PL-09-1968Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number: INSP- 130311
Scheduled Inspection Date: December 09, 2009
Inspector: Levrock, James
Owner: MOWERS, KATHERINE
Job Address: 1175 NE 101 Avenue
Miami Shores, FL 33138-
Project: <NONE>
Contractor: MR C'S PLUMBING SEPTIC INC
Permit Number: PL -11 -09 -1968
Permit Type: Plumbing - Residential
Inspection Type: Final
Work Classification: Drainfield
Phone Number
Parcel Number 1132050190230
Phone: (305)651 -7859
Building Department Comments
REPLACE 300 SQ OF DRAINFILED.
900 GALLON SEPTIC TANK TO REMAIN
Passed
Failed
Correction
Needed
pector Comments
HR AP OVAL IN FILE
Re- Inspection
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
December 08, 2009
For inspections please call: (305)762 -4949
Page 11 of 18
Miami Shores Village NOV 3 0 2119 `
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
BUILDING
PERMIT APPLICATION
FBC 2001
Permit No OM `f 1 (/
Master Permit No.
Permit Type: Plumbing ��,,�,
Owner's Name (Fee Simple Titleholder)3e b�-e�s-S Phone # 305 - 8 / 5—q41-1+
Owner's Address I I 15 N C 1t5 •
City"t (ON(
Tenant /Lessee Name
E -MAIL:
Job Address (where the work is being done) I I -1S NE 0 1 g
City Miami Shores Village County Miami -Dade Zip 38, 88
FOLIO / PARCEL # I t o q"Oo�3
Is Building Historically Designated YES NO (,/
State .1"L
Zip
Phone #
Contractor's Company Name U S t (Ay1aJ ) )1064 &e et-Phone # 8O.S G S I "7& s
Contractor's Address 3.2 N W a A- Nt-e.
City 1" Ql GLe— State 1" L., Zip 33{
Qualifier Name 0-0k r I a. i4 �`e L j
Phone # CS( .7 gSct
State Certificate or Registration No.CF—.- (H- ( Certificate of Competency No.
E -MAIL:
Architect /Engineer's Name (if applicable) Phone #
Value of Work For this Permit $ e CC572•• 'era
Square / Linear Footage Of Work:
Type of Work: ❑Addition ❑Alteration ['New
Describe Work: /\
Repair /Replace ❑ Demolition
******** * * * * * * * * **** * * *** ** *x * * *I** * *** Fees*** * ** * ** *** * *, *xxxxx rx ** xxxxxxx** *w **w* ***
Submittal Fee $ Permit Fee $ t "UY� CCF $ .2.( CO /CC
Notary $ Training /Education Fee $ 0 40
Scanning $
,,.. • 1 Radon $
Bond VP it V I Code Enforcement $ Double Fee $
Structural Review. $ Total Fee Now Due $ 4,1,• 2-0
Technology Fee $
I'(.o0
DPBR $ Zoning $
See Reverse side -4
Bonding Company's Name (if applicable)
Bonding Company's Address
City
State
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address
City
Zip
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.
Signatufe " / 4611' ;--e
Owner or Agent
The foregoing instrument was acknowledged before me this 30
day of 200C1 , by)G � /,�Y /i�oFVe.✓f
who is personally known to me or who has produced
As identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
My Commission
** ** **Y* **** **
KEMBLE ETTRICK
MY COMMISSION # DD 891340
Y g
* idrierfi i> P te1WfiPe
r§x
APPLICATION APPROVED BY:
(Revised 02/08/06)
Signature
Con tractor
The foregoing instrument was acknowledged before me this qO
day of I al ,200`�,by UOkr, 9 r 1.ey
who is personally known to me or who has produced
as identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
My Commi
. :,.,II
¶.aa, es MY COMMISSION # DO ;41340
EXPIRES: September 14, 2013
p *43endadThrabit PgblregloteR" itM*
Inn
******
Plans Examiner
Engineer
Zoning
STATE OF FLORIDA
DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT AND DISPOSAL
SYSTEM
CONSTRUCTION PERMIT FOR: OSTDS Repair
APPLICANT: Jaffrey Mowers
PROPERTY ADDRESS: 1175 NE 101 St Miami, FL 33138
LOT: 13
PERMIT #: 13-SC-1080229
APPLICATION •: AP943485
DATE PAID:
FEE PAID :,
RECEIPT 8:.
