PL-11-725Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number: INSP - 159937
Scheduled Inspection Date: May 18, 2011
Inspector: Hernandez, Rafael
Owner: MCFADDEN, DANIEL
Job Address: 9280 NE 12 Avenue
Miami Shores, FL 33138-
Project <NONE>
Contractor: MR C'S PLUMBING SEPTIC INC
Permit Number: PL -4 -11 -725
Permit Type: Plumbing - Residential
Inspection Type: Final
Work Classification: Septic
Phone Number (305)762 -6519
Parcel Number 1132050070172
Phone: (305)651 -7859
Building Department Comments
DRAINFIELD REPAIR
Passed
Failed
Correction
Needed
Re- Inspection
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
Inspector Comments
AO 1-A)
May 17, 2011
For Inspections please call: (305)762 -4949
Page 22 of 27
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 (circle): Building Electrical
APR 2 5 2
fl
Permit No. 1 'm
Master Permit No.
Plumbing Mechanical Roofing
Owner's Name (Fee Simple Titleholder) %L « c (eke r 6-1/4--- Phone # C) ° Z -6 s-1 1
Owflner's Address Z 4) ' I
CRY M a rz1.5 State FL--
Tenant/Lessee Name
Phone # •—
Job Address (where the work is being done)
City Miami Shores Villa=
claw 106
County Miami -Dade
FOLIO / PARCEL # I `5 i,® oC –013 7 -(3V-7A.
Is Building Historically Designated YES NO
Contractor's Company Name
Contractor's Address
City
Qualifier Name DoIN krj
State Certificate or Registration No L..`.f &o
3Z /Irk) 9.24'a �e
Zip 3SI
Phone #d
State r(,
Architect/Engineer's Name (if app icable)
Value of Work For this Permit $
Tyne of Work: DAddition
Describe Work: . L
Zip -S I
Phone # ? .451 `17151
Certificate of Competency No.
DAlteration
Phone #
Square / Linear Footage Of Work:
['New VRepair/Replace
❑ Demolition
* * *** *******************************F , *, * *** * * ** ** * **** *,t ** *** r*F ,r, * *, * *, * ** * * * *,t*** *, , * * * * ** * * * * *** *** **** **
Submittal Fee
Notary $
Permit Fee $ 57
Training/Education Fee $
Scanning $ Radon $
Bond $
� �� Code Enforcement $
Structural Review. $
DPBR $
CCF $
CO /CC
Technology Fee $
Zoning $
Double Fee $
Total Fee Now Due $
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 must be posted at the job site
for the first inspection which occurs seven (7) days after the . ilding permit is issued. In the absence of such posted notice, the
inspection will t be appj'oved and a reinspection fe ' e charged
Signature
1
Owner or Agent V Contractor
The foregoing instrument was acknowledged efo e e this . The foregoing instrument was acknowledged before me this e)
day of ► ; `l 20 1 t , by `-'a In I ' o`c➢;N day of �� . ' 201( , by
who is personally known to me or who has produced who is pers nally known to me or who has produced
As identification and who did take an oath. as identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print
My Commission E
1
1.11 �L
•-
* * * * * * * * * * * * * * * **
tEAr � ley �
. MY COMMISSION # •
.- � EXPIRES: Septembe r 14, 201
3
,*@coed W PubllcUnderwriters
APPLICATION APPROVED BY:
(Revised 02/08/06)
* * * * **
NOTARY PUBLIC:
Sign:
Print:
My Commis
• MY COMMISSION # DD 891340
* * * * * * * * * * * * * * * * * **
*** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
Plans Examiner
Engineer
Zoning
KEMBLE ETTRICK
P� PV •.
