PL-11-1098Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number: INSP- 161018 Permit Number: PL -6 -11 -1098
Scheduled Inspection Date: June 24, 2011
Inspector: Hernandez, Rafael
Owner: RODRIGUEZ, JOHN
Job Address: 5 NW 106 Street
Miami Shores, FL 33150-
Project: <NONE>
Contractor: STATEWIDE SEPTIC CONNECTIONS
Permit Type: Plumbing - Residential
Inspection Type: Final
Work Classification: Septic
Phone Number (305)776 -0889
Parcel Number 1121360060240
Phone: (954)963 -0082
Building Department Comments
PUMP & ABANDON REPLACE BROKEN SEPTIC TANK &
NEW 225 & DRAINFIELD AND NEW 900 GALLON SEPTIC
TANK
Passed
Failed
Correction
Needed
Re- Inspection
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
Inspector Comments
June 24, 2011
For Inspections please call: (305)762 -4949
Page 12 of 18
j7� 11 -l�fii� K\:0 iQosk
mment
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
BUILDING Permit NoK, t ,--
PERMIT APPLICATION Master Permit No.
FBC 20
JUAN 1 5 2011
Permit Type: PLUMBING
OWNER: Name (Fee Simple Titleholder): � °e�� �t S�"�'i 1 ( e Phone #: /8644/ 6 2..
Address: 5 ►J,vJ i.:47
City: l'ASko 1-e,$
State:
Zip: 3315
Tenant/Lessee Name: Phone #:
Email:
JOB ADDRESS: 5 Nvq O
City: Miami Shores County: Miami Dade
Folio/Parcel #: i t- 2 13 6 -006-.024-0
Is the Building Historically Designated: Yes NO 1✓ Flood Zone:
CONTRACTOR: Company Name: Skc +e W`i de Sc .0 C,r c (vtC Phone #: 3 �� —� 33
Zip: 331 St
Address: ‘' 0 &- 24 �# Z6
City: M 't ro O { State: zip: 33323
Qualifier Name: '-er-tso. ,,,..01 .43 rho Phone #:
State Certification or Registration #: SM O Ct 11 Z-6 Z. Certificate of Competency #:
Contact Phone #: 5 I LG I -- (0 b `a'' Email Address:
DESIGNER: Architect/Engineer: Phone#:
Value of Work for this Permit: $ 50ocf4 Square/Linear Footage of Work: 122 C.
Type of Work: ❑Address ❑Alteration ONewtepair/Replace ❑Demolition
Description of Work: iki 4- oc a C?-e ei c c.Q DYKE r
G in I .t-q‘
t- Noe 3,...+ goo CocA l.or7 S1 f t C '1-cn(r
* * * * * *** * * * ** ; .. * * * * * * * *** * * * * * * * **** Fees * * * ** * * ** * * **** ** **** x** ** **** **** **** * ***
Submittal Fee $PP1 Permit Fee $
o 0 CCF $ CO /CC $
Scanning Fee $ ' Radon Fee $ DBPR $ Bond $
Notary $ Training/Education Fee $ Technology Fee $
Double Fee $ Structural Review $
TOTAL FEE NOW DUE $ .0
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 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 app oved and a reinspection fee will be charged.
