PL-10-1653Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number: INSP - 151363
Scheduled Inspection Date: August 10, 2011
Inspector: Hernandez, Rafael
Owner: LOCKHART, TONI
Permit Number: PL -9 -10 -1653
Job Address: 925 NE 98 Street
Miami Shores, FL
Project: <NONE>
Contractor: MR C'S PLUMBING SEPTIC INC
Permit Type: Plumbing - Residential
Inspection Type: Final
Work Classification: Septic
Phone Number (786)564 -5796
Parcel Number 1132060143430
Phone: (305)651 -7859
Building Department Comments
INSTALL SEPTIC TANK AND CONNECT TO EXISTING
DRAINFIELD
Passed
1'l
Failed
Correction
Needed
Re- Inspection
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
Inspector Com
FINAL HRS IN
ents
ILE
August 09, 2011
For Inspections please call: (305)762 -4949
Page 3 of 29
•
r
,3
BUILDING
PERMIT APPLICATION Master Permit No.
FBC 20
Permit Type: PLUMBING
OWNER: Name (Fee Simple Titleholder): � rif (0 i19-�' S yotk Phone #: 78C 33 b3T
Address: (= rsi- ✓ ✓✓
City: State: Zip: 3 3/ 3Yr
Tenant/Lessee Name: Phone#:
Email:
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
EOMITIS
AUG 0 8 2011
Permit No. Pi wop
JOB ADDRESS: aS C 98-5 T
City: Miami Shores County: Miami Dade Zip: 3 3/ 5't
Folio/Parcel #: 113 a O b 6 l q-3 E-3 0
Is the Building Historically Designated: Yes NO Flood Zone:
CONTRACTOR: Company Name: 114 r (j S �L ) d Phone#: iOS CS ( 7751"
Address: I' 32. MA) a Gulf
City: M ) -,.., State: Zip: 33/ G 5
Qualifier Name: Phone #:
State Certification or Registration #: Certificate of Competency #:
Contact Phone #: Email Address:
DESIGNER: Architect/Engineer: Phone#:
Value of Work for this Permit: $ Square/Linear Footage of Work:
Type of Work: OAddress UAlteration ONew air/Replace
Description of Work: s}c t '��,r,� 4� 4 /lf: c lot
ODemolition
********** ******** * * ** xm*********a:** ** *Fe)es * ** �x�x: xu�u�x�******** * *�x:x�x***** * * **�x�x�x *�x*****
Submittal Fee $ Permit Fee $ fi i2 CCF $ CO /CC $
Scanning Fee $ Radon Fee $ DBPR $ Bond $
Notary $ Training/Education Fee $ Technology Fee $
Double Fee $ Structural Review $
TOTAL FEE NOW DUE $ 150" lJl�'
•
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 approveii and a reinspection fee will be charged.
Signature
0 e or Agent
The foregoing instrument was acknowledged before me this g
d a y of , 20 by 0 S t gelakkgrAi )
who is personally known to me or who has produced
As identific. 'on and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
My Commission
� : r
, .
11
1• ,11\( COMMISSION et 420
XPIRES undenM
tes
` • ETNot�P
BMW'
Contractor
The foregoing instrument was acknowledged before me this
day of los A ' , 20 ` (, by CID kk an t'en
who is personally known to me or who has produced
as identification . ' 1 who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
My Com
*** **********akaksk *********** *** **** *********
APPROVED BY
Plans Examiner
Structural Review
(Revised 07 /10 /07)(Revised 06 /10/2009)(Revised 3/15/09)
S$t p s: KEMSIE ETTRICK
MY COMMISSION # DD 891340
= EXPIRES: September a3
ids Tin Notary Public
.• Bonded
* * *** * *****
* * ** ** * **
Zoning
Clerk
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 No.
PERMIT APPLICATION
FBC 20
Permit Type: PLUMBING ,�°-
OWNER: Name (Fee Simple Titleholder): 1 f7 11 l 1- b clmia /`t' k h0l Phone#: 7a i S6 f S716
Address: etas Me W. Sfi
City: ,, l ia..: J5h.sre o State: fie. Pie& zip: 3 3 /3r
Tenant/Lessee Name: Phone#:
Email:
Master Permit No. L 10 (C)53
JOB ADDRESS: qaJ N 6 IC(
City: Miami Shores County:
Folio /Parcel#:
11..3ao.. 014-- 343o
Miami Dade
Zip: g3I 3 y
Is the Building Historically Designated: Yes NO Flood Zone:
