PL-11-926Permit Number: PL -5 -11 -926 I
Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number: INSP- 160023
Inspection Date: June 08, 2011
Inspector: Hernandez, Rafael
Owner: FRANCIS, BERNARD
Job Address: 9338 NW 2 Court
Miami Shores, FL 33150-
Project: <NONE>
Contractor: MR C'S PLUMBING SEPTIC INC
Permit Type: Plumbing - Residential
Inspection Type: Final
Work Classification: Septic
Phone Number
Parcel Number 1131010150120
Phone: (305)651 -7859
Building Department Comments
INSTALL NEW 900 SEPTIC TANK, EXISTING 200 SQ FT
DRAINFIELD TO REMAIN
Passed
Inspector Comments
HRS APPROVAL IN FILE
MI
Failed
Correction
Needed
Re- Inspection
Fee
No Additional Inspections can be scheduled
re- inspection fee is paid.
until
June 08, 2011
For Inspections please call: (305)762 -4949
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qR
Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795,2204 Fax: (305) 756.8972
INSPECTION'S PHONE NUMBER: (305) 762.4949
Permit No.0 11-- qA. 0
7 VTi
MAY21.0 2011
BY:
BUILDING
PERMIT APPLICATION
FBC 20
Master Permit No.
Permit Type: PLUMBING
OWNER: Name (Fee Simple Titleholder): offAaak
"Tniit4J.43 Phone#: 7>t 3 3
Address: 6131( A.) to 2- ct
City: S krfr..4) State: Tt- Zip: 3310)
Tenant/Lessee Name: Phone#:
Email:
JOB ADDRESS:
City:
ci33( No..) Ct
Miami Shores County: Miami Dade Zip: '531S-0
Folio/Parcel#: I — Q -- (
Is the Building Historically Designated: Yes
NO Flood Zone:
CONTRACTOR: Company Name: DAP Seja, Phone#: 3t-e•S-1 TS- /
Address: ( 3 Ou4e
City: ft State: Zip:
Qualifier Name: A4.. ffj ej Phone#: Zkt-4S-/-*61
State Certification or Registration #: CFC, (4.2(14—f Certificate of Competency #:
Contact Phone#: Email Address:
DESIGNER: Architect/Engineer: Phone#:
Value of Work for this Permit: $ 00 0 • 0-0 Square/Linear Footage of Work:
Type of Work: ClAddress CIAlteration UNew Lair/Replace LIDemolition
Description of Work: L S4*2
***************************************Fees******************************************
Submittal Fee $ Permit Fee $ eird, ---- CCF $ CO/CC $
Scanning Fee $ Radon Fee $ DBPR $ Bond $
Notary $ Training/Education Fee $ Technology Fee $
Double Fee $ Structural Review $
TOTAL FEE NOW DUE $
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. 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 laws regulating
construction in this jurisdiction. 1 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 FAIL TO RECORD A NOTICE OF
COMMENCEMENT MAY RESULT IN YOUR PAYING CE 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 w the issuance of a building permit with an estimated value exceeding $2500, the applicant must
promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person
whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site
for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the
inspection will not be approved and a reinspection fee will be charged.
Signature
Owner or Agent
The foregoing insp t was acknowledged before me this
day of / rvC , 20 It , by 3EMRCLO A-TAW-15 ,
who is pessonally known to me or who has produced
As identification and who did take an oath.
NOTARY PUB I
Sign:
Print:
My Commission Exp'
oyol„,
74.t.
4--
MY COMMISSION # DD 891340
***** * *** *** 4.* * * * ****
APPROVED BY
Signature
The foregoing instrument was acknowledged before me this
day of / .20 IL, by Le--1
who is personally known to me or who has produced
as identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
My Co
ot
V
uSr}ti*Siiie of Florida
1781$
014
Plans Examiner Zoning
Structural Review Clerk
(Revised 07/10/07)(Revised 06/10/2009)(Revised 3/15/09)
STATE OE' FLORIDA
DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM
CONSTRUCTION PERMIT
CONSTRUCTION PERMIT FOR: OSTDS Repair
APPLICANT: Bernard Francis
PERMIT #: 13-SC-1315792
APPLICATION # : AP 1003580
DATE PAID:
FEE PAID:
RECEIPT #•
DOCUMENT #: PR843548
PROPERTY ADDRESS: 9338 NW 2 Ct Miami, FL 33150
LOT: 4
BLOCK: 2 SUBDIVISION:
PROPERTY ID #: 11- 3101 - 015 -0120
[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 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 HRS #Pumps [ ]
D [ 200 ] SQUARE FEET SYSTEM
R [ 0 ] SQUARE FEET SYSTEM
A TYPE SYSTEM: [x] STANDARD [ ] FILLED [ ] MOUND [ ]
I CONFIGURATION: [ ] TRENCH [x] BED [ ]
N
F LOCATION OF BENCHMARK: FFE : 13.2' NGVD
I ELEVATION OF PROPOSED SYSTEM SITE
E BOTTOM OF DRAINFIELD TO BE
L
D FILL REQUIRED: [ 0.00 ] INCHES
T
H
E
R
[ 25.20 ] [I INCHES I FT 3 [ ABOVE a BELOW N BENCHMARK /REFERENCE POINT
[ 53.20 ] [) INCHES I FT ] E ABOVE 4 BELOW ',BENCHMARK/REFERENCE POINT
EXCAVATION REQUIRED: [ ] INCHES
- Install 900 g septic tank.
- Existing 200 sq ft drainfield to remain
The licensed contractor installing the system is responsible for installing the minimum category of tank in accordance with
s. 64E- 6.013(3)(f), FAC.
- Not for additions.
SPECIFICATIONS BY:
APPROVED BY:
DATE ISSUED:
Kemble G. ick
R Eger
05/0 y 011
TITLE:
TITLE: Engineer Specialist II
DH 4016, 08/09 (Ob {•letes all previous editions which may not be used)
Incorporated: 64E - 6.003, FAC
v 1.1.4 AP1003580
Dade CRD
EXPIRATION DATE: 07/31/2011
SE843147
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