Signature
Owner or Agent
The foregoing instrument was acknowledged before me this tG
day of Jv , 20 [ I , by C S t e6 c acv l l-e
who is personally known to me or who has produced 9-14 • V -4v As iden ' ::j nianie ++hitidiCl. in oath. amomow
NOTARY PUBLIC: .04 v4 Comm# DD0733346
Expires 111812011
2 14
Sign:
Print:
My Commission Expires:
Assn, Inc E
e
Signature
Contractor
The foregoing instrument was acknowledged before me this )
day of Gs _ , 20 t,. , byl9 A
who is personally known to me or who has produced r v'
as identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
My Commission Expires:
e�'.�° 'ios5scaa
I uai35imbo3
01110d ANION
Z6oZI90i£0
APPROVED BY ' ' (` 7 t '09rt�tm" toning
Plans Examiner
Structural Review
(Revised 07 /10 /07)(Revised 06 /10 /2009)(Revised 3/15/09)
Clerk
STATE OF FLORIDA
DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM
CONSTRUCTION PERMIT
CONSTRUCTION PERMIT FOR: OSTDS Repair
APPLICANT: Esteban Stavile
PERMIT #: 13-SC-1355049
APPLICATION # : AP 1038902
DATE PAID:
FEE PAID:
RECEIPT #'
DOCUMENT # : PR847428
PROPERTY ADDRESS: 5 NW 106 St Miami, FL 33150
LOT: 16
BLOCK: 206 SUBDIVISION:
PROPERTY ID #: 11- 2136- 006 -0240
[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 [
A [
N [
K
900 ] GALLONS / GPD Septic
0 ] GALLONS / GPD
0 ] GALLONS GREASE INTERCEPTOR CAPACITY
] GALLONS DOSING TANK CAPACITY
D [ 225 ] SQUARE FEET
R [ 0 ] SQUARE FEET
A TYPE SYSTEM: [x] STANDARD
I CONFIGURATION: [x] TRENCH
CAPACITY
CAPACITY
(MAXIMUM CAPACITY SINGLE TANK:1250 GALLONS]
]GALLONS @[ ]DOSES PER 24 HRS #Pumps [ ]
SYSTEM
SYSTEM
[ ] FILLED [ ] MOUND [ ]
[ ] BED [
N
F LOCATION OF BENCHMARK: F.F.E.:12.30' NGVD
I ELEVATION OF PROPOSED SYSTEM SITE
E BOTTOM OF DRAINFIELD TO BE
L
D FILL REQUIRED: [ 0.00] INCHES
0
T
H
E
R
[ 21.60 ] [I INCHES f FT ] [ ABOVE a BELOW b BENCHMARK /REFERENCE POINT
[ 39.60 ] [I INCHES Y FT ] [ ABOVE A BELOW b BENCHMARK /REFERENCE POINT
EXCAVATION REQUIRED: [ 18.00] INCHES
1- Install 900 gal. category-3 septic tank equipped with an approved filter. 2 -The licensed contractor installing the system
is responsible for installing the minimum category of tank in accordance with sec. 64E- 6.013(3)(f). 3- Install 225 sf of
drainfield in trench configuration. 4- Perimeter of excavation area shall be at least 2 ft wider and longer than the proposed
absorption trench. 59.50'NGVD. -Invert elevation of drainfield to be no less than 9.50' NGVD. 6. Bottom of drainfield
elevation to be no less than 9.00' NGVD.
THIS PERMIT ISA NOT FOR ADDITION(s).
Contractor f
SPECIFICATJRNOW'.
'role of a! inspe t Pri
APPROVED gm sh.li :, 4t
I * nee) is : , _fired to perform a
Cf' • n.
C ion. o
•
re
DATE ISS
.aor
royal, ttla;
Nits to the originf8eVa ':'i8gubmitted Are the
ohm tee 1.410/5tPaRtickart if the contractor Is not
DH 4016, oat % i 'btiitM Rni149.t9Pevious editions which
64E- 6.003, FAC
004P 4AM D PAR'FMEN?
Incorporated:
v 1..1.4
may not be used)
AP1038902
Dade cHD
EXPIRATION DATE: 09/13/2011
SE646261
Page 1 of 3
STATE OF FLORIDA
DEPARTMENT OF HEALTH
APPLICATION FOR CONSTRUCTION PERMIT
Scale: Each block re
•
Permit Application Number
PART II - SITEPLAN
resents 10 feet and 1 inch = 40 feet.
•
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;ite Plan submitted by:
'Ian Approved
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ore S 3315o
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Date
County Health Department
ALL CHANGES MUST BE APPROVED BY THE COUNTY HEALTH DEPARTMENT
-I 4015, 08/09 (Obsoletes previous editions which may not be used) Incorporated: 64E- 6.001, FAC
Lock Number: 5744 -002- 4015 -6)
Page 2 of 4