11�. : °P ' • MY COMMISSION # DO 891340
I «:.. : *' September 14, 2013
r6' EXPIRES: Notary Underwriters
±,f o ,�• Bonded Thai Notary
STATE OF FLORIDA
DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT AND DISPOSAL FEE PAID:
SYSTEM
RECEIPT #:
PERMIT #: 13-SC-1313419
APPLICATION # : AP 1001912
DATE PAID:
CONSTRUCTION PERMIT FOR: OSTDS Repair
APPLICANT:
Daniel Mofadden
DOCUMENT #: PR842079
PROPERTY ADDRESS: 9280 NE 12 Ave Miami, FL 33138
LoT: Na
BLOCK: Na SUBDIVISION: Na
PROPERTY ID #: 11- 3205 - 007 -0172
[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 [
D
R
A
I
N
F
I
E
L
D
0
T
H
E
R
SPECIFICATIONS BY:
APPROVED BY:
DATE ISSUED:
900 ] GALLONS / GPD Septa existina
0 ] GALLONS / GPD
0 ] GALLONS GREASE INTERCEPTOR CAPACITY
] GALLONS DOSING TANK CAPACITY
[ 300 ] SQUARE FEET
[ 0 ] SQUARE FEET
TYPE SYSTEM: [x] STANDARD
CONFIGURATION: [ ] TRENCH
CAPACITY
CAPACITY
[MAXIMUM CAPACITY SINGLE TANK:1250 GALLONS]
]GALLONS @[ ]DOSES PER 24 FIRS #Pumps [ ]
SYSTEM
SYSTEM
[ ] FILLED [ ] MOUND
[x] BED [ ]
LOCATION OF BENCHMARK: FFE 10.20' NGVD
ELEVATION OF PROPOSED SYSTEM SITE
BOTTOM OF DRAINFIELD TO BE
FILL REQUIRED: [ 0.00 ] INCHES
[ 15.60 ] ti INCHES k FT ] [ ABOVE /I BELOW U BENCHMARK /REFERENCE POINT
[ 43.60 ] ti INCHES I FT ] [ ABOVE /I BELOW b BENCHMARK /REFERENCE POINT
EXCAVATION REQUIRED: [ 40.00] INCHES
- Install 300 sq ft drainfield.
- Install 12" of slightly limited soil under bottom of drainfield.
- Elevation of bottom of drainfield to be no less than 6.57' NGVD.
- 900 g existing septic tank to remain.
Kemble
ek
The contractor (or designee) is required to perform a
soli boring adjacent to the drainfield excavation at the
time of final inspection. Prior to Final Approval, the DOH
inspector shall witness the soil boring and compare the
results to the original site evaluation submitted. A
relnspectlon fee will be assessed if the contractor is not
at the jobsfte at the arranged time.
DH 4016, 08/09 (0
Incorporated:
6
TITLE:
: Engineer Specialist II
letes all previous editions which may not be used)
6.003, FAC
v 1.1.4 AP1001912
Dade
EXPIRATION DATE: 07/18/2011
3E842062
CHD
Page 1 of 3
STATE OF FLORIDA
DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT AND DISPOSAL FEE PAID:
SYSTEM
RECEIPT #:
PERMIT #: 13-SC-1313419
APPLICATION # : AP 1001912
DATE PAID:
CONSTRUCTION PERMIT FOR: OSTDS Repair
APPLICANT: Daniel Mofadden
DOCUMENT #: PR842079
PROPERTY ADDRESS: 9280 NE 12 Ave Miami, FL 33138
LOT: Na
BLOCK: Na SUBDIVISION: Na
PROPERTY ID #: 11- 3205- 007 -0172
[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 existina
0 ] GALLONS / GPD
0 ] GALLONS GREASE INTERCEPTOR CAPACITY
] GALLONS DOSING TANK CAPACITY
D [ 300 ] SQUARE FEET
R [ 0 ] SQUARE FEET
A TYPE SYSTEM: [x] STANDARD
I CONFIGURATION: [ ] TRENCH
N
F LOCATION OF BENCHMARK: FFE 10.20' NGVD
CAPACITY
CAPACITY
[MAXIMUM CAPACITY SINGLE TANK:1250 GALLONS]
]GALLONS @[ ]DOSES PER 24 HRS #Pumps [ ]
SYSTEM
SYSTEM
[ ] FILLED [ ]
[x] BED [ ]
MOUND
I ELEVATION OF PROPOSED SYSTEM SITE
E BOTTOM OF DRAINFIELD TO BE
L
D FILL REQUIRED: [ 0.00 ] INCHES
0
T
H
E
R
SPECIFICATIONS BY:
APPROVED BY:
DATE ISSUED:
[ 15.60 ] [I INCHES I/ FT ] [ ABOVE 4 BELOW b BENCHMARK /REFERENCE
Y
[ 43.60 ] [) INCHES FT ] [ ABOVE 4 BELOW I] BENCHMARK /REFERENCE
EXCAVATION REQUIRED: [ 40.00] INCHES
POINT
POINT
- Install 300 sq ft drainfield.
