PL-08-1436Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Date: January 27, 2009
Inspector: Levrock, James
Owner: RODRIGUEZ, CLAUDIO & MARIA
Job Address: 335 NE 101 Street NE
Miami Shores, FL 33138-
Project: <NONE>
Contractor: MR C'S PLUMBING SEPTIC INC
Permit Type: Plumbing - Residential
Inspection Type: Final
Work Classification: Drainfield
edismime
Phone Number
Parcel Number 1132060135211
Phone: (305)651 -7859
Building Department Comments
/ A,
1
,JAN 2 9 ENT'D
In .
c'
Comments
Passed
�
Failed
Correction
Needed
Re- Inspection
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
January 26, 2009
Page 1 of 1
01/26/2009 10:43 3056515610
MR C PLUMB SEPTIC PAGE 01/01
'n5 to E 101 gaol
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 No.
Master Permit No.
Lip pr-I, J 1 233 J)
BY: -
PI OYI4r0
Permit Type: Plumbing
Owner's Name (Fee Simple Titleholder) C, A uL'^"o
Pock( T Phone # 00g 02 4' —
Owner's Address � 0.6 o1 54
City \(.`.1M ( State ? Zip 3 31 -'c
Tenant/Lessee Name Phone #
E -MAIL:
Job Address (where the work is being done)
353 o'er to 1 s+
City Miami Shores Village County Miami -Dade
FOLIO /PARCEL# k ^ Ii
Is Building Historically Designated YES NO L�
Zip
3519g
i ` _
Contractor's Company Name e `R-Lt \)\5+ 'eePnone # 36 5 GS 1 PSI
Contractor's Address \ Grt 3a IJW *'J ( \cvt •
City nitq State 9L Zip 5 16
Qualifier Name O®kh h 12t-3 Phone # 05 G5) 1k
State Certificate or Registration No. Ci Q 1 -t4 -� S 1 Certificate of Competency No
E -MAIL:
Architect/Engineer's Name (if applicable)
Value of Work For this Permit $
i kao • cso
Phone #
Square / Linear Footage Of Work:
Type of Work: ❑Addition ❑Alteration ENew
Describe Work: /1
%°
Repair /Replace ❑ Demolition
►
*****krxxxxxx xxxxx xxxx* WWw* xxxxxxx xxr.CC*F ee* xxx**********W WWWWWWWWWWWWxxxxxxxWWWWWWWW%WW
Submittal Fee $ Permit Fee $
Notary $
Scanning $ Radon $
Bond $(n •(,`� �� Code Enforcement $ Double Fee $
Training /Education Fee $
DPBR $
CCF $ i • CO /CC
Technology Fee $ 4.3"1
Zoning $
Structural Review. $
Total Fee Now Due $
See Reverse side —>
Bonding Company's Name (if applicable)
Bonding Company's Address
City St
at
i
i
Mortgage Lender's Name (if applicable)
Mortgage Lender-'s Address
City
State / Zip
Application is hereby made to obtain a ermit to do the work and
p installations as indicated. [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 a reinspection fee will be charged.
Signature
Owner or Agent
The foregoing instrument was acknowledged before me this c(2
day ofc74-44 , 20 u;), by a4 ') `o / f &t.)g4
who is personally known to me or who has produced
As identification and who did take an oath.