DOCUMENT it: PR791296
BLOCK: 176
PROPERTY ID it: 11- 3205-019-0230
SUBDIVISION: Miami Shores
[SECTION, TOWNSHIP, RANGE, PARCEL NUMSER)
[OR TAX ID NUMBER]
SYSTEM MUST BE CONSTRUCTED IN ACCORDANCE WITH SPECIFICATIONS AND STANDARDS OF SECTION
381.0065, F.S., AND CHAPTER 645 -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 PROM COMPLIANCE WITH OTHER FEDERAL,
STATE, OR LOCAL PERMITTING REQUIRED FOR DEVELOPMENT OF THIS PROPERTY.
SYSTEM DESIGN AND SPECIFICATIONS
T [ 750 l GALLONS / GPD Septic ,ACITY
A [ 1 GALLONS / GPD a' CAPACITY
N [ 0 l GALLONS GREASE INTERCEPTOR CAPACITY DMUCUMMK CAPACITY SINGLE TANK:1250 GALLONS]
K [ ] GALLONS DOSING TANK CAPACITY [,,f" ]GALLONS @[ ]DOSES PER 24 HRS #Pumps I ]
D [ 300 l SQUARE FEET ..* SYSTEM
R [ l SQUARE FEET SYSTEM
A TYPE SYSTEM: [K] STANDARD [ l FILLED [ l MOUND [ ]
I CONFIGURATION: [ 1 TRENCH ;' [X] BED [ 1
N
F LOCATION OF BENCHMARK: F.F.E.: 9.9' NGVD
I ELEVATION OF PROPOSED SYSTEM SITE [ 13.20 ] I WOES FT ] ( ABOVE r-�EK/ POINT
E BOTTOM OF DRAINFIELD TO BE [ 41.20 ] I .. «: * ; FT 1 [ ABovE 1[z, -1u azilaINARK/REFERENCE POINT
L
O FILL REQUIRED: [ 0.00] INCHES
0
T
H
E
EXCAVATION REQUIRED: [ 28.00 INCHES
THIS PERMIT IS FOR THE NOTHWEST SYSTEM OF THE PROPERTY.1.- Existing 900 gal. septic tank certified d by ° Mr
C's Plumbing & Septic" on 11/23/2009 to remain. 2- Install 300 sf of drainteld in bed c:onfiguratlion 3- Perimeter of excavation
area shall be at least 2 ft wider and longer than the proposed absorption bed. 4- Invert elevation of drainfiield to be no less
than 6.96' NGVD 5. Bottom of drainfeld elevation to be no less than 6.46' NR r,
IfflAVXDArE cowry HEALTH ' RTMff
DH 4016, 10/97 (Previous Editions May Be Used)
e 1.1.4 AP943485
Dade CHD
EXPIRATION DATE: 02/2212010
0E801721
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 I inch = 40 feet.
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Notes: I I --I !\.)"5- t G7) t t Ct r .
vca
i srh f 2f i , 't -e d czete. h e
141C 3 - r a- ► ,' "34 c.- 44, �+.n� ' ethi1 :tom.
Sac.
v.
-I Ea .s f-- 21d.e.. -#t I mart,- •
Site Plan submitted by: AN: A_ ai I 9 --- Gc..a —Lt l -e ,r .
Plan Approved `a Approved Date 1 t is-3/04:1
By County Health Department
ALL CHANGES MUST BE APPROVED BY THE COUNTY HEALTH DEPARTMENT
DH 4015, 10196 (Replaces HRS-H Form 4016 which may be used)
(Stock Number: 5744-002-4015-6)
Page2of4
12 07/200'
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