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PL-08-1228Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 i •ttivt:xi» Inspection Date: 07/15/2008 Inspector: Levrock, James Owner: ARDISSON, PATRICIA Job Address: 636 101 Street NE Miami Shores Village, FL JUL 1 7 Project: <NONE> Contractor: A TIP TOP SEPTIC TANK I t. Block: Permit Type: Plumbing - Residential Inspection Type: Final Work Classification: Septic Phone Number Parcel Number 1132060172120 Lot: Phone: (954)920 -6500 Building Department Comments NEW SEPTIC TANK AND DRAINFIELD AA t Passed J!.lctor dpjf• Comments ,___ L Failed if Correction Needed Re- Inspection Fee ($75) No Additional Inspections can be scheduled re- inspection fee is paid . until Monday, July 14, 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 Permit Type: Plumbing Owner's Name (Fee Simple Titleholder) 1P IC C Ca, UG.) fl OC 15C,N lgEgraEsTE flit JUL 0 8 2008 BY: Permit No. Pi 06T 1227 Master Permit No. c- CAS Owner's Address eg, 3 b /.J • / v ! S r— Phone # 736 Y� ©- / U 3 2_ City /1/1 /4,41 f 5;60v.e, State /-7-L Zip 3 31 33— Tenant/Lessee Name Phone # E -MAIL: Job Address (where the work is being done) C,.3 lr ( 6 City , Miami Shores Village County Miami -Dade FOLIO /PARCEL# Z0 _ O. JL(— 2%2 Is Building Historically Designated YES NO 1 Zip Contractor's Company Name / 77 roe Sr_; (� l / c-- T4v^ (C Phone # 9 57/ 5 2 Q)5-6 Contractor's Address p- 0 e (! S X, / / `f L City Q/ , J / E c /'E State Zip 3 0c)--f Qualifier Name ( %,r e,.J c 6 /4( Ic / f Phone # Yar I °-12G State Certificate or Registration No. 5 9 r v b19 — 0 ° 7- Certificate of Competency No. E -MAIL: Architect/Engineer's Name (if applicable) Phone # Value of Work For this Permit $ l C) t) Square / Linear Footage Of Work: Type of Work: ❑Addition ['Alteration ['New Re air /Re lace p p ❑Demolition Describe Work: (j e_ i R `t RA , e ,i zxxxx' Rxxxzxxzzxx' tx' 4dr' 4*' 4*****xx' c' r' r 'r'v'czx*Fees'Yx'Y****xxzzxxx *x atzxxxzx xx xxxzxx *xxxxxxxx*xx Submittal Fee $ Permit Fee $, CCF $ ,b1-9 CO /CC Notary $ 5.0 Training /Education Fee $ Q .(Q Technology Fee $. ZSTZ Scanning $ Radon $ DPBR $ Zoning $ Bond $.Y P ')2 3 Code Enforcement $ Double Fee $ Structural Review. $ Total Fee Now Due $ Yea' IS See Reverse side -+ 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 mus be posted at the job site for the first inspection which occurs seven (7) days after the building permit is iss :(! In the absen e o suc posted notice, the inspection will not be approved and a reinspection fee will be charged. Signature The fore day of who is NOTAR Owner or Agent o'ng instrument was ac„nowledged before me this Sign: Print: My Commission Expires: Ily know' to me or who h produced 1-_ J PUBLIC: s identification and who did take an oath. Signature Contractor The fore i ss )�'g ins rument was • ged before me day of l�"'�i , 2�� )f by , /:...� I t /]who i personallly known to me or who has produced 141 f . .vsi= entification and who did take an". NOTARY PUBLIC: x,tic,Y &xK,Y***tex,Yxxxxx****** Sign: Print: My Co ission Expires: ic,e x ie is n ; x is ie x is **,e x,t x ie ie is 'x* ie,t ie*ie is x is APPLICATION APPROVED BY: 1P (Revised 02/08/06) *X * ** ans Examiner Engineer Zoning BUILDER'S BOND Issued: 07/14/2008 Amount: $ 300.00 Bond #: 1731 Permit #: PL -7 -08 -1228 PATRICIA ARDISSON owner of property, in consideration of the issuance to me of a permit or permits to construct or repair a building or buildings at the following address: 636 101 Street NE Miami Shores Village FL do hereby deposit the sum of: $300.00 and I agree that when such construction has been completed by me, within the meaning of the ordinances of this district, I will clear all premises and repair any property damaged by me, used for the deposit of material or equipment in the construction or repair and that, if I do not so clear and repair