NOTARY PUBL ```�`� ®e 51Aj4iRO:.%�
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Sign:
Print:
My Commission Expires:
APPLICATION APPROVED
(Revised 02/08/06)
Contractor
The foregoing instrument was acknowledged before e this
day of , 20 eg, by 3 h 1 (,ti
e or who has produced
as identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
My Comm
ww www ww W wY.w wwwww
MY C •• ►�,
Ires: EXPIRES: Sept. 14, 2009
407) 398-0169 Florida Notary Serwoeeom
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Plans Examiner
Engineer
Zoning
r STATE OF FLORIDA
DEPARTMENT OF HEALTH
-0" „'.�°' ONSITE SEWAGE TREATMENT AND DISPOSAL
1 SYSTEM
PERMIT #: 13-SG- 947862
APPLICATION # : AP889305
DATE PAID : 07/21/2008
FEE PAID: $55.00
RECEIPT #: 13 -PID -10484
DOCUMENT #: PR745665
CONSTRUCTION PERMIT FOR: OSTDS Repair
APPLICANT: Claudio Rodriguez
PROPERTY ADDRESS: 335 NE 101 St MIAMI, FL 33138
LOT: 18 & 19 BLOCK: 38 SUBDIVISION: Miami Shores No.1
[SECTION, TOWNSHIP, RANGE, PARCEL NUMBER]
[OR TAX ID NUMBER]
PROPERTY ID #: 11- 3206-013 -5211
SYSTEM MUST BE CONSTRUCTED IN ACCORDANCE WITH SPECIFICATIONSOF SYSTEM DOES STANDARDS NOT GUARANTEE
SECTION
381.0065, F.S., AND CHAPTER 64E -6, F.A.C. DEPARTMENT APPROVAL MATERIAL RANTS, IN
SATISFACTORY PERFORMANCE FOR ANY SPECIFIC PERIOD OF TIME. THE APPLICANT AT MODIFY THE
WHICH SERVED AS A BASIS FOR ISSUANCE OF THIS PERMIT, REQUIRE AND
APPLICATION. MODIFICATIONS MAY THE APPLICANT FROM COMPLIANCE WITH OTHER FEDERAL,
ISSUANCE OF THIS PERMIT IT DOES NOT EXEMPT
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 #Pampa [ ]
D [ 300 ] SQUARE FEET Bed confiauration SYSTEM
R [ 0 ] SQUARE FEET
SYSTEM
A TYPE SYSTEM: [X] STANDARD [ ] FILLED [ ] MOUND
I CONFIGURATION: [ ] TRENCH [X] BED
N
F LOCATION OF BENCHMARK: FFC eI.:12.00"" NGVD
I ELEVATION OF PROPOSED SYSTEM SITE [ 28.80 ] [I INCHES If FT ] [
E BOTTOM OF DRAINFIELD TO BE ( 44.80 1 (1 INCHES I FT ] [
L
D FILL REQUIRED: [ 2.00] INCHES EXCAVATION REQUIRED:
O
T
s
E
R
SPECIFICATIONS BY:
ABOVE /L owbBENCHMARK /REFERENCE POINT
ABOVE BELOWbBENCHMARK /REFERENCE POINT
[ 28.00 1 INCBES
1.-Existing 900 gal. septic tank to remain.
2.- Install 300 sf of drainfiek] in bed configuration.
3.- Invert elevation of drainfield to be no Tess than 7.76 ft NGVD.
6.- Bottom of drainfield elevation to be no Tess than 7.26 ft NGVD.
THIS PERMIT IS NOT FOR " ADDITION(s) ".
APPROVED BY:
DATE ISSUED:
�l=r
and L Philizaire
Astrid V Edwards
07/22/2008
TITLE:
TITLE: Engineer Specialist II
DH 4016, 10/97 (Previous Editions May Be Used)
v 1.1.4
n1,gS9305
Dade
EXPIRATION DATE: 10/20/2008
SE/62670
Page 1 of 3
STATE OF FLORIDA
DEPARTMENT OF HEALTH
APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PERMIT
Permit Application Number
PART II - SITEPLAN
Scale: Each block represents 10 feet and 1 inch = 40 feet.
1
Notes: b50 6 l o t 33138'
51-trAnA. 3a) 42 chrei,,y,_6.4 14,pia •
goo bed seen -4 as vt- 'i-D ma>i r -
Site Plan submitted by:
Plan Approved
By
Not Approved
Date '7
County Health Departme
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: 5744002 - 4015 -6)
Page 2 c