- Install 12" of slightly limited soil under bottom of drainfield.
- Elevation of bottom of drainfield to be no Tess than 6.57' NGVD.
- 900 g existing septic tank to remain.
The contractor (or designee) is required to perform a
soil boring adjacent to the drainfield excavation at the
time of final inspection. Prior to Final Approval, the DOH
inspector shall oiliness the soil boring and compare the
results to the original site evaluation submitted. A
relnspection fee WIH be assessed ff the contractor is not
at the jobslte at the arranged tune.
Kemble Ettrick
TITLE:
Engineer Specialist II
DH 4016, 08/09 (Ob
Incorporated: 64
etes all previous editions which may not be used)
003, FAC
v 1.1.4 AP1001912
Dade
EXPIRATION DATE: 07/18/2011
SE842062
CHD
Page 1 of 3
STATE OF FLORIDA
DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT AND DISPOSAL FEE PAID:
SYSTEM
RECEIPT #.
PERMIT #:13 -SC- 1313419
APPLICATION # : AP 1001912
DATE PAID:
CONSTRUCTION PERMIT FOR: OSTDS Repair
APPLICANT:
Daniel Mofadden
DOCUMENT #: PR842079
PROPERTY ADDRESS: 9280 NE 12 Ave Miami, FL 33138
LOT: Na
BLOCK: Na SUBDIVISION: Na
PROPERTY ID #: 11- 3205 - 007 -0172
[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 [
D
R
A
I
N
F
I
E
L
D
0
T
H
E
900 ] GALLONS / GPD Septic existina
0 ] GALLONS / GPD
0 ] GALLONS GREASE INTERCEPTOR CAPACITY
] GALLONS DOSING TANK CAPACITY
[ 300 ] SQUARE FEET
[ 0 ] SQUARE FEET
TYPE SYSTEM: [x] STANDARD
CONFIGURATION: [ ] TRENCH
CAPACITY
CAPACITY
[MAXIMUM CAPACITY SINGLE TANK:1250 GALLONS]
]GALLONS @[ ]DOSES PER 24 HRS #Pumps [ ]
SYSTEM
SYSTEM
[ ] FILLED [ ] MOUND
[x] BED [ ]
LOCATION OF BENCHMARK: FFE 10.20' NGVD
ELEVATION OF PROPOSED SYSTEM SITE
BOTTOM OF DRAINFIELD TO BE
FILL REQUIRED:
[ 15.60 ] [1 INCHES f FT ] [ ABOVE /) BELOW h BENCHMARK /REFERENCE
[ 43.60 ] [) INCHES k FT 3 [ ABOVE A BELOW b BENCHMARK /REFERENCE
[ 0.00] INCHES EXCAVATION REQUIRED: [ 40.00 ] INCHES
POINT
POINT
- Install 300 sq ft drainfield.
- Install 12" of slightly limited soil under bottom of drainfield.
- Elevation of bottom of drainfield to be no less than 6.57' NGVD.
- 900 g existing septic tank to remain.
The contractor (or designee) is required to perform a
soil boring adjacent to the dralnfleld excavation at the
time of final inspection. Prior w Final Approval, the DOH
inspector shall witness the soil boring and compare the
results to the original site evacuation submitted. A
reinspection fee will be assessed if the contractor is net
at the jobsite at the arranged time.
SPECIFICATIONS BY:
Kemble E- ick
APPROVED BY: a' /a
ePh
DATE ISSUED: / 04/1
Piver
TITLE:
TITLE: Engineer Specialist II Dade
DH 4016, 08/09 ('- soletes all previous editions
Incorporated: 64E- 6.003, FAC
v 1.1.4
which may not be used)
AP1001912
EXPIRATION DATE: 07/18/2011
9E842062
CHD
Page 1 of 3