIT BEING MADE
ISSUANCE OF THIS PERMIT DOES NOT EXEMPT THE APPLICANT FROM COMPLIANCE WITH
STATE, OR LOCAL PERMITTING REQUIRED FOR DEVELOPMENT OF THIS PROPERTY.
SYSTEM DESIGN AND SPECIFICATIONS
T [
A [
N [
K [
900 ] GALLONS / GPD
0 ] GALLONS / GPD
0 ] GALLONS GREASE INTERCEPTOR CAPACITY
] GALLONS DOSING TANK CAPACITY
Septic Tank
CAPACITY
CAPACITY
[MAXIMUM CAPACITY SINGLE TANK:1250 GALLONS]
]GALLONS @[ ]DOSES PER 24 HRS #Pumps [ ]
D [ 200 ] SQUARE FEET Bed configuration SYSTEM
R [ 0 ] SQUARE FEET SYSTEM
A TYPE SYSTEM: [x] STANDARD [ ] FIT.T3D [ ] MOUND [ ]
I CONFIGURATION: [ ] TRENCH [x] BED [ ]
N
F LOCATION OF BENCHMARK: FFE 13.30 "" NGVD
I ELEVATION OF PROPOSED SYSTEM SITE
E BOTTOM OF DRAINFIELD TO BE
L
D FILL REQUIRED:
0
T
H
E
R
SPECIFICATIONS BY:
APPROVED BY:
DATE ISSUED:
DH 4016, 10/97 (Pre ous Editions May Be Used)
v 1.1.4
[ 0.00 ] INCHES
[ 20.40 ] [I INCHES y FT ] [ ABOVE A BELOW Il BENCHMARK /REFERENCE POINT
[ 38.40 ] [( INCHES I FT ] [ ABOVE a BELOW I] BENCHMARK /REFERENCE POINT
EXCAVATION REQUIRED: [ 30.001 INCHES
11..- Existing 900 gal. septic tank to remain.
4.- Install 200 sf of drainfield in bed configuration.
3. -Invert elevation of drainfield to be no less than 9.60 ft NGVD.
6.-Bottom of drainfield elevation to be no less than 9.10 ft NGVD.
THIS PERMIT IS NOT FOR "ADDITION(s) ".
HEALTH H DEFA.R i MEN,`;"
Gera
Phili
--TITLE:
:Engineer Specialist II
AP901279
Dade CHD
EXPIRATION DATE: 02/05/2009
9E771973
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