such premises immediately upon the completion of construction within the meaning of the ordinances, the district may clear and repair the same and pay the cost of such clearance and repairs out of the Builder's Bond, and return the remainder to me; and that, if I shall clear and repair the property immediately, then the Builder's Bond shall be returned to me. WITNESS AND DATE: 07/14/2008 Signature INSTRUCTIONS TO BUILDER: When the above mentioned construction is completed and the premises are cleared and repaired, take this bond to the District Building Department for a refund of your money in accordance with the above agreement . BUILDING INSPECTOR'S APPROVAL I hereby certify that the construction contemplated under this Bond , has been completed and that the builder thereof has caused the surrounding premises to be cleared and repaired in as good condition as they were before commencing said construction . WHEN CLEARED AND REPAIRED BY THE DISTRICT: Amount of Bond: $ Cost of clearing and repairs done by District: $ Balance due Builder: $ Cancelled: By: Building Official Date Bond refund payable to applicant only. ($10.00 CHARGE IF BOND IS LOST OR DAMAGED) Miami Shores Village, Florida BUILDER'S BOND Issued: 07/11/2008 Amount: $ 300.00 Bond #: 1728 Permit #: PL -7 -08 -1228 KNOW ALL MEN BY THESE PRESENTS, that I, CLARENCE MITCHELL of A TIP TOP SEPTIC TANK at PO BOX 1142 DANIA BEACH FL 33004- in consideration of the issuance to me by Miami Shores Village, Florida, of a permit or permits to construct or repair a building or buildings at the following address : 636 101 Street NE Miami Shores Village FL do hereby deposit with Miami Shores Village , Florida, the sum of: $300.00 and I agree with Miami Shores Village that, when such construction has been completed by me, within the meaning of the ordinances of Miami Shores Village, I will clear all premises and repair any Village property damaged by me, used for the deposit of material or equipment in the construction or repair and that, if I do not so clear and repair such premises immediately upon the completion of such construction within the meaning of such ordinances, the Village may clear and repair the same and pay the cost of such clearance and repairs out of the aforesaid Builder's Bond, and return the remainder to me; and that, if ! shall clear and repair said property immediately, as aforesaid, then said Builder's Bond shall be returned to me. WITNESS MY HAND and Seal at Miami Shores Village, Florida this date: 07/11/2008 Signature INSTRUCTIONS TO BUILDER: When the above mentioned construction is completed and the premises are cleared and repaired , take this bond to the Village Building Inspector and obtain his approval , after which Miami Shores Village will refund your money in accordance with the above agreement . VILLAGE BUILDING INSPECTOR'S APPROVAL I hereby certify that the construction contemplated under this Bond , has been completed and that the builder thereof has caused the surrounding premises to be cleared and repaired in as good condition as they were before commencing said construction . WHEN CLEARED AND REPAIRED BY THE VILLAGE: Amount of Bond: Cost of clearing and repairs done by Village: Balance due Builder: Cancelled: By: Village Building Inspector, Miami Shores Date Bond refund payable to applicant only. ($10.00 CHARGE IF BOND IS LOST OR DAMAGED) STATE OF FLORIDA DEPARTMENT OF HEALTH ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM CONSTRUCTION PERMIT FOR: OSTDS New APPLICANT: Jacqus Ardison PERMIT #: 13 -SG -91622 APPLICATION #: AP858290 DATE PAID: 05/07/2008 FEE PAID: $55.00 RECEIPT #: 13 -PID -10099 DOCUMENT #: PR739779 PROPERTY ADDRESS: 636 NE 101 St MIAMI, FL 33128 LOT: 5,6,7 BLOCK: 103 SUBDIVISION: Miami Shores PROPERTY ID #: 11- 3206- 017 -2120 [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 [ 1,200 ] GALLONS / GPD Seotic CAPACITY A [ ] GALLONS / GPD N/A CAPACITY N [ ] GALLONS GREASE INTERCEPTOR CAPACITY [MAXIMUM CAPACITY SINGLE TANK:1250 GALLONS] K [ ] GALLONS DOSING TANK CAPACITY [ ]GALLONS @[ ]DOSES PER 24 HRS #Pumps [ ] D [ 625 ] SQUARE FEET SYSTEM R [ ] SQUARE FEET N/A SYSTEM ' A TYPE SYSTEM: [X] STANDARD [ ] FILLED [ ] MOUND [ ] \I CONFIGURATION: [ ] TRENCH [x] BED [ ] N F LOCATION OF BENCHMARK: E. P/L & C/L NE 101 St : 9.52" "NGVD L I ELEVATION OF PROPOSED SYSTEM SITE [ 6.24 ][1 INCHES I FT ][ ABOVE A BELOW tlBENCHMARK/REFERENCE POINT E BOTTOM OF DRAINFIELD TO BE [ 36.24 ] [) INCHES I FT ] [ ABOVE /) BELOW b BENCHMARK /REFERENCE POINT L D FILL REQUIRED: 0 T H E R [ 0.00] INCHES EXCAVATION REQUIRED: [ 30.00] INCHES 1.Install 1200 g septic tank. 2.Install 625 sq ft drainfield in bed configuration 3.Perimeter of excavation area shall be at least 2 ft wider and longer than the proposed absorption bed. 4.Invert elevation of drainfield to be no less than 7.0' NGVD. 5.Bottom of drainfield elevation to be no less than 6.50' NGVD. The licensed contractor installing the system is responsible for installing the minimum category of tank in accordance SPECIFICATIONS BY: Joseph APPROVED BY: 11 >iver r DATE ISSUED: F y 05/23/2008 TITLE: Engineer Specialist II TITLE: Engineer Specialist II Dade EXPIRATION DATE: 11/23/2009 DH 4016, 10/97 (Previous Editions May Be Used) v 1.1.4 AP858290 SE757021 CHD Page 1 of 3 STATE OF FLORIDA DEPARTMENT OF HEALTH ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM SITE EVALUATION AND SYSTEM SPECIFICATION APPLICANT: Jacqus Ardison CONTRACTOR / AGENT: A Tip Top Septic Tank `LOT: 5,6,7 SUBDIVISION: Miami Shores APPLICATION # AP858290 PERMIT # 13-SG- 916228 DOCUMENT # SE757021 BLOCK: 103 ID #: 11- 3206 - 017 -2120 TO BE COMPLETED BY ENGINEER, HEALTH DEPARTMENT EMPLOYEE, OR OTHER QUALIFIED PERSON. ENGINEERS MUST PROVIDE REGISTRATION NUMBER AND SIGN AND SEAL EACH PAGE OF SUBMITTAL. COMPLETE ALL ITEMS. PROPERTY SIZE CONFORMS TO SITE PLAN: [X]YES [ ]NO TOTAL ESTIMATED SEWAGE FLOW: 500 GALLONS PER DAY AUTHORIZED SEWAGE FLOW: 654.00 GALLONS PER DAY UNOBSTRUCTED AREA AVAILABLE: 1260.00 SQFT NET USABLE AREA AVAILABLE: 0.34 ACRES RESIDENCES- TABLE1 / OTHER -TABLE 2 ] 1500 GPD /ACRE OR 2500 GPD /ACRE ] UNOBSTRUCTED AREA REQUIRED: BENCHMARK /REFERENCE POINT LOCATION: E. P/L & C/L NE 101 St : 9.52'NGVD 1250.00 SQFT ELEVATION OF PROPOSED SYSTEM SITE 6.24 [I INCHES I/ FT ] [ ABOVE / BELOW 1 BENCHMARK /REFERENCE POINT THE MINIMUM SETBACK WHICH CAN BE MAINTAINED FROM THE PROPOSED SYSTEM TO THE FOLLOWING FEATURES SURFACE WATER: n/a FT DITCHES /SWALES: n/a FT NORMALLY WET: [ ]YES [X]NO WELLS: PUBLIC: n/a FT LIMITED USE: n/a FT PRIVATE: n/a FT NON - POTABLE: n/a FT BUILDING FOUNDATIONS: 5 FT PROPERTY LINES: 5 FT POTABLE WATER LINES: 5 FT SITE SUBJECT TO FREQUENT FLOODING? 10 YEAR FLOOD ELEVATION FOR SITE: SOIL PROFILE INFORMATION SITE 1 [ ] YES [X]NO 10 YEAR FLOODING? [ ] YES [X]NO] FT [ MSL / NGVD ] SITE ELEVATION: 9.00 FT [ MSL / NGVD USDA SOIL SERIES: Munsell # /Color Urban land Texture Depth 10YR 2/1 Sand O To 16 10YR 7/1 Sand 16 To 30 10R 5/4 Sand 30 To 72 OBSERVED WATER TABLE: 72.00 INCHES [ ABOVE / ESTIMATED WET SEASON WATER TABLE ELEVATION: BELOW 72 HIGH WATER TABLE VEGETATION: [ ]YES [X ]NO SOIL TEXTURE /LOADING RATE FOR SYSTEM SIZING: TION SITE 2 USDA SOIL SERIES: Munsell #/Color Urban land Texture Depth 10YR 2/1 Sand O To 15 10Y 7/1 Sand 15 To 31 10R 5/4 Sand 31 To 72 ] EXISTING GRADE TYPE: INCHES [ABOVE / MOTTLING: [ ]YES [X]NO BELOW [ PERCHED / APPARENT ] EXISTING GRADE DEPTH: INCHES Sand DEPTH OF EXCAVATION: 30 INCHES DRAINFIELD CONFIGURATION: [ ] TRENCH [X] BED [ ] OTHER (SPECIFY) REMARKS /ADDITIONAL CRITERIA SITE EVALUATED BY: DH 4015, 09/2006 (Previous /,ditions „,Prverger, Jose Title: Engineer Specialist I1) sed) - AP858290 EID918228 DATE: 05/23/2008 Page 3 of 4 v 1.0.2