CONTRACTOR: Company Name: r �S Y `c144i't� ! ��t Phone#: gig-45'I 7 -7
Address: MI i 3■ Ali CO oZ "it et ,v42
2 I!"
City: Ma%a.•. t State: �f QfA Zip: 3.3 % 6 4
Qualifier Name: Jo k#\ 144.4 6/ Phone#: 3 ost. S`7
State Certification or Registration #: <PMcia67r 1 Certificate of Competency #:
Contact Phone#: Email Address:
DESIGNER: Architect/Engineer: Phone#:
Value of Work for this Permit $ 1,5*C'o• O SquareJLinear Footage of Work:
Type of Work: UAddress ❑Alteration ONew DRepair/Replace ❑Demolition
Description of Work: .%rtst4l1 Se pG covinedi- -6 existI j 2A-(N.1e &
Submittal Fee $ Permit Fee $ 'co
Scanning Fee $ Radon Fee $
Notary $ Training/Education Fee $
Double Fee $ Structural Review $
CCF $ CO /CC $
DBPR $ Bond $
Technology Fee $
TOTAL FEE NOW DUE $
M__1..1l..Y
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,
W F.i d ,S, 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 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 a r • roved and a reinspection fee will be charged.
Sign
�r
Owner or Agent Contractor
The fore ointinstrument was acknowledged before me this I The foregoing instrument was acknowledged before me this
day of P , 201O , by lot' 0 54.9 d i'S ^ r• day of ,201t) , by 4e kr `.
who is personally known to me or who has produced who is personally known to me or who has produced
as identification and who did take an oath.
Sign:
Print:
My Commission Exp
APPROVED BY
0° Plans Examiner
Structural Review
(Revised 07 /10/07)(Revised 06/10/2009)(Revised 3/15/09)
Zoning
Clerk
STATE OF FLORIDA
DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT AND DISPOSAL
SYSTEM
CONSTRUCTION PERMIT FOR: OSTDS Repair
APPLICANT: Toni Lockmart
PERMIT #:13 -SC- 1278185
APPLICATION #: AP978340
DATE PAID:
FEE PAID:
RECEIPT #•
DOCUMENT #: PR821701
PROPERTY ADDRESS: 925 NE 98 St Miami, FL 33138
LOT: 16 +17
BLOCK: 80 SUBDIVISION:
PROPERTY ID #: 11- 3206- 014-3430
[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 [ 750 ] GALLONS / GPD Existian Septic Tank to remain CAPACITY
A [ 900 ] GALLONS / GPD Proposed new tank 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 Existina drainfield bed to re SYSTEM
R [ 200 ] SQUARE FEET Existina drainfield bed to re SYSTEM
A TYPE SYSTEM: [x] STANDARD [ ] FILLED [] MOUND [ ]
I CONFIGURATION: [ ] TRENCH [x] BED
N
F LOCATION OF BENCHMARK: F.F.E., 12.00' NGVD.
I ELEVATION OF PROPOSED SYSTEM SITE
E BOTTOM OF DRAINFIELD TO BE
L
D FILL REQUIRED:
0
H
E
R
SPECIFICATIONS BY:
APPROVED BY:
DATE ISSUED:
[ 0.00] INCHES
[ 33.60 ] [1 INCHES f FT ] [ ABOVE A BELOW 1] BENCHMARK /REFERENCE POINT
[ 61.60 ] [I INCHES f FT ] [ ABOVE a BELOW b BENCHMARK /REFERENCE POINT
EXCAVATION REQUIRED: [
] INCHES
Replace and abandon one existing broken septic tank only.
-The licensed contractor installing the system is responsible for installing the minimum category of tank in accordance with
sec. 64E- 6.013(3)(f). F.A.C.
T71777! r2S'A ..77 gq !,17.7 a
r.,
d
TITLE:
DH 4016, 08/09 (Obsoletes all previous editions which may not be used)
Incorporated: 64E- 6.003, FAC
v 1.1.4
Dade CHD
EXPIRATION DATE: 12/12/2010
A2978340 SE825436
Page 1 of 3
i
NOTICE OF RIGHTS
A party whose substantial interest is affected by this order may petition for an
administrative hearing pursuant to sections 120.569 and 120.57, Florida Statues. Such
proceedings are governed by Rule 28 -106, Florida Administrative Code. A petition for
administrative hearing must be in writing and must be received by the Agency Clerk for the
Department, within twenty -one (21) days from the receipt of this order. The address of the
Agency Clerk is 4052 Bald Cypress Way, BIN # A02, Tallahassee, Florida 32399 -1703. The
Agency Clerk's facsimile number is 850 -410 -1448.
Mediation is not available as an alternative remedy.
Your failure to submit a petition for hearing within 21 days from receipt of this order will
constitute a waiver of your right to an administrative hearing, and this order shall become a 'final
order'.
Should this order become a final order, a party who is adversely affected by it is entitled
to judicial review pursuant to Section 120.68, Florida Statutes. Review proceedings are
governed by the Florida Rules of Appellate Procedure. Such proceedings may be commenced
by filing one copy of a Notice of Appeal with the Agency Clerk of the Department of Health and a
second copy, accompanied by the filing fees required by law, with the Court of Appeal in the
appropriate District Court. The notice must be filed within 30 days of rendition of the final order.