PL-11-1171Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number: INSP - 162977 Permit Number: PL -6 -11 -1171
Scheduled Inspection Date: August 10, 2011
Inspector: Hernandez, Rafael
Owner:
Job Address: 351 NE 98 Street
Miami Shores, FL
Project: <NONE>
Contractor: THE NEW MIAMI SHORES PLUMBING
Permit Type: Plumbing - Residential
Inspection Type: Final
Work Classification: Drainfield
Phone Number
Parcel Number 1132060135630
Phone: (305)751 -2446
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
CREATED AS REINSPECTION FOR INSP- 162252. CREATED AS
REINSPECTION FOR INSP- 161476.
HRS IN FILE need 'o` epair sidewalk
August 09, 2011
For Inspections please call: (305)762 -4949
Page 28 of 29
610 0 \ oodli
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. P 11 ) fl
BUILDING
PERMIT APPLICATION
FBC20
Master Permit No.
Permit Type: PLUMBING f(
OWNER: Name (Fee Simple Titleholder): G Ioid co LI)& Phone #:
` iU
Address: ,5 1 4114) 441
City: AI 11G°! 4 , State: F Zip: S.31
Tenant/Lessee Name: Phone #:
Email:
JOB ADDRESS:
City:
Folio/Parcel #:
351 NE �lll Sfi
Miami Shores
County
Miami Dade Zip:
Is the Building Historically Designated: Yes
NO Flood Zone:
CONTRACTOR: Com any Name: \ CS (11') ON Q ?\ornkiiij Phone #: 3° 7C1 2.412/4,
Address: 1 DO V I l ti S4.'
City: 1,91, /"t ► State: 17-1^ zip:
s21
Qualifier Name: Phone #:
State Certification or Registration #: ata 81 1 g 2 l Certificate of Competency #:
Contact Phone #: Email Address:
DESIGNER: Architect/Engineer: Phone #:
Value of Work for this Permit: $ ,, / 120 Square/Linear Footage of Work:
Type of Work: DAddress DAlteration DNew )6Repair/Replace ❑Demolition
Description of Work: ; r Ok f 6;,
* * * **il!** ************** ** : ***** ** * ****Fee slit* * x*+ x*x:******** ****** * ************ ***+x*****
Submittal Fee $ Permit Fee $ /TIP 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. 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.
ex
Owner or Agent
The foregoing instrument was acknowledged before me thisTttr1.
day of 16 ,20 t1 ,by C0i
STATE OF FLORIDA
DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM
CONSTRUCTION PERMIT
CONSTRUCTION PERMIT FOR: OSTDS Repair
APPLICANT: Gladys Lowen
PROPERTY ADDRESS: 351 NE 98 St Miami, FL 33138
LOT: 18 -19
PERMIT #: 13-SC-1356472
APPLICATION #: AP 1039681
DATE PAID:
FEE PAID:
RECEIPT #:
DOCUMENT #: PR848104
BLOCK: 41 SUBDIVISION:
PROPERTY ID #: 01/01/1954
[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 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 [ 300 ] SQUARE FEET SYSTEM
R [ 0 ] SQUARE FEET SYSTEM
A TYPE SYSTEM: [x] STANDARD [ ] FIT.T,RD [] MOUND
I CONFIGURATION: [ ] TRENCH [x] BED [ ]
N
F LOCATION OF BENCHMARK: F.F.E.: 12.0' NGVD.
I ELEVATION OF PROPOSED SYSTEM SITE [ 19.20][ INCHES I/ FT ][ABOVE 4 BELOWbBENCHMARK/REFERENCE POINT
E BOTTOM OF DRAINFIELD TO BE [ 49.20] [I INCHES' FT ] [ABOVE 4 BELOW bBENCHMARK /REFERENCE POINT
L
D
O
T
H
E
FILL REQUIRED:
[ 0.00] INCHES
EXCAVATION REQUIRED: [ 36.00] INCHES
1- Existing 750 gal. septioc tank certified by " Statewide Septic Connections Inc." on 06/17/2011 to remain. 2- Install 300 sf
of drainfield in trench configuration. 3- Perimeter of excavation area shall be at least 2 ft wider and longer than the
proposed absorption trench. 4 -Invert elevation of drainfield to be no less than 7.90' NGVD. 5. Bottom of drainfield
elevation to be no less than 7.20' NGVD.
THIS PERMIT IS NOT FOR ADDITION(s).
R
SPECIFI
APP
DATE ISSUED:
0
inclesi nee ; Da de -AD
Pedro N ospiaaS011 9Sbrniy adjacent t� Y in ° e , excavation at rfi�
06/23/2011
time of final inspection. Prior to Final Approval, the DC .EXPIRATION DATE:
inspector shall witness the soil borin ng «,,� ,;.;;�, the
DH 4016, 08/09 (Obsoletes all prevreSu43S FltiEf1'it tay k, 10 brne.
Incorporated: 64E - 6.003, FAC reinspection fee will be assessed if the contractor isI1�p
„ l . At the jobsite at the ar e, 55e468z4
09/21/2011
Page 1 of 3
O." tW iWte ra t :! !'Astir 7- 4.,
STATE OF FLORIDA
DEPARTMENT OF HEALTH
APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PERMIT
Permit Application Number
PART II = SITE PLAN
Scale: Each block represents 5 feet and 1 inch = 50 feet.
Site Plan submitted by:
Plan Approved
By
County Health Department
ALL CHANGES MUST BE APPROVED BY THE COUNTY HEALTH DEPARTMENT
0114015, 10196 (Replaces HRS-H Forth 4015 which may be used)
(Stock Number: 5744- 002.4015 -6)
Page 2 of 3